feea's Series of Pocket Text=5°°ks- MATERIA MEDICA, THERAPEUTICS, £ it MEDICAL PHARMACY, PRESCRIPTION-WRITING, AND MEDICAL LATIN. A MANUAL FOR STUDENTS AND PRACTITIONERS. BY WILLIAM SCHLEIF, Pn.G., M.D., Instructor in Pharmacy in the University of Pennsylvania. SERIES EDITED BY BERN B. GALLAUDET, M.D., Demonstrator of Anatomy and Instructor in Surgery, College of Physicians and Sur- geons, New York; Visiting Surgeon, Bellevue Hospital, New York. LEA BROTHERS &~CO., PHILADELPHIA AND NEW YORK. Entered according to Act of Congress, in the year 1899, by LEA BROTHERS & CO., In the Office of the Librarian of Congress, at Washington. All rights reserved. WESTCOTT & THOMSON, ELECTROTYPERS, PHILAOA. PREFACE. This volume is intended to afford a condensed yet compre- hensive text-book and work of reference on Materia Medica, Therapeutics, and a range of cognate subjects which can be grouped with manifest advantage. In addition to the para- graphs covering the Physical Properties, Physiological Action, Therapeutics, and Toxicology of each medicinal agent, chap- ters will be found on Prescription-writing, Medical Latin, Medical Pharmacy, and Practical Anaesthesia. Tables of Doses, of Poisons and Antidotes, and of Incompatibilities, together with a Therapeutic Index of Diseases and Remedies and a General Index, conclude a volume which it is hoped may prove of service to practitioners as well as students. It contains in a concise, definite, and assimilable form the essen- tial knowledge required in the most complete college courses on Materia Medica and Therapeutics. Acknowledgment is due to Dr. L. F. Warner, of New York, whose excellent book has been freely used with his permission. w. s. 115 South Sixteenth Street, Philadelphia, June, 1899. 3 CONTENTS. PAGE Imponderable Remedies : Heat; Light; Cold ; Electricity; Massage 17-21 Pharmacological Remedies : Actions and Modes of Adminis- tering Drugs 21-25 Weights and Measures 26-28 Prescription-writing 28-34 Classification of Drugs 35 Antispasmodics: Camphora; Spiritus JEtheris Compositus; Valeri- ana; Asafcetida; Moschus; Succinum ; Humulus; Cimicifuga . 35-41 Anaesthetics : JEther ; Practical Anaesthesia; Chloroformum; Nitrogen Monoxide; Ethyl Bromide; Local Anaesthesia; Cocainae Hydrochloras ; Eucaine Hydrochlorate 41-51 Hypnotics (Somnifacients) : Opium ; Cannabis Indica ; Chloral; Croton Chloral; Chloralamid ; Chloralose : Chloral Camphor ; ButyLchloral Hydrate ; Sulphonal; Trional; Tetronal ; Amyl- ene Hydrate; Paraldehydum; Urethan ; Hypnone ; Methylal . 51-65 Belladonna Group (Mydriatics or Delirifacients): Belladonnas Folia ; Belladonnae Radix ; Stramonii Folia ; Strainonii Semen ; Hyoscyamus: Duboisia; Agaricin; Coca (Cocaine); Tropa- cocaine; Schleich's Solution 65-75 Spinants: Excito-motors: Nux Vomica; Ignatia; Picrotoxinum . 75-80 Depresso-motors: Physostigma ; The Bromides ; Curare ; Conium ; Gelsemium ; Lobelia; Tabacum 80-90 Nitrite Group : Amyl Nitris ; Spiritus Glonoini; Potassii Nitris ; Sodii Nitris ... 90-93 Cardiac Stimulants: Ammonia; Alcohol; Digitalis; Stroph- anthus; Convallaria; Sparteinae Sulphas; Adonidin ; Caf- feina 93-116 5 6 PAGE Cardiac Depressants: Antimonium; Veratrum Viride; Verat- rina; Aconitum; Pulsatilla; Arnica; Staphisagria ; Acidum Hydrocyanicum ; Potassii Cyanidum ; Vegetable Acids: Acidum Citricum; Acidum Tartaricum; Acidum Aceticum; Oxalic Acid116-129 Astringents: Vegetable Astringents: Acidum Tannicum ; Acidum Gallicum ; Pyrogallol; Galla ; Krameria ; Catechu ; Kino ; Hsematoxylon ; Geranium ; Hamamelis ; Quercus Alba ; Rhus Glabra ; Rosa Gallica ; Rosa Centifolia ; Rubus ; Castanea; Agaric129-136 Mineral Astringents: Argentum; Bismuthum ; Cuprum ; Zincum ; Plumbum; Alumen ; Cerii Oxalas136-148 Tonics: Ferrum; Manganum; Acidum Sulphuricum; Acidum Hydrochloricum; Acidum Nitricum; Acidum Nitro-hydro- chloricum; Acidum Lacticum; Phosphorus148-159 Alteratives : Acidum Arsenosum; Hydrargyrum ; lodum; Potassii lodidum ; lodoformum ; lodolum ; Soziodol; Aristol ; Oleum Morrhuae; Acidum Phosphoricum; Calcii Phosphas Praecipitatus; The Hypophosphites ; Sarsaparilla ; Guaiaci Lignum; Mezereum; Jambul; Sassafras; Taraxacum; Ich- thyol; Colchicum159-178 Animal Alteratives: Thyroid Extract; Diphtheria Antitoxin ; Tuberculin; Tetanus Antitoxin ; Streptococcus Antitoxin; Nuclein 178-180 Antiperiodics: Cinchona (Quinine) ; Eucalyptus; Acidum Picri- cum180-187 Antipyretics : Acidum Salicylicum; Salicinum ; Oleum Gaul- theriae ; Salol; Betol ; Acidum Carbolicum ; Sodii Sulphocar- bolas ; Creosotum; Creolin; Guaiacol; Menthol; Thymol; Resorcin ; Benzoinum; Acidum Benzoicum ; Antipyrinum ; Acetanilidum ; Phenacetin ; Thallin ; Kairin 188-205 Stomachic Bitters: Simple Bitters: Quassia; Gentiana; Calumba; Chirata 205-207 Aromatic Bitters: Serpentaria; Anthemis; Matricaria; Eupato- rium; Cascarilla; Absinthium 207-209 Astringent Bitters: Cornus; Salix; Prunus Virginiana 209-210 Diuretics: Scilla; Hydrargyrum Chloridum Mite; Scoparius; Apocynum; Triticum .... 210-212 CONTENTS. CONTENDS. 7 PAGE Vascular Diuretics: Digitalis ; Strophanthus ; Caffeine ; Theo- bromine; Diuretin 213 Refrigerant Diuretics: Potassium; Potassii Carbonas; Potassii Bicarbonas; Potassii Acetas ; Potassii Bitartras ; Potassii Citras; Potassii Nitras; Potassii Chloras ; Saccharum Lactis .... 213-218 Blennorrhetics: Buchu ; Pareira ; Matico; Uva Ursi; Oleum Juniperi; Chimaphila; Oleum Erigerontis; Terebinthina (Oleum Terebinthinse) ; Copaiba; Cubeba; Oleum Santali . . 218-226 Cathartics: Laxatives: Tamarindus; Manna; Sulphur; Oleum Ricini; Magnesia; Magnesia Ponderosa; Magnesii Carbonas ; Pulvis Glycyrrhizae Compositus ; Cassia Fistula ; Oleum Olivae ; Oleum Amygdala Expressum; Oleum Lini; Rhamnus Pur- shiana; Frangula 226-230 Salines: Magnesii Sulphas; Liquor Magnesii Citratis ; Magnesii Citras Effervescens ; Potassii et Sodii Tartras ; Sodii Phosphas; Sodii Sulphas; Potassii Sulphas; Potassii Bitartras 230-232 Purgatives: Rheum; Senna; Aloe; Juglans; Leptandra. . . . 232-235 Drastic Purgatives: Jalapa; Podophyllum ; Chelidonium ; Iris; Euonymus ; Scammonium; Colocynthis ; Cambogia ; Elater- inum ; Oleum Tiglii 235-239 Mercurial Cathartics 239-240 Anthelmintics: Santonica; Spigelia; Chenopodium ; Azedarach . 240-242 Tamiafuges: Aspidium; Granatum; Kamala; Cusso; Pepo; Oleum Terebinthinae ; Cocoa-nut; Ailanthus 243-244 Emetics: Local Emetics : Cupri Sulphas ; Zinci Sulphas ; Alumen ; Hydrargyri Subsulphas Flavus; Sinapis Alba et Nigra; Syrupus Scillse Compositus; Mechanical Measures 244-246 Systemic Emetics: Ipecacuanha; Apomorphinse Hydrochloras; Sanguinaria; Antimonii et Potassii Tartras 246-249 Diaphoretics: Stimulating Diaphoretics: Pilocarpus; Liquor Ammo- nii Acetatis ; Spiritus JEtheris Nitrosi 249-252 Nauseating Diaphoretics: Antimony; Ipecac 252-253 Refrigerant Diaphoretics: Cardiac Depressants ; Alcohol .... 253 Expectorants : Nauseating or Sedative Expectorants: Lobelia; Anti- mony ; Ipecac; Grindelia; Pulsatilla 253-255 8 CONTENTS. PAGE Stimulating Expectorants: Senega; Ammonii Chloridum; Allium ; Balsamum Peruvianum; Balsamum Tolutanum ; Pix Liquida; Terebenum ; Terpini Hydras 255-259 Emmenagogues: Tonic Emmenagogues: Ferrum; Manganum; Myrrha; Acidum Oxalicum 259-260 Purgative Emmenagogues: Aloes 260 Direct or Stimulating Emmenagogues: Sabina; Ruta; Petroselinum; Tanacetum ; Hedeoma; Polygonum Hydropiperoides; Can- tharides 260-262 Oxytocics : Ergota; Gossypii Radicis Cortex ; Ustilago ; Hydras- tis ; Hydrastininae Hydrochloras; Quinine ; Kola 262-267 Irritants: Rubefacients: Sinapis Alba et Nigra; Capsicum; Pix Burgundica; Pix Canadensis; Oleum Terebinthinae; Linimenta; Cups 267-271 Vesicants or Epispastics: Cantharis; Aqua Ammoniae Fortior . 271-273 Escharotics: Argenti Nitras Fusus; Potassa; Soda; Acidum Arsenosum ; Zinci Chloridum ; Bromum ; Acidum Chromicum ; Hydrargyrum ; Acidum Nitricum . 273-277 Suppurants: Unguentum Antimonii (Sapo Mollis); (Chrysaro- binum) 277-278 Demulcents: Aqua; Acacia; Tragacantha ; Cetraria ; Chondrus; Ulmus; Glycyrrhiza; Lycopodium; Linum; Amylum ; Althaea; Cydonium; Sassafras Medulla 278-283 Emollients : Adeps Lame Hydrosus; Glycerinum ; Saccharin ; Petrolatum ; Adeps; Oleum Theobromatis; Cetaceum ; Cera FlavaetAlba; Poultices- 283-286 Protectives: Pyroxylinum; Collodium; Gutta-percha 286-287 Antacids : Sodium (salts); Calx ; Liquor Calcis; Syrupus Calcis ; Calcium (salts) 287-290 Antiseptics, Disinfectants, Germicides: Ferri Sulphas; Acidum Carbolicum; Calx ; Ozone; Aqua Hydrogenii Dioxidi; Potassii Permanganas; Acidum Sulphurosum; Hydrargyri Chloridum Corrosivum ; Naphthalinum ; Acidum Boricum ; Sodii Boras ; Aqua Chlori; Calx Chlorata 290-296 Aromatics: Cinnamomum: Caryophyllus; Myristica; Macis; Pimenta; Cardamomum; Zingiber; Piper ; Capsicum; Oleum Cajuputi; Oleum Lavandulae Florum; Oleum Rosmarini; CONTENTS. 9 PAGE Oleum Sassafras; Aurantii Amari Cortex; Aurantii Dulcis Cortex29G 299 Dietetics: Animal Foods: Milk; Cream; Skimmed Milk; Butter; Buttermilk; Cheese; Koumyss; Matzoon; Peptonized Milk; Eggs; Beef; Veal; Mutton ; Pork; Chicken; Animal Viscera; Fish 299-307 Vegetables: Wheat and Rye; Cracked Wheat; Oatmeal; Corn- meal; Farinaceous Food-stuffs; Potatoes 307-308 Special Plans of Diet: Low Diet; Dry Diet; Animal Diet; Diet in Fevers 308-309 Diet in Diseases: In Acute Gastritis; In Chronic Gastritis; In Intestinal Indigestion ; In Chronic Constipation; In Cachectic Conditions 309-310 Digestive Ferments : Pepsinum; Pancreatinum ; Papayotin ; Diastase311-312 Table of Doses313-318 Important Poisons and their Antidotes319-320 Incompatibilities 320-321 Classification of Drugs 322-323 MATERIA MEDICA AND THERAPEUTICS. Materia Medica is that branch of medical science which treats of medicinal remedies, their names, origin, chemical composition, physical peculiarities, methods of preparation, their mutual antagonism and synergism, and their physiolog- ical effects in medicinal and poisonous doses. Therapeutics teaches of the uses of remedies in the various morbid conditions of the human economy. Remedies may be divided into- Hygienic, which are treated of exhaustively in works on this subject; Mechanical, such as venesection, cupping, aspiration, infu- sion, transfusion, etc., which fall more appropriately within the realm of minor surgery; Imponderable, as air, light, heat, cold, and electricity ; Pharmacological, or drugs properly so called, to which, strictly speaking, our field is limited: in this sense Pharma- cology is synonymous with Materia Medica. Pharmacy treats of the art of collecting, preparing, and dispensing medicines. IMPONDERABLE REMEDIES. LIGHT. The effects of heat and light are hard to dissociate. Light is a stimulant to all vital functions, and its use is indicated whenever there is imperfect nutrition from any cause. HEAT. Like light, heat is a vital stimulus, a necessity to all organic life. Although the normal temperature of the body 2-M. M, 17 18 IMPONDERABLE REMEDIES. is remarkably uniform (about 98.4° F.), yet, as is well known, man is able to bear exposure to great variations of heat and cold without harmful effect. We are not surprised, then, to find that most of the physiological effects of heat upon which depend its uses are of a local nature, not systemic. It is used as an excitant, evulsive, and analgesic over small areas, in the hot-water bottle, poultice, etc., and over large areas to produce vicarious eliminative action of the skin (diaphoresis) in certain conditions of imperfect kidney-elimination and in certain cutaneous affections. For this latter purpose a more general application is obtained by hot baths-hot-air or "Turkish" baths and hot-vapor or "Russian" baths. Dry heat is a most valuable resource in combating surgical shock. The Turkish bath consists in exposing the subject to a grad- ual increase of temperature from 95° to about 155° F. : an immensely increased activity of cutaneous circulation results, and consequently a corresponding diminution of that of internal organs. These baths are a valuable remedy in the conditions mentioned above, but may prove dangerous if the patient be the victim of extensive cardiac or arterial dis- order. Heat is also employed to the extent of actual tissue-de- struction in vesication and cauterization. The thermo- and galvano-cauteries are exceedingly valuable as counter-irritant, revulsive, and haemostatic measures. Thermometric scales: The Fahrenheit scale is in ordinary use in America and England; the centigrade is used on the continent of Europe. To convert degrees of the centigrade scale into those of Fahrenheit: Multiply the number of the former by 9 and divide by 5 ; if the temperature be above the freezing-point (0°), add 32 ; if it be below the freezing-point, subtract the result from 32, algebraically. To convert degrees of the Fahrenheit scale into those of centigrade: If the temperature be above the freezing-point (32°), subtract 32 ; if it be below the freezing-point, subtract the number from 32, algebraically ; then multiply the remain- der by 5 and divide by 9. COLD-ELECTRICITY. 19 The effects of cold are primary and secondary. For the pri- mary effects a considerable degree is required. Cold is efficient by lessening vascular and nervous excitement, constringing the tissues, lessening the actual volume of parts, and pro- ducing local anaesthesia. Cold is used in nervous disorders, as meningitis, chorea, epilepsy, hysteria, etc., generally as an application to head or spine-to abate inflammatory processes and check hemorrhage in a variety of conditions. The secondary effects of cold are obtained by a lesser degree, but applied over a larger area, generally nearly the whole body-surface, as in the cold bath, wet pack, etc. They are useful as a general tonic in debilitated conditions ; as a respiratory stimulant in the narcotic poisoning of opium, chloral, alcohol, chloroform, and ether; as antipyretic in the hyperpyrexia of insolation (sunstroke), rheumatism, typhoid and other continued fevers. Action of hot and cold applications to the spine: It is sup- posed that heat causes stimulation, and cold, paresis, of the vaso-motor nerves of the parts of the body deriving their vaso-motor supply from the section of the spinal cord over which the application is made (Chapman). COLD. ELECTRICITY Electricity is used in medicine for its therapeutic effect, as well as for purposes of diagnosis and prognosis. Two currents are used, the primary or galvanic and the induced or faradic, the battery furnishing the current being supplied with a positive pole, or anode, and a negative pole, or cathode. When the electrical current is passed through a muscle it causes contraction of the latter, the greatest contraction resulting if the current be applied directly to the motor point, or place where the motor nerve enters the muscle. As a muscle degenerates it loses its electro-contractility, the response to the faradic current disappearing first, while the galvanic current produces contraction for some time longer, until finally no current will produce any effect. The con- 20 IMPONDERABLE REMEDIES. traction occurs at the moment of making or breaking the circuit; slow interruptions bring about alternate contraction and relaxation, while very frequent interruptions throw the muscle into a condition of spasm. The constant current pro- duces no contraction while it is flowing through the muscle. If a current of sufficient strength be used, and the positive pole, or anode, is placed over the muscle at any other than its motor point, a contraction occurs when the circuit is closed, and a slighter one when the current is opened ; if the cathode, or negative pole, be applied, a greater contrac- tion occurs than with the anode. This refers to normal muscle. When the muscle degenerates, at first both poles cause a similar contraction, and later on the anode produces the greater, so that the original order is reversed ; at last no current produces any response. The following formulae are used to denote these reactions of degeneration: AnCIC < CaCIC AnOC > CaOC reaction of normal muscle ; AnCIC = CaCIC AnOC = CaOC first stage of degeneration of muscle ; AnCIC > CaCIC AnOC < CaOC advanced degeneration of muscle. AnCIC and AnOC stand for anodal closing contraction and anodal opening contraction ; CaCIC and CaOC for cathodal closing contraction and cathodal opening contraction; the sign <C is " less than " ; > is " greater than ". Electricity-therapeutics : Electricity is used in palsies, neu- ralgia, rheumatism, and anaesthesias, and as a tonic. In func- tional palsies, such as those due to various poisons (tobacco, mercury, arsenic, lead), the electric treatment is very useful; in organic palsies, due to hemorrhage into the brain or cord, elec- tricity simply elevates the tone of the muscle, but cannot influence the paralysis. In organic palsies with inflammation the current does harm. In general, the current selected in the treatment of paralysis should be the one giving the greatest amount of contraction with the least amount of PHARMACOLOGICAL REMEDIES. 21 pain. In anaesthesias the dry brush should be used, as it is the most painful ; in neuralgias, the mild galvanic; in rheu- matism, the mild faradic. As a tonic, if the patient is con- fined to bed, electric excitation of each muscle takes the place of exercise. MASSAGE. Massage is a term used to designate methodical rubbing, kneading, and percussion of the body. The person practising massage is known as a masseur (male) or masseuse (female). Massage is performed by making regular movements from the extremities toward the centre of the body, in a way which can only be learned by special instruction and con- tinued practice. It acts as a stimulant to both nerve and muscle and to many of the functions of the body, assisting the circulation and favoring the removal of waste-products. Massage is employed both for its local and general effect: in paralyses; in synovitis; arthritis, sprains, and fractures ; in neuralgia; in chronic constipation (abdominal massage); in pelvic disorders of women (pelvic massage). In the " rest- cure" (S. Weir Mitchell) it is combined with isolation, rest, forced feeding, and faradism. It is also useful for its general effect in neurasthenia, nervous prostration, and hysteria. PHARMACOLOGICAL REMEDIES. Drugs-action of: Drugs may act (1) locally, usually from some direct chemical effect on tissues; (2) constitutionally (systemically or remotely), for which it is necessary that they should be absorbed by the capillaries and lymphatics into the blood, often undergoing chemical changes in the process. The process of absorption is generally proved by finding traces of drug-elements in the blood, tissues, and secretions, and also by the fact that if the circulation be interrupted the influence of drugs is not transmitted. Circumstances modifying the activity of drugs : Diversity of action may depend on the drug itself as modified by season, climate, etc.; on the pharmaceutical preparation used : as the 22 PHARMA COL 0GICA L REMEDIES. solubilities of the active principles of the same drug may vary, it is evident that their activity will vary with the solvent used (vide Digitalis, its tincture and infusion); again, liquid preparations are more potent than solid ; on chemical or physiological antagonism or synergism of drugs taken at or about the same time ; on age and sex of patient: females require proportionately smaller doses, unless we except cathartics ; infancy and old age bear drugs poorly : however, there are certain drugs, notably belladonna, arsenic, quinine, aconite, and cathartics generally, which are borne by children in proportionately larger doses. Young's rule for graduating the dosage for children may be expressed thus : a^e . age + 12 Cowling's rule is to divide the age at next succeeding birthday by twenty-four. On idiosyncrasy of patient: Some individuals are peculiarly susceptible, or the opposite, to certain drugs. Thus the admin- istration of two grains of quinine to a very susceptible person may be followed in a short time by a severe attack of spas- modic asthma, accompanied by a very pronounced and dis- tressing urticaria. On habit: Certain forms of disease, time of administration regarding meals, and the condition of the stomach may all modify effects. Drugs-avenues of introduction : (1) By the skin. (а) Encpidermatic-application to skin without friction: absorption is more rapid if a liquid be used as solvent. It is not much used because of interference offered by the epidermis and secretions of the skin. (б) Epidermatic-with friction: systemic effects may be produced, as is especially well seen in the inunction of the ointment or oleate of mercury, or of cod-liver oil in marasmic conditions. (c) Endermatic-the application of a drug to a surface de- nuded of its epidermis by vesication : painfid, and practically obsolete. (2) By the mucous membranes: (a) Of gastro-intestinal tract, the most usual method : per- fect conditions for absorption are afforded either in the acid PHARMACOLOGICAL REMEDIES. 23 secretion of the stomach or the alkaline of the small intes- tine. Also by rectal enemata: when absorption is desired, from f§j to f.siv of fluid should be injected : dosage by rec- tum is roughly about double that by mouth, or of narcotic drugs somewhat less than this. Medicinal and nutritive ene- mata are very valuable in cases of persistent vomiting from any cause, inability to swallow, or in/orced feeding and stim- ulation. Enemata of defibrinated beef-blood have proved beneficial in pernicious anaemia. (6) Absorption may also take place through the mucous membranes of the conjunctiva, nose, throat, bronchi, and genito-urinary tract. (3) By the subcutaneous areolar tissue, principally by the hypodermic method : the usual sites of injection are the arm, thigh, and abdomen, and perfect asepsis is required to pre- vent infection. Under this subdivision may also be placed transfusion of blood and infusion of blood, milk, saline solutions, etc. Drugs-preparations: These preparations may be solid, semi-solid, or liquid. The solid preparations are as follows: Abstracta (abstracts), alcoholic extracts diluted with lactose (milk-sugar), and representing twice the strength of the parent drug. No longer official. Pulveres (powders), drugs in finely divided state, and ren- dered so by pulverization, precipitation, or elutriation ; they are a suitable form for administration of drugs of pleasant taste and slight bulk, which are permanent in the atmos- phere. Extracta (extracts) are obtained by evaporating liquid prep- arations, as tinctures, infusions, or vinegars, to a solid or semi- solid consistency. Extracts of fresh drugs may be alcoholic, acetic, or aqueous. Triturationes (triturations) are more finely divided than powders: strength, 10% in milk-sugar. Pilulce (pills) are small globular masses suitable for the exhibition of drugs which are insoluble in the ordinary solvents or offensive to taste, but not bulky. Trochisci (troches, lozenges,, tablets, or pastilles); canfec- 24 PH A RM A COL 0 QIC AL REMEDIES. tiones (confections); and chartce (papers) complete the list of solid preparations. Resince (resins) are made by precipitating with water, tinctures of drugs which owe their activity to resinous bodies. Masses (masses) are pill-masses kept on hand by the pharmacist. The liquid preparations are- Liquores (solutions) are made by dissolving non-volatile principles in water. Aquce (waters) are solutions of volatile principles in water. Misturce (mixtures) contain insoluble substances sus- pended in water by some viscid substance, as gum arabic, tragacanth, or sugar. Tinctures, (tinctures), or solutions of the soluble principles of recognized drugs in alcohol, ethereal spirit, or aromatic spirit of ammonia, and known accordingly as alcoholic, ethereal, or ammoniated tinctures. As these menstrua evaporate readily, tinctures should be kept tightly corked, or they may become seriously increased in strength. Infusa (infusions) contain the virtue of the drug as ob- tained by digestion or maceration in cold or hot (but not boiling) water; cold water is used when the active principles are affected by heat or are volatile. When boiling water is used we have a decoction (decoctum). Emulsiones (emulsions) are aqueous liquids containing oil or resin in suspension. Glycerita (glycerites) are solutions of medicinal principles in glycerin. Elixiria (elixirs) are sweetened liquids of pleasant flavor containing some alcohol, and are intended mainly as vehicles. Mucilagines (mucilages) are liquids containing some gummy substance in solution or suspension. Collodia (collodions) are intended for external use, and contain gun-cotton in solution in a mixture of ether and alcohol. Spiritus (spirits) arc alcoholic solutions of volatile substances, bearing much the same relations to tinctures that aquse do to liquores. PH A RM A COL OGICA L REMEDIES. 25 Vina (wines) are solutions of medicinal principles in stronger white wine. Aceta (vinegars) are solutions of medicinal principles in dilute acetic acid. Mellita (honeys) are preparations containing drugs held suspended or dissolved in honey. Syrupi (syrups) are preparations of medicinal substances in concentrated solutions of sugar. Syrupus (simplex) is com- posed of 65 parts of sugar heated with sufficient water to make 100 parts. Flavoring and medicated syrups contain other agents in addition. Extracta Fluida (fluid extracts) are very convenient prep- arations, produced by partial evaporation of solutions of active principles in alcohol or diluted alcohol. One minim represents one grain of drug (1 c.c. = 1 Gm.). Oleoresince (oleoresins) are extracts of crude drugs made with ether, and are composed of fixed or volatile oils holding resins in solution: they are liquids and self-preserving. The ether is separated by distillation. The semi-solids are- Suppositoria (suppositories), which are mixtures of medic- inal agents in cacao-butter, melting at the body-temperature in rectum, vagina, or urethra. Unguent a (ointments), which are preparations of agents for local use in some fatty substance, generally benzoinated lard, or in petrolatum. Oleata (oleates) are combinations of metallic bases or alka- loids with oleic acid. Cerata (cerates) are ointments to which enough white wax or spermaceti is added to render them still solid at the body- temperature. Linimenta (liniments) are alcoholic or oily preparations, always liquid at body-heat, and intended to be applied with friction. Emplastra (plasters) are adhesive at body-heat; made in different ways, but often have as a basis lead plaster, a com- pound of olive oil and litharge (lead oleate). 26 WEIGHTS AND MEASURES. WEIGHTS AND MEASURES. In the United States, Troy or Apothecaries' Weight is still used most extensively, although the metric system is gradually coming into vogue. The Pharmacopoeia has adopted the latter for its formulae. Troy, or Apothecaries', Weight. 20 grains (gr.) = 1 scruple (B) = 20 grains. 3 scruples = 1 drachm (5) = 60 " 8 drachms = 1 ounce (.5) = 480 " 12 ounces - 1 pound (ft)) = 5760 " Wine, or Apothecaries', Measure. 60 minims (iff) = 1 fluidrachm (fs). 8 fluidrachms = 1 fluidounce (f§). 16 fluidounces = 1 pint (O). 2 pints = 1 quart. 4 quarts = 1 gallon (Cong., C) = 231 cubic inches. 1 ounce (av. oz.) = 437.5 grains. 16 ounces = 1 av. lb. (abbrev. lb.). 1 pound = 7000 grains. Avoirdupois Weight. The Troy weight is used in the compounding of prescrip- tions, the Avoirdupois weight is in ordinary use generally, and the Wine measure is used for measuring liquids in pharmaceutical work. In this country liquids are measured and solids are weighed. The Troy and Avoirdupois pounds are abbreviated in the same manner, lb., but differ in the number of grains con- tained (5760, 7000). The Troy pound is used very rarely. The scruple (B) is becoming obsolete; it is just as convenient to write for 20 grains, and the abbreviation for scruple may be mistaken for a carelessly written drachm mark. The older systems were based on the grain, originally a grain of wheat, taken from the centre of the ear. WEIGHTS AND MEASURES. 27 Metric System. Myriameter (Mm.) 10,000 Kilometer (Km.) 1,000 Hectometer (Hm.) 100 Decameter (Dm.) 10 Meter (m.) 1 Decimeter (dm.) A Centimeter (cm.) to Millimeter (mm.) yoVo Myrialiter (Ml.) 10,000 Kiloliter (KI.) 1,000 Hectoliter (Hl.) 100 Decaliter (DI.) 10 Liter (1.) 1 Deciliter (dl.) Centiliter (cl.) y-Jy Milliliter (ml.) yAo Myriagramme (Mg.). Kilogramme (Kg.). Hectogramme (Hg.). Decagramme (Dg.). Gramme (Gm.). Decigramme (dg.). Centigramme (eg.). Milligramme (mg.). The Latin prefixes represent its subdivisions; the Greek prefixes, its multiplications. The units of the metric or decimal systems are: 1, the meter, the measure of length, the millionth part of the earth's circumference; 2, the liter, or measure of capacity, the cube of meter; 3, the gramme, the weight of 1 cubic centimeter of water at 4° centigrade. The subdivisions used in medicine are the centimeter (cm.), the millimeter (mm.), and occasionally the micromillimeter, or the yyoo- part of a millimeter (mkm., used in microscopic work); the liter (1.) and cubic centimeter (c.c.); the gramme (Gm.), the centigramme (eg.), and the milligramme (mg.); the kilogramme, or kilo (Kg.), is used in commercial trans- actions. The equivalents of the metric system in inches, grains, and liquid measure are : meter = 39.37 in.; the centimeter is therefore almost .4 inch, or we may estimate 2| centi- meters to the inch ; the liter measures 2.113 pints, or a little over a quart; there are approximately 30 c.c. in the fluid- ounce ; the gramme weighs 15.432 grains, variously estimated at either 15 or 16 grains. Comparative equivalents of Troy and metric weights: A gramme is practically equivalent to 15 grains : 5j therefore = Gm. 4.; - 30 c.c. Bearing these few points in mind, transposition from one system to the other is readily done. Thus, reduce the quantity to grains and divide by 15, the quotient representing, approximately, the quantity in gram- mes. Or reduce to drachms and multiply by 4. The terms decagramme, hectogramme, and kilogramme are seldom used in prescribing, their equivalent being expressed in Gm. : thus 28 PRESCRIPTION- WRITING. Gm. 10, Gm. 100, etc.; for subdivision, Gm. .1, Gm. .01, Gm. .001, etc. Drops (guttae, gttd) are usually regarded as equal to minims, but vary with a number of conditions : of tinctures, for the most part, a fluidrachm contains about 120 drops, or 2 drops to the minim, while an equal amount of chloroform contains over 200. In prescribing less powerful liquids a teaspoonful is roughly used as equalling f 3j ; but it is safer to consider six teaspoonfuls to the f§j ; a tablespoonful for a wineglass- ful for ; a teacupful for fgiv. It is much safer to rely on the accurately graduated medicine-glasses now furnished by all druggists. PRESCRIPTION-WRITING. A complete prescription consists of the Superscription, or heading; the Inscription, or names of the ingredients; the Subscription, or directions to the compounder; the Signa or Signatura, the directions to the patient; the name of the physician, the name of the pata'c/d, and the date. Latin is preferred in the writing of prescriptions for the same reasons which commend its use in the naming of pharmacopoeial drugs and compounds in general-viz., the terms are distinc- tive, not subject to change, and mean the same in all civilized countries ; occasionally they are useful in withholding the names of drugs from the patient. The superscription con- sists of the abbreviation R, for "recipe," with a terminal stroke on the R, which survives as a remnant of the sign of Jupiter, O|_, formerly preceding all medical formulae as an in- vocation to the deity. Literally translated " take thou," or " take," it tells the pharmacist to compound the ingredients which follow. These are invariably in Latin, the quantities following on each line, indicated by the customary abbrevia- tions. Thus : gr. for granum, plural grana, grain or grains; 9 for scruple (scrupulus); 5 for drachm (drachma); 5 for ounce (uncia); and O for pint (octarius). The abbreviations lb. for pound (libra) and Cong, for gallon (congius) are more rarely used. Ilf stands for minim (minimum); and the liquid PRESCRIPTION- WRITING. 29 drachms and ounces are indicated by the prefix f, thus fgj, The metric weights and measures are expressed in decimals in Ara6w numerals, followed or preceded by c.c. or Gm., signifying measure or weight (10.50 c.c., 5.125 Gm.). A prescription written with the Troy system of weights always contains Ao/nan numerals : gr. iv, gr. xlviii, etc. Examples of prescriptions : For Mr. R Plumbi acetatis, Gm. 4. Tincturae opii, c.c. 45. Aquae, quantum sufficit ad c.c. 500. M. Sig.-For external use. 2. 4. '99. Dr. For Mrs. R Sodii bicarbonatis, Sodii boratis, aa 3j. Acidi carbolici, TTL xxx. Glycerini, Aquae, Oii. M. Sig.-Use as a spray. 2. 4. '99. Dr. For Baby R Hydrargyri chloridi mitis, 0.35. Sodii bicarbonatis, 3.00. M. Fiant tabcllae No. xxiv. Sig.-One tablet every hour until eight have been taken. 2. 4. '99. Dr. 30 PRESCRIPTION- WRITING. For Mr. R Aloini, gr. v. Extract! Belladonn®, gr. iv. Strychnin® sulphatis, gr. ss. M. Divide in pilulas No. xxiv. Sig.-One pill at bedtime. 2. 4. '99. Dr. The complete inscription is made np of the basis, or main medicinal ingredient; the adjuvant, or aid to the basis; the corrective, or agent to counteract or correct some unpleasant action of the basis ; and the vehicle or diluent (excipient, if the prescription calls for pills), which serves to dilute and present the whole in as pleasant a combination as possible. Most prescriptions do not contain all of these ingredients; many call for but one. The names of the drugs are abbreviated. If written out in full, the quantities would be in the accusa- tive, the names of the ingredients in the genitive, case. The subscription, or directions to the pharmacist, is simple, consisting of M. for " misce," S. for " solve," etc. The signa, signatura, or the directions to the patient, ab- breviated Siff., are always written in English, to lessen the chance of mistake. There is every reason why the patient should be able to read this part of the prescription, and great importance attaches to the careful wording of this part of the formula. It is careless and often dangerous to write "Use as directed," but the directions should be as clear and concise as possible. The name of the patient properly appears at the top of the formula, particularly when several patients are prescribed for in the same house. The name of the physician and the date are added below. The order usually adopted in writing prescriptions is as follows: The names of the ingredients are first produced, in the order of their importance ; the number of doses is next decided upon, and the individual dose of each drug mul- tiplied by the number of doses and the quantities affixed to the names of the ingredients. The character of the combina- tion influences the number of doses-e. g., a cough-mixture is PRESCRIPTION- WRITING. 31 usually given at frequent intervals, while a laxative in many instances requires but one dose daily. In selecting the proper quantity for liquid mixtures the regular sizes of vials alone are considered. These are of 1, 2, 3, 4, 6, 8, 16 ounces capacity, and it should be remembered that in all cases a bottle should be filled. A partially filled vial immediately excites a patient's suspicion as to the possibility of mistake on the part of prescriber or compounder. In ordering pills or powders even numbers-12, 24, 32-are found convenient; in metric formulae decimal subdivisions are useful. The rules of Latin grammar particularly applicable to prescription-writing are : The quantities of the ingredients appear in the accusative case, governed by the imperative "Recipe" ; they are seldom produced in full. The names of the ingredients appear in the genitive case, the construction reading " Recipe drachmam unam Acidi Borici," take one drachm of Boric Acid, R Acidi Borici, 3j. The directions to the compounder are very simple : M. for " misce," S. for "solve," " M. Ft. pil. No. xxiv," "Misce. Fiant pilulse No. xxiv." The directions to the patient are in English. All nouns ending in a form a genitive or, and are of the first declension ; the accusative ends in ant and the nominative plural in oe ; exceptions, Physostigma, Aspidosperma, Theo- broma, enema, gargarisma, gramma (of Greek derivation); these form a genitive of atis. Nouns terminating in us are of the second declension, and change to i for the genitive, uni for the accusative, singular number; i for the nominative plural; exceptions, a few nouns of the fourth declension, fructus, Cornus, Quercus, and spiritus (these do not change in the genitive). Rhus becomes Rhois. Those nouns ending in um are neuter in gender and of the second declension. They change to i for the genitive, um for the accusative, a for the nominative plural. All other pharmacopceial nouns belong to the third declension and change variously. Thus : as be- comes atis ; is may become is, idis, itis, eris, for the genitive; the accusative of as becomes am, the nominative plural ates. So much variety exists that the nouns must be studied indi- vidually. Sassafras, Kino, Cusso, Matico, Buchu, Catechu do not change. Adjectives agree with their nouns in num- 32 PRESCRIPTION- WRITING. ber, gender, and case; those ending in us take on the termi- nation a for the feminine and um for the neuter gender, and are declined according to the first and second declensions. Adjectives ending in is and ens are declined according to the third declension ; the first takes on the termination e for the neuter gender. A few nouns of Greek origin end in e, and form a genitive of esand an accusative of en, Aloe, Aloes, Mastiche, Mastiches. Pills, capsules, and powders may be indicated in the sub- scription as follows: Fiat pulvis. Dispensa tales doses No. xij: " Let a powder be made. Dispense 12 such powders." Divide in chartulas No. xij: "Divide into 12 powders." Dis- pensa in capsulis: "Dispense in capsules." Fiant pilules No. xij: "Let 12 pills be made." jFW massa in pilulas No. xij dividenda: " Let a mass be made which is to be divided into 12 pills." Again, an official formula may be specified as follows: R Pilulas Aloes et Mastiches No. xij: "Take 12 pills of Aloes and Mastiche." Or, the formula for a single pill may be written and then the order given to compound a certain number: Fiat pilula. Dispensa tales pilulas No. xij. The prepositions most frequently employed are : ana, abbr. aa, " of each " (Greek, genitive case); in, " in," governing accusative case when it means into, otherwise followed by ablative case ; cum, " with " (ablative); ad, " to," " up to " (accusative). The most commonly occurring nouns, verbs, and phrases and their abbreviations comprise the following groups : Nouns: Centimetrum cubicum (c.c.), a cubic centimeter; Charta, se (chart.), a small paper; Cibus, i (cib. or c.), food; Cochlear, aris (coch.), Cochleare, aris (coch.), a spoonful; Cochleare magnum (coch. mag.), Cochleare amplum (coch. ampl.), a tablespoonful = f 3ss ; Cochleare modicum (coch. med.), Cochleare modicum (coch. mod.), a dessertspoonful - f 3ij ; PRESCRIPTION- WRITING. 33 Cochleare parvum (coch. parv.), a teaspoonful = fsj; Collyrium, ii (collyr.), an eye-wash; Congius, ii (Cong.), a gallon; Cyathus, i (cyath.), a glass ; Decoctum, i (decoct.), a decoction; Dosis, is (dos.), a dose ; Drachma, ae (3), a drachm ; Fluidrachm, ae (f.5), a fluidrachm ; Fluiduncia, ae (fA), a fluidounce ; Gargarisma, atis (garg.), a gargle; Gramma, atis (Gm.), a gramme ; Granum, i (gr.), a grain ; Gutta, ae (gtt.), a drop ; Haustus, i (haust.), a draught; Infusum, i (inf.), an infusion ; Lagena, ae (lag.), a bottle ; Libra, ae (lb.), a pound ; Manipulus, i (manip.), a handful; Massa, ae (mass.), a mass; Mica panis (mica pan.), crumb of bread; Minimum, i (YTL), a minim; Mistura, ae (mist.), a mixture ; Octarius, ii (O), a pint; Pilula, ae (pih), a pill; Poculum, i (poc.), a cup ; Pulvis, eris (pulv.), a powder; Scatula, ae (scat.), a box ; Scrupulus, i (9), a scruple; Spiritus, us (spir.), a spirit; Tabella, ae (tab.), a tablet; Uncia, ae (5), an ounce. Adjectives and participles: Bullions, entis (bull.), boiling; Colatus, a, um (col.), strained; Contusus, a, um (cont.), ground ; Dividendus, a, um (gerund, divid.), to be divided, being divided. 3 M. M. 34 PRESCRIPTION- WRITING. Exactus, a, um (exact.), accurate; Semis, ss, a half; Talis, such, like this. Prepositions and adverbs: Ad (acc.), to, up to; Ana (dd, gen.), of each; Ante (acc.), before; Bene, well; Cum (abk), with ; Guttatim (guttat.), by drops; In (acc.), into; In (abk), in ; Numero (no.), by number; Per (acc.), through, by; Post (acc.), after; Pro (abk), for; Secundum (acc.), sec. according to; Statim (stat.), immediately. Verbs : Adde (addere), add; Bulliat, bulliant (bullio), let it, let them, boil; Capiat, let him take; Da (dare), give; Detur (dentur), let there be given ; Divide (di vide re), divide ; Dividatur (dividere), let it be divided; Dividendus (gerund.), to bo divided ; Fac (facere), make; Fiat (fieri), let it be made; Fiant (fieri), let them be made; Filtra (filtrate), filter; Misce (AL, miscere), mix ; Recipe (R, rccipere), take; Solve (S., solvere), dissolve; Sufficit (sufficere), it suffices ; Tore (tcreo), rub. CAMPHORA. 35 Some classification of medicinal agents seems necessary, but, owing to the great variety of effects and uses of certain individual remedies, no satisfactory arrangement is possible. Various groups, as antispasmodics, anaesthetics, somnifacients, delirifacients, cardiac stimulants and depressants, etc., to be later defined, are recognized. Our purpose will be to treat of each drug in that class in which it finds its chief efficiency, and to mention it in its other less important therapeutical associations. CLASSIFICATION OF DRUGS. ANTISPASMODICS. Antispasmodics are a class of drugs whose physiological effects are not pronounced, acting in some unexplained man- ner on the cerebrum, and especially valuable in neurotic conditions, as hysteria, " nervousness," etc. They are all stimulant and diaphoretic, and most of them have a strong, peculiar odor. Origin and properties: Camphor is a stearopten (having the nature of a ketone) obtained from the roots and branches of Cinnamomum Camphora (nat. ord. Laurinese), or camphor laurel, an Asiatic tree, and purified by sublimation. It occurs in soft, rather consistent pieces, of hot and peculiar taste and cooling after-taste, and of characteristic odor. It is volatile, burns with a very smoky flame, floats on water, in which it is quite insoluble and by which it is precipitated from its solutions in alcohol, ether, chloroform, and oils. Chemically, it resembles the turpentines, and forms substitu- tion-products with the chlorine group. Preparations and doses: Camphora, dose gr. v-xv ; best given in emulsion or pill. Camphora Monobromata (see below), dose gr. v. Aqua Camphorae (.8%), dose Oss-ij. Spiritus Camphorae (10%), dose Tf[xx-xl. CAMPHORA, U. S. (Camphor), CI0H16O 151.66. 36 ANTISPA SMODICS. Linimentuni Camphorae, 20% in olive oil, Ceratum Camphorae (2%), Linimentum Saponis, external use. Physiological action : Camphor is much more active than other members of this group. Locally, it is an irritant to skin and mucous membranes, producing superficial inflam- mation of the former, and, when swallowed, symptoms of irritant poisoning; it is mildly diaphoretic, stimulant to cir- culation in medicinal, and depressing in larger, doses. Ner- vous system-small doses exhilarate, larger doses cause head- ache, dizziness, delirium, and epileptiform convulsions, while toxic doses produce convulsions, stupor, and coma. Upon the genito-urinary tract moderate doses exert a sedative effect, while larger doses seem to stimulate. Therapeutics: In hysteria, melancholia, nervous headache, and dysmenorrhoea as a sedative; in typhoid and adynamic fevers as a stimulant diaphoretic; in diarrhoea, dysentery, cholera, etc., generally combined with opium; in chronic bronchitis and emphysema, acting as a blennorrhetic and anti- spasmodic; to allay irritation of the genito-urinary tract, as in priapism, chordee, nymphomania, dysmenorrhoea, etc., in which large doses are necessary; acute coryza in its incipicncy may be aborted by camphor. Its external applications are valuable mild counter-irri- tants. Camphorated Oil (Oleum Camphoratum) is a solution of camphor in cotton-seed oil or other fixed oil. Ten or twenty minims of a 10% solution may be given hypodermically in the heart-failure of pneumonia, typhoid fever, etc. In this form it is a rapidly acting cardiac stimulant. Acidum Camphoricum (Camphoric Acid) occurs in small white scaly crystals, freely soluble in hot water and alcohol; sparingly soluble in cold water. It is very effective in con- trolling the night-sweats of phthisis, and has been found serviceable in ammoniacal cystitis. It is made by boiling camphor with nitric acid. Dose gr. x-xxx, best given in capsules. Oleum Camphorce (Oil of Camphor) consists of a terpene SPIRITUS JETHERIS COMPOSITUS. 37 containing some camphor and safrol in solution ; the latter imparts to it an odor suggesting oil of sassafras. Oil of camphor is obtained as a by-product in the manufacture of camphor; its action is similar to that of oil of turpentine modified by the small amount of camphor it contains. Camphora Monobromata, U. S. (Monobromated Camphor), C10H15BrO, is camphor in which one atom of hydrogen is replaced by bromine. It occurs in colorless crystals or scales, freely soluble in alcohol, and combines the sedative action of the bromides and camphors. Dose gr. v, in nervous excite- ment; it is particularly useful in spermatorrhoea. SPIRITUS AjTHERIS COMPOSITES, U. S. (Compound Spirit of Ether; Hoffman's Anodyne). Ingredients and properties: Hoffman's anodyne is com- posed of oleum oethereum, 2|%; ether, in alcohol. It owes its activity to the first two. Oleum oethereum, or heavy oil of wine, is obtained by distilling alcohol with an excess of sulphuric acid, and adding an equal amount of ether to the distillate: it is antispasmodic, but is only used in the above preparation. Hoffman's ano- dyne is a colorless, volatile, inflammable liquid, of ethereal odor and burning but sweetish taste, and giving when mixed with water a milky color, which is a test of its purity. The color is due to precipitation of the oil of wine, which is expensive and often wanting in sophisticated preparations. Occasionally, castor oil is added to mixtures not containing the oil of wine; on dilution with water a milky appearance results, but if the precipitated oil be gathered on a filter, it is found non-volatile. The value of Hoffman's anodyne probably depends upon its containing three ingredients, which stimulate in the order named-ether, alcohol, and the heavy oil of wine-the ether being the most rapidly acting and evanescent, the oil of wine the third to take effect and the most lasting (Hare). The mixture is no more toxic than its ingredients. Therapeutics : It is an efficient antispasmodic in the dis- tressing attacks of cardiac disease, having slight stimulating 38 ANTISPA SHOD ICS. effects ; it is also employed in hiccough, asthma, and hysteria, and as a valuable carminative and anodyne. VALERIANA, U. S. (Valerian). Origin: The rhizome and roots of Valeriana officinalis (nat. ord. Valerianeae). Habitat: Europe and Northern Asia ; naturalized in New England. Valerian contains a volatile oil, oleum valeriance, of peculiar odor and yielding valerianic acid, valerian camphor, and resin. Preparations: The number of official preparations is out of proportion to its usefulness. The principal are- Tinctura Valerianae (20%), dose Tinctura Valor. Ammoniata (20%), dose Extractum Valerianae Fluidum, dose fgj. Ammonii Valerianas, dose gr. ij-viij. Zinci Valerianas, dose gr. j-iij ; a zinc salt. The oil of valerian, and the valerianates of iron and quinine, complete the list. Elixir Ammonii Valerianatis, unofficial, but much used, dose f.5j. Physiological action and therapeutics: Valerian is not con- stant in its action, at times exciting and at others allaying reflex excitability-a variability which may be due to the numerous phases of the condition for which it is most em- ployed. Large doses may cause epigastric burning and symptoms of gastric irritation, with headache, vertigo, mental exhilaration, and hallucinations ; but these are not invariable. It probably stimulates slightly the circulation. Its chief value has been found in hysterical conditions generally, in which it is frequently used; also used with varying success as an antispasmodic in pertussis, asthma, chorea, and spas- modic conditions generally; but will prove most efficient in those of neurotic origin, as laryngismus stridulus. The valerianate of ammonium has met with success in neuralgias, nervous headache, and hysteria. Origin and composition: A gum-resin obtained from the root of Ferula foetida (nat. ord. Umbelliferse). Habitat: ASAFCETIDA, U. S. (Asafetida). MOSCHUS. 39 Central Asia. It is made by drying the milk-juice collected after incising the living root. Besides gum and resin, it con- tains a volatile oil, which gives the drug its peculiar garlicky odor. Preparations : Asafoetida, gum-resin, dose gr. x-xv. Pilula? Asafoetidse (in each gr. iij), No. ij-iv. Emulsum Asafoetida? (milk of asafoetida), dose f^ss-j. Mistura Magnesiae et Asafoetida? (Dewees' carminative) contains 7 % of tinct. asafoetidae and 1 % of tinct. opii; dose Tllxx (unofficial). Tinctura Asafoetida? (20%), dose A pill of aloes and asafoetida and a plaster are official. Physiological action: Its effects are disputed. It is prob- ably mildly stimulant and carminative; it increases the secretions of the bronchi and intestines, and gives rise to very offensive stools; by some it is claimed to stimulate peristalsis. Therapeutics: Like valerian, it is of use in hysterical conditions. From its supposed expectorant and intestinal effects it is said to have peculiar efficiency in spasmodic pectoral affections, in flatulence and tympanites : these con- ditions in children may be relieved by encmata of emulsum asafoetidse, though the odor renders the remedy very objec- tionable. MOSCHUS, U. S. (Musk). Musk is the dried secretion from tlie preputial follicles of Moschus moschiferus (class Mammalia; order Ruminantia), or musk-deer; seldom found in shops, and is apt to be greatly sophisticated. Habitat: Central Asia. Preparations : Moschus, dose gr. v-xv. Tinctura Moschi, dose Physiological action and therapeutics: On the healthy organism its effects are probably nil. In certain adynamic and nervous conditions it may prove exhilarant, stimulant, and antispasmodic. It has its advocates in conditions of collapse and in the adynamic stages of typhoid and alcoholic pneumonias, and may prove valuable in hysterical manifesta- tions, singultus, and other spasmodic conditions. Musk is 40 A NTISPA SNOB ICS. indicated especially in the crises of low fevers; a single dose is given by enema. SUCCINUM (Amber). Oleum succini (oil of amber) is a volatile oil obtained by destructive distillation from amber, which in turn is a fossil resin of an extinct coniferous tree (JPinitis succinifer) found along the Baltic shores. Locally, it is an irritant, and has been used in rheumatism and as an embrocation in whooping-cough. Internally, it is a reputed antispasmodic. Dose gr. v-xv in capsule: larger doses may cause gastric irritation. HUMULUS, U. S. (Hops). Origin and composition : The strobiles (cones) of Tlumulus lupulus (nat. ord. Urticaceae), or hop vine, having at the bases of their imbricated leaves a yellowish powder, officially known as lupulinum, and containing among other principles a bitter principle and a volatile oil. Habitat: cultivated. Physiological action and therapeutics: Like other bitters, it is a stomachic tonic, and may be used as such : the drug may produce diaphoresis, exerts a slightly sedative effect on the cerebrum, and is a slight cardiac excitant. Humulus has been recommended in combination with tinct. capsici as a substitute for alcohol. It exerts a somewhat sedative effect on the genito-urinary tract, and is used in abnormal sexual excitement and vesical irritability, meeting with most success in functional conditions. It is a domestic remedy and has a number of therapeutically weak preparations. Dose of the tinct- ure, foj-iij ; of fluid extract, l)Ix-xv; of the oleoresin, gr. ij-v. Lactucarium, IT. S., the concrete milk-juice of Lactuca saliva (nat. ord. Composite) (garden lettuce), has an official fluid extract and a syrup, but is probably inert. Sedative properties have been claimed for it. CIMICIFUGA, U. S. (Cimicifuga). Source and composition; The r/wzome and roots of Cimici- fuga racemosa (nat. ord. Ranunculacese), an indigenous herb. ANESTHETICS. 41 Its exact status as to classification is not clear. It contains, however, a volatile oil, which gives to tiie plant its character- istic odor, tannic and gallic acids, a resin, and a not yet isolated active principle. Preparations: Cimicifuga, dose gr. xx-3j. Tinctura Cimicifugse (20%), dose f-Sss-gj. Extractum Cimicifugae fluidum, dose TTLxv-fnss. Extractum Cimicifugae, dose gr. iij-v. Physiological action: The taste of the drug is bitter and slightly astringent, and in small doses it promotes appetite and digestion. It slows the heart and lowers the arterial pressure, acting as a direct cardiac depressant. On the uterus and unstriped muscle it certainly has some action, as it seems of value in dysmenorrhoea and in the pelvic congestions of the climacteric. Anodyne and soporific properties are claimed for it. It undoubtedly increases the secretions of the skin and bronchial mucous membrane. Therapeutics: Cimicifuga is certainly of value in simple chorea of children ; it must be given in doses approaching the therapeutic limit, which is reached with the appearance of frontal headache. As a stomachic bitter it is used in dyspepsia, especially if atonic or irritative; sedative and analgesic effects are claimed for it in acute rheumatism and neuralgia ; while by a tonic action on the unstriped muscular fibre it is probably of use in congestive dysmenorrhoea, subin- volution of the uterus, and spermatorrhoea. It is also a good expectorant in chronic bronchitis, especially the forms asso- ciated with profuse expectoration. Large doses may cause vomiting. ANESTHETICS. The term " anaesthetic," which from its derivation (a, non, and atatiytrit;, sensation) would apply to any pain-allaying measure, has been limited to certain ethereal substances administered by inhalation and producing unconsciousness, accompanied by loss or diminution of sensation, motion, and reflex action. The manner in which they accomplish this is still under discussion, but they probably act directly upon 42 ANAESTHETICS. the cerebral cortex. Those most commonly employed are ether and chloroform. 2ETHER, U. S. (Ether). Chemistry: Ether is a liquid composed of about 96% by weight of absolute ether or ethyl oxide ((C2H5)3O = 73.84), and about 4% of alcohol containing a little water. It is formed by the dehydration of ethyl alcohol by sulphuric acid (hence erroneously called sulphuric ether), and subse- quent purification by calcium chloride, by which the alco- hol and acid impurities arc removed. Properties: Ether is a thin, volatile liquid of pungent odor, soluble in 10 parts of water, and easily in all ordinary sol- vents (alcohol and chloroform in all proportions). It is inflammable, explodes forcibly when ignited, and boils at about the body-temperature (98.2° F.). Its sp. gr. is about 0.725; but its vapor sinks, being heavier than the atmosphere ; hence artificial lights should be placed above it. Physiological action: Two stages are recognized. The first, or so-called stage of excitement, is characterized by a choking sensation, coughing, and other symptoms of irrita- tion of the respiratory tract; then succeed mental excite- ment, lightness of the head, buzzing in the ears, and a variety of emotional disturbances (laughing, weeping, shout- ing, fighting, etc.); the patient can still be somewhat aroused. At the end of the first stage a tetanic condition may occur, with cyanosis and great muscular rigidity. The second stage begins with complete unconsciousness, upon which loss of susceptibility to pain quickly supervenes, with abolition of reflexes and, generally, complete muscular relaxation (although rigidity may last much longer, especially in alcoholic patients). The portions of the body retaining sensibility longest are the eyes and muco-cutaneous junctions. The action of all the nervous centres is suspended except that of the medulla, which continues to preside over the organic functions of respiration and circulation. If pushed, death results from respiratory paralysis, although heart-failure may, in some cases at least, occur first. Early in anaesthesia there is car- PR A OTIC A L A NjESTIIESIA . 43 diac and vaso-motor stimulation ; later, the blood-pressure falls. Therapeutics: Ether is antispasmodic and anodyne, with slight primary stimulant effect. Hypodermically, it is valu- able in collapse as a cardiac stimulant. Locally applied, it evaporates quickly and causes coolness and slight anaesthesia of the parts. Preparations: uEther, used for anaesthesia ; by mouth, dose f3ss-j. Spiritus jEtheris (about one-third ether and two-thirds alcohol), dose fsj-iij. Spiritus JEtheris Compositus (antispasmodic), dose Spiritus JEtheris Nitrosi, dose The last is known as " sweet spirit of nitre," and is an alcoholic solution of ethyl nitrite, containing about 5% of the ether (to be considered later). Practical Anaesthesia. The technique of etherization may be divided into three stages : a, the preparation of the patient; b, the administra- tion of the ether; c, the after-care of the patient. The preparation of the patient is important, especially in prolonged operations, as those on the abdomen. This is done (1) by emptying the digestive tract; by the administra- tion of liquid diet on the evening preceding operation, fol- lowed by thorough purgation ; the danger from vomiting is thus greatly reduced, an important factor in abdominal ope- rations ; (2) by a physical examination of heart and lungs, and by a chemical and microscopic analysis of the urine. The administration of the ether: The effects of the anaes- thetic appear in three stages: 1, excitement; 2, narcosis; 3, paralysis. Previous to the giving of ether foreign bodies should be removed from the mouth. The ether is to be given slowly, and the patient warned about its primary irritative effect and assured that plenty of fresh air will be allowed him if much coughing should ensue. The anaesthetic is now administered drop by drop and the patient encouraged to breathe regularly. Frequently by this method the second 44 ANESTHETICS. stage is reached without any of the symptoms of irritation, such as coughing and choking. Should this occur, it is best to suspend the ether for a few seconds, until the patient regains his composure. During the first few minutes there is sometimes a cessation of respiration. This is a true respi- ratory forgetfulness, which is soon overcome by encouraging the patient to breathe, and perhaps by pressure on the lower ribs. Occasionally, absolute unconsciousness, absence of muscular rigidity, and loss of sensation are reached in the first stage ; but usually the second, or surgical, stage is re- quired. This is marked by regular, automatic breathing; by a slightly accelerated, full, strong and regular pulse ; by the absence of the conjunctival and other reflexes; by complete muscular relaxation ; the skin is warm and dry. It should be the aim of the etherizer to keep the patient in this stage with the minimum amount of ether until the operation is completed. The amount of ether, the time required fully to anaesthetize a patient, and the quantity necessary for pro- longed anaesthesia vary with the person, and each case must be judged individually. In general, the absence of muscular rigidity is taken as the sign for beginning the operation ; this is absolutely necessary for most operations. The conjunctival reflex is early abolished, and the reaction of the pupil to light is the last to disappear. The dangers from ether are twofold-from respiratory and from cardiac failure. The largest number of ether-deaths have occurred from primary failure of respiration. In the third stage the respirations become more frequent and shal- low ; the pulse increases in frequency and loses in volume ; the skin becomes cool and relaxed, and is bathed in perspira- tion ; and the reflexes, even that of the pupil to light, arc absolutely lost. It is the stage of exhaustion. The danger- signals are: weak breathing; rapid and feeble, frequently additionally an intermittent pulse (which may be regular); the fixed dilatation of the pupil; the expression of the face; noisy, blowing breathing, due to complete paralysis of the muscles of the pharynx. Frequently a sudden change occurs in the facial expression synchronous with cardiac failure. Accidents during etherization are : Vomiting. This Pit A OTIC A L ANAESTHESIA. 45 occurs from insufficient etherization, and carries the danger of suffocation with it if solid particles of food lodge in the larynx. It is not to be confounded with the accumulation of mucus in the mouth and throat. In either case the head is turned to one side and the jaw is pushed well forward, so as to allow of the ready expulsion of solids or liquids. In- spired mucus not infrequently causes catarrhal pneumonia, which may be ascribed to the irritant effects of the ether. Should an over-dose be taken the treatment is symptomatic : the head is allowed to hang low, the tongue is pulled far for- ward, and the chest is slapped with a wet towel or ether is poured over it; artificial respiration is resorted to, aug- mented, if possible, by the electric brush. Strychnine in doses of gr. hypodermically is the best vaso-motor, respiratory, and cardiac stimulant in such cases. The time usually required to place a patient fully under the action of the anaesthetic varies from 8 to 10 minutes; the quantity to reach this stage varies from 1 to 3 ounces, and the amount for the average operation varies from 3 to 6 ounces, according to the method of administration. Methods of administration: (1) The use of the ordinary Allis inhaler; (2) a piece of folded gauze placed over the patient's nose and mouth ; or (3) a towel folded in shape of a cone, with a piece of loose cotton in the apex. The Allis inhaler is safe, but allows of considerable ingress of air, so that a larger quantity of ether is required than by the other two methods. If it becomes necessary to push the ether, a towel may be placed over the inhaler for a few seconds. The unpleasant after-effects of ether are vomiting and nausea, both of which are very much lessened, if not alto- gether eliminated by thorough purgation before operation and careful etherization. Inspiration of mucus or of particles of food should be guarded against by keeping the head low, and turned to one side, with the chin well forward. Bronchitis is a not uncommon sequel, recognized by the ordinary signsand treated by the usual methods. Pneumonia may occur from inspiration of mucus, but may not develop until some days after an operation ; it maybe due in part to the irritant action of the ether and in part to cold contracted during or after 46 ANAESTHETICS. a prolonged operation. It is usually very insidious in its onset, and is frequently characterized by a rise of tempera- ture long before pain, cough, or physical signs call attention to the chest. Children are usually quickly anaesthetized, because they are apt to cry actively and to take full inspirations; for this reason the administration must be watched with especial care to avoid an over-dose. The depression at the end of narcosis is proportionately greater than in adults. Aged people usually bear ether well and occasionally take more in proportion than do robust adults. Stout people fre- quently become excessively cyanosed, so that the ether can- not be pushed to complete narcosis. Men take a larger quantity than women do, and show a greater tendency to become violent during the first stage. CHLOROFORMUM, U. S. (Chloroform), CHC13= 119.08. Chloroform, trichlormethane, is a liquid consisting of 99 to 99.4% by weight of absolute chloroform, and 1 to 0.6% of alcohol. It should be kept in dark amber-colored, glass- stoppered bottles, in a cool and dark place. It is a colorless fluid of neutral reaction, hot and sweetish taste, and peculiar, pleasant odor; it is very sparingly soluble in water, freely soluble in other solvents, and is itself a very good solvent for fats, resins, some of the balsams, and many alkaloids. It is also called methylic ether. Chloroform is usually prepared by the action of calcium hypochlorite upon acetone; it also results when chloral is heated with an alkali, and may be made by the action of calcium hypochlorite upon alcohol. Physiological action: When inhaled the effects resemble those of ether, but are much more rapid and powerful, and marked by an absence of faucial irritation when given in the proper dilution with air (about 3|% of chloroform vapor). Complete anaesthesia takes place in from one-half to two minutes, while the average for ether is eight to ten minutes; there is less liability to unpleasant sequelae, as vomiting, etc., and the patient regains consciousness earlier. Circulation: Authorities agree that it is more depressing to CHL0110F0RMUM. 47 the heart than ether; that the arterial tension is lower; and that death takes place generally from cardiac paralysis, but in rare instances from arrest of respiration : these unpleasant symptoms may occur with hardly any warning. Locally, undiluted, it is decidedly irritant, and vesicates when evapo- ration is prevented. By mouth its effects resemble those of ether closely-anodyne and antispasmodic. Preparations: Aqua Chloroformi, a saturated, aqueous solu- tion, dose f.3j-f.5ss. Chloroform um, official chloroform, should have a sp. gr. of at least 1.49; seldom used internally; this is the form for inhalation. Emulsum Chloroformi (chloroform 8%, tragacanth 25%, expressed oil of almond 6%), dose fsss-j. Spiritus Chloroformi (G%), dose fffx-f.sj. Linimcntum Chloroformi (chloroform 30%, soap liniment 70%). Therapeutics: Anaesthesia by ether and chloroform is indi- cated in operative surgery, where both anaesthetics find their chief utility. During the second stage of labor, not to full anaesthesia, ether may be used; but chloroform seems safer here than in other conditions, and is probably preferable. In dislocations and fractures they are valuable, by over- coming muscular spasm, both for diagnosis and reduction ; in convulsions of all kinds; in the diagnosis of hysteria and malingering from actual disease. Internally, they correspond closely, chloroform having the advantage of being more palatable. In their various prep- arations they are used in gastralgia, colicky pains, dysmenor- rhoea, hysteria, and as vermifuges. Chloroform is said to abort malarial paroxysms, and its liniments are standard local remedies for chronic rheumatism and neuralgia. Contraindications : In cardiac disease, cither valvular without compensation or when structural changes exist in the walls; in cerebral tumors and cerebral endarteritis the primary con- gestion may produce hemorrhage; in chronic alcoholism: these patients bear anaesthesia badly ; in advanced pulmonary dis- ease, ether especially; in acute nephritis ether may cause uraemia, and chloroform is to be preferred. 48 ANAESTHETICS. Ether, being undoubtedly less liable to cause death, is to be preferred in all cases except the following, in which chloro- form is more available : in hot climates, ether boiling at less than 100° F.; in military practice, chloroform being less bulky and expensive; in young children it is less apt to cause fright, but is distinctly more dangerous; in diseases of stom- ach and kidneys there is less danger of nausea and uraemia ; or when artificial light is needed or the cautery is to be applied about the face. Toxicology. During ether-anasthesia: When dangerous symptoms arise suspend the anaesthetic, draw the tongue for- ward, give atropine or strychnine hypodermically, and if necessary artificial respiration and faradization of respiratory muscles should be employed. During chloroforrn-ancesthesia: Stop its administration, and immediately invert the patient, head downward, which sends the blood to the right heart and causes it to contract. Ammonia, strychnine, digitalis, or strophanthus may be given hypodermically, or amyl nitrite by inhalation. When either is taken internally in toxic amount, treat as a case of irritant poisoning. Preparation: This non-official gas, so much used in den- tistry, is prepared by heating ammonium nitrate, decomposing it into water and nitrogen monoxide. Physiological action: Inhaled, it produces in from one to three minutes anaesthesia, preceded by a period of excitement, with hilarious, pugnacious, or erotic sensations; its modus operandi is not known, but this is probably more than pure asphyxia. It may be used as an anaesthetic in brief minor surgical operations, being comparatively harmless and the safest of all known anaesthetics. As it causes a great rise in the blood-pressure, it is contraindicated in atheroma; it is said to have produced diabetes. It does not produce mus- cular relaxation, and is therefore of little use in general surgery. NITROGEN MONOXIDE, or LAUGHING-GAS. ETHYL BROMIDE-COCAINE HYDROCHLORAS. 49 ETHYL BROMIDE, or HYDROBROMIC ETHER. Ethyl bromide, or hydrobromic ether, is a certain and moderately safe anaesthetic for operations requiring a brief anaesthesia. As it decomposes easily, with formation of compounds dangerous to life, it must be absolutely pure. Ethyl bromide does not reduce the contractions of the uterus during labor as much as other anaesthetics, and was therefore recommended especially in obstetric practice. A number of cases of sudden death arc recorded, probably due to im- purities. Local Anaesthesia. Slight local anaesthesia has been produced by the topical application of carbolic acid, chloroform, tincture of aconite, veratrine, certain volatile oils, as those of peppermint and of bitter almond, and by dilute hydrocyanic acid. A method still somewhat in vogue is the production of cold by the rapid evaporation of volatile substances, as ether or rhigolene. These means, however, have been practically superseded by the advent of cocaine. C0CAIN2E HYDROCHLORAS, U. S. (Cocaine Hydrochlorate; Cocaine). Cocaine is the hydrochlorate of an alkaloid obtained from Coca. Coca also contains a larger or smaller percentage of Tw/r/rme, an alkaloid having mydriatic powers. Action : Cocaine acts as an anaesthetic w/ien in contact with nerves of sensation or special sense. The skin forms a bar- rier against these effects, while no such barrier exists with mucous membranes. The tissues are at first constringed from vaso-motor stimulation, but a reactionary congestion soon follows. Slight paresis of motor nerves may also be produced (Wood). The skin barrier is overcome by hypo- dermic use: the cocaine solution (2 to 8%) should be injected just into the skin, and not deeply in the tissues : the hydro- chlorate is the salt used, and forms a watery solution. Greater efficiency is secured in the extremities by controlling the circulation with an elastic band (Corning's method). 4-M. M. 50 ANAESTHETICS. Otherwise it is partially carried away by the circulation. Laparotomy even may be performed under its use. Action on mucous membranes : The mucous membranes react very differently as to absorptive power: cocaine is absorbed quickly by the mucous membrane of the eye, the nose, the pharynx, and the rectum; it is absorbed very slowly by the vaginal and vesical mucous membranes, repeated applications being sometimes necessary. The safe maximum dose by mouth regulates the quantity which can be applied locally to mucous membrane, which is grain. It is best to use a 4% solution. A 10% solution is necessary to secure anaesthesia in operations about the vagina. Indications for local anaesthesia: In the minor surgical operations of ophthalmic, laryngological, gynecological, and general practice. Bony structures arc with difficulty ren- dered insensitive, and ether is more suitable. In pruritus ani and pruritus vulva, anal fissure, and other painful conditions its topical use affords great relief. In neuralgias by injection into the neighborhood of the affected nerve-trunk at any point proximal to the seat of pain. In hay asthma repeated applications contract the turgescent vessels, and most of the cases are alleviated. Gastralgia from gastritis or gastric ulcer, and persistent vomiting, may yield to its internal administration in doses of gr. of the hydrochlorate. The special disadvantage of local anaesthesia lies in the fact that muscular action is not controlled, and the rigidity is fre- quently so marked as to interfere with operative procedures. In operations on the eye the presence of consciousness is a decided advantage. Constitutional symptoms: In all instances in which co- caine is used for its local anaesthetic effect constitutional symptoms may arise. Death has occurred in a girl of eleven years of age, from grain ; convulsions and mania have resulted in the adult from the use of grain. The symptoms of poisoning from its local use are the same as those produced in other cases of cocaine-poisoning, viz.: hurried breathing, collapse, in many cases epileptiform convulsions and cyanosis. The treatment is symptomatic. E VC AINE H YDR 0 CI I L ORA TE- OPI UM. 51 EUCAINE HYDROCHLORATE. Eucaine hydrochlorate is a synthetic product similar in com- position to cocaine, and has been introduced as a substitute for the latter. It differs from cocaine in not producing a contraction of the bloodvessels when locally applied, and in yielding a permanent solution in water. It produces a dis- tinct smarting when a solution is dropped into the eye. Eucaine is a good local anaesthetic, but in over-doses pro- duces symptoms similar to those caused by cocaine, over which it does not seem to possess any decided advantage; it is rapidly declining in favor. Dose and uses are the same as those of cocaine. HYPNOTICS (SOMNIFACIENTS). This class of drugs, known also as narcotics, may be sub- divided into those which have a pain-allaying effect (anal- gesics), of which opium is a notable example, standing in many respects alone, and the pure hypnotics, or sleep-pro- ducing agents, the number of which has recently been much augmented. OPIUM, U. S. (Opium). Opium is the concrete, milky exudation obtained by incising the unripe capsules of Papaver somniferum (nat. ord. Papav- eracese), and yielding, in its normal, moist condition, not less than 9% of crystallized morphine when assayed. Properties : Good opium is of a fine chestnut color and dense consistency, and has a strong characteristic odor. It should break with a deeply notched fracture, and when drawn across white paper should leave an interrupted stain. It has a bitter, acrid taste, and imparts its activity to water, alcohol, and diluted acids. Preparations : Opii Pulvis should contain not less than 13% nor more than 15% of morphine; used in making most of the opium preparations; dose gr. ss-ij. Opium Deodoratum : this is powdered opium deprived by ether of its narcotine; contains 13-15% of morphine, and is thus of the same strength as the powder; dose gr. ss-ij. 52 HYPNOTICS. Pilules Opii: each contains gr. j; opium pills may be borne better by an irritable stomach. Extractum Opii : twice the strength of opium; dose accordingly. Emplastrum Opii; has very little utility. Trochisci Glycyrrhizee et Opii, each contains gr. of extract. Pulvis Ipecacuanhee et Opii (Dover's powder); the powder of ipecac and opium, of each gr. j to lactose gr. x ; dose gr. x. Tinctura Opii (laudanum); 10% of powder; dose Tlfx-xv (20 to 30 drops); a favorite for use in encmata. Tinctura Ipecacuanhas et Opii ; TT[x = opium gr. j. Tinctura Opii Camphorata (paregoric); contains opium gr. ij to f§j and a variety of other ingredients, including camphor in same amount; used for children ; dose fAj-f.sss for adults, proportionately smaller for children; forms 12% of mist, glycyrrhizee comp. Tinctura Opii Dcodorati; narcotine and odorous principles removed by ether; strength and dosage same as laudanum. Less apt to cause nausea. Acetum Opii (black drop); also 10% ; dose, see Lauda- num. Vinum Opii (Sydenham's laudanum); 10% of opium; dose ffixij or gtt. xxv. Mistura Magnesiae et Asafoetidae, not official; contains 1% of laudanum. The alkaloids and their salts are : Morphina, for pharmaceutical use principally. Morphinee Acctas, Morphines Sulphas, Morphines Hydrochloras, dose gr. | to Pulvis Morphines Compositus; contains of morph, sul- phate 1 part, with 20 parts each of camphor, licorice, and calcium carbonate; known as Tully's powder ; dose gr. x. Trochisci Morphines et Ipecacuanhas; morphine sulphate gr. and ipecac gr. in each. Codeina, U. S., gr. ss to ij ; about one-quarter as strong as morphine; a favorite in cough-medicines and diabetes. Important unofficial preparations : Liquor Magendie (" Ma- OPIUM. 53 gendie's solution ") has been used for hypodermic purposes ; contains gr. xvj of morph, sulph. to aq. f ; fsj=gr. ij, f3ss = gr. j; an ordinary dose for hypodermic use is Iffvj to x. Liquor Morphime Sulphatis (U. S. P., 1870); contains gr. j to fsj. Physiological action: The effects of opium vary decid- edly with the size of the dose. Small doses, in persons un- accustomed to the drug, produce at first a sense of well- being, stimulation of the mental faculties, especially the imaginative (probably due to lessened restraint by blunting of the highest mental endowments, as judgment, etc.), fol- lowed by a blissful dreamy state, merging more or less quickly into a sleep which may be disturbed or restful, and from which the patient awakes either refreshed or witli more or less headache, nausea, and depression. Larger Doses: When large medicinal doses have been administered the period of stimulation is shorter, the sleep more profound, the pupils arc somewhat contracted, sweating may ensue, and the symptoms of depression and gastric disturbance arc more marked. When very large doses have been taken the patient sinks almost at once into a profound sleep, with slow and noisy breathing, slow full pulse, and minutely contracted pupils, while the skin gets cool and becomes covered with clammy perspiration. After fatal doses stupor, coma, stertor, respiratory and circulatory depression occur, and finally death from paralysis of the respiratory centre. The effects seriatim, in different portions of the body and their explanations on physiological grounds as far as known, are as follows: Nervous system: A progressive paralysis, involving in succession the cerebral, sensory, and reflex functions, and finally the important centres in the medulla. Circulation: A. primary acceleration of pulse-rate, followed by a slow, full pulse and increased arterial pressure : these effects are due to stimulation of the pneumogastric and of the cardiac muscle. After toxic doses a rapid and feeble pulse from paralysis of the same. Respiration: Opium slows respiration by a centric effect; 54 HYPNOTICS. in poisoning the respirations may be as infrequent as one a minute, or even less. Pupils: Generally equally contracted, and after large doses very much so-a centric effect, as it does not occur when instilled into the eye. All secretions except perspiration are decreased; the urinary solids may be increased or de- creased, but the fluids are always diminished; retention of urine may occur. Digestion: Secretions and peristalsis diminished; as a direct consequence digestive impairment, with anorexia, nausea, and constipation, results. Secretions: Opium checks all secretions except that of the skin. Absorption and elimination: Opium is absorbed quickly and eliminated largely by the gastro-intestinal mucous mem- brane ; to a less extent by the kidneys. It is, therefore, of great importance to wash out the stomach repeatedly in case of poisoning. Morphine. This alkaloid, representing practically the medicinal and for the most part the physiological powers of opium, occurs in colorless crystals, odorless, but of very bitter taste. Owing to its insolubility, its salts, the sulphate, hydrochlorate, and acetate, are most frequently used. Morphine should average 14% in good opium (13 to 15%); hence gr. J- about equals gr. j of opium. Morphine differs from opium in being less apt to derange digestion, less constipating, less diaphoretic, and less tetanizing, while it is more apt to cause pruritus, is more hypnotic and analgesic, and probably more of a cardiac stimulant; reten- tion of urine is less apt to occur under its use. Codeina, IT. S. (Codeine). Codeine is present in small amount (0.03%). The physio- logical powers of this alkaloid are not clearly understood; it probably, as used, has varied in composition, which alone would explain the conflicting reports upon its effects. OPIUM. 55 Other Alkaloids. Besides morphine and codeine, opium contains a number of other alkaloids, the most important of which are- Thebaine or paramorphine, Laudanine, Porphyroxine, tetanizing agents. Narcotine, to which some attribute the unpleasant gastric effects. Narceine, papaverine, meconine, cryptopine, and hydro- cotanine, have been somewhat investigated. Opium also contains various acids (meconic, theobolactic, and sulphuric), gum, extractive, and a volatile odorous prin- ciple, the last of which shares with narcotine the reputation of being the nauseant principle. Acute opium-poisoning-treatment: Very small doses have proved fatal in children, and gr. Jf of morphine is said to have caused death in a feeble adult. When toxic symptoms develop after a moderate dose, or when a presumably toxic dose has been taken- Empty the stomach at once, preferably with the stomach- pump or gastric siphon-the latter may be improvised from a rubber tube and funnel-or emetics may be given : mustard, being generally available, may be given in §ss dose and repeated in ten or fifteen minutes, or the sulphate of copper or zinc may be administered in proper doses. Next give chemical and physiological antidotes to neutral- ize the remainder-potassium permanganate, tannic acid, strychnine, or atropine; the last should be administered tentatively in small doses, guided by its physiological effects, especially on respiration. The remainder of the treatment consists in various meas- ures to maintain respiration, such as walking patient about, flagellation, hot and cold affusions, faradism, and, if neces- sary, artificial or forced respiration and oxygen inhalation ; strong coffee is valuable, given by mouth or rectum. The electric brush is perhaps the most effective and least exhausting measure to keep the patient awake; there is considerable 56 HYPNOTICS. danger from death through exhaustion late in the poisoning. Potassium permanganate is the most efficient chemical anti- dote. The lavage of the stomach should be continued at intervals, as morphine is eliminated by the mucous mem- brane of the gastro-intestinal tract. Chronic opium-poisoning or habit: Toleration of the drug may be greatly increased and large amounts consumed. The digestive and nervous systems are most affected ; the subject loses mental and moral tone ; if rapidly increasing amounts be taken, great deterioration of the general health may ensue. Treatment of the habit is very often only temporarily effectual; the drug may be withdrawn immediately or more slowly. The danger of sudden withdrawal is from collapse, and as this method offers no advantages it is considered best to withdraw more slowly, say in the course of a week or two. Much depends on careful attention, nursing, feeding, and moral support. The simple hypnotics may be given with stimulating nutritious food. On withdrawing the drug a diarrhoea may be set up and require very careful treatment. Prophylaxis is all-important. Opium-therapeutics: This drug is indicated and is a most valuable remedy in pain of true organic origin. It is a potent analgesic; as an antispasmodic in certain conditions, notably spasmodic asthma, which may frequently be aborted by its hypodermic use; also in spasm of glottis and lead colic; in diarrhoea and dysentery opium combined with astringents is the most available treatment. In peritonitis comparatively large doses are given, acting by allaying pain, decreasing peristalsis, and, in early sthenic stages, by some direct antagonism to the inflammatory process itself (antiphlogistic). In cholera morbus, invaluable hypodermically. In beginning inflammation of pleura and lungs and in acute coryza it seems to lessen activity of process. In h emorrhages and in the distressing paroxysms of val- vular disease, morphine subcutaneously. In b'ue diabetes, codeine preferably; also in diabetes insipi- dus ; in urcemia, hypodermically and with care; in acute dis- eases, as the exanthemata; in distressing cough. CANNABIS INDICA. 57 Its use is warranted in the last stages of chronic disease and in small amounts in old age; as hypnotic only in very rare cases. Administration: Opium may be administered by mouth, by rectum, or subcutaneously as the conditions demand. It should never be given as a hypnotic when simpler measures are adequate, is contraindicated in coma of any kind, and caution should be exercised in using it in cerebral conditions, chronic kidney disease, uraemia, respiratory embarrassment, delirium tremens, or when possibility of hernial strangulation exists. Never follow a dose of opium or its synergists by another dose subcutaneously, for the two may take effect at the same time. Remember that children bear opium badly, and that certain adults have an idiosyncrasy. CANNABIS INDICA, LT. S. (Indian Cannabis; Indian Hemp). Cannabis Indica is the flowering tops of the female plant of Cannabis sativa (nat. ord. Urticaceae), grown in the East Indies. The same plant, grown in America, yields a drug (Cannabis Americana) devoid of activity. It is used in India as a narcotic stimulant under the various names of hashisch, bhang, churrus, and gunjah. Two alkaloids have been found: cannabinine and tetanocannabinine. Preparations: Extractum Cannabis Indicae; most used; dose gr. 1-j. Extractum Cannabis Indicae Fluidum, dose ffij-x-r. Tinctura Cannabis Indicae (20%), dose f.oss. Physiological action: There are two stages: ized by mental exhilaration, followed by (2) drowsiness and sleep. After a dose varying with efficiency of drug and the temperament and surroundings of the patient a condition of peculiar agreeable mental exhilaration is felt; the ideas flow quickly, and the sense of duration of time and extent of space is lost. Sometimes a condition of double consciousness exists. There is more or less cutaneous anaesthesia, a sensation of weight in limbs, and some muscular incoordination from loss of muscular sense. Hallucinations and mild delirium may occur. Then succeed drowsiness and sleep, from which the 58 HYPNOTICS. patient awakens with some depression. Cannabis differs from opium in not affecting respiration, in that it dilates the pupils, and in not lessening the secretions. The circulation is not affected. No fatal cases are recorded. In Hindoos it not infrequently produces catalepsy. Cannabis indica contains a volatile oil and a resin, canna- bin, probably also several alkaloids, one of which has received the name cannabinine. The extract is most commonly used, but is of very uncertain strength ; it is soluble in alcohol and ether, but not in water. All the preparations of canna- bis indica arc notably unreliable; the extract is regarded usually as the best, but it is advisable to determine the value of each specimen by actual therapeutic test. Therapeutics: Its uses are fewer than formerly. It has been used in tetanus, chorea, and hysteria as an antispasmodic ; in neuralgias, muscular rheumatism, and migraine as an anal- gesic ; as an addition to cough-mixtures and in phthisis to produce comfort. It is said to be a feeble sexual stimu- lant. As a hypnotic it has been used, but is of uncertain strength and not now in favor, while as an anaesthetic it is useless. Tannate of cannabine is also an uncertain hypnotic. CHLORAL, U. S. (Chloral; Chloral Hydrate). Chloral hydrate is a crystalline solid, composed of tri- chloraldehyde or chloral with one molecule of water (C2HC13O,H2O = 164.97). Chloral is a thin, oily, colorless liquid, prepared by passing chlorine gas through anhydrous alcohol, the results being chloral and hydrochloric acid, which separate in layers, the lowermost of which is chloral. It is purified by distillation with sulphuric acid and quicklime. Chloral is not itself used in medicine. Chloral hydrate is not a true hydrate, but a combination of a chloral element with an entire molecule of water. It is a colorless, crystalline, deliquescent salt of disagreeable taste, more stable than chloral, and freely soluble in water, alcohol, and ether. CHLORAL. 59 Physiological action: Locally, chloral is an irritant, and occasionally causes gastro-intestinal irritation. In medicinal doses of gr. xv-xx the principal effect of chloral hydrate is a quiet, natural, and refreshing sleep. Larger doses cause pro- found sleep, diminution of reflexes, depression of respiration, depression of cardiac force and capillary dilatation, slightly contracted pupil, muscular weakness, and perhaps a cer- tain degree of anaesthesia. Toxic doses are followed by coma, and cause death by cessation of respiration, of circula- tion (more rarely), or of both simultaneously. The depres- sion of respiration is caused by a direct action on the centre; the heart is depressed directly and stops in diastole ; the loss of reflexes and motion is due to depression of the motor cord and the anaesthesia to a late depression of the sensory cord. The nerves arc unaffected, but the vaso-motors are paralyzed with the heart. The supposed transformation into chloroform by the alkaline blood does not occur, the drug acting as chloral. In large doses it lowers the bodily temperature decidedly. Chloral is eliminated by the kidneys as uro- chlor alic acid. Therapeutics: The chief uses of chloral hydrate, medici- nally, arc hypnotic and anticonvulsant. It is used as a hypnotic in sleeplessness not dependent on pain, as in insom- nia from overwork or hysteria, acute mania or delirium tremens, succeeding the better the more purely nervous the cause. It is used as an anticonvulsant in puerperal, uraemic, infantile, or strychnine convulsions, in all of which, adminis- tered by rectum or mouth, it is very efficient in palliating until other curative measures can be tried; in tetanus a large percentage of cures is reported by some, while with others it has failed; in trismus neonatorum; whooping-cough and choreic spasm are alleviated; sea-sickness and the vomiting of pregnancy and other neurotic vomiting may be checked by chloral combined with recumbent position and proper diet; in conditions of high arterial tension it affords relief. The crossed action of chloral and morphine may be obtained in the following combination : 60 HYPNOTICS. R Chloralis, 3v. Morphinae sulphatis, gr. iv. Syrupi, f'3ij. Aquae aurantii florum, q. s. ad f§iv. M. Sig.-A teaspoonful at bedtime, if necessary. Chloral hydrate is used by some obstetricians to relax a rigid cervix uteri and to relieve the pains of labor. This is the only condition in which it is analgesic in safe doses. It is a good antifermentative, and as such it is used to prevent decomposition of urine; added to liq. Magend. in small per- centage it renders it more stable. Toxicology : Acute and chronic poisoning. Acute poisoning: The principal symptoms are profound depression of respiration and circulation, stupor and coma, suffusion of conjunctivae, and muscular weakness, as shown by dropping of the lower jaw, with a pronounced fall of the bodily temperature. Treat as for opium-poisoning, avoiding, however, anything (as forced exercise) which causes muscular exertion on the patient's part, and watch the heart's action closely. Dry heat is a valuable measure. Chronic poisoning: The continued abuse of chloral hydrate may cause mental weakness, dementia, and in some cases paralysis or paresis; respiratory disturbance, as pronounced dyspnoea; cutaneous eruptions, probably from continued dila- tation of the superficial capillaries, taking the form of erythema or urticaria (especially after chloral and alcohol), catarrhal pharyngitis, and many other rarer effects. Administration : Dose gr. v-xx (the latter the maximum dose ordinarily), to be given in some agreeable syrup. Chloral has caused death suddenly, like chloroform, a fact always to be remembered. Rectal administration may prove convenient or necessary ; the drug is readily absorbed and the dose is the same as by mouth. Alkalies are incompatible, forming chloroform and formic acid. Caution is necessary when any cardiac lesion is present. Croton chloral: This is a crystalline substance, freely soluble CHLORALAMID. 61 in water and possessing effects similar to, but weaker than, chloral hydrate, with the added power of causing, it is said, anaesthesia of the head and face. It is very little used, except in trifacial neuralgia. Chloralamid is a product of chloral hydrate and formamid, occurring in colorless crystals of somewhat bitter taste; slowly soluble in 19 parts of water, and easily so in alco- hol, from which solution it is not precipitated by water. It is decomposed by alkalies and by a temperature of 140° F.: hence it should never be prescribed in warm solutions. Physiological action and therapeutics: Containing, as it does, about two-thirds by weight of chloral hydrate, we should expect to find it acting similarly; but this is not true throughout the entire range of its action. Upon the respira- tion and circulation in proportionate dosage its effects are almost nil, although slight decline in blood-pressure may follow large doses. It is entirely non-irritating even in strong solutions, and gives rise to no digestive disturbances. It acts feebly upon the spinal cord, but upon the cerebrum its effects are pronounced (Wood). In medicinal doses (gr. x-xxx) it induces a natural and refreshing sleep, lasting from six to nine hours, and is in most cases entirely free from any unpleasant accompanying or after-effects, though it is slower and more uncertain than chloral. Large doses (gr. xlv-3j) occasionally cause headache, dizziness, nausea, and slight intoxication. It seems to a slight degree analgesic, but its principal use will be as a pure hypnotic. One theory of its action is that a slow conversion takes place into chloral hydrate in the alkaline blood, the absence of depression being ascribed to the slowness with which this takes place, and also to a possible stimulant effect by the formamid ele- ment. It is cheaper than sulphonal, acts more quickly, and is apparently as free from depressing effects. It may be given in one dose of gr. xxx (or gr. xv repeated) and in alcoholic solution. CHLORALAMID. 62 HYPNOTICS. Chloralose (C8H1IC13OG): This compound is formed together with parachloralose when anhydrous chloral and glucose are heated together. Chloralose produces profound sleep with- out unpleasant after-effects. It is a stimulant to the motor side of the cord and has little influence on the circulation. Dose 5 to 10 grains, administered in the form of capsules. Chloralose is readily soluble in hot water. Chloral camphor is a liquid formed when equal parts of chloral and camphor are rubbed together. Its action is counter-irritant and anaesthetic when applied locally in neu- ralgia. Butyl-chloral hydrate: This is also called croton-chloral hydrate, and is formed by the action of chlorine gas on aldehyde. In medicinal doses, 5 to 15 grains, it produces deep sleep with anaesthesia of the head. In large dose it causes death by respiratory arrest; the circulation is unaf- fected except by enormous doses. This drug has been highly recommended in tic-douloureux and may be given in 5-grain doses every half hour until 30 grains have been taken (Wood). It is slowly soluble in water, and only to a limited extent. SULPHONAL, or SULFONAL, (CH3')2CfSO2C2H5)2. Sulphonal, chemically diethyl-sulfon-dimethyl-methane, was first brought to professional notice in 1888. It occurs in very stable crystals, soluble in 20 parts of hot and 100 parts of cold water, and is tasteless and odorless. Physiological action: In medicinal doses, gr. v to xxx in man, it produces quiet sleep by direct action on the cerebral cortex. Owing to its insolubility and consequent slow ab- sorption, its hypnotic effects are not produced until one-half to two hours have elapsed, and they are apt to be protracted, causing lassitude and mental confusion during the succeeding day. There seems to be no cardiac or respiratory depression, and the motor and sensory nerves are unaffected ; hence it is not analgesic. Convulsions may occur in animals, but have TRIONAL-TETR ONA L. 63 not been noticed in man. It is eliminated as ethyl-sulphonic acid. Sulphonal lessens reflex action in man and the animals probably by a stimulation of the inhibitory (Setschenow's) centre. Large amounts have been taken in single dose with- out fatal effect, but a number of fatal cases of poisoning are on record following the protracted use of medicinal doses. This chronic form of poisoning is exceedingly dangerous, as most of the cases go on to a fatal issue. The first symptom is a red color of the urine, due to the presence of hematopor- phyrin,a decomposition-product of the luematin of the blood. Albumin and blood usually appear later on, and the kidneys show decided evidences of nephritis after death. These renal symptoms are often accompanied by gastro-intestinal and nervous disturbance, such as colic, obstinate constipation, anorexia, local palsies and anaesthesias, mental depression, general ascending paresis, and failure of memory, often fol- lowed rapidly by death. The treatment consists in the im- mediate withdrawal of the drug and the ingestion of large amounts of hot water. Therapeutics and administration: As a pure hypnotic it is very valuable, being safer than, but not so certain as chloral; it is useless when pain exists. Sulphonal is used in the insom- nia of mental over-exertion or nervous excitement, of hysteria, and of insanity. Small doses, gr. iij to vj, often prove anti- emetic. It should be administered in powder-form, mixed with warm milk, broths, etc., about one and a half hours before sleep is desired. Tablets and pills may escape ab- sorption. Sulphonal has also been used as an antispasmodic in hiccough, chorea, and epilepsy ; as a sexual sedative in sperm- atorrhoea and chordee ; as an intestinal antiseptic, given one hour after meals. Trional {cliethyl-sulfon-methyl-ethyl-methane) and Tetronal {diethyl-sulfon-diethyl-methane) are two compounds closely re- sembling sulphonal. They are more prompt in their action, and until recently were considered safe. Several cases of poisoning have been reported from the continued use of these drugs, and it is probable that they are poisonous in much the same manner that sulfonal is, The dose is from 5 to 20 grains, 64 HYPNOTICS. given in milk, on retiring. Both drugs are especially valu- able in the insomnia due to mental excitement. AMYLENE HYDRATE. Amylene hydrate is a colorless liquid of penetrating odor and somewhat pungent taste, readily miscible with alcohol in all proportions, and soluble in 8 parts of water; intro- duced in 1885. Moderate doses induce sleep without de- pression of organic functions : large doses may cause narcotic symptoms, with paralysis of centres in medulla. In medic- inal doses, 1T| xx to xl, it is a safe and moderately reliable hypnotic, but is inferior to chloral and sulphonal in activity. PARALDEHYDUM, U. S. (Paraldehyde), CGH,A = 131.7. Paraldehyde is a colorless fluid at ordinary temperatures, of very penetrating odor and peculiarly disagreeable taste. Ordinary doses act as a pure hypnotic of rather uncertain power, requiring two or three times the amount that chloral does. No unpleasant effects follow, except that the breath becomes offensive. Very large amounts may paralyze respi- ration and circulation. An erythematous eruption may follow a single dose, while its continued use may cause malnutri- tion. Paraldehyde has never been used to any extent, be- cause of its horribly nauseating taste, because of the odor imparted to the breath, and because of its uncertain effect. In doses of or more it is a pure hypnotic; it should be well diluted. URETHAN. Urethan, which is chemically carbamide of ethyl, occurs in crystals easily soluble in water and not unpleasant to the taste. Its administration is followed in from one-quarter to three-quarters of an hour by natural sleep, without unpleasant after-effects, with no depression of circulation, and possibly slight depression of respiration. It is not so certain in its action as chloral and sulphonal. Large amounts produce paralysis of respiration in animals. It does not affect the sensory nerves. Dose gr. xv to 3j by mouth or rectum. HYPNONE-BELLADONNA GROUP. 65 It is used as a hypnotic; as an antispasmodic in uraemic or puerperal convulsions. HYPNONE. Hypnone, or aceto-phenone, is an uncertain hypnotic, caus- ing death by asphyxia when given in over-dose to the lower animals. Most clinicians report unfavorably upon it. It is a colorless, volatile liquid, of characteristic odor, and is easily soluble in alcohol. Dose to METHYLAL. Methylal, like hypnone, is a very volatile liquid, but has a greater solubility, being dissolved by water, alcohol, and oils. It is claimed by its advocates to produce lowered excitability of the cerebral cortex, with decrease of reHex activity and a varying degree of anaesthesia, and by mouth or inhalation to produce sleep without either depression of circulation or respiration ; others, however, have found it depressing to these functions. It is quickly absorbed and eliminated, and its hypnotic effect is of brief duration. Patients quickly lose susceptibility to the drug, and its value is still in doubt. Dose fsj. The di 'ugs of this group present a marked similarity of action and uses. They cause marked mydriasis (dilatation of pupil) and a peculiar delirium ; they are antispasmodic. BELLADONNA GROUP. Belladonnse Folia, U. S. (Belladonna Leaves). The leaves of Atropa belladonna (nat. ord. Solanaceae). Belladonnse Radix, U. S. (Belladonna Root). The root of Atropa belladonna (nat. ord. Solanaceaf). Belladonna is the deadly nightshade, a plant indigenous in Europe, the whole of which contains the narcotic principle; 5-M. M. 66 DELIRIFA CIENTS. but the leaves and root only are official. Its sole active con- stituent is atropina (atropine); this occurs in crystals of a bitter, burning taste, odorless, quite soluble in alcohol and ether and in about 300 parts of cold water. The official sulphate is easily soluble in water. Preparations : Of the leaves: Tinctura Belladonme Foliorum (15%), dose 1T[x-fnss. Extractum Belladonme Foliorum Alcoholicuni, dose gr. i_l 8 2* Unguentum Belladonna? (10% of above). Emplastrum Belladonnse. Of the root: Extractum Belladonme Fluidum, dose TT|j-ij-iv. Linimentum Belladonnas (5% camphor in fluid extract of belladonna root). Atropina, U. 8., Atropinse Sulphas, U. 8., Physiological action. Nervous system: In general, atropine may be considered to stimulate the sympathetic system, and to depress the motor, and to a less degree the sensory, nerves, thus diminishing the reflexes. But in therapeutic doses these effects on the motor and sensory nervous organs are probably slight. Sufficient doses excite the cerebrum, taking the form of an active, busy delirium, followed, if dose be toxic, by stupor, deepening into coma. (It is not a true hypnotic.) Convulsions are present or absent according as the cerebral excitement or the peripheral paralysis predominates. The delirium is produced by direct action on the cerebral cortex. Heart: After a primary slowing (?) its action is increased in rapidity from (a) paralysis of the inhibitory fibres of the pncumogastric, and (6) stimulation of the cardiac sympathetic ganglia. Large doses may prove cardiac paralyzers. Vaso-motor apparatus: The sympathetic vaso-constrictors arc stimulated by therapeutic doses, with a resulting increase of arterial pressure; large doses paralyze and the blood- pressure falls. Respiration: Belladonna is one of our most potent meas- ures for stimulation of the respiratory function, acting when vagi arc cut-viz., by direct stimulation of the respiratory dose gr. to GROUP. 67 centre. Very large toxic doses cause paralysis in the same manner. The temperature also is increased by medicinal and lowered by very large doses, probably by an action on the heat-centre. Intestinal canal: Peristaltic movement is said to be stim- ulated at first from peripheral depression of the splanchnic (inhibitory) nerves; later it is doubtless lessened by depres- sion of the smooth muscular fibres. Secretions: Secretion of salivary and muciparous glands is diminished, causing as one of the earliest symptoms a dry- ness of the mouth. This is due to depression of the terminal filaments (e.g., in the case of the submaxillary gland de- pression of the terminal filaments of the chorda tympani), with probably a stimulation of the sympathetic. Belladonna lessens all the secretions except those of the bowels and kidneys. Perspiration is decreased through action on the nervous system ; at the same time a bright, so-called scarlatiniform eruption may develop, followed in some cases by desquama- tion. The effects on urinary and intestinal secretion are in doubt, though the urine is probably increased from diminution of perspiration, and its solids are said to be augmented. The drug is largely eliminated unchanged by the urine. Muscles: Non-striated muscle is depressed, while volun- tary muscle is probably not affected ; though the drug may check spasm in the latter by direct action on the peripheral motor nerve terminals (thrown into muscle directly by hypo- dermic syringe). Eye: The pupils are dilated, however the drug be exhib- ited, this mydriasis being due to paralysis of the oculo- motor nerve and stimulation of the cervical sympathetic. It is accompanied by loss of power of accommodation and in- creased intraocular tension, and lasts from five to twelve days. As intraocular tension is increased by atropine, the latter is contraindicated in glaucoma. The mode of action is probably the same whether topically applied or administered internally. Local effects : It acts as a paralyzant of motor and sensory 68 DELIRIFA CIENTS. nerves, although probably not enough is absorbed through the epidermis to cause analgesia. Therapeutics: Belladonna, or its equivalent atropine, is used to fulfil the following indications: (1) To relieve spasm in whooping-cough, nervous cough, spasmodic asthma, and hiccough. It may palliate and is often used in spasm of the sphincter ani from fissure or other painful rectal or anal condition, and in urethral spasm it may be advantageously given as a suppository. It has been used hypodermically in torticollis. In simple spasmodic colic, spasmodic dysmenorrhoea, and peristaltic spasm (as in lead-colic) it is valuable. In the last- named condition, where the pain and constipation are due to a tetanic condition of the muscles of the intestinal wall, the rationale of its use is not apparent unless we consider the splanchnics largely cerebro-spinal nerves, which are accord- ingly depressed. In nocturnal incontinence of urine in children, when due to relaxation of the sphincter vesicse or to a morbid irritability of the bladder mucous membrane, it is often of great value, but must be pushed almost to the physiological limit; also in nocturnal emissions1 and as an adjunct to cathartics to prevent griping. (2) To diminish secretions in ptyalism, either mercurial or that of pregnancy ; chronic gastritis with excessive secretion ; acute coryza-simply palliative; colliquative diarrhoea and night-sweats-very effectual; to diminish lacteal secretion- either locally as an ointment or internally. (3) As a stimulant in shock, where the loss of temperature is due to vaso-motor paralysis, it is invaluable. It is also employed, but with less success, in adynamic fevers : it is valuable in collapse occurring suddenly in the course of any acute disease, and as a respiratory stimulant in ether- narcosis. (4) To relieve pain in neuralgia, especially facial, sciatic, 1 In this condition the patient should be directed to empty his bladder and rectum thoroughly before retiring to relieve all prostatic pressure, to abstain from fluid during evening, to lie upon the side, and should be encouraged for moral effect. BELLADONNA GROUP. 69 and ovarian, it may prove satisfactory; but has its superiors. It should be injected into the region of the affected nerve. Locally its effects must be slight, but it has found employ- ment in pruritus vulvce, vaginismus, etc. (5) As an antidote to opium-poisoning it should be cau- tiously employed (see Opium). (6) In ophthalmology atropine is much used in gr. iv to f.?j solutions for the following purposes : to dilate the pupil and paralyze accommodation ; for thorough examination in cases of astigmatism or cataract, and for thorough examination of the fundus in general; as a remedy in preventing adhesions of iris in iritis, and to break them up when formed ; in inflam- matory conditions of the cornea, etc. Toxicology : Toxic doses of belladonna or atropine produce a dilated pupil; a dry mouth, throat, and skin; a peculiar, wakeful delirium ; a scarlet rash, resembling that of scarlet fever, but not punctate; lessened reflexes; a rapid, corded pulse; deep and quickened respirations, with an elevation of the bodily temperature. The later symptoms are: fall of temperature, pupils dilated absolutely, stupor and coma, respirations quick and shallow, heart rapid and feeble, skin cold and clammy, muscles relaxed; finally death by asphyxia. There are no characteristic post-mortem lesions. The characteristic symptoms are dryness of throat, rapid breathing and pulse, muscular relaxation, pupils dilated- often enormously so-skin eruption, active delirium with or without convulsions, passing into stupor or coma, and com- plete collapse. Belladonna-poisoning can often be recognized by dropping the patient's urine into the eye of a cat or rabbit, causing dilatation of the pupil. Treat by evacuation of stomach by pump, syphon, or emetic ; by chemical antidotes- tannic acid and solutions of the caustic alkalies; then admin- ister remedies to prevent circulatory and respiratory failure (see Opium). The physiological antidotes are morphine, pilocarpine, and physostigmine; but their use should be guided by the symptoms presented. Systemic effects, such as delirium, retention of urine, etc., often follow the pro- longed use of the drug in the eye and occasionally result from a single instillation. 70 DELIRIFA CIENTS. Homatropine Hydrobromate: Atropine is resolvable into tropine and tropic acid. Tropine salts with hydrochloric acid form tropeins. Homatropine is a tropein derived in this manner from tropine amygdalate. It is chiefly employed as a mydriatic. Its effects are similar to those of atropine, but are more quickly developed and pass off much more rapidly. Hie mydriasis produced by homatropine usually disappears in less than forty-eight hours, but the paralysis of accommodation is not so complete. It does not cause systemic disturbance so readily as atropine. STRAMONIUM. Stramonii Folia, U. S. (Stramonium Leaves). The leaves of Datura Stramonium (nat. ord. Solanaceae). Stramonii Semen, IT. S. (Stramonium Seed). The seed of Datura Stramonium (nat. ord. Solanaceae). Habitat: Asia; naturalized in most countries. The active principle is daturine, probably a mixture of atropine and hyoscyamine. Preparations: There are no official preparations of the leaves, but they are dried and used for smoking. Of the seed we have- Extractum Stramonii Seminis, dose gr. Extractum Stramonii Seminis Fluidum, dose ffij-iij. Tinctnra Stramonii Seminis, dose Unguentum Stramonii (10% of extract). The physiological and toxic effects of stramonium corre- spond so closely to those of belladonna that no separate con- sideration is needed. Owing to the common occurrence of the weed, poisoning is rather more frequent. Treat as for bell ad onna-p oisoning. Judging from its physiological effects the uses corre- spond closely to those of belladonna, but it is not com- monly employed. Often used in the form of cigarette in asthma. HYOSCYAMUS. 71 HYOSCYAMUS, U. S. (Hyoscyamus; Henbane). Hyoscyamus is the leaves and flowering tops of Hyoscyamus niger (nat. ord. Solanacese), collected from plants of the second year's growth. Habitat: Europe. It contains two alkaloids -the one, hyoscyamine, crystalline, isomeric with atropine, and having an official sulphate; the other, hyoscine, amor- phous, isomeric with atropine and hyoscyamine, but differing from them in physiological effects. The latter forms crystal- lizable salts, and is most used as the hydrobromate. Preparations: Hyoscyami Pulvis, dose gr. v-x. Extractura Hyoscyami Alcoholicuni, much used, dose gr. H.b . , Extractum Hyoscyami Fluidum, dose Tffv-x. Tinctura Hyoscyami (15%), most used, dose Hyoscyamime Sulphas, dose gr. Tthr* Hyoscime Hydrobromas, dose gr. 2io~rbi' Physiological action : The physiological effects of hyoscya- mus are very analogous to those of belladonna, hyoscyamine being nearly identical with atropine. Hyoscyamus differs in being less energetic, less persistent in its action, and more hypnotic. Toxicology: The same as of Belladonna, which see. Therapeutics: The preparations of hyoscyamus may be employed to fulfil the same indications as belladonna-viz., antispasmodic, slightly analgesic, to diminish secretions, etc. As a respiratory stimulant it is inferior to its companion drug. Hyoscine: This alkaloid has recently been studied, and seems to be the hypnotic principle of hyoscyamus. In addi- tion to the ordinary symptoms produced by drugs of this group, it has a marked depressing effect on the cerebral cortex and the motor tract of the spinal cord, and, unlike them, it is a respiratory depressant (Wood). In large doses hyoscine produces a peculiar, muttering delirium, dryness of the throat, dilated pupils, slow respirations which become weak, lessened reflexes, a slow, weak pulse; the voice be- comes husky, at times there is aphonia; the sexual centres are depressed. The dominant symptom of an ordinary dose 72 DEI ARIF A CIENTS. is deep sleep. Hyoscinc is a centric respiratory depressant; the heart is also directly depressed, while the lessened reflexes are caused by motor cord depression. Hyoscinc hydrobromate is employed as a hypnotic in sleeplessness with great mental excitement, as in mania, insanity, and delirium tremens. It is said to be safe in ad- vanced kidney disease when morphine is inadmissible; also valuable in nymphomania, spermatorrhoea, and sexual excite- ment generally (Wood). It is devoid of the unpleasant after-effects of opium, and may be given in doses of gr. to T'H) by mouth or hypodermically. Some persons show a de- cided susceptibility to this alkaloid, and doses within these limits have caused alarming symptoms ; but no fatal cases are reported. The drug is contraindicated in inflammatory sore throat. Duboisia, which is unofficial, contains dufoisMW, probably identical with hyoscyamine, and its effects and uses arc those of other members of this group. It is derived from Duboisia myoporoid.es (nat. ord. SolanaceeD), and is a native of Aus- tralia. Dose gr. y1K. It has been used as a hypnotic in insanity, and as an antispasmodic in paralysis agitans and in epilepsy. DUBOISIA. Agaricin is a preparation of agaricus or larch fungus (genus Boletus). Its mode of action is unknown. It is suc- cessful in colliquative sweating and excessive bronchial secretion, and may therefore be considered in this connec- tion. The dose of agaricin (the active principle) is from 1 to 2 grains, that of agaric 5 grains. AGARICIN. Coca is the leaves of Erythroxylon coca (nat. ord. Linese). Habitat: Peru and Bolivia; cultivated in South America. It contains cocaine, the local anaesthetic effects of which have already been considered, and hygrine, a mydriatic principle. Extractum Erythroxyli Fluidum is official, dose ffixx-fgj. COCA, U. S. (Coca). COCA. 73 Physiological action: Coca leaves have long enjoyed a reputation among the natives of Western South America for allaying hunger while under great bodily strain. It is highly probable that this effect is caused by the local anaesthetic effect of the drug on the stomach, and that the individual takes in sufficient food at the end of the journey to make up for any deficient amount while actively exercising. Experi- ments as to the action of cocaine on tissue-waste are contradic- tory, though it is asserted that the fresh South American leaf when chewed produces an effect entirely different from that of the dried drug or its active principle, cocaine. It is also certain that the peculiar sensation of mental exaltation claimed for the drug does not appear in the European, though it may be produced in the Indians of South America, whose nervous systems are not so highly developed. Nervous system: A sense of exhilaration and stimulation of the mental faculties, followed by restlessness or " nervous- ness," is produced ; loss of desire for sleep and lessened sense of fatigue; reflexes are at first increased, but later diminish, probably from paralysis of afferent and efferent nerve-fibres both peripherally and in the cord. Later, after large doses, delirium, inco-ordination of movement, epileptiform convul- sions, paralysis, and anaesthesia may ensue. Circulation: The heart's action is rendered more rapid by depression of the cardio-inhibitory fibres of the vagus, and a consequent increase of blood-pressure follows. Large doses depress the circulation. Respiration is at first powerfully stimulated; but later, after large doses, is depressed, and toxic doses destroy life by paralysis of this function: these effects are centric, occurring when vagi have been divided. Cocaine increases heat-pro- duction and the body-temperature is raised. Secretions: Cocaine is eliminated in the urine, which may be increased ; the skin may be moist: neither effect is constant. Eye: Pupil primarily slightly contracted, later widely dilated, from its local application ; the intraocular tension is lowered and accommodation paralyzed, but to a less extent than by atropine. It causes desquamation of the corneal epithelium if its use is persisted in. 74 DELIRIFA CIENTS. Local action : Cocaine, locally applied, causes anaesthesia in a part covered by mucous membrane and also a primary blanching, due to vaso-motor constriction. This is followed by dilatation of the smaller arteries. Injected under the skin in aqueous solutions it produces anaesthesia by a direct action on the terminal filaments of the sensory nerves. It does not penetrate the unbroken skin (see also page 49). Cocaine-habit: The symptoms are digestive disturbances, insomnia, emaciation, general enfeeblement of body and intel- lect, with tremors and loss of co-ordinate movement. With- draw the drug. This can usually be done at once. Acute poisoning may occur: the symptoms are restlessness and excitement, rapid breathing, and muscular twitchings; later, collapse, slow and labored respiration, largely dilated pupils, epileptiform convulsions, loss of consciousness, delusions, mania, etc. The smallest fatal dose is not certain. Respi- ratory stimulants are indicated. Therapeutics: Cocaine is used as a respiratory and vaso- motor stimulant, as a local anaesthetic, and may be used as a mydriatic and vaso-constrictor. As a respiratory stimulant it ranks between strychnine and atropine; as a vaso-motor stimulant it is useful in shock and collapse. As a local anaesthetic it finds its widest range of usefulness, acting on all mucous membranes, but is very apt to cause constitutional symptoms (see Local Anaesthetics). It acts more quickly, less permanently, and is not so powerfid as atropine as a mydriatic; unlike atropine, it causes shedding of the corneal epithelium and does not completely paralyze accom- modation. As a local astringent it is very useful (in 4% aqueous solution) to reduce an engorged mucous mem- brane ; the astringent effect may be made more permanent by following its use with a 20 grain to the f.sj antipyrin solution. Coca is a nervous tonic, and may do good in melancholia, neurasthenia, etc. It will often relieve gastralgia and the pain of gastric ulcer, and check vomiting. Tropacocaine, or benzoyl tropein, is a tropeine prepared from the narrow-leaved, coca-plant of Java. It resembles NUX VOMICA. 75 cocaine in its general action, but is said to be far less toxic. Death from centric asphyxia has been produced in animals by large doses. The method of administration for local anaesthesia is the same as that for cocaine. It does not produce the local astringent effect of cocaine. Schleich's solution contains a small percentage of morphine and cocaine, together with a small amount of common salt. Used hypodermically, it exerts a local anaesthetic effect, probably merely through distention of the tissues, as the quantity of cocaine and morphine employed is too small to exert any marked effect. Bucaine (see page 51). SPINANTS. Spinants are drugs tending to excite muscular contraction or motor paralysis, and may be divided into excito-motors and depresso-motors. As far as striped muscle is concerned, the drugs so consid- ered are those containing strychnine and brucine. Ergot and digitalis act similarly on particular organs, the uterus and heart. EXCITO-MOTORS. NUX VOMICA, U. S. (Nux Vomica). Nux vomica is the seed of Strychnos Nux vomica (nat. ord. Loganiaceae). Habitat : India and East India Islands. It contains two alkaloids-strychnine and brucine-in combina- tion with igasuric acid. Strychnine represents fully the activity of its parent drug ; brucine being similar, but weaker, in its action. Preparations: Extractum Nucis Vomicae, dose gr. -]-j. Extractum Nucis Vomicae Fluidum, dose lifij-v. Tinctura Nucis Vomicae (20%), dose Hfv-xv. Strychnina, IT. S., Strychninae Sulphas, IT. S., dose gr. gL-V- Strychnine is a white powder, crystallizing from its solu- tions, odorless, intensely bitter, very insoluble in water, but 76 EXCITO-MOTORS. freely so in alcohol, and present to the extent of to in the crude drug. Its sulphate is soluble in water; but its solutions are seldom used medicinally, because of their intense bitterness. It yields a violet color with oxidizing agents, and this is the basis of several tests for the drug; but the physiological test is more reliable. The latter consists in injecting some of the suspected solution into a frog or other small animal, and noting if physiological effects are produced. The chemical test consists in dissolving a crystal of the alkaloid or one of its salts in concentrated sulphuric acid, and adding a crystal of potassium bichromate, when a bluish and then violet-purplish-color is produced (Otto's test). This test is exceedingly delicate. Physiological action. Nervous system,; The cerebrum is unaffected, and consciousness is unimpaired, except in the last stages of poisoning, when its loss is due to asphyxia. Strych- nine exerts a selective action on the motor cells in the anterior cornua, the reflex function being exaggerated and the convul- sions due to a direct action on the motor side of the cord. The convulsion itself is produced by peripheral irritation reaching the over-excited motor cord through the afferent nerves. In poisoning, the motor nerves are depressed, partly from exhaustion and partly from a direct action on their fibres. The sensory nerves are little affected. Circulation: Heart-action accelerated and arterial tension increased by medicinal, and depressed by toxic, doses. The blood-pressure rises during a convulsion, but is above normal independently of this from centric vaso-motor stimulation, the additional rise being due to muscle-spasm and asphyxia. The respiration is greatly stimulated. Death may result from a tetanic condition of the respiratory muscles, result- ing in asphyxia (cramp asphyxia), or more rarely from exhaustion. Special senses; Vision and hearing are rendered more acute; tinnitus aurium may occur; during a convulsion the eyes arc wide open and staring. Digestion: From its bitter taste it excites the secretions of the gastro-intestinal tract, increasing appetite and promoting digestion. It increases peristaltic action. NUX VOMICA. 77 Elimination: Absorption and elimination are rapid, the alkaloid appearing in the urine as strychnine and as strych- nic acid. Toxicology: Strychnine may be used with criminal intent, and gr. ss has proven fatal in the adult. The symptoms of poisoning appear usually in fifteen or twenty minutes, and are as follows in their order of development: sense of uneasiness, jerky respiration, stiffness of inferior maxilla, and shuddering; these are suddenly succeeded by tonic con- vulsions, especially of extensors, causing risus sardonicus; opisthotonos, the relative strength of the different muscles determining the position of the patient; pallor, succeeded by cyanosis from respiratory embarrassment. Consciousness is complete unless abolished by prolonged asphyxia. These spasms succeed one another on the slightest peripheral irrita- tion, and may cause death in a period varying from a few minutes to several hours, either by asphyxia or exhaustion by directly paralyzing the motor nerves. Very large doses in- jected into the circulation may cause death quickly and almost without symptoms (by paralyzing the motor nerves). Given in ascending doses, the physiological limit is reached when it causes nervousness, restlessness, stiffness of the mus- cles of the throat and back, with muscular twitchings. Diagnosis: Traumatic tetanus is the main condition from which its toxic effects are to be differentiated. The follow- ing points of difference may be tabulated : Strychnine Tetanus. (1) Duration short. (2) Development sudden. (3) Extremities first involved. (4) Intermission and muscular relaxation more marked. (5) Swallowing possible. Traumatic Tetanus. Duration longer. Gradual. Face first (trismus). Less marked ; spasm almost constant, especially tris- mus. Impossible. Treatment consists in (1) eliminating the poison, (2) check- ing the convulsions, (3) maintaining respiration, and (4) in keeping the patient absolutely quiet. The drug remaining 78 EXCITO-MOTORS. in the stomach may be rendered partially insoluble by tannin, after which the stomach is emptied by tire stomach-pump. Emetics are contraindicated after the effect is once felt, because of the danger of producing convulsions through excessive irritation. The spasms may be averted by the joint use of chloral and bromides; but if already present, the temporary use of ether, or even chloroform, may be neces- sary. Artificial or forced inspiration is to be employed if cyanosis develops. Therapeutics: Strychnine is used (1) in gastro-intestinal disorders as a stomachic tonic in anorexia, chronic gastritis, and atonic dyspepsia, in which conditions it should be given before meals; in morning nausea and the vomiting of preg- nancy and alcoholism, which may be relieved ; in functional disorder of the liver with intestinal indigestion, and as a tonic in cirrhosis; in constipation from inactivity of the muscular coat. (2) In hsemic disorders, as anaemia, chlorosis, hemorrhagic diathesis, purpura, etc., it may prove a good indirect tonic. (3) In relaxed conditions of the genito-urinary system, as in impotence, nocturnal emissions, incontinence of urine, etc., when atonic or functional and not dependent on organic defect; it is also occasionally used in amenorrhoea and neu- ralgic dysmenorrhoea. (4) In paralyses, especially those of peripheral origin, as lead-palsy and peripheral neuritis, it is often of great value, and is best administered hypodermically in the affected re- gion. It is of less value, but may do good, when the paral- ysis is of centric origin ; but is positively contraindicated during the early or rigid stages, or when any acute process obtains. Amaurosis due to alcohol or tobacco, and amblyopia from disuse, as is seen in strabismus, maybe cured by strych- nine. In all paralyses the drug must be pushed to the pro- duction of slight physiological effects. Given hypodermically or in encmata, by stimulating respiration and circulation it is of great value in surgical shock and in asthenic conditions generally. It is partially antidotal to opium and chloral. In the dyspnoea of cardiac disease it is an efficient adjuvant to digitalis. Petit mal may be benefited by strychnine. IGNA TIA-ITC'R 0 TOXIN UM. 79 (5) As a respiratory stimulant in emphysema, chronic bron- chitis, and in acute poisoning with respiratory depression; it forms a valuable addition to cough-mixtures when expectora- tion is delayed because of weakness. (6) In chronic valvular disease, cardiac weakness due to functional or organic disease, in cardiac depression from acute disease, strychnine forms a most valuable cardiac tonic. Administration: Strychnine is generally given in pill-form, except when large doses arc required, when solutions should be employed to avoid inaccuracy of dosage. It should not be given in the same solution with tannic acid ; nor should it be combined with bromides and iodides, which precipitate it partially from its solutions. Such combinations may cause the last portion to contain an overdose. It is very readily absorbed by the rectum, and the rectal dose should be the same as by mouth. Brucine : Recent experiments seem to show that this alka- loid differs from strychnine in depressing the sensory nerves, being somewhat anaesthetic in strong solutions. It has little effect when taken by the mouth, owing to its rapid elimina- tion, and is less powerfully convulsant than strychnine. It forms a beautiful scarlet or blood-red color with nitric acid. Ignatia is the seed of Strychnos Ignatia. It contains the same active alkaloids as mix vomica, the strychnine being present in larger proportions or more). Its preparation is- Tinctura Ignatiae, dose TT[x-xx. Its action and uses, consequently, are those of nux vomica. The drug is no longer official. IGNATIA. PICROTOXINUM, U. S. (Picrotoxin; Cocculus Indicus). Picrotoxin is a neutral principle obtained from the seed of Anamirta paniculata (nat. ord. an East Indian shrub. Cocculus Indicus is the dried berries of Anamirta paniculata. 80 DEPRESSO-MO TORS. It owes its activity to the neutral principle, picrotoxin, which is a white, crystalline, bitter substance, somewhat soluble in water and freely so in alcohol and ether. Not being an alka- loid, it is not precipitated by substances containing tannic acid. It is official as picrotoxinum. Physiological action and therapeutics: Like strychnine, picrotoxin is a tetanizing agent, having a selective action on the centres in the medulla (Biddle), and in large doses causes death by tetanic fixation of the respiratory muscles. It produces decided diaphoresis. In poisonous doses it causes violent convulsions, which are both cerebral and spinal, slow- ing of the pulse, intermittent respiration, and finally death. Small amounts increase blood-pressure. It is chiefly used locally as a decoction or ointment for the destruction of lice and the parasite of tinea versicolor. Lately it has been used in doses of gr. to for the night-sweats of phthisis. Otherwise it is little used internally. Ergot and Digitalis, although muscular excitants, will be more properly considered elsewhere. DEPRESSO-MOTORS. PHYSOSTIGMA, U. S. (Physostigma; Calabar Bean). Physostigma is the seed of Physostigma venenosum (nat. ord. Leguminosse). Habitat: Tropical Western Africa. The seed is kidney-shaped and contains as its active principle an alkaloid, physostigmine, or eserine. Calabarine and other alka- loids have been isolated, but they arc probably decomposition- products of eserine. Calabarine is believed to be a tetanizing agent. Eserine is sparingly soluble in water, but its official salt, the salicylate, dissolves in 130 parts of water. Preparations: Tinctura Physostigmatis, dose 1T[V-XX- Physostigminae Sal icy las, dose gr. yl--gy. Extraction Physostigmatis, dose gr. Physiological action : The symptoms produced by full doses are giddiness, pallor and coolness of the skin, contracted pupils, a slow and full pulse, muscular tremors followed by PHYSOSTIGMA. 81 relaxation, weakness, and drowsiness, but no stupor; vomit- ing and purging may occur. Toxic doses add to these effects symptoms of respiratory embarrassment, a total loss of re- flexes, and finally paralysis (dominant symptom). Nervous system: The cerebrum is unaffected even by large doses; but the centres in the gray matter of the spinal cord arc depressed, causing diminution or complete loss of reflexes. Depression of the motor nerves occurs only after large doses. Circulation: Small doses slow the pulse-rate. Toxic doses may arrest the heart in diastole, but the heart generally con- tinues to beat after respiration fails. This slowing is prob- ably due to stimulation of the pneumogastric, which is de- pressed by large doses; this, however, has not been positively proved to be its mode of action. The arterial tension is at first raised, but by toxic doses is finally lowered. Respiration is depressed, and in fatal cases death takes place from respiratory paralysis (centric depression). Intestines: Peristalsis is decidedly increased by a direct action on the muscular coat, a tetanic condition being pro- duced by large doses : this is followed by relaxation from over-stimulation and exhaustion. Eye: The pupil is strongly contracted, probably by local influence-i. e., by paralysis of the sympathetic terminals and oculo-motor stimulation. Thus it antagonizes the effects of atropine. This myosis is not constant, and is not of so long duration as the mydriasis of atropine. The ciliary muscle is stimulated, the drug thus acting in antagonism to atropine with regard to power of accommodation. Muscles: Physostigma is a muscle-poison, acting either directly upon the muscle itself or upon its contained nerve- filaments. Toxicology: The prominent symptoms are contracted pupils, embarrassed respiration, muscular weakness, and abolition of reflexes. The characteristic sign of poisoning by Calabar bean is the presence of muscular tremors associated with paralysis. Severe symptoms have been recovered from. Treatment: Atropine tentatively is the proper antidote. Measures against shock, as artificial warmth, etc., and arti- ficial respiration, are to be employed as necessity arises. C>-M. M, 82 DEPRES80-M0T0RS. Therapeutics : Internally, it may be used with success in tetanus, strychnine-poisoning, and convulsive conditions generally. A good preparation of the drug will prove one of the best measures against tetanus. In chorea and bronchial catarrh with dyspnoea it has its advocates. In ophthalmology it is used to antagonize atropine or to alter- nate with it in breaking up adhesions, etc. Physostigma or its alkaloid may sometimes be used as an addition to purga- tive pills; if physostigmine is employed, its dose should not exceed of a grain, cautioning the patient against increas- ing the dose. POTASSII BROMIDUM, U. S. (Potassium Bromide), KBr = 118.79. Potassium bromide is prepared by the reaction of ferrous bromide and potassium carbonate, potassium bromide re- maining in solution and crystallizing on evaporation. It is a colorless, crystalline, anhydrous salt, of saline taste, easily soluble in water, a property common to all the bromides in common use. Physiological action: Bromides act as universal depressants to all bodily functions. They depress the brain, spinal cord, respiration, circulation, sexual function, and temperature. Locally applied, potassium bromide obtunds the sensibility of mucous membranes and is slightly irritant. Nervous system: Upon the cerebral cortex it exerts a marked sedative effect, and especially diminishes the irri- tability of the motor area. Reflexes are diminished, from paralysis partly of reflex centres and partly of afferent nerves and their end-organs, the receptive side of the cord being most affected. Painful and tactile sensations are dimin- ished, but the motor nerves are not affected. Circulation: The activity of the heart is lessened, the pulse becoming slower, with lengthened diastole, from direct sedative effect. On the vaso-motor apparatus its effects are still sub judice. Arterial tension is probably lowered. Respiration is diminished in frequency, and a slight fall of temperature occurs, Exhalation of CO2 is lessened, POTASSII BROMIDUM. 83 Secretions are increased, but, unlike the iodides, it pro- duces no lachrymation, salivation, or nasopharyngeal catarrh. Large doses may cause diarrhoea. The effects upon the urine appear to vary. It exerts a marked sedative effect on the genito-urinary tract, the vesical irritability being lessened and genital excitement allayed. The drug is rapidly ab- sorbed, but slowly eliminated unchanged in all the excre- tions, principally those of the kidney, skin, and intestines. Potassium bromide-toxicology: Acute fatal poisoning does not occur. A single large dose causes gastro-intestinal irrita- tion, nausea, and vomiting, with great mental apathy, drowsi- ness, stupor, and some muscular weakness. After continued use bromism is produced, a chronic poisoning which may re- sult in death. The symptoms of this condition are anaemia and malnutrition, mental weakness and aberration, somno- lence, hallucinations, and even a mild form of mania; an eruption, generally acneform and occasionally eczematous; depression of circulation and respiration, with a fall in tem- perature ; hoarseness, aphonia, loss of co-ordination, and a feeling- of muscular weakness; absolute loss of sexual desire and impaired sensibility of the mucous membranes, as is well seen in the pharynx, titillation of which does not excite retch- ing. The physiological limit is reached when mental dulness, the acne-rash, and the fetid breath appear. These symptoms subside on withdrawing the drug, and are less severe when it is administered with Fowler's solution or when the mixed bromides are taken. They are also lessened when gastro- intestinal antiseptics like salol are simultaneously exhibited. Death may occur in advanced bromism from universal de- pression. Potassium bromide-therapeutics : This drug acts as a hyp- notic in conditions of mental excitement, hysteria, and nervous over excitability generally. Combined with chloral it is valu- able in delirium tremens. In the restless forms of insanity it is well combined with chloral or cannabis indica, but is contraindicated in melancholia and in all conditions of exhaustion and asthenia. As an antispasmodic it is valuable in the reflex vomiting of pregnancy, nausea marina, uterine disorder, or migraine; in 84 DEPliESSO-MOTORS. tetanus, probably constituting the best treatment when given in large doses in strychnine-poisoning ; in chorea, whooping- cough, and convulsions generally as an adjuvant to other measures. From its sedative effect on the genito-urinary organs it is useful in nymphomania, chordee, excessive venereal desire, masturbation, spermatorrhoea, etc. It is also of avail in the nervous disturbances of the menopause. Neuralgias may be benefited if not dependent on anaemia. Its greatest efficacy, however, is in the treatment of epilepsy. It succeeds better in grand than petit mat, but is often useful in the latter. It should be given in large doses until mild bromism is pro- duced, and must be continued for a long period after attacks have ceased. It is well to combine antipyrin with the mixed bromides, adding a small amount of Fowler's solution to prevent the ache-rash. Tachycardia of functional origin or symptomatic of exophthalmic goitre is often relieved. Administration: Dose gr. xv to 3j or more, in elixirs or syrups; its saline taste may be made less evident by the ad- dition of sodium bicarbonate. It should not be long con- tinued in conditions of malnutrition or anaemia. SODII BROMIDUM, U. S. (Sodium Bromide), NaBr 102.76. Sodium bromide, in its preparation, chemical and physical properties, and uses corresponds closely with potassium bromide. It is less disagreeable to the taste, less soluble, less depressing, and by some is considered to be less liable to cause symptoms of bromism. AMMONII BROMIDUM, U. S. (Ammonium Bromide), NH,Br 97.77. Ammonium bromide is formed by precipitating a solu- tion of ferrous bromide by aqua ammoniae, the desired salt remaining in solution. It is crystalline, but not perma- nently so, and is more often seen as a powder. It is analogous to the potassium compound, but is somewhat less active and more disagreeable to the taste, and causes more gastric irritation. By some it is said to be less depressing to STRONTII BROMIDUM-CURARE. 85 the heart, but probably all the symptoms of bromism may be caused by it. Its physiological action is not fully under- stood. It does not so readily produce acne. It may be used to fulfil the same indications as potassium bromide, and especial efficacy is claimed for it in pertussis and acute rheumatism. STBONTII BROMIDUM, U. S. (Strontium Bromide), SrBr,4 6HL,0 354.58. This salt appears in very deliquescent crystals, readily soluble in water and alcohol. It does not produce gastric derangement like the other bromides, but is said to exert a beneficial effect on digestion. It is used in somewhat larger dose and for the same indications as potassium bromide; it is less apt to produce symptoms of bromism. LITHII BROMLDUM, U. S. (Lithium Bromide), LiBr 86.77. Lithium bromide, an expensive salt with no particular advantages, contains a larger proportion of bromine than other bromides. It is said to have proved efficacious in some cases of epilepsy in which other bromides failed. Dose gr. xv to 5ss. Acidum Hydrobromicum Dilutum, U. S., is a 10% solution of gaseous hydrobromic acid (HBr=5 80.76) in water, acting much like the bromides, but being more irritant to the stomach; it should be well diluted. Indications as for bromides. It is also used as a corrigcnt to quinine, prevent- ing the headache and tinnitus aurium so often caused by that drug. Dose in its official dilution fgj-ij. Curare is an unofficial drug of uncertain origin, being derived from different varieties of Strychnos, but containing no tetanizing principle. It contains an alkaloid, curarine, the dose of which is gr. to or even larger by mouth, or gr- 20 77 hypodermically. The dose of the crude drug is gr. to CURARE, or WOORARA. 86 DEPRESSO-MO TORS. Physiological action: Curare is comparatively innocuous by mouth because of its slow absorption. Hypodermically, its only action is to paralyze the terminal motor flaments, with an incidental diminution of the reflexes, the muscular fibres and sensory nerves preserving their irritability. Death is caused by paralysis of the respiratory muscles. Therapeutics: Although chiefly employed in physiological experimentation, it has been used in tetanus, hydrophobia, strychnine-poisoning, and muscular cramps and spasms. In all these conditions it can only be of use by lessening the exhaustion dependent upon the spasms. CONIUM, U. S. (Conium). Conium is the full-grown /ruz7 of Conium maculatum (nat. ord. Umbelliferae) gathered while yet green. Habitat: Europe and Asia ; naturalized in North America. Its active principle is coniine, a transparent oily fluid, of bitter taste and of peculiar mouse-like odor. Coniine is one of the volatile alkaloids (the others being lobeline, nicotine, and sparteine). It is found in varying proportions in the drug: this, together with the volatile character of the active principle, accounts for the uncertain action of the drug. Preparations : Extractuni Conii, dose gr. 1-iij. Extractum Conii Fluidum, in which the coniine is fixed by acetic acid, is the best preparation, in doses of Thj-xv. Squibbs' Fluid Extract of Conium is a good preparation, the commencing dose being Ylfx, to be increased until effects are produced. In fact, whatever preparation is used it is safer to begin with the minimum dose and increase it in this way. Of coniine itself the dose is Tify1- Physiological action : The symptoms produced are weakness and heaviness of the extremities, beginning in the legs, ptosis, disordered vision, and giddiness. Large doses cause respiratory failure. Nervous system: The cerebral hemispheres are unaffected except by asphyxia produced during the poisoning; the characteristic effect is paralysis of motor nerves, affecting GELSEMIUM. 87 first their end-organs, the muscles retaining their irritability after death. Sensation and the spinal reflex centres are per- haps slightly affected by large doses. The pupils arc dilated, but not constantly so. The drugs which paralyze the motor nerves are belladonna, lobelia, conium, pelletierine, and iso- pel letierine. Respiration: The nerves supplying the muscles of respira- tion are paralyzed, thus causing death. The circulation is depressed. The temperature is slightly reduced. Elimina- tion takes place by the urine, and the secretions are only slightly affected by the drug. Toxicology: Toxic doses produce nausea, vertigo, ocular disturbances, as ptosis, diplopia, and dilated pupils, muscular and respiratory paralysis, coma, convulsions, and death. The treatment consists of cardiac and respiratory stimulation, espe- cially artificial respiration, external warmth, etc. Therapeutics: Conium has been used medicinally in chorea, local spasms (as blepharospasm), and in acute mania with great motor excitement. In all these conditions it must be pushed to the production of its physiological effects. Gelsemium is the rhizome and roots of Gelsemium semper- virens (nat. ord. Loganiaceae). This is the yellow or Caro- lina jasmine. It contains as its active principle the alkaloid gelsemine, in combination with gelsemimc acid (Worm ley). Preparations: Tinctura Gelsemii (15%), dose TT[x-xx or more. Extractum Gelsemii Fluidum, dose Tf[v-xv. The latter is the favorite preparation. A drachm of it has caused serious symptoms, and two drachms death. Physiological action : Small amounts produce few symptoms or none ; medicinal doses cause languor, muscular fatigue, dizziness, ocular disturbances, and frontal headache; large doses are followed quiekly by an aggravation of these symp- toms, with strongly dilated pupils, diplopia, ptosis, and some- times internal strabismus, falling of jaw, weakness of pulse, GELSEMIUM, U. S. (Gelsemium). 88 DEPRESSO-MOTORS. and lessened respiration. Toxic doses add to these effects the following: inco-ordinate movements, coldness of surface, and unconsciousness, followed by death from paralysis of respiration. Nervous system: The cerebrum is unaffected. The motor tract of the spinal cord is paralyzed, this paralysis being at times preceded by a period of spinal excitability with con- vulsions. The depression of respiration is due to an effect on the respiratory centre (Wood). The ocular symptoms noted above are due to paralysis of the peripheral endings of the oculo-motor and abducens nerves respectively. Therapeutics: This drug may be used with success in spasmodic conditions, as tetanus, spasmodic and hysterical cough, laryngismus stridulus, and asthma; in neuralgias, especially of the facial and ovarian types; in the early stages of pneumonia and pleurisy, in which conditions it does good by lessening the frequency of the respiration and depressing the general circulation, thus lessening the liability to pul- monary stasis (Bartholow). Toxicology : Cases of poisoning are to be treated by cardiac and respiratory stimulants. In administering the drug give it until muscular weakness, slight ptosis, or double vision is complained of. Lobelia is the leaves and tops of Lobelia infata (nat. ord. Lobeliacese), collected after a portion of the capsules have become inflated. Habitat: North America. Its sole active principle is lobeline, a liquid alkaloid. Preparations: Extractum Lobelite Fluidum, dose Wj-v. Tinctura Lobelite (20%), dose Tflx-xx. Physiological action: Lobelia produces, in large doses, burning of fauces, oesophagus, and stomach ; vomiting, purg- ing, and other symptoms of gastro-intestinal irritation ; slow pulse, cold sweating, and profound muscular depression. Toxic doses add to these effects collapse, stupor, coma, and death, which is at times preceded by convulsions. The mus- cular paralysis is due to a direct depressant action on the LOBELIA, IT. S. (Lobelia; Indian Tobacco). TABACUM. 89 motor nerves; the respiratory depression is centric (dominant action). Therapeutics: Its uses are few, the chief being as an anti- spasmodic in asthma. An infusion (3j toOj) is recommended as a local application in the eruption produced by poison-ivy. As an emetic it is far too harsh, and is no longer used. It has been used as a stimulating expectorant. Toxicology: For symptoms of poisoning, see above. The treatment consists in copious draughts of warm solutions of tannic acid, its antidote, with stimulation by alcohol, ammo- nia, strychnine, and external heat. Tobacco is the commercial, dried leaves of Nicotiana Ta- bacum (nat. ord. Solanaceae). Habitat: Tropical America; cultivated. Its active principle is nicotine, a volatile, liquid, and very potent alkaloid, colorless, transparent, and having the odor of tobacco. It is freely soluble in water. When tobacco is burned nicotine does not appear in the smoke, pyridine and collodin being formed. It is said that col- lodin is less active, and is present in greater amounts in cigar-smoke, while in that from pipes pyridine prepon- derates. Preparations: Tabacum alone is official. Extemporaneous infusions, decoctions, and wines may be used. Physiological action: Like lobelia, tobacco is a nauseant, depressant, and an antispasmodic. The symptoms of the two drugs correspond closely, but a greater toleration for tobacco can be acquired. It increases the secretions of the salivary and intestinal glands, of the kidneys, and of the skin. It slows and depresses the heart and lowers the arterial tension. Death is due to respiratory, and occasionally to cardiac, failure. Its continued use by smokers often leads to chronic pharyngitis, gastric disorder, nervous depression, amaurosis either functional or due to retinal atrophy, and "irritable heart." These effects are especially marked in the young, and even mental deterioration seems to follow its use. Nico- tine itself is a very rapid poison, death having resulted TABACUM, U. S. (Tobacco). 90 NITRITE GROUP. almost immediately from a toxic dose. The indications in poisoning are the same as for lobelia. Therapeutics: Although its use is not to be recommended on account of the danger entailed, it has been employed as a depressant antispasmodic in asthma, tetanus, strychnine- poisoning, and intestinal obstruction. Locally, it has been used in infusion or decoction as a parasiticide; but is danger- ous and has caused death. Smoking, when indulged in moderately, seems in some to stimulate, in others to quiet, mental activity. NITRITE GROUP. This group of drugs acts in a dominant way upon the spinal cord and circulation. It includes amyl nitrite, the nitrites of sodium and potassium, and nitroglycerin, the last chemically a nitrate, but probably converted into a nitrite in the blood. AMYL NITRIS (Amyl Nitrite). Amyl nitrite is a liquid containing about 80% of amyl (principally isoamyl) nitrite (C5HnNO2--116.78), together with variable quantities of undetermined compounds. It is pale yellow, oily, and of very great volatility, and has a banana-like odor, aromatic taste, and a neutral or slightly acid reaction. It is formed by the reaction of nitric acid on amylic alcohol (fusel oil). Physiological action: The effects of this drug are typical of those of the group. Inhaled in moderate amounts, it is very quickly absorbed and produces almost immediately the fol- lowing peculiar train of symptoms : a sense of fulness, dis- tention, and pain in the head, flushing of face, rapid heart- action, violent palpitation, and labored respiration, with a rapid lessening of reflexes. The pulse becomes full and very soft. Xanthopsia (a yellow coloring of objects seen) may occur. These symptoms pass away in a few minutes. Toxic doses cause pallor of the skin, muscular relaxation, irregular respiration, and death by asphyxia (centric). Although gen- AMYL NITRTS. 91 erally administered by inhalation, it is readily absorbed by all channels except the skin. The effects seriatim are as follows: Circulation: The heart is stimulated, its rate being greatly increased and its individual beats strengthened ; but after toxic doses cardiac paralysis ensues. The blood-pressure is notably diminished from vaso-motor paralysis, principally by a direct action on the muscular coat of the vessel-wall. The cardiac effects are due to (1) a probable initial stimulation of the nervo-muscular apparatus of the heart; (2) paralysis of the vagus ; and (3) the sudden relief of resistance from the dilating vessel-walls. Nervous system: Motor paralysis and loss of reflexes occur, due to depression of the motor part of the spinal cord (domi- nant action). It is not anaesthetic. Blood: The haemoglobin of the blood is converted into a substance, probably methaemoglobin; but this action is only partial. The color of arterial blood approaches that of venous, and in poisoning both become chocolate-colored. Owing to this lessened, oxidizing power of the blood the tem- perature is depressed. Amyl nitrite-therapeutics : It is used as an antispasmodic in the following conditions : In angina pectoris, in which, by overcoming the accom- panying increase of arterial tension, it gives marked and immediate relief whatever may be the causative condition. In asthma, the attacks of which may generally be relieved, especially 'when of purely bronchial type with no underlying cardiac or emphysematous condition. Epilepsy: In cases in which an aura precedes, giving an opportunity for its administration, it will abort the attack ; in the constantly recurring spasms of the status epilepticus it is invaluable, theoretically, by lessening the arterial spasm of the motor area which is supposed to cause the convulsion. The " nitrite-of-amyl pearls" are very convenient for this purpose. They are delicate glass capsules containing the drug, and may be carried by the patient, broken on his hand- kerchief, and inhaled. In spasmodic conditions generally, as in te/cmus, strych- 92 NITRITE GROUP. nine-poisoning, puerperal convulsions, uraemia, etc., it may prove valuable. In the heightened arterial pressure of renal disease it is used; but nitroglycerin is preferable from the longer dura- tion of its effects. In migraine, when due to arterial spasm, and in nervous dysmenorrhoea, it may prove palliative. It is also used as a cardiac stimulant in sudden syncope, profuse hemorrhage, and the cardiac failure of chloroform- narcosis ; but care should be exercised not to increase the existing cardiac depression by too large a dose; dose Ulij-v, by mouth or inhaled. SPIRITUS GLONOINI, U, S. (Spirit of Nitroglycerin; Spirit of Glonoin). Spirit of glonoin is an alcoholic solution of Glonoin [glyc- eryl (or propenyl) trinitrate, or nitroglycerin ; C3H5(NO3)3 =226.58], containing 1 % by weight of the substance. Nitroglycerin (also called tri nitroglycerin) is a colorless, oily liquid, of a specific gravity of 1.600, formed by the action of a mixture of nitric and sulphuric acids on glycerin. It is a violent explosive, and is used in medicine in a 1 % alcoholic solution, known as Spiritus Glonoini, the dose of which is gtt. ss-iij. Efficient tablet triturates are also employed. Physiological action: Nitroglycerin acts upon the circula- tion, blood, spinal cord, and muscles as does amyl nitrite; but differs in its slower action, less marked, vaso-motor depres- sion, and greater tendency to produce headaches. It takes effect in from five to ten minutes, and these effects are not protracted beyond an hour, so that in order to maintain a constant effect it must be frequently repeated. Nitro- glycerin is in reality a nitrate; but it is highly probable that it is decomposed in the blood, circulating and acting as a nitrite. The physiological limit of the drug is reached when it produces intense frontal headache. Therapeutics: Its uses are those of amyl nitrite (which see), with the exception, of course, of epilepsy and angina pectoris, in which the volatility of the amyl compound makes POTASSII NI TRIS- AMMONIA. 93 it preferable. Glonoin is more efficient when it is desirable to maintain a steady reduction of arterial tension. POTASSII NITRIS ( Potassium Nitrite), KN02. SODII NITRIS, U. S. (Sodium Nitrite), NaNO, = 68.93. The nitrites of potassium and sodium are crystalline, deli- quescent, and freely soluble in water, in which respect they have the advantage over nitroglycerin, to which they are closely analogous in their effects. They have the same gen- eral effects as the other nitrites, except that they arc slower in action and their effects are more lasting. They are liable to contamination by nitrates, and are said to produce disagree- able eructations. They are eliminated as nitrates. Their uses correspond to those of the preceding drug. Dose gr. '•HU- Sweet spirit of nitre (spirit of nitrous ether) in large doses produces the cyanosis and other symptoms characteristic of the other nitrites, coupled with the effects produced by alcohol. CARDIAC STIMULANTS. Cardiac stimulants are drugs used to promote the force of the circulation. No general rule for their method of action can be laid down. Ammonia is a colorless, very irritant gas, very alkaline, and very soluble in water. It is obtained as a waste-product in the manufacture of coal-gas. It enjoys a wide range of therapeutic uses, but may be best considered as a cardiac stimulant. Preparations: Aqua Ammonise Fortior (28% ammonia), external use only : a powerful corrosive poison (see Toxi- cology'). Aqua Ammonia (10%) 1 well diluted dose Spiritus Ammonia (10%), ) ' dose irx ijss. Spiritus Ammonia; Aromaticus (contains ammon. carbonat., 3.4%; aq. ammonia;, 9%; flavored with the oils of lavender AMMONIA. 94 CARDIAC STIMULANTS. flowers, nutmeg, and lemon), a favorite and agreeable antacid, stomachic, and stimulant; dose Linimentum Ammonise (aq. amnion., 35%; ol. gossip, semin., 60%; alcohol, 5%). Liquor Ammonii Acetatis (spirit of Mindererus) contains 7 % of the salt, and is used principally as a vehicle; dose Oss-ij. Ammonii Carbonas (sal volatile), dose gr. v-x. Ammonii Chloridum (ammonium muriate or sal ammo- niac); we have an official troche, gr. ij in each ; dose gr. v-x. A stimulating expectorant. Ammonii Phosphas, dose gr. x-xxx ; this has the action of the other phosphates. The nitrate is official for pharmacopceial purposes only; while the benzoate, bromide, iodide, and valerianate produce the effects of the other constituents; these salts are therefore not properly treated of here. All are official. Physiological action: Locally, solutions of ammonia act as powerful irritants, causing painful vesication of the skin and mucous membranes. Inhaled, ammonia causes irritation and inflammation of the air-passages. Swallowed in strong solu- tions it produces vomiting, epigastric pain, bloody diarrhoea, and other symptoms of gastro-intestinal irritation, with at times convulsions of spinal origin (due to action on the motor side of the cord). Death may rapidly ensue from oedema of the glottis; from respiratory depression ; or long afterward from pyloric stricture or other resulting structural changes. Circulation: To this function ammonia is a rapid, diffusible stimulant, increasing the heart-action, probably by stimula- tion of the cardiac accelerators : it also increases the blood- pressure, not by stimulation of the general vaso-motor system, for it occurs after spinal section, but perhaps by a direct action on the peripheral nervo-muscular structures. The respiration is accelerated by direct stimulation of the respiratory centre. The secretion of the bronchial mucous membrane is increased, and, indeed, the drug appears to exert a selective action on mucous membranes generally. It is not a hepatic stimulant. Ammonia is readily absorbed, however administered, and exists as such in the blood. It is AMMONIA. 95 quickly oxidized, and is eliminated by the urine as nitric acid and urea, thus giving the urine an acid reaction when ammonia itself, or its tartrate, carbonate, or chloride, is admin- istered. Therapeutics: Ammonia is used- As a cardiac stimulant in syncope from cardiac disease or hemorrhage, in chloroform-narcosis, surgical shock, snake-bite, or hydrocyanic-acid poisoning, or in cardiac failure occurring in infectious diseases; its action is very evanescent, and frequent repetition is necessary. For inhalation in sudden syncope the spirit, and for administration by mouth or for hypodermic use the aqua, is preferred, well diluted. As a blennorrhctic expectorant in acute bronchitis or pneu- monia after subsidence of the acute stage (carbonate pre- ferred), and in chronic bronchitis with profuse expectoration (chloride). In hepatic disorders, whether functional or due to structural changes, as beginning fatty and cirrhotic liver, catarrh of the bile-ducts, etc., the chloride is efficacious, its modus operandi being, however, not clear. In acute exanthemata with circulatory depression and high temperature the liquor amnion, acetatis is much used as a mild febrifuge and stimulant. In catarrhal conditions of the stomach or intestines the chloride does good, but the continued use of this or any other strong saline is not advisable. In gastric acidity with vomiting and headache the car- bonate in solution in liq. ammon. acetat. is a valuable remedy; also in combating the after-effects of acute alcoholism. In cystitis the ammonia salts above mentioned are useful, and the benzoate is particularly valuable by acidifying the urine and disinfecting the mucous membrane of the bladder. Toxicology: Poisoning may occur from the ingestion of the stronger ammonia-water. The symptoms are those of corrosive poisoning: abdominal pain, vomiting, bloody purg- ing; at times convulsions with or without consciousness, at others stupor and coma without convulsions. The odor of ammonia can often be detected upon the breath or in the air of the room. The treatment consists in the immediate admin- 96 CARDIAC STIMULANTS. istration of dilute acids, as vinegar, lemon-juice, etc., prefera- bly mixed with a bland oil, and followed by respiratory and cardiac stimulants; tracheotomy if oedema of the larynx threatens life. ALCOHOL, U. S. (Alcohol). Alcohol is a liquid composed of about 91 % by weight, or 94% by volume, of Ethyl Alcohol (C2H5OH = 45.9) and about 9 % by weight of water. Alcohol Absolutum, U. S., Absolute Alcohol, is ethyl alcohol, containing not more than 1 % by weight of water. An alcohol is an organic compound, the hydrate of some organic radical. (Thus, methyl hydrate, CH3OH, is methyl alcohol, or wood alcohol; C2H5OH is ethyl hydrate or ethyl alcohol, or alcohol.') Alcohol is obtained by fractional distil- lation from the liquids in which it exists, having been formed in these by vinous fermentation of grape-sugar, or glucose. This substance is changed under the action of a ferment (the yeast-plant, or Torula cerevisice) directly into alcohol and carbonic acid. The glucose exists already formed in grape- juice and other fruit-juices; but is usually obtained by con- version of starch, with subsequent fermentation. Alcohol Deodoratum, U. S., Deodorized Alcohol, is a liquid composed of about 92.5 % by weight, or 95.1 % by volume, of ethyl alcohol (C2H5OH=45.9), and about 7.5% by weight of water. Alcohol Dilutum, U. 8., Diluted Alcohol, contains about 41 % by weight, or 48.6% by volume, of absolute ethyl alcohol; made by mixing equal volumes of alcohol and water. This is used for pharmaceutical purposes. Official alcohol, ethyl alcohol (C2H5OH), is a colorless, inflammable, and volatile liquid, having a strong affinity for water, and reacting to sulphuric acid, with the production of ether and water. Consisting of so large a percentage of unoxidized C and H, alcohol is evidently capable of consid- erable oxidation and of liberating energy. The ultimate results of oxidation are CO2 and H2O. Physiological action : The effects of alcohol are (1) primary, A LCOHOL. 97 which follow when topically applied or when circulating un- changed in the blood; and (2) secondary, which result from long-continued use. Locally, alcohol applied to the skin is slightly irritant, especially if evaporation be prevented; abstracts water from the tissues and hardens the epidermis; when evaporating it produces a cooling and slightly anaesthetic effect. Internally, in small doses well diluted, it stimulates glandular secretion by (1) causing a superficial congestion of the mucous membrane, and (2) by a direct stimulation of the orifices of the glands, causing an outpouring of their secretion. Hence the appetite and digestive powers are promoted. When, however, too concentrated or in too large an amount, it pre- cipitates the pepsin secretion, causes nausea, vomiting, and loss of appetite, interferes with digestion, and produces cer- tain pathological changes, to be described later. Large doses of alcohol cause mental, physical, and emo- tional excitement in the first stage, with depression in the later stages; death may occur from general weakness, sudden pulmonary congestion, cardiac or respiratory failure, inter- current apoplexy, or acute Bright's disease. Nervous system: The cerebral effects vary with the size of the dose. They are characterized by mental exhilaration, especially of the emotional faculties, often spoken of as stimu- lation; but it is rather a blunting of the higher mental powers of reason and judgment by which the emotional are generally controlled : the phases of intoxication are too familiar to need enumeration. Somnolence and stupor fol- low, often very quickly when large doses are taken. The other ce rebro-spin al effects in their order of appearance are -further disorders of intellection, resulting in any phase of intoxication or brutality; disorders of motion and sensation: the sensory disturbance may take the form of dysaesthesia, paraesthesia, or anaesthesia, and generally begins in the lower extremities (occasionally the face) and advances upward: these show an effect on the basic'ganglia of the brain and the spinal centres ; lack of co-ordinating power from (1) disordered cerebellum and (2) impaired muscular sense; finally, death from respiratory paralysis, due to involvement of the medulla. 7-M. M. 98 CARDIAC STIMULANTS. As a general rule, then, the highest centres are first affected, and the others in the order of their importance. Circulation: The heart-action is stimulated in frequency, or in force and frequency : in adynamic states the force of the pulsation is often increased and the frequency lessened. Thus in medicinal doses alcohol is a stimulant to the circula- tion ; but toxic doses tend to depress the heart's action. Upon the vaso-motor system alcohol acts to dilate the cutaneous vessels by vaso-motor paresis; as results, we have flushing of the surface, sensations of heat, and sweating. The respiration is at first quickened, but later is depressed, and in fatal cases death takes place from paralysis of the centres in the medulla. The temperature is lowered slightly, for the following reasons: (1) the cutaneous circulation is increased and there is a greater loss of heat from radiation and diaphoresis; (2) the oxygenating power of the blood is lessened; (3) there is lessened muscular activity. This fall of temperature is not of importance therapeutically; but it is evident that alcohol is not an aid in resisting prolonged exposure to cold, but the opposite. Elimination: Alcohol is eliminated in small amounts by the kidneys and skin ; but nearly all of it is "burnt up" in the system to form CO, and H2O, leaving the body by way of the lungs. Medicinal doses are probably destroyed com- pletely. Nutrition: Alcohol is available for immediate oxidation; hence it is an immediate food up to f.5j to daily. Other substances ingested at the same time may be stored up as body-tissue, to be consumed on occasion. Hence alcohol tends indirectly to produce fat. The value of alcohol as a food has caused much discussion and has been the subject of a considerable amount of experi- mentation. The evidence to-day seems to indicate that alcohol is a wasteful and unsuitable food when taken in health ; that in diseases like typhoid fever it is an exceedingly valuable food, in addition to taking the part of a medicine, fulfilling the role of acting: (a) as a food; (6) as an aid in the assimi- lation of other foods, like milk; and (c) as a cardiac stimu- ALCOHOL. 99 lant; in typhoid it also has a distinct antipyretic action. In proper dose it seems to check tissue-waste. It appears to be established that small quantities of alcohol taken habitually are not productive of injurious results; that alcoholic bev- erages taken in moderate quantity aid in the digestion of other foods; and that the malted liquors, like beer, ale, and porter, and wines, are much less apt to cause harm than distilled spirits. The alcohol should in such cases be taken in diluted form. If the alcohol is taken in excess in diluted form, as in beer, ale, porter, etc., it produces extensive fatty infiltration, and later on fatty degeneration of the viscera, especially of the liver and kidneys. If taken in concentrated form, as whiskey, brandy, rum, or gin, it causes cirrhosis, particularly of the stomach, liver, and kidneys, and also of the heart and blood- vessel-walls. Gin is much more irritating than the others, and is very apt to produce hepatic cirrhosis. Sweetened liqueurs (cock-tails, etc.) are particularly injurious, and ab- sinthe seems most injurious of all. In connection with the alcoholic habit, it must not be forgotten that many pharma- ceutical preparations arc strongly alcoholic; that a table- spoonful of a tincture made with diluted alcohol is equivalent to a dose of whiskey plus the active principles of the drug; and that it is not of infrequent occurrence to trace the alco- holic habit to the use of compound spirit of lavender or other alcoholic preparation. Secondary effects: When habitually used alcohol has cer- tain characteristic effects, mostly due to an interstitial hyper- plasia. Stomach: The continued irritation of any but very small doses causes finally a decrease in its secretory power: there is an increased production of connective tissue, the glands arc obliterated, and a chronic gastritis results. Liver: Alcohol is mostly absorbed in the stomach, and is thus carried immediately by the portal circulation to the liver : here, again, constant irritation causes growth of con- nective tissue and consequent gland-obliteration, and cir- rhosis of the liver results. On both stomach and liver alcohol acts more harmfully when taken fasting, because of its con- 100 CARDIAC STIMULANTS. centration. Fatty liver may also result from the alcoholic habit. Vaso-motor changes: Alcohol causes a constant paresis of the superficial vessels, one of the results of which is drunkard's acne. It is also a potent factor in the produc- tion of atheroma of the vessel-walls. Nervous system: Here too, probably, the effects are due to increased connective tissue (neuroglia). Among other condi- tions thus brought about are amaurosis, alcoholic neuritis, epilepsy, general paresis, alcoholic tremor, delirium tremens, and sclerosis of the brain and spinal cord. Delirium tremens, or mania d potu, is a form of chronic alcoholism. It frequently develops abruptly; but never after a single debauch. The premonitory symptoms are anorexia, alcoholic tremors (which are worse in the morning, and are improved by alcohol), depression of spirits, and insomnia. The characteristic symptoms of active mania a potu are hallucinations and delusions, the so-called " hor- rors," in which the mental images take the form of animals, serpents, rats, etc., and which are always unpleasant. Delirium tremens usually terminates in recovery; the first attack always does. It may go on to permanent insanity or end in death. Alcoholic insanity differs from acute mania in being aggressive only when the patient thinks others are attacking him ; he becomes aggressive only in apparent self-defence. The treatment of delirium tremens is directed toward elim- inating any alcohol remaining, quieting the patient, and nourishing the system. For the first indication, the stomach may be emptied by the pump or an emetic, preferably ipecac ; the bowels are emptied by a brisk purge. Bromides, chloral, and morphine may be employed for the second indication, taking care not to push the bromide too far because of depression, and to give morphine in single doses because of the danger of acquiring the habit. Strychnine and digi- talis may be necessary to sustain the heart, while tincture of capsicum, in doses of 1T[x to frequently repeated, stimulates the stomach to retain food and relieves the craving for drink. Usually, whiskey will only aggravate the trouble, and it is better to withdraw it at once. ALCOHOL. 101 Diagnosis of acute alcoholism: Intracranial hemorrhage, opium-narcosis, uraemic and diabetic coma, and cerebral con- cussion may closely simulate profound alcoholic coma. Diag- nosis of these conditions is by no means easy, and indeed is often impossible in the absence of a history of the case. Too much weight is not to be placed on the odor of laud- anum or alcohol on the breath, nor on the condition of the pupils : nothing is positively diagnostic. In alcoholic coma the odor of alcohol, or of some of its excretory products, is upon the breath ; the pupils are usually somewhat dilated and equally so; the pulse is rapid and soft; the skin moist and relaxed; the respiration is not much affected ; and the temperature is lowered. In apoplexy there are usually signs of unilateral involvement: the pupils are unequal; one side is more or less paralyzed; there is facial palsy, with more or less blowing respiration on one side; the skin is warm and dry ; the pulse slow and full; the tempera- ture raised, with frequently a difference in the two axillae; the odor of alcohol upon the breath is not diagnostic, as a drunken man may die of apoplexy. In opium-poisoning both pupils are pin-point in size; the skin is warm, except in advanced poisoning; the pulse is slow and full; the respi- rations very slow, but regular; and the odor of laudanum may be upon the breath. In urcemia the skin is dry; the odor of the breath urinous; the pulse slow and hard; the urine contains albumin and casts; and the patient is more apt to have convulsions (these may occur in poisoning from alcohol). In diabetic coma the history of the case and the examination of the urine will establish the diagnosis. Treatment of acute alcoholism : Evacuate the stomach if necessary; employ warmth to the extremities and farad ism to the respiratory muscles; use cardiac stimulants in addition to the hot bath. Therapeutics of alcohol: In adynamic conditions, as con- tinued fevers, given in doses frequently, it really acts as a food, as a stimulant, as an aid to digestion, and as an antipyretic. In typhoid fever alcohol forms a most useful drug, whiskey or brandy being selected according to whether the patient is 102 CARDIAC STIMULANTS. constipated or lias diarrhoea. Some clinicians begin its nse, in fsj-ij doses every two hours, early; while others wait until the pulse softens. It is borne in large doses, and should be pushed as long as it makes the patient less nervous and as long as it reduces the pulse and temperature. The odor upon the breath is the physiological limit. It is preferably given mixed with milk, as it aids in its digestion. In the convales- cence of typhoid dry wines are more suitable. In acute inflammations with cardiac depression, particularly pneumonia, it is a valuable stimulant. In ordinary colds, whiskey or other alcoholic stimulant often forms a valuable adjunct to quinine and the hot foot- bath. Often a cold can be aborted by the use of hot lemon- ade with foss--ij of whiskey. Alcohol probably acts in these cases by relieving internal congestion. In atonic dyspepsia, in small doses with or after meals, it is of benefit in some cases, but should not be too long con- tinued, less a habit be engendered ; and the fact that, like all aids to gastric digestion, its continued use may lead to ordinary dyspepsia should also be borne in mind. The stomach becomes dependent upon them, and when they are withdrawn dyspepsia ensues. In the summer diarrhoea of children, cholera infantum, and diarrhoeal disorders generally brandy is particularly serviceable because of its astringency. In poisoning from snake-bite the administration of alcohol should be carried to the point of narcosis. Chloroform-inhalation should be preceded by f.?j or f§ij of whiskey or brandy, which are also used with great advan- tage hypodermically in cardiac failure, or in any sudden depression. In streptococcus infection it forms the most reliable treat- ment, and may be used in connection with the antitoxin. In puerperal septic infection the same treatment is the best. Alcohol in large doses forms one method of treating diph- theria. In pulmonary and other forms of tuberculosis alcohol does good as a digestive aid and food. It should be given in ALCOHOL. 103 small doses with the meals ; as soon as digestion becomes disordered, it is doing harm, and its nse should be stopped. In delirium tremens it acts as a food and cardiac tonic, and is often very valuable, especially in that type of the disease characterized by inanition. In all forms of syncope, except that following ether- or chloroform-narcosis. Alcohol is not a vaso-motor and not a marked respiratory stimulant; therefore it is not so useful as other drugs in shock. Insomnia in some cases may be relieved by the administra- tion of an alcoholic beverage just before retiring. Vomiting is often checked by effervescent wines. Locally, alcohol is used as a prophylactic- against bedsores or chapped nipples, doing good by hardening the skin, and as an evaporating lotion in bruises, sprains, etc. It lias been highly recommended in erysipelas as a local application. As an addition to the water used in giving sponge-baths, it assists evaporation and in addition stimulates the skin. Whiskey frequently forms a most valuable liniment. Administration: In prescribing alcohol remember that patients at the extremes of life, childhood and old age, bear the drug poorly. Certain conditions, notably shock following injury, venomous bites, and severe hemorrhage, call for large doses. Habit causes lessened susceptibility to the drug. It should never be prescribed for any great length of time, lest the alcoholic habit be formed. For immediate effect, whiskey or brandy is given, undiluted and hot. As an aid to diges- tion, alcohol is given in diluted form, with the food. Preparations : The official arc : Spiritus Vini Gallici, U. S., Brandy. An alcoholic liquid obtained by the distillation of fermented grapes, and at least four years old. It contains from 46 to 55% by volume of alcohol, is more constipating than whiskey, and owes its flavor to various ethers, such as oenanthic and acetic. The best brandy is obtained by distilling French wines, and is called Cognac. American brandy is obtained on a large scale in California. Spiritus Frumenti, U. S., Whiskey. An alcoholic liquid, obtained by the distillation of the mash of fermented grain 104 CARDIAC STIMULANTS. (usually mixtures of corn, wheat, and rye), and at least two years old. The cheapest source of starch in this country is corn, wheat, or rye; in the manufacture of whiskey the starch is converted into glucose by the addition of a certain proportion of barley-malt, which contains diastase. The process is called mashing, and in it the starch is con- verted into glucose at certain temperatures, the diastase acting as the converting agent. Yeast is added to the entire mash and /ermeraWmn takes place, the glucose splitting up into alcohol and carbon dioxide. The fermented mash is sub- jected to distillation and the product is crude whiskey. The highly rectified product is the alcohol of commerce ; if aged for a number of years, it constitutes whiskey, which usually contains about 50% of alcohol by volume and is then of proof strength. Crude whiskey is contaminated by a per- centage of fusel oil, or amyl alcohol, which varies somewhat with the source, and which becomes converted into ethers by the aging process. Crude whiskey is very much more injurious than the same product properly mellowed by age. Vinum Album, U. S., White Wine. An alcoholic liquid, made by fermenting the juice of fresh grapes, the fruit of Vitis vinifera (nat. ord. Vitacere), freed from seeds, stems, and skins. Vinum Rubrum, U. S., Red Wine. An alcoholic liquid, made by fermenting the juice of fresh colored grapes, the fruit of Vitis vinifera (nat. ord. Vitaccse), in presence of their skins. Grape-juice contains among other principles grape-sugar and acid potassium tartrate, together with calcium tartrate and other salts. Subjected to fermentation, the sugar is changed to alcohol and carbon dioxide, the potassium bitar- trate precipitating as it becomes insoluble in the increasing amount of alcohol. The color of wine is produced by the skins; the astringency, by the presence of the seeds. A wine is sweet when the quantity of sugar is so large that some of it has escaped fermentation. If the proportion of sugar has been small and has completely fermented, the wine is dry. A light wine contains a small amount of alcohol; a strong (generous) wine, a larger percentage. A sour wine is ALCOHOL. 105 characterized by an acid, a rough wine by an astringent, taste (due to tannic acid). Ordinary wines are still. Sparkling wines contain carbon dioxide (champagnes). Both white and red wines should con- tain not less than 12%, nor more than 17%, of alcohol by volume (77. S. P). The aroma, or bouquet, of wines depends upon the presence of various ethers, such as oenanthic and caproic, which develop during fermentation and during the aging process. Any domestic wines which answer to the official requirements may be used; the California wines are frequently fortified by the addition of alcohol. No wine can be made stronger than 20% by fermentation alone, as the growth of the yeast-cell is checked. In the aging process, wines and whiskies lose some of their water, with a cor- responding reduction in quantity but with an increase in the percentage of alcohol. The class of official preparations known as Vina, or Wines, are made with a menstruum of white wine; they are not so permanent as the tinctures. Vinum Portense, or Port Wine, is a heavy, sweet wine; while Vinum Xericum is Sherry Wine, and is dry. Cham- pagne is a sparkling wine which contains CO2, because it is bottled before fermentation ceases; it may be sweet or dry. Spiritus Juniperi Compositus, U. S., Compound Spirit of Juniper. This is practically gin, though an artificial prod- uct. Gin is made from rye or barley, with the addition of juniper berries. These impart to the spirit diuretic proper- ties, merely through the irritation produced by the oil. Gin- drinking is particularly apt to cause cirrhosis of the liver as well as of the kidney. Spiritus sacchari tosti (spirit of burnt sugar), or rum, is made from fermented molasses ; arrac, from fermented rice. Whiskey, brandy, gin, and rum may be said to average 50% of alcohol by volume. The malt liquors are beer, ale, and porter. Domestic beers average from 4 to 6 % in alcoholic strength. They are made by a slow fermentation (lager beer). English ales contain from 5 to 9 % of alcohol, and are made by a more rapid form of fermentation (top fermentation). Porter and brown stout are also stronger in alcohol and extractive than is beer. All 106 CARDIAC STIMULANTS. of these malt liquors should be old enough to be free from yeast. Malt liquors are indicated, particularly when mild stimula- tion is needed for a protracted period of time; wines, in the convalescence of fevers and as a stimulant at meal-time; the ardent spirits, during the height of fevers, etc. When it is advisable to vary the flavor and increase the nutritive power alcohol may be given as mulled wine, wine-whey, milk-punch, or egg-nog. Mulled wine is made by beating up an egg with three or four ounces of sherry wine and adding an equal quantity of boiling water. Wine-whey is made by mixing eight ounces of sherry with a pint of boiling milk, straining off the coagu- lated casein and sweetening to taste. Milk-punch is made by adding from one to two fluidounces of one of the ardent spirits to a glassful of milk, with spices and sugar, Egg-nog contains the yolk of an egg beaten up with a cupful of milk and from one to two tablespoonfuls of whiskey, brandy, or rum. The mixture is sweetened and served with the white of an egg beaten into a froth. DIGITALIS, U. S. (Digitalis; Foxglove). Digitalis is the leaves of Digitalis purpurea (nat. ord. Scrophularineae), collected from plants of the second year's growth. Habitat: Europe; but it is cultivated in this coun- try : the European leaves are the best. The active principles are still in dispute. It contains four glucosides: (1) digitalin, which probably most nearly represents the drug, and is solu- ble in alcohol, but not in water; (2) digitalein, soluble in both water and alcohol; (3) digitonin, which resembles saponin in its action, but slightly differs chemically, and is soluble in water, but only slightly so in alcohol; and (4) digitoxin, a very active constituent, insoluble in water and only sparingly so in alcohol. Digitonin probably represents the diuretic action of the drug, and.being insoluble in alco- hol, but soluble in water, it is present in the infusion and not in the tincture ; the former is therefore the better diuretic preparation. DIGITALIS. 107 Preparations : Pulvis Digitalis, dose gr. j. Extractum Digitalis, dose gr. |. Extractum Digitalis Fluidum, dose fflj-iij. Tinctura Digitalis (15%), dose 1TLv-f3ss. Infusum Digitalis (1.5%); fsj =about gr. vij of powdered drug: is flavored with cinnamon; dose fsj-fsss. The unofficial digitalin of commerce is of uncertain strength and varying composition ; dose about gr. Physiological action: The most important effects of digitalis are upon the- Circulation: Digitalis in therapeutic doses produces a strong, slow, full pulse and raises the blood-pressure. In toxic dose, the effects are increased: the pulse becomes dicrotic and then irregular, the pressure falling. The full pulse is due to direct stimulation of the heart and its contained ganglia; prolonged diastole is caused by stimulation of the pneumo- gastrics. Digitalis contracts the walls of the bloodvessels, and the rise of blood-pressure is in part due to this and in part to the action on the vaso-motor centres. Death occurs usually through systolic arrest, a tetanic condition from over- stimulation of systole; rarely, from diastolic arrest, in which case pneumogastric stimulation stops the heart. The dicrotic pulse is caused by an abortive attempt at diastole; finally, the systolic spasm becomes permanent. The systolic con- traction of the heart is so powerfid that the apex becomes white and all the blood is literally squeezed out of it, so that the heart becomes entirely empty. This fact, together with the lengthened diastole and the stimulation of the cardiac trophic nerve, the pneumogastric, makes digitalis such a useful remedy. Nervous system: This is not affected by medicinal doses; after very large or toxic doses some cerebral disturbance and lowered reflex excitability occur. These symptoms may go on to the production of stupor, coma, delirium, and convulsions, caused by cerebral anaemia. The diminution of the reflexes is due to stimulation of Setschenow's centre; later on, to direct paralysis of the spinal cord. It is also a depressor of motor nerves and of muscular tissue. Gastro-enteric: Large doses are irritant, causing nausea, 108 CARDIAC STIMULANTS. vomiting, at times diarrhoea and other symptoms of gastro- enteric irritation. Prolonged use may cause loss of appetite. In acute poisoning empty the stomach if necessary, give diffusible stimulants, as whiskey or ammonium carbonate, and place the patient in the recumbent position. The temperature is distinctly lowered by large doses, but this is not of therapeutic importance. The urine is increased in amount by digitalis, the urea being diminished, and the other urinary solids increased. Its mode of action as a diuretic is disputed : by some it is held to be entirely due to increased blood-pressure in the kidneys; by others, that there is a distinct stimulation of the Mal- pighian tufts (Brunton). It is probably indirect. Clinical experience proves it to be a rather uncertain diuretic. Digitalis stimulates uterine contractions and lessens sexual appetite. The slow, full pulse is the physiologic limit of the drug. Cumulative action: By many it is held that after continued administration of the drug sudden alarming symptoms may be developed. Others deny this, and claim that in the strictest sense it is not cumulative, but that these effects are due to the slow elimination of the drug, so that the doses overlap each other as it were, and that the same would be true of many other drugs not considered cumulative. Therapeutics: The clinical indications depend for the most part on its effects on the circulation. Digitalis is indicated- In mitral disease, either stenosis or insufficiency ; when there is an excess of blood on the venous side, the symptoms of which are congestion of the lungs and viscera and rapid, feeble, palpitating, or irregular heart-in these conditions digitalis slows and steadies the pulse and gives the auricle a chance to empty itself. In aortic disease its sphere is more limited. In stenosis with compensatory hypertrophy it is not indicated, and may prove dangerous in large doses; but when this stenosis lias secondarily affected the mitral vedve digitalis is useful. In general it is indicated in rapid and weak heart-action with lowered arterial tension. Digitalis produces good effects in four ways : (a) it prolongs DIGITALIS. 109 diastole and reduces the number of beats, thus resting the heart; (6) its stimulant action is felt by the trophic fibres of the pneumogastrics as well as by the motor; (c) it increases systole to such an extent that all the blood leaves the cham- bers ; while (d) the blood-supply to the heart itself is increased and its own nutrition improved. Digitalis is also of value in irritable heart from excessive exertion, as seen in oarsmen, soldiers, etc.-a condition of muscular hypertrophy. From its double diuretic action it is valuable in renal dropsies, especially that of acute nephritis, and also does good in the chronic varieties : for this pur- pose the infusion should be given. In cardiac dropsies it is particularly valuable. In exophthalmic goitre digitalis relieves the tachycardia and palpitation. In adynamic con- ditions, as typhoid, it is often very useful. In poisoning by certain drugs which arrest the heart in diastole and greatly diminish the blood-pressure, as aconite or muscarine, it is used with advantage. In pneumonia and other acute inflam- mations it has been used in the early stages with the view of lessening exudation, but is of doubtful efficacy; later it is often indispensable as -a stimulant, especially in alcoholic cases. In passive hemorrhages, the hemorrhagic diathesis, and purpura it may be beneficial. In menorrhagia and metror- rhagia it will only prove serviceable when the condition is due to cardiac disease. In spermatorrhoea it is supposed to act as an anaphrodisiac. Hypodermic injections of its tinct- ure, ffixv-xxx, are valuable in sudden cardiac depression from any cause, as during operation or acute hemorrhage; but it is more irritating and slower in action than the tincture of strophanthus, which is often preferred. Digitalis poultices over the lumbar region in the ureemic state, the patient not being able to swallow or vomiting re- peatedly, seem to do good ; this is due probably more to the moist heat applied than to the drug, very little of which is absorbed. In all cases it is necessary to consider the slow absorption and elimination of digitalis. It is usually necessary to give it for a day or two in small doses, frequently repeated, before the effect becomes evident. As digitalis is not a respiratory 110 CARDIAC STIMULANTS. stimulant and its effects are so slowly manifested, the drug is inferior to others in shock and collapse. Contraindications : Digitalis should be used with care in the following conditions: fatty heart; aneurism and cerebral endarteritis, in which conditions the increased blood-pressure might rupture the already weakened wall and cause fatal hemorrhage ; in any valvular lesions with compensatory hyper- trophy, or when such hypertrophy is evidently taking place. Th all cases in which it increases prcecordial distress. This is particularly so when the left auricle is dilated from the prolonged strain thrown upon it in mitral regurgitation. In high fevers digitalis does not act, and an undesirable powerful action may result if the temperature drops sud- denly after continuous administration of the drug. Toxicology: The characteristic symptoms of poisoning by digitalis are gastro-intestinal and circulatory, nausea, vomit- ing, diarrhoea, profound depression, and marked pallor of face, with a pulse which, while it may be full, strong, and slow in the recumbent position, becomes rapid, weak, and irregular when the patient assumes a sitting posture; stupor, coma, delirium, and convulsions. These symptoms may follow the continued use of the drug, and are said to be more apt to develop (1) after tapping in ascites or hydrothorax, which relieves pressure in the lymphatics and facilitates absorption; (2) after quick defervescence from some acute disease; or (3) when its diuretic action is not marked. Chronic poisoning has resulted from the prolonged exhibi- tion of digitalis. The symptoms are anaemia, disturbances of digestion, anorexia, persistent diarrhoea,, vertigo, mental con- fusion, and occasionally even delirium. The treatment consists in the immediate withdrawal of the drug, keeping the patient in the recumbent position, and the administration of diffusible stimulants, as alcohol and am- monia. The minimum fatal dose of digitalis is not known; large single doses have been recovered from. STROPHANTHUS, U. S. (Strophanthus). Strophanthus is the seed of Strophanthus hispidus (nat. ord. Apocynaceae), deprived of its long awn. Habitat: Central STR OPHA NTIIUS. 111 and Western Africa. The drug is used as an arrow-poison by the natives, and is said to be quickly fatal. The seeds yield an intensely bitter glucoside, strophanthin, which is converted by sulphuric acid into glucose and strophan- thidin. Physiological action: Its most obvious effects, and the most interesting from a therapeutic standpoint, are circulatory. In medicinal doses (fffy to x of the 5% tincture) it slows the action of the heart, increases its capability for work, and raises the blood-pressure. Its cardiac effects are probably due to a direct stimulation of the heart itself, while the increased arterial tension is secondary to this stimulation, together with some local stimulation of the arterial constrictors. Poisonous doses cause at first a slow, full pulse, with a rise in the arterial pressure ; nausea and vomiting; diuresis; then death from heart-failure or paralytic asphyxia. Upon the nervous system the drug acts very slightly ; it is a muscular paralyzer, first increasing the tonicity of the muscular fibre, and then destroying it, the muscle passing directly into a state of post-mortem rigidity (a true muscle- poison). Death generally results from cardiac depression, but possibly at times from paralysis of respiration. Its diuretic effects are disputed; but the weight of opinion seems to be that it acts as such in both health and disease, and especially in cardiac disorders. The position of stro- phanthus as a diuretic and cardiac stimulant seems to be intermediate between digitalis and caffeine. Digitalis is most reliable in its effect on the heart, and least reliable in its effect on the kidney ; while caffeine is the best diuretic, and least certain in its action on the heart (Wood). Large doses cause irritation of the mucous membrane of the alimentary tract, but less than digitalis. Stroplianthus is eliminated in the urine. Therapeutics : Strophanthus may be used to fulfil the same indications as digitalis (7. w.), differing, however, from that drug in being much quicker of action and less protracted, and perhaps less certain. Thus it may be substituted for digitalis when a quick effect or a change of medication is desired. It is less irritating and more prompt when given 112 CA RD I A C ST IM ULANTS. hypodermically than digitalis. Some clinicians have reported a cumulative action. Strophanthus was not official in the U. S. P. of 1880. The tincture is in use (5%), dose hlv-x, or Rlij-iij fre- quently repeated. Strophanthin is too powerful a drug for general use. Convallaria is the rhizome and roots of Convallaria majalis (nat. ord. Liliaceae). The " lily of the valley " is an indig- enous plant, also growing in Europe and Northern Asia. It contains two glucosides-convallarin, which is a purgative principle; and convallamarin, which represents the drug in its effects upon the circulation. Physiological action: The rationale of its action is still obscured by a number of experiments with diverse results. It acts, however, at first to slow the pulse-rate, to raise the arterial pressure, and probably to stimulate the respiratory function. Later, after large doses, it depresses all these functions, thus resembling digitalis to a degree, but being less energetic and passing less readily into the toxic stages. It acts as a diuretic, probably indirectly, by increasing the blood-pressure. Therapeutics : It is recommended in dropsies of all kinds and in valvular lesions of the heart, probably fidfilling the indications for digitalis. The fluid extract (Extractum Convallariae Fluidum, U. S.) is given in doses of from 5 to 15 minims. CONVALLARIA, U. S. (Convallaria). SPARTEIN2E SULPHAS, U. S. (Sparteine Sulphate). Sparteine sulphate is the neutral sulphate of an alkaloid obtained from Scoparius. Sparteine is a volatile liquid alka- loid from Sarothamnus scoparius, or broom-plant. It is colorless, extremely bitter, insoluble in water, but soluble in alcohol, ether, and chloroform. Its sulphate, the form in which it is used, is freely soluble in water. Physiological action: This is little understood at present. It seems to increase the contractile energy of the heart and to A D ONIDIN- CAFFEINA. 113 exercise a peculiar stimulating influence upon its action when irregular, with very little or no effect on the vascular tension. It increases the amount of urine; but whether it represents the entire diuretic power of its parent drug, or whether it has any direct kidney-effects, is not clear. It depresses the central nervous system and kills by respiratory paralysis. Death is preceded by convulsions. Therapeutics: It has been employed in valvular disease, asthma, and conditions characterized by cardiac depression, with dropsy; but it seems particularly adapted to the func- tional or nervous disorders of the heart. Like other members of this group, it is recommended in Graves' disease, and may do good. Dose gr. |-|. Two grains in the twenty-four hours, in divided doses, will usually produce its characteristic effect. ADONIDIN. Adonidin is a glucoside derived from Adonis vernalis, a European plant (nat. ord. Ranunculaceae). Its effects re- semble digitalis. Small doses slow the heart's action and increase the blood-pressure, while large doses depress both. It is irritant to the digestive tract, but only in very large doses. Therapeutics: The indications for this drug, resembling digitalis as it does very closely in its effects, may be con- sidered the same as for that drug. It may be substituted, and is generally administered in the form of a 2% to 4% infusion of the whole herb, the dose of which is every two or three hours. Dose of adonidin gr. three times a day. CAFFEINA, U. S. (Caffeine; Theine). Caffeine (theine) is a feebly basic, proximate principle, obtained from the dried leaves of Thea sinensis (nat. ord. Ternstroemiacese), or from the dried seeds of Coffea arabica (nat. ord. Rubiacese), and found also in other plants. Among other drugs containing a large percentage of caffeine are Guarana, U. S., a dried paste chiefly consisting of the 8-M. M. 114 CAllDIAC S'L'IMULANTS. crushed or powdered seeds of Paullinia Cupana (nat. ord. Sapindaceae; habitat, Northern and Western Brazil); Kola, the nut of Kola acuminata, a tree growing in Africa ; Mate, the leaves of Ilex paraguayensis, grown in Brazil. Chocolate, made from the prepared seed of the Theobroma Cacao, contains theobromine, which is closely related to caffeine; the latter is probably methyl-theobromine. Caffeine and theine are identical. The commercial article is chiefly prepared from damaged tea or from the sweepings obtained in the tea-houses of London. Caffeine occurs in white, silky, odorless crystals, soluble in 100 parts of water, the solution being feebly basic in reaction, but forming salts with acids. Preparations : Caffeina, the alkaloid itself, dose gr. j-v. Caffeime Citrata, dose the same. Caffeime Citrata Effervescens, contains 10% of caffeine. Physiological action: In small doses caffeine is a stomachic tonic, promoting the appetite and increasing the digestive power. In larger amounts it causes cerebral excitement, with stimulation of the higher mental powers (whereas opium stimulates the imaginative). Still larger doses cause mental confusion, hallucinations, muscular trembling followed by stiffness and then relaxation, and even delirium. It is, then, a true stimulant to the cerebral cortex. In animals convul- sions and in man muscular trcmulousness (a direct muscle- poison) are produced, the exact origin of which is not known. Probably they are due to stimulation of the spinal centres and to muscular depression. Circulation: This function, upon which the physiological effects are especially interesting in view of the therapeutic uses of the drug, is at first stimulated and later depressed. The heart's action is at first rendered more rapid and the arterial pressure is raised ; but later the pulse becomes slower and irregular and the blood-pressure falls. No exact ex- planation of these effects can at present be offered; but prob- ably they are due in large part to a direct stimulation of the cardiac nervo-moscular apparatus with some action on the vessel-walls. Toxic doses depress both circulation and respi- ration and lower the temperature. It acts as a powerful diuretic, the amount of urine being CAFFE INA. 115 decidedly increased. The effect upon the solids eliminated is still under discussion. The diuretic effect is almost wholly due to the action of the drug on the secreting structure; it is the most reliable diuretic, but is much inferior to digitalis as a cardiac stimu- lant. Respiration: Caffeine stimulates respiration by a direct action on the centre. Elimination: Small doses are entirely destroyed in the system ; large amounts arc partially eliminated in the urine. Nutrition: Experiments in regard to the effect of caffeine on protoplasmic change are at present contradictory. Therapeutics: In migraine and other nervous headaches, with or without gastric derangement, it is an uncertain remedy; in many cases, however, acting well. In opium-narcosis it is a standard remedy, either in the alkaloidal form or as black coffee. In adynamic conditions generally it may be used in either form as a cardiac stimulant. In cases of respiratory depression. In all forms of cardiac inefficiency the indications for its use are the same as for digitalis. In renal and cardiac dropsies it is valuable, and in ascites of hepatic origin it succeeds when any diuretic is of avail. It differs from digitalis in the promptness and comparatively brief duration of its effects, and is less apt to cause gastro- intestinal disturbance. Its complete destruction in the system would seem to indi- cate that it is in some degree a supporting element or food. Toxicology: Acute poisoning by caffeine is rare. The symptoms are great restlessness, frequent urination, muscular tremors, faintness, and finally collapse. Its antagonists are tannic acid chemically, and opium physiologically; the treat- ment is wholly symptomatic. Chronic coffee-poisoning is not so infrequent. The symp- toms are anaemia, insomnia, intense periodic headaches, gastro-intestinal disturbance (frequently diarrhoea), great nervousness with mental depression. The use of coffee is to be stopped at once. 116 CARDIAC DEPRESSANTS. Administration : Caffeine is one of the few alkaloids not suitable for hypodermic use because of its large dose. It is usually given in powder-form, in doses of 3 grains. Because of the well-known tendency to produce wakefulness, the doses should be given in the earlier part of the day. CARDIAC DEPRESSANTS. Antimony and its salts now enjoy much less reputation than formerly. Preparations: The preparations of antimony most in use are- Antimonii et Potassii Tartras (tartar emetic or tartarized antimony), dose gr. yg-j. Vinum Antimonii (tartar emetic gr. 1.8 to fgj), dose ffix- f3j- Syrupus Scillae Compositus (tartar emetic gr. j to f 5j). Antimonii Oxidum, Antimonii Sulphidum, and Antimonii Sulphidum Purificatum are official "for pharmacopoeial use." Antimonii Sulphuratum, Pilulse Antimonii Comp., and Pulvis Antimonialis are official, but no longer used. Physiological action: Tartar emetic may be taken as a type of the antimonial preparations. Locally, it is an irritant, and if continued may produce an eruption of papules, vesicles, and pustules resembling smallpox. In therapeutic doses it causes a slowing of the pulse, with clamminess of the skin. The emetic dose produces a soft, slow pulse, nausea, and vomiting, with free sweating. In sufficient dose it acts as a gastro-intestinal irritant, producing violent and protracted vomiting (which in rare cases may be absent even in poison- ing), profuse sweating, violent muscular cramps, a weak, thready pulse, abdominal pain, violent choleraic diarrhoea with finally bloody stools, profound depression, collapse, con- vulsions, and death from general exhaustion. The nausea and vomiting are due in part to gastro-intes- tinal irritation, and in part caused by a direct action on the vomiting-centre. The muscular cramps are probably caused ANTIMONIUM (Antimony). ANTIMONIUM. 117 by the depletion of the circulation from the violent purging ; the convulsions are likewise due to cerebral anaemia. The sweating is due to cutaneous relaxation. Two grains have caused death in an adult; gr. in a child. If given in gradually increasing doses, marked tolerance may be estab- lished. For emetic action, see Emetics. Circulation: Tartar emetic is a direct depressant of the heart-muscle, which does not respond to stimulation after death ; and this, together with a direct paretic effect on the vaso-constrictors, causes extreme diminution of the vascular tension. The spinal cord is depressed especially, it is claimed ; the sensory side is affected and the reflexes are consequently diminished. Respiration also is depressed by a direct action on its centre, and indirectly by the venous congestion and blood-changes. Secretions: Antimonial preparations increase secretions gen- erally, and especially those of the skin, bronchi, and intestinal tract, and, like other metallic salts, are probably eliminated by the intestine. Therapeutics: Tartar emetic is employed as a nauseant, emetic, sudorific, and expectorant, and locally as a counter- irritant. Practically, its use is now limited to the dry stages of laryngitis, bronchitis, and asthma, in the first two of which it produces secretion, and in the last relaxes spasm as well. It is rarely employed, because of the great depression which is apt to follow its use. Toxicology : The symptoms have been fully described ; they are those of gastro-intestinal irritation, cardiac depression, and collapse. Poisoning by antimony may closely simulate cholera ; but in rare cases there is neither vomiting nor purg- ing. Small doses administered for some time produce the same symptoms more gradually, and finally death from general exhaustion. The post-mortem lesions usually show decided evidence of gastro-intestinal inflammation. The antimony may be recovered from the body and identified by the customary chemical tests. The treatment consists of tannic acid, which forms an insoluble tannate; the hypo- dermic exhibition of morphine and free stimulation. 118 CARDIAC DEPRESSANTS. Veratrum viride is the rhizome and roots of Veratrum viride (nat. ord. Liliacese), an indigenous plant known as American or swamp hellebore, Indian poke, poke-root, green hellebore, etc. It contains two alkaloids, jervine and veratroidine, which differ physiologically in some respects. Preparations: Extractuni Veratri Viridis Fluidum, dose THj-iv. Tinctura Veratri Viridis (40%), dose U[iij- x. Norwood's tincture is one-tenth stronger; not much used. Physiological action : Jervine is a white powder, insoluble in water, ether, and alcohol, but soluble in chloroform. It acts directly to depress the cardiac muscle, does not affect the vagus, and lowers arterial pressure both by cardiac depression and by vaso-motor paralysis: the pulse-rate is diminished. Reflex excitability is also diminished by direct depression of the spinal reflex centres. Respiration is affected, and death occurs after large doses from paralysis of this function. Veratroidine, which may yet be found to be a compound substance, and closely resembles veratrine, caiises emesis, and at times catharsis, by its local irritation. Like its companion alkaloid, it lessens the reflexes and paralyzes respiration. It acts as a direct paralyzant to the heart-muscle, and indirect?/ through the vagus, and does not affect the arterial tension except by depressing the heart, having no effect on the vaso- motor system: before death the tension rises greatly from respiratory embarrassment, the drug acting as a marked respiratory depressant. The parent drug itself in moderate doses causes languor, muscular weakness, and inco-ordination, and quiets the cir- culation, lessening the pulse-rate and lowering the arterial tension. It combines the action of its two alkaloids, lower- ing arterial tension by a direct action on the heart-muscle, on the pneumogastric, and on the vaso-motor centres ; causing muscular relaxation by depression of the spinal cord; free sweating by cutaneous relaxation. Cases of poisoning are rare, as the emetic action of the veratroidine protects to a great degree against this, and the patient responds easily to VERATRUM VIRIDE, U. S. (Veratrum Viride). VERA TRINA-A CONITUM. 119 stimulation. This renders it the safest and most manageable of all the cardiac depressants. Therapeutics: Veratrum viride may be used to depress the circulation and lessen inflammatory exudation in acute inflammations, as in the early stages of pneumonia, pleurisy, etc.; but it is contraindicated in asthenic conditions gen- erally because of the depression produced. It should be given guarded by small amounts of opium to prevent vomit- ing. It may be employed in cardiac hypertrophy, when this is more than compensatory. By its depressant action on the vaso-motors it invites the blood away from an inflamed lung, besides quieting the circulation. Veratrum viride is never employed in practice as a spinal depressant. Toxicology: In toxic cases the recumbent position must be strictly enforced, with elevation of the foot of the bed, and large draughts of warm water given to wash out the stomach. Opium and free stimulation with alcohol or ammonia by the rectum or hypodermically, and general warmth to the body, complete the treatment, which is generally successful. Large amounts have been recovered from, and the minimum fatal dose is not known. Administration: Veratrum viride should be given prefer- ably as the tincture, combined with tincture of opium, and in gradually increasing and frequent doses until its physio- logical effects upon the circulation are manifested. VERATRINA, IT. S. (Veratrine). Veratrine is a mixture of alkaloids obtained from the seed of Asagrcea officinalis (nat. ord. Liliaceoe). When pure it is crystalline. It is extremely irritant when applied to any surface. It acts upon the circulation similarly to veratrum viride; but it is also a motor paralyzer, and at times causes convulsions before the paralysis (a muscle-poison); it prob- ably also paralyzes the sensory nerves. Its therapeutic uses are very limited. ACONITUM, U. S. (Aconite). Aconite is the tuber of AcomVwn Napellus (nat. ord. Ranun- culacese). Aconite, commonly called wolf's bane or monk's 120 CARDIA C DEPRESS A NTS. hood, is a plant of Europe and Asia. It resembles horse- radish, and when mistaken for this has caused fatal poisoning. It is differentiated from horseradish by its lack of odor when scraped and the brown color of its cortex. It has a bitter, acrid taste, with a benumbing after-effect on the mouth and tongue. It contains as its active principle an alkaloid, aco- nitine, in combination with aconitic acid. The preparations sold as aconitine vary greatly in potency. Aconitine is a bitter, acrid, odorless, whitish-yellow powder, producing numbness of the mucous membranes; it is partially soluble in water, and its salts are readily dissolved by water, alcohol, and chloroform. Preparations: Extractum Aconiti, dose gr. Extractum Aconiti Fluidum, dose mj-iij. Tinctura Aconiti (40%), the best preparation, dose hiss-v. Fleming's tincture is twice as strong as the official, and is chiefly used externally. Duquesnel's aconitine is crystalline; its commencing dose is gr. g-J-jy. Physiological effects : Topically, aconite produces numbness and tingling by its effect on the sensory nerve-endings. Nervous system: The cerebrum is unaffected by ordinary doses; the reflexes are diminished, largely from paralysis of the peripheral sensory nerves, but partly perhaps from paralysis of the motor nerves as well. Epileptiform convulsions, if they occur after poisonous doses, are due to cerebral anaemia. The sense of numbness and tingling is due to a direct action on the sensory nerve-terminals. Circulation: This is depressed, the pulse-rate becoming at first slow, then weak and rapid, and finally irregular from direct action upon the contained motor apparatus of the heart. The primary slowing is attributable to stimulation of the inhibitory apparatus (?). Arterial pressure is greatly lessened-whether from any specific action is not clear. Respiration is depressed and temperature lowered: the former from a centric action; the latter from increased sweat- ing and heat-dissipation. The sweating is due to depression of the circulation and to cutaneous relaxation. The secretion of urine is increased, and the drug is presumably eliminated therein. ACONITUM. 121 Large doses produce local numbness and tingling (later becoming general), motor weakness, a sense of constriction of the throat, occasionally nausea and vomiting, and always salivation, diaphoresis, and diuresis, with circulatory and respiratory paralysis and lowered temperature. After toxic doses the effects are augmented ; and there are added collapse with cold, clammy perspiration, stiffness and pallor of the face, dilated (or contracted) pupils, and finally CO2 narcosis, with death from respiratory or cardiac paralysis, preceded it may be by convulsions; usually the mind is clear to the end. Toxicology: Aconite is a very dangerous poison, as it usually paralyzes the sensory nerves of the stomach to such an extent that vomiting becomes impossible. It is a rapidly acting poison : death usually occurs in three hours. Tingling of the entire body-surface, and especially of the mouth, face, and extremities, is the diagnostic symptom. The indications are immediate evacuation of the stomach, recumbent posture, heat locally, free stimulation, and artificial respiration if the respiratory function fails. Therapeutics : From its benumbing effects on the sensory nerves the tincture is a valuable local application in all painful affections of nerves, and internally is especially efficacious in the trifacial variety. It may be employed in local itching, as in pruritus vulvce. It is of use in chronic rheumatism, gout, and other painful diseases. By reducing the activity of the circulation aconite is of value in- Acute tonsillitis and pharyngitis, in which conditions it is almost specific, acting as an analgesic to the painful parts, as well as an antiphlogistic. In acute pulmonary inflammations, as bronchitis, pneumonia, etc., aconite acts beneficially during the early stages. In acute pleurisy and peritonitis, before effusion takes place, it is doubly serviceable from the analgesia produced. In febricula and exanthemata it reduces temperature, and may palliate or exert a prophylactic influence against the complications of the latter. In these cases it must be borne in mind that very small doses sometimes produce decided effects on the pulse in children. In the reflex vomiting of pregnancy, given before meals. 122 CARDIAC DEPRESSANTS. Urethral chill after catheterization may be prevented ; but with careful attention to asepsis this will seldom occur. It is also recommended in septic conditions (as puerperal fever), facial erysipelas, overacting heart, and intestinal fluxes; but is not so much used for these purposes as formerly. PULSATILLA, U. S. (Pulsatilla). Pulsatilla is the herb of Anemone Pulsatilla and Anemone pratensis (nat. ord. Ranunculacee), collected soon after flowering. It is found in both hemispheres, and contains an acrid oily principle, which is easily converted into anemonin, a volatile, camphoraceous product, and anemonic acid, which is physiologically inert. The dose of the powder is gr. ij to iij. No other preparations are official, but of a non-official tincture the dose is Physiological action and therapeutics: Pulsatilla is an irri- tant to the skin and mucous membranes, and a depressant to the circulation, respiration, spinal centres, and peripheral nerves. It dilates the pupils and causes diuresis and dia- phoresis, and is eliminated by the urine. It thus closely resembles aconite. It has proved useful in acute catarrhs of the nasal, facial, laryngeal, and bronchial mucous membranes, but probably only in the early stages, like other depressants, and is contraindicated in inflammations of the gastro-intestinal tract, because of its irritant tendencies. It has a good repu- tation in epididymitis and functional amenorrhoea and dys- menorrhoea. Many clinicians report that pulsatilla has entirely failed in their hands. Arnicae Flores, U. S. (Arnica Flowers). ARNICA. The flower-heads of Arnica montana (nat ord. Composite). Arnicse Radix, U. S. (Arnica Root). The rhizome and roots of Arnica montana (nat. ord. Com- posite). Habitat: Europe, Northern Asia, Northwestern America ; in mountainous localities. Both flowers and roots contain a volatile oil and arnicin. STAPHISAGRIA-ACIDUM HYDROCYANICUM. 123 Preparations: The number of official preparations is in inverse ratio to the therapeutic importance of the drug. They are- Tinctura Arnicse Florum (20%), dose 1ffx-f5ss. Tinctura Arnicse Radicis (10%), dose Tffxx-fsss. Extractum Arnicae Radicis, dose gr. iij-v. Extractum Arnicae Radicis Fluidum, dose Yflv-x. Emplastrum Arnicae extract). Physiological action and therapeutics: Locally, arnica and its preparations arc irritant, producing a decided eczema on delicate skins, and marked symptoms of gastric irritation when taken internally. Of its systemic effects very little is known. It appears to be a decided cardiac depressant, having, however, less effect on the vaso-motor system than most drugs of this class. It is not used to-any extent inter- nally. The tincture of the flowers is used locally. No fatal cases are recorded, though decided poisoning has occurred in a number of instances; the symptoms have varied consider- ably. Coma, delirium, diaphoresis, and diuresis approaching collapse have been noted. Staphisagria is the seed of Delphinium Staphisagria (nat. ord. Ranunculaceae), stavesacre or licebane, a flowering plant of Southern Europe. The seeds contain an alkaloid, delphinine, which acts locally as a rubefacient and even irri- tant; and internally as a cardiac and respiratory depressant and paralyzer of voluntary muscles (motor nerves). It kills by arrest of respiration. The principal symptoms produced are dyspnoea, salivation, and vomiting. The seeds contain other alkaloids of unknown activity. It has been recom- mended in rheumatism, dropsy, vomiting of pregnancy, etc. ; but its chief use is as a parasiticide ointment (3j-ij of seeds to .sj) in phtheiriasis and scabies. STAPHISAGRIA, U. 8. (Staphisagria). ACIDUM HYDROCYANICUM (Hydrocyanic Acid). Pure hydrocyanic acid (HCN) is a colorless, transparent, inflammable liquid, extremely deadly even when inhaled, 124 CARDIAC DEPRESSANTS. which accident, owing to its extreme volatility, may occur when carelessly handled (prussic acid). It is readily pro- duced in small amount in a number of vegetable substances, especially the bitter almond, peach-kernel, wild cherry, and cherry-laurel. It is not used in medicine. Preparations: Acidum Hydrocyanicum Dilutum, a 2 cfi watery solution, is formed by the reaction of potassium ferro- cyanide and sulphuric acid, or by precipitating silver cyanide from its solutions by means of hydrochloric acid. Under the influence of light it decomposes and deteriorates. Dose Ulj-iv. Potassii Cyanidum, dose gr. -J- Potassii Ferrocyanidum, used only as above indicated. Oleum Amygdalae Amarae (natural) contains hydrocyanic acid if unpurified, varying in amount, and developed from a principle called amygdalin, under the influence of a ferment. It is about five times as strong as the official dilute acid, and the dose is accordingly 1-. Much of the commercial article is artificially prepared benzoic aldehyde, C6H5COH, chemically identical with oil of bitter almond, and contains no HCN. Physiological action: Locally applied, the drug causes numbness, and may be absorbed by the mucous membranes. Nervous system: Small doses produce simply a calming effect upon the cerebrum, while larger ones cause giddiness, confusion, and convulsions which have been shown to be of cerebral origin, not occurring in parts below a section of the spinal cord. The motor and sensory nerves and the spinal centres are depressed. Circulation: Small doses simply quiet the heart, while toxic doses stop it in diastole, apparently from a direct effect on its muscle and contained ganglia. The vaso-motor system is paralyzed after a brief period of stimulation. Blood- changes occur, the exact nature of which is not clear. There is at first excessive oxidation of the blood, the venous becom- ing of arterial hue, and later excessive carbonization. Outside the body a mixture of this drug with blood produces cyano- haemoglobin, which has little or no ozonizing power. This may take place in the body, and be one of the causes of death. A CID UM HYDROCYA NICUM. 125 Respiration: Ten to fifteen minims produce disturbance of this function, rendering it labored and irregular. Toxic doses cause death by paralysis of the respiratory centre. The muscles, both voluntary and involuntary, are affected by the drug, and lose partially or in toto their power of electric excitability after death. Elimination is rapid by the saliva, kidneys, and lung, so that those who barely escape toxic effects rally very quickly. Toxicology: After overwhelming doses death may take place almost immediately, with hardly any prior symptoms. In the slower forms three stages are recognized (Wood): (1) a very brief period characterized by depression of all the organic functions, especially respiration and circulation ; (2) a convulsive stage, in which the pupils are dilated, convulsions with spasmodic evacuations occur, and unconsciousness super- venes ; (3) a stage of asphyxia, paralysis, and collapse. The most diagnostic points are the suddenness of the development of the unconsciousness and other symptoms, and possibly the recognition of the odor of prussic acid upon the breath. The treatment is generally of no avail. Evacuation of the stom- ach, ammonia by inhalation and hypodermically, the use of the hot and cold douche, and artificial respiration are indi- cated, remembering that either a fatal termination or recovery may be expected quickly. The cyanides produce similar symptoms, though they act more slowly, because the cyanide is decomposed in the stom- ach with production of hydrocyanic acid. The only other form of poisoning which resembles that of prussic acid is that of nitrobenzole (QgH5NO2), or oil of mirbane. In large doses this may cause death as quickly and in a similar manner as hydrocyanic acid. Taken in small quantity the symptoms are often delayed for some time; then cyanosis begins, with circulatory and respiratory depression, stertorous breathing, and profound unconsciousness. The patient usually dies from centric respiratory arrest. The treatment is essentially the same as that for prussic acid-cardiac and respiratory stimulants, with perhaps hypo- dermoclysis. Oil of mirbane may be identified by the odor alone-it resembles that of oil of bitter almond, but has a 126 VEGETABLE ACIDS. peculiar rank flavor. It is used largely in the arts as a cheap substitute for the latter, as in perfuming soap. Poisoning has occurred from the use of such soap in washing the hands. Chemically, nitrobenzole is converted into aniline by oxidiz- ing agents. In cases of poisoning its odor is persistent, while that of hydrocyanic acid is so evanescent that it may entirely escape observation. Therapeutics : Hydrocyanic acid is used as an antispasmodic and analgesic in a variety of conditions, as in gastrodynia and neuralgic abdominal conditions, and in checking per- sistent vomiting ; in the coughing of bronchitis, pulmonary tuberculosis, and the spasmodic cough of pertussis and asthma; it is a favorite ingredient of cough-mixtures, gen- erally in some combination with opium; to allay irritability of the cutaneous nerves in neuralgia, urticaria, and prurigo; locally, fsj-ij to water Oj. Administration: The dose of the official preparation is 1 to 3 minims gradually increased, remembering that it is unstable and apt to vary in strength. Potassium cyanide is formed by heating potassium ferro- cyanide with potassium carbonate (U. S. P.). It is non- crystalline, of characteristic odor and taste, deliquescent, and readily soluble in water. Being converted by the stomach acids into prussic acid, its physiological and toxic effects are the same, and it may be substituted therapeutically. Five grains have proven fatal; dose should not exceed gr. -j-. Oleum Amygdalae Amarae is to be carefully discriminated from the expressed oil of almond, the dose of which is ad lib- itum. Of Aqua Amygdalae Amarae (1 : 1000) (bitter almond water) the dose is POTASSII CYANIDUM, U. S. (Potassium Cyanide). VEGETABLE ACIDS. The official vegetable acids are tartaric, citric, and acetic, the last only being liquid, the others solid. They are all slight cardiac depressants, and from their "refrigerant" ACIDUM CITRICUM-ACIDUM TARTARICUM. 127 effects-which are by no means very marked-may be con- sidered here. They affect secretion as do the mineral acids, increasing the alkaline and decreasing the acid secretions of glands with which they come in contact. Thus the salivary and intestinal secretions are increased. They all increase and slightly acidify the urine, and after continued use are apt to derange the digestion. Acidum citricum, citric acid, is the familiar acid of lemon- or lime-juice. It is generally used in the form of lemon-juice (succus limonis, the juice of Citrus limonum). Citric acid is made from lime-juice by saturating the boiling liquid with calcium carbonate; the resulting calcium citrate is insoluble in boiling water and subsides. It is collected, decomposed by sulphuric acid with the formation of calcium sulphate as a precipitate, and the solution is evaporated until it crystallizes. It is the mildest of the acids, non-toxie in man, and a certain pro- phylactic against and specific for scurvy. It has been used with good effect in acute rheumatism, but is inferior to the alkalies and salicylates. Citric acid in the form of lemon-juice is also used in tor- pidity of the liver, in catarrhal jaundice, and as hot lemonade at the beginning of a cold. Neutralized with potassium bicarbonate, lemon-juice forms the mixture formerly official as Mistufa Potassii Citratis, which is a useful basis of refrigerant fever-mixtures and which is superior to the preparation at present official as Liquor Potassii Citratis, made from citric acid instead. In all its therapeutic uses it should be remembered that lemon-juice is distinctly more efficacious than any mixture containing citric acid only, and should be preferred. Whenever mistura potassii citratis is ordered (neutral mixture) the pharmacist is required to pre- pare it from fresh lemon-juice. ACIDUM CITRICUM, U. S. (Citric Acid), H3C6H5O7H2O. ACIDUM TARTARICUM, U. S. (Tartaric Acid). Acidum tartaricum, tartaric acid, is the acid of grape-juice, and is prepared from argol, or crude cream of tartar, which is 128 VEGETABLE A CIDS. impure potassium bitartrate, which deposits on the sides of the casks during tiie fermentation of wine. It is the only one of the vegetable acids which yields a precipitate (cream of tartar, or potassium bitartrate) with solutions of neutral potassium salts. It is cheaper than citric acid, and may be substituted for it. Tartaric acid is distinctly more irritant than citric acid, and a few fatal cases are recorded. It produces the gastro- enteritis caused by irritant poisons, with cardiac depression. The treatment consists in the administration of milk, alkalies, mucilaginous drinks, etc. The after-treatment is directed to the effects of the irritant on the gastro-intestinal mucous membrane. Its chief use is in the Scidlitz Powder (g. r.) and other effervescing draughts; citric acid is preferable for most of its indications. ACIDUM ACETICUM, U. S. (Acetic Acid). Acidum aceticum, the official acid, is a liquid containing 36% of absolute acetic acid (HQH/X = 59.86) and 64% of water, and is used as a mild caustic to warts and exuberant granulations. Acetic acid may be made by distilling vinegar, which is prepared by allowing a dilute alcoholic liquid to trickle over beech-wood shavings until the alcohol has been oxidized to aldehyde and finally to acetic acid. Most of the commercial acid is made by subjecting oak-wood to a tem- perature short of carbonization (dry distillation), thereby avoiding the formation of empyreumatic substances. Acidum Aceticum Dilutum contains 6 % of the same, and is the only preparation employed internally. Acidum Aceticum Glaciale is nearly absolute acetic acid, is a crystalline solid at or below 59° F., and is employed as a caustic only. The dilute acid is somewhat used as a refrigerant. Locally, it is a cooling and pleasant application in febrile conditions and in superficial cutaneous inflammations, as sunburn, while injections of vinegar and water are said to be useful in vaginal gonorrhoea. Pmegar is one of the best applications in post-partum hemor- rhage ; it is applied directly to the womb by means of a sponge. OXALIC ACID. 129 OXALIC ACID. Oxalic acid is not much used in medicine, and is inter- esting chiefly from its toxic effects. It is prepared by acting on sawdust with a mixture of potassium and sodium hydrates at a temperature of 200° C. Oxalic acid occurs in small colorless, prismatic crystals, which may be distinguished from magnesium sulphate by their sour taste; and from zinc sul- phate by the astringent, nauseating taste of the latter. The acid is frequently used to remove ink-stains, and fulfils a variety of purposes in the arts. In medicine it has been recommended as an emmcnagogue in doses of gr. 1 three times a day, given in syrup of lemon. It is a powerful germicide and is extensively used to disinfect the hands of the surgeon: the hands are first carefully cleaned, then immersed in a solution of potassium permanganate. This stains them a deep mahogany color, which is removed by dipping them into a solution of oxalic acid (saturated). The acid is finally removed by thorough washing in sterile water. Oxalates appear in the urine of patients suffering from neurasthenia; they are probably caused by deficient tissue- metabolism. Toxicology: The poison is taken either as the acid itself or as acid potassium oxalate (or " essential salt of lemons "). The symptoms produced are intense burning in the region of the oesophagus and stomach, abdominal pain, vomiting of an acid, generally bloody, mucus, collapse, and in some cases paralysis. The autopsy shoAVS erosions and perhaps perforation of the stomach, and an excess of oxalate crystals in the kidneys. The antidote is lime or chalk in the most quickly available form, as Avhitewasli; or the precipitated calcium carbonate or syrup of lime may be administered. Alkalics are to be carefully avoided, as they render the acid more soluble. ASTRINGENTS. Astringents are medicines which produce corrugation and contraction of the tissues by their local action. They are employed as tonics, as correctives to relaxation of tissues, 9-Af. AT. 130 VEGETABLE ASTRINGENTS. and to prevent excessive secretory or hemorrhagic discharges. They are divided into vegetable and mineral astringents. VEGETABLE ASTRINGENTS. The vegetable astringents include a large number of drugs acting as above indicated, and possessing this power by virtue of tannic acid or its derivative, gallic acid. ACIDUM TANNICUM, U. S. (Tannic Acid), HC14H9O9 = 321.22. Tannic acid is derived from nutgall by the action of washed ether, the water being the solvent agent. It is a yellowish- white, non-crystalline powder of astringent taste, and is easily soluble in water, alcohol, and glycerin. It precipitates albumin, gelatin, and the alkaloids, and with iron salts forms ink. It is a glucoside, being changed by dilute mineral acids into glucose and gallic acid, and is gallic anhydride, or gallic acid minus 1 molecule of water. Preparations : Acidum Tannicuni, dose gr. j-xv. Glyceritum Acidi Tannici (20% in glycerin). Trochisci Acidi Tannici; each contains gr. j. Unguentum Acidi Tannici (20% in benzoinated lard). Physiological action: Its effects throughout are due to a local action. It coagulates tissue-albumin, lessens the cal- ibre of superficial vessels, and causes diminished secretions wherever applied. It checks peristalsis. It is absorbed after conversion into gallic acid, is reconverted into tannic acid in the blood (?), where it exists as an albuminate, and is eliminated by the kidneys and intestinal canal as tannic, gallic, and pyrogallic acids. Injected into the blood, it causes multiple thrombosis. ACIDUM GALLICUM, V. S. (Gallic Acid), HC7H5O5+H2O =187.55. Gallic acid is obtained by the hydration of tannic acid, either slowly by exposure to the atmosphere (in contact with water) or quickly through the agency of dilute sulphuric acid. It is crystalline, slightly soluble in cold water, but readily so in alcohol, and should be given in alcoholic soln- ACIDUM GALLICUM. 131 tion, from which it is not precipitated by water. Acidum Gallicum, dose gr. v-xv. Tannic acid differs from gallic acid as follows : It is less irritant, and therefore preferable for internal administration with a view to remote astringency, although some writers deny to it anything but a local astringency. Its local effects are similar to, but less in degree than, those of tannic acid. The following table expresses these differences and others : Tannic Acid. Non-crystalline. Soluble in water. Not readily absorbed as such. Precipitates albumin and gelatin. Locally astringent. Gallic Acid. Crystalline. Slightly soluble. Readily absorbed. Does not. Remotely (?) astringent. Therapeutics: From their different physiological action various differences result in their use. Thus, tannic acid is valuable in hemorrhages and increased secretions where local application is possible, as in luxmatemesis and intestinal hemor- rhages, either from simple or typhoid ulcers or from portal congestion, but not in those resulting from acute inflam- mation ; in epistaxis and oozing from large surfaces, as a styptic; in gastric catarrh from relaxed conditions of the mucous membrane; in diarrhoeas when acute stages have subsided, and especially in chronic diarrhoea, chronic dysen- tery, and the colliquative diarrhoea of phthisis, generally with opium ; in mercurial stomatitis, elongated uvula, and relaxation of the palate, as a mouth-wash or gargle ; in the various forms of conjunctivitis and keratitis; in chapped nipples and soreness of the feet, to harden the skin : for the former glycerite of tannin is especially good ; as an antidote to all the alkaloids and to tartar emetic: with the former it forms an insoluble tannate; in hemorrhoids it is a good ingredient in ointments; in catarrh of the cervix and body of the uterus tampons of glycerite of tannin, or iodoform and tannin in powder-form, are particularly valuable ; in the chronic vulvitis or chronic otorrhoea of children glycerite of tannin is of service. G-allic acid is used as follows by those who consider it to have a remote action : 132 VEGETABLE ASTRINGENTS. In pulmonary and renal hemorrhage ; in the hemorrhagic diathesis, as evidenced by menorrhagia, hsematuria (when not malarial), epistaxis, or purpura, it should be given, alternat- ing but not combined with iron compounds, or combined with ergot and digitalis; in chronic bronchitis with profuse expectoration; in the colliquative sweating of pulmonary tuberculosis it is often used, combined with belladonna or hyoscyamus or alternating with zinc oxide. PYROGALLOL, U. S. (Pyrogallol; Pyrogallic Acid), C6H3(OH)S= 125.7. A triatomic phenol, obtained chiefly by the dry distillation of gallic acid. It occurs in white, shining plates or tine needles, readily soluble in water and alcohol. In animals large doses have produced vomiting, dyspnoea, coma, convnl- sions, and death. Pyrogallol has been used in psoriasis and parasitic skin diseases in the form of a stimulating ointment ; it stains the skin deep brown. The following vegetable astringents owe their activity principally to the tannic acid they contain : GALLA, U. S. (Nutgall). Galla is an excrescence on Quercus lusitanica (nat. ord. Cupuliferae), caused by the punctures and deposited ova of Cynips Gallce tinctorice (class Insecta, order Hymenoptera). Habitat: the Levant. It yields its properties to water and alcohol, more readily to the former. Two varieties are rec- ognized, black and white galls, the latter being inferior in strength. Tannic acid is present to the extent of about 60%, gallic acid 3%. The preparations are- Tinctura Gal he (20%), dose Unguentum Gallse (20%). Nutgall is not much used internally. It is used as a gargle, and as an enema in chronic dysentery due to ulcerations in the lower cud of the large intestine; as an ointment for hem- orrhoids and in certain irritable skin lesions, notably urticaria. KR A MERIA-KINO. 133 KRAMERIA, U. S. (Krameria; Rhatany). Krameria is the root of Krameria triandra and of Krame- ria Ixina (nat. ord. Polygaleae). Habitat: Peru and Bolivia ; K. tomentosa, New Granada. The cortical portion is most efficient. It contains kramero-tannic acid (about 20%), and has an astringent, slightly bitter, and sweetish taste. The dose of the powder is gr. xx-xxx. Its prepara- tions arc- Trochisci Krameriae, each containing gr. j. Extractum Krameriae, dose gr. v-xv. Extractum Krameriae Fluidum, dose ffixx-fgj. Syrupus Krameriae (| fl. ext.), dose f?j-iij. Tinctura Krameriae (20%), dose It is a favorite remedy in diarrhoea, especially the summer diarrhoea of children, and in dysentery, intestinal hemor- rhages, etc.: it is administered by mouth, or, when the lesion is in the lower intestinal tract, by enema. CATECHU, U. S. (Catechu; Cutch). Catechu is an extract prepared from the wood of Acacia catechu (nat. ord. Leguminosae), a small East Indian tree. It is composed of catechu-tannic acid 50%, catechin (an extrac- tive) 30%, and other ingredients. Its uses are those of krameria, but it is more powerful from its larger percentage of tannic acid; also used as an urethral injection in chronic urethritis, for which purpose the compound tincture is diluted with water. Like krameria, it is often employed in com- bination with other measures. Gambir is similar in compo- sition and properties. The official preparations of catechu are- Catechu (powdered), dose gr. x-3ss. Trochisci Catechu, in each gr. j. Tinctura Catechu Composita (contains cinnamon), dose f-Jss-ij. KINO, U. S. (Kino). Kino is the inspissated juice of Pterocarpus marsupinm (nat. ord. Leguminosae), an East Indian tree. It occurs, in 134 VEGETABLE ASTRINGENTS. brittle, reddish-brown fragments, breaking in angular forms, and having a very astringent taste. It contains kino-tannic acid. Tinctura Kino (10%) is official, dose f.oj-ij, and it contains 15% of glycerin to prevent precipitation. Of the powder the dose is gr. x-xxx. It is a favorite remedy in intestinal hemorrhages and fluxes, and is employed as an injection in leucorrhoea, gonorrhoea, and gleet. HAMATOXYLON, U. S. iHaematoxylon). Hsematoxylon is the heart-wood of Hcematoxylon campechia- num (nat. ord. Leguminosse). This tree is indigenous in Central America; naturalized in the West Indies. The wood contains tannic acid, haematoxylin, haematein, which is used as a dye, etc. It is used for the same purposes as its sister remedies. The red color imparted to the stools may arouse suspicions of hemorrhage. It is particularly advo- cated in cholera infantum and the diarrhoea of phthisis. It has an official extract, given in gr. x-xxx doses. Geranium is the rhizome of Geranium maculatum (nat. ord. Geraniacese). Habitat: North America. Geranium contains tannic and gallic acids, gum, resin, starch, etc. It is an excellent astringent, well borne by the stomach, and can be substituted for the more expensive foreign drugs in any of their uses, as in enema, injection, gargle, or internally. I)ose of the powder, gr. xx-xxx ; of the fluid extract, fjss-j. GERANIUM, U. S. (Geranium; Crowfoot or Cranesbill) HAMAMELIS, U. S. (Hamamelis; Witchhazel). Hamamelis is the leaves of Hamamelis virginiana (nat. ord. Hamamelaceae), collected in autumn. Hamamelis virginiana is an indigenous shrub : the bark may also be used. It contains tannic acid and other principles. It is used as an astringent, and is thought by some to have haemostatic prop- erties peculiar to itself. It is particularly useful in hemor- rhoids, both locally and internally, and to fulfil any indication for tannic acid. Hamamelis has an official fluid extract, dose fsss-j. The so-called spirit of witchhazel is made by adding QUERCUS ALBA. 135 about 10% of alcohol to an aqueous distillate of the leaves, which enjoys much the same reputation among the laity for- merly possessed by tincture of arnica. QUERCUS ALBA, U. S. (White Oak). The bark of Quercus alba (nat. ord. Cupuliferae). Habi- tat : North America. The bark contains querco-tannic acid, 6-11 %, which turns bine with ferric salts. It is used as an astringent, and fidfils the indications for tannic acid. It has no official preparations, and a decoction may be used. As a cheap source of tannic acid, the infusion or decoction may be used when an astringent wash or a bath is indicated for the entire surface of the body. Rhus Glabra, U. 8. The fruit of Rhus glabra (nat. ord. Anacardicae). Habitat: North America. Sumach. This drug owes its acidity to malic acid, present as calcium and potassium malates, and is used as an agreeable astringent, acid addition to gargles in acute and subacute pharyngitis. It is frequently combined with potassium chlorate. Dose of the official fluid extract Rosa Gallica, U. 8., Red Rose. The petals of Rosa gallica (nat. ord. Rosaceae), collected before expanding. Habitat: Asia Minor and Southern Europe; cultivated. The petals contain quercitrin and volatile oil, and are used as a mild aromatic astringent. Preparations: Extraction Rosae Fluidum, dose fsj-ij; Syrupus Rosae fluid extract), dose f.~j ; Mel Rosae (12% fluid extract), dose f 3j ; Confectio Rosae, a useful excip- ient for pills. Rosa Centifolia, U. 8., Pale Rose. The petals of Rosa centifolia, (nat. ord. Rosaceae). Pale rose contains volatile oil and tannic acid. Oleum Rosai, U. S., is a volatile oil distilled from the fresh yZowers of Rosa damascena (nat. ord. Rosaceae). Aqua Rosai, U. S., and Aqua Rosce Portion, IT. S., are 136 MINERAL ASTRINGENTS. obtained as by-products in the manufacture of oil of rose, and are used as flavors. Rubus, U. S., Blackberry. The bark of the root of Rubus villosus, Rubus canadensis, and Rubus trivialis (nat. ord. Rosacea;). The bark of the root of the indigenous black- berry; a useful astringent, due to the tannic acid it con- tains. Dose of the official fluid extract, fyj. Syrupus Rubi contains 25% of the fluid extract. Castanea, U. S., Chestnut. The leaves of Castanea dentata (nat. ord. Cupulifene), collected in September or October, while still green. The official fluid extract has enjoyed a reputation as an efficient antispasmodic in pertussis. Dose Agaric (Agaricus albus ; Boletus laricis). Agaric, or larch fungus, is a fungus derived from Polyporus officinalis. It contains agaric acid, which is used to control night-sweats in doses of gr. 1. Large doses of agaric produce purging, but no poisonous effects. These and many others contain tannic acid, and may be used in the form of a decoction. MINERAL ASTRINGENTS. Mineral astringents are a class of metallic salts having many actions and uses in common, but differing widely in other respects. As astringents their uses correspond to those given above. ARGENTUM (Silver). Preparations : silver is inert. Argenti lodidum, U. S., AgT 234.19; dose gr. j-ij. Argenti Nitras, 17. 8., AgNO3 -- 169.55; nitrate of silver, an anhydrons salt occurring in colorless rhombic crystals freely soluble in water. It has a metallic, astringent taste, and gives a white precipitate (silver chloride) with soluble chlorides; dose gr. ARGENTUM. 137 Argenti Nitras Fusus, U. S. (lunar caustic); for external use. Argenti Nitras Dilutus, U. 8., "mitigated stick," equal parts of silver and potassium nitrates ; for external use. Argenti Oxidum, U. 8., Ag2O = 231.28 ; a brownish pow- der slightly soluble in water; dose gr. j. Argenti Cyanidum, U. 8., AgCN = 133.64; pharm. use. Incompatibles and antidote of silver : Silver salts are incom- patible with hydrochloric, sulphuric, tartaric, and sulphurous acidsand their salts; with alkalies, alkaline carbonates, and astringent solutions. The antidote is common salt (sodium chloride) in large amounts in tepid, water, which acts to form the insoluble silver chloride and as an emetic. Physiological action: Locally, the nitrate of silver, which is the preparation most used, is a mild caustic, forming silver albuminate and limiting its own action, the skin becoming brown, changing to black. Nervous system: In small doses it is a tonic and antispas- modic; in large doses it causes headache, vertigo, loss of memory, nervous depression, etc., by a centric action, and hypodermically may paralyze. Circulation: Heart not affected; silver salts probably are absorbed into the blood as albuminates. Small doses increase the secretions of the gastro-intestinal tract and of the liver; large doses or long-continued use causes catarrhal symptoms, and may even result in erosions and ulcers of the stomach. Toxicology: Large doses of silver nitrate cause abdominal pain, with purging and vomiting of white curds (silver chloride), which rapidly become darker; the lips may be stained white, becoming brown and then black; nervous symptoms develop, such as headache, vertigo, unconsciousness, epileptiform convulsions, and finally death from asphyxia. The treatment consists in the immediate administration of sodium chloride, the chemical antidote, evacuation of the stomach, and symptomatic treatment. Chronic argyria is a term applied to a train of symptoms following the prolonged use of the drug. Owing to its slow elimination by the kidneys and intestines, it becomes deposited 138 MINERAL ASTRINGENTS. in the tissues, and when this deposit is exposed to the light, as in the skin or mucous membranes, a slate or bluish color is developed. Parenchymatous or fatty degeneration of the liver and kidneys may also take place. The treatment of this condition consists in administering potassium iodide to cause elimination, with baths of sodium hyposulphite, or in local applications of potassium cyanide. These measures usually fail. Prophylaxis is important. Never continue the use of silver salts more than six weeks at a time. Therapeutics : Locally, the nitrate is used in acute tonsillitis in early stages ; a strong solution (5ss to f§j) may abort or at least greatly alleviate. Ulcers of the mucous membranes, as of the mouth, tongue, cervix uteri, and endometrium, whether syphilitic or other- wise, may be benefited by strong solutions or the " stick." In indolent ulcers or sinuses as a stimulating application. In irritable ulcers the " stick " forms a protecting pellicle and relieves pain; in vaginal gonorrhoea it may be used in strong solutions, and is sometimes injected into the male urethra to abort gonorrhoea, with doubtful results; in cystitis dilute solu- tions are often indicated. In granular urethritis a deep injection of 1f[v-x of a gr. x to solution may cure; pruritus vulvas is cured by application of a solution (gr. xx to to cervix, vagina, or external genitals, depending on the seat of the cause of the reflex excitement; in conjunctivitis weak solutions (gr. j to f 5j) or the mitigated stick, if of the granular variety. There is danger of deposits of silver salts on corneal ulcers, and consequent opacities, hence zinc salts arc preferable; cystic tumors, hydrocele, and interstitial thyroid tumors may be cured or diminished by the injection of Tflij-x of a 20-grain solution, first having withdrawn the fluid, if any. Internally, nitrate of silver is used in the later stages of cholera infantum as an astringent; in the summer diarrhoea of children ; in chronic dysentery, cither by mouth or by high enemata (gr. xx-xxx to water Oj); in chronic diarrhoeas, as of tuberculosis, generally with opium ; in nervous dyspepsia and chronic gastritis, in which gastralgia and symptoms of fermentation are prominent; in gastric ulcer the nitrate BISMUTH. 139 stimulates healing and relieves pain ; in chorea as an anti- spasmodic it may improve; the progress of locomotor ataxia may apparently be stayed. Pepper recommends its use in gr. 1 doses during the entire attack of typhoid fever. Administration: Silver nitrate is decomposed so readily that few substances are compatible with it. For intestinal medication it is best prescribed in the form of pills, which may be coated with keratin, so as not to dissolve in the gastric contents. To produce the best effect on the gastric mucous membrane the nitrate is ordered in solution in dis- tilled water (gr. ] to and diluted with about 2 ounces of water before it is taken ; if the stomach contains much mucus, it may be washed out by administering a few grains of sodium bicarbonate dissolved in a glassful of hot water half an hour before giving the nitrate. Silver nitrate is essen- tially a sedative, alterative astringent to mucous membranes. BISMUTHUM (Bismuth). Official salts: Bismuthi Citras, U. S., Bismuth Citrate. Bismuthi ct Ammonii Citras, U. S., Bismuth and Ammo- nium Citrate. Bismuthi Subcarbonas, U. S., Bismuth Subcarbonate. Bismuthi Subnitras, U. S., Bismuth Subnitrate. The subcarbonate and subnitrate of bismuth are practically insoluble and identical in action. The subnitrate is in more general use. It is a white, odor- less, almost tasteless, very heavy, insoluble powder. Locally, the insoluble salts of bismuth exert a protective, antiseptic, sedative, and astringent action ; this is especially marked on the mucous membranes, and makes them peculiarly valuable in acute and subacute inflammations of the entire gastro- intestinal tract. The heavy character of the powder renders the action persistent. Formerly, cases of poisoning were reported from large doses; but it is more than probable that these effects were caused by contamination with arsenic. The peculiar local action of the subnitrate has led to its use locally to abraded surfaces, and a number of cases are recorded in which its 140 MINERAL ASTRINGENTS. application to large surfaces was followed by toxic symptoms. These were, particularly, the appearance of a stomatitis with blue or black spots on the gums, often involving the entire mucous membrane of the mouth ; diarrhoea, and in severe cases albuminuria with epithelial casts. There is often a garlicky odor to the breath. The insoluble salts are non-toxic when given internally; the soluble ones, such as the citrate and ammonio-citrate, are capable of causing violent intestinal irritation. Fatal cases show fatty degeneration of the liver, heart, and kidneys, the metal appearing in the urine during life. The stools are colored dark green or black during its administration. The bismuth salts are used in allaying irritation of mucous membranes; in vomiting; in diarrhoeas, where carbolic acid (lT[j) frequently forms a useful addition; in mariy inflamma- tions of the gastro-intestinal tract, where their tendency to produce constipation must not be lost sight of. They have been used in gonorrhoea, leucorrhoea, and coryza. Bismuth subnitrate is best exhibited in the form of powder. It may be administered in capsides, or in the form of mixture, remembering its very heavy character. Dose gr. v-xxx. The citrate of bismuth and ammonium is soluble, more rapid in action, more astringent, and much more irritant. Its use is rarely indicated. Dose gr. j-iij in solution. CUPRUM (Copper). Preparations : Cupri Sulphas, U. S., Blue Vitriol or Blue Stone, dose gr. j-v. Copper sulphate is obtained by roasting the native sul- phide, and occurs as a by-product in silver-refining. It is in the form of prismatic blue crystals, efflorescing slightly and becoming covered by a white powder. It has a styptic taste, and is freely soluble in water. Copper acetate occurs in bluish-green rhombic prisms, and resembles the sulphate. Incompatibles and antidotes: The alkalies, alkaline car- bonates, mineral salts, iodides, and vegetable astringents arc incompatible with copper salts. Acute poisoning is rare CUPRUM. 141 because the salts act as emetics. The antidotes arc albumin (white of egg, Hour, etc.), forming an insoluble albuminate, or potassium ferrocyanide, which forms copper ferrocyanide; after the use of either, the stomach should be emptied by the stomach-pump or an emetic. Physiological action: Metallic copper is inert. Locally, its salts are astringent and mildly caustic to mucous membranes and abraded surfaces. Nervous system: In small doses it is a tonic; but in large doses it causes headache, vertigo, inco-ordination, cramps, stupor, with perhaps convulsions and paralysis. Circulation : It probably exists in the blood as an albumi- nate ; large doses are cardiac depressants. Poisonous doses produce symptoms of gastro-enteric irrita- tion and collapse-viz., vomiting, abdominal cramps, diarrhoea with greenish or bloody stools (in chronic poisoning it resem- bles lead, causing cramps and constipation), coldness of skin, rapid and shallow breathing, cardiac depression, and any of the cerebral symptoms mentioned above. The urine is fre- quently black from altered haemoglobin, and if the patient live for twenty-four hours, jaundice is not an uncommon symptom. Fatty degeneration of the liver may be found after death. Copper sulphate is exceedingly rapid in its action. The antidote-milk, eggs, and potassium ferrocyanide -should be given quickly, followed by evacuation of the stomach. Chronic poisoning may result from the inhalation of fumes in certain arts or from eating food cooked in copper vessels. The symptoms are those of bronchial or gastro- intestinal irritation, with or without cerebral symptoms. Therapeutics: Locally, its sulphate may be used in indolent ulcers to stimulate granulations; in granular eyelids; in gonorrhoea after acute stage, as injection, gr. j to f.yj ; in scabies and tinea, as lotion or ointment. Internally, it is occasionally of service in chronic diarrhoea and dysentery, gr. combined with opium and gradually increased to gr. very efficient ; in vomiting of pregnancy, gr. T'(T, it acts as an anti-emetic. In neuralgia, chorea, and epilepsy it is seldom used. Copper sulphate forms the most efficient antidote to phosphorus-poisoning; gr. v, the 142 MINERAL ASTRINGENTS. emetic dose, should be given at once, and repeated if neces- sary. It combines with phosphorus to form an insoluble copper phosphide, acting as an emetic at the same time. For its emetic action, see Emetics. Metallic zinc is inert. Its salts act in a way analogous to, but much milder than, copper. Preparations: Zinci Acetas. Zinci Carbonas Praecipitatus, pharmacopceial use. Zinci Chloridum, caustic. Liquor Zinci Chloridi (50% chloride). Zinci lodidum, dose gr. ss-ij. Zinci Oxidum. Zinci Sulphas (white vitriol), dose gr. j-xxx. Ungucntum Zinci Oxidi. Zinci Valcrianas, dose gr. j-ij. Zinci Bromidum and Zinci Phosphidum are considered under Bromum and Phosphorus, respectively. Olcatum Zinci, for external use. Incompatibles and antidotes: Zinc is incompatible with alkalies and alkaline carbonates, nitrate of silver, and vege- table astringents, all of which precipitate zinc salts. In poisoning, which only occurs after the more powerful salts, the milder acting as emetics, the proper antidotes are albumin, mucilaginous drinks, soap, and opium. Physiological action: The soluble salts (chloride, sulphate, and acetate) are readily absorbed, probably as albuminate, and are more active than the insoluble. Elimination takes place by the secretions of the liver, intestines, and kidneys, and, although slow, is comparatively much more rapid than that of silver, lead, or copper. Locally, they act by coagu- lating albumin, the chloride being a strong escharotic and disinfecting its own slough, the sulphate acting much more mildly, and solutions of proper strength are mild astringents. Acute poisoning is rare because of emetic action. It resem- bles acute poisoning by copper: the symptoms are pain, nausea, vomiting, purging, and death from violent gastro- ZINCUM (Zinc). PLUMBUM. 143 enteritis. Eggs and milk are to be given ; soap, alkalies or their carbonates are the chemical antidotes. Chronic poison- ing may cause a train of symptoms similar to chronic plumb- ism-constipation, colic, muscular weakness, or multiple neuritis. Both forms of poisoning rarely occur. Therapeutics: Zinc sulphate is used as an emetic (see Emetics). The emetic dose is gr. xxx. It is also used in bronchitis with profuse expectoration as a remote astringent; in nervous disorders, as chorea, epilepsy, etc., as an anti- spasmodic and nervous tonic, but not so much as formerly. Locally, it is used as an astringent wash or injection in con- junctivitis, otorrhoea, and gonorrhoea in gr. j-vj to f§j solu- tions, and as a stimulant to sluggish granulations. Zinc acetate is used similarly to the sulphate, but weaker. Zinc chloride is a favorite escharotic for the destruction of lupus, epithelioma, malignant and indolent ulcers, and malignant growths generally. It is commonly used with Hour (1 to 3, 4, or 5 parts), and is known as Canquoin's paste. Zinc oxide is used internally in gastralgia, chronic diar- rhoea, dysentery, etc.; in night-sweats of phthisis as a remote astringent, gr. j-ij, combined with hyoscyamus or belladonna it is often very effectual; in spasmodic asthma and whooping- cough as an antispasmodic. Locally, as the official ointment or some of its modifica- tions, it is of great value in eczema, erythema, impetigo, herpes, and other skin disorders. It is used for its drying and alterative effects. Zinc valerianate has met with success in hysterical head- ache, cough, or aphonia, and in neuralgia which is reflex from pelvic disorder. PLUMBUM (Lead). Preparations: Metallic lead is not official. The official salts are- Plumbi Acetas, Sugar of Lead ; the salt selected for internal use ; dose gr. ss-iij. Liquor Plumbi Subacetatis (Goulard's extract), 25%. 144 MINERAL ASTRINGENTS. Liquor Plumbi Subacetatis Dilutus, 3% liq. plumb, sub- acetat. Ceratum Plumbi Subacetatis (Goulard's cerate) contains liq. plumbi subacetat. 20%, ceratum camphorse 80%. Plumbi Carbonas, white lead, chiefly used in Unguentum Plumbi Carbonatis, which is 10% in benzoinated lard. Plumbi lodidum, dose gr. ss-iij. Unguentum Plumbi lodidi, 10%. Plumbi Nitras, externally only. Plumbi Oxidum, litharge. Emplastrum Plumbi contains one-third of the oxide in olive oil, and is the basis of most plasters. Unguentum Diachylon, externally, 60% of the above. The acetate is most used. It is made by dissolving litharge in crude acetic acid. It occurs in colorless efflores- cent crystals freely soluble in water. Incompatibles : The sulphate, carbonate, and iodide of lead are insoluble, and hence solutions of lead are chemically in- compatible with solutions of sulphates, carbonates, carbonic acid, or iodides; also incompatible with albumin. Physiological action: Locally, the soluble salts act as astringents, sedatives, and irritants, and decrease secretions. They are absorbed as albuminates, like other metallic salts, and depress the circulation, lessening the force and frequency of the heart. They may act as remote, astringents as well, checking hemorrhage and decreasing secretions; but this is denied by some authorities. Lead is eliminated chiefly by the kidneys, and in suspected cases of poisoning the metal may be found in the urine. Toxicology: Toxic effects may appear in two forms, acute and chronic. Acute poisoning is rare, because of self-emesis, but may take place after large doses (3j+) of the acetate. The nitrate is the most soluble and poisonous, the ranks next in virulence, while the least poisonous, but the salt most frequently producing acute symptoms, is the acetate (sugar of lead). The symptoms are a sweet, metallic taste, intense cramps, vomiting of white material (PbCl2), and black purg- ing (sulphide); finally, failure of heart and respiration. An ounce of the acetate lias produced death in several instances. PLUMBUM. 145 The proper remedies are the soluble sulphates (Epsom or Glauber salt), or alum, soap, and albumin to precipitate, fol- lowed by the use of the stomach-pump; opium. Chronic poisoning, or chronic plumbism, on the other hand, is quite common. It may originate in various ways-in workers in lead, from paints containing lead, from silk thread weighted with lead, from hair-dyes and hair-restorers, cosmetics, and especially from pure water running through lead pipes; pure water containing CO2 dissolves lead, forming a soluble bicar- bonate, while ordinary drinking-water is protected by the formation of an insoluble sulphate and silicate on the inner surface of the pipe, etc.-and may take any of the following forms: Colica pictonum, or painters' colic, the characteristic symp- toms of which are retracted abdomen, pains radiating from the umbilicus and supposed to be due to over-excitation of the intestinal ganglia, obstinate constipation with clay-colored stools, a corded pulse, nausea, vomiting, marked anaemia, jaundice, and a blue line on the gums. Tremors and chorea, epilepsy, headache, saturnine asthma, multiple palsies and neuritis, anaesthesia, nephritis, pruritus, and amblyopia may exist. Lead arthralgia, a painful condition of the joints, supposed to be caused by deposition of urates in the joints from deficient oxidation. Lead encephalopathy, a rare form, characterized by head- ache, delirium, convulsions, coma, and death. This is espe- cially apt to appear from the use of hair-dyes and washes containing lead. Lead-paralysis, a frequent variety of the disease. It is a peripheral neuritis, more often affecting the extensor than the flexor muscles, and the upper than the lower extremity (" wrist-drop " or " toe-drop " is caused). The nephritis is of the chronic interstitial variety, marked by low specific gravity of the urine, reduced quantity of the latter, the appearance of casts and of albumin. The heart and bloodvessels often share in the fibroid change. A symptom which may accompany any of these forms of chronic poisoning, and is seen especially in uncleanly persons, 10-M. M. 146 MINERAL ASTRINGENTS. is a blue or slate-colored line along the gums. Death may occur from malnutrition, paralysis of the respiratory muscles, or from coma. The symptoms are caused as follows: the corded pulse is due to the intense colic in the small intestine, which forces the blood from the intestinal vessels; the blue line on the gums is due to a deposition of lead as the black sulphide; the wrist-drop is due to paralysis of the extensors, in most cases caused by a peculiar peripheral neuritis, though in other cases an anterior poliomyelitis exists. The treatment is prophylactic and eZwitnatwe. The former consists in the avoidance of any source of contamination and by directing workers in lead carefully to clean their hands before meals. Sulphuric-acid lemonade and albumin (milk) are also to a degree prophylactic. Elimination is effected by the soluble sulphates mentioned above, potassium iodide, and sulphur baths. For the palsy galvanism is indicated, a peculiarity being that voluntary movement lasts longer than electrical excitability, and returns first. The treatment otherwise is directed against the symptoms, such as colic, constipation, etc. In poliomyelitis produced by lead-poison- ing strychnine acts as a specific. Therapeutics : As mentioned above, lead acetate is almost the only salt used internally. It has been found useful in chronic diarrhoea, dysentery, cholera, and yellow fever, acting by its local astringcncy; in bronchitis and colliquative sweating, by virtue of its supposed remote astringency; in aneurism, from its combined sedative and astringent effects; in hcemat- emesis from gastric ulcer; valuable in haemoptysis; probably one of the best remote haemostatics. Locally also the acetate is a favorite, although the oxide and carbonate are used, as in eczema and other irritative skin lesions ; in superficial inflammations, as lead-water and laud- anum ; in burns the lead solutions relieve pain, and white lead may be used over small areas. Lead water is not to be employed as a collyrium. The subacetate, in the form of liquor plumbi subacetatis or Goulard's extract, is diluted with water, and is then used as lead-water for its local sedative and astringent effect. ALUMEN. 147 ALUMEN (Alum). The official alum is a double sulphate of aluminium and potassium; it is crystalline, slowly efflorescent, and soluble in water; when heated it gives up its water of crystallization and is called " dried" or " burnt alum." Preparations : Alumen, the above, or Potash Alum, dose gr. x-3ss. Alumen Exsiccatum, U. S., Dried Alum, Alumini Hydras, IT. S., Alumini Sulphas, U. S., external use. Incompatibles: The alkalies and their carbonates, soluble lead salts, and tannic acid are the principal incompatibles. Physiological action: Alum acts locally as an astringent by causing coagulation of albumin, and in large doses as a gastro-intestinal irritant. It is slowly absorbed, and is sup- posed to act as a remote astringent, causing contraction of the tissues and capillaries. Therapeutics: Alum is used as a direct astringent in hoematemesis and intestinal hemorrhage due to passive conges- tion, no active inflammatory process being present; in chronic dysentery and diarrhoea, generally in combination. Locally, it is used as an astringent to painful ulcers, hemor- rhoids, or fissures; in conjunctivitis as alum-whey, etc.; in night-sweats, alum baths may check excessive perspiration. In large doses alum causes violent gastro-enteritis with pain- ful vomiting, purging, and finally death. Its continued use in small quantities is probably injurious. Alum has been used extensively to produce a pure white color in lard, and especially in flour. It is a most efficient precipitant of sus- pended impurities in water, but renders the water unfit for drinking. For additional uses see Emetics. It is believed by some to act as a remote astringent in bronchorrhoea and haemoptysis; but insufflation of the powder is preferable. It is a very efficient agent in lead-colic, acting as a soluble sulphate, and in some unknown way when there is no lead in the intestinal tract. The acetate of aluminium has recently found favor as a 148 TONICS. non-irritating antiseptic lotion in superficial inflammatory processes. CERII OXALAS, U. S. (Cerium Oxalate), C2(C2O4)3 + 9H,O 704.78. Cerium oxalate is a white, granular powder, permanent in the air, insoluble in water and alcohol, used in doses of gr. j-iij as a remedy in controlling nausea. It is especially recom- mended in the nausea and reflex vomiting from uterine dis- turbance, as in pregnancy. It has been used in the treatment of seasickness. TONICS. FERRUM, U. S. (Iron), Fe 55.88. Iron is an essential element in the haemoglobin of the red blood-cells, is thus a food, and is found to exist in small proportions in most food-products, especially beef. When- ever, from insufficient ingestion or assimilation of iron or from its abnormal discharge or excretion, as in hemorrhage, an insufficiency of this clement occurs, a condition of ancemia is established. If in a patient in this condition the causes of deterioration be checked and iron be given, a rapid increase in the blood-elements takes place, and the patient returns to a healthy condition. In health its administration probably causes little effect. Physiological action: The organic salts are absorbed directly into the blood, the acid radical being oxidized, while salts of the mineral acids may be absorbed unchanged. Soluble preparations are probably converted into the chloride by the acids of the gastric juice. Iron probably exists in the blood as an albuminate, and is conjectured to act by convert- ing the respired oxygen into ozone, a more efficient form for purposes of oxidation-i. e., it is an adjuvant to the processes of oxidation in the body. The red blood-disks are increased in number and the haemoglobin in amount under its use. Secretions: Iron preparations are astringent, decreasing the secretions generally, and especially the gastro-intestinal, thus FERRUM. 149 causing constipation, with stools stained black by the sul- phide. The urea, however, is increased as a result of increased tissue-metamorphosis. It is eliminated by the bile, urine, and faeces. Therapeutics: The main indication for the use of iron is ancemia, particularly the form attended with a marked dimi- nution of haemoglobin without a corresponding decrease in the number of red blood corpuscles (chlorosis). Many conditions dependent to a greater or less degree on anaemia are greatly benefited by the use of this blood tonic, especially neuralgia, hysteria, chorea, and occasionally epilepsy. Iron preparations are also used as stomachics and astringents; they should be administered on a full stomach. The chief contraindication to the use of iron is found in plethora. In many cases the astringent effects of iron pro- duce constipation and, indirectly, headache. Preparations : The preparations of iron differ in their gen- eral properties as to astringency and chalybeate effect, while some of them possess peculiar properties. The chalybeates readily yield iron to the red blood-corpuscles. Reduced iron, the carbonate in its various forms, such as Vallet's mass, Bland's pill, and the saccharated carbonate, with the soluble citrate and tartrate, are the best chalybeates. The most astringent preparations are Monsel's solution (liquor ferri subsulphatis) and ferrous sulphate (green vitriol). Prepara- tions possessing peculiar properties are the iodide, the syrup of ferrous iodide, the hydrated oxide (antidote to arsenic), and the tincture of ferric chloride. The following preparations are important enough to require detailed notice : Ferrum Reductum, U. 8., Reduced Iron, obtained by passing hydrogen gas over heated subcarbonate of iron : it is a taste- less, gray powder, insoluble in water, but very soluble in sulphuric acid, and very prone to oxidize ; it is a mild chaly- beate of very slight astringency, and suitable for prolonged administration in chlorosis, etc.; dose gr. iij-vj. Ferri Oxidum Hydratum, U. 8., Ferric Hydrate, prepared officially by the reaction of ferric sulphate and ammonium hydrate : when dried it is not used medicinally, but, freshly 150 TONICS. precipitated as a moist reddish-brown magma, it is an anti- dote to arsenic, given ad libitum for this purpose. In an emergency the hydrated oxide of iron may be prepared by precipitating any solution of a ferric salt with water of ammonia; the tincture of ferric chloride is usually at hand. The bulky precipitate is collected on a strainer, washed quickly to remove the excess of ammonia and administered at once. Ferri Oxidum Hydratum cum Magnesia, U. 8., Ferric Hydrate with Magnesia: similar to the above preparation, but precipitated by magnesia instead of ammonia. From its slightly purgative action it is preferable as an antidote to arsenic. Dose sss or more, frequently repeated. The phar- macopoeia directs that a diluted solution of ferric sulphate and a mixture of magnesia and water should be kept in separate bottles by the pharmacist, to be mixed for immediate use; straining is unnecessary. Ferri Carbonas Saccharatus, U. 8., Saccharated Ferrous Carbonate, prepared by the double reaction of ferrous sul- phate and sodium bicarbonate in the presence of sugar to prevent oxidation : a valuable preparation, as it retains its ozonizing power; dose gr. v-xxx. Massa Ferri Carbonatis, 77. /S'., Mass of Ferrous Carbonate, Vallet's Mass, contains half its weight of ferrous carbonate : prepared as above. Ferri Sulphas, U. 8., Ferrous Sulphate, FeSO4 + 7H2O =■• 277.42, when impure called green vitriol or copperas: prepared for medicinal purposes by dissolving iron in dilute sulphuric acid by the aid of heat; occurs as greenish-blue crystals of styptic taste, and soluble in water; in the air these effloresce, absorb oxygen, and become pale-viz., ferric sulphate is formed ; heated, they give up water of crystallization, and the dried sulphate (Ferri Sulphas Exsiccatus, U. /S'.) is formed. It is an active chalybeate, but too astringent for continued use. It has also been used as an emmenagoguc and quite extensively as a deodorant and disinfectant. Dose gr- jyv. Liquor Ferri Tersulphatis, U. 8., Solution of the Tersul- phate of Iron: very styptic; employed to form the hydrate FERRUM. 151 for arsenic-poisoning and locally as an astringent. It con- tains ferric sulphate, Fe2(SO4)3 = 399.2. Liquor Ferri Subsulphatis, U.S., Monsel'sSolution, is a solu- tion of a basic ferric sulphate. It is useful as an internal astrin- gent in gastric and intestinal hemorrhage (dose h] v-xv), and topically applied it is one of the best styptics. In dilution it is a valuable application in inflammations of mucous mem- branes. Its use to control hemorrhage is attended by the disadvantages common to the use of all styptics, namely, of forming a clot which conceals bleeding still going on under- neath and of forming an excellent culture-medium for infec- tion. Tinctura Ferri Chloridi, U. S., Tincture of Ferric Chloride, is one of the efficient iron salts, having a marked styptic taste and astringent effect, and in large doses causing irritation. It contains an ether, to which it probably owes its slightly diuretic effect and its specific astringent effect on the genito- urinary tract. It is used with good effect in erysipelas, and has its advocates in diphtheria and scarlet fever. As it is particularly destructive to the teeth, care should be taken in prescribing it. Dose gtt. xv-xxx, well diluted with water, taken through a glass tube. Liquor Ferri et Ammonii Acetatis, U. S., Solution of Iron and Ammonium Acetate, Basham's Mixture, is said to be very valuable in the anaemia of chronic nephritis. Dose f§ss. Syrupus Ferri lodidi, U. S., Syrup of the Iodide of Iron, is a transparent, pale-green liquid, combining the effects of iodine and iron, not constipating, and is a standard remedy in scrofulous and tuberculous conditions, especially in children ; dose gtt. x-xxx. Ferri et Potassii Tartras, U. S., Iron and Potassium Tar- trate, occurs as transparent red crystals, wholly soluble in water, prepared by the addition of ferric hydrate to potassium bitartrate. Like the preceding preparation, it is non-con- stipating, which, with its agreeable flavor and its compati- bility with alkalies, renders it valuable for children. Ferri Phosphas Solubilis, U. S., Soluble Ferric Phosphate, is a mixture of ferric phosphate with sodium citrate, the 152 TONICS. latter presenting the phosphate in a soluble form. Dose gr. v-x. Ferri Pyrophosphas Solubilis, U. S., Soluble Ferric Pyro- phosphate ; greenish scales, freely soluble in water: a valu- able chalybeate ; dose gr. ij-x ; probably a mixture of sodium citrate with ferric pyrophosphate, and rendered soluble by the presence of the sodium salt. Ferri Hypophosphis, U.S., Ferric Hypophosphite: supposed by some to be especially valuable in nervous lesions, generally in combination with other hypophosphites; dose gr. x-xxx. Liquor Ferri Nitratis, U. S., Solution of Ferric Nitrate : in addition to its tonic action this is a good astringent, and as such is employed in intestinal and other fluxes when associ- ated with anaemia. Syrupus Ferri Bromidi, U. S., Syrup of Ferrous Bromide, combines the action of iron and bromide, and is especially indicated in chorea with anaemia. Ferri Citras, U. S., Ferric Citrate, is very slowly soluble, and may be prescribed in pill-form. It appears in the form of garnet-red scales. Ferri et Quininae Citras, U. S., Citrate of Iron and Quinine: a valuable tonic, combining the effects of its two components ; dose v-x. Vinum Ferri Amarum, U. S., Bitter Wine of Iron, con- tains the preceding as its active ingredient, and is a good bitter tonic ; dose f5j-ij. Ferri et Ammonii Citras, U. S., Iron and Ammonium Citrate, has antacid properties. It is but slightly astringent and very soluble. Ferri et Ammonii Sulphas, U. S., Ferric Ammonium Sul- phate, Ammonio-ferric Alum: used in chronic diarrhoea and dysentery for astringent effect. Ferrum Dialyzatum, a very valuable chalybeate : formed by the dialysis of a solution of ferric chloride. Its exact composition is unknown. It should not be used in combina- tion. It is only slightly constipating, and is a good antidote for arsenic. Dose gtt. x-xx, followed by sodium chloride to insure its absorption. Other preparations of iron, all possessing tonic properties, MANGANUM-ACID UM SULPHURICUM. 153 arc very numerous, but the foregoing are sufficient for prac- tical purposes. MANGANUM (Manganese). The metal manganese is a normal constituent of the body, the blood, hair, etc., existing in minute portions, and has tonic properties when administered alone or in combination with iron in conditions of anaemia and cachexia, but is inferior to iron. Official compounds : Mangani Dioxidum, U. 8., Manganese Dioxide; Black Oxide or Binoxide of Manganese, MnO2 = 86.72. A grayish-black, amorphous, or crystalline powder, odorless, tasteless, and insoluble in water; dose gr. j-v. Mangani Sulphas, U. 8., Manganese Sulphate, MnSO4+ 4H2O - 222.46 : transparent, slightly rose-colored crystals, odorless, with a slightly styptic taste and soluble in water; dose gr. j-iij. Therapeutics: These salts are used as above indicated, as a succedaneum to iron. By some they are regarded as resem- bling bismuth, and are given in gastrodynia and pyrosis: others attribute to them emmenagogue properties. The sul- phate is thought to be cholagogue, and has been given in jaundice due to inflammation of the bile-ducts. Potassium permanganate is an antiseptic. ACIDUM SULPHURICUM, U, S. (Sulphuric Acid). Preparations: Acidum Sulphuricnm, U. 8., Oil of Vitriol, contains of the absolute acid, H2SO4= 97.82; is used externally as a caustic. Acidum Sulphuricnm Dilutum (V./S'.): 10% strength in water; dose ffix-xxx : it is inferior medicinally to Acidum Sulphuricnm Aromaticum (U. /S'.), which is of 20% strength, with alcohol, tincture of ginger and oil of cinnamon. Physiological effects: Sulphuric acid is a powerful pene- trating caustic, abstracting water from the tissues by its pow- erful affinity therefor, and carbonizing (charring) the flesh. Therapeutic doses of its weaker preparations are absorbed as 154 TONICS. sulphate, and eliminated in that form by the kidneys, intes- tinal tract, and skin, upon which tissues it exerts an astrin- gent effect. Therapeutics: Locally, strong sulphuric acid is still some- what used as a caustic in a paste with asbestos or charcoal in the treatment of chancroidal and other ulcerations. Diluted, and preferably as acidum sulphuricum aromaticum, it is used in diarrhoeas, especially the profuse watery forms, and also in cholera and cholera infantum; also in the colliquative sweating of debilitated conditions ; in hemorrhages as a remote astrin- gent, probably ineffective; in lead-poisoning, in the acute form of which it is an efficient antidote, forming the insoluble lead sulphate; in chronic plumbism its efficacy is doubtful, but in the form of sulphuric-acid lemonade it may prove a prophylactic; as a solvent for cinchona salts. In Asiatic cholera it has been found an efficient prophylactic. In administering sulphuric acid care should be taken of the teeth, and it should be well diluted, and taken through a glass tube, for even the weaker preparations are irritating. Toxicology : After a poisonous dose of the strong acid we have two stages : immediately pain in the oesophagus, throat, and epigastrium is experienced, followed by violent vomit- ing, often of tarry matter, with symptoms of severe collapse, death ensuing in from two to ten hours. If the patient sur- vives this stage, he suffers subsequently from ulcerations of the pharynx, larynx, oesophagus, and stomach, the parotids become inflamed from occlusion of Steno's duct, and an acute parenchymatous nephritis may develop. The blackened slough makes the diagnosis. The treatment of the acute condition consists in the administration of the carbonates of magnesium and calcium or of the alkaline car- bonates. Whitewash or soap may be the most available. These antidotes should be given freely in milk, water, or other diluent. Subsequent treatment is according to the nature of the sequelae. ACIDUM HYDROCHLORICUM, U. S. (Hydrochloric Acid). Acidum Hydrochloricum, 31.9% of the gas (HC1--36.37); not much used medicinally; dose Iffv-x, well diluted. A CID UM NITRIC UM. 155 Acidum Hydrochloricnm Dilutum, 10% of gas; preferable form for administration by stomach. Physiological action and therapeutics : This drug exhibits neither pronounced caustic nor astringent effects. Being a normal stomach acid, and having a stimulating effect on the intestinal glandular system, its administration aids digestion by prolonging the action of the pepsin ferment. Thus it is useful in gastric dyspepsia, and as the normal acidity of the stomach is not developed until at least half an hour after the ingestion of food, it may be given at a corresponding time, often in combination with pepsin. In intestinal dyspepsia combinations with mix vomica or some aromatic stomachic arc valuable. These arc the principal uses of this acid. The toxicology and treatment are the same as for other mineral acids. ACIDUM NITRICUM, U. S. (Nitric Acid). Acidum Nitricum contains 68% of the absolute acid, IINO3=62.89 ; at first colorless, it changes on exposure to light to a yellowish color; for external use only. Acidum Nitricum Dilutum, 10% strength, dose Iffxv-fsj. Physiological action: Locally, in strong solutions, nitric acid is a powerful chemical caustic; in weaker solutions, an astringent stimulant. Internally, in considerable dilution, it stimulates the intestinal glandular apparatus, and has a local astringent effect, checking watery discharges. It is absorbed as the nitrate, but its method of elimination is unknown. Therapeutics: Locally, it is used as a caustic in chancres, venereal warts, etc.; care being taken to protect the sur- rounding healthy tissues with petrolatum, and to limit its action, when sufficient, by an alkaline lotion. Also used as caustic in cancrum oris and other phagedsenic conditions. Internally, nitric acid is used in dyspepsia, especially of the intestinal type, with torpidity of the liver; and in serous diarrhoeas, in which Hope's camphor mixture is a good pre- scription. Toxicology : Nitric acid is a very powerful corrosive poison, causing deep, yellow sloughs, which are diagnostic. The symptoms and treatment arc those of other mineral acids. 156 TONICS. ACIDUM NITRO-HYDROCHLORICUM, U. S. (Nitro-hydro- chloric Acid). This acid combination, known also as nitro-muriatic, con- sists of nitric acid 18 and hydrochloric acid 82 parts, forming an orange-colored, chlorine-evolving liquid, which changes on standing to a yellow color. The acids are decomposed: nitrosyl chloride, NOCI, free Cl, and water are formed. Care should be taken to allow the completion of the process before the liquid is dispensed. It should be placed in glass-stoppered bottles but partly filled, and is incompatible with organic mix - tures because of its free chlorine. Dose lYfiij-v, well diluted. Acidum Nitro-hydrochloricum Dilutum contains 4 parts of nitric acid, 18 parts of hydrochloric acid, with water to make 100 parts. It is thus about 20% in strength. Dose flfxx-xxx. The acids must be mixed in concentrated form, and the reaction must be completed before the liquid is diluted with water. Physiological action : What becomes of the drug after inges- tion is not clear. Like the acids of which it is composed, it seems to be an intestinal glandular stimulant, with a special action on the hepatic secretion. Therapeutics: This acid is used in intestinal dyspepsia with hepatic congestion, the so-called "bilious" condition, and is very efficacious; in chronic diarrhoea, especially in those cases due to imperfect digestion, with consequent irritations from undigested or fermenting food, acting by aiding digestion ; also in syphilitic dyscrasia and certain chronic skin diseases, in which it accomplishes good in the same manner. The diluted acid is a specific in the oxaluria of certain classes of neuras- thenics (Wood). Locally, as baths (f ffiij to Oij of water); as a local appli- cation to the region of the liver to the pint) it has been recommended in chronic diseases of the liver, as cirrho- sis, fatty liver, etc. Toxicology same as for other members of this groiq). ACIDUM LACTICUM, U. S. iLactic Acid). An organic acid, usually made by subjecting milk-sugar or grape-sugar to the lactic fermentation; composed of 75% by PHOSPHORUS. 157 weight of absolute lactic acid (HC3H5O3 89.79) and 25% of water. Dose 1Tlv-xv. It exists as a normal acid in stomach digestion, and has been administered as an aid to the pepsin ferment in dyspep- sia. PHOSPHORUS, U. S. (Phosphorus). Phosphorus is a non-metallic element, solid at ordinary temperatures, igniting at about 100° F. and melting at 111° F. It is translucent, colorless when pure (generally slightly yellow), and has a peculiar garlicky odor. It is obtained from bone-ash (calcium phosphate) by removing the lime with sulphuric acid and reducing the residuum with charcoal at high temperatures. It is insoluble in water, soluble in oils, ether, and alcohol, and freely so in chloroform. Preparations: Phosphorus, never given in substance, dose Sr- Ko- Oleum Phosphoratum, 1 % in ether and expressed oil of almond, dose Ulj-iij. Elixir Phosphori, each contains about gr. Pilulae Phosphori, each contains gr. pL. Zinci Phosphidum, dose gr. The various hypophosphites do not have the effects of phosphorus, and are considered later. Physiological action: Locally, this drug is an irritant, pro- ducing inflammation, ulceration, and even gangrene. Con- stant inhalation by workmen having carious teeth may cause necrosis of the lower jaw, the point of entrance always being a defective tooth. When taken internally it varies decidedly in its effects with the size of the dose. Medicinal doses stimulate the nervous system and act as a tonic, repair- ing waste; stimulate the circulation; elevate and then slightly lower the temperature; and have a direct effect on bone-formation. Phosphorus is absorbed in its own form, dissolved in some fatty substance, and is eliminated by the liver and general glandular system. It leaves the body in the form of hypophosphorous acid. The therapeutic limit of the drug is reached when a matchy taste develops. It is also apt to produce digestive disturbances. 158 TONICS. Toxicology: The symptoms develop tardily in from three to twelve hours. They are-general wretchedness, vomiting, at first of food, and bile with alliaceous odor and luminous in the dark, later perhaps coffee-colored from exuded blood; purging (the stools also being phosphorescent and often clay- colored) and abdominal pain ; jaundice of the non-obstructive variety develops on the second day. Later, pronounced nervous disturbances occur-headache, giddiness, sleepless- ness, somnolence, wild maniacal, sometimes erotic delirium, and coma : when these arc marked a fatal termination may be expected. Death ensues from general exhaustion. The urine is generally scanty and albuminous, and may contain glucose ; when jaundice develops it reacts to the biliary acids and coloring-matters. It may contain leucin and tyrosin. Death generally occurs not earlier than the second day, and may be postponed much longer; it has resulted from gr. jss. Phosphorus-poisoning closely resembles acute yellow atro- phy of the liver in its symptomatology and course. In both a curious remission may occur about the second day, the symptoms then reappearing and going on to a fatal termina- tion. Epigastric and hepatic tenderness persists during the remission. The odor upon the breath, and phosphorescence of the vomited matter and stools, and the primary enlarge- ment of the liver may aid in diagnosis. Post-mortem changes: The Zwer is enlarged, friable, and pale, with fatty degeneration of its parenchyma, followed in protracted cases by atrophy. The gastro-intestinal mucous membrane is swollen, opaque, and light-colored from a gen- eral adenitis, but is seldom eroded. The kidneys undergo changes analogous to those of the liver. The blood becomes dark, loses its power of coagulation, and ecchymoses occur in all parts of the body. Treatment: Avoid all fatty substances, which dissolve phosphorus and aid in its absorption ; give copper sulphate (gr. v) as emetic, for it is also a chemical antidote by forming a black copper phosphide; after thorough emesis and thor- ough purgation the same drug may be given in small doses combined with opium as an antidote merely ; then old French or acid oil of turpentine, which contains oxygen, the essential ACIDUM ARSENOSUM. 159 antidote, may be given if available. Usually, in this country, we rely entirely on copper sulphate as a chemical antidote, as the French oil of turpentine is seldom obtainable. After the phosphorus has begun to act, the treatment is sympto- matic. Therapeutics: Three classes of disease call for the use of phosphorus-viz., diseases of bone-formation, of the nerves, and chronic affections of the superficial layers of the skin. Thus it is used in rickets and osteomalacia with markedly good results, generally in combination with iron; in nervous exhaustion, neuralgia, cerebral softening, and myelitis it is used with advantage; in acne indurata, psoriasis, the furuncular diathesis, and lupus it is a valuable succedaneum to arsenic. It certainly stimulates bone-formation, and in this differs essentially from the phosphates, which furnish merely bone-constructing material. Administration: The official phosphorated oil being already a solution, is readily absorbed, and should be used with care. Phosphorus pills, made by the manufacturer, should only be used if they have a decided odor of phosphorus when crushed. The phosphide of zinc acts as a phosphorus com- pound, and although it is one-fourth phosphorus, only one- half of this is available. Hence the dose is eight times that of phosphorus (gr. ff, although Prof. Seguin gives as much as gr. ALTERATIVES. This term has been applied to a class of drugs which have been found empirically to have a slow but certain effect in certain diseases or diatheses, the rationale of their action being unknown. Their immediate effects in ordinary doses are slight; but in larger or continued dosage they may depress very decidedly the nutrition and general condition of the body. ACIDUM ARSENOSUM, U. S. (Arsenous Acid). Arsenic, or arsenous acid (formerly called arsenious acid), when first sublimed from its ores occurs in glassy, colorless, 160 ALTERATIVES. transparent masses, which on keeping become milky-white externally. It is soluble in water, has a faintly sweetish taste, and volatilizes without fusing at a temperature of 400° F. or less. It is also called arsenous (or arsenious) oxide or white arsenic. Preparations: The metal arsenicum is not official. The following are : Acidum Arsenosum, dose gr. Jy. Liquor Aeidi Arsenosi (1%), dose Tftij-viij. Arseni lodidum, dose gr. g1-- i_# Sodii Arsenas, dose gr. yL- Liquor Sodii Arsenatis (1%), solution of sodium arsenate; dose ffiij-x. Liquor Potassii Arsenitis (Fowler's solution) contains of arsenous acid 1 %, of pot. bicarb. 2%, and of tinct. lavand. comp, to color 3%. It is most used. Dose ffiij-viii. Liquor Arseni et Hydrargyri lodidi (Donovan's solution) contains 1 % each of arsenous iodide and the red iodide of mercury; dose ffiv-x. Physiological action: In moderate doses arsenic stimulates digestion and promotes nutrition. Aside from this, its effects are not obvious unless long continued, in which case dryness of the throat, nausea, pain in the stomach, perhaps diarrhoea, conjunctival and nasal irritation, and a peculiar facial oedema, especially noticeable beneath the eyes, may develop. The last is a signal for suspending the administration of the drug. This selective action on the mucous membranes takes place however the drug be administered. If continued longer or in too large medicinal doses, a chronic poisoning with an increase of the symptoms supervenes, and digestive disorders, conjunctivitis, oedema, dropsy, cutaneous eruptions with falling of the nails and hair, and albumin and tube- casts in the urine (nephritis), and local paralyses may result. Large doses are supposed to be taken not only with impunity, but are said to be followed by good results when used habit- ually by the so-called arsenic-eaters of Styria. Arsenic-toxicology: The symptoms develop in from fifteen minutes to one hour: they are faucial constriction, burning pain in the oesophagus and stomach, succeeded by violent ACIDUM ARSENOSUM. 161 spasmodic abdominal pain and persistent vomiting; purging, the stools at first bilious, but later serous, with mucoid flakes and sometimes blood, excessive thirst, and suppression of urine soon follow; then ensue collapse, with small feeble and rapid pulse, embarrassed breathing, coldness of the extremities and cyanosis, and finally death, preceded by coma. In some cases a remission of these symptoms occurs; but the urinary symptoms, the epigastric and hepatic tender- ness, and the intense thirst continue, and the above symp- toms are again developed, with pronounced nervous symp- toms, tremblings, cramps, and convulsions, fever, skin eruptions, and finally a fatal termination in from two to six days. Atypical cases may present as dominant symptoms: coma, immediate collapse, violent serous purging, and other symptoms resembling Asiatic cholera. Sequelae: In cases which recover there may be developed (1) inflammatory conditions of the alimentary tract in any part; (2) a widespread multiple neuritis, the muscles pre- senting the reaction of degeneration associated with various sensory disturbances; (3) in some cases perhaps an actual lesion of the spinal cord (poliomyelitis): the affected muscles generally recover. A remarkable overgrowth of hair has been noted. Lesions: At the autopsy the gastro-intestinal mucous mem- brane is found swollen, congested, and in places covered by a plastic exudation, and, as the contents of the intestinal tract, a fluid resembling the discharges of cholera; actual fatty degeneration of the liver, spleen, and kidneys; in some cases congestion of the broncho-pulmonary mucous membrane has been noted. The tissues, and especially the nervous organs, are found to contain arsenic. (During life, after elimination of the drug has ceased, the administration of potassium iodide will cause it to reappear in the secretions.) This storing of the drug in the tissues takes place however admin- istered, and diffusion may take place post-mortem. Treatment: In recent cases immediate evacuation of the stomach, preferably by the stomach-pump, is indicated. One of the following antidotes should then be freely admin- istered : (1) Freshly precipitated ferric hydrate (q.v.f which 11-M. M. 162 ALTERATIVES. forms an insoluble arsenate of iron ; (2) ferri oxidum hy- dratum cum magnesia; (3) dialyzed iron, followed by com- mon salt or some alkali. Demulcent drinks, opiates, and stimulants, p. r. n., complete the treatment. Chronic arsenical poisoning results in those who work with the preparations of arsenic in the arts; from the use of arsenical dyes, especially some of the cheap green and brown shades; from wall-paper and toys colored with the same dyes. The symptoms are those of irritation of the mucous membrane of the respiratory tract, if the drug has been in- haled : dryness of the nose and throat, dry cough ; to these are added diarrhoea and gastric irritation ; nervous disturb- ance of motion and of sensation ; eruptions and pigmentation of the skin. Therapeutics: Locally, arsenous acid is a powerful caustic, and is used as such, either pure or mixed in varying pro- portions with sulphur, in the treatment of lupus, indolent sinuses, etc. The danger of absorption is said to be less when freely applied. Fieraa/fy, it is much used in certain nervous conditions, as chorea, migraine, neuralgia, and newr- asthenia; in chronic diseases of the superficial layers of the skin, as psoriasis, pityriasis, pemphigus, and certain chronic forms of eczema, but never until all acute symptoms are past; in irritative dyspepsias, gastric ulcers, etc., small doses (TTIj-ij of Fowler's solution) before meals may relieve the symptoms and promote digestion; ancemias, and especially the per- nicious form, may be greatly benefited-best combined with iron in chlorosis ; in malarial poisoning (especially the chronic forms) not yielding to quinine, and not in the acute stage, but only when paroxysms have ceased or become infrequent and irregular: it should be given in large doses; multiple lymphadenomata and other glandular swellings have been known to disappear under its use. Arsenous acid is also used for its alterative effect on mweows membranes, such as those of the pharynx, larynx, and entire respiratory tract. In rheum- atoid arthritis it is a valuable remedy; also in acute and chronic rheumatism. It has also been employed in alopecia. In the chorea of childhood, Fowler's solution is usually administered in ascending doses until the physiological action HYDRARGYRUM. 163 is made manifest; its use is then suspended for a day or two, when the patient is again placed on a smaller dose. Administration : The dosage will depend, as has been seen above, upon the condition to be reached. Thus, malarial poisoning and glandular enlargements will require consider- able doses, while only small ones will be tolerated in certain gastric conditions. The liquor sodii arsenatis is said to be less irritating to the stomach, but Fowler's solution or the acid itself is the form most used. Donovan's solution will receive notice under Mercurial Preparations. HYDRARGYRUM, U.S. (Mercury), Hg= 199.8. Mercury, or quicksilver, is a volatile metal, liquid above -40° F., exceedingly heavy (sp. gr. 13.5), but otherwise of negative properties. It is obtained from its native sulphide or cinnabar. Preparations: Massa Hydrargyri (blue mass), one-third metallic mercury; dose gr. j-x. Hydrargyrum cum Creta (gray powder) contains mercury 38 parts, creta prseparata 57 parts, and clarified honey 10 parts; dose gr. v-3ss. Unguentum Hydrargyri (blue ointment), 50% mercury. Emplastrum Hydrargyri and Emplastruni Ammoniaci cum Hydrargyro are unimportant. Hjdrargyri Chloridum Mite (calomel), dose gr. ss-xv. Calomel is an ingredient of the compound cathartic pill. Black wash (lotio nigra) is made by adding calomel 3j to lime-water Oj, the black oxide being formed. Hydrargyri Chloridum Corrosivum (corrosive sublimate), dose gr. 3^-In yellow wash (lotio flava) we have the yellow oxide of mercury, formed by adding 3ss of corrosive sublimate to Oj of lime-water. Hydrargyrum Ammoniatum (white precipitate) is con- tained in Unguentum Hydrargyri Ammoniati, 10%. Hydrargyri Cyanidum, dose gr. |. Hydrargyri lodidum Rubrum, dose gr. -j1- Liquor Hydrargyri et Arseni lodidi (Donovan's solu- tion). 164 ALTERATIVES. Hydrargyri lodidum Flavum, dose gr. j. Liquor Hydrargyri Nitratis, a caustic. Unguentum Hydrargyri Nitratis, citrine ointment. Hydrargyri Oxidum Flavum (yellow precipitate) is an in- gredient of Unguentum Hydrargyri Oxidi Flavi, 10%, and of Oleatum Hydrargyri, 10%-a very useful preparation. Hydrargyri Oxidum Rubrum (red precipitate), used only in Unguentum Hydrargyri Oxidi Rubri, a 10% ointment. Hydrargyri Sulphidum Rubrum is cinnabar, dose 3ss. Hydrargyri Subsulphas Flavus (turpeth mineral) is an emetic (see Emetics). Physiological action: Mercury in its liquid state is inert, but workmen exposed to its vapors may develop salivation or mercurial palsy. Its compounds, however, are all active, and when locally applied produce effects varying from a very slight irritation to a violent causticity. Internally, single small doses cause very few symptoms beyond a slight stimu- lation of the secretions generally. Larger medicinal doses, continued, cause a train of symptoms called salivation or ptyalism. The milder symptoms are tenderness and tume- faction of the gums, which bleed on the slightest abrasion ; soreness of the entire mouth, swelling of the tongue, and greatly increased secretion of the salivary and buccal glands, with a peculiarly foetid breath and strong metallic taste in the mouth. Swelling and inflammation of the salivary glands, a deep-red line along the gums, and in extreme cases falling of the teeth and necrosis of the maxillae, may occur. Added to this we may have a low fever, diarrhoea, neuralgia, nervous disorders, and a general debilitated condition. The blood undergoes decided changes, its power of coagulation being lessened by a diminution of its fibrin and other solid portions. The nutrition of the body is lowered by large doses, but small ones probably have a tonic effect, at least in certain dyscrasite. Workers in mercury after long-continued inhalation of its vapor may become the victims of a mercurial tremor simulat- ing paralysis agitans, or of a spasmodic condition resembling chorea. Other nervous symptoms often accompany this, as loss of memory, vertigo, and at times local paralysis, prob- HYDRARGYRUM. 165 ably due to a peripheral neuritis. A mercurial cachexia has been noted, with a train of symptoms simulating scurvy. The cathartic, emetic, and antiseptic effects of mercurial preparations will be considered under their respective head- ings. Administration: Mercury may be given by the stomach, by inunction, by sublimation, and by hypodermic injection. For continued internal use the yellow (green or proto-) iodide is often selected ; calomel may also be given in small doses. The latter is the preparation most apt to cause diarrhoea; it is a cholagogue purgative in large dose or in minute quantities frequently repeated. During the third stage of syphilis the bichloride is used in combination with iodides; it is least apt to produce salivation. For hypodermic administration, the bichloride is also selected in spite of its pronounced irritating properties ; gr. y-g-may be given in aqueous solution, pre- ceded by a hypodermic injection of cocaine. In emergencies, when a syphilitic tumor of the brain threatens life, mercury may be given by all of the routes : by the mouth (calomel), by the skin (the bichloride hypodermically), and by inunction (blue ointment). The mercurial preparations differ greatly in their poisonous properties, and this largely in proportion to their solubility. The bichloride is the most irritating and poisonous. The nitrate, the yellow and red iodides, the ammoniate, the yellow and red oxides, and the yellow sub- sulphate are next in order as to irritant properties. The mildest preparations are calomel, the oleate, the ointment, mercury with chalk and blue mass. These are less apt to produce poisoning by single large doses, but very easily cause ptyalism in small doses frequently given. Toxicology: The bichloride is the most corrosive prepara- tion. The symptoms which appear rapidly are those of extreme gastro-intestinal irritation, intense pain in the oesophagus and stomach, vomiting, purging of bilious matter and finally bloody mucus, albuminous and even bloody urine, with collapse and death. It is a very fatal poison, and anti- dotes must be used quickly. The best of these is white of egg, followed by evacuation of stomach and bowel. Soap is a partial antidote. The after-treatment is that of any form of 166 ALTERA TIVES. corrosive poisoning. The post-mortem lesions are due to its violent caustic effect; ulceration of the gastric and intestinal mucous membrane is commonly found ; there may be per- foration. Elimination: Mercury has been found in all the tissues and secretions. After its spontaneous elimination has ceased it will appear after the administration of potassium iodide, showing that it is stored somewhere in the tissues. Absorption seems to take place readily enough, but elimi- nation is sometimes very irregular. For this reason patients who are on a protracted course of the drug require careful supervision. The bichloride is probably absorbed as an albuminate, while the alkaline juices of the intestine convert calomel into the black oxide, which is in turn dissolved by some of the fatty contents of the bowel and so absorbed. Metallic mer- cury in the form of blue mass or mercury with chalk is prob- ably also absorbed as the black oxide. It is customary to prescribe calomel in small doses (gr. -g-pj-), frequently re- peated with gr. i-ij of sodium bicarbonate, as it acts more powerfully in this manner than in single large dose. Therapeutics: We will consider here the antiphlogistic and antisyphilitic uses of the drug, leaving until later its other uses. In small doses mercury increases the number of red corpuscles and has a tonic effect. By decreasing the fibrinous elements of the blood, mercury may be useful in lessening plastic exudate in inflammations of the serous membranes, as pleurisy, peritonitis, pericarditis, and iritis. Its value in endocarditis and pneumonia is less certain. The pseudo- membranous forms of laryngitis are especially benefited. For this antiphlogistic effect it should be administered during the stage of exudation, and it is valueless in subacute inflam- mations, Calomel and the mass are the favorite forms. In syphilis its action is specific, and its administration should be begun as soon as the diagnosis is made, and continued during the secondary stage in dosage just sufficient to maintain a mild influence on the system. In the tertiary lesions it is indicated in combination with potassium iodide when an immediate effect is required on local lesions, as those of the IODUM. 167 brain or liver, which threaten life. Otherwise the iodide is used alone by many authorities. In the cachexia of syphilis it has been proven to increase the number of red blood-cells. An an antisyphilitic remedy mercury is employed in various ways-by mouth in the form of calomel or blue mass, by in- unctions of the oleate or ointment, by fumigations of calomel, cinnabar, or the black oxide. In the later lesions the bichlo- ride and the iodides are supposed to be especially efficacious as adjuvants to potassium iodide. In the secondary stage the administration of mercury should be pushed until constitutional symptoms are produced and the dose then reduced to a point just sufficient to control the disease. Usually one-half of the dose necessary to reach the physiological limit is required (White and Martin). The constitutional effects to be observed are tenderness of the gmns when the teeth arc forcibly brought together, ptyalism, and diarrhoea. It is well to alternate the internal administration with the use of blue ointment. IODUM U.S. (Iodine), 1 = 126.53. Iodine is a soft, friable substance, somewhat volatile at ordinary temperatures, of a chlorinous odor, melting at 225° F., with the emission of a beautiful violet vapor. It is soluble in glycerin, alcohol, and ether, but is practically insoluble in water. Therapeutics and toxicology: Locally, it is a powerful irri- tant, and even a mild caustic. The tincture stains the skin, causes a brief smarting sensation, and finally desquamation. Medicinal doses produce a sensation of heat in the epigastrium, a general increase of the secretions, with an especially marked effect on the mucous secretion of the respiratory tract and that of the salivary glands. If too long continued, it gives rise to a train of symptoms known as iodism, as subacute gastro-cnteritis, headache, giddiness, and other evidences of cerebro-spinal disorder, coryza, sore throat, frontal headache, salivation, a skin eruption, generally of acne, and sometimes atrophy of the mammae or testes. The circulatory effects are feeble, but it probably lessens vascular spasm, although 168 ALTERATIVES. perhaps not to a sufficient degree to render it of therapeutic importance. Taken in toxic doses it produces the symptoms of violent gastro-enteric poisoning, with profound collapse and some- times convulsions. The ejected matter is brown or, if the stomach contained starchy food, blue. The post-mortem lesions include fatty degeneration of some of the viscera. Its injection into cavities has given rise to severe symptoms. Gr. xx are said to have caused death, while gij have been recovered from. The antidote is starch in any available form. Iodine is readily absorbed, exists in the blood as an alka- line iodide, and is eliminated principally in the urine, but also in other secretions. Its elimination is apt to be irreg- ular, so that it may show a tendency to accumulate in the system. Therapeutics: Iodine is seldom used alone internally. With potassium iodide, as in Lugol's solution, it is employed as a resolvent in thyroid enlargements and scrofula; in the latter, combined with iron and cod-liver oil, it is considered especially beneficial; as an alterative in secondary and tertiary syphilis, but it is inferior to its potassium salt. Topically, the tinctures are favorite applications in gland- ular hypertrophy, parasitic skin diseases, chronic painful joint-affections, and as a counter-irritant in pleuritic and other pains. Deep injections have been employed with gratifying results in bronchocele and hydrocele, after aspira- tion of the contents, with the purpose of producing adhesive inflammation; and by some practitioners in phthisical cavities. POTASSII IODIDUM, U. S. (Iodide of Potassium), KI = 165.56. Potassium iodide is prepared by the addition of an excess of iodine to an aqueous solution of potassa, and the subse- quent conversion of a contaminating potassium iodate into potassium iodide by heating with charcoal. It is a white anhydrous salt, rather deliquescent in moist air, soluble grain for minim in water, and soluble also in alcohol. Its aqueous solution dissolves iodine (see ImgoVs Solution, below). POTASSII TODIDUM. 169 Physiological action and therapeutics: Its physiological effects are analogous to, but less energetic than, those of iodine. Locally, it is an irritant. Internally: large doses may cause gastro-intestinal irritation; it increases the secretions, with the exception of that of the mammae, which it decreases. It is used in rheumatism, the subacute and muscular varieties being especially benefited by it, while in gout and rheumatoid arthritis it may be tried; in neuralgias, especially the sciatic variety, which may be cured ; in asthma, given between the paroxysms, it seems to prevent their recurrence in some cases, especially in the cases associated with bronchitis and emphysema (perhaps antisyphilitic); in chronic inflammations with serous accumulations, as chronic pleurisy or pericarditis, it appears to promote absorption ; in aneurism it has a good reputation, but being only slightly sedative to the circulation, its method of action is not clear; in chronic metallic poison- ing, especially by lead or mercury, it is very efficient, forming soluble double salts with the metal deposited in the tissues, and thus aiding in their elimination. In the latter, if not used with care, it may cause serious salivation; in tertiary syphilis, as in the osseous, visceral, or nervous lesions of that disease, it is our main reliance. It is also employed in chronic Bright's disease and in hepatic torpor. It is also used as an antidote to poisoning by the alkaloids, with which it forms insoluble precipitates. Potassium iodide-administration: The ordinary dose is gr. x three times daily, to be gradually increased; but in lesions liable to cause fatal results, as in gummata of the brain or liver, much larger doses are given, up to 5J-ij per diem. The saturated, solution, which is practically grain for minim, is a convenient method for administering and increasing the dose. Given in milk or accompanied by small doses of Fowler's solution, it is less apt to cause acne, which is sometimes an unpleasant complication. It is always well to remember that small doses sometimes occasion very decided symptoms. Preparations of iodine and its combinations: lodum. Unguentum lodi, 170 ALTERATIVES. Ammonii lodidum, dose gr. iij-x. Sodii lodidum, dose gr. v-xxx. Strontii lodidum, dose gr. v-xxx. Potassii lodidum, dose gr. x-xxx or more. Unguentum Potassii lodidi, 12%. Liquor lodi Compositus (Lugol's solution) contains iodine 5 and potassium iodide 10 parts in 100; dose lT[v-xv. Tinctura lodi, 7 %, chiefly for external use. Syrupus Acidi Hydriodici, 1 % of the acid, dose lT[xx-xl. The iodides of zinc, silver, arsenic, and lead are official, and have been mentioned under the corresponding metals. Other iodides: Hydriodic acid and the iodides of sodium and ammonium produce effects similar to potassium iodide, and may be substituted for it; but they probably have no advantages, and the ammonium salt is more irritating. Stron- tium iodide is less irritating to the digestive tract. Iodoform (formyl teriodide or tri-iodo-methane, CHI3) occurs in yellowish scaly crystals, of disagreeable odor, insoluble in water, but freely soluble in alcohol, ether, chloro- form, and oils. It contains 96% of iodine. Iodoform may be made by passing chlorine gas through a solution of potas- sium bicarbonate in alcohol and water, to which iodine has been previously added ; iodoform separates in small crystals. Physiological action: Topically, in powder or in strong solution, it produces considerable anaesthesia. It is readily absorbed from wounds, less readily from the gastro-intestinal tract. Large doses are depressant to the nervous, circulatory, and respiratory functions. It is supposed to owe its activity to a liberation of iodine in the tissues. Elimination takes place slowly, for the most part in the urine. Iodoform-toxicology: When too freely applied to a large abraded surface poisoning may result. A variety of types of poisoning are recognized, as first pointed out by Schede. They are as follows: (1) febrile type; (2) characterized by fever with gastro-intestinal irritation ; (3) profound circu- latory depression; (4) the same with fever; (5) immediate IODOFORMUM, U. S. (Iodoform), CHI3 = 392.56. IODOL UM-ARISTOL. 171 collapse and death; (6) meningeal type. Care should be taken not to confound this condition with delirium tremens. The treatment consists in the immediate withdrawal of the drug, and stimulating and sustaining measures generally. Post-mortem lesions: Widespread fatty degeneration. Therapeutics: Iodoform is not ranch used internally. Locally, in surgical conditions, it has made itself indis- pensable, acting as an ancestAefo'c stimulant, and antiseptic. The explanation of its efficacy in the latter direction is not clear, but probably it is only of value when decomposed by the discharges from a wound, liberating iodine, which acts as an antiseptic. In its own form it is not a germicide. It is used in all varieties of ulcers, especially if painful, in surgical wounds, and in painful rectal conditions, in gr. v-x supposi- tories : in tubercular conditions, such as tubercular laryngeal ulcers, its topical use is of value, while in cold abscesses its injection may prove curative. It is further used in a variety of surgical conditions too numerous to mention here. We have an official ointment (10%). I0D0LUM (Iodol). Iodol is a brownish crystalline powder, resembling iodoform in its solubility, but differing from it in being odorless and tasteless. Its iodine percentage is stated by various authors at from 85% to 90%. It is more slowly absorbed than iodoform, and hence is less liable to cause poisoning. It may be used locally as a pleasant substitute for this drug. Soziodol, or Di-iodo-para-phenol-sulphurie Acid, is a white powder, soluble in hot water and containing more than 50% of iodine. It has been used as a local remedy in eczema and impetigo, and has a range of usefulness somewhat resembling that of iodoform. It has a slight antiseptic action. ARISTOL. Aristol contains 45.8 % of iodine: chemically it is di-t hymol- di-iodide; of doubtful germicidal value; it is non-irritating, and has been used locally in inflammations of the nose and 172 ALTERATIVES. upper air-passages, and in psoriasis, lupus, and syphilitic skin lesions. OLEUM MORRHU.ZE, U. S. (Cod-liver Oil; Oleum Jecoris Aselli). Cod-liver oil is a fixed oil obtained from the fresh livers of Gadus Morrhua, or of other species of Gadus (class Pisces; order Teleostei; family Gadidse). Habitat: North Atlantic Ocean. The " shore oil " as used in medicine is a yellow, thick oil, not rancid, and of a peculiar and to most people disagreeable odor and taste. Its composition is quite com- plex, the most important constituents being/h#?/ acids, several biliary principles, gaduin (which is not an active principle), and traces of iodine, bromine, phosphorus, and other sub- stances. By the addition of ammonia trimethylamine is formed (see Ergot). Cod-liver oil is soluble in ether, chloroform, and carbon disulphide. Physiological action: Like other fats, cod-liver oil is absorbed by the small intestine and acts as a nutrient, pro- ducing an increase of the body-weight ; its biliary ingredients probably aid in its absorption, but its effects arc greater than those of other fats, and its complex nature probably gives it some alterative powers. Like other fats, it is difficult of digestion, and if the absorptive powers be overtaxed it may cause diarrhoea and other symptoms of digestive disorder. Therapeutics: Cod-liver oil is looked upon as the most useful agent at hand in the treatment of tuberculous and scrofulous conditions. In the early stages of pulmonary tuberculosis it is an essential, and in some cases apparently curative, element of treatment. In all tuberculous manifes- tations, whether glandular, osseous, articular, or ulcerative, it is of value, but less so the more advanced the case and the older the patient. In conditions of ancemia or defective nutrition it is serviceable, especially in children; thus in rickets this drug is of great value, and likewise in syphilitic cachexia ; and to this effect on the general nutrition may be attributed also its beneficial action in nervous affections, neuralgias, skin disorders, and chronic rheumatic conditions. CALCII PHOSPHAS PRAECIPITATUS. 173 Administration: Dose for a child one year old f;sj, for an adult fsss or more three times daily. The physiological limit is reached when the oil causes digestive disturbance. Various expedients are resorted to in order to disguise its taste. It may be taken with a pinch of salt, or in suspension in whiskey; it may be given in the form of emulsion, flavored with oil of peppermint; in capsule. The time for adminis- tration is about two hours after a meal. If all other methods fail and the oil is not tolerated by the stomach, it may be given by inunction, by itself or mixed with 25% of soap liniment. Inunctions of cod-liver oil arc best given at night, the oil being rubbed into the skin of the abdomen, and a flannel binder worn over night. Children, fortunately, soon learn to tolerate and even to like it. When after repeated trials it is not accepted by the stomach, or when no gain in weight results, it is doing no good. ACIDUM PHOSPHORICUM AND ITS SALTS. Phosphoric acid has been used as an alterative in scrofulous affections and rachitis, but is inferior to its salts. The official acid should contain not less than 85% by weight of absolute orthophosphoric acid (H3PO4=97.8). It is used as Acidum Phosphoricum Dilutum (10%), the dose of which is ffixv-fgj. CALCII PHOSPHAS U. S. (Precipitated Calcium Phosphate), Ca3' POffi=309.33. Calcium phosphate forms more than 50% of bone, and is also an essential part of the soft tissues; a diet from which it is excluded causes sickness and death. Tims, its use is clearly indicated where there is deficiency of bone-formation, as is seen in rachitis and osteomalacia, and it has been found of value in delayed union after fracture, in caries, and in other diseased conditions of bone. It is also used in chronic phthisis, tuberculosis generally, the anaemia of pregnancy, and certain syphilitic lesions, especially gummata and periostitis. Calcii Phosphas Praecipitatus was recognized as official in the U. S. P. of 1880, the dose of which is gr. x or more, t. i. d.; but this, owing to its insolubility, is inferior to the 174 ALTERATIVES. lacto-phosphate of calcium (Syrupus Calcii Lacto-phosphatis, U. S.), which is much used as an ingredient in emulsions of cod-liver oil. THE HYPOPHOSPHITES. The hypophosphites of calcium, potassium, sodium, and iron are official. They are seldom employed alone, but together in Syrupus Hypophosphitum, dose fsj-ij. Syrupus Hypophosphitum cum Ferro, dose Acidum Hypophosphorosum Dilutum, contains 10% of absolute hypophosphorous acid, HP(OH)2 65.88. These syrups, which have been imitated in many proprie- tary preparations, are useful tonics, furnishing an easily oxidizable series of salts which may be readily converted into phosphates in the body. They do not represent the activity of phosphorus compounds. Like the phosphates, they may be used in ansemia, rickets, mollifies ossium, neurasthenia, debilitated conditions generally, and tuberculosis, in the last of which the claim of curative action made for them is not now believed. SARSAPARILLA, U. S. (Sarsaparilla) Sarsaparilla is the root of Smilax officinalis, Smilax medica, Smilax papyracca, and of other undetermined species of Smilax (nat. ord. Liliacete). It lias been considered to be diuretic, diaphoretic, and alterative, but physiological experi- mentation has proven it practically inert. It is used princi- pally as a vehicle for potassium iodide, in the form of Syrupus Sarsaparilla) Compositus, in syphilitic disorders. Its other preparations are : Decoctum Sarsaparillse Compositum contains sarsaparilla, guaiac wood, glycyrrhiza, and mezereum ; dose fffiv-vj. Extractum Sarsaparilla; Fluidum, dose Extractum Sarsaparilhe Fluidum Compositum contains sarsaparilla, sassafras, glycyrrhiza, and mezereum ; dose f,"SS-j. Syrupus Sarsaparilla? Compositus. Made with the fluid GUAIACI LIGNUM. 175 extracts of sarsaparilla, glycyrrhiza, and senna, flavored with oil of sassafras, anise, and gaultheria. Dose f'sss. GUAIACI LIGNUM, U. S., GUAIACI RESINA, U. S. The wood is the heart-wood of Guaiacum officinale and of Guaiacum sanctum (nat. ord. Zygophylleae). Habitat: West Indies and Northern South America. It contains the resin in the proportion of 60% or more. Guaiac is a very complex substance, but no satisfactory active principle has been dis- covered. The resin represents the full activity. Physiological action and therapeutics : Guaiac has a siala- gogue effect from its acrid taste; it also stimulates the hepatic (?) and intestinal secretions. It is absorbed and acts as a diaphoretic (?), expectorant, and alterative. Its con- tinued use may cause gastro-enteric irritation. It is used in subacute and chronic rheumatism, in which it has a reputation; in tonsillitis, which it may abort, but more often fails; and is probably more successful in cases dependent on the "rheumatic diathesis." It has been used in syphilis, but is of doubtful efficiency. Mezereum, U. S., Mezereum. The bark of Daphne Meze- reum, and of other species of Daphne (nat. ord. Thymelacese). Habitat: Europe. Mezereum contains the glucoside daphnin, with an acrid resin and oil. It is intensely irritant, and in consequence the drug has been reserved almost entirely for external use. Internally, it has been used as an alterative in conjunction with sarsaparilla. A fluid extract is officially recognized, the dose of which is ffij. Externally, an ointment is used as a stimulant and irritant. Jambul, Jambul. The bark of Eugenia Jambolana, a native tree of East India and Queensland. The chemical nature of the active principle which appears present in the bark, seeds, and rind of the fruit, has not been determined. The use of the fluid extract in doses beginning with ffix, has been followed by reduction of the sugar excreted in cases of diabetes, and in some instances by a total disappear- 176 ALTERATIVES. ance. In other cases jambul has had no effect; but as no unfavorable results have followed its administration, a careful trial is to be recommended in all cases of glycosuria. Sassafras, U. S., Sassafras. The bark of the root of Sas- safras variifolium (nat. ord. Laurinese). This bark contains an official volatile oil, Oleum Sassafras, which in turn owes its flavor to saffrol, C10H1(1O2, now obtained on a large scale from oil of camphor. It is classed among the alteratives, but is almost solely used as a flavoring agent. Combined with oil of wintergreen and other volatile oils it constitutes the popular sarsaparilla flavor. Taraxacum, U. S., Taraxacum (Dandelion). The root of Taraxacum officinale (nat. ord. Composite), gathered in autumn. Habitat: Europe; naturalized in North America. It contains taraxacin. Official preparations are an extract (gr. xxx-lx) and a fluid extract (fsj-ij). Dandelion root is supposed to possess cholagogue and diuretic properties, and may be used in cases of dyspepsia, with hepatic torpor. ICHTHYOL. Ichthyol is found in the shops as the ichthyo-sulphates of sodium and ammonium, both of which combine in all pro- portions with fats and petrolatum. Ointments of 10% to 20% strength are most used. Both ichthyo-sulphates are soluble in water, the former having an alkaline, the latter a weak acid, reaction; both have a peculiar bituminous taste and smell. Physiological action and therapeutics: Locally, ichthyol is an irritant and a valuable stimulant to sluggish granulations. It is said to have a decidedly alterative effect on the skin and subjacent tissues. It is used in various skin affections, as chronic eczema, chronic urticaria, etc.; in painful rheumatic, gouty, and traumatic joint-conditions. In erysipelas, applied in 50% strength after thorough disinfection, it is said to act very effectively and quickly ; also mixed with collodion. COLCHICUM. 177 COLCHICUM. Colchici Radix, U. S. (Colchicum Root). The corm of Colchicum autumnale (nat. ord. Liliacese). Colchici Semen, U. S. (Colchicum Seed). The seed of Colchicum autumnale (nat. ord. Eiliaceae). Colchicum autumnale is a small plant of Europe. The so-called root is a corm or bulb. Both parts have a bitter, acrid taste, and contain an alkaloid, colchicine, soluble in both alcohol and water, upon which their activity undoubtedly depends. Preparations: Extractum Colchici Radicis (an acetic ex- tract), dose gr. j-ij. Extractum Colchici Radicis Fluidum, dose YiTij-x. Vinum Colchici Radicis (40%), dose TT[x-xx. Extractum Colchici Seminis Fluidum, dose Tinctura Colchici Seminis, Vinum Colchici Seminis, 15%, dose Physiological action: The effects of moderate medicinal doses of colchicum preparations are more or less gastric and enteric disturbance, as evidenced by abdominal uneasiness and pain, mild purgation, anorexia, and at times nausea, cardiac depression, and occasionally diaphoresis. A general stimula- tion of secretions takes place, but the effect upon the urinary solids is disputed, it being held by some that the elimination of urinary solids is increased, by others that it is unaffected. The flow of urine is generally increased. Excessive doses cause symptoms of irritant poisoning, nausea, persistent vom- iting, purging (occasionally bloody), and severe abdominal pains; convulsions may occur, and there is always profound cardiac depression. Consciousness is preserved to the last, and death takes place from exhaustion or cardiac paralysis. Colchicum kills by producing excessive intestinal irritation. The mucous membrane of stomach and bo\vel is found greatly swollen and ecchymosed in fatal cases. Toxicology: The smallest fatal dose of colchicum is not 12-M. M. 178 THE AJUMAL ALTERATIVES. definitely recorded. Of the wine of the root fffijss and fffiijss have proved fatal. The treatment consists in evacua- tion of the stomach and intestines, if this has not spontane- ously taken place, and the administration of tannic acid as a chemical antidote, opium and demulcents in the later stages to allay irritation, and stimulation as necessity arises. Therapeutics : The use of colchicum is purely empirical, its therapeutic value having no apparent connection with its physiological effects, so far as these are known. In acute gout in sufficient doses to excite the skin, kidneys, and gastro- enteric tract, but with care to avoid the production of vomit- ing and pronounced diarrhoea (of the wine of the root, gtt. x-xx every four hours), it will diminish the pain and swell- ing and shorten the duration of the attack. In the intervals of the attacks, taken in smaller doses and less frequently, it is a good prophylactic, and is well combined with potassium iodide. In subacute rheumatism and the so-called rheumatic gout colchicum in the same combination is very serviceable. In the constipation and functional disturbances of the liver of the gouty diathesis combinations of colchicum and salines are of value. THE ANIMAL ALTERATIVES. Thyroid extract: An extract prepared from the thyroid gland of animals, notably the sheep. It has been known for some time that excision of the thyroid gland (as in extir- pation of the gland in the surgical treatment of goitre) was followed by a condition allied to myxoedema, a disease clinic- ally characterized by mucoid degeneration of the subcu- taneous tissues, atrophy of the thyroid gland, and mental impairment. When only one-half of the gland was removed this train of symptoms did not occur. It has been clinically found that this artificial myxoedema disappeared under the administration of extract of thyroid gland. Used in myxoe- dema and cretinism, in which it frequently acts as a specific, producing some effect in all cases; in goitre (particularly that of mountainous districts); and in obesity with decided results. Thyroid extract is contraindicated in exophthalmic THE ANIMAL ALTERATIVES. 179 goitre, which seems to be caused rather by a perversion of the normal activity of the gland. The active principle is at least in part thyro-iodine, though this probably does not represent the full activity. Thyroid gland, its extract, or various preparations are given to the point of physiological tolerance, beginning with gr. 3-ij, and increasing rapidly. The therapeutic limit is in- dicated by tachycardia, oppression, exophthalmos, and irri- tability. No serious results have followed the administration of large doses to animals. Diphtheria antitoxin has reduced the death-rate from this disease in a most striking manner. It should be used early, in large doses, as a true micrococcus infection exists at this time; later on, a septicaemia is added to this and the serum becomes powerless. Dose, hypodermically, to a child of one year, 500-1000 units; to a child of three years, 1500 units; and to an adult, 3000 units. Medicinal and local treatment should be combined with the use of the serum. Tuberculin is an impure toxin generated by the tubercle bacillus. When injected into phthisical patients it causes a rise of temperature by adding toxin to that already present; this is accompanied by rapid destruction of the degenerated tissue, with liberation and expectoration of debris swarming with tubercle bacilli. Its injection has frequently been fol- lowed by miliary tuberculosis. Tuberculin is of no thera- peutic value, but the rise of temperature following its injec- tion is made use of to diagnose tuberculosis in cows afflicted with the disease. Tetanus antitoxin prevents tetanus in the rabbit, but seems of little value in man. When the symptoms establish the diagnosis it is usually too late to be of any use. Its injec- tion has been followed by death. [Cases have also been reported in which its early use has seemed beneficial.-Ed.] Streptococcus antitoxin is of value where a real streptococ- cus infection exists, and should be combined with the ordi- nary treatment by stimulation. 180 ANTIPERIODICS. Nuclein (nucleinic acid), usually prepared from yeast, is a remedy producing a hyperleucocytosis of the blood, and is useful in infectious diseases when this effect is desirable. It may be given by mouth, but is more efficient when employed hypodermically. Nuclein has been used in tuberculosis, in septic puerperal diseases, in typhoid fever, and in pneumonia. ANTIPERIODICS. These are remedies which, by affecting the nutrition of the body or by a direct paralyzing effect on the malarial organ- ism, check malarial paroxysms. CINCHONA, U. 8. (Cinchona). Cinchona is the bark of Cinchona Calisaya, Cinchona offici- nalis, and of hybrids of these, and of other species of Cinchona (nat. ord. Rubiacese), yielding, when assayed by the process of the Pharmacopoeia, not less than 5 % of total alkaloids, and at least 2j- % of quinine. Cinchona Rubra, U. 8., Red Cinchona. The bark of Cin- chona succirubra (nat. ord. Rubiaceae), containing not less than 5% of its peculiar alkaloids. Habitat: In the Andes of tropical South America, at an altitude of 2300-8000 feet; cultivated in India (Himalaya and Neilgherry Mountains), Java, Jamaica, and other coun- tries ; also in South America. Constituents: The alkaloids of cinchona are quinine, quini- dine, cinchonine, and cinchonidine, while two others, quinicine and cinchonicine, have been produced artificially by heating quinine and cinchonine respectively, and are amorphous. Several other unimportant alkaloids have recently been dis- covered and more or less thoroughly investigated. Quinine and cinchonine exist in combination with kinic acid. Cin- chona also contains cinchotannic and kinovic acids, starch, and a trace of a volatile oil. Varieties : Cinchona Flava (Calisaya or yellow bark) con- tains a large proportion of quinine and very little cincho- nine. CINCHONA. 181 Cinchona Rubra (the red bark) contains a considerable proportion of each. Pale bark and Carthagena or Columbian bark are weaker in alkaloids, but arc used in the manufacture of the latter. Preparations and doses: Of the yellow bark the following preparations are official: Extractum Cinchonae, dose gr. v-x. Extractum Cinchonae Fluidum, dose ffiv-x. Tinctura Cinchonae, 20%, dose f.oj-ij. Infusum Cinchonae, 6% with 1% of aromatic sulphuric acid ; dose Oj-ij. Of the red bark only the following : Tinctura Cinchonae Composita (Huxham's tincture), a 10% tincture, containing also bitter orange-peel and serpentaria, and constituting a valuable tonic and antipyretic; dose fgj- f£ss. The other preparations mentioned above are seldom used, the following alkaloids and their salts being preferred : Quinina. Quininae Sulphas, gr. j-xx. Quininae Bisulphas, Quininae Hydrobromas, Quininae Hydrochloras, Quininae Valerianas, practically equal to the sul- phate. Quinidinae Sulphas, Cinchonina, Cinchoninae Sulphas, Cinchonidinae Sulphas, dose from one-fourth to one- third greater than of the sul- phate. Properties of quinine and cinchonine : Quinine, either in an amorphous white powder or in the crystalline form, is with- out odor, very bitter, and practically insoluble in water (1670 parts). Of its salts the bisulphate is most soluble, dissolving in 10 parts of water, the hydrobromate in 16, the hydro- chlorate in 34, while the sulphate, the salt most frequently used, is again practically insoluble (740 parts), and hence is commonly given in pill, powder, or capsule. If a solution is desired, aromatic sulphuric acid dissolves the sulphate, minim for grain, and the bisulphate, minim for gr. ij. Cinchonine is a white crystalline substance, somewhat less 182 ANTIPERIODICS. bitter than quinine, but, like the latter, practically insoluble in water. It is also very insoluble in ether, and is thus separated from quinine, which is easily soluble in that men- struum. Incompatibles: The preparations of cinchona are rendered insoluble by, and are therefore incompatible with, the alkalies and their carbonates, tannic acid, and iodine preparations, while ferric salts precipitate their tannin and form ink. Physiological action: Locally, to mucous membranes and to surfaces denuded of their epidermis, quinine and its salts are actively irritant. Internally, in sufficient dosage, the size of which varies greatly with the susceptibility of the individual, a train of symptoms called cinchonism is produced. The initial symptoms of this condition are tinnitus aurium, some deafness, and a sense of fulness in the head. After large doses these symptoms become more marked, and severe headache, disorders of vision, cutaneous eruptions, giddiness and a staggering gait, delirium, convulsions, and even collapse may occur. Nervous system: The symptoms produced by quinine would seem to indicate cerebral congestion, but this has not been proven. However this may be, the tinnitus aurium seems to be due to congestion of the middle ear. Temporary and even permanent deafness may result under its protracted medicinal use. The convulsions are epileptiform. In animals the reflex excitability of the spinal cord is diminished or abol- ished, probably by stimulation of a centre supposed to pre- side over the reflexes, and known as Setschenow's inhibitory centre. In frogs small doses increase the reflexes, probably by stimulating the peripheral sensory nerves; larger doses de- crease them, by stimulating Setschenow's (inhibitory) centre; toxic doses abolish them by paralyzing both the sensory nerves and the sensory cord. Circulation.: Large doses decrease the force and frequency of the heart's action by a direct action on its motor ganglia, while very large doses produce dilatation of the blood- vessels. Blood-changes occur; the amoeboid activity of the white corpuscles is decidedly lessened and their number is CINCHONA. 183 diminished ; the red corpuscles arc decreased in size, and the power of their haemoglobin to carry oxygen and ozone is impaired. Digestive tract: Upon the stomach quinine acts as a simple bitter, increasing the appetite and digestive powers; but in very large doses it may prove irritant enough to produce nausea and vomiting. It is absorbed only by the stomach, the alkaline secretions of the intestinal tract precipitating it and preventing its absorption. Temperature: In health the temperature is very slightly affected, but in fever it is lowered promptly and decidedly, probably from a diminished heat-production dependent upon lessened oxidation. Eye: Quinine may cause blindness when given in large doses; this is usually a transient condition, but true atrophy of the optic nerve has followed its use in animals. Antiseptic action: The activity of the malarial plasmodia is lessened or they actually disappear from the blood under its use. It also exerts a preventive influence upon putrefac- tive and allied processes. As has been already noted, quinine is an excito-motor, with a special action upon the uterine muscle; but probably it only acts after labor-pains have begun, and is incapable of originating them. Absorption and elimination: As has already been stated, quinine is absorbed entirely, or, for the most part, by the stomach. In the blood it is apparently held in solution by the loosely combined CO2 present, and it is eliminated largely by the urine. Under ordinary circumstances most of the quinine is eliminated in forty-eight hours. Therapeutics. Malarial conditions: Quinine has been used in a great variety of conditions, but its greatest value has been found in these, for which it is in most cases a specific. In the regular intermittent type it may be used as a specific and prophylactic. There can be no doubt of its prophylactic value in doses of gr. ij, two or three times daily. Various methods of administration have found favor when the parox- ysm has already occurred. Some advocate continued dosage of gr. v-x three times daily; but it is preferable to give it in 184 ANTIPERIODICS. frequently repeated small doses for twelve hours before the expected paroxysm., or in large doses six and eight hours before that time. In any case it is well to continue its use for several days after the paroxysms have ceased, and to induce a slight of cinchonism on the seventh day, when a relapse is most likely to take place. In mild or severe malarial poisoning its efficiency is greatly increased by preceding it with a mercurial purge. In the pernicious form no delay is permissible, and the patient should be cinchonized as rapidly as possible, it being necessary to give at least as much as 3ss-j during the day; and the hypodermic exhibition of the bisulphate is strongly urged, together with its administration by rectal injection. Chronic malaria is marked by an irritable stomach, irreg- ular chills, anaemia, and enlargement of spleen and liver. Quinine is indicated during the chill; arsenic (Fowler's solu- tion) with purgatives and tincture of ferric chloride during the intermission. In the cachexia following intermittent, remittent, or irregular malaria, arsenic and iron should be used in preference to quinine. In a variety of conditions characterized by periodicity quinine is very valuable. Thus, neuralgias, chorea, haema- turia, asthma, hay fever, and hiccough may in many cases be cured by quinine, although large doses may be necessary. In chorea and neuralgic headaches it is advisable to determine carefully the presence of any malarial taint before adminis- tering this drug, for otherwise they may be made worse by its use. In the irregular and chronic forms of malaria its action is less certain, and it often fails. In bilious or remit- tent fever it may be given freely. In conditions of septic intoxication, septicaemia, pyaemia, and puerperal fever it has been much in vogue, but evidence of its utility is wanting. As an antipyretic in typhoid, typhus, and other continued fevers it will undoubtedly lower temperature, especially after crisis or lysis has taken place, but it has been largely super- seded by the more recent antipyretics. As a stomachic tonic it is used in dyspepsia, especially of the fermentative varieties; while in debilitated conditions generally combinations of small doses (gr. j-ij) with iron are of great value. In fer- CINCHONA. 185 mentative diarrhoeas it may also do good. Acute coryza may be aborted by its use in some cases, and chronic bronchitis is often greatly benefited. Locally, quinine inhalations have been advocated in hay asthma and whooping-cough, but have not demonstrated the claims made for them. Administration and contraindications: Because of its ex- tremely bitter taste quinine is best administered in freshly prepared pills or in capsules. Hypodermically it is particu- larly efficient, but exceedingly irritating, and in pernicious forms of malaria may necessarily be so administered. It should be slightly acidulated with tartaric or other acid to prevent its immediate precipitation by the alkaline reaction of the blood. This form of administration is only used in emergencies, as great irritation, abscess, gangrene, and even tetanus have followed its hypodermic injection. Quinine should be used with care when any gastro-enteric inflammation exists, and is absolutely contraindicated in inflammations of the middle ear. It is also contraindicated in inflammation of the kidneys and bladder and in skin dis- eases of an inflammatory type. Cases of idiosyncrasy arc not uncommon. Two grains may produce in susceptible individ- uals a troublesome rash and symptoms of apparent syn- cope, with the sensation as though the patient were dying. Combinations with dilute hydrobromic acid or chloral are said to diminish the unpleasant subjective sensations of cin- chonism. Quinidine: Quinidime Sulphas, in which form alone this alkaloid is official, acts chemically like the sulphate of quinine, but exhibits different refractive qualities. It is weaker than quinine by about one-third, and its effects and uses are sim- ilar to those of its sister alkaloid. Cinchonine; Cinchonidine : The Sulphate of Cinchonine is a bitter crystalline salt soluble in 54 parts of water. As a tonic and antiperiodic it resembles quinine, but requires about one-third larger dosage. Cinchonidinae sulphas : Of the properties and powers of this salt little is at present known. It seems a reliable substitute for quinine. 186 ANTIPER10DICS. Chinoidinum: This preparation, known as chinoidin or quinoidin, is a blackish resinous substance obtained by evap- orating the mother-liquor from which the alkaloids have been obtained by crystallization. It is cheap, and efficient according as it contains more or less of the active prin- ciples. Warburg's tincture : Warburg's tincture is now prepared by a modification of a very complicated formula, and owes its efficiency to aromatics and stimulants and a large percentage of sulphate of quinine. It is much used as an antiperiodic in malarial fevers, and is said to be particularly efficient in the severe and malignant forms, in which, after free purga- tion, it is given in two or three doses of f§ss each before the expected paroxysm, and induces profuse perspiration. It is a useful tonic in fsj doses three times a day. EUCALYPTUS, U. S. (Eucalyptus). Eucalyptus is the leaves of Eucalyptus globulus (nat. ord. Myrtaceae), collected from the older parts of the tree. This tree is a native of Australia, but is cultivated in other countries. The drug contains tannic acid, resin, and a volatile oil, the last of which is its active principle, present in greater amount in the leaves, and has a pungent, aromatic odor and taste. Physiological effects : The effects of eucalyptus are not fully understood. In large doses the oil causes mental exhilaration, and excessive doses produce sensory disturbances, as numb- ness, sense of weight in limbs, etc., and some motor palsy, probably by paralysis of the spinal centres, as the peripheral nerves retain their irritability. Death is said to be caused in animals by paralysis of the respiratory centre. The oil (Oleum Eucalypti, U. 8., or its active principle, Eucalyptol, U. 8., C10H 1SO) is an antiseptic and more or less irritant, and possesses the general stimulant properties of the volatile oils. Like oil of turpentine and the terpenes in general, it is eliminated by the kidneys, skin, and respiratory tract. Upon the latter it exerts a stimulant expectorant effect. It imparts the odor of violets to the urine. ACIDUM PICRICUM. 187 Therapeutics: Eucalyptus is used empirically. It meets with success in mild malarial attacks, probably like other volatile oils, not as a specific, and is an excellent stimulant expectorant in acute and chronic bronchitis. The usual form for administration is the oil in doses of Tf[v-x, in capsule, every two hours. Eucalyptol is also used with an idea to remote disinfection in offensive discharges of the broncho- pulmonary and genito-urinary passages. The cultivation of the trees is said to render malarial dis- tricts more inhabitable. Oleum Eucalypti, U. S., Oil of Eucalyptus. A volatile oil distilled from the fresh leaves of Eucalyptus globulus, Eucalyptus oleosa, and some other species of Eucalyptus (nat. ord. Myrtaceae). The oil contains Eucalyptol, C10H16O, and two terpenes of the formulae C10H14 and C1()H]6. Eucalyptol, U. E, Eucalyptol, C10H18O = 153.66. This is the active principle of oil of eucalyptus. Both the oil of eucalyptus and eucalyptol are irritant when applied locally. Internally, small doses produce a peculiar intoxication, while larger doses are followed by marked constitutional disturbance. Both remedies directly paralyze the spinal cord and medulla, directly depressing the heart. Medicinally,' eucalyptus or its active principle possesses decided antiperiodic properties, though much inferior to quinine. It is perhaps the most useful of all stimulating expectorants, and is eliminated by lungs, skin, and kidneys. The dose of the oil or of eucalyptol is 1ffv-x, enclosed in capsule. Acidum Picricum (Picric Acid, Tri-nitro-phenol, C6H2(NO2)3.- OH) occurs in the form of yellow, shining crystals, soluble in water and alcohol. It has some antiperiodic virtues in doses of gr. | three times a day. Picric acid in aqueous solution forms an exceedingly delicate test for albumin in the urine ; unfortunately, it also precipitates other substances, such as some of the alkaloids. 188 ANTIPYRETICS. Antipyretics are drugs which so modify nutrition as to lower febrile temperatures. ANTIPYRETICS. ACIDUM SALICYLICUM, U. S. (Salicylic Acid). Salicylic acid may be obtained from the methyl salicylate of oil of wintergreen or oil of birch. Most of it, however, is formed artificially by the combination of carbonic acid and phenol. It occurs as permanent, fine, needle-shaped crystals, odorless, tasteless, or with a somewhat astringent after-taste, and an acid reaction. It is practically insoluble in cold water (450 parts), but freely so in alcohol, ether, and glycerin. Acidum Salicylicum, dose gr. x-3j (never used internally). Lithii Salicylas, dose gr. xx-xl. Sodii Salicylas, dose gr. xx-3j. Physostigminse Salicylas (see Physostigmd), dose gr. Physiological action : As might be inferred from its origin, salicylic acid resembles carbolic in some of its effects. Given in sufficient doses, it causes symptoms somewhat resembling cinchonism-tinnitus aurium and a feeling of fulness in the head, or, if more pronounced, deafness, ptosis, strabismus, partial blindness, and excessive sweating. In cases of poison- ing, ptosis, restlessness, and severe headache, delirium (either wild or of a melancholic type), olive-green urine, and slow and labored respiration occur, ending in collapse and death. Nervous system: Ordinarily the cerebral symptoms produced resemble those of quinina, and the delirium is not marked; they may be due to congestion. Salicylic acid seems to have some depressing effect on the motor nervous centres. Circulation: Authorities differ about the cardiac effects of this drug, but in medicinal doses it has little or nodepressing effect upon the circulation. Salicylic acid probably increases arterial pressure by stimulation of the heart and vaso-motor centres. It is claimed that excessive doses produce slow and labored pulse, probably by a direct action on the heart. In the blood it has been proved to have a depressing effect on the activity and emigration of the white blood-corpuscles. A CID UM 6A LICYLIC UM. 189 Respiration is at first stimulated, later depressed. Temperature: In health this function is not affected by moderate doses, but in febrile conditions in large doses it produces a considerable fall of temperature, which is pre- ceded or accompanied by profuse sweating. To obtain this effect large doses (sj) must be given. Continued administra- tion may cause gastric disturbance. Absorption and elimination: Salicylic acid is probably absorbed as an alkaline (sodium) salicylate. It is elimi- nated chiefly by the urine unchanged or as salicyluric acid. Absorption is rapid, the acid appearing in the urine in from eight to ten minutes, but elimination is slow. The urine is colored green from an increase of the indican, or per- haps by pyrocatechin, and after excessive doses may be albu- minous from renal irritation. The antiseptic effects of salicylic acid will be considered elsewhere. Salicylic acid or its salts increase the elimination of urea and uric acid, and probably in this way act beneficially in rheumatism. Therapeutics : The most important use for salicylic acid at present is in the treatment of acute articular rheumatism. Given in doses of gr. x-xv every two or three hours, it reduces the temperature, relieves the pain, and greatly short- ens the painful part of the attack; but there is doubt as to its efficacy in preventing relapses and cardiac complications ; in fact, most authorities are inclining to the belief that it does not. It is advantageously combined with alkalies, and one of the salts is always selected for internal use. In gonorrhoeal and subacute rheumatism it is less efficient, but often proves valuable; while in lumbago and myalgia generally, and in chronic rheumatism and gout, especially the irregular forms, it is often serviceable. In acute tonsillitis, especially in those cases which seem to depend upon a rheu- matic diathesis, it is often of signal service in small, fre- quently repeated doses. Rheumatic iritis has been reported cured by its use. In typhoid and other continued fevers and in the exanthemata it is now seldom used as an antipyretic. As it does not destroy the spirillum of relapsing or the plas- modium of malarial fever, it can in no sense be considered a specific in these conditions, but may do good by abating cer- 190 A NTIPYRETICS. tain symptoms, especially the fever, although we now have better antipyretics. Sodium Salicylate (Sodii Salicylas, U. S., NaC7H5O3 159.67) is the salt usually prescribed, salicylic acid itself being too irritating for general use. It is very soluble in water as well as in alcohol, and is usually given in aqueous solution. It has a disagreeable taste and frequently produces nausea. Ammonium Salicylate (U. 8.) is rapid in its action ; stron- tium salicylate is least apt to derange the digestive tract. Any of the salicylates may be given in milk to disguise their taste and prevent gastric irritation. SALICINUM, U. S. (Salicin). Salicin is a glucoside obtained from several species of Salix and Populus (nat. ord. Salicacese). It occurs in permanent, odorless, prismatic crystals of bitter taste, and is soluble in 28 parts of water and 30 of alcohol, and insoluble in ether and chloroform. Hence it is generally given in capsule, wafer, pill, or in mixture. Physiological action and therapeutics : The effects of salicin are not pronounced. Compared to salicylic acid, it is less irritant to the stomach, and perhaps less apt to cause unpleasant head-symptoms, and it is free from toxic effects. Part of it at least is converted into salicylic acid in the blood. It is eliminated unchanged and as salicylic and salicyluric acids. It is useful in acute rheumatism, accomplishing the same results as salicylic acid, but acting much more slowly. When the latter drug causes gastric irritation or cerebral symptoms this will prove a very efficient substitute in doses of gr. xv-xx every two or three hours. It is also used as a bitter tonic, as an antifermentative in diarrhoeas, and occa- sionally as an antipcriodic. OLEUM GAULTHERIA1, U. S. (Oil of Gaultheria; Oil of Wintergreen). Oil of gaultheria is a volatile oil distilled from the leaves of Gaultheria procumbens (Wintergreen; nat. ord. Ericaceae), consisting almost entirely of methyl salicylate (CH3C7H5O3= SALOL. 191 151.64), and nearly identical with volatile oil of betula. Oil of wintergreen (teaberry) is a volatile oil, heavier than water, of a peculiar, agreeable odor, and consists of 90% of methyl salicylate. Its salicylate strength is five-sixths that of salicylic acid, and the dose should be proportionately larger. Physiological action: The uses are identical with those of salicylic acid, and the oil forms (in capsule or in mixture) a reliable and easy method of administering the salicylates in acute rheumatism, the usual dosage being about fsj daily in fre- quently repeated doses. Oil of birch and the artificial oil are often substituted for it, and are equally efficient. The odor of the oil appears in the urine after its use, and this secre- tion decomposes less rapidly. Hence the oil is used with a view of asepticizing the genito-urinary tract. SALOL, U. S. (Salol), (C(iH5)C7H5O3=213.47. Salol is salicylate of phenol, or salicylic acid in which 1 atom of H has been replaced by phenol. It is a white crys- talline powder, with a slight odor of oil of wintergreen, taste- less, nearly insolnble in water, bnt soluble in alcohol and ether. Physiological action: Salol is not dissolved in the stomach, but in the alkaline secretion of the intestinal tract it is slowly broken up into its two component parts, yielding 36 parts of carbolic and 64 parts of salicylic acid. In its effects it more closely resembles salicylic acid, producing ringing in the ears and other constitutional symptoms of that drug, but to a less degree and with almost no gastric disturbance, as it is not dissolved in the stomach. After large amounts the urine has the smoky color of carbolic-acid poisoning. Therapeutics : Salol is a good disinfectant, and is used as such in the various forms of stomatitis and pharyngitis, while its similarity to salicylic acid renders it a valuable substitute for that drug in acute rheumatism and as an antipyretic. It is less certain, less efficient, and more poisonous than salicylic acid. It is used also to render the urine aseptic in cystitis, and at one time was in favor as an intestinal antiseptic in typhoid fever and cholera. It can be useful in these condi- 192 ANTIPYRETICS. tions only by preventing the development of bacteria, as its dilution must be far too great for any actual germicidal effect; and even in strong solutions its germicidal powers are so weak as to render it probably inert in these conditions. Owing to its insolubility in the stomach, it may be used as a test of the peristaltic activity of that organ or of the presence of pyloric obstruction. When the stomach is healthy the urine should show the presence of salicyluric acid in from one-half to three-quarters of an hour; and if its appearance be delayed beyond an hour, a pathological condition is prob- able. Salol is eliminated in the form of the educts of both salicylic and carbolic acids. Administration : Salol is generally given in pill or capsule, the dose being gr. v-x, repeated rather frequently. When its local action is desired in the mouth or pharynx tablets slowly dissolved in the mouth are useful. BETOL, or NAPHTHOLOL. Betol is another compound of the same scries, and is analo- gous in composition to salol, the difference consisting in the substitution of beta-naphthol, instead of phenol for the H atom. It occurs in small whitish crystals, insoluble in water, but soluble in alcohol and fats, and having a high melting- point. Physiological action and therapeutics : Like salol, betol passes undissolved and unabsorbed through the stomach, is con- verted into its component parts by the pancreatic secretion, and acts as salicylic acid, of which it yields about 55 %. It is entirely non-toxic. Of its antiseptic properties and thera- peutic uses the same may be said as of salol, though it is probably not so efficient because it contains less of the acid. ACIDUM CARBOLICUM, U. S. (Carbolic Acid; Phenol), C(IH5OH 93.78. Carbolic acid is a constituent of coal-tar, obtained by frac- tional distillation, and subsequently purified. Although this drug finds use chiefly as an antiseptic, yet its physiological effects and chemical composition demand for it notice in this ACIDUM CARBOLICUM. 193 connection. Carbolic acid, known also as phenol, phenic acid, phenyl hydrate, and phenyl alcohol, is a coal-tar deriva- tive. It is formed by adding a hot concentrated solution of potash to crude coal-tar, and then water, when it is converted into a light oil and a heavier alkaline liquid ; the latter is neutralized with hydrochloric acid, separating crude carbolic acid. In this form it contains several analogous substances, chiefly xylic and cresylic acids, which possess very similar properties to itself. Physical properties: When pure, carbolic acid is colorless, crystalline at ordinary temperatures, and has a characteristic odor and burning taste. The pure acid generally acquires a slight pinkish tinge on standing. It is soluble in about 15 parts of water, and freely so in alcohol, ether, glycerin, and the fixed and volatile oils, and deliquesces when exposed to moist atmospheres. It is neutral in reaction, but combines with salifiable bases. The acid is readily recognized by forming a violet-blue color with ferric salts. Physiological action: Locally, phenol is a protoplasmic poison, destroying all organic tissues. It produces more or less anaesthesia, not only of the parts with which it comes in immediate contact, but also of the underlying tissues, and in its pure state produces white eschars followed by superficial gangrene. It is a direct poison to all the higher tissues. Its local application produces a white eschar, which changes to a dark red if the acid is removed at once. Absorption and elimination : Carbolic acid is absorbed, and exists in the blood as an alkaline carbolate. It is eliminated by all the secretions as an alkaline carbolate, as well as certain products of its oxidation when small amounts are ingested, but mostly unchanged after large doses. The urine contains sulpho-carbolic and glyco-uronic acids in combination with alkalics; if the amount taken is large, unchanged carbolic acid is eliminated. Nervous system: Poisonous doses produce in man vertigo, contracted pupils, and tremors, while in animals convulsions, apparently of spinal origin, and paralysis occur. Circulation: The heart may be slowed or be normal from direct depression; the arterial pressure is at an early period 13-M. M. 194 ANTIPYRETICS. lowered by paralysis of the vaso-motor centre in the medulla; and the movements of the white blood-corpuscles are ren- dered more sluggish. The respiration is rendered rapid and shallow by large doses, death usually occurring through respiratory arrest; some reduction of temperature takes place, but the drug has no value as an antipyretic. The urine derives a dark-brown color from the oxidation-products, and as this smoky color gives the first warning of poisoning from its external or internal use,' the urine should be carefully watched and the drug withdrawn upon its earliest appearance. Carbolic acid-toxicology: Poisoning may be slow or rapid. In the slow variety, which occurs from absorption after opera- tions or dressings, the symptoms are smoky and albuminous urine, great feebleness and collapse, diminished circulatory and respiratory power, muscular weakness, and giddiness. In the rapid form, occurring after the ingestion of a concen- trated fatal dose, the symptoms are impairment of sensation and motion, unconsciousness, dyspnoea, stertor, feeble and frequent pulse, collapse, tremors, and death. If the patient lives long enough, symptoms of gastro-enteric irritation may develop. Carbolic acid may kill very rapidly (one minute); usually the fatal result is postponed for from one to eight or ten hours. The smallest fatal dose is f-5j, and comparatively large doses have been recovered from under active treatment. The diagnostic signs are the characteristic odor upon the breath, whitened patches on the visible mucous membranes, and discolored urine. The treatment consists in evacuation of the stomach by the stomach-pump, and the administration of some soluble sulphate, as magnesium or sodium sulphate, or dilute sul- phuric acid. These form the comparatively harmless sul- phocarbolates, and are antidotes even after the poison has been absorbed. Free hypodermic stimulation with ammonia, ether, or alcohol, and demulcent drinks during the later stages, complete the treatment. Appearances post-mortem: After the ingestion of a fatal dose of the concentrated acid hard white areas of necrotic ACIDUM CARBOLICUM. 195 tissue, surrounded by zones of inflammation, are found wherever the acid has been in contact; the hollow viscera are filled with imperfectly coagulated blood, and the liver and kidneys sometimes show fatty degeneration. Preparations : Acidum Carbolicum, dose gr. j-iij. Unguentum Acidi Carbolici, 10%. Acidum Carbolicum Crudum, for disinfecting purposes. Therapeutics: Internally, carbolic acid is employed for its local effects in nervous vomiting and gastrodynia, which are alleviated by the anaesthesia produced-gr. j-ij doses repeated frequently; in diarrhoeas, especially of the irritative and fermentative varieties-generally combined with bismuth ; in gangrene of the lung, which is said to be much benefited by its combined use internally and by inhalation. Locally, the pure acid may be used as a caustic where extensive action is not desirable, as in condylomata, diph- theritic conditions, etc.; in weaker solutions it is a favorite ingredient in gargles and sprays. Burns and painful or itch- ing ulcers may be relieved by its weak dilutions in oily men- strua (gr. x-xv to ?j of petrolatum, etc.). Injections of 2% solutions into inflamed serous cavities, as in synovitis, have been employed with good effect; while the injection of a few drops of the pure acid into the tunica vaginalis after aspira- tion of the contents of a hydrocele is one of the methods of radical cure. The use of carbolic acid as an antiseptic will be mentioned later. It is to be borne in mind that the external use of the acid, even in watery solution, may be followed by severe and even fatal poisoning; this may occur through the unbroken skin. It is probable, however, that some of the cases reported were due to the limited solubility of carbolic acid in water, and that the supposed solution contained globules of the pure acid in suspension, which then came into immediate contact with the skin or wounded surfaces. A solution of one part of carbolic acid in eight parts of cotton-seed or olive oil pro- duces no constitutional effects if it is not applied too pro- fusely or over too large an area; such an oily solution has been used with marked success in the treatment of rhus toxicodendron poisoning. 196 ANTIPYRETICS. SODII SULPHOCARBOLAS, U. S. (Sulphocarbolate of Sodium), NaSO3C6H4(OH).2H2O = 231.56. This salt, which we have seen is the harmless result of administering soluble sulphates in carbolic-acid poisoning, is a colorless, transparent salt, permanent in the atmosphere, soluble in 5 parts of water and also in glycerin and alcohol. The corresponding salts of magnesium, potassium, and cal- cium are also employed. Physiological action and therapeutics: All of these possess weaker antiseptic properties than carbolic acid, but from their non-toxic effects are employed to fulfil many of the in- dications for which that drug is used. Thus, they are valu- able in gastric and intestinal disorders, vomiting nod flatulence being especially benefited, and as topical applications in inflammations of the mouth, nose, and pharynx. Dose gr. x-xx. Creosote is obtained as a product of the dry distillation of wood-tar or from crude pyroligneous acid. It is a colorless, oily liquid, turning dark on exposure, and having a peculiar smoky odor, burning taste, and neutral reaction. It is solu- ble in 80 parts of water, and in all proportions in alcohol, ether, chloroform, benzine, and acetic acid. In composition it is very complex, containing phenol, benzol, creosol, and other derivatives of the guaiacol series. The pure drug is difficult to obtain, and crude phenol is often substituted for it-a sophistication which can be detected by its solubility in commercial glycerin, while creosote is not. The odor of car- bolic acid also differs essentially from that of creosote; the latter has the odor of wood-smoke. Carbolic acid coagulates albumin; creosote does not. Physiological action and therapeutics: Creosote possesses many qualities in common with carbolic acid. The symp- toms of poisoning and the proper antidotes are the same as for that drug. It is rapidly absorbed and rapidly eliminated by the kidneys and the bronchial mucous membrane; upon the latter it acts as a stimulant expectorant. Creosote CREOSOTUM, U. S. (Creosote). CREOLIN. 197 appears in the urine mainly as creosol and guaiacol sul- phates. Its uses also correspond to those of carbolic acid; it is employed to allay vomiting and gastralgia, and is a good astringent antiseptic in diarrhoeas. It is at present used in pulmonary tuberculosis, and, combined with proper hygienic measures, may cure in the early stages. It is especially useful in cases associated with free expectoration (Wood). Locally, it is used in varying degrees of dilution as a dressing for foul-smelling and indolent ulcers and in irritative skin diseases, and as a gargle in putrid sore throat. In dentistry it is much used as an analgesic in toothache. Administration: The dose for internal administration is gtt. ss-ij, and should be taken frequently. It is best given in pz7Z-form, and the dose gradually increased until digestive disturbances appear. Under all circumstances it must be given so as to reach the gastric mucous membrane in a diluted form, to avoid its corrosive action. Creosote is there- fore best given after meals. Aqua Creosoti, a 1 % solution, is a convenient form for administration. This preparation may be used externally as a disinfectant and to allay itching ; but carbolic acid is usually employed, because less expensive. CREOLIN (Kreolin). Creolin is a derivative of coal-tar. Its specimens vary in composition, some being soluble in water, while others form emulsions. It is a dark-brown, syrupy liquid, of tarry odor and somewhat biting taste. Physiological action and therapeutics: Creolin is an anti- septic, and is said to be more powerful against non-spore-bear- ing than against spore-bearing organisms. It is absolutely innocuous to man when used in 1 to 2% solutions. It may be a stimulant to indolent granulations. Solutions of 1 % strength are useful substitutes for dressings of carbolic acid or bichloride of mercury when these prove irritant to the skin; and have been used extensively as vaginal douches. 198 ANTIPYRETICS. Guaiacol, Methyl pyrocatechin, C6H4.OH.OCH3. The active principle of creosote, which is in the form of a thick liquid. It has been used in a pure state and also as guaiacol carbo- nate. Both preparations are used for the same indications as creosote itself. Guaiacol seems to have a decided action in reducing the temperature not only of phthisis, but also of pneumonia and typhoid fever; YHxx-xl are painted on the skin of the abdomen or chest (Guinardj. The dose of guaiacol is 1H.v, or ffixx-xl daily, while that of guaiacol carbonate is gr. v. The latter is an almost odorless and tasteless powder. Menthol, U. S., Menthol, C10H19OH = 155.66. A stear- opten (having the character of a secondary alcohol), obtained from the official oil of peppermint (from Mentha piperita), or from Japanese or Chinese oil of peppermint (from Mentha arvensis, var. piperascens, and Mentha canadensis, var. gla- brata; nat. ord. Labiate). Menthol is a useful local anaes- thetic, causing a sensation of cold, though the temperature really rises locally. It has a marked tendency to control superficial inflammations. In neuralgia, menthol applied to the seat of pain frequently gives great relief. A solution in albolene is employed as a spray in pharyngitis. THYMOL, U.S. (Thymol), C,H11O 149.66. Thymol is a crystalline solid, or occasionally a liquid, obtained from oil of thyme (Oleum Thymi, U. S.) by frac- tional distillation. Oil of thyme is a volatile oil derived from Thymus vulgaris and other plants. Thymol is soluble in 1200 parts of water, and freely so in alcohol, ether, chlor- oform, and oils, and has a peculiar odor which to some individ- uals is unpleasant, and which attracts flies. Physiological action and therapeutics: Thymol is a strong antiseptic, ranking just above carbolic acid in power, and re- sembling it in producing cutaneous anaesthesia. Taken by the mouth, it causes tinnitus aurium, partial deafness, some re- duction of temperature, with at times nausea, vomiting, and diarrhoea. Although less toxic than carbolic acid, large doses RESORCIN-A CID UM BENZOICUM. 199 may cause violent delirium and collapse, accompanied by profuse sweating and a dark-green coloration of the urine. It may be used to fulfil the indications for carbolic acid, but is expensive and little used. As an antiseptic mouth-wash in aphthous stomatitis it is particularly valuable, and in 1 :1000 solutions (made with alcohol) it is a good antiseptic and non- irritating to the skin. RESORCIN, U.S. (Resorcin), C6H4(OH)2= 109.74. Resorcin is a substance first obtained from the resins of galbanum and asafoetida, but now derived from phenol, to which it is closely related chemically. It is crystalline, colorless at first, but becomes reddish on exposure, and is freely soluble in water, alcohol, and ether. Physiological action: In doses of gr. xx-xl resorcin causes giddiness, tinnitus aurium, profuse diaphoresis, and reduction of temperature, the latter, however, not being constant and of uncertain duration. After poisonous doses cerebral and sensory disturbances, unconsciousness, epileptiform convul- sions, and collapse may follow. Therapeutics: This drug is now seldom used as an anti- pyretic, being uncertain and unsafe in the dosage required to produce such effects. It is employed as an antifermentative and analgesic in gastric ulcer, gastralgia, and diarrhoeal dis- orders : as a spray-inhalation it is of reputed efficiency in pertussis and hay asthma. Externally, it may be employed in the same surgical condi- tions as carbolic acid, to which it is preferable because there is less danger of toxic effect and because it is more freely soluble in water. It has been particularly recommended in erysipelas, cystitis, chronic otitis, and leucorrhoea. For antiseptic pur- poses solutions of from 1 to 5% are used. Ointments of from 5 to 10% are also used for a variety of skin diseases. BENZOINUM (Benzoin). ACIDUM BENZOICUM (Benzoic Acid), HC7H5O, = 121.71. Benzoin is the concrete juice, occurring in tears, obtained from incisions into the bark of Styrax Benzoin (nat. ord. 200 ANTIPYRETICS. Styracese), a tree of Sumatra, Java, and Siam. It is a bal- samic resin, being composed chiefly of resin and benzoic acid, with the occasional presence of cinnamic acid and vanillin. It also contains a volatile oil. It owes its efficiency chiefly to benzoic acid. Preparations: Adeps Benzoinatus, Ammonii Benzoas, Lithii Benzoas, Sodii Benzoas, Acidum Benzoicum, dose gr. x-xxx. Tinctura Benzoini, 20%, dose TT[xx-xl. Tinctura Benzoini Composita (" Friar's balsam," "balsam de Malta," " Turlington's balsam ") contains benzoin, storax, balsam of Tolu, and aloes; dose Physical properties: Benzoic acid is obtained by sublima- tion from benzoin, or it may be made artificially from hip- puric acid obtained by concentrating the urine of cattle; from naphtalin, C1OHS, and from trichlormethyl-benzol, which is made from toluol, C7Hg. The official acid should have the aromatic vanilla-like odor of benzoin. It takes the form of shining hexagonal scales, has a slightly aromatic odor, warm acid taste, and acid reaction. It is soluble in 500 parts of water, and freely so in ether, alcohol, and in 7 parts of chlor- oform. Physiological action : Locally, benzoic acid is an irritant and protoplasmic poison, and is about equal to salicylic acid as a germicide. In therapeutic doses it is followed by very few symptoms, and its chemistry in the body is not clearly under- stood. In large doses it increases the circulatory and respi- ratory force, and is supposed to produce a greater fall of tem- perature than salicylic acid. It stimulates the cutaneous and bronchial secretions. Its chief effect of interest is in acidify- ing the urine, which is accomplished by its conversion into hippuric acid, which takes place in the kidneys, and probably at the expense of the uric acid, which is therefore decreased. It produces none of the unpleasant effects of salicylic acid. Therapeutics: This drug is a standard remedy in cystitis and whenever there is a tendency to the formation of phos- ANTIPYRINUM. 201 phatic calculi. It has also been advocated in acute rheuma- tism, in which it is less efficacious and better borne than salicylic acid; in diphtheria, locally and internally ; and in chronic bronchitis as a stimulating expectorant. Its anti- septic properties will be noted elsewhere. Sodium benzoate is a white, amorphous, freely soluble pow- der, having a faint odor of benzoin, a sweetish astringent taste, and a neutral reaction. It has been used in the same conditions as benzoic acid-viz., rheumatism, cystitis, and diphtheria, in the last of which it is given in large doses. Lithium benzoate: This salt has been introduced for use in the uric-acid diathesis. The theory of its action is that the formation of uric acid is lessened by the benzoic acid, and that the lithium element forms with the remainder the more soluble lithium urate, and hence is more readily eliminated. It is better borne by the stomach than benzoic acid. It is also antiseptic. Antipyrin is derived by a complicated patented process from pyrrol, a coal-tar derivative. Chemically, it is phenyl- dimethyl-pyrazolon, and occurs as a somewhat bitter grayish crystalline solid, easily soluble in water, alcohol, and chloro- form. Physiological action: Given in medicinal doses (gr. v-x) in fevered patients, antipyrin produces a fall of temperature which reaches a maximum in from two to five hours, lasts five to eight hours, and is generally accompanied by sweating and slight depression. Owing to its slow elimination the duration of its antipyresis is greater than that of other anti- pyretics of this group. After larger doses or continued administration it causes general malaise, a peculiar cyanosis of the skin, feebleness of the pulse, and frequently an erup- tion which may resemble urticaria, measles, or erythema, and may be accompanied by oedema, catarrhal inflammations of the mucous membranes (conjunctivitis, coryza, or laryngitis), and sometimes by constitutional disturbances. The tlierapeu- ANTIPYRINUM (Antipyrin; Phenazonum, Br. P.). 202 ANTIPYRETICS. tic limit is chilliness, languor, and cyanosis. In detail its effects are as follows: Nervous system: Giddiness, somnolence, unconsciousness, coma, and epileptiform convulsions may occur after large doses, from some unexplained cerebral influence; the spinal cord is at first stimulated and then depressed, the reflexes becoming tardy or abolished, while both motor and sensory nerves are depressed. Circulation: In sufficient dosage it is undoubtedly a cardiac depressant; the arterial pressure is at first increased and later decreased, a vaso-motor dilatation taking place. Respiration: This function is not affected by moderate doses; by large ones it is depressed, dyspnoea and rapid breathing occurring in some cases. Temperature: The lowering of temperature is due partly to diaphoresis, and perhaps to a lessened heat-production, resulting from a direct influence on the thermogenic centres. That the latter is a probable element is shown by the less- ened elimination of nitrogenous waste in the urine under its use. Antipyrin is well borne by the stomach, especially when administered with wine or aromatics. Therapeutics: Antipyrin maybe therapeutically employed for the following : (1) to reduce temperature and abate accom- panying symptoms in typhoid, typhus, pneumonia, the exan- themata, etc., whenever it is evident that the elevation of temperature of itself is harming the patient; (2) to allay motor excitability in chorea, epilepsy, dysmenorrhoea, after- pains of labor, etc., but there are better remedies; (3) to relieve pain in migraine, neuralgias, the lightning-pains of locomotor ataxia, etc.; in rheumatism it acts much like salicylic acid, reducing the temperature and relieving pain, but affording no security against relapses; (4) it is considerably used as a /or morphine in attempting the cure of the morphine-habit; it is a valuable haemostatic: thus, spraying or sniffing it up the nose will often check epis- taxis, and hsematemesis and haemoptysis are said to be bene- fited by its exhibition by stomach or inhalation, as the case may be. Locally applied to mucous membranes, antipyrin causes a ACETANILIDUM. 203 vaso-constriction sufficiently pronounced and permanent to make it a useful application in local congestions. Administration : Antipyrin may be given in solution, pill, or capsule. When given in fevers for antipyretic purposes it is best to administer it in alcohol, to counteract its depressing effects ; dose gr. v-xv. It is to be remembered that medicinal doses have caused serious depression, and that the drug is to be used with care. ACETANILIDUM, U. S, (Antifebrin; Acetanilid), C6H5.NH.CH3O = 134.73. Antifebrin is an anilin derivative, and chemically is acet- anilid or phenylacetamid. It is an odorless, slightly bitter, crystalline powder, not very soluble in water, but freely so in alcohol, ether, and chloroform. Physiological action: Antifebrin resembles antipyrin in its action as far as this is understood; but produces less sweat- ing, is less apt to cause cyanosis, respiratory disturbance, cutaneous eruptions, and collapse, although these are all reported to have occurred in some cases. Some experiments have been made tending to show that its antipyretic effect is due to a centric effect upon the heat-producing nervous centre. In healthy persons little or no decrease of fever is produced. It agrees well with the stomach, occasions no nausea, and often even promotes appetite. Therapeutics : Antifebrin in gr. iv doses is about equal to gr. xv of antipyrin, and may be used as an antipyretic in the same conditions, acting with equal promptness and efficiency and for nearly the same length of time. It is not so efficient in rheumatism and motor disturbances, but may be used in migraine, neuralgias, etc. It is cheaper than antipyrin. Owing to its insolubility, it is generally given in capsule, wafer, or tablet form. Clinical experience proves that it is safer than anti pyrin, but not so safe as phenacetin. Phenocoll Hydrochloride: This coal-tar derivative is very soluble in water, and is quickly absorbed and quickly elimi- nated, so that it forms one of the safest of this class of anti- 204 ANTIPYRETICS. pyretics. No cases of poisoning have been reported. The dose is gr. x-xv, in solution or capsule. PHENACETIN. Phenacetin is a tasteless, colorless, crystalline substance, only slightly soluble in water, but more soluble in alcohol. Physiological action and therapeutics: It acts as an anti- pyretic, without producing vaso-dilatation, with a varying degree of diaphoresis, and probably from an effect on the nervous centres. Like antipyrin, it is analgesic and anti- spasmodic; but unlike that drug unpleasant results arc seldom developed, and, being less poisonous and probably equally efficient, it is a valuable antipyretic, analgesic, and antispas- modic. (For uses of phenacetin, compare Antipyrin.) Thallin occurs in two forms, the sulphate and the tartrate, both yellowish-white crystalline powders with a bitter taste. The sulphate, commonly used, is soluble in 7 parts of water. In ordinary doses (gr. v) it produces a fall of temperature, at times accompanied by considerable sweating. After larger doses a great fall of temperature, profuse perspiration, and at times an erythematous eruption and cyanosis occur. The urine assumes a greenish hue under its use. The blood- pressure is diminished only by large doses. In some cases violent chills are developed during the reactionary rise of temperature, and vomiting and diarrhoea have been observed. Therapeutics: Although dangerous in large doses, in re- peated small doses (gr. ij-iij) it is an efficient antipyretic with very little danger, and may be used in acute rheu- matism and conditions of high temperature. In 1 : 1000 solutions it is an antiseptic, and to 2|% solutions may be injected into the urethra with gratifying results in gonor- rhoea and gleet. THALLIN. KAIRIN. Kairin is a chinolin derivative, crystalline, bitter, and easily soluble. In gr. v-x doses it exerts an antipyretic effect, QUASSIA. 205 causes copious sweating, and is a cardiac depressant. It has no advantages over antipyrin and other drugs of this group, and although no deaths arc reported from its use, the symp- toms have been so alarming that it has fallen into disuse. STOMACHIC BITTERS. The vegetable bitters may be arranged in three classes : (1) simple or pure bitters; (2) aromatic bitters, which contain a volatile oil as well as a bitter principle; (3) the astringent bitters, which contain tannic and gallic acids, and are astrin- gent as well as tonic. Physiological action: Probably all bitter substances in- crease more or less the activity of the glands with which they come in contact, and thus promote digestion and increase appetite. The increased ingestion of food and improved assimilative powers affect the general nutrition, so that they are indirect tonics. In overdoses they are somewhat irritant, and may cause nausea and occasionally vomiting and diar- rhoea. Therapeutics: Bitters are chiefly of use when the appetite is poor and during slow convalescence from acute disease. They are contraindicated when there is inflammation or over- sensitiveness of the alimentary tract. SIMPLE BITTERS. QUASSIA, U. S. (Quassia). Quassia is the wood of Picrcena excelsa (nat ord. Simaru- bea?). Habitat: Jamaica. It is odorless, but very bitter, and yields its activity, which is due to a neutral principle, quassin, to both alcohol and water. Preparations: Extractum Quassire, dose gr. j-iij. Extractum Quassia? Fluidum, dose Tfly-xv. Tinctura Quassia?, 10%, dose f.zj-ij. Quassin, the bitter principle, may be given in gr. ss doses. Therapeutics: Like other simple bitters, the preparations of quassia may be used in anorexia, atonic dyspepsia, chloro- 206 STOMACHIC BITTERS. sis, and atonic conditions generally. An infusion (sj-ij to Oj) is an excellent injection in the treatment of " seat-worms." GENTIANA, IT. S. (Gentian). Gentian is the root of Gentiana lutea (nat. ord. Gentianese), a perennial plant of the Alps. Water and alcohol extract its virtues, which reside in an intensely bitter principle called gentio-picrin, besides which gentian contains a fixed oil and gentisic acid, which is tasteless and inert. Preparations, action, and therapeutics: An extract, fluid extract, and compound tincture are official, the last of which contains gentian, cardamom, and bitter orange-peel, and is probably more used than any other simple bitter (Tinctura Gentianse Composita, Gentian is a very efficient bitter, and is said to be somewhat laxative in large doses. The indications for its use are the same as for Quassia, q. v. CALUMBA, IT. S. (Calumba; Columbo). Calumba is the root of Jateorrhiza palmata (nat. ord. Meni- spermacese), a climbing plant of Mozambique. It contains two bitter principles, columbin and berberine, columbic acid, and starch, and yields its bitterness to alcohol and water. Preparations, action, and therapeutics : Calumba, the pow- dered root, dose gr. x-xx. Extractum Calumbse Fluidum, dose FLx-xx. Tinctura Calumbse, dose Calumba is very slightly aromatic, is very well borne by the stomach, and may be used whenever a simple bitter is indicated, sharing with gentian the preference among bitter tonics of its class. Chirata is the entire plant, Swertia Chirata (nat. ord. Gen- tianeae). Habitat: Mountains of Northern India. Chirata contains a bitter principle, chiratin, and ophelic acid. It is one of the best of the simple bitters, resembles gentian, and may be used in the same ways. The preparations are- CHIRATA, U. S. (Chirata). SERPENTA RIA-ANTHEMIS. 207 Chi rata , dose gr. xx. Extractum Chiratae Fluidum, dose fgss. Tinctura Chiratae, 10%, dose f3j-ij. AROMATIC BITTERS. As we have already seen, the essential constituents of drugs of this class are a volatile oil and a bitter principle. Most of them contain in addition more or less tannic acid. SEBPENTARIA, U. S. (Serpentaria; Virginia Snakeroot). Serpentaria is the rhizome and roots of Aristolochia Ser- pentaria, and of Aristolochia reticulata (nat. ord. Aristolo- chiacese). Both plants are indigenous. They contain a volatile oil, bitter principle, resins, and tannin, and have an agreeable aromatic odor and a bitter, somewhat pungent taste. Preparations : Extractum Serpentariae Fluidum, dose Tlfx- XXX. Tinctura Serpentariae, 10%, dose f.3j-5ss. Physiological action and therapeutics: Serpentaria is a stimulant tonic, with somewhat diuretic and diaphoretic prop- erties. In large doses it may cause vomiting, purging, and other symptoms of gastro-intestinal irritation. It is an efficient tonic, and is often combined with stronger bitters, and also with cinchona, in the treatment of (see Huxham's Tincture) and in slow convalescence from fevers. Chamomile is the flower-heads of Anthemis nobilis (nat. ord. Composite), collected from cultivated plants. This is a small trailing plant of Europe, cultivated also in this country. It contains a volatile oil, a bitter principle, and a trace of tannic acid, and has a strong, peculiar odor, probably due to anthemic acid. Physiological action and therapeutics : Chamomile is a good stimulant tonic, especially during convalescence. The usual method of administration is in infusion, dose fffij two or three times daily. In larger doses of the hot infusion it is an emetic. Of the powder the dose is 5ss-j. ANTHEMIS. U. S. (Anthemis; Chamomile). 208 AROMATIC BITTERS. Matricaria, U. S., or German chamomile, the flower-heads of Matricaria chamomilla (nat. ord. Composite), is very similar in composition and properties; but its taste is more disagreeable, and it is seldom used in this country. EUPATORIUM, U. S. (Eupatorium). Eupatorium (boneset, thorough wort) is the leaves and flow- ering tops of Eupatorium perfoliatum (nat. ord. Composite). This is a common indigenous plant, the leaves and flowering tops of which contain a bitter glucoside, eupatorin, tannic acid, and a small amount of volatile oil. It is usually given in infusion, but n fluid extract is official, the dose of which is lllxx-fsj. Physiological action and therapeutics: Thoroughwort is a stomachic tonic, expectorant, and diaphoretic, and in large doses may prove emetic. It is a standard domestic remedy in the treatment of "cold" and bronchitis, for which it is given in hot infusion freely, and has been used in rheuma- tism with asserted good effect. CASCARILLA, U. S. (Cascarilla). Cascarilla is the bark of Croton Eluteria. (nat. ord. Euphor- biacese). Croton eluteria is a small tree of the Bahama Islands. The drug yields its properties to alcohol and partially to water, and has an agreeable, aromatic odor, most noticeable when burning. It contains a crystalline, bitter principle, cascarillin, a volatile oil, a resin, and some tannic acid. It is a pleasant aromatic bitter, well borne by the stomach, and may be used for the same indications as serpentaria. The dose of the powder is gr. xx-xxx. No official preparations. Absinthium : The leaves and tops of Artemisia Absinthium (nat. ord. Composite). Habitat: Europe, Asia, Northern Africa; naturalized. In small doses, absinth is a stimu- lating tonic. In continued doses, in the form of the liqueur iC absinthe," it shows a peculiar tendency to produce nervous symptoms, attended by hallucinations, convulsions, and CORN US-PR UN US VIRGINIANA. 209 impotency. This belongs also to this class, but is seldom used. ASTRINGENT BITTERS. Cinchona and its alkaloids have already been discussed : they are very valuable stomachics in small doses. CORNUS. Cornus is the bark of the root of Cornus florida, or (log- wood, a small indigenous tree. The taste is bitter, astringent, and slightly aromatic. Its constituents are cornin, resin, and tannic and gallic acids. Physiological action and therapeutics: It is a bitter, and is said to have antipcriodic effects as well. In too large doses it may prove irritant enough to cause gastric disorder. Salix is the bark of Salix alba (white willow) and other varieties of Salix. It is chiefly of interest because of its neutral principle, salicin, which is a valuable antirheumatic and antiseptic. PRUNUS VIRGINIANA, U. S. (Wild Cherry). Prunus virginiana is the bark of Prunus serotina (nat. ord. Rosacese), collected in autumn. Wild cherry, officially Prunus Virginiana, but more properly P. serotina, is an indigenous tree, the bark of which contains a bitter principle, tannic and gallic acids, amygdalin, and emulsin. Amygdalin is a gluco- side which, with emulsin, a ferment, in the presence of water yields on distillation a volatile oil containing hydrocyanic acid. Emulsin is an albuminous substance, and is coagulated by heat, so that the value of the bark is destroyed by boiling. Preparations : Prunus Virginiana, powdered, dose Sss-j. Extractum Pruni Virginianae Fluidum, dose Infusum Pruni Virginianae, 4%, dose f.?j-ij. Syrupus Pruni Virginianae, 15%, dose Physiological action and therapeutics: Wild cherry bark is a somewhat astringent stomachic tonic, and, owing to the hydro- cyanic acid developed, a nervous and circulatory sedative. In the natural bark, however, this is present in a rather small 14-M. M. 210 DIURETICS. percentage, and it is doubtful whether this small proportion has any remedial value. The syrup and the fluid extract are much used as vehicles, and possess a certain tonic sedative effect which renders them of value in phthisis. DIURETICS. Diuretics are remedies which increase the renal secretion, cither by a direct stimulating effect on the secreting cells or by increasing the blood-pressure generally or locally. The ingestion of large amounts of fluid may also prove diuretic by flushing out the kidneys. It is to be borne in mind that the secretions of the skin and intestinal tract may be affected vicariously, and when a purely diuretic action is required these should be avoided; but in practice it ordinarily matters little how the fluid is eliminated. SCILLA, U. S. (Squill). Squill is tlie bulb of Urginea maritima (nut. ord. Libacese), deprived of its dry, membranaceous outer scales, and cut into thin slices, the central portions being rejected. Habitat: the shores of the Mediterranean. These bulbs resemble onions in their appearance, and are found in the shops sliced and dried. Two varieties, the red and the white, arc recognized, but they are of equal efficiency medicinally. Squill contains as active principles scillipicrin, scillitoxin, and scillin, and yields its activity to water, alcohol, and vinegar. Preparations : Pulvis Scillae, dose gr. j-ij. Extractum Scillae Fluidum, dose 'TH j-ij. Tinctura Scillae, 15%, dose Iffx-xx. Acetum Scillae, 10%, dose Syrupus Scillae (ffixxv-gr. j), dose fjss-j. Syrupus Scillae Compositus ("Coxe's hive syrup") contains squill and senega, cm 6; tartar emetic, part in 100 (about gr. j-f.sj); dose .5ss. Physiological action: In small doses squill increases the secretions of the bronchial and intestinal mucous membranes and of the kidneys, its diuretic action being the most con- stant, and probably due both to direct stimulation of the SCOPARIUS. 211 renal cells and to the increased blood-pressure which it causes. Whether the actual elimination of urinary solids is increased is not clear. In larger doses it is a gastric and an intestinal irritant, causing nausea, vomiting, and purg- ing. In toxic doses it produces symptoms of severe gastro- intestinal and renal irritation-viz., violent vomiting, purg- ing, and abdominal pain, with bloody, suppressed, and albuminous urine-collapse, and death. Therapeutics: Squill is used as a diuretic in conditions not dependent upon nephritis, in which disease it is distinctly con- traindicated. It is one of the most irritant of all the diuretics in common use. Thus it is employed in ascites, in chronic pleurisy, or pericarditis with effusion, and in cardiac dropsies, in which it is combined with digitalis. Combinations of digitalis, squill, and calomel are much in favor in cardiac dropsy. Squill is also efficient as a blennorrhctic expecto- rant in subacute and chronic bronchitis, especially when the expectoration is viscid and tenacious. Toxicology: Gr. xxiv of squill have proved fatal. Suffi- cient has been said of the symptoms. The treatment consists in evacuation of the stomach if necessary, the free adminis- tration of opium and demulcents, with warmth and stimula- tion as necessity arises. It is well to remember that hive syrup, or Coxe's hive syrup, the official compound syrup of squill, although used considerably by the laity, contains two powerful remedies, both poisonous in overdose : squill and tartar emetic (about gr. j to the fluidounce). Hydrargyri Chloridum Mite, U. S. Calomel has been found a very efficient diuretic in some cases of Bright's disease, and in others it fails entirely to produce any effect. It is neces- sary to administer it in full doses (gr. vj-xij a day, in divided doses); the combination of gr. j of calomel with gr. j each of squill and digitalis acts very happily in many cases of cardiac dropsy. Scoparius is the tops of Gytisus scoparius (nat. ord. Legu- minosae). This is the common broom-plant, a native of SCOPARIUS, U. S. (Scoparius; Broom). 212 DIURETICS. Europe, but cultivated in this country. The dried tops have a strong, peculiar odor and a bitter, nauseating taste. Broom contains a neutral principle, scoparin-which by some authorities is considered unimportant, by others to represent its diuretic and purgative properties-and sparteine, an alka- loid discussed under Cardiants. It has no official prepara- tions, an extemporaneous decoction being most used. Physiological action and therapeutics: In moderate doses scoparius is an efficient hydragogue diuretic, and in large doses may produce purgation and even vomiting. In general dropsy it proves a very valuable diuretic. Of a decoction (§ss to Oj boiled down to Oss) fsj-ij may be given every two hours. APOCYNUM, U. S. (Apocynum; Canadian Hemp; Dog's Bane). Apocynum is the root of Apocynum cannabinum (nat. ord. Apocynacese). This is an indigenous herb. It contains apocynin (resinous), apocynein (yellowish glucoside), gallic and tannic acids, a bitter principle, etc., and yields its virtues to both water and alcohol. The taste of apocynum is bitter, acrid, and nauseating. The root alone is official. It is gen- erally prescribed in infusion (3ss to Oj of water), the dose of which is Physiological action and therapeutics : Canadian hemp in- creases the secretions of the skin, bronchi, and kidneys, and in large doses is an intestinal irritant, causing vomiting and purging. In dropsy it proves a powerful remedy. TRITICUM, U. S. (Triticum). Triticum is the rhizome of Agropyrum repens (nat. ord. Graminese), a perennial herb of Europe and North America, gathered in the spring and deprived of the roots. The rhi- zome has a sweetish taste, due to the presence of several sugars. It also contains triticin. Although but a feeble diuretic, it is of considerable value as a sedative to the genito- urinary tract, especially in cystitis with profuse mucous dis- charge. The best form of administration is an infusion or decoction. Of the official fluid extract the dose is fsss-fsss. POTASSIUM. 213 VASCULAR DIURETICS. Drugs of this class produce diuresis by increasing the gen- eral arterial tension. Among them are such valuable diuretics as digitalis, strophanthus, and caffeine, which have already been fully treated of under Cardiants. Certain diaphoretics, to be later described, act, when the perspira- tion is lessened in any manner, to produce diuresis-e. g., jaborandi. Theobromine and Diuretin. The latter is a salicylate of theobromine and sodium; the former, the alkaloid obtained from the seed of Theobroma cacao, or the chocolate-plant. Theobromine resembles caffeine; the latter is methyl-theo- bromine, and this resemblance also extends to its cardiac, diuretic, and stimulant effects. No fatal cases of poisoning are reported, and the best results are claimed from large doses, as many as gr. xxx-c a day. REFRIGERANT DIURETICS. POTASSIUM. Potassium salts-physiological action: Foremost among diuretics of this class are the acetate and citrate of potassium. As the effects of potassium salts are in a considerable measure due to the potassium element or modified by it, a good oppor- tunity is here afforded for the study of these effects. Locally, some of the potassium salts, as potassa fusa, dissolve albumin and saponify fats, thus acting as caustics. Internally, they depress the spinal cord and lessen reflex excitability. They are all cardiac depressants, in moderate doses slowing the heart, while larger ones also lower arterial tension. Animals poisoned die by cardiac paralysis, the paralyzant effect being direct upon the heart-muscle. Potassium salts are poisonous to all the higher forms of tissue. However, in ordinary medicinal doses the depressing effect is slight and attended with very little danger. Given in large or continued doses they promote oxidation of the tissues, markedly increase the 214 DIURETICS. urinary solids, and if too long continued cause emaciation and perverted nutrition ; the blood contains less fibrin, and the venous blood is lighter in color. After large doses of the nitrate or chlorate the haemoglobin is decomposed, methae- moglobin is formed, and the oxidizing power of the blood is diminished. Secretions: The acetate and citrate of potassium, which are neutral at first, are partially oxidized in the blood, and are converted into carbonates-viz., become alkaline after absorp- tion-and are said to be alkaligenous. These alkaligenous salts, and those whose solutions are already alkaline {potas- sium hydrate, carbonate, tartrate, and the tartrate of sodium and potassium), increase the alkalinity of the blood, render the urine alkaline, and act as alkalies upon the glands with which they come in contact, increasing the activity of those whose secretions are acid, and decreasing that of glands with alkaline secretions. The nitrate, chlorate, sulphate, and bitartrate have no such effect, being permanently acid or neutral, and are eliminated unchanged. In large doses potassa, or the chlorate, nitrate, or carbon- ate, causes vomiting, purging, and other symptoms of gastro- intestinal irritation, accompanied by more or less marked nervous symptoms and collapse. Elimination of potassium salts takes place largely by the urine. Some of the prepara- tions of potassium require detailed notice. POTASSII CARBONAS, U. S. (Potassium Carbonate), K2CO3 = 137.91. Potassium carbonate is prepared by purification of pearlash, which is an impure carbonate obtained from wood-ashes and other sources, or by calcining potassium bicarbonate, thus depriving it of one molecule of CO2 and reducing it to the carbonate. It is a coarse white, granular powder of alkaline reaction, freely soluble in water, and deliquescing in moist air to an oily liquid. It is chiefly employed as an antacid and diuretic. In large doses it is a corrosive poison, the antidotes for which are oils and dilute acids. It is eliminated unchanged. POTASSII BICARBONAS- POTASSII BITARTRAS. 215 POTASSII BICARBONAS, U. S. (Potassium Bicarbonate), KHCO.) 99.88. Potassium bicarbonate is made by passing CO2 through an aqueous solution of purified pearlash until saturation is reached. It occurs in prismatic crystals, permanent in the air and easily soluble in water. The effects of this salt re- semble those of the carbonate, except that it is better borne by the stomach, and it may be used as an antacid. It is a favorite in acute rheumatism and gout, in which conditions it is freely used up to §iss daily, with opium, if necessary, to relieve pain. It is eliminated as the carbonate. POTASSII ACETAS, U. S. (Potassium Acetate), KC2H3O2=97.89. Potassium acetate is a white, extremely deliquescent salt, neutral in reaction and very soluble in water. It is formed by evaporating a solution of the bicarbonate in acetic acid. As noted above, it is alkaligenous, alkalizing the blood and urine, promoting diuresis, and increasing the solids of the urine, with the exception of the uric acid, which is dimin- ished by the increased oxidation. Potassium acetate is elimi- nated as the carbonate. It constitutes one of the best forms of administration for the alkaline treatment of acute rheuma- tism, while in subacute forms combinations with potassium iodide are valuable. In the acute form it should be given freely, §j-iss daily. It is also of service in catarrhal jaundice •and functioned disorder of the liver, as a prophylactic against uric-acid calculus, and by alkalizing the urine it affords relief in acute cystitis and urethritis. It can be administered in lemon-juice. POTASSII BITARTRAS, U. S. (Potassium Bitartrate), KHC1H1Og= 187.67. Potassium bitartrate, also known as cream of tartar, or acid potassium tartrate, is obtained by purifying argol, which is deposited during fermentation on the sides of wine-casks. It has an acidulous taste, is insoluble in alcohol, and only 216 DIURETICS. slightly soluble in water, in which, however, it may be easily dissolved by adding sodium borate. It is the most active diuretic of the potassium salts, and in large doses a hydra- gogue cathartic. Potassium bitartrate is eliminated un- changed. It is chiefly used in general dropsies of cardiac or renal origin, in which its double action as diuretic and cathartic renders it particularly valuable. POTASSII CITRAS, U. S. (Potassium Citrate), K3C6H5O7 + H2O = 323.59. Potassium citrate is usually seen in the form of a granular powder, readily soluble in water, deliquescent on exposure. The medical virtues of potassium citrate are those of a non-irritating, agreeable refrigerant diaphoretic and diure&c, together with those of a sedative expectorant of great value. It may be given in the form of the official Liquor Potassii Citratis, which is an aqueous solution containing about 9 % of the anhydrous salt. This solution is always prepared extemporaneously by the action of citric acid on potassium bicarbonate in solution, and the liquid is sufficiently charged with carbonic-acid gas to make it very acceptable to a deli- cate stomach. Mistura Potassii Citratis (U. S., 1880) has long been known as neutral mixture, and is made by neutral- izing fresh lemon juice with potassium bicarbonate. It is even more agreeable and efficient than the ordinary solution. Both the solution and the mixture are excellent bases for diaphoretic and diuretic mixtures. The dose of either prepa- ration is fass; that of potassium citrate, gr. v-xxx. POTASSII NITRAS, U. S. (Potassium Nitrate), KNO3 = 100.92. Potassium nitrate, nitre or saltpetre, is obtained from natural or artificial nitre-beds, in which it has been formed by the oxidation of ammonia and its subsequent combination with the bases of the soil. It is a crystalline substance of saline and rather cooling taste, soluble in 5 parts of water and in- soluble in alcohol, and decomposing when heated, with the liberation of nascent oxygen. POTASSTI CHLORAS. 217 Physiological action and therapeutics : Applied to any raw surface or mucous membrane, saltpetre acts as a decided irri- tant, and it is due to this property that poisonous effects more often follow its ingestion than that of other salts. The symptoms of poisoning are severe epigastric burning pain, violent vomiting, at times of blood, purging, followed very shortly by collapse and great muscular weakness. Nervous symptoms may or may not be pronounced as in other gastro- intestinal irritations. Suppression of urine may occur. The lesions at autopsy are intense gastro-enteric inflammation, often to the extent of ulceration of the mucous membrane. Although probably no more depressing to the heart than other potassium salts, aside from the depression secondary to this inflammatory condition, it does seem to produce more renal irritation. The treatment consists in giving opium and demulcents after evacuation of the stomach and bowels. The salt is now seldom used, and is chiefly of interest from its toxic effects. It was formerly thought to do good in rheumatism. POTASSII CHLORAS, U. S. (Potassium Chlorate), KC103 = 122.28. Potassium chlorate is prepared by various processes. It occurs as a white, anhydrous, fairly permanent salt, of a cool, saline taste, and soluble in 16.5 parts of water. Absorbed, and to a very great extent at least eliminated unchanged, it does not differ decidedly in its effects from other potassium salts except in its irritant effects, which are similar to those of the nitrate. Tn poisonous doses it produces diarrhoea, vomiting, labored respiration, cyanosis, and circulatory de- pression. The post-mortem changes are those of violent irri- tation of the gastro-intestinal tract, swelling of spleen and liver, with evidence of acute nephritis; the blood is choco- late-colored, due to conversion of the haemoglobin into meth- amioglobin. The latter is the most characteristic change. In continued doses it is apt to produce chronic parenchymatous nephritis. It does not give up its nascent oxygen at the body-temperature, as was once supposed ; and experiments 218 BLENNORRHETICS. have shown that it is nearly all eliminated unchanged. Hence the theory of its oxidizing power is no longer held. Potassium chlorate is eliminated unchanged by all the secre- tions, including the saliva. Therapeutics: Potassium chlorate has been extensively used in diphtheria, scarlet fever, and other conditions supposed to depend on the presence of toxic products in the blood, and is still considered valuable by some. It is to be scrupulously avoided in diseases attended with renal irritation. Locally, as a gargle or mouth-wash, it is of value in simple and mer- curial stomatitis, ozxna, subacute and chronic pharyngitis, and foetid ulcerations of the mucous membranes generally. Saccharum Lactis, U. S., Sugar of Milk, C12H22OU + H2O = 359.16, a peculiar crystalline sugar, obtained from the whey of cows' milk by evaporation, and purified by recrystalliza- tion. Milk-sugar, a member of the carbohydrate group, is present to the extent of 4J-5% in ordinary cows' milk and is pre- pared from this by evaporation and purified by crystallization. It occurs in white crystalline masses, soluble in 6 parts of water, and of such hardness that it forms a useful addition to powders which require minute subdivision (Dover's powder). Sugar of milk is present to the extent of 7 % in mother's milk ; so that in artificial feeding, mixtures of cows' milk and cream require the addition of this sugar. It is much more readily assimilated by infants than is cane-sugar. Sugar of milk is not directly subject to the vinous fermentation, but yields alcohol and carbonic-acid gas after conversion into glucose by acids. It reduces Fehling's solution. Medicinally, sugar of milk is laxative and a good hydra- gogue diuretic, acting with especial advantage in cardiac dropsies. The dose is 5ss-v daily. BLENNORRHETICS. Blennorrhetics are remedies which promote secretions of mucous membranes, and are used to restore a healthy action in cases of deficient, abnormal, or excessive secretion. They are BUCHU-MATICO. 219 principally employed in such conditions of the bronchial mu- cous membrane (expectorants) and of the genito-urinary tract (blennorrhetic diuretics). BUCHU, U. S. (Buchu). Buchu is the leaves of Barosma betulina and of Barosma crenulata (nat. ord. Rutacese). Habitat: Southern Africa. These leaves have a bitter taste and aromatic odor, contain a bitter extractive, volatile oil, and a stearopten, diosphenol, and yield their virtues to water and alcohol. Physiological action and therapeutics: Buchu is slightly diuretic and a gentle stimulant to secretions generally, with a sedative action on the urinary mucous membrane. It is used in chronic pyelitis, chronic cystitis, and chronic urethritis. From its bitter principle it may prove tonic. The fluid extract is official (dose fqj), but an infusion is the usual form for administration. PAREIRA, U.S. (Pareira; Pareira Brava). Pareira is the root of Chondodendron tomentosum (nat. ord. Mcnispermacese), a climbing plant of Brazil. It contains an alkaloid, pelosine or cisampeline, identical with buxine and beberine obtained from Buxus sempervirens and Nectandra Rodicei; also a resin, starch, etc. It imparts its activity to water, and the fluid extract (dose f;sj) and extemporaneous infusions are the proper preparations for use. It is a mild tonic, laxative, and diuretic, and an efficient corrective to chronic inflammation or irritation of the bladder associated with digestive disturbance and constipation. Extractum Pareirse Fluidum, dose f,"j. MATICO, U. S. (Matico). Matico is the leaves of Piper angustifolium (nat. ord. Piper- accae). Habitat: a shrub of Tropical America. It contains a pungent resin, tannin, volatile oil, and a crystalline prin- ciple, artanthic acid. Matico is an aromatic tonic and a stimulant alterative to diseased mucous membranes, especially 220 BLENNOBRHETICS. those of the bladder and bronchi. It has a reputation as a haemostatic also. Dose of the powdered leaves, 3ss-iij ; of Extractum Matico Fluidum, f3ss-ij ; and of the 10% tinct- ure, fsj-ij. UVA URSI, U.S. (Uva Ursi; Bearberry). Uva ursi is the leaves of Arctostaphylos Uva ursi (nat. ord. Ericaceae), a shrub of the Northern Hemisphere. It contains tannic and gallic acids, a bitter principle, and arbutin or ursin, which is a glucoside and the active principle of the drug. Arbutin occurs also in different species of Chimaphila, Epigeca repens, Gaultheria procumbens, and other Ericaceae. Physiological action and therapeutics: Arbutin is a mild diuretic, with an alterative effect upon the mucous membrane of the genito-urinary tract. It is partially decomposed in the kidneys, with the production of glucose and hydrochinon, and partly eliminated unchanged. It asepticizes the urine and retards decomposition. From its combined astringent, diuretic, and alterative effects it is of value in chronic pyelitis and chronic cystitis, and is especially recommended as a pal- liative when the latter is due to enlarged prostate. It is said in some cases to prevent bleeding from the kidneys. Arbutin is devoid of poisonous properties, but must be given in rela- tively larger doses than the leaf itself; therefore it seems probable that it is not the sole active principle. The fluid extract (Extractum Uvse Ursi Fluidum) is official, and is given in doses. OLEUM JUNIPERI, U. S. (Oil of Juniper). Oil of juniper is a volatile oil distilled from the fruit or so-called berries of Juniperus communis (nat. ord. Coniferse), a shrub of Europe naturalized in this country. These berries are of the size of a pea, and have a sweetish, aromatic taste resembling turpentine. They yield their activity, which depends upon a volatile oil (oleum juniperi), to boiling water and alcohol. Like other drugs of this class, the oil is diuretic, and being a terpene, C10H16, like oil of turpentine, is some- what irritant to the gastro-intestinal tract, producing CHI MA PH I LA-TEREBINTHINA. 221 strangury and bloody urine when given in large doses. It may prove emmenagogue. An infusion is occasionally used as a vehicle for potassii bitartras and other saline diuretics, and for its own action in chronic pyelitis, cystitis, etc. It is contraindicated in acute and subacute renal inflammation. The preparations are as follows : Oleum Juniperi, dose TRv-xv. Spiritus Juniperi, 5% of the oil, dose Spiritus Juniperi Compositus (corresponds closely to Hol- land gin), dose Gin is the most irritating of all alcoholic stimulants and the one most apt to produce chronic interstitial nephritis. CHIMAPHILA, U. S. (Chimaphila; Pipsissewa). Chimaphila is the leaves of Chimaphila umbellata (nat. ord. Ericaceae), a small indigenous, perennial plant, and contains tannin, arbutin, and other principles. Arbutin is its most active principle, and its effects and uses are therefore the same as those of uva ursi-viz., tonic, slightly astringent, and diuretic. Of the fluid extract the dose is or more. OLEUM ERIGERONTIS, U. S. (Oil of Erigeron; Oil of Fleabane). Oil of erigeron is a volatile oil, distilled from the fresh flowering herb of Erigeron canadense (nat. ord. Composite). The oil has properties much like oleum terebinthime, and consists mainly of a terpene, C1()H16, with a small percentage of an oxygenated oil. It is, however, weaker and more pleasant to the taste. It possesses haemostatic and diuretic properties, and has been used in chronic catarrhs of the genito- urinary organs, in dysentery, and in uterine hemorrhage. Dose gtt. v-xxx, frequently repeated, in capsule. A turpentine is a liquid or semi-solid vegetable juice which contains resin and oil of turpentine. There are two official turpentines : Terebinthina, U. S., a concrete oleoresin obtained from Pinus TEREBINTHINA, U. S. (Turpentine). 222 BL ENNORRHETICS. palustris, and from other species of Finns (nat. ord. Coniform), the common American white turpentine, obtained chiefly from the yellow pine, growing in the Southern States. Terebinthina canadensis, TJ. S., Canada Turpentine, Canada Balsam, Balsam of Fir, a liquid oleoresin obtained from Abies balsamea (nat. ord. Coniferae), or American silver fir, growing in the northern portions of North America. Among the non-ojjicial varieties arc Bordeaux, Venice, and Chian turpen- tines. Properties: The turpentines are inflammable, insoluble in water, and quite soluble in alcohol and ether. By distilla- tion they yield resin and oil of turpentine, both of which are official. Oleum Terebinthinae (Oil of Turpentine ; Spirit of Turpentine): A volatile oil distilled from turpentine. This, the active principle of turpentine, is a colorless, volatile, inflammable liquid of a strong, penetrating odor and hot, pungent taste. It is insoluble in water, moderately soluble in alcohol, and freely so in ether. When exposed to the air it absorbs oxygen and converts it into ozone. It is the type of the terpenes, which have the formula C10H16, and have similar medicinal properties. Physiological action : Locally turpentine is a powerful irritant. Internally in medicinal doses it produces gastric warmth, exhilaration, and a sort of intoxication : the pulse is increased in force and frequency. It is eliminated by the bronchi and kidneys, imparting its odor to the breath and an odor of violets to the urine. Poisoning by turpentine is rare, because in large doses the drug is eliminated by the bowel before absorption can take place. The symptoms produced by too large doses are abdominal pain, vomiting and diar- rhoea, strangury, priapism, constant desire to urinate, sup- pression of urine or hsematuria, complete unconsciousness, and a weak and rapid pulse. The lethal dose must be very large, and has not been determined. Its effects in detail are as follows : Circulation and respiration are stimulated by small, and depressed by large, doses. Ceuito-urinary system: After small doses few symptoms TEREBINTHINA. 223 are produced except some increase in the amount of urine, with perhaps lumbar pain, frequent micturition, and a sen- sation of smarting pain in the urethra during the act: the effects of larger doses have been stated above. Turpentine is eliminated by the bronchi and genito-urinary mucous membrane. Therapeutics: Locally, oil of turpentine is much used as a counter-irritant over large surfaces, in the form of turpentine stupes, which may be made by wringing out cloths in hot water and then in turpentine or sprinkling them with tur- pentine. Another ready method of preparing turpentine stupes is to pour a tablespoonful of oil of turpentine on a pint of hot water and then dip the cloths in this, the latter retaining sufficient of the oil after they are wrung out. Tur- pentine stupes are valuable in bronchitis and abdominal pain, and applied over the bladder will often relieve retention of urine, especially when of nervous origin. Turpentine in amounts of is a valuable addition to enemata in cases where the rectum is impacted with faeces. Internally, it is used in typhoid fever: in two stages of this disease it is very valuable. In the second and third weeks the distressing tympanites may be markedly decreased by gtt. x of the oil every three or four hours, its action being a local stimulation of the muscular coat of the intestinal wall, while in convales- cence, which is protracted and accompanied by diarrhoea (in which case ulceration may be suspected), this drug is a valu- able stimulant, promoting healing. In other ulcers of the stomach and bowels it acts locally in the same way. In chronic pyelitis and chronic cystitis it does good. In impo- tence, spermatorrhoea, and gleet due to relaxed states of the parts, these conditions are not infrequently greatly benefited by moderate and continued doses. In passive hemorrhages from mucous surfaces, as hcematuria, purpura, scorbutus, etc., it is generally useful. In adynamic conditions it is also useful as a general stimulant. Its use as a taeniacide will be mentioned later. In flatulence, chronic intestinal catarrh, and subacute dysentery it does good by stimulating peristalsis and by its supposeol antifermentative action. Owing to its elimi- nation by the bronchial mucous membrane it is used as a 224 BLENNORlllIETICS. blennorrhctic expectorant in chronic bronchitis and emphysema, and may palliate in gangrene of the lung. COPAIBA, U. S. (Copaiba; Balsam of Copaiba). Copaiba is the oleoresin of Copaiba Langsdorfii, and of other species of Copaifera (nat. ord. Leguminosse). Habitat: Northern South America. Copaiba is a yellowish liquid of a peculiar terebinthinate odor and nauseating, burning taste. It is insoluble in water, but salable in alcohol, ether, and the fixed and volatile oils. It is resolvable into a volatile oil and a resin (copaivic acid), both of which are official, but neither one represents the sole activity. To call it a balsam is incorrect, as it contains neither benzoic nor cinnamic acid. Preparations : Of copaiba itself the dose is Tffxx-xl. Oleum Copaiba), dose Thx~xv- Resina Copaiba;, dose gr. x-xv. Massa Copaibas (copaiba 94, magnesia to 100 parts), dose gr. x-xx. Physiological action: In medicinal doses copaiba produces no systemic effects. In large doses in susceptible persons it may cause fever, hot skin, gastro-enteric irritation, and not infrequently an exanthematous eruption very like measles. Its chief effects, however, are local. It is diuretic, the resin being even more so than the oil, and an alterative to the genito-urinary, and perhaps the bronchial mucous membrane. Large doses in susceptible persons may produce strangury and renal irritation, even to the extent of hsematuria. Under its use it is to be remembered that the urine gives with nitric acid a white precipitate resembling albumin, but differing from it in being soluble in alcohol, and in not being precipi- tated by heat. It is slowly eliminated, its constituents appear- ing in the urine for some days after large doses. Therapeutics: Copaiba is chiefly used in suSacwte and chronic inflammations of the genito-urinary tract. In gonor- rhoea it finds its great popularity, and is indicated in the sub- acute stages. During the acute stage it is too stimulating, although used by some. It is also used, as are the other drugs of this class, in chronic pyelitis and cystitis, and by CUBEBA. 225 some in chronic bronchitis and chronic diarrhoea. Ointments containing it often afford considerable relief in hemorrhoids. Administration: Copaiba or its oil may be given in capsule or in an emulsion of some aromatic substance, the latter of which is said to agree better with delicate stomachs. CUBEBA, t. S. (Cubeb). Cubeb is the unripe fruit of Piper Cubeba (nat. ord. Piper- aceae), a climbing plant of Java; cultivated. These berries have a characteristic aromatic odor and a peculiar camphora- ceous taste. Their important constituents are a volatile oil (Oleum Cubebae, U. S.), resin, cubcbic acid, and cubebin. The activity resides in the cubebic acid, resin, and volatile oil; cubebin is inert. Preparations: Pul vis Cubebae, dose 3ss-ij. Oleum Cubebae, dose Tlfx-xxx. Extractuni Cubebae Fluidum, dose TTLx-xl. Oleoresina Cubebae, dose hfx-xv. Tinctura Cubebae, 20%, Trochisci Cubebae, No. j. Each troche contains gr. Physiological action : Cubeb exerts a stomachic effect much like pepper, which after large doses becomes an active irritant. Medicinal doses do not produce much systemic effect, but large ones may be slightly stimulant to the circulatory func- tion. Its characteristic effect, however, is stimulation of the mucous membranes, with a special action on that of the genito-urinary tract. It is a diuretic, this property, it is said, residing in the resin, while a carminative effect is claimed for the oil. An eruption like that of copaiba may follow its use. In the form of lozenges, cubeb has long been employed to clear the voice in colds. In the form of cigar- ettes, smoke impregnated with the volatile principles has been found efficient to reach directly the bronchial mucous membrane. Therapeutics: Its uses correspond closely with those of copaiba, with which it is often beneficially combined. It is less apt to derange digestion. Cubeb may be given in powder or syrup. The oleoresin nearly represents the drug, and may be given in emulsion. 15-M. M. 226 CATHARTICS. Oil of santal or sandal-wood is a volatile oil distilled from the wood of £«nddum album (nat. ord. Santalacese), an East Indian tree. It is yellowish, strongly volatile, of a very characteristic odor, and readily soluble in alcohol. It is used as a substitute for copaiba in gonorrhoea, succeeding best in the subacute stages; and is also of value in chronic bronchitis and chronic inflammations of the genito-urinary tract. OLEUM SANTALI. CATHARTICS. Cathartics are drugs which act to produce or increase the evacuations from the bowels. They may act either by stim- ulating the glandular secretions of the mucous membrane or of the highly specialized glandular organs, the liver and pancreas, or by stimulating the muscular coat of the intes- tine, and thus increasing peristalsis. Different drugs have special actions on different parts of the intestine. Cathartics are intended to act as adjuncts to hygienic, dietetic, and mechanical measures in the treatment of consti- pation. Chronic constipation may be due to a variety of causes, among which are irregular habits of life and of stool, overwork of the nervous or muscular systems, intestinal atony; various forms of metallic poisoning, the use of readily digestible articles of diet which leave no residue (such as milk), and to many other causes. Acute constipation may be due to focal impaction, strangu- lated hernia, intussusception, pressure during pregnancy, mechanical occlusion of the intestine by a foreign body, as a gall-stone, etc. The use of laxatives under such conditions demands great caution. Chronic constipation is treated, (ci) by selection of a diet which leaves sufficient residue to stimulate peristaltic action ; (/>) by exercise in the open air or abdominal massage; (c) by establishing a regular habit of stool; (d) by encouraging the patient to drink moderate quantities of water ; (e) by the use of laxative enemata; (/) by the judicious use of cathartics. Cathartics are classified, according to the vigor and method TAMA RIND US-S ULPII UR. 227 of their action, as laxatives, salines, purgatives, hydragogues, cholagogues, and mercurials. Cholagogues are laxatives which increase the flow of bile; they will not be considered under a special heading. LAXATIVES. Laxatives are cathartics which mildly produce evacuations, chiefly by an effect on the muscular coat and slightly on secretions. The following are thus classed : Tamarindus, U. S., the preserved pulp of the fruit of Tama,- rindus indica (nat. ord. Leguminosae). This is a large East Indian and African tree. The dose of tamarinds is 5ss-j or more. It is an ingredient of confectio sennas. Manna, U. S.: The concrete, saccharine exudation of Fraxi- nus ornus (nat. ord. Oleaceae). Habitat: Sicily. Manna con- tains a resin, fraxin, a glucoside, and mannite, a sugar. It is chiefly used for children because of its agreeable taste. Sulphur is official in three forms: Sulphur Sublimatum (S ~ 31.98), Sulphur Lotum, and Sulphur Prcecipitatum. Sul- phur often contains a little sulphuric acid; but oxidation and washing with dilute water of ammonia frees it from this impurity. The precipitated form is in the finest state of subdivision, and is often preferred in making ointments. Sulphur is often used in rheumatism in the form of mineral waters containing H2S, which have attained considerable reputation; also in the treatment of syphilis and gout. There is no doubt about the efficiency of sulphur in the form of an ointment when used as a stimulating application in chronic skin diseases. The ointment forms one of the best remedies in the treatment of itch, killing the acarus. Sul- phur is one of the ingredients of compound licorice powder. Washed sulpur (sulphur lotum) is a mild laxative. It slightly increases the secretions, producing stools which are soft and very offensive from sulphuretted hydrogen gas (H2S). It is valuable in painful anal diseases, as fissures, hemorrhoids, etc., to relieve the pain attendant upon defalcation. 228 CATHARTICS. Oleum Ricini, U. S. (castor oil): A fixed oil expressed from the seed of JRicinus communis (nat. ord. Euphorbiacese), a tree of the East Indies, but cultivated as an annual plant in other latitudes. It is also obtained by decoction and by solution in alcohol, but the expressed oil is the best. It is a familiar light-yellow liquid of nauseating taste. It contains palmitic and ricinoleic acids; the latter peculiar to itself and consti- tutes the drastic element. Castor oil acts in from four to six hours. It stimulates peristalsis, excites very slightly the glandular secretions, and is not a cholagogue. It has an astringent after-effect. It is used when a thorough evacuation, as of scybalous masses, is desired, and also in diarrhoeas due to the ingestion of some irritating substance, and in dysentery. For these latter pur- poses it is combined with or followed by opium or some astringent. It is especially useful in infantile diarrhoeas. It is not a good remedy in chronic constipation, because of its constipating after-effect. Castor oil is usually given alone, and is very nauseating to most persons ; this effect is probably produced by the viscid oil adhering to the papillte of the tongue. This can be over- come by preceding the oil with a drink of water or, better still, to serve it between two liquids: the pharmacist draws a small quantity of syrup of sarsaparilla into a glass, the castor oil is then added and the whole covered with a little soda water carefully drawn. In this manner the nauseating effect is entirely overcome. The oil may also be given in emulsion with similar freedom from taste. The seeds themselves con- tain a principle that is decidedly poisonous. MAGNESIA, U. S. (Magnesia; Light Magnesia), MgO = 40.26. MAGNESIA PONDEROSA, U. 8. (Heavy Magnesia), MgO = 40.26. MAGNESII CARBONAS, U. S. (Magnesium Carbonate's approximately (MgCO3)4,Mgl OH)2 + 5H2O = 484.62. These preparations are all white powders, nearly insoluble in water, and may be classed with salines, though their action is much milder. They are mild laxatives and antacids. Mag- RHAMNUS PURSHIANA. 229 nesia is said not to be laxative except when combined with acids forming soluble salts, so that when this effect is desired it should be followed by an acid, as citric acid or lemonade. Magnesia Ponderosa (or heavy magnesia), the dose of which is the same as magnesia, oss-ij, has the same effects. Magnesium Carbonate is more sedative to the stomach from evolution of CO2 gas. Although laxative, the main use of these magnesia preparations is as antacids, and their chief indication is found when gastric acidity exists with constipa- tion. Pulvis Glycyrrhizse Compositus contains senna 18, washed sulphur 8 parts, with licorice, oil of fennel, and sugar to 100 parts. The senna and sulphur are its active principles, while fennel acts as a mild antispasmodic. It is a deservedly popular laxative, but may cause griping. Dose 3j-iv. Cassia Fistula is the fruit of Cassia Fistula (nat. ord. Legu- minosae). This is an East Indian tree, which is naturalized in tropical America and Africa. Cassia fistula is chiefly used as an ingredient of confectio sennae. Oleum Olivae, Oleum Amygdalae Expressum, and Oleum Lini are laxatives, but are chiefly used in laxative enemata. The last may be used by mouth. RHAMNUS PURSHIANA, U. S. (Cascara Sagrada; California Buckthorn). Cascara sagrada is the bark of Rhamnus Purshiana (nat. ord. Rhamnaceae). Habitat: Rocky Mountains and westward to the Pacific. Extractuni Rhamni Purshianae Fluidum, dose flfx-fsj. Cascara sagrada contains a crystallizable principle, prob- ably a glucoside, a resin, and the usual constituents of plants. Physiological action and therapeutics : Cascara is a particu- larly good stimulant of peristaltic action, especially that of the lower bowel. It also exerts a tonic effect on unstriped muscle. Hence it has become a standard remedy in chronic 230 CATHARTICS. constipation. Of the fluid extract fflx-fsss may be given two or three times daily, beginning with the smaller dose and giving just enough to produce a free morning evacuation. It rarely produces griping, and may then be combined with bel- ladonna or hyoscyamus to prevent this. FRANGULA, U. S. (Frangula; Alder Buckthorn). Frangula is the bark of Fdiamnus Frangula (nat. ord. Rhamnaceffi), collected at least one year before being used. Habitat : Europe and Northern Asia. Frangula contains the glucoside frangulin and emodin (the latter also present in rhubarb). When green it has an emetic tendency. When dry it is cathartic and diuretic, and is also an anthelmintic of value; dose of fluid extract fsss-j. SALINES. Salines increase both secretions and peristalsis, producing loose, watery stools, with very slight irritation and without systemic depression. They act rather quickly, especially if taken on rising. Their purgative action is due slightly to increased peristalsis, but chiefly to increased secretion and to a free outward osmosis of the body fluids, which is not a true secretion of the glandular apparatus. The salines are hydra- gogue cathartics. Magnesii Sulphas, U. 8. (Sulphate of Magnesium or Sal Epsom), is a white, slowly efflorescent salt, very soluble in water, and having a nauseating, bitter taste, although usually well tolerated by the stomach ; dose 3ij-oj. Liquor Magnesii Citratis, U. 8., the dose of which is and Magnesii Citras Effervescens, U. 8., in doses of 3j-?ss, are also much used. The former is effervescent from the reaction of citric acid and potassium bicarbonate, and is a pleasant and mild cathartic. The latter is a coarsely granular powder, del- iquescent on exposure to the air, and soluble, with free effer- vescence, in water. It should be kept in closely corked bottles. POTASSII ET SODII TARTRAS-SODII SULPHAS. 231 Potassii et Sodii Tartras (sal Rochelle) occurs as slightly efflorescent crystals, of mildly saline and bitter taste, and freely soluble in water; dose 3ss-j. It is frequently pre- scribed in the Pulvis Effervescens Compositus, or Seidlitz powder, which consists of Rochelle salt 3ij and sodium bicarbonate gr. xl in the blue, and tartaric acid gr. xxxv in the white paper, to be dissolved in water and taken while effervescing. Sodii Phosphas, U. S. Sodium phosphate occurs in large, efflorescent crystals, which are readily soluble in water. Phosphate of sodium is a mild hydragogue cathartic with a special cholagogue action. It is a good saline laxative in chronic constipation, especially if this be attended by hepatic torpor. It is also a valuable nutrient alterative in the diar- rhoeas of bottle-fed children. Dose gr. x-sss. Therapeutics : In ascites, renal and cardiac dropsies salines are very valuable by producing watery transudation from the intestines and lessening the work of the kidneys. They are especially efficacious in ascites if pressure be not too great; in uraemia, oedema of the brain, and cerebral hyperromia, as depletants. In dysentery Epsom salt and Rochelle salt are much used. They lessen the hypersemia of the mucous mem- brane and cause faecal evacuations, with decrease of pain and distressing tenesmus. After abdominal operations, when the temperature is rising, they assist in the removal of deleterious matter, and do good by depletion, and are now commonly employed by most laparotomists. In anaemia with constipa- tion they are advantageously combined with iron. In lead-constipation, lead-colic, and saturnine cachexia magnesium sulphate is very valuable to prevent reabsorption of the lead from the bile, in which it is largely excreted. It accomplishes this by forming the insoluble lead sulphate, PbSO4. In carbolic poisoning magnesium and other soluble sulphates form insoluble sulphocarbolates and prevent absorption. Other unimportant members of this group and their doses are- Sodii Sulphas, sodium sulphate, or Glauber's salt, an ingre- 232 CATHARTICS. dient in many mineral waters, 3ss or less. It is harsher in its action and offers no advantage over magnesium sulphate. It is largely used in veterinary practice. Potassii Sulphas (Sulphate of Potassium), dose £ss-ij. Potassii Bitartras (or Cream of Tartar), a good diuretic, but weak laxative; dose gss-j. Few of these salines are now used as laxatives. PURGATIVES. Purgatives probably act by increasing both secretions and peristalsis, and are more vigorous in action than the laxa- tives ; but this action is not sufficiently violent to produce actual inflammatory change in large dose. Rhubarb is the root of Rheum officinale (nat. ord. Polygona- cese). Habitat: Western and Central China. Its composi- tion is not yet fully determined. It contains four resins- erythroretin, pheeoretin, aporetin, and emodin-all of them cathartic ; also chrysophan, chrysophanic, rheumic, and rheo- tannic acids, to the last of which is due its astringent after- effect. It owes its yellow color to chrysophan and chryso- phanic acid, which occasionally tint the urine yellow. Preparations : Rheum, powdered, dose gr. v-xx. Pilulae Rhei, each = gr. iij, with gr. j soap. Extractum Rhei, dose gr. v-x. Extractum Rhei Fluidum, tffv-xxx. Pilulae Rhei Compositae, containing in each rhubarb gr. ij, purified aloes gr. jss, myrrh gr. j, and oil of peppermint gr. To J No-j-iij-. Pulvis Rhei Compositus (Gregory's powder), dose 3ss-j. Tinctura Rhei, 10%, dose fsj-ij. Tinctura Rhei Aromatica (rhubarb 20%, with cinnamon, cloves, and nutmeg), dose fgss-j. Tinctura Rhei Dulcis (rhubarb 10%, with licorice, anise, and cardamom), dose Syrupus Rhei, dose RHEUM (Rhubarb). SENNA. 233 Syrupus Rhei Aromaticus dose gtt. An excellent laxative in the summer diarrhoeas of children. Mistura Rhei et Sodae (contains ext. rhei fl., ext. ipecac, fid., sodii bicarb, and spt. menth. pip.), dose Physiological action: In small doses rhubarb is a tonic astringent and stomachic; in sufficient amount (gr. iv-vj) a slow and mild cathartic, only occasionally causing griping. Its mode of action is not perfectly understood, but it is probably cholagogue. Therapeutics : I n intestinal dyspepsia due to deficiency of the intestinal and hepatic secretions small doses do good; in jaundice from catarrh of the duodenum or bile-ducts, especially when occurring in children; in summer diarrhoea it has a secondary astringent effect, and nothing is more often used than the aromatic syrup or one of the tinctures. It is apt to impart a yellow color to the milk of nursing women and to the urine. Senna is the leaflets of Cassia acutifolia (Alexandria Senna), and of Cassia angustifolia (India Senna) (nat. ord. Legumi- nosae). Habitat: shrubs of Egypt and Arabia. The activity of senna resides in a glucoside, cathartic acid: it probably also contains chrysophanic acid and chrysophan, with other substances not well understood. Preparations: Confectio Sennae contains senna 10%, with tamarind, cassia fistula, prunes, fig, oil of coriander, sugar, etc.; dose 3j-ij. Extractum Sennae Fluidum, dose Infusum Sennae Compositum ("black draught") contains senna 6%, manna and mag. sulph. aa 12%; dose f§iv. Syrupus Sennae, dose f-sj-iv. Pulvis Glycyrrhizae Compositus (for which see Laxatives), dose 3ss-ij. Physiological action and therapeutics : Senna is a prompt and efficient cathartic, acting in about four hours to produce copious liquid stools, without any irritation. It is probably slightly cholagogue, and increases the secretion of the whole intestinal canal. It has a slight tendency to produce griping, SENNA. 234 CATHARTICS. and aromatics are advantageously combined with it. Its uses are those of the class to which it belongs. ALOE (Aloes). Aloe Barbadensis, U.S., Barbadoes Aloes. The inspissated juice of the leaves of Aloe vera (nat. ord. Liliaceae). Aloe Socotrina, U. S., Socotrine Aloes. The inspissated juice of the leaves of Aloe Perryi (nat. ord. Liliaceae). Three varieties are known to commerce : Cape, Socotrine, and Barbadoes aloes. The drug contains as its active prin- ciple a neutral substance, aloin (dose gr. |-ij), which may vary slightly in different varieties of aloes; also a resin, which is not purgative when pure. Preparations: Aloe, Aloe Purificata, dose gr. ij-xv. Extractum Aloes, dose gr. j-v. Pilulae Aloes, each =gr. ij each of purified aloes and soap. Pilulae Aloes et Asafoetidae: one pill contains gr. of each and soap. Pilulae Aloes et Ferri, aloes and dried sulphate of iron, of each gr. j, with aromatic powder; used in amenorrhcea. Pilulae Aloes et Mastiches (Lady Webster's dinner pill), aloes gr. ij, mastic and red rose aa gr. J in each pill. Pilulae Aloes et Myrrhae, aloes gr. ij, myrrh gr. j, and aro- matic powder gr. in each pill. Tinctura Aloes, 10%, dose fsss-ij. Tinctura Aloes et Myrrhae, 10% of purified aloes, myrrh, and licorice root, dose fsj-ij. seldom used. Physiological action and therapeutics: Aloes is a very slow cathartic (ten to twelve hours), acting mostly on the peristalsis of the large intestine, but in large doses increasing the secre- tions of the liver and mucous membranes. It is said to cause congestion of the pelvic viscera. Aloes is contra-in- dicated in pelvic or rectal inflammation, and must be carefully used in pregnancy. Aloin is a favorite in intestinal dyspepsia with torpidity of the liver and of the muscular coat of the intestinal wall. It may prove an emmenagogue. It is fre- JALAPA. 235 quently combined with belladonna (or atropine) and strychnine (in the so-called A. B. and S. pill). Juglans, U. S., Juglans (Butternut). The inner bark of Juglans cinerea (nat. ord. Juglandaceae), collected in autumn. Habitat: North America. The bark contains nucin. It is tonic and cathartic. Dose, of the official extract, gr. x. Leptandra, U. S., Leptandra, Culver's Root. The rhizome and roots of Veronica virginica (nat. ord. Scrophularinese). Leptandra contains leptandrin, a crystalline principle, and is cathartic, cholagogue, and alterative. Dose gr. x-Hss. The /uid extract (TIJxx) and the extract (gr. x) are official. Drastics, or hydragogues, act very powerfully both upon the secretions and peristalsis, the more powerfid and active producing in large doses severe gastro-cnteritis and poisoning. They are all hydragogue cathartics. DRASTIC PURGATIVES. JALAPA, f. S. (Jalap). Jalap is the faz6erous root of Ipomoea Jalapa (nat. ord. Convolvulacese). Its activity resides in a resin which is official, and consists of two portions, both cathartic, the one soluble in ether, the other insoluble. The latter is a glucoside known as convolvulin, and is probably the more active. Preparations: Jalapa, powdered, dose gr. xv-3ss. Extractum Jalapae, dose gr. x-xx. Pulvis Jalapae Compositus (about one-third jalap, two- thirds potassium bitartrate), used as cathartic and diuretic; dose 3ss-j. Resina Jalapae (see above), dose gr. ij-v. Pilulae Catharticae Compositae (see Colocyntld). Physiological effects and therapeutics : Jalap is a powerful hydragogue cathartic, acting very promptly. It is an hepatic stimulant, markedly increases the secretions of the intestinal glands, producing large watery stools, and may cause griping. It is much used in ascites, general dropsy, and threatened 236 CATHARTICS. uraemia, the compound jalap powder being a favorite pre scription. PODOPHYLLUM, U. S. (Podophyllum; Mandrake; Mayapple). Podophyllum is the rhizome and roots of Podophyllum pel- tatum (nat. ord. Berberideae). Habitat: North America. The official resin is an alcoholic extract of the root, and con- tains, besides berberine, podophyllotoxin, picropodophyllin, and podophylli nic acid. Resina podophylli contains all the active principles. Preparations: Pulvis Podophylli, dose gr. xv-xx. Extractum Podophylli, dose gr. i-ij. Extractum Podophylli Fluidum, dose ffiv-xv. Resina Podophylli (note the dose), dose gr. Physiological action and therapeutics : Mandrake is a pow- erful hydragogue cathartic, but slow in its action ; also an hepatic stimulant, and has a tendency to act upon the upper intestinal tract. Hence it is useful in intestinal indigestion and constipation dependent on deficient hepatic secretion and torpidity of the intestinal wall, in portal congestion, jaundice, and ascites. Death has been caused by the ingestion of a large amount. CHELIDONIUM, U. S. (Chelidonium; Celandine). Chelidonium is the entire plant, Chelidonium ma jus (nat. ord. Papaveracese). Habitat: Europe ; naturalized in North America. It contains two alkaloids, chelerythrine and cheli- donine, with chelidoxanthin and chelidonic acid. Dose It has no official preparations and is of no therapeutic impor- tance. It is a hydragogue cathartic, and is said to be narcotic and diuretic. Iris is the rhizome and roots of Iris versicolor (nat. ord. Iridese). Habitat: North America. It contains a bitter resin, to which is probably due its activity. Iris stimulates the hepatic secretion and that of the intestinal glands, and in large doses causes violent vomiting and purging, with depres- IRIS, U. S. (Iris; Blue Flag). EUONYMUS-COLOCYNTHIS. 237 sion. It is used in (1) jaundice, especially of malarial origin; (2) functional disturbance of the liver (torpidity so called); (3) intestinal dyspepsia; and (4) dropsy. The following preparations are official: Pulvis Iridis, dose gr. v-xv. Extractum Iridis, dose gr. i-ij. Extractum Iridis Fluidum, dose 1T[iij-x. EUONYMUS, U. S. (Euonymus). Euonymus is the bark of the root of Euonymus atropur- pureus (nat. ord. Celastrineae). Habitat: United States. It contains a bitter principle, euonymin, a resin, etc. It pro- duces a powerful stimulation of the hepatic secretion, and to a less extent of the intestinal, and may be, but seldom is, used for this purpose. It acts very slowly. An extract is official, the dose of which is gr. i-ij. Euonymin, dose gr. Hi- Scammony is a resinous exudation from the living root of Convolvulus scammonia (nat. ord. Convolvulacese). Habitat: Western Asia. A resin called scammonin constitutes 80 to 90% of its weight, and is colorless, tasteless, and soluble in alcohol and ether. It is a powerful hydragogue cathartic, and seldom used alone. Of the drug the dose is gr. v-x ; of its resin, which is official as resina scammoniae, gr. iij-vj. It is most used in the compound extract of colocynth, of which this resin constitutes 14%. SC AMMONIUM, U. S. (Scammony). COLOCYNTHIS, U. S. (Colocynth; Bitter Cucumber; Bitter Apple). Colocynthis is the fruit of Citrullus colocynthis (nat. ord. Cucurbitacese), deprived of its rind. Habitat: Southern and Western Asia; Northern Africa. The fruit of this vine is a round gourd; the seeds should be rejected. It yields its active principle to water and alcohol, and contains a resin, colocynthin, a glucoside, and colocynthitin. Preparations : Extractum Colocynthidis, dose gr. ij-v. 238 CATHARTICS. Extractum Colocynthidis Compositum (contains of the extract 16, purified aloes 50, resin of scammony 14 parts, with cardamom and soap to 100 parts), dose gr. j-xv. Pilulae Cathartic® Composite, a pill in very common use; contains of the above compound extract gr. 11, abstract of jalap and calomel aa, gr. j, and gamboge gr. 1. Physiological action and therapeutics: Even in very moder- ate doses this drug is a gastro-intestinal irritant, a powerful cholagogue, and a hydragogue. Owing to its liability to cause inflammation, it is used only in combinations, chiefly as the compound extract, which is a safe and efficient purgative. A number of cases of fatal poisoning are recorded from hyper- catharsis produced by this drug. CAMBOGIA, U. S. (Gamboge). Gamboge is a c/um-resin obtained from Garcinia Hanburii (nat. ord. Guttifene). Habitat: India. It is composed of about 75% of resin, gambogic acid, and about 20% of gum, is official only in the compound cathartic pill, of which it constitutes 10%, and is a gastro-intestinal irritant and hydra- gogue cathartic, but not a hepatic stimulant; dose gr. ij-v. ELATERINUM, U. S. (Elaterink Elaterin is a neutral principle obtained from Elaterium, a substance deposited by the Juice of the fruit of EcbctUium Ela- terium (nat. ord. Cucurbitace®). Habitat : Western Asia and Southern Europe; cultivated. Ecballium elaterium is the squirting cucumber. Elaterin occurs in colorless, odorless, bitter crystals, insol- uble in water and readily soluble in alcohol. It is a very violent hydragogue, powerfully irritant, and may cause death. It is also slightly diuretic. It is used in uraemia and as a revulsive in cerebral affections, also in general dropsy and ascites, but is unsafe. It is best given in combination. Dose of elaterin gr. -ly-j^; of Trituratio Elatcrini, which was the only official trituration in the U. S. P. of 1890, the dose is gr- H- OLE UM TIGLII-MERCURIA L CA TH A R TICS. 239 OLEUM TIGLII, U. S. (Croton Oil). Croton oil is a fixed oil expressed from the seed of Croton Tiglium (nat. ord. Euphorbiaceae). Habitat : India and Philippine Islands; cultivated. The purgative principle has not been isolated. A principle called crotonoleic acid is said to produce the irritant and drastic effects. It is a viscid, reddish-brown liquid, with a slight peculiar odor and bitter, acrid taste. It is soluble in ether and slightly so in alcohol. Physiological action and toxicology : In doses of gtt. j-iij it is a very powerful hydragogue cathartic, acting slightly also as a diuretic. Larger doses, unless vomited, may cause fatal gastro-enteritis. It is unreliable, however, and at times large doses may not affect the bowels. It is the quickest of cathartics, often taking effect in from one-half to two hours. Locally applied, it causes a vesicular and pustular eruption somewhat resembling that of smallpox. Therapeutics: Croton oil is extremely valuable as a re- vulsive cathartic in cerebral and uraemic conditions when swallowing is difficult or impossible (gtt. j-iij dropped on the tongue or taken in bread-crumb), and may be useful in very obstinate constipation and in severe dropsies if the general condition be good. A number of fatal cases of poisoning have been recorded. Preparations: Hydrargyri Chloridum Mite (calomel), dose gr. TV-xx. Massa Hydrargyri (blue mass), dose gr. J-xx. The purgative action of these mercurials is characteristic- ally slow, ten to twelve hours elapsing before catharsis is produced. They are also uncertain in their action, and are often used in combination with or followed by other cathar- tics, generally salines. They act by increasing the flow of bile into the intestine, and probably by increasing the secre- tions of the mucous membrane and pancreas. Whether an actual increase in bile-production occurs is doubtful, their probable effect being to cause the gall-bladder to empty itself. Frequently repeated small doses (gr. t1q--1) are given when MERCURIAL CATHARTICS. 240 A NTH EL MLNTICS. exhibited with the view of acting on the liver. Blue mass resembles calomel in its action; but is weaker and more uncertain, and is seldom used as a cathartic. Therapeutics: Calomel is used as a purgative when there is a deficiency of bile in the intestine; the indication is found when the stools arc clay-colored. In small repeated doses (gr. jo-|) it will often check obstinate vomiting. In other cases it causes vomiting. Calomel colors the stools green. It was formerly frequently employed as an antiphlogistic. It has mild diuretic and anthelmintic properties. ANTHELMINTICS. Anthelmintics are remedies which promote the expulsion of worms from the intestinal tract; vermifuges expel para- sites; vermicides kill as well as expel them. They act in one of three ways : (1) riiechanically ; (2) by some intoxicating influence; (3) by an actual poisonous effect. The general precautions to be observed in the case of treat- ment for any form of worm consist in the thorough evacua- tion of the gastro-intestinal tract. A light supper is given on the evening previous to the administration of the anthel- mintic ; the latter is preferably given in the morning before breakfast. A liquid diet is preferable, so as to empty the intestinal tract, and in obstinate cases it may be necessary to withhold all food for a short time. If no cathartic is given with the drug, the latter should be reinforced by a brisk purgative three or four hours after its administration. In all cases it is necessary to remember that poisonous symptoms may be produced by almost all of the anthelmintics. The parasites which we are ordinarily called upon to treat are-(1) Ascaris or Oxyuris vermicularis, the so-called "seat- worm," which inhabits the large intestine, especially the rectum, and in females may inhabit the vagina; (2) Ascaris lumbricoides, or " round worm," which exists in all parts of the alimentary tract; and (3), most important of all, Taeniae, of which three varieties are known-Taenia solium, Taenia mediocanellata, and Taenia bothriocephalus latus. The first two are by far the most common in this country. SANTONICA. 241 Treatment for oxyuris : For the expulsion of this parasite enemata of the following are available and efficacious; (1) infusions of quassia; (2) decoction of aloes; (3) weak solu- tions of carbolic acid ; (4) plain water or salt and water fre- quently repeated. As a safeguard against autoinfection by mouth from the fingers strict cleanliness of the hands must be enforced. For the Ascaris lumbricoides the following remedies are employed: SANTONICA, U. S. (Santonica; Levant Wormseed). Santonica is the unexpanded flower-heads of Artemisia pauciflora (nat. ord. Composite). Habitat: Persia and Asia Minor. Among other elements it contains a neutral princi- ple, crystalline, colorless, odorless, and practically insoluble in water, called santonin, which represents the virtues of the drug. Preparations : Pulvis Santonicse, dose gr. x-5ss. Santoninum, U. 8., dose gr. ij-iv; for child two years old, sr- Sodium Santoninate is freely soluble, and is not safe to employ as a vermifuge. Physiological action and therapeutics: In ordinary medicinal doses santonin produces no obvious effect. Large doses may cause gastro-enteric irritation and chromatopsia. Objects in the visual field arc generally colored yellow, but occasionally green, blue, or even red. The urine is colored yellow. Toxic doses cause severe cerebral symptoms, but such toxic effects are rare. The only use of santonica and its principle, santonin, is for the expulsion of round worm. Santonin is probably a vermicide. For this purpose it should be given on an empty stomach and followed by a brisk cathartic. Quite a number of fatal accidents following the ingestion of from one to six grains of santonin are recorded. One of the early symptoms of poisoning seems to be a peculiar pallor, with a blue color about the eyes. 16-M. M. 242 ANTHELMINTICS. SPIGELIA, U. S. (Spigelia; Pink Root, or Carolina Pink). Spigelia is the rhizome and roots of Spigelia marilandica (nat. ord. Loganiaceae). Habitat : United States. Spigelia contains a bitter principle, a resin, and a volatile oil. The dose of the powdered root is 3j-ij. An extract is official in doses of foj-ij. Physiological action and therapeutics: The effects of this drug in poisonous dose are dilatation of the pupils, cardiac depression, delirium. Two cases have ended in death. By some it is considered the best remedy for the round worm. The method of administration is similar as for santonin. Frequently the Fluid Extract of Senna and Spigelia (U. S. P., 1870) is selected, which combines a laxative action with that of an anthelmintic. It is no longer official. Spigelia seems to stupefy the worm and must be aided by a cathartic. Chenopodium, U. S.: The fruit of Chenopodium ambro- sioides, and variety anthclminticum (nat. ord. Chenopodiaceae). Habitat: United States. It is a very efficient anthelmintic. Oleum chenopodii is the only preparation used; dose gtt. v-xv; for a child of two years, gtt. iv-viij. Azedarach: This drug is the bark of the root of Melia azedaraeh (nat. ord. Meliaceae), or bead tree, of Syria, Persia, and India. It is said somewhat to resemble spigelia. Re- peated doses (f 5ss-j) of a decoction over a period of some days arc claimed to be effectual. Treatment to expel taeniae : In the treatment of taeniae the preliminary measures are as important as the drugs them- selves. The patient should fast for from twenty-four to forty-eight hours, and a thorough purgative should be taken. Then the drug selected should be administered, followed in a few hours by another brisk cathartic. No case is to be considered cured until the head is discovered by a careful examination. The following drugs are used to expel taeniae : ASPIDIUM-CUSSO. 243 ASPIDIUM, U. S. (Aspidium; Male Fern). Aspidium is the rhizome of Dryopteris Filix-mas and of Dryopteris marginalis (nat. ord. Filicis). Habitat: D. Filix- mas-Canada, Rocky Mountains, Northern Asia, Europe; D. marginalis-United States. Its activity is supposed to depend on filicic acid, which can be extracted with ether. The other constituents are unimportant. Used with the preliminaries mentioned above, it is an efficient remedy against all taeniae. Dose of the oleoresin, which is the most efficient preparation, Granatum is the bark of the stem and root of Punica Granatum (nat. ord. Lythrarieae). Habitat: India and Southwestern Asia; cultivated. Its active principle is pel- letierine, or pelleterine, which is also used, and is of equal efficiency; it also contains three other alkaloids-iso-, methyl-, and pseudo-pelletierine. Pomegranate causes some intestinal disturbance and generally purges, failing in which it should be followed by a brisk cathartic. It is a very certain taenia- fuge, and is generally administered in the form of a decoction of the fresh root Of pelletierine the dose is gr. iij-v; in larger doses its effects are said somewhat to resemble curare (motor-nerve depressant). GRANATUM, U. S. (Pomegranate). KAMAL A, U. S. (Kamala). Kamala is the glands and hairs from the capsules of Mal- lotus philippinensis (nat. ord. Euphorbiacese), a small tree of Asia and Australia. Kamala contains rottierin, and is made up of resins to the extent of 75%. It imparts its virtues to alcohol, and, having no official preparations, may be used as a tincture. It is fairly efficient. The dose of the powder is Cusso is the female inflorescence of Hagenia abyssinica (nat. ord. Rosaeeae.) Habitat: India, China, Philippine Islands, Australia. Cusso contains kosin, a bitter resinous principle. Its efficiency as a tseniafuge is established; the CUSSO, U. S. (Kousso: Brayera). 244 EMETICS. worm is usually killed. It produces no poisonous symptoms in large doses. Dose of the powder 5ss; of the official fluid extract, of a 6% infusion (not official), f.sviij. Pepo is the seed of Cucurbita Pepo (nat. ord. Cucurbitaceae). Habitat: Tropical Asia and America ; cultivated. It is one of the most efficient taeniafuges, and possesses the advantage of being perfectly harmless. It is given in ffij-iv doses of the seeds pounded in a mortar with some excipient so as to form a paste; or made into an infusion. With proper pre- liminary precautions failure seldom attends its use. Other remedies used as taeniafuges: Oleum Terebinthinae, U. S., in doses of may be used and is effective, but has the disadvantage of sometimes causing symptoms of genito-urinary irritation. Cocoanut: The milk and meat of two cocoanuts, taken raw after the usual preparations (see above), have proved efficient, perhaps from their mechanical effects. Ailanthus, a non-official drug, the oleoresin or a decoction of the fresh bark of which may be employed. PEPO, U. S. (Pumpkin Seed). EMETICS. Emetics are medicines employed to produce vomiting (emesis). They may be either local or general. Local or reflex emetics are drugs which by locally irritating the gastric filaments of the vagus institute an impression which is transmitted to the vomiting-centre in the medulla, and thus establish reflex vomiting. Systemic or general emetics act directly upon the vomiting-centre in the medulla after absorption into the blood. The activity of emetics is increased when fever or gastritis exists; decreased, often decidedly, in cerebral disease or narcotic poisoning. Indications and contraindications for emetics: Emetics are used to empty the stomach of deleterious substances, as poisons, etc.; to expel substances forcibly from the pharynx CUPRI SULPHAS-SYRUPUS SCILLM COMPOSITUS. 245 and oesophagus (foreign bodies, false membrane); to relax spasm, as in laryngismus stridulus and in certain hysterical conditions; as nauseants to increase secretions; to produce revulsion, or shock (as in hysteria and insanity). They are contraindicated in pregnancy, hernia, congestion of the brain, acute inflammation of the stomach, and cerebral endarteritis. LOCAL EMETICS. These comprise certain metallic salts, chiefly sulphates, and certain vegetable drugs. Cupri Sulphas (copper sulphate, blue stone, or blue vitriol), gr. v, repeated if necessary in fifteen minutes, is a prompt emetic, and produces only slight depression ; it is especially valuable in narcotic and pAosp/wrus-poisonings, in the latter of which it is antidotal as well as emetic. Zinci Sulphas (zinc sulphate, or white vitriol) corresponds in action to copper sulphate in doses of gr. x-xxx, and is con- sidered by some safer and more prompt; it is not antidotal to phosphorus. The dose may be repeated. Alumen (alum, sulphate of aluminum and potassium), 3j in syrup, acts as a safe but slow emetic (one-half to three-quar- ters of an hour). It has been recommended in croup. Hydrargyri Subsulphas Flavus (turpeth mineral), dose gr. ij-v; it is tasteless, and produces emesis with very little nausea and only moderate depression; used in croup, and quite slow in its action. Sinapis Alba, or Sinapis Nigra (white or black mustard in the form of mustard flour), 3j-ij in water, causes emesis with- out prostration. Indeed, it is a cardiac and respiratory stimu- lant. Its chief advantage, however, lies in the fact that it is so generally available. It is very efficient, but sometimes even violent in its action. Syrupus Scillae Compositus, containing tartar emetic (gr. j to f.oj), senega, and squill, is much used as a nauseant and emetic in doses of Tfix-yss; known also as hive syrup. It must be very carefully used. Mechanical measures: Mechanical irritation of the pharynx with a feather or a finger, unless its sensibility be too much 246 EMETICS. obtunded, will produce vomiting. Tepid water in large draughts may often prove valuable when other means are not at hand. SYSTEMIC EMETICS. IPECACUANHA, U. S. (Ipecac). Ipecac is the root of Oephaelis Ipecacuanha (nat. ord. Rubi- acese). This is a small shrub of Brazil. Ipecac contains an alkaloid, emetine, as its active principle, in combination with ipecacuanhic acid. Preparations : Pul vis Ipecacuanhae, dose gr. -j-5ss. Extraction Ipecacuanhae Fluidum, dose Tfl.|-f3ss. Pulvis Ipecacuanhae et Opii (Dover's powder) (see Opium). Trochisci Ipecacuanhae; seldom used; each = gr. Trochisci Ipecacuanhae et Morphinae; each = gr. with morphine sulphate gr. Tinctura Ipecacuanhae et Opii (see Opium). Syrupus Ipecacuanhae, 7 % of fluid extract ; dose Vinum Ipecacuanhae, 10% of fluid extract; dose FLx-fsiij. Physiological action : Ipecac may well be considered in its entirety in this connection, although it has other uses and actions than as an emetic. Locally, it is an irritant to the skin and mucous membranes. In small doses it is a stom- achic tonic. Larger doses increase the secretions of the salivary glands, bronchi, stomach, skin, and liver, the bile being unaltered in its composition. The circulation is but little affected, but the respiration is slightly depressed and the surface temperature is lowered. It acts as a mixed emetic, both influencing the medulla and irritating the termi- nal filaments of the vagus. For this purpose the dose varies (gr. iv to xxx), but it is preferably given in doses of gr. xxx until emesis is produced. It is very mild and certain in its emetic action. Therapeutics : Ipecac is used as an emetic, stomachic, tonic, anti-emetic, and blennorrhetic expectorant. As an emetic it is used in gastric irritation caused by undigested food ; in sick headaches and acute indigestion, which may often be aborted; APO MORPIIINPE HYDROCHLORAS. 247 in membranous croup, laryngismus stridulus, lodgement of foreign bodies, etc., for its mechanical effect. As a stomachic tonic it is a favorite in doses of gr. T^-in combination with other drugs. In the same dosage it is also valuable to check vomiting, the cases in which it succeeds being of nervous origin, as the vomiting of pregnancy, sea- sickness, sick headache, etc. As an expectorant in hay fever and in the acute stages of coryza and bronchitis it does good by increasing the secretions. Empirically, ipecac has been found valuable in acute dysentery; large doses (gr. x-xx), combined with opium so that it may be retained, ameliorate the tenesmus and abdominal pain and give the patient great relief, and have seemed to decrease the mortality of epidemics. It is also employed in chronic dysentery and diarrhoeal dis- eases. If no good effect be produced after a trial of two or three days, it is best abandoned. Carried to the point of producing nausea, it seems to have antihemorrhagic powers, and is especially recommended in uterine hemorrhage and haemoptysis. Incompatibles : The Zannrde of emetine is extremely insolu- ble; hence tannic acid and drugs containing it should not be combined with ipecac. Lead and mercury salts and vege- table acids are also incompatible. It is assisted in its action by all emetics and nauseants. AP0M0RPHLN7E HYDROCHLOR AS, U. S. (Apomorphine Hydrochlorate), C17H]7NO2HC1 302.79. Apomorphine is morphine from which one molecule of water has been taken by heating morphine and hydrochloric acid under pressure. It occurs as a white powder, readily absorbing moisture from the air and becoming green in the process. Apomorphince hydrochloras is easily soluble in water, and is slowly decomposed by boiling water. Physiological action and therapeutics: This salt is our best example of a purely systemic emetic, acting equally well by stomach or hypodermic exhibition, and acting promptly (gen- erally in from five to twenty minutes), with frequent repeti- tion of the vomiting, which occurs with but little nausea. It 248 EMETICS. depresses the circulation and respiration, and in fatal doses causes death by respiratory paralysis. Neither the cir- culation nor the respiration is appreciably affected by medicinal doses. After large doses convulsions followed by paralysis may ensue. The emesis is entirely centric. Its only use is as an emetic (gr. | by month, gr. j1(r by hypo- dermic injection), and it may be used when sudden emetic action is desired or when swallowing is difficult or impossible, but it does not succeed well in profound narcosis. Gr. has caused death in the adult. In very small doses apomorphine is a valuable relaxing expectorant, and may be used in both acute and chronic bronchitis. SANGUINARIA, U. S. (Sanguinaria). Sanguinaria (blood-root) is the rhizome of Sanguinaria canadensis (nat. ord. Papavcraceae), collected in autumn. Habitat: North America. It yields its virtues, which reside in an alkaloid, sanguinarine, to both alcohol and water, and deteriorates by keeping. Another alkaloid is also present, but has not been named. Preparations: Extractum Sanguinariae Fluidum, dose Fli'j-v. Tinctura Sanguinariae, 15%, dose ULx-xx. Physiological action: Locally, it is a decided irritant, causing violent sneezing when inhaled, and acro-narcotic poisoning when taken by the stomach in large doses; it exerts an escharotic action upon fungous granulations. Large doses cause collapse, with coldness of the surface, cold sweating, dilated pupils, and diminished reflexes; they de- press the circulation and respiration and cause death by respiratory paralysis. It acts as a mixed emetic, both local and systemic, with great nausea and depression, and is now seldom used for that purpose. The secretions of the stomach and intestines are increased, and the bile is rendered more fluid and increased in amount. Therapeutics: In atonic dyspepsia, duodenal catarrh, and catarrh of the bile-ducts sanguinaria is serviceable in small doses as a tonic; in acute bronchitis, later stages, in combina- DIAPHORETICS. 249 tion as an expectorant; in chronic rhinitis with hypertrophy as an insufflation; in functional amenorrhoea as an emmena- gogue; and in chronic syphilitic and tubercular affections as an alterative. Antimonii et Potassii Tartras (tartar emetic), dose gr. ss-j; gr. ij have proven fatal; it is too depressing to use except in an emergency, and acts as a mixed emetic. DIAPHORETICS. Diaphoretics are remedies employed to increase the secre- tory activity of the skin. They arc employed therapeutically (1) as revulsive agents in the formative stages of certain diseases, acting by eliminating certain deleterious waste-prod- ucts and by relieving internal congestion; (2) to hasten absorption in general dropsy and serous accumulations, as pleurisy, pericarditis, ascites, etc.; (3) to eliminate poisonous materials from the blood, notably urea in uraemia; and (4) to aid in the subsidence of certain diseases which naturally end with a sweat. Non-medicinal measures: Certain measures for producing sweating are in vogue, as the hot-air or Turkish bath, the hot-vapor or Russian bath, and hot-water baths, either gen- eral or of portions of the body, as the foot-bath. Exercise, warm temperatures, and the ingestion of large amounts of hot fluids also favor sweating. The hot-water bath is given at a temperature of 110°-115° F., the patient immersed in it for ten to fifteen minutes and afterward wrapped in blankets. A hot pack may be given if the hot bath is inconvenient ; a cold pack also acts as a diaphoretic, if the sheet used to wrap about the patient is wrung out of cold water and the patient is well covered with blankets. A hot vapor-bath is given at a temperature of 120° F. If the Russian bath is not available, the same effect may be obtained by applying a mackintosh closely about the patient, who is seated on a chair; a vessel of hot water is placed underneath the chair and the water kept hot by a spirit lamp. The hot-air (Turkish) bath may be improvised by 250 DIAPHORETICS. the same arrangement, omitting the hot water and regulating the temperature so as to rise between 160° and 200° F. Many diuretics act as diaphoretics if the patient is well covered and kept warm so as to favor sweating. Classification : Diaphoretics are generally classified as : (1) Stimulating, direct, or simple, which enter the circulation and produce a direct stimulating effect upon the secreting tissues or their peripheral nerves: this class includes the diffusible stimulants and aromatic substances generally, and certain narcotics, notably opium and camphor. (2) Nauseating, which act by relaxing the orifices of the glands and allowing of a freer transudation of fluids through them-e. g., ipecac and tartar 'emetic. (3) Refrigerant, which produce sweating by reducing the force of the circulation and restoring the secre- tion of the skin, which like that of other organs is checked in the early stages of febrile conditions. STIMULATING DIAPHORETICS. PILOCARPUS, U. S. (Pilocarpus; Jaborandi). Pilocarpus is the leaflets of Pilocarpus Selloanus (Rio Janeiro Jaborandi) and of Pilocarpus Jaborandi (Pernam- buco Jaborandi (nat. ord. Rutaccse). Pilocarpus is a Brazilian shrub. The leaves have a characteristic odor and a strong aromatic taste, and owe their activity to pilocarpine, an alkaloid of bitter astringent taste and soluble in all the ordinary menstrua. Another alkaloid, jaborine, has been isolated : it is a derivative of pilocarpine and antagonistic to it, in many respects resembling atropine. The leaves con- tain also a volatile oil. Preparations: Pilocarpus, powdered, dose gr. xx-3j. Extractum Pilocarpi Fluidum, dose Tt[xv-f3j. Pilocarpinse Hydrochloras (CnH16N2O2.HCl = 243.98), dose gr- P Physiological Action.-The diaphoretic action of pilocarpus or its alkaloid, pilocarpine, upon which its activity depends, is due to a direct stimulation of the secretory nerves at their periphery. After the hypodermic administration of LIQUOR AMMONII ACETATIS. 251 the drug sweating begins quickly, reaches its maximum in one-half to three-quarters of an hour, and lasts from two to four hours. The total amount is often very large, and there is found to be a large increase in the amount of urinary solids, especially urea, in its composition. The saliva is also often greatly increased, this increase being in inverse ratio to that of the perspiration. The explanation of this sialagogue effect is not clear, but it is due to stimulation of either the gland-cells or the nerve-endings. The secretions of the stomach and bronchi are also increased, in some cases that of the mammae; and if the dose be too small to produce sweating, diuresis may occur. Children require proportion- ately very large doses to produce sweating. Other effects of jaborandi are slowing of the pulse with increased arterial tension, reduction of temperature when sweating begins, and great contraction of the pupil with increased intraocular tension, the myosis being due to peripheral influence. It increases the power of uterine contractions when labor has begun. It also stimulates the nutrition of the hair. Therapeutics: Pilocarpus is serviceable in pleurisy with effusion, a very efficient means of promoting absorption ; in general oedema, efficient but depressing; in uraemia and puer- peral convulsions this and hot-air baths are our main reliance; in pulmonary oedema, cases of which have been successfully treated by this drug; in muscular rheumatism, often greatly beneficial. In alopecia continued small doses may promote growth of hair. In diphtheria pilocarpus was at one time used with the idea of throwing off* the membrane by the exudation produced. It is, however, too depressing. Administration: The hypodermic administration of the hydrochlorate of pilocarpine, in doses of gr. in watery solution, is preferable. LIQUOR AMMONII ACETATIS. Solution of ammonium acetate, or spirit of Mindererns, (spiritus Mindereri) is made by adding to dilute acetic acid enough ammonium carbonate to neutralize. When freshly made it contains about 7 % of acetate of ammonium and 252 DIAPHORETICS. free carbonic acid. It has been frequently employed as a refrigerant diaphoretic and diuretic, often in combinations with camphor, opium, or sweet spirit of nitre, but its action in these directions is feeble. It has slightly stimulating properties, and may be used in adynamic fevers, and in fre- quent large doses it is often of value in relieving the effects of acute alcoholism. Dose f.?ss-j every two hours in sweet- ened water, as it is disagreeable to the taste. SPIRITUS AITHERIS NITROSI, U. S. (Spirit of Nitrous Ether). This preparation, commonly known as sweet spirit of nitre, and already mentioned under Ether, is a 5 % solution of ethyl nitrite in alcohol. It is a pale-yellow, volatile, inflammable liquid of pleasant, ethereal odor and sharp burning taste. Physiological action and therapeutics : In therapeutic doses it produces no effect beyond mild diaphoresis and diuresis, with a slightly stimulant effect on the nervous system. In convulsive diseases of children it seems to be antispasmodic. Inhaled in large doses it produces a train of symptoms similar to those of the nitrites (g. v.), and may even cause death. It is much used, chiefly in the febrile affections of childhood, as a refrigerant diaphoretic and diuretic, and is especially useful when nervous symptoms and a tendency to convulsions are present. Dose R[x-f3j. NAUSEATING DIAPHORETICS. As mentioned above, practically only two drugs of this class are used for this purpose, ipecac and antimony. Antimony, as tartar emetic in doses of gr. may be used in the early or sthenic stages of acute inflammations. Ipecac: The various preparations of this drug, and pre- eminently Pulvis Ipecacuanhse et Opii (Pidvis Doveri), Dover's Powder, have for a long time been used in this way and with excellent results in the early stages of " cold," which may often be " broken up " by the timely use of this drug combined with a hot foot-bath and a large, hot, alco- holic draught; also in muscular and acute rheumatism, in which it allays the pain and produces sweating; thereby EXPECTORANTS. 253 presumably assisting in the elimination of deleterious mat- ters ; for this purpose gr. v should be given every three or four hours. In suppression of menstruation with very severe pain it is often particularly efficient. REFRIGERANT DIAPHORETICS. All cardiac depressants, as aconite, veratrum viride, and the vegetable acids, belong to this class. The citrate of potassium is constantly employed in this way, cither as the effervescing citrate or the neutral mixture (mistura potassii citratis), and is preferable to the more powerful depressants. Alcohol: Alcohol in full dosage, especially when taken in hot drinks, causes dilatation of the cutaneous vessels and a more or less profuse perspiration. It is a domestic remedy of value, and is much used, combined with Dover's powder or a hot foot-bath, in " cold," rheumatism, and dysmenorrhoea. EXPECTORANTS. Expectorants are remedies used in inflamed conditions of the mucous membranes to modify secretion in some way. There are two classes of expectorants, which are to be em- ployed judiciously according to the stage of inflammation. In the so-called " dry " or early stages of bronchial inflam- mations the sedative expectorants, by nauseating and by lowering arterial tension, give rise to a relaxation of the tissues which favors secretion, just as is the case with dia- phoretics. In the later subacute or chronic conditions an entirely different class, the stimulating expectorants, are indi- cated. In pneumonia expectorants are contraindicated; and in all inflammations of the broncho-pulmonary mucous mem- brane, narcotics, as opium, hyoscyamus, and other depressing drugs, some of which no doubt decidedly modify secretions, are to be used with caution, especially in children and the aged. NAUSEATING or SEDATIVE EXPECTORANTS. Two of the three sedative expectorants in common use, ipecac and antimony, are also diaphoretic. Lobelia is also 254 EXPECTORANTS. somewhat used for this purpose. All of these have been treated of at length, and a few words only are necessary as to their expectorant properties. LOBELIA. Lobelia is used only when there is a tendency to bronchial and laryngeal spasm, as in asthma, either iodiopathic or sec- ondary to some other condition, in whooping-cough, and in laryngismus stridulus. It is a somewhat dangerous remedy, and is now seldom used, especially for children. ANTIMONY. Generally used in the form of tartar emetic. It also is too depressing for ordinary use, but is sometimes of great value in aborting an attack of acute bronchitis, for which pur- pose it has to be carried to the point of producing decided nausea or even vomiting. Its employment for children is contraindicated except in the most minute dosage. The wine of antimony may also be employed. IPECAC. Ipecac is the depressing expectorant most commonly used. Syrup of ipecac is a standard remedy in the early stages of acute bronchitis, given in frequently repeated, moderate doses (ffixx-xxx), although any other preparation may be used. It is perfectly safe, and is the best one of these drugs to be used for children. GRINDELIA, U. S. (Grindelia). Grindelia is the leaves and flowering-tops of Grindelia robusta and of Grindelia squarrosa (nat. ord. Composite). Habitat: North America, west of the Rocky Mountains. It contains a volatile oil, resin, and probably an alkaloid. The fluid extract is official in doses of Physiological action: The taste of grindelia is pungent and persistent, and it produces in the stomach a sensation of SENEGA. 255 warmth, at first stimulating the appetite and digestion, but, if continued, deranging them. It depresses the heart and lowers arterial tension (?), but after therapeutic doses these effects are very slight. Impairment of sensation and mobility and diminution of reflexes are produced by large doses. Toxic effects are rare. It is eliminated by the kidneys and pul- monary mucous membrane, and partakes of the character of a mixed sedative and stimulating expectorant. Therapeutics : Grindelia is used principally in respiratory conditions where bronchial spasm is a prominent feature, as in asthma, in which its utility is very great, and in whooping- cough. It may also be used in subacute and chronic bron- chitis, and is said to be a successful stimulant of the urinary tract in chronic pyelitis, chronic cystitis, etc. Pulsatilla. This drug, which has already been mentioned in another connection, is also a valuable sedative in the very early stages of acute bronchial inflammation. It should never be used when gastro-intestinal irritation is present. STIMULATING EXPECTORANTS. Some drugs which arc employed as expectorants of this group have been already mentioned among the blennorrhetic diuretics, notably oil of turpentine. SENEGA, U. S. (Senega; Senega Snake Root). Senega is the root of Polygala Senega (nat. ord. Polygalese). Habitat: United States. The cortical portion of the root alone is active, the woody part being inert. The dried root has a faint, peculiar odor, and a taste at first sweet and muci- laginous, but later acrid and irritating. It yields its virtues to both water and alcohol, and owes its activity principally to polygalic acid or senegin. Preparations : Extractum Senegae Fluidum, dose 1T|ij-v. Syrupus Senegae, dose fsj-ij. It is also present (8% of fluid extract) in the Compound Syrup of Squill (q. v.). 256 EXPECTORANTS. Physiological action and therapeutics : Locally, senega is an irritant, and in large doses may prove emetocathartic. In small doses it freely stimulates secretions generally, with a special action on the pulmonary mucous membrane. It is chiefly given as a stimulating expectorant in subacute and chronic bronchitis. In combination with the nauseating expec- torants, as in syrupus scillae compositus, which contains tartar emetic, it is sometimes prescribed in the acute stages. It has been used as an emmenagogue and diuretic. AMMONII CHLORIDUM, U. S. (Ammonium Chloride or Muriate; Sal Ammoniac), NH4C1 = 53.38. Ammonium chloride is formed by neutralizing gas-liquor (water which has been used to wash illuminating-gas, and contains the carbonate, hydrosulphate, and sulphate of am- monium) with hydrochloric acid and purifying the product. It occurs in white, translucent, tough masses, odorless, but having a sharp saline taste. It is partially deliquescent, somewhat soluble in alcohol, and freely soluble in water. Physiological action and therapeutics: Locally, this salt is an irritant to the skin and mucous membranes, and in large doses purges and occasionally produces emesis. After absorp- tion it is an alterative, diminishing the plasticity of the blood and increasing the urinary solids, with the exception of uric acid, which is somewhat diminished. It differs from other ammonium preparations in producing, in medicinal doses at least, very slight circulatory effects, and in large doses it appears to be depressant. It exerts a special action on mucous membranes, producing nutritive changes and epithe- lial exfoliation. It is eliminated chiefly by the urine, but in small proportion by all the secretions. Ammonium chloride is chiefly used in the later stages of acute and in chronic bronchitis. It is also used in wzscwfctr rheumatism, neuralgias (especially in migraine and ovarian neuralgias'), and hepatic torpor, and good effects have been claimed for it in hepatic abscess. Dose gr. v-x three times daily, or for children gr. j-ij. For neuralgias large doses, gr. xx-xxx, repeated in an hour, are given. ALLIUM-BALSUM TOL UTA NUM. 257 ALLIUM, U. S. (Garlic). Allium is the bulb of Allium sativum (nat. ord. Liliaceae), a small perennial plant indigenous to Southern Europe and cultivated in this country. The bulb is the portion used. Its physical properties are too well known to require comment. It yields its virtues to water, vinegar, and alcohol, and owes its efficiency to an essential oil, which is very volatile and irritating. Garlic locally is irritant and rubefacient, and is used for these purposes externally. It is also claimed to be a cardiac and nervous stimulant. It is especially valuable in the acute bronchitis of children, and has also been employed as an expectorant in subacute and chronic bronchitis, and as a stomachic ami diuretic in other conditions. Its preparations are- Allium, dose 3ss-ij. Syrupus Allii, dose fqj-ij. Balsam of Peru is a balsam obtained (by incisions into the bark} from Toluifera Pereirce (nat. ord. Leguminosae), a tree of Central America. It occurs as a thick, reddish-brown fluid of pleasant odor and warm acrid taste. It is soluble in alcohol. It contains resin, benzyl cinnamate, benzyl ben- zoate, and cinnamic and benzoic acids as its essential elements, and several other constituents. In doses of gtt. x-xxx it is used as a stimulating expectorant in catarrhs of the respiratory tract, and to some extent in those of the genito-urinary tract, but is not nearly so much used internally as is balsam of tolu. In surgery it has a distinct place as a stimulant appli- cation to sluggish granulations, although recently antiseptic properties have been denied it. It is given in emulsion. BALSAMUM PERU VIANUM, U. S. (Balsam of Peru). Balsam of Tolu is a balsam obtained (by incisions into the bark) from Toluifera Balsamum (nat. ord. Leguminosae), a Central American tree. It is at first a thick, viscid fluid, like balsam of Peru, but hardens with time into a resinous solid. It has a fragrant odor, a warm sweetish taste, and is BALSAMUM TOLUTANUM, IT. S. (Balsam of Tolu). 17-M. M. 258 EXPECTORANTS. quite soluble in alcohol and essential oils. Its composition, effects, and uses are practically the same as those of balsam of Peru, but its more agreeable flavor renders it preferable to the latter for internal use. Its tincture and syrup are much used as vehicles. Of the former the dose is fsj-ij of the latter, fsj-fgss. Tar is an empyreumatic oleoresin obtained by the destruc- tive distillation of the wood of Pinus palustris, and of other species of Pinus (nat. ord. Coniferse). Pinus palustris is the yellow pine of the South. The physical peculiarities of tar are well known. It is soluble in alcohol, ether, volatile oils, and fixed oils, and contains resin, oil of turpentine, etc. When distilled it yields pyroligneous acid and oil of tar (from which creasote is obtained), the residuum being pitch. The prepa- rations are- Oleum Picis Liquidse, external use. Syrupus Picis Liquidse, fsj-ij. Unguentum Picis Liquidse, tar and suet, and yellow wax. Physiological action and therapeutics: Tar resembles the turpentines in action. Locally it is a decided stimulant, and in ointments and soaps is used in eczema, psoriasis, scabies, and other skin diseases. Its internal use may lead to some gastric irritation, and in large doses to irritation of the kid- neys and some increase of. the urine. As the syrup or as tar-water internally or inhaled as a vapor it is employed as an expectorant in laryngitis and bronchitis. PIX LIQUIDA, IT. S. (Tar). Terebene is a liquid consisting chiefly of pinene, and con- taining not more than very small proportions of terpinene and dipentine. It is a colorless volatile oil, of a not un- pleasant terebinthinate odor, formed by the action of strong sulphuric acid upon oil of turpentine. It is a valuable stimu- lating expectorant, and is employed with good effect in subacute and chronic bronchitis, probably acting on the broncho-pul- monary and genito-urinary mucous membranes much like oil TEREBENUM, U. S. (Terebene), C10HI6 = 135.7. TERPINI HYDRAS. 259 of turpentine. It should be administered in emulsion or capsule in doses of Iffv-xv. TERPINI HYDRAS. U. S. (Terpin Hydrate), C10H18(OH)2+H,O = 189.58. Terpin hydrate, also a derivative of turpentine, is the hydrate of the diatomic alcohol terpin, and is a crystalline solid of very slight taste and odor. Its effects, uses, and method of administration are the same as those of terebene, but it is probably inferior to that drug. EMMENAGOGUES. Emmenagogues are remedies employed to promote the menstrual discharge. Absence of this function, or amenor- rhoea, may be dependent on or associated with a variety of constitutional conditions, as anaemia, plethora, constipation, wasting disease, etc., relief of which may bring on the menses. Drugs employed for this purpose are called indirect emmenagogues, and may be still further subdivided into tonic and purgative emmenagogues. Direct or stzmuZafo'nr/ emmena- gogues act not, as in the case of blcnnorrhetics, specifically and by appearing in the secretion, but by causing congestion of the pelvic organs. TONIC EMMENAGOGUES. Ferrum: Iron with its compounds is by far the most important member of this group. The association of amen- orrhoea with a uremia is very common, and is the indication for the use of this drug. It is given in full doses, and it is often well to combine it with purgatives or stimulating emmcnagogues. Manganum: Manganese, either as the binoxide or the manganate of potassium, is employed in the same way as iron, and probably produces similar effects, although some claims have been made that it directly stimulates uterine contraction, viz., that it is a direct emmenagogue. Dose of either prepa- ration gr. j-ij. The binoxide is preferable, as it causes less gastric disturbance. 260 EMM ENA GOG UES. Myrrha: Myrrh has been employed for emmenagogue pur- poses, but its efficacy is doubtful. It is generally used in combination with iron or aloes. Acidum oxalicum: Oxab'c acid (not official) has lately been used in cases of amenorrhoea with at least partial success. The dose is gr. | three times a day, in solution. Gr. is said to have been followed by symptoms of poisoning. PURGATIVE EMMENAGOGUES. Aloes: This drug, as is shown under Cathartics, exerts a specific action on the peristalsis of the large intestine, and part of this irritation seems to be transmitted to the neigh- boring uterus. It is a useful emmenagogue in cases asso- ciated with constipation and atonic conditions generally. It is to be given in sufficient doses daily to produce a moderately laxative effect, and it is well to administer a large dose at the proper time for the menstrual period. When plethoric amen- orrhoea exists, which is probably rare, salines and depleting drugs are indicated. DIRECT or STIMULATING EMMENAGOGUES. SABINA, U. S. (Savine). Sabina is the tops of Juniperus Sabina (nat. ord. Conifers), a small evergreen shrub of Southern Europe. Its activity depends upon an official volatile oil (Oleum Sabince), which has a strong, peculiar, heavy odor and a burning, nauseating taste. Physiological action and therapeutics: Locally, the oil of savine is an irritant to the skin and mucous membranes. In medicinal doses it produces a feeling of warmth in the stom- ach, with perhaps nausea, and slightly stimulates the circula- tion and secretions. In doses large enough to be toxic the symptoms produced are those of acro-narcotic poisoning- viz., nausea, vomiting, purging, abdominal pain, suppression of urine, or hsematuria, with such nervous symptoms as un- consciousness and at times convulsions. Collapse and death R UTA-TANA CETUM. 261 ensue. The lesions produced are those of gastro-intestinal inflammation. It has a very decided effect on the uterus, instituting or increasing its contractions, and in pregnancy may cause abor- tion, but in sufficient dose to produce this effect seriously endangers life. It is useful in amenorrhcea and menorrhagia when dependent upon a relaxed condition of the organs. Preparations: Extractum Sabime Fluidum, dose Ttliij-viij. Oleum Sabinae, dose Tflj-v. Ceratrum Sabinae, seldom used. Rue is the leaves of Ruta graveolens, or garden rue, a shrub of Europe. Its activity depends upon a volatile oil, oleum rute, also non-official, and it also contains a neutral principle, rutin. It is a decided irritant, its effects and uses resembling those of savine. It is also used somewhat as a carminative, an effect which it owes to its aromatic volatile oil. Dose of the oil, gtt. ij-v. RUTA (Rue; not official). PETROSELINUM (Parsley). Parsley is the root of Pdroselinum sativum, or garden parsley, which contains a volatile oil known as apiol or parsley cam- phor. This is a colorless or yellow oil, with a strong characteristic odor, soluble in alcohol, ether, and chloro- form, but not in water. It has been successfully used in functional amenorrhcea and neuralgic dysmenorrhcea. Dose gtt. iij-vj, b. i. d., in capsule for three or four days previous to the expected menstrual period. TAN ACETUM, IT. S. (Tansy). Tanacetum is the leaves and tops of Tanacetum vulgare, the common garden tansy (nat. ord. Composite). Habitat: Asia and Europe ; naturalized in North America ; cultivated. It is sometimes employed in the form of a decoction (" tansy tea") or of its volatile oil as a stimulant emmenagogue, or more often for criminal purposes. It is a very unsafe 262 OXYTOCICS. remedy, sufficient doses causing symptoms of gastro-intestinal irritation and epileptiform convulsions. Hedeoma, U. 8., Hedeoma (Pennyroyal). The leases and tops of Hedeoma pulegioides (nat. ord. Labiatae). Habitat: North America. This plant owes its activity to a volatile oil, official as Oleum Hedeomce. It is a stimulating emmena- gogue of uncertain power. POLYGONUM HYDROPIPEROIDES. Polygonum hydropiperoides, known also as water-pepper or smartweed, is an indigenous plant growing in moist places, and containing polygonic acid and other principles. It is a diaphoretic, diuretic, and expectorant, and in excessive doses a gastro-intestinal irritant. It is a stimulant emmenagogue and aphrodisiac, and has been employed inamenor- rhoea and functional impotence, as well as in diarrhoea and dysentery, and for its diuretic properties. Cantharides and other stimulating diuretics are also em- ployed as emmenagogues. Combinations of iron, cantharides, aloes, and guaiac are favorite prescriptions for this purpose. OXYTOCICS. Oxytocics are remedies used during or immediately after labor to energize uterine contractions. Practically, the only drug used for this purpose is ergot, although similar powers are claimed for quinine and certain other remedies. ERGOTA, U. S. (Ergot). Ergot is the sclerotium of Claviceps purpurea (class Fungi), replacing the grain of rye, Secale cereale (nat. ord. Graminese). This is then known as " spurred rye " (Secale cornutwmf The composition of ergot is very complex, and the identity of its active principle has not been made out. It contains sclerotic acid, scleromucin, sclererythrin, scleroiodin, picro- ERGOTA. 263 sclerotin, ergotic and sphacelic acids, and a variety of other constituents. Sclerotic acid is probably its active principle. Ergot yields its activity to both water and alcohol, and ergotin, which is in reality nothing more than a watery extract, represents the drug. Preparations : These should be freshly made, as both the powder and its derivatives deteriorate decidedly on expos- ure : Ergota, powdered, dose 3ss-ij. Extractum Ergotse, dose gr. v-3ss. Extractum Ergotte Eluidum (most used), dose f,3ss-f.sss. Vinum Ergotse, 1-5%, dose Ergotin, which is not official, is really an aqueous extract, and may be used when a solid preparation is desired. Bon- jean's is best. Dose gr. iij -x. Physiological action: To the therapeutist the chief interest lies in its effect upon the circulation and the uterus. Ergot induces contraction of unstriped muscle wherever found, with a specific action on that of the uterus and the intestine. In the impregnated uterus ergot has the power of initiating con- tractions, and of greatly increasing their force when already begun ; while in the unimpregnated it also produces contrac- tions, as is seen from the pain produced and its effect on hemorrhagic and other morbid processes of the uterus. Circulation: Upon this function its effects are quite notice- able : it slows the pulse, probably by a direct action on the heart, and causes a contraction of the arterioles through stim- ulation of the vaso-motor centre, which results in an immense increase of arterial pressure. It is a pure centric vaso-motor stimulant. In some cases, at least, the intestinal peristalsis is very greatly stimulated. Toxicology: Two varieties of poisoning may occur-acute and chronic, to the latter of which the term ergotism is applied. The symptoms of a single overdose are nausea and vomiting; dizziness; dilatation of the pupils; marked fall of temperature; circulation at first stimulated, later on de- pressed ; increased peristalsis. The chronic form of poison- ing, or ergotism, results generally from eating ergotized grain, and has never occurred to any extent in this country, 264 OXYTOCICS. but epidemics of it occur from time to time in Europe. Two forms are recognized-convulsive and gangrenous ergotism. In either form the initial symptoms are generally identical-• itching, formication and other subjective sensations of the feet. Then in the convulsive variety symptoms of gastro- enteric irritation appear, followed in a short time by violent and painful tonic contractions of the flexor muscles, at first with intermissions, but later becoming more or less tetanic, and finally resulting in death from exhaustion. In the gan- grenous form are added sensation of weight in the limbs, sub- jective or real coldness of the surface, anaesthesia, and finally an atrophic gangrene of the extremities or of the nose, ears, etc. In the acute poisoning rarely anything more than abor- tion is produced. When this is threatened, quiet, a recum- bent position, and nervous sedatives are indicated. In the chronic form many die. Therapeutics: In obstetrical practice ergot is employed in the following conditions : Its most common use is in labor after the delivery of the pla- centa, to insure full uterine contraction, the expulsion of clots, and to prevent post-partum hemorrhage. By some it is given as early as the second stage, but there is a possi- bility of its rendering the delivery of the placenta difficult. By others it is administered as soon as the head is born. In uterine inertia small doses have been administered, it having first been ascertained that no mechanical impediment to a natural and speedy delivery exists either in the mother or the child. The dangers of administering ergot before delivery of the child are that it may set up a tetanic contrac- tion of the uterus, which may result in its rupture or suffoca- tion of the child by interfering with the placental circulation. Ergot is employed to arrest bleeding in a variety of condi- tions where no local measures are available, as in menorrhagia and metrorrhagia, whether from fibroids, endometritis, or other causes; in the hemorrhagic diathesis combinations with digitalis and gallic acid will often prove valuable; also in purpura, epistaxis, haemoptysis, luematemesis, etc., but its efficiency is not great. It has been recommended to reduce an enlarged spleen or liver in malaria and in goitre. In GOSSYPII RADTCIS CORTEX-HYDRASTIS. 265 cerebral congestion, if hemorrhage can be positively excluded -which in most cases is impossible-and in congestion of the spinal cord, it may give satisfaction, and should be adminis- tered in large doses (fgss-j of the fluid extract, t. i. d.). Some deny it any efficacy in both of these conditions, and from the uncertainty of diagnosis in cerebral conditions its use in the former is probably unsafe. Ergot has also been used with asserted success in neuralgias, epilepsy, whooping- cough, leucaemia, varicose veins, enlarged prostate, aneurism, and numerous other conditions. It has been employed in vascular relaxation with over-secretion-in colliquative diar- rhoeas, night-sweats, diabetes insipidus, and other forms of polyuria. GOSSYPII RADICIS CORTEX, V. S. Cotton root bark : The of the root of Gossypium herba- ceum, and of other species of Gossypium (nat. ord. Malvaceae). This remedy, which is said to be used as an abortifacient by the negro women of the South, probably possesses feeble oxytocic properties, and it has not come into favor to any extent as a uterine stimulant. It has been used to some extent in amenorrhoea and dysmenorrhoea. The dose of the fluid extract is fgss-ij. It is asserted that this preparation is inert, and that the full activity of the drug can only be obtained in a freshly prepared decoction. USTILAGO (Corn Ergot). Ustilago maydis (corn smut or corn ergot) is a fungoid growth on Zea mays, or Indian corn. It occurs as irregular masses growing on all parts of the plant, but more frequently on the ears, composed of black gelatinous matter enclosing dark nodular spores. Its odor is disagreeable and its taste unpleasant. It probably contains sclerotic acid, and its effects are supposed to be those of ergot, for which it has been substituted. Dose of the fluid extract f3j-ij. HYDRASTIS. U. S. (Hydrastis). Hydrastis is the rhizome and roots of Hydrastis canadensis (nat. ord. Ranunculaceae), golden seal, yellow root, orange 266 OXYTOCICS. root, a small native plant. It contains a white alkaloid, hydrastine, a yellow one, berberine, and probably a third, .TanfAopuccme, besides starch, sugar, etc. The exact status of this drug is not clear, recent experiments having shown it to be allied to strychnine. At present it seems best to con- sider it in this connection. Preparations: Glyceritum Hydrastis, 100%. Extractum Hydrastis Fluidum, most used, dose fsss-ij. Tinctura Hydrastis, 20%, dose Physiological action: Hydrastis is a stomachic bitter, with a particular stimulant effect on the hepatic and intestinal secre- tions. Given to frogs, the alkaloid, hydrastine, heightens the reflexes and excites motor irritability, producing tetanic con- vulsions ; but these effects are much less in degree and longer of duration than those of strychnine. The circulatory effects are disputed : probably the heart is slowed and the arterial pressure raised as by digitalis, with a later depression of the vaso-motor system. It is said to be diuretic; it possesses the power to produce contractions in the non-pregnant uterus, and is said to have produced abortion. Berberine is an active depressant in large doses, but is not used in practical medicine. Hydrastin is a commercial, impure article, which contains the alkaloids hydrastine, berberine, some resin, and perhaps other principles. Hydrastine is a universal muscle-poison, acting on striped and unstriped muscle alike, first stimulating and then depress- ing the muscle of the heart, arteries, intestine, uterus, and general muscular system. Thus it raises the blood-pressure, increases peristalsis, induces uterine contraction, and in poisonous dose causes death from cramp-asphyxia or from centric respiratory arrest coupled with that of peripheral origin. Its dominant action is stimulation of the motor cord; it acts as an alterative to mucous membranes. Therapeutics : Hydrastis is used as a tonic in dyspepsia and chronic gastritis; also in duodenal catarrh, catarrhal jaundice, and constipation, from its stimulant effect on the hepatic secretion. Locally, cystitis is said to be benefited by its use, while gonorrhoea in the declining stages and gleet are im- IRRTTANTS. 267 proved by injections of the fluid extract (lT|xv-fyj), as are otorrhoea, leucorrhoea, and other mucous discharges. Menor- rhagia and metrorrhagia are often decidedly benefited by the fluid extract in repeated doses, either alone or combined with ergot. Hydrastininse Hydrochloras, U. S., Hydrastinine Hydro- chlorate. This is the salt of an artificial alkaloid made by oxidizing hydrastine. Hydrastinine has a well-defined oxy- tocic action. Poisonous doses arrest the motor system, the motor cells in the brain, cord, the motor nerves, and the muscles themselves. In large dose it is a depressant to the entire heart in systole. The blood-pressure is elevated by moderate doses, and the heart, the vaso-motors, and the ves- sel-walls stimulated ; the pulse is slow and full. The reflexes are at first increased and then diminished. Therapeutics: Hydrastinine is used to check bleeding from the uterus; it seems to exert a well-defined alterative action on the uterine mucous membrane, and is useful in all forms of metrorrhagia. It has also been recommended as a cardiac tonic and as an antispasmodic in epilepsy. Quinine and its salts are the most reliable remedies to stimulate contractions of the uterus during labor. Quinine probably acts constitutionally rather than on the uterus itself, and intensifies the natural contractions. A few observers claim that it produces abortion in normal pregnancy; but this is denied by the great majority of clinicians. It may prevent abortion when threatened by malaria. The dose is gr. x-xx, given in divided doses of gr. v each. Kola (Kola-nut, Guru-nut), the seed of Sterculia acuminata, and of other species of Sterculia, has been recommended as an oxytocic. By virtue of the caffeine it contains it stimu- lates the entire system, produces wakefulness, and indirectly counteracts uterine inertia. The dose is stated at flfxxx of the fluid extract. IRRITANTS. Irritants are remedies employed to produce hypersemia or inflammation of the parts to which they are applied. Ac- 268 IRRITANTS. cording to the intensity of their action they are divided into rubefacients, which simply produce redness of the skin; vesicants or epispastics, which cause an exudation of serum beneath the cuticle; suppur ants, which cause postulation; and escharotics, which cause actual tissue-destruction. Physiological action: The modus operand! of counter-irri- tants is not altogether clear. Clinical experience for ages, however, has shown their value, which probably depends upon some reflex effect upon the vaso-motor supply or the trophic nerves, by which the vascular supply of in- ternal organs is modified and inflammatory processes are checked. Therapeutics: These measures are used (1) for the relief of pain, either by an immediate action upon the painful nerve or by affecting its blood-supply reflexly ; (2) to modify sthenic inflammatory processes; (3) to promote absorption of serous accumulations, as in pleurisy, pericarditis, and chronic joint-diseases; and (4) to produce a general tonic effect upon the circulatory and nervous systems, as by mild counterirritation by the actual cautery over consid- erable areas. Contraindications: Counter-irritants are not to be used in acute conditions characterized by high arterial and febrile excitement, lest they add to these by the general febrile dis- turbance they themselves cause : nor, again, in cases where decided asthenia exists, lest they produce a destruction of tissue, which, owing to the weakened condition, will not readily be repaired. This class of irritants is employed when a local analgesic effect is required or a local stimulation of the capillary system, and also as a mild, general, but not permanent, stimulant in depressed conditions of the system. They are particularly valuable as pain-allaying measures. When too long continued they may prove destructive to tissue-viz., epispastic or escharotic-and this is to be guarded against in asthenic conditions. RUBEFACIENTS. SINAPIS ALBA-SINAPIS NIGRA. 269 SINAPIS ALBA, U. S. (White Mustard). SINAPIS NIGRA, U. S. (Black Mustard). Mustard is the seed of Brassica alba (nat. ord. Cruciferae) and the seed of Brassica nigra (nat. ord. Cruciferae). Habitat: Asia and Southern Europe; cultivated. The seeds of Bras- sica alba are larger, of a yellowish color externally, and have a less pungent taste than those of Brassica nigra. The two varieties differ somewhat in composition. By the action of myrosin, an albuminous ferment, upon sinigrin (potassium myronate), a principle peculiar to black mustard, in the presence of water, a very pungent volatile oil is formed. It does not pre-exist in the seeds. The white seeds yield no volatile oil, but by the action of the same ferment upon sinalbin an acrid fixed principle (acrinyl thiocyanate) is pro- duced, having somewhat similar properties. The activity of the ferment is checked by heat and acids, and somewhat by alcohol, so that cold, or at most tepid, water is the proper menstruum for both varieties. The volatile oil and the acrid fixed principle, then, are the active constituents of the two varieties of seeds. Preparations: Sinapis Alba is only used externally; no official preparations. Sinapis Nigra, powdered, as emetic internally ; dose 3j-ij. Charta Sinapis. Oleum Sinapis Volatile is used only in Liniraentum Sinapis Compositum. Physiological action and therapeutics: Internally, in small doses, mustard is a stomachic and cardiac stimulant: in large doses it produces vomiting, while very large amounts cause gastro-intestinal inflammation. Locally, mustard is an irri- tant, the degree of its activity depending on the dilution in which it is used and the duration of its employment. These effects vary from those of a very mild rubefacient to vesica- tion, and even the production of sloughing. Its internal use is for the most part limited to the produc- tion of emesis (see Emetics'). Locally, it is very much em- ployed as a sinapism for mild cutaneous irritation in a variety of painful and inflammatory conditions. It is an active irri- 270 IRRITANTS. taut, but is very easily controlled by judicious admixture with flour, Indian meal, or flaxseed. CAPSICUM, CT. S. (Capsicum ; Cayenne, Red, or African Pepper). Capsicum is the fruit of Capsicum fastigatum (nat. ord. Solanacese). Habitat: probably tropical America; cultivated. It contains fixed and volatile oils and a principle called cap- saicin. Preparations: Emplastrum Capsici. Extractum Capsici Fluidum, dose lT[ss-j. Oleoresina Capsici, dose ULj-j. Tinctura Capsici, dose Physiological action and therapeutics: Locally, capsicum is an excellent rubefacient, and if its use is prolonged it may vesicate. It is less used than mustard, because more diffusible and more apt to produce irritation of distant parts. Many other spices, as cloves, cinnamon, black pepper, ginger, etc., are used as counter-irritants, either alone or in some combination generally known as " spice plasters?' PIX BURGUNDICA, U. S. (Burgundy Pitch). Burgundy pitch is the prepared resinous exudation of Abies excelsa (nat. ord. Coniferse), or Norway spruce, occurring in the shops as a yellowish brittle substance, of a taste and odor resembling turpentine. At the surface temperature of the body, however, it is plastic and adhesive. Preparations: Emplastrum Picis Burgundicae, 90%, in yellow wax. Emplastrum Picis Burgundicse cum Cantharide, or "warm- ing plaster," which sometimes vesicates. It is also used as a basis for several other plasters. Physiological action and therapeutics: Burgundy pitch is a gentle irritant, producing only mild inflammation and seldom vesicating, although at times a vesicular eruption may follow its use. In its various emplastra it is employed in chronic joint and pulmonary conditions and in muscular rheumatism, especially lumbago. PIX CANADENSIS-CUPS. 271 PIX CANADENSIS (Canada Pitch). Canada pitch is the prepared resinous exudation of Abies Canadensis, or hemlock spruce. It resembles the preceding in appearance, but is somewhat darker in color and possesses very little odor or taste. Its effects, which are due, as in Burgundy pitch, to a contained resin and volatile oil, and its uses correspond to those of that drug, but it is softer at the body temperature and is a less convenient application. Its only preparation is- Emplastrum Picis Canadensis, which contains 9 parts of pitch, with 1 part of yellow wax to give it consistency. The use of turpentine stupes has already been spoken of. In stronger solutions oil of turpentine is a powerful and painful irritant. The preparations are- Oleum Terebinthinae, dose Tffx-fsss. Linimentum Terebinthinae, " Kentish ointment." OLEUM TEREBIN THIN A). Linimenta or Liniments. This class of preparations is used for its local stimulant effect in rheumatic and neuralgic pains. are used to abstract blood from congested areas by their counter-irritant effect. Wet cups are employed for local bleeding; dry cups are applied to the chest in pleurisy, pul- monary congestion, and threatened pneumonia. Cups VESICANTS, or EPISPASTICS. The theory of their action has already been discussed. Their chief uses are (1) as derivatives or revulsants for the cure of acute or chronic inflammation; (2) as analgesics; (3) to promote absorption of collections of fluids; (4) in nervows conditions to break up a train of morbid associations; and (5) for the cure of certain diseases of the skin. The drug most used for vesication is 272 VESICANTS. CANTHARIS, U. S. (Cantharides). Cantharides, commonly known as Spanish fly, is a dried insect, Cantharis vesicatoria or Lytta vesicatoria (class Insecta; order Coleoptera), found in Southern Europe. The odor of the insects is described as resembling that of mice, and their taste as acrid, burning, and urinous. They contain as their active principle cantharidin, which is odorless, tasteless, and insoluble in water, but rendered soluble in this menstruum by other constituents of the drug, so that cantharidin yields its virtues to water and also to alcohol. It sublimes at 100° C. Preparations: Pulvis Cantharidis (seldom used), dose gr. j-T. Tinctura Cantharidis, 5%, dose gtt. j-v. Ceratum Cantharidis, "blistering plaster," 32%. Charta Cantharidis, " blistering paper." Collodium Cantharidatum, about 60% cantharides. Emplastrum Picis Cantharidatum (warming plaster) con- tains 8 parts of cerate of cantharides and 92 parts of Bur- gundy pitch. With the exception of the tincture, these preparations are all used for blistering. This takes place in from six to eight hours ; but it is advisable to allow the blister to remain from four to six hours, and to follow its use by the application of a flaxseed poultice. " Cantharidal collodion " is easily applied, and is valuable in refractory patients because not easily removed. Physiological action: Locally to the skin, in which way it finds its chief use, cantharis is an active irritant, causing red- ness, burning pain, vesication, and, if too long maintained, even sloughing of the deeper tissues. Its effects upon the mucous membranes are similar. Internally: when ingested in large doses it causes violent gastro-enteritis. The drug is eliminated by the kidneys, and there again proves irritant, in small doses increasing the amount of urine, and perhaps causing pain on urination, while large doses may be followed by haematuria, bloody purging, strangury, priapism, intense erotic desire, excru- AMMONITE FORTIOR. 273 dating pain, and death from collapse. The aphrodisiac effect is not constant. Cantharis is freely absorbed from its own blister, and when so used may cause these symptoms, and should be employed with care when any kidney lesion exists. Cantharides-toxicology: The effects of toxic doses are severe gastro-enteric and genito-urinary irritation. The treat- ment consists in evacuation of the stomach, if this has not already taken place, and the administration of opiates and demulcents, avoiding, however, all oily substances, in which cantharidin is easily soluble : gr. xx are said to have proved fatal. The lesions after death are those of intense inflamma- tion of the entire alimentary tract and an acute desquamative nephritis. Therapeutics: Its occasional use as a diuretic and emmena- gogue has already been noted. Locally, it is a favorite, and the most efficient vesicant; it is used to fulfil any of the indications for blistering, bearing in mind the possibility of its causing genito-urinary irritation in patients with renal disorder. Cantharis vittata, or potato fly (indigenous to the United States), and other varieties of Cantharis are used as substi- tutes for Cantharis vesicatoria. They contain cantharidin and possess similar properties to the official drug. Aqua Ammoniae Fortior. This drug, applied to the skin on flannel or under a watch-glass to prevent evaporation, will produce vesication very quickly (five to ten minutes); but it is extremely painful, and should seldom be used except in an emergency. As ordinarily applied it is an efficient rubefa- cient. ESCHAROTICS. Escharoties, caustics, or cauterants are drugs employed to destroy the structure or vitality of tissues. They are em- ployee! (1) to effect the removal of morbid growths, as warts, condylomata, lupus, cancer, etc.; (2) to destroy as far as pos- sible the virus in wounds made by rabid or venomous ani- mals ; (3) to cure violent inflammations, as in gonorrhoea, ophthalmia, malignant pustule, etc.; and (4) to stimulate indo- 18-M. M, 274 ESCHAROTICS. lent ulcers and sinuses. They vary greatly in the character and intensity of their action, from the production of a mere film, as by lunar caustic, to the widely destructive action of some members of the group. ARGENTI NITRAS FUSUS, U. S. (Moulded Silver Nitrate; Lunar Caustic). This preparation, which has already been described, does not liquefy, and so affects the tissues to which it is applied only superficially and forms a protecting pellicle over them. It is very frequently used to stimulate granulations and destroy them when exuberant, and in a great variety of inflammatory conditions. Nitrate of silver is also frequently used in solution to stimulate granulations. POTASSA, U. S. (Potassa), KOH - 55.99. Caustic potash is prepared by evaporating liquid potassa. When fused it is cast into moulds, forming sticks of a grayish or brown color, very deliquescent, and having a caustic, salt- ish taste. These contain certain impurities which are insolu- ble in alcohol, while potassa itself is freely soluble in this menstruum and in water. In this way a pure white salt is obtained, known as alcoholic potassa. Physiological action and therapeutics: Potassa is a very powerful caustic. When applied to the skin it melts, abstracts water from the tissues, and forms a dirty grayish slough which is very permeable, so that its action extends to a considerable depth. A dilute acid may be employed to check its action. It causes great pain. It may be used to meet any of the indications for the more powerful cauterants, as in the destruction of chancres, poisonous bites, malignant pustule, lupus, rodent ulcers, and epithelioma. Potassa cum calce, or potassa with lime, contains equal parts of these ingredients. It occurs in sticks or in an alco- holic paste called "Vienna paste." It is milder, less deli- quescent, and more easily limited than potassa, and is more often used. 275 SODA-ZINCI CHLORIDUM. Caustic soda is prepared in an analogous way to potassa. Its physical properties are also for the most part similar; but it is less translucent, and, although deliquescent, it does not remain permanently liquid, but after a time effloresces. "London paste" is composed of equal parts of caustic soda and lime. The uses of caustic soda are the same as of Potassa. SODA, U.S. (Soda; Caustic Soda), NaOH = 39.96. ACIDUM ARSENOSUM, U. S. (Arsenous Acid), As2O3 = 197.68. Arsenic has already been described at length. It remains only to consider its action and uses as a caustic. Applied to the tissues, it is a very powerful but slow and extremely painful escharotic, producing intense inflammation of sur- rounding tissues. It affects the tissues as an irritant, de- stroying their vitality, rather than in a chemical manner. Absorption of a serious nature may take place from a raw surface. However, the more freely it is applied the less the danger of absorption seems to be, and when used over areas of any size it must be used freely. Various pastes and oint- ments have been employed, varying only in the substances used to render its effects milder and less painful. It is occasionally used in lupus, epithelioma, and other dangerous conditions. ZINCI CHLORIDUM, U.S. (Zinc Chloride), ZnCl2 = 135.84. Zinc chloride is only slightly less powerful than potassa, and seems to possess to a degree the power of disinfecting its own slough, so that the subjacent tissues are left in a healthy granulating condition after the slough separates. Its use is free from danger as regards absorption. The indications for its use are those mentioned under Potassa, and it is also an excellent stimulant to sluggish ulcers and sinuses. It may be employed in an alcoholic or a watery solution, in either of which menstrua it is freely soluble; but it is more generally used as Canquoin's paste, which is made by mixing it with equal parts of wheaten flour and a little water; 276 ESCHAROTICS. the proportions, however, of the chloride are varied according to the effect desired. The element bromine is a dark-red liquid, volatilizing in exceedingly pungent fumes, which are very irritating to the broncho-pulmonary mucous membrane. It is caustic to the taste and of a disagreeable odor, and is freely soluble in ether, less so in alcohol and water. Physiological action and therapeutics : It affects the tissues chemically, decomposing hydrogen compounds and forming hydrobromic acid. Owing to its liquid form and volatility it is a rapid and thorough caustic, and possesses deodorant and disinfectant properties. It is seldom used as a caustic, the occasion for its use being limited chiefly to hospital gan- grene and to cancer of the uterus. In weak solutions it may be inhaled in small amounts in offensive catarrhal conditions, as ozsena. BROMUM, U. S. (Bromine), Br = 79.76. ACIDUM CHROMICUM, U.S. (Chromic Acid), CrO3 = 99.88. Chromic acid (chromic anhydride) is made by the addition of sulphuric acid to a solution of potassium bichromate. It occurs in deep-red, acicular crystals, easily deliquescing to a deep-red liquid, and very soluble in water, forming an orange-yellow solution. Physiological action and therapeutics: Applied to living tissues, it rapidly oxidizes and decomposes them, its cauterant action being very active, but less painful than that of other members of this group. Internally, it is a violent corrosive poison, and death has taken place from absorption following its external use. It finds its chief use in the hands of the dermatologist for the destruction of syphilitic condylomata and other dermal growths. It is also used as a caustic ap- plied to the nose and throat, where it is necessary to limit the action to a small area. A heated applicator is dipped into the acid and a small bead will form at the tip from fusion of a few of the crystals. HYDRARG YR UM-ACID UM NITRICUM. 277 Incompatibles: When mixed with easily oxidizable sub- stances, as strong alcohol, glycerin, etc., it is liable to cause combustion, or even an explosion, so great is its oxidizing power. HYDRARGYRUM. Hydrargyri Chloridum Corrosivum (corrosive sublimate) in saturated solutions may be used as a mild caustic in chan- croidal and other conditions. It is less powerful in its action than liquor hydrargyri nitratis. This preparation is made by dissolving Hg or its red oxide in an excess of nitric acid. It is a clear, acid, highly corrosive liquid, contains free nitric acid, and is said to possess peculiar efficacy in syphilitic conditions. Nitric acid is a powerful caustic, useful for the cauterization of small areas. It is applied with a glass rod or a splinter of wood, as it attacks and destroys most metallic substances. It is very penetrating, a drop or two being sufficient. When enough tissue has been destroyed its action is limited by neutralizing it with an alkali. Like that of other mineral acids, its action is apt to extend beyond the point of applica- tion. ACIDUM NITRICUM, U. S. (Nitric Acid). Other agents employed as caustics : Sulphuric, hydrochloric, and the stronger and glacial acetic acids are also caustics of a varying degree of activity, but, with the exception of glacial acetic, are seldom used for this purpose. The su/p/mtes of zinc and copper and dried alum are employed as mild caustics to exuberant granulations. The actual and galvano-cazderies are much used for this purpose, and are indicated in very chronic inflammation ; in chronic meningitis the actual cau- tery is applied to the back of the neck after the tissues have been rendered insensible by the application of ice and salt. SUPPURANTS. Oleum Tiglii. Croton oil, applied with friction to the skin, produces an inflammation accompanied by a pustular erup- 278 SUPPURANTS. tion. For purposes of counter-irritation it is applied, either undiluted or mixed with one or two parts of olive oil or oil of turpentine, to the chest in chronic bronchitis and allied conditions, and to rheumatic joints. Unguentum Antimonii. This preparation produces effects similar to those of oleum tiglii, and may be used in similar conditions, but is a more painful application. In this subdivision may also be considered two drugs which, although they do not possess vesicant, rubefacient, or escharotic action, are much used by the dermatologist. Sapo Mollis, U. S., Soft Soap (Sapo Viridis, Green or Soft Soap). Green soap is prepared from potassa and the fixed oils, and is chemically a combination of the oleate, stearate, and palmitate of potassium. Officially it is prepared from linseed oil and potassa. It is a soft, greenish soap of the consistency of jelly, and is very soluble in water and alcohol. Owing to the potassa it contains it is an irritant, and consti- tutes an invaluable preparation for local application in the scaly skin diseases, as in the scaly forms of eczema, and in sca- bies. As an alkali it is an efficient antidote to acid-poisoning, and possesses the advantage of being generally available. Too long continued, it may produce decided irritation of the skin. Chrysarobinum, U. S., Chrysarobin. A neutral principle (in its commercial more or less impure form), extracted from Goa powder, a substance found deposited in the wood of Andi r a araroba (nat. ord. Leguminosae). This is a large tree of Brazil. Chrysarobin is an orange-colored, tasteless, odor- less, and crystalline powder, insoluble in water, slightly solu- ble in alcohol, and freely soluble in ether. Action and therapeutics: Its internal effects are disputed, but gr. v-vij prove emetic and purgative. Applied to the skin, it produces a yellow stain, and causes irritation, with at times oedema and a furuncular inflammation. In the treatment of psoriasis it is a specific, and it is also employed with success in the other scaly skin diseases. The official (5%) ointment sometimes proves too irritating for the skin, and has to be diluted with one or two parts of some simple ointment. The stain appearing on the skin after its use is almost indelible; this is the reason why the drug is rarely employed. AQUA-ACACIA. 279 Demulcents are substances, consisting chiefly of gum or mucilage, which soften and relax the tissues and diminish the heat, tension, and pain of inflamed areas. As most of them contain sugar and starch, their constitutional effects are chiefly nutritive. They are employed internally to relieve severe gastro-intestinal irritation, as after the ingestion of irritant poisons; in acute inflammations; to affect reflexly slight bronchial inflammations, and locally those of the pharynx and larynx ; and as light diet for the sick. Externally, they are extensively employed to relieve the symptoms of burns, wounds, etc., while in pharmacy they are much used to sus- pend substances insoluble in water. A very common form for external use is the poultice or cataplasm, which consists of some mucilaginous or starchy substance made into a soft paste with water and spread upon suitable material. They form a convenient method for the application of heat and moisture, and have already been sufficiently considered. DEMULCENTS. AQUA, IT. S. (Water). Water fulfils important dietetic, medicinal, and pharmaceu- tical uses. It aids in the solution and digestion of food, the metamorphosis and construction of tissue, and is said to increase the total solids eliminated by the urine. It is the best of demulcents, and as such is much used. The ingestion of too large amounts, however, causes disturbances of diges- tion. For pharmaceutical purposes distilled water (Aqua Destillata, £7. /S'.) should alone be employed. ACACIA, U. S. (Acacia; Gum Arabic). Acacia is a gummy exudation from Acacia Senegal (nat. ord. Leguminosae), a small African tree. Several varieties of gum Arabic are known, all of which are somewhat trans- parent, hard, and pulverizable. They are odorless, and have a somewhat sweetish taste. They are almost wholly made up of arabin, or more properly arabic acid, which is soluble in water, forming mucilage, from which solution it is precipitated by alcohol. It is also precipitated by solution of subacetate 280 DEMULCENTS. of lead, by ferric salts, and solutions of silicates and borates. Acacia forms the type of a class of compounds known as gums, which dissolve in water with the formation of a mucilaginous liquid, from which they are precipitated by alcohol. Physiological action and therapeutics: Gum arabic is not digestible, and its only effect is that of a demulcent, for which it is used in gastro-intestinal conditions, as diarrhoea, dysentery, acid-poisoning, etc., and as a lubricant in catarrhal affections. It is much used as a vehicle for anodynes and expectorants in cough-mixtures. The following preparations are official: Pul vis Acacise, Mucilago Acacise, Syrupus Acacise, used as vehicles; dose ad lib. All the preparations of acacia become sour very readily and should be freshly prepared for medicinal use. Tragacanth is a gummy exudation from Astragalus gum- mifer and from other species of Astragalus (nat. ord. Legum- inosse), small shrubs of Asia Minor. Tragacanth occurs in odorless and nearly tasteless flakes, and when heated with water it swells up and forms a paste without actual solution. Its chief constituents are arabin (or a similar substance) and tragacanthin. Its chief use is for suspending heavy insoluble powders and to give a proper consistency to lozenges. Tragacantha and Mucilago Tragacantlise are official. TRAGACANTHA, U. S. (Tragacanth). Cetraria, or Iceland moss, is a lichen, Cetraria islandica (class Lichenes), chiefly obtained from Iceland and Norway. It contains a starch, liehenin, and a bitter principle, cetraric acid. It imparts its bitterness to cold and all its virtues to boiling water. It is a highly nutritious demulcent, and may be used in jelly, the bitter principle having first been re- moved by maceration with cold water. Preparation : Decoctum Cetraria}. In this the bitter prin- CETRARIA, U.S. (Cetraria; Iceland Moss). CHONDR US-GL YCYRRHIZA. 281 ciple has been removed by previous maceration with cold water. Dose f 5ss-j. CHONDRUS, U.S. (Chondrus; Irish Moss or Carragheen). Irish moss is Chondrus crispus, and Gigartina mammillosa (class Algae), sea-weeds found on the coast of Ireland and the Northern United States. Its active principle, carragheenin, is a substance somewhat resembling starch, but not giving the characteristic iodine reaction. Boiled in water, it yields a solution which gelatinizes on cooling. It is best freed from adherent salts by thorough washing with water. It is a nutritious demulcent, and is given as an article of diet to the sick in the form of decoction with suitable flavoring, or with milk as blanc mange. Ulmus, or slippery elm, is the inner bark of Ulmus fulva (nat. ord. Urticacese), an indigenous tree. It contains a large amount of mucilaginous matter and some tannic acid, and has found employment in catarrhs of the intestinal and genito-urinary tracts. It possesses considerable nutritive value as well, and it is used externally in poultices. Mucilago Ulmi is official, and is used as a demulcent drink. ULMUS, U. S. (Elm). GLYCYRRHIZA, U.S. (Glycyrrhiza; Licorice Root). Licorice is the root of Glycyrrhiza glabra, of the variety glandulifera (nat. ord. Leguminosse). Habitat: Southern Europe. Its long fibrous roots have no odor, but a sweet mucilaginous taste, which they owe to a glucoside, glycyrrhizin, soluble in boiling water and alcohol. It is also soluble in ammonia, with the formation of ammoniated glycyrrhizin ; from the latter solution it is precipitated by acids, hence preparations of glycyrrhiza should not be prescribed in acid media. Licorice is used as a demulcent and as a flavoring agent to disguise the taste of unpleasant drugs. The cortex of the root is acrid and possesses no demulcent properties. It has many preparations : 282 DEMULCENTS. Extractum Glycyrrhizse, Extractum Glycyrrhizse Purum, Extractum Glycyrrhizse Fluidum, used as sweetening agents. Trochisci Glycyrrhizse et Opii ; each contains opium gr. Pulvis Glycyrrhizse Compositus (see Senna}. Mistura Glycyrrhizse Composita (brown mixture), a favorite vehicle for cough-mixtures; contains extr. glyc. purum, acacia, sugar, spir. setheris nitros. ad 3 parts, paregoric 12 parts, wine of antimony 6 parts, with water to 100 parts. Glycyrrhizinum Ammoniatum. Ammoniated Glycyr- rhizin. LYCOPODIUM, U. S. (Lycopodium). Lycopodium is the spores of Lycopodium clavatum, and of other species of Lycopodium (nat. ord. Lycopodiaceae) (club- moss). Habitat: Europe, Asia, and North America. Lyco- podium occurs as a fine yellow powder, which is much used as a dusting-powder, not being moistened by water. It is also used in pharmacy to coat pills so as to prevent them from adhering together. Lycopodium contains 47 % of fixed oil and flashes when thrown into a flame. LINUM, U.S. (Linseed; Flaxseed). Linum is the seed of Linum usitatissimum (nat. ord. Lineae). Flaxseed contains large quantities of mucilage and fixed oil (oleum lini). It is the most common basis for poultices, and is used internally as a demulcent, sometimes in infusion, but preferably in decoction. In the arts it is very valuable because it is a drying oil, absorbing oxygen from the air and forms a valuable basis for paints. AMYLUM, IT. S. (Starch). Amylum or starch, is officially the fecula. of the seed of Zea Mays (nat. ord. Graminese), or corn, but is found as a proximate principle in a large variety of plants throughout the vegetable kingdom. It is a carbohydrate (C6HWO5), and swells with water at an elevated temperature to the formation of starch paste. By boiling it with dilute sulphuric or hydro- ADEPS LANrE HYDE OS US- GLYCERINUM. 283 chloric acid it is converted into an isomeric principle, dextrin, and this in turn into glucose or grape-sugar. Physiological action and therapeutics: The starches are an important group of nutrients, the consideration of whose physiological history falls more properly elsewhere. It is used as a dusting-powder, as a constituent of poultices, and is the antidote for iodine. Other drugs possessing similar qualities arc- Althaea, U. S., Althaea, Marshmallow. The root of Althaea officinalis (nat. ord. Malvaceae). Habitat: Europe ; natural- ized in North America. The official syrup affords a pleasant vehicle for the administration of medicines to children. The decoction is a useful demulcent in gastritis. Cydonium, the seed of Cydonia vulgaris or quince; the mu- cilage has been a favorite basis for collyria. Sassafras Medulla, U. S., Sassafras pith. The official muci- lage is employed as an eye-wash. EMOLLIENTS. Emollients are bland substances, principally of a fatty nature, which are used externally to soften the skin and render it pliable. ADEPS LANJl HYDROSUS, U. S. (Hydrous Wool Fat; Lano- lin). Lanolin is the purified fat of the wool of the sheep (Otis Aries, class Mammalia; order Ruminantia), mixed with not more than 30% of water. This purified fat constitutes about 45% of the wool of sheep, and consists of the secretion of the sebaceous follicles. It contains cholesterin. When first intro- duced the property of being quickly absorbed, together with that of impregnating substances, was claimed for it, but recent experiments have apparently disproved this. GLYCERINUM, U. S. (Glycerin). Glycerin, a liquid obtained by the decomposition of vegeta- ble or animal fats or fixed oils, and containing not less than 284 EMOLLIENTS. 95% of absolute glycerin (C3H5(OH)3=91.79), is chemically propenyl alcohol, and is liberated from its combinations with the fatty acids (stearic, margaric, oleic, etc.) during the process of saponification, when these acids unite with an alkali. In this form, however, it is impure and apt to be an irritant. The purest and blandest forms are derived from this soap-waste by a patented process, but the largest amounts are made by passing superheated steam through fats. Glycerin is a thick, colorless liquid, with a sweet, slightly burning taste. It mixes in all proportions with alcohol, oils, and water, and is itself a solvent for iodine, bromine, tannic and vegetable acids, salicin, and many neu- tral salts, etc. It is very hygroscopic and does not evaporate. The use of glycerin as a nutrient and alterative has now been abandoned, and it is chiefly used topically. Either in its own form or in combinations in various creams it is employed in chapped skin, excoriations, seborrhoea, and other skin diseases. Even in dilute form it is irritating to some skins. For a similar emollient effect upon the mucous mem- branes it is used in coryza and laryngitis. Internally, it exerts a mild laxative effect; one of its uses is to disguise the taste of unpleasant medicines, as castor oil, turpentine, iron solu- tions, etc.; also as a substitute for sugar in diabetes, but it possesses no curative properties. It is sometimes added to laxative eneraata, but is largely used to abstract water in chronic inflammation of mucous membranes by its local appli- cation. Large doses of glycerin, injected hypodermically, produce vomiting, thirst, bloody urine, fall of temperature, depression of heart and respiration, muscular weakness, convulsions, coma, and death. SACCHARIN (Glusidum, Br. Ph.). Saccharin is a complex, white, crystalline, intensely sweet powder, slightly soluble in water, with which it forms an acid solution, and readily soluble in glycerin, alcohol, and ether. It is a coal-tar derivative. Even in large amounts it produces no marked physiological effects. It is chiefly of PETROLATUM. 285 use where sugar is contraindicated for any reason, as in diabetes or obesity. It acidifies the urine and prevents decom- position, and may be used with advantage in conditions where the urine is ammoniacal, as from cystitis, etc. PETROLATUM. Petrolatum is official in three forms : Petrolatum liquidum; Petrolatum molle; Petrolatum spissum. It is a yellowish, translucent, semi-solid mixture of substances chiefly of the marsh-gas series. It is obtained by distilling off the more volatile parts of crude petroleum and purifying the residue when it has the desired melting-point. It is insoluble in water and alcohol, but readily soluble in ether, chloroform, oil of turpentine, and the fixed and volatile oils, and melts at a temperature of 105° to 125° F. It is similar to various proprietary substances, as vaseline, Cosmoline, etc., and was introduced as a substitute for them. Parafin is composed of the higher compounds of the marsh-gas series, and may be prepared from petrolatum. The advantages of these hydrocarbon oils and solids consist in their freedom from odor and acridity, their resistance to chemical agencies, and the fact that they do not get rancid. Physiological action and therapeutics : Petrolatum in any ordinary dose does not produce physiological effects. Its chief use is as a protective external application and as a basis for ointments. Other substances are used for similar purposes. Adeps, U. S. (Lard). The prepared, internal fat of the abdomen of Sus scrofa (class Mammalia, order Pachyder- mata), purified by washing with water, melting and straining. This is a mild fat melting at the body temperature and largely used in pharmacy, often as adeps benzoivatus, which contains the soluble constituents of 2% of benzoin. Oleum Theobromatis (Oleum Theobromae, U. S., 1880) (cacao butter), a fixed oil expressed from the seed of Theo- broma, Cacao (nat. ord. Sterculiaceae). This is a tropical plant of South America. Cacao butter is a bland vegetable fat, 286 PROTECTIVES. solid at ordinary temperatures, but melting at that of the body, and is much used in suppositories. Cetaceum, U. S. (spermaceti), a peculiar, concrete, fatty substance, obtained from Pliyseter macrocephalus (class Mam- malia ; order Cetacese). Spermaceti is obtained from the head of the sperm whale : used to give consistency to oint- ments. Ceratum cetacei, U. S., contains spermaceti 10, white wax 35, and olive oil 55 parts. Cera flava, U. S., Yellow Wax. A peculiar, concrete sub- stance, prepared by Apis mellifica (class, Insecta; order, Hymenoptera). Cera alba, U. S., White Wax. Yellow wax, bleached. Yellow and white wax are used to increase the consistency of ointments. Poultices. Poultices are applied in superficial and also in deep-seated inflammation. They are powerfully sedative when allowed to remain in contact with the skin for a pro- tracted period of time. In deep inflammations they invite the blood to the surface away from the congested areas; for this purpose they are used in pneumonia, pleurisy, and peri- tonitis, and should be applied hot and frequently renewed. The jacket poultice is a favorite form for the chest. Late in superficial inflammation the poultice facilitates the pointing of an abscess. Flaxseed meal, Indian meal, bread and milk, and slippery elm are used as bases for poultices, though the active medium of all is probably only the water they contain, while the basis retains both the heat and moisture. Mustard or yeast will make a poultice stimulating instead of sedative, and may be added in varying proportions. PROTECTIVES. The name " protectives " is applied to a class of remedies which are used medicinally to exclude the air from and pro- tect inflamed superficial tissues. PYROXYLINUM, U. S. (Pyroxylin; Soluble Gun-Cotton). Pyroxylinum, or soluble gun-cotton, is made by macerating purified cotton, Gossypium purificatum, U. S. (absorbent COLL 0 LI UM- G UTT A-PERCHA. 287 cotton), in a mixture of nitric and sulphuric acids, and after- ward washing with water and drying. The official pyroxylin is not so highly nitrated as other varieties of gun-cotton, and is more soluble. It resembles ordinary cotton in appearance, but is harsh to the touch. It is used in medicine only in making collodion. COLLODIUM, U. S. (Collodion). Collodion is a colorless, syrupy liquid with a strong odor of ether. It consists of pyroxylin 3, stronger ether 75, and alcohol 25 parts. When applied to the dry skin the menstrua quickly evaporate, leaving a thin, flexible, and very con- tractile film. It may be used as a protective to wounds and bed-sores or for the coaptation of the edges of incised wounds. It is also valuable for the solution of medicinal substances, as cantharides, capsicum, etc., when these are applied locally. When it contains tannic acid it is called collodium stypticum. Collodium flexile, or flexible collodion, contains castor oil 3 and Canada turpentine 5 parts, and shrinks very little on drying-a decided advantage in many cases. The turpentine makes it slightly irritating. Cantharidal collodion has already been considered under Epispastics. GUTTA-PERCHA. Gutta-percha is the concrete exudation of Isonandra gutta, an East Indian tree. A 9%> solution in chloroform was formerly official as liquor gutta-perclue, and when applied to the skin forms a thin adhesive film which constitutes an efficient protective for small cuts, fissures, etc., in domestic practice. Other protectives: Certain plasters, as Emplastrum Resinse, Emplastrum Plumhi, Emplastrum Saponis, etc., are also used as protectives to denuded surfaces. They should be spread upon very soft kid, and should be fresh enough not to have lost their plasticity. 288 ANTACIDS. ANTACIDS. Antacids are remedies employed to neutralize excessive acidity of the gastric and intestinal contents. This acidity may be due to hypersecretions or to fermentation of undigested food. Ina wider sense antacids are substances which enter the blood, increasing its alkalinity and that of the secretions. The alkalies and alkaline earths and their carbonates are included in this class. Given before the ingestion of food, alkalies increase the acid secretion ; after meals, they help to neutralize this acidity. For the former purpose smaller doses are given than for the latter. SODIUM. The arsenate, bromide, nitrate, phosphate, sniphate, and many other sodium salts having peculiar effects due to these constituents have already been mentioned. The following salts of soda are antacids: Liquor Sodas, U. 8., solution of soda. This is a colorless liquid of unpleasant taste, containing about 5% of sodium hydrate. Sodii Carbonas, U. 8., carbonate of soda (Na2CO3+10H2O =285.45). This salt occurs as colorless crystals, efflorescing to a white powder and very soluble in water. Sodii Carbonas Exsiccatus (dried sodium carbonate), which is formed by heating the carbonate and driving off its water of crystallization. Sodii Bicarbonas, U. 8., sodium bicarbonate (NaHCO3= 83.85). This salt is prepared by saturating solutions of the carbonate with CO2; it occurs in the form of a white powder, odorless and of a cooling saline taste and slightly alkaline reaction. Soluble in 12 parts of water and insoluble in alcohol. The carbonate and bicarbonate may be employed as ant- acids, anfdplastics, and diuretics: they are less irritating and more palatable than the corresponding potassium salts. Of the two, the bicarbonate is the less irritating and more agree- able, and is used in many effervescing mixtures. Locally, it CA LX-SYR UP US CALCIS. 289 is a valuable domestic remedy, as ordinary baking-soda, in the treatment of burns, scalds, and the bites of insects. CALX, U. S. (Lime). Unslaked lime is a powerful corrosive, and is used in Vienna paste (potassa cum calce). Slaked lime possesses properties due to its alkalinity and slight astringency. Lime-water is a saturated solution of lime containing 0.17 % of calcium hydrate. It is colorless, odorless, and of a some- what disagreeable alkaline taste. Unless kept tightly corked it absorbs CO2 from the atmosphere, and calcium carbonate is precipitated. Physiological action and therapeutics : Lime-water combines antacid and astringent properties. Internally, it is used in cases of gastric irritability, small amounts of milk and lime- water in varying proportions being a valuable and frequently used remedy for checking vomiting. It is also of value in diarrhoeas of fermentative origin, and is suitable as an anti- dote for poisoning by acids, as sulphuric and oxalic. Ex- ternally, it is used in certain skin diseases-prurigo, scabies, and especially tinea capitis-and as an injection in leucorrhcea and gleet. Inhaled or administered by atomization, it will dissolve diphtheritic exudations. Linimentum Calcis, U. S., or Carron oil, is an invaluable soothing application to relieve the pain of recent burns. LIQUOR CALCIS, U. S. (Solution of Lime). Lime dissolves more readily in syrup than in water, and the syrup contains about 5%, forming a saccharate of calcium. It is twenty-four times as strong as lime-water, and is a useful astringent in diarrhoeas. It may be used as an anti- dote in poisoning by carbolic or oxalic acid, but is not the best. Dose fgss-ij. Calcii Carbonas (calcium carbonate or chalk) is a native product of physical properties too well known to require SYRUPUS CALCIS, U.S. (Syrup of Lime). 19-M. M. 290 ANTISEPTICS, DISINFECTANTS, GERMICIDES. description. It is insoluble in water, but soluble in dilute hydrochloric acid. Creta Praeparata, U. S., prepared chalk, made from the above by levigation and elutriation, is a white, perfectly smooth powder, generally dispensed in the form of small cones; dose gr. x-xxx. Calcii Carbonas Praecipitatus, U. S., Precipitated Calcium Carbonate (CaCO3 = 99.76). This is formed by the reaction of calcium chloride and sodium carbonate, and exists as a white, smooth powder; dose gr. x-xxx. Physiological action and therapeutics: Prepared chalk and the precipitated carbonate possess similar properties and equal efficiency. They act as antacids and slight astringents, and form very valuable remedies in diarrhoeas where an ant- acid is indicated. They are also used in dyspepsia, the gouty diathesis, and in rachitis. Externally, they are employed as desiccants and protectives to excoriated surfaces. Other antacids: The preparations of potassium, the effer- vescing preparations of magnesium, and the aromatic spirit of ammonia are often used as antacids. ANTISEPTICS, DISINFECTANTS, GERMICIDES. Disinfectant and antiseptic are terms which for the most part are used interchangeably. Antiseptics are substances which prevent putrefaction or septic decomposition. Germi- cides are remedies which destroy disease-producing germs or their spores. The same substances may thus be both anti- septics and germicides, depending on their concentration. All germicides are necessarily antiseptics, but not all anti- septics are germicides. Putrefaction ordinarily, and the septic processes of human pathology as well, require certain conditions for their develop- ment: (1) organic substances capable of easy disintegration; (2) certain conditions of heat, air, and moisture; (3) certain ferments, which in most cases are living organisms, generally vegetable. If any of these conditions are wanting, these processes cannot take place. Thus, it is well known that FERRI SULPHAS-ACIDUM CARBOLICUM. 291 extreme cold, the exclusion of air (as in the domestic process of canning), and a very dry atmosphere will prevent or delay putrefaction. So, again, the destruction or exclusion of the ferments will produce the same effect; and it is here that the drugs and measures of this class find their field. Physical disinfectants: The most potent agent of this sort is fire, and by it contaminated clothing, etc., may be disposed of. Next in power, and first in importance, arc sunlight, air, and water, which act as potent oxidizing agents ami are the best natural disinfectants. Free dilution of a poisoned atmos- phere with pure air is all-important, and is our main reliance in rendering safe infected rooms and wards. FERRI SULPHAS, U. S. (Ferrous Sulphate). Copperas, the impure sulphate of iron, is a valuable disin- fectant, decomposing noxious gases and destroying many de- composing organic substances, probably by partial conversion into the sesquioxide, which exerts an ozonizing power in oxidizing filth. Sulphate of iron is regarded as devoid of direct germicidal power. It is a cheap commercial product, and may be sprinkled over decomposing substances or thrown into cesspools. ACIDUM CARBOLICUM, U. S. (Carbolic Acid). The germicidal power of carbolic acid is well known. A 1 % solution destroys the bacteria of ordinary pus, the tuber- cle bacillus, and a number of other pathogenic germs. solution destroys all spores. The more extended use of car- bolic acid is prevented by two factors: one, its own poisonous action, though this seldom becomes manifest in the dilute solutions used by surgeons; the other, that it produces sufficient anaesthesia when applied to the skin to interfere materially with delicacy of touch. In general, carbolic acid is an efficient disinfectant, though it coagulates albumin; the crude acid is said to be even more efficacious, as it con- tains cresylic acid. 292 ANTISEPTICS, DISINFECTANTS, GERMICIDES. CALX (Lime). Lime is a destructive agent, causing a slow oxidation of organic matter. Oxidation is, as we have seen, a valuable means of disinfection. Lime is much used for disinfection of sewage, etc., but causes the evolution of volatile gases which may carry noxious matter with them. Other uses of lime have been noted. OZONE. Ozone (O3), an allotropic form of oxygen, is a powerful oxidizer. It is present in small proportion in the atmos- phere, and undoubtedly is an important factor in Nature's antiseptic processes, but has not yet taken rank as a practical antiseptic. It has been used for the relief of distressing dyspnoea, as in asthma, pneumonia, etc. AQUA HYDROGENII DIOXIDI, U. S. (Solution of Hydrogen Dioxide; Hydrogen Peroxide). Aqua hydrogenii dioxidi is a slightly acid, aqueous solution of Hydrogen Dioxide (H2O2 = 33.92) containing, when freshly prepared, about 3%, by weight, of the pure Dioxide, corre- sponding to about 10 volumes of available oxygen. The compound (dioxide of hydrogen, H2O2) gives up its oxygen easily, and is dispensed in a watery solution, slightly acidu- lated with HC1 to give it stability, and yielding from 10 to 15 volumes of oxygen gas. It decomposes at a temperature of 60° F., and must be kept in a cool place. It is a power- ful oxidizing agent and germicide, coagulating albumin, but is not very irritant. It has been used to some extent inter- nally, but its chief value is in suppurating conditions of the ear, mouth, pleural cavity, etc., and in inoperable sinuses gener- ally, in which it acts as a stimulant antiseptic. It is a useful agent in irrigation of pus-cavities in ordinary surgical practice. POTASSII PERMANGANAS, U. S. (Potassium Permanganate), KMnO4 = 157.67. This drug, already mentioned elsewhere, contains a large amount of readily available O2, to which it owes its antiseptic HYDRARGYRI CHLORIDUM CORROSIVUM. 293 power. It is a powerful antiseptic, but of very short dura- tion, being quickly deprived of its oxygen and rendered inert. As a practical germicide its value is not great, because the organic matter in which the noxious elements are present so quickly deprives it of its oxygen. It is a good deodorizer, and is of considerable service, locally, in such offensive sur- gical conditions as foetid ozeena, otorrhoea, leucorrhoea, foul and sloughing ulcers, cancerous or otherwise. The usual strength is 1:500 or 1:1000, but much stronger solutions may be used. A dilute solution is used for irrigation of the urethra in gonorrhoea. Sulphurous acid is a liquid composed of not less than 6.4%, by weight, of Sulphurous Acid Gas (Sulphur Dioxide, SO3 = 63.9) and not more than 93.6% of water. This is, of all disinfectants, the most commonly employed for the disinfec- tion of rooms. It acts as a deoxidizing agent, breaking up organic compounds, and becoming sulphuric acid in the process ; but probably its efficiency is due to a direct but not powerful germicidal effect, and it is said not to affect spores. The usual method of employment is to burn sulphur in a tightly closed room, allowing from 20 to 30 ounces to every 1000 cubic feet of space, with proper precautions against fire. ACIDUM SULPHUROSUM, U. S. (Sulphurous Acid). HYDRARGYRI CHLORIDUM CORROSIVUM, U.S. (Corrosive Chloride of Mercury). This salt, mercuric bichloride or corrosive sublimate, is so much used in surgical procedures as to warrant detailed notice. As a germicide it is particularly powerful, solutions of 1 : 2000 quickly destroying micrococci and bacilli, while 1 :500 will destroy the most resistant spores. It is decom- posed by ammonia, albumin, and many other chemical sub- stances-facts which lessen its value as an antiseptic-but it still remains one of the best measures for this purpose. It is much used (1:1000) for disinfecting bedding, etc., and stronger solutions have been used for destroying the germs 294 ANTISEPTICS, DISINFECTANTS, GERMICIDES. in al vine discharges. It is indispensable as an antiseptic in surgical operations for disinfecting the held of operation, hands, sponges, dressings, etc., but corrodes instruments, which should be kept in solutions of carbolic acid or in sterilized water. Notice has been already taken of the antiseptic properties of carbolic and salicylic acids, iodoform, iodol, thymol, creolin, etc. NAPHTHALINUM, U. S. (Naphthalin). Naphthalin is a benzol derivative, obtained by dry dis- tillation of coal-tar, and occurring in white, shining scales, insoluble in water, but soluble in alcohol, ether, chloroform, and oils. Physiological action and therapeutics : This drug disinfects, or at least deodorizes, the feces. It or its products are eliminated by the urine, upon which it acts as an antiseptic, retarding decomposition. It is chiefly used in chronic diar- rhoea (gr. v-x in capsule every four or six hours) and as a disinfectant in intestinal catarrhs. It is also highly spoken of in bronchitis and bronchorrhoea and in diseases of the intestinal tract. Locally, in 10% oily solution it is used in scabies and prurigo. At one time it bade fair to be useful in typhoid fever, and some cases were supposed to be aborted by its use, but it has not sustained its reputation. ACIDUM BORICUM, U. S. (Boric Acid; Boracic Acid), H3BO3 = 61.78. Boric (or boracic) acid occurs in transparent, white, hex- agonal plates, unctuous to the touch, permanent, and soluble with a slightly acid reaction in 25 parts of water, more soluble in glycerin and alcohol. It is a good antiseptic, but possesses only weak germicidal effects. Internally, it acidifies the urine. It forms a very useful antiseptic wash in some conditions of the mucous membranes, as cystitis, conjunctivitis, sordes, etc., producing antiseptic results with very slight irritation. Ab- sorbed or taken in large amounts, it is said to produce gastro- SODII BORAS-AQUA CHLORI. 295 enteritis, but such effects must be rare. It has occasioned death in several instances; the symptoms are reduction of temperature, depression of the circulation, nausea and vomit- ing, disturbance of respiration. In most cases the amount ingested seems to have been large. " Thiersch's solution " : A combination much used in the surgery of mucous membranes, as the bladder, oral and nasal cavities, etc., is that of Thiersch, or " boro-salicylic," which contains of salicylic acid 2 parts and boric acid 12 parts, in water to 1000 parts. SODII BORAS, U.S. 'Sodium Borate; Borax), Na,B4O7+10H2O = 380.92. Borax differs from the acid principally in being efflorescent, and in forming alkaline solutions with water, in which it is soluble, 1 :16. It is insoluble in alcohol and freely soluble in glycerin. Its alkaline reaction gives it antacid properties, and as a combined antacid and antiseptic it finds its chief value in aphthous, diphtheritic, and other inflammations of the mouth and throat. Claims of utility in epilepsy have been made for it. AQUA CHLORI, U. S. (Chlorine-water). Aqua chlori is an aqueous solution of Chlorine (Cl = 35.37), containing at least 0.4% of the gas. This preparation, in which form alone chlorine is official, is made by the reaction of manganese binoxide and HC1. It is a clear, greenish- yellow liquid, containing 0.4% or more of Cl, and having the unpleasant odor and taste of that element. Physiological action and therapeutics : Chlorine gas acts as an indirect oxidizing agent, uniting with the hydrogen of organic matter and liberating O, which rapidly destroys the organic compound. It is a powerful germicide, an hour's exposure to a moist atmosphere containing 1 % of the gas being sufficient to destroy all spores; but it is a decided respiratory irritant, and somewhat destructive to textile fabrics, especially if colored. Chlorine-water has been used 296 AROMATICS. internally in doses of well diluted, as an intestinal disinfectant, but probably is of no value. In proper dilution it is a good disinfectant and stimulant wash tor foul ulcers, and as a gargle in scarlet fever and sore throat. Chlorine gas is generally used in the form of CALX CHLORATA, U.S. (Chlorinated Lime). Chlorinated lime, or bleaching-powder, is a compound result- ing from the action of chlorine upon calcium hydrate, and containing not less than 35% of available chlorine. This chlorine gas can be slowly set free by CO2, more rapidly by the addition of an acid. Chlorinated lime occurs as a white powder of chlorinous odor and a disagreeable saline taste, gradually becoming moist and decomposing by exposure to the atmosphere. Physiological action and therapeutics : It acts only locally, and may be used in the same conditions as chlorine-water. For the disinfection of rooms the room should be tightly closed, an acid added to hasten the evolution of the gas, and left for many hours. For the disinfection of rooms it is inferior to sulphur, but for that of excreta and infected filth generally, a saturated solution is the most efficient agent. " Labarracpie's solution": Liquor Sodas Chlorinates, U.S., Solution of Chlorinated Soda . This contains 2.6 % of avail- able chlorine. Upon this its effects and uses depend, and they correspond to those of calx chlorata. Its advantages lie in its liquid form and its comparative freedom from odor, so that it is a more pleasant form for use. Eau de Javelle is the corresponding preparation of potassium. AROMATICS. Drugs of this class owe their efficacy to oils obtained from them by distillation, and termed volatile, distilled, or essential oils. These oils are volatile, inflammable, soluble in alcohol and ether, and themselves dissolve fixed oils. Locally, they are used as (1) counter-irritants, (2) local anaesthetics, and (3) antiseptics; internally, as (4) antispasmodics or carminatives CI NN A MOM UM CASSIA -MA CIS. 297 by stimulating the intestine and thus expelling flatus ; as (5) digestive aids, (6) diffusible stimulants, and (7) to disguise the taste of unpleasant drugs. The following is a brief descrip- tion of some of the most important ones, few of which require detailed notice : Cinnamomum Cassia, U. S., Cassia Cinnamon. The bark of the shoots of one or more undetermined species of Cinna- momum grown in China (Chinese cinnamon) (nat. ord. Laurineae). The bark of any species is "cinnamon," and contains Oleum Cinnamomi (U. S.) and tannic acid. The oil is much used to disguise the taste of unpleasant medicines. Aqua cinnamomi (.2% of the oil) is also used as a vehicle. For the aromatic and astringent effects of the drug the tinct- ure (fsj-ij) and spirit (flfx-xxx) may be employed. Cinnamomum Saigonicum, U. S., Saigon Cinnamon. The bark of an undetermined species of Cinnamomum (nat. ord. Laurineae). Cinnamomum Zeylanicum, U. S., Ceylon Cinnamon. The inner bark of the shoots of Cinnainomum Zeylanicum (nat. ord. Laurineae). Caryophyllus, U. S., Cloves. The unexpanded floivers of Eugenia aromatica (nat. ord. Myrtaceae). Habitat: Molucca Islands; cultivated. Oleum Caryophylli, to which it owes its efficiency, is official; dose ffij-vj. It fidfils the general indications for aromatics mentioned above, and is much em- ployed as a local anaesthetic in toothache. Cloves are an efficient carminative and a popular spice. Myristica (nutmeg) : The seed of Myristica fragrans (nat. ord. Myristicaccae), deprived of its testa. Habitat: Molucca Islands ; cultivated. It contains a fixed and a volatile oil, the latter official-Oleum Myristicae. Large doses produce nar- cotic effects. Although employed chiefly as a condiment, it is an agreeable flavoring agent, and is used to prevent the griping of cathartics and in diarrhoea. Besides the oil, the dose of which is Tflij-v, Spiritus Myristicae is official (dose f3j). Macis, U. S., Mace. The arrillode of the seed of Myristica fragrans (nat. ord. Myristicaceae). It contains the same vola- tile oil as myristica and fulfils the same indications. 298 AROMATICS. Pimenta, U. S., Pimenta (allspice). The nearly ripe fruit of Pimento, officinalis (nat. ord. Myrtacese). Habitat: Trop- ical America; cultivated. It contains a volatile oil (Oleum Pimentse, U. Sf), the dose of which is gtt. ij-v. Cardamomum, U. S., Cardamom. The fruit of Elettamia repens (nat. ord. Scitamineae). Habitat: Malabar; culti- vated. Cardamom contains a volatile oil, fixed oil, starch, etc. It is very agreeable to the taste, and much employed as a car- minative and to conceal the taste of unpleasant medicines. Tinct. cardamom, comp, is a pleasant vehicle for castor oil and other drugs. Zingiber, U. S., Ginger. The rhizome of Zingiber officinale (nat. ord. Scitamineae). Habitat: India; cultivated in the tropics. Varieties-India, African, Jamaica Ginger. Zingi- ber in its various preparations, official and proprietary, is a domestic remedy for colic, and is used as a stomachic in dyspepsia, especially when accompanied by flatulence. Its preparations are- Oleoresina Zingiberis, dose ffiss-ij. Extractuni Zingiberis Fluidum, dose ffix-xxx. Syrupus Zingiberis, dose Tinctura Zingiberis (20% in strong alcohol), dose Trochisci Zingiberis, each contains gr. ij of the tincture. Piper, U. S., Pepper. The unripe fruit of Piper nigrum (nat. ord. Piperaceae). Black pepper contains a volatile oil, an acrid resin, and an alkaloid (piperine) which was once supposed to possess antiperiodic properties. Its effects are those of a carminative stimulant. Its preparations are- Oleoresina Piperis, j (in pill). Piperina, dose gr. j-v. Capsicum, U. S., Capsicum, Cayenne Pepper, African Pep- per. The fruit of Capsicum fastigiatum (nat. ord. Solanaceae). Habitat: Probably tropical America ; cultivated. Capsicum already mentioned under Irritants, has a distinct value in feeble digestion, and especially that of alcoholism. It is said to be of value locally in acute tonsillitis and scarlatinal sore throat, either in the form of the diluted tincture as a gargle or as the strong tincture applied locally. DIETETICS. 299 Oleum Cajuputi, U. S., Oil of Cajuput. A volatile oil dis- tilled from the leaves of Melaleuca Leucadendron (nat. ord. Myrtaceae). Used externally as a counter-irritant; inter- nally as an efficient carminative in intestinal colic and diar- rhoea, and seems to have some action in rheumatism. Dose ffiiij-v. It is frequently combined with opium. Oleum Lavandulae Florum, U. S., Oil of Lavender Flowers. A volatile oil distilled from the fresh flowers of Lavandula officinalis (nat. ord. Labiatae). Spiritus Lavandulae, 5% of the oil, dose fsj. Tinctura Lavandulae Composita, 8% of the oil, with Oil of Rosemary, Cloves, Cinnamon, Nutmeg, and Red Saunders; formerly known as the compound spirit. Its use has fre- quently led to the production of the alcoholic habit. Dose f3j ij. Oleum Rosmarini, U. S., Oil of Rosemary. A volatile oil distilled from the leaves of Rosmarinus officinalis (nat. ord. Labiatae}. Carminative. Other frequently employed flavoring vehicles are Oleum Sassafras, Aurantii Amari Cortex, and Aurantii Dulcis Cortex. DIETETICS. Naturally, but a brief resume of this extensive subject can be attempted in a treatise of this kind. The importance of foods as remedial agents in various forms of disease cannot be overestimated, for on them mainly we rely to repair tissue- waste, while the regulation of the diet in certain diseases, notably acute febrile conditions, gastric disorders, and ne- phritis, is all-important. The ultimate uses of food, then, are to repair tissues, and to supply energy, which is mani- fested in muscular, secretory, and nervous activity, etc. Classification : The various aliments may be classified under the following groups : I. Mineral substances, which enter into the composition of tissue, are incapable of further oxida- tion, but perform certain necessary functions in the human economy-i. e., water, calcium phosphate, sodium chloride, etc. ; II. Substances capable of further oxidation, with the production of heat and energy, or of being stored up as tissue, 300 ANIMAL FOODS. which secondarily undergoes oxidation with the same effects. This forms the most important group, and includes proteids, fats, carbohydrates (sugar, starch, etc.); III. Food adjuncts, including tea, coffee, alcohol, etc. A convenient classification of foods for purposes of present consideration is into animal and vegetable foods. ANIMAL FOODS. MILK. Milk : A perfect food, then, must contain proteids, fats, carbohydrates, salts, and water. The nearest approach to this we find in milk, a good specimen of which contains all these requisites and is an ideal food. An analysis of milk shows proteids (casein and albumin), fats (cream), carbohydrates (lactose or sugar of milk), salts (chlorides, sulphates, and phosphates), and water. In infant feeding, when for any reason breast-milk is not available, the following substitutes may be employed : (1) Good fresh cows' milk properly prepared. Woman's milk differs from that of the cow in containing larger amounts of sugar and of albumin or casein, which coagulates in smaller flocculi. This casein in cows' milk coagulates into a denser mass, it being intended for further mastication by the young ruminant. To make cows' milk as nearly as possible resemble the infant's natural food, it should be diluted with water, lime- water, barley-water, etc. Lactose (sij to Oj ) and cream should then be added to make good the deficiency of these ingredients. In this way the casein coagulation is regulated by dilution. (2) It may also be made more normal and its digestion assisted by the addition of peptonized milk powders. (3) Condensed milk is used as a partial and inefficient substitute, especially in large cities, where wholesome cows' milk is well-nigh impossible to procure. This consists generally of a thick, viscid, semisolid mass, obtained by evaporating milk at a gentle heat and add- ing sugar to preserve it. Its indefinite strength is a disad- vantage, rendering its proper dilution rather problematic, and most infants do poorly under its use. (4) Sterilized milk is also of great value in bottle-feeding during the summer MILK. 301 months, and is a prophylactic and curative agent in diarrhoeal disorders. A very practical formula is that recommended by Dr. Botch : it consists of 3 ounces of milk, 2 ounces of cream, 10 ounces of water, 1 ounce of lime-water, and 4 teaspoonfuls of milk-sugar to the pint of mixture thus prepared. The whole may be sterilized by keeping it at a temperature of 167° F. for twenty minutes; the temperature is sufficient for practical sterilization, but insufficient to affect the digestibility of milk as boiling will do. Many clinicians strongly advo- cate maltose or malt-sugar, instead of milk-sugar, as an addi- tion to milk mixtures. Unwholesome modifications of milk: Milk obtained from cows during the first two or three weeks of lactation contains more or less colostrum, which gives it an unpleasant odor and taste and some purgative properties, and renders it unsuit- able for feeding children. Milk from cows during advanced pregnancy, during and for some days after " heat," or when suffering from inflammation of the udder, is unwholesome. Poisonous pasturage may affect milk. Cows suffering from tuberculosis, anthrax, foot-and-mouth disease, etc., should not be utilized for milking purposes: tuberculosis and anthrax have without doubt been thus communicated to man. Diseases caused or conveyed by milk: Scarlet fever and diphtheria have been conclusively proven to have been thus transmitted; at least in the case of the former a very similar disease exists in the young animal. Typhoid fever has at times been traced to milk. Tyrotoxicon-poisoning: As the result of certain putrefactive changes, due here as elsewhere to micro-organisms, a poisonous principle called " tyrotoxi- con" is developed; milk or milk-products, as ice cream, cheese, etc., containing this poison give rise to the symptoms of irritant poisoning-viz., nausea, violent vomiting, burning pain in the throat, oesophagus, and stomach, diarrhoea, and profound depression, lasting for a few hours and generally ending in recovery. While the symptoms are very distress- ing and severe, the autopsies in fatal cases have been almost negative, the lesions of gastro-enteritis being almost entirely absent. From this it has been inferred that the poison exerts a purely centric effect. 302 ANIMAL FOODS. Indications for a milk diet: Full milk diet consists of from 4 to 6 pints of milk daily. Many patients will not be able, however, to consume even the smaller of these amounts, the fats being in greater quantity than they can assimilate. The customary method of administration is to give a glassful (f 3yj-viij) every two hours. Some patients have an idiosyn- crasy and really cannot take it. Many more will say they cannot, but after a thorough trial will generally succeed. Lime- water, Vichy, common salt, etc., may make it more palatable and more digestible. Its use is indicated in pwZmonan/ tuberculosis and wasting diseases generally. The object of its administration in these cases is to promote tissue-formation : the patient's digestion must be good, and no more should be taken than can readily be assimilated. In/e6n/e conditions generally it forms an easily digested food. In chlorosis and the severer anaemias forced feeding with plenty of milk is a valuable adjuvant to drugs. In albuminuria an exclusive milk diet will generally greatly ameliorate the symptoms, and may cause the entire disappearance of albumin from the urine. In gastric ulcer, toxic gastritis, and typhoid fever it is the only permissible food, while in carcinoma of the stomach, dyspepsia, and severe gastralgia it may give relief. In diar- rhoeas, dysentery, and chronic intestinal indigestion it leaves no undigested residue to ferment and irritate, and often proves efficacious. Unpleasant effects of prolonged milk diet: The continued use of milk is apt to prove repugnant to the patient. It tends to constipate, the cases in which it produces diarrhoea being due to lack of assimilation and consequent fermenta- tion and irritation. A decrease of body-weight often occurs, and the patient may experience disagreeable sensations of emptiness, dizziness, and weakness. In rare cases these symptoms may be so pronounced as to necessitate its discon- tinuance. CREAM. This substance is obtained from milk by allowing it to rise or by centrifugal force. It is employed in making butter and cream cheeses. It represents most of the fat of the milk, of which constituent it contains from 25 to 33%. SKIMMED MILK-KO UMYSS. 303 SKIMMED MILK. Milk minus cream, or skimmed milk, still contains a fair amount of proteids and lactose, and hence has considerable value as food. BUTTER. By agitation, or "churning," the fat of the cream is sepa- rated, and is known as butter. Butter presents fats in an easily digestible form, and contains of them about 85%. Rancidity of this product is due to a fermentative process, resulting in the separation of the butyric and other acids from their base, glycerin. It is hastened by the presence of too much casein or water from imperfect separation. Buttermilk, the resultant liquid in butter-making, is a nutritious food ; it contains casein, lactin, and salts. It is easily digestible, probably in consequence of the lactic acid it contains, and may be substituted for milk in albuminuria, diabetes, and gastric disease, constituting the so-called butter- milk cure for these disorders. Cheese is made by coagulating the casein of milk by rennet and subsequent compression. The coagulating casein entan- gles the fats and some of the lactose and salts in its meshes, so that analyses of cheese show it to be a highly nutritious product. By the "ripening process," which lasts from four to six weeks, volatile odorous constituents are developed, giving it its flavor. Although so highly nutritious, it is, in the main, difficult to digest, and is not suitable for the sick. Whey, the liquid portion of the milk expressed during cheese- making, contains very little of nutritive value. KOUMYSS. Koumyss is an effervescing alcoholic drink obtained by fermentation of milk. Mares' milk was originally used, and is preferable; but cows' milk is now employed in its manu- facture, lactose being added to give more sugar for fermenta- tion, and thus greater alcoholic strength. Besides alcohol, 304 ANIMAL FOODS. this milk-product contains carbonic acid and certain ethers. During fermentation the milk separates in layers, the upper- most being koumyss and the lowermost casein. In good koumyss not all the casein should be precipitated, and no sugar should be present, as it should all have been changed to alcohol. It contains 1| to 4% of alcohol, and, roughly speaking, is one-third the strength of champagne. It should be kept tightly corked and in a cool place, and should be fre- quently shaken. Although its sour taste is disagreeable to some palates, it is surprisingly well borne by even the most delicate stomachs, and forms a valuable stimulant and food in cases of malnutri- tion from any cause, especially when accompanied by gastric disturbance. When first introduced it was claimed to be a specific in tuberculosis, but this claim is no longer made for it. Matzoon is milk which has undergone lactic-acid and not alcoholic fermentation, yet differs from sour milk in that the process is checked when a certain degree has been reached. It is said to be well borne by irritable stomachs. MATZOON. PEPTONIZED MILK. This artificial milk-product is of such undoubted value, and so indispensable in certain cases, that a somewhat de- tailed account of its preparation and uses may be given. Milk, as we have seen, is a perfect food. Two of its com- ponents, lactose and fats, are easily digested, but with the albuminoid, casein, the case is different, and by its partial or complete conversion into peptone the digestion of milk may be greatly facilitated. The steps in peptonizing milk are as follows: The most convenient form in which to obtain the pancreatic principle is in the various proprietary preparations of "extractum pan- creatini," which are dispensed in tubes mixed with varying proportions of sodium bicarbonate. Ordinarily, one of these tubes is sufficient for one pint of milk. To the contents of EGGS. 305 one tube add about of water and stir thoroughly. Then add a pint of warm fresh milk, and keep the mixture at a temperature of 100° F. for thirty minutes, at the expiration of which time it is removed to a cool place-which checks the activity of the ferment-and kept until used. If the process be continued too long, certain products unpleasant to the taste, and perhaps poisonous, may develop. The bitter flavor should not be marked. By first removing the cream, then peptonizing, and then adding the cream again, a prepara- tion more palatable and more milky in appearance is said to be obtained. If suitable arrangements for regulating the temperature are not available, milk may be peptonized at the ordinary temperature of the sick-room, as follows : To a pint of milk, mixed with pint of water, add 14 tubes of the extract; then set aside for from four to five hours, and use immedi- ately, or bring to a boiling-point to stop fermentation, and keep in a cool place. Therapeutic uses of peptonized milk: In wasting diseases, especially when more or less complete anorexia obtains ; in the persistent and intractable vomiting of chronic gastritis, uraemia, gastric congestion from cirrhosis or chronic endarteritis; and after abdominal incision, it may often furnish relief; in gastric ulcer small amounts of this or other artificially digested fluids form the most rational and efficient treatment. EGGS. The eggs of the ordinary domestic fowl form a highly nutritious article of diet, containing a large proportion of nitrogenous matter (14%) and a comparatively small amount of non-nitrogenous. In full diet, then, they should be com- bined with starchy and fatty food. The fat of eggs is found entirely in the yelk, while the white of the egg is the more highly nitrogenous. In cooking, the albumen should be ren- dered simply opaque, as hard-boiled eggs are indigestible and cause constipation. To invalids uncooked eggs are given with milk and alcohol. 20 -M. M. 306 ANIMAL FOODS. BEEF. Roughly speaking, good beef contains about 20% of nitrogenous and 20% of fatty matter, with salts, extractives, etc. The nitrogenous elements are partly in solution (as myosin, the cause of rigor mortis) and partly solid. From its composition it is seen that beef contains nutritive principles of prime importance to the sustenance of the body. During rigor mortis the normal alkalinity of the body fluids changes to acidity and the myosin is coagulated. Meat ordi- narily should not be eaten until this subsides. VEAL. Veal has the reputation of being more slowly digested than beef-an opinion due probably to the fact that it is more difficult to masticate thoroughly. It sometimes exerts a laxative effect, and is seldom used by invalids. It contains, roughly speaking, 17% of nitrogenous and 16% of fatty sub- stances. Although possessed of a lower nutritive value than beef, mutton is easily digested and forms a valuable article of diet for occasional use. Continued use develops a repugnance to it, and in some an apparent idiosyncrasy exists against its use. It contains a large amount of fat (about 40%) and between 9 and 10% of nitrogenous substances. MUTTON. Of all meats in common use, pork is the most difficult to digest, requiring between five and six hours for complete digestion. It is the fattest of meats, containing about 65% of fat and 8 % of nitrogenous elements. With two exceptions it is not used for invalids, as it is not well borne by the stomach. Bacon, however, is well tolerated by many weak stomachs; and roast pig may at times be taken with advan- tage during convalescence. If tolerated by the stomach, pork is suitable for phthisical patients. PORK. CHICKEN. 307 CHICKEN. The flesh of the ordinary domestic fowl, combining as it does ease of mastication and digestion with an agreeable flavor, is a valuable and much-used article of diet for the sick. Other domestic and wild fowl may often be of value. Animal viscera: Sweetbread, properly the thymus of the calf, but more often the pancreas, is an agreeable, nutritious, and easily digested food. Tripe, the stomach of the ox and other ruminants, combines the same qualities. The brain is also easily digested, and contains fats and phosphorus. Liver, although nutritious, is too difficult of digestion for the sick. Kidneys are objectionable for both sick and well. Fish suitable for invalids: Certain varieties of fish, as whitefish, bass, trout, etc., are suitable articles of diet for the sick. As a rule, they are easily digestible if boiled, in which way alone they should be served to invalids. Of shell-fish, oysters are especially valuable. They are more easily digested when served uncooked, because the brown part of the oyster, the liver, is composed of glycogen and a ferment, which aids in digesting the former, if not destroyed by heat. VEGETABLES. Wheat and rye: Among the cereals wheat and rye are most important. Wheat bread, properly made, is easily digested, nutritions, and nearly all assimilated, leaving very little residue. This fact accounts for its tendency to produce constipation. Bread made from unbolted flour is more nutri- tious, less apt to produce constipation, and being less perme- able to the digestive fluids, is less easily digested. Fresh bread is difficult to masticate thoroughly, and should not be served to invalids. Cracked wheat, oatmeal, cornmeal: Cracked wheat, which is boiled until the envelope is burst, is eaten with cream and sugar, forming a pleasant, highly nutritious, and somewhat laxative food. Oatmeal and cornmeal are staple articles of food, and, prepared in various ways, are acceptable to the 308 DIETETICS. sick. Like the above, they are apt to produce a somewhat laxative effect. Farinaceous food-stuffs: Starch, sago, tapioca, and arrow- root are quickly digested ; and are largely used for the sick. They contain no nitrogen, and hence are not capable of main- taining life for any considerable time. Potatoes : Next to wheat, the ordinary potato is the most popular vegetable in general diet. It contains a large amount of starch (about 16%) and small percentages of sugar and nitrogenous matters. Boiled to a dry and mealy condition, it may be used by the sick, but in no other condition is it suitable for this purpose. The sweet potato differs chiefly in the larger proportion of sugar it contains, and is probably less easily digested. Other vegetables in common use are seldom used for the sick. SPECIAL PLANS OF DIET. Low diet: In obesity. For the reducing of superfluous fat it is necessary largely to interdict the saccharine, fatty, and starchy elements of food; of these, sugar is the most fat- tening, and should be very sparingly used. Various treat- ments of this sort have received the name of Bantingism. In aneurism. By a combination of perfect rest in the recumbent position and extremely low diet, largely dry, a good effect may be produced upon internal aneurism. Dry diet: A diet in which the amount of fluid ingested is limited may be of signal service in dropsical conditions, hydrothorax, ascites, etc. A satisfactory plan is to limit the amount of fluids so that the watery excreta are in excess of those ingested. Animal diet: The chief indication for a more or less exclu- sive meat diet is found in diabetes. Most vegetables contain sugar or starch (which easily undergoes conversion into sugar), and should be interdicted. Tomatoes, celery, and raw cab- bage are about the only vegetables consistent with a strict diabetic diet. Gluten bread relieves to a degree the longing for wheat bread, which is ordinarily the greatest deprivation. Fats generally must be used freely. By a strictly meat diet DIET IN DISEASES 309 nearly or quite all of the glucose may be made to disappear from the urine. Meat diet also proves of value in diarrhoea, whether acute or chronic, and is indispensable in cachectic conditions gen- erally. Diet in acute febrile conditions: During acute inflammatory and febrile conditions all the organs of the body are subject to a degenerative process, and all the functions are to a greater or less degree impaired. This tissue-destruction is evidenced by a large increase in those excretory elements which represent tissue, especially urea, urates, phosphates, etc. On the other hand, the processes of constructive meta- morphosis are incomplete. The digestion shares with others this lessened power. Hence the importance of administering such food as shall be most easily digested. As a general rule, in such conditions milk diet is indicated. Beef tea, which once enjoyed popularity for this purpose, is inferior in nutritive properties and more difficult of digestion. Digesti- bility, to be sure, may be enhanced by peptonizing (by a process similar to that given in detail under Milty, but this does not make good the inferior food value. DIET IN DISEASES. Diet in acute gastritis : In all conditions our guiding prin- ciple should be to give the affected organ as nearly complete physiological rest as possible. Thus in acute gastritis small amounts of milk, milk with lime-water, milk with Vichy or carbonic waters, milk with barley-water, and demulcent drinks should be given frequently. Effervescent drinks, as champagne in small quantities, are generally well borne. Diet in chronic gastritis: When for any reason there ap- pears to be a deficiency of gastric juice, our aim should be to administer foods largely digested in the small intestine, such as starches, tapioca, arrow-root, rice, and the farinaceous vegetables generally. On the other hand, when heartburn (acid fermentation) occurs from fermentation of starchy and fatty foods, these articles should be taken sparingly. Diet in intestinal indigestion : Again, in cases of intestinal 310 DIETETICS. indigestion, summer diarrhoea, and other conditions dependent upon functional or inflammatory disorders of the small intes- tine, foods entirely or for the most part digestible in the stomach should be given. Starches and fats should be inter- dicted, and nitrogenous foods, as milk, eggs, meats, should be administered. Diet in chronic constipation: Here a suitable diet is of prime importance. Materials leaving a large amount of in- digestible residue, as fresh vegetables, oatmeal, corn, and brown bread, raisins, almonds, prunes, etc., may materially aid in overcoming this condition. Diet in cachectic conditions: The objects to be attained are an increase of the muscular and fatty tissues. As fat-forming elements, fats (in milk, cream, meats), sugar (in its own form or in sweet fruits), and starches in abundance are indicated. Thus, a combination of nitrogenous and carbonaceous foods is to be given, and freely. In severe anaemic conditions, as pernicious anaemia, Addison's disease, etc., frequent (or " forced ") feeding may prove advantageous. DIGESTIVE FERMENTS. In this connection we may consider briefly certain physi- ological ferments which have to do with the digestive process. Pepsin is a proteolytic ferment or enzyme obtained from the glandular layer of fresh stomachs from healthy pigs, and capable of digesting not less than three thousand times its own weight of freshly coagulated and disintegrated egg albu- men, when tested by the process given in the Pharmacopoeia. Pepsin is the digestive ferment of the gastric juice. It is somewhat soluble in water, and freely so in water slightly acidulated with hydrochloric acid. The purest and most reliable pepsin is obtained by dissolving it in hydrochloric acid, drying, and diluting to a fixed standard, when it is known by its digestive power as 1 :1000, 1 : 2000, 1 : 3000, etc. As first obtained, pepsin is a viscid fluid ; dried upon plates and without artificial dilution, it is known as " scale pepsin." PEPSINUM, U. S. (Pepsin). PANCREA TIN UM. 311 Alcohol destroys the activity of the ferment, so that prepara- tions made with wine and alcohol are inferior. Glycerin solutions are potent and keep well. Pepsinum Saccharatum, U. S., Saccharated Pepsin. This contains 10% of Pepsin, U. S., and 90% of Sugar of Milk. Therapeutics: Naturally, the chief indication for pepsin is weakened digestive power. When hydrochloric acid is wanting or diminished in the gastric secretion, the addition of this clement undoubtedly increases its value. Even at the standard strength indicated above, the doses habitually given could be of very little actual benefit unless a stimulant action upon the mucous membrane takes place ; and some authorities are skeptical as to its real value. Acting as a ferment, how- ever, its activity may be increased by repeating the dose of hydrochloric acid. The diarrhoea of children, dependent upon imperfect gastric digestion, may be greatly benefited by pepsin. It has been suggested as a solvent for diphtheritic membranes and blood- clot in the bladder. PANCREATINUM, U. S. (Pancreatin). Pancreatin is a mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog (Sus scrofa; class Mam- malia ; order Pachydermata). Useful preparations of this important ferment exist both in the liquid and solid forms-liquor pancreaticus and ex- tract of pancreatin. Given by mouth, it is probably rendered more or less inert by the gastric juice before it reaches an alkaline medium in which it can act. Pancreatin may be given in capsule so as to reach the intestine. Its chief and great value is for the partial digestion of food before it is given. This artificial digestion of food has already been considered (see Peptonized MilP). Papayotin (Papain or Papoid} is a digestive ferment ob- tained from the/n«7 of Carica papaya, a tree cultivated in tropical countries. It is credited with digesting starches and 312 DIETETICS. albuminoids, besides emulsifying fats, and is active in acid or alkaline solution. Dose gr. j-x. Diastase : This is the peculiar ferment developed in germi- nating seeds, hence found in malt. It resembles the ptyalin of the saliva in so far that it converts starch and dextrin into sugar in slightly alkaline or neutral media. Diastase is use- ful in cases where starches are digested with difficulty. Usually the liquid preparations of malt are employed; only those contain diastase which have not been heated above 55°-65° C., as the ferment is destroyed at higher tempera- tures. TABLE OF DOSES OF REMEDIES MOST FREQUENTLY ADMINISTERED. For hypodermatic use the dose should be half that used by the mouth. For use by rectum the dose should be twice that used by the mouth. Doses for Children.-Dr. Young's rule: Add 12 to the age, and divide by the age to give the denominator of a fraction, the numerator of which is 1. 12 + 2 Example: For a child two years old, -|; the dose should be |th that for an adult. In giving powerful medicines and opium still smaller doses must be used for children. Remedies. Grains or Minims. Grains or Cubic Centimeters. Abstracta. (See Extracta. Take half the dose.) . . . Acetanilid (antifebrin) 2-15 0.1 - 1. Acid, arsenos 0.001 - 0.003 benzoic 5-15 0.3 - 1. boric 5-10 0.3 - 0.65 carbolic 4- U 0.03 - 0.1 gallic 3-15 0.15 - 1. hydrobrom, dil 10-60 0.65 - 4. hydrocyan, dil 2- 6 0.1 - 0.35 hydrochlor, dil 5-20 0.3 - 1.3 nitric, dil 5-20 0.3 - 1.3 nitro-hydrochlor. dil 5-20 0.3 - 1.3 phosphoric, dil 5-30 0.3 - 2. salicylic 5-20 0.3 - 1.3 sulphuric, dil 5-30 0.3 - 2. sulphuric, arom 5-15 0.3 - 1. sulphuros 30-60 2. - 4. tannic 2-10 0.1 - 0.65 Aconitina (white crystals) s4u-st® 0.0002- 0.0003 Adonidin 4 0.006 - 0.02 Agaricin 0.008 - 0 015 Aloe 2- 5 0.13 - 0.3 Aloinum 4- 1 0.008 - 0.18 Ammonii benzoas 10-20 0.65 - 1.3 bromid 5-30 0.3 - 2. carb 3-10 0.2 - 0.65 chlorid 10-30 0.65 - 2. iodid., 1 valer., J 2-15 0.1 - 1. Amyl nitris (inhaled or internally) / . 2- 5 0.1 - 0.35 Amylene hydrate (hypnotic) 10-60 0.6 - 4. Antimon, et pot. tart.; diaph. or expectorant . . et pot. tart.; emetic 0.003 - 0.006 0.03 - 0.06 Antipyrin 2-15 0.1 - 1. Apiol 5-10 0.3 - 0.65 Apomorph, hydrochlor 0.003 - 0.006 Arbutin 5-15 0.3 - 1. 313 314 TABLE OF DOSES. Remedies. Grains or 1 Grams or Cubic Minims. Centimeters. Argenti nitras 0.01 - 0.03 Arsenii iodidum 0.001 - 0.006 bromid 0.001 - 0.004 Atropinee sulphas 12 R Bi 0.0005- 0.002 Auri et sodii ehlorid A- 4 0.002 - 0.008 Bismuthi subnitras 5- 60 0.3 - 4. Caffeina 1- 5 0.06 - 0.3 Calcii lacto-phosphas 5- 10 0.3 - 0.65 Calx sulphu'rata 1 0.006 - 0.06 Camphora 3- 10 0.2 - 0.65 Camph.monobrom 2- 5 0.1 - 0.3 Capsicum 1- 5 0.06 - 0.3 Cerii oxalas 1- 10 0.06 - 0.6 Chinoidinum - 3- 30 0.2 - 2. Chloral 3- 20 0.2 - 1.3 Chloroformum 1- 15 0.06 - 2. Chrysarobinum b- 3 0.01 - 0.2 Cinchonidina, and its salts 5- 30 0.3 - 2. Cocaina (locally, 1 to 4 0 sol.), internally 0.004 - 0.03 Codeina p- 2 0.004 - 0.13 Colchicin 0.0006- 0.0013 Confectio sennee 60-120 4. - 8. Coniina, and its salts 0.0006- 0.01 Copaiba 15- 60 1. - 4. Creasotum 0.03 - 0.3 Creolin (locally, £ to 2 0 sol.), internally Croton chloral 2 1- 5 0.03 - 0.3 0.06 - 0.3 Cubeba 2- 60 0.12 - 4. Cupri acetas 1- i 0.008 - 0.03 sulphas 0.004 - 0.015 Curare 0.002 - 0.006 Digitalinum A A 0.001 - 0.002 Digitalis $- 2 0.008 - 0.13 Elaterinum; 0.001 - 0.005 Ergota 15- 60 1. - 4. Ergotinuni 2- 8 0.13 - 0.5 Eserina, and its salts 0.001 - 0.003 Extractum aconiti [rad.]; U. S. P. 1880 0.005 - 0.015 aconiti [rad.], fluid.; U. S. P. 1880 1 0.03 - 0.06 aloes aquos J- 10 0.03 - 0.65 bellad. alcohol J- 3 0.01 - 0.03 bellad. fl 1- 3 0.06 - 0.02 buchu fl 30- 60 2. - 4. calumbee fl 15- 30 1. - 2. cannab. ind. (with caution) A- I 0.004 - 0.03 cannab. ind. fl. (with caution) i~ 1 0.03 - 0.06 cascaree sagrad. fl 5- 30 0.6 - 2. eimicifugse fl 5- 30 0.3 - 2. colchici rad. fl., 1 0.12 - 0.5 colchici sem. fl., J 2- 8 colocynthidis comp 5- 15 0.3 - 1. conii fl 1- 10 0.06 - 0.6 convallariae rad. fl 5- 30 0.3 - 2. digitalis J- 1 0.008 - 0.06 digitalis fl 1- 6 0.06 - 0.4 ergotse 4- 15 0.03 - 1. ergot® fl 15- 60 1. - 4. erythroxyli fl. (coca) 15-120 1. - 8. eucalypti fl 5- 30 0.03 - 2. gelsemii fl 2- 5 0.13 - 0.3 gossypii fl 15- 60 1. - 4. grindeliee rob. fl 10- 60 0.6 - 4. guaranee fl. 30-120 | 2. - 4. TABLE OF DOSES. 315 Remedies. Grams or Cubic Minims. Centimeters. Extractum heematoxyli 10- 30 0.6 - 2. Hydrastis fl 10-120 0.6 - 2. hyoscyami alcohol A " 0.03 - 0.13 hyoscyami fl ignatiae 2- 8 1- 4 0.1 0.008 - 0.5 - 0.03 iridis 11 5- 10 0.3 - 0.65 leptandree fl lobeliae fl 20- 30 1- 5 1.3 0.06 - 2. - 0.3 matico fl ■ 30- GO 2. - 4. nucis vomicae J- i 0.008 - 0.03 nucis vomica: fl 1- 5 0.06 0.008 - 0.3 - 0.06 opii J- 1 physostigmatis pilocarpi fl IB - B 5- 30 0.004 0.3 0.03 - 0.01 - 2. - 0.2 podophvlli prun. virg. fl 30- 60 2. - 4. pulsatillse fl 2- 5 0.1 - 0.3 quebracho fl. (aspidosperma) rhei fl 20- 60 5- 30 1.3 0.3 - 4. 2. sciilfe fl 2- 3 0.1 - 6.2 scoparii fl 15- 60 1. - 4. Scutellariae fl 15- 60 1. -■ 4. senegee fl 1- 5 0.06 - 0.3 sennae fl 60-240 4. -16. serpent, fl 20- 30 1.3 - 2. spigeliee fl 10- 60 0.6 - 1. stillingieefl stramonii 15- 45 1. - 3. i h 0.015 - 0.03 taraxaci 5- 60 0.3 - 4. ustilag. fl 15- 60 1. - 4. uvee ursi fl 30- 60 2. - 4. - 4. valer. fl 30- 60 veratr. vir. fl • ■ 2- 8 0.1 - 0.5 viburni • • ■ 15- 60 1. - 4. xanthoxyli fl 15- 60 1. - 4. Fel bovis purif. 5- 10 0.3 - 0.65 Ferri arsen - A 0.003 - 0.01 bromid 1- 5 0.06 - 0.3 carb, sacch 2- 15 0.1 - 1. et ammon. citr 5- 10 0.3 - 0.65 et ammon. tartr 5- 15 0.3 - 1. et pot. tart 10- 30 0.6 - 2. et strvchn. citr 1- 5 0.06 - 3. hypophosphis 5- 10 0.3 - 0.65 iodidum sacch 2- 5 0.13 - 0.33 lactas 1- 3 0.06 - 0.2 oxid. hydrat. cum. magnes. | (antidote to arsenic), J ' ff3 |-f511 ( frequently ) 16. -32. pyrophosphas 1- 5 0.06 - 0.3 subcarb. . 5- 30 0.3 ~~~~ 2. sulphas 1- 3 0.06 - 0.2 sulphas exsiccat b- 0.03 - 0.15 valer 1- 3 0.06 - 0.2 Ferrum dialys 1- 15 0.06 - 1. reduct 1- 5 0.06 - 0.3 Gaultheria, oil of 3- 15 0.2 - 0.65 Guarana 8- 30 0.5 - 2. Homatropinx hydrobrom, (mydriatic, 1 0.001 - 0.003 locally, 0.2 0 to 4 0), internally, J ' - 0.006 Hydrarg. clilor. corros 64 177 0.001 chlor, mite ib- io 0.004 - 0.65 iodid. rubr BO- ll0 0.0013- 0.006 iodid. vir I- 1 0.01 - U.Ub 316 TABLE OF DOSES. Remedies. Grains or Minims. Grams or Cubic Centimeters. Hydrarg. subsulphas flav 1- I 0.015 - 0.03 as emetic 2- 5 0.12 - 0.3 c. creta 3- 8 0.2 - 0.5 Hydrastin • 3- 5 0.2 - 0.3 Idydrogeniiperoxid.(10 voLsol.), locally) ... (25 to 100 d), pus destroyer; tonic- > . . . . 30-120 2. - 8. stimulant and antiseptic, per os, . Hyoscinse hydrobrom 20B b'o 0.0003- 0.001 Hyoscyaminee sulph Rtf 0.0003- 0.001 Ilypnone 5- 10 0.3 - 0.65 Ichthyol (locally, 10 to 50 %), internally 3- 5 0.2 - 0.3 Infusum digitalis f3 1-f54 4. -16. Iodoform um 1- 5 0.06 - 0.3 Iodol 0.01 - 0.03 lodum 0.006 - 0.015 Ipecacuanha { B- 1 15- 30 0.01 - 0.06 1. - 2. Jalapa 15- 30 1. - 2. Liq. ammon. acet.... f5 2-f3 8 8. -32. acidi arsenosi, _ Commencing 1 arsenn bromidi, doses to bJe 1 arsen, et hydr. iod., increased f 1- 5 0.06 - 1. potassn arsenit., cautiously. 1 sodn arsenatis, ' ferri chloridi 2- 10 0.15 - 0.65 ferri dialys 10- 30 0.65 - 2. potassii citrat f5 2-f3 4 8. -16. Lithii benzoas 5- 20 0.3 - 1.3 bromid 5- 20 0.3 - 1.3 carb ... 2- 10 0.13 - 0.65 citras 5- 20 0.3 - 1.3 salicylas 5- 30 0.3 - 1.3 Lupulinum 5- 30 0.3 - 2. Magnesii carb 15- 60 1. - 4. citr. gran 5 2-3 8 8. -32. sulphis 10- 30 0.6 - 2. Mangani oxid. nigr 1- 5 0.06 - 0.3 Massa copaibee 5- 30 0.3 - 2. ferri carb 5- 15 0.3 - 1. hydrarg 1- 15 10.06 - 1. Mist, asafoetidee f54-f3 8 6. -32. chloroform! f5 1-f5 8 4. -32. ferri et amm. acet f 3 1-1'3 4 4. -32. glycyrrhizee comp f.31-f.34 4. -32. magnes. et asafcet f.3 1-f 3 4 4. -32. potassii citr f 3 2-1 5 2 16. -64. rhei et sodse f3 j-f3 1 16. -32. Morphina, and its salts IB- 5 0.004 - 0.03 Morrhuol (derivative of cod-liver oil) 3- 60 0.15 - 4. Moschus 2- 15 0.1 - 1. Naphthol 2- 5 0.15 - 0.3 Narceina 0.01 - 0.3 Nitro-glycerinum (1 % sol.) f gtt. 1 in- 1 ( creased. J 0.03 increased. Oleoresina aspidii (filix mas) .... 15- 60 1.0 - 4.0 capsici 0.01 - 0.03 cubebee 5- 20 0.3 - 1.3 lupulini 2- 5 0.13 - 0.3 Oleum copaibee 8- 15 0.5 - 1. erigerontis 5- 15 0.3 - 1. eucalypti 5- 10 0.3 - 0.6 phosphoratum 1- 3 0.06 - 0.2 terebinthinae 2- 30 0.12 - 2. TABLE OF DOSES. 317 Remedies. Grains or Minims. Grams or Cubic Centimeters. Oleum tiglii gtt. i- 2 0.01 - 0.06 Opium (14 % morphine) 2 0.008 - 0.12 Paraldehyde 20- 60 1.3 - 4. f 3 4-f3 1 15. -32. Phenacetin 2- 10 0.1 - 0.4 Phosphorus T2H BO 0.0005- 0.0013 Physostigminaj sulphas T2K Stf 0.0005- 0.0011 Picrotoxinum 0.0005- 0.0011 Pilocarpina, and salts C4 2 0.001 - 0.03 Plumbi acetas i~ 3 0.03 - 0.2 Potassii acetas. . , 15- 60 1. - 4. bicarbonas 8- 60 0.5 - 4. bitartras 1- 2 0.06 - 0.13 bromidum 8- 60 0.5 - 4. chloras 8- 30 0.5 - 2. cyanidum 2'5- H 0.003 - 0.008 iodidum 2- 30 0.13 - 2. nitras 2- 15 0.13 - 1. tartras 5 1-5 8 4. -32. Puly. antimonialis 1- 3 0.06 - 2. Pulv. glycyrrhizae comp 30- 60 2. - 4. ipecac, et opii 5- 15 0.3 - 1. jalapse comp 10- 60 0.6 - 4. morphinse comp 5- 15 0.3 - 1. rhei comp 5- 60 0.3 - 4. Resina copaibie 2- 10 0.13 - 0.65 euonvmi 2- 5 0.13 - 0.3 gnaiaci jalapee 5- 20 2- 5 0.3 - 1.3 0.13 - 0.3 podophvlli IB- 4 0.005 - 0.03 scammonii 2- 10 0.13 - 0.65 Resorcin 2- 5 0.1 - 0.3 Rheum 2- 30 0.13 - 2. Saccharin (substitute for sugar) A- 5 0.03 - 0.3 Salicinum 5- 30 0.3 - 2. Salol 2- 10 0.15 - 0.65 Santonica 8- 60 0.5 - 4. Santoninum i- 5 0.015 - 0.3 Senna 8-180 0.05 -12. Sodii arsenas 0.001 - 0.006 benzoas 5- 15 0.3 - 1. boras (in epilepsy) 5- 30 0.3 - 2. bromidum 5- 30 0.3 - 2. chloras 2- 5 0.13 - 0.3 hyposulphis 5- 20 0.3 - 1.3 iodidum 2- 30 0.13 - 2. phosphas 2-120 0.13 - 8. salicvlas ... 5- 30 0.3 - 2. sulphas 60-120 4. - 8. Sparteines sulph. (cardiant and diuretic) is- i 0.004 - 0.25 Spiritus setheris nitrosi 15-120 1. - 8. Eether, comp 15-120 1. - 8. ammoniae arom 15- 60 1. - 4. camphora; 5- 30 0.3 - 2. Spiritus chloroformi 15- 60 1. - 4. Strvchnina, and salts 0.001 - 0.005 Sutphonal (best in hot milk) 5- 20 0.3 - 1.3 Sulphur 5 4-5 4 2. -16. Syr. ferri bromidi 5- 60 0.03 - 4. ferri iodidi 5- 30 0.03 - 2. scillse 30- 60 2. - 4. scillse comp 5- 30 0.03 - 2. senegae f 5 1-f5 2 4. - 8. 318 TABLE OF DOSES. Remedies. Grains or Minims. Grams or Cubic Centimeters. Syr. sennse f51-f5 8 4. -32. Terebene 5- 15 0.3 - 1. Terpin hydrate (tonic expectorant) . . . 2- 5 0.13 - 0.3 Thymol 1- 5 0.06 - 0.3 Tinct. aconiti 1- 5 0.03 - 0.3 aloes ... 15- 60 1. - 4. arnicee rad 5- 15 0.3 - 1. asafoetidae 30- 60 2. - 4. belladonna) 2- 15 0.1 - 1. cannabis ind 5- 20 0.3 - 1.3 capsici 8- 15 0.5 - 1. cimicifug® 30- 60 2. - 4. cinchona) comp 15-120 1. - 8. colchici [sem.] 5- 20 0.3 - 1.3 conii 5- 30 0.3 - 2. digitalis 3- 15 0.2 - 1. ferri chloridi 10- 30 0.6 - 2. gelsemii 2- 15 0.1 - 1. guaiaci ammon hydrastis ... 30- 60 2. - 4. 30-120 2. - 8. hyoscyami 5- 30 0.3 - 2. ignatiee 5- 30 0.3 - 2. iodi comp /- 15 0.06 - 1. kino 15-120 0.1 - 8. lobelia; 5- 30 0.3 - 2. moschi 15- 60 1. - 4. nucis vomicae 5- 15 0.3 - 1. opii 2- 15 0.1 - 1. opii camph 5-240 0.3 -16. physostigmatis 5- 15 0.3 - 1. stramon 5- 15 0.3 - 1. strophanthi (cardiant and diuretic) . . . . . 2- 10 0.1 - 0.65 valer. ammon 10-120 0.6 - 8. veratr. vir 3- 10 0.2 - 0.6 Tri tn ratio elaterini (10 H 1 0.008 - 0.06 Urethane (hypnotic) 5- 30 0.3 - 2. Vin antim. exPeet- et alt 1- 8 0.06 - 0.5 30- 75 2. - 5. colch. rad. (40 %) 5- 15 0.3 - 1. colch. sem. (15 %) 5- 30 0.3 - 2. ergotse f51-f3 3 4. -12. ferri amar 30- 60 2. - 4. inecac 1 expect 5- 15 0.3 - 1. f5 2-f56 8. -24. opii 5- 15 0.3 - 1. Zinci acet. . 5- 2 0.03 - 0.13 bromid 0.03 - 0.3 iodid J- 3 0.03 - 0.2 oxid 1- 5 0.06 - 0.3 phosph id A- B 0.006 - 0.01 sulphas (emet.) 15- 30 1. - 2. valerianas A- 5 0.03 - 0.3 IMPORTANT POISONS AND THEIR ANTIDOTES. Acids, Hydrochloric, Nitric, Sulphuric. See Mineral Acids. Acid, Carbolic. Evacuation of stomach; soluble sulphates, as the sulphates of mag- nesium, sodium, or dilute sulphuric acid. Acid, Hydrocyanic. Ammonia by inhalation and subcutaneously; alcohol and atropine hypodermically; artificial respiration. Acid, Oxalic. Lime salts (whitewash, chalk, etc.); calcii carbonas praecipitatus; syrupus calcis. Aconite. Evacuation of stomach; recumbent position and perfect quiet; diffusible stimulants (ammonia, alcohol); artificial respiration if necessary. /Ether. Artificial respiration; faradization of respiratory muscles; atropine and Strychnine subcutaneously. Alcohol. Evacuation of stomach; aqua ammonite; heat. Alkalies, Caustic Potassa, and Soda. Weak acids, as acetic (vinegar), citric (lemon- juice) ; later demulcent drinks. Alkaloids. Tannic acid; iodide of potassium. Ammonia. Weak acids; demulcents. Antimonii et Potassii Tartras. Tannic acid; morphine; free stimulation. Arsenic. Thorough evacuation of stomach; ferri oxidum hydratum, freshly prepared and frequently administered ; ferri oxidum hydratum cum magnesia; ferrum dia- lysatum; stimulants. Atropine. Evacuation of stomach; respiratory and circulatory stimulants; mor- phine; physostigma. Belladonna. See Atropine. Cantharides. Opiates; demulcents in large quantities (water, flaxseed tea, etc.); Avoid oils; alkaline diuretics. Chloral. As for Opium, q. v., but avoiding forced exertion; cardiac stimulants ; heat. Chloroform. Inversion of patient, head downward ; cardiac stimulants, alcohol, am- monia, and strophanthus hypodermically ; amyl nitrite; artificial respiration. Colchicum. Opium; stimulants ; demulcent drinks in later stages. Conium. Cardiac and respiratory stimulants ; artificial respiration ; external warmth and measures against shock in general. Copper Sulphate. Albumin ; sodii bicarb. Corrosive Sublimate. Albumin; milk ; emetics. Croton Oil. Opium; astringents; demulcents. Digitalis. Quiet in recumbent position; diffusible stimulants, as ammonia and alcohol. Gelsemium. Alcohol; ammonia. Gas, Coal or Illuminating. Oxygen inhalations ; stimulants. Hyoscyamus. See Atropine. Ignatia. See Strychnine. Iodine. Starch; demulcents. Iodoform. Stimulants as indicated. 319 320 INCOMPA TIBILITIES. Lobelia. Tannic acid; stimulants; opiates. Mineral Acids. Calcium and magnesium salts (chalk, aqua calcis, magnesia); al- kaline carbonates (soap); water and demulcent drinks. Muscarin (poison Mushrooms). Atropine; emetics if necessary. Nux Vomica. See Strychnine. Nitrate of Silver. Common salt (sodium chloride). Opium and its Alkaloids. jEvacwafion of stomach by stomach-pump or emetics-by the latter preferably mizstard, cupri sulphas, or zinci sulphas; tannic acid ; strych- nine ; atropine tentatively, guided by respiratory effects; caffeine; black coffee; various methods of respiratory stimulation ; oxygen inhalations; cardiac stim- ulants. Oleum Amygdalae Amar®. See Hydrocyanic Acid. Physostigma. Atropine ; heat; artificial respiration. Phosphorus. Sulphate of copper as emetic and antidote ; old French oil of turpentine. Potassii Chloras and Potassii Nitras. Emetics; cathartics; opium; demulcents. Potassa, Caustic. See Alkalies. Prussic Acid. See Hydrocyanic Acid. Potassii Cyanidum. See Hydrocyanic Acid. Stramonium. See Atropine. Strychnine. Chloroform or ether, if necessary to check convulsions; chloral; bromides. Soda, Caustic. See Alkalies. Tartar Emetic. See Antimonii et Potassii Tartras. Veratrum Viride. Emetics if drug have not been self-emetic; recumbent posture and enforced quiet; heat; diffusible stimulants subcutaneously and per rectum. Zinc, Chloride or Sulphate. Albumin ; sodium bicarbonate. INCOMPATIBILITIES. Drugs may be physically, physiologically, or chemically incompatible .with each other. Physiological incompatibility will be understood only by a thorough knowledge of their physiological effects, chemical incompatibility by strict attention to chemical principles, and physical incompatibility by a knowledge of their physical properties. Chemical incompatibility occurs when substances precipitate each other in solution (this may be intentional), form explosive compounds or volatile ingredients, and when chemical decomposition takes place from any cause. The most commonly occurring instances are the combination of liquid preparations of vegetable sub- stances with solutions of iron (inky tannate of iron formed); alkaloids with tannic acid, alkalies, or alkaline salts, mineral acids with weaker acids (carbonic). Physical incompatibility results when precipitates are formed without chemical action. Usually this takes place in liquids which differ in their menstrua; alco- holic tinctures,*fluid extracts, and spirits do not mix without precipitation with the aqueous preparations, like infusions, decoctions, waters, and solutions. The pre- cipitate may be active or inert. Therapeutic incompatibility takes place when substances of opposite physiological action are combined in the same formula. When possible make use of the greatest simplicity in prescribing, avoiding multi- plicity of drugs in the same prescription. Scientific interest will thus be subserved, a clearer insight into the effects of individual drugs will be possible, and at the same time all likelihood of the ingredients neutralizing each other or forming unpleasant or dangerous compounds avoided. INCOMP A TIB IL I TIES. 321 Remember the chemical principle that soluble salts brought together in the same solution generally, if possible, exchange radicals, with a resultant insoluble com- pound or precipitate. Hence such combinations are to be avoided; also, that the stronger mineral acids decompose salts of the weaker mineral and vegetable acids, and form ethers with alcoholic preparations. These general statements simply serve to illustrate the bearing of chemistry on the subject of incompatibles. A complete list of incompatible combinations would be inappropriate in a work of this kind. The following are a few general statements, involving the most important ones: Alkalies are incompatible with acid solutions, alkaloids, and the soluble non-alka- line metallic salts. Alkaloids in general with tannic acid, alkalies, and alkaline salts. Stronger mineral acids with alkalies and salts of relatively weak acids (carbonic, hydrobromic, hydriodic, acetic, citric, etc.). Arsenic with tannic acid, salts of iron (especially hydrate), and lime and magnesia. In fact, as a matter of course, all drugs with their antidotes. Carbonates with stronger acids and acid salts. Chlorides with salts of silver and lead, and with alkalies. Corrosive Sublimate with almost everything: it is best given alone in simple syrup, even the compound syrup of sarsaparilla being said to slightly decompose it; it is, however, often administered in combination with potassium iodide, which it decom- poses, with the formation of an efficient double salt. Digitalis with iron and preparations containing tannic acid. Glucosides with free acids and substances containing emulsin. Iodine and Iodides -with alkaloids and the ordinary soluble metallic salts. Iodine and potassium iodide are compatible, as in Lugol's solution. Iron salts with tannic acid (tincl ures, infusions, fluid extracts, etc.) and astringents. Mucilages with acids, iron salts, and alcohol. Syrup of Squill contains acetic acid, and is incompatible with the carbonate of am- monium, but not with the chloride. Sweet Spirit of Nitre with sulphate of iron, tincture of guaiac, and carbonates. Tannic and Gallic acids and the vegetable astringents with alkaloids and salts of iron and lead. Vegetable infusions in general with metallic salts. Tannic acid pre- cipitates albumin and gelatin. Nitrate of Silver and the acetate and subacetate of lead are best prescribed alone. The first may be administered with opium and extract of hyoscyamus. The lead salts are much used with opium in " lead-and-opium wash," the insoluble precipitate resulting being therapeutically efficient. Water with tinctures and other alcoholic preparations containing resin; the resin is precipitated. When such combinations are necessary, add acacia or other emul- sifying agent. Powerful oxidizing agents with easily oxidizable substances: combustion, and even explosion, may occur. Among the oxidizing agents in general medicinal use may be mentioned potassium chlorate, potassium permanganate, chromic, nitric, and nitro-hydrochlonc acids. Especially combustible are glycerin, sugar, alcohol, fats, sulphur, and phosphorus. 21-M. M. 322 CLASSIFICATION OF DRUGS. CLASSIFICATION OF DRUGS ACCORDING TO THEIR ACTION. Antispasmodics. Camphor, spiritus setheris compositus, valerian, asafcetida, mos- chus, oleum succini, humulus. Anaesthetics. 2Ether, chloroform, nitrogen monoxide, ethylene bichloride, ethyl bromide. Local Anaesthetics. Cocaine, eucaine, tropacocaine. Hypnotics or Somnifacients. Opium, cannabis Indica, cannabis Americana, chloral, chloralamid, sulphonal, amylene hydrate, paraldehyde, urethane. Belladonna Group. Belladonna, stramonium, hyoscyamus, duboisia, coca. Spinants.-Excito-motors. Nux vomica, ignatia, cocculus indicus [ergot, digitalis],- Depresso-motors. Physostigma, the bromides, the nitrite group-amyl nitrite, nitroglycerin, potassium nitrite, sodium nitrite-curare, conium, gelsemium, lobelia, tabacum. Affecting Circulatory System.-Cardiants. Ammonia, alcohol, digitalis, strophan- thus, convallaria, sparteine, adonidine, caffeine.-Cardiac Depressants. Antimony, veratrum viride, veratrine, aconite, pulsatilla, arnica, staphisagria, hydrocyanic acid, potassium cyanide, oil of bitter almonds, vegetable acids-acetic, citric, tartaric. Astringents.- Vegetable Astringents. Tannic acid, gallic acid, galls, krameria, cate- chu, kino, hsematoxylon, hamamelis, quercus alba, rosa gallica, rubus, castanea, rhus glabra, etc.-Mineral Astringents. Silver, copper, zinc, lead, alum. Tonics.-Iron and its salts, manganese, sulphuric acid, hydrochloric acid, nitric acid, nitro-muriatic acid, lactic acid, phosphorus. Alteratives. Arsenous acid, mercury, iodine and the iodides, iodoform, iodol, cod- liver oil, phosphoric acid, hypophosphites, sarsaparilla, guaiac, mezereum, sas- safras, taraxacum, ichthyol, colchicum, the animal alteratives. Antiperiodics. Cinchona and its alkaloids, eucalyptus, Warburg's tincture. Antipyretics. Salicylic acid and the salicylates, salicin, oil of gaultheria, salol, betol, carbolic acid, creosote, kreolin, thymol, resorcin, benzoin and benzoic acid, antipyrin, antifebrin, phenacetin, thallin, kairin, naphthaline. Stomachic Bitters.- Simple. Quassia, gentian, calumba, chirata, hydrastis.-Aro- matics. Serpentaria, cascarilla, anthemis, eupatorium, cimicifuga, absinthe.- Astringents. Cornus, prunus Virginiana. Diuretics. Squill, scoparius, apocynum, triticum, vascular diuretics (see Cardiants'), potassium compounds. Blennorrhetics. Buchu, pareira, matico, uva ursi, juniper, chimaphila, oil of erig- eron, oil of turpentine, copaiba, cubeb. Cathartics.-Laxatives. Tamarind, manna, cassia fistula, castor oil, olive oil, mag- nesia.- Salines. Magnesium sulphate, solution of magnesium citrate, Rochelle salt, phosphate of soda, sulphate of potassa, bitartrate of potassium.-Purgatives. Rhubarb, senna, aloe, cascara sagrada, frangula, juglans, leptandra.-Drastics. Jalap, podophyllum, chelidonium, iris, euonymus, scammony, colocynth, cam- boge, elaterium, croton oil.-Mercurials. Calomel, massa hydrargyri. Anthelmintics. Santoniea, spigelia, chenopodium, azedarach, aspidium, granatum, kamala, brayera, pumpkin, oil of turpentine, ailanthus. Emetics.-A. Local: Mineral. Copper sulphate, zinc sulphate, alum, turpeth mineral. - Vegetable. Mustard- B. Systemic: Ipecac, apomorphine, sanguinaria, tartar emetic. Diaphoretics. Pilocarpus, liquor ammonii acetatis, sweet spirit of nitre, antimony, ipecac, refrigerant diaphoretics. CLASSIFICATION OF DRUGS. 323 Expectorants. Lobelia, antimony, ipecac, grindelia, pulsatilla, senega, ammonium chloride, garlic, balsam of Peru, balsam of Tolu, pix liquida, terebene, terpin hydrate. Emmenagogues -Tonic Emmenagogues. Iron, manganese.-Purgative Emmenagogues. Aloe-Stimulating Emmenagogues. Savine, rue, parsley, tansy, water-pepper. Oxytocics. Ergot, cotton-root bark, ustilago, cimicifuga. Irritants.-(1) Rubefacients. Mustard, capsicum, Burgundy pitch, Canada pitch, oil of turpentine.-(2) Vesicants. Cantharides, stronger ammonia.-(3) Escharotics. Nitrate of silver, caustic potassa, caustic soda, arsenous acid, zinc chloride, bro- mine, chromic acid, solution of nitrate of mercury, nitric acid.-(4) Suppurants. Croton oil, ointment of antimony.-(5) Mild Irritants. Green soap, chrysarobin. Demulcents. Water, acacia, tragacanth, cetraria, chondrus, ulmus, licorice, lyco- podium, starch, altheea, cydonium, sassafras medulla. Emollients. Lanolin, glycerin, petrolatum, lard, oil of theobroma, cetaceum, white and yellow wax. Protectives. Pyroxylum, collodion, gutta percha, etc. Antacids. Sodium and its salts, lime and lime salts. Antiseptics. Lime, ozone, peroxide of hydrogen, permanganate of potassium, sul- phurous acid, corrosive sublimate, boric acid, borax, chlorine-water, chlorinated lime, solution of chlorinated lime. Aromatics. Cinnamon, cloves, nutmeg, allspice, cardamom, ginger, pepper, cap- sicum. GENERAL INDEX. A. Absinthium, 208 Absolute alcohol, 96 Absorbent cotton, 286 Acacia, 279 Acetanilid, 203 jAcetanilidum, 203 Acetic acid, 128 Aceto-phenone, 65 Acid, acetic, 128 arsenous. See Arsenic, 159-163 benzoic, 199 boric, 294 camphoric, 36 carbolic, 192-195 chromic, 276 citric, 127 cresylic, 193 gallic, 130-132 hydrobromic, 85 hydrochloric, 154 hydrocyanic, 123 lactic, 156 nitric, 155, 277 nitro-hydrochloric, 156 nitro-hydrochloricum, 156 oxalic, 129 phosphoric, 173 picric, 187 pyrogallic, 132 salicylic. See Salicylic Acid, 188-190 sulphuric, 153 tannic, 130-132 tartaric, 127 vegetable, 126-129 xylic, 193 Acidum lacticum, 156 phosphoricum, 173 Aconite, 119-122 physiological action, 120 preparations, 120 therapeutics, 121 toxicology, 121 Aconitine, 120 Duquesne] 's, 120 Aconitine, 119-122 Adeps, 285 lanae hydrosus, 283 Adonidin, 113 yEther, 42 African pepper, 298 Agaric, 136 Agaricin, 72 Ailanthus, 244 Alcohol, 96-106, 253 absolute, 96 amylic, 90 as diaphoretic, 253 deodorized, 96 dilute, 96 ethyl, 96 as a food, 98 habitual use of, 99 official, 96 preparations of, 103-106 secondary effects, 99 value as a food, 98 Alcoholic potassa, 274 Alcoholism, 101 acute, diagnosis of, 101 chronic, 100 treatment of, 101 Alder buckthorn, 230 Ale, 105 Allium, 257 Allspice, 298 Almond oil, 229 Aloes, 234, 241, 260 Barbadoes, 234 Cape, 234 preparations, 234 Socotrine, 234 Aloin, 234 Alteratives, 159-180 animal, 178, 179 Althaea, 283 Alum, 147, 245 325 326 GENERAL INDEX. Alumen, 147 as emetic, 245 Amber, 40 American hellebore, 118 Ammonia, 93-96 Ammoniated glycyrrhizin, 281 Ammonii bromidum, 84 chloridum, 256 Ammonium acetate, 251 bromide, 84 carbonate, 94 chloride, 94, 256 salicylate, 190 Amygdalin, 124, 209 Amylene hydrate, 64 Amylic alcohol, 90 Amyl nitris, 90-92 Amylum, 282 Anaesthesia, local, 49-51 indications for, 50 practical, 43-46 Anaesthetics, 41-51 in obstetric practice, 47, 49 Anemonin, 122 Animal alteratives, 178 foods, 300-309 viscera, 307 Anode, 19 Antacids, 288, 290 Anthelmintics, 240-244 Anthemis, 207 Antidote to arsenic, 150 Antifebrin, 203 Antimonii et potassii tartras, as dia- phoretic, 252 as expectorant, 254 Antimonium, 116, 117 Antimony, 116, 117, 252, 254 ointment, 278 ■ preparations, 116 Antiperiodics, 180, 187 Antipyretics, 187-205 Antipyrin, 201-203 Antipyrinum, 201-203 Antiseptics, 290-296 Antispasmodics, 35-41 Antitoxin, diphtheria, 179 streptococcus, 179 tetanus, 179 Apiol, 261 Apocynum, 212 Apomorphinae hydrochloras, 247 Apothecaries' measure, 26 weight, 26 Aqua, 279 ammoniae, 94, 273 Aqua ammoniac fortior, as vesicant, 273 chlori, 295 destillata, 279 ' fortis, 155 hydrogenii dioxidi, 292 regia, 156 Arabic acid, 279 Arabin, 280 Arbutin, 220, 221 i Argentum. See Silver, 136 Argol, 127, 215 Argyria, 137 Aristol, 171 Arnica, 122, 123 Arnicae flores, 122 radix, 122 Aromatic bitters, 207 sulphuric acid, 153 Aromatics, 296 Arrow-root, as an article of diet, 308 Arsenic, 159-163, 275 preparations, 160 therapeutics, 160-162 toxicology, 160-162 Arsenous acid, 159-163 (as escharotic), 275 Artificial feeding, 300 Asafcetida, 38 Ascaris lumbricoides, treatment for, 241 Aspidium, 243 Astringent bitters, 209 Astringents, 129-146 I mineral, 136 vegetable, 130 Atropine. See also Belladonna, 66-69 use in ophthalmology, 69 Aurautii amari cortex, 299 dulcis cortex, 299 Avoirdupois weight, 26 Azedarach, 242 B. Baking soda, 289 Balsam, Canada, 222 of copaiba, 224 de Malta, 200 of fir, 222 of Peru, 257 of Tolu, 257 Balsamum Peruvianum, 257 Tolutanum, 257 Barbadoes aloes, 234 Bark, tincture of, 181 GENERAL INDEX. 327 Basham's mixture, 151 Bath, hot vapor, 249 water, 249 Russian, 249 Turkish, 249 Bearberry, 220 Beef, 306 Beer, 105 Belladonna group, 65 leaves, preparations, 66 physiological action, 66, 67 root, preparations, 66 therapeutics, 68, 69 toxicology, 69 Belladonnse folia, 65-69 radix, 65-69 Benzoates, 200, 201 Benzoic acid, 199-201, 257 aldehyde, 124 Benzoin, 199-201 preparations, 200 Benzoinum, 199-201 Benzoyl-tropein, 74 Berberine, 206, 266 Betol, 192 Betula, volatile oil of, 191 Bichloride of mercury, 163 Birch, volatile oil of, 191 Bismuth, 139, 140 salts, 139 Bitter almond, oil of, 128 apple, 237 cucumber, 237 wine of iron, 152 Bitters, 205-210 aromatic, 207 astringent, 209 simple, 205-207 stomachic, 205-210 Blackberry, 136 Black cohosh, 40 draught, 233 drop, 52 mustard, 245 oxide of manganese, 153 snake root, 40 wash, 163 Blanc mange, 281 Bleaching powder, 296 Blennorrhetics, 218-226 Blistering-paper, 272 -plaster, 272 Bloodroot, 248 Blue flag, 236 gum tree, 186 mass, 163, 239 Blue ointment, 163 stone, 1-10 vitriol, 140 Boletus laricis, 136 Boneset, 208 Boracic acid, 294 Borax (as antiseptic), 295 Boric acid, 294 Brandy, 103 Brayera, 243 Bromides, 82-85 Bromine, 276 Bromism, 83 Bromum, 276 Broom, 112, 211 Brown stout, 105 Brucine, 75, 79 Buchu, 219 Buckthorn, alder, 230 California, 229 Burgundy pitch, 270 Butter, 303 Buttermilk, 303 Butternut, 235 Butyl-chloral hydrate, 62 c. Cacao, 114 butter, 285 Cachexia, mercurial, 165 Caffeina, 113-116 poisoning, 115 Cajuput, 299 Calabar bean, 80-82 Calabarine, 80 Calcii phosphas prsecipitatus, 173 Calcium phosphate, precipitated, 173 salts, 289, 290 Calisaya bark, 180 Calomel, 211, 239 as diuretic, 211 as purgative, 239 Calumba, 206 Calx, 289 chlorata, 296 as disinfectant, 292 Cambogia, 238 Camphor, 35-37 oil of, 36 monobromata, 37 Camphorated oil, 36 Camphoric acid, 36 Canada balsam, 222 pitch, 271 328 GENERAL INDEX. Canadian hemp, 212 Cannabinine, 57 Cannabis indica, 57, 58 Canquoin's paste, 275 Cantharidal collodion, 272 Cantharidin, 272 Cantharides, 262, 272 as emmenagogues, 262 preparations of, 272 toxicology, 273 vittata, 273 Cape aloes, 234 Capsicum, 270, 298 Carbolic acid, 192-195, 241, 291 as antiseptic, 291 preparations, 195 therapeutics, 195 toxicology, 194 Cardamom, 298 Cardiac depressants, 116-126 stimulants, 93-116 Carolina jasmine, 87 pink, 242 Carragheen, 281 Carron oil, 289 Caryophyllus, 297 Cascara sagrada, 229 Cascarilla, 208 Cassia fistula, 229 Castanea, 136 Castor oil, 228 Cataplasms, 279 Catechu, 133 Cathartics, 226-239 classification, 226 hydragogue, 230 mercurial, 239 Cathode, 19 Caustic potash, 274 soda, 275 Caustics, 277 Cautery, actual, 277 gal van o, 277 Cayenne pepper, 270, 298 Celandine, 236 Cera alba, 286 flava, 286 Cerii oxalas, 148 Cetaceum, 286 Cetraria, 280 Chamomile, 207 German, 208 Roman, 207 Champagne. 105 Cheese, 303 Chelidonium, 236 Chenopodium, 242 | Chestnut, 136 Children, dosage for, 22 1 Chimaphila, 221 Chinese oil of peppermint, 198 Chinoidinum, 185, 186 Chi rata, 206 Chloral, 58-60 camphor, 62 -habit, 60 hydrate, 58-60 Chloralamid, 61 Chloralose, 62 Chlorinated lime, 296 Chlorine-water, 295 Chloroform, 46-48 Chocolate, 114 Cholagogues, 227 Cholesterin, 283 Chondrus, 281 Chromic acid, 276 Chrysarobin, 278 Chrysarobinum, 278 Cimicifuga, 40 Cinchona, 180-186 alkaloids, 180, 181 flava, 180, 186 preparations, 180 rubra, 180, 186 varieties, 180 Cinchonidine, 181, 185 Cinchonine, 185 Cinnamic acid, 257 Cinnamon, 297 Ceylon, 297 Chinese, 297 Saigon, 297 Cinnamomum Cassia, 297 Saigon icum, 297 Zeylanicum, 297 Citric acid, 127 Citrine ointment, 164 Classification of drugs, 322 Cloves, 297 Club moss, 282 Coca, 72-75 physiological action, 73 Cocainse hydrochloras, 49 Cocaine, 49, 73, 74 -habit, 74 hydrochlorate, 49 local action, 74 therapeutics, 74 Cocculus indicus, 79,80 Cocoanut, 244 I Codeina, 54 GENERAL INDEX. 329 Cod-liver oil, 172, 173 Colchici radix, 177 semen, 177 Colchicum, 177 preparations, 177 Cold, 19 pack,249 Colica pictonum, 145 Collodium, 287 cantharidatum, 287 flexile, 287 Colocynth, 237 Colostrum, 301 Colombo, 206 Compound spirit of ether, 37 syrup-of squill, 116, 245 Condensed milk, 300 Coniine, 86 Convallaria, 112 Convallamarin, 112 Corivallarin, 112 Copaiba, balsam of, 224 preparations, 224 Copper, 140-142 action, 141 preparations, 140 sulphate, 245 Copperas, 150 as disinfectant, 291 Corn ergot, 265 smut, 265 Corning's method of local anaesthesia, 49 Corn us, 209 Cornmeal, 307 Corrosive sublimate, 163, 293 as antiseptic, 293 Cosmoline, 285 Cotton, absorbent, 286 -root bark, 265 Couch-grass, 212 Coxe's hive syrup, 210 Cramp asphyxia, 76 Cranesbill, 134 Cream, 302 of tartar, 127, 215, 232 Creolin, 197 Creosol, 196 Creosote, 196, 197 Creosotum, 196 Cresylic acid, 193 Creta praeparata, 290 Croton-chloral, 60, 61 oil, 239 as suppurant, 277 Crowfoot, 134 Cubeb, 225 preparations, 225 Culver's root, 235 Cuprum. See Copper. Cupri sulphas (as emetic), 245 Cups, 271 Curare, 85, 86 Curarine, 85 Cusso, 243 Cutch, 133 Cyanides, the, 125 Cydouium, 283 D. Dandelion, 176 Daturine, 70 Deadly nightshade, 65 Degeneration, reactions of, 20 Delirifacients, 65-75 Delirium tremens, 100 Demulcents, 279-283 Deodorized alcohol, 96 Depresso-motors, 80-90 Dewee's carminative, 39 Dextrin, 283 Diachylon ointment, 144 Dialyzed iron, 152 Diaphoretics, 249-253 nauseating, 252 non-medicinal measures, 249 refrigerant, 253 Diastase, 104, 312 Diet, 308 in acute gastritis, 309 animal, 308 in cachectic conditions, 310 in chronic constipation, 310 in diabetes, 308 in disease, 309, 310 in fevers, 309 in intestinal indigestion, 310 low, 308 dry, 308 special, 308 Dietetics, 299 Digestive ferments, 310 Digitalis, 80, 106-110 physical action, 107 preparations, 107 principles, 106 therapeutics, 108, 109 toxicology, 110 Di-iodo-para-phenol-sulphuric acid (soziodol), 171 Diluted alcohol, 96 330 GENERAL INDEX. Diphtheria antitoxin, 179 Disinfectants, 290-296 physical, 291 Distilled water, 279 Di-thymol-di-iodide (aristol), 171 Diuretics, 210-218 refrigerant, 213-218 vascular, 213 Dog's bane, 212 Dogwood, 209 Donovan's solution, 160,163 Doses for children, 22 table of, 313 Dover's powder, 246, 252 Drastic purgatives, 235-239 Drugs, classification of, 322 E. Eau de Javelle, 296 Egg nog, 106 Eggs, 305 Elaterinum, 238 Electricity, 19 therapeutics, 20 Elixir of vitriol, 153 Elm, 281 Emetics, 244 local, 245 mechanical measures, 245 systemic, 246 Emetine, 246 Emmenagogues, 259 purgative, 260 tonic, 259 Emollients, 283 Enemata, 23 Epispastics, 271 Epsom salt, 230 Equivalents of troy and metric weights, 27 Ergot, 80. See also Ergota, 262 corn, 265 Ergota, 262 action, 263 preparations, 263 therapeutics, 264 toxicology, 263 Ergotin, 263 Ergotism, 263 Erigeron, oil of, 221 Erythroxylon, 72 Escharotics, 273 Eserine, 80 Essential salt of lemons, 129 Ether, 42, 43 Ether, administration of, 43 dangers during, 44 hydrobromic, 49 methods of administering, 45 Ethyl alcohol, 96 bromide, 49 sulphonic acid, 63 Eucaine hydrochlorate, 51 Eucalyptus, 186, 187 oil of, 187 Euonymus, 237 Eupatorium, 208 Excito-motors, 75-80 Expectorants, 253-259 nauseating or sedative, 253 stimulating, 255 F. Farinaceous food-stuffs, 308 Ferments, digestive, 310 Ferri citras, 152 et ammonii citras, 152 et quininae citras, 152 hypophosphis, 152 pyrophosphas solubilis, 152 sulphas as disinfectant, 291 Ferric hydrate, 149 sulphate, 150 Ferrous sulphate, 150 Ferrum, 148 dialyzatum, 152 as emmenagogue, 259 reductum, 149 Fish berries, 79 suitable for invalids, 307 Flaxseed, 282 Fleabane, oil of, 221 Fleming's tincture, 120 Foods, animal, 300-309 Formyl teriodide, 170 Frangula, 230 French oil of turpentine, 158 Friar's balsam, 200 Fowler's solution, 160 Fox-glove, 106-110 Fusel oil, 90 G. Galla, 132 Gallic acid, 130-132 Gambir, 133 Gamboge, 238 Garlic, 257 Gaultheria, oil of, 190 Gelsemium, 87, 88 GENERAL INDEX. 331 Gentian, 206 Gentio-picrin, 206 Geranium, 134 German chamomile, 208 Germicides, 290-296 Gin, 105, 221 Ginger, 298 Glacial acetic acid, 128 Glauber's salt, 231 Glonoin, 92 spirit of, 92 Glucose, 283 Glusidum, 284 Glycerin, 283 Glycogen, 307 Glycyrrhizin, 281 Goa powder, 278 Golden seal, 265, 266 Gossypii radicis cortex, 265 Gossypium purificatum, 286 Goulard's cerate, 144 extract, 143 Granatum, 243 Grape-juice, 104 Gray powder, 163 Green soap, 278 vitriol, 150 Gregory's powder, 232 Grindelia as expectorant, 254 Guaiac (wood and resin), 175 Guaiaci lignum, 175 resina, 175 Guaiacol, 198 Guarana, 113 Gum Arabic, 279 Gums, 280 Gun-cotton, soluble, 286 Guru-nut, 267 Gutta-percha, 287 H. Hsematoxylon, 134 Hamamelis, 134 Hartshorn, 94 Hashish, 57 Heat, 17, 18 Hedeoma, 262 Hellebore, American, 118 green,118 swamp, 118 Hemlock, poison, 86 Henbane, 71 Hive syrup, 210, 245 Hoffman's anodyne, 37 Holland gin, 221 Homatropine hydrobromate, 70 Hops, 40 Hot pack, 249 Humulus, 40 Huxham's tincture, 181 Hydragogue cathartics, 230 purgatives, 235-239 Hydrargyri chloridum corrosivum as antiseptic, 293 as escharotic, 277 mite as diuretic, 211 subsulphas flavus, 245 Hydrargyrum. See Mercury, 163-167 Hydrastine, 266 hydrochloras, 267 Hydrastis, 265 Hydrobromic acid, 85 ether, 49 Hydrochloric acid, 154 Hydrocyanic acid, dilute, 124 toxicology, 125 Hydrogen peroxide, 292 Hydrous wool fat, 283, Hygrine, 72 Hyoscine hydrobromate, 71, 72 Hyoscyamus, 71,. 72 Hypnone, 65 Hypnotics, 51-75 Hypophosphites, 174 syrups, 174 I. Iceland moss, 280 Ichthyol, 176 Idiosyncrasies, 22 Ignatia, 79 Important poisons and their antidotes, 319 Incompatibles, 320 Indian cannabis, 57 Indian hemp, 57, 58 poke, 118 tobacco, 88, 89 Infant feeding, 300 Iodides, the, 170 Iodine, 167, 168 preparations, 169, 170 lodism, 167 Iodoform, 170, 171 Iodol, 171 lodum, 167 Ipecac, 246, 252, 254 as diaphoretic, 252 as expectorant, 254 preparations, 246 332 GENERAL INDEX. Ipecac, therapeutics, 246, 247 Ipecacuanha, 246 Iris, 236 Irish moss. 281 Iron as emmeuagogue, 259 preparations, 149-152 therapeutics, 149 Irritants, 267-278 Iso-pelletierine, 243 J. Jaborandi, 250 Jalap, 235 preparations, 235 Jambul, 175 Japanese oil of peppermint, 198 Jasmine, Carolina, 87 yellow, 87 Jervine, 118 Juglans, 235 Juniper, oil of, 220 K. Kairin, 204 Kamala, 243 Kentish ointment, 271 Keratin, 139 Kidneys, as an article of diet, 307 Kino, 133 Kola, 114, 267 Koumyss, 303 Kousso, 243 Krameria, 133 Kreoliu, 197 Li. Labarraque's solution, 296 Lactic acid, 156 Lady Webster's dinner pill, 234 Lanolin, 283 Lard, 285 Laudanum, 52 Laughing-gas, 48 Lavender, 299 Laxatives, 227-230 Lead plaster, 287 -poisoning, chronic, 145 salts and preparations, 144 toxicology, 144, 145 -water, 144 Lemons, essential salt of 129 -juice, 127 Leptandra, 235 Licebane, 123 Lichenin, 280 Licorice, 281 compound powder, 229 root, 281 Light, 17 Lignum vitae, 175 Lily of the valley, 112 Lime, 289 as disinfectant, 292 -juice, 127 salts, 289, 290 -water, 289 Liniment, lime, 289 Liniments, 271 Linseed, 282 oil, 229 Linum, 282 Liquor ammonii acetatis, as diapho retie, 251 calcis, 289 ferri nitratis, 152 magnesii citratis, 230 sodae chlorates, 296 Lithii bromidum, 85 Lithium benzoate, 201 bromide, 85 Lobelia, 88, 89 as expectorant, 254 Local anaesthesia, 49 cocaine, 50 eucaine, 51 rhigolene, 49 emetics, 246 Logwood, 134 London paste, 275 Lotio flava, 163 nigra, 163 Lugol's solution, 168, 170 Lunar caustic, 137, 274 Lupulinum, 40 Lycopodium, 282 M. Mace, 297 Macis, 297 Magendie's solution, 52 Magnesia, 228 ponderosa, 228 Magnesii carbonas, 228 citras effervescens, 230 Male fern, 243 Malt liquors, 105 -sugar, 301 GENERAL INDEX. 333 Maltose, 301 Mandrake, 236 Manganese, 153 as emmenagogue, 259 preparations, 153 Mangani dioxiduru, 153 Manganum, 153 as emmenagogue, 259 Mania-a-potu, 100 Manna, 227 Marshmallow, 283 Massage, 21 Mat6, 114 Materia medica, 17 definition of, 17 Matico, 219 Matricaria, 208 Matzoon, 304 Mayapple, 236 Meadow saffron, 177 Mehthol, 198 Mercurial cathartics, 239 Mercuric bichloride, 163 chloride, 163 Mercury, 163-167 absorption, 166 action, 164 administration, 165 preparations, 163, 164 in syphilis, 166 therapeutics, 166 toxicology, 165 Methaemoglobin, 91 Methyl pyrocatechin, 198 Methylal, 65 Metric system of weights and ures, 27 Mezereum, 175 Milk, condensed, 300 -diet, indications for, 302 diseases conveyed by, 301 modified, 301 peptonized, 304 punch,106 skimmed, 303 sterilized, 300 sugar of, 218 Mineral astringents, 136 Mistura potassii citratis, 127, 253 rhei et sodae, 233 Mitigated stick, 137 Modified milk, 301 Monk's hood, 120 Monsel's solution, 151 Morphine, 54 Mosch us, 39 . Moss, Iceland, 280 Irish, 281 Mulled wine, 106 Muriatic acid, 154 Musk, 39 Mustard, 245 black, 245, 269 white, 245, 269 Muttou, 306 Mydriatics, 65-75 Myristica, 297 Myrrh, 260 as emmenagogue, 260 N. Naphthalin, 294 Naphthalinum, 294 Naphtholol, 192 Nauseating diaphoretics, 252 expectorants, 253 Neutral mixture, 127, 253 Nicotine, 55, 89 Nightshade, deadly, 65 Nitrate of silver, 136, 137 antidote, 137 toxicology, 137 Nitre, sweet spirit of, 93 Nitric acid, 155, 277 as eschar otic, 277 Nitrite of amyl, 90-92 group, 90-93 Nitrobenzole, 125 Nitrogen monoxide, 48 Nitroglycerin, 92 spirit of, 92 Nitro-hydrochloric acid, 156 Norwood's tincture, 118 Nuclein, 180 Nucleinic acid, 180 Nutgall, 132 Nutmeg, 297 Nux vomica, 75-79 preparations, 75 O. Oatmeal, 307 Oil of allspice, 298 of amber, 40 of bitter almond, 126 of bitter orange-peel, 299 of camphor, 36 of cinnamon, 297 of cloves, 297 cod-liver, 172, 173 334 GENERAL INDEX. Oil of fleabane, 221 of lavender flowers, 299 of mirbane, 125 of mustard, volatile, 269 of nutmeg, 297 of rosemary, 299 of sandalwood, 226 of sassafras, 299 of sweet orange-peel, 299 of tar, 258 of teaberry, 190 of theobroma, 286 of turpentine, 244, 271 of vitriol, 153 of wine, heavy, 37 of Wintergreen, 190, 191 Oleum aethereum, 37 amygdalae amarae, 124, 126 expressum, 229 cajuputi, 299 camphoratum, 36 caryophylli, 297 cinnamomi, 297 erigerontis, 221 eucalypti, 187 gaultheriae, 190 hedeomae, 262 jecoris aselli, 172 juniperi, 220 lavandulae florum, 299 lini, 229 morrhuae, 172 myristicae, 297 olivae, 229 pimentae, 298 ricin i, 228 rosae, 135 rosmarini, 299 sabinee, 260 san tali, 226 sassafras, 299 sinapis volatile, 269 succini, 40 terebinthinae, 222-224 as anthelmintic, 244 theobromatis, 285 tiglii, 239, 277 as suppurant, 277 Olive oil, 229 Opium, 51-57 acids of, 55 administration, 57 alkaloids of, 55 -habit, 56 -poisoning, 55 acute, treatment of, 55 Opium-poisoning, chronic, 56 preparations, 51-53 physiological action, 53, 54 therapeutics, 56 Orange root, 265 Otto's test, 76 Oxalic acid, 129, 260 as emmenagogue, 260 Oxytocics, 262, 267 Oxyuris, treatment for, 241 Ozone, 292 Pack, cold, 249 hot, 249 Painters' colic, 145 Pale rose, 135 Pancreatin, 311 Pancreatinum, 311 Papain, 311 Papayotin, 311 Papoid, 311 Para-chloralose, 62 Paraffin, 285 Paraldehydum, 64 Parasites, 240 Paregoric, 52 Pareira, 219 brava, 219 Parsley, 261 Pearlash, 214 Pelletierine, 243 Pennyroyal, 262 Pepo, 244 Pepper, 270, 298 African, 298 Cayenne, 270, 298 red, 270, 298 Pepsin, 310 saccharated, 311 Peptonized milk, 304 Peruvian bark, 180 Petrolatum, 285 jelly, 285 Petroselinum, 261 Pharmacy, definition of, 17 Phenacetin, 204 Phenazonum, 201-203 Phenic acid, 192 Phenocoll hydrochloride, 203 Phenol, 192, 195 Phenyl alcohol, 192 -dimethyl-pyrazolon, 201 salicylate, 191 Phosphoric acid, 173 GENERAL TNDEX. 335 Phosphorus, 157-159 action, 157 preparations, 157 therapeutics, 159 toxicology, 158 Physostigmine, 80 Picric acid, 187 Picrotoxinum, 79, 80 Pilocarpus, 250 therapeutics, 251 Pimenta, 298 Pinene, 258 Pink root, 242 Piper, 298 Piperine, 298 Pipsissewa, 221 Pitch, 258 Burgundy, 270 Canada, 271 PixLurgundica, 270 canadensis, 271 liquida, 258 Plasters, 287 lead, 287 resin, 287 soap, 287 Plumbum, 143-146 Podophyllum, 236 preparations, 236 Poison hemlock, 86 Poisons and their antidotes, impor- tant, 319 Poke root, 118 Polygonum hydropiperoides, 262 Pomegranate, 243 Poplar, 190 Pork, 306 Porter, 105 Port wine, 105 Potassa cum calce, with lime, 274 Potassii acetas, 215 bicarbonas, 215 bitartras, 215 bromidum, 82-84 carbonas, 214 chloras, 217 citras, 216 et sodii tartras, 231 nitris, 93, 216 permanganas as antiseptic, 292 Potassium acetate, 215 bicarbonate, 215 bitartrate, 215, 232 bromide, 82-84 Potassium bromide, toxicology, 83 chlorate, 217 citrate, 216 cyanide, 124, 126 ferrocyanide, 124 iodide, 168-170 nitrate, 216 permanganate, 292 salts, 213-218 and sodium tartrate, 231 sulphate, 232 Potatoes, 308 Poultices, 286 Practical anaesthesia, 43-46 Preparation of drugs, 23-25 Prepared chalk, 290 Prescriptions, examples of, 29 -writing, phrases used in, 32 rules of Latin grammar, 31 Propenyl alcohol, 284 trinitrate, 92 Protectives, 286 Prunus Virginiana, 209 Prussic acid, 123-126 Ptyalin, 312 Ptyalism, 164 Pulsatilla, 122, 255 Pul vis effervescens compositus, 231 glycyrrhizse compositus, 229 Pumpkin seed, 244 Purgatives, 232-235 drastic, 235-239 emmenagogues, 260 hydragogue, 235-239 mercurial, 239 Pyrogallic acid, 132 Pyrogallol, 132 Pyroligneous acid, 258 Pyroxylinum, 286 Q. Quaker button, 75 Quassia, 205 preparations, 205 Quercus alba, 135 Quince seed, 283 Quinidine, 185 Quinine, 180, 181, 267 action, 182 as oxytocic, 267 preparations, 181 properties, 181 therapeutics, 183 336 GENERAL INDEX. R. Reactions of degeneration, 20 Red bark, 181 pepper, 298 precipitate, 164 rose, 135 wine, 104 Refrigerant diaphoretics, 253 diuretics, 213-218 Remedies, 17 hygienic, 17 imponderable, 17 mechanical, 17 pharmacological, 17 Resin plaster, 287 Resorcin, 199 Rest-cure, 21 Rhamnus purshiana, 229 Rhatany, 133 Rheum, 232-233 Rhigolene, 49 Rhubarb, 232-233 preparations, 232 Rhus glabra, 135 Rochelle salt, 231 Roman chamomile, 207 Rotch's formula (modified milk), 301 Rosa centifolia, 135 gallica, 135 preparations, 135 Rubefacients, 268 Rubus, 136 Rue, 261 Rum, 105 Russian bath, 18, 249 Ruta, 261 Rye, 307 S. Sabina, 260 Saccharin, 284 Saccharum lactis, 218 Sago as an article of diet, 308 Salicinum, 190 Salicylates (sodium and ammonium) 188-190 Salicylic acid, 188-190 action, 188 preparations, 188 therapeutics, 189 Salines, 230 Salivation, 164 Salix, 209 Salol, 191, 192 Sal ammoniac, 94, 256 Epsom, 230 Rochelle, 231 volatile, 94 Salicin, 190 Saltpetre, 216 Sandal-wood oil, 226 Sanguinaria, 248 Santonica, 241 Santoninum, 241 Sapo mollis, 278 viridis, 278 Sarsaparilla, 174 flavor, 176 Sassafras, 176 medulla, 283 pith, 283 Savine, 260 Scammonium, 237 Schleich's solution, 75 Scilla, 210, 211 preparations, 210 Scoparius, 211 Sedative expectorants, 253 Seidlitz powder, 128, 231 Senega 255 Senna, 233 preparations, 233 Serpentaria, 207 Shell-fish suitable for invalids, 307 Shore oil, 172 Silver, 136-139 nitrate, 136, 274 preparations, 136, 137 therapeutics, 138 Simple bitters, 205-207 Sinalbin, 269 Sinapis alba, 245, 269 nigra, 245, 269 Sinigrin, 269 Skimmed milk, 303 Slippery elm, 281 Smart-weed, 262 Snakeroot, senega, 255 Virginia, 207 Soap, green, 278 plaster, 287 soft, 278 Socotrine aloes, 234 Soda, 275 Sodii boras as antiseptic, 295 bromi dum, 84 nitras, 93 phosphas, 231 sulphas, 231 sulpho-carbolas, 196 GENERAL INDEX. 337 Sodium benzoate, 201 phosphate, 231 salicylate, 189 salts, 288 sulphate, 231 sulpho-carbolate, 196 Soft soap, 278 Solution of chlorinated soda, 296 of lime, 289 Somnifacients, 51 Soziodol, 171 Spanish fly, 272, 273 Sparteine, 212 Sparteinae sulphas, 112 Special diet, 308 Spermaceti, 286 Spice plaster, 270 Spices, 270 Spigelia, 242 Spin ants, 75-90 Spirit of Mindererus, 94, 251 of nitroglycerin, 92 of nitrous ether, 252 of salt, 154 of turpentine, 222 Spiritus setheris nitrosi as diaphoretic, 252 compositus, 37 ammonise, 94 frumenti, 103 glonoini, 92 juniperi compositus, 105 sacchari tosti, 105 vini gallici, 103 Spurred rye, 262 Squill, 210, 211 comp, syrup, 210 preparations, 210 toxicology, 211 Staphisagria, 123 Starch, 282 as an article of diet, 308 Stavesacre, 123 Sterilized milk, 300 Stimulating diaphoretics, 250 expectorants, 255 Stomachic bitters, 205-210 Storax, 200 Stramonii folia, 70 semen, 70 Streptococcus antitoxin, 179 Strontium bromide, 85 Strophanthus, 110-112 Strychnine, 75-79 administration, 79 physiological action, 76 Strychnine, therapeutics, 78 toxicology, 77 Succinum, 40 Sugar of lead, 143 of milk, 218 Sulfonal, 62, 63 Sulphur, 227 dioxide, 293 Sulphuretted hydrogen, 227 Sulphuric acid, 153 aromatic, 153 dilute, 153 ether, 42 Sulphurous acid, 293 Sumach, 135 Suppurants, 277 Swamp hellebore, 118 Sweet-bread as an article of diet, 307 Sweet spirit of nitre, 93, 252 as diaphoretic, 252 Sydenham's laudanum, 52 Syrup of the iodide of iron, 151 of lime, 289 Syrupus calcis, 289 ferri bromidi, 152 scillse comp., 116 as emetic, 245 Systemic emetics, 246 T. Tabacum, 89 Table of doses, 313 Tsenia, treatment for, 242 Tseniafuges, 242 Tamarindus, 227 Tanacetum, 261 Tannic acid, 130-132 Tansy, 261 Tapioca, as an article of diet, 308 Tar, 258 Taraxacum, 176 Tartar emetic, 116, 249 as diaphoretic, 252 as expectorant, 254 Tartaric acid, 127 Tartarized antimony, 116 Teaberry, oil of, 190 Terebene, 258 Terebinthina canadensis, 222 Terpini hydras, 259 Tetano-cannabinine, 57 Tetanus antitoxin, 179 Tetron al, 63 Thallin, 204 Theine, 113, 116 22-M. M. 338 GENERA L INDEX. Theobromine, 114, 213 Therapeutics, definition of, 17 Thermometer, 18 Thermometric scales, 18 Thiersch's solution, 295 Thoroughwort, 208 Thymol, 198 Thyroid extract, 178 Thyro-iodine, 179 Tobacco, 89-90 Indian, 88 Toe-drop in lead-poisoning, 145 Tonics, 148 Tonic emmenagogues, 259 Torula cerevisise, 96 Tragacantha, 280 Tri-iodo-methane, 170 Trinitroglycerin, 92 Trinitrophenol, 187 Tripe as an article of diet, 307 Triticum, 212 Tropacocaine, 74 Tropeins, 70 Troy weight, 26 Tuberculin, 179 Tulley's powder, 52 Turkish bath, 18,249 Turlington's balsam, 200 Turpentine, 221-224 oil of, 222, 271 spirit of, 222 therapeutics, 223 varieties, 221, 222 Turpeth mineral, 164, 245 Tyrotoxicon-poisoning, 301 u. Ulmus, 281 Unguentum antimonii, 278 Urethan, 64, 65 Uro-chloralic acid, 59 Ustilago, 265 Uva ursi, 220 V. Valeriana, 38 Vallet's mass, 150 Vascular diuretics, 213 Vaseline, 285 Veal, 306 Vegetable acids, 126-129 astringents, 130 Vegetables, 307 Veratrina, 119 Veratrine, 119 Veratroidine, 118 Veratrum viride, 118-119 preparations, 118 Vermicides, 240 Vermifuges, 240 Vesicants, 271-273 Vienna paste, 274 Vinegar, 128 Vinum album, 104 ferri amarum, 152 rubrum, 104 Virginia snakeroot, 207 w. Wahoo, 237 Warburg's tincture, 186 Warming plaster, 270, 272 Water, 279 -pepper, 262 Wax, white, 286 yellow, 286 Weights and measures, 26-28 Wet cups, 271 Wheat, 307 cracked, 307 Whiskey, 103 White arsenic, 160 mustard, 245 oak,135 precipitate, 163 vitriol, 142 wax, 286 willow, 209 wine, 104 Wild cherry, 209 Willow, 190 Wine of antimony, 116 of iron, bitter, 152 measure, 26 red, 104 whey, 106 white, 104 Wines, 104, 105 Wintergreen, oil of, 190 Wistar's lozenges (trochisci glycyr- rliizm et opii), 282 Witch hazel, 134 Wolf's bane, 120 Woorara, 85,86 Wormseed, American, 242 levant, 241 Wrist-drop in lead-poisoning, 145 GENERAL INDEX. 339 X. Xanthopsia, 90 Xanthopuccine, 266 Xylic acid, 193 Y. Yeast, 104 Yellow bark, 180 jasmine, 87 precipitate, 164 root, 265 wash, 163 Yellow wax, 286 Young's rule of dosage, 22 Z. Zinc, 142, 143 chloride, 275 preparations, 142,143 salts, 142 sulphate, 245 Zinci sulphas as emetic, 245 Zincum, 142,143 Zingiber, 298 THERAPEUTICAL INDEX. A. Abscess, cold, iodoform in, 171 hepatic, ammonium chloride in, 256 hydrogen peroxide in, 292 poultices in, 286 Acne indurata, phosphorus in, 159 Addison's disease, diet in, 310 Albuminuria, buttermilk in, 303 milk-diet in, 302 Alcoholism, capsicum in, 298 Alopecia, arsenic in, 162 pilocarpus in, 251 Amaurosis due to alcohol, strychnine in, 78 due to tobacco, strychnine in, 78 Amblyopia, strychnine in, 78 Amenorrhcea, aloes in, 234 apiol in, 261 anaemic, iron in, 259 with constipation, aloes in, 260 cotton root bark in, 265 emmenagogues in, 259 ipecac in, 253 manganese in, 259 myrrh in, 260 oxalic acid in, 129 pennyroyal in, 261 pulsatilla in, 122 rue. in, 261 sanguinaria in, 249 savine in, 261 strychnine in, 78 tansy in, 261 water-pepper in, 261 Anaemia, cod-liver oil in, 172 hypophosphites in, 174 iron in, 149 milk-diet in, 302 of nephritis, Basham's mixture in, 151 pernicious, arsenic in, 162 diet in, 310 Anaemia of pregnancy, prec. calcium phosph, in, 173 strychnine in,78 Anaesthesia, electricity in, 21 Aneurism, ergot in, 265 iodides in. 169 lead acetate in, 146 low diet in, 308 Angina pectoris, amyl nitrite in, 91 Anorexia, peptonized milk in, 305 quassia in, 205 strychnine in, 78 Aortic disease, digitalis in, 108 insufficiency, digitalis in, 108 stenosis, digitalis in, 108 Aphonia, hysterical, zinc valerianate in, 143 Arterio-sclerosis, amyl nitrite in, 92, 93 Ascites, caffeine in, 115 diaphoretics in, 249 dry diet in, 308 elater in in, 238 jalap in, 235 podophyllum in, 236 salines in, 230 squill in, 211 Asthma, amyl nitrite in, 91 belladonna in, 68 gelsemium in, 88 grindelia in, 255 Hoffman's anodyne in, 38 hydrocyanic acid in, 126 iodides in, 169 lobelia in, 89, 254 opium in, 56 quinine in, 184 sparteine in, 113 stramonium in, 70 tartar emetic in, 117 tobacco in, 90 valerian in, 38 zinc oxide in, 143 Astigmatism, belladonna in, 69 341 342 THERAPEUTICAL INDEX. B. Bedsores, alcohol in, 103 Bilious fever, quinine in, 184 Biliousness, nitro-hydrocliloric acid in, 156 strychnine in, 78 Bites of insects, sodium bicarbonate in, 289 Bladder, irritability of, hops in, 40 Blepharospasm, conium in, 87 Bronchitis, acute, aconite in, 121 ammonia in, 95 ammonium chloride in, 256 antimony in, 254 apomorpbine in, 248 garlic in, 257 ipecac in, 247, 254 oil of eucalyptus in, 189 potassium citrate in, 216 pulsatilla in, 122, 255 sanguinaria in, 248 tartar emetic in, 117 chronic, ammonia in, 95 ammonium chloride in, 256 apomorphine in, 248 benzoic acid in, 201 camphor in, 36 cimicifuga in, 41 copaiba in, 225 croton oil in, 278 gallic acid in, 132 garlic in, 257 grindelia in, 255 lobelia in, 89 oil of eucalyptus in, 189 oil of san tai in, 226 oil of turpentine in, 224 quinine in, 185 senega in, 256 squill in, 211 strychnine in, 79 terebene in, 258 eupatorium in, 208 hydrocyanic acid in, 126 iodides in, 169 lead acetate in, 146 naphthalin in, 294 oil of turpentine in, 223 physostigma in, 82 subacute, garlic in, 257 grindelia in, 255 senega in, 256 terebene in, 258 tar in, 258 zinc sulphate in, 143 I Bronchocele, iodine in, 168 Bronchorrhcea, alum in, 147 naphthalin in, 294 Bruises, alcohol in, 103 witch-hazel in, 135 Burns, carbolic acid in, 195 carron oil in, 289 demulcents in, 279 lead acetate, in, 146 sodium bicarbonate in, 289 c. Cachexia, animal diet in, 309 diet in, 310 saturnine, salines in, 231 uric acid, potassium acetate in, 215 Cancer, escharotics in, 273 of stomach, milk-diet in, 302 of uterus, bromine in, 276 Cancrum oris, nitric acid in, 155 Caries, calcium phosphate in, 173 Cardiac depression, digitalis in, 109 Cataract, belladonna in, 69 Catarrh of cervix, tannic acid in, 131 duodenal, hydrastis in, 266 rhubarb in,233 sanguinaria in, 248 nasal, pulsatilla in, 122 of respiratory tract, balsam of Peru in, 257 Chancre, nitric acid in, 155 potassa in, 274 Chancroid, nitric acid in, 155 Chapped nipples, alcohol in, 103 glycerin in, 284 tannic acid in, 131 skin, glycerin in, 284 Chlorosis, iron in, 149 milk-diet in, 302 quassia in, 205 strychnine in, 78 Cholera, Asiatic, sulphuric acid in, 154 camphor in, 36 infantum, alcohol in, 102 haematoxylon in, 134 silver nitrate in, 138 sulphuric acid in, 154 lead acetate in, 146 morbus, opium in, 56 salol in, 191 sulphuric acid in, 154 Chordee, bromides in, 84 camphor in, 36 sulphonal in, 63 Chorea, antipyrin in, 202 THERAPEUTICAL INDEX. 343 Chorea with anaemia, syrup of bromide of iron in, 152 arsenic in, 162 bromides in, 84 cannabis indica in, 58 chloral in, 59 cimicifuga in, 41 cold in, 19 conium in, 87 copper sulphate in, 141 iron in, 149 physostigma in, 82 quinine in, 184 silver nitrate in, 139 sulphonal in, 63 valerian in, 38 zinc sulphate in, 143 Cirrhosis, ammonia in, 95 nitro-hydrochloric acid in, 156 peptonized milk in, 305 strychnine in,' 78 Cold, alcohol in, 102, 253 citric acid in, 127 Dover's powder in, 252 eupatorium in, 208 foot-bath in, 252 Colic, abdominal, oil of turpentine in, 223 chloroform in, 47 ginger in, 298 lead-, opium in, 56 oil of cajuput in, 299 spasmodic, belladonna in, 68 Collapse, belladonna in, 68 cocaine in, 74 ether in, 43 Condyloma, carbolic acid in, 195 escharotics in, 273 syphilitic, chromic acid in, 276 Congestion, cerebral, croton oil in, 239 elaterin-in, 238 ergot in, 265 salines in, 231 spinal, ergot in, 265 portal, podophyllum in, 236 pulmonary, cups in, 271 Conjunctivitis, alum in, 147 boric acid in, 294 sassafras pith in, 283 silver nitrate in, 138 tannic acid in, 131 zinc sulphate in, 143 Constipation, aloes in, 234 cassia fistula in, 229 castor oil in, 228 chelidonium in, 236 Constipation, chronic, cascara sagrada in, 229 diet in, 310 sodium phosphate in, 231 citrate of magnesia in, 230 colocynth in, 237 compound licorice powder in, 229 corn meal in, 307 cracked wheat in, 307 croton oil in, 239 elater in in, 238 euonymus in, 237 expressed oil of almond in, 229 frangula in, 230 gamboge in, 238 hydrastis in, 266 iris in, 236 jalap in, 235 juglans in, 235 due to lead, salines in, 231 leptandra in,235 linseed oil in, 229 magnesia in, 228 magnesium carbonate in, 228 sulphate in, 230 manna in, 227 massage in, 21 mercury in, 239 oatmeal in, 307 olive oil in, 229 potassium bitartrate in, 232 potassium sulphate in, 232 podophyllum in, 236 rhubarb in,232 Rochelle salt in, 231 scammony in, 237 senna in,233 sodium sulphate in, 231 sulphur in, 227 tamarind in, 227 Convulsions, bromides in, 84 infantile, chloral in, 59 puerperal, chloral in, 59 pilocarpus in, 251 urethan in, 65 strychnine, chloral in, 59 uraemic, chloral in, 59 urethan in, 65 Coryza, acute, belladonna in, 68 camphor in, 36 opium in, 56 quinine in, 185 ipecac in, 247 alcohol in, 102 bismuth subnitrate in, 140 glycerin in, 284 344 THERAPEUTICAL INDEX. Cough, acacia in, 280 cannabis indica in, 58 glycyrrhiza in, 282 hydrocyanic acid in, 126 hysterical, gelsemium in, 88 zinc valerianate in, 143 nervous, belladonna in, 68 opium in, 56 spasmodic, gelsemium in, 88 strychnine in, 79 Cretinism, thyroid extract in, 178 Croup, alum in, 147, 245 turpeth mineral in, 245 Cystitis, acute, potassium acetate in, 215 ammonia in, 95 boric acid in, 294 benzoic acid in, 200 camphoric acid in, 36 chronic, buchu in, 219 copaiba in, 224 grindelia in, 255 oil of juniper in, 221 oil of turpentine in, 223 uva ursi in, 220 hydrastis in, 266 salol in, 191 silver nitrate in, 138 sodium benzoate in, 201 triticum in, 212 D. Delayed union, prec. calcium phosph in, 173 Delirium tremens, alcohol in, 103 bromides in, 83 hyoscine in, 72 Diabetes, buttermilk in, 303 insipidus, ergot in, 265 opium in, 56 mellitus, animal diet in, 308 glycerin in, 284 jarabul in, 175 opium in, 56 saccharin in, 285 Diarrhoea, acacia in, 280 animal diet in, 309 bismuth subnitrate in, 140 camphor in, 36 carbolic acid in, 195 castor oil in, 228 chalk in, 290 chronic, alum in, 147 copaiba in, 225 copper sulphate in,141 Diarrhoea, chronic, ferric ammonium sulphate in, 152 lead acetate in, 146 naphthalin in, 294 nitro-hydrochloric acid in, 156 silver nitrate in, 138 zinc oxide in, 143 colliquative, belladonna in, 68 ergot in, 265 tannic acid in, 131 creosote in, 197 fermentative, lime-water in, 289 quinine in, 185 salicin in, 190 infantile, castor oil in, 228 pepsin in, 311 sodium phosphate in, 231 ipecac in, 247 krameria in, 133 milk-diet in, 302 oil of cajuput in, 299 opium in, 56 of phthisis, luematoxylon in, 134 resorcin in, 199 serous, nitric acid in, 155 sulphuric acid in, 154 summer, alcohol in, 102 diet in, 310 rhubarb in, 233 silver nitrate in, 138 syrup of lime in, 289 water-pepper in, 261 Diphtheria, alcohol in, 102 benzoic acid in, 201 carbolic acid in, 195 diphtheria-antitoxin in, 179 pepsin in, 311 pilocarpus in, 251 potassium chlorate in, 218 sodium benzoate in, 201 tincture of ferric chloride in, 151 Dropsy, apocynum in, 212 cardiac, caffeine in, 115 calomel in, 211 digitalis in, 109 potassium bitartrate in, 216 salines in, 230 sparteine in, 113 squill in, 211 sugar of milk in, 218 convallaria in, 112 croton oil in, 239 diaphoretics in, 249 dry diet in, 308 general, elaterin in, 238 jalap in, 235 THERAPEUTICAL INDEX. 345 Dropsy, general, scoparius in, 212 iris 'in, 237 renal, caffeine in, 115 potassium bitartrate in, 216 staphisagria in, 123 Dysentery, acacia in, 280 acute, ipecac in, 247 camphor in, 36 castor oil in, 228 chronic, alum in, 147 ipecac in, 247 silver nitrate in, 138 tannic acid in, 131 copper sulphate in, 141 ferric ammonium sulphate in, 152 krameria in, 133 lead acetate in, 146 milk-diet in, 302 oil of erigeron in, 221 opium in, 56 subacute, oil of turpentine in, 223 water-pepper in, 261 zinc oxide in, 143 Dysmenorrhoea, alcohol in, 253 amyl nitrite in, 92 anti pyrin in, 202 camphor in, 36 chloroform in, 47 cimicifuga in, 41 cotton-root bark in, 265 neuralgic, apiol in, 261 strychnine in, 78 pulsatilla in, 122 spasmodic, belladonna in, 68 Dyspepsia, acute, ipecac in, 246 atonic, alcohol in, 102 quassia in, 205 sanguinaria in, 248 strychnine in, 78 capsicum in, 298 chalk in, 290 cimicifuga in, 41 diastase in, 312 gastric, hydrochloric acid in, 155 ginger in, 298 hydrastis in, 266 intestinal, aloes in, 234 ammonia in, 95 diet in, 309 hydrochloric acid in, 155 iris in, 237 milk diet in, 302 naphthalin in, 294 nitric acid in, 155 nitro-hydrochloric acid in, 156 oil of turpentine in, 223 Dyspepsia, intestinal, pancreatin in, 311 podophyllum in, 236 rhubarb in,233 strychnine in,78 irritative, arsenic in, 162 lactic acid in, 157 milk-diet in, 302 nervous, silver nitrate in, 138 papoid in, 311 pepsin in, 311 quinine in, 184 taraxacum in, 176 E. Eczema, arsenic in, 162 chronic, ichthyol in, 176 lead acetate in, 146 soft soap in, 278 soziodol in, 171 tar in, 258 zinc oxide in, 143 Emissions, nocturnal, strychnine in. 78 Emphysema, camphor in, 36 iodides in, 169 oil of turpentine in, 224 strychnine in, 79 Endocarditis, calomel in, 166 Endometritis, tannic acid in, 131 Enlarged spleen, ergot in, 264 Epididymitis, pulsatilla in, 122 Epilepsy, antipyrin in, 202 amyl nitrite in, 91 borax in, 295 bromides in, 84 cold in, 19 copper sulphate in, 141 duboisine in, 72 ergot in, 265 hydrastinine in, 267 iron in, 149 lithium bromide in, 85 sulphonalin, 63 zinc sulphate in, 143 Epistaxis, antipyrin in, 202 ergot in, 264 gallic acid in, 132 tannic acid in, 131 Epithelioma, arsenous acid in, 275 potassa in, 274 zinc chloride in, 143 Erysipelas, aconite in, 122 alcohol in, 103 ichthyol in, 176 346 THERAPEUTICAL INDEX. Erysipelas, resorcin in, 199 tincture of ferric chloride in, 151 Exanthemata, aconite in, 122 ammonia in, 95 antipyrin in, 202 sweet spirit of nitre in, 252 Exophthalmic goitre, bromides in, 84 Exhaustion, alcohol in, 101 F. Febricula, aconite in, 122 Fever, acetanilid in, 203 antipyrin in, 202 citric acid in, 127 convalescence from, serpentaria in 207 kairin in, 204 milk-diet in, 302 phenacetin in, 204 phenocoll hydrochloride in, 203 thallin in, 204 Fissures, alum in, 147 anal, sulphur in, 227 Flatulence, allspice in, 298 aromatics in, 296 asafetida in, 39 capsicum in, 298 cardamon in, 298 cinnamon in, 297 cloves in, 297 ginger in, 298 mace in, 297 nutmeg in, 297 oil of cajuput in, 299 of turpentine in, 223 pepper in, 298 sodium sulphocarbolate in, 196 Furunculosis, phosphorus in, 159 G. Gangrene, hospital, bromine in, 276 of lung, carbolic acid in, 195 oil of turpentine in, 224 Gastralgia, chloroform in, 47 cocaine in, 50, 74 milk-diet in, 302 resorcin in, 199 silver nitrate in, 138 zinc oxide in, 143 Gastric acidity, ammonia in, 95 ulcer, arsenic in, 162 cocaine in, 74 milk-diet in, 302 peptonized milk in, 305 Gastric ulcer, resorcin in, 199 silver nitrate in, 138 Gastritis, acute, diet in, 309 altluea in, 283 ammonia in, 95 bismuth subnitrate in, 140 buttermilk in, 303 chronic, diet in, 309 with excessive secretion, bella- donna in, 68 hydrastis in, 266 peptonized milk in, 305 silver nitrate in, 138 strychnine in, 78 lime-water in, 289 milk-diet in, 302 with relaxation, tannic acid in, 131 Gastrodynia. carbolic acid in, 195 hydrocyanic acid in, 126 manganese in, 153 Gleet, kino in, 134 lime-water in, 289 oil of turpentine in, 223 Glycosuria, jambul in, 176 Goitre, ergot in, 264 thyroid extract in, 178 Gonorrhoea, bismuth subnitrate in, 140 chronic, catechu in, 133 copper sulphate in, 141 escharotics in, 273 hydrastis in, 266 kino in, 134 potassium permanganate in, 293 silver nitrate in, 138 subacute, copaiba in, 224 oil of santal in, 226 vaginal, acetic acid in, 128 silver nitrate in, 138 zinc sulphate in, 143 Gout, acute, colchicum in, 178 iodides in, 169 sulphur in, 227 Gouty diathesis, chalk in, 290 Grand mal, bromides in, 84 Granular eyelids, copper sulphate in, 141 Granulations, sluggish, balsam of Peru in, 257 lunar caustic in, 274 Graves's disease, sparteine in, 113 H. Hsematemesis, alum in, 147 antipyrin in, 202 ergot in, 264 THERA PE U TIC A L INDEX. 347 Haematuria, oil of turpentine in, 223 quinine in, 184 uva ursi in, 220 Haemoptysis, antipyrin in, 202 alum in, 147 ipecac in, 247 lead acetate in, 146 Haemorrhage, antipyrin in, 202 Hay-fever, cocaine in, 50 ipecac in, 247 quinine in, 184 resorcin in, 199 Headache, hysterical, zinc valerianate in, 143 neuralgic, quinine in, 184 sick, ipecac in, 246 Heart disease, adonidin in, 115 caffeine in, 115 functional, sparteine in, 113 hydrastinine in, 267 nervous, sparteine in, 113 strychnine in, 78 valvular, convallaria in, 112 digitalis in, 108 opium in, 56 sparteine in, 113 strophanthus in, 111 strychnine in, 79 hypertrophy of, aconite in, 122 veratrum viride in, 119 irritable, digitalis in, 109 weakness of, strychnine in, 79 Hematemesis, lead acetate in, 146 tannic acid in, 131 Hematuria, gallic acid in, 132 Hemoptysis, ergot in, 264 Hemorrhage, ammonia in, 95 cold, 19 gastric, Monsel's solution in, 151 intestinal, alum in, 147 kino in, 134 krameria in, 133 Monsel's solution in, 151 tannic acid in, 131 matico in, 220 opium in, 56 passive, digitalis in, 109 oil of turpentine in, 223 post-partum, acetic acid in, 128 ergot in, 264 pulmonary, gallic acid in, 132 renal, gallic acid in, 132 sulphuric acid in, 154 tannic acid in, 131 Hemorrhagic diathesis, digitalis in, 109 Hemorrhagic diathesis, ergot in, 264 strychnine in, 78 Hemorrhoids, alum in, 147 copaiba in, 225 nutgall in, 132 sulphur in, 227 tannic acid in, 131 Hepatitis, ammonia in, 95 nitro-hydrochloric acid in, 156 Herpes, zinc oxide in, 143 Hiccough, belladonna in, 68 Hoffman's anodyne in, 38 musk in, 39 quinine in, 184 sulphonal, 63 Hope's camphor mixture, 155 Hydrocele, carbolic acid in, 195 iodine in, 168 silver nitrate in, 138 Hydrophobia, curare in, 86 Hydrothorax, dry diet in, 308 Hyperacidity, antacids in, 288 Hyper-lactation, belladonna in, 68 Hysteria, asafetida in, 39 bromides in, 83 cannabis indica in, 58 camphor in, 36 chloral in, 59 cold in, 19 Hoffman's anodyne in, 38 iron in, 149 massage in, 21 musk in, 39 sulphonal in, 63 valerian in, 38 I. Impetigo, soziodol in, 171 zinc oxide in, 143 Impotence, oil of turpentine in, 223 strychnine in, 78 water-pepper in, 261 Incontinence of urine, belladonna in, 68 strychnine in, 78 Inflammations, acute, alcohol in, 102 demulcents in, 279 digitalis in, 109 chronic, actual cautery in, 277 of genito-uriuary tract, copaiba in, 224 chronic, oil of santal in, 226 cubeb in, 225 oil of erigeron in, 221 irritants in, 268 348 THERA PE UTICAL INDEX. Inflammations of joints, Burgundy pitch in, 270 local, Canada pitch in, 271 capsicum in, 270 liniments in, 271 mustard in, 269 oil of turpentine in, 271 poultices in, 286 sodium sulphocarbolate in, 196 superficial alum, in, 148 lead acetate in, 146 vesicants in, 271 Insanity, bromides in, 83 hyoscine in, 72 Insomnia, alcohol in, 103 amylene hydrate in, 64 chloral in, 59 chloralamid in, 61 chloralose in, 62 hypnonein, 65 of insanity, duboisine in, 72 with mental excitement insanity, hyoscine in, 72 due to mental excitement, tetronal in, 64 due to mental excitement, trional in, 64 methylal in, 65 due to nervous excitement, bro- mides in, 83 due to pain, opium in, 56 paraldehyde in, 64 sulphonalin, 63 urethan in, 64 Intermittent fever, quinine in, 184 serpentaria in, 207 Intestinal fermentation, sulphonal in, 63 Iritis, mercury in, 166 rheumatic, salicylates in, 189 J. Jaundice, catarrhal, citric acid in, 127 catarrhal, hydrastis in, 266 catarrhal, potassium acetate in, 215 iris in, 237 manganese in, 153 podophyllum in, 236 rhubarb in,233 Joint, diseases of, irritants in, 268 gouty, ichthyol in, 176 rheumatic, croton oil in, 278 ichthyol in, 176 K. Keratitis, belladonna in, 69 tannic acid in, 131 L. Labor, after-pains of, antipyrin in, 202 pain of, chloral in, 60 Laryngismus stridulus, gelsemium in, 88 ipecac in, 247 lobelia in, 254 valerian in, 38 Laryngitis, acute, tartar emetic in, 117 glycerin in, 284 pseudomembranous, mercury in, 166 tar in, 258 Lead-colic, alum in, 147 salines in, 231 -poisoning, iodides in, 169 sulphuric acid in, 154 Leucorrhoea, bismuth subnitrate in, 140 hydrastis in, 267 kino in, 134 kreolin in, 198 lime-water in, 289 potassium permanganate in, 293 resorcin in, 199 Leukaemia, ergot in, 265 Liver, fatty, nitro-hydrochloric acid in, 156 torpidity of, aloes in, 234 ammonium chloride in, 256 calomel in, 240 citric acid in, 127 euonymus in, 237 iodides in, 169 iris in, 237 nitric acid in, 155 podophyllum in, 236 potassium acetate in, 215 rhubarb in, 234 sanguinaria in, 248 sodium phosphate in, 231 taraxacum in, 176 Locomotor ataxia, antipyrin in, 202 silver nitrate in, 139 Lumbago, Burgundy pitch, 270 salicylates in, 189 Lupus, aristol in, 172 arsenic in, 162 arsenous acid in, 275 escharotics in, 273 THERAPEUTICAL INDEX. 349 Lupus, phosphorus in, 159 potassa in, 274 zinc chloride in, 143 Lymphadenoma, arsenic in, 162 iodine in, 168 M. Malaria, chloroform in, 47 chronic, arsenic in, 162 quinine in, 184 pernicious, quinine in, 184 quinine in, 183 Warburg's tincture in, 186 Malignant pustule, potassa in, 274 escharotics in, 273 Malnutrition, koumyss in, 304 Mania, acute, conium in, 87 chloral in, 59 hyoscine in, 72 63 Masturbation, bromides in, 84 Melancholia, camphor in, 36 coca in, 74 Membranous croup, ipecac in, 247 Meningitis, chronic, actual cautery in, 277 cold in, 19 Menorrhagia, acetanilid in, 203 amyl nitrite in, 92 antipyrin in, 202 arsenic in, 162 bromides in, 83 caffeine in, 115 cannabis indica in, 58 digitalis in, 109 ergot in, 264 gallic acid in, 132 hydrastinine in, 267 hydrastis in, 267 ipecac in, 247 oil of turpentine in, 223 savine in, 261 ' Mitral disease, digitalis in, 108 insufficiency, digitalis in, 108 stenosis, digitalis in, 108 Mollifies ossium, hypophosphites in, 174 Morphine-habit, antipyrin in, 202 Myalgia, salicylates in, 189 Myelitis, phosphorus in, 159 Myxoedema, thyroid extract in, 178 N. Nausea, morning, strychnine in, 78 Nausea, reflex, cerium oxalate in, 148 Nephritis, Basham's mixture in, 151 chronic, iodides in, 169 digitalis in, 109 strophanthus in, 112 Nervous disturbances, of menopause, bromides in, 84 excitability, bromides in, 83 excitement, monobromated camphor in, 37 exhaustion, phosphorus in, 159 headache, caffeine in, 115 camphor in, 36 valerian in, 38 prostration, massage in, 21 Neuralgia, abdominal, hydrocyanic acid in, 126 acetanil id in, 203 ammonium chloride in, 256 anti pyrin in, 202 arsenic in, 162 bromides in, 84 cannabis indica in, 58 chloral camphor in, 62 chloroform in, 47 cimicifuga in, 41 cocaine in, 50 cod-liver oil in, 172 copper sulphate, 141 electricity in, 21 ergot in, 265 facial, belladonna in, 68 gelsemium in, 88 hydrocyanic acid in, 126 iron in, 149 massage in, 21 menthol in, 198 ovarian, belladonna in, 69 gelsemium in, 88 phosphorus in,159 quinine in, 184 reflex, zinc valerianate in, 143 sciatic, belladonna in, 68 iodides in, 169 trifacial, aconite in, 121 croton-chloral in, 61 valerian in, 38 Neurasthenia, arsenic in, 162 coca in, 74 ferric hypophosphite in, 152 hypophosphites in, 174 massage in, 21 nitro-hydrochloric acid in, 156 Neuritis, peripheral, strychnine in, 78 Night-sweats, agaric acid in, 136 350 TIIER A PE UTICA L INDEX. Night-sweats, agaricin in, 72 alum in, 147 belladonna in, 68 camphoric acid in, 36 ergot in, 265 gallic acid in, 132 picrotoxin in, 80 sulphuric acid in, 154 white oak in, 135 zinc oxide in, 143 Nocturnal emissions, belladonna in, 68 Nymphomania, bromides in, 84 camphor in, 36 hyoscine in, 72 o. Obesity, low diet in, 308 saccharin in, 285 thyroid extract in, 178 (Edema, cerebral, salines in, 231 general, pilocarpus in, 251 pulmonary, pilocarpus in, 251 Ophthalmia, escharotics in, 273 Opium-poisoning, belladonna in, 69 caffeine in, 115 Osteo-malacia, phosphorus in, 159 prec. calcium phosph, in, 173 Otitis, chronic, resorcin in, 199 Otorrhcea, chronic, tannic acid in, 131 hydrastis in, 267 potassium permanganate in, 293 zinc sulphate in, 143 Oxaluria, nitro-hydrochloric acid in, 156 Oxyuris, quassia in, 206 Ozaena, bromine in, 276 potassium chlorate in, 218 potassium permanganate in, 293 P. Palate, relaxation of, tannic acid in, 131 Palsies, electricity in, 20 Paralysis agitans, duboisine in, 72 lead-, strychnine in, 78 massage in, 21 Pelvic disorders, massage in, 20 Pemphigus, arsenic in, 162 Periostitis, syphilitic, prec. calcium phosph.in, 173 Pericarditis, calomel in, 166 diaphoretics in, 249 with effusion, squill in, 211 Pericarditis, iodides in, 169 irritants in, 268 Peritonitis, aconite in, 122 opium in, 56 poultices in, 286 veratrum viride in, 119 Pertussis, ammonium bromide in, 85 belladonna in, 68 bromides in, 84 chestnut in, 136 chloral in, 59 ergot in, 265 grindelia in, 255 hydrocyanic acid in, 126 lobelia in, 254 oil of amber in, 40 resorcin in, 199 valerian in, 38 zinc oxide in, 143 Petit mal, bromides in, 84 strychnine in, 78 Pharyngitis, acute, aconite in, 121 pulsatilla in, 122 rhus glabra in, 135 chronic, potassium chlorate in, 218 creosote in, 197 menthol in, 198 salol in, 191 subacute, potassium chlorate in, 218 rhus glabra in, 135 Phthiriasis, staphisagria in, 123 Phthisis, cannabis indica in, 58 cod-liver oil in, 172 creosote in, 197 guaiacol in, 198 hydrocyanic acid in, 126 hypophosphites in, 174 iodine in, 168 milk-diet in, 302 prec. calcium phosph, in, 173 wild cherry in, 210 Pityriasis, arsenic in, 162 Pleurisy, acute, aconite in, 122 calomel in. 166 chronic, iodides in, 169 squill in, 211 cups in, 271 diaphoretics in, 249 gelsemium in, 88 iodine in, 168 irritants in, 268 pilocarpus in, 251 poultices in, 286 veratrum viride in, 119 Pneumonia, aconite in, 121 alcoholic, musk in, 39 THERAPEUTICAL INDEX. 351 Pneumonia, ammonia in, 95 antipyrin in, 202 cups in, 271 digitalis in, 109 gelsemium in, 88 guaiacol in, 198 mercury in, 166 nuclein in, 180 poultices in, 286 typhoid, musk in, 39 veratrum viride in, 119 Poisoning, acid, acacia in, 280 acute, strychnine in, 79 alcohol in, 102 by alkaloids, iodides in, 169 . tannic acid in, 131 ammonia in, 95 arsenic, ferric hydrate in, 150 carbolic acid, magnesium sulphate in, 231 emetics in, 245 ivy, carbolic acid in, 195 lobelia in, 89 lead-, iodides in, 169 mercury, iodides in, 169 phosphorus, copper sulphate in, 141 zinc sulphate in, 143 Poisonous bites, potassa in, 274 Polyuria, ergot in, 265 Priapism, camphor in, 36 Prostate, enlarged, ergot in, 265 uva ursi in, 220 Prurigo, hydrocyanic acid in, 126 lime-water in, 289 naphthalin in, 294 Pruritus ani, cocaine in, 50 vulvae, cocaine in, 50 silver nitrate in, 138 Psoriasis, aristol in, 172 arsenic in, 162 chrysarobin in, 278 phosphorus in, 159 pyrogallol in, 132 tar in, 258 Ptyalism, mercurial, belladonna in, 68 of pregnancy, belladonna in, 68 Puerperal fever, aconite in, 122 septicaemia, nuclein in, 180 quinine in, 184 streptococcus antitoxin in, 179 Pruritus vulvae, belladonna in, 69 Purpura, digitalis in, 109 ergot in, 264 gallic acid in, 132 Purpura, oil of turpentiue in, 223 strychnine in, 78 Pyelitis, chronic, buchu in, 219 copaiba in, 224 grindelia in, 255 oil of juniper in, 221 oil of turpentine in, 223 Pyemia, quinine in, 184 Pyrosis, manganese in, 153 R. Rectum, inflammation of, iodoform in, 171 Remittent fever, quinine in, 184 Retention of urine, oil of turpentine in, 223 Rheumatism, acute, ammonium bro- mide in, 85 arsenic in, 16*2 benzoic acid in, 201 citric acid in, 127 ipecac in, 252 oil of Wintergreen in, 191 potassium acetate in, 215 bicarbonate in, 215 salicin in, 190 salicylates in, 189 salol in, 191 alcohol in, 253 antipyrin in, 202 chloroform in, 47 chronic, arsenic in, 162 cod-liver oil in, 172 guaiac in, 175 cimicifuga in, 41 electricity in, 21 gonorrhoeal, salicylates in, 189 gout, colchicum in, 178 muscular, ammonium chloride in, 256 cannabis indica in, 58 iodides in, 169 ipecac in, 252 pilocarpus in, 251 oil of cajuput in, 299 sodium benzoate in, 201 staphisagria in, 123 subacute, colchicum in, 178 guaiac in, 175 iodides in, 169 salicylates in, 189 sulphur in, 227 Rheumatoid arthritis, arsenic in, 162 iodides in, 169 Rhinitis, chronic, sanguinaria in, 249 352 THERAPEUTICAL INDEX. Rhus toxicodendron poisoning, car- bolic acid in, 195 Rickets, chalk in, 290 cod-liver oil in, 172 hypophosphites in, 174 phosphoric acid in, 173 phosphorus in, 159 prec. calcium phosphate in, 173 Round worm, azedarach in, 242 oil of wormseed in, 242 santonin in, 241 spigelia in, 242 S. Scabies, copper sulphate in, 141 lime-water in, 289 naphthalin in, 294 soft soap in, 278 staphisagria in, 123 sulphur in, 227 tar in, 258 Scarlet fever, capsicum in, 298 chlorine-water in, 296 potassium chlorate in, 218 tincture of ferric chloride, in, 151 Scrofula, cod-liver oil in, 172 iodine in, 168 phosphoric acid in, 173 Scrofulosis, syrup of iodide of iron in, 151 Scurvy, citric acid in, 127 oil of turpentine in, 223 Sea-sickness, bromides in, 83 cerium oxalate in, 148 chloral in, 59 ipecac in, 247 Seat-worms, quassia in, 206 Seborrhcea, glycerin in, 284 Septicaemia, alcohol in, 102 puerperal, aconite in, 122 alcohol in, 102 quinine in, 184 Sexual excitement, hops in, 40 hyoscine in, 72 sulphonalin, 63 Shock, ammonia in, 95 belladonna in, 68 cocaine in, 74 strychnine in, 78 Skin diseases, chronic, sulphur in, 227 chrysarobin in, 278 cod-liver oil in, 172 irritative, creosote in, 197 parasitic, pyrogallol in, 132 Skin diseases, resorcin in, 199 vesicants in, 271 Snake-bite, alcohol in, 102 ammonia in, 95 Softening of the brain, phosphorus in, 159 Spasm, bronchial, grindelia in, 255 lobelia in, 254 conium in, 87 curare in, 86 of glottis, opium in, 56 laryngeal, lobelia in, 254 peristaltic, belladonna in, 68 of sphincter ani, belladonna in, 68 urethral, belladonna in, 68 Spermatorrhoea, bromides in, 84 cimicifuga in, 41 digitalis in, 109 hyoscine in, 72 monobromated camphor in, 37 oil of turpentine in, 223 sulphonalin, 63 Sprains, alcohol in, 103 witch-hazel in, 135 Stomatitis, aphthous, thymol in, 199 mercurial, potassium chlorate in, 218 tannic acid in, 131 potassium chlorate in, 218 salol in, 191 Streptococcus infection, alcohol in, 102 antitoxin in, 179 Strychnine-poisoning, bromides in, 84 curare in, 86 physostigma in, 82 tobacco in, 90 Subinvolution of uterus, cimicifuga in, 41 Sunburn, acetic acid in, 128 Sunstroke, cold in, 19 Sweating, colliquative, lead acetate in, 146 Synechiae, belladonna in, 69 physostigma in, 82 Syncope, alcohol in, 103 ammonia in, 95 amyl nitrite in, 92 Synovitis, carbolic acid in, 195 massage in, 21 Syphilis, aristol in, 172 (cachexia), cod-liver oil in, 172 guaiac in, 175 iodine in, 168 nitro-hydrochloric acid in, 156 prec. calcium phosph, in, 173 sanguinaria in, 249 THERAPEUTICAL INDEX. 353 Syphilis, sarsaparilla in, 175 secondary, mercury in, 166 sulphur in, 227 tertiary, mercury in, 166 iodides in, 169 T. Tachycardia, bromides in, 84 Tape-worm, ailanthus in, 244 aspidium in, 243 cocoa-nut in, 244 cusso in, 243 granatum in, 243 kamala in, 243 oil of turpentine in, 244 pepo in, 244 Tetanus, amyl nitrite in, 91 antitoxin in, 179 bromides in, 84 cannabis indica in, 58 chloral in, 59 curare in, 86 gelsemium in, 88 physostigma in, 82 tobacco in, 90 Thyroid enlargement, iodine in, 168 Tic douloureux, butyl-chloral hydrate in, 62 Tinea capitis, lime-water in, 289 copper sulphate in, 141 Tonsillitis, acute, aconite in, 121 capsicum in, 298 salicylates in, 189 silver nitrate in, 138 guaiac in, 175 Toothache, creosote in, 197 oil of cloves in, 297 Torticollis, belladonna in, 68 Trismus neonatorum, chloral in, 59 Tuberculosis, cod-liver oil in, 172 hypophosphites in, 174 iodoform in, 171 koumyss in, 304 nuclein in, 180 prec. calcium phosph, in, 173 pulmonary, alcohol in, 102 sanguinaria in, 249 syrup of iodide of iron in, 151 tuberculin in, 179 Tumors, cystic, silver nitrate in, 138 Tympanites, asafetida in, 39 oil of turpentine in, 223 Typhoid fever, alcohol in, 101 autipyrin in, 202 camphor in, 36 Typhoid, fever, guaiacol in, 198 milk-diet in, 302 nuclein in, 180 oil of turpentine in, 223 salol in, 191 silver nitrate in, 139 quinine in, 184 Typhus fever, antipyrin in, 202 quinine in, 184 u. Ulcers, chancroidal, sulphuric acid in, 154 chlorine-water in, 296 gastric, arsenic in, 162 resorcin in, 199 indolent, arsenic in, 162 copper sulphate in, 141 creosote in, 197 escharotics in, 273 ichthyol in, 176 silver nitrate in, 138 zinc chloride in, 143, 275 iodoform in, 171 irritable, silver nitrate in, 138 malignant, zinc chloride in, 143 painful, alum in, 147 carbolic acid in, 195 rodent, potassa in, 274 sloughing, potassium permanganate in, 293 of stomach and bowel, oil of turpen- tine in, 223 silver nitrate in, 138 syphilitic, corrosive sublimate in, 277 Uraemia, croton oil in, 239 diaphoretics in, 249 elaterin in, 238 jalap in, 236 opium in, 56 peptonized milk in, 305 •pilocarpus in, 251 salines in, 231 Urethral chill, aconite in, 122 Urethritis, chronic, buchu in, 219 catechu in, 133 granular, silver nitrate in, 138 potassium acetate in, 215 Uric-acid diathesis, lithium benzoate in, 201 Urticaria, chronic, ichthyol in, 176 hydrocyanic acid in, 126 nutgall in, 132 Uterine inertia, ergot in, 264 23-M. M. 354 THERAPEUTICAL INDEX. Uterine inertia, kola in, 267 quinine in, 267 Uvula, elongated, tannic acid in, 131 V. Vaginismus, belladonna in, 69 Varicose veins, ergot in, 265 Vomiting, alcohol in, 103 of alcoholism, strychnine in, 78 bismuth subnitrate in, 140 cocaine in, 50, 74 creosote in, 197 hydrocyanic acid in, 126 lime-water in, 289 nervous, carbolic acid in, 195 neurotic, chloral in, 59 peptonized milk in, 305 of pregnancy, aconite in, 122 bromides in, 83 chloral in, 59 Vomiting of pregnancy, copper sul- phate in, 141 ipecac in, 247 staphisagria in, 123 strychnine in, 78 reflex, cerium oxalate in, 148 sodium sulphocarbolate in, 196 of uterine disease, bromides in, 83 Vulvitis, tannic acid in, 131 W. Warts, escharotics in, 273 venereal, nitric acid in, 155 Wasting diseases, milk-diet in, 302 peptonized milk in, 305 Worms, chloroform in, 47 Y. Yellow fever, lead acetate in, 146 CATALOGUE OF PUBLICATIONS OF LEA BROTHERS & COMPANY, 706, 708 & 710 Sansom St., Philadelphia. Ill Fifth Ave. (Cor. 18th St.), New York. The books in the annexed list will be sent by mail, post-paid, to any Post-Office in the United States, on receipt of the printed prices. INDEX. ANATOMY. Gray, p. 11 ; Treves, 30 ; Gerrish, 11; Brockway, 4. DICTIONAitlES. Dunglison, p. 8 ; Duane, 8 ; National, 4 PHYSICS. Draper, p. 8 ; Robertson, 24 ; Martin & Rockwell, 20. PHYSIOLOGY. Foster, p. 10; Chapman, 5; Schofield, 25; Collins & Rockwell, 6. [Luff, 19 ; Remsen, 24. CHEMISTRY. Simon, p. 26 ; Attfield, 3 ; Martin & Rockwell, 20; PHARMACY. Caspari, p. 5. [Bruce, 4 : Schleif, 25. MATERIA MEDICA. Culbreth, p. 6 ; Maisch, 19 ; Farquharson, 9 ; DISPENSATORY. National, p. 21. THERAPEUTICS Hare, p. 13 ; Fothergill, 10 ; Whitla, 31 ; Hayem & Hare, 14 ; Bruce, 4 ; Schleif, 25 ; Cushny, 6. PRACTICE. Flint, p. 9 ; Loomis & Thompson, 19 ; Malsbary, 20. DIAGNOSIS. Musser, p.21; Hare, 12; Simon, 25; Herrick, 15; Hutchi- son & Rainey, 16 ; Collins, 6. CLIMATOLOGY. Solly, p. 26 ; Hayem & Hare, 14. NERVOUS DISEASES. Dercum, p 7 ; Gray, 11 ; Potts, 23. MENTAL DISEASES. Clouston, p. 5 ; Savage, 24 ; Folsom, 10. BACTERIOLOGY. Abbott, p. 2; Vaughan & Novy, 30; Senn's (Surgical), 25. Park, 22 ; Coates, 6. [Vale, 21. HISTOLOGY. Klein, p. 17 ; Schafer's, 25 ; Dunham, 8 ; Nichols & PATHOLOGY. Green, p. 12; Gibbes, 10; Coats, 6; Nichols & Vale, 21 SURGERY. Park, p. 22; Dennis, 7; Roberts, 24; Ashhurst, 3; Treves, 29; Cheyne & Burghard, 5 ; Gallaudet, 10. SURGERY-OPERATIVE. Stimson, p. 27 ; Smith, 26 ; Treves, 29. SURGERY-ORTHOPEDIC. Young, p. 31 ; Gibney, 10. SURGERY--MINOR. Wharton, p. 30. [Ballenger & FRACTURES and DISLOCATIONS. Stimson, p. 27. [Wippern, 3. OPHTHALMOLOGY. Norris & Oliver, p. 21; Nettleship, 21; Juler, 17; OTOLOGY. Politzer, p. 23; Burnett, 5; Field, 9; Bacon, 4. LARYNGOLOGY and RHINOLOGY. Coakley, p. 6 ; DENTISTRY. Essig (Prosthetic), p. 9 ; Kirk (Operative), 17 ; Ameri- can System, 2; Coleman, 6; Burchard 4. URINARY DISEASES. Roberts, p. 24; Black, 4. VENEREAL DISEASES. Taylor, p. 28 ; Hayden, 14 ; Cornil, 6 ; SEXUAL DISORDERS. Fuller, p. 10; Taylor, 29. [Likes, 19. DERMATOLOGY Hyde, p. 16 ; Jackson, 16 ; Pye-Smith, 24 ; Mor- ris, 20 ; Jamieson, 16; Hardaway, 12 ; Grindon, 12. GYNECOLOGY. American System, p. 3 ; Thomas & Mund6, 29 Emmet, 9 ; Davenport, 7 ; May, 20 ; Dudley, 8 ; Crockett, 6. OBSTETRICS. American System, p. 3 ; Davis, 7 ; Parvin, 22 ; Play- fair, 23 ; King, 17 ; Jewett, 17 ; Evans, 9. PEDIATRICS. Smith, p 26 ; Thomson, 29 ; Williams, 31 ; Tuttle, 30. HYGIENE. Egbert, p. 9 ; Richardson, 24 ; Coates, 6. MEDICAL JURISPRUDENCE. Taylor, p. 28. QUIZ SERIES, POCKET TEXT-BOOKS and MANUALS. Pp. 18, 25 and 27. 1.15.00. 2 Lea Brothers & Co., Philadelphia and New York. ABBOTT (A. C.). PRINCIPLES OF BACTERIOLOGY: a Practical Manual for Students and Physicians. New (5th) edition thoroughly revised and greatly enlarged. In one handsome 12mo. vol. of 585 pages, with 109 engrav., of which 26 are colored. Just ready. Cloth, $2.75, net. One of its most attractive charac- teristics is that the directions are so clearly given that anyone with a moderate amount of laboratory train- ing can, with a little care as to detail, make his experiments sue- cessfully. To those who require a condensed yet nevertheless complete work upon Bacteriology we most cordially recommend it.- The Thera- peutic Gazette. AMERICAN SYSTEM OF PRACTICAL MEDICINE. A SYS- TEM OF PRACTICAL MEDICINE. In contributions by Various American Authors. Edited by Alfred L. Loomis, M.D., LL.D., and W. Gilman Thompson, M. D. In four very handsome octavo volumes of about 900 pages each, fully illustrated. Complete work now ready. Per volume, cloth, $5; leather, $6; half Morocco, $7. For sale by subscription only. Prospectus free on application. Every chapter is a masterpiece of completeness, and is particularly ex- cellent in regard to treatment, many original prescriptions, formulse, charts and tables being given for the guidance of the practitioner. "The American System of Medi- cine" is a work of which every American physician may reasonably feel proud, and in which every prac- titioner will find a safe and trust- worthy counsellor in the daily re- sponsibilities of practice.-The Ohio Medical Journal. AMERICAN SYSTEM OF DENTISTRY. In treatises by various authors. Edited by Wilbur F. Litch, M.D., D.D.S. In three very handsome super-royal octavo volumes, containing about 3200 pages, with 1873 illustrations and many full-page plates. Per vol., cloth, $6; leather, $7; half Morocco, $8. For sale by subscription only. Pros- pectus free on application to the Publishers. AMERICAN TEXT-BOOKS OF DENTISTRY. In Contribu- tions by Eminent American Authorities. In two very handsome octavo volumes, richly illustrated : PROSTHETIC DENTISTRY. Edited by Charles J. Essig, M.D., D.D.S., Professor of Mechanical Dentistry and Metallurgy, Department of Dentistry, University of Pennsylvania, Philadelphia. 760 pages, 983 engravings. Cloth, $6; leather, $7. Net. No more thorough production will be found either in this country or in any country where dentistry is un- derstood as a part of civilization.- The International Dental Journal. It is up to date in every particular. It is a practical course on prosthetics which any student can take up dur- ing or after college.-Dominion Den- tal Journal. OPERATIVE DENTISTRY. Edited by Edward C. Kirk, D.D.S., Professor of Clinical Dentistry, Department of Dentistry, University of Pennsylvania. 699 pages, 751 engravings. Cloth, $5.50; leather, $6.50. Net. Just ready. Written by a number of practi- tioners as well known at the chair as in journalistic literature, many of them teachers of eminence in our colleges. It should be included in the list of text-books set down as most useful to the college student.- The Dental News. It is replete in every particular and treats the subject in a progressive manner. It is a book that every progressive dentist should possess, and we can heartily recommend it to the profession.- The Ohio Dental Journal. Lea Brothers A Co., Philadelphia and New York. 3 AMERICAN SYSTEMS OF GYNECOLOGY AND OBSTET- RICS. In treatises by the most eminent American specialists. Gyne- cology edited by Matthew D. Mann, A. M., M. D., and Obstetrics edited by Barton C. Hirst, M. D. In four large octavo volumes comprising 3612 pages, with 1092 engravings, and 8 colored plates. Per volume, cloth, $5 ; leather, $6; half Russia, $7. For sale by subscrip- tion only. Prospectus free on application to the Publishers. AMERICAN TEXT-BOOK OF ANATOMY. See Gwa/i, page 11. ALLEN (HARRISON). A SYSTEM OF HUMAN ANATOMY; WITH AN INTRODUCTORY SECTION ON HISTOLOGY, by E. O. Shakespeare, M.D. Comprising 813 double-columned quarto pages, with 380 engravings on stone, 109 plates, and 241 wood cuts in the text. In six sections, each in a portfolio. Price per section, $3.50. Also, bound in one volume, cloth, $23. Sold by subscription only. A PRACTICE OF OBSTETRICS BY AMERICAN AU- THORS. See Jewett, page 17. A TREATISE ON SURGERY BY AMERICAN AUTHORS. FOR STUDENTS AND PRACTITIONERS OF SURGERY AND MEDICINE. Edited by Roswell Park, M.D. See page 22. ASHHURST (JOHN, JR.). THE PRINCIPLES AND PRACTICE OF SURGERY. For the use of Students and Practitioners. Sixth and revised edition. In one large and handsome octavo volume of 1161 pages, with 656 engravings. Cloth, $6 ; leather, $7. As a masterly epitome of what has been said and done in surgery, as a succinct and logical statement of the principles of the subject, as a model text-book, we do not know its equal. It is the best single text-book of surgery that we have yet seen in this country.-New York Post-Graduate. A SYSTEM OF PRACTICAL MEDICINE BY AMERICAN AUTHORS. Edited by William Pepper, M. D., LL. D. In five large octavo volumes, containing 5573 pages and 198 illustrations. Price per volume, cloth, $5 ; leather $6 ; half Russia, $7. Sold by subscrip- tion only. Prospectus free on application to the Publishers. ATTFIELD (JOHN). CHEMISTRY; GENERAL, MEDICAL AND PHARMACEUTICAL. New (16th) edition, specially revised by the Author for America. In one handsome 12mo. volume of 784 pages, with 88 illustrations. Cloth, $2.50, net. It is replete with the latest inform- ation, and considers the chemistry of every substance recognized officially or in general practice. The modern scientific chemical nomenclature has been adopted, bringing the work into close touch with the latest United States Pharmacopoeia, of which it is a worthy companion.- The Pittsburg Medical Review. BALLENGER (W. L.) AND WIPPERN (A. G.). Shortly. A POCKET TEXT-BOOK OF DISEASES OF THE EYE, EAR, NOSE AND THROAT. In one handsome 12mo. volume of about 400 pages, with many illustrations. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See p. 18. BARNES (ROBERT AND FANCOURT). A SYSTEM OF OB- STETRIC MEDICINE AND SURGERY. Octavo, 872 pages, with 231 illus. Cloth, $5 ; leather, $6. 4 Lea Brothers & Co., Philadelphia and New York. BACON (GORHAM). ON THE EAR. One 12mo. volume, 400 pages, 109 engravings and a colored plate. Cloth, net, $2.00. Just ready. It is thebest manual upon otology. | dents of medicine-Cleveland Jour- An intensely practical book for stu- I nal of Medicine. BARTHOLOW (ROBERTS). CHOLERA; ITS CAUSATION, PRE- VENTION AND TREATMENT. In one 12mo. volume of 127 pages, with 9 illustrations. Cloth, $1.25. BARTHOLOW (ROBERTS). MEDICAL ELECTRICITY. A PRACTICAL TREATISE ON THE APPLICATIONS OF ELEC- TRICITY TO MEDICINE AND SURGERY. Third edition. In one octavo volume of 308 pages, with 110 illustrations. BILLINGS (JOHN S.). THE NATIONAL MEDICAL DICTIONARY. Including in one alphabet English, French, German, Italian and Latin Technical Terms used in Medicine and the Collateral Sciences. In two very handsome imperial octavo volumes containing 1574 pages and two colored plates. Per volume, cloth, $6; leather, $7; half Morocco, $8.50. For sale by subscription only. Specimen pages on application to the publishers. BLACK (D. CAMPBELL). THE URINE IN HEALTH AND DISEASE, AND URINARY ANALYSIS, PHYSIOLOGICALLY AND PATHOLOGICALLY CONSIDERED. In one 12mo. volume of 256 pages, with 73 engravings. Cloth, $2.75. A concise, yet complete manual, treating of the subject from a prac- tical and clinical standpoint.-The Ohio Medical Journal. Concise, practical, clinical, well illustrated and well printed.-Mary- land Medical Journal. BLOXAM (C. L.). CHEMISTRY, INORGANIC AND ORGANIC. With Experiments. New American from the fifth London edition. In one handsome octavo volume of 727 pages, with 292 illustrations. Cloth, $2 ; leather, $3. BROCKWAY (F. J.). A POCKET TEXT-BOOK OF ANATOMY. In one handsome 12mo. volume of about 400 pages, with many illus- trations. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. BRUCE (J. MITCHELL). MATERIA MEDICA AND THERA- PEUTICS. New (6th) edition. In one 12mo. volume of 600 pages. Just ready. Cloth, $1.50, net. See Student's Series of Manuals, page, 27. PRINCIPLES OF TREATMENT. In one octavo volume. Pre- paring. BRYANT (THOMAS). THE PRACTICE OF SURGERY. Fourth American from the fourth English edition. In one imperial octavo vol. of 1040 pages, with 727 illustrations. Cloth, $6.50; leather, $7.50. BURCHARD (HENRY H.). DENTAL PATHOLOGY AND THER- APEUTICS. Handsome octavo, 575 pages, with 400 illustrations. Cloth, net, $5.00; leather, net, $6.00. Lea Brothers & Co., Philadelphia and New York. 5 BURNETT (CHARLES H.)« THE EAR: ITS ANATOMY, PHYSI- OLOGY AND DISEASES. A Practical Treatise for the Use of Students and Practitioners. Second edition. In one 8vo. volume of 580 pages, with 107 illustrations. Cloth, $4; leather, $5. CARTER (R. BRUDENELL) AND FROST (W. ADAMS). OPH- THALMIC SURGERY. In one pocket-size 12mo. volume of 559 pages, with 91 engravings and one plate. Cloth, $2.25. See Series of Clinical Manuals, page 25. CASPARI (CHARLES JR.). A TREATISE ON PHARMACY. For Students and Pharmacists. In one handsome octavo volume of 680 pages, with 288 illustrations. Cloth, $4.50. The author's duties as Professor of Theory and Practice of Pharmacy in the Maryland College of Phar- macy, and his contact with students made him aware of their exact wants in the matter of a manual. His work is admirable, and the student who cannot understand must be dull indeed. The book is full of new, clean, sharp illustrations,which tell the story frequently at a glance. The index is full and accurate.- National Druggist. CHAPMAN (HENRY C.). A TREATISE ON HUMAN PHYSI- OLOGY. New (2d) edition. In one octavo volume of 921 pages, with 595 illustrations. Just ready. Cloth, $4.25; leather, $5.25, net. In every respect the work fulfils its promise, whether as a complete treatise for the student or as an ad- mirable work of reference for the physician.-North Carolina Medical Journal. CHARLES (T. CRANSTOUN). THE ELEMENTS OF PHYSIO- LOGICAL AND PATHOLOGICAL CHEMISTRY. Octavo, 451 pages, with 38 engravings and 1 colored plate. Cloth, $3.50. CHEYNE (W. WATSON). THE TREATMENT OF WOUNDS, ULCERS AND ABSCESSES. In one 12mo. volume of 207 pages. Cloth, $1.25. One will be surprised at the amount of practical and useful in- formation it contains; information that the practitioner is likely to need at any moment. The sections devoted to ulcers and abscesses are indispensable to any physician.- The Charlotte Medical Journal. CHEYNE (W. W.) AND BURGHARD (F. F.). SURGICAL TREATMENT. In six octavo volumes, illustrated. Now ready. Volume 1, 299 pages and 66 engravings. Cloth, $3.00 net. Volume 2, 382 pages, 141 engravings. Cloth, $4.00 net. CLARKE (W. B.) AND LOCKWOOD (C. B.). THE DISSECTOR'S MANUAL. In one 12mo. volume of 396 pages, with 49 engravings. Cloth, $1.50. See Students' Series of Manuals, page 27. CLELAND (JOHN). A DIRECTORY FOR THE DISSECTION OF THE HUMAN BODY. In one 12mo. vol. of 178 pages. Cloth, $1.25. CLINIC AL MANUALS. See Series of Clinical Manuals, page 25. CLOUSTON (THOMAS S.). CLINICAL LECTURES ON MENTAL DISEASES. New (5th) edition. In one octavo volume of 750 pages, with 19 colored plates. Cloth, $4.25, net. Just ready. JS@**Folsom's Abstract of Laws of U. S. on Custody of Insane, octavo, $1.50, is sold in conjunction with Clouston on Mental Diseases for $5.00, net, for the two works. 6 Lea Brothers & Co., Philadelphia,(and New York. CLOWES (FRANK). AN ELEMENTARY TREATISE ON PRACTI- CAL CHEMISTRY AND QUALITATIVE INORGANIC ANALY- SIS. From the fourth English edition. In one handsome 12mo. volume of 387 pages, with 55 engravings. Cloth, $2.50. COAKLEY (CORNELIUS G.). THE DIAGNOSIS AND TREAT- MENT OF DISEASES OF THE NOSE, THROAT, NASO- PHARYNX AND TRACHEA. In one 12mo. volume of 526 pages with92 engravings and 2 colored plates. Justready. Cloth, $2.75. net. COATES (W. E., JR.). A POCKET TEXT-BOOK OF BACTE- RIOLOGY AND HYGIENE. In one handsome 12mo. volume of about 350 pages, with many illustrations. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. COATS (JOSEPH). A TREATISE ON PATHOLOGY. In one vol. of 829 pages, with 339 engravings. Cloth, $5.50; leather, $6.50. COLEMAN (ALFRED). A MANUAL OF DENTAL SURGERY AND PATHOLOGY. With Notes and Additions to adapt it to Amer- ican Practice. By Thos. C. Stellwagen, M.A., M.D., D.D.S. In one handsome octavo vol. of 412 pages, with 331 engravings. Cloth, $3.25. COLLINS (C. P.). A POCKET TEXT-BOOK OF MEDICAL DIAGNOSIS. In one handsome 12mo. volume of about 350 pages, with many illustrations. Shortly. Thea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. COELINS (H. D.) AND ROCKWELL (W. H.). A POCKET TEXT-BOOK OF PHYSIOLOGY. 12mo. of 316 pages, with 153 illustrations. Justready. Cloth, $1.50; flexible red leather, $2.00, net. Lea's Series of Pocket Text-books, edited by Bern B. Gallau- det, M. D. See page 18. CONDIE (D. FRANCIS). A PRACTICAL TREATISE ON THE DIS- EASES OF CHILDREN. Sixth edition, revised and enlarged. In one large 8vo. volume of 719 pages. Cloth, $5.25; leather, $6.25. CORNIL (V.). SYPHILIS: ITS MORBID ANATOMY, DIAGNO- SIS AND TREATMENT. Translated, with Notes and Additions, by J. Henry C. Simes, M.D. and J. William White, M. D. In one 8vo. volume of 461 pages, with 84 illustrations. Cloth, $3.75. CROCKETT (M. A.). A POCKET TEXT-BOOK OF DISEASES OF WOMEN. In one handsome 12mo. volume of about 350 pages, with many illustrations. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. CROOK (JAMES K.) ON MINERAL WATERS OF THE UNITED STATES. Octavo, 575 pages. Justready. Cloth, $3.50, net. CULBRETH (DAVID M. R.). MATERIA MEDICA AND PHAR- MACOLOGY. In one handsome octavo volume of 812 pages, with 445 illustrations. Cloth, $4.75. CUSHNY (ARTHUR R.). TEXT-BOOK OF PHARMACOLOGY. Handsome 8vo., 728 pages, with 47 illus. Just ready. Cloth, $3.75, net. Lea Brothers & Co., Philadelphia and New York. 7 DALTON (JOHN C.). A TREATISE ON HUMAN PHYSIOLOGY. Seventh edition. Octavo, 722 pages, with 252 engravings. Cloth, $5; leather, $6. DOCTRINES OF THE CIRCULATION OF THE BLOOD. In one handsome 12mo. volume of 293 pages. Cloth, $2. DAVENPORT (F. H.). DISEASES OF WOMEN. A Manual or Gynecology. For the use of Students and Practitioners. New (3d) edition. In one handsome 12mo. volume of 387 pages, with 150 illustrations. Cloth, $1.75, net. Just ready. DAVIS (EDWARD P.). A TREATISE ON OBSTETRICS. FOR STUDENTS AND PRACTITIONERS. In one very handsome octavo volume of 546 pages, with 217 engravings and 30 full-page plates in colors and monochrome. Cloth, $5; leather, $6. From a practical standpoint the work is all that could be desired. A thoroughly scientific and brilliant treatise on obstetrics. -Med. News. DAVIS (F. H.). LECTURES ON CLINICAL MEDICINE. Second edition. In one 12mo. volume of 287 pages. Cloth, $1.75. DE LA BEGHE'S GEOLOGICAL OBSERVER. In one large octavo volume of 700 pages, with 300 engravings. Cloth, $4. DENNIS (FREDERIC S.) AND BILLINGS (JOHN S.). A SYS- TEM OF SURGERY. In contributions by American Authors. Complete work in four very handsome octavo volumes, containing 3652 pages, with 1585 engravings and 45 full-page plates in colors and monochrome. Per volume, cloth, $6.00; leather, $7.00; half Morocco, gilt back and top, $8.50. For sale by subscription only. Full prospectus free on application to the publishers. It is worthy of the position which surgery has attained in the great Republic whence it comes. - The London Lancet. It may be fairly said to represent the most advanced condition of American surgery and is thoroughly practical.-Annals of Surgery. No work in English can be con- sidered as the rival of this.-The American Journal of the Medical Sciences. DERCUM (FRANCIS X., EDITOR). A TEXT-BOOK ON NERVOUS DISEASES. By American Authors. In one handsome octavo volume of 1054 pages, with 341 engravings and 7 colored plates. Cloth, $6.00 ; leather, $7.00. Net. Representing the actual status of our knowledge of its subjects, and the latest and most fully up-to-date of any of its class.-Jour, of Amer- ican Med. Association. The most thoroughly up-to-date treatise that we have on this subject. -American Journal of Insanity. The work is representative of the best methods of teaching, as devel- oped in the leading medical colleges of this country.-Alienist and Neu- rologist. The best text-book in any lan- guage.-The Medical Fortnightly. DE SCHWEPNITZ (GEORGE E.). THE TOXIC AMBLYOPIAS. Their Classification, History, Symptoms, Pathology and Treatment. Very handsome octavo, 240 pages, 46 engravings, and 9 full-page plates in colors. Limited edition, de luxe binding, $4. Net. 8 Lea Brothers & Co., Philadelphia and New York. DRAPER (JOHN C.). MEDICAL PHYSICS. A Text-book for Stu- dents and Practitioners of Medicine. In one handsome octavo volume of 734 pages, with 376 engravings. Cloth, $4. DRUITT (ROBERT). THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. A new American, from the twelfth London edition, edited by Stanley Boyd, F. R. C. S. In one large octavo volume of 965 pages, with 373 engravings. Cloth, $4; leather, $5. DUANE (ALEXANDER). THE STUDENT'S DICTIONARY OF MEDICINE AND THE ALLIED SCIENCES. New edition. Com- prising the Pronunciation, Derivation and Full Explanation of Medi- cal Terms, with much Collateral Descriptive Matter. Numerous Tables, etc. Square octavo of 658 pages. Cloth, $3.00; half leather, $3.25; full sheep, $3.75. Thumb-letter Index, 50 cents extra. DUDLEY (E. C.). THE PRINCIPLES AND PRACTICE OF GYNECOLOGY. New (2d) edition. Handsome octavo of 717 pages, with 453 illustrations in black and colors, and 8 colored plates. Cloth, $5.00, net; leather,$6.00,net. Just ready. The book can be safely recom- mended as a complete and reliable exposition of the principles and prac- tice of modern gynecology.-Inter- national Medical Magazine. DUNCAN (J. MATTHEWS). CLINICAL LECTURES ON THE DISEASES OF WOMEN. Delivered in St. Bartholomew's Hospital. In one octavo volume of 175 pages. Cloth, $1.50. DUNGLISON (ROBLEY). A DICTIONARY OF MEDICAL SCI- ENCE. Containing a full explanation of the various subjects and terms of Anatomy, Physiology Medical Chemistry, Pharmacy, Phar- macology, Therapeutics, Medicine, Hygiene, Dietetics, Pathology, Sur- gery, Ophthalmology, Otology, Laryngology, Dermatology, Gynecol- ogy, Obstetrics, Pediatrics, Medical Jurisprudence, Dentistry, etc., etc. By Robley Dunglison, M. D., LL. D., late Professor of Institutes of Medicine in the Jefferson Medical College of Philadelphia. Edited by Richard J. Dunglison, A. M., M. D. Twenty-first edition, thor- oughly revised and greatly enlarged and improved, with the Pronuncia- tion, Accentuation and Derivation of the Terms. With Appendix. In one magnificent imperial octavo volume of 1225 pages. Cloth, $7 ; leather, $8 Thumb-letter Index for quick use, 75 cents extra. The most satisfactory and authori- tative guide to the derivation, defini- tion and pronunciation of medical terms.-The CharlotteMed Journal. Covering the entire field of medi- cine, surgery and the collateral sciences, its range of usefulness can scarcely be measured.-Med. Record. Pronunciation is indicated by the phonetic system. The definitions are unusually clear and concise. The book is wholly satisfactory.- Uni- versity Medical Magazine. DUNHAM (EDWARD K.). MORBID AND NORMAL HIS- TOLOGY. Octavo, 450 pages,with 363 illustrations. Cloth, $3.25, net. The best one-volume text or refer- ence book on histology that we know of published in America.- Virginia Medical Semi-Monthly. EDES (ROBERT T.). TEXT-BOOK OF THERAPEUTICS AND MATERIA MEDICA. In one 8vo. volume of 544 pages. Cloth, $3.50 ; leather, $4.50. EDIS (ARTHUR W.). DISEASES OF WOMEN A Manual for Students and Practitioners. In one handsome 8vo. volume of 576 pages, with 148 engravings. Cloth, $3; leather, $4 Lea Brothers & Co., Philadelphia and New York. 9 EGBERT (SENECA). A MANUAL OF HYGIENE AND SANI- TATION. In one 12mo. volume of 359 pages, with 63 illustrations. Just ready. Cloth, Net, $2.25. It is written in plain language, and, while primarily designed for physicians, it can be studied with profit by any one of ordinary intel- ligence. The writer has adapted it to American conditions, and his suggestions are, above all, practical. -The New York Medical Journal. ELLIS (GEORGE VINER). DEMONSTRATIONS IN ANATOMY. Eighth edition. Octavo, 716 pages, with 249 engravings. Cloth, $4.25; leather, $5.25. EMMET (THOMAS ADDIS). THE PRINCIPLES AND PRAC- TICE OF GYNAECOLOGY. Third edition. Octavo, 880 pages, with 150 original engravings. Cloth, $5; leather, $6. ERICHSEN (JOHN E.). THE SCIENCE AND ART OF SUR- GERY. Eighth edition. In two large octavo volumes containing 2316 pages, with 984 engravings. Cloth, $9; leather, $11. ESSIG (CHARLES J.). PROSTHETIC DENTISTRY. See American Text-Books of Dentistry, page 2. EVANS (DAVID J.). A POCKET TEXT-BOOK OF OBSTETRICS. In one handsome 12mo. volume of about 300 pages, with many illustra- tions. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. FARQUHARSON (ROBERT). A GUIDE TO THERAPEUTICS. Fourth American from fourth English edition, revised by Frank Woodbury, M. D. In one 12mo. volume of 581 pages. Cloth, $2.50. FIELD (GEORGE P.). A MANUAL OF DISEASES OF THE EAR. Fourth edition. In one octavo volume of 391 pages, with 73 engravings and 21 colored plates. Cloth, $3.75. FLINT (AUSTIN). A TREATISE ON THE PRINCIPLES AND PRACTICE OF MEDICINE. Seventh edition, thoroughly revised by Frederick P. Henry, M. D. In one large 8vo. volume of 1143 pages, with engravings. Cloth, $5.00; leather, $6.00. The work has well earned its lead- ing place in medical literature.- Medical Record. The best of American text-books on Practice.-Amer.Medico-Surgical Bulletin. A MANUAL OF AUSCULTATION AND PERCUSSION; or the Physical Diagnosis of Diseases of the Lungs and Heart, and of Thoracic Aneurism. Fifth edition, revised by James C. Wilson, M. D. In one handsome 12mo. volume of 274 pages, with 12 engravings. A PRACTICAL TREATISE ON TJEJE DIAGNOSIS AND TREATMENT OF DISEASES OF THE HEART. Second edition enlarged. In one octavo volume of 550 pages. Cloth, $4. A PRACTICAL TREATISE ON THE PHYSICAL EXPLO- RATION OF THE CHEST, AND THE DIAGNOSIS OF DIS- EASES AFFECTING THE RESPIRATORY ORGANS. Second and revised edition. In one octavo volume of 591 pages. Cloth, $4.50. MEDICAL ESSAYS. In one 12mo. vol. of 210 pages. Cloth, $1.38. ON PHTHISIS: ITS MORBID ANATOMY ETIOLOGY, ETC. A Series of Clinical Lectures. In one 8vo. volume of 442 pages. Cloth, $3.50. 10 Lea Brothers & Co., Philadelphia and New York. FOLSOM (C. F.). AN ABSTRACT OF STATUTES OF U. S. ON CUSTODY pF THE INSANE. In one 8vo. vol. of 108 pages. Cloth, $1.50. With Clouston on Mental Diseases (new edition, see page 6) $5.00, net, for the two works. FORMULARY, POCKET, see page 32. FOSTER (MICHAEL). A TEXT-BOOK OF PHYSIOLOGY. New (6th) and revised American from the sixth English edition. In one large octavo volume of 923 pages, with 257 illustrations. Cloth, $4.50; leather, $5.50. Unquestionably the best book that can be placed in the student's hands, and as a work of reference for the busy physician it can scarcely be excelled.-The Phila. Polyclinic. This single volume contains all that will be necessary in a college course, and all that the physician will need as well.-Dominion Med. Monthly. FOTHERGILL (J. MILNER). THE PRACTITIONER'S HAND- BOOK OF TREATMENT. Third edition. In one handsome octavo volume of 664 pages. Cloth, $3.75; leather, $4.75. FOWNES (GEORGE). A MANUAL OF ELEMENTARY CHEM- ISTRY (INORGANIC AND ORGANIC). Twelfth edition. Em- bodying Watts' Physical and Inorganic Chemistry. In one royal 12mo. volume of 1061 pages, with 168 engravings, and 1 colored plate. Cloth, $2.75; leather, $3.25. FRANKLAND (E.) AND JAPP (F.R.). INORGANIC CHEMISTRY. In one handsome octavo volume of 677 pages, with 51 engravings and 2 plates. Cloth, $3.75; leather, $4.75. FULLER (EUGENE). DISORDERS OF THE SEXUAL OR- GANS IN THE MALE. In one very handsome octavo volume of 238 pages, with 25 engravings and 8 full-page plates. Cloth, $2. It is an interesting work, and one which, in view of the large and profitable amount of work done in this field of late years, is timely and well needed.-Medical Fortnightly. The book is valuable and instruc- tive and brings views of sound pathology and rational treatment to many cases of sexual disturbance whose treatment has been too often fruitless for good. - Annals of Surgery. FULLER (HENRY). ON DISEASES OF THE LUNGS AND AIR PASSAGES. Their Pathology, Physical Diagnosis, Symptoms and Treatment. From second English edition. In one 8vo. volume of 475 pages. Cloth, $3.50. GALLAUDET (BERN B.). A POCKET TEXT-BOOK ON SUR- GERY. In one handsome 12mo. volume of about 400 pages, with many illustrations. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. GANT (FREDERICK JAMES). THE STUDENT'S SURGERY. A Multum in Parvo. In one square octavo volume of 845 pages, with 159 engravings. Cloth, $3.75. GIBBES (HENEAGE). PRACTICAL PATHOLOGY AND MORBID HISTOLOGY. Octavo, 314 pages, with 60 illustrations. Cloth, $2.75. GIBNEY (V. P.). ORTHOPEDIC SURGERY. For the use of Practi- tioners and Students. In one 8vo. vol. profusely illus. Preparing. Lea Brothers & Co., Philadelphia and New York. 11 GERR1SH (FREDERIC H.). A TEXT-BOOK OF ANATOMY. By American Authors. Edited by Frederic H. Gerrish, M. D. In one imp. octavo volume of 915 pages, with 950 illustrations in black and colors. Just ready. Clth,$6.50; flexible waterproof, $7; leath., $7.50, net. In this, the first representative treatise on Anatomy produced in America, no effort or expense has been spared to unite an authoritative text with the most successful anatomical pictures which have yet appeared in the world. The editor has secured the co-operation of the professors of anatomy in leading medical colleges, and with them has prepared a text conspicuous for its simplicity, unity and judicious selection of such anatomical facts as bear on physiology, surgery and internal medicine in the most compre- hensive sense of those terms. The authors have endeavored to make a book which shall stand in the place of a living teacher to the student, and which shall be of actual service to the practitioner in his clinical work, emphasizing the most important subjects, clarifying obscurities, helping most in the parts most difficult to learn, and illustrating everything by all available methods. GOUED (A. PEARCE). SURGICAL DIAGNOSIS. In one 12mo. vol. of 589 pages. Cloth, $2. See Student's Series of Manuals, p. 27. GRAY (HENRY). ANATOMY, DESCRIPTIVE AND SURGICAL. New and thoroughly revised American edition, much enlarged in text, and in engravings in black and colors. In one imperial octavo volume of 1239 pages, with 772 large and elaborate engravings on wood. Price of edition with illustrations in colors : cloth, $7 ; leather, $8. Price of edition with illustrations in black: cloth, $6; leather, $7. This is the best single volume upon Anatomy in the English language.- University Medical Mag- azine. Gray's Anatomy affords the student more satisfaction than any other treatise with which we are familiar. -Buffalo Med. Journal. The most largely used anatomical text-book published in the English language.-Annals of Surgery. Particular stress is laid upon the practical side of anatomical teach- ing, and especially the Surgical Anatomy.-Chicago Med. Recorder. Holds first place in the esteem of both teachers and students.- The Brooklyn Medical Journal. The foremost of all medical text- books.-Medical Fortnightly. Gray's Anatomy should be the first work which a medical student should purchase, nor should he be without a copy throughout his pro- fessional career.-Pittsburg Medical Review. GRAY (LANDON CARTER). A TREATISE ON NERVOUS AND MENTAL DISEASES. For Students and Practitioners of Medicine. New (2d) edition. In one handsome octavo volume of 728 pages, with 172 engravings and 3 colored plates. Cloth, $4.75; leather, $5.75. An up-to-date text-book upon nervous and mental diseases com- bined. A well-written, terse, ex- plicit, and authoritative volume treating of both subjects is a step in the direction of popular demand.- The Chicago Clinical Review. The descriptions of the various diseases are accurate and the symp- toms and differential diagnosis are set before the student in such a way as to be readily comprehended. The author's long experience renders his views on therapeutics of great value. -The Journal of Nervous and Men- tal Disease. 12 Lea Brothers & Co., Philadelphia and New York. GREEN (T. HENRY). AN INTRODUCTION TO PATHOLOGY AND MORBID ANATOMY. New (8th) American from the eighth London edition. In one handsome octavo volume of 582 pages, with 216 engravings and a colored plate. Cloth, $2.50, net. Just ready. A work that is the text-book of probably four-fifths of all the stu- dents of pathology in the United States and Great Britain.-The American Practitioner and News. It is fully up-to-date in the record of fact, and so profusely illustrated as to give to each detail of text sufficient explanation. The work is an essential to the practitioner- whether as surgeon or physician. It is the best of up-to-date text-books. - Virginia Med. Monthly. GREENE (WILLIAM H.). A MANUAL OF MEDICAL CHEM- ISTRY. For the Use of Students. Based upon Bowman's Medical Chemistry. In one 12mo. vol. of 310 pages, with 74 illus. Cloth, $1.75. GROSS (SAMUEL D.). A PRACTICAL TREATISE ON THE DIS- EASES, INJURIES AND MALFORMATIONS OF THE URINARY BLADDER, THE PROSTATE GLAND AND THE URETHRA. Third edition. Octavo, 574 pages, with 170 illustrations Cloth, $4.50. GRINDON (JOSEPH). A POCKET TEXT-BOOK OF SKIN DISEASES. In one handsome 12mo. volume of 350 pages, with many illustrations. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. HABERSHON (S. O.). ON THE DISEASES OF THE ABDOMEN Second American from the third English edition. In one octavo vol- ume of 554 pages, with 11 engravings. Cloth, $3.50. HALL (WINFIELD S.). TEXT-BOOK OF PHYSIOLOGY. Octavo of 672 pages, with 343 engravings, and 6 full page colored plates. Just ready. Cloth, $4.00 ; leather, $5.00, net. HAMILTON (ALLAN MCLANE). NERVOUS DISEASES, THEIR DESCRIPTION AND TREATMENT. Second and revised edition. In one octavo volume of 598 pages, with 72 engravings. Cloth, $4. HARDAWAY (W. A.). MANUAL OF SKIN DISEASES. New (2d) edition. In one 12mo. volume of 560 pages, with 40 illustrations and 2 plates. Cloth, $2.25, net. Just ready. The best of all the small books to recommend to students and practi- tioners. Probably no one of our dermatol ogists has had a wider every- day clinical experience. His great strength is in diagnosis, descriptions of lesions and especially in treat- ment.-Indiana Medical Journal. HARE (HOBART AMORY). PRACTICAL DIAGNOSIS. THE USE OF SYMPTOMS IN THE DIAGNOSIS OF DISEASE. New (4th) edition. In one octavo volume of 623 pages, with 205 engravings and 14 full-page colored plates. Cloth, $5.00, net. Just ready. It is unique in many respects, and the author has introduced radical changes which will be welcomed by all. Anyone who reads this book will become a more acute observer, will pay more attention to the simple yet indicative signs of disease, and he will become a better diagnosti- cian. This is a companion to Prac- tical Therapeutics, by the same author, and it is difficult to conceive of any two works of greater practical utility.-Medical Review. Lea Brothers & Co., Philadelphia and New York. 13 HARE (HOBART AMORY). A TEXT-BOOK OF PRACTICAL THERAPEUTICS, with Special Reference to the Application of Reme- dial Measures to Disease and their Employment upon a Rational Basis. With articles on various subjects by well-known specialists. New (7th) and revised edition. In one octavo volume of 776 pages. Cloth, $3.75, net; leather, $4.50, net. Its classifications are inimitable, and the readiness with which any- thing can be found is the most won- derful achievement of the art of in- dexing. This edition takes in all the latest discovered remedies.- The St. Louis Clinique. The great value of the work lies in the fact that precise indications for administration are given. A complete index of diseases and remedies makes it an easy reference work. It has been arranged so that it can be readily used in connection with Hare's Practical Diagnosis. For the needs of the student and general practitioner it has no equal. -Medical Sentinel. The best planned therapeutic work of the century.-American Prac- titioner and News. It is a book precisely adapted to the needs of the busy practitioner, who can rely upon finding exactly what he needs.-The National Med- ical Review. HARE (HOBART AMORY) ON THE MEDICAL COMPLICA- TIONS AND SEQUELAE OF TYPHOID FEVER. Octavo, 276 pages, 21 engravings and two full-page plates. Just ready. Cloth, $2.40, net. A very valuable production. One of the very best products of Dr. Hare and one that every man can read with great profit.-Cleveland Journal of Medicine. HARE (HOBART AMORY, EDITOR). A SYSTEM OF PRAC- TICAL THERAPEUTICS. In a series of contributions by eminent practitioners. In four large octavo volumes comprising about 4500 pages,with about 550 engravings. Vol. IV., just ready. For sale by sub- scription only. Full prospectus free on application to the Publishers. Regular price, Vol. IV., cloth, $6; leather, $7; half Russia, $8. Price Vol. IV. to former or new subscribers to complete work, cloth, $5 ; leather, $6; half Russia, $7. Complete work, cloth, $20; leather, $24; half Russia, $28. The great value of Hare's System of Practical Therapeutics has led to a widespread demand for a new volume to represent advances in treatment made since the publication of the first three. More than fulfilling this request the Editor has secured contributions from practically a new corps of equally eminent authors, so that entirely fresh and original matter is ensured. The plan of the work, which proved so successful, has been fol- lowed in this new volume, which will be found to present the latest devel- opments and applications of this most practical branch of the medical art. The entire System is an unrivalled encyclopaedia on the practical parts of medicine, and merits the great success it has won for that reason. 14 Lea Brothers & Co., Philadelphia and New York. HARTSHORNE (HENRY). ESSENTIALS OF THE PRINCIPLES AND PRACTICE OF MEDICINE. Fifth edition. In one 12mo. volume, 669 pages, with 144 engravings. Cloth, $2.75. A HANDBOOK OF ANATOMY AND PHYSIOLOGY. In one 12mo. volume of 310 pages, with 220 engravings. Cloth, $1.75. A CONSPECTUS OF THE MEDICAL SCIENCES. Comprising Manuals of Anatomy, Physiology, Chemistry, Materia Medica, Prac- tice of Medicine, Surgery and Obstetrics. Second edition. In one royal 12mo. vol. of 1028 pages, with 477 illus. Cloth, $4.25; leather, $5. HAYDEN (JAMES R.). A MANUAL OF VENEREAL DISEASES. New (2d) edition. In one 12mo. volume of 304 pages, with 54 en- gravings. Cloth, $1.50, net. It is practical, concise, definite and of sufficient fulness to be satis- factory.- Chicago Clinical Review. This work gives all of the prac- tically essential information about the three venereal diseases, gon- orrhoea, the chancroid and syphilis. In diagnosis and treatment it is par- ticularly thorough, and may be relied upon as a guide in the man- agement of this class of diseases.- Northwestern Lancet. It is well written, up to date, and will be found very useful.-Inter- national Medical Magazine. HAYEM (GEORGES) AND HARE (H. A,). PHYSICAL AND NATURAL THERAPEUTICS. The Remedial Use of Heat, Elec- tricity, Modifications of Atmospheric Pressure, Climates and Mineral Waters. Edited by Prof. H. A. Hare, M. D. In one octavo volume of 414 pages,with 113 engravings. Cloth, $3. This well-timed up-to-date volume is particularly adapted to the re- quirements of the general practi- tioner. The section on mineral waters is most scientific and prac- tical. Some 200 pages are given up to electricity and evidently embody the latest scientific information on the subject. Altogether this work is the clearest and most practical aid to the study of nature's therapeutics that has yet come under our obser- vation^-The Medical Fortnightly. For many diseases the most potent remedies lie outside of the materia medica, a fact yearly receiving wider recognition. Within this large range of applicability, physical agencies when compared with drugs are more direct ana simple in their results. Medical literature has long been rich in treatises upon medical agents, but an authoritative work upon the other great branch of therapeutics has until now been a desideratum. The section on climate, rewritten by Prof. Hare, will, for the first time, place the abundant resources of our country at the in- telligent command of American practitioners. - The Kansas City Medical Index. HERMAN (G. ERNEST). FIRST LINES IN MIDWIFERY. In one 12mo. vol. of 198 pages, with 80 engravings. Cloth, $1.25. See Student's Series of Manuals, page 27. HERMANN (L.). EXPERIMENTAL PHARMACOLOGY. A Hand- book of the Methods for Determining the Physiological Actions of Drugs. Translated by Robert Meade Smith, M. D. In one 12mo. volume of 199 pages, with 32 engravings. Cloth, $1.50. Lea Brothers & Co., Philadelphia and New York. 15 HERRICK (JAMES B.). A HANDBOOK OF DIAGNOSIS. In one handsome 12mo. volume of 429 pages, with 80 engravings and 2 colored plates. Cloth, $2.50. Excellently arranged, practical, concise, up-to-date, and eminently well fitted for the use of the prac- titioner as well as of the student.- Chicago Med. Recorder. This volume accomplishes its ob- jects more thoroughly and com- pletely than any similar work yet published. Each section devoted to diseases of special systems is pre- ceded with an exposition of the methods of physical, chemical and microscopical examination to be em- ployed in each class. The technique of blood examination,including color analysis, is very clearly stated. Uranalysis receives adequate space and care.-Neio York Med. Journal. We commend the book not only to the undergraduate, but also to the physician who desires a ready means of refreshing his knowledge of diag- nosis in the exigencies of professional life.-Memphis Medical Monthly. HILL (BERKELEY). SYPHILIS AND LOCAL CONTAGIOUS DISORDERS. In one 8vo. volume of 479 pages. Cloth, $3.25. HILLIER (THOMAS). A HANDBOOK OF SKIN DISEASES. Second edition. In one royal 12mo. volume of 353 pages, with two plates. Cloth, $2.25. HIRST (BARTON C.) AND PIERSOL (GEORGE A.). HUMAN MONSTROSITIES. Magnificent folio, containing 220 pages of text and illustrated with 123 engravings and 39 large photographic plates from nature. In four parts, price each, $5. Limited edition. For sale by subscription only. HOBLYN (RICHARD D.). A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE COLLATERAL SCIENCES. In one 12mo. volume of 520 double-columned pages. Cloth, $1.50; leather, $2. HODGE (HUGH L.). ON DISEASES PECULIAR TO WOMEN, INCLUDING DISPLACEMENTS OF THE UTERUS. Second and revised edition. In one 8vo. vol. of 519 pp., with illus. Cloth, $4.50 HOFFMANN (FREDERICK) AND POWER (FREDERICK B.). A MANUAL OF CHEMICAL ANALYSIS, as Applied to the Examination of Medicinal Chemicals and their Preparations. Third edition, entirely rewritten and much enlarged. In one handsome octavo volume of 621 pages, with 179 engravings. Cloth, $4.25. HOLMES (TIMOTHY). A TREATISE ON SURGERY. Its Prin- ciples and Practice. A new American from the fifth English edition. Edited by T. Pickering Pick, F.R.C.S. In one handsome octavo vol- ume of 1008Jpages, with 428 engravings. Cloth, $6; leather, $7. A SYSTEM OF SURGERY. With notes and additions by various American authors. Edited by John H. Packard, M. D. In three very handsome 8vo. volumes containing 3137 double-columned pages, with 979 engravings and 13 lithographic plates. Per volume, cloth, $6 ; leather, $7 ; half Russia, $7.50. For sale by subscription only. 16 Lea Brothers & Co., Philadelphia and New York. HORNER (WILLIAM E.). SPECIAL ANATOMY AND HIS- TOLOGY. Eighth edition, revised and modified. In two large 8vo. volumes of 1007 pages, containing 320 engravings. Cloth, $6. HUDSON (A.). LECTURES ON THE STUDY OF FEVER. In one octavo volume of 308 pages. Cloth, $2.50. HUTCHISON (ROBERT) AND RAINY (HARRY). CLINICAL METHODS. A GUIDE TO THE PRACTICAL STUDY OF MEDICINE. In one 12mo. volume of 562 pages, with 137 engrav- ings and 8 colored plates. Cloth, $3.00. A comprehensive, clear and re- markably up-to-date guide to clinical diagnosis. The illustrations are plentiful and excellent. As exam- pies of the more recent additions to medical knowledge which receive recognition, we mention Widal's test for typhoid and the Neuron theory of the nervous system.- Montreal Medical Journal. HUTCHINSON (JONATHAN). SYPHILIS. In one pocket-size 12mo. volume of 542 pages, with 8 chromo-lithographic plates. Cloth, $2.25. See Series of Clinical Manuals, p. 25. HYDE (JAMES NEVINS). A PRACTICAL TREATISE ON DIS- EASES OF THE SKIN. New (4th) edition, thoroughly revised. In one octavo volume of 815 pages, with 110 engravings and 12 full- page plates, 4 of which are colored. Cloth, $5.25; leather, $6.25. This edition has been carefully re- vised, and every real advance has been recognized. The work answers the needs of the general practitioner, the specialist, and the student.-The Ohio Med. Jour. A treatise of exceptional merit characterized by conscientious care and scientific accuracy. - Buffalo Med. Journal. A complete exposition of our knowledge of cutaneous medicine as it exists to-day. The teaching in- culcated throughout is sound as well as practical.-The American Jour- nal of the Medical Sciences. It is the best one-volume work that we know. The student who gets this book will find it a useful investment, as it will well serve him when he goes into practice.- Vir- ginia Medical Semi-Monthly. A full and thoroughly modern text-book on dermatology. - The Pittsburg Medical Remew. It is the most practical hand- book on dermatology with which we are acquainted.-The Chicago Med- ical Recorder. JACKSON (GEORGE THOMAS). THE READY-REFERENCE HANDBOOK OF DISEASES OF THE SKIN. New (3d) edition. In one 12mo. volume of 637 pages, with 75 illustrations and a colored plate. Just ready. Cloth, $2.50, net. As a student's manual, it may be considered beyond criticism. The book is singularly full.-St. Louis Medical and Surgical Journal. Without doubt forms one of the best guides for the beginner in der- matology that is to be found in the English language.-Medicine. JAMIESON (W. ALLAN). DISEASES OF THE SKIN. Third edition. In one octavo volume of 656 pages, with 1 engraving and 9 double-page chromo-lithographic plates. Cloth, $6. Lea Brothers & Co., Philadelphia and New York. 17 JEWETT (CHARLES). ESSENTIALS OF OBSTETRICS. In one 12mo. volume of 356 pages, with 80 engravings and 3 colored plates. Cloth, $2.25. Just ready. An exceedingly useful manual for student and practitioner. The au- thor has succeeded unusually well in condensing the text and in arrang- ing it in attractive and easily tangi- ble form. The book is well illus- trated throughout.-Nashville Jour, of Medicine and Surgery. THE PRACTICE OF OBSTETRICS. By American Authors. One large octavo volume of 763 pages, with 441 engravings in black and colors, and 22 full-page colored plates. Just ready. Cloth, $5.00, net; leather, $6.00, net. A clear and practical treatise upon obstetrics by well-known teachers of the subject. A special feature of this work would seem to be the excellent illustrations with which the book abounds. The work is sure to be popular with medical students, as well as being of extreme value to the practitioner. - The Medical Age. JONES (C. HANDFIELD). CLINICAL OBSERVATIONS ON FUNCTIONAL NERVOUS DISORDERS. Second American edi- tion. In one octavo volume of 340 pages. Cloth, $3.25. JULER (HENRY). A HANDBOOK OF OPHTHALMIC SCIENCE AND PRACTICE. Second edition. In one octavo volume of 549 pages, with 201 engravings, 17 chromo-lithographic plates, test-types of Jaeger and Snellen, and Holmgren's Color-Blindness Test. Cloth, $5.50; leather, $6.50. The volume is particularly rich in matter of practical value, such as directions for diagnosing, use of instruments, testing for glasses, for color blindness, etc. The sections devoted to treatment are singularly full and concise.-Medical Age. KING (A. F. A.). A MANUAL OF OBSTETRICS. Seventh edition. In one 12mo. volume of 573 pages, with 223 illustrations. Cloth, $2.50. From first to finish it is thoroughly practical, concise in expression, well illustrated, and includes a statement of nearly every fact of importance discussed in obstetric treatises or cyclopedias. The well-arranged index renders the book useful to the practitioner who is in haste to refresh his memory. - Virginia Medical Semi-Monthly. KIRK (EDWARD C.). OPERATIVE DENTISTRY. Handsome octavo of 700 pages, with 751 illustrations. Just ready. See American Text-Books of Dentistry, page 2. We have only the highest praise for this valuable work. It is replete in every particular, and surpasses anything of the kind heretofore at- tempted. We can heartily recom- mend it to the profession.-The Ohio Dental Journal. KLEIN (E.). ELEMENTS OF HISTOLOGY. New (5th) edition. In one 12mo. volume of 506 pages, with 296 engravings. Just ready. Cloth, $2.00, net. See Student's Series of Manuals, page 27. It is the most complete and con- cise work of the kind that has yet emanated from the press.- The Med- ical Age. This work deservedly occupies a first place as a text-book on his- tology.-Canadian Practitioner. 18 Lea Brothers & Co., Philadelphia and New York. LANDIS (HENRY G.). THE MANAGEMENT OF LABOR. In one handsome 12mo. volume of 329 pages, with 28 illus. Cloth, $1.75. LA ROCHE (R.). YELLOW FEVER. In two 8vo. volumes of 1468 pages. Cloth, $7. LAURENCE (J. Z.) AND MOON (ROBERT C.). A HANDY- BOOK OF OPHTHALMIC SURGERY. Second edition. In one octavo volume of 227 pages, with 66 engravings. Cloth, $2.75. LEA'S SERIES OF POCKET TEXT-BOOKS, edited by Bern B. Gallaudet, M. D. Covering the entire field of Medicine in a series of 16 very handsome 12mo. volumes of 350-450 pages each, profusely illustrated. Compendious, clear, trustworthy and modern. The following volumes constitute the series. Coates' Bacteriology and Hygiene. Beockway's Anatomy. Collins and Rockwell's Physiology. Mabtin and Rockwell's Chemistry and Physics. Nichols and Vale's Histology and Pathology. Schleie's Materia Medica, Therapeutics, Medical Latin, etc. Mals- baby's Practice of Medicine. Collins' Diagnosis. Potts' Nervous and Mental Diseases. Gallaudet's Surgery. Likes' Genito- urinary and Venereal Diseases. Gbindon'S Dermatology. Ballen- geb and Wippebn'S Diseases of the Eye, Ear, Throat and Nose. Evans' Obstetrics. Cbockett's Gynecology. Tuttle's Diseases or Children. For separate notices see under various authors' names. LEA (HENRY C.). A HISTORY OF AURICULAR CONFESSION AND INDULGENCES IN THE LATIN CHURCH. In three octavo volumes of about 500 pages each. Per volume, cloth, $3.00. CHAPTERS FROM THE RELIGIOUS HISTORY OF SPAIN; CENSORSHIP OF THE PRESS; MYSTICS AND ILLUMINATI- THE ENDEMONIADAS ; EL SANTO NlfJO DE LA GUARDIA; BRIANDA DE BARDAXI. 12mo., 522 pages. Cloth, $2.50. FORMULARY OF THE PAPAL PENITENTIARY. In one octavo volume of 221 pages, with frontispiece. Cloth, $2.50. SUPERSTITION AND FORCE; ESSAYS ON THE WAGER OF LAW, THE WAGER OF BATTLE, THE ORDEAL AND TORTURE. Fourth edition, thoroughly revised. In one hand- some royal 12mo. volume of 629 pages. Cloth, $2.75. STUDIES IN CHURCH HISTORY. The Rise of the Temporal Power-Benefit of Clergy-Excommunication. New edition. In one handsome 12mo. volume of 605 pages. Cloth, $2.50. AN HISTORICAL SKETCH OF SACERDOTAL CELIBACY IN THE CHRISTIAN CHURCH. Second edition. In one hand- some octavo volume of 685 pages. Cloth, $4.50. LEHMANN (C. G.). A MANUAL OF CHEMICAL PHYSIOLOGY. In one 8vo. volume of 327 pages, with 41 engravings. Cloth, $2.25 Lea Brothers & Co., Philadelphia and New York. 19 LIKES (SYLVAN H.). A POCKET TEXT-BOOK OF GENITO- URINARY AND VENEREAL DISEASES. In one handsome 12mo. volume of about 350 pages, with many illustrations. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. LOOMIS (ALFRED L.) AND THOMPSON (W. GILMAN, EDITORS). A SYSTEM OF PRACTICAL MEDICINE. In Contributions by Various American Authors. In four very hand- some octavo volumes of about 900 pages each, fully illustrated in in black and colors. Complete work now ready. Per volume, cloth, $5; leather, $6 ; half Morocco, $7. For sale by subscription only. Full prospectus free on application to the Publishers. See American System of Practical Medicine, page 2. LUFF (ARTHUR P.). MANUAL OF CHEMISTRY, for the use of Students of Medicine. In one 12mo. volume of 522 pages, with 36 engravings. Cloth, $2. See Student's Series of Manuals, page 27. LYMAN (HENRY M.). THE PRACTICE OF MEDICINE. In one very handsome octavo volume of 925 pages, with 170 engravings. Cloth, $4.75 ; leather, $5.75. Complete, concise, fully abreast of the times and needed by all students and practitioners.- Univ. Med. Mag. An exceedingly valuable text-book. Practical, systematic, complete and well balanced.- Chicago Med. Re- corder. LYONS (ROBERT D.). A TREATISE ON FEVER. In one octavo volume of 362 pages. Cloth, $2.25. MACKENZIE (JOHN NOLAND). ON THE NOSE AND THROAT. Handsome octavo, about 600 pages, richly illustrated. Preparing. MAISCH (JOHN M.). A MANUAL OF ORGANIC MATERIA MEDICA. New (7th) edition, thoroughly revised by H. C. C. Maisch, Ph. G., Ph. D. In one very handsome 12mo. volume of 512 pages, with 285 engravings. Just ready. Cloth, $2.50, net. Used as text-book in every college of pharmacy in the United States and recommended in medical col- leges.-American Therapist. Noted on both sides of the Atlantic and esteemed as much in Germany as in America. The work has no equal. -Dominion Med. Monthly. The best handbook upon phar- macognosy of any published in this country.-Boston Med. & Sur. Jonr. 20 Lea Brothers & Co., Philadelphia and New York. MALSBARY (GEORGE E.). A POCKET TEXT-BOOK OF THEORY AND PRACTICE OF MEDICINE. In one handsome 12mo. volume of 405 pages, with 45 illustrations. Just ready.. Cloth, $1.75, net; flexible red leather, $2.25, net. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. MANUALS. See Student's Quiz Series, page 27, Student's Series of Manuals, page 27, and Series of Clinical Manuals, page 25. MARSH (HOWARD). DISEASES OF THE JOINTS. In one 12mo. volume of 468 pages, with 64 engravings and a colored plate. Cloth, $2. See Series of Clinical Manuals, page 25. MARTIN (EDWARD). A MANUAL OF SURGICAL DIAGNOSIS. In one 12mo. volume of about 400 pp., fully illustrated. Preparing. MARTIN (WALTON) AND ROCKWELL (WM. H.). A POCKET TEXT-BOOK OF CHEMISTRY AND PHYSICS. In one hand- some 12mo. volume of about 350 pages, with many illustrations. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. MAY (C. H.). MANUAL OF THE DISEASES OF WOMEN. For the use of Students and Practitioners. Second edition, revised by L. S. Rah, M. D. In one 12mo. volume of 360 pages, with 31 engrav- ings. Cloth, $1.75. MEDICAL NEWS POCKET FORMULARY, see page 32. MITCHELL (S. WEIR). CLINICAL LESSONS ON NERVOUS DISEASES. In one 12mo. volume of 299 pages, with 19 engravings and 2 colored plates. Cloth, $2.50. Of the hundred numbered copies with the Author's signed title page a few remain; these are offered in green cloth, gilt top, at $3.50, net. The book treats of hysteria, recur- rent melancholia, disorders of sleep, choreic movements, false sensations of cold, ataxia, hemiplegic pain, treatment of sciatica, erythromelal- gia, reflex ocularneurosis, hysteric contractions, rotary movements in the feeble minded, etc. Few can speak with more authority than the author.- The Journal of the Ameri- can Medical Association. MITCHELL (JOHN K.). REMOTE CONSEQUENCES OF IN- JURIES OF NERVES AND THEIR TREATMENT. In one handsome 12mo. volume of 239 pages,with 12 illustrations. Cloth, $1.75. Injuries of the nerves are of fre- quent occurrence in private practice, and often the cause of intractable and painful conditions, conse- quently this volume is of especial interest. Doctor Mitchell has had access to hospital records for the last thirty years, as well as to the government documents, and has skilfully utilized his opportunities, -The Med. Age. MORRIS (MALCOLM). DISEASES OF THE SKIN. New (2d) edition. In one 12mo. volume of 601 pages, with 10 chromo-litho- graphic plates and 26 engravings. Cloth, $3.25, net. Just ready. MULLER (J.). PRINCIPLES OF PHYSICS AND METEOROL- OGY. In one large 8vo. vol. of 623 pages, with 538 cuts. Cloth, $4.50. Lea Brothers & Co., Philadelphia and New York. 21 MUSSER (JOHN H.). A PRACTICAL TREATISE ON MEDICAL DIAGNOSIS, for Students and Physicians. New (3d) edition, thor- oughly revised. In one octavo volume of 1082 pages, with 253 en- gravings and 48 full-page colored plates. Just ready. Cloth, $6.00, net; leather, $7.00, net. Notices of previous edition are appended. We have no work of equal value in English. - University Medical Magazine. His descriptions of the diagnostic manifestations of diseases are accu- rate. This work will meet all the requirements of student and physi- cian.-The Medical News. From its pages may be made the diagnosis of every malady that afflicts the human body, including those which in general are dealt with only by the specialist.-North- western Lancet. It so thoroughly meets the precise demands incident to modern research that it has been adopted as a leading text-book by the medical colleges of this country.-North American Practitioner. Occupies the foremost place as a thorough, systematic treatise.- Ohio Medical Journal. The best of its kind, invaluable to the student, general practitioner and teacher.-Montreal Medical Journal. NATIONAL DISPENSATORY. See Stille, Maisch & Caspari, p. 27. NATIONAL FORMULARY. See Stillb, Maisch & Gaspari's National Dispensatory, page 27. NATIONAL MEDICAL DICTIONARY. See Billings, page 4. NETTLESHIP (E.). DISEASES OF THE EYE. New (5th) American from sixth English edition, thoroughly revised. In one 12mo. volume of 521 pages, with 161 engravings, and 2 colored plates, test-types, formulae and color-blindness test. Cloth, $2.25. Just ready. By far the best student's text-book on the subject of ophthalmology and is conveniently and concisely ar- ranged.-The Clinical Review. It has been conceded by ophthal- mologists generally that this work for compactness, practicality and clearness has no superior in the English language. - Journal of Medicine and Science. The present edition is the result of revision both in England and America, and therefore contains the latest and best ophthalmological ideas of both continents.- The Phy- sician and Surgeon. NICHOLS (JOHN B.) AND VALE (F. P.). A POCKET TEXT- BOOK OF HISTOLOGY AND PATHOLOGY. In one handsome 12mo. volume of 452 pages, with 213 illustrations. Just ready. Cloth, $1.75, net: flexible red leather, $2.25, net. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. NOKRIS (WM. F.) AND OLIVER (CHAS. A.). TEXT-BOOK OF OPHTHALMOLOGY. In one octavo volume of 641 pages, with 357 engravings and 5 colored plates. Cloth, $5 ; leather, $6. A safe and admirable guide, well qualified to furnish a working knowledge of ophthalmology. - Johns Hopkins Hospital Bulletin. It is practical in its teachings. We unreservedly endorse it as the best, the safest and the most compre- hensive volume upon the subject that has ever been offered to the Amer- ican medical public.-Annals of Ophthalmology and Otology. 22 Lea Bbothebs &'Co-> Philadelphia and New Yobe. OWEN (EDMUND). SURGICAL DISEASES OF CHILDREN. In one 12mo. volume of 525 pages, with 85 engravings and 4 colored plates. Cloth, $2. See Series of Clinical. Manuals, page 25. PARK (ROSWELL). A TREATISE ON SURGERY BY AMERI- CAN AUTHORS. New and condensed edition. Just ready. In one royal octavo volume of 1261 pages, with 625 engravings and 37 full-page plates. Cloth, $6.00, net-, leather, $7.00, net. work is also published in a larger edition, comprising two volumes. Volume I., General Surgery, 799 pages, with 356 engravings and 21 full-page plates, in colors and monochrome. Volume IL, Special Surgery, 800 pages, with 430 engravings and 17 full-page plates, in colors and monochrome. Per volume, cloth, $4.50; leather, $5.50, net. The work is fresh, clear and practi- cal, covering the ground thoroughly yet briefly, and well arranged for rapid reference, so that it will be of special value to the student and busy K".tioner. The pathology is , clear and scientific, while the suggestions upon treatment are clear-cut, thoroughly modern and admirably resourceful.-Johns Hop- kins Hospital Bulletin. The latest and best work written upon the science and art of surgery. Columbus Medical Journal. The illustrations are almost en- tirely new and executed in such a way that they add great force to the text.-The Chicago Medical Re- corder. The various writers have em- bodied the teachings accepted at the present hour.-The North Amer- ican Practitioner. Both for the student and practi- tioner it is most valuable. It is thoroughly practical and yet thor- oughly scientific.-Medical News. A truly modern surgery, not only in pathology, but also in sound surgical therapeutics. - New Or- leans Med. and Surgical Journal. PARK (WILLIAM H.). BACTERIOLOGY IN MEDICINE AND SURGERY. 12mo., 688 pages, with 87 illustrations in black and colors, and 2 plates. Just ready. Cloth, $3.00 net. PARRY (JOHN S.). EXTRA-UTERINE PREGNANCY, ITS CLINICAL HISTORY, DIAGNOSIS, PROGNOSIS AND TREAT- MENT. In one octavo volume of 272 pages. Cloth, $2.50. PARVIN (THEOPHILUS). THE SCIENCE AND ART OF OB- STETRICS. Third edition. In one handsome octavo volume of 677 pages, with 267 engravings and 2 colored plates. Cloth, $4.25; leather, $5.25. In the foremost rank among the most practical and scientific medical works of the day.-Medical News. The book is complete in every de- partment, and contains all the neces- sary detail required by the modern practising obstetrician. - Interna- tional Medical Magazine. Parvin's work is practical, con- cise and comprehensive. We com- mend it as first of its class in the English language.-Medical Fort- nightly. Lea Brothers & Co., Philadelphia and New York. 23 PEPPER'S SYSTEM OF MEDICINE. See page 3. PEPPER (A. J.). FORENSIC MEDICINE. In press. See Student's Series of Manuals, page 27. SURGICAL PATHOLOGY. In one 12mo. volume of 511 pages, with 81 engravings. Cloth, $2. See Student's Series of Manuals, p. 27. PICK (T. PICKERING). FRACTURES AND DISLOCATIONS. In one 12mo. volume of 530 pages, with 93 engravings. Cloth, $2. See Series of Clinical Manuals, page 25. PLAYFAIR (W. S.). A TREATISE ON THE SCIENCE AND PRACTICE OF1 MIDWIFERY. Seventh American from the ninth English edition. In one octavo volume of 700 pages, with 207 engravings and 7 plates. Cloth, $3.75 net; leather, $4.75, net. Just ready. In the numerous editions which have appeared it has been kept con- stantly in the foremost rank. It is a work which can be conscientiously recommended to the profession.- The Albany Medical Annals. This work must occupy a fore- most place in obstetric medicine as a safe guide to both student and obstetrician. It holds a place among the ablest English-speaking authori- ties on the obstetric art.-Buffalo Medical and Surgical Journal. An epitome of the science and practice of midwifery, which em- bodies all recent advances. -■ The Medical Fortnightly. THE SYSTEMATIC TREATMENT OF NERVE PROSTRA- TION AND HYSTERIA. In one 12mo. volume of 97 pages. Cloth, $1. POCKET FORMULARY, see page 32. POCKET TEXT-BOOKS, see page 18. PODITZER (ADAM). A TEXT-BOOK OF THE DISEASES OF THE EAR AND ADJACENT ORGANS. Second American from the third German edition. Translated by Oscar Dodd, M. D., and edited by Sir William Dalby, F. R. C. S. In one octavo volume of 748 pages, with 330 original engravings. Cloth, $5.50. The anatomy and physiology of each part of the organ of hearing are carefully considered, and then follows an enumeration of the dis- eases to which that special part of the auditory apparatus is especially liable. The indications for treat- ment are clear and reliable. We can confidently recommend it, for it contains all that is known upon the subject.-London Lancet. A safe and elaborate guide into every part of otology.-American Journal of the Medical Sciences. POTTS (CHARLES S.). A POCKET TEXT-BOOK OF NERVOUS AND MENTAL DISEASES. In one handsome 12mo. volume of about 450 pages. Shortly. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See page 18. PROGRESSIVE MEDICINE, see page 32. PURDY (CHARLES W.). BRIGHT'S DISEASE AND ALLIED AFFECTIONS OF THE KIDNEY. In one octavo volume of 288 pages, with 18 engravings. Cloth, $2. 24 Lea Brothers & Co., Philadelphia and New York. PYE-SMITH (PHILIP H.). DISEASES OF THE SKIN. In one 12mo. vol. of 407 pp., with 28 illus., 18 of which are colored. Cloth, $2. QUIZ SERIES. See Student's Quiz Series, page 27. RALFE (CHARLES H.). CLINICAL CHEMISTRY. In one 12mo. volume of 314 pages, with 16 engravings. Cloth, $1.50. See Student's Series of Manuals, page 27. RAMSBOTHAM (FRANCIS H.). THE PRINCIPLES AND PRAC- TICE OF OBSTETRIC MEDICINE AND SURGERY. In one imperial octavo volume of 640 pages, with 64 plates and numerous engravings in the text. Strongly bound in leather, $7. REICHERT (EDWARD T.). A TEXT-BOOK ON PHYSIOLOGY. In one handsome octavo volume of about 800 pages, richly illustrated. Preparing. REMSEN (IRA). THE PRINCIPLES OF THEORETICAL CHEM- ISTRY. New (5th) edition, thoroughly revised. In one 12mo. vol- ume of 326 pages. Cloth, $2. A clear and concise explanation of a difficult subject. We cordially recommend it.-The London Lancet. The book is equally adapted to the student of chemistry or the practi- tioner who desires to broaden his theoretical knowledge of chemistry. -New Orleans Med. and Surg. Jour. The appearance of a fifth edition of this treatise is in itself a guarantee that the work has met with general favor. This is further established by the fact that it has been trans- lated into German and Italian. The treatise is especially adapted to the laboratory student. It ranks unusu- ally high among the works of this class. This edition has been brought fully up to the times.-American Medico-Surgical Bulletin. RICHARDSON (BENJAMIN WARD). PREVENTIVE MEDI CINE. In one octavo volume of 729 pages. Cloth, $4; leather, $5. ROBERTS (JOHN B.). THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. New (2d) edition. In one octavo volume of 838 pages with 473 engravings and 8 plates. ready. Cloth, $4.25, net; leather, $5.25, net. THE COMPEND OF ANATOMY. For use in the Dissecting Room and in preparing for Examinations. In one 16mo. volume of 196 pages. Limp cloth, 75 cents. ROBERTS (SIR WILLIAM). A PRACTICAL TREATISE ON URINARY AND RENAL DISEASES, INCLUDING URINARY DEPOSITS. Fourth American from the fourth London edition. In one very handsome 8vo. vol. of 609 pp., with 81 illus. Cloth, $3.50. ROBERTSON (J. MCGREGOR). PHYSIOLOGICAL PHYSICS. In one 12mo. volume of 537 pages, with 219 engravings. Cloth, $2. See Student's Series of Manuals, page 27. ROSS (JAMES). A HANDBOOK OF THE DISEASES OF THE NERVOUS SYSTEM. In one handsome octavo volume of 726 pages, with 184 engravings. Cloth, $4.50; leather, $5.50. SAVAGE (GEORGE H.). INSANITY AND ALLIED NEUROSES, PRACTICAL AND CLINICAL. In one 12mo. volume of 551 pages, with 18. typical engravings. Cloth, $2. See Series of Clinical Man- uals, page 25. Lea Brothers & Co., Philadelphia and New York. 25 SCHAFER (EDWARD A.). THE ESSENTIALS OF HISTOL- OGY, DESCRIPTIVE AND PRACTICAL. For the use of Studente. New (5th) edition. In one handsome octavo volume of 359 pages, with 392 illustrations. Cloth, $3.00, net. Just ready. Nowhere else will the same very moderate outlay secure as thoroughly useful and interesting an atlas of structural anatomy.-The American Journal of the Medical Sciences. The most satisfactory elementary text-book of histology in the Eng- lish language.-The Boston Med. and Sur. Jour. A COURSE OF PRACTICAL HISTOLOGY. New (2d) edition. In one 12mo. volume of 307 pages, with 59 engravings. Cloth, $2.25. SCHLEIF (WILLIAM). MATERIA MEDICA, THERAPEUTICS, PRESCRIPTION WRITING, MEDICAL LATIN, ETC. 12mo., 352 pages. Cloth, $1.50, net; flexible red leather, $2.00, net. Just ready. Lea's Series of Pocket Text-books. Edited by Bern B. Gallavdet, M. D. See page 18. SCHMITZ AND ZUMPT'S CLASSICAL SERIES. Advanced Latin Exercises. Cloth, 60 cts. Schmidt's Elementary Latin Exer- cises. Cloth, 50 cents. Sallust. Cloth, 60 cents. Nepos. Cloth, 60 cents. Virgil. Cloth, 85 cents. Curtius. Cloth, 80 cents. SCHOFIELD (ALFRED T.). ELEMENTARY PHYSIOLOGY FOR STUDENTS. In one 12mo. volume of 380 pages, with 227 engravings and 2 colored plates. Cloth, $2. SCHREIBER (JOSEPH). A MANUAL OF TREATMENT BY MASSAGE AND METHODICAL MUSCLE EXERCISE. Octavo volume of 274 pages, with 117 engravings. SENN (NICHOLAS). SURGICAL BACTERIOLOGY. Second edi- tion. In one octavo volume of 268 pages, with 13 plates, 10 of which are colored, and 9 engravings. Cloth, $2. SERIES OF CLINICAL MANUALS. A Series of Authoritative Monographs on Important Clinical Subjects, in 12mo. volumes of about 550 pages, well illustrated. The following volumes are now ready: Yeo on Food in Health and Disease, new (2d) edition, $2.50; Carter and Frost's Ophthalmic Surgery, $2.25; Hutchinson on Syphilis, $2.25; Marsh on Diseases of the Joints, $2; Owen on SurgicalDis- eases of Children, $2; Pick on Fractures and Dislocations, $2; Savage on Insanity and Allied Neuroses, $2. For separate notices, see under various authors' names. SERIES OF STUDENT'S MANUALS. See page 27. SIMON (CHARLES E.). CLINICAL DIAGNOSIS, BY MICRO- SCOPICAL AND CHEMICAL METHODS. New (2d) edition. In one very handsome octavo volume of 530 pages, with 135 engravings and 14 full-page colored plates. Cloth, $3.50. Just ready. This book thoroughly deserves its success. It is a very complete, authen- tic and useful manual of the micro- scopical and chemical methods which are employed in diagnosis. Very excellent colored plates illus- trate this work.-New York Medical Journal. In all respects entirely up to date. -Medical Record. The chapter on examination of the urine is the most complete and advanced that we know of in the English language.- Canadian Prac- titioner. 26 Lea Brothers & Co., Philadelphia and New York. SIMON (W.). MANUAL OF CHEMISTRY. A Guide to Lectures and Laboratory Work for Beginners in Chemistry. A Text-book specially adapted for Students of Pharmacy and Medicine. New (6th) edition. In one 8vo. volume of 536 pages, with 46 engravings and 8 plates showing colors of 64 tests. Cloth, $3.00, net. Just ready. It is difficult to see how a better book could be constructed. No man who devotes himself to the practice of medicine need know more about chemistry than is contained between the covers of this book.- The North- western Lancet. Its statements are all clear and its teachings are practical.-Virginia Med. Monthly. SLADE (D. D.). DIPHTHERIA; ITS NATURE AND TREAT- MENT. Second edition. In one royal 12mo. vol., 158 pp. Cloth, $1.25. SMITH (EDWARD). CONSUMPTION; ITS EARLY AND REME- DIABLE STAGES. In one 8vo. volume of 253 pp. Cloth, $2.25. SMITH (J. LEWIS). A TREATISE ON THE DISEASES OF IN- FANCY AND CHILDHOOD. Eighth edition, thoroughly revised and rewritten and much enlarged, tn one large 8vo. volume of 983 pages, with 273 engravings and 4 full-page plates. Cloth, $4.50; leather, $5.50. A safe guide for students and phy- sicians.- The Am. Jour, of Obstetrics, For years the leading text-book on children's diseases in America.- Chicago Medical Recorder. The most complete and satisfac- tory text-book with which we are acquainted.-American Gynecologi- cal and Obstetrical Journal. SMITH (STEPHEN). OPERATIVE SURGERY. Second and thor- oughly revised edition. In one octavo volume of 892 pages, with 1005 engravings. Cloth, $4 ; leather, $5. One of the most satisfactory works on modern operative surgery yet published. The book is a compen- dium for the modern surgeon.-Bos- ton Medical and Surgical Journal. SOLLY (S. EDWIN). A HANDBOOK OF MEDICAL CLIMA- TOLOGY. In one handsome octavo volume of 462 pages, with en- gravings and 11 full-page plates, 5 of which are in colors. Cloth, $4.00. Just ready. A clear and lucid summary of what is known of climate in relation to its influence upon human beings. - The Therapeutic Gazette. The book is admirably planned, clearly written ,and the author speaks from an experience of thirty years as an accurate observer and practical therapeutist.-Maryland Med. Jour. Every practitioner of medicine should possess himself of a copy and study it, and we are sure he will never regret it.-St. Louis Medical and Surgical Journal. STILLE (ALFRED). CHOLERA; ITS ORIGIN, HISTORY, CAUS- ATION, SYMPTOMS, LESIONS, PREVENTION AND TREAT- MENT. In one 12mo. volume of 163 pages, with a chart showing routes of previous epidemics. Cloth, $1.25. THERAPEUTICS AND MATERIA MEDICA. Fourth and revised edition. In two octavo volumes, containing 1936 pages. Cloth, $10; leather, $12. Lea Brothers & Co., Philadelphia and New York. 27 STILLE (ALFRED), MAISCH (JOHN M.) AND CASPARI (CHAS. JR.). THE NATIONAL DISPENSATORY: Containing the Natural History, Chemistry, Pharmacy, Actions and Uses of Medicines, including those recognized in the latest Pharmacopoeias of the United States, Great Britain and Germany, with numerous refer- ences to the French Codex. Fifth edition, revised and enlarged, including the new U. S. Pharmacopoeia, Seventh Decennial Revision. With Supplement containing the new edition of the National Formu- lary. In one magnificent imperial octavo volume of about 2025 pages, with 320 engravings. Cloth, $7.25; leather, $8. With ready reference Thumb-letter Index. Cloth, $7.75 ; leather, $8.50. STIMSON (LEWIS A.). A MANUAL OF OPERATIVE SURGERY. New (3d) edition. In one royal 12mo. volume of 614 pages, with 306 engravings. Cloth, $3.75. A useful and practical guide for all students and practitioners.-Am. Journal of the Medical Sciences. The book is worth the price for the illustrations alone.- Ohio Medical Journal. STIMSON (LEWIS A.). A TREATISE ON FRACTURES AND DISLOCATIONS. In one handsome octavo volume of 831 pages, with 326 engravings and 20 plates. Cloth, $5.00, net; leather, $6.00, net. Preeminently the authoritative text-book upon the subject. The vast experience of the author gives to his conclusions an unimpeachable value. The work is profusely il- lustrated. It will be found indis- pensable to the student and the prac- titioner alike.- The Medical Age. Taken as a whole, the work is the best one in English to-day.-St. Louis Medical and Surgical Journal. Pointed, practical, comprehensive, exhaustive, authoritative, well writ- ten and well arranged.-Denver Medical Times. STUDENT'S QUIZ SERIES. Thirteen volumes, convenient, author- itative, well illustrated, handsomely bound in cloth. 1. Anatomy (double number); 2. Physiology; 3. Chemistry and Physics; 4. Histol- ogy, Pathology, and Bacteriology; 5. Materia Medica and Thera- peutics ; 6. Practice of Medicine; 7. Surgery (double number); 8. Genito- urinary and Venereal Diseases; 9. Diseases of the Skin; 10. Diseases of the Eye, Ear, Throat and Nose; 11. Obstetrics; 12. Gynecology; 13. Diseases of Children. Price, $1 each, except Nos. 1 and 7, Anatomy and Surgery, which being double numbers are priced at $1.75 each. Full specimen circular on application to publishers. STUDENT'S SERIES OF MANUALS. 12mos. of from 300-540 pages, profusely illustrated, and bound in red limp cloth. Herman's First Lines in Midwifery, $1.25; Luff's Manual of Chemistry, $2; Bruce's Materia Medica and Therapeutics (sixth edition), $1.50. net. Bell's Comparative Anatomy and Physiology, $2; Robert- son's Physiological Physics, $2; Gould's Surgical Diagnosis, $2; Klein'S Elements of Histology (5th edition), $2.00, net; Pepper's Surgical Pathology, $2; Treves' Surgical Applied Anatomy, $2; Ralfe's Clinical Chemistry, $1.50; and Clarke and Lockwood's Dissector's Manual, $1.50. The following is in press : Pepper's Forensic Medicine. For separate notices, see under various author's names. 28 Lea Bbothers A Co., Philadelphia and New Yobk. STURGES (OCTAVIUS). AN INTRODUCTION TO THE STUDY OF CLINICAL MEDICINE. In one 12mo. volume. Cloth, $1.25. SUTTON (JOHN BLAND). SURGICAL DISEASES OF THE OVARIES AND FALLOPIAN TUBES. Including Abdominal Pregnancy. In one 12mo. volume of 513 pages, with 119 engravings and 5 colored plates. Cloth, $3. TAIT (LAWSON). DISEASES OF WOMEN AND ABDOMINAL SURGERY. Vol. I. contains 546 pages and 3 plates. Cloth, $3. TANNER (THOMAS HAWKES) ON THE SIGNS AND DIS- EASES OF PREGNANCY. From the second English edition. In one octavo volume of 490 pages, with 4 colored plates and 16 engrav- ings. Cloth, $4.25. TAYLOR (ALFRED S.). MEDICAL JURISPRUDENCE. New American from the twelfth English edition, specially revised by Clark Bell, Esq., of the N. Y. Bar. In one 8vo. vol. of 831 pages, with 54 engrs. and 8 full-page plates. Cloth, $4.50; leather, $5.50 Just ready. To the student, as to the physician, we would say, get Taylor first, and then add as means and inclination enable you.-American Practitioner and News. It is the authority accepted as final by the courts of all English- speaking countries. This is the im- portant consideration for medical men, since in the event of their being summoned as experts or wit- nesses, it strongly behooves them to be prepared according to the princi- ples and practice everywhere ac- cepted. The work will be found to be thorough, authoritative and modern.-Albany Law Journal. Probably the best work on the subject written in the English lan- guage. The work has been thor- oughly revised and is up to date.- Pacific Medical Journal. - ON POISONS IN RELATION TO MEDICINE AND MEDI- CAL JURISPRUDENCE. Third American from the third London edition. In one octavo volume of 788 pages, with 104 illustrations. Cloth, $5.50; leather, $6.50. TAYLOR (ROBERT W.). THE PATHOLOGY AND TREAT- MENT OF VENEREAL DISEASES. In one very handsome octavo volume of 1002 pages, with 230 engravings and 8 colored plates. Cloth, $5.00, net; leather, $6.00, net. By long odds the best work on venereal diseases.-Louisville Medi- cal Monthly. In the observation and treatment of venereal diseases his experience has been greater probably than that of any other practitioner of this con- tinent.-New York Medical Journal. The clearest, most unbiased and ably presented treatise as yet pub- lished on this vast subject.-The Medical News. Decidedly the most important and authoritative treatise on venereal diseases that has in recent years ap- peared in English.-American Jour- nal of the Medical Sciences It is a veritable storehouse of our knowledge of the venereal diseases. It is commended as a conservative, practical, full exposition of the greatest value.-Chicago Clinical Review. The best work on venereal dis- eases in the English language. It is certainly above everything of the kind.- The St. Louis Medical and Surgical Journal. Lea Brothers & Co., Philadelphia and New York. 29 TAYLOR (ROBERT W.). A PRACTICAL TREATISE ON SEX- UAL DISORDERS IN THE MALE AND FEMALE. In one 8vo. vol. of 448 pp., with 73 engravings and 8 colored plates. The author has presented to the profession the ablest and most scien- tific work as yet published on sexual disorders, and one which, if carefully followed, will be of unlimited value to both physician and patient.- Medical News. A CLINICAL ATLAS OF VENEREAL AND SKIN DISEASES. Including Diagnosis, Prognosis and Treatment. In eight large folio parts, measuring 14 x 18 inches, and comprising 213 beautiful figures on 58 full-page chromo-lithographic plates, 85 fine engravings and 425 pages of text. Complete work now ready. Price per part, sewed in heavy embossed paper, $2.50. Bound in one volume, half Russia, $27; half Turkey Morocco, $28. For sale by subscription only. Address the publishers. Specimen plates by mail on receipt of ten cents. TAYLOR (SEYMOUR). INDEX OF MEDICINE. A Manual for the use of Senior Students and others. In one large 12mo. volume of 802 pages. Cloth, $3.75. THOMAS (T. GAILLARD) AND MONDE (PAUL F.). A PRAC- TICAL TREATISE ON THE DISEASES OF WOMEN. Sixth edition, thoroughly revised by Paul F. Munde, M. D. In one large and handsome octavo volume of 824 pages, with 347 engravings. Cloth, $5; leather, $6. The best practical treatise on the subject in the English language. It will be of especial value to the general practitioner as well as to the specialist. The illustrations are very satisfactory. Many of them are new and are particularly clear and attrac- tive.-Boston Med. and Sur. Jour. This work, which has already gone through five large editions, and has been translated into French, Ger- man, Spanish and Italian, is the most practical and at the same time the most complete treatise upon the subject.-The Archives of Gynecol- ogy, Obstetrics and Pediatrics. THOMPSON (SIR HENRY). CLINICAL LECTURES ON DIS- EASES OF THE URINARY ORGANS. Second and revised edi- tion. In one octavo vol. of 203 pp., with 25 engravings. Cloth, $2.25. THE PATHOLOGY AND TREATMENT OF STRICTURE OF THE URETHRA AND URINARY FISTULA. From the third English edition. In one octavo volume of 359 pages, with 47 engravings and 3 lithographic plates. Cloth, $3.50. THOMSON (JOHN). DISEASES OF CHILDREN. In one crown octavo volume of350 pages, with 52 illus. Cloth, $1.75, net. Just ready. TODD (ROBERT BENTLEY). CLINICAL LECTURES ON CER- TAIN ACUTE DISEASES. In one 8vo. vol. of 320 pp., cloth, $2.50. TREVES (FREDERICK). OPERATIVE SURGERY. In two 8vo. vols. containing 1550 pp., with 422 illus. Cloth, $9 ; leath., $11. A SYSTEM OF SURGERY. In Contributions by Twenty-five English Surgeons. In two large octavo volumes. Vol. I., 1178 pages, with 463 engravings and 2 colored plates. Vol. II., 1120 pages, with 487 engravings and 2 colored plates. Complete work, cloth, $16.00. 30 Lea Brothers & Co., Philadelphia and New York. TREVES (FREDERICK). SURGICAL APPLIED ANATOMY. In one 12mo. volume of 540 pages, with 61 engravings. Cloth, $2. See Student's Series of Manuals, page 27. TUTTLE (GEORGE M.). A POCKET TEXT-BOOK OF DISEASES OF CHILDREN. In one handsome 12mo. volume of 374 pages, with 5 plates? Just ready. Cloth, $1.50, net; flexible red leather, $2.00, net. Lea's Series of Pocket Text-books, edited by Bern B. Gallaudet, M. D. See p. 18. VAUGHAN (VICTOR C.) AND NOVY (FREDERICK G.). PTOMAINS, LEUCOMAINS, TOXINS AND ANTITOXINS, or the Chemical Factors in the Causation of Disease. New (3d) edition. In one 12mo. volume of 603 pages. Cloth, $3. The work has been brought down to date, and will be found entirely satisfactory.-Journal of the Ameri- can Medical Association. The most exhaustive and most re- cent presentation of the subject.- American Jour, of the Med. Sciences. The present edition has been not only thoroughly revised throughout but also greatly enlarged, ample consideration being given to the new subjects of toxins and antitoxins.- Tri-Stnte Medical Journal. VISITING LIST. THE MEDICAL NEWS VISITING LIST for 1900. Four styles: Weekly (dated for 30 patients); Monthly (undated for 120 patients per month); Perpetual (undated for 30 patients each week); and Perpetual (undated for 60 patients each week). The 60- patient book consists of 256 pages of assorted blanks. The first three styles contain 32 pages of important data, thoroughly revised, and 160 pages of assorted blanks. Each in one volume, price, $1.25. With thumb-letter index for quick use, 25 cents extra. Special rates to advance-paying subscribers to The Medical News or The American Journal oe the Medical Sciences, or both. See p. 32. WATSON (THOMAS). LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC. A new American from the fifth and enlarged English edition, with additions by H. Hartshorne, M. D. In two large 8vo. vols. of 1840 pp., with 190 cuts. Cloth, $9; leather, $11. WEST (CHARLES). LECTURES ON THE DISEASES PECULIAR TO WOMEN. Third American from the third English edition. In one octavo volume of 543 pages. Cloth, $3.75; leather, $4.75. ON SOME DISORDERS OF THE NERVOUS SYSTEM IN CHILDHOOD. In one small 12mo. volume of 127 pages. Cloth, $1. WHARTON (HENRY R.). MINOR SURGERY AND BANDAG- ING. New (4th) edition. In one 12mo. volume of 594 pages, with 502 engravings, many of which are photographic. Just ready. $3.00, net. We know of no book which more thoroughly or more satisfactorily covers the ground of Minor Surgery and Bandaging.-Brooklyn Medical Journal. Well written, conveniently ar- ranged and amply illustrated. It covers the field so fully as to render it a valuable text-book, as well as a work of ready reference for sur- geons.-North Amer. Practitioner. The part devoted to bandaging is perhaps the best exposition of the subject in the English language. It can be highly commended to the student, the practitioner and the specialist.-The Chicago Medical Recorder. Lea Brothers & Co., Philadelphia and New York. 31 WHITLA (WILLIAM). DICTIONARY OF TREATMENT, OR THERAPEUTIC INDEX. Including Medical and Surgical Thera- peutics. In one square octavo volume of 917 pages. Cloth, $4. WILLIAMS (DAWSON). THE MEDICAL DISEASES OF CHIL- DREN. In one 12mo. volume of 629 pages, with 18 illustrations. Just ready. Cloth, $2.50, net. The descriptions of symptoms are full, and the treatment recommended will meet general approval. Under each disease are given the symptoms, diagnoses, prognosis, complications, and treatment. The work is up to date in every sense.- The Charlotte Medic&l Journal. WILSON (ERASMUS). A SYSTEM OF HUMAN ANATOMY. A new and revised American from the last English edition. Illustrated with 397 engravings. In one octavo volume of 616 pages. Cloth, $4; leather, $5. THE STUDENT'S BOOK OF CUTANEOUS MEDICINE. In one 12mo. volume. Cloth, $3.50. WINCKEL ON PATHOLOGY AND TREATMENT OF CHILDBED. Translated by James R. Chadwick, A. M., M.D. With additions by the Author. In one octavo volume of 484 pages. Cloth, $4. WOHLER'S OUTLINES OF ORGANIC CHEMISTRY. Translated from the eighth German edition, by Ira Remsen, M. D. In one 12mo. volume of 550 pages. Cloth, $3. YEAR-BOOK OF TREATMENT FOR 1892, 1893, 1896,1897 and 1898. Critical Reviews for Practitioners of Medicine and Surgery. In con- tributions by 25 well-known medical writers. 12mos., about 500 pages each. Cloth, $1.50. In combination with The Medical News and The American Journal of the Medical Sciences, 75 cents. YEO (I. BURNEY). FOOD IN HEALTH AND DISEASE. New (2d) edition. In one 12mo. volume of 592 pages, with 4 engravings. Cloth, $2.50. See Series of Clinical Manuals, page 26. We doubt whether any book on dietetics has been of greater or more widespread usefulness than has this much-quoted and much-consulted work of Dr. Yeo's. The value of the work is not to be overestimated. -New York Medical Journal. A MANUAL OF MEDICAL TREATMENT, OR CLINICAL THERAPEUTICS. Two volumes containing 1275 pages. Cloth, $5.50. YOUNG (JAMES K.). ORTHOPEDIC SURGERY. In one 8vo. volume of 475 pages, with 286 illustrations. Cloth, $4; leather, $5. In studying the different chapters, one is impressed with the thorough- ness of the work. The illustrations are numerous-the book thoroughly practical-Medical News. It is a thorough, a very compre- hensive work upon this legitimate surgical specialty and every page abounds with evidences of prac- ticality. It is the clearest and most modern work upon this growing de- partment of surgery.- The Chicago Clinical Review. PERIODICALS. A Quarterly Digest of New Methods, Discoveries, and Improvements in the Medical and Surgical Sciences by Eminent Authorities. Edited by Dr. Hobart Amory Hare. In four abundantly illustrated, cloth bound, octavo volumes, of 400-500 pages each, issued quarterly, commencing March 1st, 1899. Per annum (4 volumes), $10.00 delivered. PROGRESSIVE MEDICINE. THE MEDICAL NEWS. Weekly, $4.00 per Annum. Each number contains 32 quarto pages, abundantly illustrated. A crisp, fresh weekly professional newspaper. THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. Monthly, $4.00 Per Annum. Each issue contains 128 octavo pages, fully illustrated. The most advanced and enterprising American exponent of scientific medicine. Four styles, Weekly (dated for 30 patients); Monthly (undated, for 120 patients per month); Perpetual (undated, for 30 patients weekly per year); and Perpetual (undated, for 60 patients per year). Each style in one wallet-shaped book, leather bound, with pocket, pencil and rubber. Price, each, $1.25. Thumb-letter index, 25 cents extra. THE MEDICAL NEWS VISITING LIST. THE MEDICAL NEWS POCKET FORMULARY. Containing 1600 prescriptions representing the latest and most ap- proved methods of administering remedial agents. Strongly hound in leather; with pocket and pencil. Price, $1.50, net. American Journal of the Alone. In Combination. COMBINATION RATES: PER ANNUM. Medical Sciences S> 4.00 Medical News 4.00 $7.50 $15.00 Progressive Medicine .... 10.00 Medical News Visiting List . . . 1.25 Medical News Formulary . . . 1.50 net, In all #20.75 for #16.00 First four above publications in combination . . $15.75 All above publications in combination .... 16.00 Other Combinations will be quoted on request. Full Circulars and Specimens free. LEA BROTHERS & CO., Publishers, 706, 708 & 710 Sansom St., Philadelphia. Ill Fifth Avenue, New York.