^:Mi& iy—.. .•■»■■• •••■■■ •«• *^F ..."V. .T 8 € VllZrK NLM001030707 ^^ I ^W s ^^ l vj^ i v^/ i \^ NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE aNOiaaw jo Aavaan tvnoiivn SNiDiasw jo Aavaan tvnoiivn 3NOIQ3W jo Aavaan tvnoiivn A TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS, AND PHARMACOLOGY. BY GEORGE FRANK £UTLER, Ph.G, M.D., Professor of Materia Medica and Clirrical Medicine in the College of Physicians and Surgeoi Chicago; Professor of Materia Medica and Therapeutics, Northwestern University, Woman's Medical School; Attending Physician to Cook County Hospital; Member of the American Medical Association, Illinois State Medical Society, Chicago Medical Society, Chicago Pathological Society, and Fellow of the Chicaga Academy of Medicine, etc., etc. Miscris succurrere disco. PHILADELPHIA : W. B. SAUNDERS, 925 Walnut Street. 1896. Bd85t Copyright, 1896, By W. B. SAUNDERS. ELECTROTYPED BY WESTCOTT & THOMSON, PHILAOA. PRESS OF W. B. SAUNDERS, PHILADAv TO THE MEDICAL STUDENTS OF THE UNITED STATES, IN THE HOPE THAT IT MAY AID THEM IN ATTAINING A CORRECT KNOWLEDGE OF THE NATURE AND ACTION OF DRUGS AND THE RATIONAL TREATMENT OF DISEASE, THIS WORK IS CORDIALLY INSCRIBED BY THE AUTHOR. \ PREFACE. The present work has been undertaken with the immediate object of supplying the student of medicine with a clear, concise, and practical text-book, adapted for permanent reference no less than for the requirements of the class-room. The arrangement—embodying the synthetic classification of drugs based upon therapeutic affinities—the author believes to be at once the most philosophical and rational, as well as that best calculated to engage the interest of those to whom the academic study of the subject is wont to offer no little perplexity. Should an intelligent and comprehensive understanding of Materia Medica and Therapeutics be facilitated by the author's treatment of the theme, the deductions derived from his experience as a practitioner and instructor will not have been committed to print in vain. Special attention has been given to the Pharmaceutical section, which there is reason to hope will be found exceptionally lucid and complete. It has been deemed advisable, however, in the general work to include in the descriptive enumeration only such drugs as experience has proved to be of unquestionable value and are of standard and authoritative acceptance in general prac- tice. In accordance with this plan, many new and comparatively untried remedies have been omitted, since, while of established efficacy in certain conditions, they are as yet too imperfectly known to warrant association with remedial agents bearing the sanction of exhaustive scrutiny. So, too, a few official drugs have been excluded because they are practically never used or are employed only in isolated instances. It will be observed that "Untoward Action" and "Poisonin?" o n 12 PREFACE. are treated under separate heads. By the former it is intended to record the effects of medicinal doses in developing certain symp- toms dependent more or less upon individual susceptibility, not necessarily assuming the aggravated form incident to toxic doses, which exert a definite influence regardless of idiosyncrasy. In giving the careful Latin accent and quantity of medicinal nomenclature (Foster), so far as practicable with the prosodial signs employed, the design has been to correct a prevalent dis- regard of proper pronunciation reflecting little credit upon those to whom a knowledge of the subject should be as exact as it is familiar. To the prescription-writer the appropriate Latin genitive, and in a few cases the accusative, will doubtless afford valuable assistance. During the preparation of the work many important text- books, periodicals, etc. have been freely consulted, and from the U. S. Pharmacopoeia chiefly, and from the National Dispensatory, have been adopted almost verbatim the "Origin " and "Description and Properties " of the various drugs under consideration. In reviewing the progress of the present volume the author desires to express his cordial acknowledgments to Prof. Carl S. N. Hallberg, Ph. G, whose exhaustive contribution of "Weights anl> Measures" and "Pharmaceutical Preparations" cannot fail to lend permanent interest to the work; to Dr. Alfred C. Cotton, Dr. Wm. E. Quine, and Dr. James B. Herrick, for friendly suggestions; to Dr. D. Lee Shaw, Dr. Fred C. Zapffe, and Dr. Thomas J. Jack- son, for assistance in compilation. To Mr. Storrow Higginson the author's personal thanks are due for his scholarly assistance in the revision of the text. G. F. B. Chicago, III., 794 West Adams St., September, 1896. CONTENTS. PAGE INTRODUCTION ..........................17 'PHARMACOLOGY AND GENERAL THERAPEUTICS........21 • Classification of Medicines....................24 Administration of Medicines....................29 Definitions............................34 Weights and Measures.......................40 PHARMACEUTICAL PREPARATIONS................ 49 Solutions.............................51 Aquse Medicatse—Medicated Waters.................51 Liquores—Solutions.........................S1 Spiritus—Spirits..........................57 Syrupi—Syrups...........................58 Elixiria—Elixirs..........................64 Glycerita—Glycerites........................71 Liquid Mixtures—Internal.....................72 Misturse—Mixtures.........................72 Emulsa—Emulsions........................76 Extractive Preparations......................79 Infusa—Infusions..........................81 Decocta—Decoctions........................82 Aceta—Vinegars..........................82 Vina—Wines...........................82 Tincturae—Tinctures........................84 Extracta Fluida—Fluid Extracts...................90 Extracta—Extracts.........................95 Abstracta—Abstracts........................96 Oleoresinse—Oleoresins.......................97 Resinse—Resins...........................9^ Solid Mixtures for Internal Use.................99 Pulveres—Powders.........................100 Sales Effervescentes—Effervescent Salts................103 Confectiones—Confections......................104 Trochisci—Troches..........■..............105 Massse—Masses..........................106 Pilulse—Pills..........................107 Unofficial Forms of Mixtures of Solids for Internal Use.........112 Preparations for External Use..................113 Linimenta—Liniments........................114 Lotiones—Washes.........................115 Oleata—Oleates..........................116 13 14 CONTENTS. PAGI Olea Infusa—Infused Oils......................Ii; Collodia—Collodions........................11; Unguenta—Ointments . ........................\\\ Cerata—Cerates..........................120 Suppositoria—Suppositories.....................1:1 Emplastra—Plasters...................... .12: Chartse—Papers..............■...........124 Poultice or Cataplasm........................125 Fomentations...........................125 Plaster Mull............................125 Bandages, Antiseptic Dressings....................125 Medicated Dressings........................126 Medicated Cottons.........................126 Medicated Gauzes—Carbasa.....................126 Plaster-of-Paris Bandages......................12; CLASS I.—DISEASE MEDICINES................i2j Division I.—Restoratives......................125 Group I.—Digestants.......................129 Group II.—Fats and Oils.....................132 Group III.—Mineral Acids.................. . 137 Group IV.—Vegetable Acids...................i4< Group V.—Alkalies.......................149 Group VI.—Mineral Waters...................165 Group VII.—Bitters.......................170 Simple Bitters....................170 Aromatic Bitters...................172 Group VIII.—Hematics......................175 Animal Extracts (Organo-therapy)...............217 Division II.—Specifics.......................221 Serum-therapy...................265 CLASS II.—ANTISEPTICS....................302 Aromatics.....................357 CLASS III.—SYMPTOM MEDICINES..............379 Group I.—Antispasmodics.....................379 Group IT.—Antipyretics.....................388 Group III.—Anesthetics.....................396 Group IV.—Hypnotics......................410 Group V.—Narcotics.......................427 Group VI.—Motor Excitants...................464 Group VII.—Motor Depressants.................498 Bromides......................c2J Group VIII.—Cardiac Stimulants.................534 Group IX.—Cardiac Sedatives..................c^6 Group X.—Diaphoretics..................... 592 Group XL—Emetics........................^ Group XII.—Expectorants....................6I4 Group XIII.—Diuretics................... 52jj CONTENTS. 15 PAGE Group XIV.—Cathartics.....................656 Laxatives.....................664 Simple Purgatives..................672 Hydragogue Purgatives...............682 Salines.......................686 Drastic Purgatives..................689 Group XV.—Anthelmintics....................693 Group XVI.—Emmenagogues and Ecbolics.............702 Group XVII.—Astringents....................708 Vegetable Astringents................710 Mineral Astringents.................724 TOPICAL REMEDIES. Group XVIII.—Caustics or Escharotics..............754 Group XIX.—Vesicants and Epispastics..............761 Group XX.—Rubefacients.....................769 Group XXL—Emollients, Demulcents, and Protective Agents . . .771 PRESCRIPTIONS..........................782 INDEX...............................811 A TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS, AND PHARMACOLOGY. INTRODUCTION. The history of medicine since the time of Hippocrates is the record of a more or less continuous series of experimental re- searches, having for their paramount object a precise and compre- hensive knowledge of the nature of disease and the practical application of remedial science. Regarded sensa latiori, the various " schools" which have arisen from time to time are philosophically co-ordinate, their fundamental principles being ref- erable to one dominating thought—the art of healing. It is scarcely practicable here, even were it necessary, to review in detail the separate doctrines which have obtained during the evolution of sectarian therapy. From the earliest ideas promul- gated by the ancient priests of ^sculapius, through the subse- quent era of Hippocrates, Theophrastus, and the Alexandrian school, influenced by the crude, misguided notions prevailing ere science emerged from its infancy; discernible in the Galenic and other tentative yet memorable systems, in the epoch of Paracelsus and the Monastic Medicine of the Mediaeval period, and in the radical theories of Rasori and Roeschlaub which attended the development of the last, and have left a passing impress upon the present, century,—through all, the gradual acceptance of empiri- cism as a legitimate guide to therapeutic truth is manifest. Yet viewed with reference to their underlying animus, these varied expressions of scientific endeavor distinguishing the past are per- ceptibly linked with the ampler system which has emanated from the more rational methods of modern research. 2 17 18 A TEXT-BOOK OF MATERIA MEDICA. The light of inductive reasoning and the marvellous progress in scientific knowledge which characterize the nineteenth century are a living appeal from the idealism of a less enlightened age. The release from tradition—anticipated in the labors of Bichat and others—to which later investigation owes so many signal triumphs, has doubtless been profoundly affected by the realistic tendency of modern thought. It is to the startling advancement attained in the i natural sciences, however, resulting in a chemical skill and in me-1 chanical appliances of incomparable value, that we must look for | the originating impulse which has inspired the therapeutic know-j ledge of the present day. It needs but little reflection to perceive! the immeasurable superiority of actual acquirements over the vague, J hesitating—though ardent and laborious—methods to which the I theory and practice of medicine were so long subservient. We have said that, considered in the larger sense, the history of medicine has been a harmonious rather than an intermittent devel- opment. It is not to be supposed that, in the evolution of so momentous a scheme as the formulation of a remedial system applicable to the extensive catalogue of human ailments, there should not have occurred spasmodic and ill-adjusted theories, crystallizing in many a strange cidtus, which, if ineffectual in retarding the onward sweep of rational progress, has, it may be safely averred, worked incalculable injury to the cause of medical truth. Mesmerism, astrology, spiritualism, even theosophy, how- ever incongruously conjoined, and similar vagaries have not failed to enlist among their votaries many enraptured, even noted, be- lievers ; nor is the mental strabismus with which they are afflicted amenable to any resource of rational treatment. We need, more- over, but contemplate the pitiable hallucinations which urge the pious pilgrimages to Marpingen, Lourdes, and Treves, and the criminal negligence and incredible offence to reason which stultify the so-called " Christian Scientists " (as ironical a misnomer as lan- guage permits), to realize that miraculous cures still hold blighting yet potent sway over the minds of the ignorant and credulous. May not even the assumption of thaumaturgical powers be one day possible with those who arrogate to themselves a knowledge little short of omniscience, and to whose rudimentary intelligence the laws of nature convey no perceptible lesson ? As from the sublime to the ridiculous, so from faith to fanaticism, it is but a step, after all. It is appropriate here to emphasize the unfailing—nay, ever- INTRODUCTION. 19 increasing—importance of therapeutics in its relation to the wel- fare of mankind. Especially imperative is this obligation in an epoch of unprecedented achievement in every department of science which contributes to the perfection of the healing art, in which general advancement medicine has borne no inconspicuous a role. The rapid advance of experimental philosophy, however, applied to medical treatment, culminating in bacteriological discoveries of signal value to mankind, and the remarkable triumphs attending the development of operative surgery, have inevitably tended to disparage the equally noble and far more widely cultivated field of therapeutic science. This result is the more deplorable since it creates in the minds of the young and inexperienced an impression of contrast and divergence in departments of study naturally and indissolubly correlated. It is scarcely surprising that the marvels of the laboratory and the splendid achievements of the arena should possess for the tyro an entrancing interest. Yet it is to be borne in mind that the most brilliant triumphs of diagnostic and surgical skill might prove futile as the means of arresting disease were they not supplemented by the course of treatment which constitutes therapy. It must be confessed that medical art has too often been dis- credited by professional incompetence, and consequent failure to effect the cure that with the laity is wont to form, however ignor- antly, the only criterion of ability. In America especially—where from defective laws the widest latitude is given to incapacity and imposture—the lack of proper academical training is frequently the cause of serious consequences in practice, little calculated to enhance the popular confidence and esteem. It therefore behooves the student of medicine to master thoroughly the details of the remedial art, become practically conversant with physiological conditions and the manifold phenomena of morbid anatomy, and so familiarize himself with the varying indications of disease that in the presence of whatever malady, his diagnosis and treatment may command respect—not only from the laity, but, what is of far more consequence to him, from the profession. It is almost superfluous to lay stress upon pharmaceutical know- ledge as a powerful weapon in the armament of the medical prac- titioner. Yet no branch of therapeutic science has, perhaps, been more neglected than a practical acquaintance with the nature and uses of Materia Medica, their origin, potency, and characteristic value, as well as their physiological action, and the incompatible 20 A TEXT-BOOK OF MA TERIA MEDICA. and synergistic agents upon which their efficacy often largely depends. Thanks to careful and competent training among pharmacists, the skilful preparation and dispensing of drugs relieve the physi- cian of much responsibility; yet he should be keenly sensible of the fact that the larger share of public confidence is reposed in him, and by diligent study of the subject endeavor to command the minutiae of pharmacology, holding himself morally accountable for errors quite possible in the druggist's dispensary. It may imt be irrelevant to add that in all medical procedure a sympathetic yet perfectly controlled nature, ready tact, and sterling common sense are cardinal requisites to professional triumph, it being gene- rally true, as was long since observed by Hufeland, that " success- ful treatment requires only one-third science and two-thirds sat faire" Finally, the author would counsel the utmost seriousness in the pursuit of a calling which might aptly be termed " Christian Science"—the power to alleviate human suffering by means of curative agents with which the laboratory of nature has. been mercifully stored. There can be no loftier, more practical mani- festation of love to men than is exemplified in the benignant effort to assuage the ills to which mortality is heir; nor can any devotionj be more privileged and inspiring than that which softens the shock) of disease, illumines the darkness of mental and physical distress, and from the debris of misfortune, vice, and heredity creates anew the image of divine perfection. It is this uplifting, consecrated zeal, akin to veneration for medical science, which has endeared to the world the masters of the profession—of which the same wise Hufeland said: " To him who fails to make a religion of the heal^ ing art it is the most cheerless, wearisome, and thankless labor upon earth; indeed, in him it must become the greatest frivolity and a sin." And for those—and they are many—to whom the material, possibly mercenary, aspect of their task appeals unduly it is enough to cite in rebuke the elevated maxim of Stigelius: Non omnia quafi suscipimus lucrum spectant. PHARMACOLOGY AND GENERAL THERAPEUTICS. Remedies.—In a comprehensive sense every means of counter- acting, curing, or mitigating disease or bodily disorder may be termed a remedy or remedial agent. The mode of treatment may be preventive, reparative, or restorative; but the agents employed by the physician are properly called remedies. Although their number is wellnigh as great as the multifarious causes of disease, the chief classes of remedies are comparatively few, and may be grouped mainly under the following heads : Prophylactic, whereby attention is directed to the immediate environment of the patient, with a view to secure proper sanita- tion and outward conditions more favorable to recovery sug- gested by hygienic laws. Sanitary, when hygienic treatment is combined, as it now usually is, with medical remedies, constituting what is known as regimen, including proper ventilation, temperature, diet, bathing, and exercise. Imponderable, as when the forces of light, heat, cold, and elec- tricity or magnetism are brought into requisition by the aid of science. Mechanical, pertaining to certain surgical methods and remedial applications, or a course of physical training, including the peculiar yet often efficacious treatment known as massage. Pharmaceutical, including a very large and varied class of remedies which, from their established curative properties and their signal importance to the physician (medicus), are technically termed medicines. They are designed to preserve or restore the health of the animal organism, promote recovery in cases of injury or disease, and, in short, perform every office proper to a palliative or remedial agent. Pharmacology is, strictly speaking, the science which treats of the origin, nature, chemical affinities, and physiological action of drugs. For the sake of a clearer knowledge of its relations to 21 22 A TEXT-BOOK OF MATERIA MEDICA. remedial treatment, and to facilitate a practical understanding of so comprehensive a subject, pharmacology may be regarded as a union of two correlated themes of research: Materia Medica, which deals especially with the sources from which drugs are derived, their chemical and physical properties, their constituent elements, and their general function as substances or agencies in the practice of medicine. Pharmacy, restricted to the analysis and determination of drugs, and the science of preparing and dispensing medicines in the forms in which they are best administered. Therapeutics (from the Greek word meaning to attend, to serve) is the science and practice of selecting and applying remedies for sickness and disease, and necessarily includes the proper care and treatment of invalids. "The ultimate aim of all medical research," it has been truly said, " is the treatment and prevention of disease." This constitutes the primary object of the therapeutist. In its amplest signification therapeutics embraces all that relates to the science and art of healing, and the application not only of medicines, but of every remedial agent likely to accomplish this paramount motive of the physician's labor. Under the general term of therapeutics, therefore, are included the action of natural forces, the varied resources of Materia Medica, and the contingent considerations of climate, food, clothing, etc., grouped under two principal divisions: Natural Therapeutics, being, as the term implies, a curative method dependent upon the laws of nature rather than the sub- sidiary arts of man. Applied Therapeutics, including the scientific application of palliative or remedial agents having no counterpart in the living organism, designed, through the art of medicinal administration, to assist nature in the process of restoring health. This division con- stitutes more properly the study of therapeutics and the domain of professional practice. Empirical Therapeutics implies the application of remedies to which experience has ascribed certain specific properties irre- spective of systematic value. It is not based upon scientific research, but rather upon formulae established by the accumula- tion of isolated facts—empiricism—and practical observation, apart from theoretical reasoning and the relations of physiological phenomena as revealed by modern methods of investigation. Were it possible to extend indefinitely the list of remedial agents PHARMACOLOGY AND GENERAL THERAPEUTICS. 23 so as to embrace the entire field of therapeutic knowledge, the empirical method might attain the dignity of an exact science. Such, however, is the complexity arising from the manifold, often contradictory, impressions drawn from human experience that for the evolution of a systematic scheme of therapeutics the empirical system must of necessity prove inadequate. Rational Therapeutics is based upon the use of medicines in accordance with a scientific knowledge of pathology and the physi- ological effects of remedial agents. Here nothing is left to chance, and the nostrums of the older system have but little weight com- pared with the methods of careful and intelligent diagnosis and a skilful administration of remedies suggested by well-known and accepted indications of disease. Every department of medical sci- ence has been illumined by the light of modern research, and the chemical and physical properties of Materia Medica submitted to severe and competent analysis, that Rational Therapeutics may establish a system through which the errors and uncertainty of empiricism may be supplanted by a more stable and philosophical method, and the chances of inaccuracy minimized. Through the college curriculum and the medium of professional intercourse, afforded by personal comparison of opinions and by innumerable publications throughout the world, the results of scientific experi- mentation are becoming widely diffused and the scope of serious investigation constantly enlarged. In connection with this subject it may be well to call the atten- tion of the student to the technical signification of the following terms: Pharmacopoeia is the descriptive list of drugs and their prepara- tions recognized by the medical profession of any locality or coun- try as official. In foreign countries pharmacopoeias are issued under government sanction and are strengthened by legal accept- ance. In the United States the work is published under the auspices of the medical and pharmaceutical professions, being revised every ten years by a convention called for that purpose. It may be added that the British Pharmacopoeia is in the main in conformity with that of our own country. In all, twenty-four countries issue pharmacopoeias, while thirteen have none. Official—Officinal.—Unnecessary confusion appears to prevail concerning the precise import of these terms. They are readily understood by reference to the Latin originals from which they are derived. 24 A TEXT-BOOK OF MATERIA MEDICA. Official drugs are those which bear the stamp of professional— i.e. official—-sanction (Lat. officium, authority). They are prac- tically ordered by the Pharmacopoeia to be kept in all druggists' shops, the formulae being supplied by the work revised in decennial conventions. Officinal drugs are those prepared or kept by the druggist upon his own responsibility, bearing only the authority of the shop (Lat. officina, a shop). Such preparations are often included in works on Materia Medica, and, together with those emanating from other individual formulae, are marked " unofficial." The term " unofificinal," it will be seen, is a solecism; and it fol- lows, moreover, that there are many preparations which are in pharmacy officinal, but not official, and that a pharmacopoeial formula cannot possibly be officinal, although, speaking generally, all official drugs are officinal in that they are kept or prepared in the druggist's shop. Dispensatory.—This is a compilation of and commentary on one or more pharmacopoeias, enlarging the authoritative but re- stricted pharmacopoeial formulae by including the medical and physical history of the various substances, with directions regard- ing dosage, together with observations on their physiological action and therapeutics. It also contains information concerning drugs not accepted by pharmacopoeial authority, yet which are of occa- sional use or interest. The Dispensatory is in effect a private pub- lication and unofficial, in this respect differing essentially from a pharmacopoeia. There are in the United States various works of this character, the United States and National Dispensatories being commonly in use. CLASSIFICATION OF MEDICINES. The classification of drugs and remedial agents is a theme regarding which the many writers upon and teachers of medicine have shown a wider diversity of opinion, perhaps, than upon the physiological action and medical uses of individual remedies. The fact that therapeutics is far from being an exact science, and the rapid advance in our knowledge of normal physiological processes, of pathological conditions, and the systematic action of drugs, are sufficient explanation of the ever-changing judgments of'our best observers concerning the action of certain medicinal agents under given conditions. CLASSIFICATION OF MEDICINES. 25 It follows that from time to time, as appears in reviewing the literature of the subject, different writers, in their attempt to keep pace with the advancement of knowledge, have devised various systems of classification. In earlier days, when the therapeutist culled from the fields his simples for the cure of disease, there was naturally created a strong tendency toward a botanical classification. So far was the system pushed that in certain so-called schools of medicine the authority of Scripture was invoked, it being proclaimed as an axiom that " the leaves of the tree were for the healing of the nations " (Rev. xxii. 2). The outgrowth of this eclecticism, strange as it may seem to-day, was the Thompsonian or Botanical system of thera- peutics. On the other hand, as an evolution of the old alchemic school, an attempt was made to found a classification by explaining the remedial action of all medicines upon a purely chemical basis. With the advent of more modern methods of study, applied to the physiological action of drugs upon the animal economy, came the physiological classification, in which the effects of remedial agents were explained upon rational grounds. It is hardly necessary to state that coexistent with these various endeavors to attain a philosophical method of classification, com- plicating them and perplexing their votaries, the dominating prin- ciple of empiricism held universal sway, setting at defiance in many instances the cardinal maxims of rational therapeutics, the rational therapeutist even to-day welcoming as a last resort the cruder, though often efficient, empirical method. Some authors, perceiving the inutility of the older systems, have contented themselves with a mere alphabetical arrangement of medicinal agents, regardless of their origin, mode of preparation, or physiological affinities. With due respect for the many able and worthy efforts at classification recorded in the history of modern therapeutics, the author believes that the main object of classifying medicinal reme- dies—viz. to facilitate the retention of a vast number of valuable yet isolated facts—is best accomplished by grouping them along the lines of greatest practical utility. Remembering that the medical student of to-day is animated by an earnest effort to fit himself for the noblest sphere of usefulness —knowledge applied to the relief of human suffering—the author holds that the most philosophical, as well as practical, synthesis and comparison of remedial agents, based upon manifest physical 26 A TEXT-BOOK OF MATERIA MEDICA. and physiological relationships, will afford to the pupil the widest grasp, from a therapeutical standpoint. With the object of aiding the student, in accordance with this con- viction the author has endeavored in this work to give emphasis to a therapeutical classification, claiming for it no especial originality,1 but assured that the method he has selected is alike the most judi- cious and the one best calculated to respond to the demands of daily, practical utility. The thoughtful and logical student of medicine must realize that there are two great classes of remedial agents: i. Those used in cases which cannot be relieved by a single dose of any remedy, but require repeated and prolonged admin- istration. 2. Those employed in cases which are susceptible of immediate relief by the exhibition of a single dose. The remedies employed for the cure of the first class of cases have been appropriately styled Disease-Medicines—an unscientific term, perhaps, yet useful to convey the intended idea, since they remove the cause of the departure from normal physiological action in the living organism—i. e. perversion of functional integrity, or disease. Upon reflection it will be seen that remedial agents in the second class are, by the nature of the case, designed for the relief of some manifestation or change in the system or in its functions indicating the character, locality, severity, etc. of a morbid process—a symp- tom of disease. The remedies in this class, therefore, are termed Symptom-Medicines, partly because of their specific virtue in reliev- ing symptoms, partly from the fact that they produce certain mani- festations characteristic of themselves. The classes named might be subdivided ad infinitum, yet it has seemed advisable to the author, for the sake of simplicity, to divide only the first class, Disease-Medicines, including the remedial agents employed therein under three general heads, Restoratives, Specifics, and Antiseptics. It is obvious to every reflecting physician that a class of reme- dies act as such by supplying some deficiency in the animal organ- ism, the agent in such cases being either itself the substance lacking, or its analogue, or by its presence restoring the deficient element or secretion. Iron or fats, for instance, act in certain forms 1 This classification is adapted from one formerly used by Prof. William N. Thompson of New York. CLASSIFICATION OF MEDICINES. 2J of anemia in which these ingredients are wanting in the red blood- corpuscles ; phosphorus or the earthy salts behave similarly in conditions where the tissues are deficient in these necessary constit- uents; and bitters, though not natural ingredients of the system, act upon the gastro-intestinal mucous membrane, stimulating the glands to secrete a larger quantity of normal digestive fluid. In view of the physiological action of the remedies pertaining to this division, the term Restoratives so aptly expresses their general character that no apology is needed for its adoption. The second division, Specifics, can be administered without injurious results only in diseased conditions, in which the particular remedy combats in a specific and occult manner the prime etiologi- cal factor of the pathological derangement. These medicines act properly only upon diseased organisms, their peculiar effect never being obtained by the exhibition of a sin- gle dose, but only after prolonged administration. They normally produce no symptoms, the patient being unaware of their action save by a recognition of his gradually improved condition. Should, in fact, symptoms occur, they should serve as a warning that the remedy is not indicated or that the dose is unsuitable to the condition. To elucidate this principle, the use of morphine to allay the pain of gout may be cited. A single dose is usually sufficient, yet it is not curative; while lithia acts as a restorative through its well- known solvent and eliminative properties, reinvigorating the circu- lation and by continued treatment curing the disease. Again, caffeine may be employed to relieve anemic neuralgia, yet it requires hemic restoratives to alleviate the condition produ- cing the symptoms. A genuine specific is tolerated only by the system in which it antagonizes some disease. For instance, A and B are put under a prolonged course of mercury: A is salivated beyond recognition, while B's health improves—simply for the reason that B had syphilis, which A had not. At the present day the number of remedies which we are compelled to relegate to this class, Specifics, for want of accu- rate knowledge regarding their modus operandi, is quite limited. Quinine was formerly considered a specific in malaria, until the fact was recognized that the drug is analogous to a normal constituent of healthy bile in its action upon plasmodia malariae. The second great class of agents to which the name Symptom- 28 A TEXT-BOOK OF MA TERIA MEDICA. Medicines is applied embraces all medicinal substances which, being introduced into the system, may produce by a single dose abrupt or serious disturbances of function. From the earliest his- tory of medicine they have offered a tempting field to the thera- peutist, because of the absolute certainty of their action in allaying symptoms or producing manifestations peculiar to themselves. It is perhaps superfluous to add that, owing to their extreme activity, the greater number of therapeutic errors may be ascribed to their use. To the young practitioner the charm of therapeutics lies in that class of agents which produce immediate and tangible results. These are obtained most readily by the remedies affording instant relief of prominent symptoms of disease, such as pain, pyrexia, insomnia, etc. Yet the author is here constrained to add a word of caution to the amateur therapeutist, reminding him that, in the maturer knowledge derived from subsequent experience, he will have less to regret should he confine his study and practice to physiological medication—that is, to the examination and adminis- tration of legitimate restoratives and specifics—rather than yield to the allurements presented by the energetic action of a large number of agents classed among Symptom-Medicines. The members of this class of remedies have been variously divided and subdivided by different writers on therapeutics. Antiseptics are classed among Disease-Medicines on account of their property of restoring to their normal condition the tissues, fluids, and secretions of the body by destroying the germs or micro-organisms which by their presence excite pathological processes. This great class, Antiseptics, embraces some of our most important neurotics. Most of them are antipyretic, and many of them possess analgesic and hypnotic properties. Instance, chloral, a powerful antiseptic, hypnotic, antipyretic, and circulatory depressant. Con- sidered only as an antiseptic, it would be classed as a Disease- Medicine ; clinically, however, it is used more as a hypnotic, and therefore in this work it is ranked as a Symptom-Medicine—a neurotic in the subdivision of Hypnotics. Drugs, in fact, exhibit so many different actions that an arbitrary line of demarcation between them is practically impossible, the author merely desiring to assign a given remedy to the class to which its chief therapeutic uses would naturally attribute it. The principal use of opium, as we know, is to relieve pain. It ADMINISTRATION OF MEDICINES. 29 is the typical narcotic, yet it possesses astringent and hypnotic properties, and could therefore not inaptly be classed as an astrin- gent or hypnotic. It is already a question whether antipyrine should not be ranked in the division of Analgesics rather than Antipyretics, since, while formerly it was used almost exclusively for the reduction of tem- perature, we now know it to possess marked anodyne properties; so that it is actually doubtful which is its more important use—to lower temperature or to relieve pain. These few illustrations serve to show how varied are the actions of drugs, and how their several divisions overlap one another. Thus, the last division of Disease-Medicines, Antiseptics, imme- diately precedes the first group of Symptom-Medicines, Antispas- modics, so closely are they allied, the last-named class possessing properties similar to those of that interesting division of Antisep- tics—the Aromatics. The next group, Antipyretics, is logically followed by Anes- thetics, and this in turn by Hypnotics, Narcotics, etc., each group being succeeded by the one most closely resembling it in physio- logical and therapeutic action. The last group comprises the Astringents, classed under Symptom-Medicines, these agents occu- pying the borderland between external and internal medicines. Caustics, the first group under topical remedies, naturally follow Astringents, since they differ from the latter drugs only in degree perhaps, as is well shown in sulphuric acid, which when diluted is an astringent, but undiluted an active caustic. A thoughtful study of drugs as classified in this work will, it is hoped, enable the student to become more familiar with the com- parative value of the various remedial agents than were possible had the author chosen an alphabetical arrangement, associating remedies having no possible relationship either in their actions or their medical uses. ADMINISTRATION OF MEDICINES. External Method of Application.—In order to utilize the absorptive power of the cutaneous surface for therapeutic pur- poses various methods have been adopted. The simplest of these, though by no means the most successful, is by Inunction, which consists in an outward application of the 30 A TEXT-BOOK OF MATERIA MEDICA. medicinal agent, without abrasion of the cutis, and compulsory absorption through the process of " rubbing in." The horny epidermis, however, presents an effectual barrier to the absorption of many drugs, and the Endermic Method has been found more serviceable. This plan consists- in producing, by means of a blister, a raw surface, which readily absorbs the medicinal agent—morphine, strychnine, atro- pine, quinine, etc.—with highly marked effect. The process is somewhat painful and necessarily slow in action, being now almost wholly superseded by the Hypodermic Method.—This consists in injecting the drug into the subcutaneous tissues by means of the hypodermic needle and syringe. Since absorption by the tissues takes place readily, it will be seen that this method of application is far more efficacious than those previously mentioned. Not all drugs, it is to be observed, are available for administration by the hypodermic process of injection. The eminent success attending the operation, however, renders it of signal value to the physician. Parenchymatous Method.—This is a more heroic means of injection, by which the drug is deposited in the corporeal tissues. It is said to afford temporary relief in sciatica, but for various reasons is highly objectionable, chiefly because of the excruciating pain consequent to the operation. Intravenous Injection may be resorted to in desperate cases: its dangers are obvious, however, and, save for the purpose of trans- fusion after severe hemorrhage, it can seldom be attempted with impunity. Internal Administration.—The most obvious, and by far the most useful, method of internal administration is by the mouth; yet care and discretion are to be used even in so ordinary a process, and the physician should consider thoughtfully the time, consequent effects, and chemical changes, that the drug may produce the most beneficial results. Inhalation is in many respects of the first importance as a method of internal administration. Its great facility in practice and its unquestionable efficiency—as in the case of anesthetics- render it readily available and highly beneficial, although the method has attained as yet only a limited use in therapeutics beyond a resort to it in pulmonary diseases. Enemata.—A different class of administrative operations consists in injections into the rectum, which injections may be purgative, ADMINISTRATION OF MEDICINES. 31 anodyne, nutrient, emollient, astringent, anthelmintic, etc. For speedy and efficient cleansing of the large intestine the purgative enema is of incomparable value, care being taken that the quantity of the injection be sufficient, that it be passed up as far as possible, and that it remain as long as the patient is able to retain it. Absorbable enemata are usually small in quantity; they have proved useful in certain cases of diarrhea and dysentery, and are serviceable when the act of swallowing is precluded by affections of the esophagus or in cases where the stomach requires complete rest. The rectum, however, possessing no digestive capacity, the injection should consist of the simplest materials and contain pepsin and acid or pancreatic fluid. Another mode of securing beneficial results from internal admin- istration through the absorptive properties of the intestine is by means of suppositories, readily introduced within the sphincter ani and dissolving at the temperature of the body. Dosage.—The term dose implies the quantity of a medicinal agent which under certain conditions it is advisable to administer, many considerations entering into the question, to be weighed by the features of the individual case. Dosage may be regarded as perhaps the most vulnerable point in therapeutic science, yet one upon which the art of healing almost wholly depends. Since Heller in 1755 enunciated his philosophical maxims touching the rational method of testing the therapeutic effects of drugs, eminent clinicians have sought to solve the mysteries attend- ing the action of various remedies whose modus operandi remains to this day obscure. Indeed, so great is the diversity of operation pertaining to the commonest remedies, conditioned by the character and circumstances of the case, as well as the amount and quality of the drug, that it is next to impossible to predicate the precise effects of agents whose physiological properties are theoretically and even practically established. The dose may often determine the specific action of a remedy, yet medicinal doses are specific as regards each other, their true action being discoverable only by experience. The doses given in many text-books differ materially from those prescribed in actual practice, being intended to express only the average quantities to be administered, the exact amounts varying with the conditions of the particular case. These conditions may be classed under the heads of age, sex, temperament, idiosyncrasy, habit, state of the system, temperature of the body, time of administration, intervals 32 A TEXT-BOOK OF MATERIA MEDICA. between doses, cumulative action of the drug, and the contingent considerations of diet, climate, race, etc.—oftentimes a complicated problem even to the most skilful therapeutist. A few suggestions regarding the leading characteristics of dosage, as limited by these various circumstances, may be of value to the student. The influence exercised by Age is indubitable, as a rule the young requiring smaller doses than adults, the aged being least susceptible to therapeutic impressions. With regard to children several mathematical formulae have been devised, none being infallible, and the best of them based upon conditions of weight and preconceived estimates of physiological effects to the detri- ment of other factors than age, upon which infant development largely depends. Nor can deductions as to the efficacy of a given dose be drawn from the action of drugs with which the agent is naturally associated. A single drop of laudanum has been known to produce the death of a child, whereas large doses of belladonna, conium, arsenic, and mercury have been taken with impunity. The most convenient rule (Young's) adds 12 to the child's age and divides by the age to get a denominator of a fraction whose numerator is 1, this fraction representing the proportion between adult and infant doses. Thus, for a child three years old 3+12 —\— = 5> or i> tne dose being one-fifth of that given to an adult. Temperament acts as an important agent in modifying the effect of medicinal remedies, phlegmatic subjects readily tolerating cer- tain medicines, such as opium, which those of nervous temperament are unable to bear. Stimuli act upon sanguineous patients forcibly, yet upon others their influence may be either tardy or ineffectual. The condition is one which discloses a wide field of inquiry, the mental, moral, and physical tendencies of the individual being involved in the practical administration of medicines. Closely allied to the foregoing is the question of Idiosyncrasy, the constitutional peculiarity which exerts a subtle influence, scarcely understood, as potent as it is obscure. Its characteristics cannot be formulated, but must be studied with the aid of experience—.in odor, a taste, a casual or fixed impression, or hereditary instinct often determining their existence and manifestation. In tempera- ment and idiosyncrasy, indeed, the psychological rather than the physiological side of therapeutics is developed, requiring for its treatment a professional acumen not always at command. The influence of Habit is to diminish the susceptibility of the ADMINISTRA TION OF MEDICINES. 33 organism to impressions which under normal conditions would be speedy and effectual. Only by gradually increasing the quantity of the dose can results be obtained which in ordinary circumstances require few exhibitions. Thus, patients accustomed to the use of alcoholic stimulants accept heroic doses of alcohol with little or no indication of effects quickly perceptible in temperate subjects. Bodily condition obviously affects the action of remedial agents. It is well established that in severe pain opium may be adminis- tered in quantities which in a healthy organism would produce untoward, perhaps fatal, results. The salivation occasionally caused by mercury is seldom apparent in febrile conditions. Yet in cases where sensibility is diminished great care is necessary to avoid the deleterious effects of over-stimulation or excessive dosage. Respecting Sex, although it is generally admitted that females require smaller doses than males, the exceptions to the rule are so numerous as almost to vitiate the accepted theory. The Time of Administration is closely connected with the Form of the Remedy given, as a rule remedies being withheld immedi- ately before and after meals. The practice, however, is subject to modifications, certain drugs acting best on an empty stomach, and others, such as local irritants, being more safely diffused when the stomach is full, in which case by mingling with the food they are not brought into irritating contact with the intestinal mucous membranes. With regard to Intervals between Doses it may be said, in brief, that they are to be determined by the special features of the case, the character and potency of the drug, and the degree of tolerance and assimilation evidenced by the patient. Every remedial agent, under normal conditions, produces a specific and definite action, the system by absorption and elimination limiting the period of its efficacy in cases of prolonged treatment, so that the drug is evi- dently to be renewed in order to secure perfect results. Failure to continue treatment has frequently proved disastrous, even fatal, to the patient, and it should be borne in mind that, in the absence of contraindications or untoward effects, a primary object of dosage is to create and maintain an impression upon the morbid system. Knowledge of therapeutic action and a thorough understanding of pathological conditions can best determine the interval requisite to attain the most beneficial effect of successive dosage. Other considerations—by some therapeutists held to be of minor, by others of paramount, importance—affect the vital question 3 34 A TEXT-BOOK OF MATERIA MEDICA. of dosage. The emotions, for example, play an interesting part in the toleration or rejection of remedial agents. Strangely enough, too, the imaginative faculty is often a cause of idiosyncrasy, numer- ous instances being adduced by reputable authorities wherein either positive or fancied ills were affected through the agency of spurious remedies—bread-pills, deceptive concoctions, and the like —the ethical aspect of therapeutics being here left to the conscience of the physician. DEFINITIONS. There are certain general terms employed to signify specific actions of drugs which may properly be here defined. Acids.—Salts of hydrogen, of great value in medicine and sur- gery. They are marked by a high diffusive power when used externally, and act as depressants upon those glands whose normal secretion is acid, while stimulating those whose normal secretion is alkaline. Mineral acids act as astringents, and possess the power of arresting fermentation, some of them being characterized by strongly antiseptic properties. Alteratives.—Medicines having the power to produce favorable changes in the system or alter some abnormal condition. They are especially useful in specific or chronic diseases. Their modus operandi is unknown, and they require time to produce favorable results. Anesthetics.—Certain substances having the property of de- stroying sensation or producing anesthesia, either general or local. Various alcohols and ethers are used for this purpose, the degree of unconsciousness being regulated by the nature of the anesthetic and the method of administration. The invaluable properties of ether and chloroform are well known in connection with operative surgery. Analgesics or Anodynes.—Agents used to reduce or efface the sensation of pain, without necessarily inducing stupor, the sense of j touch being usually unaffected. In this respect they offer a marked difference from anesthetics, which destroy all sensation. Anaphrodisiacs.—Agents whose action tends to reduce venereal desire and sexual power. They act by depressing the brain-centers or the spino-genital center, or by lessening the blood-supply to the genital organs. DEFINITIONS. 35 Anhydrotics.—Medicinal agents employed to check perspira- tion, acting either upon the sweat-glands and centers or upon the cutaneous circulation. Antacids or Alkalies.—Agents used to counteract acidity, neutralizing the strongest acids, and with weak acids forming salts having alkaline properties. When applied to the ducts of glands whose normal secretion is acid, they increase it, lessening the secretion from alkaline glands. They dissolve albumin, rendering the blood more alkaline, and consequently neutralize the acidity of the urine. Antidotes.—Remedies which either counteract the effect of poisons or by their action serve to eliminate or destroy the poison itself. Anti-emetics.—Medicines effecting a diminution of nausea and vomiting, either by reducing the irritability of stimulated centers or by sedative action upon the gastric nerves. Antigalactagogu.es.—Remedies which prevent, reduce, or arrest the secretion of milk. Antilithics or Lithontriptics.—Agents found to be efficacious in checking the formation of urinary and biliary calculi, or of dis- solving them when formed. Antiperiodics.—Medicines employed to prevent the periodical recurrence of paroxysmal symptoms, especially the attacks incident to febrile disorders. Antiphlogistics.—Agents used to reduce inflammation. The term is related to ancient practice—the methods of bloodletting, depressing regimen, etc.—the remedies holding but a subordinate place in modern therapeutics. Antipyretics.—Remedies designed for the reduction of an abnormally high temperature of the body, acting in various ways, some of which are still imperfectly understood, the principal modes of action being (i) by limiting the production of heat, and (2) by favoring the loss of heat. Antiseptics.—These prevent or check putrefaction and septic infection, destroying the germs which produce them or neutralizing the toxic products of these germs. Antisialics.—Medicines having the effect of reducing the secre- tions of the salivary glands or checking salivation. Certain drugs lessen reflex excitability, while others act through paralysis of the nerve-terminals or a reduction of the blood-supply to the salivary glands. 36 A TEXT-BOOK OF MATERIA MEDICA. Antispasmodics.—Remedies used to allay spasms, whether the muscular action be voluntary or involuntary. They may act as stimulants to certain nerve-centers or as depressants upon others, according to the agent employed and the nature of the spasmodic disorders. Antizymotics.—Agents used as preventives in zymotic dis- eases, by arresting fermentative development. Aphrodisiacs.—Medicines whose effect is to stimulate sexual desire and power, acting either upon the cerebral or the spino- genital center. Astringents.—Agents which cause the contraction of living tissues, diminishing the amount of blood or other fluid in them, reducing hemorrhage, or, through constipating action, limiting the intestinal secretions, as well as those from mucous membranes generally. Cardiac Sedatives.—Agents designed especially to control palpitation or to reduce the action of the pulse in certain febrile conditions. They are employed to allay over-energetic action of the heart, a hypersystolic condition. Cardiac Stimulants.—Remedies acting upon the cardiac appa- ratus in depressed conditions, having the specific effect of length- ening and invigorating the contraction of the cardiac muscle, increasing the force and frequency of the heart's action. Cardiac Tonics.—Properly, these agents act directly upon the muscles of the heart, increasing its nutrition and giving tone both to the cardiac muscle and to the nervous mechanism of the heart, thereby increasing its capacity for work. Carminatives.—Chiefly aromatic agents, used for the purpose of expelling gas from the stomach and intestines, correcting flatulency. Cathartics.—Agents employed to promote intestinal evacuations. They are numerous, being divided into several groups according to their physiological effect: Purgatives, Laxatives, etc. Cerebral Depressants.—The effect of these remedies is to produce primarily cerebral stimulation, followed by functional de- pression. Among them are included Narcotics, Anesthetics, etc, some of which, such as chloroform and the like, should be admin- istered with great care, lest their powerful action induce dangerous conditions. Cerebral Excitants.—Medicines used to augment brain-activity without necessarily impairing the normal exercise of the cerebral DEFINITIONS. 37 functions. Their modus operandi is through the heart—and, con- sequently, the circulatory system—or by direct action upon the brain. Ciliary Excitants.—By acting on the tracheal and bronchial cilia these agents assist the expectoration of bronchial secretions, the mucus being expelled by reflex stimulation of the upper respiratory tract. Demulcents.—Drugs possessing soothing properties, the local action of which, owing to their oily or mucilaginous nature, is that of a sedative and protective to the parts under treatment. Many demulcents appear to affect favorably remote portions of the organ- ism, since they are frequently given internally to allay irritation of the respiratory, gastro-intestinal, and genito-urinary tracts. Dentifrices.—Various medicated powders or liquids used for cleansing the teeth and gums, an excellent basis for the powders being chalk. Antiseptics, as well as stimulants and disinfectants, are desirable, the lodgement of food frequently resulting in fer- mentation and the production of organic acids, with consequent injury to the dentine (caries). Deodorants.—Agents employed for the destruction of noxious gases and foul odors. Diaphoretics.—Medicines intended to produce perspiration, affecting the sweat-glands of the skin either through local or cen- tral action or by relaxing the cutaneous blood-vessels. The name " sudorifics" has been applied to those agents causing profuse sweating. Diluents.—Agents which, being absorbed, perform the office of diluting the excretory fluids. Pure water is the simplest and best. Disinfectants.—Agents that prevent infection by destroying the specific germs of disease or rendering them innocuous. Diuretics.—A class of remedies tending to increase the secre- tion of the kidneys, thereby augmenting the urinary flow. Emetics.—Agents which produce vomiting, acting either by reflex or direct stimulation. Emollients.—These are medicinal substances which soften and relax the tissues in topical applications. By relieving tension they modify the pressure and guard the affected parts from irritation. They usually act upon the skin, whereas Demulcents are designed to act upon the mucous membrane. Emmenagogues.—Agents intended to restore or increase the menstrual function, 38 A TEXT-BOOK OF MATERIA MEDICA. Errhines or Sternutatories.—Remedies used to promote nasal irritation and produce sneezing, causing the discharge of mucus. Escharotics or Caustics.—Medicinal agents possessing caustic properties, destroying the tissue to which they are applied and pro- ducing a slough. Expectorants.—Designed to promote expectoration, modifying and facilitating the expulsion of the bronchial secretions. Galactagogues.—Agents used to increase the secretion of milk. Some of them are of doubtful efficacy, while others, such as the leaves of the castor-oil plant, have produced excellent results. Gastric Tonics or Stomachics.—These remedies are service- able in aiding digestion and promoting appetite and the secretion of gastric juice. Hepatic Depressants.—Intended to reduce the secretion of bile in the liver by lowering hepatic activity, and thereby lessening the formation of urea and glycogen. Hepatic Stimulants.—Agents employed to increase the func- tional activity of the liver and the formation of bile, urea, and gly- cogen. Cholagogues are generally regarded as synonymous with Hepatic Stimulants, but their special office is to remove the accu- mulated bile from the duodenum, thus preventing its reabsorption, rather than for the purpose of increasing its secretion. Hypnotics.—Medicines designed to produce sleep, in a general sense embracing Anesthetics and Narcotics, yet lacking their specific or analgesic properties. Many agents are employed to cause artificial sleep besides those classed under simple hypnotics, their efficacy varying with the mental and physiological condition of the patient. Intestinal Astringents.—Remedies used to act upon the walls of the intestines, reducing exudation and rendering the feces less fluid, or acting by constriction of the intestinal mucous membrane. Irritants.—Applied to the cutaneous surface, these remedies produce vascular excitation. When the irritation occurs remote from the seat of application they are termed counter-irritants. Ischemics or Hemostatics.—Agents capable of arresting hem- orrhage. Local- Stimulants.—Agents which increase nervous sensibility, acting upon the nerves or stimulating blood-circulation. Local Sedatives.—Remedies intended to produce effects the reverse of the foregoing. DEFINITIONS. 39 Local Anesthetics or Anodynes.—Medicines which so lower the susceptibility of the sensory nerves that they become incapable of transmitting impressions. The peculiar property of Anesthetics is to destroy or paralyze; that of Anodynes, to temper. Motor Depressants.—Agents which reduce the activity of the motor apparatus and spinal cord. Motor Excitants.—Employed to stimulate the activity of the motor nerves. Mydriatics.—Agents used to produce mydriasis, or persistent dilatation of the pupil. Myotics.—Agents which contract the pupil. Narcotics.—Powerful agents which, acting on the brain, may produce sleep, stupor, coma, and death, the nerve-centers being at first stimulated and afterward paralyzed. Oxytocics or Ecbolics.—Medicinal agents employed to con- tract the muscular fibers of the womb during pregnancy. Pancreatic Stimulants.—Remedies used to increase the func- tional activity of the pancreas. Parasiticides.—Lotions and ointments of drugs employed to destroy animal and vegetable parasites infesting the human body. Protectives.—These are various substances, including medicinal agents, used to protect injured surfaces by excluding air, water, etc. Pulmonary Sedatives.—Agents used to lessen irritation of the respiratory tract, reducing cough and dyspnea. Refrigerants.—Medicines employed to quench thirst and cool the overheated system. Respiratory Depressants.—Agents which depress the action of the respiratory center, resulting in slow and shallow respi- rations. Respiratory Stimulants.—Agents which stimulate the respi- ratory apparatus, deepening and quickening the respirations. Restoratives.—Agents which act upon the tissues to restore exhausted or impaired activity, by supplying the deficiency through dietetic treatment or by means of various medicinal resources. They are natural ingredients of the system, or analogous to them, acting directly or indirectly to restore or renew some tissue or structure or to sustain or increase some vital action. Sedatives.—These remedies are of several classes, all tending to soothe the system by tempering functional activity. Sialagogues.—Agents used to promote secretion in the salivary glands, either topical or general in their action. 4° A TEXT-BOOK OF MATERIA MEDICA. Styptics and Hemostatics.—Remedies designed to arrest hemorrhage, Styptics being those applied externally, and Hemo- statics those used for internal administration. Uterine Depressants.—Agents employed to restrain the con- tractions of the gravid uterus, thereby controlling its action. Uterine Tonics and Alteratives.—Remedies having, or sup- posed to have, a specific influence upon the uterus. Vascular Sedatives.—These have the effect of contracting the vessels and diminishing the circulation. They are useful in check- ing hemorrhage and allaying local inflammation. Vascular Stimulants.—Medicines which increase and equalize circulation, acting through dilatation of the cutaneous vessels and heart-stimulation. Vascular Tonics.—These tend to increase blood-pressure, acting upon the mechanism of the vessels through the vaso-motor nerves, lessening the caliber of the arterioles. Vesical Sedatives.—Agents employed in allaying irritation of the bladder and relieving pain. Vesical Tonics.—These increase the contractile force of the vesical muscles. Urinary Sedatives and Astringents.—Agents which, being administered internally, become incorporated with the urine, and thus act upon the entire urinary tract. They relieve irritation (sedative) or diminish or check abnormal secretion (astringent), the latter agents being usually applied locally in the form of an injection. WEIGHTS AND MEASURES. The history of Weights and Measures affords a striking example of the incongruity resulting from the absence of a uniform standard of stable value to science, and must be regarded as the strongest argument in favor of the Metric, or Decimal, System An idea of the confusion prevailing under the old methods may be gamed from an examination of their comparative units, by which we find that a pint is not a pound, an ounce not equal to a fluid- ounce, a drachm not equivalent to a fluidrachm, and a minim not commensurate with a grain. It was not until !836 that the Secre- l7J")t Vi T ^ freCtGd by C°^reSS to *™ish each State in the Union with a complete set of revised standards includ- WEIGHTS AND MEASURES. 41 ing the troy pound of 5760 grains, from which the Apothecaries', or Troy, weight is derived, the latter term at present being applied only to the system used in weighing precious metals. For commercial purposes the following Weights and Measures are employed: Avoirdupois Weights: the Pound divided into 16 Ounces. Liquid Measures: the "Wine Measure," of which the U. S. Gallon represents a volume of 231 cubic inches; each cubic inch of water at the maximum density (40 C.) being equivalent to 252.892 grains, the weight of a Gallon being therefore 58,418 grains. The Gallon is divided into 8 Pints (octarius), and the Pint is divided into 16 Fluidounces, each containing 8 Fluidrachms, or 480 Minims, the Fluidrachm containing 60 Minims. The signs used to designate these units are—1TL, denoting minim or minims; fo, fluidrachm or fluidrachms ; and f|, fluidounce or fluidounces. Apothecaries' (Wine) Measure. 20 grains (gr. granum) = 1 scruple 9 (scrupulum). 60 grains, or 3 scruples = I drachm 3 (drachma). 480 grains, or 8 drachms = I ounce § (uncia). 5,760 grains, or 12 ounces — 1 pound ft) (libra). Apothecaries' (Troy) Weight. 60 minims (m) = 1 fluidrachm f£. 480 minims, or 8 fluidrachms = 1 fluidounce fj. 7,680 minims, or 16 fluidounces = 1 pint O (octarius). 61,440 minims, or 8 pints = 1 gallon C (congius). This lack of uniformity in the units and the denominations of the three systems of weights and measures is exemplified in the subjoined table. While the two weight systems have a unit in common, the grain, there is no correlation in the higher denomina- tions, ounces and pounds. The desirability of adopting a fixed standard, applicable in all cases where great accuracy in weights and measures is requisite, has been frequently emphasized by writers on therapeutics. As we have premised, the present diffi- culty forms a cogent argument in favor of the metric system, as wisely adopted in the U. S. Pharmacopoeia. A remarkable dis- parity is shown in the liquid measures, in which there is no unit in common : a minim is not a grain, nor " a pint a pound the world around." 42 A TEXT-BOOK OF MATERIA MEDICA. Table of Apothecaries' Weight and U. S. Liquid Measure, showing the equivalents of the various denominations (by reading from the left-hand column. and referring to headings), the weight equivalent of liquid measures being for water at 15° C.: Symbol. Minim. Granum. Scru-pulus. Drach-ma. Fluid-drachma. Av. 1 Fluid-| ounce.! uncia. "'«•»«• Libra. Av. pound. Octa-rius. Con-gius. gr. 3 3 f5 av. oz. fl. 3 3 lb. lb. av. O. Cong. I 0.95 63 60 480 7,680 61,440 0.95 1 20 60 57 437-5 456 480 5,760 7,000 7,292 20 1 3 24 288 35o 57 60 3 « 731 '8' 96 n6§ 60 57 1 73 8 128 1,024 437-5 7bo 7'i 1 23 I? iA 16 480 456 '8' I 16 128 480 24 8 8* 0.9115 1 14-58 5.76o 288 96 100 134 12 I O.823 7,000 350 1168 iiof 16 14.58 1.215 1 7,680 7,3°° 128 i6§ 16 1 8 61,440 58,400 1024 128, Y 1 Minim. Grain. Scru-ple. Drachm. Fluid-drachm. Av. oz. Fluid-ounce. Apoth. or Tr. oz. Apoth. or Tr. pound. Av. pound. Pint. Gal-lon. THE METRIC SYSTEM. The Metric System of Weights and Measures, destined to sup- plant all others, originated with Prince de Talleyrand, bishop of Autun, in 1790. Its almost universal adoption by civilized nations, its legality, though not compulsion, in England and the United States, and its adoption by the U. S. Pharmacopoeia of 1890, require that it should be understood alike by the physician and the druggist. Save in the English-speaking world it is the only system used for governmental, statistical, and scientific purposes, and in the arts and manufactures its value has long since been recognized. Its extreme simplicity, its uniformity, and its facility of computation render it far superior to any other system of Weights and Measures, and it is highly probable that in the near future it will prevail in the transactions of every-day life, as it has already acquired international importance, and is in fact referred to as the International System. The starting-point is the unit of length, the meter (metre), which is the 40W0-000 Part of tne earth's circumference around the poles.1 From this apparently irrelevant measure of length the unit of 1 In 1806, Francois Arago and Biot were commissioned by the French government to complete the meridional measurements interrupted in 1804. The object of their survey was to determine, with as great nicety as possible, the ten-millionth part of a quadrant of the meridian passing through Paris, which had been chosen by the National Convention as the standard unit of length, and named the metre. It being impossible to measure from the poles, an arc of the meridian, equalling a quadrant, from Dunkirk to Barcelona was selected, and from their known difference of latitude the entire length of the arc was deducted. WEIGHTS AND MEASURES. 43 capacity, or volume, the liter, was established, it being the cube of i ofa meter. With equal simplicity and clearness, from the meter was derived the unit of weight, the gramme, which is the weight of that quantity of pure water at the maximum density, 40 C. (39.20 F.), which will fill the cube of y1^ part of a meter1 (cubic centimeter). The Metric is also known as the Decimal System, because its multiples and subdivisions are obtained by ten (Lat. decern). The prefixes denoting multiplication are of Greek derivation, and are usually spelled with a capital letter: Deka 10, Hecto 100, Kilo 1000, Myria 10,000. Division of the units is indicated by Latin pre- fixes, not capitalized : deci y^, centi y1-^, milli yoVo". To distinguish readily one process from the other the word GILD has been aptly suggested as a mnemonic : GILD. Greek increases, Latin decreases. It may be observed that, strangely enough, while we still oppose the general adoption of the Metric System, our enumeration is decimal. We count from one to ten, and begin a new, yet similar, series of another ten units, and so on indefinitely,. We compute money in dollars, dimes, cents, and mills, decimally, and our record of time—years, decades, centuries—is in harmony with decimal arithmetic. Even the provision of the Federal Constitution declaring that a national census be taken every ten years is pertinent as a sugges- tion of decimal convenience; and in the period prescribed for the State censuses, every five years, one-half of ten, there is no great deviation from the same principle of utility. Contrary to a prevalent opinion, the Metric System is easily mastered. A perfect acquaintance with the metric tables is, nat- urally, indispensable, and the abbreviations for the different weights and measures should be thoroughly at command. For the rest, the system is simply that of arithmetical decimals, requiring chiefly a correct use of the decimal point. Only a tyro would read .065 six and five-tenths hundredths instead of sixty-five thousandths ; so Gm. .065 would never be read by one acquainted with decimals ^he unit of surface measure, the are, the square often meters, and the unit of the solid measure, the siere, having the capacity of a cubic meter, need not claim the atten- tion of the physician or the practical pharmacist. 44 A TEXT-BOOK OF MATERIA MEDICA. six centigrammes and five milligrammes, but sixty-five milli- grammes. Metric Table of Lengths. 10 millimeters 10 centimeters 10 decimeters 10 Meters 10 Dekameters 10 Hectometers 10 Kilometers make i centimeter. i decimeter. i Meter. i Dekameter. i Hectometer. i Kilometer. i Myriameter. Abbreviations for the different divisions and multiples of the Meter are herewith given, together with their equivalents in inches, showing that the written system depends wholly upon the place of the decimal point, the figures remaining unchanged. It may be noted that the first abbreviations cited are those commonly in use, although in certain cases the second are preferable: Metric Table of Linear Measure. I millimeter is written I mm., or M .001, equal in inches to -039370432, approx. ^. 1 centimeter ' I cm., " M .01, .39370432, " 0 1 decimeter ' 1 dm., " M .1, 3.9370432, " 4 1 Meter ' iM„ " M 1., 39-370432, " 40 1 Dekameter ' 1 Dm., " M 10., 393-70432 I Hectometer 1 Hm. " M 100., 39370432 1 Kilometer • 1 Km., " M 1000., " 39370.432 1 Myriameter 1 Mm. " M 10000., " 393704-32 The term micromillimeter, one-thousandth of a millimeter (0.000001), is used, especially in microscopy, the abbreviations being mmm., mic, mkm., or the Greek letter /i. Metric Table of Rapacities. 10 milliliters make 1 centiliter. 10 centiliters 10 deciliters 10 Liters 10 Dekaliters 10 Hectoliters 10 Kiloliters 1 deciliter. 1 Liter. 1 Dekaliter. 1 Hectoliter. 1 Kiloliter. 1 Myrialiter. Abbreviations for the different divisions and multiples of the Liter, with their corresponding equivalents in minims or ounces are as follows: WEIGHTS AND MEASURES. 45 i milliliter is written i Cc.1 or L .001, equal in minims to 16.23 1 centiliter » 1 cl. ' L .01, " " 162.3 1 deciliter " 1 dl. ' L .1, " 1623. 1 Liter 1 L. ' L 1., fl. ounces 33-814 1 Decaliter " 1 Dl. ' L 10., " << 338-14 1 Hectoliter 1 HI. ' L 100., " u 33814 1 Kiloliter " 1 Kl. ' L 1000., " (( 33814- 1 Myrialiter 1 Ml. ' L 10000., " " 338140. Metric Table of Weights. 10 milligrammes make 1 centigramme. 10 centigrammes 10 decigrammes 10 Grammes 20 Dekagrammes 10 Hectogrammes 10 Kilogrammes 1 decigramme. 1 Gramme. 1 Dekagramme. 1 Hectogramme. 1 Kilogramme. 1 Myriagramme. Abbreviations for the different divisions and multiples of the Gramme, with their corresponding equivalents in grains, are as follows: 1 milligramme is written 1 mg., or Gm. .001, equal in grains to (fa) 1 centigramme 1 decigramme 1 Gramme 1 Dekagramme 1 Hectogramme 1 Kilogramme 1 Myriagramme 1 eg., " Gm. .01, " 1 dg., " Gm. .1, " 1 Gm., " Gm. 1., " I Dg., " Gm. 10., " I Hg., " Gm. 100., " 1 Kg., " Gm. 1000., " 1 Mg., " Gm. 10000., " (*) .015432 ■15432 1-5432 I5-432 154-32 I543-2 15432.3 154323-4 METHOD OF CONVERTING METRIC WEIGHTS, MEASURES, AND LENGTHS INTO THOSE IN COMMON USE, AND VICE VERSA. Approximate Table of Weights. 1 grain 151 grains 1 drachm = troy ounce = .0,65 Gm. (65 milligrammes). 1. Gm. 3.9 Gm. 31.1 Gm. Approximate Table of Capacities. 1 minim = .06 Cc. 16 minims = 1. Cc. 1 fluidrachm = 3.75 Cc. 1 fluidounce = 30. Cc. 1 This is designated by Cc. instead of Ml, and in practice only cubic centimeters and Liters are employed. 46 A TEXT-BOOK OF MATERIA MEDICA. Approximate Table of Lengths. I inch = .025 M. (25 millimeters). 40 inches = 1. M. Weights. To Convert Grains into the Corresponding Metric Equivalents.— It has been seen that 1 grain is equal to Gm. .065. In order, then, to convert grains or fractions of a grain into the corresponding metric quantity, we have simply to multiply the number of grains by .065. 2 grains = 2 x„ .065, or .130 Gm. 60 grains = 60 X .065, " 3.9 Gm. \ grain = \ of .065, " .0325, Gm. yi-o grain = y^ of .065, " .00065 Gm., etc. To Convert Metric Quantities into their Equivalent in Grains.— Instead of multiplying as above, divide, using the same number, .065, as a divisor. Gm. .130 = .130 -*- .065, or 2 grains. Gm. 3.9 = 3.9 h- .065, " 60 grains. Gm. .0325 = .0325 -5- .065, " .5 grain. Gm. .00065 = .00065 -5- .065, " .01 grain. It follows that to convert Apothecaries' drachms into Grammes we multiply the number of drachms by 3.9, the number of Grammes in 1 drachm ; and to convert Grammes into Apothecaries' drachms we divide the number of Grammes by 3.9. The same rule applies to the conversion of Apothecaries' ounces into Grammes and Grammes into ounces, the multiplier and divisor being 31.1, the number of Grammes in 1 ounce. Volumes. To convert minims into the corresponding metric equivalents, multiply the number or fractions of minims by .06, this being the equivalent in Cc. of 1 minim; and to convert the metric quantities into the corresponding equivalents in minims, divide the metric quantity by .06. To convert fluidrachms into Cc, multiply the number of drachms by 3.75, the number of Cc. in 1 fluidrachm; and to convert Cc. into fluidrachms, divide the number of Cc. by 3.75. To convert fluidounces into Cc, multiply the number of ounces by 30. Cc, the equivalent of 1 fluidounce; and to convert Cc. into fluidounces, divide the number of Cc by 30. WEIGHTS AND MEASURES. 47 For convenience of ready reference and to facilitate computa- tion the following tables are subjoined: Table of Metric Equivalents of Grains, Drachms, Minims, and Fluidrachms. 3 Grains. Milligrams, mg. Centigrams, eg. Decigrams, dcg. Grammes, Gm. Minims. Cubic centi-meters, Cc . 1 1 TT5TS O.65 0.065 O.O065 O.OO065 1 T5 O.85 O.085 O.O085 O.OO085 1 T>T I. O.I O.OI O.OOI 1 i-3 O.I3 O.OI3 O.OOI3 A 2-5 O.25 O.O25 O.OO25 A 6.5 O.65 O.065 O.O065 1 ■5 13. 1-3 O.I3 O.OI3 1 16. 1.6 O.I6 O.OI6 1 32- 3-2 0.32 O.O32 1 65- 6.5 O.65 O.065 I O.06 2 13- i-3 O.I3 2 O.I2 3 20. 2. 0.2 3 O.18 4 25- 2-5 O.25 4 O.24 5 30. 3- o-3 5 o-3 71 50. 5- o.5 8 o-5 10 65- 6-5 0.65 10 0.6 15 100. 10. 1. 16 1. 20 13- i-3 20 125 3° 20. 2. 32 2. 3J 60 40. 4- 60 3-75 f3J 100 65- 6-5 100 6. 3>j 120 80. 8. 120 7-5 f3ij 150 100. 10. 150 9- 3"] 180 200 12. 13- 180 200 11.25 12. fciii 3iv 240 16. 240 15- fjiv 3V 300 20. 300 18. *3V 3VJ 360 400 24. 26. 360 400 22.5 24. *3VJ 3viJ 420 45o 28. 30. 420 45° 26.25 27. fgvij Si 480 32. 480 30. SJ Equivalents. Various methods have been proposed for adapting the metric weights to our apothecaries' weights used in prescription writing without entailing calculations in fractions. The method of taking 32 Grammes as equivalent to one troy ounce, and 30 Cc, or fluid Grammes, as equal to one fluidounce, seems to be the least objec- tionable. These equivalents are shown in the following: 32 Gm. = 1 ounce; 32 -=- 8 = 4. Gm. = 1 drachm. 30 Cc. = 1 fluidounce; 30 -f- 8 = 3.75 Cc. = 1 fluidrachm. The exact metric equivalent of 1 grain is obtained by dividing the unit by the Gramme equivalent in grains; thus, 1. -+- 15.432 = 0.0648 Gramme (or 6^ centigrammes). 48 A TEXT-BOOK OF MATERIA MEDICA. The metric equivalents of all the other denominations may be obtained by multiplying the grain equivalent by the number of grains in one drachm ; the number of drachms in a troy ounce, etc. The following exact Gramme equivalents are thus obtained: I grain. i drachm. I ounce av. i ounce troy. I lb troy. I lb av. 0.0648 3.888 28.349 3Ilo3 373-250 453-592 To convert avoirdupois or troy into metric weights, the equiva- lent of the Gramme in grains—15.432—should be remembered, as it serves the purpose of a basis for obtaining the equivalent of all the higher denominations. Table of Metric Equivalents of Ounces (Apoth., Av., and Fluid) in Grammes and Cubic Centimeters. Ounces, I Grs. Grammes, Fluidounces, Cubic centimeters, Exact Apoth., Gm. or G. f% Cm. or Cc. equivalents. 1 31 I 30 29-57 2 62 2 60 59-15 3 93 3 90 88.72 3 IO3 100 3-38 IOO 4 124 4 120 II8.3 5 155 5 150 I47.87 6 186 6 180 177-44 7 217 7 2IO 207.01 8 248 8 240 236.59 8 l8 250 8.45 250 9 280 9 270 266.16 10 3H 10 300 295-73 11 342 11 330 325-31 1 lb 12 373 12 1 pt. 16 17 A 360 354-88 Av. Ounces. Grs. 453-6 480 500 493.18 I lb 16 17 278 500. 20 600 591-47 20 566.8 24 720 709.77 24 680. 2 pt. 32 960 946-35 28 793-2 34 A IOOO 2 lb 32 907.25 3pt. 48 I440 1419. 35 120 1000. 4 Pt- 64 1920 1892.71 3 R> 48 1360. 68 A 2000 4 lb 64 1814.5 5 pt- 80 24OO 2365.9 5tt> 7o 80 100 240 2000. 2268 2835 100 1 gal. 128 3OOO 384O 2957-37 378543 10 lb 160 4536 It will be noted that in the Pharmacopoeia of 1890 the Gramme (Gm.) and the Cubic Centimeter (Cc) are the only metrical terms used. The reason of this is simply that these two terms express sufficiently the quantities ordinarily handled, the remaining ones being excluded to avoid confusion, Grammes and Cubic Centi- meters standing as perfect equivalents of ordinary weights and measures, as the foregoing tables indicate. PHARMACEUTICAL PREPARATIONS. 49 PHARMACEUTICAL PREPARATIONS. Preparations made by the pharmacist are called pharmaceutical preparations. Nearly one-half of the articles of the United States Pharmacopoeia are pharmaceutical; formulas being given for their preparation, they are intended to be made in the pharmacy. A still greater number are unofficial, being chiefly such as are made according to the formulas or prescriptions of eminent medical practitioners and teachers. Such of the latter as have attained general use and proved of value have been incorporated in the National Formulary, a work published under the direction of the American Pharmaceutical Association. The importance of having a uniform standard for the prepara- tion and strength of this class of medicines has long been recog- nized, instead of the variation in strength and product inseparable from a number of manufactures with the consequent multiplicity in processes and formulas. These preparations of the National For- mulary, designated N. F., are included in this work, following the official preparations (U. S. P.) of the classes to which they belong. The pharmaceutical preparations may be divided as follows : I. Solutions. II. Liquid Mixtures—Internal. III. Extractive Preparations—Liquid and Solid. IV. Mixtures of Solids—Internal. V. Mixtures for External Use—Liquids and Solids. These groups are each divided into a number of Classes, each class having a distinct Latin title by which its members, or indi- vidual preparations, are officially designated and alphabetically arranged in the U. S. P. In addition to the Latin and English titles, each class is also known by an English name, besides various synonyms. There are altogether 34 of these Classes official, besides a number unofficial. Official number. I. The Solutions are divided, according to the charac- ter of the solvent, into— Aqueous: Aquae—Waters.......... 19 Liquores—Liquors (solutions proper)..... 24 Alcoholic: Spiritus—Spirits.......... 25 Elixiria—Elixirs.............. 2 Vina—Wines (by solution)......... 3 4 5° A TEXT-BOOK OF MATERIA MEDICA. Official number, Saccharine: Syrupi—Syrups......... 32 Mellita—Honeys............. 2 Glycerin : Glycerita—Glycerites........ 6 II. The Liquid Mixtures—Internal: Misturae—Mixtures (proper)........ 4 Emulsa—Emulsions............ 4 III. Extractive Preparations: Liquid : Aqueous : Mucilagines—Mucilages....... 4 Infusa—Infusions............. 4 Decocta—Decoctions........... 2 Acetous : Aceta—Vinegars.......... 2 Vinous: Vina—Wines ........... 5 Alcoholic: Tincturae—Tinctures........ 71 Extracta Fluida—Fluid Extracts........ 89 Solid: Alcoholic: Extracta—Extracts........ 33 Abstracts (unofficial). Resinae—Resins.............. 3 Semi-liquid: Ethereal: Oleoresinae—Oleoresins....... 6 IV. Mixtures of Solids—Internal: Pulveres—Powders............ g Trituratio—Trituration........... I Sales effervescentes—Salts, effervescent .... 4 Confectiones—Confections......... 2 Trochisci—Troches............ 15 Massae—Masses.............. 3 Pilulae—Pills................ 15 V. Mixtures of Solids—External: Liquid: Linimenta—Liniments......... 9 Oleata—Oleates.............. 3 Collodia—Collodions......x...... 4 Solid: Unguenta—Ointments.......... 23 Cerata—Cerates.............. 6 Suppositoria—Suppositories......... I Emplastra—Plasters........... 13 Chartae—Papers............. 2 Total................ 453 PHARMACEUTICAL PREPARATIONS. 51 AQILE MEDICATE—MEDICATED WATERS. The Medicated Waters are solutions of volatile substances in Water. They comprise (1) the Aromatic Waters and (2) the Chemical Waters. The Aromatic Waters are made by dissolving the volatile oils of their respective drugs, or distilling the latter with Water; two Waters are saturated solutions of other liquids than volatile oils— viz. Aqua Chloroformi and Aqua Creosoti. The following are official: Contains Cc. in 100 Cc, Aqua__ or percentage by volume. Amygdalae Amarae.......bitter almond oil 0.1 Anisi................ anise oil 0.2 Aurantii Florum Fortior........saturated Aurantii Florum..........of the above 50. Camphorae..............camphor 0.8 Chloroformi1............chloroform 0.5 Cinnamomi.............cinnamon oil 0.2 Creosoti................creosote I. Foeniculi...............fennel oil 0.2 Menthae Piperitae.........peppermint oil 0.2 Menthae Viridis...........spearmint oil 0.2 Rosae Fortior.............saturated Rosas...............of the above 50. The Chemical Waters are solutions of gases in Water. The fol- lowing are official: Contains gas, percent- Aqua— aSe h weight- Ammonias................NH3 10 Ammoniae Fortior.............NH3 28 Chlori...................cl 0.4 Hydrogenii Dioxidi (Hydrogen Peroxide) . . . H202 3. LIQUORES—SOLUTIONS. The Solutions (also termed Solutio, -nes, Lat.) are solutions of non-volatile substances in Water. The official Solutions are all solutions of inorganic salts. They are made either by simple solution (dissolving the particular salt in 1 Chloroform Water, aside from its medicinal properties, is an efficient preservative agent, and forms a good solvent in place of water for preparing solutions intended to be kept free from micro-organisms, as, for example, those for hypodermic use. 52 A TEXT-BOOK OF MATERIA MEDICA. Water) or by chemical solution (reacting upon different substances, and obtaining the newly-formed salt in solution in the Water). The following 24 are official: The Arsenic Solutions: these are all of the same strength— viz. 1 per cent.; 10 minims (0.6 Cc.) represent y\r grain (0.006 Gm.) of arsenic, the usual dose : Percentage Liquor— or Gm. in 100 Cc. Acidi Arsenosi...........acid, arsenous 1. Arseni et Hydrargyri Iodidi.....arsenic iodide 1. (Donovan's Solution). mercuric iodide 1. Potassii Arsenitis . . . potas. bicarb. 2 ; acid, arsenous 1. (Fowler's Solution) tinct. lavender comp. 3. Sodii Arsenatis..........sodium arsenate 1. The Alkaline Salt Solutions, prepared by saturating an organic acid with an alkaline carbonate or bicarbonate, furnishing an agree- able and refreshing potion (also designated Saturatio, Potio, Lat.) charged with Carbonic Acid Gas. The dose is from 2 to 4 fluid- drachms (8-15 Cc), except Liq. Magnesias Citratis: Liquor— Gm. in 100 Cc. Ammonii Acetatis (Spiritus Mindererus) ammon. carb. 5. acid, acetic, dil. 100. Ferri et Ammonii Acetatis . . . liquor ammon. acet. 20. (Basham's Mixture), acid, acetic, dil. 3.; tr. ferri chlor. 2. elix. arom. 12; glycerin 10; aqua ad 100. Magnesii Citratis . . . magnes. carb. 15.; acid, citric. 30. potas. bicarb. 25.; syrup. acid, citric. 60 Cc.; aqua ad 350. Potassii Citratis (Neutral Mixture) . . potass, bicarb. 8. acid, citric. 6.; aqua ad 100. The Iron Solutions, containing ferric salts in the following pro- portions by weight: Gm. in 100, or Liquor— percentage by weight. Ferri Acetatis...........ferric acetate 31. Ferri Chloridi...........ferric chloride 37.8 Ferri Citratis............ferric citrate 42.5 Ferri Nitratis............ferric nitrate 6.2 Ferri Subsulphatis (Monsel's) . . ferric subsulphate 43.7 Ferri Tersulphatis.........ferric sulphate 28.7 PHARMACEUTICAL PREPARATIONS. 53 These are mostly used in producing other Iron preparations and compounds, particularly the Tincture of Ferric Chloride, the Ferric Hydrate (arsenical antidote), and the scaled salts of iron. The Alkali Solutions: Percentage by vol. Liquor— or weight. Calcis (Lime Water).......calcium hydrate 0.17 Potassas............potassium hydrate 5. Sodas..............sodium hydrate 5. Sodas Chloratas (Labarraque's)......chlorine 2.6 Lime Water is given as an antacid (10-30 Cc); Labarraque's Solution is used as a powerful disinfectant. The Solutions of Metallic Compounds; all but that of Iodine are used only externally: Percentage by vol. Liquor— or weight. Iodi Compositus (Lugol's Solution) . . potass, iodid. 10. iodine 5. Hydrargyri Nitratis........mercuric nitrate 60. Plumbi Subacetatis........lead subacetate 25. Plumbi Subacetatis Dilutus .... of above solution 3. (Lead Water).......distilled water to 100. Sodii Silicatis...........sodium silicate 50. Zinci Chloridi...........zinc chloride 50. The dose of Liq. Iodi Comp. is 3-10 minims (0.2-0.6 Cc), preferably given in a little milk. Unofficial Liquors of the National Formulary. Liquor— Acidi Phosphorici Compositus (Acid Phosphates). Alumini Acetatis (Alumini Acetici, Ph. Ger.).—Contains 8 per cent, of basic Aluminum Acetate. Alumini Acetico-tartratis.—Contains about 50 per cent. of dry, so-called Aluminum Acetico-tartrate, which may be obtained by evaporating the solution. Auri et Arseni Bromidi.—Ten minims contain -^ grain (0.002 Gm.) of Tribromide of Gold and -^ grain (0.004 Gm). of Tribromide of Arsenic. Bismuthi.—Each fluidrachm (4 Cc.) represents 1 grain (0.06 Gm.) Bismuth and Ammonium Citrate. Bromi (Smith's Solution of Bromine).—Bromine, 20 per cent; Potassium Bromide, 10 per cent.; Water. A TEXT-BOOK OF MATERIA MEDICA. or— Calcis Sulphurate (Solution of Oxysulphuret of Calcium; Vleminck's Solution or Lotion). Cupri Alkalinus (Fehling's Solution). I. The Copper Solution, Copper Sulphate, pure......grains 505 . . 34,639 Gm. Distilled Water . . enough to make fluidounces 16. . 500 Cc. II. The Alkaline Solution. Potassium and Sodium Tartrate . . grains 252 . . 173 Gm. Soda (U. S. P.).........troy ounces 2 . . 60 Gm. Distilled Water . . enough to make fluidounces 16 . . 500 Cc. Keep both solutions, separately, in small well-stoppered vials, in a cool and dark place. For use, mix exactly equal volumes of both solutions by pouring the copper solution into the alkaline solution. Ten Cc. of the mixture prepared by metric weight and measure correspond to 0.05 Gm. of glucose. Of the mix- ture prepared by apothecaries' weight and measure, 210 minims correspond to 1 grain of glucose. Electropoeicus (Battery-fluid). A. For the Carbon and Zinc Battery.—I. (For ordinary use).—Potassium Bi- chromate, in powder, 6 troy ounces (180 Gm.); Sulphuric Acid, commercial, 6 fluidounces (180 Cc.); Water, cold, 48 fluidounces (1400 Cc).—II. (For use with the galvano-cautery).—Sodium Bichromate, in powder, 6y£ troy ounces (185 Gm.); Sulphuric Acid, commercial, 14 fluidounces (420 Cc); Water, cold, 48 fluidounces (1400 Cc). Pour the Sulphuric Acid upon the powdered Bichromate and stir the mix- ture occasionally during one hour. Then slowly add the Water. Sodium Bi- chromate is more soluble than the Potassium Salt, and also much cheaper. When it cannot be obtained, the Potassium Salt may be substituted for it, weight for weight. B. For the Leclanche Battery.—Ammonium Chloride, 6 troy ounces (180 Gm.); Water, enough to make 20 fluidounces (600 Cc.) ; dissolve the Salt in the Water. Ferri Oxysulphatis (Oxysulphate of Iron). Ferri Protochloridi (Solution of Ferrous Chloride).—Each fluidrachm (4 Cc.) represents about 20 grains (1.3 Gm.) of Protochloride of Iron (ferrous chloride). Hydrargyri et Potassii Iodidi (Solution of Iodide of Mer- cury and Potassium ; Channing's Solution).—Red Mercuric Iodide, 72 grains (5.0 Gm.); Potassium Iodide, 56 grains (3.8 Gm.); in Distilled Water, 16 fluidounces (450 Cc). Hypophosphitum.—Each fluidrachm (4 Cc.) contains 2 grains (0.12 Gm.) of Calcium Hypophosphite, \\ grains (0.75 Gm.) of Sodium Hypophosphite, and 1 grain (0.06 Gm.) of Po- tassium Hypophosphite. Iodi Carbolatus (Boulton's Solution ; " French Mixture ").— PHARMA CE UTICAL PRE PARA TIONS. 55 Liquor— Comp. Tincture of Iodine, no minims (7 Cc.); Carbolic Acid, 40 grains (3.0 Gm.); Glycerin, 2\ fluidounces (100.0 Cc.); in 16 fluidounces (450 Cc). Iodi Causticus (Iodine Caustic; Churchill's Iodine Caustic). —Iodine, I troy ounce (31 Gm ); Potassium Iodide, 2 troy ounces (63 Gm.); in Water, 4 fluidounces (120 Cc). Magnesii Bromidi.—Each fluidounce (30 Cc.) contains about 7 grains (0.5 Gm.) of Magnesium Bromide. Morphin.e Citratis.—Each fluidrachm (4 Cc.) contains 2 grains (0.12 Gm.) of Morphine in the form of citrate. Morphine Hypodermicus (Magendie's Solution of Morphine). —16 grains (1 Gm.) Morphine Sulphate to 1 fluidounce (30 Cc). Pancreaticus (Pancreatic Solution).—Each fluidrachm (4 Cc.) represents I grain (0.06 Gm.) of Pancreatin, effectually pre- served in Glycerin and a little Alcohol. Pepsini Aromaticum.—Each fluidrachm (4 Cc.) represents 1 grain (0.06 Gm.) of Pepsin. Phosphori (Thompson's Solution of Phosphorus).—Each fluid- drachm (4 Cc.) contains about -^ grain (0.0025 Gm.) of Phosphorus, preserved in Absolute Alcohol and Glycerin. Picis Alkalinus (Tar, Alkaline). Potasse Chlorat.e (Solution of Chlorinated Potassa; Javelle Water).—An effective and popular disinfectant. Potassii Arsenatis et Bromidi (Liquor Arsenii Bromidi; Clemens' Solution).—This solution contains an amount of Arsenic in combination corresponding to about 1 per cent. of Arsenous Acid. The title " Solution of Bromide of Arsenic " (Liquor Arsenii Bromidi), which is often applied to Clemens' Solution or similar preparation, is a misnomer, since bromide of arsenic cannot exist, as such, in presence of water, but is split up into hydrobromic and arsenous acids. The proportions of the ingre- dients, in the formula above given, have been adjusted as closely as practicable, so as to yield definite compounds—viz. arsenate and bromide of potassium. Saccharini (Solution of Saccharin).—Each fluidrachm repre- sents 4 grains of Saccharin. Intended to be used for sweetening liquids and solids when the use of sugar is objectionable, or when a sweet taste is to be imparted to a liquid without increasing its density. 1 Particular care should be taken in prescribing and dispensing this solution, so that it may not be mistaken for the so-called United States Solution of Morphine (Liquor Morphise Sulphatis, U. S. P. 1870). containing only I grain of Sulphate of Morphine in each fluidounce, which is still occasionally used. 56 A TEXT-BOOK OF MATERIA MEDICA. Liquor— Seriparus (Liquid Rennet). If this liquid is to be used merely for curdling milk, without separating the whey as a distinct layer, it should be added to the milk, previously warmed to a temperature of about 350 C. (950 F.), and the mixture should then be set aside undisturbed until it coagulates. If the whey is to be separated the Liquid Rennet should be added to the milk while cold, and the mixture heated to about 350 C. (950 F.), but not exceeding 400 C. (1040 F.). One part of the liquid should coagulate between 200 and 300 parts of cows' milk. Liquor Sodii Arsenatis, Pearson.—This Solution contains about yVj- per cent, of anhydrous Sodium Arsenate. This preparation should not be confounded with the Liquor Sodii Arsenatis of the U. S. P., which is ten times stronger than the above. Pearson's Solu- tion is official in the French Pharmacopoeia, under the title Solute d'Arse- niate de Soude (or Solution Arsenicale de Pearson). Sodii Boratis Compositus (Dobell's Solution).—Sodium Borate and Sodium Bicarbonate, each 120 grains (8.0 Gm.); Carbolic Acid, 24 grains (1.5 Gm.); Glycerin,! fluidounce (15 Cc); in Water, 16 fluidounces (450 Cc). Sodii Carbolatis (Phenol Sodique).—Carbolic Acid, 50 per cent.; Soda, 3 per cent.; in Water. Sodii Citratis.—Saturatio (Potio Riveri, Ph. Ger.).—Citric Acid, 150 grains (10.0 Gm.); Sodium Bicarbonate, 190 grains (12.5 Gm.); in Water, 16 fluidounces (450 Cc). Sodii Citro-tartratis (Effervescing Saline Water).—Sodium Bicarbonate, Tartaric Acid, Citric Acid, Syrup, and Water, in about the same proportions as in Solution of Magnesium Citrate, for which it is a cheaper substitute. Sodii Oleatis (Oleate of Sodium).—Intended to be used in the preparation of oleates. Strychnine Acetatis (Hall's Solution of Strychnine).—Each fluidrachm (4 Cc.) contains \ grain (0.008 Gm.) Strychnine Acetate. The Ph. Br. directs a Liquor Strychninse Hydrochloratis (with synonym, Liquor Strychnise) which is much stronger, and should not be confounded with the above preparation. It should never be dispensed unless expressly designated. Zinci et Ferri Compositus (Deodorant Solution).—A com- bination of Sulphates of Zinc and Iron, Naphthol, Oil of Thyme, and Hypophosphorous Acid, in Water. Used as a simple deodorant and antiseptic for common domestic use when it is unnecessary or impracticable to employ more powerful agents. PHARMACEUTICAL PREPARATIONS. 57 When a deodorant solution is required for purposes where iron is objection- able—as, for instance, when woven fabrics are to be steeped in it—the follow- ing preparation may be employed : Liquor Zinci et Alumini Compositus, in which the Iron Sulphate is replaced by Aluminum Sulphate. Liquor— Zingiberis (Essence of Ginger).—A 25 per cent, preparation of Ginger for flavoring aqueous mixtures. SPIRITUS—SPIRITS. The Spirits are solutions of volatile substances in Alcohol. They comprise (1) the Natural Spirits; (2) the Aromatic Spirits, or so-called " Essences;" and (3) the Medicinal Spirits. The Natural Spirits are produced by distillation, and include: Spiritus Frumenti (Whiskey), containing Alcohol 50-58 per cent, by volume. Spiritus Vini Gallici (Brandy), containing Alcohol 46-5 5 per cent, by volume. Spiritus Juniperi Comp. (Gin), containing Alcohol 60-70 per cent, by volume. The Aromatic Spirits are made by dissolving the respective oils or aromatic principles in (deodorized) Alcohol: Cc. in 100 Cc, Spiritus— or percentage by vol. Amygdalae Amaras (water 20) . . bitter almond oil 1. Anisi (alcohol deod.)........anise oil 10. Aurantii " " ........orange oil 5. Aurantii Comp. (alcohol deod.) .... orange oil 20. oils, anise 0.5, coriander 2; lemon oil 5. Camphoras..............camphor 10. Cinnamomi............cinnamon oil 10. Gaultherias...........wintergreen oil 5. Juniperi..............juniper oil 5. Lavandulae (alcohol deod.).....lavender oil 5. Limonis...........lemon peel 5 ; oil 5. Menthae Piperitas.....peppermint herb 1; oil 10. Menthae Viridis . . . • . . spearmint herb 1; oil 10. Myrcias (Bay Rum).....water 38; oil of bay 0.8 oils, orange, pimenta, each 0.05 Myristicae..........nutmeg (vol.) oil 5. These are chiefly used for flavoring purposes; some are used 58 A TEXT-BOOK OF MATERIA MEDICA. medicinally as aromatic stimulants and carminatives in doses of from 15-30 minims (1-2 Cc.); Spiritus Amygdalae Amaras con- tains Hydrocyanic Acid, and is never used internally except in very small quantities as a flavor. The Medicinal Spirits are made by solutions of the medicinal substance in Alcohol. The following are official: „ . _ ° Cc. in 100 Cc, Spiritus— or percentage by vol.. yEtheris............ether (C2H5)20 32.5 Athens Comp. (Hoffmann's Anodyne) . ethereal oil 2.5 ether 32.5 By weight. /Etheris Nitrosi (Sweet Spirit of Nitre) . ethyl nitrite 4. Ammonias............ammonia gas 10. Ammonias Aromaticus . . water 14; ammonia water 9. ammonia carb. 3.4 oils, lavender, nutmeg, each 0.1 ; lemon oil 1. Chloroformi...........chloroform 6. Glonoini.............nitroglycerin 1. Phosphori.....absolute alcohol, phosphorus 0.12 The dose of these Spirits is from 30 to 60 minims (2 to 4 Cc.; about 75 to 150 "drops"), except the Ammonia Spirit, used only in the preparation of Liniments (externally), and that of Phosphorus, which is for the preparation of the Elixir. Unofficial Spirits of the National Formulary. Spiritus— Acidi Formici (Spirit of Ants, Ph. Ger.).—A solution of 3 per cent, of Formic Acid in Water and Alcohol. Ophthalmicus (Alcoholic Eye-wash).—A solution of 10 min- ims (0.6 Cc.) Oil of Lavender and 30 minims (2 Cc.) Oil of Rosemary, in Alcohol 1 fluidounce (30 Cc). Saponatus (Spirit of Soap). Sinapis (Spirit of Mustard, Ph. Ger.).—A solution of 2J per cent, of Volatile Oil of Mustard in Alcohol. SYRUPI—SYRUPS. Syrups are nearly saturated Solutions of Sugar in Water, in which aromatic or medicinal substances are dissolved. The official Syrup, Syrupus, contains 65 per cent, by weight, 85 per cent, by volume, of Sugar (about 7 pounds, average, in PHARMACEUTICAL PREPARATIONS. 59 I gallon) : with a smaller proportion of Sugar the syrup undergoes fermentation (spoils). The " Medicated Syrups " contain less sugar, owing to the solu- tion of the medicinal substances, which usually reduce the solubility of the sugar in the liquid from which the syrup is prepared. Syrups should be kept in a cool place, in cork-stoppered bottles, in order to preserve them. The thirty-two official Syrups are made by different methods : by solution, or mixing the medicinal substance with the syrup; by dissolving the Sugar in the medicinal solution; by extraction from the drug; and by chemical reaction and solution. They may be divided into (i) the aromatic or adjuvant syrups, and (2) the medicinal syrups, comprising (a) those made from extractive drugs, including alteratives, astringents, cathartics, and expectorants, and (b) those made from chemicals, either by simple solution or by chemical reaction and solution, including the hypo- phosphites, iron, and other tonics. The Aromatic or Adjuvant Syrups are mostly used as additions to, or vehicles of, liquid mixtures containing Bromides, Iodides, Phosphates, or similar salts of disagreeable saline taste, desirable to disguise. The following are official: „ . 0 Cc. in 100 Cc, Syrupus— or percentage by vol. Acacias............mucilage acacia 25. Acidi Citrici......spir. lemon, I ; acid, citric 1. Althasae.............marshmallow 5. Amygdalae . . (bitter almond 4, sweet almond 14) 18. orange flower water 10. Aurantii......orange, fresh exterior rind 5. Aurantii Florum......orange flower water 50. Rubi Idasi . . .'.....raspberry j uice (fresh) 40. Tolutanus.............tolu balsam 1. Zingiberis........fluid extract of ginger 3. The Extractive Syrups are often made by mixing the Fluid Extract of the respective drugs with Syrup. Tinctures and Fluid Extracts of resinous drugs often precipitate when mixed with Syrups and aqueous solutions. In order to fur- nish clear mixtures it is therefore sometimes necessary to mix the extractive preparation with Water, clarify the mixture by filtration, and dissolve the sugar in the filtered liquid. 60 A TEXT-BOOK OF MA TERIA MEDICA. The following are official: Gm of Drug Syrupus— "* IO° Cc. Allii.............vinegar of garlic 20. Ipecacuanhas..........fl. ext. ipecac 7. Kramerias...........fl. ext. rhatany 45. Lactucarii.........tinct. lactucarium 10. Picis Liquidae.......... glycerite, tar 7.5 Pruni Virginianae.........wild cherry 15. Rhei............. fl. ext. rhubarb 10. Rhei Aromaticus......tinct. rhubarb,arom. 15. Rosas............fl. ext. red rose 12.5 Rubi .........fl. ext. blackberry bark 25. Sarsaparillae Comp.......fl. ext. sarsaparilla 20. fl. ext. glycyrrh., senna, each 1.5 oils, sassafras, anise, gaultheria, each 0.01 Scillas............vinegar of squill 45. Scillas Comp.....fl. exts. squill, senega, each 8. (Coxe's Hive Syrup) . . antimony and potass, tart. 0.2 Senegas............fl. ext. senega 20. Sennas.........oil coriander 0.5 ; senna 25. The dose of the Syrups of Ipecac, Squill, Squill Comp., and Senega as an expectorant is from 5-30 minims (0.5-2 Cc); as emetic, from 1-2 fluidrachms (4-8 Cc). The Chemical Syrups are an elegant class of preparations in which the taste of the medicinal agents is greatly modified. They do not keep well unless put up in small bottles completely filled, ready for dispensing. Except the Syrup of Iodide of Iron, which is best preserved in bottles exposed to light, they should be kept in a cool and dark place. The dose is from 1 to 2 teaspoonfuls (4 to 8 Cc), except of the Syrup of Iodide of Iron, the ordinary dose of which is 10 drops, nearly equivalent to 10 minims (0.6 Cc). The Syrup of Iron, Quinine, and Strychnine Phosphates (Easton's Syrup, Ph. Br.) is almost identical with the well-known unofficial Elixir of that name. It contains -^ grain of Strychnine in 80 min- ims (1 mg. in 5 Cc); the formula of the U. S. P. 1880 yielding a Syrup nearly three times as strong, care should be observed that the preparations of the two formulas be not accidentally confused with each other. A somewhat similar preparation is the Syrupus Hypophosphitum Compositus of the N. F. PHARMACEUTICAL PREPARATIONS. 6l The following are official: Percentage, Gm. or Cc. Syrupus— in ioo. Acidi Hydriodici.....acid, hydriodic, by weight i. Calcii Lactophosphatis . . . calcium lactophosphate i. Calcis..........lime (calcium saccharate) I. Ferri Iodidi.......ferrous iodide, by weight io. Grains Percent- in i fluid- age by drachm (4 Cc). vol. Ferri, Quininae et Strychninae Phosphatum: ferric phosphate, soluble i^- 2. quinine sulphate 2 3. strychnine -£$ 0.02 acid, phosphoric 3 4.8 Hypophosphitum . . . calcium hypophosphite 3 4.5 potassium and sodium hypophosphites, each 1 1.5 spirit lemon 0.5 ; acid hypophos. dil. 0.2 Hypophosphitum cum Ferro . . ferrous lactate 1. with potass, citrate 1, in syrup hypophosph. Unofficial Syrups of the National Formulary. Unless otherwise stated, the dose is 1 to 2 fluidrachms or tea- spoonfuls (4-8 Cc). Syrupus— Actee Compositus (Cimicifuga or Black Cohosh).—Contain- ing 2\ grains (0.15) each of Cimicifuga and Wild Cherry, \\ grains (0.07) Glycyrrhiza and Senega, and -| grain (0.04) Ipecac in each fluidrachm (4 Cc). Asari Compositus (Canada Snake Root).—Each fluidrachm (4 Cc) represents 3^ grains (0.2) of Asarum. Calcii Chlorhydrophosphatis (Chlorhydrophosphate of Lime).—Each fluidrachm (4 Cc) contains 1 grain (0.06) of Calcium Phosphate. Calcii et Sodii Hypophosphitum (Hypophosphite of Lime and Soda).—Each fluidrachm (4 Cc.) contains 2 grains (0.13), each, of Hypophosphites of Calcium and Sodium. Calcii Hypophosphitis (Hypophosphite of Lime).—Each fluidrachm (4 Cc.) contains 2 grains (0.13) of Calcium Hypo- phosphite. Calcii Iodidi (Iodide of Calcium).—Each fluidrachm (4 Cc.) contains about 5 grains (0.3) of Calcium Iodide. 62 A TEXT-BOOK OF MATERIA MEDICA. Syrupus— Calcii Lactophosphatis cum Ferro (Lactophosphate of Lime with Iron).—Each fluidrachm (4 Cc.) contains \ grain (0.03) of Lactate of Iron and about \ grain (0.015) of Calcium Lactate (or about -f grain (0.02) of so-called Lacto- phosphate of Calcium). Chondri Compositus (Irish Moss).—Containing 1 grain (0.06) each of Squill and Senega, -^ grain (0.004) eacn of Ipecac and Irish Moss, and if minims (0.1) Tincture Opium Camph. to each fluidrachm (4 Cc). Cinnamomi (Cinnamon, Ph. Ger.).—Chiefly used for flavoring. Codeine.—Containing \ grain (0.3) Codeine Sulphate in each fluidrachm (4 Cc). The Syrup of the French Codex is about one-fourth this strength. Coffee (Coffee).—Containing 15 grains (1.) of the choicest Coffee (Java and Mocha) in fluidrachm (4 Cc.); an elegant vehicle for Quinine and addition to nauseous mixtures. Eriodictyi Aromaticus (Yerba Santa; Syrupus Corrigens). —Chiefly intended as a vehicle for disguising the taste of Quinine and other bitter substances. Ferri Arsenatis.—Each fluidrachm (4 Cc.) contains about ■fa grain (0.001) of Arsenate of Iron (ferric). Ferri Bromidi (U. S. P., '80).—Containing 10 per cent, of Ferrous Bromide. Ferri Citro-iodidi (Tasteless Syrup of Iodide of Iron).— Each fluidrachm (4 Cc) contains an amount of Iron corre- sponding to about 3.6 grains (0.25) of Ferric Iodide. The official Syrupus Ferri Iodidi contains about 8 grains (0.5) of Ferrous Iodide (Protiodide of Iron) in each fluidrachm (4 Cc). Ferri et Mangani Iodidi (Iodide of Iron and Manganese).— Each fluidrachm (4 Cc) contains 6 grains (0.4) of Iodide of Iron (ferrous) and 3 grains (0.2) of Iodide of Manganese. Ferri Hypophosphitis (Hypophosphite of Iron).—Each fluid- drachm (4 Cc.) contains 1 grain (0.06) of Hypophosphite of Iron (ferric). Ferri Lactophosphatis (Lactophosphate of Iron).—Each fluidrachm (4 Cc.) contains 1 grain (0.06) of Lactate of Iron, or about i£ grains (0.1) of so-called Lactophosphate of Iron. Ferri Protochloridi (Ferrous Chloride).—Each fluidrachm PHARMACEUTICAL PREPARATIONS. 63 Syrupus— (4 Cc) contains about 1 grain (0.06) of Protochloride of Iron. Ferri Saccharati Solubilis (Soluble Saccharated Iron; Saccharated Oxide of Iron, Ph. Ger.).—Each 75 minims (5 Cc) represents approximately 1 grain (0.06) of Metallic Iron, or 3 grains (0.2) of Oxide of Iron. Glycyrrhize (Liquorice).—Each fluidrachm (4 Cc.) repre- sents 30 grains (2.) of Glycyrrhiza. Hypophosphitum Compositus.—Each fluidrachm (4 Cc.) con- tains 2 grains (0.12) of Calcium Hypophosphite, 1 grain (0.06), each, of the Hypophosphites of Potassium and Sodium, \ grain (0.008), each, of the Hypophosphites of Iron and Manganese, -fa grain (0.004) °f Quinine Hydro- chlorate, and 1 \ minims (0.01) of Tincture of Nux Vomica. This Syrup should not be confounded with the official Syrupus Hypo- phosphitum (Syrup of the Hypophosphites : Calcium, Sodium, and Potassium). It is intended to replace a well-known proprietary article, for which it has been found by many physicians to be a satisfactory substitute. It is uniform in com- position and more stable and elegant than the patent article. Ipecacuanhe et Opii (Syrup of Dover's Powder).—Each fluidrachm (4 Cc.) represents 5 grains (0.3) of Dover's Pow- der, or \ grain (0.03), each, of Ipecac and Opium. Manne (Syrup of Manna, Ph. Ger.). Morphine Compositus.—A preparation sometimes dispensed as Jackson's Pectoral Syrup, but, as it differs in essential particulars, the N. F. recommends that this preparation be dispensed only when expressly designated under this title. Each fluidrachm (4 Cc.) contains \ grain (0.008) Ipecac, 5 grains (0.3) Senega, 1 grain (0.06) Rhubarb, and -g1^ grain (0.002) Morphine, with Oil of Sassafras. Morphine Sulphatis (Syrup of Morphine).—Each fluid- drachm (4 Cc.) contains \ grain (0.008) of Sulphate of Morphine. Papaveris (Poppy, Ph. Br.; Diacodii, Ph. Ger.).—Similar to the preceding, but considerably weaker. Pectoralis (Jackson's Pectoral Syrup).—Each fluidrachm (4 Cc.) contains -fa grain (0.002), each, of Morphine and Oil of Sassafras. Phosphatum Compositus (Chemical Food).—Each fluidrachm (4 Cc.) contains about 2 grains (0.12) of Phosphate of 64 A TEXT-BOOK OF MATERIA MEDICA. Syrupus— Calcium, i grain (0.06), each, of the Phosphates of Iron and Ammonium, and smaller quantities of the Phosphates of Potassium and Sodium. Pini Strobi Compositus (White Pine Compound).—A com- bination of White Pine, Wild Cherry, Spikenard, San- guinaria, Chloroform, and Morphine, -fa grain (0.002) in a fluidrachm. Rhamni Cathartice (Buckthorn Berries; Syrupus Spinas Cervinas, Ph. Ger.). Rubi Aromaticus (Blackberry, Aromatic).—A combination of Rubus, Cinnamon, Nutmeg, Cloves, and Allspice. Sanguinarie (Bloodroot).—Each fluidrachm (4 Cc.) repre- sents 13 grains (0.8) of Sanguinaria. Senne Aromaticus (Senna, Aromatic).—Each fluidrachm (4 Cc.) represents 7J grains (0.5) of Senna, 3 grains (0.2) of Jalap, and 1 grain (0.06) of Rhubarb, with aromatics. Senne Compositus (Senna, Compound).—Each fluidrachm (4 Cc.) represents 8 grains (0.5) of Senna, 2 grains (0.12), each, of Rhubarb and Frangula. Sodii Hypophosphitis.—Each fluidrachm (4 Cc.) contains 2 grains (0.12) of Sodium Hypophosphite. Stillingie Compositus.—Each fluidrachm (4 Cc.) represents 15 minims (1 Cc.) of Compound Fluid Extract of Stillingia. Oxymel Scille (Oxymel of Squill, Ph. Br.).—A preparation of Honey containing about 5 grains (.32 Gm.). of Squill in each fluidrachm (4 Cc). ELIXIRI A—ELIXIRS. Elixirs are a class of elegant preparations similar to wines or cordials, composed of Water, Sugar, Alcohol, and Aromatics. The medicinal substances are usually in such proportion that an ordinary dose may be contained in one or two teaspoonfuls (4 to 8 Cc) of the elixir. There are but two Elixirs official: Aromatic Elixir, which serves as a vehicle, and one medicinal, Elixir of Phosphorus. Elixir Aromaticum.....spirit of orange, comp. 12 Cc. mix with.....alcohol, deodorized, to make 250 Cc. to this solution add in several portions, agitating after each addition..........syrup 375 Cc. and in the same manner.........water 375 Cc. PHARMACEUTICAL PREPARATIONS. 65 mix the liquid with precipitated calcium phosphate 15 Gm. and filter, adding . . water 3 ; alcohol 1 ; to make 1000 Cc This illustrates the method by which Elixirs are made. The medicinal ingredients are dissolved in the Water, or Alcohol, as indicated by their solubilities, before mixing the Alcoholic Solution of Oils with the Saccharine Solution. Elixir Phosphori: glyc 55 ; anise oil 0.2; sp. phosph. 21 Cc. mix by agitation ; then add . aromatic elixir, to 100 Cc. This Elixir contains of phosphorus 25 mg. in 100 Cc, or fa grain (1 mg.) in 1 fluidrachm (4 Cc), the ordinary dose. Some Salts and Fluid Extracts may be dissolved in or mixed with the Elixir itself. For example : Potassii Bromidi.............. 10. Elixir Aromatici...........q. s. ad 100. Cc. This contains 15 grains (1 Gm.) in 21- fluidrachms (10 Cc), 6 grains in 1 fluidrachm or teaspoonful. Elixirs of the National Formulary. The value of pleasant vehicles to mask or modify the taste of bitter and nauseous drugs is recognized by every prescriber. The following Elixirs of the National Formulary have been carefully selected, and embrace the most effective combinations of adjuvants and aromatics for disguising the different drugs for which they are recommended: Elixir— Anisi; a combination of Anethol, Fennel, and Bitter Almond. Curassao (Curacao Cordial); a combination of Curacao, Orris, and a little Citric Acid. Adjuvant Elixirs.—The following are intended as vehicles for Quinine and similar bitter substances, and as adjuvants for Tinctures and Fluid Extracts of bitter and resinous drugs, such as Cinchona, Cascara Sagrada, etc. They all contain Glycyrrhiza, which, in the form directed in the N. F. (Russian Licorice Root, peeled), is most effective in masking the bitter taste of Quinine, when it is directed to be simply suspended in the. mixture without the use of acid for effecting solution. Acids precipitate the glycyrrhizin and destroy its power of masking the bitter taste : Elixir— Adjuvans ; a combination of Orange, Wild Cherry, Glycyr- rhiza, Coriander, and Caraway. Except for the exhibition of Quinine this is the most effective of the adju- vant Elixirs. 5 A TEXT-BOOK OF MA TERIA MEDICA. Elixir— Eriodictyi Aromaticum (Arom. Elixir Yerba Santa; Elixir Corrigens).—A solution of Yerba Santa in Comp. Elixir of Taraxacum, intended as a vehicle for Quinine and other bitter remedies. Glycyrrhize (Elixir of Licorice); a solution of Licorice in t Aromatic Elixir, the most effective vehicle for Quinine. Glycyrrhize Aromaticum ; Elixir of Licorice, with the addi- tion of strong aromatics. Taraxaci Compositum ; an improved form of this well-known compound, useful as a mild adjuvant. Medicinal Elixirs.—These comprise the Elixirs mostly in use; also, a number of preparations in which the prescriber will find satisfactory substitutes, designated by scientific titles and of definite strength and uniform composition, intended to replace various nostrums. Active Drug in i Fluidrachm. 4 Cc. Elixir— grains. Gm. Acidi Salicylici............. 5 0.3 Ammonii Bromidi............ 5 0.3 Ammonii Valerianate.......... 2 0.12 The odor and taste of the salt being well covered by the addition of vanilla and a little chloroform. Ammonii Valerianatis et Quinine.—The above, with Quinine Hydrochlorate .... \ 0.015 Apii Graveolentis (Celery Compound).—Con- taining Celery, Coca, Kola, and Viburnum, each................. 4 025 Bismuthl—Bismuth and Ammonium Citrate . 2 0.12 BucHu.................. 71 0.5 Buchu Compositum.—Buchu, Cubeb, Juniper, and Uva Ursi, combined........15 1. Buchu et Potassii Acetatis.—Elixir Buchu, with Potassium Acetate........ c 0 ^ Caffeine.—Caffeine (in solution in Hydro- bromic Acid)........... T _ Qg Calcii Bromidi.......... - 0. Calcii Hypophosphitis....... 2 I2 PHARMACEUTICAL PREPARATIONS. 67 Active Drug in 1 Fluidrachm. 4 Cc. Elixir— Grains. Gm. Calcii Lactophosphatis.—Calcium Lactate (in Phosphoric Acid)............ 1 0.06 Catharticum Compositum.—Each fluidrachm (4 Cc.) contains Senna y\ grains (0.5); Podo- phyllum 4 grains (0.25); Leptandra and Jalap, each 3 grains (0.2); Rochelle Salts *]\ grains (0.5); and Sodium Bicarbonate 1 grain (0.06). The mixture should be shaken. Chloroformi Compositum.—A mixture of equal parts of Chloroform, Tincture of Opium, Spirit of Camphor, Aromatic Spirit of Ammonia, and Alcohol, flavored with Cin- namon. The old title, " Chloroform Pare- goric," is recommended to be abandoned for the above. Each fluidrachm (4 Cc.) contains 1 grain (0.06) of Opium and 11 minims (0.7) of Chloroform. Cinchone (Elixir Calisaya).—This preparation is from the best Calisaya Bark, representing about 2 grains (0.12) in each fluidrachm (4 Cc). It is preferable to preparations made from Quinine and the cheaper alkaloids in being a more agreeable and effective anti- periodic tonic. Cinchone et Ferri (Calisaya and Iron; Fer- rated Elixir of Calisaya).—Phosphate of Iron . 2 0.12 Cinchone et Hypophosphitum.—Calcium and Sodium Hypophosphites, each...... 1 0.06 Cinchone, Ferri, Bismuthi et Strychnine. —Phosphate of Iron......... 2 0.12 Bismuth and Ammonium Citrate..... 1 0.06 Strychnine Sulphate...........Y^o" 0.0007 Cinchone, Ferri et Bismuthi.—Phosphate of Iron................ 2 0.12 Bismuth and Ammonium Citrate..... I 0.06 Cinchone, Ferri et Calcii Lactophosphatis. —Phosphate of Iron......... \\ 0.1 Calcium Lactophosphate......about 1 0.06 68 A TEXT-BOOK OF MATERIA MEDICA. Active Drug in i Fluidrachm. 4 Cc. Elixir— Grains. Gm. Cinchone, Ferri et Pepsini.—Phosphate of ■ Iron................ i| 0.1 Pepsin................ 1 0.06 Cinchone, Ferri et Strychnine.—Phosphate of Iron............... 2 0.12 Sulphate of Strychnine.........-3-^ 0.0007 Cinchone, Pepsini et Strychnine.—Contain- ing smaller quantities of the Cinchona Alka- loids, Pepsin 1 grain (0.06), and Sulphate of Strychnine............jfa 0.0007 Coce (Coca).—Leaves, Erythroxylon Coca . . 7^ 0.5 Coce et Guarane.—Coca and Guarana, of each 7 J 0.5 Corydalis Compositum.—Containing of Cory- dalis, Stillingia, Iris, and Xanthoxylum, combined..............15 1. Potassium Iodide............ 3 0.2 Digestivum Compositum.—Containing about 5 grains (0.3) of Pulvis Digestivus in each fluidrachm (4 Cc). Eucalypti.—Eucalyptus Globulus..... 7L 0.5 Euonymi (Wahoo).—Euonymus Atropurpureus 10 0.6 Ferri Hypophosphitis. — Hypophosphite of Iron (ferric)............. I 00.6 Ferri Lactatis ............. I 0.06 Ferri Phosphatis.—Phosphate of Iron (U.S. P.) 2 0.12 Ferri Phosphatis, Cinchonidine et Strych- nine.—Phosphate of Iron....... 2 0.12 Cinchonidine.............. 1 0.03 Sulphate of Strychnine......... 1 0.0007 Ferri Phosphatis, Quinine et Strychnine. —Phosphate of Iron, 1 grain (0.06); Qui- nine ................ i. 0.03 Sulphate of Strychnine.........JL 0.001 Ferri Pyrophosphatis.......... 2 0.12 Ferri, Quinine et Strychnine.—Ferric Chlo- ride, 1 grain (0.06); Quinine Hydrochlorate \ 0.03 Sulphate of Strychnine........._i_r 0.0007 Frangule (Buckthorn).—Rhamnus Frangula . 15 1. PHARMACEUTICAL PREPARATIONS. 69 Active Drug in 1 Fluidrachm. 4 Cc. Elixir— Grains. Gm. Gentiane................ 2 O.I2 Gentiane cum Tincture Ferri Chloridi.— Tincture Citro-chloride of Iron..... 5 0.3 Gentiane et Ferri Phosphatis (ferrophos- phated).—Phosphate of Iron...... 1 0.06 Grindelie.—Grindelia Robusta...... 4 0.25 Guarane.—Paullinia Cupana........12 0.75 Humuli................. 7| 0.5 Hypophosphitum.—Calcium Hypophosphite . 3 0.2 Sodium and Potassium Hypophosphites, each 1 0.06 Hypophosphitum cum Ferro.—Calcium and Sodium Hypophosphite, each...... 1 0.06 Potassium and Iron Hypophosphites, each . \ 0.03 Lithii Bromidi............. 5 0.3 Lithii Citratis............. 5 0.3 Lithii Salicylatis............ 5 0.3 Malti et Ferri.—Phosphate of Iron .... 1 0.06 Malt Extract..............15 1. Paraldehyde—Paraldehyde........15 1. Pepsini.—Pepsin.........• . . . 1 0.06 Pepsini, Bismuthi et Strychnine.—Elixir Pep- sin and Bismuth, and Strychnine .... -^fa 0.0007 Pepsini et Bismuthi.—Pepsin....... 1 0.06 Bismuth and Ammonium Citrate...... 2 0.12 Pepsini et Ferri.—Elixir of Pepsin and Tinc- ture Citro-chloride of Iron....... 5. 0.3 Phosphori et Nucis Vomice.—Elixir Phos- phorus, with Tincture Nux Vomica ... 2 0.12 Picis Compositum.—A combination of Prunus Virginiana, Tolu, Methylic Alcohol, and Sul- phate of Morphine ..........fa O.0015 Pilocarpi (Jaborandi).—Pilocarpus Selloanus . 4 0.25 Potassii Acetatis............ 5 °-3 Potassii Acetatis et Juniperi.—Elixir Potass. Acet. with Juniper.......... 7\ 0.5 Potassii Bromidi.—Potassium Bromide, effect- ually masked in Adjuvant Elixir . . . . 10 0.6 An Elixir half this strength has also been used. 70 A TEXT-BOOK OF MATERIA MEDICA. Active Drug in i Fluidrachm. 4 Cc. Elixir— Grains. Gm. Quinine Compositum (Red).—Sulphates of Quinine, \ grain (0.008), Cinchonidine and Cinchonine, each.............fa 0.004 Chiefly intended as a substitue for Elixir Cinchona when the administration of other constituents of the bark may be deemed ob- jectionable. Quinine et Phosphatum Compositum.—Qui- nine Sulphate............ \ 0.015 Phosphate of Iron........... 1 0.06 Calcium Lactophosphate......... f 0.05 Quinine Valerianate et Strychnine.—Va- lerianate of Quinine.......... 1 0.06 Sulphate of Strychnine..........Y^g- 0.0007 Rhamni Purshiane (Cascara Sagrada).—Rham- nus Purshiana, its bitterness effectually masked with Elixirs of Glycyrrhiza and Taraxacum Compound ..............15 1. Rhamni Purshiane Compositum (Laxative Elixir; Elixir Purgans).—Cascara Sagrada . 7J 0.5 Senna and Juglans, each......... 5 0.3 Associated with aromatics and correctives ; a most effective laxative in doses of from 1 to 2 fluidrachms (4-8 Cc). Rhei.—Sweet Tincture of Rhubarb, represent- ing Rhubarb.............. 2\ 0.15 Rhei et Magnesie Acetatis.—Magnesium Acetate, 4 grains (0.25) ; Rhubarb..... 71 0.5 Rubi Compositum (Blackberry Compound).— Blackberry Root, Galls, and Cinnamon (Sai- gon), in equal proportions, combined .... 10 0.6 with smaller quantities of Cloves, Mace, and Ginger, in Blackberry Juice and Syrup. Sodii Bromidi.—Sodium Bromide, in Adjuvant Elixir.................IO 0.6 Sodii Hypophosphitum.......... 2 0.12 Sodii Salicylate (to be freshly prepared when required for use)............ 5 0.3 PHARMACEUTICAL PREPARATIONS. JI Active Drug in z Fluidrachm. 4 Cc. Elixir— Grains. Gm. Stillingie Compositum. — Compound Fluid Extract of Stillingia, N. F.........15 1. Strychnine Valerianate.........jfa 0.0007 Turnere (Damiana).—Turnera Aphrodisiaca . 10 0.6 Viburni Opuli Compositum.—Viburnum Opu- lus, Aletris Farinosa, each....... 5 0.3 Trillium (Beth Root) ... ......10 0.6 Viburni Prunifolii (Black Haw)...... 7! 0.5 Zinci Valerianate.—Zinc Valerianate ... 1 0.06 Cordiale Rubi Fructus (Blackberry Cordial).—An aromatic Syrup of Blackberry Juice, used as a mild astringent in bowel complaints. Succus Limonis cum Pepsino (Lime Juice and Pepsin).—Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Pepsin. GLYCERITA—glycerites. The Glycerites, or " Glyceroles," are solutions of substances in Glycerin. They are made either by direct solution, by heat, or by extrac- tion of a drug, as in Hydrastis ; one is made by chemical reaction —i. e. Boroglycerin. There are six official, comprising those used externally either alone or as additions to washes, gargles, injections, etc.: Percentage Glyceritum— h weight. Acidi Carbolici...........acid, carbolic 20. Acidi Tannici.............acid, tannic 20. Boroglycerini............boroglyceride 50. Hydrastis.........representing hydrastis 100. The following are used chiefly as pharmacal agents ; the Gly- cerite of Starch as an excipient for Pill-masses; and the Glycerite of Egg-yolk as an emulsifying agent: Glyceritum— Amyli..............water 10, starch 10. Vitelli...............fresh egg-y°lk 45- The Glycerite of Starch is sometimes used externally, and is 72 A TEXT-BOOK OF MATERIA MEDICA. known as Glycerin Ointment, also as " plasma." The Glycerite of Egg-yolk, also known as " glyconin," has been used as an applica- tion to sore nipples. Unofficial Glycerites of the National Formulary. Glyceritum— Pepsini (Glycerole of Pepsin).—Each 4 Cc. (fluidrachm) repre- sents 0.3 (5 grains) of Pepsin. Picis Liquide (Tar).—Containing about 0.3(5 grains) of Tar. Tragacanthe.—Containing about 12 per cent, of tragacanth. MUCILAGINES—MUCILAGES. The Mucilages are prepared by extracting a mucilaginous drug with Water or dissolving a Gum in Water. The following four are official: Gm. in ioo Cc, Mucilago— or percentage. Acacias................gum arabic 34. Sassafras Medullas..........sassafras pith 2. Tragacanthas........glycerin 18 ; tragacanth 6. Ulmi..............slippery-elm bark 6. The Mucilages are chiefly employed as vehicles in Mixtures to aid in suspending insoluble substances ; as excipients in Pills and Troches; and as emulsifying agents. They are sometimes used for their demulcent effect. THE LIQUID MIXTURES—INTERNAL. MISTURE—MIXTURES. The official Mixtures are liquid preparations, for internal use, of medicinal substances dissolved or suspended in Water containing sugar, gum, or glycerin. They should be prepared extemporane- ously. The term Mixture is also applied to any combination of substances that cannot be otherwise classified. There are four official mixtures : Mistura— Gms. in 100 Cc. Cretas (Chalk Mixture) .... comp. chalk powder 20. cinnamon water 40; water, to 100. Ferri Comp. (Griffith's Mixt.) . . . myrrh, sugar, each 1.8 potass, carb. 0.8 triturate with gradual addition of rose water 70. ferrous sulphate, 0.6; spir. lavend., 6; rose water, to 100. THE LIQUID MIXTURES—INTERNAL. 73 Mistura— Gms. in 100 Cc Glycyrrhizas Comp.....pure extract glycyrrhiza 3 (Brown Mixture) Spirit ether nitrous 3 wine antimony 6 tinct. opium, camph. 12 syrup 5 ; mucilage acacia 10; water, to 100 Rhei et Sodas.........sodium bicarbonate 3 fl. exts. ipecac 0.3, rhubarb 1 spirit peppermint 3.5 ; glycerin 35.; water, to 100 Unofficial Mixtures of the National Formulary. Mistura— Acacie—(Mistura Gummosa, Ph. Ger.).—Acacia, pulv., Sugar, in Water. Should be freshly made when wanted for use. Adstringens et Escharotica (Villate's Solution).—Solu- tion of Lead Subacet. \\ fluidounces (45.); Sulphates of Copper, Zinc, each, 1 troy ounce (30.) ; Acetic Acid 13 fluid- ounces (360 Cc). Ammonii Chloridi (Mistura Solvens Simplex).—Ammonium Chloride, Purif. Ext. Glycyrrhiza, each 180 grains (12.), in Water 16 fluidounces (450 Cc). Mistura (or Mixturd) Solvens Stibiata is prepared by dis- solving 0.3 Antimony and Potassium Tartrate in 1000 Cc. of Mistura Ammonii Chloridi. Camphore Acida (Mistura Antidysenterica; Hope's Mix- ture).—Nitric Acid 120 mins. (8 Cc); Tinct. Opium 80 mins. (5 Cc.); in Camphor Water 16 fluidounces (450 Cc). Camphore Aromatica (Parrish's Camphor Mixture).—Tinct. Lavender Comp. 4 fluidounces (120 Cc); Sugar 240 grains (15.); in Camphor Water 16 fluidounces (450 Cc). Carminativa (Dalby's Carminative).—Magnes. Carb. 1 troy ounce (30.); Potass. Carb. 20 grains (1.3); Tinct. Opium 180 mins. (12 Cc); Oils of Caraway, Fennel, Peppermint, each, 4 drops (0.1) ; Syrup 2\ fluidounces (75 Cc.); in 16 fluidounces (450 Cc). Each fluidounce (30 Cc.) represents about 1 grain of Opium (0.06). Chloral et Potassii Bromidi Composita (Mixture of Chloral and Bromide).—Each fluidrachm (4 Cc.) contains 15 grains (1.), each, of Chloral and Potassium Bromide, 5 5 74 A TEXT-BOOK OF MATERIA MEDICA. Mistura— and \ grain (0.008), each, of Exts. Indian Cannabis and Hyoscyamus. Chloroformi et Cannabis Indice Composita (Chloroform Anodyne).—Each fluidrachm (4 Cc) represents *]\ minims (0.5 Cc), each, of Chloroform and Tinct. Indian Cannabis- 3f minims (0.25 Cc.) Tinct. Capsicum; and about \ grain (0.01) of Morphine Sulph. Contra Diarrhceam (Cholera Mixture).—Tinctures of Opium, Capsicum, Rhubarb, and Spirits of Camphor and Pepper- mint, each, equal volumes. The above formula appears to be that in most general use, also known under the name of " Sun Mixture." Of other similar preparations in more or less general use, the following may be mentioned here: 2. Loomis' Diarrhea Mixture.—Tincture Opium, \ fluid- ounce (15 Cc.) ; Tincture Rhubarb,^ fluidounce (15 Cc); Tincture Catechu Comp., 1 fluidounce (30 Cc.); Oil of Sas- safras, 20 minims (1.3 Cc); Tincture Lavender Comp., to make 4 fluidounces (120 Cc). 3. Squibb's Diarrhea Mixture.—Tincture Opium, 1 fluid- ounce (30 Cc); Tincture Capsicum, 1 fluidounce (30 Cc); Spirit of Camphor, 1 fluidounce (30 Cc.); Purif. Chloroform, 180 minims (12 Cc.); Alcohol, enough to make 5 fluidounces (150 Cc). 4. Thielemann's Mixture (Mixt. Thielemanni, Ph. Suec.).— Wine Opium, 1 fluidounce (30 Cc); Tinct. Valerian, \\ fluidounces (45 Cc); Ether, \ fluidounce (15 Cc.); Oil Peppermint, 60 minims (4 Cc); Fl. Ex. Ipecac, 15 minims (1 Cc); Alcohol, to make 4 fluidounces (120 Cc). 5. Velpeau's Diarrhea Mixture.—Tincture Opium, Tinc- ture Catechu Comp., Spirit Camphor, of each, equal volumes. Copaibe Composita— 1. Lafayette Mixture.—Copaiba, 2 fluidounces (60 Cc); Tinct. Lavender Comp., 2 fluidounces (60 Cc); Solution Potassa, 1 fluidounce (15 Cc); Spirit Nitr. Ether, 2 fluid- ounces (60 Cc); Syrup, 5 fluidounces (150 Cc.); Mucilage Dextrin, to make 16 fluidounces (450 Cc). This mixture should be well agitated when used. Each fluidrachm con- tains j\ minims of Copaiba. 2. Chapman s Mixture.—Copaiba, 4 fluidounces (125 Cc); THE LIQUID MIXTURES—INTERNAL. 75 Mistura— Tinct. Lav. Comp., 240 minims (15.5 Cc.); Tincture Opium, 240 minims (15.5 Cc.); Spirit Nitro. Ether, 4 fluidounces (125 Cc.) ; Mucilage Acacia, 1 \ fluidounces (45 Cc); Water, to make 16 fluidounces (450 Cc). Expectorans, Stokes (Stokes' Expectorant).—Ammonium Carb., 120 grains (8.); Fl. Ext. Senega, \ fluidounce (15 Cc.); Fl. Ext. Squill, \ fluidounce (15 Cc.); Tinct. Opium, Camph., 2\ fluidounces (80 Cc.); Water, \\ fluidounces (45 Cc.); Syrup Tolu, to make 16 fluidounces (450 Cc). Guaiaci (Guaiac Mixture, Ph. Br.).—Resin Guaiac, Sugar, each, 190 grains (12.5); Acacia Powder, 100 grains (7.); Cinna- mon Water, 16 fluidounces (450 Cc). To be well agitated when used. Magnesie et Asafcetide (U. S. P. 1880.).—Dewees' Carmina- tive.—Magnesium Carbonate, 90 grains (6.0); Tinct. Asa- fcetida, 2 fluidrachms (8 Cc.); Tinct. Opium, 20 minims (1.2 Cc.); Sugar, 180 grains (12.0); Water, to make 4 fluid- ounces (120 Cc). Olei Balsamica (Balsamum Vitas Hoffmanni, Ph. Ger.).— A solution of Oils of Lavender, Thyme, Lemon, Mace, Orange-flowers, Cloves, Cinnamon, and Balsam Peru in Alcohol. Olei Picis (Tar Mixture).—A mixture of Oil of Tar, \ fluid- ounce (15 Cc.) ; Chloroform, 75 minims (5 Cc.); Oil of Pep- permint, 20 minims (1.3 Cc), in Elixir, to make 16 fluid- ounces (450 Cc). Rhei Composita (Squibb's Rhubarb Mixture).—Fl. Ext. Rhubarb, 120 minims (6. Cc); Fl. Ext. Ipecac, 16 minims (1. Cc.); Sodium Bicarb., 330 grains (11.); Glycerin, 6 fluid- ounces (240.), in Peppermint Water, 16 fluidounces (450 Cc). Sassafras et Opii (Mist. Opii Alkalina; Godfrey's Cordial).— A mixture of Oil of Sassafras, Tincture of Opium, and Potass. Carb. in Molasses, Alcohol, and Water. Each fluidrachm (4 Cc.) contains 2 minims (0.12) Tinct. Opium, correspond- ing to \ grain (0.01) Opium. Sode et Menthe (Soda Mint).—Sodium Bicarb., 320 grains (20.); Spirit Ammonia Arom., 4 Cc. (60 minims); Spear- mint Water, 16 fluidounces (450 Cc). Splenetica (Spleen Mixture; Gadberry's Mixture).—Iron Sulphate, Quinine Sulphate, Nitric Acid, each, 100 grains 76 A TEXT-BOOK OF MA TERIA MEDICA. Mistura— (7.); Potassium Nitrate, 300 grains (20.), in Water, 16 fluid- ounces (450 Cc). Sulphurica Acida (Haller's Acid Elixir, Ph. Ger.).—Sul- phuric Acid, 1 part; Alcohol, to make 4 parts, by weight. EMULSA—EMULSIONS. Emulsions are liquid preparations consisting of oily, fatty, resin- ous, or otherwise insoluble substances suspended in watery liquids by the intervention of gum, mucilage, or other viscid matter. For the internal administration of Oils it is often necessary to exhibit them in a palatable form, so that they may be borne by the stomach and their assimilation favored. This is usually effected by suspending the oil in a watery liquid or mixture by means of an emulsifying agent, such as acacia, etc. Many natural substances are intimate mixtures of oils or fats with water, in the form of an emulsion. Of animal products, Milk is a most perfect emulsion ; so is Egg-yolk. From the Milk-juice of some plants the water evaporates and the dried milk-juice col- lects in the seeds, as in almonds and other nuts, or exudes from other portions of the plant when the parts are wounded; in this way the gum-resins of asafoetida, etc. are produced. From these substances Emulsions may be obtained by restoring the water lost by evaporation—that is, by rubbing them with water in a mortar. In this way the so-called natural Emulsions are made. Artificial Emulsions. These are made by mixing the Oil with a certain proportion of the emulsifying agent, adding Water, and triturating the mixture in a mortar or agitating it in a flask. There are various methods, but these are general rules: The emulsification of the oil should be complete before the mixture is made up to the required measure. When alcoholic liquids are to be added, they should first be diluted as much as possible. Salts should be dissolved before being added. No heat should be employed, as the oil separates when an emulsion is heated. Emulsions should be freshly prepared and be preserved in a cold place. The most common emulsifying agent is Powdered Gum Acacia (Acacia pulv.). The Oil is thoroughly mixed by trituration in a mortar with one-fourth its weight of powdered Acacia. To this one and a half times as much water as of gum is added at once and the mixture is rapidly triturated with a rotary motion of the pestle THE LIQUID MIXTURES—INTERNAL. until it becomes stiff and assumes a milk-white color. This so- called " mother-emulsion" may now be diluted to the required measure, and other substances, flavors, etc. be added. Powdered Tragacanth may be used in the same way or in the form of mucilage, but it does not produce so permanent emulsions as does gum acacia. Mucilage of Acacia or of Irish Moss is not so satisfactory as powdered gum: while it produces a good emulsion, the division of the oil-globules is not so thorough as in the preceding: emulsifica- tion being incomplete, the mixture more rapidly separates into a heavier, watery liquid and a lighter, thick, gelatinous emulsion, which requires thorough mixing before use. Extract of malt is an excellent emulsifying agent when its use is admissible. The Oil should be added to the Malt Extract contained in a capacious mortar, and incorporated in small quantities at a time. A good article will emulsify an equal volume of cod- liver oil. Condensed Milk and Egg-yolk produce the most perfect emulsions, and also the most palatable, but they rapidly ferment and spoil. Glycerin and sugar added to emulsions for the purpose of preservation and palata- bility induce separation, and their use is not advisable. Emulsification " by intervention " is the best and only reliable method to be employed with Ethereal Oils and all substances of themselves not emulsifiable. The process is illustrated in the official Chloroform Emulsion. Oil of Turpentine, for example, is emulsified by dissolving the Turpentine Oil in twice its volume of a bland fixed oil (Almond Oil), incorporating an equal weight of powdered Acacia, adding Water, and proceeding as with an ordinary emulsion. Pancreatin emulsionizes fats in preparing them for digestion, but it does not produce a permanent emulsion when used artificially. While, therefore, not a reliable emulsifying agent, it aids the assimilation of oils, and its addition to emulsions is sometimes therapeu- tically desirable. As it is only active in alkaline media, the Emulsion should be prepared with a little Sodium Bicarbonate. The addition of Alkalies to emulsions should be avoided. Soaps are not Emulsions, nor is the use of Soap-bark to be recbmmended. Of the four official Emulsions three are natural emulsions; one is artificial: Gm. in ioo Cc, Emulsum— or percentage by vol. Ammoniaci..............ammoniac 4. Amygdalae............sweet almond 6. sugar 3; acacia 1. Asafcetida........asafcetida, in select tears 6. Chloroformi .... tragacanth powd. 1.5 ; chloroform 4. expressed oil almond 6; water, to 100. 78 A TEXT-BOOK OF MATERIA MEDICA. Shake the Chloroform and Tragacanth together in a dry bottle, incorporate 25 Cc Water, then the Almond Oil in small quantities, and finally in the same way add the remainder of the Water. Unofficial Emulsions of the National Formulary. Emulsions should, of all pharmaceuticals, be prepared within a reasonable period previous to the time of dispensing. A true emulsion should contain the oil simply suspended in the form of a mechanical mixture, which, from its very character, cannot with- stand the effects of variation in temperature any better than a natural emulsion, such as milk or emulsions of almonds, gum- resins, etc., and consequently quickly degenerates or spoils. An emulsion may be perfect—that is, the oil-globules entirely extinguished—yet a separation similar to that occurring in milk will take place, which, though in its first stage not so objection- able, will eventually impair the medicinal value of the preparation. These reasons are, it is believed, sufficient to condemn the various "ready-made" or patent emulsions, and to justify the physician in prescribing such as are kept on hand by the pharmacist, in smaller quantities, prepared according to these formulas. A typical formula for emulsions, with Acacia, is— ^. Olei Morrhuas.......120 Cc, £iv; Acacias pulv........30 Gm., §j; Aquas.......q. s. ad 240 Cc, Iviij. Emulsify by trituration in a mortar, and add the flavoring. The following are flavors employed: (1) Gaultheria, (2) gaul- theria and sassafras, (3) aromatic spirit, (4) gaultheria, bitter almond, and coriander, (5) gaultheria, sassafras, and bitter almond, (6) gaul- theria and bitter almond, (7) oil of neroli, bitter almond, and cloves, Unless otherwise specified, that designated as No. 5 may be em- ployed in these Emulsions. The following formulas may be useful as indicating the form of prescription for any combination desired. Hypophosphite Salts or any medication desired may usually be dissolved in the water directed in the formula, should a preparation be indicated different from any of the following emulsions of the N. F.: Emulsio— Olei Morrhue cum Calcii et Sodii Phosphatibus.—Cal- cium Phosphate, Sodium Phosphate, of each, 1 grain in 1 fluidrachm (0.06 in 4 Cc). EXTRACTIVE PREPARATIONS. 79 Olei Morrhue cum Calcii Lactophosphate.— Calcium Lactophosphate, 3 grains in 1 fluidrachm (0.2 in 4 Cc). Olei Morrhue cum Calcii Phosphate.—Calcium Phos- phate, 2 grains in 1 fluidrachm (0.12 in 4 Cc). Olei Morrhue cum Extracto Malti.—Contains 40 per cent. Extract of Malt. Olei Morrhue cum Hypophosphite.—The Hypophosphite Salt or any combination of the following: Calcium, Po- tassium, Sodium, or Iron, to be directed by the prescriber, 8 grains to the fluidounce (0.5 in 30 Cc). Olei Morrhue cum Pruno Virginiana.—Wild Cherry (Fluid Ext.), \ fluidrachm to 1 fluidounce (2 Cc. in 30 Cc). Olei Ricini.—1 fluidounce (30 Cc.) contains 21- fluidrachms (10 Cc.) Castor Oil, disguised by the addition of Vanilla. Olei Terebinthine.—Contains 1 fluidrachm (4 Cc.) Oil of Turpentine 1 fluidounce (in 30 Cc), prepared according to the following formula: ty. Olei Terebinthinas......3iv, Acacias pulv.......gr. xxx, Vitelli Ovi (Egg-yolk); Elixir Aromaticas .... ana 3iv, Aquas Cinnamomi . . q. s. ad §iv, Make an emulsion by trituration in a mortar. Phosphatica (Phosphatic Emulsion).—Prepared with Glycerite of Egg-yolk, and contains in 1 fluidounce (30 Cc.) Cod Liver Oil, 2 fluidrachms (8 Cc.); Dilute Phosphoric Acid, 22^ minims (1.5 Cc.); Jamaica Rum, flavored with Bitter Almond and Orange Flower Water. 12.5 Cc; 2.0 15 Cc.; IOO Cc. EXTRACTIVE PREPARATIONS. The active medicinal constituents, or principles, of crude drugs are obtained by extraction. Extraction is effected either by macera- tion, expression, and filtration or straining, or by maceration with heat, when it is called digestion, or by percolation. The liquid employed, termed menstruum (pi. menstrua), may be Water or Al- cohol, or Alcohol and Water in various proportions, sometimes with Glycerin. A few drugs require alkaline menstrua, some acid menstrua, while the oleoresins are made with Ether. 80 A TEXT-BOOK OF MATERIA MEDICA. The Infusions and Decoctions are the simplest preparations made by extraction, and represent most nearly all the soluble constitu- ents of the drugs. But not all drugs are adapted to this method of extraction nor to this exceedingly effective, though not espe- cially elegant, form of exhibition. The most generally convenient and effective class of extractive preparations are the Tinctures. They are the simplest form of alco- holic preparations, and the other more concentrated preparations are usually first obtained as tinctures and then concentrated by evaporation, so as to yield the fluid extract, extract, or resin respectively. The only accurate method for determining the doses of extrac- tive preparations is to compare their drug-strength. Thus, the doses of the respective preparations of Nux Vomica, based upon their relative drug-strength, would be as follows: Average Dose of Drug. of Preparation. Tincture . . .20%, I in 5, 3 grains (0.2) = 15 minims (1. Cc). Fluid Extract 100%, 1 in 1, 3 grains (0.2)= 3 minims (0.2 Cc). Extract . . . 1000%, 10 in 1,3 grains (0.2) =fa grain (0.02 Gm.). In the same way the doses of the preparations of Opium may be presented: Average Dose of Drug. of Preparation. Tincture of Opium . 10%, 1 grain (0.06) = 10 minims (0.6 Cc). " " deod. 10%, 1 grain (0.06) = 10 minims (0.6 Cc). Vinegar of Opium . 10%, I grain (0.06) = 10 minims (0.6 Cc). Wine of Opium . . 10%, 1 grain (0.06) — 10 minims (0.6 Cc). Extract of Opium . 150%, 1 grain (0.06) = \ grain (0.04). While the preparations of these two drugs are standardized according to their alkaloid percentage strength in the U. S. P., such strength is not as available for computing or estimating doses as is the drug-strength. The determination of alkaloidal percentage in preparations is a check upon their preparation, but is not of so much importance to the physician as it is that the preparations be made by a skilful and conscientious pharmacist, from the very best quality of material, in a thorough manner. EXTRACTIVE PREPARATIONS. 8l INFUSA—INFUSIONS. Unless otherwise directed, Infusions are prepared by the general official process: Of the Drug, coarsely comminuted...... 5 Gm. Boiling Water...............100 Cc. Pour the boiling Water on the Drug in a suitable vessel, provided with a cover, and let it stand for half an hour; strain, and add enough Water through the strainer to make 100 Cc. Caution.—The strength of Infusions of powerful drugs—e. g. Ipecac—should be especially prescribed. The following Infusions are official, being prepared of different strengths and by other processes than directed in the general formula: Gm. in ioo Cc. Infusum Digitalis . alcohol, 10; cinnamon water, 15; digitalis 1.5 Infusum Sennas Comp. (Black Draught) . . fennel 2; senna 6. manna, magnesium sulph., of each 12. Drugs whose active principles are volatile or changed by heat are prepared by percolation without heat, or cold Infusion: Gm. in ioo Cc Infusum Cinchonas .... acid arom. sulph. 1 ; cinchona 6. Infusum Pruni Virginianas........wild cherry 4. Unofficial Infusions of the National Formulary. Infusum^ Brayere (U. S. P. 1880).—Brayera (Cusso), 6; Boiling Water, 100 Cc. To be dispensed without straining the mixture. Gentiane Compositum Fortius.—For preparing Infusum Gentianas Compositum by mixing 1 volume with 3 volumes of water. Rose Compositum (Compound Infusion of Rose, Ph. Br.).— An infusion of Red Rose in diluted Sulphuric Acid, Sugar, and Water. The Species (Teas) are mixtures of drugs contused or bruised for the preparation of Cataplasms; or Infusions and Decoctions, sometimes designated as Haustus (Draught). The following are in the National Formulary: Species— Emollientes (Emollient Cataplasm, Ph. Ger.).—A mixture of Althaea Leaves, Mallow Leaves, Melilot Tops, Matricaria, and Flaxseed, equal parts of each. 6 82 A TEXT-BOOK OF MATERIA MEDICA. Species— Laxantes (St. Germain Tea, Ph. Ger.).—A mixture of Senna, Elder-flowers, Fennel, Anise, and Potassium Bitartrate. Pectorales (Breast Tea, Ph. Ger.).—A mixture of Althasa, Coltsfoot, Glycyrrhiza, Anise, Mullein Flowers, and Orris Root. Infusum Pectorale (Pectoral Infusion, or Infusion of Pec- toral Species) is made by infusing I troy ounce (30 Gm.) of the above in the usual manner, so as to obtain 10 fluid- ounces (300 Cc.) of strained product. DECOCTA— DECOCTIONS. Unless otherwise directed, Decoctions are prepared according to the following general process: Of the Drug, coarsely comminuted...... 5 Gm. Boiling water, to make...........100 Cc. Pour the boiling Water on the Drug, contained in a suitable vessel provided with a cover, bring it to a boil, and let it boil for fifteen minutes; let it cool to 400 C. (1040 F.j, express, strain, and add cold Water through the strainer to make 100 Cc. Caution as with Infusions. The following Decoctions are official, as being made of strengths and methods other than those directed in the general process: Gm. in 100 Cc. Decoctum Centrarias........Iceland moss 5. Decoctum Sarsaparillas Comp. mezereum 1 ; sarsaparilla 10. glycyrrhiza, sassafras, guaiac wood, of each 2. Decoctum Aloes Compositum, N. F., is a mixture of Ext. Aloes, Myrrh, Saffron, Potass. Carb., Ext. Glycyrrh, Tinct. Cardamom Comp., and Water.—Extempore. ACETA—VINEGARS. The Vinegars are made by extraction with Dilute Acetic Acid. By maceration : Gm. in 100 Cc. Acetum Opii (Black Drop) . sugar 20; nutmeg 3; opium 10. Scillas................squill 10. The Vinegars of Lobelia and Sanguinaria (U. S. P. 1880) were of the same strength. VINA—WINES. The Wines are made by solution, by maceration, or by macera- tion and percolation. The Menstruum is White Wine, to which from EXTRACTIVE PREPARATIONS. 83 10 to 15 per cent, of Alcohol is added to aid in the extraction and the preservation. There are ten Wines official. The Natural Wines: Vinum Album and Vinum Rubrum are treated under Alcohol. Vinum— Gm. in 100 Cc Antimonii . . . antimony, potass, tart. (sol. water) 0.4 Colchici Radicis........colchicum root 40. Colchici Seminis........colchicum seed 15. Ergotas................ergot 15. Ferri Amarum . . soluble iron and quinine citrate 5. (Bitter Wine of Iron) tinct. orange peel 15 ; syrup 30. Ferri Citratis .... iron and ammonium citrate 4. syrup 10; tinct. orange peel 15. Ipecacuanhas.....alcohol 10; fl. ext. ipecac 10. Opii......cinnamon, cloves, each, 1 ; opium 10. The Dose of the Vinegar and Wine of Opium is the same, 10 minims (0.6) representing 1 grain (0.06) opii pulvis. The dose of the Wine of Colchicum Root is 10 minims (0.6), it being nearly three times the strength of the Wine of Colchicum Seed, of which the dose is 30 minims (2 Cc). Unofficial Wines of the Natio7ial Formulary. The Wines, with a few exceptions, are prepared with White Wine (Vinum album, U. S.), usually with the addition of 10 per cent, of Alcohol, in order better to preserve the preparation. Vinum— Aloes (U. S. P. 1880).—Representing 6 per cent, of Aloes with Aromatics. Aurantii.—Sherry Wine flavored with Orange. Aurantii Compositum (Elixir Aurantiorum Compositum).—A combination of Bitter Orange Peel, Absinthium, Menyanthes, Cascarilla, Cinnamon, and Gentian, in Sherry Wine. Useful as a stomachic tonic in doses of 1 fluidrachm (4 Cc). Carnis (Beef and Wine).—Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Extract of Beef. The Extract of Beef in this and similar preparations is that which is pre- pared by Liebig's method. Carnis et Ferri (Beef, Wine, and Iron).—Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Extract of Beef and 2 minims (0.12) Tincture of Citro-chloride ("Tasteless" Tincture) of Iron. 84 A TEXT-BOOK OF MATERIA MEDICA. Vinum— Carnis, Ferri et Cinchone (Beef, Wine, Iron, and Cinchona). —Each fluidrachm (4 Cc.) represents 2 grains (0.12) Extract of Beef, 2 minims (0.2) Tincture Citro-chloride of Iron, and small quantities of Cinchona alkaloids, in Angelica Wine. Coce (Erythroxyli).—Each fluidounce (30 Cc.) represents 30 grains (2 Gm.) of Coca in Claret Wine. Coce Aromaticum.—Each fluidounce (30 Cc.) represents 30 grains (2 Gm.) of Coca with Aromatics. Fraxini Americane (White Ash).—Each fluidrachm (4 Cc.) represents 30 grains (2 Gm.) of Fraxinus (bark). Pepsini (Pepsin).—Each fluidrachm (4 Cc.) represents 1 grain (0.06) of Pepsin. Picis (Tar).—A saturated solution of Tar, in Sherry Wine. Pruni Virginiane (Wild Cherry).—Each fluidrachm (4 Cc.) represents 15 grains (1 Gm.) of Wild Cherry, in Angelica Wine. Pruni Virginiane Ferratum (Wild Cherry, Ferrated).—Each fluidrachm (4 Cc.) represents 5 minims (0.3 Cc.) of Tincture of Citro-chloride of Iron and 13! grains (0.9 Gm.) of Wild Cherry, in Angelica Wine. Rhei (U. S. P. 1880).—Representing 10 per cent, of Rhubarb and 1 per cent, of Calamus. TINCTURE—TINCTURES. Tinctures are liquid preparations made by the extraction of Drugs with menstrua of Alcohol and Water in various propor- tions. They are prepared by maceration and filtration; also by percolation: By maceration and filtration, those containing resins and oleo- resins, Musk, and tinctures of fresh herbs; in a few instances with heat, the Tincture of Quillaja and Tincture of Strophanthus. By percolation, when prepared from dried vegetable drugs—i. e. barks, leaves, roots, etc, usually after brief maceration. By solution, mixing a solution (chloride of iron) or dissolving a solid in Alcohol (Iodine, Ext. Nux Vomica). Assayed Tinctures.—Two of the most important Tinctures are required to be of certain specified alkaloidal strengths, and their classification according to their respective drug-strengths is there- fore only approximately correct. Tinctura Opii is made so as to represent from 1.3 to 1.5 per EXTRACTIVE PREPARATIONS. 85 cent, of crystallized morphine, the proportion obtained from 10 per cent, of Opii Pulvis, U. S. Tinctura Nucis Vomicce is made by solution of 2 per cent, of the official Extract, representing about ten times its weight of the drug; the Tincture therefore represents 20 per cent, of the drug, and con- tains 0.3 per cent, total alkaloids. Tincturae Herbarum Recentium.—Tinctures of Fresh Herbs, or " Green Tinctures," similar to the Homoeopathic or so-called " German Tinctures," also to the specific tinctures of the Eclectics, when not otherwise directed are to be prepared by the following general formula: Take of the fresh herb, bruised or crushed, 50 Gm.; macerate for fourteen days in Alcohol 100 Cc.; express the liquid and filter. Tinctures of the U. S. P. Name. Tinctura— Aconiti Aloes Aloes et Myrrhae . . Arnica? Florum Arnicse Radicis Asafcetidse . . Aurantii Amarse Aurantii Dulcis Belladonna? Foliorum Benzoini..... Drug;. Root ... Aloes . . Licorice Aloes......10 Myrrh.....10 Licorice.....10 Flowers.....20 Root......10 Gum resin ... 20 Bitter Orange peel 20 Sweet.....20 Leaves ..... 15 Balsam.....20 Gm. Average Dose. Menstrua. . . in Alcohol, Drug. Rep. Tinct. IOO Cc. per cent. Grains. Gm. Cc. Min. 35 70 I O.06 0.2 3 10 \ 50 6 0.4 4. 60 Benzoini Composita (Turlington's Bal- sam). Bryonia..... Calendula? . . . Calumba?..... Cannabis Indicse . . Cantharidis .... Capsici...... Cardamomi . . . . Cardamomi 1 Composita > Benzoin .... 12" Storax..... 8 Tolu...... 4 Aloes...... 2 Root......10 Florets.....20 Root .••... 10 Flower tops ... 15 Insect ..... 5 Fruit...... 5 Fruit......10 Cardamom .... 2 Cassia Cinnam. . . 2 Caraway .... I Cochineal .... 0.5 Glycerin.....5°. 75 50 65 100 60 IOO 50 IOO IOO IOO 60 IOO IOO 95 50 50 0.8 0.2 0.2 0.4 0.4 0.4 0.1 0.4 o-5 0.2 0.4 0.4 0-3 0.015 0.1 0.4 1. 2. 2. 2. 2. 0.6 2. 60 15 30 30 30 30 10 30 30 30 30 60 3° 5 30 60 60 86 A TEXT-BOOK OF MATERIA MEDICA. Catechu Composita . < Name. Drug. Tinctura— Catechu I Cinnamon Chiratse.......Herb . Cimicifuga?.....Rhizome Cinchona?......Bark . . C Red Cinchona Cinchona? Composita ■&-., ^ r Bitter Orange (Huxham's Tine- -J c . • *■ j Serpentana ture). ~, ' I Glycerin . Cinnamomi.....Ceylon Colchici Seminis . . . Seed Croci.......Saffron . Cubeba?......Fruit Digitalis......Leaves . Ferri Chloridi .... Solution Galla? .......Nutgall Gelsemii......Root {Gentian Bitter Orang Cardamom Guaiaci.......Resin . Guaiaci Ammoniata . . Resin . Humuli......Hops . Hydrastis......Rhizome Hyoscyami.....Herb . Iodi ........ Iodine . i Ipecac . . Ipecacuanha? et Opii ■<.-.• -, , r I Opium deod Kino........Insp. juice Krameria?......Rhatany . Lactucarii......Insp. juice rOil Lavender Oil Rosemary Cinnamon . Lavandulae Composita-| .-,, r Cloves. . . (For flavoring.) Nutmeg ^ Red Saunders Lobelia?......Herb . . . Matico ....... Leaves . . . Moschi.......Musk . . . Myrrhae......Gum resin . Nucis Vomicae .... Extract . . Opii........Pulv. Opium r Opium pulv. I Acid Benzoic 1 Camphor . . Oil Anise . I Glycerin . . Gm. Menstrua. Alcohol, Average Dose. peel 8 I Opii Camphorata (Paregoric.) Drug. IOO Cc. per cent. Grains. Gm. IO I SO 12 0.8 IO J 10 65 6 0.4 20 100 12 0.8 67 12 0.8 Rep. Tinct. Cc. Min. 20 IO] 7.;j 10 15 10 20 15 25 Cc. 20 15 10 4 1 20 20 20 20 15 7 10 j 10} 10 20 5° 0.8 0.2 2. °-5 1. 1. 20 10 5 20 2 10 o-4i 0.4 0.4 0.4 4- J r 85 75 60 5° 100 5° 75 90 65 60 5o 5° 5° 100 20 65 5o 50 75 50 50 50 100 75 50 50 4 12 2\ 12 6 12 12 5 0.8 0.4 °-3 0.4 0.8 0.15 0.25 0.8 0.15 0.8 0.8 0.4 0.8 0.8 Q'3 Only externally 0.06 1 6 0.4 12 0.8 For syrup 6 3 6 Opium 1 0.4 0.2 0.1 0.4 0.02 0.06 2. 2. 2. 2. 1. 0.6 60 60 60 60 60 60 30 60 60 '5 15 60 '5 60 60 30 60 60 30 30 0.015 4- EXTRACTIVE PREPARATIONS. 87 Name. Tinctura— Opii Deodorata . . . Physostigmatis . . . . Pyrethri...... Quassia?...... Quillaja?...... Rhei Rhei Aromatica (For syrup.) Rhei Dulcis (Sweet 1 Tincture of Rhu- r barb.) ^ Sanguinaria?..... Scilla?....... Serpentaria?..... Stramonii Seminis . . Strophanthi..... Sumbul...... Tolutana...... Valeriana?..... Valeriana? Ammoniata?. Vanilla?...... Veratri Viridi . . . . Zingiberis...... Drug. Opium . . . Calabar Bean Pellitory . Wood . . Soap Bark Rhubarb . Cardamom Rhubarb . Cinnamon Cloves . . Nutmeg . Glycerin . Rhubarb . Glycyrrhiza Anise . . Cardamom Glycerin . Blood-root Squill . . Rhizome . Seed . . Seed . . Musk-root Tolu . . Root . . Root . . Fruit . . Rhizome . Ginger . . Average Dose. Gm. Menstrua Alcohol, in Drug. Rep. Tinct. IOO Cc . per cent. Grains. Gm. Cc. Min. IO 20 I O.06 0.6 IO 15 IOO I 0.06 0.4 7 20 IOO Ex ternally. IO 35 3 0.2 2. 3° 20 35 6 0.4 2. 30 "} 6° 8 °-5 4- 60 20- 4 4 50 15 1. 4- 60 2 10J IO] 4 4 > 5° 6. 120 ' io-1 15 60 5 0.3 2. 3° 15 75 21 0.15 I. 15 10 65 6 0.4 4- 60 15 50 H 0.15 1. 15 5 65 1 0.015 0.3 5 10 65 3 0.2 2. 30 10 100 3 0.2 2. 30 20 75 12 0.8 4- 60 20 6 0.4 2. 3° 10 65 3 0.2 2. 30 40 100 2 0.12 o-3 5 20 100 6 0.4 2. 30 Unofficial Tinctures of the National Formulary. Tinctura— Amara (Bitter Tincture, Ph. Ger.).—Containing Gentian, Cen- taury, Bitter Orange Peel, Orange Berries, and Zedoary. Antacrida (Dysmenorrhoea Mixture; Fenner's Guaiac Mix- ture).—A mixture of Guaiac, Canada Turpentine, Oil of Sas- safras, and \ grain (0.02) Corrosive Mercuric Chloride in each fluidrachm (4 Cc). Dose, from 10 to 20 minims (0.6 to 1.3 Cc). Antiperiodica (Warburg's Tincture).— With Aloes: Rhubarb, Angelica Seed, of each, grains 56 (4.); Elecampane, Saf- fron, Fennel, of each, grains 28 (2.); Aloes (aq. ext.), Gen- tian, Zedoary, Cubeb, Myrrh, White Agaric, Camphor, of each, grains 14 (1.); Quinine Sulphate, grains 160 (10.); Diluted Alcohol, enough to make fluidounces 16 (473 Cc). 88 A TEXT-BOOK OF MATERIA MEDICA. Tinctura— Antiperiodica (Warburg's).—The preceding without Aloes. Each fluidounce (30 Cc.) of either tincture contains 10 grains (0.6) of Quinine Sulphate. Aromatica (Stomachic, Ph. Ger.).—A combination of Cinna- mon, Ginger, Galangal, Cloves, and Cardamom. Capsici et Myrrhs (Hot Drops).—The preparation popularly known as " Number Six." Cinchona Detannat,e.—For admixture with preparations containing Iron. Conii (U. S. P. 1880).—Representing 15 per cent, of Conium. Coto.—This preparation contains 7J grains (0.5) true Bolivian Bark in each fluidrachm (4 Cc). The Para Coto, frequently employed, differs considerably from the above. Ferri Chloridi ^therea (Bestucheff's Tincture; Lamott's Drops, Ph. Ger.).—Each fluidrachm (4 Cc) represents about J grain (0.3) Metallic Iron. Ferri Citro-chloridi (Tasteless Tincture of Iron).—Practi- cally identical in the strength of Iron, but not in Alcohol, with the officinal Tincture of Chloride of Iron, containing an amount of Iron equivalent to j\ grains (0.5) of Dry Chloride of Iron in each fluidrachm (4 Cc). A convenient form of Iron for admixture with Tinctures of vegetable astringent drugs, such as Gentian and Cinchona, preparations of which it does not, unlike other iron com- pounds, discolor. Ferri Pomata (Ferrated Extract of Apples; Malate of Iron, Ph. Ger.).—Each fluidrachm (4 Cc.) represents about f grain (0.025) of Metallic Iron. Guaiaci Composita (Dewees' Tincture of Guaiac).—Each fluidrachm (4 Cc.) represents jh grains (0.5) Guaiac. Ignati^e (U. S. P. 1880).—Representing 10 per cent, of Ignatia. Iodi (Churchill's).—A solution of 10 grains (0.6) Iodine in each fluidrachm (4 Cc), with Potassium Iodide in Alcohol. Not to be confounded with Churchill's Iodine Caustic (Liquor Iodi Causticus). Iodi Decolorata (Colorless Tincture of Iodine).—Contain- ing about 1 per cent, of Ammonium Iodide, with some other Iodine compounds, in alcoholic solution; for external use. EXTRACTIVE PREPARATIONS. 89 Tinctura— Jalaps (U. S. P. 1870).—Each fluidrachm (4 Cc.) represents about 10 grains (0.6) Jalap. Jalaps Composita.—Each fluidrachm (4 Cc.) represents yh grains (0.5) Jalap and about 2 grains (0.12) Scammony. Kino Composita— Tinctures of Kino, Opium, each . . minims 180 12. Cc Spirit of Camphor....... " 130 8.5 " Oil of Cloves......... " 2\ 0.15 " Aromatic Spirit of Ammonia . . 15 1. Cochineal...........grains 16 1. Diluted Alcohol to make fluidounces 4 . . . .120. Each fluidrachm (4 Cc) represents \ grain (0.03), each, of Kino and Opium. Papaveris (Poppy).—Each fluidrachm (4 Cc.) represents 30 grains (2.) of Poppy (Capsule). Pectoralis (Bateman's Pectoral Drops).—A popular mixture of Opium, Catechu, Camphor, and Oil of Anise, containing 2\ minims (0.15) Tincture of Opium (^ grain Pulv. Opium) in each fluidrachm (4 Cc). Persionis (Cudbear).—Intended as a coloring agent when a bright-red tint or color is to be produced, particularly in acid liquids. Persionis Composita.—A mixture of Cudbear and Caramel, intended as a coloring agent when a brownish-red tint or color is to be reproduced. PimpinelltE (Pimpinella, Ph. Ger.).—Each fluidrachm (4 Cc), represents about 10 grains (0.6) Pimpinella Root. Rhei Aquosa (Rhubarb, Aqueous, Ph. Ger.).—Each fluid- drachm (4 Cc.) represents about 5§ grains (0.4) of Rhu- barb, with alkalies, flavored with Cinnamon. Rhei et Gentians.—Each fluidrachm (4 Cc.) represents 5 grains (0.3) of Rhubarb and 1 grain (0.06) of Gentian. Rhei Vinosa (Rhubarb, Vinous, Ph. Ger.).—Each fluidrachm (4 Cc) represents about 5 grains (0.3) Rhubarb, with Bitter Orange and Cardamom, in Sweet Sherry Wine. Saponis Viridis Composita.—A solution of about 15 per cent, of Green Soap and 2 per cent, of Oil of Cade. Tincture ^/thereze (Ethereal Tinctures).—The drug, prop- erly comminuted, troy ounces 2 (60 Gm.); Stronger Ether, 1 volume; Alcohol, 2 volumes; enough to make fluid- 9° A TEXT-BOOK OF MA TREIA MEDICA. Tinctura— ounces 16 (473 Cc). A general formula for the prepara- tion of Ethereal Tinctures of Belladonna, Castor, Digitalis, Lobelia, Valerian, and other drugs. Official in several European pharmacopoeias, and sometimes prescribed by foreign physicians. Tolutana Solubilis (Tolu, Soluble).—A so-called soluble essence of Tolu, for flavoring. Vanillini Composita.—A solution of Vanillin and Coumarin, intended for flavoring. Zedoari^e Amara (Zedoary Comp.).—Similar to, but not identical with, the Tinctura Carminativa, Wedelii, etc., for- merly official in some Continental pharmacopoeias. Each fluidrachm (4 Cc.) represents 15 grains (1 Gm.) of Zedoary, 7I grains (0.5) of Aloes, and 3f grains (0.25), each, of Rhubarb, Gentian, White Agaric, and Saffron. EXTRACTA FLUIDA—FLUID EXTRACTS. Fluid Extracts may be defined as a class of concentrated tinctures of such strength as to represent the drug, volume for iveight. The fluid extracts of the U. S. P. previous to 1880 represented 1 grain of drug in 1 minim, or 1 troy ounce in 1 fluidounce. In the U. S. P. of 1880 the standard adopted was 1 Gm. in 1 Cc, and this strength has been retained as the standard of the U. S. P. 1890. Fluid extracts are made by percolation, maceration, or digestion. Except on a large scale or by fractional percolation, they cannot be prepared by simple percolation without evaporation to concen- trate the percolate to the required measure. Fractional percolation or repercolation, or simultaneous frac- tional percolation, by employment of which the use of heat for concentrating the percolate is avoided, may be used to advantage when the quantity operated upon is sufficiently large to warrant the greater time and attention required. The following is the process chiefly employed: In proceeding to percolate 100 Gm. of the drug, according to directions, the first 80 to 90 Cc. are reserved, and percolation con- tinued until the exhaustion is completed. The weak percolate is evaporated to a soft extract (the alcohol being recovered) and dis- solved in the reserved percolate. Sufficient menstruum is then added to make the product measure 100 Cc EXTRA CTI VE PREPARA TIONS. 9 Average Dose. Official Name of Drug. Part. Cc. Mi ' Extractum Fluidum— Aconiti......Aconitum Napellus.......Tuber . . . 0.06 1 Apocyni.....Apocynum Cannabinum.....Root . . . . 1. 15 Arnica? Radicis . . Arnica montana........Root .... 0.5 8 Aromaticum .... Pulvis Aromaticus.............0.5 8 Asclepiadis .... Asclepias tuberosa.......Root .... 2. 30 Aspidospermatis . . Aspidosperma Quebracho-bianco . Bark ... 2. 30 Aurantii Amari . . Citrus vulgaris ........Rind. . . . 1. 15 Belladonna? Radicis . Atropa Belladonna.......Root. . . . 0.2 3 Buchu......Barosma betulina.......Leaves ... 2. 30 Calami......Acorus Calamus........Rhizome . . 2. 30 Calumba?.....Jateorrhiza palmata......Root .... 2. 30 Cannabis Indica? . . Cannabis sativa........Fl. Tops . . 0.6 10 Capsici......Capsicum fastigiatum .....Fruit .... 0.2 3 Castanea?.....Castanea dentata........Leaves ... 4. 60 Chimaphila? .... Chimaphilaumbellata......Leaves ... 2. 30 Chirata?.....Swertia Chirata........Plant.... 2. 30 Cimicifuga? .... Cimicifuga racemosa......Rhizome . . 2. 30 Cinchonae.....Cinchona Calisaya.......Bark .... 2. 30 Coca?.......Erythroxylon Coca.......Leaves ... 2. 30 Colchici Radicis . . Colchicum autumnale .....Corm ... 0.3 5 Colchici Seminis . . Colchicum autumnale ..... Seed .... 0.3 5 Conii.......Conium maculatum......Fruit. ... 0.25 4 Convallaria? .... Convallaria majalis.......Rhizome . . 0.6 IO Cubeba?.....Piper Cubeba.........Fruit .... 2. 30 Cusso......Hagenia Abyssinica......Inflor. ... 4. 60 Cypripedii .... Cypnpedium pubescens.....Rhizome . . 1. 15 Digitalis.....Digitalis purpurea.......Leaves ... 0.12 2 Dulcamara? .... Solanum Dulcamara......Branches . . 2. 30 Ergotae......Claviceps Purpurea.......Sclerotium . 2. 30 Eriodictyi.....Eriodictyon glutinosum.....Leaves ... 2. 30 Eucalypti.....Eucalyptus globulus......Leaves . . . 1. 15 Eupatorii.....Eupatorium perfoliatum.....Herb.... 2. 30 Frangula?.....Rhamnus Frangula.......Bark .... 4. 60 Gelsemii.....Gelsemium sempervirens .... Rhizome . . 0.2 3 Gentiana?.....Gentianalutea........Root. ... 1.3 20 Geranii......Geranium maculatum......Rhizome . . 2. 30 Glycyrrhiza? .... Glycyrrhiza glabra.....• . Root .... 4. 60 Gossypii Radicis . . Gossypium herbaceum.....Root Bark . 2. 30 Grindelia?.....Grindelia robusta.......Leaves ... 2. 30 Guarana? ..... Paullinia Cupana........Seeds ... 4. 60 Hamamelidis , . . Hamamelis Virginiana.....Leaves ... 2. 30 Hydrastis.....Hydrastis Canadensis......Rhizome . . 2. 30 Hyoscyami .... Hyoscyamus niger.......Herb ... 0.3 5 Ipecacuanha? . . . Cephaelis Ipecacuanha.....Root. . . .0.06-2. 1- Iridis .....Iris versicolor.........Rhizome . . 1. 15 Krameria?.....Krameria triandra.......Root .... 2. 30 Lappa?......Arctium Lappa........Root .... 2. 30 Leptandrse .... Veronica Virginica.......Rhizome . . 2. 30 Sarsaparilla? Com- positum 92 A TEXT-BOOK OF MATERIA MEDICA. Average Dose. Official Name Drug. Part. Cc. Minims. Extractum Fluidum— Lobelia?.....Lobelia inflata .... ..... Herb .... 0.6 10 Lupulina?.....Humulus Lupulus.......Powder . . . 0.6 10 Matico..... Piper Angustifolium......Leaves ... 4. 60 Menispermi .... Menispermum Canadense .... Rhizome . . 2. 30 Mezerii......Daphne Mezereum.......Bark .... 0.3 c Nucis Vomicae . . . Strychnos Nux-vomica.....Seed .... 0.2 3 Pareirae......Chondodendrum tomentosum . . . Root .... 2. 30 Phytolacca Radicis . Phytolacca decandra......Root .... 0.5 8 Pilocarpi.....Pilocarpus Selloanus (Jaborandi) . Leaves ... 2. 30 Podophylli ... Podophyllum peltatum.....Rhizome . . 0.6 10 Pruni Virginiana? . Prunus serotina........Bark .... 2. 30 Quassia?.....Picraena excelsa........Wood . . . 0.5 8 Rhamni Purshiana? . (Cascara sagrada).......Bark .... 2. 30 Rhei.......Rheum officinale.......Root .... I. 15 Rhois Glabra? . . . Rhus glabra.........Leaves ... 2. 30 Rosa?......Rosa Gallica.........Petals ... 2. 30 Rubi.......Rubus villosus . .......Root Bark . 2. 30 Rumicis.....Rumex crispus........Root .... 4. 60 Sabina?......Juniperus Sabina........Tops .... 0.5 8 Sanguinaria? .... Sanguinaria Canadensis.....Rhizome . . 0.3 5 Sarsaparilla? .... Smilax officinalis, etc......Root .... 4. 60 ' Sarsaparilla, 75 Glycyrrhiza, 12 Sassafras, 10 Mezereum, 3 Scilla?......Urginea maritima.......Bulb .... 0.3 5 Scoparii.....Cytisus Scoparius.......Tops . . . . 1. 15 Scutellaria? .... Scutellaria lateriflora......Herb ... 2. 30 Senega?......Polygala Senega........Root .... 0.3 5 Senna?......Cassia acutifolia and Angust. . . Leaves ... 4. 60 Serpentaria? .... Aristolochia Serpentaria.....Rhizome . . I. 15 Spigelia?.....Spigelia Marilandica......Rhizome . . 2. 30 Stillingia?.....Stillingia sylvatica.......Root .... 2. 30 Stramonii Seminis . Datura Stramonium......Seed .... 0.2 3 Tainxaci.....Taraxacum officinale......Root .... 4. 60 Tritici......Agropyrum repens.......Rhizome . . 4. 60 Uva? Ursi.....Arctostaphylos Uva Ursi .... Leaves ... 2. 30 Valerianae.....Valeriana officinalis.......Rhizome . . 2. 30 Veratri Viridis . . . Veratrum viride........Rhizome o. 12 2 Viburni Opuli . . . (Cramp bark).........Bark Viburni Prunifolii . (Black haw).........Bark . 2 Xanthoxyli .... Xanthoxylum Americanum . . . Bark . . . . 1. 15 Zingiberis.....Zingiber officinale.......Rhizome . 0.6 10 Unofficial Fluid Extracts of the National Formulary. Unless otherwise indicated, the dose of the following Fluid Ex- tracts is from \ to 1 fluidrachm (2 to 4 Cc): 3° 2. 30 30 EXTRACTIVE PREPARATIONS. 93 Extractum Fluidum— Adonidis.—Root of Adonis vernalis L. (Bird's Eye). Aletridis.—Rhizome of Aletris farinosa L. (Stargrass). Angelica Radicis.—Root of Archangelica L. (Angelica). Apii Graveolentis.—Seed of Apium graveolens L. (Celery). Aralia Racemos/e.—Root of Aralia racemosa L. (American Spikenard). Arnica Florum.—Flower heads of Arnica montana L. (Ar- nica). Berberidis Vulgaris.—Bark of the root of Berberis vulgaris L. (Barberry). Boldi.—Leaves of Peumus Boldus Molina (Boldo). Buchu Compositum.—A combination of Buchu, 10; Cubeb, 2; Juniper, 2 ; Uva Ursi, 2 parts. Calendula.—Flowering herb of Calendula officinalis L. (Marigold). Camellle.—Leaves of Camellia Thea Link (Tea). The best quality of commercial black tea, " Formosa Oolong," to be employed for this preparation. Caulophylli.—Rhizome and rootlets of Caulophyllum thalic- troides Mich. (Blue Cohosh). Coffe.e Viridis.—Unroasted seeds of Coffea Arabica L. Coffee Tost.e.—Roasted seeds of Coffea Arabica L. The N. F. recommends equal portions of Java and Mocha to be employed in preparing the Fluid Extracts of Coffee. Convallaria Florum.—Flowers of Convallaria majalis L. (Lily of the Valley). Coptis.—Rhizome of Coptis trifolia Salisb. (Goldthread). Cornus Circinat.e.—Bark of Cornus circinata L'Her. (Green Osier.) Cornus Florida (U. S. P. 1880).—Dogwood Bark. Corydalis.—Tubers of Dicentra Canadensis De C. (Turkey Corn). Coto.—Coto bark, undetermined tree. Dose, from 5 to 15 minims (0.3 to 1 Cc). Fuci.—Thalus of Fucus vesiculosus L. (Bladder-wrack). Helianthemi.—Herb of Helianthemum Canadense Mich. (Frost-wort). Humuli.—Strobiles of Humulus lupulus L. (Hops). Hydrangea.—Root of Hydrangea arborescens L. (Seven Barks). 94 A TEXT-BOOK OF MATERIA MEDICA. Extractum Fluidum— Jalapa.—Tuber of Exogonium purga Benth. (Jalap). Dose, from 15 to 20 minims (1 to 1.3 Cc). Juglandis.—Bark of the root of Juglans cinerea L. (Butternut). Juniperi.—Fruit of Juniperus communis L. Kava.—Root of Piper methysticum Forster (Kava; Kava- Kava). Lactucarii (U. S. P. 1880).—Insp. juice of Lactuca virosa L. Malti.—(Fluid Extract of Malt). Menyanthis.—Leaves of Menyanthes trifoliata L. (Buckbean; Trifolium fibrinum, Ph. G.). Mezerei (U. S. P. 1880).—Bark of Daphne mezereum L Dose, from 5 to 10 minims (0.3-0.6 Cc). Petroselini Radicis.—Root of Petroselinum sativum Hoff- man (Parsley). Quillaja.—Bark of Quillaja Saponaria Molina (Soap Bark). Rhamni Purshiana Aromaticum.—Cascara Sagrada de- prived of its bitter taste. Rhei Aromaticum.—A combination of Rhubarb, Cinnamon, Cloves, and Nutmeg. Senna Deodoratum (Aqueous Fluid Extract of Senna).— This preparation is free from the objectionable " griping" qualities of the ordinary fluid extract. Sterculia.—Seeds of Sterculia acuminata R. Brown (Cola or Kola). Stilllingia Compositum (Stillingia Comp.).—Stillingia, Cory- dalis, each, 4 parts; Iris, Sambucus, Chimaphila, each, 2 parts; Coriander, Xanthoxylum Berries, each, 1 part. Trillii.—Rhizome of Trillium erectum L. (Bethroot). Turnera.—Leaves of Turnera microphylla De C. (Damiana). Urtica.—Root of Urtica dioica L. (Nettle). Verbasci.—Leaves (and flowers) of Verbascum Thapsus L. Verbena.—Root of Verbena hastata L. (Vervain). . Zea.—Stigmatum Maydis ; Corn Silk ; Stigmata of Zea Mays L. (Indian Corn). As a rule, a Fluid Extract is made of every vegetable drug which is a part of a plant. There are altogether about 500 Fluid Extracts. Relatively, the Fluid Extracts are not as strong as the Tinctures, but they have the great advantage over the latter in that they are more concentrated and of uniform drug-strength—the strength of the drug. EXTRACTIVE PREPARATIONS. 95 EXTRACTA—EXTRACTS. Extracts—or " solid " extracts as they are termed, to distinguish them from fluid extracts—are the soluble active principles of vege- table drugs, concentrated by evaporation to a soft solid or a plastic mass of pilular consistence. The strength of an extract depends upon the amount of the crude drug it represents. Hence, the smaller the percentage of extract obtained from a drug, the greater the relative strength of the extract, provided that the drug be exhausted with menstrua adapted to secure all the active principles in this form. The yield of extract is influenced by the character of the men- struum employed : with a few drugs like Rhubarb the quality of the drug sometimes governs the yield, the least percentage being obtained from the poorest quality. As a general rule, the more aqueous the menstrua, the greater the yield of extract; conversely, the more alcoholic the menstrua, the smaller the yield of extract. To obtain the extracts, therefore, of official strength it is necessary to use official menstrua in the extraction. Thus the extracts of different drugs are as many times stronger than the drug as the quotient obtained by dividing the drug at ioo by the percentage yield. For example : Podophyllum yields 10 per cent, of extract; then ioo •+- IO = io ; that is, the extract is ten times as strong as the drug and the fluid extract, or o.i of the extract represents I Gm. of the drug or i Cc. of the fluid extract. The drug-strengths of the official Extracts, calculated by this method, as well as their relative doses based upon the amounts of drug they represent, are exhibited in the table given on page 96. The 33 official Extracts are made by extraction with alcoholic menstrua or with water, sometimes by the addition of acid or alkali. There are four extracts made by the addition of powders to the extracts, including the Extract of Colocynth, the Compound Extract of Colocynth, and the assayed extracts, made by the addi- tion of Sugar of Milk to represent a certain alkaloidal strength in the powdered extract. Extractum Nucis Vomicae contains 15 per cent, of total alka- loids ; 1 Gm. represents about 10 Gm. of drug. Extractum Opii contains 18 per cent, of crystallized morphine; 1 Gm. represents 2 Gm. of normal moist opium, about 1.4 Opii pulvis (14 per cent, morphine). Q6 A TEXT-BOOK OF MATERIA MEDICA. Table showing the Drug-strength and the Average Doses of the Official Extracts. Parts of Drug Dose of Drug. Dose of Extract. Extractum. Part. in 1 part of Extract. Grains. Gm. Grains. Gm. 5 2 I .06 1 .012 •32 IO •6,S 5 5 5 IO •65 .2 2 .12 Belladonna? Fol. Alcoholic. . Leaves . . . 5 3 1 .03 Cannabis Indica? . . ... Herb .... 10 IO •6S 1 .06 10 IO ■6<5 1 .06 Cinchona? (Calisaya) .... Bark .... 6 30 2. 5 ■3 3 5 •3 2 .12 Colocynthidis (powder) . . . Fruit .... 6 3 .2 1 •°3 fExt. Colocynth, 16; Colocynthidis Com- J Cardamom, 6; Aloes, positum (powder) j 50; Soap,Scammony, 5 ■3 I each, 14. J 4 4 .25 1 .06 4 5 5 1 30 3° 6 4 ■4 2. 6 Gentiana? (aqueous) .... Root . . . 4 20 i-3 5 •3 3 30 2. 10 ,6s Glycyrrhiza? Purum (ammon.) Root .... 3 60 4- 20 i-3 Haematoxyli (aqueous) . . . Logwood . . 4 10 •6S 21 ■ IS 6 6 •4 1 .06 7 6 7 15 15 •5 06 3 3 Juglandis.......Bark .... 6 I: .2 Krameria? (aqueous) .... Root .... 5 IS 1. 3 .2 5* 15 1. 3 .2 Nucis Vomica? (powder) . . Seed .... 10 3 •2 i .02 ii 1 06 3 .04 .01 20 1 .06 1 IO 10 •6S I .06 25 5 •3 I .06 3 10 3 3° 3 3° .65 •15 .6s Stramonii.........Seed . . .2 2. 1 10 3 30 2. 10 .65 ABSTRACT A—ABSTRACTS. A class of powdered extracts, prepared from the extracts by the addition of sufficient Milk Sugar to make the product represent one-half its weight of the crude drug, was official in the U. S. P. VI. (1880) under the title of Abstracts. The Abstracts have a uniform relation to the drug—viz. / grain represents 2 grains of the drug, just as the fluid extracts have the uniform relation of representing the drug measure for weight. In preparing an abstract the drug is exhausted, the extract obtained incorporated with its weight of Milk Sugar, the mixture EXTRACTIVE PREPARATIONS. 91 powdered, and enough Milk Sugar added to bring the product to one-half the weight of the drug employed. Abstracts must be pre- served in small, perfectly dry, and well-corked vials in a dry and cool place. Their uniformity alone should have favored the employment of Abstracts in preference to the Extracts, since they do not share the variability in strength of the extracts, the dose of the Abstract being exactly one-half that of the crude drug or Fluid Extract. This advantage was offset by the disadvantage that Abstracts are more bulky, and caused their deletion in the U. S. P. 1890. The Ab- stracts are therefore unofficial. The official Extracts of Jalap and of Nux Vomica have su- perceded the abstracts of these respective drugs in a more con- centrated and equally convenient form. Of the remaining nine Abstracts formerly official, Aconite, Belladonna, Conium, Digitalis, Hyoscyamus (Ignatia, superceded by Nux Vomica), Podophyllum, Senega, and Valerian, the five first mentioned, commonly but erroneously called the " narcotic extracts," may be prepared, in the powdered form, of such strength as to represent the same drug-strength as their respective official " solid extracts." Extractum Ferri Pomatum, N. F.—Ferri Malas Crudus (Fer- rated Extract of Apples, Ph. Ger.). Extractum Glycyrrhiza Depuratum, N. F.—Succus Liqui- ritiae, Ph. Ger. (Purified Extract of Liquorice). OLEORESIN/E—OLEORESINS. To natural Oleoresins, derived as plant-exudations, belong the Turpentines and the Pitches. From similar exudations are ob- tained the Gum Resins, mixtures of Gum and Resins and sometimes Volatile Oils; also the Balsams, which are Resins or Oleoresins associated with Benzoic or Cinnamic Acid. These are treated under their respective Drugs. The pharmaceutical Oleoresins are semi-liquid extracts, obtained by exhausting oleoresinous drugs with Ether. Ether extracts fixed and volatile oils from drugs, as well as resin; these principles constitute therefore the oleoresins, which some- times also contain other active matter in solution or suspension. The menstruum (Ether), being easily volatilized, is recovered by distillation ; it is sometimes superseded by Alcohol, which yields an extract very similar to that obtained with ether. 7 98 A TEXT-BOOK OF MA TERIA MEDICA. The six following are official: Dose. Oleoresina— ____________,__________ Aspidii; separates in two layers, to be mixed when used . . . 1-2 drachms. 4.-8. Capsici; separates fat, used only as corrective.........-^-\ grain. 0.01-0.005 Cubebae; separates wax .... 1-2 grains. 0.06-0.1 Lupulinae..........2-3 grains. 0.1-0.2 Piperis; separates piperine, to be rejected..........1-2 grains. 0.08-0.1 Zingiberis..........i_i grain. 0.02-0.01 RESINS—RESINS. The official Resins may be divided into the (1) Natural Resins (2) Resins obtained from Oleoresins by separating the Volatile Oil by distillation, and (3) the Pharmaceutical Resins, prepared by pre- cipitation. When a concentrated tincture of a resinous drug is poured into a large quantity of cold water, the resinous matter becomes insoluble and is precipitated; this, after being washed, dried, and sometimes powdered, is termed a resin. Resins are usually soluble in alkalies and insoluble in acids (dilute); for this reason the water used for precipitation is some- times rendered slightly acid to favor the separation. The three following are official: Per cent, yield from Drug. Dose. Rep. Drug.. Resina— ,______._________________,______ Jalapae........15 3 grains 0.2 20 grains 1.3. Podophylli......5 l grain 0.03 10 grains 0.6. Scammonii......65 3 grains 0.2 5 grains 0.3. Resina and Resina Copaiba are obtained as residue in the dis- tillation of the respective Oleoresins, Turpentine and Copaiba. The natural Resins are obtained as exudates—e. g. R. Guaiac. The terms resin, resinoid, and concentration are also applied to a class of preparations used by eclectic physicians, prepared by this general process with some modifications. (See U. S. and Am. Disp.) They are named after their respective Drugs with the ending in, as in Glucosides, and must not be confused with the latter. While the Glucosides are usually the active medicinal constituents repre- senting the drug, the resinoids, with the exception of those made SOLID MIXTURES FOR INTERNAL USE. 99 from drugs whose active principles are resins, such as Cimicifuga and Podophyllum, are more or less inert, unreliable mixtures, too indefinite in their composition and strength for medicinal use. SOLID MIXTURES FOR INTERNAL USE. Mixtures of Solids for internal use embrace the following classes of preparations: Powders, Effervescent Salts, Confections, Troches, Masses, and Pills. Powders are substances reduced to a fine pulverulent condition to favor their administration and solution or absorption. A powder may be simple, such as a powdered drug, Pulvis opii, or a pow- dered salt—i. e. Quinina sulphas; or it may be compound, a mix- ture of several substances. Sparingly soluble substances, when finely powdered (impalpable) and thoroughly mixed by trituration in a mortar with some inert powder (diluent) such as Milk Sugar, are rendered more soluble, since a greater surface is exposed to the solvent action of the liquids of the body, and prompter and fuller effects are obtained. The potency of calomel, of the resins, and of alkaloids is in this way considerably increased within certain limits, but not to the unreasonable extent advocated by Homoeopathic pharmacy, in which this process is carried to a reductio ad absurdum. It is an excellent and convenient method for dispensing and administering the more potent agents, such as arsenous acid, mercury com- pounds, and the alkaloids. Substances triturated in this way have been called Triturations, for whose preparation the U. S. P. gives a general formula: Take of the substance, for example, Elaterin . . . I Gm. Milk Sugar, in fine powder..........9 Gm. First thoroughly triturate the medicinal substance (Elaterin) with an equal weight of Milk Sugar, then add the remainder of the Milk Sugar, and mix thoroughly by trituration (for about ten minutes). Unless otherwise specified, triturations should be of the official strength—i. e. IO per cent, of the drug. By the addition of about an equal weight of Alcohol to the triturate it becomes a soft mass, which, after being moulded into IOO A TEXT-BOOK OF MATERIA MEDICA. disks of about I grain (0.06) each, after the evaporation of the Alcohol, furnishes the so-called Tablet Triturates. These afford a convenient method of medication for such substances as are adapted to trituration, which is, however, confined, as indicated, to a comparatively limited number of agents. To represent in the form of these tablets every kind of medicinal agent of volatile cha- racter, or drugs otherwise susceptible to change through the inevi- table exposure to the atmosphere to which every such mixture is liable, is simply to invite error in practice. These tablets, more- over, with certain chemical substances, undergo chemical changes which render them entirely insoluble, and thus practically inert. In order to be effective and otherwise reliable, they should be pre- pared extemporaneously by the pharmacist, in order to ensure their solubility. They should always be dissolved in a little water before they are administered. When it is desired to obtain a mild and prolonged local effect of a medicinal agent in the mouth or throat, the substance is made into a soft mass (confection) with a diluent and excipient, Sugar and Mucilage, and flavor, and formed into round or oval-shaped disks, weighing from 8 to 30 grains (\ to 2 Gm.), called variously Lozenges, Troches, Tablets, and Pastils. Troches.—When these are allowed to dissolve slowly in the mouth the diluent serves as a vehicle for the medicinal agent, and a gradual prolonged effect is obtained upon the mucous surfaces. This form of medication is adapted only to astringents, antacids, expectorants, and stomachics consisting of substances not especi- ally disagreeable to the palate. Tablets, or Lozenges, are not intended to be swallowed, nor adapted to exceedingly volatile, caustic, irritant, or otherwise un- palatable substances. For ingestion, medicinal agents should be made into a Mass (massa) with an excipient, and formed into small spheres, or balls, as a rule not over 5 grains (0.3) in weight, to be swallowed and slowly dissolved in the stomach or intestines. Such preparations are the so-called Fills (Piluloz, from pila, ball). PULVERES—POWDERS. The nine official Powders are impalpable mixtures of one or more active drugs, usually with some nearly inert substance, such as Sugar, as a diluent, and Aromatics. They are made by trituration. SOLID MIXTURES FOR INTERNAL USE. IOI Pulvis— Gm. in ioo. Antimonialis (James') . calc. phos. 67; antimon. oxide 33. Aromaticus .... cinnamon (Ceylon), ginger, each 35. cardamom (seed), nutmeg, each 15. Cretae Compositus . acacia p. 20; sugar 50; prep, chalk 30. Glycyrrhizae Compositus . . . senna 18; glycyrrhiza 24. fennel oil 0.4; sulphur, washed, 8 ; sugar 50. Ipecacuanhae et Opii . . . ipecac, opium pulv., each 10. (Dover's Powder) sugar of milk 80. Jalapae Compositus .... potass, bitartrate 65 ; jalap 35. Rhei Compositus . magnesia 65 ; ginger 10; rhubarb 25. In 60 grains. Pulv. Morphinae Compositus . . camphor 10; morphine (Tulley's Powder) sulph. 1. calcium carb., precip.; glycyrrhiza p., each 20. For 12 pow.; in each, grains. Effervescens Compositus . (Seidlitz Powder) potassium and sodium tartrate 93 Gm. 120 sodium bicarbonate 31 Gm. 40 acid tartaric. 27 Gm. 35 Many methods are in use for the purpose of disguising the taste of disagreeable remedies in the powder form. Of these the most elegant and effective method is that of enclosing the powder in a cachet or wafer. Originally wafers were made of starch-paste in thin sheets; a piece about 0.5 dcm. (2 inches) square, immersed in water for a minute, being placed in a spoon, the powder poured into it, and then enwrapped by folding up the edges and swallowed with a little water. The cachets or " konseals " are wafer-disks consisting of two concentric halves, one of which is filled with the powder, and the other half attached by moistening the edge and pressing the edges together by means of various devices. These cachets are of three sizes, the largest holding 5 grains (0.3) Quinine Sulphate. After one minute's immersion in water they can be swallowed without any effort. Unofficial Powders of the N. F. Pulvis— Acacia Compositus (Pulvis Gummosus, Ph. Ger.). Acetanilidi Compositus.—Containing 50 per cent. Acetan- 102 A TEXT-BOOK OF MATERIA MEDICA. Pulvis— ilid, 2 per cent. Caffeine, with Tartaric Acid and Sodium Bicarbonate. Aloes et Canella (Hiera Picra). Amygdala Compositus (Almonds Comp.)—A mixture of Sweet Almond, Sugar, and Acacia, in fine powder; 180 grains (10 Gm.), triturated with Water, yield about 4 fluid- ounces (119 Cc.) of Emulsum Amygdalae. Anticatarrhalis (Catarrh Snuff.)—Hydrochlorate of Mor- phine, 1 part; Acacia, 60 parts; Subnitrate of Bismuth, 180 parts, in fine powder. Catechu Compositus (Compound Powder of Catechu, Ph. Br.). —Catechu, 4 parts; Kino, 2 parts; Krameria, 2 parts; Cinnamon, 1 part; Nutmeg, 1 part. Creta Aromaticus.—A mixture of Cinnamon, Saffron, Nut- meg, Cloves, Cardamon, prepared Chalk, and Sugar. Creta Aromaticus cum Opio.—Aromatic Powder of Chalk, with 1 grain (0.06) of powdered Opium, in 40 grains (1.5) of the mixture. Official in the Ph. Br. Hydrargyri Chloridi Mitis et Jalapa (Calomel and Jalap).—A mixture of Mild Chloride of Mercury, 10 grains (0.6), and Jalap, 20 grains (1.3). When " Calomel and Jalap " is prescribed for an adult, without any specifi- cation of quantities, the N. F. recommends that the above mixture be dispensed as one dose. Iodoformi Compositus (Iodoform and Naphthalin).—A mixture of Iodoform, 2 parts; Boric Acid, 3 parts; Naphthalin, 5 parts; with Oil of Bergamot, in fine powder. This powder is used in many cases where a diluted preparation of Iodo- form, for external purposes, is desired. The odor is masked both by the Oil of Bergamot and by the Naphthalin. Kino Compositus.—A mixture of Kino and Cinnamon, with 1 grain (0.06) of Powdered Opium in each 20 grains (1.3). Myrica Compositus (Composition Powder).—A mixture of Bayberry, Ginger, Capsicum, and Cloves. Pancreaticus Compositus (Peptonizing Powder).—A mixture of 20 parts Pancreatin and 80 parts Sodium Bicarbonate; 25 grains will peptonize 1 pint of milk. Pepsini Compositus (Pulvis Digestivus).-A mixture of Pep- sin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, with Milk Sugar to represent the gastric juice. SOLID MIXTURES FOR INTERNAL USE. 103 Pulvis— Rhei et Magnesia Anisatus (Compound Anise Powder.)— A mixture of Rhubarb, Heavy Magnesia, and Oil of Anise. Talci Salicylicus (Salicylated Powder of Talcum).—A mix- ture of Talcum with 3 per cent. Salicylic Acid and 10 per cent. Boric Acid, in fine powder. Powders are usually directed to be divided into papers (char- tulce); thus, for example, a formula for a prescription would be— B/, Hydrargyri Chloridi Mitis . . 1. Sacchari Lactis......9. Misce cum trituratio et in chartulae No. x. divide. Encapsuling powders by filling them in gelatin capsules is a very convenient and elegant form of administration. No mixture which is desired to be given in the form of powder, however, should be made into a mass for facilitating the encapsuling process— a custom too frequently adopted. Many substances, especially Bismuth Subnitrate and Calomel, become exceedingly hard and quite insoluble when made into a mass. No dispenser should assume the prerogative of changing the form of medication pre- scribed. sales effervescentes—effervescent salts. These are granulated mixtures of Salts with Sugar and Sodium Bicarbonate and Tartaric Acid, which decompose when the Salt is dissolved in Water and furnish agreeable aerated draughts. The following are official, the strength indicated being that con- tained in 90 grains (6 Gm.), a heaped teaspoonful being the ordinary dose, dissolved in about 6 fluidounces (180 Cc.) of water: Caffeina Citrata Effervescens......caffeine 0.06 Lithii Citras Effervescens .... lithium citrate 0.06 Magnesii Citras Effervescens . magnesium citrate 1.0 Potassii Citras Effervescens . . . potassium citrate 3.0 Effervescent Salts (Granular), N. F. The strength given for these is the quantity contained in 90 grains (6 Gm.), which represents about the quantity of these Salts contained in a heaped teaspoonful of ordinary size, the average dose. 104 A TEXT-BOOK OF MATERIA MEDICA. Ferri et Quinina Citras Effervescens, i grain (0.06) Citrate of Iron and Quinine. Ferri Phosphas Effervescens, 2 grains (0.12) Phosphate of Iron, Potassii Bromidum Effervescens, 20 grains (1.3) Potassium Bro- mide. Potassii Bromidum cum Caffeina, 10 grains (0.6) Potassium Bro- mide and 1 grain (0.06) Caffeine. Sal Carolinum Factitium Effervescens (Effervescent Carlsbad Salt, artificial).—A solution of about 8y grains (5.5) in 6 fluid- ounces (178 Cc.) of Water represents an equal volume of Carlsbad Water (Sprudel). Sal Kissingense Factitium Effervescens (Effervescent Kissingen Salt, artificial).—A solution of about 80 grains (5 Gm.) in 6 fluid- ounces (178 Cc.) represents an equal volume of Kissingen Water (Rakoczy). Sal Vichyanum Factitium Effervescens (Effervescent Vichy Salt, artificial).—A solution of about 57 grains (4 Gm.) in 6 fluidounces (178 Cc.) of Water represents an equal volume of Vichy Water (Grand Grille). Salts (Non-effervescent). Sal Carolinum Factitium.—In two forms, Dry (Ph. Ger.) and Crystalline. A solution of about 16 grains (1 Gm.) of the Dry (27 grains (1.8) of the Crystalline) in 6 fluidounces (178 Cc.) of Water represents an equal volume of Carlsbad Water (Sprudel). Sal Kissingense Factitium.—A solution of about 24 grains (1.5) in 6 fluidounces (178 Cc.) of Water represents an equal volume of Kissingen Water (Rakoczy). Sal Vichyanum Factitium.—A solution of about 14 grains (1 Gm.) in 7 fluidounces (207 Cc.) of Water represents an equal volume of Vichy Water (Grand Grille). CONFECTIONES—CONFECTIONS. Confections may be defined as flavored masses wherein the adhesive substance is Sugar in large proportions, serving as a vehicle for masking the taste of the drug. Confections, when made by beating a fresh drug, first reduced to pulp with sugar until of the proper consistence, are termed conserves. When made from powders or extracts they are called electuaries. SOLID MIXTURES FOR INTERNAL USE. Only one representative of each class is official: Gm. in ioo Cc. Confectio Rosse......rose water 16, red rose 8. (Conserve of Rose) sugar 64, honey 12. f oil coriander 0.5, senna 10. Confectio Sennas . < cassia fistula 16, fig 12, tamarind 10. (Electuar. Senna) I prune 7, sugar 55, water to 100. The Confection of Senna is a very agreeable laxative, especially adapted for constipation in women and children. It is exceedingly agreeable to the taste. TROCHISCI—TROCHES. Troches, or lozenges, are confections made into various forms and then dried. The vehicle or excipient consists of Powdered Gum Tragacanth or Sugar with flavoring—in some cases orange flower water, in others tolu, nutmeg, vanilla, etc. The active ingredients are mixed with the diluent or vehicle and made into a plastic mass with the particular excipient, Water or Syrup. The mass is rolled out to the requisite thickness, and the disks formed by cutting through it with a punch or troche-cutter. The troches are then dried by exposure. The size and weight of the troche are regulated by the thickness of the mass and the diameter of the cutter. The 15 official Troches vary in weight from Gm. 0.5 to 1.5. Active Drug. Gm. in Gm. in Grains in 100 each each Trochisci— Troches. Troche. Troche. Acidi Tannici...... 6. 0.06 1 Orange flor. Ammonii Chloridi .... 10. 0.1 \\ Tolu. extract glycyrrhiza 25. 0.25 4 Catechu........ 6. 0.06 1 Orange flor. Cretae.........25. 0.25 4 Nutmeg. Cubebae .... oleoresin 4. 0.04 § extract glycyrrhiza 25. 0.25 4 sassafras oil 1. 0.01 \ Ferri . . . ferric hydrate 30. 0.3 5 Vanilla. Glycyrrhizae et Opii ext. glycyrrhiza 15. 0.15 21 Anise. powd. opium 0.5 mg.5. ^ 106 A TEXT-BOOK OF MATERIA MEDICA. Active Drug. Gm. in Gm. in Grains in ioo each each Trochisci__ Troches. Troche. Troche. Ipecacuanhae...... 2. 0.02 \ Orange. Krameriae .... extract 6. 0.06 1 flor. Menthae Piperitae ... oil 1. 0.01 \ Peppermint. Morphinae. morphine sulph. 0.16 mg. 16 -^ Gaultheria. et Ipecac, powd. ipecac 0.50 " 5. -tV Potassii Chloratis .... 30. 0.3 5 Lemon. Santonini........ 3- °-3 i Orange flor. Sodii Bicarbonatis .... 20. 0.2 \ Nutmeg. Zingiberis . . tinct. ginger 20. 0.2 \ Ginger. Lozenges of Peppermint, Lemon, Musk, Vanilla, and Gaultheria may readily be prepared by saturating sugar lozenges with the respective essences or tinctures and permitting the alcohol to volatilize. MASS.E—MASSES. Masses are plastic mixtures of pilular consistence. They are made by incorporating the drug with adhesive substances, by chem- ical reaction, and sometimes by both processes. The Masses are intended to be formed into pills whenever they are to be dispensed. They are therefore often called Pil., Pilulce, instead of Massa. There are only three official: Massa Copaibae .... water 1, magnesia 6, copaiba 94. The Copaivic Acid combines with the magnesia, forming mag- nesium copaivate of pilular consistence. This is also known as " solidified copaiba." Massa Ferri Carbonatis f sodium carb., ferrous sulph., each 100. (Vallet's Mass) \ honey 38, sugar 25, syrup to 100. By double decomposition between the Ferrous Sulphate and Sodium Carbonate ferrous carbonate is formed, which is incorpo- rated with Honey and Sugar to prevent oxidation and to render the mixture a plastic mass. The Pill of Ferrous Carbonate (Pil Blaudii) is preferable to this mass, as in the pill the ferrous car- bonate is better protected against oxidation. Massa Hydrargyri . glycyrrhiza 5, althaea 25, mercury 33. (Blue Mass) glycerin 3, honey of rose 34. SOLID MIXTURES FOR INTERNAL USE. The mercury is extinguished by trituration with the rose honey and glycerin and the powdered glycyrrhiza; the other ingredients are then incorporated. The usual dose is from 5 to 10 grains (0.3-0.6). PILULE—PILLS. Pills are spherical, more or less soluble masses of medicinal substances rendered cohesive, plastic, and firm in consistence by the addition of some substance (usually inert) termed an excipient. The kind of excipient employed varies with the nature of the medicinal substance. As a general rule, such substances are chosen as give to the mass, with the smallest proportion, the greatest plas- ticity, and also best preserve the spherical shape of the pills. The excipient must also, unless the contrary be directed for especial purposes, be indifferent in character, to avoid change in the medic- inal agents. Soluble substances are rendered adhesive by the action of sol- vents, and require, according to their solubilities, the addition of some liquid such as Water, Alcohol, Glycerin, etc. Others require the addition of adhesive substances, such as Syrup, Mucilage, Glu- cose, Glycerite of Starch or Tragacanth, etc. Drugs adapted for dispensing in the form of pills maybe divided as follows: (1) The official Masses, Extracts, and Scaled Salts. Masses and extracts, being of pilular consistence, require no addition except when hard or dry; Water should then be incor- porated to restore them to their original form. Abstracts and powdered extracts are best made into a mass with Water. (2) Vegetable Powders in which the dose does not exceed five grains. With these adhesive excipients are indicated, such as Syrup, Mu- cilage, Glycerite of Tragacanth, and Glucose. The last mentioned answers the requirements better than most other substances. Con- fection of Rose and Extracts of Gentian, Glycyrrhiza, and Taraxa- cum are also used when their color is not objectionable. (3) Salts not too deliquescent, and Alkaloids. Excipients for these must combine adhesive and absorbent quali- ties. They are first triturated with a dry powder—e. g. Althaea, Glycyrrhiza, or Milk Sugar—and then mixed with the adhesive substance—viz. Glucose or Glycerite of Starch or Tragacanth. No excipient must be used that will give to the mass a color different from that of the medicinal ingredients (the base). 108 A TEXT-BOOK OF MA TERIA MEDICA. (4) Volatile Oils and Oleoresins. The quantity of these when dispensed in pills being compara- tively large, it is necessary to add some light absorbent substance, such as Magnesia or Starch, to which is added the adhesive material. The practice of adding wax or resin to oils is not to be recommended except as a last resort, since they tend to render the pill insoluble. (5) Resins and Gum Resins. These form an adhesive mass by the addition of a little Alcohol, with which more bulky excipients, such as Soap, may be incorpo- rated to preserve the shape of the pill. (6) Salts of the Cinchona Alkaloids, Quinine and Cinchonidine Sulphates, etc. These are often prescribed in pill form in large doses, and it is therefore desirable to reduce their bulk. For this purpose dilute Sulphuric Acid or Tartaric Acid is added in small quantity, which acts as a solvent upon the salt, thereby converting it into a mass. This mass is incorporated with a little Glycerite of Starch, other- wise it soon loses its plasticity; it must therefore be rolled into pills as soon as formed. (7) Substances easily decomposed by organic matter. Potassium Permanganate and Silver Nitrate are quickly " re- duced " when incorporated with the excipients usually employed. These should be mixed with an inorganic diluent not affected by them, such as Kaolin, Pipe Clay, or Fuller's Earth, and made into a mass with Water, Petrolatum, Resin Cerate, etc. In order to disguise the bitter or otherwise disagreeable taste of pills, they are usually coated with sugar or gelatin. These coated pills are often objectionable on account of the coating, or the pill itself, becoming quite insoluble. When a coated pill is desired, it should be freshly made and enclosed in a gelatin capsule of the smallest size. Pills may also be coated extemporaneously by rolling them on a piece of filter-paper saturated with Mucilage of Acacia, and then in powdered Milk Sugar. Keratin-cozi&d pills are designed for solution in the duodenum, the pills being dipped in a solution of Keratin prepared from horn shavings treated with pepsin and hydrochloric acid. Concentric pills are made up of concentric layers of different ingredients, intended to dissolve and become active at various stages in their passage through the intestinal tract. The following 15 Pills are official: SOLID MIXTURES FOR INTERNAL USE. 109 Pilule. Aloes.........aloes purif., soap, each Aloes et Asafcetidse . aloes, asafcetida, soap, each Aloes et Ferri . . aloes, iron sulph., arom. powder Aloes et Mastiches (Dinner Pill).....aloes mastic red rose Aloes et Myrrha.'............aloes myrrh arom. powder Antimonii Comp......antimony, sulphurated (Plummer's Pills) mild mercurous chlor. guaiac Asafcetida;.............asafcetida Catharticse Comp......ext. colocynth comp. mild mercurous chloride extract of jalap gamboge Catharticse Vegetabilis . . . ext. colocynth comp. exts. hyoscyam., jalap, each ext. leptandra, res. podophyll. oil peppermint Ferri Carbonatis........ferrous sulphate (Ferruginous, Chalybeate, Blaud's) potass, carb sugar 4 ; tragac, althaea, each Ferri Iodidil..........reduced iron iodine glycyrrh., sugar, each ext. glycyrrh., acacia, each Opii...........soap 2; opium pulv. Phosphori2............phosphorus althaea, acacia, each Rhei............soap 6; rhubarb Rhei Comp..............rhubarb aloes myrrh oil peppermint Gm. for 100. Excipient. 13 9 7 13 4 3 13 6 4 4 4 8 20 8 6 3 i-5 6 3 i-5 0.8 16 4 5 4 1 6-5 0.06 6 20 13 10 6 o.5 13 9 7 13 4 3 13 6 4 4 4 8 20 8 6 3 1-5 6 3 1.5 0.8 6 6.5 0.06 20 13 10 6 Glyc. water. Conf. rose. Water. Syrup. Castor oil. Soap. Water. Water. Glyc. water. Water. Glyc. water. Water. Unofficial Pills of the National Formulary. When a large number of pills are to be prepared in accordance with the given proportions, and the quantities of the ingredients are to be determined by multiplying with the number of pills re- quired, it is recommended that the nearest whole number, or near- est convenient fraction, in each case, be chosen. Pilulae— Ad Prandium (Dinner Pills).—When " Dinner Pills," under this or some other equivalent name, are prescribed without further specification, the National Formulary recommends that the Pilulae Aloes et Mastiches of the U. S. P., also called " Lady Webster's Dinner Pills," be dispensed. 1 Coated with ethereal solution of Balsam Tolu. 2 Phosphorus dissolved in Chloroform. HO A TEXT-BOOK OF MATERIA MEDICA. Pilulae — Of other combinations bearing similar names or used for similar purposes, the following appear to be those most commonly in use: Chapman's Dinner Pill.—Aloes, Mastic, each, grains \\ (o.i); Ipecac, grain i (0.06); Oil of Fennel, grain \ (0.015). Cole's Dinner Pill.—Aloes, Mass of Mercury, and Jalap, each, grains \\ (0.075); Ant. and Potas. Tartrate, grain ^ (0.0013). Hall's Dinner Pill.—Aloes, Ext. of Glycyrrhiza, Soap, and Molasses, each, grain 1 (0.06). Aloes et Podophylli Composita (Janeway's Pills).—Aloes, grain 1 (0.06); Resin Podophyllum, grain \ (0.03); Ext. Bellad. Ale, Ext. Nux Vomica, each, grain \ (0.015). Aloini Composita.—Aloin, grain \ (0.03); Resin Podophyl- lum, grain \ (0.01); Ext. Belladonna, grain \ (0.015). Aloini, Strychnina et Belladonna.—Aloin, grain \ (0.01 Gm.); Strychnine, alkaloid, grain T^- (0.0005 Gm.); Alco- holic Extract of Belladonna, grain \ (0.008 Gm.). Aloini, Strychnina et Belladonna Composita.—Aloin, grain \ (0.012); Ext. Bellad. Ale, grain \ (0.008 Gm.); Strychnine, alkaloid, grain T^ (0.0005); Ext. Rham. Pursh., grain £ (0.03). Antidyspeptica.—Strychnine, alkaloid, grain -fo (0.0014); Ipecac, Ext. Bellad. Ale, each, grain T\j (0.006); Mass of Mercury, Ext. Colocynth. Comp., each, grains 2 (0.13). Antineuralgica.— 1. Gross' Antineuralgic Pills: Quinine Sulphate, grains 2 (0.13); Morphine Sulphate, grain -^ (0.003) 5 Strychnine, alkaloid, grain -^ (0.002); Arsenous Acid, grain ^ (0.003)! Ex. Aconite Leaves (U. S. P. 1870), grain h (0.03). When " Antineuralgic Pills," or " Neuralgia Pills," with- out other specifications, are prescribed, it is recommended that the above preparation be dispensed. Sometimes the Morphine is directed to be omitted. 2. Brown-Seguard's Antineuralgic (or Neuralgia) Pills: Extracts of Hyoscyamus and Conium, each, grain § (0.04); Extracts of Ignatia and Opium, each, grain h (0.03); Ext. Aconite Leaves, grain J (0.02); Ext. Stramonium, grain \ (o.Oi); Ext. Indian Cannabis, grain ^ (0.015); Ext. Bellad. Ale, grain \ (0.01). SOLID MIXTURES FOR INTERNAL USE. in Pilulae— Antiperiodica (Warburg's Pills).—i. With Aloes: Aqueous Extract of Aloes, grain I (0.06); Rhubarb, grain \ (0.03); Elecampane, Saffron, Fennel, each, grain \ (0.015); Zedo- ary, Cubebs, Myrrh, White Agaric, Camphor, each, grain \ (0.008); Quinine Sulphate, grains if (0.085); Extract of Gentian, a sufficient quantity. 2. Without Aloes: The same formula as above, with omis- sion of the Aqueous Extract of Aloes. These pills have been introduced for the purpose of facilitating the adminis- tration of Warburg's Tincture in a solid form. When " Warburg's Pills " or " Pills of Warburg's Tincture " are prescribed, without further specification, those containing Aloes are recommended to be dispensed—those without Aloes only when they are expressly demanded. Each Warburg's Pill represents about 1 fluidrachm (4 Cc.) of Warburg's Tincture. (See Tinctura Antiperiodica^) Colocynthidis Composita (Pilulae Cochia).—Extract of Colo- cynth, grain \ (001); Aloes, Resin of Scammony, of each, grains 2 (0.13); Oil of Cloves, min. \ (0.015). Colocynthidis et Hyoscyami.—Extract of Colocynth, grain y^ (0.006); Aloes, Resin of Scammony, Ext. Hyoscyamus, each, grains \\ (o-1); Oil of Cloves, min. \ (0.01). Colocynthidis et Podophylli.—Compound Extract of Colo- cynth, grains \\ (0.16); Resin of Podophyllum, grain \ (0.015). Ferri Composita (U. S. P. 1880).—Myrrh, \\ grains (0.1); Ferrous Sulphate, Sodium Carbonate, each, \ grains (0.048). Galbani Composita (U. S. P. 1880).—Galbanum, Myrrh, each, \\ grains (0.1); Asafcetida, \ grain (0.03). Glonoini (Nitroglycerin).—Spirit of Glonoin (1 per cent), Athaea, each, grains 200 (13.0); Confection of Rose, a suf- ficient quantity. Make a mass and divide it into two hun- dred (200) pills. Each pill contains jfa grain (0.0007) of Glonoin (Nitro-glycerin). Laxativa Post-partum (Barker's).—Ext. Colocynth. Comp., grains if (0.1); Aloes, grain f (0.05); Res. Podoph., Ipecac, each, -jL grain (0.005); Ext. Nux Vomica, -^ grain (0.03); Ext. Hyoscyamus, 1 ^ grains (0.8). This is the formula generally employed by Dr. Fordyce Barker, except where special circumstances render modi- 112 A TEXT-BOOK OF MATERIA MEDICA. Pilulae— fications necessary. The formula usually quoted in manu- facturers' lists and some formularies is not correct. Metallorum (Metallorum Amarae). — Reduced Iron and Quinine Sulphate, each, grain i (0.06); Strychnine and Ar- senous Acid, of each, grain -^ (0.003). Aitken's Tonic Pill is a similar combination: Reduced Iron, grain f (0.04); Quinine Sulphate, grain 1 (0.06); Strychnine, Arsenous Acid, each, grain -^ (0.0012). Opii et Camphora.—Powdered Opium, 1 grain (0.06); Cam- phor, grains 2 (0.13). Opii et Plumbi.—Powdered Opium and Acetate of Lead, each, grain 1 (0.06). Podophylli, Belladonna et Capsici (Squibb's Podophyllum Pills).—Resin Podophyllum, grain \ (0.015); Capsicum, grain ^ (0.03); Ext. Bellad. Ale, grain \ (0.008); Sugar of Milk, grain 1 (0.06); Acacia, Glycerin, and Syrup, each, a sufficient quantity. Quadruplices (Ferri et Quininae Compositae).—Ferrous Sul- phate, Quinine Sulphate, Aloes, each, grain 1 (0.06); Ext. Nux Vomica, grain \ (0.015); Ext. Gentian, sufficient. Triplices (Triplex).—Aloes, grains 2 (0.13); Resin Podo- phyllum, grain \ (0.015); Mass of Mercury, grain I (0.06). When Pilula Triplex, under this name or some equiva- lent, is prescribed without further specification, the N. F. recommends that the above preparation be dispensed. A formula devised by John W. Francis is also in use: 2. Francis's Triplex Pill.—Aloes, Scammony, Mass of Mercury, of each, grain f (0.05); Croton Oil, -^ min. (0.003); Oil of Caraway, grain \ (0.015); Tincture of Aloes and Myrrh, a sufficient quantity. UNOFFICIAL FORMS OF MIXTURES OF SOLIDS FOR INTERNAL USE. Granules are small pills, less than 1 grain (0.06) in weight, usually sugar-coated and containing alkaloids and other active drugs. Parvules are identical with granules. They are usually colored red or pink. Globules (Orbiculce) are sugar pellets to be saturated with alco- holic solutions of medicinal agents, chiefly in Homoeopathy. PREPARATIONS FOR EXTERNAL USE. 113 Compressed Pills are made by compressing powders into disks not exceeding 5 grains (0.3) in weight, without any excipient. Friable Pills are made by aggregation, spreading the powdered mixture upon nuclei or sugar granules in a revolving pan until the pills are formed. Bolus is the name given to pills exceeding 5-10 grains (0.3-0.6) in weight, used in veterinary practice. A sugar-coated bolus is called a Dragee. Rotuloz are disk-shaped forms of sugar about 1^ grains (0.1) in weight, which may be flavored with alcoholic solution (spirits). Bacilli are cylindrical sticks, a form of lozenge (Licorice). Lamellce, thin squares of gelatin in which the active agent has been incorporated, intended for solution in the eye. PREPARATIONS FOR EXTERNAL USE. To this group belong the liquid preparations: Liniments, Oleates and Collodions, and the mixtures of solids: Ointments, Cerates, Suppositories, Plasters, and Papers. The Vehicle, some- times incorrectly called the " base," consists chiefly of fatty sub- stances which serve as protectives or facilitate absorption. The Collodions are, however, an exception. The solid mixtures may be classified according to their fusi- bility, or melting-points, because their therapeutic uses, as well as their pharmaceutical forms, are through this quality respectively determined. Ointments fuse at the body-temperature, and therefore produce an emollient effect, or induce absorption of the medicinal substance by the system. They are applied by rubbing or inunction. Cerates have a higher fusing-point, due to Wax they contain; the medicinal agent is not so readily absorbed, and they are there- fore used to produce local effects, being spread on cloth and applied as dressings. Suppositories have the same fusibility as cerates, and may be said to be cerates intended for application to the orifices of the body, both for absorption and local effect. Plasters have a still higher fusibility; they do not melt, but become adhesive by the body-temperature, and are intended to produce local effects and afford mechanical support to the parts affected. 8 114 A TEXT-BOOK OF MATERIA MEDICA. The fusibilities of these various preparations are likewise gov- erned by the respective vehicles employed. LINIMENTA—LINIMENTS. The Liniments are liquid preparations for external use, consist- ing of solutions of oily or resinous constituents in Alcohol or Oils, or mixtures of liquid Soaps. The nine official Liniments are prepared by simple admixture or solution. Linimentum— Ammoniae . . cotton seed oil 60 Cc.; ammonia water 35 Cc; alcohol 5 Cc. Belladonnae . . . fl. ext. belladonna 95 Cc.; camphor 5 Gm. Calcis (Carron Oil) . . linseed oil 50 Cc; lime solution 50 Cc, Camphorae .... cotton seed oil 80 Gm.; camphor 20 Gm. Chloroformi .... soap liniment 70 Cc.; chloroform 30 Cc. Saponis..............camphor 4.5, soap 7, rosemary oil I ; alcohol 75 ; water, to 100 Cc. Saponis Mollis, alcohol 35 Ce; lavender oil 2; soft soap 65 Gm. Sinapis Comp. . . . fl. ext. mezereum 20; mustard oil, vol. 3, camphor 6; castor oil 15 ; alcohol, to 100 Cc. Terebinthinae . . resin cerate 65 Gm.; turpentine oil 35 Gm. Unofficial Liniments of the National Formulary. Linimentum— Aconiti et Chloroformi.—Tincture of Aconite, Chloroform, each, 2 fluidounces (60 Cc.); Soap Liniment, 12 fluidounces (355 Ce). Ammonii Iodidi.—Iodine, 30 grains (2.); Oil of Rosemary, Oil of Lavender, each, no minims (7 Ce); Camphor, 220 grains (15.); Water of Ammonia, if fluidounces (50 Cc); Alcohol, enough to make 16 fluidounces (473.17 Ce). On standing, it becomes colorless. Cantharidis (U. S. P. 1880).—Oil of Turpentine containing 15 per cent, of Cantharides. Iodi (similar to Ph. Br.).—Iodine, 900 grains (60.); Potassium Iodide, 360 grains (24.); Glycerin, \ fluidounce (15 Cc); Water, 1 fluidounce (30 Ce); Alcohol, enough to make 16 fluidounces (473.17 Ce). Opii Compositum (Canada Liniment).—Tincture of Opium, \\ fluidounces (45 Cc.); Camphor, 120 grains (8.); Alcohol, 4 fluidounces (118 Cc.); Oil of Peppermint, 180 minims PREPARATIONS FOR EXTERNAL USE. 115 Linimentum— (12 Ce); Water of Ammonia, 6 fluidounces (180 Ce); Oil of Turpentine, enough to make 16 fluidounces (473.17 Ce). Plumbi Subacetatis (U. S. P. 1880).—Solution of Lead Sub- acetate, 35 parts; Cotton Seed Oil, 65 parts. Saponato-camphoratum (Opodeldoc; Solid Opodeldoc).— White Castile Soap, \\ ounces (45.); Camphor, \ ounce (15.); Alcohol, 20 fluidounces (592 Ce); Oil of Thyme, 30 minims (2 Cc.); Oil of Rosemary, 60 minims (4 Ce); Water of Ammonia, Fort., 1 fluidounce (30 Ce). Terebinthina Aceticum (Linimentum Album., Stokes' Lini- ment ; St. John Long's Liniment).—Oil of Turpentine, 3 fluidounces (89 Cc.); Fresh Egg, 1 ; Oil of Lemon, 60 minims (4 Cc.); Acetic Acid, 300 minims (20 Cc.); Rose Water, 2\ fluidounces (75 Ce). Tiglii (Linimentum Crotonis, Ph. Br.).—Croton Oil, 2 fluid- drachms (8 Ce); Oil of Cajuput, 7 fluidrachms (27.5 Ce). Tiglii Compositum.—Croton Oil, 1 fluidounce (30 Cc.); Oil of Sassafras, 1 fluidounce (30 Cc.); Oil of Turpentine, 1 fluidounce (30 Ce); Oil of Olive, 2 fluidounces (60 Ce). LOTIONES—WASHES. Lotio— Adstringens (Warren's Styptic).—A mixture of Sulphuric Acid, Oil of Turpentine, and Alcohol. Flava (Yellow Wash, Aqua Phagedaenica Flava, Ph. Ger.). —Corrosive Mercuric Chloride, 24 grains (1.5), in Lime Water, 16 fluidounces (473 Ce). Nigra (Black Wash; Aqua Phagedaenica Nigra, Ph. Ger.). —Mild Mercurous Chloride, 64 grains (4.), in Lime Water, 16 fluidounces (473 Ce). Plumbi et Opii (Lead-and-Opium Wash).—Lead Acetate, 120 grains (8.); Tincture of Opium, \ fluidounce (15 Ce); in Water, 16 fluidounces (473 Ce). To be shaken when dispensed. The following are unofficial solutions and mixtures for external use: Injectio, -ones.—Aqueous solutions for introduction by means of a syringe in the orifices of the body. A TEXT-BOOK OF MA TERIA MEDICA. Injectio Hypodermica.—Solution for hypodermic or subcu- taneous injection. Enema, -atis ; Clyster.—A warm solution of Soap or a muci- laginous mixture for injection in the rectum to produce evacuation, or for nutrition. Gargarisma, -atis ; Gargle.—A wash or lotion for the throat. Collyrium, -i; "Eye-wash!'—A weak solution for instillation in the eyes. Nebula, -ce ; Spray.—A liquid intended for application by means of an atomizer. Vapor, -oris; Inhalation.—Volatile agents to be added to boiling water and inhaled, to affect the air-passages. Balneum, -ei; Bath.—Mixture to be added to water for bath- ing purposes. OLEATA—OLEATES. The official Oleates are solutions of oleates in Oleic Acid. They are distinct from the solid oleates, which are made by double decomposition of salts of the metals and alkaline earths and sodium oleate, or Soap. (See Soap) The liquid Oleates are intended for endermic medication. They are applied by inunction, when the Oleic Acid favors the absorp- tion of the medicinal agent, the oleate in solution. When it is not desirable to administer remedies by the mouth, the Oleates afford an effective form of medication. The solid Oleates are either dry powders, well adapted for pro- tectives as dusting powders, or soft, pliable masses to be applied in the form of ointments or plasters. Three are official—two liquid, and one, Zinc Oleate, semi-solid. They are made by incorporating the solid with the Oleic Acid, contained in a warm mortar, and effecting solution with a gentle heat: Percentage by weight. Oleatum Hydrargyri .... yellow mercuric oxide 20. Oleatum Veratrinae........ veratrine 2. Oleatum Zinci Oxidi.........zinc oxide 5 Unofficial Oleates of the National Formulary. The following are simply solutions of the alkaloids in Oleic Acid: PREPARATIONS FOR EXTERNAL USE. 117 Oleatum— Aconitina.—Contains 2 per cent, of crystallized Aconitine (Duquesnel's). Quinina.—Contains 25 per cent, of Quinine (Alkaloid). Of the solid Oleates introduced by Dr. J. V. Shoemaker, the following have been recognized, but others may also be prepared as desired: Oleatum Plumbi.—Contains about 28 per cent, of Lead Oxide. It is of the consistence and general character of Lead Plaster, and suggests similar use. Oleatum Zinci.—In the form of a soft white powder, useful as a "dusting powder," or converted into a plaster or ointment by mixing it with such proportion of Oleic Acid as may be required. OLEA INFUSA—INFUSED OILS. These preparations are obtained by infusing a dry herb, usually from the so-called narcotic plants, in five times its weight of a mixture of equal parts of Cotton Seed Oil and Lard Oil. Oleum Hyoscyami Infusum is the most familiar example. Oleum— Carbolatum.—A mixture of Cotton Seed Oil with 5 per cent. of Carbolic Acid. Hyoscyami Compositum (Balsamum Tranquillans).—Infused Oil of Hyoscyamus, with a small proportion of each of the Ethereal Oils of Absinth, Lavender, Rose, Sage, and Thyme. COLLODIA—COLLODIONS. The Collodions are solutions in Ether-Alcohol of Pyroxylin or Soluble Gun Cotton. Upon evaporation of the solvent the remain- ing film excludes the air, thus protecting abraded surfaces. Col- lodion is also used as a vehicle when a prolonged local effect is desired. The following forms are official: Collodium . . solution in ether 75 ; alco. 25 ; pyroxylin 3 Collodium Flexile . . . castor oil 3; Canada turpentine 5 Collodium Acidi Tannici . . alco. 5 ; ether 25 ; acid tan. 20 Collodium Cantharidatum (Blistering Collodion) . (flex. collo.) cantharides 60 118 A TEXT-BOOK OF MATERIA MEDICA. Unofficial Collodions. Collodium— Iodatum (Iodized Collodion).—Contains 5 per cent. Iodine in Flexible Collodion. Iodoformatum (Iodoform Collodion).—Contains 5 per cent. Iodoform in Flexible Collodion. Salicylatum Compositum (Corn Collodion).—Contains 11 per cent. Salicylic Acid and 2 per cent. Ext. Cannabis Indica in Flexible Collodion. Tiglii (Croton Oil Collodion).—Contains 10 per cent. Croton Oil in Flexible Collodion. UNGUENTA—OINTMENTS. Ointments are mixtures of a fatty vehicle with which medicinal agents are incorporated, readily fusing at the body-temperature, 35°to4o0C. (950 to io4°R). The vehicles used are: Benzoated Lard, Ointment (simple), Lard, and Wax or Spermaceti in different proportions, Lard Oil, Olive Oil, and Suet. Petrolatum and Wool-fat (Adeps Lantz Hydrosus, U. S. P.) are employed in unofficial ointments. The medicinal ingredients must be minutely distributed through the vehicle in order that the ointment may not prove irritating, and that the greatest possible surface be presented to the epidermis with a view to quick and uniform absorption. For this reason the highest quality of an ointment (next to its proper melting-point) is smoothness. In the preparation of ointments care must therefore be taken that the method employed be such as to yield smooth products. The melting-point is governed by the fusibility of the vehicle used, which is either officially 'directed, as in official preparations, or in extemporaneous preparations prescribed by the physician. The twenty-three official Ointments are prepared (1) by me- chanical admixture, (2) by fusion, or (3) by chemical reaction. Mixing the medicinal substances with the fatty body in a mor- tar or on a slab is the process usually employed for solid sub- stances, especially when insoluble in the fat. Powdered drugs, acids, alkaloids, extracts, and salts (not attended by chemical union) are examples adapted to this process. The following points must be observed: Solids must be in a fine powder before being incorporated with the vehicle; sometimes it is an advantage to triturate the solid with PREPARATIONS FOR EXTERNAL USE. 119 a small quantity of a bland fixed oil, as Almond Oil or Olive Oil, into a smooth cream before it is mixed with the vehicle proper— Lard, etc. Extracts should be reduced to a semi-liquid condition by tritura- tion with a little dilute Alcohol or Water. Substances soluble in fats, such as Carbolic Acid, Iodine, and Camphor, may be dis- solved directly in the fat by the aid of a gentle heat. The following are the official Ointments, with their drug- strengths, their respective vehicles being given in parentheses: Percentage Unguentum— of Drugs. Acidi Carbolici............(ointment) 5 Acidi Tannici.............(benz. lard) 20 Aquae Rosae (Cold Cream) . . spermaceti 12.5 ; white wax, 12 ; expressed oil of almond 60 then incorporate borax 0.5 ; rose water 19 Belladonnas (dil. alcohol 5) extract . . . (benz. lard) 10 Chrysarobini (chrysophanic acid) ...... " 5 Diachylon (Hebra's).........lead plaster 50 oil lavender 1 ; olive oil 49 Gallae................(benz. lard) 20 Hydrargyri (Blue Ointment).......mercury 50 mercuric oleate 2 ; suet 23 ; lard 25 Hydrargyri Ammoniati........(benz. lard) 10 Hydrargyri Oxidi Flavi.........(ointment) 10 Hydrargyri Oxidi Rubri (castor oil 5) . . . 10 Iodi (potass, iod. 1, water 2 parts) .... (benz. lard) 4 Iodoformi............... 10 Picis Liquidae . . . yellow wax 12.5 ; lard 37.5 ; tar 50 Plumbi Carbonatis..........(benz. lard) 10 Plumbi Iodidi............. " 10 Potassii Iodidi (sod. hypo, sulph. 1; water 10) 12 Stramonii (dil. ale 5) Extract...... 10 Sulphuris (washed)........... 30 Veratrinae (olive oil 6)......... 4 Zinci Oxidi............• • 20 Unofficial Ointments of the National Formulary. Unguentum Acidi Gallici (U. S. P. 1880).—Contains 10 per cent. Gallic Acid. 120 A TEXT-BOOK OF MATERIA MEDICA. Unguentum Calamina (Unguentum Zinci Carbonatis Im- puri; Turner's Cerate).—Contains 17 per cent. Zinc Car- bonate (Imp.). Unguentum Camphora (Unguentum Camphoratum).—Con- tains 20 per cent. Camphor. Unguentum Fuscum (Unguentum Matris; Mother's Salve). —Contains 50 per cent, of Camphorated Brown Plaster (N. F.). Unguentum Mezerii (U. S. P. 1880).—Represents 25 per cent. Mezereum. Unguentum Picis Compositum (Tar, Comp.).—Contains Oil of Tar, 4 per cent.; Tincture of Benzoin, 2 per cent.; and Oxide of Zinc, 3 per cent. Unguentum Sulphuris Alkinum (U. S. P. 1880).—Contains 20 per cent. Sulphur and 10 per cent. Potassium Carbonate. Unguentum Sulphuris Compositum (Wilkinson's Ointment; Hebra's Itch Ointment).—Precipitated Calcium Carbonate, 10; Sublimed Sulphur, Oil of Cade, of each, 15; Soft Soap and Lard, of each, 30 parts. The Lard is mixed with the Soft Soap and Oil of Cade; the Sublimated Sulphur and Precipitated Calcium Carbonate are then grad- ually incorporated. CERAT a—cerates. Cerates are mixtures of fats similar to the ointments, but of firmer consistence, because they contain Wax or Resin (having a higher melting-point than Lard) in greater proportion than do oint- ments. In the preparation of Cerates the same rules are to be observed as noted under Ointments. The six official Cerates are prepared by fusion or simple admix- ture, and one by extraction and digestion (Ceratum Cantharidis): Percentage of Drugs. Ceratum (Simple).........lard 70; white wax 30 Camphorae . camphor liniment 10; lard 60; white wax 30 Cantharidis (Blistering Cerate) . . .oil of turpentine 15 lard, 22 ; cantharides 32 yellow wax, resin, each 18 previously fused, and evaporate to IOO Cetacei . . . olive oil 55 ; white wax 35 ; spermaceti 10 PREPARATIONS FOR EXTERNAL USE. 121 Percentage of Drugs. Plumbi Subacetatis (Goulard's Cerate), camphor cerate 80 solution lead subacetate 20 Resinae (Basilicon) . . yellow wax 15 lard 50; resin 35 in cold weather yellow wax 12; lard 53 ; resin 35 In the " Blistering Cerate" the maceration in Turpentine Oil and subsequent digestion dissolve the vesicating principle of the Cantharides, and the preparation is therefore more active. Ceratum Camphora Compositum, N. F. (Camphor Ice).— Moulded into small cakes suitable for popular use as an applica- tion to excoriated surfaces. It contains very small quantities of Benzoic and Carbolic Acids. Ceratum Extracti Cantharidis (U. S. P. 1880).—Repre- sents 30 per cent. Cantharides. Ceratum Sabina (U.S. P. 1880).—Represents 25 per cent Sabine. suppositoria—suppositories. Suppositories may be defined as variously shaped masses of medicated fat, possessing a consistence ensuring their quick fusion when introduced in the orifices of the body. The U. S. P. defines Suppositories with reference to their weights and shapes, corresponding to their several uses—i. e. for introduction in the respective orifices of the body—as follows: Rectal, cone-shaped, should weigh 15 grains (1 Gm.). Urethral, pencil-shaped, should weigh 15 grains (1 Gm.). Vaginal, globular, should weigh about 45 grains (3 Gm.). The vehicle is Cacao Butter (Oleum Theobromatis), which pos- sesses the property of melting at the temperature of the human body, 350 C. (95° F.), and yet remaining firm at ordinary tempera- tures. An addition of 10 per cent, of spermaceti has been recom- mended to raise the melting-point and thus give more stability to suppositories during the heated seasons of the year. The U. S. P. gives a general formula for preparing supposi- tories ; only one Suppository is official, and this is not made from Cacao Butter. The methods of preparing suppositories are quite numerous: any process may be employed by which the product is obtained uniform in size and shape and with the medicinal ingredients thor- 122 A TEXT-BOOK OF MATERIA MEDICA. oughly incorporated. Moulds are usually employed; the medici- nal ingredients, if solid, are first reduced to powder in a mortar, and mixed with a small quantity of the grated Fat; the remainder of the Fat, previously melted and cooled to 35° C, is then gradually incorporated with this mixture, thoroughly mixed, and, if possible, without further heating, poured into the moulds, previously chilled. Another process consists in rolling the mass on a slab, cutting it as in making pills, and forming the cones with the fingers. By cold compression in a screw-press " machine," suppositories may be formed from the prepared mass. Urethral Suppositories are commonly called Bougies, or, more properly, Medicated Bougies. They are usually made with the addition of Wax, or from Glyco-gelatin mass. Suppositoria Glycerini.—Made by reaction of Sodium Carbonate 5 grains (0.3), in Glycerin 1^ grains (6 Gm.), with Stearic Acid 8 grains (0.5), and heating until a solution of sodium stearate or soap is formed, which is poured into a mould. Upon cooling, the mixture gelatinizes and the suppository is wrapped in tin-foil. Uses.—Upon introduction into the rectum the mass melts, and the Glycerin, acting upon the feces, produces evacuation. Rectal suppositories are usually made twice the official size, or 30 grains (2 Gm.). A formula for suppositories would be : Extracti Belladonnas Fol., ale, 0.1 ; Acidi Tannici, 1.0; Olei Theobromatis, q. s. (20 Gm.). Ut fiat suppositories No. x. (2 Gm.). Each suppository would contain \ grain (0.01) Ext. Belladonna and !-§- grains (0.1) Tannic Acid. emplastra—plasters. Plasters are mixtures of various fatty or resinous solids of such high melting-point as to be friable when cold, but rendered adhesive by the warmth of the body. The vehicles of plasters are : Lead plaster; resinous substances, made adhesive by admixture with the medicinal ingredients; and simple plasters, such as isinglass. The making of plasters does not differ materially from the pro- cess employed for ointments and cerates, since they are all prepared by melting the various substances and incorporating the medicinal PREPARATIONS FOR EXTERNAL USE. 123 substances last. The spreading of plasters, though usually done on a large scale, may be easily effected by the pharmacist with the use of a plaster iron. The thirteen official Plasters may be divided into—(1) Lead Plasters; (2) Pitch and Gum-Resin Plasters, and (3) Isinglass Plaster. (1) The most important plasters are made from Lead Plaster, or Lead Plaster mixed with Resin, the official Resin Plaster. Percentage or Emplastrum— Parts in 100. Plumbi (Diachylon) .... olive oil 60; lead oxide 32 mix, and add to water 10 Boil the mixture until the reaction has ceased and the plaster is of the right consistence, replacing water lost by evaporation from time to time. Resinae (Adhesive)......yellow wax 6 ; resin 14 lead plaster 80 Saponis..........lead plaster 90; soap 10 From these the following are prepared: Emplastrum— Arnicas.....resin plaster 67; extract arnica root 33 Belladonnas........ext. belladonna leaves 20 resin plaster, soap plaster, each 40 Capsici . . . resin plaster, oleoresin capsicum q. s. Hydrargyri, lead plaster 70; mercury oleate 1.2; mercury 30 Containing lead plaster and pitch : Emplastrum— Ferri (Strengthening) . . . olive oil, 5 ; ferric hydrate 9 Burgundy pitch 14; lead plaster 72 Opii . Burgundy pitch 18 ; lead plaster y6; ext. opium 6 Picis Cantharidatum (Warming) . . . Burgundy pitch 92 cerate cantharides 8 (2) Pitch and Gum Resin Plasters: Emplastrum— Ammoniaci cum Hydrargyro .... oleate mercury 0.8 mercury 18 ammoniac 72; dil. acetic acid, lead plaster, to 100 Picis Burgundicae.....olive oil 5 ; yellow wax 15 Burgundy pitch 80 124 A TEXT-BOOK OF MATERIA MEDICA. (3) Isinglass plaster (Emplastrum Ichthyocollae; Court-plaster). —A solution of 10 Gm. Isinglass is dissolved in hot Water 120 Gm.; one-half of the solution is spread upon silk (taffeta) in suc- cessive layers, and when dry the other half of the solution is spread on in a similar manner, after first having been mixed with Alcohol 40 Gm., Glycerin 1 Gm. The taffeta is then coated on the reversed side with Tincture of Benzoin to make it waterproof and antiseptic. Unofficial Plasters of the National Formulary. Emplastrum— Ammoniaci (U. S. P. 1880).—Gum-resin Ammoniac with Acetic Acid. Aromaticum (Spice Plaster).—Consisting of Cloves, Cinna- mon, and Ginger, each, 10 per cent; Capsicum and Cam- phor, each, 5 per cent. Asafcetida (U. S. P. 1880).—Asafcetida 35 p.; Galbanum 15 p.; with Lead Plaster. Fuscum Camphoratum (Matris Camphoratum, Ph. Ger.).— Camphorated Mother's Plaster. A plaster similar to lead plaster, and containing camphor, 1 per cent. Galbani (U. S. P. 1880).—Galbanum Plaster. Picis Canadensis (U. S. P. 1880).—Canada Pitch Plaster. Picis Liquida Comp.—A mixture of Resin and Tar, with Podo- phyllum, Phytolacca, and Sanguinaria, of each, 10 per cent. CHARTS—PAPERS. There are two Papers official. One is made by saturating strips of white unsized paper in a 20 per cent, solution of Potassium Nitrate and drying; the other is paper coated with Mustard, used similarly to the Plasters : Charta Potassii Nitratis .... potass, nitrate 20; water 80. Vapors from incineration as inhalant. Charta Sinapis . . oil-free black mustard, 4 Gm. in 60 sq. cm. The Mustard is freed from the fixed oil by extraction with Ben- zin, and mixed with a solution of India Rubber in equal volumes of Benzin and Carbon Disulphide, and spread upon Paper. This is the well-known Mustard Plaster or Mustard Paper. When applied, the paper should be immersed in lukewarm water for a few minutes, in order to render the vesicating principle active. Charta Cantharidis, U. S. P. 1880.—Cantharidis Paper (Blis- tering Paper). PREPARATIONS FOR EXTERNAL USE. 125 Poultice or Cataplasm (Lat. Cataplasm, -atis).—A coarsely ground substance or mixture of substances, such as flaxseed or elm-bark, made into a mass with hot water or some other liquid, spread upon cloth or filled into porous bags, and applied to the body while hot. Fomentations (Lat. Fomentum, -i).—Porous woollen cloths sat- urated with hot infusion or decoction of herbs, or other hot liquids or lotions, and applied hot. Spongiopiline.—A thick cloth covered with layers of sponge for the saturation and retention of medicinal agents intended for absorption, the exterior being composed of waterproof material, such as rubber. Plaster-Mull.—A thin cloth made impervious with rubber or gutta-percha tissue, upon which is spread or painted medicinal agents in the liquid form, intended for local application. Caustics or Escharotics (Lat. Escharotica, -at).—Substances used to destroy tissue by chemical action or by heat, either semi- solid mixtures made into a paste with starch or other diluent, or chemicals fused and moulded into sticks called pencils or " crayons " (Lat. stilus, -i), to be applied directly to the skin. Moxa is the name given to small cones of combustible substances which upon incineration do not inflame, but give off an intense heat, used for cauterization when heat is desired. Bandages; Antiseptic Dressings.—The material used for bandages is cellulose in various modifications, such as cotton, linen, jute, and other fibrous substances. Aside from the me- chanical support afforded, bandages also serve to keep wounds clean by absorbing and withdrawing secretions (pus) which would otherwise prove irritating, and by protecting them against extrane- ous matter serve to promote the healing process. These various substances may be used either plain or medi- cated, when they are called antiseptic. Gossypium Purificatum, U. S. P.; Absorbent Cotton.—The hairs of Gossypium herbaceum L., freed from oil and resinous substances by treatment with alkalies and bleaching agents. These hairs rep- resent microscopic ducts in which liquids are absorbed through capillarity. The freer from oily constituents, the more readily will watery liquids be taken up and retained ; hence the absorbability of cotton depends upon its purity. This is equally true with all other bandage material. Linen in the form of thin sheets, known as Muslin or Muslin- 126 A TEXT-BOOK OF MATERIA MEDICA. gauze, or purified similarly to cotton, when it is called Lint, is made from the bast-fibres of the Linum usitatissimum L., Flax. Hemp and Jute are the bast-fibres of their respective plants. Medicated Dressings.—These are made by saturating the ma- terial or vehicle in a solution of certain strength of the medicinal agent, or incorporating the latter in powdered form. In the appli- cation of a dressing which has been rendered aseptic or antiseptic by impregnating it with Phenol (Carbolic Acid), Salicylic Acid, Mercuric Chloride, or similar agent, it is desired to bring in con- tact with the wound a solution of certain strength—for example, a 5 or IO per cent, solution of Phenol, a -^ or -^ of i per cent. solution of Mercuric Chloride, etc. The quantity of material which conveys the agent is of no consequence, as the fabric simply serves as a vehicle for the medicinal or antiseptic agent. The strengths of such dressings should therefore be designated by the percentage- strength of the solutions by which they are saturated, rather than by the percentage by weight of the medicinal agent the finished dress- ing may contain. In dressings of antiseptic agents that are usually applied in sub- stance, such as Boric Acid and Iodoform, the percentage-amount actually contained by weight in the finished dressing should be stated. Here the use of a vehicle is only a matter of convenience, and it is desirable to know just how much of the medicinal agent is contained in a certain quantity by weight or by area of the dressing. Medicated Cottons.—Purified cotton is saturated in a solution in Water, or Glycerin and Water, of the strength desired of the medicinal agent, and thoroughly expressed. The following are the usual strengths : Percentage. Gossypium Boratum...........acid boric 5 or 10 Carbolatum..............phenol 5 or 10 Iodoformatum ...........iodoform 10 to 20 Salicylatum...........acid salicylic 10 to 20 Stypticum.........Monsel's solution Sublimatum........mercuric chloride -fa to -fa Iodoform, being insoluble in Water, should be dissolved in Ether or, preferably, in a mixture of Alcohol and Glycerin. Medicated Gauzes; Carbasa.—The material used for making Medicated Gauzes is a muslin gauze free from sizing or other ex- traneous matter. The gauze is thoroughly impregnated with the PREPARATIONS FOR EXTERNAL USE. 127 solution of the particular strength required, then forcibly expressed, after which it is ready for use; or, if desired for future use, it should be tightly rolled, wrapped in parchment paper, and kept in closely covered boxes in a cool, dry place. The following are the most commonly used Gauzes and their strengths : Percentage. Carbasus Boratum.............acid boric 5-10 Carbolatum...............phenol 5-10 Iodoformatum.............iodoform 10-20 Salicylatum............acid salicylic 10-20 Sublimatum..........mercuric chloride ^-^ The Iodoform Gauze is made in the same way as the Cotton, by saturation with a solution of Iodoform in Alcohol and Glycerin. All the others, except the Mercurial Gauze, contain Glycerin. Mercuric Chloride is dissolved in Water with a little Acid Tartaric (5 parts for 1 of Mercuric Chloride), the presence of which in the Gauze prevents the formation of insoluble albuminate of mercury when it is brought in contact with the albuminous discharges from wounds. Plaster-of-Paris bandages are made by thoroughly incorpo- rating Calcium Sulphate (gypsum) into linen bandages. When applied, the bandage, after being dipped in water, sets hard and firm in a few minutes. CLASS I.-DISEASE MEDICINES. DIVISION I.—RESTORATIVES. GROUP I.—DIGESTANTS. [In the present work care has been taken to designate the proper pronunciation [Foster) of the names of drugs and their preparations common to Materia Medica and Therapeutics. The simplest and most efficient method appears to be that herein fol- lowed—namely,* to indicate accent and quantity by a single sign; for example, Pep- slnum (nom.)—Pepsini (gen.), in which the i is long and the accent upon the second syllable; Cocculus—Cocculi, in which the o is short and the accent upon the first syllable. In nearly all cases the genitive, as used in prescription-writing, and the English equivalent, are given. When the accusative, not genitive, is .adopted, the usage is marked by "(ace.)"; as Pilulae, Pilulas (ace), etc.] Pepsinum—Pepsini—Pepsin. IT. S. JP. Origin.—A proteolytic ferment or enzyme obtained from the glandular layer of fresh stomachs from healthy pigs, and capable of digesting not less than 3000 times its own weight of freshly coagulated and disintegrated egg albumen when tested by the process given in the United States Pharmacopoeia. Description and Properties.—A fine white, or yellowish-white, amorphous powder, or thin, pale yellow, or yellowish, transparent or translucent grains or scales, free from offensive odor, and having a mildly acidulous or slightly saline taste, usually followed by a suggestion of bitterness. It slowly attracts moisture when exposed to the air. Soluble, or for the most part soluble, in about 100 parts of water, with more or less opalescence; more soluble in water acid- ulated with hydrochloric acid; insoluble in alcohol, ether, or chlo- roform. Pepsin usually has a slightly acid reaction. It may be neutral, but should never be alkaline. Dose.—5-60 gr. (0.3-4.0 Gm.). 9 129 13° A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Pepsinum Saccharatum—Pepsini Saccharati—Saccharated Pepsin. Formula: Pepsin 10, Sugar of Milk 90 parts. Dose, 30 gr.-4 dr. (2.0-16.0 Gm.). Antagonists and Incompatibles.—Tannic and gallic acids are incompatibles. Mineral salts, alcohol, and alkalies precipitate pep- sin from solution, the two latter impairing its digestive property, The " Wine of Pepsin " is therefore unreliable. Synergists.—Diluted hydrochloric, lactic, acetic, and citric acids increase its digestive action. Physiological Action.—Its only influence seems to be upon the digestive system. Pepsin is a typical restorative, being a normal Constituent of the gastric juice, and in the presence of hydrochloric acid digesting the nitrogenous elements of the food, converting them into peptones or albumoses. Therapeutics.—Externally and Locally.—Its digestive action is utilized to dissolve or digest the false membrane in diphtheria and croup. A solution of pepsin has also been injected into the blad- der to digest blood-clots. It has been further recommended as an application to cancer of the cervix uteri. Internally.—As a restorative, where there is a lessened secre- tion of gastric juice, atonic dyspepsia, apepsia of infants, cancer of the stomach, and gastric ulcer, pepsin has proved serviceable. It is also employed to favor digestion in convalescence from acute and long illness. It is frequently necessary to give pepsin, or " pepton- ized milk," in acute dyspeptic diarrhea of infants. Administration.—Pepsin should be given in powder or dis- solved in glycerin (Glycerol of Pepsin), or in water acidulated with hydrochloric acid, directly after meals. The drug should not be given continuously for too long a period, lest the function of the stomach become impaired from disuse, the artificial digestion having replaced the natural, normal process. Unless there be some direct indication for its use, rather than give pepsin it is better to stimulate the gastric glands to secrete a larger amount of their normal juice, that they may not lie idle, and their function be consequently impaired by disuse. Hydro- chloric acid administered with pepsin probably slightly promotes glandular activity. Often, however, pepsin must be given, and in certain cases the stomach is in such a condition that nutrient en- emata must be administered. Yet, since the rectum possesses very DIGESTANTS. J3i feeble powers of digestion, the food should always be predigested. Suppositories of peptonized meat are frequently used for this purpose. Pancreatlnum—Pancreatini—Pancreatin. V. S. I*. Origin.—A mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog. Description and Properties.—A yellowish, yellowish-white, or grayish amorphous powder, odorless, or having a faint, peculiar, not unpleasant odor, and a somewhat meat-like taste. Slowly and almost completely soluble in water, insoluble in alcohol. Pancreatin digests albuminoids and converts starch into sugar. Prolonged contact with mineral acids renders it inert. Dose.—10-20 gr. (0.6-1.2 Gm.). Antagonists and Incompatibles.—Mineral acids. Synergists.—Alkalies and the digestive ferments. Physiological Action.—The four ferments which it contains render it capable, in alkaline media, of digesting albuminoids; emulsifying fats and oils, and resolving them into fatty acids and glycerin; converting starch into sugar; and curdling milk. Therapeutics.—Like pepsin, it is used as an artificial agent in certain disorders of digestion. Administration.—It may be given dry, in powder, capsules, or compressed pills, or in solution. It should be administered in combination with an alkali, as the activity of pancreatin is de- stroyed by acids, and should be given ordinarily from two to four hours after meals, when the chyme has entered the intestine. It may also be administered immediately after eating or with the food, since there is an interval of from fifteen minutes to half an hour after the ingestion of food before the stomach-contents are ren- dered sufficiently acid by the gastric juice to interfere with the activity of the pancreatin. For rectal nourishment pancreatin is preferable to pepsin, be- cause of its superior action in predigesting food. Papain, Papoid, or Papayotin. Origin.—The inspissated juice of the unripe fruit of Carica Papaya. Description and Properties.—A whitish, slightly astringent powder, soluble in water. 132 A TEXT-BOOK OF MATERIA MEDICA. Dose.—1-8 gr. (0.06-0.5 Gm.). Antagonists and Incompatibles.—Tannic and gallic acids. Lead salts and alcohol are incompatible with papain. Synergists.—The digestive ferments. Physiological Action.—In this it resembles pepsin, though dif- fering from the latter, as well as from pancreatin, in that it is equally active in neutral, alkaline, or acid media. It converts pro- teids into soluble peptones, and acts as a stimulant to the gastric glands. It converts starch into maltose, and upon false membranes acts more energetically than pepsin. It dissolves intestinal worms. Therapeutics.—Externally.—The uses of papain are more mani- fold than those of the digestive ferments previously mentioned. Like pepsin, it has been successfully employed to dissolve false membrane in diphtheria and croup. The juice of pineapple, which possesses a ferment (bromelin) similar to that of papain, is a val- uable domestic remedy in these diseases. Papain has been used with some benefit in indurated eczema and in syphilitic ulcerations of the tongue. It has been highly recommended by Johnston as a solvent of cerumen: 15 drops (1.0 Cc.) of a solution of 20 grains to 1 oz. (1.2 Gm-30 Cc.) of distilled water are dropped into the outer meatus, and the parts syringed an hour afterward with a solution of boric acid. Internally, papain may be used for the same purposes as pepsin and pancreatin; yet, while theoretically superior, it is practically inferior to them, fortunately not having supplanted them in actual practice. Administration.—When used to aid digestion, papain should be given after meals, either in powders, capsules, compressed tablets, or aqueous solution freshly prepared. GROUP II.—FATS AND OILS. Oleum Morrhuae—Olei Morrhuse—Cod Liver Oil. U. S. P. Origin.—A fixed oil obtained from the fresh livers of Gadas Morrhua L. and other species of Gadus. Description and Properties.—A pale-yellow, thin, oily liquid, having a peculiar, slightly fishy, but not rancid odor, and a bland, slightly fishy taste. Specific gravity 0.920 to 0.925 at 150 C. (590 F.). Scarcely soluble in alcohol, but readily soluble in ether, FATS AND OILS. 133 chloroform, or carbon disulphide, also in 2.5 parts of acetic ether. It contains several glycerides, the principal one being olein, traces of iodine, bromine, chlorine, biliary salts, phosphoric and sulphuric acids, a peculiar principle (gaduin), and several alkaloids. Morrhuol, a name given by Chapoteaut to a mixture of the various alkaloids and important principles of cod liver oil, occurs as an amber-brown, bitter, aromatic liquid. Dose.—1-4 fluidrachms (3.8-15 Cc). Physiological Action.—Externally and Locally.—It possesses emollient properties, and may be applied to the skin and mucous membranes without causing irritation. It slightly reduces tempera- ture in fever when applied to the body. Internally.—Fat is a normal and necessary constituent of the body. It is the fuel used to supply force, and those tissues and organs which are the most energetic require the most fat. Conse- quently, nerves, muscles, and glands are more abundantly fur- nished with fat than cartilage, and in cases of starvation those structures demanding the greater supply must have it, at the ex- pense of the less highly organized and active tissues—as is seen in the great emaciation preceding the decline of mental powers. The blood contains about one-half of 1 per cent, of fat; the muscles, 3 per cent.; the brain, 8 per cent.; and the nerves 22 per cent, In order, therefore, that the various cells of the body may possess sufficient vitality to withstand by physiological resistance the en- croachments of disease and the invasion of pathogenic micro-or- ganisms, this equilibrium must be maintained. Yet this Tiecessary food, fat, is more frequently deficient than any other, from the difficulty either of obtaining a supply or of digesting and assimi- lating it. Dr. Hughes Bennett was near the truth in observing that " the main causes of tuberculosis are the dearness of butter and the abundance of pastry-cooks," intimating that the poor and underfed are unable to obtain sufficient fat, while the digestion of the wealthy class is deranged by pastries, so that they are unable to assimilate a proper amount of fat. Dr. Brunton cites the case of a barrister who before pleading a case invariably took a full dose of cod liver oil, believing that it rendered his mind more active. Before oils or fats can enter the various cells and act as food, and consequently a source of power, they must be digested and assimilated by the system. The value of an oil is based upon—(1) 134 A TEXT-BOOK OF MA TERIA MEDICA. Its rate of absorption; (2) its rate of oxidation; (3) its agreeable taste. Cod liver oil, while to many persons repugnant in taste, is more readily absorbed and oxidized than any other fat. It has already been prepared by the liver, and therefore partly elaborated, and, owing to the biliary salts which it contains, it passes more readily through animal membranes. Moreover, Naumann has shown that cod liver oil is more easily oxidized than any other oil, rendering this substance almost an ideal ready-made food. Its actions upon the several systems are here considered. Digestive System.—Large doses disturb the stomach and may even occasion vomiting, but in medicinal doses alone, or in the form of an emulsion, it may be taken usually without discomfort, in some cases even increasing the appetite. In the stomach cod- liver oil is unaffected, but in the intestines it meets the pancreatic juice, which resolves a portion of it into glycerin and fatty acids, the latter combining with the alkalies of the bile and the intes- tinal juice to form soaps, while the remaining, and larger, por- tion is emulsionized by the alkaline secretions of the intestines. Circulatory System.—The number of red corpuscles is increased and the quality of the blood is greatly improved. Nervous System.—This shares with the other tissues of the body the general amelioration, the drug being a food and tonic to the brain and nerves. Respiratory System.—No special action is noticeable other than the natural improvement in the respiratory power incidental to better blood and an increased functional activity of the nerves and muscles. Absorption and Elimination.—Cod liver oil can be absorbed only after it enters the intestines. The glycerin and fatty acids formed by the pancreatic juice, having a great affinity for water, readily diffuse through the mucous membrane; the soaps produced by the action of the bile and the intestinal juice are also readily ab- sorbed by osmosis. The oil remaining, as has been stated, is emulsionized—that is, it is subdivided into minute globules each enclosed in an envelope composed of alkaline albuminate and soap, which has a great affinity for the mucous membrane and carries the oil through the columnar epithelium of the intestinal villi into the lymph-spaces. The osmosis inward of the oil-emulsion is rendered still easier by the action of the bile with which the mucous membrane is bathed. FATS AND OILS. *35 Oils and fats which are absorbed and not needed for cell-food are deposited beneath the skin as subcutaneous fat, serving as a protection against external cold as well as a reserve supply in case the economy needs more fat than can be taken into the system and assimilated. The weight, therefore, is usually greatly increased under the administration of cod liver oil. It will be seen that much of the oil taken into the system is oxidized, being subsequently excreted as carbonic acid and water. Temperature.—When taken internally the temperature is unaf- fected, but, as has been observed, when applied to the epidermis the bodily heat is reduced. Untoward Action.—In addition to disturbances of digestion sometimes occasioned by moderate doses, cod liver oil at times produces a vesicular eczema which may spread over the entire body. This eruption is probably caused by the volatile fatty acids which the oil contains. Poisoning.—Cod liver oil possesses no poisonous action. Therapeutics.—Externally and Locally.—Cod liver oil is much used by dermatologists in diseases of the skin, being especially ser- viceable in softening the crusts of eczema. It has been applied to the skin to allay irritation and for the reduction of temperature in the exanthemata. In cases of marasmus and rachitis, and in wasting diseases generally, it is a valuable remedy to sustain the vital energy and improve nutrition, the oil being given in the form of baths. Daily inunctions are beneficial in chronic scaly skin diseases, while a local application to the chest has seemed at times to influ- ence favorably the course of pertussis. Local applications have also been adopted empirically, and with satisfactory results, in chronic rheumatism and rheumatoid arthritis. Internally.—For two or three centuries cod liver oil has been used both externally and internally for chronic rheumatism, but it is only since 1841 that it has been employed in the treatment of tuberculosis. While to-day it does not receive the enthusiastic support which attended its introduction in the latter disease, it is nevertheless a standard and highly efficacious remedy in the various forms of the disorder. It is equally valuable in scrofulous affections, and even more potent in rachitis. Chronic bronchitis is perhaps more frequently relieved by its use than by any other internal remedy. Diseases resulting in anemia are usually more benefited by cod liver oil than by other remedial agents. Chronic arthritis, 136 A TEXT-BOOK OF MATERIA MEDICA. fistula, and abscess in the neighborhood of the joints have been greatly improved by its use. Atheroma of the arteries and many cutaneous diseases, particularly the strumous variety, and syphilo- dermata yield to its alterative and nutrient properties. Probably no single drug is employed in nervous diseases with effects so markedly beneficial as those of cod liver oil. While possessing no specific action, it increases the strength and vitality of the patient, enabling him to resist morbid tendencies more suc- cessfully, and, by augmenting the force-producing material and improving the condition of the nerves, lessens the liability to nervous derangement. Diabetes mellitus and Bright's disease, with anemia yet unat- tended by marked digestive disturbance, are decidedly improved by the administration of cod liver oil. Should no gastric disorder supervene, this remedy should invari- ably be given in the last-named diseases. It certainly serves to maintain the general health, and is singularly efficacious in pro- longing the lives of the afflicted patients, enabling them to profit by hygienic measures, upon which great reliance should be placed. The tonic and nutritive properties of the drug have been strikingly shown in the rapid improvement of patients convalescing from acute diseases. In catarrhal conditions, especially in ozena and otitis following measles and scarlet fever, it is of marked benefit. Without entering upon specific considerations other than the above, it will be seen that cod liver oil is indicated whenever there is defective activity, whether inherited or acquired. Contraindications.—It is to be remembered that cod liver oil is a food and not a medicine: it is therefore contraindicated in all diseases where it proves detrimental to the appetite, causing eruc- tation, heartburn, diarrhea, etc. It is usually contraindicated in fevers, owing to the suspension of the secretions and impairment of digestion characteristic of acute febrile disorders Administration.-In the early use of cod liver oil it is advis- able to prescribe small doses, that its toleration by the stomach may be gradual y acquired. To many patients, however, it is ex- remely distasteful, and the repugnance is increased rather than lessened by continued use. In such cases it is better, if possible, to disguise the taste and smell in some manner rather than to abandon so valuable a remedy when clearly indicated. Various means have been employed for this purpose. An emulsion may be made which obviates its disagreeable qualities. There are in MINERAL ACIDS. 137 the market soft capsules containing this oil that serve an excellent purpose, being easily swallowed and disguising completely the taste and odor of the drug. Administration should occur ordi- narily some time after meals, that the oil may reach the intestines as soon as possible. GROUP III.—MINERAL ACIDS. Mineral Acids are classed here as Restorative Medicines, be- cause three secretions of the body—the perspiration, urine, and gas- tric juice—are normally of acid reaction, the last-named on account of its acidity to hydrochloric acid. Sulphuric and nitric acids are not normal constituents of the body, and are by some authors classed as astringents, although the action and medical uses of these inorganic acids will here be considered. There are, however, certain characteristics common to all mineral acids which claim pri- mary attention: 1. Concentrated mineral acids are caustic to a greater or less degree. 2. They combine with alkalies and alkaline earths to form salts, and unite with vegetable acids, setting them free from their com- bination with bases. 3. When in contact with the tissues of the body they combine with the protoplasm, neutralizing the alkalies which the latter con- tains and forming mineral salts. They also combine with the albu- min, forming acid albumin. 4. Upon the blood they precipitate the albuminous constituents and decompose the hemoglobin. 5. Acids stimulate the secretion of alkaline glands—salivary, duodenal, pancreatic, and hepatic. On the other hand, they depress the secretion from acid glands—gastric, sudoriparous, etc. 6. Mineral acids reduce the formation of urea, preventing the conversion of retrograde products into this substance. 7. They diminish the functional activity of the muscular and nervous systems. Applied locally in a concentrated form, or taken internally in poisonous doses, they tend to produce rigidity of the muscles by coagulating the myosin. 8. The alkalinity of the blood is lessened and the activity of the urine increased by the internal administration of all mineral acids save nitric, the great amount of nitrogen which the latter contains being converted into ammonia, an alkali. 138 A TEXT-BOOK OF MATERIA MEDICA. Acidum Hydrochloricum—Acidi Hydrochloric!— Hydrochloric Acid. 77. 8. I*. (Muriatic Acid.) Origin.—A liquid composed of 31.9 per cent, by weight of Abso- lute Hydrochloric Acid (HCL = 36.37) and 68.1 per cent, of Water. Description and Properties.—A colorless, fuming liquid, of a pungent odor and an intensely acid taste. Fumes and odor disap- pear on diluting the acid with 2 volumes of water. Specific grav- ity about 1.163 at 150 C. (590 F.). Miscible in all proportions with water and alcohol. Hydrochloric acid should be kept in dark,. amber-colored, glass-stoppered bottles. Dose.—25 minims (0.12-0.3 Cc), well diluted. Official Preparations. Acidum Hydrochloricum Diliitum—Acidi Hydrochlorici Diluti—Diluted Hydrochloric Acid (Diluted Muriatic Acid).—Dose, 10-20 minins (0.6-1.2 Cc). Formula: Hydrochloric Acid, 100; Distilled Water, 219. Sp. gr. about 1.050. Acidum Nitrohydrochloricum —Acidi Nitrohydrochlorici—Nitrohydro- chloric Acid.—Dose, 2-5 minims (0.12-0.3 Cc), well diluted. (Described under Nitric Acid.) Acidum Nitrohydrochloricum Diliitum—Acidi Nitrohydrochlorici Diluti —Diluted Nitrohydrochloric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). (Described under JVilric Acid.) Acidum Phosphoricum—Acidi Phosphorici— Phosphoric Acid. 77. S. I*. Origin.—A liquid composed of not less than 85 per cent, by weight of Absolute Orthophosphoric Acid (H3P04 = 97.8) and not more than 15 per cent, of Water. Description and Properties.—A colorless liquid, without odor, but having a strongly acid taste. Specific gravity not below 1.710 at 150 C. (590 F.). Miscible in all proportions with water or alco- hol. Phosphoric acid should be kept in glass-stoppered bottles. Dose.—The diluted acid only is given internally. Official Preparation. Acidum PhosphSricum Dilutum-Acidi PhosphSrici Diluti (Diluted Phos- phoric Acid).—Dose, 5-25 minims (0.3-1.5 Cc). Diluted phosphoric acid contains 10 per cent, by weight of absolute orthophosphoric acid. Acidum Sulphuricum—Acidi Sulphurici—Sulphuric Acid. XT. 8. I*. Origin.—A liquid composed of not less than 92.5 per cent, by MINERAL ACIDS. J39 weight of Absolute Sulphuric Acid (H2S04 = 97.82) and not more than 7.5 per cent, of Water. Description and Properties.—A colorless liquid of oily con- sistence, inodorous, and very caustic and corrosive. Specific gravity not below 1.835 at 150 C. (590 F.). Miscible in all proportions with water and alcohol, with evolution of so much heat that the mixing requires great caution. Sulphuric acid should be kept in glass-stoppered bottles. Dose.—2-5 minims (0.12-0.3 Cc), well diluted. Official Preparations. Acidum Sulphuricum Aromaticum—Acidi Sulphurici Aromatici—Aro- matic Sulphuric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). Formula: Sulphuric Acid, 100; Tincture of Ginger, 50; Oil of Cinnamon, 1; Alcohol, to make 1000 parts. Acidum Sulphuricum Diliitum—Acidi Sulphurici Diluti—Diluted Sul- phuric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). Diluted sulphuric acid contains 10 per cent, by weight of absolute sulphuric acid. Acidum Nltricum—Acidi NItrici—Nitric Acid. U. S. P. Origin.—A liquid composed of 68 per cent, by weight of Abso- lute Nitric Acid (HNOs = 62.89) anc^ 32 per cent, of Water. Description and Properties.—A colorless, fuming liquid, very caustic and corrosive, and having a peculiar, somewhat suffocating odor. Specific gravity about 1.414 at 150 C. (590 F.). Nitric acid should be kept in dark, amber-colored, glass-stoppered bottles. Dose.—2-5 minims (0.12-0.3 Cc), well diluted. Official Preparations. Acidum Nltricum Diliitum—Acidi Nitrici Diluti—Diluted Nitric Acid.— Dose, 5-20 minims (0.3-1.2 Cc). Diluted nitric acid contains 10 per cent, by weight of absolute nitric acid. Acidum Nitrohydrochloricum —Acidi Nitrohydrochlorici —Nitrohydro- chloric Acid.—Formula: Nitric Acid, 180; Hydrochloric Acid, 820 parts. Description and Properties.— A golden yellow, fuming, and very corrosive liquid, having a strong odor of chlorine. Completely volatilized by heat. It readily dissolves gold-leaf, and a drop of it added to potassium iodide T. S. liberates iodine. Dose.—1-3 minims (0.06-0.18 Cc). Acidum Nitrohydrochloricum Diliitum—Acidi Nitrohydrochlorici Diluti— Diluted Nitrohydrochloric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). Formula: Nitric Acid, 40; Hydrochloric Acid, 180; Distilled Water, 780 parts. Antagonists and Incompatibles.—Hydrochloric acid and its preparations are incompatible (forming explosive compounds) with 140 A TEXT-BOOK OF MATERIA MEDICA. oxidizable substances—phosphorus, sulphur and the sulphides, alcohols, ethers, carbohydrates, etc. All the mineral acids are in- compatible with the alkalies and their carbonates, salts of lime, lead, and silver, and decompose glucosides. Synergists.—The action of hydrochloric acid upon the digestive system is aided by the digestive ferments and the vegetable bitters. Physiological Action.—The general action of mineral acids upon the various systems is herewith given in detail: Externally and Locally.—Applied in a concentrated form to the skin or to any tissue of the body, acids abstract the water from the tissues and destroy the protoplasm, acting as escharotics. Weaker solutions vesicate, merely inflaming the parts to which they are applied, without destroying the tissue, while extremely diluted or weak solutions are irritant and astringent. Internally.—Digestive System.—Diluted acids only should be administered internally. Save with reference to the poisonous effects of concentrated acids, therefore, the physiological action of diluted acids only will be here considered. The salivary glands are stimulated, resulting in an increased flow of saliva, moistening the mouth and allaying thirst. The appetite and digestion are improved, and the secretions from the liver and the duodenal glands are increased. Long-continued use of the mineral acids impairs digestion by lessening the normal secretion of the gastric glands, while protracted use may produce salivation. Mineral acids tend to constipate the bowels. Circulatory System.—Diluted acids act as general astringents, narrowing the caliber of the blood-vessels, increasing the heart's action, and raising arterial tension. Concentrated acids relax the muscular tissue of both the heart and blood-vessels. Mineral acids combine with the albumin or the alkaline bases of the blood, less- ening the alkalinity of that fluid. Nervous System.—Medicinal doses, so far as observed, produce no special action upon the nervous system other than to occasion a slight stimulation of the brain, due probably to a gentle arterial excitement. Respiratory System.—No important action under medicinal doses has been observed. Absorption and Elimination.—Mineral acids, above all hydro- chloric acid, possess high diffusive power. They are quickly con- verted into neutral salts in the intestines, and are absorbed as such. That portion of the acid which does not enter into combination in MINERAL ACIDS. 141 the stomach and intestines rapidly diffuses into the blood, combin- ing with either its alkaline bases or its albumin. When, however, the acid is eliminated by the excretory glands, the albumin remains in the blood, while the acid is expelled in union with other bases, acting as an astringent at the points of elimination. Temperature.—Medicinal doses have no influence upon temper- ature. Untoward Action.—Mineral acids under too prolonged admin- istration impair the appetite and disturb digestion, occasioning toothache and gastric oppression, and at times salivation and diar- rhea. The prolonged use of nitric acid may produce erosion of the gums and tongue, with loosening of the teeth. Poisoning.—The mineral acids when taken in a concentrated form and in toxic doses act like corrosive poisons, causing intense burning in the stomach and intestines and active gastric inflamma- tion. Violent vomiting occurs, the ejected matter containing blood, and, in the case of hydrochloric acid, a white cloud of ammonium chloride is discerned if the ejecta be placed near the vapor of ammonia. The respiration is greatly depressed, and there is a strong, persistent acid taste in the mouth, the mucous membrane of which is discolored, while the tongue is swollen and inflamed. There is great thirst, and the pulse becomes rapid and tense. The temperature, at first elevated, soon falls below normal, pro- found prostration supervening, and death resulting either from shock or from secondary inflammation. A post-mortem examination shows the results of corrosive poi- soning: ulceration or evidences of intense inflammation of the mucous membrane of the mouth, esophagus, stomach, and intes- tines. Occasionally the walls of the latter are perforated. Should death be delayed for some time, there is found fatty degeneration of the kidneys and other internal organs. Treatment of Poisoning.—This should be prompt. The cautious administration of alkalies is indicated to neutralize the acid, though the evolution of carbonic-acid gas resulting therefrom may rupture the stomach. The stomach should be washed out, and this treat- ment followed by demulcent drinks and oil, milk, and eggs. Opium may be necessary for the relief of pain, and brandy or whiskey subcutaneously in case of collapse. Therapeutics.—Externally and Locally.—Hydrochloric acid is employed as a caustic in noma and putrid sore throat. Mixed 142 A TEXT-BOOK OF MATERIA MEDICA. with two or three parts of honey, it is an efficient application to the throat in diphtheria. Andrews and Morris have recommended diluted hydrochloric acid for the removal of sequestra, and Chas- saignac has utilized the acid in removing necrosed bone in osteitis and caries. Nitric acid is a much more powerful caustic, and as such is used more extensively than any other mineral acid, because of its limited action and the ease with which it is controlled. It is an excellent caustic in cases of cancer of the cervix, venereal zuarts, hospital gangrene, phagedenic ulceration, hemorrhoids, and prolapse of the rectum, especially in the case of children. In cases also of fungoid granulation and excessive hemorrhage from the uterus it has been highly recommended. In certain diseases of the throat, nose, and ear this acid has been used for the destruction of growths, as well as for its escharotic action in ulcerated conditions. Dermatologists find nitric acid to be an efficient application for the removal and destruction of epithelioma, moles, ncvi, chloasma, etc., caution being exercised in the latter case merely to produce an exfoliation of the skin, not sufficient destruction of tissue to result in a cicatrix. Liveing recommends a veiy weak solution of nitric acid with tincture of opium in pruritus. Phosphoric acid, in the strength of 50 grains (3.2) to the ounce (30.0 Cc.) of distilled water, has been suggested by Grossich in the treatment of scrofulous ulcers, and an injection of this solution into tuberculous glands of the neck is highly recommended by the same authority. Sulphuric acid is perhaps the most persistent, irritating, and destructive caustic known. Its affinity for water, and its consequent extensive action, render it when used alone unfit for caustic pur- poses. Mixed with powdered charcoal, however, it forms a paste which is an efficient caustic application to chancres, cancers, etc. Frazer considers the strong sulphuric acid the best caustic in the bites of rabid animals. Diluted solution, in the proportion of 6 parts of the strong acid to 4 parts of diluted alcohol, has been recommended for epistaxis. Internally.—Hydrochloric acid, being a normal constituent of the stomach, is indicated in certain forms of gastric dyspepsia, par- ticularly in the atonic variety. In these latter cases there is usually decomposition and fermentation of food, which condition is greatly MINERAL ACIDS. 143 relieved by the administration of pepsin or hydrochloric acid after meals, or the same with bitters before meals. In intestinal indigestion hydrochloric acid is an admirable rem- edy, given one or two hours after meals. The diluted hydrochloric acid is a valuable internal remedy in the treatment of diphtheria, and during the course of fevers, par- ticularly typhoid. As a routine treatment in the latter disease the author almost invariably gives hydrochloric acid in connection with pepsin, finding that it not only allays thirst and moistens the tongue, but exerts an antiseptic influence in the bowels, thereby lessening the danger of auto-infection and relapse. Alkiewicz recommends weak solutions of hydrochloric acid as efficacious in nausea and vomiting accompanying certain infectious diseases. In certain affections of the skin dependent upon deranged diges- tion hydrochloric acid often proves a potent remedy. Nitric acid has been used for the same purposes as hydro- chloric acid, although for digestive disorders it is inferior to the latter drug. In intermittent and periodical fevers, however, nitric acid is an efficient remedy. In hepatic disorders the diluted nitrohydrochloric acid deservedly holds a high place as a remedial agent, and the same remedy is frequently employed with success in chronic syphilis. In the conditions known as oxaluria and lit hernia nitric and nitrohydrochloric acids serve an excellent purpose. The invaluable preparation introduced by Dr. Hope in 1826, known as " Hope's camphor mixture "—a combination of nitrous acid, camphor-water, and tincture of opium—has never been sur- passed as a remedy in serous diarrhea. The aphonia of singers and public speakers is often relieved by the diluted nitric acid, certain cases of bronchitis being also bene- fited by the same remedy. Melancholia and the hypochondriasis of dipsomaniacs are some- times relieved by diluted nitrohydrochloric acid. Phosphoric acid has acquired some reputation as a remedy in anemia and as a tonic in wasting diseases and neurasthenia. Its value, however, is based more upon theory than upon the results of clinical observation. The experience of the author warrants the assumption that phosphoric is inferior to hydrochloric aoid in these conditions, its action being entirely due to increasing diges- tion and thereby improving nutrition. Probably phosphoric acid is superior to the other mineral acids 144 A TEXT-BOOK OF MA TERIA MEDICA. only in its action in diabetes, in which disease it certainly possesses a remarkable influence in diminishing thirst and lessening the secretion of urine. Sulphuric acid, in the author's opinion, is inferior to nitric or nitrous acid in serous diarrhea. It is nevertheless an invaluable, as well as an old and tried, remedy in cholera, the statistics furnished by the Insane Department of the Philadelphia Almshouse during an epidemic of this disease appearing to prove its efficacy. This remedy also deserves favorable consideration in the treat- ment of acute lead-poisoning. Moreover, in chronic lead-poisoning water acidulated with sulphuric acid makes an efficient prophylactic, and the remedy has also been suggested as a preventive of Asiatic cholera. Owing to its astringent and antiseptic properties this acid, par- ticularly the aromatic sulphuric acid, proves a good remedy in cer- tain cases of diarrhea. It is especially valuable in checking the sweating in phthisis. The same preparation has been found bene- ficial in hematemesis, as well as in intestinal and uterine hemorrhage. Where there is a tendency to dissolution of the blood, as in scurvy and purpura, sulphuric acid has proved valuable, and it has been recommended as an internal remedy in lichen, prurigo, and many itching diseases of the skin. Contraindications.—Acute inflammation of the stomach, rheu- matism, gout, and where the urine is excessively acid and of high specific gravity. Administration.—Only the diluted acids should be given in- ternally, and even these should be further diluted, and taken, if possible, through a glass tube, to prevent injury to the enamel of the teeth. They should not be administered for too long a period, and the first indication of untoward action, such as griping, diar- rhea, etc., is to be taken as a warning that the drug must be with- drawn. Acidum Lacticum—Acidi Lactici—Lactic Acid. U. 8. P. Origin.—An organic acid usually obtained by subjecting milk sugar or grape sugar to lactic fermentation. It is composed of 75 per cent, by weight of Absolute Lactic Acid (CHC3H503 = 89.79) and 25 per cent, of Water. Description and Properties.—A colorless, syrupy liquid, odorless, of a purely acid taste, and absorbing moisture on ex- MINERAL ACIDS. *45 posure to damp air. Specific gravity about 1.213 at 150 C. (590 F.). Freely miscible with water, alcohol, or ether; insoluble in chloroform, benzin, or carbon disulphide. Dose.—20-30 minims (1.2-1.8 Cc), diluted and sweetened. Official Preparation. Syrupus Calcii Lactophosphatis—S^rupi Calcii Lactophosphatis—Syrup of Calcium Lactophosphate.—Dose, 1-2 fluidrachms (3.7-7.3 C). Formula: Precipitated Calcium Carbonate, 25; Lactic Acid, 60; Phosphoric Acid, 36; Orange Flower Water, 25; Sugar, 700; Water, q. s. ad 1000. Antagonists and Incompatibles.—Alkalies and the salts of the mineral acids are incompatible with lactic acid. Synergists.—Pepsin, vegetable acids, hydrochloric acid, and sodium chloride. Physiological Action.—Externally and Locally.—Lactic Acid is a caustic to highly organized tissues, resembling the mineral acids in its local action. It dissolves false membrane to which it is applied. Internally.—Digestive System.—It is normally present in the stomach, especially during the digestion of carbohydrates. Its action on the digestive system does not differ materially from that of hydrochloric acid. Circulatory System.—Being absorbed from the stomach, it com- bines with bases in the blood, forming lactates which are rapidly converted into carbonates. In certain morbid conditions of the system, such as acute rheumatism, it is found free in the blood. Richardson has produced endocarditis in dogs by injecting lactic acid into the peritoneal cavity. Large doses decrease the normal alkalinity of the blood. Nervous System.—Large doses greatly depress the nervous sys- tem, frequently producing neuralgia and myalgia. Absorption and Elimination.—It is absorbed from the stomach, undergoes a change in the blood, and is eliminated by the kidneys, although, according to Lehmann, when large doses have been taken it is found in the urine unchanged; and we have BenzeHus and Scherer as authorities that lactic acid can be detected in the spleen and the muscular fluid and has been found in the exudates of puerperal fever. Untoward Action, Poisoning, and Treatment of Poisoning are similar to those of the mineral acids. Therapeutics.—Externally and Locally.—It has been used 10 146 A TEXT-BOOK OF MATERIA MEDICA. locally for the same purposes as the mineral acids, but it is thought by many clinicans to be superior to the latter in tubercu- lous ulceration. In the Hamburg General Hospital, Dr. Zippel has employed it with excellent success in the treatment of tubercu- lous fistulae. He inserted into the fistula rods made of lactic acid, gelatin, and menthol, enveloped with a thin layer of collodion. As a solvent of false membranes lactic acid is unquestionably superior to the mineral acids, being highly recommended for this purpose in diphtheria and croup by such authorities as Morell Mackenzie, Lennox Browne, Weber, Dureau, etc. Internally.—Digestive System.—It is used in the digestive dis- orders, such as atonic and irritative dyspepsia, and in all those derangements of digestion which are benefited by hydrochloric acid. In oxaluria, lithemia, chronic cystitis with ammoniacal urine, chronic dysentery, and dyspeptic and tuberculous diarrhea it has proved an efficient remedy. It has been recommended by Dr. Foucaut as a prophylactic in gout. Since this drug was suggested by Cantani as a remedy in dia- betes mellitus it has been used with varying success. Balfour and Foster, as well as Cantani himself, have reported many cases which have greatly improved under the administraton of lactic acid accompanied by an appropriate dietetic regimen. In the continued use of this drug for diabetes, however, it is well to remember that acute rheumatism and rheumatic endocarditis may be induced, endangering the life of the patient even more than the disease for which the drug was prescribed. Lactic acid has been recommended by Preyer, Mendel, and Maragliano as a hypnotic. Yet the authority appears to rest rather upon theoretical deduction than the result of clinical observation. Contraindications.—The same as for mineral acids. Administration.—Lactic acid should be given well diluted. GROUP IV.—VEGETABLE ACIDS. Acidum Aceticum—Acidi Acetici—Acetic Acid. XT. 8. P. Origin.—A liquid composed of 36 per cent, by weight of Ab- solute Acetic Acid (HC2H302 = 59.86) and 64 per cent, of Water. Description and Properties.—A clear, colorless liquid, having VEGETABLE ACIDS. 147 a strong, vinegar-like odor, a purely acid taste, and a strongly acid reaction. Miscible with water or alcohol in all proportions. Dose.—The diluted acid only is given internally. Official Preparation. Acidum Aceticum Diliitum—Acidi Acetici Diluti—Diluted Acetic Acid.__ Dose, 1-2 fluidrachms (3.7-7.4 Cc). Acidum Citricum— Acidi Citrici—Citric Acid. XT. 8. P. Origin.—An organic acid usually prepared from lemon-juice. Description and Properties.—Colorless, translucent, right- rhombic prisms; odorless, having an agreeable, purely acid taste; efflorescent in warm air and deliquescent when exposed to moist air. Soluble in 0.63 part Water, in 1.61 parts of alcohol, in about 0.4 part of boiling water, and in 1.43 parts of boiling alcohol. Dose.—5-20 grains (0.3-1.25 Gm.). Official Preparation. Syrupus Acidi Citrici—Syrupi Acidi Citrici—Syrup of Citric Acid.—Dose, 2-8 fluidrachms (7.4-30. Cc.) (10 per cent.). Acidum Tartaricum—Acidi Tartarici—Tartaric Acid. XT. 8. P. Origin.—An organic acid usually prepared from argols. Description and Properties.—Colorless, translucent, mono- clinic prisms, or crystalline crusts, or a white powder; odorless, having a purely acid taste, and permanent in air. Soluble in about 0.8 part of water and in 2.5 parts of alcohol; also in about 0.5 part of boiling water and in 0.2 part of boiling alcohol. Dose.—10-30 grains (0.6-2.0 Gm.). Antagonists and Incompatibles.—Alkalies are chemically in- compatible with the vegetable acids. With the alkaline, earthy, and metallic bases vegetable acids unite to form salts, the acetates of which are all soluble. Synergists— Alkalies,and, under certain circumstances, mineral acids and the digestive ferments. Physiological Action.—Externally and Locally.—The vege- table acids have about the same action externally and locally as the diluted mineral acids, not caustic but irritant, acetic acid being the most powerful and citric acid the weakest. 148 A TEXT-BOOK OF MA TERIA MEDICA. Internally.—Digestive System.—Their action on the salivary and gastric glands is similar to that of the mineral acids. Their influ- ence upon the stomach is not so marked as that of hydrochloric acid, though the secretions from the intestinal glands are more augmented by vegetable than by mineral acids. Too large or prolonged doses of the vegetable acids produce flatulence and abdominal pain, and may even occasion diarrhea or enteritis. Circulatory System.—Large doses retard and weaken the pulse. As with mineral acids, their tendency is to lessen the alkalinity of the blood. They unite with alkalies in the stomach to form salts, and as such enter the blood, where they are oxidized, the product being carbonic acid, which lessens the alkalinity of the blood and increases the acidity of the urine. Absorption and Elimination.—As stated, vegetable acids unite with the alkalies to form salts, as such entering the circulation. They are eliminated chiefly by the kidneys, increasing the excre- tion of both water and solids. Elimination also takes place to a considerable extent by the intestinal canal. Untoward Action.—Under prolonged dosage there is great ema- ciation, deterioration of the blood, and a scorbutic condition. Poisoning.—Their toxic effects are almost identical with those of the mineral acids, the Treatment of Poisoning being the same as with the latter. Therapeutics.—Externally and Locally.—All the above-named vegetable acids are irritant, more or less antiseptic, and hemo- static, acetic acid being the most powerful antiseptic of the three. Englemann regards acetic acid as superior to mercuric chloride as a disinfectant in obstetrical practice, employing a solution of from 3 to 5 per cent, for this purpose. A diluted solution is a valuable injection in gonorrhea of the female. The glacial acetic acid is a powerful caustic, and is much used to dissolve horny growths, warts, corns, etc. The most important use of acetic acid is in the treatment of certain parasitic skin diseases, probably no remedy excelling it in cases of ringworm and pityriasis. Diluted acetic acid, or vinegar, is an efficient gargle in simple sore throat and the last stage of angincz of exanthemata, as well as a valuable hemostatic, espe- cially in epistaxis. Citric acid is but little used locally, although solutions have been employed with some success to relieve the itching and sting- ing of " prickly heat" and urticaria. A sponge-bath of vinegar ALKALIES. 149 and water is a grateful and efficient means of reducing temperature and checking excessive sweating in disease. Tartaric acid has been used by Potter as an application to the throat in diphtheria, the effect being to convert the membrane into a gelatinous mass which is more easily expelled. Internally.—Acetic acid is little used internally. Citric acid, however, in the form of a lemonade, is a refreshing refrigerant drink in fevers, while a similar hot lemonade taken at bedtime is a valuable and agreeable means of aborting a " cold." Lemon- or lime-juice is an infallible prophylactic against scurvy, being unques- tionably the most efficient remedy for the disease. It is well known by the laity that eating lemons increases the functional activity of the liver. Lemons and citric acid, there- fore, are efficient remedies in relieving attacks of biliousness and catarrhal jaundice, and they even appear to counteract the effects of malaria. Lemon-juice is an old and esteemed remedy in acute rheumatism. Vegetable acids are used for the same disorders of the digestive tract as mineral acids, although not so efficient as the latter, espe- cially the hydrochloric. Much of the benefit derived from sour table-wines is due to the fruit-acids they contain. Contraindications.—Ordinarily the same as for mineral acids. It is a matter of observation that nursing mothers may produce a troublesome diarrhea in the infant by partaking too freely of vine- gar or acid fruits. Administration.—A solution of citric acid may be made of about the acidity of lemon-juice by dissolving 570 grains (36.93 Gm.) in 1 pint (473.17 Cc) of distilled water. Vegetable acids when taken internally should be mixed with, or dissolved in, water and diluted and sweetened, that they may be pleasant to the taste and acceptable to the stomach. GROUP V.—ALKALIES. Alkalies are classed as Restoratives because the blood and many secretions of the body are normally alkaline in reaction. The fol- lowing drugs are numbered among alkalies or antacids: Liquor potassae, potassii acetas, potassii bicarbonas, potassii bitartras, potassii carbonas, potassii citras, potassii tartras, liquor sodae, sodii 150 A TEXT-BOOK OF MATERIA MEDICA. acetas, sodii bicarbonas, sodii carbonas, sodii carbonas exsiccatus, calcii carbonas praecipitatus, creta preparata, liquor calcis, mistura cretae, syrupus calcis, lithii benzoas, lithii carbonas, lithii citras, lithii citras effervescens, lithii salicylas, magnesii carbonas, ammonii carbonas, spiritus ammoniae aromaticus. Liquor Potassae—Liquoris Potassae—Solution of Potash. XT.8.I*. Origin.—An aqueous solution of Potassium Hydrate containing about 5 per cent, of the Hydrate. Description and Properties.—A clear, colorless liquid, odor- less, having a very acrid and caustic taste and a strongly alkaline reaction. It should conform to the same reaction and tests as an aqueous solution of potassa. (See Potassa.) Dose.—5-20 minims (0.3-1.2 Cc), well diluted. Potassii Acetas—Potassii Acetatis—Potassium Acetate. XT. 8. P. Origin.—Prepared by the action of Acetic Acid upon Potassium Carbonate. Description and Properties.—A white powder or crystalline masses, of a satiny lustre, odorless, and having a warm, saline taste; very deliquescent on exposure to the air. Soluble in 0.36 part of water and in 1.9 parts of alcohol; with increasing tempera- ture it becomes much more soluble in both liquids. Potassium acetate should be kept in well-stoppered bottles. Dose.—15-60 grains (1.0-4.0 Gm.). Potassii Bicarbonas—Potassii Bicarbonatis—Po- tassium Bicarbonate. XT. 8. I*. Origin.—Prepared by the action of Carbon Dioxide upon a solution of the Carbonate. Description and Properties.—Colorless, transparent, mono- clinic prisms, odorless, and having a saline and slightly alkaline taste. Permanent in the air, soluble in 3.2 parts of water at 150 C. (590 F.) and in 1.9 parts at 500 C. (1220 F.). At a higher temper- ature the solution rapidly loses carbon dioxide, and, after boiling, contains only potassium carbonate. It is almost insoluble in alcohol. The drug should be kept in well-stoppered bottles. Dose.—10-40 grains (0.6-2.5 Gm.). ALKALIES. I51 Potassii Bitartras—Potassii Bitart rat is—Potassium Bitartrate. XT. 8. P. (Cream of Tartar.) Origin.—Prepared by purifying and crystallizing Argol or Crude Tartar, a residuum of grape-juice after fermentation. Description and Properties.—Colorless or slightly opaque, rhombic crystals, or a white, somewhat gritty powder, odorless, and having a pleasant, acidulous taste ; permanent in the air. Sol- uble in about 200 parts of water and in about 16.7 parts of boiling water; very slightly soluble in alcohol. Dose.—10 grains—\ ounce (0.6-16.0 Gm.). Official Preparation. Ptilvis Jalapse Comp6situs—Ptilveris Jalapae Comp6siti—Compound Pow- der of Jalap.—Dose, 10-30 grains (0.6-2.0 Gm.); used as a hydragogue cathartic. Potassii Carbonas—Potassii Carbonatis—Potas- sium Carbonate. XT. 8. I*. Origin.—Prepared from the ash obtained from the residue of the beet-sugar manufacture. It may also be obtained from wood-ashes. Description and Properties.—A white, granular powder, odor- less, and having a strongly alkaline taste; very deliquescent; solu- ble in i.i parts of water at 150 C. (590 F.) and in about 0.65 part of boiling water; insoluble in alcohol. Its aqueous solution (1 in 20) has a strongly alkaline reaction upon litmus-paper, and effer- vesces with acids. Potassium carbonate should be kept in well- stoppered bottles. Dose.—5-30 grains (0.3-2.01 Gm.). Potassii Citras—Potassii Citratis—Potassium Citrate. XT. 8. JP. Origin.—Prepared by the action of Citric Acid upon a solution of Potassium Carbonate. Description and Properties.—Transparent, prismatic crystals, or a white, granular powder, odorless, and having a cooling, saline taste; deliquescent on exposure to the air. Soluble in 0.6 part of water at 150 C. (590 R), and very soluble in boiling water; feebly soluble in alcohol. Potassium citrate should be kept in well-stop- pered bottles. Dose.—15-60 grains (1.0-4.0 Gm.). 152 A TEXT-BOOK OF MATERIA MEDICA. Potassii Tartras—Potassii Tartratis—Potassium Tartrate. (Unofficial.) Origin.—Prepared by the action of Acid Potassium Tartrate upon Potassium Carbonate. Description and Properties.—It occurs usually in the form of a granular or fine white powder, inodorous, and of a saline, bitter- ish taste. Soluble in 0.75 part of water at 2° C. (35.60 F.), and in 0.47 part of water at 640 C. (147.2° F.). Dose.—30 grains—\ ounce (2.0-16.0 Gm.). PREPARATIONS OF SODIUM. Liquor Sodae—Liquoris Sodae—Solution of Soda. XT. 8. I*. (Solution of Sodium Hydrate.) Origin.—An aqueous solution of Sodium Hydrate (NAOH = 39.96), containing about 5 per cent, of the Hydrate. Description and Properties.—A clear, colorless liquid, odor- less, having a very acrid and caustic taste and a strongly alkaline reaction. Dose.—5-20 minims (0.3-1.8 Cc). Sodii Acetas—Sodii Acetatis—Sodium Acetate. XT. 8. P. Origin.—It may be obtained by neutralizing Acetic Acid with Sodium Carbonate. The usual article, however, is manufactured on a large scale in the United States in the process of purifying acetic acid from wood vinegar. Description and Properties.—Colorless, transparent, mono- clinic prisms, or a granular, crystalline powder, odorless, and having a cooling, saline taste; efflorescent in warm, dry air. Soluble in 1.4 parts of water and in 30 parts of alcohol; also in 0.5 part of boiling water and in 2 parts of boiling alcohol. Sodium acetate should be kept in well-stoppered bottles. Dose.—15-60 grains (1.0-4.0 Gm.). Sodii Bicarbonas—Sodii Bicarbonatis—Sodium Bicarbonate. XT. 8. I*. Origin.—Prepared by saturating a mixture of 2 parts of Crys- tallized and 3 parts of Dried Sodium Carbonate with Carbon Diox- ALKALIES. x53 ide, generated by the action of hydrochloric acid upon marble. The damp Salt formed is shaken with half its weight of Distilled Water, the undissolved portion being dried by exposure to the air. Description and Properties.—A white, opaque powder, odor- less, and having a cooling, mildly alkaline taste; permanent in dry, but slowly decomposed in moist, air. Soluble in 11.3 parts of water at 150 C. (590 F.); above that temperature the solution loses carbon dioxide, and at a boiling heat the salt is entirely converted into normal carbonate. Insoluble in alcohol and ether. The drug should be kept in well-closed vessels, in a cool place. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Mistura Rhei et Sodse—Misturae Rhei et Sodas—Mixture of Rhubarb and Soda.—Dose, \-2 fluidounces (7.4-59 Cc). Trochisci Sodii Bicarbonatis—Trochiscos (ace.) Sodii Bicarbonatis— Troches of Sodium Bicarbonate.—Dose, 1 to 6 troches. Sodii Carbonas—Sodii Carbonatis—Sodium Carbonate. 77. 8. I*. Origin.—Obtained from Sodium Sulphate and Sodium Chloride, but chiefly by a complicated process, known as Leblanc's, from Sodium Sulphate, which is mixed with Chalk and Coal, the mixture ignited, and the resultant mass exhausted with Water and concen- trated, the carbonate separating from the hot liquid being purified. Description and Properties.—Colorless, monoclinic crystals, having a strongly alkaline taste. In dry air the salt effloresces, and if left exposed soon loses about half its water of crystallization (31.46 per cent, of its weight), becoming a white powder. Soluble in 1.6 parts of water at 150 C. (590 F.), in 0.09 part at 380 C. (100.40 F.), in 0.2 part of boiling water, and in 1.02 parts of glycerin; insoluble in alcohol and ether. The aqueous solution gives an alkaline reaction with litmus-paper, and effervesces strongly with acids. The drug should be kept in well-closed vessels. Dose.—10-30 grains (.06-2.0 Gm.). Official Preparation. Sodii Carbonas Exsiccatus—Sodii Carbonatis Exsiccati—Dried Sodium Carbonate.—Description and Properties.—A loose white powder, conforming to the reactions and tests for sodii carbonas. Dose.—3-10 grains (0.2-0.6 Gm.). 154 A TEXT-BOOK OF MATERIA MEDICA. PREPARATIONS OF CALCIUM. Calcii Carbonas Praecipitatus—Calcii Carbonatis Prascipitati—Precipitated Calcium Carbonate. XT. 8. P. Origin.—Prepared by mixing aqueous solutions of Calcium Chloride and Sodium Carbonate, the resulting precipitate of Cal- cium Carbonate being purified. Description and Properties.—A fine white powder, without odor or taste, permanent in the air. Nearly insoluble in water, its solubility being increased by the presence of ammonium salts, and especially by carbonic acid, and diminished by alkali hydrates. Insoluble in alcohol, but in diluted acetic, hydrochloric, or nitric acid completely soluble, with effervescence. Dose.—15-30 grains (1.0-2.0 Gm.). Creta Praeparata—Cretan Praeparatae—Prepared Chalk. X.8.JP. Origin.—Native, friable Calcium Carbonate freed from most im- purities by elutriation. Description and Properties.—A white, amorphous powder, often moulded into conical drops, odorless and tasteless, permanent in the air. Almost insoluble in water; insoluble in alcohol; soluble in diluted acetic, hydrochloric, or nitric acid, with copious efferves- cence, but without leaving more than a trifling residue. Dose.—5-60 grains (0.3-4.0 Gm.). Official Preparations. Hydrargyrum cum Creta—Hydrargyri cum Creta—Mercury with Chalk.— Dose, 2-10 grains (0.12-0.6 Gm.). (Described under Hydrargyrum^ Ptilvis Cretae Comp6situs—Ptilveris Cretae Compfisiti —Compound Chalk Powder.—Dose, 20-60 grains (1.30-4.0 Gm.). TrocMsci Cretae—Trochiscos (ace.) Cretae—Troches of Chalk.—Dose, ad libitum. Unofficial Preparations. Ptilvis Cretae Aromaticus—Ptilveris Cretae Aromatici—Aromatic Powder of Chalk.—Dose, 30-60 grains (2.0-4,0 Gm.). A mixture of Aromatics with Chalk. Ptilvis Cretae Aromaticus cum Opio—Ptilveris Cretae Aromatici cum Opio —Aromatic Powder of Chalk and Opium.—Dose, 10-20 grains (0.6-1.30 Gm.). 1 grain (.06 Gm.) of Opium in every 40 grains (2.5 Gm.) of the previous mixture. ALKALIES. *55 Liquor Calcis—Liquoris Calcis—Solution of Lime. V. 8. I*. (Solution of Calcium Hydrate; Lime Water.) Origin.—A saturated, aqueous solution of Calcium Hydrate. Description and Properties.—A clear, colorless liquid, without odor, and having a saline and feebly caustic taste. It absorbs carbon dioxide from the air, so that a pellicle of calcium carbonate forms on the surface of the liquid. On being heated it becomes turbid through separation of calcium hydrate, which redissolves when the liquid is cooled. It gives a strong alkaline reaction with litmus paper. Dose.—1-4 ounces (15.0-118.3 Cc). Official Preparations. Linimgntum Calcis—LinimSnti CSlcis—Lime Liniment (Carron Oil).— For external use. Mistura Cretae—Misturae Cretae—Chalk Mixture.—Dose, 1-4 fluidrachms (4.0-15. Cc). Compound Chalk Powder, Cinnamon Water, and Water. Syrupus Calcis—Syrupi Calcis—Syrup of Lime.—Dose, \-2. fluidrachms (1.8-7.4 Cc). PREPARATIONS OF LITHIUM. Lithii Carbonas—Lithii Carbonatis—Lithium Carbonate. XT. 8. JP. Origin.—Lithium is found in many mineral waters, the carbon- ate being prepared from lepidolite. Description and Properties.—A light white powder, odorless, and having an alkaline taste; permanent in the air. Soluble in 80 parts of water and 140 parts of boiling water; much more soluble in water saturated with carbon dioxide; insoluble in alcohol, but soluble in diluted acids, with active effervescence. Dose.—2-10 grains (0.12-0.6 Gm.). Lithii Citras—Lithii Citratis—Lithium Citrate. XT. 8. P. Origin.—Prepared by adding Lithium Carbonate to a solution of Citric Acid. Description and Properties.—A white powder, odorless, and having a cooling, faintly alkaline taste; deliquescent on exposure to the air. Soluble in 2 parts of water and in 0.5 part of boiling 156 A TEXT-BOOK OF MATERIA MEDICA. water; almost insoluble in alcohol or ether. Lithium citrate should be kept in well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Official Preparation. Lithii Citras Effervescens—Lithii Citratis Effervescentis—Effervescent Lithium Citrate.—Dose, 1-2 drachms (4.0-8.0 Gm.). PREPARATIONS OF MAGNESIUM. Magnesia—Magnesias—Magnesia. XT. 8. P. (Light Magnesia; Calcined Magnesia.) Origin.—Prepared by subjecting Magnesium Carbonate to a low red heat in a Cornish or Hessian crucible closed loosely by a lid. Description and Properties.—A white, very light, and very fine powder, without odor, and having an earthy, but not a saline, taste. On exposure to the air it slowly absorbs moisture and car- bon dioxide. Almost insoluble in water and insoluble in alcohol, but soluble in diluted acids. Magnesia should be kept in well- closed vessels. Dose.—As an antacid, 10-15 grains (0.6-1.0 Gm.). Official Preparation. Ptilvis Rhei Compftsitus-Ptilveris Rhei CompSsiti-Compound Powder of Rhubarb.-ZW, as a laxative, 20-60 grains (1.30-4.0 Gm.). Formula: Rhubarb, 25; Magnesia, 65 ; Ginger, 10 parts. Magnesii Carbonas— Magnesii Carbonatis— Magnesium Carbonate. XT. 8. JP. " Origin.—Prepared by evaporating to dryness the mixed solu- tions of Magnesium Sulphate and Sodium Carbonate, and purifying and drying the residue. Description and Properties.—Light, white, friable masses, or a light, white powder, without odor, and having a slightly earthy taste; permanent in the air. Almost insoluble in water, to which, however, it imparts a slightly alkaline reaction; insoluble in alco- hol, but soluble in diluted acids, with active effervescence. Dose.—As an antacid, 5-20 grains (0.3-1.3 Gm.). PREPARATIONS OF AMMONIUM. Ammonii Carbonas—Ammonii Carbonatis— Ammonium Carbonate. XT. 8. P. Origin.—Prepared by a complicated process by heating in an iron or earthen retort a mixture of Sal Ammoniac and Chalk. ALKALIES. *57 Description and Properties.—White, hard, translucent, striated masses, having a strongly ammoniacal odor without empyreuma, and a sharp, saline taste. On exposure to the air the salt loses both ammonia and carbonic acid, becoming opaque, and is finally converted into friable porous lumps or a white powder. Slowly but completely soluble in about 5 parts of water at 150 C. (590 F.) and decomposed by hot water, with the evolution of carbonic acid and ammonia. By prolonged boiling with water the salt is com- pletely dissipated. The aqueous solution possesses a strongly alkaline reaction and effervesces with acids. Dose.—3-10 grains (0.18-0.6 Gm.). Official Preparation. Spiritus Ammoniae Aromaticus—Spiritus Ammoniae Aromatici—Aromatic Spirit of Ammonia.—Composition: Ammonium Carbonate, Ammonia Water, Aro- matic Oils, Alcohol, and Water. Description and Properties.—A nearly colorless liquid when freshly prepared, but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor and taste. Dose.—\-\ fluidrachm (1.8-3.7 Cc). Antagonists and Incompatibles.—The alkalies and their car- bonates are incompatible with acids and with metallic salts. The ammonium carbonate is incompatible with the acidulous salts and with lime water. Synergists.—Agents promoting waste, such as vegetable acids, mercury, iodine, etc., increase the therapeutic activity of the alkalies. Physiological Action.—The alkalies mentioned in this group may be divided into direct antacids, or those which neutralize or lessen the acidity of the stomach, and indirect antacids, or those which, being oxidized in the blood, are excreted as carbonates, diminishing the acidity of the urine and increasing the alkalinity of the blood, although not influencing the acidity in the stomach. The direct antacids are lime water, prepared chalk, and magnesia. The indirect antacids are potassium acetate, bitartrate, citrate, and tartrate, sodium acetate, and lithium citrate. The following alkalies are both direct and indirect antacids: solution of potassa, solution of soda, carbonates and bicarbonates of potassium, sodium, lithium, magnesium, and ammonium. The physiological action of the various alkalies will now be considered in detail. 158 A TEXT-BOOK OF MATERIA MEDICA. Externally and Locally.—The hydrates of potassium and sodium are caustic and rubefacient. The solutions of soda and potassa, when applied undiluted, irritate the surface of the skin and soften and dissolve the epidermis and horny tissues, uniting with the albumin of the various structures to form a soluble alkali-albu- minate. The carbonates and bicarbonates exert a similar, though much weaker, action, while the acetates, bitartrates, citrates, and tartrates have no local influence. The ammonium salts do not affect the epidermis in the manner of those previously mentioned, penetrating without dissolving it, irritating the underlying structures, and inducing an effusion of lymph, thus acting as vesicants. Should a strong solution of ammonia be applied to the skin and evaporation be prevented, suppuration and sloughing may ensue. Internally.—Digestive System.—Potassium salts in small doses promote the secretion of gastric juice, thus obeying the law by which alkalies augment acid secretions. Large doses neutralize free acid in the stomach, and, by rendering the chyme neutral or alkaline, interfere with the secretion from the pancreas, liver, and intestines, thereby deranging digestion. Circulatory System.—The salts of potassium, by lessening the acidity of the gastric juice and entering the circulation, increase the alkalinity of the blood. The bicarbonates, however, taken in large doses upon an empty stomach, enter the circulation unchanged, where, by decomposing the neutral phosphate of sodium present, they form the acid phosphate of sodium, reducing the alkalinity of the blood and increasing the acidity of the urine. Far different are the effects of these alkalies when taken after meals, the salts being then decomposed in the stomach by the acid gastric juice, the alkaline base increasing the alkalinity of the blood. The acetates, citrates, and bitartrates enter the blood unchanged. The acid radical being destroyed, and the base combining with the carbon dioxide formed, the salts are converted into the alkaline car- bonates, increasing the alkalinity of the blood and urine. It is believed that the amount of hemoglobin is increased by the potas- sium salts when the blood is deficient in this substance, though large doses interfere with the ozonizing function of the red blood- corpuscles. Should the caustic alkalies be injected directly into the blood, death quickly ensues from coagulation of that fluid, arising from ALKALIES. 159 excessive formation of alkali-albuminate. Under very large or poisonous doses the heart-muscle is weakened, decreasing the force of its contractions, arrest taking place in diastole. Even medicinal doses', if long continued, may occasion cardiac depression, diminish- ing the force of the circulation. Small doses may increase blood- pressure, though the pulse-rate be diminished. Brunton and Cash have demonstrated that minute amounts of potassium salts applied to muscle increase its contractile power, while large doses diminish or paralyze this force. Nervous System.—When potassium salts are administered in medicinal doses and for a reasonable length of time, no important action upon the nervous system is produced; but if excessive doses be taken, the nerve-centers and motor nerves are paralyzed, after a period of temporary excitement. Owing, however, to the fact that potassium is a protoplasmic poison, affecting alike the muscles and nerve-tissues, its salts should not be given in full doses for too long a period without counteracting their depressing influence by the use of muscle- and nerve-tonics. Respiratory System.—The only action of importance upon the respiratory system is the increased amount and diminished viscidity of the secretion from the bronchial tubes. Absorption and Elimination.—The potassium salts possess very high diffusive power. They are easily and quickly absorbed and rapidly excreted, the salts with vegetable acids being eliminated as alkaline carbonates, rendering the urine alkaline. Salts of potas- sium are chiefly eliminated by the kidneys, though the process takes place to some extent through the bronchial mucous mem- brane and other secretions. They are active diuretics, increasing the amount of water and, by stimulating the renal epithelium, augmenting the excretion of solids. The uric acid is greatly dimin- ished, being converted into urea, and as such eliminated, showing that the alkalies increase oxidation and promote waste. Temperature.—Medicinal doses have no effect upon temperature. Untoward Action.—Under prolonged dosage the digestion be- comes impaired. There is present paralysis of the muscular fibers of the intestines, accompanied by diarrhea or constipation and tym- panites. There may be also present emaciation, muscular weakness, nervous prostration, and anemia. Poisoning.—The caustic preparations of potassium produce all the symptoms of a corrosive mineral poison, somewhat resembling the poisonous action of the mineral acids already described. Death 160 A TEXT-BOOK OF MATERIA MEDICA. is occasionally preceded by convulsions, the heart's action being arrested before respiratory failure. The carbonates and bicarbonates and the salts of vegetable acids are not considered poisonous, nor do they produce the corrosive effects of caustic potash or its solution. Treatment of Poisoning.—Vegetable acids are chemically incom- patible, and should be given freely, together with oils and demul- cent drinks as protectives, and opium, if necessary, to relieve pain. Cardiac stimulants—digitalis, brandy, caffeine, etc.—may be required to sustain the heart, to be given hypodermically. The Comparative Action of the Alkalies.—Sodium salts in their action are analogous to potassium, although less irritating to the gastro-intestinal tract. They are also less depressing to the circulatory, muscular, and nervous systems. They differ from the potassium salts in that they lengthen, instead of shortening, the muscular curve. They are neither absorbed nor eliminated so rapidly, and are consequently less active as diuretics. They are not nearly so powerful solvents of uric acid, and are therefore inferior to the potassium salts in gout. Indeed, the nodules, known as " chalk-stones," frequently found upon the joints of gouty pa- tients are composed of urate of sodium. Lithium salts closely resemble in their effects those of potas- sium, their action upon the nerves and muscles, however, being less powerful. The contractile force of muscle is invariably di- minished by lithium and increased by potassium. As a solvent of uric acid, lithium is the most powerful of all the alkalies, the urates, formed under the administration of the carbonate or citrate, being extremely soluble, rendering the alkaline salts of lithium superior to the other alkalies in gout and in the uric-acid diathesis. Calcium salts are more sedative and astringent in their action upon the gastro-intestinal tract than the other alkalies, and are direct antacids. They tend to produce constipation. The nervous and muscular systems are less affected by these salts than by the remaining alkalies, the contractile muscular force, however, being increased by calcium. They are less readily absorbed and excreted than the foregoing alkalies, and less active in increasing the alka- linity of the urine. Magnesium Salts.—Magnesia and the magnesium carbonates are direct antacids and sedative to the stomach, acting upon the intestinal canal as saline cathartics. In their influence upon the circulatory system they are feebler than, but similar to, the potas- sium salts, slightly increasing the alkalinity of the blood. They ALKALIES. 161 are not so readily absorbed, nor so rapidly excreted, as the salts of potassium and sodium, while increasing the amount of water and solids excreted and acting as solvents of uric acid. Ammonium Salts.—These preparations are used rather as car- diac stimulants, their physiological action being more extensively considered under that group. As antacids their action may be briefly compared with that of the other alkalies. Their effect upon the gastric juice and its secretion is similar to that of the car- bonates and bicarbonates above mentioned. They dilate the blood- vessels of the stomach, augmenting the blood-supply and pro- ducing a sensation of warmth in the epigastrium. Lethal doses act as emetics. They increase the glycogenic function of the liver and stimulate the circulatory system, elevating the pulse-rate and rais- ing arterial tension. In medicinal doses they stimulate the spinal cord, motor nerves, and muscles, while toxic doses paralyze these structures. They prevent the coagulation of the blood and lessen the oxygen-carrying power of the red corpuscles. By them also the respirations are increased in frequency. The salts of ammonium are quickly absorbed and undergo oxi- dation in the body, augmenting the amount of uric acid and urea in the urine, thereby increasing its acidity to some extent. As regards the poisonous activity of the alkalies mentioned, ammonium ranks next to potassium, the most toxic of all. Therapeutics.—Externally and Locally.—Norton has recom- mended liquor potass^ in ingrowing toe-nail, the solution being applied to the nail, which is soon rendered so soft that it can be easily scraped without causing pain. The same remedy is used in many. diseases of the skin to allay itching and soften the horny epithelium. It is also employed extensively in diseases of the ear and throat, and in the proportion of I part to 10 of water it is very effective in softening impacted cerumen. The potassium carbonate in solution is frequently used in various pruriginous diseases of the skin, being a highly efficient antipruritic. The detergent and sialagogue properties of potassium citrate and tartrate are rendered serviceable in certain diseases of the mouth. Sodium bicarbonate is a deservedly popular dressing for burns, and pain and swelling of the joints in acute articular rheumatism are sometimes greatly relieved by enveloping the articulations in a hot solution rendered alkaline with this salt. T. Michailoff highly recommends sodium bicarbonate in granular tonsillitis and pharyn- gitis, the powdered salt being applied every two or three hours. n A TEXT-BOOK OF MATERIA MEDICA. In diseases of the ear it is used for the same purposes as the potas- sium preparations above mentioned. It is one of the ingredients of "Dobell's Solution," which is an effective antiseptic wash in nasal catarrh, and the solution of sodium bicarbonate has been sug- gested by Forchheimer as a valuable remedy in thrush or aphtha. Sodium carbonate may be used for the same purposes as the bicarbonate, though probably inferior to it in all cases save infantile eczema capitis, in which condition it is a most valuable remedy for softening the eczematous crusts. Prepared chalk is an ingredient of many ointments used in the treatment of erysipelas and subacute eczema. Lime water, mixed with equal parts of linseed or olive oil, is highly prized as a dress- ing for burns, and the efficiency of the " black " and " yellow" washes in the treatment of venereal sores is too well known to require further testimony in their favor. These latter preparations also make excellent applications in acute eczema. Lime water may sometimes be used with advantage in leucorrhea and vaginitis. Lithii carbonas, in the proportion of 5 grains (0.3 Gm.) to 1 ounce (30.0 Cc.) of water, is highly recommended by Garrod for the removal of gouty deposits, the solution being kept con- stantly applied to the parts by means of lint or absorbent cotton. Magnesium carbonate makes an efficient dusting powder in der- matitis and irritable conditions of the skin. Ammonium carbonate mixed with lanolin readily dissolves the epidermic scales of psori- asis, and the aromatic spirit of ammonia is a grateful application to the scalp in pityriasis. Internally.—Digestive System.—The carbonates and bicarbon- ates, when given before meals, serve to increase the flow of gastric juice. They act as sedatives to the stomach, particularly in painful conditions arising from a deficient secretion of gastric juice. As antacids, when given after meals, they are very useful in counter- acting excessive acidity of the stomach. The acidity due to the formation of fatty acids, the result of defective digestion, is not relieved by the administration of these salts after meals, but if taken before meals they are valuable in correcting the deficiency of gastric secretion to which the disordered digestion is due. In atonic dyspepsia these preparations administered with vegetable bitters serve a useful purpose. The bicarbonates and the salts of the vegetable acids, by increas- ing the alkalinity of the blood, are of great value in gout, the lithia salts being the most efficient in this condition. They are also of ALKALIES. 163 great benefit in the treatment of acute rheumatism. The extensive experience of the author in connection with the latter disease justifies the statement that in the treatment of them alkalies are far superior to any other drugs, salicylic acid not excepted. It is necessary to saturate the system with some bland alkali, preferably a sodium salt, that the pernicious effects of the increased amount of uric acid formed may be rendered nugatory until convalescence shall have become assured. Thorough alkalinization should be produced and maintained, so that the sweat, saliva, and urine, which are acid in acute rheumatism, shall give no acid reaction to blue litmus-paper. While it is admitted that the treatment of acute rheumatism by alkalies alone will not shorten the course of the disease so readily as the employment of salicylates, there is certainly less danger of heart-complications, the period of convalescence is reduced, and the tendency to relapse lessened by the use of alkaline remedies. Even in chronic rheumatism where no serious renal derange- ments exist the mild alkalies, which are well borne by the stomach, are undoubtedly indicated, since it is well known that in chronically rheumatic subjects there is a decidedly lessened alkalinity of the blood. It is, perhaps, unnecessary to add that in the treatment of these cases proper hygiene, food, and cholagogues are important adjuncts to successful management. The author is disposed to go still further and urgently recommend complete alkalinization of the system, in connection with other therapeutic measures, in dealing with rheumatoid arthritis. The acetates, bitartrates, and citrates are efficient diuretics, cathartics, and diaphoretics, the first-named salts being superior diuretics, the potassium bitartrate a reliable cathartic, and the citrates active diaphoretics. In lithemia these salts serve a valuable purpose by rendering the urine persistently alkaline, retarding the formation of uric-acid calculi, and even dissolving small calculi of this variety. In chronic Bright's disease the acetates and citrates are fre- quently indicated for their diuretic action, while potassium bi- tartrate is one of the most effective cathartics and diuretics in acute nephritis and cardiac dropsy. Lime water is a useful remedy for vomiting—whether due to irritability, gastric ulcer, or cancer—and is also valuable in check- ing this symptom in pulmonary tuberculosis. It is an important adjunct to milk, in preventing the formation of curds and relieving infantile vomiting. 164 A TEXT-BOOK OF MATERIA MEDICA. In the acute mycotic diarrhea of children, characterized by acid gastro-intestinal fermentation, the above combination is extremely useful. The symptoms also of chronic diarrhea and dysentery are often mitigated by this simple remedy. In rachitis and osteomalacia it has in certain cases appeared to be beneficial. Lime water is without doubt a very efficient remedy in diabetes insipidus, and may also exert a favorable influence in chronic bron- chitis by checking and otherwise modifying the mucous secretion. It should be remembered that this preparation is a valuable anti- dote in arsenical poisoning. The syrup of lime is a very inferior remedy, the sugar which it contains neutralizing the beneficial action which the lime alone might exert. Prepared chalk, or chalk mixture, is useful in relieving the premonitory diarrhea of cholera, and simple diarrheas of children, with greenish acid stools and flatulent distention of the abdo- men, are greatly benefited by this preparation. It is very neces- sary, however, that the chalk mixture be freshly prepared, the cinnamon water it contains being liable with age to fungoid con- tamination, and the propagation of microorganisms, which would seriously aggravate the condition for which the remedy is given, occasioning vomiting, etc. Magnesia is an invaluable antacid in gastric disorders, and especially in aphtha attending infantile diarrhea. As above stated, the lithium preparations are unquestionably superior to the other alkalies in the gouty and uric-acid diatheses. The ammonium preparations are useful antacids, being particu- larly efficacious in the dyspepsia of drunkards to allay nausea and vomiting, render the mucus less viscid, and act as stimulants to the circulation. Their excitant qualities, together with their prop- erty of modifying the mucous secretion, render them also of value in appropriate cases of subacute and chronic bronchitis. The re- maining important uses of the ammonium preparations will be considered under " Cardiac Stimulants." In conclusion, it may be well to mention the value of alkalies in aiding the digestion of fats, and as efficient remedies in the dys- pepsia and indigestion from which obese, gouty, and rheumatic subjects frequently suffer. The virtue and uses of mineral waters will be fully discussed in the following group devoted to the subject. Contraindications.—Alkalies are contraindicated in the phos- phatic diathesis, since there is danger of the formation of phosphatic MINERAL WATERS. l65 calculi. The calcium preparations should not be given to patients suffering from oxaluria. Administration.—The alkalies should invariably be adminis- tered largely diluted, thus favoring absorption and preventing their irritant action upon the gastro-intestinal mucous membrane. The time of administration—whether before or after meals—will depend entirely upon the effect desired, a thorough knowledge of their action as above given being necessary to an intelligent and proper use of the various preparations. GROUP VI.—MINERAL WATERS. The line of demarcation between mineral and ordinary waters cannot be definitely drawn. Although in the former there is usu- ally present an excess of mineral constituents or of temperature, some drinking waters contain more mineral ingredients than others, while many very pure waters, both cold and warm, have been re- garded for ages as mineral springs. As Pliny observed, waters are such as the soil through which they flow, it being a matter of observation that chalk or limestone formations, for instance, natu- rally impregnate with their normal constituents the springs originat- ing in them. Still, it is impossible to determine with certainty the depth from which these waters flow, or to ascertain the various dis- tances from the surface at which they assimilate foreign ingredients. Nor are the geographical distribution and altitude of mineral springs less remarkable than the diversity of their constituents. Although especially abundant in volcanic regions, mineral springs are by no means confined to them. They have been found on alpine heights—even at the snow-line in the Himalayas—and they rise from the bottom of the sea, as at Baiae and Ischia. The foreign ingredients of mineral waters, as shown by analysis, are very numerous, some of them occurring in exceedingly minute, others in large, quantities. Among them are soda, magnesium, calcium, potash, alumina, iron, boron, iodine, bromine, arsenic, lithium, cesium, rubidium, fluorine, barium, copper, zinc, manga- nese, strontium, silica, phosphorus, besides extractive substances and various organic deposits known under various names. The constituent gases include carbonic and hydrosulphuric acids, nitro- gen, oxygen, hydrogen, and ammonia. Of all these, by far the 166 A TEXT-BOOK OF MATERIA MEDICA. most important from a therapeutic point of view are sodium, mag- nesium, iron, carbonic acid, sulphur, and perhaps hydrosulphuric acid. The various substances detected separately by chemists are in their analyses combined by them into various salts—if not with absolute certainty, undoubtedly with a close approximation to it. These combinations are very numerous, some waters containing from 10 to 20 per cent, of them; yet there are always certain pre- dominating constituents which mark the character of the spring, while many substances, such as cesium, rubidium, or fluorine, occur in mere traces and must be regarded as unimportant. Mineral waters may be considered, therefore, as weaker or stronger solutions of salts and gases of higher or lower tempera- ture, although the quantity of saline ingredients commonly bears but a very small proportion to that of the fluids containing them. For purposes of therapy they are used either externally in the form of baths or internally as beverages. With regard to the former use—or, to speak technically, balneotherapy—the scope of the present work precludes treatment in extenso. Enough to say that in certain conditions the system is undoubtedly benefited by resort to baths of various characters, especially when accompanied by the accessory aid of well-considered diet and regimen. The literature connected with the subject of potable waters is voluminous, yet the deductions drawn by various observers touch- ing their efficacy and in relation to the comparative value of natural springs are too frequently colored by individual bias, or based upon too hasty analysis to furnish infallible data or warrant the definite statement possible in ordinary therapeutics. That certain waters charged with foreign ingredients when ingested react upon the system favorably in the case of certain disorders it were futile to deny. Yet even here there are subsidiary considerations not to be ignored; and it is an open question how far the patient may be relieved by the potency of the remedy per se, or whether the col- lateral aids of environment, climate, altitude, temperature, etc. may not have an important bearing upon beneficial results. It has been well observed that in the case of water taken in situ the curative atmosphere of the surroundings, the favorable season of the year, the reflex influence of social amenities, and freedom from customary cares, aided by studied regimen under constant medical supervision, play no unimportant part in the alleviation of positive or imaginary disorders. The maxim, " Amuse the patient and let nature work the cure," seems not wholly inapplicable to MINERAL WATERS. 167 many fashionable resorts where a constant round of gayety acts as a practical, though imperceptible, tonic or stimulant upon subjects of certain nervous susceptibilities. These considerations are no less forcible in the case of American " watering-places " than in those of the more famous resorts of Europe. Various attempts have been made to range mineral waters according to their therapeutic action, their external and internal effects physiologically, and, most frequently, according to their chemical composition. Yet their influence is so dependent upon idiosyncrasy and their constituents so varied that it is wellnigh impossible to select a definite system free from objections, although a scientific classification, uniformly adopted, would undoubtedly promote their rational employment. Many sulphur waters are practically earthy or saline ones, yet the presence of minute quan- tities of hydrosulphuric acid, an ingredient so palpable as always to attract attention, has determined a classification obviously at variance with natural fact. The general rule has been to class waters under the head of their predominating elements, the desid- eratum being comparative simplicity untrammelled by theoretical considerations. In this view perhaps the most convenient arrange- ment of native mineral springs is that subjoined, adopted by Dr. A. N. Bell and widely accepted by writers on therapeutics: Alkaline.—These waters owe their chief therapeutic value to the alkaline salts they contain. They are rich in alkaline car- bonates, especially the sodium carbonate. Other substances are included among their ingredients, many of them strongly charged with carbonic-acid gas, which may possibly contribute to their physiological activity. Saline.—These either contain (1) chloride of sodium as the principal ingredient, or (2) are largely impregnated with the sul- phates of sodium and magnesium. Several other ingredients enter into their composition, yet their efficacy chiefly depends upon their predominating elements: the second class includes the bitter or purgative waters highly prized both in this country and abroad. Sulphuretted.—The sulphuretted hydrogen present in these waters lends to them their chief therapeutic value. They contain also various sulphides—of potassium, sodium, calcium, and mag- nesium—together with earthy and other sulphates, which doubtless contribute in a measure to their potency as physiological agents, although their action upon the system is still a matter of con- jecture. i68 A TEXT-BOOK OF MATERIA MEDICA. Chalybeate. — Many mineral springs contain iron, yet in amounts so insignificant as to be of little value to therapy. There are, however, chalybeate waters highly charged with iron salts in the form of the carbonate or sulphate which have acquired a repu- tation for efficacy in the treatment of certain diseases. Acidulous.—The valuable property of these springs lies in the superabundance of carbonic-acid gas they contain, to which the solid constituents are subordinate, the carbon dioxide being the important therapeutic ingredient. Calcareous.—Calcium, in the form of the carbonate, is the valuable constituent of calcareous waters. Besides this substance they contain magnesium carbonate in varying quantities. Their utility as mineral waters has been questioned, many authorities refusing them recognition as therapeutic agents. The following enumeration able list compiled by Dr. A. N. Alkaline: Adams, California. Albury, Vermont. Alum, Virginia. Borax, California. Blount, Alabama. Berkshire, Vermont. Canon City, Colorado. Carlisle, Colorado. Congress, California. Elgin, Vermont. Fry's Soda, California. Highland, California. Highgate, Vermont. Lower Soda, California. Milford, New Hampshire. Manitou, Colorado. Middletown, Vermont. Napa Soda, California. Newbury, Vermont. Perry, Illinois. Rocky Mountain, Colorado. Ravenden, Arkansas. South Park, Colorado. of native springs is from the admir- Bell: Summit Soda, California. Seltzer, California. Sheldon, Vermont. Vichy, California. Wilholt Soda, California. Calcic: Bethesda, Wisconsin. Butterworth, Michigan. Birch-Dale, Vermont. Clarendon, Vermont. Eaton Rapid, Michigan. Gettysburg, Pennsylvania. Hubbardstown, Michigan. Silurian, Wisconsin. Chalybeate: Abbeville, South Carolina. Bedford, Pennsylvania. Blossburg, Pennsylvania. Cooper's Well, Mississippi. Esbitt, Kentucky. Fayette, Pennsylvania. Gordon's, Georgia. MINERAL WATERS. 169 Greencastle, Indiana. Kittrell's, North Carolina. Madison, Georgia. Manley, North Carolina. Milford, New Hampshire. Montvale, Tennessee. Owasso, Michigan. Rowland's, Georgia. Schooley's Mountain, New Jersey. Schuyler County, Illinois. Sparta, Wisconsin. Versailles, Indiana. Purgative Saline: Blue Lick, Kentucky. Crab Orchard, Kentucky. Elgin, Vermont. Esculapian, Kentucky. Harrodsburg, Kentucky. Midland, Michigan. Pagosa, Colorado. Saline: Fruit-Port Well, Michigan. Grand Haven, Michigan. Louisville Artesian, Kentucky. Michigan Congress, Michigan. Mt. Clemens, Michigan. Ocean, Alabama. Salt, Virginia. Spring Lake Well, Michigan. St. Louis, Missouri. Sulphurous: Alpena, Michigan. Balston, New York. Bladon, Florida. Blue Lick, Kentucky. Carlisle, Pennsylvania. De Soto, Louisiana. Dremion, Kentucky. French Lick, Indiana. Glenn's, South Carolina. Highgate, Vermont. Indian, Georgia. Indian, Indiana. Lodi Artesian, Indiana. Manley, North Carolina. Minnequa, Pennsylvania. Montesano, Missouri. Olympian, Kentucky. Portea Springs, Colorado. Salt Sulphur, Virginia. Saratoga, New York. Sharon, New York. Sheldon, Vermont. Shocco, North Carolina. St. Helena White Sulphur, California. St. Louis, Michigan. Sweet, Missouri. Valhemosa, Alabama. West Baden, Indiana. White Sulphur, Louisiana. White Sulphur, Montana. White Sulphur, Virginia. Unclassified: Alum, Virginia. Birch-Dale, New Hampshire. Borax, California. Climax, Missouri. Eureka, Arkansas. Fairview, Texas. Greeneleone, Florida. Geysers, the American, Wyo- ming. Geyser Spa, California. Iodide and Bromide, Missouri. Piedmont, Texas. Stafford, Connecticut. 170 A TEXT-BOOK OF MA TERIA MEDICA. Summit, Maine. Sheldon, Vermont. Thermal Springs: Agua Caliente, New Mexico. Arrow-Head, California. Buncombe County, North Carolina. Calistoga, California. Chalk Creek Hot, Colorado. Charleston Artesian, South Carolina. Des Cahutes Hot, Oregon. Harbines, California. Hot Springs, Arkansas. Idaho Hot, Colorado. Merriweather, Georgia. Middle Park Hot, Colorado. Ojo Caliente, New Mexico. Paraiso, California. Passo Robles, California. Salt Lake, Utah. Seigler, California. Skaggs, California. Volcano, Nebraska. Warm and Hot, West Virginia. GROUP VII.—BITTERS. SIMPLE BITTERS. Quassia—Quassise—Quassia. XT. 8. P. Origin.—The wood of Picrama excelsa Swz., a tree resembling the common ash, attaining a height of from 60 to 80 feet (18-24 M.), indigenous in Jamaica. Description and Properties.—In the shops it is usually met with in the form of chips or raspings of a yellowish-white color. Quassia contains two bitter principles—quassin and picrasmin. It contains no tannin. Dose.—20-30 grains (1.30-2.0 Gm.). Official Preparations. Extractum QuSssiae—ExtrScti Quassias—Extract of Quassia.—Dose, 1-3 grains (0.065-0.2 Gm.). Extractum Quassias Fluidum—Extracti Quassias Fluidi—Fluid Extract of Quassia.—Dose, 10-60 minims (0.6-0.4 Cc). Tinctura Quassias—Tincturas Quassias—Tincture of Quassia.—Dose, \-z fluidrachms (2.0-7.3 Cc). Gentianae—Gentianse—Gentian. XT. 8. _P. Origin.—The root of Gentiana lutea L., a plant from 2 to 3 feet high, indigenous in the mountainous portions of Central Europe. Description and Properties.—It appears in nearly cylindrical pieces or longitudinal slices about 1 inch (25 Mm.) thick, the upper portion closely annulate, the lower longitudinally wrinkled; exter- nally deep yellowish-brown ; internally lighter; somewhat flexible BITTERS. 171 and rather thick, separated from the subspongiose meditullium by a black cambium line. Odor peculiar, faint, stronger when moist- ened; taste sweetish and persistently bitter. Gentian contains a bitter principle, gentiopicrin, and also gentisic acid, to which its yellow color is due. It contains about 15 per cent, of glucose, but no starch or tannin. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations. Extractum Gentianae—Extracti Gentianae—Extract of Gentian.—Dose, 2- 10 grains (0.12-0.6 Gm.). Extractum Gentianas Fliiidum—Extr3cti Gentianas Fluidi—Fluid Extract of Gentian.—Dose, 10-60 minims (0.6-4.0 Cc). Tinctura Gentianae Comp6sita—Tincturas Gentianae CompOsitas—Com- pound Tincture of Gentian.—Dose, 1-2 fluidrachms (4.0-8.0 Cc). 10 per cent. with Orange Peel and Cardamom. Calumba—Calumbae—Calumba. XJ. 8. P. (COLUMBO.) Origin.—The root of Jateorhiza palmata, Lam., a plant native to the forests of Eastern Africa and Madagascar, and cultivated in the East Indies. Description and Properties.—Nearly circular disks I to 2 inches (25-50 Mm.) in diameter and \ to \ inch (6-12 Mm.) thick. Externally greenish-brown and wrinkled; internally yellowish or grayish-yellow ; depressed in the center, with a few interrupted cir- cles of projecting wood-bundles ; distinctly radiate in the outer por- tion; fracture short, mealy; odor slight; taste mucilaginous, slightly aromatic, very bitter. It contains a bitter crystalline principle, ca- lumbin, calumbic acid, berberine, and starch. No tannin is present. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Extractum Calumbae Fluidum—Extracti Caltimbae Fluidi—Fluid Extract of Calumba.—Dose, 15-60 minims (1.0-4.0 Cc). Tinctura Caltimbae—Tincturas Caltimbae—Tincture of Calumba.—Dose, 1- 4 fluidrachms (4.0-15. Cc). Calendula—Calendulas—Calendula. XT. 8. P. (Marigold.) Origin.__The florets of Calendula officinalis L., an annual plant, a native of the Levant and Europe, frequently cultivated as a garden ornament. 172 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—Florets about \ inch (12 Mm.) long, linear and strap-shaped, delicately veined longitudinally, yellow or orange-colored, three-toothed at the apex, the short, hairy tube enclosing the remnants of a filiform style elongately cleft. Odor slight and somewhat heavy; taste rather bitter and faintly saline. It contains a peculiar gummy principle, calendulin, a bitter constituent, and a trace of volatile oil. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparation. Tinctura Calendulas—Tincturas Calendulas—Tincture of Calendula.—Dose, 15-60 minims (1.0-4.0 Cc). Unofficial Preparation. Extractum Calendulas Fluidurn—Extracti Calendulas Fluidi—Fluid Ex- tract of Calendula.—Dose, 10-30 minims (0.65-2.0 Cc). Chirata—Chiratae—Chirata. XT. 8. I*. Origin.—The entire plant, Swertia chirata Hamilton, an annual, native to Northern India. Description and Properties.—Chirata as found in the shops consists of short sections of the stem and branches pressed and split, brown or dark-purple in color, and mixed with a few leaves and flowers. It contains a very bitter yellow principle, a hygro- scopic powder, chiratin, a bitter syrupy liquid, ophelic acid, a resin, coloring matter, etc. Dose.—5-15 grains (0.3-1.0 Gm.). Official Preparations. Extractum Chiratae Fluidurn—Extract! Chiratae Fluidi—Fluid Extract of Chirata.—Dose, 15-60 minims (1.0-4.0 Cc). Tinctura Chiratae—Tincturas Chiratae—Tincture of Chirata.—Dose, yz-\ fluidrachm (2.0-4.0 Cc). AROMATIC BITTERS. Anthemis—Anthemidis—Anthemis. XT. 8. P. (Chamomile.) Origin.—The flower-heads of Anthemis nobilis L., a low peren- nial plant indigenous in Southern and Western Europe. Description and Properties.—Heads subglobular, about f inch (2 Cm.) broad, consisting of an imbricated involucre and numerous white, strap-shaped, three-toothed florets, and a few, if any, yellow BITTERS. *73 tubular disk-florets, inserted upon a chaffy, conical, solid receptacle ; of a strong, agreeable odor and an aromatic, bitter taste. Anthemis contains a bitter principle, a pale-blue or yellowish-brown volatile oil, and a trace of tannin, together with other unimportant con- stituents. Dose.—15-60 grains (1.0-4.0 Gm.), in infusion or fluid extract. Cascarilla—Cascarillae—Cascarilla. XT. 8. JR. Origin.—The bark of Croton eluteria, Bennett, a small shrub indigenous in the Bahama Islands. Description and Properties.—Quills or curved pieces about ^ inch (2 Mm.) thick, having a grayish, somewhat fissured, easily detached, corky layer, more or less coated with a white lichen, the uncoated surface being dull brown, the inner surface being smooth. The bark breaks with a short fracture, having a resinous and radially striate appearance. When burned it emits a strong, aro- matic, somewhat musk-like odor; taste warm and very bitter. It contains a volatile oil, a bitter, crystalline principle, cascarillin, tannin, resin, etc. Dose.—20-30 grains (1.2-2.0 Gm.), or \-2 fluidrachms (2.0-8.0 Cc.) of the fluid extract. Prunus Virginiana— Pruni Virginianae—Wild Cherry. XT. 8. P. Origin.—The bark, collected in autumn, of Prunus serotina Ehr, a large forest tree indigenous in North America. Description and Properties.—It is met with in curved pieces or irregular fragments ^ mcn (2 Mm.) or more thick; outer surface greenish-brown or yellowish-brown, smooth and somewhat glossy, marked with transverse scars. If the bark is collected from the old wood and deprived of the corky layer, the outer surface is nut-brown and uneven; inner surface somewhat striate or fissured. Upon maceration in water it develops a distinct bitter-almond odor. Taste astringent, aromatic, and bitter. It contains a volatile oil, hydrocyanic acid, tannin, a bitter glucoside, resin, etc. Dose.—J-1 drachm (2.0-4.0 Gm.). Official Preparations. Extractum Pruni Virginianae Fluidum—Extr3cti Pruni Virginianae Fluidi —Fluid Extract of Wild Cherry.—Dose, 30-60 minims (2.0-4.0 Cc). 174 A TEXT-BOOK OF MATERIA MEDICA. Infusum Pruni Virginianae—Infusi Pruni Virginianae—Infusion of Wild Cherry.—Dose, 1-2 fluidounces (30.0-60.0 Cc). Syrupus Pruni Virginianae—Syrupi Pruni Virginianae—Syrup of Wild Cherry.—Dose, 2-4 fluidrachms (8.0-15. Cc). Serpentaria—Serpentariae—Serpentaria. XT. 8. P. (Virginia Snake-root.) Origin.—The rhizome and roots of Aristolochia serpentaria L., and of Aristolochia reticulata Nutt, perennial herbs indigenous in the United States. Description and Properties.—The rhizome is about I inch (25 Mm.) long, thin, curved; on the upper side with approximate, short stem-bases; on the lower side with numerous thin, branching roots about 4 inches (10 Cm.) long; dull yellowish-brown, inter- nally whitish; the wood-rays of the rhizome are longest on the lower side; odor aromatic, camphoraceous; taste warm, bitterish, and camphoraceous. It contains \ per cent, of volatile oil, a bitterish principle, aristolochine, tannin, resin, starch, etc. The roots of Aristolochia reticulata are coarser, longer, and less interlaced than those of Aristolochia serpentaria. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations. Extractum Serpentariae Fluidum—Extracti Serpentariae Fluidi—Fluid Extract of Serpentaria.—Dose, 30 minims-i fluidrachm (2.0-4.0 Cc). Tinctura Cinchonas Compftsita—Tincturas CinchSnae Compttsitae—Com- pound Tincture of Cinchona.— Dose, 1-4 fluidrachms (4.0-15. Cc.) (2 per cent. of serpentaria.) Tinctura Serpentariae—Tincturae Serpentariae—Tincture of Serpentaria.— Dose, \-2 fluidrachms (2.0-8.0 Cc). Antagonists and Incompatibles.—The salts of iron, lead, and silver are incompatible with gentian and the aromatic bitters, though preparations of iron can be given with quassia and calumba. Boil- ing water impairs the virtues of wild cherry. Synergists.—The digestants, mineral acids, and, under certain conditions, alkalies, and the restorative agents generally, aid the action of vegetable bitters. Physiological Action.—Because of their action in augmenting the secretions from the salivary and gastric glands, aiding diges- tion and improving nutrition, Vegetable Bitters are classed among Restoratives. By increasing the activity of the various glands they BITTERS. 175 aid digestion, and by their effect upon the nerves they stimulate the appetite. Pure bitters act immediately upon contact; that is, their efficiency is due to their local action upon the mucous membrane of the gastro-intestinal tract, with which they are brought into direct contact. There are certain drugs, however—such as cin- chona, nux vomica, etc.—which act also upon the blood or remote parts of the system. When used as bitters we are concerned only with the local action of these agents. I. Bitters increase the secretion from the salivary glands. This effect is produced by stimulating the ends of the nerves of taste distributed in the mucous membrane of the mouth, from which nerves the im- pression is conveyed to the center in the medulla, and from there transmitted to the vaso-motor and secretory nerves sup- plying the salivary glands, increasing their blood-supply and activity, and at once promoting the secretion of saliva. Were salivary secretion stimulated by the drug entering the circulation, and through the blood exciting the medulla and the glands, a much longer time would elapse before an increased flow of saliva would be pro- duced. It is therefore certain that the rapid reflex excitation of the glands, and consequent immediate increase in the sal- ivary secretion, are due to direct contact with the nerve-endings in the mucous membrane of the mouth. The accompanying diagram (Fig. 1) will serve to elucidate the action named. II. Bitters increase the secretion from the gastric glands. The primary action is an augmented flow of gastric juice, caused by reflex stimulation from the mouth. It is well known that there is an intimate relationship between the stomach and the senses of taste and smell—the taste of victuals or the odor of a tempting dinner, or the familiar instance of a dog looking wistfully at a meat- stand, exciting the appetite and, reflexly, the flow of gastric juice. Bitters act in a similar manner. The nerves of taste are stimu- lated; the impression is conveyed to the medulla, and from it trans- mitted not only to the salivary glands, but through the fibers of Fig. 1.—Diagram illustrating the action of bitters on the salivary glands: 1, nerve conveying the impression from the mucous mem- brane of the mouth (C) to the me- dulla (A); 2, secretory nerve trans- mitting the impression from the medulla (A) to the salivary gland (B); 3, duct of the salivary gland. 176 A TEXT-BOOK OF MATERIA MEDICA. the vagus, increasing the blood-supply to the gastric glands and thereby promoting their functional activity. When the bitters have been swallowed, an increased secretion ensues, occasioned by direct stimulation of the mucous mem- brane of the stomach. Through the sen- sory fibers of the vagus the impression is conveyed to the center in the medulla, returning by the vaso-motor and secretory fibers, and increasing the functional activity of the glands. This action is well shown in the diagram (Fig. 2). When too large a dose of bitters has been taken, or under prolonged medicinal dosage—when contraindicated by an irri- table stomach—the effects are a diminished secretion of gastric juice and a corre- sponding increase in the secretion of mucus. This effect of over-stimulation or irritation is well illustrated in persons addicted to the excessive use of alcohol, a moderate amount promoting the secretion of gastric juice and improving the appetite, while excess occa- sions nausea and the vomiting of glairy mucus. The theory governing the above action is that a medicinal dose of bitters is just sufficient to stimulate the functional activity of the gastric glands, but that immoderate or continuous dosage tends to convey the impression farther up in the medulla, causing stimulation of the vaso-constrictor fibers, con- tracting the blood-vessels, and lessening the blood-supply and the secretion from the glands. At the same time the secretory fibers supplying the mucous cells are stimulated, causing an increased secretion of mucus. Should the dose be sufficiently large to pro- duce vomiting, the action is due to the fact that the impression is conveyed still higher in the medulla, and from there transmitted to the nerves supplying the abdominal walls and diaphragm, the effect being to produce emesis. The diagram (Fig. 3) graphically illustrates this action. III. Bitters stimulate the peristaltic movements of the stomach by reflex action. The sensory nerves in the mucous membrane are Fig. 2.—Diagram illustrating the action of bitters on the gas- tric secretion: A, medulla; B, stomach ; C, gland; D,D, blood- vessels supplying the gland; E, nerves of taste ; i, vaso-motor fibers ; 2, secretory fibers ; 3, sen- sory fibers. BITTERS. 177 irritated, and an impression is conveyed by them to Auerbach's plexus between the muscles in the walls of the stomach, from which plexus, or ganglion, the influence is transmitted to the mus- cles themselves, causing increased activity or peristalsis. Another method by which peristalsis is stimulated occurs when the impression is conveyed by the sensory nerves directly to the center in the medulla, and from there through the motor fibers of the vagus to Auerbach's plexus, affecting the muscles in the man- ner above described. The cut (Fig. 4) will serve to illustrate the modus operandi. Fig 3.—Diagram illustrating the supposed nervous connections of the stomach. A gentle stimulus applied to the walls of the stomach is transmitted by the afferent nerves {A) to a nerve-center {B), and thence along the vaso-dilating nerves (C) and the secreting nerves (Z>) to the vessels of the mucous membrane and the cells of the gastric follicles. A stronger stimulus is transmitted up to the nerve- center (E), and thence along the vaso-constricting fibers (F) and the secreting fibers (G) of the mu- cous follicles. A still stronger stimulus is transmitted to H, and thence along the motor nerves to the abdominal walls (K, K), causing them to contract and produce retching or vomiting. IV. Bitters augment absorption by increasing the blood-supply to the mucous membrane of the stomach. It is a physiological fact that the larger the blood-supply passing through the blood- vessels, and the greater the amount of lymph conveyed through the lymph-channels, the more rapid the absorption. V. Bitters are more or less antiseptic and arrest fermentation, both physiological and pathological. The peptonization of food is 12 178 A TEXT-BOOK OF MATERIA MEDICA. a physiological fermentative process, forming a contraindication to the administration of bitters during active digestion. Therapeutics.—Externally and Locally.—Calendula, in the form of a poultice, is an efficient and grateful application as a dress- ing to cancer of the breast. The tincture of calendula is recommended by many phy- sicians as an external application for contu- sions, sprains, etc., although not so efficient as tincture of arnica. The drug has been used topically in chronic pharyngitis and suppurative inflammation of the ear. Internally.—The simple bitters are pecu- liarly useful in atonic and fermentative dys- pepsia, chronic gastric catarrh, and as a tonic in convalescence from acute disease, in mala- rial fever, and in the anorexia following it. Infusion of quassia is a most efficacious injection to destroy seat-worms (Oxyuris ver- micularis), the infusion being injected into the rectum, which has been previously washed out with soap and water. The aromatic bitters are used to stimu- late the appetite and improve the condition of the digestive apparatus. The simple bit- ters are similarly used, but the former pos- sess more stimulating and tonic properties, owing to their volatile and astringent con- stituents. Chamomile, in addition to its action as a stimulant to the digestion, has been employed with benefit in delirium tremens and as an emmenagogue, while in the form of hot poultices chamomile flowers serve as an efficient appli- cation for local pains of almost any description. Wild cherry might not inaptly be called a sedative tonic, its peculiarly bitter yet not unpleasant taste causing it to be well toler- ated by the stomach, and rendering it one of the best stomachic tonics, especially during convalescence, when its sedative action upon the heart allays febrile and cardiac excitement. The syrup of wild cherry is a common ingredient of " cough syrups." It is thought to quiet the cough and allay the irritability of the nervous system in bronchitis and phthisis. Serpentaria is considered an efficient expectorant in pneumonia Fig. 4.—Diagram illustrating the action of bitters upon peri- stalsis : A, medulla; B, stom- ach; C, Auerbach's plexus; D, mucous membrane; E, muscles ; i, motor fibers; 2, sensory fibers. HEM A TICS. 179 and capillary bronchitis. Next to its use as a stomachic its chief value seems to be as a stimulant in typhus and typhoid fevers, the compound tincture of cinchona being a most excellent remedy in the low forms of typhoid. The fluid extract of serpentaria is con- sidered somewhat of a sexual stimulant. It is a valuable applica- tion for poisoning by Rhus toxicodendron. Contraindications.—1. Bitters should not be given when the secretion of gastric juice is diminished as the result of organic disease. 2. They are contraindicated as stomachics during the course of acute disease, as in fevers. 3. When, after a reasonable time, they fail to improve the appetite, they should be discontinued. 4. In convalescence from acute disease, when the appetite is vora- cious, they are contraindicated. 5. In catarrhal conditions of the mu- cous membrane of the stomach—as in chronic gastritis and " drunk- ards' catarrh of the stomach "—alcoholic preparations of bitters, tinctures, etc. should not be administered, aqueous preparations only, like infusions, being permissible. 6. Should the digestion be impaired and the appetite good, it is an indication that the indiges- tion is intestinal, and therefore beyond the influence of bitters. Administration.—To improve the appetite bitters should be given from one-half to one hour before meals. When necessary to use them for a long time, one bitter should be substituted for another in the course of every week or two ; otherwise the stomach may rebel at the monotony. Bitters may be given in the form of a powder or a solid extract. Ordinarily, however, it is preferable to administer a liquid preparation—fluid extract, tincture, or infusion. A pleasant method of giving the latter preparation in the case of quassia is to allow water to stand over-night or for a few hours in a quassia-cup—purchasable at almost any drug-store—when the water will become impregnated with the bitter principle of the quassia. GROUP VIII.—HEMATICS. PREPARATIONS of iron. Ferrum Reductum—Ferri Reducti—Reduced Iron. XT. 8. P. (Iron by Hydrogen; Quevenne's Iron.) Origin.—Obtained by passing Hydrogen through a hot closed tube containing freshly prepared and thoroughly washed Ferric Oxide. 180 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—A very fine, grayish-black, lustre- less powder, odorless and tasteless; permanent in dry air; insolu- ble in water or alcohol. Dose.—1-5 grains (0.5-0.3 Gm.). Ferri Carbonas Saccharatus — Ferri Carbonatis Saccharati — Saccharated Ferrous Carbonate. XT. 8. P. Origin.—Prepared from Ferrous Sulphate, Sodium Bicarbonate, Sugar, and Distilled Water, by solution and filtration. Description and Properties.—A greenish-brown powder grad- ually becoming oxidized by contact with air; without odor, and having at first a sweetish, afterward a slightly ferruginous, taste. Only partly soluble in water, but completely soluble in hydro- chloric acid, with copious evolution of carbonic-acid gas, forming a clear, greenish-yellow liquid. The product should be kept in small, well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Massa Ferri Carbonatis—Massae Ferri Carbonatis —Mass of Ferrous Carbonate. XT. 8. P. (Vallet's Mass.) Origin.—Prepared by solution, filtration, and evaporation from Ferrous Sulphate, Sodium Carbonate, Clarified Honey, Sugar, Syrup, and Distilled Water. Description and Properties.—When recently prepared the mass is of a greenish-gray color, but on exposure it becomes greenish-black. Dose.—3-5 grains (0.15-0.3 Gm.). Mistura Ferri Composita— Misturse Ferri Com- positae—Compound Iron Mixture. XT. 8. P. (Griffith's Mixture.) Origin.—Prepared by mixing Ferrous Sulphate, Myrrh, Sugar, Potassium Carbonate, Spirit of Lavender, and Rose Water. Description and Properties.—When newly prepared it is of a dirty greenish color, but slowly oxidizes on exposure to the air, and should therefore be freshly prepared when needed. Dose.—l-ii- ounces (15.-45 Cc). HE MA TICS. 181 Ferri Iodidum Saccharatum—Ferri Iodidi Saccha- rati—Saccharated Ferrous Iodide. XI. 8. P. Origin.—Prepared by solution, filtration, evaporation, and tritu- ration from Iron Wire, Reduced Iron, Iodine, Distilled Water, and Sugar of Milk. Description and Properties.—A yellowish-white or grayish, hygroscopic, odorless powder, having a sweetish, ferruginous taste. Soluble in 7 parts of water, but only partially soluble in alcohol. It should be kept in a cool, dark place, in small, perfectly dry, securely-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). Pilulae Ferri Iodidi—Pilulas (ace.) Ferri Iodidi—Pills of Ferrous Iodide. XJ.8.P. Origin.—Pills made of Reduced Iron, Iodine, Glycyrrhiza, Sugar, Extract of Glycyrrhiza, Acacia, Balsam of Tolu, Water, and Ether, evaporated to pilular consistence. Description and Properties.—These preparations are very un- stable, and should be kept from the light as much as possible. Dose.—One to two pills, each pill containing nearly 1 grain (0.061 Gm.) of ferrous iodide. Syrupus Ferri Iodidi—Syrupi Ferri Iodidi—Syrup of Ferrous Iodide. XT. 8. P. Origin.—A syrup containing 10 per cent, of Ferrous Iodide. Description and Properties.—A transparent, pale-green liquid, having a sweet, strongly ferruginous taste and a neutral reaction. Dose.—5-30 minims (0.3-2.0 Cc). Ferri Chloridum—Ferri Chloridi—Ferric Chloride. Origin.—Prepared by the action of Hydrochloric Acid and Distilled Water upon Iron Wire, subsequent filtration, addition of Nitric Acid, and crystallization. Description and Properties.—Orange-yellow, crystalline pieces, odorless or having a faint odor of hydrochloric acid, and a strongly styptic taste ; very deliquescent in moist air; freely and completely soluble in water or alcohol, also in a mixture of 1 part of ether and 3 parts of alcohol. Ferric chloride should be kept in glass- stoppered bottles protected from light. Dose.—It is chiefly used topically, as an astringent and hemo- static. 182 A TEXT-BOOK OF MA TERIA MEDICA. Liquor Ferri Chloridi—Liquoris Ferri Chl5ridi— Solution of Ferric Chloride. XT. 8. P. Origin.—An aqueous solution of Ferric Chloride (Fe2Cl6 = 323.98), containing about 37.8 per cent, of the anhydrous salt, corresponding to 62.9 per cent, of the crystallized salt, or about 13 per cent, of metallic iron. Description and Properties.—A reddish-brown liquid, having a faint odor of hydrochloric acid, an acid, strongly styptic taste, and an acid reaction. Dose.—2-10 minims (0.12-0.6 Cc), largely diluted. Tinctura Ferri Chloridi—Tincturae Ferri Chloridi— Tincture of Ferric Chloride. XT. 8. P. Origin.—A hydro-alcoholic solution of Ferric Chloride, con- taining about 13.6 per cent, of the anhydrous salt, corresponding to about 4.7 per cent, of metallic iron. Description and Properties.—A bright, brownish liquid having a slightly ethereal odor, a very astringent, styptic taste, and an acid reaction. Dose.—5-30 minims (0.3-2.0 Cc). Liquor Ferri Acetatis—Liquoris Ferri Acetatis- Solution of Ferric Acetate. XT. 8. P. Origin.—An aqueous solution of Ferric Acetate, containing about 31 per cent, of the anhydrous salt, corresponding to about 7.5 per cent, of metallic iron. Description and Properties.—A dark, reddish-brown, clear liquid, of an acetous odor, a sweetish, acidulous, somewhat styptic taste, and a slightly acid reaction. Dose.—1-8 minims (0.06-0.5 Cc). Liquor Ferriet Ammonii Acetatis—Liquoris Ferri et Ammonii Acetatis—Solution of Iron and Ammonium Acetate. XT. 8. P. (Basham's Mixture.) Formula.—Prepared with Tincture of Ferric Chloride, 20 parts; Diluted Acetic Acid, 30; Solution of Ammonium Acetate, 200; Aromatic Elixir, 100; Glycerin, 120; Water, to 1000. Dose.—1-4 fluidrachms (4.0-15.0 Cc). Ferri Citras—Ferri Citratis—Ferric Citrate. U.S.P. Origin.—Prepared by evaporating solution of Ferric Citrate on a water-bath at a temperature not exceeding 6o° C. (1400 F.). HEM A TICS. i83 Description and Properties.—Thin, transparent, garnet-red scales, without odor and having a slightly ferruginous taste. Slowly but completely soluble in cold water, and readily soluble in hot water, but diminishing in solubility with age. Insoluble in alcohol. Ferric citrate should be kept in well-stoppered bottles, protected from light. Dose.—5-20 grains (0.3-1.20 Gm.), in solution. Liquor Ferri Citratis—Liquoris Ferri Citratis— Solution of Ferric Citrate. XT. 8. P. Origin.—Prepared by precipitating a solution of Ferric Sulphate in Water with Ammonia Water, adding Citric Acid, filtering, and evaporating the filtrate to the proper amount. Description and Properties.—A dark-brown liquid, odorless, of an acid reaction, and possessing a slightly ferruginous taste. Dose.—5-15.minims (0.3-1.0 Cc). Vinum Ferri Citratis—VTni Ferri Citratis—Wine of Ferric Citrate. XT. 8. P. Composition.—Iron and Ammonium Citrate, Tincture of Sweet Orange Peel, Syrup, and Water. Dose.—|-i fluidrachm (2.0-4.0 Cc). Ferri et Ammonii Citras—Ferri et Ammonii Citratis —Iron and Ammonium Citrate. XT. 8. P. Origin.—Prepared by evaporating a solution of Ferric Citrate and Ammonia Water. Description and Properties.—Thin, transparent, garnet-red scales, odorless, and having a saline, mildly ferruginous taste; deliquescent in moist air. Completely soluble in water, but insoluble in alcohol. Dose.—5-10 grains (0.3-0.6 Gm.). Ferri et Quinlnae Citras—Ferri et Quininae Citratis —Iron and Quinine Citrate. XT. 8. P. Origin.—Solution of Ferric Citrate in Distilled Water and solution of Quinine and Citric Acid in Distilled Water are mixed, evaporated on a water-bath to the consistence of syrup, and dried on plates of glass. Description and Properties.—Thin, transparent scales, of a 184 A TEXT-BOOK OF MATERIA MEDICA. reddish-brown color, without odor, and having a bitter, mildly ferruginous taste ; slowly deliquescent in damp air. Gradually but completely soluble in cold water, more readily soluble in hot water, and but partially soluble in alcohol, its solubility diminishing with age. It should be kept in well-stoppered bottles, protected from light. Dose.—2-10 grains (0.12-0.6 Gm.). Ferri et Quinlnae Citras Solubilis—Ferri et Quininae Citratis Solubilis—Soluble Iron and Quinine Citrate. V. 8. P. Origin.—Prepared in the same manner as the above salt, but with the addition of Ammonia Water. Description and Properties.—Thin, transparent scales, of a greenish, golden-yellow color, odorless, and having a bitter, mildly ferruginous taste; deliquescent in damp air. Rapidly and com- pletely soluble in cold water, but only partially soluble in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose.—2-10 grains (0.12-0.6 Gm.). Ferri et Strychnlnae Citras—Ferri et Strychninae Citratis—Iron and Strychnine Citrate. XT 8. P. Origin.—Solution of Iron and Ammonium Citrate in Distilled Water and solution of Strychnine and Citric Acid in Distilled Water are mixed, evaporated to the consistence of syrup by means of a water-bath, and dried on plates of glass. Description and Properties.—Thin, transparent scales, varying in color from garnet-red to yellowish-brown, without odor, and having a bitter, slightly ferruginous taste; deliquescent in damp air. Readily and completely soluble in water, but only partly sol- uble in alcohol. It should be kept in well-stoppered bottles, pro- tected from light. Dose.—1-3 grains (0.06-0.18 Gm.). Vinum Ferri Amarum—Vini Ferri Amari—Bitter Wine of Iron. XT. 8. P. Composition.—Soluble Iron and Quinine Citrate, Tincture of Sweet Orange Peel, Syrup, White Wine. Dose.—1-2 fluidrachms (4.0-8.0 Cc). HEMATICS. 185 Syrupus Ferri, Quinlnae, et Strychnlnae Phospha- tum— Syrupi Ferri, Quinlnae, et Strychnlnae Phosphatum—Syrup of the Phosphates of Iron, Quinine, and Strychnine. XT. 8. P. Dose.—1-2 fluidrachms (4.0-8.0 Cc). Ferri Lactas—Ferri Lactatis—Ferrous Lactate. XT. 8. P. Description and Properties.—Pale, greenish-white crusts, con- sisting of small, needle-shaped crystals, having a slight, peculiar odor, and a mild, sweetish, ferruginous taste. Slowly but com- pletely soluble in 40 parts of water and in 12 parts of boiling water; almost insoluble in alcohol. Ferrous lactate should be kept in well-stoppered bottles. Dose.—1-3 grains (0.06-0.2 Gm.). Syrupus Hypophosphitum cum Ferro—Syrupi Hy- pophosphitum cum Ferro—Syrup of Hypophos- phites with Iron. XT. 8. P. Ferrous Lactate and Potassium Citrate dissolved in Syrup of Hypophosphites. Dose.—|—1 fluidrachm (2.0-4.0 Cc). Ferri Oxidum Hydratum—Ferri Oxidi Hydrati— Ferric Hydrate. U.8.P. (Ferric Hydroxide—Hydrated Oxide of Iron.) Origin.—To a solution of Ammonia Water in Water is added a solution of Ferric Sulphate in Water, and the precipitate collected. Description and Properties.—A brownish-red magma, wholly soluble in hydrochloric acid, without effervescence. Dose.—4 drachms (16 Gm.), or ad libitum in case of arsenical poisoning. Ferri Oxidum Hydratum cum Magnesia—Ferri Oxidi Hydrati cum Magnesia—Ferric Hydrate with Magnesia. XT. 8. P. Solution of Ferric Sulphate, Magnesia, and Water. Dose.—Amounts as necessary ad libitum. 186 A TEXT-BOOK OF MATERIA MEDICA. Ferri et Ammonii Sulphas—Ferri et Ammonii Sul- phatis—Ferric Ammonium Sulphate. XT. 8. P. (Ammonio-ferric Sulphate—Ammonio-ferric Alum.) Origin.—The crystals formed by adding Ammonium Sulphate to a boiling-hot solution of Ferric Sulphate. Description and Properties.—Pale violet, octahedral crystals, odorless, and having an acid, styptic taste; efflorescent on exposure to the air. Soluble in 3 parts of water and in 0.8 part of boiling water; insoluble in alcohol. The product should be kept in well- stoppered bottles. Dose.—5-15 grains (0.5-1.0 Gm.). Ferri et Ammonii Tartras—Ferri et Ammonii Tar- tratis—Iron and Ammonium Tartrate. XT. 8. P. (Ammonio-ferric Tartrate.) Description and Properties.—Thin, transparent scales, varying in color from garnet-red to reddish-brown, without odor, and having a sweetish, slightly ferruginous taste; slightly deliquescent in the air. Very soluble in water; insoluble in alcohol. Iron and ammonium tartrate should be kept in well-stoppered bottles, pro- tected from light. Dose.—10-30 grains (0.6-2.0 Gm.). Ferri et Potassii Tartras—Ferri et Potassii Tar- tratis—Iron and Potassium Tartrate. XT. 8. P. (Potassio-ferric Tartrate.) Description and Properties.—Thin, transparent scales, vary- ing in color from garnet-red to reddish-brown, without odor, and having a sweetish, slightly ferruginous taste; slightly deliquescent in the air. Very soluble in water; insoluble in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose.—5-20 grains (0.3-1.2 Gm.). Ferri Phosphas Solubilis—Ferri Phosphatis Solu- bilis—Soluble Ferric Phosphate. X.8.P. Description and Properties.—Thin, bright-green, transparent scales, odorless, and having an acidulous, slightly saline taste. The salt is permanent in dry air when excluded from light, becoming dark and discolored when exposed to it. Freely and completely HEM A TICS. 187 soluble in water, but insoluble in alcohol. It should be kept in dark amber-colored, well-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). Ferri Pyrophosphas Solubilis—Ferri Pyrophospha- tis Solubilis—Soluble Ferric Pyrophosphate. U. 8. P. Description and Properties.—Thin apple-green, transparent scales, without odor, and having an acidulous, slightly saline taste; permanent in dry air if protected from light, and if exposed to it becoming dark and discolored. Freely and completely soluble in water, but insoluble in alcohol. It should be kept in dark amber- colored, well-stoppered bottles. Dose.—2-5 grains (0.1-0.3 Gm.). Ferri Hypophosphis—Ferri Hypophosphltis—Ferric Hypophosphite. XT. 8. P. Origin.—The precipitate formed by mixing solutions of Sodium Hypophosphites and Ferric Chloride or Ferric Sulphate. Description and Properties.—A white or grayish-white pow- der, odorless and nearly tasteless, permanent in the air. Only slightly soluble in water. It should be kept in well-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). Ferri Valerianas—Ferri Valerianatis—Ferric Valerianate. XT. 8. P. Origin.—The precipitate obtained by adding to a cold solution of Ferric Sulphate or Ferric Chloride a cold solution of Sodium Valerianate. Description and Properties.—A dark, brick-red, amorphous powder, of somewhat varying chemical composition, having the odor of valerianic acid and a mildly styptic taste; permanent in dry air. Insoluble in cold water, but readily soluble in alcohol. Boiling water decomposes it, setting free the valerianic acid and leaving ferric hydrate. It should be kept in small, well-stoppered bottles, in a cool, dark place. Dose.—1-3 grains (0.06-0.18 Gm.). 188 A TEXT-BOOK OF MATERIA MEDICA. Ferri Sulphas—Ferri Sulphatis—Ferrous Sulphate. U. 8. P. Origin.—Obtained by the action of Sulphuric Acid and Water upon Iron Wire. Description and Properties.—Large, pale bluish-green mono- clinic prisms, without odor, and having a saline, styptic taste; efflorescent in dry air; on exposure to moist air the crystals rap- idly absorb oxygen, becoming coated with a brownish-yellow, basic ferric sulphate. Soluble in 1.8 parts of water and in 0.3 part of boiling water; insoluble in alcohol. Dose.—1-3 grains (0.06-0.18 Gm.). Ferri Sulphas Exsiccatus—Ferri Sulphatis Exsic- cati—Dried Ferrous Sulphate. XT. 8. P. Description and Properties.—A grayish-white powder, slowly but completely soluble in water. Dose.—1—2 grains (0.03-0.12 Gm.). Ferri Sulphas Granulatus—Ferri Sulphatis Granu- lati—Granulated Ferrous Sulphate. U. 8. P. Description and Properties.—A pale bluish-green, crystallized powder, which should conform in every respect to the reactions and tests given under Ferri Sulphas in the U. S. P. Dose.—|—3 grains (0.03-0.18 Gm.). Liquor Ferri Subsulphatis—Liquoris Ferri Subsul- phatis—Solution of Ferric Subsulphate. XT. 8. P. (Solution of Basic Ferric Sulphate—Monsel's Solution.) Origin.—An aqueous solution of basic Ferric Sulphate—of varying chemical composition—corresponding to about 13.6 per cent, of metallic iron. Description and Properties.—A dark, reddish-brown liquid, odorless or nearly so, of an acid, strongly styptic taste, and an acid reaction. Miscible with water and alcohol in all proportions, without decomposition. Dose.—1-10 minims (0.06-0.6 Cc), largely diluted—chiefly used, however, as a local styptic. HEMATICS. 189 Liquor Ferri Tersulphatis—Liquoris Ferri Tersul- phatis—Solution of Ferric Sulphate. XT. 8. P. Origin.—An aqueous solution of normal Ferric Sulphate, con- taining about 28.7 per cent, of the salt, and corresponding to about 8 per cent, of metallic iron. Description and Properties.—A dark, reddish-brown liquid, almost odorless, having an acid, strongly styptic taste, and an acid reaction. Miscible with water and alcohol in all proportions, with- out decomposition. Dose.—1-10 minims (0.06-0.6 Cc), given in the same manner and for the same purposes as the preceding preparation. Pilulae Aloes et Ferri—Pilulas (ace.) Aloes et Ferri— Pills of Aloes and Iron. XT. 8. P. Described under Aloes. Dose.—5-10 grains (0.3-0.6 Gm.), or two or three pills. Emplastrum Ferri—Emplastri Ferri—Iron Plaster. XT. 8. P. (Strengthening Plaster.) Formula: Ferric Hydrate, 90; Olive Oil, 50; Burgundy Pitch, 140; Lead Plaster, 720. For external use. Trochisci Ferri—TrochTscos (ace) Ferri—Troches of Iron. XT. 8. P. Composition.—Ferric Hydrate; Vanilla; Sugar; Mucilage of Tragacanth. Dose.—One to two troches, each troche containing 5 grains (0.3 Gm.) of ferric hydroxide. Liquor Ferri Nitratis—Liquoris Ferri Nitratis— Solution of Ferric Nitrate. XT. 8. P. Origin.—An aqueous solution of Ferric Nitrate, containing about 6.2 per cent, of the anhydrous salt, corresponding to about 1.4 per cent, of metallic iron. Description and Properties.—A clear, amber-colored or red- dish liquid, odorless, having an acid, styptic taste, and an acid reaction. Dose.—5-10 minims (0.3-0.6 Cc). 190 A TEXT-BOOK OF MATERIA MEDICA. Pilulae Ferri Carbonatis—Pilulas (ace) Ferri Car- bonatis—Pills of Ferrous Carbonate. XT. 8. P. (Ferruginous Pills—Chalybeate Pills—Blaud's Pills.) Dose.—2 to 5 pills, each pill containing I grain (0.064 Gm.) of ferrous carbonate. Unofficial Preparations. Tinctura FSrri Acetatis—Tinctiirae FSrri Acetatis—Tincture of Ferric Ace- tate, U. S. P.—Composition: Solution of Ferric Acetate; Alcohol; Acetic Ether. Description and Properties.—A clear, dark, reddish-brown liquid, transparent in thin layers, having the odor of acetic ether, an acidulous and astringent taste, and a slightly acid reaction. Miscible in all proportions with water, without becoming turbid. The tincture should be kept in the dark and in a cool place. Dose.—5-30 minims (0.2-2.0 Cc). FSrri Arsenas—FSrri Arsenatis—Iron Arsenate.—Description and Proper- ties.—A green or blue-green, amorphous powder, insoluble in water and in alcohol. Dose.—■£$-? grain (0.003-0.03 Gm.). FSrri Albuminas—FSrri Albuminatis—Albuminate of Iron.—Description and Properties.—Golden yellow, transparent scales, containing 3.34 per cent, of iron. Dose.—5-30 grains (0.3-2.0 Gm.). A liquor and a syrup of albuminate of iron are used. FSrrum Dialysatum—FSrri Dialysati—Dialyzed Iron (Liquor Ferri Dia- lysatus—Liquor Ferri Oxychlorati).—Description and Properties.—Perfectly transparent, thin layers, of a deep brown-red color, inodorous, and almost destitute of styptic taste. Miscible with alcohol, glycerin, syrup, and distilled water, but not with spring-water or other, even dilute, saline solutions. Dose.—10-30 minims (0.6-2.0 Cc). Liquor FSrri Peptonati—Liquoris FSrri Peptonati—Solution of Peptonate of Iron.—Dose, i—2 fluidrachms (2.0-8.0 Cc). Liquor Mangano-FSrri Peptonatus—Liquoris Mangano-FSrri Peptonati (Gude)—Solution of Peptonate of Iron and Manganese.—A proprietary prepa- ration from the formula of Dr. Gude. Dose.—2-4 fluidrachms (8.0-15.0 Cc). Allied Compounds. Haemogallol.— Origin.—Prepared by the action of Pyrogallol on the coloring matter of the blood. Description and Properties.—A reddish-brown, tasteless powder. Dose.—1-8 grains (0.06-0.5 Gm.). Hxmol.—Origin.—Prepared by the action of Zinc Dust on the coloring matter of the blood. Description and Properties.—A blackish-brown powder having a slight taste. Dose.—1-8 grains (0.06-0.5 Gm.). Ferratin.—Origin.—A compound of Iron first obtained by Professor Schmiedeberg from hog's liver. Description and Properties.—A fine, reddish-brown powder containing about 7 per cent, of iron. One variety is insoluble, though the sodium ferratin is freely soluble in water. HEM A TICS. 191 Dose.—10-20 grains (0.16-1.2 Gm.). Haemalbumin.—A preparation said to contain two albuminoids and salts of the blood. Description and Properties.—A permanent powder, soluble in water and in alcohol. Dose.—5-15 grains (0.3-1.0 Gm.). Haemoglobin.—Said to be the coloring principle of the solid elements of the blood. Dose.—1-3 grains (0.06-0.18 Gm.). Haemoferrum.—Claimed to be a natural proteid compound of Iron obtained from bullock's blood. Dose.—1-3 grains (0.06-0.18 Gm.). Iron Quinine Chloride.—A yellowish-red powder, soluble in water, alcohol, and glycerin. Dose.—1-3 grains (0.06-0.18 Gm.). Used externally as a hemostatic. Antagonists and Incompatibles.—The ferric salts are incom- patible with tannic and gallic acids and vegetable astringents, and gelatinize mucilage of acacia. The carbonates are also incompatible with tannic and mineral acids and acidulous salts. The salts of the vegetable acids and the iodides are incompatible with mineral acids, tannic acid, and with alkalies and their carbon- ates. The tincture of the chloride of iron is also incompatible with tannic acid, vegetable astringents, alkalies and their carbon- ates, lime water, and the carbonates of calcium and magnesium, Synergists.—All the restorative medicines are synergistic. Physiological Action.—Iron is a typical restorative, being an essential element of the blood, there being 1 part of iron to 230 of red globules. It has also been found in the gastric juice, bile, lymph, chyle, milk, urine, pigment of the eye, etc. This omni- presence is readily accounted for when it is remembered that the food of man contains iron in variable quantities. Indeed, this use- ful metal may well be called a respiratory nutrient because of its property of increasing the oxygen-carrying power of the red blood- corpuscles—muscular force and functional activity generally being dependent upon the supply of oxygen, or proper respiration, as the motive power. When the system is in a normal, healthy condition, sufficient iron is furnished by the mixed diet to answer all physiological requirements. In many diseased conditions, however, there is a deficiency of iron, and it is necessary to restore this element in one way or another. The chief actions of iron are—I. To increase the oxygen- carrying powers of the blood; 2. To convert the oxygen present in the tissues into ozone; 3. To serve both as a local and general astringent. 192 A TEXT-BOOK OF MATERIA MEDICA. The physiological effects upon the various systems, locally and internally, now to be considered, are due directly or indirectly to the principal actions above mentioned. Externally and Locally.—Neither the ferric nor the ferrous salts exert any action upon the unbroken skin. When applied, however to mucous membranes or denuded surfaces, they are astringent and hemostatic, the ferric salts being the more powerful, coagulating albuminous fluids. When applied to bleeding surfaces the hemo- static action is due rather to the coagulation of the blood, forming a natural barrier to its escape, than to any direct action upon the walls of the; vessels. The vegetable salts—scale preparations- possess so feeble astringent properties that they are rarely, if ever, used as local applications. The acid and astringent preparations of iron act upon the teeth. The ferric oxides are disinfectant, owing to their property of con- verting oxygen into ozone. Internally.—Digestive System.—The teeth and tongue are black- ened by the preparations of iron. In the stomach, when not con- traindicated and in small doses, its slightly irritant and astringent properties render iron quite a valuable stomachic tonic. Under excessive doses or prolonged administration the acid preparations especially are apt to cause gastric derangement—anorexia, nausea, and serious indigestion. The ferric chloride is particularly valu- able in that its ingestion does not, like that of other preparations of iron, diminish the supply of hydrochloric acid in the gastric juice. The scale salts, though disturbing the digestion less than the acid preparations, are ordinarily inferior to the latter. All the preparations of iron are probably converted into the chloride in the stomach. When entering the intestines they are converted into the ferric oxide, ferrous chloride, the alkaline albu- minate, and the insoluble sulphide and tannate. Most of the iron preparations are constipating, the phosphate and pyrophosphate being exceptions. They tend to diminish the bile and the secre- tions from the gastro-intestinal tract. Circulatory System.—The action of iron upon the blood is of great importance, since, the metal being a normal constituent of that fluid, its administration has a nutrient as well as a medicinal influence. A primary effect is to supply a deficiency of red cor- puscles and bring the hemoglobin up to the normal standard. Iron enables the red corpuscles to convey more oxygen to the tissues, converting that element into ozone and thereby rendering it HE MA TICS. 193 more active in promoting oxidation. The muscular power of the heart is increased, the arterioles slightly contracted, and arterial tension somewhat raised. Nervous System.—The general effect is tonic, the influence of iron and its salts being highly beneficial in strengthening the action of the nerves in cases of physical debility. With subjects inclined to plethora, however, certain untoward symptoms may result from administration of the stronger preparations, including a feeling of congestion in the cerebrum. Respiratory System.—No immediate action is perceptible under normal conditions, but in anemic states, by supplying the nerve- centers, muscles, and lungs with better blood, the respiratory power is increased. Absorption and Elimination.—Opinions differ regarding the form in which iron is absorbed. Probably much of it is converted into the soluble chloride and absorbed as such, while a portion, passing into the intestines, may there be converted into the insoluble alka- line albuminate capable of absorption. The larger portion of iron taken into the system, however, is changed into the insoluble sul- phide and tannate, and excreted as such, giving to the feces a black color. Such part of the iron as enters the circulation com- bines with the red corpuscles. The salts of the organic acids are absorbed directly into the blood. Such careful pharmacologists as Bunge, Schmiedeberg, and Hamburger claim that inorganic preparations of iron are neither absorbed nor assimilated, maintaining that the blood and hemo- globin are influenced only by the organic compounds. Yet, not- withstanding these statements, clinical experience has fully demon- strated the value of such preparations as reduced iron, tincture of the chloride, carbonate, etc.; and it is still perhaps a mooted ques- tion whether appreciable amounts of them are actually absorbed, or whether, according to Bunge, the inorganic prevent the decom- position of the organic salts of iron in the food by fixing the decomposing agents in the intestines. At all events, the beneficial results in anemia and chlorosis of large doses of the inorganic preparations are too manifest to justify abandonment of these agents because of our ignorance touching their modus operandi. Bunge's hypothesis would at least seem plausible when it is remembered that only traces of iron can be found in the urine when the drug is given by the stomach, while if injected into the circulation large quantities are eliminated by the kidneys. It is 13 194 A TEXT-BOOK OF MA TERIA MEDICA. quite possible that the improvement in the red corpuscles, and the promotion of oxidation independent of them, take place in the portal circulation, and that when the iron reaches the liver it is there intercepted and, together with the bile, turned back into the intestines. The amount of urea is increased and micturition rendered more frequent by preparations of this metal. Elimination takes place chiefly by the feces, to which a blackish color is imparted by the formation of ferrous sulphide. The bile, urine, and even the skin, as well as the mucous and serous mem- branes, share in the excretory process. Temperature.—The administration of iron tends to raise bodily heat. This, however, may be due only to the normal influence of the metal, the ozonizing power of which, affecting the promo- tion of tissue-waste, naturally causes an elevation of temperature. Untoward Action.—The continued use of ferruginous prepara- tions has a tendency to impair the normal digestive powers, occa- sioning even gastric oppression, nausea, and vomiting. Reduced iron, the phosphate, and the pyrophosphate produce less untoward action than other preparations, and the ferrous are better tolerated than the ferric salts. Not infrequently acne of the face, breast, and back is occasioned, while the prolonged administration of the drug may in rare cases be accompanied by hemorrhages from the mucous membranes and symptoms of plethora and vascular excitement. Large doses of the ferrous sulphate may occasion obstruction of the bowels. Poisoning.—The ferric preparations in a concentrated form pro- duce all the symptoms of an irritant poison—gastric pain, vomit- ing, etc. Treatment of Poisoning.—The stomach should be emptied by an emetic or carefully cleansed, the treatment being followed by the administration of alkali solutions, tannic acid, and demulcent drinks, the procedure being similar to that employed in poisoning from mineral acids. Therapeutics.—Externally and Locally.—The astringent and styptic properties of chlorides and sulphates of iron have rendered them serviceable in controlling hemorrhage and as local astrin- gents in relaxed conditions of the pharynx and larynx and mucous membranes generally. The tincture of the chloride has been highly recommended as a local application to the throat in diph- theria, and chronic and indolent ulcers may often be benefited by HE MA TICS. J95 awash containing from 2 to 5 grains (0.12-0.3 Gm.) of the sulphate to 1 ounce (30.0 Cc.) of water. Internally.—The most important use of iron is to restore the number of red corpuscles. In nearly every form of anemia, there- fore, iron is indicated. In chlorosis, especially, it is of great value; but in order that its effects may be most beneficial, cathartics, such as rhubarb and aloes, which do not weaken the intestines should accompany its use. Even the anemia due to hemorrhage calls for iron; yet if the assimilative functions are not impaired, the drug should be reinforced by plenty of nutritious food, from which the constituents of the blood are normally elaborated. The anemia of scrofula and syphilis is benefited by some form of iron, care being taken in these cases to select the proper salts. In glandular scrofula, for instance, the iodide is to be preferred, and, theoretically, this salt is preferable also in syphilis, yet in the latter disease the efficacy of the salt depends less upon its particular radical than upon its restorative properties and its power of counter- acting the depressing and mischievous effects so often produced by excessive use of the specific. In the desquamative forms of Bright's disease iron is of signal benefit. In this condition the blood-disks are rapidly destroyed by the urea; moreover, certain preparations of iron possess quite a local action upon the kidney. Iron is also useful in jaundice where there is more or less cholemia, with destruction of the red corpuscles. Many nervous disorders dependent upon anemia are relieved by iron. Even in chorea and various neuralgias—especially those of an intermittent nature arising from an impoverished state of the blood—iron is of decided value. In many chronic nervous diseases, however, good judgment in the use of the drug is necessary, lest it prove more prejudicial than advantageous. In anemia of certain cardiac diseases iron is of unquestioned value, though the fact is well known to observant practitioners that in these cases iron alone is but a single element in the successful treatment of them. While iron is of great service in lessening the muco-purulent expectoration of chronic bronchitis, its influence in pulmonary tuber- culosis is less favorable. At times, it is true, the drug appears to improve the condition of phthisical patients, yet more frequently it induces hemoptysis and hastens the progress of the disease. In -certain disorders of the genito-urinary tract—prolapsus uteri, incon- 196 A TEXT-BOOK OF MATERIA MEDICA. tinence of urine, seminal emissions, prostatorrhea, etc.—iron is an appropriate remedy. It is an important agent in the treatment of diabetes, though care should be taken to guard against its tendency to constipate the bowels. As observed later on, iron is contraindicated in febrile diseases, yet it is a matter of clinical experience that the drug acts favorably in modifying the course of idiopathic erysipelas, pyemia, septicemia, and diphtheria. The astringent action of iron is available in the treatment of vaginal leucorrhea, hematcmesis, and passive hemorrhages from the uterus, bladder, kidneys, etc. It has also proved highly beneficial in certain forms of chronic diarrhea and dysentery. In amenorrhea and menorrhagia, when due to a deficiency of normal blood, iron is an extremely valuable remedy. Contraindications.—Iron is usually contraindicated in fever and acute inflammatory conditions, in anemia of malignant disease, such as cancer, in Addison's disease, and in the hemorrhagic diath- esis. Should the use of iron derange digestion or aggravate hemorrhoidal conditions, the drug should be discontinued or care- fully administered, being associated with stomachics or laxatives to mitigate its untoward effects. Administration.—If the appetite be poor, iron should be ad- ministered in small doses (invariably after meals) or preceded by vegetable bitters. The tincture of the chloride and the stronger preparations should be freely diluted with water. The citrate of iron is a mild preparation well adapted for children and persons of delicate stomach. Probably the salt richest in iron, yet of all the ferruginous preparations the most agreeable and least irritating, is the iron and potassium tartrate. The soluble ferric pyrophosphate is also a mild and pleasant preparation. The compound iron mixture pos- sesses special advantages in the treatment of chlorosis and chronic diseases of the skin, while the solution of iron and ammonium acetate (Basham's mixture) is the best preparation in albuminuria— particularly that accompanying tubular nephritis—it being agree- able and well tolerated. The best styptic is the ferric subsulphate or its solution. Dialyzed iron, being agreeable to the taste, was formerly a pop- ular remedy. Some of the allied compounds above mentioned are very useful. The ferratin especially is a most valuable compound of iron, while HE MA TICS. 197 the liquor mangano-ferri peptonatus is an agreeable and efficient remedy, having no deleterious effect upon digestion, but, on the contrary, actually improving the appetite. Manganum—Mangani—Manganese. This metal is a normal constituent of the body, existing in ap- preciable though minute quantities in the blood, bile, etc. From the fact of its presence in the blood, and because of the similarity of its chemical affinities to those of iron, theorists, rather than careful and practical observers, have advocated its use as a worthy and efficient substitute for the latter agent. Its therapeutic uses as a restorative, or as an alternative or synergist to iron, are based more upon abstract deductions than upon clinical observation. Still, as its chemical character resem- bles that of iron—though the metal in its operation is often antagonistic to the latter—its salts are of sufficient therapeutic importance to merit brief mention here. Mangani Dioxidum—Mangani Dioxidi—Manganese Dioxide. XT. 8. P. (Black Oxide of Manganese.) Origin.—Native, crude manganese dioxide, containing at least 66 per cent, of the pure dioxide. Description and Properties.—A heavy, grayish-black, more or less gritty powder, without odor or taste; permanent in the air; insoluble in water or alcohol. Dose.—5-40 grains (0.3-3.0 Gm.). Mangani Sulphas—Mangani Sulphatis—Manganese Sulphate. XT. 8. P. Origin.—Obtained by heating Manganese Dioxide with suf- ficiently strong Sulphuric Acid, evaporation, and crystallization. Description and Properties.—Colorless or pale rose-colored, transparent, tetragonal prisms, odorless, and having a slightly bitter and astringent taste; slightly efflorescent in dry air. Soluble in 0.8 part of water and in 1 part of boiling water; insoluble in alco- hol. Manganese sulphate should be kept in well-stoppered bottles. Dose.—2-5 grains (0.1-0.3 Gm.). (For Potassium Permanganate see section on Antiseptics') Antagonists and Incompatibles.—The salts of lead, silver, and mercury are incompatible with manganese. 198 A TEXT-BOOK OF MATERIA MEDICA. Synergists.—Iron is theoretically synergistic, and the salts of zinc, copper, and silver are similar in their action on the nervous system. Physiological Action.—Externally and Locally.—The two salts above mentioned have no important local action. Internally.—In large doses these salts, especially the sulphate, irritate the gastro-intestinal tract, while excessive doses may even occasion gastro-enteritis. The sulphate acts as an emeto-cathartic and possesses cholagogue properties. As is the case with . many other drugs of this character, small doses may even promote the appetite and improve the digestive function. Large doses, or the continued administration of these preparations, affects the system more like zinc than iron, pro- ducing great depression, muscular weakness and waste, diminishing the pulse-beat, weakening the heart, and lowering arterial tension. There is, moreover, a tendency to fatty degeneration of the muscles and liver. Therapeutics.—The manganese dioxide has been used in the treatment of gastralgia, pyrosis, and simple ulcer of the stomach. Its action probably resembles that of bismuth, though it is a much less efficient remedy than the latter drug. The sulphate is used occasionally as a cholagogue purgative in malarial jaundice, although why it should be preferred to many other and superior cholagogues it is difficult to understand. Gouty dyspepsia appears to have been much improved by the use of manganese. The association of iron and manganese makes a valuable combination in the treatment of chlorosis and many variations of anemia. Phosphorus—Phosphori—Phosphorus. XT. 8. P. Origin.—It exists, chiefly as phosphates, in many minerals and in all plants and animals. It is prepared by treating Calcined Bones with Sulphuric Acid, evaporation, and distillation. Description and Properties.—A translucent, nearly colorless solid, of a waxy luster, having at ordinary temperatures about the consistence of beeswax. When kept for some time the surface becomes red and occasionally black. Phosphorus has a distinctive and disagreeable odor and taste (tasting being allowable only in the form of extreme dilution). When exposed to the air it emits white fumes, visible in the dark, and having an odor somewhat resembling HEM A TICS. 199 that of garlic. Upon prolonged exposure to air it takes fire spon- taneously. Phosphorus is insoluble, or nearly so, in water, to which, how- ever, it imparts its characteristic disagreeable odor and taste. It is soluble in 350 parts of absolute alcohol, in 80 parts of absolute ether, and in about 50 parts of any fatty oil. It is very soluble in chloroform or in carbon disulphide, the latter yielding a solution to be handled with the greatest care to prevent accident from combus- tion. The drug should be carefully kept under water, in strong, well-closed vessels, in a secure and moderately cool place protected from light. Dose.—i \ 0 3*0 grain (0.0006-0.002 Gm.). Official Preparations. Oleum Phosphoratum—Olei Phosphorati—Phosphorated Oil.—Dose, 1-5 minims (0.06-0.3 Cc). A clear, yellowish liquid, having the odor of phosphorus and of ether, but not phosphorescent in the dark. It should be perfectly free from particles of undissolved phosphorus. Pilulae PhSsphori—Pllulas (ace) PhOsphori—Pills of Phosphorus.—Dose, one to two pills. Each pill contains T-lg grain (0.0006 Gm.) of phosphorus. Spiritus Phbsphori—Spiritus Ph6sphori—Spirit of Phosphorus (Tincture of Phosphorus).—Dose, 5-30 minims (0.3-2.0 Cc). Elixir Ph&sphori—Elixir Phbsphori—Elixir of Phosphorus.—Dose, \-2 fluid- drachms (2.0-8.0 Cc). Antagonists and Incompatibles.—The principal chemical anti- dotes are hydrated magnesia, lime water, powdered charcoal, cop- per sulphate, and old acid turpentine. Synergists.—Cod liver oil and the Restoratives generally aid the action of phosphorus. It is claimed that arsenic and sulphur are also synergistic. Physiological Action.—Externally and Locally.—Applied to the skin, phosphorus causes local inflammation, ulceration, and possibly gangrene. The fumes may produce the most serious results—even maxillary necrosis where dental caries is present, as well as great irritation of the conjunctivae arid the respiratory mucous membrane. The graver systemic symptoms are confined to the conditions induced by toxic doses of the drug. Internally.—Digestive System.—Taken into the stomach, no special effect is apparent as a result of small doses, save that the drug acts as a functional stimulant. Larger amounts have been held to impede digestion by impairing the action of the gastric juice upon albuminoid materials. Immoderate doses occasion A TEXT-BOOK OF MATERIA MEDICA. great irritation of the stomach and intestines, accompanied. by abdominal distress, vomiting, and purging. Jaundice is a not infrequent result of ingestion, due to obstruction of the biliary ducts. Minute quantities stimulate the nutrition of the tissues especially that of the osseous system. Circulatory System.—The primary action is stimulating, the pulse rising and acquiring additional force, though not firmness. The facial capillaries are expanded, often congested; the cutaneous circulation becomes more rapid; and diaphoresis is produced. Under toxic doses the action of the heart is strongly depressed. Nervous System.—In repairing the waste of tissue phosphorus acts upon the nervous system as a tonic, improving the nutrition of debilitated parts and restoring to normal conditions the func- tional activity of organs and tissues. Small or moderate doses act as -stimulants to the entire nervous system, intellectual activity being promoted and the sexual appetite increased. Toxic effects include coma, and occasionally vertigo, with delirium, convulsions, insensibility, and collapse. Respiratory System.—The deleterious action of the fumes of phosphorus is exemplified in their irritating effect upon the broncho- pulmonary mucous membrane. Toxic symptoms are often accom- panied by serious disturbances, respiratory failure being among the immediate causes of death. Absorption and Elimination.—The modus operandi of absorption is a matter of some dispute. Probably a portion of the drug undergoes oxidation in the stomach, and the phosphoric acid formed, combining with the alkalies, enters the blood as phos- phates. A part of the phosphorus is dissolved in the fats and oils present in the stomach, probably entering the circulation as ele- mentary phosphorus. The drug, having undergone oxidation in the system, is elim- inated as phosphoric acid, chiefly by the urine, increasing the excretion of urinary phosphates. f The liver shares in the excretory process. Temperature.—Owing to capillary expansion, the superficial temperature is at first slightly raised, being subsequently dimin- ished. Evaporation and radiation, arising from profuse diaphoresis, contribute to thermal reduction. Eye.—In chronic poisoning from phosphorus hemorrhages and patches of degeneration in the retina are sometimes visible, the ophthalmoscopic picture resembling the retinitis of albuminuria. HEM A TICS. 201 Under medicinal doses no special effects upon the eye are reported, although, as has been stated, the vapor of phosphorus is highly irritant to the conjunctivae. Uterus.—The action of phosphorus tends to increase the men- strual flow. Untoward Action.—Small doses produce in some individuals severe gastric disturbance, and in rare cases diarrhea, tenesmus, and jaundice. The fatty degeneration of the retinal capillaries mentioned above—such as results from chronic intoxication affect- ing workers in match-factories—is an untoward manifestation to be guarded against by every available means. Poisoning.—The effects of a fatal dose of phosphorus are not immediate. After a lapse of several hours great weakness occurs, accompanied in a large majority of cases by vomiting. Abdominal pains follow, the symptoms becoming more acute, mucus and bile being present in the ejecta, which for a while retain the odor and luminosity of phosphorus. With the cessation of vomiting pain is abated, although it may extend over the entire abdominal region and even be attended with paroxysms. The foregoing symptoms are accompanied by pronounced anorexia, thirst and fever, a thickly-coated or whitish tongue, burning in the throat, and often signs of collapse. The temper- ature at first reaches nearly the maximum possible without proving fatal, subsequently sinking below the normal. After a few days jaundice sets in. The urine is diminished, becoming charged with albumin and urates, and even bloody, containing among other ingredients biliary acids and coloring matter. In fatal cases urea is almost wholly wanting. The stools may be normal, but the general condition is usually marked by diarrhea or constipation and flatulence. Hemorrhage often occurs, wounds bleeding pro- fusely, and as the severity of the symptoms increases delirium ensues, or coma terminating in convulsions. Serious nervous manifestations are frequently preceded by restlessness, insomnia, headache, and vertigo. In some delirious conditions wild, erotic states of the mind are the precursors of convulsive or comatose symptoms. Somnolence is not uncommon, with partial spasms and contraction or paresis of the voluntary muscles. Post-mortem examinations show that the liver, heart, kidneys, muscles, capillaries, and arterioles are implicated in the general effects of the poisoning, undergoing fatty degeneration. Sometimes the preponderating influence of the poison affects 202 A TEXT-BOOK OF MA TERIA MEDICA. the bronchial and gastro-intestinal mucous membranes, or it may visit the nervous system or be manifested in the circulatory sys- tem. In cases of acute poisoning the duration of the malady varies greatly, death occurring at times within a few days, or, again, being deferred for a few weeks. As a rule, recovery is retarded, the elimination of the drug requiring time. The symptoms of chronic poisoning are in some respects espe- cially marked, inhalation of phosphorus-fumes frequently resulting in pronounced conditions of necrosis, particularly of the lower max- illary, although it has been maintained that this feature of the poi- soning is contingent upon denuded surfaces of bone, disintegration or softening of tissues, caries of the teeth, or communicating wounds. Very rarely the palate and frontal bones are similarly attacked. Treatment of Poisoning.—Emetics and purgatives are of the first necessity. Copper sulphate is the most efficient emetic as well as the best chemical antidote. Hydrated magnesia, charcoal, and lime water have been suggested, yet their action is tardy, and a more efficient antidote is desirable. Several chemical and physio- logical agents have been employed to counteract the effects of the drug, among them old acid (oxygenated) oil of turpentine and potassium permanganate in a \ per cent, solution, opium being used as a stimulant to the heart and the circulatory system. As prophylactic measures for the protection of workmen against phosphor-necrosis masks covering mouth and nose have been found serviceable, as well as inhalation of the vapor of turpentine obtained by suspending a small bottle of the fluid about the neck. The teeth should be kept constantly in good condition, since caries favors the tendency to necrosis. Therapeutics.—Phosphorus is not used externally, but inter- nally it is a food, especially of the nervous and osseous systems, stimulating protoplasmic activity, although, according to Gubler, " phosphorus is a rapid stimulant, but it acts by causing waste, and not by increasing power; it impoverishes, and does not enrich; it momentarily galvanizes, as it were, the torpid functions, but is incapable of renewing a dilapidated constitution or even a nervous system exhausted by chronic disease." Clinical experience has certainly demonstrated its utility as a nutrient tonic to the nervous and osseous tissues. In neurasthenia and chronic nervous exhaustion it is highly efficacious. Paraplegia, particularly when resulting from excessive venery, is usually bene- fited by this drug, while the cases of locomotor ataxia improved by HEM A TICS. 203 phosphorus are numerous enough to deserve special consideration. Neuralgia, particularly of the fifth nerve and accompanied by great debility, is relieved by full doses administered every four hours. It is claimed by competent observers that certain cases of angina pectoris have been completely relieved by phosphorus. It has even been recommended in epilepsy, but its value here becomes more than doubtful when no mention of it is made by the best authorities on this disease. In paralysis resulting from cerebral hemorrhage it has been found beneficial. It has proved of great value in osteomalacia and rachitis, and the drug is credited with the cure of pernicious anemia, though it is singular, if the drug possesses any real value in this disease, that the fact has been recognized by so few observers. Such able men as Fox and Broadbent praise its efficacy in lymphadenoma. The insomnia of the aged and the wakefulness of cerebral anemia and exhaustion usually yield to this remedy. As to its aphrodisiac effects there is great difference of opinion, some physicians believing it to be a most powerful agent in reliev- ing functional impotence, while others—among them so enthusiastic an advocate of phosphorus as Thompson—conclude that the drug is inefficient for this purpose unless given in larger doses than safety prescribes. The enthusiastic praise of its eulogists, however, as a remedy in impotence of a functional character is of so con- vincing a nature as to certainly justify an extended trial in this condition. Scarcely less is the testimony regarding its efficacy in chronic psoriasis, lepra, lupus, and acne indurata'. Administration.—Since many persons have a peculiar suscepti- bility to phosphorus, its administration should begin with small doses, and, should it be thought necessary to prolong the adminis- tration for an indefinite period, the tendency of the drug to produce general steatosis should not be forgotten. The phosphorus pill is undoubtedly the best form in which to administer the drug, though it possesses the disadvantages of being insoluble in the intestinal fluids and of producing more or less irritation of the gastro-intestinal mucous membrane, though the latter effect is usually unnoticed under ordinary medicinal dosage on a full stomach. The liquid preparations of phosphorus are more unstable, tending to become rapidly inert by oxidation. The spirit of phosphorus is sometimes given in cod liver oil or the elixir of calisaya. 204 A TEXT-BOOK OF MATERIA MEDICA. Calcii Hypophosphis—Calcii Hypophosphitis—Cal- cium Hypophosphite. XT. 8. P. Origin.—Obtained by heating Phosphorus with Milk of Lime and exposing the mixture to the air. Description and Properties.—Colorless, transparent, mono- clinic prisms, or small, lustrous scales, or a white, crystalline powder; odorless, having a nauseous, bitter taste, and permanent in the air. Soluble in 6.8 parts of water and in 6 parts of boiling water; insoluble in alcohol. Dose.—5-6 grains (0.3-0.4 Gm.). Calcii Phosphas Praecipitatus—Calcii Phosphatis Prsecipitati—Precipitated Calcium Phosphate. XT. 8. P. Origin.—Prepared by the action of Hydrochloric Acid and Water upon Bone-ash, the addition of Solution of Ammonia to render the mixture of an alkaline reaction, and washing and drying the precipitate. Description and Properties.—A light, white, amorphous pow- der, odorless and tasteless, permanent in the air. Almost insoluble in cold water; partly decomposed by boiling water, which dissolves out an acid salt; almost insoluble in acetic acid, except when freshly precipitated; easily soluble in hydrochloric or nitric acid; insoluble in alcohol. Dose.—10-30 grains (0.6-2.0 Gm.). Sodii Hypophosphis—Sodii Hypophosphitis— Sodium Hypophosphite. XT. 8. P. Origin.—Prepared by adding Sodium Carbonate to a solution of Calcium Hypophosphite and evaporating the filtrate. Description and Properties.—Small, colorless, transparent, rec- tangular plates of a pearly lustre, or a white, granular powder, odorless, and having a bitterish-sweet, saline taste. Very deliques- cent on exposure to moist air. Soluble in 1 part of water and in 30 parts of alcohol, also in 0.12 part of boiling water and in 1 part of boiling alcohol; slightly soluble in absolute alcohol; insoluble in ether. Sodium hypophosphite should be kept in well-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). HE MA TICS. 205 Potassii Hypophosphis—Potassii Hypophosphitis— Potassium Hypophosphite. XT. 8. P. Origin.—Prepared in a similar manner to Calcium Hypophos- phite, or by double decomposition of Calcium Hypophosphite and Potassium Carbonate. Description and Properties.—White, opaque, hexagonal plates, or crystalline masses, or a granular powder, odorless, and having a pungent, saline taste; very deliquescent. Soluble in 0.6 part of water and in 7.3 parts of alcohol. Potassium hypophosphite should be kept in well-stoppered bottles. Dose.—5-30 grains (0.3-2.0 Gm.). Acidum Hypophosphorosum Dilutum—Acidi Hypo- phosphorosi Diluti—Diluted Hypophosphorous Acid. XT. 8. P. Origin.—Prepared by decomposing Potassium Hypophosphite by Sulphuric Acid, filtering, and evaporating to a syrupy consist- ence. It contains 10 per cent, by weight of absolute hypophos- phorous acid. Description and Properties.—A colorless liquid, without odor, and having an acid taste. Specific gravity about 1.046. Miscible in all proportions with water. Dose.—It is never used as a therapeutic agent by itself, but in the syrup of the hypophosphites. Syrupus Hypophosphitum—Syrupi Hypophosphi- tum—Syrup of Hypophosphites. Formula: Calcium Hypophosphite, 45 ; Sodium Hypophos- phite, 15; Potassium Hypophosphite, 15; Diluted Hypophos- phorous Acid, 2; Spirit of Lemon, 5; Sugar, 500; sufficient Water to make 1000. Dose.—1-2 fluidrachms (4.0-8.0 Cc). Syrupus Hypophosphitum cum Ferro—Syrupi Hy- pophosphitum cum Ferro—Syrup of Hypophos- phites with Iron. Formula: Ferrous Lactate, 10; Potassium Citrate, 10; Syrup of the Hypophosphites, to 1000. Dose.—1-2 fluidrachms (4.0-8.0 Cc). 206 A TEXT-BOOK OF MATERIA MEDICA. Zinci Phosphidum—Zinci Phosphidi—Zinc Phosphide. XT. 8. P. Origin.—Prepared from Vapor of Phosphorus in a current of Dry Hydrogen over heated Zinc, after all atmospheric air has been expelled. Description and Properties.—A gritty powder of a dark-gray color, or crystalline fragments of a dark, metallic luster, and having a faint odor and taste of phosphorus. In contact with air it slowly emits phosphorous vapor. Insoluble in water or alcohol. Zinc phosphide should be kept in small glass-stoppered bottles. Dose.—y1^—\ grain (0.004-0.02 Gm.). Antagonists and Incompatibles.—The sodium and potassium hypophosphites are incompatible with the soluble salts of mercury and silver, and the soluble phosphates and carbonates are incom- patible with calcium hypophosphite. Zinc phosphide is decom- posed by mineral acids. Synergists.—Phosphorus, cod liver oil, and the Restoratives generally. Physiological Action.—Although not possessing the active and poisonous properties of phosphorus, the hypophosphites are similar in their effect to small doses of phosphorus—i. c. in stimu- lating and regenerating the nervous system and those tissues which contain phosphorus and lime. The calcium phosphate possesses no action superior to that of the hypophosphite, and its virtues are chiefly those of the hypo- phosphite. The phosphate is soluble to a slight extent in lactic and hydro- chloric acids, so that when taken by the stomach a portion diffuses into the blood. The zinc phosphide is more active, and resembles more closely the action of phosphorus, and in too large doses it irritates the stomach in the same manner as uncombined phosphorus. Therapeutics.—Externally and Locally.—The calcium phos- phate, combined with a little free phosphoric acid, has been recommended by Doubenski in the treatment of tuberculous ulcera- tions. "Cold abscesses and fistulous tracts were treated by packing with gauze soaked with a solution of 5 parts to 100." Internally.—The hypophosphites may be employed for the same conditions as those in which phosphorus is used. In chlorosis, anemia, scrofula, and tuberculosis they have been highly recom- mended. In the author's opinion, in the cachexiae mentioned the HE MA TICS. 207 benefit derived from their use is slight compared with that of cod liver oil and the hygienic influences rendered serviceable in these conditions. The praise bestowed upon calcium phosphate consists largely of assertions rather than evidence: if it possesses any therapeutic value, it is chiefly that of the hypophosphite. The zinc phosphide has medicinal virtues greatly superior to those of the preparations above mentioned. In nervous disorders dependent upon defective nutrition it is equal, if not superior, to phosphorus, and it may be employed for any condition in which the latter drug is useful. Administration.—The zinc phosphide is best given in pill form. The hypophosphites and calcium phosphate may be given in cap- sules, though the syrup of the hypophosphites is usually preferred. It is a question whether the sugar which the syrup contains may not tend to induce or aggravate the gastric fermentation so often present in cases requiring the use of a reconstituent Cinchona—Cinchonae—Cinchona. XT. 8. P. Origin.—The bark of Cinchona Calisaya Weddell, Cinchona officinalis L., and of their hybrids and those of other species of Cinchona, yielding, when assayed by the process given in the U. S. Pharmacopoeia, " not less than 5 per cent, of total alkaloids and at least 2.5 per cent, of quinine." The genus Cinchona as at present constituted consists of from thirty-one to thirty-six species, all of which are native to South America. The habitat of the tree follows the eastern slope of the Andes, beginning in Bolivia and extending through Peru. From about 2° south lati- tude in Ecuador it occupies also the eastern slope of the Western Cordilleras, until by two narrow belts it enters the highlands of New Granada, whence it spreads northeast and northward into Venezuela, reaching the vicinity of Caracas and the Caribbean Sea. The climate in which the most valuable species are found is, according to Karster (1858), characterized by a rainy season lasting for nine months, heavy rains falling principally during the night, alternating with sunshine and fog during the day. During the remaining three months of the year the nightly temperature fre- quently sinks below freezing-point, in the day-time, however, reaching 25 ° C. (yy° F.), producing dense fogs. The Cinchonas are evergreen trees or shrubs, the most valuable 208 A TEXT-BOOK OF MATERIA MEDICA. species attaining a height of from 40 to 80 feet (12 to 24 M.). They are not met with in the valleys, but are found at altitudes varying from 330 feet (100 M.) to 11,500 feet (3500 M.). Accord- ing to Weddell, the most valuable species grow at an altitude of 5300 to 7900 feet (1600 to 2400 M.). All the species are found in the primeval forests, either singly or in collections of a few specimens. The tree is cultivated in British Sikkin, Ceylon, Java, and Jamaica. Description and Properties.—In quills or in curved pieces, varying in length, and usually -^ or \ inch (2 or 3 Mm.), or some- times \ inch (5 Mm.), thick; the outer surface covered with a gray or brownish-gray cork, usually slightly wrinkled, marked wjth transverse and also intersecting longitudinal fissures (C. Calisaya), and sometimes with scattered warts and slight longitudinal ridges; inner surface light cinnamon-brown, very highly striate; fracture of the outer layer short and granular, finely fibrous in the inner layer; powder light- or yellowish-brown; odor slight, somewhat aromatic; taste bitter and somewhat astringent. Cinchona Rubra—Cinchonae Rubra—Red Cin- chona. XT. 8. P. Origin.—The bark of Cinchona succirubra Pavor, containing not less than 5 per cent, of its peculiar alkaloids. Description and Properties.—In quills or in curved pieces, varying in length, and from -^ to ^ or \ inch (2 to 4 or 5 Mm.) thick; the outer surface covered with a grayish-brown cork, more or less rough from warts and longitudinal warty ridges, and few, mostly short, transverse fissures; inner surface more or less deep reddish-brown and distinctly striate; fracture short-fibrous in the inner layer; powder reddish brown; odor slight; taste bitter and astringent. Among the various alkaloids found in cinchona the following are the most important: Quinine, quinidine, cinchonine, and cin- chonidine, the medicinal value of the bark depending almost exclu- sively upon the alkaloid quinine. Other less important ingredients are kinic and kinovic acids, kinovin, cinchotannic acid, cinchona-red, and a minute quantity of a butyraceous, volatile oil. The ash amounts to between 1 and 2 per cent, consisting chiefly of the carbonates of calcium and potas- sium. Dose of powdered cinchona, 15-60 grains (1.0-4.0 Gm.). HEM A TICS. 209 Official Preparations of Cinchona. Extractum Cinchonae—Extracti Cinchonae—Extract of Cinchona.—Dose, 5- 30 grains (0.3-2.0 Gm.). Extractum Cinchonae Fliiidum—Extracti Cinchonae Fluidi—Fluid Extract of Cinchona.—Dose, 10-60 minims (0.6-4.0 Cc.). Infusum Cinchonae—Infusi Cinchonae—Infusion of Cinchona (6 per cent.).__ Dose, 1-4 fluidrachms (4.0-15.0 Cc). Tinctura Cinchonae—Tinctiirae Cinchonae—Tincture of Cinchona (20 per cent.).—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Official Preparation of Cinchona Rubra. Tinctura Cinchonae Comp6sita—Tinctiirae Cinchonae Compftsitae—Com- pound Tincture of Cinchona (10 per cent., with Bitter Orange Peel 8 per cent., and Serpentaria 2 per cent.).—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Official Alkaloids and Salts. Cinchonidinae SQlphas—Cinchonidinae Sulphatis—Cinchonidine Sulphate. —Description and Properties.—White, silky, acicular crystals, without odor and having a very bitter taste; slightly efflorescent on exposure to air. Soluble in 70 parts of water and in 66 parts of alcohol. Dose.—10-30 grains (0.6-2.0 Gm.). Cinchonina—Cinchoninae—Cinchonine.—Description and Properties.__White lustrous prisms or needles, without odor, at first almost tasteless, but soon developing a bitter after-taste; permanent in the air; soluble in 3760 parts of water and in 116 parts of alcohol. Dose.—5-30 grains (0.3-2.0 Gm.). Cinchoninae Sulphas—Cinchoninae Sulphatis—Cinchonine Sulphate.__ Description and Properties.—Hard, white, lustrous, prismatic crystals, without odor and of a very bitter taste; permanent in the air; soluble in 66 parts of water and in 10 parts of alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). Quinidinae Sulphas—Quinidinae Sulphatis—Quinidine Sulphate.—Descrip- tion and Properties.—White silky needles, odorless, and of a very bitter taste; per- manent in the air; soluble in 100 parts of water and in 8 parts of alcohol. It should be kept in well-stoppered bottles, in a dark place. Dose.—5-30 grains (0.3-2.0 Gm.). Quinlna—Quinlnae—Quinine.—Description and Properties.—A white, flaky, amorphous or crystalline powder, odorless, and having a very bitter taste; permanent in the air; soluble in 1670 parts of water and in 6 parts of alcohol. Quinine should be kept in well-stoppered bottles, in a dark place. Dose.—1-60 grains (0.06-4.0 Gm.). Quinlnae Bisiilphas—Quinlnae Bisulphatis—Quinine Bisulphate.—Descrip- tion and Properties.—Colorless, transparent, or whitish orthorhombic crystals or small needles; odorless and having a very bitter taste; efflorescent on exposure to the air. Soluble in 10 parts of water and in 32 parts of alcohol. It should be kept in well- stoppered bottles, in a dark place. Dose.—1-15 grains (0.06-1.0 Gm.). Quinlnae Hydrobromas—Quinlnae Hydrobromatis—Quinine Hydrobro- mate.—Description and Properties.—White, light, silky needles; odorless and of a very 14 2IO A TEXT-BOOK OF MATERIA MEDICA. bitter taste. The salt is liable to lose water on exposure to warm or dry air. Soluble in 54 parts of water and in 0.6 part of alcohol. It should be kept in well-stoppered bottles, in a dark place. Dose.—1-20 grains (0.06-1.3 Gm.). Quinlnae Hydrochloras—Quinlnae Hydrochloratis—Quinine Hydrochlorate. —Description and Properties.—White, silky, light, and fine needle-shaped crystals, odorless, and having a very bitter taste. The salt is liable to lose water on exposure to warm air. Soluble in 34 parts of water and in 3 parts of alcohol. Quinine hydro- chlorate should be kept in well-stoppered bottles, in a dark place. Dose.—1-15 grains (0.06-1.0 Gm.). Quinlnae Sulphas—Quinlnae Sulphatis—Quinine Sulphate.—Description and Properties.—White, silky, light, and fine needle-shaped crystals, fragile and somewhat flexible, making a very light and easily compressible mass, lusterless from superficial efflorescence after being for some time exposed to the air; odorless and having a per- sistent, very bitter taste. The salt is liable to lose water on exposure to warm air, to absorb moisture in damp air, and to become colored by exposure to light. Soluble in 740 parts of water and in 65 parts of alcohol, also in 40 parts of glycerin and in about 680 parts of chloroform, and freely soluble in dilute acids. It should be kept in well- stoppered bottles, in a dark place. Dose.—1-60 grains (0.06-4.0 Gm.). Quinlnae Valerianas — Quinlnae Valerianatis — Quinine Valerianate.— Description and Properties.—White or nearly white, pearly, lustrous, triclinic crystals, having a slight odor of valerianic acid, and a bitter taste; permanent in the air; soluble in 100 parts of water and in 5 parts of alcohol. It should be kept in well-stoppered bottles, in a cool place. Dose.—1-20 grains (0.06-1.3 Gm.). Unofficial Alkaloids and Salts. Chinoidinum—Chinoidini—Chinoidine.— Origin.—Obtained from the mother- liquor in the preparation of quinine sulphate, cinchonine, and the other alkaloids of cinchona. Description and Properties.—Cylindrical rolls or masses, of a more or less deep- brown or black color and a resin-like appearance. It has but a slight taste, being faintly bitter on mastication. Almost insoluble in water; freely soluble in alcohol. Dose.—3-30 grains (0.2-2.0 Gm.). Cinchonidinae Sallcylas—Cinchonidinae Salicylatis—Cinchonidine Salicy- late.—Dose, 2-10 grains (0.12-0.6 Gm.). Cinchonina Iodosulphas—Cinchoninae Iodosulphatis—Cinchonine Iodosul- phate (Antiseptol) (50 per cent, of iodine).—Description and Properties.—A light powder of a reddish-brown color; insoluble in water, but soluble in alcohol. Used principally as a substitute for iodoform. Chinolin—Chlnolin—Chinolin (Quinolin).—Origin.—Prepared from Cincho- nine or Quinine by distillation, or obtained synthetically. Description and Properties.—A colorless liquid, with an aromatic, pungent odor; slightly soluble in water, freely soluble in alcohol. Dose.—3-10 minims (0.18-0.6 Cc). Chlnolin Tartras—Chinolin Tartratis—Chinolin Tartrate.—Soluble in 70 or 80 parts of water. Dose, 5-15 grains (0.3-1.0 Gm.). Quinetum—Quineti—Quinetum.—A mixture of the alkaloids precipitated by an alkali. Dose, 1-60 grains (0.06-4.0 Gm.). HEM A TICS. 211 Quininae Hydrochloras Carbamidata—Quinlnae Hydrochloratis Carbami- datae.—Double salt of Quinine and Urea. Soluble in water. Dose, i-io grains (0.06- 0.6 Gm.). Usually employed hypodermically. Antagonists and Incompatibles.—Agents promoting waste— such as the salts of mercury, iodine, copper, zinc, and lead—are therapeutically antagonistic to cinchona. The cerebral effects of quinine are antagonized by morphine, while atropine opposes its action upon the nervous and circulatory systems, as well as its antipyretic powers. The incompatibles are free tannic acid, alkalies and alkaline earths, and iodine. Fowler's solution is incompatible with infusion and decoction of cinchona. Synergists.—The Restoratives and all agents promoting con- structive metamorphosis. The antipyretic action of quinine is enhanced by the antipyretics, salicylic acid, and some of the anti- septics. Its antiperiodic action is aided by arsenic, eucalyptus, carbolic acid, and creasote. Quinine fully represents the crude drug. It is classed as a Restorative because it is analogous to taurocholate of sodium, taurin being a natural antiseptic and germicide, destroying or pre- venting the propagation of many pathogenic organisms entering the system. The name Cinchona given to Peruvian bark was accorded in honor of the countess of Chinchon, cured of tertian fever by the use of the drug, as early as the seventeenth century, the Spanish conquerors of the country having discerned the curative properties of the plant which scientific investigation has rendered invaluable as a therapeutic agent. The native Indians had long been ac- quainted with its medicinal virtue, and but for the inquisitorial bigotry of the age the beneficiary of its potency, upon her return to Spain, would have introduced it into Europe. Such, however, was the antagonism aroused among an over-zealous c^erSY> and so great the force of professional rivalry, that every- where the new discovery encountered opposition, one religious body formally spurning it as the invention of unenlightened sav- ages, although the countess was not deterred from employing it among the peasantry dwelling upon her estates (Markham). About the middle of the seventeenth century a large quantity of the bark received from America reawakened discussion, and finally a council of Jesuits held at Rome approved a distribution of the drug—called therefrom " Jesuits' bark." It quickly found 212 A TEXT-BOOK OF MATERIA MEDICA. its way to other parts of the Continent and to England; yet still the opposition to its use was pronounced, and it was only when an English quack doctor succeeded in effecting cures among persons of rank by an employment of the drug that its services became general in malarial and typhoid fevers, as well as in various other diseases. The discovery of the active principles of cinchona, crudely es- tablished by Duncan in 1803, was perfected by Pelletier and Cav- entou in 1820 by the preparations of quinine and cinchonine. In 1833'quinidine became partially known, being completely isolated as an active principle in 1852, quinine and cinchonine having been employed since 1820-21. Until the researches of Marchiafava, Celli, Laveran, Golgi, and others had disclosed the true etiology of malaria, quinine was used empirically in malarial diseases, its precise action being unknown. Its efficacy is now ascertained to be due to its power of destroying the plasmodia of malaria. In addition to this action, which renders the drug of the greatest value in malarial diseases, quinine pos- sesses many other important properties, which are here considered. Physiological Action.—Externally and Locally.—The drug is a potent antiseptic, preventing putrefaction and fermentation by its destructive influence upon fungi and infusoria, a solution of 1 :250 being sufficient for this purpose, while 1 : 500 is fatal to certain micro-organisms, and even so weak a solution as 1 : 1000 suffices to destroy some infusoria. Upon the unbroken skin it has little effect, other than to pro- duce occasionally a slight roughening of the surface. To raw surfaces, however, and to mucous membranes it is irritant. Internally.—Digestive System.—Its action resembles that of vegetable bitters, augmenting the secretions from the salivary and gastro-intestinal glands, stimulating peristalsis, and increasing the blood-supply to the stomach. Under moderate doses, therefore, the appetite and digestion are improved. Large dosage disturbs digestion, occasioning nausea, with, possibly, vomiting and diarrhea. The acidity of the stomach is said to be increased by quinine sul- phate. Circulatory System.—Small doses increase the force and fre- quency of the heart's action, excessive doses slowing and weaken- ing it, and, frequently in children, causing an intermittent pulse. Toxic doses paralyze the heart, arresting it in diastole. It is not certain whether these effects are due to an action on the cardiac HE MA TICS. 213 muscle or on the ganglia. It is evident, though, that small doses elevate and large doses depress arterial tension. Quinine in a remarkable manner affects the constituents of the blood. The ameboid movements of the white blood-corpuscles are arrested, preventing their migration through the capillary walls in inflammation, while their number is diminished by full doses of the drug both in health and in inflammatory conditions. The red corpuscles are materially increased in number, at least in propor- tion to the white corpuscles, the size of the former being dimin- ished in febrile conditions. Quinine retards or impairs the ozonizing power of the blood, and lessens the oxygen-carrying capacity of the red corpuscles. Nervous System.—Small doses stimulate the cerebrum. Large doses occasion cerebral congestion, with a sensation of dizziness, fulness in the head, and other symptoms described at length under " Cinchonism." The reflex function of the spinal cord is reduced, and under toxic doses ultimately abolished, owing to stimulation of Setsche- now's inhibitory center, and later to direct depression of the spinal cord and nerves. In frogs the sensory nerves are first excited and subsequently paralyzed, through the influence of the drug upon the peripheral endings. The muscles are uninfluenced, though when applied directly to muscular fiber the drug acts as an irritant, producing muscular contractions. Respiratory System.—Quinine exerts but little influence upon the respiration, small doses slightly increasing and large doses depressing the respiratory movements. Absorption and Elimination.—The drug is quite rapidly absorbed from the stomach, but not from the intestines. While its presence may be detected in the urine within fifteen minutes after the inges- tion of a full dose, many hours, or even days, may elapse before the drug is finally excreted. Much of the drug undergoes a change in the system, being oxidized in the liver, yet it may be detected in the urine as quinine and various isomeric modifications of it. While chiefly eliminated by the kidneys, it may escape from the system by other channels, having been found in the milk, sweat, saliva, tears, bile, and in dropsical effusions. The excretion of uric acid, urea, and other nitrogenous material is considerably diminished under the use of quinine. Temperature.—In health the temperature is unaffected by qui- 214 A TEXT-BOOK OF MATERIA MEDICA. nine, but in febrile conditions, particularly in malarial fever, the drug acts as a powerful antipyretic. Yet it is doubtful whether the drug is a true antipyretic—i. c. through its action upon the thermo- genetic tissues or centers. It is a matter of clinical observation that intermittent, typhoid, and one form of puerperal fever are the only diseases which readily yield to the antipyretic influence of quinine, the temperature in such maladies as erysipelas, pneu- monia, pleurisy, etc. being comparatively unaffected even by large dosage, seeming to prove that the drug is an antipyretic only when it destroys or renders inert the infective agent producing the fever. Eye.—There have been recorded several cases of quinine amau- rosis, with transitory blindness, color-blindness, wide dilatation of pupils—irresponsive to light, but responding to accommodation effort—pallor of the optic disks, with extreme diminution of both retinal veins and arteries and contraction of the visual field. Quinine amaurosis, however, is probably very rare, but a lim- ited number of cases being recorded, although Rogers believes that "incomplete ocular cinchonism " is of quite frequent occur- rence. Uterus.—After the inception of labor quinine seems frequently to stimulate the uterine contractions. It also increases a scanty menstrual flow. There appears to be no authoritative evidence that quinine is an abortifacient. Untoward Action.—Besides the symptoms of cinchonism from which some persons suffer after the ingestion of a small dose, there are often occasioned various eruptions of the skin, often accom- panied by marked pruritus, the eruption produced by the drug at times strongly resembling scarlatina. Peculiar disturbances of vision and impaired hearing not infre- quently attend the administration of quinine. There have been recorded cases of renal and vesical irritation, varying in intensity, following the use of the drug. The administration of the salts of quinine in pill form is often followed by gastro-intestinal catarrh. The drug has also been known to occasion epistaxis and hem- optysis. Poisoning.—Excessive doses of quinine produce a series of symptoms collectively termed cinchonism. They are—a feeling of fulness in the head, ringing or buzzing in the ears, varying degrees of deafness, headache, with possibly delirium, disturbances of vision, vertigo, and muscular weakness. Should the dose be lethal, there may be marked cardiac and respiratory failure, and collapse. HEM A TICS. 215 Treatment of Poisoning.—Potassium bromide and hydrobromic acid are the best agents to relieve the symptoms of cinchonism, full doses of the latter given with quinine being said to prevent untoward results. Should the dose be sufficient to depress the heart and respira- tion in a marked degree, cardiac and respiratory stimulants would be indicated. Therapeutics.—Externally and Locally.—Powdered cinchona bark is an ingredient of many tooth-powders. Quinine also enters into the composition of many " hair tonics," and is highly recom- mended by some physicians in the treatment of alopecia. The drug has been employed with varying success in many diseases of the nose and throat, such as hay fever, whooping cough, ozena, tonsillitis, etc. Ledetsch has highly recommended quinine bisulphate, 1 part to 100 parts of water and glycerin, as an injection in gonorrhea. The drug has been used with tincture of ferric chloride as a paint to prevent the spread of erysipelas. A 2 per cent, solution has proved an efficient remedy in cystitis, effectually preventing the decomposi- tion of the urine. Internally.—Undoubtedly the principal use of quinine is in the treatment of malarial diseases. When we realize that quinine in 1 part to 20,000 is destructive of the plasmodium malariae, it is readily understood why the drug should be so efficient as an antimalarial remedy. Quinine is one of the most powerful antiperiodics, being of more or less value in many diseased conditions characterized by periodical exacerbations. All forms of malarial fever usually yield to the proper use of quinine. It seems to be equally efficient as a prophylactic. The periodical affections due to paludal miasm are peculiarly amenable to this drug, among these disorders being the various neuralgias, headache, asthma, hay fever, chorea, jaundice, diarrhea, dysentery, etc. Quinine is a potent antiphlogistic, being very efficient in check- ing inflammation and suppuration. It is particularly beneficial in cases of prolonged suppuration, such as pulmonary phthisis, fistu- lous discharges, septicemia, pyemia, puerperal fever, etc. It favor- ably influences the formative stages of acute inflammations, as in the beginning of endocarditis, pneumonia, pleurisy, etc. As a tonic or restorative during the course of febrile diseases, 2l6 A TEXT-BOOK OF MATERIA MEDICA. as well as in convalescence, quinine is highly efficient. Its action upon the gastro-intestinal tract renders it valuable in many forms of dyspepsia, especially the atonic variety. In these cases, where anemia is present, the drug may be advantageously combined with iron and nux vomica. Quinine is but little used now as a pure antipyretic, being of value in this respect, as previously stated, only when it destroys the infective cause of the fever. Its antipyretic influence is conse- quently more marked in intermittent fever. It is of value also in typhoid, although now seldom employed in this disease. The remedy has proved efficient in some cases of chorea and whooping cough. It is of decided value in the yeasty vomiting pro- duced by the sarcina ventriculi, and equally beneficial in impetigo; while acne and ecthyma, when occasioned by reduced vitality and impaired nutrition, are greatly benefited by its internal use. Quinine is serviceable in stimulating the uterine contractions during labor and increasing the menstrual discharge in amenorrhea. Contraindications.—The drug is contraindicated in acute in- flammations of the genito-urinary and gastro-intestinal tracts, in acute or subacute inflammations of the middle ear, and in menin- gitis and cerebritis. It should not be given to infants suffering from eczema, nor to persons having a marked idiosyncrasy against the drug. Administration.—Because of its intensely bitter and disagree- able taste quinine should not be given in solution. It may be sus- pended in syrup of yerba santa or in the aromatic elixir of liquorice, which disguises the taste quite effectually, and for children is pref- erable, as a method of administration, to capsules or pills. In the case of adults the drug should be given in gelatin capsules or in the form of gelatin- or sugar-coated pills. The tannate of quinine is comparatively tasteless, and may be incorporated with chocolate in the form of lozenges, thus being readily taken by children. The drug may be also administered in a suppository by the rectum or incorporated in lard and rubbed into the skin, preferably in the axillae and the inner side of the thighs or over the abdomen. It has been employed to some extent hypodermically, the quinine hydrobromate and hydrochlorate being the salts preferred for this purpose. Injections should be made in the buttocks, and very slowly administered, since this method of administration depresses the heart to a considerable degree. ANIMAL EXTRACTS. 217 Occasionally in the treatment of malaria Warburg's tincture, containing numerous aromatics, is more efficient than quinine. In obstinate malarial affections aromatics and spices greatly enhance the effect of quinine, capsicum making one of the best adjuvants. The portal circulation is stimulated, rendering the absorption of the drug more rapid and its effects more lasting. As to the time and method of administration in malarial dis- eases, the student is referred to any standard work on the Practice of Medicine. The various tinctures and elixirs of cinchona are used exten- sively ; when employed as stomachics they should be given before meals. Quinine is best given on an empty stomach or after the active process of digestion is completed. ANIMAL EXTRACTS (ORGANOTHERAPY). The striking fact that various excretions and tissues of the living organism, when administered under certain conditions, possess a peculiar therapeutic value is now well established. The theory has long been the subject of studious attention, yet the practical application of organotherapy has in recent years acquired unprece- dented importance. Extracts derived from almost every portion of the human system, together with many animal secretions, have been prepared, one of the most original being the hypodermic injection of an extract from the recent testicles of mammals adopted by Brown-Sequard in .1889 in the treatment of senile debility. As a nutrient restorative spermini hydrochloras was found to be an efficacious remedy, abundant evidence showing that the functional activity of deteriorating organs of the animal economy was per- ceptibly improved, the nervous system responding favorably to the influence of the new agent. Cancer and chorea are said to have also been benefited by spermine. Subsequently neurasthenia, locomotor ataxia, and declining nervous force due to old age were successfully treated with a glycerin extract from the gray matter of a sheep's brain, the pro- cedure, as suggested by Paul, consisting of a nervous transfusion by hypodermic injection. The most rational and successful application of organotherapy, however, was that of Murray in 1891, who proposed the subcu- 2l8 A TEXT-BOOK OF MATERIA MEDICA. taneous injection of a thyroid extract in the treatment of myxedema, many cases of which have ameliorated, while others have been definitely cured, by the adoption of the remedy. The preparations in this case have included the ingestion of the dry powder, the injection of a glycerin extract, and the raw or partially cooked gland administered as food. The general testimony of writers amply attests the efficacy of the remedy, which now receives almost universal acceptance. Baumann has recently isolated from the thyroid glands of sheep an organic compound which he believes to be the essential prin- ciple of the gland and the efficient agent in the treatment of various forms of myxedema. Clinical observations by Ewald, Ross, and Treufel seem to prove the correctness of Baumann's opinion. In exophthalmic goiter the employment of thyroid gland has been held to be favorable, although authorities are not wanting who claim that its use tends to aggravate the symptoms. Especially interesting are the results of thyroid treatment in cretinism of infants—infantile myxedema—authentic reports offer- ing highly encouraging details of its successful application in this disease, eliciting from Sinkler the declaration: " It is too short a time since the introduction of the thyroid-feeding in cretinism to form any opinion as to the final results; but since in all the cases reported remarkable changes have taken place, we have reason to rejoice in possessing a remedy which can accomplish so much as has already been done in these once worse than hopeless cases." It is tq be observed that both the endemic and sporadic forms of the above malady have proved amenable to the thyroid treat- ment. Jackson concludes that " in myxedema and cretinism it is worth while to run a risk as to life in the hope of removing symptoms that make life hardly worth living. In dermatoses, on the con- trary, life is generally little endangered, and we are not justified in resorting to too heroic measures." The remedy has been applied in insanity, with the effect of im- proving depressed, but intensifying maniacal, conditions, care being requisite in the presence of certain contraindications, such as tuberculosis, valvular disease of the heart, etc. Bramwell reports a case of tetanus resulting from thyroid extir- pation cured by doses of the gland; another of idiopathic tetany yielding to the same treatment. With regard to thyroid treatment in skin diseases, Abraham ANIMAL EXTRACTS. 219 asserts that there is no'constant effect in psoriasis and many other cutaneous affections, and that in a large number of cases the results are negative, and that untoward effects are alarmingly frequent. Improvement has been noted in several cases of malignant syphilis, Menzies considering that thyroid acts as a powerful skin- tonic and a useful adjuvant to mercury and potassium iodide in the treatment of this disease. With regard to thyroid, however, it must be admitted that, save in myxedema, simple goiter, and obesity, the remedy is of com- paratively slight value, and even in these affections only by con- tinued treatment have favorable results been obtained. The favorable results often attending the partial employment of animal agents in diseases of corresponding organs, and especially the noteworthy benefits derived from the application of the thyroid treatment in myxedema, have suggested the preparation of many extracts of varying efficacy. Among these are— Nucleins, compounds of proteid substances with nucleic acid, obtained by artificial digestion, among their sources being pus-cor- puscles, the spermatozoa of various animals, testicles, thyroid gland, yolk of hens' eggs, liver, brain, cows' milk, etc. A marked property of the blood, as has long been known, is its germicidal power, and it has furthermore been satisfactorily determined that the basic force resides in a nuclein. The agent has consequently been essayed in the hope of establishing a bactericidal influence. Vaughan reports that in tuberculosis the effect of moderate injec- tions has been to lower the temperature, without untoward mani- festations. Indolent ulcer, too, according to the same authority, has yielded completely to a similar treatment, the nuclein being; derived from yeast. It is also stated upon high authority that the remedy is useful in " all forms of anemia, in chronic and recurrent malaria, in diges- tive disorders, and in acute and chronic pulmonary affections" (Aulde), the nuclein adopted being obtained from the thyroid and thymus glands. The latter author suggests the use of nuclein in the treatment of typhoid, in which disease the activity of leucocy- tosis is defective. Bone-marrow has proved efficacious in anemia (Dickson, Frazer), and has also been employed by Filleau in tuberculosis. Brain-extract, besides its utility in locomotor ataxia and senile debility, has been reported as beneficial in certain organic and func- tional diseases of the nervous system—in epilepsy, hysteria, mi- 220 A TEXT-BOOK OF MA TERIA -MEDICA. graine, hebephrenia, etc., as well as in bulbar palsy and general paralysis of the insane. Heart-extract has been recommended in cases of nervous prostration, it being claimed that its action tends to raise the blood-pressure and increase the number of red corpuscles; muscle-extract has served a useful purpose in affections of the corresponding tissues; extract of pancreas, though with small success, has been employed in diabetes mellitus; and among other preparations used with doubtful or auspicious results are medullin, from the cord; renin, from the kidneys; gastrin, from the stom- ach ; and ovarin, from the ovaries. The subject is fraught with interest to the clinician, and, as in serum-therapy, the rapid progress of therapeutic knowledge bids fair to extend its value in the rational treatment of human disease. DIVISION II.—SPECIFICS. These drugs are unnatural to the system, though acting spe- cifically, and in some unknown way, against certain diseases or morbid conditions. They are given with a view to influencing the course of the disease itself, not for their effect upon the symptoms alone. If administered for any length of time, there is danger of causing an artificial disease, because of the characteristic action of these medicines, which differs essentially from their remedial influence. When used as specifics they do not produce or relieve symp- toms, except by renewal of health or by removing either the pathological condition or the disease. Whenever, therefore, these drugs produce symptoms when used specifically, it is a sign that they are contraindicated, or have been given for too long a time, or in too large doses. As they are unnatural, and consequently more or less poisonous to the system, their administration should be accompanied by restoratives to lessen their tendency to unto- ward manifestations and systemic depression. Mercury, being perhaps the most typical specific, will be first considered. Hydrargyrum—Hydrargyri—Mercury. IT. 8. P. (Quicksilver.) Origin.—The knowledge of this drug antedates the Christian era. It is found in Spain, Austria, Peru, and China, but is obtained principally from New Almaden, California. It occurs to some ex- tent in the metallic state in the form of minute or large globules; also in combination with oxygen, chlorine, selenium, etc.; but the principal ore from which it is extracted is cinnabar. Description and Properties.—A shining, silver-white metal, without odor or taste. It is liquid at the ordinary temperature, and easily divisible into spherical globules; but when cooled to —39.380 C. (—38.880 F.), it forms a ductile, malleable mass. Specific gravity, 13.5584 at 15° C. (590 F.). Insoluble in the ordinary solvents, also in concentrated hydro- chloric acid, and, at common temperatures, in sulphuric acid, but dissolving in the latter when boiled with it, and readily and com- pletely soluble in nitric acid. Mercury should be kept in strong, well-stoppered bottles. 221 222 A TEXT-BOOK OF MATERIA MEDICA. Dose.—Mercury is seldom given internally except in the modi- fied form of blue pill. Hydrargyrum Ammoniatum—Hydrargyri Ammo- niati—Ammoniated Mercury. XT. 8. P. Origin.—Prepared by mixing solutions of Ammonia and Cor- rosive Mercuric Chloride. Filter and wash the precipitated am- moniated mercury. Description and Properties.—White, pulverulent pieces, or white, amorphous powder, without odor, and having an earthy, and afterward styptic and metallic taste. Permanent in the air. Almost insoluble in water or in alcohol. It should be kept in well- stoppered bottles, protected from the light. Used externally. Official Preparation. UnguSntum Hydrargyri Ammoniati—UnguSnti Hydrargyri Ammoniati— Ointment of Ammoniated Mercury.—Formula: Ammoniated Mercury, 10; Ben- zoinated Lard, 90 parts. For external use. 1 Hydrargyrum cum Creta—Hydrargyri cum Creta— Mercury with Chalk. XT. 8. P. Origin.—Obtained by trituration of Mercury, Prepared Chalk, Clarified Honey, and Water. Description and Properties.—A light gray, rather damp pow- der, free from grittiness, without odor, and having a slightly sweet- ish taste. It contains 38 per cent, of mercury. This preparation should be kept in well-stoppered bottles, protected from light. Dose.—3-10.grains (0.18-0.6 Gm.). Massa Hydrargyri—Massae Hydrargyri—Mass of Mercury. XT. 8. P. (Pilula Hydrargyri—Blue Mass—Blue Pill.) Composed of Mercury, Glycyrrhiza, Althaea, Glycerin, and Honey of Rose. Dose.—h-10 grains (0.03-0.6 Gm.). Unguentum Hydrargyri —Unguenti Hydrargyri - Mercurial Ointment. XT. 8. P. (Blue Ointment.) Composition: Mercury, Lard, Suet, and Oleate of Mercuiy. Used externally. SPECIFICS. 223 Emplastrum Ammonlaci cum Hydrargyro —Em- plastrum (ace.) Ammonlaci cum Hydrargyro- Ammoniac Plaster with Mercury. XT. 8. P. Composition : Ammoniac, Mercury, Oleate of Mercury, Diluted Acetic Acid, and Lead Plaster. Used externally. Emplastrum Hydrargyri—Emplastri Hydrargyri— Mercurial Plaster. XT. 8. P. Composition: Mercury, Oleate of Mercury, and Lead Plaster. Used externally. Hydrargyri Chl5ridum CorrosTvum — Hydrargyri Chloridi Corroslvi—Corrosive Mercuric Chloride. XT. 8. P. (Corrosive Chloride of Mercury—Corrosive Sublimate.) Origin.—Prepared by heating a mixture of Mercuric Sulphate, Sodium Chlorate, and Manganese Dioxide. The corrosive chloride sublimes and is condensed. Description and Properties.—Heavy, colorless, rhombic crys- tals or crystalline masses; odorless and having an acrid and per- sistent metallic taste. Permanent in the air. Soluble in 16 parts of water, in 3 parts of alcohol, in 2 parts of boiling water, in 1.2 parts of boiling alcohol, in 4 parts of ether, and in about 14 parts of glycerin. It should be kept in well-stoppered bottles. Dose.—gJ^-^ grain (0.001-0.008 Gm.). Hydrargyri Chloridum Mite —Hydrargyri Chloridi Mitis—Mild Mercurous Chloride. XT. 8. P. (Calomel—Mild Chloride of Mercury.) Origin.—Obtained by triturating Mercuric Sulphate, Mercury, Sodium Chloride, and boiling Distilled Water. Sublime, and wash the sublimed calomel with boiling distilled water. Description and Properties.—A white, impalpable powder, be- coming yellowish-white on being triturated with strong pressure. It is odorless and tasteless, and permanent in the air. Insoluble in water, alcohol, or ether, and also in cold, diluted acids. When strongly heated it is wholly volatilized, without melting. Calomel should be kept in dark, amber-colored bottles. Dose.—^5-10 grains (0.002-0.6 Gm.). Calomel enters into the following 224 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparations. Pilulae Antimonii CompSsitae—Pilulas (ace.) Antimonii Compfisitas—Com- pound Pills of Antimony.—Dose, I or 2 pills. Pilulae CathSrticae CompSsitae—Pilulas (ace.) Cath3rticas Compbsitas— Compound Cathartic Pills.—Dose, i to 3 pills. Hydrargyri Cyanidum—Hydrargyri Cyanidi—Mer- curic Cyanide. XT. 8. P. Origin.—It may be obtained by boiling pure Ferrocyanide of Iron with Mercuric Oxide; the mercuric cyanide, entering into solution, is separated by filtration, evaporization, and crystallization from diluted alcohol. Description and Properties.—Colorless or white prismatic crystals; odorless, and having a bitter, metallic taste (the salt is exceedingly poisonous), becoming dark-colored on exposure to light. Soluble in 12.8 parts of water and in 15 parts of alcohol. Dose.—r^o-rV gram (0.0006-0.004 Gm.). Hydrargyri Iodidum Flavum—Hydrargyri Iodidi Flavi—Yellow Mercurous Iodide. XT. 8. P. (Hydrargyri Iodidum Viride—Protiodide of Mercury—Yellow (or Green) Iodide of Mercury.) Origin.—Prepared by mixing solutions of Potassium Iodide and Mercurous Nitrate with Nitric Acid and Distilled Water. The precipitate is washed and dried. Description and Properties.—A bright yellow amorphous powder, odorless and tasteless. By exposure to light it becomes darker in proportion as it undergoes decomposition into metallic mercury and mercuric iodide. Almost insoluble in water, and wholly insoluble in alcohol or ether. It should be kept in dark, amber-colored vials, with the least possible exposure to light. Dose.—\-\ grain (0.01-0.03 Gm.). Hydrargyri Iodidum Rubrum-Hydrargyri Iodidi Rubri—Red Mercuric Iodide. IT. 8. P. (Biniodide of Mercury—Red Iodide of Mercury.) Origin.—Prepared by mixing solutions of Corrosive Mercuric Chloride and Potassium Iodide; filter, and dry the precipitated red iodide. Description and Properties.—A scarlet-red, amorphous pow- der, odorless and tasteless ; permanent in the air. Almost insoluble SPECIFICS. 225 in water, but soluble in 130 parts of alcohol. It should be kept in well-stoppered bottles, protected from light. Dose.—$VtV grain (0.002-0.004 Gm.). This drug enters into the Official Preparation. Liquor Arseni et Hydrargyri Iodidi—Liquoris Arseni et Hydrargyri Iodidi —Solution of Arsenic and Mercuric Iodide.—(Described under Arsenic.)—Dose, 5 minims (0.3 Cc), gradually increased. Hydrargyri Oxidum Flavum—Hydrargyri Oxidi Flavi—Yellow Mercuric Oxide. XT. 8. P. Origin.—Prepared by precipitating a solution of Corrosive Mercuric Chloride with Soda. Description and Properties.—A light orange-yellow, amor- phous, heavy, impalpable powder; odorless, and having a some- what metallic taste. Permanent in the air, but turning darker on exposure to light. Almost insoluble in water or in alcohol. It should be kept in well-stoppered bottles, protected from light. Not used internally. Official Preparation. UnguSntum Hydrsirgyri Oxidi Flavi—UnguSnti HydrSrgyri Oxidi Flavi— Ointment of Yellow Mercuric Oxide.—Formula: Yellow Mercuric Oxide, 10; Ointment, 90 parts. Used externally. Hydrargyri Oxidum Rubrum—Hydrargyri Oxidi Rubri—Red Mercuric Oxide. XT. 8. P. (Red Precipitate.) Origin.—Prepared by dissolving Mercury in Diluted Nitric Acid. Evaporate to dryness. Triturate the mercuric nitrate thus formed with mercury and heat. Description and Properties.—Heavy, orange-red crystalline scales, or a crystalline powder, becoming yellower the finer it is divided; odorless, and having a somewhat metallic taste; perma- nent in the air. Almost insoluble in water and in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose.—g1!-tV gram (0.001-0.006 Gm.). Official Preparation. Unguentum Hydrargyri Oxidi Rubri—UnguSnti Hydrargyri Oxidi Rubri —Ointment of Red Mercuric Oxide.—Formula: Red Mercuric Oxide, 10; Castor Oil, 5; Ointment, 85 parts. Used externally. 15 226 A TEXT-BOOK OF MA TERIA MEDICA. Hydrargyri Subsulphas Flavus—Hydrargyri Sub- sulphatis Flavi—Yellow Mercuric Subsulphate. V. 8. P. (Basic Mercuric Sulphate—Turpeth Mineral.) Origin.—Obtained by dissolving Mercury in Sulphuric and Nitric Acids. Add a sufficient quantity of Water. Decant and dry the residue. Description and Properties.—A heavy, lemon-yellow powder, odorless and almost tasteless; permanent in the air. Soluble in about 2000 parts of water. Insoluble in alcohol. It should be kept in well-stoppered bottles, protected from the light. Dose.—1-3 grains (o.oi 5-0.18 Gm.). Liquor Hydrargyri Nitratis-Liquoris Hydrargyri Nitratis-Solution of Mercuric Nitrate. V. 8. P. A liquid containing about 60 per cent, of Mercuric Nitrate, together with about 11 per cent, of free Nitric Acid. Description and Properties.—A clear, nearly colorless, heavy liquid, having a faint odor of nitric acid and a strongly acid reac- tion. ' The product should be kept in glass-stoppered bottles. Used externally as a caustic. Unguentum Hydrargyri Nitratis —Unguenti Hy- drargyri Nitratis—Ointment of Mercuric Nitrate. XT. 8. P. (Citrine Ointment.) Formula: Mercury, 70; Nitric Acid, 157; Lard Oil, 760 parts. Used externally. Unofficial Preparations. Hydrargyri Sallcylas—HydrSrgyri Salicylatis—Mercurous Salicylate.— Dose of Mercurous Salicylate, \-\ grain (0.008-0.015 Gm.).—Dose of Mercuric Salicy- late, ^-\ grain (0.004-0.008 Gm.). Hydrargyri Formamidatum—Hydrargyri Formamidati—Formamidate of Mercury.—Dose for hypodermic use, ^-\ grain (0.005-0.01 Gm.). Hydrargyri Tannas—Hydrargyri Tannatis—Mercurous Tannate— Dose, \-\ grain (0.03-0.06 Gm.). Lotio Flava—LotiSnis Flavae—Yellow Wash.—Corrosive Sublimate, 25 grains (1.5 Gm.), in Lime Water, 16 ounces (473.17 Cc). For external use. Lotio Nigra—Lotionis Nigrae—Black Wash.—Calomel, 64 grains 14.15 Gm.), in Lime Water, 16 ounces (473.17 Cc). For external use. Asparagin Hydrargyrate— Dose, \ grain (0.01 Gm.), hypodermically. SPECIFICS. 227 Antagonists and Incompatibles.—Mercury with chalk is in- compatible with acids and acidulous salts. Calomel is incompatible with alkalies, alkaline earths, alkaline carbonates, iron, lead, copper, iodine, bromides, soaps, sulphydrates, and nitrohydrochloric acid, as well as hydrochloric acid, potassium, ammonium, and sodium chloride. Corrosive sublimate is incompatible with alkalies and their car- bonates, soap, lime water, tartar emetic, the iodides of potassium and sodium, acetate of lead, silver nitrate, the sulphides, albuminous liquids (as milk, etc.), many vegetable infusions, and compound syrup of sarsaparilla. In general, metallic preparations of mercury are incompatible with iodine and the chlorides. Synergists.—Potassium iodide enhances the antisyphilitic action of mercury. Depressants—such as antimony and alkalies—increase the physiological activity of mercury and its preparations. Tonic and resin-bearing purgatives—such as aloes, rhubarb, and podophyllum—aid the cathartic action of some of the mercurial preparations. Physiological Action.—Externally and Locally.—Liquid metal- lic mercury is inert. Most of the preparations applied to the skin are antiparasitic and antiseptic, corrosive mercuric chloride being one of the most important antiseptics and universal germicides known. Some of the mercurials are powerful irritants, the nitrate being an active caustic. The mercurous salts, even, possess slightly stimulating properties. Metallic mercury and its salts are readily absorbed with the aid of friction, at times producing a slight irritation resulting from their stimulating properties. Absorption may also take place from local application in the form of a fine vapor. The. introduction of the drug into the system through the medium of the skin is attended with all the symptoms of mercurial poisoning. The local actions of the various preparations differ somewhat, yet they agree in certain physiological effects produced after absorption of the drug. A common feature of mercurial application is a slight, peculiar fetor in the mouth, accompanied by soreness of the teeth, swelling of the gums, and an increase of saliva, ptyalism being a marked symptom of mercurial disturbance. A disagreeable metallic taste is seldom absent. These symptoms assume a serious phase if the 228 A TEXT-BOOK OF MATERIA MEDICA. application be continued, stomatitis and other graver conditions ensuing. Internally.—Digestive System.—Small doses have little untoward effect; they may even prove tonic. Large doses act unfavorably upon the gastro-intestinal mucous membrane, causing diarrhea and possibly more serious derangement. As purgatives the mercurial preparations act by augmenting the secretions of the intestinal glands; at the same time the pancreatic secretions are increased and there is marked activity of the absorbent system. The prin- cipal action is on the duodenum, hastening evacuation of the bile and preventing its reabsorption. While promoting excretion of bile, they act the reverse as to its secretion. This is particularly true of calomel, which actually diminishes that secretion, though it is alleged that the corrosive mercuric chloride is a direct chola- gogue, stimulating to some extent the hepatic secretory apparatus. Circulatory System.—Corrosive sublimate exerts a decided in- fluence upon the heart, its toxic effect tending to diminish cardiac action. The remaining preparations of mercury appear to be less active in this respect. The physical action of the drug upon the corpuscular constituents of the blood has been well ascertained, anemia, reduced cohesion, and final dissolution having been ob- served. It is to be noted that under prolonged or over-dosage the blood becomes impoverished, its ozonizing function is impaired, and the fibrin loses its coagulability. But when administered in minute doses the mercuric corrosive chloride acts as a tonic to the blood, increasing the number of red corpuscles and the body- weight. Should " tonic doses " be continued for too long a period, there would be increased weight, owing to too great stimulation of the lymphatic system. Nervous System.—The full effects of mercury and its prepara- tions upon the nervous system are best seen when toxic doses are given. The effects are considered in extenso under the head of " Poisoning." Respiratory System.—The general tendency of mercury, in those who have been subject to prolonged dosage, is to depress the cir- culation, rendering the breathing labored and debilitated, a sense of respiratory constriction being present. Absorption and Elimination.—When a preparation of mercury is taken internally it is converted in the stomach into a double chloride of sodium and mercury. This substance, uniting with the SPECIFICS. 229 albuminous juices, is soluble in an excess of albumin and sodium chloride, and, readily diffusing into the blood, is converted into, and exists in that fluid as, the oxyalbuminate of mercury. The absorption of this drug is gradual, yet, notwithstanding every secretion of the body contributes to its general expulsion from the system, its cumulative action is a well-established fact. Elimination occurs chiefly by the urine, the saliva, bile, sweat, milk, and feces. Even the semen shares in the process. Single doses may be eliminated in twenty-four hours, but the drug has been detected in the liver a year after the discontinuance of prolonged treatment. Mercury has been found in serum and in pus from ulcers. Calomel possesses marked diuretic action, greatly increasing the amount of urine. Temperature.—Save in a secondary manner, temperature is sel- dom affected. From over-stimulation or irritation the drug may produce local inflammatory conditions or even febrile symptoms. Eye.—Himly mentions that amaurosis mcrcurialis occurs in workers in mercury, while Galezowski reports an example of optic atrophy, and Square cites a case of optic neuritis, due to the toxic action of mercurial salts. Untoward Action.—Many affections of the skin manifest them- selves after the exhibition of mercury, erythema and eczema (eczema mercuriale) frequently occurring after either the ingestion or the external application of mercurial preparations. The author recalls one patient in whom \ grain (0.016 Gm.) of calomel excited an exanthematous eruption over the entire body, some edema of the face, together with fever and angina of the fauces. At another time similar symptoms were produced in this patient by immersing the hands in a 1 : 2000 solution of corrosive sublimate. In certain persons having an idiosyncrasy regarding this drug extreme salivation and stomatitis may be induced by the internal use or the external application of mercurial preparations in medici- nal quantities. Medicinal doses may produce, in susceptible persons, marked disturbances of nutrition, sensation, and motion to such a degree as to suggest poisoning. Poisoning.—Although mercury in a metallic state is compara- tively innocuous, its vapor is capable of producing violent and dangerous symptoms. All the salts are active poisons, especially 230 A TEXT-BOOK OF MATERIA MEDICA. that known as corrosive sublimate. The symptoms following toxic doses of this preparation resemble those occasioned by arsenic. The salt, however, being more readily soluble, produces propor- tionately more speedy and pronounced effects. They are, briefly, a strong, metallic taste in the mouth, frequent and bloody evacua- tions, tenesmus, severe abdominal pains, vomiting, and labored res- piration. There may be suppression of urine, syncope, and perhaps insensibility and convulsions. One of the most obstinate features of mercurial poisoning is ptyalism or salivation. This condition is first manifested by tender- ness of the gums and teeth. The gums are inflamed and covered by a white, sticky substance, and bleed at the slightest provocation. The breath is very offensive. The teeth become loose, and may drop out. Necrosis of the maxillary bones may appear, and ex- tensive ulcerations of the gums and cheeks frequently occur. Accompanying these manifestations is an enormous increase in the amount of saliva secreted, which in some instances literally runs from the mouth night and day, often depriving the patient of sleep. Not infrequently a swelling of the lymphatic glands is also ob- served. Articulation and deglutition are interfered with from swell- ing of the tongue and ulceration of the gums, cheeks, palate, and tonsils. These symptoms, together with the fever, anorexia, mus- cular weakness, and headache which are constant accompaniments of ptyalism, render the condition of the patient very serious and tormenting. Chronic mercurial poisoning, or mercurial cachexia, is the effect produced by prolonged exposure to the fumes of mercury. The blood becomes thin and poor, with degeneration of the corpuscles. The person becomes emaciated, the heart is weak, and the whole muscular system impaired. Respiration is rapid and shallow, and the mental faculties are affected. Loss of memory, irritability of temper, melancholia, and, in rare cases, mania, may ensue. All the special senses are affected. Deafness, dimness of vision, impaired taste and sensation, as well as intestinal derangement, edema, articular pains, and generally disordered secretions, manifest them- selves. Mercurial cachexia frequently produces muscular tremors, usu- ally beginning in the upper extremities with gradual extension. Even paralysis of groups of muscles is often the result of chronic mercurial poisoning. Treatment of Poisoning.—In acute poisoning from corrosive sub- SPECIFICS. 231 limate or other active salt of mercury it is necessary to evacuate the stomach as quickly as possible, and give white of eggs freely. The after-treatment is similar to that of other corrosive poisons— the use of demulcents and opiates. For salivation, potassium chlorate probably occupies the first place as a prophylactic and curative agent. It is employed as a gargle and mouth-wash in a 2 to 3 per cent, solution. An astrin- gent wash is frequently necessary. Such drugs as tannin, myrrh, krameria, etc. may be used for this purpose. Where there is ex- tensive ulceration of the mouth disinfectant and antiseptic solutions will be found desirable. In cases of chronic mercurial poisoning it is of primary import- ance to remove all traces of the drug from the system by means of iodides, the dosage being limited in quantity, but continued for some time. Elimination of the poison from the tissues may be accomplished in various ways—the potassium iodide administered alternately with magnesium sulphate, laxatives, sulphur baths, and sulphur given internally. A change of air, liberal and nutritious diet, and tonics are also necessary. Therapeutics.—Externally and Locally.—As a germicide, anti- septic, and antiparasitic the preparations of mercury are extremely valuable, the corrosive chloride of mercury being extensively em- ployed as an antiseptic in general surgery in strengths of from 1:1000 to 1 : 10,000. In diseases of the skin due to animal or vegetable parasites there are no drugs so valuable as certain preparations of mercury, the ointment of ammoniated mercury being highly prized. Calomel in the form of an ointment, 5 to 20 grains (0.3-1.25 Gm.) to 1 ounce (32.0 Gm.) is an efficient remedy in eczema. Indolent venereal ulcers are much improved by dusting them with calomel, while the early inflammatory conditions of these sores may be greatly benefited by the use of black wash. Many diseases of the eye, ear, nose, and throat yield to various preparations of mercury. The ointment of the yellow oxide of mercury is particularly adapted to phlyctenular ophthalmia, pannus, keratitis, chronic blepharitis marginalis, etc. Inunction with mercurial ointment or with oleate of mer- cury is excellent for the constitutional treatment of syphilis. These two preparations are of great value in subacute synovitis, pelvic cellulitis, and syphilitic orchitis and epididymitis. 232 A TEXT-BOOK OF MATERIA MEDICA. The ointment of the red iodide of mercury has a reputation as an efficient remedy in goiter and enlargement of the spleen, as well as in pachymeningitis. The solution of nitrate of mercury is an active and reli- able caustic in the treatment of phagedenic ulcerations and venereal ulcerations of the os uteri. The use of mercurials is usually attended with excellent results in promoting resolution of fibrous induration resulting from chronic inflammation. Internally.—The principal use of mercury is undoubtedly as an antisyphilitic. Mercury is an antidote against constitutional syphilis, being particularly efficient in the secondary stage. Many methods of mercurializing a patient have been adopted, mention of which will be made under " Administration." It is perhaps un- necessary to caution the therapeutist to make an accurate and positive diagnosis of syphilis before instituting the mercurial treat- ment, as otherwise the consequences may be disastrous. Mercury has been used in all stages of the disease, though, possibly from ignorance of its proper use, its employment has met with less favorable results in the primary than in the secondary form, while a careful study of syphilology leads one to believe that in tertiary syphilis it is inferior to the iodides, if not, indeed, actually contraindicated. The medical uses of mercurial preparations in disorders of the alimentary tract are very numerous. Chronic dysentery will frequently yield to j^ to -^ grain (0.0006-0.0001 Gm.) of corrosive chloride of mercury and diarrheas of children—particularly those characterized by pale, offensive stools—together with ileo-colitis of infants, are greatly benefited by small doses of calomel or gray powder, which will also allay obstinate vomiting. As a purgative in bilious attacks, hepatic congestion, and cirrhosis calomel is an extremely valuable drug. Its action as a purgative will be more fully described under " Cathartics." This drug is also a remarkably efficient diuretic. The internal use of mercury is of great value in all nonsuppu- rative inflammations, as cirrhotic conditions in the glandular struc- tures, or in scleroses in the nervous system, such as hepatic cirrhosis, chronic interstitial nephritis, locomotor ataxia, chronic endarteritis, chronic affections of the lungs and pleura, etc. Many acute febrile and inflammatory conditions, such as menin- SPECIFICS. 233 gitis, pericarditis, and hepatitis, are sometimes benefited by the in- ternal administration of calomel, though in acute inflammations the chief value of the drug, whether specific or non-specific, is manifest in iritis and in acute bronchitis which shows a tendency to persist. Calomel given in from 10- to 20-grain (0.6-1. Gm.) doses in cases of pneumonia is esteemed very highly by some authorities. Calomel and opium have been used and recommended by some physicians in the treatment of Asiatic cholera. The internal use of bichloride of mercury is unquestionably of much value in the treatment of diphtheria, and the subsulphate of mercury is an old and very effective emetic in membranous laryngitis. The author has often successfully treated marasmus of infants with bichloride of mercury administered three times a day in doses of from yfg- to y^- grain (0.0005-0.0006 Gm.). Contraindications.—Mercury is usually contraindicated in tuberculosis and in persons of strumous diathesis; and, while it is of value when judiciously employed in chronic interstitial nephritis, it must nevertheless be given cautiously, and if the excretion of urine is diminished by its use, the drug should be immediately discontinued. Children, though not easily salivated, are very susceptible to other poisonous actions of calomel. Ordinarily, acute asthenic diarrhea and dysentery in adults would contraindicate the use of mercurials. Administration.—Mercuiy is introduced into the system by— 1. Inunction.—The portion of the body upon which the prepa- ration is to be applied should first be thoroughly washed with soap and warm water, and the ointment well rubbed in with the palm of the hand. The best localities for application are the inner sides of the thighs, the sides of the chest, the axillae, abdomen, and back. An excellent way to mercurialize a child is to put the ointment on the abdomen beneath a flannel binder. An efficient means also of favoring absorption is to apply the ointment to the soles of the feet, when it will be rubbed in by walking. Mercurial ointment is ordinarily used for this purpose, 15 to 30 grains (1.0-2.0 Gm.) being required for each inunction. Oleate of mercury when applied externally should not be rubbed in, the simple application to the skin being sufficient. 2. Fumigation.—The iodide, mercuric sulphide, and calomel are used in this manner. The latter preparation, being preferable, is the 234 A TEXT-BOOK OF MATERIA MEDICA. one ordinarily used. From 5 to 20 grains (0.3-1.2 Gm.) of calomel are put in a plate or a porcelain dish over a lighted spirit-lamp, These are placed under a cane-bottomed chair, in which the patient sits, nude, enveloped in a blanket reaching to the floor and fastened loosely about the neck. The calomel is volatilized by the heat, deposited in minute particles over the surface of the body, and read- ily absorbed. The fumigation should last fifteen to twenty minutes. 3. Endermically.—Mercurials may be absorbed by dusting calo- mel and certain other preparations on ulcers, open wounds, etc. 4. By the Rectum.—Mercury may be administered in the form of a suppository containing 5 to 10 grains (0.3-0.6 Gm.) of mer- curial ointment. 5. Hypodermically.—From yV to i grain (0.005-0.01 Gm.) of the bichloride of mercury, dissolved in 5 to 10 minims (0.3-0.6 Cc.) of distilled water, is injected deeply into the muscles of the gluteal region or in the subcutaneous areolar tissue of the back. The solution of peptonate of mercury has been used for this pur- pose, though the preparation which is the least objectionable is the solution of the formamidate of mercury, 16 minims (1.0 Cc), cor- responding to \ grain (0.1 Gm.) of mercuric chloride. A 1 per cent, solution of asparagin hydrargyrate has been highly recommended by Neumann for hypodermic use, the dose being about 15 minims (1.0 Cc), equivalent to \ grain (o.oi Gm.). Numerous other preparations have been recommended, but probably possess no advantage over those mentioned. 6. Internally.—In the treatment of syphilis nearly every prepara- tion of mercury has been employed, authorities differing in their choice. Bumstead prefers the bichloride, the mercurous iodide, and the mercurial pill; Berkeley Hill, the red mercuric iodide; Fox, the cyanide; Hutchinson, the gray powder, etc. It matters little which of these preparations is used. That which agrees best with the patient is advisable. Calomel, gray powder, blue pill, and corrosive sublimate are ordinarily used in disorders of the ali- mentary tract. As a rule, the first two are preferable. ARSENIC. Acidum Arsenosum — Acidi Arsenosi — Arsenous Acid. U.8.P. (Arsenic Trioxide—White Arsenic.) Origin.—Arsenic has been found in minute proportions in many mineral waters. It is obtained in large quantities by roasting SPECIFICS. 235 arsenical ores—cobalt, nickel, tin, and particularly arsenical iron pyrites—and purifying by resublimation. Description and Properties.—It is a heavy solid, occurring either as an opaque white powder or in irregular masses, of two varieties—the one, amorphous, transparent, and colorless, like glass; the other, crystalline, opaque, or white, resembling porce- lain. Frequently the glassy variety is found enclosed in an opaque, white crust. Contact with moist air changes the glassy into the white, opaque variety. Both are odorless and tasteless. Both varieties dissolve very slowly in cold water, the glassy variety requiring about 30, the porcelain-like about 80, parts of water at 150 C. (590 F.). Both are slowly but completely soluble in 15 parts of boiling water. Arsenous acid is but slightly soluble in alcohol, but is soluble in about 5 parts of glycerin. Oil of tur- pentine dissolves the glassy variety only. Both varieties are freely soluble in hydrochloric acid and in solutions of alkali hydrates and carbonates. Dose.— eTj-^o gram (0.001-0.003 Gm.). Official Preparations. Liquor Acidi Arsenosi—Liquoris Acidi Arsenosi—Solution of Arsenous Acid.—Strength, I per cent, of arsenous acid. Description and Properties.—A clear, colorless liquid, odorless, having an acidu- lous taste and an acid reaction. Dose.—2-10 minims (0.12-0.6 Cc). Liquor Potassii Arsenitis—Liquoris PotSssii Arsenitis—Solution of Potas- sium Arsenite (Fowler's Solution).—Strength, 1 per cent, of arsenous acid. Dose.—2-10 minims (0.12-0.6 Cc). Arseni Iodidum—Arseni Iodidi—Arsenic Iodide. XT. 8. P. Origin.—Prepared by triturating in a mortar finely-powdered metallic Arsenic and Iodine until they are thoroughly mixed ; or by mixing solutions of Arsenous and Hydriodic Acids, and evapo- rating. Description and Properties.—Glossy, orange-red, crystalline masses, or shining, orange-red, crystalline scales, having an iodine- like odor and taste; gradually losing iodine on exposure to air and light. Soluble in 7 parts of water and in about 30 parts of alcohol. Arsenic iodide should be kept in glass-stoppered vials, in a cool place, protected from light. Dose.—jVj-| grain (0.002-0.008 Gm.). 236 A TEXT-BOOK OF MATERIA MEDICA. Official Preparation. Liquor Arseni et Hydrargyri Iodidi—Liquoris Arseni et Hydrargyri Iodidi —Solution of Arsenic and Mercuric Iodide—(Donovan's Solution).—Strength: I per cent., each, arsenic iodide and mercuric iodide. Description and Properties.—A clear, pale-yellowish liquid, without odor, and having a disagreeable metallic taste. Dose.—1-10 minims (0.06-0.6 Cc). Sodii Arsenas—Sodii Arsenatis—Sodium Arsenate. XT. 8. P. Origin.—Prepared by heating to redness Arsenous Acid, Sodium Nitrate, and Sodium Carbonate. Dissolve the fused mass in water, and crystallize. Dissolve crystals in water, and recrystallize. Description and Properties.—Colorless, transparent, mono- clinic prisms, odorless, and having a mild, alkaline taste (the salt is very poisonous). Efflorescent in dry air, and somewhat deliques- cent in moist air. Soluble in 4 parts of water, very soluble in boiling water, and slightly soluble in cold water. Soluble in 60 parts of boiling alcohol. Sodium arsenate should be kept in well- stoppered bottles. Dose.—eV-iV gram (0.001-0.006 Gm.). Official Preparation. Liquor Sodii Arsenatis—Liquoris Sodii Arsenatis—Solution of Sodium Arsenate—(Pearson's Solution).—Strength: 1 percent, of sodium arsenate. Dose.—1-10 minims (0.06-0.6 Cc). Unofficial Preparations. Cupri Arsenis—Ciipri Arsenitis—Cupric Arsenite—(Scheele's Green, Min- eral Green, Paris Green, etc.).—Dose, yi^ grain (0.0006 Gm.), daily, in divided doses. Liquor Arseni Bromidi—Liquoris Arseni Bromidi—Solution of Arsenic Bromide—(Clemens' Solution).—Strength: the equivalent of 1 per cent, of arsenous acid. Dose.—1-5 minims (0.06-0.3 Cc). Liquor Arseni et Atiri Bromidi—Liquoris Arseni et Auri Bromidi—Solu- tion of Arsenic and Gold Bromide.—Originated with, and recommended by, Dr. Barclay, and sold under the trade name " Arsenauro." Strength : IO minims (0.6 Cc.) contain ^ grain (0.002 Gm.) of each salt. Dose.—5-15 minims (0.3-1.0 Cc). Antagonists and Incompatibles.—Arsenic is incompatible with the salts of iron, silver, magnesia, lime, copper, ammonium, and with vegetable astringents. SPECIFICS. 237 Synergists.—The Restoratives and nux vomica are synergistic to arsenic. Physiological Action.—Externally and Locally.—Applied to the skin, arsenic acts as a caustic, exciting violent inflammation. Its escharotic influence results in destruction of vitality in the affected parts, accompanied with sloughing. Internally.—Digestive System.—Except in very small doses arsenic acts as a severe gastro-intestinal irritant. Minute and medicinal doses stimulate the flow of gastric and intestinal juices, and augment peristalsis, improving the digestive and nutritive func- tions. When too long continued, the drug produces nausea, diar- rhea, and increased micturition, with a sensation of heat and dry- ness of the throat and stomach. Toxic doses are followed by violent gastro-enteritis. Indeed, in whatever manner introduced into the system, arsenic appears to have a marked selective action upon the gastro-intestinal tract. Circulatory System.—Cardiac action may be slightly stimulated by small doses, the experience of arsenic-eaters proving that the drug, so far from being necessarily deleterious, actually tends to invigorate the system. Large doses render the heart irritable and feeble and decrease the number of red corpuscles, rendering the blood less coagulable. Medicinal doses, while not increasing the number of red corpuscles, prevent their destruction in such dis- eases as pernicious anemia. Toxic doses induce, among other severe results, the characteristic arsenical symptom—fatty degen- eration of the cardiac muscle. Nervous System.—The general effect of arsenic upon the brain and nervous system is that of a tonic—a property which is sup- posed to explain its antiperiodic nature, in which respect quinine alone is its superior. The cerebral functions are stimulated, even to the point of exhilaration. Experiments have shown that the sensory nervous apparatus is strongly and untowardly affected. The action finally involves the motor system, complete paralysis supervening. Medicinal amounts act as a nervous excitant, stimu- lating the trophic apparatus (Hare). Large doses produce dis- orders of motility and sensibility, tremors, and other serious symptoms. It has been noted that the continued use of arsenic produces tingling and a sensation of numbness in the tips of the fingers. Under prolonged use arsenic tends to accumulate to a greater extent in nervous than in other tissues. Thus, according to 238 A TEXT-BOOK OF MATERIA MEDICA. Scolosuboff, if 1 part is found in fresh muscle, the proportion in the liver is 10.8; in the brain, 36.5 ; in the spinal cord, 37.3. Respiratory System.—Ordinary amounts effect no special change in respiration other than increased power and stimulation of the respiratory center. It has been held, with authority, that small doses stimulate the peripheral endings of the pulmonary vagi. In toxic doses arsenic acts as a powerful respiratory depressant. Absorption and Elimination.—Arsenic is readily absorbed by the blood. Its presence has also been detected in the viscera, bile, urine, sweat, the bronchial and intestinal mucous membranes, and even in the parenchymatous tissues. It is eliminated slowly from the system by the intestines, and rapidly by the urine; possibly, also, by the bile and the skin. The saliva, milk, and even the tears, are said to share in the process of elimination. Medicinal doses prevent tissue-change, while large doses in- crease nitrogenous metamorphosis. The therapeutic action is cer- tainly to modify and improve nutrition. Temperature.—The temperature is unaffected by medicinal doses. Toxic doses are accompanied by a considerable rise in bodily heat, though the extremities are often cold. Eye.—Large doses of arsenic are followed by injection of the conjunctivae, eczema, inflammation, and edema of the lids. Zehn- der asserts that the prolonged administration of arsenic has caused retrobulbar neuritis, and Hutchinson believes vitreous opacities may result from such a course. Untoward Action.—Differing from the characteristic symptoms of poisoning occasionally produced by medicinal doses in very susceptible persons, there are induced, not infrequently, restless- ness, headache, alopecia areata, bronchitis, hoarseness, disturbances of digestion, thirst, coryza, and, in rare cases, epistaxis, anaphro- disia, icterus, lacrymation, photophobia, amblyopia, dermatitis, and various cutaneous eruptions, frequently followed by desqua- mation. An eruption resembling that of measles, produced by 3 drops (0.18 Cc.) of Fowler's solution, is reported by Macnal (Medical Times and Gazette, 1868). Falck reports a case in which arsenic produced a discolored sanguinolent eruption with erysipelatous swelling. Papules and eiythematous pustules have also been observed. The variety of these eruptions is well, yet somewhat homeo- pathically, described by Imbert-Gourbeyre (quoted from Lewin): SPECIFICS. 239 " Eruptions petechiales ou ecchymoses, eruptions papuleuses, ortiees, vesiculeuses, erysipelateuses, pustuleuses, . . . telles sont les formes principales de l'arsenic, exanthematogene dans ses mani- festations a la peau." Poisoning.—Large doses of arsenic produce symptoms of acute poisoning, the drug almost immediately manifesting its character- istic effects upon the gastro-intestinal canal (to which it is a marked irritant), exciting active inflammation in its delicate membrane. Other symptoms are colicky pains in the stomach, looseness of the bowels, great pain in the esophagus, and edema of the face indicated by puffiness under the eyelids. The passages are at length similar to the " rice-water " discharges of cholera, although different from the latter in the presence of blood or serum. The purging becomes obstinate and exhausting. In certain cases other choleraic symptoms are especially manifested, as increasing cold- ness of the body and cramps. Among the more prominent symp- toms is violent vomiting, which, however, aids in eliminating the poison from the stomach. The effects of arsenic are somewhat variable, intestinal inflam- mation, as autopsies show, not always being present. The quan- tity requisite to produce poisoning is often dependent upon idio- syncrasy, minute doses having proved fatal, and large amounts followed by surprising recoveries. Frequently, in place of the usual symptoms, profound coma occurs from which the patient is, perhaps, never roused. Convulsions and localized paralysis have also been observed. It is well established, too, that absorption of arsenic from a wound or from injection into the blood causes stomachic and intestinal effects often as severe as those attend- ing its ingestion. Various cutaneous symptoms are recorded, and in some cases the effects of arsenical poisoning strongly resemble those of acute yellow atrophy of the liver-. Chronic Poisoning.—This malady is frequently due to the fumes or powder of arsenic inhaled in certain processes connected with the arts and manufactures or from manufactured products, such as wall-paper, certain dyes, textile fabrics, etc. The symptoms are similar to those accompanying full doses of the drug, save that they appear occasionally in a more aggravated form. Ordinarily, loss of appetite occurs, with nausea, abdominal pains, vomiting, mild diarrhea, and headache. The conjunctivae are injected, the eyes and nose watery. In severer cases peripheral neuritis may be 240 A TEXT-BOOK OF MATERIA MEDICA. induced, as well as herpes zoster and paralysis of the muscles of the limbs, particularly the extensors of the hands and feet. Ataxic gait and darting pains, with rapid loss of muscular power, are not infrequent. Death from arsenical poisoning, however, is commonly the result of gastro-enteritis or collapse. The post-mortem changes are usually characteristic of corrosive poisoning—ecchymoses, erosions, and softening of the mucous membrane. The lungs and bronchial membrane are frequently congested. There is also present marked fatty degeneration of the heart, kidneys, liver, and spleen. Treatment of Poisoning.—It is necessary that treatment be ex- peditious, and the agents and methods adopted carefully chosen. Vomiting often renders the use of the stomach-pump unnecessary, yet emetics are frequently serviceable, the cleansing of the stomach being of primary importance. Various antidotes have been suc- cessfully used, the best, chemically, being freshly prepared hydrated sesquioxide of iron, administered in water, 2 or 3 tablespoonfuls every fifteen or twenty minutes. Magnesia, chalk, and lime-water also serve as efficient antidotes. The temperature of the patient should be maintained, and demulcents (oil, milk, etc.) freely given. The after-treatment should include mucilaginous drinks, opiates if indicated, cathartics, and, in case of necessity, stimulants. Therapeutics.—Externally and Locally.—The chief use of arsenic locally is as an escharotic. For this purpose it is employed to destroy malignant growths, such as cancer, sarcoma of the skin, and multiple sarcomatous degeneration of the lymphatic glands. In the latter affection the parenchymatous injection of 5 minims (0.3 Cc.) of Fowler's solution, diluted with twice the amount of distilled water, is used. Many of the pastes and " quack " cancer remedies owe what- ever efficiency they possess to arsenic. Manec's paste contains arsenous acid, 15 grains (1.0 Gm.); black sulphide of mercury, 75 grains (5.0 Gm.); burnt sponge, 35 grains (2.3 Gm.). The noted poudre caustique de Frere Cbsme ou du Rousselot is a similar preparation, containing about the same quantity of arsenic. The solution of arsenous acid is an excellent local application to warts and corns. If these growths are very firm and horny, their removal may be facilitated by the previous application of solution of potassa. When used over large surfaces arsenic should be applied in good strength and heroically, so that active inflam- mation may be excited and the danger of absorption lessened. SPECIFICS. 241 Internally.—Arsenic is a peculiarly efficient remedy in chronic scaly skin diseases. Like all other specifics, it influences diseases of a chronic nature more favorably than acute disorders, invariably aggravating acute skin diseases. This drug, therefore, is one of the most valued remedies in psoriasis, lepra, and chronic squamous eczema. While arsenic cannot, perhaps, be classed as a specific in the above-mentioned diseases, it undoubtedly yields uniformly better results than any other single drug. The solution of potassa is a valuable synergist to arsenic in these conditions, especially in eczematous cases. Pemphigus, prurigo, acne, and lichen ruber have also been fa- vorably influenced by the continued administration of Fowler's solution. In the successful management of these chronic skin diseases it is necessary that the preparation of arsenic employed be given in as large doses as can be tolerated by the patient, and the treatment continued unremittingly for a long period. Lymphoma, whether superficial or occupying the great cavities, is frequently benefited greatly by similar treatment. Asthma and bronchitis, whether acute or chronic, accompanying or succeeding scaly skin diseases, are singularly amenable to this medicine when the dose is carried to the full physiological limit. Another condition, dysmenorrhea, frequently noticed in women with a tendency to asthma or subject to chronic diseases of the skin, is often cured or greatly benefited by arsenic. The obstinate and often incurable disease known as pernicious anemia yields better to arsenic than to any other known remedy. The effect of the drug in this disease is not due to its increasing the number and quality of the red blood-corpuscles, but rather to its preventing or delaying their destruction in the portal circulation. It should be given continuously and in gradually increasing doses until symptoms of arsenical poisoning appear, when the increase should cease and the same dose be maintained for some time. By carefully watching the indications and by the timely use of lax- atives the dosage may be easily adjusted so that the full benefit may be derived from this invaluable drug. The statements in the preceding paragraph are applicable also to leukemia, whether splenic, myelogenic, or lymphatic, and to Hodg- kin's disease. Arsenic ranks next to quinine in the treatment of malaria. 16 242 A TEXT-BOOK OF MA TERIA MEDICA. Chronic cases in which quinine has lost its power are generally benefited in a marked manner by arsenic. It is a peculiar fact that relapses are fewer after the arsenic treatment than after the use of quinine. Moreover, arsenic can be administered in intermittent fever, frequently with as favorable results as quinine would give. Arsenic can be employed in cases of malaria at all times with- out regard to the presence or absence of fever or chills. The neuralgias, anemia, and headache of malarial origin are singularly amenable to this medicine. In the treatment of malaria with arsenic it must be remembered that the paroxysms of ague are not relieved at once, as is the case when quinine is the medicament used; but they recur with less severity, and are of shorter duration, gradually declining until they disappear altogether. Fowler first reported the remarkable efficacy of arsenic in neuralgia of the intercostal and fifth pair of nerves. It is equally valuable in these cases whether the disease be due to malaria or to general debility. The author wishes to recommend urgently the use of arsenic in pulmonary phthisis. In certain forms of this disease he regards it equal, if not superior, to any other remedy. It is useful, however, only in those conditions which are characterized by excessive expectoration and a slow degenerative process. The good results of the arsenic treatment in these cases is shown in a conspicuous manner by a marked improvement in the general condition of the patient, there being a lessened pulmonary secretion, a reduction in temperature, improvement of the appetite, and consequent increase of the body-weight. Arsenic is contraindicated in phthisis when the cough is harsh and paroxysmal, with but scanty expectoration and a tendency to pulmonary hemorrhage. If this drug is specific in any one disease, it is so in chorea, very rarely failing to effect a cure when judiciously administered. It should be given in full doses, and increased as tolerance is established. This medicine seems to act equally well in gastralgia. It is also an efficient remedy in gastritis or the vomiting of gastritis, espe- cially in that occasioned by the excessive use of alcohol. Many irritative conditions of the stomach are relieved by minute doses of Fowler's solution. Excessive peristalsis, resulting in diarrhea, coming on immediately after taking food, is usually cured com- pletely by very small doses of Fowler's solution, alone or com- SPECIFICS. 243 bined with an equal quantity of tincture of opium. Arsenic has also been recommended in gastric ulcer and cancer. It has proved of great service in hay fever, spasmodic asthma, and acute coryza. It is often very serviceable in catarrhal pneu- monia and in chronic bronchitis. Bromide of arsenic is highly recommended in diabetes mellitus. Rheumatoid arthritis is more favorably influenced by the use of arsenic than by any other medi- cine. It should be employed in the treatment of chronic rheuma- tism. Even in secondary syphilis a combination of mercury and arsenic has produced better results, in some cases, than mercury alone. Anstie has recommended arsenic in angina pectoris, alleging that it mitigates the severity of the attacks. Chronic diarrhea, when induced by intestinal fermentation or chronic malarial infec- tion, is sometimes greatly benefited by this drug. Constipation, also, if due to deficient intestinal secretion, may frequently be relieved by the administration of small doses of arsenic. Albuminuria dependent upon imperfect digestion of albuminous substances is almost invariably relieved by Fowler's solution taken with meals. Certain nervous diseases of the aged, not due to malaria, such as melancholia and hypochondria, are often relieved by small doses of this drug. Finally, arsenic is a valuable adjunct to iron in the treatment of simple anemia and chlorosis. It is thought by some clinicians to retard the progress of epithelioma, and particularly gastric and uterine cancer. Contraindications.—In acute skin diseases and pulmonary tuberculosis with a tendency to hemoptysis. Administration.—Arsenic should be given ordinarily after meals. There are certain conditions, however, requiring its admin- istration in small doses before meals. Wrhen it is desired to give arsenic in pill form, the arsenous acid should be used; and for solutions the liquor potassii arsenitis is usually preferred. In syphilitic disorders Donovan's solution is an excellent prepa- ration to use. Children are much less susceptible to the drug than adults, often being able to take adult doses with impunity. During a course of arsenic the patient should be instructed to watch carefully for the first untoward manifestations, such as puf- finess about the eyes, itching of the conjunctivae, nausea, diarrhea, or numbness of the fingers. Any one of these symptoms is an 244 A TEXT-BOOK OF MATERIA MEDICA. indication that the dose should not be increased; and it may be necessary to lessen the dose, or even to discontinue the remedy altogether, for a while. There are two methods of getting a patient thoroughly under the influence of the drug: i. Begin with a full dose of Fowler's solution, and decrease i minim (0.06 Cc.) a day until a minim (0.06 Cc.) dose is reached; then repeat the method. 2. Begin with a small dose of Fowler's solution, and increase 1 minim (0.06 Cc.) a day until untoward symptoms appear or the dose has reached 10 or 15 minims (0.6-1.0 Cc); then either re- peat the method or decrease the amount 1 minim (0.06 Cc.) a day. Enormous doses of arsenic can be given hypodermically, and it is then much less toxic than when given by the mouth. Equiva- lents of 20 (1.2 Cc), 50 (3.2 Cc), and indeed 100, minims (6.5 Cc.) of Fowler's solution have been given in this manner at a single dose without toxic symptoms. Arsenic often acts more efficiently when given in this manner than when given by the mouth. The liver has a strong elective affinity for arsenic, but it is absorbed through the alimentary canal with considerable diffi- culty. The toxic action expends itself almost wholly upon the stomach and upper portion of the intestine. The hypodermic use of arsenic distributes the drug through the system just as mercury is distributed by inunction, carrying it immediately to all parts of the system by the circulation. The arsenite of sodium is free from any objection for hypodermic use : it never causes the least sign of irritation. Fowler's solution is objectionable : it invariably causes much irritation, and frequently forms an abscess. Careful study of the effects of the drug in each case will make it possible to guard its administration so that tolerance can be established—a result much to be desired in order to secure the maximum benefit. Considering the enormous doses to which the arsenocophagi become habituated, failure in the medicinal administration of arsenic argues the want of ability to employ it scientifically. Iodum—Iodi—Iodine. XT. 8. P. Origin.—It is found in the ashes of sea-weeds and is prepared from the mother-liquor obtained in the purification of Chili salt- petre. SPECIFICS. 245 Description and Properties.—Heavy, bluish-black, dry and friable rhombic plates, having a metallic luster, a distinctive odor, and a sharp and acrid taste. It imparts a deep-brown, slowly evanescing stain to the skin, and gradually destroys vegetable colors. Iodine is soluble in about 5000 parts of water and in 10 parts of alcohol, with a brown color; also freely soluble in ether and in a solution of potassium iodide, with a brown color, and in chloroform or carbon disulphide, with a violet color. It should be kept in glass-stoppered bottles, in a cool place. Dose.—About £ grain (0.016 Gm.), although seldom given in substance. Official Preparations. Liquor Iodi Compdsitus—Liquoris Iodi Compositi—Compound Solution of Iodine (Lugol's Solution).—Iodine, 5; Potassium Iodide, 10; Distilled Water, to make ioo parts. Strength, 5 per cent. Dose, 1-10 minims (0.06-0.6 Cc). Tinctura Iodi—Tinctiirae Iodi—Tincture of Iodine.—Iodine, 70; Alcohol, to 1000. Strength, 7 per cent. Dose, 1-5 minims (0.06-0.3 Cc). Unguentum Iodi—Ungufenti Iodi—Iodine Ointment.—Iodine, 4; Potassium Iodide, 1; Water, 2; Benzoinated Lard, 93. Strength, 4 per cent. For external use. Syrupus Acidi Hydriodidi—Syrupi Acidi Hydriodidi —Syrup of Hydriodic Acid. XT. 8. P. A syrupy liquid containing about I per cent, by weight of hydriodic acid. Description and Properties.—A transparent, colorless, or only pale straw-colored liquid, odorless, and having a sweet and acidu- lous taste. Dose.—\-2 fluidrachms (2.0-8.0 Cc). Ammonii Iodidum—Ammonii Iodidi—Ammonium Iodide. XT. 8. P. Origin.—It is prepared by dissolving Potassium Iodide and Ammonium Sulphate in boiling Water, adding Alcohol, filtering, washing the filtrate, and evaporating it to dryness. Description and Properties.—Minute, colorless, cubical crys- tals, or a white, granular powder, without odor when colorless, but emitting a slight odor when colored, and having a sharp, saline taste. The salt is hygroscopic, and soon becomes yellow, or yellowish-brown, on exposure to the air and light, owing to the loss of ammonia and the elimination of iodine. Soluble in 1 part 246 A TEXT-BOOK OF MATERIA MEDICA. of water and in 9 parts of alcohol. Ammonium iodide should be kept in small, well-stoppered vials, protected from light. Dose.—3-20 grains (o. 18-1.2 Gm.). Potassii Iodidum—Potassii Iodidi—Potassium Iodide. IT. 8. P. Origin.—Iodine is dissolved in a solution of Potassa in hot dis- tilled Water. The solution is evaporated, and the residue heated with charcoal. Dissolve in boiling Water, filter, wash the filtrate, and crystallize. Description and Properties.—Colorless, transparent or trans- lucent, cubical crystals, or a white, granular powder, having a pecu- liar, faint, iodine-like odor, and a pungent, saline, and afterward bitter taste. Permanent in dry air and but slightly deliquescent in moist air. Soluble in 0.75 part of water and in 18 parts of alcohol; also soluble in 2.5 parts of glycerin. Potassium iodide should be kept in well-stoppered bottles. Dose.—2-30 grains (0.12-2.0 Gm.). Official Preparation. Unguentum PotSssii Iodidi—Unguenti Potassii Iodidi—Ointment of Po- tassium Iodide.—Potassium Iodide, 12; Sodium Hyposulphite, i; Water, 10; Ben- zoinated Lard, 77. For external use. Sodii Iodidum—Sodii Iodidi—Sodium Iodide. XT. 8. P. Origin.—Prepared from a solution of Soda in a manner similar to the preparation of potassium iodide. Description and Properties.—Colorless, cubical crystals, or a white, crystalline powder, odorless, and having a saline and slightly bitter taste. In moist air it deliquesces and becomes partially de- composed into sodium carbonate and free iodine, assuming thereby a reddish color. Soluble in 0.6 part of water and in about 3 parts of alcohol. It should be kept in well-stoppered bottles. Dose.—2-30 grains (0.12-2.0 Gm.). Strontii Iodidum—Strontii Iodidi—Strontium Iodide. V. 8. P. Origin.—Prepared by neutralizing freshly prepared solution of Hydriodic Acid with Strontium Carbonate, concentrating the filtrate, and crystallizing. Description and Properties.—Colorless, transparent, hex- SPECIFICS. 247 agonal plates, odorless, and having a bitterish, saline taste; deli- quescent and colored yellow by exposure to air and light. Soluble in 0.6 part of water, also soluble in alcohol, and slightly in ether. It should be kept in dark, amber-colored, glass-stop- pered vials. Dose.—2-30 grains (0.12-2.0 Gm.). Zinci Iodidum—Zinci Iodidi—Zinc Iodide. XT. 8. P. Origin.—Obtained by dissolving Zinc Oxide or .Carbonate in Hydriodic Acid, or digesting Granulated Zinc in 10 parts of Iodine and 20 parts of Water, and evaporating to dryness. Description and Properties.—A white, granular powder, odor- less, and having a sharp, saline, and metallic taste. Very deliques- cent, and liable to absorb oxygen from the air and to become brown from liberated iodine. Readily soluble in water, alcohol, or ether. Zinc iodide should be kept in small, glass-stoppered bot- tles. Dose.—1-3 grains (0.06-0.18 Gm.). Sulphuris Iodidum—Sulphuris Iodidi—Sulphur Iodide. XJ. 8. P. Origin.—Prepared by heating Washed Sulphur and Iodine in a flask until the ingredients combine. Description and Properties.—Brittle masses, of a crystalline fracture and a grayish-black, metallic luster, having the odor of iodine and a somewhat acrid taste. Almost insoluble in water; soluble in about 60 parts of glycerin; very soluble in carbon di- sulphide. Alcohol and ether dissolve out the iodine, leaving the sulphur. Sulphur iodide should be kept in glass-stoppered bottles, in a cool place. Dose.—1-5 grains (0.06-0.3 Gm.). Unofficial Preparation. Ungugntum Sulphuris Iodidi—Ungugnti Sulphuris Iodidi—Ointment of Sulphur Iodide.—Sulphur Iodide, 30 grains (2.0 Gm.); Lard, 1 ounce (30.0 Gm.). For external use. Plumbi Iodidum—Plumbi Iodidi—Lead Iodide. XT. 8. P. Origin.—Mix solutions of Lead Nitrate and Potassium Iodide, filter, wash the precipitate with Distilled Water, and dry it at a gentle heat. 248 A TEXT-BOOK OF MA TERIA MEDICA. Description and Properties.—A heavy, bright-yellow powder, without odor or taste. Permanent in the air. Soluble in 2000 parts of water; very slightly soluble in alcohol, but soluble, with- out color, in solutions of the fixed alkalies, in concentrated solu- tions of the acetates of the alkalies, of potassium iodide, and of sodium hyposulphites, and in a hot solution of ammonium chloride. Lead iodide should be kept in well-stoppered bottles, protected from light. Dose.—l grain (0.013 Gm.), although, as a rule, this drug is employed externally. Argenti Iodidum—Argenti Iodidi—Silver Iodide. 77. 8. P. Origin.—Aqueous solutions of Silver Nitrate and of Potassium Iodide are poured together; the precipitate is then collected upon a filter and washed with Distilled Water and dried upon bibulous paper. Description and Properties.—A heavy, amorphous, light-yel- lowish powder, unaffected by light if pure, but generally becom- ing somewhat greenish-yellow, and having neither odor nor taste. Insoluble in water and alcohol. Dose.—|—2 grains (0.008-0.13 Gm.). Allied Compounds. Iodi Bromidum—Iodi Bromidi—Bromide of Iodine.—Origin.—Obtained by heating together Iodine and Bromine. Description and Properties.—A dark, reddish-brown liquid, resembling bromine in appearance and sensible properties, but yielding a perfectly transparent, brown-red solu- tion with less than 6 parts of water. For external use. Iodi Chloridum—Iodi Chloridi—Iodine Chloride (Iodine Trichloride).— Origin.—Prepared by passing dry Chlorine Gas over dry Iodine. Description and Properties.—Orange-yellow needles, gradually changing to large, transparent, rhombic plates. It has a penetrating, pungent odor, resembling bromine. Soluble in 5 parts of water, and also in alcohol and ether. Dose.—\ grain (0.01 Gm.), and externally in -£%-\ per cent, aqueous solution. Antagonists and Incompatibles.—Iodine and the iodides are antagonized by most of the Restoratives. Iodine is incompatible with the alkaloids and most of the mineral salts and acids, and with ammonia. The iodides are incompatible with mineral acids and acid salts, bismuth subnitrate, alkaloids, silver nitrate, soluble lead salts, spirit of nitrous ether, potassium chlorate, liquorice, and SPECIFICS. 249 preparations containing starch. The tincture of iodine is incom- patible with water and aqueous preparations. Synergists.—The specifics, alkalies, and remedies increasing waste. Physiological Action.—Externally and Locally.—Iodine is a powerful disinfectant and rubefacient, as well as vesicant, caustic, parasiticide, and antiseptic. When applied to the skin or mucous membrane it produces a yellow, brown, or black stain, and is irri- tant or caustic according to the strength and frequency of the application. The discoloration, however, can be easily removed by sodium hyposulphite or ammonia. It combines with the albumin of the tissues and prevents putre- factive changes. When tincture of iodine is frequently applied or large amounts are used, desquamation of the skin is produced, and sometimes rapid vesication, or perhaps sloughing. The blood- vessels of the organs subjacent to the area to which it is applied are reflexly dilated, rendering this drug an efficient counter-irritant. The vapor of iodine when inhaled produces considerable irrita- tion of the respiratory passages, exciting cough, sneezing, increased secretion of mucus, dyspnea, and more or less pain in the chest, although when inhaled in moderate amounts its antiseptic proper- ties exert a beneficial influence upon the bronchial tissues, prevent- ing decomposition of the secretions. The iodides have no local action. Internally.—Digestive System.—Taken internally in small doses, iodine acts as a gastric tonic, minute doses acting as a sedative, allaying nausea. In other cases a single moderate dose may occa- sion gastric uneasiness, larger amounts intensifying the discomfort and causing violent vomiting, increased salivary flow, abdominal pains, and purging. The iodides in moderate doses produce a sense of warmth in the stomach, larger amounts acting like iodine, though less irri- tating to the gastro-intestinal tract than the latter drug. Owing to their rapid diffusibility, the iodides can be tasted in a kw minutes after their ingestion, considerably increasing the flow of saliva. Circulatory System.—The effects of iodine and its salts have been variously reported, it being claimed that their tendency is to contract the vessels and cause increased cardiac action. Intro- duced into the veins, a slight increase, followed by decrease of pressure, has been observed. The rapidity of elimination from the 250 A TEXT-BOOK OF MATERIA MEDICA. blood is doubtless an impediment to any marked action on the circulation. Trasbot claims that potassium iodide dilates the blood-vessels, thereby increasing glandular secretion. The iodides are all supposed to be converted into the sodium iodide in the blood, without modifying the composition of that fluid. Nervous System.—No special action is recorded, although the potassium iodide is known to occasion unpleasant symptoms, in- cluding distress of mind and depression of spirits, accompanied now and then by lassitude and muscular debility—symptoms due rather to the influence of potassium upon the spinal cord. Respiratory System.—Little or no effect from medicinal doses has been noted. Absorption and Elimination.—Iodine and the iodides are rapidly absorbed by the mucous membranes generally, being found in the blood, mainly in combination with sodium. Elimination takes place by various channels—the urine, saliva, milk, intestinal and nasal mucous membranes. Salivary elimina- tion appears to be even more active than the urinary process, although the drug escapes largely through the kidneys, increasing the amount of water, urea, uric acid, and phosphoric and sulphuric acids excreted. At the points of elimination the iodine escapes in its nascent state, setting free ozone, which occasions more or less irritation. Temperature.—No effects have been noted, the temperature appearing to remain stationary even in the presence of decidedly untoward symptoms. Eye.—Beyond a local congestion of the minute vessels of the sclerotic coat under certain conditions little effect has been ob- served. The symptoms of ocular iodism at times present are described under " Poisoning." Uterus.—Small doses may increase or hasten the menstrual flow and act as aphrodisiacs; larger doses have a marked anaphro- disiac effect; while prolonged administration may result in atrophy of the ovaries. It has been maintained with authority that the catamenia are liable to increase, and that during pregnancy the drug may cause abortion. Untoward Action.—The untoward manifestations, in susceptible patients, are identical with those of iodism. Poisoning.—Taken in excessive doses, iodine acts as a poison, and has even produced death, though rarely. The symptoms of SPECIFICS. 251 acute poisoning are those of severe gastro-enteritis, characterized by distressing stomachic and abdominal pains, accompanied by painful irritation of the esophagus, followed by violent purging and vomiting. An early symptom is a strong metallic taste in the mouth, to- gether with increased salivation. Suppression of urine, hiccough, and dysenteric pain have been reported in a fatal case resulting from external application (Biddle, p. 460). Very immoderate doses are attended with rapid and feeble pulse, deathly pallor, severe renal irritation affecting urinary secretion, and final loss of vital power followed by respiratory failure. The condition induced by prolonged or excessive use of iodine or its salts is known as Iodism. Together with a metallic taste there are present tenderness of the teeth and gums, nausea and coryza or symptoms of gastric irritation, acneiform eruptions— even a vesicular and purpuric variety not infrequently occurs— while under continued dosage the coryza becomes more pro- nounced, accompanied by edema of the eyelids, lacrymation, and ocular pains. Moreover, muscular twitchings, edema of the glottis, neuralgic pains, and atrophy of mammae, testicles, and other tis- sues occasionally supervene. Anemia and even cachexia are often manifest. Treatment of Poisoning.—The use of large amounts of starch, in the form of arrowroot or starch-water, has been successfully adopted as an antidote. Hypodermic injections of ammonia, strychnine, digitalis, alcohol, and atropine have been employed with excellent results, as tending to restore the circulation and assist respiratory movements. More recently bicarbonate of so- dium has proved an efficient antidote. The use of the stomach-pump and the application of heat to the body and extremities are naturally of the first importance. Therapeutics.—Externally and Locally.—The tincture, com- pound solution, and ointment are extensively employed as coun- ter-irritants and as aids to the absorption of fluid. The tincture is an efficient application to joints in chronic rheumatism, gout, and synovitis, and in pleurisy, both for the purpose of aborting an attack and to aid the absorption of fluid when effusion has taken place. In neuritis, onychia, periostitis, venereal bubo, glandular swellings, etc. the tincture, applied externally, will often be of service. This same preparation is of marked benefit when hypodermi- 252 t A TEXT-BOOK OF MATERIA MEDICA. cally injected in goiter, particularly of the soft or cystic variety, hydrocele, empyema, extensive serous arthritic effusion unaccompanied by inflammation, spinal meningocele, and anal fistula. The tincture is also a very efficient application in chronic metritis and chronic endometritis. In many diseases of the skin iodine serves a useful purpose as a discutient and parasiticide, lentigo, lupus, chloasma, tinea tonsurans, etc. especially indicating its use. Many chronic splenic and hepatic disorders are favorably influ- enced by an external application of the iodine ointment. The tincture of iodine has been recommended as an efficient application in recession of the gums attendant upon pyorrhoea alveolaris. The vapor of iodine is frequently employed in subacute ca- tarrhal deafness and in acute coryza. A mixture of tincture of iodine \ fluidrachm (2.0 Cc), carbolic acid 10 minims (0.6 Cc), glycerin and water, each, \\ ounces (45.0 Cc), has been highly recommended by Samuel Johnston in the treatment of chronic pharyngitis. As an inhalant in chronic laryngitis and phthisis iodine in some form is highly esteemed by many physicians. Internally.—One of the principal and most important uses of iodine and the iodides is in the treatment of secondary and tertiary syphilis. All the manifestations of this disease, such as syphilitic periostitis, meningitis, endarteritis, gummata, paralysis, etc., are re- lieved by large doses of the iodides to saturation of the system. The more chronic the disease, the larger the dose required; and the more acute the attack, the smaller the dose. Iodine is peculiarly useful in combining with and eliminating mercury from the system of patients suffering from mercurial cachexia, paralysis, etc. Other metals, lead, etc., are readily elim- inated by a course of potassium iodide. Potassium iodide is of marked utility in arresting the various manifestations of scrofula, such as inflammation and ulceration of cartilaginous structures and mucous catarrhs, and hastening the reso- lution of adenitis and enlargement of lymphatics. With regard to the use of iodine in the treatment of aneurysm of the aorta Walshe says : " Not only has relief of neuralgic pains and of the general distress followed its administration, but the local pressure-symptoms have been mitigated, and firm thrombosis has taken place within the sac, while the area of pulsation and of per- SPECIFICS. 253 cussion-dulness has exhibited sensible reduction." Other authori- ties have reported favorably of its use in this condition. As a cardiac tonic iodine is of undoubted value, being especially serviceable in fatty degeneration of the heart, and in usually miti- gating the symptoms of chronic valvular diseases of the heart, especially those of the aortic orifice. It is a particularly useful remedy in chronic asthma and bronchitis, and to hasten the removal of inflammatory products of pneumonia, pleurisy, and pericarditis. The spasmodic asthma of adults and the bronchitis of children, both of which alternate with eczematous attacks, are greatly relieved by the potassium iodide. Even hereditary asthma occurs at less frequent intervals and in a milder form when the patient is kept constantly under the influ- ence of moderate doses of this drug. And if there is any remedy which has a beneficial influence in acute tubercular meningitis, it is potassium iodide. In the early stages of cirrhosis, whether of the liver or kidneys, as well as in sclerosis of the cord, it is an efficient remedy. The dropsy of splenic or hepatic induration is relieved by iodine, while in the various forms of muscular rheumatism it is one of the most potent medicaments. It has been advocated as a successful remedy in sciatica and chronic gout. It unquestionably retards the changes in chronic interstitial nephritis, though the tincture of iodine in these cases is considered superior to the potassium iodide. Ammonium iodide is highly recommended as an efficient rem- edy in acute catarrhal pneumonia and capillary bronchitis. It is especially useful in catarrhal jaundice, and has, moreover, been suggested as a good remedy in hay fever and in malarial fevers. The syrup of hydriodic acid has been commended by Craig as a valuable agent in acute rheumatism. Contraindications.—The drug should be discontinued at once when symptoms of iodism appear. It is contraindicated also in pulmonary tuberculosis when there is rapid change taking place in the lung. The iodides should not be given immediately before or after the administration of quinine. Administration.—The sodium iodide is less active and toxic than the potassium salt. The strontium iodide may be used for the same purposes as the other iodides, and possesses the advantage of disturbing the stomach less, besides being less likely to produce iodism. 254 A TEXT-BOOK OF MATERIA MEDICA. The iodides should be given in a large quantity of liquid. Their unpleasant taste may be concealed to a considerable extent by dissolving them in carbonic-acid water or Vichy water. Milk, com- pound syrup of sarsaparilla, and currant and raspberry syrups have all been used for this purpose. It is said that tincture of belladonna or sodium bicarbonate prevents the coryza caused by the iodides. The syrup of hydriodic acid is quite pleasant to the taste, and has but little tendency to produce iodism or untoward effects. This preparation should always be administered upon an empty stomach. Colchicum—Colchici—Colchicum. XT. 8. P. (Meadow Saffron.) Origin.—A plant indigenous in Europe, in the southern and central portions of which it is frequently found in pastures and meadows, flowering in September or October, and ripening its seeds in June following. The root and seeds are official. Description and Properties.—The root is about I inch (25 Mm.) long, ovoid, flattish, with a groove on one side; externally brownish and wrinkled, internally white and solid ; often in trans- verse slices reniform in shape, and breaking with a short, mealy fracture; inodorous ; taste sweetish, bitter, and somewhat acrid. Dose.—2-8 grains (0.12-0.5 Gm.) in powder. Official Preparations of the Root. Extractum Cblchici Radicis—Extracti Colchici Radicis—Extract of Col- chicum Root.—Dose, \-i grains (0.03-0.12 Gm.). Extractum C61chici Radicis Fluidum—Extracti C&lchici Radicis Fluidi— Fluid Extract of Colchicum Root.—Dose, 2-8 minims (0.12-0.5 Cc). Vinum C61chici Radicis—Vini Colchici Radicis—Wine of Colchicum Root.—Dose, 5-20 minims (0.3-1.2 Cc). Colchicum seeds are subglobular, about -^ inch (2 Mm.) thick, very slightly pointed at the hilum; reddish-brown, finely pitted, internally whitish; very hard and tough; inodorous; taste bitter and somewhat acrid. Both the root and seeds contain an active principle, colchicine, which is present in greater proportion in the root. Dose of the Powdered Seeds.—1-5 grains (0.06-0.3 Gm.). Dose of Colchicine.—x I0 ^ grain (0.0012-0.001 Gm.). SPECIFICS. 255 Official Preparations of the Seed. Extractum CSlchici Sfeminis Fliiidum—Extr3cti CSlchici SSminis Fluidi__ Fluid Extract of Colchicum Seed.—Dose, 1-5 minims (0.06-0.3 Cc). Tinctura C61chici Sfeminis—Tinctiirae CSlchici S&minis—Tincture of Col- chicum Seed.—Dose, 10-30 minims (0.6-2.0 Cc). Vinum C&lchici S&minis—Vini CSlchici SSminis—Wine of Colchicum Seed.—Dose, 10-30 minims (0.6-2.0 Cc). Antagonists and Incompatibles.—Alcohol and opium antago- nize the cardiac depression produced by colchicum. Tannic acid and vegetable infusions containing it are incompatible, forming an insoluble tannate with the alkaloid. Synergists.—Diuretics, purgatives, emetics, and alkalies pro- mote the therapeutic activity of colchicum. Physiological Action.—Externally and Locally.—Colchicum is a decided local irritant, and when applied to the skin acts as a rubefacient. The dust when inhaled excites sneezing. Internally.—Digestive System.—In small medicinal doses colchi- cum slightly stimulates the salivary, gastric, biliary, and intestinal secretions. If these doses are repeated for several days, a sensa- tion of heat is experienced in the epigastrium, accompanied by loss of appetite and frequently by nausea. Full medicinal doses may produce purging and colic. Larger doses occasion profuse watery and choleriform or bloody evacuations from the bowels, severe abdominal pain and tenderness, excessive vomiting—in fact, all the symptoms produced by a violent gastro-intestinal irritant. Circulatory System.—Full medicinal or larger doses produce great depression of the circulation, with a small, rapid, and thready pulse. The marked cardiac depression and collapse which occur when poisonous doses of colchicum have been taken are more the result of the severe gastro-enteritis than of any direct action upon the heart. Nervous System.—The nervous system is unaffected by medici- nal doses. Even when poisonous doses have been taken the intellect usually remains unimpaired, though Toulmouche has seen the drug induce marked cerebral excitement. Discordant state- ments have been made regarding the action of colchicum upon the nervous system. The drug evidently affects different persons dif- ferently. Thus numbness or prickling, muscular pains or spasms, and occasionally convulsions, have been noticed; yet the recent investigations of Laborde and Houde upon the action of colchicine show that it has no influence upon the centers of intelligence and 256 A TEXT-BOOK OF MATERIA MEDICA. volition, and does not induce paralysis of central origin, either motor or sensory, though the sensory nerves are considerably depressed. Respiratory System.—Large or poisonous doses of colchicum render the respiratory movements slow and shallow. This action is not due to any direct effect upon the respiratory center, but reflexly to the depression occasioned by the violent action of the drug upon the gastro-intestinal tract. Absorption and Elimination.—Colchicum is quite rapidly ab- sorbed, and is eliminated chiefly by the bowels and kidneys, the skin sharing to some extent in the excretory process. Some ob- servers allege that colchicum does not increase the amount of urine or the excretion of urea and uric acid, while others claim that these substances are increased. The author's experiments are sufficient to satisfy him that the excretion of all these sub- stances is considerably heightened under medicinal doses of col- chicum. Temperature.—Under moderate medicinal doses the temperature is unaffected, though doses large enough to produce emeto-cathar- sis are followed by a reduction of temperature. Untoward Action.—Many symptoms described under " Poison- ing " have been produced by very small doses. It is a matter of speculation whether these untoward manifestations were due to a decided idiosyncrasy on the part of the patient, or to the fact that the preparation employed might have contained an unusually large percentage of the alkaloid. Poisoning.—The symptoms of poisoning by colchicum are vio- lent vomiting and purging, griping and intense pain in the abdomen, and at times excessive salivation or possibly convulsions. While death is for a time delayed under a poisonous dose, a fatal termina- tion is almost inevitable. Meanwhile the patient suffers excruci- atingly, being little relieved by treatment. Treatment of Poisoning.—All that can be done is to combat symptoms, giving opium for pain, oil and demulcent drinks for the irritation, and stimulants to counteract respiratory and cardiac depression. Washing out the stomach or the use of emetics may be required. Tannic acid serves as a partial antidote, precipitating the colchicine. Therapeutics.—Externally and Locally.—Colchicum has no local therapeutic action. Internally.—Colchicum is the typical vegetable specific. Its SPECIFICS. 257 effects are in many ways analogous to those of mercury and iodine, even resulting in fatty degeneration of the liver, loss of hair, nails, teeth, etc. The drug is as valuable and certain a specific for gout as is mer- cury for syphilis. Gout in all its varied manifestations is relieved by this invaluable remedy. Diarrhea, dysentery, dyspepsia, bron- chitis, asthma, neuralgia, and eczema depe?ident upon a gouty condi- tion are singularly benefited by colchicum. This medicine, while quite efficacious in chronic rheumatism, and occasionally of some benefit in rheumatoid arthritis, is of no value in acute articular rheumatism. Its value is more apparent in acute than in chronic gout, and in the first attacks than in succeeding ones. Chronic gout, as well as chronic rheumatism, yields better to a combination of colchicum and potassium iodide than to colchicum alone. Some physicians recommend hypodermic injections of colchi- cine into the sheath of the nerve in sciatica. The author's quite limited use of this method has resulted in so much local irritation that he is prompted to caution the reader against the hypodermic employment of this drug. In combination with certain other agents colchicum serves an excellent purpose as a cholagogue, full doses being frequently very effective in relieving ascites due to obstructive diseases of the liver. Colchicum is sometimes employed as a drastic purgative in cerebral and portal congestion, although when given in doses suf- ficient for this purpose it occasions considerable nausea and abdom- inal distress. Colchicum has also been recommended in the treatment of gonorrhea and chordee. In doses of -^ grain (0.001 Gm.) colchicine has been suggested by Darier in certain inflammatory diseases of the eye. Hypochon- driasis resulting from renal insufficiency is frequently benefited by colchicum. Contraindications.—The drug would be contraindicated in acute inflammatory conditions of the gastro-intestinal tract. It should be cautiously administered to old people. Administration.—The liquid preparations are to be preferred, and, in order to secure the full curative effects of the drug, it is unnecessary to give it in doses sufficiently large to excite vomiting or purging. The initial dose, therefore, should be small, that it may occasion no gastric disturbance. 17 258 A TEXT-BOOK OF MA TERIA MEDICA. The beneficial effects of colchicum may be enhanced by first emptying the intestinal canal by means of a saline cathartic. The preparations of colchicum vary greatly in strength. The crude drug contains different percentages of the alkaloid, accord- ing to the season of the year in which the plant is gathered, the colchicum root collected in July and August containing the largest percentage of colchicine. Owing to this variation in strength the assayed tincture or the alkaloid is recommended as the best prepa- ration to use, though, because of its activity and poisonous prop- erties, the alkaloid should be given in very small doses at first— not to exceed T^-g- of a grain (0.0005 Gm.) two or three times a day. Guaiaci Lignum—Guaiaci LTgni—Guaiacum Wood. V. 8. P. (Lignum Vitve.) Origin.—The heart-wood of Guaiacum officinale L. and of Guai- acum sanctum L., trees indigenous in the West Indies and on the northern coast of South America. The former is about 40 feet (12 M.) high, having evergreen pinnate leaves. Description and Properties.—The wood is heavier than water, hard, brown or greenish-brown, resinous, marked with irregular concentric circles surrounded by a yellowish alburnum; splitting unevenly, when heated emitting a balsamic odor; taste slightly acrid. It contains from 20 to 25 per cent, of resin, its most important constituent. Dose.—^-1 drachm (1.0-4.0 Gm.). Official Preparation. Guaiacum wood is contained in Decoctum Sarsaparillse Compositum, for which see Sarsaparilla. Guaiaci Resina—Guaiaci Reslnse—Guaiac. XT. S. P. Origin.—The resin of the wood of Guaiacum officinale. Description and Properties.—Irregular masses or subglobular pieces, externally greenish-brown, internally of a glassy luster, and in recent guaiac usually reddish-brown, transparent in thin splinters, fusible, feebly aromatic, the odor becoming stronger upon heating; taste somewhat acrid; powder grayish, turning green on exposure to air. Soluble in potassium or sodium hydrate T. S. and in alco- SPECIFICS. 259 hoi, the alcoholic solution being colored blue by the addition of tincture of ferric chloride. The principal constituents of guaiac are—guaiaconic acid, guai- acic acid, guaiaretic acid, and a small amount of gum. These substances are insoluble in water, but soluble in alkalies. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations. Pilulae Antimonii CompSsitse—Pilulas (ace) Antimonii CompSsitas—Com- pound Pills of Antimony (Plummer's Pills).—Dose, 1 or 2 pills. Tinctura Guaiaci—Tinctiirae Guaiaci—Tincture of Guaiac.—Dose, 30-60 minims (2.0-4.0 Cc). Tinctura Guaiaci Ammoniata—Tinctiirae Guaiaci Ammoniatae—Ammoni- ated Tincture of Guaiac.—Dose, 30-60 minims (2.0-4.0 Cc). Unofficial Preparation. Emiilsum Guaiaci—Emiilsi Guaiaci—Guaiac Emulsion.—Dose, \-z fluid- drachms (2.0-8.0 Cc). Antagonists and Incompatibles.—Spirit of nitrous ether and the mineral acids are incompatible with guaiac. Water is pharma- ceutically incompatible with the tinctures, precipitating the resin. Synergists.—Many of the diaphoretics and diuretics aid the action of guaiac Colchicum, sarsaparilla, mezereum, stillingia, sassafras, sanguinaria, and xanthoxylum are also synergistic. Physiological Action.—Externally and Locally.—Guaiac is antiseptic, and possesses mildly astringent properties, being used locally as a gargle. Internally.—Digestive System.—It increases the flow of saliva and gastric juice, producing a sensation of warmth in the epigas- trium. It also augments the secretions from the intestinal canal, excessive doses even causing vomiting and purging. Circulatory System.—Guaiac increases the force and rapidity of the heart's action and dilates the cutaneous blood-vessels. Nervous System.—No special action has been observed. Respiratory System.—The drug is an expectorant, increasing, the production and excretion of bronchial mucus. Absorption and Elimination.—Though a colloidal substance, it is absorbed into the blood with considerable facility, being excreted chiefly by the skin, exciting free diaphoresis. The bowels, kidneys, and bronchial mucous membrane assist in the excretory process. Temperature.—Under doses sufficient to cause free diaphoresis 260 A TEXT-BOOK OF MATERIA MEDICA. the temperature may be reduced. Guaiac has, however, no direct influence upon the heat-center. Uterus.—Large doses of guaiac induce contraction of the womb, the drug thus acting as an ecbolic Untoward Action.—No special symptoms are manifest other than the gastro-intestinal disturbance mentioned, and occasionally headache and giddiness. Poisoning.—Guaiac cannot be classed as a poisonous substance. Excessive doses act as a gastro-intestinal irritant, although no case of death is recorded resulting directly from this drug. Treatment of Poisoning.—This should be symptomatic, and similar to the treatment of poisoning from colchicum. Therapeutics.—Externally and Locally.—Guaiac in some form is an excellent application in follicular tonsillitis, rheumatic pharyn- gitis, and quinsy. For these cases the emulsion of guaiac serves as an efficient gargle, or the troches of guaiac may be used. Internally.—From the sixteenth to the eighteenth century guaiac was renowned as a cure for syphilis, having been introduced into Europe from San Domingo. The heroic manner, however, in which the drug was employed rendered the results more injurious than beneficial, so that the guaiac treatment was condemned, one of its most vigorous opponents being Paracelsus, to whom the reintroduction of mercury for the treatment of syphilis is largely due. Since we have learned to use mercury and iodine and its preparations intelligently the guaiac treatment of this disease pos- sesses only a historic interest. Nevertheless, the drug possesses properties which render it exceedingly valuable in chronic muscular rheumatism, neuralgic dysmenorrhea, and atonic amenorrhea. Guaiac is considered to be an efficient remedy in lumbago and chronic gout. Its most important service, however, in therapeutics is in the treatment of quinsy. It is doubtful whether there is any drug which will modify the course of this disease or abort an attack of tonsillitis so readily as this medicine. The tincture of guaiac is the preparation usually employed for this purpose, \ fluidrachm (2.0 Cc.) being given in the form of an emulsion every three or four hours. Contraindications.—There are no marked contraindications to its use. Administration.—The tinctures are very acrid and disagreeable to the taste, and should be given in the form of an emulsion. The emulsion of guaiac, a formula for which is given in the Dispensa- SPECIFICS. 261 tories, is not unpleasant, and is altogether the best liquid prepara- tion to give. The lozenges of guaiac, allowed to dissolve slowly in the mouth, serve as an agreeable and efficient method of medicating the throat with this drug. Sarsaparilla—Sarsaparlllae—Sarsaparilla. XT. 8. P. Origin.—The root of Smilax officinalis Kunth and other species of Smilax growing in swampy forests in Mexico and as far south as the northern portion of Brazil. They are woody climbers, often attaining a great height. Description and Properties.—About \ to \ inch (3.17-6.35 Mm.) thick, very long, cylindrical, longitudinally wrinkled, exter- nally grayish- or orange-brown; internally showing a whitish and mealy or somewhat horny cortical layer surrounding a circular wood-zone enclosing a broad pith; nearly inodorous ; taste muci- laginous, bitterish, and acrid. The thick, woody, knotty rhizome, if present, should be removed. Sarsaparilla contains an active principle, parillin, an acrid gluco- side which froths with water and otherwise closely resembles sapo- nin in its action. Dose.—30-60 grains (2.0-4.0 Gm.). Official Preparations. DecSctum Sarsaparlllae CompSsitum—DecScti Sarsaparlllae CompSsiti— Compound Decoction of Sarsaparilla.—Dose, 4-6 fluidounces (118.-178. Cc). 10 per cent., with Sassafras, Guaiac-wood, Glycyrrhiza, and Mezereum. Extractum Sarsaparlllae Fltiidum—Extracti Sarsaparlllae Fluidi—Fluid Extract of Sarsaparilla.—Dose, \-2 fluidrachms (2.0-8.0 Cc). Extractum Sarsaparlllae Fluidum Compositum—Extr3cti Sarsaparlllae Fluidi CompSsiti—Compound Fluid Extract of Sarsaparilla.—Dose, \-2 fluid- drachms (2.0-8.0 Cc). Syrupus Sarsaparlllae CompSsitus—Syrupi Sarsaparlllae CompSsiti—Com- pound Syrup of Sarsaparilla.—Dose, 2-4 fluidrachms (8.0-16.0 Cc). A Fluid Extract, 20 per cent., with the Fluid Extracts of Glycyrrhiza and Senna, and the Oils of Sassafras, Anise, and Gaultheria. Antagonists and Incompatibles.—Alkalies and free iodine are incompatible with the official preparations of sarsaparilla. Corro- sive sublimate is said to be changed into calomel by the compound syrup of sarsaparilla. Synergists.—The specifics, diaphoretics, and diuretics. Physiological Action.—Sarsaparilla has no local influence. 262 A TEXT-BOOK OF MATERIA MEDICA. Internally its action is similar to that of guaiac, though not so energetic and irritant in large doses. Therapeutics.—As with guaiac, the history of sarsaparilla is full of interest. Introduced into Europe in the sixteenth century by the Spaniards, who had learned of its alleged virtues in consti- tutional syphilis in Peru, San Domingo, and Brazil, it retained its reputation as a specific in this disease for a century or more, when it was abandoned, only to be revived at the close of the eighteenth century. Since that time it has retained its place in medicine more through the wonderful virtues ascribed to it by nostrum-venders than to any real medicinal properties which it possesses. The consensus of competent opinion seems to be that sarsa- parilla can claim no special medicinal virtues other than its diuretic and diaphoretic properties. The compound decoction of sarsaparilla is probably the most useful official preparation, and appears to have been of some bene- fit in scrofula and strumous cutaneous affections. Indeed, some cases of constitutional syphilis have improved more rapidly under the administration of this preparation than when mercury or potas- sium iodide has been given alone. Contraindications.—There are none. Administration.—No special directions can be given for the administration of the various preparations. The compound syrup of sarsaparilla is quite pleasant to the taste, and is used extensively as a vehicle, particularly for potassium iodide. Stillingria—Stilllngriae—Stillingia. XT. 8. P. (Queen's Root.) Origin.—The root of Stillingia sylvatica L., a perennial herb growing in dry and sandy soil in the Southern United States as far north as Eastern Virginia. Description and Properties.—About I foot (30 Cm.) long and nearly 2 inches (5 Cm.) thick, subcylindrical, slightly branched, compact, wrinkled, tough, grayish-brown, breaking with a fibrous fracture, showing a thick bark and porous wood, inner bark and medullary rays having numerous yellowish-brown resin-cells. The odor is peculiar and unpleasant; the taste bitter, acrid, and pungent. The fresh root, probably contains an active principle not yet determined. (Old roots are nearly inert.) It contains an acrid SPECIFICS. 263 resin, sylvacrol, a volatile and a fixed oil, resin, starch, gum, and tannin. Dose.—15-30 grains (1.0-2.0 Gm.). Official Preparation. Extractum Stillingiae Fluidum—Extracti Stillingiae Fluidi—Fluid Extract of Stillingia.—Dose, \-i fluidrachm (1.0-4.0 Cc). Unofficial Preparations. DecSctum Stillingiae—DecScti Stillingiae—Decoction of Stillingia.—Dose, 1-2 fluidounces (30-60 Cc). Extractum Stillingiae Fluidum CompSsitum—Extracti Stillingiae Fluidi CompSsiti—Compound Fluid Extract of Stillingia.— Dose, 1-2 fluidrachms (4.0- 8.0 Cc). Stillingia, 130; Corydalis, 130; Chimaphila, 60; Iris, 60; Sambucus, 60; Xanthoxylum Berries, 30; and Coriander, 30; to make 500 parts Fluid Extract with Dilute Alcohol. Syrupus Stillingiae CompSsitus—Syrupi Stillingiae CompSsiti—Compound Syrup of Stillingia.—Dose, 1 fluidrachm to 1 ounce (4.0-30 Cc). Compound Fluid Extract, 1, to Simple Syrup, 3 parts. Tinctura Stillingiae—Tinctiirae Stillingiae—Tincture of Stillingia.—Dose, \-\ fluidrachm (2.0-4.0 Cc). Antagonists and Incompatibles.—There are none affecting Stillingia. Synergists.—The same as for sarsaparilla. Physiological Action.—The action of stillingia resembles that of sarsaparilla, the drug increasing the various secretions and stim- ulating the heart and circulation. Therapeutics.—The medical uses are the same as those of sarsaparilla. Sanguinaria—Sanguinariae—Sanguinaria. XT. 8. P. (Blood-root.) Origin.—The rhizome of Sanguinaria Canadensis L., a low perennial, a native of Canada and the United States, where it grows in open woods in a rich soil. The rhizome should be collected in autumn. Description and Properties.—Of horizontal growth, about 2 inches (5 Cm.) long and f inch (1 Cm.) thick, cylindrical, some- what branched, slightly annulate, wrinkled, reddish-brown; frac- ture short, somewhat waxy, whitish, with numerous small red resin-cells, or of a nearly uniform, brownish-red color; bark thin; odor slight; taste persistently bitter and acrid. It contains a color- 264 A TEXT-BOOK OF MATERIA MEDICA. less alkaloid, sanguinarine, yielding red salts; chelerythine, yield- ing lemon-yellow salts ; homochelidonine ; and protopine. Dose.—2-20 grains (0.12-1.2 Gm.). Official Preparations. Extractum Sanguinariae Fluidum—Extracti Sanguinariae Fluidi—Fluid Extract of Sanguinaria.—Dose, 5-15 minims (0.3-1.0 Cc). Tinctura Sanguinariae (15 per cent.)—Tinctiirae Sanguinariae—Tincture of Sanguinaria.—Dose, 10-60 minims (0.6-4.0 Cc). Unofficial Preparations. Acetum Sanguinariae—Aceti Sanguinariae—Vinegar of Sanguinaria.—Dose, 15-40 minims (1.0-2.5 Cc.); as an emetic, 1-4 fluidrachms (4.0-16.0 Cc). Sanguinarine Nitrate.—Dose, ■£^r\ grain (0.005-0.008 Gm.). Antagonists and Incompatibles.—The irritation and circu- latory depression occasioned by blood-root are antagonized by opium, atropine, etc., while the incompatibles are tannic and gallic acids, alkalies, and metallic salts. Synergists.—The Specifics and the mineral and vegetable emetics aid the action of sanguinaria. Physiological Action.—Externally and Locally.—Sanguinaria is an irritant and a feeble escharotic. When the powder of blood- root is inhaled it produces great irritation of the respiratory pas- sages, with excessive secretion and violent sneezing. Internally.—Digestive System.—Medicinal doses occasion a sense of constriction in the throat and heat in the epigastrium, increasing the secretions from the stomach, liver, and intestines. Excessive doses are followed by marked salivation, nausea, and vomiting, the drug acting as a systemic emetic. Very large doses cause great irritation of the intestines, producing hypercatharsis. Circulatory System.—At first the heart's action is increased and arterial tension raised, but these effects are followed by cardiac and circulatory depression. Poisonous doses sometimes result in car- diac paralysis. Nervous System.—Large doses diminish reflex excitability by paralysis of the spinal centers, occasionally producing convulsions of spinal origin. Respiratory System.—Medicinal doses of sanguinaria have no apparent effect upon the respiration; poisonous doses, however, render the breathing slow and shallow, death resulting from as- phyxia due to paralysis of the respiratory center. The final col- SPECIFICS. 265 lapse is often preceded by convulsions arising from the accumulation of carbon dioxide in the blood from failure of respiration. Blood-root is a stimulant expectorant, increasing the secretion from the broncho-pulmonary mucous membrane. Absorption and Elimination.—The drug is quite rapidly ab- sorbed, and is eliminated by the intestines, stomach, skin, kidneys, and bronchial mucous membrane. Temperature.—Medicinal doses have no effect upon, but exces- sive doses lower, the temperature. Eye.—Poisonous doses produce dilatation of the pupils. Uterus.—Sanguinaria possesses emmenagogue properties. Untozvard Action.—This does not differ from the poisonous action which follows. Poisoning.—Blood-root is an acro-narcotic poison, exciting sali- vation, violent vomiting, profuse watery evacuations from the bowels, and producing all the symptoms of gastro-enteritis. The muscular system is greatly relaxed, the pulse is slow, weak, and irregular, the skin covered with cold sweat, and finally collapse of the vital powers supervenes. Convulsions may precede a fatal termination, which is due to paralysis of the respiratory or cardiac center. Treatment of Poisoning.—The stomach should be washed out and diffusible stimulants freely given. Strychnine may be admin- istered hypodermically, and digitalis and amyl nitrate given if necessary. The pain and nausea may be relieved by morphine and atropine. The normal temperature of the body should be main- tained by external warmth. Therapeutics.—Externally and Locally.—The nitrate of san- guinarine—\ grain (0.015 Gm.) to 1 ounce (30 Cc.) of glycerin— has been recommended by Keyser in conjunctivitis granulosa. The powdered blood-root has been employed as a sternutatory, and when mixed with two or three times the amount of powdered acacia or starch it has proved beneficial, in the hands of some physicians, in the dry form of atrophic rhinitis. The pure powder is said to be an efficient escharotic to nasal polypi and fungoid con- ditions of the mucous membrane. Some authorities claim it to be an effective remedy for cancer, and consider it a valuable stimulant for indolent ulcers. The decoction of sanguinaria has been employed as a gargle in scarlatinal angina. This drug is now seldom used locally, the irritation caused by 266 A TEXT-BOOK OF MATERIA MEDICA. it being so great that patients can only with great difficulty be per- suaded to submit to the treatment. Internally.—While possessing alterative properties and classed among the Specifics, one of the principal uses of sanguinaria is in acute bronchitis, when the spasmodic element predominates and after the subsidence of the more acute symptoms. In atonic conditions of the stomach and bowels, with increased secretion of mucus, small doses of tincture of sanguinaria prove beneficial. The tincture is of equal value in duodenal catarrh with jaundice. As an emmenagogue and aphrodisiac blood-root has been suc- cessfully employed in functional amenorrhea and dysmenorrhea, as well as in functional impotence with relaxation of the genital organs and daily seminal losses. Sanguinarine has been recommended in hysteria, either alone or associated with podophyllum. Protracted muscular rheumatism has apparently been benefited by this drug. Tincture of sanguinaria has served as an emetic in spasmodic laryngitis, though its depressing and irritating action renders san- guinaria much less desirable than certain other emetics. The drug is considered to possess marked alterative proper- ties, and is still frequently employed in the treatment of syphilitic and strumous affections of a chronic nature. It certainly appears to be a mild stimulant to the vegetative sys- tem of nerves, improving the circulation, nutrition, and secretion. Contraindications.—No special contraindication exists, unless it be an acute inflammatory condition of the stomach and bowels. Administration.—The nitrate of sanguinarine is the best prepa- ration to use in diseases of the respiratory tract. As a gargle the vinegar of sanguinaria is to be preferred, while, if the drug is to be employed as an emetic, the infusion, given in tablespoonful doses at short intervals, serves the best purpose. For other purposes the tincture is the most desirable preparation. The sanguinarine nitrate is best administered in pill form; the liquid preparations should be given well diluted with water. Mezereum—Mezerei—Mezereon.—Z7. 8. P. Origin.—The bark of Daphne Mezereum L. and other species of Daphne, small shrubs about 2-4 feet (0.6-1.2 M.) high, indige- SPECIFICS. 267 nous in hilly and mountainous regions of Europe, extending to the Arctic Circle and eastward to Siberia. Description and Properties.—Long, thin bands, usually folded or rolled into disks, the outer surface yellowish or brownish-yellow, with transverse scars and minute blackish dots, underneath of a light greenish color; inner surface whitish, silky. Bast in trans- verse layers, very tough; inodorous; taste very acrid. The im- portant constituent is an acrid resin, mezerin; it also contains a crystalline glucoside, daphnin. Dose.—1-5 grains (0.06-0.3 Gm.). Official Preparation. Extractum Mezerei Fluidum—Extr3cti Mezerei Fluidi—Fluid Extract of Mezereon.—Dose, 1-5 minims (0.06-0.3 Cc). Mezereon is also one of the ingredi- ents in Decoctum Sarsaparillse Compositum, Extractum Sarsaparillse Fluidum Composi- tum, and Linimentum Sinapis Compositum. Antagonists and Incompatibles.—The glucoside is precipi- tated by tannic and free acids, and the resin by water, in which it is insoluble. Synergists.—All the vegetable specifics, with the exception of colchicum. Physiological Action.—Its action, both locally and internally, is quite similar to that of sanguinaria, but when applied to the skin it is more of a vesicant than an escharotic, and taken inter- nally it is more of a diuretic than sanguinaria, in poisonous doses causing severe urinary irritation and other symptoms produced by a violent gastro-intestinal irritant. The treatment of poisoning would be the same as that prescribed under poisoning by sanguin- aria. Therapeutics.—It is employed as a masticatory in paralysis of the tongue and the muscles of deglutition, and as a counter-irritant in the form of an ointment. Internally it is now seldom if ever used alone, but in combination with other vegetable specifics it is pre- scibed in chronic rheumatism and in chronic syphilitic and non- syphilitic cutaneous diseases. Contraindications.—Acute inflammation of the stomach, bow- els, and kidneys. Administration.—As it is never given internally alone, no spe- cial instructions for its administration are necessary. The fluid extract freely diluted with water would, however, be the only preparation to use. 268 A TEXT-BOOK OF MATERIA MEDICA. Xanthoxylum—Xanthoxyli—Xanthoxylum. IT. 8. P. (Prickly Ash.) Origin.—The bark of Xanthoxylum Americanum Miller and of Xanthoxylum Clava-Herculis L. Both species are native to North America, the first being shrubby and attaining a height of 10 or 12 feet (3-3.6 M.), while the second species is a small tree some- times 30 or 40 feet (9-12 M.) high. Description and Properties. — Xanthoxylum Americanum (Northern Prickly Ash) occurs in curved or quilled fragments about ^3- inch (i Mm.) thick; outer surface brownish-gray, with whitish patches and minute black dots, slightly furrowed, with some brown, glossy, straight, two-edged spines, linear at the base and about \ inch (6 Mm.) long; inner surface whitish, smooth; fracture short, non-fibrous, green in the outer and yellowish in the inner layer; inodorous ; taste bitterish, very pungent. Xanthoxy- lum Clava-Herculis (Southern Prickly Ash) resembles the preced- ing, but is about y1^- inch (2 Mm.) thick, and is marked by many conical, corky projections, sometimes |- inch (2 Cm.) high, and by stout brown spines rising from a corky base. Xanthoxylum should not be confounded with the bark of Aralia spinosa L., which is nearly smooth externally, and beset with slender prickles in transverse rows. Prickly ash contains an acrid green oil, a colorless, crystalline resin, a bitter principle, sugar, ash, and tannic acid. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparation. Extractum XanthOxyli Fluidum—Extracti Xanth5xyli Fluidi—Fluid Ex- tract of Xanthoxylum.—Dose, 10-30 minims (0.6-2.0 Cc). Physiological Action.—The action of xanthoxylum is quite similar to that of sanguinaria, though it is more of a stomachic tonic, sialagogue, diuretic, and diaphoretic, and not so much of a local irritant. It increases the heart's action and raises arterial tension. Therapeutics.—It is used locally as a masticatory for the same purposes as mezereon, and the decoction has been highly recom- mended as a gargle in chronic pharyngitis. Internally its medical uses are the same as those of stillingia, mezereon, etc., although of more value in atonic dyspepsia. SPECIFICS. 269 Contraindications and Administration are the same as for sanguinaria. Serum-therapy. Among the marvels of scientific research which have distin- guished our century no achievements are more remarkable, nor of greater moment to the welfare of mankind, than those pertain- ing to the field of biological, pathological, and therapeutic inves- tigation. Yet, brilliant as have hitherto been the triumphs of speculative thought and the deductions drawn from tireless ex- perimentation and practically applied to the curative art, the highest generalizations and most signal exhibitions of genius are perhaps related to the special phenomena revealed by the study of zymotic diseases. The limits of the present work preclude a detailed treat- ment of so extensive and complicated a subject; yet a brief sum- mary, elucidating the theory and development of serum-therapy as exemplified in contemporaneous research, should be of interest as well as benefit to the student of modern therapeutics. A glance at the history of therapeutic procedure in the prophy- lactic treatment of infectious diseases shows that the general prin- ciple underlying all later discoveries was, however crudely, divined at a much earlier period than we are wont to suppose. In view of actual attainment it is natural that the mind should revert to the transcendent services rendered to mankind by Jenner; yet it is known that the ancient Hindus and Persians, as well as the nomad tribes and caravans of Farther Asia, practised inoculation of equine virus, or horse-pox—the mammary pustule developed during early lactation in the horse, camel, and cow, and even in woman. The inoculation of human virus is of immemorial origin, proba- bly coeval with the importation of variola from Asia into Africa by the Saracens. Certain it is that as early as the tenth century the Arabs and Chinese adopted the custom of variolization, the inoc- ulation of small-pox, although the skeptical physicians of the age consigned the practice as a monopoly to women. In 1717, Lady Montague, wife of the British ambassador at Constantinople, saw an old Thessalian woman whose immunity so impressed her that she practised the operation upon her own child. Writing from Adrianople, she says: " They take the small-pox here for diversion; I have tried it on my dear little son; I am going to bring this useful invention into fashion in England." In 270 A TEXT-BOOK OF MATERIA MEDICA. 1718 her desire was realized, King George adopting the practice in the royal family. Three years later the custom was introduced in France, being accepted by Chirac and Helvetius, although the decrees of the Sorbonne and the Faculty of Medicine condemned the innovation as " illicite et contraire a la loi de Dieu ;" notwith- standing which official malediction the practice of inoculation con- tinued to spread until supplanted by vaccination proper in 1800. The French peasants knew in the last century that the act of milk- ing cows infected with mammary pustule, where there was any lesion of the epidermis on the hands, conferred immunity against small-pox; and the mountaineers have long been accustomed to collect the crusts resulting from vaccine disease, macerating them in water, and inoculating their children with the solution. The success attending these rude experiments in France was communicated by a Frenchman, Rabault, in 1768, to Dr. Pew, an English physician, who reported the matter to his friend Jenner, who at once perceived the momentous import of the discovery. Meanwhile, in 1771, a Holstein schoolmaster vaccinated three pupils; and in 1774 an English farmer, having observed the pro- tection existing among his dairymaids, and having implicit con- fidence in the efficacy derived from inoculation of bovine virus, vaccinated his wife. It was reserved for Jenner, however, in 1776, to commence the systematic and exhaustive study of the subject destined to prove inestimably beneficial to mankind. It was, in truth, the year celebrated for his declaration of scientific independence, which, after long contumely and scurrilous ridicule, was to wrest from his humiliated adversaries every weapon of derision and reproach. His early experiments were but a repetition of the empirical yet prophetic test of the English farmer; yet with his gifted insight and indomitable courage the field of discovery was greatly ampli- fied, the results being in accordance with scientific methods inspired by Jenner's originality and force. He found in the northern counties of England a certain form of ulcer upon the hands of those employed in dairies and immune against small-pox; observed that the malady resembled the pus- tules affecting the udder of the cow, having apparently been occa- sioned by contact; vaccinated an individual supposed to be un- protected against the disease, and subsequently exposed him to infection with triumphant impunity. A long interval of laborious investigation had led to this final test, and it was not until 1798 SPECIFICS. 271 that Jenner published his first paper upon the subject, vaccination being transported to America in the following year. Such is the brief yet eloquent record of an achievement which experience has proved to be of incalculable benefit to man. To- day there is no question among the more enlightened members of the profession that the operation, properly performed, is an absolute safeguard against the infection of small-pox. Strange indeed is it that a century of comparative quiescence should have elapsed since Jenner pointed the way to the startling accomplishment of the present epoch. Yet not until Pasteur, in 1880, announced to the world the issue of his labors touching the protective inoculation of animals was the broken thread of patho- genic research taken up anew, and the task of solving its mysteries resumed—be it said with profounder acumen and far more com- plete appliances than ever before. It is a matter of record how the French savant demonstrated that cultures of the bacilli of chicken-cholera, when thoroughly dried and long exposed to the air, lost their virulence, and that fowls inoculated with the attenuated virus were rendered insensible to the attacks of more energetic micro-organisms. It was, mutatis mutandis, a modification or development of the Jennerian principle : " L'histoire de la vaccine constitue la premiere etape d'une longue serie de travaux, qu'ont inspires les admirable decouvertes revelees par le genie de Pasteur. Le principe en est toujours le meme: attenuer un virus, et l'injecter a l'animal qu'on veut immuniser" (Bernheim). Yet in the far-reaching possibilities suggested by Pasteur's experiments the present was immeasurably in advance of previous attainment. The further application of this discovery to other animal infec- tions confirmed by indisputable evidence the validity of the savant's theories and the efficacy of their practical illustration. A new light was shed upon pathogenic study; all Europe felt the impulse given to scientific thought in its relation to therapeutic progress, and in the sanctum of the laboratory many a fervent recluse sought to amplify the knowledge already attained. A striking departure from Pasteur's method by Salmon and Smith, in 1886-87, ^e(^ indirectly to the latest evolution of inocula- tive therapy. They showed conclusively that animals may be ren- dered immune against certain infectious diseases by inoculating them with filtered cultures containing the toxic products of patho- genic micro-organisms entirely free from the living bacteria to 272 A TEXT-BOOK OF MA TERIA MEDICA. which they owe their origin. By this process immunity against the bacillus of hog-cholera was attained in pigeons, the disease being almost invariably fatal to these birds. A little later (1888) Roux, employing similar sterilized cultures, succeeded in protect- ing susceptible animals against the anthrax bacillus; and more recently (1890) Behring and Kitasato have proved that immunity against the action of the tetanus bacillus may be conferred by the use of toxic products in solution freed from the presence of active germs—in a word, that purely chemical agents sufficed to attain the object hitherto deemed wholly dependent upon the influence of living bacteria. The significance of this discovery could hardly be over-estimated. By it the entire theory of causal phenomena—the protective force in which the immunizing property was supposed to reside—became modified. If not a living organism, but a chemi- cal substance, proved to be the immunizing agent, then resistance to toxic influences must proceed from some source other than bac- terial metabolism, some organic force inherent in the inoculated system. To ascertain the nature and operation of this bactericidal power and determine the rationale of acquired immunity now engaged the earnest attention of savants throughout the world. It was soon found that the lymph and blood of a normally healthy organism possessed in a degree this mysterious property of neutralizing the toxic effects of bacterial action, and gradually the truth which had thus far eluded the most searching investiga- tion was revealed. Finally, by a series of experiments involving the rarest skill and discrimination, the resistant energy developed by the infected organism was traced to certain albuminoids pertain- ing to or dissolved in the blood-serum, the acute and comprehen- sive insight of Behring, especially, sustaining the new hypothesis, which speedily passed from the realm of conjecture to the assurance of experimental proof, culminating in the establishment of serum- therapy as a legitimate and auspicious field of therapeutic science. It should be observed that the remarkable discoveries of Koch in his chosen domain of bacteriology had exercised no little influence in guiding and confirming the wider researches of his successors. Before entering upon a consideration of practical details it should be stated that the theory and practice of serum-therapy are based upon the condition of the system, whether in man or the lower animals, which renders it inhibitive of bacterial development by opposing an effective barrier to the propagation of pathogenic germs. This self-protective antagonism pertaining to the indi- SPECIFICS. 273 vidual organism is termed immunity, and may be either natural or acquired. By natural immunity is understood the absence of all personal predisposition toward certain infections or diseases, even under the most favorable exposure. A familiar example of this inherent, congenital unsusceptibility is found in poisoning by Rhus (R. toxico- dendron, R. venenata), some persons handling the plants and even chewing the leaves with impunity, while upon others the mere proximity of the poison has a toxic effect. Acquired immunity may be either accidental or artificial. In the former case protection is secured by a previous access of the disease—as, for instance, a child recovered from scarlet fever, who is rarely prone to a second attack. In the latter case the suscept- ibility is obviated by protective inoculation, it being known, to illus- trate, that an animal inoculated by injections of anthrax-poison is, after recovery from transient symptoms of disease, rendered arti- ficially immune—a fact demonstrated by the thoroughly scientific experiments of Pasteur. An eminent authority, Schleich, has declared that natural or spontaneous immunity does not exist, but that the protective qual- ity is created by the animal kingdom—either through a previous malady or, as more frequently happens, through transmission from progenitors to offspring. Syphilis or tuberculosis in parents, he maintains, confers upon children immunity from these diseases; and the author cites in support of his theory that certain infections, such as plague and leprosy, have wholly disappeared from various countries because of the inoculation of succeeding generations and the consequent attenuation of the virus—exhaustion of the soil, as it were. Bernheim asserts that no animal is endowed with absolute immunity, but that, however strong may be the resistance of the particular organism, it must succumb to an excessive invasion of microbes or of toxic products. The doctrine of immunity has, not inaptly, been styled the theorem of which serum-therapy is the logical corollary; yet it is only within a few years that the mystery which shrouded the entire subject has been dispelled. To-day, thanks to untiring researches in the fields of physiology, biology, and chemistry, we are ac- quainted, if not with its precise nature and origin, at least with many details intimately associated with its causation. Formerly supposed to be absolute in its relation to species and individuals, we now recognize that immunity is but relative, considerations of 18 274 A TEXT-BOOK OF MATERIA MEDICA. climate, race, receptivity, character of pathogenic germs, and con- ditions of infection all entering as modifying factors into the devel- opment and exercise of this potent yet complex force. Chauveau has shown that Algerian sheep, relatively immune against anthrax, contract the disease under enormous hypodermic injections of culture; on the other hand, a slight puncture of the aural epidermis is fatal to sheep in France, which, transported to Algeria, succumb to natural infection. Watson-Cheyne states that a single virulent bacillus may cause the death of a guinea-pig or induce septicemia in the mouse, provided these animals be pecu- liarly susceptible. Yet the guinea-pig is not affected by the injec- tion of a few bacilli from a septicemic mouse, while several thou- sands occasion only an abscess, although death ensues with higher dosage. Again, young white mice are quickly killed by the anthrax bacillus, while the same injection produces in the old only a local lesion. Cattle, though more amenable to infectious disease than sheep, are but slightly affected by hypodermic injections. Hogs are but slightly sensitive to anthrax, while the immunity of car- nivora is proverbial. Meat infected with anthrax is innocuous to the dog, the cat, and the fox. Again, anthrax has but little influence upon birds or fowls, especially chickens, yet it has proved fatal to sparrows and pigeons; and Pasteur overcame the immunity of chickens by plunging their feet in water, heat and cold, according to M. Roger, predisposing animals to infection, less by moderating bodily temperature than by disturbing the general economy and diminishing the power of resistance. As with anthrax, so in the case of glanders, peculiar to horses —the varying susceptibility to infectious diseases is apparent, bo- vine animals being wholly immune, and the hog, dog, singing- birds, and pigeons but slightly affected. In tuberculosis experimental injection of the same culture is followed by results widely diverse, certain animals being seized with acute phthisis, while others show marked resistance to the poison, although under excessive doses none is completely immune. In this connection it may be noted that clinical experience demon- strates the same pathological diversity in human beings. The goat, dog, ass, and sheep are rarely affected by tuberculous disease, yet all are susceptible to pathogenic inoculation. The monkey, seldom contracting the disease in his native haunts, becomes upon transportation remarkably prone to phthisical affections. With the SPECIFICS. 275 exception of the dog, most of the carnivora are easily influenced by tuberculous contagion. On the other hand, cold-blooded ani- mals are singularly immune, inoculation of toxic germs producing no development of the disease, though fatal results may occur from systemic intoxication. These examples, which might be multiplied indefinitely, suffice to show the relative character of natural immunity. It may be added that the caprice of toxic infection becomes even more appa- rent in studying the physiological and pathological conditions of the same organism when subject to the modifying influences of climate, altitude, seasons, heat, cold, traumatism, diet, ventilation, etc., and the subjective considerations of age, sex, race, fatigue, splenetic influence, nervous lesions, alcoholism, auto-intoxication, and acquired or hereditary diathesis. Indeed, the pathological records of disease abound in curious, often inexplicable, data touching individual and racial immunity. The subject is important in its bearing upon serum-therapy, and furnishes a theme of profit- able study in its relation to the practical treatment of infectious disease. With regard to the rationale of immunity, the theories advanced in explanation of this occult yet indubitable force are many, and often greatly at variance. Eliminating those which may be re- garded as too fantastic for serious consideration, the more plausible conjectures refer the phenomena in question to cellular, humoral, humoro-cellular, and vaso-motor agencies. Prominent among competent opinions is the doctrine of phago- cytosis proposed by Metchnikoff. In 1883 Metchnikoff established the existence of an intracellular digestion, showing that nomad cells were capable of absorbing vege- table filaments; that mesodermic protoplasm possessed the same power over bacteria; and that in the higher animals this phagocytic function had its analogue in the digestive property of leucocytes, or white blood-corpuscles. Gluge observed that in hemorrhage of the nervous centers these corpuscles digest the disintegrated myelin, and in a fresh-water crustacean, daphne, they have been seen to gather about the spores of algae, penetrating the meso- derm. Metchnikoff multiplied these examples of cellular defence among invertebrates, distinguishing two sorts of leucocytes: the stationary (macrophages) and the mobile (microphages), the latter including the white globules of lymph, and especially of blood, of 276 A TEXT-BOOK OF MA TERIA MEDICA. which, together, they constitute about 20 per cent. It may be said that all organs contain elements of defence—macrophages. The experiments of Gabritschevsky, who has studied phagocy- tosis in diphtheria, are highly instructive. Injecting a pure culture of Loeffler's bacillus into the anterior chamber of a rabbit's eye, he saw the devastation wrought among the leucocytes, which appeared powerless to contend against the deadly germs. But after immu- nizing the rabbit with attenuated cultures previous to the injection of toxic bacilli, a battle-royal ensued, the phagocytic action of the leucocytes resulting in the signal triumph of the latter, so that at the end of eight hours not a single free bacillus was found in the chamber, all having been absorbed within the opposing globules. Yet, notwithstanding the plausibility of Metchnikoff's hypothe- sis and the striking significance of his experiments—embracing in epitome the whole theory of preventive inoculation—certain argu- ments of Behring and Kitasato, based upon experimental research, go far to disprove the validity of the doctrine he so zealously maintained. Still, although the substances which form the defen- sive property of phagocytes, and are so fatal to the pathogenic action of microbes, remain unknown to us, the fact of phagocyto- sis cannot be denied. It was natural in the light of new developments that investiga- tion should inquire whether the leucocytes constituted the only protective force within the organism. Then followed the theory that the humors in general possess microbicidal power—either through the presence of destructive elements and the secretion of soluble toxins or through the humoral capacity of withdrawing oxygen from the invading micro-organisms. To Buchner is chiefly due the early elucidation of the humoral theory, and of first recog- nizing in serum bactericidal properties, he being followed by Behring, to whom is to be credited the more important labor of extending experimentation and proving that animals naturally immune against a certain disease may furnish serum endued with neutralizing power. Behring found that the blood and blood-serum of the rat, which is naturally immune against anthrax, possesses strong bactericidal properties, while those of mice, cattle, etc., very susceptible to anthrax infection, have none. Further research resulted in Behring's all-important law, es- tablished by searching experiment, that " the blood and blood- serum of an individual which has been rendered artificially immune against a certain infectious disease may be transferred into another SPECIFICS. 277 individual, with the effect of rendering the latter also immune, no matter how susceptible this animal is to the disease in question." This formulated doctrine became the fundamental motive in all future investigations, the culminating achievement of inoculative therapy being the announcement of Behring and Kitasato in 1890 concerning the artificial immunity against tetanus and diphtheria conferred by blood-serum, including the first emphatic declaration that the power of rabbits and mice when rendered immune to re- sist tetanus-poisoning "is based upon the ability of blood-serum to neutralize the toxins produced by the tetanus bacilli." As Krieger well observes: " These toxins are the poisonous products of bac- terial metabolism, and are the causes of acute disease when circu- lating in the organism. Their effect is an intoxication of the system, while after the introduction of virulent germs the cause of the dis- ease is an infection." The moment had now arrived for applying the therapeutic test of serum to man. In every instance the validity of Behring's law was sustained, and, moreover, the invaluable discovery was made that the serum of individuals naturally immune against a certain disease possesses no immunizing properties for other individuals. This militated partly against previous theories, and proved conclu- sively that the protective agent is not a substance produced by nature in naturally immune animals, but the result of " an organic chemism " called into activity only by introduction of the corre- sponding poison or toxin. In diphtheria and similar infectious diseases, as in tetanus, the bacillus produces toxins, the effects of which can be neutralized only by the properly prepared antitoxin. It was even shown by Ehrlich that the law applied to intoxication by certain purely chemical poisons, such as ricin and abrin, injections of gradually increased doses of serum affording complete immunity. A third theory in regard to the causes of immunity, the humoro- cellular, seeks to combine phagocytic and humoral agencies, on the ground that neither separately suffices to account for the phenom- ena observed. Such is the theory of alexins of Buchner—certain albuminoid substances in the blood which release the leucocytes at the point of infection, the bactericidal property being active rather than passive, as previously supposed. Although defended by able advocates, Hankin and others, the fallacy of certain prem- ises, as shown by Metchnikoff, served to invalidate the doctrine, while several eminent authorities have disproved the facts upon 278 A TEXT-BOOK OF MATERIA MEDICA. which the original hypothesis was founded. Nevertheless, so high an authority as Bernheim may be cited In its favor. Lastly, the vaso-motor theory of Bouchard and others asserts the claims of physiology in determining the causes of immunity. Admitting the fact of phagocytosis, they contend that the emigration of leucocytes from the vessels occurs only through the action of the vaso-motor centers, whether by exciting the dilator or paralyz- ing the constrictor muscles. From these varying opinions it is as yet difficult to form a rational conclusion entirely in accord with physiological phenom- ena. In this connection the remarks of Bernheim may be cited as those of a highly competent authority. He says, while inclining to the humoro-cellular hypothesis, " Be it as it may, we can safely aver that relative immunity exists among the majority of animals. Against certain diseases this immunity may even be absolute. Thus rats, mice, and dogs are naturally immune against the mini- mum mortal dose of the Loeffler bacillus; yet the serum from these animals when injected into other individuals is powerless to prevent infection—a point having an important bearing upon serum-therapy. Moreover, we know that man is frequently ex- posed to contagion without contracting a taint of infectious dis- ease. I myself, under the most unfavorable conditions occasioned by fatigue, have passed through epidemics of typhoid fever, cholera, and malignant influenza (la grippe) without the slightest contamination, and other practitioners have had a similar ex- perience. Meanwhile, it were folly to imitate those courageous experimenters who, wishing to prove their immunity against cer- tain diseases, have absorbed their pathogenic germs, not infre- quently with fatal results.....As many conditions tend to diminish the power of resistance in the human organism, so others fortify the system against the inroads of infection. Obedience to sound hygienic principles, a regulated and nutritious diet, and a healthy parentage render the individual capable of withstanding microbic influences which constantly assail him, his natural immu- nity being greatly reinforced by these favorable circumstances." Obscure as is the precise nature of the immunizing property possessed by serum, there is no question as to its marvellous potency. Behring and Kitasato showed that it was sufficient to mingle very small quantities of serum from an immunized subject with virulent toxins to inoculate with impunity animals sensible to infinitesimal amounts of pure toxins. In experiments made by SPECIFICS. 279 MM. Roux and Vaillard the resistant force of antitoxin passes imagination. During their researches concerning tetanus bacilli they employed cultures which, when filtered, killed guinea-pigs in doses of 0.005 ccm.; yet one cubic centimeter of equine serum served to neutralize thirty times its volume of toxin, so that by the addition of o.OOOi ccm. of serum it was possible to neutralize completely the action of a mortal dose. In order to render a mouse immune the requisite quantity of antitoxin is so infinitesimal as scarely to be computed. In fact, serum is obtainable possessing an activity of one-millionth, the immunizing unit being the quan- tity necessary to protect one gram of a mouse's weight; that is, one cubic centimeter of serum suffices to confer immunity against fatal dosage in 1000 kilograms of mice, or 70,000 of these ani- mals, each weighing about 15 grams. It will readily be understood that the discovery of so protective a force soon awakened therapeutic hopes which, if not completely realized in tetanus—largely by reason of the difficulties attending any treatment of so fatal a disease—have, on the other hand, in the case of diphtheria, been even more happily fulfilled than was anticipated. It is to be regretted, en passant, that in the use of the term antitoxin needless ambiguity should have arisen in the public mind, a fancied identity between the antitoxic and prophylactic power of serum being widely diffused. The association of the term with the preventive property of the immunizing agent—antitetanic, antidiphtheritic—has contributed not a little to this confusion of characteristic properties. In reality, nothing could be more erro- neous than to suppose coequal activities in the two forces, the pre- ventive property of serum being far more general than its antitoxin influence—as yet scarcely proven save in tetanus and diphtheria. In hog-cholera, typhoid fever, pneumonia, aviary septicemia, and cholera careful researches abundantly demonstrate that the serum of animals rendered immune against these diseases, while protect- ing the alien organism from microbic infection, has no power over bacterial products, or toxins. That the immunity is conferred apart from this latter agency is evidence that the protection is due to causes other than direct bactericidal action. It is because the present terminology is defective—antitoxin failing to denote the salient property of serum—that the more descriptive expression stimuline has been suggested on high author- ity as a substitute. It may be observed, moreover, that a still fur- 280 A TEXT-BOOK OF MATERIA MEDICA. ther confusion prevails in giving the name antitoxin to the substance injected as well as to the defensive proteids formed by its action upon the organism—an ambiguity which the use of the term " stimuline " would obviate. In considering the prophylactic effect of antitoxin, so intimately allied to serum-therapy, it may be well to emphasize the distinction between vaccination as founded by Jenner and the new method. It was formerly sought to create immunity by inoculating the individual with the pathogenic micro-organism itself—the virulent germs of disease. To-day protection is found in the injection of soluble products secreted by the micro-organism, administered in progressive doses, or, as by the latest process, in the inoculation of serum taken from an animal previously rendered immune. Herein lies the essential difference between vaccination and immu- nization—a distinction too often ignored. Vaccination can at most but prevent infection ; immunization is curative. The vaccinal sub- stance possesses no power over the actual microbes and their products: the immunizing agent is endowed with the remarkable property of neutralizing the influence of pathogenic germs or of determining their destruction. Vaccination produces in the indi- vidual inoculated deterrent forces which serve to arrest bacterial development: in immunization the obstructive agents injected are prepared, as in the laboratory, by a separate organism. In this latter medium we have a true therapeutic remedy. If we seek to draw the line of demarcation between the two methods more closely, we recognize that the modern doctrine of immunity rests upon wholly new and original researches quite distinct from those formerly pursued. Doubtless the immunizing property of serum was divined by those who adopted free vene- section in cachectic patients, abstracting the vitiated blood and replacing it with venous injection of that supplied by a healthy organism. A certain antagonism had also been observed between infectious maladies mutually opposed in their development, one of which was prone to exert a curative action upon the other. Fehleisen in 1880 cited the phenomenal case of a woman afflicted with cancer of the breast, which after three successive operations still redeveloped rapidly. Finally erysipelas affected the cicatricial wound of the amputated breast, the new malady proving beneficial to the patient, since carcinoma was not renewed. From this and similar data Emmerich inferred that it sufficed to inject the serum of animals immunized with the streptococcus of Fehleisen to treat SPECIFICS. 281 and cure (?) cancerous subjects, the toxins of streptococcus erysipe- latis preventing carcinomatous development. Having purposely dwelt at some length upon the evolution and general properties of serum-therapy, let us turn to the actual achievement of the method in its therapeutic relations to infectious disease. In view of well-authenticated and obvious records attest- ing the efficacy of the new treatment, the charge "not proven" cannot properly be sustained. Yet the observation of Achalme, that it is well to accept new theories salis cum grano, is not inap- plicable ; and the wise admonition of Bacon in regard to books, that we should read " not to accept nor refute, but to weigh and consider," is equally apposite in estimating the value of scientific discoveries, however distinguished may be their claim to recog- nition. Tetanus.—The first proof that tetanus is an infectious disease, of bacillary origin, was furnished by Carle and Rattone, who in 1884 reproduced the symptoms in a rabbit by inoculation of pus taken from a human tetanus wound. The bacilli were found in the adjacent soil, but it was not until 1889 that Kitasato succeeded in isolating pure cultures, proving conclusively the microbic nature of the disease. The earliest case treated with antitoxin was reported in 1891 by a Bolognese physician, Dr. Gagliardi, the result being highly satisfactory. In the light of subsequent experiments it is of ab- sorbing interest. The patient, a man forty-five years of age, accidentally received a wound of the left foot while crossing a rice-field. Next day (May 12, 1891), the foot having swollen considerably, he consulted Dr. Gagliardi, who made an incision and applied antiseptics. May 19th the wound was healed, but four days later symptoms of trismus appeared, becoming acute May 24th. Injections of 5 per cent, carbolic acid in the vicinity of the wound produced no effect, and on June 3d opisthotonos and aggravated symptoms were manifested. The doctor now injected 0.25 ccm. of Tizzoni's antitoxin, obtained from a strongly immunized dog, the treatment being followed by some im- provement. June 7th, relapse and tetanic spasms having super- vened, two more injections were administered, and the following day the patient gradually convalesced, being discharged as cured July 5th. The quantity of antitoxin sufficient to neutralize the tetanus-poison was less than 1 ccm. In 1891-92 four other cases were treated with like favorable results, injections of 0.25 ccm. 282 A TEXT-BOOK OF MA TER1A MEDICA. twice a day, from two to six doses in all, being attended with com- plete recovery. When it is taken into consideration that the most authentic statistics of tetanus show a mortality of about 88 per cent., and that by the above procedure it was reduced to 20 per cent, it is small wonder that the issue in these cases should be regarded as simply marvellous. And yet we have, after devious wanderings, reached but the threshold of the new science. In December, 1890, Behring and Kitasato demonstrated that the serum of animals rendered immune against tetanus by the injection of iodine trichloride in the blood was capable of neutral- izing tetanic poison, whether in the laboratory or in other animals, the property not being possessed by organisms not inoculated. Not only did they succeed in preventing infection, but they recog- nized in the serum a curative power, as shown in the inoculation and cure of mice. At the same time it was observed by Vaillard that the immunity conferred by the serum was of short duration, lasting only fifteen days. Kitasato's preventive injection—a mixture of living culture and gradually decreasing doses of iodine trichloride—was perfected by Behring, who successfully applied it to the mouse, rabbit, sheep, and horse. Various results of experimental research ensued, elicit- ing among other interesting phenomena the fact that removal of the spleen renders immunization impossible. In 1891, Vaillard showed that the serum of animals naturally immune is not anti- toxic, becoming so only after a powerful dose of tetanic poison, and that the spleen and the fluids of immunized subjects are devoid of antitoxic properties. One point in the doctrine advanced by Behring and Kitasato awakened the liveliest discussion: whether it was possible to cure disease by the serum of inoculated individuals. Tizzoni and Cat- tani had failed to attain this result, and had, moreover, recognized that the condition of immunity was transient. On the other hand, Behring had claimed the cure of tetanus in the sheep and horse, and Kitasato had obtained results equally positive in the case of mice. , All doubt on this head was dissipated by Ehrlich in 1891, who proved by experiments with ricin and abrin that the antitoxic and immunizing property of serum varies greatly with the degree of immunity conferred. In seeking a favorable issue it was evident that in cases of failure the inoculation had fallen short of the degree requisite to render the serum curative. SPECIFICS. 283 It should be added that in subsequent treatment Tizzoni, Cat- tani, and Vaillard met with perfect success in effecting cures. Thus far, the employment of serum as a curative agent had been confined to experiments upon animals. The results obtained urged its application to human tetanus. The first attempt was made by Kitasato in 1891, the serum being taken from a rabbit. It was unsuccessful, the dose of serum employed being too feeble to cope with the gravity of the conditions presented. In 1892, Tizzoni and Cattani and others reported 8 cures with serum from immunized dogs. It was contended, however, that a comparatively mild form of the disease was treated. In France the results of similar treatment in 1892 were wholly unfavorable, but in 1893 the cure of a peculiarly aggravated case was authentically announced, amelioration of symptoms having occurred in three, and complete restoration in twenty, days. The injection was subcutaneous in the abdominal region, 300 ccm. of equine serum from an immun- ized animal being given. The injections are said to be in them- selves harmless. Finally, MM. Roux and Vaillard formulated the mode of prep- aration of antitetanic serum, together with an analysis of its prop- erties and its curative application in man and the lower animals. It may reasonably be expected that future experiments with the antitoxin of tetanus, made with greater precision and untiring patience, will produce more favorable results. It is of primary importance to consider, first, whether sufficient amounts of immunizing serum are injected to combat the condi- tions of this most difficult disease, and, second, whether the doses are renewed often enough to arrest its progress or ensure immunity. These desiderata are sufficiently obvious, especially in view of the certainty that the antitoxin is wholly innocuous. Diphtheria.—It is in the treatment of this universal and terrible disease that serum-therapy has achieved its most signal triumphs, the marvels wrought by its influence attracting more and more the attention both of the medical profession and of the laity. The micro-organism of the malady was described by Klebs in 1883, ms investigations being quickly followed by those of Loeffler, who confirmed Klebs' discovery and announced that it was possible not only to isolate, but also to produce, cultures of the microbe. Roux and Yersin, as well as other savants, have established the fact that the germ is found only in the false membrane—especially its surface—and in the saliva or contiguous mucous membrane, 284 A TEXT-BOOK OF MATERIA MEDICA. never developing in the circulating fluid either of the lymph or any other portion of the organism. The bacillus frequenting the false membrane is rarely unaccom- panied, but is found associated with other micro-organisms which exert great influence upon the progress of the disease. It propa- gates rapidly upon solidified serum, bouillon, and gelatin, though not on potato, preserving its virulence for several months. In direct contact with light and air it perishes within a few weeks. The false membrane is artificially formed by painting with pure culture the buccal ulcers of the mucous membrane in rabbits, dogs, guinea-pigs, and chickens, the symptoms produced being those of human diphtheria, and frequently fatal. The researches of Loeffler indicate that no direct action is attributable to the bacillus, the sys- temic effects of the poison being rather those of a general intoxi- cation of unknown nature—an opinion sustained by the researches of Roux and Yersin. The microbe may be ejected by the mouth together with the false membrane, but oftener it remains in an iso- lated state ensconced in buccal and nasal cavities, perhaps for sev- eral days or even weeks. Although the discovery of the pathogenic micro-organism of diphtheria is of quite recent date, no time has been lost in seeking to determine the means of conferring immunity against the disease. To Behring (1889) is due the credit of having first indicated the method of immunization in the disease, as well as in tetanus, his investigations leading him to affirm that the process of conferring immunity by the soluble products of Loeffler's bacillus derived from immunized animals, combined with a solution of iodine tri- chloride, is positively innocuous and curative in diphtheria. Little progress was made by the experiments of earlier investi- gators, but, in 1891, Aronson succeeded in immunizing rabbits against diphtheria by inoculation with cultures attenuated by the vapor of formaldehyde. The serum obtained possessed great im- munizing power, a single cubic centimeter sufficing to inoculate 4 kilograms of animal weight against the minimum mortal dose of virulent cultures. Subsequently, Aronson applied this therapeutic method to numerous children affected with diphtheria, and affirmed with Behr- ing that serum-therapy was inoffensive and a sovereign remedy in a large number of cases. He obtained the serum from dogs and sheep, but declared that large animals were preferable, especially the horse. SPECIFICS. 285 In order to formulate the dosage, Behring established a techni- cal scale in which one cubic centimeter of prepared serum is consid- ered a unit, the antitoxin supplied being of the strength of 60, 150, or 500 units according to the degree of immunity of the animal from which it is derived. The value of serum depends, he affirms, upon the difference between the original condition of, and the re- fractory state attained by, the animal under immunization. Notwithstanding the significance attaching to experiments hith- erto recorded, the thereapeutic application of serum-therapy to diphtheria may be said to date from the communication of Roux to the Congress of Buda-Pesth (September, 1894). From this moment clinical observations multiplied and statistics were reported from all parts of the world. In this memorable address the author ably reviewed the entire subject of serum-therapy, stating the relations of serum to the general economy and offering advanced and cogent suggestions concerning the employment of antitoxins to arrest the ravages of infectious disease. The early failures to cure tetanus were explained by the fact that the symptoms of the disease are frequently not manifested until it is too late to stay its progress. On the other hand, in diphtheria the evident appearance of the characteristic false membrane rendered it possible to treat the malady from its inception. The most approved, though complicated, methods of preparing the toxin were minutely described—either through the medium of bouillon as a host in contact with dry air, or a similar process in a current of moist air—and explicit instructions given regarding the attenuation of the poison by means of iodine, and the modus operandi of administration in gradually intensified doses. " With regard to diphtheria associated with certain microbes," said M. Roux, " especially streptococcus, the results of sero- therapy have been far from satisfactory. I have often saved rab- bits treated six or eight hours after tracheal infection, although repeated injections of therapeutic serum were necessary: when treatment has been deferred twelve hours, the animals have inva- riably succumbed. " The efficacy of antidiphtheritic serum having been established experimentally, its application to the human malady was a natural consequence. All my experience occurred at the Hospital for Sick Children in conjunction with MM. Martin and Chaillou. From the 1st of February to the 24th of July, 1894, 448 children were ad- mitted to the diphtheritic ward, of whom 109 died—a mortality of 286 A TEXT-BOOK OF MATERIA MEDICA. 24.33 per cent. Now, the average mortality from 1890 to 1895 was 51.71 per cent, in a total of 3971 children. The advantage of serum-therapy, all conditions being equal, is 27.28 per cent, greater than under the former treatment. "Such are the gross statistics. It is necessary, however, to deduct from the foregoing 448 patients treated with serum 128 who, as the bacterial examination showed, were not affected with true diphtheria of the Klebs-Loeffler bacillus type, besides 20 desperate cases amenable to no possible treatment. The net statement, therefore, is 300 cases with 78 deaths—a mortality of 26 per cent, whereas a previous report, similarly computed, recorded a mortality of 50 per cent." M. Roux is quoted at length because his views are authoritative, embodying the most careful researches connected with serum- therapy in its application to diphtheria. With regard to the relative proportion of deaths, it is instructive to compare with his figures those of more recent investigators and medical practitioners. At an international Congress held in Munich in April, 1895, the merits of serum-therapy in diphtheria formed the subject of an interesting debate, eliciting reports from the most competent Continental authorities in which the efficacy of the new treatment was strikingly demonstrated. Dr. O. Heubner of the University of Berlin, comparing the statistics of the Berlin hospitals during 1894, stated that the mor- tality since the introduction of serum-therapy had been reduced to one-half of that recorded prior to that date, about 1500 cases being included in each period. Allowing for the condition of medium virulence which marked the disease, Prof. Heubner believed that this factor alone could not account for the great difference in the mortality. Up to the present time, he said, reliable information of over 3000 cases had been obtained from all parts of the world in which the disease was treated with antitoxin serum. The average of cures was 80 per cent. Referring to clinical analysis of 300 cases of diphtheria coming under his own supervision, he declared that the disease could be diagnosed only by identification of the diphtheria bacilli. Of 207 cases so diagnosed and treated in the Berlin Charite, the mortality in simple attacks was 10 per cent, and in more complicated ones 13 per cent. From personal expe- rience the speaker regarded, as the specific results of serum-treat- ment, the improvement in the febrile symptoms and the quickened cleansing of the air-passages—facts first noted since the introduc- SPECIFICS. 287 tion of serum-therapy, and confirmed wherever the method was adopted. Prof. A. Baginsky of Berlin said that prior to the introduction of the treatment with serum the more difficult and sorrowful por- tion of his life had been spent in combating the disease, against which he felt absolutely helpless, the mortality for the past four years, in spite of every effort, having been 50, 33, 36, and 42 per cent, respectively. The deaths occurring under treatment of 525 cases with Dr. Aronson's preparation had been 15 per cent. Prof, von Widerhofer of Vienna stated that in 300 cases of diphtheria coming under his cognizance the average mortality was 23.7 per cent. Excluding those that died within twenty-four hours, the disease having reached a very advanced stage previous to treatment, the mortality falls to 14.3 per cent. Prof, von Ranke of Munich reported that of 124 cases treated in the six months previous, 26 children, or 22.4 per cent., died, 102 cases presenting features of uncomplicated diphtheria. Compared with the mortality during the preceding eight years, the reduction was enormous, being less than half the minimum record for any year during that period. Prof, von Mehring reported on 74 cases, all treated with serum on the first or second day, of which only 4 died, giving a mortality of 5 per cent. During the preceding five years 30 per cent, of his diphtheria patients had died. Prof, von Noorden gave the results of his experience in 81 cases treated at the Frankfort Hospital. Most of them, unfortunately, were admitted at a late stage of the disease, generally on the third or fourth day, the severest symptoms being developed. Notwith- standing this obstacle, in place of the previous mortality of 45 per cent, only 23 per cent, was recorded. Dr. G. Seiz of Constance stated that of 27 cases treated with serum he lost only 1, or 3.3 per cent Prof. Sigel, in charge of the Olga Hospital at Stuttgart, reported that the general mortality for the five years previous to 1894 was 40.1 per cent., and 60 per cent, among those upon whom trache- otomy was performed in the first nine months of 1894—in fact, up to the day on which the antitoxin treatment was commenced—the mortality rising to 50.3 and 70 per cent, respectively. During the three months of serum treatment in 1894 there was an astonishing decrease in the number of deaths, the mortality falling to 12 per cent, in general and 20.3 per cent, in tracheotomy cases. 288 A TEXT-BOOK OF MATERIA MEDICA. The reports, emanating from authorities of the highest standing, were of themselves conclusive testimony in favor of serum-therapy in diphtheria as immensely superior to former methods of treatment. An interesting resume of statistics, compiled from the library of the Royal College of Surgeons, England, by Dr. G. C. Crandall of St. Louis, Mo., emphasizes in comprehensive figures the explicit advance made within a few years in the scientific control of the dis- ease. The following table embodies the results of Dr. Crandall's timely study of the subject: Authorities. Locality. Cases treated with serum. Mortality in percent. Previous mortality in per cent. Vierordt ........... Ganghofner......... Viederhofer......... Kossel.......... Baginsky (quoted by Virchow) Sonnenburg ......... Aronson .......... Ranke............ Soltmann......... Risel............ Roux, Martin, and Chaillou . . . Lebreton........... Moizard........... Washbourn, Goodall, Card, and others........... White............ Withington.......... Total number of cases........... Average mortality, per cent......... Previous average mortality, per cent...... Collective report of other observers in different countries................ Heidelberg . Prague . . Vienna . . Berlin . . . Berlin . . . Berlin . . . Berlin . . . Munich . . Leipsic . . Halle . . . Paris . . . Paris . . . Paris . . . London . New York Boston 55 no IOO 350 303 107 190 85 122 114 3OO 258 231 195 32 80 14.6 12.7 25-3 16.7 13.2 20.6 14.0 18.8 18.0 8.0 26.0 12.0 14-7 18.6 25.0 16.0 58.0 50.0 42.8 347 47-8 27.6 37-0 48.5 51-7 50.0 3ii 42.7 45-o 2632 4022 16.8 17.1 42.0 The official report from the Imperial German Health Depart- ment up to June 20, 1895, records 2228 cases, with a percentage of mortality of 17.3; and further German statistics (August io, 1895) include 10,240 cases in hospitals and private practice, 5790 of which were treated with antitoxin serum, the number of deaths being 552—a mortality of 9.5 per cent. Prof. Eulenburg, the author of this report, reiterated the import- ance of early recourse to antitoxin, stating that when used within the first forty-eight hours the mortality was only 4.2 per cent: delayed beyond this period, the percentage was increased to 16.8. In America the merits of serum-therapy have been amply attested by reports from various sections of the country, one of SPECIFICS. 289 the most recent and instructive being that of the resident physi- cian of the South Department of the Boston City Hospital, as follows: "In the Boston City Hospital, from Feb. 1, 1894, to Jan. 31, 1895, before antitoxin was used, 698 cases of diphtheria were treated, with 266 deaths—a mortality of 38.1 per cent. Since the opening of the South Department, from Sept. 1 to Nov. 30, 1895, inclusive, when antitoxin was used in every case, 332 cases were treated, with 41 deaths—a percentage of 12.3. Of these 41 deaths, 23 occurred within twenty-four hours of entrance. Eliminating these, there were 309 cases with 18 deaths—a mortality of 5.8 per cent." Finally, the statement of Prof. Welch of Johns Hopkins Uni- versity, published in July and August, 1895, contains statistics of 7166 cases of diphtheria treated with antitoxin, in which the mor- tality was 17.0 per cent., and 2276 cases treated otherwise with a death-rate of 42 per cent. The foregoing figures, selected from a mass of corroborative testimony, must certainly be regarded as an eloquent tribute to the virtues of serum-therapy. They are at least a striking illustration of what Virchow has called the "brute force" of the numerical argument. Touching the method of administration and collateral manifes- tations, Roux, in the communication previously cited, says: " The serum I have employed, derived from immunized horses, had an active strength of 50,000 to 100,000. To all diphtheritic patients entering the hospital 20 cubic centimeters of this serum, in a single dose, are systematically administered, the injection being in the subcutaneous tissue, and not renewed should bacteriological examination prove that the disease was other than diphtheria. Should the existence of the disease be fully established, I have never observed the slightest discomfort resulting from the dose. " The injection is painless, and if made antiseptically should be attended with no accident. Twenty-four hours after the first injec- tion a second is made of 10 or 20 cubic centimeters, these two inoculations sufficing, as a rule, to ensure recovery. "Should the temperature continue high, a third injection of 10 or 20 cubic centimeters is given. The average weight of chil- dren being 14 kilograms, the total dose constitutes one-thou- sandth, or in exceptional cases one-hundredth, part of their weight. Untoward sequelae are less frequent under the use of serum, 19 290 A TEXT-BOOK OF MATERIA MEDICA. although I have observed symptoms of paralysis. Eruptions, also, allied to urticaria may be occasioned by the antitoxin. " The physiological effect of the serum is apparent in its action upon the false membrane, which ceases to develop within twenty- four hours after the first injection, being detached after twenty-six, forty-eight, or, at most, sixty hours. In 7 cases only have I kiiown it to persist longer. Let me add, in conclusion, that in treatment with serum I have studiously avoided the use of local applications, simply irrigating the throat with boiled water, to which was added perhaps 50 grams (per liter) of Labarraque's solution." In commenting upon the address of M. Roux, Dr. Behring added that "the specific action of antidiphtheritic serum is the surer and more rapid in proportion to the heroic nature of the dose. Since the injection is positively harmless, it may be adopted with impunity even in simply suspected cases of the disease." The prophylactic property of equine serum is well attested by Aronson, who employed antidiphtheritic injections to immunize children in families where the disease was established. One cubic centimeter of prepared serum sufficed for his purpose, of 130 chil- dren thus treated preventively only 2 being affected with a very mild form of the disease. It is impossible, says Bernheim, to assign a definite duration to the antitoxic property of serum. It may last several weeks, or even months, according to the strength of the injection and the species of animal under treatment. But, he adds, when definite immunity has been attained the protective power of serum may be prolonged by the injection of a small quantity of toxin every fourteen days. Concerning the various untoward complications arising from the use of serum and authentically reported, it is fair to say that the same phenomena are observed in diphtheritic patients treated by other methods than serum-therapy. Notwithstanding the eminent success of the method herein con- sidered, it should be said, in conclusion, that several important features are as yet but imperfectly formulated or even understood. 1 In a paper upon the subject "Antitoxin," Prof. A. C. Cotton, M. D, of Rush Medical College, Chicago, puts the case thus strongly: " What we do not know is how much antitoxin exactly is necessary to neutralize a given quantity of toxin at somewhat lengthened periods precedent. What we do not know, and what we most particularly desire to know, inasmuch as it is about the only phase of the entire subject that has any practical bearing upon our profession as life- savers, is what number of antitoxin units is necessary to neutralize an indefinite amount SPECIFICS. 291 It is of paramount interest to ascertain, for example, the precise prophylactic power of the immunizing serum. Behring has already directed his attention to this problem, advising the injection of 5 cubic centimeters of serum in children under ten years of age, and 10 cubic centimeters in older patients. Crouzon, who has prac- tised these preventive injections in 230 cases, reports but two light attacks of the disease. A similar experience is that of Baginsky in Berlin. Bernheim asserts that he has personally injected serum in 28 subjects exposed to diphtheritic infection without noting a single case of the malady. The dose employed was somewhat in excess of that proposed by Behring, being from 10 to 20 cubic centimeters, as recommended by Hilbert, the injection being twice repeated at intervals of twenty days. From a careful consideration of the subject in its relations to diphtheria, we may safely conclude— 1st. That immunized serum forms a remedy which experience proves to be wholly innocuous and eminently adapted for use in human infection. 2d. That antidiphtheritic serum has in every respect corre- sponded with the most sanguine hopes of its advocates, its employ- ment being attended with astonishing success wherever properly used and in sufficient quantities. 3d. Finally, that it is incontrovertibly established that by means of injecting serum temporary immunity from infection may be readily conferred, permanent protection being contingent merely upon a renewal of treatment. In view of the extraordinary rapidity with which recent discov- eries have been made, it is unwise to presume that we have by any means exhausted the possibilities of serum in its dominion over this dread disease. Resources of science undreamed of in the past are now concentrated upon the momentous problem of infection. What new light future investigation may shed can be regarded only as a theme for hopeful conjecture. Tuberculosis.—It may be stated, in general terms, that the microbic nature of tuberculosis was admitted by nearly all writers upon the subject before the discovery of the pathogenic micro- organism. Villemin in 1866 had established by experiment the of diphtheria toxin of unknown virulence that has invaded at a prior indefinite time, and is presumably hourly continuing to invade, in unknown strength and quantity, from a patch of recurrent and extending culture of Klebs-Loeffler bacillus on an unknown extent of mucous surface of a human being of unknown susceptibility."—The Corpuscle, Dec, 1895. 292 A TEXT-BOOK OF MA TERIA MEDICA. infectious character of the malady; but in France the idea seemed almost revolutionary, creating no enthusiasm, it being reserved for Germany, through the indefatigable labors of Robert Koch, to develop and elucidate the theory conceived by Villemin. Koch discovered the bacillus of tuberculosis, and even succeeded in iso- lating and cultivating it, the pure cultures obtained by him always producing tuberculosis in every form. His original communication, addressed to the Physiological Society of Berlin, bore date of April 10, 1882, and at once stimulated experimental research in others, who fully confirmed his discovery. The tubercle bacillus is aerobic, its existence depending wholly upon the supply of oxygen—a fact readily explaining its predilec- tion for the pulmonary tissue. The bacillus may affect all warm- blooded animals, although in different degrees, the microbe being somewhat differentiated in the lesions of birds and those of man and the mammalia in general. Spontaneous tuberculosis is extremely frequent in man, it being estimated that one-fifth of all fatalities are due to phthisis in its various forms. It is equally common among cattle, in which the progress of the disease and its lesions are precisely similar to those observed in human beings—a fact demonstrated by the admirable studies of Koch respecting pulmonary lesions and their character- istic pathogenic micro-organisms. Like other microbes, the bacillus tuberculosis secretes a large amount of soluble products. These toxins, which of late years have been subjected to careful experiment, are derived from cul- tures of human bacilli, modified or not by aviary germs and the tuberculous products produced in the organism itself. Koch's tuberculin, now known throughout the world, is simply a soluble product, prepared by a special process, consisting of a glycerized extract drawn from pure cultures of tubercle bacillus, its activity depending upon the virulence of the germs, those derived from man being more dangerous than aviary cultures. Various methods of inoculation have been adopted in tubercu- losis: 1, inoculating the patient with another disease; 2, inocula- tion with attenuated tuberculosis or that proceeding from a different species, as from birds ; 3, inoculation of the soluble bacillar prod- ucts—tuberculin; 4, injection of blood taken from animals often immune against tuberculosis; 5, injection of serum drawn from inoculated animals; 6, finally, injection of serum taken from immunized animals. With the last two of these methods we are SPECIFICS. 293 properly concerned. The fifth has been scientifically adopted by Babes, Richard, and Hericourt, who have treated a large number of cases in which various cures have been effected. The main obstacle of the procedure lies in the difficulty of successful inocu- lation, the greater part of the animals employed dying of infectious nephritis. By the sixth method, as employed by Bernheim, this fatality is largely obviated, a careful procedure with the serum of immunized animals proving the most efficacious hitherto devised. The pro- cess of immunizing consists in injecting the toxic products nor- mally secreted by Koch's bacillus, and is, in effect, that adopted by Behring in preparing the antitoxin of diphtheria. In experiment- ing upon a large number of animals, suffice it to say that the results obtained by Bernheim were eminently satisfactory, every case indicating improvement and the actual cures being about 40 per cent. So convinced was he of the sovereign value of his method that he emphatically declared it to be the only rational procedure possible in tuberculosis : " Je puis meme affirmer que l'avenir de la therapeutique antituberculeuse reside tout entier dans cette maniere d'immuniser les animaux et d'utiliser leur serum." Applied to tuberculosis in man, there are as yet few signs of encouragement in the inoculation with the product of specific germs. The tuberculin of Koch has not responded to the hopes of its ad- vocates, the danger from untoward symptoms and relapse attending its use offsetting effectually any temporary benefit. Yet it is quite possible that the discovery of so powerful an agent may lead to others of more established efficacy. Pneumonia.—All the pulmonary symptoms which characterize this disease are produced by a single microbe, suspected by Klebs, described by Koch and others, and discovered by Pasteur in the bucco-pharyngeal cavity, its habitual haunt, whence it carries in- fection to the lungs. The pneumococcus does not confine its attacks to man, the rabbit and guinea-pig being especially sensitive to its influence. It has been observed that the microbe is a fre- quent prey to leucocytosis. It thrives in a total absence of oxygen, its vitality and virulence, so far from diminishing, being sensibly increased by anaerobic conditions. Pure cultures are easily obtain- able. Repeated inoculations of attenuated virus readily confer immunity, reduction of virulent germs being attained by the use of desiccated pneumonic viscera. The saliva of a patient, collected after defer- 294 A TEXT-BOOK OF MATERIA MEDICA. vescence, ensures protection to the mouse, the same being true of blood-serum. Immunization of animals was inaugurated by Em- merich and Fovitsky in 1891, subsequent investigators confirming their experiments under varying conditions, Foa and Scabia finally employing human serum in the inoculation of rabbits with marked success. It had been supposed that the spleen was the seat of an im- munizing product possessing greater activity, but a glycerized extract of human spleen injected into the veins of refractory rabbits failed to arrest death. The general deduction drawn from a care- ful scrutiny of the subject tends to prove that the production of the neutralizing force in the system—the antipneumotoxin—is shared by all the elements of the organism, including the spleen. The therapeutic interest of the subject centers in the application of inoculation to man. The early experiments of Foa and Scabia were without result, neither reaction nor amelioration attending their treatment; but in 1892, Klemperer reported favorably con- cerning immunization in 40 cases of human pneumonia. In January, 1893, Lava communicated to the Academy of Med- icine in Turin the application of serum-therapy with auspicious results. He inoculated 10 subjects—5 with from 4 to 9 cubic cen- timeters of rabbit's blood-serum; 4 with a like dose of glycerized extract of the viscera of immunized rabbits; and I with from 4 to 5 cubic centimeters of canine serum. There is no reaction at the point of inoculation, no general disturbance of the system, nor any influence upon temperature or respiration. On the contrary, the pulse is favorably influenced, as is also the general progress, as shown by Lava's experiments. Moreover, the injection hastens the crisis of the disease, conducing rapidly to complete restoration. Rozzolo also reported 5 cases treated with serum, 4 of which were cured. No influence upon the pulse, heart, or kidneys was noted. The effect of animal serum is fugacious; that of the human product lasts several days. In all cases the serum of immunized subjects possesses a therapeutic but not an antitoxic power. It does not diminish the virulence of pneumococci, which, injected in an inoculated organism, retain their pathogenic activity about eighteen hours, after which, indeed, their vitality is manifested by the production of toxins producing positive chemotaxis in the phagocytes. Among other curative methods in pneumonia may be cited the SPECIFICS. 295 hypodermic injection of blood taken from convalescents and the infusion of blood from similar patients. The former resulted fav- orably (Audeoud), and the latter (Hughes of Philadelphia), an intravenous operation, was no less successful. Audeoud explains the natural crisis in pneumonia by the theory of Klemperer—that the antipneumotoxin formed in the blood of an inoculated subject by neutralizing the pneumotoxin cures the infection. Cholera.—The microbe of this terrible disease had been sought since 1848, yet the subject had never been profoundly studied until Koch succeeded in isolating the germ. Being associated with other micro-organisms, the bacillus had remained undetected, being distinguishable, in fact, only in fulminant attacks of the disease, as was noted by Strauss and Roux. Stagnant water is particularly favorable to the propagation of germs. In distilled water the bacillus survives but twelve hours; in drinking-water, seven days (Babes); while in river or well-water it may live for seven months (Wolfhugel). As a rule, the acids are injurious to the bacilli, bichloride of mercury, sulphate of copper, and quinine being very powerful antiseptics in presence of the germs. Cholera has been observed in man alone, although Koch easily imparted the disease to guinea-pigs, to which it was fatal. Inocu- lation of choleraic virus has never produced the malady in man. The pathogenic power of the bacillus is well demonstrated by the fact that in one of the Berlin hospitals, of 207 patients attacked by cholera nostras (cholerine) in which no germ was manifest, but one case proved fatal; and, notwithstanding vigorous oppo- sition, Koch's original thesis appears to be sustained by observation. A singular fact in connection with cholera germs is that they may be ingested at times, if not with impunity, at least without in- ducing the disease. Pettenkofer, having taken large doses of alkali, absorbed a considerable quantity of the poison with only the effect of a diarrhea during five days, there being no disturbance of the general system or of the kidneys. Emmerich, ingesting the tenth part of Pettenkofer's dose, was seized with diarrhea twenty-four hours afterward, and became seriously ill. Purging lasted four days, and on the eleventh day the bacilli disappeared from the stools. It were beside the purpose of the present work to relate in detail the many interesting experiments upon animals undertaken 296 A TEXT-BOOK OF MA TERIA MEDICA. with a view to the application of serum-therapy in the treatment of human cholera. Although the experimental investigations of recent years foreshadow the possibility of immunization in man, it must be confessed that, as in the case of tuberculosis, they have been thus far barren of definite results. It is announced that Behr- ino- has discovered a practical method of combating the disease: until the results of his later researches are known the therapeutic problem must apparently remain unsolved. The result of Haff- kin's investigation in India will be awaited with interest. Septicemia.—The streptococcus of Fehleisen (erysipelatis), which causes erysipelas, was discovered by Nepveu in France and Htiter in Germany (1868-80), and has been the subject of careful study by Klemperer and others in the hope of determining its availability as an immunizing agent. Employing the serum of immunized rabbits, it has been found possible by intravenous injec- tion to cure the disease in mice, the serum proving efficacious only against the disease with which the animal supplying it was inocu- lated. Subsequent experiments have been attended with varying results, Marmoret in February, 1895, having succeeded in obtain- ing a germ of streptococcus so virulent that the hypodermic injec- tion of roowo of a cubic centimeter was fatal to the rabbit in thirty hours. Inoculation with this microbe or its toxins conferred im- munity upon rabbits, which furnished a preventive and curative serum. Encouraged by previous experimentation, Charrin and Roget now sought to apply the method of serum-therapy in the treat- ment of puerperal fever. Having satisfied themselves of the cura- tive property of the serum of a mule inoculated with the microbe of erysipelas, collected fifteen days after the eighth inoculation, they injected subcutaneously 8 cubic centimeters of serum in a woman affected with the fever. The report is as follows: " The next day no improvement. A second injection of 8 cubic centi- meters. Next day condition slightly improved, but still serious. Third injection of 25 cubic centimeters. Result on the following day rapid improvement; decline of fever; general good health; and early establishment of convalescence." Syphilis.—The pathogenic source of syphilis is still unknown. The disease being contagious, attempts have long been made to discover its specific microbe, yet the highest authorities agree that as yet all researches have proved abortive. No lower animal is known to be susceptible to the malady, and, although various experiments SPECIFICS. 297 have seemed to prove the contrary, it is now determined that the lesions primarily indicating contraction of syphilis were the result of septicemia induced by some agent infected with the syphilitic virus. The sero-therapeutic methods employed in the treatment of the disease consist of inoculation with the blood of naturally immune or of syphilitic subjects. Of all animals, the horse is perhaps the only one capable of syphilization. Tommasoli in 1892-93 essayed inoculation of public women, affected with acute secondary syphilis, with lamb's serum, the results being, according to his report, highly favorable—even to the cure of syphilitic infection. Many untoward symptoms, how- ever, have attended the inoculations thus made. Mozza (1893) instituted a series of experiments, employing blood from the carotid artery of a lamb or dog, and another series in which injections were made of serum drawn from sheep inoculated with serum from syphilitic subjects in whom the disease was latent. His records indicate no very satisfactory results, yet he demonstrated that aseptic precautions allow the application of serum-therapy without local or general reaction. Finally, Hericourt and Richet attempted, with dubious success, the experimental injection of syphilitic serum, the results, in their therapeutic importance, being inconsequential. Typhoid Fever.—The bacillus of this disease was first detected in the kidneys by Bouchard in 1879. The name was given by Eberth, who studied the germ in 1880-81. Old cultures contain an exceedingly toxic ptomaine, besides a soluble substance capable of inoculating animals. The vigor of the bacillus of Eberth is re- markable, Grancher and Deschamps having shown that it sur- vives five and a half months at a depth of 50 centimeters in damp soil. Infection may occur through the medium of the pulmonary tract, and the microbe is transmissible from the mother to the fetus. All animals yet submitted to experiment are naturally immune, the first effort to inoculate them dating from 1862 (Murchison); the attempt proved futile. Other experiments in this direction were attended with like failure until Vidal and Chantemesse suc- ceeded in inoculating with very virulent cultures 30 white mice, 17 of which succumbed within twenty-four hours. Later experiments have proved the extreme virulence of serum derived from a typhoid human subject, fatality speedily resulting 298 A TEXT-BOOK OF MA TERIA MEDICA. from its injection, caused not by the microbe itself, since none are found after death, but by its toxic products. Among the phenomena observed in varied experimentation the inexplicable fact was revealed that the serum of certain persons never having contracted typhoid fever conferred immunity upon guinea-pigs. Casual experiments followed without favorable progress, other than the reduction of temperature. In January, 1895, however, M. Legrain, turning his attention to typhus—so closely allied to true typhoid fever—met with encouraging success. Injecting suc- cessively increased doses of serum from typhus convalescents, besides the reduction of temperature within three hours after the operation it was noted that stupor, coma, and even hemiplegia of a toxic nature, disappeared after an injection of 10 cubic centimeters. In a case of grave typhus the injection of 14 cubic centimeters on the fourth day of the infection resulted in lowering the temperature and inaugurating recovery within two days. In other serious cases, where the injection was delayed until the sixth or eighth day of the infection's course, the disease, though not arrested, was marked by mitigated symptoms. The serum of convalescents was taken after one week's remission of febrile manifestations. Relying upon the fact that an attack of typhus confers immunity against a second access of the disease, Stern sought to ascertain whether the serum of individuals cured was endowed with immu- nizing properties. The results were partially successful, eliciting the curious fact that the protective power of the serum appeared most active in those who finally succumbed to the disease. It also seemed problematical, to judge from these and other instances, whether immunized serum employed in this disease possesses either bactericidal or antitoxic properties. Influenza.—Although the disease has occurred at intervals since the serious epidemic of 1830-33, the earliest microbiological studies of influenza date from the epidemic of 1889-90. Investigation at that time revealed no microbes in the sputum and viscera, save those which habitually frequent the bucco-pharyngeal cavity- streptococcus, pneumococcus, pneumo-bacillus, and staphylococcus —which diversity of germs might induce the belief that "la grippe" is not due to any single micro-organism, but to several. Notwithstanding this and similar suppositions, the majority of microbiologists maintain that these bacteria are but the result of a secondary infection, and that the true germ of influenza is still SPECIFICS. 299 unknown, although many investigators have thought they had iso- lated the specific microbe. One deduction is constant as the result of their studies: the great importance of secondary infections in the course of the disease. Failure to discover the germ was in reality due to a deficiency of technique—inadequate methods of staining. Pfeiffer devised a new method, by which he detected it, and Kitasato (1892) suc- ceeded in isolating and cultivating the identical microbe. Animals do not contract the disease spontaneously, although the saliva of cats and dogs contains a bacillus having a pathogenic influence upon rabbits, the character of which closely resembles that of the Pfeiffer bacillus. Monkeys and rabbits contract the malady when inoculated with the pure culture of this germ. In man the port of entry, so to speak, of this microbe is the pulmonary tract, where it often produces lesions of suppurating broncho-pneumonia. The general phenomena observed in the disease are held by Pfeiffer to be the result of intoxication, the microbes being localized; Cauch, on the contrary, considers them due to the presence of the microbe in all the organs, even the blood. The latest investigations confirm the opinion of Pfeiffer. Brischettini has demonstrated that the propagation of the Pfeiffer bacillus is not checked by the action of serum from immunized animals, being limited to diminishing the toxicity of its soluble products. The immunity caused by the injection of these products is augmented by the injection of the culture. The injection of serum of an immunized animal neutralizes in vitro the toxins secreted by the bacillus, and in a healthy organ- ism establishes immunity, whether against infection or intoxication. It is therefore assured that in future use the serum may be em- ployed at once as an inoculative and curative agent. Reptile Poisons.—It has long been known that certain animals (reptiles) possess natural immunity against their own venom. The poison of the toad having been detected in his blood, the reptile's immunity was at first thought to be due to tolerance, the same condition existing in the salamander and viper. The relation between the blood and the venomous glands demon- strates the internal secretion of these glands. The idea of an anal- ogy between microbic virus and reptilian venom was deduced from the existence of soluble microbic toxins, as elucidated by Chauveau. The attenuating power of heat upon the venom of serpents has A TEXT-BOOK OF MATERIA MEDICA. also its analogue in the similar susceptibility of micro-organisms. A mortal dose of venom subjected for five minutes to a heat of 100° C. may be injected with impunity into a guinea-pig weighing 500 grammes. The reaction of the organism engenders an antitoxin which, in- jected into a healthy animal, is preventive of fatal inoculation. The precise nature of this antitoxin is undetermined, yet its protective power is evident. Certain it is that the serum of a rabbit inocu- lated against viperous venom, when injected an hour and a half before the poison, completely neutralizes the latter. Curiously enough, this preventive serum of rabbits inoculated against the poison of vipers also confers immunity against cobra-venom. So far as affects man, Calmetti announces that he has employed serum with success in the treatment of snake-bites, even to the extent of curing them. Carbuncle (Anthrax).—The bacterium of anthrax, of the genus bacillus, has proved a subject of elaborate and interesting experi- ment, many features of which are of absorbing interest alike to the bacteriologist and the clinician. The animals subjected to inocula- tion have been chosen with great care, and those supplying the immunizing serum include many species. The general results of protective inoculation have been treated briefly early in the discus- sion of serum-therapy. Rabies.—In January, 1881, Galtier announced that intravenous inoculation of rabid saliva confers immunity upon sheep, confirm- ing his experiments later in the year by injecting the fluid into nine sheep and one goat. Pasteur, Chamberland, Roux, and Thuiller pursued experiments in a similar line, with somewhat negative results. By passing the virus successively from dogs to monkeys Pasteur was able to attenuate its virulence, and finally, by transferring the poison from monkeys to rabbits, a serviceable immunizing agent was obtained, still further experiments perfecting the method in view. Satisfied with his success, Pasteur now turned his attention to the inoculation of man against hydrophobia. The first operation (in 1885) was attended with auspicious results, and from that moment the savant's laboratory was invaded by affected individuals demanding cure. Institutes were founded in various parts of the world, that in Paris being the center of bacteriological study in France. In America the subject has received wide attention, but SPECIFICS. 301 in many instances the benefits derived from Pasteur's inoculative procedure have been of doubtful importance among intelligent observers. It has been impossible to present within a necessarily limited space the entire field covered by this profoundly interesting subject. For a multitude of details, embodying a wide range of experimen- tation, and for many expressions of individual opinion awakened by a consideration of so absorbing a theme, the student is referred to the extensive bibliography relating to every phase of serum- therapy. It may be readily imagined what would have been the discus- sion of Jenner's vaccination had our bacteriological and chemical knowledge and delicate appliances for investigation existed in his day. It is scarcely surprising, therefore, that the renewal of similar studies, after an interval of unprecedented scientific progress, should elicit from all parts of the world a zeal and enthusiasm impossible in any previous epoch, together with a mass of concurrent or dis- senting testimony touching new discoveries proportionate to the greatly increased number of competent investigators. Whatever be the limitations of serum-therapy, the consensus of opinion among thoughtful observers is that its rationale and purpose are deeply rooted in the eternal laws of matter and the methods of great Nature. " Vestigium nullum retrorsuml" it cries to us, and we must be guided by its light or still remain in darkness. CLASS II.-ANTISEPTICS. Acidum Carbolicum—Acidi Carbolici—Carbolic Acid. U.8.P. Origin.—A constituent of Coal-tar, obtained by fractional distil- lation and subsequently purified. Description and Properties.—Colorless, interlaced, or sepa- rate, needle-shaped crystals, or a white, crystalline mass, some- times acquiring a reddish tint, having a characteristic, somewhat aromatic odor, and, when copiously diluted with water, a sweetish taste, with a slightly burning after-taste. Deliquescent on exposure to damp air. Soluble in about 15 parts of water, the solubility varying accord- ing to the degree of hydration of the acid ; very soluble in alcohol, ether, chloroform, benzol, carbon disulphide, glycerin, and fixed and volatile oils. It is liquefied by the addition of about 8 per cent. of water. The vapor of the acid is highly inflammable. Carbolic acid is faintly acid to litmus-paper. It should be kept in dark amber-colored, well-stoppered bottles. Dose.—1-2 grains (0.03-0.12 Gm.). If liquefied, 1-2 minims (0.03-0.12 Cc). Official Preparations. Glyceritum Acidi Carb61ici—Glyceriti Acidi Carbblici—Glycerite of Car- bolic Acid (25 per cent.).—For external use. UnguSntum Acidi Carb51ici—UnguSnti Acidi Carbblici—Ointment of Car- bolic Acid (10 per cent.).—For external use. Unofficial Preparations. Aqua Acidi Carbblici—Aquae Acidi Carbblici—Carbolic Acid Water.— Strength, 2 drachms in I pint (8.0--473.17 Cc). Dose, 1-2 fluidrachms (4.0-8.0 Cc). Oleum Acidi Carbblici—Olei Acidi Carbblici—Carbolated Oil.—1 in 20 of Olive or Cotton Seed Oil. For external use. C3rbasus Acidi Carbblici—Carbasi Acidi Carbblici—Carbolic Acid Gauze. —Gauze containing Carbolic Acid, 1 ; Resin, 5; Paraffin, 7 parts. Used as a surgical dressing. 302 ANTISEPTICS. 303 Emplastrum Acidi Carbblici—Emplastrum (ace.) Acidi Carbblici__Car- bolic Acid Plaster.—Composed of Carbolic Acid, 25; Shellac, 75 ; coated with Gutta- percha dissolved in Carbon Disulphide. For external use. Camphora Carbolisata—Camphoras Carbolisatae—Camphorated Carbolic Acid (Phenol-camphor).—Camphor, 2; Carbolic Acid, 1; allow to liquefy. A color- less, oily liquid, having the odor of camphor, soluble in fixed oils, alcohol, and ether, nearly insoluble in water and glycerin. Used as a local anesthetic, chiefly for toothache. Liquor Sodii Carbolatus—Liquoris Sodii Carbolati—Phenol-Sodique.— Composed of Carbolic Acid, 188 grains (12.5 Gm.); Caustic Soda, 31 grains (2.06 Gm.) Distilled Water, 4 ounces (118.29 Cc.). For external use. Liquor Sodii Boratis Compbsitus—Liquoris Sodii Boratis CompSsiti__ Dobell's Solution.—Composed of Borax and Sodium Bicarbonate, of each, 2 drachms (15.0 Gm.); Carbolic Acid, 24 grains (1.8 Gm.); in Water, 1 pint (473.17 Cc). Used externally in spray. Acidum Carbblicum Iodatum (N. F.)—Acidi Carbblici Iodati—Iodized Carbolic Acid (Phenol Iodatum).—Composed of Iodine, 20 parts; Carbolic Acid, 76 parts; Glycerin, 4 parts. The iodine, the acid which has been previously melted, and the glycerin are put in a flask, digested at a gentle heat, and frequently agitated until the iodine is dissolved. It should be kept in glass-stoppered bottles in a dark place. Used locally, especially in gynecological practice. Allied Compounds. Creasols.—Obtained by distilling Coal-tar between 200° and 2io°C.; also obtained by fusing Toluene Sulphonic Acid with Potash. The familiar compounds of creasols are Crealin, Lysol, Solutol, Saprol, etc. They are powerful disinfectants and germi- cides, and less poisonous than carbolic acid. Aseptol, or orthophenol-sulphonic acid, is a commercial article, a straw-colored, slightly caustic liquid. It is a powerful antiseptic. Antagonists and Incompatibles.—Bromine, metallic salts, antipyrine, collodion, alkalies, saccharate of lime or lime, and soluble sulphates like Epsom or Glauber salts, are incompatibles. Atropine is a physiological antagonist. Synergists.—All members of the carbolic-acid group, antisep- tics, and motor depressants. Physiological Action.—Externally.—Carbolic acid is a local anesthetic, and, applied in full strength to animal tissues, acts as a caustic, but does not produce vesication. In weaker solutions it produces a burning and reddening of the skin. It acts more severely upon mucous membranes. It coagulates albumin, and therefore its caustic action is limited. The eschar is first whitish, subsequently becoming brownish. It is readily absorbed through the skin or through raw surfaces, and toxic effects have been thus produced. Weak solutions are anti- pruritic and gratefully cooling and anodyne. It is a disinfectant, a deodorant, and a parasiticide. 304 A TEXT-BOOK OF MATERIA MEDICA. Internally.—Digestive System.—In small doses it is cooling and sedative to the stomach. In large or poisonous doses it is a pow- erful gastro-intestinal irritant. Ordinary medicinal doses are con- verted by the gastric contents into the sulphocarbolates. Circulatory System.—Medicinal doses have no apparent effect on the circulation. Large doses first depress and later accelerate the heart. Poisonous doses powerfully depress the heart, stopping it in diastole. The arterial tension is lowered by lethal doses, from paralysis of the vaso-motor center in the medulla. Nervous System.—Medicinal doses have no special effect upon the nervous system. Large or poisonous doses depress the cere- brum. Vertigo may first be noticed, which is soon followed by stupor. Owing to stimulation of the anterior cornua of the spinal cord, there may be muscular trembling or convulsions. The cornua are ultimately depressed, causing abolition of reflexes and paralysis. Respiratory System.—Small doses do not affect the respiration. Large doses first accelerate the respiratory movements, rendering them full, but shallow respirations soon follow. This action is due to stimulation of the vagi, both at the periphery and at the center. If the dose has been a poisonous one, there is great depression, and ultimately paralysis of respiration, due to depression of the centers. Absorption and Elimination.—It is absorbed from the stomach, and diffuses into the blood with great facility, circulating in that tissue probably as an alkaline carbolate. It is eliminated by all the secretions—chiefly by the kidneys and lungs—and appears in the urine as salts of sulphocarbolic and glycuronic acids, and the oxidated products hydrochinon and pyrocatechin. To the last substance is mainly due the peculiar smoky or olive-green color imparted to the urine after large or continued doses have been taken. (There is also, probably, some other factor causing this change, for pyrocatechin can exist only in alkaline urine.) When a very large amount of carbolic acid has been taken, some of it can be found, in the urine unchanged. Temperature.—It is not specially affected by small doses. Full medicinal doses tend to lower bodily temperature in fever, while poisonous doses lower the temperature several degrees. The re- duction of temperature is due to its diminishing heat-production and increasing heat-dissipation. ANTISEPTICS. 305 Eye.—Poisonous doses almost invariably cause the pupil to be minutely contracted, due, probably to paralysis of the radiating fibers, the circular fibers being unaffected. Untozvard Action.—Headache, either in the frontal or the occip- ital region, heaviness and a sensation of fulness in the head, dizzi- ness, and the appearance of rings before the eyes, muscular weak- ness, especially of the legs, profuse sweating, formication. Where there is an idiosyncrasy on the part of the individual against this drug, small doses even may produce the symptoms of poisoning. Poisoning.—Carbolic acid is one of the most deadly poisons, often equalling hydrocyanic acid in its rapidity of action. The patient is rendered rapidly unconscious or may drop dead within a very few moments from paralysis of respiration. Should the dose be insufficient to produce so sudden a death, the patient suffers from all the symptoms of gastro-enteritis—intense pain, with violent vomiting and purging. Fibrillary trembling may be present. Stertorous breathing appears, with cold, clammy skin, pinched face, anxious expression, abolition of reflexes, weak, thready, and often imperceptible pulse, feeble respiration, and frequently dyspnea, and death finally occurs from failure of respiration. As toxic symptoms may be produced by the external applica- tion of solutions of carbolic acid, as in surgical dressings or vaginal or intra-uterine douches, the toxicity of this drug should be appre- ciated, and patients carefully watched for the first untoward mani- festations, such as pain in the lumbar region, smoky urine, nervous- ness, and cerebral disturbance, when the drug should be immedi- ately withdrawn. Treatment of Poisoning.—The immediate administration of mag- nesium sulphate (Epsom salts) and warm demulcent drinks should be resorted to. The application of external heat. Atropine and strychnine hypodermically. Digitalis and coffee may also be re- quired. Opium, or some preparation of it, for the relief of pain. If the patient is seen soon after the drug has been taken, the stom- ach should be washed out, after which the above treatment should be followed. Therapeutics.—Externally and Locally.—For some time after it was so prominently brought forward by Lister carbolic acid was thought to be indispensable in antiseptic surgery. It is now known that the solutions which are safe to use are inefficient, ordinarily, beyond the mere mechanical effect of washing. 20 306 A TEXT-BOOK OF MA TERIA MEDICA. The benumbing influence produced on the hands of the sur- geon, and the discoloration of bright instruments and rapid impair- ment of their cutting surfaces, render strong solutions for disinfect- ing instruments impracticable, and indeed of less value for this purpose than the prolonged boiling in distilled water rendered slightly alkaline with sodium bicarbonate. The pain of superficial burns is relieved by applying strong solutions of carbolic acid, care being taken to prevent absorption. It is an extremely valuable drug as an antipruritic, and is hence of great utility in the treatment of certain diseases of the skin— pruritus, chronic eczema. In chilblains, tinea tonsurans, t. capitis, t. circinata,favus, etc. it is of great value. Chronic laryngitis, cha- racterized by diminished secretion, is greatly benefited by the direct application to the parts of a solution of \ drachm to i ounce of glycerin (2.0-30.0 Cc). A spray containing from 2 to 5 grains (0.12-0.36 Gm.) to 1 ounce (30.0 Cc.) of water is an efficient appli- cation in the treatment of acute and chronic inflammation of the throat and nose. Camphorated carbolic acid (campho-phenique) is a useful appli- cation in toothache due to an exposed and inflamed pulp. As a deodorant it is valuable to correct the fetor arising from syphilitic ulcerations, carcinoma, gangrene of the lungs, bronchorrhea, pneumothorax, etc. It reduces the discharge and relieves the pain in acute otitis media: a 10 per cent, solution in glycerin should be used. It is also of value in the treatment of otorrhea and in acute perforations of the tympanic membrane, but should be used in much weaker solutions—1 or 2 per cent. A lotion, 8 to 15 grains (0.5-1.0 Gm.) to 1 ounce (30.0 Cc), is an efficient antiseptic in foul and indolent ulcers. The pure acid is used as a cauterant in chancroids, lupus, gan- grene, bites of rabid animals, etc. The iodized carbolic acid is a valued local remedy in endometri- tis, chronic endocervicitis, and ulcers of the cervix. H titer in 1878 advocated the use of hypodermic injections of a 3 per cent, solution of carbolic acid for erysipelas, the punctures to be made at intervals upon the edge of the inflammation. Great improvement has taken place in goitre after the treatment by hypodermic injections into the tumor of a 5 per cent, solution of carbolic acid. Internally.—While inferior to salicylic acid to check fermentation, ANTISEPTICS. 307 it is nevertheless used for that purpose in dilatation of the stomach and so-called fermentative or flatulent dyspepsia. In nervous and irritative vomiting it may be given in doses of from 1 to 2 minims (0.06-0.12 Cc), well diluted and repeated at intervals of from one to four hours according to the symptoms of the case. It has been used in acute and chronic dysentery, and as an anthel- mintic against ascarides and taenia solium. It has also been advocated as a remedy for typhoid fever and in malarial cachexia, but purely upon theoretical grounds, no clinical results having thus far justified its use in these disorders. Administration.—It may be given internally in pills or capsules, mixed with powdered liquorice-root as an excipient, or dissolved in glycerin and well diluted with sweetened water. For external use various strengths are used (from 1:10 to 1:500), and the various preparations mentioned may be used according to the case and indications. Sodii Sulphocarbolas—Sodii Sulphocarbolatis— Sodium Sulphocarbolate. XT. 8. P. Description and Properties.—Colorless, transparent, rhombic prisms, odorless, having a cooling, saline, slightly bitter taste. Somewhat effervescent in dry air. Soluble in 4.8 parts of water, 132 parts of alcohol, 0.7 part of boiling water, and in 10 parts of boiling alcohol. The aqueous solution is neutral to litmus-paper. Dose.—10-30 grains (0.60-2 Gm.). Allied Compounds. Potassii Sulphocarbolas—Potassii Sulphocarbolatis—Potassium Sulpho- carbolate. Calcii Sulphocarbolas—Calcii Sulphocarbolatis—Calcium Sulphocarbolate. Magnesii Sulphocarbolas—Magnesii Sulphocarbolatis—Magnesium Sul- phocarbolate. Zinci Sulphocarbolas—ZIncii Sulphocarbolatis—Zinc Sulphocarbolate. All of the above have been employed, but the zinc sulphocarbolate is believed to be preferable to check diarrhea and render the stools less foul. It is best given in pills, in doses of 2-3 grains (0.1-0.15 Gm.). Physiological Action.—In medicinal doses sodium sulphocar- bolate occasions no special symptoms, and in three or four times the medicinal dose it causes only slight lightness of the head. It is changed in the system into carbolic acid and sodium sul- 308 A TEXT-BOOK OF MATERIA MEDICA. phate, the latter being eliminated with the urine. The carbolic acid set free exerts its characteristic action and influence. Therapeutics.—Externally and Locally.—In the strength of \ drachm (2.0 Gm.) to 8 ounces (237.0 Cc.) of water it forms a valuable gargle in relaxed conditions of the throat. Solutions of different strengths have been used in diphtheria, acute tonsillitis, aphtha? of children, and nasal catarrh. 30 grains (2.0 Gm.) in 2 ounces (60.0 Cc.) each, of water, and hydrogen peroxide make an efficient injection in gonorrhea. Internally.—It is a mild intestinal antiseptic, and may be used internally for the same purposes as carbolic acid in such disorders as diarrhea, fermentative dyspepsia, etc. It arrests the growth of thrush, and is considered by some physicians to exert a favorable action in anginose scarlatina, diphtheria, and typhoid fever. The zinc sulphocarbolate is one of the best intestinal antiseptics to use in cases of dyspeptic diarrhea of children. Administration.—Sodium sulphocarbolate is best given in solution. Creasotum—Creasoti—Creasote. XT. 8. P. Origin.—A mixture of phenols, chiefly Guaiacol and Creasol, obtained during the distillation of wood-tar, preferably that of beech. Description and Properties.—An almost colorless, yellowish or pinkish, highly refractive, oily liquid, having a penetrating smoky odor, and a burning, caustic taste; usually becoming darker in tint on exposure to light. Soluble in about 150 parts of water, but without forming a perfectly clear solution. With 120 parts of hot water it forms a clear liquid which on cooling becomes turbid, from the separation of minute oily drops. Soluble in all propor- tions in absolute alcohol, in ether, chloroform, benzin, carbon disul- phide, acetic acid, and in fixed and volatile oils. Creosote is in- flammable, burning with a luminous, smoky flame. It is neutral, or only faintly acid, to litmus-paper. Tests.—Carbolic acid is often substituted for creosote, and the following tests for the detection of carbolic acid are important: 1. If the suspended liquid is mixed with collodion, a coagulum will form if carbolic acid be present. 2. Carbolic acid produces a violet color with ferric chloride and ammonium hydrate, creosote producing a green color passing to brown. Dose.—1-5 minims (0.06-0.3 Cc). ANTISEPTICS. 309 Official Preparation. Aqua Creosoti—Aquae Creosoti—Creosote Water.—Dose, 1-4 fluidrachms (40-15.0 Cc). Incompatibles.—Strong sulphuric and nitric acid. It reduces silver salts, and explodes when combined with oxide of silver. Synergists.—The same as for carbolic acid. Physiological Action.—Externally.—It has the same action as carbolic acid. Internally.—Its action upon the digestive, circulatory, nervous, and respiratory systems is practically the same as that of carbolic acid. It does not stimulate the spinal cord so much as carbolic acid, and differs also from the latter drug in increasing the coagulability of the blood. Poisonous doses act like those of carbolic acid, but with more marked nervous symptoms. Absorption and Elimination.—It is eliminated by the bronchial mucous membrane, but the process takes place by the kidneys as guaiacol sulphate and creosol sulphate of potassium. It is a stimulant expectorant. It has the peculiar property when applied to meat of preserving it, whence its name (creas, flesh, sohzote, preserve). Poisoning.—The symptoms and treatment of poisoning from creosote are the same as described under Carbolic Acid. Therapeutics.—Externally and Locally.—Creosote is superior to carbolic acid as an antipruritic, although not so generally used as the latter, on account of its acrid and penetrating odor. It can be used externally for the same purposes as carbolic acid. It is a valuable hemostatic, and the creosote water may be used for this purpose. Inhalations of creosote are recommended in phthisis, chronic bronchitis, and chronic congestion of the larynx and trachea. It is a powerful local anesthetic, and is largely used by dentists and the laity for aching teeth. It is used to preserve dead animal matter for dissection, etc. Internally.—Creosote can be used internally for the same pur- poses as carbolic acid, having the advantage over the latter drug in being one of the most efficient remedies in pulmonary tuberculosis. Probably no one remedy exerts so favorable an action upon the night-sweats, cough, and expectoration as creosote, or guaiacol, which is preferred by many physicians. It is of less value in cases 310 A TEXT-BOOK OF MATERIA MEDICA. accompanied by high temperature and hemoptysis, and often aggravates these symptoms. It must be remembered that many of the cases alleged to have been cured by creosote have been treated with cod liver oil, tonics, and hygienic methods as well. Contraindications.—The same as for carbolic acid. Administration.—Pure beech-wood creosote alone should be used. It may be given in the form of creosote water, emulsion, or pills, or in capsules mixed with cod liver oil. Capsules are the least offensive way of administration. Some persons prefer to take' the drug in milk. In the treatment of phthisis large doses are necessary. A tol- erance can usually be established by gradually increasing doses. If the patient manifest any untoward symptoms, the drug must be reduced in quantity or discontinued altogether. Guaiacolum—Guaiacoli—Guaiacol. Origin.—As before stated, creosote consists chiefly of Guaiacol, Creosols, and Cresols, and of these guaiacol is present to the extent of from 60 to 90 per cent. Guaiacol is obtained by fractional distillation of beechwood-tar Creosote, treated with Ammonia to remove acid compounds, and again fractionated. Guaiacol is rarely met with absolutely pure. Description and Properties.—A colorless, slightly refractive liquid, of strongly aromatic odor. Specific gravity at 150 C. (590 F.) is 1.117. Sparingly soluble in water, but readily soluble in alcohol and ether. It is soluble in solutions of sodium and potassium hydroxides, forming unstable compounds known as sodium- and potassium-guaiacol. Tests.—Pure guaiacol will separate rapidly if shaken with twice its weight of benzene, whereas the impure article forms a clear solution. " If a trace of ferric chloride is added to an alcoholic solution of guaiacol, a blue color is developed, which changes to emerald- green upon the addition of more ferric chloride." Dose.—2-10 minims (0.12-0.6 Cc). The following derivatives have been introduced: Guaiacoli B&nzoas—Guaiacoli Benzoatis—Guaiacol Benzoate (Benzosol). — Origin, by heating on a water-bath Potassium Guaiacol with Benzosol-chloride: the impure benzosol-guaiacol formed is purified by recrystallization from Alcohol. ANTISEPTICS. 3" Description and Properties.—Colorless, tasteless, and odorless crystalline powder, almost insoluble in water, but readily soluble in ether, chloroform, and hot alcohol. Dose.—10-150 grains (0.60-10 Gm.) daily. Guaiacoli Carbonas—Guaiacoli Carbonatis—Guaiacol Carbonate.__Origin, this substance is prepared by passing Phosgene Gas (carbonyl chloride) into Guaiacol previously dissolved in soda solution. The guaiacol carbonate is formed and is purified and crystallized from Alcohol. Description and Properties.—White, neutral, crystalline powder, nearly void of odor and taste, insoluble in water, slightly soluble in cold and readily soluble in hot alcohol, also in ether, chloroform, and benzene, and sparingly soluble in glycerin and fixed oils. Dose.—3-60 grains (0.2-4 Gm.) daily, gradually increased. Guaiacoli Di-iodidum—Guaiacoli Di-iodidi—Guaiacol Diodide.__Origin, by adding a solution of Iodine in potassium iodide to an aqueous solution of Sodium- guaiacol as long as precipitation continues. Description and Properties.—Reddish-brown salt, having the odor of iodine, soluble in alcohol and fixed oils, and readily decomposed. Dose.—2-15 grains (0.10-1 Gm.). Guaiacoli Sallcylas—Guaiacoli Salicylatis—Guaiacol Salicylate (Guaiacol- SALOL).— Origin, by the action of Phosphorous Oxychloride on a mixture of Sodium- guaiacol and Salicylate. It is analogous to salol. Description and Properties.—White, crystalline, odorless, and tasteless powder, in- soluble in water, but soluble in alcohol, ether, and chloroform. Dose.—10-150 grains (0.60-10 Gm.) daily. Physiological Action of Guaiacol and its Derivatives.— Guaiacol produces an action very similar to that of creosote. It is not caustic when applied in full strength. It possesses marked antipyretic properties. It is readily absorbed through the unbroken skin, and rapidly reduces febrile temperature when applied in this manner. The reduction of temperature lasts from four to six hours. It is a diaphoretic and diuretic. It is excreted by the sweat, saliva, and urine, but is only slightly thrown out by the expired air, though small amounts of the drug have been found in the lung-tissue. As it is eliminated as a salt of ethyl-sulphuric acid, it must combine with albuminous bodies in the blood, and chiefly through the sulphur present in the albumin molecules. It can be found in the urine within fifteen minutes after administration or external application in the form of a substance giving the reaction of phenol. It is more agreeable to the stomach than creosote, and fre- quently improves the appetite, though to some patients it is very disagreeable and acts as an irritant. The guaiacol carbonate is usually much better borne by the stomach, and is therefore a useful and efficient substitute. 312 A TEXT-BOOK OF MATERIA MEDICA. Benzosol, guaiacol benzoate, contains 54 per cent of guaia- col. It is usually well borne by the patient, and seldom occasions any digestive disturbance. In the intestinal canal it resolves into guaiacol and benzoic acid, and is excreted by the urine as combi- nations of these substances. Therapeutics.—Guaiacol is used for the same purposes as creosote—less likely to irritate the intestinal canal and kidneys. Guaiacol causes a marked reduction of the temperature in cases of tubercular disease when applied locally, nor is the antipyretic action when thus employed confined to tuberculous cases. It has given satisfactory results in other pyrexias. It is a very active antipyretic in erysipelas. The temperature begins to fall within fifteen or twenty minutes after the application of the drug. As with all antipyretics, the depressing action of guaiacol must be borne in mind. Raymond first suggested the local application of guaiacol in tonsillitis. It undoubtedly exerts a favorable action on the disease. Guaiacol, or some one of its derivatives, has been substituted for creosote in the treatment of phthisis and other wasting forms of tuberculosis. Guaiacol itself has no advantage over creosote. The benzosol and guaiacol carbonate possess the only advan- tage of being tasteless. Piatkowski of Vienna recommends benzosol in diabetes mcllitus. There have been conflicting reports regarding its efficacy, yet suf- ficient is known in its favor to justify a further trial of this drug in diabetes. Contraindications.—The same as for creosote. Administration.—The application of guaiacol for the reduction of temperature may be made upon any portion of the skin—the back, breast, arms, thighs, or abdomen—without causing any appre- ciable difference. From \ to 1 drachm (2.O-4.O Cc.) is applied with a brush, and the part covered with cotton or gutta-percha tissue. The application may be repeated as often as necessary for the reduction of the fever. Other than a decided taste of guaiacol and free diaphoresis, the patient usually complains of no untoward symptoms, although in some cases quite marked nervous disturbances and other unfavor- able manifestations have been observed. It may be inhaled from hot water for certain conditions in doses of from 5-10 minims (0.3-0.6 Cc). ANTISEPTICS. 3T3 The solid derivatives of guaiacol may be given in powders or capsules. Guaiacol itself may be given in the same manner as creosote—preferably, mixed with cod liver oil or enclosed in cap- sules. Acidum Salicylicum—Acidi Salicylici—Salicylic Acid. XT. 8. P. Origin.—An organic acid, existing naturally in combination in various plants like Spiroza ulmaria (meadow-sweet), Gaultheria procumbens (wintergreen), etc., but chiefly prepared synthetically by combining the elements of pure Carbolic Acid with dry Car- bonic Acid and purifying. Description and Properties.—Light, fine, white prismatic needles, or a light white crystalline powder, odorless, having a sweetish, afterward acrid taste; permanent in the air. It is soluble in about 450 parts of water, in 2.4 parts of alcohol, and in 14 parts of boiling water. The addition of 2 parts of sodium sulphite or 1 part of ammonium phosphate renders it much more soluble in water. Test.—The addition of ferric chloride to a saturated solution produces a fine bluish-violet color. Dose.—3-60 grains (0.25-4.0 Gm.). Lithii Salicylas—Lithii Salicylates—Lithium Salicy- late. U.S. P. Origin.—Obtained by heating Salicylic Acid, Lithium Carbonate, and Water until effervescence ceases, filtering, and evaporating. Description and Properties.—A white or grayish-white pow- der, odorless, having a sweetish taste, deliquescent on exposure to air, very soluble in water and alcohol. Dose.—5-60 grains (0.3-4.0 Gm.). Sodii Sal icy las—Sodii Salicylatis—Sodium Salicy- late. XT. 8. P. Origin.—Prepared by acting on Sodium Carbonate with Salicylic Acid, straining, and heating the solution. Description and Properties.—A white amorphous powder, odor- less, sweetish, saline taste, permanent in air, soluble in 0.9 part of water, in 6 parts of alcohol, and in glycerin. Dose.—5-60 grains (0.3-4.0 Gm.). 314 A TEXT-BOOK OF MATERIA MEDICA. Antagonists and Incompatibles.—The arterial and cerebral stimulants are antagonistic to salicylic acid and the salicylates. The incompatibles are the mineral acids, alkalies, metallic salts, particularly the ferric salts. Synergists.—The carbolic-acid derivatives, anesthetics, cardiac depressants, and cerebral sedatives. Physiological Action.—Externally and Locally.—Salicylic acid is antiseptic, parasiticide, irritant to mucous membranes; possesses the power to soften the epidermis ; checks perspiration when locally applied (anhydrotic). Internally.—Digestive System.—Small doses stimulate the stom- ach ; larger doses act as an irritant. It is an antiferment. Circulatory System.—Small doses of salicylic acid have no very appreciable effect upon the circulation. Full medicinal doses first cause the heart to beat faster and stronger, increasing arterial tension; later the arterial pressure is lowered, and excessive or toxic doses cause the pulse to become slow and labored. Its tend- ency ultimately, even in medicinal doses, is to depress rather than stimulate the heart. Its effect upon the blood is to restrain the migration of the white corpuscles. Nervous System.—In toxic doses, and in some susceptible per- sons in full medicinal doses, salicylic acid causes cerebral conges- tion, indicated by a feeling of tension in the cerebrum, headache, confusion of thought, tinnitus aurium, vertigo, and sometimes delirium. Toxic doses may occasionally produce cerebral con- vulsions. It lessens the reflexes, but does not affect the peripheral nerves, either motor or sensory. Respiratory System.—Small doses stimulate the respiratory cen- ter and the pulmonary vagi, making the respiration quicker and deeper. Toxic doses paralyze the center and vagi, causing slow and labored respiration and death from asphyxia. Absorption and Elimination.—Salicylic acid is converted by the gastro-intestinal secretions into the sodium salicylate, in which form it enters into the circulation. It increases the urinary flow, and the proportion of urea, uric acid, and phosphoric acid. It appears in the urine as sali- cyluric acid. The color of the urine is changed to a dark olive- green after large doses have been taken. This change is due to the presence of indican and pyrocatechin, produced by the action of the pancreatic juice upon the salicylic acid in the intestine. ANTISEPTICS. 315 It is a powerful diaphoretic, large doses often causing exhaust- ing sweating. It also increases the secretion of milk and the amount of sugar in that secretion. Elimination takes place slowly by all the emunctories, but chiefly through the kidneys and skin. Temperature.—Febrile temperature is markedly reduced by large doses of salicylic acid. The reduction takes place usually within half an hour after a dose has been taken, and lasts several hours. The antipyretic action varies in degree according to the cause of the pyrexia and the individual susceptibility of the patient. The reduction of temperature is produced by lessening heat-production and increasing heat-dissipation. Untoward Action.—Erythema, urticaria, or petechiae, accom- panied by intense itching, occasionally edema of the eyelids and lower extremities, mental depression, muscular weakness, motor disturbances, sweating, and buzzing in the ears, as mentioned under Poisoning, but to a less degree. Poisoning.—There are roaring in the ears, deafness, intense headache, vertigo, and possibly delirium, profuse and exhausting sweating, subnormal temperature, very weak, compressible pulse, feeble and shallow respirations, dimness of vision, ptosis, and often strabismus. The blood is disorganized, and the corpuscles rapidly break down. The urine and feces pass involuntarily. Death usually results from respiratory failure. Treatment of Poisoning.—Diffusible stimulants, atropine, strych- nine—the same treatment as in poisoning by acetanilid. Therapeutics.—Externally and Locally.—Salicylic acid has been satisfactorily employed, in the strength of \ to 1 drachm in 1 ounce (2.0 to 4.0 in 32.0 Gm.) of cosmoline, in the treatment of erysipelas. In the treatment of chancroid salicylic acid has been extensively employed. The powdered acid should be thoroughly dusted over the surface. The peculiar action of salicylic acid in softening and loosening thickened masses of epidermis and favoring the normal prolifera- tion of epithelium renders the drug especially useful in the treat- ment of indurated eczema, particularly of the palm and sole, ver- ruca, tylosis, callositas, corns, warts, etc. It is one of the most useful drugs in the different varieties of eczema, impetigo contagiosa, psoriasis, lupus, parasitic affections, and in non-parasitic sycosis it has been employed by Heitzmann with 316 A TEXT-BOOK OF MATERIA MEDICA. marked success. It has been used successfully in the treatment of acne, comedones, and pruritus. A 3 per cent, solution has been recommended in aspergillus of the outer auditory meatus. A wash, 3 grains to 1 ounce (0.2 to 30.0 Cc.) is efficient in otorrhea. Solutions of various strengths are frequently useful in acute coryza, diphtheria, inflammation of fauces, catarrhal stomatitis, and to cor- rect offensive expectoration, especially in phthisis and gangrene of the lung. Internally.—There is no better example of empiricism in thera- peutics than the employment of salicylic acid in acute articular rheumatism. Used at first in this disease to reduce temperature, it was found that while it exerted marked antipyretic action, it also lessened the pain and swelling, and in the majority of cases short- ened the duration of the disease. It cannot be classed as a " specific " in any sense of the word, but merely relieves certain symptoms—fever, pain, and swelling. Other symptoms—or com- plications, according to some authors—such as heart affections, are uninfluenced by this medicine. Indeed, when so-called cardiac complications exist salicylic acid is certainly contraindicated. It has no power to prevent either affections of the heart or relapses. In the author's opinion, it is doubtful if salicylic acid alone is equal to the alkaline treatment or greatly superior to acetanilid or anti- pyrine. Rheumatic tetanus, irido-choroiditis, and sclerotitis are alleged to have been cured by this drug. It is useless in gout, according to the best English authorities, and is of no value in chronic or gonorrheal rheumatism, rheumatic arthritis, or rheumatic hyper- pyrexia. It is credited with being quite efficient in chorea of rheumatic origin, and in relieving the pains of herpes zoster and neuralgic headache. It is a drug to be tried in many diseases of rheumatic origin, unless some distinct contraindication to its use exists. It surpasses any drug, with the possible exception of guaiac, in the treatment of quinsy, and particularly rheumatic tonsillitis. The medicine is highly regarded by competent advocates as a remedy in diphtheria. Lumbago often yields to its influence, and it has also been recom- mended in sciatica, although in Cook County Hospital the author has seen a great number of cases of the latter treated with salicylic acid without any apparent improvement. He also regards it as valueless in typhoid and intermittent fevers. ANTISEPTICS. 3^7 It is a useful antizymotic to prevent putrefactive fermentation and flatulence, and lessen thereby the tendency to crapulous diar- rhea. Owing to the similarity of its action to that of quinine, it has been used, and with some success, in periodical neuralgias which have not responded to the latter drug. It has been found of use in influenza, and is an efficient anti- septic remedy in chronic gastric catarrh, diarrhea, cholera, and entero-colitis. By some eminent clinicians it is considered to be one of the most effectual remedies in pleurisy with effusion. It has been recommended as an effectual anthelmintic, both for tape- and round-worms. Contraindications.—Salicylic acid should not be given in large doses to persons who have a weak heart or are otherwise greatly debilitated, at least not without counteracting its toxical tendencies with nutrients and diffusible stimulants. Administration.—Owing to its irritant action upon the mucous membranes, it is best given in a solution of glycerin and some aro- matic water, after meals. So concentrated a form as a pill or cap- sule is not recommended. Many of the untoward cerebral effects may be relieved by giving 20 grains (1.3 Gm.) of sodium or potassium bromide. Many of the toxical effects have been attributed to an impurity in the manufactured acid. If any benefit is to be derived from salicylic acid in acute artic- ular rheumatism, it must be used early in the disease and in heroic doses at comparatively frequent intervals—not less than 20 grains (1.3 Gm.) every two, three, or four hours for an adult. If too serious gastric and cerebral symptoms manifest themselves, the drug may be decreased in amount or discontinued until the unpleasant action subsides. It is better, except in acute articular rheumatism, to give a small dose, repeated frequently, than to administer a full dose at once. The physiological action and therapeutics of lithium salic- ylate are practically the same as those of salicylic acid or sodium salicylate. It is, however, richer in salicylic acid than the sodium salt, and in gout and chronic rheumatism has been found to be of more value than salicylic acid. It should be given in solution. Sodium salicylate is identical in physiological action and 318 A TEXT-BOOK OF MATERIA MEDICA. uses with salicylic acid, with the exception that it is less irritating to the stomach, and is therefore ordinarily to be preferred to the acid. It may be prescribed in aromatic water, in syrup, or in powder, pills, or capsules. Salol-Salol-Salol. XT. 8. P. (Phenyl Salicylate.) Origin.—The Salicylic Ether of Phenol, prepared by heating Salicylic Acid with Phenol in the presence of Phosphorus Penta- chloride. Description and Properties.—A white, crystalline powder, odorless, or having a faintly aromatic odor, and almost tasteless. Permanent in the air. Almost insoluble in water; soluble in io parts of alcohol; also in 0.3 part of ether, and readily in chloro- form and in fixed or volatile oils. Dose.—3-15 grains (0.19-1.0 Gm.). Physiological Action.—Externally and Locally.—It is a more powerful antiseptic than either of its constituents. Nencki claims that it is not a germicide, as it will not destroy bacteria when present, although it prevents their formation. It is not, like sali- cylic acid, irritating to the mucous membranes. Internally.—The action of salol is essentially like that of salicylic acid, but it is a more powerful antipyretic, analgesic, and cerebro- spinal sedative. It reduces temperature much more promptly, the antipyretic action occurring within fifteen minutes after a full medi- cinal dose has been taken. The effect, however, is not prolonged, repeated doses being required to maintain the reduction of tem- perature. The circulation is, perhaps, not so much depressed as by sali- cylic acid. The respirations are at first quite rapidly increased, and are rendered very shallow, requiring some time to resume their normal condition. It is converted by the pancreatic and intestinal juices into its original constituents—salicylic acid and carbolic acid. It is usu- ally absorbed and eliminated very rapidly, having been detected in the urine in the form of salicyluric acid and phenol-ether-sul- phuric acid within thirty minutes after its ingestion by the stomach. To the latter acid is due the dark, smoky color of the urine which sometimes exists under large or continued doses of salol. Therapeutics.—Externally and Locally.—Salol is especially ANTISEPTICS. ' 319 recommended as an antiseptic dressing for wounds, burns, venereal ulcers, and buboes. Powdered salol or an ointment—i part to 150 parts of petrolatum—has been used in cases of tubercular laryngitis and ozena. Like salicylic acid, it is also of value in eczema and sycosis simplex. Internally.—It is an efficient remedy in all diseases benefited by the internal administration of salicylic acid. In addition to these services it is a valuable remedy in acute and chronic cystitis, gonor- rhea, intestinal catarrh, especially duodenal catarrh and catarrhal jaundice, and to relieve the pains of neuritis and myalgia. Salol is much more useful than salicylic acid in diarrhea, cholera morbus, and cholera, the latter disease yielding better, perhaps, to this remedy than to any other. Administration.—It may be given in pills, capsules, powders, emulsion, or suspended in milk. The compressed tablets of this drug so extensively used at present are not recommended, owing to their slow and difficult solution. Salicinum—Saliclni—Salicin. XT. 8. P. Origin.—A neutral principle obtained from several species of Salix (willow) and Populus (poplar). Description and Properties.—Colorless or white, silky, shining, crystalline needles, or a crystalline powder, odorless and having a very bitter taste. Permanent in the air. Soluble in 28 parts of water, 30 parts of alcohol, 0.7 part of boiling water, and in 2 parts of boiling alcohol. Dose.—10 grains-2 drachms (0.6-8.0 Gm.). Physiological Action.—Its physiological effect is analogous to that of salicylic acid, but is much less active than the latter. It does not disturb digestion, but in moderate doses promotes appe- tite and acts like other bitters. It is more rapidly absorbed than salicylic acid, is partly decomposed, and is found in the urine, as salicin and salicylic acid, in from fifteen to thirty minutes after the ingestion of a single dose. Therapeutics.—While inferior to salicylic acid in most respects, salicin is frequently used for the same purposes. It is superior to, and safer than, salicylic acid in acute rheumatism characterized by a weak heart and depressed vaso-motor system. It is an excellent stomachic tonic, and may be used like other hitters in the treatment of atonic dyspepsia and other conditions benefited by this class of drugs. 320 A TEXT-BOOK OF MATERIA MEDICA. Contraindications.—In acute inflammatory affections of the brain and ear. Administration.—Salicin may be administered in powders, cap- sules, or solution. Owing, however, to its bulk and intensely bitter taste, it is perhaps best given in suspension in the aromatic elixir of liquorice or in syrup of yerba santa. Naphtalinum—Naphtalini—Naphtalin. XT. 8. P. Origin.—A hydrocarbon obtained from coal-tar. Description and Properties.—Colorless, shining, transparent laminae, having a strong, characteristic odor resembling that of coal-tar, and a burning, aromatic taste; slowly volatilized on expo- sure to air. Insoluble in water, but when boiled in it imparting a faint odor and taste. Soluble in 15 parts of alcohol, and very soluble in boiling alcohol; also very soluble in ether, chloroform, carbon disulphide, and in fixed or volatile oils. Naphtalin vola- tilizes slowly at ordinary temperatures, but rapidly when heated. Its vapor is inflammable, burning with a luminous and smoky flame. It should be kept in well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Naphtol—Naphtol—Naphtol. XT. 8. P. (Beta-naphtol.) Origin.—A phenol occurring in coal-tar, but usually prepared artificially from naphtalin. Description and Properties.—Colorless or pale buff-colored, shining, crystalline laminae, or a white or yellowish-white crystal- line powder, having a faint, phenol-like odor, and a sharp, pungent, but not persistent taste. Permanent in the air. Soluble in about 1000 parts of water, in 0.75 part of alcohol, in about 75 parts of boiling water, and very soluble in boiling alcohol, ether, chloro- form, and solutions of caustic alkalies. It should be kept in dark amber-colored, well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Allied Compounds. Alumnol.—An almost colorless, non-hygroscopic powder; readily soluble in cold water or glycerin, less soluble in alcohol, and insoluble in ether. It is employed as a local remedy in solutions varying in strength from I to 50 per cent. Used externally. Asaprol.—A colorless, neutral crystalline powder, soluble in \\ parts of water and in 3 parts of alcohol.—Dose, 15-60 grains (1.0-4.0 Gm.). Benzonaphtol.—Obtained by the action of Benzoic Chloride on Beta-naphtol in a ANTISEPTICS. 321 sand-bath. It is an odorless, tasteless, white, crystalline powder, or occurs in the form of long needles. Insoluble in cold water. Dose, 4-8 grains (0.18-0.5 Gm.). Betol (Naphtosaiol—Salinaphtol).—A substance analogous to salol, and pre- pared in the same manner, except that sodium-naphtol is used instead of sodium-phenol. It occurs as a colorless, odorless, tasteless, lustrous crystalline powder. Insoluble in water or glycerin, and with difficulty soluble in cold alcohol. Dose, 2-5 grains (0.12- 0.3 Gm.). Camphorated Naphtol.—Obtained by mixing 1 part of Beta-naphtol with 2 parts of Camphor. It is a brownish, transparent, syrupy liquid. Hydronaphtol.—A derivative of beta-naphtol, obtained by the action of reducing agents. It occurs in scale-like crystals, of a silvery white or grayish hue, of slightly aromatic odor and taste. Soluble in 1100 parts of water, and freely soluble in alcohol, ether, glycerin, benzene, chloroform, and fixed oils. Dose, 2-3 grains (0.12-0.18 Gm.). Antagonists and Incompatibles.—Physiological antagonists of naphtalin are the same as for other members of this group. Naphtol is incompatible with subacetate of lead. Synergists.—Carbolic acid and its derivatives. Physiological Action.—Naphtalin is antiseptic, antifermenta- tive, disinfectant, and deodorant. Its action is quite similar to salol, it being insoluble in the gastric juices, but soluble in the in- testines, where it acts as an antiseptic, deodorizing the stools and often imparting to them its own odor. It is absorbed to some extent, and is eliminated by the lungs and kidneys, but escapes principally in the feces. It is broken up into naphtol or phenol, and acts as a local antiseptic and disinfectant at points of elimina- tion, but does not occasion any local irritation unless quite large doses have been taken : " 15 grains (1.0 Gm.) daily have occasioned frequent micturition, with burning pain, vesical tenesmus, and red- ness of the urethral orifice." Purdy states that in certain cases of genito-urinary disease he has known a dose of 5 grains (0.32 Gm.) to cause severe suffering along the whole urinary tract. It is a stimulant expectorant, and differs from other members of the group in that it possesses no antipyretic action. Naphtol is quickly absorbed when applied locally. It produces considerable irritation when used in solution, but has no irritating effect when applied in the form of ointment. Toxic effects may result from its absorption by the skin, their character resembling the action of carbolic acid. Alfimnol.—An astringent antiseptic. Asaprol.—An antipyretic, analgesic, and antiseptic. It is considered superior to the salicylates in these respects, having the advantage of neither exciting vomiting nor disturbing the brain or the auditory apparatus. Benzonaphtol.—Antiseptic, diuretic, and but slightly poisonous. 21 322 A TEXT-BOOK OF MATERIA MEDICA. Betol.—Action almost identical with that of salol. Hydronaphtol.—A powerful non-irritating, non-corrosive, and non-poisonous anti- septic, said by Dr. Fowler to possess " antiseptic properties fifteen times greater than carbolic acid." 1 Dr. Levis claims that it is thirty times as antiseptic as salicylic acid, and that this property exceeds that of boric acid sixty times, of alcohol six hundred times, and that in this respect it ranks next to mercuric chloride. Therapeutics.—Externally and Locally.—Naphtalin in alcoholic solution is advised by Henri Laserre in the treatment of chronic abscesses and adenitis. It is also recommended in the treatment of scabies and other parasitic skin diseases. Internally.—It is used in typhoid fever and in the gastro-intestinal and genito-urinary disorders for which salol and carbolic acid are administered, such as chronic diarrhea and dysentery, acute or chronic cystitis, etc. The internal uses of naphtol are the same as those of naphtalin, while externally it may be employed, like carbolic acid or creasote, as a general antiseptic in cutaneous disorders, whether organic or parasitic, Altimnol.—An efficient remedy in many acute and chronic inflammatory diseases of the skin, and in gonorrhea, chancres, syphilitic ulcers, balanitis, etc. A I per cent. solution may be injected in gonorrhea, while stronger solutions (10-50 per cent.), or alumnol plaster, are recommended in chronic diseases of the skin. Asaprol.—Given for the same purposes as salicylic acid and the salicylates, although it is not so uniformly successful in acute articular rheumatism, while having the advan- tage of causing less heart-depression. Betol.—Used chiefly in the bowel complaints of children. It may be administered either by the mouth or through the rectum, associated with bismuth or antacids. It has been used also in acute articular rheumatism and bladder affections. Camphorated naphtol is considered by some practitioners to be superior to all other remedies to prevent suppuration in acute tonsillitis. Fernet has employed it successfully in tubercular ulcerations of the tongue, while Reboul of Marseilles and others have adopted it with good effect hypodermically in tuberculous adenitis and tuberculosis of the testis. It has also been used in tuberculosis of the bladder, joints, etc. Ruault claims it to be an efficient local application to the turbinated bones in ozena. Hydronaphtol.—Considered by many physicians to be superior to carbolic acid, since it is without disagreeable odor and can be used without exciting irritation or danger of toxic impression. Dockrell employs it in the form of a plaster for destroying the trichophyton fungus of tinea tonsurans, and believes it to be superior to mercuric chloride as a germicide. It has been used as a preventive of dental caries, and in the treatment of gingivitis, pyorrhoea alveolaris, diphtheria, etc. Internally it has been recommended in dysentery, diarrhea, pulmonary tuberculosis, and typhoid fever. 1 New York Med. Journ., Oct. 3, 1885. ANTISEPTICS. 323 Contraindications.—These preparations should not be given internally when the functional activity of the kidneys is defective. Administration.—Naphtalin is best given internally in the form of pills or in capsules. When it is necessary to use it topi- cally, the offensive odor of the drug may be disguised, it is said, by triturating it with a small quantity of the oil of bergamot. Naphtol should be given in capsules, in the dose recommended, three times a day or oftener if necessary. Asaprol, betol, and hydronaphtol are best given in capsules, although betol, which is tasteless and insoluble in water, may be administered in the form of powders. Resorclnum—Resorclni—Resorcin. XT. 8. P. Origin.—Prepared by melting Galbanum, Ammoniac, or Guai- acum Resin with Potassa. It is also prepared in a similar manner from Asafetida, Sagapenum, Ascaroid Resin, and from Phenol- sulphonic Acid and other derivatives of Phenol. Description and Properties.—Colorless or faintly reddish, needle- shaped crystals, or rhombic plates, having a faint, peculiar odor, and a disagreeable sweetish and afterward pungent taste. Resorcin acquires a reddish or brownish tint by exposure to light and air, and should be kept in dark amber-colored vials. It is soluble in 0.6 part of water, 0.5 part of alcohol, very soluble in boiling water and in boiling alcohol, readily soluble in ether and in glycerin, and very slightly soluble in chloroform. The aqueous solution is neutral or only faintly acid to litmus-paper. Dose.—3-8 grains (0.2-0.5 Gm.). Allied and Derivative Compounds. Hydroquinol—Hydroquinone—Hydrochinone—Paradioxybenzene.—Color- less, odorless, dimorphous crystals, having a sweetish taste. Soluble in 17 parts of water, and very soluble in hot water, alcohol, and ether. Dose, i\-$ grains (0.03-0.30 Gm.). Catechol—Pyrocatechin—Orthodioxybenzene.—Acicular crystals, readily solu- ble in water, alcohol, and ether. Other allied compounds are—Thioresorcin, Resopyrine, and Fluorescein. Antagonists.—Cerebral excitants, cardiac and respiratory stim- ulants. Synergists.—Salicylic acid, quinine, carbolic acid. Physiological Action.—Externally and Locally.—Resorcin is an antiferment, antiseptic, deodorant, a feeble analgesic, and a parasiti- cide. Applied to the unbroken skin, it is non-irritating, is not ab- 324 A TEXT-BOOK OF MATERIA MEDICA. sorbed by it, and when injected into the subcutaneous tissues produces but little irritation, with no suppuration. Applied to the moistened mucous membrane, its action is similar to that of car- bolic acid, producing vesication, etc. Internally.—The physiological properties of resorcin are allied to those of carbolic acid. It possesses more marked antipyretic and diaphoretic actions than carbolic acid, but when used to pro- duce these effects it greatly depresses the heart. Its chief action is on the nervous system, which it first power- fully stimulates and then depresses. It is mainly and rapidly eliminated by the urine, which it colors an olive-green or bluish-violet hue. Poisoning.—Poisonous doses produce vertigo, ringing in the ears, deafness, disturbance of vision, weak, rapid, and irregular pulse, respiration at first convulsive and jerking, afterward accelerated, shallow, and weak, death resulting finally from respiratory failure. There are great mental anxiety, epileptiform convulsions, collapse, and unconsciousness. Just before death there is a rise in temper- ature, doubtless due to excessive muscular action, although the temperature may fall below normal if there is quiet narcosis, as there may be in some instances. Treatment of Poisoning.—Hypodermic injections of atropine. The administration of diffusible stimulants. Artificial respiration. Therapeutics.—Externally and Locally.—Resorcin is especially useful in certain subacute or chronic skin affections, and may be used like salicylic acid in indurated eczema. It is of great value in psoriasis, seborrhcea sicca, pityriasis capitis, sycosis, acne rosacea, etc. A 5 to i o per cent, solution is an efficient application in pharyn- gitis, diphtheria, and ulcerative laryngitis. An ointment of resorcin is an excellent application to foul ulcers, sloughing ivounds, and syphilitic ulcers. Condylomata have been cured by dusting upon them powdered resorcin. A mixture of powdered resorcin and boric acid (i : 20 or 1:10) has been used with brilliant results in suppuration of the middle ear. A 2 per cent, solution has been found useful in the form of a spray in whooping cough, while stronger solutions of 10 or 20 per cent, have been used with some success in hay fever. Solutions of resorcin have been used in gonorrhea and cystitis. Internally.—Resorcin is preferable to carbolic acid for internal administration, especially in digestive disorders such as gastralgia, ANTISEPTICS. 325 chronic gastritis, ulcer of the stomach, and fermentative dyspepsia, so called. Owing to its sedative and antifermentative properties, it is of value in acute diarrhea of children. It has been used with some success in intermittent fever, but not with good results sufficiently uniform to justify the exclusion of quinine. As an antipyretic it may be used when a drug of that character is indicated, but it is not equal to antipyrine or acetanilid and in doses sufficient to produce the desired reduction of temper- ature it is too depressant to the heart. Its chief therapeutic value is for external or local use, and internally for the digestive disorders above mentioned. Administration.—It should be given in pills or capsules. Ichthyolum—Ichthyoli—Ichthyol. (Unofficial.) Origin.—It is obtained by the destructive distillation of bitumin- ous rock found near Seefeld in the Tyrolese Alps, which contains enormous quantities of semi-fossilized fishes and marine animals. Description and Properties.—It occurs in the form of a brown- ish-yellow, transparent, oily liquid, containing about 10 per cent, of sulphur. Upon being treated with concentrated sulphuric acid ichthyol is converted into ichthyol-sulphonic acid, which readily combines with ammonia and other alkalies, as well as with lithium, zinc, mercury, etc., forming the ammonium ichthyol, sodium ichthyol, zinc ichthyol, etc. Ammonium ichthyol occurs as a clear reddish-brown, syrupy liquid with a bituminous odor and taste. Soluble in water and in a mixture of equal volumes of ether and alcohol. Dose.—2-10 minims (0.12-0.6 Cc). The other salts of ichthyol-sulphonic acid occur as brownish or black tar-like masses, the sodium salt being the most important, as it is the one most employed when ichthyol is desirable in pill form. Dose.—Sodium ichthyol, 2-4 grains (0.1-0.25 Gm.). Allied Drugs. Thlolum—Thioli—Thiol.— Origin.—This substance is prepared by heating brown-colored paraffin or gas oils with Sulphur, and extracting the sulphurated, unsatu- rated hydrocarbons with Alcohol. Description and Properties.—It occurs as a neutral, solid body, non-hygroscopic and soluble in water, and of a dark-brown color, or in the form of a dark reddish- brown, syrupy liquid, containing about 40 per cent, of thiol. 326 A TEXT-BOOK OF MATERIA MEDICA. Dose.—\-\ grain (0.03-0.06 Gm.). Tumenolum—Tumenoli—Tumenol.— Origin.—It is obtained from purified mineral oils by the direct action of concentrated sulphuric acid, without previous sul- phuration, being a mixture of sulphones and sulphonic acids. Description and Properties.—A dark-brown or blackish-brown liquid of a syrupy consistency. Dose.—It is used only externally, in strengths of from 5 to 10 per cent. Antagonists and Incompatibles.—Ichthyol possesses marked reducing properties, and should not therefore be combined with substances, like potassium permanganate, which part readily with oxygen. Synergists.—Most members of this group, particularly the tars, carbolic acid, creasote, etc., aid its action. Physiological Action.—Externally and Locally.—Ichthyol is ischemic, sedative, parasiticide, and possesses antiseptic and prob- ably disinfectant properties. When applied to the skin in full strength it produces some irri- tation. It is readily absorbed, having the power to penetrate the skin, affecting the deeper tissues beneath. Internally.—Digestive System.—Very large doses produce con- siderable gastro-intestinal irritation. Circulatory System.—It has the power in medicinal doses of contracting the caliber of the arteries, and in large doses it increases the migration of the white blood-corpuscles. The physiological action has not been fully studied, and it is not yet positively known what action it has upon the nervous and respiratory systems and upon temperature. Therapeutics.—Externally and Locally.—Ichthyol was intro- duced by Unna as a valuable remedy in certain diseases of the skin. It is particularly useful in erythematous eczema, erysipelas, lupus erythematosus, irritable acne, and certain forms of acne rosacea. Agnew has employed it with advantage in lymphatic enlarge- ments. It has also been found useful in synovial inflammations, in- flammatory conditions of the female genital organs, and in certain diseases of the ear and nose. Thiol, although inferior, is similar to ichthyol in its therapeutic action. It has been found to be valuable in the treatment of herpes zoster, dermatitis herpetiformis, and erythema multiforme. Administration.—Ichthyol, when given internally, should be dispensed in capsules, while thiol may be given in capsules, pills, or wine. Externally, ichthyol may be employed in solution, dissolved in ANTISEPTICS. 327 chloroform or in a mixture of alcohol and ether, and applied with a brush; or in the form of an ointment mixed with soft petrolatum or lanolin in from 1-4 to 8 drachms (4.0-15.0 Cc. to 32.0 Gm.). It is used also in the form of a soap in from 5 to 20 per cent, strength. Thiol is used locally in powder form, or as an ointment of 5 to 10 per cent, of the liquid, or in collodion containing 5 per cent, of the powder, or in solutions of glycerin and aqueous solutions con- taining from 5 to 50 per cent, of the powder. Iodoform um—Iodoform i—Iodoform. XT. 8. P. Origin.—It is obtained by the action of Iodine, in the presence of fixed alkalies or alkali carbonates, upon Alcohol or Acetic and other easily-saponifiable Ethers. Description and Properties.—Small, lemon-yellow, lustrous crystals, of the hexagonal system, having a peculiar, very pene- trating, and persistent odor, somewhat resembling that of saffron and iodine, and an unpleasant, slightly sweetish, and iodine-like taste. It is very slightly soluble in water, to which, however, it imparts its odor and taste; soluble in about 52 parts of alcohol, in about 12 parts of boiling alcohol, or in 5.2 parts of ether, and very soluble in chloroform, benzin, and fixed and volatile oils. Iodoform is slightly volatile, even at ordinary temperatures, and in boiling water distils slowly over with its vapor. It should be kept in well-stoppered bottles, in a cool and dark place. Iodoform contains 96.69 per cent, of its weight as iodine. Dose.—1-3 grains (0.06-0.2 Gm.). Official Preparation. UnguSntum Iodoformi—Ungu8nti IodofSrmi—Ointment of Iodoform.—10 per cent. Used externally, Allied Compounds. Antiseptol—Cinchonine Iodosulphate.— Origin.—It is prepared by mixing an aqueous solution of Cinchonine Sulphate with an aqueous solution of Iodine and Potas- sium Iodide, and washing and drying the resulting precipitate. Description and Properties.—It occurs as a light reddish-brown powder, insoluble in water, but soluble in alcohol and chloroform. It contains about 50 per cent, of iodine. Dose.—1-3 grains (0.06-0.2 Gm.). Arlstol—Dithymol Di-iodide.— Origin.—It is obtained by adding a solution of iodated Iodide of Potassium to an aqueous solution of Hydrate of Sodium containing thymol. The resulting precipitate is washed and subsequently dried at ordinary tem- perature. Description and Properties.—A dark, brownish-red, amorphous, almost tasteless powder, of a slight, peculiar, iodine-like odor, insoluble in water and glycerin, sparingly 328 A TEXT-BOOK OF MA TERIA MEDICA. soluble in alcohol, but readily soluble in ether, collodion, and chloroform. It is also taken up by fixed oils, petrolatum, etc. Aristol is decomposed by heat and light, and it should be kept in dark amber- colored, well-stoppered bottles. It contains 45.8 per cent, of iodine. Dose.—It is not given internally. Europhen.—Prepared in a manner analogous to that of preparing aristol, except that isobutylorthocresol is used in place of thymol. Description and Properties.—An amorphous, yellow powder, having an odor resem- bling saffron; soluble in ether, chloroform, and fixed oils; insoluble in water and glycerin. It is permanent in dry air, but when moistened with water resolves into iodine, form- ing a new soluble iodine compound. When heated to no0 C. (2300 F.) it melts, forming a clear brown liquid. It contains 27.6 per cent, of iodine. Dose.—\-i\ grains (0.016-0.09 Gm.). It is used hypodermically in olive oil, and externally in the form of an ointment, in strengths varying from 3 to 10 per cent. Antagonists and Incompatibles.—It is incompatible with the preparations of mercury and zinc, with metallic oxides, and with starch. Iodol.— Origin. — Obtained by the interaction of Iodine and Pyrrol (a constituent of mineral oil) in Alcoholic Solution for twenty-four hours, the iodol being precipitated upon the addition of Water; or it may be prepared after the manner of preparing aristol, except that Pyrrol is used instead of Thymol. Description and Properties.—It is a pale-yellow or grayish-brown, more or less crystalline, bulky, tasteless, and odorless powder. It is insoluble in water, and but slightly soluble in diluted alcohol. It is soluble in alcohol and ether. The alcoholic solution is miscible with glycerin, but when mixed with water a milky precipitate is formed. Iodol contains 88.97 per cent, of iodine. Dose.—1^-2 grains (0.03-0.12 Gm.). Losophene.— Origin.—Prepared by slowly adding an aqueous solution of Iodine and Iodide of Potassium to an aqueous solution of Ortho-oxyparatoluic Acid and Sodium Bicar- bonate. The precipitate formed is washed with Water and recrystallized from Alcohol. Description and Properties.—It occurs as colorless, odorless, needle-shaped crystals. Insoluble in water and alcohol, but readily soluble in ether, benzene, chloroform, and fixed oils. It contains 78.39 per cent, of iodine. Dose.—It is used externally. Sozoiodol.—Origin.—A combination of Iodine 54 per cent., Carbolic Acid 20 per cent., and Sulphur 7 per cent. Description and Properties.—The sodium, potassium, ammonium, mercury, lead, and zinc salts of this acid are the preparations used, the sodium salt being the one most commonly employed. The sodium sozoiodolate occurs in bright, prismatic, needle-shaped crystals. Soluble in water, alcohol, and glycerin. Dose.—For external use, in strengths varying from 3 to 20 per cent. Sulphaminol.— Origin.—It is formed by the action of Sulphur on the salts of Meta- oxydiphenylamine. Description and Properties.—It is a yellow powder, insoluble in water, readily solu- ble in alkalies, alcohol, and glacial acetic acid. Dose.—1-4 grains (0.006-0.25 Gm.). Antagonists and Incompatibles.—Iodoform is incompatible with mercuric chloride. ANTISEPTICS. 329 Physiological Action.—Externally and Locally.—Iodoform or- dinarily possesses no irritating action when applied to the skin or mucous membranes, or to ulcers and wounds. On the contrary, it possesses analgesic properties. It has a tendency to check serous oozing when applied to wounds. Internally.—Digestive System.—Small doses, if they have any effect, slightly increase the appetite, and tend to increase the sali- vary, biliary, and intestinal secretions. Large doses disturb the stomach, and may occasion nausea, vomiting, and diarrhea. Circulatory System.—Small doses retard and strengthen the pulse, and, for a brief period only, increase arterial tension. Full medicinal doses lessen arterial tension and render the pulse slower and weaker. Lethal doses rapidly accelerate the pulse, causing it to become irregular; later, the action of the heart is slowed, and finally arrested in diastole, from paralysis of the cardiac muscle. Nervous System.—Large doses are apt to produce headache, restlessness, delirium, or stupor. The reflexes may be depressed, or in some cases choreic movements may appear. Muscular con- tractility and the excitability of the nerve-trunks to external stimu- lation are lessened. Respiratory System.—Very large doses produce convulsive res- piratory movements. Absorption and Elimination.—Iodoform is absorbed from the stom- ach, or from mucous membranes or wounds to which it is applied. It is slowly absorbed from the alimentary canal, but readily absorbed from wounds. It is eliminated in all the secretions, and has been detected in the urine and saliva within one hour after its administra- tion, traces of it being perceptible in the secretions for three days. Iodine is liberated at the points of elimination, either as an iodate or as some organic compound of iodine, or both. The drug is also detected in the breath, though it is chiefly eliminated in the urine as alkaline sodium iodate, coloring the urine yellow. It should be remembered that iodoform is absorbed much more rapidly than it is eliminated. Temperature.—Large doses cause a rise of temperature, while poisonous doses may, at the last, produce a decided reduction of animal heat. Untoward Action.—Sometimes iodoform excites an eczematous eruption, which may be papular or erythematous, and symptoms of vertigo. Muscular weakness and double vision have also been observed; sleepiness, alternating with excitement; incoherence of speech; headache; mental confusion; and amblyopia. 330 A TEXT-BOOK OF MATERIA MEDICA. Poisoning.—Three forms of poisoning by iodoform are described by Duret—the eruptive, the cerebral, and the syncopal. In the first of these there may be a severe and extensive ery- thema or eczematous eruption. The cerebral variety is character- ized by rapid increase of temperature and accelerated pulse—as high as 150 or 175 per minute; great irritation of the gastro-intes- tinal tract; widely dilated, or motionless and contracted, pupils; intense headache over the entire circumference of the head; mel- ancholia ; great depression of spirits; hallucinations and active delirium or suicidal mania. In the syncopal variety the patient complains of dizziness and mental confusion ; is languid and weak ; the heart's action becomes very rapid and feeble, the patient passing at length into a lethargic or comatose condition, with paralysis of the sphincters, and finally dying, perhaps quite suddenly. The symptoms of poisoning may appear soon after the applica- tion of the drug, or they may be deferred for days and even weeks. In the latter case, which may properly be termed chronic poison- ing, the patient is more apt to be melancholy, weak, and apathetic, with slight fever and accelerated pulse. Old people are the more susceptible to its toxic influence. Treatment of Poisoning.—Every particle of the drug should be immediately removed from the body or its internal administration be discontinued at once. Stimulants, diaphoretics, and diuretics should be given, with frequent bathing of the body in warm water, to hasten elimination. Opium and large doses of potassium bicar- bonate have been recommended. Therapeutics.—Externally and Locally.—Iodoform acts as an alterative, analgesic, protectant, antiseptic, and germicide to at least some forms of bacilli. It is therefore one of the best applications to wounds, ulcers, etc. It is especially valuable in the treatment of tubercular affections, such as tubercular joints, when it is used in the form of an injection—10 to 20 per cent.—in sterilized olive oil. In tubercular parenchymatous synovitis the mixture is injected di- rectly into the joint-cavity. Rinonapoli recommends a 10 per cent, ethereal solution in malignant pustule, injected hypodermically into the base of the tumor; while Terrier and Mosetig von Moorhof have both used it successfully in parenchymatous goiter. Iodoform is an exceedingly valuable application to syphilitic ulcers, chancres, chancroids, suppurating buboes, ulcerations of the uterus, uterine cancer, and indolent and irritable ulcerations of the leg. ANTISEPTICS. 331 Incorporated in a suppository, it is very efficacious in painful hemorrhoids, fistula, and fissure of the anus. It is a valuable application in many diseases of the ear, nose, throat, eye, and skin where a drug of this character is indicated. Internally.—Iodoform is used but very little internally, although it has been employed in phthisis, hemoptysis, syphilis, catarrhal jaundice, hepatic cirrhosis, gastric catarrh, diabetes, and as an intes- tinal antiseptic. The allied compounds mentioned above are used locally as sub- stitutes for iodoform. Most of them possess the great advantage of being odorless, and some of them seem to be in all respects quite as efficient as iodoform. Aristol is undoubtedly superior to it in the treatment of indolent ulcers and in many diseases of the skin, ear, nose, and throat. Europhen and iodol should certainly replace iodoform in many cases. Administration.—Internally, iodoform should be given in pills or capsules. Externally, it may be used in the form of a powder, alone or mixed with powdered borax or boric acid. It is also used in the form of an ointment or collodion. It is given hypodermi- cally, mixed with olive oil and glycerin, or dissolved in ether, in strengths varying from 10 to 30 per cent. Its disagreeable odor may be modified or disguised by mixing it with tar, liquid styrax, balsam of Peru, thymol, coumarin, menthol, ground coffee, oil of lavender, bergamot, bitter almond, coriander, musk, vanilla, or some similar aromatic and pleasantly odorous substance. Benzolnum—Benzoini—Benzoin. XT. 8. P. Origin.—A balsamic resin obtained from Styrax Benzoin Dry- ander, a large tree indigenous in Sumatra and Java, and probably also in Cochin China and Siam. Description and Properties.—Benzoin exudes from incisions in the bark, and upon exposure to the air hardens into lumps con- sisting of agglutinated, yellowish-brown tears, which are internally milk-white, or in the form of a reddish-brown mass, more or less mottled from whitish tears imbedded in it. It is almost wholly soluble in 5 parts of moderately warm alcohol and in solutions of the fixed alkalies. When heated it gives off fumes of benzoic acid. It has an agreeable balsamic odor and a slight aromatic taste. Benzoin is of the nature of a balsam, containing from 20 to 24 per cent, of benzoic acid, resin, and volatile oil. Some varieties 332 A TEXT-BOOK OF MA TERIA MEDICA. contain cinnamic acid, which is undesirable, while the benzoin from Siam contains vanillin and possesses the odor of vanilla. Dose.—Benzoin is never administered in substance. Official Preparations. Adeps Benzoinatus—Adipis Benzoinati—Benzoinated Lard (2 percent.).— For external use. Tinctura Benzoini—Tinctiirae Benzoini—Tincture of Benzoin.—Dose, 30 minims to I fluidrachm (2.0-4.0 Cc). Tinctura Benzoini Compftsita—Tinctiirae Benzoini Comp8sitae—Com- pound Tincture of Benzoin.—Benzoin, 2; Aloes, 2; Storax, 8; Tolu, 4; Alcohol, 74 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). Antagonists and Incompatibles.—The tincture and compound tincture are incompatible with aqueous preparations, the benzoins and other resins and balsams being precipitated from their alcoholic solutions by water. Physiological Action.—The action of benzoin is due to the benzoic acid which it contains, and will therefore be considered under Benzoic Acid. Acidum Benzoicum—Acidi Benzoici—Benzoic Acid. XT. 8. P. Origin.—An organic acid usually obtained from Benzoin by sublimation, or prepared artificially, chiefly from Toluol. Description and Properties.—White or yellowish-white lus- trous scales or friable scales, having a slight characteristic odor resembling that of benzoin, and of a warm, acid taste; somewhat volatile at a moderately warm temperature, and rendered darker by exposure to light. Soluble when pure in about 500 parts of water, in 2 parts of alcohol at about 150 C. (590 F.), in 15 parts of boiling water, and in 1 part of boiling alcohol. It is also soluble in 3 parts of ether, 7 parts of chloroform, and readily soluble in carbon disulphide, in benzol, and in fixed and volatile oils. Sparingly soluble in benzin. t Benzoic acid has an acid reaction and is inflammable. It should be kept in dark amber-colored, well-stoppered bottles and in a cool place. Dose.—5-15 grains (0.3-1.0 Gm.). Ammonii Benzoas—Ammonii Benzoatis—Ammo- nium Benzoate. XT. 8. P. Origin.—Dissolve Benzoic Acid in Water of Ammonia and Dis- tilled Water, evaporate, and crystallize. ANTISEPTICS. 333 Description and Properties.—Thin, white, four-sided laminar crystals; odorless, or having a slight odor of benzoic acid; a sa- line, bitter, afterward slightly acrid taste, and gradually losing am- monia on exposure to air. Soluble, at 150 C. (590 F.), in 5 parts of water, in 28 parts of alcohol, in 1.2 parts of boiling water, and in 7.6 parts of boiling alcohol. The salt is neutral or has a very slight reaction upon litmus-paper. It should be kept in well- stoppered bottles. Dose.—10-20 grains (0.6-1.2 Gm.). Lithii Benzoas— Lithii Benzoatis—Lithium Benzoate. XT. 8. P. Origin.—Prepared by decomposing Lithium Carbonate with Benzoic Acid. Description and Properties.—A light white powder, or small, shining, crystalline scales; odorless or of a faint, benzoin-like odor, and of a cooling, sweetish taste ; permanent in the air. Soluble in 4 parts of water, in 12 parts of alcohol, in 2.5 parts of boiling water, and in 10 parts of boiling alcohol. The presence of sodium ben- zoate increases the solubility in water and lessens it in alcohol. The aqueous solution (1 in 20) of lithium benzoate has a faintly acid reaction upon litmus. Dose.—5-20 grains (0.3-1.2 Gm.). Sodii Benzoas—Sodii Benzoatis—Sodium Benzoate. IT. 8. P. Origin.—Prepared by decomposing Sodium Carbonate with Benzoic Acid. Description and Properties.—A white amorphous powder, odorless or having a faint odor of benzoin and a sweetish, astrin- gent taste. Soluble in 1.8 parts of water, in 45 parts of alcohol, in 1.3 parts of boiling water, and in 20 parts of boiling alcohol. The aqueous solution is neutral to litmus-paper. It is efflorescent, and should be kept in well-stoppered bottles. Dose.—5-30 grains (0.3-2.0 Gm.). Allied and Unofficial Preparations. Bismuthi BSnzoas—Bismuthi Benzoatis—Benzoate of Bismuth. M6nthol Benzoas—Mfinthol Benzoatis—Benzoate of Menthol.—For exter- nal use. Antagonists and Incompatibles.—Benzoic acid is incompatible A TEXT-BOOK OF MATERIA MEDICA. with the alkaline salts, as those of sodium, etc., and ammonium benzoate is incompatible with the ferric salts. Physiological Action.—Externally.—When applied in a con- centrated form to the skin or mucous membrane benzoic acid is an irritant, and produces a catarrhal condition of the bronchial mucous membrane when its vapors are inhaled. It is a powerful antiseptic and germicide, preventing the growth of putrefactive bacteria in a solution of I : iooo. Internally.—Digestive System.—In full medicinal doses benzoic acid irritates the throat and produces a sense of heat in the epi- gastrium. Very large doses may occasion gastric inflammation, with nausea and vomiting. The functional activity of the liver is stimulated by sodium benzoate. Circulatory System.—In large doses benzoic acid increases the pulse-rate to a marked extent, and is a stimulant to the entire circulatory apparatus. Respiratory System.—It is a powerful stimulant in moderate medicinal doses, increasing the respiratory movements and promot- ing the bronchial secretion. Absorption and Elimination.—It is eliminated chiefly by the kidneys, but also by the skin, salivary glands, and broncho-pul- monary mucous membrane. The important action of benzoic acid is the change it undergoes in the kidneys, being converted into hippuric acid, in combination with glycocoll, at the expense of the urea. This change takes place only in the kidneys, and the hippuric acid formed renders alkaline urine acid, besides increasing the urinary flow and disin- fecting and stimulating the genito-urinary tract. Temperature.—Like other members of this group, the acid, as well as its salts, possesses antipyretic properties, many observers holding it to be equal, if not superior, to salicylic acid in this respect. It is not yet known in what manner it reduces temper- ature. Untoward Action.—Benzoic acid sometimes produces urticaria or an erythematous condition of the skin. Therapeutics.—Externally and Locally.—The compound tinc- ture of benzoin is an admirable preparation for many conditions requiring antiseptic, astringent, and stimulating dressing. It is fre- quently applied to cutaneous wounds, the alcohol evaporating and leaving upon the injured parts a protective film of balsams. A piece of lint or absorbent cotton saturated with the compound ANTISEPTICS. 335 tincture has been used to close the punctures in the skin after tenotomy. Stille recommends a combination of the compound tincture of benzoin and glycerin for the treatment of chapped hands and lips, frost-bite, and fissured and chapped nipples. R. W. Taylor treats " ringzvorm of the thighs " by painting the affected part with a mixture of bichloride of mercury and com- pound tincture of benzoin, 2-5 grains to 1 ounce (0.12-03 to 30.0 Cc). The compound tincture, diluted with water in various propor- tions, makes an efficient application in catarrhal affections of the pharynx and larynx, either in the beginning of an inflammation or during the relaxed condition which so often accompanies the ter- mination of an acute attack. The hoarseness of vocalists and public speakers, the result of excessive strain upon the vocal cords, is frequently relieved by this remedy. Inhalations of benzoin are a popular and frequently effective method of treating acute catarrhal inflammation of the upper respiratory passages. The cough and expectoration of chronic bronchitis and chronic phthisis are eased and lessened by inhaling night and morning a drachm (4 Gm.) of benzoic acid, added to boiling water. A preparation like the following is an efficient and agreeable lotion for irritative forms of chronic nasal catarrh : R. Sodii boratis, da. ^ij (60.0 Gm.); Acidi benzoici, gr. x (0.6 Gm.).—M. Fiat pulvis No. I. Sig. To half a tumblerful of water add hall a teaspoonful each of the powder and glycerin. Use freely as a lotion. The simple tincture of benzoin is an excellent application to spongy gums. There is much evidence of the efficiency of bismuth benzoate as a dressing for chronic or sloughing ulcers. Specific sores, chancroids and chancres especially, are well treated by dust- ing the parts with the benzoate after thoroughly bathing the surface with a weak solution of bichloride of mercury. Probably the most important therapeutic action of benzoic acid . is shown in the treatment of cystitis and pyelitis accompanied by decomposing and alkaline urine. The uric-acid diathesis is modified by this drug and its prepara- tions, particularly by the lithium benzoate. Phosphatic calculi 336 A TEXT-BOOK OF MA TERIA MEDICA. may be dissolved by the prolonged administration of ammonium benzoate, which is preferable to benzoic acid for this purpose. In- continence of urine, if due simply to the alkalinity of the urine, is relieved by the same remedy. Liegeois has employed sodium benzoate as a cholagogue with excellent results. He associates it with rhubarb. He also states that benzoate of sodium favorably modifies the pain of pharyngitis. Sodium benzoate is an excellent substitute for sodium salicylate, being especially useful in the septic diseases. It is equally power- ful as an antiseptic and antipyretic, though slower in its action than sodium salicylate. Its effects, however, are more permanent, and innocuous. Administration.—Benzoic acid is best administered in pill form or in capsules, with balsam of fir or Castile soap as an excipient. The soluble benzoates may be given in solution in some aromatic water or in compressed pills. The solution, however, is preferable, and the unpleasant taste may be well disguised by a little spirit of chloroform. When any of these preparations are given for their action upon the urinary tract, it may sometimes be advantageous to combine them with a urinary sedative, such as tincture of bella- donna or hyoscyamus. M^rrha—Myrrhae—Myrrh. XT. 8. P. Origin.—A gum-resin obtained from Commiphora Myrrha (Nees) Engler, a shrub or small tree " forming the chief underwood of the Arabian and African forests along the shores of the Red Sea." Description and Properties.—Roundish, irregular tears or masses, dusty brownish-yellow or reddish-brown; fracture waxy, somewhat splintery, translucent on the edges, sometimes marked with whitish veins ; odor balsamic; taste aromatic, bitter, and acrid. It contains 60 per cent, of gum, 35 per cent, of resin, and 3 or 4 per cent, of a volatile oil (myrrvhol). Dose.—5-30 grains (0.3-2.0 Gm.), in pills or emulsion. Official Preparations. Mistura FSrri CompSsita—Misturae Fern Compbsitae—Compound Iron Mixture.—Dose, \-z fluidounces (15-60 Cc). Pilulae Aloes et Myrrhae—Pilulas (ace.) Aloes et Myrrhae—Pills of Aloes and Myrrh.—Dose, 2 to 5 pills, Tinctura Aloes et Myrrhae—Tinctiirae Aloes et Myrrhae—Tincture of Aloes and Myrrh (10 per cent.).—Dose, \-2 fluidrachms (2-8 Cc). ANTISEPTICS. 337 Tinctura Myrrhae—Tinctiirae Myrrhae—Tincture of Myrrh (20 per cent.).— Dose, 15-60 minims (1-4 Cc). Physiological Action.—Myrrh is astringent, disinfectant, slightly antiseptic, and stimulant. Its action resembles that of the aro- matics, stimulating the appetite and acting as a carminative, exces- sive doses causing nausea and vomiting. It increases the number of white blood-corpuscles, and is a stimulant to the circulation. The drug is eliminated by the mucous membranes generally, aug- menting and disinfecting their secretions. It possesses emmena- gogue properties. Therapeutics.—As a stimulant and astringent myrrh is service- able as a mouth-wash in ptyalism and spongy gums and in ozena. It is useful as a gargle in pharyngitis, relaxed throat, etc., and as an injection in leucorrhea, the latter disease, as well as cystitis, being favorably influenced by the internal administration of the drug. It has been used internally, with considerable success, as a stimulant expectorant in bronchorrhea and chronic bronchitis, and as a stom- achic in atonic dyspepsia. Administration.—Myrrh may be given internally in the form of an emulsion or pills. The tincture, either in full strength or diluted, is chiefly employed externally. Balsamum Peruvianum—Balsami Peruviani—Bal- sam of Peru. XT. 8. P. Origin.—A balsam obtained from Toluifera Pareirce (Royle) Baillon, a tree growing in Brazil and near the west coast of South America. Description and Properties.—A liquid having a syrupy con- sistence, free from stringency or stickiness, of a brownish-black color in bulk, reddish-brown and transparent in thin layers, of an agreeable, vanilla-like, somewhat smoky odor, and a bitter taste, leaving a persistent after-taste. On exposure to air it does not become hard. It is completely soluble in 5 parts of alcohol. The drug contains, among other substances, benzoic and cin- namic acids, cinnamein about 60 per cent, and resin 32 per cent. Dose.—8-30 minims (0.5-1.84 Cc). Physiological Action.—Its properties are similar to those of myrrh, its action being almost analogous. Therapeutics.—In various cutaneous disorders balsam of Peru is very efficient, being employed in pruritus vulva?, eczema, scabies, ringworm, etc. It is remarkably efficacious as an application to 22 338 A TEXT-BOOK OF MA TERIA MEDICA. cracked nipples, cracked lips, indolent sores, bed-sores, etc., and is also serviceable in certain diseased conditions of the nose and throat, such as atrophic rhinitis and tonsillar diphtheria. As a stimulant expectorant the drug is efficient in chronic bron- chitis, being regarded by some physicians as of great service in phthisis pulmonalis. Like myrrh, balsam of Peru has been used to some extent as a stomachic carminative and tonic. Administration.—It is best given in an emulsion or in glycerin. Eucalyptus—Eucalypti—Eucalyptus. XT. 8. P. Origin.—The leaves of Eucalyptus globulus Labillardiere, col- lected from the older part of the tree. The blue-gum tree is a rapid grower, attaining a height of 200 to 300 feet (60-90 M.). It is native to Australia, but is cultivated in various portions of Europe, Africa, and the United States with the view of rendering malarial districts habitable by its antiseptic exhalations. Description and Properties.—Petiolate, lanceolate, scythe- shaped, from 6 to 12 inches (15-30 Cm.) long, rounded below, tapering above, entire, leathery, grayish-green, glandular, feather- veined between the midrib and marginal veins; odor strongly cam- phoraceous ; taste pungently aromatic and somewhat cooling, bitter, and astringent. The most important constituent is a volatile oil, of which the leaves yield about 6 per cent. Dose.—\-2 drachms (2.0-8.0 Gm.). Official Preparation. Extractum Eucalypti Fluidum—Extracti Eucalypti Fluidi—Fluid Extract of Eucalyptus.—Dose, 5-60 minims (0.3-4.0 Cc). Oleum Eucalypti—Olei Eucalypti—Oil of Eucalyp- tus. XT. 8. P. Origin.—A volatile oil distilled from the fresh leaves of Euca- lyptus globulus Labillardiere, E. oleosa F. v. Mviller, and some other species of the genus. Description and Properties.—A colorless or faintly yellowish liquid, having a characteristic, aromatic, somewhat camphoraceous odor, and a pungent, spicy, and cooling taste. Soluble in all proportions in alcohol. This oil consists of two hydrocarbons (cymene and eucalyptene), terpene, and a substance upon which its medicinal value depends—eucalyptol. Oil of eucalyptus should be ANTISEPTICS. 339 kept in well-stoppered bottles, in a cool place, protected from light. Dose.—5-15 minims (0.3-1.0 Cc). Eucalyptol—Eucalyptol—Eucalyptol. IT. 8. P. Origin.—A neutral body obtained from the volatile oil of Eucalyptus globulus. Description and Properties.—A colorless liquid, having a cha- racteristic, aromatic, and distinctly camphoraceous odor, and a pun- gent, spicy, and cooling taste. Soluble in all proportions in alcohol. Dose.—5-10 minims (0.3-0.6 Cc). Unofficial Preparations. Aqua Eucalypti—Aquae Eucalypti—Eucalyptus Water.—Dose, 2-4 fluid- drachms (7.39-15.0 Cc). Tinctura Eucalypti—Tinctiirae Eucalypti—Tincture of Eucalyptus.—Dose, 1-4 fluidrachms (3.7-15.0 Cc). Antagonists and Incompatibles.—Agents promoting waste an- tagonize the therapeutic action of eucalyptus. The chemical incom- patibles are the mineral acids, mineral salts, and alkalies. Synergists.—The vegetable bitters, aromatics, antispasmodics, turpentine, cubebs, and copaiba. Physiological Action.—Externally and Locally.—Locally ap- plied, the oil of eucalyptus and eucalyptol are more or less irritant, though perhaps less active than many volatile oils. In contact with mucous membranes or injected hypodermically, they cause pain, and, when swallowed, produce a burning sensation in the throat, stomach, and intestines. If the vapor of eucalyptus be confined by preventing evapora- tion, vesication and pustulation result, the drug also acting as a rubefacient. Inhalation affects the bronchial mucous membrane unfavorably, the beneficial effects of the remedy residing in its properties as a powerful antiseptic and disinfectant. It is also slightly detergent and astringent. Internally.—Digestive System.—Small doses, by stimulating the salivary and peptic glands, improve the appetite and digestion, while peristalsis is increased, the drug acting as a mild laxative. The ingestion of large amounts may occasion anorexia, nausea, vomiting, and perhaps diarrhea, although the drug cannot be con- sidered an active emetic nor does it possess marked purgative properties. 340 A TEXT-BOOK OF MATERIA MEDICA. Circulatory System.—Like quinine, eucalyptus arrests the ame- boid movements of the white blood-corpuscles. It resembles that drug also in its reputed property of contracting the enlarged spleen. Medicinal doses of eucalyptol stimulate the heart, increasing the blood-pressure—probably the effect of reflex action from the stom- ach. The arterial tension, however, though at first raised, is sub- sequently reduced, the pulse, which under moderate amounts of the drug shows an increase in force and frequency, being lowered by immoderate dosage. Nervous System.—Small doses stimulate mental activity. Fre- quent accompaniments of large doses are insomnia in the healthy and somnolence in debilitated subjects, and under certain condi- tions cerebral congestion, owing to the increased quantity of blood sent to the brain. Large or toxic doses are powerfully depressant to the brain, medulla, and spinal cord, abolishing the reflexes and at times occasioning loss of sensation in the lower limbs. " In large doses, after absorption, it seems to act chiefly on the nerve- centers, producing paralysis and death" (Hare). Respiratory System.—The drug tends to accelerate the respira- tory movements under small or moderate dosage; poisonous doses retard the breathing, finally arresting it, and causing death by paralysis of respiration. Absorption and Elimination.—The drug acting as a marked diu- retic, it is natural that elimination should take place largely by the kidneys, greatly increasing the amount of urea. The skin, bowels, and bronchial mucous membrane share in the excretory process, the drug acting as a stimulant to the structures by which elimina- tion takes place. A characteristic odor—resembling that of vio- lets—is imparted to the urine, breath, and discharges from the bowels. Renal congestion, with pain in the region of the kidneys, is occasionally produced by very large doses of the drug. Temperature.—Excessive doses result in a fall of temperature. According to Schlager, a thermal rise succeeds the hypodermic injection of the drug, due probably to local irritation. Poisoning.—While fatal results from the ingestion of large doses are recorded, the toxic effects of eucalyptus are practically confined to the lower forms of animal and vegetable life—infusoria, crypto- gamia, etc. In Gimbert's experiments upon animals it was noted that the heart continued to beat for some time after respiration had ceased; from which it may be concluded that, since the motor nerves and muscles retained their functional activity after death, ANTISEPTICS. 341 failure of mobility and reflex power is due to central action, the drug in toxic doses' being a paralyzant to the spinal cord and the medulla. Drowsiness, shallow breathing, cardiac weakness, and reduced arterial pressure are common results of poisonous doses of euca- lyptus. Treatment of Poisoning.—The stomach should be emptied, and the treatment should include the administration of alkalies or some preparation of iron, eliminants, strychnine, coffee, and diffusive stimulants. Therapeutics.—The author is indebted to Prof. G. Frank Lys- ton, M. D., for the following communication in regard to the thera- peutics of this drug. Dr. Lyston's experience with the remedy, having been very extensive, lends to his statements authoritative. weight; he is therefore quoted verbatim: " Eucalyptus is, in my experience, a most valuable remedy in chronic inflammation of mucous membranes. In nasopharyngeal catarrh it is of especial value. It may be used either in the form of spray or a thin ointment. If used as a spray, it should be com- bined with albolene or liquid vaseline in the proportion of 15 to 20 drops (0.92-1.23 Cc.) of the oil of eucalyptus to the ounce (30 Cc.) of menstruum. The strength may be considerably in- creased as tolerance is established. The most eligible preparation in the form of ointment is a combination of oil of eucalyptus with lanoline, sufficient albolene being added to liquefy the ointment. The eucalyptus may be used in this manner in a strength of 30 to 60 minims (1.84-3.7 Cc) to the ounce (32.0 Gm.). The action of the eucalyptus is mildly stimulant and astringent and decidedly anti- septic. " Eucalyptus has proven of value in my hands as a local applica- tion in acute and chronic skin diseases. In simple dermatitis a mild ointment of eucalyptus is quite efficacious. In chronic affections, such as some forms of eczema and psoriasis, a strong ointment of eucalyptus, or even the pure oil itself, may in some cases be applied with great benefit. " Eucalyptus is also valuable in the treatment of sluggishly granulating wounds and ulcers. In gastro-intestinal diseases euca- lyptus is of great value. It is a gastro-intestinal antiseptic of great merit, and one which should be more generally used. In certain forms of diarrhea due to the development of toxines in the gastro-intestinal tract the drug is a most valuable remedy. It has 342 A TEXT-BOOK OF MATERIA MEDICA. the merit of marked antiseptic action without sufficient astringent effect to interfere with the normal method of elimination by the bowel. In typhoid fever eucalyptus is in my opinion more strongly indicated than any other drug. Inasmuch as salol has such an enviable reputation as an intestinal antiseptic, it might be well to suggest that the oil of eucalyptus may be with propriety combined with that drug. I have used the eucalyptus alone and combined with salol, and am satisfied that either way is better than the use of the salol alone. " It has been my fortune to have a moderately extensive expe- rience in the use of eucalyptus in malarial affections. Diseases of malarial origin are infrequently met with in Chicago and its im- mediate environs, but in the New York hospitals at the time I was serving as interne typical malarial affections were abundant. I ex- perimented at that time quite extensively with eucalyptus, and found that the drug was not to be relied upon in distinct attacks of acute ague, but that it was of considerable value in the chronic forms and in the peculiar lassitude and depression with which patients who were not affected with typical malarial exacerbations often suffered. " After some years' experimentation with eucalyptus I have become convinced that its most valuable property is that of a urinary antiseptic. I take the opportunity of repeating here what I have repeatedly said elsewhere, that eucalyptus is the most reliable urinary antiseptic at our command. Careful experimenta- tion and clinical observation have shown me that in eucalyptus we have a remedy which greatly lessens the dangers of genito-urinary surgery by lessening or entirely removing the septic property of the urine, that bete noire of the andrologist. Boric acid and salol have in my experience been disappointing, while eucalyptus has exceeded my anticipations. My method of administration is by capsule, 10 minims (0.6 Cc.) of the oil being given four times daily, beginning several days before the operation. The only disadvan- tage attending the use of eucalyptus is gastric intolerance on the part of a few patients. As a rule, the remedy is taken without complaint, but occasionally disagreeable eructations or even vomit- ing occurs. By preceding the remedy with a large draught of milk this objection may usually be done away with. In some cases sus- pension of the remedy for a few hours will enable the stomach to acquire the desired toleration. " In the administration of eucalyptus much depends upon the ANTISEPTICS. 343 preparation used. Without the slightest desire to advocate unduly any special preparation, but simply as a matter of information to the profession, I will state that in my experience the preparations known as Tyndale's are the most reliable and elegant upon the market. These preparations comprise an aqueous solution, an ointment, and an oil, the latter of which is in daily use in my practice." The foregoing quotation expresses so clearly the uses of euca- lyptus that further details appear unnecessary. The antiseptic properties of the drug are not sufficiently realized by many physi- cians. Schultz claims that eucalyptus as an antiseptic is three times as powerful as carbolic acid, and that as an agent to arrest suppuration it is perhaps fully equal to quinine. As a stimulant expectorant eucalyptus is of great value, equal- ling, if not being superior to, any other remedy in bronchorrhea, pulmonary gangrene, and fetid bronchitis, associated or not with phthisis. Chronic or catarrhal conditions of the lungs and bronchi only are benefited by eucalyptus, acute affections of the broncho- pulmonary mucous membrane contraindicating its use. A solution of oil of eucalyptus is used as an antiseptic inhalation in diphtheria. Administration.—The fresh leaves may be employed as poul- tices. Any of the preparations may be used, but for internal pur- poses the oil, or eucalyptol, is preferable, although a good fluid extract is an agreeable form of the medicine. The oil, or euca- lyptol, may be given in an emulsion or in capsules, for topical use being diluted with alcohol or oil or incorporated in suppositories or ointments. Sodii Boras—Sodii Boratis—Sodium Borate. IT. 8. P. (Borax.) Origin.—Prepared by boiling together solutions of Boric Acid and Sodium Carbonate, the borax crystallizing out. It is also found in a native state on the shores of certain lakes and as a crystalline deposit in the Borax Lake of California. Description and Properties.—Colorless, transparent, mono- clinic prisms, or a white powder, inodorous, and of a sweetish, alkaline taste; slightly efflorescent in warm, dry air; soluble in 16 parts of water and in I part of glycerin; insoluble in alcohol. Dose.—5-30 grains (0.32-2.0 Gm.). 344 A TEXT-BOOK OF MATERIA MEDICA. Acidum Boricum—Acidi Borici—Boric Acid. XT. 8. P. (Boracic Acid.) Origin.—Found native in Northern Tuscany. It may be pre- pared by the action of Hydrochloric Acid on Borax, filtration, and recrystallization. Description and Properties.—Transparent, colorless scales, of a somewhat pearly luster, or, when in perfect crystals, six-sided, triclinic plates, slightly unctuous to the touch, odorless, of a faintly bitterish taste, permanent in the air. Soluble in 25.6 parts of water, 15 parts of alcohol, and 10 parts of glycerin. The addition of hydrochloric acid increases its solubility in water. Dose.—5-15 grains (0.32-1.0 Gm.). Official Preparation. Glyceritum Boroglycerini—Glyceriti Boroglycerini—Glycerite of Boro- glycerin (Glycerite of Glyceryl Borate—Solution of Boroglyceride).— Boric Acid, 310; Glycerin, to 1000. For external use. Antagonists and Incompatibles.—The incompatibles of borax are the acids and metallic salts. Morphine and cocaine are pre- cipitated from solution by borax. Boric acid is also incompatible with the carbonates and bicarbonates, and with the alkaline, earthy, and metallic bases. Synergists.—The action of borax is enhanced by alkalies and substances promoting waste; that of boric acid, by the anti- septics. Physiological Action.—Externally and Locally.—Borax is ab- sorbent, protectant, sedative, and antiseptic. Applied to the un- broken skin, it acts upon the epidermis as a soap. By removing the stimulus to secretion and lessening irritation borax checks the secretion of the salivary glands. Boric acid possesses properties similar to those of borax, although more of an antiseptic and antipruritic. It has also an exsiccant and detergent influence. Internally.—In a general way the action of borax is analogous to that of the alkalies. It is refrigerant and diuretic, and by its immediate action upon the womb serves as an emmenagogue, large doses contracting the uterine muscles and acting as an ecbolic. Excessive doses of either of these drugs act as gastro-intestinal irritants. Boric acid, though stronger, resembles borax in its action. Both ANTISEPTICS. 345 substances, especially boric acid, retard the action of saliva upon starch, increasing that of the pancreatic juice upon albuminous substances, and increase gastric digestion. Immoderate doses of boric acid check gastric digestion. The drug is a moderate antipyretic, and when injected in large amounts into the circulation may occasion paralysis of the motor nerves and muscles. Absorption and Elimination.—It is eliminated by the saliva, per- spiration-, feces, and urine, the latter being increased in quantity. The amount of nitrogen and solid matter excreted with the feces is also increased, as well as the elimination of urea in the urine. Untoward Action.—Boric acid has occasioned the following untoward symptoms : frequent desire to micturate ; nausea, vom- iting, and other gastric disturbances ; small, weak pulse; derange- ment of the nervous system; hiccough; and various cutaneous eruptions. Poisoning.—The symptoms of poisoning are analogus to those described above. Treatment of Poisoning.—The treatment of poisoning should be symptomatic, stimulants, morphine, etc. being employed. Therapeutics.—Externally and Locally.—Both of the above drugs are exceedingly valuable as local remedies in the treatment of many disorders of the ear, nose, and throat, such as acute and chronic nasal catarrh, pharyngitis, gingivitis, and acute hoarseness. An efficient domestic remedy in aphtha? affecting the mouths of nursing children is a mixture of borax and honey. An invaluable aseptic application in acute conjunctivitis is a sat- urated solution of boric acid. Leucorrhea, gonorrhea, and chronic cystitis are greatly benefited by solutions, in various strengths, of either or both of these drugs. Sir James Simpson recommends a solution of borax, 5-10 grains (0.32-0.6 Gm.) to 1 ounce (30.0 Cc.) of hot water, for the eruption occurring on the mucous membrane of the vulva in young girls. Since the introduction of boric acid as an antiseptic by Lister in 1872 it has steadily grown in favor in this respect, being univer- sally employed to-day, both in solution and in the powdered form, for the numerous conditions requiring an agent of this character. It is invaluable as a bland, unirritating antiseptic in general surgery, and in diseases of the eye, ear, nose, throat, and skin. It is perhaps unnecessary to enumerate the multifarious and efficient uses of this drug, the practising physician readily recog- 346 A TEXT-BOOK OF MA TERIA MEDICA. nizing the conditions in which this potent remedy may be advan- tageously employed. Internally.—Borax is used internally more than boric acid. While in epilepsy inferior to the bromides, there are cases uninflu- enced by the latter remedies which respond favorably to borax. The drug has been employed in typhoid fever, though with little benefit. Dr. Sacaze of Montpelier claims to have greatly improved a case of paralysis agitans with 4- to 8-grain (0.25-0.51 Gm.) doses, given three times a day. The author has favorably influenced the character of the urine in chronic cystitis by 5-grain (0.3 Gm.) doses of boric acid three times a day. These drugs have been used internally in the summer diarrhea of children. Administration.—The remedies may be given in capsules or solution. The taste of borax may be disguised by coffee, syrup of orange, or aromatic elixir of liquorice, the drug not being admin- istered with glycerin, lest an acid reaction occur. Potassii Permanganas-Potassii Permanganatis— Potassium Permanganate. XT. 8. P. Origin.—Obtained by heating together Caustic Potash, Potas- sium Chlorate, and Manganese Dioxide. The potassium manga- nate formed is converted into the permanganate by boiling it in water. Description and Properties.—Slender, monoclinic prisms, of a dark-purple color, almost opaque by transmitted light, and of a blue, metallic luster by reflected light; odorless, with at first a sweet and afterward a disagreeable and astringent taste ; permanent in the air; soluble in 16 parts of water. In contact with alcohol it is decomposed. Potassium permanganate should be kept in glass-stoppered bot- tles, protected from light, and should not be brought in contact with organic or readily oxidizable substances. Dose.—\-2 grains (0.03-0.12 Gm.), as a pill. Antagonists and Incompatibles.—Organic matter easily deox- idizes it, causing an explosion. Synergists.—Theoretically, the antiseptics would enhance its antiseptic action. Physiological Action.—Potassium permanganate is employed as an antiseptic and oxidizing agent in certain diseases, both the ANTISEPTICS. 347 internal and external use of the drug having proved beneficial. The peculiar property of the remedy is its readiness to part with oxygen, and its consequent availability as an agent in the destruc- tion of deleterious organisms. Brunton asserts that " when mixed with cobra-poison it completely destroys the deadly power of the latter, and the mixture may be injected subcutaneously without any bad effect," though he adds that as an antidote it is unservice- able, since it does not come in contact with the venom in the tissues. In rare instances, it is asserted, potassium permanganate has occasioned a vesicular eruption not unlike eczema. It is at times decidedly caustic. Therapeutics.—Externally and Locally.—In concentrated solu- tions or in substance it is a mild escharotic Its readiness to part with ogygen renders it of great value as a deodorant, and in dilute solutions, i to 5 grains (0.06 to 0.32 Gm.) to 1 ounce (30 Cc.) of water, it is a useful application to foul ulcers, cancer of the uterus, vagina, etc A solution of this drug is employed for various pur- poses as an antiseptic, germicide, and deodorant, in the treatment of gonorrhea, leucorrhea, diphtheria, putrid sore throat, ozena, naso- pharyngeal catarrh, cancer of the tongue, and syphiltic ulcers. A weak solution of potassium permanganate is an efficient ap- plication in bromidrosis, and a 1 : 2000 or 1 : 5000 solution is recom- mended by Dr. Terson in purulent ophthalmia. Potassium per- manganate should not be used as an antiseptic in the peritoneal cavity, on account of its irritating properties. It is employed extensively in surgical practice for washing the hands and utensils. Internally.—Like iron, potassium permanganate has been em- ployed in anemia, although far inferior to the former drug. Favor- able reports are given regarding its value in gastric fermentation and lithiasis. Dr. Moor of New York recently advocated its use as an anti- dote to morphine-poisoning. Its effect here is the same as in poisoning from the bites of reptiles, it being of service only when the drug comes in contact with the poison, which it oxidizes as it does any other organic substance. After the toxic agent has en- tered the circulation the remedy is of no value, it being only a chemical antidote for mdrphine, and not a physiological antagonist. Dr. Moor claims, however, that potassium permanganate does not possess the same antidotal power over certain other alkaloids, such as strychnine, atropine, cocaine, aconitine, etc. Antal, on the 348 A TEXT-BOOK OF MATERIA MEDICA. other hand, maintains that the drug is equally serviceable in mor- phine- and strychnine-, as well as muscarine-, poisoning, and in that resulting from toxic doses of colchicum and oxalic acid. Dr. Koosa believes it to be also efficient in poisoning from hydrocyanic acid, and Dr. Hognos reports very favorably as to its antidotal power in poisoning from phosphorus, having treated two cases successfully with this remedy. Recently, Dr. Fr. Lanz reports interesting statistics of Prof. von Jaksch's clinic in which phosphorus-poisoning was treated with douches of potassium permanganate, the death-rate, however —36.66 per cent.—not speaking very favorably for the antidotal power of the drug in connection with phosphorus. Administration.—For internal use potassium permanganate should always be given in pill form, kaolin being used as an excipient, lest an explosion occur. Potassii Bichromas—Potassii Bichromatis—Potas- sium Bichromate. XT. 8. P. Origin.—Prepared by roasting in a reverberatory furnace Potas- sium Carbonate and Chrome-iron Ore, with the addition of Lime or Chalk to prevent fusion. The potassium bichromate formed is separated by crystallization from its solution in water acidulated with sulphuric acid. Description and Properties.—Large orange-red, transparent triclinic prisms or four-sided tables, odorless, and having a bitter, metallic taste. Permanent in the air; soluble in 10 parts of water; insoluble in alcohol. Dose.—ywt~l gram (0.0006-0.06 Gm.). Antagonists and Incompatibles.—Potassium bichromate is in- compatible with soluble salts of silver, mercury, and lead, and with liquor potassae, liquor sodae, and ammonia water. Synergists.—Agents promoting waste, antiseptics, and caustics. Physiological Action.—Externally and Locally.—In substance potassium bichromate is an irritant caustic, and, according to Miquel, an antiseptic in the proportion of 1 to 909. Internally.—Its action is nearly identical with that of potassium chlorate, with the additional properties of an expectorant, emetic, and mild alterative. Poisoning and treatment of poisoning do not differ essentially from those of potassium chlorate. Therapeutics.—Externally and Locally.—Potassium bichromate ANTISEPTICS. 349, is used as a caustic for warts, corns, chancres, chancroids, mucous patches, etc., and is also of considerable value as a gargle in pharyngitis. Internally.—Frazer has recently recommended this drug in the treatment of dyspepsia and gastric ulcer, claiming that the pain,. nausea, vomiting, and tenderness may be readily allayed by doses of tV to \ grain (0.005-0.01 Gm.), taken upon an empty stomach three times a day. In acute gastric ulcer he has perceived no benefit so far as its effect upon the hemorrhage is concerned, the most desirable action of the drug in the latter condition being derived from its antiseptic and analgesic influence. The author desires to recommend favorably potassium bi- chromate, in doses of y^ grain (0.0006 Gm.) every hour or two, in aphonia and hoarseness due to excessive action of the vocal cords or resulting from an acute cold. He has found this method of treatment peculiarly and speedily efficacious. Potassii Chloras— Potassii Chloratis—Potassium Chlorate. U.S. P. Origin.—Prepared by passing Chlorine into a mixture of Potas- sium Carbonate and Slaked Lime. By subsequent boiling in water the chlorate separates by crystallization. Description and Properties.—Colorless, lustrous, monoclinic prisms or plates, or a white powder, odorless, and having a cool- ing, saline taste; permanent in the air; soluble in 16.7 parts of water; insoluble in absolute alcohol. Potassium chlorate should be kept in glass-stoppered bottles. Great caution should be observed in handling the salt, since dangerous explosions are liable to occur when it is mixed with organic matters—cork, tannic acid, sugar, etc.—or with sulphur, antimony sulphide, phosphorus, or other easily oxidizable substance, or upon being either heated directly or subjected to trituration or concussion. Dose.—3-20 grains (0.2-1.3 Gm.). Official Preparation. Trochisci Potassii Chloratis — Trochlscos (ace.) Potassii Chloratis — Troches of Potassium Chlorate.—Each troche contains 5 grains (0.32 Gm). Dose, 1 to 4 troches. Antagonists and Incompatibles.—In addition to those sub- stances mentioned above with which potassium chlorate forms 35° A TEXT-BOOK OF MATERIA MEDICA. explosive compounds, mixture with glycerin and the hypophos- phites is liable to produce similar dangerous results. Synergists.—Agents promoting waste increase the activity of the drug. Physiological Action.—Externally and Locally.—It is slightly detergent and stimulant, antiseptic and astringent, being irritant when applied in concentrated solution to ulcerated surfaces. Internally.—Digestive System.—Medicinal doses have no effect; poisonous doses excite violent gastro-intestinal irritation, nausea, bloody vomiting, diarrhea, and jaundice. Circulatory System.—Small doses of potassium chlorate tend to depress and subsequently raise arterial tension, accelerating the pulse; large doses lower arterial pressure alarmingly; toxic doses convert the hemoglobin of the blood into methemoglobin, the dis- organized fluid appearing in the urine. Post-mortem lesions are— enlargement of the liver, spleen, and kidneys, with evidences of marked inflammation over the whole intestinal tract. Nervous System.—Medicinal doses are inert. Toxic doses may produce delirium and death, preceded by coma or convulsions. Respiratory System.—Large doses act as a depressant to the respiratory apparatus. Absorption and Elimination.—The drug is absorbed with con- siderable rapidity, being chiefly eliminated by the salivary glands unchanged. The drug does not increase the urinary flow, large doses, on the contrary, tending to suppress it. Temperature.—Unaffected by medicinal doses, but lowered by toxic amounts. Untoward Action.—Small doses of potassium chlorate seldom produce untoward symptoms, although in rare instances eruptions of an erythematous, papular, or vesicular nature have followed the use of the drug. Digestive disturbances occasionally ensue, with pain in the region of the kidneys and albuminuria. Poisoning.—In the few recorded cases of poisoning there were observed a continuous sensation of choking, excessive thirst, per- sistent vomiting, pain in the abdomen and renal tract, and violent hiccough. Accompanying symptoms were—a small and rapid pulse and faintness, while the urine was albuminous and diminished in quantity; epistaxis was present; the eyes and lips were cyanotic, and the skin slightly jaundiced and markedly anemic; the liver and spleen were slightly enlarged; and there were alternating sensations of cold and heat, with drowsiness ending in coma and death. ANTISEPTICS. 351 Treatment of Poisoning.—The stomach should be emptied as quickly as possible and demulcents administered. The patient should be treated symptomatically, and it may be advisable to practice venesection, followed by transfusion of blood, as suggested by Landerer. Therapeutics.—Externally and Locally.—A solution of this drug has been applied with some success in foul ulcers and moist eczema. Like the potassium permanganate, it has been employed in various diseases of the nose and throat, and is especially service- able in ptyalism and aphthous ulceration. As a remedy for syphilitic mucous patches and herpes of the buccal cavity it is of considerable value. It is more efficient in acute than in chronic pharyngitis. It possesses marked cicatrizing power, advantage of which property has been taken in the treatment of phagedenic sores, the powdered drug being used for this purpose. It is thought that ene- mas of potassium chlorate solution favor the healing of rectal ulcers. Internally.—As a remedial agent this drug has not met with the success prophesied by many physicians. Dr. Coghill of England is one of its most enthusiastic champions, the drug having proved in his hands highly efficient in improving the quality of the blood in such cases as simple anemia, chlorosis, etc., as well as in "pul- monary insufficiency" and "deficient oxygenation of the blood." Other physicians have recommended it as a valuable galactagogue, tonic, and alterative, and as beneficial in certain chronic diseases of the skin, scrofula, etc It has found some advocates as a genito- urinary antiseptic and as a remedy in typhoid fever. Yet, notwithstanding the extravagant, though isolated, reports concerning the great value of the drug, its utility has not been universally recognized; indeed, so good an authority as Marchand declares that " chlorate of potassium should be entirely rejected in practice, and particularly in the treatment of children." Administration.—It may be given in the form of troches, powder, tablets, or a solution, an agreeable means of administra- tion being in aerated water. Owing to its tendency to decomposi- tion when combined with other substances, the drug should be prescribed alone. Aqua Hydrogenii Dioxidi— Aquae Hydrogenii Diox- idi—Solution of Hydrogen Dioxide. XT. 8. P. Origin.—A slightly acid, aqueous solution of hydrogen diox- ide, containing, when freshly prepared, about 3 per cent, by weight 352 A TEXT-BOOK OF MA TERIA MEDICA. of the pure dioxide, corresponding to about 10 volumes of avail- able oxygen. Description and Properties.—A colorless liquid, without odor, slightly acidulous to the taste, and producing a peculiar sensation and a soapy froth in the mouth; liable to deteriorate with age or by exposure to heat or protracted agitation. Dose.—1-4 fluidrachms (3.7-15.0 Cc), well diluted with water. Physiological Action.—Externally and Locally.—The principal action of this preparation seems to be its property of imparting oxygen to all oxidizable substances, it being one of the most pow- erful oxidizing agents in Materia Medica, and therefore an exceed- ingly active non-toxic antiseptic. When applied to a suppurating surface, or when mixed with mucus, cerumen, or blood, active effervescence is produced. Hy- drogen dioxide is a useful detergent and bleaching agent, being employed largely for the purpose of bleaching hair and delicate fabrics. Internally.—It is asserted that hydrogen dioxide yields oxygen to the blood, slightly stimulates the nervous system, and acts as a diuretic. Therapeutics.—Externally and Locally.—Hydrogen dioxide is extensively employed to cleanse diseased surfaces, such as ulcers, buboes, fistulous tracts, etc. It has been highly recommended as an antiseptic in abdominal surgery. As an antiseptic wash in empyema, cystitis, joint-cavities, venereal sores, puerperal septic endometritis, etc. hydrogen dioxide is an exceedingly valuable agent. Hydrogen dioxide appears to be an efficient injection in gonor- rhea, and is much used as an antiseptic in many diseases of the eye, ear, nose, and throat. It has been highly recommended as a solvent for diphtheritic membrane, although when frequently applied to the throat it causes an unpleasant sensation of dryness, and it seems to prevent the exfoliation of the membrane when the patient is treated with antitoxine. Hydrogen dioxide serves a useful purpose in disinfecting drink- ing-water when suspected of pollution, 1 part sufficing for 1000 parts of water, in which amount the taste or other potable quali- ties of the water are in no way impaired. Internally.—While hydrogen dioxide has been recommended in epilepsy, diabetes, angina pectoris, pneumonia, asthma, and dyspnea due to deficient circulation of blood through the heart and lungs, the results following the internal administration in these diseases ANTISEPTICS. 353 have not warranted classing the drug among important internal medicines. Administration.—For external and local use the drug may be gargled, sprayed, or applied with a syringe or a swab, either in full strength or diluted with water. Whether for external or internal use, the solution should be freshly prepared; when given internally it should be taken from a porcelain or china, not a metal, cup or spoon. Acidum Sulphurosum—Acidi Sulphurosi—Sulphur- ous Acid. XT. 8. P. Origin.—A liquid composed of not less than 6.4 per cent, by weight of Sulphurous Acid Gas (Sulphur Dioxide) and not more than 93.6 per cent, of Water. Description and Properties.—A colorless liquid, of the cha- racteristic odor of burning sulphur, and of a very acrid, sulphur- ous taste. It should be kept in dark-colored, glass-stoppered bottles, in a cool place, and protected from light. Dose.—\-2 fluidrachms (1.8-7.39 Cc). Physiological Action.—Externally and Locally.—Sulphurous acid is a powerful deoxidizing agent, the fumes of burning sulphur having been employed centuries ago to disinfect temples, dwellings, etc. It easily abstracts oxygen from organic bodies, the acid, in short, being a powerful disinfectant, antiseptic, deodorant, and parasiticide. Internally.—The disinfecting properties of sulphurous acid are less apparent when the drug is ingested than when it is used externally. Therapeutics.—Externally and Locally.—As an antiseptic, dis- infectant, and deodorant sulphurous acid may be employed in the treatment of various parasitic skin diseases, and a solution of sul- phurous acid affords an efficient application to the throat in pharyn- gitis, particularly the gangrenous form, diphtheria, etc. According to Dujardin-Beaumetz, Sollaud, and Balbaud, non- febrile pulmonary phthisis is often favorably influenced by the daily inhalation for a short time of sulphurous-acid vapor. This dis- agreeable, not to say dangerous, method of treatment has neither been generally adopted nor proved to be of established efficacy. The acid is a useful antiseptic to apply to recent wounds, and may be employed to disinfect the dejections of the sick, the fumes 23 354 A TEXT-BOOK OF MA TERIA MEDICA. from burning sulphur also being serviceable to disinfect rooms and bedding tainted with infectious disease. Internally.—Sulphurous acid is seldom used internally, though, owing to its powerful antifermentative properties, it has been em- ployed in so-called fermentative dyspepsia, intestinal fermentation, and urticaria. While it checks fermentation in the laboratory, its effect is less certain in the body; nor can the internal administra- tion of the drug be regarded as satisfactory. Administration.—Sulphurous acid should be given well diluted with water. Sodii Sulphis—Sodii Sulphltis—Sodium Sulphite. U. 8. P. Origin.—Prepared by saturating a solution of Sodium Carbon- ate or Caustic Soda with Sulphur-dioxide Gas. Description and Properties.—Colorless, transparent, mono- clinic prisms; odorless, and having a cooling, saline, sulphurous taste. In the air the salt effloresces and is slowly oxidized to sul- phate. Soluble in 4 parts of water; sparingly soluble in alcohol. It should be kept in well-stoppered bottles, in a cool place. Dose.—5-60 grains (0.3-4.0 Gm.). Sodii Bisulphis—Sodii Bisulphltis—Sodium Bisul- phite. XT. 8. P. Origin.—Prepared from Sodium Carbonate or Bicarbonate and Sulphur Dioxide. Description and Properties.—Opaque, prismatic crystals, or a granular powder, exhaling an odor of sulphur dioxide, and having a disagreeable, sulphurous taste. Exposed to the air, the salt loses sulphur dioxide and is gradually oxidized to sulphate. Soluble in 4 parts of water and in 72 parts of alcohol. The drug should be kept in a cool place, in small, well-stoppered bottles filled as full as possible. Dose.—5-30 grains (0.3-2.0 Gm.). Sodii Hyposulphis—Sodii Hyposulphltis—Sodium Hyposulphite. XT. 8. P. Origin.—Prepared by passing Sulphurous Anhydride into a solution of Sodium Carbonate with Salts. Description and Properties.—Colorless, transparent, mono- clinic prisms; odorless, and of a cooling, afterward bitter, taste. ANTISEPTICS. 355 Soluble in 0.65 part of water; insoluble in alcohol. It should be kept in well-stoppered bottles. Dose.—5-20 grains (0.3-1.3 Gm.). Physiological Action and Therapeutics of Sodium Sulphite, Bisulphite, and Hyposulphite.—These substances are feeble ger- micides and antiseptics, checking putrefaction and other forms of fermentation. It is supposed that they are decomposed in the stomach, liberating sulphurous anhydride; on which assumption they have been given to arrest gastric fermentation and as reme- dies in typhoid and yellow fevers, diphtheria, erysipelas, etc. The hypothesis, however, upon which they have been thus hopefully employed has not been confirmed by clinical experience. These drugs have nevertheless proved efficacious in the treat- ment of scabies, sycosis, impetigo, favus, etc. Atomized solutions of sodium hyposulphite inhaled are beneficial in gangrene of the lungs, fetid bronchitis, etc. Administration.—The foregoing preparations of sulphur may be given in solution or in this form applied topically. The sodium hyposulphite may also be applied in the form of an ointment. Aqua Chlori—Aquae Chlori—Chlorine Water. XT. 8. P. Origin.—An aqueous solution of Chlorine, containing at least 0.4 per cent, of the gas. Description and Properties.—A clear, greenish-yellow liquid, having the suffocating odor and disagreeable taste of chlorine, and leaving no residue on evaporation. Chlorine water, even when kept from light and air, is apt to deteriorate; when it is required of full strength, it should be freshly prepared. Dose.—1-4 fluidrachms (3.7-15.0 Cc). Antagonists and Incompatibles.—The salts of lead and silver are incompatible. Synergists. — The antiseptics are theoretically synergistic, though practically the drug is almost always used alone. Physiological Action. — Externally and Locally. — Chlorine water is a powerful antiseptic, germicide, and deodorant. When applied to the skin it acts as a rubefacient and vesicant, while the vapor is quite irritating to the respiratory passages. Internally.—Chlorine water is more or less irritating to the mucous membrane of the stomach, and possesses an astringent taste. 356 A TEXT-BOOK OF MATERIA MEDICA. Therapeutics.—Externally and Locally.—Chlorine water is still occasionally used as an antiseptic and deodorant in gangrenous or sloughing wounds and for disinfecting foul discharges, etc. It has proved beneficial as a local application in aphthous stomatitis, diph- theria, and parasitic skin diseases. Internally.—Chlorine water is so seldom employed internally that its use in this respect scarcely requires comment. Administration.—When given internally the drug should be well diluted. Should poisoning ensue from the ingestion of exces- sive amounts, albumen is the best antidote; for the irritation occa- sioned by the inhalation of chlorine gas steam-inhalations are indicated. Calx Chlorata—Calcis Chloratae—Chlorinated Lime. XI. 8. P. (" Chloride of Lime.") Origin.—A compound resulting from the action of Chlorine upon Calcium Hydrate, and containing not less than 35 per cent. of available Chlorine. Description and Properties.—A white or grayish-white, granu- lar powder, exhaling the odor of hypochlorous acid ; of a repulsive saline taste, and becoming moist and gradually decomposing on exposure to air. It is but partially soluble in water or alcohol. The drug should be kept in well-closed vessels, in a cool and dry place. Used externally. Physiological Action and Therapeutics.—Chlorinated lime is a powerful disinfectant, yielding, when exposed to air, hypochlorous. acid, which is resolved into chlorine and chloric acid, the last in turn yielding chlorine. The effects of the drug are therefore analogous to those of chlorine, yet almost the only use which chlorinated lime serves is in disinfecting cesspools and utensils employed for the dejections of invalids. Liquor Sodae Chloratae—Liquoris Sodae Chloratae— Solution of Chlorinated Lime. XT. 8. P. (Labarraque's Solution.) Origin.—An aqueous solution of several chlorine compounds of Sodium, containing at least 2.6 per cent, by weight of available chlorine. AROMA TICS. 357 Description and Properties.—A clear, pale-greenish liquid, having a faint odor of chlorine and a disagreeable alkaline taste. It should be kept in well-stoppered bottles, protected from light. Used externally. Physiological Action.—The action of the drug resembles that of aqua chlori, although it is feebler than the latter. Therapeutics.—Solution of chlorinated soda is used as a disin- fectant iox fetid ulcers, gangrenous sores, and ozena, and as a disin- fectant wash in diseases of the uterus, vagina, and auditory canal. Administration.—There are no special directions to be ob- served in the application of this solution. AROMATICS. The following-named drugs, classed by some authors as aro- matics, are not only powerful antiseptics and antispasmodics, but possess properties very similar to those of the more typical anti- septics, antipyretics, and anesthetics. These antiseptic properties of aromatic drugs are well known to modern science, and, what is of unique interest and significance, were perfectly familiar to the ancients, who could not possibly divine the scientific value of the virtues familiarized only by the crudest empiricism. In the custom of the Egyptians of embalming the dead we have a remarkable example of their divination of antisepsis in the perfumes and spices in which their dead were buried; and in the Christian Gospel we read of Nicodemus that he " brought a mixture of myrrh and aloes," and that they " took the body of Jesus, and wound it in linen cloths with the spices, as the manner of the Jews is to bury" (John xix. 39,40). Apart, however, from the remarkable testimony of the fore- going examples, these peculiar properties of aromatic herbs appear to have been established in all succeeding ages. Especially among the Greeks were the medicinal virtues of certain aromas recognized, recipes for celebrated healing essences being inscribed on marble tablets in their temples. Among the Romans, too, the custom pre- vailed of mingling sacred aromatic ingredients with the ashes of the departed—a usage not wholly to be regarded as a religious ceremony, but rather as a recognition of the properties ascribed to these agents by their Athenian neighbors. Indeed, the history of perfumes teems with illustrations of the 358 A TEXT-BOOK OF MATERIA MEDICA. common faith in their healing power, though from the derivation of the word—per, through, and fumum, smoke—the offering of incense, by burning aromatic woods, spices, and gums, seems to have been the original use suggested by them. This conception of the sacred and purifying influence of aromas is seen to-day in the censer of the ritualistic churches, as it may be traced from earliest recorded times through the centuries that intervene. The more secular regard for aromatic herbs, however, rests rather upon a rational, though unscientific, observation of facts than upon hierarchical assumption. It is recorded, for instance, that while cholera raged in Paris and London the gentle office in which they were engaged secured to the perfumers immunity from the plague, and that when the Dutch on the island of Ternate destroyed the clove tree the colony suffered from epidemics and disorders unknown before. The property of absorbing malaria generally ascribed to the leaves of Eucalyptus globulus is a further illustration of the medicinal uses of aromatic plants, this tree being considered a potent febrifuge. Witness also the beneficial results of planting this tree in the Roman Campagna. Even the refined taste and delicacy of sense which have per- petuated the "perfumes of Araby" to "sweeten," not the murder- ous hand of a Lady Macbeth, but milady's dainty finger-tips, have their rationale in a basis of sanitary law. A writer on this subject observes that " the toilet vinegars had their origin in the presump- tion of keeping those who carried them from the effects of infec- tious disease, doubtless springing out of the story of the four thieves' vinegar—reputed freebooters supposed to have plundered the sick and dying, protected by the spell of an enchanted prophy- lactic composed of rosemary, mint, lavender, calamus, cinnamon, cloves, nutmeg, etc. macerated in vinegar." Yet the vinaigrette of a lady's boudoir of to-day has its ana- logue in the beautiful scent-bottles unearthed among the ruins of Pompeii; for the cultivated tastes which still prompt the utility, as well as beauty, of flowers are fortified by the tradition of loyal centuries, and are, after all, but a tacit tribute to the truth not in- aptly stated that " poison and malaria enter the system by neglect- ing the warning given it by the nose, that outpost of the animal citadel." Aromatics owe their virtues chiefly to the volatile oils they con- tain, which usually possess the characteristic odor and taste of the AROMA TICS. 359 plants from which they are derived. Locally, they are stimulant and irritant. Internally, they stimulate, when taken in moderate quantities, the digestive organs in the same manner as vegetable bitters, and increase the activity of the circulation reflexly by stim- ulating the sensory ends of the vagus distributed to the mucous membrane of the stomach. The impression is conveyed to the center in the medulla, and from there transmitted to the accelerator nerves of the heart. Very large doses depress the heart's action, arresting it in diastole. The poisonous action of aromatics is simi- lar to that of irritant narcotic poisons. Many of them are quite powerful local anesthetics. They first stimulate and then depress and exhaust the nervous system. In diseased conditions they are used to increase peristalsis, to impart tone to the stomach, and to act as antiseptics; to arrest gastric and intestinal fermentation; to relieve pain wherever they are applied; and, by increasing the circulation in the brain and improving the condition of the gastro- intestinal tract, to relieve many of the phenomena of hysteria. The chief contraindication for the internal use of these drugs is in inflammation of the stomach and bowels. The volatile oils and the various preparations of the aromatics should be given diluted in some proper vehicle. Anisum—Anisi—Anise. XT. 8. P. Origin.—The fruit of Pimpinella Anisum L., a plant indigenous in Western Asia and Egypt, and extensively cultivated in Europe. Description and Properties.—About \-\ inch (3-6 Mm.) long, ovate compressed laterally, grayish, finely pubescent, consisting of two mericarps, each with a flat face, and five light-brownish filiform ridges, and about fifteen thin oil-tubes, perceptible in transverse sec- tion by the aid of the microscope. Anise has an agreeable, aro- matic odor, and a sweet, spicy taste. It contains from i£ to 3 per cent, of a volatile oil. It resembles the fruit of the Conium, differ- ing from it usually in being longer and more ovate, and having another odor and taste. The fruit of the Conium has, moreover, but a single smooth mericarp without oil-tubes. Dose.—8-30 grains (0.5-2.0 Gm.). Oleum Anisi—Olei Anisi—Oil of Anise. XT. 8. P. Origin.—A volatile oil distilled from Anise. Description and Properties.—A colorless or pale-yellow, thin and strongly refractive liquid, having the characteristic odor of 360 A TEXT-BOOK OF MA TERIA MEDICA. anise, and a sweetish, mildly aromatic taste; neutral in reaction. It contains a substance known as anethol. Oil of anise should be kept in well-stoppered bottles, protected from light, and if it has separated into a liquid and a solid portion, it should be completely liquefied by warming before being dis- pensed. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua Anisi—Aquae Anisi—Anise Water.—Dose, %-i fluidounce (8.0-30.0 Cc.). Spiritus Anisi—Spiritus Anisi—Spirit of Anise.—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Oil of anise is contained in the following preparations: Spiritus Aurantii Comp6situs ; Syrupus Sarsaparlllae CompSsitus ; Tinc- tura Opii Camphorata; Trochisci Glycyrrhizae et Opii. Physiological Action.—Anise is slightly antiseptic, stimulant, and carminative; Oil of Anise is irritant if applied in full strength to mucous membranes, stimulating both the digestive and circulatory apparatus, improving the appetite, and slightly strengthening and accelerating the heart's action. In very large doses it possesses mildly narcotic properties. It is excreted in the urine, sweat, and by the bronchial mucous membrane, the secretion from which it liquefies. Therapeutics.—Anise is employed to relieve flatulence in children, as a sedative expectorant, and as a vehicle to flavor medicines. Cinnamomum—Cinnamomi—Cinnamon. XT. S.P. Origin.—There are three official varieties of cinnamon: 1, the inner bark of the shoots of Cinnamomum Zeylanicum Breyne, a tree about 30 feet high (9 M.), found in the forests of Ceylon (Ceylon Cinnamon); 2, the bark of the shoots of one or more undetermined species of Cinnamomum grown in China (Chinese Cinnamon, Cassia Cinnamon); 3, the bark of an undetermined species of Cinnamomum known as Cinnamomum Saigomcum (Saigon Cinnamon, Saigon Cassia), from Saigon, the capital of French Cochin-China, where it is collected and exported. Description and Properties.—Most of the article brought to the United States is the Cassia cinnamon. The varieties differ some- AROMA TICS. 361 what in appearance, and are found in the shops as quills of varying lengths, about -^ inch (1 Mm.) or more in thickness, yellowish- brown in color, externally rough (Cassia), of fragrant odor, a sweet, aromatic taste, but less delicate than that of Ceylon cinna- mon, which appears in large, closely-rolled quills, composed of eight or more layers of bark of the thickness of paper; pale, yellowish-brown, the outer surface smooth, marked with wavy lines of bast-bundles; of a very sweet, fragrant odor, and a warm, aromatic, delicate taste. The Saigon cinnamon is found in the shops as large quills or broken pieces, -jV to I mcn (2 to 3 Mm.) thick; the outer surface gray or light grayish-brown, with whitish patches, more or less rough and warty, transversely ridged and longitudinally wrinkled; the inner surface cinnamon or dark brown, granular and slightly striate, with short and granular fracture. It has a fragrant odor, and a sweet, warmly aromatic, and somewhat astringent taste. Constituents.—All the varieties contain volatile oil, tannin, mucilage, sugar, starch, a coloring principle, and a peculiar acid. The official Oil of Cinnamon is distilled from Cassia Cinnamon. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations {Cassia Cinnamon). Tinctura Cardamomi Comp5sita—Tinctiirae Cardamomi Compftsitae— Compound Tincture of Cardamom.—Cardamom, 20; Cassia Cinnamon, 20; Car- away, 10; Cochineal, 5; Glycerin, 50; Diluted Alcohol, q. s. ad 1000 parts. Dose, 1-2 fluidrachms (4.0-8.0 Cc). Tinctura Catechu Compbsita—Tinctiirae Catechu Compftsitae—Compound Tincture of Catechu.—Catechu, ioo; Cassia Cinnamon, 50; Diluted Alcohol, q. s. ad 1000 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). Tinctura Lavandulae Compdsita—Tinctiirae Lavandulae Compftsitae—Com- pound Tincture of Lavender.—Dose, }/z-\ fluidrachm (2.0-4.0 Cc). (Formula given under Lavender.) Official Preparations {Ceylon Cinnamon). Tinctura Cinnamomi (10 per cent.)—Tinctiirae Cinnamomi—Tincture of Cinnamon.—Dose, ]/2-2 fluidrachms (2.0-8.0 Cc). Pulvis Aromaticus—Ptilveris Aromatici—Aromatic Powder.—Dose, 10-30 grains (0.6-2 Gm.). (Formula given under Cardamomum.) Oleum Cinnamomi—Olei Cinnamomi—Oil of Cinnamon. XT. 8. P. Origin.—A volatile oil distilled from Cassia Cinnamon. Description and Properties.—A yellowish or brownish liquid, 362 A TEXT-BOOK OF MA TERIA MEDICA. becoming darker and thicker with age and exposure to the air, having the characteristic odor of cinnamon, and a sweetish, spicy, burning taste. Specific gravity, 1.055 to 1-065. Soluble in an equal volume of alcohol, the solution being slightly acid to litmus- paper ; also soluble in an equal volume of glacial acetic acid. It should be kept in well-stoppered bottles, in a cool place, protected from light. Constituents.—Oil of cinnamon contains variable quantities of hydrocarbon, but consists chiefly of cinnamic aldehyde, and when old or exposed to the air for a considerable time cinnamic acid and resin are formed. Cinnamic acid crystallizes in shining, colorless, odorless prisms, freely soluble in alcohol, ether, and boiling water. Chlorinated lime and hot dilute nitric acid oxidize it into oil of bitter almond and benzoic acid. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua Cinnamomi (0.2 per cent.)—Aquae Cinnamomi—Cinnamon Water.— Dose, \-i fluidounce (15-30 Cc). Spiritus Cinnamomi (10 per cent.)—Spiritus Cinnamomi—Spirit of Cinna- mon.—Dose, 5-20 minims (0.3-1.2 Cc). Physiological Action.—Cinnamon is an agreeable aromatic stimulant, carminative, stomachic, astringent, hemostatic, and anti- septic. The oil possesses germicidal properties. Therapeutics.—The same as for other aromatics. It is much used to impart an agreeable flavor to medicinal compounds and as an adjuvant to other members of this group. Preparations of cin- namon are supposed to stimulate the uterus and check uterine hem- orrhage, and are often employed alone or in combinations with more powerful medicines for this purpose. Coriandrum—Coriandri—Coriander. XT. 8. P. Origin.—The fruit of Coriandrum sativum L., an annual herb about 2 feet (60.0 Cm.) high, indigenous in China and on the north-eastern shore of the Mediterranean. Cultivated in Asia, Europe, and America. Description and Properties.—Globular, about \ inch (3 Mm.) in diameter, slightly pointed at the apex and crowned with the calyx-teeth at the base. The two concave mericarps cohere, en- closing a lenticular cavity, each furnished on the face with two oil- tubes ; odor and taste agreeably fragrant and aromatic. AROMA TICS. 363 Constituents.—Coriander contains nearly ^ of 1 per cent, of volatile oil, 13 per cent, of fatty matter, mucilage, and traces of tannin. Dose.—8-30 grains '(0.5-2.0 Gm.). Oleum Coriandri—Olei Coriandri—Oil of Coriander. XT. 8. P. Origin.—A volatile oil distilled from Coriander. Description and Properties.—A colorless or slightly yellow- ish liquid, having the characteristic aromatic odor of coriander, and a warm, spicy taste. It is one of the most stable of the volatile oils. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. ConfSctio SSnnae (5 per cent.)—Confectionis SSnnae—Confection of Senna. —Dose, 1-2 drachms (4.0-8.0 Gm.). (Formula given under Senna.) Spiritus Juniperi CompSsitus—Spiritus Juniperi CompSsiti—Compound Spirit of Juniper.—Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula given under Carum.) Physiological Action and Therapeutics.—The same as those of the other volatile oils. Frequently used as a corrective to pur- gative medicines. Fcenlculum—Fcenlculi—Fennel. XT. 8. P. Origin.—The fruit of Foeniculum capillaceum Gilibert, an herba- ceous annual or perennial indigenous in Southern Europe and cul- tivated in Germany, France, and the United States. Description and Properties.—Oblong, nearly cylindrical, slightly curved, from \ to \ inch (4-12 Mm.) long, brownish or greenish-brown, readily separable into the two prominent meri- carps, each with five light-brown, obtuse ribs, with four oil-tubes on the back and two or four upon the flat face; odor and taste aro- matic, anise-like. Constituents.—Fennel contains from 2 to 4 per cent, of volatile oil, which is almost identical chemically with that of anise, 12.5 per cent, of fixed oil, and sugar. Dose.—8-30 grains (0.5-2.0 Gm.). Official Preparation. Infusum SSnnae Comp6situm—Infiisi SSnnae CompSsiti—Compound In- fusion of Senna.—Dose, 1-2 fluidounces (30.0-60.0 Cc). (Formula given under Senna.) 364 A TEXT-BOOK OF MATERIA MEDICA. Oleum Fceniculi—Olei Fceniculi—Oil of Fennel. XT. 8. P. Origin.—A volatile oil distilled from Fennel. Description and Properties.—A colorless or pale-yellowish liquid, having the characteristic aromatic odor of fennel, and a sweetish, mild, and spicy taste. Soluble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a cool place, and if it has partly or wholly solidified, it should be com- pletely liquefied by warming before being dispensed. Constituents.—It has the same constituents as the oil of anise. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua Fcenlculi (2 per cent.)—Aquae Fceniculi—Fennel Water.—Dose, \-\ fluidounce (8.0-30.0 Cc). Pulvis Glycyrrhizae Compositus—Ptilveris Glycyrrhizae CompSsiti—Com- pound Liquorice Powder.—Dose, \-2 drachms (2.0-8.0 Gm.). (Formula given under Senna.) Spiritus Juniperi Compositus (0.5 per cent.)—Spiritus Juniperi CompSsiti— Compound Spirit of Juniper.—Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula given under Carum.) Physiological Action and Therapeutics are the same as those of anise. Capsicum—Capsici—Capsicum. XT. 8. P. (Cayenne Pepper.) Origin.—The fruit of Capsicum fastigiatum Blume, a small crooked-branched shrub, i to 2 feet (30-60 Cm.) high, indigenous in tropical America and Asia, and cultivated in gardens. The fruit is an oblong-conical pod from \ to \ inch (8-19 Mm.) long, of a crimson or yellow color. It encloses two or three cells con- taining flat, reniform, yellowish seeds, attached to a thick, central placenta. These pods when dried and ground form capsicum, which has a peculiar odor and an intensely hot, aromatic taste. This ground product is of a bright-red color, fading upon long exposure to the light. Capsicum of the market usually consists of several species ground together, and is often adulterated with sawdust and sometimes with red lead. Constituents.—Capsicum contains capsaicin, an acrid principle found in the greatest amount in the African product; also a vola- tile alkaloid, fixed and volatile oil, and fat acids. Dose.—3-5 grains (0.2-0.3 Gm.). AROMA TICS. 365 Official Preparations. Extractum Capsici Fluidum—Extracti Capsici Fluidi—Fluid Extract of Capsicum.—Dose, £-to 2 minims (0.03-0.12 Cc). Emplastrum Capsici—Emplastrum (ace) Capsici—Capsicum Plaster. For external use. Oleoresina Capsici—Oleoresinae Capsici—Oleoresin of Capsicum.—Dose, \-\ minim (0.015-0.06 Cc). Tinctura Capsici—Tinctiirae Capsici—Tincture of Capsicum.—Dose, 5-20 minims (0.3-1.2. Cc). Physiological Action.—Externally and Locally.—Capsicum is an irritant and rubefacient, producing vesication if kept in contact with the skin for a long time. It so irritates the mucous membrane of the mouth and nose as to induce sneezing. Internally.—Digestive System.—Capsicum is a powerful gastro- intestinal stimulant, increasing the flow from the salivary, gastric, and intestinal glands. It increases the blood-supply to, and stimu- lates the walls of, the stomach, occasioning a sense of heat. It is a powerful carminative. Large doses produce great irritation in the stomach and bowels. Circulatory System.—It is a powerful stimulant to the heart, greatly increasing the strength and rapidity of its action. Absorption and Elimination.—It is chiefly eliminated by the kid- neys, increasing the flow of urine. Large doses may produce vesical tenesmus, and aphrodisiac effects have sometimes been pro- duced. Therapeutics.—Externally and Locally.—Owing to its counter- irritant action, capsicum is employed to relieve lumbago, torticollis, neuralgia, rheumatic pains, and acute inflammations of the skin or mucous membrane. An infusion or the diluted tincture is an excellent gargle in relaxed uvula, pharyngitis, and the angina of scarlet fever. The tinctures of capsicum and cantharides have been used to stimulate the scalp in the various forms of alopecia. The tincture is frequently used as a domestic remedy for the benefit of chilblains and toothache. Internally.—Capsicum is a most valuable stomachic in an atonic condition of the digestive organs, and a very efficient remedy in the irritable and catarrhal conditions of the stomach due to the ex- cessive use of alcohol. The tincture of capsicum or the powdered drug, added to hot water or to hot water and whiskey, makes a valuable and rapid car- diac and vascular stimulant. 366 A TEXT-BOOK OF MATERIA MEDICA. Contraindications.—Capsicum and its preparations should not be given in acute inflammatory affections of the gastro-intestinal and genito-urinary tracts. Administration.—The oleoresin and the powder should be given in pills or capsules. The fluid extract and the tincture should be administered well diluted with water. Piper—Piperis—Pepper. XT. 8. P. (Black Pepper.) Origin.—The unripe fruit of Piper nigrum L., a knotted, pointed- branched, aromatic, climbing shrub, indigenous in India, and culti- vated in many of the East Indian and Philippine and some of the West Indian islands. Constituents.—Its important constituents are a volatile oil (i to 2 per cent.); a neutral principle, piperin (6 to 8 per cent.); and a pungent, soft, dark-green resin, to which the acrid taste and medici- nal properties of pepper are due. Dose.—5-20 grains (0.3-1.2 Gm.) Official Preparations. Oleoreslna Piperis—Oleoresinae Piperis—Oleoresin of Pepper.—Dose, \-\ grain (0.015-0.06 Gm.). Piperinum—Piperini—Piperin.— Origin.—A neutral principle obtained from Pepper, as well as from other plants of the natural order Piperacecz. Description and Properties.—Colorless, or pale-yellowish, shining, prismatic crystals, odorless, and almost tasteless when first taken into the mouth, but after a while pro- ducing a sharp, biting sensation. Permanent in the air; almost insoluble in water, but soluble in 30 parts of alcohol and in 1 part of boiling alcohol. It is isomeric with mor- phine, and can be decomposed into piperic acid and a liquid alkaloid, piperidine. Dose.—1-10 grains (0.03-0.6 Gm.). Derivative Compound. Piperonal—Heliotropin.—Obtained from Piperic Acid by oxidation. It occurs in small white crystals, soluble in about 600 parts of cold water, and very readily soluble in alcohol and ether. The dose is 10-15 grains (0.6-1.0 Gm.). It has been used as an antiseptic and antipyretic. Physiological Action and Therapeutics of pepper and its preparations are almost identical with those of capsicum. Pepper, particularly piperin, possesses antiperiodic and anti- septic properties to a greater extent than capsicum. Myristica—MyrlsticaB—Nutmeg". XJ.8.P. Macis— Macidis— Mace. XT. 8. P. Origin.—The seed (Myristica) and the membrane, " arillode," AROMA TICS. 367 investing the kernel (Mace) of Myris-tica fragrans Houttuyn, a tree about 30 feet (9 M.) high, found in the Molucca Islands and cul- tivated in the East Indies. Oleum Mynsticae—Olei Myrlstica^—Oil of Nutmeg. U. 8. P. Origin.—A volatile oil distilled from Nutmeg. Description and Properties.—A thin, colorless or pale-yel- lowish liquid, having the characteristic odor of nutmeg and a warm, spicy taste. It becomes darker and thicker by age and ex- posure to the air. Soluble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—1-3 minims (0.06-0.18 Cc). Official Preparation. Spiritus Myrlsticae (5 per cent.)—Spiritus Myristicae—Spirit, or Essence, of Nutmeg.—Dose, 15-60 minims (1.0-4.0 Cc). Physiological Action and Therapeutics are the same as those of anise. Caryophyllus—Caryophylli—Cloves. XT. 8. P. Origin.—The unexpanded flowers of Eugenia aromatica (L.) O. Kuntze, a hard-wood, shrubby evergreen. It was originally found in the Molucca Islands, whence it was introduced and cultivated among the East Indian Islands. Description and Properties.—The buds are about f inch (15 Mm.) long, dark-brown, consisting of a subcylindrical, solid and glandular calyx-tube, terminated by four teeth and surmounted by a globular head, formed by four petals covering numerous curved stamens, and one style. A clove resembles a nail (L. clavus; Fr. clou). Cloves have a strong aromatic odor and a pungent, spicy taste, and when pressed or scratched emit oil. Constituents.—Cloves contain about 18 per cent, of a highly pungent volatile oil, 17 per cent, of tannin, and small quantities of fixed oil, gum, resin, etc. Two crystalline principles have been separated: caryophyllin, a white, resinous substance—a stearopten —odorless and tasteless ; and eugenin, a substance soluble in boil- 368 A TEXT-BOOK OF MATERIA MEDICA. ing alcohol and isomeric with eugenol, a constituent of the volatile oil Dose.—5-10 grains (0.3-0.6 Gm.). Official Preparation. Tinctura Lavandulae CompSsita—Tincturas Lavandulae Comp6sitae—Tinc- ture of Lavender.—Dose, £-1 fluidrachm (2.0-4.0 Cc). (Formula given under Lavender.) Oleum Caryophylli—Olei Caryophylli—Oil of Cloves. XT. 8. P. Origin.—A volatile oil distilled from Cloves. Description and Properties.—A pale-yellow, thin liquid, be- coming darker and thicker by age and exposure to the air, having a strongly aromatic odor of cloves and a pungent, spicy taste. Its specific gravity is 1.060-1.067. Soluble in an equal volume of alcohol, the solution being slightly acid to litmus-paper. Constituents.—Oil of cloves consists of a light and a heavy oil, the former a hydrocarbon, supposed to be inactive; the latter a phenol-like liquid termed eugenol, a colorless oil, with the odor of cloves, a specific gravity of 1.076 to 1.0785, yielding with bases crystalline salts. Schenck has demonstrated the presence of sali- cylic acid in oil of cloves. Dose.—1-10 minims (0.06-0.6 Cc). Allied Compounds and Derivatives. Benzoyl-eugenol.— Origin.—From Eugenol. Description and Properties.—It occurs in neutral, odorless, colorless, acicular crys- tals, having a feebly bitter taste; soluble in hot alcohol, ether, and chloroform, and insoluble in water. Dose.—Not yet determined. Cinnamyl-eugenol.— Origin.—A derivative of Eugenol. Description and Properties.—Colorless, odorless, tasteless, lustrous needles, soluble in hot alcohol, ether, and chloroform, and insoluble in water. Eugenol-acetamide.— Origin. — Obtained from Eugenol-acetic-ethyl-ether by treating with solution of Ammonia. It occurs as a crystalline powder. Physiological Action.—Externally and Locally.—Oil of cloves is a counter-irritant, local anesthetic, and germicide. Internally.—Its action is essentially the same as that of anise, it being a powerful carminative and stimulant. Therapeutics.—Externally and Locally.—Oil of cloves is em- ployed as a local anesthetic in toothache, earache, and neuralgia, and as a synergist to other counter-irritants, rubefacients, and anti- AROMA TICS. 369 septics. The eugenol-acetamide is a powerful local anesthetic, being analogous to cocaine in its action. Internally.—The therapeutics are similar to those of anise. The benzoyl-eugenol has been highly recommended by some prac- titioners as a valuable remedy in tuberculosis. The author has suc- cessfully employed the following combination as an antiseptic and antifermentative in gastric fermentation, to be administered either in soft capsules, with olive oil as a vehicle, or in the form of an emul- sion: R. Olei Caryophylli, Olei Cinnamomi, Olei Menthae Piperita^, Creasoti, da. mj. M. Sig.—Take at one dose. The better way to administer it is in the form of soft capsules, each capsule containing the above dose in about 6 minims (0.37 Cc.) of olive oil. One or two capsules should be given three times a day, after meals. Pimenta— Pimentae—Pimenta. XT. 8. P. (Allspice.) Origin.—The nearly ripe fruit of Pimenta officinalis Lindley, an evergreen tree about 30 feet (9 M.) high, indigenous in the West Indies, Central America, and the northern part of South America. Constituents.—The most important constituent is the volatile oil, of which the fruit yields from 3 to 4 per cent. Oleum Pimentae—Olei Pimentae—Oil of Allspice. XT. 8. P. Origin.—A volatile oil distilled from Pimenta. Description and Properties.—A colorless or pale-yellow liquid, having a strong, aromatic, clove-like odor, and a pungent, spicy taste. It becomes darker and thicker with age and exposure. With an equal volume of alcohol it forms a clear solution. Dose.—1-5 minims (0.06-0.3 Cc). Physiological Action and Therapeutics are similar to those of cloves. Oleum Cajuputi—Olei Cajuputi—Oil of Cajuput. U. 8. P. Origin.—A volatile oil distilled from the leaves of Melaleuca 24 370 A TEXT-BOOK OF MATERIA MEDICA. leucadendron L., a tree with crooked stem and scattered branches, resembling the weeping willow, indigenous in the East Indies. Description and Properties.—A light, thin, bluish-green, or, after rectification, colorless liquid, having a peculiar, agreeable and distinctly camphoraceous odor, and an aromatic, bitterish taste. Specific gravity, 0.922. With an equal volume of alcohol it affords a clear solution, which either has a slightly acid reaction or, in the case of the rectified oil, is neutral to litmus-paper. Constituents.—The chief constituent is cajuputol, the hydrate of the hydrocarbon cajuputene. Cajuputol is identical with euca- lyptol. Dose.—1-5 minims (0.06-0.3 Cc). Physiological Action and Therapeutics are identical with those of the oil of cloves. Cardamomum—Cardamomi—Cardamom. XT. 8. P. Origin.—The fruit of Elettaria repens (Sonnerat) Baillon, a per- ennial plant 6 to 10 feet (1.8-3 M-) high- Cardamom is indigenous in Hindustan, in the mountainous regions of Malabar. The same plant furnishes three varieties of cardamoms, known in commerce as the shorts, short-longs, and long-longs. Description and Properties.—Ovoid or oblong, from f to f inch (12 Mm.-2 Cm.) long, obtusely triangular, rounded at the base, beaked, longitudinally striate; of a pale-buff coior, three- celled, with a thin, leathery, nearly tasteless pericarp and a central placenta. The seeds are about \ inch (5 Mm.) long and \ inch (3 Mm.) broad, reddish-brown, angular, rugose, depressed at the hilum, surrounded by a thin membranous arillus. They have an agreeable odor and a pungent, aromatic taste. The seeds contain 10 per cent, of fixed oil and 4.6 per cent, of a volatile oil, besides albuminous matter, gum, starch, etc. The volatile oil possesses the odor and taste of the seeds, is colorless or yellowish, dextrogyre, contains oxygen, and has a specific gravity of 0.93 to 0.94. Dose.—5-15 grains (0.3-1 Gm.). Official Preparations. Tinctura Cardamomi (10 per cent.)—Tinctiirae Cardamomi—Tincture of Cardamom.—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Tinctura Cardamomi Comp6sita—Tincturae Cardamomi Compftsitse- AROMA TICS. Compound Tincture of Cardamom.—Cardamom, 20; Cinnamon, 20; Caraway, 10; Cochineal, 5; Glycerin, 50; Dilute Alcohol, q. s. ad 1000 parts. Dose, 1-2 fluid- drachms (4.0-8.0 Cc). Pulvis Aromaticus—Pulveris Aromatici—Aromatic Powder.—Ceylon Cinna- mon, 35; Ginger, 35; Cardamon, 15; Nutmeg, 15. Dose, 10-30 grains (0.6- 2.0 Gm.). There is also a fluid extract made from this powder. Dose, 10-30 minims (0.6- 2.0 Cc). Antagonists and Incompatibles.—Free acids are incompatible with the compound tincture of cardamom, separating insoluble car- minic acid in it. Physiological Action.—In this respect Cardamom conforms to the general character of the Aromatic Group. Therapeutics.—Essentially the same as for other members of this group. Cardamom is used principally as an adjuvant to other aromatics, stimulants, stomachics, and carminatives. Zingiber—Zingiberis—Ginger. XT. 8. P. Origin.—The rhizome of Zingiber officinale Roscoe, a perennial herb indigenous in tropical Asia and now cultivated in most tropi- cal countries. Description and Properties.—A thick, flattish rhizome from i to 4 inches (25 to 100 Mm.) long, with club-shaped lobes on one side; deprived of the corky layer, pale, buff-colored, striate, breaking with a mealy, rather fibrous fracture, showing numerous small, scattered resin-cells and fibro-vascular bundles, the latter enclosed by a nucleus sheath. Agreeably aromatic, and of a warm, pungent taste. Ginger contains from f to 2 per cent, of a pale-yellow, volatile oil, to which the ginger owes its aromatic properties; also a soft resin, giving to the drug its hot, pungent taste. The proportion of resin present varies with the different varieties of ginger, that from the East Indies yielding about 8 per cent., while the Jamaica product yields only about 5 per cent. Dose.—8-30 grains (0.5-2.0 Gm.). Official Preparations. ExtrSctum Zingiberis Fluidum—Extracti Zingiberis Fluidi—Fluid Ex- tract of Ginger.—Dose, 10-30 minims (0.6-2.0 Cc). Oleoresina Zingiberis—Oleoresinae Zingiberis—Oleoresin of Ginger.— Dose, 1-3 grains (0.06-0.18 Gm.). Pulvis Aromaticus—Pulveris Aromatici—Aromatic Powder.—Dose, 10-30 grains (0.6-2.0 Gm.). (Formula given under Cardamomum.) 372 A TEXT-BOOK OF MATERIA MEDICA. Pulvis Rhei Compdsitus—Pulveris Rhei CompSsiti—Compound Powder of Rhubarb.—Rhubarb, 25; Magnesia, 65; Ginger, 10 parts. Dose, }/2-\ drachm (2.0-4.0 Gm.). Syrupus Zingiberis—Syrupi Zingiberis—Syrup of Ginger.—Dose, yz-z drachms (2.0-8.0 Cc). Tinctura Zingiberis—Tinctiirae Zingiberis—Tincture of Ginger.—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Trochisci Zingiberis—Trochiscos (ace.) Zingiberis—Troches of Ginger.— Dose, use freely as required. Physiological Action and Therapeutics are almost identical with those of other aromatics. Ginger is especially valuable as a stomachic and carminative, to stimulate the stomach, improve the appetite, and relieve flatulency and colic. It is a safe and efficient domestic remedy for the relief of simple diarrhea. It is also much used as a corrective to modify the taste and action of other medicines. Calamus—Calami—Calamus. XT. 8. P. (Sweet Flag.) Origin.—The rhizome of Acorus Calamus L., a plant indige- nous in North America, Europe, and Western Asia, growing in swamps and along the shores of streams and ponds. Description and Properties.—Calamus is found in subcylin- drical sections of various lengths, about I inch (2 Cm.) broad, externally reddish-brown, internally whitish, of a spongy texture, breaking with a short, corky fracture, showing numerous oil-cells and scattered wood-bundles. It has a strong aromatic, fragrant odor, and a warm, peculiar, bitterish taste. Calamus contains from 1 to 2 per cent, of volatile oil possessing the odor and taste of cal- amus, a glucosid (acorin) in the form of a bitter, yellow syrupy liquid, besides calamine, choline, resin, starch, and mucilage. Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparation. Extr3ctum Calami Fluidum—Extr3cti Calami Fluidi—Fluid Extract of Calamus.—Dose, 15-60 minims (1.0-4.0 Cc). Physiological Action and Therapeutics.—The action of cala- mus is similar to that of anise, but it is more tonic than the latter. Large doses of the volatile oil produce tetanic convulsions. It is used for the same purposes as anise, but probably possesses more stomachic and carminative properties. AROMA TICS. 373 Oleum Gaultheriae—Olei Gaultheriae—Oil of Winter- green. XT. 8. P. Origin.—A volatile oil distilled from the leaves of Gaultheria procumbens L., a small evergreen plant indigenous in the northern hemisphere and bearing a scarlet, fleshy, berry-like fruit. Description and Properties.—The volatile oil is a colorless or yellow, or occasionally reddish, liquid, having a characteristic, strongly aromatic odor, and a sweetish, warm, and aromatic taste. Specific gravity, 1.175 to 1.185. It consists almost entirely of methyl salicylate. It should be kept in well-stoppered bottles, protected from light. Dose.—2-10 minims (0.12-0.6 Cc). Official Preparation. Spiritus Gaultheriae—Spiritus Gaultheriae—Spirit of Gaultheria (Essence of Wintergreen).—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Physiological Action.—Externally and Locally.—Oil of winter- green is a stimulant and a powerful antiseptic. Internally.—Its action is identical with that of salicylic acid and its salts, but it does not depress the heart like the latter drugs. Therapeutics.—Externally and Locally.—Used for the same purposes as oil of cloves and other aromatic oils. Internally.—Used for the same purposes as salicylic acid. Oleum Lavandulae Florum—Olei Lavandulae Florum — Oil of Lavender Flowers. XT. 8. P. Origin.—A volatile oil distilled from fresh flowers of Lavandula officinalis Chaix. Lavender is native to Southern Europe and cultivated in gardens. Description and Properties.—A colorless or yellowish liquid, having the fragrant odor of lavender flowers and a pungent and bitterish taste. Soluble in all proportions of alcohol. It should be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Spiritus Lavandulae (5 per cent.)—Spiritus Lavandulae—Spirit of Lavender. —Dose, y2-i fluidrachm (2.0-4.0 Cc). Tinctura Lavandulae Composita—Tincturas Lavandulae Compdsitae—Com- 374 A TEXT-BOOK OF MATERIA MEDICA. pound Tincture of Lavender.—Oil of Lavender, 8; Oil of Rosemary, 2; Cassia Cinnamon, 20; Cloves, 5; Nutmeg, 10; Red Saunders, 10; Alcohol, 0.7; Water, 250; Diluted Alcohol, q. s. ad 1000 parts. Dose, yz-\ fluidrachm (2.0-4.0 Cc). Com- pound Tincture of Lavender is an ingredient of Liquor Potassii Arsenitis. Physiological Action and Therapeutics are the same as those of other volatile oils mentioned in this group. Mentha Piperita—Menthae Piperitae—Peppermint. V. 8. P. Origin.—The leaves and tops of Mentha piperita Smith, a perennial plant found in damp places in England and other Euro- pean countries and in North America. Peppermint contains about 1 per cent, of a volatile oil—its most important constituent. Official Preparation. Spiritus M6nthae Piperitae (10 per cent.)—Spiritus Menthae Piperitae—Spirit, or Essence, of Peppermint.—Dose, 5-60 minims (0.3-0.4 Cc). Spirit of Peppermint is an ingredient of Mistura Rhei et Sodae. Oleum Menthae Piperitae—Olei Menthae Piperitae— Oil of Peppermint. XT. 8. P. Origin.—A volatile oil distilled from Peppermint. Description and Properties.—A colorless or yellowish or greenish-yellow liquid, becoming darker and thicker by age and exposure to the air, having the characteristic strong odor of pep- permint, and a strongly aromatic, pungent taste, followed by a sensation of cold upon inhalation. It forms a clear solution with an equal volume of alcohol, becoming turbid when further diluted, and is soluble in all proportions in carbon disulphide and in glacial acetic acid. When exposed to a freezing temperature the oil becomes thick and cloudy, and separates crystals of menthol, to which it owes its peculiar odor. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua M6nthae Piperitae (0.2 per cent.)—Aquae Menthae Piperitae—Pepper- mint Water.—Dose, yz-\ fluidounce (15.0-30.0 Cc). Trochisci Menthae Piperitae (.01 Cc. in each)—Trochiscos (ace.) Menthae Piperitae—Troches bf Peppermint.—Dose, freely as desired. AROMA TICS. 375 Menthol—Menthol—Menthol. XT. 8. P. Origin.—A stearopten obtained from the official Oil of Pepper- mint or from Japanese or Chinese Oil of Peppermint. Description and Properties.—Colorless, acicular or prismatic crystals, having a strong and pure odor of peppermint, and a warm, aromatic taste, followed by a sensation of cold when air is inhaled. Menthol is but slightly soluble in water, but imparts to the latter its odor and taste. It is freely soluble in alcohol, ether, chloroform, carbon disulphide, and glacial acetic acid. Dose.—\-2 grains (0.03-0.12 Gm.). Allied Compounds. Benzoate of Menthol; Chloral Menthol.—These combinations are quite active local anesthetics and analgesics. Physiological Action and Therapeutics.—Externally and Lo- cally.—Menthol is an antiseptic, antipruritic, analgesic, and anes- thetic, as well as a germicide. It is used for the same purposes as oil of cloves. It is used extensively in headache, being rubbed on the forehead. Owing to its analgesic properties, it is used in the form of an ointment in various strengths for painful hemor- rhoids, burns, boils, and superficial inflammations. The oil of peppermint, or menthol, is an ingredient of many sprays and lotions for the treatment of diseases of the ear, nose, and throat. As an antipruritic menthol is a valuable remedy to relieve the itching of eczema, pruritus, urticaria, etc. It should be dissolved in oil for this purpose—in severe cases 50 grains to 1 ounce (3.2 Gm. to 30.0 Cc). Internally.—The uses of oil of peppermint are similar to those of other aromatic oils, it being a valuable carminative, stimu- lant, antifermentative, and antispasmodic. In small doses menthol has been given to allay nausea and vomiting and to relieve the pain of gastralgia. Mentha Viridis—Menthae Viridis—Spearmint. XT. 8. P. This is one of the mints, found in the same localities as peppermint, and containing, like the latter drug, a volatile oil forming its active constituent. It possesses milder properties than peppermint, although similar to it in its action and uses. To some 376 A TEXT-BOOK OF MATERIA MEDICA. people it has a more agreeable taste than peppermint, and in infantile cases it is usually preferred. Official Preparations. Aqua Menthae Viridis—Aquae Menthae Viridis—Spearmint Water. Spiritus Menthae Viridis—Spiritus Menthae Viridis—Spirit, or Essence, of Spearmint. The dose of the oil of spearmint and of the above preparations is the same as for the corresponding oil and preparations of peppermint. Thymol—Thymol-Thymol. XT. 8. P. Origin.—A phenol or stearopten occurring in, and obtained by, freezing or distilling the volatile oils of Thymus vulgaris, Thymus monarda, and Carum ajowan. Description and Properties.—Large, colorless, translucent crystals of the hexagonal system, having an aromatic, thyme-like odor, and a pungent aromatic taste, with a very slight caustic effect upon the lips. Its specific gravity as a solid is 1.069, but when liquefied by fusion it is lighter than water. It is soluble in about 1200 parts of water and in less than its own weight of alcohol, ether, or chloroform; also readily soluble in carbon disulphide, glacial acetic acid, and in fixed or volatile oils. When triturated with about equal quantities of camphor, menthol, or chloral, it liquefies. Dose.—1-5 grains (0.06-HO.3 Gm.). Allied and Derivative Compound. Thymacetin, a derivative of thymol, prepared after the manner of phenacetin, and holding the same relation to thymol as phenacetin does to phenol (carbolic acid). It is a white, crystalline powder, sparingly soluble in water. Dose, 3-10 grains (0.2-0.6 Gm.). Physiological Action and Therapeutics are similar to those of phenacetin, thymace- tin possessing marked analgesic and hypnotic properties. Physiological Action.—Thymol is a powerful antiseptic, being ten times less poisonous than carbolic acid, yet as an antiseptic far superior to it. While stimulant, it is not irritant or corrosive. It is also a deodorant, disinfectant, parasiticide, and local anesthetic, as well as an antipruritic, antipyretic, and antifermentative. Absorption and Elimination.—It is eliminated chiefly by the lungs and kidneys, producing some irritation at the points of elimination. The urine is increased in quantity, often assuming a dark greenish hue. AROMA TICS. 377 Untoward Action.—The following symptoms have been pro- duced by the administration of large doses: burning sensation in the mouth and stomach, persisting in some instances for days, accompanied by pain and tenderness under pressure. According to Balz, " perspiration is sometimes observed, and occasionally a transient buzzing in the ears and deafness." Poisoning.—In addition to untoward manifestations, there may be nausea and vomiting, profuse sweating, great reduction of tem- perature, dizziness, violent delirium, and collapse. Therapeutics.—Externally and Locally.—The applications of thymol in surgery are identical with those of carbolic acid. Among surgeons who recommend and use it is Mr. Spencer Wells, who employs it in a solution of I : IOOO for spray, irrigation, sponges, instruments, and all other antiseptic purposes. Crocker in 1878 introduced it as an efficient remedy in certain skin diseases. It probably owes its value in these cases to its anti- pruritic and antiparasitic properties. It is also extensively used in diseases of the nose, throat, and ear, and in certain disorders of the genito-urinary tract. Thymol is also administered by inhalation in certain broncho-pulmonary disorders. Internally.—Thymol is used for the same purposes as other antiseptics, such as carbolic acid, resorcin, beta-naphtol, etc. Martini highly recommends it as an intestinal antiseptic in the treatment of diarrhea, dysentery, and typhoid fever. Bulfalini has employed it with some success in limiting fermen- tation during a proteid diet in the treatment of diabetes. It has also been favorably recommended in phthisis, vesical catarrh, sto- matitis, and diphtheria. Administration.—It may be applied externally in solution (1 : 1000), as an ointment (1-10 per cent), or in the form of thymol gauze as a surgical dressing (1 per cent, of thymol). For internal use it should be given in pills or capsules. Carum—Cari—Caraway. XT. 8. P. Origin.—The fruit of Carum Carvi L., a biennial plant native to Central and Western Asia. It is cultivated in Europe and in the United States. Description and Properties.—Oblong, laterally compressed, about \ to \ inch (4-5 Mm.) in length, tapering somewhat at the 378 A TEXTBOOK OF MATERIA MEDICA. ends, brown, with five yellowish, filiform ribs, and six oil-tubes. Caraway has an agreeable odor and a sweetish, spicy taste. Constituents.—It contains from 5 to 7 per cent, of a volatile oil. Dose.—15-30 grains (1.0-2.0 Gm.). Official Preparation. Tinctura Cardamomi Compbsita (10 per cent.)—Tinctiirae Cardamomi Comp&sitae—Compound Tincture of Cardamom.—Dose, 1-2 fluidrachms (4.0- 8.0 Cc). (Formula given under Cardamomum.) Oleum Cari—Olei Cari—Oil of Caraway. XT. 8. P. Origin.—A volatile oil distilled from Caraway. Description and Properties.—A colorless or pale-yellow, thin liquid, having the characteristic aromatic odor of caraway and a mild, spicy taste. Soluble in an equal volume of alcohol, this solution being neutral to litmus-paper. By fractional distillation the oil may be separated into two portions: a light hydrocarbon with but little odor and taste, carvene, and a heavy oil having an agreeable caraway odor, carvol, and isomeric with menthol, myristicol, and thymol. Dose.—1-10 minims (0.6-0.66 Cc). Official Preparation. Spiritus Juniperi Comp6situs (0.05 per cent.)—Spiritus Juniperi Comp8siti— Compound Spirit of Juniper.—Oil of Juniper, 4; Oil of Caraway, \; Oil of Fennel, yz ; Alcohol, 0.7; Water, q. s. ad iooo parts. Dose, 2-4 fluidrachms (8.0-15.0 Cc). Physiological Action and Therapeutics.—The same as those of the other aromatic oils. CLASS HI-SYMPTOM MEDICINES. GROUP I.—ANTISPASMODICS. Antispasmodics are remedies used to allay spasm and quiet nervous excitement or improve unfavorable conditions of the mind, as in cases of convulsions, hysteria, melancholia, hypo- chondriasis, etc They act as stimulants to the brain and higher nervous centers, and as depressants of the lower centers, diminish- ing muscular activity and, partly through their action upon the higher nervous centers, increasing the co-ordinating power. They are to a considerable degree cardiac stimulants, diaphoretics, ex- pectorants, and antiseptics. Asafcetida—Asafcetidae—Asafetida. XT. 8. P. Origin.—A gum resin obtained from the root of Ferula fcetida (Bunge) Regel, a large perennial herb found in Turkestan, Western Thibet, and Western Afghanistan. Description and Properties.—Irregular masses composed of whitish tears imbedded in a yellowish- or brownish-gray, sticky mass. The tears when hard break with a conchoidal fracture, showing a milk-white color, which changes, on exposure, to pink, and finally to brown. The drug has a persistent alliaceous odor and a bitter, alliaceous, acrid taste. When triturated with water it yields a milk-white emulsion, which becomes yellow upon the addi- tion of ammonia water. It is partly soluble in ether, and at least 60 per cent, of it should dissolve in alcohol. Dose.—5-8 grains (0.3-0.5 Gm.). Official Preparations. Emiilsum Asafcetidae—Emttlsi Asafcetidae—Emulsion of Asafetida. —Dose, 2-4 fluidrachms (7.39-15 Cc). Pilulae Aloes et Asafcetidae—Pilulas (ace) Aloes et Asafcetidae.—Pills of Aloes and Asafetida.—Dose, 2 to 5 pills. Pilulas Asafcetidae—Pilulas (ace.) Asafcetidae—Pills of Asafetida.—Dose, 2 to 5 pills. Tinctura Asafcetidae—Tincturas Asafcetidae—Tincture of Asafetida (20 per cent.).—Dose, 10-40 minims (0.6-2.5 Cc). 379 380 A TEXT-BOOK OF MATERIA MEDICA. Ammonlacum—Ammonlaci—Ammoniac. XT. 8. P. Origin.—A gum resin obtained from Dorema Ammoniacum Don, a plant 6 or 7 feet (2 M.) high, found in the deserts and barren regions of Persia and Tartary. Description and Properties.—Roundish tears, y^g—| inch (1.5- 12 Mm.) in diameter; externally pale yellowish-brown, internally milk-white; brittle when cold, and breaking with a flat, conchoidal, and waxy fracture ; or the tears are superficially united into irreg- ular masses without any intervening dark-colored substance. It has a peculiar odor and a bitter, acrid, and nauseous taste. When triturated with water it readily yields a milk-white emulsion. It contains from 1.8 to 4 per cent, of volatile oil, 70 to 72 per cent. of resin, and 18 to 22 per cent, of gum. Dose.—2-10 grains (0.12-0.6 Gm.). Official Preparations. EmplSstrum Ammonlaci cum HydrSrgyro—EmplSstri AmmonTaci cum Hydrargyro—Ammoniac Plaster with Mercury.—For external use. Emiilsum Ammonlaci—Emiilsi Ammonlaci—Emulsion of Ammoniac (4 per cent.).—Dose, yz-\ fluidounce (15 to 30 Cc). Camphora—Camphorae—Camphor. XT. 8. P. Origin.—A stearopten (of the nature of a ketone) obtained from Cinnamomum camphora L., and purified by sublimation. The camphor laurel is a handsome tree 25 to 30 feet (7.5—9 M.) high, indigenous in Eastern and Southeastern Asia, and cultivated in Italy as an ornamental tree. Description and Properties.—White, translucent masses, of a tough consistence and crystalline structure, readily pulverizable in the presence of a little alcohol, ether, or chloroform; having a penetrating, characteristic odor and a pungently aromatic taste. Very sparingly soluble in water, but readily soluble in alcohol, ether, chloroform, carbon disulphide, benzin, and in fixed and vola- tile oils. When camphor is triturated in about molecular proportions with menthol, thymol, phenol, or chloral hydrate, liquefaction ensues. It melts at 1750 C. (3470 F.), boils at 2040 C. (399.20 F.), and is inflammable, burning with a luminous, smoky flame. On exposure to the air it evaporates more or less rapidly at ordinary temperatures, and when moderately heated it sublimes without leaving a residue. ANTISPASMODICS. 38l From camphor may be obtained a number of interesting com- pounds, such as camphoric acid, cymol, etc. The drug should be kept in well-closed vessels, in a cool place. Dose.—2-10 grains (0.12-0.6 Gm.). Official Preparations. Aqua Camphorae—Aquae Camphorae—Camphor Water (0.8 per cent.).__ Dose, \-2 fluidounces (15-30 Cc). LinimSntum Camphorae—LinimSnti Camphorae—Camphor Liniment.__ Camphor, 20; Cotton Seed Oil, 80 parts. For external use. LinimSntum Saponis—Linim&nti Saponis—Soap Liniment (4.5 per cent.).__ For external use. Spiritus Camphorae—Spiritus Camphorae—Spirit of Camphor (10 per cent.). —Dose, 5-40 minims (0.3-2.6 Cc). Tinctura Opii Camphorata—Tinctiirae Dpii Camphoratae—Camphorated Tincture of Opium (0.4 per cent.).—Dose, 1-4 fluidrachms (4-15 Cc). Camphora Monobromata—Camphorae Monobro- matae—Monobromated Camphor. XT. 8. P. Origin.—Prepared by heating Camphor and Bromine, dissolving in Benzin, and crystallizing from hot Alcohol. Description and Properties.—Colorless, prismatic needles or scales, of a mild, camphoraceous odor and taste, permanent in the air, unaffected by light, and neutral to litmus-paper. Almost in- soluble in water; freely soluble in alcohol, ether, chloroform, hot benzin, and fixed and volatile oils; slightly soluble in glycerin. Dose.—2-5 grains (0.12-0.3 Gm.). Acidum CamphSricum—Acidi Camphdrici—Camphoric Acid.—Origin.— Obtained by the oxidation of Camphor through the action of Nitric Acid. Description and Properties.—White, acicular crystals, odorless, and of a weak, acid, and slightly astringent taste. Soluble in hot water, alcohol, ether, and fatty oils; almost insoluble in cold water. Dose.—10-30 grains (0.6-2.0 Gm.). Valeriana—Valerianae—Valerian. XT. 8. P. Origin.—The rhizome and roots of Valeriana officinalis L., an herbaceous perennial 2 to 4 feet (0.6-1.2 M.) high, a native of Europe, and cultivated to some extent in New England and New York. Description and Properties.—The rhizome varies in length be- tween \ and 1^ inches (1-3 Cm.), and has nearly an equal diameter, thick, upright, subglobular or obconical, truncate at both ends, brown or yellowish-brown, internally whitish or pale-brownish, 382 A TEXT-BOOK OF MATERIA MEDICA. with a narrow circle of white wood under the thin bark. Roots numerous, slender, brittle, brown, with a thick bark and slender, ligneous cord. Odor peculiar, becoming stronger and unpleasant on keeping; taste camphoraceous and somewhat bitter. Valerian contains valerianic and other acids and a volatile oil. Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparations. Extractum Valerianae Fluidum—Extracti Valerianae Fluidi—Fluid Ex- tract of Valerian.—Dose, 15-60 minims (1.0-4.0 Cc). Tinctura Valerianae—Tinctiirae Valerianae—Tincture of Valerian (20 per cent.).—Dose, 1-2 fluidrachms (4-8 Cc). Tinctura Valeriana Ammoniata—Tinctiirae Valerianae Ammoniatae—Am- moniated Tincture of Valerian (20 per cent.).—Dose, 30-60 minims (2.0-4.0 Cc,). Ammonii Valerianas—Ammonii Valerianates—Am- monium Valerianate. XT. 8. P. Origin.—Obtained by saturating Valerianic Acid with Gaseous Ammonia and crystallizing. Description and Properties.—Colorless or white quadrangular plates, emitting the odor of valerianic acid; of a sharp and sweet- ish taste; deliquescent in moist air. Very soluble in water and in alcohol. Ammonium valerianate should be kept in well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Ferri Valerianas—Ferri Valerianates—Ferric Valerianate. XT. 8. P. Origin.—Prepared by mixing solutions of Ferric Sulphate and Sodium Valerianate and washing the precipitate formed. Description and Properties.—A dark brick-red amorphous powder of somewhat varying chemical composition, having the odor of valerianic acid and a mildly styptic taste; permanent in dry air. Insoluble in cold water, but readily soluble in alcohol. Ferric valerianate should be kept in small, well-stoppered bottles, in a cool and dark place. Dose.—1-3 grains (0.6-0.2 Gm.). Zinci Valerianas—Zinci Valerianates—Zinc Vale- rianate. XT. 8. P. Origin.—Obtained by evaporating hot solutions of Zinc Sul- ANTISPASMODICS. 383 phate and Sodium Valerianate, the zinc valerianate crystallizing out. Description and Properties.—White, pearly scales, having the odor of valerianic acid and a sweetish, astringent, and metallic taste. On exposure to air it slowly loses valerianic acid. Soluble in about 100 parts of water and in 40 parts of alcohol. It should be kept in small, well-stoppered bottles. Dose.—J-3 grains (0.03-0.2 Gm.). Antagonists and Incompatibles.—The actions of asafetida, ammoniac, and camphor are opposed by arterial sedatives, acids, and neutral salts, while quinine, digitalis, and ergot antagonize the action of valerian. Water and aqueous solutions precipitate camphor from its alco- holic solution. Synergists.—The antispasmodics are synergistic to each other. They are also aided in their action by the aromatics and many of the gum resins and balsams, alcohol, ether, etc. These remedies are so nearly alike in their action that their physiological effects will here be considered as a whole, mention being made of any marked difference in their individual action should it exist. Physiological Action.—Externally and Locally.—The only member of this group having any special local action is camphor. This drug has an anesthetic effect upon the unbroken skin, but in a concentrated state is very irritating to mucous membranes, and may even produce inflammation and sloughing. Camphor is also a powerful parasiticide. Digestive System.—In medicinal doses antispasmodics stimulate the digestion and augment the secretions from the gastro-intestinal tract. They also stimulate peristalsis, and are active carminatives and calmatives to the digestive tract. Asafetida is the most laxa- tive of all. Large doses of any antispasmodic cause nausea, vomiting, and purging, camphor being the most irritant, and in toxic doses acting as an irritant poison. Circulatory System.—In medicinal doses the antispasmodics in- crease the force of the heart and elevate arterial tension. Asafetida exerts the greatest influence on menstruation, while camphor has the most marked effect upon the general circulation. Nervous System.—It is probably upon the nervous system that 384 A TEXT-BOOK OF MATERIA MEDICA. these drugs exert their most potent action. They are all stimu- lants to some portion of the cerebrum. Their precise influence upon the brain is, however, unknown, and in order to form a better conception of the action of these drugs some explanation of the function of the brain is necessary. The cerebrum consists of a complex mechanism, each localized area having a definite physiological function, the relations of the several areas differing one from another, some being equal and others subordinate. These areas probably are—1. Perception areas —five; 2. Judgment areas; 3. Emotion areas; 4. Motor areas; 5. Inhibitory areas. These areas are all connected by commissural fibers. The emotion and motor areas are controlled by the functional influence of the areas of inhibition. Sometimes disturbing influ- ences modify this adjustment, so that the lower areas act inde- pendently. The perturbation may be due either to deficient power of inhibition, to unusual activity of the lower areas, or to lack of co-ordination in the connecting fibers by which the unimpeded areas are held in subjection. Even a slight loss of command occasions in the subject an irritability readily aroused, together with annoy- ance from trivial causes which under normal conditions would be inconsequential. The mental derangement accompanying these phenomena we call nervousness, and when the symptoms become still further aggravated the mental disturbance known as hysteria results. Again, the emotion and cerebral motor areas may become so far freed from restraint that even violent hysterical symptoms ensue, including convulsions or coma. Obviously, therefore, the only remedy for the malady is to restore the equilibrium between the inhibitory and lower areas. This may be effected either by stimulation of the debilitated areas of inhibition, by depression of the over-active lower areas, or by supplying a possible deficiency in the conductive force of the fibers. The first of these desiderata may be attained by improving the circulation and affording stronger nutriment. By dilating the arterioles small doses of alcohol and ether accomplish this object, and may act favorably in an attack of hysteria. Alcohol, however, in large doses exerts a deleterious influence upon the commissural fibers, resulting in incoherence. Arsenic, quinine, cod liver oil, and iron by their tonic effects may, under continued dosage, abort access of hysteria. ANTISPASMODICS. 385 Other remedial agents which tend to act directly upon the cell- ular structure of the inhibitory areas, and thereby invigorate them, are the drugs under consideration—the antispasmodics. By stim- ulation of the inhibitory centers they may allay the spasms of hysteria. The morbid activity of the lower areas may be ameliorated by depressant remedies, among which morphine and the bromides may prove particularly beneficial. The antispasmodics, it will be seen, appear to exert a calmative influence upon certain nerve-centers, allaying nervous excitement and muscular spasm. They produce a gentle, exhilarating effect upon the brain, and diffuse a feeling of warmth in the system. It is claimed that they also possess mildly aphrodisiac properties. Excessive doses, on the other hand, may occasion delirium, even merging in maniacal excitement, this being particularly true of camphor, toxic doses of which drug, in the monobromated form, cause muscular weakness, passing into paralysis, followed by stupor and collapse. Valerian may occasion formication of the hands and feet and a condition of melancholia. Respiratory System.—The antispasmodics are all respiratory stimulants and stimulant expectorants. Large doses of mono- bromated camphor depress respiration. Absorption and Elimination.—These drugs are readily absorbed from the stomach or rectum, and are eliminated by the intestinal tract, kidneys, lungs, skin, and mucous membranes generally, stim- ulating the glands in these structures, and, in the case of asafetida and valerian, imparting the characteristic odor of these drugs to the excretions. Temperature.—Unaffected except by monobromated camphor, which in large doses acts as a depressant. Uterus.—The menstrual flow and sexual appetite are increased at first; continued dosage, however, has a depressing effect upon the generative functions, camphor perhaps being the most active in large doses. It is said that the sexual passion of cats is extraordinarily excited by valerian, probably because of its odor. Untoward Action.—Camphor may occasion mental confusion, headache, vertigo, dryness of the mouth and thirst, flushing of the face, clammy perspiration, disturbances of digestion, and strangury. Musk produces similar untoward manifestations, with a sense of pressure in the eye-sockets and marked sexual excitement. The 25 386 A TEXT-BOOK OF MATERIA MEDICA. symptoms caused by valerian are very much the same, although, as in the untoward action of asafetida, there is more disturbance of the gastro-intestinal tract, such as nausea, borborygmi, diarrhea, and colicky pains. Barbier noted visual hallucinations in a person treated with valerian. Poisoning.—The symptoms of poisoning resemble the untoward action, save that the effects may be more marked, with greater irritation of the intestinal tract and more pronounced cerebral disturbance. Treatment of Poisoning.—Coffee and the arterial sedatives an- tagonize the action of camphor. The patient should be treated symptomatically; emetics or the stomach-pump should be employed, and measures taken to favor elimination. Excessive nervous mani- festations may be controlled by opium or the bromides. Therapeutics.—Externally and Locally.—The only member of the present group used locally is camphor, its anesthetic and anti- pruritic properties rendering it of great value in the treatment of diseases of the skin. "Anderson's powder," composed of pulver- ized camphor, starch, and zinc oxide, is a very soothing and efficient dusting powder in erythema, erythematous eczema, and urti- caria. " Camphor-ice " and ointments of camphor, alone or com- bined with salicylic acid, are used for " chapped hands," ulcers, etc. Various inhalants and powders containing camphor have been successfully employed in the treatment of ozena, acute coryza, and laryngitis. Suppositories of camphor afford great relief in cases of chordee, while the camphor liniment is a household remedy for sprains, bruises, chilblains, etc. Camphor chloral makes an efficient local application in neur- algia, and the campho-phenique is an excellent antiseptic, when mixed with oil being an efficient dressing for wounds. Internally.—The disagreeable odor and taste of many of the antispasmodics—notably asafetida, valerian, and musk—greatly limit their use. Asafetida is an exceedingly valuable stomachic tonic, and singularly beneficial in the atonic dyspepsia and constipa- tion of nervous and anemic women. It stimulates the appetite and digestion, acts as a laxative, and allays much of the nervousness and melancholia from which these patients so frequently suffer. Asafetida is a peculiarly potent remedy in relieving parox- ysms of hysteria, and there is probably no more effective agent for the alleviation of flatulent colic of infants and various infantile convulsions. ANTISPASMODICS. 387 Chronic bronchitis and bronchorrhea, especially when attended with spasmodic dyspnea, are very favorably influenced by this rem- edy. Its antispasmodic action renders asafetida of considerable value in whooping cough and the sympathetic cough of mothers. The drug has been highly recommended in chorea occurring in young girls about the age of puberty, who are weak, anemic, and suffering from menstrual irregularities. The emulsion of asafetida, used as an enema, often affords prompt and complete relief in the tympanitis of typhoid fever. Ammoniacum is chiefly employed as a stimulant expectorant in chronic bronchitis. Camphor is a remarkably efficient anodyne, an- tispasmodic, and carminative in flatulent colic, diarrhea of infants, and the diarrhea of the aged produced by relaxation of the bowels. For many years camphor has been considered a valuable remedy in the diarrhea ushering in an attack of Asiatic cholera. The various spasmodic and hysterical disorders for which asa- fetida is recommended are also greatly benefited by camphor. It is, moreover, a serviceable stimulant expectorant and a potent remedy, especially monobromated camphor, to allay sexual excite- ment and for the relief of chordee. It has likewise proved effica- cious in spermatorrhea. Mania, especially the puerperal form, delirium tremens, and melancholia have readily yielded to full doses of camphor. The internal use of the drug has appeared to prove beneficial in senile gangrene. Dysmenorrhea and the after-pains of labor are greatly relieved by camphor, either alone or combined with morphine. The drug has been used extensively as a cardiac stimulant and to allay the delirium and restlessness oi typhoid, typhus, and exanthematous fevers. Camphoric acid is an efficient remedy in checking the night- sweats oi phthisis and excessive perspiration in acute rheumatism. It is recommended by Wood in enuresis and spermatorrhea. While not so efficient as camphor or monobromated camphor in spas- modic and hysterical disorders, it has proved of some benefit in these conditions. Camphoric acid in from 1 to 2 per cent, solution is useful in the treatment oi acute pharyngitis and acute coryza, being employed in the form of a gargle or spray. Camphoric acid has been used internally to acidify ammoniacal urine in cystitis. Valerian has been employed for the same class of disorders as 388 A TEXT-BOOK OF MATERIA MEDICA. those treated with asafetida, but seems to be superior to the latter in mitigating the hysterical manifestations and vaso-motor disturb- ances occurring at the menopause. The hypochondriasis of feeble and morbidly sensitive girls and women is usually soon relieved by this remedy. Nervous headache and vertigo due to cerebral anemia and the irregular distribution of blood are, in the majority of cases, promptly relieved by valerian or the ammonium valerianate. Valerian has been favorably recommended in both diabetes insipidus and mellitus. Contraindications.—There are no special contraindications to the use of antispasmodics other than in acute inflammations of the gastro-intestinal tract, when camphor should not be employed. Administration.—Any of the preparations of the various mem- bers of this group may be used. Asafetida and camphor in sub- stance should always be given in the form of pills or capsules. Camphoric acid is best administered in capsules. GROUP II.—ANTIPYRETICS. Acetanilldum—Acetanilldi—Acetanilid. Origin.—An acetyl derivation of Aniline. Description and Properties.—White, shining, micaceous, crys- talline laminae, or a crystalline powder, odorless, faintly burning taste, permanent in air, neutral to litmus-paper. It is soluble, at lS° C. (590 F.), in 194 parts of water, 5 parts of alcohol, 18 parts of boiling water, and in 0.4 part of boiling alcohol; also in 18 parts of ether, and easily soluble in chloroform. Dose.—2-10 grains (0.1-0.65 Gm.). Physiological Action.—Externally and Locally.—Antiseptic, slightly sedative. 1 Antifebrin is a copyrighted name for Acetanilid, or Phenyl-acetamide, as it is sometimes called. The copyrighted word Antifebrin should never be used. The pro- prietary preparations like Antikamnia, Antinervin, Phenolyd, Exodyne, etc. are said, by different chemists who have analyzed them, to be mechanical mixtures of Acetanilid and one or more such substances as Sodium Bicarbonate, Caffeine, Ammonium Bromide, Salicylic Acid, Sodium Salicylate, etc. Such secret preparations should not be counte- nanced by medical men. Should a combination containing some of the aforesaid drugs be desired, a prescription for the same should be written, specifying the proportions wanted in each particular case, rather than prescribe a proprietary article costing a dollar or more an ounce, the same mixture being put up by any pharmacist for ten cents an ounce. AN TIP YRE TICS. 3^9 Internally.—Digestive System.—Non-irritating, sedative ; medi- cinal doses sometimes allay nausea. Circulatory System.—Acetanilid decreases the ozonizing func- tion and the oxygen-carrying power of the blood. The corpus- cles are unaffected under the influence of small doses, but toxic doses disorganize the corpuscles. When large doses are taken, or even small doses by one who has an idiosyncrasy against the drug, the arterial blood becomes venous in character, the normal alkalinity of the blood is decreased, and much of the hemoglobin is reduced to methemoglobin. Heart and Blood-vessels.—In medicinal doses the arterial ten- sion is slightly raised, while the heart is slowed. Toxic doses directly depress the heart and vaso-motor mechanism, causing an immediate fall of arterial pressure and great cardiac depression. Nervous System.—In medicinal doses acetanilid is a sedative to the sensory nerves and spinal cord. Small doses are mildly stim- ulant to the brain,, and under certain conditions the drug is a hypnotic. Toxic doses result in general anesthesia and abolitiont of reflexes, with paralysis of motor and sensory nerves. Respiratory System.—Medicinal doses produce no special effect. When toxic doses are given there is a rapid and labored respiration. Death is produced by respiratory failure, due to direct action of the drug upon the respiratory center, and indirectly by greatly de- creasing the ozonizing and oxygen-carrying power of the blood and by paralyzing the peripheral motor nerves. Absorption and Elimination.—Acetanilid is quite an active diuretic, especially increasing the excretion of urea, and to some extent the excretion of uric acid. After toxic doses have been taken the urine becomes dark or brownish in color, from the presence of disorganized corpuscular elements of the blood. It is also diaphoretic. Acetanilid is chiefly eliminated by the kidneys in the form of sulphate of para-amido-phenol. Temperature.—A full medicinal dose lowers a fevered tempera- ture within one hour after its administration, and the effect lasts about six hours. The drug acts both by increasing heat-dissi- pation and by decreasing heat-production, mainly by the latter method, and probably through the nervous system acting upon the heat-centers, and by contracting, and limiting oxidation in, the individual cells of the body. Toxic doses lower the temperature to below normal, and may produce collapse and rigors. 390 A TEXT-BOOK OF MATERIA MEDICA. Eye,—Medicinal doses have no apparent influence on the eye. Toxic doses, however, have produced contracted and motionless pupils. Untoward Action.—Under prolonged use of acetanilid conges- tion of the liver, kidneys, and spleen occurs. Paroxysms of sneezing have apparently been induced by a medicinal dose, and, under the same, redness of the skin, chilliness, and cyanosis have sometimes ensued. Poisoning.—The skin is cyanosed, the face is livid and anxious, and the body is covered with cold sweat. There may be vomiting; the pulse is soft, slow, and weak, accompanied by profound pros- tration. The respirations are first rapid and labored, and later slow and very shallow, death resulting usually from respiratory paraly- sis. After death the heart, liver, and kidneys are found in a state of acute fatty degeneration. Treatment of Poisoning.—Diffusible stimulants, like alcohol, in small doses, ammonia, and sulphuric ether. Coffee, atropine, and strychnine hypodermically as circulatory and respiratory stimu- lants. External heat and, if necessary, oxygen inhalations to over- come cyanosis. Therapeutics.—Externally and Locally.—Acetanilid has been locally applied for the treatment of chancre and chancroid, but there are other antiseptics which are generally considered to be more satisfactory. It is quite an active hemostatic, and may be used in epislaxis and hemoptysis. Internally.—The use of acetanilid in fevers has been practically abandoned by the great majority of clinicians. If an antipyretic of this character is indicated at all, it is in sthenic fevers, and then to be used only with great care. Its tendency to cause cardiac depression, profuse sweating, and collapse renders its use harmful, if not unsafe, in low conditions like typhoid fever and advanced phthisis. It may often be administered with good effect in the first stage of pneumonia. The headache, fever, and other unpleasant symp- toms in the exanthemata are greatly modified by its use, although when this drug is given to children they must be very carefully watched to avoid untoward effects. There is considerable difference of opinion in regard to the utility of acetanilid in rheumatism. Some authorities believe that it exer- cises a most favorable influence in the acute articular variety, being less apt to disturb the brain than salicylic acid or its salts. The ANTIPYRETICS. 391 drug certainly mitigates, and often entirely relieves, the pain and swelling, while it reduces the fever. Like salicylic acid, it has no power to prevent heart-complications, but, on the contrary, it should be used with great care, if at all, when such complications exist. It has no tendency to prevent relapses. The dose of acetanilid in acute rheumatism should not exceed 6 grains (0.5 Gm.) three times a day. Acetanilid is a very efficient analgesic, and the introduction of this drug, antipyrine, and other remedies of this character has enabled us to relieve the pains of certain spinal diseases more efficiently than was possible before. The crises of locomotor ataxia are quite promptly relieved by acetanilid. Neuralgias of every kind indicate its use. The pains of neuritis, lumbago, gastralgia, dysmenorrhea, sciatica, tabes dor- salis, and nearly every kind of headache usually yield to its anal- gesic influence. In many cases of chorea and epilepsy (especially the diurnal variety), and in those cases characterized by full habit and high arterial tension, the drug has often been employed successfully. Pains which are paroxysmal in character yield best to acetanilid. It quiets the excitement in mania a potu, and in exceptional cases lessens the paroxysms of whooping cough. In doses of 3-5 grains (0.2-0.32 Cc), thrice daily, acetanilid has proved efficient as a relief for sea-sickness. It has also been found serviceable in traumatic tetanus. The author has found it to be of great value in influenza, or " la gripped combined or given alternately with salol or sodium salicy- late. It is also highly praised in acute bronchitis. Contraindications.—In low fevers, at any rate not in repeated doses; in fatty or dilated heart, blood disorders, advanced tuber- cular disease, and exhaustion from hemorrhages. Administration.—It may be prescribed in powders, pills, com- pressed tablets, capsules, or alcoholic solution. A speedier effect is produced if it is taken dissolved in a small quantity of alcohol or wine diluted with water. The average dose as an antipyretic usually should not exceed 5 grains (0.3 Gm.); as an anodyne, 2-5 grains (0.1-0.3 Gm.). It may be repeated at intervals of about four hours or less, according to its effects. Its action in neuralgias, according to Hare, may be assisted by associating it with small doses of monobromated camphor. 392 A TEXT-BOOK OF MA TERIA MEDICA. Antipyrlna—Antipyrlna3—Antipyrine. Origin.—A Coal-tar derivative. Description and Properties.—A white, crystalline powder, odorless, of a slightly bitter taste, freely soluble in water, alcohol, and chloroform. Dose.—3-20 grains (o. 19-13 Gm.). Antagonists and Incompatibles.—Antipyrine is incompatible with spirit of nitrous ether and nitrous compounds, the chlorides of mercury, the iodides of arsenic and mercury, the ferric salts in solution, tincture of iodine, most of the vegetable astringents, car- bolic acid, chloral, beta-naphtol, sodium bicarbonate, sodium salicy- late, and the salts of quinine and caffeine. Synergists.—The same as for other members of this group. Physiological Action.—Digestive System.—Antipyrine differs from acetanilid in that it often produces vomiting. Respiratory System.—In medicinal doses it increases the number of respiratory movements. In every other respect it has the same action upon the respiration as acetanild. Absorption and Elimination.—Kidneys.—Antipyrine lessens the amount of urine, urea, and uric acid excreted, but increases the amount of sulphuric acid in the urine. Like acetanilid, toxic doses cause the urine to assume a dark or brownish color. It is more rap- idly eliminated than acetanilid, being detected in the urine within three hours after being taken. Eye.—Toxic doses have produced amblyopia and hallucinations of vision. Therapeutics.—The remarks on the therapeutics of acetanilid are applicable to this drug, although antipyrine is a more powerful antiseptic, analgesic, and local anesthetic As an analgesic it prob- ably ranks next to opium. The anesthesia produced by antipyrine often lasts for several hours or even days. In acute coryza and inflammation of the pharynx great relief is obtained by spraying the parts with a 2 or 4 per cent, solution, after applying a solution of cocaine to prevent the primary smarting and irritation which the antipyrine produces. A 20 per cent, solution has been used in otitis, and a 4 per cent. solution has been found very efficient in cystitis. Antipyrine has been used with some success in diabetes mellitus and malarial diseases, particularly in intermittent fever. It does not, however, possess the antiperiodic and specific action of quinine in malarial poisoning. ANTIPYRETICS. 393 Administration.—The drug is best given in water or some aromatic water or syrup. It may also be given hypodermically. In hemorrhage the powdered drug may be applied locally, or a 40 per cent, solution, which causes less irritation. From i—2 grains (0.03-0.12 Gm.), once or twice a day, is sufficient for children. Ordinarily a dose of 5 grains (0.3 Gm.) is sufficient for an adult. Phenacetin. Origin.—A Coal-tar derivative. Description and Properties.—A colorless, odorless, tasteless powder, or glistening, scaly crystals, sparingly soluble in cold water, more or less soluble in boiling water, and freely soluble in 16 parts of rectified spirits. Dose.—1-10 grains (0.06-0.6 Gm.). Physiological Action.—Phenacetin differs from acetanilid only in the following respects : Circulatory System.—Small doses increase the force of the heart, accelerate the pulse, and raise arterial tension. Large doses affect the blood and the circulatory system like acetanilid. Kidneys.—It is a diuretic, but not so active as acetanilid. When large doses have been taken the urine is dark-yellow in color and gives the reaction for sugar. As an antipyretic phenacetin is said to be slower in its action than acetanilid, nor is it so powerful as an analgesic and hypnotic. By many physicians the drug is considered one of the safest of the synthetical antipyretics, though in very large doses, accord- ing to Hare, it is more apt to disintegrate the blood than either antipyrine or acetanilid. It certainly has an advantage over many other antipyretics in being tasteless, seldom exciting nausea, exces- sive diuresis, diaphoresis, or diarrhea. The author's experience leads him to consider it as possessing a briefer antithermic action and a greater tendency to produce cyanosis and rigors than ace- tanilid or antipyrine. Therapeutics.—Phenacetin is given in the same class of diseases as acetanilid. Contraindications.—The same as for acetanilid. Administration.—The drug maybe dispensed in powders,pills, capsules, tablets, or suspended in mucilaginous drinks.1 1 Phenacetin may be adulterated with phenacetidin, a by-product in manufacture and a poisonous substance, which in small doses induces kidney trouble. Many of the toxic 394 A TEXT-BOOK OF MATERIA MEDICA. Phenocoll. Origin.—A combination of Para-amido Phenocoll and GlycocolL The phenocoll hydrochloride is the salt used in medicine. Description and Properties.—A white crystalline powder, sol- uble in 16 parts of water, and freely soluble in hot alcohol, forming a neutral solution. Dose.—3-15 grains (0.2-1.0 Gm.). Incompatibles.—All the alkalies. Physiological Action.—Phenocoll differs from acetanilid in no essential particulars other than the following: Circulatory System.—Its effect upon the heart and pulse is sim- ilar to that of acetanilid, but it has no influence upon the blood itself. Kidneys.—The excretion of nitrogen in the urine is increased. Temperature.—In febrile conditions it produces a decided fall of temperature within one hour after its administration by the stomach, caused by an enormous diminution of heat-production without any marked alteration of heat-dissipation. Therapeutics—Experience with phenocoll hydrochloride is yet too limited for us to draw any trustworthy conclusions as to its safety compared with the antipyretics previously mentioned or re- garding its real place in medicine. The results, thus far, have shown it to be comparatively safe—probably the safest of all antipyretics— and of value internally for all conditions benefited by the previously named antipyretics. It is not so valuable an antipyretic and anal- gesic in rheumatism as acetanilid or antipyrine, nor is it so efficient an analgesic in myelitis, sciatica, or neuralgia; but, on the other hand, it far surpasses these drugs in the treatment of intermittent fever, ranking next to quinine in malarial disorders. Pelletini, indeed, regards it as superior to all antimalarial reme- dies, and Bonetti considers it a real substitute for quinine. symptoms of acetanirid so closely resemble aniline-poisoning as to suggest the production of that substance in the blood. There is a close relationship between the two bodies, and there is some ground to suspect the occasional presence of aniline in samples. The important question of adulteration and impurity should not be lost sight of in consider- ing the ill effects of any drug. In the experience of the author, better results, in every particular, have been obtained from antipyrine than from either of the other antipyretics mentioned, so that he almost invariably uses it, both for adults and children, believing it the safest drug of its class, as well as the most certain and uniform in its action. These drugs are unquestionably given in too large doses by the majority of physi- cians, and persons suffering from high temperature are more susceptible to their untoward influences—like cyanosis, collapse, etc.—than those whose temperature is normal. ANTIPYRE TICS. 395 Phenocoll possesses the advantage of not producing the un- pleasant effects of quinine. It is a powerful antiseptic, and may be applied locally where a drug of that character is indicated. Contraindications.—Probably the same as for acetanilid. Administration.—Locally, the drug may be employed in solu- tion or in the form of an ointment in strengths varying from 5 to 20 per cent. Internally it may be administered, in the doses recom- mended, from three to five times a day, in powders, aqueous solu- tion, or in capsules. Exalgine (Methylacetanilide). Origin.—As the chemical name indicates, this substance is a derivative of Acetanilid. Description and Properties.—Exalgine occurs in colorless needles or prisms, inodorous and tasteless. It is neutral to test- paper, and is freely soluble in alcohol, chloroform, carbon disul- phide, and boiling water. It requires about 60 parts of cold water or 10 parts of ether for solution. Dose.—2-4 grains (0.1-0.2 Gm.). Antagonists and Incompatibles.—Exalgine is incompatible with the iodides, salicylic acid, and solution of potassa. Synergists.—All members of this group, as well as opium, cocaine, belladonna, and hyoscyamus. Physiological Action.—Exalgine is almost identical in its action with acetanilid, with the exception that it possesses less antipyretic power. In medicinal doses the drug increases arterial tension, and in full doses profoundly affects the cerebro-spinal axis. It is more uncertain than, and not so safe as, either of the drugs previously mentioned. Therapeutics.—Exalgine should never be employed as an anti- pyretic, but as an analgesic it may be given for the same purposes as acetanilid and antipyrine. Good results have been reported in the treatment of chorea by this drug. Contraindications.—The same as for other agents of this group, and, in addition, fever, it .is said, contraindicates its use. Administration.—Exalgine may be administered either in pow- ders or capsules, but the doses should not be given at frequent intervals, from six to seven hours elapsing between them, and only in exceptional cases should more than 10 grains (0.16 Gm.) be given in twenty-four hours. 396 A TEXT-BOOK OF MA TERIA MEDICA. GROUP III.—ANESTHETICS. As heretofore defined, these are substances having the property of destroying sensation, or producing anesthesia, either general or local. To Dr. Oliver Wendell Holmes is due the credit of proposing the term "anesthetic." This group naturally occupies the place between the preceding one and the next—Hypnotics. As before stated, there exists a close chemical relationship between antiseptics, antipyretics, anesthetics, hypnotics, and analgesics. The first two of these possess marked anesthetic and analgesic properties. The drugs included in the present group should properly be classed as general anesthetics, possessing more nearly the characteristics of typical anesthetics. An ideal agent of this description should be a substance capable of rapidly and safely producing profound anesthesia, and susceptible of speedy elimination, so that consciousness may be restored soon after the withdrawal of the anesthetic, with no discomfort to the patient. The typical anesthetic should also be convenient and safe— a stable, non-irritating, pleasantly odorous, homogeneous liquid, with a boiling-point neither too high nor too low. Unfortunately, there is no substance which fully meets these requirements, ether and chloroform approaching nearest to the ideal agent. The general anesthetics, with the exception of nitrous oxide, all belong to the class of alcohols and ethers. Indeed, alcohol, although in this work not classed among anesthetics, possesses marked anesthetic properties, as well as others—antiseptic, anti- pyretic, etc.—characteristic of these drugs. It has been stated by Dr. Richardson that the first recorded case of the use of an anesthetic in surgery was that of Dr. Collier in 1839, who anesthetized his patient by causing him to inhale the fumes of alcohol. It has been well known for centuries that alcohol, when taken in large quantities, possesses the power to lessen pain and sensa- tion. The anesthesia produced by this drug, however, is too tardy and prolonged to render it practically serviceable. General anesthetics abolish sensation throughout the whole body by destroying the sensibility of the nerve-centers—directly, by affecting the nervous tissue, or indirectly, by influencing the cir- culation, or the blood, in such a manner as to interfere with the functional activity of the nerve-cells. ANESTHETICS. 397 The detailed action and uses of anesthetics are fully described under " Ml&iex " and " Chloroformum." Local anesthetics are used to deaden the sensation or abolish the sensibility of the peripheral nerves of a localized, particular area. The most important are—cocaine, carbolic acid, iodoform eugenol-acetamide, and antipyrine. Some aromatics are also quite powerful anesthetics. The physiological action of local anesthetics is given under the respective agents. y^ther—Athens—Ether. XT. 8. P. Origin.—A liquid composed of about 96 per cent, by weight of Ether or Ethyl Oxide, and about 4 per cent, of Alcohol con- taining a little Water. Ether is known as sulphuric ether, and was called sEther For- tior by the Pharmacopoeia of 1880. Description and Properties.—A transparent, colorless, mobile liquid, having a characteristic odor and a burning, sweetish taste. Specific gravity, 0.725-0.728. Soluble in about ten times its vol- ume of water, with slight contraction of bulk. Miscible, in all pro- portions, with alcohol, chloroform, benzin, benzol, and fixed and volatile oils. Ether is highly volatile and inflammable, its vapor, when mixed with air and ignited, exploding violently. It should be kept in well-stoppered containers, preferably in tin cans, in a cool place, remote from lights or fire. Dose.—15-40 minims (1.0-4.0 Cc). Official Preparations. Spiritus Athens—Spiritus Athens—Spirit of Ether.—Dose, \-i fluidrachm (1.0-4.0 Cc). Spiritus Athens Comp5situs—Spiritus Athens CompSsiti—Compound Spirit of Ether (Hoffmann's Anodyne).—Ether, 325; Alcohol, 650; Ethereal Oil, 25 parts. Dose, 5-60 minims (0.3-4.0 Cc). Antagonists and Incompatibles.—The stimulant and anodyne action of ether is antagonized by the arterial sedatives, the tetaniz- mg alkaloids, strychnine, picrotoxin, etc. Synergists.—The arterial and cerebral stimulants, chloroform and other anesthetics, and alcohol. Physiological Action.—Externally and Locally.—Ether when applied to the skin produces intense cold by its rapid evaporation. If it is confined and its evaporation prevented, great irritation is 398 A TEXT-BOOK OF MA TERIA MEDICA. excited. By spraying a part with ether it becomes quickly frozen, marked local anesthesia being produced thereby. Applied to mucous membranes, it creates considerable irritation, especially of the fauces and respiratory tract when inhaled. Internally.—Digestive System.—It is a carminative, increasing peristalsis and the secretions from the pancreas and the salivary and gastric glands, at the same time dilating the vessels of the stomach. Circulatory System.—When taken into the stomach ether re- flexly stimulates the heart in a manner similar to that of alcohol, raising arterial tension by increasing the force and frequency of the heart's action. Ether stimulates the heart and increases the blood-pressure when inhaled. It is a diffusible, rapid, and reliable cardiac stimulant. In very large or poisonous amounts it exhausts the heart by over- stimulation, acting as a cardiac depressant. Nervous System.—Ether first occasions a considerable degree of excitement, due to the direct action of the ethyl upon the cere- bral cortex. Its action in this respect is analogous to that of alcohol, and, like the latter drug, it affects the nervous system in a certain order, primarily stimulating and afterward depressing, first, the cerebral hemispheres; second, the sensory areas of the spinal cord; third, the motor areas of the spinal cord; fourth, the sensory centers of the medulla oblongata; and, finally, the motor areas of the medulla. The motor nerves and muscles are unaffected. Respiratory System.—Medicinal doses stimulate and poisonous doses paralyze the respiratory center. Respiration is frequently arrested at the beginning of ether- inhalation, owing to reflex spasm arising from irritation of the peripheral ends of the vagi and trigemini. As the inhalation is continued the breathing becomes deeper and faster from stimula- tion of the respiratory center. This part of the nervous system may, in fact, become exhausted from over-stimulation, when the respirations are slow and shallow. In fatal cases of ether-narcosis the respiration is usually arrested before the cessation of the heart's action. Absorption and Elimination.—Ether is rapidly eliminated, chiefly by the lungs, but also by the kidneys, which are often considerably irritated by the process. Temperature.—The prolonged administration of ether produces a great reduction of temperature—doubtless due to the depression ANESTHETICS. 399 of the circulation and respiration and the rapid evaporation of the drug chilling the body and lungs, rather than to any direct action upon the nervous mechanism presiding over the heat-centers. In brief, the action of ether when inhaled is as follows : At first a sensation of choking and irritability of the respiratory mucous membrane is experienced. A greatly increased activity of the sali- vary glands follows, accompanied by a sensation of pricking or tingling of the hands and feet. The conjunctiva is injected, the face is flushed, the veins of the neck are distended, and there is experienced a peculiar feeling of lightness, together with a perver- sion of all the senses, due to emotional excitement. The patient may yell, laugh, cry, curse or pray, struggle or become pugilistic, while the breathing may be spasmodic or stertorous, the pulse becoming rapid and strong. As the inhalation is continued the respiration is quickened, the skin becomes moist and warm, and relaxation of the muscles en- sues, with abolition of reflexes, contracted pupils, and complete suspension of sensation. Finally, as perfect unconsciousness super- venes, the pupils are dilated; the respiration is slow and deep, and later very weak; and the skin is cool and moist. If the inhalation be discontinued before a toxic quantity of ether has been administered, consciousness gradually returns—in some cases almost at once, although some loss of sensation and muscular weakness remain for a while. The return of consciousness is usually accompanied by retching and vomiting—often by severe rigors, unless care has been taken to keep the patient warm. Great excitement not infrequently attends this stage of etherization. Treatment of Untoward Manifestations.—Withdraw the ether if there be danger of respiratory or cardiac failure, lowering the head if there be indications of the latter, and if respiratory failure be threatened, as indicated by cyanosis, avoiding a prostrate position. Meanwhile, other measures for the relief of cardiac or respiratory failure may be resorted to: artificial respiration, friction, or the electric current to excite respiratory action, one electrode being placed upon the larynx and the other upon the epigastrium. Hy- podermic injections may be resorted to—of strychnine, digitalis, or atropine, or, in desperate cases, of ammonia. When asphyxia is produced by the lodgement of mucus in the respiratory passages, the hypodermic injection of ether itself is per- missible, if necessary, to excite more vigorous respirations. 400 A TEXT-BOOK OF MATERIA MEDICA. Should nausea become too persistent, a hypodermic injection of morphine will usually suffice to quiet it. Ice-water or a little ether poured over the epigastrium will establish regular respirations when suspended, as is often the case, during the first stage of anesthesia. Therapeutics.—Externally and Locally.—The hypodermic in- jection of 15 minims (1.0 Gm.) of ether in close proximity to the affected nerve has been found valuable in neuralgia and sciatica. The hypodermic method of administration has been also prac- tised in the treatment of shock and in the threatened collapse fol- lowing post-partum hemorrhage, as well as for the cure of sebaceous cysts. The local anesthetic properties of ether render it valuable in many diseases of the skin, such as pruritus, urticaria, etc. For treatment of these disorders it is usually combined with some aromatic. A wet compress saturated with ether has been successfully applied to the forehead for the relief of epistaxis. Internally.—Ether is used as an antispasmodic in order to facili- tate certain examinations, the reduction of dislocations, and to relieve pain in the general practice of surgery, obstetrics, and den- tistry. It has been used as an anthelmintic against tape-worms. The compound spirit of ether is a stimulant, antispasmodic, and anodyne. It is an efficient remedy for gastralgia and flatulent colic, and is used to allay many of the symptoms of hysteria, as well as restlessness and insomnia unaccompanied by fever. Palpitation of the heart and nausea due to the excessive use of tobacco are also greatly benefited by this preparation. In angina pectoris and hic- cough it is an efficient remedy. Contraindications.—Acute or chronic disease of the kidneys. Dilatation or fatty degeneration of the heart. Disease of the lungs. Tumors of the brain or about the neck. Atheromatous condition of the arteries. Enlarged tonsils, chronic alcoholism, or aneurysm. It is necessary at times to give an anesthetic in the foregoing cases, and the surgeon is justified in the use of ether, but the administration should be extremely careful and conducted under skilful supervision whenever the above contraindications exist— particularly in conditions of dilated or fatty heart or chronic alcoholism. ANESTHETICS. 401 Administration.—In administering anesthetics the following precautions should be taken: The stomach of the patient should contain no undigested food. The clothing should be loose about the neck, thorax, and ab- domen, allowing perfect freedom of respiration. Artificial teeth should be removed. It should be remembered that ether is inflammable, and, when its vapor is mixed with air, explosive: it should, therefore, not be used near a flame or an actual cautery, from which it may ignite. The patient should be kept covered, in order that there may not be too great a reduction in temperature. He should, moreover, be watched for several hours after the administration, since there is always more or less danger until the effects of the ether have entirely disappeared. Under proper methods the administration of ether occasions little inconvenience. In addition to the recommendations above given, it may be added that smearing the mouth and nose with oil prevents the excoriation frequently occasioned by contact with the anesthetic. There are various means of administration, the simplest and in many cases the most efficient being a towel shaped into a funnel or hollow cone, with a piece of stiff paper laid between the outer folds to preserve the shape. Among many mechanical contrivances the inhaler of Dr. O. H. Allis of Philadelphia is perhaps the best. At the Massachusetts General Hospital a cone-shaped sponge is employed. In using the towel-cone the inner surface is saturated with about half an ounce of ether, the inhaler at first not being placed close to the mouth and nose, thus allowing the vapor to be suf- ficiently diluted with air. The effect of this method is to accustom the air-passages to the primary irritation of the anesthetic and graduate its effects. After this the towel may be pressed close to the mouth and nose and the concentrated ether freely adminis- tered. In this manner a person may become completely etherized without nausea or resistance. The insensibility of the conjunctiva and complete relaxation of the muscles, accompanied by semi- stertorous breathing, indicate that the stage of desirable anesthesia is attained. The quantity of ether administered should now be reduced, further supplies being limited to the amount requisite to maintain complete anesthesia. The symptoms incident to the primary effects of etherization— 26 A TEXT-BOOK OF MATERIA MEDICA. cerebral excitement, muscular activity, etc.—should not induce withdrawal of the anesthetic, but rather its continuance. Should vomiting occur at this stage, etherization should be suspended and the mouth thoroughly cleansed by means of a sponge or a towel. Complete loss of consciousness marks the following stage of anesthesia, when total relaxation supervenes, accompanied by gentle, regular breathing. Should stertorous respiration attend further etherization, it is a warning of paresis, and the drug should be withdrawn. Congestion of the facial muscles during anesthesia is quite normal, pallor, as a rule, indicating cardiac or respiratory debility. The practice of closely covering the face is thus to be discouraged, since it conceals important symptoms of the patient's physiological condition. The danger from asphyxia in complete etherization is shown by the entire muscular relaxation of the tongue, which is prone to drop backward, and the closing of the glottis, suspending respiration. In such an occurrence the jaw should be pressed for- ward, the head being well extended, and, if necessary, the tongue brought forward with the forceps. Under favorable conditions from five to twelve minutes are re- quired to etherize the patient completely. The effects of anesthesia upon recovery vary with the temperament and character of the individual and the conditions under which the drug is administered. Great excitability may attend awakening from etherization, or the patient may return to consciousness as from a tranquil slumber. Nausea and vomiting frequently accompany rallying from the narcosis—not, however, such as may require especial treatment. Should somnolence be manifested, it is best not to rouse the patient, that the awakening may be easy and natural. In etherizing a female patient the presence of a woman is always desirable, in order that her testimony may assuage certain abnor- mal impressions to which women during anesthesia are prone, the hallucinations being more readily dispelled by one of their own sex. To the operator and attendants her presence is also of importance. Great care should be taken to see that the patient is well cov- ered and not exposed to drafts, in its relaxed condition the body being peculiarly susceptible to pneumonia or pleurisy. The anes- thetic should be carefully examined before administration, and the character of the drug thoroughly known. ANESTHETICS. 403 Chloroformum—Chloroformi—Chloroform. XT. 8. P. Origin.—A liquid consisting of from 99 to 99.4 per cent., by weight, of Absolute Chloroform, and from 1 to 0.6 per cent, of Alcohol. Description and Properties.—A heavy, clear, colorless, mobile, and diffusible liquid, of a characteristic ethereal odor and a burning taste. Specific gravity, not below 1.490. Soluble in about 200 times its volume of cold water, and in all proportions in alcohol, ether, benzol, benzin, and fixed and volatile oils. Chloroform is volatile, even at a low temperature, and boils at 6o° to 61 ° C. (i40°-i4i.8° F.). It is not inflammable, but its heated vapor burns, emitting a green flame. It should be kept in dark, amber-colored, glass-stoppered bottles, in a cool and dark place. (See tests for chloroform in U. S. Pharmacopoeia, p. 88.) Dose.—2-15 minims (0.12-1.0 Cc). Official Preparations. Aqua Chlorof5rmi—Aquae ChlorofSrmi—Chloroform Water.—Dose, 1-4 fluidrachms (4.0-16.0 Cc). Emiilsum Chloroformi—Emtilsi Chlorofftrmi—Chloroform Emulsion.— Dose, 1-4 fluidrachms (4.0-16.0 Cc). Linimentum Chlorofdrmi—LinimSnti Chlorofftrmi—Chloroform Liniment. —For external use. Chloroform, 30; Soap Liniment, 70 parts. Spiritus ChlorofSrmi—Spiritus Chlorof6rmi— Spirit of Chloroform.—Dose, iominims-i fluidrachm (0.6—4.0 Cc). Unofficial Preparations. Chlorodyne.—This preparation was first introduced by Dr. Collis Browne of Lon- don. Numerous formulse for chlorodyne have been published, the British Pharmacopoeia containing an official preparation, Tinctura Chloroformi et Morphines, intended as a substitute for chlorodyne, and composed of chloroform, ether, alcohol, morphine hydrochlorate, dilute hydrocyanic acid, oil of peppermint, fluid extract of liquorice, treacle, and syrup. Dose, 10 minims (0.6 Cc). Parke, Davis & Co. of Detroit, Mich., prepare a similar and excellent compound known as Chlor-Anodyne. The different preparations of chlorodyne and its substitutes vary greatly in the dose, from 5 minims to I fluidrachm (0.3-4.0 Cc.); in prescribing, therefore, the strength of the agent should be ascertained. Remedies of this character possess powerful narcotic, anodyne, and antispasmodic properties, and should be administered cautiously and only under the direction of a physician. In addition to the above, there is an efficient carminative and antispasmodic known as Tinctura Chloroformi Composita (B. P.)—dose, 20 minims-i fluidrachm (1.2-4.0 Cc.)—containing chloroform and compound tincture of cardamom and various anesthetic mixtures; and chloroform ointments of different strengths. 404 A TEXT-BOOK OF MATERIA MEDICA. Antagonists and Incompatibles.—Chloroform will not mix with weak spirits or glycerin. Circulatory and respiratory stimu- lants and galvanism antagonize to some extent its poisonous action. There is no chemical antidote. Synergists.—Anesthetics, alcohol, morphine, chloral, and many of the hypnotics. Physiological Action.—Externally and Locally.—Its action is similar to that of ether, though when confined on the skin it pro- duces vesication. It is more of an irritant to mucous membranes than ether, yet when inhaled it is less irritating to the respiratory tract. Internally.—Digestive System.—Its action upon the digestive tract is nearly identical with that of ether, except that when taken in a concentrated form it occasions marked irritation of the stom- ach and intestines, often resulting in violent gastro-enteritis. Circulatory System.—Chloroform depresses the heart and cir- culation, the former by weakening the cardiac muscle, and the latter by lowering arterial pressure by depressing the vaso-motor center. It frequently produces an intermittent pulse by stimulating the inhibitory ganglia of the heart. Nervous System.—It affects the brain and spinal cord in the same manner and order as ether, like it producing death, usually by respiratory failure, though sometimes the heart first succumbs to the influence of the drug. When locally applied the sensory and motor nerves are affected in the same manner as by ether. Small amounts of chloroform stimulate, and large quantities depress, the nervous system. Respiratory System.—Its action closely resembles that of ether, though its operation is more rapid and powerful. Absorption and Elimination.—It affects the kidneys and is elim- inated in the same manner as ether. Temperature.—It depresses the temperature, although probably by a different action from that of ether, reducing bodily tempera- ture by lessening heat-production and increasing heat-dissipation. Untoward Action.—If there be any marked idiosyncrasy against chloroform, death usually occurs suddenly after a few inhalations of the drug. When applied externally there is produced not infrequently an urticaria-like eruption or an eczematous condition of the skin; vesicles may result. If applied to sensitive portions of the skin, such as the scrotum, severe and persistent pain is sometimes occa- ANESTHETICS. 405 sioned. Frequently, when applied to wounds and mucous mem- branes, it causes intense irritation, so much so that the mucous membrane may be shed in pieces. The symptomatic manifestations of chloroform-anesthesia, the methods of administration, and the treatment of chloroform acci- dents are here given in detail. The phenomena attending the administration of chloroform in- dicate three separate stages of narcosis. The first of these is allied to intoxication induced by alcoholic stimulants. In this stage, although sensation is dulled, consciousness is retained, and, al- though the period is brief as a rule, in some patients, such as those of intemperate habits, it may last for some time and be accom- panied by violent excitement. In such cases the administration of chloroform is attended with no little danger. The second stage, available for surgical operations, is one of complete anesthesia. The patient is perfectly passive, conscious- ness and sensation being for the time wholly obliterated. The third stage is the most delicate to deal with, profound un- consciousness, with stertorous breathing and total muscular relaxa- tion, as well as temporary annihilation of reflexes, indicating the danger-line of anesthesia. Only under extreme necessity should the administration be carried thus far. It is well to guard against taking the pulse as an infallible guide to the patient's condition. In each successive stage the cardiac movements are variable, although, generally speaking, certain pulsations accompany the above-named degrees of narcosis. As has been suggested in the case of ether, a few precautions in the administration of chloroform are obvious—that there be no undigested food in the stomach; that the clothing be loose about the neck, chest, and abdomen ; and that artificial teeth be removed. The appliances used in producing anesthesia by the aid of chloroform are various, the simplest, as in the administration of ether, being a cone formed of a napkin or a towel enclosing a sponge or not, a sponge alone, or a handkerchief, upon which a small quantity of chloroform—not exceeding from a half to one fluid- drachm (2.0-4.0 Cc.) at a time—is poured. The utmost vigilance is requisite in the administration, the respiration, pulse, and facial indications being constantly observed; a supply of air being allowed to mingle with the anesthetic to obviate the dangerous effect of its concentrated vapor; and the drug being instantly withdrawn upon the slightest indication of untoward symptoms, 406 A TEXT-BOOK OF MA TERIA MEDICA. such as lividity of the face, debility of heart-pulsations, and ster- torous or spasmodic respiration, and an ominous dilatation of the pupils. Should respiration cease, the tongue should immediately be brought forward or the lower maxillary manipulated as in the case of ether. Should these resources be unavailing, artificial respira- tion or the galvanic current should be tried. To restore cardiac action nitrite of amyl may be used, or hypodermic injections of ammonia or digitalis as a cardiac stimulant. A mixture of ether and chloroform has been suggested by com- petent authorities as the safest and most efficient anesthetic. Yet its utility in many cases has proved doubtful, experience in opera- tive surgery rather inclining to the use of a single agent. Although the symptomatic features of chloroform-narcosis, especially those which accompany collapse and death, have been studiously examined, the conditions causing disaster are still but imperfectly understood. Nevertheless, premonitory indications are seldom wanting which mark clearly enough the limit of safety in administration. Of these, extreme mydriasis and failure to pro- duce reflex action in the conjunctiva are alone symptoms to be regarded with the gravest apprehension. The statistics of deaths from chloroform present a melancholy yet instructive spectacle to the thoughtful physician, and the deduc- tions drawn from them go far to show the value of exceeding cau- tion in the use of so subtle and powerful an anesthetic. The pathological considerations of any given case fail to throw light upon the immediate cause of the patient's collapse, the cessation of respiration or stoppage of the pulse resulting in syncope or asphyxia varying in their mutual order and coincidences. It is not to be inferred that chloroform is of itself necessarily dangerous, its noxious effects depending upon its administration rather than upon the drug. An instance of its harmless use is found in the method of producing partial and temporary anesthesia adopted by some physicians in cases of childbirth, neuralgia, etc., by which the patient is permitted to administer the anesthetic. This method consists in saturating with chloroform a small sponge placed in a cup or tumbler, and allowing the patient to inhale the fumes at will. Before the system can absorb a lethal quantity of the drug muscular relaxation intervenes and the hand involuntarily drops, the semi-conscious state meanwhile dulling sensation and causing the patient to forget pain. Upon the return of conscious- ANESTHETICS. 407 ness the administration may be repeated, with little danger of un- toward results from the small amount of chloroform inhaled. The bottle, it is hardly necessary to say, should never be entrusted to the patient. Additional Anesthetics, and their Comparative Value. Ethyl Bromide.—A colorless, inflammable liquid, with a burn- ing taste and an odor like that of chloroform. It is readily decom- posed, with evolution of bromine. Its action is uncertain, causing great irritation of the respiratory passages, and usually producing death by paralysis of respiration. Ethyl Chloride.—A volatile, colorless, and inflammable liquid having a pleasant odor. It is a very fugacious anesthetic, greatly depressing the heart and respiration, and is mainly used, in the form of a spray, to produce local anesthesia. Ethyl Iodide.—A liquid anesthetic, similar in its physiological action to chloroform. Anesthesia produced by it, however, is more tardy, although more permanent. It is considered a comparatively safe and efficient anesthetic to relieve spasm of the respiratory passages, as in asthma and laryngitis. Ethylene Bichloride.—More rapid and powerful in its action than chloroform, though not so safe, affecting the respiratory center invariably before influencing the heart. While speedier in its action than ether, it is probably more dangerous. Ethylene Bromide.—A weak yet dangerous anesthetic, greatly depressing the respiratory center, and tending to cause paralysis of the extremities and stoppage of the heart. Ethylidene Chloride.—A non-inflammable liquid resembling chloroform in its physical appearance, and in its physiological action as well, although much less depressant to the heart. It causes more irritation to the respiratory passages, with vomiting and great languor and discomfort as its sequelae. Ethylene Iodide.—A crystalline substance, its fumes when heated producing anesthesia, with great irritation of the respiratory passages, and death by asphyxia. Methyl Chloride.—A colorless, inflammable gas, with a taste and odor resembling those of ether and chloroform. Cold lique- fies it. It is used locally to produce anesthesia and to relieve pain in neuralgia. Methylene Bichloride.—A colorless liquid, its odor being like that of chloroform. Exposure to the light decomposes it. Anes- 408 A TEXT-BOOK OF MATERIA MEDICA. thesia produced by this agent is accompanied with comparatively little irritation of the respiratory tract, but it occasions a primary stage of excitement like that induced by ether, and, as in the case of chloroform administration, vomiting is likely to ensue. Death takes place from paralysis of the heart. The numerous fatalities which have occurred under this anesthetic indicate the danger of its use, and its volatility renders its employment difficult in a hot atmosphere. Carbon Tetrachloride—Tetrochlormethane.—A transparent, colorless liquid, of an agreeable aromatic flavor, analogous in its action to chloroform, but less irritating, although far more danger- ous to the heart. Formic Ether.—A thin, colorless, inflammable liquid, of strong, agreeable odor and pungent taste. It acts like chloroform, though the signs of asphyxia are less marked. Its effects last for several hours. Methylic Ether.—A colorless, inflammable gas, heavier than air, of an ethereal odor and aromatic taste. Richardson considers it a safe anesthetic, though objectionable because of its odor—less agreeable than those of ether and chloroform—and the rapidity with which it volatilizes from its solution. Methylal—Methylen—Dimethyl Ether.—A highly volatile, colorless, limpid liquid, of penetrating ethereal odor. It is used chiefly as a local anesthetic and as an efficient hypnotic in insanity and delirium tremens. Acetic Ether (U. S. P.).—A colorless, limpid, volatile liquid having an agreeable, refreshing, ethereal, and somewhat acetous odor and taste. It has the advantage over sulphuric ether of being less inflammable and less volatile. Owing to its pungent and agreeable odor, too, it is superior to the latter drug in stimulating the nasal passages in cases of syncope and nervous agitation. Pental.—A colorless, volatile, inflammable liquid, insoluble in water, but miscible in all proportions with alcohol, ether, and chlo- roform. It has a mustard-like odor, and is comparatively free from danger. When poisonous amounts are administered the pulse is quickened, the respiration embarrassed, and death ensues from paralysis of the heart. It resembles chloroform rather than ether, but is less irritating and seldom accompanied by unpleasant after- effects. It requires but about 5 drachms (20.0 Cc) to produce anesthesia, which occurs in from two to three minutes. There is a difference of opinion as to the safety of pental, some ANESTHETICS. 409 physicians considering it less dangerous than chloroform, and others regarding it as less efficient and not so safe. Nitrous Oxide ("Laughing Gas").—A colorless gas, of a very slight, agreeable odor and sweetish taste. It is not inflammable, but supports combustion of ignited bodies. Pressure and cold condense it into either a thin, colorless, very mobile liquid or colorless crystals. It is a rapid anesthetic, unconsciousness being produced in from one-half a minute to three minutes. The pulse is strong and quick, the respirations frequent and shallow, while, as the inhalation continues, the breathing becomes stertorous and the face is cyanotic. If the inhalation be interrupted or the gas mixed with air, symptoms of intoxication are manifested, accompanied by a high degree of mental excitement. It is a very safe anesthetic, but the anesthesia is of quite short duration, rendering it valuable mainly for the extraction of teeth and in minor surgery. The comparative value of ether and chloroform may be sum- marized as follows: 1. If an anesthetic be required, ether is preferable in the case of a patient suffering from a weak cardiac action or an organic disease of the heart. 2. For operations about the face or of the stomach, as there is less danger of reflex inhibition of the heart, ether is preferable to chloroform. 3. Ether is preferable as an anesthetic in the extraction of teeth, chloroform being more apt to cause cardiac paralysis, reflexly by way of the dental nerve to the root of the vagus, and through the vagus to the inhibitory ganglia of the heart-muscle. 4. Ordinarily, ether is superior to, and safer than, chloroform as an anesthetic for adults, unless some special contraindication exist, there being less danger in ether of cardiac failure, to which adults are more liable. Chloroform is much superior to ether in— 1. Obstetrics, since the use of it is attended with less depression and irritation of the respiration and respiratory tract. Moreover, chloroform produces less nausea and vomiting, and may be admin- istered by the patient herself under proper directions. 2. It is preferable in anesthetizing children, being more rapid in its action and less potent as a respiratory depressant, the respiratory center of the child being more susceptible than that of the adult, and in children the danger of cardiac paralysis being slight. 410 A TEXT-BOOK OF MATERIA MEDICA. 3. Should the patient be suffering from nephritis, chloroform is preferable as an anesthetic, since it is less irritating to the kidneys. 4. Should an anesthetic be required for patients afflicted with pulmonary tuberculosis, empyema, or other disease of the lungs, chloroform should be used, since its effect upon the respiratory system is less depressing. GROUP IV.—HYPNOTICS. Chloral-Chloralis—Chloral. XT. 8. P. Origin.—A crystalline solid composed of Trichloraldehyde or Chloral (an unstable, oily, and colorless fluid), with 1 molecule of Water, forming the Hydrate of Chloral, the official preparation, and the only one used in medicine. Chloral itself is prepared by the action of Chlorine upon Alcohol, whence the name chlor-al. Description and Properties.—Chloral hydrate occurs as sepa- rate, rhomboidal, colorless, transparent crystals, having an aromatic, penetrating, and slightly acrid odor, and a bitterish, caustic taste. It is slightly volatilized when exposed to the air, and is freely solu- ble in water, alcohol, and ether, being also soluble in chloroform, benzol, benzin, carbon disulphide, and fixed and volatile oils. It liquefies when triturated with an equal quantity of camphor, menthol, thymol, or carbolic acid. Dose.—5-20 grains (0.3-1.2 Gm.). Unofficial Preparations. The proprietary preparation known as Bromidia contains to each drachm (4.0 Cc.) 15 grains (1.0 Gm.), each, of Chloral and Potassium Bromide, together with a small quantity of Extract of Hyoscyamus and Extract of Cannabis Indica. Camphorated Chloral.—Equal parts of Chloral and Camphor. A colorless liquid, of syrupy consistence, soluble in alcohol, ether, chloroform, glycerin, and fixed oils, and also in aqueous solutions of chloral. It is decomposed by water, chloral hydrate being dissolved and camphor precipitated. Chloral-glycerite is prepared by dissolving 1 drachm (4.0 Gm.) of Chloral in 4 drachms (15.0 Cc.) of Glycerin, being used as a solvent for powerful alkaloids. Chloral-phenol.—Prepared by triturating equal parts of Chloral and Carbolic Acid. It occurs as a colorless, viscid liquid, with a sweet caustic taste. Used externally. Allied Compounds. Amylene Hydrate.—A tertiary alcohol, the chemical name being dimethylethyl- carbinol. Description and Properties.— It occurs as a limpid, colorless, neutral fluid, of a HYPNOTICS. 411 peculiar odor and burning taste. It is soluble in 8 parts of water, and miscible in all proportions with alcohol, chloroform, benzin, glycerin, and fixed oils. Dose.—1-2 fluidrachms (4.0-8.0 Cc). Chloral-ammonium.—Obtained by passing a rapid current of dry Ammonia through a solution of Anhydrous Chloral and Chloroform as long as it is absorbed. Its chemical name is trichloramidethylic alcohol. It occurs as small, white acicular crys- tals, and is soluble in alcohol and slightly soluble in water, although the aqueous solution is unstable. Dose.—15-30 grains (1.0-2.0 Gm.). Chloralose.—Prepared by heating equal quantities of Anhydrous Chloral and dry Glucose; hence the name, chloral-ose. Description and Properties.—It occurs in the form of fine needles, completely vola- tilizing without decomposition. It has an acrid, nauseous taste, and is soluble in hot water and in alcohol. Dose.—2-10 grains (0.12-0.6 Gm.). Hypnal.—A compound of Chloral and Antipyrine, known as monochlorantipyrine. A similar preparation containing more chloral is called dichloralantipyrine. Description and Properties.—It occurs in the form of transparent, rhombic crystals, odorless and tasteless, soluble in from 5 to 6 parts of water. Dose.—5-20 grains (0.35-1.3 Gm.). Hypnone.—A term given by Dujardin-Beaumetz to a member of the ketones, known as acetophenone or phenylmethylketone, phenomethyl-acetone. Description and Properties.—A colorless, mobile, refrangent liquid, of a pungent taste and a persistent odor resembling that of bitter almond and orange. It is not inflammable, though intensifying the combustion of substances impregnated with it. It is freely soluble in alcohol, ether, chloroform, benzin, and fixed oils, sparingly soluble in glycerin, and insoluble in water. Dose.—5-10 minims (0.3-0.6 Cc). Unofficial Preparations.—A Syrup and an Elixir of Hypnone are in use. Ural—Chloral-urethane—Uralium.—A compound of the following drug, Ure- thane, and Chloral Hydrate. Description and Properties.—A crystalline body, soluble in alcohol and ether, in- soluble in cold water, and decomposed by boiling water. Dose.—10-30 grains (0.6-2.0 Gm.). Urethane—Ethyl Carbamate—Ethyl Urethane.—This substance is obtained by the action of Ammonia on Ethyl Carbonate, or by that of Urea or Carbamide on Ethyl Alcohol at a high temperature. Description and Properties.—-It occurs as colorless, odorless, columnar or tabular crystals, having a pleasant, cooling, and saline taste, somewhat resembling that of salt- petre. It is soluble in about 1 part of water, and in like proportion in ether and chlo- roform, in 0.6 part of alcohol, 0.8 part of liquefied carbolic acid, 3 parts of, glycerin, 15 parts of castor oil, and 20 parts of olive oil. Dose.—10-45 grains (0.6-3.0 Gm.). Cannabin Tannate and Hyoscine Hydrobromate are both quite powerful hypnotics, to be described under Cannabis Indica and Hyoscyamus, respectively. The action and therapeutics of the above allied compounds will be compared with those of chloral hereafter. Antagonists and Incompatibles.—Chloral is incompatible with all alkalies, and calcic hydrate converts it into formate of calcium and chloroform. 412 A TEXT-BOOK 01 MATERIA MEDICA. Liebreich considers strychnine an antagonist to chloral. The action of strychnine, however, is limited to the spinal cord, and its efficacy in opposing chloral is certainly inferior to that of chloral as an opponent to strychnine. Atropine is undoubtedly a stronger antagonist in counteracting the depressing influence of chloral upon the heart and respiration, as well as upon the spine. External heat is also an opponent. Synergists.—All the hypnotics favor its characteristic property of producing sleep. Conium and physostigma assist its action upon the spinal cord, and morphine enhances its hypnotic effects, while lessening its depressing influence upon the heart. Physiological Action.—Externally and Locally.—Chloral is antiseptic, anesthetic, and vesicant. It produces redness and some- times vesication when applied to the unbroken skin, and when strong solutions are brought in contact with the derma or with wounds they may even occasion sloughing, and in healthy mucous membranes excite much pain. When introduced into the system hypodermically chloral is apt to occasion gangrenous inflammation. Internally.—Digestive System.—Small doses are slightly seda- tive to the stomach, though causing a sense of burning in the throat and exciting more or less salivation. Large doses some- times produce nausea, vomiting, and purging. Circulatory System.—Full medicinal doses may at first accel- erate the pulse, which soon, however, becomes slower, weaker, and softer. Under toxic doses the heart's action may be weak, rapid, and irregular, when death ensues, the heart being arrested in diastole. A primary effect of chloral is to lower arterial tension by its depressant action upon the heart and by paralysis of the cardiac ganglia. It acts similarly upon the vaso-motor center and upon the structures in the arteriole wall, dilating the blood-vessels. The fluidity of the blood is increased by the action of chloral, and under large doses the red corpuscles are crenated and there is a tendency to destroy the white corpuscles. Nervous System.—Medicinal doses sometimes occasion a pre- liminary stage of cerebral excitement, due probably to a combined temporary stimulation of the circulation and of the brain-tissue itself. This is soon followed—usually in from fifteen to thirty minutes—by a sound, dreamless slumber, induced by a direct depression of the cortical cells of the psychic areas and an anemic condition of the brain. HYPNOTICS. 4^3 The sleep thus produced is perhaps nearer that of physiological slumber than any caused by other agencies, lasting from seven to eight hours, when the patient awakes refreshed and without malaise or digestive disturbance. As upon the circulation and the brain, so upon the nerve- centers, there is usually a preliminary stage of excitement, with exaggerated reflexes. This condition is, however, of short dura- tion, and is succeeded by a greatly diminished reflex irritability of the spinal cord and total abolition of reflexes if toxic doses have been taken. This action upon the spinal cord is due to the depres- sion of its motor areas, the depression of the muscles and motor nerves and the diminished sensation being also of spinal origin. Respiratory System.—In full doses chloral is a respiratory depressant, rendering the breathing slower and weaker, while under toxic doses it may cease altogether from paralysis of the respiratory center. Death may result from this action or from paralysis of the cardiac motor ganglia. Absorption and Elimination.—Chloral is quite rapidly absorbed, and is supposed to circulate in the blood in its original state. It is eliminated by the lungs and skin, but chiefly by the kidneys as urochloralic acid, although when an excessive amount of the drug has been taken it may be found in the urine unchanged. It usually increases the flow of urine, which gives a reaction for sugar with Fehling's test. Temperature.—Chloral is a decided antipyretic even in medicinal doses, while toxic doses produce a dangerous reduction of tempera- ture. This action is doubtless owing to a diminution of heat-pro- duction by limiting oxidation in the cells of the body and increasing heat-dissipation by cooling the blood in the dilated cutaneous vessels and by surface evaporation. Eye.—The continued use of chloral almost invariably results in a contracted pupil, unless psychic alterations supervene, when the pupillary contraction gives place to dilatation. This action of chloral is due to paresis of the sympathetic nerves supplying the iris. Berger claims that when mydriasis is present there is usually a congestion of the papilla, resulting from distention of the retinal veins; while, according to Ulrich, intraocular tension is lessened in the later stages of chloralism. Untoward Action.—There may occur great anxiety; disturb- ances of respiration, such as spasmodic breathing and even as- 414 A TEXT-BOOK OF MATERIA MEDICA. phyxia, together with disturbances of vision and swelling of the conjunctivae. There may also be present edema of the epiglottis, icterus, and various cutaneous eruptions commonly designated as "chloral rash." Poisoning.—Although one of the most powerful hypnotics known, extraordinary doses of chloral have failed to prove fatal, as many as 460 grains (29.8 Gm.) having been given without per- ceptible discomfort. Nevertheless, 20 grains (1.29 Gm.), an ordi- nary dose, have been followed by toxic effects, while 30 grains (1.94 Gm.) have produced death. In view of so uncertain a power great care is requisite in the administration of this drug. In many ways its action is occult, nor have careful autopsies of fatal cases furnished insight into the precise causes of collapse, however clearly certain physiological effects may be defined. The toxicology of chloral may be classed under two general heads—acute and chronic poisoning. In each of these the symp- toms are sufficiently marked to indicate a corresponding treatment, although the doubtful action of chloral hydrate has caused it to become the subject of special study and a more careful method of administration than formerly. Acute Poisoning.—Owing to the peculiar action of chloral, the symptoms of poisoning from lethal doses are those characterizing profound coma. The pulse is feeble, thready, and irregular; the temperature falls rapidly; there is a striking diminution in the fre- quency of respiration, with accompanying lividity; the skin, par- ticularly that of the forehead and extremities, is covered with cold sweat; the pupil contracts and then dilates perceptibly, and great muscular relaxation occurs, together with abolition of reflexes, until finally the cerebral functions are suspended and death ensues, caused by paralysis of the respiratory center and of the cardiac motor ganglia, the arrest of the heart's action taking place in dias- tole. Autopsies have revealed cerebral and pulmonary congestion, together with enlargement of the right cardiac cavities. Since chloral but slightly affects the motor nerves, and has little influence in impairing muscular contractility, it appears that the paralytic phenomena attending collapse are due chiefly to the direct action of the drug upon the nerve-centers. Treatment of Poisoning.—It is of primary importance to main- tain or restore the temperature by means of artificial heat—warm blankets, hot bottles, friction, massage, or other resources at com- mand. (It has been found that animals are much less susceptible HYPNOTICS. 415 to chloral-poisoning when their temperatures are sustained by out- ward appliances than when exposed.) Somnolence is to be resisted by such resources as flagellation, friction, douches, beating with wet towels, by injection of strong hot coffee in the rectum, or any other means readily available. It must be borne in mind, however, that the toxic effects of chloral, unlike those of opium, tend to reduce cardiac activity, the patient often dying simply from exhaustion ; so that violent exercise, such as brisk walking, is to be discouraged as a restorative. In order to arrest respiratory failure and stimulate the circula- tion, hypodermic injections of strychnine or atropine, inhalations of amyl nitrite, or the administration of other physiological anti- dotes, the inhalation of oxygen, and artificial respiration, may prove advantageous. Galvanism, internal stimulants, digitalis, and car- bonate of ammonium have also been tried, with beneficial results. Chronic Poisoning.—Chloral toxemia, or chloralism, is a well- recognized development of simple dosage, in which the habitual use of the drug becomes as baneful and tyrannical in its operation as the opium-habit or confirmed alcoholism. Various symptoms mark the degrees of excess, in which the respiratory apparatus, the skin, and the entire circulation are severally affected. Respiration is embarrassed by the presence of dyspnea, which, however slight, is manifested after meals or is stimulated by physi- cal exertion. The skin may be subject to erythematous eruption, either persistent or temporarily excited by trivial causes. Finally, the gravest complications may occur in the circulatory system, resulting in high fever, pyemia, and ultimate collapse. The line of demarkation between these stages of toxemia can- not be infallibly drawn, the general effects of chloralism being somewhat dependent upon the temperament and habits of the individual. The following symptoms are more or less apparent in all cases of chronic poisoning: The eyes are brilliant; the speech is voluble, often uncontrolla- ble ; and the manner strangely affected by nervous excitement. As the craving for the drug assumes the phase of monomania through habitual indulgence, its votary appears to border upon pronounced insanity. The eyes become irritable and injected, the manner more restless, and the subject is sensible of vacuity in the brain and liable to accesses of vertigo. During the daytime a listless stupor allied to melancholia is observable; the appetite is uncertain, often entirely wanting, and digestion difficult. These symptoms are 416 A TEXT-BOOK OF MATERIA MEDICA. accompanied by profound lassitude and debility of heart-action, together with marked anemia, especially of the lower extremities. Meanwhile, the hepatic functions are deranged, the secretion of bile is deficient, and an increasing weakness of the limbs simulates paralysis. The stools are colorless and wanting in biliary elements, and the urine is stained with bile and at times albuminous and sac- charine. At this stage of chloralism the necessity of the drug in order to overcome insomnia has grown to be imperative, sleep being in- duced only through the agency of the accustomed hypnotic. An over-dose may now at any moment produce death in the manner above indicated, the cumulative effects of the poison with which the system is saturated wholly deranging the vital functions and rendering elimination impossible. The simplest treatment in these extreme cases is primarily the gradual withdrawal of the toxic agent, although delirium tremens is recorded as a result of abstention. The diet should be carefully regulated with a view to restoring, if possible, the decreased vitality. Change of scene, abundant air and exercise, chalybeate tonics, calmatives, and nerve-stimulants undoubtedly contribute to re- establish functional activity and normal circulation, and occasional purgatives may assist in eliminating from the system the noxious elements with which it has become chronically affected. The following prescription has been suggested as efficacious in cases of established chloralism : R. Chloralis, 3y veliv; Morphinge sulphatis, gr. ij; Syr. lactucarii (Aubergier), f §ij; Aquae, q. s. ad f giij. Sig.—Dessertspoonful in water at 10 and 11 p. M., if necessary. Therapeutics.—Externally and Locally.—An injection into the sac of a io per cent, solution of chloral has been highly recom- mended by Marc See in the treatment of hydrocele. One ounce of this solution is injected, being followed in two or three days by a copious effusion, which is soon absorbed. The antiseptic properties of chloral are utilized as a wash or dressing in cancer of the uterus, foul ulcers, etc. For these purposes the strength should be from 5 to 10 grains (0.3 to 0.6 Gm.) to 1 ounce (30.0 Cc). Gonorrhea is readily cured in many instances by a 1 per cent, injection of this drug. Spohn recommends the continued application of a solution of 1 HYPNOTICS. 417 drachm (4.0 Gm.) of chloral in 4 drachms (16.0 Cc), each, of glycerin and water in cases of furuncle. Bromidrosis and hyperidrosis have yielded to local applications of from 2 to 5 per cent, aqueous solutions of chloral. Sir Morrell Mackenzie successfully employed a pigment com- posed of 25 grains (1.6 Gm.) of this drug to 1 drachm (4.0 Cc.) of syrup, as a local application to the throat in diphtheria. Camphorated chloral is often an efficient remedy for toothache, and, when mixed with petrolatum or simple ointment in the pro- portion of 1 to 7, makes an excellent application in pruritus and other itching diseases where the skin is unbroken. This prepara- tion undiluted has been used in neuralgia, painted over the affected nerves. Cregny employs a 20 per cent, solution of chloral in anal fis- sure, and a 1 per cent, solution is used in cracked nipples. Chloral is frequently used to preserve urine for microscopic examination, though it should not be added to urine reserved for chemical analysis intended to detect the supposed presence of sugar. Solutions of chloral are used for embalming purposes and the preservation of anatomical specimens. Internally.—The principal use of chloral internally is to depress the psychic mechanism and produce sleep. It is also employed to depress the reflexes and motor apparatus, and thereby diminish convulsions, and is sometimes useful in lowering the action of the sensory mechanism. As a hypnotic it is especially valuable in conditions character- ized by excessive cerebral activity, such as insomnia resulting from overwork or worry, and in the wakefulness of many acute diseases —typhoid, typhus, and other fevers, delirium tremens, and puerperal mania—it is a remedy of well-known efficacy. Its depressing effects should always be guarded against during the active course of disease, as well as in delirium tremens where great cardiac weakness already exists. The insomnia of convalescence would usually indicate its use. Indeed, where no special contraindication to its employment exists it is the most satisfactory hypnotic we possess. On account of its powerful depression upon the motor mechan- ism it is a valuable drug in treating the various convulsions and spasmodic disorders of childhood, such as chorea, whooping coughy laryngismus stridulus, and all infantile convulsions and colic. 27 418 A TEXT-BOOK OF MATERIA MEDICA. Even in asthma, tetanus, uremic convulsions, hiccough, and strychnine-poisoning chloral has proved an important remedy. Certain forms of epilepsy, particularly the nocturnal variety, are benefited by this drug, and it has been found useful in angina pec- toris, though it should be very cautiously administered in these cases if there be reason to suspect valvular disease or degeneration of the cardiac muscle. The reflex vomiting in pregnancy is sometimes relieved by either the internal administration of chloral or by enemas. It has also been used to depress the reflexes in sea-sickness. Cholera and cholera morbus are often alleviated by the hypo- dermic injection of this drug, in 10- or 15-grain (0.6-1.0 Gm.) doses. Spasmodic rigidity of the os uteri is greatly reduced by a medicinal dose of this remedy, and, while its action on the sensory mechanism is feeble, it is nevertheless frequently efficient in modify- ing the pains of labor and in quieting the alarm and allaying the nervous excitement of the mother. There are certain other pains of moderate intensity, especially those of neuralgia, which are temporarily more or less relieved by chloral. Its anodyne effect, however, is too transient to render chloral very popular as an analgesic. A combination of morphine and chloral is a very efficient ano- dyne and hypnotic in sleeplessness due to pain, which is palliated by this combination with less digestive disturbance than if the former drug had been used alone, and less cardiac depression than if the latter had been the sole remedy, the medicines thus aiding each other and serving the twofold purpose of mitigating pain and inducing sleep. The author desires to recommend here chloral hydrate as an antipyretic. As has been previously stated, the hypnotics possess many of the characteristics of antipyretics, antiseptics, and anes- thetics. Chloral possesses to a considerable degree the properties of a typical antipyretic. It is antiseptic, somewhat volatile, and readily eliminated, and thought by some observers to be changed in the system into chloroform and sodium formate, while, if not pushed too far, it is not toxic. We know that one of the principal actions of chloral is to re- duce temperature; indeed, toxic doses exert so marked an effect as to produce death by loss of heat alone. HYPNOTICS. 419 In sthenic fevers chloral is an admirable remedy, not only as an antipyretic, but in allaying nervous irritability, restlessness, and excessive cardiac action, and, in the opinion of the author, this remedy claims far more attention in these cases than it has received. Contraindications.—Fatty heart; marked respiratory weakness whether due to acute or chronic disease of the lungs ; atheromatous degeneration of the blood-vessels. Owing to the lessened alka- linity of the blood, the action of chloral is so unfavorable in acute inflammatory rheumatism as to justify classing this disease under the present head. The drug should be administered cautiously, the patient being uninformed as to its nature in certain nervous diseases, lest he acquire the chloral habit. Administration.—As is recommended in the case of all drugs, only the purest article should be prescribed. Frequently the un- toward symptoms of chloral are due more to the impure article than to any idiosyncrasy against it. The recrystallized form alone should be used, the first dose administered not exceeding from 15 to 20 grains (1.0 to 1.2 Gm.), repeated as occasion may demand. Ordinarily, a maximum dose should not be given oftener than once in forty-eight hours. Children bear chloral well, and, as a rule, 1 grain (0.06 Gm.) may be prescribed for each year of the child's age. Enemas of chloral may be rendered less irritating by mixing the drug with the yolk of an egg and milk. Chloral should always be well diluted when given internally, especially when combined with sodium or potassium bromide. Its disagreeable taste may be partially disguised by mixing the solution with peppermint water and elixir or syrup of orange. The following differences exist between the action and thera- peutics of chloral and those of the various allied compounds men- tioned above: Amylene Hydrate is considered by many observers to be safer than chloral, while its soporific effects are produced sooner, being manifested usually in from five to thirty minutes, the awakening being ordinarily prompt and complete. In toxic doses it para- lyzes the respiratory and cardiac centers. Its comparison with chloral is so well stated by Laves that his remarks are here quoted verbatim. " It has," he says, " neither the unpleasant and persistent taste and smell of the latter (chloral), nor the same uncertainty of action. It seems to have about half the strength of chloral, and, although its hypnotic action is perhaps less certain, the sleep it causes is more refreshing and the mind remains clearer after its use." Amylene hydrate is best given in a mixture of wine and syrup of liquorice; if administered by the rectum, it should be suspended in mucilage. A TEXT-BOOK OF MATERIA MEDICA. Chlor-ammonium is not so depressing upon the heart and circulation, yet it does not offer sufficient advantages over chloral to justify its use as a substitute. Chloralose.—Its taste is to many persons more nauseating than that of chloral, while its action is practically identical, though perhaps not so depressing upon the spinal cord, its influence being exerted rather upon the brain. It probably also possesses more anodyne properties, and would therefore be superior to chloral as a hypnotic in insomnia with pain, sleep being produced in about half an hour. Chloralose is best administered in capsules followed by a drink of water, to prevent too great irritation of the mucous membranes of the stomach. Hypnal.__This substance possesses more antispasmodic properties than chloral, and theoretically it should be a better analgesic, it being a compound of chloral and anti- pyrine. Yet physicians who have had the largest experience with the drug claim its effects to be illusory, and that it has no special value as an anodyne. Indeed, Dujardin- Beaumetz, who introduced the drug, regarded it more of a soporific than anodyne. Hypnal causes greater gastric disturbance than chloral, and, withal, cannot be recom- mended as an efficient substitute for it. It may be dissolved in almond oil and given in capsules, or administered in a mixture of wine and cordial or some aromatic syrup. Hypnone.—As a hypnotic a much weaker substance than chloral, although it has found some advocates as a remedy for the insomnia of alcoholism. Toxic doses para- lyze the heart and respiration. It should be given in capsules. Ural—Chloral-urethane.—A good hypnotic, yet possessing no special advantages. It is not so depressing upon the circulation, but is a more feeble antipyretic than chloral. Urethane.—Its physiological action is almost identical with that of chloral. It is less depressing upon the circulation and respiration, but more so upon the peripheral ends of the motor nerves. Acting directly upon the cerebrum, it produces a refreshing and dreamless sleep, with no unpleasant after-effects. Nevertheless, it is not so reliable a hypnotic as chloral, and its usefulness as a therapeutic agent is still a debatable question, probably no hypnotic having been introduced concerning the effects of which there is such diversity of opinion. Until, therefore, its use shall be restricted to a place uni- versally assigned to it, there can be no good reason why urethane should supplant chloral for any purpose. It may be given in capsules or in some pleasant water or syrup, and may also be conveniently administered as an injection by the rectum. Chloral Formamidatum—Chloralis Formamidati- Chloral Formamide. (Chloralamide.) Origin.—Obtained as the result of the interaction between An- hydrous Chloral and Formamide, consisting of Chloral Anhydride 2 parts and Formamide I part. Description and Properties.—Chloralamide occurs as white, shining, odorless crystals, having a faintly bitter taste. It is solu- ble in 9 parts of water and in \\ parts of alcohol. Dose.—10-30 grains (0.65-2.0 Gm.). Antagonists and Incompatibles.—It is decomposed into chloral with alkalies and with water at above 1400 F. HYPNOTICS. 421 Synergists.—The bromides of sodium and potassium. Physiological Action.—As might be expected, when the stim- ulating action of ammonia is combined with the soporific action of chloral, as is the case in chloralamide, we have a substance much less depressant upon the heart and respiration than chloral, although probably possessing as active hypnotic properties. Its action upon different systems compared with that of chloral is as follows: Externally and Locally.—It is not so irritating to mucous mem- branes as chloral. Internally.—Digestive System.—In its action it does not differ essentially from chloral. Circulatory System.—Its influence is very feeble, producing no perceptible effect upon the pulse in medicinal doses. Nervous System.—It probably acts as powerfully upon the cere- bral cortex as chloral, but in medicinal doses does not depress the spinal cord to the same extent, though toxic doses may abolish the reflexes and the conductivity of the motor nerves. It produces, usually in from thirty minutes to one hour after its ingestion, a sleep which lasts from six to ten hours, with no bad after-effects. As an analgesic it is superior to chloral. Respiratory System.—It is an active respiratory stimulant in medicinal doses, through its influence upon the center. Toxic doses, on the other hand, paralyze the respiratory center. Absorption and Elimination.—In the blood it is converted into chloral and formamide, being chiefly eliminated with the urine, which it tends to diminish—as well as the amount of phosphates excreted—though it is said that the urea is increased by small and lessened by large doses. Temperature.—In medicinal doses the temperature is uninflu- enced. Untoward Action.—Restlessness, mild delirium, rapid and feeble heart, great thirst, nausea, and vomiting. Poisoning.—Its toxic effects are similar to those of acute chloral- poisoning. It does not possess the cumulative action of the latter drug nor any tendency to induce chloralism. Treatment of Poisoning.—The same as for acute chloral-pois- oning. Therapeutics.—It is not employed externally and locally. Its therapeutic uses are similar to those of chloral. As a hypnotic it is superior when there is cardiac or respiratory weakness. In the insomnia of neurasthenia it is especially valuable,and, in conjunction 422 A TEXT-BOOK OF MA TERIA MEDICA. with potassium bromide, is preferable to a like combination with chloral in cases of sea-sickness. By many physicians it is thought to relieve pain better than chloral, which, if true, would render it superior in insomnia com- plicated with pain. Administration.—It is best given in aromatic elixir or some other dilute alcoholic vehicle. Simple syrup slightly acidulated with hydrochloric acid, beer, and sweet wine are also recommended as pleasant menstrua. When given at night for insomnia the medi- cine should be taken upon an empty stomach, about one hour before sleeping-time. Chloral Butyiicum—Chloralis But^lici—Butyl- chloral Hydrate. (Croton-chloral. ) Origin.—Prepared by passing dry Chlorine Gas into Acetic Aldehyde, resulting in the formation of butyl-chloral, which is separated by fractional distillation, and Water added. Description and Properties.—Butyl-chloral occurs as a heavy, colorless oil, having an odor resembling that of chloral. The hydrate (croton-chloral hydrate) used in medicine is in the form of white scales, of a silky luster, nauseous taste, and a peculiar fruit- like odor. It is freely soluble in alcohol, ether, glycerin, and hot water, but not easily soluble in cold water. Its solutions are un- stable, and are decomposed if kept on hand even for a short time. Dose.—3-20 grains (0.18-1.2 Gm.). Incompatibles and Synergists are the same as for chloral. Its Physiological Action and Therapeutics are quite similar to those of chloral, though it is considered less depressing to the heart and circulation, while possessing greater anodyne properties, having a selective action upon the fifth nerve, doses even of 2 grains (0.12 Gm.) often producing anesthesia of the trigeminal nerve before other actions of the drug are manifest. It is therefore superior to chloral as an anodyne and hypnotic in headaches, facial neuralgia, tic douloureux, migraine, etc. As a simple hypnotic it is feebler and more uncertain in its effects than chloral, and, even with its alleged advantages, it is doubtful if it will ever supplant that drug to any extent, save in cases of neuralgia of the fifth nerve and painful spasm of the face. HYPNOTICS. 423 In facial neuralgias a mixture of butyl-chloral and tincture of camphor may be applied locally. Contraindications.—Hyperemia of the brain, gastro-intestinal irritation, and weak heart. Administration.—It should be given in pill form or in capsules. If given in solution, the bitter taste may be disguised by dissolv- ing it in the aromatic elixir or syrup of liquorice. A mixture of glycerin, syrup, and peppermint water also serves as a good vehicle. Sulphonal—Sulphonal—Sulphonal. The chemical name of this drug is diethyl-sulphon-dimethyl- methane. Origin.—It is prepared by combining Ethyl Hydrosulphide (Mercaptan) with Acetone, forming mercaptol, which is oxidized by potassium permanganate into sulphonal. Description and Properties.—It occurs as colorless, odorless, nearly tasteless prismatic crystals; soluble in 450 parts of cold water, in 15 parts of boiling water, and in 65 parts of cold or 2 parts of boiling alcohol. It is a very stable substance, being un- affected by concentrated acids or alkalies. Dose.—15-30 grains (1.0-2.0 Gm.). Allied Compounds. Trional (Diethyl-sulphon-methyl-ethyl-methane).—Origin.—Prepared ex- actly like sulphonal, except that Methyl-ethyl-ketone is used in place of Acetone. Description and Properties.—Shining, colorless, odorless, crystalline plates; freely soluble in alcohol, and soluble in 320 parts of water. Dose.—10-40 grains (0.6-2.5 Gm.). T8tronal (Diethyl-sulphon-diethyl-methane).—Origin.—This substance is also prepared like sulphonal, differing from the latter in that it contains two additional ethyl groups. Description and Properties.—Colorless, shining plates and laminse, of bitter taste and slightly camphoraceous odor; soluble in 450 parts of cold and in 5 parts of boiling alcohol; insoluble in water. Dose.—10-40 grains (0.6-2.5 Gm.). Antagonists and Incompatibles.—There are none of import- ance, and, owing to its insolubility, sulphonal is usually given alone. Synergists.—Morphine intensifies its hypnotic action. Physiological Action.—Externally and Locally, sulphonal has no influence. Internally.—Digestive System.—In medicinal doses it has no 424 A TEXT-BOOK OF MA TERIA MEDICA. effect on the digestive tract. Toxic doses may result in nausea, vomiting, and gastric pain. Circulatory System.—It has no depressing action on the heart; on the contrary, it is stated by Shick to accelerate the pulse and slightly raise arterial tension. Nervous System.—Like chloral, it depresses the cerebral cortex, but has no influence upon the motor or sensory nerves. Shick believes that it stimulates Setschenow's reflex inhibitory centers, and to this influence is due the diminished reflex activity occa- sioned by the drug. It is capable of producing sleep, but its action is very much slower than that of chloral, from three to eight hours often elapsing between the ingestion of a medicinal dose and its soporific effect, the duration of which averages about seven hours. The mental disturbance which ensues is greater than in the case of chloral. Sulphonal possesses no anodyne properties. Respiratory System.—In medicinal doses it is much less depress- ing to the respiratory center than chloral, yet when death from sulphonal occurs it is usually the result of respiratory paralysis. Absorption and Elimination.—Kast alleges that it is slowly sol- uble in the gastric juice and gradually absorbed. William J. Smith of London, who has experimented extensively with this drug, claims that it is eliminated by the kidneys as ethyl-sulphonic acid. It has also been shown that under the administration of large doses or prolonged use a small quantity of sulphonal is eliminated as such unchanged. Furst states that the greater portion is excreted in the form of soluble sulphates, and that the urine often contains traces of albumin and renal elements, wisely suggesting that the drug be at once discontinued should there be reason to suspect the presence of hematoporphyrin, as indicated by the discoloration of the urine. Temperature is unaffected by medicinal doses. Eye.—Knaggs and Dillingham report cases accompanied by affection of the eye, loss of sensation in the conjunctivae, and ptosis lasting two weeks. The cause in these instances was sulphonal- poisoning. Medicinal doses produce no notable effect upon this organ. The Untoward Action and Poisoning resulting from the use of sulphonal present symptoms of so varied a character that the drug seems to possess no properties of a uniformly toxic nature. More- over, in the cases of poisoning recorded the condition of the patient HYPNOTICS. 425 and the quality of the drug have been such as to require consider- able variation in the amount given. In one case 30 grains (2.0 Gm.) produced death in forty hours {Med. News, lv. p. 166), while in another a man swallowed 3 ounces (96.0 Gm.) of sulphonal, which, although resulting in a condition of coma lasting six days, termi- nated in recovery {Journ. Amer. Med. Assn., iv. p. 21). Perhaps the most prominent symptoms of acute sulphonal-poi- soning are painful convulsions, vomiting, constipation or diarrhea, and diminished urine, containing bile, blood, and epithelial casts. " Sulphonalism," or chronic poisoning, produces vertigo, head- ache, somnolence, mental and muscular debility, edema of the eye- lids, cyanosis, and many other deranged conditions of the system. Treatment of Poisoning.—Discontinuance of the drug; elimina- tive and symptomatic treatment. Therapeutics.—Sulphonal is never used externally, and inter- nally it is valuable only as a hypnotic—in insomnia unaccompanied by pain, and particularly to produce sleep and quiet the intense ex- citement of the insane. In the author's opinion, its many disadvan- tages, together with its unreliability and uncertainty of action, should relegate it to a place greatly inferior to that of chloral or any other hypnotic mentioned above. No skilled and conservative physician can peruse the literature of sulphonal without being startled by the incongruous statements contained therein, being tempted to attribute the irrational statements concerning not only this drug, but other new synthetical remedies, to the ill-advised efforts of some sensational physicians, alike inexact and illogical, to advertise themselves rather than give expression to established, incontrovertible facts. Contraindications.—None of importance. Administration.—Sulphonal should be given in powder or cap- sules or in hot whiskey. Owing to its insolubility, it should not be administered in the form of compressed tablets. Paraldehydum—Paraldehydi—Paraldehyde. XI. 8. P. Origin.—A polymeric form of Ethylic Aldehyde. Description and Properties.—A colorless, transparent liquid, having a strong, characteristic, but not unpleasant, pungent odor, somewhat resembling that of chloroform, and a burning, cooling taste. Soluble in 8.5 parts of water and in 16.5 parts of hot water, being, as will be observed, more soluble in the former than in the 426 A TEXT-BOOK OF MA TERIA MEDICA. latter. Miscible in all proportions with alcohol, ether, and fixed and volatile oils. Dose.—£-1 fluidrachm (1.0-4.0 Cc). Unofficial Preparation. Elixir Paraldehydi—Elixir Paraldehydi—Elixir of Paraldehyde.—Dose, 1- 2 fluidrachms (4.0-8.0 Cc). Synergists.—Opium and the hypnotics aid its action. Physiological Action.—Externally and Locally.—Antiseptic, antifermentative. Internally.—Digestive System.—Paraldehyde has no action upon the digestive tract. Circulatory System.—It differs from chloral in affecting the cir- culatory system favorably in medicinal doses, tending rather to slow and strengthen the pulse. Toxic doses weaken the heart and lower arterial pressure, the heart's action ceasing in diastole. Nervous System.—Its influence upon the brain and spinal cord is similar to that of chloral. The sleep it induces, however, is not so prolonged as that caused by the latter drug, more frequent doses being required for continued soporific effects. The sequelae of paraldehyde are not unpleasant. Respiratory System.—Its action resembles that of chloral, al- though it is not so powerful a respiratory depressant In toxic doses death usually ensues from paralysis of the respiratory center. Absorption and Elimination.—Paraldehyde is eliminated by the lungs and kidneys. Temperature.—Like chloral, it lowers the temperature, but in less degree. Untoward Action.—It occasionally causes irritation of the mucous membranes and erythematous eruption. Poisoning.—The symptoms of poisoning are similar to those of chloral. Fatty degeneration of the heart and liver have been found, together with disorganization of the red corpuscles. Treatment of Poisoning.—The same as in poisoning from chloral. Therapeutics.—Like those of chloral. Paraldehyde is more hypnotic than anodyne, appearing to be best adapted to relieve so- called idiopathic insomnia. It is a better diuretic than chloral, and in certain degenerated conditions of the heart and arteries, where a diuretic as well as hypnotic is desirable, paraldehyde serves as a valuable remedy. NARCOTICS. 427 Cervello has recommended it highly in strychnine-poisoning, and several cases of its successful use in tetanus are reported. Administration.—It may be given in capsules, or, when other- wise administered, its unpleasant taste may be disguised by giving it in an emulsion flavored with orange or bitter almond. Glycerin also renders it quite palatable, yet it is always more disagreeable to the taste than chloral, besides lending to the breath an offensive and persistent odor. GROUP V.—NARCOTICS. Opium—Opii—Opium. XJ.8.P. Origin.—The concrete, milky exudation obtained by incising the unripe capsules of Papaver somniferum (L.), the substance in its normal moist condition yielding not less than 9 per cent, of crystallized morphine when assayed. The poppy from which opium is derived is indigenous in West- ern Asia and cultivated in Egypt, Persia, Asia Minor, the elevated plains of India, and in some parts of Europe. Description and Properties.—Opium appears in irregular or subglobular cakes—with the remnants of poppy-leaves and the fruit of a species of Rumex adhering to their surfaces—plastic or of a harder consistence, chestnut-brown or darker, and somewhat shining internally, showing tears, and fragments of vegetable tissue. It has a sharp, narcotic odor and a peculiar, bitter taste. This de- scription applies to the Smyrna, Levant, Turkey, and Constantinople opium. There are, however, five other varieties—viz. 1. Egyptian, flattened, roundish cakes; 2. Persian, black, cylindrical sticks, or small cakes or balls, wrapped in paper; 3. Indian, flat squares covered with mica and wax or an oiled paper wrapper; 4. Chinese, oblate-spheroidal masses wrapped in white paper; 5. European. Opium contains about twenty different alkaloids, either in a free state or in combination with meconic or sulphuric acid. The principal alkaloids, in the order of their medical importance, are morphine, codeine, narceine, and thebaine; others are narcotine, papaverine, cryptopine, pseudomorphine; protopine, hydrocotarnine, laiidanine, cadamine, rheadine, meconidine, laudanosine, lanthopine, gnoscopine, and oxynarcotine. The following constituents of opium are in some respects im- portant: Meconic acid, meconin, meconoiosin, and porphyroxin. 428 A TEXT-BOOK OF MA TERIA MEDICA. In addition to the above, opium contains these substances, making it one of the most complex drugs in Materia Medica: Mucilage, resin, fats, essential oil, glucose, caoutchouc, ammonium, calcium, and magnesium salts, and odorous and coloring matters, besides certain impurities and adulterants, such as stones, fruits, leaves, starch, water, lead, etc. Dose.—\-2 grains (0.015-0.12 Gm.). Official Preparations. Opii Pulvis—Opii Pulveris—Powdered Opium.—Dose, %-2 grains (0.015- 0.12 Gm.). Powdered opium should yield not less than 13 nor more than 15 per cent, of crys- tallized morphine. Acetum Opii (10 per cent.)—Aceti Opii—Vinegar of Opium.—Dose, 3-15 minims (0.18-1.0 Cc). Extractum Opii (18 per cent, of morphine)—ExtrScti Opii—Extract of Opium. —Dose, \-i grain (0.01-0.06 Gm.). Emplastrum Opii (6 per cent, of extract of opium)—Emplastrum (ace.) Opii— Opium Plaster.—For external use. Formula: Extract of Opium, 60; Burgundy Pitch, 180; Lead Plaster, 780; Water, 80. Opium Deodoratum (13 to 15 per cent, of morphine)—Opii Deodorati—De- odorized Opium (Denarcotized Opium).—Dose, J-2 grains (0.015-0.12 Gm.). Pilulae Opii (1 grain, or 0.06 Gm., in each pill)—Pilulas (ace.) Opii—Pills of Opium.—Dose, 1 or 2 pills. Pulvis Ipecacuanha? et Opii—Pulveris Ipecacu&nhse et Opii—Powder of Ipecac and Opium (Dover's Powder).—Dose, 5-10 grains (0.3-0.6 Gm.). Formula: 1 grain (0.06 Gm.) Opium, 1 grain (0.06 Gm.) Ipecac, 8 grains (0.5Gm.) Sugar of Milk, in every 10 grains (0.6 Gm.). Tinctura Opii (10 per cent.)—Tinctiirae Opii—Tincture of Opium (Laudanum). —Dose, 5-15 minims (0.3-1.0 Cc). 13 minims (0.78 Cc.) represent about 1 grain (0.06 Gm.) of Opium. Tinctura Opii Camphorata—Tinctiirae Opii Camphoratae—Camphorated Tincture of Opium (Paregoric).—Dose, 1-4 fluidrachms (2.0-15.0 Cc). Formula: Powdered Opium, 4; Benzoic Acid, 4; Camphor, 4; Oil of Anise, 4; Glycerin, 40; Diluted Alcohol, to 1000. Prepared by maceration and percolation. 4 fluidrachms (15.0 Cc.) represent about 1 grain (0.06 Gm.). of Opium. Tinctura Opii Deodorati (10 per cent.)—Tinctiirae Opii Deodorati—Tincture of Deodorized Opium.—Dose, 5-15 minims (0.3-1.0 Cc). Tinctura Ipecacuanhae et Opii—Tinctiirae Ipecacuanhas et Opii—Tincture of Ipecac and Opium (Tincture of Dover's Powder).—Dose, 5-15 minims (0.3- 1.0 Cc). 10 minims (0.6 Cc) contain 1 grain (0.06 Gm.) each of Opium and Ipecac. Trochisci Glycyrrhizae et Opii—Trochlscos (ace) Glycyrrhizae et Opii— Troches of Liquorice and Opium.—Dose, 1 to 3 troches. Each troche contains about ^ grain (0.005 Gm.) of Opium. Vinum Opii (10 per cent.)—Vini Opii—Wine of Opium.—Dose, 5-15 minims (0.3-1.0 Cc). NARCOTICS. 429 The Description and Properties of the official alkaloids of opium and their salts are as follows : Morphina—Morphinae—Morphine.—Colorless or white, shining, prismatic crystals, or fine needles, or a crystalline powder, odorless, having a bitter taste, per- manent in the air. Soluble in 4350 parts of water, in 300 parts of alcohol, in 455 parts of boiling water, and in 36 parts of boiling alcohol. Dose, \-\ grain (0.008-0.015 Gm.). Morphinae Acetas—Morphinae Acetatis—Morphine Acetate.—A white or faintly yellowish-white, crystalline or amorphous powder, having a faint, acetous odor and a bitter taste. Soluble in 2.5 parts of water and in 47.6 parts of alcohol. On pro- tracted exposure to the air the salt gradually loses some acetic acid, becoming less soluble. It should be kept in dark amber-colored, well-stoppered bottles. Dose, \-\ grain (0.008-0.015 Gm.). Morphinae Hydrochloras—Morphinae Hydrochloratis—Morphine Hydro- chlorate.—White, feathery needles, of a silky luster, or minute, colorless, cubical crystals, odorless, having a bitter taste, permanent in the air. Soluble in 24 parts of water and in 62 parts of alcohol. Dose, \-\ grain (0.008-0.015 Gm.). Morphinae Sulphas—Morphinae Sulphatis—Morphine Sulphate.—White, feathery, acicular crystals, of a silky luster, odorless, of a bitter taste, permanent in air. Soluble in 21 parts of water and in 702 parts of alcohol. Dose, \-\ grain (0.008- 0.015 Gm.). Codeina—Codeinae— Codeine.—White or nearly translucent, orthorhombic prisms, or octahedral crystals, odorless, having a faintly bitter taste, and slightly efflores- cent in warm air. Soluble in 80 parts of water and in 3 parts of alcohol. Dose, \-2 grains (0.03-0.12 Gm.). Various salts of codeine are in use, the sulphate being the most important. Official Preparations of Morphine Sulphate. Ptilvis Morphinae CompSsitus—Pulveris Morphinae CompSsiti—Com- pound Powder of Morphine (Tully's Powder).—Dose, 5-15 grains (0.3-1.0 Gm.). Formula: Morphine Sulphate, 1; Camphor, 19; Glycyrrhiza, 20; Precipitated Cal- cium Carbonate, 20; Alcohol, q. s. to 60. Trochisci Morphinae et Ipecacuanhae—Trochiscos (ace) Morphinae et Ipecacuanhas—Troches of Morphine and Ipecac.—Dose, 1 to 5 troches. Formula: Morphine Sulphate, 0.16; Ipecac, 0.50; Sugar, 65; Oil of Gaultheria, 0.2; Mucilage of Tragacanth, a sufficient quantity to make 100 troches. Each troche contains about -fa grain (0.0015 Gm.). Antagonists and Incompatibles of Opium and its Alkaloids. —The physiological antagonists are atropine, strychnine, coffee or caffeine. Quinine antagonizes some of the cerebral effects of the drug, while tartrate of antimony and potassa (tartar emetic) and digitalis oppose its action on the intracranial circulation. The incompatibles are alkalies, tannic acid and infusions containing it, and salts of lead, iron, copper, mercury, and zinc. The following are incompatible with morphine and its salts: iodine and iodides, bromine and bromides, Fowler's solution, and sodium borate. 430 A TEXT-BOOK OF MATERIA MEDICA. Synergists.—The hypnotic action of opium is aided by the hypnotics; its anodyne influence is enhanced by belladonna and cocaine, and its sudoriferous effects by ipecacuanha. The Physiological Action of opium differs in some respects from that of morphine or codeine, and will therefore be described first. Externally and Locally.—Applied to the unbroken skin, opium possesses feeble analgesic properties, and from mucous membranes or raw surfaces it is readily absorbed, producing marked anodyne effects. Internally.—Digestive System.—Its prominent action is upon the secretions—checking that from the salivary glands, causing great dryness of the mouth and consequent thirst—largely diminishing those from the stomach, and reducing the bile and pancreatic juice secreted. In fact, every secretion in the body is lessened except the perspiration, the cause being the depressing influence of the drug upon the secretory centers in the medulla. It may be added that the peristaltic movements of the digestive apparatus are re- duced, which, together with diminished secretions, impairs diges- tion and produces constipation. The action upon the intestines, however, varies with the dose administered, moderate or full medicinal doses checking peristalsis and promoting constipation. On the other hand, very large or very small doses increase peristalsis, the former augmenting this effect, and producing violent movement of the bowels through the drug's paralyzing action upon the splanchnic inhibitory fibers of the intes- tine, so that inhibition is removed and peristalsis reinforced. Very small doses act as purgatives when by some reflex disturbance, such as a tender ovary, the peristalsis is inhibited. Minute quanti- ties, by partially benumbing the inhibitory nerves or diverting the stimulus from them to the stimulating fibers, relieve consti- pation. This action is rendered serviceable in the similar con- stipation accompanying lead-poisoning, the metal constipating the patient not only by its astringent action, but also by the tetanic spasm of the intestines caused by the irritating action of the lead upon their mucous membrane. The feces are held by spasmodic intestinal contraction, relief of which by a small dose of opium, sufficient to induce peristalsis, will be followed by evacuation. Circulatory System.—Small doses accelerate the pulse, render- ing it fuller and firmer, and dilate the arterioles, though increasing arterial tension. This action is due to stimulation of the motor NARCOTICS. 431 ganglia and cardiac muscle, as well as to an effect upon the periph- eral vaso-motor apparatus. Large doses, while primarily quicken- ing, soon retard the heart's action, rendering the pulse full. This influence is occasioned by stimulation of both ends of the vagus. Should the dose be lethal, the pulse may become rapid and weak from over-stimulation, and consequent exhaustion, of the vaso- motor center and pneumogastric nerves. Nervous System.—Opium acts differently upon the brain and the spinal cord. Upon the former it produces a temporary period of excitement, varying in duration according to the size of the dose administered, small doses greatly stimulating the imaginative fac- ulty. The state of excitation is followed by drowsiness, soon yield- ing to deep sleep, frequently disturbed by dreams, which may be of a pleasant, voluptuous character or disagreeable and hideous, the condition of the patient at this time varying with the dose he has taken. If it has been sufficient to produce profound stupor, the patient is insensible to sound, light, or external irritation. Pain is abolished, and the reflexes transmit no impression. On waking the patient complains of headache, a feeling of languor, vertigo, nausea, and constipation. Opium first stimulates and afterward depresses the higher cen- ters, the same action being subsequently manifested in the lower centers. The cerebral exhilaration is doubtless the result of an increased blood-supply to the brain, while the sleep and mental depression are due to the direct sedative action of the drug upon the cortical cells of the brain. Pain is relieved by opium through its depressing influence upon the entire sensory apparatus, the peripheral ends of the sensory nerves, the conducting path in the spinal cord, and the receiving cerebral center all being similarly affected by opium, rendering the drug one of the most powerful analgesics known. Respiratory System.—In very small doses opium slightly stim- ulates respiration; in full or large doses it is a strong respiratory depressant, its action being upon the center in the medulla. Death is usually caused by paralysis of respiration. Absorption and Elimination.—Opium is rapidly absorbed, and is eliminated chiefly by the gastro-intestinal mucous membrane and the kidneys. Moderate quantities of the drug are oxidized in the body, though when large doses are administered 'opium may be found A TEXT-BOOK OF MATERIA MEDICA. unchanged in the urine. It is also excreted in the bile, in the milk, and to some extent in the sweat, which is largely increased by opium, particularly when the drug is combined with ipecacu- anha, as in Dover's powder. The sweat is the only secretion aug- mented by opium, although the manner in which the sudoriparous glands are stimulated is not positively known—whether centrally or peripherally. Probably the action is due to increasing venosity of the blood stimulating the sweat-centers in the spinal cord. The reabsorption of opium may be prevented by frequently washing out the stomach, from which viscus the drug is mainly eliminated. Catheterization is also indicated from time to time to assist elimination. Temperature is at first raised, but later lowered when free diaphoresis is established. Eye,—The pupils are minutely contracted by large doses, the modus operandi not being fully understood, though probably the action is due to stimulation of the oculo-motor center. The pupil usually dilates just before death from opium-poisoning, owing either to paralysis of the oculo-motor center or depression of the sympathetic fibers, and, perhaps, excessive venosity of the blood. Untoward Action.—Headache, disturbances of hearing, muscular tremor or temporary paralysis, itching of the skin with or without eruption. In case the latter symptom appears, it is commonly in the form of small red spots resembling roseola. An erythematous inflammation may affect the mucous membrane of the mouth and throat. Morphine has produced paresthesia of the sense of taste, as well as spasm of accommodation of the eye and edema of the eyelids. Many other untoward manifestations occur, even under minute doses, in persons having an idiosyncrasy against the drug. Poisoning.—Small medicinal doses of opium, as we know, tend to produce moderate excitement, a pleasing sense of freedom from care, and, in sleep, tranquil, even happy, dreams. Far otherwise it is with toxic doses. Under their influence the entire physiological conditions of the system are perverted. Here the drug exerts its baneful effects, and the mind rapidly succumbs to a power over which it has no control. The period of excitement is absent, the predominating desire of the patient being to sleep, and from the dull, lethargic stupor which supervenes he is roused only by vigorous and unremitting treatment. Giddiness portends this mental and physical state. The pulse, though still full, diminishes in fre- NARCOTICS. 433 quency; the breathing becomes heavy and labored, and finally stertorous; the heart is now apparently seized with indefinable oppression, and the pupils are visibly contracted; the skin is dry and warm, and the face suffused or at length of a marked cyanotic hue, cutaneous eruptions being not uncommon. Should relief be not forthcoming, the pulse continues to sink ; the drowsiness and subsequent lethargy are followed by a state of true coma; the muscular system is wholly relaxed; the reflexes are obliterated, and death ensues from respiratory failure, the asphyxia being closely accompanied by cessation of the heart's action. Although this stage of toxemia is not necessarily fatal, it will be readily seen that its alarming manifestations demand the utmost skill and vigilance on the part of the physician. In fact, the diag- nosis is not always clear, the phenomena so nearly resembling those of alcoholism, especially apoplexy, uremia, and congestion of the brain, that it is at times next to impossible to predicate from symptoms alone the presence of opium-poisoning. It may be ob- served, however, that, save in certain exceptional cases, contraction of the pupil is wanting in apoplexy, while there is present partial distortion of the face or paralysis of the limbs. From uremia opium-poisoning is differentiated by the presence in the former of edema and by albumin and casts in the urine. The treatment of acute opium-poisoning covers an ample field of therapeutic experience, the remedies employed being numer- ous, and in their physical properties often widely diverse. Three objects are of paramount necessity: to evacuate the stomach, maintain respiration, and prevent failure of circulation. The first of these may be attained by the use of the stomach- pump or siphon-tube (easily improvised). Active stimulants and irritating emetics are of great service, the latter being assisted by frequent and copious draughts of warm water in the intervals of vomiting, and the doses being large in order to .make an im- pression upon the insensibility of the stomach. Various agents, including chemical antidotes, may aid recovery—tannic acid, per- manganate of potassium, strychnine especially, atropine, strong black coffee, hypodermic injections of apomorphine, etc.—and other resources have been tried with varying success. Warm water in- jected into the rectum and stomach have proved efficacious. Coun- ter-irritants, flagellation, shouting in the ear, may rouse the patient from his lethargy. Should artificial respiration become necessary, either Sylvester's method or the use of the faradic current can be 28 434 A TEXT-BOOK OF MATERIA MEDICA. adopted. It is here of great importance that the subject should be kept awake, that he may voluntarily assist in the recuperative pro- cess, which while the will is quiescent in sleep he is unable to do. The full force of the faradic battery may be used, but it should never be applied to the phrenic nerve directly, lest paralysis of the cardiac muscles ensue. Should the bodily temperature fail to be sustained, external heat should be employed to supply the de- ficiency. In maintaining the circulation strychnine and atropine, both powerful antidotes to opium, will be of great value. Rubbing, massage, flagellation—but never such as to produce exhaustion— and, if necessary, moderate venesection, may be used as supple- mentary efforts at restoration. Walking the patient will often ward off somnolence, the exercise being continued until thorough wake- fulness results, provided there be no untoward muscular debility. Inhalations of ammonia have proved efficacious, and the use of the catheter has been found to stimulate excretion by the kidneys. Special efforts should be directed, however, toward sustaining respiration, since failure in this respect is most to be feared. Should the breathing be normally resumed, or even partially so, there is no special danger to be apprehended from the state of coma. Cerebral effects have sometimes been relieved by quinine. The use of atropine is not to be encouraged, save in exceptional cases—and then without repetition—since it may prove irritating to the cardiac ganglia, while continued doses are liable to induce belladonna-poisoning, as dangerous as the original condition. In the choice of remedies it should be borne in mind that the influence of opium is limited to the nervous system, and that lethal doses tend to cause paresis of the arterioles and veins. Each case, moreover, is to be studied individually, scarcely any drug being more dependent than opium upon the idiosyncrasies of the patient. Chronic opium-poisoning, resulting from the habitual use of opium, its most active constituent morphia, or its salts, is undoubt- edly one of the most pernicious habits to which the human system can be subjected, its mental, moral, and physical phenomena being among the saddest and most terrible known to therapeutics. The symptoms of this disease of mind and body are in some respects similar to those of acute opium-poisoning in their physio- logical aspect, but the psychological features of the malady are more abhorrent and less amenable to treatment. Extreme nervous- NARCOTICS. 435 ness and tremors; abnormal exercise of cerebral functions, mani- fested in extraordinary hallucinations; hypochondria; anxiety; insomnia; spasms and painful neuralgia; and not infrequently suicidal intent or mania,—these are among the prominent charac- teristics which mark the victim of the opium habit. The physio- logical symptoms include dryness of the tongue; vesical irritation, with possibly excessive urinary discharge; constipation; serious disturbances of the sexual function, resulting in impotence or sus- pension of catamenia; while caries of the teeth is also sometimes present,—the derangement of the system being wellnigh com- plete, often beyond the reach of therapeutic aid. In the words of a votary to the habit, " My head throbs like a trip-hammer; my teeth are set; a metallic taste is in my mouth; my face, neck, and arms are red as fire, and all the veins swollen. Worst is the throbbing in my head." The conditions inducing the opium-habit are frequently caused, or are largely influenced, by the therapeutic employment of the drug—as was the case with De Quincey, whose graphic analysis of the Pleasures and Pains of opium, if possibly to be taken salis cum grano, is at once the most powerful and the most eloquent ever written. The patient who has once experienced the anodyne influence of the drug—as captivating to his senses as though it were a draught of fabled Lethe—readily yields to it upon the slightest occasion, as, for instance, to alleviate trivial indispositions for which, in ordinary circumstances, he would ridicule the idea of medical treatment. With repeated indulgence—often promoted by a casuistic reasoning of which by degrees the subject is scarcely conscious, or by persistent and intentional deception—comes the craving which knows no restraint, and which can be quieted only by complete mental and physical regeneration or the merciful re- lease of death. Dependent for fancied happiness upon his ex- traneous resource, the blind idolater of personal ease pursues his ignus fatuus heedless of consequences, in his mental and moral degeneracy apparently lost to all finer feeling or to manlier resist- ance in presence of his insidious, blighting temptation. Mean- while, physiological torpor demands an ever-increasing amount of the drug that the system may be sufficiently impressed. Psychical emotions, anxiety, anger, mental anguish, or, indeed, the most puerile pretexts, continue to furnish occasion for indulgence, and the facilities of administration afforded by the modern method of hypodermic injection unhappily serve to stimulate a longing for 436 A TEXT-BOOK OF MATERIA MEDICA. momentary exhilaration or the alluring oblivion which may oblit- erate the past, but which reason cannot suffer to ignore the future when the mind recalls the overwhelming testimony of experience. Should amelioration be now attempted and the drug withheld, more distressing symptoms still are developed. Depression and exhaustion are manifested at once, followed by increasing melan- cholia, attended by horrible visions and anxieties no mental energy —such as remains of it—can dispel. The pulse is scarcely percepti- ble ; the patient is in a state of nervous tension, occasionally evinced by paroxysms of despair; and in the deprivation endured the poor wretch, with outstretched hands and imploring expression, begs, screams, for morphine, laudanum, or other habitual form of opium, at last breaking down utterly in a fit of passionate weeping when denied the solace craved. It is, indeed, an appalling spectacle of human misery which, could it be witnessed by those in whose imaginations the first subtle effects of opium awaken dreams of elysium, might well persuade the victim to forswear a gratification for which so tragic a fate is reserved. The treatment of so dire a malady—for such the chronic use of opium must be regarded—demands the utmost forethought, patience, and tact. The method of sudden, absolute withdrawal of the drug is admitted by the wisest observers to be fraught with danger commensurate with that of the indulgence to be overcome. Collapse, insanity, and other serious results have attended so dras- tic a measure, the general opinion obtaining to-day being that a gradually reduced dose of the drug is the safest and most rational mode of procedure. The conditions are extremely difficult to combat successfully, repeated hypodermic injections being eradi- cated from the system far less readily than opium from the stom- ach. The moral nature of the patient, too, has become so per- verted that little or no reliance can be reposed in his veracity, the physician being thrown upon his unaided resources, supplemented by the untiring vigilance and fidelity of the attendant. The gravity of the situation should from the first be fully real- ized, since it is too often simply a case of life or death, the patient being not infrequently seized with the desire of self-destruction in the extremity of mental anguish occasioned by the ordeal imposed by unwonted abstinence. Could he be put upon his honor, and that honor be steadfast, his co-operation would be invaluable. But this assistance is seldom at command, the patient's loyalty of pur- pose and unswerving resolution, as professed, being wholly sub- NARCOTICS. 437 servient to a volition long since weakened, if not annihilated, by pitiful sophistries and moral degradation. Nevertheless, the case must be approached from the sympathetic side, and every means of inspiring confidence employed, remembering that a human will as well as body is under treatment, and that mental sanity as well as physiological health is to be restored. Of the many agents suggested by therapeutic science, valerian- ate of ammonia, fluid extract of coca or camellia, judicious tonics, easily digested and strengthening food, and, if necessary, alcoholic stimulants, have been especially beneficial. Other remedies, such as dilute phosphoric acid, tincture of lupulin, codeine, trional, co- nium, and cannabis Indica, have in many cases proved efficient. Change of scene, a healthful, stimulating diet, and abundant out-door exercise—always favorable to diversion of thoughts— seldom fail to react encouragingly upon the mind and physique of the patient. The exhibition of symptomatic remedies not indicated has been authoritatively condemned, the primary object of treat- ment being not so much to afford temporary relief of pathological conditions as to remove the dominating cause. Cocaine has also been discouraged, lest its use generate habitual desire for the drug. In conclusion, it may be said that the obstacles attending a com- plete mastery of the opium habit by means of therapeutic resources are apparent from the fact that but a small proportion of patients addicted to the use of morphine are permanently cured. Yet, though the admission be made with regret, it is no disparagement to pro- fessional science nobly directed, and assuredly carries with it a fearful warning to those who are tempted to seek immunity from mortal ills by purblind indulgence in so fatal a medium of relief. Therapeutics.—In a general way, the medical uses of opium are—I, to relieve pain ; 2, to produce sleep; 3, to lessen reflex irri- tation ; 4, to diminish secretion ; 5, to support the system ; 6, to act as a sudorific. Opium is the most important and useful drug known to medi- cine, as well as the most remarkable in its multifarious applications. It would, therefore, be idle—indeed, wellnigh impossible—to enu- merate all the maladies and abnormal conditions for which this invaluable remedy has been employed. It perhaps best represents the typical symptom medicine, being used almost invariably for the relief of one or more symptoms of disease, rather than for its spe- cific or direct curative action upon the disease itself. Unless some 438 A TEXT-BOOK OF MA TERIA MEDICA. special contraindication exists, it may be employed when any of the above medical uses are desired. Externally and Locally.—It is used to relieve pain, either in the form of an ointment, a liniment, or a suppository, an aqueous solu- tion of morphine sulphate as a collyrium in conjunctivitis, in the form of bougies, injections, snuff, or lozenges, or solution in diseases of the genito-urinary tract, the ear, nose, and throat. Tincture of opium is frequently added to flaxseed poultices to allay the pain of superficial inflammation. Internally.—Either opium or morphine may be used for the relief of pain, regardless of the seat or cause. Pain of moderate intensity may often be allayed by other anodynes, such as anti- pyrine, exalgin, etc.; but when it is severe or excruciating, it is useless to experiment with other drugs when so potent an agent for relief as opium is obtainable. It is not recommended for ordinary use to produce sleep, because of its seductive, insidious action and the danger of creating in the patient a tendency toward the opium habit. When, however, sleep- lessness is occasioned by pain, and in the insomnia of delirium tremens or acute mania, opium or some one of its preparations is often an indispensable remedy. Spasmodic conditions of involuntary muscles, as in cases of asthma, the convulsions of tetanus, uremia, hydrophobia, chorea, etc., frequently call for a drug as powerful as opium. The paroxysms of periodical fevers, and especially the congestive chills of virulent malaria, often yield more readily to this medicine than to quinine. In dysentery, cholera morbus, and cholera it has been used with excellent results, having also been employed in many cases of excessive secretion in other portions of the body. Opium is frequently given in bronchitis with profuse secre- tion and irritable cough, in which condition it acts favorably through depression of the reflexes and power to allay irritation and check secretion. In these cases, however, small doses only should be administered, and the condition of the patient carefully watched, especially that of the aged, lest the respiratory apparatus be so depressed that expulsion of the accumulated viscid mucus be impossible and danger of death from suffocation ensue. As a supporter of the system when the vital forces are weak- ened by acute or chronic disease or injury there are but few drugs as efficacious as opium. It calms and strengthens the debilitated NARCOTICS. 439 heart, and secures to the patient refreshing sleep, soothing and in- vigorating his system by means of the much-needed rest. If pain be persistent, wearing seriously upon the sufferer's vitality, opium by its anodyne influence enables him to recuperate during the interval of relief. One of its most valuable services is in peritonitis, although, not- withstanding its incomparable value, some physicians, more scien- tific than practical, have subordinated it to the treatment by free purgation with saline cathartics or the irrigation of the peritoneal cavity with antiseptic solutions in order to eradicate from the sac the pathogenic bacteria. Despite the aggressiveness and dogmatism of abdominal sur- geons, opium still remains, and justly so, the abiding resource of the great mass of conscientious physicians, more thoughtful of their patients' welfare than of enhancing their skill and technique in abdominal surgery. When given in proper doses in peritonitis, opium reduces peri- stalsis and removes the pain, promoting the patient's comfort and supporting his vital powers. It diverts the blood from the con- gested peritoneum by dilating the cutaneous blood-vessels. Further- more, it possesses the peculiar property of causing the irritation in the inflamed area to contract reflexly the local blood-vessels, thus diminishing the blood-supply to the diseased part. In shock from severe injury, opium, by benumbing sensation and depressing the reflex mechanism, lessens the danger of cardiac and respiratory failure. In pleurisy it is the most efficient remedy, relieving congestion as in peritonitis, besides reducing the respirations, and consequently the friction of the inflamed pleural surfaces, as well as allaying the pain accompanying each respiration. Dover's powder is a common and valuable agent in acute coryza, it also being one of the most efficient diaphoretics. Opium is considered the best remedy in puerperal septicemia. It has also been advocated for hemorrhage, both active and passive, its greatest utility being manifested in the latter condition. Although frequently used in continued fevers of various kinds, it is indicated as a rule only during their course—or, rather, after the fever is well established or during its decline—to mitigate its violence or conserve the strength and relieve the nervous manifes- tations foreboding exhaustion. Clinical experience has demon- strated its inutility, ordinarily, at the onset or climax of such fevers. 44° A TEXT-BOOK OF MA TERIA MEDICA. Even in exanthematous fevers opium has proved valuable when the eruption is delayed. As already intimated, the space allotted to this drug will scarcely permit an enumeration of the many disorders for which this remedy has been successfully administered. The independent and thought- ful physician, knowing the chief indications for its use, will find no difficulty in employing opium alike to the relief of the patient and his own satisfaction. Contraindications.—If avoidable, opium should not be given to children under five years of age. Should the necessity of ad- ministration under that age be deemed advisable in the judgment of the physician, it should be remembered that the drug acts with greatly disproportionate power upon the nervous systems of the young, i minim (0.06 Gm.) of tincture of opium having caused the death of a child one day old, and a few drops of camphorated tinc- ture of opium having proved fatal to an infant of nine months. The death is even recorded of a nursing babe, from the mother having taken a medicinal dose of laudanum. Opium is contraindicated in excessive bronchial secretion of the aged during the second stage of pneumonia, in cerebral conges- tion, and in alcoholism. Administration.—As has been stated under Poisoning, there are many circumstances which modify the action of opium, the young and the old requiring smaller doses and great care in administra- tion. For children the best preparation is paregoric. Females, moreover, need smaller doses than males, since they are more readily affected by the drug and more subject to untoward mani- festations, such as nausea, headache, etc. Caution should be exercised in administering opium to those who have an idiosyncrasy against it. On the other hand, persons addicted to the opium habit require enormous doses to make a medicinal impression. Agonizing pain seems to antagonize the drug, so that in peri- tonitis or during the passage of biliary or renal calculi, in severe neuralgia, tic douloureux, etc., opium is well borne, doses which under other conditions might produce dangerous symptoms having little effect save to deaden the pain, frequently not even inducing sleep. In other cases, such as nephritis, very small doses may be fol- lowed by serious and alarming consequences, continued adminis- tration resulting in an accumulation of the drug in the system, NARCOTICS. 441 owing to defective elimination. Should prolonged administration be desirable, it is necessary to increase the dose gradually in order to produce the requisite effect, because of the growing insensibility to the drug. Certain preparations are preferable in given conditions. Thus, if it be necessary to produce diaphoresis, Dover's powder or some other combination with ipecac is advisable. When relief of pain, unless it be intense, is desired, small doses of morphine or tincture of opium will usually be sufficient, full doses being required to produce sleep. The deodorized tincture of opium causes less disagreeable symptoms than the plain preparation, which contains narcotine. Potassium bromide is said to prevent untoward after-effects. When opium is demanded for its astringent action, it should be given in small or stimulant doses or combined with chalk or with some of the astringents. The camphorated tincture, owing to the camphor it contains, is probably the most astringent liquid prepa- ration of opium, and is therefore preferable in cases of diarrhea, as it is the favorable form as an adjunct to cough-mixtures. When the prolonged sedative and astringent effect of opium is desired, as in intestinal hemorrhage, diarrhea, nausea, and certain diseases of the stomach, an old, dry opium pill or pill of opium and lead is better than any liquid preparation or morphine, owing to its tardy solution. In diseases of the rectum requiring opium a suppository con- taining the extracts of opium and belladonna is perhaps the best combination to use. Ovarian and pelvic pain more readily succumbs to the anodyne action of codeine than distress in other parts of the body. When opium is used as a soporific, it is best to combine it with chloral, a small dose only of each being necessary. These unite in their action upon the brain, depressing the heart less than if chloral alone had been given, and attended by less serious after- effects than had morphine been the sole agent employed. Opium prolongs the narcotic effect of chloroform, and in cer- tain operations it is good practice to administer a dose of the drug, following it soon with a few inhalations of the anesthetic. The hypodermic injection of morphine is usually preferable to the internal administration of opium in cases of severe pain, since a smaller dose is required and a much more rapid effect produced, with less danger of affecting the appetite and bowels. 442 A TEXT-BOOK OF MATERIA MEDICA. The many circumstances influencing the action of the drug appear to confirm the statement that " there is no dose of opium," its conduct being wholly dependent upon the age, sex, idiosyn- crasies, and condition of the patient. The amounts given under the different preparations are such as experience has shown to be safe ordinarily as the initial ones for adults, succeeding doses being adjusted according to the indications of the individual case. Opium compared with its Alkaloids. Morphine does not stimulate the nervous and circulatory sys- tems so much as opium, nor is it so decided a narcotic or con- vulsant. Morphine is more apt to excite nausea and vomiting, and its sequelae are of longer duration. Opium slightly increases the temperature—morphine lowers it;, and, while the former accelerates, the latter retards the pulse. The continued use of morphine hypodermically tends to con- stipate, while its prolonged action upon the stomach is apt to occasion diarrhea: under like circumstances opium does not pro- duce diarrhea, its only effect being a cessation of confinement in the bowels. Morphine, therefore, ingested, fails to constipate, while opium is the better drug to check diarrhea. Morphine is excreted more readily than opium, and does not affect the secretion of bile. Opium possesses, greater diaphoretic properties than morphine. Morphine produces more irritability of the bladder, frequently causing ardor urinae. It also occasions much greater itching of the skin, which usually begins and is intense about the eyes and nose. In its action as an anodyne and soporific morphine is more rapid and certain than opium. Codeine is a much feebler anodyne and hypnotic than morphine, 4 grains (0.25 Gm.) being about equivalent to 1 grain (0.06 Gm.) of the latter drug. It produces sleep, however, freer from disturb- ance, with a less disagreeable sequel. Codeine has a more marked and selective action than morphine upon the nerves of the abdominal viscera. It possesses an advantage over both opium and morphine in that it can be given in increasing doses without producing narcosis. It is more stimulating to the spinal cord and sedative to the pneumogastric nerve than morphine. Codeine is superior to opium or morphine as a stimulant to the glycogenic function of the liver. In the treatment of diabetes rnel- NARCOTICS. 443 litus it surpasses all other drugs, almost invariably lessening, and often entirely removing, the sugar from the urine. In justice, how- ever, to authorities so eminent as Bruce, Frazer, and Osier it may be said that they consider morphine much more reliable than code- ine in diabetes, regarding the latter as nothing save a weak or diluted morphine. Admitting the general correctness of this opinion, codeine is nevertheless preferable to morphine or opium in prolonged admin- istration, as is necessary in diabetes, at least for the reasons that no untoward manifestations accompany its use, and that it does not engender an habitual proclivity for the drug. Finally, codeine is a valuable remedy in troublesome or nervous cough or to quiet the cough in bronchitis and phthisis, and is also efficient in gastrodynia. Codeine should be administered in water, syrup, elixir of orange, or in the form of pills or capsules. The true action of the following alkaloids is so questionable that they are seldom, if ever, prescribed: Narceine is alleged by equally competent observers to possess feeble hypnotic properties and to be practically inert. Narcotine is a misnomer, the preparation being devoid of nar- cotic power, although it is said to possess marked stomachic and antiperiodic properties. Papaverine is a mild hypnotic and cardiac sedative. Thebaine is a powerful tetanizing poison, its action upon the spinal cord being analogous to that of strychnine and brucine. Humulus—Humuli—Hops. XT. 8. P. Origin.—The strobile-like aments of Humulus lupulus L., a rough, climbing perennial, native and cultivated in the north tem- perate zone. Description and Properties.—Ovate, about i^ inches (3.17 Cm.) long, consisting of a thin, hairy, undulating axis and many obliquely ovate, membranaceous scales, the upper portion of which is reticu- lately veined and the lower parallel-veined, glandular, surrounding a subglobular akene; color of the scales greenish, free from red- dish or brownish spots, odor aromatic, and taste bitter, aromatic, and slightly astringent. The active and important constituent is— LupulTnum—Lupullni—Lupulin. XT. 8. P. Origin.—A glandular powder separated from the aments of Humulus lupulus. A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—Bright, brownish-yellow, becom- ing yellowish-brown, resinous, consisting of minute granules which under the microscope are seen to be subglobular, or, rather, hood- shaped, and reticulate—aromatic and bitter. Dose of Lupulin.—5-30 grains (0.3-2.0 Gm.). Official Preparations of Humulus. Tinctura Humuli—Tinctiirae Humuli—Tincture of Hops.—Dose, 1-2 fluid- drachms (4.0-8.0 Cc). Official Preparations of Lupulin. Extractum Lupulini Fluidum—Extracti Lupulini Fluidi—Fluid Extract of Lupulin.—Dose, 5-30 minims (0.12-2.0 Cc). Oleoresina Lupulini—Oleoresinae Lupulini—Oleoresin of Lupulin.—Dose, 1-5 grains (0.06-0.3 Gm.). Unofficial Preparations. Infusum Humuli—Infusi Humuli—Infusion of Hops.—Dose, 1-4 ounces (30-125 Cc). Tinctura Lupulini—Tincturae Lupulini—Tincture of Lupulin.—Dose, l/2-2 fluidrachms (2-8 Cc). Antagonists and Incompatibles.—Mineral acids and metallic salts. Synergists.—Alcohol; opium, lactucarium, and many other narcotics. Physiological Action.—Externally and Locally.—Hops are sedative and astringent. Internally.—Digestive System.—The action of hops is similar to that of vegetable bitters, augmenting the secretions from the sali- vary and gastric glands, thereby promoting appetite and digestion. Circulatory System.—The heart's action is slightly increased, the remedy also raising arterial tension and exciting the cutaneous cir- culation. Nervous System.—Like opium, hops primarily stimulate the brain, and secondarily act as a mild soporific. These effects are increased if the preparation be an alcoholic one, such as beer. The hypnotic action is due partly to the volatile oil which the hops contain. Respiratory System.—They slightly stimulate the respiration. Absorption and Elimination.—The active principles of hops are chiefly eliminated by the skin and kidneys, increasing considerably the sweat and urine. NARCOTICS. 445 Temperature is unaffected. Untoward Action.—None is noticeable, although the drug pos- sesses marked aphrodisiac properties. Therapeutics.—Externally and Locally.—The sedative action of hops is utilized in what are known as hop poultices in superficial and abdominal inflammations, in orchitis, and as a preventive of chordee. A hop pillow is frequently employed to induce sleep and allay the pain of earache, while, if the pillow be moistened with weak vinegar and the fumes inhaled, the result is found to be efficacious in the treatment of inflammatory conditions of the upper respiratory passages. Internally.—Its stomachic and carminative properties render this remedy valuable in atonic dyspepsia, so called, and in flatulent colic. Preparations of hops are also useful in febrile restlessness. Priapism, perverted sexual appetite, spermatorrhea, etc. may be relieved by lupulin. The combined tinctures of lupulin and capsicum serve as ex- cellent substitutes for alcoholic stimulants during the treatment of alcoholism, as well as being useful remedies in mild attacks of delirium tremens. Administration.—Lupulin and oleoresin of lupulin are best given in pills and capsules respectively. The tincture and fluid extract should be administered in syrup. Lactucarium—Lactucarii—Lactucarium. IT. 8. P. Origin.—The concrete milk-juice of Lactuca virosa L.; a bien- nial rank-smelling herb growing in Europe. Description and Properties.—It occurs in sections of plano- convex, circular cakes, or in irregular, angular pieces, externally grayish-brown or dull reddish-brown, internally whitish or yellow- ish, of a waxy lustre, heavy, narcotic odor, and somewhat bitter taste. It contains lactucin, lactucopicrin, lactucic acid, lactucerin, and wax. Dose.—5-60 grains (0.3-4.0 Gm.). Official Preparations. Tinctura Lactucarii—Tinctiirae Lactucarii—Tincture of Lactucarium.— Dose, \-2 fluidrachms (1.0-8.0 Cc). Syrupus Lactucarii—Syrupi Lactucarii—Syrup of Lactucarium.—Dose, 1- 4 fluidrachms (4.0-15.0 Cc). 446 A TEXT-BOOK OF MATERIA MEDICA. Synergists.—The same as for opium. Physiological Action and Therapeutics.—Its action closely resembles that of opium, save that it is very feeble, in adults never producing alarming symptoms. It is slightly soporific and anodyne, and also diuretic, which properties, especially in the syrup form, render it of some value in cases of irritating cough, as well as in sleeplessness and nervousness of children. Lactucin may be given in doses of from I to 5 grains (0.06-0.3 Gm.) as a mild sedative and hypnotic. Cannabis Tndica—Cannabis Tndicae—Indian Can- nabis. XT. 8. P. (Indian Hemp.) Origin.—The flowering tops of the female plant of Cannabis sativa L., grown in the East Indies. Description and Properties.—The article of commerce con- sists of bundles of a few flowers, the branches and bracts, and nearly ripe fruit, the whole more or less agglutinated by a resinous exudation. Of a brownish-green color, peculiar, narcotic odor, and slightly acrid taste. The drug contains a resin, cannabin, a brown, amorphous powder soluble in absolute alcohol, and a vola- tile oil. The crude drug is commonly called in India " gunjah." " Bhang," " siddhi," or " hashish," the term usually employed—from whose toxic effects, frequently inciting to murder, is said to be derived our word " assassin "—is another form of cannabis appearing as the Arabian confection prepared by mixing aromatics with fruits and dried leaves. Dose.—2-5 grains (0.12-0.3 Gm.). Official Preparations. Extractum Cannabis Indicae—Extracti Cannabis Indicae—Extract of In- dian Cannabis.—Dose, \-i grain (0.015-0.06 Gm.). Extractum Cannabis Indicae Fluidum—Extr3cti Cannabis Indicae Fluidi— Fluid Extract of Indian Cannabis.—Dose, 3-6 minims (0.18-0.36 Cc). Tinctura Cannabis Indicae (15 per cent.)—Tinctiirae Cannabis Indicae— Tincture of Indian Cannabis.—Dose, 5-20 minims (0.3-1.2 Cc). Unofficial Preparations. Cannabine Tannate.—Dose, 2-10 grains (0.13-0.60 Gm.). Cannabinone.—Dose, \-i grain (0.03-0.06 Gm.). NARCOTICS. 447 Antagonists and Incompatibles.—Strychnine, caustic alkalies, acids, and aqueous preparations are pharmaceutical incompatibles, precipitating the resin. Synergists.—Alcoholics, ether, bromides, cocaine, and members of the present group enhance its cerebral effects. Physiological Action.—Externally and Locally.—Its only local action is that of a feeble sedative. Internally.—Digestive System.—It is slightly sedative to the stomach, in many persons appearing to promote the appetite and aid digestion. Its use is not followed by constipation or other gastro-intestinal disturbance. Circulatory System.—A slight acceleration of the pulse is notice- able, probably due more to the stimulation of the nervous system than to any direct action upon the circulatory apparatus. Nervous System.—-Like opium, it primarily stimulates the brain, large doses producing a peculiar exhilaration and subsequent reac- tion more fully described under Poisoning. The period of excita- tion is more prolonged than with opium, but is eventually succeeded by sleep—almost always disturbed by dreams and spectral illusions. The coma resulting from cannabis is never so profound as in the case of opium. It is like the latter drug as an analgesic, but feebler in its action. It is unlike opium in producing a sensation of tingling and numb- ness, through its effect upon the sensory nerves, followed by cutaneous anesthesia, accompanied by muscular debility and fre- quently a cataleptic condition. Respiratory System.—No marked or uniform action upon the respiration has been observed, it being at times quickened and again retarded, though the effects are less pronounced than with opium. Absorption and Elimination.—Cannabis is slowly eliminated, though in what manner is unknown, the effects of the drug some- times persisting for twenty-four or thirty-six hours. Of all the secretions, the urine alone is affected, the amount being increased. Temperature.—Cannabis has no direct depressing action upon temperature, which, however, may rise during the period of excita- tion and be diminished somewhat during sleep. Eye.—The drug differs from opium in that it dilates the pupil and produces exaggerated vision. Uterus.—It is considered to be a powerful uterine stimulant, and like properties are usually ascribed to it as an aphrodisiac, though 448 A TEXT-BOOK OF MATERIA MEDICA. its effect upon sexual desire is not always manifest. It undoubtedly increases the energy of the uterus, though possessing no power to inaugurate uterine contractions when once suspended. Untoward Action.—The uncertain effects of different prepara- tions, together with varying susceptibilities to the drug, render it almost impossible to cite any characteristic untoward symptoms. Certain of the effects described under Poisoning may be present even under small doses in persons having an idiosyncrasy against the remedy. Poisoning.—Large doses of cannabis Indica are wont to produce toxic effects which in their manifestations present a singular study of psychological phenomena, varying with the temperament and idiosyncrasies of the subject, yet in certain characteristics common to all who experience the full force of the drug. The transition from the influence of medicinal doses to that exerted by poisonous absorption is often gradual, many features of the conditions result- ing therefrom being strikingly similar. Moderate administration, however, is seldom attended by unto- ward effects, whereas toxic doses, in place of emotional delight— among the earlier sensations—develop an intensity of mental anxiety which even contemplates death as the inevitable issue of the malady. The buoyancy of spirit, the soothing calm and insouciance, the ecstasy of an ethereal mood by which finer natures are swayed,—these have given place to a mental and physical oppression best described as " a sensation as of the brain boiling over and lifting the cranial arch like the lid of a tea-kettle." Not infrequently the blissful nirvana induced by moderate doses is rudely broken by an intemperate use of the drug, extreme vio- lence and even murderous thoughts supplanting calmer reveries and the intellectual solace of passive emotions. Especially is this true among Oriental nations—the Hindustanis, for example— addicted to excessive indulgence in bhang or hashish, the form of the drug generally employed, its effects upon the grosser passions rivalling those of opium among the Malays. Among the most curious and striking of the psychological phenomena attending immoderate doses of hashish is the abolition of space and time. So manifold are the images which throng the imagination, and so rapid and intense the impressions made upon the mind, that the sense of proportion and the normal relations of material objects become wholly lost. Thus, the furniture in the room may appear infinitely removed to the distorted vision, while NARCOTICS. 449 a few seconds of time may be prolonged by the disordered fancy into hours, days, weeks, and even years. These hallucinations, strangest of all, are not accompanied by corresponding loss of reasoning power, the intellect taking cognizance frequently of the true relations of external things, as if aware of its own abnormal condition. Nor is volition seriously affected, the mental lesion, so to speak, existing rather in lack of coordination between con- sciousness and the imaginative faculty. These spasmodic or persistent hallucinations are often associated with a haunting sense of dual existence, in which all trace of per- sonal identity is for the time either obliterated or hopelessly con- fused. During a certain stage of poisoning, moreover, the conviction of impending death takes possession of the mind; fear and des- peration seize upon the bewildered faculties, intensified by an im- pression of physical dissolution ; and the subject endures unspeak- able anguish, in which gloomy forebodings of disaster contrast terribly with the buoyancy, the temporary joy, and peals of laughter accompanying the earlier effects of the drug. Upon regaining his normal condition the hashish-eater is either wholly oblivious of the events which have transpired during the interval of intoxication, or recalls vividly the scenes and incidents through which he has passed. As in the case of opium, the pecu- liar influence of the drug is largely dependent upon temperament, sex, age, and idiosyncrasy. A refined and noble intellect, like De Quincey's, might readily be moved to gentler emotions and sensi- bilities suffused with human sympathy and love. A baser, more unfeeling nature might exhibit latent symptoms of ungovernable passion manifested in sensual or criminal conduct scarcely con- ceivable either to himself or to others. The physiological symptoms characteristic of cannabis-poisoning are well marked, the drug acting reflexly yet powerfully upon the mental state. Loss of consciousness, followed by collapse or stupor, or in some cases resulting in catalepsy and convulsions, in all cases complete anesthesia, and in very many a depression of the pre- cordium, a sensation of arterial contraction, and cardiac palpitation, are among the prominent features of the malady. The sight and hearing are perceptibly rendered more acute; the pupils are dilated, although contracting to light; the reflexes are lowered by stimu- lation of inhibitory centers; and an oppressive sense of paralysis in the extremities induces horror and despair. The urinary se- cretions are augmented, although constipation seldom occurs, 29 450 A TEXT-BOOK OF MATERIA MEDICA. and a ravenous appetite almost invariably attends the toxic phe- nomena. Occasionally there is experienced great difficulty in breathing, as if the lungs were on the point of bursting. An increase of sexual desire is common, although the aphrodisiac properties of the drug are not always present. The after-effects of hashish indulgence vary with the physiolog- ical and mental peculiarities of the individual. As a rule, they are not disagreeable, though it requires time to eradicate the effects of the poison. Death directly attributable to the drug has not been recorded. Treatment of Poisoning.—Among antidotes, lemon-juice, coffee, and tobacco have been favorably mentioned. The best treatment appears to be similar to that adopted in cases of chloral- and opium-poisoning. Therapeutics. — Externally and Locally.—Cannabis is very seldom used locally, although it is an ingredient of a powder recommended by W. H. Beverly for insufflation in hay fever. Internally.—Cannabis has been discarded as a remedy in many disorders for which it was formerly used. It is, however, still employed to a considerable extent as an hypnotic in melancholia and mania and for its anodyne and anesthetic action in neuralgia and pruritus. As a uterine tonic and anodyne it has been found efficient, either alone or in combination with other medicines, in subinvolution, chronic metritis, dysmenorrhea, meuorrhagia, etc. Probably there is no remedy superior to cannabis Indica in functional impotence, its action in this disorder being aided by com- bining it with ergot and nux vomica. It is a valuable adjuvant to cough-mixtures intended to relieve tickling or irritation of the throat, as well as to quiet the excessive cough of bronchitis or phthisis, being superior to opium in this respect, since it disturbs the stomach less and does not produce constipation. It has been used in spasm of the bladder, and in gonorrhea and chordee it has been found to be a most valuable remedy. In considering the therapeutics of cannabis Indica reference should be made to its efficacy in migraine and headaches, particu- larly those present at the menopause. Although as a remedy for the former disorder cannabis has been largely superseded by the adoption of antipyrine and agents of its class, the old use of tine- NARCOTICS. 451 ture of gelsemium, combined with tincture of cannabis, serves an important purpose in aborting the distressing attacks of migraine. Administration.—The extract should be given in pill form ; the tincture and fluid extract, in an alcoholic menstruum. As has been already intimated, different samples vary greatly in strength; it is therefore best to begin with the minimum dose until the force and quality of the preparation be ascertained. It is advisable to prescribe invariably the preparations of that particular manufacture which experience has shown to produce samples of uniform strength. The following drugs—Belladonna, Stramonium, Hyoscyamus, Duboisia, and Dulcamara—belong to the Solanaceae, and are by some authors classed as Mydriatics, on account of their character- istic action on the pupil. It has been thought best in the present work to include them in the subdivision of Narcotics, because of their narcotic properties, utilized clinically in the treatment of dis- eased conditions. Belladonna is considered the type of the Mydriatic Narcotics, and claims the first attention. Two portions of the plant are used —the leaves and the root. Belladonnas Folia—Belladonnas Foliorum—Bella- donna Leaves. U. 8. P. Origin.—The leaves of Atropa Belladonna L., a nearly glabrous, herbaceous, perennial plant, from 4 to 6 feet (1.2-1.8 M.) high, bearing dark-purple, bell-shaped flowers and shining purplish- black berries of the size of a cherry. It is found in the woods, chiefly in the mountainous districts, of Central and Southern Eu- rope, and as far east as Asia Minor, Caucasia, and Central Asia. It is cultivated in Europe and in the United States to some extent, being known by the common name of " deadly nightshade." Description and Properties.—The leaves are from 4 to 6 inches (10-15 Cm.) long and about one-half as broad, broadly ovate, equilaterally narrowed into a petiole, tapering at the apex, entire on the margin, smooth, thin, the upper surface brownish- green, the lower surface grayish-green, both surfaces whitish punc- tate ; odor slight, taste bitterish and disagreeable. Belladonna leaves contain from 0.2 to 0.6 per cent, of atropine, the most important alkaloid, belladonnine (probably anhydro-atro- 452 A TEXT-BOOK OF MA TERIA MEDICA. pine), besides an alkaloid identical with hyoscyamine, duboisine, daturine, atropamine—sometimes present—and chrysatropic acid (scopaline). Dose.—1-5 grains (0.06-0.30 Gm.). Official Preparations. Extractum Belladdnnae Foliorum Alcohdlicum—Extracti Belladdnnae Fo- liorum Alcohdlici—Alcoholic Extract of Belladonna Leaves.—Dose, \-\ grain (0.008-0.048 Gm.). Emplastrum Belladdnnae (20 per cent.)—Emplastrum (ace) Belladdnnae— Belladonna Plaster.—For external use. Formula: Alcoholic Extract of Belladonna Leaves, 200; Resin Plaster, 400; Soap Plaster, 400. Tinctura Belladdnnae Foliorum (15 percent.)—Tinctiirae Belladdnnae Folio- rum—Tincture of Belladonna Leaves.—Dose, 5-20 minims (0.3-1.2 Cc). Ungu6ntum Belladdnnae (10 percent.)—Ungufinti Belladdnnae—Belladonna Ointment.—For external use. Formula: Alcoholic Extract of Belladonna Leaves, IO; Diluted Alcohol, 5; Ben- zoinated Lard, 85. Belladonnas Radix—Belladonnas Radicis—Bella-, donna Root. XT. 8. P. Description and Properties.—The root of Atropa Belladonna occurs in cylindrical, somewhat tapering, longitudinally wrinkled pieces, \ inch to I inch (12-25 Mm.) thick; externally brownish- gray, internally whitish; fracture nearly smooth and mealy, not radiating or showing medullary rays in the thicker roots, except in the layer near the bark; nearly inodorous, of sweetish taste, after- ward bitterish and strongly acrid. The root contains the same constituents as the leaves, with the exception of chrysatropic acid—which is wanting—and in addition a red coloring principle, atrosin, found also in the berries. Official Preparations. Extractum Belladdnnae Radicis Fluidum—Extr3cti Belladdnnae Radicis Fluidi—Fluid Extract of Belladonna Root.—Dose, 1-3 minims (0.06-0.18 Cc). Linimentum Belladdnnae (95 per cent.)—Linimgnti Belladdnnae—Bella- donna Liniment.—For external use. Formula: Camphor, 50; Fluid Extract of Belladonna Root, 950. The important alkaloid of belladonna is— Atropina—Atroplnas—Atropine. XT. 8. P. Description and Properties.—White acicular crystals, or a more or less amorphous white powder, odorless, having a bitter, NARCOTICS. 453 acrid taste, gradually assuming a yellowish tint on exposure to air. Soluble in 130 parts of water, 3 parts of alcohol, 16 parts of ether, 4 parts of chloroform, and about 50 parts of glycerin. Dose.—x\^ ^0 grain (0.0005-0.0016 Gm.). Atroplnas Sulphas—Atroplnas Sulphatis—Atropine Sulphate. XT. 8. P. Description and Properties.—A white, indistinctly crystalline powder, odorless, having a very bitter, nauseating taste, permanent in air. Soluble in 0.4 part of water, 6.2 parts of alcohol, 2270 parts of ether, and 694 parts of chloroform. Dose.—Tl0- iQ grain (0.0005-0.0016 Gm.). HOMATROPINA—HoMATROPIN.-E—HoMATROPINE. An unofficial and derivative alkaloid, obtained by the action of dilute hydrochloric acid on amygdalate of tropin. The hydrobro- mate of homatropine is used only as a mydriatic. Allied Plants. Atropa Mandr3gora L., Mandrake, closely resembles Atropa Belladonna. It pos- sesses marked anesthetic properties, and contains a mydriatic alkaloid. It is especially interesting because of its ancient history, its action having been fully described by Dioscorides and Pliny. Historians and poets have alike celebrated its peculiar and wonderful properties. Scdpola Carnidlica and Scopola Japonica both resemble belladonna physically, and somewhat In their physiological action, the roots and leaves of these plants having been found mixed with those of belladonna. Antagonists and Incompatibles.—Muscarine antagonizes the action of belladonna in nearly every particular, and physostigmine, pilocarpus, and aconite counteract many of its effects. Opium an- tagonizes its action on the cerebrum, pupil, heart, respiration, arterial tension, and kidneys. Atropine is incompatible with caustic alkalies, tannin, and vege- table infusions containing tannin, an insoluble tannate of the alka- loid being formed. Synergists.—The mydriatic drugs mentioned above aid the action of belladonna. Physiological Action.—The action of belladonna is dependent upon the amount of atropine it contains. Externally and Locally.—When locally applied atropine is anodyne, antispasmodic, resolvent, antisecretory, and mydriatic. 454 A TEXT-BOOK OF MA TERIA MEDICA. When thus used, in combination with absorbable substances— such as alcohol, camphor, animal fats, glycerin, etc.—it diminishes the sensibility of the sensory nerves, and when absorbed from raw surfaces of the skin or from the subcutaneous tissue it is capable of producing systemic effects. Internally.—Digestive System.—Even small doses produce dry- ness of the mouth, owing to the greatly diminished secretion of saliva and mucus. The salivary secretion is lessened through paralysis of the peripheral endings of the chorda tympani nerve in the submaxillary gland. The drug probably diminishes the secretions from the stomach, liver, pancreas, and intestines in a similar manner. It is reasonable to suppose that it produces these effects, since it checks all other secretions, with the possible exception of the urine. The sweat is diminished through paralysis of the peripheral nerve-endings in the sudoriparous glands. The secretion of milk is reduced by paral- ysis of the peripheral terminations of the secretory nerves in the mammary glands. The secretion from the bronchial mucous mem- branes is lessened through the depressing influence of the drug upon the nerve-endings. The peristaltic movements of the intestines are increased by small doses, large doses checking them. The intestines contain a complicated nervous mechanism: I. Auerbach's plexus, located between the muscular walls of the intestine, and possessing the function of maintaining rhythmical vermicular movements of the intestines. 2. Two sets of nerves—the accelerator and inhibitory, situated outside of the intestines, but connected with Auerbach's plexus, their function being to coordinate peristalsis. When a small dose of belladonna is administered it paralyzes the peripheral terminations of the inhibitory nerves, so that, the inhibition being interfered with, peristalsis is increased. On the other hand, a large dose paralyzes Auerbach's plexus, interfering with the transmission of impressions from the accelerator nerves to the intestinal walls, thereby diminishing peristalsis. The action of belladonna, therefore, upon the intestines may at first sight appear paradoxical, its tendency being to remove constipation and to check diarrhea, although a correct understanding of the matter will serve as a rational explanation of these apparently contradictory effects. Circulatory System.—Medicinal doses of atropine or belladonna at first retard the pulse, but it is quickly accelerated and rendered NARCOTICS. 455 firmer, with increased arterial pressure. The primary transitory action is due to a slight stimulation of the vagi roots, the subse- quent quickening of the pulse resulting from depression of the peripheral ends of the pneumogastric nerve distributed in the car- diac muscle. The inhibition being thus removed, the heart re- sponds to the influence of the accelerator nerves. The center for these nerves in the medulla is also stimulated by the drug, increas- ing still further the rapidity of the heart's action. The cardiac muscle itself, being stimulated, renders the contractions of the heart more forcible. Arterial tension is increased not only by the greater rapidity and force of the heart, but also by the contraction of the arterioles arising from stimulation of the vaso-motor center. Very large or poisonous doses lower arterial pressure. This effect is produced by exhaustion of the vaso-motor center from over-stimulation, resulting in dilatation of the cutaneous arterioles, which lowers arterial tension and flushes the skin. Overwhelming doses may weaken the cardiac muscle itself from over-stimulation, weakening the heart's contractions, as well as paralyzing the terminal nerve- filaments in the muscles of the vessel-walls, and even the muscular fibers. Nervous System.—A full medicinal dose of belladonna stimulates the brain, while large doses—and, in susceptible persons, medicinal ones—may produce hallucinations and delirium, accompanied by spectral illusions. The delirium may be mild, joyful, and talkative, or it may assume a violent type. It may, moreover, persist for a long time, after which the patient sinks to sleep, induced either by exhaustion from the delirium or a secondary depressing action of the drug. True coma, like that produced by opium, rarely if ever occurs. The spinal cord shares in the stimulation caused by belladonna. The reflexes are at first slightly exaggerated, being afterward diminished. Very often under poisonous doses there is complete motor paralysis, the loss of power occurring first in the lower extremities. The sensory nerves are depressed, especially when the drug is locally applied, the influence being exerted on their terminal fila- ments. For this reason belladonna is of little service as an ano- dyne when given internally. Respiratory System.—Medicinal doses quicken and deepen the respirations, owing to stimulation of the respiratory center. The 456 A TEXT-BOOK OF MATERIA MEDICA. peripheral nerve-filaments of the pulmonary vagi are, however, depressed; which, were it not for the increased action of the center, would retard respiration. Poisonous doses over-stimulate, and consequently exhaust or / paralyze, the respiratory center, the result being slow and shallow breathing or perhaps death from asphyxia. Absorption and Elimination.—Atropine is rapidly absorbed and eliminated, chiefly by the kidneys, but also to some extent by the bowels. It is said that part of the drug is destroyed by the liver. Temperature.—Large doses increase bodily heat, probably by increasing the circulation and respiration, consequently augmenting combustion. Some authors maintain that belladonna stimulates the heat-center. In cases of severe poisoning from the drug the temperature rapidly falls. Eye.—Belladonna dilates the pupil, whether locally applied or taken internally, its effect differing from that of cannabis Indica in that the pupil cannot be made to contract by stimulation of the third nerve, although excitement of the muscle itself causes pupil- lary contraction. The manner in which atropine dilates the pupil is not yet satisfactorily explained, the prevailing opinion being in favor of Jessup's theory that the action is due to a stimulation of the ends of the sympathetic nerve-filaments distributed to the iris, and paralysis of the peripheral ends of the oculo-motor nerves. Atropine increases intraocular tension, rendering it a dangerous drug in glaucomatous conditions. Untozvard Action.—Very frequently there appears, especially in children, an erythematous or scarlatinal eruption, oftener noticeable on the face and neck, but sometimes affecting the entire surface of the body. Redness and pain in the throat may also be present, but no fever, with itching of the skin or desquamation. Occasionally instillation of atropine into the eye produces pro- fuse lacrymation, edema of the eyelids, and blepharo-conjunctival irritation. When taken internally in medicinal doses it sometimes occasions in certain persons vertigo, turgescence of the face, hallucinations, erethistic debility, and impaired assimilation. Homatropine has caused dizziness, uncertainty of gait, fatigue, difficulty in deglutition, and loquacious delirium. Poisoning.—The poisonous actions of belladonna may be sum- marized as follows: The skin is dry and hot; the conjunctivae are congested, with, NARCOTICS. 457 possibly, edema of the eyelids and pupils widely dilated; the face is swollen, while the whole body may be covered with an erythem- atous rash, and there is a sensation of heat and pain in the throat and difficulty in swallowing. Rapid respirations, muscular weakness, and incoordination of movements appear; the patient becomes dizzy or mildly or violently delirious, continually talking, shouting, or laughing. While there is a constant desire to micturate, there is an inability to pass any urine. At this stage the respirations are slow and shallow. Finally, convulsions may occur, and the patient sink into a coma- tose condition and die from asphyxia and cardiac exhaustion. Treatment of Poisoning.—Wash out the stomach with solutions of tannic acid, pursuing the treatment with the cautious adminis- tration of physostigmine, opium, or the hypodermic injection of pilocarpine. Should cardiac failure be pronounced or the patient lapse into a state of stupor, stimulants and the subcutaneous injec- tion of caffeine are indicated, the patient being aroused meanwhile and kept awake if possible, respiration being maintained by the use of strychnine and by artificial means when necessary. Should the temperature fall below normal, external heat must be applied. Atropine compared with Morphine. Atropine stimulates respiration ; morphine is a powerful respi- ratory depressant. Atropine dilates the pupil; morphine contracts it. Atropine increases bodily heat, and frequently reddens the surface of the skin; morphine produces pallor of the skin and lowers temperature. Atropine augments peristaltic movements of the bowels; mor- phine checks them. Atropine reinforces the functional activity of the kidneys ; morphine lessens it. On the other hand, atropine checks the secretion from the skin, while morphine increases it. The remaining secretions are diminished by both drugs, but in different ways. Atropine, for instance, checks secretion by depress- ing the peripheral terminations of the secretory nerves; morphine, by depressing the secretory center in the medulla. Both drugs depress the sensory mechanism, yet again by differ- ent actions, atropine depressing the function of the sensory nerve- terminations, and morphine depressing the center mainly, although to some extent influencing the entire sensory tract. Atropine acts rather as a cerebral excitant, producing delirium, hallucinations, and disturbed sleep; morphine is more of a cerebral 458 A TEXT-BOOK OF MATERIA MEDICA. depressant, the period of mental excitation being comparatively brief, while sleep is longer and more profound. In medicinal doses atropine contracts the arterioles; morphine dilates them. Again, while morphine, like atropine, causes the heart to beat faster and stronger, it is by no means so powerful a cardiac stimulant as atropine. In many respects these drugs are mutually synergistic. Both relieve pain, though morphine is much the more powerful anodyne. Both cause incoordination of muscular movements and mental confusion. Although in many respects antagonistic, they are frequently combined when an anodyne action is desired. As has been forcibly suggested, their reciprocal influence, when administered together, modifies in a remarkable manner their physiological effects. Therapeutics.—The many uses for which belladonna has been employed would render it a difficult, perhaps useless, task to enumerate them. As in the case of opium, there are cer- tain general and important actions in disease which the physician can utilize in daily practice, a succinct mention of which is ap- pended : i. Belladonna is serviceable in relaxing spasms of invol- untary muscles, as in asthma, spasmodic colic, lead colic, spasmodic dysmenorrhea, laryngismus stridulus, etc. 2. In diminishing secretion, as in acute coryza, bronchitis, night- sweats of phthisis, and to check the secretion of milk, mercurial ptyalism, etc. 3. In relieving pain, either combined with opium or morphine, or alone, particularly where it can be applied locally, as in lumbago, neuralgia, pleurodynia, etc. 4. Belladonna is used to stimulate the circulatory system in cases of a weak heart and low arterial tension, as in fevers, etc. 5. For its peculiar action upon the eye in ophthalmo- logical practice, to dilate the pupil, prevent adhesion, remove congestion, relieve pain, and afford rest. While, as has been said, it is impossible to mention in detail the manifold uses of belladonna, its more important therapeutic services may be here mentioned : Externally and Locally.—Belladonna ointment is useful in the treatment of boils, carbuncles, chronic inflammatory conditions about the articulations, chronic synovitis of the knee-joint, its efficiency in the latter condition being enhanced by combining it with mercurial NARCOTICS. 459 ointment. Orchitis is greatly relieved by covering the testicle with belladonna ointment. Suppositories containing extract of bella- donna are beneficial in the treatment of hemorrhoids and in anal fissure. A rigid os may be made to dilate, hastening delivery, by smearing the cervix with the ointment of this drug. Eczema and excessive sweating of certain areas of the skin, such as the palms and soles, are benefited by a local application of the tincture or the dried and powdered extract mixed with some inert desiccant powder like powdered talcum. Belladonna plaster is one of the most useful applications in cases of acute or chronic muscular rheumatism, and in certain forms of neuralgia. In its power to arrest the secretion of milk the drug is perhaps without an equal. Should inflammation have already set in and the breasts be swollen and painful, the ointment is to be applied and the breasts covered with hot flaxseed poultices, the parts being entirely supported by wide bandages. Internally.—Belladonna is combined with opium to relieve the pain of gastralgia and enteralgia, while its combination with strych- nine and iron is useful in anemic neuralgia. Next to bromoform, it is the most efficient remedy in whooping cough; the spasmodic manifestations of hysteria are also favorably affected by full doses of tincture of belladonna. Nocturnal incontinence of urine in children, when resulting from supersensitiveness of the mucous membrane of the bladder, derives signal benefit from this drug. By depressing the ends of the sen- sory nerves distributed to the bladder belladonna prevents the irri- tation of the accumulated urine from being conveyed to the center in the cord, and from there reflexly exciting the detrusor muscle of the sphincter and causing micturition. Belladonna combined with strychnine stimulates the respiration and checks the sweating in phthisis. A similar union with some laxative drug makes an exceedingly useful pill in habitual constipa- tion, while the obstinate constipation due to lead-poisoning is greatly relieved by belladonna. This drug, as well as the other mydriatic narcotics, is one of the most reliable remedies we possess to relieve the symptoms of spas- modic asthma. It is highly recommended also by many physicians in typhoid fever to support the circulation and relieve many dis- tressing symptoms of the disease. In scarlatina, too, it is thought to be a useful remedy. Cardiac pain and distress due to over-action of the heart are 460 A TEXT-BOOK OF MATERIA MEDICA. alleviated by the application of belladonna plaster over the cardiac region or by the internal use of the drug. Intestinal, hepatic, and renal colic, cystitis, prostatitis, spermator- rhea, exophthalmic goiter, cerebral and spinal hyperemia, sea-sickness, facial erysipelas, and menorrhagia have all apparently been favor- ably influenced by belladonna. Atropine subcutaneously injected is a powerful antidote to chlo- roform-, physostigma-, aconite-, and jaborandi-poisoning, as well as that contracted from toadstools. Administration.—The crude drug, leaves, and root are seldom if ever used. Owing to its action in diminishing secretion, it is better to time the internal administration of belladonna so as to interfere as little as possible with the process of digestion. Children are peculiarly insusceptible to this drug, tolerating even larger doses than adults. When atropine is used hypodermically in cases of sciatica or neuralgia, the injection should be made deeply in close proximity to the affected nerve-trunk. The part of the body to which a belladonna plaster is to be applied should be first thoroughly cleansed and dried, the exact area to be covered being specifically designated by the physician. Caution should be exercised in the application, lest too large a space be covered by the plaster and dangerous symptoms super- vene from absorption of its more active constituents, a result which may also occur from too prolonged contact, from three to five days being usually sufficient. Should it be desirable to continue the influence of the drug, the application of fresh plaster from time to time will produce better results than too long use of a single one. Stramonii Folia—Stramonii Foliorum—Stramonium Leaves. XJ. 8. P. (Thorn-apple; Jamestown or Jimson Weed.) Origin.—The leaves of Datura Stramonium L., a coarse-look- ing annual weed, believed to be a native of Asia, but found grow- ing in waste places and along roadsides throughout the greater part of the world. Description and Properties.—From 3 to 8 inches (7-20 Cm.) long, petiolate, dark-green, smooth, ovate, pointed, unequal, espe- cially at the base, coarsely and sinuately toothed; thin, brittle and nearly inodorous ; taste unpleasant, bitter and nauseous. Stramo- NARCOTICS. 461 nium leaves contain about 0.2 per cent, of a mixture of atropine and hyoscamine known as daturine. Dose.—1-5 grains (0.06-0.3 Gm.). Stramonii Semen—Stramonii Seminis—Stramo- nium Seed. XT. 8. P. Origin.—The seed of Datura Stramonium L. Description and Properties.—About \ inch (4 Mm.) long, reniform, flattened, pitted and wrinkled, testa dull brownish-black, hard, enclosing a cylindrical, curved embryo imbedded in a whitish, oily perisperm; of an unpleasant odor when bruised, and of an oily and bitter taste. The seeds contain a larger proportion of daturine than the leaves, besides scopalimine, resin, fixed oil, etc. Dose.—1-3 grains (0.06-0.2 Gm.). Official Preparations. Extractum Stramonii Sfeminis—Extracti Stramonii Seminis—Extract of Stramonium Seed.—Dose, J-J grain (0.02-0.03 Gm.). Extractum Stramonii SSminis Fluidum—Extracti Stramonii SSminis Fluidi—Fluid Extract of Stramonium Seed.—Dose, 1-3 minims (0.06-0.2 Cc). Tinctura Stramonii SSminis—Tinctiirae Stramonii SSminis—Tincture of Stramonium Seed (15 per cent.).—Dose, 5-10 minims (0.3-0.6 Cc). Ungu6ntum Stramonii—Ungufinti Stramonii—Stramonium Ointment (10 per cent, of extract).—For external use. Antagonists and Incompatibles and Synergists are the same as for belladonna. Physiological Action.—The action of stramonium is almost identical with that of belladonna, the main difference being the influence of stramonium upon the sympathetic system, the motor and sensory nerves being less powerfully affected than by bella- donna. Stramonium is more apt to occasion irregular action of the heart, and the involuntary muscle-fibers of the bronchial tubes are relaxed more by stramonium than by belladonna. It usually occasions more delirium and is more of an aphrodisiac than bella- donna. Poisoning and Treatment of Poisoning are precisely the same as described under Belladonna. Therapeutics.—The medical uses of belladonna are applicable to this drug, although stramonium is much the better remedy in spasmodic asthma. The stramonium ointment appears to be 462 A TEXT-BOOK OF MATERIA MEDICA. superior to that prepared from belladonna as an application to painful hemorrhoids. Administration.—No special directions are necessary, any of the preparations being serviceable. For asthma the leaves may be smoked in a pipe or in the form of cigarettes, this method of em- ploying the drug to relieve bronchial spasm being probably superior to internal administration. Hyoscyamus—Hyoscyami—Hyoscyamus. XT. 8. P. (Henbane.) Origin.—The leaves and flowering tops of Hyoscyamus niger L., collected from plants of the second year's growth. Henbane is a biennial growing in sandy soil and waste places throughout the greater portion of Europe and Asia, and naturalized in North America. Description and Properties.—Leaves ovate or obovate-oblong, up to 10 inches (25 Cm.) long and 4 inches (10 Cm.) broad; sinu- ate-toothed, the teeth large, oblong, or triangular; grayish-green, and, particularly on the lower surface, glandular-hairy; midrib prominent; flowers nearly sessile, with an urn-shaped, five-toothed calyx and a light-yellow, purple-veined corolla; odor heavy, nar- cotic ; taste bitter and somewhat acrid. The active constituents are hyoscyamine and hyoscine, and a very poisonous volatile oil is obtained by distillation of the leaves, which contain also a small percentage of potassium nitrate. Dose of the Leaves.—5-15 grains (0.3-1.O Gm.). Official Preparations. Extractum Hyoscyami—Extracti Hyoscyami—Extract of Hyoscyamus.— Dose, 1-3 grains (0.06-0.2 Gm.). Extractum Hyoscyami Fluidum—Extr3cti Hyoscyami Fluidi—Fluid Ex- tract of Hyoscyamus.—Dose, 5-15 minims (0.3-1.0 Cc). Tinctura Hyoscyami—Tinctiirae Hyoscyami—Tincture of Hyoscyamus (15 per cent.).—Dose, 10-60 minims (0.6-4.0 Cc). Hyoscinae Hydrobromas— Hyoscinae Hydrobro- matis— Hyoscine Hydrobromate. XT. 8. P. Origin.—The hydrobromate of an alkaloid obtained from Hy- oscyamus. Description and Properties.—Colorless, transparent, rhombic crystals, odorless, and having an acrid, slightly bitter taste ; perma- NARCOTICS. 463 nent in the air. Soluble in 1.9 parts of water and in 13 parts of alcohol. It should be kept in small, well-stoppered vials. Dose.—xtU—^o" grain (0.0006-0.001 Gm.). Hyoscyamlnae Hydrobromas— Hyoscyamlnae Hy- drobromatis — Hyoscyamine Hydrobromate. U. 8. P. Origin.—The hydrobromate of an alkaloid obtained from Hy- oscyamus. Description and Properties—A yellowish-white, amorphous, resin-like mass or prismatic crystals, having, particularly when damp, a tobacco-like odor and an acrid, nauseous, and bitter taste. Deliquescent on exposure to the air; soluble in about 0.3 part of water and 2 parts of alcohol. It should be kept in small, well- stoppered vials. Dose.—j^Q—jro grain (0.0006-0.0015 Gm.). Hyoscyami Sulphas—Hyoscyami Sulphatis—Hyos- cyamine Sulphate. XT. 8. P. Origin.—The neutral sulphate of an alkaloid obtained from Hyoscyamus. Description and Properties.—White, indistinct crystals or a white powder, without odor, and of a bitter, acrid taste; deliques- cent in damp air. Soluble in 0.5 part of water and 2.5 parts of alcohol. It should be kept in small, well-stoppered bottles. Dose.—r^o~To gram (0.0006-0.0015 Gm.). Antagonists, Incompatibles, and Synergists the same as for belladonna. Physiological Action.—The action of hyoscyamus is analo- gous to that of belladonna, with the following differences: 1. Hyoscyamus increases the peristaltic action of the intestines more than belladonna, while at the same time it is more efficient in relieving the griping and pain occasioned by the rougher cathartics. 2. It is less powerful than belladonna as a cardiac stimulant, though stronger than stramonium. 3. It does not occasion nearly so much mental excitement as belladonna, on account of the hyoscine it contains, which is a powerful hypnotic and cerebral and spinal sedative. 464 A TEXT-BOOK OF MA TERIA MEDICA. 4. As a urinary sedative hyoscyamus is greatly superior to belladonna. 5. It differs from belladonna in affecting the respiration less powerfully. Untoward Action, Poisoning, and Treatment of Poisoning are the same as for belladonna. Therapeutics.—Hyoscyamus may be used for the same pur- poses as belladonna, but is considered superior to the latter drug as a urinary sedative in the treatment of incontinence of urine, vesical tenesmus, cystitis, prostatitis, etc. For the relief of colic of various forms, and to allay the griping produced by certain purgatives, hyoscyamus is better than bella- donna. In mental and convulsive diseases, such as delusional insanity, delirium tremens, acute and febrile mania, insomnia, chronic dementia, hysterical convulsions, chorea, paralysis agitans, etc., hyoscyamus, particularly hyoscine, is superior to belladonna. Hyoscyamus and its alkaloids are fully equal to belladonna in the treatment of asthma, whooping cough, neuralgia, enteralgia, etc. As an anodyne and hypnotic for children hyoscyamus is safer than, and frequently as efficient as, opium. Contraindications.—The same as for belladonna. Administration.—Like belladonna, this drug should be admin- istered tentatively. Any of the preparations may be given. The salts of the alkaloids may be administered either subcutaneously or internally. The hyoscine is tasteless, and may be easily given in various drinks. When used internally its action is slower, but more pro- longed, than when given hypodermically, though the dose under the former method should be twice that of the latter. GROUP VI.—MOTOR EXCITANTS. The drugs belonging to this group excite the functional activity of the spinal cord and the sympathetic nervous system. They serve to stimulate muscular contraction and the functional opera- tions of the heart, lungs, and secretory apparatus. It is difficult to separate by sharply-defined limits the remedies having these actions, and group them according to their analogous therapeutic uses. MOTOR EXCITANTS. 465 In the present group, for instance, are placed ergot and gossyp- ium, chiefly used for their action upon the uterus, while those drugs which, although excito-motors, are employed principally for their action upon the circulatory system are placed in the group, Cardiac Stimulants. The motor excitants are exceedingly valuable remedies, the typical member of the group being Nux Vomica, and therefore first considered. Nux Vomica—Nucis Vomicae—Nux Vomica. XT. 8. P. Origin.—The seeds of Strychnos Nux Vomica L., a small tree common in many parts of Hindustan, Farther India, some of the East Indies, and in some parts of Australia. Description and Properties.—Nux vomica is about 1 inch (25 Mm.) in diameter, orbicular, grayish or greenish-gray; soft- hairy, of a silky luster, with a slight ridge extending from the center of one side to the edge; internally horny, somewhat trans- lucent, very tough, with a large circular cavity, into which the heart-shaped, nerved cotyledons project. It is inodorous and per- sistently bitter. Nux vomica contains two important alkaloids—strychnine and brucine, the former being in excess. The seeds also contain iga- suric acid, with which these alkaloids are combined. Of total alkaloids the drug should contain from 2.5 to 5 per cent. Dose.—1-5 grains (0.06-0.3 Gm.). Official Preparations. Extractum Nucis VSmicae—Extracti Nucis V&micse—Extract of Nux Vomica.—Dose, \-\ grain (0.008-0.03 Gm.). Extractum Nucis Vomicae Fluidum—Extracti Nucis V6micae Fluidi— Fluid Extract of Nux Vomica.—Dose, 1-5 minims (0.06-0.3 Cc). Tinctura Nucis V6mica—Tinctiirae Nucis V6micae—Tincture of Nux Vomica.—Dose, 5-20 minims (0.3-1.2 Cc). Strychnina—Strychnlnae—Strychnine. XT. 8. P. Origin.—An alkaloid obtained from Nux Vomica, and also derived from other plants of the natural order Loganiacea. Description and Properties.—Colorless, transparent, octahedral or prismatic crystals, or a white, crystalline powder, odorless and having an intensely bitter taste, perceptible even in highly dilute (1 to 700,000) solution. Permanent in the air. Soluble at 150 C. 30 466 A TEXT-BOOK OF MA TERIA MEDICA. (590 F.) in 6700 parts of water, in no parts of alcohol, in 2500 parts of boiling water, and in 12 parts of boiling alcohol; also soluble in 7 parts of chloroform, but almost insoluble in ether. Dose.—eVrV gram (0.001-0.004 Gm.). Strychnine enters into the following preparations: FSrri et Strychnlnae Citras. Syrupus Fferri, Quinlnae et Strychnlnae Phosphatum. (See Ferrum, page 185.) Strychnlnae Sulphas—Strychnlnae Sulphatis— Strychnine Sulphate. XT. 8. P. Description and Properties.—Colorless or white, prismatic crystals, odorless, and having an intensely bitter taste, perceptible even in highly dilute (1 in 700,000) solution. Efflorescent in dry air. Soluble at 150 C. (590 F.) in 50 parts of water and in 109 parts of alcohol; also soluble in 2 parts of boiling water and 8.5 parts of boiling alcohol. Almost insoluble in ether. Dose.—64-1*6 grain (0.001-0.004 Gm.). Antagonists and Incompatibles.—Chloral, tobacco, potassium bromide, chloroform, and ether antagonize the toxic action of strychnine, the first-named drug being the best antagonist. Phy- sostigma, curare, conium, opium, hydrastine, and oil of chamomile are also antagonistic. The incompatibles are tannic acid, bromides, iodides, and chlo- rides. Synergists.—The motor excitants, ergot, ustilago, electricity, and cold. Physiological Action.—Since strychnine fully represents the physiological action of nux vomica, that of the former is here given. Externally and Locally.—Strychnine is a very powerful anti- septic, yet on account of its poisonous nature it is too dangerous to be serviceable. Locally, it possesses the power of arresting the movements of protoplasmic life, and from mucous membranes it is readily absorbed. Internally.—Digestive System.—Strychnine is an excellent sto- machic tonic, improving the appetite greatly and aiding digestion. By its favorable action upon the gastric mucous membrane it facili- tates the secretion of gastric juice, and by imparting tone to the muscular walls of the intestines it increases peristalsis and allays constipation. Probably the favorable action which strychnine exerts on the MOTOR EXCITANTS. 467 stomach is due to its stimulation of the nerve-centers which preside over the vascularity and the secretory cells, thus rendering the digestive process more perfect. Circulatory' System.—Strychnine stimulates the heart by its action on the cardiac muscle and motor ganglia. The pulse at first is decreased in frequency, due to stimulation of the cardio- inhibitory apparatus. Soon, however, the pulse is increased, though under paralytic doses it is lowered, because of a depression of the excito-motor ganglion in the heart. Medicinal doses increase arterial pressure by stimulation of the vasomotor centers in the medulla oblongata. Poisonous doses, how- ever, lower arterial tension. It is to be observed that, al- though when mixed with blood strychnine exhibits an oxidizing power, there is no evidence that the process occurs in the living organism. Nervous System.—Strychnine enormously increases the excita- bility of the motor nerve-cells in the spinal cord. That its action is not cerebral is proved by con- clusive experiments. Moreover, in cases of poisoning the brain retains its activity to the last, the cerebral functions remaining un- impaired. Violent tetanic spasms, on the contrary, indicate its pow- erful action upon the spinal cord, especially its reflex mechanism. Very large doses paralyze the motor apparatus, involving dimi- nution or loss of voluntary move- ments. The large multipolar gan- glia in the anterior column of the cord are affected by selective action of the drug, paralysis from over-stimulation following the first excitatory effects. Notwithstanding authoritative proof of the action of strychnine upon the spinal cord, it has been maintained by Falck that the Fig. 5.—Diagram showing how strychnine affects the motor and reflex mechanisms: A, motor and sensory mechanisms; B, cerebral motor areas ; C, sensory center; D, motor tract; E, sensory tract; F, spinal motor areas; G, switch center, or mechanism for conveying im- pressions from sensory to motor nerves ; H, sensory nerve ; I, motor nerve; K, muscle. 468 A TEXT-BOOK OF MATERIA MEDICA. primary effects of the drug are manifested in its influence upon the brain or its vasomotor center; next upon the inhibitory center of the heart; then upon the respiratory apparatus ; and lastly upon the reflex apparatus of the cord, the spasms being the combined result of these actions. The prolonged administration of small doses has a marked effect upon the sensory nerves, stimulating the senses of touch, sight, and hearing, so that ordinary impressions are rendered more acute. The motor mechanism is the most sensitive to the action of strychnine, as is indicated by the convulsions. The points of this mechanism which may possibly be attacked by the drug are—(i) the cerebral motor areas; (2) the spinal motor areas; (3) the spinal motor tracts; (4) the ends of the motor nerves; (5) the muscles. Careful experiments, however, have shown that the only points in the motor apparatus stimulated by strychnine are the spinal motor areas (2). See Fig. 5. Strychnine greatly intensifies reflex excitability, so that in strychnine-poisoning a bright light, a sound, a jar of the bed, or touching the skin may reflexly produce a convulsive seizure. The points where the drug may act to increase reflex muscular action are—(6) the ends of the sensory nerves; (7) mechanism in the cord for switching from sensory nerves; (8) the ends of the motor nerves. Experiment has proved that strychnine stimulates only the reflex mechanism in the spinal cord (7) (see Fig. 5). It will be seen, therefore, that the whole action of strychnine upon the motor mechanism is exerted upon the spinal cord rather than upon the nerves, muscles, or cerebrum. Respiratory System.—The effect of strychnine being to excite the spinal cord and respiratory centers, the breathing is rendered quicker and deeper. From prolonged contraction of the respira- tory muscles under poisonous doses, and consequent exhaustion, the patient may become asphyxiated, the heart having been observed to beat after death, showing that the fatal effects of the drug are due to failure of respiration. Contrary to the opinion of other able observers, Reichert does not consider strychnine in medicinal doses a direct respiratory stimulant, but believes that its beneficial influence on the respira- tion is due to its stimulation of the nerve-centers in general. Regardless of the exact modus operandi, it is well known to every observing clinician that strychnine not only increases the frequency of the breathing, but also the respiratory capacity. PLATE I. Strychnine-poisoning. MOTOR EXCITANTS. 469 Absorption and Elimination.—Strychnine is rapidly absorbed and slowly excreted, and consequently accumulates in the system. It is eliminated mainly by the kidneys, appearing in the urine as strychnine and strychnic acid, a product of oxidation. The sali- vary and cutaneous channels share in the excretory process. Temperature.—Ordinary doses have little or no effect upon tem- perature, but toxic doses, by producing spasms and tetanic convul- sions, raise arterial pressure, thereby increasing bodily heat. Eye.—The general nervous stimulation produced by strychnine affects the mechanism of the eye, vision, as has been remarked, being rendered more acute. Uterus.—Strychnine exerts some influence upon the muscular uterine tissues and assists the catamenia. Untoward Action.—Certain peculiar manifestations, having but slight resemblance, or none whatever, to the characteristic symp- toms of poisoning, have followed the ingestion of small doses of strychnine, such as the presence of a scarlatiniform eruption; cramps followed by perspiration, resembling in some respects the tertian type of intermittent fever; redness of the eyes ; formication; a peculiar heaviness and stiffness of the limbs ; persistent and painful priapism ; and gastric uneasiness. Children are exceedingly susceptible to the untoward effects of strychnine, its administration requiring extreme caution. The author, however, is familiar with a case resulting beneficially in the practice of Dr. Alfred C. Cotton of Chicago, when -^ grain (0.036 Gm.) of strychnine sulphate was given hypodermically every three hours to a child three years of age seriously ill with pneu- monia. Such heroic dosage is nevertheless seldom advisable. Poisoning.—As is the case with other active poisons, strychnine in lethal doses produces varying effects dependent upon tempera- ment, idiosyncrasy, and physiological conditions. Generally speak- ing, the absorption of large doses is followed by rigidity of the lower maxillary, dilatation of the pupils, increased action of the reflexes, and spasmodic and distressing muscular contraction, affect- ing the extensors particularly. Finally, the respiratory muscles are affected with tetanic rigidity, death resulting from asphyxia. In many cases the earliest symptoms of poisoning are restlessness and anxiety, twitching of the muscles, and stiffness of the neck. Spinal convulsions are manifested, the patient assuming the position of opisthotonos, so that he rests upon his head and his heels. The slightest external irritation at this stage, even a movement 47° A TEXT-BOOK OF MATERIA MEDICA. of the bed-clothes, is sufficient to cause a recurrence of convulsions. Notwithstanding these grave symptoms, the mind remains unaf- fected until carbonic-acid poisoning sets in, and the stomach is usually retentive. Accompanying the usual symptoms in cases of acute poisoning is the distortion of the features, which assume a ghastly grin (risus sardonicus). The action upon the genito- urinary tract is quite marked, involuntary ejaculations of semen frequently taking place, together with incontinence of urine. The earlier paroxysms attendant upon the effects of the drug are seldom fatal, but in the intervals of repose the patient's mind is oppressed with a sense of impending dissolution, intensified by each renewed access of spasm and increasing severity of pain. Treatment of Poisoning.—Emetics and cleansing of the stomach are naturally of the first importance. Animal charcoal and tannic acid should be freely administered, while copious anal injections containing potassium bromide and chloral are often efficacious in relieving the spasms. Amyl-nitrite inhalations may prove serviceable as an aid to restore failing respiration when artificial means are required. The chemical antidote to strychnine is tannin, which should be given immediately, perhaps best in the convenient form of strong, unstrained decoctions of tea or coffee, the stomach being subse- quently well cleansed. Catheterism should be performed frequently to favor elimination, care being taken not to create a recurrence of spasm and consequent convulsions, which may often be obviated by the use of nitrite of amyl or chloroform. The bowels should be evacuated, croton oil per rectum being an efficient agent. As has been stated, potassium bromide, chloral, and physostig- mine are serviceable physiological antidotes. Opium and conium may also be used to counteract the effects of the drug. Paralde- hyde has been preferred to chloral, and tobacco and alcohol have been suggested, even in heroic doses, should the malady refuse to yield to other remedial agents. Therapeutics.—Externally and Locally.—M. Mackenzie has rec- ommended strychnine in 2*4 ~ A grain (0.0027-0.004 Gm.) doses in some harmless and inert medium as an insufflation in anosmia, and lint saturated with the tincture of nux vomica and applied to the perineum has been advised in incontinence of urine. Internally.—There is no more efficient remedy in atonic dys- pepsia than nux vomica or strychnine. Both possess all the prop- erties of the simple bitters, besides stimulating the nerve-centers, MOTOR EXCITANTS. 471 rendering the co-ordination of the digestive process more perfect and enabling the stomach to respond more readily when the stim- ulus of food is applied to it. The gastric catarrh of inebriates is especially benefited by this drug, which also serves a useful purpose in the vomiting of preg- nancy and of phthisis. Its tonic action upon the intestinal muscles renders it an invalu- able remedy in habitual constipation, atonic diarrhea, and prolapsus of the rectum, the latter condition being frequently observed in children and aged persons, especially the latter, who are often men- tally depressed by this infirmity, and who are relieved by strych- nine, either given internally or injected as a solution into the sub- cutaneous tissue of the rectum, toning up the muscles and at the same time stimulating the cerebrum, relieving the melancholia and inspiring the patient with hope. Strychnine is a most valuable cardiac tonic, having a marked action on the cardiac nervous system. In pneumonia, typhoid fever, and other diseases accompanied by dyspnea and feeble heart-action no more valuable drug can be employed. It differs from alcohol and other cardiac stimulants in that its use is not followed by depression. The hypodermic injection of full doses of strychnine ordinarily renders the pulse full and strong, even when it is scarcely perceptible and death appears imminent. Many clinicians have un- doubtedly tided pneumonic patients over the critical period by the heroic use of strychnine, when, but for the drug, they would have died. The functional irregularity of the heart's action accompany- ing hysteria, hypochondriasis, and pregnancy is greatly relieved by moderate doses of tincture of nux vomica. As a tonic in chlorosis and anemia strychnine is an esteemed rem- edy, being, in the author's opinion, the best we possess in general efficiency. It improves the appetite, prevents putrefactive changes, and aids digestion, thereby enabling the patient to partake of and assimilate more nutriment. It also increases the force of the heart, quickens the circulation, and raises arterial tension, nourishing all parts of the body and rendering the condition more favorable for oxidation in the tissues and for the removal of waste products. The amount of urine is increased, constipation is relieved, and thus elimination of these products facilitated. Oxidation is further enhanced by the increased respiratory movements, rendering the blood richer in oxygen and increasing the number of the red corpuscles. 472 A TEXT-BOOK OF MA TERIA MEDICA. The potent action of strychnine upon the nervous system stimu- lates the spinal cord, giving the patient greater strength, and, by invigorating the brain, animating him with cheerfulness and con- fidence and a disposal to exercise. Strychnine, then, is at once a gastric, vascular, nervous, mus- cular, and respiratory tonic, being an invaluable remedy in debility from any cause. In bronchial and neurotic asthma, as well as in many forms of neuralgia, particularly the visceral variety, the drug is an efficient remedy. In bronchitis also, and to relieve the coughs of neurotic origin, it is of great value. Paralysis of spinal origin—paraplegia, etc.—and hemiplegia pre- vious to degeneration, with complete relaxation of the muscles, are benefited by strychnine, although in the latter affection it is of little if any value in recent cases or when the muscles do not respond to the electric current. The sphincters of the body, although belonging to the unstriped muscles, are more or less under the control of the will; still, when there is an atonic condition of these structures, as in incontinence of urine, due to weakness of the sphincter, strychnine is a very powerful remedy. For the same remedial properties it is equally valuable in retention of urine when the detrusor muscle is too weak to empty the bladder. Probably no other drug equals strychnine in diphtheritic paraly- sis, the form of the disease most benefited by the remedy. It is of use, however, in all varieties of functional paralysis, such as those resulting from hysteria, mental emotion, alcoholism, venereal ex- cesses, the abuse of opium, lead-poisoning, gout, rheumatism, concussion of the spinal marrow, etc. Jewell claims that strychnine has caused an improvement in myelitis after the failure of other remedies. The weak and semi-paralyitic condition sometimes induced by bromides is improved by strychnine. The drug has found a few supporters in the treatment of tetanus, epilepsy, tic douloureux, and chorea, though it has not been gener- ally adopted as a remedy in these diseases. Strychnine is exceedingly efficacious in amaurosis due to exces- sive use of alcohol or tobacco, being also valuable in paresis of the ocular muscles. Night-blindness is also greatly benefited by this drug. It is of undoubted merit in delirium tremens, as well as in pre- MOTOR EXCITANTS. 473 venting the usual effects of alcoholic intoxication ; in fact, the drug is one of the best remedies in the treatment of alcoholism, the strychnine nitrate being usually employed, hypodermically. Ac- cording to the best authorities on dipsomania, strychnine seems to be a true antagonist to the untoward action of alcohol, and it is probably the important constituent of the numerous " cures " for the alcohol habit. No less valuable is strychnine in the treatment of acute poisoning by chloral, morphine, and physostigminc. As an aphrodisiac it is of unquestioned value in functional sper- matorrhea, and it is thought to produce contractions of the gravid uterus and cause abortion or premature delivery. When a predis- position to post-partum hemorrhage exists, the administration of strychnine may prove of great service. Finally, strychnine has been highly recommended in the night- sweats of phthisis and in diabetes mellitus. Contraindications.—Strychnine is contraindicated or of no value in true voluntary muscular paralysis, where the region is directly under the control of the cerebrum. It is also contraindi- cated in acute inflammatory conditions of the spinal cord and excessive reflex irritability. Administration.—The extract of nux vomica, the tincture, the fluid extract, or the alkaloid strychnine may be given and gradually increased, a tolerance by the system being rapidly established. The salts of strychnine are preferable to other preparations, the crude drug and its preparations vaiying greatly in strength, 10 minims (0.6 Cc.) of one tincture sometimes containing as large a percent- age of strychnine as 20 minims (1.2 Cc.) of another. The drug should be cautiously administered to children, the initial dose for a child five or six years of age not exceeding y^- grain (0.0006 Gm.). In using strychnine hypodermically the soluble hypodermic tablets should be freshly dissolved in distilled water. The solutions of strychnine and of the other alkaloids should not be kept in stock, as they become contaminated with microscopic plants. Cocculus—Cocculi—Cocculus Indicus. (Fish Berry.) Origin.—The dried fruit of Anamirta Cocculus Wright and Arnott, a climbing shrub in Eastern India, native to the Malabar coast. 474 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—A globular, kidney-shaped, one- celled berry, about \ inch (6 Mm.) in diameter and f inch (10 Mm.) in length, blackish-brown and wrinkled. The seed is very bitter, but the pericarp is tasteless. The chief constituent is picrotoxin, the poisonous principle contained in the kernel and first isolated by Boullay in 1819. The crude drug is not used internally. Unofficial Preparations. Tinctura C&cculi— Tinctiirae Cocculi—Tincture of Cocculus.—Dose, 2-20 minims (o.12-1.2 Cc). ExtrSctum C&cculi Fluidum—Extracti C6cculi Fluidi—Fluid Extract of Cocculus.—Dose, 1-3 minims (0.06-0.2 Cc). Picrotoxinum—Picrotoxini—Picrotoxin. XT. 8. P. Origin.—A neutral principle obtained from the seed of Ana- mirta paniculata Colebrooke. Description and Properties.—Colorless, flexible, shining, pris- matic crystals, or a micro-crystalline powder, odorless and having a very bitter taste; permanent in the air. Soluble in 240 parts of water and in 9 parts of alcohol. Dose.—^—^V grain (0.OOI-O.OO2 Gm.). Antagonists and Incompatibles.—Chloral, the motor depres- sants, acetic acid, and the anesthetics antagonize the effects of picrotoxin. Synergists.—All the motor excitants. Physiological Action.—Externally and Locally.—It is a power- ful parasiticide, being very destructive to lower forms of animal life. Internally.—Digestive System.—In small medicinal doses its action is similar to that of strychnine. Circulatory System.—Its general effects do not differ essentially from those of strychnine. Nervous System.—Picrotoxin differs somewhat from strychnine in its action upon the nervous system, poisonous doses producing epileptiform convulsions and spasms of the flexor muscles, alter- nating from tonic to clonic, whereas the spasms induced by strychnine affect principally the extensor muscles and are tetanic in character. The brain also is differently affected—toxic doses resulting in stupor, delirium, coma, and complete insensibility. Respiratory System.—Picrotoxin tends to stimulate the respira- tory center, its general influence being analogous to that of strych- nine. MOTOR EXCITANTS. 475 Absorption and Elimination.—The drug is rapidly absorbed, and, as in the case of strychnine, is eliminated chiefly by the kidneys, the sweat being also a channel of excretion, since cocculus, even more than strychnine, acts as a powerful diaphoretic. Temperature.—No special action has been noted, though the temperature may be raised slightly during the convulsive period. Eye.—The pupils are dilated during the tonic and contracted during the clonic spasms. An ophthalmoscopic examination shows a marked hyperemia of the ocular fundus. Poisoning.—The drug produces muscular twitchings, incoordi- nation, great restlessness, tonic convulsions, with opisthotonos or emprosthotonos, alternating with clonic spasms and succeeded by paralysis, delirium, and coma. The respiratory apparatus is affected as in strychnine-poisoning. The symptoms are very similar to those of an epileptic seizure, and the post-mortem lesions are analogous to those of epilepsy. Treatment of Poisoning.—This is identical with that prescribed in cases of poisoning by strychnine. Therapeutics.—Externally and Locally.—The most important use of cocculus locally is in the treatment of parasitic and skin dis- eases, an ointment of picrotoxin—10 grains to I ounce (0.6-32.0 Gm.)—being employed for this purpose. Caution should be used in applying it to abraded surfaces lest poisoning result. The decoction or tincture of cocculus Indicus is very effective in destroying parasitic vermin infesting the head and body. Internally.—Picrotoxin has been used, although less success- fully, for many diseases treated with strychnine, especially paralysis of the extremities and of the sphincters, Planat has highly recommended the use of cocculus in epilepsy ; the best results in this disease, however, are obtained in the treat- ment of the nocturnal variety. The same authority advised the employment of the drug in chorea, infantile eclampsia, and chronic spasm of the limbs. Bartholow suggested that the drug, like strychnine, would prove valuable in intestinal torpor. Bokai has advocated its use in opium-poisoning. Unquestionably, its most valuable action is in controlling the night-sweats of phthisis. Mirrell, who first used it for this purpose, reported but one failure in twenty. Gubler has succeeded in greatly benefiting glosso-labio-laryngeal paralysis by the hypo- dermic injection of -^ grain (0.001 Gm.) of picrotoxin. 476 A TEXT-BOOK OF MATERIA MEDICA. Dysmenorrhea and migraine occurring at the menstrual period are said to be greatly relieved by this drug. Even sero-purulent leucorrhea, it is claimed, has derived benefit from the administration of some preparation of cocculus. Contraindications.—Similar to those for strychnine. Administration.—The picrotoxin is far preferable to other preparations of cocculus, both for external and internal use. It should be very cautiously administered, however. Ergrota—Ergotae—Ergot. XT. 8. P. (Ergot of Rye.) Origin.—The sclerotinum of Claviceps purpurea (Fries) Tulasne (Fungi), replacing the grain of rye, Secale cereale L. Most of the commercial article comes from Spain and Russia. Description and Properties.—Somewhat fusiform, obtusely triangular, usually curved, about \\.o \\ inches (2-3 Cm.) long and \ inch (3 Mm.) thick ; three-furrowed, obtuse at both ends, purplish- black, internally whitish, with some purplish striae, breaking with a short fracture; odor peculiar, heavy, increased by trituration with potassium or sodium hydrate T. S.; taste oily and disagreeable. Old ergot, which breaks with a sharp snap, is almost or entirely devoid of a pinkish tinge in the fracture, is hard and brittle between the teeth, and comparatively odorless and tasteless—should be rejected. Ergot should be but moderately dried and preserved in a close vessel, with a few drops of chloroform added from time to time to prevent the development of insects. When more than one year old it is unfit for use. The active constituents of ergot are not definitely ascertained. It contains, however, an acid soluble in water and variously termed sclerotinic, ergotinic, and ergotic acid, and another, soluble in alka- lies, known as sphacelic acid. Both of these acids possess ecbolic properties. Ergot also contains a principle known as cornutin, and 30 per cent, of a yellow non-drying saponifiable fixed oil, besides proteids, sugar, tannin, and ash. The commercial ergotin is merely a purified aqueous extract of ergot. Dose.—5-20 grains (0.30-1.30 Gm.). Official Preparations. Extractum Ergotae—Extracti Ergotae—Extract of Ergot.—Dose, 2-10 grains (0.12-0.06 Gm.). MOTOR EXCITANTS. 477 Extractum Ergotae Fluidum—Extracti Ergotae Fluidi—Fluid Extract of Ergot.—Dose, 15-60 minims (1.0-4.0 Cc). Vinum Ergotae—Vini Ergotae—Wine of Ergot.—Dose, 1-3 fluidrachms (4.0- 12.0 Cc). Unofficial Preparations. Tinctura Ergotae—Tincturas Ergotae—Tincture of Ergot.—Dose, \-z fluid- drachms (2.0-8.0 Cc). Ergotin (Bonjean's).—Dose, 2-8 grains (0.012-0.5 Cm.). Antagonists and Incompatibles.—The cardiac and motor depressants antagonize the action of ergot. Caustic alkalies and metallic salts are chemically incompatible. Synergists.—Its action upon the circulation is aided by digitalis and belladonna; upon the nervous system by strychnine; while ustilago, hydrastine, gossypium, and the emmenagogues enhance its influence upon the uterus. Physiological Action.—Externally and Locally.—Ergot has no distinctive action upon the skin, but upon mucous membranes its influence is that of an astringent, possessing hemostatic properties. Internally.—Digestive System.—In large doses it is a gastro- intestinal irritant, occasioning considerable heat and dryness of the throat, accompanied by thirst and succeeded by pain in the stom- ach and bowels, vomiting, and occasionally purging, with violent peristalsis, although constipation is the commoner sequence. Circulatory System.—Repeated medicinal doses increase the blood-pressure, although rendering the pulse slower and smaller, the result either of stimulation of the peripheral endings of the inhibitory vagi or the inhibitory ganglia, and excitation of the vaso- motor system, contracting the arterioles. A poisonous dose lowers arterial tension, causing the pulse to beat faster and softer—an effect due to exhaustion from over- stimulation or to direct depressant action upon the heart-muscle. It is claimed by competent authority that there is no active and actual contraction of the arteries, the result of stimulation of the vaso-motor system, but that the arteries contract because of the fulness of the veins, there not being sufficient blood to fill both systems, marked arterial anemia consequently resulting. It must be admitted that the true physiological action upon the circulatory system is not yet generally understood, being still sub judice, since equally competent pharmacologists maintain that the arterial pres- sure is increased as explained above. It is an undisputed fact, however, that the cardiac muscle is 478 A TEXT-BOOK OF MATERIA MEDICA. actually contracted by ergot. Indeed, Willebrand claims that " the normal or hypertrophied heart so contracts under the action of ergot that the difference in size is appreciable by percussion" (Bartholow). If any changes are produced by this drug in the composition of the blood, they have not been ascertained. Nervous System.—Medicinal doses have no especial action, though excessive doses sometimes depress the sensory mechanism, producing general cutaneous anesthesia. The action of toxic doses on the nervous system will be described under " Poisoning." Respiratory System.—Medicinal doses produce no particular effect. Large doses depress the respiratory center, rendering the breathing shallow. This action is manifest from the first, there being no primary stimulation of the respiration. Death from an overdose of ergot usually results from paralysis of the respiratory center. Absorption and Elimination.—The active constituents of ergot are rapidly absorbed into the blood, and are eliminated principally by the kidneys, increasing the urinary flow. Temperature.—No special action has been observed. Eye.—The caliber of the retinal and nutrient opticus blood- vessels is reduced, resulting in marked pallor of the disk, transitory amblyopia, and pupillary anemia. Uterus.—Probably the most important action of ergot is upon this organ. It produces in full doses tetanic, tonic contraction of the uterine muscle, the uterus becoming hard and pale, and forcing the blood out of the uterine arterioles. The organ is more sensi- tive to the action of the drug during pregnancy. The precise manner in which ergot affects the uterus is still a matter of discussion, although Hemmeter's experiments would seem to prove that the uterine contractions are the result of stimu- lation of the centers in the lumbar portion of the spinal cord. The drug causes a contraction of involuntary muscles throughout the body. It is doubtful if any drug in our Materia Medica has been more carefully studied than ergot, and, if opinions differ widely as to its modus operandi, it is because we have to deal with a very complex substance, the nature, and even the number, of whose constituents are as yet inadequately known. Many principles of the drug are unstable and variable in their action, certain preparations differing MOTOR EXCITANTS. 479 decidedly from others in their influence, as, for instance, Tanret's ergotinine, which has no effect upon the uterus. Bonjean's ergotin is a powerful ecbolic, and has a marked action, moreover, upon the vascular system, whereas Wigger's ergotin is inert. Untoward Action.—In addition to the gastro-intestinal disturb- ances already described, there are occasionally produced headache, mental confusion, dizzinesSj a feeling of chilliness, muscular weak- ness, dilatation of pupils, and glimmering before the eyes. Poisoning.—There are two varieties of ergot-poisoning, acute and chronic. Under the administration of immoderate doses pecu- liar symptoms appear, known collectively as acute ergotism. Rest- lessness, mental worry, headache, tinnitus aurium, dilatation of the pupils, pallor and coldness of the skin, and other effects are present. At times cutaneous anesthesia is manifest or general formication. Epileptiform spasms, great reduction of respiration and temperature, may occur, while obstruction of cardiac movements, with sudden nausea and violent vomiting, and other alarming manifestations, attest the untoward properties of the drug. Chronic ergotism is confined chiefly to Europe, where ergotized rye is used in bread-making. The disease is marked by convulsive or gangrenous conditions. The first variety, the convulsive, is characterized by paroxysmal spasms of the flexor muscles, which later become continuous, re- sulting in opisthotonos or emprosthotonos. There is dimness of vision, while an increasing intensity of symptoms develops affection of other special senses, those of hearing and smell being either impaired or temporarily lost. Violent abdominal cramps also occur, together with painful dyspnea, death resulting from asphyxia or coma. The second (gangrenous) form is signalized by severity of local phenomena, profound dyscrasia, formication or cutaneous anes- thesia, impairment of special senses, and numbness of the muscles or extremities, followed by sloughing or atrophy of the diseased parts and mummification or dry or moist gangrene. Fatal results of chronic ergotism are usually traceable to the convulsions, although moist or dry gangrene may in certain cases produce death. Treatment of Poisoning.—Symptoms of acute poisoning may be alleviated by hot baths and the administration of tannic acid and cardiac stimulants. For the treatment of chronic ergotism hygienic measures and symptomatic remedies are indicated. 480 A TEXT-BOOK OF MATERIA MEDICA. Therapeutics.—Externally and Locally.—Ergot, in an impalpa- ble powder, has been recommended as an external application in the treatment of carbuncle and epithelioma. In the form of lozenges or diluted fluid extract the drug has been employed in acute pharyngitis. The hypodermic injections of ergotin are valua- ble in nasal hypertrophies, prolapsus of the rectum, hemorrhoids, enlargement of the prostate gland, aneurysm, varicocele, and vari- cose veins. Internally.—The most important medical use of ergot is to promote uterine contractions in labor. The preponderance of testimony among the most experienced obstetricians is in favor of its use only after the expulsion of the uterine contents. This is a rule, however, which cannot be invariably followed. While the employment of the drug is contraindicated in the first stage of labor, it may be safely employed during the second stage, when there is uterine inertia, provided all the parts be in a normal condition and there exists no mechanical impediment to the rapid delivery of the child. Ergot is of service also when the placenta is retained owing to inefficient and feeble uterine contractions. With these exceptions it is customary—and the author concurs in the procedure—to delay the administration of the drug until the expulsion of the placenta, when a full dose of the fluid extract is given, or ergotin hypodermically. When ergot is administered during the second stage of labor, it should be given in small doses, so as to promote intermittent rather than continuous contractions of the uterus. No drug possesses so energetic and prompt an action as ergot in post-partum and uterine hemorrhage. It is an exceedingly efficacious remedy also in subinvolution and in uterine fibroids and polypi. The accompanying diagrams will illustrate the control of hemor- rhage through the contraction of the uterine muscle and arterioles, and the influence of ergot upon submucous fibroid tumors by mechanical compression and consequent diminution of their blood- supply. It is obvious that the location of a subperitoneal tumor is such that the drug cannot influence its growth as it can a sub- mucous fibroid. This remedy is also extremely useful in the treatment of ple- thoric amenorrhea, congestive dysmenorrhea, menorrhagia, chronic metritis, etc. Dilatation of the cardiac cavities without valvular lesion is much improved by the administration of ergot; the remedy has MOTOR EXCITANTS. 481 also been employed with considerable success in chronic diarrhea and dysentery. Incontinence of urine—depending either upon enlarged prostate, irritability, or a paretic or paralytic condition of the bladder—is Fig. 6.—Diagram showing how ergot reduces Fig. 7.—Diagram showing how ergot reduces uterine hemorrhage : A, uterine muscle; B, B, the size of a submucous fibroid, but has no effect arteries. upon a subperitoneal fibroid : A, uterine muscle; B, subperitoneal fibroid ; C, submucous fibroid ; D, D, arteries. greatly relieved by this remedy. The atonic form of spermatorrhea is palliated or cured by ergot. The drug is of value also in cerebral hyperemia and consequent mania, as well as in cerebrospinal meningitis, congestion of the spine, myelitis, and congestive headaches. Ergot has been highly recommended, notably by Dr. J. M. Da Costa, in diabetes insipidus, and by such authorities as Heitzmann and D'Enslow in prurigo, erythema, urticaria, and acne rosacea. Owing to the peculiar action of ergot upon unstriped muscular fiber it is a valuable drug in various forms of hemorrhage. The diseases mentioned as being favorably influenced by the local application yield as readily perhaps to the internal administra- tion of ergot. Finally, this remedy has met with some success in the treatment si leucorrhea, galactorrhea, hypostatic congestion of the lungs, whoop- ing cough, the different varieties of purpura, colliquative sweats, splenic enlargements, and exophthalmic goiter. Contraindications.—During the first stage of labor and in cerebral or spinal anemia. Administration.—For its action upon the uterus a valuable 31 482 A TEXT-BOOK OF MATERIA MEDICA. fluid extract is the best preparation as an internal remedy; for . hypodermic use the aqueous extract (ergotin) or some of the non-alcoholic fluid preparations manufactured by certain reliable pharmacists for this particular purpose, should be employed. Ergotin may be incorporated in suppositories when for any reason it is desirable to administer the drug per rectum. Goss^pii Radicis Cortex—Gossypii Radicis Corticis— Cotton Root Bark. XT. 8. P. Origin.—The bark of the root of Gossypium herbaceum L. and of other species of the genus, indigenous in the tropical and sub- tropical regions of Asia and Africa. The plant has been cultivated in the United States and other countries from a very early period, many characteristic varieties having been produced. Description and Properties.—It occurs in thin, flexible bands or quilled pieces, the outer surface brownish-yellow, with slight longitudinal ridges or meshes, small, black circular dots, or short, transverse lines, and dull, brownish-orange patches, from the abra- sion of the thin cork; inner surface whitish, of a silky lustre, finely striate; bast-fibers long, tough, and separable into papery layers; inodorous; taste very slightly acrid and faintly astringent. It contains a fixed oil, a small quantity of tannin, sugar, and starch, a yellow resin, and, in the fresh bark, a pale-yellow chromo- gene, soluble in alcohol, which on exposure to air becomes red and resinous. Dose.—15-60 grains (1.04-4.0 Gm.). Official Preparation. Extractum Goss^pii Radicis Fluidum—Extracti Gossypii Radicis Fluidi— Fluid Extract of Cotton Root Bark.—Dose, \-\ fluidrachm (1.8-3.7 Cc). Antagonists and Incompatibles.—The same as for ergot. Synergists.—Ergot and its synergists. Physiological Action.—Identical with that of ergot, but infe- rior in certainty of action. Therapeutics.—Cotton root bark is employed only for its action upon the uterine system, in which respect it is identical with ergot. An exception may possibly be in its use in the treatment of subin- volution and tumors of the uterus, in which cases it is less efficient than ergot. Contraindications.—The same as for ergot. Administration.—The fluid extract only should be employed. MOTOR EXCITANTS. . 483 Hydrastis—Hydrastis—Hydrastis. XT. 8. P. (Golden Seal.) Origin.—The rhizome and roots of Hydrastis Canadensis L., a perennial native to Canada and the United States east of the Mis- sissippi, growing in rich woodlands and in the Southern States, confined to mountainous districts. Description and Properties.—The rhizome is from 1 to 2 inches (2-5 Cm.) long arid about \ inch (6 Mm.) thick, oblique, with short branches, somewhat annulate and longitudinally wrinkled; externally brownish-gray; fracture short, waxy, red- dish-yellow, with a thickish bark, about ten narrow wood-wedges, broad medullary rays, and large pith. Roots thin, brittle, with a thick yellow bark and subquadrangular woody centre. Odor slight, taste bitter. The principal constituents are hydrasiine (colorless and slightly acrid) and berberine (yellow and intensely bitter), the latter alkaloid being also found in berberis, Colombo, menispermum, coptis, etc. There is a yellow resinoid (hydrastin) on the market which should not be confounded with the active alkaloid hydrastine. Dose.—The crude drug is not given internally. Official Preparations. Extractum Hydrastis Fluidum—Extracti Hydrastis Fluidi—Fluid Extract of Hydrastis.—Dose, 10-30 minims (0.6-2.0 Cc). Glyceritum Hydrastis—Glyceriti Hydrastis—Glycerite of Hydrastis.—Used externally. Tinctura Hydrastis—Tinctiirae Hydrastis—Tincture of Hydrastis.—Dose, 30-60 minims (2.0-4.0 Cc). Hydras una—Hydrastinae—Hydrastine (unofficial).—An alkaloid obtained from Hydrastis. Origin, Description, and Properties.—Colorless, very brilliant, glassy crystals; taste slightly acrid; fully soluble in ether and chloroform, but freely soluble in water. Dose.—^-\ grain (0.002-0.03 Gm.). Hydrastinae Hydrochloras—Hydrastinae Hydrochloratis—Hydrastine Hy- drochlorate. U. S. P.— Origin.—The hydrochlorate of an artificial alkaloid derived from Hydrastine. Description and Properties.—Light-yellow, amorphous granules, or a pale-yellow crystalline powder, odorless, and having a bitter, saline taste ; deliquescent on exposure to damp air. Soluble in 0.3 part of water and in 3 parts of alcohol. The product should be kept in well-stoppered vials. Dose.—j-^-J grain (0.005-0.03 Gm.). Antagonists and Incompatibles.—The alkalies, mineral acids, and tannic and other vegetable acids are incompatible with prepara- tions of hydrastis. The physiological antagonists are chloral, potassium bromide, and the motor depressants. 484 A TEXT-BOOK OF MATERIA MEDICA. Synergists.—Quinine and the vegetable bitters aid its action upon the digestive tract, ergot upon the uterus, and strychnine upon the spinal cord. Physiological Action.—Externally and Locally.—Hydrastine possesses considerable anesthetic action when applied locally, and upon the eye its effect is to contract and afterward dilate the pupil. Internally.—Digestive System.—Its action resembles that of strychnine, though excessive doses produce greater gastric dis- turbance, almost invariably occasioning vomiting. Circulatory System.—Its influence is similar to that of strych- nine, but not so powerful. In its effect upon the white blood-cor- puscles it resembles quinine, arresting their movements. Nervous System.—Here also the action of hydrastis is analogous to that of strychnine, although it is much less powerful, while more persistent. It differs from its congener, however, in its effect upon the sensory nerve-fibers, very large doses impairing their func- tional activity, and, when locally applied, producing anesthesia. Respiratory System.—In its action upon the respiratory system it resembles strychnine, differing in no essential particular. Absorption and Elimination.—It is slowly absorbed, tending to accumulate in the system. It is eliminated chiefly by the kidneys, increasing slightly the urinary flow. Temperature.—Medicinal doses have no effect; poisonous doses decrease bodily heat. Eye.—It has no particular action upon the eye, other than to first contract and then dilate the pupil when directly applied. Uterus.—Hydrastine is a feeble oxytocic, affecting the womb in a manner similar to, though much less powerful than, ergot. Untoward Action.—The untoward manifestations are essentially those of poisoning. Poisoning.—The symptoms are almost identical with those of strychnine. Treatment of Poisoning.—The same as that of poisoning by strychnine. Therapeutics.—Externally and Locally.—Hydrastin (the yellow resinoid)—in the proportion of 5 grains (0.3 Gm.) to 1 ounce (30.0 Cc.) of water, or the fluid extract of hydrastis, 15 to 20 minims (1.0-1.2 Cc.) to 4 ounces (118 Cc.) of water—makes an efficient injection in gonorrhea. Hydrastine (the alkaloid), or, preferably, hydrastine hydro- MOTOR EXCITANTS. 4«5 chlorate—3 grains (1.2 Gm.) to 1 ounce (30.0 Cc.) of glycerin— affords great relief in certain forms of chronic conjunctivitis. Hydrastis is a valuable remedy in catarrh of the upper respira- tory tract. The tincture—1 fluidrachm (3.7 Cc.) to 1 ounce (30.0 Cc.) of water—is a valuable mouth-wash in all indolent and offensive ulcera- tions of the mouth and throat, such as syphilitic and mercurial affec- tions, follicular pharyngitis, etc. The fluid extract serves a useful purpose in the local treatment of anal fissure and of rectal ulcer, vaginal and uterine ulcerations, and leucorrhea. Indolent ulcers anywhere, and chancres and chan- croids, are stimulated to a healthier condition by the application of this preparation. An ointment of hydrastine hydrochlorate, in strength vary- ing from 5-30 grains (0.3-2.0 Gm.) to 1 ounce (32.0 Gm.) of simple ointment, affords an efficient local application in acne and seborrhea sicca, and the same preparation makes a serviceable dressing for ulcerated carcinoma and bromidrosis. The distilled extract of witch-hazel with hydrastine hydro- chlorate is recommended in hyperidrosis. Palmer has successfully employed inhalations of a solution of 1 part of the extract to 3 parts of salt water in tubercular and simple bronchitis.. The topical action of hydrastis and its preparations is that of an antiseptic and tonic, strengthening the circulation and nutrition, rendering the drug peculiarly valuable in diseases of mucous sur- faces. Internally.—As a remedy for diseased conditions of the stomach and bowels it is of much the same value as the vegetable bitters, and may be used for the same purposes. Hydrastine possesses considerable antiperiodic power, having been employed in intermittent fever and chronic malaria, though much inferior to quinine, and probably also to arsenic. Its bene- ficial action in these conditions is undoubtedly due to its power to increase the functional activity of the liver, this influence also ren- dering it valuable in chronic constipation induced by hepatic inac- tivity—catarrhal jaundice, too, being frequently relieved by the remedy. Hydrastine, more especially hydrastine hydrochlorate, acts upon the uterus very much like ergot, and has been highly recom- mended by well-known authorities in uterine hemorrhage and other 486 A TEXT-BOOK OF MA TERIA MEDICA. uterine disorders for which ergot is used. By careful observers, of experience with the drug, it is considered superior to ergot in the hemorrhage of puberty and the menopause, as well as in congestive dysmenorrhea. Bossi, who has employed hydrastis Canadensis extensively in obstetrical practice, regards it as a valuable hemostatic, believing it to be much safer than ergot in the hands of ignorant individuals and midwives. Koniger has treated hemoptysis successfully with the fluid extract in 20- or 30-minim (1.2-2.0 Cc.) doses, repeated several times a day. The drug has proved equally beneficial in arresting the night-sweats of phthisis, and is an efficient substitute for alco- holic stimulants when their use is abandoned. Hydrastine hydrochlorate has recently been favorably men- tioned as a remedy for epilepsy, strychnine-poisoning, and hydro- phobia. Contraindications.—The same as for vegetable bitters, strych- nine, and ergot. Administration.—When taken for its action upon the stomach and bowels it should be given before meals; for its effect on the uterus it is best administered in divided doses or the hydrastine hydrochlorate hypodermically. Rhus Toxicodendron—Rh5is Toxicodendri—Rhus Toxicodendron. XT. 8. P. (Poison Ivy.) Origin.—The fresh leaves of Rhus radicans L., a climbing shrub indigenous in Canada and the greater part of the United States westward to the Rocky Mountains. Description and Properties.—Long-petiolate, trifoliate, the lat- eral leaflets sessile or nearly so, about 4 inches (10 Cm.) long, obliquely ovate, pointed; the terminal leaflets stalked, ovate or oval, pointed, with a wedge-shaped or rounded base; the leaflets entire and glabrous or variously notched, coarsely toothed, or lobed, more or less downy ; when dry papery and brittle; inodorous ; taste somewhat astringent and acrid. The fresh leaves abound in an acrid juice which darkens on exposure to air, and when applied to the skin produces inflammation and swelling. The leaves should therefore not be touched with the bare hands. The fresh leaves contain a volatile acid (toxicodendric), which MOTOR EXCITANTS. 487 is almost entirely absent in the dried leaves. In addition to this active constituent the leaves contain tannin. Dose.—1-5 grains (0.06-0.3 Gm.). Unofficial Preparation. Tinctura Rhus Toxicodendri—Tinctiirae Rhois Toxicodendri—Tincture of Toxicodendron.—Dose, fa-2 minims (0.006-0.12 Cc). Prepared from fresh plants —1 part of fresh leaves to 2 parts of alcohol. Physiological Action.—Externally and Locally.—The fresh leaves of this common plant are extremely irritant to the skin, generally acting as a marked vesicant and establishing severe local inflammation, manifested by acute dermatitis, excessive edema, and hyperemia. In many cases these effects are much less pronounced, while in certain individuals they are never occasioned by contact with or even chewing the leaves. As with poison sumach—Rhus venenata—the toxic influence of the plant derived from local appli- cation is apparently more virulent during the period of florescence. The inflammation somewhat resembles erysipelas, being rapidly diffused and accompanied by a general systemic disturbance, in- cluding abdominal pains, nausea, and vomiting, with perhaps diar- rhea, diuresis, and serous passages. Profuse diaphoresis and lum- bar and articular pains may also result. These symptoms cease after about ten days or a fortnight without other sequel than desquamation of the affected surface. Internally.—The effects of the drug administered internally are to cause gastro-intestinal inflammation, with drowsiness and stupor, and occasionally delirium and convulsions. Vertigo, nausea, chilli- ness, thirst, weak and irregular cardiac movements, diaphoresis, muscular debility, and diuresis are also reported. Dilatation of the pupils is also a result of ingestion or internal absorption, and an illustration of the virulence of the drug is seen in the fact that even air impregnated with exhalations from the leaves may cause epi- dermic eruption, while the berries have produced serious symptoms in the spinal and cerebral systems, and in an authentic case the root has proved notably fatal. Treatment of Poisoning.—Many remedies have been used, with varying efficacy, to allay the toxic effects of the drug. Dermal poisoning has been relieved by glycerite of carbolic acid or alkaline lotions. In the earlier stage of external irritation warm soapsuds and sodium bicarbonate have been successfully applied. Alum- curd, ammonia in weak solution, solution of chlorinated soda, and 488 A TEXT-BOOK OF MA TERIA MEDICA. many other agents have been employed to meet the requirements of certain stages of the affection. A solution of cocaine, 4 to 8 per cent., quickly relieves the cutaneous irritation ; a liquid prepara- tion of grindelia robusta makes a grateful application; while opium, coffee, and laxatives would be indicated. Therapeutics.—Externally and Locally.—The diluted tincture— 8 minims (0.5 Cc.) to 4 ounces (118 Cc.) of water—has met with some favor, as has been stated, in the treatment of sprains, burns, etc. In weak solution with alcohol the remedy has been used as a stimulating application in cases of sprains, chilblains, burns, insect-stings, etc. Internally.—It has been recommended in rheumatic affections of fibrous tissues, paralysis, erysipelas, herpes zoster, pemphigus, eczema, and erythema. Dr. Rothrock believes it to be a valuable cerebro-spinal stimu- lant. It has been supported as a strong palliative or cure in inconti- nence of urine depending upon atony of the bladder. It is evident that the drug needs to be much more thoroughly investigated, there being widely diverse opinions regarding its thera- peutic value. There is, however, sufficient testimony in its favor from competent authorities to justify further examination and use of this extremely active remedy. Contraindications.—The meager knowledge we possess re- specting its true action in disease renders it impossible to mention any special contraindication to its employment. Administration.—The tincture is the only preparation used, and should be cautiously administered. Coca—Cocae—Coca. XT. 8. P. Origin.—The leaves of Erythroxylon Coca Lam., a shrub about 6 feet (1.8 M.) high, with numerous spreading purplish-brown branches, bearing bright green leaves varying in size according to the nature of the plant or of the soil in which it grows. The flowers, found either alone or in clusters, are small, regular, her- maphrodite, white or greenish-yellow, being succeeded by small scarlet berries. Coca is indigenous in the mountains of Peru and Boliva, and on the eastern slopes of the Andes is cultivated in damp, warm valleys from 3000 to 6000 feet (914.5-1829 M.) above the sea- MOTOR EXCITANTS. 489 level, being also grown in some parts of Colombia, Brazil, the Argentine Republic, and the island of Java. The province of La Paz in Bolivia produces the largest crops, the article being more highly esteemed than the Peruvian variety. Cocaine, how- ever, is obtained from leaves of the Javanese plant. Description and Properties.—In size and shape the leaves resemble those of tea, ovate, lanceolate, or obovate-oblong, from | to 2 or 2f inches (2-5 or 7 Cm.) long and 1 to ij inches (25- 37 Mm.) broad ; short-petiolate, entire, rather obtuse or emarginate at the apex, slightly reticulate on both sides, with a prominent midrib, and on each side of it a curved line running from base to apex; odor slight and tea-like, taste somewhat aromatic and bitter, when chewed temporarily benumbing the lips and tongue. The active constituent is the alkaloid cocaine. The plant also contains two other alkaloids—ecgonine and hygrine, and a peculiar tannin, coca-tannic-acid, having a green reaction upon salts of iron. Dose.—f-4 drachms (2.0-16.0 Gm.). Official Preparation. Extractum Cocae Fluidum—Extracti Cocae Fluidi—Fluid Extract of Coca. —Dose, 20 minins-i fluidrachm (1.2-4.0 Cc). Cocaina—Cocainae—Cocaine (unofficial).—Description and Properties.—Color- less, prismatic crystals, of a strongly alkaline reaction. The taste is bitterish and pro- duces a transient numbness of the tongue. Soluble in 704 parts of water, in much less alcohol and ether, and in fixed oil. Dose.—\-i grain (0.03-0.06 Gm.). Cocainae Hydrochloras—Cocainae Hydrochloratis— Cocaine Hydrochlorate. TJ.8.P. This is the only official salt of cocaine, and the one almost invariably used in medicine. Description and Properties.—Colorless, transparent crystals or a white, crystalline powder, odorless, of a saline, slightly bitter taste, and producing upon the tongue a tingling sensation followed by numbness of some minutes' duration. Permanent in air, soluble in 0.48 part of water and 3.5 parts of alcohol; very soluble in boiling water and in boiling alcohol. Dose.—-|—2 grains (0.008-0.12 Gm.). Cocainae Phenas—Cocainae Phenatis—Cocaine Phenate (unofficial).—This salt contains about 75 per cent, of the alkaloid. Description and Properties.—It occurs as a yellow, viscid mass. Soluble in alcohol, insoluble in water. Dose.—J2-£ grain (0.005-0.01 Gm.). 490 A TEXT-BOOK OF MATERIA MEDICA. Antagonists and Incompatibles.—Morphine, chloral, amyl- nitrite, alcohol, chloroform, and ether are physiological antagonists. The most direct opponents are chloral and morphine. Cocaine is incompatible with caustic alkalies and the alkaline carbonates and bicarbonates, as well as with bichloride of mercury, iodine and the iodides, ammonia, zinc chloride, and borax. Synergists.—Medicinally, its cerebral effects may be enhanced by the cerebral stimulants, such as alcohol, cannabis Indica, and belladonna, while its analgesic and anesthetic action may be aided by carbolic acid, atropine, opium, and conium. When used as a mydriatic atropine serves as a valuable synergist. Physiological Action.—For our first knowledge of the physio- logical properties of coca we are indebted to its empirical use among the natives of Peru. The history of the drug is replete with interest and romance. It was regarded as the living repre- sentation of the Deity, the ground whereon it grew being held sacred. During the reign of the Incas its use was a royal privi- lege, the people being compelled to obtain permission from the governor to avail themselves of its benefits. Later it was adopted indiscriminately. The native coqueros (coca-chewers) have learned from experi- ence that they can climb the Andes, work laboriously in the mines, and endure fatigue and hunger more hardily when chewing the leaves of the plant, and from time immemorial the drug has been recognized by observers as possessing powerful nutritive, stimulant, and restorative properties. In describing the action of the crude drug the author can add little to the words of Linnaeus, who long ago wrote that coca possessed "the penetrating aroma of vegetable stimulants, the astricting and fortifying virtues of an astringent, the antispasmodic qualities of bitters, and the mucilaginous, nutritive properties of analeptics or of alimentary plants." "This leaf," he adds, "ex- hibits with energy its action on all parts of the animal economy. Olido in nervos, sapido in fibras, utroque in fluidoT Since the isolation of the alkaloid cocaine, to which the drug owes its physiological and medical properties, by Gaedeke in 1855, and the subsequent study of it by eminent pharmacologists and therapeutists, we have learned more of the physiological action of coca. Its effect upon different systems are here described in detail. Externally and Locally.—Cocaine is analgesic, anesthetic, and MOTOR EXCITANTS. 491 ischemic. Upon the unbroken skin it has no action, but upon mucous membranes or the subcutaneous tissue it produces com- plete local anesthesia. The surface to which it is applied becomes paler than normal, owing to contraction of the blood-vessels, but afterward reddens and appears turgescent through secondary dila- tation of the vessels. The absorption of the drug by mucous membranes varies with the locality to which it is applied—with difficulty from the conjunctiva, yet with great readiness from the Schneiderian membrane, producing its characteristic constitutional effects. Applied to the conjunctiva, or even taken internally, cocaine causes a transitory contraction of the pupil, soon followed by dila- tation. The accommodation is impaired, but not completely de- stroyed, the ocular tension being lowered. The anesthetic action of cocaine applied locally is due to the depression of the ends of the sensory nerves. It dilates the pupil by stimulating the ends of the sympathetic nerve, which innervates the radiating fibers of the iris. In addition to its local analgesic action the drug possesses the power of destroying the functions of the nerves of special sense, so that taste and smell, as well as the tactile sense, are abolished. When applied locally or taken internally it primarily checks many of the secretions, though those from the pancreas and liver seem to be uninfluenced by its internal use. The secondary impression of cocaine, however, when the blood-vessels become dilated, is accompanied by increased secretion. Francois-Franck, who has made an exhaustive study of the local action of cocaine, contends that it is " a powerful paralyzing poison, acting alike on sensory and motor nerve-endings, on all kinds of peripheral nerves, on nerve-centers, muscles, glands, epithelium, leucocytes, vegetable protoplasm, micro-organisms, etc." Internally.—Digestive System.—On account of its stimulant action upon the constrictor fibers of the great sympathetic nerve, under the influence of moderate doses peristalsis is largely increased in the stomach and intestines, very large or poisonous doses, on the contrary, causing great sluggishness of the bowels. Although it has been shown by experiments upon animals that cocaine is incapable of sustaining life, it diminishes in man the sen- sation of hunger, owing to its local anesthetic action upon the mucous membrane of the stomach, so that the coqueros are able to 492 A TEXT-BOOK OF MATERIA MEDICA. abstain from food for days, thirst also being allayed. This diminu- tion of hunger does not seem to impair appetite and digestion, since food is subsequently relished and digested as well as, if not better than, if coca had not been used. Circulatory System.—Medicinal doses of cocaine increase the force and frequency of the cardiac contractions, and also arterial pressure. Large or poisonous doses render the pulse slow, soft, and weak, and lower arterial tension. The exact modus operandi is not fully determined, such eminent authorities as Mosso, Von Aurep, Vulpian, Ott, Nikolsky, and others differing as to its action upon the circulatory apparatus. It is quite probable that its action is similar to that of atropine in this respect. Nervous System.—When given internally its first action is upon the brain, moderate doses greatly stimulating the intellectual facul- ties and producing a feeling of ecstasy and well-being, in many respects akin to the sensations experienced under the action of cannabis Indica. In the course of a few hours the stage of cere- bral excitement is succeeded by mental, moral, and muscular depression. Toxic doses result in incoherent speech and wild delirium, accompanied by swaying of the head, followed by epileptiform con- vulsions and narcosis. The convulsions are of cerebral origin, the effect of cocaine upon the spinal cord being yet but imperfectly understood. The sensory nerves are depressed by small and paralyzed by lethal doses. The motor nerves are also depressed by large doses, this action, however, being subordinate to that exerted upon the sensory nerves. The muscles are stimulated by medicinal doses through impression upon the motor tracts, although large doses greatly depress muscular activity. The chewing of coca, as prac- tised by the natives of Peru and Bolivia, undoubtedly appears to augment muscular strength and powers of endurance. Mosso claims that small doses of cocaine serve as a power- ful muscular stimulant in cases of exhaustion from hunger or fatigue. Laffont states that cocaine possesses an "excito-functional action on the great sympathetic constrictor nerve, consequently an exalta- tion of the functional action of all the non-striated muscles or muscles of organic life which are subordinated to it." Respiratory System.—Medicinal doses powerfully stimulate the respiratory center, increasing the rapidity and depth of the respira- MOTOR EXCITANTS. 493 tions. Poisonous doses paralyze the center, the result being dys- pnea, feeble breathing, and death from respiratory failure. Absorption and Elimination.—Cocaine is quickly absorbed, being eliminated principally by the kidneys in a form differing from its original nature. Much of it undergoes oxidation in the body. The amount of urine is increased, though the nitrogenous ele- ments are diminished. The habitual use of the drug lessens urinary secretion. Cocaine possesses no cumulative action, although its effects become more marked under repeated dosage, due probably to some special dynamic action upon the nervous system. Temperature.—Medicinal doses have no influence on bodily heat, but poisonous doses usually raise the temperature, owing, according to Reichert, to an increase of heat-production. Eye.—Cocaine produces a noticeable dilatation of the pupil, as already explained under " Local Action," the maximum change being reached in about an hour, and the normal state regained in from twelve to twenty-four hours. Cocaine-poisoning.—Among the more prominent physiological symptoms resulting from the ingestion of excessive doses of coca- ine or repeated and continued injections are a tendency to coma or collapse; a feeble, thready pulse, often running extremely high; great emaciation ; anorexia and impairment of the digestive powers; and increased frequency, and again alarming depression, of respira- tion. There are other symptoms, scarcely less serious, which, as the majority of observations show, render cocaine one of the most generally deleterious of drugs, opium not excepted. Dropsy, ma- rasmus, numbness, syncope, profound malaise, muscular twitchings with mild convulsions, insomnia, amblyopia, mydriasis, visual hal- lucinations, headache, vertigo, dangerously elevated temperature, dental decay, and fetid breath,—even this admonitory catalogue of ills fails to complete the recorded phenomena attending poisoning from cocaine. Yet, grave as are the foregoing physical changes incident to an immoderate use of the drug, the mental and, above all, the moral effects of cocaine-poisoning are far more deplorable. It is a melan- choly but indubitable fact that to one fully committed to the so-called " cocaine habit" there appears at times no principle of honor or deco- rum to which the vitiated sensibilities are amenable. The enfeeble- ment of the intellectual faculties, the loss of memory, inability to coordinate or control ideas, a consciousness occasionally merged 494 A TEXT-BOOK OF MATERIA MEDICA. in pronounced mania, possibly with homicidal inclination, and an intense selfishness of thought and purpose, in which apathy, neg- lect of domestic obligations, and complete debasement of nobler qualities are developed,—these lamentable accompaniments mani- fest too clearly the degenerating influences exerted by a constant resort to the use of this ill-fated, if not fatal, drug. An instance coming under the author's personal observation will serve to illustrate the entire lapse of the subject's morale. The case is that of a well-known, successful, and highly esteemed practitioner, who, becoming addicted to the employment of cocaine as an alleviation for bodily and mental depression, reached at last a stage of moral degradation in which he neither shrank from lying and stealing nor considered any means of gratifying his dis- eased appetite too abject—the persuasions of friends, the considera- tions of professional duty and social position, and the distracted appeals of his own family being alike unavailing to arrest the passion to which he had succumbed. It is grateful to record that from his moral turpitude the subject at length emerged triumphantly, to-day occupying a proud position reflecting honor upon himself and his profession. A still more distressing case, in that it was attended with fatal results, is that of a physician personally known to the author who, contracting the cocaine habit, in blind folly administered the drug to his wife and child, all dying within the period of a few months. The desperation to which the cocaine habitue may be driven in his temporary madness is shown in the case of a young man scarcely twenty years of age, son of an eminent surgeon, who, the author is authentically informed, during a journey by rail in which he was deprived of the customary facilities for hypodermic injection, ripped open his arm with a pocket-knife and poured the drug into the wound. In such cases the salient features of the malady may be prop- erly regarded as allied to those of acute mania, the treatment being exceedingly difficult—the more so because of the absence of deter- rent motives prompted by conscience, which in the course of the indulgence becomes torpid or perverted. There is, moreover, with cocaine-poisoning always danger of deliberate or involuntary reiapse. It frequently happens that cocainism arises from a desire to relieve effects produced by the immoderate use of opium. Yet the latter drug, being taken to offset the influence of cocaine, in reality MOTOR EXCITANTS. 495 but aggravates the evil, the two agents interacting and still further lessening the chances of recovery. Treatment of Poisoning.—Several antidotes have been favorably adopted—amyl nitrite, caffeine, atropine, and inhalations of ammonia. Chloroform, ether, subcutaneously injected, and strychnine have also proved more or less efficient remedies. With regard to the withdrawal of cocaine, equally competent authorities appear to differ, the immediate cessation of the drug being advocated, and again this course condemned as liable to produce collapse. The author is of the opinion that, as in other respects, the procedure followed in the treatment of the opium habit is the wisest and safest. The disease, however, at least during its more serious manifes- tations, is essentially allied to insanity, and permanent cure must look to the rationale of the conditions, with the paramount object of restoring to its normal activity the moral tone of the patient's thought and desire. That complete regeneration of mind and body may be reasonably contemplated is amply attested by the case above cited; nor should discouragement deter the physician from his task, nor measures of untimely severity be suffered to exas- perate and confirm an untoward mental state possibly susceptible of intelligent control. Therapeutics.—Externally and Locally.—The indications for the local anesthetic action of cocaine are very numerous. The general surgeon will find many opportunities to employ the drug advantageously; indeed, in many instances it has replaced all other anesthetics. In many operations on the genito-urinary tract, rectum, nose, throat, ear, and eye it serves a most valuable pur- pose. The urethra can be rendered perfectly insensible to pain by the application of a 2 to 4 per cent, solution, repeated two or three times at intervals of five or ten minutes. Even the sensibility of the bladder itself can be benumbed to a great extent by the local application of a cocaine solution, so that sounding for stone may be painlessly accomplished. A case of lithotrity is reported in which, without suffering, an operation was performed in fifteen minutes, the only anesthetic used being a solution of cocaine applied to the parts. Urethral caruncles may be removed successfully and without inconvenience to the patient by the injection of a 4 per cent, solu- tion at the lines of attachment. An injection of a small amount of the same solution into the cellular tissue of the prepuce pre- 496 A TEXT-BOOK OF MA TERIA MEDICA. vents pain in circumcision and in the operation for phimosis. In the treatment of fistula in ano, hemorrhoids, both internal and external, and other diseases of the rectum, cocaine is of signal value. An ointment of cocaine, 4 per cent, strength, affords a grateful anodyne dressing for burns, it being borne in mind that in all cases where ointments of this drug are used the alkaloid cocaine, and not its salts, is to be employed. Cocaine is an important anesthetic in many minor operations, such as opening of felons, abscesses, etc.; it is also highly service- able in dentistry and for the removal of small neoplasms. Prob- ably its most extensive use in this respect is in operations upon the eye, nose, and throat, its widest field of usefulness being in operative ophthalmic surgery. The following prescription makes an efficient application for the relief of many of the distressing symptoms of acute coryza and hay fever: R. Cocainae hydrochloratis, gr. x (0.6 Gm.); Menthol, gr. xij (0.72 Gm.); Pulveris camphorae, gr. iij (0.2 Gm.); Pulveris magnesiae, Sacchari lactis, da. 3ij (8.0 Gm.). M.—Sig. Use a small portion as a snuff twice a day. A small quantity of morphine sulphate is sometimes an excellent addition to the above. The peculiar qualities of cocaine render it one of the safest, as well as most convenient and serviceable, mydriatics. It quickly dilates the pupil, which regains its normal condition in from ten to twenty hours. The dilatation, too, is easily overcome by the application of eserine, a solution of \ grain (0.03 Gm.) to 1 ounce (30.0 Cc.) of the latter drug being strong enough to neutralize the effects of a 4 per cent, solution of cocaine. It should be remembered that local applications to the conjunc- tivae, nares, and fauces may produce in susceptible persons systemic effects. Cocaine combined with atropine forms a mydriatic which for many purposes is superior to either drug separately, the mydriasis being of longer duration than that produced by cocaine, while the paralysis of the accommodative apparatus is briefer than that occasioned by atropine. The phenate of cocaine is less toxic than the hydrochlorate, MOTOR EXCITANTS. 497 owing to its power of coagulating albumin, and thereby being less readily absorbed. It is also more agreeable to the taste. While it does not produce anesthesia so readily as the hydrochlorate, its effect is more permanent, and, in addition, it possesses powerful antiseptic properties. By many physicians it is preferred in laryn- gological work. Internally.—Coca has been successfully used in gastralgia and to improve the digestion. Cocaine is frequently an efficient remedy in sea-sickness and to allay excessive vomiting. Bartholow has highly recommended the drug in chorea, asthma, paralysis agitans, and alcoholic and senile tremor. It has also been suggested as a cure for the opium, alcohol, and tobacco habits. The wine of coca is an excellent tonic during convalescence from acute disease and in debilitated conditions generally. It has been extensively employed in melancholia. Cocaine combined with atropine is said to make an efficient hypnotic. Contraindications.—No special or distinct contraindication to its use exists. In diseases of the kidneys with diminished urinary flow it should be cautiously administered, lest cumulative effects ensue. With subjects suffering from weak or diseased heart similar caution is to be used. Administration.—For hypodermic use solutions of from 2 to 5 per cent, are generally employed. It should be noted that children and females require smaller doses of the drug. It is altogether probable that many of the coca wines on the market contain varying quantities of cocaine. The reckless and indiscriminate prescription of these preparations, therefore, is liable to induce the cocaine habit. It is questionable, indeed, whether the administration of cocaine with a view to curing the intemperate use of opium, alcohol, or tobacco is wise. It frequently happens that patients thus treated lose their craving for the latter drugs only to acquire an inordinate appetite for cocaine, which, as has been shown, is possibly more dangerous than either of them in its physical and moral effects. 32 498 A TEXT-BOOK OF MATERIA MEDICA. GROUP VII.—MOTOR DEPRESSANTS. Conium—Conli—Conium. XT. 8. P. (Hemlock.) Origin.—The full-grown fruit of Conium maculatum L., gath- ered while yet green. Spotted hemlock is a biennial indigenous in the temperate regions of Asia, Europe, and Northern Africa, and naturalized in some portions of New England, New York, and South America. It grows in waste places and along streams. Description and Properties.—About \ inch (3 Mm.) long, broadly ovate, laterally compressed, grayish-green, often divided into two mericarps, each with five crenate ribs, without oil-tubes, and containing a seed grooved on the face; odor and taste slight. When triturated with solution of potassium or sodium hydrate conium gives off a strong, disagreeable, mouse-like odor. The most important constituent is a volatile liquid alkaloid, coniine. It also contains methyl-coniine, conhydrine, and its isomer pseudo-conine. Dose.—1-5 grains (0.06-0.3 Gm.). Official Preparations. Extr3ctum Conii—ExtrScti Conii—Extract of Conium.—Dose, \-\ grain (0.03-0.06 Gm.). Extractum Conii Fluidum—Extr3cti Conii Fluidi—Fluid Extract of Co- nium.—Dose, 1-5 minims (0.06-0.3 Cc.). Unofficial Preparations. Tinctura Conii—Tincturas Conii—Tincture of Conium (15 per cent.).—Zto, 10-30 minims (0.6-1.8 Cc). Succus Conii—Succus Conii—Conium Juice.—Dose, 1-2 fluidrachms (1.8-7.4 Cc). The juice expressed from fresh leaves, and \ volume of alcohol added to pre- serve it. Coniina—Coniinae—Coniine.—Description and Properties.—A colorless, inflam- mable, oily liquid, having a strong alkaline reaction and a penetrating, suffocating odor. It is soluble in all proportions in alcohol, ether, chloroform, benzene, benzin, and fixed oils. It requires 100 parts of cold water for solution, the liquid becoming turbid on warming. Dose.—fa-i minim (0.006-0.06 Cc). Coniinae Hydrobromas—Coniinae Hydrobromatis—Coniine Hydrobro- mate.—Description and Properties.—It occurs in colorless, transparent prisms; soluble in water and alcohol in the proportion of 1 to 2 parts; very slightly soluble in ether. Dose.—-fa-l grain (0.002-0.06 Gm.). Antagonists and Incompatibles.—Nux vomica and its alka- MOTOR DEPRESSANTS. 499 loids, cocculus and picrotoxin, are antagonistic to conium. Tannic acid and the alkalies are chemically incompatible. Synergists.—The motor depressants and morphine. Physiological Action.—Externally and Locally.—Coniine, the active principle of conium, has no effect upon the unbroken skin. Applied to bruised surfaces, it has been thought to possess anes- thetic or analgesic properties. The specific behavior of the drug, however, renders the above action problematical, according to some authorities. Internally.—Digestive System.—Conium increases the salivary secretion, and when taken into the stomach exerts no special action upon the digestive system, other than an occasional disturbance of the gastro-intestinal tract, possibly resulting in vomiting and diar- rhea under full dosage. Circulatory System.—Although when ingested coniine is rapidly absorbed by the blood; circulating in the system unchanged, its action is not clearly defined, though it has been held that the cir- culation is first accelerated and then retarded, with a lowering of arterial pressure preceded by a decided increase. From its capacity to paralyze the terminal vagi it is natural to suppose that it increases the rapidity of the cardiac movements, yet a characteristic feature of the absorption of coniine is the appar- ent absence of cardiac derangement, the heart, as well as the mind, remaining unaffected in the presence of alarming symptoms. Nervous System.—The brain is unaffected, consciousness being preserved to the last; muscular irritability is uninfluenced; and even under large doses there is little impression made upon the nerves beyond a slight impairment of their conductivity, although the motor mechanism is peculiarly susceptible to the effects of the drug, which acts as a powerful depressant upon their functional energy. This latter influence is first manifested in the peripheries, gradually ascending until the spinal cord is involved, the reverse process marking the effects of methyl-coniine. Respiratory System.—Large or poisonous doses act as depres- sants upon the respiratory center in the medulla, and, although the breathing may at first be normal, paralysis and asphyxia may finally result from immoderate ingestion. Absorption and Elimination.—The drug is readily absorbed, elimination taking place by various channels, but chiefly through the kidneys and by expiration. Coniine has been detected in con- siderable quantities in the liver, lungs, and spleen. 500 A TEXT-BOOK OF MATERIA MEDICA. Temperature.—It has been held that bodily temperature is per- ceptibly lowered by conium, proportionately with the extent of the paralysis occasioned. High authorities, however, assert an increase of temperature under both therapeutic and toxic doses. Eye.—Heaviness of the eyelids, dilated pupils, accompanied by double or confused vision and occasionally entire loss of sight, have been noted among the symptoms incident to the administra- tion of active dosage. The effects thus recorded have been ascribed to paralysis of the third nerve rather than to stimulation of the sympathetic. Poisoning.—A frequent symptom of conium-poisoning is ptosis, arising from paralysis of the oculo-motor nerves. Staggering gait, general muscular relaxation, impairment of vision, nausea, and ver- tigo are also not infrequent. The severer symptoms are marked by muscular paralysis of the extremities, derangement of vocal organs resulting in difficulty of speech, and dilatation of the pupils. The brain meanwhile remains unaffected until overcome by the accumulation of carbonic-acid gas in the blood, when delirium and coma may ensue, and finally cerebral convulsions and fatal collapse through respiratory failure. With regard to the effect of toxic doses upon the heart conflict- ing statements are recorded, experiment having proved that in warm-blooded animals the cardiac movements speedily cease, it being authoritatively stated, on the other hand, that the drug exerts no influence upon the heart. Treatment of Poisoning.—The stomach should be evacuated by means of emetics or lavage, after which tannic acid and the phys- iological antidotes may be administered—tetanizing agents, such as strychnine and picrotoxin, with alcoholic stimuli if necessary. Coffee and also hypodermic injections of atropine have been highly recommended. Muscular exercise has been known to delay the action of the poison, and free counter-irritation by mustard may be serviceable. Therapeutics.—Externally and Locally.—In many respects the medicinal operation of conium bears no relation to its physio- logical action. Experimentation shows that it exerts but a feeble action upon the sensory nerves, yet clinical experience establishes its value in mitigating the pain of cancer when locally applied. In ulcerating cancer of the breast especially, poultices composed of conium leaves afford wonderful relief from pain and greatly improve the condition. A similar application has proved beneficial MOTOR DEPRESSANTS. 501 in scrofulous glandular sores. Dewees has recommended an injec- tion composed of the extract 3 parts to water 16 parts in uterine cancer. Ovarian mcnorrhagia is well treated by inserting in the vagina once or twice daily a suppository containing 1 or 2 grains (0.06- 0.12 Gm.) of conium. , Acute laryngitis may be greatly relieved by the inhalation of a solution containing 2 fluidrachms (7.4 Cc.) of succus conii to 16 or 20 ounces (473-591.5 Cc.) of water and 20 grains (1.2 Gm.) of sodium carbonate. The vapor of coniine inhaled is an efficient palliative of the cough of phthisis and acute bronchitis. The peculiar mouse-like odor renders the use of conium in dis- eases of the respiratory tract objectionable to many persons. Internally.—Its action upon the motor mechanism gives value to the drug in diseases characterized by excessive motor activity. Conium is therefore an efficient remedy in allaying the motor excitement of acute ma?iia. Advantage has been taken of its action in the treatment of asthma, and in chorea and paralysis agitans it certainly serves a useful purpose. It has been claimed that whooping cough yields to its influence. It has proved beneficial in other spasmodic affections, such as tetanus and blepharospasm accompanying many acute inflamma- tions of the eye. Coniine has even been suggested as a remedy in hydrophobia and strychnine-poisoning. Coniine hydrobromate has been proposed by Wolfenden as an efficient remedy in epilepsy. Conium has also been suggested in puerperal convulsions, while in infantile convulsions the drug has been employed with great benefit, being well tolerated by children. Coniine has been used hypodermically and with marked success to relax the muscles in dislocations of the joints, as well as in pneu- monia and pleurisy. In the latter diseases the drug so depresses the ends of the motor nerves that the impulse exciting the respira- tory muscles is interfered with and the cough greatly relieved, a reduction of the pulse-rate and temperature usually accompanying the cessation of coughing. Contraindications.—Conium should not be given to persons suffering from great exhaustion and debility or from diseases inter- fering with the rhythm of the heart. Administration.—The preparations of conium are very unreli- 502 . A TEXT-BOOK OF MA TERIA MEDICA. able, the fluid extract being perhaps the one to be depended upon most uniformly. Owing to the uncertainty of their strength, the administration should begin with small doses gradually augmented until interference with involuntary motion is observed, when further increase should be stopped. The effects of the drug are weakened by repeated doses, rendering an increase in the dose necessary from time to time. Coniine and morphine greatly aid each other, and this combination is a particularly efficient one in the treatment of painful muscular spasms and acute mania with excessive motor activity. Dr. Squibbs has stated that there is danger in diluting the fluid extract, a precipitate being formed containing the active principle. Gelsemium—Gelsemii—Gelsemium. XT. 8. P. (Yellow Jasmine.) Origin.—The rhizome and roots of Gelsemium sempervirens (L.) Pers., a plant indigenous in the southern United States, growing in moist woods. Description and Properties.—Cylindrical, long or cut in sec- tions about i inch (25 Mm.) in length, externally light yellowish- brown, with purplish-brown longitudinal lines; tough, fracture splintery; bark thin, with silky bast-fibers closely adhering to the pale-yellowish, porous wood, which has five medullary rays, and in the rhizome a thin pith; odor aromatic, heavy; taste bitter. It contains an alkaloid, gelsemine, which forms its active princi- ple, gelseminine, gelseminic acid, volatile oil, resins, gallic acid, etc. Dose.—2-10 grains (0.13-0.6 Gm.). Official Preparations. Extractum Gelsemii Fluidum—Extr3cti Gelsemii Fluidi—Fluid Extract of Gelsemium.—Dose, 5-15 minims (0.3-1.0 Cc). Gelsemina (unofficial)—Gelseminae—Gelsemine.—Description and Proper- ties.—A brittle solid, transparent, crystallizable mass, converted into a colorless liquid at 450 C. (1130 F.). Insoluble in cold water, but soluble to a slight extent in hot water, as well as in alcohol; taste bitter. Dose.—^\-$-fa gram (0.0003-0.001 Gm.). Antagonists and Incompatibles.—The cardiac and diffusible stimulants are antagonistic; tannic acid and caustic alkalies are incompatible, precipitating the alkaloid. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—It is a mild sedative and astringent, the alkaloid being a mydriatic. MOTOR DEPRESSANTS. 503 Internally.—Digestive System.—No special action has been noted, though when excessive doses have been taken nausea and vomiting may ensue. Circulatory System.—Medicinal doses of gelsemium produce no marked effect, but toxic doses reduce the heart's action, rendering the pulse slower and weaker and lowering arterial tension. Nervous System.—The drug has no effect upon higher cerebral centers, the mind remaining clear to the last. In large doses it paralyzes the roots of the motor cerebral nerves and the motor areas of the spinal cord, with consequent paralysis of all the mus- cles of the body. This condition is succeeded by cutaneous anes- thesia, due to depression of the receiving center and the sensory tract in the spinal cord. The motor nerves and muscles are unaf- fected. Convulsions rarely result in man from a poisonous dose, but occur in animals, with backward movements. The exact cause of this action is undetermined. Respiratory System.—The breathing is rendered slower and shallower, being frequently irregular. Death results from asphyxia, caused by depression and ultimate paralysis of the respiratory center. Absorption and Elimination.—Gelsemium is speedily absorbed and readily excreted, chiefly by means of the kidneys. Untoward symptoms produced by immoderate amounts of the drug prac- tically subside within three hours after ingestion. Fig. 8.—Diagram showing how gelsemium produces convergent strabismus : A,A, superior rectus ; B,B, external rectus—too weak; C,C, internal rectus; D,D, third nerve; E,E, sixth nerve; F,F, optic nerve; G,G, lesser wing. Temperature.—Poisonous doses cause a reduction in temper- ature. Eye.—Under full dosage the pupil is widely dilated and diplopia and marked ptosis ensue. The mydriasis and ptosis are caused by 504 A TEXT-BOOK OF MATERIA MEDICA. paralysis of the third nerve. The sixth, which innervates the ex- ternal rectus muscle, is often depressed more than the third nerve, supplying the internal rectus, producing convergent strabismus, as shown in Figure 8. The diplopia is caused by the squint and incoordination of the ocular movements. In strabismus the eyes are not directed exactly to the object, and the image does not fall on corresponding parts of the retinae; consequently, two perceptions are received in the visual center and two objects apparently seen. Uterus.—No important action has been observed. Untoward Action.—This does not essentially differ from that observed in poisoning, though the symptoms may be of a milder form. Poisoning.—In toxic doses gelsemium is quickly fatal. The early symptoms include drooping of the eyelids, wide dilatation and immobility of the pupils, extreme muscular weakness, affecting first the muscles of the upper extremities, and incoordination of movements. Diplopia and dimness of vision may ensue, accom- panied by difficulty of speech, coldness of the body surface, and general cutaneous anesthesia, with decidedly lower temperature. Meanwhile, there is marked diminution in the force and frequency of the pulse and respiration. While the patient may be drowsy, the mind is unaffected until carbonic-acid necrosis supervenes. Death is usually the result of respiratory failure, due to paralysis of the muscles of respiration. (See Plate I.) Treatment of Poisoning.—The evacuation of the stomach is of the first importance, either by the stomach-pump or by the use of emetics. Washing out with a solution of tannic acid is probably the best method to pursue. External heat should be applied and diffusible stimulants administered, followed by digitalis and strych- nine. The hypodermic injection of morphine and atropine is highly recommended in gelsemium-poisoning. Therapeutics.—Externally and Locally.—The drug is seldom used externally, although it has been employed by ophthalmolo- gists as a mydriatic. Internally.—Clinically, gelsemium is now considered less valu- able than formerly. It has been favorably mentioned by certain authors in the treatment of tetanus, mania with motor excitement, and paralysis agitans. Theoretically, it would seem to be of value in certain convulsive disorders, like chorea, pertussis, etc., yet its PLATE II. Gelsemium-poisoning. MOTOR DEPRESSANTS. 505 use has not met with the success which its action upon the mus- cular system would indicate. The drug appears to be more serviceable in trifacial neuralgia, and it seems to be even more efficient in neuralgia with involve- ment of the inferior dental nerve. In these disorders, as in ovarian neuralgia, dysmenorrhea, etc., for which it has been employed with some success, the drug should be pushed to its physiological limit. Bartholow praised the action of gelsemium in cerebrospinal meningitis and " acute inflammations of the lungs and pleura!' Bulkley is responsible for its use in pruritus and eczema, the itching of which it certainly appears to alleviate. The therapeutics of gelsemium would perhaps be incomplete without mentioning hemoptysis, remittent fever, acute coryza, mi- graine, Meniere's disease, and spermatorrhea, in all of which the drug has been used and recommended. Contraindications.—Diseases accompanied by exhaustion and great muscular weakness. Administration.—Any of the preparations may be given, the initial dose being small, and the amount increased gradually until dilatation of the pupil or drooping of the eyelids is manifest. Grindelia—Grindeliae—Grindelia. XT. 8. P. Origin.—The leaves and flowering tops of Grindelia robusta Nutt, and of Grindelia squarrosa Dunal, herbaceous or suffruticose perennials indigenous in the western part of North America and Mexico. Description and Properties.—Leaves about 2 inches (5 Cm.) long, varying from broadly spatulate or oblong to lanceolate, sessile or clasping, obtuse, more or less sharply serrate, often spinous- toothed or even laciniate-pinnatifid, pale-green, smooth, finely dotted, thickish, brittle; heads many-flowered, subglobular or somewhat conical, the involucre hemispherical, about f inch (10 Mm.) broad, composed of numerous imbricated, squarrose- tipped, or spreading scales; ray-florets yellow, liqulate, pistillate; disk-florets yellow, tubular, perfect; pappus consisting of two or three awns of the length of the disk-florets; odor balsamic; taste pungently aromatic and bitter. The principal constituent is probably a resinous substance. It also contains an alkaloid principle, grindeline, and a volatile and a fixed oil. Dose.—10-60 grains (0.6-4.0 Gm.). 506 A TEXT-BOOK OF MATERIA MEDICA. Official Preparation. Extractum Grindeliae Fluidum—Extracti Grindeliae Fluidi—Fluid Extract of Grindelia.—Dose, 10-60 minims (0.6-3.7 Cc). Antagonists and Incompatibles.—The motor excitants and cerebral stimulants are antagonistic. Aqueous preparations, the caustic alkalies, and mineral salts are incompatible. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—The drug is sedative and mildly astringent. Internally.—Digestive System.—When ingested it excites a sense of warmth in the epigastrium, and in moderate doses increases the secretion of the gastric juice, stimulating the appetite and improv- ing digestion. Circulatory System.—It differs somewhat from conium in that the heart is slowed by medicinal doses through stimulation of the inhibitory center. The blood-pressure, however, is raised and maintained by stimulation of the vaso-motor center. Nervous System.—Grindelia possesses considerable hypnotic power. Its effect upon the motor mechanism is similar to that of conium, the muscular weakness affecting first the lower extremi- ties. The sensory nerves are first depressed, there being quite marked cutaneous anesthesia. The drug depresses the reflex mechanism in the spinal cord, so that the reflex movements are greatly lessened : it is said that it also depresses the phrenic nerve. Respiratory System.—Small doses have little effect upon the respiratory movements ; large doses retard the breathing; while toxic doses may produce death through paralysis of the respiratory muscles. The drug slightly increases the secretion from the pulmonary mucous membrane, and relaxes the circular fibers of the bronchial muscles through depression of the ends of the motor fibers of the vagus distributed to these muscles and of the reflex center in the medulla. The ends of the sensory nerves distributed to the pul- monary mucous membrane are also depressed. Absorption and Elimination.—Grindelia is readily absorbed, and is eliminated chiefly by the kidneys, increasing the urinary flow, the lungs sharing in the excretory process. Temperature is unaffected. Eye.—Large doses cause dilatation of the pupil. Uterus.—No effect has been noticed. Untoward Action.—Excepting drowsiness, reduction of cutane- MOTOR DEPRESSANTS. 507 ous sensibility, slight gastric disturbance, and a feeling of weakness no symptoms have been recorded. Poisoning.—The drug is feebly toxic; excessive doses, how- ever, act as a gastro-intestinal irritant. The patient is sleepy and complains of muscular weakness ; there is a numb or anesthetic condition of the skin, while the pupils are dilated and the pulse and respiratory movements slow and feeble. Should death occur, it will be from paralysis of the muscles of respiration. Treatment of Poisoning.—The same as in poisoning from conium—diffusible stimulants, strychnine, etc. Therapeutics.—Externally and Lo- cally.—Grindelia is a very efficient ap- plication to the skin in rhus-poisoning. Indeed, it serves as a soothing lotion in many acute inflammations of the skin, such as eczema, etc. The fluid extract used should be well diluted and applied on cloths. Indolent ulcers are well treated by a diluted solution of the drug. It also serves as an efficient injection in gonor- rhea, leucorrhea, and vaginitis. Internally.—Grindelia has acquired an enviable reputation as a remedy for spasmodic asthma, its action upon the bronchial muscles rendering it singu- larly beneficial in this disorder. It acts upon every possible point to relax the spasm of the bronchial muscles, as is shown in Fig- ure 9. The drug has no influence, however, in preventing a recur- rence of the paroxysms. The drug has been highly recommended in acute and chronic bronchitis, hay fever, whooping cough, and in spasmodic cough of whatever nature. It has even been suggested as a palliative remedy in pneumonia and cardiac and pulmonary dyspnea. There are no special Contraindications or directions for Ad- ministration, save that the fluid extract is pharmaceutically incom- patible with aqueous preparations. Fig. 9.—Diagram showing how grin- delia relaxes spasm of the bronchial muscles in asthma. The sensory nerves (B) in the mucous membrane of the bronchial tubes are depressed, so that there is less irritation transmitted to the medulla, to be returned by the motor fibers supplying the bronchial muscles, thus exciting bronchial spasm. The respiratory center (A) is depressed, together with the ends of the motor nerves (C), limiting the amount of irri- tation in the bronchial muscles (E). The diaphragm (F) is relaxed through depression of the phrenic nerve (D). 508 A TEXT-BOOK OF MA TERIA MEDICA. Physostigma—Physostlgmatis—Physostigma. XT. 8. P. (Calabar Bean.) Origin.—The seed of Physostigma venenosum Balfour, a lofty, half-shrubby, climbing plant (somewhat resembling the scarlet- runner or Spanish bean of our gardens) growing near the mouths of the Niger and Old Calabar River in Western Africa, and attain- ing a height of 40 or 50 feet (12-15 M.). Description and Properties.—The seeds are about 1 to 1] inches (25-30 Mm.) long, f to f inch (15-20 Mm.) broad, and f to finch (10-15 Mm.) thick; oblong and somewhat reniform; testa granular, chocolate-brown, with a broad black groove extending the entire length of the convex edge; embryo with a short, curved radicle and two large, white concavo-convex cotyledons; inodor- ous ; taste bean-like. The drug contains an alkaloid, physostigmine (also known as eserine), which is the principal constituent; calabarine, to which the drug owes its tetanizing properties ; and eseridine (a laxative and motor excitant); besides a neutral principle, physosterin, related to cholesterin. Dose.—1-4 grains (0.065-0.25 Gm.). Official Preparations. Extractum PhysostYgmatis—Extracti Physostlgmatis—Extract of Physo- stigma.—Dose, -£$-\ grain (0.004-0.01 Gm.). Tinctura Physostlgmatis—Tinctiirae Physostlgmatis—Tincture of Physo- stigma.—Dose, 5-10 minims (0.3-0.6 Cc). The alkaloid, Physostigmine, is not official. It occurs in colorless or slightly pink- ish crystals; sparingly soluble in water; readily soluble in alcohol.—Dose, -^—^ grain (0.0006-0.003 Gm.). The salicylate and sulphate of physostigmine are official. Physostigminae Sallcylas—Physostigminae Salicylatis—Physostigmine Salicylate (Eserine Salicylate). U. S. P. Description and Properties.—Colorless or faintly yellowish, shining, acicular, or short, columnar crystals, odorless, and of a bitter taste; acquiring a reddish tint when exposed to light and air; soluble in 150 parts of water and 12 parts of alcohol. The salicylate should be kept in small, dark amber-colored, and well-stoppered vials. Dose.—f^Tj-jft grain (0.0005-0.002 Gm.). Physostigminae Sulphas—Physostigminae Sulphatis—Physostigmine Sul- phate (Eserine Sulphate). U. S. P. Description and Properties.—A white, or yellowish-white, micro-crystalline pow- der, odorless, and of a bitter taste. It is very deliquescent when exposed to moist air, gradually turning reddish in air and light. Very soluble in water and alcohol; still more so at the boiling-point of these liquids. It should be kept in small, dark amber- colored, and well-stoppered vials. Dose.—jjtt-sV gram (0.0005-0.002 Gm.). MOTOR DEPRESSANTS. 509 Unofficial Preparation. Physostigminae Hydrobrdmas—Physostigminae Hydrobromatis—Physo- stigmine Hydrobromate.—Dose, i^-jg- grain (0.0005-0.002 Gm.). Antagonists and Incompatibles.—The action of physostigma upon the heart, respiration, and pupils is antagonized by atropine; that on the spinal cord by chloral; while, in a general way, the motor excitants, particularly the tetanizing agents, are therapeuti- cally antagonistic. The caustic alkalies and tannic acid are chemically incompatible. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—No external Fig. lo.-Diagram illustrating the mechanism of secretion. An impression is transmitted over the afferent nerve (B) to the medulla {A), and thence over the secretory nerve (C) to the secretory cells [K, K) of the gland (F). At the same time the vaso-motor nerves (E) are stimulated, causing a con- traction of the arterioles (/) supplying the gland; hence, as soon as the lymph in the lymph-spaces (H) is consumed, the secretion from the gland is diminished for lack of material necessary to the secretory cells in elaborating their normal secretions. action of physostigma and its preparations is noted, unless it be its effect upon the pupil, which outward application contracts, and the slight abolition of functional activity in the motor and sensory 510 A TEXT-BOOK OF MATERIA MEDICA. nerves, occasioned, it is said, by a strong solution of physostig- mine. Internally.—Digestive System.—The administration of the drug tends to stimulate the salivary, gastric, and intestinal secretions, followed by lessened secretion (see Figure 10), and, by acting upon the muscular coats of the stomach and intestines, to increase peristalsis. Nausea, retching, vomiting, and purging may result. The rationale of its action is doubtless direct stimulation of the unstriped muscle-fibers. Circulatory System.—No influence on the blood has been de- tected. Small doses increase arterial tension, the heart's action becoming slower and stronger. Although the effect upon the heart is somewhat obscure, it appears that under poisonous doses the cardiac pulsations are greatly reduced, being slow and feeble, and finally ceasing alto- gether. It is reasonably supposed that this action is due to pri- mary stimulation of the peripheral vagi, influencing the cardiac ganglia, and also to the effect upon the vaso-motor centers. The subsequent exhaustion and relaxation of the arteries are doubtless the result of a similar influence. There is marked elevation of blood-pressure under moderate doses, although there may occur a brief period of depression. Toxic doses are accompanied by a notable decrease of arterial ten- sion, the cardiac ganglia being seized with paralysis and the heart finally arrested in diastole. Nervous System.—As with conium, the mind is comparatively unaffected by physostigma, remaining lucid even to the verge of final collapse. The spinal cord, however, appears to bear the prin- cipal shock, the total abolition of reflex activity indicating a selective action of the drug. To the effect on the motor nerves, occasioning a diminution of power, must be attributed the muscular debility and paralytic symptoms manifest under the administration of toxic doses. Respiratory System.—No interference with respiration is caused by moderate doses of the drug. Larger amounts primarily de- press the respiratory centers, stimulate the peripheries of the pul- monary vagi, and contract the caliber of the bronchial tubes, even to the extent of serious constriction, death usually resulting from asphyxia. The breathing is first quickened and then retarded, the effect of the drug upon the respiration being more powerful than its circu- MOTOR DEPRESSANTS. 5" latory influence, the heart continuing to beat for some time after pulmonary action has ceased. Absorption and Elimination.—The active principles of physo- stigma and its alkaloids are rapidly diffused in the blood. They are largely excreted by the kidneys, the bile and saliva contributing to the process of elimination, and have been detected in the gastric juices after intravenous injection. Temperature.—A slight depression has been noted. Eye.—Applied locally to the conjunctiva or introduced into the circulation, whether by ingestion or injection, physostigmine causes myosis or contraction of the pupil by stimulating the peripheral endings of the oculo-motor nerves, possibly by a depression of the sympathetic fibers. Other prominent symptoms present are spasm of accommoda- tion and decreased intraocular tension and myopia. Irritation of the third nerve is the principal cause of these phenomena: they have also been attributed to the stimulating action of the drug upon the muscular fibers of the iris rather than to any paralyzing influence upon the sympathetic, pupillar dilatation being manifest under excitation of the latter nerve. The intraocular pressure is lowered (1) by lessening the blood- supply to the eye through contraction of the blood-vessels; (2) by diminishing the secretion of the aqueous humor from the glands on the surface of the ciliary body; (3) by contracting the iris, so that the aqueous humor can more readily pass through the canal of Schlemm. Uterus.—The full influence of the drug tends to produce uterine contraction. Untoward Action.—When eserine is applied to the eye it occa- sionally produces a nervous contractile pain in the entire eyeball, which extends in a manner similar to ciliary neurosis along the course of the supraorbital nerve, resembling migraine. Small doses have in some individuals produced nausea and general uneasiness, and occasionally intense pain in the epigas- trium. Poisoning.—Taken in poisonous doses, physostigma causes nausea, giddiness, and muscular tremors and weakness, followed by complete muscular relaxation. Cardiac action is diminished; the reflexes are in abeyance; the respiration is retarded; and myosis and motor paralysis are manifest. The pupils visibly con- tract, and purging and vomiting may ensue. Fatal results are 512 A TEXT-BOOK OF MATERIA MEDICA. possible through paralysis of the respiratory center and consequent asphyxia. The more rapid collapse succeeding the administration of lethal doses is due to cardiac syncope. Treatment of Poisoning.—The stomach should be evacuated, the process being followed by the hypodermic injection of a solution of atropine, which may prove an efficient physiological antidote. Tannic acid may be used as a chemical antagonist. Diffusible stimulants, such as ether or ammonia, may serve to arrest cardiac and respiratory failure. Digitalis and alcohol have also been suc- cessfully employed. Temperature should be maintained by the application of external heat. Therapeutics.—Externally and Locally.—Physostigmine and eserine sulphate are the preparations usually employed, their only action of importance being in diseases of the eye. They are of value in breaking up adhesions of the iris to the cornea or lens, strengthening the muscle of accommodation, reducing intraocular pressure, and removing the effects of atropine, although Jessup claims that complete ciliary paralysis by atropine and the mydriasis induced by hyoscine are unaffected by eserine. In certain cases of ulcer of the cornea uncomplicated with iritis and sloughing keratitis, where there is little inflammation or ciliary irritation, eserine sometimes produces prompt improvement when atropine has failed. Paralytic mydriasis and paralysis of accommodation are tempo- rarily relieved by this drug, and weak solutions have been employed with varying success in accommodative asthenopia without refrac- tive errors. The remedy is of unquestioned value in the early stages of glaucoma, but only at the commencement of an acute attack and contraindicated in the hemorrhagic form. Should the drug fail to contract the pupil when used for glaucoma, it may induce irritating spasm of the ciliary muscles by increasing the blood-supply to the iris. Physostigmine is sometimes employed to prevent prolapsus of the iris, following peripheral perforation of the cornea or cataract extraction, particularly without iridectomy. The remedy serves a useful purpose also in coal-miners' nys- tagmus, one drop of a collyrium containing \ grain (0.096 Gm.) of physostigmine sulphate in 1 ounce (30.0 Cc.) of distilled water being dropped into the eye three times a day. Eserine is also em- ployed in neuralgia of the eyeball and photophobia. MOTOR DEPRESSANTS. 5*3 Internally.—Physostigma has proved efficacious in constipation due to an atonic condition of the intestines with deficient secretion. The state of the muscular intestinal layer frequently allows gas to accumulate in the bowels, with consequent troublesome flatulence. The drug, by imparting tone to the muscles and increasing peri- stalsis, greatly relieves this unpleasant condition. Gastric and intestinal dilatation have been successfully treated by Hare with this remedy. It is valuable in chronic bronchitis with dilatation of the bronchial tubes, and is said to relieve bronchial asthma and emphysema. Progressive paralysis of the insane is sometimes relieved by physostigma, while its good reputation in tetanus is well estab- lished. It has been used, but with less favorable results, in chorea, epilepsy, infantile convulsions, and other spasms. Some authorities have recommended it in the treatment of paraplegia due to myeli- tis, renal hemorrhage, night-sweats of phthisis, and locomotor ataxia. Contraindications.—The same as for conium. Administration.—The extract or the tincture is usually pre- ferred for internal administration, although the alkaloid fully repre- sents the drug and may be given either by the mouth or hypo- dermically. For application to the eye the salts of the alkaloid are used. A convenient form of eserine in ophthalmic practice is the medicated gelatin disks. Curare—Curare—Curare. (WOORARI.) Origin.—An extract of uncertain composition prepared by the natives of South America as an arrow-poison. Dr. Jobert reported to the French Academy in 1878 that the poison was prepared chiefly from Strychnos Castelno?ana and other species of Strychnos, and Cocculus toxiferus, containing also variable quantities of other poisonous plants, such as Didelphys cancrivora, etc. It is alto- gether probable that its ingredients include the poison of venomous reptiles. Description and Properties.—The extract is a blackish-brown, friable solid, brittle or hygroscopic, of a very bitter taste; almost completely soluble in dilute alcohol. Cold water dissolves about 75 per cent, which portion contains the poisonous alkaloids and is insoluble in ether and but sparingly soluble in absolute alcohol. Two alkaloids have been obtained from this substance—curarine and curine. 33 514 A TEXT-BOOK OF MATERIA MEDICA. Dose.—2V-! gram (0.003-0.03 Gm.), hypodermically given. Dose of Curarine.—ginj-TOT Sram (0.0003-0.0006 Gm.), hypo- dermically. Antagonists and Incompatibles.—The excito-motors are an- tagonistic. Tannic acid and the caustic alkalies are chemically incompatible. Synergists.—The depresso-motors. Physiological Action.—When applied to the denuded skin it is a powerful irritant; introduced into the circulation hypodermically, it exerts a very decided and characteristic action. Circulatory System.—Medicinal doses render the pulse fuller and exceedingly rapid; there is marked dilatation of the blood- vessels of the skin and the various glands; while the blood-pres- sure, though little affected by small doses, is decidedly lowered by large ones. The action on the circulation is due to diminished inhibition on the heart, owing to paralysis of the ends of the vagi, while the accelerator nerves are stimulated. Nervous System.—Immoderate doses cause great muscular weakness and paralysis of all the voluntary muscles. The ends of the motor and sensory nerves are paralyzed, the former being soonest affected. Beyond a slightly diminished contractility the voluntary muscles are but little influenced. The spinal cord may be paralyzed under toxic doses, although the brain-centers remain unaffected until carbonic-acid narcosis sets in. Respiratory System.—Curare is a powerful respiratory depress- ant, paralyzing the ends of the motor nerves distributed to the respiratory muscles. When lethal doses have been given the paralysis becomes central, finally producing death by its action on the respiratory muscles. Absorption and Elimination.—When ingested the process of absorption is exceedingly slow, but when injected into the circula- tion the drug is rapidly absorbed. It is quickly eliminated by the kidneys, causing sugar to appear in the urine. A portion of the poison is also excreted with the feces. The sweat, saliva, nasal mucus, and tears, although their secretion is greatly increased by the drug, do not seem to share in the process of elimination. Temperature.—The temperature is elevated. Eye.—Under poisonous doses there is marked ptosis, disordered vision, protrusion of the eyeballs, and, as a late ocular symptom, myosis. MOTOR DEPRESSANTS. 515 Poisoning.—Curare is a rapid and active poison. The move- ments of the heart are greatly accelerated; the pulse is weak and dicrotic; the temperature is elevated, and the respiration corre- spondingly depressed; extreme muscular weakness ensues, with incoordination of movements; the urine becomes saccharine. Finally, paralysis of the extremities and the respiratory muscles supervenes, death occurring from respiratory paralysis. Treatment of Poisoning.—The same as in the treatment of poi- soning from conium, with catheterization of the bladder to favor elimination, and artificial respiration. Therapeutics.—While of great scientific interest and of value for experimental purposes in ascertaining the effect of certain drugs upon animals, the therapeutic uses of curare are quite limited, being confined to certain spasmodic diseases, particularly hydrophobia. The remedy has also been used with varying success in chorea, tetanus, and epilepsy, but when the convulsions are due to excessive activity of the cerebral motor areas the bromides are superior to curare. Contraindications.—The same as for conium. Administration.—The crude drug or the alkaloid curare should be given hypodermically. Aspidosperma—Aspidospermatis—Aspidosperma. XT. 8. P. Origin.—The bark of Aspidosperma Quebracho-bianco Schlech- tendal, a large evergreen tree, of exceedingly hard wood (Sp. quebrar, to break, and hacha, an axe), indigenous in the Argentine Republic. Description and Properties.—Occurring in nearly flat pieces about \ to \\ inches (12.0-30.0 Mm.) thick; the outer surface yel- lowish-gray or brownish, deeply fissured, inner surface yellowish- brown or reddish-brown, distinctly striate; fracture displaying two sharply-defined strata of about equal thickness, both marked with numerous whitish dots and striae arranged in tangential lines; the fracture of the outer lighter-colored layer rather coarsely granu- lar, and that of the darker-colored inner layer short-splintery; inodorous; taste very bitter and slightly aromatic. Six alkaloids have thus far been isolated from aspidosperma, the most important being as pido spermine and quebrachine, the former occurring in colorless prismatic crystals insoluble in water and soluble in 48 parts of alcohol. Dose.—5-30 grains (0.3-2.0 Gm.). 516 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Extralctum Aspidospermatis Fluidum—Extracti Aspidospermatis Fluidi— Fluid Extract of Aspidosperma.—Dose, 5-30 minims (0.3-1.8 Cc). Aspidospermine (unofficial).—Dose, \-\ grain (0.016-0.03 Gm.). Quebrachine (unofficial).—Dose, 1-2 grains (0.06-0.12 Gm.). Physiological Action.—Externally and Locally.—No important action has been noted. Internally.—Digestive System.—It is a stomachic, having an action analogous to the vegetable bitters. Circulatory System.—Aspidosperma depresses the heart, render- ing its action slower, with reduction of arterial tension. Nervous System.—In its action it resembles conium. It de- presses the motor mechanism by its influence on the motor centers, and lessens the reflexes through its influence on the spinal cord. Excessive doses cause vertigo and headache, together with paraly- sis of the extremities, the lower being first affected. Respiratory System.—Medicinal amounts of aspidosperma retard the breathing, but deepen the inspirations; aspidospermine, on the contrary, increases the respiratory movements. Toxic doses para- lyze the respiratory center, death resulting apparently from asphyxia and convulsions. Absorption and Elimination.—It readily passes into the blood, and is excreted chiefly by the urine, the saliva and sweat sharing in the process of elimination. Temperature.—It is antipyretic, febrile temperature being re- duced by full doses of the drug. Poisoning.—Aspidospermine is an active respiratory poison, the toxic symptoms being vertigo, headache, free diaphoresis and sali- vation, great muscular weakness, with paralysis of the lower extremities, slow and weak heart, reduction of temperature, marked depression of the respiration, and death from respiratory failure. Treatment of Poisoning.—The same procedure is advisable as in cases of poisoning from the other motor depressants. Therapeutics.—Aspidosperma is not employed locally, its chief value being in the treatment of dyspnea of whatever variety, though it is fair to state that Pluzoldt considers it contraindicated in cardiac dyspnea. The drug is equal, if not superior, to grindelia in the treatment of spasmodic disorders of the respiratory apparatus. By some clinicians it is claimed to be an efficient remedy in pneumonia, being especially useful in relieving cyanosis. MOTOR DEPRESSANTS. 517 Aspidospermine has been highly recommended as an anti- periodic in malaria, and has appeared to modify the symptoms of acute articular rheumatism. Administration.—Both the fluid extract and the alkaloid may be given internally, although a favorite and efficient method of administering the alkaloids is by hypodermic injection. Sumbul—Sumbul—Sumbul. IT. 8. P. Origin.—The root of Ferula sumbul (Kauffmann) Hooker fil, a perennial about 8 feet (2.4 M.) high, indigenous in regions north and east of British India. Description and Properties.—It occurs in transverse segments, varying in diameter from 1 to 3 inches (2-7 Cm.), and in length from 6 to 12 inches (14-30 Cm.); light spongy, annulate or longi- tudinally wrinkled; bark thin, brown, more or less bristly fibrous; the interior whitish, with numerous brownish-yellow resin-dots and irregular, easily separated fibers; odor strong, musk-like; taste bitter and balsamic. It contains sumbulic and valerianic acids, a small quantity of volatile oil, and two balsamic resins to which its odor is due. Dose.—15-30 grains (1.0-2.0 Gm.). Official Preparation. Tinctura Sumbul—Tincturse Sumbul—Tincture of Sumbul.—Dose, 15-60 minims (1.0-3.7 Cc). The drug has not yet been carefully studied. It is unknown just what substances are incompatible with it, though the motor excitants are probably antagonistic. The exact physiological action is not definitely understood, yet so far as it has been investigated it seems to possess some of the properties of both the motor de- pressants and antispasmodics, having a sedative action upon the brain and spinal cord. Therapeutics.—The drug is valuable in the various manifesta- tions of hysteria, and has been employed with some success in ovarian neuralgia and dysmenorrhea. It is similar to, though not so efficient as, grindelia in spasmodic coughs. Indeed, most of the disorders benefited by the antispas- modics yield to the influence of sumbul. In neurasthenia with anemia the extract of sumbul, combined with iron and arsenic, serves a very useful purpose. 518 A TEXT-BOOK OF MATERIA MEDICA. Administration.—It may be given in the form of the tincture, or the extract may be administered in pill form. Viburnum Prunifolium—Viburni Prunifolii—Black Haw. XT. 8. P. Origin.—The bark of Viburnum prunifolium L., a tall shrub or small tree 10 to 20 feet (3-6 M.) high, growing in thickets through- out the greater portion of the United States east of the Mississippi. Description and Properties.—Thin pieces or quills, glassy purplish-brown, with scattered warts and minute black dots; when collected from old wood, grayish-brown, the thin corky layer easily removed from the green layer; inner surface whitish, smooth; frac- ture short; inodorous; somewhat astringent and bitter. It contains a bitter principle (viburnin), a bitter resin, valerianic acid, besides tannic, oxalic, citric, and malic acids. Dose.—30-60 grains (2.0-4.0 Gm.). Official Preparation. Extractum Viburni Prunifolii Fluidum—Extracti Viburni Prunifolii Fluidi —Fluid Extract of Black Haw.1—Dose, y2-\ fluidrachm (1.8-3.7 Cc). Antagonists and Incompatibles.—It is chemically incompatible with iron and other substances affected by tannic acid. Synergists.—Antispasmodics and uterine sedatives. Physiological Action and Therapeutics.—The action of black haw is not thoroughly understood. It appears to have a sedative action upon the spinal centers, similar in many respects to that of conium. It acts as an antispasmodic, diuretic, nervine, and tonic, being especially useful in various uterine disorders, such as spas- modic and membranous dysmenorrhea. The various vaso-motor disturbances and the menorrhagia inci- dent to the menopause are frequently relieved by this remedy. It is also of some value in the prevention of abortion. Its sedative properties render it serviceable in relieving the severity of after- pains. Liquor Sedans (P., D. & Co.) is superior to the fluid extract of black haw for the disorders mentioned. Contraindications and Administration require no special com- ment or suggestion. 1 Parke, Davis & Co. of Detroit manufacture a preparation called Liquor Sedans, intended as a substitute for certain secret preparations. The formula is given on the label of each bottle, and the remedy is composed of black haw, golden seal, and Jamaica dogwood, combined with aromatics, in the form of an elixir. MOTOR DEPRESSANTS. 519 Viburnum Opulus—Viburni Opuli—Cramp Bark. XT. 8. P. Origin.—The bark of Viburnum Opulus L., a small tree 10 to 15 feet (3-4.5 M.) high, indigenous in Canada, the Northern United States, Europe, and Northern Asia. Description and Properties.—Flattish or curved bands, or occasionally quills, sometimes 12 inches (30 Cm.) long and from ^ to y^ inch (1-1.5 Mm.) thick; outer surface ash-gray, marked with somewhat transversely scattered, elongated warts of a brown- ish color, due to abrasion, and marked more or less with blackish dots, with black, irregular lines or thin ridges, arranged chiefly in a longitudinal direction; underneath the easily-removed corky layer of a pale-brownish or reddish-brown color; the inner surface dingy white or brownish; fracture tough, the tissue separating in layers; inodorous; taste somewhat astringent and bitter. Dose.—1-2 drachms (4.0-8.0 Gm.). 'Official Preparation. Extractum Viburni Opuli Fluidum—Extracti Viburni Opuli Fluidi—Fluid Extract of Cramp Bark.—Dose, 1-2 fluidrachms (3.7-7.3 Cc). The general observations upon Viburnum prunifolium are appli- cable to this drug. Acidum Hydrocyanicum Dilutum—Acidi Hydrocy- anici Diluti—Diluted Hydrocyanic Acid. XT. 8. P. (Prussic Acid.) Origin.—A liquid composed of 2 per cent, by weight of abso- lute Hydrocyanic Acid and 98 per cent, of Water, prepared by distilling a mixture of Potassium Ferrocyanide, Sulphuric Acid, and Water into Distilled Water. Description and Properties.—A colorless liquid, of a charac- teristic odor and taste, resembling those of bitter almonds. As it is very poisonous, great care should be taken in tasting it. It should be kept in small, dark-amber colored, cork-stoppered bottles, in a cool place. Dose.—1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles.—Atropine is a physiological antagonist, the diffusible stimulants also counteracting the effects of the drug. The metallic salts, particularly cobalt nitrate, are chemically incompatible. 520 A TEXT-BOOK OF MATERIA MEDICA. Synergists.—The cardiac and motor depressants. Physiological Action.—Externally and Locally.—Applied lo- cally to the unbroken skin, its first effect is slightly irritating, but soon after sedative and anesthetic, because of its influence in causing paralysis of the sensory nerve-endings. It is very rapidly absorbed from raw surfaces, even toxic effects resulting from its application. Internally.—Digestive System.—Being quickly absorbed by the mucous membranes, hydrocyanic acid acts as an anesthetic and sedative upon the stomach, moderate doses having little influ- ence upon a healthy organism. Toxic doses may be followed by vomiting and the terribly lethal action of the drug, the peculiarly sudden and violent activity of which renders it the most fatal poison known. Circulatory System.—Prussic acid passes very readily into the blood, upon which it acts with physical effects variously reported, it having been observed that the blood is at first changed to a bright red or arterial tint, soon changing to a dark venous color. Upon the heart its influence, though in small doses sedative through stimulation of the vagus center, in toxic doses is particu- larly active, suspending its movements and arresting it in diastole. A temporary, yet doubtful, increase, followed by a decline, of arterial pressure has been noted. In lethal doses the decrease of tension is unquestionable. Observations upon the physiological effects of prussic acid have been attended with considerable dif- ficulty : a slow and frequently irregular pulse, however, is among the authenticated phenomena. By its action on the respiratory functions of the red blood-corpuscles the supply of oxygen to the circulation is impeded. Nervous System.—Medicinal doses have no appreciable effect save to occasion a depression of the sensory fibers of the vagus. The cerebral effects of large doses are giddiness and stupor, often accompanied by total insensibility or coma. Toxic doses produce marked cutaneous anesthesia, beginning in the lower extremities, caused by paralysis of the sensory ends and sensory tracts. The motor mechanism shares in the general influence, which causes excessive muscular weakness, resulting from depression of the spinal motor areas, the ends of the motor nerves, and the mus- cles respectively. Respiratory System.—Very small doses of hydrocyanic acid have no effect upon respiration. Full or large doses have been observed MOTOR DEPRESSANTS. 521 to render the breathing labored and irregular. Under toxic doses the respiration becomes enfeebled, finally ceasing altogether, death ensuing from asphyxia due to paralysis of the respiratory move- ments by direct action upon the center. It has been noted that lethal doses are so quickly fatal that the respirations cannot be counted. Absorption and Elimination.—As has been remarked, absorption takes place with great rapidity, elimination being probably through the kidneys, salivary glands, and lungs, the process being accel- erated by means of the drug's exceeding volatility. In case of poisoning, should death be averted for half an hour there is chance of recovery. Temperature.—No special influence has been observed. Eye.—The pupils are, as a rule, visibly dilated under serious dosage, a temporary hemianopia having been also observed in a case of poisoning with recovery. Untoward Action.—There are no untoward manifestations save those described under " Poisoning." Poisoning.—The celerity of action characteristic of prussic acid is evidenced by the fact that death may be instantaneous, the sub- ject falling with a gasp and momentary convulsion, followed by immediate collapse. In such cases the countenance is cyanotic, the teeth firmly set, the eyes wide open, and the lips covered with bloody froth. In less violent cases the symptoms may take the form of reduced respiration, impairment of cardiac movements, and cerebral disturbance. A third stage is marked by wide dilatation of the pupils, loss of consciousness, delirious cries, accompanied by strong convulsions, vomiting, incontinence of urine, involuntary defecation, and even erections of the penis and ejaculations of semen (Hare). In still another stage asphyxia, collapse, and death occur in rapid succession. Treatment of Poisoning.—Owing to the physical action of prussic acid upon the blood, artificial respiration is generally pow- erless to avert fatal results (Ringer). Efficient antidotes are ammonia and its carbonate, to be administered whenever prac- ticable. Alcoholic stimuli may prove of service, yet the fearful rapidity of the drug's action renders poisoning by prussic acid rarely amenable to systematic treatment. A vigorous recourse to alternately warm and cold affusions, together with inhalations of ammonia, has been recommended as of primary importance. Secondary means of allaying toxic effects 522 A TEXT-BOOK OF MATERIA MEDICA. may be found in the internal administration of chlorine water or of potassium carbonate, followed by the sulphates of iron. More recently the subcutaneous injection of atropine has been suggested as the true physiological antidote (Farquharson), while Dr. Antal considers cobalt nitrate the best chemical antagonist. So long as the faintest pulsation is discernible no efforts at recovery should be remitted. Therapeutics.—Externally and Locally.—Hydrocyanic acid is a valuable antipruritic, being frequently employed to relieve the itching of various diseases of the skin, such as eczema, erythema, urticaria, pruritus vulva?, etc. It is commonly applied in strengths of \ fluidrachm (1.8 Cc.) to 1 ounce (30.0 Cc.) of water. Inhalations of a solution containing 3 minims (0.18 Cc.) of diluted hydrocyanic acid to 8 ounces (236.6 Cc.) of water at a temperature of 1200 F. have been recommended by Mackenzie and others in asthma and the irritative cough of phthisis. Internally.—Its sedative properties render the drug an efficient remedy in obstinate vomiting and gastric pain from whatever cause. It is also valuable to relieve coughs of a dry, hacking nature, whooping cough, and various neuroses of the respiratory organs. Macdonald reports a case of night cough of a child that yielded promptly to hydrocyanic acid after every other treatment had been tried in vain. The drug has also been employed in neuralgia and acute mania and melancholia. In irritable conditions of the heart it serves as a useful palliative, and it is also of some value in relieving the distress of irritative dyspepsia. Contraindications.—Extreme muscular weakness and the last stages of valvular heart disease. Administration.—Owing to the exceedingly rapid elimination of prussic acid the dose should be frequently repeated—every hour or two. In the early administration the minimum dose should be first prescribed, the amount being gradually increased to the maximum or until the patient complains of constriction about the throat or other untoward manifestation, when the dosage should be discontinued. Whenever a fresh supply is prescribed it is best to begin with the minimum dose, owing to the variations in strength in the different samples. Hydrocyanic acid may be given in syrup, water, or glycerin, or in some effervescent draught. MOTOR DEPRESSANTS. 523 Potassii Cyanidum—Potassii Cyanidi—Potassium Cyanide. X.8.P. Origin.—Prepared by heating in an iron crucible a mixture of exsiccated Potassium Ferrocyanide 8 parts and Potassium Carbon- ate 3 parts until effervescence ceases. Description and Properties.—White, opaque, amorphous pieces, or a white, granular powder, odorless when perfectly dry, but in moist air exhaling the odor of hydrocyanic acid. The taste is sharp and somewhat alkaline, but should be ascertained with great care, as the salt is very poisonous. In moist air it deliquesces; soluble in about 2 parts of water and sparingly soluble in alcohol. Potassium cyanide should be kept in well-stoppered bottles. Dose.—rV~i gram (0.004-0.008 Gm.). Cyanide of potassium differs from hydrocyanic acid, with which it generally assimilates, in being less rapid in its action, producing dermatitis or eczematous eruption by local application to the epi- dermis, and in its possibly fatal results from free contact with abraded surfaces. The therapeutic uses are practically those of hydrocyanic acid. Amyl Nltris—Amyl NitrTtis—Amyl Nitrite. XT.8.P. Origin.—Obtained by the action of Nitric Acid upon Amylic Alcohol—a liquid containing about 80 per cent, of amyl (princi- pally iso-amyl) nitrite, together with variable quantities of unde- termined compounds. Description and Properties.—A clear yellow or pale-yellow liquid, of a peculiar, ethereal, fruity odor and a pungent, aromatic taste. Almost insoluble in water; miscible in all proportions with alcohol or ether. In alcoholic solution it gradually decomposes, with formation of ethyl nitrite and amylic alcohol. It should be kept in small, dark-colored, glass-stoppered bottles, in a cool and dark place, remote from lights and fire. Dose.—|-i minim (0.03-0.06 Cc.) internally ; for inhalation 1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles.—The motor excitants antago- nize the action of amyl nitrite. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—Its action is that of a mild irritant when applied to the skin. 524 A TEXT-BOOK OF MATERIA MEDICA. Internally.—The following actions apply to ingestion or inhala- tion of the drug. Digestive System.—No important action has been observed. Circulatory System.—Almost immediately after inhalation of amyl nitrite there is a marked increase in the heart's action and great dilatation of the arteries, with lowering of arterial pressure. The rapidity of the pulse is due to depression of the vagus and the removal of inhibition from the low arterial tension. The exact cause of dilatation in the arterial system is undetermined, some experimenters believing it to be due to depression of the muscular coat of the vessels or ganglia, while others suppose its action to be on the vaso-motor center. The inhalation of large amounts renders the heart very weak, toxic doses arresting that organ in diastole. The functional activ- ity of the hemoglobin is checked, giving to the arterial and venous blood a dark chocolate color. Nervous System.—Among the effects are cerebral oppression, flushing of the head and face, vertigo, headache, and confusion of ideas, with diminished reflex excitability, muscular weakness, and unsteadiness of gait, both the voluntary and involuntary muscles being relaxed. These actions are due to the depressing influence of the drug upon the motor areas of the brain and spinal cord. Respiratory System.—Small doses quicken the respiration by lowering arterial pressure and possibly by stimulation of the cen- ter. Immoderate or toxic amounts render the breathing slow and labored from depression of the respiratory center and arrest of the corpuscular action of the blood. Absorption and Elimination.—Amyl nitrite is rapidly absorbed, being eliminated chiefly by the kidneys, increasing the amount of urine, uric acid, and urea excreted. Sugar may frequently be de- tected in the urine, probably resulting from the action of the drug in dilating the hepatic vessels and increasing the circulation in the liver. Temperature.—Bodily heat is reduced both in health and in fever, due to dilatation of the peripheral blood-vessels and a reduc- tion of the oxygen-carrying power of the red blood-corpuscles. Eye.—There is marked dilatation of the retinal vessels and hyperemia of the papilla, producing chromatopsia of the parti- colored variety and hallucinations of vision. These effects are usually transitory, and disappear with the elimination of the drug. Uterus.—The uterine muscle is relaxed. MOTOR DEPRESSANTS. 525 Unhnvard Action.—In addition to the symptoms described under "Poisoning," there have been noted gastric disturbance, nausea and vomiting, dryness of the mouth and trembling of the lips, irritation of the throat, defective vision, and subjective sensations of color, usually yellow vision. Poisoning.—The toxic effects of amyl nitrite include an exceed- ingly rapid and weak heart, final retardation of the pulse, cyanosis of the face, slow and shallow respiration, cold extremities, subnor- mal temperature, great muscular weakness, abolished reflexes, vertigo, intense headache, and disordered vision. Death results from cardiac or respiratory failure. Treatment of Poisoning.—Strychnine and digitalis are required to sustain the heart; ergotin or atropine may be administered sub- cutaneously, together with cold applications to the head, diffusible stimulants, and artificial respiration if necessary. Sodii Nltris—Sodii Nitritis—Sodium Nitrite. XT. 8. P. Origin.—Obtained by heating Sodium Nitrate with Lead, the oxygen from the nitrate being abstracted by the lead oxide formed. Description and Properties.—White, opaque, fused masses, usually in the form of pencils, or colorless, transparent, hexagonal crystals; odorless, and of a mild, saline taste. When exposed to the air the salt deliquesces and is gradually oxidized to sodium nitrate. Soluble in about 1.5 parts of water; slightly soluble in alcohol. It should be kept in well-stoppered bottles. Dose.—2-5 grains (0.12-0.3 Gm.). Spiritus Glonolni—Spiritus Glonolni—Spirit of Glo- noin. U.S. P. (Spirit of Nitroglycerin.) An alcoholic solution of 1 per cent, of nitroglycerin. Origin.—Nitroglycerin is obtained by gradually adding Dehy- drated Glycerin to a mixture of Nitric and strong Sulphuric Acid, the nitroglycerin formed being washed with water and dilute soda solution to remove all acid. Description and Properties.—Nitroglycerin occurs as a clear, colorless liquid possessing the odor and taste of alcohol. It should be tasted and handled with great caution, since it is apt to produce violent headache, whether ingested or applied to the skin. It explodes with great force, and should be kept in a cool place, remote from lights or fire. 526 A TEXT-BOOK OF MATERIA MEDICA. Dose.—1-3 minims (0.06-0.18 Cc.) of the spirit. The actions of sodium nitrite and nitroglycerin are very similar to those of amyl nitrite, although they are less prompt, while more persistent. Nitroglycerin produces a frontal headache of much greater intensity than that caused by amyl nitrite. This is also true of sodium nitrite, though the headache it occasions is less severe than that resulting from nitroglycerin. Both the sodium nitrite and nitroglycerin are preferable to the amyl nitrite for internal administration. Therapeutics.—Externally and Locally.—The nitrites are not used for external purposes. Internally.—The property of amyl nitrite in suddenly lowering arterial pressure and dilating the arterioles renders it of inestima- ble value as a relief for the terrible precordial pain in angina pectoris. Epileptic seizures may often be aborted by the instant inhalation of amyl nitrite upon the first indication of the aura epileptica. The drug has also been successfully employed for the relief of asthma, particularly the uremic form, as well as for cardiac dyspnea and puerperal eclampsia. Like many other motor depressants, it has been used in the treatment of tetanus and strychnine-poisoning. It has proved an efficient preventive for the chill occurring in virulent malarial fever, and has served as a valuable antidote in poisoning from chloroform. The drug is indicated in all conditions of high arterial tension, as in chronic nephritis, etc. It is also beneficial in congestive dys- menorrhea. The sodium nitrite is used for the same purposes as the amyl nitrite, though superior to it for internal administration, as in cases of abnormally high arterial tension. Nitroglycerin is specially adapted for the treatment of cardi- opathies occurring after middle life. The tendency to increase of peripheral resistance in the vessels after adult life is attained renders possible the favorable administration of doses of nitroglycerin intol- erable in early life. The drug is often of marked benefit in the arrhythmia of slightly enlarged and degenerated hearts with arteriosclerosis. It is also of considerable value in relieving the pseudo-anginas which are frequently a feature of vascular disease. It should be given in doses of 2-g-jr to y^j- grain (0.00032-0.0006 Gm.) twice or four times daily. MOTOR DEPRESSANTS. 527 Osier recommends the prolonged administration of nitroglycerin in locomotor ataxia, affirming that it lessens the frequency of the crises and relieves the neuralgic pains. The drug is of use in sciatica, and frequently relieves obstinate hiccough. It has been recommended for the same diseases for which amyl nitrite is used. BROMIDES. Potassii Bromidum—Potassii Bromidi—Potassium Bromide. U. 8. P. Origin.—Prepared by adding Bromine to a solution of Potassa, evaporating to dryness, mixing With Charcoal, heating to redness, dissolving in Water, and crystallizing. Description and Properties.—Colorless or white, cubical crys- tals or granules, odorless, with a pungent, saline taste; permanent in air; soluble in about 1.6 parts of water and in 200 parts of alcohol. Dose.—5-60 grains (0.3-4.0 Gm.). Sodii Bromidum—Sodii Brdmidi—Sodium Bromide. U. 8. P. Origin.—Obtained from a solution of Soda in the same manner as Potassium Bromide. Description and Properties.—Colorless or white, cubical crys- tals, or a white, granular powder, odorless, and with a saline, slightly bitter taste. From air the salt abstracts moisture without deliquescing. Soluble in 1.2 parts of water and in 13 parts of alcohol. It should be kept in well-stoppered bottles. Dose.—10-60 grains (0.6-4.0 Gm.). Ammonii Bromidum—Ammonii Bromidi—Ammo- nium Bromide. U. 8. P. Origin.—Obtained by neutralizing Hydrobromic Acid with Ammonia or Ammonium Carbonate, evaporating, and crystallizing. Description and Properties.—Colorless, transparent, prismatic crystals, or a white, crystalline powder, odorless, and of a pungent, saline taste; permanent in the air. Soluble in 1.5 parts of water and in 30 parts of alcohol. Dose.—5-30 grains (0.3-2.0 Gm.). 528 A TEXT-BOOK OF MA TERIA MEDICA. Lithii Bromidum—Lithii Bromidi—Lithium Bromide. U. 8. P. Origin.—Prepared by a solution of Ferrous Bromide and Lithium Carbonate, the cool liquid being evaporated and crystallized. Description and Properties.—A white, granular salt, odorless, and having a sharp, slightly bitter taste; very deliquescent. Solu- ble in 0.6 part of water and very soluble in alcohol. It should be kept in well-stoppered bottles. Dose.—5-20 grains (0.3-1.2 Gm.). Calcii Bromidum—Calcii Bromidi—Calcium Bro- mide. U. 8. P. Origin.—Prepared by dissolving pure Calcium Carbonate in Hydrobromic Acid and evaporating. Description and Properties.—A white, granular salt, odorless, of a sharp, saline taste and very deliquescent. Soluble in 0.7 part of water and in 1 part of alcohol. It should be kept in well- stoppered bottles. Dose.—10-30 grains (0.6-2.0 Gm.). Zinci Bromidum—Zinci Bromidi—Zinc Bromide. U. 8. P. Origin.—Prepared by digesting Granulated Zinc in Hydrobromic Acid, concentrating the solution, acidulating with Hydrobromic Acid, and drying upon a water-bath. Description and Properties.—A white, granular powder, odor- less, and having a sharp, saline, and metallic taste. Very deliques- cent. Readily soluble in water and alcohol. Dose.—1-5 grains (0.06-0.3 Gm.). Strontii Bromidum—Strontii Bromidi—Strontium Bromide. U. 8. P. Origin.—Obtained by neutralizing Hydrobromic Acid with Strontium Carbonate, filtration, and evaporation. Description and Properties.—Colorless, transparent, hexagonal crystals, odorless, and having a bitter, saline taste. Very deliques- cent. Soluble in 1.05 parts of water and readily soluble in alcohol. Dose.— 5-30 grains (0.3-2.0 Gm.). MOTOR DEPRESSANTS. 529 Acidum Hydrobromicum Dilutum—Acidi Hydro- bromici Diluti — Diluted Hydrobromic Acid. U. 8. P. Origin.—A liquid composed of 10 per cent, by weight of Abso- lute Hydrobromic Acid and 90 per cent, of Water. Description and Properties.—A clear, colorless liquid, odor- less, and having a strongly acid taste. Miscible in all proportions with water and alcohol. It should be kept in glass-stoppered bottles, protected from light. Dose.—20 minims-2 fluidrachms (1.23-7.39 Cc). Bromoformum—Bromoformi—Bromoform (Unofficial). Origin.—Obtained by the action of Bromine upon equal parts of Methylic Alcohol and Caustic Potash. Description and Properties.—A colorless, limpid liquid with an agreeable odor and sweet taste. Insoluble in water, but soluble in alcohol and ether. It should be kept in well-stoppered, dark, amber-colored bottles. Dose.—1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles.—The bromides are antago- nized by the motor excitants and cardiac stimulants. The incom- patibles are acids, acidulous and metallic salts. Spirit of nitrous ether is incompatible with the ammonium bromide. Synergists.—Their action upon the brain is enhanced by opium and the hypnotics, while the cardiac depressants increase their effect upon the circulatory system. Physiological Action.—The action of potassium bromide is here given, that being the type of the group: later the comparative actions of the various members will be considered. Externally and Locally.—Potassium bromide is slightly seda- tive to mucous membranes when applied locally, lessening the reflex irritability, particularly of the pharynx. Internally.—Digestive System.—No effect is produced by mod- erate amounts. Excessive doses have occasioned a sense of cold- ness in the epigastrium, with nausea and looseness of the bowels. Circulatory System.—The bromides depress the circulation,, causing the pulse to become slower, softer, and weaker, and short- ening the systole while prolonging the diastole of the heart. The caliber of the vessels is diminished, although arterial pressure is 34 530 A TEXT-BOOK OF MATERIA MEDICA. lowered. Arterial anemia of the brain is present, owing to the contraction of the blood-vessels and diminished arterial pressure. Toxic doses of potassium bromide cause dilatation of the heart and paralysis in diastole. The exact points where the bromides act to cause this circula- tory depression are undetermined. Nervous System.—When given for a long time or under large dosage the bromides depress the cerebral cells, producing somno- lence, reducing the excitability of the brain, and, if long continued, impairing the memory and intellect. Under their influence there is marked depression of the motor mechanism, resulting in muscular weakness. Every possible point of the apparatus is depressed—the cerebral and spinal motor areas, the spinal motor tracts, the ends of the motor nerves, and even the muscles themselves. Bromides also lessen greatly the reflex excitability of the spinal cord. As in their action upon the motor mechanism, they depress every part of the reflex apparatus—the ends of the afferent and efferent nerves and the reflex center wherever it may be. The sensory mechanism is therefore impaired, causing dimin- ished sensibility of the skin and mucous membranes. The functional activity of the sexual organs is considerably less- ened by these drugs. Respiratory System.—Under full doses the respirations are slower and shallower, owing to depression of the respiratory center, paralysis of which usually causes death, although fatal paralysis may affect the heart because of the poisonous influence of the potassium upon the cardiac muscle. Absorption and Elimination.—The bromides are very rapidly absorbed, having been found in the urine ten minutes after their ingestion (Dujardin-Beaumetz), and are quickly eliminated, chiefly by the kidneys, increasing the flow of urine, and also by the skin, saliva, intestinal and mammary glands, and the bronchial mucous membrane. The sulphur and nitrogen in the urine are increased and the amount of phosphorus decreased. Notwithstanding the rapid elimination of the bromides, under prolonged administration they tend to accumulate in the system, being found abundantly in the nerve-centers. Temperature.—Immoderate doses cause a reduction of temper- ature, due to depression of the circulation and lessening of tissue- change. MOTOR DEPRESSANTS. 531 Eye.—There may occur dilatation of the pupil, conjunctival catarrh, diplopia, amblyopia, dimness of vision, and dilatation of the retinal blood-vessels. Uterus.—A diminution of the catamenia may sometimes be present. Untoivard Action.—The susceptibility of individuals to the un- toward action of the bromides is extremely variable. The symp- toms observed are—gastric uneasiness with eructation, nausea and vomiting, analgesia of the epiglottis and pharynx, bronchial catarrh, hoarseness and cough, acute coryza and conjunctivitis, offensive breath, dysuria, diminished sensibility of the genito-urinary mucous membrane, and a variety of cutaneous eruptions. Poisoning.—Bromism, as the symptoms of poisoning are termed, may be divided into acute and chronic Acute bromism, resulting from a single toxic dose, is manifested by violent frontal headache, great muscular weakness, incoordi- nation of movements, abolition of reflexes, somnolence, slow and shallow breathing, subnormal temperature, lustreless eyes, and very slow and weak pulse, death resulting from either respiratory or cardiac failure. Chronic bromism, caused by prolonged use of the bromides, is characterized by mental apathy, constant drowsiness, hallucination or melancholia, considerable cutaneous anesthesia, muscular weak- ness, poor circulation, cold extremities, marked anemia, impairment of the sexual function, deranged digestion, and cutaneous eruptions of various forms collectively designated as " bromine acne." Treatment of Poisoning. — The drug should be immediately withdrawn and methods adopted to hasten elimination, such as the administration of diuretics, cathartics, etc. Tonics, such as strych- nine, iron, and the cardiac stimulants, should be given, while exer- cise and change of scene may counteract the psychical symptoms. It is claimed that the daily administration of Fowler's solution causes a rapid disappearance of the bromine eruption. Comparative Action of the Bromides.—Potassium bromide contains 66 per cent, of bromine. It is the least hypnotic and most toxic to the heart and muscular system. Sodium bromide, y8 per cent, of bromine, is more hypnotic, but much less toxic, than the potassium salt. Its effect upon the cir- culation is the most pronounced of all the bromides. Ammonium bromide is less toxic and more stimulating than potassium bromide, though resembling it in other respects. 532 A TEXT-BOOK OF MA TERIA MEDICA. Lithium bromide is the richest in bromine, containing 92 per cent., and is probably the most hypnotic of all. Its action more nearly resembles that of the sodium salt. Calcium bromide, while resembling them in its action, is less energetic than the other bromides. Zinc bromide is the most irritant, and is supposed to possess both tonic and sedative properties. Strontium bromide is the mildest of all, being less prone to cause bromism. Diluted hydrobromic acid in its action resembles the bro- mides, though much less depressant than the potassium salt, and less likely to occasion symptoms of chronic poisoning. Therapeutics.—Externally and Locally.—Pharyngitis is relieved by a gargle containing potassium bromide and potassium chlorate. A solution of potassium bromide diminishes the sensibility of the throat, so that examinations are more easily made. A solution of 4 parts of potassium bromide in 20 parts of glycerin affords a soothing lotion in painful hemorrhoids. It is asserted that the powdered salt has been dusted over indolent ulcers with benefit. Internally.—The bromides are especially useful in allaying excessive brain activity, the insomnia (particularly the sleeplessness de- pendent upon nervous excitement, exhaus- tion, and irritability) and headache of cerebral congestion yielding readily to these remedies. They are undoubtedly the most efficient medicinal agents for the relief of epilepsy, being given either alone or in combination with some vegetable bitter. Fere combines with them an intestinal antiseptic, asserting that the union lessens the tendency to bro- mism. Bechterew highly recommends a com- bination of the bromides with Adonis vernalis. Being such marked depressants of the reflex centers, they are of decided benefit in nervous spasmodic disorders, and particu- larly valuable in infantile convulsions. During dentition children suffer from various disturbances due to irritation of the dental nerve—convulsions, cough, indigestion, diarrhea, strabismus, etc.—in all of which the bromides, being Fig. 11. — Diagram showing how irritation of the dental nerve in teething, by stimulating the sensitive reflex mechanism of the infant, may produce strabismus {B), cough (D, K), indigestion (L), diarrhea (M), and convul- sions (jV). MOTOR DEPRESSANTS. 533 powerful depressants of the reflex mechanism, prove of great value. (See Diagram 11.) Whenever there is increased reflex excitability the bromides are indicated. They are therefore valuable in the reflex disturbances of the menopause, spasmodic asthma, laryngismus stridulus, whooping cough, and other coughs of reflex origin. They have also been used in tetanus and strychnine-poisoning. Excessive nervous irritability is quickly relieved by these reme- dies, either singly or in combination with some of the antispas- modics, such as asafetida, valerian, etc. Because they depress the sexual mechanism they are of decided benefit in spermatorrhea of the plethoric or in the condition arising from irritation of the deep urethra. Menorrhagia resulting from excessive ovarian excitement is frequently relieved by these agents, while nymphomania and delirium tremens are often greatly benefited by full doses of the bromides. The ammonium bromide has been employed with benefit, it is said, in diabetes of nervous origin. Cerebral vomiting and the vomiting of pregnancy axe sometimes singularly amenable to the influence of the bromides. The author is quite partial to a combination of sodium bromide, spirit of nitrous ether, and tincture of aconite, in anise water, as a remedy in acute febrile attacks of children with delirium. Small doses are given at frequent intervals until there is a decided im- provement in the symptoms. The bromides are claimed to be of value in acute and muscular rheumatism. The lithium salt is undoubtedly of service in these cases and in the uric-acid diathesis. The sedative action upon the circulatory apparatus exerted by the bromides renders them valuable in cardiac irritability when not due to anemia. They are particularly useful in quieting the heart's action in exophthalmic goiter. Augagneur advises the use of the bromides together with the iodides in the treatment of syphilis, believing that their administra- tion prevents such untoward manifestations as dysphonia, aphonia, or dyspnea in laryngeal syphilis. The strontium bromide is highly recommended in fermentative dyspepsia due to decomposition of food. Bromoform ranks to-day superior to all other remedies in the treatment of whooping cough, an overwhelming amount of authori- tative evidence tending to prove that the drug not only greatly 534 A TEXTBOOK OF MATERIA MEDICA. curtails the duration of the disease, but mitigates the severity of the paroxysms and renders them less frequent. Bromoform has also been highly recommended in acute mania and delirium tremens. Diluted hydrobromic acid is used for the same purposes as the bromides, some clinicians preferring it to the latter to quiet the delirium of simple continued fevers. It is employed extensively to relieve the symptoms of cinchonism. Contraindications.—The bromides are contraindicated in con- ditions of great debility, anemia, or fatty or weak heart with low arterial pressure. Administration.—The bromides should be given in solution, and when long continued, as in the treatment of epilepsy, they should be accompanied by restorative agents. Carbonated waters, milk, and aromatic elixir serve as efficient vehicles to disguise the taste of these salts. Children acquire a remarkable tolerance for the bromides, so that large doses may be given them with but little danger. Bromoform may be dropped into a spoonful of water and ad- ministered in this simple manner, or it may be dissolved in gly- cerin. P. W. Bedford has originated a formula which makes an exceedingly palatable and perfect solution: Bromoformi, TTlxyj (i.o Cc); Alcoholis, Tincturae Cardamomi Compositae, da. f^ij (7.39 Cc.); Glycerini, q. s. ad. oij (60.0 Cc). Each fluidrachm contains 1 minim (0.06 Cc.) of bromoform. The diluted hydrobromic acid should be given in water or syrup. GROUP VIII.—CARDIAC STIMULANTS.1 Cardiac remedies may be divided into Cardiac Tonics, Cardiac Stimulants, and Cardiac Sedatives or Depressants. The grouping is a rational one, both from a clinical and a physiological point of view, although the Cardiac Sedatives are at present much more 1 The author is indebted to Joseph M. Patton, M. D., Professor of Medicine in the Chicago Policlinic, for valuable assistance in preparing the present group, his observa- tions on therapeutics being occasionally cited verbatim. CARDIAC STIMULANTS. 535 limited in their clinical application than they were a few years ago, being used principally in sthenic fevers with excessive cardiac action. Cardiac Tonics.—By these are implied those drugs which add tone to the cardiac muscle and the nervous mechanism of the heart, increasing the nutrition of that muscle, and consequently augment- ing its capacity for work. The cardiac tonics have little or no effect upon the dynamic force exerted through the contraction of the heart-muscle, herein lying their essential distinction from cardiac stimulants, which affect per se the muscular contractile force. The proper period for the employment of cardiac tonics antici- pates that where the exhibition of cardiac stimulants becomes neces- sary. They are, moreover, prophylactic against the latter contin- gency, preventing the development of a hyposystolic condition of the heart. They are also indicated subsequent to the temporary use of cardiac stimulants to improve the nutrition of the heart and maintain the beneficial results of stimulation. Cardiac tonics should be given in small doses and the adminis- tration prolonged. The principal members of the group are—strychnine, the iodides, arsenic, and iron, to which should be added mercury in small doses. The most useful are strychnine and the iodides, and they are well adapted for combined administration. Since most cases requiring the exhibition of this class of remedies occur after middle life, they are especially benefited by the action of strychnine on the cardiac nervous system and the increased nutrition to the heart-muscle through the effect of the iodides on the smaller vessels. The progressive tendency of after- lifetime toward loss of elasticity and a contraction of the smaller arteries is opposed by the action of the iodides in dilating these vessels. The advantage of prolonged administration of mercury in small doses in chronic cardiopathies during or after middle life is probably due to the stimulating effect of the drug on the func- tions of elimination. Mercury is adapted to nearly all senile cardiopathies, particu- larly in conditions of general vascular sclerosis, the most desirable form being the bichloride or red iodide in doses of -fa grain (0.001 Gm.) three times daily. Arsenic may be used in the form of the arsenic iodide or as 536 A TEXT-BOOK OF MA TERIA MEDICA. Fowler's solution. It is of special value in anemic conditions associated with cardiopathies in young persons. The most eligible form of iron for cardiac patients, especially after middle life, when elimination is an important consideration, is the liq. ferri et ammonii acetatis (Basham's mixture), or the so-called tasteless tincture of iron, with which the tincture of nux vomica may be well combined. The physiological action and further medical uses of these cardiac tonics are more fully described under their respective heads. Cardiac Stimulants.—As cardiac stimulants are designated those drugs endued with the specific property of lengthening and invigorating the contraction of the cardiac muscle. This effect would necessarily be more or less temporary, and, while some permanent benefit may be derived from improved nutrition result- ing from a better blood-supply afforded by these agents, they are adapted only for passing administration and are not true cardiac tonics. The general indication for the employment of this class of remedies rests in the presence of dynamic insufficiency of the muscle, which may be either actual or relative, as is the case of increased peripheral resistance to the blood-current. In the latter instance it is evident that the extracardiac obstruction must be removed before the salutary effects of cardiac stimulants can be obtained. It is in actual failure of the contractile force of the cardiac muscle that these stimulants display their most beneficial influence. This failure is due to a greater quantity of blood in the cavity than the muscle is able to cope with. The amount of dynamic force required at each contraction to expel this quantity is so great that the muscle is unable to withstand the pressure without stretching, and consequently dilatation is developed. Here the favorable action of cardiac stimulants is manifest, since by stimulating the muscle to more vigorous contraction the equilibrium of the circu- lation is maintained until compensatory increase in muscular power has had time to develop. The principal cardiac stimulants are—Digitalis, Strophan- tus, Caffeine, Alcohol, Ammonia, Spartein, Cactus grandi- flora, Adonis vernalis, and Convallaria, all fully described under their respective heads. In addition to these, strychnine, opium, and nitroglycerin are CARDIAC STIMULANTS. 537 sometimes used as cardiac stimulants. They are fully described under their respective heads. Digitalis is the typical medicament of the group, after many years still retaining its place as the most trustworthy and generally useful cardiac stimulant. Digitalis— Digitalis— Digitalis. U. 8. P. (Fox-glove.) Origin.—The leaves of Digitalis purpurea L., collected from plants of the second year's growth. The plant is a biennial, 2-5 feet (0.6-1.5 M.) high, indigenous in Southern and Central Europe, and growing wild as far north as Norway. It is also found in Madeira and the Azores, and is well known everywhere as an ornamental garden plant. Description and Properties.—From 4 to 12 inches (10-30 Cm.) long, ovate or ovate-oblong, narrowed, with a petiole, crenate, dull green, densely and finely pubescent, wrinkled above, paler and reticulate beneath, midrib broad near the base; odor slight, some- what tea-like; taste bitter, nauseous. The leaves of mullein, Inula coryza and Inula helenium, are sometimes mixed with those of fox-glove. It is yet undecided what the chief constituents are. Five prin- ciples, however, have been isolated, neither of which represents the crude drug. They are—digitalin (soluble in alcohol, insoluble in water); digitalein (soluble in water and alcohol); digitonin, the most active diuretic principle (soluble in water, insoluble in alcohol); digitin, an inert substance; and digitoxin, the most active con- stituent (insoluble in water and sparingly soluble in alcohol). All save digitoxin are glucosids. Dose.—\-2 grains (0.03-0.12 Gm.). Official Preparations. Extractum Digitalis—Extracti Digitalis—Extract of Digitalis.—Dose, \-\ grain (0.01-0.03 Gm.). Extractum Digitalis Fluidum—Extracti Digitalis Fluidi—Fluid Extract of Digitalis.—Dose, lA-2 minims (0.03-0.12 Cc). Infusum Digitalis—Infiisi Digitalis—Infusion of Digitalis (i}4 per cent.).— Dose, 1-4 fluidrachms (37-15 Cc). Tinctura Digitalis—Tincturae Digitalis—Tincture of Digitalis (15 per cent.). —Dose, 5-20 minims (0.3-1.2 Cc). Unofficial Preparations. Digitalinum—Digitalini—Digitalin.—Description and Properties.—An amor- phous, yellowish-white, crystalline powder or scales, or light, white crystalline tufts of 538 A TEXT-BOOK OF MA TERIA MEDICA. needles, odorless and of an intensely bitter taste. Insoluble in water, soluble ir» alcohol. Dose.—T$ff—jV grain (0.0006-0.002 Gm.). DigitSxin—Digit6xin—Digitoxin.—Description and Properties.—A white, crys- talline body, of a bitter taste ; insoluble in water, soluble in chloroform. Dose.—^ff-Ttftw, 1 to 6 troches. Oleum Cubebae—Olei Cubebae—Oil of Cubeb. U. 8. P. Origin.—A volatile oil distilled from Cubeb. Description and Properties.—A colorless, pale-greenish, or yellowish liquid, having the characteristic odor of cubeb and a warm, camphoraceous, aromatic taste. Soluble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—5-15 minims (0.3-1.0 Cc). Antagonists and Incompatibles.—The motor depressants and cardiac stimulants antagonize the action of cubeb. Synergists.—Buchu, copaiba, oil of santal, black pepper, and many of the aromatics and volatile oils. Physiological Action.—Externally and Locally.—-Like the aromatics and drugs containing a volatile oil, cubeb is irritant and rubefacient when applied by inunction. 650 A TEXT-BOOK OF MA TERIA MEDICA. Internally.—Digestive System.—In medicinal amounts cubeb is an aromatic stomachic, increasing the appetite and improving digestion. As is the case with other drugs of this class, large dos- age or the too prolonged use of small amounts irritates the stomach and deranges digestion, cubeb acting as a laxative and occasioning a sensation of heat and discomfort about the rectum. Circulatory System.—Like other members of the Pepper family, cubeb enters the blood with facility, and increases the force and frequency of the heart's action. Nervous System.—No important action has been noted. Respiratory System.—There is no perceptible effect when the drug is given in medicinal doses. Absorption and Elimination.—Cubeb is absorbed and eliminated with considerable rapidity. It escapes from the system chiefly by the urine, though the skin and bronchial mucous membrane share in the excretory process. The drug acts as an active stimulant and disinfectant to the structures by which it is excreted, and is consequently a diuretic expectorant and mild diaphoretic The urine and the amount of uric acid are increased by cubeb, the drug appearing in the urine as a salt of cubebic acid, which may be precipitated by nitric acid, the precipitate resembling that of albumin. Untoward Action.—Cubeb occasionally produces great disturb- ance in the gastro-intestinal tract, colicky pains, and diarrhea. The most frequent untoward manifestations, however, are various cutaneous eruptions, appearing in the form of papules, and often- times as a diffuse erythema. No febrile symptoms attend these eruptions, which usually disappear shortly after the suspension of the drug. Poisoning.—Although cubeb is not regarded as a poison, very large doses may be followed by all the symptoms of severe gastro- intestinal irritation. Treatment of Poisoning.—The indications are to empty the stomach, favor elimination, and treat the patient symptomatically by the use of demulcents, anodynes, stimulants, etc., as necessary. Therapeutics.—Externally and Locally.—The drug is a de- servedly popular remedy in many diseases of the nose and throat. The insufflation of an impalpable powder of cubeb or the inhala- tion of smoke from the burning drug is an efficient palliative to the sense of oppression arising from turgescence of the nasal mucous membrane. DIURETICS. 651 The troches of cubeb are extensively used for coughs, hoarse- ness etc. The oil of cubeb is used as an inhalant and as a local application in many diseases of the throat and respiratory passages. Internally.—Cubeb is used internally for about the same pur- poses as copaiba, although by many physicians considered to be inferior to the latter drug in genito-urinary disorders. The drug has been recommended in certain nervous disorders, such as headache, impaired memory, vertigo, and fainting, and has even been thought to prove beneficial in certain cases of paralysis. Contraindications.—The same as for copaiba. Administration.—Any of the preparations may be given. The oleoresin is best administered in capsules or emulsion. Diuretin—Diuretin—Diuretin. (SODIO-SALICYLATE OF THEOBROMINE.) Origin.—The name indicates the origin, the drug being a chemi- cal combination of Theobromine (49.7 per cent.) and Salicylic Acid (38.1 per cent.). It is, in reality, a definite double compound of Sodium Theobromine and Sodium Salicylate. Description and Properties.—A white powder, soluble in less than half its weight of hot water, the solution remaining perfect on cooling. Sparingly soluble in cold water; soluble in warm alco- hol ; insoluble in chloroform or ether. The drug has a disagree- able, soap-like taste, and undergoes decomposition when exposed to the air. Dose.—15 grains (1.0 Gm.); 45 to 105 grains (2.9-7.0 Gm.) may be given in divided portions in twenty-four hours. Antagonists and Incompatibles.—The properties of diuretin being as yet imperfectly known, it is impossible to enumerate all the antagonists, incompatibles, and synergists. The action of the drug would certainly be retarded by the cardiac and motor de- pressants. Acids, both mineral and vegetable, are incompatible. Synergists.—The therapeutic influence of the drug would theoretically be enhanced by caffeine, digitalis, and many of the cardiac stimulants and diuretics. Physiological Action.—Externally and Locally.—There is none. Internally.—Digestive System.—Diuretin has no important ac- tion, though in many cases it may cause disturbance of digestion, impair the appetite, and even occasion nausea, vomiting, and diarrhea. . . Circulatory System.—-There is some difference of opinion regard- 652 A TEXT-BOOK OF MATERIA MEDICA. ing the effect of diuretin upon the heart and blood-vessels. Pa- winski concluded, from a study of over 50 cases, that the drug does not regulate the heart's action through any influence on the nerves of that organ, its effect upon it being due entirely to the action of diuretin in diminishing the edema by its diuretic property, thereby removing the obstacles to be overcome by the heart. This view is entertained by Cohnstein, Gram, and Schroeder, and, to judge from a few careful experiments, the author is of the same opinion. On the other hand, authorities so eminent as Pfeffer, Kress, Hoffman, Geissler, Babcock, and Herrick believe that the drug strengthens the heart's action after the manner of digitalis. Nervous System.—Large and continued doses frequently occa- sion headache, somnolence or insomnia, with buzzing in the ears, and symptoms resembling those produced by the salicylates. Respiratory System.—Diuretin exerts no direct influence upon the respiratory system. Yet dyspnea, bronchitis, etc., the result of a dropsical condition, are relieved by the administration of the drug. Absorption and Elimination.—Diuretin is somewhat rapidly ab- sorbed, being eliminated mainly by the kidneys, the process greatly stimulating the renal epithelium. It is proper to state, however, that some authors attribute the diuretic power of the drug to its action upon the circulation, rather than to any effect upon the secreting structures of the kidney. The author's experience leads him to incline to the opinion that the principal action of the drug is upon the kidneys. In cases where diuretin is indicated the amount of urine is increased from three- to sixfold in twenty-four hours, under its administration the diuretic action of the drug gradually reaching its maximum between the second and third days. In the case of healthy persons diuretin has little influence upon the amount of urine excreted. Untoward Action.—In certain individuals the drug causes great disturbance of the gastro-intestinal tract, such as nausea, vomiting, diarrhea, palpitation of the heart, headache, and slight fever; occa- sionally cutaneous eruptions may be present. Poisoning.—No cases of poisoning are recorded. Therapeutics.—The drug is used exclusively as a diuretic in cases of dropsy, ascites, pleuritic effusion, etc. Diuretin is worthy of a thorough trial for the removal of drop- sical fluids, irrespective of the cause. DIURETICS. 653 Dr. Herrick of Chicago, who has not only devoted much study to the literature of the subject, but has also had a wide experience with the remedy, in a recent paper on " Diuretin " sums up the medical uses of the drug as follows: " Diuretin is a diuretic acting by direct stimulation of the renal epithelium, and best suited to cases in which there is general drop- sical effusion. It is the best medicinal remedy for removing drop- sical fluid due to valvular disease of the heart after digitalis and pure cardiac tonics have failed. Diuretin has oftentimes a bene- ficial effect in other circulatory diseases with dropsy, as myocarditis, pericarditis, aneurysm, arteriosclerosis. Its action is here more uncertain than in valvular disease. In the dropsy of nephritis it can be used without danger of irritating the kidney, the effects in acute nephritis being more certain than in chronic nephritis. Where the renal epithelium has undergone too extensive degeneration the drug may fail to act. In the dropsy of portal obstruction, and especially of cirrhosis of the liver, it usually fails to give good results." Contraindications.—There are no special contraindications to the use of diuretin, unless it be in cases of marked gastric irritation, when the drug would undoubtedly aggravate the symptoms. Administration.—Diuretin may be given in capsules or dis- solved in some aromatic water or in milk. It should never be dispensed in powders, since it absorbs carbonic acid from the air and undergoes decomposition. It is preferable to give the drug in solution; and it can be easily associated with digitalis and similar remedies, but when used with the cardiac remedies the doses of diuretin should be smaller. When giving this drug in cases of marked ascites, or for the removal of large quantities of dropsical fluid, the first doses should be small and gradually increased to the maximum amount or until the desired effect be produced, lest by a too sudden removal of the fluid alarming collapse ensue. As acids are incompatible with the drug, diuretin should not be given immediately after meals, but its administration postponed for about three hours, to avoid unpleasant symptoms arising from the action of the gastric juice upon the remedy. The practice of adding fruit syrups or juices to a solution of diuretin for the purpose of rendering it more palatable should be strictly avoided, since the theobromine is precipitated by the vege- table acids as a thick white sediment. 654 A TEXT-BOOK OF MATERIA MEDICA. The maximum daily amount which can be safely administered is 150 grains (9.72 Gm.). The average daily amount is 45 to 105 grains (2.9-7.0 Gm.), given in divided doses of about 15 grains (1.0 Gm.) each. If diuresis is not increased in six days, the use of the drug should be suspended and recourse to other treatment adopted. Piperazlnum—Piperazlni—Piperazin. (PlPERAZIDINE; ETHYLENEIMINE; DlETHYLENEDIAMINE; DlSPERMINE.) Origin.—Obtained by the action of Ammonia on Bromide or Chloride of Ethylene. Description and Properties.—It occurs as a crystalline solid, exceedingly soluble in water, the solution being practically taste- less. When exposed to the air the drug is very deliquescent, becoming completely liquefied on long exposure. Dose.—5-15 grains (0.3-1.o Gm.). Antagonists and Incompatibles.—The incompatibles are alka- loids, tannic acid, preparations of cinchona, salts of iron, alum, Donovan's solution, acetanilid, phenacetine, and sodium salicylate. Synergists.—Lithium and its salts and the lithontriptics enhance the therapeutic action of piperazin. Physiological Action and Therapeutics.—The drug apparently has no effect whatever upon either the Digestive, Circulatory, or Respiratory Systems. Excessive doses, however, have affected the Nervous System, producing certain untoward manifestations, such as muscular tremors, hallucinations, and clonic spasms. The drug is non-irritating when applied to mucous membranes. Piperazin is rapidly absorbed from the stomach, circulates in the blood unchanged, and reaches the concretions of urates and gouty deposits, neutralizing and dissolving them, thus hastening their removal from the body. Piperazin may be detected in the urine two hours after ingestion. The only important action of piperazin is its property of dis- solving uric acid, with which it forms a neutral and exceedingly soluble salt, piperazin urate, said to be seven times more soluble in water than lithium urate. The superiority of piperazin over lithium carbonate as a uric- acid solvent has been indubitably established. Under the administration of piperazin there is an enormous in- crease in the amount of urea, with a corresponding decrease in the elimination of uric acid, indicating that there is active oxidation. DIURETICS. 655 While greatly increasing the amount of urea eliminated, neither the volume of urine nor the acid reaction of that fluid is ordinarily influenced. Moreover, while in certain cases diuresis is consider- ably augmented, the specific gravity of the urine is lowered, al- though the urine never becomes alkaline or even neutral. Therapeutics.—Externally and Locally.—A solution of pipera- zin (1 to 2 per cent.) in a mixture of water and alcohol (1 to 4, re- spectively) has been applied locally to gouty joints and swellings with beneficial results. A similar solution is equally effective in relieving the pain, allaying the inflammation, and hastening the healing of gouty sores. Solutions of piperazin may be injected into the bladder in order to dissolve vesical calculi. The drug has been recommended for local hypodermic injection in gout, although Wittsock, who used it in this manner consider- ably, claims that the subcutaneous administration of piperazin is painful and dangerous, causing inflammation with tendency to abscess. Internally.—Piperazin is one of the most useful remedies in gout. Its efficacy in this disease is said to be enhanced by combining with it phenocoll hydrochloride or phenacetin. Renal and vesical calculi of the uric-acid variety are dissolved by the free administration of piperazin. It has even proved bene- ficial in chronic cystitis and chronic rheumatic arthritis. Gruber has advocated the use of the drug in diabetes mellitus, and it has proved to be of service in renal colic and hematuria. It is in the uric-acid diathesis, however, that the drug is par- ticularly useful. The pruritus of this condition and other manifes- tations so frequently resulting from imperfect elimination of nitrog- enous material are promptly relieved by the internal administra- tion of this remedy. Contraindications.—None of importance can be named. Administration.—Piperazin is best given in aerated water, al- though it may be acceptably administered in distilled water and syrup, orange flower water, or other agreeable vehicle. Saccharin um—Saccharin i—Sacchari n. (Anhydro-ortho-sulphamin-benzoic Acid; Benzoyl-sulphonic-imide; Gluside; Glucusimide.) Origin.__A derivative of the aromatic series, prepared by a complicated process from Toluene. 656 A TEXT-BOOK OF MA TERIA MEDICA. Description and Properties.—A white, crystalline powder, of an acid reaction, a faint, amygdaloid odor, and an intensely sweet taste. One part of saccharin in 70,000 parts of water will impart to the solution a decidedly saccharine flavor, the drug being nearly 300 times sweeter than cane-sugar. Saccharin is slightly soluble in water, 1 :400; soluble in 30 parts of alcohol; and freely soluble in glycerin. The commercial article is usually very impure. Dose.—\-2 grains (0.03-0.12 Gm.). Physiological Action.—In a neutral or alkaline medium sac- charin acts as an antiseptic. Internally it exerts no notable influ- ence. It is said that when mixed with food it interferes with the action of saliva upon starch, and it is thought to retard the action of the other digestive ferments. The drug is not decomposed in the body, and is eliminated by the kidneys unchanged, increasing the amount of chlorides excreted in the urine, which fluid is so influenced by the drug that it does not so readily undergo fer- mentation. Therapeutics.—Externally and Locally.—Saccharin is used as a mouth-wash, being especially beneficial in aphtha. Felici of Rome highly recommends the application of a solution of saccharin in ozena. Internally.—The principal use of the drug is as a substitute for sugar in cases of diabetes. Dr. James Little recommends saccharin in chronic cystitis with ammoniacal urine. The drug is extensively used in various elixirs, syrups, etc. to overcome the bitterness of quinine and other bitter alkaloids. Administration.—Saccharin should be given in solution. GROUP XIV.—CATHARTICS. Cathartics or Purgatives are substances which produce in- testinal evacuations—either (1) by increasing peristalsis, (2) by augmenting secretion, or (3) by diminishing absorption. Physiological Action.—In order to produce evacuations from the bowels drugs act (1) locally— (a) Upon the muscles and glands of the intestines; (b) Auerbach's and Meissner's ganglia; (c) Ends of the afferent nerves in mucous membranes of the CATHARTICS. 657 intestines, passing respectively to Auerbach's and Meiss- ner's ganglia; {d) Ends of local efferent nerves, passing from Auerbach's and Meissner's ganglia to the intestinal muscles and glands. (2) They act through the coordinating* mechanism— (a) By acting upon the peripheral endings of the afferent nerves which pass from the intestinal mucous membrane to the six intestinal centers in the brain; (b) Upon the six centers in the brain; (c) Upon the six sets of efferent nerves which pass from the six centers in the brain through the various abdominal ganglia to the intestine, terminating in Auerbach's and Meissner's ganglia in the walls of the arterioles; (d) Probably by acting upon certain abdominal ganglia, such as the suprarenal and mesenteric plexuses and similar ganglia. Intestinal peristalsis may be increased by stimulation of— 1. The intestinal muscles (moderate stimulation); 2. The afferent nerves connecting the intestinal mucous mem- brane with Auerbach's ganglia; 3. Auerbach's ganglia; 4. The ends of the efferent nerves passing from Auerbach's ganglia to the intestinal muscles; 5. The ends of the afferent nerves passing from the intestinal mucous membrane to the brain; 6. The motor centers in the brain ; 7. The ends of the motor nerves terminating in Auerbach's ganglia. Depression of— 8. The inhibitory motor center; 9. The ends of the inhibitory motor nerves terminating in Auerbach's ganglia; 10. The inhibitory motor center in the suprarenal plexus. It will be seen that any substance which stimulates the motor apparatus or depresses the inhibitory motor mechanism will increase peristalsis. Intestinal secretion may be promoted by stimulation of— 1. The secretory cells; 2. The ends of the afferent nerves passing from the intes- tinal mucous membrane to Meissner's plexus; 42 658 A TEXT-BOOK OF MATERIA MEDICA. 3. Meissner's ganglia; 4. The ends of the efferent nerves passing from Meissner's ganglia to the intestinal glands; 5. The ends of afferent nerves in the intestinal mucous membrane which pass from the secretory center in the brain; 6. The secretory center in the brain ; 7. The ends of the secretory fibers from the brain terminat- ing in Meissner's ganglia. Depression of— 8. The inhibitory secretory center in the brain; 9. The ends of the inhibitory secretory fibers from the brain terminating in Meissner's plexus ; 10. The inhibitory secretory center in the superior mesenteric plexus ; 11. The afferent nerves in the intestinal mucous membrane which pass to the vaso-constrictor center in the brain; 12. The vaso-constrictor center in the brain; 13. The ends of the vaso-constrictor nerves from the brain terminating in the ganglia in the walls of the arterioles. Similar actions upon the vaso-dilator apparatus would affect intestinal secretion. It is obvious that intestinal secretion may be promoted by any substance which serves to stimulate the secretory or the vaso- dilator apparatus, or to depress the inhibitory secretory or vaso- constrictor mechanism. The methods by which absorption is diminished are not thor- oughly understood, but it is known that— 1. By increasing peristalsis and hastening the removal of fluid from the bowels absorption takes place less rapidly; 2. By giving drugs—e. g. magnesium sulphate—having high osmotic equivalents, with a great affinity for water, the absorption of fluid is prevented; 3. Substances which in some manner affect the columnar epithelium of the intestinal glands retard absorption; 4. Drugs which diminish the circulation in the intestinal mucous membranes act as deterrents to the absorptive process. Cathartics may be classified according to their various actions, the following table serving to show how and where the various drugs exert their several influences: CATHARTICS. 659 /. Classification according to their Mode of Laxatives. Cassia. Castor oil. Cascara sagrada. * Glycerin. * Magnesia. * Magnesium carbonate. Manna. Sulphur. Taraxacum. There are certain drugs which are not classed as cathartics, which are some- times prescribed by physi- cians as laxatives, such as— Belladonna.* Ergot* Hyoscyamus* Nux vomica.* Physostigma* Stramonium.* Certain articles of diet are laxative, such as bran bis- cuit, brown bread, ginger- bread, oatmeal, figs, honey, molasses, prunes, raspber- ries, strawberries, tama- rinds, olive oil, etc. Action. Simple purgatives. Hydragogue purgatives. Drastic purgatives. Aloes. Croton oil (small Cathartic acid (hy Calomel.* doses). podermically). Cascara sagrada Elaterin. Colocynth. (full doses). Gamboge. Croton oil. Castor oil (full Elaterin. doses). Salines. Gamboge. Ox-gall. Magnesium citrate. Jalap. Rhubarb. Magnesium sulphate. Scammony. Euonymus. Potassium bitartrate.* Podophyllin Iris. Potassium sulphate. Juglans. Potassium tartrate.* Leptandra. Potassium and sodium Senna. tartrate. Sodium phosphate. Sodium sulphate. 2. Classification accoi'ding to their Manner of reaching the Intestinal Mechanism. By first contact. Nearly all the drugs used as cathartics. By circulation contact. Belladonna.* Morphine.* Muscarine.* Physostigma.* Pilocarpine.* Strychnine.* By excretion contact. Aloes. Castor oil. Croton oil. Colocynth. Elaterium. Podophyllin. Rhubarb. Senna. j. Conditions of the Intestines affecting the Action of Drugs. Drugs requiring the presence of an alkali or bile to act. Aloes. Elaterium. Gamboge. Jalap. Drugs requiring the presence of an acid to act. Magnesium carbonate.* Magnesia.* Drugs not requiring the presence of either alkali, bile, or acid. Castor oil. Colocynth. Croton oil. Euonymin. (Drugs marked with an asterisk (*) are here given in detail; others are described elsewhere.) 66o A TEXT-BOOK OF MATERIA MEDICA. Drugs requiring the presence of an alkali or bile to act. Scammony. Sulphur. Drugs not requiring the presence of either alkali, bile, or acid. Iris. Leptandra. Magnesium citrate. Magnesium sulphate. Podophyllin. Potassium and sodium tar- trate. Rhubarb. Senna. Sodium phosphate. ^. Classification according to the Anatomical Portion of the Intestinal Canal on which they Act. Small intestine. Colon. Calomel.* Colocynth. Castor oil. Croton oil. Jalap. Elaterium. Leptandra. Gamboge. Podophyllin. Magnesium citrate. Rhubarb. Magnesium sulphate. Scammony. Potassium bitartrate.* Senna. Potassium sulphate. Potassium tartrate.* Potassium and sodium tartrate. Sodium sulphate. Descending colon and rectum. Aloes. 5. Classification of Cathartics according to Other Actions. Stomachics. Hepatic stimulants and cholagogues Galactagogues. Rendering the milk purgative. Increasing menstrual flow. Aloes. Aloes. Castor oil. Aloes. Aloes. Cascara sagrada. Colocynth. Castor oil. Euonymin. Colchicin. Rhubarb. Leptandrin. Iridin. Euonymin. Iridin. Senna. There are Rhubarb. Leptandrin. Podophyllin. Sodium phosphate. Sodium sulphate. Cholagogues. probably some other cathartics that affect the milk. Aloes. Mercury with chalk* Calomel.* Pil. hydrargyri.* Colocynth. Podophyllin. Euonymin. Rhubarb. Iridin. (Drugs marked with an asterisk (*) are here given in detail; others are described elsewhere.) CATHARTICS. 66l It is apparent that certain drugs produce various effects, and that their mode of action varies according to the size of the dose and occasionally with the idiosyncrasy of the patient. Nearly all cathartic drugs act by some local influence upon the intestinal mucous membranes previous to absorption ; others, again, affect the bowels after they have entered the circulation—strych- nine, for example, physostigmine, pilocarpine, etc., acting in this manner. Certain other drugs, such as podophyllin, colocynth, etc., if in- jected into the circulation are excreted by the mucous membrane of the intestines, and by their irritation produce catharsis. The condition of the intestinal canal has much to do with the activity of certain drugs. Thus certain medicines produce cathar- sis regardless of the reaction of intestinal fluids; others are inert without the presence of bile or other alkaline fluids or salts; and still a third class occasion catharsis only when after ingestion they come in contact with an acid. Of the last mentioned, magnesium carbonate is an excellent example, the drug being inert unless it be acted upon by an acid in the stomach or bowels. It is a remarkable fact that, as is shown in the tables, different cathartics act more energetically upon different portions of the in- testines. The action of calomel, for instance, is almost entirely confined to the duodenum, while aloes acts only upon the descend- ing colon and the rectum. In selecting a cathartic, therefore, a knowledge of the part of the intestinal canal to be acted upon and the locality in which the drug operates is necessary in order to secure the most satisfactory results. Many cathartics contain principles which render them tonic to the stomach; others greatly stimulate the secretion of bile (hepatic stimulants); while the cholagogues merely hasten the expulsion of bile from the intestinal canal, preventing its absorption. Certain drugs, being excreted in the milk, which it renders purgative, are well adapted for administration to the nursing mother in order to produce catharsis in the infant. Castor oil, greatly augmenting the secretion of milk, is an excellent medium as a laxative in such cases. Aloes increases the menstrual flow; other drugs promote the secretion of urine, etc. Therapeutics.—Cathartics are employed— I To remove feces and produce a simple evacuation of the bowels. The Laxatives are best adapted for this purpose. 662 A TEXT-BOOK OF MA TERIA MEDICA. 2. For the relief of chronic constipation. For this purpose great judgment is requisite in the selection of a drug or combination of agents, it being important to determine whether there is diminished peristalsis or secretion ; whether there exists an atonic condition of the intestinal muscles; or whether the disorder is located in the small intestine, the colon, or the rectum. 3. To remove from the bowels noxious substances or pathogenic matter. For this purpose the mercurial preparations, calomel or gray powder, are best, since they are not only active cathartics, but bactericides as well. 4. To stimulate the torpid liver. For this purpose the hepatic stimulants would naturally be employed. 5. To lessen the activity of the liver, as in bilious conditions. In such cases the cholagogue cathartics should be used. 6. To deplete the gastro-duodenal mucous membrane, where the congested and swollen mucous membrane obstructs the outflow of bile, resulting in jaundice. In this condition the salines, especially the sodium salts, are the most efficient cathartics. 7. To promote absorption and remove dropsical effusions in cer- tain diseases of the heart, liver, and kidneys. Here active cathar- sis is necessary, the hydragogue cathartics being indicated. 8. To remove urea, etc., from the blood. Occasionally in certain renal diseases the functional activity of the kidneys is so defective that waste matter, urea, etc., rapidly accumulates in the system, occasioning uremic convulsions, coma, or other serious symptoms. In such cases it may be necessary to give a drastic purgative, such as croton oil, which acts rapidly, causing profuse watery stools. 9. To lower the blood-pressure where high arterial tension aggra- vates a malady, as at the onset of many acute diseases, and in cerebral hemorrhage, meningitis, etc. In these conditions it is necessary to employ such drugs as, by dilating the intestinal blood- vessels, drain the blood away from other organs and cause abun- dant watery discharges from the bowels. Hydragogue or drastic purgatives answer the required purpose. 10. For the relief of hemorrhoids, in which cases the mild laxa- tives, such as sulphur, senna, etc., are serviceable. 11. To aid the restoration of the catamenia. For this purpose aloes is usually employed, particularly if it be necessary to deter- mine more blood to the pelvic organs. If depletion be required, the selection should be made from the hydragogue cathartics. 12. To purge the nursing infant through the mother's milk. For CATHARTICS. 663 this purpose such drugs as rhubarb, senna, and castor oil may be administered to the mother. 13. To lower the temperature in fever, in which cases the saline cathartics may be advantageously employed. Contraindications.—Active catharsis by the more powerful hydragogue or drastic purgatives would be contraindicated in ap- pendicitis, peritonitis, typhlitis, intussusception, pregnancy, and typhoid fever, or where there is inflammation of the mucous mem- brane of the gastro-intestinal tract. Administration.—Probably no group of medicines defnands greater judgment in administration than Cathartics. Ordinarily, the efficiency of these agents is increased and their operation rendered less irritant by associating drugs acting upon different portions of the alimentary canal. Their action, too, is more prompt and certain when the remedies are given upon an empty stomach and the efficiency of their operation is enhanced by exercise and diminished by sleep. The action of cathartics is promoted by the addition of small doses of emetics, mydriatics, quinine, and bitters, quinine especially strengthening the action of magnesium sulphate. Mild diluent beverages also promote the activity of cathartics. Cold applied to the abdomen, enemata, massage of the abdominal walls, and electricity, all act as adjuvant measures in the employment of purgative medicines. As has been previously suggested, a knowledge of the portion of the intestinal canal upon which the various cathartics act is of primary importance. Thus, if it be necessary to influence only the duodenum, calomel or podophyllin should be used; if the small intestine, senna or jalap ; if the descending colon or rectum, aloes,—the drugs acting upon these organs alone. Moreover, due consideration should be given to the proper time for the administration of the different cathartics, the resinoid pur- gatives acting best when taken at night or before dinner, and the salines when taken in the morning before breakfast. The mode of administration is also of great importance, in order to obtain from these agents the fullest benefit. The salines, for instance, act best when given in solution in either very cold or very hot water, their activity being enhanced by association with bitters, iron, or sulphuric acid. On the other hand, the resinoid druo-s should be administered in the form of pills, and if, for any reason it is desirable that the drug should enter the intestine with- 664 A TEXT-BOOK OF MATERIA MEDICA. out coming in contact with the mucous membrane of the stomach, the drug may be given in the form of pills coated with keratin, which is unaffected by the gastric juice, but readily dissolved in the alkaline intestinal juices. In the following detailed description cathartic drugs are grouped according to their modus operandi, the mildest drugs or laxatives being first considered. LAXATIVES. Certain substances never produce active purgation, but simply unload the bowels by slightly increasing both peristalsis and secre- tion, expelling the feces in a softened though solid and formed condition, without irritation and without perceptibly affecting the general system. These agents are especially useful where we wish to evacuate the bowels with the least possible local derangement, as in simple constipation from dyspepsia, in children, pregnant women, con- valescents from acute disease, or patients affected with hemorrhoids, hernia, affections of the rectum or womb, typhoid fever, early simple diarrhea, or in inflammation or surgical operations about the abdomen and pelvis. Besides the laxative drugs mentioned below there are many articles of diet which by purely mechanical action produce catharsis, such as oatmeal, brown bread, whole flour, molasses, prunes, figs, etc. Cassia Fistula—Cassiae Flstulae—Cassia Fistula. U. 8. P. (Purging Cassia.) Origin.—The fruit of Cassia Fistula L., a tree 30 to 50 feet (9-15 M.) high, indigenous in the East Indies. Description and Properties.—Cylindrical, 1 \ to 2 feet (45-60 Cm.) long, nearly 1 inch (25 Mm.) in diameter, blackish-brown, somewhat veined, the sutures smooth, forming two longitudinal bands; indehiscent, internally divided transversely into numerous cells, each containing a reddish-brown, glossy, flattish-ovate seed imbedded in a blackish-brown sweet pulp; odor resembling that of prunes. Dose.—1-2 drachms (4.0-8.0 Gm.). CATHARTICS. 665 Official Preparation. Conffectio SSnnae—Confectionis SSnnae—Confection of Senna.—Described under Senna, p. 681. Physiological Action and Therapeutics.—Cassia is a mild and pleasant laxative. It is seldom given alone, however, but forms an ingredient in the confection of senna. Oleum Ricini—Olei Ricini—Castor Oil. U. 8. P. Origin.—A fixed oil expressed from the seed of Ricinus com- munis L., a plant indigenous in Southern Asia and cultivated in temperate countries for ornament and other purposes, remaining a large annual. Description and Properties.—A pale-yellowish or almost color- less, transparent, viscid liquid, having a faint, mild odor and a bland, afterward slightly acrid and generally offensive taste. Solu- ble in an equal volume of alcohol and in all proportions in abso- lute alcohol. Castor oil should be kept in well-stoppered bottles. Dose.—\-2 fluidounces (8.0-60. Cc.) Physiological Action.—Externally and Locally.—Castor oil— like other bland fixed oils, such as almond oil, olive oil, etc.—is sedative and protective when applied to the skin or mucous membranes. Internally.—The only important action is upon the gastro- intestinal tract, the effects of the drug being those of a mild yet efficient purgative. Castor oil requires from four to six hours to operate, its action being usually attended with little pain. Indeed, the author is inclined to attribute anodyne properties to the drug, since it has frequently occurred to him in practice that a dose of castor oil given to a child suffering with colicky pains, while pro- ducing no movement of the bowels, served to allay the distress and cause the patient to sink into a quiet sleep. The purgative principle of castor oil rapidly enters the blood, increasing the secretion of the mother's milk and imparting to it purgative properties. The leaves of the castor-oil plant, applied to the breasts in the form of a poultice, greatly augment the secretion of milk. Castor beans have in several cases caused the death of persons who have eaten them. The symptoms were—violent abdominal pain, vomiting, purging, collapse, and fatal results. Post-mortem examinations have revealed evidences of severe inflammation in the stomach and intestines. 666 A TEXT-BOOK OF MATERIA MEDICA. Castor oil should not be used as an habitual laxative, its con- tinual employment being liable to occasion constipation with all its attendant evils. Therapeutics.—Castor oil is used alone or associated with bal- sam of Peru as a sedative protectant dressing for superficial ulcera- tions. The drug is also serviceable in various diseases of the skin and mouth. It is probably superior to all other laxatives, and is applicable to all conditions for which laxatives are employed. In large doses it is one of the best purgatives to give in conjunction with an anthelmintic. Administration.—The unpleasant taste of castor oil is the only objection to its use. Yet it can be rendered quite palatable by mixing it with an equal quantity of glycerin, to which may be added a few drops of oil of cinnamon or oil of wintergreen. Various other devices for disguising the taste have been adopted, such as enveloping the oil in the froth of beer, ale, or porter, or washing out the mouth with brandy or whiskey previous to admin- istration, and allowing the patient to swallow the oil quickly, when it will not adhere to the mouth and fauces, especially if followed by a drink of some alcoholic liquid. In the form of an emulsion the taste of the oil is well disguised. There are also soft capsules of castor oil which are of course taste- less, yet they are too bulky to be popular. Castor-oil emulsion may be used as an enema when a mild injection is required. Rhamnus Purshiana—Rhamni Purshianae-Cas- cara Sagrada. U. 8. P. Origin.—The bark of Rhamnus Purshiana D. C, a shrub or small tree 15 to 20 feet (4.5-6 M.) high, indigenous on the Pacific coast of North America from the British possessions southward to Northern California. Description and Properties.—Quills or curved pieces about 1 to 4 inches (3-10 Cm.) long and about fa inch (2 Mm.) thick; outer surface brownish-gray and whitish, the young bark with numerous, rather broad, pale-colored warts ; inner surface yellow- ish to light brownish, becoming dark brown with age; smooth or finely striate, fracture short, yellowish, in the inner layer of thick bark somewhat fibrous ; inodorous ; taste bitter. The bark contains red, yellow, and brown resins, tannic, malic„ CATHARTICS. 667 and oxalic acids, a volatile oil, and a neutral, crystalline sub- stance. Dose.—30-60 grains (2.0-4.0 Gm.). Official Preparation. ExtrSctum Rhamni Purshianae Fluidum—Extracti Rhamni Purshianae Fluidi—Fluid Extract of Rhamnus Purshiana.—Dose, %-i fluidrachm (1 0-40 Cc). Unofficial Preparations. Certain pharmaceutical chemists, in order to overcome the bitter taste of cascara have devised various preparations, such as— Cascara Cordial. Aromatic Fluid Extract of Cascara. Elixir of Cascara, etc. Messrs. Parke, Davis & Co. of Detroit offer a concentrated preparation of the drug, known as Cascarin, which is almost tasteless and soluble in water. Dose, %-V2 grain (0.01-0.03 Gm.). Physiological Action.—Cascara sagrada is a peculiarly efficient laxative, although in certain individuals it appears to be inert unless associated with other purgatives. The bitter principle it contains gives to the drug stomachic properties, and it is also said to stimu- late slightly the functional activity of the liver. The action of cascara is seldom attended with irritation or un- pleasant symptoms, the drug requiring from six to ten hours to operate. Therapeutics.—Cascara is a very valuable laxative, being em- ployed chiefly to overcome habitual constipation due to simple tor- por of the colon without associated disease. The drug is not adapted for rapid evacuation of the bowels, but rather for regulating their action. Administration.—The fluid and solid extracts are usually em- ployed, although the cascara cordial and the aromatic fluid extract, while requiring larger doses, are so palatable that they have become deservedly popular. Whatever be the preparation used in cases of habitual consti- pation, it should be given in small but repeated doses, gradually diminished until a natural action of the bowels shall have been established. The drug should be administered upon an empty stomach and in as diluted a condition as possible. Magnesia—Magnesiae—Magnesia. U. S. P. (Light Magnesia; Calcined Magnesia.) Origin, description, and properties given under "Alkalies," p. 156. Dose.—5-60 grains (0.32-4.0 Gm.). 668 A TEXT-BOOK OF MATERIA MEDICA. Magnesii Carbonas—Magnesii Carbonatis—Mag- nesium Carbonate. U. 8. P. Origin, description, and properties given under " Alkalies," p. I56. Dose.—|—2 drachms (1.0-8.0 Gm.). Physiological Action.—Both magnesia and magnesium car- bonate are mild antacid laxatives, requiring the presence of an acid in the stomach and bowels to render them active. Occasion- ally, when there is marked acidity of the stomach, magnesium carbonate occasions flatulence. When taken in large amounts or for a long time magnesia tends to accumulate in the intestines. This untoward effect may be pre- vented by administering with the drug lemonade, the acid of which increases the solubility of the magnesia. Therapeutics.—Magnesium carbonate as a protective powder is an effective agent in the treatment of dermatitis of the external auditory passage. The drug is a valuable antidote to counteract the effects of phosphorus-poisoning in the throat. Both magnesia and magnesium carbonate are mild alkalies, and may be used for the same purposes as the alkalies. They are serviceable antidotes to poisoning from mineral and oxalic acids and many mineral salts. They are pleasant laxatives, being ex- tensively employed for children. Manna—Mannae—Manna. U.S. P. Origin.—The concrete, saccharine exudation of Fraxinus Ornus L., a slender tree indigenous on the northern shore of the Mediter- ranean from Asia Minor west to Spain. Description and Properties.—Flattish, somewhat three-edged pieces, about 8 inches (20 Cm.) long and 2 inches (5 Cm.) broad (usually smaller), friable, externally yellowish-white, internally white, porous, and crystalline; or fragments of different sizes, brownish-white and somewhat glutinous on the surface, internally white and crystalline ; odor honey-like ; taste sweet, slightly bitter, and faintly acrid. Manna contains a resin, the purgative principle, besides mannite, fraxin, and sugar. Dose.—l-i ounce (16.0-32.0 Gm.), dissolved in hot water. Official Preparation. Infusum Sfinnae Compftsitum—Infiisi SSnnae Comp8siti—Compound Infu- sion of Senna.—See Senna, p. 681. . CATHARTICS. 669 Physiological Action and. Therapeutics.—Manna is a laxative, cholagogue, and nutrient. Its mild laxative action renders the drug peculiarly efficient in constipated conditions of pregnant women, and children and persons suffering from piles or irritation of the genito-urinary tract. The drug is slow in its action, tending to confine the bowels after the primary laxative effect. Sulphur Sublimatum—Sulphuris Sublimati—Sub- limed Sulphur. 77. S. P. Origin.—Obtained from Crude Sulphur by sublimation. Description and Properties.—A fine yellow powder, having a slight characteristic odor and a faintly acid taste. Insoluble in water; slightly soluble in absolute alcohol; more readily soluble in benzin, benzol, oil of turpentine and many other oils, as well as in ether, chloroform, and boiling aqueous solutions of alkaline hydrates. Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparations. Sulphur Lotum—Sulphuris Loti—Washed Sulphur.— Origin.—Sublimed Sul- phur, ioo; Water, ioo; Ammonia Water, 10; digested, filtered, drained, and dried. Description and Properties.—A fine yellow powder without odor or taste. Insoluble in water, but soluble in the substances which dissolve sulphur. Dose.—15-60 grains (1.0-4.0 Gm.). Unguentum Sulphuris—Unguenti Sulphuris—Sulphur Ointment.—Washed Sulphur, 300; Benzoinated Lard, 700. For external use. Washed sulphur is an ingredient of compound liquorice powder. Sulphur Praecipitatum—Sulphuris Praecipitati— Precipitated Sulphur. U. S. P. (Milk of Sulphur ; Lac Sulphur.) Origin.__Sublimed Sulphur is boiled with Slaked Lime and Water. To the solution is added Hydrochloric Acid, which throws down Sulphur as a fine precipitate, the powder being washed and dried. Description and Properties.—A fine amorphous powder of a pale-yellow color, without odor or taste. Insoluble in water. Dose.—15-60 grains (1.0-4.0 Gm.). Physiological Action.—Externally and Locally.—Sulphur is an active parasiticide, antiseptic, and keratoplastic agent. Upon the skin the drug of itself has no influence; a portion of it, however, 670 A TEXT-BOOK OF MATERIA MEDICA. is converted into hydrogen sulphide, which acts as a mild cutane- ous irritant. Internally.—As observed, sulphur proper has no action either externally or locally, although it is a normal constituent of nearly all the solids and fluids of the body. When ingested some of it is converted into hydrogen sulphide and other sulphides, which increase the intestinal secretions and promote peristalsis. The drug is chiefly excreted with the stools, which are rendered soft and semi-liquid. A portion of the hydrogen sulphide formed is eliminated through the kidneys, lungs, skin, and milk-glands. The drug is usually found in the urine as sulphate. There is imparted to the breath the offensive odor of hydrogen sulphide, and the minute portion eliminated through the skin is suf- ficient to discolpr silver ornaments in contact with the body-surface. While hydrogen sulphide is a powerful poison, decomposing the blood and paralyzing the nervous and muscular systems, the amount formed and absorbed under the administration of sulphur is too small to produce marked toxic symptoms, even when large amounts of sulphur have been ingested, there is produced only violent vomiting and purging, a slight elevation of temperature, and a distinct odor of hydrogen sulphide in the breath. When sulphur is used in full doses for a long time, it tends to impair the quality of the blood and produce muscular weakness. Occasionally untoward manifestations, such as miliary eruption and eczema, accompany either the external application or the ingestion of the drug. As a laxative sulphur is slow and mild, although it occasionally causes considerable flatus, in some cases rendering the drug objec- tionable as a purgative. Therapeutics.—Externally and Locally.—While classed among laxative drugs, sulphur is a most efficient remedy in many diseases of the skin, nose, throat, etc., the external uses of sulphur being very numerous. The drug is perhaps the most serviceable parasiticide we possess in scabies, sulphur ointment well rubbed into the skin being usually sufficient to destroy the parasite. Even diseases induced by vegetable parasites, such as tinea versicolor, etc., are cured by inunctions of sulphur ointment. The drug is successfully employed in the treatment of infil- trated eczema, impetigo, sycosis, ecthyma, acne, comedo, and psoriasis. The flowers of sulphur is an old domestic remedy, and quite CATHARTICS. 671 an efficient one, in diphtheria and pharyngitis. Finally, Coroden and Duchane have both reported the successful treatment of sciatica by enveloping the affected limb in precipitated sulphur the profuse sweating induced being followed by a decided allevi- ation of pain. When sulphur is burned sulphur dioxide is formed, a powerful germicide. By the fumes rooms and clothing may be disinfected, fumigation by sulphur being a common procedure to destroy the germs of typhoid fever, tuberculosis, cholera, diphtheria, small- pox, etc. Internally.—The principal internal use of sulphur is as a mild laxative, the drug being especially indicated for persons afflicted with hemorrhoids or anal fissure. Lozenges are prepared containing sulphur and cream of tartar, which, if taken daily for some time, will overcome habitual consti- pation, being especially serviceable in constipation due to disease of the liver. Sulphur has been used internally, and occasionally with con- siderable success, in bronchitis, chronic rheumatism, and eczema attended with much itching. Administration.—Sulphur may be given in the form of loz- enges or mixed with molasses—either alone or associated with cream of tartar, which is said to enhance the action of sulphur. Milk and syrup have been used as vehicles in the administration of the drug. Sulphurous baths, both natural and artificial, have been em- ployed in the treatment of rheumatism, gout, and some cutaneous affections. Not only for these purposes, but for their laxative influence as well, sulphurous waters are held in great repute. Taraxacum—Taraxaci—Taraxacum. U. 8. P. (Dandelion.) Origin.__The root of Taraxacum officinale Weber, a perennial, acaulescent herb found in most countries of the northern hemi- sphere. Description and Properties.—Slightly conical, about 12 inches (30 Cm.) long and \ to 1 inch (12-25 Mm-) tnick above, crowned with several short, thickish heads, somewhat branched, dark brown, longitudinally wrinkled; when dry breaking with a short fracture, showing a yellowish, porous central axis surrounded by a thick, 672 A TEXT-BOOK OF MA TERIA MEDICA. white bark containing numerous milk-vessels arranged in con- centric circles ; inodorous ; bitter. The drug contains a bitter principle, taraxacin, besides inulin, resin, sugar, and mucilaginous substances. Dose.—1-4 drachms (4.0-15.0 Gm.). Official Preparations. Extractum Tarfixaci—Extracti TarSxaci—Extract of Taraxacum.—Dose, 5-60 grains (0.3-4.0 Gm.). Extractum Taraxaci Fluidum—ExtrScti Taraxaci Fluidi—Fluid Extract of Taraxacum.—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Physiological Action and Therapeutics.—Taraxacum is a stomachic tonic, diuretic, laxative, cholagogue, and feeble hepatic stimulant. It has been a popular remedy for constipation associated with hepatic congestion and atonic dyspepsia, yet the drug is now less employed than formerly, in actual practice being usually united with other laxatives. The extract or fluid extract may be given, the latter and the expressed juice being the more active. SIMPLE PURGATIVES. These differ from laxatives only in degree, the former being more active, exciting greater peristaltic action and causing a larger secretion from the intestinal glands. Simple purgatives usually oc- casion one or more copious and somewhat liquid stools, frequently accompanied by considerable irritation and griping. Aloe—Aloes—Aloes. U. 8. P. Origin.—The inspissated juice of the leaves of Aloe (A. vera (L.) Webb; A. Perryi Baker), a plant resembling the so-called century plant (Agave Americana), indigenous in India and North- eastern Africa, and naturalized along the shores of the Mediter- ranean and in the West Indies. Official Varieties. Aloe Barbadensis— Aloes BarbadSnsis— Barbadoes Aloes (Curacoa Aloes).— Origin.—Prepared from Aloe vera. Habitat.—Island of Barbadoes. Description and Properties.—Hard masses, orange-brown, opaque, translucent on the edges; fracture waxy or resinous, somewhat conchoidal; odor saffron-like; taste strongly bitter. CATHARTICS. 673 Dose.—£-10 grains (0.03-0.6 Gm.). Aloe Socotrina—Aloe Socotrfnae—Socotrine Aloes.— Origin.—Obtained from Aloe Perryi. Habitat.—Island of Socotra in the Strait of Bab-el-Mandeb. Description and Properties.—Hard masses, occasionally soft in the interior, opaque, yellowish-brown, orange-brown, or dark ruby-red, not greenish, translucent on the edges; fracture resinous, somewhat conchoidal. When breathed upon it emits a fragrant, saf- fron-like odor. Taste peculiar, strongly bitter. Almost entirely soluble in alcohol and in 4 parts of boiling water. The aqueous solution becomes turbid on cooling and yields a deposit. Examined under the microscope, Socotrine aloes exhibits numerous crystals. The active principle of the various Aloes is aloin, a neutral prin- ciple, varying in chemical composition and physical properties according to the species from which it is derived; thus the sub- stance from Barbadoes aloes (barbalo'in) is soluble in 60 parts of water, 20 parts of alcohol, and 470 parts of ether; that from Soco- trine aloes (socaloin) is soluble in 60 parts of water, 30 parts of absolute alcohol, and 380 parts of ether. Nataloin, obtained from the unofficial Cape aloes, may be distinguished from the official aloin by heating the former with a drop or two of sulphuric acid and exposing it to the vapor of nitric acid, when nataloin changes to a blue color; barbalo'in and soca- loin are unaffected by this test. Nitric acid applied to barbaloin gives a crimson color, which rapidly fades; the crimson color imparted to nataloin is permanent, while no color is produced when nitric acid is applied to socaloin. Dose.—J-10 grains (0.03-0.6 Gm.). Official Preparations. Extractum Aloes—Extr3cti Aloes—Extract of Aloes.—Dose, \-d grains (0.03-0.4 Gm.). Aloe Purificata—Aloes Purificatae—Purified Aloes.—Dose, \-\o grains (0.03- 0.6 Gm.). Extractum Colocynthidis CompOsitum—ExtrScti Colocynthidis CompSsiti —Compound Extract of Colocynth.—Dose, 5-25 grains (0.3-1.6 Gm.). The following official preparations are prepared from purified aloes: Pilulae Aloes—Pilulas (ace.) Aloes—Pills of Aloes.—ZW, 1 to 4 pills. Pilulae Aloes et Asafcetidae—Pilulas (ace.) Aloes et Asafcetidae—Pills of Aloes and Asafetida.—Each pill contains about ii grains (0.085 Gm.) of each.— Dose, I to 5 pills. Pilulae Aloes et Ferri—Pilulas (ace.) Aloes et FSrri—Pills of Aloes and Iron.-Each pill contains about 1 grain (0.06 Gm.), each, of Aloes, dried Ferrous Sul- phate, and Aromatic Powder.—Dose, 1 to 4 pills. Pilulae Aloes et Mastiches—Pilulas (ace.) Aloes et Mastiches—Pills of Aloes and Mastich.-Each pill contains about 2 grains (0.12 Gm.), together with Mastich and Red Rose.—Dose, 1 to 3 pills. _ Pilulae Aloes et Myrrhae—Pilulas (ace.) Aloes et Myrrhae—Pills of Aloes and Myrrh.-Each pill contains 2 grains (0.12 Gm.), together with Myrrh and Aromatic Powder.—Dose, I to 3 pills. 43 674 A TEXT-BOOK OF MATERIA MEDICA. Pilulae Rhei Comp&sitae—Pilulas (ace.) Rhei Compftsitas—Compound Pills of Rhubarb.—Each pill contains i grain (0.06 Gm.) of Aloes.—Dose, 1 to 3 pills. Tinctura Aloes—Tinctiirae Aloes—Tincture of Aloes (10 per cent.).—Dose, £-1 fluidrachm (2.0-4.0 Cc). Tinctura Aloes et Myrrhae—Tinctiirae Aloes et Myrrhae—Tincture of Aloes and Myrrh (10 per cent, of each, with Glycerin 10 per cent.).—Dose, \-2\ fluidrachms (2.0-10.0 Cc). Tinctura Benzoini Compdsita—Tinctiirae Benzoini Cornpositae—Compound Tincture of Benzoin (2 per cent, of Aloes).—Dose, 10-40 minims (0.6-2.6 Cc). Aloinum—Aloini—Aloin. U. S. P.—Origin.—-A neutral principle obtained from several varieties of Aloes. Description and Properties.—Minute, acicular crystals, or a micro-crystalline pow- der, varying in color from yellow to yellowish-brown; odorless or possessing a slight odor of aloes, of a characteristic, bitter taste, and permanent in the air. The solubilities of barbaloin and socaloin are given above. Dose.—\-2 grains (0.03-0.12 Gm.). Physiological Action.—Aloes has no local action, although the drug is readily absorbed from ulcers or abraded surfaces. Internally, it is stomachic, increasing the secretions from the gastro-intestinal tract. It probably increases the secretion of bile. Its principal action appears to be upon the colon, the muscular coat of which it stimulates, besides augmenting the secretion from the large intestine. In from ten to fifteen hours after the ingestion of the drug it causes soft, dark-colored evacuations, its action being usually attended with more or less griping pain. The blood-supply to the lower bowel and pelvic viscera is increased by aloes; and the drug, if used habitually, may bring on or aggravate hemorrhoids. The menstrual function is stimu- lated, the drug being quite a decided emmenagogue. Aloes is readily absorbed; it is thrown off through the bowels and kidneys, and is found also in the milk. Therapeutics.—The principal use of aloes is as a purgative in habitual constipation due to a torpid condition of the large intestine. Jaundice resulting from hepatic congestion is well treated with aloes and blue pill. Pills of aloes and iron are useful adjuvants to other remedies in the treatment of chlorosis. Amenorrhea, which is such a common condition in chlorosis, is relieved by aloes. Pills of aloes and iron are equally valuable in menorrhagia arising from debility. Contraindications.—Aloes is ordinarily contraindicated in hem- orrhoids, although those cases attended with a mucous discharge are frequently benefited by it. The drug is considered objection- CATHARTICS. 675 able in pregnancy, in persons of plethoric, bilious, or hemorrhagic constitution, and in menorrhagia of the strong and full-blooded. Administration.—When desired as a purgative, aloes in pill form is preferable to the liquid preparations, and the drug may be given alone or associated with other purgatives, tonics, or antispasmodics. Aloin is perhaps to be preferred to aloes, as it gripes less and may be given in smaller doses. As a purgative aloes ranks between rhubarb and senna. Fel Bovis—Fellis Bovis—Oxgall. U. 8. P. (Fel Tauri.) Origin.—The fresh bile of Bos Taurus L. Description and Properties.—A brownish-green or dark-green, somewhat viscid liquid, having a peculiar, unpleasant odor and a disagreeable, bitter taste. Dose.—5-15 grains (0.3-1.0 Gm.). Official Preparation. Ffel Bovis Purificatum—FSllis Bovis Purificati—Purified Oxgall.—Descrip- tion and Properties.—A yellowish-green, soft solid, having a peculiar odor and a partly sweet and partly bitter taste. Very soluble in water and in alcohol. Dose.—5—15 grains (0.3-1.0 Gm.). Physiological Action and Therapeutics.—Like bile, oxgall augments the duodenal secretions, emulsionizes fats, and increases intestinal peristalsis. The drug liquefies the bile, and acts as a cholagogue and purgative. It is a useful cathartic when the stools are very offensive and of a light clay color, indicating a deficient biliary secretion. The drug is serviceable in jaundice due to obstruction of the common duct by inspissated bile or mucus. Impacted feces are readily removed by an enema containing 15 or 20 grains (1.0-1.3 Gm.) of oxgall. The drug is an efficient intes- tinal antiseptic, and may be beneficially employed for that purpose in typhoid fever and intestinal fermentation. Oxgall is usually given in pill form. Rheum—Rhei—Rhubarb. U. S. P. Origin.—The root of Rheum officinale Baillon, a plant indigen- ous in the western and northwestern portions of China. Description and Properties.—In cylindrical, conical, or flattish 676 A TEXT-BOOK OF MATERIA MEDICA. segments, deprived of the dark-brown, corky layer, smoothish or somewhat wrinkled, externally covered with a bright yellowish- brown powder, marked with white, elongated meshes, containing a white, rather spongy tissue, and a number of short, reddish- brown or brownish-yellow striae ; compact, hard; fracture uneven; internally white, with numerous red, irregularly-curved, and inter- rupted medullary rays, which are radially parallel only near the cambium line; odor somewhat peculiar, aromatic ; taste bitter, some- what astringent. When chewed, rhubarb feels gritty between the teeth and imparts a yellow color to the saliva. Rhubarb which is very porous, or has a prominently mucilaginous taste, or is of a dark-brown color internally, should be rejected. The drug contains the following constituents: chrysophan (and chrysophanic acid), emodin, aparetin, phasoretin, erythroretin, rheumic acid, and rheotannic acid, besides starch, calcium oxalate, etc. Dose.—5-30 grains (0.32-1.94 Gm.). Official Preparations. Extractum Rhei—Extracti Rhei—Extract of Rhubarb.—Dose, 3-15 grains (0.19-i.oGm.). Extractum Rhei Fluidum—Extracti Rhei Fluidi—Fluid Extract of Rhubarb (this preparation is used in Mistura Rhei et Sodae and in Syrupus Rhei).—Dose, 5-60 minims (0.3-4.0 Cc). Pilulae Rhei—Pilulas (ace) Rhei—Pills of Rhubarb.—Each pill contains 3 grains (0.19 Gm.). Dose, 1 to 5 pills. Pilulae Rhei Compdsitae—Pilulas (ace) Rhei Compdsitas—Compound Rhubarb Pills.—Each pill contains about 2 grains (0.12 Gm.) of Rhubarb, with puri- fied Aloes i*A grains (0.09 Gm.), Myrrh, and Oil of Peppermint. Dose, 1 to 3 pills. Pulvis Rhei CompSsitus—Pulveris Rhei CompSsiti—Compound Rhubarb Powder (Gregory's Powder)—(25 per cent., with Magnesia and Ginger).—Dose, y2- 1 drachm (2.0-4.0 Gm.). Tinctura Rhei—Tinctiirae Rhei—Tincture of Rhubarb (10 per cent., with Cardamom).—Dose, ^-4 fluidrachms (2.0-15.0 Cc). Tinctura Rhei Aromatica—Tinctiirae Rhei Aromaticae—Aromatic Tincture of Rhubarb (20 per cent., with Cassia, Cinnamon, Cloves, and Nutmeg).—Dose, 1-3 fluidrachms (4.0-12.0 Cc). This preparation is used to make Syrupus Rhei Aromaticus. Tinctura Rhei Dulcis—Tinctiirae Rhei Diilcis—Sweet Tincture of Rhubarb (10 per cent., with Glycyrrhiza, Anise, and Cardamom).—Dose, ^-4 fluidrachms (2.0- 15.0 Cc). Mistura Rhei et Sodae—Misturae Rhei et Sodae—Mixture of Rhubarb and Soda.—Formula: Sodium Bicarbonate, 35; Fluid Extract of Rhubarb, 15; Fluid Extract of Ipecac, 3; Glycerin, 350; Spirit of Peppermint, 35 ; Water, to 1000.—Dose, «^-2 fluidounces (8.0-60.0 Cc). Syrupus Rhei—Syrupi Rhei—Syrup of Rhubarb.—Formula: Fluid Extract CATHARTICS. 677 of Rhubarb, 100; Potassium Carbonate, 10; Spirit of Cinnamon, 4; Glycerin, 50; Water and Syrup, to 1000.—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Syrupus Rhei Aromaticus—Syrupi Rhei Aromatici—Aromatic Syrup of Rhubarb.—Formula: Aromatic Tincture of Rhubarb, 150; Syrup, 850.—Dose, ^-2 fluidrachms (2.0-8.0 Cc). Physiological Action and Therapeutics.—Rhubarb in mod- erate doses is a stomachic, acting similarly to the aromatic bitters, increasing secretion, peristalsis, vascularity, and absorption, thereby aiding digestion and serving as a tonic. In larger doses it is a mild cathartic, producing in from four to eight hours a soft yellow- ish-brown evacuation, not watery, which is not infrequently accom- panied by griping. It undoubtedly slightly increases the secretion of bile, though it is by no means an active cholagogue. After full doses of rhubarb have been taken the purgative action is succeeded by quiescence of the bowels, the constipation being the result of the action of the astringent constituents of the rhu- barb. Small doses, however, taken daily, serve a useful purpose in relieving habitual constipation, without in the least impairing digestion. The drug is excreted with the feces, urine, perspiration, and milk; the urine is slightly increased in amount, and together with the perspiration and milk, is colored yellow. The milk acquires a bitter taste and purgative properties. Rhubarb is one of the best purgatives for children suffering from diarrhea caused by irritating ingesta in the bowels or to cold ; it is also of value in some cases of dysentery. Summer diarrhea of children is often cured by some preparation of rhubarb alone, the diarrhea ceasing after a free purge by the drug. As a simple laxative for children it is a valuable remedy, owing to its secondary tonic and astringent effects, and is recommended ^ as a laxative to expel thread-worms. When hemorrhoids are connected with constipation, much relief may be obtained by the gentle action of rhubarb. Administration.—Rhubarb is seldom given alone, because of the griping it occasions. For children the syrups are excellent preparations, and the mixture of rhubarb and soda is an appropri- ate remedy when the secretions of the stomach and bowels are unduly acid. In habitual constipation of adults the simple rhubarb pill is an efficient preparation. 678 A TEXT-BOOK OF MA TERIA MEDICA. The choice of the preparation will depend largely upon the individual case. Euonymus—Euonymi—Euonymus. U. 8. P. (Wahoo.) Origin.—The bark of the root of Euonymus atropurpureus Jacquin, a shrub 6 to 10 or 14 feet (1.8 to 3 or 4.2 M.) high, found growing in shady woods of the northern and middle section of the United States east of the Mississippi. Description and Properties.—In quilled or curved pieces fa to \ inch (2 to 5 Mm.) thick; outer surface ash-gray, with blackish patches, detached in thin and small scales; inner surface whitish or slightly tawny, smooth; fracture smooth, whitish, the inner layers of a laminated appearance; nearly inodorous; taste sweet- ish, somewhat bitter and acrid. The chief constituent of the drug is a resin, euonymin. Dose.—1-2 drachms (4.0-8.0 Gm.). Official Preparation. Extractum EuSnymi— Extracti Eudnymi—Extract of Euonymus.—Dose, 1-5 grains (0.06-0.3 Gm.). Euonymin (unofficial).— Origin.—A resin from the root and stem-bark of Euonymus atropurpureus Jacquin. Description and Properties.—A brown or greenish-brown hygroscopic powder with a feebly bitter taste, soluble in water, almost insoluble in alcohol and ether. Dose.—%-"$ grains (0.01-0.19 Gm.). Physiological Action and Therapeutics.—Euonymus resem- bles rhubarb in its action, but is milder, small doses being stimu- lant to the stomach. The drug is an active hepatic stimulant, increasing the secretion of bile and facilitating its excretion into the intestine. It is excreted by the kidneys and broncho-pulmonary mucous membrane, being a mild diuretic and expectorant. Euony- mus is an excellent cathartic, particularly in cases of constipation attended with impaired functional activity of the liver. Euonymin is the preparation usually employed, although the official extract of euonymus is a reliable preparation. Tris—Tridis—Iris. U.S. P. (Blue Flag.) Origin.—The rhizome and roots of Iris versicolor L., found growing in wet and swampy meadows from Canada southward to Florida and westward to Minnesota and Arkansas. CATHARTICS. 679 Description and Properties.—Rhizome of horizontal growth, consisting of joints 2 to 4 inches (5 to 10 Cm.) long, cylindrical in the lower half, flattish near the upper extremity, and terminated by a circular scar, annulated from the leaf-sheaths, grayish-brown; roots long, simple, crowded near the broad end; odor slight; taste acrid and nauseous. The drug contains an acrid resin, iridin, fixed oil starch, gum, tannin, sugar, and indications of an alkaloid. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Extractum Tridis—Extracti Iridis—Extract of Iris.—Dose, 1-3 grains (0.06- 0.2 Gm.). w Extractum Iridis Fluidum—Extracti Iridis Fluidi—Fluid Extract of Iris. __Dose, 10-30 minims (0.6-2.0 Cc). Iridin (unofficial).—Dose, 1-3 grains (0.06-0.2 Gm.). Physiological Action and Therapeutics.—Iris is similar in its action to euonymus, although it is more apt to disturb the stomach and occasion nausea. It is actively purgative and possesses diu- retic properties. Like euonymus, it is a hepatic stimulant, and may be used for the same purposes as the former drug. It may be used in dropsy, and has been found to be an efficient cathartic in malarial and catarrhal jaundice and bilious remittent fever. It exerts a specific influence in enlargement of the thyroid gland. The dried drug is inert, the fluid extract and iridin being the most reliable preparations to use. Juglans—Juglandis—Juglans. U. S. P. (Butternut.) Origin.__The bark of the root of Juglans cinerea L., a tree 30 to 40 feet (9-12 M.) high, growing in forest and bottom-lands in Canada, and the greater portion of the United States westward to Missouri and Arkansas. Description and Properties.—In flat or curved pieces, from \ to l inch (3 to 6 Mm.) thick; the outer surface dark gray and nearly smooth or deprived of the soft cork, and deep brown; the inner surface smooth and striate; transverse fracture short, deli- cately checkered, whitish and brown ; odor feeble; taste bitter and somewhat acrid'. The drug contains a bitter, oily extractive, juglandic acid, two other acids, and various salts. Dose.—1-2 drachms (4.0-8.0 Gm.). 680 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparation. Extractum Jugiandis—Extracti Jugl3ndis —Extract of Juglans.—Dose, 5-30 grains (0.3-2.0 Gm.). Physiological Action and Therapeutics.—The action and medical uses of this drug are analogous to those of euonymus. Leptandra—Leptandrae—Leptandra. U. S. P. (Culver's Root.) Origin.—The rhizome and roots of Veronica virginica L., a plant indigenous in Canada, and in the United States as far west as the Mississippi Valley. Description and Properties.—Of horizontal growth, from 4 to 6 inches (10 to 15 Cm.) long and about \ inch (6 Mm.) thick, some- what flattened, bent and branched, deep blackish-brown, with cup- shaped scars on the upper side, hard, of a woody fracture, with a thin, blackish bark, a hard, yellowish wood, and a large, purplish- brown, about six-rayed pith; roots thin, wrinkled, very fragile; inodorous; taste bitter and feebly acrid. Leptandra contains a crystalline glucosid, leptandrin, besides tannin, gum, and a small quantity of volatile oil. Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparations. Extractum Leptandrae—Extracti Leptandrae—Extract of Leptandra.—Dose, 1-5 grains (0.06-0.3 Gm.). Extractum Leptandrae Fluidum—Extracti Leptandrae Fluidi—Fluid Ex- tract of Leptandra.—Dose, 15-60 minims (1.0-4.0 Cc). The Pilulae Catharticae Vegetabiles contain % grain (0.01 Gm.) of Extract of Leptandra to each pill. Leptandrin (unofficial).—Dose, 1-3 grains (0.06-0.2 Gm.). Physiological Action and Therapeutics.—The action of lep- tandra is similar to the actions of euonymus, iris, and juglans, the green root, however, being more of an irritant to the gastro-intes- tinal tract, possessing marked emeto-cathartic properties. It is an active hepatic stimulant, and may be advantageously employed for the same purposes as euonymus, iris, etc. Senna—Sennae—Senna. U. S. P. Origin.—The leaflets of Cassia acutifolia Delile (Alexandria senna) and of Cassia angustifolia Vahl (India senna), small shrubs CATHARTICS. 681 found in Upper Egypt and southward to Nubia, Sennaar, and Kor- dofan, and farther westward in tropical Africa {Cassia acutifolid), and in Southwestern Arabia, along the Somali coast of Africa, and east- ward in Northern India {Cassia angustifolid). Description and Properties.—Alexandria senna consists of leaflets about I inch (25 Mm.) long and f inch (10 Mm.) broad, lanceolate or lance-oval, subcoriaceous, brittle, rather pointed, un- equally oblique at the base, entire, grayish-green, somewhat pubes- cent ; of a peculiar odor and a nauseous, bitter taste. India senna consists of leaflets 1 to 2 inches (2.5-5 Cm.) long and | to f inch (10-15 Mm.) broad, lanceolate, acute, unequally oblique at the base, entire, thin, yellowish-green or dull green, nearly smooth ; odor peculiar, somewhat tea-like ; taste mucilagi- nous, bitter, and nauseous. Senna contains a sulphuretted glucosid, cathartic acid, to which the purgative properties of the drug are due. Senna also contains chrysophan, besides sennacrol and sennapicrin (two bitter princi- ples), catharto-mannite, mucilage, etc. Dose.—10 grains-3 drachms (0.6-12.0 Gm.). Official Preparations. Conf6ctio SSnnae—Confectionis Sennae—Confection of Senna.—10 per cent., with Cassia Fistula, Tamarind, Prune, Fig, Sugar, and Oil of Coriander. Dose, 1-3 drachms (4.0-12.0 Gm.). Extractum SSnnae Fluidum—Extract! SSnna Fluidi—Fluid Extract of Senna.—Dose, 10 minims-3 fluidrachms (0.6-11.09 Cc). Infusum SSnnae Compbsitum—Infiisi SSnnae CompSsiti—Compound Infu- sion of Senna.—6 per cent., with Manna and Magnesium Sulphate, each, 12 per cent., and Fennel 2 per cent. Dose, 1-2>£ fluidounces (30.0-75.0 Cc). Pulvis Glycyrrhizae CompSsitus—Pulveris Glycyrrhizae CompSsiti—Com- pound Powder of Glycyrrhiza.—Formula: Senna, 180; Glycyrrhiza, 236; Oil of Fennel, 4; Washed Sulphur, 80; Sugar, 500. Dose, #-2 drachms (2.0-8.0 Gm.). Syrupus SSnnae—Syrupi SSnnae—Syrup of Senna (25 per cent.).—Dose, %-i fluidounce (8.0-3.0 Cc). _ Cathartic Acid, Cathartinic Acid (unofficial).—Origin.—An active principle obtained from the leaves of various species of Cassia. Description and Properties.-It occurs as brown, hygroscopic scales, freely soluble in water and in alcohol. Dose.—2-6 grains (0.12-0.38 Gm.). Physiological Action and Therapeutics.—Senna is an active purgative acting upon nearly the entire intestinal tract, increasing both peristalsis and intestinal secretion, although having but little effect upon the biliary secretion. It is apt to occasion much flatu- lence and griping unless it is associated with aromatics. Full doses 682 A TEXT-BOOK OF MATERIA MEDICA. open the bowels in from four to eight hours, producing one or more copious liquid, yellow stools, but never occasioning hyper- catharsis, and the purgation is not followed by constipation. An infusion of senna, if injected into the veins, excites both vomiting and purging. Some persons are so susceptible to the influence of senna as to be purged even by its odor. The drug, or some constituent of it, is eliminated by the urine, to which it imparts a red color, and by the milk, rendering it pur- gative. The various preparations of senna are very efficient purgatives in cases of simple constipation or in cases of fecal accumulation in the colon. Infusion of senna is an admirable purgative with which to suc- ceed the administration of blue pill. In cases of biliousness there is probably no better treatment than calomel or blue pill at night and infusion of senna in the morning. Habitual constipation and the constipation of pregnancy are safely and agreeably treated by compound liquorice powder. Administration.—Senna is seldom given alone, but is generally associated with some corrective to prevent griping. The infusion, compound liquorice powder, syrup, and confection of senna are employed. The compound liquorice powder and the confection being the mildest and pleasantest, the latter preparation, when coated with chocolate, is readily taken by children, and in this form is the well- known laxative " Tamar Indien." HYDRAGOGUE PURGATIVES. These drugs are more active than the preceding class, pro- ducing an abundant secretion from the intestinal mucous mem- brane, removing a large quantity of water from the blood-vessels, and producing several copious, watery stools. Oleum Tiglii—Olei Tiglii—Croton Oil. U. S. P. Origin.—A fixed oil expressed from the seed of Croton Tiglium L., indigenous in Hindostan and some of the East Indian and Philippine islands. Description and Properties.—A pale-yellow or brownish-yel- low, somewhat viscid, and slightly fluorescent liquid, having a slight, fatty odor, and a mild, oily, afterward acrid and burning, taste CATHARTICS. 683 {great caution is necessary in tasting). Croton oil should be kept in small, well-stoppered bottles, and should be handled with caution, for when applied to the skin it produces rubefaction or a pustular eruption. When fresh, croton oil is soluble in about 60 parts of alcohol, the solubility increasing by age. The drug contains several volatile acids, of which tiglinic acid is the characteristic one; besides this, it contains lauric, myristic, palmitic, stearic, formic, acetic, isobutyric, and isovalerianic acids. Dose.—\-2 minims (0.01-0.12 Cc.) on a lump of sugar or mixed with some bland oil. Physiological Action.—Externally and Locally.—Croton oil is a powerful irritant when applied to the skin, exciting inflammation and quickly producing vesication, which rapidly merges into pus- tules closely resembling those of variola, and perhaps lasting sev- eral days. In many cases permanent cicatrices mark the site of these pustules. If the drug be rubbed over the abdomen, it may produce pur- gation. Internally.—When a drop or two of croton oil is taken into the stomach it occasions a sense of heat in the epigastrium, which is soon succeeded by griping and abdominal pain, and in from half an hour to two hours after the ingestion of the drug there are pro- duced profuse watery stools, with considerable burning and irrita- tion about the anus. The drug greatly increases the vascularity of, and the secretion from, the gastro-intestinal tract, without specially influencing the biliary secretion. Large doses produce violent gastro-enteritis, hypercatharsis, with great prostration and collapse resembling that of cholera. In case of poisoning the stomach should be immediately evacu- ated, and demulcent drinks freely given. Opium and stimulants may be necessary. Therapeutics.—Externally and Locally.—The external use of croton oil is comparatively limited. It is occasionally painted over the seat of pain in intercostal neuralgia, while a liniment of croton oil applied to the chest is said to be beneficial in phthisis and chronic bronchitis. The same prep- aration is recommended as a local application in congestive dysmen- orrhea and chronic congestion of the uterus. Croton oil has been put to many other uses, but the results 684 A TEXT-BOOK OF MATERIA MEDICA. obtained are so unsatisfactory that it is needless to enumerate them. Internally.—The drug is used as a purgative, as a rule only in cases of emergency, and then a single dose is usually sufficient. It is employed in such cases as intestinal obstruction from accumu- lated feces produced by torpor of the bowels, diseases of the nervous system, lead-poisoning, etc. In lead colic it is probably superior to all other purgatives. Croton oil is sometimes employed for its revulsive action in apoplexy. As a purgative it is frequently given to lunatics, because, on account of the smallness of the dose, it may be easily placed on the back of the tongue, where it is quickly swallowed reflexly. Contraindications.—The drug should never be given to preg- nant women, to children, nor to patients suffering from hemor- rhoids, peritonitis, gastritis, or enteritis. Administration.—Croton oil may be given in emulsion, or mixed with some bland oil, or dropped on a piece of loaf sugar, or in pill form. The best excipient for pills of croton oil is breadcrumb. Elaterinum—Elaterini—Elaterin. U. 8. P. Origin.—A neutral principle obtained from Elaterium, a sub- stance deposited by the juice of the fruit of Ecballium elaterium L., commonly known as " squirting cucumber," a vine growing in the Mediterranean regions of Europe, Africa, and Asia. Description and Properties.—Minute, white, hexagonal scales or prismatic crystals, without odor, and having a slightly acrid, bitter taste; permanent in the air; soluble in 4250 parts of water and 337 parts of alcohol. Dose.—fa-fa grain (0.002-0.005 Gm.). Official Preparation. Trituratio Elaterini—Triturationis Elaterini—Trituration of Elaterin.— Dose, about f grain (0.05 Gm.). Physiological Action and Therapeutics.—Elaterin is the most powerful hydragogue purgative known. The drug greatly increases the salivary, gastric, and intestinal secretions, as well as those from the liver and pancreas. It is a violent purgative, whether given internally or injected CATHARTICS. 685 subcutaneously, producing abundant watery evacuations attended with much griping pain and great prostration. Elaterin is indicated where profuse serous discharges are de- sired, as in cases of congestion of the brain and lungs, ascites, and chronic nephritis. Contraindications.—The drug is not permissible in inflamma- tory conditions of the gastro-intestinal tract, nor in pregnancy, and it should be administered with much care, if at all, in heart disease. Administration.—The drug may be given in pill form, in alco- holic solution, or in the form of the trituration. Elaterin varies greatly in strength, which suggests caution in its use. Cambogia—Cam bogiae—Gamboge. U. 8.P. Origin.—A gum-resin obtained from Garcinia Hanburii Hooker filius, a medium-sized tree, indigenous in Siam, Cambodia, and Cochin China. Description and Properties.—In cylindrical pieces, sometimes hollow in the center, 1 to 2 inches (2 to 5 Cm.) in diameter, longi- tudinally striate on the surface; fracture flattish-conchoidal, of a waxy luster, orange-red; in powder bright yellow; inodorous; taste very acrid; the powder sternutatory. Gamboge is partly soluble in alcohol and in ether. Dose.—1-5 grains (0.06-0.32 Gm.). Official Preparation. Pilulae CathSrticae CompSsitae—Pilulas (ace) CathSrticas Comp6sitas— Compound Cathartic Pills.— Dose, 1-3 pills. Physiological Action and Therapeutics.—Gamboge is a vio- lent hydragogue purgative, exciting active peristalsis and greatly augmenting the secretion from the intestinal glands, although not increasing the secretion of bile. Small and repeated doses are slightly diuretic, coloring the urine yellow. Gamboge is seldom given alone, being usually associated with other purgatives. It is used in combination when a hydragogue action by the kidneys as well as the bowels is desired. It is thought to be of use in hepatic congestion arising from malarial causes. The drug is an efficient anthelmintic, and is occasionally prescribed with vermicide medicines. 686 A TEXT-BOOK OF MA TERIA MEDICA. SALINES. Magnesii Citras Effervescens—Magnesii Citratis Effervescentis—Effervescent Magnesium Ci- trate. U.S. P. Formula: Magnesium Carbonate, 10 ; Citric Acid, 46; Sodium Bicarbonate, 34; Sugar, 8; Alcohol and Distilled Water, a suf- ficient quantity. Description and Properties.—A white, coarsely granular salt, without odor, and having a mildly acidulous, refreshing taste. Deliquescent on exposure to the air. Soluble, with copious effer- vescence, in 2 parts of water; almost insoluble in alcohol. The product should be kept in well-closed vessels. Dose.—^—1 ounce (8.0-32.0 Gm.). Liquor Magnesii Citratis—Liquoris Magnesii Citratis —Solution of Magnesium Citrate. U. 8. P. Formula: Dissolve Magnesium Carbonate, 15, in a solution of Citric Acid, 30; add Syrup of Citric Acid, 60; then Crystals of Potassium Bicarbonate, 25. Cork the bottle and wire immediately. The product effervesces when uncorked. Dose.—2-8 fluidounces (60.0-237.0 Cc). Magnesii Sulphas—Magnesii Sulphatis—Magne- sium Sulphate. U. 8. P. (Epsom Salt.) Origin.—Obtained by the action of Sulphuric Acid upon native Magnesium Carbonate, treated with Water, filtered, and the filtrate evaporated to crystallization. Description and Properties.—Small, colorless, rhombic prisms or acicular crystals, without odor, and having a cooling, saline, and bitter taste; slowly efflorescent in dry air. Soluble in 1.5 parts of water; insoluble in alcohol. Dose.—^-1 ounce (8.0-32.0 Gm.). Antagonists and Incompatibles.—Magnesium sulphate is in- compatible with alkaline carbonates, phosphoric acid, phosphates, lead acetate, silver nitrate, and lime water. Synergists.—Saline purgatives. Potassii Sulphas—Potassii Sulphatis—Potassium Sulphate. U.S. P. Origin.—Prepared by adding Potassium Carbonate to Acid Potassium Sulphate. CATHARTICS. 687 Description and Properties.—Hard, colorless, transparent, six- sided, rhombic prisms terminated by pyramids, or in white powder; odorless, and having a somewhat bitter, saline taste. Permanent in the air. Soluble in about 9.5 parts of water, insoluble in alcohol. Dose.—J-4 drachms (2.0-16.0 Gm.). Potassii et Sodii Tartras—Potassii et Sodii Tartrates —Potassium and Sodium Tartrate. U. 8. P. (Rochelle Salt.) Origin.—Prepared by adding Acid Potassium Tartrate to a hot solution of Sodium Carbonate. Description and Properties.—Colorless, transparent rhombic prisms, or a white powder, odorless, and having a cooling, saline taste. The crystals slightly effloresce in dry air. Soluble in 1.4 parts of water, almost insoluble in alcohol. Dose.—30 grains-i ounce (2.0-32.0 Gm.). Official Preparation. Pulvis EffervSscens CompSsitus—Ptilveris Effervescentis Compositi— Compound Effervescing Powder (Seidlitz Powder).—Each powder has of Ro- chelle Salt, 120 grains (8.0 Gm.); of Sodium Bicarbonate, 40 grains (3.0 Gm.), mixed in a blue paper; and of Tartaric Acid, 35 grains (2.26 Gm.), in a white paper. Dose___One or two of each dissolved separately in separate quantities of water, the solutions poured together and drunk while effervescing. Sodii Phosphas—Sodii Phosphatis—Sodium Phos- phate. U.S. P. (Sodium Orthophosphate.) Origin.__Prepared by digesting Bone Ash with Sulphuric Acid. The solution is filtered, and to it is added Sodium Carbonate, and the filtrate evaporated to crystallization. Description and Properties.—Large, colorless, monoclinic prisms, odorless, and having a cooling, saline taste. The crys- tals effloresce in the air, and gradually lose 5 molecules of water of crystallization. Soluble in 5.8 parts of water; insoluble in alcohol. Sodium phosphate should be kept in well-stoppered bottles, in a cool place. Dose.—5 grains-i ounce (0.32-32.0 Gm.). 688 A TEXT-BOOK OF MATERIA MEDICA. Sodii Sulphas—Sodii Sulphatis—Sodium Sulphate. U. 8. P. (Glauber's Salt.) Origin.—The residue left in the manufacture of Hydrochloric Acid from Salt is neutralized with Sodium Carbonate. Description and Properties.—Large, colorless, transparent, monoclinic prisms or granular crystals; odorless, and having a bitter, saline taste. The salt effloresces rapidly in the air, and finally loses all its water of crystallization. Soluble in 2.8 parts of water and in glycerin; insoluble in alcohol. Dose.—1-8 drachms (4.0-32.0 Gm.). Physiological Action and Therapeutics of the Salines.—These preparations greatly augment the intestinal secretions, their activity depending upon the nature and amount of the salt and the strength of its solution; the greater the amount of the solution, the sooner the purgative action is produced. Save the sulphate and phosphate of sodium, which are mild hepatic stimulants, the salines have no effect upon the biliary secretions. The sodium salts are more efficient than the potassium salts as purgatives, owing to the slower absorption of the former, which enables them to act more directly upon the intestinal canal. Purgation by the salines is painless, and occurs usually in from two to three hours after administration, there being ordinarily two or three watery evacuations. In cases of habitual constipation, particularly that associated with the gouty diathesis, there are no better purgatives than the salts of sodium or mineral waters containing them, such as Carlsbad, Marienbad, Hunyadi Janos, etc. For children there is no better purgative than sodium phos- phate, especially where the stools show a deficiency of bile. In duodenal catarrh excellent results are obtained by this drug; also in chronic rheumatism, and to retard the formation of biliary calculi. Concentrated saline purgatives are efficient remedies for the removal of dropsical and pleuritic effusions. Magnesium sulphate, combined with dilute sulphuric acid, is the most efficient treatment in cases of chronic lead-poisoning. Rochelle salt and Seidlitz powder are pleasant and useful purgatives in cases of biliousness, migraine, etc. Solution of mag- CATHARTICS. 689 nesium citrate is used for the same purpose, but, while very palatable and acceptable to the stomach, is not always reliable, besides being apt to occasion slight griping. Administration.—The salines should be taken dissolved in plenty of water, and ordinarily should be administered in the morning, when the stomach is empty. DRASTIC PURGATIVES. These drugs are even harsher in their action than hydragogue purgatives, exciting violent peristalsis, and in large doses producing gastro-enteritis and all the symptoms occasioned by an irritant poison. The evacuations produced by these drugs are numerous, copious, and watery, attended with much griping pain, tenesmus, and borborygmi. Colocynthis—Colocynthidis-Colocynth. U. 8. P. Origin.—The fruit of Citrullus Colocynthis Schroder, deprived of its rind. The colocynth plant is indigenous in Japan and is cultivated and naturalized in Spain. Description and Properties.—From 2 to 4 inches (5-10 Gm.) in diameter; globular; white or yellowish-white, light, spongy; readily breaking into three wedge-shaped pieces, each containing, near the rounded surface, many flat, ovate, brown seeds; inodor- ous ; taste intensely bitter. The active constituent of colocynth is colocynthin, a glucosid, of which there is present about 2 per cent. Colocynth also con- tains resin, gum, and an amyloid principle. Dose.—5-10 grains (0.3-0.6 Gm.). Official Preparations. ExtrSctum Colocynthidis—ExtrScti Colocynthidis—Extract of Colocynth. Dose, |-2 grains (0.03-0.13 Gm.). Extractum Colocynthidis Compbsitum—ExtrScti Colocynthidis CompSsiti —Compound Extract of Colocynth.—Extract of Colocynth 16 per cent., with Aloes, Scammony, Cardamom, and Soap. Dose.—5-25 grains (0.3-1.6 Gm.). Compound Extract of Colocynth enters into the following pills : Pilulae CathSrticae Composite (8 per cent.). Pilulae Catharticae Vegetabiles (6 per cent.). Physiological Action and Therapeutics.—The action of colo- cynth is very similar to that of elaterin. In small doses, however, 44 690 A TEXT-BOOK OF MATERIA MEDICA. it rather acts as a stomachic, improving the appetite and augment- ing the secretions of the whole gastro-intestinal tract. Colocynth is quite a decided hepatic stimulant and cholagogue. Pills containing colocynth are useful to produce abundant watery evacuations, as is necessary sometimes in the treatment of hepatic and renal diseases where there is constipation and ascites. The drug should be employed only when there is some marked indication for its use, as colocynth, like the other drastics, is too irritant for habitual use. Gastro-intestinal inflammation, pregnancy, etc., would contra- indicate its use. Jalapa—JalapaB—Jalap. U.S. P. Origin.—The tuberous root of Ipomcea Jalapa Nuttall, a twin- ing herbaceous perennial growing in damp and shady woods on the eastern slope of the Mexican Andes. It has been introduced into India and Jamaica. Description and Properties.—Napiform, pyriform, or oblong, varying in size, the large roots incised, more or less wrinkled, dark brown, with lighter-colored spots and short, transverse ridges; hard, compact, internally pale grayish-brown, with numerous con- centric circles composed of small resin-cells ; fracture resinous, not fibrous; odor slight, but peculiar, smoky, and sweetish; taste sweetish and acrid. Jalap contains two resins, one hard, the other soft, the former, termed jalapin or convolvulin, being the active principle of the drug. According to the U. S. Pharmacopoeia, there must be not less than 12 per cent, of resin, of which not less than 10 per cent. must be soluble in ether. Dose.—5-30 grains (0.32-2.0 Gm.). Official Preparations. Extr3ctum Jalapae—Extracti Jalapae—Extract of Jalap.—Dose, 2-5 grains (0.13-0.3 Gm.). Ptilvis Jalapae Compbsitus—Pulveris Jalapae CompSsiti—Compound Jalap Powder (35 per cent., with Potassium Bitartrate).— Dose, 15-60 grains (1.0-4.0 Gm.). Resina Jalapae—Resinae Jalapae—Resin of Jalap.—Description and Proper- ties.—Yellowish-brown or brown masses or fragments, breaking with a resinous, glossy fracture, translucent at the edges, or a yellowish-gray or yellowish-brown powder, having a slight, peculiar odor, and a somewhat acrid taste. Permanent in the air. Soluble in alcohol in all proportions. Dose.—2-5 grains (0.13-0.3 Gm.). Extract of Jalap is one of the ingredients of Pilulae Catharticae Compbsitae and Pilulae Catharticae Vegetabiles. CATHARTICS. 691 Physiological Action and Therapeutics. — The purgative action of jalap is developed in the duodenum, where it comes in contact with the bile. The secretion from the intestinal glands is greatly augmented, as well as the vascularity and peristalsis of the intestines. The biliary flow is but little affected. Purgation is produced by jalap in three or four hours, the evacuations being profuse and watery and attended with griping pain. Jalap—or, preferably, the compound jalap powder—is a reliable hydragogue cathartic for the removal of dropsical effusions, being especially appropriate for nephritic patients. Small doses of jalap are serviceable in constipation due to de- ficient intestinal secretion. The drug is frequently associated with anthelmintic medicines as a vermifuge. Scammonium—Scammonii—Scammony. U. 8. P. Origin.—A resinous exudation from the living root of Convol- ■ vulus Scammonia L., a herbaceous, twining perennial, growing in Syria, Asia Minor, and Greece. Description and Properties.—Occurring in irregular angular pieces or circular cakes, greenish-gray or blackish, internally por- ous, and breaking with an angular fracture, of a resinous luster; odor peculiar, somewhat cheese-like; taste slightly acrid; powder gray or greenish-gray. It contains a resin, jalapin, which is the active principle, besides gum, starch, etc. Dose.—1-15 grains (0.06-1.0 Gm.). Official Preparation. Resina Scammonii—Resinae Scammonii—Resin of Scammony.—Descrip- tion and Properties.—Yellowish-brown or brownish-yellow masses or fragments, break- ing with a glossy, resinous fracture, translucent at the edges, or a yellowish-white or grayish-white powder, having a faint, peculiar odor, and a slight, peculiar taste. Soluble in alcohol in all proportions. Dose.—1-8 grains (0.06-0.5 Gm.). Physiological Action and Therapeutics.—The action of scam- mony is identical with that of jalap, save that it stimulates the muscular coat of the intestines more, producing more irritation and griping than jalap, though not increasing secretion so much as the latter drug. 692 A TEXT-BOOK OF MATERIA MEDICA. The tnerapeutics are the same as for jalap. The drug may be given in powder, emulsion, or in milk, but is inactive in pilular form. Podophyllum—Podophylli—Podophyllum. U. S. P. (May Apple.) Origin.—The rhizome and roots of Podophyllum peltatum L., an herbaceous perennial growing in rich woodlands in Canada and the United States. Description and Properties.—Of horizontal growth, consisting of joints about 2 inches (5 Cm.) long, flattish cylindrical, about \ inch (6 Mm.) thick, but somewhat enlarged at the end, which has a circular scar on the upper side, a tuft of about ten nearly simple, fragile roots on the lower side, and is sometimes branched laterally; smooth or somewhat wrinkled, orange-brown, internally white and mealy, with a circle of small wood-bundles; pith large; nearly inodorous ; taste sweetish, somewhat bitter and acrid. Podophyllum contains a resin, podophyllin, composed princi- pally of podophyllotoxin, which is probably a mixture of picropodo- phyllin, the purgative principle, and podophyllinic acid, an inactive resin acid. Among other constituents of the drug are several minor resins and a coloring principle. Dose.—5-20 grains (0.32-1.29 Gm.). Official Preparations. Extractum Podophylli—Extracti Podophylli—Extract of Podophyllum.— Dose, 1-3 grains (0.06-0.2 Gm.) Extractum Podophylli Fluidum—Extracti Podophylli Fluidi—Fluid Ex- tract of Podophyllum.—Dose, 5-20 minims (0.32-1.29 Cc). Resina Podophylli—Reslnae Podophylli—Resin of Podophyllum.—Descrip- tion and Properties.—An amorphous powder, varying in color from grayish-white to pale greenish-yellow or yellowish-green, turning darker when exposed to heat; having a slight peculiar odor and a peculiar, faintly bitter taste; permanent in the air; soluble in alcohol in all proportions. Dose.—£-1 grain (0.008-0.06 Gm.). Podophyllotftxin (unofficial).—Dose, ^-fa grain (0.0006-0.006 Gm.). Physiological Action and Therapeutics.—The powdered root is an irritant to the skin, and when inhaled occasions a decided irritation of the eyes and respiratory passages. It is absorbed when applied to ulcers and raw surfaces, producing its character- istic purgative effects. The drug is a gastro-intestinal irritant, being ANTHELMINTICS. 693 apt to excite nausea, in full doses producing salivation and greatly augmenting the intestinal secretions, and especially the bile. Under full doses of podophyllum there is marked peristalsis, attended with severe griping pains, and in the course of ten or twelve hours there is produced a complete evacuation of the bowels, the feces being liquid and deeply stained with bile. The drug being one of the most active hepatic stimulants and cholagogues in the Pharmacopoeia, it is a peculiarly appropriate remedy in that condition known as torpor of the liver. The con- stipation attending hepatic cirrhosis and cancer, as well as that from any hepatic disorder, is well treated by podophyllum. The slowness and completeness of its action, together with its property of stimulating the functional activity of the liver, renders the drug extremely serviceable in the treatment of habitual consti- pation from any cause. It should, however, be associated with antispasmodics, such as hyoscyamus or belladonna, to overcome its griping. When asso- ciated with other purgatives care should be exercised to select those only which, like itself, are tardy in their action. Owing to the susceptibility of certain persons to the drug, the dosage should be small at first and gradually increased as necessary. GROUP XV.—ANTHELMINTICS. Anthelmintics are remedies which kill or expel intestinal worms. Those drugs which kill the parasites are called vermi- cides, and those which simply promote their expulsion are called vermifuges) The vermicides are— Aspidium, Kamala, Chenopodium, Oleum Terebinthinae,* Cusso, Pepo, Granatum, Santonica. The vermifuges are— Calomel,* Spigelia. Hydragogue Purgatives,* Anthelmintics are here divided according to the kind of intesti- nal parasite against which they are employed. The Oxyuris vermicularis is the small worm, often called seat- 1 Drugs marked with an asterisk (*) are considered elsewhere. 694 A TEXT-BOOK OF MATERIA MEDICA. worm or thread-worm, that infests the large intestine and rectum. The Ascaris lumbricoides is the common round-worm, found chiefly in the small intestine. The To3nio3 are the tape-worms. Remedies employed against the Oxyuris vermicularis : A weak solution of Carbolic Acid,* Lime Water,* Infusion of Quassia,* Calomel,* Decoction of Aloes,* Oleum Terebinthinae.* Remedies employed against the Ascaris lumbricoides : Chenopodium, Calomel,* Santonica, Hydragogue Purgatives,* Spigelia, Oleum Terebinthinae.* Remedies employed against the Taenia Solium and other varieties of Tamia: Aspidium, Kamala, Cusso, Pepo, Granatum, Oleum Terebinthinae.* Chenopodium—Chenopodii—Chenopodium. U.S.P. (American Wormseed.) Origin.—The fruit of Chenopodium ambrosioides L., and the variety anthelminticum Gray, plants indigenous in the West Indies, and Central and South America, and naturalized in the United States. Description and Properties.—Nearly fa inch (2 Mm.) in diam- eter, depressed globular, dull greenish or brownish, the integu- ments friable, and containing a lenticular, obtusely-edged, glossy, black seed. It has a peculiar, somewhat terebinthinate odor, and a bitterish, pungent taste. It contains a volatile oil, to which its medical properties are due. Dose.—15-30 grains (1.0-2.0 Gm.). Oleum Chenopodii—Olei Chenopodii—Oleum Che- nopodii. U.S. P. (Oil of American Wormseed.) Origin.—A volatile oil distilled from Chenopodium. Description and Properties.—A thin, colorless or yellowish liquid, having a peculiar penetrating, somewhat camphoraceous odor, and a pungent and bitterish taste. Dose.—2-10 minims (0.12-0.6 Cc). ANTHELMINTICS. 695 Physiological Action and Therapeutics.—Both the powdered seed and the oil are efficient anthelmintics, particularly useful to expel round-worms {Ascarides lumbricoides} from children. The drug should invariably be followed by a brisk cathartic. The powder may be given suspended in molasses, or the oil may be given dropped upon loaf-sugar, or in the form of an emulsion, or enclosed in capsules. Santonica—Santonicae—Santonica. U. 8. P. (Levant Wormseed.) Origin.—The unexpanded flower-heads of Artemisia pauciflora Weber, a plant growing in Asia and exclusively collected in North- ern Turkestan. Description and Properties.—From -fa to \ inch (2 to 3 Mm.) long, oblong-ovoid, obtuse, smooth, somewhat glossy, grayish- green, after exposure to light brownish-green, consisting of an in- volucre of about twelve to eighteen closely imbricated, glandular scales with a broad midrib, enclosing four or five rudimentary florets; odor strong, peculiar, somewhat camphoraceous; taste aromatic and bitter. The drug contains about 2 per cent, of a neutral principle, santonin, to which its anthelmintic properties are due. It also contains about 1 per cent, of an unimportant volatile oil. Dose.—10-60 grains (0.6-4.0 Gm.). Santonlnum—Santonini—Santonin. U. 8. P. Origin.—A neutral principle obtained from Santonica. Description and Properties.—Colorless, shining, flattened, pris- matic crystals, odorless, and nearly tasteless when first put into the mouth, but afterward developing a bitter taste; not altered by ex- posure to air, but turning yellow on exposure to light. Nearly insoluble in cold water; soluble in 40 parts of alcohol. Santonin should be kept in dark, amber-colored vials, and should not be exposed to light. Dose.—l~i gram (0.016-0.06 Gm.) for a child; 1-5 grains (0.06-0.32 Gm.) for an adult. Official Preparation. Trochisci Santonini—Trochlscos (ace.) Santonini—Troches of Santonin.— Each troche contains \ grain (0.03 Gm.).— Dose, 2 (child) to 10 troches (adult). 696 A TEXT-BOOK OF MATERIA MEDICA. Physiological Action and Therapeutics.—In full or large doses santonin may excite nausea or vomiting, with abdominal pain, diarrhea, eructations, borborygmi, and great thirst. It readily enters the blood, where it exists as sodium santoninate. Large doses may cause giddiness, headache, hallucinations of smell and taste, tremors, and a species of depression, the combination of symptoms forming what is called santonin intoxication. The drug is chiefly eliminated through the kidneys, small amounts of santonin even imparting to the urine a distinct yellow color if the urine is acid, and a decided purplish or even red color if the urine is alkaline. Under certain circumstances when the urine is decidedly alkaline, as in cases of cystitis, the administra- tion of santonin may produce so marked a discoloration of the urine as to suggest hematuria. Probably the most remarkable phenomenon attending the inges- tion of medicinal doses of santonin is that of xanthopsia or yellow vision, which may continue for several hours. According to Rose, " there occasionally appears before the peculiar yellow sight, after large doses of santonin, a violet color of the field of vision: the intensity of this color is in proportion to the darkness of the objects looked at. All light objects, such as windows, paper, etc., appear actually yellow. Red and blue appear often in their complementary colors, orange and green, so that carmine-red appears pale, madder- red a bronze color, and the sky and blue objects green. This. however, is not always the case, and it has been noticed after the employment of santonin that red appears violet or light, and dark objects appear orange to one person, and to another green." (Quoted from Lewin.) This peculiar effect of santonin is due, according to Rose, to a nervous change in the retina or in the brain. Affections of the skin—e. g. urticaria—have occasionally fol- lowed the administration of santonin. Decidedly poisonous effects have sometimes been produced by comparatively small amounts of the drug. The symptoms of a fatal case from over-dose of santonin were convulsions accompanied by unconsciousness, twitching of the eyeballs, dilated pupils, cold sweat, weak pulse, feeble respiration, and, after some hours, sudden death. In case of poisoning by santonin the remedial measures are in- ternal and external stimulants, eliminants, and artificial respiration. Santonin is certainly a most efficient remedy against the ascaris, and to a less extent it is of use against the oxyuris. It has no effect on the tenia. ANTHELMINTICS. 697 The drug should be given on an empty stomach, either alone or associated with calomel, and followed in two or three hours by castor oil or other brisk cathartic. It may be administered in the form of a powder mixed with sugar or jelly, or in pills or cap- sules. Troches of santonin are much used and are very efficient. Spigelia—Spigeliae—Spigelia. U. 8. P. (Pinkroot.) Origin.—The rhizome and roots of Spigelia marilandica L., a plant growing in rich shady woods, chiefly in the southern part of the United States, but found as far northward as Pennsylvania and Wisconsin. Description and Properties.—Of horizontal growth, about 2 inches (5 Cm.) or more long, about \ inch (3 Mm.) thick, dark purplish-brown, bent, somewhat branched on the upper side, with cup-shaped scars; on the lower side with numerous thin, brittle, light-colored roots about 4 inches (10 Cm.) long; the rhizome internally with a whitish wood and a pith which is usually dark colored or decayed; odor somewhat aromatic; taste sweetish, bitter, and pungent. It Contains a volatile alkaloid, spigeline, which is the active principle. Dose.—1~2 drachms (1.0-8.0 Gm.). Official Preparation. Extractum Spigeliae Fluidum—ExtrScti Spigeliae Fluidi—Fluid Extract of Spigelia.—Dose, \-2 fluidrachms (1.0-8.0 Cc). Physiological Action and Therapeutics.—Spigelia is a pow- erful anthelmintic, being a decided vermifuge against the Ascaris lumbricoides. When given alone and in full doses it may produce symptoms of narcotic poisoning. This may be obviated by asso- ciating it with cathartics and aromatics. The drug may be administered in the form of a tea, associated with senna, fennel, or other aromatics. The fluid extract is a reli- able preparation. Remedies employed against the different varieties of Taenia : Aspldium—Aspidii— Aspidium. U. S. P. (Male Fern.) Origin.__The rhizome of Dryopteris Filix mas Schott and of Dryopteris marginalis Gray, plants indigenous in North America, 698 A TEXT-BOOK OF MATERIA MEDICA. a portion of South America, Asia, Europe, and some parts of Africa. Description and Properties.—From 3 to 6 inches (7 to 15 Cm.) long, \ to 1 inch (12 to 25 Mm.) thick, and, together with the closely imbricated, dark-brown, roundish, and slightly curved stipe-remnants, 2 to 3 inches (50 to 75 Mm.) in diameter; densely covered with brown, glossy, transparent, and soft, chaffy scales; internally pale green, rather spongy; vascular bundles about ten {Dryopteris Filix mas) or six {Dryopteris marginalis) in number, arranged in an interrupted circle; odor slight, but disagreeable; taste sweetish, acrid, somewhat bitter, astringent, and nauseous. Aspidium contains filicic acid, tannaspidic acid, pteritannic acid, filicin (filicic acid anhydride), fixed oil, a trace of volatile oil, and chlorophyl. Dose.—J-2 drachms (2.0-8.0 Gm.). Official Preparation. Oleoresina Aspidii—Oleoresinae Aspldii—Oleoresin of Aspidium.—Dose, J-l fluidrachm (1.0-4.0 Cc). Note.—Oleoresin of aspidium usually deposits, on standing, a granular crystalline substance. This should be thoroughly mixed with the liquid portion before use. The oleoresin should be kept in well-stoppered bottles. Physiological Action and Therapeutics.—Aspidium is the most reliable teniacide known to materia medica. Though it is employed against both the armed and unarmed varieties of tape- worm, it is nevertheless against the latter that it is specially effec- tive. In the cases of armed taeniae special precautions must be taken to ensure success. The drug possesses tonic and astringent properties, and if taken in very large doses may occasion nausea, vomiting, diarrhea, and gastric and abdominal pains. Several fatal cases of poisoning have occurred, and it is believed that the fatalities were due not so much to excessive dose as to increased absorption of the drug through the influence of the castor oil that had been administered with it. When given for the expulsion of tape-worm the bowels should first be emptied by a castor-oil purge, and then the oleoresin be administered in gelatin capsules or in emulsion. Previous to the exhibition of the anthelmintic the patient should for at least twenty-four hours live on exceedingly spare diet, and the medicine then be given in the morning fasting. A few hours ANTHELMINTICS. 699 later an active purge of about 1 ounce (30.0 Cc.) of castor oil or calomel and jalap should be given to expel the dead worm, which should be carefully examined for the head. If the head did not pass, the treatment should be repeated the following day or soon after. Cusso—Cusso—Kousso. U. 8. P. (Brayera.) Origin.—The female inflorescence of Hagenia Abyssinica (Bruce) Gmelin, a handsome tree 40 to 50 feet (12 to 18 M.) high, in- digenous on the table-land and in the mountainous districts of Abyssinia. Description and Properties.—In bundles, rolls, or compressed clusters consisting of panicles about 10 inches (25.0 Cm.) long, with a sheathing bract at the base of each branch; the two round- ish bracts at the base of each flower and the four or five obovate outer sepals are of a reddish color, membranous and veiny; calyx top-shaped, hairy, enclosing two carpels or nutlets; odor slight, fragrant, and tea-like; taste bitter, acrid, and nauseous. It contains a neutral active principle, kosin, a tasteless and an acid resin, and about 24 per cent, of tannin. Dose.—2-4 drachms (8.0-16.0 Gm.). Official Preparation. ExtrSctum Cusso Fluidum—ExtrScti Cusso Fluidi—Fluid Extract of Cusso.—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Kosin—Koussein (unofficial).— Origin.—The active principle from the flowers and unripe fruits of Hagenia Abyssinica (Bruce) Gmelin. 'Description and Properties.—An amorphous yellowish crystalline powder having a pungent bitter taste. Insoluble in water, but readily soluble in alcohol and in ether. Dose, 15-30 grains (1.0-2.0 Gm.), to be divided into four doses and taken at inter- vals of half an hour. Physiological Action and Therapeutics.—The action of kousso upon the digestive tract, under large doses, is similar to the action of aspidium. It is a reliable anthelmintic for all species of tape- worm. The fluid extract should be given in the form of an emul- sion, the patient having previously fasted, and the exhibition of the drug followed in a few hours by a large dose of castor oil. Granatum—Granati—Pomegranate. U. S. P. Origin.—The bark of the stem and root of Tunica Granatum L, a shrub or small tree about 20 feet (6 M.) high, indigenous in Southwestern Asia from Northern India to Palestine. 700 A TEXT-BOOK OF MATERIA MEDICA: Description and Properties.—In thin quills or fragments from 2 to 4 inches (5 to 10 Cm.) long and from fa to \ inch (1. to 3. Mm.) thick; outer surface yellowish-gray, somewhat warty or longitudinally and reticulately ridged; the stem-bark often partly covered with blackish lichens; the thicker pieces of the root-bark more or less scaly externally; inner surface smooth, finely striate, grayish-yellow; fracture short, granular, greenish-yellow, indis- tinctly radiate; inodorous; taste astringent, very slightly bitter. It contains as its active constituent a liquid alkaloid, pelletierine, with its three allied alkaloids, methyl-pelletierine, pseudo-pelletierine, and iso-pelletierine, besides mannite and punico-tannic acid. Dose.—\-\\ drachms (2.0-6.0 Gm.). Unofficial Preparations. Pelletierine.— Origin.—An alkaloid derived from the root-bark of Punica grana- tum L. Description and Properties.—A colorless liquid. Soluble in 20 parts of water and miscible in all proportions with alcohol. It forms crystalline salts with acids, the prin- cipal one being the tannate. There are also the sulphate, hydrobromate and hydrochlorate. Pelletierinae Tannas—Pelletierinae Tannatis—Pelletierine Tannate.—De- scription and Properties.—A yellowish, hygroscopic, odorless powder, with a pungent astringent taste. Soluble in 700 parts of water and in 80 parts of alcohol. Dose.—1-5 grains (0.06-0.32 Gm.). Physiological Action and Therapeutics.—Locally pomegran- ate is astringent. In large doses it excites vomiting, acts as a purgative, paralyzes the motor nerves, but does not affect sensa- tion, and dilates the capillaries. Pomegranate and its alkaloid, pelletierine, are efficient anthel- mintics for tape-worm. Like other anthelmintics, the drug should be given on an empty stomach, and if the bowels are not freely moved by the remedy, an active cathartic should follow its administration. A decoction of the bark may be used, but, owing to the diffi- culty in obtaining the fresh drug, which alone possesses anthel- mintic properties, the tannate of pelletierine, which is always reliable, is usually administered. Kamala—Kamalae—Kamala. U. 8. P. (Rottlera.) Origin.—The glands and hairs from the capsules of Mallotus Philippinensis (Lamarck) Mueller, Arg., a large shrub or small tree A N THEL MIN TICS. 701 growing wild in Australia, Eastern China, India, Southern Arabia, and Abyssinia. Description and Properties.—A granular, mobile, brick-red or brownish-red powder, inodorous and nearly tasteless, imparting a deep-red color to alkaline liquids, alcohol, ether, or chloroform, and a pale yellow tinge to boiling water. Under the microscope it is seen to consist of stellately arranged, colorless hairs, mixed with depressed-globular glands, containing numerous red, club-shaped vesicles. It contains a resinous coloring matter, rottlerin, and several resins. Dose.—1-2 drachms (4.0-8.0 Gm.). Physiological Action and Therapeutics.—Kamala is a gastro- intestinal irritant and purgative, and an efficient anthelmintic against the Taenia solium, as well as the Oxyuris vermicularis and the Ascaris lumbricoides. The drug should be taken suspended in syrup, and followed by a full dose of castor oil. Pepo—Peponis—Pumpkin Seed. U. 8. P. Origin.—The seed of Cucurbita Pepo L., the common pumpkin, indigenous in tropical Asia and America, and cultivated through- out the temperate zones. Description and Properties.—About f inch (2 Cm.) long, broadly-ovate, flat, white or whitish, nearly smooth, with a shallow groove parallel to the edge; containing a short, conical radicle and two flat cotyledons ; inodorous ; taste bland and oily. It contains an acrid resin, supposed to be the active principle, and from 30 to 35 per cent, of a thick red fixed oil. Dose.—1-3 ounces (32.0-94.0 Gm.). Physiological Action and Therapeutics.—Pumpkin seed ranks next to aspidium as a remedy for the destruction of tape-worm, and has the advantage of being free from any disagreeable taste or unpleasant action. For administration the fresh pumpkin seeds should be beaten into a paste with powdered sugar and diluted with milk or water to about 1 pint (473-17 Cc). Previous to its administration the patient should fast for twenty-four hours, when the bowels should be flushed out with a large saline purgative. A portion of the emulsion of pumpkin seed is then to be taken, preferably in the morning, and the balance taken in two doses at intervals of about two hours, the patient meanwhile remaining in bed to prevent, as far as possible, disturbance of the stomach. 702 A TEXT-BOOK OF MATERIA MEDICA. Three or four hours after the last dose of the emulsion has been taken the patient should be given a full dose of castor oil. GROUP XVI.—EMMENAGOGUES AND ECBOLICS. Emmenagogues are remedies which restore or increase the men- strual flow. They are divided, according to their action, into two classes. Those which act upon the uterine muscle or mucous membrane are said to be direct; those which influence the uterus by affecting the general health of the body, or by altering the blood-supply of the parts, or by influencing the nervous system, are said to be indirect. The principal Direct Emmenagogues are— Ergot, Borax, Digitalis, Rue, Savine, Hydrastis, Quinine, Caulophyllum, Asafetida, Tansy, Myrrh, Apiol, Guaiac, Hedeoma. Cantharides, The Indirect Emmenagogues are:— Iron and the Hematics, Cinnamon, Cod Liver Oil, Aloes. Strychnine, c Hot foot-bath. Baths I Hot hip-bath. I Mustard bath. To genitals. To thighs. ( Baths. Mustard < Poultices to thighs. I Stupes. Ecbolics or Oxytocics are remedies which act directly upon the uterine muscular fibers, inducing uterine contraction, and are chiefly used during or immediately after parturition to produce or increase uterine action. They are therefore contraindicated before parturi- tion, lest they induce abortion, although they are often used crimi- nally for this purpose. The exact manner in which ecbolics act is unknown, but it is Leeches EMMENAGOGUES AND ECBOLICS. 703 supposed that they act directly by stimulating the uterine center in the cord or reflexly through uterine congestion. In small doses many of the ecbolics are emmenagogue, while many of the direct emmenagogues are ecbolic. The only justifiable uses for ecbolics are in parturition, with uterine inertia and unobstructed and well-dilated maternal parts, when it is desired to hasten the delivery of the child, or, second to induce firm contraction of the uterus, and thus prevent or check uterine hemorrhage after the birth of the child. The principal Ecbolics are— Ergot, Oil of Rue, Ustilago, Borax, Hydrastis, Pilocarpine, Savine, Potassium Permanganate, Quinine, Strong Purgatives. Cotton Root Bark, Drugs which have not been considered elsewhere in the present work will now be described. Sabina—Sabinae—Savine. U. 8. P. Origin.—The tops of Juniperus Sabina L., a small ever- green procumbent or erect shrub, distributed throughout the greater portion of Europe, Siberia, Canada, and the Northern United States. Description and Properties.—Short, thin, subquadrangular branchlets; leaves rather dark green, in four rows, opposite, scale- like, ovate-lanceolate, more or less acute, appressed, imbricated, on the back with a shallow groove containing an oblong or round- ish gland; odor peculiar, terebinthinate; taste nauseous, resinous, and bitter. It contains 2 per cent, of a volatile oil, tannin, resin, gum, etc. Dose.—5—15 grains (0.3-1.0 Gm.). Official Preparation. Extractum Sabinae Fluidum—ExtrScti Sabinae Fluidi—Fluid Extract of Savine.—Dose, 5-15 minims (0.3-1.0 Cc). Oleum Sabinae—Olei Sabinae—Oil of Savine. U. 8. P. Origin.—A volatile oil distilled from Savine. Description and Properties.—A colorless or yellowish liquid 704 A TEXT-BOOK OF MATERIA MEDICA. having a peculiar terebinthinate odor and a pungent, bitterish, and camphoraceous taste. It becomes darker and thicker by age and exposure to the air. Soluble in an equal volume of alcohol. Dose.—1-5 minims (0.06-0.3 Cc). Physiological Action and Therapeutics.—The action of savine depends on the presence of the volatile oil, and this oil differs in its local external effect from the oil of turpentine merely in that the oil of savine is more active. It occasions much irritation, vesi- cation, and even pustulation when applied to the skin. Taken internally in small doses, it produces a sensation of heat in the epigastrium, with flatulence and frequently nausea. Toxic doses excite violent gastro-enteritis. The drug stimulates the circulation, and later, under full me- dicinal doses, depresses it. It is rapidly absorbed, and is excreted by various channels, increasing the urinary and bronchial excre- tions. These excretions, as well as the sweat and breath, smell strongly of the drug. Savine is a decided irritant to the uterus and ovaries, inducing marked hyperemia of those organs, and promoting contractions of the pregnant uterus. Toxic doses produce symptoms similar to those occasioned by oil of turpentine—violent gastro-enteritis, suppressed or bloody urine, great depression, etc The treatment in poisoning by oil of savine would be full doses of Epsom salt, demulcents, anodynes, and stimulants if necessary. Savine in the form of an ointment is used as a stimulant appli- cation to keep up the discharge from blisters. An alcoholic solu- tion of oil of savine, 5-30 minims (0.3-1.8 Cc.) to 1 ounce (30.0 Cc), is used in alopecia pityroides. Oil of savine is a very efficient remedy in amenorrhea, and is also of benefit in certain cases of menorrhagia due to an enlarged and passively congested uterus. The hemorrhage following abor- tion is usually well controlled by this remedy. The powder or fluid extract may be given, but the oil is the most effective preparation, and may be prescribed in capsules, pills, or emulsion. It should be given cautiously. Ruta—RGtae—Rue. (Unofficial.) Origin.—The leaves of Ruta graveolens L., an herbaceous or suffruticose perennial 2 or 3 feet (60 or 90 Cm.) high, indigenous in Southern Europe. EMMENAGOGUES AND ECBOLICS Description and Properties.—The leaves are ternate, the leaf- lets being obovate-oblong, yellowish-green, thickly dotted with minute, transparent oil-vesicles. They have a peculiar, strongly balsamic odor, and possess an aromatic, bitter, and acrid taste. The principal constituent of rue is a volatile oil. Dose.—5-20 grains (0.3-1.3 Gm.). Oleum Rutae—Olei RGtae—Oil of Rue. (Unofficial.) Origin.—A volatile oil distilled from Ruta graveolens L. Description and Properties.—A colorless or greenish-yellow liquid with the peculiar odor of the plant, and a pungent, some- what acrid, bitterish taste. Soluble in an equal weight of alcohol. Dose.—2-5 minims (0.13-0.3 Cc). Physiological Action and Therapeutics.—The action of oil of rue is analogous to that of oil of savine, though less powerful. It is used for the same purposes also, and has occasionally been employed in hysteria. The oil should be administered in capsules. Caulophyllum—Caulophylli—Caulophyllum. U. 8. P. (Blue Cohosh.) Origin.—The rhizome and roots of Caulophyllum Thalictroides (L.) Michaux, a smooth and glaucous perennial, found in rich woodlands from Canada south to Carolina and Kentucky. Description and Properties.—Rhizome of horizontal growth, about 4 inches (10 Cm.) long and about i to f inch (6 to 10 Mm.) thick, bent; on the upper side with broad, concave stem-scars and short, knotty branches; externally grayish-brown, internally whitish, tough, and woody. Roots numerous, matted, about 4 inches (10 Cm.) long and fa inch (1 Mm.) thick, rather tough; nearly inodorous; taste sweetish, slightly bitter, and somewhat acrid. Caulophyllum contains an odorless, colorless, and tasteless alka- loid, caulophyllin, besides resins, tannin, starch, gum, etc Dose.—5-30 grains (0.3-2.0 Gm.). Physiological Action and Therapeutics.—Blue cohosh is em- menagogue, antispasmodic, diuretic, and demulcent. It is quite an efficient remedy to increase the force of uterine contractions, and is of service in the treatment of spasmodic dysmenorrhea. It is usually given in the form of a decoction. 45 706 A TEXT-BOOK OF MATERIA MEDICA. Tanacetum—Tanaceti—Tansy. U. 8. P. Origin.—The leaves and tops of Tanacetum vulgare L., a perennial herb indigenous in Europe and Central Asia, and nat- uralized in many parts of North America. Description and Properties.—Leaves about 6 inches (15.24 Cm.) long, bipinnatifid, the segments oblong, obtuse, serrate, or incised, smooth, dark green, and glandular; flower-heads corym- bose, with an imbricated involucre, a convex, naked receptacle, and numerous yellow tubular florets; odor strongly aromatic; taste pungent and bitter. It contains a volatile oil and a bitter principle, tanacetin, besides tannin, resin, etc. Dose.—15-60 grains (1.0-4.0 Gm.), in infusion. Physiological Action and Therapeutics.—In moderate doses tansy acts as an aromatic bitter. Excessive amounts produce all the symptoms of an irritant narcotic—vomiting, purging, severe abdominal pain, loss of consciousness, convulsions, and great car- diac and respiratory weakness, death usually resulting from paral- ysis of respiration. The drug is regarded as an efficient remedy in amenorrhea, and is extensively employed in domestic practice in hysteria and colic, and topically for bruises, sprains, muscular rheumatism, etc. It is used in the rural districts to promote or restore menstrua- tion, and occasionally is employed with criminal intent as an abor- tifacient, but usually with negative results. The drug may be given in the form of an infusion, I ounce to 1 pint (32.0 Gm.-473.17 Cc), of which 1 or 2 ounces (30.0 or 60.0 Cc.) may be taken at a dose. The oil of tansy is occasionally prescribed in doses of 1-5 minims (0.06-0.3 Cc). Petroselinum—Petroselini—Parsley. Origin.—The root of Petroselinum sativum (Hoffmann), Apium Petroselinum L., a plant indigenous in Southern Europe, and much cultivated for culinary purposes. Description and Properties.—The root is tapering, from 4 to 8 inches (10-20 Cm.) long, about \ inch (12 Mm.) thick; exter- nally yellowish or light brown ; odor aromatic ; taste sweetish and aromatic. It contains a volatile oil and apiol, the chief constituent. Dose.—30-60 grains (2.0-4.0 Gm.). EMMENAGOGUES AND ECBOLICS. 707 Apiolum—Apioli—Apiol (Unofficial).— Origin.—A camphor obtained from the fruit of Petroselinum sativum Hoffmann. Description and Properties.—White needles, of a feeble, parsley odor. Insoluble in water, but freely soluble in alcohol and in ether. Dose.—10-15 grains (0.6-1.0 Gm.). Physiological Action and Therapeutics.—The root is carmin- ative, laxative, and diuretic. Apiol is an active emmenagogue. Given in excessive doses, it occasions severe frontal headache, dizziness, and ringing in the ears. It causes a rapid rise of blood- pressure, due to increased cardiac action and stimulation of the vaso-motor centers. Apiol, or Chapoteaut's apioline, is usually prescribed, and is an efficient remedy in amenorrhea, dysmenorrhea, and as an anti- periodic in malarial affections. As an emmenagogue in cases of scanty or deficient menstruation apioline is very effective. The drug is best given in capsules, as prepared by Chapoteaut,1 one or two capsules being taken after meals three times a day. Hedeoma—Hedeomae—Hedeoma. U. 8. P. (Pennyroyal.) Origin.—The leaves and tops of Hedeoma pulegioides (L.) Per- soon, an annual herb indigenous in North America. Description and Properties.—Leaves opposite, short-petioled, about \ inch (12 Mm.) long, oblong-ovate, obscurely serrate, glan- dular beneath; branches roundish-quadrangular, hairy; flowers in small, axillary cymules, with a tubular-ovoid, bilabiate, and five- toothed calyx, and a pale-blue, spotted, bilabiate corolla, containing two sterile and two fertile exserted stamens ; odor strong, mint-like; taste warm and pungent. Its virtues depend upon a volatile oil. Dose.—15-60 grains (1.0-4.0 Gm.) in infusion. Oleum Hedeomae—Olei Hedeomae—Oil of Hede- oma. U. 8. P. (Oil of Pennyroyal.) Origin.—A volatile oil distilled from Hedeoma. Description and Properties.—A pale-yellowish, limpid liquid, having a characteristic, pungent, mint-like odor and taste. It should 1 M. Chapoteaut has prepared from the alcoholic solution of a petrol-ethereal extract a thick reddish liquid, to which he has given the name Apioline. This substance he claims to be the true active principle, and it is dispensed in capsules containing 3 minims {0.18 Cc.) each. 708 A TEXT-BOOK OF MATERIA MEDICA. be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—2-10 minims (0.1-0.6 Cc). Physiological Action and Therapeutics.—Hedeoma is aro- matic, stimulant, carminative, and emmenagogue, while the oil is rubefacient if rubbed into the skin. The herb is given in the form of a hot infusion to bring on retarded or suspended menstruation and for the relief of flatulent colic, pharyngitis, bronchitis, etc., as well as to dissipate congestions of various parts. The oil of hedeoma is an active emmenagogue, and is used to increase the rubefacient effect of various embrocations. GROUP XVII.—ASTRINGENTS. Astringents are medicines which cause the contraction of living tissues, diminishing the amount of blood or other fluid in them, and reducing hemorrhage, or, through their constipating action, limiting the intestinal secretions as well as those from mucous membranes generally. They act chemically upon the tissues, and, when taken inter- nally, their influence is similar to that of tonics, invigorating the various structures of the body, their principal use being, in cases of relaxed conditions of the muscles and fibers or of the mucous membranes characterized by excessive secretion. Astringents are more or less irritating, and should therefore not be employed, as a rule, in acute inflammatory conditions. There are, however, four exceptions—lead acetate or subacetate, bismuth subnitrate or subcarbonate, cerium oxalate, and silver nitrate— which are sedative astringents and would be indicated in acute inflammatory states. Astringents vary in the intensity of their action, their strength being directly proportionate to the condensation of tissue. Herein lies the chief difference between astringents and caustics. If the heavy metals be arranged according to their astringent properties, the feeblest at one extreme and the strongest at the other, it will be observed that the least astringent is the most caustic, and the most astringent the least caustic, the order being as follows: lead {astringent), iron, zinc, copper, silver, tin, mercury {caustic), lead being the most astringent and least caustic, and mercury the most caustic and least astringent. ASTRINGENTS. 709 The explanation of these diverse properties is that the astrin- gents expel the fluid from the protoplasm, contracting or constring- ing the tissue and causing it to occupy less space; whereas the caustics relax the eschar, reducing the space it occupies. The caustic action of a mineral salt depends both upon the nature of the base and the acid radical. In other words, the salt and the products of its action must both be somewhat soluble in water, otherwise the eschar will be firm, and the drug will therefore act as an astringent. The chlorides of the heavy metals are usually soluble, and are generally the more caustic, as, for instance, zinc chloride, mercuric chloride (corrosive sublimate), etc. Should a chloride be insoluble in water, it will not act as a caustic—as, for example, the insoluble, and consequently inert, silver chloride. Certain drugs which in a concentrated state are caustic are, if sufficiently diluted, astringent, as is the case with sulphuric acid. An astringent drug employed to check hemorrhage is called a styptic, the subsulphate of iron being extensively used as such. Astringents differ in some respects from other groups of medi- cines, in that they do not, as a rule, assist one another by combi- nation. They are divisible into—(1) Vegetable astringents; (2) mineral astringents. The vegetable astringents mentioned in this group, beginning with the type, are— Tannic Acid, Kino, Rhus Glabra, Gallic Acid, Krameria, Rosa Gallica, Galla, Hematoxylon, Rubus. Quercus Alba, Hamamelis, Catechu, Geranium, Cinnamon also possesses considerable astringent properties, but is classed among the Aromatics. The mineral astringents, beginning with the type, are- Lead, Silver, Bismuth, zinC;' Alum, Cerium Oxalate. Copper, Certain salts of iron are powerfully astringent, although classed with iron under the Restoratives. Diluted sulphuric and nitric acids also possess marked astringent properties. (See Mineral Acids.) Antagonists and Incompatibles.—The vegetable astringents are incompatible with the salts of iron (ferric and ferrous), and also with the salts of lead, silver, antimony, and copper; with the alka- 710 A TEXT-BOOK OF MATERIA MEDICA. loids, the glucosids, and gelatin ; and with the alkalies and mineral acids and emulsions. Spirit of nitrous ether is incompatible with gallic acid. Synergists.—Tonics and bitters, and also agents increasing waste, favor the action of vegetable astringents. VEGETABLE ASTRINGENTS. Acidum Tannicum—Acidi Tannici—Tannic Add. U. 8. P. Origin.—An organic acid obtained from Nutgall. Description and Properties.—A light-yellowish, amorphous powder, usually cohering in the form of glistening scales or spongy masses; odorless or with ai faint characteristic odor and a strongly astringent taste ; gradually turning darker when exposed to air and light. Soluble in about i part of water and in 0.6 part of alcohol; very soluble in boiling water and in boiling alcohol; also soluble in about 1 part of glycerin with the assistance of a moderate heat; freely soluble in diluted alcohol and sparingly in absolute alcohol; almost insoluble in absolute ether, chloroform, benzol, or benzin. Dose.—1-20 grains (0.06-1.2 Gm.). Official Preparations. Collodium Stypticum—CollSdii Styptici—Styptic Collodion.—Used exter- nally and locally. (Tannic Acid, 20; Alcohol, 5; Ether, 25; Collodion, to 100.) Glyceritum Acidi Tannici—Glyceriti Acidi TSnnici—Glycerite of Tannic Acid.—Used externally and locally. (Tannic Acid, 20; Glycerin, 80.") Trochisci Acidi TSnnici—Trochlscos (ace.) Acidi Tannici—Troches of Tannic Acid.—Dose, 1 to 3 troches. Unguentum Acidi Tannici—Unguenti Acidi T3nnici—Ointment of Tannic Acid.—Used externally and locally. (Tannic Acid, 20; Benzoated Lard, 80.) Physiological Action.—Externally.—Tannic acid has little if any effect upon the unbroken skin. Upon raw surfaces, however, it acts as a powerful astringent, contracting the tissues and coagu- lating the albumin. Urticaria and erythema sometimes follow its use. Internally.—Digestive System.—By coagulating the albumins tannic acid imparts a dryness to the mouth, accompanied by a sen- sation of puckering. It partially paralyzes the sensory nerve- endings, thus blunting the sense of taste. Large doses produce vomiting by an irritant action, while diarrhea, followed by consti- pation, may be present. ASTRINGENTS. 711 By its action on the stomach pepsin is precipitated, albumin co- agulated, and the secretion of gastric juice diminished, all of which actions tend to impair the digestive function. There is a partial conversion of the tannic acid into gallic and pyrogallic acids. To facilitate absorption there must be a preliminary conversion of tannic into gallic acid, and this reaction takes place in the intestine. A diminution of peristalsis is followed by constipation. Circulatory System.—Its astringent property makes tannic acid a valuable hemostatic. It arrests hemorrhage by contracting the blood-vessels. The blood absorbs it as gallic acid, and is not affected by it. Nervous System.—No special effect has been observed. Respiratory System.—Save in arresting hemorrhage of the lungs, no influence is known. Absorption and Elimination.—Being absorbed as gallic acid, the kidneys eliminate it in that form. A doubtful action ascribed to it by some authorities is that of diminishing albuminuria. Uterus.—No special influence other than arresting hemorrhage has been noted. Untoward Action.—A dose of 3 grains (0.2 Gm.) may cause pain in the stomach and intestines. Following such a dose, there may be coating of the tongue, thirst, eructation of gas, and tenes- mus. A tendency to hemorrhoidal congestion is enhanced. Therapeutics.—Externally and Locally.—Tannic acid is a val- uable application for bed-sores and ulcers. Its astringent property is of use in cases of intertrigo, impetigo, sycosis, sore nipples, and eczema of the chronic, desquamating variety. It is beneficial in hyperidrosis of the hands and feet, of the axillcs and genitals. A solution of the acid has been found of advantage in erysipelas and lymphangitis. The glycerite of tannin, applied locally in cases of otorrhea and ozena as sequelae of scarlet fever or measles, is of great benefit. The same preparation or a powder may be used in stomatitis, ton- sillitis, and pharyngitis, as well as in cases of spongy or ulcerous gums. The lozenges are beneficial in whooping cough. Sup- positories of tannic acid are employed for hemorrhoids, fissure, prolapse, and rectal ulcers. An aqueous solution of tannic acid is very useful in leucor- rhea. The glycerite and iodoform tannin are excellent agents in inflammation of the cervix uteri. Tannic acid also dispels the odor and allays the discharges in carcinoma uteri, being applied as a 712 A TEXT-BOOK OF MATERIA MEDICA. vaginal douche. It is useful as a lotion in herpes and alopecia cir- cumscripta. Injection of the acid or insufflation of the powder into the urethra is of some value in gonorrhea. In hemoptysis an aque- ous solution (5—10 grains to the ounce of water) may be used as a spray. In acute dysentery much benefit may be derived from an enema of 10 grains of tannin added to a 4 per cent, solution of boric acid. It lessens pain and tenesmus and controls hemorrhage. Internally.—For other than local action gallic is preferable to tannic acid, the latter not being absorbable. Tannic acid is styptic in hematemesis and intestinal hemorrhage and checks diarrhea. It forms tannates when given as an antidote for poisoning by alkaloids and tartar emetic. Since these tannates are more or less soluble, however, some drug should be given as a purgative. Contraindications.—From comparative absorbability of tannic and gallic acids the former is preferable for local, the latter for systemic, effects. Administration.—For hematemesis powders of 10-20 grains are given. For effect upon the intestines it should be administered in pills, 3-5 grains, or it may be dissolved in the stomach. Locally it may be applied as a solution, glycerite, powder, suppository, or an ointment. Styptic collodion is a protection to lacerated or incised wounds. Acidum Gallicum—Acidi Gallici—Gallic Acid. U. 8. P. Origin.—An organic acid usually prepared from Tannic Acid. Description and Properties.—White or pale fawn-colored, silky, interlaced needles or triclinic prisms; odorless, having an astringent or slightly acidulous taste; permanent in the air. Sol- uble in 100 parts of water and in 5 parts of alcohol. Dose.—5-20 grains (0.3-1.2 Gm.). Physiological Action.—Gallic acid resembles tannic acid in its action, but does not coagulate albumin, and therefore does not possess the local influence of the latter. It is eliminated by the kidneys as gallic acid. Therapeutics.—Externally and Locally.—Gallic acid is seldom used externally. Locally, tannic acid is preferable, but gallic acid is effectual applied as a glycerite, 1 drachm-i ounce (4.0-32.0 Gm.), in cases of tonsillitis and pharyngitis. Gallic acid and stramonium ointment in equal parts form an unguent for hemorrhoids. In alcoholic solution it is applied to the membrane of diphtheria. ASTRINGENTS. 713 Internally.—Gallic acid is chiefly serviceable in hemorrhage from the stomach, intestines, lungs, and kidneys, It is employed in men- orrhagia, but ergot is better. It reduces albumin in some forms of Brighfs disease, and is useful in checking excessive sweating and bronchorrhea. In chronic phthisis it relieves the night-sweats and reduces profuse expectoration. Cystitis, dysentery, and chronic diar- rhea are benefited by its use. It checks suppuration and stays the .progress of pyelitis and pyelo-nephritis. Used in conjunction with opium, it has been found beneficial in diabetes insipidus. Pyrogallic acid is of use in acne, but produces a discoloration of the skin. Pyrogallol, 2 grains (.12 Gm.), is used in internal hemorrhage. As an ointment, 1 drachm-1 ounce (4.0-32.0 Gm.), it is palliative in psoriasis, and it is also beneficial in lupus and epithelioma. Gallanol, the analid of gallic acid, is a bactericide, and is use- ful in psoriasis in the form of a powder or in an ointment (1 to 30). It is also used in alcoholic solutions of 10 per cent, strength. It relieves the pruritus of chronic eczema. In favus and tricophytosis a mixture is used consisting of gallanol 10 parts, ammonia 1 part, and alcohol 50 parts. Gallicine, methyl ether of gallic acid, applied in finely divided form with a brush, is of benefit in keratitis and conjunctivitis, as well as in eczema of the eyelids. Administration.—Gallic acid is not to be combined with iron. It is administered in powder or pill form. The glycerite and the ointment are used locally. Galla-Gallae-Nutgall. U. 8. P. Origin.__An excrescence on Quercus Lusitanica Lamarck, caused by the punctures and deposited ova of Cynips galte tinctorial Olivier. Quercus Lusitanica is a small tree, or oftener a shrub, 4 to 6 feet (1.2-1.8 M.) high, indigenous in the basin of the Mediter- ranean. Description and Properties.—Nutgalls are subglobular, about 1 inch (25 Mm.) in diameter, more or less tuberculated above, otherwise smooth, heavy, hard; often with a circular hole near the middle communicating with the central cavity containing either the partly developed insect or pulverulent remains of it; inodor- ous ; taste strongly astringent. Galla in substance is seldom given internally. 714 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Tinctura Gallae—Tinctiirae GaUlas—Tincture of Nutgall.—Dose, I to 2 fluid- drachms (4.0-8.0 Gm.). Unguentum Gfilla—Unguenti GSllae—Ointment of Nutgall.—Used exter- nally. Physiological Action.—Its action is that of tannic acid, which is derived from galls. Therapeutics.—Externally and Locally.—Galla, in combination with stramonium liniment or 1 drachm (4.0 Gm.) of powdered opium to each ounce (32.0 Gm.) of nutgall ointment, is an excellent application for external hemorrhoids. For eczema of the scalp, herpes, fissured nipples, indolent ulcers, and chilblains nutgall oint- ment has proved beneficial, as well as for alopecia circumscripta and rectal prolapse. One part of powdered galls to seven or eight of vaseline is a most excellent application for lessening the cica- tricial contraction following extensive burns. Galla is used little locally, but is recommended as a gargle and wash, being applied to the relaxed mucous membranes of the mouth, vagina, and rectum. Internally.—Tannic and gallic acids are preferable in severe diarrhea and dysentery, an infusion or decoction being used as an enema. Administration.—Galls are used mostly in the form of an infusion or ointment. The tincture is seldom employed. Qugrcus Alba—Quercus Albae—White Oak. U. 8. P. Origin.—The bark of Quercus alba L. The oaks are shrubs or trees growing chiefly in the temperate zone, often forming exten- sive forests. The white oak is a stately tree, 60 to 80 feet (18-24 M.) high, found from Canada to Florida and west to Wisconsin and Eastern Texas. Description and Properties.—In nearly flat pieces deprived of the corky layer, about \ inch (5 Mm.), pale brown; inner surface with short, sharp, longitudinal ridges; tough and of a coarse, fibrous fracture, a faint, tan-like odor, and a strongly astringent taste. As found in the shops, it is usually an irregularly coarse fibrous powder, which does not tinge the saliva yellow. Dose.—Seldom given in substance. A decoction is sometimes given internally, but the chief use of the drug is for external or local application. ASTRINGENTS. 715 Physiological Action.—The general action is that of tannic acid. , Therapeutics.—Externally and Locally.—It is used for chapped nipples, gangrene, ulcers, and dermatitis venenata. It is of value as an ointment in hemorrhoids, prolapsus ani, anal fissure, and leu- corrhea. The drug is also serviceable in relaxed uvula and as a tooth-powder. It stains the linen, however, which somewhat limits its use. Pessaries made of the bark have been used to check uterine hemorrhage. For hernia the concentrated fluid extract is injected into the tissues for the purpose of exciting inflammation and consequent contraction of the hernial ring. Internally'.—It reduces bronchial discharge, hemoptysis, serous diarrhea, and dysentery. Administration.—Externally it is used as a poultice—chiefly in the form of the powdered bark. The decoction is employed almost exclusively as an injection and for internal administration. The laity were formerly wont to roast the acorns and chew them, or grate them and mix the gratings with cocoa or chocolate, believing them to be a cure for diarrhea as well as for flatulent dyspepsia and scrofula. Catechu—Catechu—Catechu. U. S. P. Origin.—An extract prepared from the wood of Acacia catechu (Linn, fil.) Willd., a tree 30 to 40 feet (9-12 M.) high, indigenous in the East Indies and Ceylon. Description and Properties.—Occurring in irregular masses, containing fragments of leaves; dark-brown, brittle, somewhat porous and glossy when freshly broken. It is nearly inodorous and has a strongly astringent and sweetish taste. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Tinctura CStechu CompSsita—Tinctiirae Csitechu Compositae—Compound Tincture of Catechu.—Dose, \-2 fluidrachms (2.0-8.0 Cc). (Catechu, 100; Cassia Cinnamon, 50; by maceration and percolation with Diluted Alcohol to 1000.) Trochisci C3techu—Trochlscos (ace.) Csitechu—Troches of Catechu.— Dose, 1 to 6 troches. (Each troche contains 1 grain (0.06 Gm.) of catechu.) Physiological Action.—Catechu does not differ in its action from tannic acid. It is to be preferred to kino, however, since its operation is more energetic. Therapeutics.—Externally and Locally.—Though used but little externally, it is a very efficient remedy for ulcerated nipples 716 A TEXT-BOOK OF MATERIA MEDICA. and chronic ulcers, the form employed being that of a lotion, used either alone or in combination with copper sulphate or alum. Catechu is of service in constringing relaxed tissues, and is used as a mouth-wash in spongy gums, ptyalism, and relaxation of the uvula. It is also of use as a gargle in pharyngitis and chronic sore throat of public speakers and users of tobacco. In gonorrhea and leucorrhea an injection of 2-3 drachms (8.0-12.0 Gm.) of the tincture in 5-6 ounces (160.0-192.0 Gm.) of water is beneficial. Catechu has been used by persons suffering from pyrosis. It is claimed that chewing a small pellet of the drug diminishes the coating of mucus on the mucous membrane of the stomach. It is applied to aphtha in stomatitis. Internally.—Its prevailing use is in chronic serous diarrheas, but the administration must be preceded by a saline purge in order to secure the fullest effect. Catechu checks uterine hemor- rhage and the secretions in bronchitis and chronic phthisis. Administration.—The troche is best used in chronic pharyn- gitis and relaxed buccal mucous membranes, or a piece of the drug may be chewed with beneficial results. For diarrhea the compound tincture, with a little morphia or the official chalk mixture, is the best form for use. Kino—KIno-Kino. U. 8. P. Origin.—The inspissated juice of Pterocarpus marsupianum Roxburgh, a tree (called buja in Bengal) 60 to 80 feet (18-24 M.) high, indigenous in India and Ceylon. Description and Properties.—Small, angular, dark brownish- red and transparent; inodorous, very astringent and sweetish, coloring the saliva deep red. Soluble in alcohol, nearly insoluble in ether, and only slightly soluble in cold water. Dose.—10-20 grains (0.6-1.2 Gm.). Official Preparation. Tinctura Kino—Tinctiirae Kino—Tincture of Kino.—Dose, £-2 fluidrachms (1.0-8.0 Cc). Physiological Action.—Its action is similar to that of tannic acid. It colors the saliva red. Therapeutics.— Externally and Locally.—Kino is an efficient dressing for flabby, indolent ulcers, acting as a stimulant. Yet the other astringents deserve precedence. As a gargle in pharyngitis and relaxed uvula kino is valuable, but, owing to its disagreeable ASTRINGENTS. 717 taste, krameria is to be preferred. Owing to its speedy action, it checks the hemorrhage in epistaxis where other astringents fail. In leucorrhea and gonorrhea an infusion or injection is serviceable. Internally.—In the polyuria of diabetes, in menorrhagia, the sweating of phthisis, and pyrosis it has been used to some advan- tage ; also in dysentery and chronic diarrheas with profuse serous discharges. It is less irritating than the other astringents. Administration.—The powder is used as an insufflation in epistaxis, and is dusted on ulcers. In diarrhea it is best to use kino in combination with opium or chalk mixture. The tincture is used internally. Krameria—Krameriae—Krameria. U. S. P. (Rhatany.) Origin.—The root of Krameria triandra Ruiz et Pavon, and of Krameria ixina L., a low shrub with spreading branches, native to Bolivia and Peru, growing in sandy localities in the mountains at an altitude of 3000 to 8000 feet (900-2440 M.). Description and Properties.—From 1 to \\ inches (25-38 Mm.) thick, knotty and several-headed above, branched below, the branches long; bark smooth, or in the thinner pieces scaly, deep rust-brown, fa-fa inch (1-2 Mm.) thick, very astringent, inodor- ous; wood pale, brownish-red, tough, with fine medullary rays, nearly tasteless. The root of Krameria ixina (Savanilla rhatany) is less knotty and slenderer, and has a dark purplish-brown bark about \ inch (3 Mm.) thick. Dose.—8-30 grains (0.5-2.0 Gm.). Official Preparations. ExtrSctum Krameriae—Extracti Krameriae—Extract of Krameria.—Dose, 5-10 grains (0.3-0.6 Gm.). Extr3ctum Krameriae Fluidum—Extracti Krameriae Fluidi—Fluid Extract of Krameria.—Dose, 5-30 minims (0.3-2.0 Cc). Tinctura Krameriae—Tinctiirae Krameriae—Tincture of Krameria.—Dose, \-2 drachms (2.0-8.0 Cc). Trochisci Krameriae—Trochlscos (ace) Krameriae—Troches of Krameria. —Dose, I to 5 troches. (Each troche contains 1 grain (0.06 Gm.). Syrupus Krameriae—Syrupi Krameriae—Syrup of Krameria.—Dose, \-\ fluidrachms (2.0-16.0 Cc). Physiological Action.—The action of krameria is identical with that of tannic acid. Therapeutics.—Externally and Locally.—Its value as a topical application is of little consequence, but it has served satisfactorily 718 A TEXT-BOOK OF MATERIA MEDICA. as an ointment for hemorrhoids. It is used as an infusion or injec- tion of the diluted tincture or fluid extract in leucorrhea, gleet, and especially in anal fissure, for which it has been highly recom- mended, since it checks the accumulation of feces in the rectum by constricting its walls, rendering defecation less painful and prevent- ing the formation of ulcers. The powder is used in epistaxis and rectal bleeding, also in prolapsus ani and ozena of a non-specific nature. It is used extensively in the preparation of tooth-powders, being especially beneficial where the gums display a tendency to bleed readily. A mouth-wash and gargle are used in ptyalism, spongy gums, pharyngitis, and relaxation of the uvula. Internally.—Krameria has gained a wide reputation for allaying habitual, but not profuse, uterine hemorrhage. It may be used to check intestinal hemorrhages, hematuria, hematemesis, and hemopty- sis, but the other astringents are preferable. It is a good tonic for debilitated patients. It is also used in chronic diarrhea and dysen- tery and in incontinence of urine. Administration.—The powder is used in the nose and rectum either by insufflation or by means of a pledget of cotton. As an injection and enema the fluid extract is used. In fissure of the anus the rectum must be emptied first by an enema; then a solu- tion of the extract, i drachm (4.0 Gm.) to 1 ounce (30.0 Cc.) of water, is emptied into the bowel and allowed to run out, repeating the process several times. This procedure is very painful at first, but as the fissure gradually heals the operation will cause the patient little if any pain. Keep the bowels open with a mild saline laxative. The success attending the operation warrants any discomfort which the patient may experience. The nasal douche is best in ozena, followed by an insufflation of the powder. Haematoxylon—Haematoxyli—Haematoxylon. 77. 8. P. (Logwood.) Origin.—The heart-wood of Hcematoxylon Campechianum L., a tree 30 to 40 feet (9-12 M.) high, indigenous on the shores of the Gulf of Campeachy and in certain parts of South America. Description and Properties.—Heavy, hard, externally pur- plish-black, internally brownish-red, marked with concentric cir- cles, splitting irregularly; odor faint, agreeable, taste sweetish, astringent. When chewed it colors the saliva dark pink. Only the preparations of Haematoxylon are used' internally. ASTRINGENTS. 719 Official Preparation. Extractum HaematSxyli—Extr3cti Haemat6xyli—Extract of Haematoxy- lon.—Dose, 5-15 grains (0.3-1.0 Gm.). Physiological Action.—Its astringent properties are due to the tannin which haematoxylon contains. Therapeutics.—Externally and Locally.—It is a valuable anti- septic, as well as a healing application in gangrene and foul- smelling sores. It is also beneficial as an injection in leucorrhea. Internally.—Haematoxylon has a very agreeable, sweetish taste; hence it is well taken by children. It is of marked benefit in in- fantile diarrhea, but has the disadvantage of coloring the dis- charges and diaper blood-red, causing much alarm to the mother. The urine is also colored. It arrests internal hemorrhage and sweating, and is also used in dysentery, tuberculous diarrhea, and atonic dyspepsia. Some authorities claim that haematoxylon causes phlebites. Administration.—In diarrhea a decoction with a little aromatic sulphuric acid is the best preparation. To it may be added a little syrup of ginger and camphorated tincture of opium. The decoc- tion is, in fact, the best preparation to use. Hamamelis—Hamamelidis— Hamamelis. U. S. P. (Witch-hazel.) Origin.—The leaves of Hamamelis Virginica L., a shrub 6 to 10 feet (1.8-3.0 M.) high, growing in damp woods and thickets in Canada and the United States. Description and Properties.—Short-petiolate, about 4 inches (10 Cm.) long, obovate or oval, slightly heart-shaped and oblique at the base, sinuate-toothed, thickish, nearly smooth, inodorous; taste astringent and bitter. Official Preparation. Extractum HamamSlidis Fluidum—Extracti Hamamfilidis Fluidi—Fluid Extract of Hamamelis.—Dose, ^-2 fluidrachms (2.0-8.0 Cc). Physiological Action.—The action of tannic acid is also that of hamamelis, save that the latter has a somewhat different influ- ence upon the circulation. Circulatory System.—Hamamelis acts on the muscular fibers of the veins, the modus operandi, however, not being satisfactorily determined. Large doses produce severe throbbing headache. 720 A TEXT-BOOK OF MA TERIA MEDICA. Therapeutics.—Externally and Locally.—For sprains and bruises hamamelis is a favorite application, although some authorities re- gard it merely as a placebo. Locally, the fluid extract, with the addition of one-third its volume of glycerin, has been used in urticaria, rhus-poisoning, and phlegmasia dolens. Owing to its marked sedative properties, hamamelis ointment is extremely beneficial in varicose ulcers, eczema, herpes, seborrhea, and acne rosacea, as well as in checking excessive secretions. It is also efficient in carbuncle, freckles, hyperidrosis, lupus erythematosus, burns, and frost-bites. The local action of the drug is important. The distilled extract, diluted with alcohol or water, is applied to inflamed gums, the nasal mucous membrane after removal of polypi, and in pharyn- gitis as a spray. As a suppository or applied by means of a piece of cotton or wool soaked with the fluid extract, hamamelis affords a most grateful relief in bleeding piles, especially the internal vari- ety. In cystitis and hemorrhage from the bladder an injection of the diluted fluid extract or distilled extract is very valuable, besides being a most reliable topical application in capillary hemor- rhage from wounds, epistaxis, and bleeding after extraction of teeth. The ointment is used in rectal fissures and ulcers, and the lotion has been employed to some extent in chronic rheumatism, since it relieves the pain and stiffness in the muscles and joints. The decoction, with a little boric acid and a I per cent, solution of creasote, has been recommended as a gonorrheal injection. Internally.—Given internally, hamamelis enhances the results obtained by the local application in bleeding piles, leucorrhea, and gonorrhea, and, owing to its peculiar action upon the veins, in varicose veins. It lessens the pain of dysmenorrhea, while by its use in menorrhagia the flow is remarkably diminished. It is highly beneficial in internal hemorrhages, hemoptysis, hematuria, hemateme- sis, and especially in uterine hemorrhages. It reduces suppuration in pyelitis and the excessive morbid discharge in chronic bronchitis. It is a valuable remedy in purpura hcemorrhagica, chronic enteritis, diarrhea, dysentery, and varicocele. Hamamelis also prevents abortion. Administration.—The best preparation, both for internal and external use, is the distilled extract, although it is not official. The ointment and lotion are used externally, and the fluid extract internally. The preparations of hamamelis to be found in drug- stores are unreliable unless they be perfectly fresh. Some of the ASTRINGENTS. 721 proprietary preparations are concocted with extreme care and accuracy, and are often much more efficient than the official articles which have been standing in the shops for a long while, possibly exposed to the air. Geranium—Geranii—Geranium. U. S. P. (Cranesbill.) Origin.—The rhizome of Geranium maculatum L., a perennial herb with a stem 2 to 3 feet (30-60 Cm.) high, very common in Canada and the United States westward as far as Kansas. Description and Properties.—Growth horizontal, cylindrical, 2 to 3 inches (5-7 Cm.) long and about \ inch (1 Cm.) thick; rather sharply tuberculated, longitudinally wrinkled, dark brown; bark thin ; wood-wedges yellowish, small, forming a circle near the cambium line; medullary rays broad, central pith large; roots thin, fragile, inodorous; taste strongly astringent. Dose.—20-40 grains (1.2-2.40 Gm.). Official Preparation. Extractum Geranii Fluidum—Extr3cti Geranii Fluidi—Fluid Extract of Geranium.—Dose, 20-40 minims (1.2-2.40 Cc). Physiological Action.—The action of geranium corresponds with that of tannic acid. Therapeutics.—Externally and Locally.—Geranium is not used externally. Its local action is varied. It is serviceable as an astringent gargle in sore throat; as a mouth-wash in aphthous stomatitis ; in relaxed conditions of the rectum, vagina, and throat; in buccal ulcer, metrorrhagia, and anal fissure ; in prolapsus ani and epistaxis. It has also proved valuable as an injection in leucorrheah gonorrhea, and gleet. Internally.—Owing to its agreeable taste, it is useful in infantite diarrhea and for persons having weak stomachs. In the early stages of phthisis it is very beneficial, as it reduces the fever and pulse-rate, at the same time checking the night-sweats, cough,. expectoration, and hemoptysis. Under it the patient's appetite im- proves and he gains in weight. The fluid extract, in combination with an aromatic, gives perceptible temporary relief in rapid acute phthisis attended with severe, distressing cough and debilitating night-sweats. It has also been used to advantage in internal, hemorrhages. 46 722 A TEXT-BOOK OF MATERIA MEDICA. Administration.—Locally, the powdered root and fluid extracts are used, but the fluid extract diluted with water is preferable. For an injection a decoction, I ounce (32.0 Gm.) to 1-2 pints (512.0-1024.0 Gm.) of water, is used, and the decoction in milk is of service in infantile diarrhea. Prof. Johnson claims that gera- nium contains mucilaginous material which, acting as a demulcent, makes the decoction a much more desirable preparation than a simple solution of tannin. Rhus Glabra—Rhois Glabrae—Rhus Glabra. U. 8. P. (Sumach.) Origin.—The fruit of Rhus glabra L., a shrub or suffruticose plant about 12 feet (3.6 M.) high, growing in rocky or barren soil in North America. Description and Properties.—Subglobular, about \ inch (3 Mm.) in diameter, drupaceous, crimson, densely hairy, containing a roundish-oblong, smooth putamen; inodorous; taste acidulous. Dose.—The preparations only are used internally. Official Preparation. Extractum Rhois Glabrae Fluidum—Extracti Rhois Glabrae Fluidi—Fluid Extract of Rhus Glabra.—Dose, \-\ fluidrachm (1.0-4.0 Cc). Allied Species. Rhus Aromatica—Rhus Aromaticae—Sweet Sumach. Unofficial Preparation. Extractum Rhois Aromaticae Fluidum—Extracti Rhois Aromaticae Fluidi —Fluid Extract of Rhus Aromatica.—Dose, 5 minims-1 fluidrachm (0.3-4.0 Cc). Physiological Action.—The action of Rhus glabra resembles that of tannic acid. Therapeutics.—Externally and Locally.—An infusion or the fluid extract is used as a topical application for ulcers and in- flamed wounds. The infusion is an excellent mouth-wash in spongy gums, ptyalism, pharyngitis, aphthous stomatitis, and tonsil- litis. It can be used alone, but is much more efficient when com- bined with potassium chlorate and glycerin, adding a little menthol, 2-3 grains (.12-20 Gm.), to make the mixture more agreeable. It is also of service as an injection in leucorrhea. Internally.—Rhus glabra acts well in staying incontinence of urine and hematuria. A dose of 10-30 drops of the fluid extract, ASTRINGENTS. 723 taken two or three times daily, has produced complete temporary suspension of nocturnal cneurcsis of children, as well as senile eneuresis. Administration.—The fluid extract is used exclusively. Rosa Gallica—Rosae Gallicae—Red Rose. U. 8. P. Origin.—The petals of Rosa gallica L., collected before ex- panding. Description and Properties.—Usually occurring in small cones consisting of numerous imbricated, roundish, retuse, deep purple- colored, yellow-clawed petals, having a roseate odor and a bitterish, slightly acidulous, and distinctly astringent taste. Official Preparations. Confectio Rosae—Confectionis Rosae—Confection of Rose.—Used as an excipient in pill masses. Extractum Rosae Fluidum—Extracti Rosae Fluidi—Fluid Extract of Rose. —Used chiefly as a vehicle. Physiological Action.—It acts like tannic acid. Therapeutics.—Externally and Locally.—The ointment is used for chapped lips and hands, and also for superficial burns and in erythema. The fluid extract is used as an application to inflamed eyes, buccal, aural, and anal ulcers, and in aphthous stomatitis. It has been employed in conjunction with sodium salicylate to prevent the pitting of small-pox. Its chief use, however, is as a vehicle and flavoring extract. Internally.—-It is practically of but little value as an internal agent, although it exerts some action in checking profuse sweats and in uterine hemorrhages. Administration.—The fluid extract is mainly used, an infusion of which is given internally. The fresh leaves, crushed, are ser- viceable as a poultice. Rubus—RCibi—Blackberry. U. 8. P. Origin.—The root-bark of Rubus villosus Ait., Rubus Canaden- sis L., and Rubus trivialis Mx, common shrubby North American plants. Description and Properties.—Thin, tough, flexible bands, outer surface blackish or blackish-gray, inner surface pale-brownish, some- 724 A TEXT-BOOK OF MATERIA MEDICA. times with strips of whitish, tasteless wood adhering; inodorous; taste strongly astringent, somewhat bitter. Official Preparation. Extractum Riibi Fluidum—Extracti Riibi Fluidi—Fluid Extract of Rubus. —Dose, \-2 fluidrachms (2.0-8.0 Cc). Physiological Action.—Identical with that of tannic acid. Therapeutics.—Internally.—The fluid extract is used in the summer diarrhea of children—practically its only employment. An infusion of the leaves is claimed by Popoff to be an excellent remedy for debility of the bladder. Administration.—The fluid extract and the infusion are used as medicinal agents. The syrupus rubi idaei is used only as a vehicle. Blackberry cordial and blackberry brandy are favorite modes of administration. It is commonly believed by the laity that the various blackberry and raspberry preserves are efficacious as remedies ; on the contrary, they are highly irritating, because of the seeds present in them. mineral astringents. Plumbum—Plumbi—Lead. The salts of lead only are used in medicine. Plumbi Acetas—Plumbi Acetatis—Lead Acetate. V. 8. P. (Sugar of Lead.) Origin.—Metallic Lead is dissolved, in the presence of air, in Acetic Acid, or Lead Oxide is dissolved by the aid of a gentle heat in Acetic Acid and Water, the solution being filtered, evaporated, and crystallized. Description and Properties.—Colorless, shining, transparent, monoclinic prisms or plates, or heavy, white, crystalline masses, or granular crystals, having a faintly acetous odor and a sweetish, astringent, and afterward metallic taste. On exposure to the air efflorescent and absorbing carbon dioxide. Soluble in 203 parts of water and in 21 parts of alcohol, in 0.5 part of boiling water, and in 1 part of boiling alcohol. Lead acetate should be kept in well-stoppered bottles. Dose.—i—5 grains (0.03-0.3 Gm.). ASTRINGENTS. 725 Official Preparations. Liquor Plumbi Subacetatis—Liquoris Plumbi Subacetatis—Solution of Lead Subacetate (Goulard's Extract).—Used externally and locally. (The solu- tion contains about 25 per cent, of Lead Subacetate.) Liquor Plumbi Subacetatis Dilutus—Liquoris Plumbi Subacetatis Diluti —Diluted Solution of Lead Subacetate (Lead Water).—Used externally and locally. (It contains 3 per cent, of Lead Subacetate.) Ceratum Plumbi Subacetatis—Cerati Plumbi Subacetatis—Cerate of Lead Subacetate (Goulard's Cerate).—Used externally and locally. (Goulard's Extract, 20; Camphor Cerate, 80 parts.) Unofficial Preparation. Linimentum Plumbi Subacetatis—Linimenti Plumbi Subacetatis—Lini- ment of Lead Subacetate.—Used externally and locally. (40 parts of Lead Sub- acetate to 60 parts of Cotton Seed Oil.) Plumbi Carbonas—Plumbi Carbonatis—Lead Car- bonate. U.S. P. (White Lead.) Origin.—Obtained by passing Carbon-dioxide Gas through a solution of Lead Acetate, or by adding an Alkali Carbonate to a solution of a Neutral Lead Salt. Description and Properties.—A heavy, white, opaque powder or a pulverulent mass, without odor or taste. Permanent in the air. Insoluble in water or alcohol, but soluble in acetic or diluted acetic acid, with effervescence. Lead carbonate should be kept in well-stoppered bottles. Used externally and locally. Official Preparation. Ungu6ntum Plumbi Carbonatis—Unguenti Plumbi Carbonatis—Ointment of Lead Carbonate (10 per cent.).—Used externally and locally. Plumbi Iodidum—Plumbi Iodidi—Lead Iodide. U. 8. P. Origin.—Obtained by mixing a solution of Lead Nitrate and Potassium Iodide, and drying the precipitate. Description and Properties.—A heavy, bright-yellow powder without odor or taste. Permanent in the air. Soluble in about 2000 parts of water and in about 200 parts of boiling water, sep- arating from the latter solution in brilliant golden-yellow spangles or crystalline laminae. Very slightly soluble in alcohol, but sol- uble without color, in solutions of the fixed alkalies, in concen- 726 A TEXT-BOOK OF MATERIA MEDICA. trated solutions of the acetates, of the alkalies, potassium iodide, and sodium hyposulphite, and in a hot solution of ammonium chloride. Lead iodide should be kept in well-stoppered bottles. Dose.—\ grain (0.13 Gm.). Official Preparation. UnguSntum Plumbi Iodidi—UnguSnti Plumbi Iodidi—Ointment of Lead Iodide (10 per cent.).—Used externally and locally. Plumbi NItras—Plumbi Nitratis—Lead Nitrate. U. 8. P. Origin.—Prepared by dissolving Lead in Diluted Nitric Acid. Description and Properties.—Colorless, transparent, octahedral crystals, or white, nearly opaque crystals, without odor and having a sweetish, astringent, and afterward metallic taste. Permanent in the air. Soluble in 2 parts of water; almost insoluble in alcohol. Used externally and locally. Plumbi Oxidum—Plumbi Oxidi—Lead Oxide. U. S. P. (Litharge.) Origin.—Obtained by roasting Lead in air. Description and Properties.—A heavy, yellowish or reddish- yellow powder or minute scales, without odor or taste. On expo- sure to the air it slowly absorbs moisture and carbon dioxide. Almost insoluble in water and insoluble in alcohol. Soluble in acetic or diluted nitric acid and in warm solutions of the fixed alkalies. Lead oxide should be kept in well-closed vessels. Used externally and locally. Official Preparations. Emplastrum Plumbi—Empiastri Plumbi—Lead Plaster (Diachylon Plas- ter).—Used externally and locally. (Lead Oxide or Lead Plaster is contained in Emplastrum Ammoniaci cum Hydrar- gyro and in Emplastra Ferri, Hydrargyri, Opii, Resinse, and Saponis.) UnguSntum Diachylon—UnguSnti Diachylon—Diachylon Ointment.— (Lead Plaster, 500; Olive Oil, 490; Oil of Lavender Flowers, 10.) Used externally and locally. Physiological Action.—Lead per se is practically inert; some of its salts, however, particularly the acetate, possess valuable therapeutic properties. ASTRINGENTS. 727 Externally and Locally.—Applied to the unbroken skin, lead salts have little if any effect, yet they act readily upon denuded surfaces, blanching the tissue of the parts by contraction of the small blood-vessels. In sores and ulcers they coagulate the albumin of the discharge and the protoplasm of the neighboring superficial cells, thus forming a protective coating for the healthier structure beneath. These salts have likewise a sedative action because of the decreased local circulation and the presumably depressant effect upon the nerve endings. Moreover, by virtue of their astringency they furnish valuable hemostatic and antiphlogistic remedies. In some cases the skin is discolored by their use. Internally.—Digestive System.—Lead acts immediately in the mouth, causing a sweet, styptic taste and coagulating the mucus. It contracts the cells and vessels of the entire alimentary canal, inducing dryness by diminished secretion. Consequent to the dis- turbed physiological functions of the digestive tract, the peristaltic movements diminish, and constipation necessarily ensues. Circulatory System.—The heart's action is slowed through the branches of the vagus by irritation of the cardiac inhibitory center. The pulse is lessened in volume and frequency, and lacks regularity. The blood takes up the lead as an albuminate, which soon passes into the tissues. While yet in the vascular system it inter- feres with the nutritive function of the corpuscles, producing by their destruction a watery condition of the blood. This explains the anemia usually present in cases of plumbism or lead-poisoning. Nervous System.—Both sensory and motor functions become deranged, especially the latter. This central irritation causes a dis- turbance, and finally paralysis, of various muscles. The involun- tary muscles appear to be most affected, and of these primarily the intestinal; hence, with the assistant local effect, arise distressing abdominal pains and spasms. The cardiac center and vagal branches to the heart are influenced, as already stated. Respiratory System.—The irritation produced in the respiratory centre has an inhibitory action through the vagus upon the respira- tion. Absorption and Elimination.—The preparations of lead are con- verted in the stomach into an albuminate, and thence taken up by the blood, very little absorption taking place in the intestine, where the lead is converted into an insoluble sulphide. It is absorbed by the abraded skin, and enters directly into combination with the 7^8 A TEXT-BOOK OF MATERIA MEDICA. albumin of the tissues. A portion of the lead albuminate is elimi- nated by the liver with the bile into the intestine, where, being con- verted into a sulphide, it is excreted in that form with the feces. The skin, kidneys, and mammary glands assist in its elimination. Lead is not easily removed from the whole system, owing to its retention by the ubiquitous albumin ; consequently some alterative, such as potassium iodide, should be administered. Uterus.—Under the influence of lead, abortion is liable to occur or the child be still-born. This is probably due to a disturbance of the quality and quantity of the blood-supply to the affected parts. Untoward Action.—Undesirable results have followed the ad- ministration of medicinal doses of lead acetate, evidently arising from insufficient elimination. Baker observed loss of appetite, gas- tralgia, constipation, and paralysis of three weeks' duration. This last symptom occurred in the hand of a man who had taken i grain (.06 Gm.) of lead acetate twice daily for four days to relieve hema- turia. In another case attacks of colic, lasting several months, fol- lowed the exhibition of 4 grains (.25 Gm.) of the same salt for three days. Tanquere des Planches suggests caution in too free an administration of lead preparations, as being prone to occasion disagreeable symptoms. The external application of lead solutions and ointments some- times produces unpleasant effects, such as discoloration of the skin. In the mucous membrane lead rarely excites symptoms of poison- ing, a single case being reported where lead water compresses were applied to the eye. Gastric pains have occurred after re- peated applications of such compresses to a contused shoulder, the pains ceasing with their withdrawal and reappearing with a renewal of the treatment. Colic and paralysis of the member have fol- lowed washing of a large ulcer of the leg with lead water, these symptoms disappearing upon a withdrawal of the drug. In still another case a sweetish, styptic taste in the mouth and stiffness of the neck resulted from the external use of the solution. Poisoning.—Cases of acute poisoning are in therapeutics for- tunately rare, the acetate—the form generally given—producing emesis, thus preventing toxic effects of the drug. The first symptom of poisoning is a sweetish, metallic taste, soon followed by nausea and vomiting of a white, milky fluid con- taining curdy material—the result of a combination of the exces- sive lead with the hydrochloric acid of the gastric juice, and the ASTRINGENTS. 729 formation of lead chloride. Constipation and subsequent diarrhea usually occur, with black passages, the discoloration being caused by the sulphide of lead formed in the intestinal canal. There is severe, persistent pain in the abdominal muscles, which are rigid and contracted, while a retraction of the abdominal walls is clearly perceptible. There are great thirst, and possibly cramps in the calves of the legs, neuralgic pains, muscular twitchings, vertigo, stupor, anesthesia, and paralysis. Tenesmus is present, and the face is pale and the lips livid. A blue line, due to a deposit of the sulphide, is usually found on the gums near the incisor teeth. As a rule, the liver is retracted and often diminished in size. The pulse is rapid and tense at first, becoming weak, compressible, and slow. Treatment of Poisoning.—Evacuation of the stomach is impera- tive, the process being more or less assisted by the emetic property of the drug. Some sulphate should be administered in order to form an insoluble lead compound. Epsom and Glauber's salts are the best antidotes, since they are readily soluble and easily ob- tained; acting, moreover, as a purge, they empty the intestinal canal. Opium will serve to relieve pain and irritation, while to maintain bodily temperature hot applications can be used on the feet and abdomen. Chronic Poisoning.—The acute form of poisoning just considered is always produced by a soluble lead salt; chronic plumbism, on the contrary, is invariably caused by an insoluble salt. The symp- toms are numerous and manifold, there being no physiological dis- turbance of the acute which is not present in the chronic condition. The train of untoward symptoms is occasioned by long-continued medicinal use of lead preparations. Very frequent sources of poisoning are: drinking water conveyed in lead pipes, and foods colored with chrome yellow and those contained in cans soldered with lead It is especially liable to occur among painters (colica pictonum), manufacturers of lead salts, color-grinders, and type- setters and founders. Wrist-drop, bilateral, resulting from paralysis of the extensor muscles of the forearm, is one of the most prominent symptoms, although not a constant occurrence. The supinator longus, being also a flexor, usually escapes this influence. Colic, sharp abdom- inal pains chiefly in the umbilical region, retraction of the abdom- inal muscles and cramps, and paralysis of the calves of the legs may be present in plumbism—or " saturnism," as it is sometimes termed a word transmitted to us from medieval alchemy. Obsti- 73° A TEXT-BOOK OF MATERIA MEDICA. nate constipation, with the passage of clay-colored stools, as has been stated, necessarily occurs; and anorexia, gastralgia, and arthralgia are seldom absent. The liver, the most important me- dium in the elimination of the poison, in severe cases becomes overtaxed and reduced in size. The tongue is white and coated, and the skin, lips, and mucous membranes are discolored. A blue line on the anterior gums is pathognomonic, although it may be absent in those who take special care of the teeth. Headache, delirium, and epileptiform convulsions, constituting encephalopathia saturnina, may occur, being usually due to uremia induced by insufficient elimination of the poison. Albuminuria, cirrhosis, and contraction of the kidneys, with diminished excretion of uric acid, are present, and amblyopia and amaurosis may be in- cluded among the symptoms. The heart and the entire vascular system are, as has been said, considerably deranged. Multiple neuritis, anterior poliomyelitis, and atrophy of the nerve-trunks, with resultant muscular wasting and loss of power, gradually mani- fest themselves. Gout sometimes occurs, and, as noted in acute poisoning, miscarriage is liable to take place. Treatment of Poisoning.—The sulphates are given for their chemical and purgative effects, yet in chronic plumbism the hepatic purgatives—calomel, gamboge, jalap, etc.—are preferable. Opium and morphine relieve pain and spasms, being claimed by some authorities as specifics in lead-poisoning. Sulphuric-acid lemonade and plenty of milk have been found beneficial. Potassium iodide in ten-grain doses, three times daily, has an eliminative effect. The cerebral symptoms may be alleviated by a diaphoretic, such as pilocarpin or an alcohol sweat. In progressive paralysis strychnine is widely employed. Fara- dization of the muscles, if they respond, or otherwise galvanization, should be used to increase muscular force and prevent atrophy. Plumbi Acetatis.—This being the typical lead salt, its action will be first considered. Therapeutics.—Externally and Locally.—It acts as a sedative as well as an astringent in acute inflammations, such as eczema (not chronic), impetigo, lichen, and erythema; but it must not be used stronger than 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) of water. It is of service as an injection in gonorrhea, leucorrhea, gleet, and otorrhea. In combination with opium it makes a good topical application for hemorrhoids. As a gargle it is of some value, and is also serviceable in orchitis, synovitis, and paronychia. ASTRINGENTS. 731 Internally.—Its most important use is in checking hemorrhages, in which it is associated with opium, although it is chemically in- compatible with that drug. It is of service in hemorrhage in typhoid fever, yellow fever, hemoptysis, and gastric ulcer. It lowers the heart's action, constringing the arterioles, in this respect resembling digitalis, combined with which drug it is beneficial in hypertrophy of the heart. Morbid discharges, such as the night-sweats and diarrhea of phthi- sis and the diarrhea of typhoid, dysentery, cholera infantum, secretions in bronchorrhea, and serous diarrhea, are effectually checked by the acetate of lead and opium, which diminishes the pain, griping, and tenesmus attending the respective affections. By far its most fre- quent use, however, is in serous diarrheas, the drug acting very quickly and efficiently, and being both sedative and astringent. Given in chronic gastritis with pain, lead acetate affords marked relief. It was at one time advocated in internal aneurysm, but is of little if any value in this respect. Liquor Plumbi Subacetatis.—This preparation is used exten- sively for bruises, sprains, acute eczema, and as a cooling application in ecthyma, erysipelas, and all kinds of inflammations; it should be well diluted. It also relieves the itching of urticaria, pruritus pudendi, and eczema. A felon may be aborted by saturating bread-crumbs with Goulard's solution, making a poultice, and placing it over the finger. Plumbi Iodidi.—Used very little. It acts beneficially when employed as an ointment applied to enlarged lymphatic glands and spleen ; also for psoriasis and chronic eczema. It is given in 1-2 grain- (0.06-0.12 Gm.) doses to reduce malarial spleen. Carbonate of lead is used only externally, in the form of an ointment for burns, scalds, erysipelas, and intertrigo. It should never be'applied to abraded surfaces, as it is rapidly absorbed. It should be mixed with linseed oil. Plumbi Oxidum.—Hebryre commends an application of equal parts of lead plaster and linseed oil for sweating of the feet. It is chiefly used in the preparation of diachylon or lead-plaster, emplas- trum saponis and emplastrum resinae being also prepared with the ^Plumbi Nitras—Used with good results in onychia and also in the manufacture of Ledoyne's disinfectant. It is an excellent remedy for fissured nipples, care being taken to wash the nipple 732 A TEXT-BOOK OF MATERIA MEDICA. before suckling. Should the fissures be deep, it is well to wash the nipple with morphine sulphate or a little cocaine, as the lead application is exceedingly painful. It destroys the fetid odor arising from gangrenous sores and offensive discharges from the ears, nostrils, rectum, and vagina. It has also proved serviceable in epithelioma. Chloride of lead and tannate of lead have been used ex- ternally as ointments—the chloride to allay pain and arrest morbid growths, and the tannate in threatening bed-sores. Administration.—Locally a watery solution of lead acetate, 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc), is used. Powdered opium can be added, 1 drachm to the pint of water. Applied to mucous membranes or used as an injection, 2 grains (0.12 Gm.) to 1 ounce (30.0 Cc.) of water, or 5 grains (0.32 Gm.) of the acetate and 5 (0.32 Gm.) of zinc sulphate in 1 ounce (30.0 Cc.) of water—rose-water, for instance—proves a most efficient application. Suppositories for hemorrhoids may contain I grain (0.06 Gm.) of opium to 3-5 grains (0.19-0.32 Gm.) of the acetate. The pilulae plumbi cum opio—lead acetate 3 grains (0.19 Gm.), opium 1 grain (0.06 Gm.)—is mostly used internally, one pill being taken every three hours. In dysentery and cholera infantum an enema containing 5 grains (0.32 Gm.) of lead acetate to 1 grain (0.06 Gm.) of opium, or \ grain (0.03 Gm.) of morphine to 1 ounce (30.0 Cc.) of water, gives excellent results. Should there be any abrasion of the skin, lead subacetate must not be used, as it prevents healing by constringing the edges of the wound. It is not used internally. Solution of subacetate of lead is most frequently used in union with opium, forming the well-known L. and L., or lead-water-and- laudanum, solution. It is also used in conjunction with glycerin, 1 ounce of each, or as Goulard's cerate, consisting of 20 parts Goulard's extract to 80 parts camphor cerate. For ulcers, fissured nipples, and epithelioma lead nitrate is used, chiefly in the powdered form. In the nose, ears, vagina, and rectum a douche (2-5 grains (0.13-0.32 Gm.) to 1 ounce (30.0 Cc.) of water) is used. A solution of 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) of glycerin or brandy is a very good application for sore nipples. Zlncum—Zinci—Zinc. U. 8. P. Origin.—Obtained by roasting the native Zinc Sulphide or Car- bonate, and reducing the resulting oxide with charcoal. ASTRINGENTS. 733 Description and Properties.—A bluish-white metal, showing a crystalline fracture and having a specific gravity ranging from 6.9 when it is cast to 7.2 after it is rolled. Soluble in diluted sulphuric or hydrochloric acid, with evolution of hydrogen gas. Metallic zinc occurs in the form of thin sheets or in irregular, granulated pieces, or moulded into thin pencils, or in a state of fine powder. The following salts of zinc are official: Zinci Acetas—Zinci Acetatis—Zinc Acetate.— Origin.—Obtained by dissolv- ing Zinc Acetate in Acetic Acid and Water and boiling: zinc acetate crystallizes out. Description and Properties.—Soft, white, six-sided, monoclinic plates, of a pearly luster, having a faintly acetous odor and an astringent metallic taste. Exposed to the air, the salt gradually effloresces and loses some of its acid. Soluble in 2.7 parts of water and 36 parts of alcohol. Zinc acetate should be kept in well-stoppered bottles. Dose.—As a tonic, %-2 grains (0.03-0.12 Gm.); as an emetic, 10-30 grains (0.6-2.0 Gm.); but principally used externally and locally. Zinci Carbonas Praecipitatus—Zinci Carbonatis Praecipitati— Precipitated Zinc Carbonate.— Origin.— Prepared by pouring together solutions of Zinc Sulphate and Sodium Carbonate, and drying the precipitated zinc salt. Description and Properties.—-An impalpable white powder, of somewhat variable chemical composition, without odor or taste ; permanent in the air. Insoluble in water or alcohol. Dose.—2-3 grains (0.12-0.18 Gm.). Chiefly used externally. Zinci Iodidum—Zinci Iodidi—Zinc Iodide.— Origin.—Prepared by dissolving Zinc Oxide or Carbonate in Hydriodic Acid. Description and Properties.—A white, granular powder, odorless, having a sharp, saline, and metallic taste. Very deliquescent, and liable to absorb oxygen from the air, becoming brown from liberated iodine. Readily soluble in water, alcohol, or ether. Zinc iodide should be kept in small glass-stoppered bottles. Dose.—%-2 grains (0.03-0.12 Gm.). Also used externally. Zinci Oxidum—Zinci Oxidi—Zinc Oxide.— Origin.—Prepared by heating Zinc Carbonate to redness in a crucible. Description and Properties.—An amorphous white powder without odor or taste. Insoluble in water or alcohol. It should be kept in well-stoppered bottles. Dose.—%-$ grains (0.015-0.3 Gm.). Official Preparations. Ungu6ntum Zinci Oxidi—UnguSnti Zinci Oxidi—Ointment of Zinc Oxide (20 per cent).—Used externally and locally. Zinci Sulphas—Zinci Sulphatis—Zinc Sulphate.— Origin.—Prepared by dis- solving Granulated Zinc in Sulphuric Acid, certain precautions being taken to remove impurities. Description and Properties.—Colorless, transparent, rhombic crystals, without odor, and having an astringent, metallic taste. Efflorescent in dry air. Soluble in 0.6 part of water and in 3 parts of glycerin; insoluble in alcohol. Zinc sulphate should be kept in well-stoppered bottles. Dose.—1-3 grains (0.06-0.18 Gm.); as an emetic, 10-60 grains (0.6-4.0 Gm.). Antagonists and Incompatibles.—The salts of zinc are incom- 734 A TEXT-BOOK OF MATERIA MEDICA. patible with the vegetable astringents, alkalies and their carbonates, lime water, the sulphides, silver nitrate, lead acetate, and milk. Synergists.—The same as for lead. The metallic form is not used in medicine. Physiological Action.—Externally and Locally.—The zinc salts resemble the lead salts in their action, but they are less powerful astringents. They are also to a slight extent hemostatic. The chloride is exceedingly caustic. Internally.—Digestive System.—The sulphate of zinc and, in a slight degree, the carbonate are specific emetics, causing rapid emesis, with but little nausea or depression. Their modus operandi is not definitely known, but it is believed that their effects are partly due to local action on the stomach, and partly to stimulation of the vomiting center in the medulla. Vomiting is also produced by injecting a solution of the salt into the circulation; but this is doubtless owing to the fact that the salt is excreted by the stomach, and that it also exerts an influence on the medullary center. The salts of zinc also act as astringents upon the gastro-intes- tinal mucous membrane. Circulatory System.—Practically nothing is known of the action of zinc salts on the heart, blood, and vessels. They exist in the blood as albuminates, in close relation with the red corpuscles. Nervous System.—Zinc valerianate acts as a sedative, but this action is wholly dependent upon the valerian. The salts are also astringents and possess some tonic properties. They may cause transverse myelitis. Absorption and Elimination.—The zinc salts are absorbed from the stomach or enter directly into the circulation when injected. They are eliminated by the liver and kidneys, but mainly by the intestinal glands. Zinc salts do not accumulate so rapidly as mer- cury, lead, and copper. Untoward Action.—3-5 grains (0.19-0.32 Gm.) have produced nausea and gastric oppression, while if the zinc salt reaches the intes- tines diarrhea results. When taken on a full stomach the salts form an insoluble albuminate which undergoes the regular digestive process. Repeated small doses, 3 grains (0.19 Gm.), have produced gastric oppression, eructations, slight confusion of thought, dizziness, bodily exhaustion, thirst, gastralgia, vomiting, and diarrhea. Zinc dyscra- sia may follow, characterized by obstinate constipation, emaciation, and anemia. ASTRINGENTS. 735 Poisoning.—Continued use or excessive doses of zinc will pro- duce poisoning, with symptoms resembling those of lead-poisoning. Chronic zinc-poisoning is rare. . Treatment of Poisoning.—Chemical antidotes are the bicarbon- ates of soda and potassium. Flour and water, soapsuds, and milk are also beneficial. Morphine given hypodermically relieves the vomiting. Laxatives and potassium iodide may serve later to assist in eliminating the zinc. Therapeutics.—Zinc Oxide.—Externally and Locally.—The ointment or powder is used in chronic eczema, intertrigo, burns, fis- sured nipples, anal fissure, ulcers, and skin diseases. In combination with linseed oil the oxide has also been used in erysipelas. The drug has proved useful as an injection in leucorrhea. Internally.—Associated with bismuth, sodium bicarbonate, or belladonna, it is very effective in diarrhea-—particularly the summer diarrhea of children—and dysentery. It is a most excellent remedy for colliquative sweating and the sweating of phthisis, and also serves to check the profuse secretion of bronchorrhea, although its use may occasion disordered diges- tion, since zinc is but sparingly soluble. It has been used extensively in the treatment of hysteria, spas- modic asthma, chorea, and epilepsy ; yet, even though it is claimed to be a specific, its action as such is exceedingly doubtful. Zinc oxide has proved highly beneficial in whooping cough, de- lirium tremens, and chronic alcoholism—especially the two latter, which are attended with considerable nervousness. The oxide is also valuable in gastralgia. Zinc Acetate.—It is used only externally and as an injection in gonorrhea and leucorrhea. In conjunctivitis it is useful as a collyrium. Zinc Sulphate.—Externally and Locally.—The external use is chiefly in weeping eczema, pruritus, and ulcers. Locally it is of ser- vice as a wash in ophthalmia and conjunctivitis, and as an injection in gonorrhea, leucorrhea, vulvitis, and otitis. It is also used in gan- grenous stomatitis, cancrum oris, and as a gargle in enlarged tonsils and relaxed sore throat. In nasal polypi the powder is insufflated, the solution being applied to the stump after removal of the poly- pus. It dries up soft tumors near the vagina, anus, and female urethra. It is also used in lupus exedens and cancer of the breast, but does not act upon parts covered by epithelium. Its application is very painful, but the eschar does not tend to spread, and sepa- rates much more readily than those of many other caustics. 736 A TEXT-BOOK OF MATERIA MEDICA. Internally.—Its chief use is that of an emetic after ingestion of poison, irritating foods, and especially narcotics, as well as where the air-passages are obstructed, as in croup and diphtheria. It acts as an astringent in chronic diarrhea and dysentery when associated with opium and ipecac. It is serviceable in typhoid fever, flatulent dyspepsia, coursing oxularia, spasmodic asthma, and whoop- ing cough. Like the other zinc salts, it has also been used in hysteria, chorea, epilepsy, and angina pectoris. Zinc Carbonate.—This preparation is used only externally, for blisters, weeping eczema, and intertrigo. It is employed in the form of a powder, but generally as an ointment—cardamine ointment. Zinc Iodide.—This salt is but little used, but is of some value as a gonorrheal injection, as an application to enlarged and indu- rated tonsils, and in scrofulous glands. Zinc phosphide and zinc valerianate are used only for the benefit derived from the phosphide and valerian, and may properly be omitted here. Administration.—Externally the powder or ointment of zinc oxide is used, or the drug may be mixed with powdered starch, lycopodium, or acacia. Before applying these preparations it is well to wash the parts with a weak solution of carbolic acid. Internally, \ grain (0.01 Gm.) zinc oxide and 3 grains (0.19 Gm.) sodium bicarbonate are given in diarrhea, or, if preferable, bismuth subnitrate 10 grains (0.64 Gm.), pepsin (Sheffer's) 3 grains (0.19 Gm.), and zinc oxide \-\ grain (0.03-0.06 Gm.), with a little opium added. As an injection a combination of 10 grains (0.64 Gm.) each of zinc sulphate and lead acetate is used, the two salts interacting and pro- ducing lead sulphate—which is precipitated and insoluble—and zinc acetate. Locally and externally the dry powder of zinc sulphate is used, or a mixture of zinc sulphate 10 grains (0.64 Gm.), aqua rosae 4 ounces (118.29 Cc), and glycerin 1 drachm (4.0 Cc), as a lotion. As an injection it is associated with lead acetate, forming the zinc acetate and lead sulphate. In ophthalmia neonatorum zinc sulphate 5 grains (0.32 Gm.), morphine sulphate 3 grains (0.19 Gm.), and aqua rosae I ounce (30 Cc), perhaps with atropine added, form an excellent mixture. Internally, in dyspepsia 1-2 grains (0.06-0.12 Gm.) maybe given, and for intestinal affections 1 grain (0.06 Gm.) each of the sulphate, powdered opium, and ipecac three times daily. To produce emesis 5 grains (0.32 Gm.) are sufficient. ASTRINGENTS. 737 The collyrium consists of \ grain (0.03 Gm.) of the salt in 1 ounce (30 Cc.) of rose water. Cupri Sulphas— Cupri Sulphatis—Copper Sulphate. U. 8. P. Origin.—Prepared by heating Copper and Sulphuric Acid to- gether, dissolving the soluble product in hot Water, and evaporating. Description and Properties.—Large, transparent, deep blue triclinic crystals, odorless, of a nauseous, metallic taste; slowly efflorescent in dry air. Soluble in about 2.6 parts of water and in 0.5 part of boiling water; almost insoluble in alcohol. Dose.—\-\ grain (0.008-0.03 Gm.), as an astringent; as an emetic, 2-20 grains (0.12-1.2 Gm.). Antagonists and Incompatibles.—Alkalies and their carbon- ates, the sulphides, mineral salts (except the sulphates), lime water, the iodides, and vegetable astringents. Synergists.—The same as for lead. Physiological Action.—Copper sulphate is the salt mostly used, and the only official preparation. Its action is therefore given as characteristic of that of cuprum. Externally.—Applied to the unbroken skin, it produces little effect, but on raw surfaces or mucous membranes it acts as a pain- ful caustic and astringent. It also possesses antiseptic properties. Internally.—Digestive System.—It acts as an irritant, causing vomiting of greenish matter, though nausea does not follow the emesis. The secretions are augmented, and salivation and purging of blood and mucus are attendant consequences of its ingestion. Should emesis be delayed, the stomach should immediately be emptied, otherwise the copper is liable to produce inflammation. Circulatory System.—Copper exists normally in the blood, and acts as a tonic, being present in the circulation as an albuminate. It depresses the heart's action, causing a small, weak, rapid pulse. Nervous System.—It acts as a depressant. Respiratory System.—Its influence is to hasten and depress the respiratory movements. Absorption and Elimination.—Copper salts are slowly absorbed, tending to accumulate in the liver. The drug is eliminated by the liver, kidneys, salivary glands, and intestinal canal. Poisoning.—Acute poisoning results from the inhalation of cupreous fumes, eating fruits cooked in copper vessels, or from an overdose of a copper salt. 47 738 A TEXT-BOOK OF MATERIA MEDICA. When inhaled the first symptoms are those of bronchial catarrh and irritation. Internally administered, the symptoms do not usually appear at once, but after an hour's interval there are manifest a strong metallic taste in the mouth, burning and constriction of the pharynx and fauces, salivation and vomiting of greenish matter, and purging, the passages after a while containing mucus streaked with blood. There are present also burning in the epigastrium and griping, colicky pains. Copper enters the circulation quickly, it being highly diffusible. A characteristic symptom of poisoning is a green line on the gums. Sometimes jaundice 'may be present, and headache, convulsions, suppression of urine, cardiac depression, and hurried respiration are among the graver symptoms. Treatment of Poisoning.—A chemical antidote should be given at once, potassium ferrocyanide being the best, as it forms an in- soluble copper cyanide. Other recourses are white of egg, milk, sweet oil, emetics, and the use of the stomach-pump. A mustard plaster, with a little opium added to allay the pain and irritation, may be applied over the pit of the stomach as a counter-irritant. Should vomiting have already occurred, emetics should be with- held. Chronic poisoning usually results from long-continued use of the medicine. The symptoms are the same as those of acute poi- soning, with the following superadded: paresis of the limbs, paral- ysis, incoordination of muscles, atrophy of the liver, with fatty degeneration of the liver-cells, and proliferous growth of the con- nective tissue. There may also be present congestion of the lungs and fatty degeneration of the kidney, together with bronchial catarrh. The treatment is the same as for acute poisoning. Therapeutics.—Externally and Locally.—Copper sulphate stimulates old, flabby, granulating ulcers. Ring-worm, scabies, and tinea sycosis derive great benefit from its use. The crystal or solution, 2 grains to 1 ounce (0.12-32.0 Gm.) of water, is used extensively in conjunctivitis, tinea tarsi, and trachoma condylomata, and as a gargle in relaxed sore throat. The aphthae in aphthous stomatitis are benefited by touching with the copper- sulphate solution. It is also used as an injection in gonorrhea and gleet, 2 grains to 1 ounce (0.12-32.0 Gm.). It is also valuable in mercurial sore mouth and gangrene of the pharynx. Internally.—Copper sulphate is the chemical antidote for phosphorus-poisoning, yet it should be given with great caution, ASTRINGENTS. 739 lest of itself it produce acute poisoning. It is a speedy emetic, since it acts directly upon the stomach. If emesis is not produced by the first dose, sulphate of zinc or mustard may be employed. It is used as an emetic in croup. In chorea, hysteria, and epilepsy copper is beneficial. In chronic dysentery and diarrhea an enema of a pint of water (512.0 Gm.) and 10 grains (0.6 Gm.) of sulphate of copper is an efficient remedy, being by some authors considered the best metallic astringent in chronic dysentery. Copper associated with arsenic is highly beneficial in anemia, building up the blood and adding firmness to the flesh. Oleate of copper is used in the skin affections mentioned. Nitrate and acetate of copper act like the sulphate. Arsenite of copper has been suggested as a remedy in anemia, and has been used in doses of yfo gram (0.0006 Gm.) in diarrhea and cholera infantum. Administration.—For an enema in diarrhea and dysentery it maybe combined with opium—2 grains to 1 ounce (0.12-32.0 Gm.) of water being used. For eye affections the crystal or solution is employed. In addition to the enema copper sulphate, 1 grain (0.06 Gm.) may be united with magnesium sulphate 1 ounce (32.0 Gm.) and I drachm (4.0 Gm.) diluted sulphuric acid in 4 ounces (128.0 Gm.) of water, a tablespoonful of the mixture being given every three or four hours. To produce emesis 10-15 grains (0.6-1 Gm.) are dissolved in about 5 ounces (160.0 Gm.) of water, a tablespoonful being given every ten minutes until vomiting is produced. Argenti Cyanidum—Argrenti Cyanidi-Silver Cya- nide. U. 8. P. Origin.__Obtained by distilling a solution of Potassium Ferro- cyanide acidulated with Sulphuric Acid, the distillate passing into a receiver containing a solution of Silver Nitrate. The process should be continued until the distillate no longer produces a precipitate in the receiver. The precipitate is finally washed with distilled water and dried. Description and Properties.—A white powder, without odor or taste; permanent in dry air, but gradually turning brown on exposure to light. Insoluble in water, alcohol, or cold nitric acid; soluble in boiling nitric acid, ammonia water, and solution of 74° A TEXT-BOOK OF MATERIA MEDICA. sodium hyposulphite or potassium cyanide. It should be kept in dark, amber-colored vials, protected from light. Not used internally. Official Preparation. Acidum Hydrocy3nicum Diliitum—Acidi HydrocySnici Diluti—Diluted Hydrocyanic Acid (Prussic Acid).—Dose, 2-5 minims (0.12-0.3 Gm.). (Described under Hydrocyanic Acid, page 519.) Argenti Iodidum—Argenti Iodidi—Silver Iodide. U. S. P. Origin.—Prepared from Silver Nitrate and Potassium Iodide, washing and drying the precipitate. Description and Properties.—A heavy, amorphous, light-yel- lowish powder, unaltered by light if pure, but generally becoming somewhat greenish-yellow; without odor or taste. Insoluble in water and alcohol. Silver iodide should be kept in dark, amber- colored vials, protected from light. Dose.—\-\ grain (0.015-0.06 Gm.). Argrenti NItras—Argenti Nitratis—Silver Nitrate. U. 8. P. Origin.—Obtained by dissolving Silver in Nitric Acid with the aid of heat, evaporating, and crystallizing. Description and Properties.—Colorless, transparent, tabular, rhombic crystals, becoming gray or grayish-black on exposure to light in presence of organic matter. Without odor, but having a bitter, caustic, and strongly metallic taste. Soluble in 0.6 part of water and in 26 parts of alcohol. It should be kept in dark, amber-colored vials, protected from light. Dose.—\-\ grain (0.015-0.06 Gm.). Official Preparations. Argfcnti NItras Dilutus—ArgSnti Nitratis Diluti—Diluted Silver Nitrate (Mitigated Caustic).-Or^m.—Prepared by fusing together Silver Nitrate 30, and Potassium Nitrate 60, and casting in suitable moulds. Description and Properties.—A white, hard solid, generally in the form of pencils or cones of a finely granular fracture, becoming gray or grayish-black on exposure to light in the presence of organic matter; odorless, having a caustic, metallic taste, neutral to litmus-paper. It should be kept in dark, amber-colored vials. Used externally. Argfcnti NItras Fiisus—Argfcnti Nitratis Fusi—Moulded Silver Nitrate (Lunar Caustic).—Origin.—Obtained by melting Silver Nitrate 100, Hydrochloric Acid 4, and pouring the melted mass into suitable moulds. Description and Properties.—A white, hard solid, usually cone- or pencil-shaped, of ASTRINGENTS. 741 a fibrous fracture, becoming gray or grayish-black on exposure to light in presence of organic matter; odorless, having a bitter, caustic, and strongly metallic taste. Soluble in 0.6 part of water and in 26 parts of alcohol. The product should be kept in dark, amber-colored vials, protected from light. Used externally and locally. Argrenti Oxidum—Argrenti Oxidi—Silver Oxide. U. 8. P. Origin.—Prepared by shaking a solution of Silver Nitrate with solution of Potassa and washing the precipitate. Description and Properties.—A heavy, dark, brownish-black powder, liable to reduction by exposure to light; odorless, with a metallic taste; very slightly soluble in water and insoluble in alcohol. Dose.—\-2 grains (0.03-0.12 Gm.). Antagonists and Incompatibles.—The silver nitrate is incom- patible with the alkalies and their carbonates, chlorides, hydro- chloric and tannic acids, potassium iodide, solutions of arsenic, and many of the organic acids. Silver oxide is rapidly oxidized, forming explosive compounds with chlorides and organic substances. Synergists.—Preparations of copper, lead, and zinc aid the action of silver salts. The silver nitrate and its preparations and the silver oxide are the only salts which possess any value as astringents or caustics. The silver nitrate is the typical astringent salt, and its physiological action will be hereafter considered. Physiological Action.—Metallic silver is practically of no use in medicine, though of great value in surgery, because of its inert- ness. Silver nitrate is the salt of silver chiefly employed. Externally and Locally.—It is a powerful caustic, but does not wound very deeply, as it forms an eschar by coagulating the albu- min of the tissue, thus protecting the underlying structures. The eschar is white, but on exposure to light very soon becomes black, owing to the fact that the silver is reduced to its metallic state. Like lead salts, silver salts ar,e hemostatic. They are severely irritant to mucous membranes when used in solution. Internally.—Digestive System.—The drug causes increased secre- tion of intestinal glands and larger flow of bile. Silver salts are changed in the stomach into peptonates and albuminates. Under 742 A TEXT-BOOK OF MATERIA MEDICA. ordinary doses nutrition is promoted ; by large doses it is impaired, with resulting loss of flesh and weight. Circulatory System.—The heart is stimulated by small doses, and the blood becomes darker and contains less fibrin. The red corpuscles lose shape and color and the hemoglobin is con- verted into hematin. Large doses depress cardiac action, while thrombosis and embolism may ensue. Nervous System.—In small doses silver salts are tonic; in large doses they produce epileptiform convulsions and paralysis of centric origin. Respiratory System.—The primary effect of the drug is to stim- ulate respiration. Large doses, however, cause death by paralysis of the respiratory center. Absorption and Elimination.—It is absorbed from the stomach and eliminated very slowly, chiefly by the feces, a small portion being excreted by the kidneys. Temperature.—At first increased; afterward, through the blood- changes, lowered. Untoward Action.—Long-continued use of silver nitrate pro- duces discoloration of the skin—either general or more pronounced in particular spots, such as the face. Even when the skin is per- fectly intact the application of nitrate of silver will discolor it, \ grain (.016 Gm.) having caused palpitation of the heart and irreg- ular pulse. Silver is very apt to accumulate in the tissues. Poisoning.—A poisonous dose of silver nitrate produces a violent gastro-enteritis. The earliest symptom is an intense pain in the abdomen, followed by vomiting and purging. The abdominal muscles are hard and retracted, the face livid and covered with perspiration and wearing an anxious expression. The lips are blanched, gradually becoming black; the vomited matter is black- ish and sometimes resembles milk-curds. Epileptiform convulsions, delirium, and paralysis ensue, the latter symptom being of centric origin. Death results from cessation of respiration, due to the centric paralysis. A large amount of mucus is thrown into the bronchial tubes by the lining mucosa. Treatment of Poisoning.—The chemical antidote is common salt. It is essential to protect the mucous membrane of the esophagus and stomach, and at the same time dilute the poison as much as possible, for which purposes large quantities of salt water and soap water or milk are valuable. Opium allays the pain and irritation. ASTRINGENTS. 743 Chronic poisoning, or argyria, results from prolonged medicinal use of silver nitrate or its employment as a hair-dye for any length of time. The drug is deposited in all parts of the body, being especially manifest in a slaty, permanent discoloration of the skin. The first symptoms are discoloration of the sclerotic conjunctivae and a dark line on the inner side of the lips. Ulcerative stomatitis may occur, or even gastric ulcer. Treatment of Chronic Poisoning.—Iodide of potassium or hypo- sulphite of soda will aid in eliminating the poison. Baths of the hyposulphites or lotions of cyanide of potassium may produce absorption and excretion of the silver deposits, but the discolora- tion is rarely removed in any way. Therapeutics.—Externally and Locally.—A very important use of silver nitrate is that of preventing ophthalmia neonatorum, a 2 per cent, solution being dropped into the eyes. For adults a 2 to 4 per cent, solution is used in various forms of conjunctivitis, the eyelids being painted with a camel's-hair brush, and the solution being washed off immediately to prevent discoloration. The nitrate- of-silver stick may also be used. Felons, boils, and bed-sores may be aborted by the use of a strong solution—20 grains to I ounce—of silver nitrate. An injection of 2-3 grains (.12-20 Gm.) is beneficial in subacute gonorrhea and leucorrhea. This may also be used as a wash in pruritus ani and vulvoe, to relieve the itching. The stick may be applied to uterine ulcers. As a caustic it is used in indolent ulcers and chancroids, stimu- lating them and producing a healthy granulating surface. A solution painted over the eruption of variola is supposed to prevent pitting. The vesicles may also be punctured with a needle and the silver nitrate then introduced. The pain and swelling of orchitis and epididymitis are consid- erably relieved by painting the scrotum with a solution of this salt. After a cold, when the throat feels raw and sore, a gargle of 60 grains (4.0 Gm.) to the ounce (30.0 Cc.) is very gratifying, and the same may be used in inflammations of the pharynx, fauces, and mouth. A spray of 40 grains (2.59 Gm.) to the ounce (30.0 Cc.) is very effective in laryngeal croup, trachitis, chronic ulceration of the larynx, and whooping cough. The caustic pencil is used in tonsil- litis sore nipples, mercurial sore mouth, and poisoned, lacerated, and punctured wounds. A solution of 1-2 grains (.06-12 Cc.) to the 744 A TEXT-BOOK OF MATERIA MEDICA. ounce (30.0 Cc.) is valuable in otorrhea, vesical catarrh, and balanitis. Internally.—Dr. Pepper recommends this salt in intestinal ulcer- ations, given in keratin-coated pills. It is a cure for gastric ulcer, in which it may be combined with opium. Gastralgia and chronic gastritis, ulceration of the rectum, dysentery, and diarrhea of typhoid have been remarkably benefited by its use. For stomach affections \—\ grain (.01-016 Gm.) is given, and for intestinal an enema of 3-10 grains (.20-64 Gm.) to the ounce (30.0 Cc). It has been used in congested conditions of the cord, locomotor ataxia, epilepsy, and chorea. It is the only remedy of any value in locomotor ataxia; but, owing to the discoloration it produces, it cannot be used continuously, and in many cases it fails entirely. Argentic iodide was once used extensively in the treatment of syphilis, but is now obsolete. Argentic oxide is not so active as the nitrate. It has been employed for checking sweats, and, owing to its less caustic action, it may be preferable to the nitrate in gastric ulcer and gastralgia. Administration.—The dose of silver nitrate is \-\ grain (.01- .016 Gm.), and for a constitutional effect should always be given in pill form during the process of digestion. The keratin-coated pill is to be administered for intestinal dis- orders, and when a local action on the alimentary canal is desired an ordinary pill should be given one to two hours before meals. It is well to discontinue the drug for a short time after three or four weeks' treatment, the salt being so slowly eliminated that its prolonged use is very apt to result in argyria. Argonin.— Origin.—A soluble compound of Silver and Casein, first prepared by Rohmann and Liebreich. Description and Properties.—A dilute solution of this substance in water is opales- cent ; opaque when concentrated, but immediately cleared by the addition of ammonia or carbonate of soda. Used externally and locally. Physiological Action and Therapeutics.—Argonin is a very powerful, non-irritating germicide. The addition of a little ammonia to a solution of argonin vastly increases its bactericidal power, but deprives the drug of its bland, non-irritating character. It appears to lack astringent properties, and concentrated solutions are neither corrosive nor irritant. From experimental research Meyer concludes that argonin has a strong disinfecting influence upon certain bacteria, particularly the gonococcus, investigation having shown that a 1:30,000 solution of ammoniacal argonin completely suspended the growth of this microbe for five minutes. Judassohn, who has had an extensive experience with argonin in the treatment of gonorrhea, draws the following conclusions: (1) 1.5 to 2 per cent, solutions exert a rap- idly destructive action upon gonococci. (2) Strong solutions are devoid of inflammatory ASTRINGENTS. 745 or corrosive action, and are consequently adapted to the treatment of acute gonorrhea of the anterior and posterior urethra in men, and of the uterus and urethra in women. (3) It appears to lack astringent properties, so that purely anticatarrhal treatment will indicate the assistance of other remedies. AIGmen—Aluminis—Alum. U. 8. P. Origin.—Prepared by a complicated process from a mixture of Aluminum Silicate and Iron Sulphide by roasting, lixiviating with water, concentrating the solution, and, while hot, mixing with Po- tassium Chloride. Upon cooling the alum separates as a crystal- line powder, which is purified by one or two recrystallizations. Description and Properties.—Large, colorless, octahedral crys- tals, sometimes modified by cubes, or crystalline fragments, without odor, but having a sweetish and strongly astringent taste. On exposure to the air the crystals are liable to absorb ammonia and acquire a whitish coating. Soluble in 9 parts of water and 0.3 part of boiling water; also freely soluble in warm glycerin. Insoluble in alcohol. Dose.—5-40 grains (0.3-2.60 Gm.); as an emetic, 1-2 drachms (4.0-8.0 Gm.). Official Preparation. Aliimen Exsiccatum—Aluminis Exsiccati—Dried Alum (Burnt Alum).— Origin.—Alum heated until it is deprived of its water of crystallization. Description and Properties.—A white, granular powder, without odor, possessing a sweetish, astringent taste and attracting moisture from the air. Very slowly but com- pletely soluble in 20 parts of water, and quickly soluble in 0.7 part of boiling water. Dose.—1-5 grains (0.06-0.3 Gm.). Unofficial Preparation. Aluminis Glyceritum—Aluminis Glyceriti—Glycerite of Alum (20 per cent. alum).—Used externally. Allied Compounds. Alumnol—Alumnol—Alumnol.— Origin.—This substance was discovered by Filehne of Breslau, and is a mixture of Aluminum Salts of Naphthol-sulphonic Acid, containing about 5 per cent, of aluminum and 15 per cent, of sulphur. Description and Properties.—It occurs as a light, odorless, white or reddish-white, non-hygroscopic powder. ,It possesses a sweetish and astringent taste, and is readily soluble in water or glycerin, less so in alcohol, and insoluble in ether. While becoming darker on exposure to the air, its properties are unaffected. Used externally and locally. Aluminum Aceto-tartrate.—6>^m.—First prepared by Athenstadt by dissolving 5 parts of Basic Aluminum Acetate in a sufficient quantity of water by the aid of 2 parts of Tartaric Acid, and evaporating the solution to dryness. 746 A TEXT-BOOK OF MA TERIA MEDICA. Description and Properties.—It occurs in shining, almost colorless, amorphous masses, with a faint, acetous odor and an acidulous astringent taste. Soluble in water; insoluble in alcohol. Used externally and locally. Aluminum Boroformate.— Origin.—Prepared by heating together Boric Acid, Formic Acid, and Alumina. Antagonists and Incompatibles.—The alkalies and their car- bonates ; lead, mercury, and iron salts; tartrates and tannic acid. Synergists.—The vegetable and mineral astringents. Alumini Hydras—Alumini Hydratis—Aluminum Hydrate. U.S. P. Origin.—This substance is found in nature as the rare crystal- line mineral gibbsite of North America—the diaspore of Eastern Europe. The aluminum hydrate may be prepared by precipitating the solution of an aluminum salt with an alkali or alkali carbonate. Description and Properties.—A white, light, amorphous pow- der, odorless and tasteless, permanent in dry air. Insoluble in water or alcohol, but completely soluble in hydrochloric or sul- phuric acid, and also in potassium or sodium hydrate T. S. Dose.—3-6 grains (0.2-0.4 Gm.). Alumini Sulphas—Alumini Sulphatis—Aluminum Sulphate. U. 8. P. Origin.—It is occasionally found as an efflorescence near vol- canoes and upon alum-slate. For medicinal use it should be pre- pared from Aluminum Hydrioxide, by dissolving it in the requisite quantity of Dilute Sulphuric Acid. Description and Properties.—A white, crystalline powder, having a sweetish and afterward astringent taste; permanent in the air. Soluble in 1.2 parts of water, and much more freely in boiling water; insoluble in alcohol. Used externally. Description and Properties.—It occurs in pearl-like crystals or crystalline scales, which are very soluble in water. It contains 33.5 per cent, of alumina. Used externally and locally. Sozal—Origin.— Obtained by dissolving Aluminum Hydrate in Phenol-sulphonic Acid. Description and Properties.—A crystalline substance having an astringent taste and a faint odor of carbolic acid. It is freely soluble in water, glycerin, and alcohol. Used externally and locally. Physiological Action.—Externally and Locally.—Alum con- tracts the small blood-vessels and coagulates the albumin in the AS TRINGENTS. 747 tissues, but in order to have any effect it must be applied to a denuded surface. It is also mildly escharotic. Applied to the unbroken skin, it thickens and hardens it. Internally.—Digestive System.—Its first effect when taken into the mouth is to excite the salivary secretion, the albumin in it, as well as that of the buccal mucous membrane, being precipitated. When its astringent action takes effect the secretions are dimin- ished and the mucous membrane of the mouth and tongue is blanched and puckered. The enamel of the teeth is affected, breaking under its influence. The digestive juices are diminished in quantity and the pepsin precipitated. Constipation follows, though it may be preceded by a slight diarrhea. Taken in large doses, alum produces nausea, vomiting, purging, and abdominal pain. Circulatory System.—Notwithstanding the fact that alum coag- ulates albumin, it is nevertheless absorbed into the blood-vessels, and by contracting them lessens all the secretions and arrests hemorrhage. When injected directly into the blood it produces thrombi and emboli. Nervous System.—Spasms are relieved by alum, but this action is in all probability dependent upon contraction of the blood- vessels. Absorption and Elimination.—As stated, alum is absorbed by the blood-vessels; it is eliminated by the kidneys and liver. Untoward Action.—The prolonged use of alum is very apt to produce a cough in persons having sensitive bronchi. Therapeutics.—Externally and Locally.—Alum is used to de- stroy exuberant granulations and verrucosities. It is an excellent hemostatic in epistaxis and bleeding from the gums, vagina, rectum, bladder, bites, and sockets of extracted teeth. It is much used for sore throat by public speakers and singers, and is also efficient in tonsillitis, particularly the follicular form, gangrenous pharyngitis, stomatitis ulcerosa, relaxation of the uvula and pharyngeal mucous membrane, swollen and overriding gums, and mercurial ptyalism. The destructive effect of alum upon the teeth must always be borne in mind: the alum stick or a swab is preferable whenever possible. If a mouth-wash or gargle be necessary, wash and brush the teeth well immediately after using the alum. Five grains (.32 Gm.) to 1 ounce (30.0 Cc.) of water is an excel- 748 A TEXT-BOOK OF MATERIA MEDICA. lent preparation for ophthalmia, conjunctivitis, and trachoma, but must not be used if there is any corneal inflammation, as it is apt to cause ulcers. By adding milk or white of egg to the mixture its efficiency is greatly increased. This preparation is also very serviceable in preventing the discoloration of a " black eye." An injection of 5-10 grains (.32-64 Gm.) to the ounce (30.0 Cc.) of water is much used in gonorrhea, leucorrhea, and gleet, and also for washing the vulva in pruritus. Sweating of feet, hands, and axilla?, when excessive and fetid, is checked by the application of a lotion or powdered alum. Soaking a piece of cotton or lint with alum and placing it under an ingrowing toe-nail affords marked relief. Chilblains, old sores, and ulcers are also benefited by the use of alum. A spray, gargle, or insufflation has been used with good results in diphtheria, bronchorrhea, chronic laryngitis, aphonia due to atony, bronchitis, and whooping cough. Internally.—Alum operates advantageously as an astringent in arresting gastric and intestinal hemorrhages, hematuria, and menor- rhagia. The diarrheas of typhoid fever and chronic dysentery, and occasionally the acute forms, are strikingly benefited by an alum enema. It has been used in polyuria and diabetes mellitus, though in the later affection it is of little value. Although alum produces, it also relieves, constipation when flatus has existed for some time, and atony of the bowel diminished peristalsis. Given in emetic doses in membranous croup, it loosens the membrane, and as this is expelled it lessens the chance of another one forming by constringing the mucosa and blood-vessels, and thus preventing further exudation. By checking absorption and producing emesis alum serves as an antidote for lead-poisoning, and is an efficient remedy in lead colic. Alumen exsiccatum is employed chiefly as an escharotic for fungous growths, and to stimulate indolent ulcers and mucous membranes with morbid secretions. Whenever the drug is used as a powder externally or for insuf- flation, powdered dried alum is the form to use. Administration.—The emetic dose of alum is 1-2 drachms (4.0-8.0 Gm.) in syrup. Warm water will increase its action when retching begins. ASTRINGENTS. 749 For internal use, 5-10 grains (.32-64 Gm.), mixed with a little simple syrup or syrup of orange peel to prevent nausea, will be found beneficial. For collyria, 2-3 grains (.12-20 Gm.) in 1 ounce (30.0 Cc.) of water, or the alum curd, as already mentioned, may serve best. The curd may be separated by adding 2 drachms (8.0 Gm.) of alum to 1 pint (473. Cc.) of milk, boiling, and straining. The gargle and injection can be used in strengths of 5-20 grains (.32-1.29 Gm.) to 1 drachm (4.0 Gm.). For insufflation the dried alum is employed. Bismuthi Citras—Bismuthi Citratis—Bismuth Ci- trate. U. 8. P. Origin.—Bismuth Subnitrate and Citric Acid are boiled in suf- ficient Water, and the precipitate washed and dried. Description and Properties.—A white, amorphous or micro- crystalline powder, odorless and tasteless, permanent in the air. Insoluble in water or alcohol, but soluble in ammonia water and in solutions of the citrates of the alkalies. Dose.—1-3 grains (0.06-0.2 Gm.). Official Preparation. Bismuthi et Ammonii Citras—Bismuthi et Ammonii Citratis—Bismuth and Ammonium Citrate.— Origin.—Prepared by mixing Bismuth Citrate with Dis- tilled Water to make a paste, adding sufficient Ammonia Water to make a solution, filter- ing, evaporating, and drying on plates of glass. Description and Properties.—Small, shining, pearly, or translucent scales, odorless, with a slightly acidulous and metallic taste, becoming opaque on exposure to the air. Very soluble in water, but sparingly soluble in alcohol. The product should be kept in well-stoppered bottles, protected from light. Dose.—1-10 grains (0.06-0.6 Gm.). Bismuthi Subcarbonas—Bismuthi Subcarbonatis— Bismuth Subcarbonate. U. S. P. Origin.__Obtained by dissolving purified Bismuth in Nitric Acid and Water, decanting and filtering, mixing with Ammonia Water, washing the precipitate and dissolving in Nitric Acid. The solution is then mixed with a solution of Sodium Carbonate, and the resulting precipitate collected and washed. Description and Properties.—A white or pale yellowish-white powder, of somewhat varying chemical composition, odorless and tasteless, permanent in the air. Insoluble in water or alcohol, but 750 A TEXT-BOOK OF MATERIA MEDICA. completely soluble in nitric or hydrochloric acid, with copious effervescence. Dose.—5-20 grains (0.3-1.2 Gm.). Bismuthi Subnitras—Bismuthi Subnitratis—Bis- muth Subnitrate. U.S. P. Origin.—Prepared by dissolving purified Bismuth in Nitric Acid and Water, concentrating by evaporation, adding more water, stir- ring well, and washing and drying the precipitated bismuth sub- nitrate. Description and Properties.—A heavy white powder, of some- what varying chemical composition, odorless and almost tasteless, permanent in the air. Nearly insoluble in water and insoluble in alcohol, but readily soluble in nitric or hydrochloric acid. Dose.—5-20 grains (0.3-1.2 Gm.). Allied Compounds. Bismuthi Salicylas—Bismuthi Salicylatis—Bismuth Salicylate.—Dose, 1- 20 grains (0.06-1.2 Gm.). Bismuthi Subiodidum—Bismuthi Subiodidi—Bismuth Subiodide.—Used externally. Bismuth Naphtholate.—Dose, 15-30 grains (1.0-2.0 Gm.). Bismuth Tribromphenate.—Dose, 60-75 grains (4.0-5.0 Gm.). Dermatol (Bismuth Subgallate).—Description and Properties.—A fine saffron- yellow powder, odorless, non-hygroscopic, unaffected by exposure to air or light, insoluble in water, alcohol, or ether. Dose.—15-30 grains (1.0-2.0 Gm). Dermol (Bismuth Chrysophanate).—Description and Properties.—An amor- phous yellow powder, neutral in reaction, insoluble in water or alcohol. Used externally and locally. Thioform.—A combination of Bismuth, Sulphur, and Salicylic Acid. Description and Properties.—A light, grayish-yellow powder, odorless and tasteless, insoluble in water, alcohol, or ether. ' Used externally and locally. Antagonists and Incompatibles.—The salts of bismuth are insoluble, and should not be prescribed with other agents in solution. Synergists.—The sedative action of bismuth upon the stomach may be increased by calomel and cerium oxalate, and pepsin may be given as a substitute for this purpose. The astringency of the bismuth salts may be enhanced by opium and tannic acid. Physiological Action.— Externally.—Bismuth salts are mildly astringent, but have no effect upon the unbroken skin. Internally.—Digestive System.—Bismuth is insoluble in the ASTRINGENTS. 751 gastro-intestinal juices. It coats the mucous membrane, lessening secretions and absorbing excess of free acids, at the same time act- ing as a sedative and feeble astringent. The tongue and stools are tinged a dark clay color, due to conversion into the sulphide. The soluble salts are absorbed very slowly, and increase the appetite and digestion, constipation being the result. Circulatory System.—A minute quantity passes into the blood, acting as a tonic. Nervous System.—Bismuth salts are sedative to the peripheral nerve-endings. Absorption and Elimination.—The salts of bismuth are absorbed into the circulation, and are eliminated by the urine, liver, and feces. Untoward Action.—Odier noticed nausea, and Weenesk vomit- ing, colicky pains, diarrhea, or constipation, headache, sensation of heat, dizziness, and general debility. Poisoning.—It has always been assumed that cases of poisoning are due to the lead and arsenic contained in the bismuth prepara- tions, but Carnot and Riche found these metals present in such quantities as to be practically inert. The symptoms are similar to those of lead-poisoning. Large concretions may be found in the intestines, and sloughs in the mouth and gastro-intestinal canal may be present, as well as desquamative nephritis and albuminuria. Treatment of Poisoning.—Lavage, demulcents, and chemical anti- dotes for arsenic, magnesium, and calcium; best of all, freshly precipitated hydrated oxide of iron. Therapeutics.—Externally and Locally.—Bismuth subnitrate is serviceable in intertrigo, erythema, acne rosacea, as a protective dressing for wounds, ulcers, and epithelioma, and as an application for chapped nipples and hands, relieving the smarting and itching. It is also of use in fissure, prolapsus ani, and superficial burns. It is used as an injection in gonorrhea, leucorrhea, and ozena, and was formerly used as an insufflation in acute nasal catarrh, being abandoned because of the arsenic which it sometimes con- tains. It serves as a wash in aphthous stomatitis, mild cases of mercurial salivation, and cancrum oris, as well as for the fetid sweating of feet and other parts, and for chancres and phlegmonous erysipelas. It has also proved beneficial in chronic conjunctivitis and granular lids or trachoma. Internally.—It allays irritation, and is consequently useful in irritative vomiting and diarrhea. Gastric pain is relieved by it. 752 A TEXT-BOOK OF MATERIA MEDICA. It is valuable in pyrosis, chronic diarrhea, gastric ulcer, chronic dysentery, diarrhea of typhoid, early stages of cholera and cholera infantum, and in the gastritis due to alcohol. The citrate of bismuth and ammonium is very soluble, and should be used only for local applications. The oxide is insoluble, and combined with morphine has been used as a snuff in ozena and nasal catarrh. Subcarbonate of bismuth is not used in medicine. Salicylate of bismuth reduces the pulse and temperature in typhoid fever, and also corrects the fetid stools. Bismuth subgallate, or dermatol, was first used by Heintz and Liebrecht, being intended as a substitute for iodoform; but it is very astringent, although not irritating. The preparation is used in weeping eczema, otitis media, herpes, wounds, burns, diarrhea, and dysentery. In stagnant ulcers it is of no service, since they need stimulation. Bismuth citrate is insoluble, and is of no service medicinally. Besides the foregoing preparations there is a tannate of bis- muth, used to some extent in diarrhea, gonorrhea, leucorrhea, and ophthalmia. Phosphate of bismuth is the least soluble of all the bismuth compounds, and is used, but rarely, in diarrhea, dysentery, gastral- gia, and dyspepsia. Subiodide of bismuth is used as a substitute for the subnitrate, and is of special value in chronic ulcers. It is supposed to be slightly anesthetic. Valerianate of bismuth is of no medicinal value. Subbenzoate of bismuth is mildly escharotic. Administration.—The drug is used externally as a powder or ointment in combination with naphthalin or vaseline, to which a little morphine may be added. Belladonna, opium, and oleate of bismuth are also used. For gastralgia and dyspepsia, pepsin or magnesium and calcium phosphate may be combined with bismuth. If a cathartic is desir- able, rhubarb may be added. Bismuth, aromatic powder, and carbonas liqui make an excel- lent combination in flatulent dyspepsia. In infantile diarrhea and summer complaint bismuth I grain (.06 Gm.), syrupus aurantii 15 minims (.92 Cc), and calumba 15 minims (.92 Cc.) are efficacious, particularly as they allay the alternating pain. ASTRINGENTS. 753 Bismuth, 5-15 grains (.32-1.0 Gm.), is given for stomach affec- tions, and 15 grains (1.0 Gm.) to 1 drachm (4.0 Gm.) for intestinal disorders, one to two hours after meals as the stomach is emptied. Cerii Oxalas—Cerii Oxalatis—Cerium Oxalate. U. 8. P. (Cerous Oxalate.) Origin.—Prepared by a complicated process by the action of acids, etc. upon the powdered mineral. Description and Properties.—A white, granular powder, with- out odor or taste, and permanent in the air. Insoluble in water, alcohol, or ether. Dose.—1-8 grains (0.06-0.5 Gm.). Physiological Action.—The physiological action of this drug is imperfectly understood : it is supposed to be a nervous sedative. Therapeutics.—Internally.—Its widest application is in the vom- iting of pregnancy, but it also controls the emesis of uterine disease and of dyspepsia, due to gastric acidity or deranged innervation of the stomach, as in sea-sickness. It does not derange digestion, and is therefore of value in checking the cough of phthisis and bronchitis, especially when accompanied by vomiting. Simpson regarded it as almost a specific in chorea. In combi- nation with bismuth it is useful in checking diarrhea. Administration.—Cerium oxalate is usually administered in pill form, 1-3 grains (.06-20 Gm.) three times daily, but the powder is used when the drug is associated with other remedies. 48 TOPICAL REMEDIES. GROUP XVIII.—CAUSTICS OR ESCHAROTICS. Caustics are medicines which destroy the tissues to which they are applied. They excite inflammation and vascular dilatation of the surrounding area. The eschar produced by these drugs is separated from the living tissues by the inflammation and suppura- tion produced. When a drug acts as a caustic—that is, when it destroys a cir- cumscribed portion of living tissue—it penetrates deeper in pro- portion as the product of its action {i. e. the eschar) is looser, and is shallower in proportion as the eschar is firmer or more com- pact. This is the essential difference between Astringents and Caustics: the former contract the tissues, causing the protoplasm to be firmer and occupy less space; the latter cause the protoplasm to be softer and occupy more space. It will be seen, therefore, that the more caustic a drug is, the less astringent it is, and vice versa. The caustic action of a drug depends upon whether the drug and its products are both soluble in water; for if the medicine is not soluble in water, it cannot have a caustic action, and if the products of the caustic action are not soluble in water, the eschar will be firm, the drug acting more as an astringent than as a caustic. For example, the chlorides of the heavy metals, such as mer- curic chloride, zinc chloride, etc., are usually freely soluble in water, and are, as a rule, the most caustic of the metallic salts. Should a metallic chloride be insoluble in water, it will have no caustic action—e.g. silver chloride. If the heavy metals be arranged in a series, placing at one end the most astringent salts, and at the other the least astringent, it will be noticed that those salts which are the least astringent are the most caustic, becoming less and less caustic as they are more and more astringent. Most Astringent. Least Astringent. Lead, Iron, Zinc, Copper, Silver, Tin, Mercury. Least Caustic. Most Caustic. 754 CAUSTICS OR ESCHAROTICS. 755 Caustics act— I. By abstracting the water of the tissues ; 2. By combining with the albumin of the tissues; 3. By corrosive oxidation. The important caustics, arranged according to their mode of action, are enumerated below. Caustics which act by abstracting the water from the tissues: Arsenious Acid, Potassa and Lime, Antimony Chloride, Caustic Soda, Carbolic Acid, Glacial Acetic Acid, Chromic Acid, Lime, Caustic Potash, Mineral Acids. Caustics which act by combining with the albumin of the part : Alum (burnt), Mercuric Oxide, Copper Sulphate, Silver Nitrate, Mercuric Chloride, Zinc Chloride, Mercuric Nitrate, Zinc Sulphate. Caustic zt'hich acts by corrosive oxidation : Bromine. Caustics are employed— 1. To destroy excrescences on the skin or mucous membranes, and to effect the destruction or removal of malignant growths, as in cases of warts, condylomata, polypi, lupus, epithelioma, etc.; 2. To open abscesses, or to maintain a chronic irritation, or to stimulate indolent sinuses, ulcers, etc.; 3. To destroy and prevent the absorption of the virus from the bites of rabid and venomous animals, and for the destruction of chancres and malignant pustules. Those escharotics which have not been discussed elsewhere will now be considered in detail: Liquor Antimonii Chl5ridi—Liquoris Antimonii Chloridi—Solution of Antimony Chloride. (Unofficial.) (Butter of Antimony.) Origin.__Prepared by the action of Hydrochloric Acid upon Purified Black Antimony. Description and Properties.—A yellowish or yellowish-red liquid, having the specific gravity 1.47, and yielding with water a white precipitate of antimonious oxychloride {powder of AlgarotJi). Used externally as a caustic. 756 A TEXT-BOOK OF MATERIA MEDICA. Physiological Action and Therapeutics.—Solution of anti- mony chloride is one of the most powerful caustics employed in surgery. It is a violent corrosive poison, toxic doses producing complete general collapse, corroding and charring any living tissue with which it comes in contact. The treatment of poisoning by butter of antimony would be—chalk, magnesia, demulcent drinks, tannic acid, anodynes, and stimulants if necessary. Solution of chloride of antimony may be used as a caustic for the bites of rabid animals and venomous reptiles, chancres, con- dylomata, malignant pustules, etc. The preparation should be cautiously applied with a camel's- hair pencil. Acidum Chromicum—Acidi Chromici—Chromic Acid. U.S. P. (Chromic Trioxide; Chromic Anhydride.) Origin.—Dissolve Potassium Bichromate in Sulphuric Acid and Water; decant, heat with more Sulphuric Acid; cool, and crystallize. Description and Properties.—Small, needle-shaped crystals or rhombic prisms, of a dark purplish-red color and metallic luster; odorless; destructive of animal and vegetable tissues; deliquescent in moist air. Very soluble in water, forming an orange-red solution. When brought in contact with alcohol, ether, glycerin, and other organic solvents decomposition takes place, sometimes with dangerous violence. Chromic acid should be kept in glass-stoppered bottles, and great caution should be observed to avoid bringing it in contact with organic substances, such as cork, tannic acid, sugar, alcohol, etc., as dangerous acci- dents are liable to result. Used externally. Physiological Action and Therapeutics.—Chromic acid is a powerful caustic, deodorant, and disinfectant. It coagulates albumin and oxidizes organic matter. Its action is slow, and the pain following its application is usually of shorter duration than that of most caustics. Weak solutions are stimulant, astringent, and alterative. Chromic acid is used in the form of a paste or in solutions of various strengths for the removal of syphilitic warts, vegetations, condylomata, etc. As a caustic and stimulant application in many diseases of ear, nose, and throat it serves a valuable purpose, as in nasal polypi, enlarged tonsils, chronic and syphilitic laryngitis, laryn- CAUSTICS OR ESCHAROTICS. 757 geal papillomata, chronic superficial glossitis, tuberculosis of the tongue, ozena, ulcerations of the mouth, etc. A 10 per cent, solution of chromic acid has been found service- able in the treatment of hyperidrosis. A solution of I part of chromic acid in 40 parts of water makes an efficient lotion for disinfecting foul ulcers and as an injection in gonorrhea, leucorrhea, etc. Sessile piles and salivary fistula are efficiently treated by touch- ing the parts with pure chromic acid. Potassa—Potassae—Potassa. U. S. P. (Potassium Hydrate; Potassium Hydroxide; Caustic Potash.) Origin.—Prepared by evaporating Liquor Potassse, fusing the residue, and pouring into clean cylindrical moulds which have been previously warmed. Description and Properties.—Dry, white, translucent pencils, or fused masses, hard and brittle, showing a crystalline fracture; odorless or having a faint odor of lye, and of a very acrid and caustic taste. Because of its active effect upon organic tissues it should be tasted and handled with exceeding care. Exposed to the air, it rapidly absorbs carbon dioxide and moisture, and deliquesces. Soluble in about 0.5 part of water and in 2 parts of alcohol. Potassa should be kept in well-stoppered bottles made of hard glass. Used externally. Potassa cum Calce—Potassae cum Calce—Potassa with Lime. U.S.P. (Vienna Caustic or Vienna Paste.) Origin.—Prepared by rubbing together equal parts of Potassa and Lime in a warm iron mortar. Description and Properties.—A grayish-white powder, deli- quescent, having a strongly alkaline reaction. Used externally. Soda—Sodae—Soda. U. S. P. (Sodium Hydrate; Sodium Hydroxide; Caustic Soda.) Origin.—Prepared from a solution of Soda in the same manner as described under Potassa. Description and Properties.—Dry, white, translucent pencils or fused masses, showing a crystalline fracture, odorless, and having an acrid and caustic taste. Great caution is necessary in 758 A TEXT-BOOK OF MA TERIA MEDICA. tasting and handling it, as it rapidly destroys organic tissues. Exposed to the air, it rapidly deliquesces, absorbs carbon dioxide, and becomes covered with a dry coating of carbonate. Soluble in 1.7 parts of water, very soluble in alcohol. Soda should be kept in well-stoppered bottles made of hard glass. Used externally. Physiological Action and Therapeutics.—Potassa is one of the strongest and most penetrating caustics known. It possesses the property of abstracting water from the tissues, neutralizing free acids, decomposing nitrogenous compounds, and of forming solu- tions of fibrin, albumin, and gelatin. When applied to the soft tissues it occasions severe pain, and produces a moist, ashen, and then black, leathery slough, which leaves a granulating ulcer behind it. When potassa is taken internally in immoderate doses it pro- duces all the symptoms of corrosive poisoning. Small doses, freely diluted, have the same action as the alkalies. As a caustic, potassa is used for the same purposes as the caus- tics previously described. Potassa with lime in its operation is similar to, but milder than, potassa. The action and therapeutics of soda are identical with those of potassa, save that soda is less depressing to the heart, muscular and nervous systems. It is not used so much as potassa, the latter preparation usually being preferred as a caustic. To limit the caustic action of these drugs a piece of adhesive plaster should be applied first, with an aperture of the size desired. Upon the skin exposed in the hole in the plaster the caustic is placed, the skin having been previously moistened. The caustic action may be arrested at any time by wetting the part with vinegar. Acidum Aceticum Glaciale—Acidi Acetici Glacialis —Glacial Acetic Acid. U. 8. P. Origin.—Prepared by distilling dry Sodium Acetate with strong Sulphuric Acid. Description and Properties.—A clear, colorless liquid, of a strong, vinegar-like odor, and a very pungent, purely acid taste. Its specific gravity at 150 C. (590 F.) should not be higher than 1.058, corresponding to at least 99 per cent, of absolute acid. Used externally. Physiological Action and Therapeutics.—Glacial acetic acid is a powerful corrosive poison, having an action similar to that of the CAUSTICS OR ESCHAROTICS. 759 mineral acids. The drug is principally used as a caustic for the removal of zuarts and corns, and occasionally for blistering the skin. Calx—Calcis—Lime. U. 8. P. Origin.—Obtained by burning White Marble, Oyster Shells, or the purest varieties of natural Calcium Carbonate. Description and Properties.—Hard, white or grayish-white masses, which, in contact with air, gradually attract moisture and carbon dioxide, and fall to a white powder; odorless ; of a sharp, caustic taste. Soluble in about 750 parts of water; insoluble in alcohol. Used externally. Physiological Action and Therapeutics.—Quicklime when used undiluted is caustic, producing effects similar to those de- scribed under Potassa. For caustic purposes it is usually mixed with potassa (potassa cum calce). When lime is given in diluted solution, it acts as an astringent and antacid. (See Liquor Calcis, p. 155.) The conditions for which lime is employed as a caustic are men- tioned under Potassa. Zinci Chloridum—Zinci Chloridi—Zinc Chloride. U. 8. P. Origin.—Prepared by dissolving Zinc in boiling Hydrochloric Acid. To the solution is added first Nitric Acid, then Zinc Car- bonate to precipitate the impurities. Filter and finally evaporate. Description and Properties.—A white, granular powder or porcelain-like masses, irregular or moulded into pencils ; odorless ; of such intensely caustic properties as to make tasting dangerous, unless the salt be dissolved in much water, when it has an astrin- gent, metallic taste. Very deliquescent; soluble in about 0.3 part of water, forming a clear solution ; very soluble in alcohol. Zinc chloride should be kept in small, glass-stoppered bottles. Used externally. Physiological Action and Therapeutics.—Zinc chloride is caustic, antiseptic, disinfectant, excitant, astringent, and slightly hemostatic, according to the strength of the preparation. Its caus- tic action is painful, yet, while the drug penetrates very deeply, limited to the seat of application. Poisoning by zinc chloride is evidenced by all the symptoms produced by a violent corrosive irritant poison. 760 A TEXT-BOOK OF MATERIA MEDICA. The drug formerly enjoyed quite a reputation as a remedy for cancer, especially epithelioma, in which case it was used in the form of " caustic arrows " inserted in the base of the growth so as to separate it from the healthy tissues. It is used as a paste and lotion for morbid growths, lupus excdcns, putrid ulcers, nozvi, and syphilitic sores. Solutions of zinc chloride are injected into polypi and scrofu- lous glands, and for the destruction of the pulp of decayed teeth. A weak solution of zinc chloride is an efficient injection in gonorrhea, leucorrhea, and hemorrhagic endometritis. For caustic purposes the zinc chloride itself may be used, or a paste prepared with starch, gypsum, flour, anhydrous sulphate of lime, or powdered althea. Mayet's paste consists of zinc chlo- ride 8 parts, zinc oxide I part, dried wheat flour 7 parts, and water I part. The cuticle must always be removed before applying the paste, strong water of ammonia answering for this purpose. Bromum—Bromi—Bromine. U. S. P. Origin.—It is found both in sea-water and in saline springs, but is chiefly obtained from the mother-liquors of salt-works in the United States and at Strassfurth, Germany. Description and Properties.—A heavy, dark brownish-red, mobile liquid, evolving, even at ordinary temperatures, a yellowish- red vapor, highly irritating to the eyes and lungs, and having a peculiar suffocating odor, resembling that of chlorine. Soluble in 30 parts of water and readily soluble in alcohol or ether. Bromine should be kept in glass-stoppered bottles, in a cool place. Used externally. Physiological Action and Therapeutics.—Bromine is a power- ful corrosive irritant, the fumes of which occasion severe irritation of the eyes and respiratory passages, with cough, hoarseness, and dyspnea. When taken into the stomach it produces all the symp- toms of corrosive poisoning. The drug is an active caustic, deodorant, and disinfectant. It was formerly extensively employed, particularly during the Civil War of the United States, for the treatment of hospital gangrene, for which it is a most efficient remedy. Bromine has also been used as an injection (1 part to 3 of alcohol) in various forms of cancer. Owing to the pain attending the operation, however, the treatment has not been generally adopted. Bromine is an efficient disinfectant, and has been employed to VESICANTS AND EPISPASTICS. 761 disinfect and deodorize the atmosphere of hospitals, etc. Berlin sanitary officials declare that " 3I ounces of bromine can disinfect a space of 918 cubic feet, and deodorize a space of 7000 cubic feet." GROUP XIX.—VESICANTS AND EPISPASTICS. These are drugs which excite more or less local inflammation when applied to the skin; the inflammatory condition is accom- panied by an effusion of serum between the epidermis and dermis— i. e. a blister. The principal Vesicants are— Acetic Acid (glacial), Mezereon, Ammonia (the confined vapor), Mustard (volatile oil), Cantharides, Rhus Toxicodendron. Iodine, There are certain drugs which affect certain parts of the skin— for instance, the orifices of the sudoriferous glands—in a special manner, and their action on these parts is such as to give rise to pustules rather than blisters. Drugs which affect the skin in this manner are called Pustulants. The following-named drugs are the most important of them : Croton Oil, Silver Nitrate, Tartar Emetic, Ipecac. Therapeutics.—Vesicants are employed as local stimulants in chronic ulcers and to facilitate the absorption of effusions, as in chronic synovitis or chronic thickening about the joints. Blisters are also of use in endocarditis, neuralgias, sciatica, chronic pericarditis, pleurisy, hysterical paralysis, and aphonia, cerebral or spinal meningitis, etc. Pustulants are more particularly employed to maintain a con- tinuous though moderate irritation in chronic inflammations. They are used for the same class of cases as vesicants, but are preferable when it is desirable to prolong the local irritation without exciting too much inflammation. Contraindications.—Vesicants are usually contraindicated in acute inflammations and in inflammation of the cutaneous tissues, as rubeola and scarlatina. Vesicants are not permissible in preg- nancy, debility, scorbutus, and purpura, or in extreme infancy and old age. They should not be applied over the scrotum or the 762 A TEXT-BOOK OF MATERIA MEDICA. mammary glands, nor over bony prominences where the healing processes are apt to be retarded. All the vesicants and pustulants have, with two exceptions, been discussed elsewhere. Cantharis—Cantharidis—Cantharides. U. 8. P. (Spanish Flies.) Origin.— Cantharis vesicatoria De Geer, a beetle indigenous to Southern and Central Europe, and found eastward as far as West- ern Asia. Description and Properties.—About 1 inch (25 Mm.) long and \ inch (6 Mm.) broad; flattish-cylindrical, with filiform antennae, black in the upper part, and with long wing-cases and ample, membranous, transparent, brownish wings, elsewhere of a shining, coppery-green color. The powder is grayish-brown, and contains green shining particles. Odor strong and disagreeable ; taste slight, afterward acrid. Cantharides contains a fatty crystallizable body, cantharidin, which is the active principle, a volatile oil also possessing vesica- tory properties, and a green oil closely allied to chlorophyl. Used externally. Official Preparations. Ceratum Canthandis—Cerati Cantharidis—Cantharides Cerate.—Cantha- rides, 320; Yellow Wax, 180; Resin, 180; Lard, 220; Oil of Turpentine, 150.—Used externally. Collodium Cantharidatum—Collodii Cantharidati—Cantharidal Collodion (Blistering Collodion).—Used externally. Tinctura Canthandis—Tinctiirae Cantharidis—Tincture of Cantharides.— Dose, 1—15 minims (0.06-1.0 Cc). The Cantharides Cerate is an ingredient of Emplastrum Picis Cantharidatum. Antagonists and Incompatibles.—There are no known physi- ological antagonists or incompatibles. Synergists.—Members of this group enhance the vesicating action of cantharides. Its aphrodisiac action is aided by phos- phorus and strychnine. Physiological Action.—Externally and Locally.—Cantharides is a slow though very powerful irritant. When the drug is applied to the skin or mucous membrane it excites a tingling, burning pain, with marked redness of the cuticle. In the course of three or four hours after the application of cantharides there are formed numer- VESICANTS AND EPISPASTICS. 763 ous vesicles which soon coalesce, forming one large bleb full of clear serum. The drug not only causes vascular dilatation of the part to which it is applied, but reflexly dilates the blood-vessels of the deep-seated organs underneath, thus acting as a counter-irritant. The active principle of cantharides may be absorbed through the skin, producing its constitutional effects. Internally.—Digestive System.—Moderate doses of cantharides produce a sensation of heat in the stomach, and may even occasion gastrodynia. Large amounts occasion severe gastro-intestinal irri- tation. There is a sense of constriction in the esophagus, a burning heat in the throat, ptyalism, intense gastric pain, nausea, and vomit- ing of glairy mucus often containing blood. There is great tender- ness over the abdomen, fibrinous and sometimes bloody stools, attended by griping pain and tenesmus. Circulatory System.—Full medicinal doses excite the heart, increasing the force and rapidity of its action, and elevate arterial tension. Under large doses the pulse and arterial pressure fall, and there is great depression of the entire circulatory system. Nervous System.—Small doses have no influence on the nervous system other than would be produced by stimulation of the circulation. Excessive amounts have produced marked cerebral effects, consisting of partial or general convulsions, coma, and insensibility. Respiratory System.—No effect follows medicinal doses; toxic amounts accelerate and weaken the respiration. Absorption and Elimination.—The active principle of cantharides is rapidly absorbed into the blood, and in large doses produces marked irritation of the genito-urinary organs. There is at first increase of urine, which is soon greatly diminished in amount, and which may be albuminous or bloody. There is strangury and fre- quent desire to micturate, and severe pain in the loins and bladder. The local irritation is apt to occasion priapism, with frequently erotic excitement and seminal emissions. There may also be swelling and inflammation of the external genitals. In women cantharides may also occasion increased sexual desire, cause abor- tion, or induce menstruation. Yet amatory desire does not always follow the ingestion of cantharides, even in large doses. Indeed, the aphrodisiac effect of the drug is usually more manifest under small or full medicinal doses than from the ingestion of immoderate amounts. The drug is principally eliminated by the kidneys. 764 A TEXT-BOOK OF MATERIA MEDICA. Temperature.—The temperature is at first elevated by excessive amounts, but declines together with the depression of the circu- latory system. Uterus.—The uterus and female genital organs are stimulated by the drug, as has been previously described. Untoward Action.—The untoward manifestations do not differ from the symptoms produced by excessive amounts, as described under the different systems. These various untoward effects vary in intensity according to the individuality of the patient. Poisoning.—Toxic amounts of cantharides produce violent gastro- intestinal and genito-urinary inflammation. The general symptoms are great pain in the throat, stomach, and bowels, excessive thirst, vomiting of bloody mucus, frequent stools which may contain blood, burning pain in the kidneys, strangury, scanty, albuminous, and bloody urine, painful erections of the penis, seminal emissions, swell- ing and inflammation of the external genitals, a rapid, small, and weak pulse, accelerated respiration, skin hot and dry, congestion of the face, pain in the head, delirium, trembling, partial or general convulsions, and coma. The post-mortem appearances are swell- ing, ecchymoses, and sometimes gangrene of the mucous mem- brane of the alimentary canal. The kidneys are enlarged and engorged, and are in a condition of parenchymatous and desquam- ative nephritis. Treatment of Poisoning.—The stomach should be emptied, and demulcents, stimulants, and opiates given as necessary. Oils and fats should be avoided, as they increase the solubility and favor the absorption of cantharidin. Therapeutics.—Externally and Locally.—A cantharidal blis- ter is frequently of service as a revulsive when there is a local tend- ency to congestion. The drug is applied to the chest in the second stage of pneumonia and in pleurisy, and "flying" blisters are beneficial in hydrothorax and chronic pleurisy. The cure of boils and carbuncles has been hastened by applying a cantharidal blister to the indurated spot. The drug is also of service to stimulate indolent ulcers, fistulce, etc. A blister over the region of the heart will often afford marked relief in pericarditis. A cantharidal plaster applied over the course of the affected nerve frequently affords great relief from pain in neuralgia and some forms of sciatica. VESICANTS AND EPISPASTICS. 765 In certain diseases of the brain and spinal cord blisters applied to the nape of the neck or along the course of the cord, a little to one side of the vertebrae, will often favorably influence the course of the disease. Blisters are frequently of service in synovitis and periostitis of the larger bones. A blister applied to the epigastrium will some- times allay gastric pain and obstinate vomiting. Blistering over the region of the ovary is an efficient means of relieving the symptoms of chronic ovaritis, and a blister applied to the mastoid region will frequently be of benefit in otitis media. Small patches of tinea tonsurans and of tinea circinata may be removed by blistering. Liniments and lotions containing tincture of cantharides are among the best means of curing alopecia. The National Dispensatory aptly gives the general uses for cantharides in the form of blisters as follows: " 1, to stimulate the whole or a particular part of the system ; 2, to promote the absorption or prevent the accumulation of inflammatory exuda- tions ; 3, to recall suppressed discharges; 4, to act as a depletory; 5, to promote the cure of internal diseases by counter-irritation of the skin." Internally.—Certain diseases of the genito-urinary organs, as debility of the bladder with accompanying incontinence of urine, chronic pyelitis, chronic catarrh of the bladder, etc., are benefited by small doses of tincture of cantharides. Small doses of this preparation are sometimes serviceable in the treatment of acute desquamative nephritis. Diabetes insipidus has been arrested by the internal administration of cantharides. Gleet, prostalorrhea, and spermatorrhea are benefited by this drug. Menorrhagia and amenorrhea occurring in debilitated women will often be benefited by cantharides. Tincture of cantharides, with tincture of iron, tincture of nux vomica, and phosphoric acid, is an efficient combination in impo- tence, the result of old age, sexual excesses, or masturbation. In scaly skin diseases cantharides often proves very serviceable after arsenic and the external application of tarry preparations have failed. Cantharidin and potassium cantharidate have been recom- mended by Professor Liebreich as efficient remedies in tuberculosis. Hypodermic injections not exceeding Tfa grain (0.0006 Gm.) of cantharidin are used, and in some cases apparently have been 766 A TEXT-BOOK OF MA TERIA MEDICA. followed by good results. The treatment, however, has not proved sufficiently successful to warrant its employment to the exclusion of other measures. Administration.—A cantharidal blister should not be allowed to remain on. the skin for more than twelve or twenty-four hours, six to eight hours usually being sufficient. When blebs are formed, they should be carefully opened at their most dependent parts. When the serum has drained away the part should be dressed with a layer of borated cotton kept in place by the aid of a few strips of adhesive plaster. Should the blistering by cantharides occasion too great pain, a poultice made of breadcrumb and solution of subacetate of lead, to which is added \ or \ grain (0.008 or 0.01 Gm.) of morphine sulphate or other soothing application, should be applied to the blistered part. The obstinate ulcers which sometimes follow the use of cantharides blisters may be treated effectively by Goulard's cerate. It is said that the strangury which plasters of cantharides fre- quently cause may be prevented by sprinkling the surface of the plaster with powdered camphor or sodium bicarbonate. For internal use the tincture of cantharides is the only prepara- tion to employ. Sinapis Alba—Sinapis' Albae—White Mustard. U. 8. P. Origin.—The seed of Brassica alba L., Hooker filius et Thomp- son. Sinapis Nigra—Sinapis Nigrae—Black Mustard. U. 8. P. Origin.—The seed of Brassica nigra L., Koch. Both the white and black mustard are annual plants, indigenous in Southern Europe and Western Asia, cultivated, and sometimes found wild, in the United States. Description and Properties.—White mustard seeds are almost globular, about yL- inch (2 Mm.) in diameter, with a circular hilum; testa yellowish, finely pitted, hard; embryo oily, with a curved radicle and two cotyledons, one folded over the other; free from starch ; inodorous ; taste pungent and acrid. Black mustard seeds resemble the preceding in shape, but have a diameter only of -fa inch (1 Mm.); blackish-brown or deep red- VESICANTS AND EPISPASTICS. 767 dish-brown, with a testa covered with shallow pits, and when crushed and macerated with water acquiring a strong and pungent odor. White mustard seed contains an almost tasteless, yellowish, fixed oil, and a substance known as sinalbin, which is the chief con- stituent. This substance may be converted into allyl sulphocyanide (a volatile oil) by the action of the ferment myrosin and water. Black mustard seeds contain the same fixed oil as the white mus- tard, and a glucosid, sinigrin, which by the action upon it of myro- sin in contact with water converts it into sulphocyanate of acrinyl (the volatile oil of mustard). To this volatile oil of mustard, which is official, is due both the pungent taste and odor of the moistened powder. Dose.—1-4 drachms (4.0-15.0 Gm.). Official Preparation {of Black Mustard Seed). Charta Sinapis—Chartae Sinapis—Mustard Paper. Oleum Sinapis Volatile—Olei Sinapis Volatilis—Vol- atile Oil of Mustard. US.P. Origin.—A volatile oil obtained from Black Mustard by macera- tion with Water and subsequent distillation. Description and Properties.—A colorless or pale yellow, limpid, and strongly refractive liquid, having a very pungent and acrid odor and taste. Freely soluble in alcohol, ether, or carbon disulphide. Used externally. Official Preparation. Linimentum Sinapis Comp8situm—LinimSnti Sinapis Compbsiti—Com- pound Liniment of Mustard.—Formula: Volatile Oil of Mustard, 30; Fluid Ex- tract of Mezereum, 200; Camphor, 60; Castor Oil, 150; Alcohol, to 1000, by solution. Used externally. Physiological Action.—Externally and Locally.—Mustard is irritant, counter-irritant, rubefacient, and vesicant. Any degree of irritation, from slight redness of the skin to severe blistering, may be produced by mustard. It is more rapid in its action than can- tharides, and when applied to the skin there is produced almost immediately a sensation of warmth, which rapidly passes into a severe burning pain. This irritation of the sensory nerves is suc- ceeded by paralysis and more or less loss of sensation, so that if mustard be allowed to remain on the skin until blistering ensues there is a decided diminution of pain. 768 A TEXT-BOOK OF MA TERIA MEDICA. The local application of mustard reflexly stimulates the heart and respiration. Internally.—Mustard in small amounts is taken as a condiment, and is a powerful stimulant of the gastro-intestinal tract. Large doses irritate the stomach and act as an emetic, producing prompt emesis without depression, owing to the reflex stimulation of the heart and respiration. The volatile oil of mustard is never intentionally given inter- nally. It is a powerful caustic irritant, a single drop upon the tongue producing an intense burning pain in the throat, stomach, and nose. Therapeutics.—Externally and Locally.—Mustard may be used locally for the same purposes as cantharides, being superior to the latter-named drug when a simple rubefacient effect is desired. Mustard when applied locally is more of a stimulant to the circu- latory and respiratory systems than cantharides, and is therefore an efficient remedy in syncope, asphyxia, and coma. As a stimulant in these conditions, a large mustard poultice is applied to the legs. A mustard bath, in the strength of i drachm (4.0 Gm.) to 1 gallon (3785.43 Cc.) of water, is an efficient means of breaking up a cold, and if properly used is of service when the rash in measles or scarlet fever has receded. The menses may often be re-established when suppressed by a mustard sitz-bath, taken at the time of the expected period. Internally.—Other than the use of mustard as a condiment, the drug is given only to produce vomiting, being one of the best emetics in indigestion and narcotic poisoning. Obstinate hiccough has sometimes been arrested by an infusion of mustard. Administration.—A mustard plaster, or sinapism, is prepared by mixing equal parts of wheaten or rye flour with water to the consistence of a thick paste, which is spread on linen or cotton cloth and applied to the skin. A dampened piece of gauze inter- posed between the plaster and the skin will prevent the former from adhering. A mustard cataplasm is a weaker preparation. A flaxseed or cornmeal poultice is made, to which a small quantity of ground mustard is added. This is intended to maintain a gentler but more prolonged action than the sinapism. " Mustard leaves," or plasters which may be obtained ready pre- R UBEFA CIENTS. 769 pared at drug-stores, are intended to be simply dipped in water and applied to the skin. Their activity may be lessened by interposing a thin piece of linen or cotton cloth between the plaster and the skin. Liniments containing oil of mustard are efficient rubefacients, care being taken to adapt the strength of the preparation to the delicacy of the skin. When mustard is taken as an emetic, it is given in the form of an infusion, in the proportion of 1, 2, or 3 drachms (4.0, 8.0, or 12.0 Gm.) to 1 pint (473.17 Cc.) of water. A preparation known as mustard whey is sometimes given. It is prepared by boiling 1 \ ounces (46.65 Gm.) of bruised mustard seed in a mixture of 1 pint (473.17 Cc.) of milk and 1 quart (946.35 Cc.) of water, until it is curdled, when the whey should be strained off. GROUP XX.—RUBEFACIENTS. These are drugs which, when locally applied, are intended to produce temporary redness and congestion of the skin. Some of them are vesicant if applied in full strength, and if their contact with the skin be sufficiently prolonged, vesication, or even total destruction of tissue, may result. The following list embraces the principal rubefacient drugs: Ammonia, Menthol, Alcohol, Mezereon, Arnica, Mustard, Camphor, Oil of Cajuput, Capsicum, Oil of Turpentine, Chloroform, Pitch, Ether, Volatile Oils. Iodine, Hot water and friction are also rubefacient agents. Rubefacients are used for their influence upon the skin itself or for their effect on deep-seated structures. Rubefacients are efficient means of relieving neuralgic pains, conditions of nervous debility, nervous excitement, the sense of fatigue, and as an aid in narcotic poisoning, also to hasten the absorption of inflammatory exudates, to remove the swelling and restore the function of chronically inflamed joints, etc. 49 77° A TEXT-BOOK OF MA TERIA MEDICA. Rubefacients should ordinarily be applied with friction, as rub- bing of the skin aids the action of many of them. Save one, all the rubefacients mentioned in the preceding list have been considered elsewhere in the present work. Pix Burgtindica—Picis Burgundicae—Burgundy Pitch. U.S. P. Origin.—The prepared resinous preparation of Abies excelsa Poiret, the spruce fir, or Norway spruce, a stately tree growing in Northern Asia and Northern Europe, and frequently cultivated in the United States. Description and Properties.—Hard, yet gradually taking the form of the vessel in which it is kept, brittle, with a shining, con- choidal fracture, opaque or translucent, reddish-brown or yellowish- brown ; odor agreeably terebinthinate; taste aromatic, sweetish, not bitter. It is almost entirely soluble in glacial acetic acid or in boiling alcohol, and partly soluble in cold alcohol. Burgundy pitch contains a resin and a volatile oil in variable proportion. Used externally. Official Preparations. Emplastrum Picis Burgundicae—Empiastri Picis Burgundicae—Burgundy Pitch Plaster.—Contains 90 per cent, of Burgundy Pitch. Used externally. EmplSstrum Picis Cantharidatum—Empiastri Picis Cantharidati—Can- tharidal Pitch Plaster (Warming Plaster).—Contains 8 per cent, of Cerate of Cantharides. Used externally. Burgundy Pitch is contained in Emplastrum Fern and Emplastrum Opii. Physiological Action and Therapeutics.—Burgundy pitch when applied to the skin in the form of a plaster occasions red- ness and a papular eruption, accompanied by itching. If the plaster is allowed to remain in contact with a delicate skin for too long a period, there may be produced a vesicular or even pustular eruption. The chief uses of Burgundy pitch plaster are to protect, sustain, or stimulate the part to which it is applied. The plaster is an efficient remedy in subacute and chronic pleurisy, chronic bronchitis, lumbago, muscular rheumatism, etc. Before applying a Burgundy pitch plaster to a hairy skin, the hair should be shaved off. The removal of the plaster may be facilitated by warming it, applying to the back of the plaster a hot bottle or hot water-bag. Any particles of pitch which may EMOLLIENTS, DEMULCENTS, ETC. 771 adhere to the surface of the skin may be removed by washing with warm alcohol. GROUP XXL—EMOLLIENTS, DEMULCENTS, AND PROTECTIVE AGENTS. Emollients are substances which soften, relax, and protect the tissues to which they are applied They relieve pain and tension by diminishing heat and lessening the pressure on the nerves. The principal emollients are— Glycerin, Soap Liniment, Starch, Fats and Oils, Hot Fomentations, Lard, Olive Oil, Almond Oil, Spermaceti, Linseed Oil, Cacao Butter, Petroleum, Paraffin, Petrolatum, Vaseline, etc. Poultices, Linseed Meal, Oatmeal, Bran, Bread, Flour, Figs, etc. Demulcents are substances which soothe and protect the parts to which they are applied. They are generally of a mucilaginous nature, and are employed for their action upon mucous membranes, while emollients are principally used on the skin. The important demulcents are— Acacia, Marshmallow, Sassafras-pith, Barley, Liquorice, Isinglass, Cetraria, Starch, Honey, Almond, Tragacanth, Gelatin, Flaxseed, Glycerin, Bland Oils. Slippery Elm, White of Egg, 772 A TEXT-BOOK OF MATERIA MEDICA. Both Emollients and Demulcents are exceedingly useful agents to relieve irritation of the skin in certain cutaneous diseases; by softening the skin and mucous membranes they also prevent crack- ing or chapping from exposure to cold. They are also efficient agents to prevent bed-sores and to lessen friction between approx- imating surfaces, as between the nates and about the groins of children. Demulcents are employed internally with good results when there is an irritated or inflamed condition of mucous membranes, whether of the respiratory, gastro- intestinal or genito-urinary tracts, as in bronchitis, gastritis, enteritis, diarrhea, dysentery, strangury, cystitis, etc. Demulcents—such as flaxseed, slippery elm, marshmallow, or sassafras-pith—are very agreeable and efficient agents to quench thirst and to relieve the irritation of mucous surfaces in febrile affections. Protectives are agents used to mechanically cover and protect injured or diseased surfaces from extraneous influences, as from air, water, etc. Certain agents classed as protectives are employed for their absorptive power of taking up by capillary attraction any moisture or fluid present. They are useful agents as protective coatings to bed-sores or to excoriated, abraded, or burned surfaces. The principal protectives are— Collodion, Solution of Gutta-percha, Solution of Sodium Silicate, Court-plaster (Emplastrum Ichthyocollae), Lycopodium, Charcoal, Animal Charcoal, Purified Cotton. The Emollients, Demulcents, and Protectives which are deemed sufficiently important to merit more consideration than has been given them elsewhere in the present work, will be now considered. Glycerinum—Glycerini—Glycerin. U. S. P. Origin.—A liquid obtained by the decomposition of vegetable or animal fats or fixed oils, and containing not less than 95 per cent, of absolute glycerin. EMOLLIENTS, DEMULCENTS, ETC. 773 Description and Properties.—A clear, colorless liquid, of a thick, syrupy consistence, oily to the touch, odorless, very sweet and slightly warm to the taste. When exposed to the air, it slowly abstracts moisture. Specific gravity not less than 1.250. Soluble in all proportions in water or alcohol; also soluble in a mixture of 3 parts of alcohol and 1 part of ether, but insoluble in ether, chloroform, carbon disulphide, benzin, benzol, and fixed or volatile oils. Dose.—5-60 minims (0.3-4.0 Cc). Official Preparations. Glyceritum Amyli—Glyceriti Amyli—Glycerite of Starch.—Starch, 10; Water, 10; Glycerin, 80. Used internally or externally. ' Glyceritum Vitfelli— Glyceriti VitSlli—Glycerite of Yolk of Egg (Glyco- NIN).—Fresh Yolk of Egg, 45 ; Glycerin, 55. Used freely internally or externally. Suppositoria Glycerini—Suppositoria (ace.) Glycerini—Suppositories of Glycerin.—(Each suppository contains 93 grains (6.0 Gm.) of glycerin.) Used as re- quired. Glycerin is also contained in the following official preparations: Glyceritum Acidi CarbSlici, Glyceritum Acidi T3nnici, Glyceritum Boro- glycerini, Glyceritum Hydrastis, Mucilago Tragacanthae, Massa Hydrargyri Pilulae Ph6sphori, and in many extracts and fluid extracts. Antagonists and Incompatibles.—Glycerin is incompatible with potassium permanganate and with chromic acid. Synergists.—Its emollient properties may be enhanced by emollients and demulcents. Physiological Action.—Externally and Locally.—When gly- cerin is applied to the skin or mucous membrane it is ordinarily bland and unirritating, although in certain cases the drug occasions a sensation of burning and smarting, which may be due either to an impure preparation, the rapid absorption of water from the tissues, or merely to a marked idiosyncrasy on the part of the patient Should the pure drug show a tendency to irritate the skin the glycerin should be properly diluted with water. Preparations more concentrated than the specific gravity recom- mended by the U. S. Pharmacopoeia—viz. 1.25—should be avoided, because of their irritating properties. Glycerin abstracts water from the tissues, and is rapidly absorbed through the skin. It possesses marked diffusive power, being capable of diffusing itself freely over and through organic matter. Internally.—The principal action of glycerin when taken inter- 774 A TEXT-BOOK OF MA TERIA MEDICA. nally is that of a purgative. The drug purges when given by the rectum, either as enema or in the form of a suppository. Glycerin is readily absorbed from the alimentary canal, and it is thought by some physicians to undergo oxidation, thereby act- ing as a food and increasing body-weight. Other competent inves- tigators allege that it is not in the least degree nutritious. When immoderate amounts of the drug are taken, it may be detected in the urine, while under excessive doses effects may be produced similar to those resulting from alcoholic poisoning. Following the ingestion of very large doses, there may be extreme muscular weakness, dryness of mucous membranes, dark- colored urine, collapse, and death. The drug is not considered poisonous, excessive amounts being necessary to produce the symptoms above described. Therapeutics.—-Externally and Locally.—Glycerin is a popular and efficient remedy for chapped hands and slight excoriations. Fissured nipples and fissure of the anus are well treated with pure glycerin or with glycerin and tannic acid. The drug also makes an efficient application to bed-sores. Glycerin is employed as an injection in gonorrhea. It may be used alone or medicated with bismuth subnitrate or with extract of opium. Glycerin is one of the best solvents for hardened cerumen, and tampons wet with glycerin or with glycerite of tannic acid are very serviceable in leucorrhea and erosion of the cervix, and endo- metritis with congestion and subinvolution of the uterus. Glycerin possesses marked antipruritic properties, and, whether applied pure or combined with oils or ointments, will allay itching of most affections of the skin. Lotions or diluted aqueous solutions of glycerin are fre- quently employed in various diseases of the ear, nose, and throat, such as fissure of the tongue, chronic laryngitis, chronic nasal catarrh, coryza, pharyngitis, etc. A mixture of glycerin and water will lessen or prevent dry- ness of the mouth from fever or other causes. • Glycerin is an efficient topical remedy for the reduction of edema of the prepuce, and is a serviceable antiseptic dressing for wounds, carbuncles, boils, etc. Glycerite of starch is an excellent soothing emollient in acute eczema, and quite an efficient preparation to prevent pitting in variola. EMOLLIENTS, DEMULCENTS, ETC. 775 Glyconin (glycerite of yolk of egg) makes an agreeable, sooth- ing application in erysipelas, fissured nipples, etc. Internally.—The principal internal use for glycerin is for the relief of habitual constipation, being far more efficient in habitual than in occasional constipation, and more generally applicable to females than to males, and to those cases where the fecal mass is retained in the rectum than in the sigmoid flexure or above it. For the purpose of relieving constipation it may be given by the mouth, alone or associated with castor oil, or i or 2 fluidrachms (4.0-8.0 Cc.) injected into the rectum, or, which perhaps is the most agreeable method, by the insertion into the rectum of a glycerin suppository. Glycerin is said to relieve the acidity, pyrosis, and flatulence of dyspepsia. It has been employed in diabetes, but without favorable results. Administration.—Whether glycerin be used externally or in- ternally, it should always be chemically pure, otherwise much irri- tation may be produced. For external use it may be used pure or mixed with water, or in various lotions, ointments, etc. Internally it is seldom given alone, but with syrups, water, wine, or other alcoholic liquors. Oleum Olivae—Olei Ollvae—Olive Oil. U. S. P. Origin.—The fixed oil expressed from the fruit of Olea Europoza L, a shrubby, thorny, medium-sized tree, indigenous in Western Asia, but cultivated in the countries bordering on the Mediter- ranean and in the Southern United States, California, and several South American and other countries. Description and Properties.—A pale yellow or light greenish- yellow, oily liquid, having a slight, peculiar odor, and a nutty, oleaginous taste, with a faintly acrid after-taste. Very sparingly soluble in alcohol, but readily soluble in ether, chloroform, or car- bon disulphide. Olive oil should be kept in well-stoppered bottles in a cool place. Dose.—Freely. Physiological Action and Therapeutics.—Olive oil is a singu- larly bland and agreeable oil, and very useful as an emollient and demulcent. It serves as an efficient protective to the skin, from which it is readily absorbed. As a lenitive and protective in cases 776 A TEXT-BOOK OF MATERIA MEDICA. of superficial wounds, bruises, excoriations, burns, bites and stings of insects, sprains, etc. it serves a valuable purpose. It is extensively employed by dermatologists to soften and facili- tate the removal of crusts, scales, and epithelial debris of various cutaneous disorders. The application of warm olive oil, made with gentle friction to painful and engorged mammary glands during pregnancy and after parturition, generally lessens the pain and swelling. The drug is an efficient palliative in painful deglutition, and is sometimes injected into the rectum as a soothing emollient in dys- entery, and to destroy " seat-worms" and allay the irritation pro- duced by them. Frequently the forcible injection into the urethra of olive oil will dilate an unusually tight stricture, partly overcoming the dif- ficulty to the introduction of a sound. Olive oil is habitually employed as a lubricant for sounds, cathe- ters, specula, pessaries, etc. Where a fat or an oil is not contraindicated, olive oil is one of the most efficient demulcents to administer in cases of poisoning from corrosive irritating drugs. Olive oil is a useful and pleasant laxative, and is used to a con- siderable extent for that purpose. The oil is also credited with facilitating the discharge of gall-stones. It unquestionably increases the secretion of bile, which may account for its apparent influence in favoring the expulsion of these concretions. Oleum Amygdalae Expressum—Olei Amygdalae Ex- pressi—Expressed Oil of Almond. U.S.P. Origin.—A fixed oil expressed from Bitter or Sweet Almond {Prunus Amygdalus, var. amara and dulcis, De Candolle), a tree 15 to 20 feet (5 to 6 M.) high, indigenous in Western Asia and culti- vated in subtropical countries. Description and Properties.—A clear, pale straw-colored or colorless, oily liquid, almost inodorous, and having a mild, nutty taste. Only slightly soluble in alcohol; soluble in ether, and in chloroform in all proportions. It should be kept in well-stoppered bottles, in a cool place. Dose.—1-4 fluidrachms (4.0-8.0 Cc). Expressed Oil of Almond is contained in Unguentum Aquae Rosae. Physiological Action and Therapeutics.—The expressed oil EMOLLIENTS, DEMULCENTS, ETC. 777 of almond is a peculiarly bland and agreeably efficient demulcent and emollient, being used both externally and internally for the same purposes as olive oil. Oleum Lini—Olei Lini—Linseed Oil. U. 8. P. (Oil of Flaxseed.) Origin.—A fixed oil expressed without heat from the seed of Linum Usitatissimum L. Description and Properties.—A yellowish or yellow, oily liquid, having a slight, peculiar odor, and a bland taste. When exposed to the air it gradually thickens and acquires a strong odor and taste; and if spread in a thin layer on a glass plate, and allowed to stand in a warm place, it is gradually converted into a hard, trans- parent, resin-like mass. Soluble in about 10 parts of absolute alco- hol, and, in all proportions, in ether, chloroform, benzin, carbon disulphide, or oil of turpentine. Linseed oil should be kept in well-stoppered bottles. Dose.—1-2 fluidounces (15.0-60.0 Cc). Physiological Action and Therapeutics.—The action and uses of flaxseed oil are similar to those of olive oil. One of its most important uses, when mixed with an equal quantity of lime water, is in the treatment of burns. The linseed itself is used extensively as a domestic demulcent in the form of a tea, for cough, etc., while the ground linseed makes an excellent poultice for all deep-seated inflammations. Acacia—Acaciae—Acacia. U. 8. P. (Gum Arabic.) Origin.—A gummy exudation from Acacia Senegal Willdenow, a small tree about 20 feet (6 M.) high, found in India and Africa, especially in the district of Khartoum, westward to Senegambia. Description and Properties.—In roundish tears of various sizes, or broken into angular fragments, with a glass-like, some- times iridescent fracture, opaque from numerous fissures, but trans- parent and nearly colorless in thin pieces; nearly inodorous, taste insipid, mucilaginous; insoluble in alcohol, but soluble in water, forming a thick mucilaginous liquid. Acacia should be slowly but completely soluble in 2 parts of water. Official Preparations. Mucilago Acaciae-Muciiaginis Acaciae—Mucilage of Acacia (34 per cent.). —Dose, freely. 77& A TEXT-BOOK OF MATERIA MEDICA. Syrupus Ac3ciae—Syrupi Acaciae—Syrup of Acacia.—Dose, freely. Acacia is contained in Emulsum Amygdalae, Pulvis Cretae Compositus, and in some trochisci. Physiological Action and Therapeutics.—Acacia is a valuable demulcent, and gum water is in ordinary use to serve as a protective to inflamed and irritated mucous membranes of the respiratory, alimentary, and genito-urinary tracts, as in cases of pharyngitis, laryngitis, dysentery, gastritis, typhoid fever, and in febrile affections generally. The mucilage of acacia is sometimes used as a pro- tective for superficial burns, excoriations, etc. Cetraria—Cetrariae—Cetraria. U. S. P. (Iceland Moss.) Origin.— Cetraria Islandica L., fronds of a lichen indigenous in the Northern Hemisphere. Description and Properties.—From 2 to 4 inches (5 to 10 Cm.) long, foliaceous, irregularly branched into fringed and channelled lobes, brownish above, whitish beneath, and marked with small, depressed spots; brittle and inodorous; when softened in water, cartilaginous, and having a slight odor; its taste is mucilaginous and bitter. Official Preparation. Decoctum Cetrariae—DecScti Cetrariae—Decoction of Cetraria. Physiological Action and Therapeutics.—Cetraria is a demul- cent and tonic, and may be used for the same purposes as acacia. It is, however, more nutritious than acacia, and is used to a con- siderable extent for chronic pulmonary affections. Ulmus—Olmi—Elm. V. 8. P. (Slippery Elm.) Origin.—The inner bark of Ulmus fulva Michaux, a medium- sized tree, from 30 to 60 feet (9 to 18 M.) high, found in the United States and Canada. Description and Properties.—In flat pieces, varying in length and width, about ! inch (3 Mm.) thick, tough, pale brownish-white, the inner surface finely ridged; fracture fibrous and mealy; the transverse section delicately checkered; odor slight, peculiar; taste mucilaginous, insipid. EMOLLIENTS, DEMULCENTS, ETC. 779 Official Preparation. Mucilago Ulmi—Muciiaginis Ulmi—Mucilage of Elm.—Dose, freely. Physiological Action and Therapeutics.—Elm is a decided demulcent and possesses nutritive properties. It is pleasant to the taste and does not readily disturb the stomach. It is principally used as a demulcent in diseases of the gastro-intestinal and genito- urinary tracts, as diarrhea, dysentery, cystitis, urethritis, etc. The fibrous bark is moulded into tents used to dilate the neck of the uterus, fistulous openings, etc. Althaea—Althaeae—Althaea. U. S. P. (Marshmallow.) Origin.—The root of Althcea officinalis L., a perennial herb in- digenous in the temperate portion of Northern and Western Asia and in the greater part of Europe. Description and Properties.—In cylindrical or somewhat con- ical pieces, from 4 to 6 inches (10 to 15 Cm.) long, about \ inch (12.7 Mm.) thick, deeply wrinkled, deprived of the brown corky layer and small roots; externally white, marked with a number of circular spots, and of a somewhat hairy appearance from the loosened bast-fibres ; internally whitish and fleshy. It breaks with a short, granular, and mealy fracture, and has a faint, aromatic odor and a sweetish, mucilaginous taste. It contains asparagin, muci- lage, sugar, and pectin. Official Preparation. Syrupus Althaiae—Syrupi Althaiae.—Syrup of Althaea.—Dose, freely. Physiological Action and Therapeutics.—Marshmallow is emollient, demulcent, and protective, and is an efficient protective and emollient in irritable and inflamed conditions of the skin, and a highly efficacious demulcent in all inflammatory and irritable conditions of the respiratory, digestive, and urinary organs. Tragacantha-Tragacanthae-Tragacanth. U. 8.P. Origin —A gummy exudation from Astragalus gummifcr Labil- lardiere and from other species of Astragalus, low shrubs, indige- nous in'a portion of the territory lying between Eastern Persia and Greece Description and Properties.—In narrow or broad bands, more or less curved or contorted, marked by parallel lines or ridges, white or faintly yellowish, translucent, horn-like, and tough. It 780 A TEXT-BOOK OF MA TERIA MEDICA. contains 33 per cent, of a gum, bassorin, which is only slightly soluble in water. Official Preparation. Mucilago Tragacanthae—Muciiaginis Tragacanthae—Mucilage of Traga- canth.—Dose, freely. Physiological Action and Therapeutics.—Tragacanth is de- mulcent and nutritious, and may be used for the same purposes as acacia, Iceland moss, etc. The mucilage of tragacanth is sin- gularly efficacious as a soothing emollient in chapped hands and irritable conditions of the skin. Sassafras Medulla—Sassafras Medullae—Sassafras Pith. U.S. P. Origin.—The pith of Sassafras variifolium (Salisbury) 0. Kuntze, a tree indigenous in North America. Description and Properties.—In slender, cylindrical pieces, often curved or coiled, light, spongy, white, inodorous, and insipid. Macerated in water, it forms a mucilaginous liquid, which is not precipitated by the addition of alcohol. Official Preparation. Mucilago Sassafras Medullae—Muciiaginis Sassafras Medullae—Mucilage of Sassafras Pith.—Dose, freely. Physiological Action and Therapeutics.—Mucilage of Sassa- fras Pith is an agreeable demulcent and a mild local stimulant, and may be used for the same purposes as slippery elm, tragacanth, acacia, etc. It forms a pleasant vehicle for more active remedies. • Ichthyocolla—Ichthyocollae—Isinglass. U. 8. P. Origin.—The swimming-bladder of Acipenser Huso L. and of other species of Acipenser. Description and Properties.—In separate sheets, sometimes rolled, of a horny or pearly appearance; whitish or yellowish, semi-transparent, iridescent, inodorous, insipid; almost entirely soluble in boiling water and in boiling alcohol. A solution of isinglass in 24 parts of boiling water forms, on cooling, a trans- parent jelly. Dose.—Freely. EMOLLIENTS, DEMULCENTS, ETC 781 Official Preparation. Emplastrum Ichthyoc611ae—Empiastri Ichthyocollae—Isinglass Plaster— (Court Plaster). Physiological Action and Therapeutics.—Isinglass is emol- lient, demulcent, and protective, and possesses nutritive properties. Isinglass plaster is commonly employed to protect abraded sur- faces and slight cuts of the skin. It should be moistened with pure water and never with saliva. Lycopodium—Lycopodii—Lycopodium. U. S.P. Origin.—The spores of Lycopodium clavatum L. and of other species of Lycopodium, low-creeping perennials found in dry woods distributed over the greater portion of the globe. Description and Properties.—A fine powder, pale yellowish, very mobile, inodorous, tasteless, floating upon water and not wetted by it, but sinking on being boiled with it, and burning quickly when thrown into a flame. Under the microscope the spores are seen to be sphaero-tetrahedral, the surfaces marked with reticulated ridges, and the edges beset with short projections. Lycopodium contains a fixed oil and a minute quantity of a volatile base, methylamine. Used principally externally. Physiological Action and Therapeutics.—Lycopodium is an admirable protective, and possesses great power of absorbing oils. Its lightness, dryness, and absorptive power render it an excellent dusting powder for excoriated surfaces, eczema, herpes, intertrigo erysipelas, superficial ulcers, etc. Its peculiar property of not being wetted with water makes it a valuable protective to prevent irritation or chafing caused by the urine or alvine dejections of infants. The drug is used as a basis for insufflations and in pharmacy to prevent the adhesion of pills. 782 A TEXT-BOOK OF MATERIA MEDICA. PRESCRIPTIONS. A prescription (L. pro?, for; scribo, I write) is an order on the pharmacist to compound for the patient certain medicines intended to meet the requirements of the individual case. Considering it as an order, therefore, it should begin with the Name of the person for whom it is designed and the Date on which it is written. In some cases it may be advisable to omit the name, but the date should never be omitted. The date is often indicated by the calendar number, instead of the name of the month, thus: 3. | March, 3d month | 10. | day of the month | '96. | year | . Unfortunately, there is no uniform usage in this respect, some persons writing the number and others the day of the month first, so that a druggist unfamiliar with the custom of the physician could not know whether 3. 10. '96. meant March 10th or October 3d of the year. The Latin numerals are also employed to designate the month : III. 10. '96. To avoid all chance of error, it is best to abbreviate the month or write it in full: March 10, 1896. The importance of the date is manifest from its value to the physician or pharmacist as a reference, and the possibility of its evidence being required in medico-legal contingencies. After the name and date comes the prescription proper, the name of the article required or the ingredients in case of a mixture. In the latter instance the various ingredients are written in a cer- tain order or sequence with reference to their medicinal action or importance, which usually is also in accord with their pharma- ceutical requirements for satisfactory dispensing. For the purpose of examination a regular prescription may be divided info six parts : 1. The name of the patient and the date of the order; 2. The superscription, or heading, indicated by the symbol 1^, standing for the Latin word Recipe, " take ; " 3. The inscription, expressing the names and quantities of the ingredients; 4. The subscription, being instructions to the pharmacist or compounder; 5. The signature, containing directions to the patient or attendant; 6. The Name of the Physician. PRESCRIPTIONS. 783 Example: ~Bf} Olei morrhuae, Vini albi, Glyceriti vitelli, q. s. ad Fiat emulsum.3 Sig. Tablespoonful after meals.4 Here the small numeral or exponent, 1, is the superscription ; 2, the inscription ; 3, the subscription ; i, the signature. A typical prescription consists of a formula of four divisions: The Basis, or principal active agent; The Adjuvant, or auxiliary, to aid the action of the Basis; The Corrective, to correct or modify its action; The Vehicle, to give proper form or taste to the whole. Each ingredient should have a separate line, although it is not necessary that all prescriptions should include the above complete formula. Combination of Drugs. In writing a prescription we assume that it is intended, as should always be the case, to fulfil a single therapeutic purpose only; and we are to decide first, whether the medicine shall be administered in a solid or in a liquid form; and second, whether a single medi- cine shall be prescribed or a combination of remedies. The drug upon which we base our expectations of success, the Basis of the inscription, should always be written first, and this drug may be the only one required. Frequently, however, some other drug is necessary to assist the action of the Basis, which substance would be the Adjuvant (Lat. adjuvare, to assist). No general rule can be laid down in this matter. The course to pursue will depend entirely upon the therapeutic indication, the physio- logical action of the drug, and the idiosyncrasies of the patient. The tendency to-day, among many able therapeutists and clinicians, is to prescribe single drugs or simple combinations, while the pre- scriptions of former times are good examples of polypharmacy. There is, at all events, danger in going to the extreme of sacrificing therapeutic efficiency to simplicity of form and elegant pharmacy; and it must be confessed that such compounds as Warburg's tinc- 1 In ancient times it was customary to preface a prescription with a pious invocation to Jupiter or some guardian deity. These prayers were finally abbreviated, until they came to be expressed by the simple astronomical sign % symbol of the planet Jupiter. The upright stroke across the letter R heading modern prescriptions is a curious relic of ■the above heathen usage condensed in the planetary sign. 784 A TEXT-BOOK OF MATERIA MEDICA. ture and the bolus prescribed by Dr. Graves in the treatment of dropsical patients prove the efficacy of polypharmacy in many cases. Curare Base To cure Cito Adjuvant Quickly Tuto Corrective Safely Etjucunde Vehicle "^ " \ And pleasantly. or Diluent J The hackneyed rule of Asclepiades that medicines should always be so combined as to cure quickly, safely, and pleasantly (curare, cito, tuto, et jucunde) has resulted in the adoption of the above form of inscription. The theoretical prescriber writes by rule, religiously avoids incompatibles, and would be shocked by, and have little respect for, a physician who should deliberately include in the same pre- scription the names of substances directly antagonistic to each other physiologically. The subject will be further discussed here- after. As a general rule, we prescribe only one drug to provoke emesis, and a combination of several if we wish a diuretic. A purgative is usually multiple, but if the selection be castor oil or croton oil, it will be single. After we have selected the Basis, or chief ingredient, of our prescription, the next point to determine is whether we can add anything which will in any manner be of real assistance to that Basis. This ingredient, or Adjuvant, as it is called—has usually a physiological action similar to that produced by combining two cathartics or two diuretics acting upon different portions of the intestines or kidneys. Sometimes, however, an Adjuvant may differ in its effects—as sulphuric acid serves as an Adjuvant to quinine, by favoring its absorption and thereby hastening and increasing'its action, as mercury assists the action of squills upon the kidneys, or iron acts as an Adjuvant to a cardiac stimulant. The Adjuvant, as a rule, should not be directly opposed in its action to that of the Basis, as chloral is to strychnine, a diuretic to a diaphoretic, or a typical cardiac stimulant to a cardiac depressant. Having chosen the Adjuvant, the next point to consider is whether the action of the drugs selected may not be rendered more kindly through the addition of some other substance as a PRESCRIPTIONS. 7^5 corrective. A substance may be added which will correct some disagreeable effect of the active agents by producing a medicinal impression upon the patient. Extract of belladonna or hyoscya- mus relieves the griping occasioned by some of the more violent cathartics, like podophyllin, and other well-known instances of this kind are those of the aromatic spirit of ammonia, which mitigates the unpleasant symptoms of iodism, and hydrobromic acid, which lessens the untoward action of quinine. Again, a corrective may act by producing some chemical effect upon the Basis—as salicylic acid is rendered more soluble and less irritating by combining it with sodium carbonate or bicarbonate, forming the sodium salicylate. Great eare and thought should be given not only to the Basis, Adjuvant, and Corrective, but also to the Vehicle, which claims equal attention. A prescription is often rendered more kindly, and no less efficient, through the medium of some substance producing a more agreeable taste. It is a mistaken idea that medicines, in order to be effective, should be repulsive to the patient. The homeopath's success is largely due to the very agreeable taste of his remedies. The mere caprice of the patient, however, should not be considered in the choice of a remedy when, in the best judgment of the physician, it is indicated. Still, it is well to study carefully the art of prescribing agreeable doses, so far as may be compatible with fidelity to science. It is to be noted that pleasant- ness of taste is far more important in the case of fluids than in that of solids. Aromatic elixirs, syrups, aromatic waters, etc. are in frequent use as Vehicles, yet it must be remembered that oftentimes a sen- sitive patient repudiates sweets and syrupy mixtures. In many cases simple syrup or pure water serves, after all, as the best vehi- cle, although the physician's choice must be governed mainly by experience. It will be observed that in the body of the present work, in the majority of cases, the method of administration is fully explained. It may here be noted that liquids are much more readily absorbed than solids, yet adults usually prefer to take medicines in the solid form, such as pills, capsules, powders, and tablets. In illness the patient's condition is often such that the gastric and intestinal secre- tions are greatly reduced, and there may not be sufficient fluid to dissolve the solid, so as to render it in a condition to be absorbed. It frequently happens, for instance, that pills are voided with the 50 786 A TEXT-BOOK OF MA TERIA MEDICA. stools unchanged, and, on the other hand, solid substances, such as pills or capsules, may remain in the intestinal canal until the secre- tions are restored, when the accumulated medicine will all be acted on at once, and, passing into solution, be absorbed in excessive doses. Such is the frequent cause of the cumulative effect which sometimes occurs, not without serious consequences. Even alkaloidal salts, which are readily soluble, are, perhaps, in many instances, best given in solution. Infants require liquid medicines, water or syrup being the best vehicle. Bitter medicines, like quinine, may be given in aromatic elixir of liquorice or syrup of yerba santa. As a general rule the metals and their compounds should be administered in the form of pills or in a small quantity of fluid. The purgative salts, potas- sium iodide, and the diuretics, are best given in large quantities of fluid. Prof. H. C. Wood, M. D., has written so clearly upon the art of combining, or, more correctly speaking, associating, medicines that we cannot do better than quote his observations verbatim: " The art of combining medicines is not a difficult one, but in practice certain principles should not be lost sight of. Chief of these are, to prescribe as few remedies as possible, and to use no powerful drug without a very distinct idea of what it is intended to do. Whenever it is desired to give a powerful remedy in increasing doses until its physiological effect is produced, it should always be given by itself. Thus, it may be necessary to give arsenic so as to impress the system, at the same time that iron is indicated ; but the two remedies should be given separately, so that the dose of either can be increased or diminished independently of the other." The principles of combination formulated below were long ago enunciated by Dr. Paris, but are to-day as imperative as ever. Medicines are combined— "First. To augment, correct, or modify the action of a medicine. Thus, purgatives act much more kindly when a number of them are united together. The chief reason of this probably is that, as different remedies affect different portions of the gut, the whole in- testine is best reached by a union of the diverse substances. It may take an intense irritation of the mucous membrane to purge as"actively as does a mild irritation of both the mucous membrane and the muscular coat. " There are powerful medicines which act similarly upon some parts of the organism, but dissimilarly upon other parts. By com- PRESCRIPTIONS. 787 bining such remedies powerful effects can be obtained at the points where the two lines of action cross each other, without influencing to a great extent other portions of the system. Thus, chloral pro- duces sleep by its action upon the brain, and also has a distinct influence upon the heart, but none upon the intestinal tract. Mor- phine acts upon the brain, and does not influence the heart, but has a powerful effect upon the intestinal tract. By combining chloral and morphine we get an overwhelming conjoined influence upon the brain in producing sleep, with the least possible disturbance of the heart and of the intestinal tract. " Second. To obtain the joint action of two or more diverse remedies. Thus, in a cough-mixture morphine may be included to quiet the cough, whilst ipecacuanha and squill (in accordance with the first principle) are added to affect the mucous membrane. The application of this principle requires caution, or the practitioner will be led into that chief abomination—polypharmacy. It is worse than futile to attempt to prescribe for every symptom. It is the underlying cause of the disorder, or the under-stratum of bodily condition, which must be sought out and prescribed for simply. " Third. To obtain a special combination which is really a new remedy, or which experience has shown acts almost as a new remedy. Thus, when to potassium iodide in solution corrosive sublimate is added a new chemical compound (potassio-mercuric iodide) is formed, which experience has shown to be of great value in syphilitic diseases. Griffith's antihectic mixture (mistura ferri comp.) is another instance of the use of chemical changes, the protocarbonate of iron (ferrous carbonate) being formed out of the sulphate of the metal and the potassium carbonate. In the famous Dover's powder no chemical change occurs, but the ordi- nary action of opium upon the skin is so enhanced by the ipecac that the combination may be looked upon almost as a new remedy. "Fourth. To afford a suitable form. Thus, acacia is added to make an emulsion, or confection of rose to make a pill. In the choice of excipients care should be exercised to select a substance free from medicinal properties, having no chemical incompatibility with the medicinal agent and of suitable physical character. Bread- crumb often makes a good excipient for pills, but with silver nitrate it is chemically incompatible, on account of the sodium chloride it contains. . " When writing a prescription the utmost care should be taken to use such excipients that the combination should not only be 788 A TEXT-BOOK OF MATERIA MEDICA. attractive to the eye, but also as little repulsive to the palate as may be. Whenever possible the pill form should be employed with bitter or disagreeable medicines. The pill may be readily coated with silver-foil; tonic pills may be coated with iron by shaking or rolling them in ferri pulvis while soft and sticky. Sugar-coated pills and ' compressed pills' are apt to get so hard and insoluble that their use requires caution. In regard to mixtures, flavoring oils should be freely used, and the power of glycerin to conceal the disagreeable taste of many substances should be remembered." x As vehicles for liquid mixtures for internal use the following classes of official preparations are best adapted—The aromatic waters: rose, anise, fennel, and the mints when flavor alone is desired, the most delightful flavor of all being orange flower water. The aromatic syrups: orange, orange flower, and tolu when it is desired to disguise the taste and to suspend resinous or otherwise sparingly soluble substances in the mixture. The elixirs when in addition to agreeable flavor it is desirable to employ a vehicle as a solvent for certain salts not readily soluble in water or syrups. The elixirs containing about 25 per cent, of alcohol, they are useful vehicles for tinctures and fluid extracts of resinous drugs such as cubeb, buchu, uva ursi, valerian, viburnum, etc. When flavor alone is desired the elixir aromaticum, U. S. Ph., a delightful combination of orange and other aromatics, should be used. To disguise the taste of bitter drugs, as in the last men- tioned, elixirs of licorice, or of eriodictyon (yerba santa) are mostly employed. Incompatibility. Due regard is to be paid to the mutual chemical, pharmaceutical, and therapeutical relations of the drugs combined in a prescription. When different substances, whether liquid or solid, are com- bined or associated and undergo a more or less complete change, they are said to be incompatible, the incompatibility consisting of three kinds : chemical, pharmaceutical, and therapeutical, although the last division is not scientifically correct, since one substance cannot be therapeutically incompatible with another, although it may be a physiological antagonist. The incompatibles and antagonists of the different substances are fully mentioned under the respective drugs. The principles governing incompatibility, however, may well be considered here. 1 Therapeutics, 7th edition, pp. 108 et seq. PRESCRIPTIONS. 789 Chemical incompatibility is of the most importance. The commonest forms of chemical incompatibility occur under the following conditions: 1. When a new and insoluble salt is formed, resulting from a mixture of solutions of soluble salts. Example (1): mixing solutions of lead acetate and zinc sulphate, both soluble salts, but producing by chemical decomposition a new and insoluble salt, the sulphate of lead, which is precipitated. 2. By the addition of a strong acid to solutions of salts of weak or volatile acids, such as carbonates and bicarbonates, with resulting decomposition. Example (2): ammonium carbonate, the salt of a weak acid radical, added to syrup of squills, containing acetic acid, causes decomposition to take place, with effervescence and the liberation of carbonic acid gas. 3. Salts of a feeble or volatile base are decomposed by the addition of a strong alkali. Example (3) : the evolution of ammonia when a strong alkali is added to ammonia alum, and when chloral hydrate is decomposed by alkalies, such as aromatic spirit of ammonia, lime solution, etc. 4. Alkaloids, or their salts, are thrown out of solution or pre- cipitated from their solutions by the addition of alkalies or alkaline salts. Example (4) : sulphate of strychnine in solution is precipitated as the insoluble bromide of strychnine by the addition of a larger proportion of potassium bromide. Quinine sulphate is precipitated as insoluble quinine acetate when mixed with a solution of potas- sium acetate. 5. Tannic and gallic acids and preparations containing them, as well as many other vegetable acids, produce discoloration or precipitation of iron and many of its compounds. Example (5): ink is the best illustration of this incompatibility. Writing fluids are usually combinations of tannic or gallic acid with some preparation of iron. Add the tincture of ferric chloride to tincture of cinchona, and notice the discoloration. There are certain preparations of iron, like the compounds with ammonium or sodium citrate (see tinct. ferri citro-ch onde, N. F tasteless tincture of iron) which produce little discoloration with vegetable astringents, and none at all with vegetable preparations containing no tannic or gallic acid. Pharmaceutical incompatibility is the production of fewer or more insoluble substances in mixtures or preparations of vegetable drugs associated or not with any chemical compounds. Pharma- 79° A TEXT-BOOK OF MATERIA MEDICA. ceutical incompatibility may occur in liquids or solids, although much more frequent in liquid mixtures, causing a separation of either inert or active ingredients. Examples: vegetable tinctures of resinous drugs with water, such as tincture of guaiac and water; copaiba and oils with aqueous preparations; spirit of nitrous ether with mucilage of acacia, etc The separation or precipitation may frequently be prevented by the intervention of some viscid sub- stance, such as syrup, glucose, glycerin, mucilage of acacia, etc. Incompatibility may be both chemical and pharmaceutical. In the following ljst the substances which cannot be classed as incom- patible under any of the above divisions are given for reference: Substance. Acacia .... Acids in general Acid. Arsenous. Salicylic . . Tannic . . . Bismuth. Subnitrate Chloral. Hydrate . Podine. . . . Lead. Acetate Mercury. Bichloride . Mild chloride (Calomel) Potassium. Chlorate . . Iodide Permanganate Sodium. Bicarbonate . Bromide . . Silver. Nitrate . . . Incompatible with Alcohol, alcoholic and ethereal tinctures; * borax; ferric chloride; lead salts. \ Alkalies, alkaline solutions; metallic oxides. { •j Ferric hydrate; magnesia; lime water. Those marked wi \ Iron compounds; potassium iodide; * lime water. Alkalies, carbonates and bicarbonates; lime water; chlorine water; albumin; gelatin. Calomel; * sulphur; tannin. Alkalies, carbonates ; * ammonium and mercury compounds; potassium bromide and alcohol. Ammonia;* alkalies, carbonates; chloral; metallic salts; starch.* Acacia; acid hydrochlor.; acid sulphuric and sulphates; ammon. chloride; carbonates; lime water, iodine; potas- sium iodide; tannin. Potassium iodide; * salts, carbonates; tannin ; borax. Acids, acid salts; alkalies, carbonates; ammon. chloride; iodine; potassium iodide ; ferric chloride, iodide; sulphur. Acids, mineral; calomel; organic substances; sulphur. Acids, acid salts; alkaloids; iron; lead and mercury salts; potassium chlorate; silver nitrate; chlorine water. ( Ammonia, salts; alcohol; glycerin; ethereal oils; organic | substances. j Acids, acid salts; acid, tannic; alkaloids; metallic salts. \ Acids, mineral; chlorine water; mercury compounds. Acids, acetic, hydrochloric, hydrocyanic, sulphuric, tartaric, and their salts; alkalies, carbonates; iodine; potass, iodide, bromide; sulphur. th an * are sometimes directed to be compounded for the purpose of effecting some special change or producing new compounds PRESCRIPTIONS. 791 Among the above, potassium permanganate forms an explosive mixture with glycerin ; so does chromic acid. Chlorates of potas- sium, etc. explode when triturated with sulphur. The strong acids, nitric and sulphuric acids, and especially mixtures of these, react so strongly with volatile oils (hydrocarbons) as to cause explosion. Iodine affects these oils in the same way—fulminates. It not infrequently happens that the physician intentionally writes a chemically incompatible prescription. " Black wash " and "yellow wash" are examples. Other instances are such pharma- copoeial preparations as liquor ammonii acetatis, mistura ferri com- posita, and liquor magnesii citratis. Physiological antagonists are often given together, as atropine and morphine, or aconite and digitalis in certain cases of cardiac arrhythmia. No general rule can be laid down for the avoidance of so-called therapeutical incompatibility. Some of our most valuable drugs contain active principles which are physiologically opposed to each other in their action ; instance : jaborandi, which contains two abso- lutely antagonistic alkaloids, pilocarpine and jaborine, the latter in small quantity, yet sufficient to control the action of the former. Digitalis contains several distinct principles, one of which, digi- tonin, is the direct antagonist of the others. Opium is a conspicuous example of a complex remedy, con- taining, besides gum, sugar, etc., eighteen different alkaloids, two neutral principles, and two peculiar acids; so that a prescriber of this drug, while he may, perhaps, flatter himself that he is con- forming strictly to the present notions of pharmaceutical simplicity, is in effect a polypharmacist of most pronounced type. Moreover, not only are the constituents of opium very numerous, but, like others mentioned, the drug affords in its thebaine and morphine a further illustration of direct physiological antagonism. The author cannot too strongly recommend that physicians ignorant of the physiological action of drugs in large and small doses if they prescribe at all, should avoid including many reme- dies in one prescription. Such practitioners had best adhere to a single remedy or adopt homeopathy. But, given a competent and thorough knowledge of the'action of drugs and the exact condi- tion of the patient, the physician is justified in giving one or twenty drugs in the same prescription, since he is perfectly familiar with the several agents of relief, and can foretell with nicety the effect to be produced by their combination; and in all cases a physician 792 A TEXT-BOOK OF MATERIA MEDICA. should be as certain of the action, strength, and reliability of the drugs he administers as the surgeon of the aseptic condition of his hands and instruments. Estimation of Amounts in a Prescription. Having decided upon the various ingredients which are to enter into the prescription, the next consideration is the amount of each desirable. In the first place, do not prescribe more than the prognosis seems to call for. If in your judgment the patient will not require medicine more than five or six days, and not oftener than three times a day, a two-ounce mixture should be prescribed if a liquid, or the required number of pills, powder, capsules, etc. if a solid, is desired. In prescribing liquid medicines note must be taken of the several sizes of medicine-vials, their capacities being in this coun- try i, 2, and 4 fluidrachms, and i, 2, 3, 4, 6, 8, 12, and 16 fluid- ounces. In the larger cities vials may also be had of metric capacities—30, 60, 90, 120, 240, and 500 Cc. While it is not essential, it is in much better taste to have a prescribed mixture aggregate just a bottleful of one of the above sizes. Where two different mixtures for the same person are prescribed, or differ- ent mixtures for different persons in the same house or family, it is well to order them put up in vials of different sizes to avoid confusing the medicine. This is especially desirable when both internal and external remedies are prescribed for the same person. The amounts of the ingredients requisite for any given prescrip- tion are determined in various ways. The amount of the active ingredients will of course be the product of two factors, the quan- tity of dose and the number of doses required; and the quantities must be such as can be expressed in the system of weights and measures adopted, and indicated by round numbers such as best conform to the relation between the denominations of the particular system followed in the prescription. There is no difficulty in computing the amounts in a solid mix- ture, powders, pills, or suppositories, especially if ten or its multiple is prescribed, nor in external preparations, where the strength is expressed by percentage, and are therefore most conveniently and accurately prescribed according to the metric system ; but many additional considerations occur in estimating amounts in fluid mixtures. PRESCRIPTIONS. 793 Frequently solids like salts, etc. are prescribed in solution, but their bulk may be safely disregarded in the estimation of amounts of the liquid measure ; for a solid in the quantity usually prescribed increases the whole volume of the solution but very little. Ordi- narily a fluidrachm (4.0 Cc), or a teaspoonful, should not contain over 5 grains (32 Gm.), nor a tablespoonful, or 4 fluidrachms (15.0 Cc), over 20 grains (1.29 Gm.), of a solid in solution, unless the substance be very bland, when twice these quantities are permissible. The following is a very simple rule for estimating amounts in Apothecaries' Measure: In an eight-ounce mixture, the dose being a drachm, take as many drachms of the medicine as there are wanted minims or grains to the dose. It will be observed that in this case the basis is an eight-ounce mixture, yet it typifies the rule, which, when thoroughly understood, may easily be applied to a four-ounce or a two-ounce mixture, one-half or one-fourth as many drachms; while if the dose is to be a dessertspoonful, or two drachms, it is only necessary to take one-half as many drachms to an eight-ounce mixture, reducing for smaller mixtures in accordance with the rule. If the dose be a tablespoonful, or four drachms, one-fourth as many drachms must be taken to an eight-ounce mixture as there are minims or grains to the dose. This rule, while not fractionally exact, is sufficiently accurate for all practical purposes. Examples : We desire to give an eight-ounce mixture, with a drachm for a dose, each dose to contain 12 grains of potassium bromide and 10 grains of chloral, the vehicle to be syrup of orange and water. We have here, then, 64 doses of a drachm each : to be exact, therefore, we should have 768 grains of potassium bromide, or 12 drachms and 48 grains; but, following the rule, we put in the mixture 12 drachms, since we desire 12 grains to the dose. Of chloral we would require exactly 640 grains, or 10 drachms and 40 grains, but we use the round number, 10 drachms, in the mixture. We see that in each case there is but the fraction of a grain short in the dose. The prescription would consequently be written as follows: fy. Potassii bromidi, 3xij; Chloralis, 3x; Syrupi aurantii, §iv; Aquae, q. s. ad gviij. M. et ft. sol. Sig. Teaspoonful for a dose. 794 A TEXT-BOOK OF MA TERIA MEDICA. This is more of each ingredient than should be prescribed in a fluidrachm. It were better, then, that the dose should be a dessert- spoonful, or two drachms; and in order that the two teaspoonfuls should contain only 12 grains of potassium bromide and 10 grains of chloral, the whole amount of the medicament must be divided by 2—i. e. the prescription should read: fy. Potassii bromidi, 3yj; Chloralis, 3v; Syrupi aurantii, Siv; Aquae, q. s. ad Bviij. M. et ft. sol. Sig. A dessertspoonful for a dose. In case the prescription be for a four-ounce mixture, with a dessertspoonful for a dose, the amounts of the solid substances would, of course, be one-half, and if for a two-ounce mixture, one- fourth of the above. When writing a prescription put down first all the ingredients which are to enter into the combination, and after the last one, which is usually the vehicle, write the whole amount; /. e. if it is to be a four-ounce mixture, write after the name of the vehicle " q. s. ad f §iv." Then begin with the Basis, the first ingredient, and write the amount required in the whole mixture. In other words, decide upon the doses to be given after the medicines have been selected. It is important to adopt as a golden rule to carefully and delib- erately read over the entire prescription before it is handed to the patient, and more especially to scrutinize each item and the quanti- ties to guard against transposition of the latter, which otherwise may result in a fatal error. The next thing to be determined is the manner in which the medicine should be measured out to the patient for internal use. A graduated medicine-glass is always preferable to a domestic measure, and should be ordered in all cases.. Teaspoons, as well as dessertspoons and tablespoons, vary considerably, besides, owing to adhesion, may, according to the manner in which they are filled, show a variation of nearly 50 per cent, in their capacity. A teaspoonful, considered to be equivalent to one fluidrachm, may contain from one-half to two fluidrachms; a dessertspoonful, which should be equivalent to two fluidrachms, and a tablespoonful, equal to one-half fluidounce, vary almost as much in capacity. It is necessary to be exact in the administration of medicines, it PRESCRIPTIONS. 795 "Pppppppppopppppppp b\On w m m h '« b b b b b b b b b b b 1*1 v*i u. OnOj iipti-iOOOOOO On to ONOJ (MO m n O O t/lUOJ CX ON l*i Oi 0 a j s I n o era „ - „ „ :3 > y ON l*i l*i O) Ni to M era OnO) _ ►. 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OJ to t*i ON to to On 00 ONOn UM O O O O to to On-£- ■*>• OJ l*i Oi to On 10 w O O On l*i -p. to NO 00-E* 10 On On ii On to i ONl*i OJ to to "" "■ OnOJ m » w O On to OOj 0 O O O 0 8 £ 8 O O t ON O o: ^OJ to JO .- O O O O O o o .s; ^ 796 A TEXT-BOOK OF MATERIA MEDICA. being well known that the action of drugs varies greatly with the size of the dose, small doses in their action being often directly opposite to large doses. Ordinarily, it is unwise to prescribe medicines to be dropped out, since a drop varies greatly in dimension according to the vis- cosity and specific gravity of the fluid, the shape, size, and charac- ter of the neck and lip of the bottle, as well as its degree of fulness, and the steadiness of the hand in dropping. In computing doses of powerful medicines, therefore, always estimate for minims instead of drops. Direct the use of a " dropper " or minim pipette for the admin- istration of liquids by drop doses, such as Fowler's solution, collyria, etc. There are exactly sixty minims of any fluid to one fluidrachm, while sixty drops may be fewer or more than one drachm, as the following list shows: Drops in f 3j Weight of f 3j. (60 M.). Gr. Gm. Acidum Carbolicum..........m 59 3.82 Acidum Sulphuricum Aromaticum .... 146 53 3.43 ..?*&r. NLM001030707