3j§ ■t\^$* &$& O^V - Ur SNiDiasw jo Aavaan ivnouvn s i^ns * i "* ^ooioaafct 7' INE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE o 3 a. NATIONAL LIBRARY OF MEDICINE NATIONAL LIB NLM001028667 AL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE / ^j.^i^Cvi .^ NATIONAL LIBRARY OF MEDICINE 5 \ NATIONAL LIBRARY OF MEDICIN .n*. ' 6 REFERENCE-BOOK OF PRACTICAL THERAPEUTICS BY VARIOUS AUTHORS Edited by FRANK P. FOSTER, M. D. EDITOR OF THE NEW YORK MEDICAL JOURNAL AND OF FOSTER'S ENCYCLOPAEDIC MEDICAL DICTIONARY IN TWO VOLUMES VOL. II NEW YORK' APPLETON AND COMPANY l897 WB NITROBENZENE days by an attack of acute bronchitis. On the resumption of the injections the patient was cured in ten days more and her general health much improved. No local troubles or general symptoms followed the injections. The solu- tions, says the author, should not be more con- centrated than 2 or 3 per cent.] Some of the Nitrites Compared.—Headache is more common after the amyl, isobutyl, and propyl compounds, and least frequent after the nitrites of sodium and ethyl. The pulse is most accelerated by the amyl nitrites, but so- dium and ethyl nitrites cause only slight in- creased action. Gastric irritation occasionally follows the use of nitrites of sodium, potas- sium, and ethyl. When rapidity of action is desired, nitrite of amyl is to be preferred to all the other nitrites, but if a more prolonged influence of a nitrite is the object, nitrite of sodium is preferable. Cash found isobutyl and secondary propyl compounds most active in lowering blood-pressure, and Leech thinks that isobutyl nitrite is more reliable for the relief of anginal pain than the official amyl nitrite. In cases where it is desirable to in- crease the flow of urine temporarily, ethyl ni- trite or the spirit of nitrous ether is fairly efficient, if given in sufficiently large quanti- ties. Dose and Administration.—Half a fl. oz. of spirit of nitrous ether, or 1 fl. drachm of the 2-5-per-cent. solution of the nitrite of ethyl, should be given to an adult. The former con- tains, when pure, from 2'5 to 275 per cent, of nitrite of ethyl. It should not be mixed with water except in combination with an alkaline solution, such as the acetate of ammonium or potassium, until just before administration, as it rapidly deteriorates after water has been added. The nitrite of ethyl is soluble in absolute alco- hol, and must not be mixed with water until the time of its administration. Of the two alka- line preparations (of sodium and potassium) of which most is known, the nitrite of sodium is most commonly employed when a prolonged effect of a nitrite is desired. The sodium and potassium nitrites may be given in doses vary- ing from 1 to 5 grains. Two grains is the ordinary dose to begin with, but it is always safe to begin with the minimum dose of a medicine that is sometimes followed by un- pleasant symptoms, and increase the quantity after the susceptibility of the patient is ascer- tained. The nitrite of sodium or potassium may be given in water. When it is desirable to administer a nitrite hypodermically, a solu- tion of nitroglycerin, which acts like a nitrite, is to be preferred to the nitrite of sodium or potassium. (See Nitroglycerin.) Jeremiah T. Eskridge. NITROBENZENE, or nitrobenzol, C6HB N02, oil of mirbane, artificial oil of bitter almonds, is an oily liquid that has an odour resembling that of bitter almonds, and a very sweet taste. It is produced by the action of strong nitric acid on benzol, the resulting prod- uct being washed with water. If nitrobenzene is injected into the blood- vessels of a rabbit, death with convulsions en- NITROGEN NITROGLYCERIN 14 sues in a few seconds. Administered internally to an animal, it produces unconsciousness, epi- leptoid spasms, in some animals glycosuria, and sometimes death in consequence of paralysis of the motor-centres of the nervous system. The inhalation of the fumes of nitrobenzene produces in man headache, muscular weakness, drowsiness, mental disturbance, and a blue colour of the face. Taken internally, the drug is absorbed more or less slowly, and, in addi- tion to the foregoing symptoms, the entire body acquires the bluish colour, the pupils are dilated, the respiration is rapid, shallow, and irregular, the pulse is rapid and thready, soon becoming imperceptible, the muscles are com- pletely relaxed, and consciousness is lost. Fif- teen drops have caused death. Nitrobenzene has no therapeutic uses, but is employed in manufactures. In case of poison- ing with it, apomorphine or some other emetic should be administered at once so as to empty the stomach, which should be washed out by means of a stomach-pump or stomach-tube; hypodermic injections of strychnine should be administered as may be necessary; the bodily temperature should be maintained with hot- water bottles or bags; and massage and arti- ficial respiration should be used if necessary. Samuel T. Armstrong. NITROGEN, nitrogenium, or azote.—This gas is disengaged freely from certain mineral waters, such as those of Lippspringe and the Ottilien-Quelle at Paderborn. According to Dr. I. Burney Yeo (Manual of Medical Treat- ment, Philadelphia, 1893). the gases that those waters give off contain respectively 83-25 and 97 per cent, of nitrogen. Great improvement of the general symptoms in cases of pulmonary tuberculosis, says Dr. Yeo, is stated to follow the inhalation of this gas, which is conducted with the aid of a special apparatus; the sleep is said to become calm, the appetite to increase, the night sweats to diminish, the diarrhoea, if there has been any, to be allayed, and the pul- monary capacity, the weight, and, except in desperate cases, the bodily strength and ac- tivity to be increased. But the fever has been reported as variously influenced. Treutler (Oertel's Respiratory Therapeutics, Yeo's trans- lation) says: " In slighter cases it soon dis- appeared, in others it was sometimes even exaggerated for the first week or two, after- ward diminishing somewhat rapidly or ceas- ing altogether, while in hopeless cases it was unaffected." Dr. Yeo refers to Oertel's book for a full description of the mode of conducting the in- halations, and makes the following quotation from his translation of it: " It is difficult as yet to express a decided opinion on the influence of nitrogen inhalations on chronic pulmonary infiltrations, as we have not nearly sufficient observations on the subject to exclude com- pletely all the casualties which always occur in the treatment of pathological processes running so varied a course, and to be able to separate the influence of the various other agents which come into operation. For the present it behooves us to give a fair trial of nitrogen inhalations in the treatment of chronic pneumonia and its products." On the other hand, Rhoden, of Lippspringe (cited by Yeo), is inclined to attribute the good effects of the treatment to the moist cli- mate, the inhalation of vapour of water, and the drinking of a great amount of warm water containing a considerable quantity of calcium salts, together with a little sodium sulphate, the patient fasting. NITROGLYCERIN, an organic nitrate, glyceryl trinitrate, C^^ONO^, is an explo- sive compound, and to obviate the prejudice that some patients might therefore have against its use, it has been employed under the names of trinitrin and glonoin. It is an agent of con- siderable importance and is principally used in medicine when it is desirable to make a rapid and powerful effect upon the vascular appa- ratus by dilating the arterioles. It occupies a place between amyl nitrite and sodium nitrite, being less rapid in its action and more per- manent in its effects than the former, but expending its influence on the vascular sys- tem more quickly than the latter, although the headache which is very common after a large dose of nitroglycerin persists much longer than one produced by sodium nitrite. The effects of nitroglycerin are first expe- rienced by the patient in from a few seconds to one or two minutes after the drug has been administered. In small doses, yet large enough to be appreciable, these consist of full and throbbing sensations in the head and slight dizziness, followed, in some instances, by head- ache. Larger medicinal doses give rise to sud- denly developed dizziness, full, throbbing, and constricting feelings in the head, amounting frequently to decided headache; a choking sensation in the throat, at times nausea, faint- ness, rapid action of the heart, lessened arterial pressure, dilatation of the arterioles, followed by languor, and. according to Bartholow, some- times pams in the stomach. In still larger, or lethal doses, the effects are rapidly developed and very pronounced, amounting to an ex- treme degree of languor and muscular relaxa- tion, weak and rapid action of the heart, small, feeble, or imperceptible pulse, cold, clammy perspiration, and even unconsciousness. The effects of nitroglycerin are most rapidly de- veloped when it is administered in alcoholic solution. On account of the variable susceptibility exhibited by different persons to the influ- ence of this medicament, considerable care is required that the initial dose should not be larger than is necessary to produce the desired results. One minim of a 1-per-cent, alcoholic solution has produced insensibility, and 2 minims have been followed by loss of conscious- ness and absence of the pulse at the wrists (II. C. Wood, Therapeutics and Materia Me'dica, 6th ed., p. 390). I have observed unpleasant, effects to follow the use of Yko of a grain. On the other hand, some persons experience no disagreeable symptoms after taking 2 or 3 minims of a 1-per-cent. solution. Persons soon become accustomed to increasing doses of 11 nitroglycerin. Dr. Murrell gave 10 minims eight times daily, the only effect being to re- lieve anginal pain and cause some headache (Croonian Lectures. Brit. Med. Jour., July 8, 1893, p. 57). Bartholow thinks that women and persons of feeble constitution are more susceptible to the drug under consideration than the robust (Materia Medica and Thera- peutics, 8th ed., p. 6(J7). Like nitrite of amy], nitroglycerin, in toxic doses, causes the blood to assume a chocolate colour, owing, no doubt, to its power of interfering with hasmic respira- tion. Death may be produced by large doses of nitroglycerin, and such a result is apparently due to paralysis of the muscles of respiration; but if ordinary care is used in the employment of this powerful agent, nothing further than slight inconvenience will be encountered in those who are the most susceptible to its influ- ence. Even when unconsciousness has been produced by its too free use, recovery has taken place without an untoward symptom beyond headache that persisted for some hours. Dose and administration.—It is always safer to begin with a small dose in persons whose susceptibility to the influence Of nitro- glycerin is unknown, ,and rapidly increase the quantity until slight inconvenience is experi- enced by the patient, or the desired results are obtained. The initial dose for weak and ner- vous persons should not exceed xhxs or ?io °£ a grain, and if no appreciable effects are experi- enced the same quantity may be repeated in ten minutes. If still no effects are observed, the dose may be doubled and repeated as often as is found necessary. There are two solutions of nitroglycerin in use—the alcoholic, spiritus glonoini (U. S. Ph.), and the aqueous. They are both 1-per-cent. solutions. The alcoholic solu- tion is more reliable than the aqueous, but the disadvantage of it is that it becomes explosive in proportion to the amount of evaporation that has taken place of the alcohol holding it in solution. Hare recommends that it should be kept in tightly stoppered tins, in a cool place. The dose to begin with of either of these solu- tions should not exceed \ a minim in persons whose susceptibility to nitroglycerin is not known. Tablets and pellets of nitroglycerin are made by manufacturing chemists. The amount of nitroglycerin contained in them varies from 5^ to rim of a grain. 1 have known the weaker ones to cause unpleasant symptoms. [The British official tablets, tabellce nitrogly- cerin (Br. Ph.), are tablets of chocolate, each containing TU of a grain of pure nitroglyc- erin.] To Dr. Murrell, of London, belongs the credit of having first employed nitroglycerin for the relief of spasmodic attacks of angina pectoris. It seems to lessen or cut short the precordial pain and distress by suddenly dilat- ing the arterioles, especially of the pulmonary circulation, and thus relieving the distended cavities of the heart. When great promptness of action is required, inhalations of amyl ni- trite should be given for its temporary effect, followed by nitroglycerin for its more perma- nent influence. As soon as the susceptibility NITROGEN 5 NITROGLYCERIN of the patient to the influence of this drug is ascertained it must be pushed to the point of tolerance. Larger doses are required in this disease than in almost any other spasmodic affection. Leech (Brit. Med. Jour., July 15, 1893, p. 109) states that he has had to gradually raise the dose to 20 minims, and a larger dose is frequently required. The nitrites generally, and nitroglycerin es- pecially, are useful in cardiac dyspnoea, both of pulmonary and of cardiac origin. In cases in which the heart is weak or fatty, it is thought care should be exercised lest damage to the heart result, but, on the whole, the weight of testimony is in favour of the use of this agent, even under such circumstances. Some cases of spasmodic asthma are bene- fited by nitroglycerin, but in this affection, as in angina pectoris, the less the structural changes that have taken place, the better the effects of the nitrites; therefore it is in the early stages of these diseases that most may be expected from the use of any of the nitrite group. It is well known that the arterial tension is increased in Bright's disease, and, as nitroglyc- erin lessens this, it, as well as the other ni- trites, has been employed with, as is alleged, more or less advantage to the patient (Bar- tholow, Robson, et al.). Nitroglycerin has been employed with some success in hiccough, whooping-cough, laryngis- mus stridulus, tetanus, seasickness, reflex vom- iting, gastralgia, and hepatic and renal colic. It is not so effectual in preventing an attack of epilepsy as amyl nitrite. In migraine attended with blanching of the face, and in neuralgia of the trigeminal nerve due to in- sufficient blood supply to the affected nerve ni- troglycerin acts promptly in cutting short an attack. Headaches due to anaemia of the brain are relieved by this agent. Bartholow speaks highly of the use of nitroglycerin in the cure of anaemia. The cold stage of intermittent fever may be aborted by any of the promptly- acting nitrites. Gowers recommends the use of nitroglycerin thrice daily in persons who are subject to migrainous headaches, given during the interval of the attack for the purpose of increasing the blood supply of the brain. [Nitroglycerin has recently been found a very potent remedy in sciatica. A Russian physician, Dr. Milkhalkine (Semaine med. ; Lyon med., Feb. 24, 1895), reports three cases of persistent sciatica that had been absolutely rebellious to the action of antipyrine, of acet- anilide, of chloral hydrate, of the bromides, and of other analogous drugs, as well as to the em- ployment of revulsives. Under the influence of nitroglycerin two of the patients were radi- cally cured of their sciatica, and in the third case it produced a considerable amelioration. It was administered sometimes in a 1-per-cent. alcoholic solution, of which three drops a day were taken, sometimes under the form of the following mixture: A 1-per-cent. alcoholic solution of nitroglyc- erin, 75 grains; Tincture of capsicum, 113 grains; Distilled peppermint-water, 225 grains. S. : From 5 to 10 drops three times a day. NITROHYDROCHLORIC ACID NITROUS OXIDE 16 Dr. William C. Krauss, of Buffalo (N. Y. Med. Jour., Feb. 29, 1896), before he had seen Milkhalkine's report, and having only a vague knowledge that Lawrence had recommended the use of nitroglycerin in the treatment of sciatica, treated seven cases with the drug, using it indiscriminately in all his cases of sciatic pain. Dr. Krauss reports that all these seven pa- tients received decided benefit from the very beginning of this mode of treatment. In the acute cases they recovered in from ten days to a month ; in the chronic cases they improved notably and gained daily. Just how to explain the action of this drug on sciatic disturbances, says Dr. Krauss, is extremely difficult; to say that it has the effect of dilating the arterioles of the nerve sheaths, affording more nourish- ment to the nerve, might answer in cases of neu- ralgic sciatica, but would hardly be accepted for neuritic sciatica. The action in these lat- ter cases can be explained in no satisfactoiy way, and therefore had better be left unex- plained. The only discomforts arising from the use of the drug noted by Dr. Krauss were congestive headaches and flushing of the face sometimes following the first dose of the medi- cine, while in other cases they did not supervene until the maximum doses were administered. To counteract these effects, he says, the bro- mides may be used, thus robbing the nitroglyc- erin of all the physiological effects where they are not wanted, and allowing them to proceed without hindrance in those places where they are desired. Dr. Krauss adds: " I do not wish to convey the idea that nitroglycerin will cure every case of sciatica—far from it; but if it cures 50 per cent, of all cases in a period of from one to three weeks, it will be doing what no other drug or measure has heretofore done. If after a period of administration of ten days no per- ceptible effects have been obtained, it should be abandoned and kept in store for the next case. The treatment of anaemic conditions, diatheses, and local causes, such as pressure— these, perhaps, provoking and setting up the sciatic pain—must, of course, be considered and carried out in conjunction with the special treatment. From my experience I should ad- vise beginning the treating sciatica with nitro- glycerin, and only after its inability to cure is apparent falling back upon the other drugs and measures with which we are all ac- quainted." Dr. G. Lindsay Turnbull (Lancet, Feb. 8, 1896), who records a case of the successful use of nitroglycerin in the treatment of gallstone colic, suggests its use when morphine is not well borne.]—Jeremiah T. Eskridge. NITROHYDROCHLORIC ACID, or ni- tromuriatic acid, aqua regia, acidum nitro- hydrochloricum (IT. S. Ph.), contains 18 parts of nitric acid and 82 of hydrochloric acid, is of an orange-yellow colour, and is highly cor- rosive, but is somewhat unstable, and should be freshly prepared to be of the highest thera- peutic value. Although strongly escharotic, it is never employed as a caustic, and possesses no advantage over nitric acid. In the propor- tion of 1 fl. oz. to the gallon of warm water it is often used for sponging cachectic children that have a dry, wrinkled skin, white pasty stools, and an inclination to gaeophagia. A somewhat stronger solution—from 2 to 3 fl. oz. of the acid to the gallon of water—is very ser- viceable in the treatment of jaundice due to duodenitis or malaria; it is used for sponging the surface of the body and as a pediluvium, or a general bath in it may be taken. Nearly all chronic, but not the acute, diseases of the liver are benefited by the constant wearing of a broad bandage moistened in a solution of this strength and covered with oiled silk, over the region of the liver. The efficacy of the external application of this acid is usually increased by its simultaneous internal admin- istration. Dysentery, jaundice, and dropsy of hepatic origin, especially in persons residing in hot climates, are also generally alleviated by a continued use of it. In constitutional syph- ilis it is more useful than nitric acid, particu- larly after a long course of potassium iodide and mercury. It may be used in place of nitric acid in the various digestive disorders, lithaemia, etc., and often is more efficient, but no rule can be given for the selection of the cases in which it would be the more appro- priate. In xanthelasma, acne, and all cuta- neous affections due to or aggravated by digestive disturbances it is a highly useful adjuvant to any special treatment which may be indicated. It is advised that it should not be combined with alcoholic solutions, as suf- ficient gas may be given off to cause an ex- plosion. The dose is from 3 to 6 drops, well diluted, three times daily. The dilute acid, acidum nitrohydrochloricum dilutum (U. S. Ph., Br. Ph.), is of about one third the strength of the undiluted, and may be given in doses of from 10 to 20 drops, but is not very reli- able, as the reaction between the diluted acids used in its preparation is very different from that which occurs when the undiluted acids are mixed.—Russell H. Nevins. NITROUS OXIDE, laughing gas, pro- toxide of nitrogen, or nitrogen monoxide, is a colourless, transparent gas of the specific grav- ity of 1-527 and of neutral reaction. It has a sweetish odour and scarcely any taste. It is made by careful heating of nitrate of ammo- nium, NH4NO3, which splits up into water and nitrous-oxide gas, N20. To be freed from any trace of acid or nitric oxide, the gas should be passed through a solution of hydrate of potassium and a solution of ferrous sul- phate, and should be held over water in a jar for at least twenty-four hours. Nitrous-oxide gas supports combustion almost as well as oxygen By pressure, a colourless liquid may be made of the gas. and further pressure will cause its solidification. Water will take up almost its own bulk of nitrous-oxide gas. Priestley discovered the gas, but Sir Hum- phrey Davy was the first to discover its anaes- thetic properties. It was his belief that it could be substituted for oxygen in inspired air; but this has since been proved false by the researches of Hermann and of Amory (N. Y. 17 NITROHYDROCHLORIC ACID NITROUS OXIDE Med. Jour., Aug., 1870). Davy did not carry his experiments far enough, however, to realize the possibility of the use of nitrous-oxide gas for surgical purposes. Mr. Colton, now an aged man living in New York, was demon- strating the anaesthetic properties of the gas in one of his public exhibitions in which per- sons under its influence seemed to feel no sensibility to pain, when the notion was seized by Horace Wells, a dentist of Hartford, Conn., to use the substance for the painless extrac- tion of teeth. Dr. Wells made an unsuccessful effort in 1844 to induce the medical profession to adopt nitrous oxide as a general surgical anaesthetic, but his attempt failed. It was not until 1863 that it came fully into vogue among dentists. Since that time it has been used for anaesthetic purposes on a gigantic scale all over the civilized world. For our knowledge of the physiological ac- tion of nitrous oxide we are indebted princi- pally to Hermann (Arch. f. Anat. u. Physiol., 1864), Amory (loc. cit.), and Zuntz (Pfluger's Archiv, Bd. 17,1878, i and ii). Though there is a difference in the methods employed by these observers, their results are almost iden- tical. Arterial blood shaken up with nitrous- oxide gas becomes dark, and venous blood remains dark. Inhaled pure, the gas pro- duces a feeling of suffocation and at the same time of stimulation. The gas is, therefore, not respirable in the true sense of the word, for it does not give up its oxygen to the blood. All observers are agreed that asphyxia is pro- duced by this strong molecular cohesion, de- priving the blood temporarily of a sufficient supply of oxygen. The anaesthetic properties of the gas lie in close connection with its as- phyxiating tendencies. On inhalation of nitrous-oxide gas, there is first noticed a stimulation of the entire system, as in alcoholic intoxication. The entire body tingles, and the keenness of the senses is ac- centuated. The pulse becomes fuller and more rapid, and the respirations are increased in frequency and are shallow. Consciousness is maintained up to this point, and the subject answers questions rationally. The face is pale. If the administration of the gas is continued, the face and visible conjunctivas become deeply cyanosed, and the breathing grows stertorous. Consciousness disappears and anaesthesia of the senses follows, sensation and muscular power being the last to disappear. Unless the use of the anaesthetic is continued, the aboli- tion of sensation lasts but a minute or two, the patient recovering from the influence of the narcotic as soon as oxygen is inhaled. Rhythmic muscular movements, twitchings, or rigidity may manifest themselves during the anaesthesia; or, on recovery, there may be erotic symptoms or hysterical conduct. During the second period of anaesthesia, when the face is dark and the pulse scarcely perceptible, it is well to guard against the pos- sibility of complete asphyxia or the appearance of convulsions by giving the patient a few whiffs of atmospheric air. During the period of insensibility, dilatation of the pupil, im- peded respiration, irregularity of the heart, I and diminished pulse-rate are often seen. | Warner (Lancet, June 17, 1882, p. 985) reports that he has seen coma, hemiplegia, catalepsy, hysteria, and clonic convulsions follow the use of laughing gas. Cardiac disturbances are not rarely witnessed, and an interesting case is recorded by Ottley (Lancet, Jan. 20, 1883). Lafout has observed a transient albuminuria and glycosuria following the inhalation of nitrous-oxide gas (University Med. Mag., vol. ii, p. 248). The great majority of people may be narcotized without any disagreeable occur- rences. Occasionally, however, persons are met with who complain of an " anxious feel- ing" about the breast—something like that witnessed in pseudo-angina pectoris. Some- times the psychical effects of the gas are disagreeable rather than pleasing, and the occasional slight convulsions already noted indicate an irritation of the cerebral cortex. Long-continued anaesthesia with this gas may be followed by a venous condition of the arte- rial blood, due to the deprivation of oxygen from the haemoglobin of the red blood-cells. Erotic excitation is not uncommonly ob- served after nitrous oxide anaesthesia. The same precaution of having a third responsible person present during the narcosis of females should be observed as in ether anassthesia. Vomiting and nausea practically never occur in the use of this gas. Minor operations under its influence can therefore be under- taken without consideration of a previous meal. Recovery from the influence of nitrous oxide is marked by a slight mental dulness, which rapidly disappears. The face and visible mu- cous membranes return to their normal colour, and within a minute or a minute and a half the patient is entirely conscious. He may laugh or cry for a few minutes, or may remain very solemn in his demeanour. That nitrous oxide is the safest of the three great anaesthetics is axiomatic. Deaths after or during its use are extremely rare. Thus, Darin, making a statistical comparison, gives these figures: Chloroform, one death out of 2,872 anaesthesias; ether, one out of 23,203; and nitrous-oxide gas, one out of 100,000 (Brit. Med. Jour., Jan 24, 1885). The present writer has been able to find but eighteen cases of death from nitrous-oxide, one of these being an unrecorded instance. The gas is used, un- doubtedly, hundreds of thousands of times an- nually, and report is certain to be made of a fatal result in its administration. Evidence is almost unanimous that it is the safest of the general anaesthetics. Holden has pointed out that inhalation of the gas may be followed by haemorrhagic tendency, and that its employment is always attended with pulmonary engorgement. He regards nitrous oxide, therefore, as contra-indicated in pulmonary disease, particularly when there has been a haemoptysis, and in haemophiliacs (Kappeler, Anaesthetica, Stuttgart, 1880). Nitrous-oxide gas has its greatest use among dentists in the extraction of teeth and their roots. Among surgeons it has gained wider and wider favour during the last decade for NOSOPHENE NUCLEINS 18 use in minor operations of short duration. Un- ' fortunately, its physiological action is so su- preme that it will not admit of prolonged employment. It is called into requisition for the opening of abscesses, tenotomies, and the re- duction of dislocations and fractures. Barton recommended it highly for the last-mentioned purposes, because of its safety and the quick muscular relaxation it produces (Phila. Med. Times, vol. xvi, p. 108). It can be satisfactorily used in operating an ingrown toe nail and in circumcision. In fact, in any surgical pro- cedure which requires only a short anaesthesia, nitrous-oxide gas has its distinct indication. More extensive operations than those indicated have been performed with the use of nitrous oxide. Carnochan, in England, removed a woman's breast, giving the patient alternate inhalations of the gas and of atmospheric air. The late Dr. J. Marion Sims extirpated an abdominal tumour with a nitrous-oxide anaes- thesia lasting twenty minutes. The use of the gas in labour has naturally been tried. Zweifel and Doderlein, of Erlan- gen, made a thorough research in regard to it (quoted in Brit. Med. Jour., Nov. 7, 1885), and found that it did not retard labour in the later stages, as chloroform does. Sensation is benumbed, but the patient remains conscious. This obtundity of pain lasts long enough to suture a ruptured perinmum. Nitrous-oxide gas could be introduced into private obstetrical practice only under peculiarly favourable cir- cumstances; and, indeed, so rare is a death from chloroform during confinement that the obstetrical use of laughing gas will probably always remain restricted to maternity hospitals. No great advantage seems to accrue from mix- ing it with oxygen in the proportion of 4 to 1, as has been proposed. At the present day English surgeons fre- quently begin an ether narcosis by rendering the patient unconscious with nitrous-oxide gas. By this means the primary disagreeable effects of ether are obviated. The gas may be administered in two ways. Both methods require, besides the iron reser- voir, a caoutchouc bag connected by rubber tubes with the reservoir on one side and with a mouthpiece on the other. This mouthpiece is furnished with a valve opening outward, allowing the expired air to escape. With each inspiration the valve closes, permitting only pure gas to enter the lungs. A lever-like ar- rangement renders it possible to administer gas and atmospheric air at the same time. In the first method, pure nitrous oxide is given for inhalation for from one to two minutes, fol- lowed by an occasional whiff of atmospheric air. The second manner of inducing anaesthe- sia is characterized by permitting the simul- taneous inhalation of the gas and air. The latter requires a longer time to accomplish the purpose, and the narcosis is more difficult to produce. The method first described is tb,e one in most common use. The only objection to the apparatus above defined is that an ap- preciable quantity of gas is lost. To overcome this loss, an apparatus has been devised for institutions where much gas is used in which the expired air is returned to the reservoir after being passed through limewater to rid it of its contained carbonic-acid gas. The advantages of nitrous-oxide gas as an anaesthetic may be said to be: 1. The rapidity of its action. 2 Its comparative and prac- tically absolute safety. 3. The rapid return to consciousness. and sensation. 4. The almost total absence of disagreeable sequelae. Among its disadvantages are its unfitness for prolonged operations and the difficulty of transporting the necessary apparatus for its use. Blake and Hamilton (Med. Record, Jan. 31, 1880) have recommended inhalations of ni- trous-oxide gas in cases of melancholia and nervous exhaustion, as a hypnotic and stimu- lant. Its use in this connection has entirely disappeared. Dr. George J. Ziegler (Researches on the Medical Properties and Application of Nitrous Oxide, Philadelphia, 1865) has also urged the employment of the gas in small quantities in "permanent chemico-organic, ar- terial, nervous, and cerebral changes," and as a " general stimulant" in all asthenic diseases. These suggestions undoubtedly rested upon the belief, now known to be false, that the oxygen of the gas was given up to the blood. Nitrous-oxide water is water impregnated with nitrous oxide under pressure. This was known as " Searle's patent oxygenous aerated water," and about fifteen years ago had a large sale as a diuretic, stimulant, and alterative. Serullas employed it in Asiatic cholera. It possesses merely a historic interest. [In the Medical Record tor May 11,1895, Dr. Charles G. Pease treats of the use of nitrous- oxide gas as an anaesthetic in prolonged opera- tions. As anaesthesia, he says, may be prolonged with the gas up to one, two, three, and four hours, with so much greater safety to the pa- tient than with other anaesthetics, and with no unpleasant sequelae, it must surely come into more general use. He admits that he finds it far more tiring to administer gas than to ad- minister the other anaesthetics, but that, he says, should have no weight, in view of the great advantages to the patient. Dr. Pease has devised a portable outfit consisting of small cylinders containing 100 gallons of gas each (condensed) with a convenient case for carry- ing them, a gas-bag, tubing, and an inhaler, with valves to admit air and shut off gas, and vice versa. The gas, he says, should never be administered to an alcoholic patient, and alco- hol should not be allowed prior to the admin- istration, as the patient is very apt to become unmanageable. At a meeting of the New York Surgical So- ciety held on November 27, 1895 (Annals of Surg., Feb., 1896), Dr. Francis II. Markoe pre- sented the subject of the use of oxvgen in con- nection with that of nitrous oxide and ether (see under Oxygen).]—Samuel M. Brickner. NOSOPHENE, or tetraiodphenolphthalein, (C6H2I2.OH)2.C (U. S. Ph.), which con- tains 2 per cent, of veratrine. Oleatum zinci (unofficial), of 5, 10, and more per cent. Oleatum atropine (unofficial), of 1, 2, or more per cent. 0LE0RES1NS OPIUM 34 Oleate of aconitine was at one time praised as a very efficient agent in neuralgia, but has been found too risky for general use. True oleates may be prepared by double de- composition between the solution of an oleic- acid soap and the solution of a metallic salt. The resulting precipitate, for instance, oleate of lead, of copper, of bismuth, etc., when thor- oughly washed and dried, is usually in the form of a dry, hard mass or in dry powder. These oleates are either used, by themselves, as dressings, or are combined with fatty bases, and applied as ointments.—Charles Rice. OLEORESINS. — As the name implies, these are compounds of oils and resins. The word "oil" in this connection is to be taken in the sense of " volatile oil." In pharmacy the term is applied to preparations made from vegetable drugs containing an essential oil and a resin which are medicinally active, more particularly such as are of a pungent, spicy character. Oleoresins may be prepared by various vola- tile menstrua, such as benzin, ether, chloro- form, etc., but ether is the one usually employed, as it is the easiest to be removed from the product without leaving its own taste be- hind. Owing to the volatility of the menstruum, it is preferable to employ some form of appa- ratus which will prevent too great a loss of ether by evaporation. This is best accom- plished by connecting the percolator in which the exhaustion of the drug by ether is effected air-tight with the receiver, establishing a com- munication between the air-spaces of the two vessels by a separate connection (tubing). As fast as the ether percolates through the drug and drops, loaded with dissolved matters, into the receiving vessel below, the air displaced in the latter is transferred to the percolator. In the manufacture of oleoresins on a large scale special precautions are taken, by means of suitable condensers, to diminish the loss of ether to a minimum. The oleoresins which are official in the U. S. Ph. are the following: Oleoresina aspidii, formerly called oleo- resina filicis (oleoresin of aspidium or male fern; very commonly called simply "oil of male fern "). This is prepared by exhausting the green parts of the rhizome of male fern, previously powdered, with ether. From the percolate the greater part of the ether is re- moved by distillation on a steam-bath, and the residue is then exposed to the air until the re- maining ether has evaporated. This oleoresin has the peculiar property of gradually depositing a granular-crystalline precipitate which consists of filicic acid, the most active principle contained in the drug. Ignorant pharmacists are apt to regard this as an inert matter, such as will often form in tinctures containing pectin bodies, and they are anxious to get rid of it by filtration or other- wise. In the present case the sediment should be carefully incorporated with the liquid por- tion before any of the oleoresin is removed for use. Oleoresina capsici, oleoresin of capsicum, is prepared in the same manner. When the ether is finally evaporated a considerable amount of a waxy substance will be found mingled with the liquid oleoresin. In order to get rid of this, it is best not to evap- orate until all traces of ether vapour are gone, as the mixture will then usually be too thick to be strained. If it is strained while yet just sufficiently liquid, the waxy constitu- ent may be completely separated. Oleoresin of capsicum is the most concen- trated pharmaceutical preparation of the drug, and must be employed with caution. It is used externally, spread in a thin layer upon adhesive plaster as a rubefacient. For internal use it must be largely diluted with other sub- stances. Of the other official oleoresins, that of cubeb is employed in making troches or pastils of cubeb. The remaining ones—viz., those of lupulin, pepper, and ginger—are but little in use.—Charles Rice. OLEUM CADINUM (U. S. Ph.)—Oil of cade (see under Tar). OLIBANUM, or frankincense, thus ameri- canum (Br. Ph.), is a gum-resin which enters largely into the composition of incense, on ac- count of its yielding, when burning, a fragrant odour. In medicine it has essentially the same effects upon the respiratory mucous membranes as the other gum-resins and may be substituted for balsam of Peru and balsam of Tolu in the treatment of bronchitis, etc. The fumes aris- ing from its slow combustion or those furnished by exposing it to heat are recommended in chronic bronchitis and laryngitis, on account of their slight stimulant effects. Combined with charcoal, saltpetre, and a little gum, it forms pastils which are sometimes burned to disguise unpleasant odours in sick-rooms, etc. The dose of olibanum ranges from 15 to 60 grains, and it is recommended to combine with it a little soap, which is believed to add to its activity. Russell H. Nevins. OLIVE OIL, or sweet oil, oleum olive (U. S. Ph., Br. Ph.), oleum olivarum (Ger. Ph.), is a bland oil obtained by expression from the fruit of the Olea europea, a native of the countries bordering upon the Mediterranean but cultivated in nearly all the semi-tropical countries of the world. It is almost entirely without odour, has a sweetish taste, and is yellow or greenish-yellow in colour, the oil of the latter colour beins the most delicate and highly prized, but rarely met with outside of the regions in which it is produced. Varieties less commonly met with are dark-coloured and are used almost exclusively in the manufacture of soap, plasters, etc. When exposed to the ac- tion of the air and light, olive oil rapidly be- comes rancid, assumes a darker colour, and acquires an unpleasant taste and odour. After its exposure to a temperature slightly below that of freezing it solidifies into a mass of about the consistence of soft butter, and at slightly higher temperatures is apt to become turbid on account of the separation of small particles of palmatin and stearin. This con- 35 OLEORESINS OPIUM dition often leads to the suspicion that the sample has been sophisticated, but slight agi- tation and warmth will cause the oil to be- come perfectly clear. When kept in tightly closed vessels it will remain sweet for long periods; but when once exposed to the air it should be used at once or kept in a very cool place, such as a refrigerator. It is more than probable that little of the olive oil consumed outside of the countries in which it is made is free from adulteration, but the only important adulterant and the one most commonly em- ployed is cotton-seed oil, and, provided the latter is pure and sweet, the principal objec- tion which can be urged against the sale of the sophisticated article is that it is a fraud upon the consumer. From nearly every stand- point cotton-seed oil is as desirable as olive oil, but lacks in a measure the delicate flavour of the finer grades of the latter. Olive oil is largely used in pharmacy in the preparation of liniments, cerates, and oint- ments, but has been almost entirely replaced in the U. S. Ph. by cotton-seed oil, which is equally useful and much cheaper. For the preparation of salads olive oil, or what is com- monly so termed, is oftener used than cot- ton-seed oil; but for all other purposes in cooking it is no better, although more expen- sive. For inunction and for the protection of raw surfaces it is less suitable than cacao but- ter or vaseline, as it becomes rancid very quick- ly and the fatty acids developed are irritating to the skin. In all wasting diseases it forms a valuable addition to the food, as it may be incorporated into salads of various kinds and will not usually be regarded by the patients as a necessary element in their treatment. In conditions in which a fatty food is imperative- ly demanded cod-liver oil is to be preferred, for the reasons mentioned under that head. Like nearly all fatty bodies, olive oil is laxative and may be used as such in doses of from 1 to 2 fl. oz., but it is not very efficient and its use is almost limited to children and infants. It may be added in almost any proportions to enemata when there are large accumulations of hard feces in the rectum, but, while it un- doubtedly softens them, it is not so efficient as linseed oil, which has in addition an irritant effect upon the rectum. As large amounts as can be taken without exciting nausea are re- puted to increase the quantity and fluidity of the bile, and consequently to be of use for the relief of biliary calculi. [The olive-oil treatment of biliary colic is regarded by some physicians as one of very great efficiency; others consider it of no value. The question must be regarded as still unset- tled. Professor Combemale, of Lille (Bull. med. du Nord, July, 1893 ; Gaz. med. de Paris, Sept. 23, 1893), who seems to have no doubt of its value, finds a similitude between biliary colic and lead colic; hence he has been led to try large doses of the oil in the treatment of painters' colic. He reports four cases of its successful employment, and thinks it is in some respects superior to other remedies for this form of plumbism.] Russell H. Nevins. OPIUM.—It is, of course, impossible to de- tail all of the countless therapeutic applica- tions of opium. It will therefore be the aim of the writer to deal with the general princi- ples which underlie the use of this drug rather than to summarize all the detailed uses to which it might be applied. In the first place, its power to support life as a substitute for food is of great value, as is also its poAver to contribute to the support of the body as an auxiliary to food. Millions of well-to-do, sober, and industrious Orientals take their opium daily as the European takes his wine—as a sort of supplementary food. This they do with no more thought of dissipation than we have in smoking a cigar, and oftentimes with less damage. Taken in this way, indeed, it seems to entail no evil consequences, and it does not cause narcosis. In this country there seems to be an increas- ing number of those who take opium as most do alcohol, simply to remove fatigue or to add to a too slender food allowance. The food- power of opium is certainly great, and in cir- cumstances of privation it has been shown to exist for horses as well as for men. It is not intended to intimate that opium is in any sense a tissue-builder, but merely that it serves the clinical purpose of making the lack of food less disastrous. It is of controlling importance that one should bear in mind the danger of forming the opium-habit by any avoidable use of the drug, but it is only fair to admit that great benefit has followed its use in cases of profound enfeeblement due to deprivation of food, or loss of sleep, or fatigue from excessive exertion. In such conditions food and rest would be the natural restoratives to apply, but without question recovery is more rapid if small amounts of opium are given, or perhaps preferably small doses of morphine, such as a fifteenth or a tenth of a grain. The only ob- vious effect of such doses is a general addition to the patient's comfort and to his power of repair. It is extremely important that large doses be not given. The slightest develop- ment of narcosis, being followed, as it invaria- bly is, by reaction, would be very harmful. Another illustration of its restorative power is in prostration from severe hemorrhage. It is within the experience of many surgeons and obstetricians that after severe haemorrhage opium in full doses seems to sustain life until food can be assimilated in a way superior even to alcohol. Under these circumstances both these agents are well borne and in large doses, and seem to cause no other effect than the removal of certain grave symptoms, such as rapidity and feebleness of the heart, restless- ness, delirium, wakefulness, etc. Of the two, opium is the more useful in this condition. It is impossible to say what the exact doses should be; it should be given in small amounts and at frequent intervals until it produces the desired effect,but it is very important to avoid narcotism. The modus operandi is entirely unknown, but it is known that the induction of narcotism is fraught with great danger. In hemoptysis which is at all profuse opium is of value, as it is in all cases of severe haem- OPIUM 36 orrhage, but it is of special value in small bleedings with nagging cough which seems to keep up the bleeding. The use of opium dimin- ishes the cough, and this is often followed by cessation of the bleeding. It is far more use- ful in this condition than all the real and imaginary styptics. In the hectic fever of phthisis it often gives great comfort by relieving the irritating cough that is so distressing. In hemorrhage from a typhoid ulcer it is of great value, not only on the general principles above enunciated, but because it allays the patient's apprehension and puts him at rest, and thus tends to immobilize the bleeding point. By this means the danger of a recur- rence of the bleeding is reduced to a minimum. In the irritable restlessness due to prostra- tion of prolonged and enfeebling diseases, such as protracted fever or suppuration, its effects are often highly beneficial. In this condition only small doses are required, and unless there is some contra-indication, it is best adminis- tered subcutaneously. Who does not recognise the condition ? A feeble, rapid pulse, great general weakness and depression associated with delirium, muscular tremors, picking at the bedclothes, a dry, brown, shaky tongue—these are its prominent symptoms, and among them stand out con- spicuously wakefulness and delirium. The administration of from a tenth to a quarter of a grain of morphine subcutaneously will often be followed by a calm, quiet, restful sleep, after which great improvement in the general condition may be observed. If diarrhea is excessive in typhoid fever, and especially if it is associated with delirium, we have a double indication for the adminis- tration of the agent. It is a fact, so far as I am aware, without exceptions that there is absolutely no danger of engendering the opium habit by its use in this latter condition ; and, incidentally, the same may be said with regard to alcohol. Indeed, these two agents are usually to be used jointly in these conditions, and such use is likely to produce better results than the use of either alone. Although the above-mentioned small doses will usually be sufficient, the therapeutist must never forget that he is using opium here to accomplish a definite effect, and that this necessarily implies a somewhat indefinite dose. It must be given in divided doses until it produces the effect that is sought. It is extremely important here again not to narcotize the patient. In collapse due to cholera it has been found very beneficial. Here, of course, opium per os would be useless, because of the greatly di- minished absorption that takes place. Its trial in this condition seems to have been care- fully undertaken in the British Seamen's Hospital at Constantinople. A dose varying be- tween a quarter and half a grain was followed in numerous instances by a quiet sleep, after which recovery usually took place. Occasion- ally the same patient needed to have this dose repeated two or three times. There has been a disposition to elevate this to the height of a method of treating cholera—a contention for it which is absurd. That certain symptoms of the stage of collapse may be benefited by it may well be allowed. It is in heart disease that opium achieves its most significant modern victory. In speaking of the general subject I have used the words opium and morphine inter- changeably, but I should like to be understood as having a decided preference for morphine, as a rule, and as using this by subcutaneous injection in the absence of contra-indication. The recommendation to use morphine in heart disease came from England. It is a singularly apt illustration of the great benefit to be obtained from an accurate clinical knowl- edge of the action of the agent which no amount of laboratory study or research could have rendered possible; and, moreover, it isan illustration of the value of the subcutaneous injection of this alkaloid which can not be re- placed by mouth administration of the same alkaloid or of opium. Opium given by the stomach is not suitable in the distress of most forms of heart disease. It is especially in late stages of mitral ste- nosis and mitral insufficiency that morphine, given subcutaneously, accomplishes such happy effects. Here we see all the appearances of general venous congestion. It begins, of course, in the lungs and extends thence to the entire body, manifesting itself by cyanosis, pallor, and dropsy. The heart may be unduly active, even tumultuous in its effort to overcome the mechanical impediment to the circulation, and the patient may be slowly suffocating in con- sequence of the inability of the blood to convey the needed oxygen to "the tissues. Anything at all approaching narcosis would further ag- gravate the existing congestion and general distress. But a non-narcotic dose of morphine, given subcutaneously, has a totally different effect. An eighth of a grain or double that amount seems to restore the disturbed balance in the circulation, and most of the distressing symptoms are thus ameliorated. The face be- comes less turgid, the expression calmer, the precordial distress disappears, the pulmonary congestion abates, the heart becomes more tranquil and regular, and the patient may enjoy the refreshing influence of a tranquil sleep. The effect is certainly better in mitral than in aortic disease, and yet in parallel eases of aortic disease we need not fear to use it in the same way. In angina pectoris, if the pain is severe, it will sometimes yield to no other treatment, although it is proper first to try the arterial dilators in this condition. In some of these cases it seems to exercise a lasting influence over the symptoms. In old cases of this dis- tressing condition the severe paroxysms of pain are not always associated with' arterial spasm and increased arterial tension, and in such cases the use of the nitrites is not indi- cated. In another form of dyspnea it will often serve an exceedingly useful purpose. In con- 37 OPIUM ditions of laryngeal stenosis caused by inflam- matory swelling, by croup, or by diphtheria, it will often cause a very marked subsidence of the dyspnoea and its attendant distress. For a child a year old doses of two drops of the deodorized tincture, for older children larger doses, up to five drops, given two, three, or more times a day, have often been followed by an amelioration of the dyspnoea with all its attendant symptoms of distress. In some cases this treatment will replace operative procedure; in others it will enable one to postpone an operation. Even this is often a great gain. In diabetes codeine and morphine will some- times exercise a controlling influence over the amount of urine, as well as over the sugar per- centage, and many of the much more distress- ing symptoms of this grave malady. Neither of these alkaloids should be administered in narcotizing doses for this purpose, and one need entertain no hope of being able to cure the disease by this means. For the cure of pain opium is without a rival. In general, it is better administered sub- cutaneously for this purpose. It is not neces- sary to narcotize a patient in order to cure his pain; in fact, the relief of pain is exceedingly common even without the production of sleep at all. It is of great importance to give the small- est dose that will accomplish the purpose, for many reasons. Anything resembling narcosis is very objectionable on numerous accounts, but particularly because it is likely to be fol- lowed by a condition of depression which makes one distinctly less able to endure pain. If large doses are used there is much more danger of establishing the opium-habit. To relieve pain the doses to begin with should be from a fifteenth to a sixth of a grain of morphine. If the pain is due to a chronic condition or to one that is to recur frequently, it is exceedingly de- sirable not to use opium in its relief at all, of course; but in the pains of acute conditions, such as acute inflammations, it is of immense value. Once in a great while a case may occur in which it will be necessary to narcotize a pa- tient in order to relieve his pain. This is true occasionally in the pain due to ulcerations of malignant disease involving sensitive nerves, as it also is in some of the painful conditions due to pressure, as by brain tumours, aneu- rysms, and the like. In these conditions the dose must be indefinite, but it is to be dis- tinctly borne in mind that in giving large doses one is surely approaching the end of the usefulness of the drug. It is of inestimable value where death is in- evitable and imminent, to relieve pain and rest- lessness. The latter condition may be purely reflex, and the patient may be unconscious of it; but it may be so distressing to his family that one is justified in controlling it by a small dose of morphine, administered by preference subcutaneously. As a means of inducing sleep in many con- ditions of delirium it is without a rival. To d© this it is not necessary, nor is it proper, to narcotize the patient. ,It is largely the unjus- tifiable production of narcosis that formerly was in vogue that led to the disuse of this agent in all cases of delirium tremens. Sleep is recognised as essential to the cure of this condition, and if the pulse justifies its use chloral is certainly better; or if one can ac- complish the purpose with any of the modern hypnotics it is certainly better not to use mor- phine. Moreover, if the delirium is very ac- tive it will not be controlled by a small dose of morphine; but occasionally cases of chronic alcohol poisoning occur, with great depravity of nutrition, anaemia, emaciation, and such feebleness of the heart's action as not to allow of the administration of chloral—cases with persistent, uncontrollable insomnia and mild delirium. Sometimes, after trying the safe hypnotics in vain, one is driven to administer morphine subcutaneously in this condition. A sixth, a quarter, a third of a grain will sometimes succeed when other agents have failed. In general, in delirium tremens it is not so good as other agents. In raving mania, with active circulation, small doses will not produce sleep, and large doses are not well borne. But, combined with hyoscine hydrobromide and given subcutane- ously, morphine is of great utility in this con- dition. In the milder delirium of nervous exhaustion in the acute fevers small doses will often sup- plement in an admirable way the supporting and stimulating treatment that is most appro- priate, as has been already stated. In melancholia a few small doses are often most serviceable, as they also are in wakeful- ness and delirium from anaemia of the brain after severe haemorrhages. The same distinction must be drawn in re- gard to dyspnea. In dyspnoea from respira- tory disease opium narcosis would be likely to aggravate the condition, but that is no reason why a small dose should not be administered in bronchitis, or pneumonia, or pleurisy associ- ated with wakefulness from incessant cough or from pain. Indeed, in these conditions such treatment is often highly beneficial. Its use has been properly abandoned as un- justifiable in tetanus, epilepsy, and chorea. The same is true of hiccough and asthma. In obstinate vomiting it is often of great value. Bright's disease in general and uremic con- vulsions in particular were formerly regarded as absolute contra-indications to the use of opium in any form. Although other agents are, without doubt, better in general, still it is true that small doses of morphine will often act as a useful adjunct in the treatment of uraemic convulsions. No other agent with which I am familiar is so useful in the dyspnoea which is associated with the uraemic condition. In the treatment of cough it is in general not a desirable agent. It is of great value, associated with rest, as a means of averting abortion if that accident is susceptible of being averted in any given case. In some forms of inflammation it seems capable of opposing the morbid process in an unknown way. Many people can abort an OPIUM 38 acute catarrhal attack by taking a small dose of opium and facilitating perspiration. In peritonitis it is often proper to push it to the verge of the production of narcotism. A useful measure of the dose is given by the respirations, which, in this condition, may be reduced to the frequency of twelve a minute. As a means of repressing intestinal secretion small doses are of great value in the treatment of diarrhea, if that is not kept up by the presence of irritants in the intestine. In dysentery it is used symptomatically to relieve the pain and tenesmus. To cure the disease the modern local treatment is of in- comparably greater value. [There are some persons who bear opium badly under ordinary circumstances; they are narcotized by comparatively small doses, or they suffer from cardiac weakness soon after taking the drug, or they experience in an ex- aggerated degree the unpleasant after-effects that are not uncommon. This is due, no doubt, to idiosyncrasy in the great majority of in- stances, but there seems reason to attribute it to hysteria in some cases. Nevertheless, mor- phine has been recommended for the cure of hysterical anorexia. M. Dubois (Proqr. med., Feb. 22, 1896; N. Y. Med. Jour., March 14, 1896) reports three cases in which he used it subcutaneously with success after all other treatment had failed. He says that, if the morphine is well tolerated, no inconvenience will arise from the employment of three injec- tions a day, each containing \ a grain of mor- phine hydrochloride, at intervals of four hours. M. Dubois insists upon the following points: 1. The injections should be given each day at the same hour, and food should be given half an hour after the injections, with or without forced feeding. 2. The patient must be assured that the food will be retained and will cause no pain. If this treatment, both physical and psychical, he says, is well directed, in less than three months a rebellious anorexia may be cured. The strength of the solution is dimin- ished from week to week until a final cessation of the use of the morphine is attained.] A minute dose of atropine, a hundredth of a grain or less, seems often to add to the useful effects of a small dose of morphine and to diminish its unpleasant effects. It must not be forgotten that among the effects which it is likely to control is the sweating, and therefore atropine should not be given if this is desired. Of the preparations of opium itself the best to use are the deodorized preparations of the phar- macopoeia. Those made from the crude drug should be abandoned, as causing needless sub- sequent discomfort to the patient. With de- odorized opium, the deodorized tincture, and the tincture of ipecac and opium, practically we have all the preparations that are neces- sary, if we except paregoric, which for the ad- ministration of minute doses is of distinct value. (See Paregoric.) Laudanum is espe- cially objectionable and should never be used. [In an article on the therapeutic abuse of opium (Jour, of the Am. Med. Assoc, Jan. 25, 1896), Dr. G. Walter Barr, of Keokuk, Iowa, remarks that, while our knowledge of pathol- ogy and physiological action has long since passed the point of the treatment of symp- toms, yet we still cling to this one drug which does most of its work in relieving symptoms only, but must always be a potent agent for therapeutic good. Chemically and physio- logically, he continues, opium is perhaps the most complex drug in the pharmacopoeia. It contains a large number of active principles which have been isolated, and a number more that are probably present in the crude drug, although it is maintained that they are merely products of chemical manipulation. It may also contain some that have not yet been iden- tified as chemical entities by laboratory re- search. It seems a little strange, says Dr. Barr, that, with the present tendency to pre- scribe the use of the drugs uncombined with others, so many active principles should be so often prescribed at once under the title of opium. That the combination of so many principles has, by virtue of the correlation of physiological forces, a dynamic action of its own, is obvious ; that this action, he says, can not be prognosticated with much certainty is proved by the large number of cases of alleged idiosyncrasy. That opium is of great thera- peutic value is maintained at the outset; that it is overrated is also contended. When the natural polypharmacy of opium itself is avoided, says the author, its most ac- tive constituent, morphine, is nearly always resorted to. The effects of morphine upon the secretions, upon metamorphosis, and upon the disposal of waste products are exactly what is not desired in most cases of disease. Yet mor- phine is usually chosen to produce certain ef- fects upon the nervous system without regard to its energetic action in other directions. Dr. Barr regards codeine as for many purposes preferable to morphine. He is thoroughly satisfied that it does not produce bad habits, even in highly sensitive neurotics, and that it acts with little energy upon the digestive tract and the heart. As a cardiac stimulant, mor- phine, he says, acts quickly and energetically, but the after-depression which always comes after its use may be avoided by using strych- nine, nitroglycerin, caffeine, digitalis, or even atropine, in the proper dose. To use opium or morphine for a condition of nervous excita- tion and exalted reflexes is, in many cases, says Dr. Barr, like stunning a refractory patient with a club. Valerian, hyoscyamus," and the bromides will, he thinks, generally give better therapeutic results of greater permanence, and with less risk. It is in those diseases of the digestive tract which are commonest in summer, says Dr. Barr, that opium does the most harm. Close observation, he says, must drive the physician to the conclusion that very rarely indeed is opium indicated in the treatment of diarrhea. This affection usually needs some drug which increases the excretory functions, and thus drives out of the body something which, by its presence, is producing the flux from the bowel. Opium temporarily relieves the chief symp- tom at once, and when its influence has sub- sided and the disease still persists the condition 39 OPIUM is called a relapse or a new attack. Dr. Barr admits that opium has a real value therapeu- tically in certain inflammations, in great pain, in rare forms of diarrhea, as a splint for the intestines, and in some other conditions. The usual dose of opium, either in its crude form or in powder, opii pulvis (U. S. Ph.), for an adult is 1 grain, and the maximum under ordinary circumstances is 2 grains ; not more than 7 grains should be given in the course of twenty-four hours. Young children are singu- larly susceptible to opium, and the dose, if the drug is to be used at all for infants should be minute. Dr. Samuel 0. L. Potter (Handb. of Mat. 31ed., Pharm., and Therap.) reminds us that a single minim of laudanum has killed a child a day old, and that a medicinal dose given to a nursing mother has proved fatal to her infant. The dose of opium for a child a year old should not exceed fa of a grain, and even this should be given with caution. If opium is given to children less than a year old, some dilute preparation, such as paregoric, should be selected, and great caution observed that the dose directed is so small at first as to contain but an infinitesimal amount of opium ; indeed, in the case of very young infants it is safer not to use opium. The aged, too, are very susceptible to opium, and with them the ordinary doses should be materially reduced. Besides these considerations of age, idiosyn- crasy should not be forgotten ; there are some persons in whom even a small dose of opium or morphine produces alarming depression, and so it is apt to do in the case of hysterical women. Hence, in prescribing opium for a given individual for the first time, it is prudent to order only very small doses, and, as a gen- eral rule, somewhat smaller doses should be prescribed for women than for men. The doses of opium and those of its United States, British, and German official preparations that are given internally are as follows: Ph., Br. Ph.), is occasionally employed as an anodyne plaster. Care should be taken that it be not applied over a part denuded of epi- dermis. The same is to be said of opium lini- ment, linimentum opii (Br. Ph.). For the unguentum galle cum opio (Br. Ph.), see under Galls. Sydenham's laudanum, vinum opii compositum (Fr. Cod.), is practically the same as vinum opii. For lead-and-opium wash, see under Lead, p. 577. Morphine, morphina (U. S. Ph.), and its salts—the acetate, morphineacetas (U. S. Ph., Br. Ph.), the hydrochloride, morphine hydro- chloras (U. S. Ph., Br. Ph.), morphinism hy- drochloricum (Ger. Ph.), and the sulphate. morphine sulphas (U. S. Ph., Br. Ph.)—are practically of the same strength. The proper initial dose is from ^ to J of a grain. A fl. drachm of injectio morphine hypoder- mica (Br. Ph.) contains 4£ grains of acetate of morphine (formed from the hydrochloride by the action of the acetic acid used in its prepara- tion). The dose, by subcutaneous injection, is from 1 to 5 minims. The dose of liquor mor- phine acetatis (Br. Ph.), by the mouth, is from 10 to 60 minims. The dose of liquor morphine hydrochloratis (Br. Ph.), by the mouth, is from 10 to 60 min- ims. The trochisci morphine (Br. Ph.) con- tain each fa of a grain of the hydrochloride. From 1 to 6 lozenges may be given at a dose. The trochisci morphine et ipecacnanhe of the U. S. Ph. contain the sulphate ; those of the Br. Ph., the hydrochloride. From 1 to 6 may be given at a dose. The suppositoria mor- phine of the Br. Ph. contain each \ a grain of the hydrochloride. The suppositoria mor- phine cum sapone (Br. Ph.) contain the same amount of the morphine salt along with glyc- erine of starch, powdered starch, and curd soap. The dose of pulivs morphine compositus (U. S. Ph.), containing the sulphate, is from 7 to 10 grains. A solution of sulphate of morphine Aaituw opii (U. S. Ph.)...................................... Cmifectio opii (Br. Ph.)...................................... Extractum opii (U. S. Ph., Br. Ph.)........................... " (Ger. Ph.).................................... " " liqvidum (Br. Ph.)............................ Opii pulvis (U. S. Ph.) ) Opium (U. S. Ph., Br. Ph., Ger. Ph.) V........................ Opium deodoratum (U. S. Ph.) ) Pilulce opii (U. S. Ph.)......................................... Pulvis ipecacuanha et opii (U. S. Ph ) I. Dover's powder... " " opiatvs iGer. Ph.)t v " opii compositus (Br. Ph.), which is not Dover's powder Tinctura opii (U. S. Ph., Br. Ph.)............................ " " ammoniata (Br. Ph.)............................ " " benzoica (Ger. Ph.).............................. " " camphorata (U. S. Ph.)......................... " " crocata (Ger. Ph.)............................... " deodorati (U.S. Ph.)........................... " " simplex (Ger. Ph.).............................. " ipecacuanha; et opii (U. S. Ph.)...................... Trochisci gli/cyrrhiza? et opii (U. S. Ph.) | " opii (Br. Ph.) ( "' Vinum opii (IT. S. Ph., Br. Ph.)............................... For an adult. to 15 drops. " 20 grains. } grain. 1 " " 40 minims. 1 grain. 1 pill. 10 grains. " 5 " " 40 minims. " 1 fl. dr. 200 minims. " 4 fl. dr. 20 minims. » 4 12 10 1 lozenge. 10 minims. For a child a year old. J to £ drop. k " | grain. * " . * " a 13 minim. a'o grain. Not to be used. 3 grain. A to i » £ " 1 minim. 1 " 2 minims. e 2 " 8 § minim. 1 Not to be used. 3 minim. The enema opii of the Br. Ph. consists of \ a fl. drachm of laudanum and 2 fl. oz. of mu- cilage of starch, the whole to be administered at once by injection into the rectum. The official opium plaster, emplastrum opii (U. S. containing 16 grains to the fl. oz., commonly known as Magendie's solution of morphine, was formerly official, and is still much used. The dose, by subcutaneous injection, is from 3 to 7 minims. OPIUM 40 Another salt of morphine, the bimeconate, figures in the liquor morphine bimeconatis of the Br. Ph., the dose of which, by the mouth, is from 5 to 40 minims. The dose of codeine, codeina (U. S. Ph., Br. Ph.), is from \ to \\ grain; that of the phos- phate, codeinum phosphoricum (Ger. Ph.). is the same. Not more than 7 grains of codeine should be given in the course of twenty-four hours (cf. Codeine).] Toxicology.—In its toxicological relations opium is of great practical importance, be- cause it is one of the commonest of all the poisons and is everywhere easily accessible. Moreover, its poisonous properties are well known to the laity. Thus, either under its own form or in the form of a morphine salt, it is a frequent cause of death, both by murder and by suicide. It is said by Taylor to have been the cause of five hundred and forty deaths in England in five years. The fatal dose of opium can hardly be defi- nitely stated—i. e., the smallest fatal dose. Even large doses produce very uncertain ef- fects under different circumstances. Thus, a large dose may be promptly vomited and may in this way fail to be absorbed; or following the ingestion of a large dose and the absorp- tion of a certain amount of it, one effect of the drug then may be to retard the absorption of the rest, and in this way the total effect of the large dose may be less than would have been expected. Individual susceptibility to the poisonous effects of opium differs, as is the case also with regard to its therapeutic effects. Thus, two persons of similar weight and health may be poisoned to very different extents by the same dose; and, again, of two persons who may seem to present the same degree of poisoning, the same depth of coma, etc., one will die and the other get well under exactly similar con- ditions as to treatment. This latter observation is equally true in disease; it is often impossible to say why one man dies and another does not in conditions of acute disease. Besides these causes of uncertainty as to a minimum fatal dose, treatment becomes a dis- turbing element in determining this point, for it may in any given case modify the natural course of the symptoms and prevent a fatal issue. Probably the smallest fatal dose of which we have,satisfactory knowledge is 2^ grains of the extract, which may be said to be the equivalent of 4 or 5 grains of opium. One, 2, and 3, drachms of laudanum have killed, and 5 an ounce of the latter preparation has often proved fatal. It is stated, even in recent editions of good text-books, that cases have occurred in which the subcutaneous administration of so small an amount as £ of a grain of a morphine salt has caused death. These cases are alluded to briefly, in edition after edition, quoted by author after author, without any one appar- ently giving himself the trouble to trace them to their origin and ascertain whether they are well observed and well recorded, and especially whether all possibility of other con- tributing factors has been excluded in assign- ing the causes of death. It is probably true that | a grain of a mor- phine salt has caused death; it is probably untrue that any smaller quantity has done so. On the other hand, recovery has occurred, without vomiting, after the ingestion of 55 grains of opium, and after 6 ounces of lau- danum, which contained 225 grains. In two cases recovery is known to have oc- curred from 8 ounces of laudanum, although the patients were untreated for hours. Infants are easily poisoned, and indeed a large percentage of opium deaths is contrib- uted by children under five years of age. One explanation offered of this fact is that in child- hood the brain is proportionately larger than in adult life and that, as opium probably acts only upon the central nervous system, it thus can operate more powerfully upon children. It is stated on excellent authority that the death of a child four years of age was caused by a single grain of Dover's powder. It is perhaps not unlikely that this preparation may be sometimes carelessly compounded, so that the ingredients are unevenly mixed and the opium percentage in a given specimen may thus be higher than we suppose. It would perhaps be safer not to give this preparation to children at all. Of the numerous children whose deaths have been traced to minute quantities of opium, it can be said that we have no testimony as to the excellence of the preparation which was used, and often none as to the diseased condi- tion of the patient which caused the adminis- tration of the drug. In a child nine months old four drops of laudanum are said to have caused death. Infants a few days old are said to have been killed by two drops and even by a single drop of laudanum; but in this latter case we are informed that the bottle had been left un- corked, and its contents had presumably be- come concentrated by evaporation. The nearest approach to a vanishing quan- tity as the cause of death with which I am familiar is found in a case recorded by Taylor, that of an infant four weeks of age who is said to have been killed by 2£ minims of pare- goric which ought to have contained only about fa of a grain of opium. It is well to bear in mind that under treat- ment children have often recovered from large doses. Thus a child nine months of age re- covered after swallowing 2 drachms of lau- danum, a quantity that has often killed an adult. It is probably safe to say that, if a healthy adult who is not accustomed to opium should take 4 grains of opium or a grain of a mor- phine salt, he should be carefully watched, and if necessary carefully treated, as having taken a quantity which is on the border line of possibly fatal dosing. Symptoms of Poisoning. — Overpowering drowsiness is one of the early symptoms. It is often possible before the poisoning has 41 OPIUM become very profound to bring about an in- stantaneous change from deep sleep to full wakefulness by arousing the patient rather forcibly, but, left to himself again, he relapses into his former condition. Contraction of the pupils is seen in the drowsy stage. If the patient is kept awake by external irritation, he is likely to become con- scious of dryness of the throat and thirst. There is a distinct disposition to perspire. The pulse, which is accelerated by a small dose of opium and also during the earlier symptoms following a large dose, becomes rather slow and full as symptoms of poisoning deepen. Respiration becomes steadily diminished in frequency as the poison proceeds. Before consciousness is lost, complaint is often made of a sense of fulness of the head, beginning at the nape of the neck. In some cases there is an early development of mental excitement, with more or less con- fusion of ideas, and at the same time a sense of general heat which may be almost insup- portable may precede the sweating. During this initial stage nausea and even vomiting may occur. The sleep soon deepens into a semi-coma or deep stupor from which the patient can still be aroused, but with difficulty, and if he is aroused he very speedily becomes again un- conscious on being left to himself. The face is often congested, the skin gener- ally more or less anaesthetic, and itching at the nose becomes in some cases a very prominent symptom. All these symptoms may pass off without treatment if the dose has not been very large. In case the dose was actually a poisonous one, and especially if the stomach was empty and the preparation a soluble one, this condition may come on rapidly, and there may be an intensification of many of the symptoms. There is profound stupor, with complete mus- cular relaxation and absolute anaesthesia. All the nerve-centres seem to be overwhelmed— the medulla oblongata alone continuing to perform its function sufficiently for the main- tenance of life, but in a very imperfect manner. An evidence of centric impairment is seen in the facts that emetics are of no avail and that mustard fails to redden the skin. After the stupor has lasted for a few hours with these symptoms, if the patient is not treated, or if treatment is unsuccessful, respi- ration becomes slower and shallower, and the heart's action, which was full and slow, be- comes rapid and feeble. As this change takes place the venous congestion of the face, which was caused by impairment of respiration with- out much impairment of heart power, gives place to a ghastly pallor; the skin, which was previously warm, becomes cold and the sweat- ing continues. The pupils have become tightly and uni- formly contracted and not responsive. Death is caused by apncea, commonly in from six to twelve hours after taking the fatal dose. Convulsions may precede death, and may be said to be not uncommon in children. If the poisoning is not fatal, recovery takes place gradually and is attended by great pros- tration, languor, listlessness, disordered diges- tion, and very often nausea and vomiting, anorexia, constipation, relaxed skin, headache, and sometimes dysuria. Such may be said to be about the usual clin- ical picture from toxic doses of opium and morphine, but it must be admitted that cases occur in which the effect of idiosyncrasy or of habit will be seen to modify greatly the "course of the symptoms. Of the symptoms of poisoning, certain ones may be said to be alarming and to indicate the necessity for immediate and active treat- ment. One of them is coma so deep that the patient can not be aroused, accompanied or not by stertorous breathing. The face may be pale and ghastly if the pulse has become feeble, instead of being suffused and livid, as it prob- ably was at an earlier period in the same case. This pallor is an indication that the heart power is failing, and is a direct suggestion of the need of treatment to be addressed to that organ. At the same time the pulse will be rapid and feeble, instead of slow and full, as it is early in the onset of symptoms of poison- ing. Another alarming symptom is great decrease in the number of respirations (below ten to the minute), and the respiratory act is likely to be accompanied by tracheal rales. There are apt to be noted dropping of the lower jaw as an indication of muscular relaxation, complete relaxation of the sphincter ani, and almost always, preceding death, dilatation of the pre- viously contracted pupils. The diagnosis of opium poisoning would thus seem to be easy; but excellent authorities believe it to be impossible without a history of the taking of the drug. In other words, they believe that the diagnosis may be impossible if one has the symptoms only to guide him. Cases certainly bear much resemblance to some cases of uraemia and to some cases of alcohol poisoning, and still more to apoplexy. Indeed, haemorrhage into the pons Varolii pro- duces all the symptoms of opium poisoning, including extreme and it may be equal con- traction of the pupils. In all these conditions there may be coma, stertorous breathing, slow respiration and pulse, and a congested face. In opium poisoning we see contracted pupils, in alcohol poisoning dilated pupils, in apoplexy often unequal pupils, except in haemorrhage into the pons. Moreover, inequality of the pupils is said to have occurred in opium poi- soning, and, if atropine has been previously applied locally—as it may well be in criminal cases with intent to deceive—the resulting mixture of symptoms may be extremely con- fusing. Unilateral paralysis with an hypertrophied heart or with valvular disease would point to brain lesion as the cause of the coma. The history of the case is of course the chief aid to diagnosis. The presence of albumin and casts in the urine would point to uraemia, but would not necessarily exclude opium; moreover, it must OPIUM 42 be borne in mind that there is ample clinical evidence that the urine may promptly become highly albuminous in ordinary apoplexy or even in cases of traumatic intracranial haemor- rhage, although the kidneys may have been previously healthy. The smell of alcohol in the breath or of the various ethers that occur in spirits may be misleading, for the patient may have taken both these poisons in overdoses. The smell of opium might be a help, but there is no odour to morphine. The detection of morphine in the urine might help greatly, but in ordinary cases it is not practicable to resort to this aid to diag- nosis. Erection of the penis is an unusual symptom, but when it occurs in coma it points to opium poisoning. The time of the onset of cerebral symptoms varies considerably even in fatal cases, and this has an important bearing on jurispru- dence. The patient may be able to perform intelligent acts two or three hours after swal- lowing a fatal dose, but generally symptoms begin in from half an hour to an hour. The length of time that elapses before the devel- opment of symptoms depends upon the rapidi- ty with which the toxic dose has been absorbed, and this is dependent upon the form in which it is taken, whether fluid or solid, and upon the condition of the stomach as to its being empty or not when the poison is taken. Even after hours of absolute stupor the pa- tient may sometimes be aroused and become rational, and ultimately relapse into coma and die in spite of energetic treatment. A case is recorded in which an ounce and a half of laudanum was taken. After more than nine hours of coma the patient rallied, his face became natural, his pulse grew steady, his pow- er of swallowing returned, he recognised the bystanders, and in a thick voice gave an ac- count of the accident. This state lasted sev- eral minutes. He then relapsed into profound coma and died after the lapse of about five hours. I have been roundly abused by a patient whose life I was trying to save by the usual means of treatment because they were disturb- ing to him, and he preferred to be left to him- self in his enjoyment of the effects of the poison; and, in spite of my persistence with ample assistance to relieve me, I have seen him relapse into a condition of coma and die from gradual failure of heart power, although we kept him breathing regularly. Although death generally occurs in from six to twelve hours, in rare cases it has taken place in five, three, two hours, and in one case in three quarters of an hour. In this latter instance a soldier had swallowed an ounce of laudanum and died in convulsions. On the other hand, death is sometimes post- poned, usually by the effects of treatment, from fifteen to twenty-four hours. Generally, it may be said that if patients survive twelve hours and recover from the stupor they ulti- mately get well, but this is not always the case. In case of recovery it may be several days before all the symptoms have disap- peared. From what has been said it may be inferred that the prognosis in any given case is ex- ceedingly difficult to make with certainty, and it may often be impossible; and from this the logical inference is that, no matter how grave the symptoms are, treatment should never be suspended until the heart has ceased to beat. Treatment.—If the patient is seen early enough to justify the hope that some of the poison may still be in the stomach, that vis- cus should be emptied. If the symptoms are not already very pronounced it is safe enough to administer an emetic. For this purpose mustard followed by copious draughts of warm water is perhaps the best. Apomorphine may be given subcutaneously if the coma is not profound; but if it is, the inference is justified that the vomiting centre is not likely to re- spond to any emetic, and, furthermore, when it has failed to act under these circumstances, apomorphine has seemed to aggravate an ex- isting condition of collapse. The irritant emet- ics should not be administered if there seems any likelihood that they may not operate, un- less there is the means at hand of removing them from the stomach in case of their failure to act. This means is the stomach-pump or gas- tric siphon; and, if this is at hand, it is far better to use it at once than it is to depend upon any emetic. On the whole, it is better, in cases in which one may be in doubt as to the existence of the poison in the stomach, to give the patient the benefit of that doubt and wash out his stomach. It is well, if possible, to have the washings tested until they no longer respond to tests for morphine before feeling that this procedure may be discontinued. But it should be borne in mind that solid opium may remain in the stomach in spite of the most energetic and persistent lavage. It has been maintained of late that symp- toms of poisoning may be aggravated by the reabsorption of morphine which has been once excreted by the gastric mucous membrane, and that therefore one single emptying of the stomach may not be sufficient in a given case. On that account, perhaps, it is well to lay stress upon the fact that has already been mentioned of the desirability of continuing the process of lavage as long as the stomach-wash- ings respond to the chemical tests for mor- phine. This proceeding must not be undertaken if the respiration is clearly failing; then the most imperative duty is to attend to that func- tion, and neglect everything else that might interfere with it. It is plain that the most important thing to do is to keep the patient breathing. As an aid to this end it is impor- tant, if possible, to keep him awake. If he be- comes comatose he ceases absolutely to render voluntary assistance in the matter "of respira- tion, but if he is kept awake he not only breathes because he feels the instinctive neces- sity which impels him in health, but he can also be made to inspire deeply at command.. Of the numerous chemical antidotes, none is available after the poison has been absorbed, 43 OPIUM and, unless it has been impossible to empty the stomach, none can be said to be indicated. Tannin is perhaps the best of them, and it may be administered in the form of a vege- table infusion, as in the shape of a cup of strong tea. It forms a compound with the morphine which is temporarily insoluble, al- though it would be likely to undergo slow solution and absorption if it were allowed to remain in the alimentary canal. Coffee tends to diminish somewhat the be- numbing effects of opium, and is useful as a means of preventing the onset of coma and of lessening the severity and the duration of coma which may already have come about. Coffee may be administered by the stomach or by the rectum, or by both. If it is possible to cause the patient to walk about between two attendants, this may act as an external irritant to the extent of pre- venting the supervention of coma. A similar service is sometimes rendered by any effi- cient and equally harmless external irritation. Shaking the patient, beating him gently with a towel or with a slipper or a bundle of twigs is often resorted to. These proceedings all have the object of keeping the patient awake, which has already been shown to be important in itself. As a stimulant to respiration, cold affusions to the chest or the nape of the neck are of de- cided value. It is important to avoid chilling the patient's surface too severely, and on this account it is preferable to use alternate hot and cold affusions. These and all other means that are used must be intelligently employed. Care must be taken not to exhaust the patient by too ener- getic treatment, and therefore the frequency and force of the pulse must be closely watched and any indications for treatment by stimulants carefully observed. The great importance of keeping up the respiration has been alluded to, and certain means to that end have been mentioned. In case the coma is pronounced and the respira- tion failing, artificial help to accomplish this purpose must be resorted to. The application of the faradaic current to the region of the phrenic nerves in the neck, or the application of an electrode over the ensiform cartilage and the other over the phrenics, seems occasionally to cause contraction of the diaphragm, al- though, upon the whole, this is likely to be a disappointing procedure. The current need not be strong, and certainly no stronger than the operator can himself bear without pain. Artificial respiration is a more troublesome but a much more efficient means of accom- plishing this end, and it should be performed with every precaution to insure the potency of the air-passages, such as drawing the tongue forward, etc. It should not be too frequent- ly repeated, eighteen times a minute being about as often as is desirable. The use of atropine in opium poisoning depends largely upon its effect upon the respiratory centre. The subject of this use of atropine is so impor- tant and so generally misunderstood that it is proper to lay stress upon it. It is largely used 47 as the physiological antagonist to opium in spite of the fact that it is not, properly speak- ing, such an agent. Indeed there is much dif- ference of opinion as to its possessing any efficacy at all in opium poisoning, although the weight of opinion is strongly in favour of its usefulness within certain limits. Atropine is not in any proper sense a phys- iological opponent of opium—i. e., the two drugs are not possessed of the power of causing exactly opposite effects, nor are their effects mutually abrogated by the employment of suitable doses. Atropine in part opposes and in part enhances the action of opium, as it does with regard to certain other drugs whose actions are complex. Thus, in relation to cala- labar bean, atropine opposes the action of cala- bar upon the pupil, upon the spinal cord, and upon the respiratory centre, but it enhances the effect of the other poison upon the motor nerves and upon peristaltic activity. Equally mixed are the relations between at- ropine and morphine. They are synergic in many of their effects, as in their production of motor-nerve palsy, sensory anaesthesia, spinal irritation, and cerebral disturbance. Even with regard to those organs which they affect very differently in small doses—namely, the heart and lungs—even here in large doses they become synergic, and poisoning by one of them may be aggravated in regard to the heart and the respiration by adding the poi- sonous effects of the other. It is important, therefore, to lose sight of the oft-quoted idea of one of these drugs being an opponent to the other. This idea leads to the false conclusion that the effects of a large dose of one of them may be neutralized by a properly adjusted large dose of the other. Practice founded upon this theory would be likely to kill patients by the combined effects of the two poisons. The real question to be answered is this: Is atropine useful in opium poisoning? It cer- tainly is of great value, exactly as drugs are of value in treating disease. The effects of opium poisoning are to be regarded as a disease from which the patient is suffering. As is the case with many other acute diseases, it may be curable if it is not too severe, or it may be so severe as to prove fatal in spite of intelli- gent treatment. But for the intelligent treat- ment of the condition it is important to get rid of the idea that we have an agent which will act as a chemical or even as a physio- logical antidote to opium after it has been ab- sorbed and has reached the nerve-centres. Atropine is both a medicine and a poison, as opium is. Certain of its medicinal powers happen to have a curative influence over some of the more formidable symptoms of the opium disease. Hence, properly used in that condi- tion, it may do much good, and may even be the principal means of saving life ; but it may fail in too severe a case to influence these symptoms to the patient's benefit. Its poison- ous effects are of a kind parallel with the worst symptoms of opium poisoning, and hence are especially to be avoided in that condition. How, then, is it that atropine does good ? It OPIUM 44 is often answered that it will dilate the pu- Eils which have been contracted by opium; ut that symptom of opium poisoning does not kill, and it matters little to a man whether he dies with a small pupil or a big one. More- over, the effect of atropine upon the pupil is of no use as a guide, even in the matter of dose. Opium contracts the pupil by a centric influence; atropine, while not opposing this centric influence in the least, dilates the pupil by its power over the periphery. The valuable and indeed the essential point is that atropine directly irritates the respira- tory centre, which has been more or less com- pletely paralyzed by opium, and thus averts asphyxia; it sometimes actually restores the frequency and depth of the respirations. Be- sides this, it enables the heart to overcome the difficulties which the opium has imposed upon it; it accelerates the pulse and increases the arterial tension, and thus relieves the condition of congestion of important organs which opium has brought about. As to doses of atropine much difference of opinion exists. In opium poisoning there is a greatly increased tolerance of belladonna. Doses of the plant or its alkaloid which would be likely to be fatal under ordinary circum- stances have been freely and safely given. Under conditions of profound physiological disturbance there is in general an unusual tol- erance established of many powerful drugs. Thus, opium is borne in enormous doses in tetanus and after profuse haemorrhage. It is best to administer atropine subcutaneously. It is almost impossible to define the doses sharply, but in general we must expect to give large quantities. We are guided in this respect by the physiological effect, and to this end we must watch especially the clinical results upon the respiration and pulse. If the respirations rise to a frequency of ten a minute, probably no further administration of atropine is neces- sary. If the pulse increases in frequency and diminishes in force under its influence, too much has been given. The state of the pupils, as we have seen, is absolutely valueless as a clinical guide, having no relation whatever to the antagonism between the two poisons which is really of value. No direct effect upon the condition of coma is to be expected—unless, indeed, the atropine is given in poisonous doses, when it will deepen the coma due to morphine. It is a matter requiring great nicety of judg- ment to determine when to give atropine and how much to give. It is perhaps as good a plan as any to give it in every case in which the respirations are failing, and to continue to give it in small doses until distinct improve- ment in this function has taken place. From a twenty-fifth to a fortieth of a grain may be given, to begin with, subcutaneously; and every twenty minutes the smaller of these doses may be repeated until three or four doses have been given, unless earlier improve- ment in the patient's condition renders such repetition unnecessary. If the condition of res- piration is improving, give no more atropine while the improvement lasts. It must never, be forgotten that it is possible by overdosing to add the coma of atropine to the coma of mor- phine. Very large doses of atropine have been given without injury to the patient. In bad cases a grain has been given at a dose, or a half grain, repeated in an hour. Doses of a quarter and a third of a grain have often been given. It is far better to give smaller doses and repeat them at short intervals. It is important to emphasize the fact that cases which were apparently desperate have ended in recovery under active and intelligent treatment. I have several times seen patients recover whose respirations were as infrequent as four in the minute. Within the last few years much has been written of potassium permanganate as an anti- dote to morphine; and there is reason to be- lieve that, if the two agents are placed in the stomach together, the former may oxidize the latter and alter it chemically so as to interfere with its action. But there seems at present no good reason to believe that the permanga- nates can affect the course of the poisoning after the morphine has been absorbed into the circulation. Chronic Opium Poisoning.—Chronic poi- soning, or "opium eating," is a very common vice in the East, and is probably becoming of more frequent occurrence here. In China it has long been a national evil and has more than once necessitated legislation, and led to foreign warfare, without, however, any real tendency toward its suppression. Thus, in a town of a million and a quarter inhabitants nearly eight thousand pounds of opium are consumed a month. Formerly it was taken either by the stomach or by inhalation, as in smoking, but of late years the worst victims of this drug that we see here are those who have learned to take it subcutaneously. In the East there is open and deliberate in- dulgence in opium as a matter of luxury, just as there is in regard to whisky and tobacco with us. Mohammedans use opium largely because the Koran forbids the use of alcohol. With us and in Europe a large majority of the victims of this habit have acquired it as the result of having to use the drug for medicinal purposes—or, in other words, they owe their misfortune directly or indirectly to some doc- tor. Deliberate indulgence in opium and de- liberate formation of the habit of indulgence in it are comparatively rare with us, although perhaps less rare than they were a generation ago, before we had learned opium smoking from our Chinese immigrants. _ These facts should make us extremely cau- tious in recommending or administering mor- phine, especially subcutaneously. It should never be forgotten that, if it is once acquired, the habit of taking morphine subcutaneously is harder to break than any other of the opium habits. Like all habits which depend upon self-indulgence, it most easily fastens itself upon people of weak and vacillating character, especially upon sufferers from insomnia or from chronic pain. These reasons should prevent our using this drug in 45 OPIUM the treatment of chronic disease if it is possi- ble to avoid it. In general, the effect of chronic opium tak- ing may be said to be an interference with digestion, followed by malnutrition, anaemia, emaciation, and later failure or perversion of Cower—physical, mental, moral—and, if the abit is continued and increasing doses are taken, as is usually the case, comparatively early death. In aggravated cases the patients are emaci- ated and shrivelled, with a sub-icteric hue, and are apt to suffer from a variety of nervous symptoms. They are feeble in mind and char- acter as in body. They complain of vertigo, headache, insomnia, and neuralgia; they are fanciful and discontented, peevish and irrita- ble. They manifest failure of memory, intelli- gence, energy, and will; and they are especially prone to be untruthful about their opium in- dulgence. Taking it by the stomach is especially likely to disorder digestion, while those who take it by injection or by smoking are likely to be able to do so without as much impairment of appetite or digestion. Those who indulge in opium commonly take but little interest in the parallel vices, namely, those of alcohol and tobacco ; but exceptionally an opium eater of more than common energy is found who unites the three forms of indul- gence. Of late, too, a combination between opium and cocaine has been repeatedly made and with the most disastrous results. Combi- nations between opium and the other hypnot- ics are becoming very common. In spite of the gravity of this vice in its ulti- mate effects, which I have endeavoured not to exaggerate, it is only fair to admit that a per- sistent moderate indulgence in opium or mor- phine by people of regular habits and good general surroundings has often been shown to be possible without impairment of health. As has been said elsewhere, in the East millions of thrifty, well-to-do people use opium daily as the European does his wine, and with no more thought of excess. Such moderation in opium indulgence seems hardly possible with us, or, at all events, it may be said to be unusual. Opium seems to have the same tendency to repress secretion when taken chronically as when taken occasionally. Chronic opium-eat- ers show this in the diminished functional ac- tivity of the sebaceous and mammary glands, as also of the ovary, testicles, and intestines. Men are usually rendered impotent, and women are apt to cease to ovulate during the con- tinuance of the habit. These functions are re- stored if the patients are cured. The amounts which different people consume vary very greatly. It is not infrequent to find the daily allowance as low as two grains or as high as sixty. Among those who use morphine subcutane- ously, occasionally an intermittent fever de- velops whose paroxysms are less regular than those of malarial fever. It may, however, in any given case, easily lead to a false conclu- sion. The absence of malarial organisms and the impotence of quinine in checking it serve, however, to establish the diagnosis. As in true malarial fever, neuralgia is a common symp- tom also of this form of intermittent. The prognosis of the opium-habit is very unfavourable as regards permanent cure; and it is extremely difficult to treat the individual attacks, if one may so call them. In general, it may be said to be more difficult to treat in proportion to its duration as a habit. More- over, if the patient suffers from any chronic painful condition he seems to be really de- pendent upon the drug. Again, if he is of weak will-power and prone to yield to a de- sire for stimulants, or if he is in general self- indulgent, it may be impossible to treat him with success. Treatment may be said to be possible in three ways. Either the drug may be withheld at once absolutely, or it may be withdrawn rapidly, or it may be gradually withdrawn. The exact method to be followed must be de- termined for each case, and it must depend upon the patient's general condition, the size of the doses, the number of doses that he takes in a day, and the original cause of the habit. If he is in the habit of taking a few grains of morphine a day, not more than six or eight days should be consumed in withdrawing the drug completely. If he is habituated to large amounts—20 or 30 grains a day—probably twelve or fourteen days should be occupied in withdrawing the drug. The very slow withdrawal—spoken of as " the tapering-off " process—is not a good one, and is not likely to be as well borne as the quick- er method, or, as it has been called, the " rapid withdrawal." The sudden withdrawal of the drug—and by this I mean the immediate and forcible cessa- tion of the habit—is not a safe means of treat- ment in many cases. Active maniacal delirium may be caused by such a method, and very se- rious, threatening, even fatal prostration may ensue. Doubtless with some few patients whose general nutrition is not much impaired, whose habit is not inveterate, and whose daily allowance is small, this method may be the best one to follow. Gastric disturbance, manifesting itself by anorexia or nausea or vomiting, may occur un- der any system of withdrawal; and so also may a rather profuse and watery diarrhoea. The more frequent the antecedent'relapses, the more difficult is the cure. Patients who have tried all three methods are said uniformly to prefer the method by rapid withdrawal as being productive of the least pain and distress to them. They are all apt to be untruthful as to the daily amounts to which they are accustomed, both to excite surprise in their attendants and to enable them to secure large doses in the course of their treatment. Before putting themselves under treatment they are apt to prime themselves with large doses. However intelligent and apparently in earnest they are, they are apt to conceal a supply about them and deliberately deceive the doctor while they appear to be improving. Before seriously be- OPODELDOC OSMIC ACID 4 ginning treatment a patient must be removed from his usual surroundings and contact with his friends, for even these may also be party to the deceits that are so often practised. The patient's clothing should be searched if any suspicion arises as to his honesty of purpose. He should be surrounded by good, trusty, in- corruptible attendants who should not be di- rectly in his pay. Dangerous weakness, amounting even to collapse, may ensue, so that treatment may have to be suspended. The general treatment should be supporting, and stimulating if necessary. I have known the use of antipyrine inter- nally to serve a useful purpose in calming a fatient during the withdrawal of morphine. ts taste is suggestive of that of morphine, and in some cases may lead to the belief that morphine is being received. In general, they are weaned from morphine in two weeks, but during this time they may suffer from insomnia, neuralgia, nausea, vomit- ing, diarrhoea, and other symptoms of general systemic derangement. The diarrhoea usually requires no treatment; the other conditions are to be treated upon general principles. It is a good plan to give up the night dose last of all. Great assistance is derived from the modern hypnotics, such as sulphonal, trio- nal, amylene hydrate, and others. Of all the drugs upon which reliance is Jilaced as a means of making the treatment ess distressing to the patient, cocaine is per- haps the least desirable to use. It is extremely easy to engender a fondness for this alkaloid in these patients, and the combined cocaine and morphine habits are incomparably worse than the morphine habit alone. The market is flooded with so-called opium antidotes. Most of them are solutions of mor- phine in disguise. The patient is easily de- ceived by them, because, while apparently abstaining from his drug, he feels pretty well, and does not miss it. All this time he may be taking more than he has been accustomed to take. Of twenty "opium-habit cures," including „ all the principal " cures " advertised through- out the country examined in 1885-'86 by the State Analyst of Massachusetts, all but one contained morphine. This one was called a " double chloride of gold," and, while it did not contain morphine, it did not contain even the minutest trace of gold, and would "have been quite as worthless if it had. One plan of treatment which has been re- cently advocated can hardly be taken serious- ly. It is that by which codeine is substituted for morphine; and it is about as reasonable as it would be to attempt to cure a man of a fondness for whisky by giving him brandy in place of it. (See also Paregoric and under Hypnotics.)—George L. Peabody. OPODELDOC. — This is a camphorated soap liniment, linimentum saponato-camphora- tum (see under Soap). ORANGES.—See Aurantium. ORCHITIC EXTRACT.—See Animal ex- tracts AND JUICES. OREXINE HYDROCHLORIDE, phe- nyldihydrochinazoline hydrochloride, C H i N('H UhU \ CH2NCflII5HCl, is a complex derivative of quinoline that was introduced as a proprietary remedy in 1890. It occurs in colourless, odourless, lustrous crystals that have a bitter, pungent taste. Originally Penzoldt recommended the sub- stance as an active stomachic that increased the appetite and exercised a tonic influence on the digestive organs; but subsequent investi- gation showed that it neither promoted nor re- tarded digestion, and that it exercised no influence over the peptonization of albumin. It was recommended for anorexia associated with anaemia, chronic gastric catarrh, neuras- thenia, tuberculosis, and some neuroses. A number of physicians have reported that its administration produced eupepsia, while others, including the writer, have not observed any benefit following its use. In doses exceeding 6 grains it has caused nausea, vomiting, colic, and vertigo. The dose is from 1 to 3 grains, in a wafer, several hours before each meal. Samuel T. Armstrong. ORGANIC EXTRACTS, ORGANO- .THERAPY.—See Animal extracts and juices. ORIGANUM.—Origanum vulgare, the wild marjoram, was formerly official, and was es- teemed as a diaphoretic and emmenagogue. It has now fallen into almost complete disuse. ORPHOL.—This is the copyrighted name of a compound said to contain 26-5 per cent, of /3-naphthol and 73-5 per cent, of bismuth. Dr. E. Chaumier, of Tours (Therap. Woch., Dec. 1, 1895), describes it as an efficient substitute for /3-naphthol as an internal antiseptic and as be- ing free from the offensive odour and burning taste of j8-naphthol. He states that he has used it chiefly in the diarrheal diseases of children, and has found it more satisfactory than other remedies of its class. Chaumier alleges that it is absolutely harmless and may be given to an infant a month old to the amount of from 30 to 45 grains in the course of twenty-four hours, and to older children to the amount of from 45 to 75 grains. The powder may be given in milk, syrup, or honey. ORRIS ROOT, rhizoma iridis (Ger. Ph.), is the rhizome of Iris germanica, Iris pallida, and Iris florentina. The last-named plant, which is the commonest source, grows in southern Europe, particularly in Italy, whence by far the largest amounts are exported. The root as found in pharmacy is denuded of its epidermis and is rough, knotted, and irregular. Its odour is faint, peculiar, and agreeable; its taste is bitter and slightly acrid. It contains gum, extractive, resin, fixed oil, volatile oil, and vegetable fibre. In large doses orris root is a gastro-intestinal irritant and competent to cause vomiting and purgation. In fact, it was at one time con- siderably used as a cathartic and an emetic. It is also said to be possessed of a considerable diuretic power. At the present time it has no use save to disguise an offensive breath and to OPODELDOC 47 OSMIC ACID provide an agreeable addition to tooth pow- ders. It is said to be employed in France in making issue peas, its odour, its slight acridity, and its swelling by the absorption of moisture rendering it suitable for the purpose. (See under Iris.)—Henry A. Griffin. ORTHINE, otherwise called orthohydra- zine-paraoxybenzoic acid, seems to be an arti- ficial alkaloid. The hydrochloride, a white powder soluble in water, is said to be a very powerful antipyretic in daily amounts of from 4 to 8 grains. Its use can not be recommended until further observations regarding it have been published. ORTHOCHLOROPHENOL.—See under Chlorophenols. ORYZA SATIVA.—See Rice. OSMIC ACID.—The substance which is commonly known as osmic acid is osmium tetroxide (0sO4), a perosmic acid. Of true osmic acid (Il2<»s04), in the free state, nothing seems to be known. Perosmic acid is a vola- tile, odourous, crystalline substance, and is made by the action of hydrochloric acid on osmium or its lower oxides. It is readily soluble in al- cohol and in ether, and dissolves slowly, but completely, in water. The aqueous solution is at first colourless, but On exposure to light it „ darkens and soon becomes black, the black osmic hydrate, the tetrahydroxide, Os(OH)4, being formed. It is a powerful deoxidizing agent, and very irritating to living tissues, even when diluted with several parts of water. When the acid is brought in contact with the skin it produces a severe and painful eruption. The vapour of osmic (perosmic) acid acts as a violent irritant to mucous membranes, and when it is inadvertently inhaled the eyes, nose, larynx, and lungs suffer. In small quantities it causes increased lacrymation, coughing, and difficulty in breathing, and in excessive amounts it will cause death. The poisonous properties of osmic acid will be ap- preciated if we accept Deville's statement that " osmium is the most deadly poison known, a thousandth part of a grain,.diffused through 100 cubic yards of air, being sufficient to poi- son all persons inhaling it: and no antidote for it is known " (Foster's Encyclopedic Med- ical Dictionary). The eyes seem to suffer greatly from exposure to the vapour of osmic acid, a severe and distressing conjunctivitis resulting, and it is thought that vision may be permanently impaired by the deposition of metallic osmium on the cornea. Barnell gives the symptoms of chronic osmic-acid poisoning in his own person. He made about two hun- dred experiments with the acid on animals, and as a result of prolonged exposure experi- enced "a feeling of weight and a sensation of cold in the back extending to the loins, pain in the region of the groins and testicles, swelling of the inguinal glands, loss of appetite, and malaise. These symptoms slowly disappeared when exposure was discontinued" (Reference Handbook of the Medical Sciences, art. Per- osmic Acid). Raymond (Progres midical, June 27. 1874) reports a case of apparently acute poisoning from osmic acid. The chief symp- toms were inflammation of the eyes, a cutane- ous eruption, indigestion, diarrhoea, and severe headache, and finally pneumonia, which ap- peared to be the immediate cause of death. At the autopsy the stomach was found the seat of considerable inflammatory reaction along its greater curvature. A chemical analy- sis revealed no traces of osmium (ibid.). Claus has recommended careful inhalations of hydrogen sulphide as an antidote to poison- ing from the vapour of osmic acid, but, as the antidote is a violent poison, " the remedy may be worse than the disease" unless great pre- caution is exercised in its use. Osmic Acid as a Hardening and Stain- ing Agent.—A 1-per-cent. solution of this acid kills the lower forms of animal and vege- table life almost instantly without distorting them, and hardens and preserves the tissues; it is thus a valuable agent to the microscopist in certain lines of investigation. By its select- ive action on certain tissues, and its power of turning fat black, it is a staining agent much prized in studying fatty degeneration in neu- ritis. The inconveniences experienced in the use of osmic acid in microscopy are its expen- siveness and the readiness with which it dete- riorates on exposure to light. Therapeutics.—Wildermuth, in 1884, em- floyed osmic acid in the treatment of epilepsy. t was given in the form of a pill containing fa of a grain, and repeated until the daily quantity amounted to \ of a grain. Stekonlis has alleged great success from injections of 15 minims of a 1-per-cent. solution of osmic acid deep into the region close to the sciatic nerve in obstinate cases of sciatica. At first the injections were made daily; later, every three or four days (U. S. Dispensatory). Dr. Schapiro (Lancet, Aug. 13,1887) confirmed the value of the remedy in the treatment of sci- atica. He used 5 minims of a solution com- posed of 1 part of osmic acid, 40 parts of glycerin, and 60 parts of water. Solis-Cohen, ofPhiladelphia (Med. News, April 6, 1889), has reported the cure of an obstinate case of sci- atica by injections of a 1-per-cent. solution of osmic acid. The injections were made near the nerve, two or three times a week; the dose varied from 10 to 20 minims, and the treat- ment was continued about three weeks. Seelig- mtlller, in 1887 and 1888, reported the use of 1 to 10-per-cent. solutions in the treatment of intercostal neuralgia. The injections were made deep into the muscles along the spine, and gave sharp pain at first, followed later by relief. Grinevitski, in 1888, advised for muscu- lar rheumatism injections of from 8 to 20 minims of a 1-per-cent. solution of the acid, thrown deep into the parenchyma of the af- fected muscle (Ann. of the Univ. Med. Sci., vol. v, A-114, 1889). Dr. Carl Schroder em- ployed the acid in pill form in eight cases of epilepsy. The daily quantity was about £ of a grain. Two of the patients showed some im- provement, and the six others appeared to derive no benefit from the treatment (Med. Annual, 1891, p. 199). Auerbach has employed parenchymatous injections of osmic acid with alleged success in the destruction of morbid OSMIUM HYDROXIDE OXYGEN 48 growths (Jour, of Laryngol. and Rhinol., June, 1891). Dr. Burton W. Swayze (Med. Summary, Dec, 1892) reports three cases of sciatica favour- ably influenced by daily injections of a 1-per- cent, solution of osmic acid. The use of osmic acid as a therapeutic agent has not been very extensive, as the references just mentioned seem to be the principal ones relating to its employment in therapeutics. The results obtained from it in epilepsy have not been gratifying, but in certain cases of ob- stinate and intractable neuritis and muscular rheumatism, in which a local stimulant is needed deep in the affected tissues, a weak solution of osmic acid seems to meet the indi- cations. The solution first recommended by Schapiro, consisting of 1 part of osmic acid, 40 parts of glycerin, and 60 parts of water, is probably the best. It will rarely occur that a stronger solution than one of 1 per cent, will be necessary, although a 10-per-cent. solution has been injected (Seeligmuller). This seems to be unnecessarily strong, and might set up a violent inflammation. The quantity of the weaker solution, to begin with, should not, as a rule, exceed 5 minims, but this may be gradually increased, as tolerance is estab- lished, to three or four, or even five times this amount. It seems safer not to employ the injections oftener than every second day, but the severity and duration of the reaction fol- lowing each injection will form the best guide for the frequency of subsequent injections. An injection should not be repeated until all tenderness and soreness from the previous in- jection have passed away. Jeremiah T. Eskridge. OSMIUM HYDROXIDE, OSMIUM TETROXIDE.—See Osmic acid. OUABAIN is a crystalline glucoside, C3oH46012 + 7H20, obtained from an Abys- sinian arrow-poison which is a concentrated extract of the wood of Acocanthera ouabaio, an apocynaceous tree. Ouabain is said to be identical with strophanthin. It is white, in- odorous, slightly bitter, soluble readily in al- cohol and in boiling water, and slightly soluble in cold water. Ouabain is a powerful cardiac and respiratory poison. According to Rondeau and Gleg (cited by Bocquillon-Limousin), 0-031 of a grain will kill a dog weighing twenty-six pounds in a few minutes. In minute doses, never reaching to daily amounts of more than 0*015 of a grain, it has been given to children affected with whooping-cough, and a favoura- ble action has been noted; but it is too violent a poison to be recommended as a remedy for this disease. OVARINE.—An extract prepared from the ovary (see under Animal extracts and juices). OVI ALBUMEN, OVI VITELLUS.— See under Eggs. OXALIC ACID.—This crystalline acid, C2H2O4 + 2II2O, is a violent caustic and corro- sive poison, so violent, indeed, that a case of fatal poisoning with sorrel, which owes its sour taste to potassium oxalate, has been recorded (Hosp. Gaz., June, 1886; U. S. Dispensatory, 17th ed., p. 1707). The minimum fatal dose, according to Taylor, is a drachm. Swallowed dry or in strong solution, oxalic acid immedi- ately gives rise to horrible pain in the stomach and oesophagus, accompanied by retching. It does its work speedily, and the corrosive symp- toms soon give place to fatal collapse. When diluted so as to show no corrosive action, the acid is still highly poisonous, acting as a para- lyzer of the heart. The treatment of oxalic-acid poisoning is that of poisoning with the other corrosive acids (see vol. i, page 6). As this acid and some of its salts (known as "salt of sorrel" and " salt of lemon ") are extensively used as cleansing agents and to remove ink stains, iron-rust stains, etc., and as the acid crys- tals are exceedingly apt to be mistaken for those of Epsom salts, oxalic-acid poisoning is of frequent occurrence. The treatment must be prompt and assiduous. After wash- ing out the stomach with a siphon, or empty- ing the organ by means of an emetic if no siphon is at hand, chalk or magnesia, mixed with water, should be given freely. If neither of these is readily to be obtained, lime, in the form of scrapings from a plastered wall, may be used. Afterward white of egg, milk, or some like bland substance may be employed as in poisoning with other corrosives. For the toxic paralysis of the heart which results from the ingestion of solutions of oxalic acid too weak to be caustic, cardiac stimulants, such as digitalis, may be given, but there seems to be little hope of their proving efficient, in view of the radical destruction worked by the poison on the functional capabilities of nerve and muscle. This is well illustrated in an arti- cle on The Action of Oxalate Solutions on Nerve and Muscle Irritability and Rigor Mor- tis, by Professor W. H. Howell, of the Johns Hopkins University (Jour, of Physiol., vol. xvi, 1894, p. 476). In the action of oxalate solu- tions upon muscle and nerve, Professor Howell says, there are certain points of resemblance which may be mentioned. In each, the irrita- bility is quickly destroyed, but the tissue does not at once entirely lose the structure charac- teristics of organized matter. This is made probable by the fact that the nerve-fibre still shows a demarcation current, and the muscle- fibre is still capable of undergoing rigor mor- tis. The action of the oxalates, however, ac- celerates in each case the disorganization of the living structure of the tissue; rigor sets in more rapidly in the muscle, and the demarca- tion current disappears more quickly in the nerve. He thinks the important fact brought out in his experiments is that the action of oxalate solutions upon skeletal muscle may be carried far enough to completely destroy its irritability toward electrical stimulation with- out injuring or, at least, destroying its prop- erty of entering into the conditions of risror mortis. Oxalic acid is little if at all used in thera- peutics. In 1886 a committee of the Paris So- ciety of Therapeutics reported on a paper in which M. Poulet had proposed its use in asth- OSMIUM HYDROXIDE 49 OXYGEN ma, in daily amounts of 30 grains, dissolved in about 5 fl. oz. of vehicle. As this dose was considered dangerous, the committee reported adversely on the paper (Gaz. hebdom. de med. et de chir., May 7, 1886). Very soon an article by M. Poulet appeared in which he advocated the use of the acid as an emmenagogue and as a remedy for dysmenorrhea (Gaz. hebdom. de med. et de chir., May 14, 1886), He recom- mended the following formula: Oxalic acid.................. 2 parts; Warm water................. 200 " Syrup of bitter-orange peel.... 60 " A teaspoonful to be taken every hour. At the meeting of the Society of Therapeu- tics succeeding the one at which the report on M. Poulet's paper on the use of the acid in asthma had been received, M. Rougon (Gaz. hebdom. de med. et de chir., May 21, 1886), who had made the report, reviewed the subject of the advisability of admitting oxalic acid into the list of substances to be used medici- nally. He spoke of its having been employed with favourable results as a palliative in cases of strangulated hernia, but, in view of its tox- icity, 45 grains of potassium binoxalate (" salt of sorrel") having killed a person fifteen years old, he thought it unsafe to employ in the doses recommended by M. Poulet. As a mat- ter of fact, oxalic acid has not come into use in medicine, although oxalate of cerium (see under Cerium) is a recognised remedy. OXALIS.—Oxalis acetosella, or common sorrel, has been used in infusion as a cooling drink. As it contains potassium binoxalate, a violent poison (see Oxalic acid), its immod- erate use, either as a medicine or as an ingredi- ent of salads, etc., is not wholly free from danger. OX-BILE, OX-GALL, fel bovis (U. S. Ph.), fel tauri, is the fresh bile of Bos Taurus, the ox. It is a green or brownish-green, vis- cid liquid of disagreeable odour and bitter, nauseous taste. Its composition is not entirely known, for biliary chemistry has thus far proved defiant of solution, but it contains what are known as bile salts and bile pigments, as well as cholesterin, urea, fats, mucus, and some inorganic salts. Crude ox-gall is not employed in medicine. Purified ox-gall, fel bovis purificatum (U. S. Ph.), fel bovinum purificatum (Br. Ph.), is fresh ox-gall purified by filtration with the aid of alcohol and evaporated to a pilular con- sistence. It is a yellowish-green mass of pe- culiar odour and "bitter and sweetish taste. It is freely soluble in water and in alcohol. Ox-gall has the physiological properties of bile; that is, when in the intestine, it aids in the absorption of fats and peptones, it dimin- ishes putrefaction, and it stimulates peristal- sis. For these purposes it has been given in ailments in which biliary secretion is thought to be deficient. It may thus be serviceable in habitual constipation, in intestinal dyspepsia, and in malnutrition from inability to properly digest fatty foods, and it may be combined with cod-liver oil to aid in its assimilation. It is not a remedy which is extensively employed, for it is not effective as compared with others, and it must be confessed that even if it were effective its use would not be altogether ra- tional, for certainly it would serve to palliate rather than to cure. Ox-gall has the serious disadvantage, too, of interfering with gastric digestion. If it is used, therefore, it should be at a time sufficiently remote from the taking of food, and it is well to administer it in a cap- sule. The dose of purified ox-gall is from 5 to 10 grains. [Ox-gall enemata have been thought to be of value as a solvent of hardened faecal masses in cases of fecal impaction. The enemata should be large and should be retained by the patient for a considerable length of time.] Henry A. Griffin. OXYGEN is a chemical element. It is the most active of electro-negative substances. Under ordinary terrestrial conditions free oxy- gen assumes the gaseous state, but under great pressure, combined with extreme cold, may be liquefied and even solidified. Oxygen gas is colourless, tasteless, and odourless. Its den- sity is a little greater than that of air, being 1-10563. The density of liquid oxygen at — 140° C, under a pressure of 530 atmospheres, is 0-9787—that is to say, a little less than that of water. At 0° C, under a pressure of 076 metre, a litre of air weighs 1-2930 gramme. Under the same conditions of temperature and pressure a litre of oxygen weighs 1-4298 gramme. Oxygen is but slightly soluble in water, which at ordinary temperatures will take up about 4-6 per cent, of its volume. Biological Relations.—Oxygen is sepa- rated from carbon dioxide in the atmosphere by plants, which retain the carbon and give off oxygen, animals complementary absorbing oxygen and giving off carbon dioxide. Physio- logically, it is thus of the greatest importance, its free supply to the respiratory organs being absolutely essential to the maintenance of life. Entering the alveoli of the lungs by way of the bronchi, trachea, larynx, mouth, and nos- trils, it unites with the' haemoglobin of the blood to form oxy-haemoglobin, carbon dioxide being given off at the same time. This change, effected in the capillaries of the lungs, marks the conversion of dark, or venous, into bright, or arterial, blood. The volumes of oxygen and of carbon dioxide absorbed and given off respectively are proportional, being dependent upon the chemical and physical relations of the two gases. By the blood, oxygen is given up in part to the cruder products of digestion, but more largely to the fixed tissues by which it is made use of in the development of energy, combining with their constituents to form a number of products—nutrient, functional, and excretory. The final results of vital oxidation are chiefly carbon dioxide and water, although certain quantities of urea, uric acid, and other products of the oxidation of food and tissue are excreted without further reduction. While the whole subject is still obscure and in dis- pute, it seems to be reasonably demonstrated that some of the toxic metabolins giving rise to symptoms of disease are the results of im- OXYGEN 50 perfect oxidation. It is estimated that about one fifth of the oxygen contained in atmos- pheric air, as ordinarily inhaled, is absorbed into the blood, combining with the haemoglobin, the four other fifths being returned to the at- mosphere in the expired breath. Medical History.—Attempts to use oxy- gen in therapeutics were made by Priestley, its discoverer, and by his contemporaries, of whom Beddoes has contributed observations of the greatest value to medicine. From Priestley's day to the present, oxygen has been much abused by charlantry and by honest ig- norance. The name has a decided hold upon the imagination, and sufferers and hypochon- driacs are ready to welcome it as a remedy for every imagined and imaginable ill. The facts that the inhalation of oxygen produces a tem- porary exhilaration in almost every instance, and that certain cases, both of chronic and of acute affections, are really benefited by such inhalation, render it easier for pretenders to deceive their clients, and for physicians, igno- rant of the true field of usefulness of the rem- edy and of its limitations and dangers, to deceive themselves. Preparation and Administration.— Oxygen may be extemporaneously prepared for medical use in many ways, for the details of which chemical treatises may be consulted. The best is by gently heating in a suitable re- tort a mixture of 4 or 5 parts of potassium chlo- rate and 1 part of manganese dioxide. Purity of the ingredients is essential, not only to avoid contamination of the product, but to prevent accident in the preparation. The gas as evolved should be passed through three wash-bottles containing water, and to the first of them should be added about £ per cent. of potassium hy- droxide, and to the second about \ per cent, of sil- ver nitrate to ab- sorb any free acid or chlo- rine that might be given off. The last washing should be with pure water. The ap- paratus designed by Dr. Wallian is the best in the American market. The gas may be collected in a suitable gasometer and kept for a short time, or in rubber bags and used promptly. Another method of preparing it, which has come into vogue within re- cent years, since pure hy- drogen dioxide has been more readily obtained in the shops, is to allow a solu- tion of potassium perman- ganate, 8 grains to the ounce, to drip slowly into a solution of hydrogen di- oxide contained in a Woolf bottle or other suitable re- ceptacle furnished with two openings for the ingress and egress tubes, the latter, to which the mouthpiece is attached, not being allowed to pass more than about an inch below the stopper. A plan even more convenient is to introduce into a long-necked flask of about 4 oz. capacity, stopped with rubber and furnished with an air-tube and mouthpiece (see figure), 2 oz. of the official solution of hydrogen dioxide, and pour upon it an equal quantity of boiling water. To this should then be added half a teaspoonful of washing soda (sodium carbonate) as free from lumps as possible. Oxygen will be disengaged and bubble slowly through the fluid. Sir Benjamin Ward Richardson believes what he terms '■ ethereal oxygen " to be one of the most useful of his many contributions to our resources. In a two-necked Woolf bottle, one neck of which is furnished with a delivery tube and a valved mouthpiece, he places 2 oz. or more of "ozonic ether" (which is a 30-vol- ume solution of hydrogen dioxide in ether), pours through a funnel in the other opening 1 oz. of a solution of potassium permanganate (8 grains to the ounce), and then corks that opening while the patient inhales ether and oxygen through the mouthpiece (Asclepiad. vol. ix, 1892, p. 167). He has also shown the usefulness of oxygen as a carrier of other va- pours than ether, such as ethylene, chloroform, methylene, methylal, amyl nitrite, ammonia, iodine, bromine, benzoin, turpentine, and vola- tile oils. The oxygen may be freshly evolved from hydrogen dioxide in a flask containing the volatile substance on or in the dioxide solution, or a gentle current of oxygen from any convenient reservoir may be passed through the medicated solution into the in- haler. When water is not admissible, the volatile substance—say iodine or turpentine— is placed in a good-sized flask with a double neck, and the oxygen simply flows over it on its way to the inhaler. Another method is to charge an elastic receiver with oxygen that has passed over the volatile medicament, and to have the patient inhale directly from this a fixed quantity. Clover's (chloroform) inhaling bag and the cellulite valved mouthpiece of Richardson are the best for use in this man- ner. A convenient method for the adminis- tration of oxygen much in vogue at the present day is to store the pure gas (prepared from potassium chlorate and manganese di- oxide, or from atmospheric air, and properly washed), or oxygen mixed with nitrogen mon- oxide in various proportions, in stout metal cylinders under greater or less pressure, ac- cording to the size of the cylinder in which it is desired to hold the given'volume. Under a pressure of 1,800 lbs. to the square inch, 40 gallons may be stored in a cylinder 3 inches by 12|| inches, weighing 11 pounds. It will have "a purity of 95 to 96 per cent., being diluted by the small quantity of air in the cylinder. From the cylinder the gas may be drawn into rubber balloons and inhaled (passing through water in a wash-bottle on its way to the mouthpiece), or the wash-bottle may be attached by tubing directly to the cylinder. A special apparatus for the administration of oxygen by rectal in- jection (or insufflation) has been devised. The 51 OXYGEN writer has had no experience with this method of administration. Physiological Effects. —Inhaled undi- luted, oxygen causes subjectively a sensation of warmth in the mouth and air-passages, and there seem to be lightness and ease in respira- tion, sometimes in mental processes likewise. Objectively, there is acceleration of the pulse with increased hardness, indicating a rise of blood-pressure from increased force of the cardiac action. Warmth of the cutaneous surface is usually observed. The visible mu- cous membranes, sometimes the cheeks as well, are heightened in their red colour. Sometimes there is increased moisture of the skin. The respirations are usually increased in frequency at first, but subsequently the depth increases and the number diminishes. If the inhalation is continued for too long a time, violent men- tal and physical excitement, with rise of tem- perature, may be produced. This is marked in small animals, such as the mouse, guinea-pig, cat, and dog kept in an atmosphere of undi- luted oxygen. In such animals death may oc- cur in a few hours and all the viscera be found congested or inflamed. Such effects are not common in human beings inhaling oxygen for medicinal periods, except in the case of sub- jects of pulmonary tuberculosis, in whom in- creased inflammation and febrile movement may result from the inhalation of oxygen, as was long ago pointed out by Beddoes. In the . researches of Sir B. W. Richardson (Asclepiad, vol. iv, 1887, pp. 71 and 172) concerning the effects of oxygen upon lower animals, the process of manufacture of the oxygen used seemed to make a difference, probably due to the admixture of ozone in some cases. Tem- perature exerted a marked influence, oxygen at 20° or 125° F. becoming practically a nar- cotic poison. The range of temperature most favourable to life was from 55° to 90° F. Be- tween these temperatures and the extremes be- fore noted an anaesthetic effect was produced. The degree of concentration of oxygen in the factitious atmosphere was also found to modify the effect. Life could be sustained longer in an unchanged atmosphere of diluted oxygen than in the pure gas, the most favour- able mixture being that found in ordinary air, one part of oxygen to four parts of ni- trogen. Important differences were noted in the reactions to oxygen of cold-blooded and of warm-blooded animals, the former being little affected, while among the latter dif- ferences of effect in different species were ob- served, the rabbit, for example, resisting the pyretic and phlogistic influences. Perhaps the most striking result obtained by Richard- son is that dependent upon the difference in the effect of breathing a still atmosphere of pure oxygen and that of breathing pure oxy- gen in current. In the former case, after the stage of excitement, narcosis and death ensue in the course of a few hours; in the latter case the animal continues to live for days. That this is not due to accumulations of carbon di- oxide is proved by making provision to absorb it; and even when all other products of respi- ration are removed, the oxygen that has been breathed and rebreathed for some time, while still able to support combustion, is unable to support life. " Devitalizing oxygen " may, how- ever, be made " vitalizing " ag'ain by the effect of an electric discharge (cf. Ozone). These facts indicate a source of danger in crowding and lack of ventilation apart from those com- monly recognised. The physiological effects described are usu- ally transient, but after repeated inhalations certain permanent effects begin to be mani- fest in addition. There are increase of appe- tite and increased ingestion of food, with consequent gain in weight. The number of red corpuscles in the blood and the relative as well as the absolute haemoglobin percentage are augmented. The excretion of uric acid diminishes and that of urea probably increases; observations upon the urinary excretion are, however, conflicting. Applied to the unbroken skin, oxygen is practically without effect, perhaps increasing the exhalation of carbon dioxide. When, how- ever, the gas is allowed to come in contact with wounds or ulcerated surfaces, it produces immediate and painful irritation, accompanied with increased redness and abundant liquid exudation; granulations increase, and, if the process is too long continued, become ecchy- motic and lose their tendency to cicatrize. Oxygen may be introduced beneath the skin, in the form of gas or held in loose combina- tion as hydrogen dioxide, without danger. As hydrogen dioxide, it may be injected into the pulmonary tissues through the chest wall, and it is said that with caution oxygen gas may safely be injected into the veins. It has been passed into the stomach through a suitable tube. However introduced, it is readily ab- sorbed, and produces its effects primarily upon the tissues and blood locally, secondarily upon the organism as a whole. Upon pathological conditions certain specific effects have been alleged for oxygen; thus its inhalation has been said to diminish the pro- duction of sugar in diabetes and to have proved capable of averting diabetic coma by the oxidation of products that would other- wise form diacetic and oxybutyric acids. Therapeutics.—Oxygen may be applied to the skin or mucous covering of the body, or introduced into the blood by way of the lungs. Solution of hydrogen dioxide (q. v.), given by the stomach, or with due caution subcutane- ously, has also been supposed to yield oxygen to the blood. It has been used as a stimulat- ing application to indolent ulcers, and has been said to promote their repair. It has also been used in cases of infected wounds, and especially when there have been sloughing and gangrene, for the purpose of destroying foul odours and preventing putrefaction. The charcoal-and- oxalic-acid poultice is supposed to be of ad- vantage by virtue of the oxygen which it slowly gives off. Hydrogen dioxide is also supposed to owe much of its undoubted therapeutic value to the fact that upon being brought into contact with decomposing or- ganic matter, with pus and other morbid products, it liberates oxygen in the active OXYGEN 52 (nascent) state. Day (Australian Med. Jour- nal, July, 1878, p. 183) prepares dressings by saturating cotton with terebinthinate oils and exposing them to the air, hydrogen dioxide being thus generated. A useful formula is the following: Very old turpentine, 1 part; benzine, 7 parts; oil of verbena, 5 drops to the ounce. Eucalyptus oil is also useful: 1 part of eucalyptus to 4 of benzine makes a good disin- fecting mixture, readily yielding its oxygen. [Stoker (Med. Press and Circular, Apr. 17, 1895; Therap. Gaz., Aug., 1895) states that in the local treatment of wounds and ulcers the oxygen may be diluted with pure air, accord- ing to the requirements of each case. It is not necessary that an absolute vacuum should be brought about. When the treatment is to be applied to the extremities it is necessary to have rubber bags of the simplest construction. If to the knee, for instance, what is required is an oval rubber receptacle open at both ends, larger at one end than at the other. The lower or smaller end of the bag embraces the limb below the knee and the upper or larger end embraces the limb above the knee. When this rubber receptacle is used it is not neces- sary to have a continuous stream. The bag should be filled and the tap turned off, and after five or six hours it should be filled again. Such bags may be made to include any part of the body. The method of procedure is as fol- lows: First the wound is washed, then the rubber cap is placed so as to embrace the part. The bag is then filled with oxygen diluted with air. Pure oxygen causes a great deal of pain, but some patients stand it well. A 50- per-cent. mixture is commonly employed, di- luted with purified air; this is passed through two wash-bottles before entering the gas-bag, the first containing limewater, and the sec- ond a strong solution of Condy's fluid; then the oxygen is passed into it out of a cylinder. When the bag is to be refilled it is connected with the receptacle by a small tube, the tap is turned partially on, and the oxygen-container is refilled as often as is necessary. There is usually immediate relief from pain. For the first twelve hours the micro-organisms do not differ in number or character, but after that the discharge diminishes and the germs show remarkable changes. In one of Stoker's cases, in addition to lesions in other parts of the body, there was a tuberculous ulcer on the back of the hand, involving nearly all the dorsal surface. Other eases were of tubercu- lous disease of the tibia, of tuberculous syno- vitis, and of syphilitic rupia of the head.J By inhalation oxygen is used either pure or diluted with air or with nitrogen monoxide in various proportions. Its principal employ- ment in the hands of educated physicians has, unfortunately, been in the treatment of pul- monary tuberculosis, in which disease it is rarely useful and usually harmful. This fact, first pointed out by Beddoes, was independ- ently observed by Fourcroy, and has been confirmed by the studies of J. Solis-Cohen (Inhalation, etc, 2d ed., Philadelphia, 1876, p. 77) and by those of the writer. It should not be understood, however, that the inhalation of oxygen is at all times and under all circum- stances to be avoided in the treatment of pulmonary tuberculosis. Under certain cir- cumstances it has considerable palliative value; but it should be distinctly recognised that it is palliative only, to be used for tempo- rary purposes, and for short periods as a stimulant, or to relieve dyspnoea. The com- bination of one third oxygen and two thirds nitrogen monoxide is usually the best for em- ployment in this manner, as the nitrous oxide diminishes the untoward activity of the oxy- gen. Toward the end of life in pulmonary tuberculosis oxygen assists in smoothing the passage to the grave. It is of use in hypo- chondriasis and neurasthenia as a stimulating agent, and especially in cases of neurotic dys- pepsia attended with perverted gastric secre- tion. In chronic gastric and gastro-intestinal catarrh oxygen given by inhalation and ap- plied locally through a stomach-tube, oxygen- ated water, and hydrogen-dioxide solution have been used with benefit. Oxygen is a useful palliative in gastric carcinoma. It sometimes relieves the insomnia due to auto-intoxication, and especially when this is remotely due to mental fatigue. It is of benefit in rhachitis, in the scrofulosis of children, in debilitated states, in gout, and in diabetes. As a pallia- tive in asthma during the attack it is of ser- vice, though not often successful in cutting short a paroxysm. In chlorosis and the ane- mias, even in pernicious anemia and in leuce- mia, it is of distinct service. In acute lobar pneumonia it has often saved life. The ad- ministration of oxygen in this affection is ra- tional, because the diminution in lung surface requires a concentration of respiratory pabu- lum. Nascent or at least recently prepared oxygen is preferable because it exerts antisep- tic powers. Resort to oxygen should not be postponed until the patient is moribund. The inhalations should be regular and continuous, not sporadic and spasmodic; and should the patient be unconscious or unable to assist, the delivery nozzle should be inserted into the nos- tril and the gas allowed to flow in a continuous current at a gentle rate. In acute obstructive diseases of the air-pas- sages, such as croup and laryngeal diphtheria, before or after intubation or tracheotomy, in the capillary bronchitis of children, in the catarrhal pneumonia of the aged, and in acute diseases attended with prostration or col- lapse, such as cholera asiatica, cholera in- fantum, severe cases of measles and scarlatina, the terminal stages of typhoid fever and puer- peral and other forms of sepsis, inhalations of oxygen will always afford comfort and prolong life, and may sometimes greatly assist recov- ery. In connection with artificial respiration oxygen is a potent agent in the treatment of asphyxia. In toxic narcoses, especially those brought about by carbon dioxide, coal qas, opium, belladonna and its congeners, chloral, ether, chloroform, and similar agents, if re- sorted to in time and used persistently, it may save life. [The value of oxygen in coma has been well illustrated by Dr. Charles J. Macalister, of 53 OXYGEN Liverpool (Clinical Sketches, Jem., 1896; N. Y. Med. Jour., Feb. 15, 1896), who describes two cases. The first case was that of a man, thirty- nine years old, who had pains in his limbs, se- vere headache, and frequent vomiting, which had been attributed to a series of exposures to cold and wet. He had an alcoholic appear- ance. The urine was diminished in amount, and contained more than a quarter of albumin. The temperature was normal. Two days after he entered the hospital he seemed drowsy and complained of spots floating before his eyes. The respiration was hurried and the pulse was 82. There was severe frontal headache, with some vomiting; the bowels moved freely. In the afternoon the patient became delirious, and later on he was found to be absolutely blind. The temperature was 100-8° F.; the pupils were very much contracted, with no reaction to light; there were no muscular twitchings. Early in the evening he became semi-comatose; the breathing was loud and stertorous, and the lips, the nose, and the ex- tremities were somewhat cyanosed. The tem- perature was 101° F. Two hours later he was in a profound coma; his eyes were open and the pupils were contracted to pin-points; the muscles were relaxed, the extremities were cyanosed, the mouth was closed, and the heart beat tumultuously. The pulse was 118; there was oedema of the extremities. The patient was insensitive to pain and was apparently under the influence of some poison which in- terfered with oxidation. Dr. Macalister ad- ministered oxygen freely, pure oxygen through one nostril and air through the other. The results were very striking, for the face and the lips rapidly became less cyanosed, and in ten minutes the patient tried to push the tube from his nose. The pulse was at once reduced from 118 to 96. The respirations became slower and freer from stertor, and the pupils were less contracted; the corneae were sensi- tive. Later on the patient turned voluntarily on to his side, but no replies could be elicited to questions. A cupping-glass was then ap- plied over the loin, and the pain effectually aroused him. He sat up in bed and became so violent that assistance was necessary to re- strain him, although he took no notice of any questions put to him and made no attempt to speak. He presently relapsed into a drowsy condition, for which the administration of the oxygen was repeated, and ten minutes later he sat up and asked for a drink. There was no return of unconsciousness, although two days later there was a threatening of it, which was averted by the oxygen. In twenty-four hours the urine measured 108 ounces, and contained an eighth of albumin, with hya- line and granular casts; the specific gravity was 1-005. Four days later the patient was able to see; the ophthalmoscope showed small haemorrhages, especially in the left fundus. A few days afterward the headache disappeared and the albumin rapidly subsided. A week later the man left the hospital perfectly well. The second case was one of morphine poison- ing, and the cure seemed to have been acceler- ated by the use of oxygen.] The most recent advance in the therapeutic use of oxygen is the application in surgical anaesthesia of Sir B. W. Richardson's sugges- tions as to the use of oxygen as a menstruum for ether and chloroform. Cole, of New York (Med. Record, Oct. 16, 1895), seems to have been the first to put the plan into actual opera- tion. The writer has adapted the ordinary face-mask of his compressed-air apparatus to this purpose by the addition of an expiration valve. From a cylinder of compressed oxygen the gas is passed through a wash-bottle con- taining the anaesthetic into the mask. By this plan, which has been adopted in the service of Dr. T. S. K Morton at the Philadelphia Poly- clinic Hospital, anaesthesia is produced with- out suffocation or struggling, may be prolonged with less ether and continued with less cyanosis and less danger, and recovery (which is aided by the inhalation of pure oxygen) is more rapid and without distress. [At a meeting of the New York Surgical So- ciety held on November 27, 1895 (Annals of Surgery, Feb., 1896), Dr. Francis II. Markoe read a paper on the use of oxygen with ether for anaesthesia. He said that the use of oxy- gen prevented the cyanosis that was so com- mon when ether alone was employed; and that if anaesthesia was induced by oxygenated nitrous oxide it could be most satisfactorily and safely prolonged with oxygenated ether. It had been suggested also that chloroform anaesthesia might be made safer with oxygen. In the discussion which followed the read- ing of Dr. Markoe's paper, Dr. Robert Abbe said that, so far as his limited experience with the method went, it seemed to show that it pos- sessed advantages. That there was a gain in ox- idation during etherization could not be ques- tioned. The patient's complexion was pink- er, the blood in the wound was more arterial, the minute arteries seemed to spurt more, but the blood clotted quickly, so that there was no greater haemorrhage. Its use had been attend- ed by less secretion of saliva and a less abun- dant production of mucus in the bronchi than where ether alone had been employed. The patients had experienced less nausea subse- quently, and the effects had been pleasanter. In a case of mitral lesion which had caused much anxiety, the patient had borne the anaes- thesia and a long operation very well, and had experienced no nausea. Dr. B. Farquhar Curtis said he had tried the method in about ten cases, and must say that he had not witnessed much improve- ment over older methods. There had been cyanosis in some of his cases, whereas he had supposed that cyanosis was the principal dis- agreeable symptom which could be prevented by the use of oxygen. The stage of excite- ment had been quite prolonged in some of his cases, and there had been nothing in the his- tory of the patient to account for it. In some cases he had observed want of efficient anaes- thesia, and he suspected that it was due to the diminished quantity of ether inhaled when ad- ministered in this way. The effects on the blood seemed to be about as described by Dr. Markoe, but perhaps this advantage also was OXYMELS OXYTOCICS 54 due to the fact that the patient got less ether. In a case in which he had kept the patient waiting about two weeks to get rid of a bron- chitis before submitting to some trivial opera- tion, it had been noticeable that there was ab- solutely no irritation of the bronchi after the operation, although there had been rales only two or three days before. He would warn the profession against the use of oxygen with ni- trous oxide. He had tried it experimentally over and over again, and had found that the oxygen had no effect whatever, except in di- minishing the anaesthetic influence of the ni- trous oxide. Dr. W. W. Van Arsdale agreed with Dr. Markoe that the ideal anaesthesia of the future would probably begin with nitrous oxide and be continued with ether. He had used this form in private practice for two years, and had been fortunate in having an experienced ad- ministrator assist him. By giving pure nitrous oxide and afterward substituting plain ether the patient could be placed remarkably, alarm- ingly quickly under anaesthesia, sometimes in half a minute, and without any disagreeable sensations or period of excitement, and with- out any of the after-effects following the use of ether alone. He had had no experience with the use of ether mixed with oxygen. It impressed him as a step in the right direction, but he feared that clinically it would meet with some objection. More ether had to be given, which was not a desideratum; if there were less cyanosis, that would be an advantage in itself. Dr. Howard Lilienthal had used nitrous ox- ide at the beginning of anaesthesia and had been almost alarmed at the rapidity with which the patient became anaesthetized. A method which would do away with cyanosis would rob us of one of the danger signals. He added that this mixture of oxygen and ether was probably highly inflammable, if not explosive, and therefore should be used with extra pre- caution. Dr. Andrew J. McCosh had used the com- bination of oxygen and ether in eight or ten cases, and had found the chief objection to lie in the fact that it was difficult to bring the patient under the influence of the anaesthetic, and relaxation had riot been complete. During the greater part of the time before unconscious- ness the patient was in a jolly mood. There was an absence of the distress which ether usually caused, there was no cyanosis, and the blood was well aerated. Some years ago the method had been extensively employed, the tube conveying the oxygen passing into a cone made of paper and a towel, but after having been used in fifty or sixty cases the method had been abandoned. Regarding the combina- tion of nitrous oxide and ether, it was rather troublesome, and, unless the anaesthetizer was a man of experience, the patient was apt to re- gain consciousness when the change was made from nitrous oxide to ether. Dr. Markoe believed with Dr. Van Arsdale that the future method would be to induce anaesthesia with nitrous oxide, but he thought it would be modified with oxygen. Dr. I. N. De Hart, of Brooklyn (Boston Med. and Surg. Jour., April 16, 1896), who has re- ported a number of cases in which he has used oxygen in conjunction with an anaesthetic, says that pure oxygen should not be used with ether, on account of its tendency to counteract the anaesthetization or make it a very slow pro- cess ; but it may be used with chloroform. He has found that oxygen diluted with 33 per cent, of nitrous monoxide or atmospheric air is the best form of gas to be used in producing anaesthesia, with either ether or chloroform, during surgical operations. The amount of oxygen used during the operations which he reports averaged about a gallon a minute during the etherization, and afterward it was given with less pressure dur- ing the operation. The amount of ether con- sumed by an adult averaged about 4 ounces an hour, and he presumes it would require about half that quantity for a child. Of chlo- roform, from 2i to 3 drachms an hour were used. Of the A. C. E. mixture about 4 ounces were used in an hour and forty minutes in one case. In another case only 8 ounces of ether were consumed in two hours and a half. The longest time required to produce complete anaesthesia with ether and oxygen gas (diluted) was fourteen minutes; the shortest time with the same anaesthetic, seven minutes. With pure oxygen etherization with ether requires from twenty to twenty-five minutes, and then it will sometimes require the giving of ether with a cone and dispensing with oxygen gas for two or three minutes. With chloroform and oxygen gas (diluted) the results are far more satisfactory, and anaesthetization is very rapid, usually requiring about two or three minutes.]—Solomon Solis-Cohen. OXYMELS.—These are mixtures contain- ing honey and some dilute acid, used mostly for their agreeable flavour. The oxymel of the Br. Ph. is composed of 8 parts of clarified honey and 1 fl. part each of acetic acid and distilled water. It may be used as a refriger- ant in doses of from 1 to 2 fl. drachms. OXYNAPHTHOIC ACID, C„H803, formed by the reaction of an alkaline com- pound of o-naphthol on carbon dioxide under pressure at a high temperature, is a colourless crystalline substance hardly soluble in water, but fairly soluble in alcohol, in ether, and in oils. It is poisonous and is not used internally, but has been proposed as a topical antiseptic. OXYQUINASEPTOL. _ See Diaphthe- RIN. OXYSPARTEINE.—This derivative of sparteine has been found by Langlois .and Maurange (Gaz. med. de Paris, Aug. 24, 1895) more active than sparteine as a cardiac stimu- lant. The dose of the hydrochloride, admin- istered subcutaneously, is from £ to $ of a grain. OXYTOCICS.—This term, in the broadest sense, includes all measures which hasten par- turition by increasing the strength of the expellent forces, especially of the uterine con- tractions. Such agents are also sometimes 55 designated as ecbolic, ocytocie, ocyodinic, or oxytoceous .agents. The unstriped muscular fibres of the uterus are apparently capable of rhythmical contrac- tion independently of the action of the general nervous system. Yet at the same time they are under the control of nerve-centres in the spinal cord and the brain. The spinal centre is situ- ated in the lumbar portion of the cord, and the uterine contractions go on normally after the cord has been divided above the lumbar region. This lumbar centre may act independently of the cerebral centre, or may be excited by it. The mode of action of ecbolics is not yet fully understood. While their effects are" in the main due to stimulation of nerve-centres, some of them also possess to some extent the power of directly causing contraction of the uterine muscle fibres. Under the foregoing definition there are two classes of ecbolic measures, medicinal and me- chanical. Of drugs, there is a long list which have been credited with the power of stimu- lating the uterine contractions during labour. Chief among these are ergot, hydrastis, cimici- fuga, thuja, mistletoe, ustilago maidis, borax, cottonwood, savine, rue, tansy, wormwood, apiol, yew, pennyroyal, black hellebore, quinine, sugar, digitalis, squill, laburnum, grains of paradise, guaiacum, salicylate of sodium, oil of amber, pilocarpine, belladonna, phosphorus, strychnine, broom-fern, lignum vitae, hoar- hound, chamomile, mugwort, cantharides, juniper, juice of bamboo, milk hedge and other euphoriaceous plants, chiretta, carrot seeds, sassafras, arsenic, corrosive sublimate, cyanide of potassium, sulphate of copper, drastic ca- thartics, and the inhalation of carbonic oxide, of illuminating gas, or of the vapour of carbon disulphide. Most of these drugs exert but a feeble influence upon the uterine contractions, and are of no practical importance as oxytocics. A few deserve special mention. Ergot is an agent of undoubted power as a uterine excito-motor. It intensifies the uterine contractions when they are already established, and is capable of exciting them primarily in the gravid uterus. In large doses it produces a tonic contraction of the uterus. The inter- vals between the contractions are nearly or quite obliterated, the organ remaining in a state of spastic rigidity. Under smaller doses the action of the uterine muscles is intermit- tent, but the relaxation is not so complete as in spontaneous labour. In very small quanti- ties (10 minims of the fluid extract) the effect is to produce contractions very closely resem- bling those of natural labour. The pains are rendered more frequent and more energetic. The use of ergot, however, for the purpose of accelerating labour is generally condemned by obstetric authorities. The nearly continuous contraction of the uterus under full doses of the drug interferes with the utero-placental circulation and is frequently fatal to the child. Violent ergotic contractions are dangerous to the mother as well, exposing her to the risk of uterine rupture. While ergot in very small doses may no doubt be given to advantage in inertia uteri, it is usually inferior to other OXYMELS > OXYTOCICS means and the practice is seldom to be recom- mended. Hydrastis canadensis is a powerful ec- bolic. Its action is believed to be of centric origin, since it ceases on section of the uterine nerves. The dose of the fluid extract is from 5 minims to i fl. oz. Hydrastine, the domi- nant principle of hydrastis, may be substituted for the drug itself. The dose is from 4, to $ of a grain. Hydrastinine is an artificial alkaloid produced by acting on hydrastine with oxidiz- ing agents. It is an active oxytocic. In full doses, like ergot, it produces "violent uterine tetanus. (See vol. i, p. 475.) Quinine has the power to intensify con- tractions of the uterus already established ; possibly in some cases that of originating them. Probably it acts more by rousing the general nervous system than by its direct ef- fect on the uterus. However that may be, the writer has seen abundant evidence of its value in stimulating the flagging pains of labour. A single dose of 10 grains usually suffices. Sugar has recently been added to the list of ecbolic agents. It is given in doses of about an ounce dissolved in water. Its effect on the pains is manifest in from twenty-five to forty- five minutes. Rarely is a second dose required. The contractions induced by sugar are said to be of the usual normal character. Cotton Root.—The fluid extract of cotton root exerts a pronounced oxytocic influence. It is open to substantially the same objection as ergot. The dose of the fluid extract is | fl. drachm. Cimicifuga has been employed as a uterine stimulant during labour. It produces normal, not tonic, contractions. The fluid extract is the best preparation. It is given in doses of from { to 1 fl. drachm three or four times daily. Of the tincture, from 1 to 2 fl. drachms may be given with the same freqtiency. Electricity is one of the most reliable ec- bolics. The faradaic or the interrupted gal- vanic current is used. To avoid injury to the foetus, the current must not be too strong, and it should not be passed directly through the child's head. One electrode may be applied to the sacro-lumbar region and the other over the middle of the abdomen. The current should be mild at first and increased gradually, to guard against over-stimulation and consequent destruction of the electro-muscular contractili- ty. Each application may last from five to thirty minutes. Before the escape of the waters the introduc- tion of an aseptic English bougie between the foetal membranes and the uterine wall may be practised for accelerating labour, as it is for inducing it. Glycerin, injected between the ovum and the uterus, has recently been much employed for the induction of labour. It is most effect- ive when carried high up into the uterus, and retained for a time by the aid of the latero- prone posture. It is believed to act partly as a direct irritant and partly by the separation of the membranes and by its osmotic effect. Labour is in most cases promptly established. In numerous recorded cases, however, the in- OYSTER SHELL OZONE 56 tra-xiterine injection of glycerin has been fol- lowed by haemoglobinuria, with evidence of glomerulo-nephritis and even of interstitial hepatitis. Pelzer, by whom the method was introduced, still regards it as a safe procedure provided the quantity of glycerin injected does not exceed half an ounce. The alternate use of hot and of cold appli- cations to the abdomen during labour is a powerful stimulant of uterine contractions. In the first stage of labour standing or walking, and in the second sitting erect, are useful pos- tural measures. A semi-recumbent or a squat- ting posture favours the expulsive efforts. Hot rectal or vaginal douches increase the strength and frequency of the pains. Mam- mary irritation is a well-known reflex stimu- lant of uterine contractions. It is especially necessary in slow labours that the bladder and the rectum be kept empty. When these viscera are distended the uterine efforts are partially inhibited. Misdirection of the uterine axis should be corrected. A firm abdominal binder is frequently a material help during the second stage of labour, especially in relaxed conditions of the abdominal walls. While it does not increase the energy of the uterine contractions, it adds to their efficacy by furnishing a point d'appui for the intra-ab- dominal pressure.—Charles Jewett. OYSTER SHELL.—See Testa pr^ipa- RATA. OZONE.—Chemistry.—Ozone is allotropic oxygen. Its molecule contains three atoms in- stead of the two atoms forming the molecule of ordinary oxygen. Its formula is written as 03, or sometimes as 020. It combines energet- ically at ordinary temperatures with nearly all oxidizable substances. Moisture favours its action. In forming combinations it yields the additional atom of oxygen, the remaining atoms resuming the ordinary form of Oa. This residue of uncombined oxygen occupies the same volume as the original ozone, which was therefore condensed. The density of ozone has been experimentally shown to be 24, or half as much again as that of oxygen, and its molecular weight 48, or three times that of oxygen. It has been separated from oxygen only in minute quantities, and in medicine ozonized air is the agent ordinarily employed to produce the effects of ozone. As a rule, 50 per cent, is the highest proportion of ozone that can be obtained in mixture with oxygen, and readily available apparatus produce much less. Heated to 300° C. (572J F.)—some say 250° C. (482°F.) — ozone reverts to the condition of ordinary oxygen with corresponding expansion in volume. It may be liquefied by cold and powerful pressure (from 150 to 125 atmos- pheres). Liquid ozone has a blue colour, it boils at 106° C. (222-8° F.)—some say 159° C. (286-2° F.)—and, if it is inclosed in a glass tube, changes to blue gas, which may again be liquefied by cooling. Preparation and Properties. — Schon- bein, in 1839, proved that the characteristic phosphorus-like odour accompanying electric discharges was due to a gas developed in and from the air by the chemical effect of the dis- charge, and on account of its odour he gave to this new gas, afterward shown to be modi- fied oxygen, the name by which it is now known. The best means of preparing ozone in large quantities is to pass air or oxygen through a narrow dielectric space between two parallel conductors, as by means of a Siemens's induc- tion tube or some similar device connected with a Holtz electric machine or a powerful Ruhmkorff coil, the silent discharge being more effective than the spark. Houzeau's ap- paratus consists of a glass tube about 0*1 of a millimetre in calibre and from 40 to 45 centimetres in length, containing a stout plat- inum filament, and wrapped around with a spiral of some good conducting material, such as copper wire. One of the rheophores of the induction coil is connected with the platinum wire, the other with the copper spiral. The current of pure, dry oxygen gas is allowed to pass through the tube at the rate of a litre an hour. The quantity of ozone produced is the greater the lower the temperature, about 50 per cent, of the oxygen being converted into ozone at —88°. An effective machine based upon this principle but much improved in detail has been placed on the American market and has been described by Dr. W. J. Morton in the New York Medical Journal for June 23 and 30, 1894. The output of the machine is meas- ured in milligrammes of ozone per minute, and the dosage regulated accordingly. To remove irritating and deleterious nitrogen compounds the ozonized air is passed through a wash bottle containing a solution of caustic alkali (sodium hydroxide or potassium hydroxide). When pure oxygen has been ozonized this procedure is obviously needless. As ozone is always formed in greater or less quantity when oxygen is lib- erated or takes part in a reaction, especially if the evolution of heat is prevented, various chemical processes of production are available. Thus, several pieces of stick phosphorus may be placed in a large flask and half covered with water; after some hours the flask will contain considerable ozone. A current of oxygen may be conducted over moistened phosphorus in a glass tube. Barium dioxide or potassium per- manganate or a mixture of potassium perman- ganate and oxalic acid may be gradually added in small portions to cold sulphuric acid. Ozone may be allowed to diffuse through the air of an apartment, or (mixed with air or oxygen) may be collected over water in glass vessels. It can not be collected in rubber, as it quickly destroys organic substances. It is soluble in pure water in the proportion of 8-81 per cent., the larger part, however, being converted by the water into oxygen without the formation of hydrogen dioxide. It is soluble in oils, some of them taking up as much as 25 volumes per cent. Essential oils and terebinthinates absorb ozone readily; they will also absorb oxygen from the air and convert it into ozone, becom- ing rich in ozone with long exposure. Ozone exists in moderate and variable quantity in the atmosphere. According to some authorities, it is the form in which oxygen exists in the blood 57 OYSTER SHELL OZONE combined with the haemoglobin, but this opin- ion must be said to lack demonstration. It is supposed that the ozone of the atmosphere arises in great part from the slow oxidation of organic matters in a state of decomposition. If the combination takes place with elevation of temperature, the ozone formed is immedi- ately broken up. Thunderstorms and silent electric discharges in the atmosphere, the evaporation of water, especially of salt water, and the respiration of plants, especially Conifere, are among the other sources of ozone in Nature. Its presence may be detected by the blue coloration which it brings about in tincture of guaiac, the decol- orization of indigo, or the liberation of iodine from combination in potassium iodide, as dem- onstrated by the blue reaction of starch paper. One source of fallacy in observation is the fact that most of the agents employed to detect atmospheric ozone react similarly to hydrogen dioxide, but, allowing for this, the production of ozone in Nature must be extensive, and its destruction almost equally so. It is the great natural purifier, attacking energetically putre- fying materials and converting deleterious into harmless products, nitrous and nitric acids, water, hydrogen dioxide, and carbon dioxide. Schonbein showed that one part of ozone in 3,240,000 of air was sufficient to destroy the odour of decay in a vessel of 60 litres (about 127 pints) in which had been placed for one minute 120 grammes (about 4 oz.) of putrid meat, and later observers have abundantly demonstrated its deodorizing properties. (Fox, Ozone and Antozone, London, 1873.) Under ordinary conditions, it does not, however, de- stroy bacteria, moisture of the ozone and its prolonged contact in quantity with the germs being necessary, while the presence of lifeless organic matter retards or prevents the action of ozone on the living matter.* Various diseases have been attributed to the increase of ozone in the atmosphere, especially pneumonia and influenza. It is unquestionable that ozone, if respired in appreciable quantity, will excite catarrhal inflammation of the re- spiratory tract, and that at times its presence in the atmosphere, in notable quantities, is co- incident with an epidemic of pulmonary in- flammation or with la grippe. On the other hand, both of these diseases have been found to be epidemic at times when the ozone of the atmosphere was at a minimum. Diminution of atmospheric ozone has been found to be co- incident with epidemics of cholera. This loss of ozone has by some been placed among the causative factors of the epidemic, and by others referred to the increased destruction of ozone by the germs. Physiological Effects.—The evidence as to the action of ozone upon man and animals is confused and contradictory.! Albumin is rendered incoagulable by acids or boiling after exposure to ozone. Blood out of the body be- comes dark, then black, when ozone is passed * Ohlmiiller. Ueber die Einwirkung des Ozons auf Bakterien. Arbeiten aus dem kaiserlichen Gesund- heitsumte, viii, 1, Berlin, 1892. t For extensive bibliography, see Morton, loc. cit. through it, finally becoming a clear fluid with- out albumin, a gas not analyzed being given off. Haemoglobin, like vegetable protoplasm, if brought in contact with ether or terebinthi- nate oils which have absorbed ozone, will at once cause the latter to give up their ozone. It has also been demonstrated that red blood- cells (or haemoglobin) can transform the oxygen of the air into ozone by contact, even after they have become saturated with carbon monoxide, which prevents them from absorbing oxygen, the action being comparable to that of the platinum sponge. It has been supposed that the blood transforms into ozone the oxygen which it absorbs, and that the same effect is produced within the blood by tissue oxidation without elevation of bodily heat. Binz, how- ever, by agitating ozone with a solution of albumin and guaiac, with the result that the guaiac was not discoloured, while the albumin was transformed, proved that free ozone could not exist in the blood serum, though the oxygen of oxyhaemoglobin might be yielded up as ozone under some circumstances. The quan- tity of ozone ordinarily contained in the air is about 1 part in 450,000 by weight, 1 in 700,000 by volume, at about 20 metres above the earth. This quantity, absorbed during respiration, plays the part of a useful stimu- lant ; and to the absence of ozone from the atmosphere has been attributed the torpor and malaise which occur, especially in nervous women, at certain times—particularly in hot, moist weather and before the approach of thunderstorms. The fact that these symptoms frequently disappear after the storm is attrib- uted to the generation of atmospheric ozone by the electric discharges. In large quantities, however, ozone is irritating to the air-passages and destructive to the blood. Birds, which live in the atmospheric regions ordinarily richest in ozone, are the least affected by its toxic action ; however, in sufficient concentra- tion (1 in 2,000) it may prove toxic even to birds, causing not only violent pulmonary inflamma- tion, with catarrhal discharges from the mu- cous membranes in general, as in the case of any other irritating gas, but coagulation of the blood, proving almost immediately fatal. As the passage of ozone through coagulated blood outside of the body restores its fluidity, the eoagulation of the blood which follows ozone poisoning has been attributed not to a direct fibrinogenetic influence, but to a destructive influence upon the lung epithelium and even the red cells, interfering with the discharge of carbon dioxide, which therefore accumulates in the organism, and may give rise to all the toxic symptoms. There is depression of the heart and nervous system, due partially to the destructive action of ozone upon the albumin of their tissues, partially to carbon dioxide poisoning, and partially to reflex irritation from the air-passages. In moderate doses by inhalation or by internal use in water or in oil, ozone acts as a local antiseptic and under some circumstances as a stimulant to metabolic pro- cesses, and hence to nutrition in general. A regenerative influence upon the red blood-cells has been attributed to it. PALMETTO WINE PAPAW 58 Therapeutics.—In therapeutic applications, ozone has thus far been demonstrated to have but a limited field of usefulness. Its bacteri- cidal properties are not available in treatment, though its deodorizing and disinfectant powers are useful in preventive medicine. Thus, it should be evolved in quantities in public halls after the presence of crowds, and in small quantities during their occupany. In croup, diphtheria, whooping-cough, scarlet fever, small-pox, cholera, and similar infections, if the sick-room can be charged with ozone in moderate quantity the patients will do better and- contagion will be minimized. This is the probable usefulness of the evolution of vapours of turpentine, eucalyptus, and the like. To disinfect the sick-room after contagious dis- eases, ozone evolved in the largest possible quantity is more efficacious than sulphurous fumigations or other ordinary means. The presence of moisture retards the conversion of oxygen into ozone, but assists the process of disinfection after the ozone has been produced. By direct inhalation, ozone, largely diluted, may be employed with caution. Statements as to doses are quite discrepant in form and sub- stance. French observers speak of fa milli- gramme of ozone to the litre of air. Morton recommends 45 to 70 milligrammes of ozone a minute in nasal cases, and but 1 milligramme a minute in chronic bronchitis. Ransome, how- ever, states that his tuberculous patients in- haled for ten or fifteen minutes oxygen of which 9 per cent, had been electrified into ozone. Yet a mixture containing 10 parts of ozone in one hundred has proved fatal to large animals. By inhalation, ozone has been used by com- petent observers with apparent good effect in diphtheria* in cholera, in chronic nasal ca- tarrh, bronchitis, asthma, and emphysema, in gout and diabetes, in pernicious anemia, and other diseases of the blood. In ozena it may prove of great benefit not only as a deodor- izer, but as a stimulant to the nasal mu- cous membrane, increasing watery secretion and facilitating the reproduction of healthy epithelium. Caille has thought ozone inhala- tions beneficial in early pulmonary tuberculo- sis, while Ransome (Med. Chronicle, viii, 1888, p. 37; x, 1889, p. 97) observed great ameliora- tion in advanced cases of pulmonary phthisis, especially improved appetite and sleeping pow- er, and consequent gain in weight. Mr. J. C. Dittrich has recently introduced preparations of ozone dissolved in water (with the addition of 2-5 per cent, of sodium hypo- phosphite) in various vegetable and ethereal oils and in cod-liver oil. These preparations, unfortunately, have proprietary names at- tached. Doubtless they will be found useful as gastric and intestinal antiseptics, as stimu- lants to the circulation, respiration, and diges- tion, and if the ozone escapes destruction in the stomach, as a means of increasing oxidiza- tion in asthma, in gout, in diabetes, and other affections. [The results of the examination of twenty- * Vide CaiLte, Archives of Paediatrics, Aug., 1892. two cases of whooping-cough treated exclusively with inhalations of ozone have convinced Labbe and Oudin (Progr. med., July 20, 189a) that the use of ozone produces an immediate amelioration. The spasms of coughing are rapidly modified, not only in frequency, but also in intensity and duration. The respiratory troubles, the cyanosis, and the vomiting almost entirely disappear. The general condition, says M. Labbe, naturally feels this favourable modification ; the children recover their spirits, their appetite, and their former healthy ap- pearance. None of M. Labbe's patients were attacked with the broncho-pulmonary compli- cations which are so often observed in this dis- ease. The authors think that in whooping- cough ozone seems to have a special antiseptic action.] It is quite possible that some of the good effects observed in cases of chronic malnutri- tion of various kinds treated with Franklinic electricity are to be attributed to the ozone de- veloped during the application. The whole subject is still in too much uncertainty to war- rant positive statements. It should, however, receive greater attention from clinicians. Solomon Solis-Cohen. PALMETTO WINE.—According to Dr. Ira W. Porter, of Sanford, Florida (South. Med. Record, Aug., 1895), the raw palmetto of the Southern States seems to have a medicinal action on mucous surfaces, and has been used with good results in bronchitis, laryngitis, follicular pharyngitis, amygdalitis, and gonor- rhea, also to promote the growth of the mammae and to act as a tonic and fattening agent. Palmetto wine seems to be a wine made from the juice of Florida oranges im- bued with palmetto in some manner that Dr. Porter does not describe. He states that he has prescribed it with success in a case of nervous impotence. The dose is not Kien- tioned. PAMBOTANO. — This is the Mexican shrub Anneslea grandiflora. Bocquillon has isolated a glucoside from it. Its active prin- ciples are said to be soluble in water and in alcohol. Morales and Labato have found it an efficient remedy in malarial diseases. Crespin, of Algiers (Bull. gen. de therap., Aug. 15,1895), reports that he has found it effective in many cases in which other remedies, including qui- nine, had failed, especially of the quotidian and simple continued forms, also those of chronic malarial poisoning; but in malarial neuralgia and in bilious and pernicious cases it appears to exert no decided remedial action. Pambotano is said to be an appetizer and stomachic tonic of the first rank. Valude, who reports that he has used it with success in various non-malarial febrile affections, such as typhoid fever, influenza, and the fever of tuber- culosis, recommends the administration of a decoction of about 17 drachms of the root- bark as a single dose. Pambotano is said to be perfectly harmless. 59 PALMETTO WINE .PAPAW PANCREATIC EMULSION. — More than thirty years ago Dr. Horace Dobell, of London (On Tubercidosis ; its Nature, Cause, and Treatment. With lVotes on Pancreatic Juice, 2d ed., London, 1866), suggested the hypothesis that tuberculosis was due to de- fective action of the pancreas. A sudden, al- most complete or total suspension of normal pancreatic secretion accounted, to his mind, for acute tuberculosis; a less complete sus- pension or perversion of the function of the pancreas led to chronic tuberculosis; and inter- mittent pancreatic derangement of either sort was at the bottom of recurrent tuberculosis. Acting on this theory, odd as it now seems, Dr. Dobell set about treating consumptives with various preparations of the pancreatic secretion of the pig, and finally settled on an emulsion of beef fat and pancreatic juice. This pancreatic emulsion, in the form in which it was at last put upon the market, resembled lard in ap- pearance. Although repulsive to some pa- tients, it was readily tolerated by some others who could not take cod-liver oil. While we can not look upon it as in any sense a cure for consumption, it is undoubtedly a nutrient of great value, especially suited to persons whose power of digesting fat is weak. About an ounce of the emulsion, thoroughly mixed with a pint of milk, may be given daily. PANCREATIC EXTRACT.—See Pan- creatin and under Animal extracts and juices, page 80. PANCREATIN, pancreatinum (U. S. Ph.), extract of pancreas, pancreatic extract, is de- fined in the Pharmacopeia as a mixture of the enzymes existing in the pancreas of warm- blooded animals. It is usually obtained from the fresh pancreas of the hog. It sometimes occurs in yellowish, brittle scales, but more commonly as a yellowish-white, amorphous powder without odour or having a peculiar faint odour and a faint meat-like taste. It is almost completely soluble in water, but in- soluble in alcohol. The ferments found in pancreatin are those of the pancreatic juice, and are at least three in number: trypsin, which converts albumins into peptones; pty- alin, an emulsive ferment; and amylopsin, which converts starch into dextrin and sugar. It also has faint milk-curdling prop- erties, due probably to a ferment. The pan- creatic ferment acts in alkaline or neutral solution. An acid destroys its activity. Its chief digestive action is exercised upon the proteids and starches. It converts the former into peptones and certain minor products through the agency of the trypsin. The pancreatic juice is the chief agent for the digestion of starch, which it converts into glucose. Pancreatic digestion of proteids dif- fers materially from peptic digestion. The pancreatic ferment, in an alkaline medium, acts chiefly on fibrin, which it corrodes away, for/ning leucine, tyrosine, hemipeptone, and several other less important products. The peptic ferment, in an acid medium, acts best on albumin, which swells before it is dissolved. The products of this digestion are peptones, 48 albumose, and syntonin. Five grains of good commercial extract of pancreas will digest a pint of milk rendered alkaline by bicarbonate of sodium. Pancreatic extract acts upon starch paste with great rapidity, 5 grains being sufficient to almost immediately convert 100 grains of starch into sugar. Pancreatin is chiefly used in medicine for the purpose of predigesting food. This sub- ject is fully considered in the article on Ali- mentation, to which the reader is referred. It is not infrequently given in capsules or tablets, in doses of from 3 to 5 grains. The utility of the preparation thus employed is doubtful, as its activity is probably at once destroyed by the acid secretion of the stomach. It is best administered from two to four hours after meals. For the purpose of making so- called peptonized foods it is an agent of the utmost value in the nourishment of patients seriously ill or suffering from impaired diges- tion. The pancreatic ferment, trypsin, is used for a variety of purposes for which the extract is not employed, and is considered in its proper place. [Cf. Pancreatic extract, under Animal ex- tracts and juices, vol. i, page 80.] Floyd M. Crandall. PANSY.—See Viola tricolor. PAPAIN, PAPAIVA—See under Pa- paw. PAPAVER.—See Poppy. PAPAW, papain, papaiva, papayotin, or papoid, is a ferment prepared from the juice of the papaw tree of South America and the West Indies. It is obtained by incising the half-ripe fruit of Carica papaya. A white, milky juice exudes, which on drying forms a white amorphous or slightly granular powder which has a slightly astringent but not acrid taste. This powder" contains a ferment which has not as yet been obtained in a state of ab- solute purity. It is freely soluble in water and in glycerin, but is precipitated by alcohol and the tinctures, acetate of lead, tannic acid, and nitric acid. Papain is a proteolytic agent of decided power. It resembles in its action trypsin more closely than either of the other natural digest- ive ferments, its final product being leucine. Like trypsin, it acts in an alkaline or neutral medium, but unlike trypsin, it acts also in a slightly acid medium. " Its action is arrested but not wholly destroyed by hydrochloric acid. It has been said that it is not a true ferment, but rather a solvent. Sharpe affirms that its action is that of hydration. This view is not generally held by more recent observers. It is maintained by Woodbury that it has a slight effect in converting starch into maltose. This action has not been observed by others. Its action is not interfered with by the ordinary antiseptics. Although its digestive power is great, its action has probably been somewhat overesti- mated. A feature of great importance is the fact that it is active in both acid and alkaline media, and may be administered in hydro- chloric acid or in an alkaline mixture. It is PA R A-A CETPHENETID1NE PARALDEHYDE 60 employed in the various conditions in which pepsin is indicated—namely, in forms of dys- pepsia resulting from deficiency of gastric juice. It is especially efficient in those forms of gastric catarrh which are marked by an ex- cessive secretion of mucus, a condition espe- cially common in chronic alcoholism. In such conditions it should be given before meals, as it seems to have the power to a certain degree of removing the unhealthy mucus. Another dose may be given after the meal. As is the case with pepsin, its good effects are frequently transient, and no curative results follow its use. In these conditions the dose varies from 1 to 5 grains; 2 or 3 grains are frequently as efficacious as larger amounts. It may be ad- ministered in capsules, powder, solution, or compressed tablets. The last-mentioned form is the one most commonly employed. It is very unstable, and in solution with plain water quickly decomposes. If the solution is ren- dered slightly acid or alkaline it does not de- compose so readily. A solution containing glycerin keeps indefinitely. As the ferment is more active in concentrated solution, it should not be given largely diluted, and but small quantities of water should be taken by the patient with his meals. In dilatation of the stomach, where a dry diet is used, papain acts especially well. The treatment of digestive disorders by digestive ferments is, as a rule, unsatisfactory. The applications of papain would seem to be more extensive, however, than those of pepsin or pancreatin, as it can be combined with a much larger number of drugs. Its use may therefore be added for its temporary effect to other treatment designed to cure the diseased condition. Papain has the undoubted power of de- stroying intestinal parasites. It is effectually used for the removal of roundworms and tape- worms. In large doses it seems to have a toxic effect on the worm. In smaller and repeated doses it seems to be efficacious through its power of digesting albuminous substances. It is used most successfully in doses of from 2 to 3 drachms, which should be given in the morn- ing, the patient having been prepared with the same care as should be exercised when other taeniafuges are employed. It is wise to com- bine it with bicarbonate of sodium, to neutral- ize somewhat the acids of the stomach so that the drug may act most effectually. The use of papain for dissolving the mem- brane of diphtheria has been vigorously advo- cated by Jacobi. He applies to the membrane a solution of papain in glycerin, one part to four. The solvent power of the solution thus applied is undoubted, and in many cases its good effects are equally clear. It has not, on the whole, however, proved so efficacious as to have maintained its position as an efficient and satisfactory remedy in diphtheria. At the present time it is but little used. It is em- ployed in surgery in the same manner as tryp- sin. As a dusting powder, it has been used with bicarbonate of sodium in the proportion of five parts to one, or with equal parts of boric acid. As a paste for unhealthy sores or slough- ing tissue, a drachm of papain may be thor- oughly mixed with 2 drachms of glycerin or with boroglyeeride. For injection into cavi- ties or sinuses, a drachm may be dissolved in 2 drachms of glycerin and 6 drachms of water. [According to Dr. Cerna, papoid has been recommended for dissolving accumulations of cerumen in the ear; it has been used with de- cided success in the treatment of fissure of the tongue after the failure of other applications, such as iodoform, chromic acid, and nitrate of silver; and it has been employed advantage- ously in the treatment of syphilitic ulcerations of the tongue. Dr. J. F. Barbour (Notes on New Remedies, Jan., 1894; Am. Jour, of the Med. Sci., Apr., 1894) reports a case of ulcer of the stomach in which papain relieved the symptoms, including that of pain, which did not return when the employment of the remedy was discontinued, after it had been given for three weeks. Mittra (Med. Reporter, Jan., 1894; N. Y. Med. Jour., June 9, 1894) uses papaw juice in- ternally, usually in doses of 10 drops. He thinks it a gastric sedative of great power, as is seen in the magical relief obtained from it in certain forms of gastric irritation and vomiting. He regards it as a valuable antacid also, more trustworthy than sodium bicarbon- ate. Locally, it may be used as a solvent of small polypous, warty, and other growths.] Floyd M. Crandall. PARA - ACETPHENETIDINE. — See Phenacetine. PARABROMACETANILIDE.—SeeAN- TISEPSIN. PARACHLOROPHENOL, PARA- CHLORPHENOL. — See under Chloro- PHENOLS. PARACOTOIN, PARACOTOINIC ACID.—See under Coto bark. PARACRESALOL, PARACRESOL SALICYLATE, C6H4.OH,COO,C6H4.CH8, is a crystalline compound resembling salol in its medicinal virtues, and said to be particu- larly efficient as an intestinal antiseptic. It is insoluble in water. From 3 to 30 grains may be given in the course of twenty-four hours, preferably in wafers. PARAFFIN.—The name paraffin was ap- plied, in 1830, by Reichenbach to a substance which he isolated from the products of the dry distillation of wood, as well as from ani- mal tar and coal-tar. This substance proved to be so indifferent toward energetic chemical reagents that he based its new name on this property (parum = but slightly, ajfinis = re- lated; combinable). During the next decade various attempts were made to produce this substance on a large scale, for Reichenbach had already pointed out its prospective useful- ness as an illuminating agent; but it was not until 1850 that marketable amounts of it were produced in England. Since then the produc- tion of paraffin has become very extensive in various parts of the world, most of the ma- terial being used for candles. At present paraffin is obtained chiefly dur- ing the distillation of brown coal (lignite), turf, 61 petroleum, or ozokerite. After the lighter or lower-boiling fractions, so far as they are pres- ent, have been driven over, the distillate be- comes heavier and more viscid, until the temperature of about 265° C. is reached, when the so-called paraffin oil begins to pass over. As the temperature increases this carries over a substance practically identical with it in chemical composition but capable of being separated from it in a solid condition by cooling. The crude distillate is treated with strong sulphuric acid, which chars the accom- panying resinous matters, the sulphuric acid is removed, and the residue, after being washed, is again distilled. The first fraction is liquid, and is added to the liquid paraffin oils; the remainder of the distillate constitutes the paraffin, which is set aside in suitable ves- sels to crystallize. The crude solidified paraf- fin is next subjected to centrifugal action to remove from it any liquid paraffin that may still adhere to it, and is then treated with the lightest benzin to dissolve out the remainder of the adhering impurities. As the benzin dissolves also a small portion of the paraffin, it is subsequently subjected to special processes to recover the latter. Finally, the remaining paraffin is melted and steamed to remove the odour of benzin, and then pressed into cakes. Commercial paraffin is colourless when liquid, white and translucent when solid; the softer kinds are white and opaque. It becomes readily plastic when warmed. When heated to 160° C. it begins to volatilize. At about 350° C. it begins to boil with partial decompo- sition. Paraffin is often used as a substitute for wax: in this case the high-melting varieties should be chosen. When it is combined with ordi- nary fats it is very apt to separate during the process of cooling. It is, therefore, not a good constituent of ointments. The use of paraffin as a coating for pills, or as an ingredient in pill-masses for potassium permanganate, silver nitrate, etc., which has been repeatedly advocated, is not to be recom- mended, as the paraffin is absolutely insoluble in the juices of the digestive organs. [Hard paraffin, paraffinum durum (Br. Ph.), paraffinum solidum (Ger. Ph.), is paraffin wax. The Br. Ph. prescribes its use in various oint- ments. Soft paraffin, paraffinum molle (Br. Ph.). is vaseline, the petrolatum of the U. S. Ph. Liquid paraffin, paraffinum liquidum (Ger. Ph.), is liquid vaseline.]—Charles Rice. PARAFORM, or triformol. a polymer of formaldehyde, is a white crystalline substance almost insoluble in water. The name para- form seems to have been given to it by Dr. Hans Aronson, who introduced it as an anti- septic at a meeting of the Berlin Verein fur innere Medicin held on March 5, 1894 (Berl. Id in. Woch., Sept, 24, 1894). It is chiefly as an internal antiseptic that Aronson advocates the use of this substance. His experiments show that in germicidal power it far exceeds salol, benzonaphthol, iodoform, aristol, bis- inuth-tribromphenol, and naphthalin.and that it somewhat excels 0-naphthol; this extraor- PARA-ACETPHENETIDINE PARALDEHYDE dinary efficiency he attributes to its giving off vapours of formaldehyde, for it is not neces- sary to place it in actual contact with the germs to secure their inactivity. Paraform appears to be almost if not quite free from poisonous properties; Aronson himself took 75 grains of it in the course of twenty-four hours, Aronson likens the physiological ac- tion of paraform to that of calomel; in various animals and in man, large doses (in man one or two doses of 30 grains) give rise to diar- rhoea. Aronson says that it destroys not only bacteria, but also their poisonous products; guinea-pigs he has found able to take with im- punity large quantities of a highly poisonous diphtheria culture in bouillon, provided para- form is added to it in the proportion of 1 to 500. At the time of his report he had used it with good results in twenty cases of cholera infantum, in the initial stage, in doses of from f of a grain to 1^ grain every two hours. He recommended that it be tested also in the in- cipient stage of typhoid fever and cholera in adults. The dose for adults is from 5 to 15 grains, three times a day, preferably in cap- sules. When paraform is given subcutane- ously, formaldehyde passes into the urine; when it is given by the mouth, however, this does not occur. Paraform, applied pure to raw surfaces, is highly irritant, and for use on wounds and ulcers, therefore, it should be di- luted with dermatol or talc. Ointments are not suitable for diluting paraform, according to Blaschko, for the fat contained in them in- terferes with the liberation of fumes from the drug. PARALDEHYDE, paraldehydum (U. S. Ph., Ger. Ph.), Cell-jOs, is a polymeric modifi- cation of aldehyde. As found in the shops, above a temperature of from 40° to 53° F., it is a colourless liquid, having a peculiar, unpleasant, ethereal odour and a pungent, disagreeable taste. It is very soluble in alcohol, and dis- solves in about 8 parts of cool water, but less readily in hot water. It has been principally used as a hypnotic, but in appropriate doses it is also sedative, depressant, antispasmodic, and diuretic. Its administration in large doses is followed not only by an increased flow of the watery constituents of the urine, but also by a marked increase in the elimination of urea. In producing sleep paraldehyde acts very much like chloral, with the important difference that it has less depressing effect upon the heart. It is supposed to produce sleep by its action on the brain. When given in poisonous doses to the lower animals, it lessens reflex action, paralyzes the spinal cord, and arrests respira- tion before the heart ceases to beat. In suffi- ciently large doses it depresses or paralyzes the vaso-motor centres so that dilatation of the arterioles takes place. Decreased arterial pressure, slight diaphoresis, and increased peristalsis result from the full effects of this agent. Poisoning from Paraldehyde.—Thomas MacKenzie, of Douglas, England (Brit. Med. Jour., Dec. 12, 1891), records an interesting and instructive case of poisoning from paralde- PARASITICIDES PASTES 62 hyde in a woman who took by mistake 3£ oz. The drug was taken at 11 p. m., and the patient was not found until the next morning, when she was in a deep stupor and limp, like a per- son deeply under the influence of chloroform, with a strong odour of paraldehyde on the breath, face slightly flushed, pupils moderately contracted and quite insensitive to light, pulse 120, respirations 40. A complete recovery took place. Notwithstanding every means was used to arouse her, it was forty-one hours from the time the drug was taken before she was able to understand and reply to simple questions. This remarkable case seems to indicate the harmlessness of paraldehyde when employed in therapeutic doses, provided there is no con- tra-indication to its use. The Paraldehyde Habit.—It was thought that the very disagreeable taste and odour of paraldehyde would be sufficient to prevent a craving or habit being contracted for it, but experience has taught us our mistake. Several cases of the paraldehyde habit are on record, and the results, mental and physical, have usu- ally been disastrous where the habit has been continued a great length of time. Dr. Fred- erick Peterson, of New York (Med. Record, Dec. 10, 1892), records an apparent exception. A woman took ounce doses nightly for months and grew fat, without apparently suffering any bad effects. It is probable that if such cases are watched evil effects will manifest them- selves, as fatty degeneration of the liver has been experimentally produced in animals by the use of large quantities of paraldehyde. One of the most remarkable cases on record of the paraldehyde habit is one recently published by Mr. Frank Ashby Elkins (Quart. Jour, of Inebriety, Oct., 1894, p. 333), in which the pa- tient had been accustomed to. take 16 oz. of the drug a week. The patient rapidly became emaciated, and presented great cardiac and general muscular weakness and subsequently delusions of persecution, with mental failure. A complete recovery took place in three months under restraint and appropriate treat- ment, Symptoms very similar to those of chronic alcoholism are likely to follow large doses of paraldehyde continuously employed for a considerable length of time. Krafft- Ebing has observed epileptoid convulsions to follow the prolonged and extravagant use of this drug. Therapy.—That paraldehyde in a large pro- portion of cases is an efficient hypnotic no one who has given it a fair trial doubts. In these days, when the agents by which sleep may be produced are so numerous, the physician often finds himself puzzled in trying to decide which one to select for an individual case or a par- ticular class of cases. The large dose of paral- dehyde, from 60 to 120 minims, required to produce sleep, and its repulsive odour and dis- agreeable taste, should decide against this drug when another equally efficient and harm- less and more agreeable to the patient can be obtained. The drug under consideration seems to be a respiratory depressant, and I feel inclined to indorse Dr. W. H. Flint's con- clusions : "' It is contra-indicated in cases of cyanosis with depression of the respiratory centres, as in the advanced stages of emphy- sema and cardiac dilatation" (Therap. Gaz., Jan. 15, 1890). The same writer believes that paraldehyde is contra-indicated in most cases of insomnia attended with much physical or mental depression. Krafft-Ebing has found it a most remarkable hypnotic in the sleeplessness of insanity. Dr. Leech, of England, regards it as the best hypnotic for continuous use, and Dr. Clouston favours it as one of the best when the insomnia is marked and intractable. My rule in the use of hypnotics is never to employ any one continuously for a prolonged period, but to alternate them from time to time and sometimes to give two or more in combination, never letting the patient know what drug he is taking. The three hypnotics on which I mainly rely are sulphonal, trional, and chlo- ralamide. In some cases I have found paral- dehyde to act better than any of the three just mentioned. I have found headache, vertigo, nausea, and sometimes one or two watery evacuations from the bowels to follow full doses of paraldehyde. The cases of insomnia in which this hypnotic seems to have the best effect are those attended with mental and nervous excitement. In the early stage of de- lirium tremens it sometimes affords prolonged and refreshing sleep. I have never used it to overcome the insomnia of chronic alcoholics. [Dr. B. D. Evans, of the Morris Plains Hos- pital, Morristown, N. J., an institution for the insane (quoted in Ephemeris of Mat. Med., etc., Jan., 1896), says that, although this drug is established as a valuable and reliable hyp- notic, however, there are two serious objections to it; first, that it gives to patients when swallowing it the sensation of smothering or strangling, and second, its slow elimination through the lungs, leaving some patients drowsy and all patients with its strong odour for six or eight hours after its sleep-producing effects have passed away, but withal it may be relied upon to give in a case of almost any form of insomnia from four to six hours of re- freshing sleep, when administered in doses of from 1 to 2 fl. drachms in equal parts of whis- ky and syrup of orange. In the sleeplessness of chronic alcoholism, alcoholic mania, deli- rium tremens, and " chronic disturbers," says Dr. Evans, this drug has no superior as a hyp- notic. In many of tho acute forms of insanity it acts very gratefully, but occasionally it fails. It does not disturb the appetite, and does not depress the heart's action.] Dr. A. B. Cook has found paraldehyde ser- viceable in asthma, puerperal convulsions, and cough (Ann. of the Univ. Med. Sci., v, A-115, 1889). In twelve cases of spasmodic asthma' some of which had been submitted to the usual forms of treatment, Dr. William Mackie succeeded in causing the disappearance of the spasm in a short time by the administration of paraldehyde in doses of \ a drachm, repeated every half hour until the effect was produced. The author never was obliged to give more than three doses; often one sufficed (ibid., v, A-66, 1894). [In the British Medical Journal for March 6; 21, 1896, Mr. Frederick P. Hearder states that he has used paraldehyde, with good effect, in about thirty cases of asthma, including ordi- nary spasmodic asthma, asthma with epilepsy, with heart disease, with renal disease, and with chronic bronchitis, and in two cases of asthma with pneumonia. In the majority of the cases, he says, relief was rapid and com- plete, and in the remainder the distress was lessened. The dose employed was from 45 to 60 minims, and one dose was usually sufficient; a few patients, however, needed a further dose of from 30 to 45 minims an hour or so later. Using these doses, Mr. Hearder has never ob- served any untoward action of the drug, but, on the contrary, the breathing has gradually become easy and normal, the pulse been stead- ied and strengthened, and the patient fallen into a comfortable sleep. A point in dispens- ing, says Mr. Hearder, is that the addition of a few drops of alcohol renders paraldehyde per- fectly miscible with water; any flavouring tinc- ture can be used for this purpose.] Humphrey has found paraldehyde an excel- lent remedy in Cheyne-Stokes respiration asso- ciated with broncho-pneumonia. Ignatieff and Tchervinsky have obtained good effects from the use of paraldehyde in the treatment of tetanus. About 150 minims were given daily, either by the mouth or by the rectum (Year Book of Treatment, 1892, p. 112). Dose and Administration.—The dose to pro- duce sleep should be from \ to \\ drachm. It is better, as a rule, to begin with the smaller dose and repeat it every hour or two until sleep results. Small doses rarely have much effect in overcoming obstinate insomnia. I have found the elixir of Curacoa, to which some alcohol may be added with advantage, an excellent menstruum. (See also under Hyp- notics, vol. i, p. 509). Jeremiah T. Eskridge. PARASITICIDES.—See Antiparasitics and Anthelmintics. PARATALOID.—See Tuberculin. PAREGORIC, tinctura opii camphorata (U. S. Ph.), camphorated tincture of opium, is virtually an elixir containing opium, benzoic acid, oil of anise, camphor, and glycerin in diluted alcohol. It contains somewhat less than a grain of opium in each half ounce. It is therefore the weakest official preparation of opium, and is especially adapted to use where a very small dose of that drug is desired. It is largely used where opium is indicated in dis- eases of children, as the dose can be very readily graduated. The camphor renders it especially serviceable in diarrhea. In this disease it is used in enormous quantities, as it is one of the commonest ingredients of diarrhoea mix- tures. It is a serious error, however, to add it to a mixture which is to be given at short in- tervals. The younger the patient the more serious does this error become. If it is thus given in sufficient quantities to produce ap- preciable results, it is difficult to avoid narco- tism after a few doses. It is far safer and the results are more satisfactory to administer it entirely alone at sufficient intervals to allow PARASITICIDES 3 PASTES the effect of one dose to subside before another is given. The diarrhoea mixture can thus be given as frequently as it is indicated by the symptoms. Paregoric is also a frequent in- gredient of cough mixtures. One of its chief effects when thus used is to destroy the ap- petite and disturb the digestion. The same rule as to frequency of administration applies here as in diarrhoea. The dose must be grad- uated according to the dose of opium desired. This varies so greatly that no positive rules can be given. As a rule, a minim for each month of a baby's age may be given as an initial dose. It should be remembered that paregoric, being an alcoholic solution, drops at least 2 drops to the minim. Twice as many drops, there- fore, should be given as minims. Paregoric is a preparation rarely used by persons addicted to the opium habit. In the few cases which have come under the writer's observation in which it was used the results have been espe- cially disastrous. The raw alcohol and per- haps the camphor have seemed to increase materially the bad effects of the opium. (See Opium.)—Floyd M. Crandall. PAREIRA (U. S. Ph.). pareire radix (Br. Ph.), is the root of Chondodendron tomentosum, a menispermaceous climbing plant indigenous to tropical America. It is chiefly used in the treatment of chronic cystitis. The dose of the decoction, decoctum pareire (Br. Ph.), is from 1 to 2 fl. oz.; that of the extract, extractum pareire (Br. Ph.), from 10 to 30 grains: and that of the fluid extract, or liquid extract, ex- tractum pareire fluidum (U. S. Ph.), extractum pareire liquidum (Br. Ph.), from •£• to 1 fl. drachm. PARILLA, YELLOW.—See Menisper- MUM. PARIS GREEN.—See under Arsenic PARODYNE.—See Antipyrine. PARSLEY.—See Petroselinum and Apiol. PARTHENICINE.—Dr. Ulrici, a Cuban physician (Brit. Med. Jour., June 16, 1888; N. Y. Med. Jour., Oct. 13, 1888), has experi- mented with this alkaloid, obtained from the leaves and flowers of Parthenium Hysteropho- rus, a West Indian plant. Parthenicine is described as crystalline, intensely bitter, and poisonous to animals. It is said to be anti- pyretic, antiperiodic, and analgetic. It has been given in daily amounts of 15 grains. Possibly this alkaloid is identical with parthe- nine, obtained from the same plant. PARTHENINE.—This alkaloid, possibly the same as parthenicine, is obtained from Parthenium Hysterophorus. It has been used as a remedy for malarial fever and neuralgia, in doses of "from 7 to 10 grains. PASTES.—These are plastic, cohesive, and adhesive mixtures, for internal or external use, according to the nature of the ingredients, and intended to be only slowly dissolved, or to exert a continuous slow action. The " pastes" for internal use have prac- tically ceased to be an object of the apotheca- ry's art, belonging rather to the sphere of the confectioner. And yet many medicines might PASTILLES PELLETIERINE 64 with great propriety be incorporated with such "pastes"—for instance, with those of marsh mallow, jujube, etc.—and administered in this manner. Pastes for external use are mostly intended to act as escharotics. Those more or less in use at the present time are the following: Canquoin's Paste.—Rub 300 grains of fused zinc chloride to a powder, and make a paste with 1 fl. drachm of alcohol. Then add 420 grains of flour, using strong pressure with the pestle. When the paste is homogeneous, roll it into strips about £ of an inch thick, allow them to stand exposed for a few hours, then transfer them to well-closed bottles. Latour's Paste.—Dissolve 300 grains of fused zinc chloride and 600 grains of zinc nitrate in 1 fl. oz. of water, allow the solution to cool, and incorporate 600 grains of flour. Roll the mass into strips about \ of an inch thick, and keep them in well-closed bottles. Smith's Paste.—Deprive crystallized zinc sulphate of its water by the heat of a water- bath, then transfer the powder to a crucible and keep it at a low red heat for a short time. Transfer the powder while hot to small glass- stoppered phials, which should be made abso- lutely air-tight with wax or paraffin. When the paste is required, open one of the phials and mix the contents by means of a glass rod with enough concentrated sulphuric acid to produce a plastic paste. (Recommended and used as an escharotic in cancer by Dr. Stephen Smith.) Similar pastes are those known under the names of Michel, Rust, Velpeau, and Ricord, in which the anhydrous zinc sulphate is re- placed by powdered asbestos, saffron, licorice root, and charcoal, respectively. Vienna Paste.—This is prepared from the official potassa cum calce, consisting of equal parts by weight of caustic potassa and quick- lime, rubbed together in a warm mortar so as to form a fine powder, which must be kept in well-stoppered bottles. For use it is made into a paste with alcohol. Of non-escharotic pastes, the following de- serve mention: Lassar's Naphthol Paste. Beta-naphthol............. 10 parts; Precipitated sulphur....... 50 " Soft soap J h...........2Q „ Vaseline, ) Lassar's Resorcin Paste. (1. Strong.) Resorcin, ) Zinc oxide, j- each......... 20 parts; Starch, ) Liquid paraffin............ 40 " (2. Weak.) Resorcin................. 10 parts ; Zinc oxide, ) , „,. (( Starch, \ eactl......... ^5 Liquid paraffin............ 40 " Unna's Lead Paste. MyeS:Hh............3°p»rts; Rice starch................ 10 " Vinegar.................60 " Unna's Zinc Paste. larchSide'|each......... 25 parts; Vaseline.................. 50 " Charles Rice. PASTILLES, PASTILS, are small cones or tapers prepared from an aromatic mass which, when dry, can be made to burn slowly at a glow, and thereby cause the odorous substances to be diffused through the room. Their preparation on the small scale is best carried on in . this way: The ingredients, well mixed to a tenacious but pliable mass, are rolled out on a board or on the pill-ma- chine into uniform cylinders of a diameter of about i or £ of an inch, which are cut into pieces of equal length and shaped into small cones. They are then dried at a gentle heat. The following formula is recommended, but this may be modified in many ways to produce different odours: Red Pastils.—Moisten 725 parts of red saunders, in No. 50 powder, with a solution of 75 parts of potassium nitrate in 1,000 of water, and dry the mixture. The object of this is to impregnate the powdered wood uniformly with the saltpetre. Prepare a mixture of 50 parts of tincture of benzoin, 20 of balsam of Peru, 40 of balsam of Tolu, 40 of storax, 2 of oil of sandalwood, and •£ part of cumarin, and if ne- cessary add to it just enough alcohol to render it homogeneous and capable of being poured. Having mixed the powdered red saunders with 30 parts of powdered tragacanth, incor- porate with it the odorous mixture thoroughly, and finally work into it enough mucilage of tragacanth, containing 2 per cent, of potassium nitrate, to obtain a pliable dough, which is to be rolled out and formed as above directed. Before the pastils are quite dry they may be painted with a thin coating of some liquid metallic bronze, to give them a handsome ap- pearance. Pastils not only are useful for diffusing a pleasant aroma, but may also be made the me- dium of impregnating the air with medicinal vapours. Some examples (partly after Diete- rich) will show how this may be done: Carbolic-acid Pastils.—Mix 830 parts of charcoal, in No. 50 powder, with a solution of 50 parts of potassium nitrate in 1,000 parts of water, and dry the mixture. Next mix it with 20 parts of powdered tragacanth, and then in- corporate with it thoroughly 100 parts of car- bolic acid and 1 part of oil of wintergreen, and finally work into it enough mucilage of traga- canth (containing 2 per cent, of saltpetre) to give the mass the proper consistence. Cresol Pastils.—These are made like the pre- ceding, except that 100 parts of cresol (cresylic acid) are taken in place of the carbolic acid. Creosote Pastils.—These may be made with 50 parts of creosote. Tar Pastils may be made to contain from 50 to 100 parts of tar. Chloride-of-ammonium Pastils.—Six hun- dred and fifty parts of powdered charcoal are moistened with a solution of 250 parts of am- monium chloride, 75 of potassium nitrate, 5 of 65 PASTILLES PELLETIERINE sugar, and £■ part of cumarin in 700 parts of water, and then dried. The powder is mixed with 20 parts of powdered tragacanth, and the mixture made into a mass with mucilage of tragacanth (containing 2 per cent, of salt- petre). Lastly, 10 drops each of balsam of Peru and oil of rose are incorporated, and the mass is formed in the usual manner. Diete- rich recommends giving them a coating of sil- ver-bronze. Iodide-of-ammonium Pastils. — These are made like the preceding, the quantities of the first three ingredients being 825 parts of char- coal, 100 parts of ammonium iodide, and 50 of potassium nitrate. Iodine Pastils.—Eight hundred and eighty- five parts of powdered charcoal, 40 of potas- sium nitrate, 5 of sugar, and 20 of powdered tragacanth are combined as described in the preceding formulae. To the mixture is added a solution of 50 parts of iodine and fa part of nerolin (the synthetic perfume) in 200 parts of ether; the whole is spread out and exposed to the air for a few minutes, and then it is formed into a mass with mucilage of tragacanth. When the pastils have been formed they must be dried without heat. To prevent further loss of iodine as far as possible, they should be covered with a coat of benzoin by several times applying a tincture of benzoin of double strength. When they are perfectly dry, they must be kept in glass-stoppered vessels in a cool place.—Charles Rice. PAULLINIA.—See Guarana. PEANUTS.—See Arachis. PEAT is a kind of carbonaceous earth found beneath the surface and composed principally of vegetable roots and fibres in various stages of decomposition. It is pro- duced under several different conditions of climate and topography, but usually in swampy or marshy places or where the atmos- phere is for a considerable portion of the year foggy. It is abundant in northern Europe, Scotland, Ireland, and India, and in some parts of the United States. The principal vegetables which by their decomposition form peat are the different varieties of moss called Sphagnum and—especially in India—wild rice. It is probable that peat is a product of one stage in the formation of coal, and, indeed, it is in some countries extensively used, when dried, as fuel. Peat is usually of a dark or blackish colour; it is spongy and" in its more superficial layers contains much water. Its reaction is acid, due to the presence of humic, phosphoric, and sulphuiic acids. When dried, peat is a light, very absorbent material which—because of these properties as well as by a supposed anti- septic quality, due, perhaps, to its acid constitu- ents—has been deemed suitable as a dressing for wounds. Like dry earth and charcoal, it causes the disappearance of foul odours and improves the appearance of granulations. When used for these purposes, the peat should be dusted upon the wound quite thick, and should be often renewed. It has been highly recommended in foul-smelling ulcers and in gangrene. Peat may also be used as an ordi- nary wet or dry surgical dressing, when it will be found convenient to have it sewed into bags of cheese cloth made in various sizes. It is supposed to have a special virtue as a wet dressing or poultice. It has been the practice since the beginning of the antiseptic era to moisten the wet peat dressing with one or another of the well-known antiseptic lotions, such as bichloride-of-mercury or carbolic-acid solution. The peat then, of course, has little or nothing to commend it over the more usual dressings. Still, in an emergency, such as may exist in time of war where for one reason or another the ordinary gauzes, etc., may be un- obtainable, if the country is one where peat abounds it may be found useful. Another use for it exists in certain parts of Europe and Africa—namely, as an immersion medium or kind of bath for the entire body. The peat for this purpose has(such a large ad- mixture of water that it becomes a kind of thin mud or slime. (See Baths.) White peat is the name of a very finely powdered silicious earth formed from extinct varieties of diatoms. This is not, properly speaking, a true variety of peat, but is some- thing quite different. It is silicious, not carbonaceous; it will not burn, but may be sterilized by heat. It has in itself no antisep- tic qualities. White peat in bulk is used as a filter, and it is also used in the manufacture of dynamite. Arpad G. Gerster. HOWARD LlLIENTHAL. PECTORALS.—See Expectorants. PEDILUVIUM.—The foot-bath (see un- der Baths, vol. i, p. 169). PELLETIERINE, the active alkaloid of pomegranate, is, on account of the small bulk of the dose required, the most elegant tenia- cide known, but is hardly suited for gen- eral use, on account of its relatively high cost. In appropriate doses it appears to be without any marked effect upon the gen- eral economy, but in unduly large amounts it may give rise to vertigo, diplopia, and muscular weakness, and in some instances it has been known to cause temporary paraly- sis of the voluntary muscles. It is never used in its basic state, but either as the sulphate or the tannate, the latter being regarded as the most effective. From | to 1 grain may be given in the morning after the preliminary treatment given in the article on Anthel- mintics has been followed out. It is usually followed by no general symptoms except perhaps a slight feeling of giddiness, but may excite nausea and vomiting. As a rule, it may be depended upon to purge, but if it fails to do so within two or three hours a cathartic must be administered. The proprietary preparation known as " Tan- ret's pelletierine" is very largely used instead of the tannate and appears to be entirely free from objection. Pelletierine and its salts^have been employed in the treatment of paralysis of the third and fourth cranial nerves, and with reported good results. The bark and stem of the root of Punica PELLITORY PENTAL 66 granatum, or pomegranate, granatum (U. S. Ph.), granati radicis cortex (Br. Ph.), cortex granati (Ger. Ph.). may be substituted for pelletierine, of which they are the source, but, on account of the considerable bulk necessary to constitute a proper dose, the crude drug is open to objection and, besides, is rather more apt to cause nausea and vomiting. The pow- dered drug may be given in doses of | oz., but a decoction made by soaking 2 oz. for twenty- four hours in a quart of water and afterward reducing it to one half its bulk by boiling is preferable. The whole amount may be taken at once, but it is more usual to administer it in divided doses at such intervals as may seem appropriate in individual cases. [There is an official decoction, decoctum granati radicis (Br. Ph.), the dose of which is from 2 to 4 fl. oz.]. The rind of the fruit and the flowers also are said to have the same properties as the bark. They may be given in doses of from 20 to 30 grains. The rind is also astringent, and is sometimes used in the treatment of diarrhea. (Cf. Anthelmintics).—Russell H. Nevins. PELLITORY—See Pyrethrum. PENCILS, also called bougies, are small cy- lindrical rods about fa to $ of an inch in diam- eter and from about 2 to 6 inches long, pointed at one end, and weighing from 15 to 30 grains. They are intended to be introduced into cav- ities requiring this form, such as the urethra, sinuses, etc. They may be formed either by hand or by rolling on a pill-tile or board, or they may be made by pouring the melted mixture into glass tubes previously oiled inside, and then pushing the pencils out by means of a suitable glass rod. They may be made of cacao butter or of gelatin. Those made of cacao butter are apt to be very brittle and to break easily. Those made of gelatin are preferable. For the latter, the following method may be employed: Soak 10 oz. of the best gelatin in water until it has become soft, pour off the excess of water, melt the softened gelatin, add 16 oz. of glycerin, and heat the mixture on a water-bath, constantly stirring, for about an hour. Then incorporate or dissolve in it the medicinal ingredient, being care- ful to keep the mass well stirred if the reme- dial agent is insoluble in the mixture, and pour it into suitable glass moulds previously coated on the inside with oil or soap liniment. When the mass has set, push it out by means of a rod and cut the pencil into sections of suitable length. As glass tubes are usually slightly tapering, it is well to remsmber that the pencils should be pushed out at the wider end.—Charles Rice. PENNYROYAL.-See Hedeoma. PENTAL, trimethylethylene, j8-isoamylene, C6Hio, an isomer of amylene, is a colourless and very inflammable liquid which boils at 100'4° F., and, though volatile, is not decom- posed on exposure to light or air. Its odour is strong and pungent and has been thought to resemble that of mustard. Pental is insol- uble in water, but with alcohol, ether, and chloroform it is miscible in all proportions. The physiological action of pental is in par- ticular that of a general anesthetic of rapidly developed but transient effect. From its in- halation there results, usually within two or three minutes, loss of sensibility without abso- lute loss of consciousness, so that the command to open the mouth or perform some similar action may be complied with. A persistence in the administration of the drug, however, results in narcosis. The unconsciousness produced by pental is brief, unless the administration is continued, its duration seldom exceeding four minutes. The return to consciousness is rapid and is apt to be followed by a brief period of analgesia, during which operative procedures may sometimes be continued. The inhalation of pental is but slightly irritating to the respir- atory tract, and excitement is seldom an ac- companiment of its use, but occasionally there may be observed laughter, delirium, and slight convulsive movements. During the period of narcosis the pupils are usually widely dilated. The corneal reflex is late to disappear. Sali- vation is unusual, and muscular relaxation is generally absent. Upon the patient's re- covering some dizziness and unsteadiness of gait are apt to occur, but as a rule they disappear rapidly. It has been said that there are no undesirable sequels of pental anaesthe- sia, but this is certainly a mistake, for there are credible accounts of excitability, tremors, difficulty of speech, headache, erythematous eruptions, and even convulsive movements. Albumin, casts, and blood cells have been found present in the urine after its use. That pental anaesthesia may be safely conducted is no doubt true, but that it is a safe anaesthetic is questionable, to say the least. Temporary cessation of respiration with cyanosis is not infrequent during its administration, and Cheyne-Stokes respiration has also been ob- served. Moreover, the circulation has in some cases been much depressed, and death has un- doubtedly been produced by it. These things, indeed, are scarcely to be wondered at, since experiments upon animals would seem to indi- cate that pental is a circulatory and respira- tory depressant of considerable vigour. Pental may be administered for anaesthesia in the same manner as chloroform. For a brief effect it may simply be dropped upon a cloth, but many prefer to employ an inhaler for the purpose, Junker's in particular being thought desirable. The use of pental for pro- longed anaesthesia seems hazardous, but it has certainly been used thus with success. The amount of the remedy necessary to pro- duce anaesthesia is usually from 1 to 3 drachms. It is said that- some few individuals are in- susceptible to its action. The operations suited to pental anaesthesia are those that are brief, such as the extraction of teeth and the opening of abscesses. It has been particularly recommended for producing anaesthesia in children. Pental may be used as a local anesthetic in the form of a spray. [The Lancet for January 4, 1896, after men- tioning Wood and Cerna's experiments on the physiological action of pental. and their conse- quent warning that it was a dangerous cardiac 67 PELLITORY PENTAL depressant, says: " Ruth, as late as 1894, came to the opposite conclusion, asserting pental to be a safer agent than chloroform and possess- ing many advantages over ordinary laughing- gas. It has not, however, been extensively employed, except in dental practice. Mr. Constant, after experience of some hundreds of cases, was satisfied with its action, but did not speak very enthusiastically about it. In 1892 a death was reported as having occurred during the employment of pental, but the evi- dence, so far as could be elicited, did not con- clusively prove that the anaesthetic was to blame in the case. In all these observers' hands the danger, such as was admitted, ap- pears to have been that incurred by heart fail- ure, although Ruth has expressly stated that respiration fails before the heart's action ceases. In the following case the patient was a woman aged twenty-three. She attended at the Dental Hospital in Devonshire Street, Chorl- ton-on-Medlock, for the purpose of having several teeth extracted. She was examined by the medical attendant who administers anaesthetics at that hospital, and was, in his opinion, in a fit state to undergo the operation and to take pental. This he administered, and she rapidly passed under its influence. After the extraction of five teeth her respira- tion ceased, and none of the means adopted to restore her succeeded. The dental student who had operated stated that there was no particular difficulty in the operation. Pental had been used by the anaesthetist for many patients, and he stated that he had never pre- viously met with any difficulty or danger. We are not told whether the patient was at the moment of extracting the fifth tooth resuming consciousness. If so, possibly the mechanism of death was similar to what so often occurs under chloroform. On the other hand, Hol- lander in his first paper spoke of his patients being analgesic rather than unconscious, as if there were no danger of reflex shock under this anaesthetic. This, of course, is a point of great importance. At present pental is on its trial, and the fullest information concerning the action of the drug is desirable; every acci- dent should be most carefully reported to see how far we can trust the favourable opinions so freely uttered about this substance, and how far Professor Wood is correct in his warning that 'pental will probably prove a most dan- gerous anaesthetic'" Dr. Prince Stallard, in a paper read before the London Society of Anaesthetists (Lancet, March 14. 1896; N. Y. Med. Jour., April 4, 1896), said that at the ordinary temperature of a room pental was so volatile that it was ne- cessary to administer it by the closed method, with the admission of as little air as possible. If it was dropped on to a piece of lint, as was usual with chloroform, a large quantity was required. In a hundred and forty-eight cases Clover's portable ether inhaler had been used. Two drachms of pental were poured into the reservoir, the indicator was placed at 0, and the patient was encouraged to fill the small bag with his expirations; the indicator was then turned rapidly but evenly to 3; rarely was it necessary to turn to F. Pental was thus given more rapidly than was advisable with ether, and attention had been directed to the absence of coughing, struggling, and fight- ing for breath, so characteristic of the latter drug when given alone without the previous use of nitrous oxide gas. No restriction had been placed on the patients with regard to diet, and in only one case had there been after- vomiting. The clothing should be quite loose around the throat and abdomen so that the thoracic and abdominal movements could be quite free. All the administrations had taken place at about 10 a. m. In all the cases the patients had been seated in a dental chair, the head having been placed in an easy position midway between flexion and superextension. The horizontal posture, said Dr. Stallard, would be much safer, as signs of cardiac failure had not infrequently occurred in the cases cited, for pental, in this respect, resembled chloroform. When this drug was inhaled the pulse was at first quickened, also the breathing, and then the pulse became fuller and bounding, with dilatation of the capillaries of the face, which was evinced by extreme flushing, similar to that observed when nitrite of amyl was in- haled ; swallowing movements were observed, but never any coughing or struggling; scream- ing might occur, and dreams of a pleasant na- ture were frequently experienced. Spasms, tonic and clonic, were occasionally present in the arms or in the legs. The lid reflex was usually present unless the anaesthesia was deep; when the patient was deeply under the influ- ence of the drug the pupils were dilated and the eyeballs turned upward under the upper lids, and, in some cases, the conjunctival ves- sels were prominent and congested; the arm when raised dropped helplessly to the side. At the height of anaesthesia the pulse became small, and might be running. There was no cyanosis or duskiness of the features, and ster- tor was very rare. Micturition and defecation had never been observed. Opisthotonos and twitchings of muscles had been noted in a few cases, the patients having generally been tran- quil. The breathing could hardly be heard ; this, said the author, constituted one of the dangers, and, in this respect, pental again re- sembled chloroform. Recovery was extremely rapid, and was not followed by any stupor or drowsiness. As a rule, there were no after- effects; the patients felt quite well three minutes after the removal of the face-piece, and were able to walk out of the house. One case onlv of vomiting had occurred and three or four of nausea; slight headache had been noted in a few cases, but this had rapidly passed off. The average time required to pro- duce anaesthesia had been fifty-six seconds, and the average anaesthesia obtained had lasted for seventy-six seconds. The preanesthetic stage had varied from thirty to one hundred and twentv seconds and the anaesthetic period from twenty-five to two hundred and ten seconds. The advantages maintained for pental, said Dr. Stallard, were: 1. Longer anesthesia than nitrous oxide gas yielded. 2. Simple appa- ratus. 3. No struggling, coughing, or dislike PENTANE PEPTOMANGAN 68 to the drug. 4. The small amount required, which averaged 2 drachms. 5. Rapid recov- ery. 6. The absence of after-effects. The dis- advantages were: 1. The insidiousness of its action—an overdose could easily be admin- istered. 2. Noiseless and shallow breathing. 3. Screaming. 4. The sudden cessation of respiration. 5. Sudden cardiac failure. Dr. Stallard said that he had frequently known decomposition of the drug to occur. With regard to albuminuria, he had examined the urine in twenty-five cases after its ad- ministration and found no albumin, but it must be remembered that all his cases had been short ones and the effect would not last long enough to injure the kidney. The fall of blood-pressure was marked. With regard to the length of anaesthesia obtained, he was of opinion that there was a marked personal fac- tor in many cases.]—Henry A. Griffin. PENTANE.—See Amyl hydride. PEPO (U. S. Ph.) consists of the seeds of the common field pumpkin. It has been very extensively employed as a teniafuge, and in many cases with gratifying results. Two ounces constitute an average dose. The seeds are bruised in a mortar or crushed in a coffee or spice mill and made with water into a sort of emulsion, the covering, or husk, being sep- arated by passing the mixture through a coarse sieve, although it has been advised that they also should be taken. The only drawback to its use is the considerable bulk of a dose, which may excite nausea in certain cases. If failure follows the first dose, it may be re- peated daily as long as the individual is will- ing. It is best taken in the morning, after the precautions mentioned in the article on Anthelmintics have been observed, and it should be followed by a laxative. No harm has ever followed the use of this remedy, and little seems to be known of the active agent in it. Fowls which have eaten the seeds and the soft portion of the fruit enveloping them are said to be affected with giddiness and a form of intoxication. An oil, an alcholic fluid ex- tract, and a resin are prepared which seem to vary considerably, as both successes and fail- ures have been reported as following their em- ployment. The fleshy portion of the pumpkin has also been used, but it seems to be less efficient than the seeds.—Russell H. Nevins. PEPPER, BLACK.—See Piper nigrum. PEPPER, CAYENNE.—See Capsicum. PEPPERMINT.—See Mentha piperita. PEPSIN (Br. Ph.), pepsinum (U. S. Ph., Ger. Ph.).—What is known under this name is by no means the pure gastric ferment, a body having the property of converting proteids into peptones, but is a mixture of that sub- stance and various bodies derived from the mucous membrane of the pig's stomach, from which it is prepared. These latter are insep- arable from the true pepsin and are present in varying proportions, depending upon the care with which the processes of manufacture have been conducted. The purest samples oc- cur as a yellowish-white or white powder, either amorphous or somewhat grainy or scaly. They have a slight acid or saline taste and should be free from any unpleasant odour. Pepsin is soluble in 100 parts of water, but the addition of small amounts of hydrochloric acid renders it soluble in less than half that quantity. Many samples, while agreeing in appearance with those known to be active, are entirely in- ert, having deteriorated by keeping or having always been destitute of the slightest pepto- nizing powers in consequence of lack of care in their manufacture. The U. S. Ph. calls for a pepsin which will completely digest—that is, render soluble—at least 3,000 times its own weight of the finely divided white of a hard-boiled egg when combined with 1,000 times its weight of a 2-per- cent, solution of hydrochloric acid and main- tained for six hours at a temperature of not less than 100-4° or more than 104° F., the ves- sel in which it is contained being gently agi- tated every fifteen minutes. At the end of the given time little or no residue should be observed, but a few thin flakes of the coagu- lated albumen need hardly be regarded. The Br. Ph. requires that it shall dissolve 50 times its own weight of finely sifted coagulated albu- men in thirty minutes when combined with a solution of 5 minims of hydrochloric acid in 1 oz. of distilled water and subjected to a tem- perature of 154° F. For practical purposes the latter test is the most readily applied, and is one which should be made in all cases save when the most satis- factory evidence is presented as to the activity of the sample to be prescribed. In accordance with the variations in the methods of preparation, three varieties of pep- sin are found—one form entirely soluble in water, another soluble in slightly acidulated water, and a third insoluble in either. There is but little difference in the activity of these varieties, but the insoluble variety is the most permanent and is but little liable to decomposition. The soluble specimens, when dissolved in water, are apt to spoil rapidly, and their solutions, when possessed of any un- pleasant odour, are unfit to use. The addi- tion of not over 20 per cent, of alcohol renders these solutions fairly permanent, although the activity of the pepsin is somewhat impaired. What is known as "crystal pepsin" is practically the substance obtained by the self- digestion of the gastric mucous membrane of various animals, which is dried in thin scales and sifted so as to give it a crystalline ap- pearance. It is usually quite active, but is not superior to the varieties prepared in the ordi- nary ways. No matter what precautions are exercised in the preparation of pepsin, it is undoubtedly true that there is a great dif- ference in the activity of the different lots turned out by the same manfacturers, and often that made by those of indifferent reputation is entirely inert. Consequently it is of the high- est importance that a reliable brand should be selected. Unfortunately, nearly every drug is incom- patible with this substance, the most notable 69 exceptions being codeine, bismuth subnitrate (which retards but does not diminish its activ- ity), strychnine, nux vomica, lactate of. iron, and lactic and hydrochloric acids. To obtain its maximum effects, it should be used in con- nection with either of the two last named, and nux vomica or strychnine may be advanta- geously added when a stomachic tonic appears to be indicated. Codeine or the bismuth salt may be added when gastralgia is a prominent symptom, and the latter when diarrhea is present. Of the numerous vehicles for the preservation and administration of pepsin, glycerin is by far the best, and there is little reason for the employment of any other, al- though milk sugar is unobjectionable except when its presence in the stomach would be injurious. Saccharin has been suggested as a diluent, but there would seem to be no particu- lar advantage in its employment. It is well, however, to note its perfect compatibility, as the simultaneous administration of the two might be convenient in diabetes. As pepsin is only active in neutral or acid solutions, alkalies of any kind should not be administered with it or for some time after it has been taken. Exactly what takes place when it is combined with pancreatin is not well understood, but theory indicates that, as the one requires an acid medium to bring out its full effect, and the other an alkali, little benefit would be gained from their mixture. A number of preparations exist in which the two are found and from which good results have undoubtedly been derived, but there seems to be reason to believe that either the pepsin or the pancreatin alone would have been as effectual. As a rule, it is best to administer pepsin shortly after eating and before the food passes from the stomach into the intestines. In ad- dition to its peptonizing effect upon proteids it appears to act as a stimulant of the mucous membrane of the stomach, thereby increasing the natural secretions of that organ, and by some it is maintained that its beneficial action depends more upon the latter property than upon the former. The doses ordinarily given are inadequate, and many of the failures im- puted to it are undoubtedly due to this fact. It is safe to say that in conditions where it is ur- gently demanded not less than 30 grains of the average article should be administered. The conditions in which pepsin is indicated are dyspepsia, with a sense of weight in the stomach after eating and eructations, vomiting of undigested food, lienteric diarrhea, espe- cially in children, the indigestion of phthisis, mucous gastritis, atonic dyspepsia, and cancer and ulcer of the stomach. It is also very use- ful in the convalescence from acute diseases- and in infants after weaning until the stomach has become accustomed to its new conditions. In some obscure cases of indigestion it may be necessary to adopt the procedure of testing the secretion of the stomach before it can be determined that there is a deficiency in the secretion of pepsin. This is performed by ob- taining a specimen of the gastric fluid by a stomach-bucket or an oesophageal tube. After PENTANE PEPTOMANGAN careful straining, the specimen is divided into four equal parts, to one of which pepsin is added, to another pepsin and hydrochloric acid, to the third hydrochloric acid alone, while to the fourth nothing is added. To each por- tion an equal bulk of coagulated albumen is added and the solvent effect of each is noted, the temperature of all of them being main- tained a trifle over 100° F. In this wav it can easily be determined whether the gastric juice is normal or whether pepsin or hydrochloric acid or both are lacking. The procedure is one which is rather unpleasant to the person from whom the specimen is obtained, and is only indicated in aggravated conditions. A peptonized milk may be prepared, which may be used as a nutrient enema or for intro- duction into the stomach through the oesopha- gus or a fistula, by digesting 1 oz. of milk for an hour at a temperature of 100° F. with 5 grains of pepsin and 4 drops of hydrochloric acid. The product should be clear, and must be neu- tralized with a small amount of sodium car- bonate. Meat and other albuminoids may also be treated in the same manner, but they are not very palatable and are hardly to be used except in desperate cases or in the same manner as the peptonized milk. For the removal of the exudation of diph- theria, solutions of pepsin are sprayed into the throat, and often very great temporary re- lief is obtained, the effect, however, being purely local, so that the general constitutional treatment is not to be neglected. Similar so- lutions may be applied to unhealthy suppurat- ing surfaces with a view to dissolving the superficial morbid tissues. Saccharated pepsin, pepsinum saccharatum (U. S. Ph.), contains 1 part of pepsin to 9 parts of milk sugar. Unless that diluent is objectionable, it may be used in nearly all cases in which pepsin is indicated. In conclusion, it may be stated that the greatest care should be taken that the purest possible brand is dispensed, and all tablets, troches, etc., are to be rejected. Nearly all of the elixirs and wines are inert, although, as already stated, a weak wine is entirely com- patible with pepsin. The best vehicle is glyc- erin, and in all cases, except those of infants, lactic or hydrochloric acid should be given simultaneously.—Russell H. Nevins. PEPTOMANGAN, liquor mangano-ferri peptonatus, is a liquid peptone preparation containing iron, manganese, and a small per- centage of alcohol. Each half ounce contains the equivalent of 3 grains of metallic iron and 1 grain of metallic manganese. It is essen- tially a drug in its characteristics and in no sense a food. It occurs as a transparent, dark sherry-red liquid, of a slight agreeable odour and "taste. It is neutral in reaction, non- astringent, and miscible with water, milk, or any wine free from tannic acid. It is used especially in the anemia of rhachitis, chloro- sis, and phthisis. Von Ruck reports its use in two series of cases of pulmonary tubercu- losis. In the first series of twelve cases, with a single exception, after the use of this drug PEPTONIZED MILK PHENACETINE 70 the haemoglobin increased materially. The smallest amount of increase was 3 per cent,, the largest 46 per cent., while the red blood- corpuscles showed in different patients an in- crease ranging from 33,000 to 1,990,000. Each of these patients had been receiving the ordi- nary iron mixture previously, but had gained comparatively little in either haemoglobin or corpuscles. Especially good results have also been reported in chlorosis and rhachitis. It is believed .that in certain forms of anaemia man- ganese as well as iron is of material advantage, as it is fully demonstrated that this element occurs in the blood. The dose of peptoman- gan is a tablespoonful three or four times a day. It may be given alone, as it is not un- palatable. It may be diluted, if desired, with milk or water, or may be administered in any sweet wine free from tannic acid. [Dr. Hugo Summa, of St. Louis (N. Y. Med. Jour., Feb. 9, 1895), who has used Gude's pep- tomangan extensively in doses varying from a teaspoonful to a tablespoonful, in sherry or milk, three times a day, an hour after meals, reports excellent results in chlorosis and ane- mia. Dr. Summa lays stress on the fact that this preparation does not give rise to constipa- tion.]—Floyd M. Crandall. PEPTONIZED MILK.—See under Milk. PERMANGANATES. — Potassium per- manganate, potassii permanganas (U. S. Ph., Br. Ph.), kalium permanganicum (Ger. Ph.), is a highly oxidized salt, and, parting with its oxygen with great readiness, is of considerable value as a deodorizer and disinfectant, but its relatively high cost and the property it pos- sesses of imparting a red stain, removable by oxalic acid, prevent its extensive employment. It may be advantageously used to disinfect or deodorize ulcerating surfaces from which of- fensive odours are given off, as in hospital gangrene, carbuncles, etc., and as an injection in otorrhea, ozena, or leucorrhea. Its effects, however, are rather transient and it must be used oftener than the other disinfectants em- ployed in the conditions mentioned. Solutions of 1 grain in 1 oz. of water are often employed to overcome the axillary odours and those arising from sweaty feet, also as a tooth-wash. The ordinary strength of a solution for ap- plication to wounds, etc., is from 5 to 10 grains to the ounce of water. Stronger solutions act as stimulants, and are often employed upon raw surfaces where a stimulating effect is de- sired. Occasionally the finely powdered salt is sprinkled upon unhealthy wounds, etc., with the result of obtaining a mild escharotic effect. Condy's fluid, or solution, is an aqueous so- lution of this salt to which aluminium sulphate is added under the belief that it greatly pro- motes the oxidizing effect of the permanganate. It may be employed for the same purposes as an extemporaneous solution. Internally, the permanganate has been used in the treatment of scarlet fever and of diph- theria, the throat being sprayed or swabbed with a 1-per-cent, solution. It has also been employed in all the so-called zymotic d seases, especially erysipelas, puerperal fever, and sep- ticemia, but its efficacy in these affections is denied by many. In the treatment of the bites of poisonous reptiles and rabid animals it was long ago brought forward as almost a specific, but the evidence for and against its employment is rather conflicting, so that it would be wise neither to trust to it alone nor to neglect it if it is at hand, the wounds at the same time being washed out with a 4- or 5-per- cent, solution. In delayed or arrested menstruation, espe- cially in young women and those affected with anemia, it appears to be of considerable value. From 1 to 2 grains are to be given three times a day, and the doses are to be continued for two or three days after the establishment of the flow. It is also said to assist in the re- moval of fatty tissue, and has been vaunted as a cure for obesity. In some forms of flatulence, especially that occurring in the obese, it has been used with good effects, and by some is esteemed highly in lithiasis, in which it seems to be more effectual when inclosed in capsules which do not dissolve until they enter the in- testines. It is of importance that potassium perman- ganate should not be combined either in solu- tion or in substance with organic matters, as it is rapidly reduced in their presence, and spon- taneous combustion is said to have sometimes occurred. When it is administered in the pill form, which is by far the best form for its use, kaolin and vaseline are the best excipients, or it may be compressed into pills. The usual dose is 1 grain, although the size of the dose may be as large as 4 grains without any ill results. The liquor potassii permanganatis (Br. Ph.) is a solution of 4 grains to the ounce of distilled water. It may be given in doses of from 2 to 4 fl. drachms. All solutions and the salt itself should be kept in tightly closed receptacles and in a dark place. [For further information concerning potas- sium permanganate, see under Manganese, vol. i, pages 596 and 597, and under Opium, vol. ii, page 44.]—Russell H. Nevins. PEROSMIC ACID.—See Osmic acid. PEROXIDE OF HYDROGEN. — See Hydrogen dioxide. PETROLATUM.—See Vaseline. PETROLEUM, or the mineral oil which occurs in many parts of the world, varies in colour from a light green or red to black, and has a distinctive odour which in certain varie- ties is highly offensive on account of the pres- ence of numerous sulphur and phosphorus compounds. It is more largely used in the arts than in medicine, but enjoys some repute, more especially in domestic medicine, as a local application in the treatment of rheuma- tism, pulmonary affections, chilblains, and other conditions in which a moderate degree of irritation of the skin is desired. Combined with oil of turpentine, linseed oil, and the oils of amber and juniper, it constitutes "British oil," a rubefacient liniment, more employed in veterinary medicine than in practice on the human subject. Under the name of '• Seneca " oil it was at one time regarded as a specific in PEPTONIZED MILK 71 PHENACETINE phthisis, but beyond producing a slight expec- torant effect it is of little value. Tapeworms are said to have been expelled by doses of from 20 to 40 drops given three times a day. Petroleum has been substituted for vaseline in the treatment of psoriasis, and may be used in the treatment of scabies. It is somewhat antiseptic, but is rather too offen- sive to be used except upon animals. In poultry houses and dovecotes it is probably the best agent that can be found for the de- struction of insects, the woodwork, etc., being painted with it from time to time. Refined petroleum, or kerosene (q. v.), is highly esteemed by many ignorant persons as a uni- versal remedy, but is probably without any ef- fective therapeutic action except as an irritant of the skin.—Russell H. Nevins. PETROSELINUM, or parsley, Apium Petroselinum, is largely used for culinary pur- poses, and from a medical standpoint is chiefly interesting on account of its being the source of apiol, which possesses all the virtues as- sumed to exist in the plant, and is to be pre- ferred on account of its smaller bulk. The fresh root is reputed to be laxative and diu- retic, and the herb itself antiperiodic. The seeds are thought to be aidiperiodic and em- menagogue, and play a more or less important part in domestic medicine. They are probably more active than any other part of the plant. They may be given in doses of half a teaspoon- ful. (Cf. Apiol.) [Fresh parsley, steeped in vinegar and eaten immediately after eating onions, is useful in removing the offensive odour of the breath.] Russell H. Nevins. PHELLANDRIUM.—The fruit of Phel- landrium aquaticum, the water-hemlock, was formerly official in various pharmacopoeias, and was esteemed a useful sedative in the treatment of cough, also tonic and stomachic. From 5 to 8 grains may be given three times a day, and the dose may be gradually increased to "15 grains. In large doses, the drug is said to be a narcotic poison. PHENACETINE, phenacetinum (Ger. Ph.), was first prepared by Hinsberg, chemist of the colour factories of Bayer & Co., in Elberfeld,and was first subjected to trial by this author, with Kast and Freiberg, in 1887. Soon afterward its value as an antipyretic was demonstrated at Bamberger's clinic in Vienna. Phenacetine, C6H4 N—C8H4—OC2H5. It is said to CI I,—CO have been used in several of the Italian uni- versity clinics as an antipyretic and in the treatment of acute rheumatism, in daily amounts of from 15 to 45 grains. The usual statement is made that no bad effects have been noticed from its use, but prudence seems to dictate that we should refrain from employ- ing it in practice until we have further infor- mation concerning its action. PYRAZINE, PYRAZOL, PYRAZO- LINE, PYRAZOLONE.—These derivatives of pyrrol have had various formulas assigned to them. According to A. H. Allen (Pharm. Jour, and Trans., 1890; Am. Jour, of Pharm., 1892), they are as follows : Pyrazine, HNJ^^J. Pyrazol, HN | £• ^ / . Pyrazoline, HN -J 'U-rl pjV [. Pyrazolone, HN - "j ,A p^,' I, These substances have been proposed as anti- pyretics, but Dr. Cerna says of pyrazol that it lacks antipyretic properties, but has been used as a diuretic. He gives the dose as from 15 to 30 grains. It is doubtful if any of these compounds will take a lasting place among remedies; certainly they can not now be said to have got beyond the experimental stage. PYRETHRUM (U. S. Ph.). pyrethri radix (Br. Ph.), or pellitory, is the root of Anacyclus Pyrethrum. It is of little importance from a medical standpoint. When chewed, it acts as a sialagogue and stimulant of the mucous membrane of the mouth, and has been em- ployed in headache, toothache, paralysis of the tongue, and relaxation of the soft palate. From 20 to 60 grains may be used. In the shape of a tincture, tinctura pryethri (U. S. Ph., Br. Ph.), it is employed by dentists to re- lieve toothache and to add a local stimulating effect to tooth washes. The flowers of Pyrethrum Parthenium are often substituted for chamomile flowers, and apparently with as good results. Pyrethrum carneum and Pyrethrum roseum furnish the Persian or Caucasian insect pow- der of commerce, and Pyrethrum cinerariefo- lium, the Dalmatian variety, which is rather more active than the others. It occurs as a yellow or yellowish-brown powder, and is the most valuable insecticide known, as it is without any poisonous effects upon man or the higher animals, at least in the quantities commonly employed. It is not very rapid in its action, first stupefying or intoxicating the insects which come in contact with it, but death ordi- narily follows in a short time. Upon the eggs it appears to have but little effect, and on that account is less efficient than mercurials for the destruction of bedbugs and roaches. Upon ants it seems to have rather less effect than upon the other insect pests of the household. It is of importance that it should be as widely disseminated as possible, and for this purpose a bellows is a very convenient appliance. One specially adapted for the purpose may be found nearly everywhere. In beds infested with bugs PYRETINE PYROZONE 110 the powder may be scattered over the bedding as a temporary measure, and rarely causes any inconvenience beyond in some instances a slight and temporary irritation of the skin. A small quantity sprinkled on hot coals will clear a room of flies or mosquitoes, and it is proba- ble that for several hours the entrance of others will be prevented. Pastils are made, contain- ing small quantities of nitre, which may be employed in the same manner. In kitchens and other places where flies are abundant it may be scattered around at night, the apart- ment being tightly closed until morning, with the result of killing all there are present. A solution of from 20 to 30 grains in half a gal- lon of water is very suitable for spraying upon plants infested with insects, but its expense renders its range of usefulness rather limited. A 20-per-cent. alcoholic tincture, diluted as de- sired and applied to the body, is very effectual in keeping fleas, etc., from remaining upon the person. Dogs, cats, and other animals infested with fleas may be relieved of them by a thor- ough dusting, but it is wise to select some spot remote from the dwelling to do this in, and if possible a sandy spot upon which the sun shines brightly is the best, as the dry heat insures the death of the insects; as a matter of fact they are unable to endure exposure to the naked rays of the sun. Fowls may be treated in the same manner, being held head down- ward in a barrel and the powder sifted among their feathers. Poultry houses, pigeon lofts, etc., may be freed of vermin by its liberal and frequent employment. It is hardly necessary to specify every purpose to which it may be applied, but in addition to the foregoing it may be employed in cabinets for furs and woollen fabrics, and in almost every place where insects destructive to such objects are found. The recently introduced buffalo bug, which is so destructive to carpets and rugs, appears to be but little affected by it. Carbon bisulphide, naphtha, and similar petroleum products are almost the only agent effective for their destruction. It is of great importance that insect powder should be fresh, as it loses its virtues on keeping. Much of it is inert and worthless.—Russell H. Nevins. PYRETINE, an American proprietary an- tipyretic and analqetic, is said to be a mixture of acetanilide, caffeine, calcium carbonate, and sodium bicarbonate. It has not come into general use. PYRIDINE is a basic substance obtained from bone oil. coal tar, naphtha, and other organic materials by distillation. It also oc- curs in tobacco smoke, a fact which has led some observers to credit it with the remedial action tobacco smoking has in asthma. When pure, it is a colourless, volatile liquid with a powerful and persistent empyreuraatic odour and a pungent taste. It is freely miscible with water, alcohol, ether, chloroform, and fatty oils. Its formula is C5H6N. With acids pyri- dine forms crystallizable but unstable salts. Although the physiological action of pyridine has not been exhaustively studied, it would seem that it is an agent of most vigorous action. Locally applied, it is antiseptic. Given in small doses, according to De Renzi, it stimu- lates cardiac action and raises the blood- pressure. This action on the blood-pressure, however, is denied, and many maintain that the blood-pressure is lessened by it. Inhaled, it diminishes bronchial spasm when that is pres- ent, and experiments upon animals show that it quiets irritability of the respiratory centre. In large doses, however, the drug is actively poisonous, causing cyanosis and muscular feebleness and paralysis from action upon the motor centres and nerves. Death may result from respiratory paralysis. The chief therapeutical employment of py- ridine is in the relief of bronchial asthma. The treatment was introduced by Germain See. A drachm of the drug is exposed in a saucer in a small room, the patient remaining in the room and inhaling the pyridine-charged atmosphere for a period of from fifteen to thirty minutes several times a day. Although the treatment is exceedingly disagreeable, be- cause of the offensive odour of the drug, it is said that much relief follows its use, the respi- rations becoming free and the disease often subsiding after a number of exposures to the treatment have been endured. Instead of in- haling pyridine thus, a solution containing from 5 to 20 drops in 2 oz. of water may be respired by atomization, or a few drops may be directly inhaled. Angina pectoris is said to be benefited by the internal use of pyri- dine, from 5 to 10 minims being taken daily and the dose gradually increased until 25 minims are taken in a day. In cardiac en- feeblement it is said to exercise a beneficial effect, and has even been thought a substitute for digitalis. The antiseptic action of pyridine may be made use of in the treatment of gonor- rhea, an injection of a watery solution (1 to 300, or even stronger) being employed. Henry A. Griffin. PYROACETIC ETHER or SPIRIT.— See Acetone. PYRODINE.—See Hydracetin. PYROGALLIC ACID, PYROGALLOL (U. S. Ph.), PYROGALLOLUM (Ger. Ph.), is a trihydroxylbenzol with the formula C6H603. When gallic acid is heated to subli- mation it is decomposed and carbonic acid and pyrogallol are formed. The latter substance occurs in long, flattened, prismatic or needle- like crystals, very light in weight, of a pearly colour, bitter to the taste, soluble in from 2| to 3 parts of water and also in alcohol and in ether. It fuses at 239° F. and boils at 410° F. It is a strong reducing agent. A watery solution of it, with soda or potash, as well as the moistened crystals themselves, becomes soon of a reddish or dark-brown colour from oxidation, and it readily reduces the salts of mercury, silver, gold, and platinum. Pyro- gallic acid is largely used in connection with nitrate of silver in photography, and also in the compositions of hair dyes and marking inks. To its property as a reducing agent are chiefly ascribed also its therapeutic effects. Pyro- gallic acid had seldom, if ever, been employed Ill PYRETINE PYROZONE in medicine prior to 1878, when Jarisch first introduced it as a remedy for certain cutaneous diseases. The diseases for which he especially recommended it were psoriasis and lupus, but it has also been found of more or less value in parasitic diseases, such as eczema marginatum, in epithelioma, and in simple chancre or phage- dena. In psoriasis it is generally admitted to be of considerable value when applied locally. It acts with less energy upon the disease than chrysarobin, which in many respects it resem- bles, but is more energetic in its action than tarry preparations. It is odourless and but slightly irritating to the skin (rarely causing the dermatitis that so often follows applica- tions of chrysarobin). It is often preferable to chrysarobin where the skin does not tolerate the latter, as upon the face, or in individuals with unusually vulnerable or sensitive skins. It does, however, cause irritation at times, pro- ducing considerable pruritus and occasionally follicular papules or pustules, which may re- quire a temporary suspension of its use. It stains the skin and clothing only slightly less than chrysarobin. A more serious objection to its use when incautiously employed, so as to permit considerable absorption, lies in the fact that it may give rise to grave toxic effects. Attention "was first called to this danger by Neisser, who reported a case of fatal intoxica- tion following inunctions of one half the body with a 10-per-cent. ointment, the surface hav- ing afterward been covered by gutta-percha tissue and a bandage. The symptoms began in two hours after, with rigors, diarrhoea, vom- iting, and strangury. The next day the urine was very dark-coloured from the presence of haemoglobin; all the symptoms became aggra- vated, with apathy, dyspnoea, exaggerated re- flexes and collapse, followed by death two days later. The cause of death was stated to be decomposition of the blood with haemoglobinu- ria and nephritis haemoglobinurica. Though pyrogallic acid is a more dangerous remedy than chrysarobin to the general economy, when applied to limited areas there is probably little to fear from it. It would be especially objection- able in a case of psoriasis attended with much excoriation or eczema, or in that form which approaches the character of an exfoliative dermatitis. The mode of its employment in psoriasis is similar to that of chrysarobin. A 10- to 15-per-cent. ointment is thoroughly rubbed into the affected areas. The ointment is preferable to preparations with traumaticin or gelatin, as well as to plasters. On the first indication of gastro-intestinal disturbance, strangury, or smokv urine, the remedy should be at once discontinued. In case of decided toxic symptoms Neisser recommends subcutaneous injections of ether, alcoholics frequently re- peated, energetic stimulation of the surface, and the inhalation of oxygen. In lupus pyrogallic acid has proved itself a remedy of no little value. It is especially suited to the more superficial forms. It acts on continued application as a mild escharotic, and, while it has but little effect upon the epi- dermis, it has a selective action upon the diseased subepidermal tissue, in this respect resembling the action of the arsenical pastes. The rapidity of its action is increased when the epidermis is intact by first applying a moderately strong solution of caustic potash. An ointment of the strength of from 10 to 20 per cent, is applied on lint and covered with a piece of gutta-percha tissue, which may be made to adhere to the surrounding skin by moistening its edges with chloroform. The applications are renewed daily and continued for from two to seven days or until the lupus patch has become converted into a gray pul- taceous mass, when the pyrogallic acid is replaced by an ointment of iodoform or the emplastrum hydrargyri. This treatment is repeated at intervals so long as any lupus tu- bercles are apparent, The scars left are smooth and supple. Besnier uses a saturated solution of pyrogallic acid in ether, which is brushed over the lupus patch and covered in with traumaticin, repeating the applications as above described. Brocq prefers a solution of pyro- gallic acid with salicylic acid (10 per cent, of each) in collodion. Epitlielioma of the skin has been treated successfully with pyrogallic acid employed ac- cording to the same methods as those recom- mended for lupus. In chancrous ulcerations Vidal has found this remedy efficacious. For simple chancre he used a salve consisting of 1 part of pyrogallic acid in 4 parts of lard or vaseline, and for phagedena a powder composed of pyrogallic acid and starch in the proportion of one to four.—Edward Bennet Bronson. PYROGLYCERIN.—See Nitroglycerin-. PYROLIGNEOUS ACID.—This is an impure acetic acid, obtained by the destructive distillation of wood. It is the source of the acetic acid of commerce and of the pure acetic acid of the pharmacopoeias. Crude pyroligne- ous acid, acetum pyrolignosum crudum (Ger. Ph.), and the rectified acid, acetum pyroligno- sum rectificatum (Ger. Ph)., are used topically for the same purposes as acetic acid(g. v.), PYROXYLIN (Br. Ph.), pyroxylinum (U. S. Ph.), or gun cotton, is official only be- cause it is used in the preparation of collodion. PYROZONE.—This name was at first ap- plied by an American firm of manufacturing pharmacists, Messrs. McKesson and Robbins, of New York, to a thick syrupy liquid consist- ing of pure hvdrogen dioxide, from the fact that when a fluffy fabric of silk or the like was saturated with the liquid and warmed slightly it took fire and burned "furiously, as sub- stances do in oxygen, presumably producing both fire and ozone " (Coblentz). Pure pyrozone speedily undergoes decompo- sition ; hence it is furnished in solutions of certain standard strengths. The 3-per-cent. solution in water corresponds in strength to the aqua hydrogenii dioxidi of the U. S. Ph., and is said to be purer and more stable than that preparation; also to admit of concentra- tion by evaporation without appreciable loss of hvdrogen dioxide. The use of this solution is QUASSIA QUININE 112 the same as that of hydrogen dioxide (see vol. i, page 503). The 5-per-cent. solution in ether and the 25- per-cent. solution in ether have been found to be exceedingly efficient stimulating and caustic applications, particularly valuable in checking suppuration, notably that of pyorrhea areo- laris. QUASSIA (U. S. Ph.), quassie lignum (Br. Ph.), lignum quassie (Ger. Ph.), is the wood of Picena (Quassia) excelsa, a tropical and semi- tropical tree. It is a simple bitter tonic which appears to have no injurious effects upon the economy unless it is taken in enormous doses, when it" acts as an irritant of the mucous mem- brane of the stomach and as a nauseant. It is a very useful bitter in all cases of lack of ap- petite and atony of the stomach, and is particu- larly applicable in malarial affections in which a stomachic is desirable. Its action_ depends upon a principle, quassiin, or quassin, which may be substituted for the drug or its prepara- tions in doses of £ a grain. The wood readily imparts its properties to cold water, and cups are made of it in which water is allowed to stand for two or three hours, or until it becomes distinctly bitter, and then drank. This method of administering it used to be quite common and is a very useful one, as the cups retain their properties for a long time and are always ready for use, The extract, extractum quassie (U. S. Ph., Br. Ph.), may be given in doses of from 1 to 2 grains. It is perhaps to be pre- ferred to the other preparations because, bulk for bulk, it contains a larger amount of the bitter-tonic principle than any of them. The fluid extract, extractum quassie fluidum (U. S. Ph.), is also a powerful preparation; it is used in 5- to 10-drop doses. The infusion, infusum quassie (Br. Ph.). possesses all the properties of the drug, but is somewhat objectionable on account of the bulk of the dose, from 1 to 2 fl. oz. The tincture, tinctura quassie (U. S. Ph., Br. Ph.), is used oftener as an ingredient of tonic mixtures than by itself ; it may be given in doses of from 1 to 2 fl, drachms. An infusion of 2 oz. of quassia in a pint of boiling water, when of the proper temperature, is used as an enema for causing the expulsion of ascarides, and is very efficient. The same effect is said to be produced when quassia is administered by the mouth, but the enema is much surer. By macerating 10 parts of the wood in 50 of water for twenty-four hours and adding enough sugar or molasses to make the strained infusion somewhat syrupy, a mixture is formed which is very effectual as a fly-poison. It may be exposed on a plate, or on cloth or paper soaked in it and hung up. It is perfect- ly harmless.—Russell H. Nevins. QUEBRACHO, aspidosperma (U. S. Ph.), is the bark of Aspidosperma Quebracho, or quebracho bianco, so named from the light colour of its wood. The bark employed is col- lected from old trees after the corky layer is well developed. The first detailed description of the drug came from Penzoldt, who asserted that by its use some forms of dyspnea depend- ing upon disturbances of the circulatory or respiratory apparatus could be diminished or entirely removed. He maintained that no deleterious effects were produced on other or- gans by its administration. Although the drug has a disagreeable taste, and occasionally causes nausea or diaphoresis, or salivation after its ingestion, there seemed to him to be no lowering of the pulse-rate accompanying the diminished respiratory frequency (Die Wir- kungen Quebrachodrogin, Erlangen, 1881). Penzoldt believes that quebracho acts by in- creasing the power of the haemoglobin to take up oxygen, but he found that when it was given in an overdose the oxygen was retained in the blood and metabolism was diminished. Five alkaloids have been derived from que- bracho : aspidospermatine, which is believed to hold the active principles of all the other alkaloids; aspidosamine, quebrachine, hypo- quebrachine and quebrachamine. Of these, quebrachine is the one most frequently em- ployed. Aspidospermine, an impure mixture of the alkaloids, is sold in the market as a fluid extract and as a solid extract. The dose of the former is from i to £ a fl. drachm ; that of the latter, from 1 to 3 grains. Penzoldt rec- ommends quebracho in asthma accompanied by emphysema, even in the presence of pleurisy or bronchitis. He praises it, also, in bronchial asthma and in all cases of dyspnea arising from cardiac disturbances, in which compensa- tion is well established. In dyspnoea, however, due simply to a weakly-acting, diseased heart, it is not recommended, since it lacks the in- fluence of digitalis upon the ventricles. Flint gave quebracho cordial praise in all cases of dyspnoea, particularly when this symptom was caused by mitral insufficiency. In the absence of other organic disease, he used quebracho for the symptom dyspnoea (Med. News and Ab- stract, May, 1881, p. 273). The drug has been employed, also, for the relief of uremic dysp- nea, but it is to be doubted if it is as valuable in this emergency as other remedies; as a stom- achic tonic, it formerly enjoyed some repute. After prolonged use, quebracho seems to cause some disturbance of the sympathetic nervous system. Like many other drugs, quebracho has been recommended for the protection and stimula- tion of wounds; it has been superseded, of course, by other substances. The dose of the fluid extract, extractum aspidospermatis fluidum (U. S. Ph.), is from 15 minims to 1 fl. drachm. The non-official preparations of quebracho are a tincture and a wine. The dose of the former is from 10 to 20 drops ; that of the latter, from £ to 1 fl. drachm. Quebrachine, one of the most active of the alkaloids of quebracho, has been used instead of the original drug. It appears in the mar- ket as the hydrochloride and the sulphate, of which the dose is from 1 to 3 grains. Samuel M. Brickner. 113 QUASSIA QUININE QUERCUS.—See Oak bark and Acorns. QUICKLIME.—See under Lime (vol. i. p. 582). ^ QUICKSILVER.—See Mercury. QUILLAIA, quillaja (U. S. Ph.), cortex quillaie (Ger. Ph.), or soap bark, is the inner bark of Quillaia Saponaria, a rosaceous tree indigenous to Chile and Peru, and cultivated in northern India. It contains saponin, CJ8 H30Oio, by virtue of which it has the property of producing a froth when rubbed in the presence of water. It has been used topically to some extent as a detergent. The use of the powder as a sternutatory has been suggested. Kobert (Ctrlbl. f. klin. Med., July 25, 1885) has recommended quillaia as an expectorant. He says that it is five times as rich as senega in saponin, which he regards as its active prin- ciple ; that it is rich in sugar also, and is free from the substance to which the bad taste of senega is due; that patients tolerate it better than senega; that it seldom gives rise to vomiting and diarrhoea; and that it has a de- cided expectorant action. Kobert used a de- coction of the strength of 5 parts of quillaia to 200 of water, in tablespoonful doses for adults and in teaspoonful doses for children. These statements having been confirmed by Gold- schmidt, Maslovsky (Russk. Med., 1886, No. 36; Therap. Gaz., May, 1887) employed it in twelve cases, using the preparation recom- mended by Kobert, with the addition of syrup. Two of the patients had pulmonary emphy- sema, one had interstitial pneumonia with bronchiectasis, four had pulmonary tubercu- losis, one had pleuropneumonia, three had croupous pneumonia, and one had syphilitic stenosis of the right bronchus. Maslovsky con- cluded from his observation of its action in these cases that quillaia did not irritate the gastro-intestinal tract: that it increased the discharge of sputa; that it soothed cough ; and that, on the whole, it was preferable to senega as an expectorant, although it might give rise to an attack of haemoptysis if there was a tendency to that accident, in which case it was contra-indicated, and although in some cases of phthisis it might intensify the cough without facilitating expectoration. The tincture, tinc- tura quillaje (U. S. Ph.), is used almost wholly as an emulsifying agent; it may be given in- ternally in doses of from 5 to 25 minims. Powdered quillaia, mixed with sugar, may be given in doses of from 1 to 6 grains. It should be borne in mind that saponin is de- cidedly poisonous, acting as a paralyzer to the central nervous system, and that some caution is therefore necessary in the employment of quillaia. QUILLAIN.—See Saponin. QUINALGENE.—See Analgene and Bex- zanaloexe. QUINASEPTOL.—See Diaphthol. QUINCE-SEED.—See Cydonum. QUINETUM. — This preparation is de- scribed as a mixture of other cinchona al- kaloids than quinine in which cinchonidine predominates. It is soluble in water. It has been recommended, in doses of from 1 to 8 grains, as an antiperiodic in malarial affec- tions. QUINIDINE.—This is an alkaloid occa- sionally found in cinchona bark. It is isomeric with quinine. The alkaloid itself and the bi- sulphate, the citrate, the dihydrobromide, the hydrochloride, the sulphate, and the tannate have been employed. The sulphate, quini- dine sulphas (U. S. Ph.), may be given in doses half as large again as those of quinine, and for the same purposes. It is very bitter. The tannate is almost tasteless. It does not appear that quinidine has any advantages over quinine. QUININE is the principal alkaloid of the bark of the trees Cinchona flava, Cinchona pallida, and Cinchona rubra. To be accepted by the U. S. Ph., the barks must contain at least 5 per cent, of the total alkaloids and at least 2-5 per cent, of quinine. Associated with many other alkaloids, quinine exists in greatest abundance in the bark of Cinchona flava (yel- low cinchona). It is isomeric with quinidine and quinicine, the latter an artificial compound. Quinine was first separated and identified in 1820, although the bark had been in use in Eu- rope for nearly two centuries, and in South America from time immemorial. From a solu- tion of its salts, quinine may be precipitated as a crystalline hydrate by an alkali; after subse- quent dehydration, the alkaloid appears as a white, opaque crystalline mass. It is of an in- tensely bitter taste, and is but sparingly soluble in water, although it dissolves freely in alco- hol, in ether, in benzol, and in chloroform. To distinguish quinine from salicin, the former may be dissolved in concentrated sulphuric acid with the production of only a faint yel- low colour. Heated highly on platinum foil, quinine burns entirely, leaving no ash. The salts of quinine in solution have a beau- tiful blue fluorescence. They divert the polar- ized ray to the left. The salts vary as to their solubility. Thus the sulphate is but sparingly soluble in water, whereas the bisulphate and the hydrobromide and hydrochloride dissolve easily in water. This becomes of importance in the administration of the drug. Although the bark of the cinchona trees was introduced into Europe early in the seven- teenth century by the Countess Chinchon, who had been cured of an intermittent fever by its use in Peru, the influence of the Church was sufficiently strong to prevent its general use. And it was not until Jesuit missionaries later brought quantities of the bark to the conti- nent that its use, dictated by popular demand because of the cures it produced, overcame priestly prejudice. It has since then become one of the world's staple articles of commerce— * so much so that when the South American supply threatened to run short, successful transplantation was resorted to. As a physio- logical study of the drug, this extract from the Thesaurus novus experientie medice aureus (Basel, 1704) will prove of interest and most of it will bear the light of the present day: " On ac- count of its bitter taste, it is also known as QUININE 114 'earth-gall.' Supreme virtues exist in it when used in liver, spleen, and joint diseases, jaundice, and dropsy; for which purposes a powder [made from it] is mixed with anise-seeds and drunk in beer and wine. It induces the men- strual flow and restores a lost appetite. It rids the body admirably of pin-worms, if an infusion of it is spread on a cloth over the abdomen .... It is valuable above all in the treatment of tertian and quartan fever." Though old Helmont, the compiler, placed the most important indication of the drug last in his category, one can see that the indications which call "for quinine have not varied much in the last two hundred years. The alkaloid and its salts are used to-day for many phases of disease for which there is no more primary indication than in the ancient medical tale of our fathers. Rheumatism and typhoid fever were formerly the diseases cured specifically by quinine; and there are still many physicians who regard it as more than valuable in these ailments. Its efficacy in intermittent fevers is classical, however, and even fiction has helped to establish its permanency, as in Twenty Thousand Leagues under the Sea. In their physiological action, the alkaloid and its salts are so nearly identical that they will be considered together, only such pecul- iarities of each as recommend it for particular uses being specified. An enumeration of the officinal salts follows: Quinina (U. S. Ph.), qui- nine (Br. Ph.), is the alkaloid proper. Its recog- nised salts are : quinine bisulphas (U. S. Ph.), acid quinine sulphate (Br. Ph.), quinine hydro- bromas (U. S. Ph.), quinine hydrochloras (U. S. Ph., Br. Ph.), chininum hydrochloricum (Ger. Ph.), quinine sulphas (U. S. Ph., Br. Ph.), chi- ninum sulfuricum (Ger. Ph.), quinine valeri- anas (U. S. Ph.), and chininum tannicum (Ger. Ph.). In the U. S. Ph. there is also an officinal double salt, the citrate of iron and quinine, ferri et quinine citras (U. S. Ph., Br. Ph.), chininum ferro-citricum (Ger. Ph.), which contains 12 per cent, of quinine. Among other numerous salts of the alkaloid that have been praised for some virtue or other are the arsenite, the hydro- chloride with urea, the lactate, and the acetate. The bichloride of quinine is another salt but recently added to the long list of those that have been compounded for some special pur- pose. • In general, it may be stated that the effects of quinine, as manifested upon the body and its organs, depend upon the dose. Whereas small doses are stimulating and tonic in their influence, large doses administered to the same individual are sedative and depressing. Par- ticularly is this true of the circulatory and nervous systems, which respond well and quickly to the action of the drug. The various peculiar manifestations observed in the organs of special sense, in the cerebrum, in the skin, and in the internal organs may be summed up in the universal harbour of medical refuge— personal idiosyncrasy. Yet, though it is un- questionable that some individuals are more susceptible to the subtleties of this than to those of other alkaloids, it should never be forgotten by the physician that quinine is not an indif- ferent drug which can be administered regard- less of dose and of the personal element. While it would be perfectly safe, for example, to administer from 6 to 10 grains of quinine to an otherwise healthy woman who was at the same time pregnant and suffering from mala- rial disease, it would probably induce an abor- tion or miscarriage in a woman with intermittent fever whose general condition was deteriorated by excessive work and worry. Again, a man who required a stimulant tonic might do very well on a pill or a mixture containing quinine, or he might show such decided personal suscep- tibility to the drug that its withdrawal would be imperative. The personal element, then, is as important in the administration of the cinchona alkaloid and its salts as it is in that of any other drug which produces pronounced effects. In respect to the differences mani- fested by different alkaloids of cinchona, cin- chonine seems no less inert than quinine, but its action is not so prolonged or so intense. The symptoms of the condition known as cinchonism appear after the use of either, but in the case of cinchonine the familiar buzzing in the ears is not so early a phenomenon, but an intense frontal dulness accompanied by praecordial distress, subsultus tendinum, and faintness with other severe nervous manifesta- tions, appear. Indeed, it would seem that it requires a smaller dose of cinchonine to pro- duce a physiological effect than of quinine. The causation of cinchonism has been a puzzle to physiologists. Of its existence, how- ever, there is daily proof. There are few indi- viduals who have taken quinine in moderate doses for any length of time who have not ex- perienced some of the phenomena which mark its presence. Therapeutic doses of quinine (5 to 10 grains) produce the first symptoms. These are, usually, a buzzing or ringing, a feel- ing of fulness or heaviness or both in the head, and there may be partial deafness. If the drug is withdrawn, these symptoms disappear spontaneously. Should its use be continued or larger doses given, there is an exaggeration of the symptoms mentioned, with those of cerebral congestion. The deafness becomes almost complete, if not absolutely so; an amau- rosis is developed which may well be called toxic; the face is flushed, and there are de- cided giddiness and an intense feeling of dis- tention in the head. An ataxic gait may accompany the other functional disturbances. After the administration of more than a physio- logical dose, pronounced symptoms of poison- ing show themselves in rapid succession. At first there is a heaviness in the head, with tinnitus aurium ; then there are confused and disturbed trains of thought, followed often by delirium. If the dose has been sufficiently large, loss of consciousness, complete deafness, and blindness ensue. The sensibility of the skin disappears, and the limbs are powerless. Intense paresis, sometimes paralysis, follows. The respiratory movements are not free, and death may take place in coma or in delirium, usually with symptoms of asphyxia. The treat- ment of such poisoning is direct and indirect. If the patient is seen sufficiently early, gastric 115 QUININE lavage may be employed. If the systemic symptoms are already very pronounced, treat- ment must be directed toward them. The subcutaneous use of cardiac and respiratory stimulants is indicated, and all measures which tend to restore the flagging heart and circula- tion should be resorted to. Lesser degrees of poisoning by quinine evoke similar but not so intense symptoms, the difference being in de- gree only. The toxic dose is difficult to esti- mate ; 44 grains given in divided doses in fifty hours have caused death, and 12 grains are recorded as having caused amaurosis. In this, as in the therapeutic effect to be obtained, personal idiosyncrasy plays an important role. The deafness frequently following the use of quinine usually vanishes on the withdrawal of the drug. The blindness, however, may be permanent, but is frequently only temporary. Von Graefe, Gruening. and Knapp have re- ported cases of permanent blindness, and there are many cases recorded of temporary loss of vision. If a patient recovers from quinine poisoning, he is likely to have great muscular weakness for some days. The other symptoms gradually subside, with the exceptions above noted. The influence of quinine upon the cerebrum, the spinal cord, and the organs of special sense can in part be determined by a consideration of the phenomena of cinchonism. Other con- siderations, however, require a somewhat more detailed investigation into the action of the drug upon the various organs of the body. When quinine is given in small doses (6 to 8 grains), the tone and elasticity of the cerebral vessels are enhanced, which would probably account for the observation of Brown-Sequard that quinine increases the number of epi- leptic seizures. The disturbances of sight and hearing after the administration of the drug are believed to be due to a direct or indi- rect congestion of the peripheral sense organs, as animals poisoned by quinine are found to have great congestion of the middle ear and labyrinth. So severe may this congestion be- come and under such pressure may it exist that serous or even bloody exudation ensues. In a series of experiments to determine the lesion in quinine blindness, De Sch weinitz (Oph- thal. Rev., February, 1891) found that the oph- thalmoscopic picture in dogs was similar to that seen in human beings with quinine amaurosis, blurring of the edges of the optic discs, and in one case obliteration of the vessels of the optic disc. In all, the pupils were immovably di- lated. In one case there was a decided dilata- tion of the blood-vessels, the central vein being plugged with a clot, and white thrombi filled the smaller veins. In the corneas were found dilatation of the circumcellular lymph spaces, and degeneration of the protoplasm of the cell. Proof seems to exist that the action of quinine upon the cortical centres is a stimu- lant one. Thus persons who have been in the habit of taking the drug for some time seem to feel less energetic and less active after its withdrawal. Although the influence of quinine upon the spinal cord and the peripheral nerves in man has not been scientifically demonstrated, it is well known that in lower animals it produces, in small doses, lessening of reflex activity and, in larger doses, paresis of the reflex centres, which is usually permanent. It would seem that similar influences are produced upon the central and peripheral systems of man, for re- flex disturbances whose origin may be in the cord or in the cortex are inhibited by the judi- cious use of quinine. It is true that this result may be called forth by a stimulation of the inhibitory centres, but the influence of toxic doses upon the gait, producing as they do ataxic movements, would seem to imply an impairment of the reflex arc. The safest state- ment that can be made in the light of our present knowledge is probably that upon the spinal cord quinine has the same general effect as upon the body at large : in small doses it is stimulant; in larger, still therapeutic doses, it has a sedative effect. Upon the stomach and intestines quinine acts, in small or moderate doses, as a simple bitter. Gastric digestion and the production of gastric juice seem to be favoured by its ad- ministration. Given for a long period of time, it is apt, however, to bring about a catarrhal gastritis, and, when administered in too concen- trated a form, it is very irritating to the gastric mucous membrane. Nausea and even vomiting sometimes follow its introduction into the stom- ach. A constipating effect is sometimes ob- served after the early use of the drug, which is subsequently superseded by diarrhoea, These effects are undoubtedly local, due to liberation of the tannic acid which is innate in the alka- loid. When introduced into the rectum in somewhat larger doses than usual, quinine produces its physiological effects upon the organism ; but frequently it is so irritating to the rectal mucous membrane that it can not be administered in this manner. Its absorp- tion from the alimentary tract is hastened by previous purgation, and in this instance the catharsis is best accomplished by mild meas- ures, hydragogues and cholagogues being con- tra-indicated. That quinine is readily dissolved by acids and precipitated by alkalies is well known. Thus the acid gastric juice renders it suitable to be absorbed from the intestinal mucous membrane, while the intestinal juices are apt to cause its precipitation. It has been shown that when a quinine salt passes unchanged into the intestine it is removed from the body with the faeces in the form of insoluble com- pounds. It would naturally be supposed, there- fore, that the alkaline blood would also cause its precipitation : but it is known that the gases of the blood, in some chemical manner, hold the quinine in solution. The alkaloid, however, is not deprived by this suspension of its power upon the blood-cells. It is dif- ficult to arrive at a satisfactory conclusion as to its effect upon the white corpuscles; some experimenters declare that leucocytosis follows its use, while others say that the white cells are diminished in number. If it is true, as is alleged for it, that quinine has a phagocytic action, enabling it to decrease suppuration, it QUININE 116 would seem likely that those who favour the view of leucocytosis are correct. Upon the red cells it is probable that the effect is to diminish their number to a slight degree, though the form of the red cells, according to the greater number of observers, remains un- changed. That the quinine solution, through its ability to modify or even destroy proto- plasmic structure, profoundly influences the contents of the blood-cells, is not in doubt. By the use of the drug the coagulability of the blood is diminished, and diapedesis and emi- gration—a " paralysis of the leucocytes "—are embarrassed. An effect upon the haemoglobin seems to be a diminution in its oxygen-carry- ing properties. The fall in blood-pressure after the admin- istration of quinine is due, unquestionably, to two causes: 1. To a dilatation of the periph- eral capillaries and smaller arteries. 2. To a diminution in the force of the heart-beat. The former effect may be a local one, but it is more probably due to a slight paresis of the vaso-inhibitory centre. The action upon the heart is caused by the influence of the drug upon the heart muscle or its resident gan- glia. The pulse, naturally, shows variations which correspond to the degree of these changes, which, in the use of therapeutic doses, are gradually brought about. Poisonous doses succeed in paralyzing the heart muscle after having first rendered its beat very rapid with much diminished force. Small, tonic doses of quinine act as a stimulant to the cir- culatory as to the nervous system. After its absorption into the blood and when it is not excreted in the faeces, quinine is eliminated principally through the kidneys. It can be found in the urine shortly after its introduction into the system, though it takes some hours for the total quantity to be ex- creted. A peculiar effect on the urine is the decrease in nitrogenous elements excreted. Experimental evidence leads to the belief that it is not due to diminished excretion, but to a lessening of metabolic changes in the body, in- volving the destruction of proteid elements. During its passage through the genito-urinary tract, quinine may cause renal or vesical irri- tation with albuminuria, haemoglobinuria, or cystitis. Increased frequency of micturition and retention of urine have been observed; and occasionally erotic excitement has been manifested. Large doses of quinine, however, may allay vesical irritation or tenesmus. The primary effect of moderate doses upon the respiration is stimulant. The rate of breathing is increased, but the respiratory movements are not materially deepened. Toxic doses call forth dyspnoea with stertorous, em- barrassed breathing. Death may ensue from asphyxia, as described above. This is undoubt- edly due to central action. The reduction in the size of the spleen sub- sequent to the administration of quinine in malarial disease is due to the elimination of the disease. But experimental observers have recorded the fact that the spleen in lower ani- mals has shrunk in size and its capsule has be- come loosened and its parenchyma tougher after the administration of quinine. Be this as it may, it is probably true that the dimin- ished spleen, not only in malarial disease, but also in other infective processes, is due to the victory over the disease rather than to any spe- cific action on the organ. A variety of opinions have been expressed as to the influence of quinine upon the gravid uterus. The statements that follow are, how- ever, the best teaching of the profession at the present time. An otherwise healthy pregnant woman suffering from malarial disease may take quinine with safety to her offspring. A debilitated, overwrought, highly nervous preg- nant woman under the influence of malarial poison may miscarry whether she is given quinine or not; but in precisely these cases in which malaria may induce abortion or mis- carriage the judicious use of quinine may pre- vent the mishap. Wrhen dystocia arises from exhaustion of the mother, generous doses of quinine, by their stimulation to the uterine muscles, frequently are of service. Mental en- couragement is of value, however, by inducing the patient to believe that the drug will have the action desired. Atkinson (Am. Jour, of the Med. Sci., February, 1890) concludes that qui- nine occasionally has an oxytocic action if there is an idiosyncrasy, and he advocates its use in prolonged labours with exhaustion of the mother or threatened uterine inertia. In this position he is indorsed by the bulk of the profession. The local action of quinine demands some consideration. Applied to the skin denuded of its epidermis, quinine and its salts, in powder or in solution, are active irritants. Upon an intact skin little or no irritating influence is perceived, but upon mucous membranes a distinct irritating and stimulant effect is ob- served. This is particularly marked in some individuals who can not take the drug by the mouth or by the rectum. The prolonged in- ternal administration of quinine, or even, in isolated cases, a single dose, has called forth eruptions. These may assume any character, from a mere erythematous blush to papules and vesicles. Allen (Med. Record, January 26, 1895) has reported a case in which the eruption was like that of scarlet fever, becoming suc- cessively urticarial, oedematous, and bulbous, leaving an excoriated surface. After a quinine eruption there is frequently an exfoliation of the skin. These instances are undoubtedly to be accounted for by the marked idiosyncrasy manifested by some persons against the drug. The antiseptic action of quinine has long been recognised. A solution of 1 part to 300 will preserve organic foods for a great length of time, and in a similar proportion quinine will check alcoholic fermentation in saccharine substances. Upon the higher and more viru- lent forms of bacteria its action is decidedly less powerful, although in the early antiseptic period it was used in a spray instead of car- bolic acid. It is principally upon fungi that its antiseptic influence is strongest. The antipyretic action of quinine has never been satisfactorily explained. Wood does not believe that it is due alone to the diminished oxygen-carrying function of the blood, but 117 QUININE rather to the drug's influence upon the spe- cialized nervous tissues of the body—in other words, the heat centre. Upon a normal bodily temperature quinine exerts but a feeble, if any, antipyretic action. But in febrile conditions of any kind, or at least of most kinds, the ther- mometer shows a marked fall after its admin- istration. Quinine is not a universal remedy for all febrile diseases, though its enormously wide clinical and therapeutical application would lead one to believe that it was a specific for almost all diseases in which there was an abnormal rise of temperature. The first important therapeutic application of quinine is in the various forms of malarial disease. In this disease it is a specific. Al- though other antiperiodics have been tried, and although many other alkaloids have been vaunted as curing or aborting an attack, qui- nine stands forth pre-eminent in its ability to prevent, cure, or abort the various forms of malarial intoxication. Consideration must be extended in three directions in its application in malarial disease: 1. Its prophylactic use. 2. Its curative use. 3. Its specific action on the Plasmodium malaria. Laveran's work has received such almost unanimous recognition and acceptance that for the purposes of this article it will be assumed that his discovery of the malarial parasite is uni- versally believed. The clinical evidence of the value of quinine in malarial affections is only strengthened by the adoption of the view of the Plasmodium as the aetiological factor—and the sole one—in the causation of this group of diseases. In the classical report on The Ma- larial Fevers of Baltimore (Johns Hopkins Hosp. Rep., 1895) it is stated, in the too brief chapter on the action of quinine, that the best time to attack the malarial organism is during the period of segmentation. In the tertian type of the disease this can be best accom- plished by giving one moderate dose just before the expected paroxysm, so that the qui- nine salt shall be in solution in the blood at the time of division. Blood examinations made immediately after the paroxysm show that entire groups of the plasmodium disap- pear. It is found that in the intervening stages—in which the parasite is in the endo- globular stage—quinine, administered in a single dose, has little effect upon the further development of the organism. In mild tertian cases a moderate dose, given from ten to twelve hours before an expected paroxysm, may avert the chill, but it is more efficacious if given nearer the time of the expected attack. In tertian and quartan eases treated with quinine the plasmodium disappears from the blood within the first four days. In the quotidian type, if the patient is energetically cinchonized, it may disappear even sooner. It is not known in what manner quinine is antagonistic to the specific organism which produces malarial dis- ease, but it is probably by some direct influence which destroys its vitality. Certain it is, that in addition to the clinical history of nearly three hundred years to substantiate the title of cin- chona as'a specific in intermittent fever, we have the direct evidence that quinine attacks the cause. We have every right, therefore, to regard quinine as a specific antiperiodic (and antipyretic, incidentally) in the various mani- festations of malarial disease. Two recognised plans are followed in the treatment of intermittent fever with quinine. The first is the daily administration of a dose sufficiently large to control the paroxysms. The second consists in giving the drug imme- diately after a paroxysm, on the supposition that the Plasmodium malarie yields most easily at that time. Either plan may be fol- lowed, and both will give good results. But one thing is essential: the patient under treat- ment must receive his physiological dose of quinine—he must be cinchonized. By the for- mer plan the patient will receive daily from 15 to 30 grains of quinine, given in divided doses; less than 4 grains in one dose it is use- less to give to an adult, since that quantity produces no appreciable effect. In the so- called pernicious cases it is necessary, or it may become necessary, to increase the amount of quinine, for, to cure these cases, the patient must be fully under the influence of the drug, not only during the paroxysms, but during the intervals of the disease as well. When the symptoms are becoming less marked, the dose may be gradually diminished; but the drug should not be wholly withdrawn until some weeks have elapsed. The second plan involves the giving of from 15 to 25 grains of quinine, as the temperature falls in the first paroxysm observed. This is said to be sufficient to avert the second attack; but if slight symptoms should show themselves, the administration of a second dose of 10 or 15 grains is usually suf- ficient to control the disease. No further dose need be given until the seventh day, when from 15 to 25 grains are again given. Usually this suffices; but if a tendency to relapse is noticed, or if some of the milder symptoms of malarial infection present themselves, full doses of qui- nine must again be resorted to. Sometimes a paroxysm seems to be best averted by giving quinine prior to a paroxysm, and, although some prefer giving divided doses, it seems more rational to give one or two large doses, for it would appear that small doses are able only to retard the development of the Plasmodium malarie, while larger ones are able to destroy the micro-organism. Four hours is the shortest time in which a moderate dose (10 grains) of quinine can enter the blood in solution; hence the best time for giving the drug previous to an attack is from five to six hours. A dose of 15 grains will maintain its action in the body for from four to five hours, while a dose of from 5 to 8 grains will exer- cise its influence for from two to three hours. Doses in other amounts act for lengths of time corresponding to their quantity. As pointed out above, it is necessary for a patient to be cinchonized for the drug to be of the greatest value in overcoming the malarial infection. Otherwise the disease may linger and be pro- tracted over many months, or relapses may oc- cur. Free purgation is essential during the administration of a quinine salt, This may be accomplished by mercurials, by vegetable ca- QUININE 118 thartics, or, in the case of the pernicious forms, by diuretics. The so-called "hemorrhagic" form of ma- larial fever demands cinchonism at once. For this purpose, the administration of the alka- loid is much the same as in the ordinary inter- mittent type of the disease. From 15 to 20 grains may be^given in one or in divided doses. For the condition known as malarial cachexia quinine is valuable; but after a long period of its administration, if a cure or relief does not follow, other drugs, such as arsenic, may be employed. The cachexia is dependent, indeed, not only upon malarial infection, but also on some tissue changes, and it is probable that not all cases can be cured. But even in this symptom-complex, quinine, in doses of 5 or 6 grains daily, has well-marked curative effects more frequently than not. To refer briefly again to the pernicious va- riety of malarial infection, it is usually not sufficient to administer quinine alone. The grave phenomena presenting themselves on the part of the nervous system, the intestines, the lungs, and the kidneys render symptomatic treatment necessary as well. If, indeed, the gastric symptoms are pronounced, resort must be had to the giving of quinine by the rectum or hypodermically. Like all other drugs, qui- nine given subcutaneously acts more promptly than when administered by the mouth or by the rectum: but in this form of malarial disease the choice must rest upon the conditions present. In the treatment of remittent fever quinine is indicated. Its results are not always so gratifying as in intermittent fever, but it is frequently curative. Quinine has probably an antipyretic effect in remittent fever when given at its height, and there seems to be no theo- retical objection to administering it at this time. Many observers prefer to give the drug, however, as soon as the remission appears, using drugs other than quinine with ther- molytic action to reduce the fever, or resort- ing to the full bath. Quinine frequently, however, succeeds in lowering the temperature and then exerts its specific action upon the micro-organism of the disease. No symptoms which may arise during a remittent fever are contra-indications to the use of the cinchona alkaloid. Should a severe gastritis arise, the drug may be given in solution or suppository by the rectum or subcutaneously, as in the per- nicious type of the disease. In remittent fever, from 20 to 50 grains may be given in twenty- four hours, in one or in divided doses. (For the selection of quinine salts for hypodermic administration, see page 121.) There are some forms of what are called " masked intermittent" fever which seem to be benefited by quinine. These ailments manifest themselves by the periodical appearance of certain functional disturbances without accom- panying chill or fever. Intermittent neuralgia, very frequently of the trigeminal type, though it may appear in any of the plexuses or their branches, yields readily to quinine in sufficient doses. Sometimes, though not usually, the attack is of long duration, and the drug must be given for a considerable period of time. At the time of the onset a dose of from 15 to 25 grains may be given, which will usually relieve the symptoms. After the abatement of the attack, 5 grains, thrice daily, may be adminis- tered for a few days. Other phenomena have been described as occurring periodically, and have been attributed to malarial poisoning; but although they have seemed to yield to quinine, according to their reporters, the cases have not had the appearance of having been accurately and acutely observed. They embrace such functional disturbances as intermittent haemorrhages, oedema, convulsions, and paraly- sis, and should probably be classified under other groups of disease than the malarial. How- ever, if any such symptoms arise after an attack of malarial disease of any type, and are inter- mittent in character, there can appear no valid objection to thorough dosing with quinine. There are other forms of neuralgia which, though intermittent, are not periodic in char- acter, that yield gracefully to quinine given for a few times. They can not, however, be supposed to be due to malaria, for any effect the quinine may have is soon lost. When a patient suffers from intermittent malarial fever, or any of its forms, or from remittent fever, or from any of the intermit- tent forms of disease which appear to be dependent upon the invasion of the specific parasite of the disease, he should be removed frpm the locality at once if it is known to be malarial. The mere administration of quinine, though curative in a single attack, will not prevent recurrence if re-infection is possible. Pernicious cases, indeed, follow frequently upon one or more mild attacks. Prophylaxis against the disease is possible, however, by the judicious use of quinine. The effect of the drug need not be carried to the extent of cinchonism for this purpose. From 3 to 5 or even 8 grains may be given twice daily. It does not always succeed in preventing acquisition of the dis- ease, but even in dreaded malarial tropical countries it has succeeded in keeping the dis- ease aloof. When, after prophylactic treatment, malarial poisoning does make its appearance, it is altogether likely that it is less severe than it would have been had not such treatment been instituted. The experience of the British army in India in preventing a spread of the disease among the soldiers may be taken as a good example of the value of the prophylactic use of quinine. Quinine has been recommended at various times for all the acute infectious diseases. In acute articular rheumatism it was used two hundred years ago, and was thought to be specific. Probably this belief rested upon its antipyretic power. At the present day it is used by some clinicians, not as a specific, but as a tonic, in doses of from 1 to 2 grains thrice daily during the convalescent stage. In typhus fever it is still used at the present day, and is believed not so much, to exert any specific ac- tion on the course of the disease as to give tone to the organism during the critical stage. The well-known Huxham's tincture is used in this connection. As a curative agent in typhus it is, of course, worthless; but, together with 119 QUININE other tonics and stimulants, it may help to tide the patient over his crisis. In typhoid fever it is also no specific, of course, although it has had wide use as an anti- pyretic. Strumpell is doubtful if the quinine salts, by their mere reduction of temperature, have any favourable influence upon the course of the disease. That they do sometimes reduce the temperature 2° or 3° F. is unquestioned, and in cases in which the bath treatment is contra-indicated (see Hydriatics) quinine may be used as an adjuvant in the treatment of typhoid fever. It must not be forgotten, how- ever, that by its irritant action on mucous membranes it may injure the intestine which is the seat of the disease, and make a perfora- tion possible. For the purpose of reducing temperature it may be used in doses of from 15 to 25 grains, given at once. Of more value is it in small doses during convalescence as a tonic, both gastric and general. It may then be given either in pill or in substance. A very good formula for a tonic containing quinine is: R Quinine sulphate.......... 1 grain ; Dried sulphate of iron..... 1 " Arsenious acid............fa " Mix and make one pill. One such pill to be taken thrice daily. Or, 1} Quinine sulphate.......... 1 grain; Dried, sulphate of iron..... 2 grains; Extract of nux vomica.... i grain. Mix and make one pill. One such pill to be taken, thrice daily, before meals. These combinations may, of course, be modi- fied in many ways; but the drugs, combined as in the two formulas given, have virtues as tonics of a high order. Quinine has been lauded in the treatment of puerperal fever, small-pox, scarlatina, and ery- sipelas, as well as in that of diphtheria. It has been given in these affections in the be- lief that it exerted some specific action on the poison of each disease. This is absolutely without foundation of proof. So far as its antipyretic action goes, it may relieve the pa- tient of some of the symptoms of pyrexia, if administered in sufficiently large doses; but aside from this and from its tonic action, com- mon to it in all forms of disease, there is no proof that it has any action which should de- mand its use. Prophylaxis in the first men- tioned is of more importance than treatment, and for the other diseases of the group there is much to be hoped for in recent observations and investigations. Even in cholera quinine has been advocated on the ground that the difficulty of absorption from the intestines in this disease favours the antiseptic action of the drug on the comma bacillus. It is well known, though, that the antiseptic action of the cin- chona alkaloid is too weak to exert any such effect on a bacillus of such virulence. In doses of from 20 to 40 grains it may help to combat the high fever of cholera, and its supporting action may also be brought into play with a favourable result should recovery ensue. For many years the quinine treatment of pneumonia was a recognised form of treatment in New York. It does reduce the temperature in pneumonia, with a coincident falling of the pulse. Its use is not to be commended, for its indiscriminate employment may be productive of cardiac depression and failure. Certainly in the doses recommended in former years, 20 to 40 grains in one dose, it would be feared by many practitioners for its untoward influence upon the heart. Here, as in most of the febrile diseases, its tonic influence is valuable when convalescence has been established. It has been maintained that, if given early in pneu- monia, as in follicular amygdalitis and inflam- mations of serous surfaces, it will modify the course of the disease. Indeed, one observer has alleged that the pneumonic process is less severe, that the cerebral, respiratory, and cir- culatory phenomena are less grave, if quinine is given in large doses early in the disease. It may cause, if given in a large dose, anorexia, nausea, and vomiting, and even cardiac weak- ness—symptoms which should be avoided or guarded against in pneumonia, of all diseases. In some of the diseases of the respiratory tract quinine has had extended use. Like so many other drugs, it has been recommended in the treatment of pertussis. In doses of from 5 to 10 grains twice a day (the doses for infants are, of course, correspondingly smaller) it is said to diminish the frequency and severity of the attacks. It should be given early in the disease, if at all. Laubinger (Jahrb. f. Kin- derheilkunde, xxxix, 2, 3) urges the subcutane- ous use of the dihydrochloride of quinine in cases in which the symptoms demand instant relief. In asthma good results have been alleged from the use of quinine in diminishing the spasmodic attacks. The same has been asserted for it in laryngismus stridulus. More efficacious methods of treatment, however, are at our command. The hectic fever of phthisis may be reduced by the use of quinine, and it may be used as a tonic in chronic phthisis when there are anorexia and general weakness. As a gentle stimulant in chronic bronchitis, quinine may form part of a mixture or pill. A very good formula for this use is: R Extract of belladonna..... 1 grain ; Extract of opium......... 2 grains; Extract of nux vomica..... 3 " Powder of ipecac.......... 4 " Quinine hydrochloride, or sulphate...............5 " Mix and make 20 pills. One pill to be taken four times daily. In acute coryza and hay-fever, spraying the nostrils with an aqueous solution of from -J- to fa per cent, has been reported to have cured cases. Or the quinine may be in the form of a snuff in a mixture containing bismuth or salicylate of sodium. The internal administra- tion of 5 grains, three times daily, is advised in connection with the spray. In influenza it is doubtful if quinine, locally or internally, is of great utility. In the albuminuria of scarlatina, quinine, combined with tincture of chloride of iron, is said to be efficacious; but, QUININE 120 like many other recommendations of quinine, this assertion rests on very little evidence. For other internal and functional diseases, quinine has been praised. In the treatment of insolation, Binz (Berl. klin. Wochenschr., 1895, No. 29) recommends the hypodermic ad- ministration of the bichloride of quinine. He says that at least 3f grains should be injected at one time, and this dose may be repeated in one hour if necessary. He alleges good results. Quinine in doses of from 3 to 8 grains relieves many of the chronic cases of headache which are the bete noire of the physician. Taken at night in one dose, in black coffee, for five nights, it has accomplished a cure of migraine which lasted for five months. In cases of leucemia quinine has been tried on account of its supposed effect in reducing the size of the spleen, but it has no curative effect on the disease. Mosler, quoted in StrilmpeH's Text- book of Medicine, reported good results from its use. The drug has been tried in diabetes, on theoretical grounds, but it is valueless as a curative agent. In the treatment of a few of the parasitic skin diseases, quinine, in a 5-per-cent. ointment, has been found valuable. In some forms of pityriasis and tinea it has been found effica- cious. Given in doses of from 5 to 10 grains previous to the passing of a sound into the male urethra, it will prevent the remarkable rise of temperature known as urethral fever. Moreover, after this temperature—sometimes reaching 106° F.—has made its appearance, quinine will quickly reduce it. The writer can not refrain from adding that he has always regarded this phenomenon as directly due to a surgically unclean instrument. In the treat- ment of gonorrhea, cystitis, and growths at the neck of the bladder, injections of quinine, of a strength of from 2 to 3 grains to an ounce, are said to be curative and to relieve the tenes- mus which frequently accompanies these con- ditions. There are, however, better means of combating these ailments. Rectal injections of a similar strength are of value in treating an amebic dysentery whose seat is low in the intestinal canal. On the nervous system quinine has decided effects, and has been used in various functional and organic nervous diseases. The pains of locomotor ataxia sometimes yield to the alka- loid of cinchona, though, of course, the anal- getic effect is due entirely to the sedative influence of the drug upon the peripheral nerves. Charcot's classical recommendation of quinine in Meniere's disease deserves the place it holds, for cases of cure are certain, and in some instances permanent. For this purpose, from 8 to 15 grains are taken daily in divided doses for a month. As mentioned above, malarial neuralgias yield to quinine in large doses (15 to 25 grains) if taken at once. And in the so-called " idiopathic " cases of neu- ralgia of the trigeminal type,qumine, pushed to the point of cinchonism, brings frequent relief. Sciatica yields less often to the influence of quinine. As a tonic, quinine is indicated in neurasthenia, in the combination of the formula given above. The drug has been used in steno- cardia to prevent a recurrence of the paroxysm, but its use is purely tentative. In the so-called hydropsarticulorumintermittens.a rare trophic disturbance, quinine may be used for its anti- periodic effect. As hinted at above, quinine is of use during labour when the mother has become exhausted and uterine inertia is threatened. (See also under Oxytocics, vol. ii, page 55). Initial abortifacient power does not reside in the drug. For the purpose of aiding uterine ac- tion, it may be given in doses of from 5 to 10 grains every hour or in a single dose of 15 or 20 grains. In cases of hematuria, even if not of malarial origin, quinine is often serviceable, particularly in those instances in which the attacks are paroxysmal. When inunctions of mercury are given in severe cases of syphilis, the simultaneous administration of from 15 to 30 grains of quinine daily will prevent stoma- titis and will help to cure cases which do not seem to yield to inunctions alone. (Dymnicki, Monatshft. f. prakt. Dermat., 1889, No. 39.) Quinine has some reputation as a tonic and stimulating drug in prolonged suppuration in any part of the body. It may be given in- ternally or applied "locally as an irrigating fluid. Thus, in cases of empyema of long standing, in which there are discharging si- nuses, it mav be injected into the cavity in a strength of from 4 to 5 grains to an ounce. Internally, it should be administered in the usual tonic dose. For pruritus ani or vulve, a strong solution of quinine is recommended for topical application. Ophthalmic surgeons use quinine in acute glaucoma and blennorrhagic ophthalmia with variable results. In some cases of glaucoma the pain seems to be dimin- ished by the use of the drug. [Dr. George Reich-Hollender, of Seattle (Arch, of Ophthal., xxiii, 1 and 2), used a qui- nine lotion experimentally in an obstinate case of gonorrheal ophthalmia, and found that after the third day the discharge became in- nocuous, and within two weeks not a vestige of the inflammation remained. By making cultures he satisfied himself that the gonococ- cus of Neisser was destroyed by a solution of quinine. He considers that the best way to employ quinine is in a solution containing hydrochloric acid. He believes it to be a specific in the ravages of the gonococcus. He makes a solution of 8 parts of quinine, 3 of dilute hydrochloric acid, and 720 of distilled water, and applies it every hour.] Knapp has recently used quinine in the chorea of children with good effect. It does not cure all cases, however. He does not con- sider the action of the drug to be due to its stimulation of the inhibitory motor functions of the spinal cord, but to some influence upon the toxines of the disease (Boston Med. and Surg. Rep., February 28, 1895). Good results are also alleged for the use of the alkaloid in nocturnal enuresis, especially in nervous chil- dren in whom the inhibitory function seems to be disturbed. Four grains, three or four times daily, are given for this purpose. Finally, quinine in solution may be applied to unhealthy granulating wounds, or to slowly- 121 QUININE healing ulcers. So many better topical appli- cations are to be found, however, that it is scarcely worth while to discuss the use of quinine as a surgical aid. The contra-indications to the use of quinine are inflammation of the middle ear—because of the congestion quinine produces in the mid- dle ear and labyrinth—and acute inflammatory processes of the gastro-intestinal canal, for reasons already stated. Very rarely the influ- ence of quinine upon the genito-urinary tract is irritating, so in acute processes in this region the use of quinine might be contra-indicated. Each of the salts of quinine has uses to which it is particularly adapted. The sulphate and the bisulphate are used for similar pur- poses, for internal administration, and for rectal use. For hypodermic use the bisulphate, the hydrobromide, and the hydrochloride are preferred on account of their solubility in water. The bichloride and the hydrochloride with urea are also capable of use by subcu- taneous injection. The administration of qui- nine varies with circumstances and with individuals. The intensely bitter taste of the alkaloid and its salts renders it necessary to disguise their taste. Quinine itself is rarely employed, the sulphate being the most com- monly used of the salts. It must be mentioned that the sulphate frequently varies in its sta- bility and in its effects. In two cases simul- taneously observed by the writer, suspected malarial infection was treated with the sulphate of quinine. After several weeks of its admin- istration with no improvement, the hydrochlo- ride of quinine was given, and a cure resulted within a week. A point in the administration of quinine is the fact that children excrete quinine more rapidly than adults; but from the experiments of Oui it is no longer believed that suckling children suffer a cinchonic effect from the milk of their mothers. Quinine may be administered by the mouth, by the rectum—in suppository or by enema— hypodermicallv, or dermically. The taste of quinine may be disguised by giving it in wafers, which is perhaps the most desirable method. It may' be given in the form of pills, which may be coated to obscure the bitter taste. Mineral acids should follow the administration of the sulphate in order to facilitate the solu- tion of the salt in the stomach. Either the sulphate or the bisulphate is better tolerated by the stomach if given in a solution of potas- sium tartrate. The albuminate of quinine is said to be acceptable to a sensitive stomach; but it is soluble in water only when hydro- chloric acid has been added. If a rapid result is desired, a solution of the salt should be given, and to accomplish this most satisfac- torily' the bisulphate is usually employed. After its solution in water, aromatic sulphuric acid should be added, one drop for each grain of the drug. The tablets of the quinine salts in the market are not to be too cordially com- mended, for thev are apt to defy solution. Tablets of tannate of quinine, in the form of chocolate lozenges, are sold in the shops, each tablet containing 1 grain of the drug These are especially desirable for use among children, as the chocolate completely disguises the taste of the salt. [A simple and very effective way of masking the bitterness of quinine was taught some years ago by Dr. A. Jacobi. The quinine is to be mixed in a tablespoon with enough strong black coffee, cold, to almost fill the spoon. The quinine does not wholly dissolve, but it gives the coffee the colour of cafe au tail. In this way most persons can take quinine without tasting it.] Suppositories containing quinine are apt to irritate the rectum, and enemata are not always retained. However, when the administration of the drug by the mouth is not feasible, and when it is desired to secure a local effect upon the lower bowel, it is justifiable to give it by the rectum. Potassium iodide is chemically incompatible with the quinine salts and should never be given in combination by the rectum, since iodine is set free. For hypodermic use, as brought out above, the hydrochloride, bi- sulphate, and hydrobromide are to be chosen, because of their easy solubility. The first is soluble in 34 parts of water, the second in 10 parts, and the last in 54 parts. It is alleged for the hydrochloride that it is cheap, that its injection is free from pain, and that it does not produce an abscess at the site of introduction. The same statements are made for the bichlo- ride and the compound salt of the hydrochlo- ride with urea. The hydrochloride, however, according to Briquet, is not stable. Except in an emergency, as in insolation, or when an im- mediate effect is desired, it is not necessary to resort to the hypodermic needle to secure the effect of quinine. The possibility of producing an abscess by the use of an unclean needle must not be overlooked. The dermic method of administration may be resorted to in children ; but it has been shown that, although some of the quinine ap- pears in the urine shortly after its dermic application, the greater part of the drug does not enter the blood. This method, then, is practically valueless. The dose of quinine and its salts is elastic. It may be given for tonic effect in doses of £ a grain; or, to produce cinchonism, the dose may be as high as 75 grains. No set rule can, there- fore, be laid down. The hydrochloride is given in doses of about i less than the sulphate. The dose of the valerianate is from 1 to 2 grains. The doses of the other salts are the same as those of the sulphate, which varies with indi- vidual cases and with the diseases for which it is given. (Cf. Cinchona.) [An official wine of quinine, vinum quinine (Br. Ph.), contains a grain of the sulphate in each fl. oz. It is given in doses of from \ to 1 fl. oz. Dr. Erskine B. Fullerton, of Columbus. Ohio, professor of materia medica and therapeutics in Starling Medical College (N. Y. Med. Jour., August 18. 1894), urges the use of quinine in Asiatic cholera. He recognises that it has often been tried and found to fail, but this he attributes to its having been given in an im- proper manner. Ten grains, in powder, he says, diffused through a small quantity of L22 QUINOIDINE RECONSTITUENTS 1 water, or in acid solution, at hourly intervals, until 20 to 40 grains have been given, after- ward pro re nata, should be the ordinary in- structions; the same dose at half-hourly intervals for a sufficient time in collapsed or in foudroyant cases; smaller doses, perhaps, at longer intervals in choleraic diarrhea. There should certainly be retained, of other treat- ment, adds Dr. Fullerton, appliances for the restoration of heat; saline hypodermoclyses to supply lacking serum to the blood; morphine hypodermics to allay pain and cramps, with enteroclyses of quinine where, as past experi- ence shows rarely to have been the case, the remedy is vomited; and in the sequent enteritis or otherwise persistent diarrhoea, calomel in small doses should not be lost sight of. That by so treating our patients, says Dr. Fullerton, we may hope for a mortality among collapsed. and collapsing patients of about 14 to 25 per cent, only; that by earlier administra- tion of the remedy, instead of the use of other agents that have heretofore permit- ted so many cases to run on into collapse and death, we may reduce the mortality in such cases to 2 to 5 per cent, only, seems a fair assumption for the best of reasons—i. e., it should be so, and so far it always has been so.] Samuel M. Brickner. QUINOIDINE.—See Quinidine. QUINOLINE, an oily alkaline liquid, C6H7N, obtained by distilling quinine with a caustic alkali, is colourless when pure. It has a disagreeable odour somewhat suggestive of bitter almonds, and is acrid and bitter to the taste. It is but slightly soluble in cold water, but dissolves more readily in hot water. It mixes in all proportions with alcohol, with ether, and with the essential oils. It h'as been employed as an antiseptic in a 5-per-cent. so- lution in equal parts of water and alcohol. QUINOSOL, a German proprietary prep- aration, is described by the manufacturers as a neutral compound of oxyquinoline which, when used, gives up oxyquinoline in a nascent state and consequently of great efficiency as an anti- septic. R. Kossmann (Ctrlbl. f. Gyndkol., De- cember 28,1895), states that trials of it made at the Munich Hygienic Institute go to show that it is relatively so non-poisonous that a dose of 45 grains, given to a rabbit, does not injure the animal, while a l-to-40,000 solution prevents the development of cultures of the Staphy- lococcus pyogenes aureus. For several months, he says, it has entirely supplanted corrosive sublimate and carbolic acid in his practice, and he has seen absolutely no toxic effects due to it, or any irritation, even eczema, when it has been insufflated in powder into suppurating wounds. He further states that it does not injure the skin, even in so strong a solution as that of 1 to 500, applied repeatedly; it does give the hands a yellowish tint, but this may be removed by washing with pure water. It is free from any unpleasant odour. Kossmann thinks it would prove a safe and efficient anti- septic in the hands of midwives. Solutions of it should be of the same strength as those of corrosive sublimate. It may be had in the form of tablets which are readily soluble. On the other hand, Ahlfeld, Vahle, and Witte (Ctrlbl. f. Gynak., February 29, 1896) report discouraging results as to its efficiency as an antiseptic and as to its being non-poisonous. Ahlfeld and Yahle found that even so strong a solution as one of 3 per cent, could not be altogether relied on. Eight grains of quinosol, injected subcutaneously into a rabbit, they report, killed the animal in eighteen hours ; its blood was found to be very dark-coloured, and all the organs were dusky, especially the kid- neys. Witte makes quinosol the text for some very forcible remarks about the quest for new antiseptics. In corrosive sublimate, in carbolic acid, and in lysol, he says, we have antiseptics that have been tried thoroughly; years of ob- servation have taught us the bright and the shady side of their action. The case for quino- sol, he holds, has by no means been made out. As to Kossmann's experience in the employ- ment of the drug for a number of months without the occurrence of a single case of in- fection from a wound or any appearance of poisoning whatever, even so slight as eczema, he doubts if these results are to be ascribed to the quinosol. His own, he says, have been quite as good when he used only a sterile physiological solution of common salt. Fur- thermore, he argues, even if it is true that traumatic cavities, suppurating and yielding a foetid secretion, may be favourably affected by quinosol, the fact is of little consequence, for the thing to do is to remove the putrefying masses and use drainage, and it makes no dif- ference whether this or that antiseptic is em- ployed, or, indeed, only sterile water. As to the statement that quinosol, even in substance, is in no wise irritating to wounds, his own ex- perience, he says, has been to the contrary. In two instances he has applied quinosol in substance to the cavities left after the removal of glands, and each time such intense burning pain set in that the patient begged to have it taken out. Although he himself has not ob- served symptoms of poisoning from quinosol, he insists that we can not be sure they will not occur. A minor objection to quinosol is the fact that it stains the skin and the instruments, but the stain can be removed without much trouble. Quinosol is particularly unsuitable for vagi- nal irrigation during labour, says Dr. Witte, for it is highly astringent, so that it would rob the vagina of its lubricity and make it rough and unyielding, as corrosive sublimate does. QUINQUINA.—See Cinchona. RATANHIA.—See Krameria. RECONSTITUENTS are remedies which promote reconstitution or reconstruction. They include a variety of therapeutic means of which only a part are medicinal. Among the reconstituents are diet, exercise, climatic influences, travel, bathing, and personal hy- 123 QUINOIDINE RECOMSTITUENTS giene, as well as alterative, stomachic, and tonic medicines. These, for the greater part, are considered elsewhere in this work, and it therefore remains but to point out their special actions as reconstituents. The action of food as a reconstituent is pro- nounced, and curable debility of any kind yields more quickly to it than to anything else. The most striking example of its powers is observed in the convalescence which follows acute disease. The reconstituent power, how- ever, does not reside in all varieties of food to the same degree; indeed, from their indi- gestibility, certain of the richer foods not only fail at reconstitution when given in debility, but are even productive of debility if given excessively in a state of health. Fats are, as a class, our most useful reconstructive foods, for they combine with easy digestibility a maximum Eower to nourish, milk, of course, offering the est example of this action, and tuberculosis the condition in which its benefits are most striking. Nitrogenous foods rank second to fats in reconstituent value, being both more difficult of digestion and, as a rule, less nourish- ing, while carbohydrates come last, though they are certainly nourishing and in many cases highly to be recommended. As in health, so also in debility, no exclusive diet is ordi- narily to be advocated, but instead such a judicious mixture and combination of nitro- genous, fatty, and carbohydrate foods as ex- perience has shown to be most useful. In some cases of debility a positive distaste for food has to be combated; the patient, if left to himself, would not consume a sufficient amount of food to maintain his nutrition. If this is the case there is often much benefit to be had from forced feeding, or gavage. Cer- tain beverages may be regarded as indirectly reconstituent by virtue of the stimulating and sustaining power they exert over nerve func- tion, especially that of digestion, and by virtue of their action to lessen tissue waste. Those which contain alcohol or caffeine are undoubt- edly thus active, while some few drinks are directly reconstituent because of the food value of some of their ingredients. That a judicious amount of exercise is recon- stituent needs proof no more than that over- work is debilitating. Under its influence tissue metamorphosis is made more active, and elimination of waste products is increased. Digestion and absorption are in their turn augmented and, provided the food given in response to this demand is of the proper and nutritious sort, reconstruction takes place. It is not every exercise which performs this re- constructive duty, for if excessive in amount or violent in its nature, it may have quite the opposite effect—namely, to exhaust and depress. Exercise in the open air. too, is much to be pre- ferred to exercise within doors, though the latter is not inefficient. In some cases where debility is extreme, active exercise is an impos- sibility, and then we may usefully employ massage and passive motion until, with return- ing vigour, the ability to take active exercise returns. ,,.,•„. The influence of climate upon debility is 52 great, and no more convincing proof of this is needed than the rapidity of convalescence which takes place when a change of air is sought, as compared with the relative slowness of recovery at home. That the different at- mospheric conditions deserve some credit for this usefulness is no doubt true, but they cer- tainly do not deserve it all, for, as in the case of treatment by mineral waters at the spring from which they are obtained, a number of factors must necessarily enter into the effect upon the patient. Of these factors the most important, besides atmospheric conditions, are change of scene and surroundings, relief from the cares of home or of business life, change of diet and occupation, change of hours, rest and repose, and, finally, a mental condition of hopefulness and expectation of benefit to be derived which in itself will favour recovery. That convalescence and debility in general should receive the benefits which change of residence will give needs no argument, but some cases are wrongfully treated thus. Of all conditions so mistreated, tuberculosis offers the most striking example, and we every day see patients sent from home that they may obtain the supposed benefits which change of climate can give, when it is quite evident that recovery, or even improvement, is impossible, and that deprivation of home surroundings and of home comforts to them means positive harm. The hopeless kinds and degrees of debility, there- fore, should, as a rule, receive treatment at home. As to the climate which should be sought in cases suitable for climatic treatment, there are no hard and fast rules. In many cases it is change that is the important factor rather than atmospheric conditions, and then almost any climate will be suitable, provided the element of change is present. In other cases the proper climate must be sought by ex- periment, and therefore the patient must go from place to place until he finds a locality in which he eats, sleeps, and feels well. In cer- tain diseases, however, one rather expects re- covery to be promoted by special atmospheric conditions; thus, persons with catarrhal dis- eases, as a rule, are relieved by atmospheres which are relatively warm and dry ; those with renal diseases also are generally improved by the same sort of climate; while those with nervous diseases, as a rule, are benefited by a warm and soothing air, and injured by one which is changeable in temperature and hu- midity, and, as a rule, by sea air. Patients with pulmonary tuberculosis are susceptible of improvement by a variety of climates, the chief determining elements being the purity of the atmosphere, the relative absence of moisture, and freedom from sudden changes. Further than these, the exact locality will be deter- mined by the degree of debility which is pres- ent ; those who are much enfeebled it is well to send to warm climates, while those whose vigour is preserved do well in the dry and cold mountain atmospheres, and for others still the suitable place must be sought by travel. In all tuberculous cases, however, the main requisite seems to be a continued out-of-door life. RECTAL MEDICATION RESORCIN 124 Travel as a reconstituent agent may be of much benefit, and on the other hand may be productive of great harm; the determination of the question rests upon the amount of vigour which the patient possesses and his ability to withstand fatigue. Certainly nothing could be more foolish than to hurriedly and continu- ously drag an enfeebled man from place to place and expect him to grow strong. Not only must the strength of the patient be con- sulted, but also the mode of travel, for, though an invalid might well be able to travel in the luxury of a yacht or a private car, he would be no fit occupant for the springless wagon or the saddle. In mental exhaustion from over- work travel is certainly at its best, provided anxiety can also be left behind, and in many another disturbance it may be of the greatest benefit, but in prescribing it one must care- fully consider many things, especially the patient's physical ability, the circumstances of the journey as regards comfort, the importance of the duties and interests he leaves behind, the itinerary, and the amount of benefit which it is possible for him to derive from his journey- ings. The observance of hygienic rules is highly reconstituent. This is scarcely the place to impress the importance of regularity in all which pertains to our physiological life, as concerns eating, sleeping, exercise, the evacua- tions, and bathing. The rules which should govern these matters are well known, and it is equally well known how violation of them may result in a debility which will return only when the violation ceases. As a reconstituent in convalescence and asthenia, generally, the cold bath deserves a particular mention, for its tonic power over nervous energy is very great. Whether the cold bath should take the form of sponging, of showering, or of the plunge will vary with circumstances, and for detailed information the reader is referred to the article on Baths. So far as reconstituent drugs are concerned, it might seem that they were sufficiently de- scribed as tonics, but reconstituents would appear to be the larger class, including not only tonics, but also bitters and alteratives. Alteratives certainly possess a great influence in certain cases of debility; an example of this action is seen in the anemia of syphilis, where other reconstituents are of little or no effect unless mercury or an iodide is simultaneously administered. It is doubtless true that in such conditions the alterative acts in a comple- mentary capacity to the other reconstituent, and it is perhaps more exact, therefore, to re- gard alteratives as reconstituents rather by indirect than by direct action. Bitters pro- mote reconstitution by their action upon di- gestion, for the appetite and the assimilative power become so much enhanced under their influence that larger amounts of food are taken and absorbed, to the end that general nutrition is much improved. It is for this reason that bitters are so generally employed in debilitated states, and in the convalescence from acute disease the use of the bitter remedies, like quassia, calumba, and gentian, has become almost a routine. As reconstituents, the bit- ters act indirectly by virtue of their influence upon digestion; "the tonic remedies act thus as well, for stomachic and digestive virtues reside in most of them, but they act more upon the body generally, though, again, digestion plays a part, for bodily invigoration includes digest- ive improvement, and from digestive improve- ment the general health is increased. The chief primary action of the tonics as recon- stituents is upon the body generally, and thus iron, arsenic, and strychnine become of so much service in debility. Finally, we must class cod-liver oil as in the highest degree recon- stituent, though the manner by which it acts is not clear. It is credited, as we know, with alterative, tonic, and nutritious qualities by any or all of which it might be reconstituent. Henry A. Griffin. RECTAL MEDICATION. — See under Cacao-butter. RED POPPY—See Rhceas. RED SAUNDERS.—See Sandal-wood. REFRIGERANTS are agents which effect cooling, either of the body generally or of a part. Strictly speaking, no reason exists why the name refrigerant should not • be held syn- onymous with antipyretic; it has, however, come to have the signification of producing sensations of cold, rather than of actually re- ducing the temperature of the body. Clinically, refrigerants have two uses. The first concerns their employment as cooling beverages, which are often so grateful to pa- tients suffering, from fever, and are effective rather by quenching thirst than by appreciably reducing the fever. As refrigerant drinks, there may be used ice water, carbonated waters, lemonade, or water slightly acidulated with an acid, especially diluted phosphoric acid. Naturally, these drinks are more effective if used cold, and, with due regard for the amount of the acids they may contain, they may be taken freely, the sole centra-indication to their generous employment being gastric disturbance, either present or impending. Should gastric disturbance be present, the proper refrigerant will be either cracked ice or iced water given cautiously, tentatively, in small quantities and at infrequent intervals. The second clinical use of refrigerants is for the production of local and, especially, cutane- ous cold for the purpose of diminishing local congestion and inflammation or of causing anaesthesia. As refrigerant applications use- ful in local inflammations may be cited cold water, cold air, and especially evaporating lotions. The production by cold of local anaes- thesia sufficient for the performance of minor surgical operations, such as the opening of abscesses, may be brought about by the appli- cation of ice to the part; but there are certain obvious disadvantages connected with this practice which do not apply to the spraying of very volatile liquids upon the area for opera- tion, the rapid evaporation which takes place insuring the necessary degree of cold. A num- ber of these liquids are in use; particularly serviceable are rhigolene, ethyl chloride, and RECTAL MEDICATION 125 RESORCIN ether. The use of such remedies must be cau- tious, however, because of their inflammable and even explosive nature. The term refrigerant is used by some writers to further describe the action of other remedies. Thus, refrigerant diuretics are those which act as general sedatives and render irritating urine bland. This class, naturally, consists mainly of alkalies and their salts, and the term re- frigerant used in this connection would seem to be more suggestive than exact. Refrigerant diaphoretics, too, are spoken of, the term ap- plying to drugs which promote perspiration by reducing circulatory excitement and are espe- cially useful in fever. Such are aconite and veratrum viride.—Henry A. Griffin. RELAXANTS are remedies which lessen the tension of body tissues. The power to re- lax resides in many agents; relaxation of the skin is produced by diaphoretics, of the intes- tines by various cathartics, of the blood-vessels by vascular sedatives, and of the body gener- ally by nauseants and emetics, as well as by the hot-air bath, the prolonged warm-water bath, and remedies which debilitate. All these might properly be termed relaxants, and, indeed, the name not infrequently is employed as signifying laxative, but clinically the term isoftener used in describing remedies which produce relaxa- tion in the skin to which they are directly ap- plied and in the tissues immediately beneath it. Of relaxant remedies, poultices offer a good example, together with other and similar ap- plications to the surface of the body which are active by virtue of their heat and moisture. Of similar effect, though by a different mode of action, are fatty substances, which when locally applied are productive of softening and relaxation, an action which is constantly made useful in the application of ointments. The therapeutics of relaxants will have been inferred from what has already been said, and though for the relief of cutaneous and subcu- taneous tension poulticing was so constantly practised formerly, it is now but little esteemed, for fear of the injury which poultices may do, but the softening action of fatty substances is constantly evoked in conditions in which the skin has become indurated, dried, or inflamed. Henry A. Griffin. RESINA (U. S. Ph., Br. Ph.).—See Rosin. RESINS.—These are peculiar principles, profusely distributed through the vegetable kingdom and almost entirely confined to it. They are mostly uncrystallizable solids, fusible but not volatile, insoluble in water, but soluble in one or more of the more volatile solvents, such as alcohol, ether, chloroform, benzin, etc. They are also soluble in volatile and fixed oils. Most of them have an acid character, which enables them to combine with alkalies to form so-called " resin-soaps," compounds which are soluble in water, and from which the resin may again be separated by acids. The nature of the resins is, as yet, not fully understood, but most of them are evidently oxidation products of certain hydrocarbons, such as terpenes, which are the" chief constituents of most vola- tile oils. What are ordinarily called " resins," either in the classification of drugs or in pharmacy, are in most cases not pure, homo- geneous, chemical individuals, but more or less complex mixtures. Resins are most conveniently divided into " natural"' and " pharmaceutical" resins. Natural resins are often accompanied, in their commercial form, by other proximate prin- ciples, which modify their properties to some extent and have induced pharmacologists to classify them in different ways. Fliickiger's classification, which appears the most natural, is as follows: 1. Resins mixed with gum (true gum-resins): gamboge. 2. Resins mixed with gum and volatile oil: myrrh, olibanum, asafcetida, galbanum, and ammoniacum. 3. Resins mixed with notable amounts of volatile oil: turpentine (and its varieties, such as Burgundy pitch, etc.), elemi, copaiba, and gurjun oil. In the case of the two latter, the substance remaining after the removal of the volatile oil is a true resin. They are often (but incorrectly) called balsams. 4. Resins proper: common rosin (colophony), amber, sandarac, damar. Botany- Hay resin (red and yellow acaroid resin), dragon's blood, guaiac resin, mastic, shellac, and benzoin. The latter, however, does not properly belong here, as it contains other constituents, such as vola- tile acids. Pharmaceutical resins are the following, which are official in the U. S. Ph.: a. Resina copaibe, prepared by distilling off the volatile oil from balsam of copaiba. b. Resina jalape, prepared by exhausting jalap with alcohol, concentrating the tincture, and precipitating the resin by water. c Resina podophylli, prepared like the pre- ceding, except that the water is acidulated with hydrochloric acid. Of all the official resins, this is the most complex in its composition. d. Resina scammonii, prepared like resina jalapae.—Charles Rice. RESINOL.—See Rosinol. RESOL.—This is a German proprietary disinfectant resembling creolin, said to be made by saponifying 100 parts of wood tar with 20 parts of caustic potash and adding 20 of methyl alcohol. It seems to have been used but little, if at all, clinically. RESOLVENTS.—See Sorbefacients. RESORBIN.—This is a German ointment basis said to be made from very pure oil of sweet almonds, wax, gelatin, soap, and water. It mixes freely with all fatty bodies, and facili- tates the penetration of drugs incorporated with it through the epidermis. RESORCIN, resorcinum (U. S. Ph., Ger. Ph.), resorcinol, or metadihydroxybenzene, Ce H602, is a diatomic phenol prepared by melting a gum-resin with caustic potash or soda. It forms colourless or slightly reddish acicular crystals of a peculiar but faint odour, a dis- agreeable sweetish taste, and a pungent after- taste. It grows reddish or brownish on exposure, and should be kept in dark amber- coloured bottles. It is readily soluble in water, REST-CURE 126 in alcohol, and in ether. Applied to mucous membranes, resorcin in strong solutions is irri- tating and may give rise to inflammation. Taken internally in poisonous doses, it pro- duces tremor, convulsions, unconsciousness, and paralysis of the heart and of the respira- tion. In full medicinal doses (from 15 to 30 grains in twenty-four hours), resorcin acts as an anti- pyretic and intestinal antiseptic, but it is not so eligible as several other drugs, inasmuch as its action is apt to be accompanied by lan- guor, nausea, and sweating. It is chiefly as a topical application that resorcin has been found useful. Its action is antiseptic and germicidal. It may be used in solutions or ointments of from 1 to 10 per cent., or even greater strength. Thus employed, it has proved serviceable in a great number of morbid conditions. In diphtheria it is a valu- able topical remedy, also in various inflamma- tory skin diseases, such as erysipelas, herpes, acute and chronic eczema, lupus erythematosus, and psoriasis ; in purulent and ulcerative affec- tions of the mouth, the throat, the nose, the ear, etc.; and in gonorrhea, leucorrhea, and chan- croids. Dr. Moncorvo, of Rio Janeiro, proceeding on the theory that whooping-cough is due to a microbe, has employed resorcin in that disease with great success. He sprays the larynx with a 1-per-cent. solution. Dr. C. Boeck, of Christiania (cited in the Rev. internat. de med. et de chir. prat., No- vember 10, 1895), has found that resorcin is very efficacious against chilblains, especially when the drug is associated with ichthyol and tannin according to the following formula : Resorcin, Ichthyol, Tannin, each............ 30 parts; Water................... 150 " This mixture must be thoroughly shaken be- fore it is used. The affected parts should be painted with it every night, and, after the first layer is applied, it forms in a few minutes a dry, glazed surface. Under the influence of resorcin the skin becomes shrivelled, and the chilblains, as well as the extensive cedematous tumefaction of the fingers and of the hand, dis- appear rapidly. However, this mixture, in spite of its great efficacy, presents certain inconven- iences which may restrict its employment. It stains the skin, and the region to which it is applied will remain black for from one to two weeks after the cessation of the treatment. Sometimes the mixture is not well tolerated by subjects who have a very delicate skin, in which it produces cracks. Finally, it cannot be employed in cases of ulcerated chilblains. The following formula, which, says Dr. Boeck, is less efficacious than the preceding one, may be employed if the patient's work is such that he can not use a substance which blackens his hands: Resorcin............... 60 parts; Gum arabic............ 38 grains; Water___............. 115 parts ; Talcum powder......... 15 " This mixture should be applied every night to the affected parts. Dr. Leo Leistikow (Monatsh. f. prakt. Der- matol., October 1,1894) reports great success in the treatment of leucoplakia with resorcin. He uses the following paste : Resorcin.................. 6 parts; Siliceous earth............. 3 " Lard...................... 1 part. With a thin layer of cotton wound round the pointed end of a stick, this paste is to be smeared over the patches several times a day, especially after eating and before going to bed. In from eight to fourteen days the opaline patches begin to shrink and the mucous mem- brane becomes thin and rosy. It is now very sensitive, so that smoking and eating qiquant articles of food should be avoided and the mouth rinsed frequently with peppermint water to which borax has been added. The hyperaemia caused by the resorcin may be overcome in three or four days by applications of balsam of Peru. REST-CURE.—Rest is one of the oldest forms of treatment in medical history. Doubt- less it was the chief remedy in prehistoric times, for that matter, because Nature herself has always insisted upon it, even to the extent of inflicting many a twinge of pain on such as disobeyed her precepts. One of the most in- structive books ever written on the scientific aspects of rest is that of John Hilton, who, some twenty years ago, collected in one volume, en- titled Rest and Pain, a series of lectures de- livered in the years 1860, 1861, and 1862. In this book he points out the value of rest as a curative agent. In one place he says: " So inti- mate is the association between rest and growth as to make them appear, on a superficial view, to stand to each other in the relation of cause and effect." In another, in relation to the in- crease in weight caused by rest, he says : " The value of rest in fostering the production of that highly organized animal tissue which forms so large a portion of our staple food is well known to the stock-keeper and grazier." And thus he goes on to explain how rest is the great agent in growth and also in repair, which is but a repetition of the processes of growth. Hilton applied the principles of rest chiefly to surgical disorders, but the principles are in reality ap- plicable to many other conditions of disease. This is especially true of some disorders of the nervous system, and the phrase "rest-cure" as employed nowadays refers more particularly to a method of treatment in vogue in this class of cases, of which Dr. S. Weir Mitchell, of Philadelphia, may be considered the first and chief exponent. In 1875 he published a brief chapter in Seguin's series of American Clin- ical Lectures, entitled Rest in the Treatment of Nervous Disease, and he subsequently ex- panded his ideas in a small volume with the title Fat and Blood. He made use of the treat- ment, in cases of neurasthenia and hysteria. Nowadays we apply the rest treatment to many varieties of nervous disorder. The essential feature of the treatment is rest. This promotes growth of tissue and 127 REST-CURE repair of waste. To hasten the attainment of these ends, overfeeding with easily digested foods is required. A part of the principle of true rest and repose is seclusion. In order to counterbalance any ill effects due to prolonged rest in bed, and to assist in tissue metabolism, massage and the exercise of muscles by faradi- zation are made adjuncts to the treatment. Hydrotherapy is frequently employed as an adjuvant. With this original principle of rest as one of Nature's remedial processes in view, Dr. Mitchell evolved the system of therapy known as the rest-cure, which, as we have seen, con- sists in brief of rest, particular diet, artificial exercise, and isolation. Rest.—Usually what is meant by rest in the rest-cure is absolute rest in bed for a consider- able period of time—from six weeks to two months. At first, for several weeks, the patient is not allowed to sit up, read, write, or use the hands in any way, except to clean the teeth. In many cases even the bladder and bowels are to be evacuated in the recumbent posture; when the bed is to be made up, the patient is lifted to a sofa and back again; and he is to be fed by the nurse. But not all cases require such absolute rest, and the amount of rest will vary with the needs of each patient as viewed by his physician, from absolute rest through every degree of " partial " rest-cure. Thus, there are patients who are permitted to feed themselves, to get up for stools, to read, to sew, or to write a little, and others, again, who may pursue their vocations within certain hours, being required merely to add some hours to their rest by going to bed early and rising late. Diet.—The aim in dieting the patient is to insure easy digestion and the assimilation of considerable quantities of nourishment. Milk constitutes, therefore, the major part of his food, and it is given every two hours generally, at first in small quantities, for some days (4 fl. oz.), and gradually increased until at the end of a week or ten days he takes from 8 to 12 oz. every two hours. When ordinary milk is not well borne, it may be diluted with carbonated waters or peptonized, or some digestible sub- stitutes employed, such as kumyss, matzoon, or somal. At the end of a few days a little stale bread and butter may be given twice and subsequently thrice daily; later on, a soft- boiled egg may be added, and finally a chop or steak at noontime and boiled rice at supper- time. The stimulant drinks (tea, coffee, cocoa, etc.) are not given, nor are beef tea, broths, soups, and the like, because the former are needless and the latter not especially nutritious. Ilassage.—In order to overcome the disad- vantages of lack of exercise, the muscles of the entire body are kneaded by a masseur or mas- seuse (preferably the nurse) for from fifteen minutes to an hour in the evening. This should be begun in persons unaccustomed to it by gentle ejfleurage for but a short period of time, and the" duration of the massage gradu- ally increased. Playfair advises its continu- ance for as long as three hours, but this is undoubtedly extreme. Electricity.—The object of the use of electric- ity is the same as that of employing massage— to effect tissue metabolism by passive exercise of the muscles. The current should be that of the faradaic battery. General faradization of all the muscles of the body is given, either by the nurse or by the physician, each muscle being sought out and contracted a certain number of times at each seance. It is well not to begin at once with electricity, and when it is used to use very feeble currents at first, in order not to disturb or irritate the patient un- duly at the outset. This is particularly needful when patients are sensitive and unaccustomed to the current. Besides exercising the muscles, there is probably a certain amount of " refresh- ing effect" in electricity, and its suggestive value is obvious. Isolation.—The seclusion of the patient is naturally an inherent part of the theory of the rest-cure. In some cases it must be so rigid that no one sees the patient but the physician and nurse, and letters and news of the day are excluded from the sick-room. In others some relaxation of this rule may be made, but the physician must be very judicious in such ex- ceptions. The patient may be isolated in his own home, but in perhaps the majority of cases for which the rest-cure is adopted a complete change of environment is productive of better results. Such is, in succinct form, the idea of the rest-cure, slightly modified in minor details from its original conception by the experience of the writer. In many instances hydrothera- peutic measures may be added for their sooth- ing, tonic, or stimulating effects on the nervous system, as indicated by the symptoms of indi- vidual patients. Drugs are given as required to meet special manifestations. It is well to ascertain the weight of the pa- tient from time to time during the course of treatment, when possible, and where this is not practicable the effects of the method may be judged by the appearance of the face, limbs, and trunk. The duration of the treatment will naturally vary with different cases. The rest- cure is not terminated suddenly, but in every instance there is to be a gradual relaxation in the regulations of treatment above described. It is of great advantage to write down specifi- cally, for the instruction of the nurse and for the "discipline of the patient, the duties for each hour of the day, the times for food, massage, electricity, recreation, hydrotherapy, and so on. It will be found that the personality of the physician and nurse will have much to do with the results of this treatment. As to the nature of the disorders apt to be benefited by rest-cure in its absolute or modi- fied forms, they are of many kinds. They are, taken somewhat in the order of their appropri- ateness, such diseases as neurasthenia, hysteria, exhaustion from any form of nervous or mental disease, chorea, acute mania, melancholia, exophthalmic goitre, epilepsy, and hypochondri- asis. But it must be remembered that there are exceptions in all classes of cases above enumerated. All neurasthenics, hysterical sub- jects, and other victims of nervous disorders RESTORATIVES RHUBARB 128 are not by any means to be put under such treatment. The rest-cure may be the very worst kind of therapy for some patients. The physician must exercise great judgment and discretion in selecting patients adapted for a course of seclusion, absolute repose, and over- feeding.—Frederick Peterson. RESTORATIVES may be regarded as measures or remedies to be employed when there is loss of consciousness, or temporary flagging of the vital powers, or when the con- dition popularly known as suspended anima- tion exists, as after prolonged submersion in water. The loss of consciousness observed in fainting is the form oftenest met with and usually demands but little beyond a recumbent posture with the head lower than the rest of the body, a procedure which usually results in a speedy recovery; but in the cases where the return to consciousness is slow, the inhalation of the fumes of ammonia, which may be pro- vided extemporaneously by burning close to the patient's face two or three feathers ob- tained from a pillow, or the internal adminis- tration of the same. In more pronounced cases it may be desirable to administer alcohol, apply counter-irritation over the heart, or even pass a ligature around one or more of the person's limbs, so as to turn the blood current toward the brain ; firmly grasping the ankles or wrists may be sufficient; but, whatever is done, the utmost gentleness must be observed, lest too violent a shock be inflicted upon the tempo- rarily weakened heart. It may be stated that in this condition and others in which alcohol appears to be indicated, the smallest amount possible consistent with the end in view—viz., stimulation of the heart's action—should be administered, as often too large a quantity will overstimulate, and shortly the condition may be worse than in the beginning. There- fore it is best to measure the dose by drops rather than by drachms, and when unconscious- ness is profound to instil it into the mouth by means of a dropper and trust to its absorp- tion by the oral mucous membrane, and of that of its vapour by the lungs rather than by the stomach. Moreover, when considerable quantities are given and none of the fluid en- ters the larynxa—a quite possible accident—the stomach israrely in a condition to absorb, and when no appreciable effect upon the pulse is observed, more is apt to be given and thus a dose almost lethal in its effects is in the stomach ready for absorption as soon as the circulation is quickened. A few drops of sulphuric ether may be dropped between the lips or inhaled, or, as well as alcohol, employed hypodermic- ally. Whatever method is employed, it is much wiser to administer only enough to cause a moderate strengthening of the action of the heart, and to repeat the dose at short intervals rather than to arouse the ergan to vigorous action by a full dose. In addition to fainting, the principal con- ditions in which heart stimulation is desirable are asphyxiation from submersion in water and exposure to illuminating gas or carbonic oxide or dioxide in excavations, breweries, etc. Un- necessary movements of the person are to be avoided, and, as a rule, it is much better to adopt the measures needed as near as possible to the seat of the accident, unless the weather is too inclement, rather than convey the pa- tient to a more convenient locality. This is especially important in drowning, and the neg- lect of this precaution has led to many deaths which could have been prevented if the efforts at resuscitation had been undertaken imme- diately after the taking of the person from the water. In conditions that are not serious, all that may be necessary will be dashing cold water upon the face and exposure of the chest to the cold air, but chilling of the entire body is to be avoided. In the asphyxia of the new- born, immersion in a cold bath or cold-wa- ter effusions usually excite the respiratory movements. When the depression of the vital powers is great, faradization over the heart will usually strengthen its action, while the same application made to the back, over the lower portion of the lung, should stimulate the respiratory movements. Dry heat to the sur- face is a most efficient stimulant of both the chest and the lungs, and may be applied by bottles, etc., filled with hot water, or, when practicable, by a general hot-air bath. In ap- plying heated objects directly to the body cau- tion must be observed that the indifference of the patient may not prevent his appreciating too high a temperature, and thus troublesome burns be caused. Friction of the surface of the body with the hand, flannel, etc., is also useful; but when there is marked depression the person should be protected by a blanket, In the asphyxia resulting from the inhalation of illuminating gas or of carbonic oxide or di- oxide, ammonia appears to be rather more serviceable than alcohol, and is the agent ordi- narily kept at hand in gas works, etc. To restore consciousness in alcoholic or opium coma a mustard plaster may be applied to the nape of the neck, but should not be allowed to remain in position long, lest too great irritation be set up and sloughing result. Among the less active restoratives may be included hot soups, tea, coffee, milk, and cocoa, which should be given in moderate amounts, as during periods of depression or fatigue the stomach is apt to reject too large quantities of fluids.—Russell H. Nevins. RETINOL.—See Rosinol. RETROJECTIONS. — See under Injec- tions. RHAMNIN.—This name has been ap- plied to several glucosides found in various species of Rhamnus, also to an American con- centrated preparation of Rhamnus purshiana, said to be made in the same way that podo- phyllin is. RHAMNOXANTHIN. — See under Frangula. RHAMNUS FRANGULA.—See Fran- gula. RHAMNUS PURSHIANA (U. S. Ph.), rhamni purshiane cortex (Br. Ph.), cascara, or cascara sagrada, is the bark of the Californian 12 buckthorn, a bush indigenous to the Pacific slope, which has recently been introduced into the pharmacopoeias. Its effects are cathartic, and it is especially indicated in cases of chronic constipation. It acts without purging, is said to irritate haemorrhoids, and in large doses sometimes has the effect of a powerful gastro-intestinal irritant. Preparations made from the freshly gathered bark are somewhat apt to gripe, but if it has been kept for about two years this tendency disappears. In ad- dition to its cathartic effects, it is slightly tonic to the intestinal mucous membrane, and tends to correct the constipation for which it was given. The fluid extract, extractum rhamni pursh- iane fluidum (U. S. Ph.), is the best preparation, and, as a rule, is most effectual when given in about drachm doses at bedtime, although some advise from 10 to 20 drops night and morning, gradually increased to 30 drops if necessary. The analogous British preparation, the liquid extract, extractum cascare sagrade liquidum (Br. Ph.), may be given in doses of from | to 2 fl. drachms. The dose of the extract, extrac- tum cascare sagrade (Br. Ph.), is from 2 to 8 grains. Nursing infants are apt to be affected by this drug when it is taken by the mother. Cascara amarga, or Honduras bark, is a drug having the same properties as quassia, but it is not often used, and is noted here only on account of the confusion sometimes caused by the similarity of names. Russell H. Nevins. RHATANHIA,RHATANY—See Kra- MER1A. RHEI RADIX (Br. Ph.), RHEUM (U. S. Ph.).—See Rhubarb. RHEUMIN.—See Chrysophanic acid. RHIGOLENE is a very volatile and in- flammable fluid obtained in the distillation of petroleum. Probably, like nearly all similar products, it is a mixture of a number of close- ly allied bodies, and not of any definite chemical composition. It is used in surgery to produce local anesthesia, or, rather, freezing of parts, a spray from an ordinary hand atomizer being pro- jected upon the part to be affected. Its great volatility renders it the most effective agent for the purpose, and also requires its being kept in well-stoppered bottles in a cool place. The application of the spray is to be continued un- til the part upon which it is directed has be- come blanched and insensible to the touch. The procedure is one which may often be use- ful for the painless extraction of teeth and the incision into boils, abscesses, felons, etc., but, if the action of the cold extends beyond the skin, more or less sloughing of the parts will occur. The chief advantages attendant upon this method are the ease with which it can be carried out and the portability of the apparatus, but whenever it is practicable the use of nitrous-oxide gas is much to be pre- ferred when minor surgical operations are to be performed. Rhigolene is unsafe to use in the vicinity of lights, and if considerable amounts are needed, thorough ventilation is necessary, as, when combined with air in cer- RESTORATIYES 9 RHUBARB tain proportions, its vapour is highly inflam- mable. An ointment containing 16 parts of rhigo- lene and 1 part each of camphor and sperma- ceti has been recommended in the treatment of burns; it is spread or daubed on cotton, which is applied over the affected part. Russell H. Nevins. RHODALLINE.—See Thiosinamine. RHODEORRHETIN. — See Convolvu- lin. RHG3ADOS PETALA (Br. Ph.), RH03- AS.—The fresh petals of the red poppy, Pa- paver Rheas, and preparations made from them, especially the syrup of poppies, syrupus rheados (Br. Ph.), were formerly much used as a mild anodyne and soporific, particularly for children. The dose of the syrup is 1 fl. drachm. It is now prescribed chiefly to im- part a pleasing colour to mixtures in which, such as cough mixtures, a feeble anodyne is unobjectionable. RHUBARB, rheum (U. S. Ph.). rhei radix (Br. Ph.), radix rhei (Ger. Ph.), is the root of various species of Rheum. The U. S. Ph. and the Ger. Ph. name Rheum officinale only, but the Br. Ph. recognises the root as derived from Rheum palmatum, Rheum officinale, "and probably other species." The plants of this genus are native to Asia. Though certain varieties are cultivated elsewhere, medicinal rhubarb is chiefly obtained from China and Tartary. The root, having been dug up, is cleaned, divested of its cortex, cut into pieces of convenient size, perforated, and strung upon cords. In this state it is dried by exposure either to artificial heat or to the sun, some- times both. Much obscurity surrounds the precise origin and preparation of the Asiatic root, but in commerce two sorts are recog- nised, the Chinese and the European. Chinese, or India, rhubarb is the one most esteemed medicinally. It occurs in irregularly cylin- drical or conical, flattened pieces which are generally perforated. The object of the per- foration has already been alluded to. The surface of the pieces is covered with a light yellowish-brown powder, and is frequently wrinkled. Beneath the powder the colour of the root is reddish-brown and mottled with lighter hues. The root is hard and dense, its odour is aromatic and peculiar, and its taste bitter and somewhat astringent. When chewed, the root is gritty to the teeth and stains the saliva yellow. European rhubarb, though of considerable medicinal activity, is not compar- able in worth with the Chinese variety. At the present time it is little exported, and is used probably as an adulterant of the Asiatic drug. The plant has been cultivated in sev- eral parts of Europe, especially in England and France, but less now than formerly. A variety of rhubarb known as Russian, or Turkey, rhubarb was formerly exported, but is no longer to be had. Its exact origin is un- known. The chemistry of rhubarb is not completely determined as yet. The Asiatic root contains extractive, sugar, starch, pectin, lignin, and RHUS 130 inorganic salts. It contains also tannic acid of the variety known as rheotannic acid; calcium oxalate, which occurs in crystals in large amount and accounts for the grittiness of the drug when chewed; and several colour- ing matters, among them chrysophanic acid. The existence of chrysophanic acid in rhubarb, however, has been denied, and it is stated that it occurs only when chrysophan, a glucoside which the drug is said to contain, is decom- posed under the influence of moisture, and a supposititious ferment. A crystalline sub- stance termed emodin is also described as pres- ent in the root. The medicinal power of rhubarb is thought to reside rather in the com- bination of constituents than in an active prin- ciple ; certainly no active purgative principle has been isolated. The European varieties of rhubarb contain more tannin and more starch than the Asiatic, but far less calcium oxalate; they therefore lack much of the grittiness of the Asiatic drug on being chewed. In small doses, rhubarb is bitter and sto- machic, acting decidedly to increase digestive vigour. In larger doses it is purgative, causing loose faecal evacuations, but, owing to its tan- nin, rhubarb is secondarily astringent and even constipating, a circumstance which con- tributes much to its medicinal value. The purgation from rhubarb has been attributed rather to its action upon peristalsis than upon intestinal secretion, though it is apparently proved that the drug is actively cholagogue. Occasionally it causes griping. The urine shows that a part of the drug at least is ab- sorbed, for under its influence the colour of the urine becomes more deeply yellow. The milk of a nursing woman is apt to be made yel- low if rhubarb is taken, and is said sometimes to exercise a laxative influence upon the child. The therapeutic value of rhubarb is chiefly manifested in atonic dyspepsia, where it is ac- tive because of its stomachic properties, and also valuable from its influence upon the con- stipation which is generally present. In such cases the administration of rhubarb before eating, and especially in combination with an alkali like sodium bicarbonate, is highly bene- ficial, a fact which would seem to have abun- dant confirmation in the extensive use of the familiar "rhubarb-and-soda mixture " for these purposes. Habitual constipation may be treated with rhubarb with benefit, for, though it is indeed secondarily astringent in its action, it is not injuriously so, and its strengthening properties more than compensate for its astrin- gency. Its mildness of action makes rhubarb a valuable purge for the enfeebled, and for the same reason it is practically worthless where revulsion or depletion is required. In diar- rhea of the subacute rather than of the acute variety, rhubarb is often of much benefit, serv- ing to remove irritating materials from the in- testines as well as to exert upon them an astringent and a strengthening influence. In functional disturbance of the liver in which biliary production is deficient, rhubarb is an excellent remedy. The drug is sometimes used in combination with another purgative, that mutual increase of activity may oc- cur. Thus, rhubarb and blue mass may be given together when hepatic stimulation and bilious evacuation are desired, while rhubarb and aloes make an excellent cathartic combi- nation for those who are habitually consti- pated, provided, as is always the case in chronic constipation, curative hygiene is not neglected. Rhubarb is but little employed topically, but it has at times been applied to unhealthy ulcerations in powder with sup- posed benefit. The dose of rhubarb as a stomachic is from 2 to 5 grains; as a purgative, from 20 to 30 grains. Its use in substance is uncommon, though those who suffer habitually from con- stipation may find benefit in chewing small pieces of the root from time to time. As a stomachic, rhubarb is most frequently given in a mixture; as a purgative it may be given in a pill with soap. Of European rhubarb the dose will vary between two and three times that of the Asiatic variety. The preparations of rhubarb are numerous. Extract of rhubarb, extractum rhei (U. S. Ph., Br. Ph., Ger. Ph.), is a mass of pilular consistence obtained by macerating and percolating powdered rhu- barb with alcohol and water and evaporating the percolate. The dose is from 5 to 10 grains. Compound extract of rhubarb, extractum rhei compositum (Ger. Ph.), contains 6 parts of ex- tract of rhubarb, 2 parts of extract of aloes, 1 part of resin of jalap, and 4 parts of medicinal soap. The dose is from 2 to 5 grains. Fluid extract of rhubarb, extractum rhei fluidum (U. S. Ph.), is given in doses of from 5 to 10 minims as a laxative, and from 20 to 30 min- ims as a purgative. Infusion of rhubarb, in- fusum rhei (Br. Ph.), is composed of 1 part of thinly sliced rhubarb infused in a covered ves- sel for half an hour with 40 fl. parts of boiling distilled water, and the liquid strained. The laxative dose is from 1 to 2 fl. oz., and it may be repeated every three or four hours until it operates. It is incompatible with the stronger acids and with solutions of metallic salts. Pills of rhubarb, pilule rhei (U. S. Ph.), con- tain 20 parts of powdered rhubarb and 6 parts of powdered soap mixed with a sufficient quanti- ty of water. Each pill contains 3 grains of rhubarb. Compound pills of rhubarb, pilule rhei composite (U. S. Ph.), and the compound rhubarb pill, pilula rhei composita (Br. Ph.), according to the U. S. Ph., are composed of 13 parts of powdered rhubarb, 10 of purified aloes, 6 of myrrh, \ of oil of peppermint, with a sufficiency of water; those of the Br. Ph. contain 6 parts of powdered rhubarb, 4£ of Socotrine aloes, 3 of myrrh, 3 of hard soap, £ of oil of peppermint, 2 of glycerin, and 6 of treacle. The dose of the American prepara- tion as a laxative is from 2 to 4 pills; of the British preparation, from 5 to 10 grains. Com- pound powder of rhubarb, pulvis rhei composi- tus (U. S. Ph., Br. Ph.), pulvis magnesie cum rheo (Ger. Ph.), Gregory's powder, according to the U. S. Ph., contains 25 parts of rhubarb in powder, 65 of magnesia, and 10 of ginger; ac- cording to the Br. Ph., 2 parts of powdered rhubarb, 6 of light magnesia, and 1 of pow- dered ginger; according to the Ger. Ph., 12 131 RHUS parts of magnesium carbornate, 8 of oleosac- charum of fennel, and 3 of powdered rhubarb. The powder is laxative and antacid. The dose is from i to 1 drachm. Svrup of rhubarb, syr- upus rhei (U. S. Ph., Br. Ph.), sirupus rhei (tier. Ph.), according to the U. S. Ph., con- tains 100 parts of fluid extract of rhubarb, 4 of spirit of cinnamon, 10 of potassium carbonate, 50 of glycerin, 50 of water, and enough syrup to make 1,000. It is a mild cathartic of much value for infants. The dose for an infant is 1 fl. drachm. The British svr- up consists of 8 fl. oz. of rectified spirit mixed with 24 fl. oz. of distilled water and percolated through 2 oz. each of powdered rhubarb and powdered coriander, and afterward evapo- rated to 14 fl. oz. and filtered, with the final addition to it of 24 oz. of refined sugar. The adult dose is from 1 to 4 fl. drachms. Aro- matic syrup of rhubarb, syrupus rhei aromat- icus (U. S. Ph.), contains 15 parts of aromatic tincture of rhubarb and 85 of syrup. It is an excellent laxative in diarrhoeal conditions of infants; for adults it is too feeble. The dose for an infant is 1 fl. drachm, repeated every two or three hours until the movements im- prove. Tincture of rhubarb, tinctura rhei (U. S. Ph., Br. Ph.), tinctura rhei aquosa (Ger. Ph.), according to the U. S. Ph.. is made with 100 parts of rhubarb, 20 of cardamom, 100 of glycerin, and a sufficient quantity each of al- cohol and water to make 1,000. The dose is from 1 to 2 fl. drachms. The British tincture is made with 2 oz. of rhubarb, ± oz. of carda- mom seeds, i oz. of coriander fruit, ± oz. of saffron, and 1 pint of proof spirit. The Ger- man tincture is made with 10 parts of rhu- barb, 1 of borax, 1 of sodium carbonate, 90 of water, 15 of cinnamon water, and 9 of alco- hol. The dose as a stomachic is from 1 to 2 fl. drachms; the purgative dose is from 4 to 8 fl. drachms. Vinous tincture of rhubarb, tinctura rhei vinosa (Ger. Ph.), is made with 8 parts of rhubarb, 2 of orange peel, 1 of cardamom, and 100 of sherry wine. The doses are a little larg- er than those of the tinctures previously men- tioned. Aromatic tincture of rhubarb, tinctura rheiaromatica (U'. S. Ph.), is made with 20 parts of rhubarb, 4 of cassia cinnamon, 4 of cloves, 2 of nutmeg, 10 of glycerin, and of alcohol, water, and diluted alcohol, each a quantity sufficient to make 100. The adult dose is from ■$• to 1 fl. drachm. It is used in making aromatic syrup of rhubarb. Sweet tincture of rhubarb, tinc- tura rhei dulcis (U. S. Ph.), is made with 10 parts of rhubarb, 4 of licorice, 4 of anise, 1 of cardamom, 10 of glycerin, and of alcohol, water, and diluted alcohol each a sufficient quantity to make 100 parts. The dose is from 2 to 3 fl. drachms. Wine of rhubarb, vinum rhei (Br. Ph.), is made by macerating 1£ oz. of pow- dered rhubarb and 60 grains of powdered ca- nella bark with 1 pint of sherry for seven days, straining, filtering, and adding sufficient sher- ry to make 1 pint. The dose is from 1 to 2 fl. drachms. There is occasionally used for diar- rhoeal conditions what is known as torrefied rhubarb. This is rhubarb from which the [mrgative principles have been driven off by leating, the astringent property remaining. [The dose of rhubarb-and-soda mixture, mis- tura rhei et sode (U. S. Ph.), is from 1 to 1 fl. drachm for infants, and from 2 to 4 fl. drachms for adults. A more convenient form of rhu- barb and sodium bicarbonate is that of the un- official compressed tablets, from one to six of which may be taken in the course of twenty- four hours.]—Henry A. Griffin. RHUS.—This is a genus of anacardiaceous trees and shrubs. Several of the species are poisonous, and medicinal virtues have been ascribed to some of them. Rhus aromatica.—The root-bark of this North American shrub, the sweet sumach, is diuretic, and is reputed to have a stimulating action on the muscular tissue of the bladder, the uterus, and the large intestine. It has been used with considerable success in inconti- nence of urine from vesical atony, in vesical hematuria, in metrorrhagia due to fibroid tumours of the uterus, and in hemorrhage from the rectum. The powder may be given in daily amounts of from 15 to 45 grains. There is an unofficial fluid extract of which from 10 to 30 drops may be given daily. Rhus diversiloba, the hiedra, or yeara, or poison oak, of the Pacific coast of the United States, is similar in its poisonous action to Rhus Toxicodendron, which it resembles in ap- pearance also. According to Dr. Colbert A. Garfield (Am. Jour, of Pharm., September, 1860), a remedy which is invariably efficient in poisoning with Rhus diversiloba is grin- delia (either Grindelia hirsutula or Grin- delia robusta). " The mode of using it," says Dr. Canfield, "is as follows: One may bruise the fresh herb and apply it by rubbing over the parts affected, or, boiling it in a covered vessel, make a strong decoction of the fresh or dried herb with which to wash the poisoned surfaces. Its remedial properties appear to be contained chiefly in the resin or balsamlike juice of the plant, which is particularly abun- dant on the surface. One application is some- times sufficient for a cure, but if the disease has been of long duration, several days will elapse before relief is obtained." Probably the fluid extract of grindelia will be found equally serviceable and more convenient as a remedy for this distressing form of poisoning. Rhus glabra (U. S. Ph.).—The berries of this shrub, the smooth sumach, or upland sumach, indigenous to the United States and Canada, which are edible, are sour, astringent, and refrigerant. The fluid extract, extractum rhois glabre fluidum (U. S. Ph.), diluted, forms an agreeable vehicle for gargles in various forms of sore throat. Rhus pumila, or dwarf-sumach, a small shrub found in North Carolina, is said to be the most poisonous species. Rhus radicans.—This is a climbing vari- ety of Rhus Toxicodendron, known as poison ivy. Its poisonous effects are the same as those of Rhus Toxicodendron. Rhus Toxicodendron.—Under this name, the fresh leaves of Rhus radicans, which is a variety of Rhus Toxicodendron, are official in the U. S. Ph. The poison oak, or poison ivy, is a for fear of transferring some of the poisonous principle to other portions of the skin. The well- known lead-and-opium wash (see under Lead, vol. i, page 577) is very soothing; cloths wet with it may be kept constantly applied, except to the eyes. This, however, has little if any cura- tive action, but is only palliative. The fluid extract of serpentaria has been highly recom- mended as both a soothing and a curative ap- plication. It is highly probable, in view of Dr. Canfield's experience with the use of grin- delia in cases of poisoning with Rhus diversi- loba (mentioned in the section on that species), that the fluid extract of grindelia will be found of substantial service in Rhus-Toxicodendron poisoning. Weak solutions of carbolic acid have sometimes proved efficacious. Mr. George M. Beringer (Am. Jour, of Pharm., Jan., 1895) has found hot soda baths efficacious, but for a topical application he prefers the following lotion: RHUS 1 familiar plant of the fields, woods, and road- sides of southern Canada and of the United States. Its trifoliolate leaves serve readily to distinguish this poisonous plant, the " three- leaved ivy," from the harmless Virginian creeper (Ampelopsis quinquefolia) with which it might otherwise be confounded. To most persons, Rhus Toxicodendron is a violent poison. Handling the plant or gentle contact with it—even, in the case of some in- dividuals, exposure to the emanations from it, without any contact with it whatever—is enough to cause the cutaneous form of rhus poisoning to ensue within a few hours, in the form of an intense dermatitis. In rare in- stances the entire skin is affected, but usually the effects of the poison are shown only on those parts to which the plant was originally applied or on those also to which the milky juice (some say, too, the contents of the vesi- cles incident to the inflammatory process) may be transferred by the patient's fingers. The face and the hands are the commonest seats of the cutaneous inflammation. In its character, it may range from a mere reddening of the skin through the phases of papular and vesicu- lar lesions up to a condition of redness, swell- ing, and vesication that constitutes a close counterfeit of genuine erysipelas. Whatever form the poisoning takes, it is always accom- Eanied by distressing itching and burning. •esquamation usually closes the progress of the affection, which generally begins to de- cline within two or three days, and almost al- ways in the course of a week. In severe cases, where the dermatitis is widespread, there may be a moderate degree of fever for a short time. There are some persons to whom Rhus Toxi- codendron is not poisonous; they can handle the plant and rub its milky juice on their skin without suffering any unpleasant effect. In some others, on the contrary, troublesome se- quelae follow upon the regular course of the poisoning, such as protracted eczema and re- current crops of boils. Moreover, there is on record indubitable testimony going to show that, with a few individuals, one attack of rhus poisoning entails upon the victim one or more annual recurrences at about the same time in the year without any fresh exposure to the plant. Thus, Mr. E. G. Lodeman (Garden and Forest, cited in Am. Jour, of Pharm., January, 1895), writing of his personal experience with this plant, states that the symptoms of poisoning re- appeared for six years consecutively, at about the same time of the year as that in which he had been poisoned, without his having been again exposed to the plant. An attack of ty- phoid fever occurred in the seventh year, and for several years afterward he escaped the affec- tion. Thinking himself then exempt from the influence of the poison, he rubbed a leaf of the plant on the back of his hand, and again for several years symptoms of poisoning recurred at the same time of the year. The treatment of this cutaneous form of rhus poisoning consists in the administration of cool- ing drinks and the topical application of sooth- ing remedies. The patient should always be cautioned against handling the affected parts, R Granular sodium sulphite.. 1 drachm ; Glycerin.................| fl. oz.; Camphor water, enough to make ................. 4 fl. oz. M. Mr. Beringer states that he has seemed to have good results from washing his face and hands with a solution of hydrogen dioxide as a preventive measure. The bastard nettle, dead nettle, rich weed, cool weed, or silver weed, Urtica (or Piled) pu- mila, which grows in damp, shady woods and occasionally along the roadsides, has been used for a number of summers by Dr. James Stokes, of Philadelphia (Med. and Surg. Reporter, No- vember 2,1867), in cases of rhus poisoning, and always, he says, with decided benefit, some- times when other remedies have proved slow or almost inoperative. If possible, he obtains full-grown plants, strips off the leaves, bruises the stems, and applies the juice directly to the affected parts. The coating is to be re- newed when it has become dry. In many cases, says Dr. Stokes, a complete cure is ef- fected by one or two thorough applications. Dr. Blackwell, of Philadelphia (Charlotte Med. Jour., cited in Indian Lancet, April 16, 1896), urges the use of europhene, in an oint- ment of from 10 to 30 per cent., or that of a dusting powder of from 25 to 50 per cent, with talcum, in the treatment of rhus poisoning. Cases of poisoning from the internal use of Rhus Toxicodendron are rare. In the Ameri- can Journal of the Medical Sciences for April, 1866, Dr. J. W. Moorman, of Hardinsburg, Ken- tucky, relates two cases, communicated to him by a professional friend, of poisoning from eat- ing the berries. The subjects were children, one six and the other eight years old. The quantity eaten (whether by each or by both together is not stated) was nearly a pint. In a few hours the children became' drowsy and stupid, and in a short time they began to vomit, first the partially digested fruit, after- ward a thick, tenacious fluid of a wine-colour. Then convulsions of different parts of the body followed, accompanied by slight delirium. The breathing was hurried; the pulse was at first 13 full and strong but slow, afterward small, frequent, and compressible; and the pupils were dilated. Warm water was given to pro- mote vomiting, and afterward a large quantity of sodium carbonate [bicarbonate V], dissolved in water, under the belief that it was an anti- dote. Both the children recovered, but the younger one's convalescence was very slow. Three cases of poisoning with the root have been recorded by Dr. James Stokes (toe. cit.). Four children gathered what they supposed to be sassafras roots, and made a tea from them which they drank. One of them, a boy, twelve years old, broke out with a rash resembling that of measles; his face, neck, and throat were swollen, his eyes were suffused and watery, his voice was husky, he had a dry, hoarse cough, there was soreness of his throat, with intense burning extending to the stomach, he had high fever, his tongue was coated, his urine was high-coloured, scanty, and irritating, there was intolerable itching of the skin, there were nervous twitchings, and at times his mind was wandering. He had then been ailing for a week, with catarrh and general indisposition. The scarlet appearance of the eruption on the face, with incipient vesication, and a crescentic arrangement of the rash on the body, together with the fever and catarrhal symptoms,led Dr. Stokes to a reluctant diagnosis of measles. He ordered small doses of magnesium sulphate, a tablespoonful of neutral mixture every two hours, demulcent drinks, and a farinaceous diet. On his next visit he found the u'dema more diffused, extending to the hands and feet; the eyelids were closed, their connective tissue was filled with serous fluid, and they seemed ready to burst; and the prepuce was so swollen as to cause difficulty in urinating. All resemblance to measles had disappeared. At his next visit, Dr. Stokes found two others of the children, girls fifteen and seventeen years old respectively, affected with the poison. It was then that he learned of the tea they had made ; among the roots they showed him were some that he recognised as those of Rhus Toxicodendron. The fourth child, a boy, being insusceptible, did not suffer. Lead water was now applied to the affected skin, and small doses of saline purgatives were given. All the patients recovered. The time that intervened between the tea-drinking and the onset of the symptoms is not mentioned. Therapeutics.—Rhus Toxicodendron was for- merly official in several of the pharmacopoeias, but it is now recognised only in the U. S. Ph., which, strangely enough, gives no preparation of it. The first edition of the Ger. Ph. au- thorized a tincture, tinctura toxicodendri, made by macerating 5 parts of the fresh leaves in 6 parts of alcohol. Dr. John Aulde, of Philadelphia, who has made two important contributions to the literature of the therapeu- tic use of the drug—one published in the Medi- cal Neivs for April 20, 1889, and the other in the Therapeutic Gazette for October 15,1889— makes a tincture according to the directions given in the U. S. Ph. for making tinctures from fresh herbs, using 50 parts of the fresh leaves and 100 parts of alcohol. This strong >o RHUS tincture, the dose of which he finds does not exceed -j drop, he dilutes with nine times its bulk of diluted alcohol, and the dose of this weaker tincture is 5 drops. Dr. Aulde cites Dr. Phillips as stating that rhus was first brought to the notice of the pro- fession by Dr. Dufresnoy. of Valenciennes, in 1798, and that in 1836 it was recognised in the London Pharmacopeia. Dr. Phillips recom- mended it, both taken internally and employed topically, in various subacute and chronic rheu- matic affections of fibrous tissues. Dr. Whitla and Dr. Brunton, says Dr. Aulde, have recom- mended it in incontinence of urine. In his first publication (Med. News, April 20, 1889) Dr. Aulde gives the condensed histories of seven cases in which he used rhus. Three of them were examples of various forms of sub- acute and chronic rheumatism, one was a case of sciatica, one was a case of cramps in the legs occurring at night, and two were cases of vari- cose veins. lie suggests some occult relation- ship between rheumatism and the varicose state of the veins that gives rise to pain. In all these seven cases the employment of the remedy was promptly followed by the most satisfactory results. In his second article (Therap. Gaz., October 15,1889) Dr. Aulde reports his continued satis- factory employment of rhus in various manifes- tations of chronic rheumatism. " I do not think it would be of great benefit in acute at- tacks," he says, " and my experience does not justify the statement that it can be depended upon invariably for relief" in chronic cases. In this article Dr. Aulde gives extracts from reports that have been made to him by other physicians, as follows: Dr. B. W. Allen, of Jernigan, Alabama, says he considers the reme- dy of value in neuralgia. Dr. T. C. Fenton, of Streator, Illinois, mentions a case of acute rheumatism in which four doses of the drug took away all the pain, but failed to do away with the stiffness ; a case of " rheumatism of the thigh, extending to the knee," in which six days' use of the remedy gave no relief; a case of neuralgia of the face in a woman of a nervous temperament, seven months advanced in pregnancy, in which also no effect was pro- duced ; and a severe case of sciatica which was cured with five doses. Dr. J. B. Laidley, of Carmichaels, Pennsylvania, reports a case of severe recurrent sciatica in an aged clergyman who was a sufferer from chronic cystitis. De- cided benefit seemed to be derived from the use of rhus. Dr. H. A. Mobley. of Byromville, Georgia, reports a case of sciatica in which the beneficial action of rhus was doubtful, and one of " articular rheumatism " in a weak, anaemic lad, in which the remedy acted most satisfac- torily. Dr. B. Powell, of Houston, Texas, who had himself been for years a sufferer from rheumatism and hemorrhoids, found the use of the remedy very beneficial as to both ail- ments. He began its use in a spirit of scepti- cism, but he says, with regard to his rheumatism: " In three days I began to feel better than I had done for months," and concerning his haemorrhoids: " While taking the rhus I was entirely free from all rectal annoyances. Im- RICE RUBBER 134 mediately, however, upon stopping the medi- cine the piles returned." Dr. J. Richard Taylor, of Charleston, has found the drug very efficient in subacute and chronic mus- cular rheumatism, always tolerated by delicate stomachs, but not quite so prompt as sodium salicylate. He says, however, that its action is very rapid in relieving muscular soreness due to hysterical convulsions. Dr. J. W. Welch, of New Hope, Missouri, reports its satisfactory employment in a case of rheumatism and, to a lesser degree, in one of sciatica. Dr. J. B. Whitehead, of Lovingston, Virginia, reports the cure of a case of sciatica with rhus, also the apparent failure of the drug in a case of chronic rheumatism and neuralgia. In this case, he remarks, the patient thought, from the small size of the dose, that the medicine was very dangerous, and so did not take it as she should have done. In the course of his comments on these re- ports Dr. Aulde says : " Dr. Powell speaks very highly of the value of rhus in connection with the pain and annoyance attending the presence of haemorrhoids, all of which I can fully in- dorse. It is truly wonderful how quickly local irritations of this character and varicose veins are subdued, and my observations incline me to consider favourably the use of some drug in connection with the rhus which will favour a more active discharge of the functions of the lower bowel, from the fact that haemorrhoids and constipation often go together. Few phy- sicians would be willing, however, to say that there was any relation existing between rheuma- tism and haemorrhoids, or between rheumatism and varicose veins ; but it seems to me that a relationship can be inferred, if not demon- strated, from the results which attend the ex- hibition of certain remedies. Knowing that cascara sagrada has been highly extolled for the relief of rheumatism, and knowing, further, that it acts mildly as a laxative, and is thus calculated to reduce the congestion of the pelvic organs, including the rectum, I have made a combination of the rhus with cascara sagrada cordial with the happiest effects." Rhus venenata.—This species, the swamp sumach, is reputed to give rise to severer poi- soning than that caused by Rhus Toxicoden- dron. The treatment is the same. Rhus vernicifera.—This is the plant from which Japanese lacquer is made. According to Mr. Beringer (loc cit.), Mr. D. P. Penhallow reports serious poisoning resulting from stir- ring and smelling the lacquer. He says that after a few experiences it was always possible for him to ascertain whenever he came into an atmosphere charged with the poison. This was manifested by a well-defined acid taste in the mouth and a slight, somewhat acute pain directly between the eyes, which were invari- ably symptoms of the results to follow. The Japanese, he says, employ the flesh and juices of a fresh giant crab, the Macrocheira Kemp- feri, and apply it freely to the poisoned parts. RICE.—Rice is the grain of Oriza saliva, a grass derived originally from India. It is now largely produced in the Southern United States and in southern Europe. It contains a larger proportion of starch than any of the other cereals and a smaller proportion of proteid, fat, and mineral matter. Its composition, accord- ing to Bauer, is as follows: Proteids, 7-81; fat, 0-69; starch, 76-40; cellulose, 0-78; ash, 009; water, 13-23. According to Gautier's analysis, it contains 78-1 per cent, of carbohy- drates, while others have placed the portion of them as high as 80 per cent. It is therefore the simplest in its composition of all the cereals, and is one of the most digestible of vegetable foods. But one hour is required for the digestion of boiled rice. Its nutritive value is less than that of wheat and the other cereals. It is unirritating, and is often tolerated by the stomach when other vegetable food will not be retained. It is therefore well adapted for the nourishment of invalids. The addition of milk or cream renders it more nutritious by supplying the elements which are lacking in the rice. Rice water is considerably used as a demulcent drink. It is prepared by boiling whole rice in water and straining off the clear liquid.—Floyd M. Crandall. RICINUS.—The leaves of the castor-oil plant (Ricinus communis) have by some writers been credited with galactogenic properties. The method usually recommended for their employment is as follows : The breasts are first bathed for fifteen or twenty minutes with a decoction of the fresh leaves. A fomentation of the boiled leaves is then applied to the breasts and allowed to remain till they are dry. If the desired result is not accomplished within a few hours, the process is repeated. The ex- tract of the leaves, smeared over the breast and covered with a common poultice, has been used instead of the leaves themselves. Routh rec- ommends the internal administration of a de- coction of the leaves and stalks of ricinus as a galactagogue. He says that its effects are frequently immediate, yet in some cases are not observed for several days. On ceasing its use the secretion is liable to again become scanty or even to stop altogether. In modern obstetric practice the castor-oil plant is seldom or never employed as a galactogenic agent. (Cf. Castor oil.)—Charles Jewett. ROSA CANINA, ROSA CENTIFO- LIA, ROSA DAMASCENA, ROSA GAL- LICA.—See Rose. ROSANILINE HYDROCHLORIDE, ROSEINE.—See Fuchsine. ROSE.—The fruit of the dog-rose (Rosa canina), known as hips, rose canine fructus (Br. Ph.), beaten to a pulp and deprived of its seeds, is employed in the preparation of con- fection of hips, confectio rose canine (Br. Ph.), which is used in making pill masses. The hundred-leaved rose (Rosa centifolia) is the species of which the petals, rosa centifolia (U. S. Ph.), rose centifolie petala (Br. Ph.), flores rose (Ger. Ph.), are used in the prepara- tion of compound syrup of sarsaparilla, syrupus sarsaparille compositus (U. S. Ph.), rose water, aqua rose (Br. Ph.. Ger. Ph.), oil of roses, oleum rose (Ger. Ph.), and honey of roses, mel rosatum (Ger. Ph.). RICE 135 RUBBER The damask rose, Rosa damascena, furnishes the oil, or attar, of roses, oleum rose (U. S. Ph.), which is used in the preparation of a strong rose water, aqua rose Jortior (U. S. Ph.). This diluted with distilled water, forms ordinary rose water, aqua rose (U. S. Ph.), which enters into the composition of rose ointment or cold cream, unguentum aque rose (U. S. Ph.). Of the official rose waters, that of the U. S. Ph. is the most elegant. It is employed as a flavour in cooking, as a perfume, and as a vehicle for collyria. Collyria made with rose water are less irritating to the eyes, other things being equal, than those made with plain water. The red rose, Rosa gallica, is the variety the petals of which, rosa gallica (U. S. Ph.), rose gallice petala (Br. Ph.), are used in the prepara- tion of confection of roses, confectio rose (U. S. Ph.), confectio rose gallice (Br. Ph.), acid in- fusion of roses, infusum rose acidum (Br. Ph.), fluid extract of roses, extractum rose fluidum (U. S. Ph.), honey of roses, met rose (U. S. Ph.), and syrup of roses, syrupus rose (U. S. Ph.), syrupus rose gallice (Br. Ph.). The petals of the red rose were formerly used as a tonic and astringent, but are now chiefly employed to impart an agreeable odour and flavour to preparations to which astringency is no draw- back.—Russell H. Nevins. ROSEMARY—The volatile oil of rose- mary (Rosmarinus officinalis), the oleum rosma- rini of the pharmacopoeias, acts topically as a rubefacient, and is added to rubefacient prep- arations on account of its agreeable odour. Given internally, in doses of from 1 to 4 minims, on sugar or diluted with hot water, it is car- minative. The dose of spirit of rosemary, spiritus rosmarini (Br. Ph.), is from ■$■ to 1 fl. drachm. The compound ointment of rose- mary, unguentum rosmarini compositum (Ger. Ph.)', which contains 1 part each of oil of rose- mary and oil of juniper, 2 parts each of yellow wax and oil of nutmeg, 8 parts of mutton suet, and 16 parts of lard, is useful as a mild stimulant to indolent ulcers. ROSIN, or colophony, resina (U. S. Ph., Br. Ph.), colophonium (Ger. Ph.). is the resinous residue left after the volatile oil is distilled off from turpentine. It is employed in the form of ointments and plasters for its topical stimu- lating effect. The official preparations area cerate, ceratum resine (U. S. Ph.), a plaster, emplastrum resine (U. S. Ph., Br. Ph.), com- monly called adhesive plaster, and an ointment, unguentum resine (Br. Ph.). The cerate, which is known also as basilicon ointment, is much employed as a dressing for indolent ulcers, especially those following burns. ROSINOL, resinol, or rhetinol, 03JT16, is a thickish yellow oil obtained by the dry dis- tillation of Burgundy pitch. It dissolves salol, camphor, cocaine, codeine, chrysarobin, balsam of Peru, creosote, iodol, phosphorus, oil of cade, and carbolic acid, and mixes readily with other oils. It does not become rancid and does not irritate the skin. It is an antiseptic, and has been employed topically, undiluted, in the treatment of vaginal and uterine catarrh, hemorrhoids, foul ulcers, and pruritus. ROSMARINUS.—See Rosemary. ROTTLERA.—See Kamala. RUBBER, elastica (U. S. Ph.). This, as met with ordinarily, occurs in three colours, black, white, and red, the exact shade of each depending upon the methods employed in its manufacture, and upon the diluent always found except in the purest varieties, which, however, are suitable only for articles in which great elasticity and flexibility are necessary. As a rule, the ordinary specimens of manufac- tured rubber contain carbon, zinc oxide, and lead carbonate or antimony sulphide in vary- ing proportions; in some instances the per- centage may run as high as sixty. In the cheaper rubber dolls, etc., zinc oxide is the diluent, but it is so evenly distributed through the rubber that even if particles of the toy reach the stomach no ill results are apt to follow. The same may be said of the antimony sulphide which is employed to give a reddish colour to rubber. According to the amount of sulphur employed and the degree of heat and pressure to which rubber is subjected, it ap- proaches glass in hardness, or may be as soft and flexible as kid. From the hard variety, or " vulcanite," are made drainage-tubes, bougies, pessaries, syringes, basins, etc.. and similar ob- jects which it is desirable to cleanse easily and which should be non-absorbent. It is also a poor conductor of heat, and on that account is preferable to metals for the nozzles of douche- bags, syringes, etc., which are used to inject hot fluids into the vagina and other cavities. From the softer variety, often termed pure rubber, are made catheters, bougies, drainage- tubes, and other objects for introduction into small canals, etc., the interior of which might be bruised or lacerated by a hard material and which are tortuous and not easily followed by a rigid instrument. The uses of rubber tubing are almost with- out number. It occurs in many forms, varying from a white colour to a dead black; the former is but little elasticand rapidly deteriorates, while the latter is of such consistence as to barely maintain its tubular form and will retain its properties for years. The heavy white variety is employed as a tourniquet in surgical opera- tions and may be substituted with advantage for a cord to encircle a part to check hemor- rhage or prevent the absorption of the poison introduced by the bites of venomous snakes or rabid animals. Care must be exercised that too great pressure is not exerted, as paralysis of the motor or sensory nerves may follow. Solid cords or bands may be employed in place of the tubing for the above-mentioned pur- poses and also to encircle the bases of small morbid growths, such as hemorrhoids, with the view of causing a stasis of the circulation and a resulting shrinkage of their bulk or even gangrene. Fistula of the anus and fistulae in other localities, when an operation will not be submitted to, may be treated by passing a cord or strip of rubber, called an elastic ligature, through the tract and tying it upon the sur- face, the tension being increased each day until the tissues are cut through. If the surfaces RUBEFACIENTS SACCHARIN 136 are not fibrous and indurated, success usually follows this method, but it is rather tedious and troublesome, and is hardly to be under- taken unless there is good reason for avoiding an operation. Sheet rubber is usually of about the thick- ness of blotting paper and should be of con- siderable elasticity, as its uses largely depend upon that property. It may be employed to exert moderate pressure upon varicose veins, small aneurysms, and old intractable ulcers, especially of the leg; in the place of elastic webbing, to sustain weak and injured joints and to expedite the absorption of effusions in injuries to joints and to expel the blood from limbs preparatory to operations. In this last case it should be applied from the distal end of the member toward the central, and need not remain in position longer than a few seconds, care being observed that it is applied in such manner that only very moderate pres- sure is exerted. Before its removal, two or three turns of tubing should be applied a short distance above its upper boundary and allowed to remain until the operation has been concluded and all bleeding vessels have been ligated. This method is hardly applicable when pus cavities or abscesses exist, as there might be some danger of pus absorption. Nar- row strips may be substituted for adhesive plaster in the treatment of varicocele and hydro- cele, but too great pressure is to be avoided. One point which must be borne in mind in the use of elastic bandages over any considerable extent of surface is the liability to the occur- rence of more or less severe headache, which may often prevent their employment. Elastic webbing or heavy cloth containing fine rubber cords is rather stiffer and less manage- able than sheet rubber. It absorbs fluids and loses its elasticity in a shorter time, but may be employed for the same purposes. Combined with silk and other fibre, rubber constitutes the cloth from which elastic stockings, anklets, etc., are made, which are employed to exert moderate pressure over varicose veins and upon joints into which there is effusion or which have sustained injuries. When used for any of these purposes, it is rarely that they should not be removed during the sleeping hours and the parts that have been covered by them rubbed with the bare hand, as otherwise the nutrition of the tissues will be impaired. In joint affections these bandages should be used with great caution, for if they are worn too long the vitality of the joint is lowered and in some instances its usefulness has been en- tirely destroyed. Bandages for the support of the abdomen in pregnancy and in the obese are often worn and without any evil results. Rubber tissue, or rubber in very thin sheets, when applied to the surface of the body, tends to keep it warm and moist, and is employed in the treatment of eczema and psoriasis, to pro- tect bums, to relieve the pain of rheumatic joints, to cover poultices, and as a protective and covering in surgical practice. Several thicknesses wound over a com will soften it in the course of two or three days so that it may easily be picked out. Wherever two surfaces of rubber tissue come together, the application of a piece of warmtmetal will cause them to adhere and thus an air-tight and water-tight covering may be made. A proprietary ad- hesive plaster is also made from rubber which the heat of the body renders adherent. The uses of the various appliances, such as hot-water bags, etc., which are made from rub- ber are so familiar that they need little more than passing mention. They are simply con- venient vehicles for the application of heat and cold. Rubber sheeting is largely employed as a protective of the bedclothing, etc., in childbed, in affections in which there are offensive dis- charges, in fevers when baths, etc., are given, and in a host of other conditions that occur during illness. It, however, should never be allowed to come in direct contact with the person, but a sheet or blanket must be inter- posed. Condoms maybe used for small ice bags, and are very convenient in small contusions, affec- tions of the eye, etc., where the application of cold is indicated. To preserve rubber articles they should be kept in a cool and moderately moist place, two surfaces should never come together, and, if possible, a little French chalk should be dusted upon them. [Soft rubber is very much injured by pro- longed contact with fatty matters. When any such material has lodged on the rubber, it should be washed off with ammonia water, and it is well to keep small articles of soft rubber immersed in ammonia water when they are not in use.]—Russell H. Nevins. RUBEFACIENTS.—See under Counter- irritants. RUBIDIUM.—The salts of this metal bear a close resemblance to those of caesium and those of potassium. The iodide, Rbl, has been recommended as a substitute for potas- sium iodide in cases in which the potassium salt is taken only with great repugnance or in which it deranges the digestion. Rubidium may be given in doses of from 5 to 15 grains, three times a day, in syphilis and in other affec- tions for which the iodides are employed. Top- ically, a solution of 1 part in 20 parts of distilled water has been used as a lotion for mucous surfaces. A double bromide of rubidium and ammo- nium, NHs.RbBr2, has been recommended as a remedy for epilepsy, to be given in daily amounts of from 1 to 2 drachms. It is readily soluble in water. RUBUS.—This genus of rosaceous shrubs includes the blackberry, raspberry, dewberry, etc. The rubus of the U. S. Ph. is the root bark of Rubus villosus, the blackberry, which is mildly astringent, and is employed in atonic diarrhea. The dose of the powder is from 20 to 30 grains; that of the fluid extract, extractum rubi fluidum (U. S. Ph.), is from 20 to 30 min- ims ; that of the syrup, syrupus rubi (U. S. Ph.), is from 1 to 4 fl. drachms. Rubus ideus (U. S. Ph.), the raspberry, is employed in the form of a refrigerant and 137 RUBEFACIENTS SACCHARIN flavouring syrup, syrupus rubi idei (U. S. Ph.), sirupus rubi idei (Ger. Ph.). RUE (Ruta graveolens) is a perennial herba- ceous plant of southern Europe and the Levant. The leaves chiefly are used in medicine. As their quality is impaired by drying, the oil, oleum rute (Br. Ph.), is the only preparation commonly used. It is a colourless or greenish- yellow liquid of a characteristic aromatic odour, a pungent, bitterish, disagreeable taste, and neutral reaction. It is soluble in an equal weight of alcohol. When applied to the skin, it causes heat and irritation, and may even pro- duce vesication. Its physiological actions are similar to those of savine. It is employed for much the same purposes as savine and tansy. It is used chiefly in amenorrhea, hysteria, and epilepsy. It is especially indicated in ovarian and uterine atony. In ordinary doses, it pro- duces a sensation of warmth in the stomach, and is followed by slightly increased action of the heart. In toxic doses, it produces violent gastro-intestinal symptoms, which are followed by prostration, strangury, and, in extreme cases, convulsions. Owing to its disagreeable taste and its uncertainty of action, it is now but little used in medicine, other drugs having almost completely usurped its place. The dose of the oil is from 2 to 5 drops. Floyd M. Crandall. RUM is an alcoholic liquor obtained by the distillation of molasses, skimmings from cane- sugar kettles, and other by-products of sugar manufactories after having undergone fermen- tation. When fresh it is nearly colourless, but various shades, varying from a deep claret to a pale straw, are imparted to it from the casks in which it is stored. Two varieties are found, the one being made from molasses and the other from kettle skimmings, etc., which come respectively under the general heads of New England, or Medford, and Jamaica. Of the latter, many varieties are found, named Santa Cruz, Barbadoes, etc., according to the points of manufacture, but they differ in little but name, and are as a rule dark-coloured, while the Medford variety is straw-coloured. Usu- ally an unadulterated specimen will contain about 50 per cent, by volume of alcohol and be of a peculiar rank taste which is objectionable to many, but, as a rule, the disgust it excites at first is soon overcome. Of all spirits, rum is by far the most easily obtained free from adulteration, contains less fusel oil and other deleterious bodies than whisky, and is, in ad- dition, much cheaper. It is usually easily digested, and appears to be less apt to under- go the acetous fermentation in the stomach than other spirits. It may be administered in the same manner as other alcoholics, but seems to be better relished when taken with consider- able milk. Pineapple rum is rum to which cut pine- apple has been added in the casks and allowed to remain for several months. It has a slight flavour and odour of that fruit. Rum-shrub is sweetened ruin, flavoured with the essential oils of lemon and orange, to which lemon- or orange-juice or tartaric acid is added to suit the taste. By soaking the common black wild cherry for several weeks in an equal bulk of the spirit, what is known as cherry rum is made, which is very palatable to many per- sons, but ranks rather as a liqueur than as a plain spirit, and is rather severe upon the stomach unless taken in small amounts. Russell H. Nevins. RUMEX (U. S. Ph.) is the root of Rumex crispus, the yellow dock, and of some other species of Rumex. It is moderately astringent and stomachic. It is hardly used now, except in domestic practice. The "fluid extract, extrac- tum rumicis fluidum (U. S. Ph.), may be given in teaspoonful doses. RUTA GRAVEOLENS.—See Rue. RYE.—Rye flour, the flour of the grain of Secale cereale, is much employed in making bread, particularly in continental Europe. When sound, it is wholesome and nutritious, but cases of poisoning have sometimes oc- curred from meal made from ergoted rye (see Ergot). Rye mush is occasionally employed as a laxative article of diet in cases of habitual constipation. The dry flour, dusted on to the skin, has a soothing effect in cases of bums to the degree of rubefaction, and in acute dry eczema and erysipelas. SABADILLA (Br. Ph.), or cevadilla, is the dried ripe seeds of Sehenocaulon officinale. It is now used only as a source of veratrine. SABBATIA.—One species of this Amer- ican genus of gentianaceous plants, Sabbatia angularis, was formerly official. Together with Sabbatia paniculala, it was used as a bitter tonic and appetizer and as a remedy for mala- rial fevers. An infusion of 3 parts of the plant in 10 of water may be given in daily amounts of from 1 to 2 fl. oz. SABINA.—See Savine. SACCHARIN, gluside, glusidum (Br. Ph.), or neo-saccharin, is a derivative of coal tar and is two hundred times as sweet as cane sugar, for which it has been proposed as a substitute in conditions in which the latter is contra- indicated. It may apparently be used as a sweetener of food for indefinite periods without ill results, and is excreted unchanged in the urine. It appears also to have acid properties and unites with the bitter alkaloids, such as quinine, strychnine, etc., to form bodies, pos- sibly salts, which are in a measure destitute of the bitter properties of the bases, of which they contain on an average about 60 per cent. In addition, it is antiseptic, but to no marked degree. Solutions of it have been employed to some extent as injections in the treatment of purulent affections of the ear, and a £-per- cent, alcoholic solution is useful as a wash in aphthous sore mouth. In large amounts it retards gastric and intestinal digestion, but proper doses are regarded as having no such effect. As it is very insoluble in water, 3 parts may be combined with 2 of sodium bicarbonate, SACCHARUM SALICIN 138 forming what is known as "soluble gluside" or " soluble saccharin," or " sodium saccharinate," which is readily soluble in water. As might be expected, it is largely substituted for sugar in the diet of persons suffering from diabetes mel- litus, to sweeten tea, coffee, etc., and to overcome the insipidity of the various breads made from gluten. While, of course, it does not overcome the natural physiological craving for sugar, it unquestionably is of decided value. It may also be employed in the treatment of obesity and in- digestion, both gastric and intestinal, where it is evident that saccharine and starchy foods ex- cite and aggravate the trouble, and, being com- patible with pepsin, it may be administered simultaneously with that substance. Lemon- ade may be sweetened with it when sugar would be objectionable. It can not, however, be regarded as a true physiological substitute for sugar, or substituted for it in cooking, as it is powerless to supply to the system the carbon contained in sugar. The daily amount of saccharin which may be given without inter- fering with digestion is about 20 grains, com- bined with the food.—Russell H. Nevins. SACCHARUM.—See Sugar. SACCHARUM LACTIS.—See Sugar of milk. SAFFRON.—This drug, the crocus of the pharmacopoeias, is almost disused, and it is said that it is to be omitted from the next edi- tion of the Br. Ph. Saffron is slightly carmi- native, but is chiefly used to impart a pleasing colour to mixtures. The tincture, tinctura croci (U. S. Ph., Br. Ph.), may be given in doses of from 1 to 3 fl. drachms. SAFROL.—This oily liquid, which readily crystallizes and is called also shikimol, has the same chemical constitution, according to Heff- ter (Arch. f. exp. Path. u. Pharm., xxxv, 4, 5, 1895; Fortschr. d. Med., March 1, 1896), as al- lylpyrocatechin methylene ether, /CH2 — CH = CHa C<,H3\0>CH2. It constitutes 90 per cent, of the ethereal oil. distilled from sassafras root, and is said to be present in a great variety of lauraceous and monimiaceous plants. It smells like sassafras oil. On oxidation it is converted into pipero- nylic acid. This change takes place to some extent after its ingestion, but for the most part it is exhaled unchanged from the lungs in the form of vapour. Safrol does not irritate a part to which it is applied, but it is highly poisonous, lowering the blood-pressure, abol- ishing the reflexes, and causing stupor. The subacute form of safrol poisoning closely resembles phosphorus poisoning, especially in being accompanied by fatty degeneration of many of the internal organs, notably the liver and the kidneys, with pronounced jaun- dice. The fatal dose, in experiments on ani- mals, has been found to be 15 grains for each kilogramme (about 2-2 pounds) when admin- istered by the mouth or subcutaneously, and 3 grains when injected into a vein. Safrol has been employed to a limited extent as a stom- achic and carminative, in doses of from £ to 1 grain. The crystallized form, known as sassa- fras camphor, has the same effect as thymol exerts when applied topically for the relief of neuralgia. SAGE.—See Salvia. SAGO is a starch derived from several spe- cies of palms, especially Metroxylon Sagu, a native of Ceram, Borneo, Sumatra, and other islands of the Indian Archipelago. In some of these regions sago is the chief article of food. The stems are cut from the tree and split open, and the starch is removed from the centre. This pith is placed in receptacles having a sieve-like bottom, and the cellular tissue is entirely washed away. The starch is reduced to a thick, moist mass, and rubbed through sieves. It is thus formed into grains and is then dried, and finally polished in rollers by friction. It appears in the shops in round granules, usually opaque and white, with semi- translucent spots. This is known as pearl sago. It also appears in other forms. Coarse granu- lated sago from India is sometimes called tapi- oca, a term which is properly applied to another substance. Sago is not wholly soluble in hot water, but swells, forming a light, nutritious food very easy of digestion. It has no medici- nal properties, and is used solely as a food. The method of preparing it is practically the same as that of the other forms of simple starch.—Floyd M. Crandall. SALACETOL, or salicylacetol, or acetol- salicylic ether, ✓OH C6H4 which results from exposure, to the air, or in syrups, or in combination with other drugs, 57 because of its great tendency to decomposition. It is best given in plain or aromatic water, but when the disagreeable taste causes serious ob- jection it may be given in pills or capsules. Hypodermic injections of it are said by one writer to be always followed by local abscesses. When prescribing this drug it is sometimes well to remember that if it is sold under its chemical name of sodio-theobromine salicylate it costs much less than under its proprietary name of diuretin. [Sir Benjamin Ward Richardson (Hospital, March 3, 1894) reports a case of renal dropsy in which sodio-theobromine salicylate failed to keep up free diuresis and induced systemic symptoms like those that are apt to follow the administration of sodium salicylate or salicylic acid, but without the deafness or noises in the head occasionally consequent on the action of those drugs when it is carried to a toxic de- gree. That the action was not cumulative, he says, was shown by the fact that the symp- toms quickly ceased when the use of the drug was discontinued. The Squibbs (Ephemeris, etc., 1895) cite Dr. E. Main's reminder that sodio-theobromine salicylate should not be administered to chil- dren less than eighteen months old, because in young infants it is prone to produce digestive disturbances and gastro-intestinal irritation. Dr. Louis Vintras, of the French Hospital in London (Lancet, April 25, 1896), remarks that in considering the value of a therapeutical agent of this kind it is not the ultimate termi- nation of the case which should form the basis of judgment, but its effect on an individual symptom. Sodio-theobromine salicylate, he says, can not be a specific in any disease, and its action can be exerted only for the relief of a distressing complication. Reviewing the re- sults of its use in some cases reported in his article, he says it appears that when the kidney affection is primary and well established—that is. when the deep parts of the organ are af- fected, as in the parenchymatous form of acute nephritis—and when there is much albumin in the urine, diuretin is of little or no value, while in cases in which the kidney trouble is second- ary to morbid lesions in other organs, and the epithelial layer of the urinary tubules is the seat of disease, this diuretic is a valuable thera- peutical agent.]—Matthias Lanckton Foster. SODIUM ACETATE, sodii acetas (U. S. Ph.), natrium aceticum (Ger. Ph.), is sometimes substituted for potassium acetate as a diuretic, but it is less eligible in rheumatic and gouty affections, as its action in increasing the alka- linity of the fluids is much feebler. It may be given in doses of from 20 to 60 grains.—Rus- sell H. Nevins. SODIUM AND CAFFEINE SULPHO- NATE.—See Symphorol. SODIUM AND MAGNESIUM BORO- CITRATE.—This compound has been used to some extent as a remedy for urinary lithiasis, in doses of from 5 to 30 grains. SODIUM AND MAGNESIUM TAR- TRATE may be used as a cathartic in doses of from 2 to 4 drachms. SODIUM ARSENATE SODIUM BICARBONATE 204 SODIUM ARSENATE, SODIUM AR- SENIATE, sodii arsenas (U. S. Ph.), sodii arsenias (Br. Ph.), is used in medicine in the form of Pearson's solution (see under Arsenic, vol. i, page 146). SODIUM AUROCHLORIDE.—Chloride of gold and sodium (see under Gold). SODIUM BENZOATE, sodii benzoas(\J. S. Ph.), has beenemployed in lithemiaandrheuma- tism for the purpose of freeing the system of uric acid, but it is hardly so efficient as the more commonly employed remedies. As much as 2 drachms may be administered during twenty- four hours, but the size of each single dose should not exceed 15 or 20 grains. The borobenzoate is a somewhat similar preparation. It may be given in doses of from 10 to 15 grains.—Russell H. Nevins. SODIUM BIBORATE.—See Borax. SODIUM BICARBONATE, sodii bicar- bonas (U. S. Ph., Br. Ph.). natrium bicarboni- cum (Ger. Ph.), the " baking soda" of the household, is more freely used to correct acid- ity of the stomach than any other alkaline salt, on account of its non-irritating properties and its relative freedom from disagreeable taste (cf. Alkalies). It is also useful in the acid diarrhea of children; from 10 to 20 grains, given three times a day, will often de- crease the amount of sugar in the urine in dia- betes; and saturated solutions relieve the pain and irritation of superficial burns, and also allay the irritation set up by the stings of bees, wasps, etc. When it is taken in drachm doses and followed by an equal bulk of tartaric acid, effervescence takes place in the stomach, and expulsion of its contents rapidly follows. In intestinal intussusception the two substances have been injected separately into the large in- testine for the purpose of correcting the invag- ination by the pressure of the gas evolved. The usual dose is from 10 to 20 grains. [Dr. G. Linossier (Jour, des praticiens, April 11, 1896; New York Medical Journal,*May 2, 1896) says that sodium bicarbonate is servicea- ble in deficiency of hydrochloric acid in the gastric juice only when this affection is not due to a profound alteration in the glands. The essential condition of its action is that the mu- cous membrane should be still excitable. The amount of the dose also is very important; a very small dose produces an insufficient exci- tation, and with too large a dose the excitation produced is only enough to neutralize the alka- linity provoked by the ingestion of the medi- cament. A medium dose should be employed, so that after a slight alkalinity the gastric contents may acquire an acidity greater than that usually present. It is impossible, he says, to give an idea in figures of small, medium, or large doses, for, in reality, the amount can not be absolutely determined; it is relative only to the gastric condition ascertained. He ex- plains the relation between the gastric acidity and the proper dose by saying that the sensi- tiveness to the action of this drug is in inverse ratio to the richness of the gastric secretion in hydrochloric acid. The doses should be re- duced in proportion as the deficiency of the acid becomes more marked. If it is very in- tense, not more than 8 grains should be given. If the deficiency is moderate, the dose may be increased to 15, 30, or even 45 grains. He thinks, however, that there are some incon- veniences in regard to the remote action of the drug if patients suffering with this affection are subjected to the habitual use of large doses, and that it is better to employ doses not exceeding 30 grains. It is better to give it before meals, so that alkaline saturation may take place before the food enters the stomach, when it comes imme- diately in contact with the mucous membrane which is in a complete condition of secretory excitation. The larger the dose the longer should the interval be before eating; a quarter of an hour is sufficient for a dose of 8 grains, but an hour is necessary for large doses. It is difficult, says M. Linossier, to lay down ab- solute rules in this respect, but we may be guided by the subjective symptoms. The in- gestion of this drug by dyspeptic patients when fasting is followed by a feeling of satiety analogous to that caused by a very light meal; this sensation gives place subsequently to a feeling of hunger. If the ingestion of food is deferred, and the excited mucous membrane continues to secrete, the patient experiences a sensation of tearing which occasionally pro- duces pain. These symptoms are not always very distinct, but when they are present they are an excellent guide. Sodium bicarbonate should be given at such a time that the hour for the meal shall coincide with the feeling of hun- ger. The employment of this drug should not be too prolonged; a period of from two to three weeks with intervals of rest is sufficient. This, says M. Linossier, is the surest means of obtaining a remote exciting action, and there is no danger of giving rise to depression. In cases of excess of hydrochloric acid, he says, the alkaline action of the drug may sup- press the cause of the pain and uneasiness, which are due to the contact of the mucous membrane with a very acid liquid. It may be doubted, he says, whether the exciting physio- logical action is not too much for a stomach already greatly excited ; this action, however, is not a contra-indication to the use of the drug, provided it is administered in such a way as to prevent any ill effects. For this, it is suffi- cient to give the sodium in divided doses dur- ing the course of digestion, each dose being too small to cause complete saturation of the gastric contents; there is then no violent exci- tation. The ingestion of each dose, moreover, destroys the effect of the preceding one in sat- urating the acid which is secreted anew. The doses may vary from 15 to 30 grains, accord- ing to the intensity of the excess of acid. The first dose should be given before the probable appearance of the pain; this is easy to deter- mine, as the majority of patients are attacked at an invariable time before eating. The suc- ceeding doses may be given every hour or if necessary, every half hour until digestion' is finished. M. Linossier urges the necessity of prescribing the drug before the appearance of the pain, as it is generally easier to prevent it SODIUM ARSENATE 205 SODIUM BICARBONATE than it is to allay it when it has become estab- lished. The tolerance displayed by the organism for this drug is, says the author, remarkable, and the inconveniences of large doses are few as compared to their advantages. The following prescription is often made use of by M. Linos- sier R Sodium bicarbonate.....300 grains; Calcined magnesia...... 75 " Bismuth subnitrate..... 30 " M. This quantity may be divided into twelve or twenty-five capsules, according to the in- tensity of the acidity, and the proportion of magnesia and that of bismuth subnitrate may be varied in accordance with the intestinal functions. The remote action of sodium bicarbonate, says M. Linossier, is shown by the excitation and afterward by the depression of the secre- tion. The period of excitation is very distinct in many patients treated with this drug, and after a few days the original doses, which suf- ficed to allay the pain, become too weak to saturate the overacidity, and they must be in- creased gradually. The depression is theoret- ically the result of an intense and prolonged treatment, and it occurs in patients in whom ex- cessive acidity is not very marked. After a cer- tain time the dose may be diminished by degrees and finally suppressed. In severe acidity, es- pecially if it is accompanied by oversecretion, the sensitiveness to the action of this drug is greatly diminished, and frequently only a pallia- tive effect is obtained. As regards the use of large doses of sodium bicarbonate, at a recent meeting of the Na- tional Society of Medicine of Lyons (Lyon medical, June 28, 1896) M. Tournier related the case of a woman who suffered from an ex- cess of hydrochloric acid in the gastric juice. She had been treated with instillations of sil- ver nitrate and with nutritive enemata, but without beneficial results. A course of sodium bicarbonate was then prescribed and begun with amounts of from 180 to 225 grains a day. No relief having been obtained, the quantity was increased to 375 grains, but this amount also proved insufficient, and no real relief was felt until she reached the amount of 750 grains a day. Even this was increased, and without M. Tournier's knowledge the patient took, dur- ing a period of a month, from 2 to 2 A oz. a day in doses of 45 grains every fifteen minutes, in milk. During this time, said M. Tournier, there had been no disturbance of any kind and no anaemia, and her weight had increased three kilogrammes. The urine was abundant and presented a feeble alkaline reaction. The intestinal functions were normal. M. Lepine thought that, in order to tolerate such large doses of sodium bicarbonate, there must be a special receptivity, a pathological condition with exaggerated acidity which should neutralize a part of the sodium. Large doses were incompatible with a normal condi- tion, and it would be dangerous to give them to a healthy person. In the Medical Record for January 18,1896, Dr. L. Duncan Bulkley gives his experience in the treatment of coryza with sodium bicar- bonate. He says he has used the drug for this purpose for over two years among his patients, in his family, and among his friends and ac- quaintances, and is well satisfied of its value. Recognising that all individuals are not equally " subject to colds," and also that the same individual may exhibit a stronger tend- ency to them at one" time than at another, he had long felt that the susceptibility to this affection depended upon some state or condi- tion of the system, commonly present or occa- sionally developed. Observation had convinced him also that while it was not persons with a marked gouty diathesis or in an active gouty state that were mainly subject to colds, these latter were more frequently seen in those suf- fering with minor forms of acidity, and in those in whom it had developed quickly. It therefore occurred to him that the slight'relief he had experienced from a cold had been the result of his having taken sodium bicarbonate to neutralize acidity of the stomach. He thinks it important that the remedy should be taken just right, and a definite plan carried out thoroughly, for he has never seen any effective results from a desultory use of it. For an adult of medium size and weight, from 20 to 30 grains of the bicarbonate are given in 2 or 3 ounces of water, every half hour, for three doses, and a fourth dose is given at the expiration of an hour from the last one. From two to four hours are then allowed to elapse, to see the effect, and the four doses are repeated if it seems to be necessary, as is frequently the case. After from two to four hours more, the same course may be taken again, although this is not often necessary, if the treatment has been begun early in the course of the cold. He has known the doses to be repeated four times, with final good result. The method is applicable more especially to the early stage of a cold. To be promptly effective, it should be begun with the earliest indications of coryza and sneezing, and his experience has rarely failed to break it up, even in persons much inclined to colds. After the second or third day it acts less promptly, and more frequent repetitions are needed, but he has seen very good results even much later in the trouble. In influenza it is less efficacious, but is often of service. In these eases Dr. Bulkley pre- scribes from 5 to 10 grains of phenacetine, with from 10 to 20 grains of sodium bicarbonate, and directs the powders to be taken with hot water, every two hours, continuously for a day or two. He has had a large number of very striking instances of the benefit of this plan of treatment; in some cases it was be- gun several days after the onset of the dis- ease, and in one instance after it had lasted about four weeks. In the latter case the almost immediate relief to many distressing symptoms—headache, cough, malaise, etc.,— was very striking. The patient, a remark- ably intelligent gentleman, aged forty-five, had been under varied treatment for the entire SODIUM BISULPHITE SODIUM PHOSPHATE 206 time. In regard to such a frequent repetition of doses of from 20 to 30 grains, he has never seen cause to regret it, and has never known of any later ill effects from it. Lozenges of sodium bicarbonate, trochisci sodii bicarbonatis (U. S. Ph., Br. Ph.), contain each 3 grains (U. S. Ph.) or 5 grains (Br. Ph.) of the bicarbonate. The U. S. troches are slightly aromatic, containing a little nutmeg. From 1 to 10 of the American and from 1 to 6 of the British troches may be given at a dose.] Russell H. Nevins. SODIUM BISULPHITE. — See under Sulphurous acid. SODIUM BORATE.—See Borax. SODIUM BROMIDE.—See under Bro- mides. SODIUM CANTHARIDATE has been used to some extent in the same way as potas- sium cantharidate in the treatment of pul- monary tuberculosis (see under Cantharides and Cantharidic acid). SODIUM CARBOLATE has been recom- mended as an intestinal antiseptic in diarrhea, dysentery, and typhoid fever, given in doses of from 2 to 10 grains. The sulphocarbolate has been more employed in these affections. So- dium carbolate has been used also as an ex- ternal antiseptic (see Phenol sodique, under Phenol). SODIUM CARBONATE, sodii carbonas (U. S. Ph., Br. Ph.), natrium carbonicum (Ger. Ph.), sal soda or washing soda of commerce, natrium carbonicum crudum (Ger. Ph.), is not much employed internally in medicine, as the bicarbonate possesses all of its useful proper- ties and is less irritating and of a more agree- able taste. Externally, it is used in nearly all conditions in which it is desirable to soften or remove scaly or scabby accumulations upon the skin, as in certain forms of eczema, plica polo- nica, etc. It may be given in 10-grain doses, but in overdoses is corrosive. Mild sodium carbonate, sodii carbonas exsic- catus (U. S. Ph.), sodii carbonas exsiccata (Br. Ph.), natrium carbonicum siccum (Ger. Ph.), is sodium carbonate deprived of its water of crys- tallization. It does not differ in its properties from the crystallized form, and is given in 5- grain doses, usually in the pill form. Russell H. Nevins. SODIUM CETRARATE, a salt of cetraric acid, soluble in water, is said to act as a tonic when given in doses of from 2 to 15 grains, but the clinical reports on its employment are at present not such as to warrant positive state- ments with regard to it. SODIUM CHLORATE, sodii chloras (U. S. Ph.), has essentially the same properties and uses as the corresponding potassium salt, and may be substituted for it in doses of from 5 to 15 grains. [In the palliative treatment of cancer of the uterus Boucher, of Rouen, according to the Therapeutische Wochenschrift for August 16, 1896, prescribes the following: R Sodium chlorate.............. 2 parts; Distilled water................ 10 " Syrup of orange flowers........ 3 ' M. At first two "spoonfuls" (whether tea- spoonfuls or tablespoonfuls is not stated) are to be taken in twenty-four hours, and the daily amount is to be increased gradu- ally to eight " spoonfuls." The following powder is applied on intra- eervical tampons: R Sodium chlorate, ) . „ , 0 ^o^+c . d- *u u -.. *. r of each... 2 parts Bismuth subnitrate, ) r Iodoform...................... 1 part. M. In addition, the vagina is irrigated daily with a solution of 150 grains of sodium chlo- rate in a quart of boiled water. It is said that this treatment often prolongs life for a year and makes *it reasonably tolerable.] Russell H. Nevins. SODIUM CHLORIDE, sodii chloridum (U. S. Ph., Br. Ph.), natrium chloratum (Ger. Ph.), or common salt, while it does not play a very important part in medicine, may be of considerable value as a substitute for more ac- tive remedies. A tablespoonful, dissolved in a tumblerful of cold water and swallowed be- fore breakfast, will usually act as a cathartic, and double that amount, in a similar bulk of warm water, is one of the most readily ob- tained and prompt emetics and one that is rarely followed by depression. A teaspoonful, taken dry, is a useful hemostatic in epistaxis and other capillary hemorrhages. In inter- mittent fever, 2-drachm doses, given every two hours during the intermissions, is said to be useful, especially when combined with lemon- juice or lime-juice. Added to water in the pro- portion of J of a pound to the gallon, salt forms a solution of approximately the same specific gravity as sea water, and may be used for general or local baths, being particularly useful for a foot-bath after prolonged exercise. A number of preparations termed ■' sea salt" are on the market, which purport to be the residue left upon evaporating sea water, and to be of greater value for preparing baths, etc., than the purer articles, but it is probable that there is no special virtue in them. A teaspoonful of salt, dissolved in a pint of water, may be used as a gargle in nasal catarrh and pharyngitis. It is also sometimes added to enemata to increase their irritant effect. [The value of sodium chloride in the form of the so-called " physiological salt solution " will be found set forth in the section on Infusion of the article on Transfusion. Mr. F. J. Reilly, M. R. 0. S. (British Medical Journal, November 23, 1895), says that for sev- eral years he has used common salt as a remedy for ringworm. Children, he says, who are suffer- ing from tinea tonsurans are sent to the seaside and almost invariably improve in the salt air. This improvement has hitherto been ascribed to the general favouring influence of the open- air life and improved hygienic conditions under which children live at the seaside. But, he asks, when we remember the fact that the air near the sea is impregnated with minute par- tides of sea water containing in solution as it does a large proportion of sodium chloride, may we not reasonably ascribe the disappear- ance of the skin disease to this circumstance? This fact, he says, arrested his attention and led him to think that common salt might prove a valuable remedy in ringworm. Ac- cordingly, he prepared a solution and used it in the next three cases which he was called upon to treat, applying it to the diseased scalp every night for five nights and washing it off on the following morning with 10-per-cent, boric-acid soap. In less than four weeks a cure was effected in each ease. Mr. Reilly does not mention the strength of the solution em- ployed by him, but presumably it was a strong one.]—Russell H. Nevins. SODIUM CHOLEATE.—Under this name a purified preparation of ox-gall is furnished by Merck. It is described as a yellowish-white powder, to be given in doses of from 5 to 10 grains. (See Ox-gall.) SODIUM CITRATE resembles the other alkaline citrates in being laxative, diuretic, and refrigerant. Not usually being met with in the shops, it is prepared extemporaneously by adding sodium bicarbonate to lemon-juice or a solution of citric acid. This combination effervesces quickly and quite actively, and, unless a sufficiently large vessel is employed, is apt to foam over. From 5 to 10 drachms of soda neutralized with citric acid will consti- tute a cathartic dose of this preparation. Russell II. Nevins. SODIUM CITRO-TARTRATE.—Effer- vescent citro-tartrate of sodium, sodii citro-tar- tras effervescens (Br. Ph.), is a granulated mix- ture of 17 parts of sodium bicarbonate, 9 of tartaric acid, 6 of citric acid, and 5 of sugar. It has the same laxative, diuretic, and refrig- erant properties as sodium citrate. The dose is from 1 to 2 drachms, dissolved in water and taken while it is foaming. SODIUM DIIODOPARAPHENOL- SULPHONATE. — See Sodium sozoiodo- late. SODIUM DIIODOSALICYLATE.—See under Diiodosalicylic acid. SODIUM DITHIOSALICYLATE.—See under Dithiosalicylic acid. SODIUM ETHYLATE, or caustic alco- hol, is a preparation sometimes used as a caus- tic, its alcoholic or aqueous solution being applied with a glass rod to the parts to be affected. Its action is reputed to be painless and of special value for the destruction of warts, nevi. small condylomata, and similar growths. Solutions of the strength of 20 per cent., especially those made with olive oil, are often useful for inunction in psoriasis. Liquor sodii ethylatis (Br. Ph.) is a 20-per- cent, alcoholic solution of this salt, Russell H. Nevins, SODIUM ETHYLSULPH ATE. — See Sodium sulphovinate. SODIUM FLUORIDE.—See Fluoride. SODIUM BISULPHITE 7 SODIUM PHOSPHATE SODIUM FLUOSILICATE.—See Sodi- um SILICOFLUORIDE. SODIUM FORMATE, NaCIIOo + ILO, occurs in white deliquescent crystals that are soluble in water and in glycerin. Its subcuta- neous employment, in quantities of from ^ to 1 grain, at intervals of from a week to ten days. has been reported to be of benefit in the treat- ment of tuberculous diseases. SODIUM GLYCERINOBORATE. — This glycerite of borax, prepared by Merck from 40 parts of borax and 60 of glycerin, with the aid of heat, is described as a translucent, brittle, and very hygroscopic mass soluble in water. Its uses are the same as those of the glyceritum boroglycerini (see under Boric acid, vol. i, page 191). SODIUM HYPOPHOSPHITE. — See under Hypophosphites (vol. i, page 519). SODIUM HYPOSULPHITE.—See un- der Hyposulphites (vol. i, page 519). SODIUM IODIDE, sodii iodidum (U. S. Ph., Br. Ph.), natrium jodatum (Ger. Ph.), is employed for the same purposes as potassium iodide. It may be given in doses of from 5 to 60 grains. SODIUM LACTATE, XaO.I^O,, is a thick, syrupy liquid. It may be given as a hypnotic in cases of insomnia, in doses of from 2 to 4 drachms. (See Lactic acid.) SODIUM NITRATE, sodii nitras (U. S. Ph., Br. Ph.), natrium nitricum (Ger. Ph.), or cubic nitre, has properties somewhat similar to those of the corresponding potassium salt. It is oftener employed in veterinary medicine as a diuretic than in the treatment of the human subject, although it has been recommended in dysentery, in drachm doses, freely diluted, every three hours. SODIUM NITRITE. —See under Ni- trites (vol. ii, page 13). SODIUM PARACRESOTATE, OJLNa Os, according to Merck, is a fine niicrocrystal- line powder, of a bitter taste, soluble in 24 parts of warm water. It is said to be antipy- retic, antiseptic, and analgetic. Dr. Cerna says that it has been used with success in the treatment of rheumatism, catarrhal pneumo- nia, typhoid fever, and gastro-intestinal disor- ders in general, and is well borne by the stomach. He adds that it is said to be partic- ularly suitable for children. The dose is from 1 to 20 grains. SODIUM PHENOLSULPHONATE.— Sodium sulphocarbolate (see under Sulpho- CARBOLATES). SODIUM PHOSPHATE, sodii phosphas (IT. S. Ph., Br. Ph.). natrium phosphoricum (Ger. Ph.), is hardly suitable for producing the constitutional effects of either its base or its acid, and is almost exclusively used as a laxa- tive and cholagogue, the latter action being pretty clearly established. It is freely soluble and of a not unpleasant taste, and is partic- ularly adapted for children, to whom it may be given dissolved in milk. Also tolerance of it is not established speedily, and it may be SODIUM PYROPHOSPHATE SOLANUM CAROLINENSE 208 given for months without any ill effects fol- lowing. For children who pass pasty and pale-coloured stools, exhibiting at the same time the symptoms of malnutrition, there is probably nothing so useful as 10-grain doses of sodium phosphate three times daily. Ordi- nary sick headache may also be greatly alle- viated by doses of from 20 to 30 grains three times a day, after eating, taken for a week or so, and the course repeated after an intermis- sion of the same length of time, due atten- tion being paid to the diet. An attack may also be aborted by two or three full doses, from 1 to 2 oz., taken as soon as the premoni- tory symptoms are noticed. In gastro-duode- nal catarrh and the jaundice dependent upon it, it usually works well, and it is very useful in the epidemic jaundice of warm climates not dependent upon organic disease of the liver. The tendency to the formation of biliary cal- culi is also somewhat lessened under its per- sistent administration, but after their formation it is doubtful if it is of benefit. In sclerosis of the liver it is worthy of a fair trial, for, if it has no curative effect, it renders the con- dition of the patient much more tolerable. In the obese and diabetic in whom there may be a troublesome succession of boils or carbun- cles it often effects a cure, and the same may be said of those cases in which no clearly de- fined dyscrasia exists. In lithemia it is usu- ally of value in preventing to a great extent the occurrence of the headache which appears to depend upon faulty intestinal digestion or upon fermentation of the contents of the in- testines. It is not maintained that there is anything actually specific in the action of this salt, but that whatever benefits follow its em- ployment are due to its property of restoring to its normal condition the upper portion of the intestinal canal and stimulating the flow of the bile. As a laxative, from 1 to 2 oz. may be giv- en, but when the use of the salt is to be protracted not over a drachm, three times a day, is advisable. For children 10 grains will usually be a sufficient dose. The effervescent phosphate of sodium, sodii phosphas effer- vescens, of the Br. Ph. (additions) contains, besides the phosphate, small amounts of sodi- um citrate and tartrate, and is consequently slightly diuretic. It may be given in doses of | oz. dissolved in a tumblerful of water. [The Province medicate for October 17,1896, contains an abstract of an article from the Journal de medecine de Paris for September 27, 1896, in which the writer remarks that a 0-1-per-cent. solution of sodium phosphate in sterilized water is proper to employ in subcu- taneous injections. After the usual antiseptic precautions are taken, the injections are prac- tised in the retrotrochanteric groove. These injections have been employed in tabes dor- salis, hemiplegia, neurasthenia, and progressive myopathic paralysis. In locomotor ataxia the darting pains and the troubles of motility are considerably diminished. Also in other affec- tions marked amelioration is produced. Some- times this salt has a direct action on the nervous system; the organism seems to experi- ence a functional overactivity, and it produces symptoms of intolerance. On the whole, says the writer, it may be said: 1. That sodium phosphate exerts an action on the organism which is due to the exciting influence which it produces on the central nervous system. 2. That if the injections are carefully adminis- tered hypodermically, the solution does not give rise to any local reaction. 3. That the therapeutic value in locomotor ataxia, in neu- rasthenia, in hemiplegia, and in progressive myopathic paralysis is worthy of consideration. 4. That the hypodermic injections should be carefully watched in order to prevent the ap- pearance of the symptoms of intolerance which are often produced.] (Cf. Sodium phosphate, under Phosphorus, vol. ii, page 79.)—Russell H. Nevins. SODIUM PYROPHOSPHATE. — See under Phosphorus (vol. ii, page 79). SODIUM SACCHARINATE.—See un- der Saccharin. SODIUM SALICYLATE.—See under Salicylic acid. SODIUM SANTONINATE.—See under Santonica. SODIUM SILICATE.—See under Sili- cates. SODIUM SILICOFLUORIDE. — This compound has been recommended for use like fluorol (q. v.). Sufficiently definite reports of its action are not yet at hand to warrant its recommendation here. SODIUM SOZOIODOLATE, NaOC.H, I2OHS03 + 2H20, is furnished by Merck in the form of colourless acicular crystals soluble in 14 parts of water. It is said to be antiseptic and antipyretic The powder, blown into the nose to the amount of 3 grains daily, has been reported to be efficacious in the treatment of whooping-cough. Dr. Cerna remarks that it is considered superior to iodoform as an applica- tion to syphilitic ulcers, and serviceable in nasal catarrh. Internally, as an intestinal antiseptic, it may be given in daily amounts of from 5 to 30 grains. Its internal adminis- tration is said to have proved serviceable in diabetes. SODIUM SULPHATE, sodii sulphas (U. S. Ph., Br. Ph.), natrium sulfuricum (Ger. Ph.), Glauber's salt, is used to some extent as a laxative in doses of from 2 drachms to 1 oz., dissolved in water, in cases of constipation and sluggishness of the liver. The dried sul- phate, natrium sulfuricum siccum (Ger. Ph.), is considered preferable to the crystalline salt as an ingredient of powders compounded in imitation of the salts of natural mineral wa- ters. SODIUM SULPHITE.—See under Sul- phurous acid. SODIUM SULPHOBENZOATE, sodii sulphobenzoas, has been recommended as an antiseptic It may be employed in a 1-per- cent, aqueous solution.—Russell H. Nevins. SODIUM SULPHOCARBOLATE. — See under Sulphocarbolates. SODIUM PYROPHOSPHATE 209 SOLANUM CAROLINENSE SODIUM SULPHOLEATE.—Dr. George H. Fox (Journal of Cutaneous and Genito-uri- nary Diseases, May, 1890) remarks that when sulphuric acid is added slowly to any fixed oil or fat at a low temperature, the oleic acid is transformed into sulpholeic, or sulpholeinic, acid. A soda soap made with a fat so treated— sodium sulpholeate or, if castor oil is used, so- dium sulphoricinoleate—is a mass resembling vaseline in appearance and consistence, and Dr. Fox has found it an excellent base for ointments for the reasons that it mixes readily with water, that it is absorbed rapidly by the skin, and that it dissolves a great number of medicinal substances used topically in the treatment of skin diseases. SODIUM SULPHOMETHYLATE is cathartic in |-oz. doses, but has not met with any great favour.—Russell H. Nevins. SODIUM SULPHORICINATE, SODI- UM SULPHORICINOLEATE.—See un- der Sodium sulpholeate. SODIUM SULPHOVINATE, or ethyl sulphate, is an unstable and rather expensive salt with an agreeable taste. In doses of from 4 to 5 drachms it produces free catharsis without any pain, and when it can be procured fresh and expense is no object, it is very desirable for use in children.—Russell H. Nevins. SODIUM TARTRATE. —This salt is purgative and diuretic in doses of from i to 1 oz. It is free from the bitter taste of some of the other saline cathartics. For potassium and sodium tartrate (Rochelle salt), see under Potassium tartrates. The effervescent citrotartrate of sodium, sodii citrotartras effervescens (Br. Ph.), is a granular effervescent salt which is mildly laxa- tive and refrigerant, and may be employed in the febricule and to relieve nausea. It may be given in doses of from 1 to 2 drachms dis- solved in water and drank while effervescing. Russell H. Nevins. SODIUM TAUROCHOLATE.—See So- dium choleate. SODIUM TELLURATE has been used to some extent as an anthidrotic in the night- sweats of phthisis and other exhausting dis- eases. It is soluble in water. The dose is from J to f of a grain. SODIUM TETRABORATE.—According to Professor Coblentz, this compound consists of equal parts of boric acid and sodium bibor- ate. It dissolves readily in water and is used as an antiseptic, usually in a 16-per-cent. solu- tion. SODIUM THIOPHENE - SULPHO- NATE is described by Professor Coblentz as a white crystalline powder of an unpleasant odour, soluble in water, and containing 33 per cent, of sulphur. In the form of an ointment of from 5 to 10 per cent., also in that of a dusting-powder, it has been used in the treat- ment of prurigo and some other skin diseases. SODIUM THIOSULPHATE, natrium thiosulfuricum (Ger. Ph.), is the same as so- dium hyposulphite. (See under Hyposulphites, vol. i, page 519.) SODIUM TUMENOL SULPHONATE. —See under Tumenol. SODIUM VALERIANATE.—The vir- tues of this salt are those of valerian. (See Valerian and Valerianic acid.) SOJA HISPIDA, or Glycine hispida, or Glycine Soja, is a Japanese leguminous plant from the seeds, or beans, of which a sauce known as soy is prepared. The plant has been acclimatized in India, China, and Austria. In France there are to be had bread, cakes, and biscuits made from the beans, which have been recommended as articles of food for persons affected with diabetes, on account of their comparative freedom from starch. SOLANIN.—This principle, which should not be confounded with the alkaloid solanine, is found in various species of Solanum. Ac- cording to Professor Coblentz, its formula is C42H87NOi5. It is a bitter, crystalline sub- stance insoluble in water. It has been used to some extent as an analgetic in cases of neural- gia, in doses of from \ to 1 grain. SOLANINE.—See under Dulcamara. SOLANUM CAROLINENSE.—This is the American horse-nettle, or bull-nettle, a weed that grows abundantly in the Atlantic States. The juice of the berries, succus solani, and a fluid extract prepared from them have been used as a remedy in various convulsive affections, such as chorea, puerperal eclampsia, and especially epilepsy. It has even been em- ployed in tetanus. According to Dr. Charles S. Potts, of the University of Pennsylvania (Therapeutic Gazette, December, 1895), and Dr. C. F. Barber (Journal of the American Medi- cal Association, December 14, 1895), the first published report of the use of this drug in epilepsy was made by Dr. J. L. Napier, of Blen- heim, South Carolina, in the Medical World in 1889. Dr. Napier had obtained his knowledge of it from the negroes, who used it as a domes- tic remedy for convulsions. Dr. E. B. Bondurant, of the Alabama Insane Hospital at Tuscaloosa (Medical News, March 30,1895), reports eleven cases among the inmates of the institution, in none of which was any favourable effect produced. He adds, however, that insane epileptics doubtless have the dis- ease in its most unfavourable form. He used Parke, Davis, & Co.'s fluid extract, in doses of from + to 1 fl. drachm, three times a day. On the other hand, a writer in the Medical Re- porter, of Calcutta, for July 1, 1895, says that he has used the same fluid extract in doses of from 10 to 15 drops, three times a day, after meals, and feels encouraged as to its thera- peutic powers, although the number of cases in which he has prescribed it is not large enough to warrant him in positive statements. He cites an article published in the Indiana Medical Journal for November, 1894, by Dr. Allison Maxwell, of Indianapolis, who con- cludes, from his own use of the drug and from that of several other observers, that it "materi- ally controls epileptic seizures and is worthy of considerable confidence." Dr. Potts (loc. cit.) gives the histories of SOLANUM DULCAMARA SOLVENTS 210 seventeen cases and gives his conclusions as follows: " 1. That the drug has a decided influence for good upon the epileptic paroxysm. 2. That this influence is probably not so great or so sure as that obtained by the use of antipy- rine and the bromide salts, or even of the mixed bromides. 3. That in those cases in which it is of service it relieves the paroxysms without causing other unpleasant symptoms, such as are sometimes caused by the use of large doses of the bromides. 4. That the dose ordinarily recommended (10 to 15 drops of the fluid extract) is too small, and that as much as a teaspoonful or more four times daily is often needed to secure results." Dr. Barber (loc. cit.) has of late employed the fluid extract in doses of from \ a fl. drachm to i a fl. oz. The ages of the patients ranged from eight to fifty years, and the cases com- prised those of epilepsy with idiocy, epilepsy with insanity, epilepsy with grand mal and petit mal, and epilepsy from traumatism. Among them were those of five girls and three boys. The girls, who had been having epilep- tic attacks every day, did well for three weeks, having no convulsions, but at the end of that time the convulsions returned and the patients relapsed into their former condition. The dose was pushed, but no improvement was noted, and the treatment was abandoned. The boys had a mild outbreak of convulsions fol- lowed by an interval of rest for about a week, when they gradually relapsed into their former epileptic state. A mong the epileptics who were the subjects of grand mat Dr. Barber had about the same results as with the male epilep- tic idiots, save that the period of improvement continued longer and the relapse was more gradual. Ten who were under the influence of the drug did not have a convulsion for twenty-nine days. Then a patient who was in the habit of having from three to six seizures a week had an attack so mild that he was not obliged to lie down. This patient was mentally much brighter than he had been for some time before, and was capable of doing light work about the ward. He still had his epileptic attacks, but they were milder in form than previously. Dr. Barber does not regard solanum as an efficient substitute for the bromides, but he thinks it preferable to borax. He says it un- questionably has an influence over the disease, but only a mild one ; it controls it sufficiently to warrant its use for a time to relieve the pa- tients of the depression due to the bromide treatment. Dr. E. Q. Thornton, demonstrator of thera- peutics in the Jefferson Medical College (Thera- peutic Gazette, November, 1896), has experi- mented with a soft extract made by Parke, Davis, & Co. He was unable to detect any effect on dogs, rabbits, guinea-pigs, or pigeons, but he says that when the soft extract is in- jected hypodermically into the posterior lymph space of the frog in doses of about 3 milli- grammes to the gramme weight of the batra- chian, respiration becomes gradually slower and laboured, then gradually returns to the nor- mal in about three hours as the effect of the drug passes off. If the drug is given in toxic doses the respiration becomes slow, shallow, and irregular, and death results from respira- tory failure. Dr. Thornton was somewhat surprised to find that Solanum carolinense, a plant belonging to the same natural order as belladonna and hyoscyamus, had no effect upon the circulation. The effect upon the nervous system he found most marked, depressing the cerebrum and powerfully stimulating the spinal cord. After receiving an injection of the drug into the pos- terior lymph space, the frog, he says, becomes quiet and apparently stupefied, and retains the normal posture, but if irritated it will make very long leaps, alighting usually upon its belly, although frequently upon its back, with its fore and hind legs extended in tetanic spasms, the hind limbs being more decidedly affected than the fore limbs. The limbs are thrown into spastic extension each time the animal hops or attempts to hop, and these spasms last about from ten to thirty seconds. Sharp jars, a sharp tap, and pin-pricks bring on the spasms, although they are not then nearly so marked as when the animal leaps or attempts to leap. Division of the spinal cord does not prevent the spasms. The frog recov- ers from the condition of spasm in from three to five hours if the dose has not been so large as to be lethal. Lethal doses are preceded by the condition above related, but finally depres- sion or exhaustion takes the place of excitement or stimulation, and the animal lies limp, fail- ing to respond to any stimulus. In the experiments the respiration became laboured and slower after the drug had been administered, and when large doses were given the breathing ceased before the heart stopped. SOLANUM DULCAMARA.—See Dul- camara. SOLANUM PANICULATUM. — The root of this Brazilian shrub is used by the physi- cians of Brazil as a purgative and deobstruent in diseases of the liver and of the spleen, also as a tonic and as a remedy for catarrh of the blad- der. Elsewhere than in South America it has not yet passed the experimental stage of medici- nal employment. Kobert has found it inert, but Michaelis, who has given 16 drops of a fluid extract three times a day, thinks it is undoubt- edly stomachic and useful in biliary colic and in chronic dyspepsia, (Medicinisch- chirur- gisches Central-Blatt, April 24, 1896; New York Medical Journal, May 16, 1896.) SOLIDAGO.—Solidago odora (or odorata), the sweet-scented golden-rod of the United States and Canada, was formerly official. The leaves are aromatic and carminative and, when given in a hot infusion, diaphoretic. The common golden-rod, Solidago virga au- rea, Solidago vulgaris, also was formerly used in medicine. It has lately (Therapeutische H ochenschrift, May 10,1896) been recommend- ed anew in the form of Rademacher's tincture in doses of 30 drops several times a day as a diuretic The writer gives the following for- mula : 21 3 Fresh infusion of digitalis..".... 150 parts; Rademacher's tincture of solidago. 20 " Syrup of orange peel........... 30 " M. S.: A teaspoonful to be taken every two hours. SOLPHINOL. — Professor Coblentz de- scribes this as an antiseptic mixture of borax, boric acid, and alkaline sulphites. According to Dr. Cerna, it is soluble in 10 parts of water and in 20 of glycerin, and is said to be an efficient antiseptic in the treatment of wounds, in a solution of from 2 to 10 per cent. It must not be confounded with sulphonal. SOLUTOL.—This is an alkaline solution of sodium cresylate in an excess of cresol, con- taining 15 per cent, of free cresols. It is an antiseptic used chiefly for preserving corpses and disinfecting bedclothes, excreta, privies, etc. SOLVENTS.—A solvent, as understood in pharmacy or chemistry, is a substance, usually a liquid, which is capable of dissolving another substance (gas, liquid, or solid) without alter- ing the nature of the latter. While nitric acid, for instance, will dissolve copper, or acetic acid chalk, neither of these liquids is a true solvent of the respective substance, since the latter no longer exists as such in the solution. The principal solvents employed are either non-volatile or volatilized with difficulty, such as glycerin, paraffin oil, solution of soda or potassa, limewater, etc.; or else more or less volatile, such as water, methyl alcohol (or wood-spirit), ethyl alcohol (ordinary alcohol), amyl alcohol (fusel oil), acetone, acetic acid (glacial or of other strength), ether, acetic ether, chloroform, carbon disulphide, petro- leum ether (benzin), benzol (from coal-tar), so- lution of ammonia, etc. Only a few of these solvents are suitable for retaining medicinal substances in solution when it is desired to administer the latter in a liquid form. Water is, of course, under all circumstances the most harmless and prefer- able, but it fails to dissolve or to keep in solu- tion many bodies, such as resins, oils, balsams, and various other proximate principles. In these cases a menstruum or solvent must be selected which will approach the aqueous state as far as practicable. That is to say, if it is found that a certain substance is readily soluble —for instance, in a mixture of 1 part of alcohol and 2 parts of water—the alcoholic percentage should not be increased unless, perhaps, for preservative reasons, because the physician does not wish to complicate the medicinal ac- tion of the drug with the special effects of the menstruum itself. In some cases the em- ployment of a pure volatile, non-aqueous menstruum is unavoidable. Then it becomes necessary to combine or to disguise the solu- tion in such a manner that the secondary ef- fects of the solvent are obtunded. For instance, a solution of phosphorus in absolute alcohol is very disagreeable to take. If, however, it is suitably combined with aromatic elixir, its harshness and disagreeable taste are entirely removed. The solvents mostly used for pharmaceutical SOLANUM DULCAMARA 1 SOLVENTS preparations from crude vegetable drugs are water and alcohol, either separately or in com- bination, often with the addition of glycerin, and sometimes of water of ammonia'or of acetic acid. The latter two are solvents in so far as they combine with certain insoluble ac- tive principles and convert them into soluble compounds, from which the free principles themselves can at any time be again separated in their original state by neutralizing the al- kali or the acid, as the case may be. After a drug has been exhausted by a vola- tile solvent it is often desirable to concentrate the solution. If the solvent is valuable, and a gentle heat can not injure the preparation, the latter is subjected to distillation at as low a temperature as possible, so that the volatile solvent may be recovered as far as practicable. Some of the solvents mentioned above have so little affinity for each other that, when they are mixed by agitation, they will speedily sepa- rate again, and in most cases will not"retain more than traces of each other in solution. This fact enables the chemist to transfer a substance from one solvent to another. It is particularly made use of for the separation of alkaloids, certain organic acids, and some other proximate principles. For instance, if some tincture of nux vomica is mixed with enough dilute ammonia water to set free all the alkaloids (though the latter may still re- main in solution) and the mixture* is then shaken with chloroform, the latter will take up part of the alcohol present and all of the alkaloids, together with some colouring mat- ter. On now shaking this chloroform, after separating it, with pure water, the latter will abstract the alcohol and nearly all the colour- ing matter. The chloroform will still retain the alkaloids. If it is now shaken with some dilute aqueous acid, the latter will search out the alkaloid, combine with it, and transfer the alkaloidal salt, which is not soluble in chloro- form, to the aqueous layer. From this the alkaloid may again be extracted, after the addition of an alkali, by chloroform, ether, or any other volatile menstruum capable of dis- solving it, and not miscible with water. This method of extraction is known as the process of "extraction by immiscible solvents." Water, either cold or hot, is the solvent most generally employed, and, when it alone suffices, is always to be preferred for medicinal com- pounds. It is to be regretted that the method of administering many vegetable drugs by in- fusion or decoction has almost gone out of use. In many cases it might have been retained with advantage. Infusion of digitalis has survived because it is well known to possess properties which are not inherent in any prepa- ration of digitalis made with the intervention of alcohol. Alcohol is the solvent next in importance. There are many important constituents of drugs which are insoluble in water, and require another solvent, such as alcohol, ether, chloro- form, etc. But of all these volatile solvents none is so free from objectionable features as alcohol. Wherever there are essential oils, resins, alkaloids, or certain glucosides to be ex- SOLVEOL SORBEFACIENTS 212 traded and kept in solution, alcohol usually forms at least a part of the menstruum. It does not dissolve gums, albumin, starch, lig- nin, etc., most of which substances are inert medicinally. Alcohol is also often added to preparations, not so much for its solvent as for its preservative powers. The attempt has at various times been made to banish alcohol altogether from medicinal or pharmaceutical preparations, in compliance with the demand of ignorant fanatics, who are unable to discriminate between the usefulness and uselessness of some product of nature, and who, therefore, have erroneous ideas regarding its use or abuse. Up to the present time no liquid has been found, which is not itself more or less of the nature of alcohol, which would be able to take its place as a solvent. It is not impossible that such a liquid or combination of liquids may in the future be discovered. An important step in this direction has been made by Dr. Edward R. Squibb, of Brooklyn, who has succeeded in extracting drugs, pre- viously held to be assailable by alcohol only, by means of acetic acid. It will require extended experiments, however, to ascertain whether this process will furnish preparations in every respect suitable as medicines. Glycerin is an impoitant solvent as well as preservative. Owing to its viscid nature, it is not often used alone as a solvent, but usually in combination with alcohol or water, or both. It dissolves many inorganic compounds, nearly all substances soluble in water, and many solu- ble in alcohol. Ether is more restricted in its solvent power. It dissolves nearly all oils, most resins, and many alkaloids and neutral principles. In combination with alcohol, it dissolves gun-cot- ton, the resulting product being collodion. As it possesses valuable therapeutic properties of its own, it is used as a partial solvent in such preparations as ethereal tincture of lo- belia, ethereal tincture of acetate of iron, etc. Chloroform is still more restricted, so far as medicines are concerned. It is made use of to dissolve phosphorus for the purpose of mak- ing phosphorus pills: also for preparing a solution of gutta-percha as a coating to abraded surfaces. Benzin, benzol, carbon disulphide, acetone, amyl alcohol, methyl alcohol, oils, and many other liquids are exceedingly useful as solvents for chemical and technical purposes, but are unsuited for most medicines. Alkalies and acids are also very efficient sol- vents, but in most cases they enter into combi- nation with the substance dissolved, and are therefore, under those circumstances, not true solvents.—Charles Rice. SOLVEOL.—This is a neutral concentrated solution of cresylic acid with sodium cresotate. It contains 10 per cent, of free cresols. It is a dark-coloured liquid, readily miscible with water and having a not unpleasant odour sug- gestive of carbolic acid. It is a good antiseptic in solutions of from 0-1 to 0-5 per cent. It has the advantage over creolin of not clinging to the hands or instruments in gummy masses. SOL VINES.—See Polysolves. SOMATOSE, a German proprietary meat preparation, seems to consist substantially of about equal parts of deutero-albumose and hetero-albumcse, with traces of peptone (Lan- cet, February 2, 1895). It is a pale yellowish powder, readily soluble in water, and having the nutritive value of six times its weight of beef. It is employed as a food in amounts of from ^ to 1 oz., in milk, cocoa, or soup (Cob- lentz), chiefly in cases of impaired digestion. Dr. Hans Taube, of Madrid (Wiener klinische Rundschau, December 29, 1895; New York Medical Journal, January 25, 1896), gives brief histories of a case of ulcer of the stomach and one of cancer of the stomach in which he has observed great benefit from the use of somatose. The patient with ulcer was fully restored to health, and the subject of cancer was much benefited. Dr. Taube states also that he has used somatose with advantage in chlorosis, anemia, phthisis, typhus, pericarditis, neu- rasthenia, the mercurial cachexia, and agalac- tia. Its effect, he says, was particularly striking in the case of mercurial cachexia. Dr. Gerdes and Dr. Susewind (Deutsche Aerzte-Zeitung, October 15, 1895; New York Medical Journal, January 4, 1896) have found somatose of special utility in irritation of the gastro-intestinal mucous membrane. They cite a case of severe gastro-enteritis in which all other liquid foods given in larger quantities had been vomited, while the employment of a strong so- lution of somatose (a heaping teaspoonful to three tablespoonf uls of water) not only tided the patient over a critical period of fourteen days, but exerted a very favourable influence upon his strength. Although the somatose solution was administered, at first three times, then four or five times daily, for a period of four- teen days, the patient never manifested repug- nance, and even during the stage of convales- cence relished its addition to soups or other foods. As an element in the ordinary diet of anemic and nervous persons it proved of great value, being well borne and perfectly assimi- lated for a long time. In the cases" observed by the authors an increase of strength occurred within a comparatively short time, and in chlorosis a rapid disappearance of the men- strual disturbances, headache, vertigo, etc., was noted. In some instances after the use of somatose a remarkable improvement took place in the digestion, and all the patients expe- rienced an increase of appetite which persisted after the discontinuance of its use. In the above-mentioned solution somatose, in the au- thors' opinion, seems pre-eminently indicated as a nutriment in cancer of the stomach and esophagus, where only small quantities of food can be ingested, or after gastrostomy, since its ready assimilability precludes the oc- currence of digestive disturbances. SOMNAL, C7H12C1,03N, or xOC2HB CCl3~C^H.COOC2H5'iSaGei'raanpatented preparation termed also ethylafed chloralure- thane, a clear, colourless liquid of a pungent 213 SOLVEOL SORBEFAC1ENTS taste. It is used as a hypnotic. M. Mar- andon de Montyel (Annates medico-psyeho- logiques, August, 1893 ; J'resse medicate, March 23, 1895) recommends its employment in acute melancholia. Not only has it produced sleep, in his experience, but even recovery after three or four weeks of its daily employment in amounts of from 75 to 105 grains. In other subjects, he says, somnal provokes a certain degree of intoxication before sleep comes on, agreeable dreams during sleep, and a slight excitation and gaiety on awakening. Khmelewsky has found that there is a very marked amelioration in cases of melancholia. He also says that in healthy subjects doses of from 38 to 45 grains give rise, at first, to a slight intoxication ; but in half an hour after its administration sleep follows, although it is often interrupted. From 45 to 60 grains pro- duce very profound sleep. On awakening, there is no disagreeable sensation, as is the case when trional or sulphonalisused. Khme- lewsky has not observed any particular gaiety or excitement in the patients, as M. Marandon de Montyel had alleged. In melancholia, as well as in simple insomnia, he says, somnal al- ways acts better than any other hypnotic, for not only does it induce an agreeable and pro- found sleep, but it is not accompanied by disagreeable subjective symptoms on awaken- ing; it causes no depression, as sulphonal and trional do ; it does not give rise to the motor troubles so frequently seen after the use of chloralose; and it never produces cardio-pul- monary accidents. It is only in cases of gas- tro-intestinal disorders that the use of somnal is contra-indicated, as it may aggravate dys- pepsia and diarrhoea. The usual hypnotic dose of somnal is from 15 to 30 minims, well diluted. SOPORIFICS.—See Hypnotics. SORBEFACIENTS are agents which pro- mote absorption. They may be divided into two classes: First, those which assist the lymphatics in the removal of morbid or in- flammatory products; and. second, those which promote the imbibition of nutritive or medic- inal material into the system, either by stimu- lation of the lymphatics or by furnishing excipients for less readily absorbable materials. The first class is very large, and includes drugs of very diverse action, but as the great majority have already been considered, grouped under headings which denominate their mode of action, such as cathartics, counter-irritants, diaphoretics, diuretics, etc.. the present ar- ticle will be devoted to those agents whose sorbefacient power has been empirically deter- mined, while we are still ignorant of the man- ner in which that power is exercised. These agents promote the absorption of morbid prod- ucts, and this fact furnishes a basis upon which to group them, but this common factor or result is not the most prominent feature of the action of each one, and it is not likely that it is attained in the same way by the different members of the group. They alter morbid processes of nutrition in an unknown manner, and are therefore known as alteratives; they ! also possess the power of causing the disinte- gration of pathological products and of pro- moting the absorption of the debris, whence they have been termed discutients or resolv- ents. The absorption of an inflammatory product may sometimes be hastened by inducing a modification of the surrounding circulatory conditions, thus assisting the efforts of the lymphatics to remove an abnormal deposit by overcoming an obstruction to their action. For example, in parametritis the sluggish local circulation is stimulated to a healthier activity by the use of vaginal douches of hot water, which enable the lymphatics to resume a more normal activity, and to commence the removal of the inflammatory exudation. A similar but briefer effect is produced by the use of cold instead of hot water, and in some conditions the alternate use of heat and cold may be the most efficient means for relieving the inflammatory stasis. In plastic iritis, the writer is convinced, the systematic use of applications of hot water" to the eye is of ma- terial value in promoting the resolution and absorption of the exudate, and in influencing the course of the disease, even when not indi- cated by pain. The absorption of hypopyon may also be hastened by the use of hot water, and reparative action may sometimes be in- duced in an ulcer of the cornea by the same means. The principal drugs which facilitate the ab- sorption of morbid products are mercury and iodine, particularly in the form of the iodides. We know that for a great many years these drugs have been employed to cause the dis- appearance of certain inflammatory deposits which have proved not amenable to other, pos- sibly better understood, lines of treatment, and that, in spite of an immense amount of study which has been devoted to them, we are as ignorant as our fathers were of their modes of action. The systemic action of mercury has been already thoroughly discussed. We know that it is very complex ; that the drug increases the activity of glandular structures and augments the quantity of almost every secretion ; that it tends to induce solution of imperfectly organ- ized structures, particularly when they are the results of inflammation ; and that this solvent power is most strongly exhibited when the morbid product is the result of syphilis. At the same time observation teaches us that mer- cury is not equally efficacious in all the forms or stages of syphilis, but that certain products of syphilitic inflammation are more amenable to the iodides, while still others respond more quickly to the combined use of the two drugs. Mercury does not confine its action to neo- plasms of syphilitic origin, but promotes to a greater or lesser degree the elimination of other imperfectly organized tissues from the system. From these facts we deduce the con- clusion that in some manner mercury acts to break down newly formed tissue which is lack- ing in certain qualities of organization, and to reduce it to a detritus which can be carried away bv the lymphatics. At the same time it SORBINOSE SOZOIODOL 214 probably increases the activity of the lym- phatics themselves, and by stimulation of the glandular system hastens the work of elimina- tion. Iodine is a general excitant of the vital ac- tions, especially of the lymphatic and gland- ular system. Its principal use is perhaps as a counter-irritant, and as such it is not infre- quently used over the site of inflammatory effusions or deposits. The result is not entire- ly due to its counter-irritant action, because some portion of the drug is absorbed and aids in the elimination of the morbid product. Administered internally, it seems to find its greatest efficacy in reducing glandular en- largements, such as goitre and enlarged and indurated liver, spleen, mamme, or testes. It is also useful in promoting the absorption of inflammatory effusions in the great lymphatic spaces, such as the pleural and peritoneal cav- ities. When administered in the form of the iodides, it shows a distinct eliminative power over certain neoplasms, particularly young connective-tissue growths of syphilitic origin which do not respond well to the influence of mercury. Although we can not explain its modus operandi any better than we can that of mer- cury, there is reason to believe that it is not the same. It is probable that the principal feature of its action is to stimulate the entire lymphatic system and so encourage the ab- sorption of certain imperfectly organized newly formed tissue. It does not possess the power of modifying the local circulation, and does not materially affect the lymphatics of a part which is in a state of vascular congestion from either active or passive inflammation, but when the circulatory obstruction has been removed it assists the lymphatics in their effort to re- move the products of the inflammation and restore the tissues to their normal condition. Thus the sorbefacient power of iodine is seen to be in all probability greater than that of mercury, but it is not the only one which it possesses. The study of the results produced by its use reveals evidence that it also has a power to cause disintegration of certain exu- dates and neoplastic tissues, and that these tissues differ from those which are broken down by the action of mercury. It is effective in some cases where mercury is not, and again may fail where the other will succeed. The use of the two drugs combined is frequently of greater efficiency than that of either alone, as is demonstrated in certain syphilitic con- ditions as well as in non-syphilitic affections of the skin which originate in excess of nutri- tion. If to these two drugs we add arsenic, and form what is known as Donovan's solution, we obtain the combined action of three agents, each of which acts apparently in a different way to destroy neoplastic tissue, while two exert a sorbefacient action, thus forming a very powerful means for the removal of such growths. Atrophy of the mammae and of the testicles has been ascribed to iodine, but, if authentic, such cases are very rare. No drugs of which we have knowledge can break down or cause the lymphatics to absorb hypertrophies of nor- mal tissue or the products "of slow, progressive parenchymatous inflammation. Neither the connective tissue which distorts the valves of the heart in endocarditis nor that which is present in spinal sclerosis can be removed by these means. A low grade of organization is necessary for such removal of tissue. In cases of chronic poisoning with lead or mercury the elimination of these drugs is powerfully aided by the iodides, which con- vert the deposited metal into soluble combina- tions and hasten their excretion. In addition to these two principal drugs a few other alteratives of minor importance should be mentioned, although it has not been satisfactorily determined that they have any marked sorbefacient power. Sarsaparilla and guaiacum have popular reputations as alteratives, and some practition- ers consider them useful as adjuvants to mer- cury in promoting the absorption of certain pathological products. On the contrary, other practitioners declare themselves doubtful, not only in regard to these drugs' possessing sorbe- facient powers, but in regard to their having any medicinal virtue whatever. If any stimulation of the lymphatic system is produced by iodoform and iodol, it is prob- ably referable to the iodine which enters into their composition, but the effect of iodoform upon the general system is so different from that produced by iodine as to cause a reasonable doubt in regard to the production of such stimulation. Ichthyol has been recommended as " a local alterative and an anodyne resolvent" in cer- tain skin diseases. Possibly its effect upon these morbid conditions is due to stimulation of the lymphatics, but too little is known of its action upon the general system to permit of an authoritative statement whether this is or is not a correct theory. Occasionally other drugs produce effects which are difficult of explanation in any other way than that they promote absorption." Thus, the application of nitrate of silver, sulphate of copper, and other remedies to trachoma in- duces an absorption of the trachomatous tissue which can hardly be satisfactorily explained by their caustic or astringent effect. The sorbefacients of the second class are agents by means of which the imbibition of nutritive or medicinal material into the system is aided or determined, through the skin or mucous membrane, exclusive of the processes of digestion. They may be divided into two sets—those which mechanically promote ab- sorption and those which serve as menstrua to conduct drugs more readily to the lymphatics. The hot-water bath and the vapour bath are possibly the most important of the first class. By them the surface of the skin is cleansed from extraneous substances, the pores are di- lated, and the tissues are relaxed, while the circulation and the activity of the lymphatics are increased, rendering absorption more read- ily accomplished. This method of medication is largely used in sulphur and mercurial baths as well as in those containing other drugs. 215 SORBINOSE SOZOIODOL Massage stimulates the circulation by the compression of the small blood-vessels with the muscular tissue and skin of the part op- erated on, and determines a more active circu- lation and therefore increased activity on the part of the lymphatics. At the same time the medicament is mechanically pressed into the pores of the skin and into close propinquity to the lymphatics, thus rendering its absorption easier and greater in amount. The combined use of the bath, massage, and an oily excipient for the drug is a very efficient method of secur- ing rapid absorption through the integument. Superficial irritation of the skin may be pro- duced by the application of certain counter- irritants, such as heat, hot water, and mustard, and after their removal, if absorbable medica- ments are applied, they will be taken up by the lymphatics more readily than usual, on account of their stimulation by the locally in- creased circulation. The absorption of certain drugs, such as cocaine or aconite, through the skin may be accomplished by means of the galvanic current. The positive electrode is moistened with a solu- tion of the drug which it is desired shall pass through the skin, applied to the place where the action is desired, and, placing the negative electrode elsewhere on the body, a moderate current is turned on. The drugs can be car- ried deeper into the tissues by increasing the porosity of the skin with very fine needles, but the punctures must be very fine, not large enough to be visible to the naked eye. Accord- ing to Dr. Corning, the periosteum of the bones of the arm can be thus anaesthetized with cocaine. (See also under Electricity, vol. i, p. 361.) The remaining set of sorbefacients, which act as excipients for less readily absorbed materi- als, consists mainly of fatty and oily substances of which ointments and similar preparations are made. Lanolin, cacao butter, and oleic acid possess peculiarly efficient powers of pene- trating through the skin, and deserve special mention. The oleates are solutions of certain drugs as bases in oleic acid. They penetrate the skin much more readily than the corre- sponding ointments, and thus introduce the drugs they contain more quickly into the gen- eral circulation. The principal objection to their use is that they are apt to be irritating and, when applied with friction, may even cause pustulation of the skin. Lanolin pene- trates the skin probably the most rapidly of all oils or fatty substances, and at the same time is non-irritating and can be with advan- tage applied with friction. For these reasons lanolin is the best excipient of this class when rapid absorption of a certain drug is desired. Oleum theobromae, or cacao butter, penetrates the skin nearly as well and is used in the manufacture of" cosmetics, as it is a fine emol- lient and does not leave a greasy appearance. Although solid at the usual temperature of the air. it melts at from 86° to 95° F., below the temperature of the body. On account of its usual consistence, low melting point, and great absorbabilitv, it is an almost ideal substance for the manufacture of suppositories, for which it is mainly used. It dissolves in the cavity of the body in which it is placed and penetrates the mucous membrane, carrying with it a por- tion at least of the medicament with which it has been charged. Matthias Lanckton Foster. SORBINOSE. See under Sugar. SORREL.—See Oxalis. SOY, SOYA BEAN.—See Soja hispida. SOZAL, or aluminum paraphenylsulpho- nate (C6H4(0H)S02)3A1, is an astringent and antiseptic crystalline powder soluble in water, in glycerin, and in alcohol. It is used in a 1-per-cent. solution as a wash for suppurating surfaces and as an injection in cystitis and tuberculous abscesses. SOZOIODOL, sozoiodolic acid, or diiodo- paraphenolsulphonic acid. CBHaI2(OII)S()sn, is a crystalline body readily soluble in water, in alcohol, and in glycerin. Sozoiodolic acid, mercury sozoiodolate, potassium sozoiodolate, sodium sozoiodolate, and zinc sozoiodolate are used as antiseptics. In dispensing, sodium sozoiodolate is furnished when " sozoiodol" is prescribed without qualification. Mercury sozoiodolate, or sozoiodol-mer- cury, C6H2I2.S03.0.Hg, is an orange-yellow powder soluble in salt water. It contains 41 per cent, of iodine. It is used topically in parasitic skin diseases and in syphilitic ulcers, in an ointment of the strength of from 2 to 10 per cent, or in the form of a dusting powder consisting of from 2 to 10 per cent, of the drug diluted with talc or powdered starch. Potassium sozoiodolate, or sozoiodol- potassium, is a white, odourless powder soluble in 50 parts of water, insoluble in alcohol. It is used as an antiseptic dusting powder, pure or diluted with from 3 to 10 times its weight of talc or starch, in suppurating wounds, ulcers, etc., as an odourless and non-poisonous substi- tute for iodoform. Sodium sozoiodolate, or sozoiodol-sodium, which occurs in white crystals, is soluble in 14 parts of water. It is used for the same pur- poses as the potassium compound. Moreover, Dr. S. Schwarz (Wiener klinische Wochen- schrift, 1895, No. 43; Deutsche Medizinal- Zeitung, August 10, 1896) recommends the following treatment, which he considers both prophylactic and curative of diphtheria: In the case of children under two years old he insufflates the nasal and pharyngeal cavities with this powder every four hours: R Finely powdered sodium sozo- iodolate .................. 45 grains; Flowers of sulphur.......... 90 " Saccharin.................. 15 " M. For children from two to four years old he prescribes equal parts of sodium sozoiodolate and flowers of sulphur, with the addition of saccharin; for those over four years old, so- dium sozoiodolate with a little saccharin with- out the sulphur. Zinc sozoiodolate, or sozoiodol-zinc. a white crystalline powder soluble in 20 parts of water, is used like the potassium salt. SOZOLTC ACID SPINANTS 216 SOZOLIC ACID.—See Aseptol. SPANISH FLIES.—See Cantharides. SPARTEINE, C16H26N2, is an alkaloid prepared from the flowering tops of Cytisus Scoparius, or the common broom-plant. It is a colourless, oily liquid, possessing a very pene- trating odour, and has a bitter taste. It is found in Asia and has been propagated in the United States. The sulphate, sparteine sul- phas (U. S. Ph.), is freely soluble in water. The physiological action of sparteine is that of a stimiilant to the muscular substance of the heart. The pulse may also be increased in fre- quency after its administration, but there is rarely deviation in the arterial tension. Upon the spinal reflex centres it is sedative ; less so to the circulatory apparatus. In moderate doses it may exert a narcotic influence. As the result of toxic doses, somnolence appears, attended with extreme frequency of the pulse and respiration ; intense dyspnoea with feeble- ness of the heart's action comes on and the cardiac cycle may become arrhythmical. Nau- sea, vertigo, and vastly diminished reflex ex- citability of the spinal cord follow, and death ensues, sometimes with convulsions, by paraly- sis of the respiratory centre in the spinal cord. In conditions of health, sparteine is not a diu- retic. The therapeutic uses of sparteine are as a diuretic and cardiac stimulant. In cases of pronounced anasarca, where this condition is not due to renal or splenic disease, sparteine assists in the removal of the abnormal fluid by acting upon the kidneys and as a hydragogue cathartic upon the intestines. It is inferior in this respect to other diuretic agents, but in their absence may be safely employed, usually with good results. Sparteine may be given, in the absence of digitalis, in cases of impaired heart action with diminished quantity of urine, sometimes with a gratifying sequel. [Dr. Gilbert G. Cottam (Therapeidic Gazette, November, 1896 ; New York Medical Journal, November 28,1896) states that he has employed sparteine sulphate in a number of cases as a heart stimulant during anesthesia with very positive results, and the beneficial effect of the drug has been clearly shown in nearly every instance. He refers to Bevill as having used it in doses of a fifth of a grain by the mouth, given thirty minutes before the administration of chloroform. He describes two cases in which the patients did well throughout prolonged anaesthesia. Langlois and Maurange (Semaine medicate, August, 1894), he says, give from 0-5 to 0-6 of a grain of sparteine sulphate and fa of a grain of morphine hypodermically fifteen minutes before the administration of an anaes- thetic. They have done this a hundred and twenty times on the human subject. In many of the cases the patients suffered from heart disease or had to undergo prolonged opera- tions, such as laparotomy, kelotomy, and re- duction of dislocations. In all of them the heart beats continued full and perfectly regu- lar. Dr. Cottam's mode of procedure is to in- ject hypodermically fa of a grain of sparteine sulphate ten minutes before the anaesthesia is begun. Then, if the operation is protracted, fa of a grain is injected during its progress. These doses have been found ample to secure the desired effect, although they are much smaller than is generally considered necessary. Dr. Cottam gives an account of seven cases to illustrate the points enumerated. Sparteine sulphate was used in every instance in the manner described, and the patients themselves, from various causes, were such as would be peculiarly susceptible to the depressing influ- ence of chloroform, and hence admirably adapted to demonstrate the properties of spar- teine. A study of these cases and many others of a minor nature, he says, has caused him to form these conclusions: 1. That in sparteine sulphate, administered hypodermically before the beginning of anaesthesia, in the dose of fa of a grain, repeated according to the nature of the operation and the condition of the patient, we have a safe, efficient, and prompt heart stimulant in chloroform narcosis. 2. That it is not necessary either to combine it with mor- phine or to use it in larger doses than those specified. 3. That, other things being equal, there is less shock and there is prompter reac- tion with its use.] The action of the drug upon the heart mus- cle—probably through the cardiac ganglia—is more rapid than that of digitalis, and its effect, in moderate dose, lasts for from four to six hours. In diseases of the myocardium or of the valves of the heart, when prompt action is desired, sparteine answers the purpose. See has recommended the drug highly in mitral and aortic regurgitation and in stenosis of the mitral valve. He reports results particularly gratifying in cases in which the insufficiency of the aortic valve was accompanied by a rapid- ly beating, tumultuous heart. In asthma of cardiac origin the drug has been praised. It is said that the vascular symptoms of Graves's disease may be alleviated by the use of spar- teine. Functional disturbances of the heart seem to yield to the influence of the drug. As an antipyretic, it has been used successfully by Geley, by cutaneous application, in the evening rise of temperature in phthisis, in measles, and in scarlatina (cited in New York Medical Journal, February 22, 1896). Sparteine may be administered in solution in doses of from fa to ± of a grain. As the necessity arises, the dose may be increased to 2 grains. For rapid stimulation of the heart, the sulphate may be used. Its free solubility in water renders it available for sub- cutaneous employment. The dose of sparteine sulphate is from fa to{a grain. Tablets of trie salt for hypodermic use are in the market. Samuel M. Brickner. SPASMOTIN, SPASMOTOXINE, or sphacelotoxine, or sphacelinic acid, is a princi- ple obtained from ergot, said to have the for- mula C20H21O9 and to exert the medicinalactions of ergot. According to Dr. C. Jacobj, of the 1 harmacological Institute in Strassbur"- (cited in the Cincinnati Lancet-Clinic, August 4 1894), it has been used satisfactorily in Freund's clinic, in doses of 1| grain. Too little is as yet 217 SOZOLIC ACID SPINANTS known about it, however, to warrant its general employment. SPEARMINT.—See Mentha viridis. SPECIES.—These preparations, still official in several European pharmacopoeias, are mix- tures of dried and powdered vegetable sub- stances to be used in making infusions, decoctions, etc. The species aromatice (Ger. Ph.) consist of 2 parts each of peppermint leaves, serpyllum, thyme, and lavender flowers, and 1 part each of cloves and cubeb. The species diuretice (Ger. Ph.) are equal parts of levisticum root, ononis root, licorice root, and juniper berries. The species emollientes (Ger. Ph.) consist of equal parts of coarsely powdered althaea leaves, mallow leaves, melilotus, chamomile, and flax- seed. The species laxantes (Ger. Ph.) are made by moistening with a little water 16 parts of senna leaves chopped moderately fine, then sprinkling over them as evenly as possible 4 parts of potassium bitartrate in fine powder, and, when the mixture has become dry, adding 10 parts of elder flowers and 5 parts each of fennel and anise. The species lignorum (Ger. Ph.) consist of 50 parts of guaiac wood, 10 each of sassafras wood and licorice root, and 30 of the root of Ononis spinosa. The species pectorales (Ger. Ph.) contain 8 parts of peeled althaea root, 4 parts of the leaves of Tussilago Farfara, 3 parts of licorice wood, 2 parts each of aniseed and mullein flowers, and 1 part of orris root. SPECIFICS.—Remedies which cure certain diseases in some way not indicated by their physiological action are spoken of as specifics. They are few in number, the most notable ex- amples being mercury for the cure of syphilis and cinchona for the cure of malarial disease. It is now considered certain that cinchona and its alkaloids prove curative in malarial affec- tions by their action on the Plasmodium ma- larie, and it is probable that all specifics, among which may be classed the antitoxines, act by destroying the energy of the germ or its products on which the particular disease depends. SPERMACETI, the cetaceum of the phar- macopoeias, is employed in making cerates and ointments, for which its freedom from irritat- ing properties and its consistence render it peculiarly valuable. Spermaceti ointment, un- guentum cetacei (Br. Ph.), contains, in addition to spermaceti, white wax, almond oil, and ben- zoin, and is rather more elegant than ordinary simple ointment. Spermaceti cerate, ceratum cetaceum (U. S. Ph.), is essentially the same as the ointment except that it contains no ben- zoin.— Kissell H. Nevins. SPERMINE.—This is a natural alkaloid, a leucomaine, found in the form of a double phos- phate of spermine and calcium in the testicle, in the ovary, in the thyreoid gland, in the thymus gland, in the lymphatic glands, in the pancreas, in the marrow of bone, in the blood, in the yolk of egg. etc. The spermine now used in medicine is generally in the form of a 2-per-cent. solution of the hydrochloride, of which from 8 to 16 minims are administered by subcutaneous injection once a day. Dr. Alexander Poehl, of St, Petersburg, regards spermine as a most efficient restorative of vigour, acting as an antitoxine in cases of self- poisoning by absorption from the intestines and by increasing the oxidizing powers of the blood and the tissues. Dr. George E. Krieger, of Chicago (American Therapist, June, 1895), who takes the same view, has reported the beneficial action of spermine in asthma, ane- mia, dyspepsia, chorea, diabetes, Bright's dis- ease, neurasthenia, neuralgia, locomotor ataxia, syphilis, chronic ulcers, and tuberculous and other infectious diseases. The indications for the use of spermine are the same as for that of testicle juice (see vol. i, page 73). SPHACELOTOXINE.—See Siasmotin. SPIGELIA (U. S. Ph.), or pink root, is the rhizome and small roots of the Spigelia mari- landica, an American plant which is used in medicine to cause the expulsion of the Ascaris lumbricoides, or roundworm. It is usually employed in the form of the fluid extract, ex- tractum spigelie fluidum (U. S. Ph.), of which the dose for an adult is from 1 to 2 fl. drachms, although the powdered drug is sometimes used in doses of from 1 to 2 drachms, as well as an infusion of \ an oz. in a pint of water, taken at one dose. In larger doses it is somewhat cathartic, and in overdoses gives rise to vertigo, amblyopia, dilatation of the pupils, twitching of the face, and sometimes general convulsions. Death has been reported to have followed ex- cessive doses. As there is no physiological antidote, the treatment in cases of poisoning must be conducted upon general principles. The preparatory treatment mentioned under Antiielminthics should be followed in all cases, and it is usual to administer a cathartic simultaneously, senna or calomel being the one usually selected. Spigelia anthelminthica is a native of tropi- cal America, where it is employed for the same purposes as Spigelia marilandica, but it is credited with being rather more active and more dangerous to life.—Russell II. Nevins. SPINAL-CORD EMULSION.—See un- der Animal extracts and juices (vol. i, page 82) SPINANTS.—This "barbarous vernacu- lar," as Stille terms it (Iherapeutics and Ma- teria Medica, vol. ii, page 147), has been excluded from all the recent medical diction- aries and works on materia medica and thera- peutics. It is an old term formerly used to designate remedies now known as the excito- motors, including principally vegetable sub- stances containing the alkaloids strychnine and brucine, but by some made to include the oxytocics, which apparently stimulate the mus- cular fibres of the womb" by their action on the lower portion of the spinal cord. Proba- bly strychnine is the only substance that acts as a stimulant to the entire spinal cord. Jeremiah T. Eskridge. 218 SPIRITS SPRAYS S SPIRITS. — In a pharmaceutical sense, these are alcoholic solutions of volatile sub- stances, the latter being solids, liquids, or gases. They are prepared by simple solution, or by distillation, or by a combination of the two. The spirits prepared from most of the essen- tial oils are used simply for flavouring. Oth- ers, like spirit of ammonia, spirit of ether, compound spirit of ether, spirit of camphor, whisky, brandy, etc., are used chiefly as stimu- lants.' The most important, and at the same time the most variable ones, as regards strength, are spirit of nitrous ether and spirit of glonoin. The strength of both of these should be con- trolled by assay, and it should be borne in mind that the former constantly becomes weaker by age. The method of assay is given in the IT. S. Ph., and need not, therefore, be repeated here. For spirit of glonoin, however, no reliable method of assay was known when the last U. S. Ph. was published. As the commercial article varies very considerably in strength, and as uniformity in so powerful a drug is highly desirable, the method of assay devised by the writer of this article and recently published by him (Alumni Journal, New York, vol. ii, page 183) is briefly described here : Assay of Spirit of Glonoin.—Into an Er- lenmeyer flask introduce 20 c. c. of a normal solution of potassa in absolute alcohol, heat it moderately, and then add to it, in several por- tions, 10 grammes of the spirit of glonoin to be assayed, finally rinsing the vessel, which con- tained the latter, with a little absolute alcohol, and adding this to the mixture. Test the liquid with litmus paper to ascertain whether it is still alkaline. If it is not, this shows that the amount of alkali was insufficient to decom- pose all the nitroglycerin. In this case add another portion (10 c. c. or more) of the alco- holic potassa solution, carefully measured from a burette, and consider this in the final calcu- lation. Place the flask on a water-bath and heat it until the contents begin to boil. Then stop it and set it aside to cool. Now pour off the clear, pale-coloured solution from the col- oured crystalline crust adhering to the bottom of the flask, wash the latter with alcohol, add the washings to the other liquid, then a little phenolphthalein solution, and determine the remaining excess of alkali with normal acid. Deduct the amount of this excess from the total volume of normal alkali employed in the assay, and multiply the remainder by 0-0755. The product will be the percentage, by weight, of nitroglycerin (glonoin) present in the spirit. Charles Rice. SPLENIC EXTRACT.—Dr. W. Cohn- stein. of Berlin (Allgemeine medicinische Cen- tral-Zeitung, 1896, No. 43; Therapeutische Wochenschrift, June 14, 1896), having found, like Danilewsky, that the use of a watery ex- tract of the ox's spleen, whether given by the mouth or subcutaneously, gave rise to a nota- ble increase in the number of the red blood- corpuscles in dogs and rabbits, has employed it therapeutically. He reports upon its use by several physicians in twenty-three cases. In one of them the disease was leucemia; the others were examples of anemia or chlorosis. In the case of leucaemia there was only a tran- sitory effect observed, not really therapeutical. On the other hand, in the majority of the cases of anaemia and chlorosis the action of the ex- tract was very striking. The first signs of improvement were seen in the subjective symp- toms of debility, loss of appetite, constipation, headache, and dysmenorrhea. Objectively, the pallor disappeared, and often there was an in- crease of the haemoglobin or of the number of the red blood-corpuscles. In many cases the patients gained flesh notably. In many others there were no objective signs of improvement. In no instance was any unpleasant effect ob- served. The splenic extract employed by the author was one known by the trade name of eurythrol. It is a watery extract to which salt has been added, partly to preserve it and partly to give it a better flavour. It is described as resem- bling Liebig's beef extract. The amount to be given daily is from one to two teaspoonfuls, dissolved in hot water. SPONGE, as it occurs in the shops, is rare- ly in proper condition for either medical or sur- gical purposes, containing as a rule more or less sand and calcareous matter and being of an ob- jectionable dark colour. Sponges should be soaked for a day or two in a 3-per-cent. solu- tion of commercial hydrochloric acid, to re- move the calcareous matter, and subsequently washed a number of times in fresh water. To bleach them, the method is to soak them in a 1-per-cent. solution of potassium permanganate for several hours and, after rinsing, submit them to a 2- or 3-per-cent. solution of oxalic acid, the last traces of which must be removed by repeated washings. Chlorine or a dilute solution of sulphurous acid is sometimes used to bleach them, but the texture of the sponge is more apt to be affected than when the above- described method is employed. To render them aseptic, as is necessary when they are to be used as absorbents of blood, pus, etc.. it is necessary to soak them for at least twenty-four hours in a 5-per-cent. solution of carbolic acid, and after their removal from that to allow them to remain in water sterilized by heat for two days, and then to immerse them in a carbolic- acid solution to destroy any micro-organisms which may have escaped the first part of the process. When they are prepared in this man- ner it is fairly certain that they are free from disease germs and that they retain their ab- sorbent properties. Heat, either dry or moist, injures them greatly, as do also all the com- monly employed antiseptics, such as corrosive sublimate. It is a common practice to attempt to disinfect sponges after having employed them in operations, etc., but it is much wiser to avoid their use a second time, as it is almost impossible to render them entirely aseptic. Sponges of the cheaper grades, provided they are fairly absorbent, are just as useful, and can be destroyed after having been once used, or gauze or absorbent cotton, either of which is easily sterilized, will prove reasonably satis- factory. Although inferior to skin-grafting, sponge- grafting, or the application of very thin sheets of sterilized sponge upon the surface of un- healthy granulating sores of large area, will often prove useful in hastening the process of repair and preventing the contraction of the cicatrices. The sponge should be as thin as possible and held in place by light pressure, and antiseptic dressings should be applied. It may require several weeks to insure success in this procedure, but, properly performed, it is usually successful. Sponge tents may be prepared by winding cord tightly around small pieces of dry sponge, which may or may not be previously impreg- nated with mucilage of acacia. Before they are to be used the cord is removed. On ac- count of their absorbent properties they are decidedly inferior to tents of laminaria or tu- pelo wood, except when they are to be impreg- nated with some medicinal agent. When they are employed to dilate the canal of the cervix uteri the condition of the patient must be watched carefully, as decomposition of the mucus, etc., absorbed by the tent has often oc- curred, with a resulting septicaemia. By some it is advised that when they are used in that situation it is proper to inclose them in a rub- ber condom. For tamponing the vagina they are not so suitable as absorbent cotton, but when a single plug is used, as when certain substances are to be retained against the cer- vix, there is no decided objection to the use of a sponge, provided it is not allowed to remain in position for longer than twelve hours. In post-partum hemorrhage a sponge of fair size, impregnated with vinegar and introduced with- in the uterus, is sometimes effectual in check- ing the flow of blood, but it should not be permitted to remain for more than an hour or two, lest it should be difficult of removal. Great care should be observed that the sponge is tough, so that no fragments may be detached and remain, for the blood absorbed by them would almost inevitably decompose and give rise to unpleasant results. When impregnated with a minute amount of glycerin, which may be accomplished by soaking them in a 5-per-cent. solution of that substance, sponges retain their elasticity per- manently and may be used to exert moderate pressure upon varicose veins, enlarged breasts, etc., being held in position by appropriate band- ages. (See also under Antiseptics in surgery, vol. i, page 128.)—Russell H. Nevins. SPONGIOPILINE. — See under Poul- tices. SPRAYS.—A spray is a fluid, which may hold in solution one or more drugs, reduced to a condition of minute particles by the force of a blast of air or steam. This condition of the fluid is known as atomization; the instrument employed to produce it, as an atomizer. There are many forms of atomizers on the market, which differ in size and shape accord- ing to the purposes for which they are intended to" be used or the blast power to be employed, but in all used at the present time the fluid is forced through a tube and as it emerges from 58 the mouth is reduced to a spray by a blast of air or steam. The first attempt to use a spray was made with a syringe which forced the fluid through numerous minute perforations in a plate of metal that closed the objective end cf the barrel. This method was unsatisfactory, and the apparatus devised by Sir Benjamin Ward Richardson was a very great improve- ment. In this the fluid is placed in a recepta- cle sealed with a stopper which contains two tubes, one extending beneath the surface, the other opening above the surface of the fluid and also at the mouth of the first. The sec- ond tube is also connected with the blast appa- ratus, usually a rubber bulb which is squeezed by the hand of the operator. When air is thus driven through the second tube into the res- ervoir the pressure forces some of the fluid through the first tube to its mouth, where it is met by a blast of air from the second tube which reduces it to spray. The form most employed at the present time, and the most generally useful, depends for its action upon a different principle. Two tubes with very fine mouths are placed at right angles to each other. One tube leads into a receptacle containing the fluid which it is desired to atomize, while the other is con- nected with the blast apparatus. The air driven through the latter tube across the mouth of the former causes a rarefaction of the air within and a consequent rise of fluid in the tube until it emerges and is blown into spray. The blast is obtained by compression of a rubber bulb, by the liberation of compressed air, or by steam. The hand-ball atomizer is used for many purposes, non-medical as well as medical, is portable, and is familiar to every one, but it is of far less efficacy in most cases where the use of the spray is now considered advantageous than an atomizer which obtains its power from compressed air. In order to obtain a continuous spray with a hand-ball atomizer a second bulb is inserted between the hand ball and the rest of the apparatus. This second bulb dilates as the first is compressed and by its elasticity maintains a steady blast while the first is being refilled with air. A continuous spray of this nature has some ad- vantage over the short, spasmodic action of the single-bulb apparatus, but the disadvantage of inability to stop the spray suddenly is very great and evident. By means of a reservoir of compressed air, a connecting tube, and a cut-off, a spray may be made continuous as long as is desired and stopped in an instant. Steam is sometimes used for the blast. It has the ad- vantage of warmth, but by its presence causes great dilution of the fluid, a fact which must always be borne in mind when a solution is being prepared for atomization by this means. Sprays have been used to medicate the at- mosphere of rooms, to produce local anesthesia, to be inhaled as topical remedies for the mucous membrane of the larynx, trachea, and bronchi, to cleanse the mucous membrane of the nose and throat, and to apply remedial agents to the same. In the early days of antiseptic surgery rooms SPURGE STAPHISAGRIA 220 were treated with continuous sprays of car- bolic acid from steam atomizers before and during operations, as a precaution against sepsis. Experience and a better knowledge of the principles of antisepsis have demonstrated this precaution to be unwise and useless, so it has been nearly, if not quite, totally abandoned. Sometimes the air of a room is medicated in a similar manner by means of a steam spray, and a patient is caused to remain there a cer- tain number of hours in order that the drug may become absorbed into the system through the skin or the mucous membrane of the respiratory tract. This plan is said to have been used at several of the European spas and in isolated cases elsewhere. Very often great benefit is obtained in affections of the larynx and bronchi by the use of a steam spray in the room where the patient is confined. In these cases, such as laryngeal diphtheria, the dry form of chronic bronchitis, and especially capillary bronchitis, the steam itself is a valu- able therapeutic agent, to which the added drugs may perhaps be considered adjuvants. An alkaline spray is the most generally useful, and limewater seems to be the most commonly used. Solutions of common salt, of bicarbonate of sodium, and of other alkalies are also em- ployed. A disinfectant, such as eucalyptus, turpentine, thymol, or carbolic acid, is often added, but the latter should be used very care- fully, on account of the danger of poisoning if it is used for any great length of time. Very volatile substances, like ether or rhigo- lene, when driven in the form of a spray against the skin, evaporate so rapidly as to quickly freeze that part of it, deprive it temporarily of sensation, and so produce a condition of local anaesthesia. This means, once extensively em- ployed, has fallen considerably into desuetude since the introduction of cocaine as a local an- aesthetic. For the purpose of inhalation, an atomizer is employed which reduces the fluid to a very fine spray that resembles a cloud. As the mouth and pharynx are filled with this cloud the patient is instructed to take deep inspira- tions, in the hope that a sufficient quantity of the dissolved drug may be inhaled and may remain upon the diseased mucous membrane to aid it to regain its normal condition. Unless the spray is very fine, very little indeed can penetrate into the larynx, and, though reduced to a cloudlike form, little, if any, penetrates as far as the bronchi; so this method of treatment is usually of little avail except to the mucous membrane of the larynx and the immediately adjacent portion of the trachea. In acute and subacute laryngitis such sprays of alkaline so- lutions, resorcin, cocaine, and listerine are of considerable value. Attempts have been made, said by some to have been successful, to treat diseases of the lungs by an exceedingly fine spray through the larynx and down the trachea. The principal use of the spray is in diseases of the nose and throat. In general terms, the objects to be attained are to cleanse the mucous membrane, to render its secretions alkaline, to interfere with the development of pathogenic micro-organisms, and to furnish a protective coating which will prevent too rapid evapora- tion from its surface. Alkaline sprays not only render the secretions of the mucous membrane alkaline, but also augment their amount, and are therefore most useful for the purpose of cleansing. Probably the most widely known solution used for this purpose is that known as Dobell's, the formula of which is: 5 Borax, ) Sodium bicarbon- [• each___8 grains; ate, ) Carbolic acid.............. 4 " Glycerin.................. 2 fl. drachms; Distilled water, enough to make 4 fl. oz. M. A much less irritating solution for the same purpose is that known as Seder's, the original formula of which was as follows: 9 Borax™ bicarb°nate' | each ... 8 drachms; Sodium benzoate, ) , nn ■ ;„c. Sodium salicylate, [ each..... 20 Srains; Eucalyptol,) , 1Q „ Thymol, \ each........... 1U Menthol.................... 5 " Oil of wintergreen.......... 6 drops; Glycerin................... 8| fl. oz.; Alcohol................... 2 " Water, enough to make...... 16 pints. M. The essential ingredients of this solution are usually dispensed in tablet form, on ac- count of the much greater convenience, but the proportions and even the constituents of the tablets which are sold as Seder's vary to such a degree that no certain formula can be given. To make tablets conforming to the formula given above, omit the glycerin, alcohol, and water, add lOf drachms of sodium chloride, mix thoroughly, and divide into 128 tablets. One tablet is dissolved in 2 oz. of water for use as a spray. The following formula of a Seder's tablet to be found on the market shows how wide a variance exists: R Borax, ) , ,_ Sodium chloride, \ each • • • • 5 Srains '• Menthol, ) , , . Thymol, feach............ ^of a grain; Oil of eucalyptus.......... A of a minim; Oil of wintergreen........r^u " « M. Frequently after cleansing the mucous mem- brane with this solution it is advisable to spray it with an oily solution to form a protective coating. In cases where stimulation is de- sirable, a solution of eucalyptol, thymol, and menthol in a pure hydrocarbon oil, like albo- lene, is very useful. In acute coryza this solu- tion, sprayed into the nostril, sometimes acts like a charm to lessen the congestion of the mucous membrane and relieve the feeling of oppression. It is also useful in simple chronic rhinitis. In atrophic rhinitis it is usually a pleasant application for the patient and relieves many of the disagreeable symptoms for a time though it can hardly be said to be curative. ' 221 SPURGE STAPHISAGRIA In all of the above-mentioned solutions drugs are included which tend to repress the development of pathogenic micro-organisms, but in certain diseases, such as diphtheria and croup, sprays of peroxide of hydrogen or of bichloride of mercury are recommended. In using the latter, special care must be taken that the spray is fine, because a coarse spray is of less use and sometimes harmful by inducing absorption of a too great quantity of the drug when it is used for some time. As a prophylactic against diphtheria, some authors recommend the daily use of the follow- ing throat spray, particularly for persons who are suffering from nasal catarrh : R Listerine..........1 fl. drachm : Boric acid......... 6 grains ; Glycerin........... 1 fl. drachm; Water, enough to make 1 fl. oz. M. Matthias Lanckton Foster. SPURGE.—See Euphorbia pilulifera, un- der Euphorbia (vol. i, page 401). SQUILL, scilla (U. S. Ph., Br. Ph.), bulbus scille (Ger. Ph.), is the bulb of Urginea (Scilla) maritima, a liliaceous plant. It is possessed of expectorant, diuretic, emetic, and cathartic properties, but is used only when the first two are indicated. As an expectorant, it is indicated in chronic bronchitis, when the mucus is tough and viscid, and in acute bron- chitis, when the signs of congestion of the mu- cous membrane have subsided. When, in the last-named affection, the expectoration is scanty it is desirable to combine with the squill a nauseant expectorant, such as ipecac, and, on the other hand, when it is profuse, a stimulant expectorant is useful. Squill has been employed to some extent in croup, on ac- count of its emetic and expectorant properties, but it is hardly to be commended. As a diuretic, it is contra-indicated when- ever there is any inflammatory process occur- ring in the kidneys, and it would be safer to restrict its employment to cases of cardiac dropsy. It is usual to combine with it one or another of the preparations of digitalis when it is used as a diuretic. In overdoses it purges actively, and paralysis and convulsions may en- sue. The dose of "the drug itself is from 1 to 2 grains; that of the vinegar, acetum scille (U. S. Ph., Br. Ph., Ger. Ph.), from 15 to 40 drops; that of the fluid extract, extractum scille fluidum (U. S. Ph.), 2 to 3 minims; and of the syrup, syrupus scille (U. S. Ph., Br. Ph.), from 40 to 60 drops. The compound syrup, syrupus scille compositus (U. S. Ph.), contains about a grain of tartar emetic in the ounce, also senega, and is a very useful expectorant mix- ture except for infants and persons of low vi- tality. It may be given in doses of from 10 to 30 drops. [The dose of the tincture, tinctura scille (U. S. Ph., Br. Ph., Ger. Ph.), is from 10 to 20 minims; that of the oxymel, oxymel scille (Br. Ph., Ger. Ph.). is a teaspoonful for adults (from 5 to 20 drops for infants) as an expec- torant, and a teaspoonful, given in fractional amounts at short intervals, as an emetic for children. The dose of the compound squill pill, pilula scille composita (Br. Ph.), is from 5 to 10 grains; for the pilula ipecacuanhe cum scilla (Br. Ph.), see vol. i, page 543.] Russell H. Nevins. STANNUM.—See Tin. STAPHISAGRIA (U. S. Ph.), staphisa- grie semina (Br. Ph.).—The larkspur is a ge- nus of annual or biennial flowering herbs of the natural order Ranunculacee, and includes many species. The one most used in medicine is Delphinium Staphisagria, stavesacre, indig- enous to the countries bordering on the Medi- terranean and cultivated in many parts of southern Europe. Also the species Delphi- nium Consolida, that is common in central Europe and has been naturalized in the United States, is sometimes used as well as Delphinium exaltatum and Delphinium Ajacis. The seeds of Delphinium Staphisagria, stavesacre, are most commonly employed. In earlier editions of the U. S. Ph. more promi- nence was given to the seeds of Delphinium Consolida, which were officinally designated as delphinium. The most important ingredient of the seeds is delphinine. an alkaloid upon which the virtues of the drug are supposed chiefly to depend. It is insoluble in water; soluble in 21 parts of alcohol, in 11 of ether, and in 16 of chloroform. It is an acrid sub- stance, irritating to the skin and mucous membranes. The seeds contain a non-drying fixed oil in the proportion of from 25 to 30 per cent. Larkspur seeds have been used in the form of an outward application for the destruction of vermin, both in man and in beasts, from time immemorial, and for this purpose are still somewhat in vogue, though largely superseded by more modern remedies. For such applica- tions the remedy is used either in the form of a lotion or that of an ointment. A decoc- tion made by boiling 1 oz. of the seeds in a pint of water has been employed both for phtheiriasis and for scabies. A lotion recom- mended for the destruction of pediculi capi- tis is made by macerating 1 oz. in a pint of vinegar. A tincture in the same proportions is also used, as well as a solution of 1 scruple of delphinine in 2 fl. oz. of rectified spirit. Another effectual preparation is the expressed oil sufficiently diluted with olive oil. Accord- ing to Balmanno Squire, " a cheap way of pre- paring the oil for application is to digest the seeds in melted lard and strain while hot. The filtrate is an ointment of the seeds of stavesacre. Two drachms of the bruised seeds should be used to an ounce of lard." Aside from these uses, larkspur, more par- ticularly Delphinium Consolida. has been rec- ommended as a vulnerary, and delphinine has been used as a topical remedy for the relief of neuralgia, earache, and toothache. The al- kaloid delphinine may be used for this pur- pose either in alcohol (from 16 to 30 grains to the ounce) or in an ointment (10 to 40 grains to the ounce). The unguentum staphtsugrie of the Br. Ph. contains about 10 per cent, of oil of stavesacre. STAR-ANISE STIMULANTS 222 Internally, the drug is seldom, if ever, now employed, though formerly it was used in spasmodic asthma, in dropsy, in gout, and in seasickness, usually in the form of a tincture of the seeds. The dose of delphinine is said to be i a grain, repeated at intervals of three or four hours.—Edward B. Bronson. STAR-ANISE.—See Illicium. STARCH.—The amylum of the U. S. Ph- is starch obtained from maize; that of the Br. Ph. includes starch from wheat, maize, and rice; and the amylum tritici of the Ger. Ph., as the name implies, is wheat starch only. For the use of starchy substances as articles of food, see the article on Foods. Starch may be administered freely by the stomach as an anti- dote in cases of poisoning with iodine; also, when irritant preparations of iodine, such as the tincture, have accidentally come in contact with the body or been applied too copiously, their irritating action may be checked by the immediate application of starch. Starch was formerly much employed, in the form of the starch bandage, for encasing a limb in an im- movable envelope in cases of fracture, but for this purpose it has now been almost wholly superseded by plaster of Paris. At present starch is chiefly used, finely powdered, as a topical application in intertrigo and other forms of superficial irritation of the skin, and to reduce the strength of medicinal powders used locally as dusting powders. Glycerite of starch, glyceritum amyli (U. S. Ph.), is a jellylike mass made with 10 parts of starch, 10 fluid parts of water, and 80 parts of glycerin. Glycerine of starch, glycerinum amyli (Br. Ph.), is also a jelly made with 1 part of starch, 5 fluid parts of glycerin, and 3 fluid parts of distilled water. These jellies are used as lubricants, as bases for ointments, and in the preparation of certain suppositories. Mucilage of starch, mucilago amyli (Br. Ph.), is employed chiefly as a vehicle for enemata. For iodized starch, see under Iodine (vol. i, page 537). STAVESACRE.—See Staphisagria. STEAM.—The employment of the vapour of water by inhalation is treated of in the ar- ticle on Inhalants (vol. i, page 528). In cases of acne with decided induration of the lesions and a tendency to their appearance in succes- sive crops, also in those of chronic eczema with pronounced infiltration, the daily exposure of the affected parts to the action of steam, as hot as it can comfortably be borne, continued for from fifteen minutes to half an hour, often proves of great service. Liberson (Medecine moderne, February 15, 1896; Medical Record, March 28, 1896) finds that it not only aids in the absorption of superficial and deep infiltra- tion, but also diminishes or arrests purulent secretions, removes crusts, checks oozing, and provokes a regeneration of healthy tissues. Steam has been employed as a hemostatic. In a series of lectures, etc., published under the ausoices of the Imperial University of Mos- cow (1894, No. 4 [summarized in the Central- blatt fur Gunakologie for January 19. 1895, and from that in the University Medical Maga- zine for August, 1895]), Dr. Snegirjoff advised its use for controlling hemorrhage during op- erations, and said that for seven years he had employed it after dilatation and curetting of the uterine cavity. A small metal cannula, at- tached by a rubber tube to a kettle containing water at the boiling point, was introduced into the cervical canal. The steam was applied for a minute. This was always followed imme- diately by complete haemostasis and was not associated with pain or other sym ptoms. When it was applied in carcinoma of the uterus the foetid discharge and haemorrhage disappeared, and the pain was relieved. When it was ap- plied to the cavity of a uterus that was after- ward removed the endometrium was found to be cauterized and covered with a thin white membrane, showing that the steam had acted as a caustic hemostatic, anesthetic, and antiseptic. In a series of experiments on animals, the liver was extirpated with the loss of but little blood, and the animal survived ; also a portion of the spleen, lung, kidney, and brain. Haemorrhage from bone was controlled, and a new growth of bone tissue followed the operation. A. horn of the uterus of a dog was excised. Bleeding from a longitudinal or transverse incision in the femoral artery ceased after the application. Muscular and cutaneous haemorrhage ceased immediately, and the operation was always followed by primary union. In 1893 Dr. Sneg- irjoff began to apply the method in a series of operations at the Alxina Hospital. In five cases of resection of the knee joint the oper- ation was performed without the use of an Esmarch tube, haemostatic forceps, or ligature. In amputation of the breast for cancer, and cancer, lipoma, and cavernous tumours of the skin, in amputation of the cervix uteri, and in hysterectomy for fibroid tumours, to control haemorrhage from the stump, the application proved effective. After the incision of ab- scesses it was employed as a method of disin- fection ; in haemorrhage from a sinus or fistula, particularly if it was tuberculous, haemorrhage was controlled entirely. The writer in the University Medical Maga- zine adds an abstract of a subsequent article on the subject by Dr. Ludwig Pincus, of Dant- zic (Centralblatt fur Gynakologie, March 16, 1895). Pincus referred to Snegirjoff's publica- tion and reported nine cases in which steam had been employed in controlling haemorrhage from the uterine cavity and in treating endo- metritis^ In a case of carcinoma of the fundus uteri, with severe pain in the pelvis, haemor- rhage, and foetid discharge, the application had immediately been followed by a discharge of dark-coloured fluid containing degenerated tissue, and the haemorrhage and foetid dis- charge had disappeared and not returned until after eleven days. The treatment was con- tinued for a minute and a half, and was not associated with any degree of pain. Steam was used in three cases of uncompli- cated hyperplastic endometritis, with severe menorrhagia. In one case three applications were made, each lasting a minute. The men- struation during the next two months was regular and normal, lasting from two to three 223 STAR-ANISE STIMULANTS days. In the two other cases which he had observed but two and three weeks respectively, the haemorrhage had not returned. About the third day after each application there had been a profuse leucorrhceal discharge, which had completely ceased between the ninth and the twelfth day. In one of these last cases the treatment had been followed by uterine colic. Five cases of cervical endometritis were under treatment, but had not been observed long enough for any definite results to be reported. Pincus concludes that the method is of un- doubted value, particularly from a bacteri- ological standpoint, and that it should be of great value in septic puerperal endometritis. Superheated steam has been used as a caus- tic. Dr. Panecki, of Dantzic (Therapeutische Monatshefte, January, 1896; Deutsche Medizi- nal-Zeitung, June 1, 1896; New York Medical Journal, June 20.1896), thinks steam preferable to other caustics for destroying the diseased endometrium. The caustic act'on of steam at the temperature of its generation, he says, is superficial if it is used for a brief application only; if it is applied for a long time or in a superheated state (heated to 248° F.), its action extends deeper. He says the method of its ap- plication is very easy and simple, so that the physician needs no assistant; moreover, it is entirely painless, and he has never seen it do any harm. STERCULIA.—Sterculia (or Cola) acumi- nata is a tree of the Malvales indigenous to western Africa and cultivated in various trop- ical countries. The seeds, contained in a cap- sule known as the kola nut, or garu nut, contain caffeine, a small amount of theobromine, a fixed oil, and a volatile oil. Kola, although not of- ficial, has of late come into use as a tonic and stimulant to the nervous system. Like coca, it is credited with marvellous sustaining powers that enable persons to endure great and pro- tracted exertion, either bodily or mental, or dep- rivation of food without suffering from fatigue or hunger, also with aphrodisiac properties and with promoting the appetite for food. It is an efficient and acceptable substitute for tea and coffee. It seems to act as a tonic to the heart. It is said that by chewing from 20 to 40 grains of the fresh seeds a person may often overcome seasickness in about three quarters of an hour. Kola has been used in France as a remedy for diarrhea. Dr. Albert L. Gihon, of the United States Navy (Medical Times, April 17, 1886), was among the first in this country to use kola therapeutically, in an obstinate case of neuras- thenia which rapidly yielded to its use. It is probable that its chief virtue will be shown in such cases. There are many preparations of kola on the market, most of them proprietary. Probably the fluid extract is as satisfactory as any of the others ; it may be given in doses of from 15 to 20 drops. STERESOL.—This is an antiseptic varnish said to consist of 135 parts of shellac, 5 of ben- zoin, 25 of tincture of Tolu, 3 of oil of cinna- mon, 50 of carbolic acid, and enough alcohol to make 500 parts. It is used topically in diph- theria. STERNUTATORIES, or remedies or measures which excite sneezing, were formerly employed to stimulate the secretion of the mu- cous membrane of the nose, thus relieving the system of " peccant " substances, and to relieve various morbid conditions by repeated acts of sneezing. At the present time they hardly en- ter into medical practice and are only employed when it is desired to obtain the aid of sneezing to expel foreign bodies from the nose, and even then they may be dangerous, causing rupture of weakened blood-vessels. Snuff and black pep- per are obtainable almost everywhere, and are as suitable as any other sternutatory. Occasion- ally it will be found that small objects in the eye, such as particles of sand, can be removed by causing the person to close the affected eye while sneezing is excited. The rapid passage of air through the nose undoubtedly causes a partial vacuum in the tear duct, and the con- sequent sudden gush of tears from the eye is very apt to wash out the foreign body. The same effect may often be produced by closing the nostril of the same side as the affected eye and blowing the nose with considerable force. Russell H. Nevins. STIBIUM.—See Antimony. STILLINGIA, or queen's root, is the root of Stillingia silvatica, an American herbaceous plant of the Euphorbiacee. In large doses, it is emetic and cathartic ; in the doses ordinarily employed, it is credited by some practitioners with alterative virtues similar to those ascribed to sarsaparilla, and is used in the treatment of syphilis, scrofula, and other dyscrasie. The fluid extract, extractum stillingie fluidum (U. S. Ph.), may be given in doses of from 15 to 45 minims. STIMULANTS.—These may be defined as agents whose influence is to augment the vital activity or function of an organ or to increase the vital energy of the entire system. By the heightening of the physiological functions, stimulants may, at the same time, carry a corrective or an economical effect upon sys- tems weakened or partly disturbed by diseased conditions. Many of the substances used ther- apeutically as stimulant agents evoke an in- tensifying action upon normal tissues or systems of the human organism. With few exceptions, however, the subject will be dis- cussed in this article from its therapeutical standpoint, such deviations being made only for the sake of lucidity. Colloquially, the word " stimulants " is used with reference to alcoholic liquors. Aside from the fact that these agents are of undoubted use in the treatment of disease, their ancient usage demands some consideration. Wine is referred to by Homer, and evidently its increased strength acquired by age was known to the an- cient Greeks, since the poet makes mention of wine eleven years old. The Brahmans used the moon-plant (Asr/cpias acida) as a sacrifice for the expiation of sin ; and the faithful were not allowed to touch the sacred plant except for religious purposes. The inhabitants of Egypt were acquainted with the intoxicating powers of grape wine, and fermented wine formed a STIMULANTS 224 conspicuous part in the religious services of the ancient Jews, as it does in the communion ser- vices of the present day. Every nation, say- age or civilized, possesses some characteristic stimulant, from the coffee of the Javanese and the tea of the Chinese to the kumyss of the Tartars and the coca leaves of the South Amer- ican Indians. Stimulants in some form seem to be essential to the carrying out of routine duties; and it is altogether likely that the stimulant required by the savage before his entrance into battle or previous to the under- taking of a journey, is identical, so far as its purpose is concerned, with the exhilarant which the man of higher civilization demands in his struggle for maintenance and advancement. Whatever may be the purpose of its ingestion, it is true that every race and tribe is possessed of some stimulant in its armamentarium of life. The moral and political sides of the ques- tion can not be discussed in this place. Broadly, stimulants may be grouped into two great classes, general and local. By general stimulants are meant those agents which pro- duce their effect simultaneously upon the entire system. Theoretically, most of the stimulant substances would come under this head, since vital energy or the increase in the vital forces is recognised chiefly from the mani- festations of the circulatory and nervous appa- ratus. And yet a line must be drawn, for many of the agents under consideration induce their manifestations by their influence upon organs or sets of organs. Such stimulants are known as local stimulants, and when general effects are produced by them it is by secondary action or by the ingestion of a dose larger than is necessary to call forth the merely local influ- ence. Again, not all stimulants possess alone a vivifying effect upon the organism or a part of it. Some of them, like opium, for instance, have in different doses a sedative influence; while others—for example, carbonate of ammo- nium—may produce irritation. Yet the pri- mary effect of the stimulants is stimulation, and for the present purpose they will be so consid- ered. Before reviewing some of the properties of the main stimulants, it will be well to recog- nise the general principles underlying their use and the indications for their administration. The personal element and the individual tem- perament offer bases for study. A man ad- dicted to the use of coffee, for example, will respond but poorly in emergency, as a rule, to the alkaloid of the bean. Habit plays an im- portant role in the determination of the effect desired from a stimulant agent. A patient ex- hausted in a typhoid fever who has been a heavy user of alcohol in any of its forms will require a much larger proportion of this stimu- lant to secure a beneficial action than one whose system is not permeated with it. It is so well known that drunkards withstand severe disease poorly that it has become an established prin- ciple that such patients, especially when they suffer from grave injuries which shock the nervous system, shall receive copious libations of alcoholic stimulants, for without them they will most certainly succumb. The withdrawal of any accustomed stimulant evokes a shock which is often more to be feared than the im- pending or present disease. Exception should be made, perhaps, in the case of tobacco, for many users of the weed lose their taste for smoking or chewing during an acute disease, sometimes even permanently. The individual temperament, aside from habit, must be taken under consideration, too. Coffee or tea may make one person wakeful, and have the reverse effect upon another. Tobacco may calm one mind and distress another ; it may arouse the intellect on the one hand, or may cloud and obscure its workings on the other. Alcohol in any of its forms presents the most diverse ef- fects upon different persons. It may produce drowsiness or wakefulness; it may constipate or cause diarrhoea; it may relieve a headache or be responsible for the reverse condition; its use may cause strength in one, weakness in another: from one intellect it may call forth brilliancy and it may blunt another. Sex has an important bearing upon the ad- ministration of stimulants. Women yield to them much more easily than men, and require, therefore, smaller doses. The aged require stimulation, particularly in diseased conditions, while children, in health at least, are inde- pendent in this respect. The habitual use of some stimulant is preferred for old people by many authors as giving tone to the stomach, brain, and heart. The effects of stimulants vary with race and climate. Savages yield readily to the influences of stimulant agents to which they are not accustomed, and, like diseases which are generally innocuous in civ- ilization, such agents in large quantities may prove fatal. Stimulants can be used with greater freedom and less danger in their native places than elsewhere, as witness the prolonged and harmless chewing of coca leaves by trav- ellers in South America. The effects of stimu- lants are modified by disease. Enormous doses of alcohol can be given in typhoid fever, for example, without bringing about intoxication, and in cases of chronic debility immense quan- tities of alcoholic liquors may be taken with impunity. All agents used as stimulants depend upon some contained active principle for their effect, which is, in its turn, dependent upon the quan- tity administered. Within certain limits, too, they are all capable of replacing ordinary food for the sustenance of the system. In the case of alcohol this is probably due to the preven- tion of tissue waste by purely chemical means, since carbon and hydrogen are offered to the oxygen of the blood in place of the elements in the tissues. The coca leaves offer, on cor- roborated evidence, a large amount of suste- nance and great powers of endurance. Coffee and tea have sustaining powers to a marked degree, and in the case of perhaps the greatest proportion of civilized nations form the chief element of the first meal of the day. Some African tribes, when preparing for long jour- neys, take with them only coffee and butter as articles of food. Alcoholic stimulants may stand as a type for general stimulants. Under this head may 225 STIMULANTS be included whisky, brandy, wines of all kinds, ale, beer, porter, and stout. Whisky and brandy may be regarded as representing what are known as diffusible stimulants, those which are quickly absorbed and act with correspond- ing rapidity. In diseases marked by the so- called typhoid state—that is, in adynamic conditions—the alcoholic medicines are pre- eminently indicated, not for any curative in- fluence, indeed, but because their ingestion at the time when weakness is manifested in all the organs, and mental hebetude supervenes, produces a purely stimulant effect first, and secondarily acts as a food to the patient. The dose of alcoholic stimulants in such phases of disease demands, however, careful considera- tion. Should intoxication, even of slight de- gree, supervene, the succeeding exhaustion and depression are dangerous in the extreme. The amount to be given must be accurately gauged and can be determined only by experiment. By administering these stimulants in small doses the dose for each individual may be as- certained with precision and the further ad- vantage may be gained of maintaining the stimulant action for a considerable time. The different degrees of susceptibility and their causes, as enumerated above, must be con- stantly in mind. The diffusible stimulants are of value in other conditions, too, than the mere exhaus- tion of disease. In the beginning of the milder infections, such as an acute coryza or amygda- litis, a hot alcoholic drink, taken during or immediately after the initiatory chill or chilly feeling, may abort the attack. Persons ex- posed to cold and wet feel an immediate re- newal of warmth after the ingestion of one of the diffusible stimulants, particularly if it is accompanied by immersion of the feet in hot water. In cases of temporary weakness of the heart, as in fainting, a warm alcoholic stimu- lant is of great service. In all instances of cardiac depression, whether from poisoning, shock, or haemorrhage, alcohol is one of the best means at our disposal for stimulating the heart to act, and temporarily to bridge over the crisis. It has undoubtedly saved many lives when used subcutaneously in large doses in impending death in the instances mentioned. Whisky and brandy, being very diffusible, are to be preferred for rapid stimulation. The heavier wines, such as port, burgundy, sherry, and claret, are of greater service in the conva- lescent stages of prolonged disease ; they have a more agreeable taste and are tonic as well as stimulating. Champagne is an excellent stim- ulant after severe operations and tends to allay vomiting and nausea when given very cold in frequent small doses. All the alcoholic stimulants have the same effect upon the heart's action and the cerebral areas. The stimulation by these agents is evoked by an increase in the arterial pressure and by a reflex contraction of the vessels. The heart-beat is accelerated and becomes more forcible by reason of reflex action from the sensory nerves of the mouth, oesophagus, and stomach when the fluid is taken internally. It is quite probable, too, that there ensues a local dilatation of the cerebral arteries as a consequence of the ingestion of the fluid, which accounts for the usual accompanying cerebral stimulation. The quantity and the quality of the blood sent to the brain, together with the varying contraction and dilatation of the blood- vessels and the force of the cardiac beat, also aid in giving rise to cerebral stimulation. Very small amounts of the other general stimulants, such as tea, coffee, betel nut, and the kola nut, have a rapid effect when taken by sipping. The influence is much more pronounced, and even a glass of cold water, slowly sipped, will produce a quick increase in the arterial press- ure and a stimulation of the circulation. Sim- ilar results may be obtained by stimulation of the nasal mucous membrane by the odour of volatile salts, such as carbonate of ammonium. The use of smelling salts is dependent for its restorative effects upon this principle. The cold bath is a highly valuable respira- tory and cardiac stimulant in cases of insola- tion, and thus induces a general stimulating effect. In these instances it exerts a tonic ef- fect, too, upon the peripheral nervous system, the brain, and the spinal cord. In asthenic conditions provoked by prolonged fevers or by other exhausting causes, the cold bath, judi- ciously employed, exerts a favourable influence by its stimulation of the vital functions. Rest- lessness is quieted, sleep may be induced, and delirium and prostration may be lessened by its use. The respiration and the circulation feel the influence of the stimulative process, the former being deepened and amplified, the lat- ter receiving a renewal of tone. In this in- stance stimulation is evoked by the calming and soothing sequel of the agent. The hot bath, also, by its sedative action, causes stimu- lation of the cardiac beat in a reflex way, and thus augments the energy of the system. Its good results are seen especially in atonic con- ditions of the lungs and kidneys and in some forms of heart disease. The local application of water in the form of sprays and douches and sheet baths induces a general stimulant effect which is of use in many nervous states. (For the indications and methods see under Hydriatics.) Dry heat, by affording a dilatation of the cutaneous and subcutaneous blood-vessels, ex- erts the influence of a general stimulant upon the organism. In cases of shock, whether or not it follows an operation, the application of hot-water bags, of heated sand, or of tin cases containing hot water to the sides and extremi- ties of the patient aids in keeping up the bal- ance of the circulation and in restoring the animal heat. In the algid stage of cholera and in asphyxia from immersion or from other causes, dry heat is valuable as a restorative having the subsequent effect of a general stim- ulant. In the treatment of all cases in which the temperature has fallen below the normal, dry heat in conjunction with two of the car- diac stimulants, atropine and digitalis, is pre- eminently indicated. In some manner not understood, opium may act as a supporting and stimulant agent in some forms of low fever and in conditions of STIMULANTS 226 adynamia from any cause. When there is vomiting and not enough food is retained to maintain life, opium is of service in tiding over the patient until such times as the func- tions are restored to the normal standard. In such cases, administered in small closes, it acts as a general stimulant, supporting the circula- tion, maintaining the heart and lungs, and keeping the mind clear. Electricity must be regarded as a general stimulant when its influence in restoring vital functions after deep narcotism or asphyxia is considered. After the cessation, or apparent cessation, of respiration in chloroform anaes- thesia, the faradaic current, applied to the phrenic nerve at the root of the neck, may renew respiratory movements. In asphyxia neonatorum and in impending apnea or in orthopnea, the faradaic current may evoke deeper and fuller breathing. Only in so far as electricity is of aid in stimulating the vital functions, however, can it be regarded as a general stimulant. The oxygen of the inspired air is one of the main stimulants which the body receives. It is as essential, too, as it is constant in its en- trance to the organism. Inhaled pure or as such, oxygen acts as a stimulant to the cardiac and vascular apparatus and produces a feeling of energy which is imparted to the entire sys- tem. The effects on the pulse are said to be transient, but the general exhilarating influ- ence remains as long as the oxygen is adminis- tered. In dyspnea of cardiac or pulmonary origin, whether the mind is clear or obscured, oxygen, given by inhalation, may help to take the place of the impaired movements of the lungs, furnishing a sufficient supply of the gas to last until the aetiological difficulty is over- come. Frequently it may arouse a patient from a light coma in the condition specified. Strictly speaking, only alcohol in its various forms, dry heat, and electricity should be in- cluded among the general stimulants. But it is very difficult to draw a sharp dividing line between those agents which stimulate the en- tire system and those whose influence extends indirectly to the entire organism through their action upon the cerebro-spinal axis and the vascular apparatus. Among these may be mentioned coca, coffee and caffeine, tea and thebaine, tobacco and nicotine, chocolate, wines of all kinds, ammonia and many of the salts of ammonium, ether and chloroform, and cam- phor. Many of these are cardiac stimulants and are referred to under Cardiac stimu- lants. It is of value in cases of general debility, in depressed conditions of the spinal cord, and in functional weakness of some of the internal organs to administer spinal stimulants. Where an inflammatory condition of the motor cen- tres of the cord exists, however, spinal stimu- lants are apt to do more harm than good. Little benefit can be expected from the use of these agents in paralyses of organic origin, but when a hemiplegia depends upon a toxic effect, as in lead poisoning, they are of a specially use- ful nature. The excellent results obtained from their administration in nocturnal enure- sis, in atonic retention of urine, and in loss of voluntary motion in groups of muscles are well known. When prolonged overwork or great excitement has caused mental and physical de- pression, some of the spinal stimulants are serviceable. All the spinal stimulants proba- bly act by increasing the excitability of the nerve cells in the spinal cord and thereby in- creasing the rate at which stimuli, particularly reflex impulses, are transmitted. Their influ- ence, like that of the general stimulants, ex- tends to the heart and circulation and in some part to the brain. The most prominent of the spinal stimulants is strychnine, and it may stand as a characteristic type of the group as alcohol does for the general stimulants. The- baine and brucine are next in their power of action, and others, of less importance, are ab- sinthe, ammonia, gelsemine, calabarine, and nicotine. In very large doses, also, opium, morphine, and atropine may call forth convul- sions of spinal origin, so that in this sense they might be called spinal stimulants. One of the most important groups of medi- cines in all departments of therapeutics is the class known as cardiac stimulants. Their use is essential and is indicated in many conditions of acute and chronic disease. In the treatment of shock from any cause, where there is weak- ness in the cardiac beat or depression of the cardiac ganglia or muscle, cardiac stimulants are indicated. In the prolonged course of an acute disease, infectious or not, where asthenia or adynamia supervenes, the cardiac stimulants are of use to support the patient or to carry him over a crisis. Profound collapse with depres- sion of the circulation and respiration, instances of threatened death from suffocation or drown- ing, and the shock from an anesthetic offer le- gitimate opportunities for the administration of stimulants for the heart. In the crises of pneumonia, when the right heart is working against tremendous odds, it is doubtful if we could dispense with the cardiac stimulants. Exhaustion from any cause, whether from dis- ease or from overwork, from great excitement or from prolonged emotional strain, demands the efficient and intelligent use of the medicines under consideration. There are two conditions, broadly speaking, which call for the use of cardiac stimulants. The first is convalescence from disease in which the heart, like other organs, has become de- pressed and weakened, and added to this indi- cation might legitimately be appended certain forms of heart disease in which the viscus is not properly fulfilling its function, and the weakness of old age. The second indication is, to generalize, any sudden failure of the cardiac apparatus or any group of symptoms pointing to an impending cessation of the heart's beat. The symptoms are so plain and so easy to be recognised that it is not necessary in this place to rehearse them. Suffice it to say that it does not matter what the aetiology of the heart's poor action may be, the use of stimulants in the conditions enumerated is urgently demand- ed. The cardiac stimulants properly included in the first group mentioned should, strictly speaking, come under the head of cardiac ton- 227 STIMULANTS ics, although their influence is first a stimu- lant, later a tonic one. They will therefore not be discussed here. (See under Cardiac tonics, vol. i, page 217.) The stimulants of the second group, however, come legitimately into this article. Alcohol stands foremost as a rapid and safe cardiac stimulant. In those instances in which it is used to prevent or to counteract sudden failure of the heart, it must be given in con- centrated form. Its most diffusible prepara- tions are whisky and brandy ; and to perform their work most quickly these should be ad- ministered subcutaneously. In cases in which the patient can not swallow the medicine, the alcoholic preparation may be given in the form of an enema ; but it is apt to be expelled from the rectum, for an unconscious or partly co- matose patient has little or no control over his sphincter muscles. In an emergency, alcohol is best given in small doses frequently repeat- ed, since its stimulant action is thus longer maintained. Its effect should be carefully noted, too, for it is apt to pro%re harmful rather than beneficial if it does not succeed in bring- ing the pulse nearer the normal standard in force and frequency. Moreover, it is clinically well established that large doses of alcohol may paralyze the cardiac muscle, and in some cases even a temporary reduction of the power of the heart may prove fatal. In combination with alcohol, ether forms one of the most reliable of heart stimulants, although its good effects in an emergency are as often obtained when it is used alone or with camphor. Ether must be given subcutaneously when it is given for its stimulant effect; or, rather, the injection must be made deep into the tissues. It is very prone to produce an abscess at the site of injection, but even this sequel would hardly be a formi- dable objection in the face of impending death. The field for which ether is particularly adapt- ed is that of the unexpected cardiac failure sometimes seen in chloroform anesthesia or even in ether narcosis. In Germany and Aus- tria it is chiefly depended upon as a cardiac stimulant, to the almost utter exclusion of other similar agents. In flagging of the heart evoked by a large or uncontrollable haemor- rhage, neither ether nor alcohol can be substi- tuted for an intravenous or intra-arterial saline infusion, than which there is no better stim- ulant for the heart. Particularly when the infusion is combined with the use of strych- nine is its effect upon the cardiac apparatus a strikingly stimulant one. A saline solution thrown into the rectum, if of the physiological strength, may accomplish beneficial results for the heart in instances of shock or haemorrhage. Even the injection of the same solution into the intercellular spaces, as in cases of suffoca- tion from illuminating gas, evokes a powerful cardiac stimulation. (See under Transfusion.) Ammonia has long been recognised as an efficient cardiac stimulant in collapse and in intoxications with cardiac depression. It may be thrown directly into a vein, or its vapour may be applied to the nasal mucous membrane, or it may be given subcutaneously, alone or in combination with an alcoholic preparation, Ammonia, like alcohol, is reflex in its action on the cardiac apparatus, and accomplishes its stimulation not only by its influence upon the heart, but by its effect upon the vaso-motor centres also. The best preparation of ammonia for this purpose is the aqua ammonie fortior (U. S. Ph.), or the liquor ammonie (Br. Ph.). Among the alkaloids which may be used in sudden cardiac failure, with results which vary, are atropine, strychnine, digitaline, and caf- feine. Of these, strychnine gives the greatest tone to the heart, while the others render its beat more efficient. The nitrites are excellent cardiac stimulants. While one is waiting for an effect from subcutaneous instillations, in- halations of nitrite of amyl will prove helpful in rousing a heart on the verge of collapse or failure. Nitroglycerin, hypodermically admin- istered, acts like nitrite of amyl in producing a lessening of arterial pressure with increase in the force and frequency of the pulse. Among agents not drugs which may be re- garded as reliable cardiac stimulants, heat, dry or moist, occupies a prominent position. A poultice or hot-water bag, placed over the heart, may be serviceable in time of emergency. The use of large quantities of hot water by the rectum or by the mouth will prove benefi- cial to the heart in hemorrhage especially. The impression upon a flagging or collapsed heart of counter-irritation, particularly the fre- quently repeated (sixty to seventy times a min- ute) pressure of the thumb over the praecordia, is to awaken its muscles and ganglia to re- newed efforts, and it may be satisfactorily em- ployed in sudden cessation of the beat of the heart during anesthesia. Some of the volatile oils also have a reputation as cardiac stimu- lants. Stimulation of a heart suddenly weakened demands, above all, rapidity. Hence the meth- od of evoking the stimulation should be, preferably, by subcutaneous or intravenous in- jection ; next, the rectum is to be chosen; and lastly, the mouth. T 'ascular stimulants, although closely related in their action to cardiac stimulants, are use- ful in preventing the congestion of internal organs by equalizing the visceral and periph- eral circulations. After exposure to cold and wet, for instance, a chill may be aborted and the subsequent congestion prevented by the use of a hot alcoholic drink combined with pe- diluvia. All agents which dilate the peripheral vessels may be regarded as vascular stimulants when they increase the vigour of the circula- tion in these vessels simultaneously. Such agents are the nitrites, ether, alcohol, dry or moist heat, and to a less degree ammonia. Stimulating expectorants are agents which increase the tone of bronchial mucous mem- branes which are over-secreting, and by so do- ing diminish the amount and improve the character of the expectorated material. Some of these act by increasing the blood-pressure, others by a direct action upon the mucous membrane. In this group should be included chloride of ammonium, the mineral acids, strychnine, benzoin, the balsams, licorice, sen- ega, terebene, and others of less importance. S'lXEOIIAS STRONTIUM 228 When the low pressure under which bile is secreted is interfered with, causing an ab- sorption of the biliary fluid or its partial sus- pension of secretion, hepatic stimulants are indicated. The condition of " biliousness " is so well known, even to the laity, that its de- scription is not needed here. The agents most frequently called into requisition to remedy this state are the mercurial and saline cathar- tics, the mineral acids, and some of the vege- table cathartics. The mere ingestion of food of the proper kind is frequently sufficient to call forth an abundant flow of bile. The stimulant diuretics have distinct indi- cations. When there is an accumulation of serous fluid in the tissues or cavities of the body, when the blood contains harmful toxic or metabolic products, or when the urine be- comes too concentrated, these agents are valu- able. If the excess of fluid is due to cardiac disease, digitalis and strophanthus, by their diuretic action, are of value. If the dropsy is dependent upon renal or hepatic influences, squill, uva ursi, buchu, or the potassium salts may be added. In febrile conditions, in which the solid elements of the urine are usually deficient and their retention is naturally harmful, the stimulant diuretics foster their elimination. For this purpose, and to in- crease the blandness of the renal secretion, the potassium salts, turpentine, caffeine, and ju- niper may be administered. The venous con- gestion of mitral and tricuspid disease and of chronic bronchitis may be relieved by the in- fluence of digitalis upon diuresis. For the de- tails as to all the agents used as stimulants, reference should be made to the separate arti- cles on those agents.—Samuel M. Brickner. STOSCHAS.—See Lavandula. STOMACHICS.—By some authors sto- machics are held to include all remedies that promote digestion, such as the digestive fer- ments, etc., but generally the name is restrict- ed to the aromatics and bitters (q. v.). STORAX, styrax (U. S. Ph.), styrax pre- paratus (Br. Ph.), styrax liquidus (Ger. Ph.), balsamum styracis, liquid storax, is a balsam extracted from the inner bark of Liquidambar orientate (seu imberbe). The tree from which storax is obtained re- sembles in appearance the maple or plane tree, is bushy, medium-sized, with smooth, lobed, stipulate leaves, and smooth, purplish-gray bark. It is indigenous to southwestern dis- tricts of Asia Minor, where it forms forests. Its range is a limited one, not extending to the north or to the islands of the Levant, The balsam is expressed from the inner bark which is scraped off with a sickle-shaped knife after the outer bark has been removed. The inner bark thus obtained is boiled in water from the sea, by which means a portion of the resinous matter is melted out and is skimmed off as it rises to the surface of the liquid. The boiled bark is next subjected to pressure in haircloth bags, with the addition of hot water, and a still further portion of the resin is ob- tained. The storax thus extracted is a soft, resinous compound, of honey-like consistence, and has a peculiar, balsamic, agreeable odour, and a pungent, burning taste. It is of a gray- ish-brown colour and contains a considerable amount of water, to which its opacity is due. The water separates after long standing or on heating, leaving a heavier, yellowish-brown substance which is more or less transparent. With age it improves in odour and hardens, though it always remains sticky. When pure, storax dissolves in alcohol, in ether, in chloro- form, and in most of the volatile oils. Storax is purified by melting and straining or by dis- solving in rectified spirit, filtering, and evap- orating the solvent. Among the more important constituents of storax are the hydrocarbon sty rot, or cinna- mine, C8H8, a thin, colourless liquid of fra- grant odour; storesin, CseHseOsi, an amorphous substance; cinnamic acid; and styracin, or cinnamate of cinnamyl, C9H702C9H9, a crys- tallizable substance with an agreeable hya- cinthine odour. When styracin in alcohol solution is treated with soda it is converted into cinnamate of sodium and cinnamalcohol, which latter is also known as styryl alcohol, or styrone, C9H10O, and is said to be an antiseptic and deodorizer. As found in the shops, storax is often adulterated with turpentine. As an internal remedy, storax is now but lit- tle used except as a constituent of the com- pound tincture of benzoin. It has been recommended, however, as a substitute for co- paiba, which it closely resembles in its action. It is said to be a useful expectorant in bronchial troubles, and has been highly spoken of as a rem- edy in diphtheria and in pseudo-membranous croup. In gonorrhea and also in leucorrhea it has been said to be equally efficacious with copaiba and less disagreeable to take. The dose is from 10 to 20 grains, two or three times a day. Storax is chiefly employed as an external remedy, and more especially in the treatment of scabies. Its effects are very similar to those of balsam of Peru, than which, however, it is said to be somewhat less efficacious. The two drugs may with some advantage be combined. They are both especially suited to cases in which the skin is tender, as in children, or is much inflamed and such strong remedies as sulphur, naphthol, and the like are too severe. The storax is usually applied in the form of a salve made with lard or vaseline or as a lini- ment made with olive oil. Unna used it with rape-seecToil as in the following formula : R Storax, ) , Rape-seed oil, \ each...... 10 Parts 5 Alcohol.................. 1 part. M. F The storax may be rubbed in pure or mixed with a small proportion of oil. It is but slight- ly irritating to the skin, and there is little or no danger from its absorption into the econ- omy. Unna reported nine cases of albuminous urine out of 124 cases of scabies treated with storax inunctions, but it is not improbable, as has been intimated, that the precipitate thrown down by heat and nitric acid in these nine cases, which was taken for albumin, may have 229 STOZCIIAS STRONTIUM been only a resinous deposit. The test of its solubility in alcohol was apparently not tried. In the treatment of scabies the inunctions should be preceded by a soap bath, after which the skin is allowed to become thoroughly dry before rubbing in the storax or its oily solu- tion. In simple cases two inunctions will usually suffice to effect a cure, and seldom are more than four necessary—one in the morning and one at night, for two days. Liquid storax is said to be a useful applica- tion in frostbites attended with ulceration. Edward Bennet Bronson. STRAMONIUM.—The leaves and seeds of Datura stramonium, or the thorn-apple, are both official. The official leaves, stramonii folia (U. S. Ph.), folia stramonii (Ger. Ph.), are the dried leaves of the plant. They have a heavy, strong narcotic odour and an unpleas- ant, bitter, nauseous taste. The dried ripe seeds, stramonii semen (U. S. Ph.,), stramonii semina (Br. Ph.), are bitter in taste and of an unpleasant odour when crushed. The leaves contain a small quantity and the seeds a large quantity of daturine. an alkaloid quite identi- cal with atropine. In the seeds there is also some hyoscyamine. There is very little difference in action be- tween stramonium and belladonna. The chief use of stramonium is as an antispasmodic in convulsive coughs and in asthma. It has been used as an anodyne in a few painful affections. In asthma it is taken by inhalation of the fumes of the burning leaves or ignited powder. Cig- arettes are made of stramonium for the use of asthmatic patients. A very good mixture for igniting and inhaling is one of 1 drachm of nitrate of potassium, \ drachm of chlorate of potassium, 1 drachm of stramonium, and 20 grains of ipecac. The leaves of Datura tatula have been employed as a substitute for those of Datura stramonium, the former plant con- taining the same alkaloid as the latter. [The dose of the powdered leaves is from 1 to 3 grains ; that of the extract of the seeds, extractum stramonii seminis (U. S. Ph.), ex- tractum stramonii (Br. Ph.), is from \ to \ a grain ; that of the tincture, tinctura stramonii seminis (U. S. Ph.), tinctura stramonii (Br. Ph.), is from 10 to 30 minims ; and that of the fluid extract, extractum stramonii seminis flu- idum (U. S. Ph.), is 1 minim. Stramonium ointment, unguentum stramonii (U. S. Ph.), is serviceable as a mild anodyne application in itching and burning affections of the skin, in painful hemorrhoids, in boils, in irritable ulcers, etc.]—Frederick Peterson. STREPTOCOCCUS SERUM.—See under Serum Treatment. STRONTIUM.—Three of the compounds of strontium, the bromide, strontii bromidum, the iodide, strontii iodidum, and the lactate, strontii lactas, are official in the U. S. Ph. Strontium bromide and strontium io- dide are used for the same purposes as the corresponding salts of potassium, sodium, and ammonium: in addition, the bromide has been observed to have a decided effect in re- ducing the amount of sugar lost in the urine in diabetes, and Dr. Carselli, of Palermo, has found it remarkably efficient in acute gastritis in doses of 10 grains three times a day, with or after the meals. It is said to stop the vomiting and lessen the pain, which it accom- plishes not only by a direct action on the nervous system, but also by acting as an anti- septic, thus arresting fermentation and reduc- ing flatulence. Mr. Anthony Roche (Lancet, September 26, 1896) thinks strontium bromide rather supe- rior to the other bromides in the treatment of epilepsy. He has used it, alone or in combina- tion with other bromides, in four cases. The patients were not cured, but they obtained much relief. In all the cases other bromides had been employed before, and the addition of the strontium salt seemed to be more beneficial. It has long been noticed, he says, that a com- bination of bromides acts more favourably than any one of them alone. It should be impressed upon the patient that he must take the medi- cine for a long period, whether it has at first a beneficial effect or not. Mr. Roche thinks the bromide of strontium well entitled to further trial. The treatment adopted by him, besides meeting any general indications, obtaining the best hygienic surroundings possible, and advis- ing a strictly vegetable diet with milk, is to give 20 grains of the bromide of strontium with from 5 to 10 grains of the bromide of am- monium or sodium night and morning, largely diluted with water. The dose of strontium is rapidly increased to a drachm twice a day if the smaller doses do not control the attacks, and if the patient does not complain of it. The majority of his patients, he says, took the strontium without any depression, but gener- ally with the production of an acne rash on the face. Liquor arsenicalis added to the mixture controlled the rash and increased the appetite. This course in all the cases mate- rially lessened the number of the attacks. The ordinary dose of the bromide is from 3 to 10 grains; that of the iodide is from 5 to 10 grains. Strontium carbonate has been recom- mended by Metral (Bulletin general de thera- peutique, October 30, 1895; Medical News, November 30, 1895) as a dentifrice. He gives the following formula for a tooth powder : B SI rontium carbonate, ) f each Flowers of sulphur, \ Essence of rose............... 6 drops. M. Strontium lactate has been used as an intestinal antiseptic and for the purpose of diminishing albuminuria in parenchymatous nephritis. Brouowski (Wiener medicinische Presse, September 13, 1896; British Medical Jour- nal, November 7, 1896) gives a preliminary account of the results of his clinical and ex- perimental investigations into its action upon the kidneys. His first experiments were upon rabbits, and consisted in the daily subcutaneous injection of a quantity equal to double the dose in proportion to the animal's weight. After a month one rabbit had gained 7 oz. in STROPHANTHIDIN STROPHANTHUS 230 weight, and the second 10 oz., while the third had not altered. They were perfectly well in every way, and after they had been killed the internal organs were found to be normal. The drug was then tried in ten cases of kidney dis- ease, three of which were acute parenchymatous nephritis, six mixed nephritis, and one inter- stitial nephritis. Six doses of 15 grains were given daily, and well borne. In all cases the volume of "the urine increased, and its specific gravity fell. This effect began on the second or third day, was most marked on the sixth or seventh, and persisted two or three days after the use of the drug had been discontinued. The action was most decided in acute cases, and was much slighter in the chronic forms; the albumin diminished pari passu with the increase in the urine. In acute cases it disap- peared entirely, but in chronic cases no dimi- nution was observed. The ethereal sulphates in the urine, by which the amount of intestinal putrefaction may be estimated, were unaffected, and there was no constant change in the pulse or blood-pressure. The antiseptic properties of lactate of strontium were tested upon a pa- tient with an intestinal fistula in the caecal region, and found to be extremely slight. The author concludes that strontium lactate is a pure diuretic, and is more valuable than any other remedy in the treatment of acute inflam- matory conditions of the kidney. Strontium lactate has also been found to aid the digestion in cases of dyspepsia due to an excess of hydrochloric acid in the gastric juice. It is essential that it should be pure and free from barium oxide. The dose is from 5 to 10 grains. Strontium phosphate has been recom- mended as a tonic in place of calcium phos- phate, in doses of from 10 to 30 grains. Strontium salicylate, according to Dr. Horatio C. Wood, of Philadelphia (University Medical Magazine, January, 1895), tends less to lower the arterial pressure than either sodium or ammonium salicylate. He has accordingly employed it in a large number of cases in amounts ranging from 15 to 120 grains a day. The result of these trials shows that in doses of from 5 to 10 grains, given after meals, the salt very commonly improves digestion, and the dose of 5 grains an hour after meals, in flatulent dyspepsia and in various conditions of tendency to fermentative changes in the alimentary canal, is a useful intestinal anti- septic, one that has seemed to give better re- sults than salol, naphthol, or any of the older intestinal antiseptic remedies. Dr. Wood says that it does not give rise to cinchonism so read- ily as the older salicylates, but may produce it in a pronounced degree. He has not tested it in acute articular rheumatism, but thinks it would be less efficacious than the ammonium salicylate. In muscular or subacute rheuma- tism, as well as in chronic gouty conditions with a tendency to digestive disturbance, Dr. Wood has found it to be a very valuable rem- edy, exerting the action of the salicylate upon the diathesis, and improving instead of injur- ing the digestion. It may be given in solu- tion, but it is best administered in capsules; a 5-grain capsule is of moderate size, and of these two or more may be taken at once. The taste of this salt is similar to that of the ordi- nary salicylates, but distinctly less offensive, so that, if 'it is preferred, it may be given in a weak solution. Strontium and caffeine sulphonate.— See Symphoral. STROPHANTHIDIN, STROPHAN- THIN.—See under Strophanthus. STROPHANTHUS (U. S. Ph.), semen strophantni (Ger. Ph.), is derived from the seeds of Strophanthus hispidus, a tropical climbing apocynaceous plant. Its main habi- tat is Africa, where it grows more abundantly in the heart of the continent than along the coast. A preparation of the seeds of the plant, known as ine or kombe, is used by the natives as an arrow poison, producing death by muscu- lar paralysis. The seeds have little or no odour, but an exceedingly bitter taste. The U. S. Ph. recommends this test for the purity of the seed, and it is of some importance since several va- rieties appear in commerce: " A decoction of 1 part of the seed to 10 parts of water is of a brownish colour and is not changed on the ad- dition of a solution of iodine, of ferric chlo- ride, or of potassium mercuric iodide." In 1877 Gallois and Hardy isolated from the seeds a principle, probably a glucoside, which they called strophanthin. It appears as white shining crystals ; but it is likely that this is a decomposition product, since Fraser, on more careful analysis, separated a glucosidal prin- ciple with different properties which he termed strophanthidin. This active principle of the seeds is imperfectly crystalline, is neutral in reaction, and has a very bitter taste. It is freely soluble in water, less soluble in alcohol, and insoluble in ether and in chloroform. The physiological action of strophanthus and its active principle have been studied by a number of observers, but unanimity of con- clusion has not been established in all par- ticulars. Upon the lower grades of animals, ine or kombe caused, in toxic doses, a tonic contraction of the heart terminating in an ar- rest of the beat, with death by syncope accom- panied by nausea and vomiting. The isolated heart of the amphibian is as susceptible to the drug as the organ of the uninjured animal. When the drug is brought into immediate con- tact with muscular tissue it acts at once as a muscular poison, and its influence is as marked and as immediate whether the muscle belongs to the striated or to the unstriated variety. A peculiar effect upon muscular tis- sue wrought by the drug is that the increase of tone which appears as its primary influence does not diminish ; but on the death of a muscle passes at once into a state of post- mortem rigidity. Since the reaction of the muscular tissue is, at the same time, acid, it would appear as if this state were due to the rapid development of myosin. The paralysis evoked by the contact of the poison with vol- untary muscular tissue probably extends also to the cardiac and respiratory muscles when it causes death. 23: Observers are not agreed as to the influence of strophanthus upon the circulation. The statement made by one experimenter that it in- creases the blood-pressure is as promptly denied by the next one. The bulk of evidence, how- ever, seems to be in favour of the proposition, and it is likely that the augmented blood-pres- sure is caused by the action of the drug upon the muscular walls of the arteries, like that which it exerts upon the heart muscle. The question of the diuretic value of stro- phanthus is as unsettled as that of its influ- ence upon the circulation. Some writers have asserted that in ascites especially the drug pro- duces marked diuresis; others contend that this influence appears only when there is ob- struction to the circulation in the heart. Csatary (review in the Centralblatt fur die ge- sammten Therapie, vol. v, 1887), after careful experimentation, affirms that in a perfectly healthy condition there is no diuretic action on the part of strophanthus. He finds that the toxic influence of the drug on the heart increases the force and frequency of the cardiac beat, and says this is the influence which evokes an elimination of fluids from the body. Further, he states, the normal or diseased condition of the kidneys plays no role in this diuresis. Cases have been reported of dropsy dependent upon cardiac disease with congestion of the kidneys and lungs which have been relieved by the administration of strophanthus. A fall in the number of beats of the heart is a usual result of the administration of stro- phanthus. The decrease depends upon the dose. Five drops of the tincture are said to have caused a fall of from eight to twelve beats a minute; twenty drops, a fall of thirty beats. In pneumonia the temperature is said to fall, sometimes one degree, with the de- crease in the pulse-rate ; but the respirations seem not to be similarly affected. The effect of strophanthus is quicker than that of digitalis, but is more evanescent. It seems to have no cumulative action, or very little. Its influence lasts for three or four hours, occasionally longer, when the dose must be repeated to secure a further effect. Despite the fact that its cumulative action is so rare. the tincture has produced poisonous symp- toms. In one reported case in which the drug was used for some cardiac disease, cyanosis and dyspnoea with pronounced cardiac dis- tress appeared and collapse followed. There was no pallor or vomiting, however, as in digi- talis poisoning. Evans (3Iedical News, June 16,1888) reports the case of a child who took 20 drops of the tincture. The face became flushed, the skin was dry and hot, and the pupils con- tracted and dilated alternately at very short intervals. The pulse-rate was 140, the radial pulse was full, and the heart-beat was vigor- ous. The sensorium was undisturbed. Uri- nary suppression for ten hours followed. Recovery ensued. The conclusions to be derived from a study of the writings on strophanthus may be summed up as follows: The drug, however administered, invigorates the heart muscle while dilating the cardiac cavities. The walls STROPHANTHIDIN 1 STROPHANTHUS of the arteries are also dilated and the arterial, but not the venous, pressure is probably in- creased by its use. The frequency of the heart beat and, naturally, of the pulse is reduced; the force of the heart is probably also diminished. A secondary effect is the regulation of the heart's rhythm. The drug is probably diu- retic, but not cumulative. Sometimes its use occasions nausea, vomiting, and diarrhoea. From a consideration of its physiological ac- tion, the indications for the use of strophanthus will be seen to correspond to those which call for the administration of digitalis. It may be given to tone the cardiac muscle in obstructive or degenerative valvular lesions of the heart when compensation is lacking or has not been fully established. It is especially useful in dis- ease, more particularly in stenosis, of the mitral valve without degeneration of the cardiac mus- cular fibre. Fraser, who has studied the drug more carefully than any one else, has asserted that the haemostatic power of strophanthus is much inferior to that of digitalis, and that its value in valvular disease of the heart depends upon the soundness of the muscular tissue of that organ. "When the heart muscle is im- paired, he says, strophanthus affords no more relief to the weakly-acting or overworked organ than digitalis. In any case of cardiac weak- ness strophanthus may be given with safety and its effect looked for in from half an hour to an hour. In cases of shock with impaired heart action, or in collapse or threatened syncope, it is a valuable drug. Given subcutaneously, the tincture is very irritating to the tissues, but its effect is rapid—more rapid than that of digita- lis—and in an emergency it may be so used, even if an abscess subsequently appears. It must not be forgotten that its influence does not last so long as that of digitalis, and when it is de- pended upon for cardiac stimulation, its em- ployment must be repeated. By some clinicians strophanthus is regarded as an excellent adju- vant to digitalis, although as a substitute for the latter it is not in high favour. It may re- place digitalis, however, in those cases of ex- cited heart action in which digitalis fails to evoke a sedative action, or when digitalis has been used for a long time without producing its usual effect upon the heart muscle. Digi- talis causes a diminution in the arterial tension as well as in the pulse-rate; strophanthus is capable of calling forth the latter phenomenon only. Strophanthus, because it does not con- strict the arteries while re-enforcing the energy of the cardiac beat, is useful in cases of cardiac dropsy when there is simultaneous congestion of the kidneys and lungs or of either. In ir- regular or insufficient heart action leading to edema of the lungs the drug may be given subcutaneously or by mouth with a decidedly good effect. Its diuretic action has caused its use with alleged good results in the treatment of renal calculi. In many forms of low fever with weak heart action strophanthus has been recommended. It has been praised as well in the treatment of pneumon ia. pulmonary tuber- culosis, asthma, and hemiplegia conditions. In the uremia of Bright's disease and the car- diac dyspnea attending the train of symptoms STRYCHNINE STYRONE 232 in the same disease, strophanthus is a valuable remedy. Bv its producing diuresis it aids in the elimination of the metabolic products cir- culating in the blood, and by its restoration of energy to the heart muscle it frequently suc- ceeds in effectively relieving the dyspnoea. Strophanthus is" alleged to have the power of aborting the so-called urethral chill consequent upon the passage of a sound; but in this re- spect it is probably inferior to quinine. After the administration of strophanthus malarial eh ills are said to be less rigorous, and nervous chills are alleged to lose much of their force. Because of its exceedingly bitter taste stro- phanthus has the effect of a simple bitter when taken in small doses. Since it has no cumula- tive action, its pronounced influence upon the heart need not be feared when it is given for this purpose; but there are so many drugs su- perior as stomachics to the one under consid- eration, that this tonic influence must be regarded as purely secondary ; it would not be well to give a medicine so intense in its action for purely stomachic effect. The tincture of strophanthus has been recorded as having cured a case of urticaria, but the " cure " was probably a coincidence. Success has been alleged for the drug in the treatment of exophthalmic goitre. For this purpose the tincture is given in doses of 2 drops every six hours, and the dose is gradu- ally increased to 10 drops. The good results reported are supposed to emanate from the se- dation of the cardiac action. Though one can not deny the reliability of these reports, since cases have been recorded in America and Aus- tria, it would seem that the relief of the heart's tumultuous action was regarded as a sign of cure. Children seem to be able to take strophan- thus in proper doses with no untoward effect, and some clinicians have preferred it to digi- talis when either was indicated. The toxic ac- tion of strophanthus is much more rapidly evolved than that of digitalis, however, and caution must be observed when it is adminis- tered to children. One must be prepared to combat poisonous symptoms, as evidenced by cold sweating and nausea, by appropriate symp- tomatic, stimulant treatment. The dose of the tincture, tinctura strophan- thi (U. S. Ph., Ger. Ph.). is, for an adult, from 5 to 8 drops three or four times daily. For a child the dose is 1 drop thrice daily. The tincture is best given diluted or flavoured with some syrup, since the ingestion of the pure tincture is apt to provoke irritation of the mu- cous membrane of the mouth, oesophagus, or stomach. It is well to begin with the mini- mum dose unless one is acquainted with the preparation, for it may be impure or of too great strength. When it is desired to obtain a very rapid effect of the drug, the tincture may be given hypodermically, although, as has been mentioned already, it may cause an ab- scess when so administered. There is an un- official extract of strophanthus. Strophanthin has been so little experimented with that great caution should be exercised in its administration. It seems difficult to obtain it chemically pure, and the dose has been vari- ously given as from fa^ to fa of a grain. Given hypodermically, strophanthin is a powerful ir- ritant locally, too irritating to be safely given in depressed conditions. When it is adminis- tered by the mouth it seems to produce the same physiological effects as strophanthus, one part to six million having caused systolic car- diac arrest in a frog. Locally applied, stro- phanthin is a more powerful anesthetic than cocaine. Three or four drops of a solution of one to one thousand instilled into the eye will produce complete anaesthesia of the ocular and palpebral conjunctivae that will last for several hours. The sensations of heat and cold are the last to disappear and the first to return. Al- though the glucoside does not appear to affect the conjunctivae unfavourably, it is apt to cause a cloudiness or even an ulcer of the cornea, probably by a hyperaemia induced by its irri- tant action. This, naturally, unfits it for the production of ocular anaesthesia. Peterson (Medical Record, January 31, 1891) has recom- mended the administration of strophanthin per- cutaneously by means of cataphoresis. For this purpose he uses the anode next the skin. moistened in a solution of strophanthin or a tissue-paper disc containing fa^ of a grain of the glucoside, with a current of from 5 to 8 milhamperes. No irritant action is evoked by this method of using the drug. [Dr. W. K. Wadleigh, of Hopkinton, New Hampshire (Medical News, March 14,1896), has found that among the aged strophanthus gives much better results in almost every condition than other remedies of its class. In old age, he says, we often find an atheromatous condi- tion of the arteries, and, although digitalis may not be positively contra-indicated, in all such cases it is very apt to do little good, and sometimes may even do harm. The vertigo of aged people, caused by cerebral anemia, or by a lack of balance between the different parts of the circulation of the brain, is a condition in which he has been able to do much good with strophanthus. His experience leads him to believe that strophanthus will produce bene- fit in a larger number of cases of angina pec- toris than any other single remedy. In general anemia and chlorosis, when accompanied by weakness of the heart, it not only gives great relief so far as the heart symptoms are con- cerned, but, by sending more blood to the tis- sues, increases their nutrition. It is often an advantage to combine it with nitroglycerin in anaemia. In the so-called irritable heart, char- acterized by palpitation on slight exertion, more or less pain in the region of the heart' often quite severe, and a weak, quick pulse] sometimes intermitting, but, with no organic disease of the heart present, savs Dr. Wadleigh we may give strophanthus with almost an ab- solute certainty of benefit from its use, and it will often cure the patients.] Samuel M. Brickner. STRYCHNINE.—See under Nux vomica. STUPES are cloths, sponges, or the like dipped into some fluid and wrung out to pre- vent dripping, and applied to some portion of 233 STRYCHNINE STYRONE the body. They are usually employed hot and for the relief of pain, to abort inflammatory processes, and in all conditions when poultices would be indicated, but are inconvenient to apply. Flannel is the most convenient fabric that can be used, and it may be of any shape that is most suitable for the part on which it is to be used. It should be dipped in as hot water as can be had, wrung out so as not to drip, and applied immediately, care being taken that it is not hot enough to burn sensi- tive parts. It should then be covered with a dry towel or cloth, and oiled silk or rubber cloth should be put over the whole. To pre- vent scalding of the hands in wringing out, the flannel may be placed in a towel, the too ends of which are to be twisted in opposite directions. When practicable, a hot-water bag should be placed next the flannel, so that the heat may be retained longer and the frequent renewal of the stupe avoided, which is the most serious objection to its employment. For the relief of all neuralgias of the head and face there is probably no simple measure which is so effectual. In all conditions such as colic, peritonitis, etc., when abdominal pain is severe, relief will usually be afforded, espe- cially if a few drops of oil of turpentine are sprinkled upon the flannel immediately before its application, but it is not to be used in too large amounts, as it may be absorbed and strangury result. Spirit of camphor may be substituted for the turpentine, and with bene- fit in many instances, for it will set up more or less irritation of the skin, as the plain water will if its use is continued for any length of time. Laudanum also is useful, and in acute affections of the air-passages may relieve the strong inclination to cough, especially when the stupes are applied over the front of the neck. A few grains of red pepper may be dusted on the flannel with the view of acting as a counter-irritant. Chloroform or ether will act as counter-irritants and also have a slight local anaesthetic action. Stupes of plain hot water may be useful to allay the pain of sprains, bruises, etc. They should not be em- ployed in acute affections of the chest, as it is necessary to renew them frequently, and the exposure attendant upon their removal should be avoided. For some hours after their use there may be a slight erythema of the skin. Russell II. Nevins. STYPTICIN—This is the trade name of cotarnine hydrochloride, C1aH13NO3.H2O.HCl. Chemically, says Dr. S. Gottschalk, of Berlin (Therapeuiische Monatshefte, December, 1895; Therapeutische Wochenschrift, December 22, 1895), cotarnine, which in combination with opianic acid forms the narcotine found in opium, is very closely related to hydrastinine. Cotarnine hydrochloride is comparatively non- poisonous and a very efficient hemostatic in gynecological practice. It is described as an amorphous powder, almost of a sulphur-yellow colour, readily soluble in water, forming a solu- tion which becomes cloudy on exposure to light. Dr. Gottschalk has given the drug by the mouth in doses ranging up to f of a grain five or six times a day. Subcutaneously, he has employed a sterilized 10-per-cent. watery solu- tion, and in cases of profuse metrorrhagia in- jected 3 grains (30 drops of the solution) deep into the gluteal muscles once a day. With a few patients who did not bear opium well, the drug appeared to act as a sedative and anal- getic, so that it was found particularly service- able in cases in which, together with uterine hemorrhage, there was dysmenorrhea. In this respect Gottschalk finds cotarnine superior to ergot and hydrastis, and he finds it also a suitable drug for protracted use. Cotarnine, he says, acts promptly in haemorrhages due purely to uterine subinvolution ; if, however, there are remnants of the ovum retained in the uterus, ergot and its preparations, in conjunction with hot irrigations, work better. He recommends cotarnine in haemorrhages due to fungous en- dometritis, especially if they are of ovarian origin, but only as a palliative. In hemor- rhages due to fibroids and in those associated with the climacteric cotarnine is of service, but in those that are secondary to parametric exu- dations it is inferior to hydrastis and hydras- tinine. In purely congestive menorrhagia, not dependent on organic disease, he has met with good results from the concurrent use of cotar- nine and hydrastis or hydrastinine. The rem- edy is powerless against haemorrhages that depend on the presence of polypous growths in the uterine cavity, no matter how small they may be. Cotarnine is contra-indicated in cases of threatened abortion, also in uterine haemor- rhages occurring in the course of pregnancy. It has not yet been definitively ascertained whether cotarnine acts on the walls of the blood-vessels or on the muscular tissue of the uterus. In cases of menorrhagia Dr. Gotts- chalk thinks the haemostatic effect of cotarnine is rendered more certain by giving it for four or five days before the flow is expected, but in reduced doses (not more than 0-035 of a grain), four times a day. As soon as the flow begins the doses are to be doubled. At the height of a profuse menstrual flow as much as 3 grains may be injected into the gluteal muscles, and this may be repeated for several successive days without any unpleasant result. For internal use, it is best to order cotarnine in pills or in gelatin capsules. When given by the mouth it acts more slowly than when injected into the tissues. STYPTICS.—See Hemostatics. STYRACOL.—This is the cinnamic ether of guaiacol, ^J^S)0' a ^^ line body. It is a powerful antiseptic and has been employed to some extent internally in gonorrhoea and in gastro-intestinal catarrh, but its use can not be recommended until further reports of its action are published. STYRAX.—See Storax. STYRONE.—This is a compound of storax and Peruvian balsam, a yellow, oily, aromatic liquid. Its agreeable odour commends it as an antiseptic and deodorizer. Dr. James A. Spald- SUCCINIC ACID SUGAR OF MILK 234 ing, of Portland, Maine (Archives of Otology, xx, 3), recommends its use particularly in cases of perforation of Shrapnell's membrane. Largely diluted with alcohol, so that the solu- tion contains from 1 to 5 per cent, of styrone, it may be used for syringing the auditory meatus. It reduces the amount of the dis- charge and overcomes its odour. SUCCINIC ACID, C4H604, is a colourless crystalline substance obtained by the distilla- tion of amber. Ammonium succinate has been used in medicine (see vol. i, page 58). SUCCINUM.—See Amber. SUCROL.—See Dulctn. SUDORIFTCS.— See Diaphoretics. SUET.—Mutton suet, sevum (U. S. Ph.), sevum preparatum (Br. Ph.), purified and ren- dered almost odourless by melting and strain- ing, is employed as a bland application (see Fats and Tallow). SUGAR.—The carbohydrates are organic compounds containing in the molecule six or a multiple of six atoms of carbon and about twice as many of hydrogen. They are divided into three general groups: saccharoses (da H220„), glucoses (C6H,306), and amyloses (C6Hi0O5). These groups are closely allied chemically, the first and third being readily converted into the second. They occur very widely distributed throughout the vegetable kingdom. The term sugar is applied to the saccharoses and glucoses, and in a more re- stricted sense to the saccharoses alone. The sugars have a more or less sweet taste and are very soluble in water. Chemically, they exhibit the properties of polyatomic al- cohols. Sugars, with one or two exceptions, possess the power of rotating the plane of polarized light. When this plane is rotated to the right they are known as dextrorotatory, and are represented by the mark +. When the plane is rotated to the left they are known as laevorotatory, and are represented by the mark —. The saccharoses all belong to the first class. Of the glucoses, diastase and galactose are dextrorotatory; levulose and sorgose are laevorotatory. Each element has a specific rotatory power peculiar to itself which is measured in degrees. By taking advantage of these properties very accurate methods of quantitative analysis have been devised. Saccharoses.—The chief saccharoses are saccharose, lactose, and maltose. Saccharose, saccharum (U. S. Ph., Ger. Ph.), saccharum purificatum (Br. Ph.), or cane sugar, C12H23O11, is the substance to which the term sugar is most commonly applied. It is found in the juices of most sweet fruits, in honey, in the nectar of flowers, and in the juices of many plants. It is derived chiefly from the sugar cane (Saccharum officinarum), from sorghum (Sorgho saccharatum), from beet-root "(Beta vulgaris), and from the red maple (Acer saccharinum). The juice of the sugar cane is obtained by expressing it from the stalk. By a somewhat intricate process, the crvstalliza'ble portions are removed. These, bcin"-'refined, form the ordinary sugar of com- merce. A brown liquid containing the un- crystallizable portions is left. This is known as molasses, treacle, or syrup. Cane sugar crystallizes in large transparent, double oblique prisms. It is soluble in half its weight of cold water, in one fifth of its weight of boiling water, and in 175 parts of alcohol, but is not soluble in ether. It melts at 220° F. If heated above this point it loses its water, becomes dark in colour, and forms a brown amorphous substance of a slightly bitter taste known as caramel. Strong sulphuric acid chars sugar and leaves a blackened mass. Dilute nitric acid oxidizes it into oxalic acid. Sugar forms a number of metallic compounds known as saccharates. By fermentative action sugar yields carbon dioxide and alcohol. In the open air sugar keeps indefinitely, and for long periods of time in concentrated solutions. It is readily decomposed, however, in dilute solu- tion by the action of several fungi, the yeast plant being the most common. It may also undergo acetic, lactic, and butyric fermenta- tion on the addition of specific germs. Sugar has very slight medicinal properties, but is largely used in pharmacy, chiefly in the form of syrups. Simple syrup, syrupus (U. S. Ph., Br. Ph.), is a 65-per-cent. solution of sugar in distilled water. The numerous medicinal syrups are made either directly from sugar or from simple syrup. They are used for a double purpose—to form a palatable vehicle and to preserve drugs in solution. Sugar enters largely into the composition of the various elixirs, a few tinctures, and some other preparations. It is an important element in troches. It is largely used in cough syrups, and is believed to have some effect in relieving cough. Honey, mel, is sometimes used for the same purposes as syrup. It contains a certain amount of glucose. As an article of food, sugar is used in enormous and steadily increasing quantities. It is largely used in the preservation of fruits and some other forms of food. Its excessive use is the cause of much indigestion and dys- pepsia, particularly among children and young adults, as it is prone to undergo acid fermenta- tion in the stomach. In the presence of sour milk it undergoes lactic fermentation with ex- treme rapidity. The addition of it to an in- fant's food may therefore do much to render any tendency to indigestion difficult of control. In diabetes it is necessary to prohibit its use entirely, although it is not the form of sugar which is found in the urine of these patients. [Sugar, either dry or in concentrated solution, may be used as an antiseptic application to wounds, ulcers, etc., in an emergency, when more energetic agents are not at hand. Sugar has been employed as an oxytocic. Dr. Bossi, whose account of his experience with it is summarized in the Revue international de bibliographic medicate, pharmaceutique et veterinaire for April 25, 1894, found that it answered the purpose well and was free from the inconveniences attending the action of ergot. In eleven cases of uterine inertia dur- ing labour an ounce of sugar dissolved in wa- ter was given, and in ten of them it had a most 235 SUCCINIC ACID SUGAR OF MILK favourable effect on the pains. The ecbolic action of sugar is said to be apparent in from twenty-five to forty-five minutes, and in many cases to be sufficiently prolonged to accomplish the expulsion of the child. In some of Dr. Bossi's cases it was found necessary to give a second dose of the same amount, an hour after the first one, in order to terminate the labour. The contractions excited by sugar are described as always perfectly regular, never taking on a tetanic character. (See under Oxytocics.)] Lactose, saccharum lactis, sugar of milk, CI2 H220ii.H20, is the saccharose obtained from whey. It is used largely in pharmacy and for the feeding of infants. For a more complete description see Sugar of milk. Maltose, malt sugar, C]2H220,i.II20, is formed by the action of the diastase of malt upon starch. It is the chief product resulting from the action of saliva and pancreatic juice upon glycogen and starch paste. It is soluble in water and in alcohol, but crystallizes with difficulty in fine needles. For a further de- scription of maltose, see under Malt. Glucoses.—The chief glucoses are dextrose, levulose, inosite, galactose, and sorbinose. Dextrose, or grape sugar, C6Hi206, usually passes under the name of glucose. It is widely diffused throughout the vegetable kingdom, and is found in the greatest amount in grapes, sprouting grains, honey, and sweet fruits. It is often found in the liver and blood of mam- malia, in the yolk of eggs, and in the urine of diabetics. It may be produced artificially by acting upon starch with dilute sulphuric acid. It is thus manufactured in enormous quanti- ties. Corn starch is chiefly used for this pur- pose. It is boiled with dilute sulphuric acid, then rendered neutral with lime, and the re- sulting liquid is drawn off and evaporated down to a syrup, which is allowed to crystal- lize. It crystallizes, however, with more diffi- culty than cane sugar does, and does not usually present the same crystalline appear- ance. It has much less sweetening power than cane sugar has, the proportion being as one to two and a half. Glucose readily forms com- pounds with many metallic salts, especially oxides, and is therefore considerably used as a reagent. It undergoes alcoholic fermentation with the greatest readiness, and is largely used in beer-making as a substitute for maltose. Glucose has no medicinal properties. Its value as an article of food is not wholly settled, but it is not regarded by the best authorities as entirely wholesome. It is believed that it may, if used in large quantities, predispose to diabetes. It is largely sold under the name of sugar, but fraudulently, as its sweetening power is far less than that of cane sugar, and in wholesomeness it is far inferior. It enters largely into the composition of molasses and syrups designed for food purposes, and is used in very large quantities in making candy. Levulose is closely allied to glucose. It dif- fers from it chiefly in being less fermentable, in its rotatory power, and in a few minor points. Its sweetening power, however, is less than that of glucose. When pure it is easily assimilated. 59 Inosite is a rare compound which has been found in small amounts in the muscles and in diabetic urine. Galactose resembles glucose very closely, but ferments less easily and has greater rotatory power. Sorbinose is a very sweet soluble sugar found in mountain-ash berries. Floyd M. Crandall. SUGAR OF MILK, saccharum lactis (U. S. Ph.. Br. Ph., Ger. Ph.), or lactose, Ci2H22On.H20, is the peculiar sugar derived from milk. It occurs in white, four-sided prisms, has a sweetish taste and gritty feel, and is soluble in seven parts of cold water. It is insoluble in alcohol, in ether, and in chloro- form. The sugar of milk of commerce is ob- tained chiefly from cow's milk by evaporating whey and crystallizing out the sugar. Cow's milk, according to the extensive observations of Leeds, contains from 3-5 to 55 per cent. of lactose, the average being 4-42 per cent. The lactose of cow's milk is usually stated as 4-5 per cent, The lactose of woman's milk, according to Leeds, varies from 5-4 to 7-9 per cent., the average being 7 per cent. The lactose of the two milks is iden- tical chemically, physiologically, and phys- ically. The carbohydrates in the food of adults are represented by starches and the va- rious forms of sugar. In milk they consist of lactose alone. Lactose in its chemical proper- ties is intermediate between cane sugar and starch. It occurs in larger quantity than any of the other solid constituents of human milk, forming more than half the total solids. As it is readily soluble, it is easily assimilated and requires but little expenditure of energy to ef- fect its transformation preparatory to diges- tion. In this it differs materially from starch. This is clearly a wise provision of Nature, as the infant can not maintain its animal heat by locomotion. Milk sugar readily undergoes lactic-acid fer- mentation, at least ten varieties of. bacteria be- ing known to produce that result. Butyric fermentation also takes place quite readily. It does not, however, ferment readily under the action of yeast. Until recently it was difficult to obtain per- fectly pure sugar of milk, but the largely in- creased use of it has resulted in improvements in the method of its manufacture. It can now be obtained practically pure and occurs as a. per- fectly white, transparent, crystalline powder. Its extreme hardness renders it admirably adapted for use in the trituration of drugs. It is now used for that purpose in the manufacture of Dover's powder and in nearly all triturations as well as the tablet triturates. In the manu- facture of these tablets the medicinal agent is triturated with sugar of milk until a thorough and complete division and complete distribution of it have been made. The resulting powder is then made into a paste with varying propor- tions of alcohol and water or other menstruum and afterward moulded into tablets. This method of administering medicine has become very popular during recent years. The medi- SUGGESTION SULPHONAL 236 cinal agent is thoroughly triturated and equal- ly divided, with a consequent perfect accuracy of dose. Most of the tablets containing drugs dissolve readily and are elegant in appearance. Sugar of milk is also considerably employed in the feeding of infants. It is almost universal- ly regarded by paediatric specialists as more satisfactory for this purpose than cane sugar. For further information see Milk, section on Infant feeding (vol. 1, page 633). Floyd M. Crandall. SUGGESTION.—See under Hypnotism. SULPHAMINOL is a thioxydiphenyl- amine prepared by E. Merck by boiling metoxy- diphenylamine with soda and sulphur, filtering, and precipitating with ammonium chloride. X S2 \OH. Its formula is given as | It is an odourless and tasteless yellow powder, insoluble in water, but readily soluble in alka- lies and less readily in their carbonates. Sul- phaminol is an antiseptic and is used chiefly as a substitute for iodoform in the topical treat- ment of wounds, suppurating surfaces, tuber- culous deposits, etc. It is unirritating and non-poisonous. Taken into the system, it splits up into sulphur and phenol. It has been used internally in cystitis in doses of 3f grains, four times a day. Sulphaminol-creosote, an 8-per cent, solution of sulphaminol in creosote, is used topically for the same purposes as sulphaminol. So also are sulphaminol-eucalyptol, sulphaminol-guai- acol, and sulphaminol-menthol. " Sulphaminol salicylate," a mixture of 8 parts of sulphaminol and 92 of salicylic acid, is employed topically like sulphaminol and given internally, in doses of from 3 to 6 grains, in rheumatism. SULPHANILIC ACID.-The sulphanilic acid used in medicine is one of three isomeric compounds of aniline made by heating aniline with fuming sulphuric acid. It forms tabular, prismatic, or laminar crystals which are almost insoluble in cold water, in alcohol, or in ether, but more readily soluble in hot water. Ehrlich has proposed the use of sulphanilic acid as a urinary test and also as a remedy for iodism. It may be given in daily amounts "of 90 grains, associated with sodium bicarbonate to facili- tate its solution in water. SULPHATES. — See under Sulphuric acid. SULPHIDES.—See under Sulphur. SULPHINIDE.—See Saccharin. SULPHITES.—See under Sulphurous ACID. SULPHOCARBOL.—See Aseptol. SULPHOCARBOLATES, or salts of sul- phocarbolic acid, a combination of equal weights of carbolic acid and strong sulphuric acid, are assumed to possess nearly all the medicinal properties of carbolic acid, but to exert less marked constitutional effects than the acid. Sulphocarbolates of calcium, mag- nesium, potassium, zinc, and sodium, sodii sul- phocarbolas (U. S. Ph., Br. Ph.), are found in the shops. With the exception of the last named, they are almost always used in solutions of varying strength as local applications in diph- theria, the sore throat of scarlet fever, amygda- litis, gonorrhea, and all conditions in which an astringent and feeble antiseptic is indicated. They are sometimes employed in vaginal douches in the puerperal state, and with good results. The zinc salt is probably the most useful in any of the conditions mentioned, as it has the greatest astringent power. The sodium salt is employed internally, in doses of from 10 to 30 grains, in flatulent dys- pepsia, in the vomiting of pregnancy, and whenever there appear to be fermentative changes in the alimentary canal, but, as a rule, it has not proved of great value. Russell H. Nevins. SULPHOCYANATES.—Martinotte (Ri- forma medica, February 13, 1896; British Medical Journal, April 11, 1896) has experi- mented with potassium sulphocyanate as a remedy for pulmonary tuberculosis, but defi- nite results have not yet been reported. SULPHONAL, sulfonalum (Ger. Ph.), or dional, is a synthetical product which was brought into notice in Germany in 1886 by Baumann, and now appears in the market as a semi-proprietary preparation. It is obtained by the interaction of anhydrous mercaptan and anhydrous acetone in the presence of a stream of dry hydrochloric-acid gas. The liquid becomes turbid and separates into two layers, the upper one of which is mercaptol. This is separated, washed, and oxidized by means of permanganate of potassium into sul- phonal, or, in chemical language, diethylsul- phondimethylmethane, (CH3)2C(S02C2.H6)2. It may also be" obtained by combining the chlo- ride or the bromide of ethyl with sodium thio- sulphate, treating the product with water to make ethyl mercaptan, which in the presence of alcoholic hydrochloric-acid solution and acetone is condensed to mercaptol, which is oxidized as before. It occurs in heavy colour- less, prismatic crystals, odourless and nearly or quite tasteless. Regarding its solubility in cold water, there appears to be considerable discrepancy of opinion, as various writers state that it may be dissolved in proportions from one to fifty to one to four hundred and fiftv. It is certain that it is not very soluble in cold water, but dissolves freely in hot water and also in alcohol. It is a very stable body, not affected by concentrated acids, alkalies, or oxi- dizing agents either in the cold or when warm. The physiological action of sulphonal is by no means perfectly understood, It would seem chiefly, if not wholly, to affect the cere- bral centres, and a large number of the symp- toms produced—such as somnolence, stupor disinclination to mental or physical effort' muscular weakness, inco-ordination and pare- sis, diplopia, aphasia, and slow and weak res- piration and pulse—may perhaps be explained by the theory that the irritability of the cen- tral nervous system is obtunded 'by its action SUGGESTION 237 SULPHONAL But this alone does not seem competent to explain other symptoms, such as the depres- sion of reflex activity, disorders of the digest- ive tract, and eruptions on the skin. Dr. Schick, of Easton, Pennsylvania, has investi- gated the physiological action of sulphonal by means of experiments on frogs and rabbits, and his conclusions may be quoted as the best data, on the whole, in our possession at the present time. He found that moderate doses produced relaxation of the muscles and a stag- gering gait, but did not affect the irritability of the motor or sensory nerve-fibres. Reflex activity was usually depressed, but was some- times exalted. In large doses it depressed the respiration, and this depression was not af- fected by section of the pneumogastric nerve. When it was introduced into the system through the stomach very little if any effect was produced on the circulation, and spectro- scopic examination failed to reveal any change in the blood, but when it was injected directly into the circulation it caused a slight decrease, soon followed by an increase in the arterial tension. Possibly this may be explained by the fact that when it is introduced into the stomach it acts very slowly because of its in- solubility or of its slow absorption, but when it is given subcutaneously in a warm solu- tion its effect appears much more promptly. The method of the elimination of sulphonal from the system cannot be said to have been satisfactorily determined. It has been said by some writers to be excreted in the form of combined or uncombined sulphuric acid, and it has been said that a certain amount of un- changed sulphonal could be found in the urine. The theory latest advanced by Smith, of Lon- don, based upon experiments made on dogs, is that in its passage through the system sul- phonal is broken up in such a way as to yield ethylsulphonic acid, and that this is eliminated in the urine. The same experimenter found that moderate doses increased the amount of urea and the quantity of urine excreted, but to so slight a degree that it does not appear that in such doses the destruction of nitroge- nous tissue is materially affected. The phos- phates in the urine are said by some observers to be increased by small and decreased by large doses of this drug. The colour of the urine is apt to be changed to a reddish brown by the presence of a colouring 'material which is closely allied to and has generally been sup- posed to be identical with haematoporphyrin. By almost every test the two are identical, but an examination with the spectroscope reveals a difference. It is not certain whether this substance is present in the blood or is formed during or after the process of excretion. Other pigments also are usually present in the urine. The effect of sulphonal upon the blood-cor- puscles is uncertain. Some observers say that they are reduced in number during the use of the drug, but others assert that this is an error. An occasional annoying result of its use is the occurrence of a rash on the skin, of pruritus, or of both combined. In the report of the therapeutic committee appointed by the British Medical Association to investigate the utility of various hypnotics, the disagreeable after-effects of sulphonal are thus summarized: "In six out of ten cases in which 20 grains had been given disagreeable after-effects were noted ; drowsiness next day was noted six times, giddiness four times, and headache and inco-ordination of gait each twice. In four cases where 10 grains had been given drowsiness was noted once; in five cases with 15 grains drowsiness was noted twice and giddiness twice; with 25 grains (four cases) drowsiness was noted twice, giddiness once, and headache once. In seven cases with 30 to 60 grains drowsiness was noted four times, giddiness twice, inco- ordination of gait and vomiting each once." Many other reports corroborate the frequent appearance of these symptoms, which may be termed mildly toxic, and it would seem as if a consideration of these and of the physio- logical action of sulphonal would cause the physician to exercise great care and discretion in its use, at least until the accumulated evi- dence of professional experience had demon- strated its action to be without danger. But such has not been the case. It has been loudly praised and highly vaunted as an absolutely safe hypnotic, and is still advertised as such, although there are numerous cases of death on record, some as the results of moderate doses. The most striking of these, perhaps, is reported by Pettit. A woman, twenty-eight years of age, who was suffering from melancholia with hysterical manifestations, but was not known to have any organic lesion, was given 30 grains of sulphonal in two equal doses an hour and a quarter apart. She slept for twelve hours and then could be roused and could swallow, but somnolence increased for the next twelve hours. The pupils began to contract eighteen hours after the last dose. At the end of forty hours the temperature began to rise, and the patient died in spite of active treatment such as is usually instituted in cases of narcotic poison- ing. Rehm reports a case in which the patient narrowly escaped death as the result of the ad- ministration of 18 grains for three successive days. The usual symptoms of poisoning ap- peared and finally resulted in a state of collapse marked by pallor, speech reduced so as to be hardly audible, a weak and rather rapid pulse, suppression of urine, hyperaesthesia, diplopia, meiosis, and inability to move. After the lapse of two weeks the patient could walk with difficulty. A very serious feature in most of the fatal cases of poisoning is that usually the patients have been under treatment for some time and have been apparently benefited by the drug up to the time of the appearance of the toxic symptoms. Such cases demonstrate that the drug is not so harmless as it has been alleged to be, even though it is not what one writer asserts—the most dangerous of the hypnotics. "The symptoms of poisoning are numerous and of varying degrees of severity, and may possibly be "explained as due to the action of the drug upon the nervous centres which main- tain a controlling influence over the parts of the SULPHOSALICYLIC ACID SULPHUR 238 body affected. They may be thus enumerated though all are not usually present in one case: Drowsiness, stupor, muscular inco-ordination, incapacity for mental or physical exertion, tin- nitus aurium, headache, vertigo, partial loss of the reflexes, nausea, vomiting, constipation, sometimes diarrhoea, ataxic nervous troubles, diplopia, muscular tremor or paresis, ptosis, oedema of the eyelids, slow and weak (possibly stertorous) respiration, slow pulse, elevation of temperature, general anaesthesia, urine changed in colour to reddish brown, diminished in quan- tity or suppressed, aphasia, and cyanosis. Death results from cessation of respiration. In sev- eral fatal cases motor paralysis appeared to be the most prominent symptom. Recovery is usually rapid in the non-fatal cases of poison- ing, if the patient is thoroughly purged and the changes in the urine disappear after two or three days. There is no agreement in the observations made after death from sulphonal poisoning as to the lesion produced by the drug. In several cases the kidneys have been pronounced nor- mal. Stern found extensive necrosis of the epithelium of the convoluted tubules and of the ascending limbs of Henle's loops, together with minute haemorrhages in the kidneys due to toxic nephritis. Helweg found the cells of the anterior and posterior horns of the spinal cord degenerated and their number dimin- ished. [Schulz (Neurologisches Centralblatt, Octo- ber, 1896; British Medical Journal, Novem- ber 28, 1896) records a fatal case of chronic sulphonal poisoning. The patient, a woman, aged fifty-nine, had been under treatment some years for headaches, constipation, and restless- ness, and was extremely hysterical. On ac- count of sleeplessness she had recently been taking sulphonal in doses of 15 grains, and had taken altogether about half an ounce within a month. When she was admitted into a hospital for obstinate constipation with vomiting there was a smell of acetone in the breath, the tongue was dry and furred, and there was great thirst, with restlessness and insomnia. All the organs otherwise were nor- mal ; the urine was normal. The next evening 25 grains of sulphonal were given, and on the following day the urine was scanty and brown- ish-red, but free from albumin. Four days later the gait was unsteady, and five days after this there were weakness of the limbs and anaesthesia of the legs down to the ankles; the knee-jerks, previously normal, were now diffi- cult to obtain. Weakness increased, the knee- jerks disappeared, incontinence of urine and faeces occurred, and two days later the patient died suddenly. The urine, after the single dose of sulphonal mentioned, had continued brownish-red with no albumin, but contained a few altered red blood-corpuscles. The colour was found to be due to haematoporphyrin. Schulz considers that the toxic results after only one dose of sulphonal were due to the ob- stinate constipation present, causing the sul- phonal to be retained in the body longer than usual. Great caution, he says, should there- fore be exercised in ordering sulphonal for patients who are constipated, and where it is ordered a careful watch should be kept of the urine for haematoporphyrin. Mr. F. P. Hearder (Lancet, November 14, 1896; New York Medical Journal, December 5, 1896) reports the case of a man, forty-three years of age, who, four months previously to his admission, on May 2, 1896, into the Wake- field Asylum, had hurt the back of his head in an accident; he had suffered much from shock, and had been very nervous afterward. Three weeks before his* admission he had cut his throat. On his admission the pupils were un- equal, the right being more dilated than the left, which reacted more perfectly. His knee- jerks were exaggerated, and there was slight ankle clonus. His superficial arteries were thickened and tortuous; the heart's action was irritable and irregular, and the sounds were accentuated, but there was no bruit. In the urine there was a copious mucous cloud ; it was acid, of the specific gravity of 1-022, and contained no albumin or sugar. His mental state was that of agitated or motor melan- cholia. He had a dejected and lacrymose expression, and he had aural and visual hallu- cinations and delusions that harm (murder, etc.) was happening to his mother and sister; he cried and prayed for their safety. During the next few days he continued restless and sleepless, needed forcible feeding, was con- stantly attempting to tear the bandage off his throat, and required continual supervision. A mixture of potassium bromide with chloral hydrate was given with no good effect, Sul- phonal was then tried (15 grains three times a day), administered in a warm drink, apparently with very good effect, as he took his food bet- ter, slept well at night, and was less restless during the day. On the fourth day his gait was ataxic and his expression and movements were like those of a drunken man. On the sixth day the urine was noticed to be becoming scanty and high-coloured. The use of sul- phonal was at once stopped and the urine ex- amined. It contained no blood and no albumin. On the following day there was marked oli- guria, about 5 ounces of urine having been passed in the twenty-four hours. The urine was of about the colour of porter which had been shaken; there was no deposit, it was acid, and of the specific gravity of 1-015. The amount of albumin was exceedingly copious, the urine, on being boiled, becoming almost solid. The patient was in a somewhat soporose state; there was slight oedema of the eyelids, but no swelling of the legs and ankles. The pulse was quiet and the temperature about normal. He was kept recumbent, a saline purge was administered, and a diuretic mix- ture containing citrate of potassium and ace- tate of potassium was given, with diluent drinks, milk and soda-water, and barley-water. On the following day the urine was still some- what scanty, high-coloured, acid, and of the specific gravity of P020, but it contained no blood or albumin. The patient was better and took food (fluid and semifluid) freely. After that he made considerable physical and mental improvement, but continued depressed. Sev- SULPHOSALICYLIO ACID 239 SULPHUR eral subsequent examinations of his urine re- vealed nothing abnormal.] Observers disagree in regard to the effects produced by suddenly stopping the use of the drug after it has been employed for a consid- erable length of time. Some assert that no ill effects are thereby produced, while others ascribe to its sudden withdrawal a condition which resembles that produced by the abrupt withdrawal of morphine in morphinism, marked by general weakness, digestive and motor dis- turbances, and vertigo. Sulphonal is slow in its action and is with- out doubt cumulative in the system. Hence when it is given daily for some time there is danger that it may cause toxic symptoms. This should be guarded against as far as pos- sible by care that the bowels are kept open and that the kidneys act normally and effi- ciently during its administration, as well as by its prompt discontinuance on the appearance of anorexia, nausea, gastric pain, or other dis- agreeable or toxic symptom. It is mainly employed as a hypnotic, and its use appears to be particularly indicated in cases of mental excitement or distress, over which it seems to exercise a distinct sedative action. Thus, in acute mania, melancholia, and de- lirium tremens, as well as in the milder forms of nervous insomnia, it induces sleep by night and quiet by day, a condition certainly condu- cive to the restoration of the mental equilib- rium. It is not an anodyne and does not re- lieve sleeplessness caused by pain. It has been used to relieve the paroxysms of asthma, hiccough, convulsions due to teething, and trismus neonatorum. Good results are said to have been obtained from its use as an adjuvant to other treatment in cases of chorea and epilepsy. On account of the relaxation of the muscles which is induced as one of its physiological effects, it has been found efficient to arrest spasm of the muscles of broken limbs and to relieve muscular cramps. It is one of the numerous remedies recommended as a means of prophylaxis against seasickness and the similar affection sometimes called " train- sickness." In phthisispulmonalis, 8 grains of sulphonal are said to be quite as competent as atropine to prevent night sweats equally and to exert this effect for a longer time. In diabetes it has been found to cause a diminution of the amount of sugar present in the urine, but to produce no permanent improvement, as the sugar increases to its former amount immedi- ately upon the withdrawal of the drug. Its use in typhoid fever, chronic opium poisoning, and nocturnal enuresis has not been sufficiently extensive to warrant the expression of any conclusion. Bad results have been reported from its use in angina pectoris, and it is now considered to be contra-indicated in this disease. It is difficult to determine the proper dose, not only because this differs with different persons, but also because it may vary at different times with the same person, so that the amount which at one time produced quiet, sound sleep from which the patient awoke refreshed may at another time be followed by unpleasant after- effects, or the expected soporific effect may be replaced by mental excitement, headache, and other nervous symptoms, or there may simply be a failure on the part of the drug to produce any hypnotic or other apparent effect, In any given case the amount to be given must be de- termined by the judgment of the attending physician, but the average dose may be stated as from 15 to 30 grains once a day or every alternate day. As a rule, men require larger amounts than women. Sulphonal is best administered in hot liquids about two hours before it is desired that the patient shall sleep. A good plan is to dissolve it in boiling water and to give it as soon as it has cooled sufficiently to be potable, flavoured if wished with a liqueur or cordial. Or it may be given in hot broth, milk, or coffee, and, as it is practically tasteless, it can thus be ad- ministered without the knowledge of the patient. In some cases it may be advanta- geously combined with small doses of codeine or morphine. (See also under Hypnotics [vol. i, page 509]).—Matthias Lanckton Foster. SULPHOSALICYLIO ACID, or salicyl- sulphuric acid, C6II3(SOsII)(OII)COOH, is pre- pared, according to Professor Coblentz, by the action of fuming sulphuric on salicylic acid, and forms white crystals which are soluble in water and in alcohol. It is said to have been employed in the treatment of rheumatism. SULPHOTUMENOLIC ACID. — See Tumenol. SULPHUR is a non-metallic element. It has an atomic weight of 31-98 and is variously bivalent, quadrivalent, and sexvalent. As it occurs in nature, it forms yellow, transparent, rhombic crystals. It is insoluble in water, slightly soluble in alcohol and in ether, but dissolves freely in carbon disulphide, in oil of turpentine, and in benzene. It gives forth a peculiar odour when rubbed and has a very faint taste. In nature it is found free and in combination with metals in the form of the sulphides in many ores, especially copper and iron pyrites. It is very widely distributed, al- though its most frequent occurrence is in vol- canic districts. Sulphur forms one of the constituents of the volatile oils of garlic and mustard and is found in albumins and other proteids. It is found in the Western United States, in Mexico, and in the West Indies, but the chief commercial supply comes from Italy and Sicily. Sulphur is popularly known as brimstone. The sulphur of commerce is obtained from the native ore by the action of heat, the sul- phur becoming volatilized. When this vapour is condensed, the sulphur is deposited as a fine, greenish-yellow powder with a slight charac- teristic alliaceous odour and a faintly acid taste from the presence of a trace of sulphur- ous acid. The sulphurous acid is formed by a slight oxidation of the sulphur. This form of sulphur is known as sublimed sulphur, sul- phur sublimatum (V. S. Ph., Br. Ph.), sulfur sublimatum (Ger. Ph.), or flowers of sulphur. It is slightly soluble in oils and in fats, com- SULPHUR 240 pletely soluble in carbon disulphide, and insol- uble in water. When ignited, it burns with a blue flame with the formation of sulphurous- acid gas, and should leave no ash. Washed sulphur, sulphur lotum (U. S. Ph.), sulfur depuratum (Ger. Ph.), is obtained by digesting the flowers of sulphur with dilute ammonia, washing thoroughly, and gently drying and passing through a strainer. Its characteristics are those of sulphur, but it is inodorous. The U. S. Ph. directs that on the addition of water blue litmus paper must not be reddened by washed sulphur. " ■ Precipitated sulphur, sulphur precipitatum (U. S. Ph., Br. Ph.), sulfur precipitatum (Ger. Ph.), is also known as lac sulphuris, or milk of sulphur. It is obtained by boiling sulphur with slaked lime and water, by which process cal- cium sulphide and calcium hyposulphite are formed. The addition of hydrochloric acid decomposes the salts, and the sulphur is pre- cipitated in a fine powder. To be official, this sulphur must be washed until it is tasteless, must be free from acid, and must give no re- action with oxalic acid for carbonate of calcium and water. Because of its extreme fineness, precipitated sulphur is white instead of yellow. Its other properties are like those of sulphur. The antiseptic and antizymotic action of sulphur has been known for a long time. Ap- plied locally in powder, it has the power of de- stroying fungi and other vegetable parasites on man and the lower animals. When ignited, it gives off dense fumes of sulphurous-acid gas which are known for their bactericidal action. The fumes of sulphur dioxide destroy the>germs of cholera, typhoid fever, diphtheria, glanders, and tuberculosis. The disinfecting qualities of the gas evolved by the burning of sulphur have been recognised by sanitary authorities, and it is the common practice to disinfect rooms that have been occupied by patients suffering from infectious or contagious disease by this means. The laboratory experiments of Squibb and those of Dubief and Bruhl (cited in New York Medical Journal, August 17, 1889) force one to the conclusion that the destructive action of gaseous sulphurous acid, S02, depends upon the moisture in the air aside from its own manifest bactericidal properties. Prolonged action of the pure gas may destroy germs even in a dry condition, according to these observers. To provide the desirable moisture in the air, a small kettle or vessel may be filled with water and heated previous to the disinfecting process, and the articles of furniture and the walls may be moistened with water or some disinfecting solution. All apertures into the room should be closed to prevent the escape of pungent gas ; if necessary, the frames of the windows and doors may be stuffed with rags or cotton. Not less than 3 pounds of sulphur to each 1,000 feet of space must be burned. The powdered snl- phur or fragments of the element should be laid in a pan which rests on a support in a tub of water to prevent fire. In order to hasten the combustion of the sulphur it maybe moist- ened with alcohol. This is the method in vogue with the board of health of New York city, and it seems to meet every requirement after the occupancy of a room by a patient sick with an infectious disease. Ships which have carried passengers suffering from cholera, yel- low fever, or typhus fever may be disinfected in the same way. Koch and Sternberg have shown that the spores of the anthrax bacillus are not killed by fumigation with sulphur, and that it can not be used successfully for the disinfection of clothing or bales of rags, be- cause the gas is lost by diffusion. Taken internally in doses of from 20 to 40 grains, sulphur produces soft stools. The fla- tus, after such a dose, smells strongly of sul- phuretted hydrogen, H2S. If the dose is repeated several times at short intervals, the odour of sulphur is given off by the breath and by the skin. Silver articles worn next the body are blackened, and the linen worn by the patient becomes yellow. Sulphur has also been found in the urine and milk after its ad- ministration. As sulphur is a constituent ele- ment of all albuminous bodies, it seems to be necessary to the animal economy for physiologi- cal purposes. Taurocholic acid contains the element, and it is believed that sulphur stimu- lates the bile-producing function of the liver. Poisonous effects have been observed from the ingestion and from the external use of sul- phur. These symptoms have manifested them- selves in nausea, dysentery, tonic contractions of the muscles of the extremities, the appear- ance of fever, and painful urination. In one case there were extreme prostration, a sulphu- rous breath, clammy perspiration, vomiting and purging, and intestinal colic. Sulphur ap- plied as an ointment is easily absorbed from the skin, and its possible poisonous action must be guarded against. Internally, sulphur may be given as a sim- ple laxative in doses of from 30 to 60 grains. It is especially valuable after pelvic or abdomi- nal operations, because of its depleting yet gentle action. On account of the soft stools it produces, it is useful also in piles. To con- ceal its taste, which is disagreeable to some patients, it may be administered in syrup, in milk, in molasses, or mixed with honey. Small doses of sulphur have an alterative effect, and in cases in which digestive disturbances are due to disordered or suspended hepatic func- tion sulphur may evoke good results. As an alterative the dose is from 5 to 20 grains. In colic due to impaction of a gallstone, or of any hepatic origin, daily doses of 5 grains tend to alleviate the symptoms. In cases of chlo- rosis, when iron is not well borne or has failed of its effect, sulphur may be given in alterative doses. As a stimulant to the bronchial mu- cous membrane in chronic bronchitis, sulphur has some reputation. The formula of Germain See is given here: R Precipitated sulphur........ 50 grains; Extract of belladonna leaves.. 1 grain ; Powder of ipecac and opium. 5 grains; Sugar...................... 20 " M. Make 10 capsules. Use from 2 to 10 capsules a day. In cystitis and in pyelitis of tuberculous or calculous origin sulphur has been recommend- 241 SULPHUR ed and its use has been praised in the treat- ment of derangement of the menses. It has been alleged for sulphur that it relieves the muscular pains in gout and rheumatism. Com- bined with iodine, the iodides, or arsenic, it seems to produce beneficial results in rheumat- ic arthritis. The natural sulphur baths have long been reputed to be of benefit in rheuma- tism and gout, and in these ailments the warm baths seem productive of most good. For skin diseases it is likely that partial douching of the affected parts is more effectual than total immersion. The mineral waters containing sulphur are good as laxatives, since they usu- ally contain the earthy and alkaline sulphates. In muscular rheumatism sulphur has had some use, but it is of doubtful value. What is known as balsamum pulmonum is a solution of sulphur in linseed oil to aid in the expec- toration of a chronic or acute bronchitis with profuse sputum. In habitual constipation, hemorrhoids, and rectal hemorrhages Garrod advises the employment of a lozenge contain- ing 5 grains of precipitated sulphur and 1 grain of cream of tartar. In skin diseases sulphur may be given for its tonic effect, and in dis- eases of the nails its use seems to be indicated to supply the element to those organs. Externally or locally, the most efficient em- ployment of sulphur is in the treatment of scabies. The agent destroys the path of the acarus and, as a sulphide, probably kills the parasite and its eggs. In the treatment of this parasitic disease the ordinary ointment of sul- phur or the alkaline ointment may be used; it makes no difference in the result whether the element is used alone or in combination with alkalies, the main thing desired being the application of the sulphur to the diseased area. Hebra's perfected formula is here ap- pended : R Flowers of sulphur, > ea(?h g Oil of cade, ) Greensoap, ) h.......... ^ Lard, \ Chalk....................... 4oz. M. Before the application of this or a similar oint- ment the skin must be washed with soap and warm water. One inunction is made daily for a week, the clothing next to the body remain- ing unchanged. After seven days the patient should take a full bath and be inspected. Too vigorous use of the sulphur ointment may pro- voke a dermatitis which may be difficult to cure. An ointment containing sulphur has been recommended for a host of other skin diseases, among them acne, alopecia areata, sycosis, psoriasis, and tinea versicolor. In the first and last of these a treatment combining the application of an ointment and the use of sulphur baths is said to be particularly effica- cious. Tinea tonsurans is said to be amenable to cure by the use of a sulphur ointment after the clipping of the hair. The fumes of burn- ing sulphur are reputed to be beneficial in the treatment of inveterate forms of eczema, psori- asis, impetigo, and prurigo. For this method of treatment the patient's body, except his head, is inclosed and subjected to the sul- phurous fumes. The fumes of sulphur, like so many other agents, have been alleged to relieve the parox- ysms of whooping-cough. Amenorrhea of functional origin and rheumatic and scrofulous affections have been known to yield to the fumes of burning sulphur. Care must be taken when the agent is thus employed that a dermatitis does not arise. Applied in the form of a powder, sulphur has been used since the days of Pliny as a rem- edy for lumbago. It is said to be efficient in the treatment of sciatica and of other periph- eral nervous disturbances. Sulphur ointment, spread over the body in cases of erysipelas, measles, and small-pox, is said to allay the heat of the skin and the cutaneous congestion and, in the last-named disease, to disinfect the pus- tules. Before the days of the specific treatment of diphtheria the insufflation of powdered sul- phur was in high favour in the treatment of this disease and of croup. Baumler, of Frei- burg (cited in Practitioner, August, 1894), says that in diphtheria, judging from his observa- tion in a large number of cases, sulphur is better as a local application than any of the other agents he has used. Sublimed sulphur, applied with a camel's-hair brush every two or three hours or insufflated an equal number of times, has uniformly given good results in his experience. To be of service it must be applied thick. Even in cases of gangrene of the uvula and of part of the soft palate he has observed an improvement in a few days. He adds that this method of treatment is best when the disease is confined to the fauces, but urges the insufflation of sulphur in cases of laryngeal diphtheria. In the treatment of tuberculous joints and of tuberculous osteomyelitis sulphur has been used with excellent effect, applied as part of the dressing. In infectious bone processes, whether of tuberculous aetiology or not, an emulsion of sulphur and glycerin may be injected into the cavity and allowed to remain for twenty-four hours, with satisfactory results. Ulcerative stomatitis yields to the local appli- cation of sulphur. At a meeting of the Royal Medical and Chirurgical Society of London Mr. Lane reported the results of a year's expe- rience with the use of sulphur in surgical prac- tice (cited in Medical News, January 19, 1895). He found that neither sulphur nor its by-prod- ucts had a deleterious influence upon the life or health of a patient. Its contact with re- cently incised healthy tissues for twenty-four hours sufficed to render the parts free from organisms. Advantageous results accrued from the local application of sulphur to parts poorly supplied with blood or already in a state of gangrene. In these instances the sulphur may be left on for a longer period of time. The same statement applies to granulating surfaces. Sulphur, says this author, destroys all organisms, whether"free in a cavity or lying in the surrounding tissues. Finally, the action of sulphur is painless, says this surgeon. An ointment, unguentum sulphuris, is prepared SULPHURIC ACID SUPPOSITORIES 242 by the direction of the U. S. and Br. Ph's, the former consisting of 30 parts of sulphur and 70 of benzoinated lard, that of the latter contain- ing 20 parts of sulphur and 80 of benzoinated lard. The Br. Ph. also recognises a confectio sulphur is containing 4 oz. of sublimed sulphur, 1 oz. of powdered acid potassium tartrate, 4 fl. oz. of syrup of orange peel, and 18 grains of powdered tragacanth. Sulphur iodide, sulphuris iodidum (U. S. Ph., Br. Ph.), is a local stimulant and caustic. It is sometimes used topically in the treatment of skin diseases accompanied with infiltration. The Br. Ph. authorizes an ointment, unguentum sulphuris iodidi, consisting of 5 parts of sul- phur iodide, 15 of solid paraffin, and 55 of vaseline. Bousquet (Presse medicate, July 15, 1896) suggests its employment as an anti- septic. There are many preparations which contain sulphur or its derivatives. Thus, compound licorice powder, which is official, contains 8 per cent, of washed sulphur; ichthyol is rich in the element under consideration. Potassa sulphurata, sulphurated potassa, is official in the U. S. Ph. It is prepared by the simultaneous heating of carbonate of potassium and sulphur. It is brownish in colour and has a most disagreeable, alkaline taste. Locally, potassa sulphurata is a powerful irritant; taken internally, it produces symptoms of irritation in the mucous membranes with which it comes in contact. It is employed in stimulating ointments in skin diseases of a scaly character and may be used to make sulphur baths, the strength varying from 1 to 3 oz. of the prepara- tion in 15 gallons of water. Employed in too great strength, the baths produce dermatitis. The baths have been recommended in rheuma- tism. Calx sulphurata (U. S. Ph., Br. Ph.), calcaria sulfurata (Ger. Ph.), or calcium monosulphide, is a pale-gray powder with a nauseous alkaline taste. It decomposes on exposure to the air. It is sparingly soluble in water. The drug has had a wide use, based on reliable clinical re- ports, in the treatment of suppurative diseases, of boils appearing in successive crops, and of glandular enlargements due to tuberculous invasion. The dose is from fa to \ of a grain, frequently repeated. This preparation is some- times wrongly called " calcium sulphide." [The action of the sulphides and that of sul- phuretted hydrogen are essentially that of sulphur.]—Samuel M. Brickner. SULPHURIC ACID, acidum sulphuricum (U.S. Ph., Br. Ph.), acidum sulfuricum(Grer. Ph.), is a highly corrosive liquid of an' oily appear- ance, employed largely in the arts and to some extent in medicine. On account of the frequency with which it is met with it is often the cause of severe burns of the surface of the body and of death when accidentally taken internally. The symp- toms caused by it do not differ essentially from those due to other corrosive substances, but, as a rule, the parts with which it has come in contact are blackened and charred. Magnesia, lime, and soap are the appropriate chemical antidotes, but to be of avail must be adminis- tered promptly. As an escharotic, sulphuric acid is hardly to be preferred to nitric acid, as by itself it penetrates deeply and is not easily controlled. Combined with charcoal (Ricord's paste), asbestos (Michel's paste), saffron (Vel- pcau's paste), or zinc sulphate, it is more man- ageable and may be used in the treatment of chancres and other superficial lesions requiring cauterization. A liniment containing about 1 part of the acid to 3 parts of olive oil is a de- cided counter-irritant. Diluted sulphuric acid, acidum sulphuricum dilutum (U. S. Ph., Br. Ph.), acidum sulfuricum dilutum (Ger. Ph.), and aromatic sulphuric acid, acidum sulphuricum aromaticum (U. S. Ph., Br. Ph.), are practically of the same strength and are adapted to the same purposes, the latter, however, being rather more agreeable to the taste, as it contains small amounts of ginger and oil of cinnamon. When the action of a mineral acid is desired in disturbances of digestion it is not advisable to employ sulphuric acid, as, although it may afford temporary relief, its prolonged use is followed by interference with the functions of the gastric juice. The same may be said of its employment in fevers. In such conditions hydrochloric or nitrohydrochloric acid is pref- erable. It is, however, of decided value in the treat- ment of nearly all forms of diarrhea, provided the dose is not large, especially when combined with opium or carminatives, and it is particu- larly useful in Asiatic cholera and the diar- rheas prevalent during an epidemic of cholera. In the latter conditions small doses, from 3 to 5 drops, of the diluted varieties may be given every half hour until a beneficial action has been observed. As a prophylactic against cholera, it is usually held in high esteem. Per- sons exposed to the contagion may drink freely of a 1- or 2-per-cent. solution, which may be sweetened if it is desired. In the treatment of colliquative sweating sulphuric acid is sometimes employed with good results, and also in hemorrhages of vari- ous kinds. The cathartic properties of magnesium sul- phate are increased by its combination with this acid. The dose of either the aromatic or the plain diluted acid is from 10 to 30 drops, well diluted. [A somewhat stronger preparation is the modern form of Halter's acid elixir. The mixtura sulfurica acida (Ger. Ph.), mistura sulphurica acida (N. F.), consists of 1 part of sulphuric acid and 3 parts of alcohol. The dose is from 5 to 20 drops.] Sulphates, or combinations of sulphuric acid and bases, are, as a rule, freely soluble in the ordinary menstrua, and are generally more or less astringent. The sulphates of the or- ganic bases are usually soluble in water, and those which are not are rendered so by a small amount of sulphuric acid, a soluble bisulphate usually resulting. The alkaline sulphates are cathartic, while those of the metallic bases de- pend upon the metal for their therapeutic ac- tion.—Russell H. Nevins. SULPHURIC ACID 243 SUPPOSITORIES SULPHUROUS ACID, acidum sulphuro- sum (U. S. Ph., Br. Ph.), is a 6-4-per-cent. solu- tion of sulphurous-acid gas (sulphur dioxide) in water. It is a colourless liquid having the odour of burning sulphur. It should be kept in dark amber-coloured, glass-stoppered bot- tles in a cool place and away from the light. It is an energetic antiseptic and germicide. It is chiefly used as a topical application in cases of tinea versicolor. The undiluted solu- tion may be rubbed on the affected skin once or twice daily; if it is to be applied continu- ously, it should be diluted with three or four times its bulk of water. Internally, the acid has been used to some extent in the treatment of fermentative dyspepsia and hay fever. The dose is from J to 1 fl, drachm, largely diluted. The sulphites are more suitable for inter- nal use than the acid, since they give off the acid in a nascent state in the stomach. They may be given, dissolved in an abundance of water, in daily amounts of 15 grains. The sodium compounds, sodii sulphis (U. S. Ph., Br. Ph.) and sodii bisulphis (U. S. Ph.), are most commonly used. A 10-per-cent. solution of sodium sulphite has been employed as an antiseptic SUMACH BERRIES.—See Rhus glabra. SUMACH, SWEET.—See Rhus aro- matica. SUMBUL(U.S. Ph.), sumbul radix (Br. Ph.), or musk-root, is the root of Ferula Sumbul, an umbelliferous herb indigenous to the moun- tains between Russian Turkestan and Bu- charia. Sumbul is a stimulant to the nervous system, also a tonic. It has been used in cholera, in asthenic diarrhea and dysentery, in delirium tremens, in hysteria, in neuras- thenia, and in chronic bronchitis. The dose of the powder is from 2 to 8 grains; that of the tincture, tinctura sumbul (U. S. Ph., Br. Ph.), is from 10 to 30 minims. There is a non-offi- cial extract, the dose of which is a grain. SUPPOSITORIES.—These are solid bodies intended to produce a local action by the grad- xial liberation of some active constituent held in solution or suspension in a medium which fuses more or less slowly at the temperature of the body. According to the place of applica- tion, suppositories are of various shapes and sizes. Rectal suppositories are usually of a conical or double-cone shape and should weigh about 15 grains. Vaginal suppositories are globular, and should weigh about 45 grains. Urethral suppositories are pencil-shaped, and should weigh about 15 grains. Suppositories are usually made with cacao butter as the base. Frequently, also, a mixture of gelatin and glycerin is used. Suppositories may either be rolled by hand, cast in moulds, or formed by pressure. Rolled or hand-made suppositories are pre- pared bv grating or scraping the required quantity" of cacao butter into a mortar, then adding the prescribed amount of medicinal substance, either in fine powder or in the form of a smooth paste, and mixing the whole thor- oughly to a sort of pill mass, which is then rolled out to a cylinder. This is cut into the intended number of pieces, and each piece then rolled into a cone. To prevent adhesion, particularly in warm weather, the mass must be rolled in lycopodium or some other neutral powder. Moulded or cast suppositories are prepared by melting the necessary amount of cacao but- ter and incorporating with it the medicinal ingredient either in powder or in the form of paste, or in solution in some liquid which will mix with the cacao butter (such as oleic acid, olive oil, etc.). The moulds having been pre- pared by carefully cleaning and wiping them with an oily cloth, they are filled with the melted mass, which must be not too far from the congealing point. It is best to fill them to overflowing, as the mass shrinks a little in the centre of the base on cooling. And if the medicinal constituent is a heavy powder, the mass must be constantly stirred in the capsule from which it is poured. The moulds are then placed on ice and, when the suppositories are sufficiently set, freed from the excess of adhering mass, whereupon the suppositories are removed. Pressed suppositories are prepared in special hand-machines. The mass is made in the usual manner and introduced into the apparatus, where it is allowed to set. By means of cer- tain pistons or plungers the mass is then forced into moulds by pressure. Yarious ma- chines are in use for this purpose, but they all work on the same principle. In warm weather, or when too-much of a soft or liquid mass is to be incorporated with a given amount of cacao butter, some wax or spermaceti must be added to give consistence to the mass. This addition, however, must be carefully adjusted to the circumstances of the case. The melting point of the mass should never be higher than 95° F. For a number of years past some firms have put various sizes of ready-made hollow sup- positories on the market, which are intended to be filled with the medicinal mixture. They are very convenient, but care must be taken that the filling is of the proper composition, so that when the outer mantle is melted off the intended action upon the mucous mem- brane may take place in the manner desired. For urethral suppositories, or bougies, gela- tin is usually preferred, as it is not so likely to break or crumble while being introduced. Gelatin of the best quality is soaked in water until it has been softened, and the excess of water is poured off. For every 12 parts of soft gelatin 5 parts of glycerin are added, the mixture is melted in a water-bath, the medic- inal substance is then added, and the mass is poured into a suitable mould or into glass tubes the interior of which has been coated with oil. When the mass has been thoroughly cooled it may be removed from the glass tubes by means of an oiled glass rod. The U. S. Ph. gives only one working for- mula for a special kind of suppository, but gives general directions for all others. Glyc- erin suppositories are directed by the U. S. Ph. to be made in the following manner: 3 grammes of sodium bicarbonate are to be dis- SUPRARENAL CAPSULE 244 solved in 60 grammes of glycerin in a capsule on a water-bath ; then 5 grammes of stearic acid are to be added, and the whole carefully heated until this is dissolved, and no more carbonic- acid gas escapes. The mass is then to be poured into suitable moulds, so as to produce ten suppositories. When they are set, each should be wrapped in tin foil and introduced into a glass tube to be corked at each end. Dieterich recommends preparing glycerin suppositories by mixing 90 grains of finely powdered stearin soap with 3 oz. of glycerin, heating until solution has been effected, mak- ing up any loss by evaporation of water, and then casting in moulds. This quantity is in- tended for from twenty-five to fifty supposi- tories. (Cf. Cacao butter.) Charles Rice. SUPRARENAL CAPSULE.—The su- prarenal capsule and an extract prepared from it have been further used since the article on Animal extracts and juices was written, and various observers have published accounts of their experience. In a communication pre- sented to the Physiological Society, of London, on March 16, 1895 (Journal of Physiology, April, 1895), Dr. G. Oliver and Professor E. A. Schafer referred to some earlier experiments showing that when an extract, whether pre- pared with water, alcohol, or glycerin, of the suprarenal bodies of the calf, sheep, or dog was injected—even in very small quantities— into a vein in a dog or a rabbit the following pronounced physiological effects were produced in a few seconds: 1. Extreme contraction of the arteries, which was shown to be of periph- eral origin. 2. A remarkable and rapid rise of the arterial blood-pressure, which took place in spite of powerful cardiac inhibition, and be- came further augmented when the vagi were cut. 3. Central vagus stimulation, so pro- nounced that the auricles came to a complete standstill for a time, although the ventricles continued to contract, but with a slow, inde- pendent rhythm. 4. Great acceleration and augmentation of the contraction of the auricles and ventricles after section of the vagi, the au- ricular augmentation being especially marked. 5. A slight change in the respiration, which became shallower. A large number of subsequent observations made on dogs, cats, and rabbits had confirmed these results. As in their earlier experiments, watery decoctions of the glands had been chiefly employed by them. The suprarenals experi- mented with were derived from the calf, the sheep, the dog, the cat, the guinea-pig, and man. The physiological results were exactly the same whatever the source of the glands, except with regard to two which were taken from subjects of Addison's disease. The fol- lowing effects are given by the authors: 1. As a rule, when the intravenous mode of adminis- tration was adopted, a definite small quantity of the extract representing a known weight of the fresh gland was injected. In exceptional instances, however, a continuous flow of a 5- per-cent. solution of the extract was employed. In these instances the physiological effects were maintained during the entire time the injec- tion lasted, but without the development of other apparent symptoms and without causing death. In this way large doses of the extract were administered to the dog, thereby produc- ing the most violent cardio-vascular disturb- ance without causing a fatal result. 2. In a former communication the inference as to the extreme contraction of the arteries had been derived from observations on the blood-press- ure, from the use of the limb plethysmograph, and from the arrest of the flow of normal saline solution through the vessels of a frog caused by the addition of a small quantity of suprarenal extract. Several observations with the oncometer had confirmed this conclusion and shown that it might be extended to the vessels of the kidneys, for the tracings showed a well-pronounced reduction in volume of that organ during the suprarenal effect on the cir- culation. 3. It was observed that stimulation of the depressor nerve did not produce the usual reduction of the blood-pressure while the effects of the suprarenal injection lasted ; if the depressor nerve in the rabbit was stimu- lated at the height of the pressure caused by intravenous injection of suprarenal extract, the usual fall of blood-pressure was not produced, and no depressor result was to be obtained un- til the blood-pressure had again become nearly or quite normal. The depressor result reap- peared simultaneously with the Traube-Hering curves, if these were seen at all in the tracing. 4. It was invariably found that the heart's action was remarkably accelerated and augmented in the dog, the cat, and the rabbit after section of the vagi. It was not found that solutions of less than 1 per cent, of suprarenal extract in Ringer's circulating fluid would affect the frog's ventricle with certainty, recording its pulsations in a heart plethysmograph. The following results, however, were obtained with this and with stronger solutions—up to 5 per cent.: 1. Reduction of diastole, with consequent acceleration. 2. The abolition of groups of contractions and the setting up of continuous pulsation. 3. The arrest of the ventricle in systole. As this extreme effect of the extract was not prevented or antagonized by potassium chloride, the conclusion was that it was due to calcium salts in the extract, for Ringer had shown that the calcium effect upon the con- traction of the frog's ventricle was counter- acted by potassium. Moreover, the individual contractions did not show the characteristic calcium effect. On the contrary, each individ- ual contraction remained normal, although the acceleration produced by the drug might ulti- mately be sufficient to prevent the completion of the diastole, and the contractions might thereby be caused to run together. 5. The paralyzing effect of the subcutaneous injection of the extract—about 1 or 2 grains—in the frog had not been observed in other animals experimented on in this way, except from lethal doses in the rabbit. It had been observed, however, in dogs subjected to intravenous in- jections of the extract, that when the muscles were electrically stimulated through the nerve supplying them, a modification of the normal 245 SUPRARENAL CAPSULE contraction was apparent, the relaxation being delayed, as in the case of the frog's muscle. This effect, moreover, not only was observed while the suprarenal rise of the blood-pressure was being recorded, but was traceable for some time after that rise had passed away. It was therefore inferred that the active material was probably taken up by the muscular tissues and remained for a time stored within them. 6. No definite effect upon the secretion of the submaxillary gland was observed as the result of injecting suprarenal extract into the blood. The chorda tympani was not found to be any less active in promoting the secretion of the gland in an animal the blood-vessels of which were contracted by the extract. 7. It was found that when two extracts were prepared of equal strength, one of the cortex and the other of the medulla of the perfectly fresh gland, the intravenous injection of the former would not produce the characteristic cardio- vascular disturbance, while that of the latter in the same dose would induce it in a marked degree. It is, however, the authors say, some- what difficult to prepare the cortical extract perfectly free from a trace of the medulla, so that it may happen that a comparatively large dose of cortical extract may produce a slight physiological effect; but not more than that of a much smaller portion of the medullary extract. The conclusion, therefore, is that the active principle of the extract is present in the medulla only, the effects obtained from the extract of cortex being small and inconstant and probably to be explained by accidental contamination or post-mortem diffusion. 8. Experiments were made with suprarenals from three subjects—one in which the glands were healthy, and two others in which they were diseased (cases of Addison's disease). The healthy organs yielded an extract of great physiological activity, whereas the diseased adrenals afforded one which gave no result. 9. In regard to the oral administration of the ex- tract as a remedy, it seemed desirable to ascer- tain whether peptic digestion impaired its active properties. A little of the watery ex- tract of the gland was added to artificial gastric juice (pepsin + 0-2 per cent, of hydrochloric acid) and exposed to a temperature of 104° F. for twenty-four hours. The intravenous injec- tion of a small quantity of this and of an equal portion of the same extract diluted at the time to the same extent with 0-2 per cent, of hydro- chloric acid produced identical physiological effects. The injection of an equivalent amount of acid as a check experiment produced no effects. The authors, therefore, do not think it likely that gastric digestion will seriously lessen the physiological properties of the extract. Experiments were made with the view of as- certaining how the extract was eliminated or disposed of, and whether the active principle was destroyed in the blood. This seemed not improbable, as it was found that alkalies and oxidation destroyed the activity of the extract. It was observed, however, that when allowed to stand in freshly drawn blood, with free ex- posure to the air, or with complete exclusion of air for twenty-two hours, the extract pos- sessed the same activity as when preserved in exactly the same manner in normal saline. As an altered contraction of the muscles was ob- served to persist after the subsidence of the cardio-vascular disturbance set up by the in- jection, it seemed probable that the active principle of the extract passed out of the blood into the muscles, and remained there for a time. The authors have shown that in Addison's disease the adrenals may become totally devoid of the physiologically active material. If these bodies are to be regarded as eliminators of toxic materials rather than as producers of materials which are of definite physiological value, they say the toxic materials they should remove or destroy might be expected, in cases in which their function is in abeyance, to pass out by the kidneys. They have found, how- ever, that an extract prepared from the urine in Addison's disease has precisely the same effect when injected into a vein as that of an extract prepared from normal urine. In fact, all the evidence they have leads them, says Dr. Oliver, to view the function of the suprarenal bodies— at least the medulla—as secretory rather than destructive, and the secreted product as being in all probability of great physiological impor- tance for maintaining the tonicity of the mus- cular tissues in general, and especially that of the heart and arteries. Dr. Richard C. Cabot, of Boston (Medical News, September 12, 1896), has collected ac- counts of twenty cases of the treatment of Addison's disease with suprarenal-capsule preparations. In nine of them the patients have been considerably improved. He thinks that the various fluid extracts are very inferior to the gland itself, dry or raw. Tonoli (Gazzetta medica lombarda, August 17, 1896; British Medical Journal, October 24, 1896) reports the case of a woman, aged twenty, who had suffered from Addison's dis- ease for some fourteen months. When seen she presented all the classical signs and symp- toms of the disease. On February 26t'h 20 grains of the powdered suprarenal capsule were directed to be given daily in pills, the dose being gradually increased to 2| grains. On March 6th the patient already felt better; the pains in the stomach and lower limbs had dis- appeared. By March 31st the pigmentation had become less marked, the appetite was better, and the strength had increased. On April 10th she walked well, and her strength was much greater. The menses returned after ten months' absence, and her weight increased. The patient then went out, and the treatment was suspended. Meantime the temperature had come down to normal, the weight had in- creased decidedly, the black patches had disap- peared from the mucous membrane, and the slight signs which had first been noticed at the apices of the lungs had disappeared. The author considers this was a case of cure (so far as it went), and not a mere spontaneous remis- sion in the course of the disease. In the Journal des praticiens for April 18, 1896, M. Huchard, writing on the use of the suprarenal capsule in neurasthenia, remarks 246 SWEET OTL SYMPTOMATIC TREATMENT S that Brown-Sequard's experiments and the more recent ones of Abelous, Langlois, and Albanese established the fact that the physio- logical function of the suprarenal capsules was to transform or to destroy the toxic substances which are produced in the organism under the influence of muscular activity and of the nerv- ous system. We may thence understand, he says, why the destruction of these organs ex- perimentally or by disease is capable of caus- ing in the organism an accumulation of toxic agents which is the principal cause of the sen- sation of extreme fatigue and of the profound and generalized asthenia experienced by pa- tients who suffer with Addison's disease. In neurasthenia, then, he says, patients may be benefited by this treatment. Up to the present time, says M. Huchard, the observations have not been numerous enough to permit of absolute conclusions on the results obtained, but he thinks the remedy is worthy of attention. He thinks that the treatment should be persevered with, not only because it seems to be indicated by pathological physiology, but because it has not yet given rise to accidents when used in moderation. The fresh gland, to the amount of from 15 to 30 grains a day, may be taken by the mouth. Dr. W. H. Bates, of New York (New York Medical Journal, May 16, 1896), has employed an aqueous extract of the suprarenal capsule of the sheep topically in various diseases of the eye. The extract used by him is prepared by subjecting the dried and powdered suprarenal capsule of the sheep to the action of cold water for a few minutes, filtering the liquid, and evaporating it to dryness at a temperature be- low 105° F. It requires 16 oz. of the fresh glands or 8 oz. of the powdered desiccated glands to make an ounce of the aqueous extract. The active principle of the suprarenal gland is described by Dr. Bates as very soluble in wa- ter, 1 part of the extract dissolving in some- what less than 3 parts of water. It is insoluble in strong alcohol, but soluble in dilute alcohol on account of the presence of water. It is also insoluble in ether or chloroform. The dried ex- tract has remained immersed in strong alcohol, in ether, and in chloroform for several months without apparent injury. The dried aqueous extract is brown. The colour depends partly on the temperature at which it is dried; the higher the temperature, the darker the colour. It does not crystallize. When moist, it is slight- ly sticky; when dry, it is brittle. It has a slight odour resembling that of extract of beef. The most characteristic chemical property is its reaction with tincture of iron. A drop of tincture of chloride of iron added to a neutral solution of the aqueous extract produces a green colour which gradually disappears. A precipitate is formed, and the addition of more of the iron solution may produce the green colour again, with the formation of more of the precipitate. The supernatant fluid loses its colour at the same time that the precipitate is formed. Finally, it is possible to add sufficient tincture of iron to make the solution of the extract clear, and the addition of more iron does not produce the green colour. The pre- cipitate contains the extract and the iron, be- cause the filtered fluid evaporated to dryness leaves no residue except the excess of iron. The precipitate is black and is composed in part of metallic iron, probably. Dilute hydro- chloric acid dissolves the precipitate and the solution becomes reddish. Dr. Bates's explanation of these phenomena is that the extract is a strong reducing agent. The green colour, he thinks, is due to the fact that the red perchloride is reduced to the green sesquichloride by the extract. It changes to the black of metallic iron by further reduction with the extract. What becomes of the ex- tract will require further experiments to de- termine. The reducing action of the extract he regards as remarkable. The reaction of tincture of iron with the extract is very deli- cate. A solution of less than 1 per cent, of the extract will produce the green colour on the addition of tincture of iron. If the extract is in a very strong solution, it may reduce the chloride of iron to the metallic state so quick- ly that the green colour may not be observed. This reaction, says Dr. Bates, does not occur with solutions of the thyreoid, thymus, testicle, or pineal gland. The extract does not keep unless it is steril- ized. It is incompatible with mercury bichlo- ride, silver nitrate, copper sulphate, and other astringents; indeed, Dr. Bates declares that it " does not act well when combined with other substances." When he used it in solution with cocaine, he found that the eye was irritated and not anaesthetized, and he thinks that in such a solution the medicinal properties of both drugs are impaired. The extract employed by Dr. Bates may be administered by the mouth in considerable doses without harm resulting, but large doses, particularly if given subcutaneously, may pro- duce alarming results. A lady, aged eighty- seven years, had a pulse of forty, which was intermittent and irregular; after the extract had been used in the eye for a few days the pulse became regular, increased to eighty, and remained so during a period of six months that the extract was used. A woman, aged thirty years, swallowed 60 grains at one dose. She vomited immediately, but felt no other ill effects. A man, aged sixty years, after taking 2 grains three times a day for a week, was sud- denly attacked with a peculiar eruption on his hands, which disappeared in ten days without treatment after stopping the use of the extract. In one case 10 grains given subcutaneously produced alarming symptoms. The face was livid; there was great pain in the head and chest, with a feeling of throbbing. Conscious- ness was not lost. The pulse was weak. In ten minutes the patient felt able to walk home from the dispensary, a distance of more than a mile. Dr. Bates regards the extract as a powerful astringent and hemostatic When it is in- stilled into the eye the conjunctiva of the globe and lids is whitened in a few minutes. The effect is very decided. None of the usual astringents, including cocaine, he says, can produce such an astringent effect. In normal 24 eyes the extract whitens the conjunctiva and sclera when used in very weak solutions—less than 1 per cent. The effect is increased by repeated instillations or by the use of stronger solutions. He mentions the following diseases of the eye in which the extract has whitened the con- junctiva and sclera: Trachoma, acute catarrhal conjunctivitis, chronic conjunctivitis, phlyc- tenular conjunctivitis and keratitis, interstitial keratitis, rheumatic and syphilitic iritis, epi- scleritis, irido-cyclitis, sympathetic ophthal- mia, atrophy of the globe, secondary glaucoma, traumatic conjunctivitis, traumatic keratitis, traumatic iritis, traumatic kerato-iritis, lacry- mal inflammations, and rheumatic ophthalmia. The extract is not irritating. It generally produces a cooling sensation when dropped into the eye. It does not dilate or contract the pu- pil, and it has no effect on the accommodation. A tolerance was not established in two cases in which the extract was instilled into the eye several times daily for more than three months. A third patient used the extract daily for more than twelve months, and it whitened the eye- ball and palpebral conjunctiva as well at the end of the twelve months as at the beginning. The astringent effect of the extract on the con- junctival vessels is temporary—usually in an hour the eye looks as it did before the extract was used. There is no congestion after the astringent effect has passed off. Dr. Bates is not positive that the extract is curative in any form of conjunctivitis ; but the immediate effect of its employment is very grateful to the patients. He has found it of material benefit by reducing congestion in in- terstitial keratitis, glaucoma secondary to cata- ract extraction, and iritis, and as an adjuvant to cocaine. "An operation on some nervous people is unsatisfactory, because cocaine does not produce anaesthesia. Such cases are quite common. A woman was operated upon re- cently for tenotomy of the inferior rectus. The cocaine did not whiten the ocular conjunc- tiva, dilate the pupil, or produce anaesthesia after being instilled frequently for an hour. A few drops of the extract whitened the ocular conjunctiva, and the cocaine in five minutes dilated the pupil and produced anaesthesia. The operation caused no pain. Traction on the tendon of the muscle with the hook was not painful. There was very little haemor- rhage. A previous operation on the same mus- cle, using cocaine alone, was painful, and there was an unusual amount of haemorrhage. The eye was bleeding six hours later. The eye was sore for two days. The extract in this case had a very happy effect by securing a painless operation without haemorrhage and without soreness afterward." Dr. Bates adds that an operation which re- quires more than a few minutes becomes pain- ful in some cases, although cocaine may be instilled frequently. Advancement of an ocu- lar muscle, he remarks, is generally so painful that many operators are compelled to use ether anaesthesia. The operation may begin pain- lessly, but subsequently the anaesthesia wears off, particularly if there is hemorrhage. The SWEET OIL :7 SYMPTOMATIC TREATMENT extract, when frequently instilled, prevents haemorrhage, and the cocaine anaesthesia is prolonged indefinitely for this reason. As soon as bleeding occurs, one notices very soon the sensitiveness of the eye returning. A number of advancements have been done painlessly and almost bloodlessly by the use of the extract and cocaine together. The extract prevents haemorrhage, says Dr. Bates, because of its property of contracting the small arteries. After haemorrhage be- gins it is not very efficient. It is possible to perform an almost bloodless operation on the ocular muscles or lacrymal sac by instilling the extract frequently. The following case illus- trates its value as a haemostatic: A man was operated upon four times during three months for stricture of the nasal duct. After each operation the patient lost enough blood to saturate two towels and sometimes more. The haemorrhage was unusually copious, and the operations were very painful. A fifth opera- tion was done in which the suprarenal extract was used with the cocaine. There was no pain and very little haemorrhage. The towel used had on it one spot of blood a quarter of an inch in diameter. SWEET OIL.—See Olive oil. SYMPHOROL.—The symphorols include sodium sulphocaffeinate, lithium sulphocaffe- inate, and strontium sulphocaffeinate, but the first-mentioned, called also sodium caffeine- sulphonate, is ordinarily meant, It is a crys- talline, bitter, non-poisonous substance, acting powerfully as & diuretic. The dose is 15 grains, to be given from three to six times a day. SYMPTOMATIC TREATMENT.—The symptomatic treatment of disease involves, in a certain degree, a confession of ignorance of cause and effect, since it is an acknowledgment that the ultimate aetiology has escaped detec- tion, and that it is therefore impossible to attack the fountain of origin. This do; s not imply that the pathology of a disease, which we are forced to treat as its symptoms arise, is ill or not at all understood ; for although the morbid history may be perfectly clear, the therapeutic resources at our command may not be such as to admit of our applying them with invariably successful results. In consideration of repeated observation and of manifold expe- rience, certain substances which relieve certain symptoms, increase function, or limit diseased processes are relied upon to furnish a basis for restoration to health in conditions in which we lack specific remedies. The term specific must not be loosely employed. Every drug, at least almost every remedy, has a specific action upon some portion of the human organism ; but it can not be said to have a specific influence upon a disease as an entity unless by its innate virtues, without the intervention of other forces, it succeeds in limiting or eliminating the morbid process. Specific treatment is unfortunately limited at present to a few diseases. Quinine in malarial disease, mercury in syphilis, colchi- cum in gout, and antitoxine in diphtheria are specific ; possibly the results of the administra- tion of thyreoid" extract in myxoedema and of SYMPTOMATIC TREATMENT 248 the salicylates in rheumatism may be regarded in a similar light. With these diseases and with these remedies the specific treatment of the present day comes to an end, unless one wishes to include in the category the homoeo- pathic system, than which there is no more exquisite example of putative specific treat- ment founded on array of symptoms. In the treatment of disease the fight against Nature has long since passed into deserved oblivion. The medical profession now recog- nises the force of the old Latin proverb, Medi- cus curat, natura sanat morbos, and directs its efforts toward assisting the healing power shown by Nature in diseases least influenced by artificial interference and in those which undergo spontaneous cure. Aside from the few exceptions cited above, in which accident, coincidence, or deductive inference has dis- covered a specific for disease, most physicians are obliged to treat disease from the sympto- matic point of view. It is not too much to hope, in the light of recent investigation and experience, that within a few years the treat- ment of the infectious diseases, at least, will be placed upon a specific basis. There is another sense, a broader and more generally accepted one, in which the phrase " symptomatic treatment" may be regarded. This refers to the alleviation of symptoms arising in the course or progress of a disease, not intended to be curative in its sequel, but simply and solely to combat threatening or serious manifestations and to allay disagreeable phenomena. For such measures to be thor- oughly and conscientiously pursued, there must be a clear understanding on the part of the physician of the nature of the illness which is present. Thus, few men would be willing to risk the administration of chloral hydrate for the purpose of inducing sleep in pneumonia, or in any pronounced asthenic condition ; and it would be a poor example of judgment which would allow a medical attendant to give strych- nine for incontinence of urine to a child suf- fering from chorea, although under other condition of health or disease both of the drugs referred to might be legitimately indicated. The pursuit of symptomatic treatment may lead into error, unless followed along lines of perfect knowledge of the processes presenting themselves. Sleeplessness, for example, in pneumonia may be due to disturbed nutrition, to high fever, to an embarrassed circulation or respiration, or even to pain. And success- fully to combat this symptom, the physician must determine, as accurately as his skill and experience permit, the source of the insomnia. If it is due to continued fever, an earnest effort must be made to reduce the temperature, with- out, however, interfering with, embarrassing, or obstructing other organs or functions. If car- diac weakness is responsible for the distressing symptom, or if impeded respiration is the fault, appropriate remedies acting upon the organs concerned must be chosen. And yet, although the patient may feel restored and refreshed after the sleep which is given artificially, it must not be assumed that the measure is cu- rative in any way further than that it conserves the patient's strength, and, like nourishing food, aids him to overcome the forces which are working against him. It is by such reasoning that we find the pur- poses and objects of the symptomatic treat- ment of disease justified in their immediate and remote results. No physician of experi- ence presumes to assert in any given case that a cure is certain, but he may, judging from his results in large numbers of cases, hope for a restoration to health, or a palliation of dis- tress in many diseases—frequently fatal—by the careful, wise, judicious employment of measures which will allay or conquer grave symptoms. There can be no more searching test of a physician's acumen and knowledge than the proper symptomatic treatment of disease. It involves not only an accurate acquaintance with the pathological and physiological pro- cesses at work, but also a well-grounded insight into the action, in health and in disease, of the therapeutic measures called into play. There must reside in the physician's mind an under- standing of the constructive and destructive effects of disease upon nutrition, its influence upon and relation to the blood, the normal balance between these factors and the great vital functions of the body; excretion and secretion must be carefully observed and as closely watched, and the sustaining and rest- producing functions of the organism must not escape consideration. In short, the physiology of disease must be as completely in the eye as the physiology of health. Nothing can super- sede the knowledge which experience brings in the proper choice of remedies to meet dis- turbed conditions. The differences manifested by the action of drugs in health and in diverse conditions of disease are of very wide range, and in the administration of any medicine for the relief of symptoms all the changes and modifications induced by personal peculiarities, by absorption, and by influence on the various organs of the body must be judged of. Bearing in mind that the purpose of the symptomatic administration of drugs depends upon two elements, the relief of immediate symptoms and through this the conservation of the patient's energy—in other words, the amelioration of conditions—renders the subject easy of comprehension. The relief of symptoms which threaten life or cause great discomfort is, all things considered, the first imperative duty of the physician, no matter what the causa morbi may be. Pain must be mitigated, from whatever source it springs—a pleurisy, a brain tumour, or an enteritis. By its depres- sion and sapping of the patient's strength it may so lower the vital forces, if not relieved, that the subsequent struggle against the de- structive agents of disease may be rendered futile. But even in the attempt to allay this symptom regard must be had for the effects of the chosen drug upon the organs involved. Though a general peritonitis—for instance] with paresis of peristalsis—may give rise to great pain, opium in any form would be contra- indicated, since it would lead only to further difficulty in securing evacuation of the bowels. 249 SYMPTOMATIC TREATMENT In an ordinary colic, however, brought about by an abnormal collection of intestinal gases, a simple condition only must be met, and, although the bowel here, too, requires empty- ing, the contra-indication to the use of opium is by no means so urgent, since no grave dis- ease threatens the strength of the sufferer. And so, in the treatment of the symptom pain, there is as great a difference in the degree of this "nerve lightning" in almost all diseases and their complications as exists in the two conditions mentioned as examples. The highest judgment must be called upon in this emer- gency as in the planning of any general outline of treatment. The actual subjugation of pain would con- stitute its symptomatic treatment, and yet the determination of its source is an important preliminary step. When this can be ascertained and directly attacked, it is, of course, unneces- sary to administer analgetic remedies unless ulterior conditions demand their employment. But always, in the attempt to obtund pain, the sequel upon the disease and its possible com- plications must be duly considered, for little is gained by respite from this or any other symp- tom if the subsequent result jeopardizes the life of a patient or renders a recurrence of the symptom more likely. On the part of the brain, symptoms should be considered and treated as they arise. Deli- rium, coma, and stupor can not, however, simply be treated as entities. Relief from the cause of the first must be sought when this is pos- sible, but no treatment should be instituted for this phenomenon which is apt, in the course of a disease, to increase a subsequent stupor or comatose condition. Delirium is but a symp- tom, and as such is not in itself to be feared. It is but the mark of some process whose influ- ence may lead to decrease of strength or of vital force, and hence must be fought as any other danger signal would be. The efforts, as in the- treatment of all symptoms of a grave nature, must be directed to soothing the disturbed sensorium. And the same remedy will not always be efficacious. The delirium of an acute infectious disease or of agonizing pain must receive essentially different therapy from that of alcoholic intoxication or of mania. Coma and stupor arise from causes so mani- fold that in each individual case we must exer- cise a careful consideration of the remedies which are best fitted to arouse the dormant or flagging forces. Sleeplessness, too, may de- pend upon factors so varying that, when it is possible, the origin must be sought and the appropriate treatment be instituted. There is no more select field for the judicious choice of a remedial measure than in this very domain: one drug is contra-indicated in the presence of pain ; another, in the face of delirium ; another, when there is danger of a cardiac depression; and the next, in disturbed gastric function. Yet insomnia is one of the direst symptoms to encounter, and, no matter in what disease or condition it appears, it must be satisfactorily met, The heart and lungs during the course of diseases of other organs, or when they them- selves are affected, give origin to symptoms which usually require therapeutic notice. Any embarrassment of the respiration, whether of local origin in the trachea or of cardiac source in an impaired heart, or local again in a con- solidated lung, must be met and at once. Even when a dyspnoea depends upon some in- curable disease, such as a malignant growth or an aneurysm, every intelligent effort should be made to relieve the threatening symptom. And the same rule holds true for any serious manifestation on the part of the heart." When weakened, through disease or innate condi- tions, it must be strengthened by appropriate means; when overworked or pumping against greater odds than it is able to overcome, suit- able measures for its relief must be inaugu- rated. The conditions which are able to cause sudden cessation of the heart's beat in disease must be carefully watched for, and never, if it can be prevented, allowed to gain supremacy. Cough is a symptom which may or may not demand therapeutic consideration, depending upon whether it is the sole symptom or one of a group of symptoms, and whether its presence is annoying, painful, or aggravating to the pa- tient. If its source can be attacked and de- stroyed without damage to any of the functions or organs, therapeutic measures may be prop- erly inaugurated. If it springs from a pleurisy, a pneumonia, or a pulmonary tuberculosis, it matters little how much the patient may cough if the distress is not great; but if a bron- chitis, or a chronic pharyngitis, or a long uvula, or disease of the tonsils is the origin of the cough, that disease may itself be treated. In other words, if a cough represents the effort of Nature to assist in the elimination of dele- terious material and does not cause the pa- tient too much effort or pain, it may well go untreated; if, on the other hand,it is due sim- ply to an irritation of the bronchial tract or part of it, the cough deserves and should have directed against it therapeutic interference. Constipation or diarrhea and defective ab- sorption or elimination are such common ac- companiments of many diseases that their symptomatic treatment is almost a matter of routine. And yet even these every-day mani- festations of local or constitutional disease are frequently wrongly treated, since a diarrhoea may easily yield to a laxative which causes the removal of offending material, and a constipa- tion be cured by giving the intestines a much- needed rest. In general, vomiting and nausea and the conditions already mentioned require deliberation of a careful kind, and usually de- mand treatment based upon a recognition of their causes. In this particular field of thera- py, symptomatic treatment represents espe- cially the treatment of conditions, since it is usually difficult to attack the disturbing ele- ment directly. The limits' of this article forbid an elabora- tion of the symptoms which may be evoked by disease in the several organs of the body. The underlying principles of the "rational empiri- cism " known as symptomatic treatment have been brought out, and a further multiplication of details is scarcely necessary. It may, how- SYNERGISTS SYRUPS 250 ever, not be out of place to emphasize the necessity, in this connection, of a careful watching of the general processes of the body, which, though they may not arouse special symptoms in the course of a disease, are yet so important in their bearings upon the causation of symptoms on the part of special organs that their consideration in any disease is part and parcel of the observation of the case. Refer- ence is made, of course, to the metabolic pro- cesses ; the proper exchange of gases in the blood and tissues; the correct elimination of waste and toxic products; the normal secre- tion and excretion of physiological fluids. A departure from the normal might not, in any given case, show symptoms; but eventually, if metabolism is impeded, all those evidences of a disturbance of nutrition so well known and easily recognised may make their ap- pearance. Emaciation, glandular enlargement, an excess of urea in the urine, a feeble heart, diminished secretion of bile, and the number- less other concomitants of malnutrition would make themselves felt. The physician should hold himself responsible for the non-appear- ance of this condition by observing closely the catabolic necessities of the body during the entire progress of an illness. In this direction symptomatic treatment becomes prophylactic at times, and than this there can be no higher aim in medicine. There still remain a few points toward which attention must be directed. Those conditions known as asthenic or adynamic, which may be part of any prolonged disease, acute or chronic, must always receive symptomatic treatment directed to the organs or sets of organs which are the principal seats of weakness. The treat- ment can not be specified, but must be general as indicated. If the heart shows signs of de- pression or failure, it must receive stimulants; if the intestines are weakened in their func- tion, they must be strengthened. If there is exhaustion of the nervous system or of the muscular system or deterioration of the blood, these integers must be given the benefit of measures which will restore them or aid in restoring them to their normal condition. But whatever organ is thus found weakened in func- tion, the therapeutic measure applied must be in proportion to the disturbance, and so chosen as to inflict no further injury upon the dis- abled organ or upon other organs; and this is of importance secondary only to that of the administration of some remedial agent. The giving of nourishing foods in the conditions under consideration may well come under this heading. No therapeutic agent at our com- mand can replace the nutriment to be ob- tained from proper food-stuffs which contain, in a concentrated and easily assimilable form, the essential, elementary physiological requi- sites. Conditions of malnutrition which fre- quently follow the acute diseases commonly yield in a remarkable manner to judicious feeding; every organ and system of organs seems to respond almost immediately to the ingestion of the vital principles contained in the nourishment. It may be mentioned, too, that the proper nourishment of the sick during an acute illness is frequently, in more senses than one, a form of symptomatic treatment of higher value than the mere fighting of ob- jective symptoms. It has been considered better, in the course of this article, not to refer to groups of diseases or the individual maladies; but, by pointing out some of the broad principles which gov- ern symptomatic treatment in general, to de- duce the conclusions reached. To summarize briefly, it may be repeated that symptomatic treatment is indicated in all diseases or condi- tions whose processes give rise to local or con- stitutional manifestations, and whose seat of origin can not be attacked, or when, in our ignorance, we do not know how to attack it; or, in a more limited sense, when symptoms or conditions arise in the course of any illness the treatment of which is unable to overcome the phenomena of local or general origin. Even when a cure is out of the question, the judi- cious treatment of symptoms may provide comfort and prolong life. Samuel M. Brickner. SYNERGISTS. — These are remedies which in some manner aid or intensify each other's actions. The synergistic property was formerly held to be of great importance, and an attempt was usually made to modify the complex action of the drug chosen as the prin- cipal reliance and known as the base, by com- bining with it an adjuvant to increase the desired effect, and a corrigent to neutralize such effects as were undesirable. To succeed in attaining such ideal results a much more accurate knowledge of the exact action of each drug, and the proportionate influence exer- cised by it over the various organs of the body, as well as a genius for making accurate com- binations, would be necessary to a degree not yet attained in the human race, and as the at- tempts made were usually to a greater or lesser degree failures to obtain the desired re- sults, a severe simplicity has gradually taken their place and the plain drug, uninfluenced by adjuvant or corrigent intentionally intro- duced, is the rule of prescription-writing at the present day. Nevertheless, the advantage to be derived from the employment of reme- dies which are of assistance to each other is obvious. It was the crude attempt to use the knowl- edge that most drugs produce many effects, of which some are beneficial but others delete- rious in any given case, which caused those combinations of drugs that seem strange to us ; but it is of great advantage to remember that many drugs produce similar even if not iden- tical effects, and that by the combination of two, each of which produces a similar or iden- tical effect upon a certain organ, a better re- sult can be obtained than from either singly, because, as a smaller amount of each is needed' the other effects, whether deleterious or not' are produced in a minimum degree. Thus opium and ipecacuanha are both diaphoretics, while one is a narcotic and the other a nau- seant. By combining them a better diapho- resis may be obtained than would be the case SYNERGISTS 251 SYRUPS if either were given singly, unless in sufficient- ly large doses to produce the other and unde- sired physiological effects. In the same manner manganese may be advantageously combined with iron to aid it in producing its haematinic effects. Sometimes the combination of a stronger and a weaker agent is of remarkable efficacy. Although cocaine can not compare with atropine as a mydriatic, still a more pro- nounced mydriasis may be obtained from their united action than from atropine alone, on ac- count of the mechanical expression of blood from the tissue by the contraction of the blood-vessels induced by the cocaine. This synergetic action of various drugs may possibly be explained in some cases by a close alliance in chemical composition, as is the case with metallic salts and with the members of the phenol group, or by the presence of iden- tical or closely related alkaloids or active prin- ciples, such as that of berberine in calumba and hydrastis. But such a relationship is not always necessary in order that two drugs may enhance each other's effect upon the system, as is demonstrated by the frequent and useful prescription of iron with bitter tonics. The employment of synergists in medicine should not be considered as confined to the prescription of drugs, which by their physio- logical action increase each other's force, but should also include all agencies by means of which the system is aided to respond to the in- fluence of the medicament upon which reliance is placed. Thus digestive ferments employed to improve the digestion and so contribute to furnish assimilable material for the support of the body are distinctly synergistic to the means used to combat the disease from which the patient is suffering. The same is true of tonics, stimulants, the inhalation of oxygen, and all other measures which aim at the main- tenance of the patient's strength and vitality. Water, when drank in large quantities as a di- luent, is of valuable service in inflammation of the genito-urinary tract by flushing theemunc- tories and so permitting easier and better ac- tion of the organs. Counter-irritation may frequently act syner- gistically by inducing a change in the nervous or circulatory condition of an organ, as when it is used in the lumbar region in cases of nephritis, that it may assist the kidneys to re- spond to the diuretics administered. The regulation of other organs of the body than those primarily diseased is an important aid to the restoration of functional equilib- rium, hence the use of laxatives, diaphoretics, and other eliminatives is frequently indicated. Emetics, cathartics, and general depletion fa- vour the action of depressant remedies. The svnergistic effect of electricity in the rapid production of the local effects of cocaine, aconite, and other drugs has been mentioned and classed with other mechanical, chemical, and thermal aids to absorption, under Sorbe- FACIKNTS. Hygienic measures of all kinds, pure air, proper food, exercise, massage, the various forms of baths, are most valuable synergists to proper medicinal treatment, not including sys- 60 temic depressants, and when properly carried out not infrequently become the principal in- stead of the accessory remedial measures. Un- favourable hygienic conditions increase the activity of drugs which depress the bodily functions. Finally, the synergistic effect of mental emo- tion must be considered. The modus operandi here is difficult to explain, but it is universally acknowledged that a cheerful frame of mind is of much assistance to the action of restora- tive agents, while a mournful mood increases the force of depressant remedies. Matthias Lanckton Foster. SYNOVIAL EXTRACT.—Dr. Samuel Hyde, of Buxton, England, writes in the Brit- ish Medical Journal for April 18, 1896, that he has had a glycerin extract prepared from the fresh synovial membranes and articular carti- lages of healthy animals, and is using it as a remedy for rheumatoid arthritis and some other forms of chronic joint disease. He gives it by the mouth in doses of from 15 to 30 minims two or three times a day. He reports that thus far his experience with it is encouraging. SYRUPS.—These are more or less concen- trated solutions of sugar in water, in most cases combined with some flavouring or me- dicinal agent. They may be prepared by vari- ous methods. When heat is not objectionable, they are most expeditiously made by this agent. Otherwise simple agitation or percolation must be resorted to. The hot process, if it can be applied to all, not only is the most expeditious, but produces the most stable product, as it destroys the vi- tality of any germs which may set up fermen- tation, or cause the formation of mould, etc., in the product. If it is necessary to avoid actual boiling in the preparation of a syrup, the product is usually not so clear and bright as would have been the case if the boiling point had been attained, because in the latter case the suspended matters would have all been carried to the top, where they could have been removed. In the preparation of syrups containing vola- tile or easily decomposable medicinal ingredi- ents, heat must be avoided. But such syrups, unless kept under special precautions, are very apt to deteriorate. It is therefore advisable never to prepare more of a stock than will sup- ply the demand for a short time ahead. The preservation of syrups is best accom- plished by keeping them in completely filled bottles, each holding an amount sufficient for a few days' supply, which must be hermetically sealed and kept in a cool place. If the syrup can be introduced boiling hot into the bottles, previously well cleaned and immersed in hot water, it will keep so much the better. When it is necessary to clarify a syrup which is tur- bid from minute suspended matters, this may be accomplished, if heat is not objectionable, by mixing with it, while cold, an aqueous solu- tion of white of egg and then raising it to boil- ing without stirring. As the albumen contained throughout the solution coagulates, it envelops the suspended matters and they are all carried SYZYGIUM JAMBOLANUM TABLETS 252 to the top in the form of scum. When heat cannot be used, the clarification is best effect- ed by mixing the syrup with well-shredded and moistened paper-pulp, thoroughly agitat- ing it during some time, and then filtering through paper or flannel. The first portions of the liquid may be returned to the mixture until it runs through clear. In come cases the preservation of a syrup is secured by the addition of an acid, or of alco- hol, or of glycerin. Fruit syrups, which are largely used as flavouring agents in popular beverages, as well as in medicinal compounds, are usually pre- pared with the aid of a moderate degree of fermentation. As an example may be cited syrup of cherries, which is best prepared in the following manner: Crush the cherries, with their kernels, and let the mass stand in a cov- ered vessel for two days at a temperature of from 60° to 70° F., stirring it occasionally. Then express the juice, add for every 100 parts of the latter 2 parts of sugar, and, when this is dissolved, pour the juice into one or more narrow-mouthed bottles or other convenient vessels of such a nature that only a small sur- face of the juice is exposed to the air, and tie parchment paper over the orifice. Fermenta- tion will gradually set in, its rate depending greatly on the temperature, which should be so regulated that it will not be too rapid. The fermentation produces a certain amount of al- cohol, which causes the gradual coagulation of the mucilaginous constituents. As soon as a small sample, say 4 c. cm., of a filtered portion of the juice is found to mix, without becoming turbid, with 3 c. cm. of 90-per-cent. alcohol, the process should be interrupted. The juice is now filtered as rapidly as possible, the filtrate is transferred to a suitable vessel, and for every 350 parts of filtrate 650 parts of sugar are add- ed. The mixture is slowly raised to boiling and kept at this temperature until it no longer throws up a scum, which must, while it ap- pears, be constantly removed. The finished product is then, while still hot, strained through flannel and immediately transferred to suitable vessels, which must be filled as far as possible and securely stoppered.—Charles Rice. SYZYGIUM JAMBOLANUM. — See Jambul. TABACUM.—See Tobacco. TABELL^, TABLETS.—Tablets are small disc-like masses of medicinal powders the basis of which usually consists of cane sugar or milk sugar. They are prepared either in moulds or by compression. Moulded tablets, also called tablet triturates (more correct would be triturate tablets) are prepared by triturating an active substance with a sufficient amount of milk sugar (or, in some cases, other soluble medium), so that when they are moulded and finished, each tablet will contain the exact intended amount of the me- dicinal constituent. These tablets were first suggested and introduced by Dr. Robert M. Fuller, of New York, in 1878, since which time their use and manufacture have assumed im- mense proportions. _ Since the tablets are usually of the same size, and since varying quantities of medicinal constituents occupy varying volumes, the maker has to devise a separate formula for each com- bination, so that a finished tablet will contain the exact dose of the medicine together with enough sugar of milk to make up the bulk of the tablet. The formula for each separate combination is arrived at in the following way: The mould is filled with powdered sugar of milk, previously made into a pasty mass with alcohol. The mould itself consists of a plate of hard rubber, glass, or metal, of the exact thickness of the tablets to be formed. It is pierced by a number of parallel rows of round holes of the diameter of the desired tablets. On either side are two additional single holes. The plate is laid on a flat surface, the prepared mass is forced, by means of a spatula, into the tablet holes, and all excess of the mass is care- fully removed. When the tablets are nearly set, the mould is brought over a plate contain- ing cylindrical pegs exactly corresponding to the tablet holes, the proper guidance of the mould being accomplished by two longer pegs, one on each side, which fit into the lateral holes of the mould. After the experimental tablets have been re- moved from the mould, they are thoroughly dried and weighed. They generally weigh 1-3 grain each, though this weight is slightly in- creased with any increase in the solvent action of the menstruum, since this causes more sugar to remain in a compact form in the tablet. Next it becomes necessary to ascertain how much milk sugar must be omitted from the ascertained amount to make room for the de- sired quantity of the medicinal ingredient. For this purpose 130 grains of milk sugar, corresponding to 100 plain tablets, are weighed off, and as much in bulk is removed from this as the apparent bulk of the medicinal sub- stance to be added. The amount of sugar of milk removed is ascertained by weighing. The active ingredient, if a dry solid, is now mixed by thorough trituration with the remaining sugar of milk. In the case of solid extracts, tinctures, and other fluids, these are mixed with the remaining sugar of milk, and the whole is brought to a solution by a suitable menstruiim, to insure uniform admixture. The solution is then evaporated and the residue re- duced to powder. When the powder or triturate is ready, it is wet with a suitable menstruum (see below) and moulded, care being taken that the whole mixture is transferred to the holes, which must all be filled, while none of the mass must re- main over. In most cases this is only an ex- perimental step, since, if there is either too much or too little of the mass, a new trial must he made, until there is just enough. But the proportions of sugar of milk and of me- dicinal ingredients thus ascertained will then hold good for the future, and it is only neces- 25; sary to keep a record of them for the particular combination in question. If at this trial it was found that there was not enough mass to fill all the holes, the weight of the deficiency is ascertained by finding the average weight of the finished tablets and de- ducting the calculated weight of the missing tablets from the weight of the bulk of sugar originally removed from the 130 grains. At the next trial the quantity to be removed should be less by the amount represented by the weight of the missing tablets. It is important that all the ingredients, as well as the mixture of powders ready for moulding, should be in the finest possible state of subdivision. The menstruum selected for moistening the mass should have a slightly solvent action upon one or more of the constituents, but the latter should not be too freely soluble, since the mass is then moulded with difficulty, and the tablets are apt to be uneven or become too hard. The solvent action should be so regulated that the resulting tablets will not crumble when shaken together in a phial, and yet will readily disinte- grate in water, either at once or at least after some time. The menstruum generally used is absolute alcohol, alcohol and water, or chloroform. For tablets consisting nearly altogether of sugar of milk, a menstruum of 3 volumes of alcohol and 1 volume of water is the most suitable. The larger the quantity of insoluble matters which is present in the mass, the more must the proportion of water be increased, the object being to dissolve enough of the sugar of milk to hold the particles together. This is, for instance, the case with tablets of re- duced iron, manganese dioxide, cerium oxalate, bismuth subnitrate, and similar substances. For tablets of codeine, leptandrin, aloin, etc., and bodies very soluble in alcohol, it is best to use only water. When a chemical reaction is expected to take place, so as to produce a new substance which is the desired active ingredient, the menstruum selected should not dissolve all of the partici- pants in the reaction, since the latter is ex- pected to be completed in the stomach. When the powder is ready, it is wet to a pasty condition by the most suitable men- struum, and then pressed into the holes of the tablet mould lying on the pill tile or other flat surface by means of a horn or ivory spatula which is drawn over the mould. Sometimes it will happen that the mass adheres to the spat- ula and is thus drawn out of the holes. This may be avoided or remedied by dipping the spatula in the menstruum used for moistening the mass, and then drawing it over the surface. The mould is then reversed by sliding it toward and off the edge of the tile, and the spatula applied to the other side in the same manner as before described. It is then applied to the peg plate (or pin plate), and the tablets are pushed out. They are allowed to dry for a few minutes on the pegs, then removed by striking the peg plate upon the counter cov- ered with a sheet of paper to receive the tab- lets. SYZYGIUM JAMBOLANUM 3 TABLETS If the tablets are to be finished quickly, a current of heated air is allowed to pass over the side which is to rest on the pegs. In drying tablets, it is best to use a sieve or wire cage, so as to permit of uniform drying on all sides. This is particularly necessary in the case of coloured tablets. Hypodermic Tablets.—These may be pre- pared in a similar manner with sugar of milk or some inert mineral salt as the base. Compressed Tablets,or Tabloids.—These con- sist of some medicinal substance or mixture, compressed in the form of discs. The sub- stance in this case should not be in fine pow- der, but in a granular form, being brought to this condition, if necessary, by a special pro- cess. Of course, if a mixture is to be brought into the form of compressed tablets, the ingredients must first be mixed most thoroughly by tritu- ration to a fine powder, and then brought into a granular form. This granulation is generally effected by mixing the powder with one tenth of its weight of cane sugar and one twentieth of powdered gum arabic, and moistening with water until the mass is of such consistence that it can readily be forced through a No. 12 sieve without sticking to it or clogging it, When it has thus been passed through the sieve it is dried. The finished granulation, which must be perfectly dry, is now forced through a No. 20 sieve, and the particles which do not readily pass through are forced through by the aid of a flat pestle. In moistening the granulated powder, the water must be added uniformly throughout, best in the form of a spray.and in small portions at a time. Substances which can be bought already granulated, or may be brought to this condi- tion by grinding and sifting, usually require no further preparation, and may be compressed at once—for instance, ammonium chloride, po- tassium bromide, sodium bromide, potassium chlorate, etc. In the case of the last-named salt, if it is to be combined with sugar, its danger- ously explosive property must not be forgot- ten. No trituration or forcible compression of a dry mixture of the salt with sugar must be attempted. Before the granulated substance is com- pressed, some lubricant must be added. The best has been found to be some hydrocarbon oil, which must be absolutely free from odour. A very small quantity is sufficient—about 10 or 12 drops for each pound of granulated mass. It is best added in the form of a fine spray and distributed by stirring the mixture. The particles thus become faintly lubricated and will be enabled to glide upon each other freely, easily falling into the mould space, feed- ing the same amount each time, and thus making the finished tablets equal in weight. The act of compression forces most of the oil to the surface of the tablet and lubricates the latter just enough to prevent it from sticking to the die. Finely powdered French chalk is generally used as an additional lubricant. It is added in small quantity, not to exceed 1 ounce for every 3 pounds, after the oil. Various forms of compressed-tablet moulds TABLOIDS TANNIC ACID 254 have been devised for preparing tablets on a small scale and for manufacturing purposes. A very important quality which compressed tablets should possess is that of rapid disinte- gration or solution, except in the case of those (for instance, of potassium chlorate) which are intended to dissolve slowly. In order to facili- tate their rapid disintegration, the mass to be granulated, if it requires it, is mixed with from one twentieth to one tenth of its weight of powdered starch. This is particularly neces- sary in the case of such substances as phenac- etine, acetanilide, sulphonal, trional, etc., as they would produce scarcely any effect at all if solution had to proceed gradually from the outside of a solid tablet. Indeed, without this addition such tablets would be likely to pass through the whole intestinal canal without losing much substance.—Charles Rice. TABLOIDS.—This is a synonym used in England to denote compressed tablets. Con- cerning the latter, see the article Tablets. Charles Rice. TAKA-DIASTASE.—This is a powerful amylolytic ferment, prepared by a process sim- ilar to malting, devised by Mr. Jokichi Taka- mine, a Japanese chemist, from a fungous growth on wheat bran. It is a tasteless and odourless powder capable of quickly convert- ing a hundred times its weight of starch into sugar, mostly maltose. It is used in the treat- ment of so-called amylaceous dyspepsia, and found to be exceedingly efficient. It may be given in doses of 2 grains, after eating. Dr. George Suttie, of Detroit (Medical Age, Sep- tember 25, 1895), has reported a number of cases in which its employment proved highly satisfactory. TALC.—What is generally known as talc, talcum (Ger. Ph.), is, properly speaking, steatite, or more probably a mixture of talc and stea- tite. As used in medicine, it is grayish-white in colour and has a greasy texture. It is em- ployed as a dusting powder, either by itself or combined with small amounts of boric or carbolic acid, as a soothing and protective application in intertrigo, eczema, and various other irritated conditions of the skin, and is probably the best agent of its class, except when it is to be applied to a surface secreting any acid fluid, when magnesia or magnesium carbonate is preferable, on account of its alka- linity. It is especially adapted for use on parts where there is more or less friction, as its unctuous properties allow of the free move- ments of the surfaces upon each other. Puri- fied talc, talcum purificatum (N. F.), is talc deprived of certain of its impurities by hydro- chloric acid. It may be used as a filtering agent, and, under the name of " French chalk," it is very largely employed to remove grease from fabrics, being powdered and applied over the spot and allowed to remain for an hour or two.—Russell H. Nevins. TALLOW.—Properly speaking, all animal fats that are solid at ordinary temperatures are grouped under this head, but the term is usually limited to the solid fats obtained from beeves and sheep. (See Suet.) The tallow obtained from the internal part of beeves is hardly suitable for medical purposes, as, unless prepared with great care, it contains more or less water, and speedily decomposes with the formation of various fatty acids that are irri- tating to the skin. That prepared from the adipose tissue surrounding the kidneys, the " short fat" of commerce, contains more stearin than the other varieties, and is the least objectionable.—Russell H. Nevins. TAMARIND, tamarindus (U. S. Ph., Br. Ph.), pulpa tamarindorum cruda and pulpa tamarindorum depurata (Ger. Ph.), is the acid- ulous pulp of the fruit of a semitropical and tropical tree, the Tamarindus indica, which is mildly laxative. It is often combined with other laxatives, and enters into the composi- tion of confection of senna. It may be given in doses as large as an ounce with safety, but larger amounts than that may give rise to griping. An infusion in water is an agreeable beverage in febrile conditions, when the stom- ach is in good order. Like nearly all vegetable preparations of the same class, it is moderately diuretic.—Russell II. Nevins. TANACETUM.—See Tansy. TANNAL.—There are two aluminum salts known under this name. The first, which is insoluble, is a basic aluminum tannate, Ala (OH)4(C14H909)2 -(- 10H2O, a brownish-yellow powder formed, according to Professor Cob- lentz, by precipitating a solution of an alumi- num salt with a solution of tannic acid in the presence of an alkali. The second, which is soluble, is aluminum tannic tartrate, AUfC^Hs 06)2(C]4H908)ii + 6H20, obtained, according to the same author, by treating insoluble tannal with tartaric. Both forms are astringent and antiseptic. The insoluble form is used by in- sufflation, and the soluble form in solution in nasal, laryngeal, and pharyngeal catarrh. TANNALBIN.—This is a German pro- prietary preparation. Gottlieb (Deutsche medi- cinische Wochenschrift, March 12, 1896; Therapeutische Wochenschrift, March 29, 1896) describes it as a slightly yellowish, tasteless powder containing fifty per cent, of tannin, made by subjecting a compound of tannin and albumin to a heat of from 212° to 248° F. for five or six hours, whereby it acquires the prop- erty of resisting gastric digestion, while it still remains susceptible to the slow action of the intestinal juices. Von Engel (ibid.) has found it serviceable in all diarrheal affections in which an astringent is indicated, especially chronic intestinal catarrh. It proved efficient in twenty-five out of twenty-nine subacute or chronic cases, and in nine out of ten acute ones. He reports that he has observed no harm from its use. The dose for adults is 15 grains, and that for children under four years old half that amount from two to four times a day. Vierordt (Deutsche medicinische Woch- enschrift, June 18, 1896 ; British Medical Jour- nal, July 4, 1896) has used tannalbin in some thirty selected cases, mostly of subacute or chronic intestinal catarrh, including ulcerative enteritis, occurring usually in young subjects. Regulation of the diet, other drugs as well as 255 TABLOIDS TANNIC ACID other methods of treatment, such as injections, etc., had produced no good effect. The astrin- gent action of the drug was well marked in the various forms of diarrhoea, even including cases of suspected tuberculous ulceration of the bowel. Inthe various forms of enteritis the stools be- came more solid and the mucus diminished, so that the dose of the tannalbin could soon be les- sened and its use discontinued. In four cases in which cod-liver oil containing either creosote or phosphorus produced diarrhoea, the stools became solid and less frequent when tannalbin was given in addition. No unpleasant symp- toms were produced by the tannalbin. The author discusses the possibility of a favourable action being exerted on internal organs, such as the kidneys, etc., when large quantities of tannin can thus be introduced into the body without inconvenience. Of five cases of chronic renal disease, tannalbin produced good effects in three. The drug does not produce constipa- tion in the healthy alimentary canal. The author looks upon tannalbin as being the best tannic-acid preparation yet introduced. If a favourable action is not"soon noted, the dose should be increased rapidly, the limit being 30 grains as a single dose, and 150 grains in the course of twenty-four hours. It may be given between or after meals in water or milk. TANNIC ACID.—This is an organic acid obtained from nutgall (U. S. Ph.). It is known officially as tannin, acidum tannicum (U. S. Ph., Br. Ph., Ger. Ph.), gallotannic acid, and digallic acid. The term tannin, however, is usually restricted to a class of vegetable prin- ciples which have many differences among themselves in other respects, but are alike in causing a green or bluish-black colour or pre- cipitates when ferric salts are added to their aqueous solutions, and form insoluble com- pounds with albuminous or gelatinous solu- tions. The tannin derived from galls differs from that from other sources by being con- verted into gallic acid on exposure to atmos- pheric air in a watery solution. Although tannic acid may be prepared from cinchona, tanacetum, kino, uva ursi, and the barks and roots of many other plants, the official product is derived from the nutgall. It is prepared by the action of ether upon the powdered nut- gall and the evaporation of the product, with- out, however, being an ethereal extract. Tannic acid may be derived from catechu and kino of the U. S. Ph., and from the elm bark of the Br. Ph. The variety of tannic acid obtained from these sources is known as mimo- tannic acid, which gives a greenish precipitate with neutral solutions of ferric salts. Accord- ing to some chemists, an unfermentable sugar results from its decomposition, together with an acid a little different from ordinary gallic acid. Bael fruit, official in the Br. Ph., is said to be efficient in diarrhoeal disease's because of the presence of tannic acid. The leaves of the edible Spanish chestnut contain about 10 per cent, of tannin. Among the other substances which contain tannic acid are the rind of the fruit of the pomegranate, haematoxylon, kra- meria, larch bark, the rhizome of geranium, sumach (in its leaves, stalks, and fruit), the winterberry, and the blackberry. Tannic acid is a yellowish or yellowish- white, non-crystalline powder of a highly as- tringent taste. It is nearly odourless, or has but a faint odour of ether. Its formula is Ci4Hio09. The acid is soluble in water, less soluble in alcohol and in ether; it dissolves in about its own bulk of glycerin. In solution it reddens litmus paper and it forms salts with alkalies. It precipitates albumin, starch, and gelatin, and furnishes, on the addition of a ferric-chloride test solution, a bluish-black pre- cipitate or colour. Tannic acid burns with a brilliant flame and, heated on platinum foil, it leaves little ash. The ready union of tannic acid with the vegetable alkaloids furnishes a test for the latter which is largely employed. It has a striking affinity for most of the mineral acids, forming precipitates. When it is rubbed with potassium chlorate an explosion of consider- able violence ensues. To distinguish tannic from gallic acid, the U. S. Ph. recognises two tests. One consists in adding to an aqueous solution of tannic acid a small quantity of calcium-hydrate test solu- tion. The production of a pale bluish-white precipitate, which is not dissolved on shaking, shows a distinction from gallic acid. The other difference lies in the fact that tannic acid causes a precipitate with most alkaloids and bitter principles and with solutions of starch, gelatin, and albumin. When tannic acid is applied to the skin or mucous membrane, in powder or in solution, it exerts a decided astringent effect. This is probably due to a contraction of the local blood-vessels, and the dryness of mucous membranes following its application may be attributed to the same influence. The astrin- gent action is persistent for some time, and it may be that this influence is enhanced by the coagulation of the mucus and to the constric- tion of the mouths of the mucous follicles. The local astringent influence of tannic acid takes place on all mucous membranes, whether it is actually applied or taken internally. When it is ingested, it probably forms an in- soluble compound, or one soluble with diffi- culty, with the acid juices of the stomach. These compounds, possibly albuminates, are slowly acted upon by the intestinal secretions, and the tannic acid may undergo changes which result in the production of gallic acid. After its administration tannic acid appears in the urine in the form of gallic acid, and one writer has recorded the finding of pyrogallic acid in the renal excretion after the ingestion of tannic acid. Locally, tannic acid is a more powerful astringent than gallic acid, and where it can be directly applied it is probably to be preferred, since the bulk of opinion inclines to the view that it is converted into its congener, gallic acid, when taken inter- nally. Individual susceptibility differs as to the effect wrought bv tannic acid when ingested; but, although there are no fatal cases of poi- soning recorded, there are a number of pub- TANNIC ACID 256 lished instances in which it has produced pain in the stomach and abdomen and, in a few cases, fever and a constitutional disturbance of a more or less severe nature. It can not, however, be included among the poisonous drugs, although large doses have caused a purulent diarrhoea lasting for some weeks. Tannic acid is taken up by the blood as gallic acid, but the source and manner of its conversion are not known. For this reason, as stated before, tannic acid may be preferred to gallic acid when it can be directly applied, as to the skin, to the intestines, or to the lungs or throat by spray; but for general internal use gallic acid should be chosen. Tannin is the chemical antidote of anti- mony, and where there has been poisoning by tartar emetic it should be given as promptly as possible in a strong solution. It forms a relatively insoluble precipitate with antimony, and with the vegetable poisonous alkaloids; but the precipitates are slowly dissolved in the intestines, and the tannic acid administration must therefore be accompanied by induced emeto-catharsis. Locally, tannin has been recommended in a host of ailments. As a local astringent, it may be used whenever any drug of its class is indicated. Trousseau praised its use in the treatment of chronic coryza, in the form of a finely pulverized powder used as a snuff. A snuff containing 3 per cent, of tannin is also said to abort an impending coryza. In epis- taxis its astringent action may control the haemorrhage. Good results have been ob- tained in the treatment of sore nipples by using a 1-per-cent. solution. Tannin in solution, in varying mild strengths, has been success- fully employed in excoriations about the anus and scrotum, in fissures of the anus, and in hemorrhoids. Suppositories of tannin are of particular value in the last-named ailment, especially when the piles are irritated or in- flamed. They become reduced in size, if at all susceptible to the action of astringents, and may completely disappear. Prolapse of the rectum has been treated in the same way with good results. Tannin as part of a gargle has proved valuable in cases of hypertrophy or relaxation of the uvula, and in acute, non-ex- udative inflammatory conditions of the phar- ynx. Hypertrophied tonsils, when not acutely inflamed, may be reduced in size in a similar manner or by the use of the glycerite of tannin, applied with a brush after a cleansing of the affected mucous membrane. In the treatment of chronic or acute inflammation of the eye- lids tannin has been employed with alleged satisfaction. Druitt praised its use in the form of powder or the glycerite in the treat- ment of aphthous ulcers of the mouth and of stomatitis of whatever origin. [Dr. M. A. Veeder, of Lyons, N. Y. (Medical Record, March 28, 1896), reports a rebellious case of extensive suppurating sinuses cured with a strong solution of tannin after various other applications had failed. At first a mod- erately strong solution was tried in one of the sinuses in the arm; it acted so satisfactorily that its strength was increased until it was nearly a saturated solution and the entire tract of the cavity was filled with it. The immedi- ate effect was to coagulate the pus into a cheesy mass, which, when the parts were squeezed, came out of the various openings in the form of long worms. All this material was simply washed out with plain water and there was no longer any purulent secretion whatever, a clear fluid only appearing, and the sinuses and cavi- ties healed very kindly and with great rapid- ity. The interior of "the abscess cavity and sinuses, in short, says Dr. Veeder, was simply " tanned."] Vesical catarrh is said to have yielded to daily injections of tannin, of a strength of 3 per cent., when other treatment had failed to cure. In chronic urethritis in men and in elytri- tis of gonorrheal or other character, injections and douches have resulted in cure. For the former, the glycerite of tannin or a 10-per- cent, solution has been used; for the latter, a powder containing equal parts of alum and tannin is employed. A teaspoonful of this powder dissolved in a quart of water and used as a douche is equal to any other means of treating gonorrhceal. elytritis, when combined with the other necessary hygienic and thera- peutic measures. When tannin forms a part of the medicating agent of a douche for a pregnant woman, however, its percentage must be reduced, because of the possibility of evok- ing contractions in the muscular layers of the cervix. Actual abortion, it is true, has prob- ably never been called forth by the drug; yet the individual susceptibility of gravid women varies so greatly that due caution should be observed. In ordering a douche of alum and tannin for a pregnant woman with gonorrhoea, the proportion of 1 part of tannin to 4 or 5 parts of alum is a safe one ; or, if one's fear of cervical contraction should have a clinical foundation, the tannin may be omitted, de- spite its virtue in blennorrhagic elytritis. It is doubtful if the tannic-acid treatment of acute gonorrheal urethritis in men should be recommended. Although it still has advo- cates, it has been unquestionably superseded. Before plastic surgery on the genital organs of women had reached its present develop- ment, prolapsus uteri, proctocele, and cystocele were frequently treated by means of tampons soaked m a saturated solution of tannic acid, and good results were no doubt frequently obtained. Very often in these cases it is ad- visable to try douches of an astringent charac- ter before resorting to surgical measures, for by these innocuous means the symptoms may sometimes be relieved and an operation avoided. Tannin has been praised in some affections of the skin in which a local astringent action is desired. Ringer advised its use, in the form of the glycerites, in cases of eczema. He asserts that a specially valuable result is ob- tained in the early stages of the disease, when the skin is red and swollen and exudation is free (Practitioner, i). He alleges that by its use the itching and burning are subdued and that the irritation of the skin by scratching is thus avoided. Impetigo and 'intertrigo are 257 TANNIC ACID said to have yielded to the use of tannic acid in an ointment. The drug is usually a com- ponent in preparations intended to allay hyperidrosis of the hands and feet, and it has been recommended, in a 1-per-cent. solution, in the treatment of offensive axillary sweating. Tannin has been used, in ointment form, for all excoriations and abrasions of the skin, par- ticularly where they have been kept up by irritating discharges from neighbouring organs or lesions. It has also been recommended in the treatment of chilblains, and is probably as valuable as most other remedies used for the purpose. Tannic acid has been used in the treatment of burns with good results, it is alleged, sub- duing pain and aiding in the formation of granulations. A solution of the acid in a strength of 1 to 4 in tincture of benzoin is said to prevent the formation of pustules in variola. As a vermifuge, tannin has some reputation in the treatment of threadworms in children. For this purpose it may be injected into the rectum in solution. As a styptic by internal administration, tannic acid is widely known. It was first used as a haemostatic agent in menorrhagia and subsequently in all forms of uterine hemorrhage whether of functional or organic origin. It is to be recommended for these conditions only when they are not otherwise controllable. In passive hemorrhages from the stomach and intestines its constricting and haemostatic properties have been called upon to allay bleeding. Its use is favourably com- mented upon in cases of hematuria, even when this condition is dependent upon organic change. In the hemoptysis of pulmonary tuberculosis its employment in a spray is some- times of benefit, and in cases of hemophilia tannin may be used when other haemostatic agents do not accomplish the desired result. As a local hemostatic, as in the nose, in the rectum, or applied to bleeding varicose veins or to punctured wounds of any kind, it is valu- able, though probably inferior to some other agents. It may be used in these instances in the form of styptic collodion or in a concen- trated aqueous solution. [Dr. Rosweil Park, of Buffalo (Medical News, November 16, 1895), has called attention to a preparation made by mixing antipyrine and tannic acid in solution, by which there is pre- cipitated an intensely agglutinative and co- hesive substance which is the best styptic for certain purposes that he knows of. This com- bination he first resorted to in a case of appar- ently intractable haemorrhage after the removal of adenoid tissue from the vault of the phar- ynx, to which he was called in consultation. The surgeon in attendance happened to have at hand a bottle of alcoholic solution of tannin, while Dr. Park was provided with antipyrine in powder. The case being urgent, he sug- gested the combination of the two styptics, and added the dry powder to the solution. To the surprise of both gentlemen, there was formed at once a gummy mass, at first flocculent, which quickly cohered, the result being a com- bination the adhesiveness of which quite aston- ished them. A small sponge dipped into the fluid containing this material in suspension was inserted into the post-nasal space, and the haemorrhage was instantly checked, not to re- cur. Dr. Park has since experimented with these materials, and has found that they may be united in almost any proportion with the formation of the gummy mass. He suggests that the substances be mixed in proportion to the emergency of the case and to the desire for little or much of the resulting compound. It is possible, he says, by adding strong solutions, or by pouring the powder of one into the solu- tion of the other, to precipitate so much of the agglutinative compound as to make a gum that may be placed about the margin of bleeding bone—for instance, in operations upon the cra- nium. Or a small piece of sponge or cotton sopped in this material may be forced into a tooth-socket, or in various other ways its use may be made to result in benefit and satisfac- tion. There is but one attendant difficulty— it is so remarkably cohesive that when the time comes for detachment or separation of the tam- pon it is difficult to remove it. It may be even necessary to wait a sufficient time for the for- mation of granulations and separation by nat- ural processes.] By internal administration, tannin is said to combat successfully cases of atonic dyspep- sia. In diarrheas in which no active inflam- matory condition is present it is in frequent use, and usually is an element in the diar- rhoea and cholera mixture sold in the shops. If the lesion is in the lower part of the intes- tinal tract, enemata of tannin are efficient in chronic diarrheas and dysentery. It has been given internally for night sweats, bronchitis, and phthisis, although in the last-named dis- ease its reputation rests purely upon theoreti- cal grounds. The allegation once made for the drug that it diminished the albumin in albuminuria has not been substantiated by further investigation. In bacteriological work, tannin mixed with sulphate of iron has been employed by Loffler for the staining of the flagella of typhoid fever and cholera bacilli. In the arts, as is well known, it is used to convert hide into leather. During the epidemic of cholera in Italy in 1884 Dr. A. Cantani began the use of entero- clyses of tannin in the treatment of this dis- ease. His procedure was to inject into the intestinal canal of all patients, severely or mildly ill, from 2 to 4 pints of a 1-per-cent. solution of tannin in boiled water. The tem- perature of the solution was from 100° to 104° F., and the fluid was allowed to run into the intestine gently from a height of from three to six feet. This procedure was repeated sev- eral times daily with results, according to the statistics of Cantani and others, that were de- cidedly encouraging. The enemata were begun, in the first series of cases, when stubborn vomit- ing which could not be controlled by opium had set in. Subsequently the enteroclyses were begun as soon as any symptoms of cholera manifested themselves, and in these cases, sometimes after one treatment, the diarrhoea and the vomiting ceased. TANNIGEN TANNIGENE 258 The advantages alleged by Cantani were based on bacteriological and clinical evidence. He found, in conjunction with other observers, that the exposure of pure cultures of cholera bacilli to a 1-per-cent. solution of tannin at a temperature of 102° F. for an hour and a half killed the bacilli and rendered subsequent inoculations of gelatin or bouillon from the culture experimented with sterile. A half-per- cent, solution of tannin accomplished the same result in six hours. Since tannin is innocuous to man, it therefore formed the most valuable antiseptic agent for use against the cholera bacilli. By employing the solution in the manner indicated, Cantani believes that fre- quently the ileo-caecal valve is forced open and the diseased small intestine directly attacked. He maintains that the fluid reaches the small intestine, not only by the pressure it exerts, but by the antiperistaltic action evoked by the column of water. Further, he argues, the con- striction of the mucous membrane determined by the tannin diminishes the absorption by the intestine of ptomaines and the other biological poisonous products of the bacilli present, at the same time emptying the intestine of its noxious contents. He modestly adds that, even if the enemata do not prevent the accumulation of toxic materials, at least they do not foster it. He lays stress, finally, upon the inability of the comma bacillus to thrive in an acid medium and gives the assurance that the return flow of the fluid invariably reddens blue litmus paper. By the employment of this method, after each defecation or diarrhoeal stool, Cantani asserts, the mortality record is materially lowered; he adds that the earlier the treatment is begun the better are the results, that the heat of the solution and the absorption of fluid are bene- ficial to the patient in stimulating the heart, the lungs, and the nervous system, and that frequently patients so treated do not go into the algid stage. He maintains even that after the dreaded algidity has appeared life may be saved in some cases by the employment of the tannin enemata. He sometimes adds from 20 to 30 drops of laudanum to the solution injected, which may be made with infusion of chamo- mile instead of water. The rectal treatment should be accompanied by general stimulation and, when necessary, by subcutaneous or intra- venous infusion of hot sterilized water (100° to 103° F.) containing in solution 3 per cent, of bi- carbonate of sodium and 4 per cent, of chloride of sodium. Animal experimentation seems to bear out Cantani's belief that the function of the tannin is to form insoluble tannates with the toxic materials in the intestine. (Die Er- gebnisse der Cholera-Behandlung mittelst Hy- podermoclyse und Enteroclyse wahrend der Epidemic von 1884 i>n Italien, von A. Cantani, Leipzig, 1886; Die Cholera-Behandlung, von A. Cantani, Therapeutische Monatshefte, June, 1888; Berliner klinische Wochenschrift, Sep- tember 12, 1892.) Von Generisch does not believe that the good results of Cantani's treatment resulted from the presence of tannic acid in the fluid used, but thinks that, with sufficient pressure, the ileo-caecal valve can always be opened. He therefore proposes a modification of Can- tani's method by passing into the rectum a large quantity of water from a height of from 2 to 4 feet. He asserts that after allowing from 15 to 20 pints to flow into the rectum, it will appear at the mouth, thus washing out the entire alimentary tract. Although this process of diaclysm (or diaclysis) is not attractive, the author asserts that the cleansing process is the main result desired. He eraplovs tannin in a strength of 1 or 2 parts to 1.000, but believes that a salt solution or any indifferent fluid would be equally efficient (Deutsche medicin- ische Wochenschrift, 1893, No. 41). Tannin may be administered in the form of pills, capsules, or troches. Its dose is from 3 to 10 grains. When given for haemorrhage, it is best administered in aqueous solution, sweetened and flavoured, or in an emulsion. For external employment, a watery solution of from 3 to 10 grains to the ounce may be used. A solution containing 2 parts of tannin and 1 part of gallic acid is more astringent than one of tannin alone. As solutions of the iron (ferric) salts are precipitated by tannin, they must not be given at the same time. Tannin bougies, cereoli cum acido tannico, are bougies 2^ inches in length, containing |" of a grain of tannic acid made up with syrup and gum arabic. Collodium stypticum (U. S. Ph., Br. Ph.) contains 20 parts by weight of tannic acid, 5 of alcohol, 25 of ether, and of collodion a suf- ficient quantity to make 100. This is a modi- fication of the original styptic colloid of the late Sir Benjamin Ward Richardson, of London, which did not contain sufficient tannin for the required purposes. Styptic collodion may be applied to shaded or wounded surfaces to pre- vent the admission of air. The ether and alcohol evaporate, leaving a stiff coating which, if the wound is aseptic, forms an excellent pro- tective dressing. It may be applied with a camel's-hair brush or with cotton saturated with the solution. For special purposes, mor- phine, carbolic acid, or other antiseptic agents may be incorporated with it. For small, bleed- ing wounds or for ulcerated surfaces it forms a most efficient coating. It must be kept away from a flame, since the vapour of ether may take fire. Glycerite, or glycerine, of tannin, glyceritum acidi tannici (U. S. Ph.), glycerinum acidi tannici (Br. Ph.), contains 20 parts of tannin and 80 of glycerin, and is prepared by heating the two substances over a water bath. It is the most valuable preparation of tannin for external use. It may be applied with benefit to suppurating surfaces of small extent and is of use in chronic ozena, in chronic otitis media, and in chronic relaxation of the pharyngeal vault. It makes a good dressing for irritating cutaneous eruptions, and, applied to the nip- ples during the late months of pregnancy, will frequently prevent the development of fissures of the nipples during the nursing period. In- ternally, it may be administered for any of the purposes for which tannin is used, in doses of from 10 to 40 minims. Suppositories of tannic acid, suppositoria 25 acidi tannici (Br. Ph.), contain each 3 grains of tannic acid and 12 grains of cacao butter. The suppositoria acidi tannici cum sapone (Br. Ph.), suppositories of tannic acid and soap, contain each 3 grains of tannic acid, 10 of glyc- erite of starch, 8 of curd soap in powder, and 7$ of starch powder. Although the amount of tannin is small for rectal use in an adult, the suppositories are used in cases of fissure of the anus and prolapse of the rectum, They are useful also in the treatment of internal hem- orrhoids. Tannin troches, or lozenges, trochisci acidi tannici (U. S. Ph., Br. Ph.), are used in relaxed conditions of the mucous membranes of the mouth, throat, and larynx, and to allay coughs arising from these states. In mild cases of angina they may be employed, allowing them to dissolve slowly in the mouth. In diarrheas, after washing out of the rectum, they may be administered for their astringent effect. The U. S. troches contain each about 1 grain of tan- nic acid, the British each £ grain. The troches of the two pharmacopoeias differ also in the vehicles and sweetening elements. Ointment of tannic acid, unguentum acidi tannici (U. S. Ph.) contains 20 parts of tannin to 80 of benzoinated lard. It is very useful for local application in the treatment of external or prolapsed hemorrhoids, sometimes produc- ing a cure by causing contraction of these varicosities. Applied to indolent ulcers, it some- times induces granulations. Albuminate of tannin.—See Tannalbin. Aluminum tannate, aluminii tannas, has been recommended for its efficacy, in aqueous solution, in the treatment of acute gonorrhea. The drug is not readily soluble in water, how- ever, and cannot be recommended. Bismuth, tannate, bismuthi tannas, is a light-yellow powder, insoluble in water and tasteless. It contains 53 per cent, of bismuth oxide and 47 per cent, of tannin. It is astrin- gent in its effect and has been employed in diarrheas, gonorrhea, leucorrhea, and puru- lent inflammations of the conjunctiva, Cannabene tannate is a yellowish-brown powder, insoluble in water and in ether, slightly soluble in alcohol. It has an odour which is not entirely unpleasant and a bitter taste. It is said to be the tannate of a glucoside. It is hypnotic in its effect, though not reliable. It is said to Ke devoid of the exciting effects of the extract of cannabis indica. The dose is from 4 to 20 grains. Iron tannate, ferri tan n as, is prepared by precipitating cold solutions of ferric salts with tannin. A mixture of ferrous salts and tannin, exposed to atmospheric influences, will also deposit ferric tannate. It occurs in a black or bluish-black powder which is easily decomposed by the mineral and the stronger organic acids. It has been used in chlorosis and anemia in amounts of from 8 to 30 grains in a day in pill form. Ink is a watery solution of ferric gallo- tannate, and is popularly supposed to be a remedy for ringworm. Mercury tannate, hydrargyri tannas. is odourless and tasteless and is insoluble in ordinary media. Acted upon by alcohol or TANNIGEN 9 TANNIGENE water, however, it liberates tannic acid. It may be prepared by precipitating a concen- trated solution of tannic acid and oxygenated mercurous nitrate, or by rubbing the two sub- stances together. It was first suggested by Lustgarten as a substitute for other mercuric preparations in the treatment of syphilis (Cen- tral blatt fur die gesammte Therapie. ii; New York Medical Journal, March, 1892). Although it contains 50 per cent, of metallic mercury, it is alleged for it that its special advantage is that it is not affected by the acid juices of the stom- ach, but remains stable until it comes in contact with the alkaline secretions of the small intes- tine. Within twenty-four hours it appears in the urine as mercury and is absorbed from the intestine in minute globules of the metal. It does not salivate or cause gastro-intestinal dis- turbance. It may be given in doses of 3 grains thrice daily to an adult, increasing to 5 grains until from 100 to 150 grains are being taken. Potassium tannate has been proposed as a substitute for the sodium salt, but it presents no special advantages and is rarely used. Quinine tannate contains 40 per cent, of quinine. It is a very insoluble salt and has but from % to \ the power of the sulphate. It is very slowly dissolved in the stomach and has little thermolytic influence. It is of value prin- cipally in nervous affections or as a substitute for the cinchona bark. Its tastelessness, or, rather, lack of bitterness, may be attributed to its difficulty of solution, and renders it suit- able for administration to children in malarial diseases. The dose is three times that of the sulphate. It has been recommended for whoop- ing-cough. Tablets made up with chocolate, each containing 1 grain of the drug, are in the market. Sodium tannate, sodii tannas, is prepared by dissolving 75 grains of tannic acid in 5 oz. of water and saturating the solution with bicarbonate of sodium. It has been used in albuminuria in doses of \ oz. given every two hours; but it not only failed to relieve the condition, but possibly caused death from urae- mia (Centralblatt fur die gesammte Therapie, i). Samuel M. Brickner. TANNIGEN, TANNIGENE, C14H8 (CH3.CO)209, is an acetic-acid ester of tannin in which two molecules, each, of three hydroxyl groups are replaced by one of acetyl. It oc- curs in the form of a yellowish-gray powder, without odour or taste. It is insoluble in cold water and in dilute acids, but dissolves freely in cold alcohol and in dilute alkaline solution. The experiments of Meyer, who first produced the drug, show that its influence on animals is not injurious. It produces no gastric disturb- ances, and is well tolerated even in large doses. Tannigene passes unchanged into the small intestine, where it is split up into tannic acid and acetate of potassium. It has been found as such in the faeces, so it is probable that the alkaline juices of the intestines do not break up all the tannigene ingested. Escherich (Therapeutische Wochenschrift, March 9,1896) finds that even when tannigene is excreted in the faeces some astringent effect is TANNIN TAR 260 exerted upon the intestinal mucous membrane. When there is increased secretion, however, and the intestinal juices are thoroughly alka- line, Escherich believes that tannigene is al- ways split up into its elements and exerts an elective influence upon those places where the exudation is most intense—that is, where the disease is most marked. He finds its most use- ful application in cases where the lower part of the intestinal canal is affected by a non- acute inflammatory process, and alleges that nutrition and absorption are fostered by the diminished secretion of mucus. In the same article the author lays stress upon the disin- fecting properties of tannigene and on the for- mation of insoluble compounds with alkaloids and toxines, as lending to its virtues. The therapeutic indications for the use of tannigene include the summer diarrhea of chil- dren and subacute and chronic diarrheas occur- ring in the course of pulmonary phthisis, and dysentery. Some writers have professed to have treated successfully acute enteritis and gastro- enteritis with it, but the weight of evidence seems to be in favour of its employment in subacute and chronic intestinal disturbances. Tannigene is said to exert a beneficial influ- ence upon the stools in subacute enteritis as early as the second day of its use; and in chronic diarrhoeas, although it is not so rapidly effective, the faeces become formed and are free from mucus early in the treatment. Dietetic instructions must, of course, be simultaneously observed. The good results from the use of tannigene do not seem to be confined to the intestinal mucous membrane. Oases have been reported of gastro-enteritis in which tannigene is said to have stopped the vomiting after one or two doses. The drug has also been employed in hay fever with alleged good results. It is said to be excellent, used as a snuff, in acute and chronic coryza. Insufflations of tannigene have been used in acute otitis media, and the antiseptic and astringent effect of the drug relieved the existing symptoms. Good re- sults have been reported from the applica- tion of a 3-per-cent. solution of tannigene in a 5-per-cent. solution of phosphate of sodium in the treatment of acute and chronic pharyngitis and laryngitis. It is said that a disagreeable taste has followed its employment in these in- stances. The dose of tannigene is from 3 to 10 grains, given from three to six times daily, the dose varying with the age of the patient, Escherich found it advantageous to give a large initial dose—15 grains to adults, and from 5 to 8 grains to children. It may be administered in milk or gruel, or taken dry on the tongue, followed by a drink of water. It may be combined with a salt of bismuth or with some other insoluble intestinal antiseptic if thought advisable. (See also Acetyltannin.)—Samuel M. Brickner. TANNIN.—See Tannic acid. TANNOFORM is a condensation product of tannic acid and formaldehyde, of the for- mula C29H20Oi8. It is a light reddish-white powder, insoluble in water and in acids, but dissolves in dilute alkalies. It is tasteless and. odourless. Advantages have been alleged for it over tannic acid. It is said to have an in- different action upon the gastric mucous mem- brane and to cause no irritation in the stomach, as sometimes happens when tannic acid is ad- ministered. Since acids do not dissolve tanno- form, it is not assimilated by the stomach juices, but reaches the intestinal canal un- changed, where it can exert its action, which is said to be similar to that of tannic acid. Its advocates allege that tannin, on the contrary, is of harsh, astringent taste, and forms insoluble precipitates in the stomach with albumin, pep- tone, and gelatin, thus rendering it impossible for it to reach the intestines in an active form. They also maintain, what is not strictly true, that small doses of tannin corrode the gastric mucous membrane, diminish the appetite, and cause a sensation of weight and pain. These disagreeable effects are said to be absent after the use of tannoform. The new drug may be given in cases of diarrhea and dysentery, for an astringent effect, in doses of from 5 to 15 grains three times daily. Applied locally, tannoform, it is alleged, checks excessive sweating, and it has been used with good results in hyperidrosis of the feet. In this affection it is said to surpass in efficacy both tannic and salicylic acids. In the treat- ment of old wounds, ulcers, and moist erup- tions, it may be used pure in a 10-per-cent. ointment, or mixed with equal parts of starch or chalk. It has been used in a strength of 1 part to 4 parts of starch as a dusting powder for soft chancres, and is said to be useful in the treat- ment of diabetic pruritus vulve. As a snuff in ozena, tannoform has also been recom- mended. (Therapeutische Wochenschrift, May 10, 1896.)—Samuel M. Brickner. TANOSAL.—This is a synthetical tannic- acid ester of creosote, an amorphous, dark- brown, very hygroscopic powder having a faint odour of creosote. On account of its prone- ness to deliquesce, it can not be dispensed as a powder. It is on the market in the form of a watery solution of a definite strength and in that of pills. Each pill contains about 5 grains of tanosal, equivalent to 3 grains of creosote. On account of the ready solubility of tanosal, it is easily administered in water, and it is not irritating to sound mucous membranes; yet, because of its harsh taste, the solution should be freely diluted—a tablespoonful with half a glass of sweetened water. Dr. G. Kestner, of the civil hospital in Miihl- hausen (cited in the Therapeutische Wochen- schrift, November 22,1896), thinks that tanosal is better borne by the digestive organs than any other preparation of creosote. It seems to be excreted, he says, neither unchanged nor in the form of creosote. He has used it in more than seventy-five cases. The usual dose is a tablespoonful of the solution, three times a day, gradually increased in some cases to double that amount. There have been in- stances, he says, in which patients have taken as much as nine tablespoonfuls in a day with- 261 TANNIN TAR out any inconvenience. In three cases of tu- berculous intestinal ulceration, however, the remedy gave rise to colic and diarrhoea, even in small doses. In many cases it became dis- tasteful after being used for a long time, but generally the distaste was overcome. Among the patients there were thirty-three with pulmonary tuberculosis, fifteen with acute bronchitis, eleven with chronic bronchitis, one with chronic broncho-pneumonia, five with bronchitis incidental to infectious diseases, and ten with simple catarrh'of the throat and bronchi, and it was in the last-mentioned class of cases that the best results were obtained. Reduction of the bronchial secretion is the chief effect of tanosal, and to accomplish such reduction Kestner thinks it at least equal to terpene. Its action is the more pronounced the more recent the case, but even in cases of long standing it diminishes the expectoration and the dyspnoea. Children, he has found, re- spond to it more readily than adults, and for them the amount to be taken daily is commonly a teaspoonful of the solution for each year of age. In phthisical cases, he states, it acts as well as any other preparation of creosote. TANSY, Tanacetum vulgare, is a perennial herbaceous plant indigenous to Europe, but naturalized in the United States. The parts used in medicine are the leaves and flowering tops. The herb grows to the height of from two to three feet. The leaves have a peculiar fragrance, and a bitter, slightly acrid, and aro- matic taste. Tansy has been employed in the treatment of intermittent fever, as a diuretic and stimu- lant in rheumatism and in hysteria, and the seeds are recommended as a powerful anthel- mintic The oil is also an effective vermifuge. The drug is perhaps best known from its domestic use as an emmenagogue and an aborti- facient. Its action, however, either as a stimu- lant to the menstrual flow or as an ecbolic, is extremely uncertain, and grave symptoms have followed its administration. Death has resulted even from the ingestion of small doses—a drachm—of the oil, yet as much as four drachms have been taken without fatal effect. A case is reported in which a large quantity of the infusion, taken internally, pro- duced death. The toxic effects are abdominal pain, vomiting, purging, paralysis of the mus- cles of deglutition and respiration, rapid and full pulse, convulsions, coma, asphyxia, and death. The powder is given in doses of from 30 to 60 grains. The dose of the oil as an emmena- gogue is from 1 to 3 drops. The infusion is made by steeping an ounce of the tops or leaves in a pint of water, and is given in quantities of 1 or 2 oz.—Charles Jewett. TAPIOCA is an amylaceous food obtained from Manihot utilissim'a, indigenous to Brazil, where it is known as the manioc plant. It is cultivated also in the West Indies, where it is known under the name of cassava. It is culti- vated in other portions of tropical America and in Africa as well. It is perennial, and grows in the form of a bush, from six to eight feet in height. The roots are tubers of great size, sometimes weighing thirty pounds. From three to eight of these tubers grow in a cluster. They consist largely of starch, and are the edible part of the plant, Most varieties con- tain a bitter, acrid juice, which is intensely poisonous. owing to the presence of prussic acid. This is dissipated by washing, drying, and cooking. The starch obtained from the tubers is ground by the natives, dried, and again pulverized to form " cassava meal." The tapioca of commerce is made by heating the meal on hot plates and stirring it with an iron. As the starch granules burst, a portion of the starch is converted into dextrin, and the whole conglomerates into small irregular masses. The uncooked starch is sometimes imported into this country under the name of Brazilian arrow- root. Tapioca, like arrowroot, sago, and other forms of simple starch, is used largely as a food, and is well adapted to the needs of the sick. Like them, it has no medicinal proper- ties.—Floyd M. Crandall. TAR is a highly complex product of the destructive distillation of organic substances and bituminous minerals, more particularly of certain woods and of coal. The commonest variety of wood tar, pix liquida (q. v.), is de- rived from conifers, especially Pinus palustris (in this country), Pinus silvestris, and Larix sibirica (in Europe). It is a thick, dark-col- oured, viscid liquid, and has an acid reaction, a peculiar empyreumatic odour, and a bitter taste. It is produced by distillation per de- scensum. It may be described as an impure turpentine, containing, besides turpentine, as its most important constituents, various sub- stances of the phenol group and pyroligneous acid. When it is subjected to redistillation in stills, the "oil of tar" is separated from the pitch. Oil of tar, oleum picis liquide, is a volatile, oily liquid, which is more or less colourless at first, depending upon the amount of impurities it contains, but gradually becomes darker with age, from oxidation. It has a complex com- position, containing oil of turpentine and acetic acid, with the phenols and most of the empyreumatic ingredients of crude tar, which it resembles in odour and in general properties. Like crude wood tar, the oil is soluble in alco- hol, in ether, in chloroform, in volatile oils, and in solutions of caustic alkalis. Oil of cade, oleum cadinum, oleum juniperi empyreumaticnm, is an empyreumatic wood tar, obtained by distillation per descensum from the wood of Juniperus oxycedrus (Linn., Ord. Co- nifere), a tree found chiefly in lands border- ing on the Mediterranean. It is thinner than common wood tar (pix liquida). black in mass, but brown or brownish yellow in thin layers. Its odour is pleasanter than that of the com- mon tar, which, however, in most respects it resembles. Its taste is acrid and bitter. It contains a large proportion of acetic acid. Oleum rusci is a tar obtained from the bark or other woody portions of Betula alba, chiefly in Poland and in adjacent parts of Russia proper. Birch tar has also been known as TAR 262 " Russian oil," oleum seu betulinum musco- viticum. The origin of the term oleum rusci is obscure. It has been suggested by MacEwan that it is derived from the Polish brzoza (birch), which became corrupted and Latinized into Bruscus and Ruscus. The mode of obtaining the birch tar has varied. At present it is said to be produced by distillation per descensum, as was most com- monly the case in the past. All that is now in the market is said to be produced in this way. Formerly it was rectified by a second distilla- tion. The rootlets and twigs were subjected to dry distillation in crude clay retorts con- nected by wooden pipes with a receiver buried in the ground. Such a rectified product, how- ever, is rarely if ever obtainable at the present time. It is a thick, brownish-black liquid, having the fragrant odour that we are familiar with in Russia leather. It is said to contain a larger amount of pyrocatechin than oil of cade, but less pyroligneous acid, though in its general properties it closely resembles oil of cade. Beech tar, oleum fagi, is a wood tar similar to oleum rusci and oil of cade, and is the prod- uct of Fagus silvatica, or Fagus silvestris. It has been one of the chief sources of creosote. Though often mentioned by medical authorities abroad, especially German, commercially the name is said to have little significance, except as a synonym for wood tar, or as another name for oleum rusci. It is stated on good authority that real beech tar does not at the present time exist in the market. A beech oil obtained by expression from the fruit of the tree is occa- sionally met with, and is also known as oleum fagi. It is a bland oil of a yellow colour, has a slight odour and a mild taste, and resembles almond oil. Coal tar,pixliquida lithanthracis, pix liqui- da e liquo fossili, is a semi-liquid, viscid sub- stance, black in mass, greenish-black in thin layers, of a strong, penetrating odour, and but slightly acid or alkaline reaction. It is one of the by-products of the manufacture of illu- minating gas from bituminous coal. Its com- position is very complex, including carbolic acid in large quantity, together with rosolic acid; the alkaline bases ammonia, aniline, quinoline, and pyrrhol; the neutral hydrocar- bons benzol, toluol, cresol, naphthol, naphtha- line, chrysene, anthracene, cumene, and many others. The neutral substances constitute the greater portion of it. In its physiological as well as in its thera- peutical action, tar is closely allied to turpen- tine, though certain of its effects, due to the large amount of carbolic acid or other phenols which it contains, are peculiar to it. To in- sects and other low forms of life it is destruc- tive, and in large doses it is toxic to the human organism. In moderate doses wood tar is an excitant, increasing the rapidity of the pulse and stimulating the secretions of the lungs, kidneys, and skin. If it is given in larger doses, the appetite is impaired, with more or less serious derangement of digestion, headache, and manifestations of general intoxication. These symptoms have been observed more par- ticularly after the external use of the drug. When it is freely applied, absorption may take place in sufficient degree to give rise to alarm- ing symptoms that correspond to those of car- bolic-acid poisoning. Their onset may be sudden, and occur soon after the beginning of the treatment, sometimes following a single application when the surface to which it is made is extensive. The condition is charac- terized by fever, headache, loaded tongue, belching, nausea, vomiting of black tarry mat- ter, colic, diarrhoea with tar-like evacuations, strangury, and ischuria, the urine becoming greenish, and finally black, emitting the char- acteristic odour of tar. After from twenty- four to forty-eight hours, if the applications have been suspended, the symptoms gradually abate, with copious diaphoresis and some diu- resis. First the urine turns from black to olive-green, and becomes lighter and lighter in colour till the condition finally becomes normal. It is said that if the use of the remedy is afterwards resumed the patient becomes less intolerant of it, and no further trouble is ex- perienced. Children and young persons are most susceptible. When tar in a concentrated form is applied directly to a sensitive skin, it is apt to cause irritation with an eruption of a spreading ery- thema, or of inflammatory papules, which may assume a peculiar and very characteristic ap- pearance. When the applications of tar have been extensive a follicular inflammation is apt to result, with occlusion of the sebaceous fol- licles by comedo-like plugs, composed of par- ticles of tar. It is most likely to occur over the exterior surface of the lower extremities where the hairs are abundant. Hard and more or less painful papules form, varying in size from that of a pin head to that of a pea, of a reddish- brown colour, with a black point showing in the centre of each. They may be accompanied with the formation of nodules of larger size, or with furuncles. The affection is known as " tar acne," acne picealis. Sometimes the internal use of tar is attended with the production of a cutaneous rash, which may be either erythematous, rubeolous, or urticarial in character. In common with all balsaraics, tar has a specific action on mucous tissue, whereby it becomes an effective anticalarrhal aqent. In health, it tends to increase secretion, but where there is supersecretion due to a subacute or chronic inflammatory congestion, the secretion is diminished. In the bronchorrhea of phthisis and other pulmonary affections it is often a useful remedy, and also in chronic or subacute vesical, urethral, and vaginal catarrh. The usual dose is from \ a drachm to \ oz. a day. It may be given in milk or beer, or in the form of pills or capsules. The glycerite is also a convenient and acceptable form of administra- tion. Tar water, for the same purposes, may be given to the extent of from 1 to 2 pints a day. The vapour of tar is used for inhalations in pulmonary troubles with excessive secretions and also for deodorizing and purifying vessels and sick-rooms. The tar having been mixed with carbonate of potassium in the proportion 263 TAR of 1 to 24, for the purpose of neutralizing the pyroligneous acid, which would irritate the lungs, is put into a cup which is placed in a small water bath over a spirit lamp. In this way the air of the room becomes gradually charged with the vapour. For the purpose of inhalation, the same effect may be accomplished more simply by letting the patient inhale the fumes of tar water or wine of tar by means of the steam atomizer. In diseases of the skin, more particularly in those in which the mucous layer is specially implicated, tar is a much more effective remedy than it is in diseases of the mucous membrane proper. In eczema and psoriasis tarry appli- cations are especially efficacious. Though some (notably Dr. McCall Anderson) have re- ported good results from the internal use of tar in these affections, all are agreed that the remedy is vastly more effective when applied directly to the diseased surface. In eczema, the rule is generally observed to await the de- cline of active inflammatory manifestations before beginning tar treatment. If it is begun earlier, while there is still vesiculation, surface exudation, or erosion, it is apt to aggravate the disease, resembling in this respect the treat- ment of catarrhal diseases generally by bal- samics. It is well known, for example, that if the use of copaiba balsam, sandal-wood oil, and the like is begun while a gonorrhoea is in the acute stage, the effect is bad. These remedies are not appropriate till, with the de- cline of inflammation, the purulent discharge has given place to one that contains a consid- erable proportion of mucus. In eczema where the remedy is directly applied to the diseased parts, it is usually necessary to defer the use of tar till all discharge has ceased. Espe- cially in eczema of an impetiginous character is tar objectionable. The indications for its use is generally regarded to be a condition of subacute inflammation manifested by a dry scaling surface with more or less hyperemia and pruritus, inflammatory products still re- maining in the tissues. Even at this stage it is not always well borne, the intolerance in some cases being apparently due to idiosyn- crasy. It is therefore advisable to begin al- ways with the milder preparations or with the tar in a diluted form, as in combination with an emollient ointment or with olive oil, or in weaker alcoholic or alkaline solutions. The weaker solutions of coal tar, made either from Duhring's compound tincture or from liquor carbonis detergens, often answer well. Later, stronger applications may be made. Instead of making the applications continuous, it is sometimes preferable to make them intermit- tent, as, for example, by means of the so-called " tar bath." This consists in first smearing the eczematous surface with tar or some of its preparations, afterward immersing the parts in a warm bath, washing off the tar with soap, and finally following with the application of some soothing and desiccating ointment like Lassar's paste (2 parts each of zinc oxide and powdered starch and 4 parts of vaseline). This method of using tar may be adopted with advantage even at an early stage of the dis- ease and before the surface has ceased to ex- ude. Lassar first recommended it for such early treatment. After the daily use of the tar baths for a few days an exuding surface often becomes dry, yellowish, and scaly, when it is possible to proceed to more continuous and energetic applications. For psoriasis tar was formerly used much more than it is now. Latterly it has been largely superseded by chrysarobin. As em- ployed by Hebra and others, the tar treatment was carried out very vigorously, and on this treatment the main reliance was placed. Two methods were employed—one continuous, the other interrupted or intermittent. In the for- mer the patient was first subjected to daily friction with green soap (see under Soap) or prolonged baths till the scales had been partly or wholly removed. Wood tar, preferably in the form of oleum cadini or oleum rusci, or some tarry preparation, such as tinctura rusci, was then well rubbed into the skin and allowed to dry on. To facilitate the drying, the patient was clothed in wocllen or wrapped in woollen blankets, the advantage of which was that the wool did not absorb the tar as linen or cotton would. In from two to six hours, the surface having become quite dry, the patient resumed the usual clothing. The tarry inunctions were repeated once or twice a day, at each inunc- tion the tar from the previous application being first washed off. This was continued till scales ceased to form. For intermittent applications, the tar bath was used in the manner above described, ex- cept that each bath was preceded by green-soap frictions, and after the tar had been rubbed in the patient was made to remain in the bath for at least six hours. The tar that remained on the surface was then washed off with green soap, and finally the surface, having been dried, was dressed with a soothing ointment. Formerly tar was much used as a remedy for scabies". Though it still is often employed as one of the ingredients of various " itch ointments," it is rather for the sake of its anticatarrhal effect than for the purpose of destroying the acarus. As a disinfectant for unclean or putrid sores, the tar powders with gypsum or charcoal (more especially the coal-tar powder) are effica- cious. Coal-tar powder was recommended by Devergie for rupia, ecthyma, impetigo, herpes, and eczema. An objection to the gypsum powders is their tendency to adhere and cake on the parts to which they are applied. With the recently manufactured disinfectant pow- ders at hand, this preparation is seldom re- quired. Tarhasadefiniterf»i'(VMe.s?na/*'e action, chiefly owing to the carbolic acid or allied phenols which it contains, but partly, probably, because of its effect to reduce hvperaemia. This action is exhibited even in watery solutions. For prickly heat tar water is an excellent applica- tion, and also for itching of the scalp. The alkaline and alcoholic solutions as well as the coal-tar preparations with soap bark are espe- cially serviceable for dry eczematous patches attended with itching. TARACANIN TEA 264 The wood-tar preparations for internal use include syrupus picis liquide, of which the dose is from 4 to 1 fl. oz.; glyceritum picis liquide, of which the dose is from i to 1 fl. drachm; and infusum picis liquide, aqua picis (sen picea), tar water, of which the dose is from 2 to 4 fl. oz. For external use, the prepartions of wood tar most commonly employed are the follow- ing: Oleum picis liCH.CH3, is a THIALDIN, NH CH3.CH.S/ crystalline derivative of paraldehyde. It is soluble with difficulty in water, but dissolves readily in alcohol and in ether. It is said to act as a stimulant to the heart, but enough is not known of it to warrant its use in practice at present. THILANIN—This is a compound of 3 parts of sulphur and 97 parts of lanolin. It has been employed topically to some extent in cases of eczema and other skin diseases in which sulphur may be beneficial. THIOCAMPHOR.—This name has been given to a liquid formed by the action of sul- phurous-acid gas on camphor. More or less diluted with water, it is used as a disinfectant. THIOFORM, or basic bismuth dithiosali- cylate, has been proposed as a substitute for iodoform. It is an insoluble, odourless yellow powder. According to De Buck (cited in the British Medical Journal, February 22, 1896, Epitome), it has an antiseptic and desiccative action, and forms a protective insulating layer for the parts to which it is applied. All raw, weeping, or ulcerated surfaces heal rapidly under it, he says, whether in the form of the pure powder or mixed with equal parts of levi- gated boric acid. It is indicated in all ulcera- tive skin affections, and where epidermic soft- ening exists. Internally, he has found its constipating and disinfectant qualities manifest in three cases of acute enteritis; in a fourth chronic case it caused gastric irritation and did not influence the muco-sanguinolent stools. Daily amounts of 30 grains for an adult, or from 7 to 15 grains for a child, in powder or mucilage, were perfectly well borne by the stomach. He considers the drug suited for internal use, since the dithiosalicylates are less toxic than the corresponding salicylic salts. Thioform has been used with success in purulent otitis media, in conjunctivitis, in ulcer of the cornea, in ulcers of the leg, and in burns. THIOL is a German patented sulphur derivative of various mineral oils. It occurs as a liquid or solid, according to the manner of its preparation. Its freedom from unpleas- ant odour suggested its employment instead of ichthyol, with which its effects are iden- tical, and it is used for the same purposes and under the same conditions. Internally, it has been given in the treatment of rheumatism, but with no brilliant results. The dose of the fluid variety is from 5 to 10 drops, and that of the dry thiol from 1 to 2 grains. [Solid thiol, prepared by evaporating the liquid form, is furnished in the form of pow- der and in that of scales. Both solid and liquid thiol have been found very useful in the treatment of burns. Bidder (Archiv fur klinische Chirurgie, xliii, 1892; University Medical Magazine, September, 1892) says of it that, when applied to a burned surface, it acts as a desiccant, relieves the pain, hardens the skin, and hinders the growth of micro-organ- isms if any are present. In burns of the first or second degree, where the blebs are still intact, it is only necessary to brush the burned area with equal parts of liquid thiol and water, and cover it with wool. By this method of treatment the pain almost immediately disappears. At the end of eight days the dressing should be changed, and re- applied if the blebs have not healed. If the blebs have been ruptured and the corium is ex- posed, all loose skin should be cut away and the burned area carefully cleansed; it should then be brushed with liquid thiol, powdered with salicylic or boric acid and then with pow- dered thiol, and the whole covered with vase- line and cotton wool, and bandaged. As a rule, one or two dressings only are necessary before the burn heals. The drug is of special value in relieving the pain of large granulat- ing surfaces in burns of the third or fourth degree. It is chiefly in dermatological practice that thiol has been used, in the treatment of eczema, erythema, erysipelas, ulcers, and lupus; it is said, however, to be equal to ichthyol in sorbe- facient virtues, and consequently to be of great efficiency in the treatment of inflammatory pelvic exudates and other inflammatory de- posits. For use in these cases a 10-per-cent. ointment may be made according to the fol- lowing formula: R Liquid thiol........... 1 part; Vaseline............... 2 parts; Lanolin............. 7 " M. Dry thiol dissolves readily in collodion.] Russell H. Nevins. THIOLIN, THIOLINIC ACID, accord- ing to Professor Coblentz, is a dark-green mass of the consistence of an extract, having a peculiar mustardlike odour, insoluble in water, but soluble in alcohol. It is formed by the action of warm sulphuric acid on sulphur- ated linseed oil. Its medicinal properties are similar to those of ichthyol and thiol. Sodium thiolinate is thought to be preferable to thiolin for medicinal use. THIOOXYDIPHENYLAMINE. - See Sulphaminol. 27' THIOPHENE.—This is an organic com- HC-CH pound, » II , found by von Meyer in \S' benzene and also made synthetically from coal tar. It is a colourless, volatile oil. The di- iodide, in the form of powder, has been used as an antiseptic, especially as a substitute for iodoform. The tetrabromide, a substitution compound, is a still more energetic antiseptic. Thiophene and its compounds are quite ex- pensive. THIORESORCIN, C6H4 (OS),, is a yellow- ish-gray powder, a German patented prepara- tion, made by heating resorcin with sulphur. It is insoluble in water. It has been recom- mended as an antiseptic, especially as a substi- tute for iodoform, but, according to Professor Coblentz, its use is followed by unpleasant symptoms. THIOSALICYLIC ACID.—See Sulpho- salicylic acid. THIOSAPOL.—This is a soda soap con- taining 10 per cent, of sulphur, used topically in skin diseases where sulphur is indicated. THIOSINAMINE, or allylthiourea, or allylsulphocarbamide, NH(C8H5).CS.NHa, is a substance deposited in the form of colour- less crystals of a faint alliaceous odour and a bitter taste when a mixture of 1 part each of mustard oil and alcohol and 2 parts of am- monia water, having been heated to 122c F., is allowed to cool. It is soluble in water, in alco- hol, and in ether. The aqueous solution is said to be prone to decomposition. Thiosinamine is a diuretic. In addition, it seems to have a peculiar reducing effect on cicatricial tissue and on neoplasms. It was first used in medicine by Dr. Hans Hebra, of Vienna, in the treatment of lupus. Dr. Sin- clair Tousey, of New York, who has made a careful study of the use of thiosinamine by others and employed it extensively himself (New York Medical Journal, May 2,1896), says that the method in which it was used by Hebra was by the hypodermic injection of a 15-per-cent. alcoholic solution deep into the muscular tissue between the shoulder blades. A fine needle was used, and the injection was made slowly. The beginning dose was from £ to f of a grain, and this was injected twice a week. In lupus cases the dose was increased in the third or fourth week to half or the whole of a hypodermic syringeful of a 15-per- cent, solution, equivalent to from \\ to 3 grains of thiosinamine, twice a week. These doses were as well borne as so much distilled water, but Hebra says they always produced a visible curative effect. In a few cases he went as high as one and a half or two syringe- fuls with no bad effect. Keitel and Richter also used a 15-per-cent. alcoholic solution. Dr. Tousev used a 10-per-cent. alcoholic solu- tion, and Van Hoorn, on the recommendation of Professor Duclaux, of Paris, used a 10- per-cent. solution in equal parts of water and glycerin. This he found just as active and not nearly so painful as the alcoholic solution. THERMODINE 9 THIOSINAMINE This solution, says Dr. Tousey, has the further advantage of being available for use in agar- agar cultures and the like, where the presence of alcohol would interfere. Hebra rarely used as much as 3 grains, and Dr. Tousey never exceeded \\ grain, but the other observers cited by him used 4| grains as a regular full dose, beginning, of course, with smaller ones. Dr. Tousey finds that if an alcoholic solution is used there is sharp pain lasting for less than a minute. This may be somewhat diminished by pressure to diffuse the solution through the tissues. The syringe has to be washed out with water after the use of an alcoholic solution, otherwise the leather washers on the piston become dried and loose. Like Hebra, Dr. Tousey has found it desira- ble to suspend the use of thiosinamine for ten days every six weeks or two months. Bacteriological studies of thiosinamine, says Dr. Tousey, have been reported by Hebra and Van Hoorn. Hebra at first found that rabbits were apparently made proof against anthrax, but in a second series of experiments all the rabbits died. Van Hoorn found that the pres- ence of a small percentage of thiosinamine in a culture medium rendered ineffectual an in- oculation with certain bacteria. The addition of a few drops of a 10-per-cent. solution re- tarded or rendered the further growth of a culture impossible; but even flooding it with thiosinamine for twenty-four hours did not kill any bacteria. The physiological effects upon animals have been studied by Hebra, says Dr. Tousey. He injected 3 grains daily for a month into a dog weighing twenty-two pounds. The dog re- mained perfectly normal, but became raven- ous, and gained nine pounds in weight. He further injected into curarized animals doses ten or twenty times as great in proportion to their weight than in those used on man. The only effect was a slight lowering of the pulse curve, and this was evidently due to the alco- hol in which the drug was dissolved. Its physiological effect in man, says Dr. Tousey, is in a general way that of a very mild tonic. If the subject is perfectly sound, there are no symptoms at all produced by the injec- tions, and if there is a lesion present the re- action which may occur is local, and is not accompanied by any general symptoms. Espe- cially, there is never any febrile movement. There is in all cases a tonic effect with an in- crease in weight. Hebra states that absorption of the drug is very rapid, since his patients noticed a garlicky taste in the mouth within a few minutes. The same author has noted an extraordinary diuresis, the increase in the daily amount of urine being two hundred or five hundred cubic centimetres. In no case were there renal symptoms, or was there albumin or any other pathological product in the urine. This diuresis ceases after a number of injections. Hebra thinks it is a therapeutic action and ceases after the abnormal fluids have been eliminated. Van Hoorn and Keitel, who both used large doses, noted after several weeks' treatment the onset of nausea, head- ache, and lassitude. Hebra used smaller doses THIOSINAMINE • THOROUGH WORT 280 and Dr. Tousey still smaller ones, and they have not had such an experience. Dr. Tousey cites Richter as having studied the effect of thiosinamine on the blood in a number of cases of lupus vulgaris, lupus ery- thematosus, ulcer of the leg, and cicatricial stricture of the urethra. He noted the num- ber of white and red blood-cells, the amount of haemoglobin, and the changes in the mor- phology of the histological elements of the blood. Blood examinations were made just before the injection, four hours later, and again twenty-four hours afterward. In some cases examinations were made half an hour afterward, and in eight of these cases a change in the number of leucocytes had already taken place. The blood was always obtained by pricking the finger tip and without pressure, and always at the same hour of the day. There was uniformly an immediate decrease in the number of leucocytes to one third of the nor- mal number—viz., from about fourteen thou- sand down to four thousand to the cubic millimetre. But at the end of four hours the number of leucocytes had increased to normal or beyond, and in some cases there was well- marked leucocytosis which persisted for forty- eight hours. There were no uniform changes in the number of red cells. The amount of haemoglobin was regularly increased. There was no special effect upon the number of eosin- ophile cells, but there was a uniform increase in the number of multinuclear leucocytes or leucocytes with polymorphous nuclei. Richter stat.es that in its action on the blood thiosinamine belongs to the same class of sub- stances as hemialbumose, peptone, pepsin, nu- clein, pyocyanin, tuberculin, curare, urea, uric acid, and sodium urate, the intravenous injec- tion of any of which substances causes an im- mediate leucocytolysis followed by leucocytosis. According to Dr. Tousey, there has been only one accident reported from the subcuta- neous use of thiosinamine. It consisted in the production of temporary cutaneous anaesthesia, and was observed by Keitel. The patient was a robust youth with recurrent psoriasis of a papular type, and thiosinamine was used with a view to causing absorption. The injections were made at various points, and the last one into the muscles of the extensor aspect of the forearm. This was followed very shortly by complete anaesthesia of the skin supplied by the cutaneous branch of the musculo-spiral nerve. It could not be stated positively that the nerve had been wounded by the needle, which Dr. Tousey thinks probable, and Keitel thought the effect was due to the action of the drug itself upon the nerve. In one of Dr. Tousey's cases twenty-seven hypodermics of thiosinamine were administered in the left bi- ceps at approximately the same spot without any unfavourable effect. The effect of thiosinamine upon pathologi- cal conditions, says Dr. Tousey, is that of a powerful absorptive, acting probably by in- creasing the activity of the lymphatic system. This effect is seen in the absorption of serous exudations, which is accompanied by marked diuresis. It is also visible in its effect upon lupus, corneal opacities, cicatrices, glandular swellings, and neoplasms. Hebra used it in a number of tuberculous patients who had had no recent pulmonary symptoms, and observed a return of fever after the injections. In such cases the fever is perhaps due, Dr. Tousey sug- gests, to the absorption of encapsulated pus. In one case with very severe night sweats there was repeatedly a marked amelioration follow- ing the injections. This was verified by con- trol experiments. This same absorptive effect is so active locally that in some classes of cases a latent process may be fanned into an active one. This is especially the case in its use for clearing up opacities of the cornea; if there is the slightest inflammatory condition present it will be very much aggravated, and treatment will have to be suspended. In some cases, says Dr. Tousey, this local inflammatory reaction is of benefit. Cases have been reported in which an apparently cured osteomyelitis has started up again after the injections—a new abscess has formed, a sinus has opened, and an old se- questrum has been extruded. This has been followed by definitive healing, and the entire process could only be regarded as having been a beneficent one. The results obtained by Hebra, Richter, Van Hoorn, and Tousey are somewhat at variance. Hebra and Van Hoorn observed in practically every case a local reaction which they describe as beginning in two or three hours after the injection. The diseased part became red and swollen, sometimes so much so as to cause fis- sures in the surface. There was no vesication and there was little if any serous exudation. This reaction remained undiminished for five or six hours, but at the end of twenty-four hours had entirely disappeared. Marked des- quamation sometimes follows. There was never a general reaction, and especially there was no fever. There was a sensation of heat and tension in the affected part. These two authors, says Dr. Tousey, report this reaction to have occurred in practically every lupus case, and to have been repeated without mate- rial increase of the dose after each injection. Dr. Tousey's own lupus cases have been in dis- pensary practice, and the patients have not been seen until forty-eight hours after the in- jection. So far as the patients' statement can be credited, they have not shown a local reac- tion. Richter had a comparatively large num- ber of cases of lupus (eleven), and in only two was there any reaction, and then only with the first two or three injections. His cases were under constant observation, and the doses used were large. As to the curative action upon lupus, says Dr. Tousey, Van Hoorn and Hebra observed a very great effect indeed wherever the super- ficial area of disease was great. Ulcerations healed, and the thickened and nodular edges flattened out. No case of complete cure is re- ported, and where the area involved was quite small—lupus of the cheek of the size of a dime —it was hardly influenced at all. Richter has seldom seen any effect at all upon lupus. In Dr. Tousey's own cases no " reaction " has been noted, but he has uniformly seen a diminished 28: vascularity and a softening of the edges with healing of the ulcer. He agrees with the other authors cited that local treatment is a better means of handling lupus than the use of thio- sinamine. Its therapeutic application in clearing up corneal opacities, he remarks, has been at- tended with almost perfect success in the hands of all the investigators. Hebra had a patient who, before the injections, could hard- ly avoid collisions with people on the street, and afterward the acuteness of vision had so increased as to enable him to tell the direction of the wind by the weather vane on a high tower. He and Richter report a number of such cases, and give the formulae for vision be- fore and after treatment, demonstrating a re- markable increase. This Dr. Tousey thinks is of the greatest possible importance, for we can promise almost all these patients an astonish- ing improvement in vision. The cases for which it is unsuitable are those in which a vestige of inflammation is still present and might be started up into fresh phlyctae- nulae. In the treatment of cicatricial contractures, says Dr. Tousey, thiosinamine acts by causing absorption of the fibrous tissue, whether it is situated in the skin or in deeper parts, such as tendons and ligaments; and all the authors cited report complete cures of such cases. Among these are ectropion following lupus of the cheek, partial ankylosis of the knee from lupus, and talipes equinus following a burn of the leg. One case of ectropion was so marked that the eye could not possibly be closed, the tarsal cartilage was so rarefied by pressure and traction as to be scarcely perceptible, and even the corner of the mouth was drawn up toward the eyelid. This patient was restored to a nor- mal condition, and the skin of the cheek be- came soft and freely movable on the subjacent tissues. In another case of Hebra's there was such contracture following lupus of the palm that the finger nails grew into the flesh. Com- plete extension was possible after about twen- ty-five injections, no other treatment having been employed. Dr. Tousey says it was this wonderful absorptive power over cicatricial tissues which suggested to him its use in keloid and malignant neoplasms. In the treatment of simple ulcers and of stricture of the urethra, Richter's six cases, with an average of eight injections, gave negative results; but Dr. Tousey would not regard this as final. In the case of stricture of the ure- thra or rectum, he believes the use of thiosina- mine might be a very valuable adjunct to local treatment. Dr. Tousey remarks that the action of thio- sinamine upon chronically enlarged glands has been observed by Hebra, and it is to cause a very rapid absorption., In syphilitic cases, on the other hand, absorption was not effected; and he believes that this may in some cases be of diagnostic value. He and" the other authors cited have not used it in the treatment of glandular swellings secondary to epithelioma or carcinoma. It has been used with success for uterine myomata. It has been used with THIOSINAMINE 1 THOROUGHWORT negative results in eczema, psoriasis, and lupus erythematosus. Dr. Tousey records a case of keloid in which he used thiosinamine. The patient was a man thirty-two years old. In September, 1893, his left arm was burned from shoulder to fingers. An area about four inches and a half in diam- eter immediately above the elbow healed by granulation, but the rest of the burn was more superficial. About four months after the ac- cident the cicatrix began to itch and burn, and very soon a hard, prominent mass had formed in the scar. When he was admitted into St. Bartholomew's Clinic, on July 7, 1894, he presented a typical keloid, consisting of two areas, each of the size of a silver dollar and projecting three quarters of an inch above the surface. These were on the flexor aspect of the arm just above the bend of the elbow. The treatment consisted in injections of thio- sinamine into the left biceps twice a week. The man had applied for treatment because of impaired motion at the elbow. The beginning dose was | of a grain of thiosinamine, in 10- per-cent. solution in absolute alcohol, and the highest dose used was H grain. These injec- tions produced no special effect except on the neoplasm. After one or two injections this became very much paler, and after twelve one portion had lost its thickening and induration. This part was then visible as apparently nor- mal skin, but a little paler than the rest. The other area gradually changed to the appear- ance of normal skin. The cure was complete after twenty-seven injections had been given. Complete use of the arm was restored, and there was no thickening or adhesion of the skin, though the cicatrices were still recog- nisable. Dr. Tousey concludes his valuable article as follows: " We have in thiosinamine a drug pro- ducing, when given hypodermically, no gen- eral symptoms, and even when long continued no harmful effects. It acts specifically upon certain abnormal tissues to cause their absorp- tion or conversion into normal tissues. It is of doubtful efficacy in lupus and a variety of skin diseases. But" it is of the greatest possible value in the removal of cicatricial contractures following lupus or any other cause of loss of substance. The frightful contractures from burns of the neck would yield to its action, as cases of ectropion and corneal opacity do. My own cases have shown its curative effect upon keloid, and its palliative and probably curative effect on malignant tumours." THIOSULPHATES. — See Hyposul- phites. THIURET. C8H7N3S2, an oxidation prod- uct of phenvldithiobiuret, is a white crystalline powder soluble in alcohol and in ether, but not readily in water. Its salts, the salicylate, the hydrobromide, the hydrochloride, etc., are more soluble in water. Thiuret and its salts are antiseptic, and have been recommended as substitutes for iodoform. THORN-APPLE.—See Stramonium. THOROUGHWORT.—See Eupatorium. THUJA THYMOL 282 THUJA, or arbor vite, was formerly offi- cial in the U. S. Pharmacopoeia, but was dropped in the last revision on account of lack of valuable medicinal properties. The leaves and small twigs are the parts employed, and a fluid extract or saturated tincture is the prep- aration most commonly used. Either of these may be given in drachm doses. Thuja has been employed in malarial fevers, rheumatism, and a variety of diseases, but is of little or no value.—Russell H. Nevins. THUS AMERICANUM (Br. Ph.).—See Olibanum. THYMACETINE, a white crystalline powder, is a derivative of thymol, having the formula C6H2.CH3C3H7 j §H(C25H30y lt was first obtained by Hofmann, of Leipsic. In its chemical composition it bears the same relation to thymol as phenacetine does to phenol. It probably combines the antiseptic properties of thymol with the general charac- teristics of phenacetine. Thymacetine is very slightly soluble in water. The most exhaustive physiological study of thymacetine has been made by M. Marandol de Mentyel (Bulletin general de therapeutique, vol. cxxiv), although Jolly had previously re- ported upon it clinically (Centralblatt fur die gesammte Therapie, February, 1892). The lat- ter found that in doses of from 3 to 15 grains thymacetine ameliorated nervous headaches, and had a general analgetic effect which might be compared to that of phenacetine. Occasion- ally the drug exhibits a hypnotic influence, which is not so permanent or reliable as that of other coal-tar hypnotics. As disagreeable concomitant actions, Jolly noted occasionally cerebral congestion and a tendency to drowsi- ness. Although his physiological experiments were limited, Jolly found that doses of 30 grains were not poisonous to dogs. De Mentyel (loc. cit.) finds little or no hyp- notic effect from doses of 22 grains of thym- acetine. His experiments also lead him to believe that the drug is without effect upon the intellect, exciting in paralytics and de- mented insane persons neither exaltation nor depression. Upon the vaso-motor system, the genital tract, the secretions in general, and the gastro-intestinal canal, he found thymacetine without effect. Although the drug, as Jolly maintained, sometimes produces cerebral con- gestion, de Mentyel agrees with that observer that it is valuable in headaches of nervous ori- gin. Whether the increase of muscular force observed after the ingestion of thymacetine is due to an increased activity of the nervous system or of the muscular fibre has not been determined; but the writer inclines to the former view, since he has frequently observed a rise of temperature of from one half to one degree lasting from one to two hours. The in- creased frequency of the respiratory move- ments—from one to six a minute—noted after the administration of thymacetine de Mentyel is also convinced should be attributed to the over-activity of the nervous system, since the emotional condition of his patients can not ac- count for the phenomenon, for the experiments were repeated several times with a uniform re- sult. At the same time, an acceleration of the pulse, from three to fifteen beats a minute, was noted, and a decided increase in the arterial tension was observed. This combination of phenomena would probably account for the clinical congestion of the cerebrum seen. De Mentyel noticed no diuretic effect of the drug. That author, in his resume, says that the physiological effects are independent of the size of the dose. The following phenomena were observed in connection with the experi- ments, which also proved to be in no wise de- pendent on the size of the dose given : There was sometimes a pupillary dilatation with no visual disturbance; a slight headache some- times supervened, most frequently in the after- noon ; the force of the cardiac beat was not influenced, despite the increase of arterial ten- sion and rapidity of the pulse. Occasionally lassitude was observed without severe func- tional disturbance; a coated tongue, slight anorexia, and epigastric pain occasionally ap- peared ; very rarely there were nausea and vomiting, which promptly disappeared upon the withdrawal of the drug, as did an occa- sional uretero-vesical spasm and dysuria. In conclusion, de Mentyel remarks that paralytics seem most susceptible to the influences of the drug. The dose of thymacetine is from 3 to 15 grains, repeated three or four times daily. Owing to its insolubility, it is best given in capsules or wafers.—Samuel M. Brickner. THYME, herba thymi (Ger. Ph.), is the leaves or flowering tops of Thymus vulgaris. It is fragrant and stimulating to a surface to which it is applied. The volatile oil, oleum thymi (U. S. Ph., Ger. Ph.), is employed as a stimulant and antiseptic application, acting by virtue of the thymol contained in it. The herb of another species, Thymus Serpyllum, herba serpylli (Ger. Ph.), also furnishes a vola- tile oil having similar properties to those of the oil derived from Thymus vulgaris. Oil of thyme may be used internally as a carminative and stimulant, in doses of from 1 to 3 drops on sugar. THYMOL (U. S. Ph., Br. Ph.), thymolum (Ger. Ph.), is a phenolic stearoptene known in chemical language as propylmethylphenol, CH3 I C CI0H14O=: HC HC CH C-OH C3H7 It is obtained from the volatile oils of Thymus vulgaris, Thymus Serpyllum, Monada punc- tata, Carum punctatum, and some other allied plants in one of three ways—either by saponi- fication with sodium hydrate and then treat- ing the separated soap with hydrochloric acid 283 THUJA THYMOL or by fractional distillation of the oils, or by means of prolonged refrigeration under the in- fluence of which it crystallizes. It occurs, ac- cording to the U. S. Pharmacopoeia, in large crystals of the hexagonal system, nearly or quite colourless, having an aromatic, thyme- like odour, a pungent, aromatic taste, with a very slight caustic effect upon the lips, and a neutral reaction. Soluble in 1,200 parts of water and in 1 part of alcohol at 15° C. (59° F.), in 900 parts of boiling water; freely solu- ble in boiling alcohol, also in ether, in chloro- form, in benzol, in benzin, in glacial acetic acid, and in the fixed and volatile oils. It liquefies with camphor. Its specific gravity as a solid is 1-028; after fusion it is lighter than water. It melts at about 50° C. (122° F.), re- maining liquid at lower temperatures, and boils at about 230° C. (446° F.). The crystals when rubbed develop electricity and attract small pieces of paper. In its physiological action thymol bears a resemblance to carbolic acid, and also to oil of turpentine. It is said to interfere more pow- erfully than carbolic acid with the develop- ment of schizomycetes, while it is at the same time much less caustic, irritating, or poisonous. When applied to the skin or mucous mem- branes, it causes paralysis of the end-organs of the sensory nerves and thus induces local anaes- thesia, but it can not be employed for this purpose after the manner of cocaine, because when applied in a sufficiently concentrated form to produce this effect it is also a strong local irritant. Large doses cause a sensation of heat in the epigastrium, diaphoresis, tinni- tus aurium, deafness, and a feeling of con- striction about the forehead. Toxic doses depress the nerve-centres in the medulla ob- longata and spinal cord, lessen reflex action, reduce the temperature, render the respiration slow, lower the arterial tension, produce mus- cular weakness, and may cause death in coma. Thymol is eliminated by the respiratory and urinary organs, which show a decided irritation during its excretion. The urine is increased in quantity and becomes of an olive-green hue, as in carbolic-acid poisoning. Thymol is not very frequently used in inter- nal medication, but good results from its em- ployment in a number of diseases have been reported. For this purpose it may be given in powder, capsules, or emulsion, which are recommended as preferable to either alcoholic, watery, or alkaline solutions. It has been used in acute articular rheumatism, but has not proved so effective as salicylic acid. Its use as an antiseptic to restrain abnormal fermenta- tive processes in the alimentary tract during acute and chronic intestinal disorders in both adults and children has some warm advocates. In typhoid fever it has been said to reduce the temperature, to cause the stools to become less frequent and less offensive, to lessen the tym- panites, to cause the tongue to become clean and moist, to diminish the excretion of urea, to render the cerebral symptoms less severe, and to increase the blood-pressure without in- jury to the heart. For all cases of intestinal derangement thymol may be given in doses of 62 from | to 3 grains several times a day. The aggregate may amount to, but should not ex- ceed, half a drachm in twenty-four hours. Cases of chyluria have been reported in which the disappearance of the fatty matter and of the filariae appears to have been greatly expedited by the ingestion of from 1 to 5 grains three times a day. Nugent recommends it to be given in combination with 15 or 20 grains of gallic acid. In catarrh of the blad- der it is of advantage to supplement the inter- nal administration of the drug with local treatment, washing out the organ with a solu- tion of from 1 to 2,000 to 1 to 1,500 in strength. Good results have been obtained from its use in diabetes, but it seems to produce very slight if any effect, unless the patient is con- fined to a purely nitrogenous diet. Most headaches, with the exception of true migraine, are alleged by Jolly to be as amen- able to thymol in average doses of 7J grains as to phenacetine. In diseases of the respiratory tract thymol has been more commonly used, principally in combination with other agents, as a cleansing, deodorizing, and stimulating local application, also as an inhalant, and less frequently as an internal remedy. It appears to exercise a good influence in some cases of phthisis, and is useful as a disinfectant for the sputum. In- halation of thymol is not infrequently of serv- ice in diseases of the upper air-passages as well as in bronchitis and whooping-cough, and it is said to excite the flow of blood through the lungs. A good formula is the following, suggested by Dr. Clarence Rice, a teaspoonful of which may be added to boiling water and the steam inhaled: R Menthol, ) Thymol, v each....... 5 grains; Carbolic acid, ) Oil of eucalyptus.......... 2 fl. oz.; Oil of Pinus silvestris.....3 " " M. This may also be inhaled by pouring a few drops on cotton or a sponge and holding it to the nostrils. In atrophic rhinitis, the purulent rhinitis of children, and other diseases of the nasal cavity its cleansing and deodorizing properties render it very useful and afford a certain degree of comfort to the patient and his friends, but in atrophic rhinitis at least it can not be said to influence to any great degree the course of the disease. The following is a solution proposed by Dr. Douglas for this purpose: R Thvmol................ 10 grains; Eucalyptol.............. 20 " Menthol ................ 30 " Oil of cubeb............. 40 " Oil of rose............... a sufficiency ; Benzoinol............... 4 oz. M. The amounts of the various ingredients may be varied as a stronger or weaker effect is de- sired. In the treatment of diseases of the na- sal cavitv, weak solutions of thymol may be used in the form of a spray, but stronger ones should be applied by means of a cotton-car- THYMUS EXTRACT 284 rier. According to Seiss, the following is a preparation of minimum strength from which a therapeutic effect can be expected: R Thymol.................. i grain ; Alcohol................. i drachm ; Glycerin................. Ii Water................... 1 oz. M. A stronger solution than one of 5 grains to the ounee is seldom if ever required. In the laryngitis and pharyngitis of the ex- anthemata, especially when associated with putrid exhalations, the use of a watery solution from 1 to 3.000 to 1 to 1,000 in strength has been recommended as a gargle or spray. Like- wise in diphtheria the use of a strong solution as a lotion or spray has been alleged to do some good. Its fragrant odour renders thymol a very pleasant constituent for a lotion of this nature or for a mouth wash for use in ulcera- ted or other conditions which require the use of an antiseptic, or to remove the smell of tobacco from the breath, but after a prolonged use of the drug this odour becomes disagree- able to many people. It has been strongly recommended as a ver- mifuge for several varieties of intestinal para- sites," but very large doses are necessary to render its use effectual. Some writers doubt its ability as a teniacide, but the following procedure is said to be effective. During the evening previous to the administration of the drug the patient should take half an ounce of castor oil. In the morning 60 grains of thy- mol are to be given, divided into twelve doses at intervals of fifteen minutes, and twenty minutes after the last dose half an ounce more of castor oil is to be taken. It is acknowl- edged that, in spite of free stimulation during this treatment, there may be a decided fall of the respiration, pulse, and temperature. Sand- with maintains that thymol seems to have a specific action as an anthelminthic in ankylo- stomiasis, and gives for this purpose from 60 to 90 grains in divided doses during the day, re- peats this in a week, and repeats it again if necessary. He also acknowledges that 60 grains in the course of a day may cause symp- toms of collapse. While it may possibly be true, as has been alleged, that there is no dan- ger of fatal poisoning from less than 100 grains per diem, still the appearance of such toxic symptoms as the result of the ingestion of 60 grains demonstrates that such doses are risky, although apparently necessary to secure anthelminthic action. Gratifying results have been obtained from the use of solutions as vaginal douches in leu- corrhea, and to correct offensive lochia. It has been used dissolved in glycerin to the strength of from 1 to 3,000 to 1 to 1,000 on cotton as a tampon in the treatment of ero- sions of the os uteri. Thymol is said to be able to arrest dental caries, and Hartmann has found it useful in inflammation of the dental pulp, lie cleanses the carious cavity and inserts a bit of cotton which has been powdered with thymol. To hasten its solution and action, he advises that the mouth be washed out several times with lukewarm water. As an antiseptic lotion a solution of from 1 to 3,000 to 1 to 1,000 has been used to some extent for wounds, burns, and ulcers, as well as for cleansing instruments during operations and for preserving sponges in an aseptic condition. For these purposes it is of about the same util- ity as carbolic acid, and presents fewer objec- tionable features, but will probably never become popular, because it furnishes a powerful attraction for flies. Painted on the skin in pruritus, it gives marked relief. A solution which has been recommended to be kept in stock as a basis from which to prepare any de- sired solution for external use is the following : R Thymol................. 15 grains ; Alcohol................. 2£ drachms; Glycerin................ 5 " Water.................. 1 pint. M. In a number of skin diseases, such as ring- worm of the scalp, acne, pityriasis, psoriasis, and eczema, thymol has been successfully em- ployed, usually in the form of ointments which vary in strength from 10 grains to the ounce upward. When an ointment of greater strength than 20 grains to the ounce is desired the thy- mol should first be dissolved in alcohol, a grain to a minim. Guladze reports excellent results in favus from the following treatment: The hair is cut short and the scalp washed daily with green soap for four or five days. Then an ointment of 1 part of thymol, 8 parts of chloroform, and 36 parts of olive oil is ap- plied and renewed three times a day. As soon as the crusts begin to fall the hair is pulled out and the ointment applied directly to the diseased part. He says that recovery takes place in from three to four weeks, but recom- mends the application for a week longer of a mixture of 2 parts of iodine and 1 part of glyc- erin twice a day. Matthias Lanckton Foster. THYMUS EXTRACT, THYMUS FEEDING.—The thymus gland, an organ of foetal and early infantile life, usually, as is well known, ceases to grow soon after birth and at the age of puberty begins to undergo fatty de- generation and atrophy. Sometimes a " revi- val " of the gland—that is, its renewed growth, with presumably a resumption of its functional activity—takes place in adult life. This oc- currence has been observed almost exclusively in persons affected with exophthalmic goitre, and it is supposed to be a provision of Nature whereby the gland, having recovered its func- tional power, produces an internal secretion that serves, as Mr. David Owen, of Manchester, England, says, to neutralize the toxic agents which caused the disease. At the annual meet- ing of the British Medical Association held in 1896 Mr. Owen read a paper entitled Thymus Feeding in Exophthalmic Goitre. According to an abstract of Mr. Owen's paper published in the Lancet for August 22, 1896, he described three cases of this disease under his care that had been treated with thymus gland. The first had been described in the British Medical 285 THYMUS EXTRACT Journal for February 15, 1895. Since then Mikulicz, Cunningham, Edes, Solis-Cohen, Maude, and Todd had reported on the same treatment with confirmatory results. All three of Mr. Owen's patients had been restored to health by the treatment. The dose of the raw gland was from \ to 1 oz. three or four times a week. The relief obtained in these cases must have been more than a coincidence, he thought. as in one of his cases and in several recorded by others discontinuance of the use of the gland had been followed by relapse, but on resuming it the patients had again improved. Upon one occasion a patient of his who always had been benefited by the treatment failed to respond to the glands. This was found to be due to their having been taken from full-grown sheep. On his giving calf's thymus most urgent symptoms were at once relieved, especially dyspnea, pal- pitation, and tremors. The heart, which had been irregular and rapid, improved greatly in a few days. Others had had quite as striking results. The probability of the theory that hypertrophy of the thymus had a curative ten- dency was supported by the fact that other lymphoid structures, including the spleen, were also found enlarged, and it was well known that increased lymphoid activity with consequent leucocytosis occurred in toxa>mic conditions and served an antitoxic purpose. Further confirmation of this theory was de- rived from the fact that pregnancy often re- lieved Graves's disease, and this might be due to the physiological leucocytosis which existed then. It was noteworthy that this disease was almost unknown in infancy, when the thymus gland was present. The fact that the thyreoid gland was more active during infancy than later would render the infant more liable to hyperthyreoidization were there not some counteracting influence which the thymus gland possibly supplied. Mr. Owen thought there was evidence of antagonism between the thyreoid and thymus glands. Thyreoid ex- tract increased tissue waste. On the other hand, the thymus gland was most developed during infancy and in hibernating animals at each period of hibernation, which pointed to this gland exerting an inhibitory influence over waste. This theory had been strength- ened by the results of experiments and by the effects produced by disease of the thymus gland. The thyreoidal secretion, too, had a stimulating influence over the cerebral func- tions, and increased activity of the sexual organs was associated with enlargement of the thyreoid gland. On the contrary, during hi- bernation, when the thymus gland attained its greatest size, the cerebral and sexual functions were suspended and in infancy were undevel- oped, but underwent rapid development at pubertv. when the thymus gland finally dis- appeared. This apparent antagonism supplied, in Mr. Owen's opinion, a hypothetical explana- tion of the mode of action of thymus in the treatment of exophthalmic goitre—a disease most probably due to excessive activity on the part of the thyreoid gland. Reinbach (Mittheilungen aus der Grenzge- bieten der Medizin und Chirurgie, i, 1896; Gazette hebdomadaire de medecine et de chi- rurgie. September 27,1896) reports thirty cases of goitre in which sheep's thymus was used, sometimes in its natural state and sometimes in the form of pastilles of English make. The thymus was administered in the form of hash spread on bread, in quantities of 150 grains for children and 225 grains for adults, three times a week. Larger quantities did not seem to act more energetically. The effects of the treat- ment were ordinarily manifested at the end of three or four weeks, and the results remained the same when the treatment was continued for a longer time. Three patients, children ten and twelve years of age, were completely cured anatomically. In eighteen cases there was considerable amelioration, with diminu- tion in the size of the tumour and in the symptoms provoked by it. In ten cases the treatment failed completely. In none of the cases were toxic symptoms analogous to those which are seen in the thyreoid treatment ob- served, or any other symptoms of a toxic na- ture. An analysis of the cases observed by Dr. Reinbach does not enable us to say in which anatomical variety the thyreoid treatment has greater chance of success. It seems, however, that the effects of the medication are particu- larly appreciable in diffuse, simple, hyperplastic goitre. On the whole, he says, the therapeutic results of the thymus treatment are very nearly identical with those of the thyreoid treatment. The former has, however, the advantage of not causing toxic symptoms, and for this reason it maybe preferred to the latter treatment, and should be considered as the preferable method in cases in which the thyreoid treatment has not been efficient. Among the cases reported by Dr. Reinbach there was one in which the thymus treatment led to a successful result after the thyreoid treatment had completely failed. Typhoid Thymus Extract.—In the Deutsche medicinische Wochenschrift for Octo- ber 12, 1893, Dr. Eugen Fraenkel. of Hamburg, reported that he had treated fifty-seven cases of typhoid fever by the deep subcutaneous in- jection of thymus bouillon in which the typhoid bacillus had been grown and then killed. In the same journal Dr. T. Rumpf reported thirty cases treated by the dead cultures of the Bacillus pyocyaneus grown and prepared in the same manner as the typhoid cultures. These authors stated that half a cubic centi- metre of either of these cultures, injected deep into the gluteal region, followed by the injection of one cubic centimetre twenty-four hours later, was, as a rule, followed by a slight rise of tem- perature, with or without a chill, on the third day a decided fall of temperature, not to be accounted for by the ordinary course of the disease, and on the following day a fall still more marked. If the temperature rose again, under a continuance of the injections in in- creasing doses at forty-eight-hour intervals, the patient in from six to eight days would be apvretic. The pulse came down to normal with the fall of temperature. No untoward symptoms appeared referable to the heart's action or to the lungs or kidneys. When a 86 THYMUS EXTRACT THYREOID TREATMENT 2 chill accompanied the rise after the injections the heart's action did not increase correspond- ingly with the rise of temperature. Even when the fall of temperature was not complete, the fever changed from the continuous to the remittent type. Still more marked was the change in the general condition of the patient under the influence of the injections. The somnolence, stupor, and delirium disappeared; sleep became natural; the coated tongue cleaned; the diarrhoea disappeared, and the meteorism improved. The patients' appetite returned, and they complained of hunger, even though the successive crops of roseola contin- ued and the spleen only slowly diminished in size. There was often profuse sweating with decided diuresis. This treatment, however, did not prevent complications or relapses, but when relapses did occur they quickly yielded to further injections. In some cases, however, the treatment was without effect. The earlier the stage of the disease in which it was begun, the better were the results obtained. It was effective in both severe and mild cases. Fraenkel makes no mention of his death-rate ; Rurapf lost two patients out of thirty—one by intestinal haemorrhage, the other by pneumonia. The foregoing account of Fraenkel and Ruinpf's experience is given by Dr. Alexander Lambert (New York Medical Journal, April 27, 1895), who, together with Dr. John Winters Brannan, proceeded to try the treatment in Bellevue Hospital. Dr. Lambert thus de- scribes the preparation: The thymus glands of calves were obtained as soon after death as possible, chopped very fine, and mixed with distilled water, using for every gramme of the chopped glands two cubic centimetres of the water. This was allowed to stand in the ice box for from sixteen to eighteen hours, then strained through cheese cloth and squeezed out as thoroughly as possible. This gave a cloudy mucilaginous fluid, which was alkalin- ized with potassium hydroxide until not quite neutral to the phenolphthalein test, but dis- tinctly alkaline to litmus. The fluid was then further diluted one third with water, and sterilized for half an hour in steam at 100° C. The fluid then became of a grayish-brown colour, and the coarse coagulated flocks were filtered off through absorbent cotton after the fluid cooled. The resulting fluid was of a milky, opalescent colour, and, being put in small flasks, was sterilized in steam at 100° C. for two successive days. These flasks were inoculated from a broth-culture of a typhoid bacillus obtained fresh from the spleen of a patient dead from typhoid fever. These flasks were then put into the thermostat at 37-5° C. and the cultures allowed to grow for seventy- two hours; they were then sterilized by heat- ing in a water bath at 62° to 63° C. for from twenty to thirty minutes. They were then tested on agar plates, and, if sterile, were ready for use. Twenty-eight cases were treated, including Dr. Lambert's and Dr. Brannan's in Bellevue Hospital, Dr. Northrup's in the Presbyterian Hospital, Dr. Norrie's in St. Luke's Hospital, and Dr. Draper's in the Roosevelt Hospital. Of these twenty-eight cases, fifteen showed more or less improvement, which could, Dr. Lambert thought, be fairly attributed to the injections. Twelve did not improve under the treatment, and one death occurred. In the fifteen cases showing improvement the injec- tions were begun usually about the tenth day, ranging from the sixth to the fifteenth. At first in two cases it was tried as Fraenkel had suggested, by injecting half a cubic centi- metre, and on the following day one cubic centimetre, then, at the expiration of forty- eight hours, if the temperature did not show a decided fall, two cubic centimetres; and then, if the temperature still remained high, repeat- ing the injections at forty-eight-hour intervals, increasing the amount by one cubic centimetre at each injection. Under this plan the im- provement was evident, but not marked. Therefore Dr. Lambert changed the plan of treatment, varying it somewhat in certain cases, but, as a rule, injecting increasing amounts for four or five successive days, be- ginning with a half or one cubic centimetre; then giving, at twenty-four-hour intervals, doses of two, three, or four, and then five cubic centimetres, as the case demanded; then wait- ing forty-eight hours, and, if the temperature rose again to 101° F. or over, repeating the five cubic centimetres, or even giving six or seven cubic centimetres. This gave much better results, as shown both in the tempera- ture curve and in the general improvement of the patients. In all cases the injections were made deep in the gluteal region, alternately on the right and left sides. In only one or two cases was there any local reaction, consisting of redness and tenderness, which subsided in one or two days. The temperature curve followed the descrip- tion given by Fraenkel. Sometimes there was, within from thirty minutes to two hours after the injection, a rise of temperature with or without distinct chill, and at times this rise or this chill was followed by profuse sweating. In two cases the rise of temperature was ac- companied with nausea and vomiting and head- ache. As a rule, after the third injection, the temperature curve showed a lower range, fol- lowed after the fifth injection by a decided fall of several degrees, even to normal, in the fol- lowing twenty-four hours. The continuous type of fever curve often changed to the remit- tent type while falling. At times no abrupt fall occurred, but the fever ranged lower and gradually disappeared by a long lysis. The pulse showed a decided improvement following the injections both in its frequency and in its force and tension. With the chill and rise of temperature after injections, as a rule, the pulse did not show a proportional in- crease in frequency. The general condition of the patient showed the greatest improvement, the classical picture of the third week of typhoid fever being en- tirely absent, The mental condition improved; the patients lost their apathy and became bright' the sleep became more natural, the delirium ceased, and the diarrhoea stopped. When con- stipation was present instead of diarrhoea the 28 injections had no influence whatever upon it. Marked hunger appeared in several cases co- incident with the fall of temperature. The tongue usually cleaned and became moist be- fore the use of the injection was completed. In one case, after the third injection, partial suppression of urine occurred, the patient pass- ing only six ounces in twenty-four hours. This symptom disappeared in the following twenty- four hours, and the patient showed no bad effects from it. Five cases of relapse occurred in the sixteen cases favourably affected by this treatment. These relapses were not treated in every case with further injections, but those so treated quickly subsided. The roseola, how- ever, was not affected, and the swelling of the spleen only slowly subsided. In the twelve cases that showed no benefit from the treatment the injections were begun at a time varying from the ninth to the twenty- second day of the disease, averaging on the fifteenth day. This, says Dr. Lambert, is five days later than in the group of improved cases, and bears out Rumpf's statement that the ear- lier in the disease the injections are begun the more chance there is of a beneficial action. In three cases of this group where the injections were begun on the twentieth and twenty-second days of the disease the temperature fell rapid- ly after the injections, but it was so late in the disease that one can not be sure that convales- cence would not have begun at that time had the injections been withheld. In the eight other cases there is no doubt, Dr. Lambert thinks, that the injections did not result in any benefit to the patients. On the other hand, in no one of the twenty-eight cases was there any harmful effect observed due to the injec- tions. The case that proved fatal was a very severe one, the patient being in an extremely poor general condition when the injections were begun. On the eighth day but three in- jections were given of one, two, and three cubic centimetres, respectively; tub baths were also given during and after the injections in this case, but the patient died from the severity of the disease three days after the last injection, and on the fifteenth day of the disease. The cases recorded by Dr. Lambert were taken as they came to the hospitals, and were mild, moderately severe, and severe. The diagnosis was purely clinical. Dr. Lambert cites von Jaksch, of Prague, as having used the original thymus bouillon of Fraenkel in nine cases and Rumpf's prepara- tion in eight, In one severe case coming under his care in the second week, with a tem- perature of 104° to 105° F., after five injections with typhoid thymus bouillon the patient was apyretic and the temperature did not rise again. In the eight remaining cases so marked a result did not occur. It also was evident that with the pyocyaneus culture a continuous can be changed to a remittent fever, but in severe cases this result was not obtained. He did not ob- tain valuable results with the treatment, as he did not consider that he had so modified the typhoid poison that it proved of essential bene- fit to the patient, although he had shortened the duration of the disease. Moreover, the in- THYMUS EXTRACT 7 THYREOID TREATMENT jections were unpleasant to the patients, as they often caused severe pain. In one severe case which came to autopsy, sterile pyocyaneus pus was found in the injection wound. Kraus and Buswell, of Vienna, are also cited by Dr. Lambert as having tried the pyocyaneus thymus bouillon in twelve cases. They in- jected into the thigh and observed a limited lymphangeitis follow and abscesses in two cases. The cases were severe and moderately severe, without complications, but with two deaths. The stage of the disease was the second or third week, so far as the history could show. Only three cases showed positive results on the temperature. In four or five further cases such a supposition was fairly possible, in the rest it was quite out of the question. There was no influence on the curve as to the fever's being continuous or remittent. The pulse fell with the temperature; the diarrhoea did not im- prove, the roseola persisted, and the spleen continued large. Only one case showed marked general improvement, though it showed no marked fall of temperature. In this case there was distinct increase of strength, and the stu- por and nightly delirium disappeared. These authors are not at all favourably impressed with the treatment. In summing up the results in the cases re- corded by him, Dr. Lambert says he certainly has not obtained the brilliant results alleged by Fraenkel and Rumpf. The treatment seems to him, however, to have been of benefit in a little more than half the cases tried, and where it benefited it certainly modified the severity, and in some cases shortened the duration of the disease. THYRADEN.—This preparation, called also, extractum thyreoidee, consists of a dried extract of the thyreoid gland triturated with such an amount of sugar of milk that one part of the product is equivalent to two parts of the fresh gland. It is given in daily amounts of from 15 to 25 grains in cases in which thy- reoid medication is indicated. THYREOANTITOXINE.—Dr. Sigmund Frankel, of Vienna (Medical Record, January 11, 1896), has given this name provisionally to a very hygroscopic crystalline substance, ap- parently an alkaloid, obtained by him from the thyreoid gland of the sheep and thought by him to be the active principle of the gland. So far as has been reported at present, it has been used only in experiments on animals. THYREOID EXTRACT, THYREOID FEEDING, THYREOID GLAND, THY- REOID MEDICATION, THYREOID TREATMENT.—During the past five years the attention of the medical profession has been strongly called to the therapeutic value of extracts made from certain animal tissues, many of which will probably soon pass into ob- livion, while others will almost surely obtain a permanent position in our materia medica. It is by no means the first time in the history of medicine that healing virtues have been attrib- uted to extracts made from animal tissues, for their use seems to have been known in a crude I way among the ancient peoples; references are THYREOID TREATMENT 288 made to them as well-known therapeutic agents in the Middle Ages, and during the last cen- tury a number were dropped from the London Pharmacopoeia. But no such antiquity can be ascribed to the use of extract of the thyreoid gland, although it is to-day one of the most prominent of this class of drugs whose claim to recognition is based upon what appears to be a firm foundation. Its employment is es- sentially modern and was not due to chance or analogy, but was the result of careful scientific observation and logical deduction. The history of its origin is very interesting. The function of the thyreoid gland had been a subject of curiosity for many years and vari- ous theories in regard to this function were held by different scientists, while some even made the assertion that in the adult human subject it performed no function whatever and was of no value. In 1873 the disease known as myxedema was first described by Sir William W. Gull, and a number of autopsies have re- vealed atrophy of the thyreoid gland as a con- stant pathological condition in that disease. In 1883 Kocher described a condition called cachexia strumipriva, which occurred as a re- sult of extirpation of the thyreoid gland, and a few months later Simon called attention to the identity of the symptoms of myxcedema and those of cachexia strumipriva. These char- acteristic symptoms are a subnormal tempera- ture, a sensation of chilliness, mental and physical torpor, fibrillar muscular tremors, anaemiaa, subcutaneous deposit of mucin, and a thickened, coarse, dry, and harsh skin. After removal of the gland the subnormal tempera- ture is preceded by an elevation of several degrees, and the cachexia appears the more quickly after the operation the younger the patient. The course of both conditions was marked by steady progress and usually resulted in death. A series of experiments upon the lower animals demonstrated that a similar con- dition was produced in them by the extirpa- tion of the threoid gland. It was next learned that the gland could be removed from the neck of a dog and trans- planted to the peritoneal cavity, and that, if it became vascularized and attached in the place to which it had been transplanted, the animal remained free from the symptoms of cachexia strumipriva which otherwise invariably super- vened. Attempts to transplant the thyreoid gland of a sheep into the tissues of patients suffering with myxcedema followed as a natu- ral sequence. In 1890 Bettencourt and Serrano performed this operation and obtained a great improvement, which began at once, before the gland had had time to resume its functions, or indeed to become vascularized. This demon- strated that something of a remedial nature had been introduced into the system which per se had caused the improvement, and the most reasonable explanation appeared to be that this something was present in the juice of the gland, as this had escaped freely into the tis- sues of the patient during the operation, where it could readily have been absorbed. Further experiments on the lower animals also showed that the appearance of cachexia strumipriva could be prevented after thyreoidectomy by the systematic injection of the fresh juice of the thyreoid gland. Thus all other theories of its function were done away with and it was evi- dent that the thyreoid gland produced some- thing necessary for the nutrition of the body and that this something was apparently to be found as a secretion in the juice of the gland. These questions then immediately arose: Could this substance be isolated, and could it be util- ized as a therapeutic agent ? A number of in- vestigators have attempted to accomplish the isolation of this substance, and the reports thus far published seem to promise some definite re- sult in the near future, although at the present time of writing we have little or no knowledge of its chemical nature ; but the second ques- tion was quickly answered in the affirmative. On April 13,1891, G. R. Murray gave for the first time a hypodermic injection of a glycerin extract of a sheep's thyreoid gland to a patient suffering from myxcedema, and after the main- tenance of this treatment for a reasonable length of time was gratified to observe a de- cided improvement. In the early part of 1892 several successful attempts were made to ad- minister the thyreoid gland by the mouth, in either a raw or a cooked condition or in the form of an extract, which demonstrated that the active principle secreted by the gland was not destroyed by the process of digestion, and since that time it has been employed by the profession to a considerable extent. An im- portant factor doubtless in the cordiality of its reception is the fact that the cases for which it is recommended and in which it accom- plishes the most good are of the number which before were acknowledged to be hopeless and incurable. They are also rare, fortunately, in this country. • Our knowledge of the physiological action of the secretion of the thyreoid gland is very lim- ited and consists only of what has been ob- served of the symptoms produced by its absence and those produced by larger doses than neces- sary given to patients suffering from certain pathological conditions. The symptoms pro- duced by its absence from the system are those of myxcedema and of cachexia strumipriva, and the study of these has given rise to theo- retical explanations which are as yet attended with so much uncertainty that the only defi- nite statement which can be made is that the thyreoid gland performs an important part in the nutrition of the body. The usual symp- toms which have been noticed after the admin- istration of a dose too large for the patient to tolerate are a sharp rise of the temperature, an increase in the rapidity of the pulse, headache, nausea, vomiting, prostration, and profuse perspiration. The gastro-intestinal disturb- ance is apt to be severe, and one case is record- ed which terminated in coma and death. A case reported by Beclere seems to be particu- larly instructive because the ingestion of a large amount of thyreoid gland was persisted in for several days, and the symptoms which were induced bore a remarkable resemblance to those present in exophthalmic goitre. The pa- tient, who was suffering with myxcedema, is 289 THYREOID TREATMENT said to have taken nearly three ounces (92 grammes) of thyreoid gland in eleven days and to have presented the following symptoms at the end of that time: Rapid pulse and respira- tion, elevation of temperature, restlessness, in- somnia, the presence of both albumin and glucose in the urine, which was greatly in- creased in quantity, exophthalmia, a sensation of heat, profuse perspiration, partial paraple- gia, and temporary tremor of the arms. Other authors have also observed symptoms which occur in exophthalmic goitre occasioned by the prolonged use of a greater or less excess of thyreoid extract in cases of myxcedema, and this has occurred to such an extent that it is alleged that with the exception of those symp- toms referable to the motility of the upper lid, von Graefe's and Stellwag's symptoms, and those due to swelling of the thyreoid gland, all the common and many of the less frequently observed symptoms of exophthalmic goitre have been thus produced. Swelling of the salivary glands has also been reported as a re- sult of overdoses. For medicinal purposes the thyreoid gland of the sheep is usually employed, but that of the pig or of the cow may be substituted with equally good results. The animal from which the gland is taken must be in perfect health, and that this is the condition should be deter- mined by a thorough and careful examination of its various organs. The gland should be re- moved with complete aseptic precaution, freed from fat and connective tissue, and then placed in a sterilized jar. It may be eaten raw or very slightly cooked, but, as the flavour is not pleasant, it is advisable to give it in glycerin or some other vehicle to disguise its taste when- ever this method of administration is for any reason preferable. A better form for administration is the liquid extract, which may be prepared in the follow- ing manner: The gland is finely minced and the fragments, together with the fluid which escapes during this process, are placed in a mixture of equal parts of boiled water and glycerin, in the proportion of two cubic centi- metres of the mixture to each lobe of the gland, in which they are allowed to macerate in a cool place for about twenty-four hours. The prep- aration is then filtered under pressure, and usually yields about a drachm and a half of extract "obtained from one entire gland. In the earlier preparations a 0-5-per-cent. solution of carbolic acid was used instead of boiled dis- tilled water, but this is not necessary. This extract was at first used hypodermically and may still be so given, but it is quite apt to cause localized inflammation and abscesses, and, as the process of digestion does not appear to affect the active principle, it is preferable, unless there is a special contra-indication, to give it by the mouth. When given hypoder- mically, it must be injected very slowly and in much smaller doses than when swallowed. It deteriorates after a few days, so fresh prepara- tions must be frequently made. A more elegant and on the whole more satis- factory preparation is the dry extract, which is made by pulverizing the gland or the expressed juice after it has been dried, or from precipi- tates thrown down in the liquid extract by al- cohol or other reagents. This dry extract, mixed with proper excipients, is on the market in the form of tablets and pills which are stated by the manufacturers not to be liable to dete- riorate for a considerable length of time, and form the most available and best form of the drug for administration. [Dr. S. J. Meltzer (New York Mediccd Jour- nal, May 25,1895) says concerning the thyreoid preparations: " We can hardly speak any more of thyreoid extracts. In this country the prep- arations of three firms seem to be in vogue— Parke, Davis, & Co., Armour & Co., and the London firm of Burroughs, Wellcome, & Co. The latter offer the thyreoid exclusively in the convenient form of tablets. In the English and German literature we often read of these tablets; in this country also they are preferred by some. My own experience has been less favourable—the effect was inconstant. Of Parke, Davis, & Co.'s preparations, I have em- ployed so far only the desiccated powder. In the" myxcedema case that I reported to you (the members of the German Medical Society of New York) last year I had again and again to return to the powder of Parke, Davis, & Co., which always brought the desired effect. Of Armour's preparations, I have used both the powder and the tablets. The latter have not given me satisfactory results. The tablet form is not reliable, anyhow: they often do not dis- solve, and then again it might happen that an accumulated large number would accidentally dissolve at once and produce a dangerous con- dition. The powder is furthermore preferable because you can prescribe different quantities at your own will, while fractions of the small tablets can certainly not be measured exactly. The powder is administered in wafers or in capsules, if it is simply put into the capsules without being previously made into a mass. It should be borne in mind that the weights of the preparations of the different firms have a different meaning. Parke, Davis, & Co. pre- pare fifteen grains of powder from one thy- reoid, while Armour & Co. prepare only six grains. Thus one grain of Armour & Co.'s powder is equal to about two grains and a half of the powder of Parke, Davis, & Co. For the tablets of Burroughs, Wellcome, & Co. it is maintained that they represent one sixteenth of a thyreoid and contain five grains of the substance of the gland. Then one tablet would be about equal to one grain of the powder of Parke, Davis, & Co., and from an eighth of such a tablet Bramwell has seen good results 1" Dr. Meltzer adds in a foot-note that tablets similar to those of Burroughs, Wellcome, & Co. are now furnished by Fairchild Brothers & Foster.] ., The indications for the use of thyreoid ex- tract may be briefly stated to be the symptoms caused by the absence of the normal secretion of the thyreoid gland from the system. Its therapeutic value is chiefly exhibited in the treatment of myxedema, where it appears to supplv a substance of which the system has been deprived by the functional inactivity of THYREOID TREATMENT 290 the organ by which it is normally secreted. The results which have been obtained in this heretofore incurable disease have been pecul- iarly gratifying whenever the treatment has been maintained for a sufficient length of time. Among the earliest signs of improvement are the rise of the temperature to normal and the disappearance of the feeling of chilliness. These are apt to occur during the first week of treat- ment. The swelling then begins to decrease, and care should at this time be exercised to prevent a too rapid diminution in weight, as this may occasion prostration. The skin undergoes a certain amount of desquamation and then be- gins to regain its normal condition. At first it may hang loose on the body, because it has been stretched to a considerable degree by the swelling, but it gradually regains its elasticity and contracts, while at the same time it loses its harsh, rough appearance and becomes soft and moist. After several months of treatment a new growth of hair replaces that which had fallen out and the nutrition of all parts of the body is greatly improved. The lessened hebe- tude and the gradual increase of physical and mental energy are among the early symptoms of improvement, and they progress about equally, while the speech improves until it is fluent and distinct. The treatment of myxcedema is divided into two stages, the first to remove the symptoms, the second to prevent their recurrence. The duration of the first stage is uncertain, but may be said to be several months, while that of the second will probably be for the re- mainder of the patient's life. The dose of the extract at the beginning of treatment has to be determined for each case individually. Murray says with regard to the liquid extract: " If a dose of five minims of the extract is given each morning two or three hours after breakfast and no distinct improvement has taken place at the end of a week or ten days, and the pulse has not been accelerated, the dose should be increased to ten minims and later to fifteen if ten is not found to be suf- ficient. In some cases it is necessary to give as much as fifteen minims twice a day." The pulse, temperature, and digestive organs must be watched for signs of intolerance. An in- crease of the pulse-rate of more than twenty beats a minute, a rise of temperature to a de- gree above normal, or any gastro-intestinal disturbance should be noted as an indication that the dose is too large and must be reduced. During the second stage the object is to fur- nish the exact amount for the daily need of the body, and this likewise can be determined only by experiment. [When the manifestations of myxcedema have once been subdued it is important to know when to resume the thyreoid treatment. On this point Dr. Meltzer "(loc. cit.) remarks that it is generally stated that an increase in weight is an indication to start the treatment again, but this he thinks is certainly not correct for all the cases. An increase in weight is often observed while the patient is still continuing to take the thyreoid in full doses, especially after the first rapid loss in weight; the im- proved health is the cause of gaining normal flesh. He has seen it in his own experience, and similar statements are made by others. He would rather put forward the complaint of feeling cold as a sure indication of the begin- ning of the return of myxcedema. He has noticed the appearance of this complaint sometimes even before the weight has shown an increase, and a few small doses of thyreoid were sufficient to soon do away with the chilli- ness. The chilliness is an important symptom in myxcedema, and is independent of the changes in the skin or the subcutaneous tissue.] Thyreoid extract is an efficacious remedy in cretinism, which seems to be simply a variety of myxcedema that appears in infancy or early childhood and is in like manner depend- ent on a faulty development, atrophy, or functional inactivity of the thyreoid gland. The improvement is in the same manner and on the same lines as in myxcedema, with results which are equally gratifying. On account of the arrest in their development, children who suffer from cretinism are very small, and a noticeable effect of this treatment is the rapidity of their growth after they have come under its influence. These children are able to take much larger doses of thyreoid extract in proportion to their size than myxcedema- tous adults, but too large doses produce the same class of symptoms. As in myxcedema, the administration of the remedy must be pro- longed throughout the patient's life, and it has been suggested that on this account grafting of a thyreoid gland into the neck may prove the preferable method of treating this condi- tion. [In Pediatrics for May, 1896, Dr. Frederick Peterson and Dr. Pearce IBailey report a case of cretinism, in a child eighteen months old, as probably cured by thyreoid treatment, also an- other, in a subject fifteen years old, as greatly improved. They have tabulated the cases re- ported up to the time of preparing their article, in so far as the reports were sufficiently specific to be of statistical value. They conclude that under thyreoid treatment the symptoms of myxcedema disappear from the child quite as readily as from the adult. In none of the cases cited by them did the general cedema- tous symptoms fail to yield to the remedy when it was properly and sufficiently applied. The skin became soft, the swellings disappeared, and the whole appearance of the patient was completely changed. The carrying out of the treatment of myxcedema, they remark, is at- tended with fewer difficulties "and dangers in children than in adults. Toxic symptoms have been observed in a few cases only, and but two patients have died under treatment. Of these, one died of intercurrent diphtheria and one of bronchitis; in neither of these two cases was the treatment regarded as a causa- tive factor of the fatal symptoms. In addition to the disappearance of the symptoms from the skin and subcutaneous tissues, the thyreoid treatment of sporadic cretinism has in some cases led to brilliant results by permitting a return of development and growth to children in whom these func- 291 THYREOID TREATMENT tions had been limited or arrested by the dis- ease. But although marked changes in the mental and physical condition of cretins have occurred, it yet remains to be reported, they add, that these children become the physical and intellectual equals of children who have never had myxcedema. Improvement conse- quent upon a return of development has been more constant in the body than in the brain. In a large number of the reported cases the patients have grown considerably taller and have acquired sufficient power and control of the limbs to enable them to walk, which had previously been impossible. The teeth, which had been absent or defective, began to appear normally. Intellectual progress has been neither so constant nor so rapid. In nearly all the cases there has been noted some mental improve- ment, but in only a few has the power of speech been acquired when it previously had been absent. They remark that the occur- rence, in the formative period of infancy and childhood, of a disease which attacks nutrition, development, and growth fundamentally has much more disastrous effects than when its appearance is delayed until the organism has reached maturity. They think that, while it is possible that the removal of causes inhibitory to growth may result in a gradual return of developmental processes, the thyreoid treat- ment of infantile myxcedema has in no case been carried out for a sufficient length of time to permit of the assertion that such will be the case. They have been able to find no case in which treatment is reported to have lasted more than a year and a half, and of no case is it said that the patient was in all respects cured; but from the fact that in nearly all the cases treatment was not instituted until the child was several years of age and had de- veloped but little or not at all for a consider- able length of time, several years would be necessary, by the natural processes of develop- ment, for the complete re-establishment of normal growth. Although data sufficient to justify positive assertions are lacking, it seems to them entirely within the range of possibility that, if the treatment of sporadic cretinism is begun at the outset of the disease, before growth is seriously interfered with, it will permit of the proper development of the child, without myxoedema- tous symptoms, as long as the thyreoid is ad- ministered.] Insanity is not a rare complication of myxce- dema. It usually occurs in the form of acute or chronic mania, melancholia, or dementia, and is quite amenable to treatment with thy- reoid extract. [Thyreoid treatment has been employed successfully in some cases of insanity not con- nected with myxcedema. Dr. Lewis C. Bruce (Journal of Mental Science, January, 1895 ; Dublin Journal of Medical Science, August, 1895) concludes a clinical article on the sub- ject as follows: 1. By the internal administration of thy- reoid-gland substance a true febrile process can be induced, and the resulting reaction is bene- ficial to the patient. 2. The amount of the drug necessary to induce physiological action varies in different individuals", but it is seldom neces- sary to give a larger dose than sixty grains daily. 3. Excessive and prolonged adminis- tration of thyreoid extract produces gastric irritation. 4. The use of thyreoid extract in the treatment of the insane is accompanied by a certain amount of danger from induced heart weakness. This danger can be minimized and almost discounted by confining the patient to the bed during treatment and for some days afterward. 5. The administration of thyreoid is contra-indicated in cases of mania where the excitement is acute and the loss of weight rapid, and where there is danger of exhaustion from malassimilation of food. 6. Thyreoid treatment appears to be specially useful in the insanity of the adolescent, climacteric, and puerperal periods. 7. It is especially useful in cases where recovery is protracted. 8. In cases of long standing, where there is a tendency to drift into dementia, a course of thyreoid treat- ment sometimes gives the necessary fillip which leads to ultimate recovery. 9. Patients under this treatment should be kept in as equable a temperature as possible. The use of thyreoids in the various forms of mental derangement has been made the sub- ject of special investigation in three of the New York State hospitals for the insane, says a writer in the International Medical Maga- zine for May, 1896, and the results are published in the State Hospitals Bulletin for January, 1896. In the Middletown State Hospital (homoeopathic). Dr. Ales Hrdlicka has used thyreoid tablets in four cases of general paresis, one case of suicidal melancholia, one of pri- mary dementia, one of dementia following acute melancholia, one of puerperal insanity, one of paranoia, and three of secondary dementia, All these patients were free from respiratory or circulatory disorder. The treatment ex- tended over two months and was begun with the administration of 5 grains daily, and the amount was gradually augmented to 25 or 30 grains daily. Among the effects of the drug the following are recorded: Both the pulse and respiration were increased in frequency, but this increase was never great. There was a rise in temperature of one or two degrees. The appetite improved. The bowels were reg- ulated, and in several cases diarrhoea was pro- duced. The elimination of urea was increased. The majority of patients lost weight while under treatment. Regarding the mental symptoms, there was noted, under moderate doses, pronounced general psychical improve- ment; the mind became clearer and more active, and the manner livelier. Sleep was improved. When the dose was immoderate, symptoms of irritation appeared as a rule. The patient with puerperal insanity was cured. In the case of suicidal melancholia, in that of dementia following melancholia, and in two of the cases of secondary dementia there was temporary improvement. The patient with primary dementia grew worse. There was some temporary amelioration in a few of the cases of general paresis. THYREOID TREATMENT 292 Dr. Warren L. Babcock experimented with desiccated thyreoids at the St. Lawrence State Hospital with three main objects in view: first, to definitely ascertain the physiological action of thyreoid ; second, to determine there- by in just what classes of cases it might be used to further recovery; third, to apply it therapeutically to those cases in which it offered the best results. This observer determined that extracts made from the thyreoid gland had a definite physiological action; that an unvarying strength of any given amount could be obtained by proper preparation; and that the true thyreoid preparations had no relation- ship with the so-called animal extracts. The treatment was begun by the administration of 5 grains of desiccated thyreoid extract, and this dose was increased judiciously. Fifteen grains seemed to be the maximum dose that could be given with safety for any length of time, and then only in patients whose physical health was impaired in a slight degree if at all. The physiological action of the drug he sums up as follows: The number of red blood- corpuscles to the cubic millimetre and the per- centage of haemoglobin were increased. In the majority of cases arterial tension was increased; in a small proportion the blood-pressure was diminished. Praecordial oppression occurred in a few cases. The pulse was accelerated; the respirations were not especially influenced. The temperature in the majority of cases was ele- vated from one to three degrees. In one case the temperature was subnormal. Myasthenia was pronounced in the majority of cases at an early period of treatment; flaccidity, tremor, and general weakness characterized these cases. The early development of a feeling of appre- hension, together with some mental and much motor restlessness, was noted, usually during the third day. At first there was an apparent sense of fatigue with great mental oppression, followed by a gradual clearing up of the cere- bral processes and improved mental co-ordina- tion. The reflexes, in the majority of cases, were increased and exaggerated from an early period of the treatment. In nine cases pre- senting more or less anaesthesia, the sensibility returned to normal or was very much improved. Two patients became hyperaesthetic. Diuresis was well marked in many cases, and perspira- tion was decreased. A few of the cases pre- sented varying degrees of gastric symptoms. An eruption accompanied by severe itching like urticaria, and followed by scaling and des- quamation, was observed in two cases. The elimination of the products of retrograde metamorphosis was greatly increased. Dr. Babcock thinks that the thyreoid treatment holds out a prospect of recovery or improve- ment, first, in cases of post-melancholic hebe- tude following a lengthy period of depression ; second, in cases of stuporous melancholia of long duration; third, in maniacal cases in which the attacks have been unduly prolonged ; fourth, in cases of cerebral exhaustion follow- ing acute delirium or stupor in which the elimination of urea and other nitrogenous compounds is greatly reduced : fifth, in chronic " disturbed " cases ; sixth, in doubtful cases thyreoid may assist in distinguishing between true stupor and dementia ; in delusional cases it will show whether the delusions are fixed or temporary. Dr. L. Pierce Clark, of the Craig Colony for Epileptics (Medical Record, October 24. 1896), has employed thyreoid treatment in epilepsy. The cases selected were those in which many congenital defects were noticeable, and in which epilepsy had been a prominent feature of the patient's life since early infancy. An effort was also made to select cases in which defective development mentally as well as physically was manifest. The treatment was not attended with very good results. While all the patients seemed to be benefited for the time being in some ways, Dr. Clark doubts if there will be any permanent improvement. On the whole, he says, its small effect upon epileptic seizures in these trial cases would not seem to justify its continued use in epilepsy, and its further administration has not been attempted.] Attention has been directed to the use of thyreoid extract in skin diseases by Byrom Bramwell, who in 1893 reported excellent re- sults in a number of cases of psoriasis treated in this manner, and since then it has been tried rather extensively in the treatment of various cutaneous diseases. The results can not be said to have been marked with great success, but improvement has been obtained in a suf- ficiently large number of cases to warrant further investigation. The good results some- times obtained from the use of thyreoid ex- tract in these cases suggest the question of whether it is not possible that certain forms or cases of cutaneous disease are dependent upon some irregularity or perversion of the thyreoid secretion, and whether the artificial ingestion of its active principle for a time may not enable the gland to regain a healthy activity and cause the symptomatic cutaneous eruption to dis- appear. At present a distinction can not be made between the cases which will and those which will not be benefited by this treatment. [In the New York Medical Journal for May 4, 1895, Dr. Leo Stieglitz reported the cases of two sisters affected with deformity of the nails that he had treated with thyreoid feeding. In the case of the older sister, a cook, twenty-two years old, the nails in which the disease was most advanced were of a brownish hue, " as if mortified"; they were rough, irregular, mis- shapen, short, and stunted, as if retarded in their growth. The disease, where it was less pronounced, involved only part of the nail in longitudinal section, the diseased part being brown and occasionally separated from the healthier part of the nail by a longitudinal split. The nails least affected were rough, brittle, and mottled in appearance. The skin of the hands was rough to the touch and slightly puffy. The growth of hair on the head and other parts of the body was abun- dant. The skin of the face and body was not abnormal in any respect. The nails of the toes showed the same diseased condition as those of the fingers. A careful examination of the nervous system and of the various viscera re- 293 THYREOID TREATMENT vealed no disturbance of any kind. The pa- tient was put upon the use of 5 grains of Parke, Davis, & Co.'s desiccated thyreoids, once a day the first week, the second week twice a day, and subsequently three times a day. At no time were any ill effects from the use of the drug noticeable. In four weeks after the be- ginning of the treatment the patient began to shed her nails and some of her hair. In two months more a set of new, well-developed, smooth, and shapely nails had replaced the old diseased ones. The skin of the hands became smooth and soft. The loss of hair was followed by a more luxuriant growth than had been present before. The patient was presented in this condition to the New York Society of German Physicians on February 23, 1894. She subsequently stopped taking thyreoid for a few weeks, and her nails began to show signs of returning disease, which disappeared when the treatment was taken up again, 5 grains being given every day or two. The younger girl, seventeen years old, had the nail of her right thumb affected in the same way that her sister's nails were; it was brown, rough, thickened, and stunted in its growth. The girl had worked for a year and a half in a gold factory, where she often had to put her thumbs into a solution of ammonia. For six months she had not been working. She had noticed the change in her right thumbnail for a year; none of the other nails were affected. The thyreoid preparation was administered in a 5-grain dose once a day, but it caused so much nausea that the patient stopped the treatment after a few days. Dur- ing the next nine months the condition of the nail remained unchanged, the nail not growing at all, according to the patient's statement. On December 5th she began taking Burroughs, Wellcome, & Co.'s 5-grain thyreoid tabloids, one a day, and continued to do so up to the time of the report, the tablets creating no dis- turbance of any kind. Within a few days the nail began to grow, and on December 23d it was already half renewed, the new part being somewhat uneven, but of proper colour and consistence, The girl was shown by Dr. Stieglitz at a meeting of the Manhattan Medical and Surgi- cal Society on December 29th. and it was seen that the contrast between the healthy and dis- eased portion of the nail was striking; whereas the proximal half was healthy in colour and consistence, though uneven, the distal half was brown, brittle, and stratified. These two cases show, says Dr. Stieglitz, that even in the ab- sence of myxcedema thyreoid feeding stimu- lates the growth of the" nails to a remarkable degree. In the same article Dr. Stieglitz reports a case of circumscribed sclerodermic of the leg, in a woman thirty-three years old, in which the condition was much improved by the use of 5 grains of Parke, Davis, & Co.'s desiccated thyreoid gland from once to three times a day, but he does not maintain that thyreoid treatment will cure sclerodermia. In the British Medical Journal for April 18, 1896, Dr. William Rushton Parker relates a cure of eczema with thyreoid extract as fol- lows: " Mrs. K., aged sixty-five, mother of fifteen children, had been hale and active all her life. Between 1890 and 1895 she became very much stouter, and a very conspicuous bagginess de- veloped under the chin. During the summer of 1895 her appetite failed, she became weak and lazy, and lost much of her recent accumu- lations of fat. In October eczema appeared over the whole surface, so that by November the scalp was very dry and scurfy, the hair lustreless and sparse ; the trunk dry and rough all over, swollen and erythematous in parts, and much torn by scratching; the upper limbs dry and harsh, with erythematous patches in the bends of the elbows; the lower limbs red, greatly swollen, moist, and much excoriated, worse below than above the knees, and itching severely. As the patient always felt cold, not- withstanding the mildness of the winter and her remaining in bed near a blazing fire night and day; and as she had this baggy myxcede- matoid swelling under the chin, with some suspicion of similar masses above the clavicles in the lower part of the posterior triangles, and as the entire surface had by the middle of December become dry and harsh by a few weeks' local applications to the legs, she was put on a 5-grain thyreoid tabloid daily for two weeks, and two tabloids daily in January, with the result that the chilliness vanished, the submental bagginess decreased, and the entire skin was rapidly losing its dryness, roughness, and itchiness, and becoming quite natural. She then discontinued the tabloids, when the eczema returned so badly as to be very little better in the latter half of January than in the previous November or early half of December. During February she was put on three, and afterward four, tabloids daily, when the chilli- ness again disappeared, the submental baggi- ness decreased, and the whole surface rapidly lost its dryness, harshness, and itchiness, the skin becoming so fine and soft that the tab- loids were discontinued in the beginning of March without any recurrence of the eczema during the six subsequent weeks that the pa- tient was under observation. " There was no suspicion of true myxcedema beyond the bagginess, chilliness, and dry skin; the patient was garrulous, and her mind as clear as ever, except for a problematical blunt- ing of memory. The thyreoid extract was given more on account of these symptoms than for its reputed usefulness in psoriasis and eczema; and the total disappearance of the eczema under its administration was an agree- able surprise. It should be added that the eczema rubrum of the legs was treated with lead lotions, calamine ointments, and bandaging; while quinine, strychnine, iron, and arsenic were given for the loss of appetite, weakness, and malaise; but no marked difference was observed on passing from one to another tonic at all corresponding to the obvious changes which kept pace with the variations in thyre- Dr. J. Barclay (British Medical Journal, October 24,1896; New York Medical Journal, THYREOID TREATMENT 294 November 14, 1896) calls attention to the re- sults obtained by him in the treatment of lu- pus with thyreoid extract, but adds that the slight extent of his experience does not, he thinks, entitle him to be dogmatic as to re- sults. He relates the histories of four cases. The first patient was an unmarried woman, aged twenty-five years, who had been the sub- ject of lupus of the nose and both cheeks since 1891. Scraping had been thoroughly done in 1892, and, on the disease returning, scraping and Paquelin's cautery were employed in 1893. Relapse soon followed, and in January, 1895, thyreoid tabloids, one three times a day, were given. In three weeks local reaction became apparent, very markedly resembling that fol- lowing Koch's tuberculin in this disease. First there appeared a bright-red ring sur- rounding each nodule, with swelling of the nodule and tenderness, indicating acute in- flammation. The dose was now increased to six tabloids daily, and after a couple of weeks nine were taken. These were well borne, noth- ing worse than emaciation being observed during the months of the treatment. This condition of inflammation persisted for several weeks, at the end of which the nodules began to soften and break down. Complete slough- ing followed, and a deep ulcer took the place of the nodules. At this stage all the sur- rounding redness had disappeared. After all the nodules had pursued this course of inflam- mation and consequent necrosis, the parts pre- viously affected presented a series of clean and healthy-looking sores, from which a thin dis- charge exuded. Healing was slow. Yet by merely keeping the parts clean by washing with soap and water, and by covering them with vaseline to prevent the formation of scabs, healing was gradually accomplished, and there remained only a white, flat, and sound scar. No other external application than vaseline was employed. Dr. Barclay re- grets that the discharge from the ulcers was not examined for bacilli, and that no note of the temperature during the stage of inflam- mation of the nodules was kept. In Septem- ber, 1895, it was noted that the face was nearly well, and in January, 1896, quite well. At the date of the report—July 16,1896—the face remains quite well. In another case the patient was a married woman, aged thirty-five years. She had been the subject of extensive lupus of the face since 1889. The disease included a large patch on the right cheek, one on the upper lip, and the whole of the nose and interior of the nostrils. Various attempts at destruction of the malady had been made before the author saw her, which was in April, 1891. At that time a thorough scraping was done, but the disease returned more actively than before. Cod-liver oil was taken from that time to the end of 1892, but without apparent benefit. In Feb- ruary, 1893, scraping and Paquelin's cautery were followed by temporary benefit, but after a few months matters were as bad as before. In January, 1895, thyreoid tabloids were or- dered, but were taken very irregularly, and sometimes ceased to be taken altogether for weeks at a time during all that year. On all the occasions on which the medicine had been continuously taken for three or four weeks, the usual local reaction, which is described as having occurred in the preceding case, was ob- served—namely, redness, swelling, and pain; but immediately on leaving it off these local signs gradually died away, and no necrosis or sloughing of the nodules followed. However, in January, 1896, the patient took the tabloids in earnest, first three daily, after a fortnight six, and after a month nine a day. The re- sult was that the whole of the nodules on the nose sloughed away, the deep ulcers left have become filled up, and cicatrization is going on steadily. The patch on the right cheek, which had somewhat healed over before the thyreoid treatment was begun, had become inflamed, but no necrosis followed. The nodules on the upper lip, which all along had been larger than those on the nose, seemed to have been more slowly affected by the thyreoid than the others, and at this time all had not softened down pari passu with their neighbours. At the time of the re- port she was continuing to take the medicine steadily. The only external application em- ployed was vaseline. The whole process of the local reaction fol- lowing thyreoid treatment, says Dr. Barclay, is very similar to that which we were accus- tomed to observe after tuberculin injection, with this difference, that the thyreoid reaction is less violent, both locally and constitution- ally, and the good effects will, he trusts, be more complete and more permanent. He re- fers to Mr. Jonathan Hutchinson as remark- ing, speaking of the treatment of lupus by Koch's method : " No one ventures to report an instance of complete cure. Of the cases which have been shown to me as the most sat- isfactory, I am bound to say that in every one there has been evidence at some part of the edge of the remains of lupus tissue ready, I do not doubt, to start into fresh growth on the slightest provocation." Time and experi- ence, continues Dr. Barclay, have shown the truth of this statement. Judging from these two cases, there is in them no such suspicious appearance up to the present time. As to the duration of the treatment necessary to insure a permanent cure, even with full doses given regularly and continuously, it would seem as if one could not trust to a complete cure being effected in a shorter time than a year. The dose of the medicine in lupus, as in psoriasis, requires to be larger than what is found suffi- cient for myxcedema. And, as regards the age of the patient, the older he or she may be, the more cautious ought we to be with the quan- tity prescribed. Dr. Barclay states that he has observed no serious effect in youthful patients, but in those who have passed fifty years of age some irregularity of the heart's action has been noticed, which is controlled easily, how- ever, by reducing the dose and giving some al- coholic stimulant. Some interesting questions, he thinks, might arise in the course of this treatment. For instance, he asks, would it not be prudent during the necrotic stage of 29 the nodules periodically to examine the dis- charge for bacilli? Valuable information as to the progress of the treatment might there- by be obtained. Then one might ask what would be the effect of- a similar treatment in tuberculous glands in the various situations in which these are found ? Would it be analo- gous to what he has described in lupus ? And, lastly, what would be the probable effect of this treatment in tubercle of the lungs'? Surgeon-Major C. B. Maitland, I. M. S. (Lancet, October 31, 1896), gives an account of two cases of leprosy in which he employed thyreoid treatment. One of the patients was a Mussulman and the other a Hindu. He re- marks that the thyreoid gland certainly had a beneficial influence on these two men. There was obvious improvement in the skin, as shown by the effect on the tubercles and the ulcera- tion. There were no symptoms of thyreoidism, although the Hindu was taking two glands daily from June 3d to September 15th. The glands were pounded up raw with sugar and water. These cases are interesting, says Mr. Maitland, as showing that the thyreoid gland certainly has some effect on leprosy even when given to patients who continue "their usual home life while undergoing treatment.] Our knowledge with regard to the efficiency of thyreoid extract in cases of obesity, anemia, acromegaly, and syphilis is very slight. In some of these diseases this treatment has been suggested on purely theoretical grounds, while of others a few cases have been reported ; but more extensive investigations should be made in regard to all before any conclusions are drawn. [In an excellent article entitled Thyreoid Therapy (Medicine, August, 1896), Dr. James B. Herrick, of Chicago, remarks that the rapid loss of weight that occurs in myxcedema when the remedy has been employed, suggested its use in obesity, and the results warrant a trial in all cases. Kraus, he adds, finds thyreoidin of greater value in anaemic obesity than in that form accompanied by rosy lips, ruddy cheeks, good appetite, and strong muscles. In all cases the action on the heart is to be watched. The diet may or may not be altered. Where great tendency to weakness is shown, a full nourishing diet should be allowed during the treatment. Relapses are common unless mod- erate doses are continued. Among those cited by Dr. Herrick as giving favourable reports are Davies, Leichtenstern, Wendelstadt, Der- cum, Barron, and Ewald. Losses in weight, even up to nearly 25 pounds in six weeks, are reported, according to Dr. Herrick. Ewald, he says, has found that thyreoiodinin answers fully as well in promoting reduction of weight as the entire gland does. Just why some cases are refractory and others amenable, says Dr. Herrick, is still not definitely settled. The following account of an interesting case of acromegaly treated with thyreoid extract, by Dr. G. G. Sears, of the Boston City Hos- pital, was published in the Boston Medical and Surgical Journal for July 2, 1896 : " Mrs. C, a widow, forty-five years old, first presented herself for treatment at the Boston >5 THYREOID TREATMENT City Hospital in January. 1895. Her maternal grandfather died insane; her father of a ' com- plication of diseases,' probably of cardiac ori- gin, at the age of fifty; her mother of apoplexy at seventy-one. She has lost two brothers from consumption, while one brother, when last seen several years ago, had a brownish discoloration of the skin similar to that of the patient her- self, and was ' all bloated up.' She has had three children, none of the labours being note- worthy, one of whom died of cholera infantum; the other two are well but not strong. " Her previous medical history consists of an attack of varioloid when eight years old, ery- sipelas when eighteen, and pneumonia when twenty. Five years ago she had an attack of grippe accompanied by severe pain in her left ear. She has had occasional attacks of cholera morbus, and has been under treatment for re- troversion of the uterus and a lacerated cervix. She reached the menopause about six months ago, but had been irregular for about a year. Her general health has always been good, but she has complained all her life of drowsiness, which in recent years has so increased that now she is liable to drop asleep at any time. With this exception she dates all of her symptoms from twelve years ago, when a flat-iron fell upon her left side, starting up a brisk uterine haemorrhage, which lasted, however, but a short time. The nervous shock was much greater than the physical injury, and after this she passed large quantities of urine and had attacks of sudden weakness, in which she fell but yet retained consciousness. She began also to be very susceptible to cold, so that she had to wear extra flannels and take hot-water bottles to bed with her even in summer. Lately this symptom has grown decidedly better, and she now complains chiefly of local chilly feel- ings with the appearance of ' goose flesh' in spots about as large as a five-cent piece. Soon after the accident she noticed that her hands and feet were increasing in size, so that while she once wore a 3£ shoe she now requires a broad 7, and instead of a 65 glove she now wears a 7f, while her tongue has become so large that it is frequently bitten, and at times' feels so big that she wonders whether or not she can thrust it out of her mouth.' Her face grew fuller, her nose more prominent, and her hair coarser and drier, but it has never fallen out and still hangs nearly to her knees. She has suffered intensely at times, especially at night after sweeping or washing, from a feeling of numbness in her hands, which is accompanied by itching, pain, and a sensation of pins and needles. Her body also has at times felt sore and tender all over, and on lying down her joints become so rigid that she moves with dif- ficulty, while on rising her knees are so stiff that the first few steps are hard to take. She has had frequent attacks of cardiac palpitation as well as very distressing hot flashes recurring every ten or fifteen minutes. Sweating, espe- cially at night, and most noticeably over the chest, has also been a fairly constant symptom. Every little while she hears a ' puffing' in her ears synchronous with the heart and lasting for a longer or shorter period, but which for a THYREOID TREATMENT 296 day at a time may be nearly constant. About five years ago shelost her husband after a very long and trying illness, and after this she no- ticed that her mental processes seemed slow and that her memory was greatly impaired, so that she would often begin a sentence and then forget what she was about to say. She also became unusually nervous and irritable over trifles. A month ago her nose was cleared of mucous polypi by Dr. Leland, but they have now returned. Her appetite has been raven- ous and her thirst excessive. " The patient is a rather heavily-built woman about five feet five inches tall and weighing one hundred and seventy-five pounds. She stands fairly erect, without the marked kyphosis which has been noticed in many of these cases. Her face appears somewhat lengthened, and the frontal aspect of the head is triangular in shape from an enlargement of the jaws, espe- cially the lower, the under teeth closing a lit- tle outside the upper. There is no elevation of the eyebrows, but the eyelids appear puffy, and the skin of the face is thickened and masklike. The nose is noticeably large, the enlargement being in both the soft parts and the bones. The hair of the head, as well as of the pubes and axillae,- is coarse and dry, but very abundant and only slightly streaked with gray. The teeth are in good condition, but there is some retraction of the gums. The tongue is enlarged to at least a half more than its normal size. Over considerable areas on the neck and face the skin, which is everywhere moist, is brown in colour, and similar patches of dis- coloration are seen over the trunk and limbs. Scattered over the neck and trunk are very numerous small growths varying in size from the head of a pin to that of a bean, some of which are deeply pigmented. A few are pe- dunculated but most are sessile. There is no marked fulness above the clavicles. The clav- icles themselves are not noticeably enlarged, but the manubrium seems heavier and thicker than normal, while the angle at its juncture with the second piece of the sternum is more than usually acute. Over the manubrium the percussion note is somewhat dull, the prob- able result of the increased thickness of the bone. " The ribs seem heavier and are somewhat closer to each other than they should be. Owing to the thick fat layer, it is difficult to determine changes in the ilia, but they seem to have be- come thicker and heavier. There is a very marked enlargement of the hands, especially in their breadth and thickness, which is due less to changes in the bones than in the soft part covering them. The fingers are thick and stubby: the nails are short, broad, and marked with longitudinal striations. The crescent is covered. " The feet show similar alterations, but in them an enlargement of the bones is more readily made out, the toes appearing decid- edly longer than normal. The ankles and lower part of the legs are puffy and pit deeply on pressure. The chest is fairly well shaped and measures at the two respiratory extremes 32 and 34£ inches. Except for a prolongation of the expiratory sound, which can be accounted for by a loss of elasticity of the chest walls, ex- amination of the lungs is negative. The area of cardiac dulness is slightly enlarged lateral- ly, but, except for their rapidity and weakness, there is no modification of the sounds. " The voice is thick, monotonous, and plain- tive, while words are very slowly enunciated. All muscular movements are slow and weak, while the tenderness of the hands is so great that she is unable to grasp the dynamometer with sufficient force to move the index. Pulse 128. Temperature 100° F. " The following measurements of the head, hands, and feet may be of interest. The patient is left-handed. Circumference of head........... 21J inches. Circumference (chin to vortex)... 26 " Circumference of right palm..... 8J " Circumference of left palm....... 8£ " Length of right middle finger___ 4 " Length of left middle finger...... 3£ " Circumference of middle finger (proximal joint)................. 3 " Length of right foot.............. 9| " Length of left foot................ 93 " Width at ball..................... 33 ' Length of great toe............... 2| " The enlargement of the hands and feet, how- ever, is more conclusively shown by the larger sizes of gloves and shoes which she now re- quires than by these measurements. " For the examination of the special senses as well as for the electrical tests I am indebted to Dr. P. C. Knapp, who went over the case with much care. Smell is nearly lost, there being no perception of camphor or menthol with the right nostril and only slight with the left, a condition probably explained by the presence of polypi. Vision is practically nor- mal, the field is not contracted, and the colour sense is good. Nothing abnormal was seen in the fundus oculi. Hearing in the right ear is normal, but with the left ear a watch can not be heard more than six inches away. Taste, cutaneous sensibility, and the muscle sense are unimpaired. "The electrical reactions are considerably diminished quantitatively to galvanism and slightly to faradism, but there are no qualita- tive changes. The urine had a specific gravity of 1-018, and contained neither sugar nor albu- min ; the daily amount was slightly in excess of the normal quantity. " She was put on general tonics and on the dried extract of thyreoid gland in gradually increasing doses until 12 grains a day were taken, while galvanism was for a time given by Dr. Knapp. On the 17th of April, three months after her first visit, she reported that she was feeling very much better and took more interest in current events. Her memory had improved, and she spoke and moved more rapidly. Pain in the. hands had greatly dimin- ished, so that she slept well at night, but her joints still felt stiff. Her grasp was firm, and she was able to do her own washing and iron- ing, even to wringing out the clothes with her hands. The 'puffing' in her ears was gone, and the palpitation of the heart better. There was much less puffiness about the eyes and no pitting over the ankles. She had lost over 297 THYREOID TREATMENT twenty pounds in weight, but felt stronger than for many months. " From this time to the present her general condition has remained practically the same or possibly has slightly improved. She has been able to do all her own housework, even to the sewing, and has also gone out on one or two occasions in the capacity of monthly nurse. Her mental condition is normal, except that she complains that her memory is still some- what defective. Her weight is still further reduced so that she now tips the scales at one hundred and forty-six pounds, but there has been no change in the measurements of her hands or feet. The longitudinal furrows on her nails are, however, less marked, and her tongue shows a considerable diminution in size. The mucous growths in the nose have disappeared, and the nasal passages are unob- structed. During last June she suffered for a time from very severe vertical headaches, and she has had occasional attacks of palpitation and vomiting, which were apparently due to an overdose of thyreoid extract, which she has taken almost continuously in daily amounts varying from 3 to 9 grains. The temperature, which was taken only at infrequent intervals, ranged from 98-5° to 99-2°, more commonly the latter. " The history of the case and the marked physical changes leave little doubt that we were dealing with a case of acromegaly, but certain anomalous symptoms—such as the puffy conditions of the eyelids, which may, however, have been simply the result of anaemia, though its appearance was somewhat different, the slow speech, and the altered mental state—suggested that her condition was also associated with a loss of function of the thyreoid gland, which was strengthened by the fact that it could not be felt even after she had lost considerable flesh, and the decided improvement following the administration of thyreoid extract. The direct effects of treatment were seemingly apparent in the loss of weight, the diminished trophic disturbance of the nails, the decreased size of the tongue, the disappearance of the mucous growths in the nose, and perhaps also, if Schaefer's observation is correct, that the thy- reoid secretion dilates the blood-vessels, in the cessation of pain in the hands: but in the lat- ter case it is somewhat doubtful how far this result was due to the action of the remedy, and how far to the diminishing influence of the climacteric which she had recently passed, and which may have been a more or less potent factor in causing pain from the vaso-motor disturbances incidental to it. The other treat- ment employed consisted of tonics and the careful regulation, so far as possible, of her diet and general hygiene. " Regarding the aetiology of the case, the condition of her brother, as she describes it. is interesting as showing a possible family taint, which has not been observed in any of the re- ported instances ; but the facts are too meagre on which to base even a probable diagnosis, and as he lives many miles away no more defi- nite information could be obtained. In her own history no adequate cause could be found. It is true that she dates her symptoms from the time when she was struck with a flat-iron, but the nervous shock which this produced simply called her attention to a condition which had imperceptibly come on, as a photo- graph taken some months, at least, before the accident shows that quite marked changes had already taken place."] A considerable reduction in the size of the thyreoid gland in goitre has been repeatedly obtained by the use of thyreoid extract, and a few cures have been reported. Bruns is quoted by Murray as having treated twelve cases of parenchymatous goitre in young persons with raw thyreoids, with the result that four were cured, five were improved and the goitres less- ened in size, while three were not improved. This ratio of cures appears to be unusually good, and the thyreoid treatment has certainly been proved worthy of trial in cases of this nature. - [Professor Kocher, of Bern, says the Lancet for July 20, 1895, has communicated to the Correspondenzblatt fur schiveizer Aerzte his ex- perience of the treatment of goitre by means of thyreoid administration. The effect is un- mistakable, he says, the swellings becoming distinctly smaller. Symptoms of suffocation may be abolished by the treatment in conse- quence of the diminution in size of the goitre, but in no case did the swelling entirely disap- pear. Only in three cases was the treatment unsuccessful, and one of these was that of a large cystic goitre in which success could scarcely be looked for; but, in spite of this suc- cess, Professor Kocher utters a warning against too sanguine views as to the success of thyreoid treatment of goitre, and expresses the opinion that this mode of treatment is not more effica- cious than that by iodine. Success, he says, is to be expected only if the treatment is under- taken at the right time and is carried out with energy and patience.] In exophthalmic goitre the weight of opin- ion inclines to the view that thyreoid extract is contra-indicated. Attention has already been called to the fact that excessive doses of the extract, given in myxcedema, create symp- toms which closely resemble those of exophthal- mic goitre, and it may also be noted that the view at present generally accepted regarding the pathological condition of the thyreoid gland in this disease is that it is "a true hy- pertrophy of the glandular elements of the gland with increase of its secretions and possi- bly some change in the character of that secre- tion " (Starr). If exophthalmic goitre is a disease dependent upon overactivity of the thyreoid gland, as our present knowledge seems to indicate, the administration of thyreoid ex- tract will not be followed by improvement, but rather by an exaggeration of the symptoms. The reports of results obtained by the use of the extract indicate not only that it is of no service, but that it is frequently injurious. Only once has great improvement been re- ported, and there is good reason to believe that another tissue was substituted for the thyreoid gland in this case and that thyreoid extract was not given. Thus theory and ex- THYREOID TREATMENT 298 perience unite to discountenance its employ- ment in this disease. [Dr. Ferdinand Winkler (Centralblatt fur die gesammte Therapie. vii, 1895; American Jour- nal of the Medical Sciences, October, 1895) states that Menzies has seen great benefit from the thyreoid treatment in six cases of syphilitic rupia, and Abraham a marked im- provement in two patients suffering from leprosy. Jouin (Mercredi medical, July 31, 1895; New York Medical Journal, August 31, 1895) has employed thyreoid extract for patients suffering with fibrous tumours of the uterus. He gave from four to eight tablets a day, each containing 2|- grains of the extract. In three cases he observed a diminution of the haemor- rhage, and in two cases the partial disappear- ance of the tumour. He thinks that researches should be pursued in regard to this method of treatment, although our present knowledge of the physiology of the thyreoid gland enables us to give only very hypothetical explanations in regard to the action of the thyreoid juice in the treatment of fibrous tumours. Tetany is an occasional result of removal of the thyreoid gland, and it seems susceptible of cure in some cases by means of thyreoid treatment even when the gland is present and apparently healthy. Thus, Dr. Levi-Dorn (Therapeutische Monatshefte, February, 1896 ; Therapeutic Gazette, April, 1896) relates the case of a tailoress, twenty-one years old, who, three years before she came under his observa- tion, had sought to relieve herself of sweating fingers by cold hand baths. She had after- wards at times spasms in both hands—the fingers would become so tightly clenched that they could not be loosened by the free hand; after a few days the hands would recover their natural flexibility. On July 7, 1894, the spasms occurred in connection with the prema- ture birth of a boy. The spasms had the old form, continuing only a few days, always limited to the upper extremities. Then there set in frequently a feeling of itching in all the limbs. The patient experienced great weari- ness, drowsiness, increasing heat, and anxiety. The weariness was greatest on rising in the morning. A tendency to profuse perspiration was of long standing. The disturbances in- creased. The patient's father had worked for twenty-five years in metals, especially lead and mercury, but showed no sign of poisoning. The mother herself had died of tuberculosis of the lungs. Five brothers and sisters had died at an early age, from scrofula or weak- ness, or both (four of them were twins). The patient herself presented all the symptoms which belong to tetany. Pressure upon the internal bicipital sulcus caused paraesthesia in the affected arm, followed by the typical posi- tion. The fingers were held in position for holding a pen, or clasped into a fist with the thumbs turned in. The mechanical excitabil- ity of the nerves was much increased. The disease seemed to have been started by the chilling of the hands and to have been aggra- vated by the premature labour. No associa- tion with any infectious disease or poisoning or stomach disease could be established, and no disease of the thyreoid could be discovered. Tablets of thyreoidin were now given, one tablet daily, and rapid improvement followed after three days. The spasm ceased after the sixth dose, to return temporarily fourteen days later, after menstruation. Apart from this, the patient remained completely cured of her tetany. Her general condition was decidedly improved, so that she could work again. Al- together, not more than seventeen tablets were taken. Each tablet contained f of a grain of thyreoidin. Her health had persisted up to the time of the report, a period of four months and a half, without medication. M. Lepine (cited by Meige, Revue interna- tional de medecine et de chirurgie, August 10, 1896) has employed the thyreoid treatment in two cases of myopathy and obtained successful results. To one patient, forty-four years old, who had suffered for eight years with the dis- ease, 2 oz. daily, on an average, were admin- istered every week for a period of two months. The fresh gland was mixed with powdered marsh mallow. Amelioration took place in about two weeks after the beginning of the treatment. The patient felt stronger and was able to walk alone, which he had not been able to do for some time. In the second case M. Lepine ascertained that if the thyreoid treat- ment did not improve the atrophy, it, on the other hand, considerably ameliorated the con- dition of the muscles, which had been affected for some time. In the American Journal of Insanity for July, 1896, Dr. Joseph G. Rogers, of the Northern Indiana Hospital for the Insane, gives an account of two cases of catalepsy of long duration in which prompt beneficial effects followed thyreoid medication after the complete failure of other methods of treatment. The principal points in the more remarkable case, he says, are as follows: In the autumn of 1890, during or after an attack of malarial fe- ver, the patient evinced mental aberration for about two weeks, with hallucinations and de- lusions of impending personal harm and legal involvement. Subsequently he was apparently well until the middle of January, 1892, when he was attacked by la grippe, speedily compli- cated by maniacal symptoms; he was noisy, restless, and sleepless; he had delusions of dread, which were occasionally violent (he once fired a pistol at an imaginary enemy); he was very hilarious at times, laughing and singing without provocation, and then melan- choly and dreamy. He was admitted into the hospital two weeks later, on February 2, 1892, in a fair physical condition, and showed no salient symptoms of mental alienation in conversation or conduct, but his letters to relatives, shortly after, indicated delusions of conspiracy and revenge. He soon became accustomed to his surroundings, took part in the ward work and amusements, attended chapel and the dances, and was agreeable, cheerful, contented, well-behaved, and gen- tlemanly. On June 9, 1892, he was sent home, apparently in a fair mental condition, but not discharged. On October 14, 1892, he 299 THYREOID TREATMENT was returned to the hospital in a state of great mental depression, which had existed for some time previously. For some weeks following, at times, he would lie for hours in a trance, neither speaking, moving, nor giving attention to ordinary external impressions, and, if forci- bly aroused, would at once become violent and strike those about him. Between the parox- ysms he was melancholy and silent, but would take some exercise and a sufficiency of food. The trance state, however, recurred 'more and more frequently, and on Christmas day, 1892, it became continuous, and nasal feeding was begun, because food placed in the mouth would remain unswallowed. Meantime, however, he had been fairly well nourished. For three years continuously but little change in the case was manifested. He lay during all this period like a log, to all appearances wholly oblivious to external impressions or internal sensations, uttering no sound and making no sign indicative of mental action, unless it was an occasional secretion of tears which was often noticed. For many months the limbs could be readily placed in any position without positive resistance and would remain so placed for some time, however grotesque the attitude ; later they became less flexible and assumed a fixed position, which could not be changed without the use of great force, which was avoided. Sensibility to touch and pain seemed to be almost annulled; the faradaic current produced muscular contraction, but was not notably noticed by the patient. This condi- tion continued without material change until November 1, 1895. During the first months of observation tonics of various sorts, together with faradaic electricity, massage, and baths, were diligently used, but they were of no avail, and all treatment other than good feeding, frequent bathing, and careful attention to warmth of body was finally stopped. He suf- fered no intercurrent ailment; assimilation and excretion were sufficient and regular; there seemed to be no hopeful indication for any particular method of treatment, and none was attempted for many months, until the author determined to test the efficacy of thyre- oids, and on November 1, 1895, the treatment was begun. On the 6th active movements of the fingers were noted, on the 24th the lips moved slightly, and on the 29th the patient extended his left arm almost straight. The average temperature increased a degree or more and became normal, while the pulse rose to 90. The treatment was suspended until December 16th, when it was resumed and con- tinued until January 23d, at which time it was stopped on account of the rapid action of the heart. During this period of forty-one days of medication the temperature and respiration became normal and for a few days were some- what above it; the pulse remained at about 80 for two weeks, and gradually increased until it reached 140; it was soft, small, and regular. On the 17th of January the patient was placed in a sitting posture and was able to take a cup of eggnog and drink it. On the 27th the temperature was 101° F. and the pulse 150; he laughed audibly and was quite restless. 03 An attendant offered him a piece of paper and a pencil, and much to his surprise the patient took it and wrote that he would like to have his mouth washed out with a soft cloth, and that he would like a little cold water to drink. In the course of the evening he wrote several sentences. This condition lasted until Febru- ary, when a complete relapse took place. On the 7th his condition was unchanged, on the 17th he was able to take soft food, and on the 23d he was able to speak. On the 29th he sat up during the day and ate well. During the month of March no thyreoids were given ; the pulse went down gradually and it required two weeks to reach its normal state; the respi- ration and temperature became slightly sub- normal. The relapse toward inactivity, says Dr. Rogers, when the remedy was stopped was not so complete as before, but still very not- able. For a time mastication was difficult, On March 9th the patient got up and walked with some assistance to another room. On the 12th massage was begun, and on the 28th the use of the thyreoids was again resumed. On April 7th there was a slight improvement, which gradually increased until May 27th. On that date the patient wrote a letter to his mother and was able to walk from one build- ing to another. From that time up to that of Dr. Rogers's writing he was mentally almost normal, and, although physically weak from long inactivity, he took short drives and walks, and showed general evidence of having reached permanently a plane from which he might be reasonably expected to pass on to a condition of health. The important deductions to be made from the histories of these cases, says Dr. Rogers, are the following: 1. That in conditions marked by inhibition of sensory, motor, and mental activity, without gross organic lesion, such as are met with in catatonia and in certain types of stuporous insanity and melancholia, we may expect benefit from thyreoid medication, judi- ciously used. 2. That the effects of thyreoids in fuil doses bear a striking resemblance to many of the symptoms of Graves's disease— namely, orbicular weakness, consecutive con- junctivitis, skin eruptions, and temporary bronzing, without icterus of the eyes, profuse local foetid sweats, subjective sense of heat and thirst, excessive metabolism, decided tachycar- dia, and the absence of any fixed relation be- tween pulse-rate, respiration, and temperature. 3. That the theory of Mobius, that Graves's disease is due to overactivity of the thyreoid gland, is strongly supported. Thyreoid feeding has been employed for the novel purpose of checking the growth of the foetus in utero, so as to admit of the birth of a viable child in cases of deformity of the pelvis. At a meeting of the Vienna Ge- burtshilflich-gynakologische Gesellschaft held on March 3, 1896 (Centralblatt fur Gynakolo- gie, July 4, 1896; New York Medical Journal, August 1, 1896), one of the members related the case of a woman whom he had attended in labour the year before. She had an infun- dibuliform pelvis on which the spines of the ischia encroached decidedly, and there was an THYREOIDIN THYREOIODININ 300 exostosis on the right ilio-pubic tubercle. The foetus was very large, weighing over nine pounds. After repeated attempts at extrac- tion by the high forceps operation, the reporter had had to resort to craniotomy, and even after that had been performed the extraction of the child had been very difficult owing to its size. The woman had since come under his care in the fourth month of pregnancy. In pursuance of Prochownik's idea of restricting the growth of the foetus by dieting, he had, from the be- ginning of the fifth month, employed thyreoid feeding, giving one tablet a day. At first the woman had increased in weight, but in the later period of the treatment a loss of weight was observed each week. It was judged that the growth of the foetus was well under control, and the pregnancy was allowed to go to term. When labour came on, the head was driven into the pelvic cavity, but its further advance was impeded by the projecting spines of the ischia. - On that account the forceps had to be applied, the head having rotated normally, and a living child weighing about six pounds and a quarter was easily extracted. The re- porter admitted that it was very questionable whether this difference in the weight of the two children was due to the thyreoidin treat- ment alone. The treatment had been begun in two other cases of pelvic contraction that had since come under observation at a suffi- ciently early stage of gestation, and from the results in those cases some opinion might be formed as to whether the dwarfing of the foetus in the case related had been post hoc or propter hoc. Curiously enough, thyreoid treatment, which, as we have just seen, has been resorted to for the purpose of checking the growth of the foetus, has been employed also to overcome stunting of the growth. But this is to some extent explained by Dr. J. J. Schmidt (Thera- peutische Wochenschrift, November 15, 1896; New York Medical Journal, December 12, 1896). After referring to Virchow's observa- tion, in 1883, on the relationship of rickets, cretinism, and dwarfing without any disease of the thyreoid gland being recognised as at the bottom of the relationship, he goes on to say that the thyreoid probably plays an important part in simple stunting of the growth, as well as in cretinism and infantile myxcedema. He cites a number of recorded examples of dwarf- ing associated with atrophy of the thyreoid gland, and adds that experiments on animals corroborate the idea of a direct connection be- tween the two conditions, as well as that of the feasibility of effecting by thyreoid feeding the restoration of normal growth checked by thyreoidectomy. Among the interesting ob- servations cited is one by Lanz of a hen which, four months after having had her thyreoid gland removed, laid an egg that weighed only about a tenth of what an average hen's egg weighs and had a shell as thin as paper. Dr. Schmidt gives brief notes of four cases in which he has resorted to thyreoid treatment to overcome dwarfing in children. The first was that of a girl, thirteen years old, but of the size of a girl of ten, whose growth was restored by thyreoid feeding for a period of eighteen months, followed by a five months' course of a daily tablet of Baumann's thyreoiodinin. The second was that of a girl, fifteen years old, in size only a child of eleven, who, as the result of ten months' treatment with thyreoiodinin, had gained in weight about ten pounds. The third was that of a boy, sixteen years old, but no larger than an ordinary boy six years of age, who after a six months' course of treat- ment with English thyreoid tablets had grown more than two inches in stature and gained over ten pounds in weight. The fourth was that of a. seven-year-old girl so small that her four-year-old brother exceeded her in height. After she had taken a Baumann's thyreoiodinin tablet daily for four months it had been found that she had grown two thirds of an inch taller and was more than two pounds heavier. This was not quite satisfactory to Dr. Schmidt, and he ordered two of Engelhardt's thyreoid- gland tablets to be taken daily,- Not enough time had elapsed since his making this change to enable him to report on the result.] Matthias Lanckton Foster. THYREOIDIN.—This substance,, which must not be confounded with thyreoiodinin (thyreoiodine), is a powdered extract of the thyreoid gland of the sheep or the ox. It may be given in daily amounts of from 5 to 10 grains. For its uses in therapeutics, see Thy- reoid treatment. THYREOIODINE, THYREOIODI- NIN.—The latter of these two names is to be preferred as being a closer equivalent than the other of the German name Thyreojodin given to the substance by its discoverer. In addition the name iodothyrein has recently been given to it. It is an organic iodine compound found by Baumann to be a normal constituent of the thyreoid gland and thought to be its active principle. It is an amorphous brown powder readily soluble in alcohol, but almost insoluble in water. According to Professor Ewald, of Berlin (Wiener medizinische Blatter, June 4, 1896), the fresh gland contains from 0-2 to 0-5 per cent, of thyreoiodinin, about one tenth of which is iodine. The therapeutical action of thyreoiodinin is in most respects practically identical with that of the thyreoid gland itself, but it is thought to be exerted more speedily. Baumann (Milnchener medicinische Wochen- schrift, April 7, 1896; Centralblatt fur innere Medicin, September 19, 1896) describes thy- reoiodinin as containing nitrogen and iodine in very stable combination and as being al- most insoluble in cold water and in ether, and as having a remarkable resemblance in some respects to an iodine compound recently pre- pared by Drechsel from corals. Only a small amount of free thyreoiodinin is contained in the thyreoid gland, most of it being combined with albumin and globulin, but by repeated ex- traction with diluted chloride-of-sodium solu- tion all the iodine compounds may be removed from well-minced glands. Since" an effect is often seen earlier from thyreoiodinin than from the fresh gland, Baumann assumes that thy- reoiodinin is the active principle of the gland. 30 A curious thing mentioned by Baumann is the fact that numerous observations show that in Hamburg and Berlin the thyreoid gland contains much more iodine than in Freiburg, as a rule, and that this is particularly the case with children, in whom the amount is rela- tively small. The quantity of iodine con- tained in the gland seems to be but little influenced by disease, he says, but to be notably increased if iodine in any form is absorbed. Since only a very small amount of iodine is found in goitres, and since the amount found in the gland in goitrous regions is small, says Baumann, the old doctrine of the influence of the quantity of iodine present in a locality— in the food, in the air, and in the water—on the development of goitre receives fresh sup- port. Iodine is an element necessary to life, and if no marine fish are consumed, it must enter the system chiefly in the vegetable food. Baumann has recently succeeded in finding iodine in the thymus of the calf, and he thinks it probable that in that organ also it exists in the form of thyreoiodinin. In most instances, when the amount of thyreoiodinin contained in the thyreoid gland has once been increased by the ingestion of iodine into the system it remains abnormally large for a long time. Ordinarily, therefore, a good deal of thyreoio- dinin is found in the thyreoids of persons who have taken iodine for a time. This is true even of goitrous individuals, although usually the amount of iodine contained in a goitre is smaller than that contained in the healthy gland. There is some reason to think that thyreo- iodinin is not in every way the medicinal equivalent of the thyreoid gland. Dr. J. A. Notkin (Wiener medizinische Blatter, October 22, 1896 ; New York Medical Journal, Novem- ber 14,1896) thinks that the phenomena caused by extirpation of the thyreoid gland are divis- ible into two classes, one being the symptoms of tetany and the other those of myxcedema. He thinks it probable that the phenomena of myxcedema occur only when there is left some remnant of the thyreoid parenchyma capable of performing its functions, also that myxce- dema is caused by an albuminous principle, thyreoproteid, whereas tetany depends on poisoning with products of metabolism which are not of an albuminous nature. Baumann's thyreoiodinin, he says, will cure goitre and myxcedema, but it has been difficult to assume a priori that it would also cure tetany. It appears from data furnished by Frankel, Kocher, Jr., and Gottlieb that besides thy- reoiodinin the thyreoid gland contains other specifically active substances. Notkin undertook an experimental investi- gation as to the truth of Baumann's contention that thyreoiodinin would cure all the results of removal of the thyreoid gland. In the first experiment the entire gland was removed from a dog. Two days later there were fibril- lar and occasionally clonic contractions of the muscles of the limbs. On that day and on the following day 45 and 60 grains of" thyreoiodi- nin respectively were given to the animal; nevertheless, the most pronounced cachexia THYREOIDIN 1 THYREOIODININ strumipriva was developed. The dog was now almost dead, when, by the means of a stomach- tube, 45 grains of Merck's preparation of dried thyreoids were introduced into its stomach. In the evening the convulsions ceased, and on the following day 45 grains more of the Merck preparation were given. On this day and the next the dog was lively and free from convul- sions. Now in the course of two days 180 grains of thyreoiodinin were given to it, and again fibrillar contractions showed themselves, and there was an attack of tonic and clonic convulsions. In the second experiment thyreoiodinin also proved incapable of causing the subsidence of the tetanic symptoms; indeed, they became more intense under its employment, and even when injected subcutaneously it failed to affect them. In the third experiment the animal was treated with thyreoiodinin beforehand. In spite of this and of the large doses employed after the onset of the convulsions, the dog could not be saved from the severest symptoms of the cachexia. The urine of all the three dogs was albuminous. From these experiments Notkin concludes that thyreoiodinin is incapable of overcoming the phenomena of tetany; however, he did not use Baumann's own preparation, and this, he says, may account for the difference between his and Baumann's results. With regard to the action of thyreoid-gland preparations, says Ewald (loc. cit.), we have to dis- tinguish between two constituents; one of them gives rise to objectively recognisable changes of metabolism, and the other is related to cer- tain subjective symptoms which range from slight discomfort to pronounced morbid phe- nomena, constituting thyreoidism. Under cer- tain circumstances metabolism may be notably heightened by thyreoid preparations, and this heightening can not fail to effect the general condition, as is shown by debility, loss of appe- tite, nausea, thirst, sleeplessness, depression, dizziness, pains in the back and in the loins, increased frequency of the pulse, palpitation of the heart, sensations of oppression, and stenocardiac attacks. These phenomena are more or less pronounced in all cases of sudden alteration of metabolism which are connected with a rapid breaking up of a substance con- taining albumin and with a heightened com- bustion of fat. The employment of thyreoiodinin, even to the amount of a drachm in twenty-four hours, says Ewald, has no material influence on the pulse, and there can be no chance of iodine poisoning, because the amount of iodine con- tained in the thyreoid gland and its prepara- tions is very small (one part of the sheep's thyreoid contains 0-0003 of one part of iodine); such consequences, however, as increased fre- quency of respiration, headache, pains in the limbs, salivation, urticaria, palpitation, and tremor have been reported. Often enough, on the other hand, there is no reaction, in spite of the employment of large amounts of prepara- tions known to be active. Besides the toxic symptoms mentioned, albumin, casts, and i02 THYREOPROTEIN TINCTURES 3 sugar are occasionally found in the urine as a result of thyreoid treatment. In the majority of the cases of glycosuria the excretion of sugar is only temporary, but in one observed by Ewald, that of a woman, after having first oc- curred off and on, it settled down into a con- tinuous diabetes from which the patient was still, four years after its first appearance, suf- fering, or rather not suffering, for beyond the glycosuria she had no subjective or objective symptoms of diabetes. In the many cases in which of late years Ewald has employed thy- reoid-gland preparations he has almost in- variably examined the urine for sugar, but has never found glucose, even in corpulent patients. He has therefore been surprised to learn that Noorden has observed glycosuria five times in seventeen cases of thyreoid feeding in the cor- pulent, although it quickly disappeared on dis- continuing the treatment. It will be interesting to observe, he says, whether this phenomenon takes place also in the thyreoiodinin treatment, with the avoidance of all sugar in the prepara- tion ; we shall then know whether its occur- rence is due to the specific action inherent in the gland or is a toxic by-effect. The secretion of the thyreoid gland, says Ewald, is continuously being carried into the circulation in minute amounts, where its office is to destroy certain poisonous substances of unknown nature whose existence is inferred from the toxic phenomena which follow loss of the gland or of its function—athyreosis or ecthyreosis. That these phenomena are not merely accidental rests as well on their nature, which is always in part that of active irrita- tion, as on the results of replacing the defective secretion or of artificial increase of it:—hyper- thyreoidism. Moreover, he adds, the secretion acts as an antidote to certain toxines which appear as by-products of metabolism. If the secretion is insufficient, these toxines accumu- late and metabolism is reduced; if it is secreted or introduced into the system in excess, so that the point of neutralization is overstepped, and there is too much thyreoiodinin in the organ- ism, the specific effects of this substance will show themselves. That the gland bears an essential part in metabolism, he remarks, is evident from the facts that as soon as an ex- cessive amount of thyreoiodinin gains access to the circulation an acceleration of metabolism occurs, even to the point of a morbid increase, and that, conversely, its reduction is the result of failure or deficiency of the glandular secre- tion. The difference between the normal and the pathological state is one of degree only, he thinks, and in this matter the behaviour of the thyreoid is in no wise different from that of other glands. In regard to the dose of thyreoiodinin, says Ewald, the rule has been promulgated to begin with minute doses, to increase them gradually, and not to make them too large at any time. It has been shown that the employment of very large quantities—the equivalent of one or two glands—has no therapeutic advantage, but sometimes does harm by causing a sudden outbreak of thyreoidism. The daily maximum allowable, according to Ewald, may be regarded as ten tablets, corresponding to 0-045 of a grain of iodine. Unquestionably, says Ewald, the prime indi- cation for the use of thyreoiodinin is found in myxedema, but it is almost as much indicated in sporadic, or infantile, cretinism. The idea of using the thyreoid preparations in skin dis- eases, says Ewald, was founded on observations of the myxcedematous, in whom a striking im- provement of the state of the skin and of the general nutrition had been seen to follow their employment. The treatment is especially use- ful in psoriasis vulgaris, in lupus, in ichthyosis, in xerodermia, and in sclerodermia. It seems to Ewald that the dermatologists, at least in Germany, are still rather cold toward this treatment, but he admits that the greatest re- serve is justifiable, especially with regard to psoriasis, in which spontaneous and utterly un- expected recoveries are not infrequent, It is different with the treatment of corpulence, he says, which must make an impression on the observer who records the great loss of weight by the myxcedematous. A loss of weight to the extent of ten kilogrammes in six weeks— on the average, of from four to five kilogrammes —by the daiiy use of from three to five tablets takes place, but it is only in exceptional cases that the reduction of flesh proves lasting. Since it may be considered certain, says Ewald, that metabolism as a whole, including the destruction of albumin and the combustion of fat, is increased by the thyreoid treatment, independently of any special change of diet, the loss of albumin might be reduced to a very small one by increasing the ingestion of albu- min, and so an ideal treatment of obesity be made use of—one that would reduce the fat without detriment to the albuminous constitu- ents of the body. Two questions, however, Ewald thinks, are still to be met: 1. Why is it that many cor- pulent persons are completely refractory to thyreoiodinin ? 2. Has thyreoantitoxine or thyreoiodinin the same action as the entire gland ? As regards their behaviour under thy- reoid treatment, he says, obese persons can not be grouped into those who have grown corpu- lent in consequence of improper diet and those who have become fat in spite of a strict regi- men; in each of these groups there are those on whom this treatment acts favourably and those on whom it acts unfavourably. There are certain conditions under which the system clings pertinaciously to its fatty elements. This is most forcibly shown in pernicious anaemia. The striking obesity of persons who die of this disease shows how obstinately the organism may preserve its fat in spite of the ingestion of nutritious material being reduced to the utmost, and, as recent investigations have surely shown, in spite of the fact that the assumption of oxygen and the loss of carbon dioxide are not reduced. The second question Ewald answers in the affirmative, and cites in- stances of a rapid and decided reduction of obesity as the result of treatment with thy- reoiodinin. Dr. Grawitz(Milnchener medicinische Woch- enschrift, 1896, No. 14; Deutsche Medizinal- 303 THYREOPROTEIN TINCTURES Zeitung, June 15, 1896) relates the cases of two women who were treated with thyreoiodinin for obesity. In one of them the use of the remedy was continued for only three days, at the rate of 15 grains a day. During this period the patient lost three kilogrammes in weight, and this, says Grawitz, was all the more remarkable from the fact that she took milk, butter, white bread, and eggs freely, although restriction in the matter of these articles before the thyreo- iodinin was used had brought about only a very trifling loss of weight. An increased excretion of nitrogenous matter was evident in this case—to the amount of about an ounce— so that a decided loss of weight could not fail to result. There was however, no increase of the fluid excretions, and the urine contained neither albumin nor sugar. The other patient took 15 grains of thyreoiodinin daily for three weeks, without any restriction of her diet, and she, too, lost three kilogrammes in weight. When she discontinued the use of the remedy her reduction of weight persisted for a short time, but she soon began to regain her flesh. Her subjective condition was not affected, and her urine was free from both albumin and sugar. Cf. Thyreoid treatment. THYREOPROTEIN.—This is a poison- ous albuminoid isolated by Notkin from the thyreoid gland. It is thought to be a sub- stance which it is one of the functions of the gland to eliminate from the organism. TIGLIUM.—See Croton oil. TIN appears to be physiologically inert and is without medical uses save in the granulated or powdered form, which has been employed for the expulsion of tapeworms. It is assumed to act mechanically. It may be given in drachm doses every morning until the worm is expelled. It is an unnecessarily harsh rem- edy, and not without danger, so it is rapidly passing out of use. The only salt of tin which is of interest is the chloride, which is occasionally found in carelessly put up canned goods, being formed by the action of the hydrochloric acid, employed as a flux in the soldering upon the tin. ' It has been stated that enormous doses are without physiological effect, but it is probably more or less corrosive. In cases of poisoning caused by the eating of canned food the effects produced are rarely if ever due to this salt, but rather to the pto- maines derived from the decomposed food and to the lead in the solder. The symptoms ob- served are those of gastro-enteritis, and they occur usually after the eating of canned fruits and vegetables which are naturally acid or be- come so in the cans. As tin is but little affected by the vegetable acids, the lead is probably the most important metallic element in the cases. Many cases of lead poisoning have occurred in which the so-called "tin foil" (in reality one or more thin sheets of lead covered with tin) has been the cause. Little of the tin foil in the market is free from lead, and its use in pharmacy and to envelop foods should be dis- couraged".—Russell H. Nevins. TINCTURES.—These are liquid prepara- tions, consisting mostly of solutions in alcohol, alcohol and water, or a similar solvent, of the soluble constituents of crude drugs which are not entirely soluble in the menstruum. For convenience' sake, a few preparations not ex- actly fitting this definition are usually classed as tinctiires—for instance, tincture of iodine, although the iodine is completely soluble in the menstruum. Tinctures may be prepared either by mac- eration (or solution) or by percolation. Mac- eration is usually resorted to when the drug to be extracted is of such a nature that it would cake together if packed in a percolator and prevent the solvent from penetrating it. This is the case particularly with resins, gum resins, and drugs containing a large propor- tion of soluble matters. These are always best extracted by maceration. But maceration is adapted also in all other cases without excep- tion, and is in some countries still the only process recognised officially. It is, however, rather slow and tedious, and for this reason is now getting to be more and more replaced by the process of percolation. There is a radical difference in the principles underlying the ratio of volume or weight of product to weight of crude drug in the two processes. Maceration, if conducted properly, is carried on in the following manner: A definite weight of a drug of known quality and properly com- minuted is brought in contact with a definite volume or weight (usually the latter) of a menstruum known to be capable of dissolving the useful constituents. The mixture is set aside, well covered to prevent evaporation, but is frequently agitated or stirred so as to pro- mote the action of the solvent. After a cer- tain time, often extending to some weeks, when it may be judged (or may be known from previous experience) that all soluble matters have gone into solution, the contents are removed and the liquid is separated from the undissolved residue by straining. Even assuming that none of the liquid was lost by evaporation, the whole of it will in no case be recoverable, since the residue will always re- tain at least traces of it, even under the most powerful pressure. Hence the quantity (weight) of strained liquid obtained is likely to vary more or less each time a particular tincture is made. But this variation does not affect its strength or medicinal value. If the liquid and solid have been kept in contact for a suffi- cient time, with frequent agitation, the process of osmosis will have gradually brought about a uniform condition of the solution both out- side and inside of the particles of the drug; and it will then be merely a matter of me- chanical force to obtain not only the liquid surrounding the solid particles, but also as much of the included liquid as possible. The person who can apply the greatest force will simply have more product to sell. His prod- uct need not be supposed to be better than that of another person who was unable to squeeze as much of the liquid from the solid particle as the other. Of course, the liquid thus obtained by straining is, in most cases, turbid and requires to be filtered. Some authorities have proposed to avoid TOBACCO 304 the discrepancy in the quantity of product, due to the variable amount of liquid retained by the drug, by treating the pressed drug with further fresh portions of the men- struum, to express again, and to add the prod- uct to the first strainings, until a definite weight or definite volume of product is ob- tained. But it does not need a mathematical demonstration to prove that this method intro- duces serious errors. It is impossible in this way to dissolve out from the interior of the particles all the soluble matter; even under the most favourable conditions some of it must be retained, and it would require many wash- ings, with concomitant maceration, to attain even approximate exhaustion. If the process of maceration is to be used at all, no washing of the residue is admissible. In the case of drugs which are quite readily extracted or almost entirely soluble it is pref- erable to suspend them in a cloth or other suitable material in the upper part of the column of the menstruum. As the latter dis- solves out the constituents, the dense solution sinks to the bottom, causing the uncharged or lighter-charged portions of the liquid to rise and to come in contact with the drug. This is called " superior maceration." Percolation is suitable for all substances the constituents of which are only partially solu- ble, and which are not apt to agglutinate in the apparatus. Such are, for instance, the drugs of a fibrous nature derived from the vegetable kingdom, but there are also others. Percolation is used to effect exhaustion of a drug by forcing through its finely comminuted particles a suitable solvent until the latter fasses practically free from dissolved matters. t is therefore necessary to provide for such a condition that the liquid in its downward pas- sage will not find an easier exit by the chan- nels between the particles than through the body of the latter themselves. The drug must be reduced to a more or less fine powder—the finer, the stronger in alcohol the liquid is. It must be moistened with the liquid and allowed to swell as far as it will, after which it is to be packed carefully and more or less firmly— depending on the nature of the drug—into the percolator, which is a cylindrical or conical vessel provided with an outlet the flow from which may be regulated, and it is then covered by a sufficient quantity of the liquid which is to be passed through it. The percolator is now covered, and the contents are allowed to macerate, the lower orifice being open, until liquid begins to drop from the latter, which is a sign that the liquid has penetrated the mass. The outlet is then closed and the contents are allowed further to macerate for such a length of time as previous experience may have shown desirable. Then the outlet is opened and the flow of percolate so regulated that a slow but steady extraction is secured. The surface of the powder must never be without liquid, otherwise cracks and passages would form in the packed powder, which would permit of the passage of the liquid by the side of the parti- cles. In the case of percolation a definite volume or weight of percolate bearing some previously determined relation to the weight of the drug is the object aimed at. In most cases the ratio is so fixed that practical exhaustion of the drug is secured when the desired volume or weight of product has been obtained. Should this not be the case, and it should for some reason be desired to carry the process to com- plete exhaustion, while yet securing a definite quantity of product, enough liquid may be gradually passed through the drug to exhaust it actually, the solution concentrated by distil- lation or evaporation, and the residue added to the first percolate, the volume or weight of which may then be adjusted so as to bear the proper ratio to that of the drug. It has often been recommended to prepare tinctures from the corresponding fluid extracts, and most manufacturers of the latter prepara- tions furnish upon their labels directions for making the tinctures from the latter. This practice will no doubt, in a number of cases, result in the production of tinctures of full medicinal value which can not be distinguished from those specially prepared by percolation, but in many other cases the product will ma- terially differ from that which would have been obtained by the legitimate process. When a drug contains certain useful constituents which are alone desirable and the whole of which will remain in solution in a tincture made from the corresponding fluid extract, no harm can come from this practice. But the knowledge of where this may be done without detriment is not possessed by many. It is therefore always advisable to adhere to the official directions.—Charles Rice. TOBACCO, tabacum (U. S. Ph.), tabaci folia (Br. Ph.), folia nicotiane (Ger. Ph.), has power- ful emetic and nauseant properties, and when taken in overdoses acts as a paralyzer of the respiratory muscles and secondarily depresses the action of the heart. It resembles lobelia closely in its general effects. Its poisonous properties depend upon a crystalloid body, nicotine, which is obtained by distillation or extraction and is found in small quantities in the fluid which collects in old pipes. Tannin, caustic alkalies, and iodide of potassium are chemical incompatibles which may be used in poisoning with tobacco shortly after its inges- tion, while strychnine is the physiological an- tidote. The depression, etc., observed should be combated with stimulants, ergot, digitalis, or belladonna. Tobacco was formerly employed as a depres- sant nauseant in croup and similar conditions, but its action is so uncertain that it has been abandoned in favour of less dangerous reme- dies. However, in cases of emergency patients unaccustomed to its use may be made to inhale small volumes of its smoke, but it is hardly safe to allow the person himself to smoke—it is preferable to have another person do it, the former inhaling the smoke—as a number of cases of fatal poisoning have resulted from the use of a foul pipe by children. In impaction of feces, intussusception, stran- gulated hernia, and painters' colic enemata of 30i the smoke or of one containing not over 15 grains of tobacco often prove of great value, but if lobelia is obtainable it is much to be preferred. In tetanus it appears to be of decided value, relieving the muscular spasms and thus pre- venting in a measure the exhaustion of the patient, but great care should be observed lest its poisonous action be substituted for the con- dition it is intended to cure. Poisoning by strychnine has been successfully treated with it or its active principle, nicotine, of which fa of a grain is a sufficient dose, and in all condi- tions in which tobacco is indicated nicotine may be substituted. Being capable of hypodermic use, it may in some conditions be preferable. The employment of tobacco in poultices, etc., is inadmissible, as the rapidity of its absorption varies greatly and a lethal amount may be ab- sorbed almost before its initial effects are ob- served. In amounts smaller than those necessary to produce its marked physiological effects, to- bacco, employed in the usual methods, by smoking, chewing, snuffing, or dipping (the rubbing of snuff upon the gums), may be re- garded as an accessory food, as its moderate use is accompanied by a decreased demand for the ordinary articles of food without any im- pairment of the strength, etc. It also, during periods of great strain or deprivation from food, enables those who use it to endure what would otherwise cause a " break-down." On the other hand, when used to excess, it may cause impairment of the digestion, insomnia, palpita- tion of the heart, and a state resembling neu- rasthenia. Unfortunately, the amount which can be used without disadvantage can not be estimated, as it differs in every instance. It is pretty certain, however, that in the majority of cases it is abused and that a more moderate indulgence would be followed by slightly im- proved physical conditions; also the pleasure obtained from it is greater when its use is re- stricted to the hours of leisure and those im- mediately after eating. It is pretty clearly established that smoking, etc., should be dis- couraged among those who have not yet ac- quired their growth and strength, as they are undoubtedly affected unfavourably by it. Whether there are any marked pathological effects beyond these already mentioned must be doubted, as among the Oriental races, where it is used from early childhood, there are no distinctive widespread diseases. Atrophy of the optic nerve or retina has been often at- tributed to its abuse, but it seems clear that by itself it is without effect in that direction, but when there is a confirmed over-indulgence in alcohol and tobacco these conditions are fre- quently observed. As a rule, in these cases the abandonment of the habit is followed by the cessation of the atrophy. As to what is the least objectionable method in which tobacco may be employed there will always be more or less discussion, and each user must settle the point for himself. Cigarette- smoking has been accused of being at the bot- tom of many evils, but beyond an irritation of the mucous membranes of the air-passages, which is due to the smoke furnished by the 5 TOBACCO paper with which cigarettes are made, it is doubtful if there is anything special to be urged against their use except that they are rather more apt to induce over-indulgence on account of their availability when there would not be time to smoke a cigar. It is a widely spread belief that cancer in the mouth and throat may be directly due to smok- ing, but the evidence in favour of such a theory is very slight, although there is abundant evi- dence that the mechanical irritation of a pipe or cigar may establish a focus for the disease in the same manner as a broken tooth may. Chewing tobacco can hardly be defended, as it is a filthy habit, causes a considerable waste of the saliva, which is probably the cause of the pyrosis so often observed in chewers, and un- doubtedly increases the liability to dental ca- ries. " Dipping" is rarely practised by any except the lowest, and is followed by irrita- tion of the gums and destruction of the teeth. [Dr. L. Jankau, in an article summarized in the Medical Record for February 8, 1896, dis- cusses the indications and contra-indications for the use of tobacco by the sick and the convales- cent. The employment of tobacco, he says, is to be forbidden in all surgical operations and in long convalescence after operations, except those practised upon the eyes, the abdomen, and the bladder. He would proscribe tobacco also in affections of the throat and pharynx, and, with certain restrictions, in nasopharyn- geal catarrh. As regards internal maladies, he says one should never forget the toxic action of tobacco, and in acute and serious diseases it should never be allowed. Tobacco, he says, should be absolutely forbidden in peritonitis, typhlitis, and perityphlitis. Affections of the stomach do not form an absolute contra-indi- cation. Subjects affected with organic disease of the heart do not ordinarily support tobacco well; at the same time, habitual smokers can use two or three light cigars a day. As to pul- monary affections, the author allows his anti- septic views to have a good deal of weight in guiding his judgment. On the score of the proved fact that tobacco smoke has an un- doubted influence in suppressing the develop- ment of bacilli, he rather advises smoking for persons who are in the initial stage of tubercu- losis. His reasons are the disinfecting action of tobacco upon the mouth, the depression ex- erted by tobacco upon the genital functions, and the favourable sedative influence of this drug upon the central nervous system. Be- sides that, he thinks that it tends to take away the attention of patients from themselves and make life seem more agreeable to them. Even slight haemoptyses are not absolute contra-indi- cations for the use of tobacco. In syphilitics he thinks that one should try to avoid only the abuse of tobacco, both as to quantity and quality. In nervous affections he would sim- ply recommend that the amount of smoking be very carefully controlled, the number of cigars and their strength being rigorously prescribed. In cardiac neuroses particularly the greatest circumspection is to be employed. In gastric neuroses tobacco should be cut off entirely. Persons who are subject to organic affections TOBACCO 306 of the nervous system can smoke with cau- tion. Some years ago Dr. J. C. Mulhall, of St. Louis, published in the St. Louis Courier of Medicine an account of the pleasures and the penalties of cigarette-smoking. More recently, in a paper read before the American Laryngo- logical Association and published in the New York Medical Journal for November 30, 1895, he returned to the subject as one speaking with a certain amount of authority, inasmuch as he had smoked cigarettes for twenty-five years. There is a reason why each one pursues a par- ticular plan of using tobacco, says Dr. Mul- hall. Early associations have much to do with the selection of the plan ; but, apart from this, each method has its own particular pleasure. The man who both chews and smokes derives a different kind of satisfaction from each meth- od, and he would derive a still different kind did he take snuff. Cigarette-smokers may be divided into those who inhale the smoke and those who do not. The latter class is a very small one and the pleasure is the same, in a milder degree, as that of the cigar-smoker and the pipe-smoker, who make a smoke chamber of the mouth. But all real devotees of the cigarette inhale. That is, with a quick inspir- atory act the smoke is drawn through the larynx into the trachea and, so far as he has been able by different experiments to learn, into the first division of the bronchial tubes; not, as the public believes, into the lungs prop- er. Inhalation explains the pleasure of ciga- rette-smoking. If the cigarette-smoker did not feel the smoke in his larynx and windpipe, his pleasure would be gone. If an habitual in- haler of cigarette-smoke perchance smokes a brand of cigarette very much milder than that to which he has been accustomed, he will at once reject it, simply for the reason that his larynx and trachea have been accustomed to a certain degree of irritation; they have, so to speak, acquired a habit which rejects any un- usual departure. For the same reason the in- haler rejects a brand of cigarettes much stronger than that to which he is accustomed, and he will not inhale the smoke of a cigar— vastly more irritating than that of any ciga- rette." The inhaler may change his cigarette for one more pleasing to his sense of flavour, provided always, however, that it produces his accustomed degree of laryngeal and tracheal irritation. The pleasure in cigarette-smoking, therefore, as compared with other tobacco habits, says Dr. Mulhall, may be said to be a pleasurable irritation of the laryngeal and tracheal sensory branches of the pneumogastric nerve. He goes on to say that a person absorbs nicotine in ac- cordance with the amount of absorbent surface in contact with the column of smoke. In or- dinary smoking the mouth alone is the smoke- chamber ; but when one inhales, one must add to the mouth the mucous membrane of the larynx, windpipe, and larger bronchi. There is,'hence, roughly speaking, three times as much surface for the absorption of nicotine; and consequently, though a cigar contains vastly more nico'tine, three fourths of it is wasted, so far as the question of nicotine in- toxication is concerned, as compared with the cigarette. Moreover, the cigarette-smoker con- sumes two or three while the cigar-smoker con- sumes one. The puny cigarette is, therefore, not so weak as it appears, and with this ex- planation begins to appear worthy of the news- paper term " deadly." Again, the cigar-smoker, as compared with the cigarette-smoker, is an infrequent consumer. We know that, with most drugs, if we divide an ordinary dose into ten equal parts and give one part every ten minutes until the ten parts are taken, a more powerful effect is produced than if the whole were given at one dose. So it is with ciga- rettes. The dose of nicotine is smaller, but the doses are much more frequently repeated. Dr. Mulhall says that he himself can smoke one large, strong cigar in the ordinary manner without evidence of nicotine intoxication, but he can not smoke three cigarettes in succession and inhale the smoke without nausea or ver- tigo or a rapid pulse. Dr. Mulhall says that the evil effects of ciga- rette-smoking may be divided into the local and constitutional. As compared with other tobacco habits, if the cigarette were composed of other ingredients than tobacco and paper, we should, as clinicians, be prepared to look for different signs and symptoms. So far as the constitutional effects are concerned, he states, as one who has carefully watched this question for fifteen years, that they are absolutely the same as those of tobacco used in any other form. The evil symptoms are always those of nicotine poisoning—not those of any other drug. The only chemist of high standing who, to his knowledge, has analyzed cigarettes is Dr. Ledaux, who presented to a section of the New York Academy of Medicine a report of the analysis of several popular brands of ciga- rettes. He found absolutely no evidence of any other drug but nicotine in the tobacco, and in the paper a harmless quantity of cellu- lose. The attempt has been made, says Dr. Mul- hall, to crush the cigarette evil by asserting that opium, cannabis indica, and other narcot- ics are present in cigarettes. Vice, he declares, can not be cured by misrepresentation. The only narcotic present is nicotine, and this is an evil or not according to a great many different circumstances. The chief condition in which it is always productive of great harm is youth. Dr. Mulhall says he has never seen a child (meaning one that had not reached puberty) who used tobacco habitually whose health was not in some manner badly impaired. In ado- lescence—and practically this may be said to be from puberty to the age of eighteen in fe- males and to that of twenty-one in males—the evil is not so great, he thinks, but is still a great one, for, though the nervous crisis of pu- berty has been passed, the nervous system is still rapidly developing. The nerves are more resistant than in childhood, but, on the other hand, greater demands are correspondingly made upon them, either by the higher phases of education in one class or by the actual daily struggle for existence in the other. At several 307 TOBACCO of our great universities, says Dr. Mulhall, it has been found by exact and scientific investi- gation that the percentage of winners in intel- lectual and athletic contests is considerably higher in the total abstainers from tobacco. If it is admitted, he continues, that the use of tobacco is a great evil in the young, it follows as a self-evident proposition that any method which encourages its use must be more repre- hensible than a method which discourages it, and the cigarette above all other methods pre- sents this encouragement to the use of tobacco. In its mildness is concealed its very capacity for doing harm, for the reason that it teaches the use of tobacco. The boy at first uses only the mouth as a smoke-chamber, and as a ciga- rette is so mild he absorbs but a minute quan- tity of nicotine, insufficient to produce nausea. He gradually becomes able to consume more cigarettes, and quickly acquires nicotine toler- ance. He is not allowed to pursue this method long. Invariably some other boy teaches him to inhale. At first it causes violent cough and many would never repeat the attempt, but the taunts of the other boy are heard, and with the bravado of boyhood he perseveres. The larynx and windpipe soon tolerate the smoke, then de- mand it, and the boy is a full-fledged cigarette fiend. The mildness of the cigarette explains also its fast-spreading use among young women, es- pecially the leisure-class young ladies. As a rule they do not inhale, for at the first attempt the violent cough ensuing quenches ambition in this direction, and, unlike the boy, the girl is seldom encouraged to persevere. The fear of a tobacco-tainted breath also curbs her habit. In young ladies who smoke cigarettes very mod- erately and who do not inhale, Dr. Mulhall has never seen evidences of nicotine poisoning. The immoderate use of cigarettes, even without inhalation, may, of course, he suggests, afford sufficient nicotine to disturb the health. The great evil of tobacco, says Dr. Mulhall, is its constitutional effect on the nervous sys- tem. The much lesser evil is local—namely, on the upper respiratory organs. His experi- ence is, like that of the late Sir Morell Mac- kenzie, that, provided there is no other factor, the use of tobacco provokes little or no dis- turbance of these organs. That it may aggra- vate a throat or nose trouble occasioned by other causes he admits, and that by its consti- tutional depressing effect it may aggravate such trouble; but, excluding all other causes and looking at tobacco purely in respect to its local effect, he denies that, as ordinarily used, it never causes throat disease worthy of the name. There are a few exceptions, he adds, as there are to all laws in medicine. There are idiosyncrasies in regard to the use of tobac- co, with reference to both the throat and the nervous system, but they are rare ; tobacco, in its ordinary use, at most produces a slight hyperaemia or insignificant catarrh in the healthy throat. As used in cigarettes—that is, by inhalation—the smoke comes in contact with the laryngeal, tracheal, and bronchial mucous membrane, and here produces in many persons the same trivial hyperaemia and secre- tion. This latter is pearly and is ejected with a single gentle cough. He has occasionally heard whistling rales in the bronchi of persons who inhale very deep and were immoderate smokers. Hyperaemia, not inflammation, acute or chronic, he says, is the sole disturbance. The effects in the larynx of the ordinary healthy man seem almost nil. Mario, the great tenor, inhaled cigarette smoke between the acts, and Dr. Mulhall says that he himself experiences no vocal difficulty in delivering lectures. A murderer who was confined in the St. Louis jail for two years inhaled an average of forty cigarettes a day. After his execution Dr. Mulhall examined his larynx and trachea, but could discover no evidence of morbid change other than a fracture of the hyoid bone caused by the hangman's rope. It is because of the great value of Dr. Mul- hall's communication, owing in no small de- gree to the fact of his being at the same time an experienced laryngologist and a confirmed cigarette-smoker, that it is here drawn upon at such length. The remark should be made, however, that not all habitual smokers of cigarettes inhale the smoke. In the discussion that followed the reading of Dr. Mulhall's paper, Dr. S. W. Langmaid, of Boston, said that, from a large experience in the treatment of prominent singers, he had found that smok- ing exercised a potent influence on the voice. In his own case he had learned that, in order to be in good voice, he must not smoke during the day if he was to sing that evening. Be- cause one prominent singer could smoke and sing, this was no argument that others could do so. The best singers of to-day underwent a great deal of fatigue. He had in mind one singer with a magnificent voice in whom he felt sure he could detect the effect of cigarette- smoking. He had known another singer, an inveterate smoker, who had found it necessary to abstain as long as three weeks at a time from smoking, in order that he might be at his best for some great effort in singing. He would say that the bad effect on the pharyn- geal mucous membrane was much less from cigarette-smoking than from pipe-smoking, for the reason that the smoke was not so hot. What he objected to in cigarette-smoking was its destructive effect upon consecutive thought. The cigar-smoker -did not want to be narco- tized ; the cigarette-smoker did want this. Dr. W. K. Simpson, of New York, related his per- sonal experience with regard to smoking and its effect upon the singing voice. At one time he had given up smoking absolutely for eight years, and passed through what seemed to be similar to the experience of the opium-smoker in his attempt to give up his habit. During this period when he was not smoking, his throat had been free from any discharge or uncomfortable sensation, and he had been able to use his voice with remarkable ease. After he had resumed smoking he had found it much more difficult to keep the singing voice in good order. A barytone did not suffer so much as a tenor from smoking. He felt that he could detect a smoker by the appearance of the throat. Dr. James E. Newcomb, of New TODDALIA TONICS 308 York, alluded to the occasional good effect of tobacco in cases of pharyngeal mycosis and mentioned the case of a patient of his whose decided improvement, after but little benefit from cauterization, he imputed to her having taken up the practice of smoking cigarettes, but without inhaling the smoke. Dr. Lang- maid said that he had once tried the use of a solution of nicotine in a case of this kind, and with a most disastrous result. The appli- cation had been followed by immediate and severe syncope. He wished to warn against this treatment, although it had been recom- mended. Dr. H. L. Swain, of New Haven, said that an interesting fact brought out by certain measurements taken in the colleges relative to the physical development of the students had been that among tobacco-smok- ers, as a class, there was a smaller chest expan- sion than among other students. Dr. J. H. Lowman, of Cleveland, said that possibly the irritation observed by Dr. Langmaid in singers might have been due to many of the slight causes well known to affect the throats of singers. Some well-known singers could not expose themselves to the air while riding— was this an argument, therefore, in favour of giving up open-air exercise ? Dr. Mulhall ad- mitted the truth of Dr. Langmaid's observa- tion as to the local effect of tobacco on the singer's throat. The tenors and sopranos, as compared with other singers, must have very perfect throats and perfect laryngeal muscular control, and hence not only the local effect but the indirect effect on the nervous system was of importance in such individuals. Ordinarily, smoking produced only a very transient hyper- aemia. He had not been so successful as Dr. Langmaid in detecting a smoker by the ap- pearance of the throat. He had never seen pharyngeal mycosis in smokers' throats, and to this extent could confirm the statements gen- erally made on this subject by writers. A friend of his, however, had told him that he had a smoker for a patient who was affected with this disease. He could not understand how tobacco smoke could reach sufficiently deep to affect the seat of this affection. He believed he had been the first to call attention to the fact that pharyngeal mycosis was a dis- ease which would sometimes disappear sponta- neously and reappear. The subject of smokers' vertigo was under discussion in 1895 before the French Congress of Learned Societies (Progres medical, May 4, 1895; New York Medical Journal, June 8, 1895). M. Kohos said that vertigo caused by nic- otine was of very frequent occurrence, and that it manifested itself sometimes under the form of a slight acute poisoning accompanied with pallor, salivation, cold sweats, headache, vertigo, staggering, etc., which symptoms were produced in those who smoked for the first time; sometimes the poisoning was more seri- ous, as, for instance, in the case of a man who had smoked twenty-five pipes in quick succes- sion on a wager, who suffered for many months with vertigo. The vertigo of chronic intoxica- tion from tobacco, he says, might be observed in the workmen and workwomen in tobacco factories, as well as in smokers, in snuff-takers, and in those who chewed tobacco. The action of nicotine varied according to the amount ab- sorbed, and the disturbances caused in the life of the cells in consequence of their contact with the poison might also be variable. M. Le Roy de Mericourt remarked that he had never ob- served smokers' vertigo in Brittany or in cer- tain other countries in which he had lived for a long time, but he had observed a tendency to syncope dependent upon disturbances of the circulation following intoxication with the or- dinary tobacco.]—Russell H. Nevins. TODDALIA.—Toddalia aculeata, a ruta- ceous plant indigenous to southern Asia, has been employed as a tonic in general debility, chronic diarrhea, and convalescence from fe- vers. A tincture of the bark, particularly the root-bark, known as " Lopez root," made with 1 part of the bark to 5 parts of alcohol, may be given in daily amounts of from 90 to 300 grains. TOKAY.—This expensive Hungarian wine is credited with being particularly efficacious as a tonic in cases of the debility of convales- cence, the depression of influenza, neurasthe- nia, etc. An excellent wine, having nearly the same delicate aroma and taste, and doubtless possessing identical medicinal properties, is produced in California, and costs much less than the imported tokay. (See Wines.) TOLU BALSAM, balsamum tolutanum (U. S. Ph., Br. Ph., Ger. Ph.), or balsam of Tolu, is a balsam obtained from Toluifera Balsamum (U. S. Ph.) or from the exudation which follows incision of the trunk of Myrox- ylon Toluifera (Br. Ph.). It is obtained by making V-shaped cuts in the trunk of the tree, the incisions perforating the bark. The exudation is caught in cups which are after- ward emptied into flasks of rawhide, and is transported in earthen jars or tin or glass vessels. As received in the market, balsam of Tolu is soft and tenacious. With age it be- comes brittle and hard like resin. It is shining and translucent, and has a yellowish-brown or reddish-brown colour. Its odour is very fra- grant and it has a pungent, sweetish, but not disagreeable taste. It melts when heated, burns with a flame, and, while being consumed, emits an agreeable odour. The volatile oils dissolve it readily. The U. S. Ph. gives several tests for the purity of the drug; it must be readily and completely soluble in alcohol, the solution being acid to blue litmus paper; it must be almost completely soluble in chloroform and in solutions of the fixed alkalies; it must be almost completely soluble in ether, but nearly insolu- ble in water, benzin, or carbon disulphide. Carbon disulphide, aided by a gentle heat, re- moves from the balsam scarcely anything but its cinnamic and benzoic acids. On decanting and evaporating the disulphide, no substance having the properties of a resin should re- main. The balsam is a combination of volat ile oil, free acid, and resin. This oil is principally tolene, Ci0H,6, the free acids being benzoic and cinnamic acids. The medicinal properties of Tolu balsam are TODDALIA 309 TONICS •very similar to those of balsam of Peru. Its taste, however, is more agreeable, and it is therefore much employed in cough mixtures, especially as a vehicle. It has long been known for its efficacy in chronic bronchitis. In chronic mucous fluxes of the bronchi and urinary organs it has been widely employed, and has been used with reputed "good results in various forms of chronic diarrhea and in chronic dysentery. Old catarrhs of the bron- chial apparatus are said to have yielded to inhalations or sprays of an ethereal solution of Tolu balsam. Some forms of skin disease in which Peruvian balsam has been used are said to have been equally benefited by Tolu balsam. It has been applied to suppurating or inflamed areas, mixed with equal parts of castor oil, with alleged success. In doses of from 10 to 30 grains, frequently repeated, it has been principally employed in the bronchial disorders above mentioned. It forms an element of many cough mixtures, its principal use, as a vehicle, being in favour not only because of its direct beneficial influence, but also on account of its agreeable taste. It may be given in the form of emulsion made by rubbing up the balsam with mucilage and sugar and afterward with water. Syrup of Tolu, syrupus tolutanus (U. S. Ph., Br. Ph), contains 2 fl. oz. of tincture of Tolu, 120 grains of carbonate of magnesium, 26 oz. of refined sugar, in coarse powder, and a pint of water (U. S. Ph.). The British syrup contains li oz. of balsam of Tolu, 2 lbs. of refined sugar, and a pint of distilled water. The syrup of Tolu is a very feeble preparation and has but little of the therapeutic virtues of the balsam. It is used principally as a flavouring element for mixtures. A stronger syrup may be made by adding a desired amount of the tincture of Tolu. The dose is \ fl. oz. Tincture of Tolu, tinctura tolutana (U. S. Ph., Br. Ph.), is made of the balsam of Tolu and alcohol in the proportion of 1 to 10. It possesses the therapeutic properties of the balsam and may be used in place of the latter whenever it is indicated. It is frequently employed in chronic bronchitis. The dose is from 1 to 2 fl. drachms. It may be used as a flavouring medium. The tincture becomes decomposed on the addition of water. Samuel M. Brickner. TOLUENE, TOLUIDINE, TOLUOL, or methylbenzene, C7H8, is a colourless liquid hav- ing the odour of benzene. It is obtained by the fractional distillation of the purified light oils of coal tar. Besides its use in thermom- eter tubes in place of mercury, over which it is said to have some advantages for certain ranges of temperature, it has been employed in medicine. Professor Loffler, of Greifswald (cited in the Ephemeris of Materia Medica, etc., for January, 1896). has found that it kills the micro-orgaiiism of diphtheria, and he has treated that disease by topical applications of the following mixture (American Journal of Pharmacy, March, 1895), in which the menthol serves to deaden the pain that would otherwise be caused : R Menthol.............. 10 grammes; Toluol, enough to make 36 c, cm.; Alcohol............... 60 c. cm.; Solution of ferric chlo- ride (of a strength not stated).............. 4 c. cm. M. In a series of seventy-one cases, all the patients were saved ; in another of twenty-six cases, treated after the second day of the disease, only one patient was lost. TOLYLANTIPYRINE. — See Toly- PYRINE. TOLYLHYPNAL. — Antipyrine hydro- chloride (see Antipyrine). TOLYPYRINE.—This is the tolyl analogue COCH of antipyrine, CACHsN^,^^^^ tolyl being substituted for phenyl. It has the same medicinal properties as antipyrine, and is used in the same doses. It has the advantage of being cheaper than antipyrine. The salicylate, POf'H or tolysal, C6H4CH3N'*■*■> Iron oxide.......................... Jr3iw 98-885 It has been recommended for use in anemia and chlorosis. pharynx in cases of follicular pharyngitis, Ehr- mann (cited by Bocquillon-Limousin) has found it useful when employed in the following solu- tion : TRIBROMALDEHYDE TRIONAL 6 TRIBROMALDEHYDE.—See Bromal. TRIBROMANILINE HYDROBRO- MIDE.—See Bromamide. TRIBROMHYDRIN, or more correctly allyl tribromide, is a colourless or faintly yel- low liquid at ordinary temperatures. When cooled down below 50° F. it solidifies into a mass resembling fat. Its, chemical formula is C3H&Br3. It is prepared by the action of three parts of bromine upon two parts of allyl iodide. Its specific gravity is from 2-407 to 2-430. The action of allyl tribromide is closely akin to that of the oil of garlic. The oil of garlic contains an organic radicle, allyl, C3H5. Its exceeding- ly pungent odour and acrid taste are likewise imparted to the tribromine salt. Both irritate the skin when locally applied, and may even cause vesication. Allyl tribromide, when given internally, im- parts the characteristic alliaceous odour to the urine, the perspiration, and the breath. It has not been extensively used in practice, but, in general, its effects are similar to those of the oil of garlic. It may be employed in spasmodic affections, of organic or functional origin. It has been praised in the treatment of asthma, angina pectoris, and the convulsions of in- fancy, and is said to relieve the symptoms of hysteria. It has probably the action of a mild stimulant upon the gastric mucous membrane. It may be employed, like the oil of garlic, as a stimulant expectorant in chronic bronchitis and in unyielding acute bronchitis. Allyl tribromide may be administered in capsules in doses of 5 drops. For hypodermic use, it may be given in doses of from 2 to 4 drops, when immediate action is desired, dis- solved in a small quantity of ether. Samuel M. Brickner. TRIBROMOMETHANE.—See Bromo- FORM. TRIBROMPHENOL.—See Bromol. TRIBROMSALOL.—This compound of bromol and salicylic acid, CaHe.CTHijBraOs, has been recommended as an intestinal antiseptic, but has not come sufficiently into use to war- rant any definite statement as to its value. It is said to be a very unstable compound. TRIBULUS LANUGINOSUS. — This zygophyllaceous plant, indigenous to India and Cochin-China, has been credited with being emollient, diuretic, and antispasmodic, and has been employed in the treatment of dyspnea, colic, gonorrhea, spermatorrhea, and urinary irritation. According to M. Bocquillon-Li- mousin (Formulaire de medicaments nouveaux pour 1896), it has been particularly vaunted in England as a remedy for spermatorrhoea and the mental troubles that may accompany that disorder. A fluid extract, made with equal parts of the fruit and alcohol, may be given in doses of from 5 to 10 drops three times a day. TRICHLORACETIC ACID.—This com- pound, CCU.COOH, is generally considered preferable a's a caustic to the other chloracetic acids (see Chloracetic acid). As an astrin- gent application to enlarged tonsils and to the 3 Trichloracetic acid........5 grains; Iodine................... 2 " Potassium iodide......... 2£ " Glycerin................. 1 fl. oz. M. TRICHLORPHENOL, a three - atom chlorine substitution derivative of carbolic CI acid, C6H2<(-)rT, occurs in colourless acicu- lar crystals having the odour of phenol. It has been said to be a very energetic antisep- tic, far exceeding carbolic acid, but on this point opinions are not unanimous. It has been found highly useful as a topical applica- tion in erysipelas, in the form of an ointment containing from one to two per cent, of the drug. A solution of the same strength may be employed in erysipelas, also as a wash for foul ulcers, and weaker solutions, of from half to one per cent., as a vaginal injection in leu- corrhea or for injecting into the rectum in dysentery. Trichlorphenol forms a compound with magnesium, magnesium trichlorphenate, which has been used in a two-per-cent. solu- tion as a collyrium in cases of purulent oph- thalmia. TRICRESOL is a combination of at least three members of the cresol group, which oc- curs as a colourless oily liquid with an odour resembling that of creosote and soluble in about forty parts of water. Contact with it does not benumb the hands, as in the case of carbolic acid, and it is apparently without ef- fect upon metals. It is about as poisonous as carbolic acid, but, inasmuch as solutions of one third the strength of those of that sub- stance are quite as active, it is held by some to be preferable as an antiseptic. Tricresolamine consists of two parts each of tricresol, ethylenediamine, and water. It is slightly less irritating than tricresol itself, and is employed in solutions varying in strength from one tenth to one per cent. [Professor Charteris and Dr. John Morton, of Glasgow (Lancet, March 31, 1894), have sub- jected tricresol to experimental investigation, using guinea-pigs for the purpose and inject- ing subcutaneously 6 minims of the drug mixed with 25 minims of water, also, for the sake of comparison, a solution of carbolic acid of the same strength. They found that this injection of tricresol caused in seven minutes a backward movement, which was shortly fol- lowed by convulsions of the hind legs; after- ward the whole body was affected. The convulsions were not, however, severe, and in forty minutes they ceased, leaving the guinea- pig a little dull, yet when touched it moved readily. Pure phenol injections also caused convul- sions, which commenced'in the same manner and extended over the body. They were, how- ever, somewhat more pronounced than those caused by the tricresol injection ; in the course of an hour the guinea-pig recovered. 331 TRIBROMALDEHYDE TRIONAL Neither of the injections was followed by an open sore, but in the course of three days a little hardness was detected at the sites of the punctures in the cellular tissue of the abdomen. They found that a 12-minim and a 10-minim dose of tricresol caused immediately severe convulsions, which became continuous and in- volved the whole body. From other experi- ments they came to the conclusion that a lethal dose of tricresol was from 7 to 8 minims. Experiments on micro-organisms instituted at the same time showed that tricresol was al- most, but not quite, three times as powerful a germicide as pure phenol. An exposure of the Staphylococcus pyogenes aureus to a solution of 1 in 20 of phenol invariably rendered the organisms sterile in two minutes, and a solu- tion of 1 in 60 of tricresol had the same effect; but in the shorter exposures the l-in-20 phenol solution gave a greater proportion of sterile cultures than tricresol. They therefore conclude that tricresol is three times as strong a germicide as pure phe- nol, and that it is three times less toxic. Its advantages, consequently, for surgical pur- poses are very pronounced. Mr. Robert Lee, of West Kensington, having read Charteris and Morton's article, had the idea of ascertaining if a solution of tricresol would, like one of carbolic acid, when heated, give off a vapour constantly of its own strength. lie found that it would, and he consequently suggests its use for inhalation in diseased con- ditions of the respiratory passages in which carbolic acid has been found useful. In his experiments he used a solution of a drachm of tricresol in a pint of water, but he remarks that this is rather strong for children, with whom a weaker one may be employed.] Russell H. Nevins. TRIFOLIUM FIBRINUM, or Menyan- thes trifoliata, the buck-bean, is a gentianace- ous herb widely distributed over temperate regions of Europe and America. The leaves, folia trifolii fibrini (Ger. Ph.), are tonic, cathar- tic, and in large doses emetic. They are now but little used in medicine. The dose of the powdered leaves as a tonic is 20 grains, three times a day; that of the extract, extractum trifolii fibrini (Ger. Ph.), is 10 grains. TRIFORMAL.—See Formaldehyde. TRIFORMOL.—This is a trade name for trioxymethylene, or paraformaldehyde (see Paraform). TRIIODOMETACRESOL. — See Loso- PHAN. TRIKRESOL.—See Tricresol. TRIMETHYLAMINE, or propylamine, (CH3)SN, is a colourless liquid obtained from a large number of albuminoids which have un- dergone the preparatory stages of decomposi- tion, and is usually employed in the shape of the hydrochloride or chloride. It is an active irritant of the alimentary canal, depresses the action of the heart, and lowers the tempera- ture, especially in acute rheumatism, in the treatment of which it has been employed to some extent, from 2 to 3 grains being given every three hours. The dose of the chloride is somewhat larger—5 grains. Applied locally, undiluted, trimethylamine acts as a caustic; given internally in "full doses, it is apt to cause temporary albuminuria.—Russell H. Nevixs. TRIMETHYLETHYLENE.—See Pen- tal. TRINITRIN.—See Nitroglycerin. TRINITROCELLULOSE.—See Photox- ylin. TRINITROPHENOL.—See Picric acid. TRIONAL, or diethylsulphonemethylethyl- methane, is a member of the groups of sul- phones to which sulphonal and tetronal belong. Its chemical formula is C8H15S2O4, and it dif- fers from sulphonal in containing one atom more of carbon and one fewer of hydrogen. Trional occurs in white, inodorous, almost tasteless crystals. It melts at about 258° F. It is not freely soluble in cold water, more easily so in boiling water, in alcohol, and in milk". It burns on platinum foil without resi- due. Administered in doses of from 15 to 30 grains, trional induces a quiet, usually a dream- less sleep, which lasts for from six to eight hours. If it is given at bedtime, this hypnotic effect is manifested in from fifteen to forty- five minutes, but sometimes not before an hour. The patient can usually be awakened with ease, but quickly returns to sleep. The action of trional is, as a rule, not cumulative, as that of sulphonal is. It is easily decomposed by the metabolic processes of the body. After the natural awakening at the end of the induced sleep, its effect upon the organism disappears. Its long-continued use is said to have caused the presence of haematoporphyrin in the urine; but, although this may appear as a sign of acute or chronic intoxication from the drug, it is doubtful if it appears readily, owing to the < easy decomposition of trional in the body. Occasionally in the morning, after its ad- ministration, lassitude and a sense of pressure in the head have been observed, but they have disappeared in a few hours. Very rarely a post- poned action of trional is obtained or its effect may be protracted. This is valuable in so far that one dose can thus be made to do service for several successive nights, or one large dose may supplant several smaller ones. It is det- rimental, however, in this respect, that the drowsy feeling oppresses the patient during the day. Occasionally, after the ingestion of tri- onal, patients have complained of loss of ap- petite, belching, and epigastric pain; these symptoms may be accompanied by nausea and vomiting, vertigo, and unsteadiness of gait. In one series of reported cases some of the pa- tients complained of dizziness and inability to stand, and felt as if they were intoxicated. These symptoms soon disappeared and sleep followed. Others have observed tinnitus au- rium, great sensitiveness to sounds, and hy- peresthesia. , A reduction in the blood-pressure and a lowering of the pulse from five to ten beats 65 TRIOXYBENZOL TROI'ACOCAINE 332 a minute have been observed, together with palpitation. Animal experimentation shows but little fall in the blood-pressure; at first there is an increase in the number of respira- tions and heart beats, with death from respir- atory paralysis. The writer has been able to collect six cases of acute and three of chronic intoxication by trional. The symptoms of acute trional poison- ing are an intensification of the effects of physi- ological doses. There appear severe loss of equilibrium, vertigo and ataxia, vomiting, and diarrhoea. The temperature falls below nor- mal. In one case of bronchitis and emphy- sema in which trional had been given but once there was a great increase in the rapid- ity of the pulse and respiration, accompanied by great excitation and collapse. Reinicke (Deutsche medicinische Wochenschrift, March 28, 1895) describes the case of a young woman suffering from acute hallucinatory insanity to whom trional had been given for fifteen weeks. Her bowels were regular. In one hundred and seven days she received 600 grains of trional in doses of 15 grains every other night. She be- came affected with headache, vertigo, muscae volitantes, abdominal pain, and slight elevation of temperature. The pulse became small and rapid, there were nausea and diarrhoea, and the urine contained blood and hyaline and granu- lar casts. Recovery ensued under appropriate treatment, although the general symptoms lasted for some time. Boudeau (cited in the same journal, 1895, No. 45) cautions against the too prolonged employment of trional, since he has observed, after having given it in 60- grain doses in three successive nights, somno- lence, hallucinations, stertorous breathing, cyanosis, ataxia, and red discoloration of the urine. Sometimes his patients complained of dizziness, headache, and tinnitus aurium. Chronic trional intoxication (Deutsche medi- cinische Wochenschrift, 1894, No. 17) is charac- terized by anorexia, vomiting and constipation, and epigastric pain. Collapse and death may ensue. Haematoporphyrin appears in the urine, which is probably due to some disturbance of haemoglobin. The hypnotic effect of trional is probably due to a direct influence upon the cerebral cor- tex. This may be inferred, in the absence of direct experimental evidence, from the occa- sional cortical symptoms which appear after the ingestion of the drug. Although Dr. Rus- sell Bellamy, of Colorado Springs (New York Medical Journal, July 21, 1894), in an " alco- holic service " in Bellevue Hospital, New York, found the drug useful in delirium tremens, and although Khmelewsky (cited in the New York Medical Journal, April 20, 1895) agrees with him, most observers are not of the same opin- ion. [In an article on Insomnia in Surgery, and its Treatment (New York Medical Journal, March 2, 1895), Dr. George G. Van Schaick, of the French Hospital, New York, gives a brief account of the case of a woman, thirty-five years old, in which trephining and the removal of a large portion of the frontal bone were re- quired by a depressed fracture of the frontal bone of six years' standing, complicated with extensive necrosis. The patient was an opium- eater, and was also addicted to the use of alco- hol in large quantities. The operation, though quite extensive and prolonged, was well borne by the patient, who, however, in a few days became nearly maniacal, insulting the attend- ants and nurses and being somewhat .pugna- cious. Morphine had to be given for a few days, but was soon replaced by trional. The operation succeeded very well in relieving an intense headache localized over the forehead. In her case the trional appeared to have re- placed the morphine quite satisfactorily, the opium habit seemed to disappear, and the pa- tient, who prior to the operation had spent her time either in a state of opium narcosis or in howling with pain and excitement, became very quiet and comfortable. Her mode of life and her inability to obtain proper treatment at home or in an institution, however, led Dr. Van Schaick to believe that she would soon resume the morphine habit.] Khmelewsky says the use of trional is indi- cated in cases in which no psychical disorders exist, but cautions against its employment in melancholia and hypochondriasis, because of the depression it may evoke. He has never met with circulatory, digestive, or respiratory disturbances caused by the drug. Other writ- ers, the majority, have not observed satisfac- tory hypnotic effects from trional in the face of excitement of any kind. When there is pain, trional alone is scarcely to be relied upon, but if combined with morphine, may give good re- sults. It is contra-indicated when there is an annoying cough present and in alcohol, mor- phine, or cocaine intoxication. Trional may be given, as a reliable and safe hypnotic, in insomnia resulting from organic brain disease, or sleeplessness in the different forms of neurasthenia and the functional psy- choses. In ordinary sleeplessness from worry, restlessness, overfatigue, or excessive brain work, it is admirable. It may be administered when sulphonal has failed to induce sleep. Its value as a general hypnotic is high, except in the in- stances above mentioned. As a sedative it is inferior to tetronal. [Trional has been used to some extent in the treatment of epilepsy. Dr. H. P. Boyer (Uni- versity Medical Magazine, March, 1896) re- ports his observations in regard to this use of the drug by Dr. S. Weir Mitchell, of Philadel- phia. In most instances where trional was used the patients were in some way benefited. Either the number of attacks was diminished, their severity lessened, or the general physical condition of the patient improved. The results of its use and the drawbacks are stated in an account of thirteen cases. Some of the patients suffered so much from drowsiness and vertigo, and derived so little benefit in regard to the diminution of the number of attacks, that the treatment was not kept up for more than two or three weeks. Of the thirteen cases referred to, in ten there was a marked decrease in the number of attacks during the treatment, and the physical symptoms also were singularly improved. In five of the cases the number of TRIOXYBENZOL 333 TROPACOCA1NE attacks was less under the trional treatment than under the bromide treatment: in two others, however, the bromides gave more satis- factory results. Dr. Mitchell believes, says Dr. Boyer, that trional may often prove an efficient substitute for the bromides, and he states that he has seen no ill effects follow its continuous use for many weeks. It is well, he says, at times to give the bromides in the daytime and trional at night.] Claus (Internationale klinische Rundschau, 1894, No. 45 ; American Journal of the Medi- cal Sciences, April, 1895) finds trional an effi- cient and safe hypnotic for children. He has found it to fail only when pain is present, sleep being induced when the drug was given at bedtime within ten or fifteen minutes. He has found it most reliable in chorea, pavornoctur- nus, and the insomnia of dentition and indi- gestion. No untoward effects were noted, and a habit was not formed. The advantages of trional over sulphonal are summed up by Vogt (Nouveaux remedes, 1894, No. 21). Sleep is induced more prompt- ly, the sleep is calm and natural, the awaken- ing is normal and free from disorders, and a single dose suffices for the purpose. The dose of trional for adults is from 15 to 30 grains given at bedtime. It is best ad- ministered in hot water or milk, as it is then more rapidly absorbed and a quicker action is obtained. The dose for children varies from 3 to 20 grains, depending upon the age. It may be given as early asin the first month of life. [According to Claus (loc. cit), the daily amounts of trional that may be given to chil- dren of various ages are as follows: Age. Dose. 1 month to 1 year........... 3 to 6 grains. lto2years................. 6 " 12 " 2" 6 " ................ 12 "18 " 6"10 " ................ 18 "22 " A writer in the Monatsschrift fur Geburts- hulfe und Gynakologie for April, 1896 (British Medical Journal, May 16, 1896), gives a sum- mary of recent opinions on new hypnotics and narcotics. In respect to trional, he says, the strength of the dose has been much disputed. The chief importance of this uncertainty, as far as gynaecology is concerned, is the fact that a larger dose is often required during than be- tween the menstrual periods. Bad results have been observed only when very large doses have been given or when the use of the drug has been continued too long. When trional is given for dysmenorrhea or any other painful condition, its use must never be continued for weeks or months, and it must never be given in larger doses than 30 grains.] If the drug has no effect after two or three successive nights, it is wise to replace it by some other hypnotic. Its use is best inter- rupted from "time to time in order to avoid possible cumulative effects. The constipation which is sometimes seen must be attacked and the extreme acidity of the urine should be pro- vided against by the administration of alkaline drinks.—Samuel M. Brickner. TRIOXYBENZOL.—See Gallacetophe- NONE. TRIOXYMETHYLENE. — See Para- form. TRIPHENINE.—This is a powder, C8H4 C2H6O.NH(CH3.CH2CO), homologous with phenacetine. It is insoluble in ordinary men- strua. It has been used as an antipyretic and analgetic in doses of from 4 to 10 grains, but it has not been tested in practice sufficiently to warrant its being recommended. TRITICUM (U. S. Ph.) is the rhizome of the Agropyrum repens, or couch grass, a plant widely disseminated through the Northern United States. It is a demulcent diuretic and is very useful in all conditions, such as cystitis or gonorrhea, in which it is desirable to ren- der the urine as little irritating as possible. A decoction of almost any strength may be em- ployed without restriction as to quantity, but the fluid extract, extractum tritici fluidum (U. S. Ph.), is a rather more convenient form for its administration. It may be given in doses as large as a fl. oz. [Triticum must not be confounded with the farina tritici of the British Pharmacopeia, which is wheaten flour (see Flour).] Russell H. Nevins. TROCHES (trochisci) are round, oval, or angular tablets or lozenges consisting of sugar, some medicinal ingredient, and some binding material. They are formed while in a moist or plastic condition, and without much pres- sure. They are sometimes called " pastilles," but in this work the term " pastille" will be restricted to the designation of compounds in- tended to be burned so as to diffuse a pleasant odour. The material most suitable as a binding substance for troches is tragacanth, either in powder or in the form of mucilage. All in- gredients entering into troches must previous- ly be reduced to the finest possible powder and thoroughly mixed, whereupon the mass is care- fully moistened with water or with mucilage of tragacanth if the gum is not already pres- ent in the mixture, and worked into a tough plastic mass which will not '- run" or flatten out by its own weight. On a small scale the mass is then rolled out either on a pill ma- chine or on a board with adjustable rims, so as to permit of the regulation of the thickness of the troches, and by means of a cutter pieces of the proper shape are then cut out. On a large scale machinery is employed both for making the mass and for forming it. Ma- chine-made troches are generally preferred to hand-made ones, as they are more uniform and handsome in appearance. Still, as there are some combinations which are only occasionally called for and which the wholesale manufac- turer does not care to carry in stock, the preparation of these falls upon" the apothecary. Charles Rice. TROPACOCAINE— This alkaloid, C8H14 NO.(C6H5CO),called also benzoylpseudotropeine, is obtained from the leaves of a Java coca plant. It is employed in the form of the hydrochloride as a local anesthetic, in a solu- tion of the strength of from two to three per cent. According to some writers it acts more 134 TRYPSIN _ TURPENTINE 6 rapidly than cocaine and is less poisonous. Dr. C. A. Veasey, of Philadelphia (New York Medical Journal, November 25, 1893), has found that the instillation of a three-per-cent. solution into the eye causes complete anaesthe- sia in about two minutes, and that this effect lasts for about eight minutes and may be pro- longed by repeating the instillations. In his experience the pupil was rarely affected, al- though in a few cases it was slightly dilated for a short time, and in those cases only was there slight haziness of vision, owing to the range of accommodation being changed a lit- tle, the near point being carried farther from the eye. The palpebral fissure was somewhat enlarged, but there was no ptosis. Dr. Veasey considers tropacocaine superior to cocaine in the removal of foreign bodies from the eye, in making strong astringent or caustic applica- tions to the cornea or the conjunctiva, and in cases of keratitis, inasmuch as it does not di- minish the blood supply to so great an extent. For other purposes he has not found it supe- rior to cocaine hydrochloride. According to Dr. Cerna, large amounts of tropacocaine are apt to produce slowing of the pulse, vertigo, and intense precordial anxiety. TRYPSIN.—This is the proteolytic fer- ment of the pancreatic juice. It occurs as a yellowish-white, amorphous powder freely solu- ble in water and in glycerin, but insoluble in alcohol. It acts upon proteids in a manner similar to that, of pepsin. Unlike pepsin, it does not act in an acid medium. The chief products of the action of trypsin are tyrosine and leucine. As a digestive agent it com- pletes the digestion of the proteids already begun in the stomach. For digestive purposes the extract of pancreas, which contains all the digestive agents of the pancreatic juice, is com- monly employed. Trypsin has been especially used as a solvent for diphtheritic membrane and in certain surgical conditions. In solu- tion, it is unirritating to normal tissue, but has the property of digesting the fibrin of false membranes with great rapidity. That it has the power of dissolving diphtheritic mem- branes to a decided degree can not be doubted. It was at one time very largely employed for this purpose. It is much less used at present, and by most practitioners it has been aban- doned for this purpose. It is used as a spray in the following proportions: Trypsin, 15 grains; bicarbonate of sodium, 5 grains; wa- ter, 1 ounce. It is sometimes applied to the diphtheritic membrane by insufflation, four parts of trypsin being used to one part of soda. This mixture is sometimes smeared over a dampened brush and painted upon the throat. It has also been used for the purpose of dis- solving away necrotic or seriously contused tissues. For this purpose it is prepared as in diphtheria.—Floyd M. Crandall. TUBERCULIN.—See under Animal ex- tracts and juices (vol. i, page 81). TUBERCULOCIDIN.—This is a modi- fied form of tuberculin prepared by Klebs, said to cause less febrile reaction than Koch's preparation. It has not come into use to any considerable extent. TUMENOL, or tumenolum, or sulphotu- menolic acid, is a non-official compound, dis- covered by Spiegel, which is obtained from mineral oil by treating the unsaturated hydro- carbons with concentrated or fuming sulphuric acid. The product is washed free of all excess of the acid and is then crude or commercial tumenol. This is a mixture of sulphones and sulphonic acids which occurs as a dark-brown, acid, syrupy liquid. Tumenol oil consists of the separated sulphones, and occurs as a dark- yellow, thick liquid which is insoluble in water, but readily soluble in ether and in ben- zene. Tumenolsulphonic acid can also be sepa- rated as a dark-coloured powder which has a peculiar, slightly bitter taste and is soluble in water. Aqueous solutions of tumenolsul- phonic 'acid readily take up tumenol oil when the latter is added. Tumenol was originally obtained from the bitumen found in the Messel mine near Darm- stadt, and derives its name from that sub- stance. Very little is known of its therapeutic value in addition to the statements made by a Berlin correspondent in the Provincial Medical Journal for January, 1892, which have been re- produced in various places. It appears to have been introduced into medicine by Neisser as a partial substitute for ichthyol, to which it is closely related, but is not so efficient, because it lacks the penetrating, antiparasitic, and sor- befacient properties of that drug. It is said that compresses soaked in a two- to five-per-cent. solution of tumenolsulphonic acid have been found useful in the treatment of acute recurrent eczema of the hands and \face ; that tumenol oil, in the form of a paste from five to ten per cent, in strength, has proved of value in the treatment of superficial ulcerations, impetigo, and pemphigus ; that an ointment of similar strength of tumenol oil mingled with five per cent, of oxide of zinc and nitrate of bismuth, with lard as a base, has been employed by Neisser in similar con- ditions with success; and that the itching of eczema and prurigo may be relieved by the ap- plication of a ten-per-cent. tincture diluted with equal parts of ether, alcohol, glycerin, or water. The undiluted tumenol oil is also said to have been painted over the diseased sur- faces. [The sodium salt of tumenolsulphonic acid, a soluble, dark-coloured powder, may be used like tumenol.] Matthias Lanckton Foster. TURMERIC, TURMEROL.—See under Curcuma. TURPENTINE, terebinthina (IT. S. Ph., Ger. Ph.), is an oleoresin obtained from the trunk of Pinus palustris (U. S. Ph.), Pinus aus- tralis and Pinus teda (Br. Ph.), and from Pinus pinaster and Pinus laricis (Ger. Ph.). Canada turpentine, Canada balsam, Terebinthina cana- densis (U. S. Ph., Br. Ph.), is a liquid oleoresin derived from Abies balsamea. Turpentine is a term usually used to describe liquid or concrete juices, derived from certain 335 TRYPSIN TURPENTINE trees, which contain a resin and an essential oil, the oil of turpentine. Turpentine is generally obtained from species of fir, larch, or pine trees, each species giving its name to the particular turpentine derived from it. The various tur- pentines are similar to one another in taste and odour. They are at first liquid, gradually becoming solid on exposure. The most important turpentines are white turpentine, common European turpentine, Ven- ice turpentine, Canada turpentine, and Chian turpentine. The medical properties of all these varieties depend upon the presence of the oil of turpentine for their virtues. Chian turpen- tine was at one time thought to have been used with success, locally and internally, in the treatment of cancer. Its odour is more agree- able and its taste less offensive and less bitter than those of the other turpentines. It may be given in emulsion in doses of 5 grains, gradu- ally increased as it is well borne by the patient. Canada turpentine, Canada balsam, or bal- sam of fir, called in Europe also the balm of gilead, is widely used in histological work for the mounting of specimens to be permanently preserved. After it becomes hard, it becomes and remains perfectly clear and homogeneous. Turpentine Oil.—The oil, or " spirit," of turpentine, oleum terebinthine (U. S. Ph., Br. Ph., Ger. Ph.), is a volatile oil distilled from turpentine (U. S. Ph.) or from the oleo- resin obtained from Pinus palustris, Pinus teda, or Pinus silvestris (Br. Ph.). It has the formula Ci0H16, is very highly inflammable, and is colourless or faintly yellow. Its specific gravity is 0-86. The odour of turpentine is strong and penetrating, and it possesses a hot, pungent, somewhat bitter taste. Its reaction is neutral or faintly acid. Its boiling point is about 300° F. The oil is slightly soluble in water, a little more so in alcohol, and freely soluble in ether. Artificial camphor may he produced by bringing oil of turpentine into contact with hydrochloric acid, when two com- pounds will be"formed, a red liquid and a white crystalline substance resembling camphor. Turpentine has the property of converting the oxygen which it absorbs from atmospheric air into ozone. Taken internally, in moderate doses, the oil of turpentine gives the sensation of warmth in the stomach. The circulation becomes acceler- ated and the warmth of the skin is increased, but no cerebral stimulation appears, although vertigo and intoxication may make themselves manifest if the dose is large enough. Fre- quently repeated small doses stimulate the kidneys, and may, if long continued, irritate the genito-urinary tract, sometimes even caus- ing strangury. The urine obtains a violaceous odour and may contain blood. The drug is excreted by the'lungs as well as by the kidneys, and finds its exit from the body through these channels even when it is inhaled. In large doses, turpentine induces catharsis, sometimes preceded bv nausea and vomiting. Occasion- ally an erythematous eruption is observed after its'ingesti'on. Experiments show that the co- agulability of the blood is increased by the administration of turpentine. Some cases of death from taking large doses of the oil of tur- pentine are recorded, hut the exact lethal dose is not known. It probably varies with indi- vidual idiosyncrasy, but the amount is undoubt- edly a large one. Turpentine is rubefacient, inducing in a short time an intense irritation and sometimes in- flammation in any tissue with which it comes in contact. This property is taken advan- tage of in rheumatic affections and in some internal and subcutaneous inflammatory pro- cesses. Its effect upon the skin, however, is so very violent that its local external use can scarcely be commended. In the form of a lini- ment, it has been found useful by some ob- servers in burns, as well as in erysipelas, and as a dressing for local gangrene. Its topical employment has been recommended in eczema, the lesion being changed by its use and thus offering a better opportunity for other thera- peutic agents to act. The use of turpentine in parasitic diseases of the scalp has also been praised, the statement being made that it de- stroys the micro-organisms and prevents the development of their spores. The oil of tur- pentine has extensive employment as a counter- irritant, usually in the form of stupes. These may be prepared by dipping pieces of flannel previously soaked in hot water into oil of tur- pentine which has been warmed by placing the vessel containing it in warm water. The flan- nel may then be applied to the skin and al- lowed to remain on as long as it can be borne. Turpentine stupes have been largely used in bronchitis and peritonitis with good effect, in the latter disease frequently reducing the me- teorism. As an element in enemata, the oil of turpen- tine often aids to secure an evacuation where other substances fail. After celiotomy, when cathartics are unable to induce a movement of the bowels, or when the colon is filled with hard, impacted faeces, the oil of turpentine mixed with an equal quantity of olive oil will frequently bring about the desired result by its local stimulation to the intestines. Mixed with an equal amount of the milk of asafcetida, and given as an enema, it frees the intestines of flatus in meteorism from functional causes. An equally good result may be obtained from the combination of turpentine with ox-gall. In cases of narcotic poisoning, the stimulant effect of turpentine may be employed in rectal injections to rouse the system. The oil of turpentine has been often em- ployed internally in typhoid fever when the tongue is dry and fissured and there is decided meteorism. ' Under its use, the tongue becomes moist and the tympanites diminishes. In the same disease, if a diarrhoea during convales- cence is present, indicating a slow healing of the lesion in Pever's patches, the turpentine seems to foster the healing of the ulcers. In this condition, 10 drops of the oil maybe given every two hours. Good effects have also been observed in ulcerative processes of the stomach and intestines from the use of the oil of tur- pentine, when it probably acts as a stimulant to the diseased areas. The drug has been recom- mended as being efficient as a stimulant in low TURPETII MINERAL ULMUS 336 fevers and in the local complications of typhoid fever, such as pneumonia and bronchitis. In the latter disease it may be employed as a counter-irritant and internally at the same time. In puerperal fever its local and internal use has been praised. The use of the oil has been extolled in the various neuralgias, par- ticularly sciatica, and in lumbago. Although turpentine is rarely used as a diuretic, its stimulant action upon the kidneys may be taken advantage of in cases of chronic pyelitis and cystitis; and it is said to act well upon a chronic urethritis. Its use is praised in incon- tinence of urine depending upon weakness of the vesical walls. Whether it is of advantage in whooping-cough, spermatorrhea, amenor- rhea, and impotence may be doubted. In cases of tenia solium and ascarides the internal administration of the oil of turpentine as a vermifuge has been much praised. For the same purposes it may be given in the form of an enema with an equal bulk of olive oil. As an anthelminthic, its internal dose is from£ to 1 fl. oz., given in an equal amount of castor oil or followed after a short time by castor oil. The inhalation of the vapour of the oil of turpentine was recommended by Skoda in gan- grene of the lungs and is now widely used for this affection and for fetid bronchitis and asthma. Baths of the vapour of turpentine are said to be beneficial to persons suffering from chronic rheumatism ; and the vapour aris- ing from turpentine thrown on the bedclothes is said to cure scabies. Baths containing oil of turpentine are said to give good results when the constitutional effects of the drug are sought for. From 5 to 10 fl. oz. of the oil may be added to a bath for this purpose. The antiseptic properties of turpentine are feeble, although the oil does possess some bac- tericidal properties. The oil of turpentine is an antidote to phosphorus and in cases of acute poisoning may be given in a mucilaginous mixture in a dose of from 30 to 40 drops. The dose of the oil of turpentine for ordi- nary purposes is from 10 to 30 drops, repeated every two or three or four hours as may be demanded. It may be administered on sugar or in an emulsion with glycerin and oil of gaul- theria, or with some aromatic water, to dis- guise its taste. It maybe given in capsules or it may form part of a pill made with sugar, oil of lemon, and white wax. The dose of the oil of turpentine as an anthelminthic is -J fl. oz., taken all at once or in divided doses of from 2 to 4 fl. drachms for two or three doses. In an ene- ma, it may be used, in the combinations above described, in doses of from \ to 2 fl. oz. Rectified oil of turpentine, oleum terebin- thine rectificatum (U. S. Ph., Ger. Ph.), is the oil of turpentine distilled in contact with lime- water. It is free from the disagreeable taste and odour of the ordinary oil of turpentine, and the U. S. Ph. directs that it should always be dispensed for internal administration for these reasons. Its effects and its properties are those of the oil of turpentine. Turpentine liniment, linimentum terebin- thine (U.S. Ph., Br. Ph.), contains 650 parts of resin cerate, and 350 of the oil of turpentine (U. S. Ph.). The Br. Ph. directs that it be made from soft soap, distilled water, camphor, and the oil of turpentine. The liniment of the U. S. I h. is to be preferred, since it is more stable. This liniment has a deservedly widespread employ- ment in scalds and burns, having been used in the eighteenth century by factory operatives in England and being later (1797) introduced to the profession by Dr. Kentish, of England. It should be applied as soon as possible after the emergency calling for its use. The best method of application is to saturate cotton or gauze with the liniment and lay them directly upon the burned or scalded areas. Care must be taken to avoid uninjured tissue and to exclude the air. The pain of a burn is quickly relieved by the liniment, and healing of the burned surface is promoted. Dr. Meigs, of Philadel- phia, recommended the use of turpentine lini- ment in erysipelas of traumatic origin, and it has been employed with good results in the local treatment of furuncles and carbuncles. Liniment of turpentine and acetic acid, linimentum terebinthine aceticum (Br. Ph.), contains glacial acetic acid, liniment of cam- phor, and oil of turpentine, in the proportions, respectively, of one, four, and four. It is a ru- befacient liniment of great power, and its uses are the same as those of the turpentine lini- ment. Confection of turpentine, confectio terebin- thine (Br. Ph.), is made by rubbing together 1 fl. part of oil of turpentine and 1 part of powdered licorice root, and adding 2 parts of clarified honey. Its use is an agreeable method of administering turpentine and has the effects only of the oil. The dose is from 1 to 2 drachms. The enema of turpentine, enema terebinthi- ne (Br. Ph.), is an enema containing 1 fl. oz. of the oil of turpentine and 15 fl. oz. of muci- lage of starch. [Turpentine ointment, unguentum terebin- thine (Br. Ph.), is a stimulating ointment con- taining 8 fl. parts of oil of turpentine, 1 part of resin (rosin), and 4 parts each of yellow wax and prepared lard. The German official prep- aration of the same name consists of equal parts of turpentine, turpentine oil, and yellow wax. Turpentine oil is a valuable hemostatic, par- ticularly in cases of hemorrhage following the extraction of a tooth. According to Dr. B. H. Brodnax (Times and Register, June 29, 1895), a bit of cotton saturated with it should be pressed into the cavity and kept in place for about five minutes. Dr. N. Mavne, in an arti- cle attributed to the Trained Nurse (cited in the New England Medical Monthly for May, 1896), says that for some years he has used oil of turpentine in post-partum hemorrhage, and in every case with the best results. He satu- rates a piece of lint with the turpentine, intro- duces it in his hand into the uterus, and holds it against the walls. Rapid contraction takes place, and all haemorrhage instantly ceases. In one or two cases, when the patient was almost pulseless, it seemed to act as a stimulant. On no occasion did this action fail, and it did not cause the slightest inconvenience except in one 33 case in which the side of the patient's thigh was slightly blistered by some of the oil that came in contact with it. He considers it much quicker and surer in its action than any other remedy. Sasse (Therapeutische Monatshefte, Febru- ary, 1895; Practitioner, May, 1895), having observed the immediate haemostatic action of turpentine oil in the case of a patient who had bled for several hours after the extraction of a tooth, subsequently used it in a case of scurvy, painting the gums hourly with the undiluted oil, which was kept in the mouth for a short time, and giving small doses internally. The oral haemorrhage and the haematuria gradually subsided, and the patient's general health im- proved.]—Samuel M. Brickner. TURPETH MINERAL.—See under Mercury sulphates (vol. i, page 628). TJJSS1LAGO.—Tussilago Farfara, colt's- foot, is a synantherous herb indigenous to the northern temperate zone. The leaves, folia farfare (Ger. Ph.), are demulcent and slightly bitter. They are used mostly in domestic medicine as a pectoral. A decoction made with an ounce of the leaves and a pint of water may be taken in doses of 4 fl. oz. three times a day. TUSSOL.—This fanciful name has been given to a salt of antipyrine and amygdalic (phenylglycolic) acid. Dr. Rehn, of Frank- fort on the Main (Wiener klinische Wochen- schrift, August 9, 1894), has used the drug in a number of cases of whooping-cough in chil- dren, and has found it useful in reducing the frequency of the paroxysms and mitigating their intensity. Its action, he says, is different from that of simple antipyrine, and he has ob- served no untoward effects from its use. It is soluble in water, and as a corrigent raspberry syrup is better than milk. The minimum doses for children are as follows: Under one year of age, from £ of a grain to 1£ grain, two or three times a day; from one to two years, 1-J- grain, three times a day; from two to four years, from 3f grains to 6 grains, three or four times a day; for older children, 74, grains, four times a day or oftener. Dr. Rothschild (Deutsche medicinische Wochenschrift, January 2, 1896: Therapeu- tische Wochenschrift, March 15, 1896) gives an account of an epidemic of whooping-cough which lasted from October, 1894, until the middle of February, 1895. He treated sixty- one cases, which he divides into three groups. In the first group, consisting of sixteen cases, tussol was not used. The disease lasted from six to ten weeks and was very severe; two of the children, about six months old, died. The eighteen patients of the second group were treated at first with other remedies, and then with tussol. During the first period of their treatment no substantial reduction of the number or the severity of the paroxysms was achieved, but such a reduction occurred after four days' use of tussol. In the twenty-seven patients of the third group the disease was milder; the paroxysms were short, infrequent, and followed by far less weakness than in the TURPETH MINERAL 7 ULMUS two other groups. In very few of these cases only did the tussol seem to have no effect, and they were cases in which it was doubtful if the remedy was given regularly. Rothschild states it as a certainty that in patients who were treated with tussol from the outset, and took their doses regularly, the duration of the dis- ease was notably shortened and its whole course was much milder. In a few of them it lasted not longer than about a fortnight. TUTTY.—See under Zinc. TYLOPHORA—The leaves of Tylophora asthmatica, or East Indian ipecacuanha, an asclepiadaceous plant of Asia, Africa, and Australia, are used in India as a diaphoretic and expectorant in doses of 3 or 4 grains, and as an emetic in doses of from 20 to 30 grains. Like ipecac, it has been employed with advan- tage in the treatment of dysentery. The leaves are smoked for relief from the paroxysms of asthma. Their active principle is an alkaloid, tylophorine, the hydrochloride and nitrate of which are soluble in water. These salts have not been used sufficiently to warrant state- ments as to their dose. ULEXINE, CnH14N20, is an alkaloid ex- tracted from the seeds of Ulex europeus, or gorse, a European leguminous shrub. Ulexine has been thought to be identical with cytisine (see under Cytisus laburnum), but this is questioned. It has been but little used in medi- cine, and the statements concerning it to be found in literature are contradictory. For example, a writer in the Lancet for February 4, 1888, summarizing the accounts of experi- mental studies by Bradford (Journal of Physi- ology, viii, 2) and Pinet, says that ulexine seems to have a special action on the respiration, paralyzing the vagus somewhat like curare; on the other hand, Bocquillon-Limousin speaks of it as producing spasms, and yet as being antidotal to strychnine. There is general agreement, however, that it is a diuretic of very prompt action, and it is said to have been em- ployed with decided advantage in cases of car- diac dropsy. The diuretic dose of the nitrate is from fa to fa of a grain. ULMUS (U. S. Ph.), or slippery-elm bark, the bark of Ulmus fulva, is extensively used as a demulcent in conditions in which it is proper to render the urine as mild and unirri- tating as possible, and to a certain extent in dysentery and diarrhea, but is of little or no value in these latter states. It also forms the basis of a useful poultice, as it retains its warmth and moisture for a considerable time, more especially when in a powdered state. When it is in this last condition a mucilagin- ous decoction may be made, which, if sweetened and flavoured with lemon-juice, forms an agree- able demulcent drink, useful to allay the irri- tation of the throat in pharyngitis, etc. The mucilage, mucilago ulmi (U. S. Ph.), is made with about 6 parts of the bark and 100 ULYPTOL URANIUM 338 of water, and is the usual form in which this substance is administered. It is sometimes used externally to allay the irritation of various inflammatory cutaneous affections. Russell II. Nevins. ULYPTOL.—See Eulyptol. UNGUENTS.—See Ointments. URAL, CCl,.CH:OH.NHCOa.CaH. = C6H8 OsNCl3, is a drug with reputed hypnotic power, made by mixing urethane and chloral. It occurs in white crystals or prisms, and is freely soluble in alcohol and ether, very sparingly soluble in water. Its melting point is 106° F. Burned on platinum foil, it leaves no ash. It volatilizes without decomposition. Boiled with water, it decomposes into chloral and urethane. Ural is bitter in taste. Its effects on the car- diac apparatus and on the blood-pressure seem to be trifling, and but one case of poisoning by the drug is recorded. In general, its influence is said to be similar to that of somnal. Ural has been used chiefly in Italy, and since its in- troduction, in 1889, it seems to have dropped out of use. Since 1890 there is no record of it in literature. Poppi, who experimented principally with ural, came to the conclusion that its use was indicated principally in the insomnia of chronic heart disease, in that of functional and organic mental disease, and in nervous conditions in general. The drug is probably inferior to trional, and seems to possess little or no sedative action in combination with its hypnotic power. Administered in doses of from i to 1 drachm, it induces sleep in about half an hour. In the case of poisoning recorded it produced symp- toms similar to those of chloral depression. Samuel M. Brickner. URALINE, URALIUM, URALUM.— See Ural. URANIUM.—Professor Kobert,of Dorpat, states that all the soluble and absorbable salts of this metal are violent poisons, more danger- ous even than arsenic, half a milligramme of the trioxide to each kilogramme of an animal's weight being surely fatal. Among the earliest symptoms of poisoning is glycosuria; then fol- low severe gastroenteritis, a nephritis not un- like that of scarlet fever, and haemorrhages into the heart and the liver; finally, in case death is escaped, there are the gravest disturb- ances of nutrition and excessive emaciation. Kobert sustains Woroschilsky's statements that uranium must be regarded as poisonous to protoplasm and destructive to every living tissue, even destroying the vitality of the blood. There is no known antagonist to uranium; hence its use as a medicine should be under- taken and carried out with extreme caution, for the symptoms of poisoning are insidious. In theiance^for June 13,1874. there was pub- lished a brief account of a case of diabetes melli- tus treated with uranium nitrate. It occurred in Mr. Kennedy's service at the West Ham, Stratford, and South Essex Dispensary, and the notes were furnished by the house surgeon. Mr. R. J. Carey. The patient was a girl, seventeen years old, in whom the disease was well marked. For a fortnight she was treated with tincture of chloride of iron: and then for a little over two weeks more with tincture of opium. She lost ground all this time, and uranium nitrate was then ordered, at first ^ of a grain, gradually increased to twice that amount, three times a day. In a week she was decidedly improved, and seems from the report to have been cured a little later. The account closes as follows: " Many may doubt if the nitrate of uranium had anything to do with the patient's recovery, but, as some cases of rapid cure and many of permanent pallia- tion of this disease by the use of this drug have been recorded, it is to be hoped that practitioners of large experience will properly test its value in cases of diabetes mellitus." In spite of occasional allusions to its remedial action in diabetes, however, uranium did not receive much attention until its use as a remedy for diabetes mellitus was revived by Dr. Samuel West.of London, who called to mind the investi- gations of uranium in its physiological and toxi- cological relations by Leconte, Chittenden, Lambert, Woroschilskv, and others. In 1895 and again in 1896 Dr. West brought the subject before the British Medical Association. In his first paper (British Medical Journal, August 24, 1895) he credits an English homoeopathic physician, Dr. Hughes, with having suggested the use of uranium in diabetes on the strength of Leconte's announcement, in 1851, that the prolonged administration of it in small doses caused glycosuria in dogs. Chittenden and Lambert's experiments showed, said Dr. West, that even in small quantities uranium and its salts had an inhibitory influence on amylolytic and proteolytic action, so that a few drops of a one-per-cent. solution of the nitrate prevented the action of ptyalin, and a rather larger quantity that of pepsin and trypsin. The ex- planation which they gave, of this action was that nitrate of uranium formed in combination with albumin a more or less constant and indi- gestible compound. When administered by the mouth the drug acted slowly, and small doses seemed to be almost as efficacious as large doses. For instance, they obtained the same effect with \ of a grain as with a grain. Dr. West states that in the uranium treat- ment of diabetes he at first administered the drug in a routine sort of way to a number of diabetic out-patients, with a view of seeing if any obvious action could be traced. He gave small doses at first and gradually increased them, not knowing how much a patient would be able to stand. He found after the drug had been administered a short time only that all the patients without exception stated that their thirst was greatly relieved, and the fre- quency of micturition and the quantity of urine passed greatly reduced. This result seemed very promising, and he then instituted a careful investigation by means of daily ex- aminations of the urine of certain patients whom he took into the wards for that purpose. The first patient he had under observation for more than twelve months, and during that time an almost daily examination of the urine was made, and a careful record kept of the patient's weight, diet, and general condition. The second case had also been under observa- tion for a long time, though not under the close supervision possible with a hospital pa- tient, the lady being a private patient and seen by him from time to time in consultation. In all cases he had tried to place the patient under constant conditions, so that the only difference should be the administration or withholding of the drug. The first case was that of a man, aged twenty-one years, who had complained of thirst, loss of flesh, and frequent micturition for a period of six weeks. The urine was found to be of high specific gravity (P036) and to be loaded with sugar. He was taken into the hospital, kept in bed, and dieted. The effect of this change in his habits of life was shown in the increase for the next few days in the amount of sugar and the amount of urine. The diet and general treatment effected a con- siderable improvement in the patient, so that the percentage of sugar was reduced to six, having been on the man's admission more than eight, and having risen on one occasion to as much as ten. Five pounds in weight had been gained, and the patient appeared and felt very much better. Uranium nitrate was now administered, at first in small quantities—1 and 2 grains three times a day—but this quantity was gradually increased up to 10 or even 20 grains three times a day, when it was found that it could be tolerated by the stomach without disturb- ing the digestion. The first effect noticed was diminution of the amount of urine and of the thirst. The percentage of sugar, however, did not fall materially until the medicine had been taken for more than fourteen days. It then fell to a mean of four per cent., varying, how- ever, from day to day considerably between three per cent, and five per cent. As the im- provement continued, the oscillation became less, and the tendency toward a more or less fixed percentage became marked. The dose of uranium was gradually increased up to 15 grains, and in six weeks there had been an increase in weight of 5 or 6 pounds. The percentage of sugar fell further, and be- came more or less constant, about 3-5, and there was a further decrease in the amount of urine, the quantity averaging between 2 and 3 pints daily, and "the total daily excretion of sugar, which had been as much as 5 ounces, was now under an ounce. The dose of urani- um was now gradually reduced, and about the third week in June the administration was stopped. For a time no change occurred in the patient, but after about ten days the per- centage of sugar again rose, and in the course of a week reached to between five and six ; the quantity of urine, however, was not materially altered. On July 18th the administration of uranium was again begun, but this time not in the form of the nitrate, but as a double chloride of qui- nine and uranium. As the action of this form of the drug was not known, its administration was begun in small doses, and it was not until July 30th that 6 grains had been reached, given three times daily. The smaller doses seemed to have little ef- fect, but as soon as one of 6 grains three times a day was reached, a sudden drop in the amount of urine and the percentage of sugar took place, the percentage falling to about three and the quantity to about 55 ounces. The dose was now increased to 10 grains, and during the month of August sometimes the nitrate and sometimes the double chloride was administered. In the course of September a still further fall gradually took place in the percentage of sugar, until it reached below one, the amount of urine ranging between 40 and 50 ounces. The amount of uranium given was then reduced gradually to 3 grains three times a day, and its use was continued for some time longer; and during the months of October, November, and December there was hardly more than a trace of sugar present, oftentimes considerably under one per cent. In the middle of November toast was per- mitted in the place of gluten bread, the ura- nium being still given in the same doses. This, however, caused no change in the condi- tion of the urine, and appeared to do the pa- tient no harm, so that he was allowed to have an amount of 6 oz. of toast daily, and this he had till Christmas time. He now had gained about 14 pounds. After Christmas time he was found to be not quite so well. The per- centage of sugar was found to be much higher, fluctuating and reaching to nearly six per cent., while the urine was also increased in quantity; the patient had also lost 2 pounds, and looked more ill. Presumably this relapse was due to some error of diet during the Christmas festivities. Ordinary treatment having no obvious effect, and the percentage of sugar still continuing to rise, at the end of a fortnight 5 grains of uranium were given three times a day. This, however, had no effect, and the percentage of sugar still rose, till in the middle of February it once reached as high as nearly ten, though it averaged about eight. The dose of uranium was increased rapidly to 15 grains, but it was not until this amount had been taken for nearly three weeks that its effect was produced, and then—that is to say, about the middle of March—the per- centage fell to about four, and the fall con- tinued until at the end of March the urine contained but very minute traces of it, a great deal below one per cent., and this continued to the end of May, the dose of uranium having some time previously been gradually reduced to 5 grains three times a day, which amount the patient continued to take. At the end of May and during the early part of June the percentage of sugar rose again to between one and two, and finally, when the patient left the hospital, in the middle of June, the percentage was about two, and the daily quantity of urine about 50 ounces. The pa- tient presented none of the symptoms of dia- betes, and he did not look ill. He said he felt well and strong, and left the hospital with the intention of going to work. He did not ap- pear again until October, when he said he had URANIUM been harvesting, living a good deal in the open air and under rough conditions. He came back because he did not feel so well. He had been for about three months without any of the medicine. From October 12th until the 25th the percentage of sugar was a little more than six. Doses of 5 grains of uranium were gn-en, and subsequently doses of 10 grains. By November 30th the percentage of sugar had fallen to a little below four. At Christmas time, probably again in consequence of the festivities of the season, the percentage was as high as eight. Doses of 15 grains of uranium were then given and the percentage of sugar fell rapidly, so that by the end of January it was constantly under two. During the whole time the patient had been regulating his diet so far as he was able to do so. The second case was that of a married woman, forty-five years old, who had been in robust health until about six months before Dr. West saw her, at which time she began to suffer with irritation of the pudenda, fre- quency of micturition, thirst, and loss of flesh. Examination of the urine showed that she was diabetic. She was placed upon a fixed diet and4treated with various drugs. She weighed at the beginning of her illness 129 pounds. The previous treatment had caused consider- able improvement in her general health, and the loss of weight had not continued. Before the uranium was used, analyses of the urine were made, and the quantity averaged about 1.625 cubic centimetres, the specific gravity 1-034, and the percentage of sugar about 2-4. At the end of November the use of uranium nitrate was begun in small doses. One grain was given at first twice daily, and then, a little later, three times a day. The results began to be manifest in the beginning of December, first upon the quantity of urine, which fell considerably, and as the dose was increased the percentage of sugar fell also. In three weeks from the beginning of the treatment the percentage began to fall, and with each in- crease in the medicine the percentage de- creased, until after she had been taking 2 grains three times a day for a week or ten days the percentage was under one. Then 3-J grains were given three times a day, and the percentage fell one half. Four grains were then given, and on January 22d the sugar dis- appeared entirely from the urine. At this time the average amount of urine was 1,300 cubic centimetres, and the specific gravity 1-018. From this date, says Dr. West, sugar was entirely absent from the urine, except on four odd days, until the end of April. The highest amount of sugar present on these odd days was 037 per cent. During May, June, and July traces were present, although in most of the examinations no sugar was found at all; but even when a small amount was found it was usually less than 0-5 per cent., and the highest record was only 0-7 per cent. During all this time 3£ grains of uranium ni- trate were given three times a day. In Sep- tember, although she was still taking the uranium, the percentage of sugar rose, the quantity of urine was also increased and aver- aged about 1,500 cubic centimetres, and the specific gravity was about 1-020. At the same time considerable fluctuations were noticed in the quantity of urine; in the specific gravity, and in the percentage of sugar. This relapse, says Dr. West, was due to experiments in diet and also to the consequence of worry in regard to household affairs. If he had seen her at that time, he says, he would have increased the dose of uranium nitrate. The chief point of difference between this case and the preceding one, says Dr. West, is that small doses of uranium, not exceeding 4 grains, had a marked effect, though in the first case much larger doses were given, and appeared to be necessary. Still, it is quite pos- sible, he thinks, that when the effect is once produced it can be maintained by small doses, and he is inclined to think that, though the drug takes longer to act when given in small quantities, its effect does not depend entirely upon the amount administered each day, but that in some respects, though taking longer to act, the small doses may have almost as effi- cient an action as the larger ones. Professor Chittenden observed that the pro- longed administration of uranium was followed by the presence of albumin in the urine, con- sequent upon an irritant and destructive action on the renal epithelium, but albumin did not appear at any time in the urine in either of Dr. West's cases, and he says he has never observed it in the other cases he has treated with urani- um. Possibly this may be due, he says, to the gradual administration of the drug, and what he has observed would be quite in accord with Professor Chittenden's further statements that if the albuminuria produced by a certain dose was allowed to disappear by suspension of the drug, the drug could then be given again, and the doses increased even to ten times the orig- inal amount before albumin again appeared. This, says Dr. West, would appear to point to the necessity of giving the drug in small amounts at first and increasing them gradu- ally. These cases, taken with others, says Dr. WTest, all point to the conclusion that we have in uranium nitrate a drug which has a power- ful effect upon diabetes. In the first and second cases the amount of sugar was greatly influenced by diet, and it is quite possible, he says, that this drug may be found most useful in this class of cases on account of its physio- logical action upon digestion. That the effect is clearly due to the drug is shown by the fact that when dieting and ordinary treatment have produced all the improvement that is. possible, still further improvement takes place after the administration of the drug. As to its mode of action, he says, we can do nothing but specu- late. He thinks it likely that its action is due to the effect it has in checking the rapid di- gestion of starch and of some forms of albu- min, and that it may perhaps be especially- useful by controlling excessive pancreatic di- gestion. As to the size of the dose, he has given 10, 15, and 20 grains three times a day without gastro-intestinal irritation being produced. 341 URANIUM Something depends, he suggests, upon idio- syncrasy. At the same time he thinks it pos- sible that when the patient has once come under the influence of the drug a reduced dose may be sufficient to keep up its action. In the second case the patient attributed her loss of flesh to the action of the drug. This, says Dr. West, is doubtful, and certainly the first patient continued to gain in weight while taking much larger doses. As regards the salts of uranium, he has used only two—the nitrate and the double chloride of uranium and quinine. So far as he can see, there is no difference in the action of these two salts; still, he suggests that the uranous salts, instead of the uranic which he has been using, may have a different effect. The ni- trate, he thinks, is best given freely diluted with water and after food, beginning with a small dose of 1 or 2 grains twice daily after the chief meals, and increasing the quantity slowly at intervals of a few days until its effect is produced. So given, he has not found it dis- turb digestion or cause any irritation of the stomach or bowels, and he has never found its prolonged administration produce albumi- nuria. In his second communication (British Medi- cal Journal, September 19, 1896; Therapeutic Gazette, September, 1896) Dr. West reported that further experience had confirmed the general statements that he had made the year before, and he gave brief accounts of five more cases. The first one was an instance of acute diabetes in a woman of twenty-two years. On her admission she was passing 10 pints of urine containing eight per cent, of sugar. Af- ter she had been dieted for three weeks in the hospital the amount of urine was reduced to 4 pints and the percentage of sugar from eight to six: but during all this time there were great fluctuations in the amount of urine and in the percentage of sugar, such as were usually seen in bad cases of diabetes. After she had been placed upon the use of uranium nitrate, the doses being gradually increased to 5 grains three times a day, the percentage of sugar had been reduced to four, the patient had greatly improved and gained 10 pounds in weight, and the irregular fluctuations referred to had en- tirely disappeared. On her leaving the hos- pital a short time afterward the percentage had been three and a half and the quantity of urine 3^ pints. She had gone home to the anxieties and work involved in the care of a family of small children, had been unable to continue the dieting, and had, he believed, died not long after. In the second case, that of a woman of forty- four, the patient had been passing 7 pints of urine containing seven per cent, of sugar, with considerable fluctuations between a maximum of 8-3 per cent, and a minimum of 6-5. After her being dieted in The usual way. the percent- age had fallen to 6-8. and then uranium nitrate had been given, with the result that the per- centage fell to 4-6. She had greatly improved in the hospital, and had continued to take the drug some time after she left. The third case was that of a young man, aged twenty-five, with acute diabetes of short duration. He was passing, on admission, 7 pints of urine, with a percentage of between six and seven of sugar. Ordinary diet pro- duced but little effect upon the quantity of urine and not much upon the percentage of sugar. Under the influence of the drug the percentage fell from six to between three and four. Ten grains of the drug were taken three times a day without any inconvenience, the appetite remaining good and the weight in- creasing. Toward the end of his time he was allowed to have from 4 to 6 ounces of bread or toast. The use of the drug was continued, but under this diet the percentage rose only to four and a half—not so much as might have been expected. He had been taking the drug now for a long time as an out-patient, was consider- ably heavier than when he was in the hospital, and was able to do his work well; and al- though under irregular conditions of diet the percentage of sugar was heavier, still he be- lieved the drug was a necessity to him, and he was much better and abler for his work while taking it. The fourth case was that of a man aged fifty —a bad case of only six months' duration. The daily amount of urine was about 5 pints, with six per cent, of sugar. He was dieted as strictly as possible, but could not be got to do without bread. The dose of uranium was in- creased up to 10 grains three times a day, which he took without any inconvenience, and he gained several pounds in weight. Under the combined action of the drug and diet the quantity of urine was reduced about a pint, the specific gravity remaining much the same, and the percentage of sugar fell somewhat. The most marked feature about this case was that the irregular fluctuations, which had been so marked soon after the man's admission into the hospital, entirely disappeared, and the quan- tity of urine and sugar became fairly constant. The last case was that of a private patient, aged forty-one, who had been the subject of diabetes for about four years. In this case the drug had not proved efficient. The patient had never been able to take more than about 3 grains three times a day. and while he was tak- ing the drug the lowest percentage of sugar reached was 2-3. As long as he was under observation the percentage averaged about three before he began to take the drug. Before he came under observation the analyses had been made very irregularly, but it was stated that the percentage had on occasions been lower than this and that on some days sugar had been entirely absent. These statements, how- ever. Dr. West could not vouch for. The drug, in the doses given, seem really to have little or no effect, and, as the indigestion became some- what disturbed, its use ultimately had to be suspended. The failure of the drug in this case might be attributed, he thought, in some degree to the idiosyncrasy of the patient, who was unable to take any'but very small doses, and even those for only"a brief period. Dr. West's general conclusions were the same as those he had expressed the year be- fore, viz.: that we had in uranium nitrate a URETHANE UYA URSI 342 drug of considerable value in the treatment of diabetes mellitus, though, like all other drugs, it could not be relied upon to produce equally good results in all cases indiscriminately. In spite of the fact that Dr. West's patients suffered no harm from the doses that he thought requisite, it does not seem safe, as a rule, to begin with more than 4, of a grain, to be given three times a day. URETHANE, or ethylurethane, or ethyl carbamate, CO(NIL)OC2H5, is a synthetical product which is formed by the interaction of amm'onia and ethyl carbonate or by that of nitrate of urea and ethyl alcohol at from 120° to 130° C. It is alleged by Rademaker to be a constituent of albuminous urine, from which it can be extracted, though never present in normal urine, and it has been suggested by him that the presence of this substance may occasion certain of the symptoms which are present in uraemic poisoning. It occurs in colourless tabular or columnar crystals, which are odourless or have a slight ethereal odour and a taste which resembles that of nitrate of potassium. It readily forms solutions, which are neutral in reaction, with water, alcohol, and many other media. It melts at from 47° to 50° C, and boils almost without decompo- sition between 170° and 180° C, giving off vapours which burn with a blue flame. When an aqueous solution of urethane is treated with nitric or oxalic acid or with nitrate of mercury, if a white precipitate is formed, urea is de- tected to be present. Experimental investigations on the lower animals show that urethane produces a short period of excitement and stimulation of the respiratory and cardiac action, which is fol- lowed by profound sleep during which the respiration again becomes slower. »A fatal dose causes the respiration to become slower, the temperature lowered, motion, and subse- quently sensation, to be lost, the reflexes to be abolished, the unconsciousness to become ab- solute, and the heart's action to grow feeble. Death occurs from asphyxia. In small animals it is said to be an effectual antagonist to the action of strychnine. It has no analgetic power. A careful consideration of the results of these experiments does not yield a thor- oughly satisfactory explanation of the physi- ological action of urethane. It would seem to act directly upon the cerebrum and spinal cord, and possibly upon the entire nervous system. Van Amrep demonstrated that large doses of the drug occasioned a loss of the faradaic sensibility in the cerebral cortex. The lessening of the reflex action appears to be primarily due to its influence on the spinal cord, and it seems to be probable that the ex- citability of the motor and sensory nerves is reduced. Urethane was introduced into medicine as a hypnotic in 1885 by von Jaksch. It is quite mild in its action, and seems to be devoid of the dangerously poisonous qualities which characterize the more powerful hypnotics. The very small amount which has recently ap- peared in literature regarding this drug may perhaps indicate that the conclusion of Dr. Griffith and Dr. Kirby, that it is unreliable and uncertain in its action, has been accepted by the profession and its use to a great extent abandoned, but some observers commend it very highly as a sedative and hypnotic, not only in cases of insomnia from slight causes, but also in functional disturbances and organic diseases of the brain. It is not sufficiently powerful to take the place of sulphonal, paral- dehyde, or chloral in delirium tremens or acute mania, but when the depressant effect of the stronger hypnotics is contra-indicated from any cause, and the insomnia does not depend on such grave conditions, urethane is particularly useful. Demme recommends it as of special value in children, and reports a number of cases thus treated. He gives 4 grains to a child a year old, and believes that larger doses are safe even when the children are weakly, as he has never seen any unpleasant effects from its action. Cases of the successful treatment of tetanus with urethane are recorded. Abbott has re- ported a patient as cured in two days by the ingestion of 9 grains every two hours and 30-J grains at night. It is advisable to give urethane in several small doses, frequently repeated, because a single large dose is apt to induce vomiting. In this manner from 10 to 60 grains may be administered. As it has no irritant action, it can be given hypodermically in doses of from 4 grains upward. Matthias Lanckton Foster. URICEDIN.—This is a German proprietary preparation, a white, granular substance freely soluble in water, of a slightly acid reaction, said to consist of 67 per cent, of sodium citrate, 27-5 per cent, of sodium sulphate, 1-6 per cent, of sodium chloride, and 1*9 per cent. of lithium citrate. It is used in the treatment of gout and the uric-acid diathesis, in daily amounts of from 15 to 30 grains. Large doses, from 3 to 5 drachms, may cause diar- rhoea. UROPHERINE. — This is lithio-theo- bromine salicylate, C7H7N402Li + C6H4(OH) COOLi, being an analogue of diuretin, which is sodio-theobromine salicylate (q. v.). It is a white powder soluble in water. It is used as a diuretic in doses of fifteen grains. UROTROPINE.—Dr. Arthur Nicolaier, of Gottingen, has given this name to hexamethyl- enetetramine, a compound formed by the ac- tion of formaldehyde on ammonia, because he has observed various changes in the urine un- der its use. In the Deutsche medicinische Wochenschrift for August 22, 1895 (New York Medical Journal, October 19,1895), there is an article by him on the therapeutical use of uro- tropine. He says that under the influence of the remedy diuresis is increased; that uric acid and sedimentary urates, previously pres- ent in large quantities, no longer appear; and that the disappearance of these deposits is not a mere consequence of the increased diuresis, but is due to the direct action of the remedy on the uric acid and its salts. These experi- URETHANE 343 UVA URSI mental results, he thinks, have demonstrated that urotropine may be employed not only as a diuretic, but in the treatment of the iiric- acid diathesis and the various morbid condi- tions dependent upon it. His further experiments show that the rem- edy is especially adapted to the treatment of uric-acid calculi, for after the ingestion of urotropine the urine, without any change oc- curring in its acid reaction, gains certain properties that make it a uric-acid solvent. Thus, if an adult whose urine does not dissolve uric-acid concretions even after several days' retention in the culture oven is given suffi- ciently large doses of the drug, it is found that within twenty-four hours the urine begins to dissolve such calculi placed in it, and kept at a temperature of 98-6° F., and that this goes on until after several days only the organic albuminous framework of the stone is left. The urine loses its uric-acid solvent properties as soon as the urotropine is all excreted. Further researches have shown that the in- creased diuresis may be absent in certain cases, also that, while doses of 120 and even 150 grains may be borne by adults, yet in certain cases, for some unknown reason, the continued use for lengthy periods of time of daily doses amounting to only 90 grains occasionally causes unpleasant symptoms which call for a decrease in the size of the dose. Several patients that had taken urotropine in large doses for a time began to complain of a sensation of burning in the vesical region, generally after urinat- ing; these pains radiated along the urethra, and were sometimes accompanied with an in- creased desire to micturate. The urinary ex- amination in these cases showed only a mod- erate amount of transitional epithelium and no other abnormal constituents. If in spite of these symptoms the use of the remedy was persisted in in the same doses, the trouble in- creased in severity, and occasionally red blood- corpuscles appeared in the sediment. All these troubles disappeared, however, as soon as the dose of urotropine was diminished or its use was discontinued entirely, and the urine soon returned to its normal state. From daily doses of less than 30 grains the author has never seen any ill effects, no matter how long their use was continued. Occasionally, how- ever, he has found small quantities of transi- tional epithelium in the sediment even then. He therefore now limits the doses to from 15 to 22 grains daily, that amount being taken at once, in the morning, dissolved in water. Nicolaier noticed that the urine of patients that were taking from 45 to 90 grains of uro- tropine remained clear and retained its acid reaction at a temperature of 98-6° F., even when a few drops of urine in a state of ammo- niacal fermentation were added to it. Several specimens of such urine he has kept for months in the oven, without ammoniacal decomposi- tion setting in. Even after inoculation with pure cultures of the Bacterium coli commune such urine remained sterile at 98'6 F. The same thing happened with the urine of persons who were taking daily doses of 15 or even 7^ grains. These observations have convinced him that the use of urotropine hinders the de- velopment of micro-organisms, such as the bacteria of the ammoniacal decomposition of urine and the Bacterium coli commune, which latter, he remarks, is a factor in many of the bacterial diseases of the urinary passages. The results of his experiments in this direction show, in his opinion, that the drug ought to be employed in these morbid conditions. He has used urotropine in two cases of cystitis in which the urine was strongly ammoniacal, and found it quickly efficacious. In cases in which the urine was acid he has not found it ef- fective. Dr. J. A. Flexner (American Practitioner and News, December 28, 1895) says that alkaline and putrid urine containing mucus in excess, pus and pus organisms, uric acid, or amor- phous urates, are rapidly restored by it to a normal appearance and an acid reaction. The urine is sterilized and increased in quantity, and calculi and deposits are dissolved. He concludes that urotropine is a most valuable resource in suppurations of the urinary tract and in gouty and rheumatic conditions where an active eliminant of uric acid and its salts is indicated. A further valuable property of urotropine, he thinks, is its faculty of combin- ing readily with salicylic acid and forming a soluble combination. A solution containing from 10 to 15 grains each of urotropine and salicylic acid to the fluid ounce of water or other suitable vehicle has the further advan- tage over the salicylates alone that its taste is not disagreeable. It appears, he adds, to be far less irritant to the gastric mucous mem- brane than solutions of salicylic acid usually are, and he thinks the combination promises to have a wide range of therapeutic usefulness. URTICA.—The common stinging nettle, Urtica dioica, has been recommended as a diuretic and hemostatic, especially for check- ing uterine hemorrhage. A decoction made in the proportion of 1 part of the herb to 16 parts of water may be given in doses of 4 fl. oz. three times a day. There is a non-official fluid ex- tract the dose of which is £ fl. drachm. Urtica (or Pilea) pumila, the bastard nettle, has been found efficacious in the treatment of rhus poisoning (see vol. ii, page 132). USTILAGO MAIDIS. — See Ergot of maize (vol. i, page 389). UV.33.—Grapes. See Grape cure. UVA URSI (U. S. Ph.), uve ursi folia (Br. Ph.), folia uve ursi (Ger. Ph).—The leaves of Arcto&taphylos uva ursi, or bearberry, a shrub widely distributed throughout the higher parts of the temperate zones, are astringent and di- uretic, resembling buchu in their action, al- though inferior to it. It is also somewhat tonic and is indicated in chronic cystitis, gleet, the later stages of diarrhea, and pyelitis, but is hardly active enough to take the place of other diuretics when there is ascites. Its prop- erties are believed to be due to a crystalline bodv, arbutin, which maybe substituted for the leaves in doses of from 5 to 10 grains. The leaves themselves may be given in doses of from 50 to 60 grains. The dose of the infusion, in- fusum uve ursi (Br. Ph.), is from 1 to 2 fl. oz. An unofficial decoction made in the proportion of 1 part of the leaves to 16 parts of water may be employed in doses as large as 2 fl. oz. The extract, extractum uve ursi (U. S. Ph.). and the fluid extract, extractum uve ursi fluidum (U. S. Ph.), may be given respectively in doses of from 20 to 60 grains and from 30 to 60 min- ims.—Russell H. Nevins. VACCINIUM.—Several species of this typical genus of the Vacciniacee have been used in medicine. The berries of Vaccinium Arctostaphylos, or Oriental whortleberry, Vac- cinium corymbosum (or discomorphum), or the common blueberry, Vaccinium frondosum, or the American blue whortleberry,and Vaccinium Myrtillus (or nigrum), or the English whortle- berry, were formerly used as a mild astringent in diarrhea and inflammatory affections of the throat, also as a hemostatic. Winternitz (cited by Hare, Medical Annual, 1893) has found those of Vaccinium Myrtillus efficient in the treatment ef leucoplakia buccalis, as well as in various other affections of the mouth, chiefly in the form of a concentrated decoction. The berries of Vaccinium Oxycoccus, or the cranberry, have been employed as an astringent, detersive, antiscorbutic, and refrigerant. The leaves of Vaccinium Vitis idea, the red whortleberry or red bilberry, have long been used by the Russian peasants, who call the plant brousinka, as a remedy for rheumatism. Dr. T. T. Hermann (British Medical Journal, April 19, 1892) has used it in the form of a decoction or infusion of 1 part of the fresh herb, with the roots, to 8 parts of the colature (from 2 to 3 tumblerfuls being given daily) in an obstinate case of chronic articular rheuma- tism, in which all the usual methods of treat- ment had failed. A striking improvement followed in a few weeks, and in two months the patient, an old man, was practically cured. S. P. Smirnoff, of Cronstadt (Meditzinskia Prebavlenia K'Morskomii Sporniku, Decem- ber, 1891 [cited in the same number of the British Medical Journal]), next tried the sub- stance on nine patients, sailors and soldiers aged from twenty-two to twenty-seven, of whom six were suffering from acute and three from chron- ic articular rheumatism. In all of them the treatment was begun after all ordinary means, including the use of salicylate of sodium, iodide of sodium or potassium, hot baths, local applications of tincture of iodine, turpentine oil. belladonna, mercurial or iodide-of-potas- sium ointment, etc., had proved quite ineffica- cious. The remedy was used in the form of a decoction, prepared from 1 or 2 oz. of the fresh stems, with the leaves and roots, in 6 oz. of water, and this amount was given daily in divided doses. The duration of the treatment varied from a week to three months. Of the nine patients, seven were cured, while in the re- maining two the remedy failed (in one after a week's course, in the other after three months). In ail the cases a slight increase of the daily quan „y of urine was observed, and in the patients in whom catarrhal diarrhoea was present that complication quickly ceased un- der the influence of the decoction. Smirnoff sums up as follows: 1. The results obtained by him must be regarded as exceedingly favourable. 2. The red-bilberry treatment deserves a further extensive trial. 3. The method is extremely simple, convenient, harm- less, and cheap (in Russia the red bilberry is one of the commonest of plants). 4. It is advisable to continue the use of the decoction for some time after the complete disappearance of all symptoms, since in one case, which had been cured in five weeks, a relapse occurred three months and a half later. 5. It is useful to combine the internal treatment with local applications of anodynes and counter-irritants. The decoction forms a cinnamon-brown, some- what turbid fluid, with a slightly bitter and astringent taste and a neutral reaction. As the author's analysis has shown, the decoction contains vaccinin, tannic acid, ex- tractive, proteid, and mucoid substances, etc. Vaccinin, discovered by Classen in 1865, is a glucoside occurring in the form of white, minute, acicular crystals, which are easily soluble in water but much less soluble in ether, and almost insoluble in alcohol. The glucoside is. not identical with arbutin, for the latter is soluble in alcohol and gives a green reaction with perchloride of iron, while vaccinin, when treated with the salt, assumes a cherry-red colour. VALERIAN, Valeriana (U. S. Ph.), valeri- ane rhizoma (Br. Ph.), radix valeriane (Ger. Ph.), consists of the rhizome and rootlets of Valeriana officinalis, an herbaceous perennial plant indigenous to Europe and northern Asia. It is cultivated to some extent in this country for use in medicine, but it is said that the roots of the cultivated plants contain a smaller proportion of the volatile oil than those of the wild plants. The roots which grow in a dry soil are smaller but contain a larger proportion of the oil than those from damp situations. When freshly gathered, the root has only a slight fragrance, but as it dries it develops a peculiar odour, which becomes stronger and more unpleasant with the lapse of time. The taste is at first sweetish, but later it becomes unpleasant, camphoraceous, and somewhat bitter. Its colour externally is yellowish or brown, internally white, and when the root is reduced to a powder yellowish gray. Its ac- tive principles are soluble in both" water and alcohol. The most important derivative of valerian is its volatile or essential oil, which may be obtained in proportions that vary from 0-5 to 2 per cent. This is a complex substance which, when freshly distilled, is light-greenish or yel- lowish in colour and of a neutral reaction. Changes are induced by age and exposure to the air which cause it to become of a browner or more deeply yellow colour, and to acquire a strong odour and an acid reaction. These changes are due to oxidation, which results in the formation of certain products, the chief of VACCINIUM 345 VALERIAN which are a hydrocarbon or terpene, v>,„H,e, called valerin, vuleren, or valerene; a camphor- aceous substance known as valerol, Ci2H20O ; and valerianic acid, C5Hi0O2. A serious con- fusion of terms has unfortunately been occa- sioned by the application of the name valerene to two other hydrocarbons as well as to that derived from oil of valerian. One of these hydrocarbons, known also as amylene, C5Hi0, is formed by the interaction of phosphoric oxide and ainylic alcohol; the other, Ci0H8, is obtained from Borneo camphor, and is also called borneene. The chemical formulae show that these are not identical with the valerene obtained from oil of valerian, which is a ter- pene. Valerol appears to be composed of a cam- phor, with resin and water, a mixture which readily beomes oxidized on exposure to the air into valerianic acid. Valerianic acid is a colourless, oily, volatile fluid with a very strong odour and a sour, burning, and disagreeable taste. It is soluble in 30 parts of cold water, freely soluble in alcohol, ether, or strong acetic acid, and is a solvent for camphor and some resins. It was first obtained by Chevreul from the oil of the dolphin, and received at that time the name of delphinic acid. This name was afterward changed to the one it now bears when Pentz found it in valerian. It has also been obtained from viburnum, sambucus, and other plants, as well as from organic products of animal life. But it is largely made in the laboratory by the oxidation of amylic alcohol. This last product seems to be chemically identical with the natural acid, but it is alleged that the valerianates made with it do not produce the same physiological effects as those made from acid obtained from valerian. Valerianic acid is found as an oxidation product in both the oil and the root of valerian, the amount increasing with age and exposure. It is a disagreeable irritant, and does not pos- sess the calmative properties of the oil or of the fresh root. From Reissner's experiments we learn that it coagulates albumin, blood serum, and milk, and that it is slightly irritat- ing to the skin. It increases the rapidity of the heart's action, and weakens it and the respiration as well. It causes weakness, mus- cular paralysis, convulsions, and death. If death is quickly produced, the gastric mucous membrane will be found to be pale; but if the duration of the intoxication is prolonged, the mucous membrane of the whole intestinal tract will be found to be inflamed, the kidneys con- gested, the urine turbid and bloody. The characteristic odour is not imparted to the urine or the blood, but it can be detected in the peritoneal cavity. The acid is not itself used in medicine, but several of its salts, the valerianates, are in use and will be described. In addition to these constituents of valerian, Waliszewski has isolated two alkaloids which have been named valerine and chatinine. Valerian seems to act very gently as a gen- eral stimulant, but its principal action is as a sedative upon the nervous system, to reduce its irritability, both direct and reflex. It thus acts as an antispasmodic in a similar manner to that of asafcetida, musk, lavender, and other drugs of this class. It does not produce any narcotic effects. In small quantities valerian excites a sensation of warmth in the stomach, and acts as a tonic by improving the appetite and digestion. According to Bouchard, the amount of urea excreted is diminished. The usual medicinal doses may irritate the digestive tract, so as not to act as a tonic but to cause gastro-intestinal disturbance. The pulse is also usually accelerated. Larger but yet me- dicinal doses increase the action of the heart, raise the temperature, and in many persons produce exhilaration, sometimes a slight men- tal disturbance, with formication of the hands and feet. Very large doses produce dizziness, hallucinations, diplopia, and active delirium with reduced motility, sensibility, and reflex excitability. Such quantities also cause nau- sea, vomiting, hiccough, diarrhoea, frequent micturition, and tenesmus, together with an increased flow of urine, which contains an abnormally large quantity of urates and lith- ates. The blood-pressure, as well as the pulse- rate, is lowered by the paralyzing effect of the drug upon the nerve-centres. When used for a long time valerian is apt to cause a condition of depression and melancholy. It is excreted by the kidneys, which are stimulated by it, and also by the lungs and skin. It may cause death in small animals, but is not sufficiently powerful to kill a man. Cats are notably very fond of valerian. It greatly excites their sexual appetite, and finally produces in them violent convulsions. The range of the therapeusis of valerian is quite small, as it is confined to cases of irregu- lar nervous action which do not depend upon a demonstrable lesion or upon inflammation. It quiets nervous excitement, and is a valuable remedy to give temporary relief in all forms of hysteria. In hystero-epilepsy it is sometimes of great benefit, but in true epilepsy it is sel- dom, if ever, of any use, unless in rare cases of petit mal. It relieves nervous headache, and acts as a hypnotic in insomnia of hysterical origin. It is rarely, but occasionally, of some benefit in chorea. It has proved a valuable agent to relieve the nervous disturbances inci- dent to the menopause, the nervous phenomena of exophthalmic goitre, and also pruritus of neurotic origin. It has been successfully em- ployed to relieve flatulence in infants, as well as that of hysterical and hypochondriacal sub- jects, and is useful in the nervous disorders dependent upon intestinal parasites in chil- dren. It has proved efficient in cough of nervous origin, including whooping-cough, especially in the convulsions and other neurotic troubles which result from them, in delirium with depression, and in the coma of typhus fever. It has been recommended in diabetes mellitus and insipidus, but does not induce any lasting improvement. In its action va- lerian antagonizes strychnine, brucine, and thebaine, and to the extent of its power is antidotal to those poisons. The infusion, infusum valeriane (Br. Ph.), may be given in doses of from 1 to 2 fl. oz. VALERIANIC ACID VAPOURS 346 The dose of the tincture, tinctura valeriane (U. S. Ph., Br. Ph., Ger. Ph.), is from 1 to 2 fl. drachms; that of the ammoniated tincture, tinctura valeriane ammoniata (U. S. Ph., Br. Ph.), is from 4 to 1 fl. drachm; that of the ethereal tincture, tinctura valeriane etherea (Ger. Ph.), and that of the fluid extract, extrac- tum valeriane fluidum (U. S. Ph.). are the same. The best preparation to employ is the oil, which may be given in doses of from 2 to 5 minims in cinnamon water and mucilage. The nauseous taste of the tinctures renders them undesirable. The ammoniated tincture is more useful than the simple tincture, be- cause it combines with the antispasmodic action of valerian the stimulant and carmin- ative effects of ammonia. The Valerianates.—The salts of valerianic acid are used in medicine to a slight extent. As a rule, their therapeutic value is not great and their effects correspond with those of the bases rather than with those of valerian. Ammonium. Valerianate.—This is the most valuable of these salts and the only one used at all extensively. It occurs in colourless or white quadrangular plates which emit the odour of valerianic acid and possess a sharp, sweetish taste. It effloresces in dry and deli- quesces in damp air. It readily forms solutions in water, in alcohol, and in ether which are neutral in reaction, hut become acid from the evaporation of ammonia. When the solution is dispensed this acidity, if present, should ba neutralized by the addition of a little ammo- nia, which is also useful to somewhat mask the disagreeable odour and taste of the vale- rianic acid. It is probable that small doses of this salt stimulate the functions of the spinal cord and that large ones depress them, but not to such a degree as to render the drug dangerous. It is useful in the same class of cases as valerian— that is, in mild, functional nervous derange- ments, such as certain forms of neuralgia, headache, insomnia, and palpitation of the heart. Valerianate of ammonium was introduced as a therapeutic agent in 1856 by M. Declat, who used a preparation known as Pierlot's solution, made by dissolving 1 drachm of vale- rianic acid in 32 drachms of distilled water, saturating the solution with carbonate of am- monium and adding to the salt thus formed 40 grains of an alcoholic extract of valerian in order to prevent its rapid decomposition. This solution is neutral, is brown in colour, and has a strong valerianic odour. From 6 to 30 drops are given, in water or on a lump of sugar. The dose of the salt as prepared at the pres- ent time is from 2 to 10 grains, which may be given in a pill or in water. The most elegant and the usual mode of dispensing it is in the form of the elixir of the valerianate of ammo- nium, 1 drachm of which contains 2 grains of the salt. Amyl Valerianate.—See vol. i, page 62. Bismuth Valerianate is a non-official, white, amorphous powder, insoluble in water or alcohol, and with a strong odour of vale- rianic? acid. Whatever therapeutic value this salt may possess is probably due to the bismuth alone. Caffeine Valerianate was tried by Paret in 1875 in hysteria, It appeared to act as a general stimulant and was sometimes success- fully employed to moderate nervous vomiting and to mitigate the paroxysms of whooping- cough, given in 2-grain pills three times a day. Antipyrine Valerianate.—This salt has a strong valerianic odour. It is used for the same purposes and in the same doses as anti- pyrine. [Atropine Valerianate.—See vol. i. page 157. Cerium Valerianate.—This is a yellowish- white powder which has been employed by Blondeau, in daily amounts of 1£ grain, in the treatment of the vomiting of pregnancy, in which it may perhaps have some advantage over cerium oxalate. Creosote Valerianate.—Dr. E. Grawitz (TherapeutischeMonatshefte, July, 1896; Wien- er klinische Rundschau, August 23, 1896) has found this preparation, which is a valerianic- acid ester of creosote, advantageous where creosote is indicated, for the following rea- sons : 1. Being odourless and tasteless, it is readily taken. 2. Adminstered even in large doses, it seldom gives rise to digestive dis- turbances. 3. It is comparatively cheap. It comes in the form of gelatin capsules each containing about 3 grains. One capsule a day is enough to begin with, but the number may be increased until from six to nine are taken daily.] Iron Valerianate is a dark brick-red amorphous powder, of uncertain chemical composition, which is permanent in dry air and has slightly the odour and taste of vale- rianic acid. It is insoluble in water, soluble in alcohol. It should be kept in small, well- stoppered phials, in a cool and dark place. This salt was originally proposed for use in a class of cases which combined a condition of chlorosis or anemia with hysterical symptoms, but very little if any advantage is gained by the addition of the valerianic acid, while several other preparations of iron are preferable for administration. The usual dose is 1 or 2 grains several times a day. Morphine Valerianate is a non-official salt which has been used in attempts to obtain the desired physiological effects of morphine without the accompanying disagreeable effects, but these attempts have not been attended with any marked success. Quinine Valerianate.—This salt occurs in white or nearly white, pearlv, lustrous, tri- clinic crystals which have a "slight odour of valerianic acid, a bitter taste, and a neutral reaction. It is soluble in 100 parts of water and 5 of alcohol at 59° F., in 40 parts of boil- ing water, and 1 part of boiling alcohol. It is also slightly soluble in ether. It should be kept in well-stoppered bottles. The aqueous so- lution is neutral or very slightly alkaline and not stable. It is recommended in doses of 1 or 2 grains three or more times a day in cer- tain nervous disorders, but it is not so efficient VALERIANIC ACID 847 VAPOURS as the combination of the sulphate of quinine with oil of valerian in cases in which quinine and valerian are both indicated. Goodell has recommended for certain cases of hysteria and nervousness a combination of the three valerianates of ammonium, iron, and quinine, \\ grain of each, made into a pill, three times a day. Sodium Valerianate is a non-official salt which acts in a very similar manner to the valerianate of ammonium, but much less effi- ciently. It may be used in slight functional derangements of the nervous system in doses of from 1 to 5 grains. Zinc Valerianate.—This salt occurs in soft, white, pearly scales, not deliquescent, with a slight odour of valerianic acid, and a sweet, styptic or metallic taste. It is soluble in about* 100 parts of water and in 40 of alco- hol, both solutions becoming turbid on boiling. This salt was introduced into medicine with the idea of combining the peculiar virtues of zinc and valerian so as to form a particularly valuable remedy for various nervous disorders, but it has failed to realize the expectations it excited. It has been tried in quite a number of diseases, but has not proved very effective in any. It is sometimes of use in" doses of from \ to 3 grains in mild forms of neuralgia, and it is said to give relief in incontinence of urine from a neurotic cause. [In the British Medical Journal for April 18, 1896, Dr. Peter H. Abercrombie, of the Central London Throat, Nose, and Ear Hospi- tal, reported a case of well-marked hay fever in which the administration of valerianate of zinc was followed by a cure, to all intents and purposes. The patient, a strong, healthy man, aged thirty-two years, consulted Dr. Aber- crombie early in 1893, when it was learned that he had first suffered from symptoms of the disease when he was sixteen years of age, and ever since had suffered regularly every sum- mer, with greater or less severity according to the weather. The attacks began about the middle of June and lasted about three weeks or a month, the duration of the seizures de- pending on the dryness of the summer. Some- times the attacks were so severe as to incapacitate him for business and to require confinement within doors. When he was at the seaside or in town there were never any symptoms or signs of the disease. He had two business offices, one in a large commercial city in Scot- land, and the other in a large town some seven miles distant. Between these two places he had to travel at least twice a day. The coun- try through which the railway ran consisted mainly of fields, many of which in summer time contained hav, grasses, etc. It frequently happened that he left one station feeling per- fectly well, but had an attack in the train when passing the fields, which disappeared by the time he reached the other station. Prior to the employment of the treatment suggested by Dr. Abercrombie, the only remedies used had been local. These had sometimes relieved the symptoms, but only for a very short time. The patient had been advised to go to the seaside. There was a history of nervous affections in 66 his family, and the patient himself was dis- tinctly neurotic. This led Dr. Abercrombie to prescribe valerianate of zinc as a nerve tonic. Early in 1893 he prescribed: 1. Three-grain pills of zinc valerianate, one to be taken three times a day, after meals, and this treatment to be begun a full month before the onset of the at- tack was expected and continued for at least two months. 2. As local palliative measures, if required, a 5-per-cent. solution of cocaine hydrochloride for spraying the nose and throat, and a snuff of bismuth, morphine, etc. The patient went to the seaside that summer, but in 1894 and 1895 he remained inland, followed the treatment laid down for him. and escaped the disease.]—Matthias Lanckton Foster. VALERIANIC ACID.—See under Vale- rian and Viburnum Prunifolium. VALEROL.—See under Valerian. VALZIN—See Dulcin. VANILLA (U. S. Ph.), fructus vanille (Ger. Ph.), is probably destitute of any medi- cinal properties and is only used as a flavour- ing agent. Cases of poisoning have been as- cribed to it, but it is probable that the active agents have been one or another of the ptomaine group derived from the decomposition of the food flavoured with it. Russell H. Nevins. VANILLIC ALDEHYDE, VANIL- LIN, C6H3OH.OCHs.CHO, an odorous prin- ciple found in vanilla pods, is a colourless substance soluble in 8 parts of water. It is chiefly used as a flavouring agent, but is occa- sionally given as a stomachic in dyspepsia, in daily amounts of from £ to 3 grains. VAPOURS.—Vapours, also called inhala- tions, are fumes more or less charged with medicinal agents, which are volatilized by spontaneous evaporation, or by heat, or by a current of gas or air. They may be divided into dry and moist vapours. Dry Vapours.—These are derived from the evaporation of substances readily volatilizing at the ordinary temperature. Substances of this nature are acetic ether, ethyl iodide, amyl nitrite, compound spirit of ether, ammoniacal preparations, ethereal tinctures, etc. These are inhaled either from the phials in which they are contained or from gauze, a handker- chief, or other medium to which portions of them are applied. Less volatile substances may be combined with more volatile ones. Thus, camphor may be dissolved in ether or alcohol. The same may be done with volatile oils, iodine, and bromine. Instead of ether or alcohol, some other volatile liquid, itself pos- sessing desirable medicinal properties, such as chloroform, bromoform, etc., may be used. If the vapour given out by such a combination is too strong for the air-passages, the prepara- tion may be suitably diluted or the vapour may be drawn through a layer of cotton. Among the dry vapours may also be classed the inhalation of vapours of anaesthetic agents, such as ether, chloroform, nitrous-oxide gas, etc. The former are always administered so that a certain amount of air may reach the lungs of VARNISHES VASOGEN 348 the patient. Recently a new method of ad- ministering these agents has been introduced, which consists in passing a current of oxygen gas through the liquids and making the patient inhale the gaseous mixture thus produced. Moist Vapours.—These may be cold or warm (even hot). Vapour of hot water alone is often beneficial. Usually the medicinal sub- stance, which must be volatilizable by the vapour of water, is dissolved in or added to the water in a suitable inhalation apparatus, and air drawn through it for breathing. In this way creosote, eucalyptol, fir-wood oil, and similar agents are usually administered. Chlo- rine gas is generally inhaled from a mixture of chlorinated lime with a suitable quantity of cold water. Inhalation of hydrocyanic acid is directed by the Br. Ph. to be effected from a solution of from 10 to 15 minims of the offi- cial 2-per-cent. acid in 1 fl. oz. of cold water; inhalation of iodine, according to the same authority, by adding 1 fl. oz. of tincture of iodine to 1 fl. oz. of water, gently heating it, and drawing air through it. (See also Inhala- tion and under Insufflation [vol. i, page 533].)—Charles Rice. VARNISHES.—These are preparations designed for topical application in the form of liquids which dry more or less rapidly and so form a coating over the part. Apart from collodion and solutions of gutta-percha, celloi- din, and celluloid, the varnishes now in use are mostly preparations devised by Dr. P. G. Unna, of Hamburg, consisting chiefly of traga- canth. Recently Dr. Unna has improved them by the addition of gelatin, forming a mixture which he calls "gelanth," or " gelan- thum," "an almost ideal watery varnish." Dr. Unna (British Medical Journal, October 17, 1896) says, after two years' experience in the use of gelanth, that he had long known that all the familiar watery varnishes had many disadvantages, of which the most important were want of activity and an insufficient distri- bution of the drugs they contained. But the simple and cleanly application, and the cheap- ness of these varnishes, led him to continue their use in suitable cases—namely, for slight superficial erythema and eczema, with skins which did not stand fat well, and with patients who objected to grease. The watery varnishes were a necessary evil, he says, though one could not prescribe them with absolute confi- dence in serious cases of skin diseases. The greatest technical defect of all watery var- nishes, and especially those of tragacanth, is that the insoluble drugs, such as zinc oxide, sulphur, and chrysarobin, do not remain sus- pended, but are deposited on the surface in a gradually hardening layer. But if one so in- creases the amount of tragacanth that the power of suspension of the swollen mass is sufficient to keep heavy powders in permanent suspension, we get a porridgy, lumpy mass, which can not be evenly mixed with medica- ments. These are indeed better suspended, but they are badly distributed. On the other hand, says Unna, there is in a strong gelatin solution an ideal power of sus- I pension and one of fine distribution of the medicaments at the same time. But this, mixed with the tragacanth, would give to the latter the undesirable quality of being capa- ble of being spread only when warm. If, however, a very small proportion of gelatin is added, up to 2-5 per cent., and at the same time, by moderate overheating, the gelatin has its power of gelatinizing diminished, a mass is obtained which only feebly gelatinizes, but can be spread in a very thin, uniform layer upon the skin, and at the same time preserves its quality of finest distribution of the drug. Certainly it does not possess the power of sus- pension of the stronger solution of gelatin, he adds, but this is supplied by the other con- stituent, tragacanth. Equal parts of each provide a vehicle of a new character, in which the insoluble medicaments are both distributed as finely as possible and permanently sus- pended. By the admixture of gelatin the tragacanth gains not only the power of reduc- ing all drugs to a very fine distribution, but also a second advantage—namely, the rapid drying to an absolutely smooth and not in the least sticky covering. This quality is espe- cially important for the incorporation of hy- groscopic material, such as ichthyol, in watery varnishes. As the physical properties of the gelatin help those of the tragacanth, says Unna, so do those of the tragacanth aid those of the gela- tin. The overheated gelatin would alone not provide a good varnish, for it would have be- come almost fluid. The drugs suspended in it, though evenly mixed, would be distributed irregularly along with the almost fluid gelatin. Like the ink on paper and the artist's colours on canvas, the gelatin which is to be spread on the skin needs something to give it body re- sistance, and this is supplied in an excellent manner by the swollen tragacanth. Although it has taken up a considerable amount of water, the gum still has the resistance of a stiff paste, and is therefore very well qualified to give to the gelatin the necessary body. Bv the addi- tion of the tragacanth the gelatin gains a fur- ther advantage not so readily foreseen, but one which has proved far more important than the former. On the envelopment of every particle of gelatin by the tragacanth probably" depends, says Dr. Unna, the remarkable compatibility and the indifference of the gelanthum to large amounts of those drugs which can not be used with a simple gelatin solution, such as salicylic acid, resorcin, corrosive sublimate, etc. The power of incorporation of the gelanthum with the most varied drugs, which it owes entirely to the tragacanth, is extreme. It may be mixed with 50 per cent, of ichthyol, 40 per cent, of salicylic acid, resorcin, and pyrogallol, up to 5 per cent, of carbolic acid and 1 per cent, of corrosive sublimate without influenc- ing its value as a varnish. Two incompatible bodies, such as salicylic acid and oxide of zinc, or ichthyol and salts, substances which com- bine in a watery solution, or precipitate, re- main in gelanthum without any mutual action Gelanthum thus lends itself to the use of sev- eral remedies together. To this possibility of - VARNISHES 349 VASOGEN combining large amounts of the most active medicaments gelanthum owes also a degree of activity previously unknown in watery var- nishes. With the addition of from 10 to 20 per cent, of salicylic acid to any desired medi- cine (chrysarobin, pyrogallol, resorcin, or tar), gelanthum treatment, says Dr. Unna, may be applied with all its advantages of cleanliness, circumscribed action on the diseased areas only, drying, and cheapness, in severe cases of psoriasis and dry eczema with marked thick- ening of the epidermis. Where much grease is not required, as in many eczemas of the hand, excessively dry skin, fissures, etc., he continues, one can replace the ointment with the gelan- thum, which naturally to most patients is very much pleasanter. The mode of preparing gelanthum is de- scribed by Dr. Unna as follows: Pieces of crude tragacanth are emulsified for four weeks in the cold, with twenty times their volume of water. They are then treated with steam for one day, further swollen, and finally pressed through muslin. The gelatin, on the other hand, is swollen up cold, and then filtered in his steam filter, after long exposure to steam pressure, which takes from it part of its power of gelatinizing. The mixture of the two is al- lowed to swell for two days in steam. After being pressed once more through muslin, it is mixed with 5 per cent, of glycerin, some rose water, and 2 parts to 10,000 of thymol, in order to prevent the growth of fungi. Gelan- thum contains about 2-5 percent, of gelatin and tragacanth. Dr. Unna thus sums up the advantages of gelanthum as compared with the older watery varnishes: 1. It may be better spread. 2. It dries more rapidly and with a smoother sur- face. 3. It feels more cooling, on account of the greater amount of water it contains. 4. It keeps the drugs suspended and distributes them more evenly on the skin. 5. It may be combined with drugs, either singly or in com- bination. 6. It permits of the drying of hy- groscopic drugs such as ichthyol. 7. It per- mits of the addition of grease. 8. If protected from drying, it may practically be kept forever. An antiseptic varnish known as adhesol is made, according to Professor Coblentz, of 350 parts of copal resin, 30 of benzoin, 30 of balsam of Tolu, 20 of oil of thyme, 3 of alpha-naphthol, and 1,000 of ether. For Unna's carbolized ichthyol varnish, see under Ichthyol (vol. i, page 523). VASCULAR SEDATIVES, VASCU- LAR STIMULANTS.—See Cardiac stim- ulants, tonics, and depressants. VASELINE.—There are various bland, tasteless, and odourless fatty products of the distillation of petroleum, "all of which are characterized by not becoming rancid. The three chief members of the group, those that are official, are distinguished in accordance with their consistence at ordinary tempera- tures. Liquid vaseline, or cosmoline, petrola- tum liquidum (U. S. Ph.), paraffinum liquidum (Ger. Ph.), is a colourless or slightly yellowish oily liquid. It is employed as a lubricant and as an oily vehicle for certain drugs to be ap- plied in solution, especially in the form of a spray. Soft vaseline, or ordinary vaseline, petrolatum molle (U. S. Ph.), paraffinum molle (Br. Ph.), is a whitish or yellowish greasy sub- stance of about the consistence of lard. Hard vaseline, petrolatum spissum (U. S. Ph.), paraf- finum durum (Br. Ph.), paraffinum solidum (Ger. Ph.), varies somewhat as defined in the different pharmacopoeias. The U. S. Ph. de- scribes it as a fatlike mass of about the con- sistence of a cerate, varying from white to yellowish or yellow; the British and German preparations are paraffin (q. v.). Soft vaseline is the variety almost always meant when one of the other forms is not specified. It is used largely as a base for ointments and as a lubricant. Koster (Therapeutische Monatshefte, June, 1896; Therapeutic Gazette, October, 1896) treats erysipelas by applying vaseline to the affected and surrounding parts twice a day; linen is laid over the vaseline, and a mask is made if the part affected is the face. The dressing is held in place with gauze bandages. In other respects the treatment is symptomatic—with acetanilide or antipyrine for severe headache, and the same remedies, or quinine, when the temperature rises above 100° F. Ice-bags are applied to the head, and laxatives, chloral, digitalis, and alcoholics used as indicated. The advantages of this method are said to be the following: It can be used even upon the hairy scalp; smarting, burning, and disagreeable odours are avoided; and the remedy is cheap. VASELONE.—This is a proprietary oint- ment base said to consist of a solution of stearone and margarone in a neutral mineral oil. It may be used for the same purposes as vaseline. VASOGEN, or oxygenated vaseline, is a new German ointment base said to be vase- line treated with oxygen to such an extent as to contain free oxygen. According to Pro- fessor Coblentz, another statement is that it contains about 25 per cent, of olein saponified with anhydrous ammonia, mixed with vase- line, and brought to a suitable consistence with vaseline oil. As it mixes readily with many drugs that have important topical uses, such as iodoform, creosote, ichthyol, menthol, pyrogallol, chrysarobin, creolin, camphor, etc., and is readily absorbed, it is likely to come into extensive use. Dr. Leistikow (Monatshefte fur praktische Dermatologie, 1895; Annates de dermatologie et de syphiligraphie, April, 1896) has em- ployed iodized vasogen containing 6 per cent. of iodine. In a case of recent secondary syphi- lis a course of frictions with iodized vasogen caused the symptoms to disappear rapidly, but the patient "was seized with violent headache which resisted every remedy, even iodine given internally. Daily frictions of the scalp with 75 grains of the vasogen preparation caused de- cided improvement in three days and a com- plete cure in three weeks. In a woman with extensive nodes of the tibia which had been only slightly improved by frictions the appli- VENESECTION 0 n VERATRUM VIRIDE 350 cation of carbolized mercurial plaster, and iodine given internally, frictions several times a day with iodized vasogen caused their com- plete disappearance in fourteen days. In a case of sciatica, probably of syphilitic origin, also in six cases of ano-genital mucous patches, and a case of pigmentary syphilide of the neck, the iodized vasogen proved efficient. In the case last mentioned other treatment had been ineffectual. In three cases of lupus vul- garis the results of the use of iodized vasogen were absolutely negative. In a case of ulcer- ated gumma cicatrization took place more rap- idly than with any other treatment. Leistikow ascribes the superiority of iodized vasogen over other topical remedies for syphilis to the fact that the absorption of iodine is very rapid. VENESECTION.—See Bloodletting. VERATRINE, veratrina (U. S. Ph., Br. Ph), veratrinum (Ger. Ph.), is the name ap- plied to a mixture of alkaloids obtained from the seeds of Asagrea officinalis, a bulbous plant of the natural order Liliacee, indige- nous to Mexico and Central America. It is a white or grayish-white amorphous or semi- crystalline powder, permanent in the air, odourless, but causing intense irritation and sneezing when even a minute quantity touches the nasal mucous membrane, with an acrid taste, leaving a sensation of tingling and numbness on the tongue. It is very slightly soluble in cold or hot water, is soluble in 3 parts of alcohol at 59° F., in 6 parts of ether, in 2 of chloroform, and very soluble in boiling alcohol. There seems to be considerable doubt in re- gard to the exact chemical constituents of the seeds of the plant, and the name veratrine has been applied to more than one of them. The veratrine of Merck appears to be identical with the cevadine of Wright and Luff, and occurs in anhydrous, transparent needles or compact crystals which effloresce in the air and become opaque, while the veratrine of Wright and Luff is an amorphous, resinous mass obtained from the mother liquor of the preceding by extrac- tion with ether. On account of this uncertain- ty, no further description will be attempted of the constituents of this powder or of the vari- ous alkaloidal substances known by this name. Experiments on the lower animals indicate that the physiological action of the official veratrine is principally upon either the periph- eral nervous system or upon the muscular tis- sue itself. It does not appear to affect the brain, but it excites the voluntary muscles, or possibly their controlling centres in the spinal cord, so as to give rise to tonic tetanic convul- sions, which in some respects resemble those induced by strychnine, and are followed by paralysis and loss of muscular contractility. Death results from the general paralysis in which the muscles of respiration as well as the heart are involved. The heart stops in diastole. After death the muscles are found to have lost their ability to respond to elec- trical stimulation to a very great extent if not entirely. The ingestion of veratrine in man is apt to be provocative of severe vomiting and diar- rhoea, sometimes of diuresis. The force and frequency of the heart's action are reduced in direct proportion as the size of the dose in- creases until it is rapid, irregular, and feeble. The temperature is also reduced. No fatal case of poisoning is on record, but alarming symptoms have followed the ingestion of fa of a grain. In an experiment upon himself, Esche took half a grain of the acetate, and the toxic symptoms which resulted are described as col- lapse, a pale, cold, wet skin, pinched features, a rapid, thready, irregular pulse, with violent vomiting, and marked muscular tremor. When applied to the skin, veratrine excites a sensation of warmth followed by tingling, and may cause an erythema or, less often, a pustular or petechial eruption. When the epithelium has been removed it is a very pow- erful irritant. Upon the mucous membrane it is also very irritating and causes sensations of burning and numbness in addition .to symp- toms characteristic of the membrane irritated, such as salivation from its application to the mucous membrane of the mouth or sneezing when applied in the nose. Veratrine has been used internally in a great variety of diseases, in doses of from fa to fa of a grain, but it has proved unreliable and dan- gerous, and such use has been abandoned. Its ability to reduce the pulse and temperature led to its employment in pneumonia and other febrile diseases, but no advantage was gained from its use, which was necessarily confined to sthenic fevers in robust patients. Dysmenor- rhoea, heart disease, chorioiditis, hysteria, and epilepsy may be mentioned as a few examples of the diseases for which this drug was once prescribed. At present veratrine is employed only for external use, principally as a counter-irritant or as an antiparasitic. As a counter-irritant it has been used in superficial neuralgias, pleurodynia, chronic pleurisy, tic douloureux, and myalgia, as well as chronic enlargement and stiffness of the joints, but it does not present any special advantage over the coun- ter-irritants more commonly in use. As an antiparasitic, it has proved useful in phtheiri- asis, alopecia areata, and aspergillus infec- tion. _ Two other purposes for which veratrine is said to have been used are to promote the nutrition of the muscles in infantile paralysis and, by dentists, to obtund the sensitiveness of dentin. The official preparations of veratrine are the ointment and the oleate. The ointment, un- guentum veratrine (U. S. Ph., Br. Ph.), is com- posed, according to the U. S. Ph., of 4 parts of veratrine, 6 of olive oil, and 90 of benzoinated lard; the Br. Ph. orders 1 part of veratrine, 14 parts of hard paraffin, 41 parts of soft paraffin and 7 parts of olive oil. This ointment is the preparation generally employed, but frequent- ly requires to have its strength reduced before application. It should never be applied to a raw surface, not only on account of the in- tense irritation which it would there produce but also because of the danger of absorption of the drug and consequent poisoning. The VENESECTION 351 VERATRUM VIR1DE oleate, oleatum veratrine (U. S. Ph.), is com- posed of 2 parts of veratrine and 98 of oleic acid. This was intended to take the place of the ointment when inunction rather than counter-irritation was desired, but the value of the drug, except as a counter-irritant or antiparasitic, is at best very doubtful. When the oleate is used care must be taken to avoid the absorption of too large an amount of the drug. Peugnet recommends for the treatment of aspergillus in the ear a solution composed of 2 grains of veratrine, 10 minims of acetic acid, and \ oz. each of rose water and glycerin. Matthias Lanckton Foster. VERATROIDINE. — See under Vera- trum viride. VERATROL, C8H10O2, the dimethyl ether of pyrocatechin, a colourless oil, of an agree- able aromatic odour, that has recently been introduced as an antiseptic. According to Surmont and Vermersch (Gazette medicate de Paris, August 3, 1895), the bacillus of cholera, that of typhoid fever, and that of diphtheria are susceptible to its action, and the bacillus of tuberculosis in human beings does not seem to thrive well in its presence, but the Bacillus pyogenes cyaneus and the Staphylo- coccusp yogenes aureus are less energetically influenced by it. VERATRUM ALBUM. —See Helle- bore, White. VERATRUM NIGRUM.—See Helle- bore, Black. VERATRUM VIRIDE (U. S. Ph.), veratri viridis rhizoma (Br. Ph).—This is the rhizome and roots of Veratrum viride, Ameri- can, or swamp hellebore, Indian poke, or poke root, a large perennial herb which belongs to the natural order Liliac.ee and is indigenous to the Northern United States and Canada. It is found in marshy places, on the borders of damp thickets, and by the sides of small streams as far south as "Georgia. The roots are usu- ally collected in the autumn, after the leaves have fallen, but some doubt has been expressed as to whether they are not equally good if col- lected in the spring, before the flowering season. They deteriorate in quality by the lapse of time and should not be kept more than a year. The root is of a bitter, very persistent and acrid taste, and of a disagreeable odour when fresh, but this disappears in the process of drying. The powdered root is irritating to the skin and mucous membranes and causes sneezing when snuffed, even in very minute quantity, into the nostrils. Historically, there is little to be said in re- gard to this drug. We know that the aborigines were acquainted with its peculiar intoxicating qualities, and some tribes are said to have used it as an ordeal or test of strength and vigour. It was and still is used to some extent by farmers to destroy vermin on plants and bushes, as well as to intoxicate birds which infest planted fields, so as to render them easy to cap- ture. As an antiparasitic and counter-irritant it has yielded place to more satisfactory agents. Its introduction into medicine as a cardiac de- pressant may be said to date from the publica- tion of a paper by Dr. Osgood, in 1835, which was followed by the investigations of Dr. Nor- wood. Since then the drug has been the sub- ject of considerable study, and various analyses of it have been made, with results which are very confusing. Probably several alkaloids are present which are not easily separated from the resin associated with them, and the most satis- factory analysis yet made is that by Wright and Luff, who found the plant to contain jervine, pseudo-jervine, cevadine, a very little rubijer- vine, and traces of veratrine and veratalbine. Some authors adhere to Bullock's analysis, who found two alkaloids, jervine and veratroidine, and in the principal experiments to determine the physiological action of the active principles of this drug these have been employed. These experiments were conducted by Dr. II. C. Wood, and the following descriptions of jervine and veratroidine are largely taken from his work: Jervine is present in larger quantities in Ve- ratrum viride than any other alkaloid, is of a bitter taste, and forms crystallizable salts with acids, but has not yet been employed by itself in medicine. The first symptom produced in one of the lower animals by a dose of jervine is a disposition to be quiet, associated with muscular weakness. Soon rapidly repeated thrills run through the muscles and cause vio- lent trembling. Finally, the animal is unable to stand, and at about this time violent epilep- toid convulsions occur—general clonic spasms without rigidity. These convulsions are lack- ing in force even when most violent, and they continue, growing less severe as the prostration increases and alternating with periods of re- laxation until death. Sensation is not affected until late in the poisoning, when it disappears. Consciousness is preserved to the last. The pupils are not affected. Salivation is profuse, but no vomiting or purging is induced. At first, while the animal is standing quiet- ly the frequency of the pulse is lessened, but the convulsions and sometimes the violent trembling which precede them occasion a change to great rapidity. This effect seems to be due to a direct action of the drug upon the cardiac muscle or ganglia, as well as upon the vaso-motor nerve-centres. The arterial pres- sure is greatly lowered, falling progressively from beginning to end of the poisoning. It is not certain whether the convulsions are in- duced by the irritation of the;motor centres in the brain by the drug, by the accumulation of carbon dioxide in the blood, or by the cerebral anaemia caused by the depressed circulation. Neither the pneumogastric centre, the periph- eral motor nerves, nor the voluntary muscles appear to be affected. Reflex action is dimin- ished and finally abolished. Death results from asphyxia due to cessation of respiration. Very little more is known of the action of rubijervine, when dissociated from the resin with which it is combined in veratroidine, than that it is a circulatory depressant and that it induces vomiting and purging. Veratroidine is more irritating than jervine, causes muscular twitchings or convulsions of VERATRUM VIRIDE 352 less severity, and acts in a similar manner upon the spinal cord. It is a very powerful respira- tory poison. Its action upon the circulation and upon the pneumogastrics is very peculiar. Wood says: " After a hypodermic injection of the poison the rapidity of the pulse and the arte- rial pressure are at first decidedly lessened. After a time, the pulse still remaining very slow, the individual heart-beats become en- dowed with a force greatly beyond normal, and the arterial pressure becomes normal; then suddenly the pulse-rate becomes very rapid, the individual cardiac beats losing much of their extraordinary vigour, but the arterial pressure rising nearly 50 per cent, beyond its original position." These effects would seem to be produced by the primary stimulation of the cardiac inhibitory apparatus—whether of the controlling centre or not is uncertain—fol- lowed by the results of irritation of the vaso- motor centres by the accumulation of carbon dioxide in the blood induced by paralysis of the respiratory centre. The latter appears to be the occasion of the great rise of blood-pressure, as the drug does not seem to have any influence over the vaso-motor nerves. " It is a powerful respiratory poison, lessening at first the fre- quency of the cardiac beat by stimulating the pneumogastrics, but soon losing all control over the heart, owing to the powerful influ- ences which the induced asphyxia exerts." Small doses of veratroidine stimulate the car- diac inhibitory apparatus, while larger ones paralyze it, according to Professor Wood's ob- servations. The resin which remains after the extraction of the alkaloids is somewhat irritating to the gastro-intestinal tract. The physiological action of veratrum viride is that of a powerful spinal and circulatory de- pressant. To quote Wood once more: " In full therapeutic doses it lowers the pulse-rate both by direct action on the muscle (jervine), and by stimulating the inhibitory nerves (vera- troidine) : it diminishes the force of the heart- beat by a direct influence on the cardiac mus- cle (jervine) and produces a general vaso-motor paralysis (jervine)." When small doses of veratrum viride are given, the force of the heart is lessened, the rate is at first not affected, but later becomes slow, and the pulse is soft and moderately full. This condition persists while the body remains perfectly quiet, but the slightest exertion is apt to cause the pulse to become very rapid, small, and even imperceptible. This is asso- ciated with great muscular weakness, lowered temperature, nausea, and vomiting, but rarely with catharsis. In this respect it usually ex- hibits a marked difference from its near rela- tive, veratrum album. Sometimes it occasions the appearance of an erythematous or pustular eruption on the skin. The rapid and feeble condition of the pulse precedes the nausea, which is also occasionally absent, and is there- fore not dependent on the gastric disturbance. Larger doses induce a greater intensity of the symptoms, which become very alarming. The condition now is one of collapse characterized by an almost imperceptible pulse, a cold, clam- my skin, incessant retching, absolute muscular prostration, giddiness, loss of vision, mydriasis, and semiconsciousness. Reflex action is im- paired, but sensation is not affected. Excre- tion is indirectly increased by the relaxation of the tissues, but there is probably no direct in- terference with this function. In spite of the very formidable symptoms, death very rarely occurs from poisoning with veratrum viride. Recovery after the ingestion of an ounce of the tincture has been reported, and recently Dr. J. B. Tuttle recorded a case in which four teaspoonfu Is were taken, instead of four drops, within an hour, with no worse re- sult than severe vomiting, pallor, and prostra- tion. The prompt emesis and the consequent removal of the unabsorbed drug probably fur- nish the correct explanation of such cases. Death has occurred a few times. In cases of poisoning the head should, if possible, be placed on a lower plane than the rest of the body, and heat should be applied externally while strych- nine, atropine, and other stimulants are ad- ministered internally. Opinions differ very widely in regard to the therapeutic value of this drug. One author asserts that it is the safest and best circulatory depressant which we have for adults, while an- other maintains that it is seldom useful, but almost always harmful. The beneficial power which it exerts has been ascribed to its seda- tive action on the nervous system, but the weight of evidence is in favour of the view that it depends upon its action on the circula- tion. It is not a drug to be recommended or used blindly in certain pathological or inflam- matory conditions. When used in that man- ner, it is apt to be worse than useless, but when used judiciously in the proper indicatory con- ditions, veratrum viride is of great value. It is frequently of good service during the earliest stage of many parenchymatous and serous inflammations—i. e., during the stage of congestion or hyperaemia—particularly when they occur in sthenic subjects. Thus, its em- ployment is often advantageous in pneumonia, pleurisy, hepatitis, and other acute inflamma- tions of the viscera, but as soon as this early stage is passed it is not only useless but con- tra-indicated. It should not be used in gastri- tis, peritonitis, or other visceral inflammation where the vomiting it is apt to provoke is like- ly to do harm, unless it is combined with other drugs which will correct this tendency to eme- sis. It has been recommended to prevent or ameliorate the severity of inflammations which result from injuries of the abdomen. Small doses frequently repeated, especially when combined with morphine, often deter- mine resolution in amygdalitis. Its ability to moderate the force of the circulation is some- times made use of to aid in checking hemor- rhage and to favour the formation of a clot in an aneurysm. In the .latter case the patient must be kept in a recumbent posture and on a proper regimen, while the dose given should be small and its effect carefully watched. In the abnormal cardiac tension of renal disease and in acute mania veratrum viride is often of good service. In puerperal eclampsia excel- 353 VERATRUM VIRIDE lent results have been reported from the use of very large doses. It is highly esteemed in hypertrophy and irritability of the heart, but it must never be used when there are valvular lesions, dilatation, or a weak or fatty condition of the cardiac muscle. The indications for its use in heart diseases nearly correspond to the contra-indications for digitalis. Successful re- sults have been reported from its use in exoph- thalmic goitre. Formerly it was used to a considerable extent as an antipyretic in rheu- matism, but this use has become almost if not quite obsolete. A case of persistent priapism which had re- sisted treatment with a large number of other drugs, but finally succumbed to veratrum vi- ride, is reported by Walker. The use of this drug is contra-indicated in all conditions which are characterized by adynamia, depression, or exhaustion. Thus, its use is inadmissible in typhoid fever and in delirium tremens, although in some cases of cerebral irritation from drink, in which a strong bounding pulse is present, it may per- haps be of service. The official preparations are the tincture and the fluid extract. A non-official saturated tincture, known as Norwood's, is sometimes used. For the purpose of reducing the sever- ity of an incipient inflammation one or two drops of either the official tincture, tinctura veratri viridis (U. S. Ph., Br. Ph.), or the fluid extract, extractum veratri viridis fluidum (U. S. Ph.), every half hour for two or three hours, are usually about the requisite doses. Its use should be maintained only until the skin is moist and relaxed and the pulse slower, or till there is slight nausea. In the cardiac troubles in which it is indicated 5 drops three times a day are usually sufficient. In puer- peral eclampsia such large doses have been rec- ommended as half a drachm every fifteen minutes till vomiting is produced or the con- vulsions cease. [To combat the vascular excitement of puer- peral phlebitis, the late Dr. Fordyce Barker preferred veratrum viride to all other drugs (Puerperal Diseases, New York, 1874). He says: " I meet with many who have a great fear of the veratrum viride, because it some- times produces the appearance of dangerous collapse. But this is a very temporary condi- tion, which, so far as I have heard, has never terminated disastrously. The appearance of one who has taken too much veratrum viride is almost precisely like that produced by to- bacco in those unaccustomed to its use. I have often seen this, but now, when I do, it causes no alarm, as I am sure that the effects will soon pass off." He adds that there is no objection to assisting reaction in such cases by carbonate of ammonium or small quantities of some alcoholic stimulant. In a small percent- age of cases, he says, it is quite apt to cause nausea, but this is readily counteracted by giving it in combination with tincture of gin- ger. As to its positive effects, he says that one can by it absolutely and certainly control the frequency of the pulse of inflammation and of irritation, but of course if it will ac- complish this, one would not expect to reduce the rapid pulse of exhaustion, as found in the last stages of phthisis or in typhus fever. Dr. Barker remarks that the use of veratrum viride is not incompatible with that of stimu- lants. He alludes to a case in which the vera- trum viride did not seem to produce any effect on the pulse, which remained constantly above 130, until the condition of the patient was such that he decided to give brandy. After the first ounce had been given the pulse fell to 108; after the second, to 86. The use of brandy was continued and that of the veratrum viride was suspended for a few hours, and the pulse again rose to 130. After this, if the use of either agent was suspended, the pulse would rapidly increase in frequency, while under the combined influence of the two it was kept be- low 80. Another of his patients, who recov- ered, took an ounce of brandy and from 3 to 10 drops of the tincture of veratrum viride every hour for two days, the quantity of the veratrum viride being regulated by the fre- quency of the pulse, which was never allowed to rise above 80, although it sometimes fell to 40. The directions which he generally gave to his house staff in Bellevue Hospital were, to begin the use of the veratrum viride at once, and, carefully watching its effects, bring the pulse down to 80 and hold it there. After the specific effect of the veratrum is once produced, he says, it can be kept up by very much di- minished doses. In puerperal peritonitis also Dr. Barker re- lied on veratrum to reduce vascular excitement. He says: " I regard it as very important to al- lay vascular excitement, as this necessarily leads to a rapid depression of the vital forces. Our predecessors resorted to venesection to accom- plish this, but the general experience of the profession led to the universal abandonment of this practice, as it was found that in this dis- ease it involved absolute loss of vital power. But in the veratrum viride we have an agent which reduces vascular excitement without real loss of vital power. There is a positive distinction between depression of the vital forces and absolute loss of power." In con- junction with the use of morphine, he thought it well in puerperal peritonitis to gradually reduce the frequency of the pulse by the use of tincture of veratrum viride, beginning with 5 drops with each dose of morphine. By care- fully watching the effects, and graduating the doses short of provoking vomiting, one may, he says, bring the pulse down to 70 or SO, and then one should endeavour to hold it there. Even if vomiting does come on, and, for a time, the patient seems almost in a state of collapse, this condition need excite no alarm, as it lasts but a short time, and the pulse is effectually reduced in frequency, sometimes to 30 or 40 a minute. He has seen this occur a hundred times at least, he says, and the greatest evil resulting from it is the alarm and excitement which it causes to the friends and attendants. It is therefore desirable to avoid this explosion, so to speak, of the action of veratrum viride, if possible. If the pulse has once been reduced, VERATRUM VIRIDE 354 according to Dr. Barker, 3 drops, 2 drops, or even 1 drop, may be found sufficient to con- trol it. Veratrum viride has been extensively used in the United States, especially in the South, in the treatment of puerperal convulsions. In the Medical Record for September 7,1889, Dr. Richard Cole Newton, of Montclair, N. J., says that twenty-eight years before, Dr. Cut- ler, of Jersey City, stated in the New Jersey Academy of Medicine that he had been in practice twenty-five years, and that during that time he had seen on an average eight cases of puerperal convulsions a year, in his own practice and in consultation, that he had never lost a case, and that in treating this complaint he relied upon veratrum viride. Dr. Love, who was present and heard these remarks, and shortly afterward had his atten- tion called by the late Dr. Isaac Nichols, of Newark, to the use of benzoic acid in the treat- ment of the albuminuria of pregnancy, put the hints dropped by these men together, and concluded to treat his next case of eclampsia with veratrum viride and benzoic acid. Dr. Love has had in all twenty-three cases, and he reports twenty-three recoveries. The last case was that of a primipara twen- ty-three years of age. Her urine was highly albuminous on April 30th. In spite of treat- ment, by May 15th her water had diminished to less than five ounces per diem. It resembled pea soup in appearance, and when boiled with nitric acid it promptly solidified. She then fell into convulsions and had six in twenty- four hours. During this time she remained totally unconscious. As it was difficult to make her swallow, and as the veratrum viride given by the mouth was vomited, 8 minims of Norwood's tincture were given hypodermically, but this also produced vomiting. This amount was, however, injected under the skin every hour until five or six doses had been given. The benzoic acid was also given every four hours. Dr. Love says that, in his experience, within twenty-one days after the first spasm labour will come on, and that the foetus is generally dead. Only two children in his twenty-three cases survived. His plan of treatment, says Dr. Newton, was as follows: Give 3 drops of Norwood's tincture (a freshly prepared portion) and repeat it in an hour; then 2 drops every hour or two until the patient experiences a cordlike feeling in the neck. If the nurse is not sufficiently intelligent or conscientious, the physician must give the veratrum viride him- self. The benzoic acid is given in the follow- ing prescription, which is taken from Ellis's Formulary: B Benzoic acid.................< 2 dr.; Potassium bicarbonate.........i oz.; Spirit of nitrous ether.......... 1 fl. oz.; Solution of ammonium acetate.. 2 fl. oz.; Syrup of lemon, enough to make 6 fl. oz. M. S.: A tablespoonful every four hours. In a letter published in the New York Medi- cal Journal for December 14,1895, called forth by a discussion to be mentioned presently, Dr. Newton recurs to the subject, and says that, if it seems to be indicated, a large dose of calomel is given at first, and its action may be aided by large warm enemata. If the bladder is full and does not empty itself when the bowels act, the water is drawn. The point upon which Dr. Love strenuously insists, and upon which he disagrees with the weight of authority, is ab- solute non-interference with the contents of the uterus, so far, at least, as the convulsions are concerned. He denies that emptying the uterus stops the convulsions, and affirms that where the nervous system is already so poisoned that death from shock is imminent, any further strain upon the thread of life, already stretched nearly to the utmost, is an unjustifiable and needless risk. In certain cases he would not hesitate to bleed, but considers this, as a rule, quite unnecessary. For the immediate control of the spasms he would use chloroform if he thought it indicated. When the accoucheur is called to a woman in puerperal convulsions, says Dr. Newton, he should occupy himself entirely with the control of these phenomena and with the elimination of the materies morbi so far as practicable. There is no need to bring on labour or to take special pains to accelerate it. If the nervous erethism can be controlled and the kidneys and skin made to act, Nature will deliver the pa- tient sooner or later. If the convulsions come on before labour, Dr. Love controls them and lets the uterus and its contents entirely alone. Dr. Newton concurs with Dr. Love in assert- ing that there is no use whatever in emptying the womb; the procedure, he says, adds infi- nitely to the woman's danger and does not strike at the root of the evil. The convulsions may be a concomitant of labour or they may occur long before, and in some cases have ap- peared a number of days after delivery. They generally occur at the time of labour because the poisoned and weakened nervous system is called upon for a great expenditure of force, and it is bad practice to increase the strain upon the vital powers of a human being already almost in extremis. It is generally admitted, says Dr. Newton, that pregnancy is a serious complication of the acute infectious diseases, like diphtheria or typhoid fever. Yet no one has suggested that this element of danger can be removed by bringing on labour. On the contrary, if labour does come on the case at once assumes a more serious aspect, and so the indication is to do all in our power to prevent the advent of la- bour. It may be said that, inasmuch as the strain of labour brings on the convulsions, if the labour can be concluded the exciting cause of the eclampsia will be removed. This is un- questionably true. But the acceleration of la- bour adds immeasurably to the risk, whereas its retardation will give the economy more time, with the aid of proper remedies, to put itself in a condition to safely undergo the strain of delivery. At a meeting of the Society of Alumni of Bellevue Hospital held on October 2, 1895 (New York Medical Journal, November 23, 1895), Dr. Charles Clifford Barrows reported 355 VERATRUM VIRIDE two cases of puerperal convulsions in which he had employed veratrum viride—in one case in conjunction with Duhrssen's incisions of the cervix uteri, and in the other with accouche- ment force. Each of the patients had had sev- eral convulsive seizures after the uterus had been emptied. The delivery in each case had not been followed by any urinary secretion until after the administration of the veratrum, when it had become very copious, and the pa- tient had immediately begun to improve. Dr. Barrows mentioned another case of eclampsia occurring six hours after delivery, with total suppression of urine. The usual remedies, in- cluding the free use of nitroglycerin, had been tried without success, and the patient had seemed in a fair way to die at the time he had first seen her. Under the hypodermic use of veratrum, however, the kidneys had begun to act at once, and the patient had shortly become conscious, there had been no more convulsions, and she had made an excellent recovery. In the discussion which followed (which called forth Dr. Newton's letter, already re- ferred to) Dr. J. Clifton Edgar said he did not believe any drug, except possibly chloroform, was of as much value as veratrum viride in eclampsia. He had not dared to use it in cases in which the pulse was intermittent or soft, but he had employed it freely in those where the pulse had been tense and rapid. The ac- tion of the veratrum viride on the skin should not be overlooked. This was almost as prompt as its action upon the heart and kidneys, and by the free excretion through the skin the kid- neys were greatly relieved. This, in his opin- ion, was much better than exciting the skin to action by using the hot-air bath. Dr. Mann had cited before the American Gynaecological Society a case in which a teaspoonful of the plain tincture of veratrum viride had been given by mistake, and yet the woman had sur- vived. Dr. Edgar said he recalled a case in which he firmly believed the life of the patient had been saved solely by the veratrum viride. The plain tincture had been given hypoder- mically in 10-minim doses until the pulse had been reduced to sixty, and this had been con- tinued until the pulse had shown a disposition to remain at this point without the help of the drug. Dr. W. J. Chandler, of South Orange, New Jersey, said that the use of veratrum viride in cases of puerperal convulsions had many years ago been a common treatment in the Orange Memorial Hospital. At one time a brother practitioner had told him that he was treating cases of puerperal eclampsia with teaspoonful doses of Norwood's tincture, and that all the patients recovered. This physician had also said that he was not at all afraid of this heroic treatment, because if the patient received too much of the drug it would at once be rejected by the stomach. Influenced by this statement, Dr. ('handler had decided to try the method. In 1879 he had been called to see a woman who had had convulsions before delivery. When he first saw her, after delivery, the convulsions were present, and she was somewhat maniacal. As she was unable to swallow, 25 minims of Norwood's tincture were given hypodermically. About an hour afterward he was hastily sum- moned to the bedside, and found the respira- tions reduced to four and the pulse to forty. As the drug had been given subcutaneously, of course no relief could be expected from vomit- ing, as was usually the case. Under stimula- tion and appropriate treatment the woman eventually recovered. In this case the excre- tion of urine had been increased, and the skin had been bathed in perspiration. This action of the drug he had noticed in all these cases. Since this time he had often used the drug very freely by the mouth, but he would warn against usin? it hypodermically. Dr. F. K. Willis, of Watkins, Kansas (Medi- cal News, March 28, 1890), records his favour- able experience in the treatment of puerperal convulsions with veratrum viride. He says it not only arrests convulsions, but in several cases in his hands it has prevented them when threatened. No patient, he says, has suffered eclamptic convulsions who came to him com- plaining of headache and nervousness and pre- senting some oedema, a full, hard pulse, etc. In this class of cases, 5 minims of the fluid extract should be given two or three times daily, ac- cording to the urgency of the case. When paroxysms occur, he always administers hypo- dermically 15 minims at once, and in half an hour 5 minims more if necessary. It may be necessary to continue the administration for twenty-four hours or longer to prevent recurrence. Generally speaking, the pulse should be held at 50 or 60 for a day or two. In conjunction with gelsemium, veratrum viride has been used with success in the treat- ment of traumatic tetanus by Dr. Fordyce Grin- nell, of Pasadena, California (Medical News, July 18, 1896). The case was that of a boy, six years old, who, while barefoot, cut the ball of his left foot on a piece of glass. The wound apparently healed. Some nine days after (on April 14th) he complained of stiff jaws and difficulty in swallowing. These symptoms in- creased until, on the night of the 16th, tetanic spasms began to manifest themselves. The cicatrix of the wound was cleaned and scraped. It seemed somewhat tender on pressure, but no foreign body was discovered. The site was scarified, however, and turpentine and oil were applied, and 4-grain doses of ammonium bro- mide were given every two hours. As no perceptible improvement was noted, on the 17th Norwood's tincture of veratrum viride was given, at first a drop every hour, then 2 drops every hour. As this did not seem to prevent the return of the spasms from time to time, fluid extract of gelsemium was given, at first in drop doses every hour, in conjunc- tion with the veratrum, then in 2-drop doses, and finally in 3-drop doses. The dose of vera- trum was also increased on the 20th to 3 drops every hour, so that the child was taking 3 drop's each of the veratrum viride and the gel- semium every hour, and it seemed to require this amount to control the spasms. These doses were continued for forty-eight hours. Only once during this time did they produce VERBASCUM VIBURNUM PRUNIF0L1UM 356 active vomiting or sufficient nausea to require an opiate to control it. When this relaxed condition was obtained, the drops were de- creased to 2 of each preparation on the 22d, and on the 25th to 1 of each, which was con- tinued until the 27th, when the interval was lengthened to two hours, and gradually there- after the doses were discontinued. The ammonium bromide was given in 3- to 4- grain doses every two hours during this entire period. The use of the remedies in diminished doses was continued to the 30th of April, when the boy could open his mouth without diffi- culty, had a good appetite, and was playful, but "more boisterous in his manner than usual, or, as his mother said, " more nervous." The instructions had been to decrease the amount and frequency of the doses when distinct signs of nausea appeared or the signs of convulsions abated. Dr. Grinnell says that he was led to try veratrum on account of its value in puer- peral and other convulsions, and gelsemium by reason of its action in causing relaxation of the muscles of the jaw.] Matthias Lanckton Foster, VERBASCUM.—Several species of mul- lein have been used in medicine, but chiefly the Verbascum Thapsus. Under the name of flores verbasci, the Ger. Ph. recognises the flowers of Verbascum phlomoides and Verbas- cum thapsiforme. A decoction made in the proportion of an ounce of the flowers to a pint of water may be taken in doses of from 3 to 5 fl. oz. as a demulcent and astringent in diar- rhea. The leaves are occasionally smoked to allay the paroxysms of asthma. VERDIGRIS.—See Cupric acetate (vol. i, page 303). VERNONIA. — Several species of this genus, the iron-weed, have been used to some extent in medicine. Vernonia anthelminthica is the oil-plant, or kinka, or khatzum, of the East Indies. The bitter seeds are used as a stomachic, and the fat obtained from them is said to be a powerful anthelminthic. Vernonia nigritiana, a species found in western Africa, is said to act upon the heart like digitalis, but more feebly. Vernonia has not come suffi- ciently into use to justify positive statements as to its medicinal value. VESICANTS, VESICATORIES. — See Blisters. VIBURNUM OPULUS (U. S. Ph.).— This caprifoliaceous plant, known as cramp bark, is a large shrub which is found through- out the north temperate zone. It grows on low grounds. The bark, which is the part used in medi- cine, is tough and has a bitter and slightly astringent taste. It contains a volatile oil, tannin, an acid, and a bitter principle, vi- burnin. Cramp bark has been recommended as an antispasmodic in asthma, and has been used in hysteria and in puerperal and other forms of compulsions. It has also been employed in the treatment of neuralgia and dysmenorrhea. Its medicinal value has not been established, and it is now but little used in medicine. The principal preparation is the fluid extract, ex- tractum viburni opuli fluidum (U. S. Ph.), the dose of which is from 15 minims to a fl. drachm. The berries of viburnum opulus are antiscorbutic.—Charles Jewett. VIBURNUM PRUNIFOLIUM (U. S. Ph.), or black haw, is a tall shrub indigenous to the middle and southern portions of the United States east of the Mississippi River. Closely allied to it are the Viburnum obovatum of the Southern United States and the Viburnum Lantana of Europe. The bark, which is the part used in medicine, has a bitter, astringent taste, but no odour. It contains valerianic, tannic, oxalic, citric, and malic acids, a brown- ish resinous principle, and a greenish-yellow resin, viburnin. Viburnum prunifolium is an astringent, diuretic, nervine, and antispasmodic. In the lower animals, toxic doses cause progressive muscular weakness and finally paralysis. In warm-blooded animals it is a vaso-motor relax- ant, lowering the arterial pressure. Viburnum prunifolium is much employed as a uterine sedative. It appears to inhibit uter- ine contractions and to diminish hyperemia of the pelvic organs. It is useful therefore in the prophylaxis of abortion, for the pallia- tive treatment of dysmenorrhea, especially of the spasmodic variety, and in menorrhagia and metrorrhagia, While less effective than opium for the control of uterine expulsive efforts, it has the advantage of freedom from the un- pleasant after-effects of the latter drug. It is a remedy of some value for the relief of after- pains. In dysmenorrhoeal and in certain forms of intermenstrual pain it is frequently com- bined with Jamaica dogwood or with cannabis indica; in menorrhagia, with golden seal. [Dr. Theodore Shennan (Edinburgh Medical Journal, November, 1876 ; New York Medical Journal, November 21, 1896) says that Dr. Phares, of Newtonia, Mississippi, has the credit of initiating the use of viburnum prunifolium. His paper, published in 1866, recommended it as astringent, diuretic, tonic, and antispas- modic, but chiefly as a remedy for dysmenor- rhea and as a preventive of abortion. Little more was heard of it until 1876, when Dr. Jenks, of Detroit, revived its use. He em- ployed it in menorrhagia, metrorrhagia, and dysmenorrhea with menorrhagia. He attrib- uted a great deal of its value to the presence of a body similar to valerianic acid. Rockwell, in 1879, used it in dysmenorrhoea. He considered it was indicated in delicate, nervous women in whom pain was due to slight anteflexion, slight endotrachelitis, or partial stenosis, or where it was neuralgic in character. He classed it as anodyne, anti- spasmodic and tonic. The last term is very indefinite, Dr. Shennan thinks, though in one of his cases he noticed a relief of nausea or sick- ness which followed the administration of vi- burnum. Abbot, in 1879, used it in dysmenorrhoea with great success, as also Curtis (1879) and Lyman. VERBASCUM 357 VIBURNUM PRUNIFOLIUM Chadwick, in 1879, found it gave relief in many cases, but success was not invariable, or so brilliant as previous papers had led him to expect. Its action was similar but not superior to that of zinc valerianate. Dr. R. L. Payne read a paper on Viburnum prunifolium before the Medical Society of North Carolina in 1888. This, says Dr. Shen- nan, is one of the few papers which treat the subject scientifically, and describe experiments carried out on the lower animals. Dr. Payne refers to the literature of viburnum, and the want of definite rules for its use. He experi- mented with the ordinary alcoholic liquid ex- tract; or with the solid extract rubbed up with water, with the view of getting rid of the vitiating effects of the alcohol contained in the fluid extract. He found that both had a simi- lar effect. His results were as follows: Pa- ralysis and loss of reflex motion, both with mechanical and with chemical stimuli. He got reactions with electrical stimuli—whether faradaic or galvanic is not stated—one pole to the spine, the other to the limb. He gave as much as half an ounce of the fluid extract to rabbits, and the amount of alcohol contained must undoubtedly have had an effect on the tra- cing. Dr. Shennan thinks that his experi- ments on rabbits prove this. In rabbits (the solid extract being used, rubbed up with water) the blood-pressure was found to fall very rap- idly after the injection of a syringeful into the jugular vein. Here, Dr. Shennan thinks, evi- dently no care had been taken to make the fluid neutral or slightly alkaline, and the resins, which are present in considerable quan- tity, were not removed before injection. Dr. Payne's tracings show a marked effect on the blood-pressure, but at parts suggest, by the weakness of the heart curves, that there may have been some clotting in the cannulae. There was evidently no balancing of pressure in the vessels by use of a column of mercury, and, as the blood was thus allowed to pass for some distance into the tube leading to the re- cording apparatus, the tendency was for it to clot. Dr. Shennan states that he has found this clotting to be very troublesome in his own experiments. Dr. Payne concluded that there was no effect on sensibility. The chief action was on mo- tion, paralysis, loss of voluntary motion, loss of reflex power, the extent being governed en- tirely by the amount of the drug used. The pupils contracted in cold-blooded animals and did not change in warm-blooded animals. Muscular irritability was lost after lethal doses, but nerve conduction was lost before muscular contractility. Probably the action was chiefly on the spinal cord and its posterior columns. The heart was quick and feeble in its action, and the blood-pressure lowered ; in lethal doses the heart stopped before respiration. Dr. Payne recommended the use of vibur- num in diseases with increased excitability of the motor centres—in hysteria, in hystero-epi- lepsy, in petit mal, in paralysis agitans, and in the dysmenorrha'a sometimes designated as ovarian or spasmodic. He asserted that it was harmful in menorrhagia due to congestion of the portal circulation, subinvolution of the uterus, metritis, erosions of the cervix, and fibroid tumours. It was preventive of abortion and very useful in habitual abortion. It had a paralyzing action on the uterus. Dr. J. Hinton, of Detroit, in 1889. applied it for the control of false pains, and even of labour pains. He has never observed post-partum haemorrhage or severe after-pains when using this drug. Joseph, of Landeck, in Silesia, recommends viburnum very strongly in virginal dysmenor- rhea. He used it in'two cases of habitual abortion, in which he was unsuccessful; but he does not consider this a sufficient trial. Of the forms of dysmenorrhea, according to Joseph, that is most relieved which is brought about by mechanical obstruction—for example, congenital or acquired anteflexion, as opposed to congestive dysmenorrhoea, which is more common in married women. The amount of the flux was diminished, and sank to normal; moreover, the remedy changed the interrupted course to one more continuous. He recom- mends it as an antispasmodic, and not only in uterine or intestinal colic, but also in other conditions of cramp, such as that of voluntary muscles. Dr. Boal prefers viburnum to opium in many cases, as it is more easily borne and is readily retained by the stomach. It is very beneficial in spasmodic dysmenorrhoea, and gives relief when dysmenorrhoea is due to flexion or to stenosis. It relieves pain pre- ceding and during menstruation. Even if this one action was proved, says the author, and it was able to take the place of opium or alcohol, viburnum would be very serviceable. Blackerby used it in habitual abortion, and cites a very conclusive case. A patient of his had had six abortions. Viburnum was admin- istered during the seventh pregnancy, which went to term and ended in the birth of a liv- ing child. The eighth pregnancy had a simi- lar result under the same treatment. Many other cases, says Dr. Shennan. have been re- lated in which relief was obtained in threaten- ing abortion after overexertion. In regard to the indications for the use of this drug, says Dr. Shennan, they are as fol- lows: 1. In habitual abortion, where this is not caused by syphilitic infection or by fatty placenta, good Jesuits undoubtedly seem to follow its use. 2. In threatening abortion, however caused, and at any period of gestation, if the patient is treated soon enough, it seems to be very efficient. 3. In dysmenorrhea, if functional, spasmodic, or ovarian, or attended with menorrhagia, it often cures. If there is flexion or stenosis, it gives great relief, though, of course, it can not cure. 4. In the menor- rhagias and metrorrhagias of the menopause and in the nervous disorders of that time it is very beneficial. 5. After-pains are so readily relieved by it that some, like Auvard, consider that its use is dangerous unless all clots are cleared out of the uterus previously. 6. It may be used in the diagnosis of false pains, as it speedily relieves them. 7. It is also used with success in colicky diarrhea and in dysentery. vicnv VINEGAR 358 Some even maintain that it has a curative effect on cramps of voluntary muscles. Concerning the physiological effects on ani- mals and man, Dr. Shennan has undertaken some experiments, from the results of which he draws the following conclusions : In mammals, warm-blooded animals, owing to the difficulty of giving a large enough dose hypodermically, there is no marked effect, except drowsiness and some lessening of motor power. If the substance is introduced into the heart directly, there is rapid lowering of blood-pressure to about half the normal, with slow return to near the normal as the drug is eliminated. Although too much reliance must not be placed on experimental results in cold-blooded animals as applicable to warm-blooded ani- mals, including man, we may be allowed, he says, to take something from these results and use them as probably applicable. Thus, there are probably some diminution of reflex irritability, a quieting effect on invol- untary muscle, and possibly some lowering of blood-pressure, which, even though small, might afford relief in congested conditions. Then, and very important, there is the effect of the valerianic or viburnic acid in neurotic and hysterical conditions. In the Pharmacopeia there are many drugs capable of bringing about all these desired effects. Why, then, he asks, use Viburnum prunifolium ? Opium is one of our sheet-an- chors, but then there are dangers and incon- veniences attending its use. The patient may acquire the opium habit, the constipation caused by it is very troublesome, and it is very toxic. Viburnum has similar good effects, though not so strong. It is a good form in which to administer valerianic acid. Its effect upon unstriped muscle, though not so strong as that of opium, gives the relief necessary. It has scarcely any effect in causing constipa- tion. Toxic effects have been noticed only with very considerable doses. Herrick has seen dis- turbance of vision, dryness of the mouth, and headaches; and Wilson has observed similar conditions, but these were with doses larger than are usually administered to man.] The dose of the fluid extract, extractum vi- bumi prunifolii (U. S. Ph.), is from \ to 2 fl. drachms. The solid extract, which is not offi- cial, does not appear to fully represent the drug, but in pill form it has the advantage of being less unpleasant than the former prepa- ration. The extract may be given in doses of from 3 to 10 grains.—Charles Jewett. VICHY is the most famous of the French spas. It is situated in the Department of the Allier. It is one of the most universally fre- quented resorts in Europe, twenty thousand people being accommodated each season. The season extends from early in May to late in October. The springs are numerous, and the waters are used both externally and internally. The temperature of the springs varies from 57' to 178° F. The most important springs are three in number, the Grande Grille, the Celestins, and the Hopital. In the second group are the Lucas, the Source du Pare, the Source Lardy, the Puits-Caire, and the De Mesdames. The water from these springs is exported very largely. Artificial Vichy water is much used, and is made after a chemical formula which is supposed to represent the composition of the water of the springs. The following table, showing the composition of the more important springs, is that given by Cyr: Grande Grille. 4-SS3 0-352 0 303 0-003 0-434 0-004 trace 0 291 0130 0-002 trace 0 534 0 070 Celestins. H6pital. 5-103 0-315 0-328 0-005 0 402 0 004 trace 0-291 0 091 0-002 trace 0-534 0-060 5 029 Potassium bicarbonate....... Magnesium bicarbonate...... 0 440 0 200 0 005 0 570 0-004 Manganous bicarbonate..... trace 0 291 0 046 0-002 trace 0518 0 050 7-00G 7-195 7-155 The chief ingredients of Vichy water are, therefore, the bicarbonates of sodium and of calcium and the sulphate, chloride, and phos- phate of sodium. It is abundantly charged with carbonic acid. It is properly classed as an alkaline water. Vichy water is largely prescribed for rheu- matism, gout, dyspepsia, lithemia, cystitis, and diseases of the liver. Mild but persistent forms of enteritis and gastritis are especially bene- fited by a course of Vichy water. Patients with diabetes also improve under its use in some instances. The most positive statements are made as to its efficacy in icterus and recurring attacks of hepatic colic It is a most valuable adjuvant in the treatment of diseases of the gouty and rheumatic group, but many of the favourable results are undoubtedly due to the large amount of water ingested. Floyd M. Crandall. VIEIRIC ACID, VIEIRIN.—This is a white, amorphous bitter principle obtained from the bark of Remijia Vellozii, a cin- chonaceous shrub found in Brazil. It is solu- ble in alcohol and in chloroform. It has been recommended as a substitute for quinine as a tonic and in the treatment of malarial fevers. It may be given in doses of from 1 to 4 grains. VINCA.—Two species of this genus of apocynaceous plants, Vinca major and Vinca minor, the large and the small periwinkle, have been used to some extent in medicine. They are mildly purgative, diuretic, and dia- phoretic. VINEGAR, acetum (Br. Ph.), owes its properties to the presence of acetic acid, the proportion of which varies from 4 to 6 per cent. It may be dark brown in colour or clear and transparent, the former indicating its preparation from infusion of malt, a dark-col- oured wine, or cider, and the latter that white wine has been its source. The variety most commonly employed in the household'in the United States is that prepared from cider, which is allowed to stand, except during cold weather, in the open air in casks, in each head of which is a small hole to allow the circula- tion of air and with a bottle inserted into the bunghole with the view of permitting the en- trance of light and at the same time prevent- ing the entrance of insects. It usually requires two summers to complete the process, at the end of which the vinegar should be of a clear brown colour and a slight flavour somewhat resembling that of apples, and should also be free of any woody taste. It is usual to rack off the clear part into a clean cask or, what is better, into glass or earthen receptacles, as, if it is allowed to remain, gelatinous masses con- sisting of the mycoderms of acetous fermenta- tion are formed, which under some conditions may fill the casks. This substance is popu- larly known as the " mother of vinegar." In small amounts it will cause the acetification of almost any saccharine solution, and in many cases when it is found in partially emptied vinegar casks it is customary to add a solution of sugar and water. In this way a fairly satis- factory vinegar is made, but it lacks the pecul- iar taste and odour of that made from cider alone. The other varieties of vinegar are made by allowing malt infusions, wines, or solutions of alcohol to trickle over or through pine or beech shavings. By this measure they are exposed in thin layers to the action of the air, and oxidization of the alcohol into acetic acid is accomplished. When a white wine is employed the product is known as white vinegar, while that from malt is dark. The white variety is usually the cheapest and is the variety oftenest employed in the com- mercial preparation of condiments and in the household where there is a real or fancied ob- jection to the coloured. There is no differ- ence, however, in the effects of the different varieties, and a selection is usually dictated by taste or convenience. Sulphuric acid is the commonest adulterant of vinegar, but, provided it does not exceed one part in a thousand, is without much effect. Lead is occasionally found, but rarely in suf- ficient amounts to be of any great importance. Mustard and red or black pepper are some- times used to add to the pungency of vinegar which contains less than the proper amount of acetic acid. As ordinarily employed as a condiment, vin- egar is reasonably free from objection, but in undue amounts is apt to cause indigestion and act as an irritant of the alimentary canal. It enjoys some reputation among the laity as an agent for the reduction of corpulency, but in sufficient quantities to have the desired effect is entirely unsafe. Sponging with solu- tions containing 10 per cent, of vinegar is very grateful in all febrile conditions and after se- vere exercise. For such purposes aromatic vinegar, which consists of acetic acid, water, alcohol, and a number of the essential oils, is much more agreeable, but is rather too costly for general use. If the stronger acids are not available, vine- gar may be employed as an antidote in poison- ing irith alkalies. Vinegars, the aceta of the pharmacopoeias, are solutions of various drugs in vinegar or acetic acid, more particularly the latter. They were formerly employed to a considerable extent, but are not now exten- sively used on account of their ready decom- position. [Carleton (cited in the Canadian Prac- titioner for May, 1896) states that vinegar is useful in carbolic-acid poisoning. When it is applied to the skin or to a mucous membrane which has been burned by the acid, it causes a rapid disappearance of the characteristic white- ness, as well as of the anaesthesia produced by carbolic acid, and it also prevents the forma- tion of a slough. Moreover, it neutralizes any of the acid that may have been introduced in- to the stomach. The first thing, therefore, to do. he says, in cases where carbolic acid has been swallowed is to make the patient drink some vinegar mixed with equal parts of water, and then to wash out the stomach. M. Lewin (Revue de chirurgie, September, 1895 ; Neic York Medical Journal. October 20, 1895) has employed vinegar to prevent vomit- ing after chloroform anesthesia in a hundred and seventy-four cases. In a hundred and twenty-five cases, he says, he has obtained complete success, no vomiting of any kind having been produced. In forty-nine cases there was vomiting, but it was generally slight and the rejected material was rather viscous. The method should be very carefully carried out, he says, in order to insure good results. It is known, he remarks, that chloroform is eliminated almost exclusively through the lungs, partly as free chloroform and partly as formic acid and chlorine. It is evident, he says, that the chlorine exercises an irritating action on the larynx and on the trachea, and that this is one of the principal causes of the vomiting. When a cloth saturated with vine- gar is held over the nostrils, the chlorine com- bines with the acetic acid as fast as it is evolved, and forms trichloracetic acid. It is very dangerous to use pure chloroform. says M. Lewin, and all medicinal chloroform should contain a certain quantity of alcohol, which renders its decomposition during nar- cosis more difficult. It is also known, he con- tinues, that chloroform dehydrates the tissues, and consequently after the action of the chlo- roform has been suspended it is well to make the patient breathe in air that is as humid as possible. This dehydrating action, he says, in- fluences also the endothelium of the blood- vessels and causes coagulation of the blood, to which the slackening of the circulatory move- ment and the feeble activity of the chemico- biological phenomena in the capillaries also contribute. Under such circumstances, he thinks, acetic acid is a powerful agent in re- storing to the blood its normal fluidity, owing to a property that it derives from the water it contains, and to its energetic power of destroy- ing the fibrin. Moreover, acids in general are stimulants of the respiratory tract. The fore- going considerations, he says, seem to him suf- ficient to explain the phenomena without bringing forward a hypothetical action of the vinegar, or of acids in general, on the vomit- ing centre by the intervention of the vaso- motor nerves. The following observations were made in cases where this treatment was employed by M. Lewin : Immediately after the application of the vinegar the pulse became strong, respi- ration grew deeper, the face regained a little colour, and the corneal conjunctiva became bright. The appetite returned at the end of a short time, and the patients occasionally com- plained of hunger on the very day of the op- eration. Frequently they did not suffer at all from the general uneasiness which nearly al- ways follows chloroform anaesthesia. It does not follow from this, says M. Lewin, that the application of the vinegar always suppresses the vomiting, for, in some cases where the pa- tients are very nervous or are suffering from certain affections of the lungs or of the stom- ach, vomiting may occur in spite of the treat- ment. The method of application is as follows : A piece of linen of about the size of a napkin is saturated with vinegar and lightly wrung out; it is then placed on the patient's face, over the mask, which is afterward carefully withdrawn, care being taken not to allow the air to gain access to the face too suddenly, for it ought to pass through the linen cloth before being in- haled. This cloth must be kept on as long as possible, for three hours at the least, and it is better for the patient if the application is pro- longed during the entire day, for occasionally the presence of chloroform in the expired air has been observed for more than two days after narcosis. If the cloth is removed too, soon, nausea will set in. If the linen cloth dries very rapidly, it must be replaced imme- diately with a fresh one, which is put over the first cloth before the latter is drawn away, in order to prevent the air from touching the face. If the wet cloth is annoying to the pa- tient, it may be held away from the face with a mask. It,is of the greatest importance to conform to these rules, says M. Lewin, for failure to observe them has prevented good re- sults from following the application of the vinegar.]—Russell H. Nevins. VINUM.—See Wine. VIOLA TRICOLOR.—This plant is the pansy, or heart's-ease, a flowering herb of the natural order Violacee, a native of Europe, extensively cultivated in flower gardens in this country and naturalized from Kentucky south- ward. Its medicinal properties depend chiefly on an emetico-cathartic active principle known as violine, on viola-quercitrin, and on salicylic acid. Violine is a white alkaloid, soluble in alcohol, very sparingly soluble in water, which readily unites with various acids to form salts. In the plant it is found in the form of the malate and can be extracted in a pure state only by means of a complicated process. It is allied to eme- tine, the alkaloid of ipecacuanha, but is dis- tinctly different. Viola-quercitrin is a glucoside which crys- tallizes in the form of fine yellow needles and is decomposed when boiled with a dilute acid into quercitrin and a fermentable glucose. This substance was discovered by Mandolin, who also detected the presence of salicylic acid in several species of Viola. The physiological action of Viola tricolor can hardly be distinguished from that of the other species of Viola, nearly if not quite all of which are possessed of similar properties, and very little has been written on the subject of the physiological action of the violets. But that little seems to show a noticeable resem- blance in their action to that of salicylic acid. Large doses are said to cause headache asso- ciated with a feeling of confusion and dulness in the head and a sensation of heat over the entire body, together with stimulation and irritation of the skin, the genito-urinary tract, and the salivary glands, as shown by cutaneous eruptions with intense itching and profuse perspiration, frequent and profuse micturition of foul-smelling, turbid urine, with tenesmus of the bladder, and a profuse secretion of saliva. In smaller doses the decoction forms a mucilaginous, emollient, and slightly laxa- tive drink. Viola tricolor was first introduced into med- icine as a remedy for crusta lactea, or infantile eczema of the head and face, sometimes known as " cradle cap." For this purpose it was.given in the form of a decoction of the fresh herb in milk, while a poultice of the leaves was applied locally. Gradually this remedy fell into dis- use, except in France, where it continued to be employed, and lately its use has been advocated by Dr. Piffard, of New York, as efficacious in cases of eczema. Instead of a decoction, he uses a fluid extract and gives quite full direc- tions as to its employment. The drug should be given in the second stage of the disease, when a serous or sero-purulent exudation or crusting is present. In acute eczema full doses induce aggravation and extension of the erup- tion, with increased local heat and itching which last for several days. In order to avoid these disagreeable symptoms, he advises that only from 1 to 5 drops be given once or twice a day to a young child at the beginning of treatment. This dose may be increased if neither improvement nor aggravation occurs after a few days of treatment, while if the trouble is aggravated the use of the drug should be stopped and resumed in a few days with a smaller dose. In subacute and chronic eczema initial doses of from 10 drops to 2 fl. drachms are recommended, in a small quantity of water, about half an hour before meals. The syrup of violets is prepared as an agree- able and palatable vehicle for other medicines, and has been used in bronchial affections, as a demulcent drink, and as a laxative for infants. It may also be used as a test for the presence of acids and alkalies, as the former turn the pale-violet colour of the syrup into red, and the latter turn it into green. The Viola cucullata, or common wild blue violet of America, enjoys a local reputation in Pennsylvania as an antidote to the venom of the rattlesnake. It is given internally in the form of the fresh, raw leaves or that of a de- 361 VINUM WATER coction, while a poultice of salt and indigo is applied to the wound. Matthias Lanckton Foster. VIOLETS.—See under Viola tricolor. VIRGINIA SNAKEROOT.—See Ser- pentaria. VIROL.—This seems to be an English pro- prietary preparation of bone-marrow, intended originally as a palatable substitute for cod- liver oil, but afterwards recommended as a fatty food for infants and young children. (Indian Lancet, August 16, 1896.) VIRUSES.—See under Animal extracts and juices (vol. i, page 82) and Toxines. VISCUM ALBUM, the mistletoe, is a European parasitic shrub which grows chiefly on deciduous trees, notably fruit trees. It forms a pendent evergreen bush several feet in diameter. The American mistletoe, Vis- cuni flarescens (Phoradendron flavescens), is similar in medicinal properties to the Euro- pean species. In addition to mucilage, tannin, resin, and a fixed oil, mistletoe contains a pe- culiar thick, viscid, and tenacious substance known as bird-lime or bird-glue. The latter ingredient may be obtained from the freshly bruised mistletoe bark by kneading it in water. Pawlevsky extracted from mistletoe a crystal- lizable acid nearly insoluble in water and quite so in alcohol and in ether. The fresh bark and leaves emit a peculiar unpleasant odour, and to the taste are slightly acid, bitter, and somewhat nauseous. Mistletoe seems to act upon the heart like digitalis. It also excites vigorous contractions of the uterine muscular fibres, especially during labour. The uterine contractions, unlike those of ergot, are not tonic but clonic. As an oxy- tocic, however, mistletoe is less powerful than ergot. It has been employed in the treatment of menorrhagia and other varieties of uterine hemorrhage and in amenorrhea. It was for- merly used to some extent as a nervine. The dose as an oxytocic is from 4 to 1 fl. drachm of the fluid extract repeated every thirty to sixty minutes; as a uterine haemo- static, a drachm may be given every four to six hours. A tincture and the decoction have also been employed. Taken in large quantities, the preparations of mistletoe produce vomiting and purging. A fatal case has been reported. The drug is of little value in medicine and has practically fallen into disuse. Charles Jewett. VITELLUS.—Yolk of egg. See Eggs. VITIS 1D2EA..—See Vaccinium. VITRIOL, BLUE.—See Cupric sulphate, under Copper. VITRIOL, GREEN—See Iron sulphate, under Iron (vol. i, page 549). VITRIOL, OIL OF.—See Sulphuric acid. VITRIOL, WHITE,—See Zinc sulphate, under Zinc. VULNERARIES.—These are substances which, applied to wounds, bruises, etc.. are supposed to hasten the return of the injured parts to their natural condition. So far as open wounds are concerned, it is probable that all the vulneraries that are really efficient act as antiseptics or germicides; the effects of bruises are more or less amenable to the action of sorbefacients. WAFERS.—These consist of thin, brittle sheets, square or circular, made by pouring a mixture of water and fine flour upon hot plates. For use, a suitable piece is dipped into cold water to make it pliable. It is then laid upon a tablespoon, the powder or other medicine placed in it, and the edges having been folded over, the closed wafer is swallowed. This method was formerly much in use, particularly in domestic practice in Europe, for administer- ing nauseous medicines. Limousin, of Paris, some twenty years ago, brought this form of administering medicines again into vogue by the introduction of a very convenient ap- paratus and a special form of wafer. The latter, of which there were several sizes, are made of the shape of small concave cups with flat rims. One of these wafer-cups is laid in a corresponding cavity of a frame, the requisite amount of the substance is placed in the wafer, and another wafer-cup, the edges of which have just been moistened, is brought down over the former so that the edges of the two meet ex- actly, whereupon they are gently pressed to- gether, thus causing the two wafers to cohere, enveloping the powder between them. Li- mousin's first apparatus has been somewhat improved upon, both by himself and by others, so that a number of wafers may be filled and closed in one operation. When a wafer capsule (as it may be called) is to be swallowed it should first be dipped in water so as to render it soft and flexible. A very convenient substitute for the wafer is the Japanese usego paper, consisting of almost pure cellulose and having remarkable tenacity. The medicinal substance is envel- oped in a small piece of the paper and rolled into a sort of lozenge or elongated bolus which is then dipped in water and swallowed. The paper wrapper is readily digested in the stom- ach with the medicine.—Charles Rice. WAHOO.— See Euoxymus. WASHES.—See Lotions. WATER.—The free use of pure water as a beverage is of great importance in therapeutics. It may even constitute the chief element of treatment in certain cases of disease. Dr. Hec- tor Maillart, of Geneva (Revue de medecine, March, 1894), says that, as the result of his study of the subject, he feels convinced that the treatment of typhoid fever with copious drinks may be recognised as a definite method. In order that the treatment may be efficacious, the patient should drink at least from five to six quarts of water daily during the whole fe- brile period. There is no contra-indication to this treatment; feebleness of the heart, far from contra-indicating the drinks, may become a special indication for them. The results are WATERS, MINERAL 362 a progressive lowering of the fever, disappear- ance of the dryness of the tongue and mouth, and pronounced sedation of all the alarming nervous, circulatory, and renal phenomena. These results are due to the oxidation of tox- ines and refuse material, which are rendered soluble and eliminated. The oxidation is shown by the formation of great quantities of urea, and the elimination takes place by the skin and kidneys in the form of profuse sweat- ing and abundant diuresis. This diuresis re- establishes the integrity of the renal filter, and that results in the rapid disappearance of albu- minuria. This method of treatment has no notable influence on the course or the duration of the disease. No unpleasant consequences have been observed to result from the treat- ment, either during the fever, during conva- lescence, or after recovery. The treatment, which is very acceptable to the patient, is easi- ly carried oiit, even in cases in which the nerv- ous disturbances are very decided. See also under Antiblennorrhagics (vol. i, page 105) and the articles on Waters, Mineral ; Hydri- atics, Baths, and Douches. WATERS, MINERAL.—Mineral waters is the term used to designate natural waters which hold in solution different gaseous or min- eral substances, the proportion of these latter constituents being such that the waters may be employed for medicinal purposes. Such waters may be administered internally as beverages, or externally in some of the various forms of baths. An absolutely pure water cannot be obtained even by chemical processes. Almost all natu- ral waters are impregnated with extraneous substances. Rain water contains organic mat- ter, carbonic acid or other gases, and salts which it absorbs in falling through the atmos- phere. Spring and artesian-well waters are likely to contain a certain amount of gases, such as carbonic-acid gas or sulphuretted hy- drogen produced by the decomposition of or- ganic matter in the soil, as well as a certain amount of the soluble salts dissolved from the strata between the origin and source of the flow; it is to be recalled that gases in the water will facilitate the solution of otherwise insolu- ble substances. The constituents of mineral waters may be gaseous, inorganic, or organic. The following substances have been found in mineral waters: Gaseous. Inorganic. Oxygen. Nitrogen. Carbonic oxide. Sulphuretted hydrogen. Methane. Air. Ammonium crenate, nitrate, nitrite, and sulphate. Aluminum oxide, phosphate, silicate, and sulphate. Antimony teroxide. Arsenic, arsenious oxide. Barium bicarbonate, carbonate, and sul- phate. Bromine. Cadmium sulphate. Calcium bicarbonate, bromide, chloride, crenate. carbonate, fluoride, phos- phate, silicate, oxide, sulphate, and sulphide. Cobalt carbonate and sulphate. Inorganic. Acids, free OR COMBINED. Organic. ' Copper carbonate and sulphate. Fluorine. Iodine. , Iron bicarbonate, bisulphate. carbon- ate, crenate, oxide, phosphate, sesqui- chloride, sesquicarbonate, sesquiox- ide, sulphide, and sulphate. Lead carbonate and sulphate. Lithium carbonate, chloride, bicarbon- ate, and sulphate. Magnesium bicarbonate, borate, bro- mide, carbonate, and chloride. Manganese carbonate, bromide, iodide, oxide, and sulphate. Nickel bicarbonate, carbonate, and sul- phate. Potassium bromide, chloride, nitrate, and sulphate. Phosphorus. Silica. Sodium biborate, bisulphide, bromide, bicarbonate, carbonate, chloride, io- dide, metasilicate, hyposulphite, ni- trate, phosphate, silicate, sulphate, and sulphide. Strontium bicarbonate, carbonate, and sulphate. Sulphur. Zinc bicarbonate, carbonate, and sul- [ phate. ' Boric. Hydrochloric. Hydrosulphuric. Nitric. Phosphoric. Silicic. Sulphuric. Acetic acid. Butyric " Crenic " Formic ,; Propionic " Infusoria and vegetable matter. An inspection of this list of active or inactive constituents of mineral waters will indicate the difficulty of classification. Various plans have been proposed for a suitable scheme in which to group these waters, based on their geograph- ical distribution, their geological origin, their chemical constituents, their thermal character- istics, or their therapeutical action, each of which has had its advocates. As the physician is interested simply in their remedial proper- ties, the most satisfactory method for his use is one that deals with the temperature and the chemical constituents of the water. The latter method has its disadvantages, however, as may be seen if we take, for example, Professor J. W. Mallet's analysis of the Rockbridge Alum Springs, in which some twenty-five constitu- ents are found in the water. The effects of the oxygen, nitrogen, and carbon dioxide may be accounted for; the traces of organic matter, calcium fluoride, and cadmium sulphate may be ignored so far as any influence they are like- ly to exercise is concerned, and the preponder- ance of aluminum sulphate suggests that the water will possess the physiological properties of that salt. But with all there are definite quantities of the sulphates of sodium, calcium, lithium, magnesium, potassium, manganese, nickel, cobalt, copper, zinc, and iron, as well as of sulphuric acid, that combine to give this spring certain definite features, and that may have their physiological action, moderate though it may be. It is not possible in the case of the Carlsbad water to ignore the influ- ence of the bicarbonate of sodium, which almost equals in quantity the sulphate of sodium. 363 WATERS, MINERAL There are waters that are known as chalybeate in which the percentage of iron is less than that of many of the other ingredients, vet their prin- cipal physiological effect is due to the iron salt. Other waters contain several active ingredi- ents, the physiological effects of each being manifested when they are administered, so that they might be included in several classes. The classification adopted by the better Ger- man authors on balneology has for its purpose the distinction in the therapeutic properties of the waters, though it is necessarily difficult to distinguish these properties, as, for example, between the alkaline and the alkaline-saline waters, or between the sulphuretted and the ferruginous waters. This arrangement in- cludes : {1. Simple alkaline waters. 2. Alkaline chlorinated or muriat- ed waters. 3. Alkaline-saline waters. II. Saline or chlorinated waters. III. Sulphur waters. IV. Ferruginous waters. V. Earthy, or calcareous, waters. VI. Indifferent thermal waters The alkaline waters are those that contain potash and soda ; they are clear and colourless and have either little taste or a salty taste, ac- cording to the quantity of salt that they con- tain. The most important constituents of the simple alkaline waters are sodium carbonate and carbonic acid. When common salt is pres- ent in the alkaline water in decided quantity, it is called an alkaline chlorinated water. And if, in addition to the alkali, there is sodium or magnesium sulphate, the water is alkaline- saline. Alkaline carbonates, chlorides, and sul- phates have respectively specific effects on the biliary, gastric, intestinal, and urinary secre- tions. For example, an alkaline carbonate in- creases the flow of bile, neutralizes the gastric juice, and renders the urine alkaline. The sulphates act more or less powerfully on the bowels, and increase the number of stools as well as the total amount of faeces voided in a given time. The principal ingredient of the saline waters is sodium chloride. Such waters are clear and their taste depends upon the quantity of salt present; if it is below 2 per cent, the water is simply saline, but if there is a large quantity of salt the water is a brine that can only be used therapeutically as a bath. In some chlo- rinated waters there are definite proportions of salts ,'of iodine or bromine, and these waters have been called iodine or bromine waters. A chloride acts chiefly in increasing the quantity of organic and inorganic substances eliminated by the kidneys. Sulphur waters are those that contain sul- phuretted hydrogen. Ferruginous, or chalybeate, waters are those that contain definite quantities of some iron salt. Earthy, or calcareous, waters are those in which calcium carbonate or sulphate and mag- nesia are the predominant chemical ingredi- ents. Indifferent thermal waters are those that contain an insignificant quantity of mineral constituents. The French balneologists divided mineral waters into the following classes: I. Bicarbonated waters. II. Chlorinated waters. III. Sulphur waters. IV. Sulphated waters. V. Ferruginous waters. 1. Sodium bicarbonate. 2. Calcium bicarbonate. 3. Mixed bicarbonates. 1. Sodium chloride alone. 2. Sodium chloride with bicar- bonates. 3. Sulphuretted. Sulphuretted hydrogen with sodi- um salts. Sulphuretted hydrogen with cal- cium salts. Sodium sulphate. Calcium sulphate. Magnesium sulphate. Mixed sulphates. Bicarbonated. Sulphated. With manganese salts. The disadvantage of such a chemical classifi- cation is apparent in the association of waters that contain salts which act so dissimilarly as in class IV, which includes waters that contain sodium sulphate and waters that contain cal- cium sulphate. Mineral waters in this article will be consid- ered as hot, or thermal, and as cold waters. These may be either simple, in the case of thermal waters and waters which contain very small percentages of mineral substances; gase- ous, in consequence of the presence of carbon dioxide, or carburetted. or sulphuretted hvdro- gen ; chlorinated, in which there is a predomi- nance of sodium chloride; alkaline ; saline, in which there is sufficient sodium or magnesium sulphate to produce the therapeutical effect of either of those salts; chalybeate, or ferrugi- nous ; and earthy, or calcareous. In the simple thermal waters saline and gaseous constituents are present in such insig- nificant proportions that the efficacy of the water as a remedial agent is evidently due to the temperature, which may range from 85" to more than 110° F. The most familiar ex- ample of such water is that of the Hot Springs of Arkansas, the waters of which contain 855 grains of solids to the gallon, almost 4 grains of which is calcium carbonate; the tempera- ture of the water varies from 93° to 157 F., and if taken internally it can only act, as is the case with other waters of this class, like simple hot water. Drinking the water from simple thermal mineral springs is a means of effecting gastric lavage ; the secretion of saliva, gastric juice, bile, pancreatic juice, and urine is increased, with the consequent stimulation of metabolism and the excretion of effete prod- ucts from the tissues. The warm water is more easily absorbed from the stomach than cold water is, because the temperature of the latter must be raised first to the temperature of the body; and such water gently promotes the peristaltic action of the bowels. The use of warm and hot water in baths has been described elsewhere in this work. These thermal waters were called nerve-baths by Pro- fessor Romberg, because they lessened morbid irritability of the cutaneous nerves. The internal administration of simple ther- mal water is more useful at resorts than at home, because the patients who visit them are G7 WATERS, MINERAL 364 more careful in their attention to the details of the treatment, there is likely to be less in- fraction of the rules which are laid down for dietetic observance, more exercise is taken, and there are the associated advantages of change of air, of environment, and of mental impres- sions. In prolonged and irritable phases of chronic inflammation of the throat, the stomach, or the intestines, resort to such a spring is likely to redound to the patient's advantage. In chronic constipation associated with deficiency of the hepatic or intestinal secretions, in chronic are many more such springs in which the wa- ters contain a larger amount of solids; but it has seemed to the writer that this class should be limited to springs in which the water does not contain more than a drachm of solids in each gallon, and that to include waters con- taining several hundred grains of solids is to ignore the possible medicinal effect of some of the constituent substances. For some of the data contained in this table and in subsequent lists, the writer is indebted to Leichtenstern's article on Balneotherapeutics in von Ziemssen's Handbook of General Therapeutics. Simple Thermal Springs. name. Monroe Hot Spring, near Prescott................. Rio San Francisco Hot Springs..................... Hot Springs......................................... Agua Caliente, San Diego Co....................... Calistoga Hot Spring, Napa Co..................... Hot Spring. Paoha Island, Mono Lake.............. Mono Basin Warm Spring......................... Paso de Robles (sulphuretted), San Luis Obispo Co. Canon City Hot Spring............................. Bruneau Hot Springs, Owyhee Co.................. Given's Hot Springs, Owyhee Co................... Emigrant Gulch Warm Springs, Gallatin Co....... Helena Hot Spring, Helena......................... Livingston Warm Springs ,......................... Matthew's Warm Springs........................... Hot Springs, Churchill Co.........................., Ward's Hot Springs, Humboldt Co............... Jemes Hot Springs, Bernalillo Co..................., Warm Springs....................................... Hot Springs, Bath Co................................ Solids, per gallon. Gastein...................... Johannisbad................. Neuhaus (Styria)............. Romerbad................... Teplitz..................... Tiiffer........................ Tobelbad..................... Villach (Styria).............. Bath......................... Plombieres (Vosges)......... Mont Dore (Auvergne)....... Schlangenbad (Nassau)...... Warmbrunn (Silesia)......... Wildbad (Black Forest)...... Bormio....................... Leuk (Canton Wallis)........ Pfaffers (Canton St. Gallien). 0-66 8-55 393 37-50 0-29 2-08 8-07-17-53 040 Country or State. 0"23 0-62 0-75 059 249 L19 0-24 33-87 -33-36 1135 075 103 0-75 2 32 075 1-95 7-14 092 5-9G 101 105 2-08 3-35 695 101 rheumatism, in gout, and in neurasthenia, this treatment will prove useful. The external and internal use of such waters will benefit ulcers of the skin and gunshot wounds that suppurate chronically. Old cerebral, spinal, and peripheral paralyses are often benefited^ if only by the improved condition of the pa- tient, while paralysis of toxic origin, especially that due to lead, is usually rapidly improved by the external and internal use of thermal waters. Hysteria, insomnia, neurasthenia, neuralgia, and peripheral neuritis may be treated beneficially by the combined use of such waters. The employment of these waters in the earlier stages of Bright's disease, in catarrh of the pelvis of the kidney, and in cys- tic catarrh will aid in preventing self-intoxica- tion and be likely to favourably influence the affected tissues. The accompanying list will show the situa- tion of a number of thermal springs. There Arizona. Arizona. Arkansas. California. California. California. California. California. Colorado. Idaho. Idaho. Montana. Montana. Montana. Montana. Nevada. Nevada. New Mexico. North Carolina. Virginia. Austria. Austria. Austria. Austria. Austria. Austria. Austria. Austria. England. France. France. Germany. Germany. Germany. Italy. Switzerland. Switzerland. Elevation, in feet. 5,316 6,666 718 725 331 6,730 5,412 4,296 4,150 4,485 Temperature of springs, Fahr. 1,325 150-0' 127-0' 93-0' 100-0' 85 0' 1120c 122-0° 114-0° 158 0° 190 0° 94-0° 92 ■ 0°- 50 0°- '-160 0° '-130-0° -157-0° 100-4° -195 0° 1100° - 90-0° -122-0° 104-0° 105 0° 98-0° 102 0° ■141 0° 104-0° 1220° 187-0° 200-0° 168 0° 117-0° 1100° 3,490 95-0° -138-4° 1,955 84-2° 1,200 95 0° 730 96 8° 700 118-4° 690 95-0° -102-2° 1,070 82-4° 7,000 84 0° 107-6° -1166° 1,400 66-0° -158'0° 3,430 107-6° 925 82-0° - 920° 1,100 96'8° -107-6° 1,323 91-4° - 986° 4,825 1004° 4,356 92-0° -122-0° 2,130 98 6° Carbonated waters are those that contain carbonic acid, and that gas is usually associa- ted with other chemical ingredients. Admin- istered internally, carbonic acid is a stimulant to the mucous membrane of the stomach and intestines, probably in consequence of excita- tion of the motor nerves, although it has a sedative effect on the sensory nerves when ad- ministered in small quantities. It also causes increased secretion of urine. Large quantities of carbonated water have produced gastric distention, eructations, cardiac irritability, and pulmonary and cerebral hyperaemia. A "larger quantity of carbonic acid is tolerated if the water is cold than if it is warm. In gastric and intestinal atony a simple carbonated water will frequently afford marked relief. In nausea such waters are applicable ; and in the nausea associated with malarial and other fevers the free use of carbonated waters is in- dicated. Where a natural water is inaccessible 3G5 WATERS, MINERAL the separate portions of a seidlitz powder may be dissolved in two glasses, and a tablespoon- ful of each solution given in succession; the small quantity of carbonic-acid gas evolved in the stomach is very agreeable to the patient. In certain forms of vesical or prostatic irrita- bility the frequency of micturition is lessened by using these waters. [For the use of carbon- ated waters in the Schott treatment of chronic heart diseases, see Baths (supplement)]. Chlorinated waters, which are also known as muriated or muriated saline waters, are those in which sodium chloride is the principal solid constituent, though it is frequently associated with other chlorine salts and gases. When the chlorinated waters contain iodine or bromine they are called iodine or bromine salt, or chlorinated, waters; if they contain such earthy salts as calcium or magnesium sulphate or carbonate they are termed earthy salt, or chlorinated, waters; if they contain sodium or magnesium sulphate they are known as saline chlorinated waters; if they are distin- guished by the presence of a definite quantity of an iron salt they are called chalybeate chlo- rinated waters: and if there is a large volume of carbonic acid they are called acidulous chlorinated waters. Sodium chloride plays an important part in the animal economy, and it forms the greater portion of the soluble constituents of the ash of all animal substances. The gastric juice is normally rich in sodium chloride, which is one of the sources of the hydrochloric acid in the stomach. It promotes digestion by facilitating the solution of albumin and casein, and plays an important role in furthering the processes of absorption and secretion, in consequence of its stimulating effect on the gastric and intes- tinal glands. The experiments of Braun, Griitzner, and Boas have shown that the addition of sodium chloride to the blood increases the secretion of gastric juice, and whatever quantity, in mod- eration, is in excess of the needs of the body is excreted chiefly by the kidneys. In moderate quantities it is quickly absorbed from the stomach, and Buchheim showed that within six hours it was excreted in the urine. As it is essential for the formation as well as the disintegration of cells, it stimulates not only the progressive, but also the retrogressive tis- sue changes of the animal organism. When a moderate quantity of sodium chloride is intro- duced into the stomach it stimulates the secre- tion of the gastric juice, and excites increased peristaltic action in that viscus, which favours the passage of the gastric contents into the in- testinal canal. The peristaltic action of the intestines also is increased by the salt. Bischoff, Kaupp, and Voit have proved that there is an increased excretion of urea after the administration of moderate quantities of sodium chloride. This is apparently due to the improvement in metabolism, the serum seeming to carry away albuminates, and favour their transformation into excretable products. Externally, chlorinated waters in baths in- crease the excretion of urea and decrease that of uric acid and that of phosphates. There is an increased consumption of oxygen and there is increased excretion of carbonic acid. The skin is macerated and cleansed, its functions are stimulated in consequence of the action of the sodium chloride and the usually associated carbonic acid on the peripheral nerves. Such waters are more efficacious if warm than if cold. Various theoretical influences have been ascribed to the use of baths of such water, but more exact observations are needed to deter- mine the entire scope of their therapeutic efficacy. The action of the chlorinated waters is in- creased if either carbonic acid or sulphuretted- hydrogen gas is present. As water will take up its own volume of carbonic-acid gas under pressure, the amount of that gas in natural mineral water differs according to the propor- tion of that gas forced into the source whence the water comes; the gas effervesces when the water escapes from the spring, and unless the liquid is kept in firmly closed bottles it soon loses its natural gas. The carbonated waters are usually bright, sparkling liquids which pos- sess an agreeable acidulous taste. These char- acteristics make such waters refreshing drinks in febrile and other diseases; the sensitive nerves of the stomach seem to be quieted by the influence of the gas, there is some stimula- tion of the peristaltic action of the stomach and intestines, and the action of the kidneys is increased. The presence of hydrogen sulphide increases the palatability as well as the therapeutic use- fulness of saline waters, as is shown by the Kentucky Blue Lick water, in which 516 of the 6G0 grains of solids in each gallon are sodium chloride. When chlorinated waters are warm or hot they are more quickly absorbed, and thus may exercise an effect that is not obtained by the slow and imperfect absorption of cold water. Boas observed the changes in the secretion of gastric juice during the administration of warm chlorinated waters, and noticed that after from three to four weeks of this treat- ment there was a decided improvement in the secretion of gastric juice and a coincident ces- sation of the symptoms in chronic gastritis. The chlorinated waters are indicated in all cases of gastric catarrh in which there is less- ening of the secretion, either with or without the production of mucus. Such waters are useful for patients in whom there is a defi- ciency of the gastric and intestinal secretions. In gouty and rheumatic conditions the use of such waters, by improving metabolism, furthers the excretion of effete products, and if begun in time is likely to delay the degenerative changes incident to those affections. In some forms of anem ia in which there is rapid de- crease in the proportion of red blood-corpus- cles, marked improvement will follow the external and internal employment of thermal chlorinated waters. Hepatic congestion of a chronic type, with the associated aberration in the functions of the liver and the usually at- tendant constipation, is benefited by this treat- ment. In certain cases of neurasthenia in which there is self-intoxication these waters WATERS, MINERAL 366 will be useful and are to be preferred to the saline waters which contain the sodium and magnesium salts; the latter are slowly ab- sorbed, are likely to cause gastric distress, and, by saturating the blood with neutral salts, which are improperly or slowly excreted, further involve the metabolic functions and thus contribute to do more injury to the nerv- ous system. Hypertrophy of the spleen, due to paludism, may 'be reduced by the use of this class of waters in conjunction with other treat- ment. Bronchial catarrh, associated with gen- eral asthenia, is bettered, if not cured, by a course of chlorinated waters, internally and externally. The improvement in the general nutrition produced by such waters may explain the benefit that has followed their administra- tion in caries, necrosis, and rhachitis. The principal springs of this class are the following, though in this table the difficulty of classification has been encountered, because a number of the chlorinated waters are also sul- phuretted and owe some of their properties to the presence of hydrogen sulphide: alkalies in small or moderate doses increases the secretion of gastric juice, and these alkaline waters may be administered for that purpose ; large doses of the salt impair digestion and diminish appetite and nutrition. The salt does decrease the proportion of solids and increase the fluids in the bile, and it makes the urine distinctly alkaline, in con- sequence of the neutralization of the sodium phosphate. The best effects of the drug may be obtained by its prolonged administration in small doses, rather than by the use of large doses. Consequently the value of alkaline wa- ters is apparent, because they are not likely to be taken in such large quantities or of such strength that the undesirable effects of the sodium salt will be manifested. In the case of the chlorinated alkaline waters the effects of both of the sodium salts are obtained, and these waters are best administered when it is neces- sary to improve the blood or to avoid emacia- tion. The alkaline waters are used in the treatment of those forms of dyspepsia associated with name of spring. Iola Mineral Well, Allen Co...... St. Clair Mineral Spring........... Ballston Spa, Saratoga Co......... Excelsior Spring, Syracuse........ Saratoga Springs, Saratoga......, Aurora Saline Springs, Marion Co Hall (near Steyer)................. Ischl............................... St. Catharine's Wells, Ontario..... Bourbonne les Bains............. Neuhaus, Bavaria................ Soden, Nassau.................... Kreuznach, Valley of Nahe........ Kissingen, Bavaria............... Nauheim, Wetterau.............. Durkheim, Bavaria............... Munster am Stein................ Pyrmont, Hanover............... Connstadt, Wiirtemberg......... Wiesbaden, Nassau............... Salzbrunn, Bavaria............... Baden-Baden..................... Kansas. Michigan. New York. New York. New York. Oregon. Austria. Austria. Canada. France. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Elevation, in feet. 955 310 403 265 218 1,064 1,574 "750 1,200 440 330 590 450 377 400 600 323 1,200 616 Temperature. 49°- 51° 57° 60° 130°-150° 95° 50°- 85° 89°- 96° 55°- 60° 86° 60°- 70° 142°-156° 46° 140°-154° Solids, in 1,100-27 628-37 247-1,233 668-24 258-991 86162 2,951-68 445-11 757-2 760 55-8 616 Carbonated ; 980 "5 gr. so- dium chloride. 405 53 gr. sodium chloride. Carbonated ; ferruginous. 584 53 gr. sodium chloride. Carbonated; calcic. Carbonated ; iodine and bro- mine. Calcic. Carbonated. Carbonated. Carbonated. Carbonated. Carbonated. Carbonated. The alkaline waters are those that contain a large proportion of sodium carbonate, which is usually associated with a more or less carbonic acid. In the event of the carbonic acid being present in a fairly large percentage, the water is known as acidulous alkaline; when the so- dium carbonate is associated with sodium chlo- ride it is called a chlorinated alkaline water; and when sodium or magnesium sulphate is present in sufficient quantity to produce their characteristic effects the water is known as an alkaline-saline water. Gradeau injected large quantities of sodium carbonate into the blood-vessels of a dog, and Munch has administered large quantities of that salt to-a man, but in each series of experi- ments the results were negative. The acids of the gastric juice decompose sodium carbonate, setting carbonic acid free, and forming sodium chloride, and, in certain fermentative condi- tions, sodium acetate, butyrate, and lactate. Experiments have shown that the ingestion of hyperacidity, and in phases of gastric catarrh in which large quantities of mucus are secreted, and the ingestion of the water before breakfast loosens the mucus as in gastric lavage. In all gastropathies in which there is hyperacidity, and in gastric dilatation, alkaline waters are contra-indicated. Cases in which analysis of the gastric juice after a test meal shows that there is a large quantity of acid should be treated with the stronger alkaline waters; if gastric lavage and stimulation are desired, the chlorinated alkaline waters are most suitable; and where gastric and hepatic torpidity are associated, the alkaline saline waters are most efficacious. As sodium bicarbonate acts more rapidly as a diuretic than sodium chloride, and in small doses it seems to be followed by a greater ex- cretion of the retrogressive products of metab- olism of the uropoietic apparatus, alkaline waters are indicated in pyelitis, ureteritis, and cystitis. The urine becomes alkaline and is 367 WATERS, MINERAL less irritating, the catarrhal exudation becomes thinner and is not retained, and the condition of the affected mucous membranes is improved. These waters are useful for renal or cystic calculus or the uric-acid diathesis, the water and its salts furthering the oxidation of uric acid and having a certain solvent influence on formations of this substance. The use of the water in cases of calculi of calcium phosphate or carbonate is not justified by chemical or physiological facts. The value of these waters in gout is due to the effect of copious draughts of water with the contained salts on the processes of metab- olism. In such conditions they are rarely so useful as the saline waters, though a course of the latter may be advantageously followed by a course of alkaline waters. Headache and other conditions associated with the uric-acid diathesis are benefited by the use of alkaline waters. Sir William Roberts has referred to the fact that a considerable number of the springs to which gouty patients resort are strongly im- is either to provoke a downright attack of gout, or to aggravate the symptoms under which he was suffering. This has been a common experience at spas, and the patients have been comforted with the assurance that this preliminary storm was a necessary prelude to the amendment that was to follow. In all likelihood the gouty exacerbation is due to the precipitation of the urates floating in the blood and lymph into the structure of the joint. Dr. Roberts advises that gouty persons should either entirely avoid springs that owe their activity to sodium salts, or should use them very sparingly; he considers that it is difficult to believe that they can do any direct good, and easy to believe that they can do direct harm. Chlorinated alkaline waters have proved to be very useful in bronchial catarrh, and in acute and chronic pharyngitis and laryngitis. The following table gives a list of some of the more important alkaline springs, and the proportion in a thousand of the more impor- tant solid and gaseous constituents : NAME OF SFRING. Adams Spring, Lake Co....... .(Etna Spring, Napa Co........ California Seltzer Spring..... Litton's Seltzer Spring...... Vichy Springs, New Almaden Geyser Spa, Sonoma Co...... Highland Springs, Lake Co.. Manitou Springs............. Apollinaris Spring, Mill Creek Rohitsch (Styria).......... Radein (Styria)............ Giesshubel (Bohemia)...... Chaudes-Aigues........... Mont-d'Or................. Neris...................... Vichy...................... Vals....................... Le Boulou................. La Bourboule.............. Royat...................... Vic-sur-cere................ Szczawnica................ Fachingen (Nassau)........ Fellathalquellen (Illyria)... Bilin (Bohemia)............ Obersalzbrunn (Silesia)--- Apollinaris................. Geilnau.................... Ems....................... Weilbach.................. Selters.................... California. California. California. California. California. California. California. Colorado. Montana. Austria. Austria. Austria. France. France. France. France. France. France. France. France. France. Gallicia. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Temperature. 200-0° 60-82° 43°-60° 40 0° 55-4° 53-6° 50 0° 68°-180° 106°-108° 114°-125° 53 6°-100° 55-4° 60°-68° 54°-125° 96 51-8° 50 0° 46-4° 53-6° 44 6° 69-8° 50 0° '-116° 53-6° 60 8° Sodium bi- Sodium Sodium Free carbonic acid. carbonate. chloride. sulphate. 8-8 06 1,315 116 4-5 1-2 251 80 25 Abun-dant. 90 180 31 0 50 485 30 1-5 05 10-2-0 001-010 015-124 0-13-0-47 0-19-051 9 098 0 37 094 ? 8"6 03 348 43 0-6 02 879 1-2 1,537 27-47 367 2-60 748 05 03 24-38 10.39 26 68 40-5-0 0-5 02 460-532 7-1 01 02 1,039 141-75 49-55 Trace. 360 1-86 3-15 020 Abun-dant. 1-3 1-7 o-i 379 124 36 90.34 41-58 8-4 46 711 3 6 06 945 4-2 0-2 0-5 609 4-2 03 0-8 1,337 24 o-i 04 630 1-2 0-4 03 1,500 L0 1.468 1-3-2-0 09-1-0 553-597 1-3 12 02 151 12 22 1,149 199 43 gr. solids to gal. ; carbonated (acidulous). 136 gr. per gal. 186 gr. per gal. 228 69 gr. per gal. 432 64 gr. per gal. 57p12 gr. per gal. 73-103 gr. per gal. 14 43 gr. per gal. Chalybeate. Chalybeate. Arseniuretted, chlorinated. Arseniuretted, chlorinated. Arseniuretted, chlorinated, cold. Chlorinated. 301-6 gr. to gal. ; chalybeate. Chalybeate. Chlorinated. Lithia. pregnated with the salts of sodium, and to the fact that it has been conclusively demonstrated that all the sodium salts act adversely on the solubility of sodium bi-urate, and hasten its precipitation. It may be inferred that the in- troduction of these salts into the circulation must tend to favour the occurrence of uratic depositions in the body; therefore it is not surprising to learn that not infrequently the first effect of these waters on a gouty patient Sulphated, or bitter, waters are those saline waters in which there is a large proportion of sodium or of magnesium sulphate or of both these salts. When the principal constituents are the salts mentioned these waters have been called simple sulphated, or bitter, waters; when they are combined with sodium carbonate, so- dium chloride, and other salts, they are known as alkaline sulphated waters. Neither magnesium nor sodium sulphate is WATERS, MINERAL 368 a normal constituent of the organism, and, while their action has been described in the sections devoted to those substances, some re- marks may be pertinent here. Although the nauseous taste of sodium sulphate has inter- fered with the general employment of that drug, it is less irritating than magnesium sul- phate, and is to be preferred to the latter salt in many instances. Braun is authority for the statement that the irritating effect of mag- nesium sulphate on the mucous membrane of the stomach is about fifty per cent, greater than that of sodium sulphate. Buchheim's investigations have shown that in the intestinal canal the potassium salts take a certain quantity of sulphuric acid from these sulphates, the salts being reduced to sulphides, which are decomposed by the acids of the in- testinal canal, with the generation of hydro- sulphuric acid. In general, these sulphates act by increasing the fluids of the intestinal canal. One of the most important uses of the waters of this class is for the treatment of the various disorders of the stomach. The pesearches of Jaworski on the effects of Carlsbad water have shown that, if it is taken in small quantities and for a short time, it stimulates the gastric secretion, but, if administered for a long time, it lessens and perhaps stops that secretion. Boas has stated that its prolonged use will cause atrophy of the glandular parenchyma of the stomach. Spitzer found that these waters increased the motor power of the stomach and the secretion of pepsin, but checked an excess- ive elimination of hydrochloric acid. Ewald's experience has been that the alka- line sulphated waters have such a high per- centage of alkali that they act as antacids in conditions of gastric hyperacidity. While the simple mechanical action of gastric lavage is incidental to the use of almost all mineral waters, the waters under consideration have a further action on the liver and intestines. Cordes has called attention to the fact that such waters, when given to nervous or anaemic persons, may cause an increase in the irritation and depression ; and Ewald adds an emphatic protest against the custom of sending persons so afflicted to springs where the water contains large quantities of sodium sulphate, because the waters operate badly in every case. Per- sons affected with pronounced neuroses should not be sent to such spas or treated with such waters, because of the reflexes that proceed from the stomach and intestines. In hyperacidity or increased secretion of gastric juice these waters are likely to prove beneficial, and it is on account of the existence of the first-named condition with gastric ulcer that these waters are useful in the treatment of that disease, as the water not only neutral- izes the acidity but lessens the secretion of the gastric juice. The sulphated waters are indi- cated in those gastropathies that complicate and are due to disorders of the liver and intes- tines. Simple chronic intestinal catarrh is often benefited by the use of a sodium-sulphate wa- ter, though in aiding in the removal of effete matter they may interfere in the final diges- tion of nutritious substances. In hepatic engorgement, jaundice due to ob- structions, and hepatic cirrhosis the waters containing sodium sulphate are very useful. The obstruction to the circulation in the por- tal vein reacts on all the veins of the intesti- nal tract, and the engorged capillaries are relieved by the exosmosis induced by the water. With an improvement in the local circulation there is improvement in the general nutrition of the affected region. Catarrh of the duode- num and of the gall bladder and duct are bene- fited in consequence of the depletion of the engorged intestinal vessels and mucous mem- brane and the removal of the mucus. Gall- stones are passed after a more or less prolonged course of saline waters. Corpulence has been successfully treated with saline waters, but no small part of the benefit attending their use is due to the rigorous di- etary regimen, including the abstinence from starchy and fatty foods and alcoholic or malt beverages. Too often the benefit derived from a course of the waters is lost by the patient's resuming the habits of living which originally tended to produce the corpulence. During the use of the waters there is an increased elimina- tion of proteid matters and fats by the bowels, and a diminution in the phosphoric and sul- phuric acids and the chlorides and an increase of urea in the urine. In such conditions the use of the treatment should be indicated and supervised by a physician. Diabetes due to defective metabolism of the carbohydrates may be benefited by saline wa- ters. The depletion of the intestinal vessels that follows a course of sulphated waters is of de- cided value in the treatment of hemorrhoidal conditions, which so often occur in those who may be considered degenerative assimilators. Here also the improvement in metabolism is the cause of the particular improvement in the patient. But hsemorrhoidal conditions in thin individuals whose physique indicates de- fective assimilation are aggravated by such waters. In maladies due to the so-called uric-acid diathesis, as well as in gravel and stone in the kidney or bladder, the alkaline-saline waters promote the solution of uric acid. The degree of intensity of purgative action in the bitter waters varies necessarily with the amount of sulphates that they contain. To a greater or lesser extent all of them increase the quantity of solids passed from the bowels during the day, because, in consequence of the purgative effects of the waters, the peri- staltic action of the intestines is increased, the food passes through and out of the digestive canal before all the nutrient ma- terial has been absorbed from it by the lac- teals, and, as the late Dr. George Harley re- marked, more feculent matter is excreted by the bowels than would have been the case had the digestive materials sojourned longer in the intestinal canal and have been absorbed to nourish the body. Another fact that must not be overlooked is 369 WATERS, MINERAL that the thirst produced by the saline constitu- ents of these waters increases the quantity of liquids ingested, and the more liquids that are absorbed the greater the solution of solids and the greater the elimination by the kidneys of both fluids and solids. This latter, however, is but temporary, as the continued use of sul- phated waters decreases the time during which nutritive material remains in the digestive tract; and in consequence of this there are lessened absorption by the lacteals and a smaller excess in the blood to be excreted in the urine. The following table includes the principal waters of this class : stimulates the appetite, and strengthens diges- tion by increasing the desire for food and the ability to dispose of it. But more essential in the treatment of chlorosis or anemia at a spa is the change in the mode of life—the diet, the life in the open air, and the removal of dis- turbing local influences that may exist at the patient's home. The quantity of iron, varying from half a grain to two grains, that is con- tained in all the water that is drank in a day, seems too small to be considered as the sole factor in the improvement that occurs in the diseases mentioned. Ferruginous waters are of special value in those forms of anemia due to haemorrhage, NAME OF SPRING. Crab Orchard Springs.......... Harrodsburg Springs............ Bedford Springs................. Arpad (Hungary)................ Franz-Joseph Bitterquell........ Hunyadi J&nos (Ofev)........... Sedlitz (Bohemia)................ Piillna (Bohemia)............... Saidschutz (Bohemia)........... Ivanda (Banat).................. Unter-Alap (Hungary)........... Marienbad (Bohemia)............ Franzensbad (Bohemia)......... Karlsbad, Miihlbrunnen......... Karlsbad, Sprudel............... Karlsbad, Schlossbrun.......... Fuered (Hungary)............... Brides-les-Bains................. Montmirail...................... Mergentheim (Wiirtemberg)..... Friedrichshall (Saxe Meiningen) Kissingen (Bavaria)............. Elster (Saxony).................. Bertrich (Coblentz).............. Rubinat.......................... Tarasp (Engadine)............... Birmensdorf..................... Situation. Magne- Sodium sulphate. sulphate. Per 1,000 p Kentucky. 007 002 Kentucky. 33-40 Pennsylvania. 60 01 Austria. 17 43 16-25 Austria. 247 231 Austria. 160 159 Austria. 135 Austria. 121 161 Austria. 109 60 Austria. 24 12-4 Austria. 40 181 Austria. 50 Austria. 35 Austria. 2,3 Austria. 23 Austria. 22 Austria. 07 France. 050 1-25 France. 93 50 Germany. 5'4 66 Germany. 51 60 Germany. 50 5-8 Germany. 52 Germany. 09 Spain. 3-17 93 23 Switzerland. 2 1 Switzerland. 220 70 Magne- sium chloride. Sodium chloride. arts wat er. 1-3 23 144 16 1 7 9 76 Chalybeate. Alkaline. Alkaline. Alkaline, 125° F. Alkaline, 158° F. Alkaline, 122° F. Alkaline. Carbonated, 95° F. Alkaline. Ferruginous, chalybeate, or iron waters are those in which there is a sufficient amount of some iron salt, usually the carbonate, chloride, or sulphate, to give the water a characteristic styptic taste and the therapeutic properties of those salts. While iron is contained in a large number of mineral waters, the quantity is usu- ally so small that it exercises no appreciable medicinal effect. If an appreciable quantity of sodium bicarbonate is associated with the iron, the water is called an alkaline chalybeate water; if there is enough sodium sulphate to produce medicinal effect, the water is called a saline chalybeate water; if sodium chloride is present in sufficient quantity, the water is termed chlorinated, or muriatic-acidulous cha- lybeate water; and if it contains calcium car- bonate or sulphate, it is designated as earthy, or calcic-acidulous, chalybeate water. The iron is probably absorbed with the water from the stomach and intestinal tract, the pro- cess of absorption being furthered if there is carbonic-acid gas in the water. The latter is always present when there is carbonate of iron, which is only held in solution by an excess of acid. The iron increases the red blood-corpuscles, suppuration, or protracted acute or chronic diseases. In chlorosis, in the cachexia asso- ciated with chronic paludal poisoning, in that consequent on the prolonged use of mercury in syphilis, in chronic lymphadenitis, in chorea, in menstrual derangements of hemic origin, in albuminuria, and in neurasthenia these waters may be prescribed with advantage, and a saline or chlorinated chalybeate spring is preferable. Sometimes the administration of a chalybeate water causes intestinal torpidity, and, as in chlorosis there is often self-intoxication due to constipation, the use of iron water must be dis- continued or be associated with that of a saline water. Dyspepsia or diarrhoea that appears during the use of iron waters indicates the ne- cessity of discontinuing the treatment, unless warming the water terminates the disorders mentioned. In chronic forms of paludal poisoning the iron waters that contain arsenic, such as those of Roncegno and Levico in the Austrian Ty- rol, are especially indicated. Such waters are excellent for weak and delicate persons who are affected with gastric neuroses, because their use may be continued for a long time. In all diseases these waters should be adminis- WATERS, MINERAL 370 tered at first in small doses, a tablespoonful half an hour after luncheon sufficing; this dose is gradually increased up to two or three tablespoonfuls three times a day. Atony of the stomach is improved by the ad- ministration of acidulated (carbonated) cha- lybeate waters. The following is a partial list of chalybeate springs of the United States and of Europe: those of the salts with which it is associated. Sometimes waters that contain this gas will produce a sense of heat in the stomach, excite gastric distress, and eventually cause unpleas- ant eructations of sulphuretted hydrogen; but in moderate doses, and if the waters con- tain also sodium chloride, they stimulate the secretions of the gastro-intestinal canal. Con- tinued for some time, these waters impair the NAME OF SPRING. Bailey Springs, Lauderdale Co....... Cullum's Springs, Choctaw Co....... Talladega Spring, Talladega Co...... Fulton Wells......................... Linwood Spring...................... Angier's Mineral Spring............. Schuyler County Spring............. Benham's Carburetted Saline Well.. Indian Springs....................... Ott's Well............................ Iowa Acid Spring.................... Cherokee Magnetic Mineral Spring.. Owosso Chalybeate Spring........... Bratton Spring....................... Fairview Mineral Spring............. Chittenango Springs................. Oak Orchard Acid Spring............ Kittrell Springs...................... Iron Spring (Warm Springs)......... Green Mineral Spring................ Stryker Mineral Well................ Payton Mineral Spring............... Cresson Springs...................... Kittanning Mineral Spring........... Guylych and Gay lord's Spring....... Blossburg Springs................... Austin's Spring...................... Pate Sour Well....................... Sour Lake Mineral Springs.......... Wootan Wells........................ Montebello or Newbury Springs..... Bath Alum Springs No. 2............. Bedford Alum and Iron Springs..... Church Hill Alum Spring............ Jordan Alum Springs................ Pulaski Alum Springs................ Stribling Springs..................... Rock Enon Springs.................. Wallawhatoola Alum Springs........ Sparta Mineral Wells................ Szliacs (Hungary).................... Pyrawarth........................... Franzensbad (Bohemia)............. Spa................................... Flitwick.............................. Harrogate............................ Tunbridge Wells..................... Bussang.............................. La Malou (Herault).................. St. Pardoux (Allier).................. Charbonnieres....................... Homburg............................ Elster (Saxony)..................... Schwalbach (Taunus)................ Booklet............................... Driburg (Westphalia)................ Pyrmont (Waldeck).................. Alexisbad (Black Forest)............. St. Moritz (Engadine)................ Tarasp............................... Situation. Alabama. Alabama. Alabama. California. Florida. Georgia. Illinois. Indiana. Indiana. Indiana. Iowa. Iowa. Michigan. Missouri. Missouri. New York. New York. North Carolina. North Carolina. Ohio. Ohio. Oregon. Pennsylvania. Pennsylvania. Pennsylvania. Pennsylvania. Tennessee. Texas. Texas. Texas. Vermont. Virginia. Virginia. Virginia. Virginia. Virginia. Virginia. Virginia. Virginia. Wisconsin. Austria. Austria. Austria. Belgium. England. England. England. France. France. France. France. Germany. Germany. Germany. Germany. Germany. Germany. Germany. Switzerland. Switzerland. Alkaline chalybeate. 9'64 gr. iron bicarbonate in a gal. 8'78 gr. iron carbonate in a gal. 13 gr. iron subcarbonate in a gal. ; sulphuretted. 9-6 gr. iron bicarbonate in a gal. ; chlorinated. 125 gr. iron sesquioxide in a gal. ; carbonated. 69'96 gr. iron protosulphate in a gal. ; calcic. 1071 gr. iron carbonate in a gal. ; saline. 24 28 gr. iron sulphate in a gal. ; calcic. 14 66 gr. iron carbonate in a gal. ; calcic. 97'3 gr. iron sulphate in a gal. ; acidulated. 11 '26 gr. iron carbonate in a gal. ; calcic. 15 "92 gr. iron bicarbonate in a gal. ; calcic. 36 71 gr. iron sulphate in a gal. ; calcic. 1873 gr. iron bicarbonate in a gal. ; carbonated. 20 "78 gr. iron carbonate in a gal. ; acidulated. 14 to 39 gr. iron sulphate in a gal. : acidulated. 9'2 gr. iron carbonate in a gal. ; acidulated. 31 "9 gr. iron in a gal. ; acidulated. 19-7 gr. iron carbonate in a gal. ; acidulated. 9 "93 gr. iron bicarbonate in a gal. ; chlorinated. 62 gr. iron carbonate in a gal. ; chlorinated. 23 to 33 gr. iron sulphate in a gal. ; saline. 24 gr. iron sulphate in a gal. ; calcic. 73 06 gr. iron sulphate in a gal. ; calcic. 31-32 gr. iron persulphate in a gal. ; acidulated. I 64 gr. iron sulphate I . , 1 11-2 gr. iron oxide f m a gal- 69-16 gr. iron sulphate in a gal. ; saline. 7 to 17 gr. iron sulphate in a gal. ; acidulated. 13-06 gr. iron sesquioxide in a gal. ; acidulated. j 45-04 gr. iron carbonate I- „ ol I 13 • 2 gr. iron sulphate | m a gal" 26 7 gr. iron persulphate in a gal. ; chlorinated. 19 26 gr. iron persulphate in a gal. ; carbonated. 158 79 gr. iron salts in a gal. 1854 gr. iron sulphate in a gal. 108-75 gr. iron sulphate in a gal. 12 13 gr. iron sulphate in a gal. 14-25 gr. iron oxide in a gal. 23 74 gr. iron persulphate in a gal. 14 34 gr. iron carbonate in a gal. 46 gr. iron bicarbonate in a gal. ; carbonated. 50 gr. iron bicarbonate in a gal. ; carbonated. 8 gr. iron bicarbonate in a gal. ; saline. Iron bicarbonate. Iron sulphate. 2'96 gr. iron in a gal. 6 grs. iron salts in a gal. 17 gr. iron bicarbonate in a gal.; carbonated. Iron bicarbonate. Iron bicarbonate. Iron bicarbonate. 7 gr. iron bicarbonate in a gal. ; chlorinated. Iron bicarbonate ; saline. Carbonated. Iron bicarbonate; saline. Iron bicarbonate ; alkaline. Iron bicarbonate ; alkaline. Iron bicarbonate. Iron bicarbonate ; alkaline. Iron bicarbonate : alkaline. Sulphur waters are those that owe their chief characteristic to the presence of sulphur- etted hydrogen, either as a free gas or in com- bination with calcium, magnesium, potassium, or sodium. They are easily recognised by their foetid smell, resembling the odour of rot- ten eggs. It is difficult to distinguish the remedial effects of the sulphuretted hydrogen from red blood-corpuscles, possibly in consequence of the action of sulphur on the haemoglobin, and anaemia, debility, and wasting result. The sulphuretted hydrogen is absorbed by the blood of the capillaries of the mucous'mem- brane of the intestinal tract, and it is elimi- nated by the lungs and the skin, and possibly a small quantity is excreted by the urine. Rohrig immersed rabbits in water saturated 37 with sulphuretted hydrogen, but arranged the animals so that they breathed atmospheric air; death ensued in eighteen minutes in conse- quence of the absorption of the gas. This permeability of the skin by sulphuretted hy- drogen is made use of in the treatment of certain diseases, especially saturnism and mer- curialism, by baths. Braun stated that he had personally expe- rienced the influence of sulphuretted waters in relieving congestion associated with enlarge- ment of the liver. The gas is transmitted by the blood of the portal vein, and it combines in the liver with the iron of degenerating blood-corpuscles, forming an iron sulphide, which is excreted by the faeces. Such treat- ment is particularly indicated for patients who can not use the saline waters because of intes- tinal catarrh. Hepatic congestion associated with bronchial catarrh, hemoptysis, and even pulmonary tu- berculosis, is benefited by the use of these wa- ters. The Bergeon treatment of tuberculosis by inhalations and rectal insufflations of sul- phuretted hydrogen that is obtained from some strongly impregnated water still has its advocates. Internally, these waters may be used as a laxative in constipation due to deficiency of intestinal secretion. Hemorrhoids due to de- fective circulation in the intestinal vessels are benefited by these waters, as is engorgement of the pelvic viscera in women. Braun suggested that the fact that the liver was the main depot for retained metallic poi- sons afforded an explanation of the benefit derived from the administration of sulphur water in chronic poisoning by lead or mer- cury. In saturnism and mercurialism they may be given as draughts, baths, and inhala- tions (nebulized). While the use of sulphur waters externally and internally has had great vogue in the treatment of various skin diseases, there is no good evidence to prove that they are thera- peutically useful. The use of baths of sulphur water or of sul- phur vapour, as in the. case of Glenwood Springs, Colorado, has relieved certain cases of chronic and muscular rheumatism and gout. The influence of the heat and moisture and that of the salts contained in the water must not be overlooked. The value of sulphuretted-water baths in the various forms of syphilis and in paralysis is no greater than that of warm water. Most of these waters owe their therapeutic value to the salts they contain rather than to the sulphuretted hydrogen or the sulphides. The waters of Aix-la-Chapelle, or Aachen, enjoy a general European reputation for their efficacy in the treatment of rheumatism, gout, and syphilis. Dr. E. P. Philpots (Bristol Medico-chirurgical Journal, I880, p. 104) states that after a person with syphilis has remained in water of a temperature of 95° F. for half an hour, he is dried and rubbed with about three drachms of mercurial ointment; the sohei muscles being rubbed one day, the thighs the next, then the abdomen, thorax, arm, fore- 1 WATERS, MINERAL arm, and back, and then the solsei receive an inunction again. The patient is given a mouth wash of potassium chlorate, and if salivation occurs the inunctions are discontinued for a day or so. From twenty to eighty baths and inunctions are given in each course. Aix-les-Bains is frequented by the English and French because of its proximity to London and Paris. Sir Alfred B. Garrod (Lancet, 1887, vol. i, p. 869) said he had known a patient to leave London at eleven o'clock one morning and finish the first day's treatment by the same hour the following day. He thought the best season there was from May 10th to June 10th, or from the end of August to the end of Sep- tember. The hot sulphur mineral douche, the massage, and the internal administration of the sulphur waters relieve rheumatoid ar- thritis, muscular rheumatism, sciatica, and other neuralgic affections, and cutaneous af- fections associated with rheumatoid arthritis and gout. The United States is particularly rich in springs that contain this gas, and in the list there will be found mention of such waters. Of the European spas the more important hot springs are those of Baden (temperature 131° F.), near Vienna, the Herculesbad (111-2°) at Mehadia, the springs at Ilarkany (143-6°), Grosswardein (113°, saline), Pystjan (173-?°, carbonated), Trenchin-Teplitz (104", calcic), and Warasdin (134-6°, carbonated), in Hun- gary; Abano and Battaglia (7o-7° to 160°, chlorinated), in Italy; Bareges (88° to 111-2°, calcic), Bagneres-de-Bigorre, Bagneres-de-Lu- chon (154°), Amelie-les-Bains (108° to 141-8°, calcic), Cauterets (102-2°), Eaux-Bonnes (89-6°), Saint-Sauveur (93-56°), and Vernet, in the French Pyrenees; Aix-la-Chapelle (131°, sa- line), in Germany; Aix-les-Bains (114-8°), in Savoy; Ponticosa (77° to 91-4°), in Spain; and Baden (114-8, saline), Lavey (109-4°, sa- line), and Schinznach (109'4°, saline), in Swit- zerland. Among the cold sulphur springs are those of Harrogate, in England; Lisdoonvarna, in Ire- land ; Eilsen, Neundorf (calcic), Weilbach (carbonated), Meinberg (carbonated), Langen- briicken, Ilohenstedt, Sebastiansweiler, and Kreuth, in Germany; Enghien, in France; Strathpeffer, in Scotland; and Alvenu, in Switzerland. Certain mineral waters which contain an appreciable quantity of lithium salts are re- ferred to as lithia waters, but the reports in regard to their therapeutic virtues are commoner in the secular press and in descriptive circulars than in the pages of medical journals. The Londonderry lithia water, from Nashua, New Hampshire, the Buffalo lithia water, the Farm- ville lithia water, and the Bowden lithia water have been extolled as remedies for a number of diseases. How much of their efficacy is due to the quantity of water imbibed and how much to the lithium salt is a matter for scien- tific research. Sir William Roberts (On the Chemistry and Therapeutics of Uric-acid Gravel and Gout; Croonian Lectures, 1892) has called attention to the fact that, because solutions of lithium carbonate and piperazine WATERS, MINERAL 372 possess a high solvent power for free uric acid, it has been inferred from this fact that their administration internally might exercise a fa- vouring influence on the solubility of sodium bi-urate in the bodily fluids, and thereby tend to prevent the formation of uratic deposits. This inference, however, he does not deem jus- tifiable. He found experimentally that the addition of lithium or piperazine, in the propor- tion of 0-1 per cent, and 0-2 per cent., to blood- serum or synovial fluid did not have the slightest effect in enhancing the solvent power of these media on sodium bi-urate or m retarding its precipitation from serum and synovia arti- ficially impregnated with uric acid. Sir William considered that if the remedies mentioned have any effect in gout, it is certainly not due, as has been supposed, to their solvent action on the material of gouty concretions. Dr. J. H. Claiborne (Virginia Medical Monthly, 1889, xvi, p. 708) says he has pre- scribed Buffalo lithia water for a number of years in cases of lithiasis, uremia, Bright's disease, cystitis, and nephritic colic with satis- factory results. The ingestion of large quan- tities of water, from half a gallon to a gallon in a day, often causes the solution of gravel, and it is passed as sabulous matter. Dr. James Shelton (Virginia Medical Monthly, 1887, xiv, p. 440) has found that the water from spring No. 1 relieves functional neuroses, amenor- rhea, dysmenorrhea, menorrhagia, the ca- chexia and sequele of paludal fevers, dyspepsia, scarlatinal nephritis, diabetes mellitus, syphi- lis, gleet, hepatic engorgement, eczema, and acne. [Dr. George Halsted Boyland (New York Medical Journal, August 22, 1896), who was formerly resident physician at the Buffalo Lithia Springs, says he is satisfied that there is no other mineral water either in America or in Europe so singularly adapted to such a large number and variety of maladies. He says: "The solvent properties of all three springs on grape sugar is immediate (as can be readily proved by placing 10 or 20 grains in a test tube and adding half an ounce of water), and their great value in the treatment of dia- betes mellitus is attested by numerous cases." He has found the waters useful also in jaun- dice, albuminuria, and those cases of inflam- mation of the vermiform appendix that are dependent on the formation of phosphatic de- posits in the appendix.] Earthy, or calcareous, waters are those which contain such earthy substances as cal- cium carbonate and sulphate and magnesium carbonate as prominent constituents. The calcium bicarbonate in mineral waters is usu- ally first reduced in the stomach to a carbo- nate before it can be changed into calcium chloride or lactate, and it reappears in the fasces as calcium carbonate or phosphate. Internally, the constituent salts of these waters have some action as antacids and act as astringents. The acidity of the urine is dimin- ished or that excretion may be made alkaline. The alkaline are preferable to the earthy waters in cases of gastric catarrh with hyper- acidity The bactericidal property of the calcium salts may be of value in diarrhea ac- companied by intestinal catarrh. There is no evidence to support the theory that these wa- ters are of value in caries, necrosis, osteoma- lacia, or other bone diseases, and they do not hasten the calcification of tubercles. External- ly, these waters have proved useful in gouty and rheumatic affections and some chronic exanthe- mata, probably because of the presence of car- bonic acid in the water. While these waters have been used in the treatment of bronchial catarrh, cystitis, hepatic and cystic calculi, and certain skin diseases, there is no good evidence to justify the belief that the calcium salts have exercised any therapeutic effect. These springs—in which the sum of mineral constituents does not exceed the amount pres- ent in ordinary potable water, in which there is no sodium, or only a small trace of it, and in which the principal ingredient is a small percentage of calcium carbonate or sulphate— are likely to be of value in the treatment of gout. Most if not all of the calcium salt proba- bly passes out in the fasces, so that such springs depend upon their watery constituents. As the waters are taken freely and usually on an empty stomach, they dilute the blood tem- porarily and lower its percentage of urates and sodium salts, and thus retard or prevent the precipitation of urates, and give the defective kidneys more time for the task of eliminating uric acid. Among the springs particularly indi- cated in gouty conditions are those of Bath and Buxton in England; of Aix-les-Bains, Bareges, Contrexeville, and Vittel in France; and of Gastein, Pfaffers, and Wildbad in Germany. The list of springs in the various States makes mention of the calcic waters in the United States. In Europe, the better known spas are those of Bigorre, Crausac, Contrexeville, St. Armand, St. Galmier, and Vittel, in France; Inselbad, near Paderborn, Driburg and Lipp- spring, in Westphalia, and Wildungen in Wal- deck, in Germany; and Leuk, in Canton Wallis, and Weissenburg, in Canton Bern, in Switzer- land. Calcium sulphate is found in medium amounts in the Piillna, Sedlitz, Saidschiitz, Iwanda, and Friedrickshall saline waters; in the Mergentheim, Bourbonne, Cannstadt, Schmalkalden, Rehme, Wildegg, and Mondorf chlorinated waters; and in the Neundorf, Schinznach, Eilsen, and Luben sulphur waters. Carbonate of calcium is found in the waters of a number of spas as an associated salt. Though the use of mineral waters is indi- cated at all seasons of the year, there are cer- tain times when the springs in this country and in Europe are in season. At a number of these resorts the hotels are open only during certain months in the year, and at other times accommodations are likely to be inferior. The use of the waters at home, while not without advantage, is less likely to be followed by the improvement that occurs when they are taken at the springs, where the change of air and scene add their influence to the medicinal properties of the water, and where the details of diet and mode of life are more punctiliously attended to. The season at most of the resorts extends from May to October, though at some it is 373 WATERS, MINERAL from June to September, while some—like Glenwood Springs, Colorado, Warm Springs, North Carolina, or Hot Springs, Arkansas—are open all the year, the winter and spring months being most popular at the two last-mentioned resorts. Certain resorts in Europe are not closed at any season, such as Aix-les-Bains, Aix-la-Chapelle, Amelie-les-Bains, Baden-Ba- den, Bath, Dax, and Wiesbaden. The possibility of more outdoor life during a sojourn in the warm months of the year is a factor that should be considered by the physi- cian in selecting a resort, especially for persons with diseases that are likely to be affected by variability in the weather or by confine- ment in the house. The length of treatment may best be deter- mined by the resident physician at the springs. Power of recuperation, as well as impressibility, varies in different individuals, and there are instances in which an apparently suitable spa proves to be disadvantageous to a patient. It is therefore inadvisable for the physician who recommends a course of treatment to lay down any specific rule. If the resident physician at such a resort is a competent man, he can best report on the improvement, and, as the length of sojourn should be commensurate with the advantages that are derived from it, it would be best to direct patients to follow such advice. Obvi- ously, it would be impossible for a physician at a distance to know of the features of the change in a patient affected with anaemia, but the resident physician, who should make regu- lar observations with the hsemoglobinometer and haematocrite, is prepared to speak with positiveness on the benefit afforded by the re- sort. This same is true in the several forms of nephritis, in which regular urinary analysis affords positive information of the condition of the kidneys and of the influence of the water on their action. In gastric disorders the examination of the performance of stom- ach digestion is essential. In fact, few dis- eases should be treated at these places without the regular use of the methods of precise ex- amination rather than the perfunctory ques- tioning of the patient and advice based on interpretation of his statement of his condi- tion. It is needless to say that there are very few resorts in this country where such system- atic methods are in vogue, and until such ad- vice can be secured the resorts of Europe are likely to be patronized by Americans rather than those of the United States. The empiri- cal administration of iron, mercury, potas- sium iodide, or quinine is likely to be less advantageous to a patient than the use of any STATES. Northern Atlantic States....... Southern Atlantic States....... Southern Central States....... Northern Central States....... Western States and Territories Total...................... of these drugs after careful consideration of the evidence afforded by the use of instru- ments of precision. The writer would not overrate the value of the latter, which will prove of little use if unassociated with good judgment and experience; but it is only by the aid of all such methods that physicians can escape the old-time reproach that they were a class " engaged in pouring drugs of which they knew nothing into stomachs of which they knew less."' The question in regard to the desirability of a person',s returning home immediately after a course of treatment, or of going to some other place for a longer or shorter time, should be decided by the resident physician at the springs. In many instances, especially in gas- tric, renal, or hepatic affections, it is essential for the patient to enhance or fortify his con- dition after the improvement afforded by a course of mineral waters, and some weeks at a well-selected place will insure abstinence from work and a continued attention to the details of diet. The question in regard to the choice of min- eral waters and their applicability to different patients is as unsettled as that of the selection and administration of other remedial agents. Every factor that plays a part in the choice of a suitable medicament must be considered as well in the selection of a mineral water that is likely to benefit a patient. But in choosing the latter it is necessary to consider not only the character of the disease, the degree to which the organs affected are involved, the general condition of the patient, and the analo- gous factors, but also the patient's ability to stand the journey to the springs, the effects of the various factors besides the waters that ex- ist at such resorts, and the season of the year when the visit should be made. Dr. Julius Braun has very truly said (On the Curative Effects of Baths and Waters. Trans- lated by Hermann Weber, M. D.): '"Cases of sickness of very different kinds are cured and improved by one and the same medicinal spring, and cases of similar nature are cured and improved by very different medicinal springs." Dr. A. C. Peale, who prepared the list of the mineral springs of the United States that was published in Volume V of the Bulletins of the United States Geological Survey, collected data that must serve as a basis for all future work in this field. The writer would acknowledge his obligation to that list, which has materially aided his per- sonal observations, and he reproduces herewith Dr. Peale's summary of the springs in the dif- ferent geographical divisions of this country : No. of No. of Total springs springs number of used as used com- analyses resorts. mercially. of waters. 74 72 187 152 42 164 174 36 146 122 55 224 112 18 138 634 223 S59 No. of No. of No. of spring individual springs localities. springs. analyzed. 405 657 155 371 1.048 148 721 1,911 137 601 1,276 215 724 3,951 132 2.822 8.S43 787 WATERS, MINERAL 374 From this table it may be seen that less than 10 per cent, of the number of mineral springs in this country have had their waters analyzed. while but little more than 20 per cent, of the places where mineral waters are found are used as resorts. . Alabama contains a number of mineral springs, though few of them have anything more than a local reputation, and the waters of but few have been analyzed. Those that are used as resorts have much to be desired in the matter of accommodation for visitors. Bailey Springs, in Lauderdale County, Chandler's Springs, in Talladega County, and Greene Springs, in Hale County, are chalybeate springs. Bladon Springs, in Choctaw County, is an alka- line, carbonated, and sulphuretted water, simi- lar to that of Aachen. At Blount Springs there are five saline sulphuretted springs, and a somewhat similar water is found at Cullum's Springs, in Choctaw County. There are sul- phuretted and chalybeate springs at Blue Grass Sulphur Springs, near Cornelia; at Coffee Springs, in Geneva County; at Tallahatta Springs, in Clarke County, and at White Sul- phur Springs, in Calhoun County. Alaska has within its area a number of hot springs, the better known of which are the sa- line-sulphuretted springs (temperature, 153° F.) north of New Archangel, Sitka Island. There are also cold springs of chalybeate, sa- line, and sulphuretted waters, no analyses of which have been made. In Arizona there are hot springs (tempera- ture, 130° F.) above the mouth of the San Francisco River; the Monroe Hot Springs (temperature, 150° to 160° F.), south of Prescott, are used for bathing, and there is a number of carbonated, sulphuretted, alkaline, and saline springs, none of which is used as a resort. Arkansas is better known from its hot springs than from any other feature of the State. There are some seventy springs situ- ated in a picturesque valley that is easily ac- cessible and is supplied with excellent hotel accommodations—too frequently the feature that is lacking in the spas in the United States. There is no characteristic feature in either the temperature or the ingredients of this water to make it superior to many other thermal springs in this country. But it has had a certain popu- larity in the treatment of constitutional syphi- lis and chronic rheumatism and gout, and fashion has served to enhance its position among such resorts. The consensus of opinion of expert physicians at Hot Springs is that the therapeutic value of these waters is due more to physical properties than to chemical combination (Dr. T. M. Baird, Hot Springs Medical Journal, 1894, vol. iii, p. 3; Dr. W. H. Barry, ibid., 1892, vol. i, p. 103; Dr. G. W. Galvin, New York Medical Journal, 1887, vol. xlv, p. 656; Dr. J. T. Jelks, Atlanta Medical Register, 18.81, vol. i, p. 513; Dr. J. M. Keller, St. Louis Medical and Surgical Journal, 1879, vol. xxxvii, p. 83; Dr. E. R. Lewis, Journal of the National Association of Railway Surgeons, 1889, vol. ii, p. 6). As soon as this water is allowed to stand or to flow in the open air a large amount of deposit will occur. The ex- ternal and internal use of these waters is use- ful in gout, rheumatism, neuralgia, incipient Brights disease, cystitis, functional disease of the liver, chronic diarrhea, chronic skin dis- eases, especially of squamous types, and ma- larial toxemia. [An editorial writer in the New York Med- ical Journal for December 1, 1894, says : " If we were to base our judgment on chem- ical analyses alone, it would be puzzling to account for the cures wrought by the waters; practically, they contain nothing but silica. Nevertheless they do bring about unquestion- ably the recovery of many an invalid doomed without their aid to years of drooping health and an untimely death. How do they do it % The local physicians say that it is by virtue of their occasioning a marvellous activity of the emunctories, whereby the system is enabled to tolerate huge doses of active drugs, while at the same time the patient, hoping for something akin to a miracle, subordinates all his thoughts to the effort to get well and obeys his physi- cian's instructions implicitly. "Recognising the efficacy of a sojourn in the romantic city of Hot Springs, together with a systematic use of its thermal waters, the Government has established on its reserva- tion there a general hospital for the benefit of officers and enlisted men actually in the serv- ice and suffering from ailments that have been contracted in the line of duty and have re- sisted treatment at other military or naval hospitals. ... A circular issued from the Ad- jutant-General's office says: "' Relief may reasonably be expected at the Hot Springs in the following conditions: In the various forms of gout and rheumatism, after the acute or inflammatory stage; neural- gia, especially when depending upon gout, rheumatism, metallic or malarial poisoning; paralysis, not of organic origin; the earlier stages of locomotor ataxia, or tabes; the early stages, only, of Bright's disease; diseases of the urinary organs ; functional diseases of the liver ; gastric dyspepsia not of organic origin ; chronic diarrhea ; catarrhal affections of the digestive and respiratory tracts; chronic skin diseases, especially the squamous varieties; and chronic conditions due to malarial infec- tion. Speaking generally, treatment by the Hot Springs water may be said to stimulate all the secretions and the organic functions, to promote digestion and assimilation, and to favour tissue metamorphosis and excretion, thereby relieving internal congestions, stimu- lating blood-making, increasing the appetite, and favouring new and healthy tissues at the expense of the old and inactive. The Hot Springs water is contra-indicated in all acute inflammatory diseases, tuberculosis, organic disease of the heart or brain, cancer and other malignant diseases, aneurysm, and in all cases where stimulation of the circulation is to be avoided.'"] Dr. G. Adams has published an account of the Arkansas Lithia Spring (Therapeutic Ga- zette, 1889, v, p. 13), situated near Hope, Hampstead County. An analysis showed that each imperial gallon contained 75-86 grains, 37; including sodium chloride, 24-16: lithium chloride,3-63; magnesium sulphate, 11-97; and iron oxide, 4-55 grains. The water had a di- uretic and laxative effect. There was no ac- commodation for patients. There are saline springs at Blanchard Springs, in Union County; saline and chalybeate springs at Blood Spring, in Montgomery County; sul- phuretted saline springs near Dardanelle; sul- phuretted springs at Gum Springs, in Cleveland County, at Pennywits Sulphur Springs, in Crawford County, and at White Sulphur Springs, near Pine Bluff. There are chalybeate springs at Mount Nebo Springs, near Darda- nelle. There are calcic springs at Eureka Springs, in Carroll County, the water of which contains but 5-85 grains of solids, including 4-43 grains of calcium bicarbonate in each gal- lon, and at Mountain Valley Springs, near Hot Springs, the water of which contains 21-82 grains of solids, 12-66 grains of which are calci- um bicarbonate, in a gallon. Except at Eureka Springs, the accommodations are primitive. California has probably a larger number of mineral springs, more of which are improved as resorts, than any other State. As is the case in most regions where there are evidences of volcanic action, there are many thermal springs, some of which are popular resorts. There are alkaline carbonated springs at Adams Spring, in Lake County, which have proved of value in chronic dyspepsia, hepatic congestion, and rheumatism; Mtna Springs, in Napa Coun- ty; Allen Springs, in Lake County; Cali- fornia Seltzer Spring, in Mendocino County ; Fry's Soda Spring, in Siskiyou County; Glen Alpine Mineral Springs, in El Dorado County; Litton's Seltzer Spring, in Sonoma County; Summit Soda Springs, in Alpine County; Tolenas Spring, in Solano County; and Vichy Springs, in Santa Clara County. There are sulphuretted-saline springs at Alum Rock Springs, in Santa Clara County; Byron Springs, in Contra Costa County; El Paso de Robles Springs (hot and cold), in San Luis Obispo County; on Pluton Creek, in Sonoma County; Harbin Springs and Mill's Mineral Springs (hot), in Lake County; and Tuscan or Lick Springs, in Tehama County. There are sulphuretted-chalybeate springs at Bonanza Springs, in Lake'County; El Paso de Robles Springs, in San Luis Obispo County; Mark West Springs, in Sonoma County; and Wit- 5 WATERS, MINERAL ter's Springs, in Lake County. There are alka- line-sulphuretted springs at Castalian Mineral Wells, in Inyo County, and Pearson's Springs, in Lake County. The alkaline and saline springs are Bartlett Springs, in Lake County. The alkaline springs are Geyser Springs, in Sonoma County, and Highland Springs, in Lake County. There are sulphuretted springs at Fulton Wells, in Los Angeles County; Hot Mud Springs, in Siskiyou County; Monticello Hot Springs, Mountain Glen Springs, and Las Cruces Hot Springs, in Santa Barbara County; Matilija Hot Springs, in Ventura County; Newsom's Arroyo Grande Warm Springs, in San Luis Obispo County ; Simmon's Hot Sul- phur Springs, in Colusa County; AVarner's Ranch Springs, in San Diego County: St. Helena Springs, in Napa County ; and Wilbur Springs, in Colusa County. Colorado includes within its territory both warm and cold springs, the waters of which are rich in various constituents. Among the most celebrated of these springs are the six springs at Manitou, a beautifully situated town at the foot of Pike's Peak. An analysis of the water by Oscar Loew, in 1875, showed the following ingredients: All the waters contain free carbonic acid in large quantities. Dr. S. Edwin Solly (Manitou, Colorado, U. S. A. Its Mineral Waters and Climate) recommends the administration of the water of the Navajoe spring in catarrhs, hepatic or renal plethora, gout, gravel, gastric catarrh, in- testinal catarrh, pyrosis associated with chronic dyspepsia, and gastric irritability in incipient or threatened phthisis. He has found this water useful externally in skin diseases in which pruritus or excoriation of the epidermis is a prominent feature, and as an injection it relieves intractable leucorrhea. He considers the Shoshone water useful in gallstones, hem- orrhoids, jaundice, and dyspepsia of hepatic origin. The Little Chief water is advised in those diseases in which the administration of iron is indicated. The Iron Ute spring is rec- ommended for the treatment of anemia caused by parturition or prolonged lactation, in amen- orrhea and menorrhagia of ha?mic origin, in gastric and intestinal atony, and in functional neuroses. At Glenwood there is the Yam pah spring. An analysis of the water by Professor Chandler MANITOU SPRINGS. CONSTITUENTS. Iron Ute Spring. Parts in 100,000. 59 34 59 04 14-56 trace 5-78 30-Sti 701 3159 269 Little Chief Spring. Manitou Spring. Navajo Spring. Ute Soda Spring. Shoshone Spring. Parts in 100,000. 1516 75 20 13 01 trace 1-80 51-88 624 47-97 222 Parts in 100,000. 52 26 11100 20 51 021 trace 1971 13 35 40 95 201 Parts in 100,000. 124-69 129 40 31-66 024 1842 1621 39-78 1-47 Parts in 100,000. 23-82 40 00 610 trace 140 1224 trace 1393 trace Parts in 100,000. 88-80 J-108 50 trace 37-08 512 42-12 trace 210-87 213-48 260-00 36187 97-49 281-62 ----- WATERS, MINERAL 376 showed the following constituents in each gallon: Chloride of sodium....'.......... 10898307 grains. Chloride of magnesium......... 13-0994 Bromide of sodium.............. 05635 grain. Iodide of sodium................ trace Fluoride of calcium............. Sulphate of potassium.......... 24-0434 grains. Sulphate of calcium............. 82 ■ 3861 Bicarbonate of lithium.......... 02209 grain. Bicarbonate of magnesium..... 13 5532 grains. Bicarbonate of calcium......... 24 3727 Bicarbonate of iron............. trace Phosphate of sodium........... Biborate of sodium.............. Alumina......................... Silica........................... 1-9712 grains. Organic matter................ trace Total........................ 1250-0411 grains. Dr. J. C. Blickensderfer, of Denver, has found that the external and internal use of these waters is of value in Brights disease, rheuma- tism, hepatic diseases, syphilis, and various skin diseases. Dr. Lewis R. Morris (New York Medical Journal, September 28, 1895) states that a glass or more of the water, either hot oj cold, taken in the morning before breakfast, seems to increase the appetite and relieve the nausea in dyspepsia and gastric catarrh. In chronic catarrhal gastro-enteritis, in constipa- tion, in saturnism, and in rheumatoid arthritis Dr. Morris has found these waters useful. The Siloam springs, in Garfield County, have an outflow of water varying in temperature from 94° to 104° F., and containing 616-5 grains of salts, principally sodium chloride and calcium sulphate, in each gallon. It is stated that the waters act like those of Glenwood, but there are no such luxurious accommodations as exist at the latter place. In Canon City there are several springs of therapeutic value. Dr. F. R. Blake (St. Louis Courier of Medicine, 1881, vol. vi, p. 178) states that the waters are palatable, though they purge if taken in large quantities. They act on the liver and kidneys, and he has found them especially useful in biliary obstruction. The hot springs are used for baths. Professor Loew gives an analysis of the waters in the following table: ham County; at Oxford and North Haven, in New Haven County; and at Stafford Springs, in Tolland County. The facilities of travel afford the residents of this State opportunity to visit springs where water more heavily im- pregnated with mineral substances may be ob- tained. There are no mineral springs of importance in Delaware, although water that is mildly chalybeate is found in several parts of the State. Florida is rich in springs that contain hydro- gen sulphide, and the presence of that gas is an objection to the water that is obtained from the artesian wells. As a rule, the waters con- tain but small percentages of mineral sub- stances. There are sulphuretted springs at Orange City and Enterprise (De Barry Springs), in Volusia County; at Clay Spring, near Apopka, and at Hoosier Spring, near Alta- monte Station, in Orange County; at Tarpon Springs, in Hillsborough County ; and at White Springs, in Hamilton County. There are cha- lybeate springs at Newport Sulphur Springs, near Saint Mark's, in Wakulla County, and at Wesson's Iron Springs, in Hamilton County. The accommodations at some of these places are primitive, but the waters may be employed as adjuncts to the mild climate. Georgia contains a number of mineral springs, several of which have been improved so that the resorts are satisfactory. There are carburetted chalybeate springs in Fulton County, near Atlanta, the Angier's Mineral Springs. The sulphuretted chalybeate springs are Camp's Spring, near Atlanta, in Fulton County; Beall Spring, in Warren County; the Chalybeate Springs, Warm Springs, and White Sulphur Springs, in Meriwether County; Magnolia Spring, in Sumter County; Powder Springs, in Cobb County: and Watson's Springs, in Greene County. There are saline, calcic, chalybeate, and sulphuretted waters at Catoosa Springs, in Catoosa County; at Co- hutta Springs, in Murray County; at Ferro- lithic Springs, in Clarke County; at Garnet Springs, near Toccoa, in Habersham Coun- ty ; at Gordon Springs, in Whitfield County; CONSTITUENTS. Sodium carbonate — Calcium carbonate— Magnesium carbonate Sodium sulphate...... Sodium chloride...... Total ............. Parts in 100,000. 36 26 CANON CITY SPRINGS. Parts in 100,000. 12-66 374 2,34 2-07 19-56 40-40 Big Ute. Aqua Vide. Parts in 100,000. 594 7-32 2 57 2-80 22-58 41-22 Parts in 100,000. 12 6- 3- 2- 20- 45 59 Congress Spring. 58 3- •78 4' •02 3- •49 3' •70 6' Parts in 100,000. •32 ■82 00 10 ■52 20 63 Hot Spring. Parts in 100,000. 119 5-53 211 134 301 13 20 There are no mineral springs of importance in Connecticut, although some weak chalybeate and sulphuretted springs possess a local repu- tation, while springs once used as resorts are now neglected. There are sulphuretted springs at Lebanon, in New London County, and at Suffield, in Hartford County. There are cha- lybeate springs at North Woodstock, in Wind- and at Lawrence Mineral Springs, in Chat- tooga County. There is a small sulphuretted- saline spring at Indian Springs, in Butts County. Among the best springs in the State are the Bowden Lithia Springs, in Fulton County. These springs contain the following constitu- ents: 377 WATERS, MINERAL Dr. T. S. Hopkins (Climatologist. 1891, vol. i, p. 97) says that these waters are useful in the treatment of lithiasis, uricemia, chronic cys- titis, diabetes mellitus, cystitis, prostatitis, gleet, dyspepsia, gout, neurasthenia, and he- patic derangements. When the geological formation of Idaho is recalled, the presence of hot springs there would be expected. While many of the hot springs of that State are likely to be used for medicinal purposes in the future, few*of them are improved at present. In Owyhee County there are the Bruneau Hot Spring, in Bruneau Valley, and Given's Hot Spring, near Reynolds. East of Boise City, in Ada County, there are warm and hot alkaline, chalybeate, and sul- phuretted springs. There are hot sulphuretted springs southwest of Idaho City, in Boise County, and near the Snake River, in Oneida County. The Soda Springs, at the bend of Bear River, in Oneida County, supply car- bonated, calcareous, and chalybeate waters. There are a number of springs in Illinois that contain small quantities of mineral in- gredients, but few of them are of even lo- cal importance. There are carbonated calcic springs at Alcyone Springs, in Cook County, which contain some 44 grains of solids, prin- cipally calcium and magnesium bicarbonates, to the gallon, and Zonian Spring, in Kane County, which contains 15 grains of solids to the gallon. The Ganymede Spring, in Ogle County, contains 20 grains, principally cal- cium and magnesium carbonates, of salts in each gallon. "There are saline and chalyb- eate springs at Green Lawn Springs, Mount Vernon, in Jefferson County, and Perry Springs, in Pike County. The waters of the Glen Flora Springs, near Waukegan, in Pike County, con- tain magnesium, sodium, and calcium bicar- bonates in small quantities, the total salts be- ing less than 40 grains to the gallon. There is a chalybeate spring in Schuyler County that contains a large percentage of iron. There are a number of sulphuretted springs in various parts of the State. Indiana contains within its borders a num- ber of mineral springs, the sulphuretted and chalybeate waters being most numerous. There are chalybeate springs at Anderson Spring, at Hartsville Spring, and near Azalia, in Bar- tholomew County: at Anderson Mound Spring (carbonated), in Madison County: at Central Springs, near Shoals, in Martin County: at Milburn Springs, in Pike County; and at Van Cleave Springs, in Crawfordsville, Montgom- ery County. There are chalybeate and saline springs at De Gonia Springs, in Warren County, the water of which is carbonated and contains 121 grains of solids, principally magnesium, potassium, and sodium sulphates and calcium and iron carbonates, in each gallon. Hawkins's Chalybeate Springs, in Richmond, Wayne Coun- ty, has a carbonated water that contains about thirty grains of solids, principally calcium bi- carbonate and sulphate, in each gallon. The sulphuretted saline springs are Hosea Saline Sulphur Spring, in Clarke County, the waters of which contain 897-29 grains of solids, includ- ing sodium sulphate (393-76 grains), calcium sulphate (221*42 grains), potassium sulphate (111-25 grains), calcium carbonate (88-20 grains), and sodium chloride (59-66 grains), to the gal- lon ; La Fayette Artesian Well, in Tippecanoe County, a carbonated sulphuretted water con- taining 419-54 grains of solids, principally sodium chloride (:>24-~7 grains) and calcium sulphate (56-01 grains), to the gallon; Lodi Artesian Well, in Fountain County, the water of which contains 672*45 grains of solids, prin- cipally sodium chloride (502-46 grains), calcium sulphate (55-56 grains), and magnesium chloride (53-54 grains), to the gallon; Trinity Springs, in Martin County, the water of which contains 32-08 grains of solids to the gallon ; WTyandotte Spring, in Crawford County, the water of which contains 50 grains of solids to the gallon ; and French Lick Springs, in Orange County, where the waters are carbonated and sulphuretted and average between 250 and 350 grains of solids to the gallon, the principal salts being sodium chloride, calcium and magnesium sul- phates, and calcium, magnesium, and sodium carbonates. Iowa has no mineral springs of special im- portance. Chamberlain, or Storm Lake, Min- eral Springs, in Buena Vista County, is an acidulated water that contains some 50 grains of solids, principally lime and magnesia, in each gallon; Colfax Mineral Springs, in Jas- per County, are carbonated saline chalybeate waters which contain some 140 grains of solids, principally sodium, magnesium, and calcium sulphates, to the gallon. The Iowa Acid Spring, at Eddyville, in Wapello County, contains 408-99 grains of sulphuric acid, 226-41 grains of alumina, 97-3 grains of iron sulphate, 44-65 grains of calcium sulphate, and small amounts of some other salts, to the gallon. There is a small alkaline-saline spring at Ottumwa, in Wapello County, the water of which contains 200 grains of sodium sulphate in eaeli gallon. In Kansas there are some wells that furnish ferruginous, saline, and sulpho-saline waters, several of which enjoy considerable local repu- tation. There are carbonated saline-chalybeate springs at Arrington, in Atchison County. 178 WATERS, MINERAL ^ There are chlorinated springs at Geuda Springs, in Sumner County; at Cawker City (Great Spirit Spring), in Mitchell County; at Girard, in Crawford County; and at Iola, in Allen Coun- ty. There are chalybeate springs at Louisville, in Pottawatomie County, and at Baxter Springs, in Cherokee County. Kentucky is well known on account of several of its mineral springs, and in those counties where there are the Silurian and Car- boniferous formations it is impossible to bore an artesian well without striking underground sources of some kind of mineral water. The sulphuretted springs include Allen Springs, in Warren County; Buffalo Springs, in Breckin- ridge County ; Fox Springs, in Fleming Coun- ty; Grayson Springs, in Grayson County; Hardin Springs, in Hardin County; Salubrian Springs, in Christian County; and Young's Springs, in Bath County. The sulphuretted and chlorinated springs include Beachville Springs, in Metcalfe County; Big Bone Lick Springs, in Boone County; Blue Lick Spring in Nicholas County; Campbellsville Sulphur Spring, in Taylor County; Drennon Springs, in Henry County; Elliston's Sulphur Spring, in Madison County; Estill Springs, in Estill County; Latonia Springs, in Kenton County; Olympian Springs, in Bath County; Paroquet Springs, in Bullitt County; and Sabree Springs, in Webster County. The saline springs in- clude Bedford Springs, in Trimble County; the lower Blue Lick Spring, in Nicholas County; Cerulean Springs, in Trigg County; Harrods- burg Springs, in Mercer County; Rochester Springs, in Boyle County; Tar Springs, in Breckinridge County; and Yates Mineral Spring, in Boyle County. The principal chalyb- eate springs are Bryant's Springs, in Lincoln County; Burgher's Spring, in Logan County; Davis Spring, in Hopkins County: Dripping Springs, in Garrard County; Esculapia Springs, in Lewis County; Hickman's Springs, in Daviess County; Howell Mineral Springs, in Hardin County; and Rockcastle Springs, in Pulaski County. Louisiana has no mineral springs of any particular importance. There are chalybeate springs at Abita Spring and at Claiborne Springs, both near Covington, in Saint Tam- many Parish ; they were popular resorts prior to the civil war, and still have some vogue with the residents of New Orleans. There is a sulphur spring at White Sulphur Springs, in Catahoula Parish. Maine contains mineral springs that supply waters of most of the different classes, except the thermal. Few of the springs are strongly impregnated with salts or gases. Alkaline, calcic waters are supplied by the Addison Mineral Spring, in Washington County; the American Chalybeate Spring and the Auburn Mineral Spring, at South Auburn, and the Lake Auburn Mineral Spring, at North Auburn, in Androscoggin County; the Poland Spring, at South Poland, in Androscoggin County; and the Rosicrucian Spring, in Lincoln County. Sulphuretted water is supplied by the Bethel Spring, in Oxford County; Boothbay Medici- nal Mineral Spring, in Lincoln County; and Katahdin Mineral Spring, in Piscataquis Coun- ty. There are saline springs at Hartford Cold Springs, in Oxford County; and at Lubec Saline Springs, in Washington County. The Poland Spring is the best known of the Maine springs. The water contains about 3-75 grains of solids to the gallon, principally calcium carbonate and silica. The Paradise Spring, near Brunswick, in Cumberland County, is a purer water, as it contains less than a grain of salts to the gallon, sodium carbonate and silica being the chief constituents. Maryland contains a number of springs the waters of which are impregnated with small quantities of mineral ingredients. None of them is of much importance, and several that were formerly used as resorts have been virtually abandoned. There are mild chalybeate springs at Bentley's Springs, in Baltimore County; at River Springs, in St. Mary's County; and at Spa Spring, in Prince George's County. There is an alkaline, calcic, carbonated spring, the Strontia Mineral Spring, at Brooklandville, in Baltimore County. The water contains 1*86 part of strontium bicarbonate in 100,000 parts. Massachusetts has no mineral springs that possess anything more than local importance; the waters contain but small proportions of mineral ingredients. Alkaline calcic waters are obtained from the Allandale Springs, West Rox- bury, in Suffolk County; Bethlehem Spring, near Braggville, in Worcester County; and the Commonwealth Mineral Spring, Waltham, in Middlesex County. Mild chalybeate waters are supplied by the Crystal Mineral Springs, at Stoneham, in Middlesex County; Coldbrook Mineral Springs, in Worcester County; and Hopkinton Springs, in Middlesex County. Michigan contains but few natural mineral springs, but in boring artesian wells a variety of mineral waters has been obtained. A num- ber of these wells have been referred to as magnetic ; in no instance, it is credibly stated, has the water itself any magnetic properties, the magnetic phenomena being manifested in the vicinity of the springs. Alkaline calcic wa- ters are obtained from the Eaton Rapids Mag- netic Springs and the Grand Ledge Magnetic Wells, in Eaton County; the Leslie Magnetic Wells, in Ingham County; the St. Louis Mag- netic Spring, in Gratiot County; the Hubbard- ston Magnetic Spring, in Ionia County; the Shawnee Mineral Springs, in Monroe County ; and Butterworth's Magnetic Spring, at Grand Rapids, in Kent County. Sulphuretted water is supplied by the Alpena Magnetic Well, in Alpena County; Owen's Mineral Well, at Ypsi- lanti, in Washtenaw County; and the Wyan- dotte White Sulphur Spring, in Wayne County. Saline waters are supplied by the Fruitport Artesian and Magnetic Well, in Muskegon County ; the Lansing Magnetic Well, in Ing- ham County; the Midland Magnetic Well, in Midland County; the Spring Lake Magnetic Well, in Ottawa County; and the Ypsilanti Mineral Well, in Washtenaw County. The principal chlorinated waters are those of Mount Clemens Mineral Springs (sulphuretted) which contain from 9,000 to 11,000 grains of salts, principally sodium chloride, in each gal- 379 WATERS, MINERAL Ion; and the Saint Clair Mineral Springs, in Saint Clair County. Minnesota mineral springs are compara- tively unimportant. There are alkaline calcic springs at Inglewood Springs, near Minneapo- lis, and at Owatonna Mineral Springs, in Steele County. Mississippi contains a number of mineral springs that supply almost all kinds of waters except the thermal. There are chalybeate springs near Camden, in Madison County; near Aberdeen, in Monroe County; near Gra- nada, in Granada County ; near Holly Springs, in Marshall County; at Ocean Springs, in Jackson County ; and near Columbia, in Mari- on County. The water of Lauderdale Spring, in Lauderdale County, and of Castalian Springs, in Holmes County, is chalybeate and sulphuretted. Saline waters are supplied by Cooper's Well, near Raymond, in Hinds Coun- ty, and La Fayette Springs, in La Fayette County. An analysis by J. Lawrence Smith shows that each gallon of water from Cooper's Well con- tains— Grains. Sodium sulphate........................ 11 71 Potassium sulphate..................... 0'61 Calcium sulphate........................ 32" 13 Aluminum sulphate..................... 6-12 Magnesium sulphate.................... 2328 Sodium chloride......................... 8-36 Calcium chloride........................ 4'32 Magnesium chloride..................... 348 Iron peroxide........................... 3 ■ 36 Calcium crenate......................... 0 • 31 Silicon crenate.......................... 1 -80 Total................................ 95 48 The late Dr. Joseph Jones (Times and Reg- ister, 1892, vol. xxv, p. 395) found that this water was purgative, diuretic, diaphoretic, and alterative. He recommended the water in cases of anasarca, ascites, whether of cardiac, he- patic, or renal origin, acute and chronic alco- holism; Bright's disease, uratic or oxalic calculus, jaundice, whether due to portal de- rangement or to paludism, gout, paludal toxe- mia, chronic diarrhea, chronic constipation, dyspepsia, and neurasthenia. Missouri has saline springs in Milford, in Barton County: in Climax, in Camden County ; in Elk Lick Springs, in Pike County : near Orescent Hill, in Bates County ; and at Reiger Spring, in Mercer County. There are sul- phuretted saline springs near Marshall, in Saline County, and at Rocheport, in Boone County. There are chlorinated and chalybeate springs at Aurora Springs, in Miller County; at Cedar Springs, in Cedar County: at Choteau Springs, in Cooper County; and at Zodiac Springs, in Vernon County. There are saline and chalybeate springs at Bowsher Mineral Springs, in Mercer County; at Bratton Spring, near Columbia, in Boone County; at Lan- dreth's Mineral Well, near Knox City, in Knox County: at Paris Chalybeate Springs, in Law- rence "County; and at Spaulding Springs, in Ralls County. There are chalybeate springs at Cedar Springs, in Cedar County ; at Eldo- rado Springs, in Oregon County ; at Fairview Mineral Springs, in Worth County ; and at McAllister Springs, in Saline County. There 68 are chlorinated springs at Boonesborough, in Howard County; at Harriman's Sulphur Springs, in Cooper County; at Lewis Springs, near Glasgow, in Howard County; and at Sweet Springs, near Huntsville, in Randolph County. There are sulphuretted and chlorin- ated springs at Montesano Springs, in Jeffer- son County, and at Nevada Mineral Springs, in Vernon County. There are alkaline saline springs at Siloam Springs, in Howell County. Montana contains a number of important springs, but very few of them have been im- proved. Probably the thermal springs will prove important; those now used are the Al- hambra Springs, at Clancy, in Jefferson County; Allan's Mineral Springs,"in Bitter Root Valley, in Missoula County; Big Hole Hot Springs, in Beaver Head County ; Boulder Hot Spring, in Jefferson County; Clark's Warm Springs and Puller's Springs, in Madison County; Helena Hot Springs, in Lewis and Clarke County; Hunter's Hot Springs and Mat- thews's Warm Springs, in Gallatin County ; Ryan's Hot Springs, in Beaver Head County ; and White Sulphur Springs, in Meagher County. All of these waters contain mineral ingredients. In Yellowstone Valley, near Mill Creek, in Gallatin County, there is the Apolli- naris Spring that supplies a delightful water, more palatable to the writer's taste than the imported Apollinaris. Nebraska has no mineral springs of any im- portance. The waters of some of the artesian wells contain saline ingredients, but none of them is of medicinal value. Nevada, in consequence of its sparseness of population, has had but little improvement of its mineral springs, which include hot and cold waters. There are hot springs at Elko, in Elko County; near Carson City, in Ormsby County; at Wellington, in Lyon County; at Steamboat, in Washoe County ; at Genoa, in Douglas County; and in Pine Valley, in Eu- reka County. There are sulphuretted springs north of Columbus, in Esmeralda County: near Mineral Hill, in Eureka County: and at Golconda, in Humboldt County. It is likely that within a few years several other springs in this State will be improved so as to be used as resorts. Most of the mineral springs of New Hamp- shire have but local reputation, and their waters contain but a small proportion of min- eral ingredients. There is an alkaline spring at Conway, in Carroll County, the water of which contains but 2 grains of solids to the gallon. There is a carbonated chlorinated spring at Bradford, in Merrimack County. There is a calcic spring at Birchdale Springs, near Concord, in Merrimack County. There are chalybeate springs at Charlestown and East Unity, in Sullivan County; at Milford, Am- herst, and Goffstown Centre, in Hillsborough County; and at Moultonborough, in Carroll County. There is also the Londonderry lithia spring at Nashua, in Hillsborough County. _ New Jersey has no mineral spring of im- portance. At Schooley's Mountain, in Morris County, there is a chalybeate spring, the water of which contains a little more than half a WATERS, MINERAL 380 grain of iron carbonate in each gallon. Sev- eral artesian wells in the State supply water that contains mineral substances. New Mexico has a number of mineral springs, some of which have been used for medicinal purposes since the time of the Span- ish occupation. There are saline chlorinated hot springs near Las Vegas, in San Miguel County ; near Barranca, in Taos County; near Mimbres, in Grant County; near Jemes, in Bernalillo County; and near Rio Pajarito, in Taos County. The Aztec Spring, near Santa Fe, supplies a pleasant alkaline water. The Jemes Hot Springs, in Bernalillo County, yield alkaline chlorinated waters. New York State has been noted for the char- acter of its mineral springs for more than a hundred years, the famous Saratoga Springs having been a resort since the latter portion of the eighteenth century. In part, the notoriety of the various springs has been due to the facts that the State was well populated, and the fa- cilities for reaching the various spas were bet- ter than those afforded by other States as far as local springs were concerned. There are virtually no thermal springs, the Lebanon springs having an average temperature of 75° F., and therefore being scarcely eligible for admission to the list of such springs. There are chalybeate springs at Whitehall, in Washington County, and at Lebanon Springs, in Columbia County. There are chalybeate and sulphuretted springs near Dry- den, in Tompkins County, and at Richfield Springs, in Otsego County. The Oak Orchard Acid Springs, at Alabama, in Genesee County, are acid and chalybeate. Dr. I. Ott has made a careful investigation of the physiological action of Congress water (Medical Times, 1871, vol. i, p. 352), and found that when that water is ingested the excreta are increased and the intestinal excretion and insensible perspiration are diminished, while the urinary excretion is increased. In the lat- ter the amount of urea, of sodium chloride, and of sulphuric acid is increased, and the amount of uric acid lessened ; the amount of phos- phoric acid is little altered, but more of it is united in earthy salts than when, this water is not taken. The carbonated chlorinated waters are those of Ballston Spa Springs at Ballston, in Sara- toga County. BALLSTON SPA SPRINGS. CONSTITUENTS. Artesian Franklin Lithia Spring. Artesian Well. (Old Conde Dentonian). Grains to Grains to Grains to Solids. the gallon. the gallon. the gallon. Sodium bicarbonate... 11-93 94-60 34 40 Calcium bicarbonate.. 238-16 202 33 173-48 Magnesium bicarbon- 180-60 177-87 158-35 Strontium bicarbonate 0-87 trace 019 Lithium bicarbonate.. 7'75 6-78 1551 Iron bicarbonate...... 1-58 1-61 230 Barium bicarbonate... 3-88 123 474 Potassium sulphate... 0 52 0-76 Sodium phosphate___ 005 001 trace Sodium biborate...... trace trace trace Sodium chloride....... 750 03 659 34 645 48 Potassium chloride___ 33-28 33 93 9 23 Sodium bromide...... 364 467 2-37 Calcium fluoride...... trace trace trace Sodium iodide......... 012 024 0-22 008 0-76 trace 026 0-74 trace 040 103 Organic matter....... trace Total............. 1,223 25 1,184 37 1,047-70 Gases. 426-114 460-066 358-345 The foregoing table gives the analysis of these waters made by Professor C. F. Chand- ler. Next to those of Saratoga, these are prob- ably the most popular springs in the State. There is a carbonated chlorinated spring at South Argyle, in Washington County, that is a local resort. But the most famous of the waters of this class are those of the Saratoga Springs, Professor Chandler's analyses of some of which are given herewith : CONSTITUENTS. Solids. Sodium bicarbonate___ Calcium bicarbonate— Magnesium bicarbonate Strontium bicarbonate.. Lithium bicarbonate___ Iron bicarbonate........ Barium bicarbonate--- Potassium sulphate..... Sodium phosphate...... Sodium biborate........ Sodium chloride........ Potassium chloride..... Magnesium sulphate — Sodium bromide........ Calcium fluoride........ Sodium iodide........... Alumina................ Silica................... Organic matter......... Total............... Gases. Carbonic acid........... Champion Spouting Springs. Congress Spring. Gr. to the gal. 17-62 227 07 19391 008 625 0-65 208 0-25 001 trace 702-24 40-45 ",3:58 trace 0-23 046 0-70 trace 1,195-58 465-46 Gr. to the gal. 10 77 143-40 12176 trace 476 0-34 0 93 0-K9 002 trace 400-44 8-05 "8-56 trace 0'14 trace 084 392-30 Empire Spring. Gr. to the gal. 902 109-66 42-96 trace 208 0-79 007 2-77 002 trace 506 63 4-29 "6:27 trace trace 0-42 1-46 trace 680-44 Flat Rock Spring. Geyser Spouting Spring. Gr. to the gal. 910 98-63 29-47 o-oi 3-23 0-09 o-io 0-48 004 trace 108-85 7-99 10 83 032 o-oi 004 1 34 trace 270 53 Gr. to the gal. 7123 168-39 149-34 043 9 00 098 2 01 0 32 trace trace 562-08 24-64 2 21 trace 0-25 trace 066 trace 99154 Ha- thorn Spring. Gr. to the gal. 4-29 170 65 176-46 trace 11-45 113 1-74 trace trace 509-97 1-53 trace 019 013 1-26 trace 888-40 High Rock Spring. Spring, Gr. to the gal. 34-89 131-74 54-92 trace 1-48 trace 1 61 390-13 850 Gr. to the gal. 276 120-17 76-27 trace 949 2-5 0-S8 202 trace trace 459-90 7-66 073 trace 008 1-22 2 26 trace Seltzer Spring. Gr. to the gal. 29 43 89'87 40-34 trace 0-90 1-70 trace 0 56 trace trace 134 29 1-34 099 trace 0-07 0 33 316 trace 627'56 687-28 0 63 trace 003 0-3' 2'56 trace 302-02 40946 33246 324' United States Spring. Gr. to the gal. 4'67 93 12 72-88 002 4-85 0-97 0-91 002 trace 141-87 8-Oi 0-84 trace 0 05 009 019 trace 33V84 245-73 Vichy Spring. Gr. to the gal. 82-87 95-52 41-50 trace 1-76 0-05 0 59 trace trace trace 128-69 1411 099 trace trace 048 076 trace 367-32 383 07 381 WATERS, MINERAL The most prominent chlorinated alkaline springs are the Sharon Springs in Schoharie County. Dr. G. A. Williams (Ctimatologist, 1891, vol. i, p. 110) has found that the inhala- tion of atomized Sharon Springs water benefits coryza, chronic nasal catarrh, bronchorrhea, acute laryngitis, chronic catarrhal laryngi- tis, laryngeal phthisis, larynqo-tracheitis, and acute bronchitis. Dr. G. E. Walton, in a mon- ograph on these waters, commends their in- ternal and external use for rheumatism, gout, hepatic engorgement, gallstones, renal conges- tion, cystic catarrh, chronic metallic poisoning, uterine derangements, and skin diseases. J. G. Pohle's analysis of the waters gave the fol- lowing results: SHARON SPRINGS. CONSTITUENTS. Red Sulphur Spring. Gardner Mag-nesia Spring. Solids. Sodium bicarbonate........ Grains to the gallon. 049 12 93 069 96 64 18 96 0 33 073 0 07 089 0-45 Grains to the gallon. 0 54 Calcium bicarbonate...... Magnesium bicarbonate Calcium sulphate............ 970 1-36 93 50 Magnesium sulphate......... 19 68 Sodium chloride............. 123 Magnesium chloride......... 0'44 Calcium chloride............. 016 063 Total..................... 132-18 127 64 Gases. Sulphuretted hydrogen...... Cubic Inches. 10 50 458 400 Cubic inches. 600 2'22 3-00 Sulphuretted waters are obtained at Avon, in Livingston County ; at Cairo, in Green County: at Chittenango, in Madison County; and at Clifton Springs, in Ontario County. There is an alkaline calcic spring at Dans- ville, in Livingston County. North Carolina contains almost all varieties of mineral springs. The warm springs in Madison County have a plentiful flow of a carbonated calcic water that has a tempera- ture which varies from 92° to HT" F.; there are excellent accommodations at the place, and it is a deservedly popular resort. There are chalybeate springs at Cowhead Spring, near Washington, in Beaufort County; near Hen- derson, in Vance County : at Jackson Springs and at Lemon Springs, in Moore County; and at Piedmont Springs, in Stokes County. Cha- lybeate and sulphuretted waters are obtained at All-Healing Springs, in Gaston County ; at Alum Spring, in Onslow County: at Cleveland Mineral Springs, in Cleveland County; at Copal Grove, in Stanley County; and at Pied- mont Springs, in Burke County. There are a number of springs that supply carbonated, calcic, or sulphuretted waters; but the locali- ties are virtually unimproved, and accommoda- tions for the treatment of invalids are lacking. North Dakota has within its territory a number of mineral springs, but all are virtu- ally unimproved. Ohio contains no very important mineral springs. There are calcic springs at Bellbrook, in Green County; at Castalia, in Erie County; at Delaware, in Delaware County ; and at Mag- netic Springs, in Union County. There are chalybeate springs at Mineral Springs, in Adams County, and at Wilberforce, in Green County. There are chlorinated alkaline springs south of Cleveland, in Cuyahoga County, and at Stryker Mineral Well, in Williams County. Sulphuretted waters are obtained at Howland Springs, near Warren, in Trumbull County, and near Sandusky, in Wyandot County. Oregon contains hot and cold mineral springs, but very few of them have been improved so as to make suitable resorts. Among the thermal waters are Belknap Hot Springs (184° F.), near McKinzie Bridge, in Lane County; Canter's Blue Sulphur Springs (200° F.),* in Baker County, and Des Chutes Hot Springs (143° F.), in Crook County. There is a chlorinated alka- line water at Wilhoit's Soda Springs, in Clacka- mas County. There is a number of sulphuretted and carbonated springs that have not been im- proved. Pennsylvania is especially rich in chalybeate springs. Chalybeate waters are obtained at Bed- ford Springs, in Bedford County ; at Blossburg Springs, in Tioga County; and at Cresson Springs, in Cambria County. Dr. J. D. Mor- gan (Maryland Medical Journal, 1889, vol. xxi, p. 425) says that the Bedford Spring water is useful in diseases of the stomach, liver, kidney, and bowels. He advises that one or two glasses of the magnesia water should be taken on ris- ing in the morning, and a brisk walk taken before breakfast. Just before breakfast, din- ner, and supper a small glass should be taken; a little salt may be added to increase the os- motic power of the water, which acts better if heated. Sulphuretted and chalybeate waters are obtained at Doubling Gap, in Cumberland County; at Minnequa Springs, in Bradford County; at Three Springs, in Huntingdon County; and at Loretto, in Cambria County. Gettysburg water, according to Dr. I. Ott (Medical Times, 1871, vol. ii, p. 143), increases the daily excretion of urea and of sulphuric acid, and decreases that of uric and phosphoric acids and that of sodium chloride. Dr. John Bell) Medical and Surgical Reporter, 1867, vol. xvii, p. 202) reports that it is of value in the treatment of gout, rheumatism, diabetes, dyspepsia, and constipation. The chief con- stituents in the waters of the principal springs may be seen from the table at the top of page 382. The analyses were made by F. A. Genth. Rhode Island contains no mineral springs that are of any importance from a therapeutic standpoint. South Carolina has no mineral springs the waters of which are other than mediocre in remedial properties. There are mild chalyb- eate waters at Cherokee Springs, in Spartan- burg County, and at Seneca, in Oconee County. There are sulphuretted waters at Chick's Springs, in Greenville County, and at Glenn Springs, in Spartanburg County. South Dakota contains an excellent hot spring at Hot Springs, in Fall River County. Mineral waters have been obtained from a num- WATERS, MINERAL 382 BEDFORD SPRINGS. CRESSON SPRINGS. Gettysburg Lithia Spring. CONSTITUENTS. Sweet Spring. Magnesia Iron Spring. Sulphur Spring. Magnesia Spring. Large Limestone Spring. Iron Spring. Alum Spring. Grains to the gallon. 6:52 6:14 6:65 6:31 Grains to the gallon. 8-47 0-59 trace 005 061 90 46 0-30 001 38 68 002 053 trace 0-17 001 1-27 GraiDS to the gallon. 10 21 1-00 trace 008 0 51 73 08 041 3340 0-02 037 trace 054 0-08 279 Grains to the gallon. 10-43 0-94 trace 004 033 99-83 0-18 0-13 39 62 o-oi 0 46 trace 0-77 trace 056 Grains to the gallon. 7:09 i:88 trace 004 6:58 0-27 008 029 trace 0-23 6:47 trace 377 Grains to the gallon. 353 5-04 1 64 48-92 032 22-58 23-48 0-03 0-04 1-60 1-21 Grains to the gallon. trace 375 0-70 40-20 043 27 70 49 64 trace 0 02 21-20 1-87 Grains to the gallon. 3 20 1071 5-31 003 Calcium bicarbonate....... Magnesium carbonate..... Magnesium bicarbonate... 0-48 Potassium sulphate........ Strontium sulphate........ Magnesium sulphate....... 3-30 0-28 Aluminnm sulphate........ Hydrosulphuric acid....... T78 1-62 141-17 122-49 153-30 14-70 108-39 25-24 ber of artesian wells that have been constructed. There is a spring at Pierre that supplies a chlo- rinated alkaline water the composition of which resembles that of the waters of St. Catherine, in Canada. Tennessee contains a number of mineral springs, especially the chalybeate and sulphu- retted. There are chalybeate springs at Beer- sheba Springs, in Grundy County; at Bon Air Springs, near Sparta, in White County; near Williamsburg, in McMinn County; near Elk- ton, in Giles County; near Erwin, in Unicoi County; near Mooresburg, in Hawkins County : at Howard Springs, in Cumberland County; near Erie, in London County; and at Robin- son Spring, in Van Buren County. Chalybeate and sulphuretted waters may be obtained at Alleghany and Blount Springs, near Mary- ville, and at Montvale, in Blount County; at Black Water Springs, in Granger County; near Dandridge, in Jefferson County; at Blooming- ton, in Putnam County; near Bolivar, in Harde- man County; at Epperson Springs, in Macon County; near Rogersville, in Hawkins County; at Kingston Springs, in Cheatham County; and at Oliver Springs, in Anderson County. There are sulphuretted waters at Avoca Springs, near Bristol, in Sullivan County; near Dandridge, in Jefferson County; at Beaver Dam Springs. in Hickman County; at Clancy, in Robertson County; near Bean's Station, in Granger County; and near Nashville, in Davidson County. Texas contains a number of mineral springs, but, as is the case in most of the Southern States, few of them are improved so that they may be used as resorts. A number of so-called mineral springs are artesian wells in which the water contains mineral ingredients. Chalybeate waters are obtained at Dalby Springs, in Bowie County; at Hughes's Spring, in Cass County; and at Hynson's Iron Mountain Springs, near Marshall, in Harrison County. Water contain- ing sulphuric acid is obtained from Sulphur Springs, in Hopkins County, and from the springs near Sour Lake and Luling, in Cald- well County. Utah has a number of mineral springs, but most of them are undeveloped, especially the hot springs. Near Ogden and Salt Lake City there are hot chlorinated springs that are used for bathing. There are saline, chalybeate, and calcic springs in the State which will be im- proved, in all likelihood, within a few years. Vermont has saline sulphuretted springs at Alburgh Springs, in Grand Isle County. There are sulphuretted springs at Barre and Plain- field, in Washington County; near Hartland, in Windsor County; and near Berkshire, in Franklin County. There are sulphuretted springs at Brunswick, in Essex County, and at Newbury, in Orange County. There are car- bonated calcic springs at Clarendon, in Rutland County. Virginia, like New York, includes within its borders some of the most celebrated spas in the United States. One of the more prominent re- sorts is at Hot Springs, in Bath County, the waters of which have a temperature of from 50° to 110° F., and are saline and calcic in com- position. The Warm Sulphur Springs, in the same county, discharge water of a temperature of from 96° to 98° F. The chalybeate springs include Bath Alum Springs, in Bath County; the Bedford Alum Springs, in Campbell Coun- ty ; the Church Hill Alum Springs, in Henrico County; the Clifton Springs, in Alleghany County; Harrison's Mineral Spring, in Taze- well County; Jordan Alum Springs and Rock- bridge Alum Springs, in Rockbridge County; Kern's Springs and Shenandoah Alum Springs, in Shenandoah County ; the Alum Springs near Ballsville, in Powhatan County; Pulaski Alum Springs, near Dublin, in Pulaski County; Raw- ley Springs, in Rockingham County; Sharon Springs, in Bland County; Variety Springs, in Augusta County; Washington Springs, in Washington County; and Wytheville Springs, 383 WATERS, MINERAL in Wythe County. Dr. B. Blackford (Virgin ia Medical Monthly, 1877, vol. iv, p. 778) com- mends the Bedford Alum Springs water in the treatment of uterine engorgement, chronic leu- corrhea, amenorrhea, dysmenorrhea, and chronic adenitis, the water being used inter- nally and as a douche. This use of these waters has been commended by Dr. J. W. Dil- lard (Virginia Medical Monthly, vol. v, p. 718) in chronic diarrhea. Among the more impor- tant chalybeate and sulphuretted springs are the Buckingham White Sulphur Springs, in Buckingham County; Hagan's Springs, in Scott County; Huguenot Springs, in Powha- tan County; Jordan's White Sulphur Springs, in Frederick County; Millborough Springs, in Bath County; Mungel's Springs, in Washing- ton County; Roanoke Red Sulphur Springs, in Roanoke County; Rock Enon, or Capper's, Springs, in Frederick County; and Valley View Springs, in Shenandoah County. The sulphu- retted springs include Botetourt, or Johnson's, Springs, in Roanoke County ; Cedar Bluff Sul- phur Springs, in Tazewell County; Coyner's Sulphur Springs and Debrell Spring, in Bote- tourt County; Crystal Sulphur Sprin, in Aug- gusta County; Grayson's Sulphur Springs, in Carroll County; Montgomery White Sulphur Springs, in Montgomery County; and Eggles- ton Springs, in Giles County. The saline calcic springs include Alleghany Springs and Yellow Sulphur Springs, in Montgomery County; Blue Ridge Springs, in Botetourt County; Healing Springs, in Bath County: and Sweet Chalybeate Springs, in Alleghany'County. The alkaline, calcic, and chalybeate springs include the Buf- falo Lithia Springs, in Mecklenburg County; the Farmville Lithia Springs, in Prince Edward County; the Orkney Springs, in Shenandoah County; and Wolf Trap Lithia Springs, in Halifax County. Washington has a number of mineral springs, but, as is the case in all of the more sparsely set- tled States, most of them are difficult of access and there are no accommodations for visitors. The Cascade Warm Mineral Springs, in Ska- mania County, supply a warm, saline, sulphu- retted water. An alkaline chlorinated water is obtained from Medical Lake, in Spokane County. West Virginia, like its mother State, Vir- ginia, contains a number of important mineral springs. There are alkaline carbonated springs at Capon Springs, in Hampshire County; and CONSTITUENTS. Solids. Calcium bicarbonate___ Magnesium carbonate.. Magnesium bicarbonate Potassium carbonate... Lithium bicarbonate ... Barium bicarbonate--- Iron carbonate......... Iron bicarbonate....... Sodium sulphate....... Calcium sulphate....... Lithium sulphate........ Magnesium sulphate — Potassium sulphate...... Aluminium sulphate..... Manganese sulphate..... Iron protosulphate...... Iron persulphate........ Nickel sulphate.......... Cobalt sulphate......... Copper sulphate......... Zinc sulphate............ Magnesium nitrate...... Ammonium nitrate...... Calcium phosphate...... Phosphates.............. Sodium silicate.......... Sodium chloride......... Calcium chloride........ Calcium fluoride........ Lithia................... Alumina................. Silica.................... Iodine................... Phosphoric acid......... Sulphuric acid........... Organic matter.......... Total................ Gases. Carbonic acid........... Sulphuretted hydrogen.. Oxygen.................. Nitrogen................. Carbon dioxide.......... Bedford Alum and Iron Springs. Grains to the gallon.* 087 499 024 12 58 0-71 24-18 019 0 59 19-26 004 0-06 006 007 027 0 24 030 0-23 trace 4-02 0-29 70-88 1-32 3 33 6-98 Grains to the gallon.t 12 66 1016 724 19-98 Farmville Lithia Springs. Grains to the gallon.* 133 4:49 i:99 i-26 3:59 1-81 6:18 5 30 2-52 392 trace trace trace 26 39 BUFFALO LITHIA SPRINGS. Spring No. 1, Grains to the imp. gallon.§ 39 28 050 i9:25 153 046 8-18 1-26 1-72 trace trace trace 73-60 Spring No. 2. Grains to the Imp. gallon.§ 14 96 29 30 2 25 175 0 30 33:07 0:89 '9:07 1-87 trace trace Spring No. 3. Grains to the imp. gallon. 252 3 77 2:35 6:15 3:04 98-38 Cubic inches. 691 59 Cnbic inches. 592 83 0*22 trace 6'57 trace trace 14-47 Cubic inches. 11-6 34 * M B. Hardin, analyst (1877). t William Gilham, analyst. t E. T. Fristoe, analyst. § \V. P. Toury, analyst (1874). WAX WINES 3 at Mineral Wells, near Parkersburg, in Wood County. There are chlorinated saline waters at Hart Well, near Willow Island, in Pleasants County; at Blue Sulphur Springs, in Green- brier County; at Borland Mineral Well, in Pleasants County; and at Humphrey's Spring, in Monroe County. The sulphuretted waters include the Floding, or Blue, Sulphur Springs, in Cabell County, and the Gray Sulphur and Red Sulphur Springs, in Monroe County. There are calcic, sulphuretted, and chalybeate waters at Greenbrier White Sulphur Springs, in Green- brier County, which have been used medicinal- ly since the last century. There are chalybeate springs at Shannondaie Springs, near Charles- town, in Jefferson County, and at Spa Springs, in Morgan County. CONSTITUENTS. Solids. Sodium carbonate............. Calcium carbonate............ Magnesium carbonate......... Lithium carbonate............ Manganese carbonate........ Iron carbonate................. Copper carbonate............. Caicium sulphate............ Magnesium sulphate........... Potassium sulphate............ Strontium sulphate............ Nitrates........................ Calcium phosphate............ Silicates............ .......... Sodium chloride............... Calcium chloride.............. Magnesium chloride........... Calcium fluoride............... Alumina....................... Silica.......................... Organic matter................ Total....................... Gases. Carbonic acid.................. Sulphuretted hydrogen........ Oxygen........................ Nitrogen....................... Total....................... * J. W. Mallett, analyst. Dr. J. L. Le Conte (American Journal of the Medical Sciences, 1879, vol. i, p. 148) says that the waters of Capon Spring are beneficial for renal calculi composed wholly or in part of uric acid, and for cystic deposits of the same substance; the alkalies of the water tend to disintegrate the agglutinating material of the calculi. Dyspepsia caused by too free a secretion of acid in the stomach, or due to a gouty diathesis, is also relieved. Hepatic con- gestion and enlargement due to derangement of the portal circulation, functional neuroses due to disorders of the sexual organs in women, and chlorosis are benefited by a course at this spa. The late Dr. W. C. Dabney writes in regard to the Greenbrier White Sulphur Springs (Gail- lard's Medical Journal, vol. 1, 1890, p. 331) that its waters have little or no effect upon the nervous system of healthy persons; the relief from neuralgia obtained from their use is due chiefly to the elimination of waste products that cause intoxication. The internal use of the water produces no effect on the circulatory organs, though the pulse-rate is increased by bathing in it as by any other hot balhs. The waters cause a marked increase in the flow of bile, the faecal discharge, the quantity of urine and the proportion of urinary solids, and the perspiration. These waters are useful in ane- mia and debility due to paludism or self-in- toxication, and in diseases due to a defective action of the eliminative organs or to impair- ment of the excretory functions. Included among these latter are gout, rheumatism, chronic paludal poisoning, chronic duodenal catarrh, catarrh of the bile ducts, and certain phases of Bright's disease. The waters are GREENBRIER CAPON SPRINGS. WHITE SULPHUR SPRINGS. Main Spring. Beauty Spring. Name unknown. Gr. to the imp. gal. 0-59 Gr. to the imp. gal.* 0 63 Gr. to the imp. gaLt 8-33 8'36 7-07 1-44 1-27 trace trace trace trace 0 04 005 trace 059 041 78-35 6'17 6:16 35-42 trace trace trace trace trace trace 6:06 6:05 trace 3-46 trace 0-02 trace 002 1-00 070 020 067 019 4:36 12-14 11-81 129-66 Cubic inches. 856 Cubic inches. 776 Cubic inches. 11-28 i 76 i:68 0 24 0-48 3-68 368 464 1400 1312 16-64 t A. A. Hayes, analyst. also valuable for persons who have no actual disease, but in whom the liver and bowels are inactive as a result of sedentary habits and over-indulgence in the pleasures of the table. Wisconsin mineral springs have acquired considerable reputation in the United States. The alkaline calcic waters are obtained from the Arctic Springs, at Galesville, in Trempea- leau County; the Bethesda, the Glenn, the Horeb, the Siloam, the Silurian, and the White Rock Springs, at Waukesha; the Gihon Springs at Delavan, in Walworth County: and the Iodo Magnesian Springs, Beloit, in Rock County. Alkaline-saline waters are obtained from Bris- tol Soda Springs at Woodworth, in Kenosha County, and the Artesian Mineral Well at Prairie du Chien, in Crawford County. Chalyb- eate waters are obtained from the Black Earth Mineral Springs, in Dane County; the New Saratoga Springs at Star Prairie, 'in St. Croix 385 WAX WINES County; and the Sparta Mineral Wells, in Monroe County. Wyoming contains within its territory a number of mineral springs, few of which'are improved as resorts. The hot springs in Yel- lowstone Park are not used for therapeutic purposes, but there is a hot spring at Saratoga, in Carbon County, that is a resort. Samuel T. Armstrong. WAX occurs in two forms, the yellow and white, known respectively as cera flava (U. S. Ph.. Br. Ph., Ger. Ph.) and cera alba (V. S. Ph., Br. Ph., Ger. Ph.). The latter is prepared from the former by its exposure in thin sheets to the sunlight in a moist atmosphere. Their physical properties are essentially the same, but the white variety is preferable on account of its greater freedom from impurities. Hav- ing a moderately high melting point, it is em- ployed to impart consistence to the more fluid oils and fats in the preparation of ointments and cerates. It is also used in the preparation of suppositories and medicated bougies in cases where their slow liquefaction is prefer- able to the more rapid melting which occurs when cacao butter is the principal excipient. Waxed cloth is prepared by saturating cloth with a mixture of 8 parts of white wax, 4 parts of olive oil, and 1 part of turpentine oil. It may be used as a protective, or in the prepara- tion of a blistering plaster. Internally, wax is practically inert and harmless. Chinese insect wax, or Pe la, is the secretion of a species of coccus upon a variety of ash. It may be substituted for the official variety. Japanese wax is obtained from the fruits of several varieties of Rhus, and possesses all the properties of the ordinary kind, but is apt to become rancid. Myrtle wax is the product of a number of species of Myrica, The popular name of the common United States species is bayberry. This wax is obtained by subjecting the fruit to the action of hot water. It is greenish in colour and of an agreeable odour, and may be substituted for the common variety. Russell H. Nevixs. WHEAT.—See Triticum. WHEY is the liquid remaining after coag- ulating and expressing the casein from milk. As the particles of fat are entangled with the casein the two elements are removed together. The following is the composition of ordinary whey, the figures representing percentages: Proteids. 0-82; fat, 0-25; sugar, 4-C5; ash.CKio; water, 92-30. The principal ingredient is, there- fore, sugar, the ash being practically unchanged. Whey is prepared by the use of a milk-curdling ferment, essence of pepsin or liquid rennet be- ing commonly used for this purpose. A tea- spoonful of either preparation is used to a pint of milk which is kept at a temperature of about 100° F. until coagulation has become complete. The coagulum is then broken up and the whey strained out. For the uses of whey and the " whey cure " the reader is referred to the arti- cles on Milk and Dietetic treatment. Floyd M. Crandall. WHISKY, spiritus frumenti (U. S. Ph.). is " an alcoholic liquid obtained by the distilla- tion of the mash of fermented grain (usually of mixtures of corn, wheat, and rye), and at least two years old " (U. S. Ph.). Whisky should be of an amber colour, with a characteristic taste and odour and a slightly acid reaction. The pharmacopoeia prescribes that its specific gravity shall not be more than 0-930 or less than 0-914. It should be free from more than mere traces of fusel oil, added sugar, glycerin, and aromatic substances. Whisky is one of the best of alcoholic stimu- lants. It is ordinarily preferred to brandy in this country, because of its usual purity and its cheapness. Its tendency to constipate is less than that of brandy. It may be employed in any sudden collapse of cardiac power from syn- cope, hemorrhage, or any other cause. When- ever a cardiac stimulant is indicated, whisky may be given by the mouth if possible, hypoder- mically, or in an enema, In the first and last instances it is best given hot. In adynamic fevers, like typhus and typhoid, the benefits to be derived from a systematic administration of whisky are well known and have been discussed in another article. In cases of poisoning by substances which depress the heart, alcohol in the form of whisky is indicated. In chronic pulmonary tuberculosis whisky is an almost in- dispensable medicinal agent, particularly in the last stages of the disease. It is unnecessary to enumerate all the diseases in which whisky may be employed as a rational, proper therapeutic aid. In general it may be said that when car- diac stimulation is required, where general ady- namia prevails, when constitutional weakness demands a rapid general stimulant, whisky is indicated. As an antiseptic agent whisky possesses some value, but in its employment for surgical dress- ings it has long been superseded by other sub- stances. As to its administration, whisky may be given pure or in combination with other stimulants. In an emergency it may be administered hypo- dermically—from its proneness to cause' ab- scesses, the injection should always be made deep—or by the rectum. When given in fevers, the quantity must vary with the effects. In the form of eggnog and milk-punch it is agree- able to a convalescent. The usual dose of whis- ky for an adult is from half an ounce to an ounce.—Samuel M. Brickner. WILLOW.—See Salix. WINES.—The history of the use of wines begins with antiquity. Throughout the Bible mention is made of the employment of the juice of the grape in religious ceremonies and in social entertainment. The drunkenness of Noah and the prophecy made by Jacob on his deathbed, in which there is a reference to wine, show the great antiquity of the drink. The Hebrews of antiquity drank fermented wine and an artificial wine made from the palm. Ezekiel is authority for the statement that the drinking of wines at festive gatherings was a rare form of entertainment. Moses forbade the priests the drinking of wine or of any intoxi- WINES 386 eating liquor previous to their entrance to the temple. Hosea praised the peculiar virtues of the wines of Lebanon, although they were not suited for transportation for long distances. The best of these wines is known in Europe at the present time as vin d'or. This wine is not fermented in the usual way. Fermentation is induced by placing the grape-juice in clay ves- sels in the sun. It is said of the vin d'or that a few glasses drank at one sitting will produce syncope. The vines of Palestine are still fa- mous for the size and sweetness of their grapes. The ancient Jews had a preference for red wine. The vintage, which lasted from September to November, was celebrated with joyful cere- monies. The mechanism of their wine presses was extremely crude ; part of the wine was fer- mented, part of it drank as must. The profane writings of antiquity, no less than the sacred, contain multitudinous refer- ences to the growth of grapevines, the drink- ing of wine, and its effects. Despite the testimony of Herodotus to the contrary, it seems to be established that the ancient Egyp- tians cultivated the vine. The edge of the Nile valley, from Thebes to Memphis, contained soil well adapted to the growth of the grape. Sebennytus is celebrated by Pliny as having produced very fine wine. The ripe grapes were gathered in baskets or hampers, which were car- ried by men on their heads or by yokes upon their shoulders to the shed, where the pressing of the grapes was accomplished by squeezing in a bag or by treading. According to Gene- sis (xl, 11), the juice was sometimes drank un- fermented: " I took the grapes and pressed them into Pharaoh's cup and I gave the cup into Pharaoh's hand." Usually, however, fer- mentation was allowed to take place and the wine was kept in hermetically sealed jars of beautiful forms. The light wine was made in Coptos; the heavier wines of good repute were derived from the neighbourhood of Anthylla and Lake Marea. Drunkenness among the Egyptians was by no means unknown. Men and women alike succumbed to the influence of the wine pro- vided at feasts. On the authority of Herodotus, it is believed by Egyptologists that a guest in an Egyptian household was always served with wine, although it is fair to assume that it was usually drank diluted with water. Drunken- ness was a vice in early Egyptian history, and to it must be ascribed the subjugation of the land by hardier races—the Assyrians, the Per- sians, and the Macedonian Greeks. Among the Greeks and Romans wine was employed as a drink and as a medicine. Homer mentions many varieties of wine which were celebrated for peculiar properties. He sings of the wines of Phrygia, Epidaurus, Arne, and Thrace; and the products of Cyprus, Chio, and Lesbos were equally celebrated. Horace fre- quently alludes to the virtues of Chian wine. The Chians are said to have first known the art of the cultivation of the vine, taught by (Eno- pion, the son of Bacchus. They probably made the first red wine. In some parts of Greece the wine of Lesbos was preferred to all others, be- cause of its sweetness and its delicious flavour. The wines of Naxos, celebrated as being the birthplace of Bacchus, had in ancient times, and still have, high repute. Thasos produced a wine which, though inferior to the other wines, was compared by Pliny to nectar. The Greeks always drank their wine diluted, in the proportion of two fifths wine and three fifths water. The mixing bowl usually stood near the hearth, often on a tripod, and the wine was poured from this into drinking cups. Athe- najus quotes from a poet who says that if like parts of water and wine are used, lunacy fol- lows ; if the wine is drank pure, paralysis sure- ly results. Herodotus, too, speaks of drinking pure wine as " filling like a Scythian." Homer records several kinds of wine—the red, the sparkling, and the honey-sweet. A special wine seems to have been reserved in honour of elders at feasts (■yepoiaiov). The ancient medical writers of Greece and Rome used wine, in one form or another, in almost all diseases. They studied carefully the effects of different kinds of wine upon the sys- tem. Thus they recognised that new wine had a tendency to upset the digestion, to promote diuresis, and to interfere with calm sleep. They record that unfermented wine produces colic, flatulence, and diarrhoea. The appearance of headaches and impaired digestion was attrib- uted to sweet wines. Hippocrates recognised the muscular debility which follows the too habitual use of wine, and pointed out the dan- gers of the sudden cessation of drinking. As cited by Strumpf, Hippocrates also recommend- ed wine in cases of poisoning by opium, aco- nite, conium, and mushrooms, or whenever a narcotic poison had produced depression. He also used it as an antidote to the bites of ven- omous serpents, and praises white wine as a diuretic in calculous disorders. Wine was fre- quently used, on the same authority, as an ap- plication to wounds and ulcers. Asa stimulant it was used in the algid stages of fevers. In hypercatharsis, flatulence, and diarrhoea it was supposed to act almost as a specific. Galen de- scribes a great many wines; but, like Pliny, gives more contra-indications for their use than reasons for thinking that their employment would be beneficial. The ancient Arabs possessed wines made from the grape, raisins, figs, dates, honey, and the juice of sweet fruits, as well as from the cocoa and pomegranate. Rhazes (cited in Stille's Therapeutics and Materia Medica, Philadel- phia, 1874), speaking of the advantages of wines used moderately, remarks that the complexion and nutrition are thereby improved, that the excretions, particularly that of the urine, are promoted, that the sleep is rendered sound and refreshing, and that the mental faculties are quickened. He says wines should not be taken habitually, but only at intervals of several days. Intoxication he paints in fearful colours. Its repetition, he says, induces disease, headache, paralysis, shaking palsy, and acute affections! Visceral inflammation, abscesses, furuncles, mental weakness, apoplexy, emaciation, and palpitation of the heart are some of the dire things this Arabian physician predicts for the inebriate. He recommends emetics as a reme- 387 WINES dy for the nausea and headache following a de- bauch, and advises rest with the use of acid syrups diluted with water or barley water. Probably every nation or tribe, from the dawn of history and before that time, which possessed any fermentable substance made some kind of wine. And it is altogether likely that, observ- ing the stimulant effect of wine when taken in health, they all used it for medicinal effect when- ever it was deemed wise or necessary. Evidence is not lacking on this point in the writings quoted, as well as in those of Strabo, of Galen, of Paulus iEgineta, and of Cicero. Whether or not the Egyptians made use of wines medi- cinally is not definitely known, but it may be surmised that such was the case from their con- tact with nations that did. Wine and oil al- ways stood as representing the fertility and the wealth of a country in ancient times; and the fact that " a land flowing with milk and honey'' was offered as an inducement to the ancient Jews does not militate against their having had wine, since milk and honey, on competent authority, represented their chief articles of diet. The religious use of wine probably, or possibly, began in a sacrificial way, the fermented juice of the grape being rare and therefore a thing worthy of sacrifice. Its use in the communion service is a heritage of an ancient custom. It is interesting to note that among the ceremonial usages in which wine plays a part is its administration, in the form of palm wine, to a mother among the negroes of Guiana immediately after the birth of her child. In Franconian Switzerland the relatives of a parturient woman take turns in bringing her, during the entire puerperium, a soup of peculiar make which always contains wine. Among the Roman medical writers, Soranus of Ephesus forbade the use of wine early in pregnancy, because he feared an abor- tion. The Jewish women of ancient times were not allowed to drink wine during their period of pregnancy. The Chinese seem to be more liberal in this respect, permitting their preg- nant women to drink anything that has a pleas- ant taste; but they must not drink to excess anything that is intoxicating or heating to the blood. The Laplanders, during pregnancy, may drink Sarakka wine; but with them this is a religious ceremony, since Sarakka is the goddess who presides over pregnancy and child- birth. The German women of five centuries ago were advised to drink any strong wine, especially claret; but there is no evidence that similar usages prevail to-dav (Ploss, Das Weib, Leipsic, 1891, vol. ii, pp. 331, 336, 513, 514). Finally, it may be mentioned that wine is used in the performance of some ceremonies of a semi-religious, semi-social nature. In mar- riages and engagements the drinking of wine is customary among some peoples, being essen- tial to the function. The rite of baptism and that of circumcision are frequently accom- panied by the drinking of wine, a white wine being usually chosen for this purpose. For many'hundreds of years the wine indus- try has been pursued in European countries par- ticularly, although at present American wines are forging their way to the front, and the cul- tivation of the vine and its subsequent treat- ment until the perfected product is secured are very thoroughly understood. The grapevine grows luxuriantly in many places, especially in ground rich in the salts of phosphorus and po- tassium. The manure used is of importance as well, since it is found that the richer the fertilizing agent, the greater is the effect upon the taste of the grape-juice. In Germany and France the dung of cattle is preferred to all other fertilizers, since it is very rich in phos- phorus and potassium. The finer wines, such as Burgundy and Riesling, show a difference in taste depending upon the agent used for fertilizing. Hundreds of varieties of grapes are recog- nised by viticulturists, but those most in favour are enumerated here: For white wines, Sau- vignon Vert, Golden Chasselas, and Bergher are used in America; Riesling, Rulander, and white Burgundy are chosen in Germany. For the medium and light white wines of Germany, Elbling, Orleans, and Ortlicher are used. For the manufacture of red wines, Carbanet Sau- vignon, the various Burgundy grapes, Laska, Trollinger, Mataro, Carignau, Zinf'andel, Le- noir, and St. Lawrence grapes are the princi- pal varieties. Pedro Ximenes, Black Burgundy, Trousseau.and Old Mission grapes are employed for the production of ports and sherries. Un- less otherwise specified, grape wine will be re- ferred to in this article when wine is mentioned. Ripe grapes only are chosen for the produc- tion of wine. The expressed juice of the grape is received into vats and is known as must. At the ordinary summer temperature, or even at a temperature of 60° F., fermentation begins in the clear juice of the grape within half an hour. The juice becomes cloudy and thick and gives off bubbles of carbonic-acid gas which causes a froth to form at the surface containing the more solid parts. This is called the head. The grape-sugar formerly contained in the juice is now being converted into alcohol, and the fluid loses its sweet taste and becomes vinous. The fermentation is due, according to the best au- thorities, to the presence of Saccharomyces apiculatus and to the moulds adhering to the grape-skins. Within forty-eight hours after the beginning of the fermentation, Saccharomyces ellipsoideus takes the place of the ferment above mentioned, and the process is continued for an indefinite period, varying with the ripeness of the grape, its previous nourishment, its treat- ment, and the climate. The fermentation ceases after a varying time and is renewed by stirring the contents of the vat. When the fluid be- comes perfectly clear it is considered wine and is placed in casks, where the fermentation is continued for from six to eight months. This continued fermentation is known as the sec- ondary, in contrast to that which first occurs, the primary. It is essential for its perfection that air should be excluded, and it is sometimes necessary to add wine to it. The secondary fer- mentation may not be complete, and sometimes years after the wine is pressed from the grape fermentation occurs, a sign that it was not fin- ished as it should have been when placed in the cask. During the entire time of fermentation WINES 388 a frothy matter is formed which, with the colouring matters and tartar, eventually sinks to the bottom of the cask, when it is called wine-lees. The shortest time for wine to be ready to be bottled is two years. Wines very rich in sugar may undergo occasional fermen- tation for years, always with an increase of alcohol and a decrease in the acids, the tartar, and ths sugar. It is during the secondary fer- mentation that the bouquet of a wine is devel- oped, as the lees is formed. It consists of the odorous principles contained in the grape and those developed by the fermenting pro- cess. This is to be sharply distinguished from the aroma of the wine, which is recognisable by either taste or smell. From one and a half to three per cent, of the wine usually evaporates annually through the pores of the containing casks, and in order to avoid the germination of mould and the conse- quent acetous fermentation, the cask must be refilled. The longer wine is allowed to remain sealed in casks, secure from the advent of air, the finer will its bouquet become and the greater its percentage of alcohol. Very old wine, how- ever, is found to lose in alcohol. The preser- vation of wine is achieved by burning pure sulphur in the casks in which it is to be per- manently stored. This process frees the vat from the possibility of becoming mouldy and is now almost universally practised. Filtering the wine or the adding of gelatin or albumin- ous substances to it is the means employed to make it clear. Red wines usually lose some of their colour by the employment of these pro- cedures, and on these wines it is practised to a very small extent. Among the agents used now and formerly for the preservation of wines may be mentioned salicylic acid, boric acid, electricity, plaster of Paris, peroxide of hydrogen, and phosphate of calcium. Plaster of Paris is commonly used in France and in most of the southern countries. These various measures for preserving or im- proving wine have each a chemical basis, but the processes are so involved that they have not all been thoroughly worked out. Salicylic acid is employed to preserve wines by stopping the fermentative process. Its addition to food stuffs is prohibited in Germany, and Konig is of the opinion that the small quantity which can be added without giving the wine a disagreeable after-taste is ineffectual as a preventive of fer- mentation. Boric acid has been employed with the same intent, and, indeed, boric acid in mi- nute quantities is found in the ash of the wine; but its effect upon the organism is by no means indifferent, and its employment is not to be recommended. Some Italian chemists have of late recommended electricity as a preservative of wines. The statement is made that the cur- rent aids in the improvement of the wine and helps to render it aseptic. But these results have not yet been confirmed. Experiments with hydrogen peroxide have also been made with a view to clearing the wine and ripening it quickly; but these, too, will require further elaboration to give the procedures a place among those regularly practised. Of all the measures which have gained a wide prestige for the preservation of wines, the ad- dition of plaster of Paris to the marc is the most constantly used. As mentioned above, it is freely practised in France, particularly in the southern portion, but it is generally em- ployed in southern Italy, Sicily, Spain, and Portugal. Oxidized and" non-oxidized plaster of Paris are both employed, and the statement is made that by this means fermentation is hastened, that the colour of the wine is im- proved, and that its permanence is increased. However, pldtrage, as the process is known to the French, is not only superfluous, but posi- tively injurious, since it not only changes the wine chemically, but actually produces chem- ical bodies which may be injurious to the drinker. One of the dangers consists in the liberation of free phosphoric acid under cer- tain circumstances. The chemical changes may be briefly stated as follows: When plaster of Paris is added to soluble salts of tartaric acid, an almost insoluble calcium tartrate and the bisulphate of potassium are formed. The sul- phate of potassium may disintegrate some of the salts of phosphoric acid held in solution in the must, and free phosphoric acid result from this reaction. This is the German view. The French chemists think that through the influ- ence of the calcium sulphate (plaster of Paris) the stability of the wine and its acidity are in- creased by the introduction into the wine of the potassium bitartrate which is in the grape, and, on account of its insolubility, usually re- mains in the lees. Chemists do not agree as to the changes that then take place. But it is safe to assume that tartaric acid, sulphuric acid, and potassa are set free in the wine, with the ulti- mate formation of potassium bitartrate and potassium bisulphate, the latter salt contribut- ing to the increased acidity of the wine. The gravest danger lying in plastered wines is in the deleterious effects of the potassium sulphate upon digestion, upon the action of the heart, and upon the blood. It tends to reduce the alkalinity of the blood, as has been proved ex- perimentally by Nencki, Lichtheim. and Loch- singer (Journal fur praktische Chemie, new series, vol. xxv, 1882, p. 384). These observers gave a dog for eight days, with its usual food, from 30 to 45 grains of acid potassium sul- phate, with the result of reducing the alkalin- ity of its blood 22 per cent. Concerning the plastering of wines they reach these conclu- sions : Wines which contain less than 15 grains of plaster of Paris to a quart have not proved injurious; when heavily plastered wines are used for a considerable length of time, the health may, however, become impaired; the sale of plastered wines should be a subject of legislative interference, and no wine which con- tains more than 15 grains of neutral potassium sulphate to the quart should be sold in the market. Considering the possible dangers to health, it seems rational to discard all wines which contain more than 5 grains of neutral potassium sulphate to the quart. The detec- tion of the plastering of wines depends upon the demonstration of the presence of the acid potassium bisulphate or of the neutral potas- sium sulphate. 389 WINES Attempts have been made to neutralize the calcium sulphate of the plaster of Paris by cal- cium phosphate, and it has been suggested that the potassium bisulphate may be neutralized by the addition of strontium tartrate and tar- taric acid; but it has been found that these agents do not entirely remove the potassium salt, that equal quantities of strontium salts replace it, and that the wine is even more harmful than before. Various barvum salts— the nitrate, the chloride, the carbonate, the acetate, etc.—have also been recommended for the neutralization of the plaster of Paris, but, on account of their direct poisonous effects^ are not employed. On the recommendation of Hugounenq, dicalcium phosphate may be employed for the preservation of wines and to promote their clearing. This process is called phosphatage, and is said to have all the vir- tues of the use of plaster of Paris without in- creasing the sulphuric acid or diminishing the phosphoric acid. The following table shows the changes that take place in wines which have undergone pld- trage (Bersch, Die Praxis der Weinbereitung, 1889, p. 417). one half of a given quantity of wine having been plastered, the other half not: Specific gravity......... Alcohol................. Extractive matters___ Total acidity............ Volatile acids........... Tartaric acid........... Glycerin................ Tannic acid and colour- ing matters.......... Sulphurous acids....... Potassium sulphate (HKS04).............. Ash..................... The ash contains: Sulphurous acid........ Phosphoric acid........ Ferric oxide and clay... Calcium..-............... Magnesia............... Potassium.............. Plastered. 0 9960 10 99 vol. p. c. 2'76 p. c. wgt. 6 60 per cent. 071 1-50 8-20 157 152 258 4-38 350 8-9 0 9 6-9 41 43 8 Not plastered. 0 9955 11 80 vol. 2-50 p. c, 6-00 per 0-69 150 8-20 1-68 033 056 260 15-0 151 1-8 14 100 570 p. c. wgt. cent. To procure a diminished acidity of wine, cal- cium carbonate, calcium saccharate, or neutral potassium tartrate may be added. The wine takes up little or none of the calcium salt, and it is therefore scarcely injurious. Chaptal gave the name to the process by which sugar and calcium carbonate are added to must which is hyperacid. An increase in the quantity and sweetness of wine may be obtained by the pro- cess of Gall. After the better grapes are se- lected from the poorer ones, the poor ones are made into must, and to that is added at once an aqueous solution of grape sugar, so that the must shall contain a proportion of sugar, acids, and water equal to that of must made from the best of grapes. The good taste of poor wine is enhanced by this process, which is certainly not an honest one. On the suggestion of Petiot. some inferior wines are made, especially in France, by fer- menting the mare of the grapes, from which wine has already been prepared, with an aque- ous solution of grape sugar. Some excellent wines may be manufactured in this way from grapes of superior quality: but the oftener the marc is placed in the solution of sugar, the poorer is the quality of the wine. As a rule, these wines have an agreeable taste. They are frequently adulterated with tannin, glycerin, tartaric acid, etc. There are several other processes in vogue in wine-making countries for the improvement, adulteration, reduction of acidity, and increase of quantity of wines, but the main ones have been here mentioned, and the others are scarcely of sufficient importance to warrant their descrip- tion in this article. All wines have certain common properties. They are all spirituous liquors obtained by fer- mentation from fruit or grape juices, contain- ing a certain quantity of alcohol, which varies with the juice and its subsequent treatment. Even wines of the same class differ materially in their amounts of alcohol. The following table shows the average percentages of alcohol in the principal foreign wines: Port wine........... 19 to 23 per cent, Sherry.............. 15 to 25 " Madeira............ 18 to 22 Bordeaux........... 9 to 15 " Burgundy.......... 7 to 13 " Rhine wine......... 8 to 13 " Moselle wine........ 8 to 11 Tokay.............. 9 to 12 Champagne......... 5 to 15 " (Johnston's Chemie des taglichen Lebens, Stutt- gart, 1887, p. 267.) The American wines contain from 10 to 25 per cent, of alcohol, according to their quality and variety. All grape wines contain a certain proportion of grape-sugar, to which the sweetness of their taste is due and which is responsible for their fermentation. They all contain a varying quan- tity of acid which is responsible for the more or less conspicuous '• vinosity " in the taste of the wine. The acids of wines are tartaric acid and acetic acid, the latter, as pointed out above, an impurity. Malic acid is found in wines which have been derived from unripe grapes; but it gradually disappears from the grape as it ripens, and its presence in unripe grapes is one of the reasons for choosing the ripe fruit of the vine for wine-producing purposes. The character- istic odour of wine is due to the -presence of cenanthic ether, and it is possessed by all wines. This ether is a product of the fermentation of the must, and is said by Neubauer to contain as its principal elements caprylic and caprinic ethers. It is probably increased with the age of the wine, but is always present in very small comparative quantities, from 1 to 10,000 to 1 to 40,000 parts by volume. Aside from the general characteristic odour of wines derived from this source, each wine derives an aroma from the grape from which it is made which distinguishes it from all other wines. The proverbial improvement attained by wines with age springs from the facts already enunciated. It may be well to repeat them briefly. As long as "wine contains grape-sugar, WINES 390 fermentation is induced which increases its percentage of alcohol. Wines that contain but little sugar do not improve much with age unless sugar-containing wine is added to them from time to time. The presence of oenanthic ether is fostered by the prolonged fermenta- tion, and hence the wine gets a stronger odour. The acids of the wine are diminished by the separation of tartaric acid, which increases as time passes. Lastly, the clearness and the purity of the taste of the wine are increased by the removal of the ferment. According to their colour, wines are divided into red and while. According to their taste, they are known as spirituous, sweet, dry, light, sparkling, rough, or acidulous. Red wines are made from the must of black grapes, fermented with the marc—i. e., their skins and seeds. White wines are derived from white grapes or from black grapes freed from the marc. The colour- ing matter of the skin of the grape is insoluble in water, but is dissolved by alcohol, and so the juice of grapes fermented with the marc be- comes red as fermentation proceeds. A spiritu- ous wine is produced from the juice of a grape that is very saccharine, in which fermentation is easily induced and proceeds until checked by the presence of a certain amount of alcohol. If the ferment is deficient in quantity and the sugar superabundant, a sweet wine will result. A dry wine is one free from excess of sugar. The grapes that contain but little saccharine material furnish wines having a comparatively smaller proportion of alcohol, which are known as light wines. Sparkling wines are those which continue to undergo fermentation in bottles with a production of carbonic-acid gas. The presence of tannic acid derived from the marc of the grape distinguishes the rough or astrin- gent wines, while the acidulous wines are char- acterized by the presence of tartar or carbonic acid. Among the principal sweet wines are sherry, Madeira, port, champagne, muscat, and Tokay. The principal sparkling wines are cham- pagne and Moselle. Madeira wine was formerly much in use. It is a white wine with a rich, aromatic flavour. Its frequent adulteration renders its quality uncertain. Teneriffe wine bears a close resemblance to Madeira, and when pure has a somewhat acid taste and a delight- ful aromatic odour. Claret is the most widely used French wine. It is a red, light wine. It is somewhat astringent and acid in taste, with a vinous flavour. The brands Chateau-Lafitte, Chateau-Latour, Chdteau-Haut-Brion, and St. Julien are the most celebrated. Sherry wine, vinum xericum (U. S. Ph., 1870, Br. Ph.), and port, vinum portense (U. S. Ph., 1870), will be described under the official wines. The classification of wines according to their source is convenient, and the principal ones will be here mentioned: German Wines.—1. Rhenish. The best of these are the white wines. The wines made from Riesling grapes are particularly known for their delicate, delicious, refreshing flavour and their characteristic bouquet. They are sometimes of value in nervous diseases. The Orleans wines are stronger and lack the aroma of the Riesling products. The best known of these wines are Marcobrunner, Johannisberger, Rudesheimer, Hochheimer, and Niersteiner. 2. Main wines, of which the Steinwein is the most celebrated. 3. Pfalzer wines. 4. Moselle wines. 5. Aar wines. G. Neckar wines. 7. Margrave wines. 8. Baden wines. 9. Bohemian wines. 10. Hungarianwines: white—(Edenberger; red —Ofener, Tokay, Erlauer. French Wines.—1. Champagnes may be either red or white. The white champagnes of France are famous and are consumed in all parts of the world. 2. The Burgundy wines are noted for their agreeable and delicate fla- vour and for their stimulating properties. The most famous white varieties are Chablis and Pouilly, while the best-known red Burgundies are Chambertin, St.-Georges, Pommard, and Blanue. 3. The Bordeaux wines are known for their agreeable, peculiar perfume and their slight astringency. The red varieties are the clarets above mentioned. The best-known white ones are Rions, Sauberne, and Barsac. Of Spanish wines, Malaga, sherry, and Ali- cante are widely known for their " body." The type of the white wines of Portugal is Bucellas; of the red, port. Many of the Italian wines are known : Al- bano, Alliatico, Marsala, Orvietto. The African wines, Madeira and Teneriffe, are described above. American wines have of recent years attract- ed attention for their increasing purity and strength. The first attempts to grow wines in this country failed early in the century, but the value of the Schuylkill muscatel grape and of the North Carolina Catawba grape was proved, and these varieties were subsequently employed in the manufacture of wine. It is only within very recent years, however, that the quality of American wine has attracted the attention of home consumers. Wines of great diversity of flavour, acidity, and alcoholic strength are now manufactured in America. Although most of them contain alcohol and sugar which have been added for preservation or improvement, American wines can be secured, as a rule, free from harmful adulteration and in a condition of assured purity. Among the dry red wines made in this country are Concord, Clinton, Cyn- thiana, Sonoma, Red Mission, Zinfandel, and California claret. Well-known dry white wines are California muscatel, California Sonoma hock, Pleasant Valley, Catawba, Sonoma Ries- ling, and white Concord. Sweet wines are made in many parts of the United States. Port wines, sherry wines, and sweet Catawbas appear in the market in several varieties. Many American champagnes have attracted notice of late years and will undoubtedly supersede the foreign product in time. Prominent among these wines are "grand prize," medium dry; "eclipse," ex- tra dry; " gold seal," and Cook's imperial. Vines for the product of their grapes are grown in California, in Texas, in western New York, and in southern Ohio. California leads her output in 1893 being 20,000,000 gallons of wine. While this can not be compared in point of quantity to the product of some of the wine-making countries of Europe, the produc- tion will no doubt be increased as the merits 391 WINES of American wines become better known and the demand for them is augmented. Besides the juice of the grape, there are juices of several other fruits that undergo vinous fermentation. Cider is the fermented juice of the apple. It is consumed in large quantities in southern Germany, France, Eng- land, and the United States. The expressed juice of the apple soon undergoes fermentation without the addition of a ferment agent. It contains a large percentage of grape-sugar, which becomes converted into alcohol in the manner above described. The taste and the quality of cider depend upon the variety and ripeness of the apples from which it is made, the climate, the soil, and the care of the trees. Cider is not permanent and easily undergoes acetous fermentation. Perry is the fermented juice of the pear and resembles cider in its properties. The juice of all varieties of palms is rich in grape-sugar, and is therefore easily ferment- able. Palm wine is made and drank in the islands of the Indian Archipelago, in Sumatra, in India, and in the Philippine Islands. The best palm wine is said to be found on the western coast of Africa. In the oasis of Tosar, the residents of which are Mohammedans, palm wine is a customary drink and is known as " lagmi." The drinkers justify themselves, it is reported, by saying: " Lagmi is not a wine; the edict of the prophet is against the use of wine only." The wine of the palm is produced in Chile and in most tropical countries. In Africa it is the only native alcoholic drink. In Asia it is consumed in enormous quantities. A wine may be derived from the sugar cane by spontaneous fermentation. No chemical analysis has ever been made of it, although it is highly prized by the negroes of the Southern United States. Pulque, octli, or the wine of agave, is a favourite drink, intoxicating in character, of the lower classes of Mexico. It is obtained by the fermentation of the juice of the maguey, or Agave americana. The juice has a sweetish taste and soon acquires a dis- agreeable odour. It undergoes spontaneous fermentation, and when mixed with other juice from the same species which has already begun to ferment, it ferments very rapidly. In twenty- four hours the pulque has its pleasantest taste and effects. It acquires the peculiar odour of putrefying or gamy meat, and is therefore not easily partaken of by those not accustomed to drink it. It is very refreshing and cooling in its effects, but even a small quantity may be sufficient to produce intoxication. The Mexi- cans maintain that pulque possesses many therapeutic properties of value: It aids diges- tion, promotes sleep, and is helpful in many gastric diseases. The juice of the birch provides a sweet, agreeable, sparkling wine. The wine of honey, or mead, was formerly popular in Germany, and is said to be drank at the present day in Russia. The best known of the berry wines are currant, gooseberry, strawberry, blackberry, and raspberry wines. They are all agreeable drinks and are commonly drank diluted as refrigerants in summer. "Blackberry wine or brandy has some reputation as a remedy in diarrhea. The famous wine of the Tartars, kumyss, or koumyss, is the fermented milk of the ass. It is now prepared in most civilized countries by the artificial fermentation of cow's milk, and possesses some nutritious properties. It is easily digested and assimilated, and is frequently employed as a substitute for milk in conditions in which the stomach can not digest the raw product. For such usage it is a valuable adjuvant in the treatment of asthenic conditions and as a food in the vomiting fol- lowing anesthesia. (See Kumyss.) The leban of the Arabs and the yaurt of the Turks are wines similar to kumyss. In some parts of Ireland and Scotland and in the Orkney Islands buttermilk is sometimes kept until fermenta- tion has set in. It then acquires intoxicating properties. The juice of the orange is some- times allowed to ferment, giving rise to a typical wine. An infusion of malt is capable of undergoing fermentation, giving rise to the malt liquors— ale, brown stout, porter, and lager beer. They are practically wines, but their consideration does not properly come under this heading. Champagne was first made in the latter half of the seventeenth century by Perignon, a priest in the convent of St. Peter at Haut- Villers, although the crude article had been known and prized for centuries. Its manufac- ture rapidly spread, and to-day good qualities of champagne are made in the United States, France, Germany, Austria, and Italy. In this country French champagne is the favourite, although the American brands are making their way to the front. Blue grapes make the best champagne, and those containing a mini- mum quantity of colouring matter are usually chosen. Burgundy, Ruhinder, and Riesling are used for fine champagnes. For the infe- rior qualities Ortlieber, Steinschiller, and Gu- tedel are frequently employed. The preparation of champagne has been brought to a state of perfection in France. The selected grapes are rapidly pressed and the must obtained is allowed to undergo complete fermentation in order that all traces of sugar may be removed. After this wine has cleared itself it is mixed with other wines of chosen type and character (coupage). This mixed wine, which is the basis of the champagne, is repeatedly cleared and drawn off, and in the spring of the year, as a rule, has added to it from 1 to 2 per cent, of sugar for the produc- tion of the carbonic-acid gas. This is accom- plished by adding a liqueur which contains ordinary candy sugar, wine, and cognac in the proportions of 150, 125, and 10. This is used for the better champagnes; beet-sugar is em- ployed for the cheaper ones. Sometimes port, Madeira, muscatel, or cherry-water is added to the liqueur if it is desired to produce a par- ticular flavour. The amount of liqueur added depends upon the pressure it is intended to secure and the absorptive ability of the specific wine. French champagne producers distin- guish three kinds of carbonated wines: Cre- mant, which has a carbonic-acid gas pressure of about four atmospheres; mousseux, with a WINES 392 pressure of from four to four and a half at- mospheres ; and grand mousseux, with a pres- sure as high as six atmospheres. The familiar form of champagne bottle is employed because it euables the gas to remain at the original pressure. The bottles are now carefully corked, leaving a space at the top of from twelve to fifteen cubic centimetres. They are placed horizon- tally in the fermentation cellar, which has a temperature of from 08° to 75° F. As the fermentation proceeds, the position of the bot- tle is gradually changed every few days until at the end of about two weeks it stands ver- tically, cork downward. During this process a precipitate has been formed which falls against the cork. As soon as the workmen are certain that precipitation is complete, degorge- ment is practised. This consists in removing the cork, when the precipitate, together with a small quantity of the wine, is hurled from the bottle by the force of the pressure behind it. The bottle is again filled to its former degree by dosage with a liqueur which varies for dif- ferent champagnes. It can be made sweet or dry, mild or strong, according to desire. The bottle is then so handled as to avoid the loss of any more carbonic-acid gas than is neces- sary, it is corked, the cork is secured with cord and wire, and all this is covered as far down as the empty space extends witli tin-foil or seal- ing-wax. The other methods of making cham- pagne are inferior, but it is of historic interest to note that the older method consisted in forcing carbonic-acid gas into bottles contain- ing wine already " dosed " by means of a force- pump. A champagne must naturally, to be pure, have the basis of an aerated water, as outlined above. Chemically, it must contain no im- purities injurious to health. Saccharin, oxalic acid, and salicylic acid are used in France to some extent as adulterating agents, and should be tested for if their presence is suspected. After champagne has been poured out into glasses, evidence that it is not an artificially aerated water may be adduced by stirring it. If it foams as it did when first poured out it is a pure or at least a natural champagne. If not, it is to be condemned as artificial. The medicinal uses of champagne are those of a stimulant. It may be given in convales- cence from any adynamic disease, and is serv- iceable when a patient is suffering from the effects of severe shock or collapse and when he is able to take fluids by mouth. It is of real value in cases of vomiting due to almost any cause. At these times, when the stomach re- fuses to retain anything else, cold dry cham- pagne in small doses will usually be retained and may frequently stop the vomiting alto- gether. It is of special use in the vomiting following anaesthesia when this is prolonged beyond the usual time. In cases of anemia and chlorosis, when iron is not well borne by the stomach, it may sometimes be found use- ful to give it with small doses of a dry cham- pagne. It is a good stimulant after fatigue or overexertion, but a too long-continued use of this wine is apt to produce cirrhosis. The effects of champagne are those of other diffusible stimulants, but that it does excite especially the intellectual centres, producing an unusual flow of wit and humour, its popu- larity at dinners and among postprandial speakers testifies. When drank as other fluids are, two or three glasses of champagne will rarely intoxicate one accustomed to any alco- holic drink, but when slowly sipped it may give rise to the symptoms of acute alcohol poisoning after half a glass has been taken. Although the effect of wines is dependent, to some extent, on the alcohol they contain, the liquid is so complex that much of its influence upon the human body must be ascribed to the salts, ethereal bodies, sugars, and acids in which it abounds. The action of wine is mainly stimulant, and this effect is derived mainly, it is true, from its alcohol. It is probably, how- ever, not correct to state that an equal quantity of water containing the same percentage of alcohol will accomplish the same result. After drinking wine, the whole organism responds to it. The activity of the nervous system is quickened, the special senses become more susceptible to impressions, and the intellectual faculties are more active and alert. The pulse becomes more rapid, and the cheeks usually become flushed and the eyes bright. It de- pends, of course, upon the variety of wine taken, whether these effects are more or less pronounced. The sparkling wines produce them rapidly to a high degree, stimulating the mental faculties particularly. The still wines have a less marked stimulant effect. On the other hand, the sparkling wines have a ten- dency to derange gastric digestion; the still wines have little influence in this direction. In a physiological study of the influence of alcoholic drinks upon the chemical processes of digestion, R. H. Chittenden and L. B. Men- del (American Journal of the Medical Sciences,. April, 1896) conclude that wines in small amount have little or no deleterious action upon the chemical processes of gastric diges- tion. In small amount they may even increase the rate of digestive action. In larger quanti- ties they have more or less of a retarding effect, which is dependent more upon the character and amount of the solid matter present than upon the alcohol. On pancreatic digestion, however, they find that wines have a greater inhibitory action than the stronger alcoholic liquors. This action seems to be entirely inde- pendent of the amount of alcohol, but is closely connected with the acidity of the fluid. On salivary digestion, wines as a class show a very powerful inhibitory action, due almost entirely to their acid properties; for when the acidity of a wine was experimentally neutralized, it lost completely its inhibitory effect upon sali- vary digestion. An exaggeration of these physiological effects of wine is found in the condition of acute alco- hol poisoning, commonly called drunkenness or intoxication. A condition approaching de- lirium appears after the ingestion of more wine than can be tolerated by the system. Depend- ing upon the temperament of the individual, he may be joyful or morose, combative or 393 WINES peaceful, erotic, benumbed, or active. These symptoms gradually subside, the speech be- comes incoherent and thick, the head whirls. and vision and perception of space and objects become blunted. It is a curious fact, frequently observed and commented upon, that those fac- ulties most constantly employed are the last to succumb to intoxication. An educated person will continue to reason long after he has lost the support of his limbs, while a labourer, though unable to talk, finds himself able to carry on his work. An intoxication ends in two ways: Either there is gastric derange- ment, with vomiting, diarrhoea, and sometimes evacuation of the bladder, or a condition of somnolence supervenes, characterized by an alcoholic breath, a flushed face, dilated pupils, a slow, full pulse, stertorous breathing, and sweating. Recovery is the rule, although a fatal result has often been known. The habitual dietetic use of wines is possibly harmless, but it is certainly useless in health. Yet it is an established fact that, in the wine- drinking countries of Europe, one sees little of the bad effects of the constant use of the bev- erage ; and in France and Germany it is used by persons of all ages and of both sexes. It is said that gout and calculous disease are scarce- ly known along the Rhine. The light wines of Germany and France, diluted, may be drank with safety for many years. But the heavier wines, such as sherry, port, and Madeira, are apt, after prolonged use, to induce diseases of the liver (cirrhosis), gout, apoplexy, and those conditions which are due to overstimu- lation. The light wines are refreshing after exertion, and exert a protective influence when the organism is subjected to a severe tax. In one of the hospitals of New York an old cus- tom prevails of giving claret, well diluted, to all those resident in the building during an epidemic of cholera, typhus, or small-pox. It is possible that wine produces a deleterious effect upon the complexion, and that it may prematurely arouse adult passions in children who drink it frequently. The habitual use of saccharine wines must be forbidden to persons who have gout or a tendency to obesity or to the gouty diathesis. In an investigation as to the medical prop- erties of the Bordeaux and Burgundy wines, the Lancet commission decided that the white Bordeaux wines excited the appetite, were a direct aid to gastric digestion, and were slight- ly aperient. The sauternes, it was found, were at first stimulating and later had a sedative effect. This action was more pronounced upon nervous and easily excitable persons. The white Burgundy wines had not, as had been believed, a constipating influence, but the re- verse. The clarets were found to have neither a stimulant nor a sedative influence, which the commission attributed to the combination of tannin with a small percentage of alcohol. Taken with the meals, claret was found to have an influence beneficial to digestion. The red Burgundy wines are not so helpful to digestion as claret, "and seem to show a tendency to cause obesity. These wines are not well suited to the gouty," and diabetics can not take them, because of the sugar they contain. (Lancet, June 20, July 3, July 24, October 23, 1880.) As to the sustaining qualities of wine, there can be little difference of opinion. Druitt (Medical Times and Gazette, 1878, vol. ii, p. 364) prints his correspondence with a French army surgeon and a French lady who were in Paris during the siege. Both of them give high testimony to the worth of vin ordinaire, at a time when it was impossible to obtain other nourishment, in sustaining the vital powers. The surgeon gives evidence as to how his soldiers withstood severe injuries with no other food than the wine given them. This question is discussed fully in the article Al- cohol. In the treatment of disease, wine is used differently from the more ardent spirits. In an acute anaemia, for example, dependent upon a severe haemorrhage, alcohol in a more rapidly assimilable form is called for, such as whisky or brandy; but if the patient recovers, wine would be indicated as a tonic to help him over his debility. In cases in which the prolonged use of an alcoholic stimulant is demanded and when the disease is of a mild grade, or when the stomach can not tolerate whisky or brandy, wine is pre-eminently the agent to use. This is not the place, and the writer has not the wish, to discuss the mooted question as to the wisdom of employing wine in disease. He as- sumes that the intelligent employment of some alcoholic stimulant is to be taken for granted. When wine is used medicinally it is essential that a genuine wine and a good wine be em- ployed. Adulterated wines will prove injurious only, deranging the digestion and impairing the appetite, if not inflicting more serious in- jury. In general, it may be said that sherry, containing little acid, is indicated when the stomach is weak and there is acid dyscrasia. Port is to be preferred in cases of pure debility. Claret is useful as an aperient and diuretic. Champagne is given in the debility of old age and in the collapse of low fevers. Acidulous wines are not to be given to gouty subjects, nor sweet wines to diabetics. Young infants may receive marked benefit from the judicious administration of port wine, given at hours other than meal times, when suffering from marasmus from any cause, ca- tarrhal affections of long standing, tuberculosis, or rhachitis. The appetite and nutrition are improved materially. Sherry promotes steep and aids digestion in senile debility, depending for its effects not only upon the alcohol, but upon the ethers developed in it. In fevers of all kinds, those of the acute infectious diseases as well as in those coming from acute inflam- matory processes, wine fortifies the system and helps it to get rid of the deleterious materials circulating in the blood. It is particularly valuable when there is high delirium or great nervous prostration, with a rapid dicrotic pulse which has a tendency to become arrhythmical. In typhoid fever and'in typhus fever when there is absence of the impulse and first sound of the heart, port wine is a valuable agent, adminis- tered in large doses. In the pneumonia and bronchitis of the aged it is a helpful remedy as WINES 394 well. In the exhaustion of fevers, marked by insomnia and feebleness of the heart, as seen in the third and' fourth weeks of typhoid fever, port wine is good. The use of wine is indicated, too, when derangements of digestion and nerv- ous prostration appear, entirely out of propor- tion to the gravity of the disease. For these purposes, from six to twelve ounces may be given daily in divided doses at half-hourly intervals. In threatening cardiac failure in the acute delirium of some form of insanity, wine is a useful remedy. It has been recommended in catarrhal inflammations accompanying epi- demic influenza, in the intestinal catarrhs of summer and autumn, and as a stimulant in amygdalitis. In purulent inflammations of long standing and in chronic discharges of blood, pus, or mucus from the uterus, vagina, urethra, intestines, or lungs, or from fistule or ulcers, claret wines are highly recommended. According to Binz, the alcohol tends to check the emigration of leucocytes and, on the au- thority of Anstie, it helps to overcome the excessive metabolism of the tissues. In addi- tion to this, it is no mean stimulant and sup- porting agent to one whose vitality has been drained by a long-continued discharge of pus. After recovery from a hemorrhage, strong wines may be given for their tonic effect upon the heart and peripheral blood-vessels. Half an ounce, from five to six times daily, is the proper dose. In the acute neuroses, such as infantile convulsions and acute chorea, the patients are very tolerant of wines, and the affections are sometimes decidedly relieved by them. In acute neuralgia the ethereal wines occasionally give great relief from pain. Cham- pagne is an excellent agent, given cold in small, often-repeated, doses, with which to control the vomiting following anesthesia and the vomiting of seasickness and pregnancy. In general debility which has its origin in anorexia or dyspepsia a Burgundy or a red Hungarian wine is of good service. Anaemic and chlorotic patients do not require wine; but a progressive chlorosis may be benefited by its use. The use of wine in pulmonary tuberculosis has been fought by physicians for years. It is probably correct to state that, when the wine chosen for the purpose, which must be care- fully considered in every case, reduces the fever and the night-sweats and strengthens the pulse, it is an eminently fit agent. Anything which will favour the fortification of the pa- tient's strength is a legitimate remedy in this disease, and wine frequently does. Wines—pure wines—have been recommend- ed in debility arising from protracted pain or scurvy, and in the chronic affections of the scalp and eyes of poorly nourished children. It has been advised to give it by enema in cases of gastralgia in which the stomach can not tolerate preparations of iron. Tetanus is said to have been cured by wine, and its injec- tion has been recommended in chronic dis- charges from the vagina and urethra and to lessen the discharge from fistule. Claret has also been used as an injecting fluid into the tunica vaginalis for the cure of hydrocele. The white wines of Bordeaux have been praised as tonics where there is a capricious appetite and for the decrease of corpulency, and they have been found useful in cases of biliary indiges- tion. Sauterne wines are praised for their tonic influence in pulmonary cases when there are insomnia and troublesome cough. The white Burgundy wines have been found of service in convalescence from any prolonged disease. Clarets are widely used as tonics to be taken with the meals; they rarely upset the stomach, and are agreeable to the majority of debilitated patients. In anemia and debility from any cause and in atonic gout they are useful. Diluted, they are excellent refriger- ants in the course of a febrile disease. In mal- nutrition not dependent on gastric or intestinal irritation, and as a tonic for convalescents, the red Burgundy wines are widely employed. Since they are ultimately sedative in their ac- tion, their use may preclude the administration of any narcotic agent. The quantity of wine to be administered must vary, of course, with the disease and the patient. In low fevers sometimes a pint, frequently a quart, may be given in twenty- four hours. It may be administered pure, di- luted with water or mineral waters, or in the form of wine whey. This is made by adding to a pint of boiling milk half a pint of some white wine, straining through a cloth, and adding loaf-sugar to the filtered product. The adulteration of wines is frequently prac- tised oftener in this country and France than in other European countries. Although at the present day these adulterations are not directly poisonous, they usually provoke disturbances of the stomach, and are reprehensible for this reason not only, but because the products are sold as genuine wines. The most frequently adulterated wines are port and Maderia, al- though claret, too, is frequently imitated. Lead is frequently found in minute quantities. This may spring from the shot with which the bot- tles are cleansed or from some analogous source. In the early part of this century English wine- dealers were in the habit of putting large quan- tities of shot into the barrels containing wine to keep it from turning sour. The use of oxalic acid was suggested if the lead did not answer the purpose. (Citation from The Wine Dealer's Manual, British and Foreign Medical and Chirurgical Review, April, 1858.) Cider or perry, diluted with water, may be palmed off as genuine wine. Frequently inferior wines may be made more easily salable by the addi- tion of a small quantity of a higher grade of wine. Alcohol is added to thin wines, sour wines are sweetened with sugar, honey, or raisins, and pale ones are coloured with burnt sugar. Acetate of lead may be added to wines to give them astringency, and acidulous wines are sometimes neutralized by the addition of lime or alkalies. Red wines are often made out of alcoholic dilutions, the colouring mat- ter being beets, litmus, rhatany, or logwood, and astringency is given to them by the addi- tion of alum, tannin, or oak or willow bark. Colouring matter is emploved by many wine- dealers, usually made of alum and elder berries 395 WINES Free sulphuric acid can not be detected by barium, since all wines contain some soluble sulphates. If a few drops of the suspected wine, however, are dropped on a piece of glazed paper containing starch, the texture of the paper will be unaltered and the spot, when dry, will be violet if the wine is pure; but if it contains only a trace of sulphuric acid, the spot wiil be rose-red and the paper will be friable. Adulteration has been known from Pliny's time, and this historian inveighs bit- terly against the decadence of the times since " no one can get pure wine to drink." It is known at the present day in Germany, more in France, and less in England, but most of all it is found in the United States. Wines are subject to a number of disorders, which will be briefly considered here. One of the commonest of these is the viscosity of wine, by which it becomes slimy, thick, and threadlike. It appears more frequently in wines poor in tannic acid, and is therefore more commonly found in white than in red wines. In acidulous wines this disorder some- times disappears spontaneously, particularly if they contain a considerable percentage of al- cohol. It may be cured by shaking the wine and allowing the entrance of air, or by adding grape-sugar to induce a new fermentation. Acetous fermentation may take place in wines through the growth of the fungus Myco- derma aceti. It is the most dangerous of all the disorders of wines, since it may make the wine unfit to drink in a very short time. This fermentation occurs chiefly in old wines with a small percentage of albuminous matter, in warm cellars, and When the barrel is not kept full. When a wine has become decidedly tainted with acetic acid, it is best to allow it to be converted entirely into vinegar. Pasteur- ization (vid. infra), electrolysis, and the pour- ing of the wine into another cask impregnated with sulphur have been suggested as cures. Lactic-acid fermentation may be caused in wines by chain-forming bacteria which are even noticeable to the naked eye as masses. The wine attains a smell and a taste which render it unfit for drinking. Other bacteria affect wines differently. It may become pu- trid, developing carbonic-acid gas and becom- ing turbid. The colouring matter of white as well as of red wines changes to brown, and a disagreeable odour and taste are developed. This change occurs chiefly in wines poor in alcohol which have been made from poor or rotten grapes. Through the action of a ferment not yet de- scribed, wines may become bitter. This is a peculiarity of red wines, and was first noted by Pasteur. It may take place through the action of ammonia and air on an aldehyde which sometimes develops in the wine. There is a decided lessening of the colour and of the tannic acid in this disease, and the wine is not palatable. Wines may become mouldy. This occurs only in wines deficient in alcohol, and is accomplished by the growth of a mould on the surface of the urine. Red wines may lose their colour from a va- riety of causes. It is normal for all red wines 09 to become somewhat lighter in colour as their age advances. But the wine may acquire a pallor, which is usually due to the cleaning of the containing casks with lime or with water impregnated with lime and the presence of too much air during the primary fermentation. To preserve its colour, it may be mixed with a proportionate quantity of darker wine. By chemical action, red wines may become black and white wines green, gray, or broivn. This condition is usually cured spontaneously if the wine is allowed to lie for a period. Among the other disorders to which wines are subject may be mentioned the smell of sul- phur, which is usually attributable to the earth in which the grape has grown or to some ex- ternal influence; a mouldy taste, acquired by the wine if it is preserved in mouldy vats; and the taste of the barrel in which it is kept. The same holds true of the wood from which the casks are made. The oak, larch, and mulberry barrels, for instance, give the wine a peculiar taste, The taste acquired by the wine from the ground in which the grape was grown, which is usually very characteristic, may be diminished by repeated withdrawal of quantities of the wine and refilling the cask with fresh wine (Die menschliche Nahungs'- und Genussmittel, von Dr. J. Konig, Berlin, 1893; Handbuch der chemischen Technologie, von Dr. F. Fischer, Leipsic, 1893). Pasteur suggested a method of ridding wines of most of the disorders to which they are sub- ject by warming them to a temperature of 140° F. This process is technically known as " Pasteurization," and may be easily accom- plished by the apparatus of Ballo (Fischer, op. cit.). As a rule, wines clear themselves; but to augment or hasten the process, sweet wines may be rendered clear by clay or albuminous bodies, which gradually cause the insoluble substances to sink and' to be thus easily re- moved. The colour of red wines is said to be heightened by the addition of plaster of Paris to the must. Vinum album (U. S. Ph.), white wine, is " made by fermenting the juice of fresh grapes, the fruit of Vitis vinifera, freed from seeds, stems, and skins." When a white wine is pre- scribed without further specification, a domes- tic dry white wine is recommended; such are California Riesling and Ohio Catawba. Port wine and sherry wine were formerly official in the U. S. Ph., but the increasing excellence of domestic wines induced the committee of re- vision in 1880 to return to the old nomencla- ture of white and red wines, and to allow any: white or red wine to be used which was of the required purity and alcoholic strength. Any German or other white wine is called vinum album (Ger. Ph.). Vinum album fortius (U. S. Ph.), stronger white wine, is a mixture of white wine with one seventh as much of alcohol of a specific gravity of 0-820. It must contain from 20 to 25 per cent, by weight of absolute alcohol. Vinum rubrum (U. S. Ph.), red wine, is " made by fermenting the juice of fresh col- oured grapes, the fruit of Vitis vinifera, in WINTERGREEN X RAYS 396 presence of their skins." The pharmacopoeia recommends, when no specification * made the use of a domestic dry red wine, or a native daret or Burgundy; any German or other red wine is allowed by the Ger. Ph. (For the pharmacopceial requirements of vinum album and rubrum, see the dispensatories and phar- ^Vma mtdicata, medicated wines, possess the advantage, because of their alcohol and acid of rendering some drugs soluble which do not easily dissolve in water. They are not stable and few are at present in use. The purest wines should always be chosen when they are prescribed.—Samuel M. Brickner. WINTERGREEN.—See Gaultheria. WITCH-HAZEL.—See Hamamelis. WITHERITE.—See Barium carbonate, under Barium. WOOL-FAT.—See Lanolin. WORMWOOD.—See Absinthium. WRIG-HTIA.— Wrightia (or Holarrhena) antidysenterica, an East Indian apocynaceous tree, has a bitter bark which was formerly an article of European commerce under the names of conessi bark and Tellicherry bark. It was used in diarrhea and dysentery. It contains a poisonous alkaloid, wrightine, which is sup- posed to be the active principle, but has not yet been sufficiently studied to warrant a rec- ommendation of its use in medicine. XANTHOXYLUM (U. S. Ph.) is the bark of Xanthoxylum americanum and of Xanthox- ylum Ctava Herculis. Its pommon name is prickly ash. The former species grows in the Northern, Middle, and Western United States, in rocky forests. It is a shrub from five to ten feet in 'height, and its alternate branches are covered with strong prickles, whence its popu- lar name. The shrub is a polygamous plant, flowering in April and May before the appear- ance of the foliage. The leaves and capsules possess a lemon-like odour. Xanthoxylum Clava Herculis is indigenous to the territory extending from the Atlantic coast to western Texas and from Virginia to the Gulf of Mexico. It varies in size from a large shrub to a small tree. Its bark and branches are also covered with sharp, warty prickles. Both varieties belong to the natural order Rutacee. In addition to the official shrubs recognised, there are several other varieties of the plant which are used medicinally in the localities in which they grow. In the Argentine Republic Xanthoxylum naranjillo is emploved as a diu- retic and sudorific. The Brazilians make a decoction of Xanthoxylum singuassiba which is alleged to have powerful sudorific properties and is widely used as a gargle in inflammatory and non-inflammatory affections of the throat. A tincture is used locally for severe toothache, with a reported analgetic influence. In the bark of this tree an alkaloid similar in its properties to pilocarpine has been found. Under the name of yellow Hercules s club and yellow thorn, the bark of Xanthoxylum caribeum has made its appearance in com- merce This is the satin-wood of southern Florida and the West Indies. Its bark is thin, with a bitter, disagreeable taste, and has a canary-yellow colour which is imparted to the saliva when the bark is chewed An alkaloid derived from this bark, when hypodermically injected into frogs, rabbits, or guinea-pigs, produces paralysis and subsequent death. In India Xanthoxylum alatum is used as an an- thelminthic and sudorific. The Xanthoxylum nitidum of China is said to possess febrifuge properties. On the west coast of Africa Xan- thoxylum senegalense has its habitat. _ Several alkaloids have been isolated from its bark, artarine the principal one, and one that re- sembles cubebine in its effects. The drug ar- tar root is said to be derived from this shrub. In 1829 Staples isolated from Xanthoxylum americanum a crystalline principle which he called xanthoxylin. The same result was ob- tained fifty years later by Lloyd. Moffet, in a subsequent analysis, obtained an alkaloid ot yellow crystals which were soluble in alcohol and in chloroform, insoluble in ether and in benzene. Colton, who examined Xanthoxylum Clava Herculis, isolated crystals which formed colourless, tasteless, silky needles, soluble in alcohol, in ether, and in chloroform, insoluble in water (American Journal of Pharmacy, 1880, p. 191). An alkaloid resembling berber- ine has been found in Xanthoxylum Clava Herculis. The bark of Xanthoxylum ameri- canum occurs in curved or quilled fragments. "The bark of Xanthoxylum Clava Herculis resembles it but is thicker, and is marked by many conical, corky projections and by stout, brown spines rising from a corky base (Bridges, Proceedings of the American Pharmaceutical Association, 1864). The bark is brittle, very light, and almost without odour. The taste is at first sweetish, then bitterish, and finally acrid. Xanthoxylum is said to resemble guaiac in its remedial action. It evokes a sense of heat in the stomach when ingested, increases the force and frequency of the pulse, and produces to some extent diaphoresis. Upon the nervous system it is stimulant as well. On account of its acridity, it has been employed locally as a sialagogue. An infusion, used on compresses, is said to have a revulsive action which is taken advantage of in chronic constitutional syphilis. It has some reputation as an emmenagogue and galactagogue. Success has been alleged for it in the treatment of chronic rheumatism. For diaphoretic purposes, for expelling flatus, and for the allaying of rheumatic pains, xanthox- ylum has been employed. As a counter-irri- tant, it may be employed in inflammations affecting the serous membranes. In this way it has been used in chronic pelvic disease of women in the form of a hot pack. As a means of relief from toothache, the bark is sometimes chewed. The fluid extract, extractum xanthoxyli flu- idum (U. S. Ph.), may be given in doses of from i to 1 fl. drachm. A decoction may be WINTERGREEN 397 X RAYS made by boiling 1 oz. of xanthoxylum in 3 pints of water. A pint may be given, in di- vided doses, in twenty-four hours. A satura- ted tincture may be administered in doses of 10 drops three or four times daily. A powder is prepared from the bark, the dose of which is from 10 grains to { a drachm three or four times daily.—Samuel M. Brickner. XEROFORM.—Dr. E. Heuss, of Zurich (Therapeutische Wochenschrift, April 19, 1890; New York Medical Journal, May 9, 1896), remarks that xeroform, or bismuth tribrom- phenol, C6H2.Br30-Bi-0, was recognised as an efficient intestinal antiseptic in the last cholera epidemic in Hamburg, but was not then recog- nised as a surgical antiseptic He describes it as an exceedingly fine yellow, neutral, insoluble powder, stable in the light, having a faint odour of carbolic acid, almost non-poisonous, and unirritating to mucous surfaces. It has but little effect on the human organism, but it is so highly poisonous to the comma bacillus that Hueppe declared it almost a specific against the cholera micro-organism. The au- thor's experiments, published in the Therapeu- tische Monatshefte, show that it is an excellent surgical antiseptic. He first used it with very good results in the treatment of chancroids; if they were not complicated with buboes, they healed in from eight to fourteen days. In various suppurative and necrotic affections, such as foul ulcers, buboes, infected wounds, paronychia, etc., after a preliminary cauteriza- tion with pure carbolic acid, it promoted the cessation of suppuration and led to prompt granulation and cicatrization, and never gave rise to any surrounding inflammation. In burns, xeroform, like iodoform, seemed to exert an anodyne action. In such skin diseases as eczema impetiginodes and eczema madidans a 10-per-cent. paste of xeroform promptly checked the discharge, and cicatrization speedily en- sued. It seemed to have a favourable effect in a few cases of localized itching, and a num- ber of tuberculous ulcers and glands healed quickly under a xeroform dressing applied after curetting. Xeroform seems to be itself inert, but on its coming in contact with an alkaline liquid, such as the tissue juices, the tribromphenol is gradually set free and exerts its action on the bacteria, while the bismuth oxide tends to check fermentation and acts as a desiccant, Xeroform is inferior to iodoform as a promoter of granulation. Its antiseptic power seems to be somewhat impaired by mixing it with fatty substances; hence it is better to use paste or a gauze impregnated with it. Its cost is about the same as that of iodoform, but it is cheaper to use it, because only about half the amount is required that would have to be employed of iodoform. It may be given internally in doses of from 7 to 15 grains, three times a day, in intestinal catarrh, including the summer diarrhea of children, also in chronic urticaria and in cer- tain forms of eczema in children. X RAYS.—The X rays, or Ronfgen rays, are chiefly of interest to the medical profession v from the point of view of diagnosis, but they have been employed therapeutically also. Our knowledge of them has been so recently ac- quired that some account of their nature and the processes of making use of them is appro- priate. The following, therefore, is condensed from a paper read before the Medical Society of Victoria in August, 1896, by Dr. F. J. Clen- dinnen, of Melbourne (Intercolonial Medical Journal of Australasia, August 20, 1896): The labours of Hertz, Lenard, Crookes, Hittorf, and others led up to Rontgen's discovery. The or- dinary Geissler tube was the first step in the process, then came the Crookes tube. This con- sists of a tube, pear-shaped or otherwise shaped, with platinum terminals fused into opposite ends, and exhausted of air. When a high-ten- sion current from an induction coil is passed through, a violet glow is seen in the tube. If the tube is further exhausted the glow seems to be in bands, and if the tube is still further exhausted the glow disappears, and then the glass of the tube becomes fluorescent, and glows with a bottle-green colour, provided it is made of soda glass. When the tube is in this condition the X rays are given off from the cathode. The late Professor Hertz was engaged in in- vestigating this phenomenon produced in Crookes's tube just before his death, and he instructed his assistant, Lenard, to continue these researches. He ascertained that the cathodic rays would act on a sensitive plate, and also that they would pass through wood, so that he came very close to Rontgen's dis- covery that these rays would pass through the tissues of the human body, and that some sub- stances were more easily penetrated by them than others—the soft tissues of the body more than the bones, aluminum more than other metals. What these rays are is not known; all we know is that they travel in straight lines, can not be refracted or polarized, cast a shadow, act on a sensitive plate, pass through objects opaque to light, and cause fluorescence. It has been suggested that they are ultra-violet rays of the spectrum, with which they agree in some respects, though their wave length has not been determined. In this connection, says Dr. Clendinnen, some observations made by himself on the effect produced on colour may be of interest. When taking a photograph by this process of some articles inclosed in a box painted like a tartan plaid, he found that the negative was striated, and comparing the striae with the colours on the box, he found that they corresponded with the red colours, and it flashed into his mind that these X rays were absorbed by certain colours as light was. He then tried to take a photograph of a picture painted in colours on a half-inch board, and got a contrast result. This, however, was not satisfactory, as the opacity might have been due to the lead in the paint, and the surface was uneven. To obviate this source of fallacy he next took a playing card, the knave of dia- monds, and the red colours came out opaque, the rest transparent; then, on the suggestion of Professor Lyle, he tried aniline colours, X RAYS 398 soaking blotting-paper in them, and found that red was opaque, blue semi-transparent, and white transparent to the X rays. He then cut pieces of coloured tissue paper into various shapes., so as to recognise the different colours, pink (as he had no red), orange, yellow, green, blue, violet, and white. On passing the X rays through them, he found pink semi-transparent, yellow and orange opaque, green opaque (but not so opaque as the former), blue and violet more transparent, and white quite transparent. These experiments seemed to show that the X rays obeyed some of the laws of ordinary light in that red and yellow are non-actinic. There are three things required for produc- ing these ravs: First, power or current; this may be obtained from Grove, Bunsen, or bi- chromate cells. Grove's and Bunsen's are the best, as their current is given off more evenly and lasts longer, but the fumes that arise are too pungent for comfort, This is not the case with bichromate cells, but their current is un- even. The number of cells to use must be in proportion to the strength or sparking of the coil. Accumulators may be used—such as Professor Lyle uses—a dynamo, the main, the Tesla coil, and the Wimshurst machine have all been used. Second, a Ruhmkorff induc- tion coil which gives a spark of from two to six inches; this must be in good working order. Third, a vacuum tube. The positive and negative terminals of the battery are to be connected to the coil, and the termi- nals of the secondary wire of the coil con- nected to the external terminals of the tube, which is supported on the stand, with the plate lying underneath, face upward. Owing to the capability of these rays of penetrating paper and wood with such ease, we may photograph on the plate inclosed in a box. Although these rays are invisible in them- selves, they stimulate visible fluorescence in certain salts upon which they are allowed to fall. The salts which have been.found to fluo- resce best are barium platinocyanide and calci- um tungstate. The fluorescent screen is made by painting evenly a thick piece of paper, such as drawing paper, with a mixture of gum and glycerin, and then dusting over it before it is quite dry a powder of the salts mentioned. Not only are the shadows cast on this screen, but it is used for shortening the exposure. It appears from certain experiments made by Mr. J. A. M'Clelland, an account of which is given by Professor J. J. Thomson (Proceed- ings of the Royal Society, No. 360), that the X rays are not homogeneous, but that some of them are absorbed by one set of substances and others by other sets. This lack of homogeneity is the more pronounced the smaller the amount of residual air in the Crookes's tube. Mr. M'Clelland found that with some substances there was no selective absorption, while with others it was very marked. Glass gave none, with mica and paraffin the effect was small, and with fuchsine, eosine, fluorescine. aesculin, and barium sulphide the effect was very de- cided. With several fluorescent screens the effect' was great. Pure water also gave a dis- tinct though smaller effect. When the X rays first came into use some physicians expected that they would be ioun<* to have some physiological action that could be turned to account therapeutically, and espe- cially that they would prove destructive of morbific germs. It seems, however, frorn De Renzi's experiments (Gazzetta degli ospedale, August 30, 1896; British Medical Journal, October 31, 1896) that they have no such effect, at least not on the tubercle bacillus, the bacillus of Finkler, or the cholera spirillum. Dr. P. Bosc (JVouveau Montpellier medical, April 25, 1896; New York Medical Journal, July 4,1896), having seen the opinion expressed in print that the curiosities of vision observed in the hysterical might perhaps be due to their perceiving these rays, examined a girl, fifteen years old, who was affected with hemianaesthe- sia and astasia-abasia, but whose vision seemed normal. Between the Crookes's tube and the girl's eye he placed a broad screen of two thicknesses of black paper. The light was ob- tained with a Holtz-Carre static machine. Under these conditions, neither he himself nor the girl's mother could see anything. The pa- tient, on the contrary, saw very clearly, and with each eye separately, a light which she said was "like a lamp." As long as the current was passing she saw distinctly; as soon as it was interrupted she could see nothing. At the time of making the interruption Dr. Bosc kept up a production of sparks, so that the girl did not know that he had stopped the current. He remarks that it was curious that the girl's per- ception of light varied with the luminous inten- sity of the cathode rays, the tube being the same. Dr. Frederick S. Kolle, of Brooklyn (New York Medical Journal, January 16, 1897), re- ports that of seven persons with amaurosis, subjected to the Rontgen rays, six observed a peculiar shooting-star light, the Sternschup- penlicht of the Germans. Four of the patients could count the individual stars, ranging be- tween six and thirty-two in number. Cancer is one of the diseases in which the X rays have been expected to prove remedial, and possibly they may yet be of advantage in the treatment of some forms of malignant growth. Dr. V. Despeignes (Lyon medical, July 26 and August 9,1896) reports a case in which they were used in the treatment of cancer of the stomach. At first a notable amelioration was observed, but unfortunately it did not continue. The Rontgen rays did, however, continue to diminish the size of the tumour, and at the time of the patient's death it was considerably smaller. M. Despeignes says that the treatment con- siderably ameliorated the general condition and prolonged the patient's life for fully two weeks, it absolutely suppressed the pain near the tumour, and, finally, it notably diminished the volume of the growth. He adds, however, that he thinks the amelioration of the general condition was mainly attributable to injections of artificial serum, for when their use was sus- pended at the patient's request, because they were painful, the general condition became worse. With regard to the cessation of the 399 X RAYS pain, when morphine injections ceased to have any further action, it did not seem warrant- able, he says, to attribute it to anything but the employment of the Rontgen rays, for from the beginning of the first sitting the pain ceased entirely. Before the employment of the rays the patient had been taking daily doses of 44 oz. of chloroform water, and verv often two pills containing f of a grain of ex"- tract of opium, and he frequently had one or two injections of morphine. After the em- ployment of the rays the use of the opium pills was discontinued and only very small quanti- ties of chloroform were given for two or three days. In regard to the diminution of the size of the tumour, says M. Despeignes, the action of the rays was still more distinct. As there was no sectio cadaveris, it was impossible to say what part of the tumour was influenced by the rays, but it is certain, he thinks, that the regression did not take place on the sur- face alone, but that the action of the rays was felt in the cancer; the epigastric region, which had been very much swollen on the 4th of July, was almost flat at the time of the pa- tient's death, on the 24th. This diminution extended also to the right extremity of the stomach, the part which encircled the left lobe of the liver. When death occurred it was found on palpation and percussion that this lobe of the liver was completely free, and it seemed as if the cancer had entirely disap- peared, on that side at least, for, M. Despeignes argues, if the regression had taken place in the stomach only, it is probable that the contrary would have been the case. In the presence of these results, and although the termination was fatal, he asks if there may not be hope, if not of recovery, at least of a considerable pro- longation of life by employing this treatment if the cancerous affection is not advanced or not progressing rapidly. On the other hand, some observers have put on record certain pathological phenomena that are thought to have been produced by the X rays. In the New York Medical Journal for August 29, 1896, an editorial writer says: " So far as our knowledge goes at present, these morbid results seem to affect chiefly if not ex- clusively the skin and its appendages. Dr. Marcuse (Deutsche medicinische Wochen- schrift, July 23, 1896; British Medical Jour- nal, August 15, 1896) relates the case of a lad, seventeen years old, on whom he experimented with the Rontgen rays once or twice a day for a period of four weeks, the sittings lasting from five to ten minutes, and longer when the chest was being illuminated. Hittorf's tube was sometimes placed close to the body and never more than eight or ten inches away from it. The heat from the tube is said to have been very slight. The lad was completely clothed when his head was undergoing examination, and wore his shirt when his chest was sub- jected to the apparatus. At first a slight diffuse redness was observed in one half of the face, especially above the ear, with some des- quamation. Subsequently there was a sharply defined area above the ear where the hair was very thin. The hairs could be plucked out without pain, and showed signs of degenera- tion—in short, there was incipient alopecia. There was pronounced injection of the con- junctiva of the eye that was situated on that side of the face that was affected. On the back there was a space • as large as a plate' over which the epidermis was completely sepa- rated, and the exposed corium showed haemor- rhages and exudation. The patch was quite tender, but there had been no pain until shortly before the lesions were noticed. There were similar changes, but not so advanced, over a space of about the same size on the front of the chest. The dermatitis resembled that caused by a burn. From other sources we hear of loss of the nails as a result of ex- posure to the X rays." Dr. A. B. Kibbe, of Seattle, Washington (New York Medical Journal, January 16, 1897), reports that during a certain week he devoted considerable time to experimenting with an X-ray apparatus. In general, the cur- rent strength used was about ten amperes. He found that the most convenient manner of testing the working of the tube was by using his left hand in front of the fluoroscope, and this he did frequently; but as this method gave less sharp and well-defined pictures than by using a sensitive plate and taking pictures, the fluoroscope was solely used to test the ac- tivity of the tube in producing the radiations, and, when the latter were satisfactory, pictures of the hand, wrist, and arm were taken with exposures varying from thirty seconds to five minutes. Just how often the hands were ex- posed he is unable to say, but certainly not fewer than twenty times for the left with the fluoroscope, and at least five for the right, placed on the plate holder; in no instance, however, for a longer period than five minutes. In order to obtain a picture of his elbow joint he placed it about four inches below the tube, which was of the ordinary focus pattern, the cathode a cup-shaped aluminum disc, the anode a plate of platinum set at an angle of forty-five degrees to the long axis of the tube. The focus he endeavoured to have directly over the joint, The arm was partly flexed and resting semipronated on the plate holder. A second exposure, lasting seven minutes, was tried a day or two later, and a third, lasting ten minutes, on the evening of the following day. This last was on the 8th of September. At the time a slight tingling of the skin was noticed, so slight, however, that he was not certain that it was not due to the effects of imagination, as during the "sitting" he had been going over, mentally, Tesla's arguments in favour of the assumption that the so-called rays are really due to minute particles thrown off from the cathode. In each instance the arm was covered with his usual clothing, con- sisting of heavy woollen underclothing, shirt and coat sleeve. A day or two later his attention was attracted to the appearance of the dorsal surfaces of both hands by a slight sensation of irritation and itching. At first sight the appearance suggested sunburn, but, as the weather had been cloudy for a number of days, and further, XYLENE ZINC 400 as his skin had alwavs been more than ordi- narily free from any of the common affections —eczema, etc.—he half jokingly attributed it to the X-rays. On September 18th he felt a slight itching near the elbow which had been exposed to the rays, and that night he found an extensive discoloration of the skin, ex- tending from a point two inches above the joint to a distance of about six inches down- ward toward the wrist, and including about one third the circumference of the arm. In colour it was of a brownish red, punctated at the upper and lower borders and ends and more confluent at the centre. Examination with a lens showed the punctated area to be due to an apparently greater hyperaemia around the hair follicles. No vesicles were apparent, and there appeared to be no tendency to their formation. Pressure caused the redness to disappear to a great extent, but not entirely. There was no sensitiveness, but the tempera- ture was decidedly raised above that of the adjacent healthy skin. Traction on the hairs showed no loosening. On September 20th, the affection showing no tendency to become worse, Dr. Kibbe cut out a piece of skin, a centimetre square, from the most deeply discoloured area, without using a local anaesthetic, for he feared to interfere with the structures by injecting cocaine. The stratum corneum was apparently unchanged; the stratum lucidum was not clearly visible, excepting over small areas, where the under- lying disturbance was seen to be slight. The outer layers of the cells composing the rete mucosum presented the most striking altera- tions, particularly in their nuclei. Taking the stain both with haematoxylin and lithium car- min very feebly, the nuclei showed in addition a peculiar granular change, which was first indicated in those retaining a more normal reaction to the stain by the formation of a fine nucleolus, which could be seen here and there in the process of division. Near the stratum granulosum the bodies of the cells were appar- ently becoming converted into keratohyalin as a first step to the increase in bulk, as it were, of the stratum granulosum by a development in their interior of coarse granules, staining deeply with haematoxylin, and also with carmin. With the former they appeared like blotches of India ink; in some places giving the impres- sion as though the cells had been charred by heat. This was particularly the case around the hair follicles. The corium exhibited the ordinary changes found in a mild dermatitis: capillary dilatation, with collections of round cells scattered through its structure, particu- larly around the hair follicles. No extravasa- tions of blood were noticed. On October 3d Dr. Kibbe noted that des- quamation of the entire discoloured area on his arm was going on, with absolutely no pain, excepting in the locality from which the skin had been exsected. A slight itching was all that now annoyed him. Where the flakes had been detached the hairs seemed to be as abun- dant and as firm as in the healthy skin. There appeared to have been no interference with the healing process of the raw surface pro- duced by the exsection, further than what might have been expected in removing a piece of "skin over a joint where every movement would tend to delay cicatrization. He suggests that the few reported instances of pathological phenomena produced by the X- rays are to be regarded as due to individual susceptibility. XYLENE, or xylol, or dimethylbenzene, C6H4(CH3)2, is a colourless liquid resembling benzene in general properties. Some years ago it had a temporary repute in the treatment of small-pox. Given internally, in quantities not exceeding 45 minims a day in divided doses, it was supposed to mitigate the severity of the disease and to shorten its course. It is reputed to be antiseptic. XYLENOL.—There are four isomeric xyle- nols, three of which, orthoxylenol, metaxylenol, and paraxylenol, are used in medicine, chiefly in the form of salicylates, the xylenolsalols, in doses of from 2 to 6 grains. The indications for their employment are the same as for that of salol (q. v.). XYLOL.—See Xylene. YARROW.—See Achillea. YEAST.—Beer yeast, or brewer's yeast, cerevisie fermentum (Br. Ph.), is a frothy, semifluid substance somewhat resembling soft soap in appearance, having a peculiar sourish odour and a bitter taste, consisting of the cells of Saccharomyces cerevisie. Brewer's yeast is occasionally used in medi- cine, in doses of one or two tablespoonfuls three times a day. Its employment in this way has been found to prevent the recurrence of boils. It may be given in a glass of beer at meal times. Dr. Cassaet (Semaine medicate, August 21, 1895; British Medical Journal, August 31, 1895; Therapeutic Gazette, December 16, 1895) reports good results in three cases of diabetes from the administration of brewer's yeast in daily amounts of an ounce, although the ad- ministration of the substance could not be continued long, on account of the practical difficulty in summer of preventing acetous or putrid fermentation. It was taken readily by the patients. The immediate effect was the expulsion, during the few minutes following its absorption, of a very large quantity of gas by eructation ; then in the course of the first or second day extremely foetid diarrhoea with abundant gas occurred. After a few days tol- erance was established, and the patient felt better than he had felt for a long time; his general state improved, his appetite returned, his strength increased, and pain diminished. The weight of the three patients on whom the treatment was tried increased three, five, and eight pounds respectively after the yeast had been administered for a fortnight. The gain in weight was particularly remarkable, inas- much as one of them was phthisical as well as diabetic, and another had diabetes of the grav- XYLENE 401 ZINC est type. On discontinuing the treatment loss of weight was soon observed again. As to the strength as tested by the dynamometer, an im- provement of from twelve to twenty kilo- grammes was noted in the right hand and of from seventeen to twenty-two in the left. The urea remained stationary or increased and the proportion of sugar in the urine diminished, in one case by three fourths and in another by two thirds in the fortnight. Brewer's yeast is used externally in the form of a poultice, cataplasma fermenh (Br. Ph.), made by mixing 6 fl. oz. of the yeast with its own bulk of water heated to 100° F., stirring in 14 oz. of wheaten flour, and keeping the mass in a warm place until it rises. This poultice gives off carbonic-acid gas, and thus proves stim ulant and slightly anodyne. There are, however, other and better means of accom- plishing all that it can effect. Baker's yeast, or German yeast, yeast freed from water and pressed into cakes, has been used in the treatment of enteroptosis by Dr. A. Giinzburg (Muurliener medicinische Wochen- schrift, July 7, 1896 ; Presse medicate, August 19, 1896) in a large number of cases, with suc- cessful results. Every day a quantity of about the size of a bean was given, and the fermen- tation provoked by the yeast caused a certain degree of flatulence which held and immobi- lized the intestine. Occasionally this flatu- lence became too great and provoked a feeling of distention; in this case the quantity of yeast had to be diminished. In a general manner, says Giinzburg, this treatment gives the patients a sensation of comfort. They are no longer inconvenienced with flatus, and this is attributed by the author to the peculiar action on the intestine of the carbonic acid which, under the influence of the yeast, is developed in the digestive tract. The stools become regular and abundant, and the distention of the intestine carries the aorta away from the abdominal wall so that the pa- tients do not feel the beating of this vessel. Finally, the appetite becomes better and large quantities of food can be taken without diffi- culty. Yeast is one of the sources of nuclein (q. v.). YELLOW ROOT.—See Hydrastis. YERBA SAGRADA.—See Lantana. YERBA SANTA, eriodictyon (U. S. Ph.), is the leaves of Eriodictyon glutinosum (or ca/ifornicum), or Californian tar-bush, a hy- drophyllaceous plant. Yerba santa has some reputation as a means of palliating chronic pulmonary inflammations. The dose of the fluid extract, extractum eriodictyi fluidum (U. S. Ph.), is from 20 minims to a fl. drachm. The aromatic syrup of yerba santa, syrupus eriodictyi aroniaticus (Nat. Form.), is em- ployed as a vehicle to mask the taste of qui- nine and other bitter drugs. ZEA.—See Corn-silk. ZINC, zincum (U. S. Ph., Br. Ph.).—This metal is not itself used in medicine, but is offi- cial for pharmaceutical purposes. It is de- scribed as "a bluish-white metal showing a crystalline fracture and having a specific grav- ity ranging from 6-9 when cast to 72 after it is rolled. Soluble in dilute sulphuric or hy- drochloric acid with evolution of hydrogen gas." It has a peculiar taste and a slight odour when rubbed. It is to be found in the market in the form of thin sheets or of irregu- lar, granular pieces, zincum granulatum (Br. Ph.), or in a fine powder, or moulded into pencils. For therapeutical purposes, zinc is repre- sented by several official and a large number of unofficial salts which present nearly every phase of activity in direct proportion to their solubility and power of diffusion, a variation which causes very marked differences in their physiological action. In moderate doses the soluble salts determine emesis which, though less severe than that induced by the salts of copper, is very prompt and thorough, while the insoluble salts tend to allay irritation of the gastro-intestinal tract. In regard to the lat- ter, however, it must be noted that large doses often cause nausea and vomiting, possibly on account of the conversion of a portion into a more soluble salt on contact with the contents of the stomach. Almost all the salts are as- tringent, and the soluble ones are caustic and corrosive agents which in large doses produce severe gastro-enteritis with all the accompany- ing symptoms of irritant poisoning. When applied externally, the insoluble compounds form soothing and protective dressings to irri- tated surfaces, while the soluble ones are as- tringent, irritant, and even caustic. In medicinal doses the zinc salts act as a tonic upon the nervous system, and exert a cer- tain, not very powerful, influence to ameliorate spasmodic nervous disorders, such as chorea and epilepsy. It is probable that at some time between the moment of ingestion and that of absorption into the system these salts are changed into the form of an albuminate, and as such exist and are carried about in the blood. Zinc has a tendency to accumulation, though to a lesser degree than mercury, lead, or cop- per, and is excreted from the system more rapidly than those metals. The elimination of the drug is accomplished principally by the liver and intestinal glands, but it has been alleged that it is excreted to a slight degree by the kidneys. The long-continued ingestion of considerable quantities of zinc, whether given for medicinal purposes or inhaled in the form of fumes of the molten metal, may give rise to disturb- ances of the nervous, respiratory, digestive, and haematopoietic systems, characterized by headache, muscular tremor, feebleness, paresis or paralysis, cough, dyspnoea, haemoptysis, vom- iting, diarrhoea or constipation, colic, cramps, anaemia, and other symptoms of interference with the nutrition of the body. The treat- ment of this condition of chronic zinc poi- soning is to hasten the elimination of the metal by means of potassic iodide, laxatives, and warm baths. Dr. Stephen J. Maher, of New Haven, de- ZINC 402 scribes in the New York Medical Journal for December 21, 1895, under the name of " spelter shakes," attacks of severe chills followed by fever and profuse perspiration, common among workmen in brass-foundries, and attributed by them to the inhalation of the fumes of molten zinc. These chills are said not to be associated with headache, nausea, or vomiting, and not to exhibit any periodicity or tendency to re- currence except on renewed exposure. As the workmen know that the attacks are of brief duration and consider them without danger, they are not accustomed to summon medi- cal assistance, but endeavour to obtain sleep as quickly as possible, for which purpose it is customary to imbibe considerable whisky. After a few hours they awake exhausted, but otherwise recovered. Cases of acute poisoning by the soluble zinc salts exhibit either the toxic symptoms refer- able to the acid with which the zinc is com- bined or the usual characteristics of corrosive poisoning. In the former case the patient is to be treated for poisoning by the combined acid; in the latter the acute symptoms must be relieved by washing out the stomach and the administration of bicarbonate of sodium or some other alkaline carbonate, as the best chemical antidote, followed by the ingestion of demulcents, such as milk or flour and water, together with the hypodermic injection of mor- phine in sufficient quantity to control the pain and vomiting. When an alkaline carbonate can not otherwise be quickly obtained, it is a good method to dissolve soap in water and cause that to be drank. Solutions of the soluble salts are useful for purposes of disinfection in the same manner as most soluble metallic salts and are preferred to many because they do not stain. The therapeutic applications of the zinc salts are as varied as might be inferred from a consideration of their widely different physio- logical actions. In suitable doses they agree in producing a beneficial effect upon certain diseases of the nervous system which is supe- rior to that induced by the salts of any other heavy metal, though not equal to that of the bromides, which have superseded them in the treatment of such diseases. Aside from this property, there is but little agreement in their action, and each salt needs a separate consid- eration. The zinc salts which are official in the United States, Great Britain, or Germany are the acetate, bromide, carbonate, chloride, iodide, oxide, phosphide, sulphate, and valerianate! These will be considered first, the description of each taken from the U. S. Ph., and will be followed by a number of unofficial salts, some of which are but little used, while others are employed to a considerable extent. All which are not permanent in the air should be kept in small, well-stoppered bottles. Zinc acetate, zinci acetas (U. S. Ph., Br. Ph.), zincum aceticum (Ger. Ph.).—This salt occurs in " soft, white, six-sided, monoclinic plates of a pearly lustre, having a faintly ace- tous odour and an astringent metallic taste. Exposed to the air, the salt gradually efflo- resces and loses some of its acid." It is soluble in about three parts of water and thirty-six of alcohol at ordinary temperatures, in about one and a half part of boiling water, and in three parts of boiling alcohol. When subjected to protracted boiling in water, it is rendered less soluble, a portion of the acid be- ing lost and a basic salt formed. Zinc acetate is seldom employed for internal administration, though it has been used as a nervine and to check diarrheas. In doses of from 8 to 30 grains it is an efficient emetic. Its principal use is as a local astringent, par- ticularly in gonorrhea, leucorrhea, and con- junctivitis, where its action is essentially the same as that of the sulphate, though somewhat less irritating. As a collyrium, it is usually prescribed in the strength of from % to 4 grains to the ounce of water, a drop of which is to be instilled into the eye once a day or oftener. Like all astringent collyria, this should be used only in conjunctivitis, and will do harm in certain diseases of the eye which are frequent- ly distinguished with some difficulty from that disease, such as keratitis, iritis, or scleritis. Solutions of about the same strength are used as injections in gonorrhoea, after the acute symptoms have abated, and also in leu- corrhcea. Sir Astley Cooper recommended in gonorrhoea a solution of zinc sulphate and lead acetate, in which a double decomposition ensued and resulted in the production of zinc acetate and lead sulphate. This is not infre- quently useful, as the astringent action of the zinc salt is complemented by the protection afforded to the urethral mucous membrane by a coating of the insoluble lead sulphate. An ointment containing zinc acetate is fre- quently useful in erythema and herpes. The late Dr. Tilbury Fox recommended as an as- tringent wash in erythema and eczema the following: ? Zinc acetate............. 2 grains; Rose water.............. l fl oz M. Zinc bromide, zinci bromidum (U. S. Ph.), occurs as a white granular powder, odourless] and having a sharp saline and metallic taste! It is very deliquescent, and is freely soluble in water and in alcohol. This salt is very little used. It was prob- ably introduced into medicine for the purpose of combining the tonic effect of zinc upon the nervous system with the sedative action of the bromides, but it has not proved of special effi- cacy in the treatment of nervous diseases. It is said to have been used in epilepsy in doses ot from 1 to 25 grains, but Gowers appears to have voiced the general opinion when he stated that it seemed of small value and to be badly borne, lhe dose usually recommended is from i to 2 grains. Zinc carbonate.—This salt is found in an impure condition in Nature as a mineral which is usually amorphous, but sometimes crystal- line, and varies in colour from white to red or green. This mineral, when powdered, is one ot the oldest local remedies we possess com- monly known as calamine, or tutty, and'forms 403 ZINC an important ingredient of calamine ointment which was formerly a favourite dressing for abrasions and superficial cutaneous inflamma- tions and diseases. The place of calamine has been taken in modern therapeutics by the preciDilated zinc carbonate, zinci carbonas precipitatus (U S Ph.), zinci carbonas (Br. Ph.), which is made by the interaction of zinc sulphate and sodium carbonate. It is "an impalpable white pow- der of somewhat variable chemical composi- tion, without odour or taste! Permanent in the air. Insoluble in water or alcohol; solu- ble in diluted acids with copious efferves- cence." When strongly heated it loses water and carbon dioxide, leaving a residue of zinc oxide. Zinc carbonate may be given in small doses to allay vom ding and irritation of the gastro- intestinal tract, but is seldom used for this purpose. It is slightly astringent and is use- ful as a surgical dressing, particularly for superficial inflammations which need a slight stimulation in addition to protection from the air. For this purpose it may be used as a dry powder, in a lotion, or in an ointment. The powder is also used to dust upon cutaneous surfaces which are in apposition with each other, as a prophylaxis against intertrigo. A lotion recommended by Crocker in acute inflammatory conditions of the skin is: IJ Precipitated zinc carbonate. 8 scruples; Zinc oxide................4 drachms; Glycerin.................. 2 fl. drachms ; Rose water, enough to make 3 fl. oz. M. A good ointment for most purposes is this: 3 Precipitated zinc carbonate. 2 drachms; Lard ointment............. 10 " M. Zinc chloride, zinci chloridum (U. S. Ph., Br. Ph.), zincum chloratum (Ger. Ph.), occurs as a white granular powder or in porcelainlike masses, irregular, or moulded into pencils, odourless, of such intensely caustic properties as to make tasting dangerous, unless the salt is dissolved in much water, when it has an as- tringent, metallic taste. It is very deliques- cent. It is soluble in 0-3 part of water at 15° C. (59° F.), forming a clear solution which, on protracted boiling, deposits a basic salt. It is very soluble in alcohol, less soluble in ether, and has an acid reaction. An impure zinc chloride was obtained and described by Glauber in 1648, and another im- pure form was described as "butter of zinc' by Ilellot in 1735. * When applied to the denuded tissues of the body, this salt exhibits a great affinity for the water there present, coagulates the albumin, shrivels the blood-vessels, and converts the whole into a dry, grayish, odourless mass, or eschar, which is thrown off in a week or two by the living tissue beneath. The coagulation of the albumin of the destroyed tissue serves to form a barrier which limits the caustic ac- tion of the salt and prevents its deeper pene- tration. When zinc chloride is thus applied to living tissue it causes pain for from six to , | eight hours, which, though said to be less se- vere than that occasioned by arsenic or corro- • sive sublimate, is sufficiently intense. Internally, the action of zinc chloride in l small doses is that of a weak nerve tonic, but ! larger quantities produce the symptoms of acute irritant poisoning, the treatment for s which has already been described. It is not often used for internal medication, but when ■ such administration is desired it is best to dissolve the salt in spirit of ether, in the pro- portion of a drachm to an ounce. Of this solution from 4 to 8 minims may be given twice a day. It has been alleged that in the early stage of pulmonary tuberculosis hvpo- dermic injections of a solution of this "salt tend to promote the formation of fibrous tis- sue and check the progress of the disease. It is recommended to be given in doses of 3 minims every three or four days, for five or six times, and it is stated that no objection- able local or constitutional effects are pro- duced by such administration. The escharotic, or perhaps it might better be called mummifying, property of zinc chloride has been made use of for the removal of malig- nant and other morbid growths, such as nevi, warts, and condylomata, to destroy " inoper- able " aneurysms, to open abscesses in situa- tions where puncture or incision would be dangerous, and to cleanse the surfaces of gan- grenous ulcers. The absence of danger of absorption of the drug and the natural limita- tion of its caustic action, together with its power, render it one of the most useful agents which we possess for the purpose of removing neoplasms, but the advisability of using any such agent for the removal of cancerous growths when extirpation with the knife is possible is very questionable. Although the pain caused by the caustic action of zinc chloride is considered to be less than that oc- casioned by other powerful caustics, it is never- theless far greater than that of excision, even when performed without anaesthesia, and it is doubtful if the statements of those who main- tain its superior efficacy can be substantiated. It has no selective affinity for the diseased rather than the healthy tissue, but destroys both alike, and the complete extirpation of a cancerous growth certainly*appears to be as likely to prove curative when performed with a knife as when done by the chemical action of a caustic. Sometimes and for vari- ous reasons excisions of a malignant tumour is impracticable, and then in a certain number of cases this method of removal is valuable. A certain amount of danger, albeit very small, attends the use of zinc chloride as a caustic for the purpose of removing cancerous growths, as is demonstrated by a case reported by Dr. Nichols in the Boston Medical and Surgical Journal. An epithelioma of the lip was first washed with a solution of caustic potash, and then a paste containing nearly 25 per cent, of zinc chloride was applied. This caused great pain in the growth, fol- lowed by pain in the region of the stomach, and then succeeded by unconsciousness, ster- ■ torous breathing, dilated and fixed pupils, a ZINC 404 small and weak pulse of 110, flushed face, cold perspiration, convulsions, coma, and death in about eight hours. The autopsy failed to re- veal any internal lesions which could account for the sudden death. The epithelium acts in a measure as a pro- tection against the action of this salt upon the subepithelial structures, so when zinc chloride is to be used for the purpose of removing mor- bid growths the cuticle, if present, should first be removed by means of acid nitrate of mer- cury or by a blister, and the preparation should then be applied to the raw surface. The satu- rated solution has been used for this purpose, but usually the salt is applied in the form of a paste of a strength proportioned to the situa- tion and depth of the growth which it is de- sired to extirpate. The oldest, and perhaps best known, paste is Canquoin's, which is made by mixing zinc chloride with wheaten flour in proportions which vary from one to two to one to five, and adding a sufficient quantity of water to make a paste. This is to be applied to the denuded surface, which should be surrounded by some protective covering to the neighbouring skin, such as a thick layer of simple cerate satu- rated with chloroform, which serves this pur- pose very well. The paste is applied from one twelfth to one third of an inch in thickness and allowed to remain several hours, both the thickness and the length of time to be deter- mined by the depth to which it is desired that the caustic action should penetrate. After removal of the eschar, renewed applications are necessary until the neoplasm has been re- moved. The paste is frequently moulded into pointed pieces, known as "caustic arrows," which are plunged into the substance of large tumours to secure their removal. Other pastes have been recommended which differ from Canquoin's in that they contain various admixtures of other drugs or are made with other diluents than flour, such as an- hydrous sulphate of calcium, gutta-percha, gluten, and zinc oxide, but all are used in the same manner, and with the same precautions, to accomplish the same purpose and present very few practical differences. But another method of applying zinc chloride for its caus- tic action is that of Cooke, in which lint is saturated with the deliquesced salt, cut into pieces of the size required and applied in a similar manner as the paste. Zinc chloride is a very active antiseptic and disinfectant. A 5-per-cent. solution is suffi- cient to destroy most micro-organisms, but a 20-per-cent. solution is necessary for the de- struction of anthrax spores. The official so- lution, liquor zinci chloridi (Br. Ph.), contains about 50 per cent, of the salt dissolved in water, and is a clear, colourless liquid of a very astringent, sweetish taste and acid reaction. Burnett's disinfecting fluid is a similar but somewhat stronger preparation. Both are useful as disinfectants and deodorizers for sinks, water-closets, drains, and other places where such an agent is needed. They are dangerous poisons, and fatal results have been occasioned by their ingestion. Useful antiseptic lotions for suppurating wounds and putrid ulcers may be made by di- luting the official solution to" the strength of from 2 to 10 minims in an ounce of water. Such a lotion serves to cleanse the surface, and will not infrequently stimulate old and indo- lent ulcers to a condition of healthy activity and repair. A stronger solution is useful for the irrigation of dissection wounds. Small cystic tumours, ganglia, ranule, and nasal polypi have been injected with weak so- lutions of zinc chloride in order to destroy them, but this is not usually so satisfactory a method of treatment as removal by the ordi- nary surgical procedures. Polaillon asserts that he has obtained as good results in the treatment of hydrocele by the injection of weak solutions of zinc chloride as from the similar use of tincture of iodine, and that less pain is caused by the former. IM. Leon Derville (Journal des sciences medicates de Lille, January 18, 1896; New York Medical Journal, February 22, 1896) de- scribes a mode of treating lupus when it is in the form of isolated nodules by what he calls dilaceration followed by applications of zinc chloride. The procedure is as follows: A scarificator is introduced into the centre of the tubercle and pushed until it is arrested by the cicatricial tissue which surrounds the lupous nodule; a rotatory movement is then rapidly made which tears the tuberculous tissue and often removes fragments at the same time. Employed in this manner, says the author, it not only dilacerates the diseased tissue, but it removes a part of it in the same way as a sharp curette does. After the tubercle has been torn away, a small crystal of zinc chloride is put into"the little cavity, and almost immediately the bleed- ing stops. A small black patch then forms, and this is surrounded by a whitish circle, a small eschar. This becomes dry and forms a crust over the lesion, and under it cicatrization takes place. This crust usually falls off be- tween the tenth and the fifteenth day, leaving only a reddish mark. The advantages of this process, says M. Der- ville, are the following: 1. It is scarcely pain- ful, and consequently is well borne by the patients. 2. It does not interfere with the patient's occupation; it leaves a few crusts only on the face, and does not require any dressing. 3. It gives rapid results. It is not rare to see a small nodule destroyed at the first application and replaced by a sclerotic tissue which, by becoming retracted, can have only the most favourable influence on the sur- rounding tissue. The disadvantages are that zinc chloride leaves cicatrices, often irregular and promi- nent, but this, says M. Derville, is of slight importance if they are on the body, but on the face they become deformities, and for this reason it should not be employed on the latter. Another disadvantage is the sclerotic action of zinc chloride on the tissue, which, by becom- ing shrivelled, may cause a shrinking of the natural orifices. If the nodules are situated near the mouth or the nostrils, says the au- 405 ZINC thor, other procedures are preferable, except in cases in which the lupous patches are very small. M. Derville says that he does not maintain the absolute efficacy of this treatment, for re- covery after a single application can not be hoped for unless the tubercles are superficial and not very extensive. When they are, the treatment has to be repeated several times. Usually an interval of two weeks should elapse between the applications; at the end of this time the crusts fall off or are easily detached, and dilaceration and cauterization may be re- sorted to again. This procedure, he says, if used prudently in the beginning, may be of some use in practice: it may cut short a long and tiresome treatment, and also rapidly check a relapse in the same region.] In diphtheria Wilhelmy recommends the local application of a 20-per-cent. solution on pledgets of cotton to the false membrane on the tonsils and pharyngeal walls. This se- cures the removal of the false membrane and, though it causes severe pain, the treatment is said to be remarkably efficacious. Solutions of from 15 to 60 grains to the ounce are useful local applications in cases of chronic pharyngitis, or, in general terms, to mucous membranes which have undergone fibroid degeneration or show the results of chronic inflammation. In chronic laryngitis such applications have occasionally been made to the vocal cords and the epiglottis. A solu- tion of 2 grains to the ounce is sometimes use- ful for the purpose of irrigation in cases of empyema of the accessory nasal sinuses, as well as in chronic suppurative otitis media. Solutions of from $ to 2 grains to the ounce of water have been used in chronic conjuncti- vitis, and, according to some authors, may be advantageously alternated with silver nitrate in the treatment of trachoma. Zinc chloride has also been used in gonorrheal and diphthe- ritic conjunctivitis, but if used at all in con- junctival diseases, it should be with great caution and in very weak solutions. The same caution should be observed in its use as an injection in gonorrhea and leucorrhea, for which purpose it is sometimes employed. Zinc iodide, zinci iodidum (U. S. Ph.), oc- curs as a white, granular powder, odourless and having a sharp saline and metallic taste. It is of acid reaction, very deliquescent, and apt to absorb oxygen from the air and to ac- quire the colour of the iodine thus liberated. It is readily soluble in water, alcohol, or ether. Zinc iodide has not become a popular drug. It has been given internally in chorea and in scrofulous diseases of the skin and eyes, but not with especially brilliant results. For this purpose it is best administered dissolved in syrup, in doses of from i grain upward. It possesses caustic properties which, though not so powerful, closely resemble those of the chloride, but it is seldom, if ever, used as a substitute for that salt. In the form of a 10-per-cent. ointment, it has been used as a substitute for potassic iodide to promote the resorption of tumours, but it does not appear to possess any advantage over the potassic salt as a sorbefacient. The best results obtained from the use of zinc iodide have been in the treatment of chronic inflammations of the mucous mem- branes. Thus a 3-per-cent. solution may be used as a lotion in post-nasml catarrh, and Lefferts considers that a nascent zinc iodide, made by the addition of a mixture of 240 grains of potassic iodide, 480 grains of iodine, and 3 drachms of water, drop by drop, to 200 grains of zinc sulphate and 140 minims of dis- tilled water, forms an escharotic well adapted for use in the throat and nose. Solutions of zinc iodide have been successfully used to re- duce the size of chronically enlarged tonsils. In 1859 Lente recommended the application of a solution of from 5 to 10 grains to the ounce to be thrown against the mucous membrane at the mouth of the Eustachian tube, in cases of its catarrhal swelling, for its astringent effect. He says that it is as efficacious as silver nitrate, which is frequently used for this purpose, and at the same time possesses a less disagreeable and persistent taste. In chronic conjunctivitis a ^-of-1-per-cent. solution has been employed as a collyrium. The following ointment may be of service in acne: 3 Zinc iodide.............. 5 grains; Vaseline................ 1 oz. M. The official zinc oleate, oleatum zinci (U. S. Ph., Br. Ph.), is composed of five parts of zinc oxide in ninety-five parts of oleic acid, and con- sists of a fine pearl-coloured powder, soft and soaplike to the touch. This preparation is use- ful in cutaneous diseases where ointments are not well borne, and is recommended as a useful application in bromidrosis and in hyperidro- sis, particularly of the axillae, genitals, and feet. With salicylic acid or French chalk it has been used in the treatment of comedo and acute vesicular eczema. In the combination of one part of zinc oleate to two parts of iodo- from, it has been recommended for erosions of the os uteri. [The official ointment of zinc oleate, un- guentum zinci oleati (Br. Ph.), consists of equal parts by weight of zinc oleate and soft paraf- fin.] Zinc oxide, zinci oxidum (U. S. Ph., Br. Ph.), zincum oxydatum (Ger. Ph.), is an amor- phous white powder without odour or taste. It gradually absorbs carbon dioxide from the air. It is insoluble in water or in alcohol, but soluble without effervescence in diluted acids and in ammonia water. This salt of zinc is found in Nature combined with the red oxide of manganese to form the mineral zincite. It is known in commerce as zinc white. Although zinc oxide is insoluble in the ordi- nary solvents, it is certain that some portion does enter into the circulation after ingestion into the stomach, and it is probable that a chemical change takes place in the salt on con- tact with the contents of that viscus. which converts a portion into a more soluble salt. ZINC 406 Possibly this conversion is into the albuminate, or perhaps into the lactate or chloride, which may be in turn changed into the albuminate. But whatever may be the nature of the chem- ical changes which take place, the absorption of zinc into the system after ingestion of the oxide is proved by the appearance of physio- logical symptoms after repeated doses. The experiments of D'Amore, Falcone, and Mara- maldi have demonstrated that sufficiently large doses, steadily repeated, will cause intoxication and death, at least in dogs. They gave these animals 7f grains of zinc oxide by the mouth daily, and noted as results the following symp- toms : Vomiting, feebleness, great emaciation, partial loss of sensation, a diminution in the number of the red blood-corpuscles, and a less- ened excretion of urine, which was found to contain albumin, sugar, zinc, and blood. The dogs lived from ten to fifteen days, and the post-mortem examination revealed extreme pallor everywhere, with disseminated areas of fatty degeneration in the liver, kidneys, and pancreas, surrounded by vascular and inter- stitial disturbances. The most marked lesions of the central nervous system were atrophy of the cells of the anterior cornua of the spinal cord, with some swelling of the nuclei. In medicinal doses, zinc oxide acts as a mild intestinal astringent and nerve tonic. In com- bination with bismuth and pepsin, it has proved an excellent remedy for the summer diarrhea of children. Combined with carminatives and morphine, it is efficacious in gastralgia. It has had a fair trial in epilepsy and other nervous diseases, and, while it is as good as any zinc compound and better than a salt of any other metal, it is really of little value. Bartholow considers that the cases of epilepsy in which this drug is most efficient are those in which the disease is the result of peripheral irrita- tion, having its origin in the stomach. The same author believes zinc oxide to be of pro- phylactic value in spasmodic asthma. Bene- fit is said to have been obtained from its use in the muscular tremor and unsteadiness of chronic alcoholism or poisoning with mercury and arsenic. It has also been used in doses of about 3 grains to check the night sweats of phthisis and the profuse secretion of bronchor- rhea. Zinc oxide is much used as an ingredient in cosmetics, but when so employed is apt to in- jure the skin. The principal medicinal value of zinc oxide is as a protective, slightly astringent dressing for cutaneous affections, such as abrasions, excoriations, blisters, burns, fissures of the nipples, lips, and other parts of the body, in- tertrigo, herpes, and eczema. For this purpose it is used in the form of powders, ointments, pastes, and lotions. As a powder, it may be used pure, but in certain diseases, such as ery- thematous and vesicular eczema, it is frequently too astringent and needs to be diluted with some inert powder, such as lycopodium, kaolin, or starch. Sometimes in eczematous inflammation of the eyelids, especially when due to irritating discharges from the eyes, as in the scrofulous each. 1 oz. conjunctivitis of children, a powder containing zinc oxide is an efficient application. Occa- sionally a powder 20 per cent, in strength may be applied to the conjunctiva. The following has been pronounced useful in acute eczema of the auricle and also as an ap- plication to ulcers of the septum nasi : 5 Zinc oxide.............. 1 drachm ; Alum, } Starch, M. The powdered zinc oxide has also been used, either pure or mixed with alum or tannin, for insufflation into the larynx in cases of laryn- gitis. The official ointment, unguentum zinci oxidi (U. S. Ph.), unguentum zinci (Br. Ph., Ger. Ph.), was first brought into use by Sir Erasmus Wilson. That of the U. S. Ph. is composed of 20 parts of zinc oxide with 80 of benzoinated lard; that of the Br. Ph., of 2 parts of zinc oxide and 11 of benzoated lard; and that of the Ger. Ph., of 1 part of crude zinc oxide, zincum oxydatum crudum (Ger. Ph.), and 9 parts of lard. This has long been a favourite ointment in cutaneous diseases, and frequently other drugs, such as carbolic acid, tar, and oil of cade, are incorporated with it for their medicinal effect. Other ointments than the official may be made by varying the proportion of the lard, or by using some other fatty excipient, such as vaseline or lanolin. When a non-fatty excipient is chosen, the preparation may be known as a paste, and is a useful substitute for the ointment in hot weather or when a fatty excipient is disagree- able. A good example of such a paste is the following: 3 Zinc oxide............... 50 parts; Salicylic acid, ) , „ , ' Carbolic acid, feach-- 6 Mucilage of gum ) arabic, J. i Glycerin, \ M. Neumann recommends in seborrhea and pityriasis— fy Zinc oxide, ) , . . Lead carbonate, \ each- • • 1 drachm; Spermaceti............. 1 oz. • Olive oil, enough to make a soft oint- ment. Another which has been recommended for the same purpose is— IJ Zinc oxide, ) , Honey, \ each...... 2 scruples; fellow wax........... 2 drachms: M A1m°nd oil............ 6 fl. drachms. Before either of these, or any other paste or ointment which contains zinc oxide, is ap- short S°alP' the hair Sh°uld be c^ In the form of a lotion, zinc oxide has some- times been used as a collyrium in conjunctivitis, and the following is recommended as of good each... 10 40 service in dermatitis, irritable acne, and other acute inflammations of the skin: 3 Zinc oxide........... 2 drachms: Glycerin............. 2 fl. drachms: Lead water.......... 1^. fl. drachm ; Lime water.......... i pint. M. F For use in gonorrhea, it has been suggested to mix the salt with lanolin or some other bland oil, and to allow it to remain for some time in the urethra. Zinc oxide has also been recommended as a component of firm surgical dressings. When it is mixed with the chloride and made into a paste, the basic oxychloride is formed, which will be mentioned later. A 10-per-cent. paste made with equal parts of glycerin, gela- tin, and water is recommended by Unna to be rubbed into a bandage which is immediately applied. As the mixture dries, it hardens and incases the limb bandaged in a stiff, immov- able dressing. Zinc phosphide, zinci phosphidum (V. S. Ph.), is a gritty powder of a dark-gray colour, or crystalline fragments of a dark, metallic lustre, having a faint odour and taste of phos- phorus. In contact with the air it slowly emits phosphorus vapour. It is insoluble in water or in alcohol, but soluble in diluted hy- drochloric or sulphuric acid, with the evolu- tion of hydrogen phosphide. This salt has been recommended by Reclus as very satisfactory in some cases of lymph- adenoma. It is readily decomposed in the stomach, and the physiological effects pro- duced by its administration are those of phos- phorus, of which, rather than of zinc, it should be considered a preparation. Zinc sulphate, zinci sulphas (U. S. Ph., Br. Ph.), zincum sulfuricum (Ger. Ph.), occurs in colourless, transparent rhombic crystals, without odour and having an astringent me- tallic taste. It effloresces in dry air. It is soluble in 0-6 part of water at 15° C. (59° F.) and in 0-2 part of boiling water, also in about three parts of glycerin. It is insoluble in alcohol. In small doses given internally, this salt is a tonic and astringent, in larger quantities an emetic, and in still larger an irritant poison. As a tonic it may be used in the same class of nervous diseases as all the other zinc salts, and as an astringent it is sometimes, especially when combined with opium and ipecac, of good effect in diarrhea and dysentery. Occasion- ally it is useful in bronchorrhea and in dyspep- sia, but, unless benefit is soon obtained, the use of this remedy should not be persisted in. For these purposes the dose is from fa to 2 grains, preferably in pill form. Zinc sulphate is a systemic emetic, and causes vomiting when injected into the blood as well as when ingested into the stomach. As it is also but very slightly depressant, it is a valu- able emetic "for use in narcotic poisoning as well as in such diseases as croup and whoop- ing-cough and whenever simple evacuation of the stomach is desired. To produce emesis it is usual to divide from 3 to 15 grains into >7 ZINC several portions and to give one portion every five minutes until vomiting occurs. A curious result of the long-repeated administration of zinc sulphate is that the stomach becomes re- markably tolerant after a time, so that enor- mous doses may be taken without causing nausea, but the course of treatment necessary to produce this tolerant condition may result in a superficial ulceration of the mucous mem- brane of the stomach. When an overdose has been taken the symp- toms of irritant poisoning appear and the treatment already described should be insti- tuted. Very few cases of this nature with fatal results are on record. Solutions of zinc sulphate are very useful for topical applications to mucous membranes, on account of the stimulant and astringent ac- tion of the drug. As a collyrium in conjunc- tivitis it is very popular, although rather more irritating than the acetate. It is adapted to chronic rather than acute cases, and should be used in solutions of from \ to 4 grains to the ounce of water once a day or oitener. Care should be taken, as with the acetate, not to use such a collyrium in scleritis, iritis, or kera- titis, conditions which are frequently distin- guished with difficulty from acuteconjuncti vitis. Solutions of about the same strength have been applied to the vocal cords to relieve vocal fatigue, and may sometimes be of service in acute coryza. Zinc sulphate is an efficient hemostatic i when applied to bleeding surfaces, and is of service in checking epistaxis when applied in the form of a powder or in a strong solution. A solution of 40 grains to the ounce has been employed by Dr. Bean to arrest laryngeal hemorrhage. Weak solutions have been employed to irri- gate the accessory nasal sinuses in cases of empyema, and to cleanse the nasal mucous membrane in atrophic rhinitis. In catarrhal inflammation of the mucous membrane of the Eustachian tube a solution of 1 to 2 grains to the ounce may be applied to its mouth, and solutions of from 2 to 5 grains to the ounce are frequently useful in acute or chronic cases of purulent otitis media. In inflammation of the external ear weak solutions of from J of a grain to the ounce upward are sometimes of service, but when furuncles are present in the canal the solution needs to be as strong as from 30 to 60 grains to the ounce in order to be useful. Many practitioners consider zinc sulphate one of the best remedies for gonorrhea which we possess. It is used as an injection, begin- ning with a weak solution and increasing the strength as the urethra becomes more toler- ant. When dry powdered zinc sulphate is sprinkled over the surface of an epithelioma, lupus, or unhealthy ulcer, a slough is cast off, but as this salt has not the same power of penetration as the chloride, it is not as efficient for the re- moval of malignant neoplasms. Sir James Y. Simpson recommended its use in cancer of the uterus, but it has not been very generally adopted. It is useful for the purpose of re- moving caruncles of the female urethra, warts, ZINC 408 condylomata, and similar small neoplasms or excrescences. Villate's solution has been successfully em- ployed as a local injection for the cure of caries. It consists of— 6 Copper sulphate, ) ca(}h _ ig Zinc sulphate, ) r Lead water.............. 30 " Vinegar................. 200 " M. The sinuses which lead to the carious bone are washed out with this solution so as to de- calcify and bring away the dead portions. It should not be necessary to state that in ne- crosis no such solution can be expected to re- move a sequestrum unless it is a very small one. Good results may sometimes be obtained in acne by bathing the surface with a solution of this salt with equal parts of potassium sul- phate and resorcin. The late Dr. Tilbury Fox recommended as a lotion in erythema, intertri- go, and eczema the following: 3 Zinc sulphate........... 10 grains; Alum.................. 20 " Glycerin............... 1 fl. drachm ; Rose water............. 7£ fl. oz. M. In dermatitis venenata a solution of 30 grains of zinc sulphate to the ounce of water is said to be an excellent lotion. Zinc valerianate, zinci valerianas (U. S. Ph., Br. Ph.), has already been considered un- der Valerian. The number of unofficial salts of zinc which are used in medicine is very great. Most of them are not of great importance, but some have won prominence and are quite extensive- ly employed at the present time. Zinc albuminate.—This combination is the form into which it is supposed that the various other salts are changed in the digestive organs before they enter the circulation, and this preparation has been introduced into medi- cine with the hope of securing a readier assimi- lation of the drug. It appears in the form of yellowish scales which are slightly soluble in water. It is intended for internal administra- tion in those diseases in which the use of zinc is indicated. Zinc arsenate and zinc arsenite are two preparations which are on the market, but are very little used. Each is a white powder solu- ble in acids and in sufficient quantities pro- duce the symptoms of irritant poisoning when taken internally. Zinc borate, or tetraborate, is an amor- phous white powder obtained by the interac- tion of zinc sulphate and sodium biborate in hot water. This powder has been used to a slight extent in surgical practice, dusted over the surface of wounds for its antiseptic action. Zinc bromate is a white, deliquescent pow- der, soluble in an equal part of water. It may be used in the same manner as the preced- ing, dusted over wounds as an antiseptic pow- der. Zinc carbolate is a white powder, slightly soluble in water and alcohol. This salt is slightly tonic and antiseptic in its action when given internally and has been used in cases of croup, diphtheria, and foul stomach in doses of i to 5 grains. It is also recommended as an antiseptic for surgical dressings and for use in skin diseases. Zinc chrysophanate is a brownish red powder, readily soluble in slightly alkaline wa- ter and in the alkaline secretions of wounds. The latter quality has suggested its availability as a surgical dressing. Zinc citrate is an amorphous white powder with a sharp metallic taste, not perfectly solu- ble in water, which has been very slightly used in epilepsy in doses of from 3 to 12 grains. Zinc cyanide is a snow-white powder, odourless, tasteless, insoluble in water or alco- hol, soluble in diluted acids and in solutions of the cyanides of ammonium and potassium. After a while it decomposes and acquires a sweetish, metallic taste. The physiological action of this salt is very similar to that of hydrocyanic acid and its alkaline compounds, sufficiently so that it is sometimes used therapeutically as a substitute for that drug. It has also been used in the same category of nervous diseases as the other zinc salts with about the same effect. It is fre- quently useful in neuralgia, particularly of the trigeminus, and has been employed to relieve gastralgia, dysmenorrhea, and certain cardiac neuroses characterized by pain, palpitation, and disordered rhythm. It may be occasionally given in whooping-cough with good effect, but should never be continuously administered in that disease. Formerly zinc cyanide was used in acute articular rheumatism, but it has been super- seded by other remedies because benefit is un- certain and its administration is apt to be followed by headache. The drug is also said to be anthelminthic. The usual dose is from } to li grain repeat- ed as frequently as every hour or two, because the physiological action appears to be tran- sient See also under Cyanogen. Zinc and potassium cyanide.—This salt, which is obtained by dissolving zinc cyanide in a solution of potassium cyanide, occurs in colourless or white octahedrons of a sweet and metallic taste. It is permanent in the air and treely soluble in water. The physiological action of this salt is the same as that of zinc cyanide, to which it is frequently preferred in therapeutics on ac- count of its greater solubility. It is pre- scribed in the same doses and may be given very nicely in aromatic sweetened water, but the addition of a small quantity of acid will precipitate zinc cyanide from the" solution Zinc ferrocyanide is a white, tasteless powder, insoluble in water, alcohol, and di- luted acids. The medicinal properties of this salt are the same as those of the cyanide, and it is used in the same diseases. The usual dose is given as IrTiolt-^^ A^^mofadminis- 409 ZINC B Zinc ferrocyanide...... 5 grains; Magnesia.............40 " Powdered cinnamon.__ 1 drachm. M. Divide into 10 powders. Sig.: One pow- der every four hours. See also under Cyano- gen. Mercury and zinc cyanide.—This is a white powder obtained by precipitation from a solution of potassium and mercury cyanides by means of zinc sulphate, and is probably a mixture rather than a true double cyanide. It was proposed in 1889 by Sir Joseph Lister as a non-irritating, antiseptic, surgical dressing, but was soon declared to be in no way supe- rior to the dressings previously in use. Its germicidal power is said to be slight, but a l-to-1,200 solution will prevent putrefaction in animal fluids. A ready means of preparing a dressing with mercury and zinc cyanide is said to be to dip gauze impregnated with zinc cya- nide into a l-to-4,000 solution of mercury bichlo- ride. This cyanide may also be used in the form of an ointment in the treatment of ec- zema and other cutaneous diseases, taking the place of the oxide. See also under Cyanogen. Zinc gynocardate is a yellowish, granular powder, insoluble in water and dilute acids, readily soluble in alcohol, ether, and chloro- form. This salt has been recommended in the form of an ointment for the treatment of syphilitic skin diseases, psoriasis, jirurigo, leprosy, and other cutaneous diseases in which gynocardic acid and chaulmoogra oil have been used. (See Chai-lmoogra oil.) Zinc hydrochlorite.—A solution of zinc hydrochlorite is recommended as possessing advantages over the solution of chlorinated soda as an antiseptic in that it is not alkaline and is astringent. It may be used as a lotion or as a gargle. Zinc iodate is a salt, insoluble in water, produced by the union of zinc and iodic acid, which has been used to no great extent as a topical application to affections of the mucous membranes. Zinc lactate.—This salt occurs in short, quadrangular crystals of an acid reaction and an acidulous metallic taste, obtained by dis- placing the carbon dioxide of zinc carbonate with lactic acid. It is soluble in fifty-eight parts of cold and six of boiling water, nearly insoluble in alcohol. This is the most readily tolerated of all the zinc salts, and is therefore preferable to any other for internal administration. It has been used with good results in hysterical amblyopia, and is employed in the same class of nervous diseases as the oxide. The usual dose is from £ to 1 grain several times a day. Zinc nitrate.—This salt occurs in striated, colourless, pointed, quadrilateral, prismatic crystals, is very deliquescent, is soluble in water and alcohol, and very caustic in its ac- tion. Its chief if not its only use is as a caus- tic in a similar manner to and for the same purposes as the chloride. When mixed with flour and water it forms a paste which can be easily spread, remains soft, and does not con- tract or spread at the edge through absorption of water. It may also be made into pencils in the same way as the chloride, but they must not be dried by means of heat, as that will cause some decomposition of the salt. The late Dr. Tilbury Fox recommended in severe and chronic cases of lupus erythematosus the following: B Zinc nitrate................ L} drachm; Distilled water, 1 Glycerite of starch, [■ each ... 1 " Flour, ) M. This is formed into a paste and applied to the surface of the lupus. When the paste is withdrawn a poultice is applied and the raw surface left by the removal of the eschar is dressed with an ointment like diachylon or zinc oxide. Reapplication may be needed, and the strength of the paste may be increased according to circumstances. Zinc oleostearate.—This is a semifluid, white, creamlike product of the combination of zinc stearate with benzoinated liquid albo- lene. It is of neutral reaction, almost taste- less, with the odour of benzoin, tenacious to the mucous membrane, to which it is non- irritant and acts as a protective. It is espe- cially intended for use in diseases of the naso-pharynx, pharynx, and larynx, to which it is comparatively easy of application, and as a vehicle for the application of other drugs, many of which may be combined with it, to the mucous membranes of those parts. [Dr. Walter F. Chapped (New York Medical Journal, May 30, 1896) says, speaking of the use of zinc oleo-stearate in conjunction with other drugs, that the following combinations have, in his experience, proved most valuable: Oleo-stearate of zinc with balsam of Peru, in conditions requiring stimulation and healing; with liquor plumbi subacetatis, in acute rhini- tis or the coryza accompanying a common cold ; with boric and carbolic acids, in copious wa- tery nasal discharges and hyperemic condi- tions; with iodine, in dry and atrophic rhinitis and ozena; with tannic acid, in nosebleed, and catarrhal conditions characterized by yellow discharges; with camphor and menthol, it is cooling, and therefore available in hay fever and coryza; with acetanilide, it is applied after operations as an antiseptic and protec- tive; with antipyrine, as a haemostatic in re- curring epistaxis, and as a sedative in irritable conditions of the mucous membrane; with ole- um pini pumilionis and eucalyptol, it is sooth- ing and curative as an intratracheal injection, in chronic bronchitis and asthmatic affections; with oleum pini pumilionis, as a sedative in irritable conditions of the nasal mucous membrane characterized by excessive sneezing ; and with orthochlorphenol, it is valuable in syphilitic ulcerations and ozena.] Zinc oxychloride.—When a solution of zinc chloride is added to the oxide a basic, insoluble compound, called the oxychloride, is formed, which soon dries and becomes very hard. It is used by dentists for temporary and some- times for permanent fillings for the teeth. ZINC 410 The characteristics which recommend it for this purpose are that after it has hardened in the cavity in which it has been placed it neither expands nor contracts, that it is of about the same density as dentin, and that it retains its white colour. When the wet mixture of zinc oxide and chloride is to be introduced into a dental cavity care must be taken that the pulp is not exposed to its action, because in that case it acts immediately as a painful escharotic. The hardness, firmness, and insolubility of this salt have also been made use of to some extent in the preparation of resistant surgical dressings. Zinc oxide mixed with one tenth as much zinc chloride and made into a paste with an equal weight of water has been recommended as an air-tight, firmly adherent and non-irri- tating dressing to be applied to sutured wounds, particularly when they are in situations which render them liable to infection from the bodily secretions. Thus, if applied after an operation for harelip the nasal secretions pass harmlessly over its surface, and the wound is effectually protected. After an operation for strangulated hernia also it may perhaps be of service. Such a dressing should be removed by the fifth or sixth day. It will very likely have become somewhat loosened by that time, but when it is still adherent it will need to be cut away with scissors. [Dr. G. Betton Massey, of Philadelphia (Journal of the American Medical Associa- tion, August 24, 1895), finds nascent zinc oxy- chloride valuable as an adjuvant to the gal- vanic treatment of hemorrhagic endometritis and incipient malignant conditions of the uterus. The positive electrode, made of zinc, is inserted into the uterine cavity, and the passage of the current leads to the formation of the oxychloride. Owing to the practical difficulty that has, he says, at times resulted from the adhesion of the electrode to the sur- face after a prolonged application, and also on account of the roughened surface rapidly at- tained by the electrode, he has been led to amalgamate the zinc freely with mercury be- fore using it, and is convinced that the expe- dient is a valuable one. Not only does this keep the zinc surface always smooth, lubri- cated, and non-adhesive, says Dr. Massey, but a new value is attained in the use of a nascent oxychloride of mercury in addition to the oxy- chloride of zinc and a far more efficient altera- tive^ and antiseptic action results.] Zinc permanganate occurs in crystals which closely resemble those of potassium per- manganate. It is hygroscopic, soluble in water, and unites with organic substances and with alcohol to form explosive mixtures. This salt was recommended by the late Mr. Berkeley Hill as an injection in acute gonorrhea. For this purpose it should be used alone, dissolved in distilled water, in the strength of 1 to 4,000 which is not irritating to the urethra. [Dr. A. S. Hotaling, resident physician to the Bay View Hospital, Baltimore (Jledical News, November 7, 1896), reports that zinc perman- ganate has proved more satisfactory in his hands than any other remedy in both acute and chronic cases of gonorrhoea. Its effect, he says, is discernible almost immediately, the discharge in the majority of cases becoming greatly re- duced after a few injections. After the stage of acute inflammation has subsided, the injec- tions are made four or five times a day, after urination, with an ordinary blunt-pointed hard-rubber syringe, with a capacity of from 3 to 4 drachms. His rule is to begin with a solution of half a grain to the ounce of water, gradually increasing it to a grain and a half. An alkaline diuretic is given, and the hygienic part of the treatment is followed closely in every case. The treatment is conducted under his personal supervision, instead of by the patient. He reports fifty-eight cases, of which fifty were permanently cured. In thirty-three cases it was the first attack of gonorrhoea. The average duration of urethritis before the be- ginning of the treatment was about three weeks. The average time that elapsed be- tween that of beginning the treatment and that of the cessation of the discharge was nine days. The cure was pronounced permanent in an average of twenty days after the treat- ment was begun. Zinc phosphate is a white powder, insoluble in water, but soluble in acids, which is obtained by the interaction of zinc sulphate and an al- kaline phosphate. It may occur as the diphos- phate or triphosphate, the former of which is the more soluble. This salt was introduced by Mr. Barnes, of London, who thought it pos- sessed special advantages for the treatment of certain forms of nervous diseases. Epilepsy attended with disorders of the uterine func- tions, and the nervous disorders which occur in enfeebled persons, especially in exhaustion from over-excitement, seemed much benefited by doses of from 2 to 5 grains, especially when combined with free phosphoric acid. In com- bination with quinine it was pronounced valu- able in cases of insanity during convalescence from fevers. It has been tried with but little success in locomotor ataxia and general pa- ralysis. Zinc salicylate occurs in long, colourless satiny, needlelike crystals, which have a sweet' somewhat bitter and styptic taste, are soluble in about twenty-five parts of cold water, freely in boiling water, and in three and a half parts of alcohol. Ihis salt is used solely for topical applications as an astringent and antiseptic agent. It may be sprinkled over the surfaces ot ulcerous and other inflammatory cutaneous diseases may be insufflated into the nose in the treatment of nasal catarrh, and may be applied as a collyrium in conjunctivitis in solu- tions of from one half to one per cent in strength, but it does not present any special tion? gGS °V6r °ther better-kn°™ prepara- Zinc sozoiodolate.—This salt occurs in colourless, needlelike crystals, which are sol" be m twenty parts of water and in alcohol It has been used in solutions of from one half to one per cent, in strength in acute and chronic blennorrhea arid gonorrhea, usually in comm- nahon with other drugs. In acute gonorrhoea the admixture of opium to the solution's fS 411 ZINC quently advisable, while in chronic cases the salicylate of bismuth has been recommended as a useful combination. A stronger solution has been used as a mouth wash. It has also been used mixed with some inert powder to the strength of from 5 to 20 per cent, in catarrhal inflammation of the nasal and pha- ryngeal mucous membranes. Zinc stearate compound.—This is the pro- prietary name of a light powder obtained by the combination of a soluble zinc salt with a mix- ture of stearic and other fatty acids. It is insoluble in water, slightly soluble in alcohol, and soluble in oil and turpentine. It may be used as a toilet powder, or as a protective in intertrigo, abrasions, and acute cutaneous dis- eases, but is intended principally as a vehicle for the local application of drugs used in the treatment of diseases of the cutaneous and mucous surfaces. , Zinc subgallate.—This is an odourless, non-toxic, non-irritating, greenish gray powder, of neutral reaction, insoluble in water or alco- hol, containing 44 per cent, of zinc oxide and 56 per cent, of gallic acid. Internally it has been used in doses of from % to 4 grains in fermentative dyspepsia and in night sweats. Its chief use is externally as an antiseptic and desiccant dressing in the treatment of eczema, fresh and septic wounds, and hem- orrhoids, applied pure or diluted with inert powders, or in the form of an ointment. It has also been used in affections of the nasal mucous membrane, in chronic purulent otitis media, and in gonorrhea. For the latter dis- ease it is used suspended in the proportion of one to sixteen in mucilage and water as an in- jection; Zinc sulphide.—This compound occurs in Nature as " blende," but as prepared for med- ical use is in the form of an impalpable powder. It was recommended by Duhring as a local ap- plication in subacute forms of lupus erythema- tosus and in seborrhea of the face. For this purpose the following lotion, in which this salt is obtained by double decomposition, should be applied to the surface and the sediment allowed to adhere: B Zinc sulphate, ) each- | fl d Potassium sulphide, ) Rose water................. 3 fl. oz.; Alcohol.................... 3 to 6 fl. dr. M. Zinc sulphite.—This salt is obtained by the interaction of six parts of zinc sulphate and five and a quarter parts of sodium sulphite in solu- tion, a reaction which takes place slowly, but is said to progress gradually to completion. It is not very soluble in water, but is soluble in excess of sulphurous acid, and is recommended as neither poisonous nor irritating. Tichborne says, in the Medical Press and Circular for October 12, 1892, that he introduced this salt many years ago as one especially adapted for antiseptic purposes. Any fabric can be im- pregnated with it without the use of any ad- hesive material by first boiling it in water to cleanse and sterilize it, then pouring over it a boiling solution of the above-named salts and 70 allowing the whole to stand for twelve hours. The double decomposition leaves the sulphite entangled in a semisoluble condition in the meshes of the fabric. He claims that this salt exhibits not only the antiseptic properties of zinc chloride, but also the special action of the sulphites and combines with these the healing qualities of zinc oxide. He also states that this salt is sufficiently soluble to maintain a germi- cidal condition in any supernatant 'fluid, and ascribes this power to the slow absorption of oxygen by the sulphite and its consequent change into the more soluble sulphate. This property gives it, in his opinion, a peculiar ad- vantage as a disinfectant for the stools of pa- tients with typhoid fever and cholera. Zinc sulphocarbolate, zinci sulphocarbolas (Br. Ph.), is described in the British Pharma- copoeia as occurring in " colourless, transparent, tubular, efflorescent crystals, soluble in about twice their weight of rectified spirit or of water." The appearance of the crystals varies from col- ourless to reddish according to the process of manufacture. They are odourless, of acid or neutral reaction, and have a somewhat bitter and astringent taste. During the past few years zinc sulphocarbo- late has come to be considerably used in the treatment of intestinal disorders, particularly those of childhood, and appears to act both as an astringent and as an intestinal antiseptic. It is thus indicated in all cases in which the oc- currence of foetid stools with tympanites shows the presence of fermentative processes in the gas- tro-intestinal tract, and excellent results have been obtained from its use in cholera infantum, cholera morbus, and typhoid fever. As com- pared with the other sulphocarbolates, the zinc salt seems to have the better effect in these diseases, possibly on account of its astringent and nerve-tonic action. In cholera infantum it may be given in doses of from $ to 1 grain as often as necessary, usually every two hours, until the stools reassume their normal appear- ance and lose their offensive odour. As the symptoms pass away the intervals between the doses should be lengthened. In cholera mor- bus and diarrhoea of adults the usual dose is 2-J to 5 grains every two hours until the fer- mentative processes in the stomach and intes- tines are checked. The benefit is frequently quite marked and rapid, the temperature falls, vomiting, tympanites, and diarrhoea subside, and then the drug is to be given at longer in- tervals until stopped. When the first doses are rejected by the stomach they may be repeated every fifteen minutes until one is retained. When the lower bowel is involved in either children or adults enemas of from 5 to 40 grains of zinc sulphocarbolate to the pint of warm water may be of good effect. In the treatment of these diseases it may often be of advantage to combine with this drug others which are indicated in these conditions, such as bismuth or chalk. In typhoid fever this drug has done good service in controlling the diarrhoea, and it has been said to be able to abort attacks of this disease if given during the incipient stage in doses of 2 grains every three or four hours. Good results have also ZINC 412 been reported from its use in chronic intes- tinal catarrh and haunatemesis. It is also said to have been of service in the vomiting of preg- nancy, given in combination with small doses of calomel, and to have been beneficial in scarlet fever. On account of its unpleasant taste it is best administered in the form of tablets. Externally, zinc sulphocarbolate has been used in solutions of from 1 to 5 per cent, as an antiseptic lotion, and as such is less apt to cause irritation than carbolic acid. The same lotion is useful in balanitis, and a solution from 0-5 to 2 per cent, in strength has been recommended for irrigation of the urethra in gonorrhea. In syphilitic and catarrhal laryngitis and pharyngitis a spray of a 1-per- cent, solution has been used with some bene- fit, Similar solutions have also been employed as douches for chronic purulent otitis media and for eczema of the external auditory canal. This drug has also been used for pityriasis capitis. Zinc sulphoichthyolate, or ichthyol- sulphonate, is a brownish-black, tarlike mass which was introduced into medicine together with the other compounds of sulphoichthyolic acid for the purpose of facilitating the use of ichthyol. The zinc salt is not so good as the other sulphoichthyolates for internal adminis- tration and is seldom used, but may be given in doses of from 4 to 15 grains in cases of chronic rheumatism, chronic catarrhal dis- eases of the stomach and lungs, chronic ca- tarrhal cystitis, chronic nephritis, chronic gonorrhea, and diabetes. Externally it may be used in the form of a liniment, incorpo- rated in soap, or in the form of an ointment, 45 grains to the ounce, in cases of acute or chronic rheumatism, neuralgia, sciatica, lum- bago, intrapelvic inflammatory exudations, frostbites, burns, varicose veins, eczema, pso- riasis, acne, erysipelas, and favus. Zinc sulphydrate.—This is a white, solid precipitate which decomposes on exposure to the air and must therefore be kept under water. It has been recommended for internal use in intestinal troubles dependent on bacterial in- fection in doses of from 0-5 to 2 grains, given preferably in pill form. Externally, it is useful in the treatment of chronic eczema, psoriasis, and vegeto-parasitic skin diseases, applied in a 10-per-cent. ointment with lanolin or lard. Zinc tannate is a fine, nearly white powder, insoluble in water, alcohol, or ether, obtained by the interaction of zinc acetate and tannic acid. It has been used to a slight extent in dyspepsia, phthisis, and diarrheal affections and rather more as a topical application to the mucous membranes. Bonnewyn recommended in conjunctivitis with a muco-purulent discharge— B Zinc tannate.......... 30 grains; Mucilage............. -J fl. oz.; Distilled water....... 6 oz. M. It has some effect as an astringent when ap- plied to the nasal mucous membrane, and has been used as an injection in gonorrhea. The dose internally is given as from 1\ to 4| grains. Zincohsemol is a dark-brown powder which contains about 1 per cent, of zinc in haemol. It is slightly soluble in water and is a mild astringent and tonic in its action. It has been used in anemia, chlorosis, and diarrheal affec- tions in doses of from 4 to 8 grains three times a day. Zymoidin is a proprietary article which is said to be composed of the oxides of zinc, bis- muth, and aluminum with iodine, boric, car- bolic, gallic, and salicylic acids, quinine, and other drugs. It has been placed on the market for use as an antiseptic in the form of powder, ointment, solution, or bougie. Matthias Lanckton Foster. SUPPLEMENT. Much has been added to our knowledge since the articles contained in the body of this work were prepared. Thus far, most of the literature of this additional knowledge has remained scattered through periodicals. Besides supplying accidental omissions, it is the function of this Supplement to give the substance of that literature, or at least of its more important portions, and it has been thought best to present it in many instances in almost the original authors' own words. ABRASTOL.—See Asaprol. ABRIN.—See under Jequirity (vol. i, page 562). F B ACETONE.—This substance has recently acquired some fresh importance in medicine as a solvent of celluloid (q. v., in Supplement). ACETYLENE.—See under Calcium car- bide. ACTOL.—See Silver lactate, under Silver. ADH.ffiSOL.— See under Varnishes. AIR, CONDENSED OR RAREFIED. —The use of the pneumatic cabinet is consid- ered by Dr. Charles E. Quimby (New York Medical Journal, August 1, 1896) to be a spe- cific and practically certain remedy for pul- monary hemorrhage. The flow of blood, says Dr. Quimby, can be permanently arrested only by the formation of a clot, and the formation of a clot is determined by one or more of three causes : (a) Modification of the blood elements; (b) reduction of vascular tension with slowing of circulation; and (c) compression of the bleed- ing vessels. Upon the first of these the cabi- net has no direct influence. For effecting the two others it is, facile princeps, our most pow- erful measure. To accomplish this we employ continuous respiration under negative differ- entiation with rarefactions of from a half to three quarters of an inch of mercury—differ- ential respiration. In such conditions, a pa- tient respires with the pulmonary circulation under existing barometric pressure, while the entire cutaneous expansion is relieved of from a quarter to half a pound of pressure to the square inch. The result is capillary dilatation with lowering of the systemic vascular tension, by which the venous system is filled to disten- tion, while the pulmonary vessels suffer cor- responding depletion and slowing of their circulation under lowered tension. Should the differentiation obtained by the cabinet alone not suffice, says Dr. Quimby, the use of com- pressed air for inhalation in connection with the cabinet must certainly cause compression of superficial bleeding vessels. ABRASTOL AIR " With haemorrhage thus arrested," he con- tinues, " we have to consider secondly the pre- vention of its recurrence. For our present purposes the causes of pulmonary haemorrhage may be condensed into two : Increased vascu- lar tension and diminished nutrition of the vascular walls, resulting in weakening and di- minished resistance. To fully appreciate the beauties of the cabinet action in diminishing tension and increasing nutrition, it is neces- sary to bear in mind that vascular tension serves solely the purpose of moving the blood through the vessels, for, if I mistake not, it is now generally admitted that nutritive inter- change depends upon cellular action and not upon mechanical transudation. It is certainly well recognised that the vessels of an organ in functional activity are dilated, while vascular contraction marks those parts in which the cir- culation is relatively diminished. Tissue nu- trition may therefore take place under lowered tension, provided the flow of blood is main- tained. The"evident indications in the condi- tion under consideration, then, are to hasten pulmonary circulation as a means of augment- ing tissue nutrition, without increased and, if possible, with decreased vascular tension. It is precisely this which is accomplished by the cabinet, by the motion termed force inspira- tion. When, after a few days', possibly a week's, treatment by differential respiration alone, we feel sure that the protective clots are firmly established, that motion is replaced by forced inspiration. At first, the rarefaction employed is but little more than has been used for differential respiration. But day by day it is increased until the maximum that is "deemed advisable for the case in hand is reached. This may require anywhere from two to ten days. What now is the physics of this motion ? Dur- ing inspiration the condition is that just de- scribed for differential respiration, and the action that of a general cutaneous cupping. With the higher rarefaction the effect is greater, and at two inches of mercury, if the breath is held for two or three seconds after the lungs have reached full inflation, the capillary hyper- 413 AIROL ANAESTHETICS 414 remia of the skin and the venous distention be- come very evident. At this point the breathing tube is dropped from the patient's mouth, as the controlling valve is closed, and the pul- monary pressure instantly drops to that upon the skin." AIROL.—This is a German patented sub- stitute for iodoform as an antiseptic, and is de- scribed as an iodine substitution compound of basic bismuth gallate (dermatol). Professor Coblentz gives the formula as f— OH This compound, he says, possesses the absorb- ent properties of subgallate of bismuth as well as the antiseptic properties of its iodine com- bination. It is a greenish-gray, fine, inodorous, and tasteless powder. Light produces no effect on it, while moist air causes it to turn red with loss of iodine. In contact with water, particu- larly when heated, the powder undergoes slow decomposition, becoming red with loss of io- dine. Dilute alkalies and acids dissolve it readily. Haegler (Beitrage zur klinische Chirurgie, xv, 1; Cenlralblatt fur Chirurgie, January 18, 1896) has made comparative trials of airol, der- matol, and iodoform, and has satisfied himself that airol is less poisonous than iodoform. Moreover, he says, it is free from odour and does not irritate* the sound skin. Two points of its superiority to iodoform are its property of parting with a portion of its iodine in the presence of the warm fluids of the body and the fact that, by reason of the bismuth con- tained in it, it is in a high degree desiccative. It is applied for the most part with a powder blower; it is used also in the form of a 10- or 20-per-cent. gauze, in that of a 10-per- cent. solution in collodion, and, for tuberculous affections, in that of a 10-per-cent. emulsion in a mixture of equal parts of glycerin and water. In the course of a year Haegler has used airol in about two thousand cases, and has observed its decided effect on the tuberculous process, but no untoward action. He regards it as a useful substitute for iodoform. De Sanctis, of Rome (Gazzetta degli ospedali, November 1, 1896; British Medical Journal, December 26, 1896), reports having used airol with results which he characterizes as brilliant in intertrigo, both of the secreting and of the pruriginous type. Dusted over the affected parts, he says, it gives immediate relief, sooth- ing pain, subduing itching, and healing exco- riations. He gives as examples of its use two very severe cases. One of these was that of an old woman who had intertrigo of the whole hypogastric region, both groins, one thigh, and part of the external genitals; the whole sur- face was reddened, raised, and partially cov- ered with a greasy, grayish layer, and in some places eroded to such an extent that the slight- est touch caused bleeding. Local treatment of various kinds had been tried in vain. The ap- plication of airol at once got rid of the burning feeling, which was replaced by an agreeable sense of freshness, and sleep ceased to be inter- rupted by the pain and itching. The powder was applied daily and kept on with a bandage. In four days the eroded surface was completely healed; a few days later the cure was com- plete, and there had been no complaint of re- currence four months after treatment. De Sanctis recommends airol as one of the best remedies for intertrigo ; it is non-toxic, and its use is not attended with any drawbacks. AKTOL.—See Silver lactate, under Silver. ALBOLENE.—This is an American pro- prietary refined product of petroleum which is employed as a base for ointments and as a lu- bricant. It is odourless and does not become rancid. Liquid Albolene, which is very readily dif- fused in the form of spray, is a suitable solv- ent for drugs that it is desired to apply to the nasopharyngeal passages. ALLYL SULPHOCARBAMIDE, AL- LYL STJLPHOUREA, ALLYL THIO- UREA.—See Thiosinamine. ALLYL TRIBROMIDE, C3H6Br3, is de- scribed by Professor Coblentz as a colourless or slightly yellowish liquid which has been rec- ommended as a sedative and anodyne to be given subcutaneously in doses of from 2 to 4 drops, dissolved in ether, in hysteria, asthma, whooping-cough, etc. ALUMINUM BOROTANNICOTAR- TRATE.—This is made by dissolving alumi- num borotannate in a solution of tartaric acid. It is called also cutal. It is astringent and an- tiseptic, and is employed topically, pure or at- tenuated, in catarrhal states of the skin or mucous membranes attended with supersecre- tion. Cf. Tannal. AMBER.—Dr. William Murrell. of Lon- don (Clinical Sketches. February, 1896), says that for some years he has used oil of amber, both internally and externally, in the treat- ment of whooping-cough. He has not kept notes of his cases, but the results have been so satisfactory that the custom of giving it has degenerated into a routine. He has found it useful also in chronic bronchitis and winter cough. In whooping-cough he generally orders a teaspoonful to be rubbed in along the course of the spine, night and morning, before the fire. For rheumatism he finds it better to have it made into a liniment with equal parts of aro- matic spirit of ammonia and spirit of camphor. For internal administration, from 3 to 10 drops may be taken every four hours, on a piece of sugar or on a crumb of bread, but this mode of administration presents some difficulty in the case of children. The following mixture, Dr. Murrell thinks, is preferable : R Oil of amber........... 10 minims; Powdered gum acacia. .. 1 drachm ; Syrup of orange flowers. 2 drachms ; Oil of anise............. 3 minims; Water, to.............. 1 oz. M. The difficulty is, he says, in covering the somewhat disagreeable taste of the amber oil. He has made some experiments with the view 415 AIROL ANAESTHETICS of obtaining a tasteless amber oil, but the re- sults have been unsatisfactory. He gives the following formula for a liniment: B Oil of amber............. 6 drachms; Oil of rosemary, / , , -, , Oil of origanum, \ each • • • 1 drachm" Oil of turpentine......... 1 oz.; Linseed oil, to........... 4 oz. M. Dr. Murrell is satisfied that more extensive trials will show that oil of amber is a useful therapeutic agent. AMMONIUM CHLORIDE, in drachm doses, has been used successfully in one case of delirium tremens by Dr. Gilbert G. Cottam (Jlduine, November, 1896; New York Medi- cal.Journal, November 21,1896). Having some knowledge of the patient and his tolerance of drugs, Dr. Cottam began by administering a grain of morphine hypodermically. This was without the slightest effect. Several hours after the administration of the morphine, and after the symptoms had all become aggra- vated, he gave a drachm of chloride of ammo- nium. This was promptly vomited. After a short time another was given, which was re- tained. It acted quickly and favourably. In fifteen minutes the hallucinations of snakes and lizards had disappeared, and the patient had become quite rational. In forty minutes he was asleep, and it was not thought neces- sary to continue the administration of the drug. Dr. W. Bourne Gossett, of Independence, Missouri (New York Medical Journal, January 23, 1897), reports the case of a lewd woman who had been "on a drunk " for eight days, and just before he saw her had had the usual "reptile hallucinations." He found her very restless, moving incessantly, and she had to be forced to stay in bed. At once he sent to a neighbouring apothecary's for a drachm of chloride of ammonium, but before it was brought she was beginning to get more ex- cited and seeing " snakes." As soon as he got the ammonium he at once gave her half a drachm in a large quantity of water—four ounces—and had her drink it in one or two gulps. In fifteen minutes she was quieter, and in fifteen minutes more he gave her the other half drachm. In a short time she was asleep and slept for six hours. She awoke feeling much better, and had no more trouble. Dr. Gossett says he would not hesitate to give a drachm and repeat the dose in half an hour if the patient was not better. AMMONOL. — Ammoniated phenylacet- amide (see under Phenylacetamide). AMYGDOPHENINE. — This substitu- tion derivative of paraniidophenol, ^OCOOCjH. h/\h xCOCHOHC6HB, has been employed by Dr. R. Stuve, of Frank- fort on the Main, in the treatment of rheu- matism (Centralblatt fur innere Medicin, November 16, 1895), and found to be very ser- viceable. One of the twenty rheumatic patients to whom he gave it was suffering severely from aortic insufficiency, and this patient was cured of his rheumatism in a few days. In only one of the twenty cases did the remedy prove of no benefit. Dr. Stuve found it use- ful also in neuralgia. He gave it in 15 grains from once to six times a day, in the form of Engel's compressed tablets or in powder, and observed no unpleasant effects, except in the case of a woman who, while taking 75 grains a day, complained of slight dizziness on the sec- ond day. AMYL NITRITE.—M. Hayem (Journal des praticiens, 1895; Medical Record, January 18, 1896) says this drug can be given in much larger doses than is usually believed, for he has more than once given from 50 to 100 drops to be inhaled at once, without meeting with any dangerous symptoms. The following is his method of employing the remedy in pneu- monia (Medical Press): 15 drops were poured on a compress and inhaled in the recumbent posture without effort; a few seconds after- ward the same dose was renewed, and yet 15 drops more were given, so that in the space of five minutes about 50 drops were inhaled. Redness of the face, acceleration of the pulse, and precipitation of the respiratory move- ments followed. These phenomena soon gave place to a slight cough, a thready pulse, dysp- noea, lividity of the face, and cyanosis of the extremities and of the lips. In ordinary cases only one series of inhalations was given daily, while two (morning and evening) were ordered where the symptoms were grave. It did not appear to M. Hayem that the treatment had any marked effect on the duration of the dis- ease, or on the thermic cycle; the effects seemed to be entirely local, consisting in de- crease of the dyspnoea, modification of the expectoration, and attenuation of the stetho- scopic signs. The drug did not destroy the virulence of the pneumococci; its chief influ- ence was on the pulmonary circulation, pro- ducing a strong flux which facilitated the return of the blood into the alveoli and hast- ening the absorption of the exudation. In a period of two years he had treated seventy- seven cases of pneumonia, with sixteen deaths, by inhalations of the nitrite. Several of the fatal cases had occurred in hard drinkers. AMYLOFORM.—According to the Wiener medizinische Blatter for September 3, 1896, this is a chemical compound of formaldehyde and starch, made by a patented process devised by Professor A. Classen. On its coming in contact with living tissue or with the secre- tions, formaldehyde is set free. It is thought to be an excellent antiseptic and deodorizer for wounds, far more energetic than iodoform, odourless, unirritating, and harmless. ANiESTHETICS.—Dr. F. Hewitt and Mr. A. M. Sheild (British Medical Journal, October 26, 1896) have called attention to the impor- tance of the patient's posture during general anaesthesia. They think that, so far as may L16 ANaESTILE APOMORPHINE 4 be practicable, the head should be kept in a line with the long axis of the body and the face turned to one side when the patient is in the supine posture ; that the lateral posture is of advantage in most major operations within or about the mouth and nose: and that, pro- vided there is no special contra-indication, the patient should be turned upon his side at once when the operation is finished. The Laborde method of resuscitation by rhythmical tractions on the tongue has been made the subject of laboratory experiment by Dr. H. A. Haubold, of Bellevue Hospital Medi- cal College (New York Medical Journal, Janu- ary 23, 1897). His observations have led him to conclude that the Laborde method leaves much to be desired, and he thinks it should not be employed to the exclusion of the other methods now in use. ANiESTILE.—This name has been given to a mixture of ethyl chloride and methyl chloride. It is employed as a local anesthetic. It does not render the skin so hard as methyl chloride alone does. (Dr. W. C. Daish, Aus- tralian Medical Journal, December 20, 1895.) ANETHOL, or anise camphor, a camphor- like constituent of oil of anise, has been em- ployed to some extent as an antiseptic. ANHALONIUM LEWINIL—In a pa- per read before the Association of American Physicians in May, 1896 (Medical Record, August 22, 1896), Dr. D. W. Prentiss and Dr. Francis P. Morgan, of Washington, gave an account of their investigation of the medicinal properties of mescal, or muscale, buttons, which they find to " possess properties which are re- markable, the exact likeness of which is not found in any other known drug, and also that it possesses virtues which, when applied in the treatment of certain diseased conditions, may prove the drug a valuable addition to our pres- ent list of therapeutic agents." Prentiss and Morgan experimented on eight young men, and found that the most remark- able visions were the result, the beauty and variety of which were much enhanced by drumming or otherwise marking regular time, after the manner of the Indians. One of the young men described his experience as follows: " The first sensations that followed my tak- ing the drug came upon thoughtlessly closing my eyes. Instantly there sprang into the field of view a host of little tubes of shining light, down which green and red balls the size of peas were constantly rolling. The tubes of light bent themselves into the shape of letters, but they would spell nothing, and slowly curving themselves into grotesque shapes, began to re- volve rapidly, the green and red balls going in the opposite direction with even greater veloc- ity. All the field of view between these silent wheels was filled in with a shifting mass of green. The colours were wonderful. They were the colours of the spectrum intensified as though bathed in the fiercest sunlight. No words can give an idea of their intensity or of their ceaseless persistent motion. The figures constantly changed in form and colour, but always remained a series of fantastic curves, revolving rapidly back and forth upon their own axis. The forms changed through rich arabesques, Syrian-carpet patterns, and plain geometric figures, and with each new form came a new flush of colour, every shade ap- pearing, from pure white to deepest purple. When the eyes opened and the light was turned up, the visions faded like stars going out in daylight, and the room, tables, chairs, and all surroundings came back into real exist- ence and within reach of the hands." In some cases no effect whatever was pro- duced upon the reason or will of the individ- ual. In others there were some slowness of thought and loss of power of expression, and in one of the experiments there was a marked delusion. Dilatation of the pupil was well marked in every case, and persisted for from twelve to twenty-four hours after the drug was taken. The dilatation was accompanied by a slight loss of the power of accommoda- tion and consequent disturbance of vision. More or less depression of the muscular sys- tem existed in every case, and this was the first effect noticed after the drug was taken. It ranged from a feeling of lazy contentment to decided muscular depression. Partial anaes- thesia of the skin was present in three of the cases, appearing when the effects of the drug began to wear off. The heart's action was at first rendered slower and stronger. This was followed by a rise to the normal which contin- ued during the period of greatest activity of the drug. In the cases in which the muscular depression was greatest, slight, if any, depres- sion of the heart was present. The respiration was unaffected in all cases but one. In this it seemed to partake slightly of the general mus- cular depression. Upon the stomach the drug produced an effect which varied from a feel- ing of uneasiness and fulness at intervals to nausea and vomiting. Inability to sleep for at least twelve hours after the influence of the drug passed off was a uniform effect. Appre- ciation of the duration of time was lost in all cases—as in the effect of cannabis indica. In one case a snowstorm appeared to last an hour, although in fact the vision continued not more than a minute. There was no constant effect upon the bowels, skin, temperature, or any secretion. Prentiss and Morgan think that the condi- tions in which it seems probable that the use of mescal buttons will produce beneficial re- sults are the following: General "nervous- ness," nervous headache, nervous irritative cough, colic, hysterical manifestations, and other similar affections in which an antispas- modic is indicated; that they will be found useful as a cerebral stimulant in neurasthenia and in depressed conditions of the mind— hypochondriasis, melancholia, and allied con- ditions—as a substitute for opium and chloral in conditions of great nervous irritability or restlessness, in active delirium and mania, and in insomnia caused by pain. In the last con- dition, they remark, it acts to produce sleep not as a hypnotic, but by relieving the cause of the insomnia. In full physiological doses 417 AN^STILE APOMORPHINE it produces insomnia, but in therapeutic doses it does not have this effect. Prentiss and Morgan give the dose of an- halonium in substance as from 7 to 15 grains; that of a 10-per-cent. tincture as from 1 to 2 teaspoonfuls; and that of a fluid extract as from 7 to 15 drops. Dr. D. A. Richardson, of Denver (New York Medical Journal, August 8, 1896). reports a case of occipital and frontal cephalalgia in which the attacks were kept in abeyance by nightly doses of 4 drops of the tincture. In that case these small doses seemed to Dr. Richardson to have a decided diuretic action, and he suggests that anhalonium may act as a solvent of uric acid. One of the alkaloids of anhalonium, anhalo- nine, has been recommended as a cardiac and respiratory stimulant in the treatment of an- gina pectoris and asthma, but clinical data are thus far insufficient to warrant its use in prac- tice. Not even the dose is stated in the few publications accessible in which it is men- tioned. ANHYDROGLUCOCHLORAL. — See Chloralose. ANTINOSINE.—This is a compound of sodium and nosophene, used for the same pur- poses as nosophene. ANTIPYRINE MANDELATE, AN- TIPYRINE PHENYLGLYCOLATE.— See Tussol. ANTIPYRINE SALICYLATE. — See Salipyrine. ANTISTREPTOCOCCIC SERUM, AN- TISTREPTOCOCCIC ANTISTREPTO- COCCIC SERUM.—See under Serum treatment (vol. ii, page 178), ANTIVENENE. — See under Serum treatment (vol. ii, page 188). APENTA WATER.—This is a Hunyadi water, formerly known as Rakoczy water, that has recently appeared on the market. It is particularly rich in magnesium sulphate, and is a valuable purgative. APOLYSINE.—De Nencki and de Jawor- ski (Presse medicate, October 26, 1895; New York Medical Journal, November 30, 1895) describe this as a yellowish-white crystalline powder of a sour taste, less acid than citric acid, and of a specific odour. It is soluble in cold wator in the proportion of one in twenty- five, and quite soluble in boiling water. It melts at a temperature of 161-3° F. It is easily dissolved both in alcohol and in cold glycerin. In its origin apolysine may be compared to phenacetine. Both compounds spring from paraphenetidine, and there is no difference be- tween them, except that an atom of hydrogen in phenacetine, in the amide group (NHS), is replaced by the element of acetic acid, while in apolysine the same atom of hydrogen is replaced" by the citric-acid nucleus. On com- paring the chemical formulas of these combi- nations, their origin, their formation, and their difference may be more readily understood. They show that apolysine is very closely allied to phenacetine. Apolysine, according to the authors, pos- sesses remarkable antipyretic and analgetic properties. They administered the drug both as an antipyretic and analgetic and as an anti- pyretic only. They employed it in many cases, and in the febrile affections a lowering of the temperature of from one to two degrees was observed, which was maintained for three or four hours at a time. In painful affections, such as neuralgia, etc., the pain disappeared rapidly after the administration of a few doses, which varied from 8 to 45 grains once a day. The authors state that in many of these cases other analgetics had been used previous- ly without success. Their clinical observations have led them to the following conclusions : 1. Apolysine ad- ministered to fever patients lowers the tem- perature and at the same time prevents a series of coexisting symptoms, particularly pain. 2. Given to patients suffering from neuralgia, etc., it diminishes the violence of the pain, allays hyperaesthesia, shortens the duration of the attack, and often completely suppresses the symptoms. 3. Owing to its chemical prop- erties, it acts promptly and regularly, and exercises no injurious effect on the organism. Its employment is contra-indicated during fast- ing and when there are excessive acid secre- tions in the stomach. 4. Finally, apolysine is more soluble than other drugs in the same group, and consequently more promptly and more easily absorbed. Dr. David Cerna, of Galveston (Journal of the American Medical Association, June 20, 1896), who gives the following formula of apolysine: OC3H5 C6H4< H OH N< —C< — CH2COOH, COCH2 COOH has verified some of de Nencki and de Jawor- ski's statements in experiments on animals, and has found apolysine a prompt and efficient remedy in a case of lumbago, and in one of muscular rheumatism. The dose for an adult is from 15 to 30 grains. Although apolysine has been said not to be poisonous, Dr. Cerna has known it to kill an animal, and he gives a warning against its routine and indiscriminate employment. APOMORPHINE.—Mr. Edward Balm,of Hyderabad (Indian Medical Record, July 1, 1895), has found apomorphine of great value as an antispasmodic. He says that in the Af- zulgunj Hospital, Hyderabad", Dr. Lawrie used it in the treatment of tetanus on the sugges- tion of Dr. Bomford, of Calcutta, in doses of from fa to $ of a grain hypodermically twice or three times a day, and the results were not disappointing. When, in 1894, Mr. Balm took charge of the hospital, he had a unique and distressing case of hiccough in a man fifty years old. He had suffered from it for about six months, and the acts numbered from 30 to 40 a minute. He had been a well-built man, but was reduced to a skeleton, and the sight of food was most loathsome to him. He had tried a lot of native medicines without any re- ARACniS nYPOG.EA BATHS 418 lief, and Mr. Balm's predecessor had prescribed for him almost all the drugs of the pharmaco- poeia without the slightest good. Mr. Balm subsequently tried atropine, morphine by the mouth and subcutaneously, bromide of potas- sium, camphor, chloroform, emetics, a mustard plaster over the region of the diaphragm, and a host of other measures without the least good. He then gave him i of a grain of apomorphine dissolved in 107 parts of water hypodermically. In less than three minutes the symptom sub- sided, and in five minutes more he vomited. He was not troubled with the symptom for two days, but on the third day he came again to the hospital with it, but it was less trouble- some than before. Mr. Balm gave him J o? a grain of apomorphine more, hypodermically. The symptom subsided in about the same time as before and there were retching and vomit- ing for the whole day, but the hiccough never recurred. Mr. Balm has also tried apomor- phine in a very bad case of hysteria, in a young woman, that had defied every other treatment, also in cases of asthma, and in all these instances it afforded temporary re- lief. ARACHIS HYPOG-E2A.—Dr. Heinrich Stern (Food and Sanitation, August 17, 1895; New York Medical Journal, September 14, 1895) has employed peanut meal as the chief constituent of a bread for persons with dia- betes. Peanut meal, he says, is the residue left after the oil has been expressed. He has devised the following method for preparing peanut flour in the household: The peanut kernels, including their inner coating, which is also nutritious and not very rich in car- bohydrates, are put into a tin kettle in which small holes have been previously made. This is kept uncovered and placed on or in a pan filled with water, and this has to be kept boil- ing for about half an hour to allow of par- tial extraction of the superfluous oil. After the kernels have been dried they are pounded into fine particles with the aid of" a rolling pin. The pounded or bruised kernels are then placed in boiling water acidulated to some de- gree with tartaric acid or vinegar, preferably with the latter. The boiling in the acidulated water has to be continued for some time for different reasons: For the extraction of sac- charine elements, which occur to some amount in nuts of American growth ; to overcome the smell and taste characteristic of the peanut; and to prevent emulsification of the remain- ing oil, which, to some degree, is essential to a rational diabetic food, as fats must supply the deficiency of the carbohydrate elements. It is true, says Dr. Stern, that a partial emulsifica- tion of the oil might relieve the pancreatic juice of some work, and this might be espe- cially beneficial in grave cases of diabetes mel- litus in which the pancreas seems to be involved, but he leaves it to future investiga- tion to determine whether the oil in peanut flour shall be introduced in its natural state into the alimentary tract or in the form of a partial or complete emulsion. Having undergone a thorough boiling with acidulated water, the ground kernels are sub- jected to dry heat, to effect complete evapora- tion of that fluid; but great care must be exercised, says Dr. Stern, that they do not be- come browned or roasted. An additional treatment with the rolling pin, he says, will produce nearly as fine a flour as the common wheat flour of commerce. From 30 to 40 per cent, of the oil, he says, is necessary for a complete and rational diabetic food. More hydrocarbons are not required and would interfere with digestion. It is not possible to control the amount of oil expressed by the do- mestic process and to determine its percentage with any degree of certainty; if the flour is manufactured in mills, however, this could be readily controlled and ascertained. Dr. Stern has made use of the flour in dif- ferent ways, the simplest of which is that of giving it in the form of a porridge, some milk being added to it. Bread and biscuits can also be made from it, but the most agreeable and most easily digestible form in which to use it is, he thinks, the German pancake. He has used this flour with four diabetics, and a num- ber of other patients. In the non-diabetic cases, mostly tuberculous in character, he ob- tained satisfactory results, inasmuch as diges- tion was not to any extent taxed, and in some cases the weight of the patient did not de- crease, while in one instance there was actual gain in weight noticed. With the first dia- betic patient to whom he recommended the flour its use was a complete failure at first, as the digestion became very much impaired, thereby aggravating the general condition of the patient, an old man. A more careful and rational preparation of the flour, however, and the employment of smaller quantities when starting with it, increased its digestibility, and at the time of Dr. Stern's writing this patient enjoyed, as far as circumstances permitted, a comfortable state of health. The three other patients were also thriving well on this flour, the German pancake being the usual form in which they employed it. In conjunction with eatables made of this flour, Dr. Stern allowed those patients only such food stuffs as are gen- erally recognised as permissible in diabetes mellitus. He has done this, he says, not be- cause he is a believer in the complete exclusion of carbohydrates in diabetes (for he says that fats and even nitrogenous substances are capable of producing glycogen), but to investigate the intrinsic value of peanut flour as a food, and its ability to reduce the glycogenic sugar of the urine. ARGONIN.—See under Silver (vol. ii page 197). ASBESTOS.—A Moscow surgeon. Dr. Vo- lmtzeff (Gazette des hopitaux; Union medi- cates July 18, 1896), remarks that the density ot this material is much greater than that of cotton or of tarlatan; it is less porous than either of them and less hygroscopic. The escape of vapours takes place more slowly under a dressing of asbestos than under any other. It is not so good a conductor of heat as cotton is, but on this point, says the writer . „ ARACHIS HYPOGyEA 419 BATHS the results of the investigation are not yet perfectly satisfactory. Asbestos, he savs, ab- sorbs the albuminoid secretions better than absorbent cotton or tarlatan does. In regard to clinical observations, Dr. Volintzeff thinks they are yet too small in number to enable him to give a definitive judgment. Asbestos is not expensive, he remarks, because it may be used several times. Dr. E. O'N. Kane, of Kane, Pennsylvania (Medical Record, February 18, 1896), recom- mends asbestos as a useful substance for sur- gical dressings. These dressings, he says, may be handled by dirty hands or spattered with blood or any sort of filth, and vet can be rendered absolutely aseptic in less than two minutes by tossing them upon the coals or into the blaze of an ordinary kitchen stove. However, repeated burnings, he says, seem to injure the quality of the material"somewhat. The form of asbestos most used is the asbestos fibre; it is as soft as silk floss, and its absorbent qualities are greater than those of absorbent cotton. Asbestos wicking, packing, and cord- ing are adapted for drainage tubes. ATROPINE.—Aubert (Lyon medical, Jan- uary 3, 1897; New York Medical Journal, January 23, 1897) calls attention to the effi- ciency of atropine in the correction of several inconveniences caused by quinine. Among the symptoms which are produced by the ad- ministration of quinine, even in doses of from 6 to 8 grains, the most frequent are buzzing and ringing in the ears, a sound like that of rushing water, deafness, vertigo, and head- ache. In certain cases these symptoms are rather accentuated, and the patients refuse to continue the use of the quinine. M. Aubert relates the histories of three cases of neuralgia in which he was able to attenuate to a very great degree, and even to suppress, these disagreeable symptoms by the addition of a small dose of atropine sulphate. From 5 to 7 grains of quinine were given at a time, and to each dose the author added 0-007 of a grain of atropine sulphate. In one case this prevented the disagreeable symptoms, and in the two others greatly moderated them. The periodical pains were allayed, and no appre- ciable symptom of atropinism was experienced. He states that he has not had occasion to use larger doses of quinine, and does not know what the results would be with larger quanti- ties. He is not awrare that atropine has before been employed for the purpose of mitigating the disagreeable symptoms provoked by quinine. Sodium chloride Potassium chloride.. Calcium chloride__ Magnesium chloride Calcium sulphate ... Calcium carbonate.. Iron carbonate...... Total solids....................................... Carbonic acid (in cubic centimetres).................. Temperature......................................... BATHS.—Under this heading it is proper to class what is known as the Schott treat- ment of diseases of the heart practised at the baths of Nauheim, at the foot of the eastern end of the Taunus range of mountains. An excellent account of the place and of the treat- ment has been given by Dr. William C. Rives, lecturer on diseases of the chest and on gen- eral medicine in the New York Polyclinic (New York Medical Journal, April 11,*1896). The hotels, says Dr. Rives, furnish good ac- commodation, and are most of them provided with lifts, a matter of much importance for heart patients. They are apt to be very full in the height of the season, and it is almost impossible to obtain rooms at the Kaiserhof in particular, which at the time of Dr. Rives's writing was being altered and enlarged, with- out securing them weeks or even months beforehand. The villas, which are very nu- merous and usually stand in the midst of small grounds, are large, spacious, and well man- aged ; the food and cooking are essentially German in character. Arrangements should be made beforehand as to whether board is to be provided or not, as many will prefer to take one at least of their meals at one of the hotels. Rolling chairs are to be hired by the week at reasonable prices, as well as attend- ants to push them. All ordinary articles likely to be needed can be obtained in the town ; others can be quiekly sent from Frankfort. The summer climate of Nauheim, like that of the other Taunus re- sorts, is somewhat changeable, often cold and rainy, but seldom oppressively hot. The soil is good, and the position of the town favour- able for health. The place is furnished with a water supply and a system of drainage said to be good, but the sanitary conditions are probably suscepti- ble of some further improvement. Although the surrounding country is less attractive than at many other resorts, there are walks, drives, and excursions of much interest for those who are able to undertake them. ■ The Kurhaus is large and handsome, and furnishes the usual means of recreation. Subscriptions have been already taken for an English church, and a piece of land secured upon which one will probably soon be built. The regular season at Nauheim lasts from the 1st of May to the end of September, but the bath houses are open also in April and October. The following table, showing the composi- tion of the waters, is taken from Eulenburg's Real-Encyclopddie der gesammten Heilkunde: Friedrich Wil-helmsquelle. Grosser Sprudel. Curbrunnen. Carlsbrunnen. Parts in 1,000. Parts in 1.000. Parts in 1,000. Parts in 1,000. 29'294 21824 15-421 9 860 1119 0-497 0 527 0-072 3-324 1700 1034 1-057 0-525 0-440 0-788 0 204 0 035 0 034 0 023 0227 2 601 2-354 1-146 0 951 0-048 0-038 0.026 0-014 35-357 26-353 18-682 12119 578-93 712 65 995-22 720-93 95 5° F. 88-8* F. 70-5° F. 59° F. BATHS 420 In the midst of the park, near the banks of the little river Ursa, says Dr. Rives, burst forth the springs that supply the bath houses on which the fame of Nauheim depends. These come from a great depth (five hundred and twenty-three and five hundred and ninety feet), and were found by means of borings made at different times in the course of this century. The two now in use—No. 7, the Grosser Sprudel, and No. 12, the Friedrich Wilhelmsquelle (the figures being used to des- ignate the number of the boring)—spout forth as white foaming liquids, only thirty-two feet apart, high above the surface of the ground, and are connected with five bath houses, four in the immediate neighbourhood, and a fifth (bath house No. 4) which provides only simple saline baths from spring No. 7 out- side the park at a little distance from the others. At the present time there are in the whole establishment at Nauheim a hundred and ninety-six bathrooms with two hundred and four tubs. The tubs are of wood, painted, which has been found to be the most satisfac- tory material, and are of large size, so that when a tub is filled the body of the bather is entirely immersed up to the neck, and the pressure of the water on its surface is very considerable. Everything connected with the baths, which are under government control, is admirably systematized, and the attendants are well fitted by long experience for the dis- charge of their duties. Drinking the waters, says Dr. Rives, plays but a secondary part at Nauheim, but their internal use is of some value in gouty condi- tions and disorders of the liver, and the Cur- "brunnen water, diluted, is said to resemble that of the Ragoczy spring of Kissingen, and the Carlsbrunnen, the Elizabeth-Brunnen of Homburg. The Ludwigsbrunnen is also used as a table water. The Schwalheim spring, two miles distant, yields a ferruginous water con- taining carbonic acid. The first bath house at Nauheim, according to Dr. Rives, was opened in 1835, and the baths have been used for many years with ad- vantage in gout, rheumatism, rickets, and so- called scrofulous diseases, and have acquired a well-merited repute in the treatment of lo- comotor ataxia and other diseases of the spinal cord. Professor F. W. Beneke, of Marburg, was the first to show, contrary to the views then prevailing, not only that patients with heart disease, more especially those recovering from acute rheumatism, could bear balneo- logical treatment, but that they were actually benefited by such a course. Beneke, who was physician to the Nauheim baths from 1857 to 1866, and continued to visit them up to his death, in 1883, wrote several articles upon the effects he had observed there, the earliest of which appeared in 1859. After the publica- tion of his more important work, Zur Thera- pie des Gelenkrheumatismus und der ihm verbundenen Herzkrankheiten, in 1872, patients with heart disease began to frequent Nauheim in greater numbers, and, on the lines of inves- tigation suggested by his observations, the baths began to be studied more closely by other physicians. In 1880 Dr. August Schott, who had been making independent studies since 1871, pub- lished a paper (Berliner klinische Wochen- schrift, 1880, No. 20) by far the most important and exhaustive of any that had yet appeared, and the first to do full justice to the remark- able effect of the baths upon the heart. Nu- merous articles relating to the same and allied subjects have since been written by himself and his brother, Dr. Theodor Schott, and to their joint labours the present celebrity of Nauheim is largely due. Within the last ten years the annual num- ber of visitors during the season, a large pro- portion of whom are heart patients, has more than doubled, amounting to over twelve thou- sand in 1895. The foregoing is substantially in Dr. Rives's own words. He describes the effetet of the baths as that of regulating the action and strengthening and improving the nutrition of the diseased heart, whether its inability to perform its functions properly depends upon valvular lesions and their consequences or upon malnutrition or disease of the cardiac muscu- lar substance. These results, he says, are chiefly due to the chloride of sodium, to the more irritating chloride of calcium, and to the free carbonic acid which these waters are said to contain in larger amount than almost any other baths in Germany. They contain, more- over, a considerable percentage of iron, to which may also be attributed a tonic influence. The most powerful though more temporary stimulation, as proved experimentally, is caused by the carbonic acid. By means of the action of these saline and gaseous contents of the bath upon the terminal branches of the sen- sory nerves of the skin an impression is made upon the cardiac and vaso-motor centres by which the heart is stimulated in a reflex way to more powerful and vigorous contraction and the arteries are more completely filled, and at the same time the cutaneous vessels dilate, peripheral resistance is lessened, and the whole circulation is rendered freer and more active, while metabolism is promoted and a marked influence exerted upon the trophic centres, as must be inferred from the striking evidences of improvement in the bodily nutrition in general, and in that of the heart in particular, and the persistence and even increase of the good effects long after the patient has com- pleted the course. The immediate objective results of the baths are stated by Dr. Rives as follows: "Exami- nation of the pulse, confirmed by sphvemo- graphic tracings and the sphygmomanometer, shows it to be made slower, stronger, and of increased volume, the cardiac sounds become more distinct, and in cases of dilatation an unmistakable contraction of the heart, demon- strable by percussion and by the change in the position of the apex beat, is observed This contraction is most noticeable in the transverse diameter of the heart, and takes place to it. e or no extent when the enlargement is solely compensatory, as in many cases of organic 421 BATHS mitral and aortic regurgitation. Dr. Bezly Thorne, however, affirms that there is a diminu- tion in the area of cardiac dulness, as measured in the oblique transverse diameter, of a third to about half an inch even in the healthy heart. The respiration becomes easy, and is slower and deeper, and there is usually in- creased action of the kidneys. Subjectively, a sense of weight and oppression on the chest, greater than in an ordinary bath, is at first ex- perienced, which quickly passes off; the skin soon becomes warm, and tingling, accompanied with redness, is felt in its more sensitive parts. Afterward, the patient feels invigorated, and is generally conscious of a sense of drowsiness." Dr. Robert H. Babcock, of Chicago, in a paper read before the Mississippi Valley Medi- cal Association (Journal of the American Medi- cal Association, November 11, 1893), says that during the baths there is a slowing of the pulse with increased volume and strength, and irregularity, if any exists, is lessened or disap- pears. The cardiac contractions are increased in vigour and the cavities better emptied, thus permitting of a diminution in the size of a dilated heart. This marked and beneficial effect on the action of the heart does not ap- pear at once, but persists for a considerable time subsequent to the baths. If properly ad- ministered, says Dr. Babcock, the baths occa- sion a gradual and perceptible amelioration of the symptoms. During the gymnastics the rate of the pulse falls and the volume and strength are increased. While Oertel's method is limited to cases of heart disease in which compensation has not been lost, the Schott method, says Dr. Bab- cock, is applicable to a greater variety of cases, and, as the treatment can be carried out in this country by artificially prepared baths and the gymnastics, it seems that by careful selec- tion patients subjected to this treatment may be greatly benefited. In a subsequent communication, read before the American Climatological Association (New York Medical Journal, December 8, 1894), Dr. Babcock says that the baths owe their efficacy chiefly to free carbonic acid, sodium chloride, and calcium chloride, for the other saline in- gredients are present in amounts too small to lend more than feeble aid to those named. The next important feature of the baths, he says, is their temperature. Warm baths are debilitating, and exert a decided weakening effect on the heart even in health ; so they are recognised as inadmissible in the treat- ment of disease of the heart. The tempera- ture of the Nauheim baths ranges between 92° or 93° F. at first and 87° or a little lower toward the end of a course of treatment. At these temperatures, savs Dr. Babcock, baths are cool, and even at 92 F. they impart a dis- tinct feeling of chilliness to the patients as thev enter them. The duration of each bath is limited, and is increased cautiously with the progress of the treatment and improvement of the patient's condition. Prom five or eight minutes as the initial limit, the baths gradually reach a dura- tion of twenty minutes. If the pulse is watched during the bath, it will be found to become slower, fuller, and stronger, and if it was irregular in rhythm be- fore, it is likely to improve even to the extent of attaining perfect regularity. Efforts on the part of the bather—such as speaking, forced breathing, moving about, etc.—generally occa- sion temporary irregularity and acceleration of the pulse. The respirations are generally slow and deep, partly in consequence of a feel- ing of oppression of the chest experienced by most individuals. This sensation of weight is not complained of by all in equal degree, how- ever, and it is usually lost after a few baths. The improvement in the rate and quality of the pulse is an index of the degree of benefit derived by the patient. If not counteracted by exercise, this effect on the pulse will persist for an hour or two subsequently. Changes for the better in the size of the area of cardiac dulness and in the sounds may be noted like- wise. This has been demonstrated repeatedly, says Dr. Babcock, both on himself by a com- petent Russian physician and by himself on others. Careful percussion immediately before and after a bath of from eighteen to twenty minutes' duration showed a demonstrable re- traction of the deep limits of cardiac dulness, and the heart sounds were improved in strength, the second pulmonary being less accentuated, the second aortic stronger, the abnormal differ- ence between the two sounds before being ap- preciably less marked after the bath. Murmurs that are almost inaudible before become in- tensified ; and, conversely, some loud bruits are lessened in intensity. In short, so far as can be determined by physical examination, these baths appear to lessen the rapidity and increase the force of the heart's contractions, thereby occasioning a better filling of the great arterial system with corresponding depletion of the engorged veins. This is borne out by experiments on animals conducted by Dr. August Schott, which demon- strated, by means of a mercurial manometer placed in the trachea, that a rise of arterial pressure was the result of nearly complete im- mersion in a saline solution. In this respect, therefore, the effect of these baths is similar to that following the administration of digi- talis : both lengthen diastole and augment the force of systole. In addition, digitalis exerts a powerful influence as a vaso-motor constric- tor, which action sometimes offsets its bene- ficial effect on the heart. This action on the vascular system is felt by all the arteries alike. Herein, it seems to Dr. Babcock, lies the differ- ence between the effect produced by digitalis and that exerted by these baths. Experiments have demonstrated that the contraction of cutaneous vessels effected by cold baths occa- sions at first increase of blood-pressure and of the frequency and strength of the heart's con- tractions, but that later on the acceleration gives place to a retardation of the rate. The pulse, therefore, becomes slower and stronger during a cold bath, provided this is not con- tinued until vaso-motor paresis sets in. Thus far a cold bath of moderate duration affects the heart in its contractions in the same way BATHS 422 as digitalis, although the mechanism by which this result is accomplished differs. On the other hand, says Dr. Babcock, Schiller has shown that the application of cold to the abdomen—that is, contraction of the cutaneous vessels of the abdomen—is followed by prompt dilatation of the vessels of the pia mater; whereas heat applied to the abdomen is suc- ceeded by constriction of the vessels of the pia mater. From these experiments it is probable that the effect of a cold bath is not to cause contraction of internal as well as of cutaneous vessels, but that a cold bath is fol- lowed by dilatation of internal vessels. In short, during and after a cold bath of moderate length, the heart contracts more slowly and forcibly. Furthermore, although there is not a consensus of opinion as to the balneological effect of mineral waters, whether or not their saline and gaseous constituents serve as mild stimuli to the sensory nerves of the integu- ment, it is probable, as remarked by Leiehten- stern, that they act as vaso-motor dilators, since cutaneous redness follows their prolonged use in degrees of considerable strength. From the foregoing facts, and from the em- pirical knowledge of the beneficial effect of a balneological treatment of many cases of heart disease, Dr. Babcock deduces the following as the modus operandi of these baths: Upon the patient's entering the bath there is an initial or primary constriction of the cuta- neous vessels produced by the cold. This is promptly followed by a dilatation of the inter- nal vessels and stimulation of the heart; its con- tractions, at first perhaps accelerated, become subsequently reduced in rate and augmented in force. After a moment or two the sensation of chilliness gives place to one of warmth, when it is probable the contraction of the cutaneous vessels grows less; the gentle stimulation of the sensory cutaneous nerves produced by the salt serves, however, to maintain the increased energy in the cardiac contractions. This sec- ondary feeling of warmth does not act like a primary application of heat to the surface of the body by causing contraction of internal vessels; their dilatation persists. Under these conditions, says Dr. Babcock, the heart not only has less labour to perform, but is actually aided in the accomplishment of its decreased task. Like digitalis, the baths slow and strengthen the cardiac contractions, but, un- like digitalis, they dilate rather than contract the arterial system, or, in other words, reduce rather than increase peripheral resistance. The light exercises, or, as the Schott brothers choose to designate this part of their cardiac therapeutics, the gymnastics, says Dr. Babcock, are an extremely simple but important adjunct to the baths. The individuality of this treat- ment lies in the application of counter-resist- ance made by an attendant trained for that purpose. He must see to it that the move- ments are performed slowly and steadily, that they are interrupted by short periods of repose, and that the effort exerted by the patient is not so great as to cause embarrassment of respira- tion or undue acceleration of the pulse. The attendant must watch lest the patient hold his breath and thereby overstrain the already feeble right ventricle, and must at once call a halt upon evidence of dyspnoea. Finally, he must so apply his counter-pressure as to offer resist- ance but not hinder free movement of the extremity. This requires some judgment and skill, yet'is not so difficult as to be beyond the acquirement of an intelligent friend or relative, who can then help the patient to continue his exercises indefinitely after the latter has passed from the physician's daily superintendence. These exercises exert an effect on the heart and circulation similar to that of the baths, and therefore supplement and re-enforce the balneological treatment. If they are properly performed, and if the resistance is judiciously apportioned to the patient's endurance, they slow the rate and augment the force and vol- ume of the pulse, as has been repeatedly shown by the sphygmograph and sphygmomanometer. Percussion and auscultation reveal the same improvement in the size of the dilated heart and in the character of its sounds as after a bath. Patients not infrequently comment on their feeling of euphoria succeeding this form of treatment; dull praecordial pain, discomfort, or sense of oppression gives place to a condi- tion of ease and lightheartedness. On the other hand, if too great resistance is applied, there is produced a sensation of cardiac dis- tention with a variable degree of dyspnoea, while the pulse grows more rapid and feebler. Improved arterial circulation is so manifest a result of these exercises that Dr. Schott has known them to lessen the frequency, nay, even the severity of attacks of angina pectoris in in- dividuals with arteriosclerosis who had been unable to indulge in even very moderate phys- ical exercise taken in the ordinary ways of walking, etc. Permanent amelioration of the sufferer's condition has been achieved in some of these cases. In regard to contra-indications, Dr. Babcock thinks there can be no doubt of the dangers of the treatment in degenerative changes of the blood-vessels and myocardium, such as aneu- rysm and advanced arteriosclerosis, acute soft- ening, and great fatty degeneration of the heart. In these conditions rupture might result from heightened intravascular and intracardiac pres- sure. Furthermore, the query has been made as to whether chronic interstitial nephritis is not also a contra-indication on account mainly of the danger of setting up acute inflammation of the kidneys. It might be urged, in the sec- ond place, that the increased vascular tension produced might prove disastrous by augment- ing the heightened arterial tension'already ex- isting. To the former objection Dr. Babcock replies that when Dr. Schott was questioned on this point, he stated that he did not consider chronic interstitial nephritis a contra-indication to the baths. It would seem, adds Dr. Babcock, as if the stimulating action of the salts and carbonic acid on the skin rendered the effect on the kid- neys different from that of a bath in plain water at the same low temperatures. As regards the dangerous augmentation of existing vascular tension to the extent of either 423 BATHS rupture of a blood-vessel or of stretching the cavity of the left ventricle, Dr. Babcock sug- gests that such baths would not be adminis- tered so long as the hypertrophied heart was adequate to the peripheral resistance to be over- come. They would be given only when the cardiac energy was threatening to fail or had actually failed. Under such circumstances the only thing that could preserve the patient would be a restoration of the heart's power. This might be possible if the heart's walls were not too degenerate and the kidneys not greatly contracted. Moreover, if the baths in question brought about even a slight degree of dilatation of the internal vessels, he adds, then the peripheral resistance would be lessened rather than increased; and if the circulation was thereby improved, so likewise would be the action of the kidneys. The resisted exercises, the Widerstandsgym- nastik of Ling, are fully described and figured in Dr. W. Bezly Thome's work entitled The Schott Methods of the Treatment of Chronic Diseases of the Heart (London, 1895). Dr. Rives (loc. cit.) gives the following synopsis of them: 1. Movements of the extended arms in three directions. (a) From the ordinary position by the sides of the body forward and upward until they reach the temples, and back again. (b) From the same position laterally outward and upward to the temples, and back. (c) From the horizontal position, with the palms of the hands meeting in front of the body, as far apart as possible, and back. Rotation of the extended arms about their axes as fully as possible, causing pronation and supination. 2. For the elbow, wrist, and finger joints the natural flexions and extensions; radial and ulnar abduction and adduction. 3. (a) Flexion of the trunk forward, from a little beyond the erect position, and back. (b) Lateral flexions of the trunk to right and left, and back. (c) Rotations of the trunk on its axis to right and left, and back. 4. Movements of each extended leg forward and upward, outward and upward, backward and upward, and back. 5. The natural flexions and extensions of the knee and ankle joints. The resistance, says Dr. Rives, is always made by the attendant with the palm of the hand in the direction exactly opposite to that of the movement, and in applying it to the wrist and ankle these parts are placed in the fork formed by separating the thumb and fin- gers; but a limb is never actually grasped, lest support rather than resistance should be the result. The degree of force employed, says Dr. Rives, should be as much as the patient can overcome without the slightest discomfort, and should be so uniformly applied as to en- able him to perform the movements slowly. evenly, and without jerks. He must be able to breathe quietly, and the mouth and alae nasi must be watched carefully, so that at the slightest indication of loss of breath a pause may be made. Some of the movements may be omitted according to circumstances; the most trying to the patient are the elevation of the arms above the head and the trunk exer- cises. The limbs are not allowed by the at- tendant to fall suddenly after the completion of a movement; a considerable interval of time is always allowed between the movements, and this is prolonged if the patient seems at all fatigued. The clothing should, of course, be perfectly loose and easy. The exercises are usually given for about half an hour, the series being gone over twice in that time, but they are often employed for shorter or longer periods. Dr. Rives adds that Dr. Schott has also de- vised a scheme by which the services of the attendant may sometimes be dispensed with. In carrying out these self-resisted exercises (Selbsthemmungsgymnastik), as they are called, the patient endeavours, as it were, to resist his own movements by partially contracting at the same time the antagonistic muscles. This de- mands some intelligence on his part, and it would often be unsafe to allow its employ- ment. The action of these exercises, Dr. Rives re- marks, is to produce an effect similar in many respects to that caused by the baths; the cold extremities become warm, the sense of oppres- sion in the chest is relieved, and the breathing is deepened. The pulse usually becomes fuller, stronger, and slower, and an immediate dimi- nution in the area of dulness of the dilated heart, not due to increased overlapping by the lung, with a simultaneous lessening of the di- mensions of the passively congested liver, have been frequently demonstrated. The effect is often very speedy and striking; according to Dr. August Schott, an attack of cardiac asthma which would otherwise continue for hours may be charmed away, as it were, in a few minutes, and an extreme dilatation be for the time be- ing so completely dispelled that hardly a ves- tige remains. In fresh endocarditis after rheumatism, says Dr. Rives, the baths promote to a high degree the absorption of the inflammatory products and offer hopeful prospects of a more or less complete cure. In chronic valvular disease, where there is serious damage to the valve segments, they can not ordinarily produce the slightest effect upon the injured valve itself, and those murmurs which disappear during the course are due to relaxation of the orifices or want of tone in the papillary muscles. Dr. Groedel, of Nauheim, however, states that he has met with a very few remarkable cases pre- senting evidences of fully developed valvular disease which have been cured at Nauheim, one of which is mentioned in Professor Eich- horst's Handbuch der specielfen Pathologie und Therapie, fifth edition, vol. i, p. 56. This patient had all the signs of pronounced mitral insufficiency, and these, so entirely disappeared after two seasons at Nauheim that he was ac- cepted as sound by a very strict life-insurance company. At the end of ten years there was still no trace of the disease. Although we BATHS BELLADONNA 424 can not expect, says Dr. Rives, that seriously injured valves should be restored to their nor- mal condition, failure of compensation result- ing therefrom is signally benefited, and it is in those cases especially in which digitalis is not tolerated or has not proved useful that the results are so astonishing. It is well known that in aortic regurgitation digitalis is not al- ways beneficial. Good results are secured at Nauheim, however strange it may at first ap- pear, in lack of compensation both from aortic and from mitral disease, as well as in cases of combined disease of both valves and in many instances of patent foramen ovale. The grad- ual influence exerted upon the nutrition of the heart, without the other accompanying unde- sirable effects which are often a cause for the failure of medicinal treatment, offers an im- mense advantage. In weak hearts without serious organic le- sion, from anaemia, chlorosis, and convales- cence from acute diseases, and the myocardial affections resulting from influenza, most excel- lent results are obtained, according to Dr. Rives, particularly in young subjects, as well as in cases of heart strain and dilatation due to over-exertion. In the chronic sclerotic changes (arteriosclerosis, chronic myocarditis) of the heart and vessels and fatty degenera- tion, with or without dilatation, so frequent in persons of advancing years, of which the ordi- nary treatment is usually palliative, the bene- fit to be derived is naturally more uncertain and generally requires long and persistent treatment. Some of the most remarkable re- sults of the Schott methods, however, have been obtained in apparently hopeless cases, and even patients suffering from angina pecto- ris have been practically cured at Nauheim. While many cases of angina pectoris are hope- less under any circumstances, says Dr. Rives, yet the effect of the Nauheim baths upon the cardiac nutrition is so remarkable that where the lesions are not too far advanced or only incipient the results of the treatment are emi- nently gratifying. He cites Balfour's state- ment that the expression pseudo-angina is often misleading, and should not be applied to cases presenting symptoms identical with those of true angina, merely because the heart lesion happens to be curable. Such cases it is often impossible to distinguish from the in- curable ones, and Balfour consequently ex- presses himself in regard to the prognosis to the effect that this is often more hopeful than we should at first be led to suppose. The results in cases of heart disease depend- ent upon or complicated with disease of the kidney, says Dr. Rives, are less encouraging and more variable, but albuminuria due mere- ly to secondary renal congestion may alto- gether disappear. Cases of functional nervous disturbance of the heart are usually, but not always, benefited. The contra-indications to the Nauheim treat- ment are stated by Dr. Rives, as by Dr. Bab- cock, to be advanced arteriosclerosis and aortic aneurysm. Patients with the latter affection, he says, have used the baths with some allevia- tion of symptoms, but on account of the danger of raising the blood pressure they must be em- ployed with the greatest caution. Many per- sons with very serious heart disease come to Nauheim, he remarks, and, as is only to be ex- pected, some deaths occasionally take place during the season; but such is the care taken by the local physicians, who write their orders with exact directions, that fatal accidents direct- ly attributable to the baths are practically un- known. Groedel states that during a practice of many years at Nauheim he has never had a case of sudden death during the bath, although he has known of two cases of apoplexy which occurred during the exertion of dressing. As to the exact length of time required for a cure, it is, of course, says Dr. Rives, impossible to say ; improvement is usually observed after a week or two, and some patients are relieved by a single course, but many others require a much longer period, and there are compara- tively few who are ill enough to undertake a long journey to Nauheim in search of relief for whom it is not advisable that they should return for another or several successive sea- sons, while in some desperate cases the treat- ment will necessarily fail. In an excellent article on this method of treating heart disease (Lancet, March 21 and 28, 1896), Dr. R. F. C. Leith, of Edinburgh, says: " The physiological problems raised by ' the system' are both many and complex, and there must be much still hidden from us which the future may reveal, and which may bring about a more perfect understanding of its ac- tions. So far as they are at present known to us, it is readily seen that its scope of appli- cation is far wider than that of any individ- ual drug; but to assert its applicability to all classes of cardiac derangements, reserving only advanced arterio-capillary sclerosis, aneurysms, and serious myocarditis/is surely in so many words to proclaim its impotence. It is but natural that it should fail. Evil habits of nutrition which measure their existence by months or years are not to be got rid of by one or even two courses of ' the system ' of a few weeks' duration at Nauheim or anywhere else. I have already met with failures and re- currences such as the present literature of the subject makes no mention of, and they have but served to increase my belief in its value when used in suitable cases. While we re- member that it is also capable of doing much good we must not forget that it is also capable ot doing harm. It has now been sufficiently proved to warrant its trial in suitable cases, but they must be chosen with judgment. To use it rashly, and with too great expectations is certain to lead to disappointment and to re- flect injuriously upon the system itself More- over, as at present enunciated, it does not seem to me to be as useful as it might be It is at once too wide and too restricted ; too wide in its claims and too restricted in its limitations. Why, for instance, should we pause at 86° F f Why not go further in Jt- effeotfnff-iM ma¥ Use of the ^ell-known effects of still lower temperatures, inasmuch as we can so easi]y regulate their influenco fe th duiation of time we employ them. The resist- 42^ ance exercises are good as far as they go, but why should they not be combined with mas- sage or passive or active exercises of different kinds? Eccles, Campbell, and others have testified to their value. An intelligent use of dumb-bells and other gymnastic appliances ought to prove quite as effectual as the resist- ance exercises themselves, and they have done so in my hands in the opportunities I have so far had of putting them into practice." Artificial Nauheim baths, says Dr. Rives (loc. cit), may be prepared by dissolving the requisite percentage of required salts, or, as Dr. John Broadbent points out, by the use of sea water, which contains 2-7 per cent of chlo- ride of sodium, and by adding for the pro- duction of carbonic acid suitable proportions of commercial muriatic acid and bicarbonate of sodium or chalk, or, as has been suggested, a mixture of the bicarbonate and bisulphate of sodium. The gas, however, when thus evolved, he remarks, escapes more rapidly than it does from the natural baths. Dr. Rives thinks good results may undoubt- edly be obtained in this way, and he adds that such baths have been employed by Dr. Bezly Thorne in London and by Dr. "Babcock in Chicago, as well as in the Middlesex Hospital, with success; but the greater freedom from counteracting injurious conditions to be had at a spa, and the various advantageous mental and hygienic influences to which the patient is there subjected, he thinks, are sufficient rea- sons, even allowing the artificial baths to be as effective as the natural waters, why the results obtained at Nauheim are more striking than those reported from the cities. Mineral springs in the country, especially when possessing a part of the requirements, offer more promising opportunities, and provision has been or is be- ing made at Harrogate and various places in England for carrying out the treatment. In administering the Nauheim baths to pa- tients with heart disease, says Dr. Rives, sev- eral varieties are employed, for when the effect of one kind of bath becomes less and less marked, owing to the nervous system gradually becoming habituated, a fresh stimulus is im- parted by changing to a stronger bath, and thus a longer course can be taken than would otherwise be advantageous. The method em- ployed by Dr. Theodor Schott, which is in the main practised by the other Nauheim physicians, is the following : The first bath or- dered (thermal Soolbad) is supplied by the water taken from the receiving basins, from which by exposure to the air a large part of the carbonic acid has escaped, and a considerable proportion of iron and salts has been precipi- tated, so that it is of a muddy colour and con- tains few or no bubbles of gas. No. 7 is the spring usually first employed, as it contains the smaller proportion of salts, 2-18 per cent. of chloride of sodium and 0-17 of chloride of calcium. Dr. Schott recommends for some cases, at the beginning of treatment, baths containing only 1 per cent, of chloride of sodium and 0-1 per cent, of chloride of cal- cium. The natural temperature is 888° F., but this at first is raised to one varying from BATHS 5 BELLADONNA 92° to 95° F. Temperatures above that of No. 12 spring, 955° F., are not suitable for heart patients. The duration of the bath, at first six to eight minutes, is gradually lengthened every few days, one minute at a time, while at inter- vals the temperature is lowered about one de- gree (half a degree centigrade). At first every second or third day, afterward every fourth or fifth, the bath is omitted. The percentage of salts is now gradually increased, which may be done at first by mixing the waters of Nos. 7 and 12, but is usually accom- plished by adding a quart of Nauheim " Mut- terlauge" (mother-lye)—the uncrystallizable liquid left behind in the manufacture of salt— which is subsequently increased to two and three quarts, or occasionally even more. The main ingredient of this is chloride of calcium, which may be raised eventually in the bath to the amount of 0-5 per cent. When the pro- portion of salts is thus rendered sufficiently large, the temperature by this time having been lowered several degrees, and the duration extended to not. more than twenty minutes, the patient is ready to continue treatment by a course of Sprudel baths from either No. 7 or No. 12, the former containing the greater amount of carbonic acid, the latter of salts. These differ from the others in being supplied with water direct from the springs, before it has undergone the action of the air, so that it appears of crystal clearness and filled with sparkling bubbles of carbonic acid, which it retains in undiminished quantity. They are likewise at first taken warm, usually at their natural temperatures, and for a short time— about eight minutes—and as they are con- tinued the temperature is lowered in the same cautious way and the duration prolonged in like manner. The saline contents may also be increased by successive additions of " Mutter- lauge," In consequence of the powerful exci- tation of the cutaneous circulation by the carbonic acid, which creates an agreeable feel- ing of warmth, says Dr. Rives, the tempera- ture can be lowered to a degree which could not be otherwise tolerated, but is seldom if ever reduced below 80° F. The final, most powerful form of stimulation is the Sprudel- strombad, in which the supply and overflow pipes of the bath tub are left open, so that in addition to the fresh supplies of carbonic acid, the shock of the running water against the body is experienced. BELLADONNA.—Dr. Douglass W. Mont- gomery, of San Francisco (Medical News, No- vember 16, 1895), has observed decided benefit from the use of belladonna in the form of pemphigus known as hereditary inclination to the formation of blebs. After a trial of arsenic and then of potassium iodide (on the possibility that the trouble was syphilitic) without result, Dr. Montgomery prescribed for the patient, a boy fifteen years old, 3 drops of tincture of belladonna, "and the dose was increased in a few days to 4 drops. Decided improvement then set in and for about a week no new blebs formed. A few new blisters then appeared and the dose of belladonna was increased up BENZONAPHTHOL CALCIUM CHLORIDE 426 to 6 drops three times a day, but without en- tirely controlling the formation of the blebs. The patient now disappeared for a number of months, and on his return Dr. Montgomery hit upon the probable mode of action of the belladonna. One of the best-known actions of belladonna, he remarks, is its power of con- trolling perspiration, and he was then led to think that if this was the only action of the drug, it would be as well to use it locally; a small amount was applied to the soles, and with satisfactory results. Blebs formed, but not in sufficient numbers to especially incom- mode the boy, and the disease was rendered tolerable. BENZONAPHTHOL.—Dr. Jose A. Clark (cited in the Lancet for July 20, 1895) reports having employed benzonaphthol in an epidemic of dysentery which occurred in Alquizar, Cuba, during which he had one hundred and thirty- seven cases of the disease under treatment, of which he considered twenty-three as serious and a hundred and fourteen as of a mild type. The mortality among those treated with ipecacuanha and calomel, opium, etc., amounted to 9 per cent., while that among those treated with benzonaphthol was scarcely more than 2 per cent. This drug had the great advantage of not causing vomiting, salivation, or depression of the circulation, and it also brought patients through the attack more rap- idly than the drugs generally used. Forty-five grains per diem were given to adults and but little less to children. BENZOYLANILIDE.—See Benzanilide. BENZOYL - BETA- NAPHTHOL.—See Benzonaphthol. BISMUTH.—The Deutsche Aerzte-Zeitung for February 1, 1896 (New York Medical Jour- nal, February 22, 1896), calls attention to a soluble phosphate of bismuth, " bismutum phos- phoricum solubile," a salt that contains about 20 per cent, of oxide of bismuth. Even concentrated solutions of it remain clear for some hours, and a solution containing from 1 to 2 per cent, of the salt will remain clear for days, but it is rendered turbid by boil- ing, also by the addition of an acid or of an alkali. The reaction of such a solution is fee- bly alkaline, and its taste is not very pro- nounced. Soluble bismuth phosphate has no effect on the micro-organism of anthrax or on other like resistant germs, but it seems capable of arresting the development of the Bacterium, coli. Experiments on animals have shown it to be harmless. The dose necessary in its ther- apeutical employment is much smaller than that of any of the powdery preparations of bis- muth ; from 3 to 8 grains are to be given three times a day. It has been used as a remedy for cholera infantum with good results. The following formula is attributed to D(5rf- fler: B Soluble bismuth phosphate. 1| to 2 parts; Distilled water............ 90 " Syrup of marsh mallow.... 8 " M. A child's spoonful to be given every hour In most cases the vomiting ceased after the first few doses, and the intense odour of the stools was mitigated as soon as they became black in appearance, denoting that the drug was doing its work in the intestine. From profuse diarrhoea, the intestinal evacuations were reduced to two or three in twenty-four hours. No milk was given. In the majority of cases the disease was at an end in the course of a few days. The writer thinks it advisable to continue the use of the remedy for some days after the diarrhoea has ceased. BLANCOLINE.—This is a white, odour- less substance prepared in two forms, solid and liquid. It is used like vaseline. BLENNOSTASINE.—This is a bromine derivative of cinchonidine, Ci9H24N2OBr2. Dr. Walter F. Chapped (New York Medical Jour- nal, December 5, 1896) says that it crystallizes from dilute solutions in large, prismatic crys- tals, or from concentrated solutions in the form of small, needle-shaped crystals, very soluble in water and quite as bitter as quinine. He says that it has a marked contractile effect on the vaso-motor system of the upper respira- tory tract, and, being non-toxic, is especially valuable as a substitute for belladonna, atro- pine, and similar drugs in hay fever, acute influenza, rhinitis, intermittent rhinorrhea, laryngorrhea, and bronchorrhea, has a power- ful sedative influence on the brain and spinal cord, and decidedly diminishes reflex move- ments. Blennostasine may be administered in cap- sule form, when combinations are required; but for many reasons Dr. Chapped thinks one- grain gelatin-coated pills are preferable. The dose ranges from 1 to 4 grains or more every hour, according to the effect desired. BOROLYPTOL.—This is an American proprietary antiseptic preparation, presumably so named because boric acid and oil of euca- lyptus are prominent ingredients of it. BROMATED H-3EMOL, BROMHiE- MOL.—This is a derivative of haemogallol (q. v.) said to contain 2-7 per cent, of bromine. It has been recommended in the treatment of epilepsy. CAJEPUT, CAJUPUT.—Mr. Ram Dhari Sinha, L. T. M. S. (Indian Medical Gazette, December, 1896), reports having used cajuput oil internally as an expectorant in eighteen cases of pneumonia, with satisfactory results. Ordinarily he gives 5 minims, either made into an emulsion or simply shaken with water, every four or five hours. In all the eighteen cases the dyspnea and cough were diminished and expectoration became easier. All the patients recovered. CALCIUM CARBIDE.—This compound, CaLa, is in the form of irregular lumps of vari- ous shades of gray. On contact with water it decomposes and acetylene gas is generated. Some of the French surgeons have lately em- ployed it in the treatment of cancer of the uterus M. Peyrot, according to M. Gurnard (Gazette medicate de Paris, April 18,1896), has BENZONAPHTHOL 427 CALCIUM CHLORIDE employed it in the following manner: A piece of the calcium carbide is placed directly in the vault of the vagina, where it very soon becomes decomposed into calcium oxide and acetylene by contact with the moisture. At the end of several days the oxide is removed by means of irrigation with corrosive sublimate. This treatment may be repeated several times. The results are very appreciable, says M. Guinard, for the diseased parts assume" a grayish tint and become smooth, and the haemorrhages, the foetid discharge, and the pain are suppressed. With regard to the mode of action of calcium carbide, says M. Guinard, it is rather complex. The nascent quicklime acts, he thinks, in con- cert with the acetylene, which passes into the urine, where it has been found. Perhaps, he says, by contact with the cancerous elements, it leads to a sort of special coagulation of the blood, analogous to that observed in persons poisoned with gas. M. Livet (These de Paris; Revue interna- tionale de medecine et de chirurgie, September 25, 1896), acting on M. Guinard's idea, has em- ployed calcium carbide, not only in the treat- ment of uterine cancer, but also in that of other affections accompanied by rebellious hemorrhages, pain, and fetid odours, such as certain forms of fibroma and metritis. He re- ports eight cases, four of which demonstrate that the treatment with calcium carbide is always followed by an amelioration, whether in cancer of the breast, metritis, or epithelioma of the uterus. In cases of cancer of the neck of the uterus, he says, the vulva and the vagina should first be thoroughly washed and disin- fected, and then pieces of calcium carbide should be placed in the inequalities of the tumour. If a calcium-carbide crayon is to be introduced into the cervical cavity, it must be done very rapidly, for when it comes in con- tact with the moist mucous membrane it pro- duces a bubbling and nothing more is seen of it. In cancer of the breast the cavities are simply filled with pieces of calcium carbide. In order to confine the acetylene, an ordinary dressing is used on the breast and tamponing is employed in the vagina. The action of cal- cium carbide is very rapid ; the patient feels at once a burning sensation which lasts for an hour or two, and at the end of that time the pain, the discharge, and the fcetid odour have disappeared. The clot which is formed by the coagulant action of the acetylene presents a temporary barrier, which is sometimes defini- tive, to the haemorrhage, and when the fcetid discharge is dried up the nauseous odour dis- appears. When the tampon of iodoform gauze which confines the acetylene is removed the vegetations will be seen to be diminished in volume, and covered with a grayish eschar which is easily detached with a blunt curette. It is not necessary to renew the applications of the carbide oftener than every four or five days, unless the luemorrhage should reappear on the day following the first application. If it is necessary to use the nascent lime to hasten the destruction of the neoplasm, the applica- tions of the carbide may be more frequent, In all cases the treatment, being purely symp- tomatic, should be continued until the fatal termination, which will be more or less re- tarded. According to M. Livet, the unpleasant ef- fects of this treatment are few ; in one case he observed diarrhoea and in another burns on the vaginal wall. Unfortunately, he says, the treatment is painful; the burning sensation is very intense and occasionally persists for a long time. CALCIUM CHLORIDE, according to Dr. Thomas D. Savill (Lancet, August 1, 1896; New York Medical Journal, August 22, 1896), is a very efficacious remedy for the itching that accompanies certain skin diseases. In all the cases which have come under his observation, he says, the itching has been re- lieved, and the eruption, if any existed, has disappeared at the same time. He states fur- ther that he has not met with any absolute failures so far, although sometimes the dose has had to be considerable and the employment of the drug continued for several weeks. The opportunity of trying the remedy in children for the itching that accompanies urticaria, he says, has not presented itself, but there is every reason to believe that it would be equally effi- cacious in such cases. Dr. Savill says that the doses must be con- siderable, not less than 20 grains three times a day, and they should be gradually increased. Thirty and even 40 grains have often suc- ceeded where smaller doses have failed. If ad- ministered after meals and in a wineglass of water it is surprising how little these large doses upset the stomach, and he states that he has never known them to produce vomiting. Patients sometimes complain, he says, that it makes them thirsty, and to cover the salt taste it is best administered with a drachm of tinc- ture of orange peel and an ounce of chloroform water, in which form it is really an agreeable medicine and would be well taken by children. It is important, says Dr. Savill, that at the same time the diet should be regulated, no beer, sugar, or sweets being allowed, and meat only in very moderate quantity. It is also important to keep the bowels acting freely. Although improvement is generally noted after the first dose, he says, complete recovery is sometimes not obtained until the blood becomes saturated, and the dose must be increased until this is accomplished. In long-standing cases perseverance is necessary. When recovery is obtained the dose should be gradually, not suddenly, reduced, and it is very important that the use of the remedy should be continued for at least from one to three weeks after all symptoms have disap- peared. It is not possible yet, he thinks, to indicate precisely which cases are most suit- able for this treatment, but it is worth trying in all cases where itching is a pronounced feature. In most of his cases an actual cure resulted, but in a few of very long duration relief was obtained only so long as the drug was being taken. Nevertheless, a cure, he thinks, will probably result with perseverance even in these. L28 CALCIUM SULPHIDE CARBOLIC ACID 4 Dr. William Huntlv, of Kotah (Indian Medical Record, May" 1, 1894; New York Medical Journal, June 16, 1894), speaks highly of calcium chloride as a hemostatic. In a case of bleeding after the extraction of a tooth the flow was arrested by the administration of opium, but returned on the following day, when Dr. Huntly gave the patient calcium chloride, and by" evening the bleeding had stopped. In this case the use of calcium chlo- ride was continued for three days. In another case vomiting of blood had gone on all night, and every native remedy had been tried un- successfully. Dr. Huntly" thought it clear that the hematemesis was due to an irritant powder having been swallowed by mistake, and he or- dered some soap pills to be taken at once. After the use of calcium chloride, together with other measures, there was no recurrence of the bleeding. In a case of severe epistaxis the same measures proved effectual without resort to plugging. Dr. Saundby, says Dr. Huntly, has obtained good results in a case of purpura hemorrhagica from 6-grain doses of calcium chloride repeated every two or four hours. Dr. Huntly thinks better results are to be obtained from the combination of opium and calcium chloride than from either drug alone, although opium by itself has often proved successful, as nature mends the broken surfaces while the opium is exercising its re- straining influence; but when calcium chloride is added, Nature's efforts are supplemented. Opium, he continues, acts on the smaller ar- terioles and capillaries, while calcium chloride acts through and on the blood, and the combi- nation is all the more valuable because their spheres of action do not clash. As a combina- tion, he thinks that calcium chloride and opium should be found superior to lead and opium. CALCIUM SULPHIDE.—Dr. J. Sinclair Coghill (British Medical Journal, May 4,1895 ; Therapeutic Gazette, September, 1895) reports a large experience in the use of calcium sul- phide for the prevention of influenza. He gives it in pills, each containing a grain, and one pill is to be taken daily. During the first epi- demic in which he used it all his household took it, with the exception of two servants, who, for some reason or other, did not, and the result was that all escaped except the two servants. The next year, when the epidemic again broke out, the writer asked the authori- ties of the Isle of Wight Railway to supply all their employees with the pills, and all who "took them regularly escaped. The manager of the Central Railway also asked Dr. Coghill to sup- ply his men with them, and he afterward in- formed him that, so far as he could ascertain, none of the men who had taken the pills regu- larly had had influenza. During the next outbreak the pills were again given, with like results; but on the Isle of Wight Railway they were not given out to each workman as for- merly, consequently but few took them, and the result was that a large number of influenza cases occurred among those who had not used the remedy. It takes about three days, says Dr. Coghill, before the system becomes sufficiently satu- rated with the drug to prevent infection; therefore it is rarely of use to those who have already been exposed to it, though even then it appears to modify the attack. When a case appears he believes the 5-grain dose of quinine to be more rapid in its action than the sulphide of calcium, and therefore safer to give, but he would afterward carry on the effect with the sulphide of calcium, which is equally efficacious and much easier for many to take, as it never appears to disagree in any way, although taken regularly for many weeks. Its modus operandi is thought to be that of rendering the blood unfit to receive and support the germ of the disease. CAMPHORIC ACID.—Dr. Ralph Stock- man (Edinburgh Medical Journal, January, 1897 ; New York Medical Journal, January 16, 1897) refers to the early experiments made by Gormanni and Brugnatelli, the results of which showed that this drug readily destroyed the tubercle bacillus, and that sputum after treatment with it failed to infect rabbits. Fiirbringer, he says, used it as an intestinal antiseptic in typhoid fever, and found that it greatly diminished the number of organisms in the alvine discharges, but had no effect on the duration or the severity of the lever. In the course of these observations it was noticed by Fiirbringer that it checked the secretion of sweat, and he then began to use it in cases of phthisical sweating. Other trials, says Dr. Stockman, by Dreesmann, Bohland, Niesel, Combemale, and others have confirmed this observation ; and all these investigators speak highly of its action and place it in the very first rank as an anthidrotic. Dr. Stockman states that it has been used only to a comparatively limited extent, and that, although it is said to act more power- fully than either atropine or agaricin, the ex- perience on which this opinion is founded is not very extensive. He himself began to use the drug four years ago, and since then he has given it pretty largely in phthisical and other cases of sweating. One case was that of a lady who had been treated by electricity for a myoma of the uterus. She suffered greatly at night from excessive sweating, and occasion- ally also during the day. Dr. Stockman or- dered her 15 grains of camphoric acid at night, and this completely stopped the sweating. After taking it for two weeks she found that the tendency to excessive sweating had com- pletely disappeared, and since then it has not recurred. Shortly afterward Dr. Stockman again used it successfully in a patient with en- larged prostate, who suffered from profuse sweating without any apparent cause. This tendency to perspire profusely has recurred at intervals, but is always stopped by 15 grains of camphoric acid taken once or twice a day, and sometimes one dose is sufficient. Dr. Stock- man has also used it in cases of hyperidrosis after influenza and in other cases in which there was certainly no tubercle present, and in all of them doses of from 15 to 30 grains have given good or fairly satisfactory results. CALCIUM SULPHIDE 429 CARBOLIC ACID Dr. Stockman emphasizes its value in non- tuberculous cases, because it has been stated that its usefulness is confined to the sweating of phthisis, in which its value is quite com- parable to that of belladonna or atropine. Ac- cording to his experience, camphoric acid acts as efficiently as atropine, but in one or two ob- stinate cases it has not shown itself so power- ful an anthidrotic as picrotoxin. It exercises, he says, no specific germicidal action on tu- bercle bacilli in the tissues, and it does not affect the fever or local lung condition. With regard to its administration, Dr. Stockman thinks that the best plan is to give 30 grains at night two or three hours before the sweating would begin, or it may be given in two doses at short intervals. It is best ad- ministered in powder or in capsules or cachets, as the alcoholic solution is very bitter. Owing to its insolubility, he says, it is only slowly ab- sorbed from the intestinal canal, and this is the reason why it must be given so long before the time of sweating. This slowness of action is, Dr. Stockman thinks, undoubtedly a draw- back as compared with that of atropine or picrotoxin, which can be given hypodermically and act rapidly. Camphoric acid is excreted in the urine within twelve hours after its ad- ministration by the mouth, so that its action is usually not very prolonged. The only unpleasant effect seen by Dr. Stockman has been slight irritation of the stomach after its use. It is said, however, to cause renal irritation, and in one case it was apparently the cause of a skin eruption. It seems to be non-poisonous, he says, even in large doses, and in this respect has distinctly an advantage over belladonna, picrotoxin, and agaracin. Fiirbringer has given as much as 75 grains a day in typhoid fever, and Niesel gave 750 grains in four weeks in a case of cys- titis, without any toxic or unpleasant symp- toms being produced. He adds that his own experience also bears this out, as he has never noticed any depression of the heart or nervous system, and Wagner has found that camphoric acid has much the same effect as camphor on the circulation, that it acts as a stimulant to the heart and raises the blood-pressure. In order to ascertain its mode of action, Dr. Stockman made some experiments on frogs and on sweat secretion in cats. The experi- ments on frogs showed that it was not very toxic to these animals. Doses of from 2 to 4 grains by the mouth or subcutaneously caused slight depression which lasted for some hours and was then succeeded by great increase in the spinal reflexes which lasted for several days, (iiven in this way, it scarcely affected the motor nerves and muscles, but if the same dose was injected directly into the aorta of pithed frogs, both motor nerves and muscles were paralyzed. Its action differs, therefore, very considerably from that of camphor. Doses up to 75 grains had very little effect on rabbits beyond causing slight depression sometimes followed by a very slight increase of reflexes. The toxicity of camphoric acid is therefore, remarks Dr. Stockman, very slight in animals as well as in man. CANNABIS INDICA.—The Therapeut- ische Wochenschrift for March 1, 1896 (New York Medical Journal, March 21, 1896), men- tions a new watery fluid extract of cannabis indica termed extractum cannabis indice aquosum fluidum, and states that, according to R. Cowan Lees, it possesses all the benefi- cial properties of the plant, but does not give rise to that state of intoxication, bordering on poisoning, which sometimes follows the use of even meaium doses of the alcoholic prepara- tions. It has no effect on the secretion of bronchial mucus, and consequently in suitable cases it seems more efficient than opium, and it has a manifest anodyne and hypnotic effect in pulmonary affections. Lees has observed the best results from its use in tuberculous dis- ease of the lungs, in which it materially allevi- ates the paroxysms of coughing, while at the same time it exerts the precious stimulat- ing and cheering effects of cannabis indica. It is, furthermore, of value in digestive disturb- ances connected with constipation and as a soporific in the diseases of children. The me- dium dose for an adult is from 30 to 60 drops ; for a child less than a year old, from 0-15 to 030 of a drop for each month of age; for older children, from 1-J to 3 drops for each year of age. CARBAZOTIC ACID—See Picric acid. CARBOLIC ACID.—In the Lancet for January 16, 1897, Mr. Arthur Eddowes, of Loughborough, reports a new case of trau- matic tetanus cured by the subcutaneous ad- ministration of carbolic acid. A man, aged forty-one years, received a punctured wound on the inner side of the ball of the left great toe from a boot nail on or about May 19th. Little notice Mas taken of the wound at the time, and he continued his work. On the 26th he got very wet, and thought he had contracted a chill. About June 2d the wound was ob- served to suppurate slightly, but he still did his work. On the 9th he felt slight stiffness of the lower jaw and of the nape of the neck ; the latter sensation was described " as if some- thing was constantly pulling his head back- ward." On the 10th, the symptoms being slightly worse, he consulted his medical man, who prescribed for him. He visited the prac- titioner again on the 11th and 12th, but he still continued his work. On the morning of the 13th he was advised by the medical man to go home and go to bed, but he did not do so till 6 p. M. During these days the symp- toms had been steadily increasing in severity, and by the 13th his condition was as follows: His jaws were quite closed, so that slops only could be taken. The muscles of the back were slightly rigid, sufficiently so to make move- ment difficult. By the next morning (June 14th) there was fully developed trismus with severe aching pains in the muscles around the lower jaw, rigidity and arching of the neck, rigidity and slight arching of the back, and some contraction of the abdominal walls; the lower extremities were not much complained of except for shooting pains round the knees ; the upper extremities were free. The urine CARBONIC ACID COCAINE 430 passed normally; the bowels were acted upon by 2 grains of calomel given the previous even- ing ; the surface of the body was somewhat clammy. The pulse was 66 and of good vol- ume, and the temperature was 98° F. His intellect was clear; the power of swallowing was not perceptibly affected, the patient being easily fed with slops owing to the absence of several teeth. The treatment consisted in the administra- tion of chloral hydrate and bromide of potas- sium every four hours and liquid food. On the 15th the arching of the neck and trunk was somewhat more extreme ; the trismus was still marked, and there was some degree of risus sardonicus observable. Also there was considerable pain complained of, beginning in the spine and shooting forward. The power of the extremities, however, remained good; the urine passed normally, but the bowels were not open. The pulse and temperature were the same as on the 14th. On the 16th his con- dition remained unchanged. On the 17th occasional momentary convulsive movements of the trunk, simulating hiccough, were ob- served, the arching of the neck and trunk was increased, and the power of the lower extremi- ties was slightly lessened. There were consid- erable pain and some tenderness of the spinal column. The pulse was 72 and the tempera- ture was normal; the urine passed normally, but it was highly concentrated and loaded with urates; the bowels were opened by an aperient and an enema. On the 18th the rigid- ity of the neck was less extreme, the convulsive twitchings were more frequent, and intense foetor of the breath was noticed; otherwise the condition remained the same as on the 17th. A consultation was held, and the following treatment was adopted: Highly nourishing diet was ordered, consisting of eggs with milk and brandy, milk with soda water, jellies, and cocoa, frequently administered in small quan- tities. Ten grains each of chloral hydrate and bromide of potassium were administered every two hours. Five minims of carbolic acid (2- per-cent. solution) were injected hypodermically, morning and evening. The chloral and bro- mide of potassium were given at 8 p. m., and were followed by intense excitement with numbness in the extremities half an hour later, which continued during the greater part of the night. The carbolic acid was injected at 10 p. m., and no after-effects were noticeable, the pulse being 102 and the temperature 100-8°. On the 19th, at 10-45 a. m., the pulse was 96 and the temperature 100-8°. The patient had become quieter, the convulsive movements were less frequent and less severe; he took his food well; his intellect was somewhat clouded, but he was conscious of his surroundings. There was less rigidity of the back, chest, and abdomen, and there was more power in the legs; there was no change in the degree of the trismus. The bowels were inactive, and an aperient and an enema had to be resorted to. On the 20th the pulse was 90 and the tempera- ture was 99-8 \ The convulsive movements were very slight during the night, but the pa- tient was very restless. The rigidity of the back, chest, and abdomen was much lessened, the back completely resting on the bed ; there was greater power in the lower extremities, but there was little change in the rigidity of the neck. The mouth could be opened slightly, but not sufficiently to allow of protrusion of the tongue. The bowels were still inactive, and an enema was given. The patient's con- dition had considerably improved by the after- noon, and the treatment was slightly changed, the hypodermic injection of carbolic acid being reduced to once daily and the chloral and bro- mide being given every three hours instead of every two hours as before. On the 21st the pulse was 72 and the temperature normal. The patient had had a restless night, but less so than the preceding one. The rigidity of the muscles was lessening, with the exception of those of the neck, which remained firm. The movement of the jaw was more complete, and there was less risus sardonicus. The bowels, however, had not been opened, in spite of a dose of castor oil. The use of the hypodermic injections was discontinued, and 15 grains of chloral hydrate were given three times a day. On the 22d the pulse was 78 and the tempera- ture 98-2°. The rigidity had almost disap- peared except in the neck and jaw. The patient was still restless, evidently from being confined to bed, and the bowels were still inactive, but the patient's condition was improving. On the 23d the pulse was 73 and the temperature normal. He had had a good night, but felt depressed. There were no paroxysms, but there was some pain in the back. The rigidity had considerably diminished, and the lower jaw was slightly more movable. As the bowels re- mained inactive, an aperient was given. Food was well taken. A tonic was prescribed. From this time the patient made a steady and uninterrupted recovery, and. after a month at Scarborough, returned in perfect health. CARBONIC ACID.—This gas was for- merly thought to have a remedial action when inhaled in cases of nasal catarrh. In 1864 Herpin said of it: " Douches or injections of carbonic-acid gas have been successfully used in certain affections of the pituitary mem- brane ; in cases of suppuration it corrects and diminishes the bad odour, and it favours and hastens recovery." M. Joal (Revue interna- tionale de rhinologie, d'otologie, et de laryn- gologie. May, 1896), who quotes this passage from Herpin, reports two cases of anosmia cured by the use of the gas in the form of a nasal douche, and mentions its favourable ac- tion in hypertrophic rhinitis and acute coryza He describes a simple device for the inhalation An ordinary " siphon " of carbonic-acid water is turned upside down and the valve pressed in order to allow that portion of the liquid which is above the extremity of the tube to run out. On the tip of the outlet is placed a rubber tube about six inches in length, on the end of which a nasal cannula is attached and the apparatus is ready for use. The cannula is introduced into the nostril and the valve pressed gently, and the carbonic acid pene- trates the nasal fossae; or the valve may be 43: brought near the nostril so that the patient may inhale the gas. and in this way it is drawn through the respiratory and olfactory parts of the nasal passages. CARDOL.—Under this name two oily liq- uids are on the market—one obtained from Anacardium occidentale, which is a vesicant; and the other from Anacardium orientate, which is a rubefacient. CARNIFERRIN.—According to Profes- sor Coblentz, this German meat preparation contains 30 per cent, of iron in combination with phosphoric acid. It is said to be taste- less. It may be given to children in doses of from 3 to 5 grains, and to adults in doses of 8 grains, as a tonic and nutrient. CELLOIDIN.—Dr. R. T. Williamson (Brit- ish Medical Journal, April 18, 1896) thinks that a solution of celloidin is superior to collodion in adhesive power. He says the strength of the solution he has employed has been the same as that used in microscopical work—namely, 2 parts of celloidin dissolved in a mixture of 15 parts of absolute alcohol and 15 parts of pure ether (specific gravity, 0-720). It is important, he says, to use pure absolute ether of this specific gravity, and not the sulphuric ether which has a specific grav- ity of 0735. If the latter is used the celloidin does not adhere to the skin so well. CELLULOID.—Professor Landerer and Dr. E. Kirseh (Centralblatt fur Chirurqie, July 18, 1896; New York Medical Journal, August 1, 1896). after mentioning the great drawbacks of plaster of Paris as a splint ma- terial—its weight and its proneness to become foul by absorbing sweat, urine, etc.—say that in the Medico-mechanical Institute of Stutt- gart celluloid has been found an excellent sub- stitute free from these disadvantages. A wide-mouthed bottle is packed for about a quarter of its height with celluloid cut into small pieces, and then it is filled with acetone. It is provided with an air-tight stopper to guard against evaporation. From time to time it is opened, and the contents are stirred with a stick. The celluloid dissolves in course of time. A plaster cast of the diseased or in- jured part is covered with a moderately thick layer of felt or flannel, and the celluloid solu- tion is rubbed into this covering with the hands, which are to be protected with leather gloves. This process should be repeated from four to six times. The advantages of the cel- luloid splints and corsets are their lightness, hardness, stability, elasticity, and cleanliness. CHELIDONIUM.—A Russian physician, Dr. Denissenko (Vratch, 1896, No. 30: Deutsche Medizinal-Zeitung, September 24, 1896: New York Medical Journal, October 10. 1896), has tested the action of the juice of Chelidonium majus on cancer in the municipal hospital in Brjansk. In his early experiments he used the fresh juice of the herb, but since February, 1895, he has been using the extract found in the shops. His method of employing chelidonium is as follows: lie directs that from 22 to 75 grains of the extract be taken internally, dissolved in CARBONIC ACID 1 COCALNE distilled water or peppermint water, every day throughout the treatment. Into the substance of the tumour, as close as possible to the boun- dary between it and the healthy tissue, he throws a number of injections of from 2 to 4 drops of a mixture of equal weights of the ex- tract, glycerin, and distilled water, not exceed- ing a Pravaz's syringeful in all. The frequency with which these injections are given is not stated. If the tumour is ulcerated, he paints its surface twice a day with a mixture of 1 or 2 parts of the extract and 1 part of glycerin. Iron, quinine, and other supporting remedies are employed according to the indications. Except in a few cases, he says, the internal use of the drug caused no disturbance of the stomach, but the painting of the ulcerated surfaces gave rise to a slight and transitory burning. It was different with the parenchy- matous injections: in all instances, after the injections, especially after the first one, there was burning pain at the site of the operation, the patient felt weak, there was a more or less severe chill, and then the temperature rose to between 100° and 102° F. Although these symptoms disappeared on the following day, Dr. Denissenko saw reason to exercise a certain amount of caution in the use of the injections. The effects of this treatment were shown in the course of a few days. They were the following: 1. The sallow hue of the skin dis- appeared. 2. Softening of the tumour set in. 3. After from three to five days there formed at the points of injection fistulous tracts about which the softening process went on with special rapidity. 4. In from fifteen to twenty days a line of demarcation could be distin- guished between the morbid and the healthy tissues; the one seemed to be forced away from the other. In general, the tumour diminished more than half in circumference, and the affected lymphatic glands of the neighbour- hood underwent involution. CHLORALIMIDE.—This substance, CC1, CH:NII, must not be confounded with chlo- ralamide. Chloralimide is a crystalline pow- der obtained by the action of heat on chloral ammonium. It is hypnotic and analgetic. The dose is from 15 to 45 grains, and not more than 90 grains should be given in twen- ty-four hours. Clinical data concerning its use are still so defective as to call for caution in its employment. CHLOROSALOL.—See under Salicylic acid and the salicylates (Supplement). CHOCOLATE.—See under Cocoa. CITROPHEN,acompound of citric acid and paraphenetidine, CelLOH^Qp1,^ >C6H4JS, is closely allied to apolysine (q. v.). It is em- ployed as an antipyretic and analgetic in doses of from 7 to 15 grains. COCAINE.—The Tlierapeutische Wochen- schrift for June 21, 1896, contained an inter- esting summary of several cases of poisoning with cocaine, the substance of which is given in the New York Medical Journal for July 11, 1896. The writer first remarks upon the ex- traordinary variability of the symptoms in CODEINE EROD1UM CICUTAR1UM 432 cases of cocaine poisoning. There may, he says, be intellectual torpor, tonic or clonic convulsions, or maniacal exaltation. Respira- tory disturbance's are particularly intense; the breathing is shallow, in severe cases it may be of the Cheyne-Stokes type, and death may oc- cur from respiratory paralysis. Phenomena pertaining to the circulation are less pro- nounced. Poisoning has been known to fol- low the use of so small an amount of cocaine as 0-077 of a grain, and in many cases that have been reported there has been no reason to suppose that the preparation was impure or that the recognised maximum dose was ex- ceeded ; idiosyncrasy must therefore be as- sumed to have taken a part in giving rise to the results. After making these remarks, the writer pro- ceeds to give condensed accounts of four cases of cocaine poisoning. The first and second cases were reported by Dr. M. Weinrich in the Berliner klinische Wochenschrift. In one of them the patient, who had a tumour of the bladder, had been examined with the cysto- scope several times and operated upon with the aid of that instrument and the use of a one-to-fifteen solution of cocaine. On the third day after the operation the same solu- tion was injected, and immediately signs of poisoning showed themselves—unconscious- ness, epileptoid convulsions, Cheyne-Stokes respiration, and slowing of the pulse, which was imperceptible in the wrist and hardly to be felt in the thigh. The patient was saved by means of prolonged and energetic artificial respiration. A week later there was occasion to use an injection of half the strength of the preceding ones, and no signs of poisoning showed themselves. Dr. Weinrich's other pa- tient was a man eighty years old. Similar phenomena of poisoning were observed after a urethral injection of a one-to-fifteen solution of cocaine. The first case is remarkable, says the Thera- peutische Wochenschrift, from the fact that the cocaine had been used six times without any ill effect, and then on the seventh occasion, with- out there being any condition especially favour- able to absorption, severe poisoning resulted. It seems that the mucous membrane of the urethra absorbs drugs more readily than that of the bladder, the writer goes on to say, but it may be assumed that the vesical mucosa absorbs them more readily when it is diseased than when it is healthy, on account of losses of epithelium, etc. The third case was reported by Dr. E. Pfister, of Cairo, in the Berliner klinische Wochenschrift, 1896, No. 14. The man had suffered with retention of urine a number of times in consequence of vesical calculi. He received an injection of a 20-per-cent. solution of cocaine into the bladder, and died almost immediately. A Pravaz's syringe, the writer remarks, will hold four times the amount of such a solution as would contain the maxi- mum dose of cocaine, and it is probable that in this case a still larger syringe was used, for only thus, he says, can the lightninglike ra- pidity with which the drug acted be explained. The fourth case was observed by Dr. G. Duchesne, of Orbec, and reported in the Annee medicate de Caen for 1896. A man thirty- eight years old had two injections of cocaine into the gum, in order to have a tooth ex- tracted without pain. On the following day he had oedema of the lids of each eye, espe- cially of the upper lid, which increased for forty-eight hours and then subsided entirely. Repeated examinations of his urine showed no trace of albumin. In this case, the writer in the Therapeutische Wochenschrift thinks, there was probably a vaso-motor paralysis in conse- quence of the action of the drug on the ter- minations of the inferior dental nerve, which is a branch of the inferior maxillary, or of a part of the trigeminal, which by its ophthalmic branch of Willis is in close connection with the skin and the mucous membrane of the lids. Great caution must be observed in the use of cocaine within the urinary passages, says the writer, but he adds that the capricious ac- tion of the drug is as difficult to guard against as that of chloroform. The use of cocaine is contra-indicated in anaemic persons and in those that are the subjects of respiratory or circulatory disease. When cocaine poisoning occurs, amyl nitrite and chloroform should be used, also opium and chloral hydrate for the convulsions, but above all artificial respiration and injections of camphor dissolved in ether. CODEINE.—According to Mr. Joseph W. England (American Journal of Pharmacy, July, 1894), a mixture for coughs, known as the " C.—0." cough mixture, is very largely used in the Philadelphia Hospital. The for- mula is as follows : B Codeine sulphate.......... 1 grain ; Diluted hydrocyanic acid.. 16 minims; Chloroform, Mucilage of acacia, , Syrup of wild cherry to M. Dose, a teaspoonful. A somewhat similar formula is given on page 286 of vol. i. CODOL.—See Rosinol. COPAIBA has been recommended by Pro- fessor Monti, of Vienna, in the treatment of scabies m children. Waring (Manual of Prac- tical Therapeutics, Philadelphia, 1886) states that Dr. Monti employed the balsam in twenty- seven instances, and in each case effected a complete cure. Each child was first washed with soap and water and then rubbed all over twice daily with the balsam. No other appli- cation was used. He found that the itch insect could not live in the balsam beyond two or three hours. COTARNINE HYDROCHLORIDE - See Stypticin. COTTON ROOT. ^Dr. George A. Blakeley, oi Albany, Wisconsin (Medical News, April 11 1896), reports a case of poisoning with cotton root A woman, supposing herself to be preg- nant, took 4 oz. of the fluid extract during the interval from 9 to 10 p. m. At about 11 o'clock her husband arrived home and found her un- conscious. He summoned Dr. Blakeley who [each. 2 fl. drachms; 1 fl. oz. CODEINE 433 EROD1UM CICUTARIUM soon reached her and found her in a state of complete muscular relaxation. The pupils were both widely dilated; the respiration was 10, sighing and shallow; the pulse was 150, very weak and compressible ; and the temper- ature was 95° F. in the axilla. There was a faint, peculiar odour to the breath, but there were no blisters on the lips or tongue, though the latter was very dark coloured. Dr. Blake- ley gave J of a grain of apomorphine hypo- dermically and diluted alcohol by the same method. Thorough emesis occurred in five minutes, and the vomited matter was reddish- brown. The symptoms showed rapid improve- ment, and in half an hour she could swallow, when the stomach was thoroughly washed out, getting rid of some more reddish-brown ma- terial, which appeared like extract of cotton- root bark. In about two hours she was able to talk. She improved rapidly and the next morning was able to sit up. No further trouble occurred except that she was quite weak for a few days. It turned out that she was not pregnant. CREOSAL.—This is described as a dark- brown hygroscopic powder, readily soluble in water, made by heating beechwood creosote with tannic acid and phosphorus oxychloride. It has been recommended in the treatment of catarrh of the respiratory organs, in doses of 15 grains three time a day. CREOSOL.—This is an oily liquid, called alsohomoquaiacol and homopi/rocafechinmethyl ether, C6Hs.CH8(OCHs).(OII),' obtained by dis- tilling beechwood tar or gum guaiacum (Merck). It has been recommended as an antiseptic. CREOSOTE.—Dr. J. P. West, of Bellaire, Ohio (Archives of Pediatrics, May, 1896), re- cords the cases of two children with enlarged bronchial glands in which the beneficial effect of creosote was very prompt and decided. CREOSOTE-CALCIUM CHLORHY" DROPHOSPHATE.—This is described as a white syrupy mass consisting of creosote car- bonate "and calcium chlorhydrophosphate. It has been recommended in the treatment of tuberculosis and scrofula in doses of from 3 to 8 grains, in an emulsion, twice a day. Pro- fessor Coblentz gives the following formula: R Creosote-calcium chlorhydro- phosphate ............... 5 to 10 parts; Mucilage of chondrus....... 15 Oil of sweet almonds, > each> a5 „ Syrup of Tolu, ) Orange-flower water........ 75 M. Dose, a teaspoonful twice a day. CRESALOL, CRESOL SALICYLATE. —See under Salicylic acid and the sali- cylates (Supplement). CRYOSTASE.—This is the name of an an- tiseptic preparation said by Professor Coblentz to be a mixture of eq ual parts of carbolic acid, camphor, and saponin, with traces of oil of turpentine. CUTAL.—See Aluminum borotannicotar- trate (Supplement). DERMATIN. — According to Professor Coblentz, this is a mixture of from 5 to 7 parts of salicylic acid, from 7 to 15 parts of starch, from 25 to 50 parts of talc, from 30 to 60 parts of silicic acid, and from 3 to 9 parts of kaolin, used as a protective to the skin. DESOXYALIZARIN.—See Anthraro- BIN. DEXTROSE.—See under Sugar (vol. ii, page 235). DIABETIN.—See Levulose. DI ACETANILIDE. — This compound, C6H5N(C2H302)2, is made by heating acetani- lide with glacial acetic acid. It is said to be similar to acetanilide in its action, but more powerful. DIACETYLTANNIN.—See Tannigen. DIETHYLENEDIAMINE.—See Piper- azine. DIETHYLSULPHONEDIETHYLME- THANE.—See Tetronal. DIETHYLSULPHONEDIMETHYL- METHANE.—See Sulphonal. DIETHYLSULPHONEMETHYL- ETHYLMETHANE.—See Trional. DIMETHYLETHYLCARBINOL.—See Amylene hydrate. DIOXYANTHRANOL. — See Anthra- ROBIN. DISPERMINE.—See Piperazine. DITHYMOL IODIDE.—See Aristol. DITHYMOL TRIIODIDE.—See Anni- DALIN. DUOTAL.—Guaiacol carbonate (see under Guaiacol). EMBELIC ACID.—See under Embelia RlBES. ERODIUM CICUTARIUM.—This gera- niaceous plant, the hemlock stork's-bill, wild mush, or pine grass, has been used as an astringent and diuretic. Dr. Komarovitch (Vratch, February 29, 1896; Lancet, April 4, 1896) states that he has made considerable use of it in uterine hemorrhage with excellent re- sults, often after better-known drugs, such as ergot and hydrastis, had failed. He believes that the effect of the erodium is to increase the elasticity of the muscular fibres and thus to favour their contraction. In one case where a polypus was the cause of the haemorrhage, after a fortnight's treatment the tumour was extruded into the vagina, which had never occurred with other drugs previously tried. Twenty of the cases where erodium succeeded after the failure of ergot and hydrastis were due to metritis, but others were dependent on mvoma and abortion. The preparation used was an infusion made with 12 parts of water to 1 part of the plant, to which a little pepper- mint was added to improve the taste. Of this a tablespoonful was prescribed every two hours. In no case were any unpleasant by-effects pro- duced, though sometimes the use of the medi- ETHYL CARBAMATE EUCASIN 434 cine was continued for some weeks. The active principles of the plant are stated to be " an ethereal oil, a bitter principle called geramin, and tannic acid." ETHYL CARBAMATE.—See Ure- thane. ETHYL CHLORIDE.—In addition to its use as an anaesthetic, ethyl chloride is often of service as an analgetic The spray may be applied repeatedly to the painful part, which it may not be necessary to freeze. Dr. W. C. Daisch, of Melbourne (Australian Medical Journal, December 20, 1895), has found it to give great relief in such forms of pain as that of migraine, the headache of influenza, and toothache. It will relieve the pain of iritis or conjunctivitis if sprayed round the orbit. In epididymitis it relieves and reduces inflamma- tion, and it has been used in meningitis and sunstroke. Itching, pleurodynia, and the pain of shingles may be relieved, by its use. In spasmodic dyspnea, asthma, and hiccough it should be sprayed round the base of the chest, says Dr. Daisch, who adds that it will stop epi- staxis if applied to the base of the nose, or sprayed directly into the nostrils, and might be advantageously used in persistent bleeding after tooth extraction. According to Dr. Daisch, ethyl chloride is very serviceable as a dental anesthetic. Before it is applied, he says, the gum should be thor- oughly dried and smeared with vaseline, and the neighbouring parts protected by packing with wool. The patient is instructed to breathe through the nose. During thawing, care must be observed in the use of hot water; if it is used too hot or too soon, sloughing may result. For the extraction of a tooth the gum may be frozen on each side of the tooth; it checks bleeding in addition to its action as an anaes- thetic. It is said not to be necessary to spray into the mouth at all to prevent pain in ex- tractions. If the jet is thrown on to the jaw outside, near the entrance of the dental nerve in front of the ear for the upper, behind the ramus of the inferior maxilla for the lower jaw, anaesthesia of the whole jaw on one side will be caused, and teeth may be extracted painlessly, says Dr. Daisch; he remarks that this is useful in the case of molars, which are not so accessible to the spray as the front teeth. ETHYLENE PERIODIDE.—See Di- IODOFORM. ETHYLURETHANE.—See Urethane. EUCAINE, C19H27N04, is the methyl ester of a benzoylated oxypiperidinecarbonic acid. The hydrochloride obtained by crystallization from a methyl-alcohol solution bears the for- mula Ci9Hq,N04.HCl.H02. Eucaine is insolu- ble in water, but dissolves freely in alcohol, in ether, in chloroform, and in benzene. Evapo- rated from its ethereal solution, it appears in large, brilliant, colourless crystals, which melt at 219° F. It combines with mineral acids to form more or less freely soluble salts, also crystalline in character. Eucaine hydrochlo- ride occurs in the form of brilliant platelets or crystals which dissolve readily in six parts of water at the temperature of the room. There are some points of chemical similarity and difference between the hydrochloride of cocaine and that of eucaine. Both, in solution, change in colour to yellow and orange-red when boiled with ferric chloride. The addition of a 5-per- cent, solution of chromic acid to a solution of eucaine gives rise to a beautiful yellow, crys- talline precipitate. With cocaine it does not. Again, a solution of the eucaine salt, treated with a 10-per-cent. solution of potassium iodide, presents at first a milky turbidity, and gradu- ally deposits fine colourless plates after stand- ing. In this respect it differs from cocaine. The hydrochloride of eucaine is stable in the air, and it does not undergo decomposition or change, as cocaine does, when subjected to boil- ing. Cocaine, as is well known, splits up into benzoylecgonin and methyl alcohol, which ren- ders its subsequent use upon mucous mem- branes irritating. Solutions of eucaine salts remain clear, moreover, and require, therefore, no preservative agent to be added. Dr. Gaetano Vinci, of Messina, as a result of clinical and laboratory experiments, finds (Therapeutische Monatshefte, June, 1896) that a solution of eucaine hydrochloride of a strength of from 2 to 5 per cent, induces prompt anaes- thesiaof the conjunctiva and cornea in from one to three minutes. The anaesthesia lasts from twenty to thirty minutes and may be prolonged by the further application of the solution. The pupil does not become dilated, and during the local anaesthesia reacts normally to light. Irri- tation of the conjunctiva is almost always ab- sent, but the observer reports an occasional hyperaemia following the use of cocaine. The effect of large or medium doses upon animals is a general excitation of the central nervous system, followed ultimately by pa- ralysis. Severe tonic and clonic convulsions sometimes appear, which are succeeded by paralysis. Some central irritation of the vagus nerve diminishes the frequency of the heart's beats, and because of the irritation of the vaso- motor system of nerves the blood-pressure rises. In Vinci's experiments, only fatal doses suc- ceeded in giving rise to a sudden diminution of the blood-pressure. When doses of from £ to I of a grain for each thirty-five ounces of the animal's weight are given, coma, dyspnoea, and opisthotonos, with paresis of the posterior limbs, supervene. Fatal doses kill by respira- tory failure after a preliminary hastening of the respiration with marked dyspnoea. In man, toxic symptoms have never been evoked, and if it is given in -therapeutic doses—according to Kiesel as much as 30 grains—no bad effects upon the heart or respiration are likely to follow. Vinci points out the similarity of the physi- ological action of eucaine and that of cocaine, with their differences. Eucaine is distinctly less poisonous to man than cocaine, and of animals injected with the same quantities of both drugs, those treated with eucaine sur- vived, those with cocaine died. Eucaine pro- duces a primary decrease in the frequency of the heart's action; cocaine an acceleration. So 43, far as their anesthetic properties are concerned, the two drugs are very similar, except that eucaine possesses the advantage that it favours hyperaemia, while cocaine induces ischaemia. Upon the eye, eucaine does not cause mydriasis, and it does not interfere with the reaction of the pupil to light, an advantage of importance in ophthalmological operations. Upon the mucous membranes of the nose and throat eucaine produces a strong anaes- thetic influence, with no bad effect upon the heart. Kiesel obtained good results in dental work with solutions of the hydrochloride of a strength of from 1 to 5 per cent. Schleich has found that, in the same strength, it produces a strong anaesthetic influence when subcutane- ously administered ; for infiltration anesthesia —as first advocated by Schleich—a solution of the strength of from 1 to 2 per cent, is suf- ficiently strong. He believes that eucaine will replace cocaine in instances where its simple ap- plication upon mucous membranes is required. In ophthalmological practice many other workers have substantiated Vinci's work. Carter, of London (Lancet, July 11, 1896), highly recommends eucaine hydrochloride as being less toxic than cocaine and as having no mydriatic effect, two advantages which appeal to him strongly. In cases in which a contrac- tion of the smaller vessels is desired, however, cocaine had better be employed. Vollert (Munchener medicinische Wochenschrift, 1896, No. 22) has seen occasional hyperaemia follow the local use of eucaine in the eye, as was, how- ever, stated in Vinci's original paper (Deutsche Medizinal-Zeitung, April 27,1896). Anaesthesia of mucous membranes follows the instillation of eucaine hydrochloride in from one to three minutes, and lasts, according to different ob- servers, from ten to thirty minutes. Gorl (Therapeutische" Monatshefte, July, 1896) has used eucaine as an anaesthetic for cystoscopic work, and says that patients com- plain at first of some irritation and burning, but that the anaesthesia is as profound as that of cocaine. He used a 0-5-per-cent. solution. Cystoscopy is succeeded by a slight bleeding, which he attributes to a hyperaemia induced by the eucaine. He finds that eight cubic centi- metres of the same solution occasion some burning in the urethea, but this is followed by an anaesthesia sufficiently strong for the manip- ulation of instruments. Gorl has also found the agent satisfactory in laryngological work. It has been suggested that in order to avoid the smarting sometimes incident to the use of eucaine on mucous membranes, a 1-per-cent. solution should be first instilled, and this fol- lowed in from two to three minutes by the instillation of a 2-per-cent. solution. In order to overcome the ischaemia produced by cocaine, Berger has proposed this formula for the pur- poses of local anaesthesia: B Eucaine hydrochloride, ) each_ 3 ing Cocaine hydrochloride, \ Distilled water.............. 300 minims. M. For the other requirements of local anaes- thesia, eucaine seems to be the equal of cocaine ETHYL CARBAMATE 5 EUCASIN in rapidity, in intensity, and in duration. It may be employed for subcutaneous anaesthesia in any part of the body in strengths of from 1 to 6 or 7 per cent, for the opening of abscesses, the removal of small tumours or growths of any kind, or for the general purposes of minor surgery, with perfect safety. The writer has recently used, subcutaneously, a 6-per-cent. so- lution for the extirpation of a very large wart, and perfect anaesthesia was procured. It lasted twenty minutes and allowed of extensive sutur- ing. An additional virtue of the hydrochlo- ride of eucaine rests upon the fact that it is not decomposed by repeated boiling, and may thus be sterilized as often as desired. The dose of eucaine is the same as that of cocaine. As mentioned above, Kiesel (Zahn- drztliche Rundschau, April 5,1896; New York Medical Journal, May 9, 1896) says that 30 grains may be employed safely by subcuta- neous or submucous injection. Samuel M. Brickner. EUCALYPTUS.—In the British Medical Journal for August 29, 1896, there is an ab- stract from an Italian journal of an article by Dr. Monfrida Musmeci, who, while studying the action of eucalyptus, found that a decoction of the leaves and a solution of a salt of strychnine formed a flocculent precipitate of a clear col- our, while there remained above a solution of citron-yellow tint, the strychnine at the same time losing completely its characteristic bitter taste. On this account the author raised the questions of whether the strychnine lost its toxic action, and if accordingly eucalyptus could be used as an antidote. To ascertain, he carried out a series of experiments on frogs, rabbits, and dogs. He found that a solution of nitrate of strychnine, 1 per cent., when injected with a Pravaz syringe, would kill a frog in from eight to ten minutes after a dose of 0-001 of a gramme, while a dog was killed in thirty-nine minutes by a dose of 0-001 of a gramme for each kilogramme of its weight. When a decoction of eucalyptus was adminis- tered at the same time the animal survived the same dose used for the check experiment, and even became tolerant of a much larger dose. In other experiments the eucalyptus was administered after convulsions had ap- peared, and then these became much less marked and even disappeared. From these experiments Musmeci believes that eucalyptus has a true antidotal action in strychnine poi- soning, and recommends that practical appli- cation should be made of it by using a decoction for washing out the stomach in such cases. EUCASIN.—This is a German nutrient preparation made by subjecting the casein of milk to the action of ammonia. Dr. A. Cohn (Centralblatt fur innere Medicin, July 11, 1896; New York Medical Journal, August 1, 1896) describes it as a white powder of a some- what gritty aspect, without any special taste, and having a faint odour of milk. Mixed with cold water, it forms a gelatinous mass. On shaking it with boiling water, a uniform clear- white solution is formed. This tastes like groats, but is more glutinous. EUDOXINE GEOSOTE 436 He has used it in the form of a mush of oatmeal or rice, to each plateful of which a teaspoonful of eucasin has been added, to- gether with a little salt. This mixture is read- ily taken two or three times a day. A choco- late preparation containing 20 per cent, of eucasin has been put on the market by Hart- wig & Vogel, of Dresden. Dr. Cohn gives brief accounts of several cases in which he has found eucasin of advantage, including cases of pulmonary and laryngeal tuberculous dis- ease, anemia, peritoneal irritation, typhlitis, parametritis, and perimetritis. Particularly striking were the effects of its employment in a case of acute anaemia following abor- tion. Dr. E. Salkowsky (Deutsche medicinische Wochenschrift, April 9, 1896 ; Therapeutische Wochenschrift, April 19, 1896) thinks that one of the advantages of eucasin is that it con- tains no nuclein, so that it is well fitted as an article of diet for persons of the uric-acid di- athesis and predisposed to gout. EUDOXINE.—This is a nosophene com- pound said by Professor Coblentz to contain 52-9 per cent, of iodine and 14-5 per cent, of bismuth. It is described as a reddish-brown powder, odourless and tasteless, employed as a gastric and intestinal antiseptic. From 3 to 6 grains may be given to an adult three times a day (Presse medicate beige, August 11, 1895; Revue illustree de polytechnique medi- cate, October 31, 1895). EUaUININE. — This substance is de- scribed by von Noorden (Gentralblatt fur innere Medicin, November 28, 1896; New York Medical Journal, January 2, 1897) as the ethylcarbonic-acid ester of quinine, having Of1 H the constitutional formula CO OC2oH2sNaO# It occurs in white needles which are soluble with difficulty in water, but readily soluble in alcohol, in ether, and in chloroform. It has an alkaline reaction and forms crystalline salts with acids. The chloride is readily sol- uble in water, the sulphate dissolves with some difficulty, and the tannate is almost in- soluble. The alkaloid itself, which is the form in which von Noorden has used euquinine most largely is entirely tasteless at first, but has a slightly bitter after-taste, reminding one of the taste of a very weak solution of quinine. If it is taken in sherry, milk, soup, cocoa, or the like, he says, no unpleasant taste is perceived. Healthy persons can take 15 grains, and in most instances twice that amount, daily with- out experiencing any unpleasant feeling in the head. Even after a prolonged use of these doses there were no disturbances attributable to them in any of von Noorden's patients. Euquinine is said to be a derivative of qui- nine, of which it has the characteristic reme- dial virtues without any of the unpleasant properties of that drug. This is implied in its name. It may be used in all cases in which quinine is indicated, but for any reason is ob- jectionable. EURYTHROL.—See Splenic extract. EXERCISE.—For the Schott method of treating chronic heart disease, see under Baths (Supplement). FILMOG-EN.—This fanciful name has been applied to an English preparation, apparently proprietary. According to the British Medi- cal Journal for December 19, 1896, it consists of a solution of pyroxylin in acetone, and in order to render flexible the film of nitrated cellulose left after evaporation of the acetone, a small quantity of oil is added. The solution possesses considerable solvent powers upon many drugs employed in dermatological prac- tice, such as salicylic acid, resorcin, iodoform, pyrogallic acid, mercury bichloride, chrysaro- bin, cocaine, ichthyol, and carbolic acid. Its viscosity permits of the easy suspension of such insoluble substances as sulphur, lead ace- tate, zinc oxide, etc. Filmogen, when painted on the skin, quickly forms a film, which ad- heres firmly, is flexible, and is unaffected by washing with water; the film can be removed easily by means of alcohol. FORMALDEHYDE.—Dr. Elmer Grant Horton, of the laboratory of hygiene of the University of Pennsylvania (Medical News, August 8, 1896), has experimented with for- maldehyde as a means of disinfecting books. His conclusions are as follows : 1. Books can be disinfected in a closed space simply by vapour of commercial formalin by using 1 cubic centimetre of formalin to 300 cubic centimetres, or less, of air. 2. The vapour of formalin is rapid in its disinfecting action. The effect produced in the first fifteen min- utes is practically equivalent to that observed after twenty-four hours. 3. An increase in the amount of air to each cubic centimetre of formalin is not counterbalanced by an increase in the length of time of exposure. 4. In case the disinfection has been incomplete, the vital- ity of the organisms has been so weakened that they survive only if transferred in a few hours to media suitable for their development. 5. The use of vapour of formalin has not been found detrimental to the books, and it is not objectionable to the operator beyond caus- ing a temporary irritation of the nose and eyes, somewhat similar to that produced by ammonia. Dr. J. N. Hurty, of Indianapolis (Indiana Medical Journal, December, 1896), speaks of a lamp invented by Professor F. C. Robinson, of Bowdoin College, as probably the best formalde- hyde lamp thus far devised. Dr. W. S. Alexander, of Oxford, Ohio (New York Medical Journal. January 9, 1897), re- ports having cured a rebellious case of pruri- tus vulve with formaldehyde. He says also that cases of whooping-cough are treated suc- cessfully by spraying with an atomizer three times daily for fifteen minutes at a time, using a 1-per-cent. solution. He speaks of formal- dehyde as surpassing all other remedies in the treatment of hay-fever—spraying with a nall-per-cent. solution and directing" the pa- 437 EUDOXINE GEOSOTE tient to inhale the fumes of a 2-per-cent. so- lution. FORMALOSE.—See Formaldehyde. FORMOGELATIN is stated (British Med- ical Journal, December 19, 1886) to be a com- pound of formaldehyde and gelatin. It is a gray, somewhat gritty, mobile, and odourless powder, intended to be used in the dressing of wounds as a substitute for iodoform. It is said to be a convenient preparation of formaldehyde in a dry form. Cf. Glutol. FORMYL CHLORIDE.—See Chloro- form, FORMYL TRIBROMIDE.—See Bromo- form. FORMYL TRIIODIDE.—See Iodoform. FRAXININ.—See under Manna. GADUOL.—See Morrhuol. GALACTOSE.—See under Sugar (vol. ii, page 235). GALACTOTHERAPY.—See under Se- rum treatment (vol. ii, page 187). GARGLES.—In a paper read before the British Laryngological, Rhinological, and Oto- logical Association, Mr. Lennox Browne (Jour- nal of Laryngology, Rhinology, and Otology, March, 1896; New York Medical Journal, March 21, 1896) argued in favour of abolishing gargling in the treatment of diseases of the throat by general practitioners. He said that for the purpose of laving the posterior pillars and wall of the pharynx von Troltsch's method must be used. The following were the direc- tions: "Take a portion—say a tablespoonful —of the gargle in the mouth, hold it in the back of the throat with the head thrown back ; then, closing the nose with the finger and thumb to prevent entrance of air, open the mouth and make the movements of swallow- ing without letting the liquid go down the throat." But this process, says Mr. Browne, is by no means easy to carry out efficiently, and is im- possible when any acute inflammation of the throat is present, on account of the pain caused by the necessary muscular action. The mus- cular acts required for ordinary gargling are entirely irregular, he adds, being unlike those called for in the exercise of the normal func- tions, such as breathing, speaking, swallowing, or even laughing. In all cases, therefore, of acute inflammatory disease of the throat in which the act of swallowing causes severe pain, and even movements of the tongue are attended with discomfort, and in cases (such as those of amygdalitis) in which the mouth can be opened but very slightly, the act of gargling by any method can not but tend to increase the inflammation and the patients distress Gargles are also contra-indicated, says Mr. Browne, in cases where the patient requires to be kept in the recumbent posture in bed- notably in cases of diphtheria, in which cardiac failure has to be especially guarded against— since the act requires him to rise from that position. And as, according to the well-known law, paralytic sequela? attack earliest and to the greatest extent muscles in proportion to the constancy of their use, palatal and faucial paralyses, early and frequent as they always are, can not but be accentuated by the irreg- ular and excessive functional exercise involved in the act of gargling. Lastly, gargles, however employed, whether by the ordinary method or by von Troltsch's, he says, can not be safely prescribed unless the ingredients are harmless should any portion be inadvertently swallowed. All these objec- tions to gargles in the adult apply with still greater force, he adds, in the case of children, in whom the act of gargling is in the majority of cases simply impossible. Gargles, therefore, should be employed only as emollient and antiseptic mouth washes, harmless ingredients being used. As a substitute Mr. Browne would recommend the more general use of mouth ir- rigations, sprays, lozenges, and, in the case of v children, medicated confections. In the discussion that followed, Dr. Dundas Grant said that there was one aspect of the gargling question which he thought would come up, to which we might attach at least a theoretical and also a practical value, which was that, in practising von Troltsch's method, it was not altogether useless as a method of massage, and there was a school in which mas- sage of the throat was given a prominence which he thought was quite unnecessary, but still not to be despised. He stated that he had seen some advantage from the employment of * massage of the outside of the pharynx; pos- sibly, also, the Eustachian tubes might be im- proved by the patient's practising von Troltsch's method "of gargling at the same time. The swallowing part of it was, he said, the most essential feature, and he thought that in sub- acute cases where a degree of congestion and thickening remained we might yet find it of some use, although it might be limited. GELANTH, GELANTHUM.—See under Varnishes. GEOSOTE.—This substance is described by Dr. Rieck, of Bassum (Deutsche Medizinal- Zeitung, December 24,1896 ;New York Medical Journal, January 23, 1897), as the valerianic- acid ester of guaiacol, a yellowish, oily liquid of the specific gravity of 1-037, but slightly soluble in water, but readily soluble in acid and alkaline liquids, in alcohol, in ether, in benzene, and in chloroform. It has a sweetish and smoky odour and a sweetish taste passing into a slight bitter, unaccompanied by burn- ing and not persistent. Applied to the skin and covered with gutta-percha tissue, it is rapidly absorbed and causes no irritation. In- jected subcutaneously in amounts of from to to 30 grains, it causes transitory burning and does not give rise to general symptoms. If the injection is thrown into a diseased part, slight oedema with a sensation of heat may re- sult and persist for a few days. Geosote is given internally in 3-grain gelatin GLUCOSE GUAIACOL 438 capsules. It is said not to disturb the stomach in any way when given in daily amounts of from 15 to "45 grains and used continuously for months, and not to give rise to the eructations occasioned by creosote—that is, Dr. Rieck has known it to cause eructations in only one in- stance, and in that case there was gaseous dis- tention of the stomach to begin with. He says he has given as much as 75 grains a day without giving rise to any unpleasant effects. He has found it useful in chlorosis, acute gas- tric and intestinal catarrh, tuberculosis, and articular rheumatism. GLUCOSE.—See under Sugar (vol. ii, page 235). GLUSIDE.—See Saccharin. GLUTOL.—This is a German proprietary preparation consisting of gelatin impregnated with formaldehyde. As at first prepared, it was a whitish powder insoluble in water; it is now furnished only in the granular, or "grated" form, which Dr. Schleich considers preferable to the powder. It is highly recommended as an antiseptic application to wounds, ulcers, and weeping affections of the skin and mucous membranes. Dr. C. L. Schleich, of Berlin, who introduced it into practice (Therapeutische Monatshefte, February, 1896), says that when it is in contact with living animal tissue the action of the cells of the tissue is to decompose the compound and set formaldehyde free. Glutol has been found to be particularly effi- cacious in sealing up lacerated wounds, even those communicating with a fracture. Prob- ably glutol is substantially the same thing as formogelatin (q. v.). GLYCERIN.—This familiar substance oc- casionally acts as a mild poison, even when used in small amounts. Antichievich (Archiv fur Kinderheilkunde, xx; Fortschritte der Medicin, August 1, 1896) reports an instance of acute nephritis produced by it in the case of a boy who was being treated with injections of a solution of iodoform in glycerin. The nephritis disappeared after three weeks' use of a milk diet. In another ease haemoglobinuria came on after the second injection, and there was polyuria for eight days. Olive oil was sub- stituted for the glycerin, and the injections were then well borne. Glycerin is incompatible with potassium per- manganate. GLYCEROPHOSPHATES.—During the past two years a few articles have appeared in the Paris medical journals with regard to the use of the glycerophosphates of calcium, so- dium, potassium, magnesium, and iron, which were first brought to the notice of the profes- sion by M. Robin, in the Bulletin de VAcademic de medecine de Paris, April 24, 1894, and have since then been recommended by him as of great therapeutic value. Cornet (Progres medical, August 11, 1894) gives a description of the glycerophosphate of calcium and of the method of its preparation which may perhaps be taken as applying to the glycerophosphates in general. It is a white powder, slightly crystalline, soluble in fifteen parts of cold water, almost insoluble in boil- ing w-ater, and insoluble in alcohol. The first step in its preparation is the manufacture of glycerophosphoric acid. A mixture of 3,600 grammes of pure glycerin and 3,000 grammes of phosphoric acid is maintained at a temper- ature of from 100° to 110° C. for six days, and thoroughly shaken three or four times each day. It gradually becomes darker in colour and gives off a vapour until, on the fifth day, it is brown and the vapour ceases to rise. After the sixth day the mixture is allowed to cool. It then becomes clear and transparent, and is known as glycerophosphoric acid. A solution of 500 grammes of calcium carbonate in 2 litres of water is now added very slowly to the acid and causes copious effervescence, from the formation of a large amount of carbon di- oxide. This process is continued for two days, at the end of which time the preparation is filtered, neutralized with a weak solution of milk of lime, and precipitated by means of alcohol. This precipitate is gray in colour and resembles glycerole of starch. It is poured out at the end of an hour, redissolved in water, filtered, and evaporated at a low temperature. Robin states that he has experimented with the salts of glycerophosphoric acid already mentioned, both singly and in combination, since 1888. He was induced to investigate their therapeutic action by the observations that a relatively large quantity of phosphorus in combination with organic substances could be found in the urine of certain patients, a condition which seemed to indicate an increased loss of the lecithin of the nervous system, and that most of the phosphorus in the nervous system was to be found in the form of glycero- phosphoric acid, which is one of the constitu- ents of lecithin. Another consideration which impelled him to the investigation was that drugs which contained phosphorus were as- similated with some difficulty, while an organic compound which resembled in form that pres- ent in the nervous system might be more ac- ceptable and productive of greater benefit. The physiological action of the glycerophos- phates is said by Robin to be to accelerate metabolism and the nitrogenous exchanges, to favour the assimilation of albuminoid sub- stances, and to increase the excretion of nitro- gen, which tends to lower the proportion of uric acid to urea, though it does not influence the formation of uric acid to any extent. They increase the oxidation of broken-up sulphur products and the elimination of sodium chlo- ride. Possibly they favour the assimilation of the phosphates in the food, and so afford a protective influence to the combined phosphor- us in the nervous system. The indication for the use of the glycero- phosphates is a condition of nutrition fre- quently met with in many and diverse diseases, but not always present. This is a diminution of nitrogen metabolism or oxidation changes in the tissues, evidence of which may be found in an increased amount of phosphoric acid as compared with the urea in the urine. When this is absent, and particularly when the oppo- site condition, that of increased oxidation GLUCOSE 439 GUAIACOL changes, is present, the use of these remedies is contra-indicated. Hence one patient with a certain disease may be benefited and another harmed by the administration of these drugs. The best results are said to be obtained in exhaustion of the nervous system, as in con valescence from acute diseases, some forms of neurasthenia, and muscular atrophy. They have been used in nervous asthma from various causes—chlorosis, gout, diabetes, phthisis pul- monalis, obesity, chronic nephritis, Addison's disease, the uric-acid diathesis, phosphaturia, and phosphaturic albuminuria, They are said to be adequate to relieve the pain of lumbago, sciatica, and trigeminal neuralgia, and also the lancinating pains of locomotor ataxia. Laf age is inclined to think them of some efficacy as galactagogues. The glycerophosphates may all be adminis- tered by "the mouth, and the calcium, sodium, and magnesium salts may also be given hypo- dermically. For the latter purpose Robin recommends a 5-per-cent. solution of the cal- cium salt and a 20-per-cent. solution of the sodium salt. Of these, 3 or 4 minims may be injected daily. As the solutions are not of themselves antiseptic, but readily become con- taminated, they should be freshly prepared, and the injections made with antiseptic pre- cautions. Then they usually cause no local disturbance beyond some pain occasionally. For the administration of glycerophosphates by the stomach Robin gives several formulae, of which the following is one: B Glycerophosphate of calcium.. 90 grains; " of sodium, ) " of potassium, >■ each. 30 " '* of magnesium, ) " of iron.............15 " Tincture of St. Ignatius's bean. 30 drops; Pepsin.....................45 grains; Maltine.....................15 " Tincture of kola.............2-J drachms; Syrup of cherries, sufficient to make 8 fl. oz. M. Sig.: A tablespoonful at breakfast and dinner. This syrup should be cherry-red. clear, and without deposit. The principal objections to it are that it is difficult to prepare and that it is very expensive. Moreover, M. Robin does not consider the commercial preparations of the glycerophosphates satisfactory. [The following prescription is recommended by M. Delage (Nouveaux remedes, April 24, 1896), who frequently substitutes it for the syrup: B Glycerophosphate of calcium... 5 grains; « " " magnesium 1-75 grain; " " " iron...... 0-9 " Powdered ignatia............. 0-5 Maltine...................... °'9 " Pepsin...................... 2-9 grains. M. This quantity is for one capsule, and the dose is a capsule taken at breakfast and din- ner. M. Delage considers glycerophosphate of iron the best chalybeate that can be employed in the treatment of chlorosis and in anemia with insufficiency of the oxidation of nitroge- nous food. It is preferable, he says, to give it in the form of pills, as in the following formula: B Glycerophosphate of iron... from 0-9 grain to 1-75 grain; Powdered rhubarb......... 0-9 grain ; Extract of cinchona........ 2-9 grains. M. This is for one pill: three such pills are to be taken during the day. one at each meal.] Matthias Lanckton Foster. GUAIACOCAINE.—Dr. W. J. Morton (Dental Cosmos, January, 1896) has given this name to a compound of 12 parts of guaiacol and 1 part of cocaine hydrochloride, which he has used successfully as a local anesthetic by cataphoresis. GUAIACOL has been praised by Tavitain in the treatment of swelled testicle (Medecine moderne. March 18. 1896). He applies it either pure, in amounts of from 30 to 45 grains, or in the form of an ointment, as follows: B Guaiacol................. 5 parts; Vaseline................. 30 " M. In mild cases, he asserts, three or four applica- tions will suffice. Dr. S. Solis-Cohen (Philadelphia Polyclinic, 1896, No. 16) says that guaiacol, used early in diphtheria, seems to have a germicidal effect and to prevent the spreading of the false mem- brane. Ten parts each of guaiacol and sterilized olive oil are used, with one part of menthol. In examinations of cultures after the applica- tion of this mixture no bacilli are met with where they had been found before. Prophy- lactically the mixture seems to be efficacious. In follicular amygdalitis it seems to cut short the course of the disease if applied early ; and in parenchymatous amygdalitis it is said to mitigate the severity of the disease. Dr. Maldaresco, of Bucharest, has used gua- iacol in pneumonia, apparently with excellent results (cited in Journal despraticiens, March 28, 1896). He paints the drug over the poste- rior surface of the thorax corresponding to the area of pneumonic infiltration. In from six to seven hours the temperature sinks and, if the process is repeated three or four times daily, the temperature remains down. At the same time the cough diminishes, the tongue becomes moist and soft, the expectoration is more easily accomplished,-and the sputum be- comes more fluid. The temperature usually falls from two to three degrees, and some- times not more than two applications are necessary to achieve this result. The author has never seen a relapse and has used no other drugs during this treatment. Maldaresco has obtained equally good results with the same procedure in pulmonary gangrene and broncho- pneumonia. Should repeated applications ir- ritate the skin, they may be made to the sides or to the anterior aspect" of the thorax. The author uses a mixture of guaiacol and almond oil, the latter constituting 4 per cent, of the mixture. By this method of treatment he has had 83 recoveries and 18 deaths out of 101 pa- tients. The contention that guaiacol is an ones- L40 GUAIECETIN HYDROCHLORIC ACID 4 thetic is not a new one. Laurens (Annates des maladies de I'oreille, xxii, 1896) has found that the drug, applied to the nasal and pharyngeal mucous membranes and to the ear in a 5-per- cent, solution in olive oil, produces local anaes- thesia sufficient for the performance of minor operations. He applies it on probes armed with cotton and rubs the nose and pharynx with it briskly. Anaesthesia appears in from fifteen to twenty minutes. In the ear he places 5 or 6 drops of the same solution warmed slightly and allows it to remain about twenty minutes, when it is withdrawn by ab- sorbent cotton. Paracentesis, says Laurens, may then be done painlessly. Dr. J. Petrasko reports an abortion in a woman twenty-nine years of age, three months pregnant, who received f of a grain of pure guaiacol -twice daily in addition to an infusion of senega (cited in 'New York Medical Journal, June 27, 1896). The patient was suffering from an infiltration of the apex of the left lung. On the eighth day, after she had re- ceived in all 12 grains of guaiacol, abortion took place which could not be accounted for in any other way than as having been due to the influence of the drug. The reporter re- marks that phenol and its derivatives exert a paralyzing action on the vaso-motor centres, so that they may cause abortion by inducing de- fective nutrition of the foetus. It is added that the patient was of a nervous nature and may have had an idiosyncrasy for guaiacol. [Dr. E. K. Morris, of Sturgeon Bay, Wiscon- sin (Medical News, January 9, 1897), reports having used guaiacol for rhus poisoning in two cases. The first patient was a man, forty-five years old, suffering from an aggravated form of the poisoning, the face being swollen to such an extent as to wholly obliterate the fea- tures, and the eyes being entirely closed. Dr. Morris made an application of zinc-oxide oint- ment, and ordered applications of a solution of 2 drachms of carbonate of sodium in 3 oz. of water, on absorbent cotton. The result was negative. On the third day after the onset he made an application of pure guaiacol, freely painting it over the inflamed area with a cam- el's-hair brush, and then covering the parts. On the next day there was marked ameliora- tion of the trouble, and on the fourth day after beginning the guaiacol treatment the poisoning and its resulting inflammation had entirely disappeared. The other patient was a boy of eleven years with the same trouble, one side of the face and neck being affected to about the same extent as in the previous case. Dr. Morris used gua- iacol, and on the second day the boy was out and at school, the trouble having entirely abated. Guaiacol cinnamate.—See. Styracol.] Guaiacol phosphate, PO(CaH40CH30)3, occurs in hard, colourless tablets, melting at 98° C. It is insoluble in water, in alcohol, and in ether, but is easily soluble in acetone and in chloroform. The dose has not been determined. Guaiacol succinate is an ester of guaiacol. Its formula is C^O^CJLOCH^. Its crys- tals are silky needles. It is insoluble in water, slightly soluble in ether and in alcohol, and freely so in chloroform. Samuel M. Brickner. GUAIECETIN. — According to Dr. J. Strauss (Centralblatt fur innere Medicin, June 20, 1896; New York Medical Journal, July 11, 1896), who has experimented with this sub- stance, which is a pyrocatechin-monacetic acid, C6H4<^H2COOH, obtained by introducing the carboxyl group into guaiacol, it is a taste- less powder. He gave it in doses of 7 grains, several times a day. On the whole, he thinks that it is not quite so apt to produce unpleas- ant effects as either creosote or guaiacol car- bonate. GYMNASTICS.—For the Schott method of treating chronic heart diseases, see under Baths (Supplement). GYMNEMA.—The leaves of Gymnema silvestre, an East Indian asclepiadaceous shrub, when chewed, have the effect of temporarily destroying the sense of taste for sweet and bitter substances. Their active principle, gym- nemic acid, C3H650i2, has the same property, and a 12-per-cent. solution of the acid in water containing enough alcohol to dissolve it has been employed as a mouth-wash to dissipate the taste of bitter medicines (Coblentz, op. cit.). HEAT.—The local application of dry hot air in the treatment of rheumatism has lately been attended with most gratifying results. It is essential that the hot air should be as dry as possible; otherwise, it will cause pain. Special appliances have been devised for dry- ing and heating the air, and for restricting its contact with the body. At a recent meeting of the Harveian Society of London (British Medical Journal, November 21, 1896; New York Medical Journal, December 12,1896) Dr. Knowsley Sibley presented a woman, twenty-six years old, who had been a complete cripple from rheumatism for nearly three years. Her mother and her mother's grandfather had suffered from the same complaint. The patient had had very fair health up to three years before. She had never been laid up with fever and there was no cardiac lesion. She had been for many months under treatment at Bath, but without getting any better. She was sent up to Lon- don for treatment on September 30, 1896. On her admission, the following note was made: " The patient has used a pair of crutches for two years, and can just manage to get about on the level with the aid of these ; she can not get up or down stairs, wash or dress herself, or do her hair. She feeds herself with great dif- ficulty, and only with a large spoon and fork, as she can not get either hand within several inches of her mouth. She can not rotate the elbows, which are nearly fixed at right angles. There is considerable thickening of the middle fingers of both hands, and grating and limita- tion of movements at the shoulder joints The right knee is ankylosed nearly at a right GUAIECETIN 441 HYDROCHLORIC ACID angle; there is absolutely no movement of any kind to be elicited; the thigh and especially the calf muscles of this leg are much wasted ; the patient can just touch the ground with the tip of the toes, but is unable to put any weight on the limb, and in fact can not raise it off the bed when lying on her back; there is con- stant pain of this joint; she wears a gutta-per- cha splint round it as a protection." The localized hot-air treatment, continues Dr. Sibley, was begun on October 1st. After the second application it was possible to rotate the left elbow, and after the third the patient was able to see the palms of both hands, which she had not done for two years. After the sixth bath she was able to do her front hair, and after the tenth she was able to walk a few steps without her crutches, and there was dis- tinctly some movement to be obtained in the knee joint. She had now had twenty-seven baths, and could get her left hand all over her face, head, and neck, and get up and down stairs with ease. There was also a fair amount of movement in the right knee joint; the pa- tient could flex and extend it some few inches. All these results had been obtained without at any time putting her under an anaesthetic and breaking down the adhesions, as was origi- nally suggested; and at no time had she any pain or effusion in any of the joints under treatment. Before and after each application of the dry air, which was heated to a tempera- ture of 260° F., the limbs were gently manipu- lated and massaged. She had been taking some syrup of iodide of iron, and the bowels were regulated with Condal water. Dr. Virgil P. Gibney (Medical Record, Jan- uary 23, 1897) reports seven cases of stiff and painful joints, including the rheumatic, the tuberculous, and the traumatic, also a case of apparent deformity due to chronic sciatica, in which he has applied this treatment in the Hospital for the Ruptured and Crippled. In all these cases more or less relief from pain and stiffness was afforded, and in several of them it was very decided. HELIOTROPIN.—See Piperonal. HOMOGUAIACOL.—See Creosol. HONEY.—Dr. E. Lorede Chalke, a civil surgeon of Negapatam (Indian Medical Rec- ord, May, 1896 ; New York Medical Journal, June 13, 1896), says that he has had hundreds of cases of scorpion stings to deal with and has tried various remedies to relieve the sting- ing pain and burning sensation which invari- ably are the chief symptoms for which relief is sought, and he finds that the application of honey to the affected part acts the best, pro- ducing almost instant relief. The stinging and burning sensations vary in degree accord- in"- to the species of the scorpion which causes the sting. He has seen the small, pale, red- dish-brown scorpions in the ceded districts evoke unbearable pain in the part stung, while the black, huge ones so common in the Kur- nool district (about six inches in length, with hair on the back and claws like those of crabs) cause great agony to the victim, making him simply writhe under the pain. He recalls the case of a delicate middle-aged woman, who was suffering from heart disease, and was stung by one of the black kind, a huge monster with formidable claws and a big sting. The woman was carried to his bunga- low in great agony, cold and clammy, and begged of him to relieve her of the intense pain which, she said, she could bear no longer. There was a large gathering in his place at the time, including two physicians. He im- mediately brought the honey, which he applied gently but freely over the affected part. The relief was almost instantaneous, to the aston- ishment of the patient and the spectators, par- ticularly the physicians. At the same time he gave her 10 minims of chlorodyne with brandy, which roused her spirits within a short time. He applied the honey again after an interval of five minutes, when the patient expressed herself nearly rid of the pain and comfortable. This, he says, was one of several cases he has treated with honey, and he has always found it a very reliable and prompt medica- ment. If honey is not procurable at the time, a strong solution of sugar in water will be found a very effective substitute. He has also tried over-ripe plantains squeezed and applied as a poultice over the affected part, which acts speedily in subduing the pain and burning sensation. HYDRIATICS.—For the Schott method of treating chronic heart diseases, see under Baths (Supplement). HYDROCHLORIC ACID—At a meet- ing of the American Orthopaedic Association held in May, 1896 (New York Medical Journal, August 8, 1896), Dr. Jerome Hilton Waterman reported eight cases of necrosis of bone of tu- berculous origin which he had treated by the use of hydrochloric acid at the Hospital for the Ruptured and Crippled, New York, cases some of which had not done well under the usual methods of treatment. In some of these the most radical operative means had been em- ployed, the bone being thoroughly curetted and all the necrosed tissue supposed to have been removed. Sinuses subsequently formed, and an examination under anaesthesia revealed the fact that necrotic bone was still present. In the other cases of the series, irrigation with solutions of bichloride of mercury, ap- plications of hydrogen peroxide, packing with various kinds of gauze, and the injection of creosote and protonuclein into the sinuses had been employed for many months without favourable results, either in decreasing the amount of discharge or in allaying the pro- gressive character of the pathological condi- tion. Confronted with these unsatisfactory results, Dr. Waterman resolved to try the ap- plication of hydrochloric acid. The theory was that the action of the acid on healthy bone was limited to the decomposition of the mineral constituents, consisting principally of phosphates and carbonates of calcium, together with small quantities of the alkaline salts, not affecting the animal matter, and that in ne- crosed bone there were only these mineral salts remaining, to which the chemical action of HYGIAMA ICHTHYOL 442 the acid was more particularly confined, dis- solving it without exerting any destructive influence on the underlying tissue. In this fact, says Dr. Waterman, lies one of the real merits of the treatment, for, the diseased tissue being removed, the process of repair can go on unobstructed. The acid was used in the concentrated form, whereas before for the most part dilute so- lutions and solutions in combination with various substances had been used by other sur- geons. The number of minims injected in each individual case depended on the amount of bone which was diseased and on the general condition of the patient. It is preferable, says Dr. Waterman, not to use the acid more than twice a week, owing to the reaction and pain which might result. However, in his cases but little pain was experienced, and this he attributes in part to the fact that the patients were accustomed to more or less manipulation, having been dressed daily for several months, and also to the anaesthetic effect of the acid. In case it should produce undue discomfort, he says, it is advisable to spray the tissues with a 4-per-cent. solution of cocaine or cocaine and morphine a few minutes before injecting the acid, or else employ the chloride-of-ethyl spray. He washed out the sinus thoroughly with sterilized water in order to remove any pus or detritus, and thus permit the acid to penetrate all of the diseased bony tissue. An ordinary sterilized glass pipette was found convenient for the application of the acid. The tube was introduced to the bottom of the sinus and the contents were deposited directly upon the necrosed structure. After this he usually allowed a minute to elapse, then irrigated the sinus with a saturated solu- tion of bicarbonate of sodium, and then ap- plied a wet myrrh dressing. His object in using the latter in preference to dry dressings, he says, was because of the marked foetor no- ticed in many instances after the first two or three injections, which is accounted for by the destruction of soft tissues; consequently it is more pronounced when the patient moves dur- ing the application, so that it is not made directly to the bone, but partly on the sur- rounding tissues. In certain cases of the series it was neces- sary to enlarge the opening during the course of treatment, particularly when the granula- tions were so exuberant as to protrude into the lumen of the sinus, but in the majority of in- stances they could be removed by the intro- duction of a probe. Of Dr. Waterman's eight cases he reports four apparent cures. He suggests the possi- bility that in two of the others either the necrosed area was larger than the probe indi- cated, so that not sufficient acid had as yet been applied to effect the solution, or another area of necrosis existed at some distant point not indicated by the probe. Should these con- ditions be present, he says, operative methods are necessary. For the use of dilute hydrochloric acid in conjunction with pyrozone in suppurative oti- tis media, see under Pyrozone (Supplement). HYGIAMA.—This is the name of a pro- prietary food made of condensed milk with the addition of certain cereals specially prepared and of cocoa deprived of its fat. It contains 20-4 per cent, of albuminous matter, 10 per cent, of fat, and 63-4 per cent, of carbohy- drates. According to von Noorden, it is par- ticularly useful in diseases of the stomach and intestines, in pulmonary consumption, in the debility of convalescence, in typhoid fever, and in weakly children. (Berliner klinische Woch- enschrift, 1896, No. 20; Deutsche Medizinal- Zeitung, May 21, 1896.) HYOSCY AMINE.—Dr. Chalmer Pren- tice, of Chicago (New York Medical Journal, January 2, 1897), calls attention to the action of hyoscyamine in paralysis agitans, and re- ports three cases. The'first was that of a clergyman, sixty-five years old, first seen by Dr. Prentice in January, 1891. Shaking of the head and right upper and lower extremi- ties had continued for a period of four years, gradually increasing in severity. Dr. Prentice used a solution of hydrobromide of hyoscya- mine, 2 grains to the ounce of water. This was dropped into each eye. In twenty min- utes the shaking of the upper and lower ex- tremities and head had entirely ceased. At the end of three quarters of an hour there was such a general relaxation that the patient was unable to rise from the chair. The intelli- gence did not seem to be disturbed, but the organs of speech were very much interfered with, so that it was difficult for the patient to talk. Dr. Prentice says that he anxiously watched the patient, sitting and talking with him for a period of two hours, at the end of which time he was able to get up from his chair and walk again. At the end of three hours there was no impediment to the speech and the shaking had not returned. At the end of about six hours the patient said the symptoms had gradually begun to present themselves again. On the following day the strength of the solution was reduced to 1 grain to the ounce. This did not interfere with the locomotion or the power of speech, but again put the shaking in abeyance. Dr. Prentice followed this case up for a month, during which time the paralysis agitans was kept un- der almost complete control by instilling a drop into each eye morning and evening, a so- lution of the strength of a grain to the ounce being used. The second case, that of a farmer, sixty years old, was seen in 1892. He had suffered with paralysis agitans for twenty years. No lesions were present to which any reflex action could be attributed. In this case Dr. Pren- tice started with hyoscyamine, a grain to the ounce. In thirty minutes the shaking had al- most entirely ceased, and the patient remained quiet during the day. A return of the symp- toms came on the following morning, but they were not so severe as usual. Dr. Prentice re- duced the strength of the solution to half a grain to the ounce, and advised its use three times daily. By following this treatment this case was kept entirely under control for a pe- 443 HYGIAMA ICHTHYOL riod of about two months, at which time Dr. Prentice lost sight of the patient. The third patient was an unmarried lady, aged forty-five years, first seen in May, 1893. In this case there were some strong evidences of tabes dorsalis with slight curvature in the dorsal region of the spine. The shaking was general and most torturing. A solution of hyoscyamine hydrobromide, a grain to the ounce, reduced the shaking to a minimum, and gave almost perfect relief. In this case, says Dr. Prentice, hyoscyamine seems to have been the only remedy that has ever affected the pa- tient, and for a period of three years she has depended upon it. There has been nonneces- sity to increase the dose, and during all this time there has been no period in which she could stop using the hyoscyamine without a return of the violent shaking. Dr, Prentice says he hardly believes the ef- fect can be due to the action of the drug after it has been absorbed into the circulation, for the amount so taken in from one small drop in each eye, accounting for the amount washed away by lacrymation, he remarks, would not be over ^fa of a grain, whereas the administra- tion of fan of a grain by the mouth will not produce any like effect. He suggests that per- haps the reason for the marked effect of such a small amount of hyoscyamine in the eye is the fact that the site of its application is in close proximity to the cause of some reflex dis- turbance through the visual and other allied centres. ICHTHYOL.—Guintsburg (Medecine mo- derne, May 13, 1896; Therapeutic Gazette, September, 1896) strongly recommends the use of ichthyol in intestinal disorders, particu- larly those which accompany affections of the . genito-urinary tract in women. The dose is 4 or 5 grains a day, preferably in keratin-coated pills, which are believed to pass through the stomach undissolved ; thus a disagreeable taste and eructations are avoided. The medicine is best given some little time after meals. Good results were obtained in cases of diarrhea : the appetite improved, the abdominal pains were much decreased, and the patient gained in weight; at the same time, if there was a tendency to menorrhagia, the menstrual func- tion became more nearly normal. The best results were in cases of rebellious constipation. He failed to meet with any disagreeable symp- toms such as are recorded by Bouchonieff, who found that in persons suffering from renal disease or from chlorosis ichthyol was apt to produce loss of appetite, nausea, and vomiting. He attributes these disagreeable results to too large doses. Dr. Le Tanneur (Journal de medecine de Paris, August 9, 1896; Journal of the Ameri- can Medical Association, September 12, 1896) has experimented with ichthyol to determine its antiseptic power and its effects in pulmo- nary tuberculosis. He states that absolute sterility is secured with a 5-per-cent, solution, although the shape of the Koch bacillus is al- 72 tered and its development much retarded with a 2-per-cent. solution and even a weaker one. He administered it to his patients in capsules (Chiron's) which contained 4 grains each, giv- ing from four to twenty-four a day. No effect followed the administration of six or eight capsules. M. Le Tanneur began with two cap- sules and increased the number to twenty a day, taken three times a day, during the meals. None of the fifty patients treated suffered any inconvenience from its use, and several patients with diarrhea and gastric disturbances were cured of those complications by it. The cough was much improved owing to the liquefaction of the sputa produced by the ichthyol, which also cured the congestion of the bronchial tubes. The colour of the expectoration changed from green to yellow, then to gray, and finally to the ordinary colour of mucous secretions. The dyspnoea was relieved at once by the lique- faction of the sputa and the decreased con- gestion, which rested the heart and raised the general tone of the system. Pain in the inter- costal regions was also much relieved, probably for the same reason. The general health did not show improvement so soon as with hypo- dermic injections of guaiacol, but it arrived and progressed none the less surely, and the patients gained flesh much more than with guaiacol. Several gained from seven to eight pounds in the first month, others gained four pounds, and two thirds of the patients showed a marked increase in weight. The sweats also diminished, but apparently only as the general health improved, as this effect was not noticed so promptly as with creosote or guaiacol. The appetite was not unfavourably affected as is frequently the case when guaiacol is used, but it was improved and restored to normal in many cases. Le Tanneur concludes that, while ichthyol is by no means the long-sought specific for consumption, yet great benefit is derived from its use as a substitute for creosote and guaiacol, when, as often happens, the system has become so habituated to them that they fail to affect it. It is especially indicated in bronchial tuberculosis, which it most promptly relieves. Its disagreeable odour renders the use of the capsule imperative. Dr. William J. Robinson (New York Med- ical Journal, November 14, 1896) reports a re- markable case of lymphangeio - phlebitis in which ichthyol proved speedily efficacious. The patient was a thin, badly nourished man, fifty-three years old. The disease affected the left lower limb, which was swollen to about double its normal size, of an erysipelatous red, and exquisitely painful. The long saphenous vein was felt as a hard, rigid cord, exceedingly sensitive to the touch. There was an ulcer on the leg, described as small, superficial, and altogether insignificant. The man had two inguinal hernias, which descended through the canals at the least strain. On the back, at the point of pressure of the truss, there was slight ulceration. He had intense headache, absolute loss of appetite, constipation, chills, and occa- sionally syncope. His temperature was 101-8°, and his pulse 120, small and compressible. Dr. Robinson prescribed phenacetine and salol, also IODOFORM MENTHOL 444 a mixture of cardiac stimulants, and ordered for the leg continuous hot fomentations of a 3- per-cent. solution of carbolic acid with lead- and-opium wash. The fomentations relieved the pain, but the inflammation did not abate. Dr. Robinson then used creolin, a l-to-1,000 solution of corrosive sublimate, and carbolic and salicylic-acid ointments in succession, but without being able to check the continuous, uninterrupted upward progress of the disease. Not only the entire limb was intensely in- flamed and cedematous, but the left side, to about the level of the umbilicus, was in the same condition. The scrotum and penis at- tained enormous proportions. The man was unable to move, and his sufferings were ex- treme. In about a month Dr. Robinson was hastily summoned early in the morning and found his condition such as to give rise to the gravest apprehension. The pulse was thread- like, 140 a minute; the temperature was 104°; the first heart sound was almost inaudible. He administered a hypodermic injection of digitalis, strychnine, and nitroglycerin, and ordered a 25-per-cent. solution of ichthyol in glycerin. He enveloped the inflamed parts in lint soaked in that solution, and covered it with cotton and oiled silk. At this time he entertained little hopeu)f the patient's recovery, but in the afternoon of that day the picture had completely changed. The temperature was 100°, the pulse was 96, and the redness and oedema had diminished to a remarkable degree. The applications were repeated three times a day. On the next day the swelling had completely disappeared from the leg and genitals; on the back it persisted for two days longer. His convalescence from that day on was uninterrupted. In a week every trace of inflammation had disappeared, but he felt very weak. The man afterward had an attack of phlebitis in the right leg. The symptoms were practically the same as in the first at- tack, though not quite so severe. The treat- ment was repeated, but in addition Dr. Robinson ordered very large doses of ichthyol internally—a pill of 4£ grains every hour through the day and two or three times dur- ing the night. The result was highly satis- factory ; in three days the man was quite well. Hard nodules were still to be felt in the course of the veins at the time of the report, but were disappearing rapidly under the internal and ex- ternal use of ichthyol. For external use Dr. Rob- inson prescribed ammonium sulphichthyolate, and for internal use sodium sulphichthyolate, ' Dr. W. Ottinger, of Exbriicke (Minchener medicinische Wochenschrift, December 8,1896; Wiener medizinische Blatter, December 17, 1896), has found ichthyol an admirable rem- edy in numerous cases of the stings of flies, gnats, bees, and wasps, and has found that it quickly and surely causes the phenomena of inflammation to subside. He attributes its effect to its vaso-constrictor action. It is best to apply it pure in a pretty thick layer, but it may be used in the form of an ointment. IODOFORM.—The iodoform treatment of suppurating buboes has of late come into ex- tensive use. It is described by Dr. William K. Otis (Journal of Cutaneous and Genito- urinary Diseases, May, 1893) as follows: The skin for some eight or ten inches about the affected area is rendered thoroughly asep- tic by scrubbing with green soap and washed with sulphuric ether and then with bichloride- of-mercury solution (1 to 1,000). A narrow bistoury is then inserted into the abscess cav- ity, the contents are gently but thoroughly squeezed out, and the cavity is irrigated with bichloride-of-mercury solution (1 to 1,000) and immediately filled to moderate distention with warm iodoform ointment (10 per cent, iodo- form and 90 per cent, vaseline), care being taken not to use a sufficient degree of heat to liberate iodine. The syringe used for intro- ducing the ointment is the ordinary cone- pointed glass syringe. The plunger being removed, the barrel is warmed in the flame of an alcohol lamp and filled with ointment by means of a spatula. On finishing the injec- tion, at the instant of withdrawing the syringe from the wound, a compress wet with cold bi- chloride-of-mercury solution is applied, which instantly solidifies the ointment at the orifice and prevents the escape of that in the abscess cavity. A large compress of sterilized gauze is then applied by means of a firm spica. The patient is told to return in four days, when, if all is well, the dressing is reapplied, but if any evidence of inflammatory action is found the wound is thoroughly irrigated and cleansed and the injection repeated. Out of sixteen cases, Dr. Otis reports nine cured in six days, three in twelve days, one in fourteen days, and one in twenty-three days. He alleges the fol- lowing advantages for this method: 1. It is simple and safe. 2. In suitable cases the cure, as a rule, seems more rapid than by any other method. 3. The patient is not prevented from going about during treatment. 4. The first gland being rendered thoroughly aseptic makes it less likely that other glands in the chain will become infected. 5. It leaves no telltale scar. 6. It in no way interferes with any sub- sequent surgical procedure, should such be deemed advisable. Dr. Otis says that his ex- perience has demonstrated that this method is available only in those cases of infection by the staphylococcus in which there is an appre- ciable pus cavity, and thus a storage place for ointment until absorption can take place. In diffuse phlegmons, in which no pus cavitv ex- ists, the method has not been found applicable. Dr. Otis gives the warning that there is a probability of failure unless two cardinal points are observed: 1st, absolute cleansing of the cavity of all traces of pus; and 2d, the injec- tion of ointment into it in quantity barely sufficient to produce moderate distention. iaaTB,0L'~See Silver citrate (vol. ii, page too)* JERVINE.—See under Veratrum viride. KAOLIN.—See Fuller's earth, under Earths (vol. i, page 353). IODOFORM 445 MENTHOL KRUMMHOLZ OIL.—See under Pine preparations (vol. ii, page 88). LACTOSE.—See Sugar of milk. LARD.—Dr. George Boody, of the Iowa State Hospital (American Journal of Insanity, July, 1896), reports the results of experiments made by himself with leaf-lard inunctions in cases of malnutrition with emaciation. The time over which they extended, he says, was very short and the number of cases few, but they were carefully carried out and the im- provement in each case was noted. Four cases were selected, of each of which a brief account is given, with the following conclu- sions : 1. The integument plays an important role as an organ through which food may be taken, carried to the circulation, and assimi- lated, nutrition improved, and wasted tissue repaired. 2. Inunction with lard is indicated in every case of extreme emaciation with malnu- trition in which diet and tonic treatment with massage fail to produce the expected results. 3. It is the author's belief that if the condi- tions were such that food could not be taken through the stomach, nutrition could be im- proved and the patient made to gain in weight by inunctions of leaf lard, olive oil, or other fats, twice or three times a day. LEVULOSE, or fruit sugar (see vol. ii, page 235), has been employed, under the name of diabetin, as a sweetening agent for persons affected with diabetes. MAGNESIA.—Vergely (Revue medicate, B'ebruary 16, 1896 ; New York Medical Jour- nal, March 14, 1896) reports favourable results from the use of calcined magnesia in the treat- ment of burns of moderate severity. The af- fected parts are covered with a thick layer of a paste which is prepared by mixing the calcined magnesia with a certain quantity of water. This paste is allowed to dry on the skin, and when it becomes detached and falls off it is re- placed by a fresh application. Very soon after the paste is applied the pain ceases, and under the protective covering formed by the magne- sia the parts recover without the cutaneous pigmentation which is often observed to follow burns that have been allowed to remain exposed to the air. MARROW.—Dr. William 0. Mann, of the Fergus Falls State Hospital, in Minnesota (American Journal of Insanity, January, 1897), gives his experience in the use of bone marrow among the insane, extending over a period of four months. Two preparations of bone mar- row were used: One which was made at the hospital by finely chopping ribs of sheep and adding glycerin in the proportion of a pound to twelve ribs. This was allowed to macerate four davs. It was then strained through gauze and was ready for use. The other preparation was that manufactured by Armour & Co. Twenty-two male patients were selected, eleven of whom took one form of the extract, and the other eleven the other form. Those patients were chosen whose general appear- ance was anaemic. Extract of bone marrow was given for a month, a drachm three times a day, at the end of which time the percentage of haemoglobin and the number of corpuscles were again ascertained, the same time of day being taken as at first. During this time no medicine was administered and the regular diet was given. Fifteen of the twenty-two cases were regarded as chronic, and the seven remaining were acute cases in which improve- ment had been slow and had reached a stand- still. Dr. Mann gives tables showing that in some cases the number of red corpuscles was nor- mal, while the leucocytes were increased and the percentage of haemoglobin was diminished; also that the ratio of the percentage of haemo- globin to the number of red blood-cells was irregular. The average increase in red cor- puscles was 1.361,489, and those that took the extract made at the hospital gained more than the others. The proportion of haemoglobin in- creased on an average of 12-5 per cent. The leucocytes, which in nearly all had been abnor- mal at first, decreased in number at the end of the month. The general appearance in the majority of the cases had improved. The ap- petite was better and the action of the bowels more regular. In only one case was there a tendency to diarrhoea. In the twenty-two cases there was an aggregate gain of forty-seven pounds, and on discontinuing the use of the marrow those that had lost immediately began to gain, and three months later weighed more than they ever had during their residence in the hos- pital. One man especially, that had weighed for months from ninety-six to ninety-nine pounds, now weighed a hundred and twenty- eight. Dr. Mann's experiments seem to have been chiefly directed toward ascertaining the ac- tion of marrow on anemia rather than on in- sanity, but he says that, mentally, one patient began to improve at once and soon went home recovered. Three were regarded as much im- proved, and four others were brighter and had lost a great deal of the apathy they had for- merly had. In the fourteen others the only improvement noticed was in their physical condition. Dr. Mann concludes that the use of bone marrow in anaemia results in an in- crease in the red corpuscles of the blood, and in cases of insanity associated with anaemia improvement in the mental condition may be expected in at least a third of the cases. MEDULLADEN.—This is the fanciful name of an extract of bone marrow. See Mar- row. MEDULLARY GLYCERIDE.—See un- der Marrow (vol. ii, page 599). MENTHOL.—Dr. Sidney A. Bontor (West London Medical Journal, July, 1896; New York Medical Journal, August 1,1896) has used men- thol spray in forty casesof whooping-cough, most MERCURY NAPHTHALAN 446 of them selected, he says, on account of their severity, and the result has been most satisfac- tory; in thirty-nine of them the benefit was . decided, and in only one did the spray seem to have no effect: this was a case complicated by acute bronchitis. One patient died, a weakly infant of only seven weeks, the immediate cause of death being convulsions in the third week of illness; in two the spray was not persevered with, although the paroxysms were relieved by it. because, as the attacks were not very severe, the parents thought the little smarting of the eyes an unnecessary infliction. About 20 grains of menthol were dissolved in an ounce of liquid vaseline in an ordinary nasal spray-producer; as soon as the paroxysm began, or preferably as soon as the patient felt that one was impending, a fine cloud of spray was diffused in front of the face, the spray- producer being held about two feet away; by this means the air in front of the nose and mouth was saturated with the oily particles, and at each inspiration they were drawn into the air passages; this was quite painless, but occasionally a slight spasm of the glottis oc- curred. The effect of this inhalation is quickly seen, says Dr. Bontor, for the mucus is rap- idly expectorated and the paroxysm is soon over, so that convulsions are less frequent and vomiting is rare, with the result that the pa- tient loses his dread of taking food and eats with a better appetite, his general condition be- ing thus kept at a much higher level. Among the forty cases there were none of prolonged debility, none followed by gastro-intestinal ca- tarrh, and none at the time of the report with tuberculosis. The author does not, however, maintain that this result is wholly attributable to the form of treatment, because, he says, he practises in a healthy country district where the tubercle bacillus does not flourish and where the death-rate is naturally low, but he adds that the results among patients in the same district treated by other methods have not been so satisfactory. MERCURY. — Rabinschek's method of treating whooping-cough with mercury bichlo- ride is described in the Bulletin medical de Paris for September 13, 1896 (Lyon medical, October 11,1896), as consisting in the intro- duction into the back of the mouth of a small tampon of cotton saturated with a 1-to- 1,000 solution of corrosive sublimate, and press- ing it against the lower part of the tongue in such a way that the liquid will bathe the epiglottis and the neighbouring mucous mem- brane. The method has been applied in sev- enty-one cases by Dr. Rocco Gentile ; thirty-five patients were cured after from three to twelve applications, thirteen were considerably im- proved, and the others interrupted the treat- ment or had complications which did not depend upon the whooping-cough. One of the greatest benefits to be derived from this treat- ment is said to be the rapid cessation of the vomiting which contributes so much to weaken the patients. Gentile has never employed more than one application a day. In a very small number of cases he has observed temporary disturbances, such as haemorrhages of the con- junctiva and of the ear, buccal ulcerations, and slight fever; but he says these complications are not serious. Surgeon-Major Harold Hendley, of the British Indian Medical Service (British Medi- cal Journal, January 16, 1897). refers to Celli's successful treatment of tetanus with subcutane- ous injections of corrosive sublimate (mentioned in the Medical Annual for 1896), and reports a case of his own. A Hindu boy, aged nine, son of a hillman in the Kangra District, Punjab, was first seen on August 10, 1896, when it was stated by the father that he had been suf- fering for two days from stiffness of the neck and difficulty in mastication, associated with a considerable amount of pain. On examination, marked rigidity of the muscles connected with the lower jaw, the neck, and the right arm and thigh was discovered, and any movement of these parts was attended with very considerable pain. The temperature was 101-2° F., the pulse was 96, the bowels were constipated. On the 11th his temperature was 99*8° F., the bowels had been moved once; his condition was about the same. On the 12th a very considerable amount of pain was complained of over the front of the chest, more especially over the cardiac area, and a slight systolic bruit was audible at the apex. A belladonna plaster applied over the area of greatest pain resulted in some re- lief. On the 13th slight spasms became evi- dent over the whole body at intervals of from fifteen to twenty minutes. Two grains of chloral hydrate were given thrice daily. A fair amount of sleep was obtained. On the 16th risus sardonicus and opisthotonos were well marked ; the parox}sms became very fre- quent, occurring at times every two or three minutes, and any movement of the patient in- creased their frequency. The bowels were again constipated, the temperature was 100-2°, F., and the pulse was 100, small and weak. Pain was very considerable; next to no sleep was obtained, and, in spite of the considerable amount of fluid nourishment taken in the shape of milk and soup, the patient had be- come considerably emaciated. Two grains of chloral hydrate were now given every hour, and the dose of calomel, 4 grains, which had been given on his admission, was repeated. From the 17th to the 26th, by pushing the chloral hydrate and so producing sleep, some control over the paroxysms was obtained. On the latter date, however, the patient became much worse; the paroxysms increased in se- verity and frequency, and a fatal ending seemed not far off. As the chloral hydrate appeared to have no longer any effect upon the course of the disease, it was determined to have recourse to Celli's treatment. The use of chloral hydrate was continued, and subcutane- ous injections into the buttocks of corrosive sublimate in doses of about 0-09 of a grain were given twice daily, beginning on August 27th. After the first two injections the spasms decreased decidedly in frequency and severity On September 2d—that is, after eleven in- jections—the paroxysms had entirely ceased, and from this date, when the injections were MERCURY 447 NAPHTHALAN stopped, recovery was sure, and, considering the previous state of the patient, fairly rapid. Small doses of chloral hydrate were continued up to September 8th. It is noticeable, remarks Surgeon - Major Hendley, that, as in Celli's case, very marked amelioration in the patient's condition occurred after the^second injection. After a very care- ful inquiry, no cause for the occurrence of the disease could be discovered. The early symp- toms seemed to point to conditions which might admit of the case being classified as one of rheumatic tetanus. METADIHYDROXYBENZENE.— See Resorcin. MILK.— Lachmann's so-called "vegetable milk," says a writer in Medecine moderne for September 9, 1896 (Lyon medical, October 4, 1896), when made with almonds and sugar, does not contain any starchy substances and has a sufficiently large quantity of emulsified fat. Its composition is as follows : Fat.................... 24-60 per cent.; Vegetable casein........ 7-50 " Cane sugar............. 41-80 " Vegetable dextrin....... 1-30 " Lime, potassium, etc.... 0'68 " Water................. 24-12 " This vegetable milk may be used to dilute cow's milk which is too rich in albuminoids. For this purpose it is superior to water, as it does not precipitate the casein in large flakes, but in small and soft ones. Furthermore, the addition of vegetable milk to cow's milk in- creases the fatty substance of the latter and ac- celerates its digestion. MORINGA.—The Moringa Pterygosperma, the Oriental horse-radish tree, or drumstick tree, has been used in medicine. Mr. L. B. Dhar- galkar, of Bombay (Indian Lancet, September 1, 1896; New York Medical Journal, October 19, 1896), has used the root-bark in the treat- ment of jaundice. He says the root, the gum, the leaves, the flowers, and the fruit are all useful in medicine. The root has a strong, pungent odour and is said to have the flavour of horse-radish. When distilled with water, it yields an essential oil which is very pungent to the taste. The bark is rubefacient and is used externally by the poorer classes as a coun- ter-irritant in chronic rheumatism. Some authors state, says Mr. Dhargalkar, that it is supposed to act as an emmenagogue and is used to produce abortion. The stimulant and pun- gent properties of the root-bark have been de- scribed by other observers, but Mr. Dhargalkar thinks that no one has as yet mentioned its usefulness in the treatment of jaundice. He himself accidentally found that, if adminis- tered in proper doses, it was useful in that dis- ease, and he has made several experiments with it. He relates the histories of eight cases in which he obtained satisfactory results with the tincture of moringa, the action of which was very rapid. In regard to the toxic effects of the drug, he states that he has had no opportunity to ob- serve them, as it did not produce any un- favourable symptoms in any of the patients treated by him. In order to try its effects on the healthy system, he took on an empty stom- ach a drachm of the tincture in an ounce of water. It tasted, he says, something like an infusion of bitter almonds and produced a sen- sation of warmth at the pit of the stomach for two or three minutes, but it had no other effect. The physiological action of the drug is, he says, still unknown to him. MONOCHLORMETHANE.—See Methyl chloride, under Methyl. MONOPHENETHYDRIN.—See Apoly- sine. MYDROL.—This name has been given to a new mydriatic said to be an iodomethylate of phenylpyrazol, which is a white, odourless, bit- ter powder readily soluble in water. It seems from experiments made under the direction of Professor Albertoni, of Bologna (Therapeu- tische Wochenschrift, December 6, 1896; New York Medical Journal, December 26, 1896), that mydrol dilates the pupil in animals that have a round pupil, but has no such effect on those in which the pupil is oblong. Dr. Cattaneo, of Professor Tartuferi's clinic, is cited as hav- ing found that, by reason of the short duration of its mydriatic action, when employed in a solution of from 5 to 10 per cent., and its transitory effect on the accommodation and especially on the tonicity of the eye, its diag- nostic use is of advantage in cases in which there is reason to apprehend harm from the in- crease of intra-ocular pressure caused by other mydriatics. Albertoni adds that it is absolute- ly unirritating and non-poisonous, and that it excels cocaine in diminishing the amount of blood not only in the vessels of the conjunc- tiva, but also in those of the iris and most probably in those of the deeper structures. By virtue of these properties, while it has no actual anaesthetic action, it is serviceable in ciliary and supraciliary pain, blepharospasm, lacrymation, and many diseases of the iris, the cornea, the sclera, and the conjunctiva, espe- cially that of the globe. Mydrol is said to be absorbed rapidly and to be eliminated un- changed in the urine. MYELOTHERAPY—See under Serum treatment (vol. ii, page 187). MYRTILLIN.—A thick extract of the berries of Vaccinium Myrtillus. See under Vaccinium (Supplement). NAPHTHALAN.—This is described by Dr. Rudolf Isaac, of Berlin (Deutsche medi- cinische Wochenschrift, December 24, 1896), as an ointment-like mass obtained by the frac- tional distillation of crude naphtha from the highlands of Armenia. It melts at about 158° F. It is insoluble in water and in glycerin, but dissolves readily in ether and in chloro- form, and mixes easily with fats. Naphthalan seems to have been first employed, early in 1896, in the Michael Hospital in Tiflis, in vari- ous skin diseases. Dr. Isaac reports upon its NITROUS OXIDE NUX VOMICA 448 use in about fifty cases in Dr. Max Joseph's Poliklinik for skin diseases in Berlin. Most of the cases were chronic eczema, especially the so-called " occupation-eczema," a few were acute eczema, and the remaining ones were single cases of prurigo, pruritus, psoriasis vulgaris, ichthyosis, eczema impetiginosum, eczema occurring as a sequel of scabies, dia- betes, ulcer of the leg, etc. The results were various. In several cases of eczema rapid im- provement leading to a cure was observed, in others the good effect was only temporary, and in a few so much irritation was produced that the use of the remedy had to be abandoned. There was no noteworthy effect in the cases of psoriasis. Naphthalan is absorbed by the skin very rapidly, but Dr. Isaac thinks it doubtful on that very account if its employment as a con- stituent of a mercurial ointment for the in- unction treatment of syphilis would be of advantage, since by the ordinary method time is given for the vaporization of the mercury and its absorption by the respiratory mucous membrane. Another disadvantage of naph- thalan is that it soils the linen, but the stains are readily removed. NITROUS OXIDE.—Dr. Hobart A. Hare (Therapeutic Gazette, December, 1896; New York liledical Journal, January 2,1897) reports a case of death after the inhalation of this gas —not, he says, as one of death due to the direct influence of nitrous-oxide gas, but as an in- stance of the fact that the decided rise of arterial pressure which is produced by the ad- ministration of this drug during the period of anaesthesia may cause the rupture of a blood- vessel in persons who have a tendency to apo- plexy. A man between fifty and sixty years of age, with atheromatous arteries, visited the office of a well-known dentist who makes a specialty of extracting teeth under the influence of nitrous- oxide gas, in order that he might have removed one or two molar teeth which were giving him trouble. He had often taken nitrous-oxide gas in the same dentist's office on previous occasions, and always without any ill effects whatever. On this occasion he took the ordi- nary quantity, his teeth were extracted, and he returned to consciousness with the usual ra- pidity. He left the dentist's chair, walked to a washstand, and began to rinse out his mouth with water. While doing this he stated that his right hand felt numb, then complained of the extension of this numbness up his arm, and rapidly to his leg and side. He was helped to a sofa, where in the course of a very few min- utes he became partially unconscious. When Dr. Hare saw him the attack had already lasted about twenty minutes. The patient was breathing stertorously. He seemed to under- stand questions put to him, but was unable to answer them clearly, and in the course of a very few minutes passed into absolute insensi- bility, which, notwithstanding the use of vene- section and other measures, deepened into coma, in which he died about twelve hours after taking the anaesthetic. NUCLEINS.—Dr. John Ferguson, of To- ronto (Canadian Medical Review, March, 1896; New York Medical Journal, June 6, 1896), re- cords a case of progressive anemia in which protonuclein proved curative after a failure of other drugs. Preparations of iron and arsenic had been tried fairly, but could not be toler- ated. The patient was a gentleman, aged fifty- four years, who had resided in India for several years. His health had not been good for about two years. During this period he had suffered loss of flesh, strength, and appetite. In April, 1895, the symptoms became more distressing, and it was necessary for him to give up his work as a tutor and rest. He became a patient of Dr. Ferguson's about the end of September, 1895. At this date he was a pronounced vic- tim to insomnia. His digestion was extremely bad; he had much pain and frequent nausea after taking nourishment, either liquid or solid. There was an excessive amount of flatulence. The bowels were very torpid. The pulse was weak, and usually as frequent as 100 a minute. There was always some elevation of tempera- ture, sometimes as high as 102° F. Continu- ous headache was another feature of the case. The lips and conjunctivae were almost colour- less, and the tongue was exceedingly pale. The skin had a pale lemon tint. The red blood-corpuscles were only 1,200,000 to the cubic millimetre. The urine was normal. No organic disease could be discovered. In spite of all efforts of treatment and feeding, he gradually grew worse. Dr. J. E. Graham saw the patient in consul- tation. No other disease could be discovered than progressive anaemia. It was agreed to place him in some hospital for a time. He was admitted into the Toronto Western Hos- pital on January 7, 1896. Dr. Ferguson went with him in the coupe, and says he really feared he would collapse on the way. When he arrived at the hospital he was in such a state of exhaustion as to be unable to walk up- stairs. On being taken into his room he be- came unconscious, and in this condition he was hurriedly undressed and put to bed with hot bags around him. In the course of an hour or so he gradually regained conscious- ness. At this stage of his disease there were vary- ing elevation and a subnormal condition of the temperature. He had intense headache and almost continuous insomnia. The bowels were constipated, and nearly everything in the way of nourishment was 'vomited. The pa- tient was in a state of extreme emaciation and asthenia. There were frequently low delirium and confusion of thought. He often regarded himself as a duality. On his admission the bowels were washed out daily with a large enema containing some boric acid. Daily he was given a sponge bath. The stomach was washed out every dav except occasionally when he felt too weak. "He was fed on peptonized milk, egg albumen, and beef juice. The headache continued, however, in a most intense degree, and there was no improve- ment in the insomnia. For the headache, acetanilide, phenacetine, salol, and other agents 449 NITROUS OXIDE NUX VOMICA were employed, but with only the most tem- porary relief. Opium, chloral, paraldehyde, and sulphonal were administered from time to time for the insomnia. On one occasion 30 grains of sulphonal were given, with the result of causing only a few hours' imperfect sleep, followed the day after by much vomiting, great restlessness, extreme headache, and a feeble pulse. He had been in the hospital a little over two weeks, and all the appearances pointed to an unfavourable termination of the case, when he was now placed on the use of protonuclein (tablets), as prepared by Reed & Carnrick. The enemata, lavage of the stomach, and the same nourishment were continued. Tablets were given every three hours. By the third day it became apparent that the patient was improving. The headache was the first symp- tom to become modified. In a week it had almost wholly disappeared, and at the date of the report was entirely gone. The sleep soon became better. By the end of the first week of the use of protonuclein he would sleep three and four hours at a time. At the time of the report he could sleep from six to eight hours, and woke with a rested and refreshed feeling. The appetite was good ; he could take eggs, meat, toast, porridge, oysters, beef juice, bread and butter, milk, and" light puddings without the slightest discomfort. There was no nausea or vomiting; the bowels were quite regular, and no enemata or aperi- ents had been administered for at least ten days. The temperature was constantly nor- mal. The patient was gaining in flesh and could walk about the ward and in the hall for an hour and experience no ill effects. The lips and nails had a good colour, and the tongue had lost its pallor. The abdominal walls, which had been extremely retracted, were now filling with adipose tissue. The most marked change, however, was to be found in the red blood-globules. When the proto- nuclein was first ordered there had been not quite 1,000,000 to the cubic millimetre. Now there were 3,500,000. The progress of the pa- tient had been one of daily improvement. He was to leave the hospital in two or three days, when the same line of treatment would be maintained, with the addition of a mild course of massage to assist in the development of the muscles. NUTROSE.—According to Dr. R. Stuve, of Frankfort-on-the-Main (Berliner klinische Wochenschrift, 1896, No. 20; Deutsche Medi- zinal-Zeitung, May 21,1896), nutrose is another name for a certain compound of casein and sodium. He has found it of particular value in the case of children in convalescence from scarlet fever, measles, diphtheria, or pneu- monia, Added to a milk or soup diet, it en- riches the food in albumin, and thus hastens recovery. Its taste is agreeable, and it is utterly unirritating to the intestines, from which it is readily absorbed. NUX VOMICA.—Dr. Thomas J. Mays, of Philadelphia, who regards the state of the nervous system as playing an important part in giving rise to pulmonary tuberculosis, says (Journal of the American Medical Association, October 10,1896 ; New York Medical Journal, October 27, 1896) that, of all the drugs in the materia medica, there is none that compares favourably with strychnine in the treatment of this disease, 'Aside from its elective affinity for the whole nervous system, it possesses a special influence on the nerves which preside over the function of respiration. There is rea- son for believing that it also affects the periph- eral sensory nerves. In small doses it stimulates, in medium doses it tetanizes, and in large doses it paralyzes the nervous system. The dose is a relative or a movable quantity, however, he says, for that which produces tetanus or pa- ralysis at one time may act as a stimulus at another. In regard to the action of strychnine in pul- monary consumption, continues Dr. Mays, if it is taken for granted that the lung disease is merely a superficial manifestation of disorder of the pulmonary nerve supply, the strychnine primarily raises the tone of the nervous system as a whole and that of the respiratory nerves in particular. In this way it not only in- creases the resistance of the lung to disease, but aids digestion, assimilation, and blood- building. In employing strychnine great care must be taken to avoid the danger point, yet at the same time this point must be ap- proached as closely as is consistent with safety. The best way to bring about this object, says the author, is to begin with a moderately small dose of the drug, fa of a grain four times a day; give this for a week, then increase it to fa of a grain for another week: during the next give fa of a grain, the following week raise the dose to about fa of a grain, and so on, making a slight increase every week until nervousness, restlessness, or twitching of the muscles is observed, the signs of the beginning of strychnine intoxication. In most cases these symptoms do not develop until fa or { of a grain or even a larger dose is reached. It must be understood that the drug is to be given in these doses four or even five times a day. The object is to impress the nervous system with the full stimulant effect of this drug. The sooner this end is attained the bet- ter will it be for the patient. For this reason, begin with small doses and work upward as rapidly as can be done with safety. After the desired point has been reached the question arises whether it is better to continue the largest dose or to resume the original. Dr. Mays thinks it best not to vary from this line during the remainder of the treatment, in order not to lose what has been accomplished. Keep the strychnine treatment up to the high- est level of 6afety, he says, but shun the point where its stimulus extends into the region of tetanus and of paralysis. It is best, however, to reduce the dose somewhat at this point. If, for example, it is found that £ of a grain is a maximum dose, reduce it to fa of a grain, then gradually increase the dose again until i of a grain is reached, and then return to fa or to fa of a grain. After the dose has been in- creased and decreased several times it will OPIUM OXYGEN 450 probably be found that £ of a grain no longer produces any dangerous symptoms, and that as much as £ of a grain can be given. When ad- ministered in this way the drug may be given for an indefinite period to the majority of phthisical patients. The remedial effects of the drug show them- selves in various ways. The nervousness, sleeplessness, and pain in the chest will be ameliorated, and perhaps entirely disappear; the cough, expectoration, and dyspnoea will diminish; vomiting will abate; the appetite improves; the patient gains in flesh and colour; the weak and rapid acting of the heart will become slower and stronger; the red corpuscles increase in number, and the patient becomes more hopeful and brighter. Evenhoff (Vratch ; Union medicate, July 11, 1896) has experimented with strychnine as a remedy for cardiac failure during chloroform anesthesia. Tracheotomy was practised on dogs, and a tube was introduced into the larynx and put in communication with a small bottle which contained chloroform. Artificial respiration was made in such a way that the air passed through the bottle, and it could be charged or not with chloroform. Before chloroformization the pressure was noted, then the air, charged with chloroform, was injected and, when the pressure fell to 0, pure air was thrown in and an intravenous injection of from 2 to 3 milligrammes of strychnine was admin- istered. When the pressure finally became normal the animal again received inhalations of chloroform. In this way the action of the chloroform before and after the injection of strychnine was ascertained. The results of these experiments showed that, owing to these injections, dogs, which usually tolerate chloro- form badly, could support the drug without inconvenience for a greater length of time. The favourable action of strychnine on chloro- formization was thus demonstrated. Strych- nine, however, has two inconveniences: it may possibly provoke a tetanoid attack, and, given in the dose employed by Evenhoff, it increases parenchymatous haemorrhage. Strychnine is often particularly valuable in the treatment of pneumonia. Dr. Hobart A. Hare, of Philadelphia (Therapeutic Gazette, April, 1895), says that the three sheet-anchors of treatment for pneumonia after the exudation has taken place are digitalis, strychnine, and belladonna. Of these, strychnine is the only one which we can use alone with advantage. The digitalis nearly always fails to stimulate the vaso-motor system sufficiently, and the belladonna has to be added to regulate the blood-flow by its vascular action. Often, when digitalis is used in pneumonia, the pulse is full, but soft and boggy, if such a term may be used; and, while the regularity and slowness, as well as the volume, may indicate the full action of digitalis, the patient fails to receive benefit and may have a leaky skin. Under these circumstances, belladonna, given in the dose of about 5 drops of the tincture every three or four hours, while the digitalis is given in 10-drop doses every six or eight hours, will produce marked improvement. The strych- nine finds its great value as a whip to the entire system—as a whip which will pull the patient out of collapse or syncope, or overcome the peculiar torpor which is so dangerous a symp- tom in this disease, indicating, as it does, that carbon dioxide is accumulating in the blood, or that the poison of the disease is obtunding the nerve-centres. Particularly are strychnine and belladonna useful about the time of crisis, when the rapid fall of temperature takes away the stimulating effect of the heat and produces collapse. Dr. Hare then alludes to a case exemplifying most strikingly the value of the drugs he is speaking of. A child of five years, having passed through the earlier stages of pneumonia rather uneventfully, arrived at the period for crisis. On the day that crisis occurred it sat up in bed for an instant, although the pulse was already weak from the fall in fever, and at once called out, " Light the gas, it's getting dark," and then passed into profound collapse. The case was a desperate one, and, in addition to external heat, Dr. Hare gave hypodermically fa of a grain of strychnine and fa$ of a grain of atropine every fifteen minutes till three doses were used, when the child showed signs of re- newed vitality, became flushed from the atro- pine, and eventually recovered without any further symptoms of note. Dr. Percy Kidd, of London (Practitioner, September, 1894), says he has used strychnine in the treatment of croupous pneumonia ever since he read an article published in St. Bar- tholomew's Hospital Reports, in the volume for 1886, by Dr. Herbert Habershon, who reported a series of cases of cardiac failure and two cases of double pneumonia treated with the drug. The indications for the use of strychnine, says Dr. Kidd, are mainly derived from the pulse. If the tension begins to sink, or if the frequency of the beats is much increased, strychnine should be used at once, and by subcutaneous injection, as Dr. Habershon rightly insisted, for in cases of grave disease absorption from the stomach is slow and imperfect. OPIUM.—The occasional value of opium in stopping hemorrhage is strikingly shown by a case reported by Dr. William Huntly, of Kotah (Indian Medical Record, May 1,1894). A man came to him on the morning following the extraction of a lower molar tooth. The bleeding had been very severe, and blood still flowed from the gum. Dr. Huntly stuffed the cavity with lint soaked in liquor ferri per- chloridi, but this did not stop the bleeding. The man was very weak. Remembering the effect of opium, he gave him a full dose of the tincture, and in less than a minute the pupil contracted and the bleeding stopped. The patient was then ordered to take 20 grains of calcium chloride in an ounce of rain-water every two hours until he had taken 2 drachms. The bleeding never recurred. Dr. Huntly's views of the value of calcium chloride as a ♦haemostatic will be found in the supplementary article on that drug (vol. ii, page 428). 451 OPIUM OXYGEN OPOTHERAPY.—This term is occasion- ally applied to treatment with animal juices and extracts. OREXINE HYDROCHLORIDE.—Dr. Hohn, of Wiesbaden (Therapeutische Monat- shefte, January, 1896 ; Wiener klinische Woch- enschrift, April 30,1896), remarks that orexine chloride should always be given in wafers, but that the uncombined alkaloid may subse- quently be administered without the use of wafers, when one has made sure that it does not give rise to a sense of burning in the mouth or the oesophagus. Not more than 4 grains should be given at one dose, and the entire amount given in the course of twenty-four hours should not exceed 8 grains. A dose should be taken half an hour before the mid- day meal, and perhaps another shortly before the evening meal. Hohn has used orexine in thirty-three cases, and gives the histories of ten, including three of anemia, one of gastric catarrh, one of sequele (loss of appetite, pallor, debility, etc.) of catarrh of the large intestine of several weeks' duration, two of supposed incipient tuberculous pulmonary disease, one of such disease positively recognised, and two of vomiting of pregnancy. In twenty-three other cases there was loss of appetite caused by anaemia in eight, gastric catarrh in six, and vomiting of pregnancy in one, and attendant upon convalescence in three. As regards the results, in five of the thirty-three cases they are not stated; in nine success was attained, according to the patients' accounts ; in twelve, increase of the appetite was noted; in four, the result was doubtful; and in two, failure occurred (one was that of a phthisical patient in the last stages of the disease, and the other was that of an hysterical woman). OROTHERAPY, ORRHOTHERAPY. —See Serum treatment and The whey cure, under Dietetic treatment. OVARIAN JUICE, OVARIAN SUB- STANCE, OVARINE.—The expressed juice of the fresh ovaries of healthy young animals, filtered and treated by the method described under Animal extracts and juices, an ex- tract, ovarine, made as described in that arti- cle, and the dried substance of the ovary, have all been used as remedies. The Presse medi- cate for August 15, 1896 (New York Medical Journal, September 12,1896), publishes a report of a meeting of the Congres f rancais de medecine interne at which M. Spillmann and M. Etienne presented a paper on the treatment of chlorosis with these preparations. They thought that the morbid symptoms which often preceded men- struation might be considered as the result of an intoxication which disappeared after this function was established. If chlorosis, they said, was a disease of the ovaries, their func- tions were changed or abolished, and with the suppression of menstruation chlorosis appeared. And, on the other hand, a defective general con- dition interfered with and impeded recovery of the ovarian gland. If, however, the ovarian internal secretion was restored to the organ- ism in any way. it was possible, perhaps, to stop the intoxication, to influence the organ- ism in general, and to afford a means of re- covery of the local ovarian affection. The authors had made use of three products: The fresh ovaries of the sheep, dried ovarian sub- stance, and ovarian juice prepared by the Brown- Sequard-d'Arsonval method. These remedies had been given to six chlorotic subjects, with the results that after the first dose very sharp pains, especially in the abdominal region, had been felt; there had also been headache and vague muscular pains. In two of the patients the temperature had risen to 99-1° and 100-2° F., and the pulse increased from 76 to 100. In three of the patients the remote results had been dis- tinctly favourable ; the general condition had been rapidly improved, the pallor diminished, the number of white globules increased, and the strength restored. In amenorrhea, men- struation, which had been suppressed for over three months, had returned in one case in fifteen days after the beginning of the treat- ment; in another case it had returned at the end of three months. The authors concluded that, in the treatment of chlorosis, ovarine fa- voured the elimination of the toxines and intro- duced into the organism an antitoxic principle, and in this way exerted a favourable action on the general condition, on the formation of red globules, and on menstruation. Dr. Mond (Munchener medicinische Wochen- schrift, 1896, No. 36; Gazette hebdomadaire de medecine et de chirurgie, December 13, 1896) reports twelve cases of the use of ovarine in the treatment of disturbances following oophorec- tomy and the menopause, and says that in every case the effect of the treatment was remarkable. There was progressive attenuation of the dis- turbances from the beginning of the third or fourth day, followed by their complete disap- pearance at the end of ten or twelve days. The quantity employed was ten tablets a day, each containing 8 grains of fresh ovarian substance. He advises the employment of large doses in the beginning, which may be progressively di- minished and increased again if the dose seems to be insufficient. He states that he has never seen the least symptom of poisoning in any case. In several cases he substituted for the ovarine tablets others which had the same taste, the same colour, and the same appearance, but contained only meat extract and salt. The administration of these tablets was regularly followed by the return of all the troubles, so that the administration of the real ovarine tablets evidently did not act by suggestion. OXYGEN.—At the eighteenth annual meet- ing of the American Laryngological Associa- tion, that of the year 1896 (New York Medical Journal, August *29, 1896), Dr. George Stoker, M. R. C. P. I., of London, presented a paper in which he described his method of using oxygen in the treatment of syphilitic and chlorotic ozena and chronic suppurative otitis media. The oxygen is contained in a wedge-shaped bag made'of mackintosh. This bag is placed between two boards, such as are used with the oxyhydrogen light. From the bag leads a tube, which terminates in a nose or ear piece. There are two taps—a large one on the bag, for the PELLOTINE PIPERIDINE 452 purpose of filling it, and a small one to regu- late the stream of oxygen during treatment. This bag contains a cubic foot of gas, or of gas and purified air mixed in equal quantities, and this amount should suffice for six hours' treatment. In the great majority of cases he uses equal parts of oxygen and purified air. This latter is prepared by being pumped by means of a bellows or hand ball through two wash bottles, the first containing some water and the second Condy's fluid. The bottles are attached to the bag for this purpose, and when the bag is half full it is detached from the bot- tles and filled up with oxygen. The bag being filled, the nose piece is passed into one nostril, the other nostril being plugged with cotton wool; the patient is directed to breathe through the mouth, the taps are turned on, and the treat- ment is begun. In ear cases the only differ- ence is that the terminal piece is placed in the external auditory meatus, and in case of either ears or noses it is desirable to have several dif- ferent-sized terminals to fit different-sized ori- fices. The oxygen should be allowed to pass into either the nose or ear from three to six hours daily. In nose cases it is best to use it about half an hour to an hour at a time, giv- ing intervals of rest between the times. If used for more than an hour in nose cases it is apt to cause headache. The only additional treatment is using warm water to cleanse the parts during the day, never less than twice a day. Dr. Stoker stated that of late he had been using the same treatment in cases of purulent discharge from the antrum of Highmore, the frontal sinus, or the ethmoidal cells, and up to that time the results had been satisfactory. Injections of oxygen into the peritonaeum have been recommended by M. Potain in the treatment of ascites. M. Teissier (Province medicate, July 4, 1896; New York Medical Journal, August 1, 1896) relates the case of a woman with ascites and general oedema. He punctured the abdomen and withdrew about fourteen pints of liquid, but the liquid collected again in six days. A second puncture was then made and followed by the injection of 1,300 cubic centimetres of oxygen. The operation was very well borne, and it did not provoke any pain or local reaction; there was also com- plete absence of fever during the following days. The circumference of the abdomen di- minished from 128 to 102 centimetres, and the oedema of the lower limbs disappeared very rapidly. The oxygen was easily absorbed by the peritonaeum. For a few days there was some gurgling, but this disappeared at the end of eight or ten days. At the time of the report the abdomen still measured 102 centimetres and sonorousness existed everywhere, even in the iliac fossa when the patient lay on her side. She was able to get up every day and walk in the open air. These results had been obtained in three weeks. PELLOTINE.—This is an alkaloid ob- tained from Anhalonium Williamsii. Dr. Jolly (Deutsche medicinische Wochenschrift, 1896, No. 24; British Medical Journal, Octo- ber 24, 1896) records some observations on the use of it as a hypnotic. It may be adminis- tered by the mouth or subcutaneously. The dose is from £ to f of a grain, which may be repeated if necessary. In one case as much as li grain was given in two hours. Dr. Jolly has used pellotine in forty cases, and the re- sults have been satisfactory, though in vary- ing degree. In no case were any unpleasant after-effects noticed. He considers that this drug should receive further trial. PHENETIDINE.—See Phenacetine. PHENOL.—Dr. Sbrana (Riforma medica, March 16,1896; British Medical Journal, May 2, 1896) reports the case of an Arab, aged twenty-five, who, on November 10th, wounded his left big toe near the nail by striking it against a stone. The wound was immediately dressed with cobwebs full of earth. Two or three days later, as the part became painful, the wound was washed with urine, then cov- ered with chalk, and over this a sheep's blad- der was laid. On the 22d there was some difficulty in masticating. When the man was seen, on the 25th, there was well-marked tetanus, the temperature was 101-3° F., and there were risus sardonicus, complete trismus, opisthotonos, and general clonic convulsions. A hypodermic injection of a 2-per-cent. solu- tion of phenol was given in the foot on the evening of the 25th, and three times a day afterward. On the 26th the necrosed last phalanx and part of the first were removed. On the 30th, the inguinal glands were en- larged and painful. On December 4th there was smart intestinal haemorrhage, also a copi- ous eruption of sudamina on various parts of the body. On December 11th the patient left his room quite cured. Cf. Carbolic acid. PICRIC ACID—Mr. William Maclennan (British Medical Journal, December 26, 1896; New York Medical Journal, January 16, 1897) says that the admirable results which he has seen follow the free application of picric acid in solution to painful and extensive burns led him to try its effects in the treatment of cer- tain skin diseases. He has employed it locally in a large number of cases, and has found it more efficacious than any other of the reme- dial agents commonly in use, and he thinks it worthy of a more extensive trial. Acute eczema, he says, is rapidly relieved under the influence of picric acid, and, owing to the powerful astringent properties which this chemical possesses, it forms, when applied over a discharging or denuded surface, a pro- tective layer of coagulated albumin and epi- thelial debris under which healing rapidly proceeds; and as a potent antiseptic, by in- hibiting the action of the microbes on which the formation of pus depends, or destroying them, it completely prevents suppuration. Applied as a pigment with a brush or piece of absorbent wool, even to an extensive sur- face, it is quite free from danger, and causes not the slightest pain, however vascular the surface may be. Almost immediately itching and smarting abate, and in a few days, when 45J the protective crust is removed or separates, the underlying skin is found to be compara- tively dry, free from redness, and covered with a young epidermis. Mr. Maclennan states that in that verv troublesome form of acute eczema occurring in children (eczema capitis et faciale) which is usually so intractable to the ordinary methods of treatment, he has had most encouraging re- sults from the use of picric acid. If the hair on the child's head happens to be long it should be cropped short, and all adherent crusts removed by means of poulticing. The raw surface should then be freely painted over, morning and evening, for three or four days in succession with a saturated watery solution. During this treatment the scalp and the face, when it is involved, should be protected by means of a calico mask. After the lapse of a few days the pellicle which has been formed by the action of the picric acid can be removed with some emollient if it has not previously separated, and, if any undue redness or moisture remains, a fresh applica- tion may be made. The cessation of irritation permits the child to sleep, and its general health soon improves. When the disease be- comes quiescent, the local treatment can be combined with, or followed by, the internal administration of alteratives like arsenic or gray powder. Although picric acid is so specially valuable in acute discharging eczemas, says the author, it will be found an efficient remedy in almost any superficial inflammatory affection. Thus, in three cases of erysipelas he has found a saturated solution of picric acid superior to any local remedy he has hitherto tried. It arrested the inflammation and prevented the disease from spreading, and much more rap- idly diminished local discomfort than carbolic- acid dusting powder or ichthyol. Aspland, he says, narrates the case of a soldier suffering from diabetes mellitus, who contracted ague. He was treated with picric acid. Under its influence the polyuria rapidly disappeared and the specific gravity fell from 1-032 to 1*018, and in a few weeks sugar was entirely absent from the urine. In those very troublesome cases of chronic simple diarrhea, and so-called putrid diar- rhea, with very offensive stools, Mr. Maclennan has employed picric acid largely. Often, when opiates and other astringents have failed, picric acid in grain doses has given rapid re- lief. The powerful astringent and antiseptic properties of picric acid diminish secretion and disinfect the intestinal canal. In this re- spect the action of carbazotic acid resembles that of carbolic acid, to which it is constitu- tionally related. M. P. Brocq (Revue Internationale, de mede- cine et de chirurgie, July 10, 1896) employs the following formulae in the treatment of itching of the scrotum : (1) B Picric acid........... 4| grains; Vaseline,) h..... 225 ,, Lanolin, j M. S.: For external use. PELLOTINE 3 PIPERIDINE (2) B Picric acid.......... 15 grains; Vaseline, ) , oor „ Lanolin, feacn..... ~~d M. S.: For external use. PIPERIDINE.—Piperidine guaiacolate is described by Dr. Arnold Chaplin and Dr. F. W. Tunnicliffe (British Medical Journal, January 16, 1897) as a compound formed by the action of piperidine on guaiacol in a suitable solvent, such as benzol or petrolic ether, having the formula CBHiiNC7H802, although its exact chemical composition is still under investiga- tion. It crystallizes in prismatic needles or plates. It is soluble to the extent of 3-5 per cent, in water; it is also easily soluble in most organic solvents. It is decomposed into its constituents by mineral acids and alkalies. The chemical property which from a pharma- ceutical standpoint is most worthy of note is its relative solubility. When the insolubility of the carbonate of guaiacol is borne in mind this becomes emphasized. The solubility is such that 10 grains may be administered in an ounce draught of simple water, or if the spe- cific gravity of the medium is raised by the addition of a little glycerin or mucilage, a dose of from 20 to 30 grains may be given. The salt is decomposed into guaiacol and piperidine, probably not in the acid medium of the stomach, but in the alkaline one of the duodenum. The reason for this assumption is that large doses—a drachm—can be given with- out the slightest eructation of guaiacol. The guaiacol acts in the intestine as an antiseptic: in the structures through which it is excreted, for example, the respiratory mucous membrane, it acts also as an antiseptic. As to the piperidine, its pharmacology forms in part the subject of a research to be published by Dr. Tunnicliffe in conjunction with Dr. Lauder Brunton. For the present, Chaplin and Tunnicliffe simply say that when hydrochloride of piperidine, suitably diluted, is injected into the circula- tion in doses of 0*05 of a gramme to the kilo- gramme of weight, the heart is slowed and the vessels are contracted, a considerable rise of blood-pressure taking place. When it is in- jected under the skin in doses of from 1 to 2 centigrammes to the kilogramme, an increase in reflex excitability occurs, so that if the drug is pushed convulsions may develop. Thus in suitable doses piperidine must be regarded as a cardio-vascular tonic and spinal stimulant. For three months, the authors say, an in- quiry as to the value of piperidine guaiacolate in the treatment of pulmonary tuberculosis has been carried out at the City of London Hos- pital for Diseases of the Chest. The patients to whom the drug was given were subjected to close observation, and the effects of the medi- cine were from time to time noted. In all, fourteen cases were placed under observation, of which eight were in out-patients and six in in-patients. The duration of the observations varied, but six weeks was about the average. In order to test the value of the drug effi- ciently, cases were chosen more or less at hap- hazard, some being early cases in which improvement might be expected under appro- PYRAMIDONE SALICYLIC ACID 454 priate treatment, others being more advanced, while yet others were in such a stage as to make it improbable that much good from any form of treatment would accrue. In all cases the dose to begin with was fixed at 5 grains three times a day, and this was gradually in- creased until 20, and in one case 25 grains, were given for a dose. So far as could be gathered from questioning the patients and from personal observation, no unpleasant effects were noticed. All of them stated that the medicine had agreed with them. Pains were taken to ascertain if the drug produced any gastric or intestinal irritation, but in no case could it be determined that the processes of digestion were in any way interfered with by it. The authors think this worthy of special stress, because experience has so often taught us that when other derivatives of creosote, such as crude guaiacol, are given over a length- ened period their use has to be discontinued from time to time owing to the gastric and in- testinal disturbances caused by them. But in these cases no such untoward event happened. With regard to the varied symptoms of phthisis, it is difficult to say with certainty, they remark, that the guaiacolate of piperidine had any distinct effect upon them, for in all cases of phthisis it is so frequently found that improved hygienic conditions (good food, rest, and attention), such as a residence in a hos- pital affords, plays a large part in the restora- tion of the patient's health. This much, however, they think, may be said, that in many instances the cough appreciably im- proved while the treatment was in progress. The temperature was in no case affected ad- versely by the drug; in most cases it receded to normal. The appetite, for the most part, was maintained, and very often patients ex- pressed the belief that the medicine improved it; indeed, in some cases it seemed that it had a decidedly good effect upon the appetite. Some patients gained in weight while the treatment was going on, and in two instances it was thought that more flesh was put on than would have been the case had ordinary remedies been tried. The expectoration in most cases decreased while the drug was being taken. Among the out-patients especially there was a general improvement in strength and vitality. In the case of out-patients it must be remembered, they suggest, that im- proved hygienic conditions do not come into operation to the advantage of the patient as they do in in-patient practice. As to the changes noted in the physical signs, it must be admitted, they say, that dis- cussion of this subject is full of difficulty, for it so often happens that, although considerable improvement takes place in the patient's gen- eral condition, yet no marked change occurs in the physical signs. Some of the out-patients whose condition was found to be improving were examined week by week to see if any change could be found in the physical signs. Consolidation and excavation were of course unaffected, but in not a few instances the lungs were noticed to become drier with less moist crepitant rales. This change was attributed to the fact that the area of simple inflamma- tion around the tuberculous infiltration itself had passed from an active to a more quiescent condition. The same improvement in physical signs could not be seen in most of the persons under treatment as in-patients. Two out-pa- tients considered that the medicine relieved their dyspnoea, and, to judge from the lung signs, which were under the treatment improv- ing rapidly, it might very well be the case. Dr. Chaplin and Dr. Tunnicliffe conclude with the following general statements : 1. Experience has shown that piperidine guaiacolate is a perfectly safe drug in doses of from 5 to 30 grains three times a day. 2. It causes no unpleasant effects. 3. It is exceedingly well borne by the stom- ach, and in this respect it is equal to any other derivative of creosote. 4. Patients while under its influence improve in appetite and general strength. PYRAMIDONE.—Professor Filehne, of Breslau (Berliner klinische Wochenschrift, November 20, 1896; Therapeutische Wochen- schrift, December 6, 1896), describes this sub- stance as a substitution compound of antipyrine in which an atom of hydrogen is replaced by CH the group N^pr3. It is a white crystalline, tasteless powder soluble in ten parts of water. The effects of pyramidone on the nervous system are analogous to those of antipyrine throughout, and the mechanism of its antipy- retic action is the same—that of increasing the dissipation of heat. Thorough observation, however, discloses certain differences of effect. Pyramidone acts on man in doses only a third as large as those of antipyrine ; its action is mani- fested more gradually and subsides more slowly. Its antipyretic action is much milder and lasts longer. Animals poisoned with very large doses of pyramidone show no material altera- tion of the blood, either microscopically or spectroscopically, and no haemorrhages, throm- boses, or organic degenerations. In the healthy human subject, doses of 8 grains produce neither subjective nor objective effects ; doses of from 5 to 8 grains were given to patients three times a day with advantage. The author has always found it promptly efficacious in re- lieving pain of various sorts, such as febrile headache, pain in the lymph-glands and the spleen in pseudoleucemia, that of tuberculous peritonitis, anemia, and multiple neuritis, and intercostal neuralgia occurring as a sequel of influenza. In headache it is sufficient to give 6 grains. In four cases of nephritis it had no effect on the symptoms, except on the headache in one case of contracted kidney. Its antipyretic ac- tion was proved in twelve cases, including those of tuberculosis, typhus, scarlet fever, pseudoleucaemia, influenzal pneumonia, etc. The promptness of its action as an analgetic and the mildness of its febrifuge action, the author thinks, entitle it to further trials. PYROZONE.—Dr. William Cheatham (Medical Record, September 12, 1896; New York Medical Journal, September 26, 1896) PYRAMIDONE 455 SALICYLIC ACID calls attention to a line of treatment which, he says, has rendered him the best service in two cases of suppurative otitis media. In both cases the curette, chromic acid, pyrozone, for- malin, boric acid, and many other remedies were employed, but no permanent relief was obtained. Finally Dr. Cheatham directed that 10 drops of a mixture of 10 drops of dilute hydrochloric acid and an ounce of pyrozone should be put into the ear three times a day after cleansing it; the mixture was to be left in for five minutes after having been forced in deep by firm pressure upon the tragus. In the first case a remarkable change was noticed in a few days; in a short time there was no secretion from the cavity, and there has been no return of it for several months. In the second case the patient began to improve rap- idly in a few weeks, and recovery set in with no relapse. Dr. Cheatham states that he has treated sev- eral similar cases with but one failure, and that occurred in a tuberculous subject. He has treated many cases of lesser severity with only an occasional failure, and he has not seen this treatment fail in acute cases. Of course in the primary stage of acute cases, he says, such medication is contra-indicated, but after pain, throbbing, and swelling have subsided, and suppuration continues, notwithstanding ordi- nary treatment, the acid and pyrozone check it very promptly. As to drainage in these cases, he says, the iodoform or some other of the gauzes cut into narrow strips has given him by far the best results. This treatment is not a cure-all by any means, continues Dr. Cheatham, but he hopes his brief report will lead others to try the. acid-and-pyrozone combination. Of course, when the deeper sinuses are involved, surgery is first indicated, then the pyrozone and acid. Under its use, he states, he finds mastoid-cell involvement much less frequent, and he does not believe these effervescing preparations in- crease such dangers. QUININE.—Quinine arsenite is a white crystalline powder obtained by dissolving qui- nine in a hot aqueous solution of arsenous acid. It contains about 69 per cent, of quinine. It is soluble in hot water, slightly so in cold wa- ter. It may be used as an antiperiodic in doses of from i to fa of a grain. Quinine dihydrochloride carbamate oc- curs in colourless crystals easily soluble in water. It contains 70 per cent, of quinine. Its free solubility renders it especially useful for subcutaneous employment. Quinine ferrichloride appears in the mar- ket in the form of brown scales or a reddish- brown powder highly hygroscopic. It is freely soluble in alcohol and in water. It has been praised as a hemostatic, used as a dusting powder to be applied over a bleeding area. In a 2-per-cent. solution, its employment in uterine hemorrhage is alleged to have been successful. Quinine hydrochlorsulphate is obtained by dissolving the hydrochloride and the bisul- phate of quinine in warm water in molecular proportions. The solution is evaporated, and the colourless crystals of the double salt ap- pear. It is soluble in an equal quantity of water. It has been recommended for hypo- dermic use. Quinine salicylate occurs in fine white crystals. It is soluble with difficulty in water. As an antipyretic it has been recommended in typhus fever, in gout, and in rheumatic condi- tions. The dose is from 1 to 8 grains, three times daily.—Samuel M. Brickner. RONTGEN RAYS.—See X-rays. SALICYLIC ACID AND THE SALI- CYLATES.— Thiersch's solution contains 1 part of salicylic acid and 6 parts of boric acid, dissolved in 500 parts of hot water. It is a bland, harmless antiseptic, and may be freely used on surfaces and in areas where more vigorous antiseptic fluids might be absorbed and produce poisoning. The peritonaeum and pleura are especially adapted to its employ- ment. Aluminum and ammonium salicylate, aluminum salicylate.—See Salumine. Bismuth and cerium salicylate is an insoluble pink powder. It has been recom- mended in acute diseases of the gastro-intesti- nal tract in doses of from 15 to 30 grains. Caffeine and sodium salicylate, or caf- feine and sodium cinnamate, is a freely soluble double salt, well adapted for hypodermic use. Camphor salicylate is a crystalline prepa- ration employed in the treatment of lupus and parasitic skin diseases. Internally, it has been recommended in doses of from 3-J to 5 grains for the relief of chronic dysentery and chronic diarrhea. Chlorosalol is the chlorophenylic ether of salicylic acid. Its indications and dose have not yet been determined. Cresalol, cresol salicylate is the cresalol analogue of betol and salol, for which it is sometimes employed. In the system they are split up into cresol and salicylic acid. Dithiochlorosalicylic acid appears as a reddish-yellow powder. It is reputed to have an antiseptic influence. Quinine salicylate.—See under Quinine (Supplement). Sodium sulphosalicylate, a white crys- talline powder, with no special advantages, has been proposed as a substitute for sodium sali- cylate. Sulphosalicylic acid, or salicylsul- phuric acid, is obtained from the action of fuming sulphuric acid on salicylic acid. White crystals, soluble in water and in alcohol, are the result. Albumoses and peptones will be precipitated on the addition of this salt to a solution containing them, but will be redis- solved on boiling, while albumins and globu- lins, if present, will remain precipitated. The salt is therefore a valuable testing agent. Samuel M. Brickner. SALUBROL SILVER 456 SALUBROL.—This is a new substitute for iodoform described by Dr. M. Silber, of Bres- lau (Deutsche medicinische Wochenschrift, December 24, 1896: Therapeutische Wochen- schrift, January 3,1897), as made by the action of bromine on a compound of methylene and antipyrine. It is stable under ordinary cir- cumstances, but on coming in contact with organic matter it gradually gives off bromine. The powder applied to the skin sometimes gives rise to a burning pain, but a 20-per-cent. gauze has no irritating action. Salubrol has been given to animals subcutaneously in daily amounts of 150 grains without their manifest- ing any poisonous action. SALUFER, according to Dr. Squibb (Eph- emeris, January, 1897), is the trade name given by a manufacturer in Leeds, England, to po- tassium silicofluoride. It is reported to be an efficient antiseptic and deodorizer, but the chief applications in which it has made its record are in chronic otorrhea and as a uter- ine wash in puerperal fever. It readily dis- solves in water, and a saturated solution may be made in boiling water. It is non-toxic, but stains instruments. Often the best effects are to be obtained from the saturated solution. Mr. F. Faulder White, F. R. C. S., of Coven- try, England, reports having even freely dusted very foul wounds with the powder, rapidly washing it off. Recovery takes place without local inflammation or rise of temperature. Nothing has been heard of it in America as yet. SALVIA.—Krahn (cited in Fortschritte der Jledicin, November 15, 1896) gives a resume of the literature of salvia, and says that he has used it in thirty-eight cases of profuse sweating, mostly in tuberculous per- sons. He employs a tincture made with 1 part of the leaves and 10 parts of alcohol, and he has convinced himself of its harmlessness by taking as much as 40 drops of it twice a day for six weeks. He has generally given his pa- tients 20 drops in the morning and from 20 to 40 drops in the evening. For dispensary patients he orders an infusion made with a tablespoonful of the leaves and a pint of water, of which they take a cupful night and morning. In all but two of the thirty-eight cases it acted favourably, but the action was not sustained when it was given for weeks at a time. Fever, he says, is not a contra-indica- tion, and he has observed no unpleasant effects. SENECIO.—Mr. W. E. Fothergill (Medical Chronicle, November, 1896 ; New York Medi- cal Journal, December 19, 1896) has sum- marized the work of Dr. William Murrell, Dr. Dalche, Dr. Heim, Dr. Bardet, and Dr. Bolog- nesi bearing on the therapeutic value of the senecios, and their conclusions, substantially as follows: Murrell, among other remarks, says he has found that it acts admirably in those cases of amenorrhea in which the menstrual function, having been established and performed regu- larly for some months or even years, is delayed or suspended as the result of exposure to cold or some similar cause. In cases in which the amenorrhoea is associated with or dependent on anaemia, senecio uniformly failed to do any good until the anaemic condition had been re- moved with iron. In cases in which the men- strual flow had never been established, senecio was frequently most useful, and in four cases of vicarious menstruation—the blood coming from the mouth or gums—nothing could have been more satisfactory. He is satisfied that senecio not only anticipates the period, but also increases the quantity of the flow. In many cases of dysmenorrhea it promptly re- lieves the pain, and not infrequently the men- strual headache from which many women suffer. Senecio is apparently not an ecbolic. Dalche and Heim conclude that the drug re- lieves painful menstruation if the reproductive organs are healthy, but not otherwise. They remain doubtful whether senecio provokes the menstrual flow, and they offer no hypothesis as to its mode of action. Bardet and Bolognesi conclude that senecio has the constant property of provoking men- struation, though administered in small and harmless doses. They hold that it always tends to regulate menstruation, but that it does not relieve pain at the periods, and does not increase the quantity of the discharge. They suggest that it both produces congestion of the reproductive organs and also excites contraction of the uterine muscle. M. Bardet mentioned one of the cases on which the latter supposition is based in a dis- cussion at the Societe de therapeutique. A woman, aged thirty-eight years, suffered from nausea and hypogastric sensations recalling to the mind those of pregnancy, on three occa- sions after she had taken senecio. But sub- jective phenomena described by a patient, says the writer, are very slight evidence on which to base a statement, as M. Bardet does, to the effect that her uterus contracted. M. Blondel thinks that the reports on the physiological action of senecio are both vague and contradictory, and that until the action of a drug is definitely known its indications and contra-indications can not be established. Amenorrhoea, he says, is not a disease but a symptom; its causes must be discovered before they can be attacked, and the treatment should always be indirect, on account of the risk of causing abortion. The drugs which act di- rectly in provoking menstruation, he thinks, are unreliable, dangerous, and of merely tem- porary effect. Now, these remarks of M. Blondel, contin- ues Mr. Fothergill, though likely to catch the sympathy of the superficial reader, are not really calculated to deter any one from giving respectful study to the work of these authors. For, to go over his objections in reverse order, granting that the so-called emmenagogues in use are unsatisfactory, there is no reason a priori why it should not be discovered that one or other of the active principles of the senecios is a true emmenagogue, reliable, safe, and perhaps even permanent in its action! Next, in certain cases, amenorrhoea is not a symptom of any pre-existent disease, but is 457 SALUBROL SILVER due to the action on the nervous svstem of various external and temporary causes. Sec- ondary bad effects, both mental and physical, follow the amenorrhoea, which in such cases is a primary disorder, and is certainly one suit- able for direct treatment. Thus, Edelheit mentions four cases in which amenorrhoea in- augurated a primary and serious affection, fatal in two of them, recovery in the other two following the re-establishment of menstruation. Again, the difficulties in diagnosticating early pregnancy, if great, are not insuperable to all; and there is no necessity for any one to admin- ister a possible ecbolic while still in doubt as to the diagnosis. Lastly, if no drug may be used until its action is definitely known and its indications are clearly defined, there is an end to the introduction of new therapeutic agents. All that the most exacting can demand is that the introducer of a new drug shall give a working hypothesis according to which the drug may reasonably be supposed to act. Menstruation, he continues, expresses an anabolic surplus produced by the healthy hu- man female from puberty to the menopause, except during pregnancy and lactation, the time of its occurrence probably being deter- mined by the activity of a special centre in the lumbar part of the cord. In the light of this view of menstruation, he says, substances like iron, which affect the quality or quantity of the blood, are only indirectly emmena- gogues. In like manner, substances which, by causing renal or gastro-intestinal irritation, pro- mote pelvic congestion and uterine haemorrhage, are also indirect in their emmenagogue action. To be a direct emmenagogue, a substance must act upon the nervous mechanism which initi- ates the discharge—namely, the hypothetical centre for menstruation. Thus an emmena- gogue is quite distinct from an ecbolic, which is supposed to cause contraction of the uterine muscle by acting either on the fibres them- selves or on their motor nerves. It is possi- ble, he thinks, that senecio may be found to contain an active principle which is a direct emmenagogue in the proper sense of the word, and it does not follow that this principle must be an ecbolic. Several kinds of amenorrhoea, continues Mr. Fothergill, may be classified according to treatment, and the indications defined by the use of the direct emmenagogue which senecio may prove to be. From the reports of these authors, it does not seem likely that the drug will be of much use in dysmenorrhoea. The following is his classification according to treatment: No Treatment—Physiological amenorrhoea —/. e., before puberty,'during pregnancy, dur- ing lactat ion, and after the menopause. Amen- orrhoea due to congenital or acquired deficiency or to absence of essential reproductive organs. Surgical and other Local Treatment— Amenorrhoea due to local defects, such as atresia vaginae, atresia cervicis uteri, congeni- tal or acquired neoplasms, etc. Indirect Treatment—Amenorrhoea due to general disease which so disturbs metabolism that there is no anabolic surplus—e. g., anae- mia and phthisis—where menstruation would be an unnecessary drain on the patient. Direct Treatment by Emmenagogues.— Amenorrhoea due to want of activity of the nervous mechanism initiating menstruation, caused by nervous disease, shock (mental or physical), fear or hope of pregnancy, etc.. in- cluding those cases in which the function has never been established, but where there is no local defect or general disease sufficient to ac- count for its absence. SILVER.—Dr. R. Abrahams, of the Mt. Sinai Hospital, New York (Journal of the American Medical Association, January 30, 1897), writes in praise of the action of silver nitrate in a number of morbid conditions. One of these is the epidermal callosity com- monly known as a corn. Soak the corn in hot soapy water, he says, then shave down the horny layers, and apply a 30-per-cent. solution of silver nitrate. The corn will never, or hardly ever, recur after the silver has been applied to it. Certain forms of lupus vulgaris, says Dr. Abrahams, are eminently adapted to the local application of nitrate of silver. The first in- dication is found in the small lupus papules which characterize the beginning of the de- structive disease. By effectively cauterizing the primary lesions the disease will be pre- vented from taking root. The second indica- tion is suggested by the lupus nodules which are formed by the coalescence of the initial pap- ules. Lupus in both these forms, he says, can be radically cured by the thorough application of silver caustic. The third indication is the serpiginous form of lupus. Here silver is used as a means only to stop the downward march of destruction. Kaposi thus speaks of silver in the treatment of lupus vulgaris: "Apart from mechanical treatment, the use of caustic is important. The most practicable is solid nitrate of silver. It has sufficient resistance to penetrate the individual lupus nodules, thus uniting mechanical and caustic action. It also possesses the advantage that it does not enter healthy tissues. Large nodules of lupus tumidus, and particularly suparficial infiltra- tions, may be burned out as thoroughly as with the sharp spoon. Since the solid stick not only destroys the vessels of the border and base mechanically, but also causes thrombosis, the cauterization furnishes all the require- ments for effecting a cure." In the face of this eminently authoritative statement, says Dr. Abrahams, it is hard to see why some writers of distinction fail to include this agent among the local remedies for lupus. Lunar caustic finds a fitting place in suita- ble cases of epithelioma of the skin and mucous membranes, says Dr. Abrahams. Generally speaking, he says, the method of applying the caustic in cutaneous cancers is the same as in lupus or in the other growths above men- tioned, but the indications are fewer. As in lupus, when the cancerous nodule or ulcer is small, nitrate of silver is an effective and curative remedy. It is also indicated in " in- operable " cases, in recurrent nodules, and in the serpiginous forms of epithelioma. SODIUM SULPnOSALICYLATE X RAYS 458 SODIUM SULPHOSALICYLATE.— See under Salicylic acid and the salicylates (Supplement). SUGAR.—For the use of sugar in scorpion stings, see under Honey (Supplement). VACCINIUM.—Dr. Karl Ullmann (Wiener medizinische Wochenschrift, 1895, No. 41 ; Monatshefte furpraktische Dermatologie, June, 1896) relates his experience in the use of Win- ternitz's myrtillin (an inspissated extract of Vaccinium Myrtillus) in a hundred cases of skin diseases in Hans Hebra's clinic. The ex- tract is applied to the affected skin in a thick layer, over this a thin coat of cotton is laid, and the part is bandaged. The diseased part is cleansed daily with a l-to-200 solution of sodium chloride and with alcohol or French brandy. Seventy of the cases were of eczema; the others included various itching affections, hy- perkeratoses, psoriasis, local formations of wheals, and burns to the degree of rubefaction or of vesication. The cases of eczema were chiefly those of occupation-eczema, the next most numerous were those of mycotic eczema, and finally came those of idiopathic and arti- ficial eczema. In the matter of a cure the re- sults were not so good as had been expected. In the cases of occupation-eczema, especially where there was much scaling, there was tran- sient improvement, but in the weeping, vesicu- lar, and pustular forms there was not. The effect was better, however, in cases of eczema of the fingers and feet characterized by the formation of wheals and rhagades. Mycotic eczema was improved, and the scal- ing seemed to subside, but in no instance was there an actual cure. There was no good ef- fect in cases of intertrigo and eczema of the scrotum. In cases of mycosis flexurarum, es- pecially if there was much scaling and thick- ening of the skin, a better effect was produced. The remedy acted well in seborrheal eczema of the face in children, but not so well in the seborrhcea of adults. It had no effect, or only the most transitory one, in acute idiopathic eczema, acute dermati tides, so-called trophic eczema, and psoriasis. In three instances burns to the degree of rubefaction or vesica- tion were quickly cured with it. It was used in the following compounds: (1) Purified extract of the ber- ries of Vaccinium Myr- tillus.................. 50 parts; Epidermin............... 10 to 15 " (2) Purified extract of the berries of Vaccinium Myrtillus......... 50 parts; Myrrh...................... 2 The author comes to the following conclu- sions: Extract of myrtillus is no specific against eczema. It is of advantage only in redness, scaling, and wheallike thickening in consequence of chronic eczema affecting the hairless parts of the body and in the sebor- rhoeal eczema of children. Mycotic and itch- ing affections of the skin are hardly influenced by it or only in a very transitory way. Wheals and chronic inflammatory infiltrations are softened by it. In burns of the first or second degree its action is remarkably quick and sat- isfactory. The active principle of the extract is probably a material containing tannic acid, and it possesses pronounced antizymotic prop- erties. The extract is astringent and kerato- plasty. It is in no wise irritating or poisonous. X RAYS. — M. Rendu (Progres medical, January 30, 1897) relates the case of a lad, twenty years old, who presented all the symp- toms of infectious pneumonia, although a bacteriologist professed to have found Koch's bacilli in the sputa. The patient's father asked that the Rontgen rays be used in the treatment. Daily applications of fifty-five minutes' dura- tion were begun, and after the third applica- tion a very distinct amelioration was manifest. The fever fell, there was natural perspira- tion, and there was a very abundant diuresis. After the first application there was produced on the skin where the rays had penetrated an intense erythema which was followed by blis- ters, then an eschar which did not heal for several weeks. M. Rendu questions whether recovery was the result of the acute revulsion produced by the erythema, or the result of the action of the X rays on microbes. He thinks that the patient was not tuberculous. The idea has recently been entertained that the Rontgen rays may be of service in tubercu- losis. In the Fortschritte der Medicin for Feb- ruary 1,1897, there is an abstract of an account, published in the Semaine medicate, of some experiments undertaken by M. Lortet and M. Genoud nearly a year before. On April 23, 1896, eight Guinea-pigs were inoculated in the fold of the right groin with bouillon that had been infected with a Guinea-pig's tuberculous spleen. Two days later three of the animals were stretched out on a board and the inocu- lated region was exposed to the influence of the Rontgen rays. This was done daily for about an hour for fifty-three days. On the 9th of June the five check animals were observed to have spontaneous abscesses, and their in- guinal glands of the affected side were sof- tened. On the other hand, the three that were under treatment with the Rontgen rays had no abscesses and their inguinal glands were firm and sharply defined. Nine days later the five check animals showed abundant suppura- tion in the inguinal fold or on the thigh, and they had manifestly grown thin. The three that were under treatment were in good con- dition and had gained in weight; their ingui- nal glands were small, having gradually shrunk, and showed no tendency to suppuration. The Rontgen rays, therefore", are held to have pre- vented the acute development of tuberculosis in this instance. The authors suggest the therapeutical employment of them in cases of tuberculous disease of the thoracic and ab- | dominal organs, especially in children. GENERAL INDEX. A. B. C. balsam, i, 1. A. B. C. ointment, i, 1. Abelmoschus, i, 1. Abies, i, 1. Abluents. See Detergents. Abortifacients, abortives, i, 1, Abrastol. See Asaprol. Abrin. See under Jequirity (i, 562). Abrus precatorius. See Jequirity. Absinthe, i, 1. Absinthium, i, 1. as an antispasmodic, i, 1. in the treatment of taenia, i, 101. Absorbents, i, 1. See also Sorbefacients. Abstergents, abstersives. See Detergents. Acacia, i, 1. A. C. E. mixture, i, 1. Acetal, i, 1. (as a hypnotic) in mental disturbances, i, 1. Acetaldehyde. See Aldehyde. Acetanilide, i, 2. effects of, on the heart, i, 2. " " on the kidneys, i, 2. " " on the liver, i, 2. (as an antispasmodic) in asthma, i, 4. " " chorea, 1, 4. in epidemic influenza, i, 3. " epilepsy, i, 4. " epistaxis, i, 4. " facial neuralgia, i, 3. " fever, i, 2. " gastralgia, i, 3. " grippe, i, 3. " headache, i, 3. " influenza, i, 3. ■ " lobar pneumonia, i, 4. " locomotor ataxia (lightning pains), i, 3. " migraine, i, 3. " myalgia, i, 3. " neuralgia, i, 3, 69, " neuritis, i, 3. " optic neuritis, i, 3. " pulmonary phthisis, i, 3. " rheumatism, i, 4,125. " sciatica, i, 3. " the crises of tabes, 1, 3. " tremors associated with multiple sclero- sis of the spinal cord, i, 4. " tuberculosis, i, 3. " typhoid fever, i, 3. " whooping-cough, i, 4. " zoster, i, 3. poisoning with, i, 2. 73 Acetbromanilide. See Bromacetanilide. Acetic acid, i, 4. (diluted), as an antidote to poisoning with the caustic alkalies, i, 5. (glacial), for corns, condylomata, fungous growths, and warts, i, 5." (by inhalation), in colds and headache, i, 5. (diluted), in pruritus, i, 5. (externally), in rheumatism, i, 5. in shallow or venereal ulcers, i, 227. poisoning with, i, 4. Acetic aldehyde. See Aldehyde. Acetic ether, i, 5. (by inhalation) in collapse", i, 5. " " faintness, i, 5. Acetone, i, 5 ; ii, 413. Ac.etopbenone, i, 5. as a hypnotic, i, 5. Acetphenetidine. See Phenacetine. Acetum, i. 5. " pyrolignosum. See Pvroligneous acid. Acetylaldehyde. See Aldehyde. Acetylamidobenzene. See Acetanilide. Acetylamidophenol, i, 5. as an antipyretic, i, 5. Acetylamidosalol, i, 5. Acetylene. See under Calcium carbide. Acetyl methyl. See Acetone. Acetylphenylhydrazine. See Hydracetin. Acetyltannin, i, 5. Achillea, i, 6. Acids, i, 6. antidotes for poisoning with, i, 6. mineral, i, 6. as haemostatics, i, 6. as astringents, i, 6. in pruritus, i, 6. " the treatment of taenia, i, 101. " vomiting, i, 100. poisoning with, i, 6, 7, 230. Aconite, i, 7. as a gastric sedative in vomiting, i, 100. effects of internal administration of, i, 7. in acute articular rheumatism, 1, 9. " " otitis, i, 8. " " peritonitis, i. 9. " " pleurisy, i, 9. " " sthenic inflammation, i, 118. " asthma due to exposure, i, 8. " catarrhal fever, i, 8. " chilblains, i, 9. " congestive dysmenorrhoea, i, 9. 460 GENERAL INDEX. Aconite, in congestive neuralgia, i, 69. in coryza, i, 8. " croup, i, 8. " dysmenorrhoea, i, 9. " epistaxis (of the full-blooded), i, 9. " erysipelas, i, 8. " exophthalmic goitre, i, 9. " fever of children, i, 8. " " " tuberculosis, i, 9. " gonorrhoea (early stages), i, 9. " gout (for its anaesthetic effect), i, 9. " measles, i, 8. " meningitis, i, 9. " neuralgia, i, 9, 69. " palpitation from nervousness, i, 9. " pericarditis, i, 9. " pneumonia, i, 9. " pruritus (locally), i, 9. '• quinsy, i, 8. " scarlatina, i, 8. " " smoker's heart," i, 9. " tuberculosis, i, 9. " urethral fever, i, 9. " vomiting of pregnancy, i, 9. physiological action of, i, 8. poisoning with, i, 7, 343. root, tincture of, and tincture of iodine in toothache, i, 136. Aconitine, i, 10. in chronic rheumatism, i, 11. " congestive neuralgia, i, 69. " gout, i, 11. " myalgia, i, 11. " neuralgia, i, 11, 69. " pneumonia, i, 11. " pruritus, i, 11. poisoning with, i, 10. Acorns, i, 11. Acorus calamus. See Calamus. Actaea racemosa. See Cimicifuga. Actinomeris helianthoides, i, 11. in chronic cystitis, i, 11. " dropsy, i, 11. " urinary lithiasis, i, 11. Active principles, i, 11. Actol. See Silver lactate, under Silver. Adansonia, i, 15. Adeps. See Fat, Lard, and Lanolin. Adhaesol. See under Varnishes. Adjuvants, i, 15. Adonidin, i, 15. Adonis, i, 15. effects of, on the heart, i, 15, 16. in palpitation of the heart, i, 15, 16. Adrue. See Cyperus articulatus. Mg\e marmelos. See Bela fruit. Aerotherapeutics. See Air, compressed or RAREFIED. Aerozol, i, 16. Mmgo, i, 16. ^Esculin, i, 16. iEther. See Ether. Mther anaestheticus, i, 16. " chloroformiatus, i, 16. yEtherolea, i, 16. Affusion, i, 16. cold, Currie's method of, in fever, i, 16. " in asphyxia, i, 17. " •' chorea, i, 17. " " coma, i, 17. Affusion, cold, in frostbite, i, 17. cold, in functional disturbances, i, 17. " " hysterical manifestations, i, 17. " " narcotism, i, 17. " " sunstroke, i, 16. " " syncope, i, 17. hot and cold, in chronic inflammatory thick- enings and deposits, i, 17. how to apply the, i, 17. Agaric, i, 17. Agaricin, i, 17. to diminish bronchial secretions and to stop the flow of milk, i, 17. Agaricus albus, i, 17. in night-sweats of phthisis, i, 17. Agaricus chirurgorum, i, 17. in haemorrhage, i, 17. Agaricus muscarius. See Muscarine. Agathin, i, 17. in neuralgia, i, 17. " rheumatism, i, 17. Agglutinants, i, 18, Agrimony, i, 18. Agropyrum repens. See Triticum repens. Ailantus, i, 18. Air, absolute-pressure method, i, 19. apparatus for inspiration of condensed, and expiration into rarefied, i, 21, 22. bath, condensed, in anaemia, i, 28. " " " bronchial asthma, i, 27. " " " catarrh, i, 27. " " " catarrhal deafness, i, 27. " " " chlorosis, i, 28. " " " convalescence after pleu- risy and pneumonia, i, 27. bath, condensed, in hyperaemia of the cutane- ous and respiratory surface, i, 27. bath, condensed, in obesity, i, 28. " pleuritic effusions, i, 27. " pulmonary emphysema, i, 27. ' bath, condensed, in pulmonary tuberculosis, i, 27. bath, condensed, in whooping-cough, i, 27. or rarefied, contra-indica- tions for use of, i, 27. compressed, in asthma, i, 96. condensed or rarefied, i, 18 ; ii, 413. " in pulmonary haemor- rhage, ii, 413. continuous respiration of condensed, i, 25. density of, i, 18. differential-pressure method, i, 20, 21. effect of, upon pathological conditions, i, 24. effect of, on respiration, i, 24. " " " the circulation, i, 24. " " " respiration and circulation, i, 26. expiration into condensed, i, 24. " in chronic pulmo- nary catarrh, i, 28. expiration into condensed, in consolidation after pneumonia, i, 28. expiration into condensed, in heart affec- tions, i, 28. expiration into condensed, in pulmonary tuberculosis, i, 29. expiration into rarefied, i, 25, 28. in asthma depend- ent on emphysema, i, 29. GENERAL INDEX. 461 Air, expiration into rarefied, in bronchorrhoea i, 28. expiration into rarefied, in pulmonary tuber- culosis, i, 28. inspiration of condensed, i, 24. " in asthma, i, 28. " atelectasis, i, 28. " chlorosis, i, 28. " chronic bronchi- tis, i, 28. inspiration of condensed, in chronic broncho- pneumonia, i, 28. inspiration of condensed, in chronic pulmo- nary tuberculosis, i, 28. inspiration of condensed, in convalescence from croupous or catarrhal pneumonia, i, 28. inspiration of condensed, in dyspnoea, i, 28. " lipocardiac asth- ma, i, 28. inspiration of condensed, in mitral insuffi- ciency, i, 28. inspiration of condensed, in pulmonary con- gestion, i, 28. inspiration of condensed, in stenosis, i, 28. " " aiid in- sufficiency of the aortic valves, i, 28* inspiration of condensed, with expiration into rarefied, i, 25. inspiration of rarefied, i, 25. " " for strengthening the muscles of inspiration, i, 29. inspiration of rarefied, with expiration into condensed, i, 25. inspiration of rarefied, with expiration into the same medium, i, 25. localized hot-, treatment in rheumatism, ii, 440. physiological and therapeutical action of, i, 24. physiological effects of the method of abso- lute pressure, i, 25. pneumatic cabinet, i, 19. " chambers, description of, i, 19, 20. rarefied, i, 18. " in asthma, by exhaling into, i, 93. residual, pump, i, 22. respired, i, 18. therapy of respiratory differentiation, i, 28. " " the absolute method, i, 27. Airol, ii, 414. as an antiseptic, ii, 414. " a desiecative, ii. 414. in intertrigo, ii, 414. " tuberculous affections, ii, 414. Ajowan. See Ammi. Aktol. See Silver lactate, under Silver. Alanin. See Amidopropionic acid. Albolene, ii, 414. liquid, ii, 414. Albumin, i, 29. Albuminates, i, 29. Alcohol, i, 29. and ether as heart stimulants, ii, 227. as a cardiac stimulant, ii, 227. " cleansing agent for the skin, i, 30. " narcohypnotic, i, 506. " narcotic, ii, 4. as an excitant, ii, 4. " intoxicant, ii, 4. Alcohol, as a stimulant, i, 33. as a tonic, i, 34. constitutional effects of, in health, i, 31, 32. diagnosis of chronic alcoholism, i, 36, 37. effects of, on the digestive apparatus, i, 35. " " " kidneys, i, 36. " " " " nervous system, i, 35. " " " " vascular system, i, 136. external uses of, i, 31. in A. C. E. mixture, i, 1. (by hypodermic injection) in aconite poison- ing, i, 7. in anorexia, i, 33. (externally) in aphthae of the throat and mouth, i, 31. in asthma, i, 33. " atonic dyspepsia, i, 33. " erysipelas (after Behrend's method), i, 30. " fevers, i, 30, 33. inhalations of, in collapse, i, 31. " " " extreme.asthenia, i, 31. " " inanition, i, 33. " " " shock, i, 31. (subcutaneously) in heart failure (sudden), ii, 227. injections (interstitial) of, in cancer of the uterus, i, 31. in inflammations, i, 30. " insect-poisoning, i, 30. " neuralgia, in small quantities as a nerve stimulant, i, 69. in neurotic affections, i, 33. " shock, i, 34. internal administration of, i, 31. in toxic conditions, i, 33. " treatment of contusions, wounds, and sprains, i, 29, 30. (as a stimulant) in typhoid fever, ii, 225. (externally) in ulcers, i, 31. medicinal application of, i, 29. toxic effects of, i, 34, 290. treatment of chronic alcoholism, i, 38. uses of, in disease, i, 32, 33. Aldehyde, i, 39. Aldehydum trichloratum. See Chloral. Alder. See Alnus. Alembroth. i, 39. Aletris, i, 39. Alexins, i, 39. Alexipharmacs. See Antidotes. Alimentation, i, 39. Debove's powder in rectal, i, 43. in disease, i, 41. " health, i, 40. meat injections in rectal, i, 43. peptonized milk in rectal, i, 43. " suppositories in, i, 43. rectal, i, 42. table showing daily supply of food necessary for an adult doing ordinary work, i, 4. Alisma, i, 43. in irritative affections of the urinary pas- sages, i. 43. Alkalies, i, 43. and their carbonates as antidotes to poison- ing by acids, i, 6. alkaline baths in dry and scalv eruptions, i, 45. alkaline baths in the itching of lichen, i, 45. " " " urticaria, i, 45. 462 GENERAL INDEX. Alkalies, as germicides, i, 447. in asthma, i, 96. " atonic dyspepsia, i, 44. " cirrhosis of the liver, i, 45. " cystitis without decomposition, i, 44. " diarrhoeas with acid, fluid, irritating stools, i, 44. " eczema, i, 44. " gonorrhoea, i, 44. " hepatic and splenic dropsy, i, 45. " hepatic diabetes, i, 45. " jaundice, i, 45. " leucorrhoea, i, 44. " lithiasis, i, 45. " measles, to hasten desquamation, i, 44, " rheumatism, i, 45, 125. " scarlet fever, to hasten desquamation, i, 44. " sluggish liver, i, 45. " strangury, i, 44. " the moist stage of eczema, i, 44. " undue acidity of the blood, i, 44. Alkaloids, i, 45. poisoning with, i, 232, 433. Alkanet, i, 45. Allamanda cathartica, i, 45. Allspice. See Pimenta. Allyl, i, 45. sul phocarbamide. sulphourea. thiourea. See Thiosinamine. tribromide, ii, 414. " as an anodyne and sedative, ii, 414. " in asthma, ii, 414. " " hysteria, ii, 414. " " whooping-cough, ii, 414. Almonds, i, 45. Aloes, i, 46. action of, on the intestines, i, 47. as a laxative, i, 48. as an anthelminthic, i, 48. contra-indications for the use of, i, 48. enema of, in ascarides vermiculares, i, 102. in amenorrhoea, i, 49. " anaemia, i, 48. " atony of the sexual apparatus in women, i, 49. " catarrhal jaundice, i, 49. " constipation, i, 48. " gonorrhoea, i, 49. " haemorrhoids, i, 48. " intestinal indigestion, i, 48. locally, in bedsores, and fissures in mucous membranes, i, 49. Alpha-naphthol, i, 49. Alphol, i, 49. in acute articular rheumatism, i, 49. " gonorrhceal cystitis, i, 49. Alstonia, i, 49. Alstonidine, i, 49. Alstonine, i, 49. Alterants, i, 49. Alteratives, i, 49. Althaea. See Marshmallow. Alum, i, 50. as a styptic in haemorrhage from mucous membranes, i, 50. burnt, i, 50. curd applications in chilblains, i, 50. " " " granulating tissue, i, 50. Alum, dried, for destruction of flabby and un- healthy granulations, i, 225. in catarrhal affections, i, 50. " diarrhoea, i, 50. " dysentery, i, 50. " enlarged tonsils, i, 50. " granular lids, i, 50. " lead colic, i, 50. " vomiting of chronic gastric disease, i, 50. poisoning with, i, 109. powder (faucial irrigation) in croup and diphtheria, i, 50. tannate of, in gleet and gonorrhoea, i, 50. water in colliquative sweats (by sponging the body), i, 50. whey in diabetes, i, 50. Aluminium or aluminum and its salts, i, 50. acetate of, as a surgical dressing, i, 51. as an antiseptic, ii, 414. " " astringent, ii, 414. benzoinated solution of, in fcetid leucorrhoea, i, 51. boroformate, i, 50. borotannicotartrate, ii, 414. chloride, i, 51. in catarrhal states of the skin or mucous membranes, ii, 414. hydrate, i, 51. sulphate, i, 51. '• in solution as an antiseptic for the nose, throat, and vagina, i, 51. sulphate, in weak solution, as a lotion for ulcers and foetid vaginal discharges, i, 51. sulphophenate of, and potassium, as a haemo- static and disinfectant, i, 51. tannate, in acute gonorrhoea, ii, 259. Alumnol, i, 51. application in skin diseases, i, 51. as a dressing for venereal sores, i, 51. for checking lacrymation and epiphora, i, for the irrigation of abscesses and wounds, i, 51. injections in gonorrhoea, i, 51. Alveloz, i, 51. as an application to cancerous and syphilitic ulcers, i, 51. Amanita muscaria. See under Agaric, i, 52. Amanitine. See Muscarine. Amara. See Bitters. Amber, i, 52; ii, 414. oil of, in chronic bronchitis, ii, 414. " " " gout, i, 52. " " " infantile diarrhoea, i, 52. " " " whooping-cough, i, 52 ; ii, 414. " " " winter cough, ii, 414. Amblotics. See Abortifacients. Ambrosia, i, 52. ^ in epistaxis, i, 52. Ame, i, 52. Amidobenzene. See Aniline. Amidopropionic acid, i, 52. (subcutaneously) in syphilis, i, 52. Ammi, i, 52. Ammonia, i, 52. externally, as a counter-irritant, i, 53. foetid spirit of, in gastro-neuroses, i, 53. " " " hysterical conditions, i, 53. in aconite poisoning, i, 7. " collapse, ii, 227. GENERAL INDEX. 403 Ammonia, inhalation of the vapour of, in opium narcosis, i, 52. inhalation of the vapour of, in cardiac de- pression, i, 52. inhalation of the vapour of, in syncope, i, 52. in intoxication with cardiac depression, ii, 227. in poisonous insect bites and stings, i, 53. liniment, in neuralgia and rheumatism, i, 53. physiological action of, i, 52. solution of, in collapse (by hypodermic injec- tion), i, 53. solution of, in snake-bite (by hypodermic in- jection), i, 53. spirit of, in headache, i, 53. " " in post-febrile asthenic conditions, i, 53. water, i, 52. " as an antiseptic, i, 53. " for emesis in acute alcoholism, i, 53. " in colic and flatulence of children, i, 54. water in gastric fermentation, i, 53. " " " superacidity, i, 53. Ammoniac, i, 54. as a stimulating expectorant, i, 54. Ammoniated mercury ointment in the treat- ment of pediculi, i, 116. Ammonium, i, 54. acetate, i, 54. " as a lotion in bruises, i. 54. " " " " " glandular enlarge- ments, i, 54. acetate as a lotion in sprains, i, 54. " in delirium due to biliousness, i, 54. " " exanthemata, i, 54. " " fever, i, 54. " " headache, i, 54. " " infantile coryza, i, 54. " " influenza, i, 54. " locally, in porrigo, i, 54. benzoate, i, 177. for phosphatic calculi, i, 177. in incontinence of urine, i, 177. " irritability of the bladder, i, 177. Ammonium biborate. See Ammonium borate. bicarbonate, i, 54. as an antacid, i, 55. in cystic catarrh, i, 55. '• intermittent fever, i. 55. " malarial disease, i, 55. " phthisis, i, 55. " renal colic, i. 55. carbazotate, i. 55. carbonate, i. 55. as an antacid, i, 55. as a stimulant expectorant in chronic bron- chitis and pneumonia, i, 56. effect of, on urea, i. 55. in asthma associated with cardiac disorders, i, 55. " chorea, i, 56. " chronic bronchitis, i, 55. " colic, i, 55. " cystinuria, i, 56. " diabetes mellitus, i, 56. " epilepsy, i. 56. " erythema, i, 56. " fatty liver, i, 56. " flatulence, i, 55. Ammonium carbonate, in hysteria, i. 56. in roseola, i, 56. " rubeola, i, 56. " scarlatina, i, 56. " typhoid fever, i, 56. " urticaria, i, 56. carbonicum pyro-oleosum in hysterical con- ditions, i, 56. chloride, i, 50. in amenorrhoea, i, 57. " amyloid liver, i, 57. " bronchitis, i, 56. " chronic bronchitis, i, 418. " chronic nasal catarrh, i. 528. '• delirium tremens, ii, 415. " dropsy, i, 57. " facial neuralgia, i, 57. " functional hepatic derangement associated with lithaemia, i. 56. " gastric catarrh, i. 56. '- haemorrhages, i, 57. " headache, i, 57. " hepatic abscess, i, 57. " hepatic congestion, i, 56. " hepatic inflammations, i, 56. " intercostal neuralgia, i, 57. " intermittent fever, i, 56. " intestinal catarrh, i, 56. " laryngitis, i, 57. " myalgia, i, 57. " ovarian neuralgia, i, 57. " pharyngitis, i, 57. " senile gangrene, i, 57. " subacute bronchitis, i, 57. " whooping-cough, i, 57. vapour inhalations in coryza, i, 57. " " " inflammations of the bronchi, i, 57. vapour inhalations in inflammations of the larynx, i, 57. • vapour inhalations in inflammations of the pharynx, i, 57. citrate, i, 57. embellate, i, 57. as a taeniafuge, i, 57. in diseases of the bladder, i, 57. fluoride, i, 57. •' liquor ammonii fluoridi in hyper- trophied spleens, i, 57. fluoride, liquor ammonii fluoridi inhalations in phthisis, i, 57. formate, i, 57. in muscular paresis, i, 57. " reflex paralysis, i, 57. hydrosulphide, i, 57. in catarrh, i, 57. " diabetes, i, 57. " dysuria, i, 57. " rheumatic diseases, i, 57. nitrate, i, 57. phosphate. See under Phosphorus. physiological action of, i, 54. pic'rate. See Ammonium carbazotate. picronitricum. i, 55. salicylate. See under Salicylic acid. succinate, i, 57. in delirium tremens, i, 58. (ethereal solution of) in the convulsive dis- orders of children, i, 58. solution of, in asthma, i, 58. 4G4 GENERAL INDEX. Ammonium, succinate, in convulsive disorders, i, 58. in hysterical disorders, i, 58. " rheumatism, i, 58. sulphate, i, 58. as a stimulant, i, 58. sulphichthyolate. See Ichthyol. sulphydrate. See Ammonium hydrosul- phide. tetrethylate, i, 58. in acute articular rheumatism, i, 58. " gouty deposits, i, 58. urate, i, 58. in eczema, i, 58. Ammonol, ii, 415. Amplosia, i, 58. Amygdala, amygdalin, amygdalus. See under Almonds. Amygdophenine, ii, 415. in aortic insufficiency, ii, 415. " neuralgia, ii, 415. " rheumatism, ii, 415. Amyla^ther nitrosus. See Amyl nitrite. Amyl alcohol, i, 58. chloride, i, 58. as an anaesthetic, i, 58. hydride, i, 59. as an anaesthetic, i, 59. iodide, i, 59. nitrite, i, 59. as an antidote in cocaine poisoning, i, 62. doses and administration of, i, 60. effects of, on the circulation, i, 59. " " " " nervous system, i, 59. " '' " " temperature, i, 60. '• " " " urine, i, 60. in angeiospasm, i, 60. '• angina pectoris, i, 60, 61, 528. " asthma (for temporary relief), i, 95. " bronchial spasm (by inhalation), i, 133. " cardiac failure, i, 528. " cardiac, pulmonary, and nervous disor- ders, i, 60. " cocaine poisoning, i, 62. inhalations in aortic insufficiency, i, 61. " " asthma, i, 61. " " cardiac dyspnoea, i, 61. " " cardiac failure, i, 61. " " catalepsy, i, 61. " " cerebral anaemia, i, 61. " " dyspnoea due to asthma and bronchitis, i, 61. inhalations in epilepsy, i, 61. t " " headache due to anaemia of the brain, i, 61. inhalations in heart failure, ii, 227. " " hystero-epilepsy, i. 61. ' " " migraine attended, with an- geiospasm, i, 61. inhalations in strychnine poisoning, i, 62. " " syncope, i, 61. " " tetanus, i, 61. " " uraemic dyspnoea, i, 61. in hay asthma, i, 529. " increased blood-pressure, i, 60. " neuralgia as a nerve stimulant, i, 69. " pneumonia, ii, 415. " Raynaud's disease, i, 62. " reflex vaso-motor disturbances, i, 61. " seasickness, i, 61, 99. Amyl nitrite, in strychnine poisoning, i, 528. in trigeminal neuralgia, i, 61. " uraemic convulsions, i, 528. symptoms caused by inhaling, i, 59. tertiary, i, 61. tertiary, inhalations as a hypnotic, i, 61. Amylamine chloride, i, 58. Amylene, i, 58. as an anaesthetic, i, 58. Amylene hydrate, i, 58. as a hypnotic, i, 58, 507. as an anaesthetic, i, 58. Amyloform, ii, 415. as an antiseptic and deodorizer for wounds, ii, 415. Amylonitrous ether. See Amyl nitrite. Amylum. See Starch. Amyl valerianate, i, 62. as an antispasmodic, i, 62. " a calmative, i, 62. in hepatic colic, i, 62. " hysterical paroxysms, i, 62. " migraine, i, 62. " muscular rheumatism, i, 62. " nephritic colic, i, 62. " neuralgia, i, 62. " spasmodic dysmenorrhoea, i, 62, Anacardium Occident ale. See Cashew nut. Anacyclus. See Pyrethrum. Anaesthesia, i, 62. breathing and pulse during, i, 64. general, i, 63. hypnotic. See under Hypnotism. La horde's method of resuscitation from, i, 64; ii, 416. local, i, 66, 397. mixed, i, 66. primary, i, 63. resuscitation from, i, 64, 65 ; ii, 416. vomiting during,!, 63. Anaesthetics, i, 62. administration of, i, 63, 64. Anaestile, ii, 416. as a local anaesthetic, ii, 416. Anagallis, i, 66. in rabies, i, 66. Anagyrine, i, 66. Analeptics, i, 66. Analgene, i, 66. in neuralgia, i, 66. " rheumatism, i, 66. " spasmodic asthma, i, 66. Analgesics. See Analgetics. Analgesine. See Antipyrine. Analgetics, i, 66. Anaphrodisiacs. See Antaphrodisiacs. Anatriptics, i, 69. Anda oil, i, 70. Andira, i, 70. in lumbricoid worms, i, 70. Andrographis paniculata, i, 70. Andropogon, i, 70. Anemone pratensis, Anemone pulsatilla. See Pulsatilla. Anemonin, i, 70; ii, 107. in dysmenorrhoea, i, 70. Anethol, ii, 416. as an antiseptic, ii, 416. Anethum foeniculum. See Dill. Angeioneurosine. See Nitroglycerin. GENERAL INDEX. 465 Angelica, i, 70. Angine, i, 70. Angostura, Angustura. See Cusparia, i, 70. Anhalonine, i, 70; ii, 417. as a cardiac and respiratory stimulant in angina pectoris, ii, 417. in asthma, ii, 417. Anhalonium Lewinii, i, 70; ii, 416. in colic, ii, 416. " cough (nervous), ii, 416. " delirium, ii, 416. " frontal cephalalgia, ii, 417. " hypochondriasis, ii, 416. " hysteria, ii, 416. " insomnia of pain, ii, 416. '• mania, ii, 416. " melancholia, ii, 416. Anhydroglucochloral. See Chloralose. Anhydrosulphamenebenzoic acid. See Sac- charin, Anidrotics. See Anthidrotics. Aniline, i, 70. Aniline camphorate, i, 70. in chorea, i, 70. " epilepsy, i, 70. Animal extracts and juices, i, 70. hypodermic method of administering, i. 73. preparation of, for hypodermic administra- tion, i 71. Anise, Aniseed, i, 85. Annidalin, i, 85. Anodyne colloid, i, 292. in lumbago, i, 292. " muscular pains, i, 292. " neuralgia, i, 292. Anodynes. See Analgetics. Anodynine. See Antipyrine. Antacidine, i, 85. Antacids, i, 85. in acid diarrhoea, i, 86. " aphthous sore mouth, i, 86. " colic, i, 86. " pyrosis with acid eructations, i, 86. Antagonism, physiological, i, 86. toxicological, i, 87. Antagonists, i, 86. table of, i, 89. therapeutical, i, 89. Antaphrodisiacs, i, 90. Antarthritics, i, 90. Antasthmatics, i, 91. Antatrophics, i. 97. Antemetics, i, 97. Antennaria. See Gnaphalium. Antepileptics, i, 100. Anterotics. See Antaphrodisiacs. Anthelminthics, u 101. Anthemis. See Chamomile. Anthemis inhalation in catarrh of the upper air-passages, i, 231. Anthidrotics, i, 102. Anthracite, i, 103. powdered coal in treatment of taenia, l, 102. Anthrarobin, i, 103. in erythrasma, i. 103. " psoriasis, i, 103. " ringworm, i, 103. Anthydropics, i, 103. in dropsical effusions, i, 103. Anthydropin. See under Blatta. Anthysterics, i, 103, Antiarin, i, 104. Antiaris, i, 103. Antibacteria. i, 104. Antibakterikon, i, 104. 4 Antiblennorrhagics, i, 104. Anticnesmaticsri, 106. Anticolics, i, 107. Anticonvulsives. See Antispasmodics. Antideperditories, i, 107. Antidiphtherine, i, 107. application of, i, 107. in diphtheria, i, 107. Antidiphtheritics, i, 107. Antidiphtheritic serum. See under Antitox- ines. Antidotes, i, 86, 107. chemical, i, 108. mechanical, i, 108. Antidotum arsenici, i, 111. Antidyscratics, i, 111. Antidysenterics, i, 111. Antifebnne. See Acetanilide. Antifermentatives. See Antizymotics. Antifungin, i, 111. Antigalactics, i, 111. Antigonorrhoics. See Anttblennorriiagics. Antihydropin. See Blatta. Antikamnia, i, 111. in influenza, i, 112. " melancholia, i, 112. " neuralgia, i, 112. Antikol, i, 112. Antilithics, i, 112. Antiluetics. See Antisyphilitics. Antimiasmatics. See Antiperiodics. Antimonial powder, i, 114. wine, i, 114. Antimony, i, 112. acute poisoning with, i, 112. chronic poisoning with, i, 113. compound pills of, in cutaneous disorders, i, 114. effects of small doses of, i, 112. pills of, in rheumatism, i, 114. in acute indigestion of children, i, 114. " acute sthenic inflammations, i, 118. " asthma, i, 114. " catarrhal disorders, i, 114. " dislocations, i, 114. " mammitis, i, 114. " mania, i, 114. " noisy sthenic delirium, i, 114. " orchitis, i, 114. " puerperal fever, i, 114. " rigidity of the os uteri during labour, i, 114. " sthenic fever, i, 114. " strangulated hernia, i, 114. " treatment of poisoning by, i, 112,113. Antinarcotics, i, 115. Antinervin, i, 115. Ant ineuralgics. See under Analgetics. Antinosine, ii, 417. Antiparasitics, i, 115. Antiperiodics, i, 117. Antiperiodic tincture, i, 118, 258. Antiphlogistics, i, 118. Antiphtheirics, Antiphthirics, i, 119. Antiphthisin, i, 119. in fever, i, 119. 466 GENERAL INDEX. Antiphthisin, in pulmonary tuberculosis, i, 119. in tuberculous ulcers, i, 120. (hypodermically) in tuberculosis (early stages), i, 120. preparation of, i, 119. rectal injections of, in early stages of tuber- culosis, i, 120. Anaplastics, i, 120. Antipruritics. See Anticnesmatics. Antipyonine, i, 120. for prevention of suppuration in affections of the cornea and conjunctiva, i, 120. (in weak solution) in conjunctivitis, i, 120. in corneal ulcers, i, 120. (in weak solution) in keratitis, i, 120. in panophthalmitis (after enucleation), i, 120. " pannus, i, 120. " purulent conjunctivitis, i, 120. Antipyretics, i, 120. in fever, i, 120, 121. Antipyrine, i, 123. (as an anodyne) in cystitis, i, 124. in bronchial asthma, i, 124. '• chorea, i,' 124. " delirium, i, 123. " fever, i, 123. " locomotor ataxia (for fulgurant pains), i, 124. (solution) in haemorrhage, i, 466. in hectic tuberculosis, i, 123. " hemicrania, i, 124. " measles, i, 123. " nervous dysmenorrhoea, i, 24. " neuralgia, i, 69. " pneumonia, i, 123. " rheumatism, i, 125. " scarlatina, i. 123. " sciatica, i, 124. '• typhoid fever, i, 123. " whooping-cough, i, 124. phenylglycolate. See Tussol. salicylate. See Salipyrine. table of doses for children, i, 123. Antirrheumatics, i, 124. Antirrheumatin, i, 126. in rheumatism, i, 126. Antiscorbutics, i, 126. Antisepsin, i, 126. in ulcers, i, 126. " wounds, i, 126. Antiseptic precautions in the sick-chamber i, 441. Antiseptics, i, 126. in obstetrics, i, 130. " surgery, i, 126. " " dressings in, i, 129. " " the operating room, i, 129. " " the operation before and after, i, 130. " surgery, the personal cleanliness of the operator and his assistants, i, 129. " surgery, the preparation of instruments, i, 128. " surgery, preparation of the genito-urinary passages of the male, i, 128. " surgery, preparation of the nasal and oral cavities, i, 127. " surgery, preparation of the pelvic organs in the female, i, 128. Antiseptics, in surgery, preparation of the rec- tum and anus, i, 127. in surgery, preparation of the skin of the head, trunk, and extremities, i, 127. " surgery, sutures and ligature material, i, 128. internal use of, i, 132. Antiseptol, i, 133. Antispasmin, i, 133. " in whooping-cough, i, 133. Antispasmodics, i, 133. Antistreptococcic serum, Antistreptococcin, Antistreptoeoccus serum. See under Serum treatment (vol. ii, page 178). Antisudin, i, 134. Antisudorifics. See Anthidrotics. Antisudorin, i, 134. in local hyperidrosis, i, 134. Antisyphilitics, i, 134. Antitaenia, i, 134. Antitetanics, i, 134. Antitetraizine, i, 134. in influenza, i, 134. " neuralgia, i, 134. " rheumatism, i, 134. Antithermics. See Antipyretics. Antithermin, i, 134. . Antitoxine, " double " or •' dual," ii, 175. Antitoxines, i, 134. Antivenene. See under Serum treatment (vol. ii, page 188). Antizymotics, i, 135. Antodontalgics, i, 135. Anuretics, i, 136. Aparine. See Galium. Apenta water, ii, 417. Aperients, Aperitives. See under Cathartics. Aphrodisiacs, i, 136. Apiol, i, 137. in amenorrhoea, i, 138. " dysmenorrhoea, i, 137. " intermittent fever, i, 137. " malarial neuralgia, i, 137. " neuralgic dysmenorrhoea, i, 138. Apocodeine, i, 138. Apocynum, i, 138. in dropsy, i, 138. Apolysine, ii, 417. as an analgetic, ii, 417. as an antipyretic, ii, 417. in lumbago", ii, 417. " muscular rheumatism, ii, 417. " neuralgia, ii, 417. Apomorphine, i, 138; ii, 417. as an antispasmodic, ii, 417. effects of on the bronchial secretion, i, 139. " " " " circulation, i, 139. hypodermic use of, i, 139. in asthma, ii, 418. " bronchial catarrh (as an expectorant), i, " bronchorrhoea, i, 139. " chronic bronchitis, i, 139. " hiccough, ii, 417. " hysteria, ii, 418. " pulmonary emphysema, i, 139. " tetanus, ii, 417. physiological action of, i, 138. Apone, i, 139. in dyspepsia, i, 139. GENERAL INDEX. 467 Apone, in haemorrhoids, i, 139. in muscular rheumatism, i, 139. " neuralgia, i, 139. Apozemata, i, 139. Apyonine, i, 139. Aqua. See Water. Aquozone, i, 140. Arachis hypogaea, i, 140; ii, 418. in constipation, i, 140. " diabetes (as a bread), ii, 418. Aranea, i, 140. Araroba, See under Chrysarobin. Arbor vita?. See Thuja. Arbutin, i, 140. Arbutus. See Uva ursi. Archangelica. See Angelica. Arctium. See Lappa. Arctostaphylos, i, 140.^ Arecane, Arecoline, Arekane, i, 140. Areca nut, in treatment of taenia, i, 102. Argentamine, i, 140. in gonorrhoea, i, 140. Argentum. See Silver. Argonin. See under Silver (vol. ii, page 197). as an antiseptic, ii, 197. in catarrhal conjunctivitis, ii, 197. " gonorrhoea, ii, 197. " purulent conjunctivitis, ii, 197. Aristol, i, 140. for vegetable parasites, i, 140. in chronic rhinitis, i, 140. •' interstitial keratitis, i, 140. " ozaena, i, 140. " psoriasis, i, 140. " suppurative diseases of the middle ear, i, 140. " syphilitic ulceration, i, 140. " tuberculosis (hypodermically), i, 140. " ulcers, i, 140. " ulcers of the leg, i, 140. Aristolochia. See Serpentaria. Armoracia. See Horseradish. Arnica, i, 141. and honey, as a plaster for boils, i, 141. in abrasions, i, 141. " bruises, i, 141. (in small doses) in congestive dysmenorrhoea, i, 141. in cutaneous eruptions, i, 141. " delirium tremens of an asthenic type, i, 141. " fevers, i, 141. " inflammation of pelvic cellular tissue, i, 141. " inflammatory conditions, i, 141. " melancholia of an asthenic type, i, 141. " rheumatic gout, i, 141. " rheumatism, i, 141. " shock, i, 141. " sprains, i, 141. Arnicin, i, 141. Aromatics, i, 141. Arrowroot, i, 141. Arscnauro, i. 142. Arsenic, i, 142. after-treatment of poisoning by, i, 143. and iron in neuralgia, i, 68. as a stimulant, i, 143. bromide of, in asthma, i, 97. chloride of, in asthma, i, 97. Arsenic, effects of internal doses of, i, 142, 143. effects of on the respiration and circulation, i, 142. for warts, i, 144, in acne, i, 144. " amenorrhoea, i, 146. " anaemia, i, 145. " angina pectoris, i, 146. " asthma, i, 96. '• cancer, as a caustic, i, 144. •' cardiac dyspnoea, i, 146. " cardiac neuroses, i, 146. " chlorosis (as an emmenagogue), i, 374. " chronic bronchitis, i, 146. " chronic gastric catarrh, i, 146. " chronic malarial poisoning, i, 145. " chronic oophoritis, i, 146. " chronic rheumatism, i, 145. " chronic urticaria, i, 144. " cirrhosis of the liver, i, 146. " cystic goitre, i, 146. " diabetes, i, 145. " diarrhoea, i, 146. " eczema, i, 144. " epithelioma, i, 144. " gastralgia, i, 146. " gastric neuroses, i, 146. " gastrodynia, ii, 146. " hemorrhoids, i, 146. " Hodgkin's disease, i, 144. " intermittency of the pulse, i. 146. " intermittent"fever, i, 117, 145. " intestinal indigestion, i. 146. " leucaemia, i, 145. " lichen planus, i, 144. " " ruber, i, 144. " lupus erythematosus, i, 144. " lymphoma, ii, 144. " malarial cachexia, ii, 145. " malarial infection, as a prophvlactic, i. 145. " morning vomiting of drunkards, i, 146. " multiple sarcoma, i, 114. " neuralgia, i, 146. " neurotic asthma, i, 146. " pain of aortic regurgitation, i, 146. " palpitation of the heart, i, 146. " pelvic peritonitis, i, 146. " pemphigus, i, 144. " psoriasis, i, 144. " pulmonary emphysema, i, 146. " pulmonary phthisis, early stages, i, 146. " regurgitation of food, i, 146. " rheumatic gout, i, 145. " seborrhcea, i, 144. " secondary syphilis, i, 145. " snake-bites, i, 146. " the wasting diseases of the puerperal pe- riod, i, 145. " tremor of central nervous lesions, i, 146. " ulcer of the stomach, i, 146. " uterine congestion, i, 146. " vaginal leucorrhcea, i. 146. " vomiting due to gastric irritation, i, 99. " vomiting of drunkards, i, 146. " vomiting of pregnancy, i, 146. " weak heart accompanied by pain, i, 146. ointment in pediculosis, i. 145. " " scabies, i, 145. poisoning with, i, 143, 552, 591; ii, 406. therapeutics of, i, 143. 468 GENERAL INDEX. Arsenium. See Arsenic Arsenous acid in asthma, i, 97. Arsenous oxide, i, 142. Arsenum. See Arsenic. Artemisia, i, 147. Asafcetida, i, 147. (as a stimulant expectorant) in chronic bron- chial and laryngeal affections, i, 147. in asthma, i, 147. " chorea of young girls, i, 147. " constipation, i, 147. " flatulence, i, 147. " hypochondriacal affections, i, 147. " hysterical attacks, i, 147. " indigestion, i, 147. " nervous irritability, ii, 6. " threatening abortion, i, 147. (enema) in tympanites of typhoid fever, i, 147. in whooping-cough, after the acute stage has subsided, i, 147. Asaprol, i, 148. as an anodyne, i, 68. in fermentative dyspepsia, i, 148. " influenza, as an antipyretic, i, 148. " neuralgia, for immediate relief, i, 69. (as an antipyretic) in pneumonia, i, 148. (as an antipyretic) in typhoid fever, i, 148. in rheumatism, i, 148. " treatment of boils, i, 148. Asarum, i, 148. Asbestos, ii, 419. as a surgical dressing, ii, 418. Asclepias curassavica, i, 148. Asclepias tuberosa, i, 148. in acute exanthemata, i, 148. " catarrh of the respiratory tract, i, 148. " fever, i, 148. Asepsin. See Antisepsin. Aseptol, i, 148. Asparagin, i, 148. (by hypodermic injection) in syphilis, i, 148. Asparagus, i, 149. Asparamide. See Asparagin. Aspidium, i, 149. in the treatment of taenia, i, 102, 149. Aspidosamine, Aspidosperma, Aspidosperma- tine, Aspidospermine, i, 149. Aspiration, i, 149. Dieulafoy's rules for, in empyema, i, 151. in abscesses, i, 152. " ascites, i, 152. " chronic congestive hepatitis, i, 151. " chronic hydrocephalus, i, 150. " cystic tumours of the ovaries and broad ligaments, i, 152. " diagnosis and treatment of abscesses, cysts etc., i, 149. " fluctuating enlargements of the joints, i. 152. " haemothorax, i, 151. " hepatic echinococcus, i. 151. " hernia, i, 152. " hydropericardium, i, 151. " hydrothorax, i, 151. " iliac phlegmon, i, 152. " intestinal occlusion, i, 152, " nephrydrosis, i, 151. " pericarditis, i, 150. " pericarditis with effusion, i, 151. " perityphlitic abscess, i, 152. Aspiration, in pleurisy with effusion, i, 150. in pneumonia, i, 150. " pneumothorax, i, 151. " retention of urine due to stricture, hy- pertrophied prostate, or ruptured urethra, i, 152. " spina bifida, i, 150. " suppurative hepatitis, i, 151. " valvular heart disease, i, 150. preparation of needles, tube, air-pump, etc., before, i, 149, 150. Asteracantha longifolia, i, 152. Astringents, i, 152. in checking exudation, i, 153. " chronic and subacute diarrhoeas, i, 153. " chronic inflammations of mucous mem- branes, i, 153. " haemorrhage, i, 153. " subacute inflammation, i, 153. " ulcerations, i, 153. Atropa belladonna. See Belladonna. Atropine, i, 154. anaesthetic effect of, i, 154. as a mydriatic, i, 649. as an anthidrotic, i, 103. effect of external application of, i, 154. for inflamed and swollen parts (externally), i, 154. hypodermically for its general and systemic effects, i, 156. hypodermically for local and constitutional effects, i, 156. in hepatic colic, i, 67. " inflammation of the sciatic nerve, i, 67. " spasmodic dysmenorrhoea, i, 67. (by hypodermic injection) in aconite poison- ing, i, 7. in blepharitis, i, 155. " cancerous tumors (externally), i, 154. " cardiac syncope, i, 156. " collapse of fevers, sunstroke, etc., i, 156. " conjunctivitis with granulation, i, 155. " diseases of the eye, i, 155. " earache, i, 156. " erysipelas, i, 156. " erythematous dermatitis, i, 156. " glaucoma, i, 154, 156. (externally) in infiltrations, i, 154. in neuralgia of the trigeminus, i, 156. (externally) in neuralgia, i, 154. in opium poisoning, i, 156. " phlyctaenular conditions of the cornea, i, 155. " photophobia of acute conjunctivitis, i, 155. " poisoning by Calabar bean, i, 156. (locally) in sciatica, i, 156. in serious collapse, i, 156. " swelling of the mammary glands, i, 156. internal application of, i, 157. in ulcerations of the cornea, i, 155. " vomiting, i, 99. physiological effect of, i, 154. poisoning (see under Belladonna, vol. i p 175). ' ^ sulphate (1-per-cent. solution) in toothache. l, 136. small doses, as a corrective of the unpleasant effect of quinine, ii. 419. therapeutics of, i, 155. Auramine, i, 157. GENERAL INDEX, 469 Aurantium, i, 157. juice of. in scurvy, i, 157. Aurum. See Gold. Ava. See Kava. Avena. See Oatmeal. Axeromaticon, i, 157. in hyperidrosis, i, 157. Axungia. See Lard. Aya-pana, i, 157. Azederach, i, 158. in helminthiasis, i, 158. Azote. See Nitrogen. Bacilli, i, 158. Bacteriotherapy, i, 158. treatment oftuberculosis by, i, 158, 159. Bael fruit. See Bela. Baffine, i, 159. Balneotherapeutics. See under Baths. Balsamics, Balsams, i, 159. as local stimulants, i, 159. in asthma, i, 160. " atonic catarrhal inflammation, i, 160. " laryngeal catarrh, i, 529. " pulmonary catarrh, i, 529. " pulmonary tuberculosis, i, 529. " whooping-cough, i, 529. Balsam, friar's, i, 159. Balsamum pulmonum, ii, 241. in acute and chronic bronchitis, ii, 241. Bantingism, i, 160. Baptin, i, 160. Baptisia tinctoria, i, 180. Baptisin, i, 160. Baptitoxine, i, 160. Bardana. See Lappa. Barium, 1, 160. bromide. See under Bromine. carbonate, i, 161. chloride, i, 161. in cardiac disease, i, 161. " cutaneous diseases, 1, 162. " diffuse and multiple cerebral sclerosis, i, 161. " dry eczema, i. 162. " functional cardiac disorder, i, 161. " paralysis agitans, i, 162. " tetanus, i, 161. '• valvular disease of the heart, i, 161. " varicose veins, i, 1(12. " white swelling, i, 161. dioxide, i, 162. hyperoxide, i, 162. iodide. See under Iodine. oxide, i, 162. peroxide, i, 162. poisoning with, i, 161. salts, effect of, on the ventricles of the heart, i, 160. sulphide, i, 162. sulphocarbolate, i, 162. in colliquative diarrhoea, i. 162. " gastro-intestinal disturbances, i, 102. Barley. See Hordeum. Barley water in febrile conditions, i, 351. Barosma. Sec Buchu. Baryta. See Barium oxide, under Barium, vol. i, page 162. Baryum. See Barium. Basilicon ointment, i, 162. Basilicon ointment, in burns, ii, 135. in indolent ulcers, ii, 135. Baths, i, 162; ii, 419. acid, i, 171. alkaline, i, 170. in chronic rheumatism, i. 171. " " vesicular skin diseases, i, 171. '• functional nervous disorders, i, 171. - gout, i, 171. " ichthyosis, i, 171. " jaundice, i, 171. " prurigo, i, 171. " psoriasis, i, 171. " squamous skin diseases, i, 171. " urinary lithiasis, i, 171. alternating, i, 166. aromatic, i, 171. arsenical, in rheumatic arthritis, i, 171. artificial Nauheim, ii, 425. " Plombieres. i. 171. Vichy, i, 171.' bromine, in syphilis and squamous skin dis- eases, i, 170. cold, i, 165. " action of, on the constitution, i, 482, 483, 484. " effect of, on the red blood-corpuscles, i, 164. " effect of, on the respiration, i, 164, 468. '• effects of, on the nervous system, 1, 486. " foot, in chilblains, i, 170. " " " bromidrosis, i, 170. " " " frostbite, 1, 170. " " " menorrhagia, i, 170. " for the insane, to induce sleep, i, 488. " in acute articular rheumatism, i, 488. " " " infectious diseases, i, 486. " " " hyperpyrexia, i, 486. " " asphyxia of the newborn, ii, 128. " " cardiac diseases, i, 165. " " cerebro-spinal meningitis, i, 488. " cholera infantum, i, 488. " " diphtheria, i, 488. " " epilepsy, i, 488. " " erysipelas, i, 488. " (as a stimulant) in insolation, ii, 225. " manner of giving, i, 165. " in neuralgia, i, 165. " " neurasthenia, i, 165, 488. " " pulmonary diseases, i, 165. " " quinsy, i, 488. " " rheumatic conditions, i, 165. " " scarlatina, i, 488. " " sepsis, i, 488. " " small-pox, i, 488. " " sunstroke, i, 486. " " typhoid fever, i, 486. " " typhus fever, i, 488. " (permanent or continuous immersion) in variola and pemphigus vegetans, i, 488. cold sitz, contra-indicated in heart disease, i, 169. cold sitz, in amenorrhoea, i, 169. " " " atony of the bladder, i, 169. " " " cerebral hyperemia, i, 169. " " " chordee, i, 489. " " " chronic diarrhoea, i, 169. " " " '• dysentery, i, 169. " " " " engorgement of the liver and spleen, i, 169. 470 GENERAL INDEX. Baths, cold sitz, in chronic posterior urethritis, i, 489. cold sitz, in dysmenorrhoea, i, 169. ." " " external and internal haemor- rhoids, i, 489. cold sitz, in genito-urinary affections, i, 488. " " " haemorrhoids, i, 169. " " " nocturnal incontinence of urine in children, i, 169. cold sitz, in obstinate constipation, i, 169. " " " paresis of the bladder, i, 169. " " " passive uterine congestion, i, 169. " " " pregnancy, i, 169. '• " " prostatorrhoea, i, 169. " " " pulmonary hyperaemia, i, 169. " " " rectal prolapse, i, 169. " " " spermatorrhoea, i, 169. condensed air, i, 18, 26, 27. continuous, i, 167. " in extensive burns, i, 167. " " pemphigus, i, 167. " " psoriasis, i, 167. " " variola, i, 167. drip, in chronic nervous disease, i, 490. elbow, i, 171. emollient, in acute arthritis, i, 170. " " acute inflammatory skin dis- eases, i, 172. emollient, in cold abscess, i, 171. " " lvmphangeitis, i, 171. " " phlebitis,' i, 171. foot, i, 169. gelatin, in skin diseases, i, 172. graduated, i, 170. " in typhoid fever, i, 170. half, i, 168. hand (cold), in cerebral hyperaemia, i, 170. " in epistaxis, i, 170. hot-air, i, 167. " contra-indications for use of, i, 168. " in bronchial irritation, i, 168. " '• chronic articular rheumatism, i, 168. hot-air, in chronic dropsies of serous cavities, i, 168. hot-air, in chronic neuralgia, i, 168. " " congestive pulmonary conditions, i, 168. hot-air, in diabetes, i, 168. " " dryness of the skin, i, 168. '• " gouty conditions, i, 168. '• " hepatic congestion, i, 168. " " kidney disease, i, 468. " lumbago, i, 168. " " megrim, i, 168. " " mercury poisoning, i, 168. " " obesity, i, 168. " " opium poisoning, i, 168. " '• paludal cachexia, i, 168. " " poisoning by illuminating gas, i, 168. hot-air, in rheumatism, i, 168. " " splenic congestion, i, 168. " " syphilis, i, 168. " " uraemia, i, 100, 468. " method of administering, i, 167. hot, in articular rheumatism, i, 166. " " asphyxia neonatorum, i, 166. " " atony of the lungs and kidneys, ii, 225. " " chronic muscular rheumatism, i, 160, Baths, hot, in convulsions, i, 166. hot, in cystitis, i, 166. " " dropsy, i, 489. " " dysmeiiorrhoea, i, 166. " " erysipelas, i, 166. " " heart disease (some forms), ii, 225. " " hysterical mania, i, 166. " " inflamed wounds, i, 166. " " inflammations, i, 166. " " insomnia, i, 166. " " lassitude, i, 166. " " maniacal excitement, i, 166. " " metritis, i, 166. " " metrorrhagia, i, 166. " " muscular fatigue, i, 166. " " nervous excitability of pregnancy, i, 166. hot, in orchitis, i, 166. " " pemphigus, i, 166. " " phlebitis, i, 166. " " phlegmasia alba dolens, i, 166. " " preliminary pains of labour, i, 166. " " psoriasis, i, 166. " " rheumatism, ii, 420. " " sexual disorders, i, 489. " " strangulated hernia, i, 166. " " urethritis, i, 168. " " uterine disorders in nursing women, i, 166. hot, in variola, i, 166. " " vesical spasm, i, 166. " foot, in amenorrhoea, i, 170. " " " cerebral congestion, i, 170. " " " plantar anaesthesia, i, 170. " " " rheumatic arthritis, i, 170. " " " sprains, i, 170. " " " tarsalgia, i, 170. " hip, for the stimulation of the menstrual flow, i, 375. " mustard, in cholera infantum, i, 490. " sitz, in acute inflammation of the pelvic organs, i, 169. " sitz, in acute parametritis, i, 489. " " " amenorrhoea, i, 169. " " " anal pruritus, i, 169. " " " dysmenorrhoea, i, 169. " " " haemorrhoids, i, 169. " " " lochial suppression, i, 169. " " " nervous and circulatory erethism of the pelvic organs, i, 169. " sitz, in neuralgia of the bladder, i, 169. " " " oophoritis, i, 169. " " " perimetritis, i, 489. " " " rectal prolapse, i, 169. " " " retention of urine, i, 169. " " " spasmodic conditions of the blad- der and urethra, i, 169. ; sitz, in strangulated hernia, i, 489. : " " subacute inflammation of the pelvic organs, i, 169. iodated, in scrofula, i, 172. " squamous skin diseases, i, 172. " " syphilis, i, 172. leg, i, 171. medicated, i, 171. mercurial, in treatment of syphilides, i, 172. moor. See Mud baths. mud, in debility, i, 172. " " neuralgia, i, 172. " rheumatic conditions, i, 172. GENERAL INDEX. 471 Baths, mud, in syphilis, i. 172. mustard, in cholera, i, 172. " " congestion of the abdominal vis- cera, i, 172. narcotic, in acute inflammation of the genito- urinary organs, i, 172. narcotic, in enteritis, i, 172. " " external haemorrhoids, i, 172. '• " peritonitis, i, 172. Nauheim, ii, 419. in angina pectoris, ii, 424. " diseases of the heart (Schott treatment), ii, 419. Nauheim, in endocarditis after rheumatism, ii, 423. Nauheim, in gout, ii, 420. " locomotor ataxia, ii, 420. " rheumatism, ii, 420. " " rickets, ii, 420. " scrofulous diseases, ii, 420. " " mitral insufficiency, ii, 423. " valvular disease, ii, 423. " " weak heart, ii, 424. pine, in gout, i, 172. " paralysis, i, 172. " " rheumatism, i, 172. " " scrofula, i, 172. " " skin diseases, i, 172. reducing, i, 170. " in typhoid fever, i, 170. Roman, i, 162. saline, i, 172. sand, in chronic rheumatism, i, 172. " " paralysis, i, 172. sea, in conditions of malassimilation, i, 172. " " functional nervous disorders, i, 172. " " scrofulous diathesis, i, 172. sedative, in hysteria, i, 173. " neurasthenia, i, 173. sheet, i, 169. " in anaemia, i, 169, 490. " " chronic nervous diseases, i, 490. " " fever, i, 169, 490. " " metabolic disturbances, i, 490. " " neurasthenia, i, 169, 490. " " nutritional disorders, i, 169. sitz, i, 169. slime. See Mud baths. sponge, in fever, i, 491. stimulating, i, 173. sulphurous, i, 173. " in anaemia, i, 173. " " catarrh, i, 173. " " chlorosis, i, 173. " " lead palsy, i, 173. " " scabies, i, 173. " " scrofulous diseases, i, 173. " " treatment of syphilides, i, 173. table of temperature for, i, 165. temperature of, i, 166. tepid, in bronchitis, i, 489. " " multiple sclerosis of the spinal cord, i, 489. tepid, in progressive general paralysis of the insane, i, 489. Turkish, i, 171. vapour, i, 170. " in insomnia, i, 171. " " nervous irritability, i, 171. " '• trophic cutaneous diseases, i, 171. Baths, warm, and massage in paralysis agitans and paralysis of the extremities, i, 489. warm, in acute neuritis, i, 489. " '• cardiac disease, i, 489. " " cerebral hyperaemia, i. 489. " " chronic myelitis, i, 489. " " diseases of the liver, i, 489. " " pyelitis, i, 489. " " suppression of urine, i, 489. Bebeerine, Beberine, i, 173. Beef juice, i, 333. " preparations. See under Dietetic treat- ment. " tea, i, 333. Bela fruit, i, 173. in diarrhoea and dysentery, i, 173. Belladonna, i, 173; ii, 425. and alum in whooping-cough, i, 174. " morphine in inflamed muscles (by in- jection), i, 67. and morphine in inflamed nerves (by injec- tion), i, 67. and morphine in hepatic colic, i, 67. " " " lead colic, i, 67. " " " renal colic, i, 67. " " " spasmodic dysmenorrhoea, i, 67. applications in lymphatic glandular swell- ings, i, 174. applications in sprained or inflamed joints, i, 174. as an anthidrotic, i, 102. in anal spasm, i, 133. " cancer of the rectum, i, 175. " epidemic cerebro-spinal meningitis of children, i, 175. " hereditary inclination to the formation of blebs, ii. 425. (ointment) in inflammation of the mammary glands, i, 173. in myelitis, i, 175. " neuralgia, i, 69,174. " nocturnal incontinence of urine, i, 175. " pemphigus, ii, 425. " spasmodic asthma, i, 174. " " contraction of the rectum (by the mouth or in a suppository), i, 175. " spasmodic coughs, i, 175. (internally) in spasm of muscular fibres of the intestines, i, 68. in spasm of the urethra, i, 133. " tetanus, i, 175. " vesical spasm, in a suppository or in- ternally, i, 133. " vomiting, i, 99. '• whooping-cough, i, 174. (ointment) in rigidity of the os uteri, i, 174. Benzanalgene, i, 176. Benzanilide, i, 176. Benzene, i, 176. in chronic bronchitis, i, 176. " diphtheria, i, 176. " eczema, i, 176. " scabies, i, 176. " winter cough, i, 176. Benzeugenol, i, 176. as an internal antiseptic, i, 176. Benzoic acid and the benzoates, i. 176. as an intestinal antiseptic, i, 133. 472 GENERAL INDEX. Benzoic acid in acute septic diseases, i, 178. and the benzoates, in articular rheumatism, i, 177. in chronic bronchitis, i, 177. " cystitis, i, 177. " diphtheria, i, 178. " erysipelas,.i, 178. " gonorrhoea, i, 177. " infectious diseases, i, 178. " lithaemia, i, 177. " puerperal fever, i, 178. " scarlatina, i, 178. " septicaemia, i, 178. " whooping-cough, i, 178. Benzoin, i, 178. as an intestinal antiseptic, i, 159. compound tincture of (externally), in abra- sions, bedsores, leech bites, and small wounds, i, 178. compound tincture of (externally), in chapped and fissured hands and lips, i, 178. compound tincture of (externally), in chil- blains, i, 178. compound tincture of (externally), in excori- ated and fissured nipples, i, 178. compound tincture of (externally), in eczema (as an anticnesmatic), i, 179. compound tincture of (externally), in frost- bite (as an anticnesmatic), i, 179. compound tincture of (externally), in granu- lating wounds, i, 179. compound tincture of (externally), in urti- caria (as an anticnesmatic), i, 179. (by inhalation) in acute laryngitis, i, 178. " " " chronic bronchitis, i, 178. " " " chronic laryngitis, i. 178. " " " laryngeal affections, i, 178. Benzol. See Benzene. Benzonaphthol, i, 179; ii, 426. as an intestinal antiseptic, i, 179. in dysentery, ii, 426. Benzoparacresol, i, 179. Benzophenoneid, i, 179. in phlyctenular ophthalmia, i, 179. " purulent keratitis, i, 179. " ulcers of the cornea, i, 179. Benzophenoneide. See Apyonine. Benzosol, i, 179. in diabetes, i, 179. " intestinal diseases, i, 179. " pulmonary tuberculosis, i, 179. Benzoylaconine. See Aconitine. Benzoylanilide. See Benzantlide. Benzoyl-beta-naphthol. See Benzonaphthol. Benzoylguaiacol. See Benzosol. Berberine, i, 179. Betanaphthol. See under Naphthol. Betanaphthol salicylate in acute articular rheumatism, ii, 145. in cystitis with ammoniacal fermentation, ii, 145. Betol, i, 179. in articular rheumatism, i, 179. " cystitis, i, 179. " fermentative diarrhoea, i. 179. " infectious diarrhoea, i, 179. Birch tar. See under Tar. Bismuth, i, 179. and carbolic acid in vomiting of pregnancy, i, 180. Bismuth and cerium oxalate in vomiting of pregnancy, i, 180. and pepsin in typhoid fever, i, 181. benzoate, i, 178. " in sluggish ulceration, i, 178. " " specific sores, i, 178. " " unhealthy ulcerations, i, 178. citrate, i, 180. effects of, on the blood, i, 180. in acute diarrhoea, i, 180. " " indigestion, i, 80. " cceliac disease of children, i, 181. " carcinoma, i, 180. " diarrhoea of phthisis, i, 181. " gastric pains, i, 180. " " ulcer, i, 180. " summer diarrhoea of infants, i, 180. oleate, i, 181. phosphate in cholera infantum, ii, 426. salicylate as an antiseptic dressing for ulcers, i, 182. salicylate as an antiseptic dressing in epi- thelioma, i, 182. salicylate as an antiseptic dressing in indo- lent sores, i, 182. salicylate in cholera infantum, ii, 145. " " chronic intestinal catarrh, ii, 145. salicylate in gastro-intestinal diseases, i, 180. subbenzoate, i, 181. subcarbonate, i, 179. subgallate. See Dermatol. subiodide, i, 181. subnitrate, i, 179. as a dusting powder, i, 181. " " snuff in acute nasal catarrh, i, 181. subnitrate in fissures and erosions of the rectum, i, 181. subnitrate, injections of, in dysentery, i, 181. " " urethritis, i, 181. " in rectal irritation, i, 181. " '• tenesmus, i, 181. " vomiting, i, 180. " due to gastric irrita- tion, i, 99. tannate in diarrhoea, ii, 259. " " gonorrhoea, ii, 259. " " leucorrhcea, ii, 259. " " purulent inflammations of the conjunctiva, ii, 259. Bistort, i, 182. Bitters, i, 182. action of, i, 182. aromatic, i, 182. and simple, in malaria, i, 118. astringent, i, 182. contra-indications for the employment of, i, 183. in atonic dyspepsia, i, 183. " cachexia, i, 183. " convalescence from acute disease, i, 183 " debility, i, 183. " diarrhoea (without inflammation), i 183 " digestive atony, i, 183. injections of, for thread-worms, i, 183 in malarial diseases, i, 183. " malnutrition, i, 183. " marasmus, i, 183. " morning vomiting of drunkards, i, 183. GENERAL INDEX. 473 Bitters, in obstinate vomiting, i. 183. in taenia, i, 101. " vomiting of drunkards, i, 100. pregnancy, i, 183. " seasickness, i, 183. simple, i, 182. Blackberry. Sec Rubus. Black draught, i, 183. Black drop, i, 184. Black wash, in venereal ulceration, i, 625. Blancoline, ii, 426. Blatta, i, 184. decoction of, for infantile intestinal disor- ders, i, 184. in cirrhosis of the liver, i, 184. " dropsy due to Bright's disease, i, 184. " heart disease, i, 184. Bleeding. See Bloodletting. Blennostasine, ii, 426. in acute influenza, ii, 426. " bronchorrhoea, ii, 426. " hay fever, ii, 426. " intermittent rhinorrhoea, ii, 426. " laryngorrhoea, ii, 426. " rhinitis, ii, 426, Blisters, i, 184. application of, i, 185. flying, i, 185. in acute articular rheumatism, i, 185. " " pleurisy, i, 186. " " rheumatism, i, 186. " cerebral meningitis, i, 185. " chronic rheumatism, i, 186. " colic, i, 186. " collapse and coma, i, 186. " epilepsy, i, 185. " gastric ulcer, i, 186. " headaches due to intracranial lesions, i, 185. " herpes zoster, i, 186. " hysterical paralysis, i, 185. " inflammation of the mastoid cells, i, 185. " intercostal neuralgia, i, 186. " iritis, i, 185. " meningitis, i, 185. " motor paralysis, i, 185. " neuralgia, i, 184. " oophoritis, i, 185. " otitis media, i, 185. " peritonitis, i, 185. • " persistent nausea, i, 186. " pneumonia, i, 186. " sciatica, i, 186. " sensory paralysis, i, 185. " spinal meningitis, i, 185. " trigeminal neuralgia, i, 186. " typhlitis, i, 185. Blood, i. 186. cooked, i, 186. in pernicious anemia, i, 186. '• pulmonary phthisis, i, 186. " simple anemia, i, 186. " wasting diseases, i, 186. serum, for alimentation by the rectum, i, 186. Bloodletting, i,J87. general, i, 187. in acute cerebral congestion, i. 188. " bronchial hemorrhage of the plethoric, i, 188. Bloodletting, in cerebral apoplexy, i, 189. in cerebral congestion, i, 188. " circulatory excitement, i, 187. " convulsions of adults, i, 188. " insolation, i, 188. " meningitis, i, 188. " peritonitis, i, 188. " pleurisy, i, 188. " pneumonia, i, 188. " poisoning by illuminating gas, i, 188. " puerperal convulsions, i, 188. " pulmonary gangrene, i, 188. " pulmonary hemorrhage of the plethoric, i, 188. " venous engorgement, i, 187. " " stasis, i, 188. manner of performing the operation of, i, 187. Boldine, i, 189. Boldo, i, 189. in biliary lithiasis, i, 189. " gonorrhoea, i, 189. Boldoglucin, i, 189. Boletus. See Agaric. Bonduc, i, 189. in malarial disease, i, 189. Bonducin, i, 189. Bone marrow. See Marrow. Boracic acid. See Boric acid. Borax, i, 189. and honey, in laryngitis, i, 189. as a douche for leucorrhoeal discharges, i, 189. glycerine of, i, 190. in abrasions of mucous surfaces, i, 189. (in solution) in conjunctivitis, i, 189. " cutaneous disorders, for removal of scabs, i, 189. " epilepsy, i, 189. " fissures of the nipples, i, 189. " superficial burns, i, 189. " ulcerative stomatitis, i, 189. " uterine hemorrhage, i, 189. " uric-acid lithiasis, i, 189. ointment in chilblains, i, 189. with honey and myrrh, in treatment of spongy gums, i, 189. Boric acid, i, 190. as a gastric antiseptic, i, 132. (in solution) as a spray in coryza of hay fever, i, 191. (in solution) as a spray in nasal catarrh, i, 191. (in solution) as a spray in ozena, i, 191. (in solution) as a spray in pharyngitis, i, 191. for irrigating the peritoneum after laparot- omy, i, 190. in ammoniacal cystitis, i, 190. " " decomposition of the urine, i, 190. " conjunctivitis (as a wash), i, 191. " contagious ophthalmia, i, 191. " diarrhoea, i, 190. " flatulence, i, 190. " fcetor of the feet, i, 191. " granular lids, i, 190. " inflammation of the vagina, i, 190. " otorrhoea, i, 190. " powder, for bromidrosis, i, 103. " pulmonary tuberculosis, i, 191. 474 GENERAL INDEX. Boric acid (in solution) in pruritus, i, 191. (in solution) in tinea, i, 191. in treatment of ulcers, i, 190. " " of wounds, i, 190. " unhealthy suppurating surfaces, i, 191. (in solution) in urticaria, i, 191. Borobenzoate, ii. 204. Boro-borax, i, 191. Boroglyceride, i, 191. Borolyptol, ii, 426. Boudin's solution, i, 146. Bougies. See under Pencils. Boulton's solution, i, 210. Boussingaulthia baselloides, i, 191. in uterine hemorrhage after parturition, i, 191. Brain and spinal cord substance in epilepsy, i, 80. " extract in neurasthenia, i, 80. " " " paralysis, bulbar, i, 80. " " " tabes dorsalis, i, 80. Bran, i, 191. in eczema, i, 191. Brandy. See under Alcohol. Brayera. See Cusso. Bread and milk in preparatory treatment of tenia, i, 101, 102. Brein, i, 197. Bromacetanilide. See Antisepsin. Bromal, i, 191. hydrate, i, 191. " in chorea, i, 191. " " convulsive diseases, i, 191. " epilepsy, i, 191. " " lightning pains of locomotor ataxia, i, 191. Bromal hydrate in neuralgia, i, 191. Bromalin, i, 191. in epilepsy, i, 191. Bromalum. See Bromal. Bromalum hydratum, i, 191. Bromamide, i, 191. in acute articular rheumatism, i, 192. " " fibrinous pneumonia, i, 192. " cardiac dropsy, i, 192. " chronic nephritis, i, 192. " " rheumatic arthritis, i, 192. '• hepatic dropsy, i, 192. " neuralgia, i, 192. " renal dropsy, i, 192. " typhoid fever, i, 192. Bromated hemol, ii, 426. Bromethyl. See Ethyl bromide. Bromethylformin. See Bromalin. Bromhemol, ii, 426. Bromides, i, 192. administration and dose of, i, 195. and potassium iodide in neuralgia due to lead, i, 69. as hypnotics, i, 507. bromism from, i, 193. comparison of the effects of the different, i, 193.. effects of, on nutrition and temperature, i, 193. effects of, on the heart and circulation, i, 192. effects of, on the mental faculties, i, 192. effects of, on the motor regions of the brain and spinal cord and the motor nerves, i, 193. Bromides, effects of, on the muscular system, i, 192. effects of, on the sensory nerves, i, 192. " " " " sexual functions, i, 193. " " " " vaso-motor nerves, i, 192. elimination of, i, 193. eruption from, i, 193. in asthmatic paroxysms, i, 94, 95. " cerebral overwork, ii, 6. " cholera infantum, i, 194. " congestive neuralgia, i, 69. " delirium tremens, i, 194. influence of, on the alimentary tract, i, 193. in insomnia, i, 507. " maniacal excitement, i, 194. " melancholic frenzy, i, 194. " menorrhagia of nervous origin, i, 194. " migraine, i, 194. " nervous excitement, i, 194. " " " of the heart, i, 194. " '• irritability, i, 194. " nervousness from irritation of the sexual organs, ii, 6. " numbness, i, 194. " ovarian pains, i, 194. " painful flushings, i, 194. " prolonged mental strain, ii, 6. " seasickness, i, 99. " shooting pains (of the plethoric), i, 194. " spasm due to cerebral irritation, i, 133. " " of the larynx, i, 133. " spasmodic reflex neuroses, i, 194. " tetanus, i, 194. " uterine disorders, i, 194. " vomiting due to cerebral disease, i, 99. " vomiting of pregnancy, i, 194. reflex action of, i, 192. therapeutic use of, i, 193. Bromidia, i, 195. Bromine, i, 195. as a germicide, i, 445. in cancer of the uterus, i, 195. " erysipelas, i, 445. " parasitic cutaneous diseases, i. 445. (locally) in hospital gangrene, i, 445. (locally) in putrid sores, i, 445. treatment of poisoning by, i, 109, 196. vapour in nasal catarrh, i, 196. Bromoform, i, 196. dose and administration, i, 196. in asthma, i, 196. " laryngismus stridulus, i, 196. " singultus, i, 196. " vertigo from reflex causes, i, 196. " whooping-cough, i, 196. Bromol, i, 196. as an antiseptic to wounds and ulcers in diphtheria, i, 196. in cholera infantum, i, 197. " pulmonary abscess, i, 197. " tapeworm", i, 197. " typhoid fever, i, 197. Bromum. See Bromine. Broth, egg, i. 356. mutton, i, 333. Brousnika, i, 197. Brucine, i, 197; ii, 26. in chronic pruritus, ii, 29. " inflammation of the external ear, ii, 29. GENERAL INDEX. 475 Bryonia, i, 197. as a hemostatic in hemoptysis, i, 197. in hematoma, i, 197. " inflammation, i, 197. of the serous membranes. i, 197. " post-partum hemorrhage, i, 197. " rheumatism, i, 197. " whooping-cough, i, 197. Bryonine, i, 197. Buchu, i, 197. in chronic and subacute catarrh of the uri- nary mucous membranes, i, 197. " chronic vesical irritation, i, 197. " dropsy, i, 197. " cystitis, i, 197. " pyelitis, i, 197. " urethritis, i, 197. Buckthorn. See Rhamnus. Buena. See Cascarilla. Burdock. See Lappa. Buttermilk cure for gastric disorders, i, 333. for nephritis, i, 333. Butternut. See Juglans. Butyl-chloral hydrate, i, 197. in cough, i, 197. " dysmenorrhoea, i, 197. " facial neuralgia, i, 197. " sciatica, i, 197. " trigeminal neuralgia, i, 69. Buxine, i, 197. Cacao-butter, i, 198. (by inunction) in fever, i, 198. rectal medication with, i, 198. suppositories of, for pelvic pain, i, 198. Cactine, i, 199. Cactus grandiflorus. See Cereus grandi- florus, i, 199. Cadmium, i, 199. bromide, i, 199. " in epilepsy, i. 199. Cadmium poisoning, i, 199. Cadmium salicylate in gonorrhoea, i, 200. in keratitis, i, 200. " purulent ophthalmia, i, 200. Cadmium sulphate in acute ophthalmia, i, 200. in blennorrhcea, i, 200. " gleet, i, 200. " otorrhoea, i, 200. " ulcer of the cornea, i, 200. Cesalpinia. See Bonduc. Caffeine, i, 200. and antipyrine in migraine, i, 201. '• " " nervous headache, i, 201. Caffeine citrate, i, 200. effervescent cit rated, i, 200. in chronic nephritis, i, 201. " dropsy, i, 201. '• headache, i, 201. " migraine, i, 201. " neuralgia, i, 201. " opium poisoning (as a stimulant to nerve activity), i, 201. " organic disease of the heart, i, 201. " spasmodic asthma, i, 201. physiological action of, i, 200. poisoning from, i, 200. Cahinca, i, 201. Cahinic acid, i, 201. 74 Cainca, i, 201. Cajeput, Cajuput, i, 201. as an expectorant, ii, 426. in colic, i, 201. " cough, ii, 426. " dysmenorrhoea, i, 201. " dyspnoea, ii, 426. " neuralgia, i, 201. " pneumonia, ii, 426. " rheumatism, i, 201. Calabar bean. See Physostigma. Calamine, i, 201. Calamus, i, 201. in atonic dyspepsia, i, 201. " flatulence, i, 201. " flatulent colic, i, 201. Calcaria chlorata, i, 201. usta, i, 201. Calcium, i, 201. bromide in hysteria, i, 202. " " insomnia, i. 201. " (as a sedative) in typhoid fever, i, 202. carbide, ii, 426. in cancer of the breast, ii, 427. " " " " uterus, ii, 426. " epithelioma of the uterus, ii, 427. " fibroma, ii, 427. " foetid odours, ii, 427. " metritis, ii, 427. " pain, ii, 427. " rebellious hemorrhages, ii, 427. carbonate. See Chalk. chloride, ii, 427. as a hemostatic in epistaxis and puerperal hemorrhage, ii, 428. in acne, i, 202. " acute lobar pneumonia, i, 202. " indurated glands, i, 202. " furuncles, i, 202. " lupus, i, 202. " ovarian and uterine tumours, i, 202. " rickets, i, 202. " strumous cutaneous affections, i, 202. " suppuration, i, 202. " tabes mesenterica, i, 202. " tuberculous deposits, i, 202. glvcerinophosphate, i, 202. hydrate, i, 202. hypophosphite, i, 202. hyposulphite, i, 202. iodide, i, 202. oxide as a germicide, i, 447. phosphate, i, 202. in chronic phthisis, ii, 78. " conditions where there is a deficiency of lime and phosphorus, i, 202. " debility of young children, ii, 78. " dental caries, i, 202. " fractures, i, 202. " mollifies ossium, i, 202. " rickets, ii, 78. " scrofulous ulcerations, i, 202. " sinuses, i, 202. " syphilis, ii, 78. " tuberculous tracts, i. 202. salicylate in chancres, ii, 145. '"' " diarrhoea of children, ii, 145. in syphilitic ulcers, ii, 145. sulphate. See Plaster of Paris. sulphide, i, 202. 476 GENERAL INDEX. Calcium sulphide, as a depilatory, i, 203. baths in lead poisoning, i, 203. " " rheumatoid arthritis, i, 203. in abscesses, i, 203. " acne, i, 203. " carbuncles, i, 203. " furuncles, i, 203. " glandular enlargements, i, 203. " prevention of influenza, ii, 428. " suppurative cutaneous disorders, i, 203. Calendula, i, 203. tincture of, in bruises and sprains, i, 203. Calisaya. See under Cinchona. Calolactose, i, 203. Calomel. See under Mercury. (fractional doses) as a diuretic, i, 624. as an antemetic, i, 624. " " anthelminthic, i, 624. compound pills of, in cutaneous disorders, i, 114. compound pills of, in rheumatism, i, 114. fumigation in laryngeal diphtheria, i, 530. " croup and diphtheria, i, 625. " " syphilis, i, 624. in Ascaris vermicularis, i, 102. ■' biliousness, i, 624. " cholera, i, 624. " constitutional syphilis, i, 624. (by insufflation) in corneal opacities, i, 556. in dysentery, i, 624. " functional disturbances of the liver, i, 624. " infantile diarrhoea, i, 624. " jaundice, i, 624. " malarial fever, i, 624. (by insufflation) in phlyctenular conjuncti- vitis, i, 556. in pneumonia, i, 624. " venous engorgement, i. 345. " vomiting of nervous origin, in small doses, i, 99. " weak cardiac action, i, 345. " yellow fever, i, 624. ointment in eczema of the chronic type, i, 625. powder as a dusting powder for herpetic eruptions and venereal ulceration, i, 625. powder (by insufflation) in diphtheria, i, 625. " " syphilitic laryn- gitis, i, 625. Calotropis, i, 203. in dysentery, i, 203. " epilepsy, i, 203. " hectic fever, i, 203. " intermittent fever, i, 203. " leprosy, i, 203. " snake bites, i, 203. " syphilis, i, 203. Calumba, Calumbe radix, i, 203. and capsicum in vomiting of drunkards i 100. ' and cinnamon in vomiting of drunkards i 100. and ginger in vomiting of drunkards, i, 100. Calx. See Lime. Cambogia. See Gamboge. Camomile. See Chamomile. Camphoid, i, 203. Camphor, i, 203. artificial, ii, 335. as a sedative in dysmenorrhoea, i, 205. Camphor, by hypodermic injection, as a stim- ulant in aconite poisoning, i, 7. carbolate in small-pox, ii, 73. cerate, i, 205. elixir, i, 206. for sprains and enlarged joints, i, 204. in adynamic fever, i, 205. " angina pectoris, i, 205. " atonic ulcers, i, 204. " bronchitis, i, 205. " broncho-pneumonia, i, 205. " cholera, i, 205. " chorea, i, 205. " colic, i, 205. " coryza, i, 204, 529. " delirium tremens, i, 205. " endometritis, i, 204. " erysipelas, i, 204. " fungous ulcers, i, 204. " galactorrhoea, i, 204. " gastralgia, i, 205. " headaches, ii, 6. " hospital gangrene, i, 204. " hysterical vomiting, i, 205. " idiopathic gangrene, i, 204. " influenza, i, 205. " insanity, i, 205. (powdered) in intertrigo, i, 204. in low fevers, ii, 6. " mastitis, i, 204. " migraine, i, 205. " myalgia, i, 204. " nervousness, i, 205; ii, 6. from dysmenorrhoea, ii, 6. " pharyngo-laryngitis, i, 205. " pneumonia, i, 205. " restlessness, i, 205. (as an ointment) in swellings and extravasa- tions from bruises, i, 204. in toothache, i, 204. " uterine endotrachelitis, i, 204. monobromated, in nervous excitement, i, 205. in cholera morbus, i, 205. " colic, i, 205. powdered, in eczema, i, 204. in pruritus ani, i, 204. " pruritus pudendi, i, 204. salicylated, in lupus, i, 204. " " rodent ulcer, i, 204. sassafras, in neuralgia, ii, 138. spirit of, applied to the skin for bedsores, i, 204. in boils, i, 204. suppositories in rectal spasm, i, 204. " urethral spasm, i, 204. " vaginismus, i, 204. " vesical spasm, i, 204. Camphora. See Camphor. Camphorated chalk, i, 206. chloral in neuralgia, i, 235. ether in cerebral affections, i, 204. " " peritonitis, i, 204. oil (hypodermically) in sudden prostration n, 6. injections in fever and cough of tuberculosis i, 205. salol, ii, 150. vinegar, i, 205. wine, i, 205. GENERAL INDEX. 477 Camphoric acid. See under Camphor, i, 206. as an anthidrotic, ii, 428. " " intestinal antiseptic, ii, 428. " a stimulant (cardiac), ii, 429. in hyperidrosis after influenza, ii, 428. " phthisical sweating, i, 205 ; ii, 428. " typhoid fever, ii, 428. irrigations in cystitis, i, 205. Canella. i, 206. bark, i, 206. in congestive dysmenorrhoea, i, 206. " convalescence, i, 206. " digestive atony, i, 206. •' flatulent dyspepsia, i, 206. " menorrhagia, i, 206. " during pregnancy, i, 206. " metrorrhagia of cancer, i,206. " " of chlorosis, i, 206. " persistent bleeding after delivery, i, 206. Cannabene tannate, ii, 259. as a hypnotic, ii, 259. Cannabine, i, 206. Cannabis indica, i, 206. as a hypnotic, i, 507; ii, 429. as an anodyne, ii, 429. in anorexia, i, 207. " constipation, i, 207. " dysmenorrhoea, i, 207. " hay asthma, i, 207. " headache in the neurasthenic, i, 69. '• insomnia, i, 207. " nervous headache, i, 67. " in neuralgic affections, i, 207. " ovarian or uterine pain, i, 67. " pulmonary affections, ii, 429. " sciatica, i, 207. '• tetanus, i, 207. " tuberculous disease of the lungs, ii, 429. physiological effects of, i, 206. with acetanilide, in neuralgia hypodermic- ally, i, 69. Cantharidates. See under Cantharidic acid. Cantharides, i, 207. in affections of the bladder and urethra, i, 208. " amenorrhoea. i, 208. " catarrhal inflammations of the genito- urinary tract, i, 345. " chronic cystitis, i, 208. " in chronic desquamative nephritis, i, 208. " diabetes insipidus, i, 208. " dysuria, i, 208. " fissure of eczema, i, 208. " gleet, i, 208. '• irritability of the bladder in old men, i, 208. " irritability of the bladder in women, i, 208. " menorrhagia, i, 208. " prostatorrhoea, i, 208. " in small superficial burns, i, 208. " spermatorrhoea, i,' 208. _ " tuberculous processes, i, 208. poisoning with, i, 207. Cantharidic acid, i. 2(18. in pulmonary tuberculosis, i, 208. Cantharidin, i, 209. Cantharis. See Cantharides. Capraol, i, 306. Capsicum, i, 209. Capsicum and calumba in vomiting of drunk- ards, i, 100. and gentian in vomiting of drunkards, i, 100. " serpentaria in vomiting of drunkards, i, 100. in atonic dyspepsia, i, 209. " chronic affections of the genito-urinary tract, i, 209. " collapse, i, 209. ■' delirium tremens, i, 209. " diphtheria, i, 209. '• dipsomania, i, 209. " dyspepsia of hard drinkers, i, 209. " flatulent colic, i, 209. " hemorrhoids, i, 209. " intermittent fever, i, 209. " seasickness, i, 209. " sore throat of scarlet fever, i, 209. " suppurating surfaces, i, 209. " unhealthy ulcers, i, 209. plaster for painful joints, i, 209. " in chilblains, i, 209. " " lumbago, i, 209. " " neuralgia, i, 209. Caraway. See Carum. Carbazotic acid. See Picric acid. Carbolate of camphor in small-pox, ii, 73. Carbolic acid, i, 210. and bismuth in cholera infantum, i, 212. in cholera morbus, i, 212. " diarrhoea, i, 212. " nausea and vomiting, i, 212. and tincture of iodine in malarial cachexia, i, 212. as a caustic for the destruction of morbid growths, i, 213. as a gastric sedative, i, 99. " germicide, i, 448. (solution) as a mouth-wash, i, 441. (inhalation) in abscess of the lung, i, 213. (enema) in ascarides vermicularis, i, 102. in chronic inflammatory processes, i, 213. " flatulent dyspepsia, i, 212. " ganglion, i, 213. " gastric fermentation, i, 132. " glands which threaten suppuration, i, 213. inhalation for gangrene of the lung, i, 213. " in chronic bronchitis, i, 213. " phthisis, i, 213. " " whooping-cough, i, 213. in hepatic diabetes, i, 212. injections of the solution of, in abscess, fur- uncles, erysipelas, lupus, chancroid, and buboes, i, 213. injections of the solution of, in hemorrhoids, i, 213. " hydrocele, i, 213. " morbid growths, i, 213. " nevi, i, 213. " nasal polypi, i, 213. " parasitic skin diseases, i, 212. " synovitis, i, 213. " tetanus, i, 212. " traumatic tetanus, ii, 429. " treatment of pediculi, i, 116. " typhoid fever, i, 212. local applications of, in burns and scalds, i, 213. " cutaneous diseases, i, 212. " eczema, i, 213. 478 GENERAL INDEX. Carbolic acid, local applications of, in foul ul- cers, i, 212. local applications of, in pseudo-membranous inflammations, i, 212. " skin diseases, i, 212. (as a spray) solution for hay asthma and nasal catarrh, i, 213. (as a spray) for sore throat, i, 213. solution for stomatitis, i, 213. 1-per-cent. solution, in toothache, 136. poisoning, i, 211. Carbolized gauze, i, 210. oil, i, 210. Carbon and its gaseous compounds, i, 213. dioxide, i, 213. in pertussis, i, 527. " pulmonary tuberculosis, i, 527. (by insufflation) in pulmonary tuberculosis, i, 533. in spasmodic asthma, i, 527. monoxide, i, 213. Carbonic-acid gas in carbonated waters, as an antemetic, i, 98. in acute coryza, ii, 430. " anosmia, ii. 430. " hypertrophic rhinitis, ii, 430. " nasal catarrh, ii, 430. oxide, i, 215. water, i, 214. " as a douche in uterine troubles, i, 214. Cardamom, i, 215. Cardiac sedatives, i, 217. in abnormally forcible action of the heart, i, 216. stimulants and tonics, i, 215. " in collapse, i, 216. in pericarditis, peritonitis, pleurisy, and pneumonia, i, 217. " shock, i, 216. Cardiac tonics, i. 217. Cardine, i, 218. in disease of the heart, i, 218. Cardol, ii, 431. as a rubefacient and vesicant, ii, 431. Carduus benedictus. See Centaurea bene- dicta, i, 217. Carica papaya. See Papaw. Carminatives, i, 218. Carniferrin, ii, 431. as a nutrient and tonic, ii, 431. Carpaine, i, 218. in aortic stenosis, i, 218. " diseases of the heart, i, 218. " mitral insufficiency, i, 218. Carrageen. See Chondrus. Carron oil, i, 219. as a dressing to the face in small-pox, i, 582. in burns and scalds, i, 582. " eczema, i, 582. Carum, i, 218. Carvacrol, i, 218. in toothache, i, 136. Caryophylli, Caryophyllum, Caryophyllus. See Cloves. Cascara amarga. See under Rhamnus pur- shiana. Cascara sagrada. See Rhamnus purshiana. Cascarilla, i, 219. Cascarin. See Rhamnin. I Cashew nut, i, 219. in eczema, i, 219. " general debility, 219. " psoriasis, i, 219. Cassia acutifolia, Cassia ethiopica, Cassia alba, Cassia angustifolia, Cassia elongata. See Senna. Cassia fistula, i, 219. Cassia lanceolata. Cassia marylandica, Cassia obovata, i, 219. Cassia occidentalis, i, 219. in intermittent fever, i, 219. " remittent fever, i, 219. Castanea, i, 219. in paroxysms of whooping-cough, i, 219. Castoreum, i. 219. in hiccough, i, 219. " hysterical manifestations, i, 219. " nervous exhaustion, i, 219. " the typhoid state, i, 219. Castor oil, i, 219. for breaking up a cold, i, 220. in cholera infantum, i, 220. " constipation, i, 220. " diarrhoea, i, 220. " dysentery of a mild type, i, 220. several methods of taking, i, 220. Cataphoresis. See under Electricity, and cf. Coca and cocaine. in local pain, i, 277. Cataplasms. See Poultices. Catechu, i, 221. as an application to sore and chapped nip- ples, i, 221. as an injection in gleet, gonorrhoea, and leu- corrhcea, i, 221. in aphthe, i, 221. " gingivitis, i, 221. " hematemesis, i, 221. " hoarseness, i, 221. " ptyalism, i, 221. " relaxation of the uvula, i, 221. " sore throat, i, 221. " tickling cough, i, 221. Catgut, dry method of sterilization of, i, 129. wet method of sterilization of, i, 129. Cathartics,, i, 221. drastic, i, 223. hydragogue, in dropsical effusions, i, 224. " " inflammatory effusions, i, 224. in pleurisy with effusion, i, 224. " acute sthenic inflammation, i, 119. " atonic uterine conditions, i, 222. " cerebral congestion, i, 224. " relief of constipation, i, 223. " " " intestinal colic, i, 224. " uremia, i, 224. saline, in vomiting, i. 100. Cathartinic acid, i, 225. in habitual constipation, i, 225. Catheretics, i, 225. Catramine, i, 226. in lupus and tuberculosis, i, 226. Caudle, i, 356. Caulophyllum, i, 226. Caustics, i, 226. arsenical, in lupus vulgaris, i, 144. in contracting cicatrices, i, 226. " internal hemorrhoids, i, 227. " non-malignant growths, i, 227. GENERAL INDEX. 479 Caustics, in spinal irritation, i, 226. in treatment of long-standing neuralgias, i, 226. potential, i. 227. Caviare, i. 228. Cayaponine, i, 228. C. ('. cough mixture, ii, 432. Celandine. See Chelidonium. Celastrine, i. 228. Celery, i, 228. Celluloid, ii, 431. for making splints, ii, 431. Centaurea benedicta, i, 228. in intermittent fever, i, 229. Centaurium, i, 229. Cephaelis. See Ipecacuanha. Cephalanthis, Cephalanthus, i, 229. Cera. See Wax. Cerasus. See Laurocerasus. Cerates, i, 229. Cercbrine, i, 229. Cereus grandiflorus, i, 229. in angina pectoris, i, 229. " aortic regurgitation, i, 229. " palpitation of the heart, i, 229. " rheumatism, i, 229. " sexual exhaustion, i. 229. Cerevisie fermentura. See Yeast. Cerium, i, 229. oxalate in chronic diarrhoea, i, 229. in chorea, i, 229. " cough, i, 229. " diarrhoeal conditions, i, 229. " epilepsy, i, 229. " gastralgia, i. 229. " vomiting due to uterine disease, i, 229. " " of pregnancy, i, 229. Cerussa, i, 230. Cetaceum. See Spermaceti. Cetraria, i, 230. in constipation, i, 230. " diarrhoea, i, 230. " pulmonary diseases, i, 230. Cetrarin, i, 230. Cevadilla. See Sabadilla. Chaat, ii, 268. Chalk, i, 230. as a dusting powder in chafing, ulcers, eczema, etc., i, 230. as an antidote in poisoning by acids, i, 230. camphorated, i, 206. precipitated, as a dentifrice, i. 325. in acid eructations, i, 230. " cholera infantum, i, 230. " diarrhoea, i. 230. " pyrosis, i, 230. Chalybeate bread, i, 551. Chalybeates. See Iron. Chamomile, i, 230. compound mixture of, in neurasthenic and hysterical conditions, i, 231. in convalescence, i, 231. " digestive atony, i, 231. " flatulent colic of children, i, 231. inhalations of the vapour of. in catarrh of the upper air-passages, i, 231. in rheumatism, i, 231. " simple fevers, i, 231. poultice, in abdominal distress, i, 231. in otalgia, i, 231. Champagne, i, 231. as a stimulant after severe operations, ii, 225. iced, as an antemetic, i, 99. in pulmonary troubles of the aged, i, 231. Charcoal, i, 232. as a douche for offensive leucorrhoeal dis- charges, i, 232. as a germicide, i, 440. in cancer of the stomach, i, 232. " choleraic diarrhoea, i, 232. " dyspepsia, i, 232. " epidemic dysentery, i, 232. " poisoning with alkaloids, i, 232. " pyrosis, i, 232. " ulcer of the stomach, i, 232. poultice, in foul-smelling suppuration, i, 232. poultice, in gangrene, i, 232. wood, i, 85. Charpie. See Lint. Charte, Chartule. See Powders. Chaulmoogra oil, i, 232. effects of, given internally, i, 232. in bruises, sprains, and stiff joints, i, 233. " leprosy, i, 233. " neuralgia, i, 233. " phthisis, i, 233. ' rheumatism, i, 233. " scabies, i, 233. " sciatica, i. 233. " scrofula, i, 233. " skin diseases, i, 233. " syphilis, i, 233. " toothache, i, 233. Chelidonium majus, i, 233. in cancer, ii, 431. " corns and warts, i, 233. Chemical restraint, i, 233. Chenopodium, i, 234. in lumbricoid worms, i, 234. oil of, in Ascaris lumbricoides, i, 102. Cherry laurel. See Laurocerasus. " wild. See Prunus virginiana. Chestnut leaves. See Castanea. Chimaphila, i. 234. in treatment of dropsy, i, 234. China. See Cinchona. Chininum. See Quinine. Chinoline. See Quinoline. Chionanthin, i, 234. Chionanthus virginica, i, 234. as a cholagogue, i, 234. " diuretic, i, 234. " vulnerary, i. 234. in jaundice, i, 234. " portal congestion, i, 234. Chirata, i, 234. as a tonic in exhaustion, i, 234. in acidity of the stomach, i, 234. " dysentery, i, 234. " dyspepsia, i, 234. " flatulence, i, 234. " malarial fever, i, 234. Chiratin, i, 234. Chloracetic acid, i, 234. in nevi. papillomata, and warts, i, 234. " ozena, i. 234. Chloral, i, 234. camphorated, in neuralgia, as a sedative nar- cotic, i, 235. 480 GENERAL INDEX. Chloral, in spasmodic contraction of the ar- teries, i, 133. alcoholate, i, 235. ammonium, in nervous insomnia, i, 235. caffeine, in asthmatic attacks, i, 235. in neuralgia, i, 235. cream, i, 238. formamide. See Chloralamide. hydrate, i, 235. and camphor, in toothache, i, 136. as a hypnotic, i, 507. " narcotic, ii, 4. contra-indications to the use of, i, 237. in after-pains, i, 237. " asthma, i, 237. " chorea, i, 237. " convulsions of childhood, i, 237. " '• " strychnine poisoning and tetanus, i, 237. " delirium of fever, i, 236. " " tremens, i, 237. " epilepsy, i, 237. " excitement of insanity, i, 237. " gonorrhoea, i, 237. " hiccough, i, 237. " insomnia, i, 236. '• laryngismus stridulus, i, 237. " nervous insomnia, i, 236. " paralysis agitans, i, 237. " puerperal convulsions, i, 237. " restlessness, i, 236. " rigidity of the os uteri, i, 237. " scarlet fever, i, 237. " seasickness, i, 237. " toothache, i, 237. " whooping-cough, i, 237. local action of, i, 235. locally in foul ulceration, i, 237. physiological effects of, i, 235. poisoning by, i, 236. treatment of poisoning by, i, 236. Chloralamide, i, 238 ; ii, 431. as a hypnotic, i, 507: ii, 431. " an analgetic, ii, 431. in chorea, i, 238. " epilepsy, i, 238. " insomnia, i, 238. " neuralgia, i, 238. " seasickness, i, 239. " spasmodic asthma, i, 238. Chloralose, i, 239. in hysterical chorea, i, 239. " ' " headache, i, 239. " neurasthenia, i, 239. " psychical troubles, i, 239. " sleeplessness, i, 239. " uterine pains, i, 239. Chloralum. See Chloral and also under Aluminum and its salts. Chloranodyne, i, 239. Chloric ether, i, 239. Chlorinated cotton, i, 240. Chlorine, i, 239. as a disinfectant, i, 444, 527. inhalation in phthisis, i, 240. in treatment of gangrene, i, 445. " " " ulcers, i, 445. Chlorine water, as a douche in septic condi- tions after childbirth, i, 240. as a gargle in diphtheria, i, 240. Chlorine water, in ill conditioned and foul- smelling ulcerations, i, 240. Chlorobrom, i, 240. in active melancholia, i, 240. " seasickness, i, 100, 240. " simple melancholia, i, 240. Chlorodyne, i, 240. in acute attacks of diarrhoea, i, 240. Chloroform, i, 240. anesthesia, physiology of, i, 242. " preparation of the patient for, i, 242. and morphine on the heart and respiration, i, 88. applied locally, in chronic rheumatism, i, 241. applied locally, in lumbago, i, 241. " " " neuralgia, i, 241. as a lotion in pruritus, i, 241. " " " urticaria, i, 241. " an antemetic, internally, i, 99. " a solvent, ii, 212. condition during full anesthesia by, i, 243. deaths under, i, 243. in A. C. E. mixture, i, 1. " acute coryza. i, 528. " angina pectoris, i, 528. inhalation, effects of, i, 241. in coryza of influenza, i, 528. '• flatulency as an antispasmodic and seda- tive, i, 241. injections of, in hydrocele, i, 241. " " hypodermic, in sciatica, i, 241. in nausea, i, 99. " puerperal eclampsia, i, 528. " rigid perineum in labour, i, 241. " strychnine poisoning, i, 528. " tetanus, i, 528. " toothache, i, 241. " treatment of asthma, i, 528. " uremia, i, 528. " vomiting, as an antispasmodic and seda- tive, i, 241. method of administration of, i. 242. methods of resuscitation from overdose of, i, 244. rhythmic tractions on the tongue in as- phyxia from, i, 244. spirit, in asthmatic paroxysm, i, 94. " intermittent fever, i, 241. " " persistent hiccough, i, 241. syncope by direct action of, i, 244. vapour inhalation, in biliary colic, i, 245. " convulsions, i, 245. " earache, i, 533. ,' . " " hysterical spasm of the larynx, 1, 245. vapour inhalation, in the second stage of labour, i, 245. " h versus ether, i, 397. Chloral, i, 245. Chloropercha, i, 245. Chlorophenols, Chlorphenols, i 245 in solutions, locally, in tuberculous affections of the larynx, i, 245. Chocolate. See under Cocoa (vol. i, page 285). C holagogues, i, 246. ; direct, i, 246. in bilious conditions, i, 247 indirect, i, 247. GENERAL INDEX. 481 Chlorosalol. See under Salicylic acid and the salicylates (Supplement). Chondrus, i, 247. in diarrhoea, i, 247. " dysentery, i, 247. " gastritis, i, 247. " irritated conditions of the urinary tract, i, 247. Chromic acid, i, 247. as an anthidrotic, i, 103. for goitre, i, 248. in carcinoma, i, 248. " lupus, i, 248. " malignant ulcers, i, 248. " nevi, i, 248. " uterine cancer, i, 248. paste, in condylomata, i, 248. " " neoplasms of the mucous mem- branes, i, 248. paste, in neoplasms of the skin, i, 248. solution, in chronic endometritis, i, 248. " intra-uterine growths, i, 248. " " laryngitis, i, 248. " pharyngitis, i, 248. " " sycosis, i, 248. " syphilitic glossitis, i, 248. " ulcerated gums, i, 248. in warty growths, i, 248. Chrysarobin, i, 248. for Surcina lutea, i, 249. " Staphylococcus pyogenes aureus, i, 249. in eczema seborrhoicum, i, 116. " psoriasis, i, 249. " ringworm, i, 117. Chrysophanic acid. See Chrysarobin. Cicatrizants. See Vulneraries. Cicuta, i, 249. in local pains, i, 250. " migraine, i, 250. " nervous headache, i, 250. " rheumatism, i, 250. Cigarettes, Cigars, i, 250. Cimicifuga., i, 250. as a uterine stimulant in labour, ii, 55. in acute rheumatism, i, 250. " amenorrhoea, i, 250. " bronchial catarrh, i, 250. " caseous pneumonia, i, 2r>0. " chorea, i, 250. " delirium tremens, i, 250. " dysmenorrhoea. i, 250. " fatty heart, i, 250. " fevers, i, 250. " headache, i, 250. " impotence, i, 250. " lumbago, i, 250. " nervousness, i, 250. " neuralgia and muscular pains, i, 250. " pleurodynia, i, 250. " post-partum hemorrhage, i, 250. " rheumatic taint, i, 250. " spermatorrhoea, i, 250. " wry-neck, i, 250. Cinchona, i, 250. in locomotor ataxia, ii, 120. (in powder) in ulcerations, i, 253. " " unhealthy wounds, i, 253. physiological action of, i, 252. Cinchonidine salicylate in chronic articular rheumatism, ii, 145. Cinchonidine salicylate in subacute articular rheumatism, ii, 145. Cinchonine iodosulphate. See Antiseptol. Cineraria, i, 258. in amenorrhoea, i, 258. " cataract, i, 258. " hysteria, i, 258. Cinnabar, i, 258. Cinnamic acid and glycerin in tuberculosis of joint cavities, i, 259. Cinnamon, i. 259. and calumba in vomiting of drunkards, i, 100. and gentian in vomiting of drunkards, i, 100. and serpentaria in vomiting of drunkards, i, 100. in acute dysentery, i, 259. '• diarrhoea, i, 259. " flatulence, i, 259. " indigestion, i, 259. injections in pulmonary aud intestinal tu- berculosis, i, 259. in tuberculosis of joint cavities, i, 259. " vesical hemorrhage, i, 259. Cinnamyl-eugenol. See under Cloves. Cissampelos. See Pareira. Citric acid, i, 259. in Asiatic cholera, i, 260. solution, as a gargle in diphtheria, i, 260. Citrine ointment. See under Mercury. Citrophen, ii, 431. as an analgetic and antipyretic, ii, 431. Citrullus colocynthis. See Colocynth. Clavethyl, i, 260. Climatic influence in asthma, i, 96. treatment, i, 260. " in chronic bronchitis, i, 271. " of consumption or phthisis, i, 270. treatment, sea voyages in chronic empyema, i, 271. treatment, sea voyages in chronic pleurisy, i, 271. treatment, sea voyages in chronic hemor- rhagic phthisis, i, 271. treatment, sea voyages in neuroses, i, 271. " sea voyages in scrofulous disease, i, 271. treatment, sea voyages in tuberculous exca- vation, i, 271. treatment, why coolness or cold is preferable to warmth or heat in, i, 263. treatment, why diathermancy is to be pre- ferred to dense, moist, or smoky atmos- phere in, i, 268. treatment, why dryness is preferable to moisture and is placed first in, i, 262. treatment, why rarefaction is better than sea-level pressure in, i, 265. treatment, why sunshine is superior to cloud- iness in, i, 267. treatment, why variability can be substituted for equability in, i, 267. Cloves, i, 272. as a plaster to relieve nausea and vomiting, i 272. in dental caries, i, 272, injections of the tincture of, in cold abscesses, i, 272. 482 GENERAL INDEX. Cloves, oil of, in toothache, i, 136, 272. in tuberculous affections, i, 272. Clysters. See Knemata. Cnicus benedictus. See Centaurea bene- DICTA. Coal tar, i, 272. in foul ulcers and wounds, i, 273. powder, ii, 264. " in ecthyma, eczema, herpes impetigo, and rupia, ii, 263. saponine, i, 273. Cobalt, i, 273. oxide, in rheumatism, i, 273. poisoning by, i, 273. Cobweb. See Aranea. Coca and cocaine, i, 274. Coca, effects on the organism of, i, 274. in anemia, i, 274. " neurasthenia, i, 274. leaves as a stimulant, ii, 224. Cocaine, action of, on the general svstem, i, 284. application of, in dental surgery, i, 275. " " gynecology, i, 275. " " to the eye, i, 275. " " " genito-urinary tract i, 275. application of, to the mucous surfaces, i, 275. " " " nose, pharynx, and larynx, i, 275. application of, to the rectum, i, 275. skin, i, 276. as a mydriatic, i, 649. cantharidate, subcutaneously, in pulmonary tuberculosis, i, 209. hydrochloride, in neuralgia, hypodermically, i, 68. in toothache, i, 136. " neuralgia, by the mouth and hypodermic- ally, i, 69. internally, in hysteria, i, 284. " " melancholia, i, 284. " neurasthenia, i, 284. introduction of, into the skin, i, 276. in vomiting, in small doses, i, 99. localization of the action of, in circumscribed neuritis, i, 280. localization of the action of, on the brain, i, 282. local medicationof the spinal cord with, i, 280. methods of perpetuating, upon the peripheral nerves, i, 277. poisoning, ii, 431. solution, irrigation of the cauda equina with i, 280. therapeutic thrombosis, or the localization and prolongation of the action of, i, 278. Coccus, Cochineal, i, 284. Cochlearia, i, 284. Cocillana bark, i, 284. in acute bronchitis, i, 285. " bronchitis, i, 285. " bronchopneumonia, i, 285. " phthisis, i, 285. " subacute bronchitis, i, 285. Cocoa, i, 285. Codeine, i, 286. as an anodyne, i. 67. in asthma, i, 93, 94 Codeine, in colic, i, 286. in cough, ii, 432. '• irritable and nervous cough, i, 286. " nervous and irritable conditions, i, 286. " " insomnia, i, 286. " the cure of the morphine habit, i, 286. " saccharine diabetes, i, 286. " whooping-cough, i, 286. Cod-liver oil, i, 287. by inunction in marasmus, i. 288. " " " perverted nutrition, i, 288. in cachexia, i, 288. " chorea, i, 288. " chronic diarrhoea of young children, i, 288. " " eczema, i, 288. " " laryngitis, i, 288. " " rheumatism, i, 288. •' conjunctivitis of children, i, 288. " dizziness, i, 288. " epilepsy, i, 288. " favus, i, 288. " functional disturbances of the nervous system, i, 288. " gout, i, 288. " impetigo, i, 288. " lupus, i. 288. " measles, i, 288. " neuralgia, i, 288. " from impaired nutrition, i, 68. " pharyngitis, i, 288. " phthisis, i, 288. " psoriasis, i, 288. " scarlet fever, i, 288, " scleroderma, i, 288. " scrofula, i, 288. " strumous enlargement of the glands, i, 288. " vertigo, i, 288. Codol. See Rosinol. Coffee, i, 289. effects of, as a beverage, i, 289. in alcoholic poisoning, i, 290. '• asthmatic paroxysms, i, 290. " circulatory enfeeblement, i, 291. " headache, i, 290. '■ malarial disease, i, 290. ■' migraine, i, 290. " neuralgia, i, 290. Cognac. See under Alcohol. Colchicine, i, 291. Colchicum. i, 291. in gout, i, 291. " recurrent boils, i, 291. poisoning, i, 291. Coley's treatment of sarcoma, ii, 313 Collodion, i, 292. as a protection to catarrhal or purulent ophthalmia, i, 294. bichloride-of-mercury, in nevi, i, 292. J' .., " " in venereal warts, i, 292. canthandal, 1, 292. carbolic acid. See under Styptic collo- dion. cocaine, in chilblains, i, 292. " pruritus, i, 292. creosote, in carious teeth, i, 292. ferruginous, in erysipelas, i. 293 flexible, i, 293. as a protection to the skin in small- pox, 1, 294. GENERAL INDEX. 483 Collodion, flexible, in erysipelas, i, 294. flexible, for relief of entropion, i, 294. glycerized, i, 293. ichthyol, in skin diseases, i, 293. in acute orchitis, i, 294. " congenital hydrocephalus, i, 294. " distichiasis, i, 294. " fissures of the nipple, i, 294. " mammary congestion, i, 294. " meningocele, i, 294. " spina bifida, i, 294. " toothache, i, 136. " trichiasis, i, 294. " umbilical hernia, i, 294. iodine or iodized, i, 293. iodoform, in orchitis, i, 293. " " rheumatic inflammations, i, 293. " " venereal sores, i, 293. iodo-sulphural, i, 293. salicylated, in inflamed joints, i, 293. salicylic-acid, and cannabis indica, i, 293. " " " zinc-chloride, i, 293. " and lactic-acid, i, 293, salol, i, 293. saturnine, in aneurysms, i, 294. " " condylomata, i, 294. " " contusions and wounds, i, 293. " " erysipelatous inflammations, i, 293. saturnine, in varicose veins, i, 294. sedative, in painful nerve tracts, i, 293. sinapis, i, 293. styptic, for ruptured perineum, i, 293. " in fistula, i, 293. " harelip, i, 293. " " scalp wounds, i, 293. " " superficial burns, i, 293. sulphurous, in skin diseases, i. 293. with croton oil, i, 292. Collyria, i, 294. in gonorrhceal ophthalmia, i, 295. " ophthalmia neonatorum, i, 295. Colocynth, i, 295. in cerebral disorders, i, 296. " dropsy, i, 296. " fluid effusions, i, 296. " occasional constipation, i, 296. poisoning by, i, 296. Cologne water, i, 297. Columbo. See Calumba. Condurango, i, 297. in cancer, i, 297. " syphilis, i, 297. " ulcer, i, 297. Condy's fluid, ii. 70. Confections, i, 297. Conine, Coniine. i, 297. in hydrophobia, i, 299. " pleurisy, i, 299. " pneumonia, i, 299. " strychnine poisoning, i, 299. " tetanus, i, 299. Conium, i, 297. as a motor depressant, i, 644. effect of the local application of, i, 297. in acute laryngitis, i, 299. *• angina pectoris, i, 298. " asthma, i. 298. " blepharospasm, i, 298. " cancer, i, 298. Conium, in chronic glandular enlargements, i, 298. in delirium tremens, i, 299. " diabetes, i, 299. " dysuria, i, 298. " epilepsy, i, 298. " genito-urinary affections, i, 298. " hiccough, i, 298. inhalation of, in asthma, i, 529. in irritative cough, i, 299. " laryngismus stridulus, i, 298. " mania, i, 299. '• melancholia, i, 299. " muscular spasms, i, 299. " neuralgia, i, 299. " ovarian menorrhagia, i. 298. " paralysis agitans, i, 298. " spasm from irritative lesions of nerve trunks, i, 133. " spasmodic torticollis, i, 298. " spinal sclerosis, i, 298. " tumours, i, 298. " ulcerations, i, 298. " whooping-cough, i, 298. Contrayerva, i, 299. Convallamarin, i, 299. Convallaria, i, 300. in aberration of the cardiac rhythm, i, 300. " aortic disease, i, 300. " cardiac incompetency resulting from over- strain, i, 300. " chronic phthisis, i, 300. " irregularities of the circulation, i, 300. " mitral regurgitation, i, 300. " " stenosis, i, 300. '; passive congestion, i, 300. physiological action of, i, 300. in pleuritic effusions, i, 300. " pneumonia, i, 300. " valvular disease, i, 300. Convallarin, i, 301. Convalvulin, i, 301. Copaiba, i, 301. in cirrhosis of the liver, i, 302. " gonorrhoea, i, 301. " psoriasis, i, 302. " scabies, ii, 432. Copper, i, 303. acetate in aphthe, i, 303. " " conjunctivitis, i, 303. " " gonorrhoea, i, 303. aluminated, in granular conjunctivitis, i, 303. ammoniated, in chorea, i, 303. " " epilepsy, i, 303. " " neuralgia, i, 303. arsenite as an enema in cholera, i, 304. " " " " membranous enteri- tis, i, 304. arsenite as a spray, for asthma, i, 303. " " " in acute nasal catarrh, i, 303. arsenite in aphthe, i, 303. " " chlorosis, i, 303. " cholera, i, 303, 305. " " chronic catarrh, i, 303. " " cystitis, i, 304. " " diarrhoea, i, 303. " " dysentery, i, 303. " " enteritis, i, 305. " " enterocolitis, i, 303. 484 GENERAL INDEX. Copper arsenite in functional anemia, i, 303. arsenite in gastritis, i, 305. " " glanders, i, 304. '• " inflammations of the mouth, i, 304. arsenite in inflammatory derangements of the mucous membranes, i, 304. arsenite in intestinal affections, i, 305. " " iritis, i, 305. '• keratitis, i, 305. '• " otitis externa diffusa, i, 304. " " phlyctamula', i, 305. '• " proctitis, i, 304. " rhinitis, i, 304. arsenite solution in amygdalitis, i, 304. " gleet, i, 304. " glossitis, i, 304. " " " gonorrhoea, i, 304. " " chronicgonorrhoea,i, 304. " " hay fever, i, 304. " " influenza, i, 304. " " " intertrigo, i, 304. " leucorrhoea, i, 304. " " oedema of the glottis, i, 304. arsenite solution in phthisis, i, 304. " " " prolapsus ani, i, 304. " " " puerperal fever, i, 304. " " " scurvy, i, 304. '■ sore nipples, i, 304. " " " spongy gums, i, 304. " " " stomatitis, i, 304. " the form of a spray in incipient tuberculous affections, i, 304. arsenite solution in tympanites, i, 304. " " " yellow fever, i, 304. carbonate in phosphorus poisoning, i, 306. in ganglionic abscesses, i, 303. " tuberculous arthritis, i, 303. oleate for tinea trichophytina, i, 305. in ringworm, i, 117. " warts, corns, etc., i, 305. ointment in indolent ulcers, i, 305. in ringworm, i, 305. sulphate of, as a germicide, i, 448. in acne rosacea, i, 306. Coriander, i, 306. Corn silk, i, 306. in albuminuria, i, 306. " chronic nephritis, i, 306. " in cystitis, i, 306. '• enfeebled heart, i, 306. " gonorrhoea, i, 306. " hematuria, i, 306. " lithiasis, i, 306. " oedema, i, 306. " prostatitis, i, 306. " pyelitis, i, 306. " renal colic, i, 306. " " congestion, i, 306. " suppression of urine, i, 306. " vesical irritability, i, 306. smut. See Ergot of maize. Cornu cervi. See under Ammonium carbon- ate. Cornus, i, 307. in malarial disease, i, 118, 307. Cornutine, i, 307. in hemorrhage, i, 307. " menorrhagia, i, 307. Cornutine, in metrorrhagia, i, 307. in spermatorrhoea, i. 307. " uterine inertia, i, 307. Coronilla, i, 307. Coronillin, i, 307. Correctives. Corrigents, i. 307. Corrosive sublimate. See Mercury. Coryl, i, 307. Cosmetics, i, 307. Cosmoline. See Vaseline. Cotarnine hydrochloride. See Stypticin. Coto bark, i, 309. in atrophic pharyngeal catarrh, i, 309. " diarrhoea, i, 309. Cotoin. See under Coto bark. Cotton, i, 310. absorbent, for burns, scalds, and blisters, i, 310. iodized, in ulceration of the cervix uteri, i, 310. root, i, 311. " poisoning with, ii, 432. Cotton-seed oil, i, 311. styptic, in superficial hemorrhage, i, 310. Coumarin, i, 311. Counter-irritants, i, 311. in encephalitis, i, 312. " gastric colic, i, 312. " pleuritic effusion, i, 312. where to apply, i, 312. Counter-poisons. See Antagonists and anti- dotes. Cowhage. See Mucuna. Cream, i, 636. See under Milk. as an article of diet, i, 636. in constipation of young children, i, 222, Creasote. See Creosote. Creolin, i, 312. as a germicide, i, 448. in chlorosis, i, 313. " cholera, i, 313. " infantile diarrhoea, i, 313. " leprosy, i, 312. " scrofula, i, 313. Creosal, ii, 433. Creosol, ii. 433. in catarrh of the respiratory organs, ii 433 Creosotal, i, 313. Creosote, i, 313. administration of, in different ways, i, 315. and boric-acid injections in gonorrhoea, i, 314. applications in leucorrhoea, i, 314. in burns, with suppuration, i, 314 " chilblains, i, 314. " cholera infantum, i, 314. " morbus, i, 314. " chronic eczema, i, 314. " diabetes, i, 314. " dysentery, i, 314. " enlarged bronchial glands, ii, 433. " erysipelas, i, 314. " fistula, i, 314. " fcetid otorrhcea, i, 314. " gangrenous surfaces, i, 314. " gastric fermentation, i, 314. inhalation in abscess and gangrene of the lung, i, 314. inhalation in bronchiectasis, i, 314. " chronic bronchitis, i, 314. laryngitis, i, 314. GENERAL INDEX. 485 Creosote inhalations in pulmonary tuberculosis i, 314. in intestinal dyspepsia, i, 314. " laryngeal tuberculosis, i, 316.' " lienteric diarrhoea, i, 314. " nevi, as a caustic, i, 314. " psoriasis, i, 314. " puerperal metritis, i, 314. " seasickness, i, 314. " sloughing ulcers, i, 314. " suppurating surfaces, i, 314. " toothache, i, 136, 314. " tuberculous laryngitis, by injections, i, 316. " typhoid fever, i, 314. " ulcers of the larynx, i, 314. " vomiting, i, 99, 314. " of hysteria, i, 314. " " pregnancy, i, 314. " warts, as a caustic, i, 314. physiological action of, i, 313. water as a hemostatic in bleeding from leech bites, i, 314. water as a hemostatic to uterine hemor- rhage, i, 314. Creosote-calcium chlorhydrophosphate, ii, 433. in scrofula, ii, 433. " tuberculosis, ii, 433. Cresalol, Cresol salicylate. See under Salicyl- ic acid and the salicylates (Supplement). Cresol, Cresylic acid, Cresylol, i, 318. Cresol as a germicide for the bacilli of tuber- culosis, i, 448. Creta. See Chalk. Cristalline, i, 318. Crocus. See Saffron. Croton chloral as a hypnotic, i, 508. in neuralgia, for immediate relief, i, 69. Croton-chloral hydrate. See Butyl-chloral hydrate and under Hypnotics. Croton oil, i, 318. by inoculation, for nevi, i, 318. in apoplexy, for rapid evacuation of the bowels, i,"318. '• chronic bronchitis, i, 318. " " inflammation of joints, i, 318. " " headache, by application to the nape of the neck, i, 318. " dropsy, i, 318. " dysmenorrhoea, by applications to the ab- domen, i, 318. " hydrocephalus, i, 318. " hysteria, by application to the spine, i, 318. " obstinate constipation, i, 318. " oophoralgia, by application to the abdo- men, i, 318. " paralyses of functional origin, by applica- tion to the spine, i, 318. " phthisis, i, 318. " pleurisy, i, 318. " puerperal convulsions, i, 318. " retention of urine, i, 318. '• in sciatica, i, 318. " tinea tonsurans, i, 318. " tuberculous meningitis, by application to the head, i, 318. poisoning by. i, 318. Cryostase, ii, 433. Crvptopine, i, 318. Cubeb, i, 318. Cubeb cigarettes in acute coryza, i, 430. cigarettes in acute nasal catarrh, i, 319. " " bronchial catarrh, i, 430. " " subacute bronchitis, i, 430. in affections of the bladder, i, 319. " " urethra, i, 319. " atonic dyspepsia, i, 319. " chronic bronchitis, i, 319. " " catarrh of the rectum, i, 319. cystitis, i, 319, " cystorrhoea, i, 319. " diphtheria, i, 319. :i functional irritability of the bladder, i, 319. " gonorrhoea, i, 319. " influenza, i, 319. " leucorrhoea, i, 319. " prostatorrhoea, i, 319. " pseudo-membranous enteritis, i, 319. troches, in chronic irritability of the air- passages, fauces, and pharynx, i, 319. Cubebin, i, 318. Cucumber ointment, i, 319. for cutaneous irritation, i, 319. Cucurbita. See Pepo. Cupping, i, 319. for bites by rabid or venomous animals, i, 320. dry, i, 319. " in acute inflammation of the kidneys, i, 320. " in congestion of the kidneys, i, 320. " " dyspnoea due to cardiac disease, i, 320. " in the pain and cough of acute pulmo- nary and pleuritic diseases, i, 320. in intracranial congestion and inflamma- tions, i, 320. wet, i, 320. Cupric acetate in aphthe, i, 303. in conjunctivitis, i, 303. " gonorrhoea, i, 303. oxide in gingivitis, i, 305. in chronic induration of the lymph glands, i, 305. " tenia, i, 305. phosphate in incipient tuberculosis, i, 305. sulphate as an emetic in pseudo-membranous laryngitis, i, 306. in acne rosacea, i, 306. " diarrhoea and dysentery, i, 306. " ecthyma, i, 306, " epilepsy, i, 306. " erythema, i, 306. " gangrenous pharyngitis, i, 306. " gleet, i, 306. " gonorrhoea, i, 306. " hemorrhage, i, 306. " ichthyosis, i, 307. " indolent ulcers, i, 306. " intermittent fever, i, 306. injections in buboes, i, 306. " " hydrocele, i, 306. " malignant sore throat, i, 306. " mercurial stomatitis, i, 306. " phosphorus poisoning, i, 110; ii, 76. " phthisis, i, 306. " psoriasis, i, 306. " scrofula, i, 306. " tinea tarsi, i, 306. 486 GENERAL INDEX. Cupric sulphate in trachoma, ii, 214. in typhoid fever, i, 306. " ulcerative colpitis, i, 306. " " proctitis, i, 306. " venereal ulcers, i, 306. Cuprohemol, i, 320. Cuprum. See Copper. Curare, i, 320. as a motor depressant, i, 644. in chorea, i, 321. " epilepsy, i, 321. " grave convulsive conditions, i, 321. " hydrophobia, i, 321. " strychnine poisoning, i, 321. " tetanus, i, 321. Curarine, i, 320. Curcuma, i, 321. in paludal fever, i, 322. Cure, bichloride-of-gold, for inebriety, i, 454. buttermilk, for diabetes, i, 333. " " gastric disorders, i, 333. " " nephritis, i, 833. grape, i, 333, 455. whey, for acute febrile disease, i, 333. " " irritability of the stomach, i, 333. Currant shrub, i, 352. Cusparia, i, 322. in diarrhoea, i, 322. " dysentery, i, 322. Cusso, i, 322. for tapeworms, i, 322. Cutal. See Aluminum borotannico-tartrate (Supplement). Cutin, i, 322. Cyanides. See under Cyanogen and cf. Hy- drocyanic acid. Cyanogen, i, 322. Cyanurets. See under Cyanogen. Cydonium, i, 323. in dysentery, i, 323. " poisoned wounds, i, 323. " skin diseases, i, 323. Cyperus articulatus, i, ,323. Cypripedium, i, 323. Cytisus laburnum, i, 323. in migraine, i, 323. Damiana, i, 323. in cerebral exhaustion, i, 324. " functional impotence, i, 324. " general atony of the nervous system, i, 324. " migraine, i, 324. " nervous dyspepsia, i, 324. " neuralgia, i, 324. Datura. See Stramonium. Decoctions, i, 324. Delphinine in earache, ii, 221. (topically) in neuralgia, ii, 221. " toothache, ii, 221. Delphinium. See Staphisagria. Demulcents, i, 324. Dentifrices, i, 324. Deodorizers, i. 326. Depilatories, i, 327. Depressants. See Cardiac stimulants, Tonics, and Depressants. Derivatives, i, 327. Dermatin, ii, 433. Dermatol, i, 329. Dermatol, in burns, i, 329. " eczema, i, 329. " excoriations, i, 329. " fermentative dyspepsia, i, 329. " suppurating surfaces, i, 329. Desiccants, i, 329. Desoxyalizarin. See Anthrarobin. Detergents, i, 329. De Valangin's solution, i, 144. Dewees's emmenagogue, i, 375. Dextrose. See under Sugar (vol. ii, page 235). Diabetin. See Levulose. Diacetanilide, ii, 433. Diacetyltannin. See Tannigen. Diachylon, i, 329. Dialyzed preparations, i, 330. Diaphoretics, i, 331. Diaphtherin, i, 332. in otorrhcea, i, 332. " ozena, i, 332. " ulcers, i, 332. " wounds, i, 332. Diaphthol, i, 333. in gastro-intestinal affections accompanied by fermentation, i, 333. " urinary affections, i, 333. Diastase, i, 333. Dibromethane. See Ethylene bromide. Dibromogallic acid. See Gallobromol. Dichloracetic acid, i, 333. Dielectrolysis. See under Electricity and cf. Coca and Cocaine. Diet, dry, in asthma, i, 96. in diabetes, i, 333. " dilatation of the stomach, i, 333. " dropsy, i, 333. meat, i, 333. skim-milk, i, 333. Dietetic treatment, i, 333. in acute diarrhoea, i, 336. " cancer of the stomach, i, 336. " chronic diarrhoea, i, 336. " constipation, i, 336. " continued fever, i, 334. " diabetes, i, 337. " fever, i, 333, 334. " functional dyspepsia, i, 335. " gastritis, acute and subacute, i, 335. " lithemia and gout, i, 338. " nephritis, i, 338. " obesity, i, 339. " phthisis, i, 338. " rickets, i, 338. " scurvy, i, 337. " summer diarrhoea of children, i. 336. " typhoid fever, i, 334. " ulcer of the stomach, i, 335. Diethylacetal, i, 1. Diethylenediamine. See Piperazine. Diethylsulphonediethylmethane. See Tetro- nal. Diethylsulphonedimethylmethane. See Sul- phonal. Diethylsulphonemethylethvlmethane. See Trional. Digitalein, Digitalin. See under Digitalis. Digitalis, i, 340. in aconite poisoning, i, 7, 343. " asthma, i, 342. " bronchial congestions, i, 342. GENERAL INDEX. 487 Digitalis, in chronic bronchitis (as a diuretic) ii, 228. " congestion of the kidneys, i, 342. " delirium tremens, i, 342. " dilated heart, i, 341. " diseases of the mitral and tricuspid valves of the heart, i, 341. " dyspnoea, i, 342. " epistaxis, i, 342. " erysipelas, i, 342. " exophthalmic goitre, i, 342. " hemorrhages, i, 342. " hemorrhagic diathesis, i, 342. " irritable heart, i, 342. " local inflammations, i, 342. " menorrhagia, i, 342. " migraine, i, 342. " mitral insufficiency, i, 341. " " stenosis, i, 341. " muscarine poisoning, i, 343. " palpitation of the heart, i, 342. " pericarditis, i, 342. " pneumonia, i, 342. " post-partum hemorrhage, i, 342. " renal dropsy, i, 342. " rheumatic fever, i, 342. " scarlet fever (early stages), i, 342. " spermatorrhoea, i, 342. " stenosis of the tricuspid orifice, i, 341. " typhoid fever, i, 342. " venous congestion of mitral and tricuspid disease (as a diuretic), ii. 228. " venous engorgement, i, 345. " weak cardiac action, i, 345. Digitin i, 340. Digitonin, Digitoxin. See under Digitalis. Diiodoform, i, 343. for boils, burns, carbuncles, wounds, i, 343. " the relief of pelvic pains, i, 343. in neuropathic hysteralgia, i, 343. Diiodosalicylic acid, i, 343. in articular rheumatism, i, 343. Diiodothiophene, i, 343. . Diisobutylorthocresol iodide. See Europhene. Dill, i, 344. in flatulent colic of infants, i, 344. Diluents, i, 344. Dimethvlacetal. See under Acetal. Dimethylethylcarbinol. See Amylene hy- drate. Dimethylketone. See Acetone. Dimethyloxyquinicine. See Antipyrine. Dimethylpiperazine tartrate. See Lycetol. Dioleyllecithin. See Phosphoalbumin. Diosnia. See Buchu. Dioxyanthranol. See Anthrarobin. Diph'therin. See Oxyquinaseptol. Discutients. See Sorbefacients. Disinfectants. Sec Antiseptics. Disinfection of the sick-room, l, 442. Dispermine. See Piperazine. Dita bark. See Alstonia. in malaria, i, 118. Dithiosalicvlic acid, i. 344. in acute articular rheumatism, l, 344. Dithvmol iodide. See Aristol. triiodide. See Annidalin. Diuretics, i, 344. in cystitis, i, 346. Diuretics, in dropsy due to cardiac or pul- monary disease, i, 346. " urethritis, i, 346. stimulant, ii, 228. Diuretin. See Sodio-theobromine salicyl- ate. Djamboe, i, 346. in acute gastro-enteritis, i, 346. " dyspepsia, i, 346. " infantile diarrhoea, i, 346. Dobell's solution, i, 210. Dolichos. See Mucuna. Donovan's solution, i, 146, 627. Dorstenia. See Contrayerva, Doses, i, 346. Dr. Clarke's method for determining, ac- cording to weight, i, 347. Dr. Cowling's rules for determining, i, 347. Dr. Young's rule for determining, i, 347. effect of habit on, i. 347. method of administration of, i. 348. time for administration of, i, 348. Douche, ascending, i, 349. aural, i, 349. bell, i, 349. cold effects of, i, 348. in chlorosis, i, 491. " chronic gastric disease, i, 491. " gout, i, 491. " rheumatism, i, 491. " simple anemia, i, 491. columnar, i, 349. compressed-air. i, 349. concentric, i, 349. descending, i, 348. gas, i, 349. horizontal, i, 349. lumbar, i, 349. nasal, i, 349. ocular, i, 349. rain, i, 349. ring, i, 349. sheet, i, 349. splenic, i, 349. steam, i, 349. vapour, i, 349. warm, in diseases of the spinal cord, i, 491. Douches, i, 348. Drastics, i, 349. Draughts, i, 349. Dressings, i, 129. Drinks, i, 350. effects of cold or iced, i, 350. Drops, i, 352. Duboisine, i, 352. as a mydriatic, i, 649. in acute mania, i, 353. " cardiac failure, i, 353. " insanity, i, 353. " morphine poisoning, i, 353. " night sweats of phthisis, i, 353. " paralysis agitans, i, 353. " puerperal mania, i, 353. '- respiratory neuroses, i, 353. Dulcamara, i, 353. in bronchitis, i, 353. " chronic catarrh, i, 353. " dropsy, i, 353. 4SS GENERAL INDEX. Dulcamara, in gout, i, 353. " jaundice, i, 353. " lepra, i, 353. " psoriasis, i, 353. " rheumatism, i, 353. Dulcin, i, 353. in diabetes, i, 353. Duotal, ii, 433. Earths, i, 353. Ecballium. See Elaterium. Ecbolics. See Abortifacients and Oxytocics. Ecboline. See under Ergot. Eccoprotics, i, 354. Edulcorants. See Corrigents. Effervescing preparations, i, 355. Egg broth, i, 356. flip, in asthenic conditions, i, 355. Eggs, i, 355. and brandy in anemia, i, 355. " " " cardiac feebleness, i, 355. and coffee in malnutrition, i, 354. " " •' nervous exhaustion, i, 355. and limewater for dandruff, i, 356. white of, in poisoning with corrosive sub- limate, i, 355. yolk of, and ginger, for dyspepsia, i, 355. Eleomyenchysis, i, 356. Eleosacchara, i, 357. Elastic compression of the chest in asthma, i, 92. Elastica. See Rubber. Elaterin, i, 357. in dropsy, i, 357. Elaterium, i, 357. in ascites, i, 358. " cerebral affections (as a revulsive and de- pleting agent), i, 358. " congestion (as a revulsive and depleting agent), i, 358. " dropsy, i, 358. " pericarditis, i, 358. " pleurisy, i, 358. " uremia, i, 358. Electrical stimulation in asthma, i, 93. Electricity, i, 358. alternating sinusoidal current, i, 359. as an emmenagogue, i, 375. " oxytocic, ii. 55. cataphoresis, i, 361. condensed list of nervous disorders and the modes of application of, where it is indi- cated, i, 366. destruction of aneurysms by, i, 361. frictional, i, 359. (as a stimulant) in apnoea, ii. 226. " " " asphyxia, ii, 226. in blepharospasm, 365. " clonic spasm, i, 365. " hypochondriasis, i, 366. " narcotism (as a stimulant), ii, 226. " neuralgia from impaired nutrition, i, 68. " neurasthenia, i, 366. " orthopnoea (as a stimulant), ii, 226. " paralysis, i, 365. " railway brain, i, 366. " " spine, i, 366. " the removal of superfluous hairs, i, 361. " tic convulsif, i, 305. " tonic spasm, i, 365. " torticollis, i, 365. Electricity, in writer's cramp, i, 365. methods of employing, i, 365. physiological effects of, i, 362. production of heat and light by, i, 361. refreshing effects of, i, 362. resistance of the human body to, i, 361. resuscitation of persons apparently killed by, i, 369. static, i, 359. testing the hearing by, i, 363. " sight by, i, 363. " smell by, i, 363, " " taste by, i, 363. tumours treated by, i, 361. vaso-motor effects of, i, 362. Electrolysis, i, 361. Electro-magnet, i, 360. Electrozone, i, 369. Electuaries, i, 369. Elemi, i, 369. in indolent ulcers (externally), i, 369. Elixirs, i, 369. Eller's drops, i, 58. Elm. See Ulmus. Embelia ribes, i, 370. in tapeworm, i, 370. Embelic acid. See under Embelia ribes. Embrocations. See Liniments. Emetics, i, 370. action of, i, 370. centric, i, 371. direct, in narcotic poisoning, 371. in bronchitis of children, 372. peripheral, i, 371. systemic, i, 371. Emetine. See Ipecacuanha. Emeto-cathartics, i, 374. Emmenagogue, Dewees's, i, 375. Goodell's, i, 375. Emmenagogues, i, 374. Emol, i, 376. for the removal of horny growths, i, 376. in eczema of the palm and sole, i, 376. " itching of urticaria, i, 376. keratosis of the soles and palms, i, 376. Emollients, i, 376. Emplastra. See Plasters. Emulsions, i, 376. Endermic medication, i, 377. Enemata, i, 377. Ephedra, i, 385. antisyphilitica in gonorrhoea, i, 385. in acute articular rheumatism, i, 385. '• " muscular rheumatism, i, 385. " chronic articular rheumatism, i, 385. " " muscular rheumatism, i, 385. " constipation, i. 385. " diarrhoea, i, 385. " gout, i, 385. " rheumatic osteomyelitis, i, 385. "sciatica, i, 385. trifurcata (as a styptic) in gonorrhoea, i, 385. „ , .,". " " " leucorrhoea, i, 385. Ephednne, i, 385. homatropine. i, 386. Epidermin, i, 386. Epilation in favus of the scalp i 117 Epispastics. See Blisters. Epithems, i, 386. Ergot, i, 386. GENERAL INDEX. 489 Ergot, and sodium phosphate in algidity of fevers (first stages), i, 389. and sodium phosphate in cholera (first stage), i, 389. and sodium phosphate in neuroses accom- panied by mental depression, i, 389. and sodium phosphate in senile exhaustion, i, 389. and sodium phosphate in tardy convales- cence, i, 389. and sodium phosphate in tuberculosis, i, 389. as an anthidrotic, i, 102. " oxytocic, i, 387. for after-pains, i, 388. in congestion of the spinal cord, i. 388. " deficient tone of the genital organs, i, 388. " dysentery, i, 388. " enlarged prostate, i, 388. " enuresis, i, 388. " epilepsy (to increase the action of bro- mides), i, 388. " epistaxis. i, 388. " galactorrhcea, i, 388. " hematuria, i, 388. " hemorrhage, i, 388. " hemorrhoids, i, 388. " impotence (hypodermically), i, 388. " metrostaxis, i, 388. " night sweats, i, 388. " pulmonary hemorrhage, i, 388. " spermatorrhoea, i, 388. " uterine hemorrhage, i, 388. " varicose veins, i, 388. Ergotin, Ergotine, Ergotinine. i, 389. Ergotinum, i, 390. Ergot of maize, i, 389. in primary uterine atony, i, 389. Ergotole, i, 389. in erysipelas (locally), i, 389. " hyperemia (locaily), i, 389. " phlegmonous inflammation (locally), i,389. Erigeron, i, 390. in dropsy, i, 390. oil of, in diarrhoea, i. 390. " dysentery, i, 390. " epistaxis", i, 390. " " gonorrhoea, i, 390. •' " hemoptysis, i, 390. " " intestinal hemorrhage, i, 390. " " menorrhagia, i, 390. " " metrorrhagia, i, 390. " " uterine hemorrhage, i, 390. Eriodictyon. See Yerba santa. Erodium cicutarium, ii, 433. as an astringent and diuretic, ii, 433. in uterine haemorrhage, ii, 433. Errhines. See Sternutatories. Erysipelatous inoculation. See under Toxines. Er'vthrophlceine, i, 390. (hypodermically) in locomotor ataxia), i, 390. " " sciatica, i, 390. » " spinal irritation, i, 390. Erythroxylon. See Coca. Eseridine, i, 391. Eserine, i, 391. in accommodative asthenopia, l, 392. " cataract, i. 392. (internal administration) in chorea, l, 392. in episcleritis, i, 392. " glaucoma, i, 391. Eserine. in gonorrhceal ophthalmia, i, 392. in mydriasis, i, 392. " neuralgia of the eyeball, i, 392. (internal administration) in night-sweats of phthisis, i, 392. in ophthalmia neonatorum, i, 392. " paralytic mydriasis following diphtheria, i, 392. " phlyctenular keratitis, i, 392. " photophobia, i, 392. " ulcerative keratitis, i, 392. physiological action of, i, 391. with bromides, in strychnine poisoning, i, 392. Essences, i, 392. Ether, i, 393. and alchohol, as a heart stimulant, ii, 227. nitrous oxide, as a preliminary measure lie- fore inhaling, i, 394. and oxygen, as an anesthetic, ii, 53. as an antemetic, i, 99. as a sedative, i, 528. " solvent, ii, 212. camphorated, in cerebral affections, i. 204. " " peritonitis, i, 204. cardiac failure during anesthesia by, i, 396. cone, i, 394. effect of, on the respiration, i, 395. for puerperal eclampsia, i, 397. (internally) in abdominal colic, i, 397. in A. C. E. mixture, i, 1. (by hypodermic injection) in aconite poison- ing, i, 7. (internally) in ascarides, i. 397. (hypodermically) in cardiac failure, i, 397: "ii, 227. (subcutaneously) in chloroform anesthesia, ii, 227. (subcutaneously) in collapse, i, 397. in croup, i, 528. (subcutaneously) in infantile convulsions, i, 397. (subcutaneously) in intense depression of acute infectious diseases, i, 397. (subcutaneously) in narcosis, ii, 226. in nausea, i, 99. (internally) in nervous headache, i, 397. in pathological work, i, 397. " severe pains of labour i, 397. (internally) in spasmodic vomiting of preg- nancy, i, 397. (internally) in tapeworm, i, 397. manner of administering, i, 395. position of patient during anesthesia by, i, 394. preparation of patient for anesthesia by, i, 394. spray in earache i, 397. " " nervous headache, i, 397. " " neuralgic affections, i, 397. " toothache, i. 397. sulphuric, in neuralgia, i, 69. treatment of shock during anesthesia, i, 396. versus chloroform, i, 397. vomiting during anesthesia by, i, 396. Ethoxycaffeine, i. 398. in migraine, i, 398. Ethylate of sodium in ringworm, i, 117. bromide, i, 398. (internally) in neuralgia, i, 399. Ethyl carbamate. See Urethane. 490 GENERAL INDEX. Ethyl chloride, i, 399, as a dental anesthetic, ii, 434. (spray) as an analgetic, ii, 434. " in asthma, ii, 434. " " conjunctivitis and iritis, ii, 434, " " epididymitis, ii, 434. " epistaxis, ii, 434. " hemorrhage, ii, 434. " headache of influenza, ii, 434. " hiccough, ii, 434. in meningitis, ii, 434. '■ migraine, ii, 434. " pleurodynia, ii, 434. " pruritus, ii, 434. " shingles (for relief of pain), ii, 434. " spasmodic dyspnoea, ii, 434. " in sunstroke, ii, 434. iodide, i, 399. " in bronchitis, i, 399. " inhalations in hay asthma, i, 528. " " " spasmodic dyspnoea, i, 528. iodide in syphilitic disease of the air-pas- sages, i, 528. Ethylene bromide, i, 399. in epilepsy, i, 399. periodide. See Diiodoform. Ethylphenacetine. See under Phenacetine. Ethylurethane. See Urethane. Eucaine, ii, 434. as an anesthetic, ii, 435. for infiltration anesthesia, ii, 435. for subcutaneous anesthesia for the opening of abscesses or removal of tumours or growths, ii, 435. Eucalypteol, i, 399, 400. in acute bronchitis, i, 401. " chronic bronchitis, i, 401. Eucalyptol. See under Eucalyptus. in acute and subacute inflammations of the larynx, i, 529. " cholera, i, 400. " enteritis, i, 400. " gastric catarrh, i, 400. inhalation in amygdalitis, i, 529. in chronic bronchitis, i, 529. " diphtheria, i, 529. " whooping-cough, i, 529. " tuberculosis, i, 529. " intestinal catarrh, i, 400. " typhoid fever, i, 400. Eucalyptus, i, 399. and terebene, oils of, in headache of malarial disease or congestion, i, 400. cigarettes in asthma, i, 400. in malarial fevers, i, 118. oil of, in acute bronchitis, i, 400. in acute catarrh, i, 400. " chronic bronchitis, i, 400. " enteritis, i, 400. '• gastric catarrh, i, 400. " headache, i, 400. " intestinal catanh, i,400. (internally) in scarlet fever, i, 400. in strychnine poisoning, ii, 435. " typhoid fever, i, 400. " ulcers, i, 400. " wounds, i, 400. Eucasin, ii. 435. in anemia, ii, 436. Eucasin, in gout, ii, 436. in laryngeal tuberculosis, ii, 436. " parametritis, ii, 436. " perimetritis, ii, 436. " pulmonary tuberculosis, ii, 436. " typhlitis, ii, 436. " uric-acid diathesis, ii, 436. Eudopine, ii. 436. as an intestinal antiseptic, ii, 436. Euquinine, ii, 436. Eugenic acid, i, 401. Eugenol, i, 272, 401. acetamide, i, 401. iodized, i, 401. Eulachon oil, i, 401. Eulyptol, i, 401. Euonymin in torpor of the liver, i, 401. Euonymus, i, 401. Eupatorium, i, 401. Euphorbia, i, 401. chilensis, i, 401. heterodoxa. See Alveloz. hypericifolia, i, 401. " in diarrhoea, i, 401. " " dysentery, i, 401. " " leucorrhoea, i, 401. " " menorrhagia, i, 401. maculata. See Euphorbia hypericifolia. ocellata, i, 401. " in bites of poisonous snakes, i, 401. pilulifera, i, 401. " in asthma, i, 401. '• " chronic bronchitis, i, 401. " " dyspnoea, i, 401. prostata. See Euphorbia ocellata. Euphorbium, i, 401. in indolent ulcers, i, 401. " unhealthy suppurating surfaces, i, 401. Euphorin, i, 401. in chronic articular rheumatism, i, 402. " fevers, i, 402. " migraine, i, 402. " muscular rheumatism, i, 402. " rheumatic fever, i, 402. " skin diseases of parasitic origin, i, 402. " surgical fever, i, 402. (as a local disinfectant) in aphthous stoma- titis, i, 402. (as a local disinfectant) in burns, i, 402. " " herpes, i, 402. in sciatica, i, 402. (by insufflation) in uterine endotrachelitis, i, 402. ' ' in venereal ulcers, i, 402. (in powder or solution) in ulceration of the cervix uteri, i, 402. Europhene (as a dressing) for burns, i, 402. (by insufflation) in catarrhal conditions, i, 402. in epistaxis, 1, 402. (by insufflation) in ozena, i, 403. in syphilitic ulceration, i, 402. in powder or ointment in chancre, i, 402. " chancroid, i, 402. " condvloma. i, 402. " lupus, i, 402. ' . '' " scrofuloderma, i, 402. ' ' '' powder or ointment in ulcerations, i, 402. Eurythrol. See Splenic extract. GENERAL INDEX. 491 Evacuants, i, 402. Exalgine, i, 403. as an anodyne, i, 68. in angina, i, 403. " gouty arthritis, i, 403. " headache of melancholia, i, 403. " hemicrania, i, 403. " insomnia of melancholia, i, 403. " lumbago, i, 403. " nervous headache, i, 403. ." neuralgia, i, 69, 403. " rheumatism, i, 403. " sciatica, i, 403. " simple chorea, i, 403. " the lightning pains of tabes, i, 403. Excitants, i, 403, Exercise, i, 404; ii, 436. effect and importance of, i. 408. effects of, on the muscles, i, 407. for old people, i, 410. in flat-foot, i, 416. (vocal and respiratory) in laryngeal disor- ders, i, 417. in lateral curvature of the spine, i, 416. " the development and culture of the mind, i, 414. " the treatment of cardiac and circulatory affections, i, 415. Ling's system of, i, 413. proper conditions under which, should be taken, i, 409. Swedish system of, i, 413. systemic passive respiratory, in Basedow's disease, i, 415. therapeutics of, i, 411. treatment of the insane by, i, 413. Exodyne, i, 417. Expectant treatment, i, 417. Expectorants, i, 417. stimulating, ii, 227. Extracts, i, 419. Faba calabarica. See Physostigma. Fabiana imbricata. See Pichi. Faradaism, i, 359. Faradization. See under Electricity. Farfara. See Tussilago. Fats, i, 419. in poisoning with carbolic acid, i, 109. " " " corrosive acids, i, 109. " " " metallic oxides, i, 109. " " by metallic salts, i, 109. (by inunction) in scarlet fever, i, 420. Febrifuges, i. 421. Febriline, i, 421. Feeding, forced. See under Alimentation and Gavage. Feeding. See Alimentation, Dietetic treat- ment, Foods, and Milk. Fel bovinum. See Ox gall. Fennel. See Fceniculum. Fern, male. See Aspidium. Ferratin, i, 421. Ferripyrine. See Ferropyrine. Ferroh'emol, i, 422. Ferropyrine, i, 422. (by injection) in blennorrhagia, i, 422. in nasal hemorrhage, i, 422. Ferruginous preparations. See Iron. Ferrum. See Iron. 75 Ficus, Figs, i, 422. Filix mas. See Aspidium. Filmogen, ii, 436. Fir-wood oil in rheumatism, ii, 87. inhalation in chronic laryngitis, ii, 88. Fir wool, i, 422. Flacourtia, i, 422. in diarrhoea, i, 422. " general debility, i, 422. " hoarseness, i, 422. " nausea, i, 422. Flag, blue. See Iris. sweet. See Calamus. Flaxseed. See Linseed. Flaxseed tea, i, 351. in dysentery, i, 351. " irritable conditions of the genito-urinary tract, i, 351. Flour, i, 423. baked, as a food in infantile diarrhoea, i, 423. boiled, in gastro-intestinal indigestion, i, 423. wheat, in burns, i, 423. " erythematous eruptions, i, 423. " " pruritic eruptions, i, 423. Fluorescein, i, 423. Fluoral, i, 423. Fa'iiiculum, i, 424. Fomentations, i, 424. hot, in colic, i, 469. Foods, i, 424. animal, i, 426. preservation of, i, 427. vegetable, i, 425. Forced feeding, i, 43. Formaldehyde, i, 427; ii, 436. as a disinfectant, ii, 436. in acute conjunctival diseases, i. 428. " blennorrhagic cystitis, i, 428. urethritis, i, 428. " catarrhal affections of the vagina and cer- vix uteri, i, 428. " gonorrhceal affections, i, 428. " hay fever, ii, 436. " pruritus vulve, ii, 436. " purulent cystitis, i, 428. " tuberculous cystitis, i, 428. " whooping-cough, ii, 436. Formalin. See Formaldehyde. Formanilide, i, 429. Formalose. See Formaldehyde. Formic-acid compounds, i, 429. (in powder) for ulcerated surfaces, i, 429. in laryngeal carcinoma, i, 429. (in spray) in laryngeal tuberculosis, i, 429. Formic aldehyde, Formal. See Formalde- hyde. Formogelatin, ii, 437. Formyl chloride. See Chloroform. tribromide. See Bromoform. triiodide. See Iodoform. Foxglove. See Digitalis. Franciscea. See Manaca. Frangula, i, 429. in constipation, i, 429. Fraxinin. See under Manna. Friction. See Massage. Frigotherapy, i, 429. in dyspepsia, i, 429. Fruit syrups, ii, 252. 492 GENERAL INDEX. Fuller's earth. See under Earths. in undue secretions of the skin, i, 354. Fumigation, i, 430. calomel, in cramp and diphtheria, i, 625. " " in syphilis, i, 624. mercurial, in croup, i, 430. " " laryngeal diphtheria, i, 430. " " syp'hilis, i, 430. stramonium, in spasmodic asthma, i, 430. sulphur, in chronic skin diseases, i, 430. " " muscular rheumatism, i, 430. "' " neuralgia, i, 430. " " sciatica, i, 430. Gaduol. See Morrhuol. Galactagogues, i, 430. Galactose. See under Sugar (vol. ii, page 235). Galactotherapy. See under Serum treat- ment (vol. ii, page 187). Galangal, i, 431. Galazyme, i, 431. Galbanum, i, 431. (internally) in amenorrhoea, i, 432. " " chronic bronchitis, i, 432. " " chlorosis, i, 432. " " chronic rheumatism, i, 432. " hysteria, i, 432. Galega, i, 432. Galium, i, 432. Galla. See Galls. Gallacetophenone, i, 432. (externally) in psoriasis, i, 432. Gallal, i, 432. Gallanilide, i, 432. (topically) in chronic eczema, i, 432. " " psoriasis, i, 432. Gallanol, i, 432. Gallic acid, i, 432. (internally) in hemoptysis, i, 432. " for hemorrhages, i, 432. in acute nephritis, i, 432. " albuminuria, i, 432. " bronchorrhoea, i, 432. " colliquative sweating, i, 432. " diabetes insipidus, i, 432. " hematuria, i, 432. " hemophilia, i, 432. " metrorrhagia, i, 432. " ulcers, i, 432. Gallicin, i, 432. in conjunctivitis, i, 432. " keratitis, i, 432. Gallobromol, i, 433. (by compress) in acute eczema, i, 433. (by injection) in chordee, i, 433. (internally) in chorea, i, 433. " " epilepsy, i, 433. (by injection) in gonorrhoea, i, 433. Gallol. See Gallanol. Galls, i, 433. in chronic diarrhoea, i, 433. " painful hemorrhoids, i, 433. " poisoning with an alkaloid, i, 433. Galvanism. See Electricity. Gamboge, i, 433. and calomel in malarial congestion of the liver, i, 433. in engorgement of the portal circulation, i, 433. " flatulence, i, 433. Gamboge in intestinal indigestion, i, 433. Gargles, i, 433; ii, 437. Garlic, i, 434. Gaultheria, i, 434. in rheumatism, i, 124, 125, 434. " gastro-enteritis, i, 435. Gavage, i, 435. and lavage in chronic disorders of the stom- ach, i, 436. for infants prematurely born, i, 436. in anorexia, i, 436. " brain disease, i, 436. " broncho-pneumonia, i, 436. " diphtheria, i, 436. " empyema, i, 436. " irritable stomach of phthisis, i, 436. " phthisis, i, 435. " scarlet fever, i, 436. " spasm of the oesophagus, i, 436. " typhoid fever, i, 436. " vomiting, i, 436. Geissospermine, i, 436. Geissospermum leve, i, 436. Gelanth, Gelanthum. See under Varnishes. Gelanthum (Unna's treatment) in dry eczema, ii, 349. in eczema of the hand, ii, 349. " excessively dry skin, fissures, etc., ii, 349. preparation of, ii, 349. Gelatin in poisoning by alum, i, 109. in poisoning by bromine, i, 109. Gluten in poisoning by corrosive sublimate, i, 109. Gelsemine, i, 436. Gelsemium, i, 436. as a motor depressant, i, 644. in asthma, i, 437. " chorea, i, 437. " dysmenorrhoea, i, 437. " eczema, i, 437. " facial spasm, i, 437. " fever, i, 436. " hacking cough of phthisis, i, 437. " inflammation, i, 437. " laryngismus stridulus, i, 437. " malarial disease, i, 437. " mania with motor excitement and wake- fulness, i, 437. " neuralgia, i, 69, 437. " ovarian neuralgia, i, 69. " pleurisy, i, 437. " pneumonia, i, 437. " sciatica, i, 437. " spasmodic conditions, i, 437. " trigeminal neuralgia, i, 69. " whooping-cough, i, 437. Gentian, i, 437. and capsicum in vomiting of drunkards, i. 100. ' ' and ginger in vomiting of drunkards, i, 100. Geoffrea. See Andira. Geosite, ii, 437. in acute gastric catarrh, ii, 437. " chlorosis, ii, 437. " rheumatism, ii, 437. " tuberculosis, ii, 437. Geranium, i, 437. in diarrhoea, i, 438. " dysentery, i, 438. by injection in gonorrhoea, i, 438. GENERAL INDEX. 493 Geranium in hemorrhages, i, 438. (topically) in indolent ulcers, i, 438. " inflammatory affections of the throat, i, 438. in leucorrhoea, i, 438. Germander, i, 438. Germicides, i, 438. Gin, i, 449. in dysmenorrhoea, i, 449. Ginger, i, 449. and calumba in vomiting of drunkards, i, 100. '• gentian in vomiting of drunkards, i, 100. " serpentaria in vomiting of drunkards, i, 100. troches of, in catarrhal affections of the mouth and throat, i, 449. Glacialin, i, 449. Glonoin. See Nitroglycerin. Gluco-chloral. See Chloralose. Glucose. See under Sugar (vol. ii, page 235). Glucosides. See under Active principles. Glue, i, 449. suppositories of, in habitual constipation, i, 449. Gluside. See Saccharin. Gluten, i, 449. bread in diabetes mellitus, i, 449. -peptone sublimate, i, 450. Glutol, ii, 438. as an antiseptic, ii, 438. in ulcers and wounds, ii, 438. " weeping affections of the skin and mucous membranes, ii, 438. Glyceleum, i, 450. Glycerates, Glycerides. See Glycerites. Glycerin, i, 450. and carbolic acid in acute coryza, i, 450. " " " acute pharyngitis, i, 450. " " amygdalitis, i, 450. " " " " hay fever, i, 450. as a laxative, i, 450. " solvent, ii, 212. (internally) for flatulence, i, 451. " hemorrhoids, i, 451. " " heartburn, i, 451. in acne, i, 450. enema in acute diarrhoea, i, 451. (intra-uterine injections) in atony of the uterus, i, 450. in biliary lithiasis, i, 451. '• chapping of the hands and lips, i, 450. " eczema, i, 450. " fissures, i, 450. " hepatic colic, i, 451. injections in constipation, i, 450. " " fecal impaction, i, 451. " " hemorrhoids, i, 450. " (between the ovum and uterine wall) in labour, ii, 55. injections in ulcer of the rectum, i, 450. (intra-uterine injections) in placenta previa, i, 450. in pruritus, i, 450. '• psoriasis, i, 450. " trichiniasis, i, 451. " tuberculosis, i, 451. poisoning, ii, 438. suppositories in dysmenorrhoea, i, 450. " " endometritis, i, 450. " " endotrachelitis, i, 450. [ Glycerin suppositories in pelvic cellulitis, i, 450. suppositories in salpingitis, i. 450. " uterine congestion, i, 450. Glycerines, Glycerites, Glyceroles, i, 451. Glycerophosphates, ii, 438. in Addison's disease, ii, 439. " anemia, ii, 439. " chlorosis, ii, 439. " chronic nephritis, ii, 439. " convalescence from acute disease, ii, 439. " diabetes, ii, 439. " gout, ii, 439. " obesity, ii, 439. " phosphaturia, ii, 439. " pulmonary phthisis, ii, 439. " sciatica, ii, 439. " trigeminal neuralgia, ii, 439. " uric-acid diathesis, ii, 439. Glyceryl nitrate. See Nitroglycerin. Glyconin, i, 451. Glycozone, i, 451. Glycyrrhiza. See Licorice. Glycyrrhizinum ammoniatum, i, 451. Gnaphalium, i, 451. in diarrhoea, i, 451. " dysentery, i, 451. Goa powder. See under Chrysarobin. Gold, i, 451. and arsenic in cancer, i, 454. " " " phthisis, i, 454. and sodium chloride in sclerosis, i, 454. bromide for inebriety, i, 454. " in chorea, i, 454. " " epilepsy, i, 454. " " exophthalmic goitre, i, 454. " " hysteria, i, 454. chloride in habitual abortion, i, 453. " " nervous dyspepsia, i, 454. " (as a caustic) in ulceration of the cervix uteri, i, 453. cure in inebriety, i, 454. cyanide in scrofula, i, 322, 453. " " syphilis, i, 322. in amenorrhoea, i, 453. " anemia, i, 454. " catarrh of the duodenum and bile ducts, i, 454. " chlorosis, i, 454. '• chronic metritis, i, 453. " decline of the sexual power in men, i, 453. " dropsy, i, 451, 453. " hypertrophy of the tongue, i, 453. " hypochondriasis, i, 453. " impotence, i, 453. " indurated glands, i, 453. " jaundice, i, 454. " lupus, i, 453, 454. " oza^na, i, 453. " scrofulous ulcers, i, 453. " squamous skin disease, i, 453. " sterility, i, 453. " suicidal mania, i, 453. physiological action of, on animals, i, 452. " " " " man, i, 452. therapeutics of, i, 453. Goodell's emmenagogue, i, 375. Gossypium. See Cotton. Goose grease, i, 454. (liniment) in affections of the chest, i, 454. 494 GENERAL INDEX. Goose grease (liniment) in bronchitis, i, 454. (internally) in influenza, i, 454. (liniment) in muscular rheumatism, i, 455. Granatum. See Pelletierine. Grape cure, i, 455. in chronic diarrhoea, i, 455. " engorgement of the portal circulation, i, 455. " enlargement of the spleen, i, 455. " functional disorders of the liver, i, 455. " ha>morrhoids, i. 455. " intestinal catarrh, i, 455. " phthisis, i, 455. " plethora, i, 455. " scrofula, i, 455. " tuberculosis, i, 455. Green soap. See under Soap. Grindelia, i, 455. as a dressing for blisters, i, 456. for the dressing of burns, i, 456. in bronchitis, i, 456. " chronic cystitis, i, 456. " dyspnoea, i, 456. " elytritis, i, 456. " hay fever, i, 456. " herpes zoster, i, 456. " spasmodic asthma, i, 456. " " coughs, i, 456. " uterine catarrh, i, 456. Grindeline i, 455. Gruel, flour, i, 423. in diarrhoea, i, 423. " dysentery, i, 423. Guaiac, i, 456. in chronic skin disease, i, 456. " " rheumatism, i, 456. " gout, i, 456. " pharyngeal inflammation, i, 456. " syphilis, i, 456. Guaiacocaine, ii, 439. as a local anesthetic, ii, 439. Guaiacol, i 457. and glycerin in gout, i, 461. as a local anesthetic, i, 461. carbonate in pulmonary tuberculosis, i, 461. " " typhoid fever, i, 461. cinnamate. See Styracol. effects of, administered hypodermically, i, 458. effects of, on the temperature, i, 459. in acute nephritis, i, 458. " amygdalitis, i, 460; ii, 439. " arthritic tuberculosis, i, 457. " bronchopneumonia, ii, 439. " chronic catarrh of the gastro-intestinal and genito-urinary tracts, i, 457. " chronic nephritis, i, 458. " dental surgery, i, 461. " dermatitis, i, 461. '* diabetes mellitus. i, 458. " diphtheria, ii, 439. (external application) in erysipelas, i, 460. in fever, i, 457. " foetid bronchorrhoea, ii, 459 " follicular amygdalitis, ii, 439. " influenza, i, 460. " parenchymatous amygdalitis, ii, 439. (topical application) in pleurisy with effusion, i, 460. in pneumonia, i, 460; ii, 439. Guaiacol in pulmonary gangrene, ii, 439. iu pulmonary tuberculosis, i, 457, 458, 459. " pyemia, i, 460. (ointment) in blennorrhagic epididymitis, i, 461. (ointment) in swelled testicle, ii, 439. (topical applications) in typhoid fever, i, 459, 460. phosphate, ii, 440. salicylate, ii, 145. succinate, ii, 440. Guaiacum. See Guaiac and Guaiac wood. as an emmenagogue in amenorrhoea of rheu- matism, i, 375. Guaiac wood, i, 457. in chronic gout, i, 457. " " rheumatism, i, 457. " " skin diseases, i, 457. " scrofula, i, 457. " syphilis, i, 457. Guaiecetin, ii, 440. Guarana, i, 401. in convalescence, i, 461. " debility, i, 461. " migraine, i, 461. " sick headache, i, 461. Gum arabic. See Acacia. water in diarrhoea of infants, i, 351. Gun cotton. See Pyroxylin. Gurjun balsam, i, 461. as an expectorant, i, 462. in gonorrhoea, i, 462. " leprosy, i, 462. " vaginal blennorrhagia, i, 462. Gutta percha, i, 462. applied to fractures or injuries of the jaw, i, 462. liquid, for abrasions, excoriations, etc., i, 463. Gutti. See Gamboge. Gymnastics. See under Exercise. Gymnema, ii, 440. Gynocardia, Gynocardic acid. See under Chaulmoogra oil. Gypsum. See Plaster of Paris. Hemalbumin, i, 463. in anemia, i, 463. " chlorosis, i, 463. " rickets, i, 463. " scrofula, i, 463. " ulcer of the stomach, i, 463. Hematics, i, 463. Hematin-albumin, i, 463. in anemia, i, 463. Hematinics. See under Hematopoietics. Hematopoietics, i, 463. Hematoxylon, i, 464. in diarrhoea, i. 464. Hemogallol, i, 464. in anemia, i, 464. Hemoglobin, i, 464. in anemia, i, 464. Hemol. See Hemogallol. Hemostatics, i, 464. Hamamelis, i, 467. as a hemostatic, i, 467. as a mouth gargle in sore throat, i, 467. as an application to hemorrhoids, i, 467. as a sedative, i, 467. in bruises, i, 467. GENERAL INDEX. 495 Hamamelis (externally) in epistaxis, i, 467. in gastric catarrh, i, 467. " hemorrhage from the mouth, i, 467. (externally) in hemorrhoids, i, 467. in pulmonary hemorrhages, i, 467. " renal hemorrhage, i, 467. " sprains, i, 467. " uterine hemorrhage, i, 467. Hartshorn. See under Ammonium carbonate. Headine, i, 467. Heat, i, 467. and cold, action of, on the system, i, 163,164. application of, in drowning," i, 468. " exhaustion, i, 468. " laryngismus stridulus, i, 469. as a cardiac stimulant, i, 468. " germicide, i, 443. " hemostatic, i, 466. dry (applications), in cholera (algid state), ii, 225. in chronic sciatica, ii, 441. " rheumatism, ii, 440. dry (applications), in shock, ii, 225. " in toothache, i, 136. in hemorrhage (algid state), i, 468. " menorrhagia and metrorrhagia, i, 469. " pelvic congestion, i, 469. " poisoning by aconite, i, 7. " rheumatism, ii, 440. " treatment of narcotic poisoning, i, 469. Hedeoma, i, 469. in colic, i, 469. " nausea, i, 469. Helenin, Helenium. See under Inula. in leucorrhoea (as an antiseptic), i, 534. " tuberculosis (as an antiseptic), i, 534. Heliotropin. See Piperonal. Hellebore, American. See Veratrum viride. black, i, 469. '• in sthenic febrile conditions, i, 470. " physiological action of, i, 469. green. See Veratrum viride. white, i, 470. " for the destruction of the itch mite, lice, etc., i, 470. white, in acute gastritis, i, 470. " " " pleurisy, i, 470. " " croupous pneumonia, i, 470. " " pericarditis, i, 470. Helleborein, Helleborin. See under Helle- bore, black, and Hellebore, white. Helleborus albus. See Hellebore, white. Helleborus niger. See Helleborus, black. Helmerich's ointment, i. 116. Hemidesmus, i, 470. Hemlock. See Cicuta alid Conium. Hemp. See Apocynum and Cannabis indica. Henbane. Sec Hyoscvamus. Hepatics, i, 470. Hexamethylenetctramin/e. See Urotropine. Hidrotics.' See Diaphoretics. Hirudo. See Leeching. Hive syrup. See under Squill. Hoang-nan, i, 471. in leprosy, i. 471. " rabies, i, 471. " scrofula, i, 471. Hoffmann's anodyne in dyspnoea of asthma, i, 94. Homatropine, i, 471. in incipient cataract, i, 472. " night sweats of phthisis, i, 471. Homoguaiacol. See Creosol. Honey, i, 472. and rye meal (paste) in abscess of the ear, i, 472. in scorpion stings, ii, 441. Hops. See Humulus and Lupulin. Hordeum, i, 472. decoction of, in fevers, i, 473. " " intestinal inflammation, i, 473. decoction of, in intestinal irritation, i, 473. Horehound, i, 473. in catarrhal bronchitis, i, 473. " chronic pulmonary disorders, i, 473. " colds, i, 473. " sore throat, i, 473. Horseradish, i, 473. dried root of, chewed for toothache, i, 473. in atonic dyspepsia, i, 473. " dropsy, i, 473. " flatulence, i, 473. infusion of, for hoarseness, i, 473. Hot applications in inflammatory exudations, i, 469. in itching, i, 469. Humulus, i, 473. for breaking off the opium habit, i, 474. in chordee, i, 474. " delirium tremens, i, 474. " diarrhoea, i, 474. " dyspepsia, i. 473. " incontinence of urine, i, 473. " irritable bladder, i, 474. " irritation of the genito-urinary tract, i, 474. " priapism, i, 474. " sexual erethism, i, 474. poultice for toothache and earache, i, 475. Hunyadi Janos, i, 474. for indigestion, i, 474. " disordered liver, i, 474. in acute congestion, i, 474. " chronic congestion of the pelvic organs, i, 474. " diarrhoea, i, 474. " dropsy, i, 474. Hyenancliin, i, 474. in amblyopia, i, 474. " deafness, i, 474. Hydracetin, i, 474. Hydragogues, i, 222, 475. indications for the use of, i, 475. Hydrargyrum. See Mercury. Hydrastine, Hydrastinine. See under Hydras- tis. in acne, i, 476. '• bromidrosis, i, 476. " chronic nephritis, i, 476. '• dry seborrhcea, i, 476. (as a douche) in gonorrhoea, i, 476. (internally and by injection) in gonorrhoea, i, 476. in granular conjunctivitis, i, 476. (as a lotion) in hyperidrosis, i, 476. in indolent ulcers, i, 476. " intermittent fever, i, 476. " paludal cachexia, i, 476. 496 GENERAL INDEX. Hydrastine (internally) in puerperal hemor- rhage, i, 476. in spermatorrhoea, i, 476. " ulcerating carcinoma, i, 476. (as a douche) in vaginal leucorrhoea, i, 476. Hydrastis, i, 475. canadensis as an ecbolic, ii, 55. in catarrh of the cystic duct, i, 476. " gall ducts, i, 476. (internally and topically) in catarrh of the vesical, vaginal, and uterine mucous mem- branes, i, 476. in chronic enteritis, i, 475. '- gastric catarrh, i, 475. (local applications) in follicular amygdalitis, i, 476. (local application) in hemorrhage from the lower bowel, i, 476. in membranous dysmenorrhoea, i, 476. " old ulcers, i, 476. " otorrhoea, i, 476. (local applications) in pharyngitis, i, 476. " '" " stomatitis, i, 476. in syphilitic affections of the throat and nares, i, 476. " the alcohol habit, i, 475. " ulcers of the rectum, i, 476. Hydriatics, Hydriatrics, i, 476. Hydriodic acid, i, 492. in acute rheumatism, i, 492. " asthma, i, 492. " delayed resolution of the lungs after pneu- monia, i, 492. " pleuritic exudation, i, 492. " scrofulous diathesis, i, 492. ether. See Ethyl iodide. Hydrobromic acid, i, 492. and the bromides in epilepsy, i, 492. in headache, i, 492. " nervous cough, i, 492. " neuralgia, i, 492. ether. See Ethyl bromide, i, 492. Hydrochloric acid, i, 492. as a disinfectant, i, 446. in acid dyspepsia, with pyrosis, i, 493. " acute rheumatism, i, 493. " anemia, i, 493. " chlorosis, i, 493. " diarrhoea of typhoid fever, i, 493. " fever, i, 493. " heart disease with deficient compensation, i, 493. •' indigestion, i, 493. " necrosis of bone of tuberculous origin, ii 441. " neurasthenia, i, 493. " poisoning with silver and alkalies, i, 493. (by sponging) in pruritus of urticaria, i, 493. (as a gargle) in scarlet fever, i, 493. in superficial cutaneous growths, i, 227. " vomiting due to alcoholic overindulgence, i, 100. ether. See Ethyl chloride. Hydrocotyle asiatica, i, 493. in catarrhal enterocolitis, i, 493. " fever, i, 493. " leprosy, i, 493. " lupus, i, 493. " scrofulodermata, i, 493. " syphilis, i, 493. Hydrocyanic acid, i, 493. action of, i, 496. antidotes for poisoning with, i, 501. chronic poisoning with, i, 498. in heart affections, i, 495. (dilute) in vomiting of pregnancy, i, 99. in whooping-cough, i, 495. poisoning with, i, 496. tests for, i, 499. uses of, i, 495. ether, i, 322. Hydrofluoric acid in pulmonary tuberculosis, i, 527. Hydrogen as an antipyretic, i, 527. as a sedative, i, 527. cyanide. See Hydrocyanic acid. dioxide, i, 502. " as a disinfectant, i, 502. " as a germicide, i, 445. " in abscesses, i, 502. " " amygdalitis, i. 503. " " chancroid and chancre, i, 503. " " diphtheria, i, 503. " injections in gonorrhoea, i, 503, 531. " in scarlet fever, i, 503. " " superficial ulcerations, i, 503. " " unhealthy suppurating surfaces, i, 502. gas in abdominal surgery, i. 533. peroxide. See Hydrogen dioxide. sulphide. See under Sulphur, i, 503. Hydronaphthol, i, 503; ii, 3. Hydroquinine, i, 503. Ilydroquinone, i, 503. Hydrotherapeutics. See Hydriatics. Hydroxylamine hydrochloride, i, 503. in lupus, i, 503. " parasitic skin disease, i, 503. " pityriasis, i, 503. " psoriasis, i, 503. Hygiama, ii, 442. in debility of convalescence, ii. 442. " diseases of the stomach and intestines, ii, 442. " pulmonary consumption, ii, 442. " typhoid fever, ii, 442. Ilyoscine, i, 503. effect of, on the insane, i, 504. in acute mania, i, 508. " delirium tremens, i, 508. " insomnia, i, 508. " paralysis agitans, i, 504. Hyoscyamine, i, 504. as a mydriatic, i, 649. " sedative to the nervous system, i, 504. in insanity, i, 504. " paralysis agitans, ii, 442. " spasms, i, 504. " vesical pain, i, 504. Hyoscyamus, i, 504. as a sedative to the nervous system i 504 in griping pains, i, 504. " insomnia, i, 5(18. " neuralgia, i, 505. " spasmodic conditions, i, 504. " vesical pain, i, 504. Hypnal, i, 505. in insomnia with pain, i, 505. Hypnone. See Aoetopiienone." I Hypnotic measures, i, 506. GENERAL INDEX. 497 Hypnotics, i, 505. indirect, i, 505. medicinal, i, 506. narco-, i, 505. pure, i, 505. Hypnotism, i, 509. dangers of, i, 513. induction of, i, 510. in functional disorders of the nervous sys- tem, i, 514. " functional gastro-intestinal disorders, i, 515. " labour pains, i, 514. " masturbation, i, 515. " menstrual disorders, i, 515. " nocturnal enuresis, i, 515. " onanism, i, 515. " organic diseases, i, 514. " the alcohol and drug habit, i, 515. precautions necessary in the therapeutic use of, i, 513. therapeutic value of, i, 513. Hypodermic medication, i, 515. advantages of, i, 517. disadvantages of, j, 517. manner of performing, i, 518. preparation of the solution for, i, 516. Hypophosphites, i, 518. in bone diseases, i, 518. " chronic pulmonary tuberculosis, i, 518. " disorders of the nerve-centres, i, 518. " furuncles, i, 518. " scrofula, i, 518. " styes, i, 518. nypophosphorous acid, i, 519. Hyposulphites, i, 519. (locally) in cutaneous diseases of a parasitic nature, i, 519. in gastric fermentation, i, 519. (locally) in pityriasis versicolor, i, 519. in porrigo, i, 519. (locally) in ringworm, i, 519. " " scabies, i, 519. Ice, i, 519. applied to the spine in amenorrhoea, i, 520. " " " " " scanty menstruation, i, 520. applied to the spine in seasickness, i, 520. bag in bronchitis, i, 520. " " encephalitis, i, 520. " " epididymitis, i, 520. " " inflammation of the pelvic organs, i, 520. bag in meningitis, i, 520. " " myelitis, i, 520. " " orchitis, i, 520. " " pericarditis, i, 520. " " peritonitis, i, 520. " " pleurisy, i, 520. " " pneumonia, i, 520. cradling in pneumonia, i, 520. (topically) in capillary hemorrhage, i, 520. " " inflammations, i, 519. '• " strangulated hernia, i, 519. " " superficial congestions, i, 519. to the spine for stimulation of the menstrual flow, i, 375. Iceland moss. See Cetraria. Ichthyocolla. See Isinglass. Ichthyol, i, 521. as an analgetic, i, 523. " a sorbefacient, i, 523. in acute elytritis, i, 523. " " perimetritis, i, 523. " bronchial tuberculosis, ii, 443. " burns, i, 522. " chronic constipation, ii, 443. metritis, i, 523. " " parametritis, i, 523. " cicatricial atrophy of the vagina and cer- vix uteri, i, 523. " diarrhoea, ii, 443. " eczema, i, 522. " " seborrhoicum, i, 116. " elephantiasis, i, 522. " endometritis, i, 523. " endotrachelitis, i, 523. " erysipelas, i, 522. " fissures of the nipples, i, 523. " gastric disturbances, ii, 443. " gout, i, 522. " gynecological practice, i, 523. " hyperemia, i, 522. " inflammation, i, 522, 523. " " caused by the stings of in- sects, ii, 444. injections in gonorrhoea, i. 522. (salve or solution) in intertrigo, i, 522. in intestinal disorders, ii, 443. " leprosy, i, 522. " lymphangeio-phlebitis, ii, 443. " nervous eczema, i, 522. " parasitic eczema, i, 522. " pruritus, i, 523. " " of the vulva and of the anus, i, 524. " pulmonary tuberculosis, ii, 443. " rebellious constipation, ii, 443. (externally and internally) in rosacea, i, 522. in salpingo-oophoritis, i, 523. " scars of acne, keloid, and variola, i, 522. " scleroderma, i, 522. " swollen glands, i, 522. Ignatia, i, 524. Ignipuncture, i, 524. in chronic articular inflammation, i, 524. " " hypertrophy of the tonsils, i, 524. " fungous arthritis, i, 524. " hypertrophy of the nose, i, 524. " neuralgia, i, 524. " petit mal, i, 524. " synovial cysts, i, 524. Illicium, i, 524. India rubber. See Rubber. Indigo in dysmenorrhoea, i, 375. Infiltration anesthesia, i, 524. Infusion. See under Transfusion. and the subcutaneous injection of strychnine in shock, ii, 324. in acute hydrocephalus, ii. 324. " " pericarditis, ii, 324. " brown atrophy of the heart muscle, ii, 328. " cerebral anemia, ii, 324. " cholera, ii, 324. " chronic gastro-enteritis, ii, 324. " collections of fluid (in the serous cavities'), ii, 324. " epistaxis, ii, 324. I " gastric hemorrhage, ii, 324. 498 GENERAL INDEX. Infusion in intestinal hemorrhage of typhoid fever, ii, 323. in iodoform poisoning, ii, 323. (of an isotonic saline solution) in placenta previa, ii, 324. in poisoning with carbonic oxide, ii, 323v " " " chloral, chloroform, ether, morphine, opium, or phosphorus, ii, 323. " poisoning with illuminating gas, ii, 328. " puerperal septicemia, ii, 324. " septicemia, ii, 325. intra-arterial, of sodium chloride solution in acute anemia and in collapse, ii, 328. intramuscular, in anasarca, ii, 325. " " albuminuria, ii, 325. " " pulmonary oedema, ii, 325. " " uremia, ii, 325. intraperitoneal saline, ii, 325. intravenous or subcutaneous, in acute peri- tonitis, ii, 325. intravenous or subcutaneous, in cholera, ii, 325. intravenous or subcutaneous, in pneumonia, ii, 324, 325. intravenous or subcutaneous, in puerperal septicemia, ii, 325. intravenous or subcutaneous, in septicemia, ii, 325. intravenous or subcutaneous, in tetanus, ii, 325. Infusions, i, 525. Ingluvin, i, 526. in dyspepsia, i, 526. " vomiting of pregnancy, i, 526. Inhalants, Inhalation, i, 526. Ink, ii, 259. in ringworm, ii, 259. Injection Brou in gonorrhoea, i, 531. Injections, abortive, i, 531. " hypodermic. See Hypodermic medi- cation. intravenous, i, 530. rectal. See Enemata. simple, i, 531. urethral, i, 530. Inoculation against rabies by the method of Tizzoni and Centanni, i, 82. cholera, i, 83. Instillation, i, 532. Insufflation, i, 532. of hot air in tuberculous peritonitis, i, 532. " powders in deep wounds, cold abscesses, affections of the mouth, nose, etc., i, 533, 534 Inula, i,' 534. as a tonic in amenorrhoea, i, 534. Inunction, i, 534. Iodamylum, l, 534. lodantipyrine, i, 534. Iodide of ethyl in asthma, inhalations of, i, 95. Iodides. See under Iodine. in chronic lead or mercury poisoning, ii, 214. Iodine, i, 534. as a germicide, i, 445. bath, for constitutional effects, i, 537. enema in chronic diarrhoea, i, 536. " " dysentery, i, 536. hypodermic injection of, in chronically en- larged tonsils, i, 536. hypodermic injections of, in goitre, i, 536. Iodine, hypodermic injections of, in hydatid cvsts, i, 536. hypodermic injections of, in hypertrophied prostate, i, 536. hypodermic injections of, in hypertrophy of lymphatic glands, i, 536. in articular involvements, i, 535. (externally) in atrophic rhinitis, i, 536. in chilblain, i, 536. " chloasma, i, 536. (externally) in chronic cystitis, i, 536. in chronic glandular enlargements, i, 535. " " indurations of the breast, i, 536. •' " phthisis, i, 536. (externally) in enlarged glands, i, 536. in enlargements of the liver, mamme, testes, and uterus, i, 536. (externally) in erysipelas, i, 536. (internally) in glandular enlargements, ii, 214. (externally) in goitre, i, 536. (internally) in goitre, ii. 214. (externally) in inflammation of the pharynx and larynx, i, 536. injection in ascites, i, 536. " " cystic bronchocele, i, 536. " " dropsy of the joints, i, 536. " " hernia, i, 536. " •' hydrocephalus, i, 536. (externally) in leucorrhoea, i, 536. in lupus, i, 536. (externally) in muscular rheumatism, i, 536. (small doses) in nausea, i, 536. (externally) in ophthalmia, i, 536. " " orchitis, i, 536. " " ovarian tumours, i, 536. in ozena, i, 536. (externally) in pitting of small-pox, i, 536. " " pityriasis, i, 536. " " pleurisy, i, 536. " " psoriasis, i, 536. " " ringworm, i, 536. in scrofulous diseases, i, 535. " tuberculosis, i, 527. (as an intestinal antiseptic) in typhoid fever, i, 536. in ulcers, i, 536. (externally) in urethritis, i, 536. (small doses) in vomiting, i, 536. salts in chronic rheumatism, i, 536. " " " skin disease, i, 536. " " " gout, i, 536. " lead poisoning, i, 536. " " tertiary syphilis, i, 536. terchloride as a germicide, i, 445. tincture in ringworm, i, 117. vapour in chronic bronchitis, i, 536. " " pulmonary tuberculosis, i, 536. Iodoform, i, 537. in chronic dysentery, i, 537. " cirrhosis of the liver, i, 537. (hypodermically) in cold abscesses, i, 538. in diabetes, i, 537. (hypodermically) in goitre, hydrocele, and tuberculous affections, i, 538. in inflamed mucous membrane of the genito- urinary organs, i, 538. inhalation in bronchitis, i, 540. " coryza, i. 540. in suppurating buboes, i, 539; ii, 444. GENERAL INDEX, 499 Iodoform injection in suppurating inguinal buboes, i, 539. in meningitis, i. 537. " obesity, i, 537. bk painful septic diseases of the rectum, uterus, and vagina, i, 538. '• phthisis, i, 537. -' recent wounds, i, 538. " ulcerated throats, i, 445. poisoning, i, 539. powder in septic wounds, i, 538. Iodoformin, i, 540. Iodol, i, 540. in balanitis, i, 540. " carbuncles, i, 540. " caseous glands, i, 540. (by insufflation) in chronic bronchial catarrh, i, 540. (by insufflation) in chronic inflammation of the Eustachian tube, i, 540. (by insufflation) in granular pharyngitis, i, 540. (by insufflation) in otitis media, i, 540. _ " " " posterior rhinitis, i, 540. in psoriasis, i, 540. " soft chancre, i, 540. " suppurative bubo, i, 540. " tinea tonsurans, i, 540. (by insufflation) in trachoma, i, 540. " " tuberculous laryngitis, i, _ 540. in ulcers, i, 540. " vaginal catarrh, i, 540. Iodophenacetine, Iodophenine, i, 540. Iodopyrine. See Iodantipyrixe. Ipecac, Ipecacuanha, i, 541. as a counter-irritant, i, 542. '• an emetic in croup, i. 418. in acute bronchitis, i, 373. " " dysentery, i. 542. gastritis, i, 542. " laryngitis, i, 542. " asthma (as an expectorant), i, 95. (as an emetic) in bilious attacks, i, 542. in bronchial catarrh, i, 542. " bronchitis, i, 542. " catarrhal jaundice, i, 542. " chronic bronchitis, i, 542. " " dysentery, i. 542. " diarrhoea of young children, i, 542. " diarrhoeal conditions, i, 542. " emphysema, i, 542. " epistaxis, i, 542. " hemoptysis, i. 542. " hay fever, i, 542. '• laryngismus stridulus, i. 542. " malarial disease, i. 542. " membranous croup, i, 542. " menorrhagia. i. 542. " migraine, i, 542. " narcotic poisoning, i. 541. " pharyngitis, i, 542. " post-partum hemorrhage, l. 542. " spasmodic affections of the respiratory apparatus, i, 373. " spasmodic croup, i, 373. " vomiting of gastric atony, i. 542. " nervous origin, i. 542. (small doses) in vomiting of pregnancy, i, 99, 541. Ipecac in whooping-cough, i, 542. Ipomoea. See Jalap. Iridin, i. 543. Iris, i, 543. Irish moss. See Chondrus. Irisin. See Iridin. Iron, i, 543. acetate in chronic nephritis, i, 551. albuminate in chlorosis, i, 553. ammoniochloride in amenorrhoea, rickets, and scrofula, i, 549. and arsenic in neuralgia, i, 68. as a general tonic, i, 545. " stomachic, i, 545. bromide in chorea, i, 553. " " scrofula, i, 553. carbonate in anemia, i, 547. " chlorosis, i, 547. " " digestive atony, i, 547. '• " menstrual irregularities, i. 547. chloride (tincture) in albuminuria, i. 548. " (ethereal tincture) in anemia and chlorosis, i, 548. chloride (in solution) in aneurysms and vari- ces, i. 547, 548. chloride (tincture) in arsenic poisoning, i, 143. " in Bright's disease, i, 548. " (tincture) in chronic bronchit is, i, 548. " " " diphtheria, i. 548. " " " emphysema (if anemia is present), i, 548. chloride (tincture) in epistaxis, i, 548. '• erysipelas, i, 548. " gleet, i, 548. " (solution) in hemorrhage, i, 548. " (tincture) in hemorrhages of the bowels, kidneys, etc.. i, 548. chloride (tincture) in hysteria, melancholia, and mania, i, 549. chloride (tincture) in neuralgia of anemia, i, 549. chloride (tincture) in neurotic disturbances, i, 549. chloride (tincture) in passive hemorrhage (if anaunia is present), i, 548. chloride in post-partum hemorrhage, i. 548. u (tincture) in prostatorrhoea, i, 548. " " " pseudoleukemia, i, 549. " " " purpura, i, 548. " " " pyemia, i, 549. " " " rheumatism, i, 548. " " " scarlatina, i, 549. " " " .septicemia, i, 549. in soft vegetations and growths, i, 548. chloride (tincture) in spermatorrhoea, i. 548. " " internally and externally in sore throat, i, 549. chloride (tincture) injections in varicosities, i, 549. citrate in anemia, i, 550. " malarial disease, i. 550. hydrate as an antidote in arsenic poisoning, 'i. 552. hydrate in myalgia, i. 552. in amygdalitis, i. 546. " anemia, i, 544; ii, 310. " chlorosis as an emmenagogue. i, 374. '• erysipelas, i, 540. " fatty degeneration of the heart, i, 217. GENERAL INDEX. Iron hydrate in pharyngitis, i, 546. iodide in atony of mucous surfaces with re- sultant discharges, i, 551. iodide in atonic amenorrhoea, i, 551. " " chlorosis, i, 551. " nocturnal enuresis of children, i, 551. iodide in scrofula, i, 551. " " syphilis, i, 551. lactate in chlorosis, i, 551. malate, i, 553. (Monsel's solution) in acute follicular amyg- dalitis, i, 550. nitrate in chronic diarrhoea, i, 551. " " leucorrhoea, i, 551. " " menorrhagia, i, 551. oxalate, i, 553. oxide as an antidote in arsenic poisoning, i, 552. oxide, magnetic, i, 553. phosphates in anemia with cerebral debility, i, 551. precipitated, dialyzed, in arsenic poisoning, i, 143. reduced, in anemia, i, 547. " " chronic eczema, i, 547. " " lepra, i, 547. " " psoriasis, i, 547. " " ulcerating carcinomata, i, 547. saccharated oxide of, in arsenic poisoning, i, 143. succinate in jaundice, i, 553. sulphate (Monsel's solution) in acute follicu- lar amygdalitis, i, 550. sulphate in anemia accompanied by consti- pation, i, 549. sulphate in chronic ophthalmia, i, 549. " " debilitated conditions associated with chronic discharges, i, 549. sulphate (solution) in external hemorrhages, i, 550. sulphate in gastric atony of anemia, i, 549. " gleet, i. 549. " '• hematemesis, i, 550. " " hemoptysis, i, 550. " " hemorrhoids, i, 550. " " post-partum hemorrhage, i, 550. '• '• syphilis, i, 550. " " uterine hemorrhage, i, 550. tannate in anemia, ii, 259. " chlorosis, ii, 259. " " ringworm, i, 553. tartrate, i, 552. valerianate in anemia, i, 552. " " " chlorosis, ii, 348. " " diabetes insipidus, i, 552. Irrigation, i, 553. antiseptic, of joints, i, 556. methods of, for various parts of the body, i, 553. of the ear, i, 553. " eye, i, 553. " mouth, i, 554. " nose, i, 554. " rectum and colon for septic colitis and diarrhoea of children, i, 554. of the rectum and colon in acute dysentery. i, 491. of the stomach for intestinal obstruction, i, 491. Irrigation of the stomach in summer diarrhoea of infants, i, 491. of the urethra and bladder, i, 555. " uterine cavity, i, 555. " vagina, i, 555. of wounds, i, 555, 556. Irritants, i, 556. Isinglass, i, 556. Isonaphthol. See Naphthol. Issue-peas, i, 543. Itrol. See Silver citrate (vol. ii, page 198). Izal, i, 556. as a disinfectant and germicide, i, 556. Jaborandi, i, 558. as a diaphoretic, i, 558. " sialagogue, i, 558. in acute congestive conditions following cold, i, 559. (by subcutaneous injection or by the mouth) in alopecia, i, 560. in ascites, i, 559. " asthma, i, 559. " bronchitis, i, 559. " diabetes insipidus, i, 559. " diphtheria, i, 559. " dropsy, i, 559. " dry skin diseases, i, 560. " erysipelas, i, 560. " hydrothorax, i, 559. (by spraying) in laryngitis with scanty secre- tion, i, 560. in nephritis, i, 559. " pleurisy with effusion, i, 558. " poisoning with atropine, i, 560. " prurigo, i, 560. " pulmonary oedema, i, 559. " urticaria, i, 560. " uremia, i, 559. Jalap, i, 560. in dropsical affections, i, 560. (resin) in malarial disease, i, 560. in portal congestion, i, 560. Jambol. See Jambul. Jambul, i, 561. as an astringent, i, 561. as a stomachic, i, 561. in diabetes, i, 561. Japanese belladonna. See Scopoleine. Jasmine. See Gelsemium. Javelle water, i, 240. Jecoris aselli, oleum. See Cod-liver oil. Jequirity, i, 561. in granulation of the eyelids, i, 562. " pannus, i, 562. Jervine. See under Veratrum viride. Juglans, i, 562. in constipation, i, 563. Juice, beef, i, 333. Juices, i, 563. Juniper, i, 563. in dropsy, i, 563. " impotence, i, 137. Junket, i, 42. Jute, i, 563. Kairine, i, 563. in fever, i, 563. Kalium. See Potassium. Kamala, i, 563. GENERAL INDEX. 501 Kamala in ascarides vermiculares, i, 102. in intestinal worms, i, 563. Kaolin. See Fuller's earth and Earths. Kava, Kava-kava, i, 563. as an anesthetic, i, 563. " a motor depressant, i, 563. " a diuretic, i, 563. " a sialagogue, i, 563. in cystitis, i, 564. " dropsy, i, 564. " elytritis, i, 504. " gleet, i, 564. " gonorrhoea, i, 564. " gout, i, 564. " incontinence of urine, i, 564. " retention of urine, i, 564. Kefir, i, 564. in gastro-intestinal nephritis, i, 637. Keratin, i, 564. Kermes mineral. See under Antimony (vol. i, page 14). as an emetic, i, 114. Kerosene, i, 565. in atonic and indolent ulcers, i, 565. " destruction of parasites, i, 116. Kinetotherapy, i, 565. Kino, i, 565. in diarrhoea, i, 565. " epistaxis, i, 565. " indolent ulcers, i, 565. " leucorrhoea, i, 565. " passive hemorrhage, i. 565. " polyuria, i, 565. " relaxed conditions of the mouth and throat, i, 565. Kochin, i, 565. Kola. See Sterculia. Koumyss. See Kumyss. Kousso. See Cusso. in treatment of tenia, i, 102. Krameria, i, 565. in chronic diarrhoea, i, 566. " dysentery, i, 566. " leucorrhoea, i, 566. " passive bleeding from the intestines, i, 566. " visceral hemorrhage, i, 566. Kresin, i, 566. Kristaline. See Cristalline. Krummholz oil. See under Pine prepara- tions (vol. ii, page 88). Kumyss, i, 566. as an antemetic food, i, 98. in acute febrile conditions, i, 567. " chronic bronchitis, i, 567. " convalescence of acute diseases, i. 567. " diseases of the stomach and bowels, i, 567. " impaired digestion, i, 567. " phthisis, i, 567. Laburnum. See Cytisus laburnum. Lac. See Milk. Lactic acid, i, 567. in atonic dyspepsia, i. 567. " corneal ulcers, i, 568. " croup, i, 567. " diabetes, i, 567. " diarrhoea, i, 567. " diphtheria, i, 5(17. " epithelioma, i, 568. " gastric superacidity, i, 567. Lactic acid in lingual and in nasal tubercu- losis, i, 568. in papillomata, i, 568. " photophobia, i, 568. " tuberculous laryngitis, i, 567. " " ulceration, i, 568. Lactol, Lactonaphthol, i, 568. Lactopeptine, i, 568. Lactophenine, i, 568. in influenza, i, 568. " rheumatism, i, 568. " scarlet fever, i, 568. " typhoid fever, i, 568. Lactose. See Sugar of milk. Lactuca, i, 568. Lactucarium, i, 568. in nausea following the use of opium or morphine, i, 568. Lactucin, i, 568. Lamelle, i, 568. Laminaria, i, 568. Lanolin, i, 569. (injection) in gonorrhoea, i, 569. Lantana, Lantanine, i, 570. Lantanine in malarial fevers, i, 570. Lappa, i, 570. in hemorrhoids, i, 570. " scrofula, i, 570. " syphilis, i, 570. Larch. See Larix. Lard, i, 570 ; ii, 445. in poisoning by acids or alkaloids, i, 570. inunctions in malnutrition with emaciation, ii, 445. Larix, i, 570. in chronic irritable affections of the genito- urinary tract, i, 570. Larkspur. See Staphisagria. Laudanum. See under Opium. Laurel, i, 571. in acute eczema and dermatitis, i, 571. " atonic diarrhoea, i, 571. (extract) in cerebro-spinal meningitis, i, 571. in erythema, i, 571. (extract) in megrim, i, 571. in rheumatism, i, 571. " tinea, i, 571. Laurocerasus, i, 571. Laurus. See Laurel. Lavage, i, 571. in acute indigestion, i, 572. " " vegetable poisoning, i, 491. " chronic gastritis, i, 491, 572. " dilatation of the stomach, i, 491, 572. " gastralgia, i, 572. " intoxication, i, 572. " lead poisoning, i, 491. " mercury poisoning, i, 491. " motor disturbances of the stomach, i, 572. Lavandula, i, 572. in digestive atony, i, 572. " flatulence, i, 572. " headache, i, 572. " nervous exhaustion, i, 572. Lavements. See Enemata. Lavender. See Lavandula. Laxatives, i, 222 ; i, 573. Lead, i, 574. acetate and opium in diarrhoea, i, 577. " in diarrhoea, i, 577. 502 GENERAL INDEX. Lead acetate in hemorrhage from the stomach, U 577. acetate in hemoptysis, i. 517. " '• intestinal hemorrhage, i. 577. and opium wash in erysipelas, bruises, and irritable surfaces, i, 577. _ and opium wash in rhus poisoning, 1, o,7; ii, 132. , , compound suppositories of, m dysentery and irritable condition of the rectum, i. ;in. Goulard's extract of, in sprains, blisters, bruises, etc., i, 577. iodide ointment in enlarged glands, i, o78. " " hypertrophy of the spleen, i. 578. . liniment in burns and raw surfaces, l, 5*8. " eczema of the anus and genitals, i, 577. liniment in psoriasis, i, 577. nitrate in fissured nipples and chapping, i, 578. " " onychia, i, 578. oxide ointment in eczema, i, 578. " plaster in raw or excoriated surfaces, i, 578. poisoning, I, 576. tannate in bedsores, i, 578. Unna's, paste, ii, 64. Leeching, i, 578. application of the leech, i, 579. for local depletion in children, i, 578. " conjunctivitis, i, 579. " meningitis, i, 579. " orchitis, i, 579. •• otitis, i, 579. Lemon, i, 579. -juice and coffee in intermittent fever, i, 260. " as an antidote for poisoning from the fumes of ammonia water, i, 53. -juice (diluted, as a gargle) in aphthous af- fections, i, 200. -juice in corpulence, i, 260. •• (diluted, as a gargle) in gangrenous affections, i. 260. -juice in jaundice, i, 260. " " poisoning by Indian hemp, i. 580. " post-partum hemorrhage, i, 260. (diluted) in pruritus, i, 260. " in rheumatism, i. 260. " with glycerin lotion in sunburn, i, 260. Leontodon. See Taraxacum. Leptandra, i, 580. in constipation, i, 580. (as a tonic) in dyspepsia, i, 580. Lettuce, i, 580. Levisticum. See Ligusticum. Levulose, ii, 445. in diabetes, ii, 445. Lichen. See Cetraria. Licorice, i, 580. and flaxseed in diarrhoea, i. 581. " •' '• pharyngitis and laryngitis, i, 581. compound powder of, in constipation, i, 581. in bronchial catarrh, i, 580. " bronchitis, i, 580. Lignosulphite, i, 581. in pulmonary tuberculosis, i, 581. Ligusticum, i, 581. in amenorrhoea, dropsy, and flatulent dys- pepsia, i, 581. Lily of the valley. See Convallaria. Lime, i, 581. as a germicide, i, 447. " an antidote to sulphuric-acid poisoning, ii, 242. in carbolic-acid poisoning, i, 582. incompatibility and toxicology of, i, 58-. -juice in scurvy, i, 260. physiological action of, i, 582. syrup of, in poisoning by carbolic or oxalic acid, i, 582. vapour of slaked, inhaled, in diphtheria, i, 582. -water and milk in nausea, i, 98, 582. " as a lotion in eczematous surfaces, i, 582 -water as a lotion in fissured nipples, i, 582. " " vaginal wash in threadworms, i, 582. . _oo -water as a wash in aphthe. l. 582. " in acid dyspepsia, i, 582. " " mucous enteritis, i, 582. " stone in the bladder, i, 582. " " typhoid fever, i, 582. Liniments, i, 583. Linseed, i, 583. infusion of, in bronchial inflammations, l, 584. infusion of, in diarrhoea and dysentery, i, o84. " " " inflammation, i, 584. " " " irritation and inflammation of the urinary organs, i, 584. oil as a nutrient in cachectic conditions, i, 584. Lint, i, 584. _ in burns, i, 584. Linum. See Linseed. Lipanin, i, 585. Lippia mexicana, i, 585. in asthma, i, 585. Liquorice. See Licorice. Liriodendron tulipifera in malarial disease, i, 585. Listerine, i, 585. Litharge. See Lead oxide under Lead. Lithium, i, 585. in gout and lithiasis, i, 585, 586. salicylate in acute articular rheumatism, ii, 145. salicylate in fever, ii, 145. Lithontriptics, i, 585. Lobelia, i, 586. in asthma, i, 587. " " as an expectorant, i, 95. " bronchial cough, i, 587. " chorea, i, 587. " convulsions, i, 587. " epilepsy, i, 587. (enema) in fecal impaction, i, 587. infusion of, in intestinal intussusception, i, 587. infusion of, in strangulated hernia, i, 587. in habitual constipation, i, 587. " spasmodic croup, i, 587. '* tetanus, i, 587. " whooping-cough, i, 587 Lobeline, i, 587. Loco-weed, i, 587. Logwood, i, 588. I London paste, ii, 202. GENERAL INDEX. 503 Loretin, i, 588. in cancer, i. 588. Losophan, i, 589. in acne, i, 589. " chronic eczema, i, 589. " prurigo, i, 589. " pruritus, i, 589. " rosacea, i, 589. " sycosis, i. 589. " tinea tonsurans, i, 589. " " versicolor, i, 589. Lotions, i, 589. yellow mercurial, in chronic ulcers of the skin and in syphilis, i, 589. Lovage. Se,e Ligusticum. Lozenges. See Troches. Lupulin, i, 589. in nervousness from irritation of the blad- der, kidneys, or urethra, ii, 6. Lupuline, i, 474. Lupulus. See Humulus. Lycetol, i, 589. in gout and lithiasis, i, 589. Lycopodium, i, 589. in flatulent dyspepsia, i, 590. powder in excoriated surfaces, i, 590. tincture in incontinence of urine, i, 590. " uric-acid deposits, i, 590. Lysol, i, 590. (injection) in dysentery, i, 590. in dyspepsia, i, 590. " eczema, i, 590. " gonorrhoea, i, 590. '• inflammatory affections of the throat, i, 590. " leucorrhoea, i, 590. " lupus, i, 590. Lytta. See Cantharides. Mace, i, 590. Magendie's solution in asthma, i, 93. Magnesia and rhubarb in diarrhoea, i, 591. and the salts of magnesium, i, 590. as an antidote in sulphuric-acid poisoning, ii, 242. fluid, in colic, i, 591. in arsenical poisoning, i, 591. " burns, ii, 445. " headache of indigestion, i, 591. " phosphorus poisoning, ii, 76. " poisoning with acids, i, 591. Magnesium borocitrate, i, 591. carbonate as a dentifrice, i, 591. chloride, i, 591. citrate in fever of children, i, 591. hydrate and carbonate in poisoning with arsenic, i, 109. hydrate and carbonate in poisoning with corrosive sublimate, i, 109. hydrate and carbonate in poisoning with metallic salts, i, 109. hydrate and carbonate in poisoning with phosphorus, i, 109. salicylate in fevers, i, 591. silicate, i, 592. sulphate in early stages of dysentery, i, 592. Magnolia, i, 592. in colds, i, 592. " gout, i, 592. " intermittent fever, i, 592. Magnolia in malarial disease, i, 118. in rheumatism, i, 592. Malakin, i, 592. in croupous pneumonia, i, 593. " neuralgia, i, 593. " rheumatic fever, i, 592. .Male fern. See Aspidium. Mallein, i. 593. Mallow. See Marshmallow. Malt, i, 594. extract in tuberculosis, i. 595. " " wasting diseases, i, 595. Maltine. See under Malt. Malto-carnis. i. 595. Maltose. See under Malt. Malva. See Marshmallow. Manaca, i, 595. in rheumatism, i, 595. " scrofula, i, 595. " syphilis, i, 595. Manganese, i, 595. and iron in amenorrhoea and chlorosis, i, 596. in chlorosis as an emmenagogue, i, 374. dioxide, in amenorrhoea or anemia, i, 596. iodide, in anemia, i, 596. oxide, in gastrodynia, i, 596. " " gastralgia, i, 596. " " pyrosis, i, 596. sulphate (ointment) in glandular indura- tions and in painful joints, i, 596. Mango, i, 597. Manna, i, 598. Mannitol hexanitrate. See bracketed section under Nitric acid. Maranta. See Arrowroot. Marrol, i, 598. Marrow, i, 598. in anemia, i, 598, 599 ; ii, 445. " hemophilia, i. 598. " insanity, ii. 445. Marrubium. See Horehound. Marshmallow, i, 599. in chafed or excoriated skin, i, 599. " inflammation of the mucous membranes, i, 599. " renal complications of children, i, 600. Massage, i, 600. abdominal, i. 602. " in ascitic accumulations, i, 608. " " dilatation of the stomach, i, 608 " " gallstones, i, 608. " " intestinal inertia, i, 605, 608. " " jaundice, i, 608. " " suppression of urine, i, 608. a friction in bruises, in lacerated muscles or ligaments, and in traumatic synovitis, i, 609. a frictions, i. 602. douche, i, 603. effleurage, i, 601. electro-, i, 603. for cataract, i, 610. " chronic catarrh of the middle ear, i, 610. general, i, 603. " in functional dyspepsia, i, 608. hydraulic, in rheumatism and paralysis, i, 603. in burns, i, 609. " chronic inflammatory processes of the an- terior segment of the eye, i, 610. 504 GENKRAL index. Massage in embolism of the central artery of the retina, i, 610. in fractures, i, 609. (neck) in headache, i, 608. in health, i, 607. (neck) in hemicrania, i, 608. (Brandt's method) in incontinence of urine, i, 609. in insomnia, i, 608. lateral curvature of the spine, i, 610. locomotor ataxia, i, 608. lumbago, i, 608. muscular rheumatism, i, 608. myositis, i, 608. nervous disorders, i, 607. neuralgia, i, 608. " from impaired nutrition, i. 68. palsy, i, 608. pelvic disorders of women, i, 609. pianist's cramp, i, 608. prolapse and other malpositions of the uterus, i, 609. rheumatoid arthritis, i, 608. sciatica, i, 608. spasmodic affections, i, 608. sprains, i, 609. surgery, i, 609. telegrapher's cramp, i, 608. (in the Brand treatment) in typhoid fever, i, 600. in ulcers, i, 609. " vaso-motor paresis, i, 608. " writer's cramp, i, 608. mechanical, i, 603. of the ear for deafness, i, 610. '• " " " the dislodgment of foreign bodies, i, 610. of the eye in asthenopia, i, 610. petrissage, i, 601. physiological effects of, i, 603. posture during, i, 600. tapotement, i, 602. therapeutics of, i, 606. Mastic, i, 610. Masticatories, i, 610. Mate, i, 611; ii, 268. Matico, i, 611. in acute inflammation, i, 611. " cystitis, i, 611. " diarrhoea, i, 611. " dysentery, i, 611. " epistaxis, i, 611. '• gonorrhoea, i, 611. " hematemesis, i, 611. " hematuria, i, 611. " hemoptysis, i, 611. " leucorrhoea, i, 611. " menorrhagia, i, 611. Matricaria, i, 611. Matzol, i, 611. Matzoon, i, 611. as an antemetic food, i, 98. May-apple. See Podophyllum. Meat powder, i, 333. Meconarceine, i, 611. in broncho-pulmonary affections with cough, i, 611. " insomnia, i, 611. " neuralgia, i, 611. " the morphine habit, i, 611. Mediate treatment, i, 611. in syphilis, i, 612. Medication, rectal, i, 198. Medulladen, ii, 445. Medullary glyceride. See under Marrow (vol. ii. page 599). Meiotics, i, 612. Mel. See Honey. Melilotus, i, 613. Melissa, i, 613. as a diaphoretic in fever, i, 613. Menispermum, i, 613. Menthacetic ether, i, 613. Mentha piperita, i, 613. (oil) externally in acute rheumatism, i, 613. " " arthralgia, neuralgia, etc., i, 613. in abdominal pain, i, 613. " colds, i, 613. (infusion) in colic and flatulence, i, 613. (poultice) in diarrhoea, i, 613. (infusion) in dysmenorrhoea, i, 613. inhalation of vapour of, in pulmonary tu- berculosis, i, 614. (poultice) in nausea, i, 613. in rheumatism, i, 613. (oil) in toothache, i, 613. to promote the menstrual flow, i, 613. Mentha viridis, i, 614. Menthiodol. See under Menthol. Menthol, i, 614. as a local anesthetic, i, 614. in croup, i, 529. " diarrhoea, i, 614. in furuncle of the external auditory meatus, i, 616. inhalation in chronic nasal catarrh, i, 529. in headache, i, 614. " nervous dyspepsia, i, 614. " neuralgia, i, 614. " otitis media, i, 616. " pruritus, i, 614. " toothache, i, 136. " whooping-cough, i, 529 ; ii, 445. plaster in neuralgia (mild forms), i, 614. solution (by injection) in dyspnoea of phthi- sis, i, 615. solution (by injection) in hay fever and nasal catarrh, i, 614. solution (by injection) in laryngeal and pul- monary affections, i, 614. solution (by injection) in pulmonary tuber- culosis, i, 614. solution (by injection) in ulceration of the larynx, i, 614, 615. Mentho-phenol, i, 616. in abscess, i, 616. " facial erysipelas, i, 616. " otitis, i, 616. " phagedenic chancroid, i, 616. " syphilis, i, 616. " toothache, i, 616. Mercauro, i, 454. in syphilis, i, 454. Mercurial purge at the beginning of a course of quinine, i, 117. Mercuric cyanide in diphtheria, i, 322 Mercury, i, 617. ammoniated, in psoriasis, i, 627. " syphilitic eruptions, i, 627. GENERAL INDEX. 505 Mercury, ammoniated, in tinea, i. 627. ammoniated, ointment of, in treatment of pediculi, i, 116. and cantharidin in syphilis, i, 621. " potassium iodide in neuralgia caused by syphilis, i, 69. " zinc cyanide, i, 322 ; ii, 409. as a cholagogue, i, 618, 619. " diuretic, i, 618. as an alterative, i, 617. bichloride, as a germicide, i, 447. as an antisyphilitic, i, 626. as a parasitic, i, 626. (small doses) as a systemic tonic, i, 625. bichloride, in chronic skin disease, i, 626. " deficient secretion of bile, i, 626. bichloride (small doses), in diphtheria, i, 626; ii, 221. bichloride, in gastric fermentation, i, 626. " (injections) in gonorrhoea, i, 531. bichloride, in lentigo, i, 626. " malignant onychia, i, 626. pustule, i, 626. " " nevi, i, 626. " " ringworm, i, 117. of the scalp, i, 626. " telangeiectases, i, 626. " treatment of poisoning, i, 625. " (solution), surgical employment of, i, 626. biniodide, as a germicide, i, 447. by fumigation, i, 621. " intravenous injection, i, 621. " inunction, i, 621. chlorides, i, 624. chronic poisoning with, iodides in, ii, 214. compound pill of subchloride of, in chronic rheumatic or gouty conditions, i, 625. compound pill of subchloride of, in syphi- litic skin diseases, i, 625. fumes of, in laryngeal diphtheria, i, 530. hypodermically, i, 621. in angina pectoris, i, 620. " " sine dolore, i, 620. " biliousness, i, 619. " diarrhoea, i, 619. " gout, i, 619. " heart disease, i, 620. " inflammations of serous membranes, i, 619. '• intestinal dyspepsia, i, 619. " iritis, i, 619. " rheumatism, i, 619. " skin diseases, i, 619. " syphilis, i, 620. 621. " whooping-cough (Rabinschek's method), ii, 446. (subcutaneous injections) in tetanus, ii, 446. iodide and arsenic in chronic gout, i, 627. " " " " " rheumatism, i, 627. iodide and arsenic in lepra, lupus, psoriasis, and venereal eruptions, i, 627. iodide in late syphilis, i, 627. liniment, in chronic glandular enlargemer.ts and indurations, i, 623. metallic, i, 621. nitrate, for moles and nevi, i, 628, Mercury, nitrate, in phagedenic and syphilitic ulcerations, i, 628. nitrate, in ulcers of the cervix uteri, i, 628. " ointment in eczema, psoriasis, and ulcerative conditions, i, 628. ointment in acute and subacute articular in- flammation, i, 622. ointment in epididymitis, i, 622. " " general peritonitis, i. 622. " " infantile syphilis, i, 622. " (inunction) in local indurations and enlargements, i, 622. ointment (inunction) in enlargement of the lymph glands, i, 622. ointment in orchitis, i, 622. " (inunction) in syphilis, i, 622. oleate, i, 624. " and ether in treatment of pediculi, i, 116. oleate, in ringworm, i, 117. " syphilis, i, 624. oxides, i, 623. oxide (ointment) in acute conjunctivitis, i. 623. " " " chronic marginal blepha- ritis, i, 623. oxide (ointment) in chronic rhinitis, i, 623. " " eczema of the lids, i, 623. " " " phlycta'iiular ophthal- mia, i, 623. plaster in pitting of small-pox, i, 622. " " syphilitic nodes, i, 622. red iodide, in syphilitic ulcers, i, 627. " oxide (ointment) in parasitic skin dis- ease, i, 623. red oxide (ointment) in ringworm of the scalp, i, 623. red oxide (ointment) in venereal ulceration, i, 623. sozoiodolate in parasitic skin disease, ii, 215. " " skin disease, ii, 215. " " syphilitic ulcers, ii, 215. subchloride (ointment) in skin diseases, i, 625. sulphates, i, 628. tannate, ii, 259. " in syphilis, ii, 259. with chalk in diarrhoea, i, 622. " " " intestinal disorders, i, 622. " " " syphilis of children, i, 622. Metadihydroxybenzene. See Resorcin. Metaldehyde, i, 628. Methacetin, i, 628. Methoxycaffeine, i, 628. as a local anesthetic, i, 628, in migraine, i, 628. " neuralgia, i, 628, Methyl, i, 629. alcohol, i, 628. chloride, i, 628. " in lumbago, i, 69. " " neuralgia, trigeminal, i, 69. " " sciatica, i, 69. ether, i, 628. iodide, i, 629. nitrate. See under Nitric acid, bracketed section. salicylate, i, 629; ii, 146. violet. See under Pyoctanine. Methylacetanilide. See Exalgine. Methylal, i, 629. 506 GENERAL INDEX. Methylal as a hypnotic, i, 629. inhalation in asthma, i, 629. " " neuralgia, i, 629. in insomnia, i, 629. " neuralgia (by the mouth and hypodermic- ally), i, 69. " tetany, i, 629. Methylene blue, i, 629. in amoebic dysentery, i, 630. " beri-beri, i. 630. " chronic cystitis, i, 630. " gonorrhoea, i, 630. (by the stomach or hypodermically) in gout, i, 629. in malarial disease, i, 630. " neuralgia, i, 630. " neuralgic pains of chronic malarial origin, i, 68. " posterior spinal sclerosis, i, 630. (by the stomach or hypodermically) in sci- atica, i, 629. (by the stomach or hypodermically) in syno- vitis, i, 629. Methylpyrocatechin. See Guaiacol. Mezereon, Mezereum, i, 630. in cutaneous disorders, i,.630. " rheumatism, i, 630. " syphilis, i, 630. Mica panis, i, 630. Microcidine, i, 630. Migrainin, Migranin, i, 631. in headache of influenza, i, 631. " migraine, i, 631. Milk, i, 631. adulteration, i, 637. and limewater as an antemetic, i, 98. as a food, i, 426. condensed, i, 633. cream, i, 635. dietetic uses of, i, 633. effect of food and drugs on the, i, 632. in diabetes, i, 337, 636. infant feeding with, i, 633. in parenchymatous nephritis, i, 637. " poisoning with alkaline salts, i, 109. "■ " " metallic salts, i, 109. " scarlet fever, i, 335. modified, i, 635 ; ii, 447. peptonized, ii, 69. in cancer of the intestines, i, 336. peptonized, in nausea, i, 98. preservation of, i, 632. production of disease through, i, 632. Mineral acids in treatment of tenia, i, 101. in vomiting, i, 100. oils, ii, 31. waters. See Waters, Mineral. Mint. See Mentha piperita and Mentha viridis. Mistletoe. See Viscum album. Mixtures, i, 643. Mollin, i, 127, 643. Momordica. See Elaterium. Monobromacetanilide. See Antisepsin. Monochloracetic acid. See under Chloracetic acid. Monochlormethane. See Methyl chloride, un- der Methyl. Monochlorphenol. See under Chlorophenols. Monophenethydrin. See Apolysine. Moringa, ii, 447. as a counter-irritant, ii. 447. '• an emmenagogue, ii, 447. in chronic rheumatism, ii, 447. " jaundice, ii, 447. Morphine. See under Opium. and atropine in hepatic colic, i, 67. '• " " inflammation of the sciatic nerve, i, 67. and atropine in lead colic, i, 67. " " " renal colic, i, 67. " " " spasmodic dysmenorrhoea, i, 67. as a cardiac stimulant, ii, 38. " hypnotic, i, 508. as an adjuvant to expectorant mixtures, i, 419. bimeconate in asthma, i, 93. in angina pectoris, i, 67; ii, 36. " asthma, i, 93. " Bright's disease, ii, 37. " chronic alcohol poisoning, ii, 37. " delirium of nervous exhaustion in acute fevers, ii, 37. (small doses) in diarrhoea, ii, 38. in dysentery, ii, 38. " dyspnoea, ii, 37. " heart disease, ii, 36. " hysterical anorexia, ii, 38. (subcutaneously) in mitral insufficiency, ii, 36. " " " stenosis, ii, 36. in peritonitis, ii, 38. " uremic convulsions, ii, 37. valerianate, ii, 346. Morrhuol, i, 643. Morus. See Mulberry. Moschus. See Musk. Moss, Iceland. See Cetraria. Irish. See Chondrus. Motor depressants, i, 643. Moussena, i, 645. Moussenine, i, 645. Movement cure. See under Exercise, (vol. i, page 413). Mucilages. See Demulcents. Mucuna, i, 645. in Ascaris lumbricoides, i, 102. " treatment of tenia, i, 102. Mulberry, i, 645. Mullein. See Verbascum. Midler's fluid, ii, 95. Muriatic acid. See Hydrochloric acid. ether. See Ethyl chloride. Muscale buttons. See Anhalonium Lewinii. Muscarine, i, 645. as a meiotic, i, 612. " an anthidrotic, i, 103. in belladonna poisoning, i, 645. " cholera infantum, i, 645. " diabetes insipidus, i, 645. " gout, i, 645. " hiccough, i, 645. " laryngismus stridulus, i, 645. " meningitis, i, 645. " paralysis of respiration, i, 645. " pertussis, i, 645. " spasmodic affections, i, 645. " " cough, i, 645. Muscle extract in muscular dystrophies, i, 81. GENERAL INDEX. 507 Musk, i, 645. in adynamic pneumonia of drunkards, i, 645. " obstinate hiccough, ii, 6. " sudden nervous depression, ii, 6. " typhoidal disease, i, 645. root. See Sumbul. Mussana, Mussanine, Mussena, Mussonine. See Moussena. Mustard, i, 646. and molasses in dyspepsia with constipation, i, 646. p > as a counter-irritant, i, 646. " deodorizer, i, 647. as an antiseptic, i. 647. emetic, i, 647. as a rubefacient, i, 646. bath, hot, in eruptive fevers, i, 647. foot bath, hot, in amenorrhoea, i, 647. " headache due to indiges- tion, i, 647. plaster (applied to chest and lungs) in bron- chitis, i, 647. plaster (applied to the abdomen) in diarrhoea, i, 647. plaster (applied to the stomach) in nausea, i, 98, 647. plaster in neuralgia, i, 647. poisoning, i, 648. Mutton suet. See Suet. Mydriatics, i, 649. effects of, i, 650. in glaucoma, i, 651, " iritis, i, 650. Mvdrin, i, 651. Mydrol, ii, 447. as a mydriatic, ii, 447. in blepharospasm, ii, 447. " ciliary and supraciliary pain, ii, 447. " lacrymation, ii, 447. Myelotherapy, See under Serum treatment (vol. ii, page 187). Myotics. See Meiotics. Myrcia. i, 651. Myristica. Sec Nutmeg. Mvronin, i, 651. Myrrh, i, 651. tincture of (internally), in amenorrhoea, i. 651. '• (locally), in aphthous inflamma- tion, i, 651. tincture of (internally), in catarrhal gastritis, i, 651. tincture of, in diphtheria, i, 652. " " (internally), in gastralgia, i, 651. " " (locally), in indolent ulcers, i, 651. " " in leucorrhoea, i, 651. " " (locally), in Riggs's disease. i,651. " " (locally), in sore throat, i, 651. " " (locally), in spongy gums, i, 651. Myrrholin, i, 652. in laryngeal and pulmonary phthisis, i, 652. Mvrtillin, ii, 447. Myrtol, i, 652. in chronic catarrh, i, 652. " bronchitis, i. 652. " weak digestion, i, 652. Napelline, ii, 1. Naphthalan, ii, 447. in chronic eczema, ii, 448. " diabetes, ii, 448. 76 Naphthalan in eczema, ii, 448. in prurigo, ii, 448. " pruritus, ii, 448. " syphilis (by inunction), ii, 448. " ulcer of the leg, ii, 448. Naphthalene, ii, 1. in bronchorrhoea, ii, 1. " cystitis, ii, 1. " diarrhoea, ii, 1. " dysentery, ii, 1. " foetid bronchitis, ii, 1. " pyelitis, ii, 1. " roundworms, ii, 1. '• scabies, ii, 1. " seat worms, ii, 1. " treatment of wounds, ii, 1. " typhoid fever, ii, 1. " ulcers, ii, 1. '' whooping-cough, ii, 1. Naphthalol. See Betol. Naphthol, ii, 2, as an antiseptic, i, 448. camphorated, ii, 2. " in ozena, ii, 2. " " tuberculosis, ii, 2. " tuberculous ulceration of the tongue, ii, 2. in cholera, ii, 2. (by insufflation) in chronic suppuration of the ear, ii, 2. in diarrhoea, ii, 2. " dilatation of the stomach, ii, 2. - dysentery, ii, 2. " foul ulcers, ii. 2. " gastric fermentation, ii, 2. (in solution) in hyperidrosis, ii, 2. in influenza, ii, 2. " typhoid fever, ii, 1. Lassar's, paste, ii, 64. ointment in scabies, ii, 2. " tinea circinata, ii, 2. plaster in ringworm, i, 117. salicylate. See Betol. Naphthosalol. See Betol. Narceine. See under Opium. Narcotics, ii, 3. Naregamia alata, ii. 5. in catarrhal affections, in indigestion, and in rheumatism, ii. 5. Natrium. See Sodium. Nectandra. See under Bebeerine. Nerium, ii, 5. as a cardiac tonic, ii, 5. in epilepsy, ii, 5. Nervines, ii, 5. Nervous substance. See under Animal ex- tracts and JUICES. dose and administration, i, 81. in epilepsy, i, 80. " functional and organic nervous disorder, i, 80. " insomnia, i, 80. " neurasthenia, i, 80. " paralysis, bulbar, i, 80. " tabes dorsalis, i, 80. Neurodin, ii, 7. in intestinal pain, ii, 7. " neuralgia, ii, 7. " " of the bladder and stomach, ii, 7. 508 GENERAL INDEX. Neurodin in pains in the arms (from spinal ir- ritation), ii, 7. in sciatica, ii, 7. Nicotiana, Nicotine. See Tobacco. Nitrates. See under Nitric acid. effects of, in cardiac pain, ii, 9. " " in chronic Bright's disease, ii, 10. Nitre. See Potassium nitrate. Nitric acid, ii, 7. and quinine in intermittent fever (with he- patic engorgement), ii, 8. as a germicide, i, 446. in cancrum oris, i, 227; ii, 7. " chancroids, ii, 7. " chronic bronchitis, ii, 8. " " cervical endometritis, ii, 7. " " cystitis, ii, 7. " cirrhosis of the liver, ii, 8. " colliquative diarrhoea, ii, 8. " condylomata, i, 227. " constitutional syphilis, ii, 8. " dyspepsia with phosphatic urine, ii, 8. " hemorrhage, ii, 7. " hemorrhoids, ii, 7. " hospital gangrene, ii, 7. " intra-uterine granulations, ii, 7. " lithemia, ii, 8. " oxaluria, ii, 8. " phagedena, i, 227. " phagedenic ulcers, ii, 7. " small fibroid tumours, ii, 7. " summer diarrhoea, ii, 8. " syphilis, ii, 8. " venereal ulcerations, i, 227. " warts, i, 227; ii, 7. " whooping-cough, ii, 8. Nitrites, ii, 11. dose and administration of, ii, 13. effects of, on the bowels and stomach, ii, 12. " " " " kidneys, ii, 12. " " " " nervous system, ii, 12. " " " " perspiration, ii, 12. " " " " respiration, ii, 12. " " " " temperature, ii, 12. reduction of the blood-pressure by, ii, 12. some of the, compared, ii, 13. therapeutic uses of the, ii, 13. Nitrobenzene, ii, 13. Nitrogen, ii, 14. inhalation in chronic pneumonia, ii, 14. monoxide in asthma, i, 528. '• pulmonary tuberculosis, i, 528. " " spasmodic affections, i, 528. " " whooping-cough, i, 528. Nitroglycerin, ii, 14. dose and administration of, ii, 15. effects of, ii, 14, 15. in anemia, ii, 15. " angina pectoris, ii, 15. " asthma, i, 95. " Bright's disease, ii, 15. " cardiac dyspnoea, ii, 15. " dyspnoea, ii, 10. " gastralgia, ii, 15. " headache due to anemia of the brain, ii, 15. " hepatic colic, ii, 15. " hiccough, ii, 15. " intermittent fever (cold stage), ii, 15. " laryngismus stridulus, ii, 15. Nitroglycerin in migraine, ii, 15. in neuralgia (as a nerve stimulant), i, 69; ii, 15. .. .. " neuralgia of the trigeminal nerve, n, to- " Raynaud's disease, ii, 10. " reflex vomiting, ii, 15. " renal colic, ii, 15. " sciatica, ii, 15. " seasickness, i, 99 ; ii, 15. " spasmodic asthma, ii, 15. " " contraction of the arteries, i, 133. " tetanus, ii, 15. '- whooping-cough, ii, 15. Nitrohydrochloric acid, ii, 16. as an escharotie, ii, 16. in acne, ii, 16. (sponging) in cachexia of children, ii, 16. in constitutional syphilis, ii, 16. " cutaneous affections, ii, 16. " digestive disorders, ii, 16. " diseases of the liver, ii, 16. " dropsy, ii, 16. " dysentery, ii, 16. (sponging) in jaundice, ii, 16. in syphilis, ii, 16. " xanthelasma, ii, 16. Nitrous oxide, ii, 16. administration of, ii, 18. death from inhalation of, ii, 448. in extraction of teeth, ii, 17. " melancholia, ii, 18. " nervous exhaustion, ii, 18. " labour, ii, 18. " minor operations of short duration, ii, 18. physiological action of, ii, 17. water, ii, 18. Nosophene, ii, 18. in balanoposthitis, ii, 19. '• dry rhinitis, ii, 19. " nasal diphtheria, ii, 19. " rhinitis with excessive secretion, ii, 19. " soft chancre, ii, 19. " traumatic weeping eczema, ii, 19. Nuclein, spleen, in tuberculosis, ii, 24. yeast, in amygdalitis, ii. 24. " " indolent ulcer, ii, 24. " " pharyngitis, ii, 24. " " tuberculosis, ii, 24. Nucleins, ii, 19. dose and administration of, ii, 25. germicidal properties of the, ii, 22. value of, in the treatment of dis- ease, ii, 23. in anemia, ii, 24. " bronchitis, ii, 24. " chronic Bright's disease, ii, 24. " eczema, ii, 24. " diphtheria, ii, 23, 25. " general debility, ii, 24. " hip-joint disease, ii, 24. " influenza, ii, 24. " malarial poisoning, ii, 24. " neurasthenia, ii, 25. " naso-pharyngeal catarrh, ii, 24. " night sweats, ii, 24. " pleurisy, ii, 24. " pneumonia, ii, 24. (protonuclein) in progressive anemia, ii, 448. in scarlet fever, ii, 25. GENERAL INDEX. 509 Nucleins in tuberculous adenitis, ii, 25. manner of extracting, ii, 20. prevention of disease by the use of, ii, 23. therapeutics of, ii. 22. Nutgalls. See Galls. Nutmeg, ii, 25. (oil) as a rubefacient, ii, 25. (powdered) in colic of infants, ii, 25. in enteritis, ii, 25. " gastralgia. ii, 25. " nausea, ii, 25. (oil) in neuralgia (as a rubefacient), ii, 25. " " rheumatism (as a rubefacient), ii, 25. Nutrose, ii, 449. in convalescence from scarlet fever, diph- theria, measles, or pneumonia, ii, 449. Nux vomica, ii, 26. in amblyopia, ii, 29. " cardiac failure, ii, 28. " " " during chloroform anes- thesia, ii, 450. (tincture) in diarrhoea (due to atony of the bowels), ii, 28. in flatulence, ii, 28. " flatulent dyspepsia, ii, 28. " frontal headache, ii, 28. " gastric catarrh, ii, 28. (extract) in habitual constipation, ii, 28. in headache of gastric origin, ii, 28. (injections) in "insolation" of the eyes, ii. 29. in morning vomiting of drunkards, ii, 28. " nervous cough, ii, 28. " neuralgia from impaired nutrition, i, 68. " pneumonia, ii, 450. " pulmonary tuberculosis, ii, 449. " pyrosis, ii, 28. (small doses) in vomiting associated with gastric atony, i, 99. in vomiting of phthisis, ii, 28. " " " pregnancy, ii, 28. physiological action of, ii, 26. poisoning, eucalyptus in, ii, 435. therapeutics of, ii, 28. Oak bark, ii, 30. in diarrhoea, ii, 31. " flabby ulceration, ii, 31. (enema) in hemorrhoids, ii, 31. in hyperidrosis, ii, 31. (injections) in leucorrhoea, ii, 31. Oatmeal, ii, 31. in chronic constipation, ii, 31. Odontine. ii, 31. Odontol, ii. 31. in toothache, ii, 31. Oils, ii, 31. fixed, ii, 32. in poisoning with alkalies, i. 109. " corrosive salts, i, 109. -' »> " carbolic acid, i, 109. « " metallic salts, i, 109. mineral, ii, 31. volatile, ii. 32. Ointment mulls, ii, 33. Ointments, ii. 33. Oleander. See Nerium. Oleates. See under Oleic acid. Oleoresins, ii, 34. Oleum cadinum. ii, 34. Olibanum, ii, 34. Olibanum in bronchitis, ii, 34. in laryngitis, ii, 34. Olive oil, ii, 34. as an enema, ii, 35. for the protection of raw surfaces, ii, 35. in biliary colic, ii, 35. " wasting diseases, ii, 35. Opium, ii, 35. and belladonna in uterine pain, i, 67. " cannabis indica in uterine pain, i, 67. " its derivatives, i, 67. as a hypnotic, i, 508. as an adjuvant to expectorant mixtures, i, 419. as a narcotic, ii, 3. chronic poisoning with, ii, 44, 45, 46. fumes in asthma, i, 529. " " bronchitis, i, 529. " " cardiac pain, i, 529. " " laryngitis, i, 529. " " thoracic pain, i, 529. " " whooping-cough, i, 529. by hypodermic injection, in the early stages of meningitis, i, 67. (as a stimulant) in adynamia, ii, 226. (small doses) in bronchitis, ii, 37. in collapse from cholera, ii, 36. " excessive intestinal peristalsis, i, 67. " diarrhoea of typhoid fever, ii, 36. '• enfeeblement, ii, 35. " hemoptysis, ii, 35. " hemorrhage, ii, 450. " hemorrhage from typhoid ulcer, ii, 36. " hectic fever of phthisis, ii, 36. (small doses) in inflammation of the sciatic nerve, i, 67. " insomnia due to cardiac dyspnoea, i, 508. " intestinal spasm, i, 133. (as a stimulant) in low fever, ii, 225. in nausea, i, 99. " neuralgia, i, 69. " pain, ii, 37. " pain from enteritis, i, 67. " " from rheumatism, i. 125. (small doses) in pleurisy, ii, 37. " " " pneumonia, ii, 37. in prostration from hemorrhage, ii, 35. in tenesmus, i, 67. " vomiting, i, 99. poisoning, ii, 40, 41, 42, 43, 44. vinegar of, in asthma, i, 93. wine of, in asthma, i, 93. Opodeldoc, ii, 46. Oranges. See Aurantium. Orchitic extract. See Animal extracts and juices. Orchitic iiquid, i, 73. administration and dose, i, 76. in cancer, i. 75. " contractures, i, 76. " chorea, i, 75. " debility, i, 76. " diabetes mellitus, i, 75. " epilepsy, i, 76. " hysteria, i, 76. '• hystero-epilepsy, i, 76. " impotence, i. 76. " leprosy, i, 75. '• locomotor ataxia, i, 74. " neurasthenia, i, 76. " nocturnal emissions, i, 76. 510 GENERAL INDEX. Orchitic liquid in nocturnal incontinence of children, i, 76. in senility, premature, i, 76. " skin diseases, i, 75. " tuberculosis, i, 74. Orexine hydrochloride, ii, 46. in anemia, ii, 451. " anorexia, ii, 46. " gastric catarrh, ii, 451. " incipient phthisis, ii, 451. " vomiting of pregnancy, ii, 451. Organic extracts, Organotherapy. See Animal extracts and juices. Origanum, ii, 46. Orotherapy, ii, 451. Orphol, ii, 46. in diarrhoea (of children), ii, 46. Orrhotherapy, ii, 451. Orris root, ii, 46. * Orthine, ii, 47. Orthochlorophenol. See under Chlorophe- nols. Oryza sativa. See Rice. Osmic acid, ii, 47. as a hardening and staining agent, ii, 47. injections in muscular rheumatism, ii, 47. " " intercostal neuralgia, ii, 47. " " sciatica, ii, 47. therapeutics of, ii, 47. Osmium hydroxide, Osmium tetroxide. See Osmic acid. Ouabain, ii, 48. in whooping-cough, ii, 48. Ovarine, ii, 48, 451, Ovarian juice, Ovarian substance, in amenor- rhoea, in chlorosis, and in disturbances following the menopause and oophorec- tomy, ii, 451. Ovi albumen, Ovi vitellus. See under Eggs. Oxalic acid, ii, 48. as a corrosive poison, ii, 48. as an emmenagogue, i, 367; ii, 49. in dysmenorrhoea, ii, 49. " strangulated hernia, ii, 49. treatment of poisoning with, ii, 48. Oxalis, ii, 49. Ox-bile, Ox-gall, ii, 49. Ox-bile enema in fecal impaction, ii, 49. in habitual constipation, ii, 49. " intestinal dyspepsia, ii, 49. '• malnutrition, ii, 49. Oxygen, ii, 49. and ether for anesthesia, ii, 53. biological relations of, ii, 49. ethereal, ii, 50. in acute lobar pneumonia, ii, 52. " anemia, ii, 52. (injections) in ascites, ii, 452. in asphyxia, ii, 52. " capillary bronchitis of children, ii, 52. " chlorosis, ii, 52. " chronic suppurative otitis media, ii, 451. " collapse due to acute disease, ii, 52. " coma, ii, 52. " croup, ii, 52. " diabetes, ii, 52. " diphtheria, ii, 52. (as a stimulant) in dyspnoea of cardiac or pulmonary origin, ii, 226. in gangrene, ii, 51. Oxygen in gout, ii, 52. in hypochondriasis, ii, 52. (as a stimulant) in indolent ulcers, ii, 51. in infected wounds, ii, 51. " insomnia due to mental fatigue, ii, 52. " leucemia, ii, 52. " narcotic poisoning, i, 527. " neurasthenia, ii, 52. '• -neurotic dyspepsia, ii, 52. '• ozena, ii, 4-51. " pernicious anemia, ii, 52. " prostration due to acute disease, ii, 52. " pulmonary tuberculosis, ii, 52. " purulent discharges from the antrum of Highmore, the frontal sinuses, or the ethmoid cells, ii, 452. " rhachitis, ii, 52. " scrofulosis (of children), ii, 52. " sloughing, ii, 51. " surgical anesthesia, ii, 53. " syphilitic rupia, ii, 52. " temporary obstruction of the air-passages, i, 527. " toxic narcoses, ii, 52. " tuberculosis, ii, 52. " tuberculous ulcer, ii, 52. medical history of, ii, 50. physiological effects of, ii, 51. preparation and administration of, ii, 50. therapeutics of, ii, 51. triatomic, as a germicide, i, 445. Oxygenated water and hydrogen-dioxide solu- tion (by-inhalation) in chronic gastric ca- tarrh, ii, 52. (locally through the stomach-tube) in gastro- intestinal catarrh, ii, 52. Oxymels, ii, 54. Oxynaphthoic acid, ii, 54. Oxyquinaseptol. See Diaphtherin. Oxysparteine, ii, 54. Oxytocics, ii, 54. Oyster shell. See Testa pr^eparata. Ozone, ii, 56. as a disinfectant, i, 445. chemistry of, ii, 56. in diabetes, ii, 58. " diphtheria, i, 445. " gout, ii, 58. " pernicious anemia, ii, 58. inhalation in asthma, ii, 58. " bronchitis, ii, 58. " cholera, ii, 58. " diphtheria, ii, 58. " emphysema, ii, 58. " ozena, ii, 58. " pulmonary tuberculosis, ii, 58. " whooping-cough, ii, 58. preparation and properties of, ii, 56. physiological effects of, ii, 57. therapeutics of, ii, 58. Pack, wet, in cardiac disorders, i 490 in diabetes, i, 490. " gout, i, 490. " organic cardiac disease, i, 490. " rheumatism, i, 490. Palmetto wine, ii. 58. as a tonic, ii, 58. in amygdalitis, ii, 58. " bronchitis, ii, 58. GENERAL INDEX. 511 Palmetto wine in follicular pharyngitis, ii, 58. Pambotano, ii, 58. as, a stomachic tonic, ii, 58. in fever of tuberculosis, ii, 58. " influenza, ii, 58. " malarial disease, ii, 58. " typhoid fever, ii, 58. Pancreatic emulsion, ii, 59. in tuberculosis, ii, 59. extract. See Pancreatin and under Ani- mal EXTRACTS AND JUICES. extract, i, 80. extract in pancreatic diabetes, i, 80. Pancreatin, ii, 59. Pansy. See Viola tricolor. Papain, Papaiva. See under Papaw. and sodium bicarbonate (as a dusting pow- der) in unhealthy sores and sloughing tis- sue, ii, 60. in accumulation of cerumen in the ear, ii, 60. " dilatation of the stomach, ii, 60. '' diphtheria, ii, 60. " dysentery, ii, 60. " gastric catarrh, ii, 60. " roundworms, ii, 60. " tenia, i, 102. Papaver. See Poppy. Papaw, ii, 59. as a gastric sedative, ii, 60. in fissure of the tongue, ii, 60. " gastric irritation, ii, 60. " syphilitic ulcerations of the tongue, ii, 60. " ulcer of the stomach, ii, 60. " warty growths, ii, 60. Para-acetphenetidine. See Phenacetine. Parabromacetanilide. See Antisepsin. Parachlorophenol, Pharachlorphenol. See un- der Chlorophenols. Parachlorphenol, topically, in lupus, i. 246. Paracotoin, Paracotoinic acid. See under Coto BARK. Paracresalol, Paracresol salicylate, ii, 60. Paracresalol as an intestinal antiseptic, ii, 60. Paraffin, ii, 60. Paraform, ii, 61. as an intestinal antiseptic, ii, 60. in cholera, ii. 61. " cholera infantum, ii, 61. " typhoid fever (incipient stage), ii. 61. (diluted) in wounds and ulcers, ii, 61. Paraldehyde, ii, 61. as a hypnotic, i, 509. dose and administration of, ii, 63. habit, ii, 62. in asthma, ii, 62. '• broncho-pneumonia, ii, 63. " Cheyne-Stokes respiration associated with broncho-pneumonia, ii, 63. '• delirium tremens (early stages), ii, 62. " hysteria, i, 509. " insanity, ii, 62. " insomnia of insanity, ii, 62. " " mania, i, 509. " puerperal convulsions, ii, 62. poisoning with, ii, 61. therapeutics of, ii, 62. Parasiticides. See Antiparasitics and An- thelmintics. Parataloid. See Tuberculin. Paregoric, ii, 63. Paregoric in diarrhoea, ii, 63. Pareira. ii, 63. in chronic cystitis, ii. 63. Parilla, yellow. See Menispermum. Paris green. See under Arsenic. Parodyne. See Antipyrine. Parsley. See Petroselinum and Apiol. Parsley camphor in dysmenorrhoea, i, 137. in intermittent fever, i, 137. Parthenicine, ii, 63. Parthenine, ii, 63. Paste, Canquoin's, ii, 64. Latour's, ii, 64. Smith's, in cancer, ii, 64. Vienna, ii, 64. Pastes, ii, 63. Pastilles, Pastils, ii, 64. Paullinia. See Guarana. Peanuts. See Arachis. Pearson's solution, i, 146. Peat, ii, 65. (as a dusting powder) in foul-smelling ulcers, ii, 65. (as a dusting powder) in gangrene, ii, 65. • Pectorals. See Expectorants. Pediluvium. See under Baths (vol. i, p. 169). Pelletierine, ii, 65. in paralysis of the third and fourth cranial nerves, ii, 65. " tenia, i, 102. " worms, ii, 65. Pellitory. See Pyrethrum. Pellotin'e, ii, 452. Pencils, ii, 66. Pennyroyal. See Hedeoma. Pental, ii, 66. as a general anesthetic, ii, 66. Pentane. See Amyl hydride. Pepo, ii, 68. Pepper, black. See Piper nigrum. cayenne. See Capsicum. Peppermint. See Mentha piperita. Pepsin, ii, 68. and bismuth in diarrhoea, ii, 69. " codeine in gastralgia, ii, 69. for eructations, ii, 69. in atonic dyspepsia, ii, 69. " cancer of the stomach, ii, 69. " dyspepsia, ii, 69. " indigestion of phthisis, ii, 69. " lienteric diarrhoea, ii, 69. " mucous gastritis, ii, 69. " treatment of tenia, i, 101. " ulcer of the stomach, ii, 69. " vomiting of undigested food, ii, 69. solution (by spray) in diphtheria, ii, 69. Peptomangan, ii, 69. in anemia of rhachitis, ii, 69. " chlorosis, ii, 69, 70. " phthisis, ii, 69. Peptonized beef, i, 42. gruel, i. 42. milk. See under Milk. milk as an antemetic, i, 98. " in nausea, i, 98. " punch, i, 42. Peptonizing tubes, i, 43. process for, i, 43. Permanganate of potassium in bromidrosis, i, 103. 512 GENERAL INDEX. Permanganate of potassium in unhealthy wounds, i, 446. of potassium in ulcers, i, 446. Permanganates, ii, 70. in anemia, ii, 70. " bites of poisonous reptiles, ii, 70. " carbuncles, ii, 70. " delayed menstruation, ii, 70. (internally) in diphtheria, ii, 70. in flatulence, ii, 70. " hospital gangrene, ii, 70. (injections) in leucorrhoea, ii, 70. in obesity, ii, 70. (injections) in otorrhcea, ii, 70. " " ozena, ii, 70. (internally) in scarlet fever, ii, 70. in ulcerating surfaces, ii, 70. Perosmic acid. See Osmic acid. Peroxide of hydrogen. See Hydrogen di- oxide. Petrolatum. See Vaseline. Petroleum, ii, 70. in chilblains, ii, 70. " psoriasis, ii, 71. " pulmonary affections, ii, 70. " rheumatism, ii, 70. " scabies, ii, 71. " tapeworm, ii, 71. Petroselinum, ii, 71. Phellandrium, ii, 70. as a sedative in cough, ii, 71. Phenacetine, ii, 71. as an anodyne, i, 68. in exhaustion from overwork, ii, 71. " gastralgia, ii, 71. " headache, ii, 71. " influenza, ii, 72. " insomnia of diseases of the uterus, ii, 71. " migraine, ii, 71. " neuralgia, i, 69; ii, 71. " neuritis, ii, 71. " rheumatism, for temporary relief of pain, i, 125. " sciatica, ii, 71. Phenates, ii, 72. Phenazone. See Antipyrine. Phenedine, Phenetidine. See Phenacetine. Phenic acid. See Carbolic acid. Phenidine, ii, 72. Phenocoll, ii, 72. (as an analgetic) in acute articular rheuma- tism, ii, 72. in fever of influenza, ii, 72. " " " phthisical subjects, ii, 72. " malarial fever, ii, 72. " neuralgia, ii, 72. salicylate. See Salocoll. Phenol, ii, 72. as a germicide, i, 448. camphorated, ii, 73. injections in tetanus, ii, 452. iodized, ii, 73. Phenol sodique, ii, 73. in abrasions and wounds, ii, 73. Phenosalyl, ii, 73. (internal application) in septic fever due to retained portions of placenta, ii, 73. Phenylacetamide, ii, 73. in neuralgia, ii, 73. " rheumatism, ii, 73. Phenylacetamide in the sequele of alcoholic excess, ii, 73. Phenylamine. See Analine. Phenyl formamide. See Formanilide. Phenylhydrazine, ii, 74. levulinate, i, 134. Phenyl hydride. See Benzene. Phenyl salicylate. See Salol. Phenylic alcohol. See Carbolic acid. Phenylurethane. See Euphorine. Phlebotomy, ii, 74. Phloridzin, ii, 74. as an antipyretic in malarial fevers, ii, 74. Phosphates. See Phosphorus. Phosphate of ammonium in rheumatism, ii, 78. in uric-acid conditions, ii, 78. " osteomalacia, ii, 78. " rickets, ii, 78. " tuberculosis, ii, 78. Phosphergot, ii, 74. Phosphide of zinc as a tonic in anemia, i, 68. Phosphides, Phosphites. See under Phos- phorus. Phospho-albumin, ii, 74. in anemia, ii, 74. " circulatory derangements of the climac- teric, ii, 74. " neurasthenia, ii, 74. " phthisis, ii, 74. Phosphoric acid as a germicide, i, 446. in chronic bone diseases, ii, 77. " " ulcers, ii, 77. " diabetes, ii, 77. " hysteria, ii, 77. " leucorrhoea, ii, 77. " phosphaturia, ii, 77. " sexual debility, ii, 77. Phosphorus, ii, 74. as a germicide, i, 440. " nutrient, ii, 75. " tonic, ii, 75. in acne, ii, 77. " cerebral atony, ii, 76. " " endarteritis, ii, 76. " " softening, ii, 76. " chronic eczema, ii, 77. " impotence, ii, 77. " insomnia of cerebral anemia and malnu- trition, ii, 76. " locomotor ataxia, ii, 76. " lupus, ii, 77. " mania, ii, 76. " melancholia, ii, 76. " mental enfeeblement, ii, 76. " neuralgia of the asthenic type, ii, 76. " osteomalacia, ii, 77. " paralysis agitans, ii, 76. »" " of cerebral origin, ii, 76. " pernicious anemia, ii. 77. " pseudo-leucemia, ii, 77. " psoriasis, ii, 77. " rickets, ii, 77. " spinal sclerosis, ii, 76. poisoning with, ii, 75, 76. therapeutics of, ii, 76. Photoxylin, Photoxylon, ii, 79 Phulluah, ii, 79. in frostbites and chilblains, ii, 79. " rheumatism, ii, 79. " sciatica, ii, 79. GENERAL INDEX. 513 Phulluah in sprains, ii, 79. Physiological action of drugs, ii, 80. antagonism, i, 86. salt solution, ii, 321. Physostigma, ii, 81. as a meiotic, i, 612. " motor depressant, i, 644. in hematuria, ii, 81. Physostigmine, ii, 81. salicylate in diarrhoea,*!, 146. " " dysentery, ii, 146. Phytolacca, ii, 81. in chronic eczema, ii, 81. " " rheumatism, ii, 81. " granular conjunctivitis, ii, 81. " inflammation of the lymphatic glands, ii, 81. " mammitis, ii, 81. " ulcers, ii, 81. Pichi, ii, 82. in cancer of the bladder, ii, 82. " cystitis, ii, 82. " hematuria, ii, 82. " hemorrhage, ii, 82. " hepatic diseases, ii, 82. " prostato-cystitis following gonorrhoea, ii, 82. " renal colic, ii, 82. " urinary diseases, ii, 82. Picrena excelsa. See Quassia. Picric acid, ii, 82. as a test for albumin in the urine, ii, 83. in burns, ii, 83. " chronic diarrhoea, ii, 453. " diabetes mellitus, iii. 453. (locally) in eczema, ii, 83, 452. " " erysipelas, ii. 83, 453. in fissured nipples, ii, 83. (locally) in fungous endometritis, ii, 83. " " itching of the scrotum, ii, 453. " " lymphangeitis, ii, 83. in malarial disease, ii, 83. " putrid diarrhoea, ii, 453. " trichiniasis, ii, 83. Picrol, ii, 83. Picrotoxin, ii, 83. as an antiparasitic, ii, 84. in chorea, ii, 84. " colliquative sweating, ii, 84. " epilepsy, ii, 84. " night sweating of tuberculosis, ii, 84. " paralysis agitans, ii, 84. Pictet liquid, i, 527. Piliganine. See under Lycopodium. Pilocarpine, ii, 85. as a meiotic, i, 612. in asthma, i. 95. " broncho-pneumonia, ii, 86. " conjunctivitis, ii, 86. " croup, ii, 85. " croupous pneumonia, ii, 85. " diphtheria, ii. 85. " influenza, ii. 86. " Meniere's disease, ii, 87. '• pneumonia due to influenza, ii, 86. " rhinitis, ii, 86. Pilocarpus. See Jaborandi and Pilocarpine. Pills, ii, 84. Pimenta, ii, 87. " in flatulence, ii, 87. Pimpernel, Pimpinella, ii, 87. Pine preparations, ii, 87. Pinkroot. See Spigelia. Pinol. See under Pine preparations. Pinus canadensis, ii, 88. in leucorrhoea, ii, 88. pumilio, oil of, in catarrh, ii. 88. " " " " rheumatism, ii, 88. silvestris. See under Pine preparations. strobus, ii, 88. " as an expectorant, ii, 88. Piper. See Piper nigrum. Piperazidine, Piperazine, ii, 88. Piperazine in cystic irritation, ii, 89. in diabetes, ii, 89. " gout, ii, 89. " gravel, ii, 89. " lumbago, ii, 89. " renal colic, ii, 89. " rheumatism, ii, 89. " uric-acid accumulation, ii, 89. " " " diathesis, i, 586. poisoning with, ii, 89. Piperidine, ii, 90. in pulmonary tuberculosis, ii, 453, 454. Piperin, Piperine, ii, 90. in malarial disease, ii, 90. Piper nigrum, ii, 90. as a carminative, ii, 90. " hemostatic in small wounds, ii, 90. in malarial disease, ii, 90. Piperonal, ii, 90. Pipsissewa. See Chimaphila. Piscidia, ii, 90. (as an antispasmodic) in asthma, ii, 91. in bronchitis, ii, 91. " burns and scalds, ii, 91. " chorea, ii, 91. (as a sedative) in cough, ii, 91. in hemorrhoids, ii, 91. " hysteria, ii, 91. " nervous insomnia, ii, 91. " " irritability, ii, 91. " neuralgia, ii, 91. "• pains of abortion, ii, 91. " phthisis, ii, 91. " spasmodic dysmenorrhoea, ii, 91. " toothache, ii, 91. (as an antispasmodic) in whooping-cough, ii, 91. Pistacia lentiscus. ii, 91. Pitch. See Pix burgundica, Pix canadensis, and Tar. Pituitary-body extract, ii, 91. in acromegaly, i, 81. Pix burgundica, ii, 91. as a rubefacient, ii, 91. in pulmonary affections, ii, 91. " rheumatism, ii, 91. canadensis, ii, 91. liquida, ii, 91. in chronic bronchitis, ii. 91. " " cystitis, ii, 92. " " pulmonary affections, ii, 91. Pixol, ii, 92. in acute dermatitis, ii, 92. " psoriasis, ii, 92. " simple chancre, ii, 92. " wounds, ii, 92. Placebos, ii, 92. 514 GENERAL INDEX. Plaster of Paris, ii, 93. Plasters, ii, 92. Pleurisy root. See Asclepias tuberosa. Plumbum. See Lead. Pneumatic cabinet, i, 19. 20. resistance valves, i, 22, 23. tub. See under Air, Condensed or rare- fied (vol. i, pages 18, 19, 20, 21). Podophyllin, ii, 93. in biliousness, ii, 93. " constipation, ii, 93. " functional disturbances of the liver, ii, 93. " hemoptysis, ii, 93. '• malarial infection, ii, 93. " portal congestion, ii, 93. " respiratory catarrh, ii, 93. " vomiting, i, 100. Podophyllotoxin, ii, 94. Podophyllum, ii, 94. Poisons, ii, 94. list of, and their antidotes, i, 110, 111. table of antagonistic, i, 89. Pokeberry root, Pokeroot. See Phytolacca. Polygala. See Senega. Polygonum bistorta, ii, 94. hydropiper, ii, 94. " in amenorrhoea, ii, 94. Polyporus fomentarius. See under Agaric. Polysolves, ii, 94. Pomegranate. See under Pelletierine. root in tenia, i, 102. Pommades. See Ointments. Poplar. See Populus. Populin. See under Populus. as an antipyretic, ii, 94. Populus, ii, 94. in malarial fevers, ii, 94. Poppy, ii, 94. Potash, Potassa, Potassa caustica, ii, 94. as a germicide, i, 447. in acidity of the, stomach, ii, 94. " boils, i, 228. " cancer, i, 228. " carbuncles, i, 228. " cutaneous affections, ii, 95. " deep-seated or indolent abscesses, i, 228. " gout, ii, 94. " rheumatism, ii, 94. " uric-acid diathesis, ii, 94. Potassium acetate, ii, 94. as a laxative, ii, 95. in acute rheumatism, ii, 95. and sodium tartrate. See under Potassium tartrates. and sodium tartrate in acute rheumatism, ii 100. bicarbonate. See under Potassium carbon- ates. bichromate, ii, 95. " in corns, warts, etc., ii, 95. " " solution for the destruction of small growths, venereal excrescences, and mucous patches, i, 225. bisulphate. See under Potassium sul- phate. bitartrate. See under Potassium tartrates. bromide, ii, 95. " as a motor depressant, i, 644. " in asthmatic paroxysms, i, 94. Potassium bromide in preparatory treatment of tenia, i, 101. bromide in strychnine poisoning, i, 194. " " tetanus, i, 194. cantharidate as a hypodermic in early stages of pulmonary tuberculosis, i, 209. cantharidate in cough of tuberculosis, i, 209. carbonate, ii, 95. " as an antilithic, ii, 95. " in acute rheumatism, ii, 95. chlorate, ii, 96. " in diphtheria, ii, 96. " hoarseness, ii, 96. " " pharyngitis, ii, 96. " " salivation, ii, 96. " " scarlet fever, ii, 96. " " sore throat, ii, 96. " " stomatitis, ii. 96. " " tumours of the gums and of the tongue, ii, 96. chlorochromate, ii, 96. citrate in acute rheumatism, ii, 96. " " measles, ii, 96. " " scarlet fever, ii, 96. " " uric-acid diathesis, ii, 96. Potassium cobaltonitrite. See under Cobalt (vol. i, page 273). cobaltonitrite, i, 273. " in dyspnoea, i, 273. " high arterial pressure, i, 273. " " uremia, i, 273. cyanide, i, 322; ii, 97. " in pruritus vulve, i, 323. " " severe headache, i, 323. " " skin diseases, i, 323. " stains of the conjunctiva, i, 323. cyanides, ii, 97. ferrocyanide in colliquative sweating, i, 323. " poisoning by the copper salts, i, 110. hydrate. See Potassa. hypophosphite. See under Phosphorus, ii, 97. iodide, ii, 97. " and bromide in neuralgia due to lead poisoning, i, 69. iodide and mercury in neuralgia caused by syphilis, i, 69. iodide and potassium bromide in asthma, i 97. iodide as a sorbefacient, ii, 99. " in actinomycosis, ii, 99. " " acute broncho-pneumonia, ii, 98. " " aneurysm, ii, 10. " " arterio-sclerosis, ii, 98. " " asthma, i, 97; ii, 99. " " Bright's disease, ii, 98. " chronic bronchitis, ii, 98. " copper poisoning, ii, 98. " " " enlargements of the lym- phatic glands, ii, 99. iodide in chronic lead poisoning, ii, 98. " mercury poisoning, ii, 98. " rheumatism, ii, 98. " " hypertrophy of various organs, ii 9o. iodide in inflammatory exudates, ii 98. " internal aneurysm, ii, 98.' " salicylic-acid poisoning, ii 143 " tertiary syphilis, ii, 97. GENERAL INDEX. 515 Potassium nitrate, ii, 99. nitrate, belladonna, and stramonium, fumes of, in asthma, i, 529. nitrate fumes in asthma, ii, 99. " in burns, ii, 99. nitrite. See under Nitrites. oxalates. See under Oxalic acid. permanganate, ii, 99. as a gargle in diphtheria, i, 597. permanganate as a germicide, i, 446. as an antidote to morphine poisoning, i. 596. permanganate as an antidote to phosphorus poisoning, i, 597; ii, 76. permanganate in acute articular rheuma- tism, i, 596. permanganate in bromidrosis, i, 103. " caries of bones, i, 597. " " diabetes, i, 596. " " diphtheria, i, 596. " " gangrene, i, 597. injections in gonorrhoea, i, 531. (as a spray) in ozena and pur- ulent otitis, i, 597. permanganate in sloughing malignant growths, i, 597. permanganate in snake-bite poisoning, i, 597. " ulcers, i, 446, 596. " " unhealthy wounds, i, 446. solution as an injection in subacute gonorrhoea, i, 597. permanganate solution in eczema, i, 596. " frostbite, i. 596. " " " hyperidrosis of the feet, i, 597. permanganate solution in leucorrhoea, i, 597. phosphate, ii, 99. salicylate, ii, 146. salts in renal dropsy, i, 345. silicate, ii, 99. sozoidolate in suppurating wounds, ulcers, etc., ii, 215. sulphates, ii. 99. sulphite, ii, 100. sulphocyanate, ii, 100. " in pulmonary tuberculosis, ii, 236. tannate, ii, 257. tartrate as a diuretic, ii, 100. " in dropsy due to acute nephritis, ii, 100. tartrate in valvular heart disease, ii, 100. tartrates, ii, 100. tellurate, ii, 100. " in night sweats of phthisis, ii, 100. Potio Riveri, ii, 100. Poultice, iodide of starch, ii. 103. jacket in pneumonia, ii, 102. Poultices, ii, 100. as counter-irritants, ii. 101. bran, ii, 103. bread, ii, 103. charcoal, in offensive ulcers, ii. 103. chlorine, in unhealthy sores, ii. 103. flaxseed, in eczematous incrustations, ii, 101. general rules for the employment of, ii, 102. hot, in toothache, i, 136. Indian meal, ii, 103. mustard, in deep inflammation, ii, 103. Poultices, yeast, ii, 103. Powders, ii. 103. Prescriptions, ii. 104. Propylamine. See Trimethylamine. Protonuclein. See under Nucleins (vol. ii, page 21). Prunes, ii, 105. Prunum. See Prunes. Primus virginiana, ii, 105. in cough, ii, 105. Prussic acid. See Hydrocyanic acid. Pseudaconitine, ii, 106. Pterocarpus. See Sandalwood. Ptisans. See Drinks. Ptvalagogues. See Sialagogues. Ptyalin, ii, 106. in dyspepsia, ii, 106. Ptvchotis ajowan. See Ammi. Pulsatilla, ii, 106. in acute catarrhal affections, ii. 107. " " cerebral meningitis, ii. 107. " " rheumatic gout, ii, 107. " " rheumatism, ii, 107. " asthma, ii, 107. " blepharophthalmia, ii, 107. " bronchitis, ii, 107. " catarrhal deafness, ii, 107. " chronic nasal catarrh, ii, 107. " conjunctivitis, ii, 107. " delayed menstruation, ii, 107. " dysmenorrhoea, ii. 107. " earache (of children), ii, 107. " eczema, ii, 107. " epididymitis, ii, 107. " functional amenorrhoea, ii, 107. " gonorrhceal ophthalmia, ii, 107. " heart disease, ii, 106. " indolent ulcers, ii, 107. " inflammation of the middle ear, ii, 107. " irritative cough, ii, 108. " mucous leucorrhoea, ii, 107. " nervous headache, ii, 107. - oophoritis, ii, 107. " orchitis, ii, 107. " purulent ophthalmia, ii, 107. " rhinitis, ii, 107. " spinal meningitis, ii, 107. " subacute gastritis, ii, 107. - syphilides, ii, 107. '• tapeworm, ii, 108. therapeutics of, ii, 107. Pumiline. See under Pine preparations (vol. ii, page 88). Pump, residual air, i, 22. Pumpkin seeds. See Pepo. in tenia, i, 102. Punica, Punicine. See Pelletierine. Punk. See under Agaric. Purgatives. See Cathartics. Pustulants. See under Counter-irritants. Pyoctanine, ii, 108. (internally) in acute nephritis, ii, 109. " " adenitis, ii, 109. " chronic nephritis, ii, 109. in chronic ulcers, ii, 108. " conjunctivitis, ii, 108. " corneal opacities, ii, 108. " dacryocystitis, ii, 108. " diphtheria, ii, 108. (internally) in endometritis, ii, 109. LL INDEX. 516 GENERA Pyoctanine in furuncles, ii, 108. (internally) in gonorrhoea, ii, 109. in herpetic ulcers of the cornea, ii, 108. " idiopathic ptyalism, ii, 108. (internally) in malarial fever, ii, 109. (injections) in malignant neoplasms, ii, 108. in otorrhoea, ii, 108. " pleurisy, ii, 109. (injections) in pulmonary phthisis, ii, 109. in suppurating wounds, ii, 108. " trachoma, ii, 108. (internally) in typhoid fever, ii, 109. Pyramidone, ii, 454. Pyrantine, ii, 109. in acute rheumatism, ii, 109. Pyrazine, Pyrazol, Pyrazoline, Pyrazolone, ii, 109. Pyrethrum, ii, 109. as an insecticide, ii, 109. in headache, ii, 109. " paralysis of the tongue, ii, 109. " toothache, ii, 109. Pyretine, ii, 110. Pyridine, ii, 110. fumes of, in angina pectoris, i, 530. " " " asthma, i, 530. in angina pectoris, ii, 110. " bronchial asthma, ii, 110. " cardiac enfeeblement, ii, 110. injections in gonorrhoea, ii, 10. Pyroacetic ether or spirit. See Acetone. Pyrodine. See Hydracetin. Pyrogallic acid, Pyrogallol, Pyrogallolum, ii, 110. Pyrogallic acid in chancre, ii, 111. in eczema marginatum, ii, 111. " epithelioma, ii, 111. " lupus, ii, 111. " phagedena, ii, 111. " psoriasis, ii, 111. Pyroglycerin. See Nitroglycerin. Pyroligneous acid, ii, 111. Pyroxylin, ii, 111. Pyrozone, ii, 111, 454. in pyorrhoea alveolaris, ii, 112. " suppuration, ii, 112. " suppurative otitis media, ii, 455. Quassia, ii, 112. as a bitter tonic, ii, 112. in anorexia, ii, 112. " ascarides, ii, 112. (enema) in ascarides vermicularis, i, 102. in atony of the stomach, ii, 112. Quebrachamine. See Quebracho. Quebrachine. See Quebracho. Quebracho, ii, 112. in asthma, ii, 112. " dyspnoea, ii, 112. " emphysema, ii, 112. " mitral insufficiency, ii, 112. Quercus. See Oak bark and Acorus. Quicklime. See under Lime (vol. i, page 582). Quicksilver. See Mercury. Quillaia, ii, 113. in croupous pneumonia, ii, 113. " interstitial pneumonia with bronchiecta- sis, ii, 113. " pleuropneumonia, ii, 113. " pulmonary emphysema, ii, 113. Quillaia in pulmonary tuberculosis, ii, 113. in syphilitic stenosis of the bronchus, ii, 113. Quillain. See Saponin. Quinalgene. See Analgene and Benzanal- GENE. Quinaseptol. See Diaphthol. Quince seed. See Cydonium. Quinetum, ii, 113. in malarial affections, ii, 113. Quinidine, ii, 113. Quinine, ii, 113. action of, on the cerebrum, i, 253. " " " " uterus, i, 252. antipyretic power of, i, 252. arsenite, ii, 455. as an oxytocic, ii, 55. contra-indications for the use of, ii, 121. dihydrochloride carbamate, ii, 455. ferrichloride, ii, 455. hydrochlorsulphate, ii, 455. hypodermically in pernicious intermittent fever, i, 117. in acute articular rheumatism, ii, 118. (as a spray or a snuff) in acute coryza, ii, 119. in acute glaucoma, ii, 120. " albuminuria of scarlatina, ii, 119. (rectal injections) in amoebic dysentery, ii, 120. in anemia (in non-malarial cases), i, 68. " asthma, i, 256; ii, 119. " atonic dyspepsia, i, 254. " blennorrhagic ophthalmia, ii, 120. " cholera, ii, 119, 121,122. " chorea, ii, 120. " chronic bronchitis, i, 256; ii, 119. " " gastric catarrh, i, 254. (as a tonic) in chronic phthisis, ii, 119. in convalescence, i, 254. " coryza, i, 256. (injections) in cystitis, ii, 120. in debility, i, 254. " diarrhoea, i, 255. " diphtheria, ii, 119. " dysentery, i, 255. " dystocia," ii, 116. " early stages of amygdalitis, i, 256. " " meningitis, i, 256. " " pleurisy, i, 256. " " pneumonia, i, 256. (injection) in empyema, ii, 120. in erysipelas, i, 25*5 ; ii, 119. " gonorrhoea, i, 254. " hematuria, i, 255. " hay fever, i, 253. influence of, on the gravid uterus, ii, 116. in follicular amygdalitis, ii, 119. (injections) in gonorrhoea, ii, 120. (lotion) in gonorrhceal ophthalmia, ii, 120. (injections) in growths at the neck of the bladder, ii, 120. in hematuria, ii, 120. " hemorrhagic malarial fever, ii, 118. (as a spray or a snuff) in hay fever, ii, 119 in hectic fever of phthisis, ii, 119. " hydrops articulorum intermittens, ii 120 " inflammations of the serous surfaces, iij (hypodermically) in insolation, ii, 120 in intermittent fever, i, 117 ; ii, 117, GENERAL INDEX. 517 Quinine, in intermittent fever, as an antipe- riodic, i, 254. in intermittent neuralgia, ii, 118. " laryngismus stridulus, i, 256 ; ii, 119. '• malarial cachexia, i, 255 ; ii, 118. " disease, ii, 117, 118. " neuralgia, ii, 120. " " poisoning and malarial paroxys- mal diseases, ii, 310. " masked intermittent fever, ii, 118. " Meniere's disease, ii, 120. " migraine, ii, 120. " neuralgia, ii, 118. " neurasthenia, ii, 120. " paroxysms of intermittent fever, i, 117. " pertussis, ii, 119. " phthisis, i, 256. " pityriasis, ii, 120. " " versicolor, i, 253. " pneumonia, ii, 119. " prolonged labour, ii, 116. " " suppuration, ii, 120. " " suppurative processes, i, 256. (topically) in pruritus ani, ii, 120. vulve, ii, 120. in puerperal fever, ii, 119. " remittent fever, i, 255; ii, 118. " rheumatism, i, 256. " ringworm, ii, 120. " scarlatina, i, 255; ii, 119. " sciatica, ii, 120. " septic diseases, i, 255. " small-pox, ii, 119. " stenocardia, ii, 120. " surgical fever, i, 256. " syphilis, ii, 120. " tinea circinata, i, 253. " trigeminal neuralgia, ii, 120. " typhoid fever, i, 255 ; ii, 119. " typhus fever, ii, 118. " ulcers, ii, 121. " unhealthy granulating wounds, ii, 120. " urethral fever, i, 250; ii, 120. " uterine inertia, i, 256; ii, 116, 120. " whooping-cough, i, 253. physiological action of, ii, 114. salicylate, ii, 455. tannate, ii, 259. " in malarial diseases, ii, 259. " " nervous affections, ii, 259. " " whooping-cough, ii, 259. valerianate, ii, 346. with antidiphtheritic serum in malarial fe- ver, ii, 174. Quinoidine. See Quinidine. Quinoline, ii, 122. Quinosol, ii, 122. irrigation in labour, ii, 122. Quinquina. See Cinchona. Raspberry vinegar, i, 351. Ratanhia. See Krameria. Reconstituents, ii, 122. Rectal etherization, i, 63. medication, i. 198. Red poppv. See Bho:as. saunders. See Sandalwood. Refrigerants, ii, 124. Relaxants, ii, 125. Resina. See Rosin. Resinol. See Rosinol. Resins, ii, 125. Resol, ii, 125. Resolvents. See Sorbefacients. Resorbin, ii, 125. Resorcin, ii, 125. and ichthyol in chilblains, ii, 126. as a gastric sedative, i, 100. " an intestinal antiseptic, i, 132. in chancroids, ii, 120. (topically) in diphtheria, ii, 126. in eczema, ii, 126. " " seborrhoicum, i, 116. " erysipelas, ii, 126. (antipyretic) in fever, ii, 126. in herpes, ii, 126. " leucoplakia, ii, 126. " leucorrhoea, ii, 126. '• lupus erythematosus, ii, 126. " psoriasis, ii, 126. " ulcerative affections of the mouth, throat. ears, etc., ii, 126. (by spray) in whooping-cough, ii, 126. Rest, absolute, in anemia, i, 68. cure, ii, 126. " in acute mania, ii, 127. " anemia, i. 68. " chorea, ii, 127. " " epilepsy, ii, 127. '• exophthalmic goitre, ii, 127. " hysteria, ii, 127. " " melancholia, ii, 127. " '' mental or nervous exhaustion, ii, 127. " " neurasthenia, ii, 127. Restoratives, ii. 128. Retinol. See Rosinol. Retroinjections. See under Injections. Retrojections, i, 531. Rhamnin, ii, 128. Rhamnoxanthin. See under Frangula. Rhamus purshiana, ii, 128. in chronic constipation, ii, 129. Rhatanhia, Rhatany. See Krameria. Rhei radix. Rheum. See Rhubarb. Rheumin. See Chrysophanic acid. Rhigolene, ii, 129. in burns, ii, 129. Rhoeados petala. Rhceas, ii, 129. Rhubarb, ii, 129. as a cholagogue, ii, 130. in atonic dyspepsia, ii, 130. " constipation, ii, 130. " diarrhoea, ii, 130. " functional disturbances of the liver, ii, 130. - hemorrhage from the rectum, ii, 131. (topically) in unhealthy ulcerations, ii, 130. therapeutics of, ii, 130. Rhus, ii, 131. aromatica, ii, 131. in incontinence of urine from vesical atony, ii, 131. aromatica in metrorrhagia due to fibroid tu- mours of the uterus, ii, 131. aromatica in vesical hamiaturia, ii, 131. diversifolia, ii, 131. glabra in sore throat, ii, 131. pumila, ii, 131. radicans, ii. 131. toxicodendron, ii, 131. in incontinence of urine, ii, 133. 518 GENERAL INDEX. Rhus toxicodendron in hemorrhoids, ii, 133. toxicodendron in muscular soreness due to hysterical convulsions, ii, 134. toxicodendron, poisoning with, ii, 132. " therapeutics of, ii, 133. " treatment of poisoning with, ii, 132, 133. venenata, ii, 134. vernicifera, ii, 134. Rice, ii, 134. Ricinus, ii. 134. Rontgen rays. See X rays. Rosa canina, Rosa centifolia, Rosa damascena, Rosa gallica. See Rose. Rosaniline hydrochloride, Roseine. See Fuch- sine. Rose, ii, 134. Rosemary, ii, 135. in indolent ulcers, ii, 135. Rosin, ii, 135. Rosinol, ii, 135. in foul ulcers, ii, 135. " pruritus, ii, 135. " uterine and vaginal catarrh, ii, 135. Rosmarinus. See Rosemary. Rottlera. See Kamala. Rubber, ii, 135. Rubefacients. See under Counter-irritants, and vol. i, page 312. in colic, i, 312. " lumbago, i, 312. " neuralgia, i, 312. " pleurodynia., i, 312. " sciatica, i, 312. Rubidium, ii, 136. and ammonium in epilepsy, ii; 136. in syphilis, ii, 136. Rubijervine, ii, 351. Rubus, ii, 136. in atonic diarrhoea, ii, 136. Rue, ii, 137. in amenorrhoea, ii, 137. " epilepsy, ii, 137. " hysteria, ii, 137. " ovarian atony, ii, 137. " uterine atony, ii, 137. Rum, ii, 137. pineapple, ii, 137. shrub, ii, 137. Rumex, ii, 137. " Rusma of the Turks," i, 327. Ruta graveolens. See Rue. Rye, ii, 137. "flour in acute dry eczema, ii, 137. " " burns, ii, 137. " " erysipelas, ii, 137. in habitual constipation, ii, 137. Sabadilla, ii, 137. Sabbatia, ii, 137. as an appetizer, ii, 137. in malarial fever, ii, 137. Sabina. See Savine. Saccharin, ii, 137. in aphthous sore throat, ii, 137. " diabetes mellitus, ii, 138. " indigestion, ii, 138. " obesity, ii, 138. " purulent affections of the ear, ii, 137. Saccharum. See Sugar. Saccharum lactis. See Sugar of milk. Saffron, ii, 138. tea as a diaphoretic in measles and exan- themata, ii, 269. Safrol, ii, 138. Sage. See Salvia. Sago, ii, 138. Salacetol, ii, 138. in acute articular rheumatism, ii, 139. " biliary lithiasis, ii, 139. " chronic rheumatism, ii, 139. " choleraic diarrhoea, ii, 139. " muscular rheumatism, ii, 138. Salactol, ii, 139. Salazolon, ii, 139. Salep, ii, 139. Saleratus. See under Potassium carbonates and Sodium bicarbonate. Salicin, ii, 139. in acute articular rheumatism, ii, 140. " " coryza, ii, 140. " " inflammatory processes, ii, 140. " catarrhal jaundice, ii, 140. " chronic articular rheumatism, ii, 140. " diphtheria, ii, 140. " gout, ii, 140. " hay fever, ii, 140. " lumbago, ii, 140. " neuralgia, ii, 140. " pneumonia, ii, 140. " rheumatism, ii, 140. Salicylacetol. See Salacetol. Salicylaldehyde-methylphenylhydrazine. See Agathin. Salicylamide, ii, 140. in acute amygdalitis, ii, 141. " neuralgia, ii, 141. " of peripheral nerves, ii, 141. " ovarian neuralgia, ii, 141. " rheumatism, ii, 141. Salicylates in gastric fermentation, i, 132. in intestinal fermentation, i, 132. Salicylic acid and the salicylates, ii, 141. applications in desquamative eruptions, ii, 144. applications in pustular acne, ii, 144. as an analgetic, ii, 142. " antipyretic, ii, 142. " antiseptic, ii, 142. chronic, poisoning, ii, 143. douche in chronic ozena, ii, 143. enema in dysentery, ii, 143. for the destruction of small growths, i, 225. in acute articular rheumatism, ii, 142. (on tampons) in carcinoma of the uterus, ii, 143. ' ' in chronic urticaria, ii, 143. " corns and warts, ii, 143. " coryza, ii, 143. " dysidrosis, ii, 144. " eczema seborrhoicum, i, 116. "erythema, ii, 144. (ointment) in erythematous eczema, ii 144 in exophthalmic goitre, ii, 146. " fever, ii, 142. " gastric catarrh, ii, 143. fermentation, i, 132. " gonorrhceal rheumatism, ii, 142. " gout, ii, 143. " hay fever, ii, 143. GENERAL INDEX. 519 Salicylic acid and the salicylates (for pain) in herpes zoster, ii, 143. in hyperidrosis, ii, 144. (locally) in hyperidrosis of the feet and hands, ii, 143. in impetigo contagiosa, ii, 145. " intertrigo, ii, 143. " intestinal flatulence, ii, 143. " lichen estivus, ii, 145. " lupus erythematosus, ii, 144. (on tampons) in metrorrhagia, ii, 143. in nail deformities, ii, 145. " neuralgia, ii, 142. (ointment) in papular eczema, ii, 144. in phthisis, ii, 143. '• psoriasis, ii, 143. " " guttata, ii, 144. (for swollen joints) in purpura hemorrha- gica, ii, 143. in relapsing fever, ii, 143. " rheumatism, i, 124. " sciatica, ii, 142. " sclerotitis, ii, 143. " slight hemorrhages, ii, 143. " squamous eczema, ii, 144. " syphilitic ulcerations, ii, 145. " urticaria, ii, 145. inhalation in foetid bronchitis, ii, 143. in gangrene of the lung, ii, 143. injections in cancer of the uterus, ii, 145. (ointment and solution) in inflammations of the sebaceous glands, ii, 144. ointment in eczema, ii. 143, 144. in eczema rubrum, ii, 144. ' " epithelioma, ii, 145. " ichthyosis, ii, 144. " lentigo, ii, 144. " pityriasis, ii, 144. " pustular eczema, ii, 144. " rhus poisoning, ii, 145. " seborrhoea, ii, 144. " vesicular eczema, ii, 144. " zoster, ii, 143. Salicylidene paraphenetidine. See Malakin. Saligenin, ii, 147. in acute articular inflammation, ii, 147. " " rheumatism, ii, 147. " cholera, ii, 147. " dysentery, ii, 147. " influenza, ii, 147. " malarial fevers, ii, 147. " typhoid fever, ii, 147. Salinaphthol. See Betol. Saline cathartics in abdominal hemorrhage, ii, 147. cathartics in vomiting, i, 100. Salines, ii, 147. in abdominal inflammations, ii. 147. '• acute inflammations, ii, 147. " appendicular inflammation, ii, 147. " ascites of hepatic cirrhosis, ii, 147. " congestive conditions, ii, 147. " dropsical conditions, ii, 147. " gout. ii. 147. " peritonitis, ii, 117. " rheumatism, ii, 147. injections for increasing red corpuscles, i. 464. solution injections in hemorrhage, i, 467. Salipyrine, ii, 147. as a hypnotic, ii, 148. Salipyrine as an analgetic, ii, 148. as an antipyretic, ii, 148. in acute and chronic rheumatism, ii, 148. " facial neuralgia, ii, 148. " headache, ii, 148. " intermittent fever, ii, 148. " menorrhagia, ii, 149. " metrorrhagia, ii, 149. " myalgia, ii, 148. " neuralgia, ii, 148. " trigeminal neuralgia, ii, 148. " typhoid fever, ii, 148. Salithymol, ii, 149. Salivin. See Ptyalin. Salix, ii, 149. as a sedative to the sexual organs, ii, 149. in dysmenorrhea, ii, 149. " hyperesthesia, ii, 149. '- prostatorrhoea, ii, 149. '• spermatorrhoea, ii. 149. " uterine neuralgia, ii, 149. Salocoll, ii, 149. Salol, ii, 149. and antipyrine applications in fungous en- dometritis, ii, 150. and antipyrine applications in uterine hem- orrhage, ii, 150. as an analgetic, ii, 150. " " antipyretic, ii, 150. " " antiseptic dressing for sores and ulcers, ii, 150. camphorated, in carbuncles and furuncles, ii, 150. in catarrh of the bile ducts, ii, 150. " cystitis, ii, 150. " diarrhea, ii, 150. " grippe, ii, 150. " hepatic catarrh, ii, 150. '• influenza, ii, 150. " intestinal catarrh, ii, 150. " " fermentation, i, 132. " jaundice, ii, 150. " migraine, ii, 150. " muscular rheumatism, ii, 150. " neuralgia, for immediate relief, i, 69. " neuritis, ii, 150. " pains of locomotor ataxia, ii, 150. " pyelitis, ii, 150. " rheumatism, ii, 125. 150. " summer diarrhoea of children, ii, 150. " urethritis, ii, 150. Salophene, ii, 151. as an intestinal antiseptic, ii, 151. in acute muscular rheumatism, ii, 151. " " rheumatism, ii, 151. " influenza, ii, 151. " migraine, ii, 151. " neuralgic affections, ii, 151. " rheumatism, i, 125; ii, 151. " subacute gouty arthritis, i, 125. " the nervous form of influenza, ii, 152. Salt, Carlsbad, artificial, ii, 152. " in hepatic cirrhosis, i, 224. common. See under Sodium. " enema in ascarides vermiculares, i, 102. common, in poisoning by the silver salts, i, 110. Epsom. See Magnesium sulphate (vol. i, page 592). 520 GENERAL INDEX. Salt. Monsell's, ii, 152. Rochelle. See Potassium and sodium tar- ttrae, under Potassium tartrates. Saltpetre. See Potassium nitrate. Salubrine, ii, 152. in bruises, ii, 152. '• inflammatory skin diseases, ii, 152. " muscular rheumatism, ii, 152. " ozena, ii, 152. Salubrol, ii, 456. Salufer, ii, 456. Salumine, ii, 152. (by insufflation) in dry catarrh of the nose and pharynx, ii. 152. Salves. See Ointments. Salvia, ii, 152. in atonic dyspepsia, ii, 152. " in profuse sweating, ii, 456. Sal volatile. See Ammonium carbonate. Sambucus, ii, 152. Sandal-wood, ii, 152. oil in bronchitis, ii, 153. " " diarrhoea, ii, 153. " " gonorrhoea, ii, 153. Sandarac, ii, 153. Sanders-wood. See Sandal-wood. Sanguinal, ii, 154. in debility with nervous symptoms, ii, 154. " nervousness, ii, 154. " neurasthenia, ii, 154. Sanguinaria, ii, 154. as an escharotic, ii, 154. (externally) as a stimulant, ii, 154. as a stimulant expectorant, ii, 154. for unhealthy surfaces, ii, 154. in asthma, ii, 154. " atonic amenorrhoea, ii, 154. " chronic nasal catarrh, ii, 154. " gastro-duodenal catarrh, ii, 154. " impotence, ii, 154. " jaundice, ii, 154. " scrofula, ii, 154. " syphilis, ii, 154. Sanguinarine. See under Sanguinaria. Sanguis. See Blood. Sanitary wood wool as an absorbent dressing, ii, 88. Sanoform, ii. 154. «. in buboes, ii, 154. " hard chancre, ii, 154. " open abscesses (after-treatment), ii, 154. " paronychia, ii, 154. " phimosis, ii, 154. " soft chancre, ii, 154. " wounds from excision of ulcers, ii, 154. Santalum rubrum, Santal-wood. See Sandal- wood. Santonica, ii, 155. Santonin. See under Santonica. in amenorrhoea, ii, 155. " " of chlorosis, i, 375. " ascarides vermiculares, i, 102. " nocturnal incontinence of urine in chil- dren, ii, 155. " threadworms, ii, 155. " tobacco amaurosis, ii, 155. Santoninoxime, ii, 155. Sapo. See Soap. Sapocarbol, ii, 155. Sapolanolin, ii, 155. Saponaria. ii, 155. as a local anesthetic, ii, 156. as an antipyretic, ii, 156. Saponin, ii, 156. Sapo viridis. See under Soap. Saprol, ii, 156. as a disinfectant, ii, 156. Sarracenia purpurea, ii, 156. in atonic dyspepsia, ii, 156. Sarsa. See Sarsaparilla. Sarsaparilla as a blood purifier, ii, 156. Sassafras, ii, 156. in flatulent colic, ii, 156. mucilage in painful affections of the mouth and throat, ii, 156. Sassy-bark. See under Erythrophlceine. Saunders. See Sandal-wood. Savine, ii, 156. in atonic menorrhagia, ii, 157. " chronic gout, ii, 157. " worms, ii, 157. Saxol, ii, 157. Saxoline. See Vaseline. Scammony, ii, 157. in dropsical effusions, ii, 157. " fever, ii, 157. " obstinate constipation, ii, 157. Scarification, ii, 158. in conjunctivitis, ii, 158. " inflammation of the tonsils, ii, 158. " local congestion, ii, 158. " oedema of the glottis, ii, 158. " subcutaneous dropsy, ii, 158. Scilla. See Squill. Scillain, Scillin, Scillipicrin, Scillitin, Scilli- toxin, ii. 158. Scillain (subcutaneously) in dropsy, ii, 158. Sclerotic acid, ii, 158. Dragendorff's, ii, 158. in epilepsy, ii, 158. " internal hemorrhage, ii, 158. Podwyssotzki's, ii, 158. Scoparii cacumina. See Scoparius. Scoparin, ii, 158. Scoparius, ii, 158. in venous engorgement, i, 345. Scopolamine, ii, 158. as a mydriatic, ii, 159, 649. hydrobromide in plastic iritis (incipient stages), ii, 159. in inflammation of the iris and cornea, ii, 159. ' ' " insomnia, ii, 159. " posterior synechie, ii, 159. Scopoleine, Scopolenine, ii, 159. Scurvy-grass. See Cochlearia. Scutellaria, ii, 159. Sea-tangle. See Laminaria. Sebum ovile, ii, 160. Secale in deafness from quinine, i, 389. in deafness from salicylic acid, i, 389. " fibroid tumours, i, 388. cereale. See Rye. cornutum. See Ergot. Sedatine. See Antipyrine. Sedatives, ii, 160. circulatory, ii, 161. in sthenic fevers, ii, 161 gastric, ii, 160. general, ii, 160.' GENERAL INDEX. 521 Sedatives, local, ii, 160. pulmonary, ii, 161. spinal, ii, 160. urinary, ii, 161. Seidlitz powders, ii, 161. in constipation, ii, 161. " vomiting, i, 100. Selenium, ii, 161. in skin diseases, ii, 161. Senecin, ii, 161. in amenorrhoea, ii, 161. " dysmenorrhoea, ii, 161. " hemoptysis, ii, 161. " jaundice, ii, 161. Senecine, ii, 161. Senecio, ii, 161. in amenorrho'a. ii, 162, 456. " dysmenorrhoea, ii, 162, 456. " epilepsy, ii, 162. " hemoptysis, ii, 162. " jaundice, ii, 162. " menstrual headache, ii, 456. " pruritus, ii, 162. " vicarious menstruation, ii, 456. Senega, ii, 162. in bronchitis (as a stimulating expectorant), ii, 162. " pneumonia, ii, 162. Senegin. See Saponin. Seneka. See Senega. Senna, ii, 162. in constipation, ii, 162. Septentrionaline, ii, 162. in rabies, ii, 162. " strychnine poisoning, ii, 162. " tetanus, ii, 162. Sequardine, ii, 162. Sero-therapy. See Serum therapy. Serpentaria, ii, 162. and capsicum in vomiting of drunkards, i, 100. and cinnamon in vomiting of drunkards, i, 100. and ginger in vomiting of drunkards, i, 100. in intermittent fever, ii, 162. Serpyllum, ii, 162. Serum, ii, 162. antidiphtheritic, administered by the mouth, ii, 174. antidiphtheritic, in malarial fever, ii, 174, " " scarlet fever, ii, 178. antistreptoeoccus. See under Serum treat- ment. antistreptoeoccus, in acute hemorrhagic sep- ticemia, ii, 177. antistreptoeoccus, in erysipelas, ii, 175. " " phlegmons, ii, 175. " '• puerperal fever, ii, 175. " " " septicemia, ii, 175. " " ulcerative endocarditis, ii. 178. _ artificial, ii, 163. " as a hemostatic, ii, 164. " in acute anemia from hemorrhage. ii, 163. artificial, in acute pneumonia, ii, 165. •' (intravenous injections) in anemia, ii, 164. artificial, in ascites, ii, 163. " Asiatic cholera, ii, 164. Serum, artificial, in asphyxia due to inhalation of oxide of carbon, ii, 165. artificial, in exanthematous typhus, ii, 165. " " neurasthenia, ii, 163, 164. " (intravenous injections) in septice- mia after operations, ii, 164 artificial (intravenous injections), in shock, ii, 164. cow's (subcutaneous injections), in summer diarrhoeas of children, ii. 163. de Dios Carrasquilla's, in leprosy, ii, 184. dose of, for diphtheria, ii, 170. horse (subcutaneous injections), in pulmo- nary tuberculosis, ii, 163. (saline solution) in scarlet fever, ii, 178. in small-pox, ii, 179. lactis. See Whey. Maragliano's, in tuberculosis, ii, 182, 183, 184. paste, ii, 166. • powder, ii, 166. sublimate, ii, 166. treatment, ii, 166. " of anthrax, i, 85. " " cancer, ii, 185, 186. " " cholera, i. 83; ii, 187. " diphtheria, i, 83; ii, 170, 171. " " diphtheritic laryngitis, ii, 172. " " hog cholera, ii, 188. " " hydrophobia, i, 84. " " influenza, i, 85. " " leprosy, ii, 184. " (Maragliano's) of lupus, ii, 184. " of measles, ii, 178. " " pneumonia, i, 85. " " scarlet fever, ii, 178. " " small-pox, ii, 179. " snake-bite, ii, 188, 189. " " swine plague, ii, 188. " " syphilis, i, 85 ; ii, 186. " " tetanus, i, 84. " " the plague, ii, 188. " " tuberculosis, i, 85; ii, 179, 180, 181, 182, 183. treatment of typhoid fever, i, 84. " Paquin's, of tuberculosis, ii, 183. " preparation of toxine for, ii, 167,168. " reports of, in diphtheria, ii, 173,174. Sesame oil, ii, 190. in chronic intestinal catarrh, ii, 190. " excessive acidity, ii. 190. " febrile pleurisy, ii, 190. " gastric catarrh, ii, 190. " habitual constipation, ii, 190. " phthisis with obstinate diarrhoea, ii, 190. " septic fever, ii, 190. " typhoid fever, ii, 190. " ulcer of the stomach, ii, 190. Sevum, Sevum preparatum. See Fats and Tallow. Shikimol. See Safrol. Sialagogues, ii, 190. general, ii, 191. Silica, ii, 191. (internally) in cancer (for relief of pain), ii, 191. in ephelis, ii, 191. hydrated, in buboes, ii, 191. " " chancroids, ii, 191. " " suppurating surfaces, ii, 191. 522 GENERAL INDEX. Silicates, ii, 191. Silver, ii, 191. and sodium hyposulphite in diseases of the throat, ii, 197. and sodium hyposulphite in locomotor ataxia, ii, 197. citrate in chronic cystitis, ii, 198. " " gonorrhceal inflammation of the vulvo-vaginal gland, ii, 198. citrate in gonorrhoeal urethritis (in women), ii, 198. iodide in dysmenorrhoea, ii, 197. " epilepsy, ii, 197. " " gastric troubles, ii, 197. " " trachoma, ii, 197. lactate in erysipelas, ii, 197. metallic, as an antiseptic, ii, 192. nitrate, ii, 192. " as a hemostatic, ii, 193. " " an astringent, ii, 193. " " a stimulant, ii, 193. " (as a caustic) for warts, and mollus- cum contagiosum, ii, 196. nitrate in acute coryza, ii, 195. " " " dysentery, ii, 194. " " amygdalitis, ii, 195. " " atrophic rhinitis, ii, 195. " " aural polypi, ii, 195. " " balanoposthitis, ii, 196. " " bedsores, ii, 196. " " blepharitis marginalis, ii, 195. " (injections) in buboes, ii, 196. " in catarrh of the biliary ducts, ii, 194. " " cervical endometritis, ii, 196. " " cholera infantum, ii, 194. " " chronic cystitis, ii, 196. " " chronic gastric catarrh, ii, 194. " " chronic gastritis (by irrigating the stomach), ii, 194. nitrate in chronic inflammation of the intes- tines, ii, 194. nitrate in chronic laryngitis, ii, 196. " " " pharyngitis, ii, 195. " " " purulent inflammation of the middle ear, ii, 195. nitrate in corns, ii, 457. " (injections) in cysts, ii, 196. " " dacryocystitis, ii, 195. " in eczema, ii, 196. " " " of the external ear, ii, 195. " " " " " eyelids, ii, 195. " " epilepsy, ii, 194. " " epistaxis, ii, 195. " " erosions of the os uteri, ii, 196. " " erysipelas, ii, 196. " " erythema, ii, 196. " " external otitis, ii, 195. " " exuberant granulations, ii, 195. " " fissured nipples, ii, 196. " " fissures of the lips and tongue, ii 195. nitrate in gastric ulcer, ii, 194. " gleet, ii, 196. " " gonorrhoea, ii, 196. " " hematuria, ii, 196. " " hydroceles, ii, 196. " " indolent sinuses, ii, 196. " " inflammation of the mucous mem- brane of the Eustachian tube, ii. 195. nitrate in irritable stomach, ii, 194. Silver nitrate in laryngeal ulcers, ii, 196, 457. nitrate in lichen, ii, 196. " " lupus, ii, 196. •' " naso-pharyngitis, ii, 195. " " ophthalmia neonatorum, ii, 194. " " ozena, ii, 195. " " persistent vomiting, ii, 194. " " prostatorrhcea, ii, 196. " " prurigo, ii, 196. " " pruritus of the external auditory meatus, ii, 195. nitrate in psoriasis, ii, 196. " " purulent conjunctivitis, ii, 195. " " ringworms, ii, 196. " " subacute laryngitis, ii, 196. " " tabes dorsalis, ii, 194. " internal uses of, ii, 193, 194. " in trachoma, ii, 195, 214. " " ulcers of the mouth, ii, 195. " (locally) in ulcers of the rectum, ii, 194. nitrate in ulcers of the nasal septum, ii, 195. '• •' vascular granulations, ii, 195. " " venereal sores, ii, 196. '' " vomiting (by irrigation of the stomach), ii, 194. nitrate in vomiting of chronic gastric dis- ease, i, 99. nitrate, solid, in toothache, i, 136. " solution in whooping-cough (by sponging the throat), ii, 196. oxide in diarrhoea, ii, 197. " " dysmenorrhoea, ii, 197. " " gastric hemorrhage, ii, 197. " " gastric neuralgia, ii, 197. " " gastritis, ii, 197. " " gonorrhoea, ii, 197. " " irritable dyspepsia, ii, 197. " " irritability of the stomach, ii, 197. " " profuse sweating, ii, 197. " " pulmonary hemorrhage, ii, 197. " " pyrosis, ii, 197. " " venereal sores, ii, 197. " " vomiting, ii, 197. Simulo, ii, 198. in epilepsy, ii, 198. Sinapis, Sinapisms. See Mustard. Skullcap. See Scutellaria. Slaked lime. See under Calx and Lime. Slippery elm. See Ulmus. Smilacin, ii, 198. Smilasin, ii, 198. Smilax, ii, 198. Snakeroot. See Serpentaria. Soap, ii, 198. alkaline fluid, ii, 201. as a lubricant for the fingers in making vagi- ' nal and rectal examinations, ii, 201. as an antidote to poisoning by acids, i, 6. " sulphuric-acid poisoning, ii, 242. Castile, ii, 199. glycerin, ii, 199. green, ii, 199. in eczema rubrum (of the leg), ii, 200. _ " " inveterate psoriasis, ii, 200. in acid poisoning, ii, 199. in poisoning with zinc salts, i,.109. ", corrosive sublimate, i, 109. " metallic salts, i, 109. GENERAL INDEX. 523 Soap, in poisoning with potassium bichromate, i, 109. in poisoning with salts of tin, i, 109. liquid glycerin, ii, 199. marble, ii, 201. marine, ii, 199. Marseilles, ii, 199. mercurial, ii, 200. neutral fluid, ii, 201. soft, ii, 201. " alkaline, ii, 201. superfatted fluid, ii, 201. transparent, ii, 199. Soapbark. See Quillaia. Soaps, medicinal, and their uses, ii, 199. Soapsuds as a laxative enema, ii. 199. Soapwort. See Saponaria and Saponine. Socaloin. Sec; under Aloin. Soda, Soda caustica, ii, 201. Soda as a germicide, i, 447. tartarata, ii, 202. water, i, 214. Sodio-theobromine salicylate, ii, 202. for arrhythmia, ii, 202. in acute nephritis, ii, 203. " " " of scarlatina, ii, 203. " aneurysm, ii, 203. " arteriosclerosis, ii, 203. " chronic nephritis, ii, 202. " dropsy, ii, 202. " " of cardiac origin, ii, 202. " heart disease, ii, 202. '• interstitial nephritis, ii, 203. " mitral insufficiency, ii, 203. " myocarditis, ii, 203. " nephritis, ii, 203. " in pericarditis, ii, 203. " pleuritic effusions, ii, 203. " serous effusion, ii, 202. " valvular heart disease, ii, 203. Sodium acetate, ii, 203. and caffeine sulphonate. See Symphorol. " magnesium borocitrate, ii, 203. " " " in urinary lithi- asis, ii, 203. and magnesium tartrate, ii, 203. arsenate, Sodium arseniate, ii, 204. aurochloride, ii, 204. benzoate in lithemia, ii, 204. " " rheumatism, ii, 204. biborate. See Borax. bicarbonate, ii, 204. " in acid diarrhoea of children, ii, 204. bicarbonate in coryza, ii, 205. " " deficiency of hydrochloric acid in the gastric juice, ii, 204. bicarbonate in diabetes (to reduce the amount of sugar), ii, 204. bicarbonate in excess of hydrochloric acid, ii, 204. bicarbonate in influenza, ii. 205. " (injections) in intestinal intus- susception, ii, 204. bicarbonate in rheumatism, i. 124. '• (locally) in stings of bees, wasps, etc., ii, 204. bicarbonate (locally) in superficial burns, ii, 205. bisulphite. See under Sulphurous acid. 77 Sodium borate. See Borax. bromide. See under Bromides. " in asthmatic paroxysms, i, 94. " " nervous excitement, i. 194. irritability, i. 194. cantharidate in pulmonary tuberculosis, ii, 206. carbolate, ii, 206. " in diarrhoea (as an intestinal anti- septic), ii, 206. carbolate in dysentery (as an intestinal anti- septic), ii, 206. carbolate in typhoid fever (as an intestinal antiseptic), ii, 206. carbonate, ii, 206. cetrarate, ii, 206. chlorate, ii, 206. " (for palliative treatment) in cancer of the uterus, ii, 206. chloride, ii, 206. " in capillary hemorrhages, ii, 206. " " epistaxis, ii. 206. " injections in hydrocele, ii, 163. " in intermittent fever, ii, 206. " (as a gargle) in nasal catarrh, ii, 206. chloride in nitrate-of-silver poisoning, ii, 193. " (as a gargle) in pharyngitis, ii. 207. " in poisoning with the silver salts, i, 110. choleate, ii. 207. citrate, ii, 207. citro-tartrate, ii, 207. diiodoparaphenolsulphonate. See Sodium so- zoiodolate. diiodosalicylate. See under Diidosalicylic acid. dithiosalicylate. See under Dithiosalk ylic acid. dithiosalicylate in rheumatism, i, 125. ethylate, ii", 207. " in psoriasis, ii, 207. " " warts, corns, etc., ii, 207. ethylsulphate. See Sodium sulpiiovinate. fluoride. See Fluoride. fluosilicate. See Sodium silicofluoride. formate, ii, 207. " in tuberculous diseases, ii, 207. glycerinoborate, ii, 207. hypophosphite. See under Hypophosphites. (vol. i, page 519). hyposulphite in ringworm, i, 117. iodide, ii, 207. •' and sodium bromide in asthma, i, 97. lactate, ii, 207. " in insomnia, ii, 207. nitrate, ii, 207. " in dysentery, ii, 207. nitrite. See under Nitrites (vol. ii, page 13). paracresotate, ii, 207. " in catarrhal pneumonia, ii, 207. paracresotate in gastro-intestinal disorders, ii, 207. paracresotate in rheumatism, ii. 207. " typhoid fever, ii, 207. phenolsulphonate, ii, 207. phosphate, ii. 207. " as a cholagogue, ii, 207. " " laxative, ii, 207. 524 GENERAL INDEX. Sodium phosphate in biliary calculi, ii. 208. phosphate in biliary inspissation, ii, 79. " " boils and carbuncles, ii, 208. " •' catarrhal jaundice, ii, 79. " " diarrhoea, ii, 79. " " epidemic jaundice of warm climates, ii, 208. phosphate in gastro-duodenal catarrh, ii, 208. phosphate (subcutaneous injections) in hemi- plegia, ii, 208. phosphate in hepatic torpor, ii, 79. " " intestinal dyspepsia, ii, 79. " " jaundice, ii, 208. " lithemia, ii, 79, 208. " malnutrition, ii, 208. " (subcutaneous injections) in neu- rasthenia, ii, 208. phosphate in progressive myopathic paraly- ' sis, ii, 208. phosphate in sclerosis of the liver, ii, 208. " " sick headache, ii, 208. " (subcutaneous injections) in tabes dorsalis, ii, 208. pyrophosphate. See under Phosphorus (vol. ii, page 79). saccharinate. See under Salicylic acid. salicylate in acute articular rheumatism, ii, 146. salicylate in acute follicular amygdalitis, ii, 146. salicylate in acute glaucoma, ii, 146. " " " infectious diseases, ii, 146. " " cholera infantum, ii, 146. " " diarrhoea, ii, 146. " " dry pleurisy, ii, 146. " " dysmenorrhoea, ii, 146. " " facial neuralgia, ii, 146. " " iritides of gonorrhoea, ii, 146, " " migraine, ii, 146. " " neuralgic affections of peripher- al nerves, ii, 146. salicylate in pertussis, ii, 146. " " pleurisy with effusion, ii, 146, " " rheumatic iritis, ii, 146. " " rheumatism, i, 125. santoninate. See under Santonica. silicates. See under Silicates. silicofluoride, ii, 208. sozoiodolate, ii, 208. " as an intestinal antiseptic, ii, 208. sozoiodolate in diabetes, ii, 208. " " nasal catarrh, ii, 208. " " syphilitic ulcers, ii, 208. " " whooping-cough, ii, 208. sulphate in constipation, ii, 208. " " sluggishness of the liver, ii, 208. sulphite. See under Sulphurous acid. sulphobenzoate, ii, 208. sulphocarbolate. See under Sulphocarbo- lates. sulpholeate (ointment) in skin diseases, ii, 209. sulpholeate as a base for ointments, ii, 209. sulphomethylate, ii. 209. sulphoricinate, sulphoricinoleate. See under Sodium sulpholeate. sulphovinate, ii, 209. Sodium tannate in albuminuria, ii, 259. tartrate in fevers, ii, 209. " " nausea, ii, 209. taurocholate. See Sodium choleate. tellurate, ii, 209. " in night-sweats, ii, 209. tetraborate, ii, 209. thiophene-sulphonate in prurigo, ii, 209. " " " skin diseases, ii, 209. thiosulphate, ii, 209. tumenol sulphonate. See under Tumenol. valerianate, ii, 209. Soja hispida, ii, 209. in diabetes, ii, 209. Solanin, ii, 209. in neuralgia, ii, 209. Solanine. See under Dulcamara. Solanum carolinense, ii, 209. in chorea, ii, 209. " epilepsy, ii, 209. " puerperal eclampsia, ii, 209. " tetanus, ii, 209. dulcamara. See Dulcamara. paniculatum, ii, 210. " in biliary colic, ii, 210. " " catarrh of the bladder, ii, 210. paniculatum in chronic dyspepsia, ii, 210. " " diseases of the liver and of the spleen, ii, 210. Solidago, ii, 210. Solis-Cohen's apparatus for inspiration of con- densed air and expiration into rarefied air, i, 21, 22. pneumatic resistance valves, i, 22, 23. Solphinol, ii, 211. in treatment of wounds, ii, 211. Solution, Boudin's, i, 146. Boulton's, i, 210. De Valangin's, i, 144. Dobell's, i, 210. Donovan's, i, 146. Fowler's, i, 144, 146. Pearson's, i, 146. Solutol, ii, 211. Solvents, ii. 211. Solved, ii, 212. Solvines. See Polysolves. Somatose, ii, 212. in agalactia, ii, 212. " anemia, ii, 212. " cancer of the stomach, ii, 213. " chlorosis, ii, 212. " gastro-enteritis, ii, 212. " irritation of the gastro-intestinal mucous membrane, ii, 212. " mercurial cachexia, ii, 212. '• pericarditis, ii, 212. " phthisis, ii, 212. " typhus fever, ii, 212. " ulcer of the stomach, ii, 212. Somnal, ii, 212. in acute melancholia, ii, 213. " insomnia, ii, 213. Sophora tinctoria. See Baptisia tinctoria i, 160. Soporifics. See Hypnotics. Sorbefacients, ii, 213. Sorbinose. See under Sugar. Sorrel. See Oxalis. GENERAL INDEX. Soy. Soya bean. See Soja hispida. Sozal, ii, 215. in cystitis, ii, 215. " suppurating surfaces, ii. 215. " tuberculous abscesses, ii, 215. Sozoiodol, ii, 215. Sozoiodolate, mercury, in parasitic skin dis- ease, ii, 215. Sozoiodolate, potassium, in suppurating wounds, ulcers, etc., ii, 215. Sozolic acid. See Aseptol. Spanish flies. See Cantharides. Sparteine, ii, 216. in aortic regurgitation, ii, 216. as a heart stimulant in anesthesia, ii, 216. in anasarca, ii. 216. " asthma (of cardiac origin), ii, 216. " diseases of the myocardium, ii, 216. " heart disease, ii, 216. '• measles, ii, 216. " mitral regurgitations, ii, 216. (subcutaneously) in phthisis, ii, 216. in scarlatina, ii, 216. '• stenosis of the mitral valve, ii, 216. Spas. See Waters, mineral. Spasmotin, Spasmotoxine, ii, 216. Spearmint. See Mentha viridis. Species, ii, 217. Specifics, ii, 217. Spermine, ii, 217. in anemia, asthma, chorea, chronic ulcers, diabetes, dyspepsia, locomotor ataxia, neu- ralgia, neurasthenia, ii, 217. in self-poisoning by absorption from the in- testines, ii, 217. " syphilis, ii, 217. " tuberculous disease, ii, 217. Sphacelotoxine. See Spasmotin. Spigelia, fluid extract of, in ascaris lumbri- coides, i, 102. in roundworms, ii, 217. Spinal-cord emulsion. See under Animal ex- tracts and juices (vol. i, page 82.) in rabies, i, 82. Spinants, ii, 217. Spirits, ii, 218. Spleen extract, Splenic extract, i, 81; ii, 218. in constipation, ii, 218. " debility, ii, 218. " dysmenorrhoea, ii, 218. (hypodermically) in Hodgkin's disease, i, 81. (hypodermically) in enlarged spleen, i, 81. in headache, ii, 218. (hypodermically) in leucocythemia, i, 81. in loss of appetite, ii, 218. Sponge, ii, 218. grafting in unhealthy granulating sores, ii, 219. tents, ii, 219. •' (impregnated with vinegar) in post- partum hemorrhage, ii, 219. Sponges and their substitutes, i. 128. Spongiopiline, ii, 103, and see under Poul- tices. Sprays, ii, 219. Springs. See Waters, mineral. Springs, Aachen, ii, 371. Abano and Battaglia, ii, 371. Springs, Abita, ii, 378. Adams, ii, 375. Addison Mineral, ii, 378. ^Etna, ii, 375. Aix-les-Bains, ii, 371, 372, 373. Alburgh, ii, 382. Alcyone, ii, 377. Alhambra, ii, 379. Allandale, ii, 378. Allan's Mineral, ii, 379. Alleghany (Va.), ii, 383. Alleghany, ii, 382. Allen, ii, 375, 378. All-Healing, ii, 381. Alpena Magnetic Well, ii, 378. Alum, ii, 381. Alum Rock, ii, 375. Alum (Va.), ii, 382. Alvenu, ii, 371. Amelie-les-Bains, ii, 373. American Chalybeate, ii, 378. Anderson, ii, 377. Anderson's Mound, ii, 377. Angier's Mineral, ii, 376. Apenta, ii, 417. Apollinaris, ii, 379. Arctic, ii, 384. Arrington, ii, 377. Artesian Mineral Well, ii, 384. Auburn Mineral, ii, 378. Aurora, ii, 379. Avoca, ii, 382. Aztec, ii, 380. Baden, ii, 371. Baden Baden, ii, 373. Bagneres-de-Bigorre, ii, 371. Bagneres-de-Luchon, ii, 371. Bailey, ii, 374. Ballston Spa, ii, 380. Bareges, ii, 371, 372. Bartlett, ii, 375. Bath, ii, 372, 373. Bath Alum, ii, 382. Baxter, ii, 378. Beachville, ii, 378. Beall, ii, 376. Bedford, ii, 378, 381. Bedford Alum, ii, 382, 383. Beersheba, ii, 382. Belknap Hot, ii, 381. Beloit, ii, 384. Bentley, ii, 378. Bethel, ii, 378. Bethesda, ii, 384. Bethlehem, ii, 378. Big Bone Lick, ii. 378. Big Hole Hot, ii, 379. Bigorre, ii, 372. Black Earth Mineral, ii, 384. Black Water, ii, 382. Bladon, ii, 374. Blanchard, ii, 375. Blood, ii, 375. Blossburg, ii, 381. Blount, ii, 374, 382. Blue Grass Sulphur, ii, 374 Blue Lick, ii, 378. Blue Ridge, ii, 383. Blue Sulphur, ii, 384. Bon Air, ii, 382. 526 GENERAL INDEX. Springs, Bonanza, ii, 375. Boothbay Medicinal Mineral, ii, 378. Borland Mineral Well, ii, 384. Botetourt, ii, 383. Boulder Hot, ii, 379. Bourbonne, ii, 372. Bowden Lithia, ii, 376. Bowsher Mineral, ii, 379. Bratton, ii, 379. Bristol Soda, ii, 384. Bruneau Hot, ii, 377. Bryant, ii, 378. Buckingham White Sulphur, ii, 383. Buffalo, ii, 378. Buffalo Lithia, ii, 372. Buffalo Lithia (Va.), ii, 383. Burgher's, ii, 378. Butterworth's Magnetic, ii, 378. Byron, ii, 375. California Seltzer, ii, 375. Campbellsville Sulphur, ii, 378. Camp's, ii, 376. Cannstadt, ii, 372. Canter's Blue Sulphur, ii, 381. Canton Bern, ii, 372. Capon, ii, 383. Cascade Warm Mineral, ii, 383. Castalian, ii, 379. Castalian Mineral Wells, ii, 375. Catoosa, ii, 376. Cauterets, ii, 371. Cedar, ii, 379. Cedar Bluff Sulphur, ii, 383. Central, ii, 377. Cerulean, ii, 378. Chalybeate, ii, 376. Chamberlain, ii, 377. Chandler's, ii, 374. Cherokee, ii, 381. Choteau, ii, 379. Church Hill Alum, ii, 382. Claiborne, ii, 378. Clark's Warm, ii, 379. Clay, ii, 376. Cleveland Mineral, ii, 381. Clifton, ii, 381, 382. Coffee, ii, 374. Cohutta, ii, 376. Coldbrook Mineral, ii, 378. Colfax Mineral, ii, 377. Colorado, ii, 371, 373. Commonwealth Mineral, ii, 378. Congress, ii, 380. Contrexeville, ii, 372. Cooper's Well, ii, 379. Cowhead, ii, 381. Coyner's Sulphur, ii, 383. Cresson, ii, 381. Crusac, ii, 372. Crystal Mineral, ii, 378. Crystal Sulphur, ii, 383. Cullum's, ii, 374. Dalby, ii, 382. Davis's, ii, 378. Dax, ii, 373. Debrell, ii, 383. De Barry, ii, 376. De Gonia, ii, 377. Des Chutes Hot. ii, 381. Doubling Water Lap, ii, 381. Springs, Drennon, ii, 378. Driburg, ii, 372. Dripping, ii, 378. Eaton Rapids Magnetic, ii, 378. Eaux-Bonnes, ii, 371. Eggleston, ii. 383. Eilsen, ii, 371, 372. Elk Lick, ii, 379. Elliston's Sulphur, ii, 378. El Paso de Robles, ii, 375. Enghien, ii, 371. Epperson, ii, 382. Esculapia, ii, 378. Estill, ii, 378. Eureka, ii, 375. Fairview Mineral, ii. 379. Farmville Lithia, ii, 383. Ferrolithic, ii, 376. Fox, ii, 378. French Lick, ii, 377. Friedrickshall, ii, 372. Fruitport Artesian and Magnetic, ii, 378. Fry's Soda, ii, 375. Fulton Wells, ii, 375. Ganymede, ii, 377. Garnet, ii, 376. Gastein, ii, 372. Geuda, ii, 378. Geyser, ii, 375. Gihon, ii, 384. Given's Hot, ii, 377. Glen Alpine Mineral, ii, 375. Glen Flora, ii, 377. Glenn, ii, 384. Glenwood, ii, 373. Gordon, ii, 376. Grand Ledge Magnetic, ii, 378. Grayson, ii, 378. Grayson Sulphur, ii, 383. Gray Sulphur, ii, 384. Great Spirit, ii, 378. Greenbrier White Sulphur, ii, 384. Greene, ii, 374. Green Lawn, ii, 377. Grosswardien, ii, 371. Gum, ii, 375. Hagan's, ii, 383. Harbin, ii, 375. Hardin, ii, 378. Harkany, ii, 371. Ilarriman's Sulphur, ii, 379. Harrison's Mineral, ii, 382. Harrodsburg, ii, 378. Harrogate, ii, 371. Hartford Cold, ii, 378. Hartsville, ii, 377. Hart Well, ii, 384. Hawkins's Chalybeate, ii, 377. Healing, ii, 383. Helena Hot, ii, 379. Herculesbad, ii, 371. Hickman, ii, 378. Highland, ii, 375. Hohenstedt, ii, 371. Hoosier, ii, 376. Hopkinton, ii, 378. Horeb, ii, 384. Hosea Saline Sulphur, ii, 377. Hot, ii, 381. Hot Mud, ii, 375. GENERAL INDEX. 527 Springs, Hot (Va.), ii, 382. Howard, ii, 382. Howell Mineral, ii, 378. Howland, ii, 381. Hubbard Magnetic, ii, 378. Huguenot, ii, 383. Hughes, ii, 382. Humphrey's, ii, 384. Hunter's Hot, ii, 379. Hynson's Iron Mountain, ii, 382. Indian, ii, 376. Inglewood, ii, 379. Inselbad, ii, 372. Iodo Magnesium, ii, 384. Iowa Acid, ii, 377. Iron Ute, ii, 375. Iwanda; ii, 372. Jackson, ii, 381. Jemes Hot, ii, 380. Johnson's, ii, 383. Jordan Alum, ii, 382. Jordan's White Sulphur, ii, 383. Katahdin, ii, 378. Kern's, ii, 382. Kingston, ii, 382. Kreuth, ii, 371. La Fayette, ii, 379. La Fayette Artesian Well, ii, 376. Lake Auburn Mineral, ii, 378. Landreth's Mineral Well, ii, 379. Langenbriicken, ii, 371. Lansing Magnetic Well, ii, 378. Las Cruces Hot, ii, 375. Latonia, ii, 378. Lauderdale, ii, 379. Lawrence Mineral, ii, 376. Lebanon, ii, 380. Lemon, ii, 381. Leslie Magnetic Wells, ii, 378. Leuk, ii, 372. Levico, ii, 369. Lewis, ii, 379. Lick, ii. 375. Lippspring, ii, 372. Lisdoonvarna, ii. 371. Little Chief, ii, 375. Litton's Seltzer, ii, 375. Lodi Artesian, ii, 377. Londonderry Lithia, ii, 379. Loretto, ii, 381. Lubec Saline, ii, 378. Luben, ii, 372. Magnolia, ii, 376. Manitou, ii, 375. Mark West, ii, 375. Matilija Hot, ii, 375. Matthews's Warm, ii, 379. Magnetic, ii, 381. McAllister, ii, 379. Medical Lake, ii, 383. Meinberg, ii, 371. Midland Magnetic Well, ii, 378. Milburn, ii, 377. Millborough, ii, 383. Mill's Mineral, ii, 375. Mineral Wells, ii, 384. Minnequa, ii. 3S1. Mondorf, ii, 372. Monroe Hot, ii, 374. Montesano, ii, 379. Springs, Montgomery White Sulphur, ii, 383. Monticello Hot, ii, 375. Mountain Glen, ii. 375. Mountain Valley, ii, 375. Mount Clemens Mineral, ii, 378. Mount Nebo, ii, 375. Mungel's, ii, 383. Nauheim, ii, 419. Navajoe. ii, 375. Nevada Mineral, ii, 379. Neundorf. ii, 371, 372. Newport Sulphur, ii, 376. New Saratoga (Wisconsin), ii, 384. Newsom's Arroyo Grande Warm, ii, 375. Oak Orchard Acid, ii, 380. Oliver, ii, 382. Olvmpian, ii. 378. Orkney, ii, 383. Owatonna Mineral, ii. 379. Owen's Mineral Well. ii. 378. Paris Chalybeate, ii, 379. Paroquet, ii, 378. Paradise, ii, 378. Pearsons, ii, 375. Pennywits Sulphur, ii, 375. Perry, ii, 377. Pfaffers, ii, 372. Piedmont, ii, 381. Poland, ii, 378. Ponticosa, ii, 371. Powder, ii, 376. Pulaski Alum, ii, 382. Puller's, ii, 379. Pullna, ii, 369, 372. Pystjan, ii, 371. Rawlev, ii, 382. Red Sulphur (W. Va.), ii, 384. Rehme, ii, 372. Reiger, ii, 379. Richfield, ii, 380, River, ii, 378. Roanoke Red Sulphur, ii, 383. Robinson, ii, 382. Rochester, ii, 378. Rockbridge Alum, ii, 362, 382. Rockcastle, ii, 378. Rock Enon, ii, 383. Roneegno, ii, 369. Rosicrucian, ii, 378. Ryan's Hot, ii, 379. Sabree, ii, 378. Saidschiitz, ii, 372. St. Armand, ii, 372. St, Galmier, ii, 372. St. Helena, ii, 375. St. Louis Magnetic, ii, 378. Saint Clair Mineral, ii, 379. Saint-Sauveur, ii, 371. Salubrian, ii, 378. Saratoga, ii, 380, 385. Schmalkalden, ii. 372. Schurznach. ii, 371, 372. Sebastianweiler, ii, 371. Sedlitz, ii. 372. Shannondale, ii, 384. Sharon, ii, 381, 382,_ Shawnee Mineral, ii. 378. Shenandoah Alum, ii, 382. Shoshone, ii, 375. Siloam, ii, 376, 379. 528 GENERAL INDEX. Springs, Silurian, ii, 384. Simmons Hot Sulphur, ii, 375. Soda, ii, 377. Spa, ii, 378. 384. _ Sparta Mineral, ii, 385. Spaulding, ii. 379. Spring Lake Magnetic Well, ii, 378. Stafford, ii, 376. Storm Lake, ii, 377. Strathpeffer. ii, 371. Strontia Mineral, ii, 378. Stryker Mineral Well, ii, 381. Sulphur, ii, 382. Summit Soda, ii, 375. Sweet, ii, 379. Sweet Chalybeate, ii, 383. Tallahatta, ii, 374. Tar, ii, 378. Tarpon, ii, 376. Three, ii, 381. Tolenas, ii, 375. Trenchin-Teplitz, ii, 371. Trinity, ii, 377. Tuscan, ii, 375. Valley View, ii, 383. Van Cleave, ii, 377. Variety, ii, 382. Vernet, ii, 371. Vichy, ii, 375. Vittel, ii, 372. Warasdin, ii, 371. Warm, ii, 373, 376. Warm Sulphur (Va.), ii, 382. Warner's Ranch, ii, 375. Washington, ii, 383. Watson's, ii, 375. Weilbach, ii, 371. Weissenburg, ii, 372. Wesson Iron, ii, 376. White, ii, 376. White Rock, ii, 384. White Sulphur, ii, 374, 375, 376, 378, 379. Wiesbaden, ii, 373. Wilbur, ii, 375. Wildbad, ii, 372. Wildegg, ii, 372. Wildungen, ii, 372. Wilhoit's Soda, ii, 381. Witter's, ii, 375. Wolf Trap Lithia, ii, 383. Wyandotte, ii, 377. Wvandotte White Sulphur, ii, 378. Wytheville, ii, 383. Varapah, ii, 375. Yates Mineral, ii, 378. Yellow Sulphur, ii, 383. Young's, ii, 378. Ypsilanti Mineral Well, ii, 378. Zodiac, ii, 379. Zonian, ii, 377. Spurge. See Euphorbia piluhfera, under Eu- phorbia (vol. i, page 401). Squill, ii, 221. as a stimulant expectorant, i, 418. in acute bronchitis, ii, 221. " asthma, as an expectorant, i, 95. " cardiac dropsy, ii, 221. " chronic bronchitis, ii, 221. " croup, ii, 221. " venous engorgement, i, 345. Squill in weak cardiac action, i, 345. Stannum. See Tin. Staphisagria, ii, 221. as a vulnerary, ii, 221. (decoction) in phtheiriasis, ii, 221. in scabies, ii, 221. in wounds, ii, 221. Star-anise. See Illicium. Starch, ii, 222. (powdered) for intertrigo, ii, 222. in poisoning with bromine, i, 109. " " " copper sulphate, i, 109. " " " corrosive sublimate, i, 109. " " " iodine, i, 109; ii, 222. " " " zinc sulphates, i, 109. iodized, in lupus erythematosus, i, 537. " " scrofula, i, 537. " " tuberculous ulceration, i, 537. Stavesacre. See Staphisagria. Steam, ii, 222. in acne, ii, 222. " acute inflammations of the air-passages. i, 528. " carcinoma of the uterus, ii, 222. " capillary bronchitis of children, i, 528; ii, 220. " catarrhal affections, i, 418. " cervical endometritis, ii, 223. (spray) in chronic bronchitis (dry form), ii, 220. in chronic eczema, ii, 222. " diphtheria, i, 528. " endometritis, ii, 222. " hemorrhage (during operations), ii, 222. " hyperplastic endometritis, ii, 222. " inflammatory conditions of the throat, i, - 469. " laryngeal croup, i, 528. " menorrhagia, ii, 222. " septic puerperal endometritis, ii, 223. of benzoin and paregoric in acute laryngitis, i, 528. superheated, as a caustic, ii, 223. Sterculia, ii, 223. as a heart stimulant, ii, 223. " stimulant to the nervous system, ii. 223. in neurasthenia, ii, 223. Steresol, ii, 223. in diphtheria, ii, 223. Sterilization of catgut sutures, dry method of, i, 128. wet method of, i, 129. Sternutatories, ii, 223. Stibium. See Antimony. Stillingia, ii, 223. in scrofula, ii, 223. " syphilis, ii, 223. Stimulant diuretics, ii, 228. Stimulants, ii, 223. cardiac, ii, 226. general, ii, 224. hepatic, ii, 228. local, ii, 224. spinal, ii, 226. vascular, ii, 227. Stimulation, electrical, in asthma, i, 93. Stoechas. See Lavandula. Stomachics, ii, 228. Storax, ii, 228. GENERAL INDEX. 529 Storax (as an expectorant) in bronchial troubles, ii, 228. in diphtheria, ii, 228. " gonorrhoea, ii, 228. " leucorrhoea, ii. 228. " pseudo-membranous croup, ii, 228. " scabies, ii, 228. liquid, in frostbites, ii, 229. Stramonium, ii, 229. and belladonna in asthma, i, 529; ii, 229. fumigation in spasmodic asthma, i, 430. in convulsive coughs, ii, 229. Streptococcus serum. See under Serum treat- ment. Strontium, ii, 229. bromide as an antemetic, i, 99. " in acute gastritis, ii, 229. " " diabetes, ii, 229. " " epilepsy, ii, 229. " " vomiting of nervous origin, i, 99. carbonate as a dentifrice, ii, 229. iodide, ii, 229. lactate as an intestinal antiseptic, ii, 229. " in acute parenchymatous nephritis, ii, 230. lactate in albuminuria, ii, 229. " " dyspepsia due to an excess of hy- drochloric acid in the gastric juice, ii, 230. lactate in interstitial nephritis, ii, 230. " " mixed nephritis; ii, 230. " " nephritis, ii, 230. " " parenchymatous nephritis, ii, 229, 230. phosphate, ii, 230. salicylate, ii, 147, 230. " as an intestinal antiseptic, ii, 230. " in chronic gouty conditions, ii, 230. salicylate in fermentative changes in the intestines, ii, 147. salicylate in flatulent dyspepsia, ii, 147, 230. " " muscular rheumatism, ii, 147, 230. salicylate in subacute rheumatism, ii, 147, 230. Strophanthidin, Strophanthin. See under Strophanthus. Strophanthus, ii, 230. (hypodermic injection) as a stimulant in aconite poisoning, i, 7. diuretic value of, ii, 231. in angina pectoris, ii, 232. " asthma, ii, 231. " cardiac dropsy, ii, 231. " " dyspnoea, ii, 231. " " troubles, ii, 231. " " weakness, ii, 231. " cerebral anemia, ii, 232. " chlorosis, ii, 232. " collapse, ii, 231. " congestion of the kidneys, ii, 231. « " " lungs, ii, 231. indications for the use of, ii, 231. in exophthalmic goitre, ii. 232. " general anemia, ii, 232. " hemiplegia, ii, 231. " irritable heart when no organic disease of the heart is present, ii, 232. " low fever, ii, 231. Strophanthus in malarial chills, ii, 232. in oedema of the lungs, ii, 231. " pneumonia, ii, 231. " pulmonary tuberculosis, ii, 231. '• renal calculi, ii, 281. " shock, ii, 231. " stenosis, ii, 231. " threatened syncope, ii, 231. " uremia, ii, 231. " urethral chills, ii. 232. " vertigo (of the aged), ii. 232, physiological effects of, ii. 230. Strychnine. See under Nux vomica. (by hypodermic injection) as a stimulant in aconite poisoning, i, 7. in abdominal cramps, i, 28. " alcoholism, acute and chronic, ii, 29. " bronchial asthma, ii, 28. " chorea, ii, 28. " delirium tremens, ii, 7. " diphtheritic paralysis, ii, 28. " dysentery, ii, 28. " dyspnoea of pulmonary affections, ii, 28. " epilepsy, ii, 28. " functional anesthesia, ii, 28. " heart affections, ii, 28. " hemiplegia, ii, 28. " hypochondriasis, ii, 28. (hvpodermically) in hysterical paralysis, ii, 29. in idiopathic tetanus, ii, 28. (hypodermically) in local paralysis, ii, 28. in nervousness, ii, 7. " neuralgia, ii, 28. " " from impaired nutrition, i, 68. " paralysis of the bladder in old people, ii, 28. " prolapsus ani, ii, 28. " snake poisoning, ii, 29. " torpid liver, ii, 28. " urinary incontinence of children, ii, 28. with iron and quinine in anemia, ii, 28. " " " " " chlorosis, ii, 28. Stupes, ii, 232. Stypticin, ii, 233. and hydrastis in congestive menorrhagia, ii, 233. as a hemostatic, ii, 233. in dysmenorrhoea, ii, 233. " fungous endometritis, ii, 233. " hemorrhages due to uterine fibroids, ii, 233. " hemorrhages of the climacteric, ii, 233. " uterine hemorrhage, ii, 233. " " subinvolution, ii, 233. Styptics. See Hemostatics. Styracol, ii, 233. Styrax. See Storax. Styrone, ii, 233. in perforation of Shrapnell's membrane, ii, 234. Succinic acid, ii, 234. Succinum. See Amber. Suerol. See Dulcin. Sudorifics. See Diaphoretics. Suet, ii, 234. Sugar, ii, 284. as an antiseptic, ii, 234. " ecbolic, ii, 55. " oxytocic, ii, 234. 530 GENERAL INDEX. Sugar in ulcers and wounds, ii, 234. in uterine inertia, ii, 234. of milk, ii, 285. Suggestion. See under Hypnotism. Sulphaminol, ii, 236. as an antiseptic, ii, 236. creosote, ii, 286. eucalyptol, ii, 236. guaiacol, ii, 236. in suppurating surfaces, ii, 236. " tuberculous deposits, ii, 236. " wounds, ii, 236. menthol, ii, 236. salicylate in rheumatism, ii, 236. Sulphanilic acid, ii, 236. Sulphates. See under Sulphuric acid. Sulphides. See under Sulphur. Sulphinide. See Saccharin. Sulphites. See under Sulphurous acid. Sulphocarbol. See Aseptol. Sulphocarbolates, ii, 236. in amygdalitis, ii, 236. " diphtheria, ii, 236. " gonorrhoea, ii, 236. " sore throat of scarlet fever, ii, 236. Sulphocyanates, ii, 236. Sulphonal, ii, 236. as a hypnotic, ii, 239. disagreeable effects of, ii, 237. effects of, on the blood-corpuscles, ii, 287. in acute mania, ii, 239. " asthma, ii, 239. " chorea, ii, 239. " chronic opium poisoning, ii, 239. " convulsions due to teething, ii, 239. " delirium tremens, ii, 239. " diabetes, ii, 239. " epilepsy, ii, 239. " hiccough, ii, 239. " insomnia, i, 509. " melancholia, ii, 239. " mental distress, ii, 239. " " excitement, ii, 239. " muscular cramps, ii, 239. " nervous insomnia, ii, 239. " night-sweats of phthisis, ii, 239. " nocturnal enuresis, ii, 239. " pulmonary phthisis, ii, 239. (as a prophylactic) in seasickness, ii, 239. in spasm of the muscles of broken limbs, ii, 239. " trismus neonatorum, ii, 239. " typhoid fever, ii, 239. " vomiting, i, 99. poisoning, ii, 237. Sulphosalicylic acid, ii, 239. in rheumatism, ii. 239. Sulphotumenolic acid. See Tumenol. Sulphur, ii, 239. and cream of tartar in habitual constipation, ii, 241. and cream of tartar in hemorrhoids, ii, 241. " " " " " rectal hemorrhages, ii, 241. and glycerin injections in infectious bone processes, ii. 241. and milk as an anthidrotic, i, 103. as a laxative, ii, 240. effects of, internally, ii, 240. for disordered liver, ii, 240. Sulphur fumes as an antiseptic, ii, 240. fumes in amenorrhoea of functional origin, ii, 241. fumes in chronic skin disease, i, 430. " " eczema, i, 430; ii, 241. " " impetigo, ii, 241. " " neuralgia, i, 430. " " prurigo, ii, 241. " " psoriasis, ii, 241. " " scabies, i, 430. '• " sciatica, i, 430. " " scrofula, ii, 241. " " whooping-cough, ii, 241. in chlorosis, ii, 240. " chronic bronchitis, ii, 240. " colic due to impaction of a gallstone, ii, 240. " cystitis, ii, 240. " derangement of the menses, ii, 241. " diseases of the nails, ii, 241. " eczema seborrhoicum, i, 116. " gout, ii, 241. " muscular rheumatism, ii, 241. " pyelitis, ii, 241. " rheumatism, ii, 241. " sciatica, ii, 241. " skin disease, ii, 241. " tuberculous joints, ii, 241. " osteomyelitis, ii, 241. (locally) in ulcerative stomatitis, ii, 241. ointment in acne, ii, 241. " " alopecia areata, ii, 241. " erysipelas, ii, 241. " " measles, ii, 241. " (with sulphur baths) in psoriasis, ii, 241. ointment in scabies, ii, 241. " small-pox, ii, 241. " (with sulphur baths) in sycosis, ii, 241. ointment (with sulphur baths) in tinea versi- color, ii, 241. powder (by insufflation) in ctoud, ii, 241. " diphtheria, ii, 241. " in lumbago, ii, 241. waters in gout, i, 126. " " rheumatism, i, 126. Sulphuric acid, ii, 242. and asbestos in treatment of chancres, ii, 242. " charcoal " " " " j{' o^l. " saffron " " " " [{040] in cholera, ii, 242. " colliquative sweating, ii, 242. " diarrhoea, ii, 242. " hemorrhages, ii, 242. Sulphurous acid, ii, 243. as an antiseptic, ii, 243. " a germicide, ii, 243. in fermentative dyspepsia, ii, 243. " hay fever, ii, 243. " tinea versicolor, ii. 243. Sumach berries. See R11 us glabra. Sumach, sweet. See Rhus aromatica Sumbul, ii, 243. as a germicide, i, 443. as a nervous stimulant, ii, 243. in asthenia, ii, 243. " asthenic diarrhoea, ii, 243. " cholera, ii, 243. " chronic bronchitis, ii, 243. GENERAL INDEX. 531 Sumbul in delirium tremens, ii, 7; ii, 243. in dysentery, ii, 243. " hysteria, ii, 243. " nerve exhaustion, ii, 7. " neurasthenia, ii, 243. Suppositories, ii, 243. Suprarenal capsule, ii, 244. as a hemostatic, ii, 246. " an astringent, ii, 246. in Addison's disease, ii. 245. " conjunctivitis, ii, 247. " diseases of the eye, ii, 246, 247. " glaucoma (secondary to cataract extrac- tion), ii, 247. " hemorrhage, ii, 247. " interstitial keratitis, ii, 246. " iritis, ii, 247. " neurasthenia, ii, 245. physiological action of, ii, 244. Sweet oil. See Olive oil. Syinphorol, ii, 247. as a diuretic, ii, 247. Symptomatic treatment, ii, 247. Synergists, ii, 250. Synovial extract, ii, 251. in rheumatoid arthritis, ii, 251. Syrups, ii, 251. fruit, ii, 252. of cherries, ii, 252. preservation of, ii, 251. Syzygium Janibolanum. See Jambul. Tabacum. See Tobacco. Tabelle, ii, 252. Table of antagonistic poisons, i, 89. Tablet triturates, ii, 252. Tablets, ii, 252. compressed, ii, 258. hypodermic, ii, 253. moulded, ii, 252. Tabloids, ii, 254. Taka-diastase, ii, 254. in amylaceous dyspepsia, ii, 254. Talc, ii, 54. powder in eczema, ii, 254. in intertrigo, ii, 254. Tallow, ii, 254. Tamarind, ii, 254. as a laxative, and in fever, ii, 254. Tanacetum. See Tansy. Tannal, ii, 254. in laryngeal, nasal, and pharyngeal catarrh, ii, 254. Tannalbin, ii, 254. in chronic intestinal catarrh, ii, 254. " " renal disease, ii, 255. " diarrhoea, ii, 254. " subacute intestinal catarrh, ii, 254. " tuberculous ulceration of the bowel, ii, 255. " ulcerative enteritis, ii, 254. Tannate, basic aluminum, ii, 254. Tannic acid, ii, 255. and antipyrine in hemorrhages, ii, 257, as a germicide, i, 447. " local hemostatic, ii, 257. " styptic, ii. 257. in burns, ii, 257. '• hematuria, ii, 257. '■ hyperidrosis of the hands and feet, ii, 257. " menorrhagia, ii, 257. Tannic acid in offensive axillary sweating, ii, 257. in passive hemorrhage from the stomach and intestines, ii, 257. " poisoning with digitalis, i, 86,108. " uterine hemorrhage, ii, 257. ointment in abrasions and excoriations, ii, 257. ointment in corns, ii, 257. " " external or prolapsed hemor- rhoids, ii, 259. ointment in impetigo, ii, 256. " " indolent ulcers, ii, 259. " " intertrigo, ii, 256. solution and glycerin in diseases of the ton- sillar follicles, i, 446. solution in diseases of the nose and throat, i, 446. Tannigen, Tannigene. ii, 259. in acute coryza, ii, 260. " " enteritis, ii, 260. " " otitis media, ii, 260. " chronic caryza, ii, 260. " " diarrhoea, ii, 260. " dysentery, ii, 260. " gastro-enteritis, ii, 260. " hay fever, ii, 260. " laryngitis, ii, 260. " pharyngitis, ii, 260. " subacute diarrhoea, ii, 257. " summer diarrhoea (of children), ii, 260. Tannin. See Tannic acid. albuminate. See Tannalbin. and alum douche in gonorrhceal elytritis, ii, 256. and iodine in vegetable poisoning, i, 109. as an antidote to tartar-emetic poisoning, ii, 256. glycerite of, in hypertrophied tonsils, ii, 256. in albuminuria, ii, 257. (solution) in aphthous ulcers, ii, 256. in atonic dyspepsia, ii, 257. " bronchitis, ii, 257. (Cantani's treatment) in cholera, ii. 257. in chronic coryza, ii, 256. " diarrhoea, ii, 257. " diarrhoea, ii, 257. " eczema, ii, 256. " epistaxis, ii, 256. (solution) in excoriations of the anus, ii, 256. " " " '• " scrotum, ii, 256. (solution) in fissures of the anus, ii, 257. in hemophilia, ii, 257. " hemoptysis of pulmonary tuberculosis, ii, 257. (solution) in inflammation of the eyelids, ii, 256. injections in chronic urethritis, ii, 256. " " elytritis (of gonorrhoea), ii, 256. " " gonorrhoea, ii, 256. " " vesical catarrh, ii, 256. in night sweats, ii, 257. " phthisis, ii, 257. (internally), ii, 257. (solution)"in sore nipples, ii, 256. " " stomatitis, ii, 256. in threadworms, ii, 257. (locally), ii, 256. I suppositories in hemorrhoids, ii, 256. 532 GENERAL INDEX. Tannin suppositories in prolapse of the rec- tum, ii, 256. (strong solution) in suppurating sinuses, ii, 256. tampons in cystocele, prolapsus uteri, and proctocele, ii, 256. Tannoform, ii, 260. in diarrhoea and dysentery, ii, 260. (locally) in excessive sweating, ii, 260. in hyperidrosis of the feet, ii, 260. ointment in old wounds, ulcers, and moist eruptions, ii, 260. powder in diabetic pruritus vulve, ii, 260. (as a snuff) in ozena, ii, 260. in soft chancre, ii, 260. Tanosal, ii, 260. in catarrh of the throat and bronchi, ii, 261 " chronic bronchitis, ii, 261. " " broncho-pneumonia, ii, 261. " tuberculosis, ii, 261. Tansy, ii, 261. as a vermifuge, ii, 261. in hysteria, ii, 261. " intermittent fever, ii, 261. " rheumatism, ii, 261. Tapioca, ii, 261. Tar, ii, 261. beech, ii, 262. camphor, ii, 1. coal, ii, 262. in eczema (scaly forms), ii, 92, 263. " lupus, ii, 92. " psoriasis, ii, 92. " putrid sores (as a disinfectant), ii, 263. inunctions in psoriasis, ii, 263. in scabies, ii, 263. " tinea capitis, ii, 92. Russian, ii, 262. tincture of, ii, 264. vapour in chronic inflammation of the re- spiratory tract, i, 529. vapour in pulmonary troubles, ii, 262. water in itching of the scalp, ii, 263. " " prickly heat, ii, 263. wood, ii, 264. powder, ii, 264. Taracanin. See under Blatta. Taraxacerin, ii, 264. Taraxacin, ii, 264. Taraxacum, ii, 264. as an hepatic stimulant, ii, 265. in atonic dyspepsia, ii, 265. " chronic congestion and inflammation of the liver and spleen, ii, 265. '• constipation, ii, 265. " pulmonary phthisis, ii, 264. Tartar, cream of, ii, 265. emetic, ii, 265. " (by injections) for bodies impacted in the oesophagus, i, 112. ointment as a counter-irritant, i, 114. Tartaric acid, ii, 265. Tartarlithine, ii. 265. in eczema, ii, 265. " excess of uric acid in the blood, ii, 265. " gout, ii, 265. " torpor of the liver, ii, 265. Tartarus boraxatus, ii, 265. depuratus, ii, 265. natronatus, ii, 265. Tartarus stibiatus, ii, 265. Tartrate, aluminum tannic, ii, 254. Tea, ii, 265. Abyssinian, ii, 268. action of, on the system, ii, 269. as a beverage, ii, 266, 267. boneset, as a diaphoretic in colds and fevers, ii, 269. boneset, cold, in dyspepsia, general debility, etc., ii, 269. Brazilian, ii, 268. brick, ii, 268. Bush, ii, 269. catnip, in amenorrhoea, ii, 269. " " anemia, ii, 269. " " chlorosis, ii, 269. chronic, intoxication, ii, 267. coffee, ii, 268. elderberry, ii, 269. Garfield, ii, 269. German breast, in coughs, colds, and bron- chial affections, ii, 269. Hamburg, ii, 269. Honig, ii, 269. hot, as a diaphoretic in fevers, rheumatism, bronchitis, etc., ii, 268. hot, for relief of fatigue, ii, 268. in cardiac depression, ii, 268. " narcotic poisoning, ii, 268. Jesuit's, ii, 268. Labrador, ii, 269. lie, ii, 268. linseed, as a laxative enema, ii, 269. " sedative in coughs, ii, 269. " in cystitis, ii, 269. " " dysentery, ii, 269. " inflammations of the respiratory, gastro-intestinal, and urinary mucous membranes, ii, 269. linseed, in renal colic, ii, 269. " " strangury, ii, 269. marsh, ii, 269. " in skin diseases, ii, 269. marshmallow, ii, 269. method of drying, ii, 266. Mexican, ii, 269. New Jersey, ii, 269. Oswego, ii, 269. peppermint, ii, 269. saffron, as a diaphoretic in the exanthemata, ii, 269. spearmint, ii, 269. St. Bartholomew's, ii, 268. tansy, as an anthelminthic, ii, 269. " emmenagogue, ii, 269. " irritant narcotic, ii, 269. " in amenorrhoea, ii, 269. thoroughwort, ii, 269. warm, ii, 269. " in roundworms, ii, 269. reaberry. See Gaultheria. Teas, ii, 268. Teel oil. See Sesame oil. Tents, ii, 269. laminaria, ii, 270. manner of introducing, ii, 270 sponge, ii, 270. sterilization of, ii, 270 tupelo, ii, 270. Terebene, ii, 270. GENERAL INDEX. 533 Terebene and olive oil (locally) in sloughing carcinoma of the cervix uteri, ii, 271. as an antiseptic, i, 529. " expectorant, ii, 271. in acute bronchitis, ii, 271. " asthma, i, 97 ; ii, 271. " bronchiectasis, ii, 271. (as a dressing) in burns, ulcers, and wounds, ii. 271. in chronic bronchitis, ii. 271. " " rhinitis, ii, 271. " emphysema, ii, 271. " flatulence, ii, 271. " foetid bronchitis, ii, 271. " hemoptysis, ii, 271. " phthisis, ii, 271. " pleurisy, ii, 271. " pleuritic adhesions, ii, 271. " pleuro-pneumonia, ii, 271. (inhalation) in pulmonary tuberculosis, i, 529. in subacute inflammations of the genito-uri- nary tract, ii, 271. " winter cough of chronic bronchitis, ii, 271. Terebinthina. See Turpentine. Terpin hydrate, ii, 271. in acute bronchitis, ii, 272. " chronic bronchitis, ii, 272. " " cystitis, ii, 272. " " diffuse nephritis, ii, 272. " " disease of the heart and kidneys, ii, 272. " chronic nephritis, ii, 272. " flatulence, ii, 272. " gonorrhoea, ii, 272. " hay fever, ii, 272. " whooping-cough, ii, 272. Terpinol, ii, 272. in chronic bronchitis, ii, 272. " respiratory diseases, ii, 272. Testa preparata, ii, 272. __ Testicle juice, Testicular liquid^ i, 73; n, 2/2. Testicular liquid in cancer, i, 75. in chorea, i, 75. " diabetes mellitus, i, 75. " epilepsy, i, 76. " leprosy, i, 75. " locomotor ataxia, i, 74. " neurasthenia, i, 76. " skin diseases, i, 75. " tuberculosis, i, 74. Tetanus antitoxine, ii, 272. Tetrabromide. See under Thiophene. Tetraethylammonium. See Tetrethylammo- nium. ^ Tetrahydrobetanaphthylamine. See 1 her- mine. Tetrahydroparaquinanisol. See Thalline. Tetraiodopyrrhol. See Iodol. Tetraiodphenolphthalein. See Nosophene. Tetrethylammonium, ii, 272. as a solvent for urea and uric acid, n, 2,2. in acute and chronic rheumatism, 11,273.^ " gouty joints or rheumatic tophi, ii, 273. Tetronal,'ii, 273. . . (as a sedative hypnotic) in insomnia due to nervousness or restlessness, ii, 273. in sleeplessness of the acute infectious dis- eases, ii. 273. Teucrin, ii, 273. in actinomycosis, ii, 273. Teucrin in cold abscess, ii, 273. in lupus vulgaris, ii, 273. " tuberculous adenitis, ii, 273. Teucrium, ii, 273. Thallasotherapy, ii, 273. Thalline, ii, 275. in hyperpyrexia, ii, 276. injections (as an antiseptic) in gleet and gonorrhoea, ii, 276. in tuberculosis, ii. 276. " typhoid fever, ii, 276. Thapsia, ii, 276. Thea. See Tea. Theine, ii, 276. as an analgetic and local anesthetic, ii, 276. (for relief of pain) in locomotor ataxia, ii, 277. in lumbago, ii, 277. '• myalgia, ii, 277. " neuralgia, ii, 277. " neuralgic pain, ii, 277. ' " sciatica, ii, 277. Theism, ii, 267. Theobroma. See Cacao butter. Theobromine, ii, 277. as a diuretic, ii, 277. in anasarca of Bright's disease, ii^ 277. " dropsy of cardiac origin, ii, 277. Therapol, ii, 277. Theriaca. See Treacle. Thermifugin, ii, 277. Thermine, ii, 277. as a mydriatic, ii, 277. Thermodine, ii. 278. Thialdin, ii, 278. as a heart stimulant, ii, 278. Thilanin, ii, 278. Thiocamphor, ii, 278. Thioform, ii, 278. (internally) in acute enteritis, ii, 278. in burns, ii, 278. " conjunctivitis, ii, 278. " purulent otitis media, ii, 278. " ulcerated surfaces, ii, 278. " ulcer of the cornea, ii, 278. " " " " leg, ii, 278. Thiol, ii, 278. ointment in eczema, erysipelas, erythema, inflammatory deposits, lupus, and ulcers, ii, 278. solid, in treatment of burns, ii, 278. Thiolin, Thiolinic acid, ii, 278. Thiooxydiphenylamine. See Sulphaminol. Thiophene, ii, 279. diiodide as an antiseptic, ii, 279. Thioresorcin, ii, 279. Thiosalicylic acid. See Sulphosalicylic acid. Thiosaprol, ii, 279. in skin diseases, ii, 279. Thiosinamine, ii, 279. in ankylosis (of the knee), ii, 281. " cicatrices, ii. 280. 281. " corneal opacities, ii, 280, 281. " ectropion, ii, 281. " glandular swellings, ii, 280. injections in keloid, ii, 281. in lupus, ii, 279. 280. '• erythematosus, ii, 280. " " vulgaris, ii, 280. _ " malignant neoplasms, ii, 281. 534 GENERAL INDEX. Thiosinamine in neoplasms, ii, 279, 280. in serous exudations, ii, 280. " stricture of the urethra (cicatricial), ii, 280. " stricture of the urethra or rectum, ii, 281. " talipes equinus, ii. 281. " ulcer of the leg, ii, 280. " uterine myomata, ii, 281. Thiosulphates. See Hyposulphites. Thiuret, ii, 281. Thorn apple. See Stramonium. Thoroughwort. See Eupatorium. Thuja in malarial fevers, ii, 282. in rheumatism, ii, 282. Thus Americanum. See Olibanum. Thymacetine, ii, 282. as a hypnotic, ii, 282. " an analgetic, ii, 282. in nervous headaches, ii, 282. physiological effects of, ii, 282. Thyme, ii, 282. as a carminative, ii, 282. " stimulant, ii, 282. Thymol, ii, 282. and gallic acid in chyluria, ii, 283. as a germicide, i, 448. " teniacide, ii, 284. in abnormal fermentative processes in the alimentary tract, ii, 283. " acne, ii, 284. " acute articular rheumatism, ii, 283. " " intestinal disorders, ii, 283. (as an anthelminthic) in ankylostomiasis, ii, 284. in atrophic rhinitis, ii, 283. " chronic intestinal disorders, ii, 283. " diabetes, ii, 283. " eczema, ii, 284. " erosions of the os uteri, ii, 284. " favus, ii, 284. " inflammation of the dental pulp, ii, 284. inhalation in bronchitis, ii, 283. " diseases of the upper air-pas- sages, ii, 283. in headaches, ii, 283. " laryngitis, ii, 284. " leucorrhoea, ii, 284. " offensive lochia, ii, 284. " pharyngitis, ii, 284. " phthisis, ii, 283. " pityriasis, ii, 284. " pruritus, ii, 284. " psoriasis, ii, 284. " purulent rhinitis of children, ii, 283. " ringworm of the scalp, ii, 284. " tympanites, ii, 283. " typhoid fever, ii, 283. " whooping-cough, ii, 283. physiological action of, ii, 283. Thymus extract, Thymus feeding, ii, 284. extract in dyspnoea, ii, 285. in palpitation, ii, 285. " tremors, ii, 285. " typhoid fever, ii, 285. Thyraden, ii, 287. Thyreoantitoxine, ii, 287. Thyreoid extract, Thyreoid feeding, Thyreoid gland, Thyreoid medication, Thyreoid treatment, i, 76; ii, 287. extract, dose and administration of, i, 80. " in dermatitis exfoliativa, i, 79. Thyreoid extract in exophthalmic goitre, i, 78. extract in ichthyosis, i. 79. " insanity, i, 79 ; ii, 296. " myxcedema, i, 76, 77, 78; ii, 289. '• " obesity, i, 79; ii, 295. " " psoriasis, i, 79; ii, 292. " " skin diseases, i, 79 ; ii, 293. " syphilis, i, 79; ii, 295. " " xeroderma, i, 79. treatment, administration of the. ii. 289. " for checking the growth of the foetus in utero, ii, 299. treatment, history of the origin of, ii, 288. " in acromegaly, i, 80 ; ii. 295. " " anemia, i, 80; ii, 295. " " " obesity, ii, 295. " " catalepsy, ii, 298. " " catatonia, ii, 299. " " circumscribed sclerodermia, ii, 293. treatment in cretinism, i, 78; ii, 290. " " deformity of the nails, ii, 292. " eczema, i, 79 ; ii, 293. " " epilepsy, ii, 292. " " fibrous tumours of the uterus, ii, 298. treatment in general paresis, ii, 291. " " goitre, ii, 297. " " leprosy, ii, 295. " " lupus, ii, 294. " melancholia, ii, 299. " " myopathy, ii, 298. " " primary "dementia, ii, 291. " puerperal insanity, ii, 291. " secondary dementia, ii, 291. " stunting of the growth, ii, 300. " stuporous insanity, ii, 299. " suicidal melancholia, ii, 291. " tetany, ii, 298. Thyreoiodine, Thyreoiodinin, ii, 300. in cretinism, ii, 302. " ichthyosis, ii, 302. " infantile cretinism, ii, 302. " lupus, ii, 302. " myxcedema, ii, 302. " psoriasis vulgaris, ii, 302. " sclerodermia, ii, 302. " sporadic cretinism, ii, 302. " xerodermia, ii, 302. Thyreoprotein, ii, 303. Tiglium. See Croton oil. Tin, ii, 303. Tinctures, ii. 303. Tobacco, ii, 304. enema in impaction of feces, ii, 304. in intussusception, ii, 305. " painter's colic, ii, 305. " strychnine poisoning, ii, 305. " tetanus, ii, 305. Toddalia, ii, 308. in chronic diarrhoea, ii, 308. " convalescence from fevers, ii, 308. (as a tonic) in general debility, ii, 308. Tokay, ii, 308. (as a tonic) in debility of convalescence, ii, in influenza, ii, 308. " neurasthenia, ii, 308. Tolu balsam, ii, 308. in catarrh of the bronchial apparatus, ii, 309. GENERAL INDEX. 535 Tolu balsam in chronic bronchitis, ii, 309. in chronic diarrhoea, ii, 309. " dysentery, ii, 809. " mucous fluxes of the bronchi, ii, 309. " chronic mucous fluxes of the urinary or- gans, ii, 309. " skin diseases, ii, 309. " suppurating and inflamed areas, ii, 309. Toluene, Toluidine, Toluol, ii, 309. in diphtheria, ii, 309. Tolylantipyrine. See Tolypyrine. Tolylhypnal, ii, 309. Tolypyrine, ii, 309. (as an analgetic and antipyretic) in rheuma- tism and in neuralgia (rheumatic), ii, 309. Tolysal, ii, 309. Tonga, ii, 309. in neuralgia, ii. 309. Tongaline, ii, 309. in gout, influenza, nervous headache, neu- ralgia, and rheumatism, ii, 309. Tongue traction. See under Anesthetics (vol. i, page 64). Tonics, ii, 309. gastric, ii, 310. general, ii, 310. nervous, ii, 310. specific, ii, 810. vascular, ii, 310. Tonquinol, ii, 310. Tormentilla, ii, 311. in diarrhoea and dysentery, ii, 311. Touchwood, ii, 311. Toxalbumins. See Toxines. Toxicodendron, ii, 311. Toxicological antagonism, i, 87. Toxines, ii, 311. in anthrax, ii, 315. " cancer, ii, 315. " carcinoma, ii, 313. " erysipelas, ii. 313. " "inoperable " sarcoma, ii, 311. " sarcoma, ii, 312, 314. (mixed) in syphilis, ii, 316. in tumours, ii, 313. local and constitutional effects of the, ii, 312. method of preparing, ii, 311. result of cases treated by Dr. Coley with, ii, 313. Tragacanth, ii, 316. Transfusion and infusion, ii. 316. depletory (Landois's), ii, 828. " in asphyxia, ii, 323. " " neonatorum, ii, 323. " cholemia, ii. 323. " " puerperal eclampsia, ii, 323. " " uremia, ii, 328. direct and indirect, ii, 318-320, 326, 327. hypodermic, ii, 323. in acute aiurmia, ii, 322. " •' infectious diseases, ii, 323. " ana'mia, ii, 322. " cachexia, ii, 323. " chlorosis, ii, 322. " cholera, ii, 823. indications for performing, ii. 322. in hemorrhage from traumatism, ii, 322. " inanition, ii, 823. " pernicious anemia, ii, 323. Transfusion and infusion in pyemia, ii, 323. in septicemia, ii. 323. " severe burns, ii, 323. " small-pox, ii, 323. (with lamb's blood) in typhoid fever, ii, 323. nervous, ii, 328. (Baccelli's method) of mercury in syphilis, ii, 322. peripheral, in freezing of the extremities, ii, 323. reciprocal, ii, 328. rectal, ii, 325. (von Ziemssen's method), ii, 320, 323. Traumaticin, ii, 328. and calomel (locally) in syphilis, ii, 329. as a solvent for drugs employed in skin dis- eases, ii, 329. in abrasions or slight excoriations, ii, 328. " cutaneous eruptions and fissured lips, ii, 328. (as a protective) in superficial injuries or in- flammations, ii, 828. Traumatol, ii, 329. as an antiseptic, ii, 329. in eczema, ii, 32!). " endometritis, ii, 329. " metritis, ii, 829. " varicose ulcers, ii, 329. " soft chancres, ii. 329. " vaginal gonorrhoea, ii, 329. " wounds, ii, 329. Treacle, ii, 8,29. whey in colds, ii, 329. Trefusia, ii, 829. in anemia and chlorosis, ii, 329. Tribromacetyl oxide. See Bromal. Tribromaldehyde. See Bromal. Tribromaniline hydrobromide. See Broma- mide. Tribromhydrin, ii, 330. as a stimulant expectorant, ii, 330. in acute bronchitis, ii, 330. " angina pectoris, ii, 330. " asthma, ii, 330. " chronic bronchitis, ii, 330. " convulsions of infancy, ii, 330. Tribromomethane. See Bromoi orm. Tribromphenol. See Bromol. Tribromsalol, ii. 330. as an intestinal antiseptic, ii, 330. Tribulus lanuginosus, ii, 830. in colic, ii, 330. " gonorrhoea, ii. 330. " dyspnoea, ii, 330. " spermatorrhoea, ii, 330. " urinary irritation, ii. 330. Trichloracetic acid, ii, 330. in enlarged tonsils, ii, 330. Trichlorphenol, ii, 330. applications in erysipelas, ii, 330. in dysentery, ii, 880. " foul ulcers, ii, 330. " leucorrhoea, ii, 330. Tricresol, ii, 330. inhalation in diseases of the respiratory passages, ii, 331. Tricresolamine, ii, 330. Trifolium fibrinum, ii, 331. Triformal. See Formaldehyde. Triformol, ii, 331. 536 GENERAL INDEX. Triiodometacresol. See Losophan. Trikresol. See Tricresol. Trimethylamine, ii, 331. in acute rheumatism, ii. 331. Trimethylethylene. See Pental. Trinitrin. See Nitroglycerin. Trinitrocellulose. See Piiotoxylin. Trinitrophenol. See Picric acid. Trional, ii, 331. as a hypnotic, ii, 331. for functional psychoses, ii, 332. in chorea, ii, 333. " delirium, i, 509. " dysmenorrhoea, ii, 333. " insomnia, i, 509; ii, 332. " " of dentition and indigestion, ii, 333. (for insomnia) in neurasthenia, ii, 332. in opium poisoning, ii, 332. " organic brain disease, ii, 332. " pavor nocturnus, ii, 333. poisoning by, ii, 382. Trioxybenzol. See Gallacetophenone. Trioxymethylene. See Paraform. Triphenine, ii, 333. Triticum, ii, 333. in cystitis, ii, 333. " gonorrhoea, ii, 333. Triturates, tablet, ii, 252. Troches, ii, 333. Tropacocaine, ii, 333. as a local anesthetic, ii, 334. in keratitis, ii, 334. Trypsin, ii, 334. applications in diphtheria, ii, 334. (as a solvent) in diphtheritic membrane, ii, 334. Tuberculin, i, 81; ii, 334. dose of, i, 82. in lupus, i, 81. " tuberculosis, i, 81. Tuberculocidin, ii, 334. Tumenol, ii, 334. oil and oxide of zinc in impetigo pemphigus and superficial ulcerations, ii, 334. -sulphonic acid in acute recurrent eczema of the hands and face, ii, 334. tincture in itching of eczema and prurigo, ii, 334. Turmeric, Turmerol. See under Curcuma. Turpentine, ii, 334. and olive-oil enema after coeliotomy, ii, 335. " milk of asafcetida enema in meteorism from functional causes, ii, 335. as a rubefacient, ii, 335. Canada, ii, 335. Chian (locally and internally), in cancer, ii, 335. " inflammatory processes, ii. 335. injections, rectal, in narcotic poisoning, ii, 335. in parasitic diseases of the scalp, ii, 335. " rheumatism, ii, 335. liniment in burns, ii, 335. " " " and scalds, ii, 336. " " carbuncles, ii. 336. " " eczema, ii, 335. " " erysipelas, ii, 835. " " furuncles, ii, 336. " " local gangrene, ii, 335. Turpentine oil, ii, 335. oil as a hemostatic, ii, 336. " " vermifuge, ii, 887. " baths of the vapour of, in chronic rheu- matism, ii, 336. " in amenorrhoea, ii, 336. " " ascarides, ii, 336. " (internally) in bronchitis, i, 418; ii, 336. " in chronic pyelitis, ii, 336. " " " urethritis, ii, 336. " " cystitis, ii, 336. " " erysipelas (of traumatic origin), ii. 336. " " hemorrhage following the extraction of teeth, ii, 336. " in impotence, ii, 336. " " incontinence of urine, ii, 336. " (internally) in low fevers, ii, 335. " in lumbago, ii, 336. " (locally) in neuralgia, ii, 336. " in phosphorus poisoning, ii, 336. " (internally) in pneumonia, ii, 336. " in post-partum hemorrhage, ii, 336. " (locally and internally) in puerperal fever, ii, 336. " (inhalation) in pulmonary tuberculosis, i, 529. " in sciatica, ii, 336. " " scurvy, ii, 337. " " spermatorrhoea, ii, 336. " " tenia, i, 102 ; ii, 336. " (internally) in typhoid fever, ii, 335. " " ' " ulcerative processes of the intestines and stomach, ii, 335. " in whooping-cough, ii, 336. " vapour of, in asthma, ii, 336. " '• " foetid bronchitis, ii, 336. " " " " gangrene of the lungs, ii, 336. " vapour of (thrown on the bedclothes), in scabies, ii, 336. stupes as a counter-irritant, ii, 335. " in bronchitis, ii, 335. " " peritonitis, i, 312; ii, 335. Turpeth mineral, ii, 337. Tussilago, ii, 337. Tussol, ii, 337. in whooping-cough, ii, 337. Tutty. See under Zinc. Tylophora, ii, 337. as a diaphoretic, emetic, and expectorant, ii, 337. in asthma, ii, 337. " dysentery, ii, 337. Tylophorine, ii, 337. Ulexine, ii, 337. as a diuretic, ii, 337. in cardiac dropsy, ii, 337. Ulmus, ii, 337. in diarrhoea, ii, 337. " dysentery, ii, 887. " inflammatory cutaneous affections, ii, 338. Ulyptol. See Eulyptol. Unguents. See Ointments. Ural, ii, 338. in functional and organic mental disease, ii, 338. " insomnia of chronic heart disease, ii, 338. " nervous conditions, ii, 338. Uraline, Uralium, Uralum, ii, 338. GENERAL INDEX. 537 Uranium, ii, 338. nitrate, ii, 888. in diabetes mellitus, ii, 338. " " treatment of diabetes, ii, 338-342. Urethane, ii, 342. as a hypnotic and sedative, ii, 342. in acute mania, ii, 342. " delirium tremens, ii, 342. " functional disturbances and organic dis- eases of the brain, ii, 842. " insomnia, ii, 342. " tetanus, ii, 342. Uricedin, ii, 342. in gout, ii, 342. " uric-acid diathesis, ii, 342. Uropherine, ii, 342. as a diuretic, ii, 342. Urotropine, ii, 342. as a diuretic, ii, 343. in cystitis, ii, 343. " gouty and rheumatic conditions, ii, 343. " suppuration of the urinary tract, ii, 343. " uric-acid calculi, ii, 343. " " diathesis, ii, 343. Urtica, ii, 343. as a diuretic and hemostatic, ii, 343. in rhus poisoning, ii, 343. " uterine hemorrhage, ii, 343. Ustilago maidis. See Ergot of Maize (vol. i, page 389). Uve, ii, 343. Uva ursi, ii, 343. as a diuretic, ii, 343. " an astringent, ii, 343. " a tonic, ii, 343. in chronic cystitis, ii, 343. " diarrhoea (later stages), ii, 343. " gleet, ii, 343. " pyelitis, ii, 343. Vaccinin, ii, 344. Vaccinium, ii, 344. as an astringent, antiscorbutic, detersive, and refrigerant, ii, 344. in acute rheumatism, ii, 344. " chronic articular rheumatism, ii, 344. " eczema, ii, 458. " mycosis flexurarum, ii, 458. " mycotic eczema, ii, 458. " occupation eczema, ii, 458. " rheumatism, ii, 344. " seborrhoeal eczema of the face and hands in children, ii, 458. Valerian, ii, 344. as a general stimulant, ii. 345. " an antispasmodic, ii, 345. " a sedative to the nervous system, ii, 345. in chorea, ii, 345. " coma of typhus fever, ii, 345. " convulsions, ii, 345. " cough of nervous origin, ii, 345. " delirium with depression, ii, 345. " flatulence of infants, ii, 345. " hysteria, ii, 345. '• hystero-epilepsy, ii, 345. " insomnia of hysteria, ii, 345. " nervous disorders dependent upon intes- tinal parasites in children, ii, 345. " nervous excitement, ii. 345. " " headache, ii, 345. Valerian in nervous phenomena of exophthal- mic goitre, ii, 345. in nervousness of the menopause, ii, 345. " petit mal, ii, 345. " pruritus of neurotic origin, ii, 345. " whooping-cough, ii, 345. Valerianate, ammonium, in headache, insom- nia, neuralgia, and palpitation of the heart, ii, 346. amyl. See vol. i, page 62. antipyrine, ii, 346. atropine. See vol. i, page 157. bismuth, ii, 346. caffeine, as a general stimulant, ii, 346. " in hysteria, ii, 346. " nervous vomiting, ii, 346. " whooping-cough, ii, 346. cerium, in vomiting of pregnancy, ii, 346. creosote, ii, 346. iron, ii, 346. " in anemia, ii, 346. " " chlorosis, ii, 346. " " hysterical symptoms, ii, 346. morphine, ii, 346. quinine, ii, 346. " in hysteria and nervousness, ii, 347. sodium, in functional derangements of the nervous system, ii, 347. zinc, in hay fever, ii, 347. " " incontinence of urine from a neurotic cause, ii, 347. zinc, in neuralgia, ii, 347. Valerianates, ii, 346. Valerianic acid. See under Valerian and Vi- burnum prunifolium. Valerol. See under Valerian. Valzin. See Dulcin. Vanilla, ii, 347. Vanillic aldehyde, Vanillin, ii, 347. Vapours, ii, 347. moist, ii, 348. Varnishes, ii, 348. Vascular sedatives, Vascular stimulants. See Cardiac stimulants, Tonics, and De- pressants. Vaseline, ii, 349. as a lubricant, ii, 349. liquid, ii, 349. oxygenated, ii, 349. Vaselone, ii, 349. Vasogen, ii, 349. in nodes, ii, 349. iodized, in mucous patches, ii, 350. " " sciatica, ii, 350. " " secondary syphilis, ii, 349. Venesection. See Bloodletting. Veratrine, ii, 350. as an antiparasitic, ii, 350. former use of, internally, ii, 350. in alopecia areata, ii, 350. " aspergillus infection, ii, 350. " " in the ear, ii, 351. " chronic enlargement and stiffness of the joints, ii, 350. " chronic pleurisy, ii, 350. " infantile paralysis, ii, 350. " myalgia, ii, 350. " phtheiriasis, ii, 350. " pleurodynia, ii, 850. " superficial neuralgias, ii, 350. 538 GENERAL INDhX. Veratrine in tic douloureux, ii. 350. Veratroidine. See under Veratrum viride. Veratrol, ii, 851. Veratrum album. See Hellebore, White. nigrum. See Hellebore, Black. viride. ii, 351. and gelsemium in traumatic tetanus, ii, 355. as a cardiac depressant, ii, 851. in abnormal cardiac tension of renal disease, ii, 353. " acute mania, ii, 352. " amygdalitis, ii, 853. " aneurysm, ii, 353. " cerebral irritation from drink, ii, 353. " exophthalmic goitre, ii, 353. " hemorrhage, ii, 353. " hepatitis, ii, 852. " hypertrophy of the heart, ii, 353. (fluid extract or the tincture) in incipient inflammations, ii, 353. in irritability of the heart, ii, 353. " parenchymatous and serous inflammation, ii, 352. " pleurisy, ii, 352. " pneumonia, ii. 352. " priapism, ii, 353. (Norwood's tincture) in puerperal convul- sions, ii, 354. (large doses) in puerperal eclampsia, ii, 352. (to reduce vascular excitement) in puerperal peritonitis, ii, 353. in puerperal phlebitis, ii. 353. physiological action of, ii, 351. therapeutic value of, ii, 353. treatment of puerperal convulsions with, ii, 354, 355. Verbascum, ii, 356. decoction of, in diarrhoea, as a demulcent and astringent, ii, 356. Verdigris. See Cupric acid (vol. i, page 303). Vernonia, ii, 356. as an anthelminthic, ii, 356. " a stomachic, ii, 356. Vesicants, Vesicatories. See Blisters. Viburnum opulus, ii. 356. prunifolium, ii, 356. " as a diuretic, ii, 356. " as an antispasmodic, ii, 356. " " astringent, ii, 356. " as a nervine, ii, 356. uterine sedative, ii, 356. " in after-pains, ii, 857. " " colicky diarrhoea, ii, 357. " " dysentery, ii, 357. " " dysmenorrhoea, ii, 356, 357. " " with menor- rhagia, ii, 356. prunifolium in false pains, ii, 357. " " habitual abortion, ii, 857. " " hyperemia of the pelvic or- gans, ii, 356. prunifolium in hysteria, ii, 357. 1 " " hystero-epilepsy, ii, 357. " " menorrhagia, ii, 356. " " metrorrhagia, ii, 356. " " paralysis agitans, ii, 357. " " petit mal, ii, 357. Viburnum prunifolium in threatening abor- tion, ii, 857. prunifolium in vaginal dysmenorrhoea, ii, 357. prunifolium, physiological effect of, on man, ii, 358. Vichy, ii, 858. water in cystitis, ii, 358. " " diabetes, ii, 358. " " diseases of the liver, ii, 358. " " dyspepsia, ii. 358. " " enteritis, ii, 358. " " gastritis, ii, 358. " " gout, ii, 358. " " hepatic colic, ii, 358. " " icterus, ii, 358. " " lithemia, ii, 358. " " rheumatism, ii, 358. Vieiric acid, Vieirin, ii, 358. in malarial fevers, ii, 358. Vinca, ii, 358. Vinegar, ii, 358. in poisoning with alkalies, ii, 359. " " " carbolic acid, ii, 359. " vomiting after anesthesia with chloro- form, ii, 359, 360. sponging with a solution of, in fevers, ii, 359. Vinum. See Wine. Viola cucullata in rattlesnake poisoning, ii, 360. -quercitrin. ii, 360. tricolor, ii, 360. " (syrup) in bronchial affections as a demulcent and laxative, ii, 360. tricolor in crusta lactea, ii, 360. " " eczema, ii. 360. " " infantile eczema of the head and face, ii, 360. Violets. See under Viola tricolor. Violine, ii. 360. Virginia snakeroot. See Serpentaria. Virol, ii, 361. Viruses. See under Animal extracts and juices (vol. i, page 82) and Toxines. Viscum album, ii, 361. as an oxytocic, ii, 361. in amenorrhoea, ii, 361. " menorrhagia, ii, 361. " uterine hemorrhage, ii, 361. Vitellus, ii, 361. Vitis idea. See Vaccinium. Vitriol, blue. See Cupric sulphate, under Copper. green. See Iron sulphate, under Iron (vol. i, page 549). oil of. See Sulphuric acid. white. See Zinc sulphate, under Zinc. Vulneraries, ii, 361. Wafers, ii. 361. Wahoo. See Euonymus. Washes. See Lotions. Water, ii, 361. as a lithontriptic, i, 586. " solvent, ii, 211. barley, in fevers, i, 351. cold (internally), in fevers, i, 479. effects of, on the stomach and intestine i GENERAL INDEX. 539 Water, enema of hot, in shock, i, 491. general effect of, on the interior of the body, i, 476. hot, applications of, in plastic iritis, ii, 213. hot, applications of, in ulcer of the cornea, ii, 213. hot, douche of, in catarrh of the vagina and cervix uteri, i, 480. hot, douches of, in neuralgic conditions of the ovaries, i. 480. hot, douches of, in parametritis, ii, 213. hot (by the mouth or rectum), in hemor- rhage, ii, 227. iced, injections of, in post-partum hemor- rhage, i, 480. (rectal applications) in acute and chronic dysentery, i, 479. in cancer of the stomach, i, 479. (rectal applications) in chronic hemorrhoids, i, 479. in constipation, i, 479. " cystitis, i, 346. (rectal applications) in fecal impaction, i, 479. in functional disorders of the stomach and intestines, i, 479. in gastro-intestinal catarrh, i, 479. " gouty and rheumatic diatheses, i, 350. " lithemia, i, 479. " the pelvic diseases of women, i, 480. " ulcer of the stomach, i, 479. " urethritis, i, 346. Javelle, i, 240. therapeutic effects of, i, 479. warm, as an emetic for cleansing the stomach in continued vomiting, i, 372. Waters, carbonated, ii, 364. chlorinated, ii, 365. mineral, ii, 362. " in amenorrhoea, ii. 375, 383. " " anemia, ii, 375, 384. " " anasarca, ii, 379. " ascites, ii, 379. " " biliary obstruction, ii, 376. " Bright's disease, ii, 364, 884. (Arkansas Hot Springs), in Bright's disease, ii, 374, 379. mineral, in calculus, ii, 379. " " catarrh, ii, 375. " (Arkansas Hot Springs), in catarrhal affections of the digestive tract, ii, 374. mineral, in catarrh of the bile ducts, ii, 384. " " chlorosis, ii, 384. " " chronic adenitis, ii, 383. " " " alcoholism, ii, 379. " " " catarrhal gastro-enterit is, ii, 376. mineral, in chronic constipation, ii, 379. " " " cystitis, ii. 377. " (Arkansas Hot Springs), in chronic diarrhoea, ii. 374, 379. mineral, in chronic duodenal catarrh, ii, 884. mineral, in chronic inflammations of the in- testines, stomach, or throat, ii, 364. mineral, in chronic leucorrhoea, ii, 883. » " " metallic poisoning, ii, 381. mineral, in chronic paludal poisoning, ii, 384. 78 Waters, mineral, in chronic rheumatism, ii, 864. mineral (Arkansas Hot Springs), in chronic skin diseases, ii, 374. mineral, in constipation, ii, 376. " (Arkansas Hot Springs), in constitu- tional syphilis, ii, 374. mineral, in cystic catarrh, ii, 381. " (Arkansas Hot Springs), in cvstitis, ii, 374. mineral, in debility, ii, 384. " " diseases of the stomach, liver, kidney, and bowels, ii, 381. mineral (Arkansas Hot Springs), in diseases of the urinary organs, ii, 374. mineral, in disorders of the sexual organs in women, ii, 384. mineral, in dysmenorrhoea. ii, 383. " " dyspepsia, ii, 377, 379, 384. " " "' of hepatic origin, ii, 375. mineral, in excoriations of the epidermis, ii, 375. mineral (Arkansas Hot Springs), in function- al diseases of the liver, ii, 374. mineral, in functional neuroses, ii, 375, 384. " " gallstones, ii, 375. 381. " " gastric atony, ii, 375. " " gastric catarrh, ii, 375, 376. " " gleet, ii, 377. " gout, ii, 364, 374, 375, 377, 379, 381.' mineral (Manitou Springs), in gravel, ii, 375, " in hemorrhoids, ii, 375. " " hepatic congestion and enlarge- ment, ii, 384. mineral, in hepatic derangements, ii, 377. " " " engorgement, ii, 881. mineral (externally and internally), in hyste- ria, ii, 364. mineral (externally and internally), in insom- nia, ii, 364. mineral, in intestinal atonv, ii, 375. " jaundice, ii, 375, 379. " (injections), in leucorrhoea, ii, 375. " in lithiasis, ii, 377. " (Arkansas Hot Springs), in locomo- tor ataxia, ii, 375. mineral (Arkansas Hot Springs), in malarial poisoning, ii, 374. mineral, in menorrhagia, ii, 375. " neuralgia, ii, 364, 374. 384. " " neurasthenia, ii, 364, 377, 379. " " paludal poisoning, ii, 379. " (Arkansas Hot Springs), in paraly- sis (inorganic), ii, 374. mineral (internally and externally), in pa- ralysis due to lead, ii, 364. mineral, in peripheral neuritis, ii, 364. " plethora, hepatic or renal, ii, 375. " " prostatitis, ii, 377. (Manitou Springs), in pyrosis asso- ciated with chronic dyspepsia), ii, 375. mineral, in renal calculi, ii, 384. " " " congestion, ii, 381. " " rheumatism, ii, 381, 384. " " rheumatoid arthritis, ii, 376. " " saturnism, ii, 376. " (Manitou Springs), in skin diseases, ii, 375, 381. 540 GENERAL INDEX. Waters, mineral, in uricemia, ii, 377. mineral, in uterine derangements, ii, 381. " " " engorgement, ii, 383. " alkaline, ii, 363, 366. " in acute laryngitis, ii, 367. " " " bronchial catarrh, ii, 367. mineral, alkaline (carbonated), in chronic dyspepsia, hepatic congestion, and rheu- matism, ii, 375. mineral, alkaline, in chronic laryngitis, ii, 367. mineral, alkaline, in chronic pharyngitis, ii, 367. mineral, alkaline, in cystic and renal calculi, ii, 367. mineral, alkaline, in cystitis, ii, 366. " " " dyspepsia (associated with hyperacidity), ii, 366. mineral, alkaline, in gastric catarrh, ii, 366. mineral, alkaline, in gout, ii, 367. '• " " pyelitis, ii, 366. " " " ureteritis, ii, 366. " " " uric-acid diathesis, ii, 367. mineral, bitter, ii, 367. Buffalo lithia, ii, 371. " " " in acne, ii, 372. " " " " albuminuria, ii, 372. mineral, Buffalo lithia, in amenorrhoea, ii, 372. mineral, Buffalo lithia, in Bright's disease, ii, 372. mineral, Buffalo lithia, in cachexia, ii, 372. " " " " cystitis, ii, 372. " " " " diabetes mellitus, ii, 372. mineral, Buffalo lithia, in dysmenorrhoea, ii, 372. mineral, Buffalo lithia, in dyspepsia, ii, 372. mineral, Buffalo lithia, in eczema, ii, 372. " gleet, ii, 372. " " hepatic engorge- ment, ii, 372. mineral, Buffalo lithia, in inflammation of the vermiform appendix (from phosphatic deposits), ii, 372. mineral, Buffalo lithia, in jaundice, ii 372. mineral, Buffalo lithia, in lithiasis, ii, 372. " " menorrhagia, ii, 372. mineral, Buffalo lithia, in nephritic colic, ii 372. mineral, Buffalo lithia, in paludal fever (se- quele), ii, 372. mineral, Buffalo lithia, in scarlatinal nephri- tis, ii, 372. mineral, Buffalo lithia, in syphilis, ii, 372. " " " " uremia, ii, 372. mineral, carbonated, ii, 364. " carbonate, in gastric atony, ii, 364. mineral, carbonated, in intestinal atony, ii 364. mineral, carbonated, in nausea, ii, 364. " " " prostatic or vesical irritability, ii, 365. Waters, mineral, chalybeate, ii, 369, 381. mineral, chlorinated, ii, 365. " " (externally and inter- nally), in anemia, ii, 365. mineral, chlorinated, in bronchial catarrh, ii, 366. mineral, chlorinated, in caries, ii, 366. " " (warm), in chronic gas- tritis, ii, 365. mineral, chlorinated, in gastric catarrh, ii, 365. mineral, chlorinated, in general asthenia, ii, 366. mineral, chlorinated, in gout, ii, 365. " " (externally and inter- nally), in hepatic congestion with constipa- tion, ii, 365. mineral, chlorinated, in hypertrophy of the spleen, ii, 366. mineral, chlorinated, in necrosis, ii. 366. " " " neurasthenia, ii, 365. " rhachitis, ii, 366. " " " rheumatism, ii, 365. " ferruginous, in albuminuria, ii, 369. " " " anemia, ii, 369. " " " atony of the stom- ach, ii, 370. mineral, ferruginous, in cachexia associated with chronic paludal poisoning, ii, 369. mineral, ferruginous, in chlorosis, ii, 369. " chorea, ii, 369. " " chronic lymphade- nitis, ii, 369. mineral, ferruginous, in gastric neuroses, ii, 369. mineral, ferruginous, in menstrual derange- ments of hemic origin, ii, 369. mineral, ferruginous, in neurasthenia, ii, 369. mineral, ferruginous, in paludal poisoning, ii, 369. mineral, sulphated, ii, 367. in catarrh of the duode- num, ii, 368. mineral, sulphated, in catarrh of the gall bladder and ducts, ii, 368. mineral, sulphated, in chronic intestinal catarrh, ii, 368. mineral, sulphated, in diabetes, ii, 368. " disorders of the stom- ach, ii. 368. mineral, sulphated, in hemorrhoids, ii, 368. " hepatic cirrhosis, ii, mineral, sulphated, in hepatic engorgement, ii, 368. mineral, sulphated, in jaundice due to ob- structions, ii, 368. mineral, sulphated, in uric-acid diathesis, ii, 368. mineral, sulphur, ii, 370. in saturnism, ii, 371. " mercurialism, ii, 371. ". , " " congestion associated with enlargement of the liver, ii, 371 mineral, sulphur, in hepatic congestion, ii, Oil. mineral, sulphur, in bronchial catarrh, ii o71. mineral, sulphur, in hemoptysis, ii, 371. GENERAL Waters, mineral, sulphur, in pulmonary tuber- culosis (Bergeon's treatment), ii, 371. mineral, sulphur, in constipation (due to de- ficiency of intestinal secretion), ii, 871. mineral, sulphur, in hemorrhoids, ii, 371. " engorgement of the pel- vic viscera of women, ii, 871. mineral, sulphur, in chronic lead poisoning, ii, 371. F h mineral, vapour of, in acute bronchitis, bron- chorrhoea, chronic catarrhal laryngitis, chronic nasal catarrh, coryza, laryngeal phthisis, and laryngotracheitis, ii, 381. Wax, ii, 385. Chinese insect, ii, 385. Japanese, ii, 385. myrtle, ii, 385. Wheat. See Triticum. Whey, i, 42: ii, 385, 894. cure for acute febrile disease, i, 333. " " irritability of the stomach, i, 333. Whisky, ii, 385. as a hypnotic, i, 506. as an antiseptic, ii, 385. in adynamic fevers, ii, 385. " chronic pulmonary tuberculosis, ii, 385. " hemorrhage, ii, 385. " poisoning (as a heart stimulant), ii, 385. " sudden cardiac collapse, ii, 385. " syncope, ii, 385. " typhoid fever, ii, 385. " typhus fever, ii, 385. Willow. See Salix. WTine, blackberry, in diarrhoea, ii, 391. claret, ii, 390. " in anemia, ii, 394. " " atonic gout, ii, 394. " " chronic discharges of blood, pus, or mucus, ii, 394. claret, in debility, ii, 394. " (by injection), in fistule (to lessen the discharge), ii, 394. claret, in purulent inflammations, ii, 394. " (injections into the tunica vaginalis) in hydrocele, ii, 394. Madeira, ii, 390. palm, ii, 391. port, in bronchitis of the aged, ii, 393. " " catarrhal affections (of young in- fants), ii, 393. port, in debility, ii, 393. " " marasmus of young infants, ii, 393. " " pneumonia, ii, 393. " " tuberculosis of young infants, ii, 393. " typhoid fever, ii, 393. " " typhus fever, ii, 393. sauterne, in insomnia and troublesome cough, ii, 394. sherry, ii, 390. " for indigestion, ii, 393. " in acute inflammatory processes, ii, 393. sherry, in fevers, ii, 393. " " senile debility, ii, 393. whey, ii, 394. Wines, ii, 385. acidulous, ii, 390. American, ii, 390. (white, of Bordeaux) as a tonic for a capri- cious appetite, ii, 394. i INDEX. 541 Wines, astringent, ii, 390. champagne, ii, 390. 391, 392. " in collapse from fever, ii, 393. " " debility of old age, ii, 393. # " seasickness, ii, 394. " " vomiting of pregnancy, ii, 394. dietetic use of, ii, 393. dose of, ii, 394. dry, ii, 390. effect of, ii, 392. French, ii, 390. German, ii, 390. " in nervous diseases, ii, 390. in acute chorea, ii, 894. " " neuralgia, ii, 394. " " neuroses, ii, 394. (as a stimulant) in amygdalitis, ii, 394. in cardiac failure, ii, 394. " epidemic influenza, ii, 394. " eye affections (of children), ii, 394. (as a stimulant) in hemorrhages, ii, 394. in infantile convulsions, ii, 394. injections of, in chronic discharges from the vagina and urethra, ii, 394. in insomnia of typhoid fever, ii, 394. " progressive chlorosis, ii, 394. " pulmonary tuberculosis, ii, 394. " rhachitis of young infants, ii, 393. " scalp affections of children, ii, 394. " tetanus, ii, 394. " the treatment of diseases, ii, 393. " intestinal catarrh, ii, 395. " weak heart of typhoid fever, ii, 394. Italian, ii, 390. light, i, 390. medicated, ii, 396. Orleans, ii, 390. red, ii, 390. Rhenish, ii, 390. rough, ii, 390. Spanish, ii, 390. sparkling, ii, 390. Teneriffe, ii, 390. white, ii, 390. Wintergreen. See Gaultheria. Witch-hazel. See Hamamelis. Witherite. See Barium carbonate, under Barium. Wood charcoal, i, 85, Wool-fat. See Lanolin. Wool, sanitary wood, as an absorbent dress- ing, ii, 88. Wormwood. See Absinthium. Wrightia, ii, 396. in diarrhoea and dysentery, ii, 396. Xanthoxylum, ii, 396. (as a gargle) in affections of the throat, ii, 396. (infusion) in chronic constitutional syphilis, ii, 396. in chronic rheumatism, ii, 396. (as a diaphoretic) in rheumatic pains, ii, 396. (tincture) in toothache, ii, 396. Xeroform, ii, 397. as an intestinal antiseptic in cholera, ii, 397. as a surgical antiseptic, ii, 397. 542 GENERAL INDEX. Xeroform in buboes, ii, 897. in chronic urticaria, ii, 397. " eczema in children, ii, 397. " foul ulcers, ii, 397. " infected wounds, ii, 397. " intestinal catarrh, ii, 397. " necrotic affections, ii, 397. " paronychia, ii, 397. " suppuration, ii, 397. X rays, ii, 397. in cancer, ii, 898. " '" of the stomach, ii, 398. Xylene, ii, 400. as an antiseptic, ii, 400. internally in small-pox, ii, 400. Xylenol, ii, 400. Xylol. See Xylene. Yarrow. See Achillea. Yeast, ii, 400. in boils, ii, 400. Yellow root. See Hydrastis. Yerba sagrada. See Lantana. santa, ii, 401. Zea. See Corn-silk. Zinc, ii, 401. acetate, ii, 402. " as an emetic, ii, 402. " as a nervine, ii, 402. " (as a local astringent) in conjunc- tivitis, ii, 402. acetate in diarrhoea, ii, 402. " (as a local astringent) in gonorrhoea, ii, 402. acetate (as a local astringent) in leucorrhoea, ii, 402. acetate ointment in erythema, ii, 402. " " " herpes, ii, 402. albuminate, ii, 408. and potassium cyanide, ii, 408. arsenate and zinc arsenite, ii, 408. borate, ii, 408. bromate, ii, 408. bromide, ii, 402. " in epilepsy, ii, 402. carbolate, ii, 408. carbonate, ii, 402. " (as a prophylactic) in intertrigo, ii, 403. carbonate (as a surgical dressing) in super- ficial inflammation, ii, 403. chloride, ii, 403. " as an antiseptic, ii, 404. " " " escharotic, ii, 403. " in abscesses, ii, 403. " " chronic conjunctivitis, ii. 405. " " " laryngitis, ii, 405. " pharyngitis, ii, 405, " " " suppurative otitis media, ii, 405. chloride in condylomata, ii, 403. " " diphtheritic conjunctivitis, ii, 405. chloride in empyema of the accessory nasal sinuses, ii, 405. chloride in ganglia, ii, 404. " " gangrenous ulcers, ii, 403. " " gonorrhoea, ii, 405. " " gonorrhceal conjunctivitis, ii, 405. Zinc chloride in hydrocele, ii, 404. chloride in " inoperable " aneurysms, ii, 403. " " leucorrhoea, ii, 405. (by dilaceration, M. Leon Derville's method) in lupus, ii, 404. chloride in malignant growths, ii 403. " " morbid growths, ii, 403. " " nevi, ii. 403. " " nasal polypi, ii, 404. " " pulmonary tuberculosis, ii, 403. " " ranula, ii, 404. " " small cystic tumours, ii, 404. chrysophanate, ii, 408. citrate, ii, 408. cyanide, ii, 408. " in abdominal pain, i, 323. " " cardiac neuroses, i, 323 ; ii, 408. " chorea, i, 323. " " dysmenorrhoea, ii, 408. " " epilepsy, i, 328. " " neuralgia, i, 323 ; ii, 408. " " whooping-cough, ii, 408. ferrocyanide, ii, 408. gynocardate, ii, 409. " in leprosy, ii, 409. " " prurigo, ii, 409. " " psoriasis, ii, 409. " " syphilitic skin diseases, ii, 409. hydrochlorate, ii, 409. " as an antiseptic, ii, 409. iodate, ii, 409. iodide (internally) in chorea, ii, 405. " (locally) in chronically enlarged ton- sils, ii, 405. iodide (as a collyrium) in chronic conjunc- tivitis, ii, 405. iodide (locally) in chronic inflammation of the mucous membranes, ii, 405. iodide (locally) in post-nasal catarrh, ii. 405. iodide (internally) in scrofulous diseases of the skin and eyes, ii, 405. iodide (ointment) in ,tumours, ii, 405. lactate, ii, 409. " in hysterical amblyopia, ii, 409. nitrate, ii, 409. " in lupus erythematosus, ii, 409. oleate and iodoform in erosions of the os uteri, ii, 405. oleate (locally) in bromidrosis, ii, 405. " in hyperidrosis, ii, 405. (with salicylic acid or French chalk) in acute vesicular eczema and in comedo. ii, 405. oleostearate, ii, 409. oleostearate and a solution of lead subacetate in acute rhinitis and coryza. ii, 409. oleostearate and boric or carbolic acid in nasal discharges and hyperemic condi- tions, ii, 409. oleostearate with acetanilide as an antiseptic and protective after operations, ii, 409. oleostearate with antipyrine in recurring epistaxis, ii, 409. ° oleostearate with balsam of Peru as a stimu- lant and healing agent to the mucous membranes, ii, 409. oleostearate with camphor and menthol in hay fever and coryza, ii, 409. GENERAL INDEX. 543 Zinc oleostearate with iodine in atrophic and dry rhinitis and ozena, ii, 409. oleostearate with oleum pini pumilionis and eucalyptol (intratracheal injections) in asthma and chronic bronchitis, ii, 409. oleostearate with orthochlorphenol in ozena and syphilitic ulcerations, ii, 409. oleostearate with tannic acid in catarrh and nosebleed, ii, 409. oxide, ii, 405. " applications in abrasions, burns, blis- ters, excoriations, fissures, etc., ii, 406. oxide as an anthidrotic, i, 102. " in acute eczema of the auricle, ii, 406. oxide in arsenic poisoning, ii, 406. " " bronchorrhoea, ii, 406. " (for muscular tremor) in chronic alco- holism, ii, 406. oxide in conjunctivitis, ii, 406. " " eczema, ii, 406. " " epilepsy, ii, 406. " " gonorrhoea, ii, 407. " " mercury poisoning, ii, 406. " " night sweats of phthisis, ii, 406. " " scrofulous conjunctivitis of chil- dren, ii, 406. oxide (as a prophylactic) in spasmodic asthma, ii, 406. oxide insufflations in laryngitis, ii, 406. " in ulcers of the septum nasi, ii, 406. " with bismuth and pepsin in summer diarrhoea of children, ii, 406. oxide with carminatives and morphine in gastralgia, ii, 406. oxychloride, ii, 409. " as a surgical dressing, ii, 410. " (as an adjuvant) in the galvanic treatment in hemorrhagic endometritis and incipient malignant conditions of the uterus, ii, 410. permanganate in gonorrhoea, ii, 410. phosphate, ii, 410. '• in epilepsy, ii, 410. " " exhaustion from over-excite- ment, ii, 410. phosphate in insanity during convalescence from fevers, ii, 410. phosphide as a tonic in anemia, i, 68. " in lymphadenoma, ii, 407. salicylate as an antiseptic, ii, 410. " as an astringent, ii, 410. " (as a collyrium) in conjunctivitis, ii. 410. salicylate in inflammatory cutaneous dis- eases, ii, 410. salicylate in nasal catarrh, ii, 410. sozoiodolate, ii, 215. " in blennorrhoea and gonorrhoea, ii. 410. stearate, compound, ii, 411. subgallate, ii. 411. " as a dressing in eczema, hemor- rhoids, and wounds, ii, 411. subgallate in chronic purulent otitis media, ii, 411. subgallate in gonorrhoea, ii, 411. sulphate, ii, 407. and corrosive sublimate in onychia maligna, i, 228. Zinc sulphate as a hemostatic, ii, 407. sulphate (internally, in small doses) as an as- tringent and as a tonic, ii, 407. sulphate in atrophic rhinitis, ii, 407. " " cancer of the uterus, ii. 407. " (injections) in caries, ii, 408. " in caruncle of the female urethra, ii, 407. sulphate (weak solutions) in catarrhal in- flammation of the mucous membrane of the Eustachian tube, ii, 407. sulphate in condylomata, ii, 408. " (as a collyrium) in conjunctivitis, ii, 407. sulphate (as an emetic) in croup, ii, 407. " in diarrhoea, ii, 407. " " dysentery, ii, 407. " " eczema, ii, 408. " " epistaxis, ii. 407. " " epithelioma, ii, 407. " " erythema, ii, 408. " " gonorrhoea, ii, 407. " (weak solutions) in inflammation of the external ear, ii, 407. sulphate in intertrigo, ii, 408. " " laryngeal hemorrhage, ii, 407. " " lupus, ii, 407. " (as an emetic) in narcotic poison- ing, ii, 407. sulphate in purulent otitis media, ii, 407. " " small neoplasms, ii, 408. " " unhealthy ulcers, i, 228 ; ii, 407. " warts, ii,'408. " " whooping-cough, ii, 407. sulphichthyolate (externally) in acute or chronic rheumatism, ii, 412. sulphichthyolate in burns, ii, 412. " " chronic catarrhal dis- eases of the stomach and lungs, ii. 412. sulphichthyolate in chronic gonorrhoea, ii, 412. sulphichthyolate in chronic nephritis, ii, 412. sulphichthyolate in eczema, ii, 412. " " erysipelas, ii, 412. " " favus, ii, 412. " " intrapelvic inflamma- tory exudations, ii, 412. sulphichthyolate in lumbago, ii, 412. " " psoriasis, ii, 412. " '* varicose veins, ii, 412. sulphide, in lupus erythematosus, ii, 411. " " seborrhoea of the face, ii, 411. sulphite, ii, 411. sulphocarbolate, ii, 411. " as an antiseptic in intestinal disorders, ii, 411. sulphocarbolate (externally) in balanitis, ii, 412. sulphocarbolate in catarrhal laryngitis, ii, 412. sulphocarbolate in cholera infantum, ii, 411. " " " morbus, ii, 411. " (douches) in chronic puru- lent otitis media, ii, 412. sulphocarbolate in eczema of the external auditory canal, ii, 412. sulphocarbolate in pharyngitis, ii, 412. " " pityriasis capitis, ii, 412. " " syphilis, ii,412. 544 GENERAL INDEX. Zinc sulphocarbolate in vomiting of pregnancy, ii, 412. sulphydrate, ii, 412. " in chronic eczema, ii, 412. " " psoriasis, ii, 412. " " vegeto-parasitic skin diseases, ii, 412. tannate, ii, 412. " in conjunctivitis, ii, 412. " " diarrhoea, ii, 412. " " dyspepsia, ii, 412. " " phthisis, ii, 412. " injections in gonorrhoea, ii, 412. Zinc tetraborate, ii, 408. valerianate, ii, 408. " in hay fever, ii, 347. " " incontinence of urine from nervousness, ii, 347. valerianate in neuralgia, as a sedative, i, 68; ii, 347. Zincohemol, ii, 412. as an astringent and tonic, ii, 412. in anemia, ii, 412. " chlorosis, ii, 412. " diarrhoea, ii, 412. Zymoidin, ii, 412. INDEX OF DISEASES AND REMEDIES. Abdominal pain. See Colic. Aberration of the cardiac rhythm. Convallaria, i, 300. Abortion. Gold chloride, i, 453. Viburnum prunifolium, ii, 357. Abortion, pains of. Piscidia, ii, 91. Abortion, threatening. Asafcetida, i, 147. Abrasions. Arnica, i, 141. Benzoin, tincture of, i, 178. Chalk, powdered, i, 230. Gutta percha, i, 463. Phenol sodique, ii, 73. Tannic-acid ointment, ii, 257. Traumaticin, ii, 328. Zinc oxide, ii, 406. Abrasions of mucous surfaces. Borax, i, 189. Abscess. Alumnol irrigations, i, 51. Ammonium chloride, i, 57. Aspiration, i, 152. Baths, i, 171. Bromol, i, 197. Calcium sulphide, i, 203. Carbolic acid (parenchymatous injections) i. 213. Carbolic acid (solution) inhalation, i, 213. Chlorine water, i, 240. Cloves, tincture of, i, 272. Iodoform, i, 588. Mentho-phenol, i, 616. Sanoform, ii, 15. Sozal, ii, 215. Abscess, cold. Baths, i, 171. Cloves, tincture of (injections), i, 272. Iodoform (hypodermically). i, 538. Teucrin, ii, 273. Abscess, deep-seated. Vienna paste, i, 228. Abscess, ganglionic. Copper salts, i, 803. Abscess, hepatic. Ammonium chloride, i, 57. Abscess, indolent. Vienna paste, i, 228. Abscess of the ear. Honey and rye meal, i, 472. Abscess of the lnng. Carbolic acid, i, 213. Abscess, open. Sanoform (for after-treatment), ii, 154. Abscess, perityphlitic. Aspiration, i, 152. Abscess, pulmonary. Bromol, i, 197. Abscess, tuberculous. Sozal, ii, 215. Accumulation, faecal. Aloes, combined with strychnine, i, 224. Acidity of the stomach. See Dyspepsia, Acid. Acne. Alumnol applications, i, 51. Arsenic, i, 144. Calcium chloride, i, 202. sulphide, i, 203. Collodion, i, 294. Cupric sulphate, i, 306. Hydrastine, i, 476. Ichthyol, i, 522. Losophan, i, 589. Nitrohydrochloric acid, ii, 16. Phosphorus, ii, 77. Salicylic acid, ii, 144. Steam, ii, 222. Sulphur ointment, ii, 241. Thymol, ii, 284. Waters, Buffalo lithia, ii, 372. Acne, pustular. Salicylic acid, ii, 144. Acne rosacea. Cupric-sulphate solution, i, 306. Acne vulgaris. Collodion, i, 294. Acromegaly. Pituitary-body extract (hypodermically), i, 81. Thyreoid treatment, ii, 295. Actinomycosis. Carbolic-acid injections, i, 213. Potassium iodide, ii, 99. Teucrin, ii, 273. Adenitis. Belladonna, i, 174. Cloves, tincture of, i, 272, 273. Ichthyol, i, 522. Iodine, i, 536. Iodoform, i, 538. Mercury ointment, i, 622. Nucleins, ii, 25. Plytolacca, ii, 81. 545 546 INDEX OF DISEASES AND REMEDIES. Adenitis. Pyoctanine (internally), ii, 109. Teucrin, ii, 178. Adenitis, chronic. Waters, mineral, ii, 383. Adenitis, tuberculous. Cloves, tincture of (injections), i, 272, 273. Iodoform, i, 538. . Nucleins, ii, 25. Teucrin, ii, 178. Adynamia. Opium (as a stimulant), ii, 226. After-pains. Chloral hydrate, i, 237. Ergot, i, 388. Viburnum prunifolium, ii, 357. Albuminuria. Asaprol, i, 148. Corn silk, i, 306. Gallic acid, i, 432. Infusion, intramuscular, ii, 325. Iron chloride, i, 548. Sodium tannate, ii, 259. Strontium lactate, ii, 229. Tannin, ii, 257. Waters, Buffalo lithia, ii, 372. " ferruginous, ii, 369. Albuminuria, phosphatic. Glycerophosphates, ii, 439. Alcohol habit. Ammonia water (after gastric lavage), i, 53. Bath, half, i, 169. Coffee, i, 290. Cold plunge, i, 488. Gold bromide, i, 45. Hydrastis, i, 475. Hypnotism, i, 515. Mercauro, i, 454. Nux vomica, ii, 29. Strychnine, ii, 29. Waters, mineral, ii, 379. Alcohol habit, treatment of the chronic, i, 38. Alopecia. Cantharides, i, 208. Galvanism, i, 368. Jaborandi (subcutaneous injections, or the mouth), i, 560. Sulphur ointment, ii, 241. Veratrine, ii, 350. Alopecia areata. Sulphur ointment, ii, 241. Veratrine, ii, 350. Amaurosis, tobacco. Santonin, ii, 155. Amblyopia. Hyenanchin, i, 474. Nux vomica, ii, 28. Zinc lactate, ii, 409. Amblyopia, hysterical. Zinc lactate, ii, 409. Amenorrhoea. Aloes, i, 49. Ammonium chloride, i, 57. Apiol, i, 138. Arsenic, i, 146. Baths, i, 169, 170. " hot foot, i, 170. Cantharides, i, 208. Cimicifuga, i, 250. Amenorrhoea. Cineraria, i, 258. Galbanum (internally), i, 432. Gold, i, 458. Ice applied to the spine, i, 520. Inula (as a tonic), i, 534. Iron, ammonio-chloride of, i, 549. " iodide, i, 551. Ligusticum, i, 581. Manganese and iron, i, 596. Mustard foot-bath, hot, i, 647. Myrrh, tincture of (internally), i, 651, Ovarine, ii, 451. Pulsatilla, ii, 107. Rue, ii, 137. Santonin, ii, 155. Senecio, ii, 162. Sulphur fumes, ii, 241. Tansy tea, ii, 269, 456. Turpentine, ii, 336. Viscum album, ii, 361. Waters, Buffalo lithia, ii, 372. " mineral, ii, 375, 383. Amenorrhoea, atonic. Iron iodide, i, 551. Sanguinaria, ii, 154. Amenorrhoea, functional. Pulsatilla, ii, 107. Sulphur fumes, ii, 241. Amygdalitis. Aconite, i, 8. Baths, cold, i, 488. Capsicum and hot water (as a gargle), i, 209. Cinchona, i, 256. Copper-arsenite solution, i, 304. Eucalyptol inhalation, i, 529. Glycerin and carbolic acid, i, 450. Guaiacol, ii, 439. Hydrastis, i, 476. Hydrogen dioxide, i, 503. Iron (Monsel's solution), i, 550. Nuclein, yeast, ii, 24. Palmetto wine, ii, 58. (early hours of), Quinine, ii, 256. Quinine, ii, 119. Salicylamide, ii, 141. Silver nitrite, ii, 195. Sodium salicylate, ii, 146. Veratrum viride, ii, 353. Wine (as a stimulant), ii, 394 Amygdalitis, acute. Guaiacol, i, 460. Amygdalitis, acute follicular. Iron sulphate (Monsel's solution), i, 550 Sodium salicylate, ii, 146 Amygdalitis, follicular. Guaiacol, ii, 439. Hydrastis (local applications), i, 476 Quinine, ii, 119. Amygdalitis, suppurative. Aconite, i, 8. Anemia. Air, condensed, inspiration of, i, 28 Aloes, i, 48. Amyl nitrite, i, 61. Arsenic, i, 145. Baths, i, 173. condensed-air, i, 28. " sheet, i, 169. " sulphur, i, 173. INDEX OF Anaemia. Blood, i, 186. Champagne, ii, 392. Coca (as an adjunct), i, 274. Cold douche, i, 491. Copper arsenite, i, 303. Eucasin, ii, 436. Gold, i, 454. Hemalbumin, i, 463. Hematin-albumin, i, 463. Hemoglobin, i, 464. Hydrochloric acid, i, 493. Infusion, ii, 324, 328. Iron, i, 544. " carbonate, i, 547. " chloride (ethereal tincture), i, 547, 548. " citrate, i, 550. " sulphate, i, 549. " tannate, ii, 259. " valerianate, i, 552; ii, 346, 348. Manganese dioxide, i, 596. Marrow, extract of bone, i, 81, 598,599; ii, 445. Nitroglycerin, ii, 15. Nucleins, ii, 24. Orexine, ii, 451. Oxygen, ii, 52. Ozone, ii, 58. Peptomangan, ii, 69. Permanganates, ii, 70. Phospho-albumin, ii, 74. Protonuclein, ii, 448. Pyramidone, ii, 454. Serum, artificial (intravenous injections), ii, 164. Somatose, ii, 212. Spermine, ii, 217. Splenic douches, i, 349. Strophanthus, ii, 232. Strychnine with iron and quinine, ii, 28. Thyreoid treatment, ii, 295. Transfusion and infusion, ii, 322, 323. Trefusia, ii, 329. Waters, chlorinated (externally and inter- nally), ii, 365. (due to hemorrhage), Waters, ferruginous, ii, 369. Waters, mineral, ii, 375, 384. Zincohemol, ii, 412. Anaemia, acute (from hemorrhage). Serum, artificial, ii, 163. Transfusion and infusion, ii, 322. Anaemia, cerebral. Amyl nitrite, i, 61. Copper arsenite (small doses), i, 303. Infusion, ii, 324. Infusion, intra-arterial, of sodium-chloride solution, ii, 328. Strophanthus, ii, 232. Anaemia, pernicious. Ozone, ii, 58. Phosphorus, ii, 77. Anaemia, progressive pernicious. Arsenic, i, 145. Protonuclein, ii, 448. Anaemia, rhachitic. Peptomangan, ii, 69. Anemia, with constipation. Iron sulphate, i, 549. Anesthesia, chloroform. Ether (subcutaneously), ii, 227. DISEASES AND REMEDIES. • 547 Anaesthesia, chloroform. Faradaism, i, 366. Anesthesia, plantar. Bath, hot foot, i, 170. Anasarca. Infusion, intramuscular, ii, 325. Sparteine, ii, 216. Waters, mineral, ii. 379. Anasarca of Bright's disease. Theobromine, ii, 277. Aneurysms. Electricity, i, 361. _ Potassium iodide, ii, 10. Sodio-theobromine salicylate, ii, 203. Veratrum viride, ii, 353. Zinc chloride, ii, 403. Aneurysms, " inoperable." Zinc chloride, ii, 403. Aneurysms, internal. Potassium iodide, ii, 98. Angina pectoris. Amyl nitrite, i, 60, 528. Anhalonine, ii, 417. Arsenic, i, 146. Baths, Nauheim, ii, 419. Camphor, i, 205. Cereus grandiflorus, i, 229. Chloroform, i, 528. Conium, i, 298. Exalgine, i, 403. Mercury, i, 620. Morphine, ii, 36. " (hypodermic injection), i, 67. Nitroglycerin, ii, 15. Pyridine, ii, 110. " fumes of, i, 530. Schott treatment, ii, 422. Strophanthus, ii, 282. Tribromhydrin, ii, 330. Ankylosis. Thiosinamine, ii, 281. Ankylostomiasis. Thymol, ii, 284. Anorexia. Alcohol, i, 33. Cannabis indica, i, 207. Morphine, ii, 38. Orexine hydrochloride, ii, 46. Quassia, ii, 112. Splenic extract, ii, 218. Anorexia, hysterical. Morphine, ii, 38. Anthrax. Serum treatment, i, 85. Toxines, ii, 315. Aortic disease. Convallaria, i, 300. Aortic insufficiency. Air, condensed, inspiration into, i, 28. Amyl nitrite, i. 61. Aphonia, hysterical. Faradaism, i, 366. Aphthae. Alcohol applications, i, 31. Antacids, i, 80. Bismuth subnitrate, i, 181. Borax, i, 189. Catechu, i. 221. " infusion or tincture, i, 221. Chlorine water, i, 240. 548 INDEX OF DISEASES AND REMEDIES. Aphthe. Citric acid, i, 260. Copper-arsenite solution (locally and inter- nally), i, 303. Cupric acetate (topically), i, 303. Lemon-juice (diluted, as a gargle), i, 260. Apnoea. See Asphyxia. Apoplexy. Bloodletting, i, 189. Croton oil (for rapid evacuation of the bowels), i, 318. Faradaism, i, 366. Sodium phosphate, ii, 208. Strophanthus, ii, 231. Strychnine, ii, 28. Arrhythmia. Sodio-theobromine salicylate, ii, 202. Arterial tension, high. Potassium cobaltonitrite, i, 273. Arteriosclerosis. Sodio-theobromine salicylate, ii, 203. Arthralgia. Mentha piperita (oil), i, 613. Arthritis, fungous. Cloves, tincture of (injections), i, 272. Arthritis, gouty. Exalgine, i, 403. Arthritis, rheumatoid. Baths, hot foot, i, 170. Calcium sulphide, i, 203. Synovial extract, ii, 251. Arthritis, tuberculous. Copper salts, i, 303. Articular troubles. See Rheumatism. Ascarides. Aloes, i, 102. Bitters (injections of), i, 183. Carbolic acid, i, 102. Ether (internally), i, 397. Limewater (as a wash), i, 582. Quassia, ii, 112. Salt, ii, 102. Santonin, ii, 55. Tannin, ii, 257. Turpentine oil, ii, 336. Ascites. Aspiration, i, 152. Iodine injection, i, 536. Jaborandi, i, 559. Massage, abdominal, i, 608. Salines, ii, 147. Serum, artificial, ii, 163. Waters, mineral, ii, 379. Ascites of hepatic cirrhosis. Salines, ii, 147. Serum, artificial, ii, 163. Aspergillus infection. Veratrine, ii, 350. Asphyxia. Cold affusions, i, 17. Electricity, ii, 226. Faradaism, i, 366. Heat, dry, ii, 225. Oxygen, ii, 52. Stimulants, cardiac, ii, 226. Transfusion, depletory, ii, 323. Asphyxia from oxide of carbon inhalation. Serum, artificial, ii, 165. Asphyxia, local. Amyl nitrite, i, 62. Nitroglycerin, ii, 10. Asphyxia neonatorum. Baths, cold, ii, 128. " hot, i, 166. Electricity, ii, 226. Transfusion, depletory, ii, 323. Asthenia. See Debility. Asthenopia. Massage of the eye, i, 610. Asthenopia, accommodative. Eserine, i, 392. Asthma. Acetanilide, i, 4. Aconite, i, 8. Air. condensed, inspiration of, i, 28. Alcohol, i, 33. Alkalies, i, 96. Allyl tribromide, ii, 414. Ammonium succinate, i, 58. Amyl nitrite, i, 95. Analgene, i, 66. Anhalonine, ii, 417. Antipyrine, i, 124. Apomorphine, ii, 418. Arsenic, i, 96. Arsenious solution, i, 97. Asafcetida, i, 147. Asaprol, i, 148. Balsamic fumes, i, 529. Baths, condensed-air, i, 27. Bromide of ammonium, i, 94. " " potassium, i, 94. " " sodium, i, 94. Bromoform, i, 196. Caffeine, i, 201. Cannabis indica, i, 207. Carbolic acid, i, 213. Chamomile, i, 231. Chemical means, i, 92. Chloralamide, i, 238. Chloral caffeine, i, 235. Chloral hydrate, i, 94, 237. Climatic treatment, i, 96. Conium, i, 298, " vapour inhalations, i, 299, 529. Copper-arsenite solution (spray), i, 303. Diet, careful, i, 96. Digitalis, i, 342. Elastic compression of the chest, i, 92. Electrical stimulation, i, 93. Ether (as a sedative), i, 528. Ethyl, iodide of (inhalations), i, 95. Eucalyptus cigarettes, i, 400. Expiration into rarefied air, i, 28, 93. Fowler's solution, i, 97. Galvanism of the neck, i, 368. Gelsemium, i, 437. Glycerophosphates, ii, 439. Hoffmann's anodyne, i, 94, Hydriodic acid, i, 493. Inhalation of conium, i, 529. Jaborandi, i, 559. Lippia mexicana, i, 585. Lobelia, i, 373, 587. Methylal (by inhalation), i, 629. Morphine (hypodermic injection), i, 93 Nitrogen monoxide, i, 528. INDEX OF DISEASES AND REMEDIES. 549 Asthma. Nitroglycerin, i, 95: ii, 15. Opium, fumes of, i, 529. Oxygen inhalation, i. 95. Ozone inhalation, ii. 58. Paraldehyde, ii, 02. Pilocarpine, nitrate and hydrochloride, i, Pine leaves, oil of, i, 96. Piscidia (as an antispasmodic), ii, 91. Potassium iodide, i, 97; ii, 99. nitrate, belladonna, and stramo- nium, fumes of, i, 530. Potassium-nitrate fumes, ii, 99. Pulsatilla, ii, 107. Pyridine, fumes of, i, 530. Quebracho, ii, 112. Quinine, i, 256; ii, 119. Sanguinaria, ii, 154. Sodium iodide, i, 97. Spermine, ii, 217. Stramonium, ii, 229. and belladonna, i, 529. Strophanthus, ii, 231. Strychnine, ii, 28. Sulphonal, ii, 239. (paroxysm), Sulphuric ether, i, 94. Tartar emetic, i, 114. Terebene, i, 97; ii, 27. Tonics (as an adjunct to other treatment), i, 97. Tribromhydrin, ii, 380. Turpentine oil, vapour of, ii, 336. Tylophora, ii, 337. Zinc oleostearate with oil of pine, ii, 409. " oxide, ii, 406. Asthma, bronchial. Antipyrine, i, 124. Baths, condensed-air, i, 27. Pyridine, ii, 110. Quebracho, ii, 112. Strychnine, ii, 28. Asthma, cardiac. Sparteine, ii, 216. Asthma, hay. Amyl nitrite, i, 528. Arsenic, i, 146. Cannabis indica, i, 207. Carbolic-acid solution (by spray), i, 213. Ethyl-iodide inhalation, i, 528. Asthma, lipocardiac. Air, condensed, inspiration of, i, 28. Asthma, nervous. Amyl nitrite, i, 61. Glycerophosphates, ii, 439. Asthma, spasmodic. Analgene, i, 66. Belladonna, i, 173. Caffeine, i, 201. Carbon dioxide, i, 527. Chamomile oil, i, 231. Chemical means of combating, i, 92. Chloralamide, i. 238. Chloral caffeine (hypodermically), i, 235. Grindelia. i, 456. Nitroglycerin, ii, 15. Physical means of combating, i, 92. Potassium iodide, ii, 99. Stramonium fumigation, i, 430. Zinc oxide, ii, 406. Atelectasis. Air, condensed, inspiration of, i, 28. Douches, cold rectal, i, 349. Atony. Aloes, i, 224. Bitters, i, 183. Canella, i, 206. Chamomile, i, 231. Damiana, i, 324. Electricity, i, 368. Ergot of maize, i, 389. Glycerin, i, 450. Iron carbonate, i, 547. " iodide, i, 551. Lavandula, i, 572. Phosphorus, ii, 76. Quassia, ii, 112. Rue, ii, 137. Atony, cerebral. Phosphorus, ii, 76. Atony, digestive. Bitters, i, 183. Canella, i, 206. Chamomile, i. 231. Iron carbonate, i, 547. Lavandula, i, 572. Atony, gastric. Waters, acidulated (carbonated) chalybeate, ii, 370. Waters, carbonated, ii. 364. " mineral, ii, 375. Atony, general, of the nervous system. Damiana, i, 324. Atony, intestinal. Waters, carbonated, ii. 364. " mineral, ii, 375. Atony of anaemia. Iron sulphate, i. 549. Atony of the bladder. Baths, cold, i, 169. Atony of the lungs and kidneys. Baths, hot, ii, 225. Atony of the nervous system. Damiana, i, 324. Atony of the sexual apparatus in women. Aloes, i, "49. Atony of the stomach. Electricity, i, 368. Quassia, ii, 112. Atony, ovarian. Rue, ii, 137. Atony, uterine. Aloes with iron and with myrrh, i, 224. Ergot of maize, i, 389. Glycerin (intra-uterine injections), i, 450. Rue, ii, 137. Atrophy, brown, of the heart. Saline infusion, ii, 328. Atrophy, muscular. Glycerophosphates, ii, 439. Atrophy of the vagina and cervix uteri. Ichthyol, i, 523. Atrophy, progressive muscular. Galvanism, i, 367. Balanitis. Iodol, i, 540. Zinc sulphocarbolate, ii, 412. Balanoposthitis. Nosophene, ii, 19. 550 INDEX OF DISEASES AND REMEDIES. Balanoposthitis. Silver nitrate, ii, 196. Basedow's disease. See Goitre, Exophthalmic Bedsore. Benzoin tincture, i, 178. Copper-arsenite solutions (in form of a sprav), i, 303. Lead-tannate applications, i, 578. Silver nitrate, ii, 196. Beri-beri. Methylene blue, i, 630. Biliary lithiasis. See Calculus, Biliary. Biliousness. Calomel, i, 624. Ipecac (as an emetic), i, 542. Mercury, i, 619. Podophyllin, ii, 93. Bites, leech. Benzoin tincture, i, 178. Bites, snake. Alcohol, i, 30. Ammonia (hypodermically), i, 53. Arsenic and opium, i, 146. Calatropis, i, 203. Honey, ii, 441. Serum treatment, ii, 188, 189. Strychnine, ii, 29. Bites, venomous. Cupping, i, 320. Honey, ii, 441. Bladder, affections of the. Ammonium citrate, i, 57. Cantharides, i, 208. Cubeb, i, 319. Bladder, irritable. Humulus, i, 474. Blebs, hereditary inclination to the for- mation of. Belladonna, ii, 425. Bleeding. See Haemorrhage. Blennorrhagia. See Gonorrhoea. Blennorrhoea. Cadmium sulphate (solution) injections, i, 200. Zinc sozoiodolate, ii, 410. Blepharitis. Atropine, i, 155. Copper-arsenite solution (in form of a spray) i, 303. Silver nitrate, ii, 195. Blepharitis, chronic marginal. Mercury oxide, i, 623. . Blepharitis marginalis. Silver nitrate, ii, 195. Blepharophthalmia. Pulsatilla, ii, 107. Blepharospasm. Conium, i, 298. Electricity, i, 365. Galvanization, anodal, i, 366. Mydrol, ii, 447. Blisters. Cotton, absorbent, i, 310. Grindelia, i, 456. Lead, Goulard's extract of, i. 577. Zinc oxide, ii, 406. Blood-poisoning. See Septicemia. Boils. . Alkalies (poultice of hardwood ashes), i, 4o. Arnica plaster, i, 141. Asaprol (as an internal antiseptic), i, 148. Calcium sulphide, i, 203. Camphor, spirit of, i, 204. Carbolic acid (parenchymatous), i, 213. Colchicum, i, 291. Hypophosphites, i, 518. Menthol, i, 616. Pyoctanine, ii, 108. Sodium phosphate, ii, 208. Turpentine liniment, ii, 336. (opening of), Vienna paste, i, 228. Yeast, ii, 400. Boils of the external auditory meatus. Menthol, i, 616. Boils, recurrent. Colchicum, i, 291. Bone diseases. See Caries and Necrosis. Bowel complaints, fermentative. Bismuth naphtholate, i, 182. Brain disease. See Cerebral affections. Bright's disease. Diet in, i, 338. Iron chloride, i, 548. Nitroglycerin, ii, 15. Nucleins, ii, 24. Potassium iodide, ii, 98. Strontium lactate, ii, 230. Theobromine, ii, 277. Waters, Buffalo lithia, ii, 372. mineral, ii, 374, 376, 379. " thermal, ii, 364. Bromidrosis. Boric acid (in powder), i, 103. Chromic acid, i, 103, 248. Diachylon ointment, i, 103. Hydrastine, i, 476. Zinc oleate, ii, 405. Bronchial affections. Asafcetida, i, 147. Viola tricolor (syrup), ii, 360. Bronchial congestion. Digitalis, i, 342. Storax (as an expectorant), ii, 228. Bronchiectasis. Creosote by inhalation, i, 314. Terebene, ii, 271. Bronchitis. Air, inspiration of condensed, i, 28. Alum whey, i, 50. Ammonium carbonate, i, 55, 56. Ammonium chloride, i, 56, 418. Amyl nitrite, i, 61. Apomorphine, i, 139. Arsenic, i, 146. Benzene, i, 176. Benzoic acid, i, 177. Benzoin i, 178. Ca.mPh.°r and sweet almond oil (internally) i, 20o. "" Carbolic-acid inhalations, i, 213 Cocillana bark, i, 285. Creosote inhalations, i, 314 Croton oil, i, 318. INDEX OF DISEASES AND REMEDIES. 551 Bronchitis. Cubeb, i, 319. Digitalis, ii, 228. Dulcamara, i, 353. Ethyl iodide, i, 399. Eucalyptol inhalations, i, 529. Eucalyptus, i, 400. Galbanum, i, 482. Goose-grease liniment, i, 454. Grindelia, i, 456. Guaiacol, i, 459. Ice bag, application of the, i, 520. Iodine vapour, i, 536. Iodoform inhalation, i, 540. Ipecac, i, 542. .Jaborandi. i, 559. Kumyss, i, 567. Licorice, i, 580. Mustard plaster, i, 647. Myrtol, i, 652. Nitric acid, ii, 8. Nuclein, ii, 24. Olibanum, ii. 34. Opium (small doses), ii, 37. " fumes of, i, 529. Oxygen, ii, 52. Ozone inhalation, ii, 58. Palmetto wine, ii, 58. Piscidia, ii, 91. Pix liquida, ii, 91. Potassium iodide, ii, 98. Poultices, ii, 101. Pulsatilla, ii, 107. Quinine, i, 526; ii, 119. Sandal-wood oil, ii, 153. Sanguinaria, ii, 154. Senega (as a stimulating expectorant), ii 162. Squill, ii, 221. Steam, ii, 220. Sulphur, ii. 240. Sumbul, ii, 248. Tanosal, ii, 261. Tepid baths, i, 489. Thymol inhalation, ii, 283. Tribromhydrin (as an expectorant), ii, 330. Turpentine oil (internally), ii, 336. " stupes, ii, 335. Zinc oleostearate with oil of pine, ii, 409. Bronchitis, acute. Balsamum pulmonum (as an expectorant) ii, 241. Eucalyptus, oil of, i, 400. Ipecac, i, 373. Sanguinaria, ii, 154. Squill, ii, 221. Terebene, ii, 271. Terpin hydrate, ii, 272. Tribromhydrin, ii, 330. Waters, chlorinated alkaline, ii, 381. Bronchitis, capillary (of children). Oxygen, ii. 52. Steam, i. 528; ii, 220. Bronchitis, catarrhal. Horehound, i, 473. Bronchitis, chronic. Air, inspiration of condensed, i. 28. Alum whey, i, 50. Ammonium carbonate (as an expectoran 55, 50. Bronchitis, chronic. Ammonium chloride, i, 418. Apomorphine, i, 139. Arsenic, i, 146. Benzene, i, 176. Benzoic acid, i, 177. Benzoin, i, 178. Carbolic-acid inhalation, i, 213. Creosote by inhalation, i, 314. Croton oil," i, 318. Cubeb, i, 319. Digitalis (as a diuretic), ii, 228. Eucalyptol inhalation, i, 529. Eucalyptus, oil of, i, 400. Galbanum (internally), i, 432. Guaiacol, inhalations of, i, 459. Iodine vapour, i, 536. Ipecac, i, 542. Iron chloride (tincture), i, 548. Kumyss, i, 567. Nitric acid, ii, 8. Opium, i, 508. Pix liquida, ii, 91. Potassium iodide, ii. 98. Quinine, i, 256: ii, 119. Squill, ii, 221. (dry form), Steam spray, ii, 220. Sulphur, ii, 240. Sumbul, ii, 243. Tanosal, ii, 261. Terebene, ii, 271. Terpin hydrate, ii, 272. Terpinol, ii, 272. Bronchitis, foetid. Naphthalene, ii, 1. Salicylic-acid inhalation, ii, 143. Terebene, ii, 271. Turpentine oil, vapour of, ii, 336. Bronchitis of the aged. Wine, port, ii, 393. Bronchitis, subacute. Ammonium-chloride troches, i, 57. Cubeb cigarettes, i. 430. Bronchocele, cystic. See Goitre. Bronchopneumonia. Aconite (as a sedative), i, 9. Camphor and sweet-almond oil (internally), i, 205. Cocillana bark, i, 285. Gavage, i, 436. Guaiacol applications, ii, 437. Paraldehyde, ii, 63. Pilocarpine, ii, 86. Bronchopneumonia, acute. Potassium iodide, ii, 98. Bronchopneumonia, chronic. Tanosal, ii, 261. Bronchorrhoea. Air, condensed, inspiration of, i, 28. " rarefied, expiration into, i, 28. Apomorphine, i, 139. Blennostasine, ii, 426. Gallic acid, i, 432. Naphthalene, ii, 1. Waters, chlorinated alkaline, ii, 381. Zinc oxide, ii, 406. " sulphate, ii, 407. I, i, Bronchorrhoea, foetid. Guaiacol, inhalation of, i, 459. 552 INDEX OF DISEASES AND REMEDIES. Bruises. Ammonium acetate, i, 54. Benzoin tincture, i, 178. Calendula, i, 203. Chaulmoogra oil, i, 233. Hamamelis, i, 467. Lead, Goulard's extract of, i, 577. Massage a friction, i, 609. Salubrine, ii, 152. Stupes, hot-water, ii, 233. Buboes. Carbolic acid (parenchymatous injections), i, 213. Cupric sulphate solution (injections), i, 306. Sanoform, ii, 154. Silica, hydrated, ii, 191. Silver nitrate (injections), ii, 196. Xeroform, ii, 397. Buboes, suppurating. Iodoform injection, i, 539; ii, 444. Iodol, i, 540. Burns. Aristol, i, 140. Basilicon ointment, ii, 135. Borax, i, 189. Cantharides tincture (topically), i, 208. Carbolic acid, i, 213. Carron oil, i, 582. Chalk powder, i, 230. Chloral hydrate, i, 237. Collodion, i, 293. Cotton, absorbent, i, 310. Creosote, i, 314. Dermatol, i, 329. Euphorin (as a local disinfectant), i, 402. Europhene, i, 402. Flour, wheat, i, 423. Ichthyol, i, 522. Lead liniment, i, 578. Lint, i, 584. Magnesia, calcined, ii, 445. Massage, i, 609. Picric acid, ii, 83. Piscidia, ii, 91. Potassium nitrate, ii, 99. Rhigolene, ii, 129. Rye flour, ii, 137. Sodium bicarbonate, ii, 205. Tannic acid, ii, 257. Terebene, ii, 271. Thioform, ii, 278. Thiol (solid), ii, 278. Transfusion, ii, 323. Turpentine liniment, ii, 335, 336. Xeroform, ii, 397. Zinc oxide, ii, 406. Cachexia. Cod-liver oil, i, 288. Linseed .oil (as a nutrient), i, 584. Transfusion, ii, 323. Cachexia, malarial. Arsenic, i, 145. Carbolic acid and iodine, i, 212. Hydrastine, i, 476. Quinine, i, 255; ii, 118. Waters, Buffalo lithia, ii, 372. " ferruginous, ii, 369. Cachexia, mercurial. Somatose, ii, 212. Cachexia of children. N itrohydrochloric acid (for sponging), n, 16. Calculus. Waters, mineral, ii, 379. Calculus, biliary. Boldo, i, 189. Chloroform, i, 245. Glycerin, i, 451. Limewater, i, 582. Massage, abdominal, i, 608. Olive oil, ii, 35. Salacetol, ii, 39. Sodium phosphate, ii, 79, 208. Strophanthus, ii, 231. Urotropine, ii, 343. Waters, chlorinated alkaline, ii, 381. " mineral, ii, 375, 376. Calculus, cystic. Urotropine, ii, 343. Waters, alkaline, ii, 367. Calculus, renal. Strophanthus, ii, 231. Waters, alkaline, ii, 367. " mineral, ii, 384. Calculus, uric-acid. Urotropine, ii, 343. Calculus, vesical. See Calculus, Cystic Cancer. Alcohol, i, 31. Alveloz, i, 51. Arsenic (as a caustic and in superficial forms), i, 144. Atropine applications, i, 154. Bismuth and morphine (for relief of pain), i, 180. Bromine, i, 195. Calcium carbide, ii, 427. Carbonic water, i, 314. Chelidonium, ii, 431. Chromic acid, i, 248. Condurango, i, 297. Conium, i, 298. Formic-acid compounds, i, 429. Gold, i, 454. Hydrastine, i, 476. Iodol, i, 540. Iron, reduced, i, 547. Loretin, i, 588. Orchitic liquid, i, 75. Pepsin, ii, 69. Permanganates, ii, 70. Potash, i, 228. Salicylic acid, ii, 145. Salol, camphorated, ii, 150. Serum treatment, ii, 185, 186. " (Richet and Hericourt's method), ii, 185. Silica (for relief of pain), ii, 191. Smith's paste, ii, 64. Sodium chlorate, ii, 206. " phosphate, ii, 208. Steam, ii, 222. Terebene and olive oil, ii, 271. Testicle juice, i, 75. Toxines, ii, 313, 315. X rays, ii, 398. Cancer, laryngeal. Formic-acid compounds, i, 429. INDEX OF DISEASES AND REMEDIES. 553 Cancer, sloughing, of the cervix uteri. Terebene and olive oil, ii, 271. Turpentine, Chian, locally and internally, ii, 335. Vienna paste, i, 228. Cancer of the bladder. Pichi, ii, 82. Cancer of the breast. Calcium carbide, ii, 427. Cancer of the rectum. Belladonna, i, 175. Cancer of the stomach. Charcoal, i, 232. Condurango, i, 297. Pepsin, ii, 69. Somatose, ii, 213. Water, i, 479. X rays, ii, 398. Cancer of the uterus. Alcohol (interstitial injections), i, 31. Bromine, i, 195. Calcium carbide, ii, 426. Chromic acid, i, 248. Salicylic-acid injections, ii, 145. Sodium chlorate (for palliative treatment), ii, 206. Zinc sulphate, ii, 407. Cancer, ulcerating. Conium applications, i, 298. Hydrastine, i, 476. Cancrum oris. Copper-arsenite solution (in form of a spray), i, 303. Nitric acid (fuming), i, 227. Carbuncle. Calcium sulphide, i, 203. Carbolic acid (parenchymatous injections), i, 213. Iodol, i, 540. Permanganates, ii, 70. Salol, camphorated, ii, 150. Sodium phosphate, ii, 208. Turpentine liniment, ii, 336. Vienna paste, i, 228. Carcinoma. See Cancer. Cardiac depression. Tea, ii, 265. Cardiac disease. See Heart disease. Cardiac excitement. Bromidia, i, 195. Cardiac failure. Amyl nitrite, i. 528. Duboisine, i, 353. Ether (hypodermically), i, 397. Cardiac feebleness. Egg and brandy, i, 355. Cardiac incompetency from overstrain. Convallaria, i, 300. Cardiac neuroses. Arsenic, i, 146. Zinc cyanide, i, 323; ii, 408. Cardiac pain. See Angina pectoris. Cardiac tension, abnormal, of renal dis- ease. Veratrum viride, ii, 353. Caries. Calcium chloride, i, 202. Caries. Cod-liver oil, i. 288. Hydrochloric acid, ii, 441. Hypophosphites, i, 518. Phosphoric acid, ii, 77. Potassium permanganate, i, 597. Waters, chlorinated, ii, 366. Caries, dental. Collodion, i, 293. (in children), Calcium phosphate, i, 202. Creosote collodion, i, 292. Silver nitrate, solid, i, 136. Caruncles of the female urethra. Zinc sulphate, ii, 407. Caseous glands. See Glands, Caseous. Catalepsy. Amyl nitrite, i, 61. Faradaism, i, 366. Thyreoid treatment, ii, 298. Cataract. Cineraria, i, 258. Eserine, i, 392. Massage, i, 610. Cataract, incipient. Homatropine, i, 472. Catarrh. Air, condensed, inspiration of, i, 28. Alum (by irrigation), i, 50. Aluminum borotannicotartrate, ii, 414. Ammonium hydrosulphide, i, 57. Anthemis inhalations, i, 231. Arsenic, i, 146. Balsamic fumes, i, 259. Baths, condensed-air, i, 27. " sulphur, i, 173. Bismuth powder, i, 181. Boric acid (saturated solution), i, 191. Bromine vapour, i, 196. Cantharides, i, 346. Carbonic-acid inhalation, ii, 430. Cimicifuga, i, 250. Copaiba, i, 445. Copper-arsenite solution, i, 303. Coto bark, i, 309. Cubeb, i, 319. " cigarettes, i, 43. Eucalyptol, i, 402. Europhene (by insufflation), i, 402. Formaldehyde, i, 428. Geosite, ii, 438. Ginger troches, i, 449. Guaiacol, i, 457. Hydrastis, i, 475. Ipecac, i, 542. Licorice, i, 580. Menthol solution (by injection), i, 614. Nucleins, ii, 24. Orexine hydrochloride, ii, 457. Oxygenated water and hydrogen-dioxide so- lution (by inhalation), ii. 52. Pinus pumilio, oil of, ii, 88. Pulsatilla, ii, 107. Quinine, i, 255. Salol, ii, 150. Salumine, ii, 152. Sanguinaria, ii, 154. Sesame oil, ii, 190. Silver nitrate, ii, 194. Sodium chloride, ii, 206. 554 INDEX OF DISEASES AND REMEDIES. Catarrh. Sodium sozoiodolate, ii, 208. Solanum paniculatum, ii, 210. Steam, i, 418. Tannal, ii, 254. Tannalbin, ii, 254. Tanosal, ii, 261. Tartar emetic, i, 114. Turpentine, i, 345. Water, i, 479. Waters, alkaline, i, 45. " mineral, ii, 375, 384. " sfidium sulphate, ii, 368. " thermal, ii, 364. Wine, ii, 394. " port, ii, 393. Xeroform (internally), ii, 397. Zinc salicylate, ii, 410. " sulphichthyolate, ii, 412. Catarrh, acute. Ammonium acetate, i, 54. Baths, condensed-air, i, 27. Pulsatilla, ii, 107. Catarrh, acute nasal. Bismuth powder (used as a snuff), i, 181. Copper-arsenite solution (in form of a spray), i, 303. Cubeb, i, 319. Catarrh, apical. Air, condensed, inspiration of, i, 28. Catarrh, atrophic pharyngeal. Coto bark, i, 309. Catarrh, bronchial. Apomorphine (as an expectorant), i, 139. Baths, condensed-air, i, 27. Cimieifuga, i, 250. Cubeb cigarettes, i, 430. Ipecac, i, 542. Licorice, i, 580. (associated with general asthenia), Waters, chlorinated (externally and internally), ii, 366, 367. Waters, sulphuretted, ii, 371. Catarrh, chronic. Ammonium chloride, i, 528. Copper-arsenite solution (in form of a spray), i, 303. Dulcamara, i, 353. Myrtol, i, 652. Zinc sulphichthyolate, ii, 412. Catarrh, chronic bronchial. Iodol (by insufflation), i, 540. Catarrh, chronic duodenal. Waters, mineral, ii, 384. Catarrh, chronic gastric. Arsenic, i, 146. Hydrastis, i, 475. Oxygenated water and hydrogen-dioxide so- lution (by inhalation), ii, 52. Quinine, i, 255. Silver nitrate, ii, 194. Catarrh, chronic gastroduodenal. Alkaline mineral waters, i, 45. Catarrh, chronic intestinal. Ammonium borate, i, 55. Sesame oil, ii, 190. Tannalbin, ii, 254. Waters, sodium-sulphate, ii, 368. Catarrh, chronic nasal. Ammonium chloride, i, 528. Catarrh, chronic, of the bladder. Pulsatilla, ii, 107. Catarrh, chronic, of the gastrointestinal and genito-urinary tracts. Guaiacol, i, 457. Catarrh, chronic, of the middle ear. Massage, i, 610. Catarrh, chronic, of the rectum. Cubeb, i, 319. Menthol inhalation, i, 529. Ozone inhalation, ii, 58. Sanguinaria. ii, 154. Waters, chlorinated alkaline, ii, 381. " " " (externally and internally), ii, 381. Waters, thermal, ii, 364. Catarrh, dry, of the nose and pharynx. Salumine (by insufflation), ii, 152. Catarrh, gastric. Eucalyptol, i, 400. Hamamelis, i, 467. Nux vomica, ii, 28. Papain, ii, 60. Salicylic acid, ii, 143. Sesame oil, ii, 190. Waters, chlorinated, ii, 366. " mineral, ii, 375. Catarrh, gastro-duodenal. Sanguinaria, ii, 154. Sodium phosphate, ii. 208. Catarrh, gastro-intestinal. Water, i, 479. Catarrh, hepatic. Salol, ii, 150. Catarrh, intestinal. Eucalyptol, i, 400. Grape cure, i, 455. Oxygenated water and hydrogen-dioxide so- lution (locally through the stomach-tube), ii, 52. Pulsatilla, ii, 107. Salol, ii, 150. Waters, mineral, ii, 375. Wine, ii, 394. Xeroform (internally), ii, 397. Catarrh, laryngeal. Balsamic fumes, i, 529. Baths, condensed-air, i, 27. Catarrh, nasal. Boric acid (saturated solution), i, 191. Bromine vapour, i, 196. Carbolic-acid solution (by spray), i, 213. Menthol solution (by injection), i, 614. ' Sodium chloride (as a gargle), ii, 206. " sozoiodolate, ii, 208. Zinc salicylate, ii, 410. Catarrh, nasopharyngeal. Nucleins, ii, 24. Catarrh of the air-passages. Steam, i, 418. Catarrh of the bile ducts. Salol, ii, 150. Silver nitrate, ii, 194. Waters, mineral, ii, 384 Catarrh of the bladder. Solanum paniculatum, ii, 210. Tannin injections, ii, 256 Catarrh of the digestive tract. Arsenic, i, 146. Cubeb, i, 319. INDEX OF DISEASES AND REMEDIES. ooo Catarrh of the digestive tract. Eucalyptol, i, 40(1. Geosite. ii, 488. (iuaiacol, i, 457. Hydrastis, i, 475. Orexine hydrochloride, ii, 451. Oxygenated water and hydrogen-dioxide lution (by inhalation), ii, 52. Quinine, i, 255. Salol, ii, 150. Sanguinaria, ii, 154. Sesame oil, ii,-190. Silver nitrate, ii. 194. Tannalbin, ii, 254. Water, i, 479. Waters, alkaline, i, 45. " mineral, ii, 384. " sodium sulphate, ii, 368. Wine, ii, 394. Xeroform, ii, 397. Catarrli of the gall bladder and ducts. Waters, sodium-sulphate, ii, 368. Catarrh of the genitourinary tract. Bismuth, i, 181. Cantharides, i, 845. Formaldehyde, i, 428. Guaiacol, i, 457. Pulsatilla, ii, 107. Solanum pulsatilla, ii, 210. Turpentine, i, 345. Waters, thermal, ii, 864. Catarrh of the respiratory tract. Air, condensed, inspiration of, i, 28. Anthemis inhalations, i, 231. Apomorphine (as an expectorant), i, 139. Asclepias tuberosa, i, 148. Balsamic fumes, i, 259. Baths, condensed-air, i, 27. Bismuth powder, i, 181. Boric acid (saturated solution), i, 191. Bromine vapour, i, 196. Carbonic-acid inhalation, ii, 430. Cimicifuga, i, 250. Copper-arsenite solution, i, 303. Coto bark, i, 309. Cubeb cigarettes, i, 43. Ginger troches, i, 449. Ipecac, i, 542. Licorice, i, 580. Menthol solution (by injection), i, 614. Nucleins, ii, 24. Salumine (by insufflation), ii, 152. Sodium chloride, ii. 206. " sozoiodolate, ii, 208. Steam, i, 418. Tanosal, ii, 261. Tartar emetic, i, 114. Waters, chlorinated, ii, 366, 367. Zinc salicylate, ii. 410. " sulphichthyolate, ii, 412. Catarrli of the throat and bronchi. Tanosal, ii, 261. Catarrli of the throat and mouth. Ginger, troches of, i, 449. Catarrli of the upper air-passages. Anthemis inhalation, i, 231. Catarrli of the urinary mucous membrane. Buchu, i, 197. Catarrh of the vagina and cervix uteri. Formaldehyde, i, 428. 79 | Catarrh of the vagina and cervix uteri. Iodol, i, 540. Rosinal, ii, 135. Catarrh, pharyngeal. Baths, condensed-air, i, 27. Catarrh, pulmonary. Balsamic fumes, i, 529. Catarrh, respiratory. Chamomile, i, 231. Podophyllin, ii, 93. Catarrh, subacute intestinal. Tannalbin, ii, 254. Catarrh, subacute nasal. Baths, condensed-air, i, 27. Catarrh, uterine. Douche, hot, i, 480. Grindelia, i, 450. Rosinal, ii, 135. Catarrh, vaginal. Formaldehyde, i, 428. Iodol, i, 540. Rosinal, ii, 135. Catarrh, vesical. See Catarrh of the bladder. Catatonia. Thyreoid treatment, ii, 299. Cellulitis, pelvic. Arnica, fluid extract of (internally), i, 141. Baths, hot sitz, i, 169. Electricity, i, 368. Glycerin suppositories, ii, 450. Heat, i, 468. Ice applications, i, 520. Ichthyol, i, 523. Cephalalgia. See Headache. Cerebral affections. Bloodletting, i, 188. Cathartics, i, 224. Colocynth (as a revulsive), i, 296. Elaterium, as a revulsive and depleting agent, i, 358. Electricity, i, 366. Gavage. i, 436. Salicylated camphor, i, 204. Trional, ii, 332. Urethane, ii, 342. Cerebral excitement. Cold plunge, i, 488. Cerebral exhaustion. Damiana, i, 324. Cerebral exhaustion from overwork. Bromides, ii. 6. Cerebral irritation from drink. Veratrum viride, ii, 353. Chancres. Alumnol, i. 51. Calcium salicylate, ii, 145. Europhene (in powder or ointment), i, 402. Hydrogen dioxide, i, 503. Iodoform collodion, i, 293. Nosophene, ii, 19. Pixol, ii, 92. Pyrogallic acid, ii. 111. Sanoform, ii, 154, 200. Silver nitrate, ii, 196. " oxide, ii, 197. Sulphuric acid and asbestos, ii, 241. " " " charcoal, ii, 242. 556 INDEX OF DISEASES AND REMEDIES. Chancres. Sulphuric acid and saffrdn, ii, 242. Traumatol, ii, 829. Chancroids. Alumnol, i. 51. Carbolic acid (parenchymatous injections), i, 213. Europhene (in powder or ointment), i, 402. Hydrogen dioxide, i, 503. Iodoform collodion, i, 293. Iodol, i, 540. Mentho-phenol, ii, 61. Nitric acid, ii, 7. Resorcin, ii, 126. Silica, hydrated, ii, 191. Silver nitrate, ii, 196. " oxide, ii, 197. Xeroform, ii, 397. Chapped and fissured hands and lips. Benzoin and glycerin, i, 178. Chilblains. Aconite, i, 9. Alum curd (cataplasm), i, 5a Baths, cold foot, i, 170. Capsicum paper, i, 209. Cocaine collodion, i, 292. Creosote, i, 314. Iodine, i, 536. Petroleum, ii, 70. Phulluah, ii, 79. Resorcin and ichthyol, ii, 126. Chills, malarial. See Fever, Malarial. Chills, urethral. Quinine, ii, 117. Strophanthus, ii, 232. Chloasma. Iodine, i, 536. Chlorosis. Air, condensed, inspiration of, i, 28. Arsenic, i, 145. " (as an emmenagogue), i, 374. Baths, sulphur, i, 173. " condensed-air, i, 28. Champagne, ii, 392. Cold douche, i, 491. Copper arsenite, i, 303. Creolin, i, 313. Ferratin, i, 422. Galbanum (internally), i, 432. Geosite, ii, 438. Glycerophosphates, ii, 439. Gold, i, 454. Hemalbumin, i, 463. Hydrochloric acid, i, 493. Iron (as an emmenagogue), i, 374. " albuminate, i, 553. " carbonate, i, 547. " chloride (ethereal tincture), i, 548. " iodide, i, 551. " lactate, i, 551. " tannate, ii, 259. " valerianate, ii, 346, 348. Manganese (as an emmenagogue), i, 374. " and iron, i, 596. Ovarine, ii, 451. Oxygen, ii, 52. • Peptomangan, ii, 69, 70. Somatose, ii, 212. Strophanthus, ii, 232. Chlorosis. Strychnine, with iron and quinine, ii, 28. Sulphur, ii, 240. Transfusion and infusion, ii, 322. Trefusia. ii, 32!). Waters, ferruginous, ii, 369. Wines, ii, 894. Zincohannol, ii, 412. Chlorosis, progressive. Arsenic, i. 145. Wines, ii, 394. Cholemia. Transfusion, depletory, ii, 323. Cholera. Acids, mineral, i, 6. Baths, hot, i, 160. (algid state). Baths, mustard, i, 172. Calomel, i, 624. Camphor, i, 206. Cantani's treatment, ii, 257. Carbolic acid, i, 212. (algid state), Chloral hydrate (hypodermical- ly), i, 237. Copper arsenite (enema), i, 304. Coto bark (injections), i, 307. Creolin, i, 313. Creosote, i, 314. Eucalyptol, i, 400. (algid state), Heat, i, 468. " dry, ii, 225. Infusion, intravenous or subcutaneous, ii, 324, 325. Naphthol, ii, 2. Opium, ii, 36. Paraform, ii, 61. Quinine, ii, 119. Saligenin, ii, 147. Serum, artificial, ii, 164. " treatment, i. 83; ii, 187. Sulphuric acid, ii, 242. Sumbul, ii, 243. Tannin (Cantani's treatment), ii, 257. Transfusion, ii, 323. Cholera, collapse from. Opium, ii, 36. Cholera, hog. Serum treatment, ii, 188. Cholera infantum. Baths, hot mustard, i, 490. Bismuth phosphate, ii, 426. " salicylate, ii, 145. Bromides, i, 194. Bromol, i, 197. Carbolic acid and bismuth, i, 212. Castor oil, i, 220. Chalk, i, 230. Copper arsenite, i, 303, 305. " (enema), i, 304. Creosote, i, 314. Muscarine, i, 645. Paraform, ii, 61. Serum, cow's (subcutaneous injections), ii 168. Silver nitrate, ii, 194. Sodium salicylate, ii, 146. Zinc sulphocarbolate, ii, 411. Cholera morbus. Camphor, oil of, i, 205. Carbolic acid and bismuth, i, 212 Copper arsenite, i, 303, 305. INDEX OF DISEASES AND REMEDIES. 557 Cholera morbus. Copper arsenite (enema), i, 304. Creosote, i, 814. Zinc sulphocarbolate, ii, 411. Cholerine, Camphor, i, 205. Chord ee. ('old sitz baths, i, 489. Gallobromol,(by injection), i, 433. Humulus, i, 474. Ice. applications of, i, 90. Veratrum viride, i, 90. Chorea. Acetanilide, i, 4. Ammonium carbonate, i, 56. Antipyrine, i. 124. Arsenic, i, 145. Baths, alkaline, i, 171. Cerium oxalate, i, 229. Chloralamide, i, 238. Chloral hydrate, i, 237. Chloralose, i, 239. (of uterine trouble), Cimicifuga, i, 250. (of rheumatic taint), Cimicifuga, i, 250. Cod-liver oil, i, 288. Cold affusions, i, 17. Conium, i, 298. Copper, ammoniated, i, 303. Curare, i, 321. Eserine, i, 392. Exalgine, i, 403. Faradaism, i, 366. Gallobromol, i, 433. Gelsemium, i, 437. Gold bromide, i, 454. Heat, i, 468. Iron bromide, i, 553. Lobelia, i, 587. Orchitic liquid, i, 75. Picrotoxin, ii, 84. Piscidia, ii, 91. Quinine, ii, 120. Rest-cure, ii, 127. Solanum carolinense, ii, 209. Spermine, ii, 217. Strychnine, ii, 28. Sulphonal, ii, 239. Tartar emetic, i, 113. Testicle juice, i, 75. Trional, ii, 333. Valerian, ii, 345. Warm pack, i, 469. Waters, ferruginous, ii, 369. Wines, ii, 394. Zinc cyanide, i, 323. " iodide (internally), ii, 405. " salts, ii, 401. Chorea, acute. Wines, ii, 394. Chorea, hysterical. Chloralose, i, 289. Chyluria. Thymol and gallic acid, ii, 283. Cicatrices. Thiosinamine, ii, 280, 281. Circulation, engorgement of the hepatic and portal. Alkaline mineral waters, i, 45. Circulation, irregularities of. Convallaria, i, 300. Cirrhosis. Potassium iodide, ii. 98. Cirrhosis of the liver. Alkaline mineral waters, i, 45. Arsenic, i, 146. Carlsbad salts, i, 224. Copaiba, i, 302. Iodoform, i, 537. Nitric acid, ii, 8. Waters, sodium-sulphate, ii, 368. Coccygodynia. Galvanization, stabile anodal, i, 366. Coeliac disease (in children). Bismuth (in large doses), i, 181. Colds. See Coryza. Colic. Alcohol, i, 33. Alum, i, 50. Ammonia water, i, 54. Ammonium borate, i. 55. Amyl valerianate, i. 62. Anhalonium Lewinii, ii, 416. Antacids, i, 86. Blisters, small flving (to the abdomen), i, 186. Cajeput, i, 201. Camphor, i, 205. oil of. i, 205. Capsicum, i, 209. Chamomile poultice, i, 231. Chloroform, i. 245. Cinnamon, i, 259. Codeine, i, 286. Corn silk, i, 306. Ether (internally), i, 397. Glycerin, i, 451. Linseed tea, ii, 269. Mustard applications, i, 312. Nitroglycerin, ii, 15. Nutmeg, ii. 25. Peppermint infusion, i, 613. Pichi, ii, 82. Piperazine, ii, 89. Sassafras, ii, 156. Stupes, hot, with oil of turpentine, ii, 233. Sulphur, ii, 240. Tribulus lanuginosus, ii, 330. Zinc cyanide, i, 323. Colic, biliary. Chloroform inhalation, i, 245. Electricity, i, 586. Glycerin, i, 451. Nitroglycerin, ii, 15. Olive oil, ii, 35. Solanum paniculatum, ii, 210. Sulphur, ii, 240. Vichy water, ii, 358. Water, i, 586. Colic, flatulent. Calamus, i, 201. Capsicum, i, 209. Chamomile, i, 231. Sassafras, ii, 156. Colic, lead, Colic, painter's. Alum, i, 50. Olive oil, ii, 35. Potassium iodide, ii, 98. Tobacco-smoke enema, ii, 304. 558 INDEX OF DISEASES AND REMEDIES. Colic, renal. Amvl valerianate, i, 62. Chloroform inhalation, 1, 24o. Corn silk, i, 306. Linseed tea, ii, 269. Nitroglycerin, ii, 15. Pichi, ii, 82. _ Piperazine, ii. 89. Colic, saturnine. See Colic Lead. Colic, spasmodic. Alcohol, i, 33. Waters, Buffalo lithia, ii, 3*2. Colitis. . Bismuth injections, l, 181. Colitis, chronic catarrhal. Balsams, i, 160. Colitis, septic. Irrigation of the rectum and colon, l, oo4. Collapse. Acetic ether, i, 5. Ammonia (intravenously), i, 53 ; n, 227. Atropine (hypodermically), i, 156. Blisters, i, 186. Camphorated oil (hypodermically), n, 6. Capsicum tincture, i, 209. Champagne, ii, 393. Ether (subcutaneously), i, 397. Heat, application of, i, 468. Oxygen, ii, 52. Strophanthus, ii, 231. Collapse from cholera. Opium, ii, 36. Collapse of fevers. Champagne, ii, 393. Colpitis, ulcerative. Cupric-sulphate solution, i, 306. Coma. Blisters, 1, 186. Cold affusions, i, 17. Oxygen, ii, 52. Coma of typhus fever. Opium treatment of, ii, 128. Valerian, ii, 345. Condylomata. Acetic acid, i, 5. Chromic acid, i, 248. Europhene, in powder or ointment, i, 402. Nitric acid, ii, 7. " (fuming), i, 227. Salicylic acid and (glacial) acetic acid, i, 225. Congestion (hepatic or splenic). Baths, hot-air, i, 168. Elaterium, as a revulsive and depleting agent, i, 358. Congestion, acute. Hunyadi Jtinos, i, 474. Congestion, acute abdominal. Poultices, ii, 101. Congestion, acute cerebral. Bloodletting, i, 188. Congestion, cephalic. Baths, cold foot, i, 170. Congestion, cerebral. See Cerebral affections. Congestion, chronic. Taraxacum, ii, 265. Congestion, chronic, of the intestines, liver, and pelvic organs. Hunyadi Janos, i, 474. inter- Congestion from cold. Jaborandi, i, 559. Congestion, hepatic. Ammonium chloride, l, 5b. Hepatic douches, i, 349. _ Waters, alkaline carbonated, n, 3«.'>. chlorinated (externally and nally), ii, 365. Waters, sulphuretted, n, 371. Congestion, intracranial. Chpping applied to the nape of the neck, i, 320. Congestion, local. Scarification, ii, 158. Congestion, malarial, of the liver. Gamboge and calomel, i, 433. Congestion, mammary- Collodion (applied to the whole breast), i, 294. . , . Congestion of the abdominal viscera. Baths, mustard, i, 172. Congestion of the kidneys. Digitalis, i, 342. Strophanthus, ii, 231. Congestion of the lungs. Digitalis, i, 342. Strophanthus, ii, 231. Congestion of the spinal cord. Ergot, i. 388. Congestion, passive. Convallaria, i, 300. Congestion, passive uterine. Baths, i, 169. Congestion, portal. Chionanthus virginica, i, 234. Jalap, i, 560. Podophyllin, ii, 93. Congestion, prostatic. Rectal douches, i, 349. Congestion, pulmonary. Air. condensed, inspiration of, i, 28, Baths, cold foot, i, 170. Convallaria, i, 300. Congestion, renal. Corn silk, i, 306. Poultices, ii, 102. Waters, chlorinated alkaline (externally and internally), ii, 381. Congestion, superficial. Ice (topically), i, 519. Congestion, uterine. Arsenic, i, 146. Glycerin suppositories, i, 450. Congestion, venous, of mitral and tricus- pid disease. Digitalis (as a diuretic), ii, 228. Conjunctivitis. Antipyonine (weak solutions), i, 120. Argonin, ii, 197. Bismuth tannate, ii, 259. Borax (5-per-cent. solution), i, 189. Boric acid, i, 191. Calomel insufflation, i, 556. Cod-liver oil, i, 288. Collodion, i, 294. Copper arsenite, i, 805. Cupric acetate applications, i. 303. " sulphate solution (locally), i, 306. EthyJ chloride, ii, 424. Formaldehyde, i, 428. INDEX OF DISEASES AND REMEDIES. 559 Conjunctivitis. Gallicin. i, 482. Hydrastine, i, 476. Leeching, i, 579. Mercury oxide, i, 623. Phytolacca, ii, 81. Pilocarpine, ii, 96. Pulsatilla, ii, 107. Pyoctanine, ii, 108. Scarification, ii, 158. Silver nitrate, ii, 195. Suprarenal capsule, ii, 247. Thioform, ii, 278. Zinc acetate (as a local astringent), ii, 402. " oxide (as a collyrium), ii, 406. " tannate, ii, 412.' Conjunctivitis, acute. Copper arsenite, i, 305. Mercury oxide (ointment), i, 623. Conjunctivitis, aphthous. Collodion, i, 294. Conjunctivitis, catarrhal. Argonin. ii, 197. Conjunctivitis, chronic. Zinc-chloride applications, ii. 405. Zinc iodide (as a collyrium), ii, 405. Conjunctivitis, diphtheritic. Zinc-chloride applications (with caution), ii, 405. Conjunctivitis, gonorrhceal. Zinc-chloride applications (with caution), ii, 405. Conjunctivitis, granular. Copper, aluminated, applications, i, 303. Hydrastine, i, 476. Phytolacca, ii, 81. Conjunctivitis, phlyctenular. Calomel (by insufflation), i, 556. Conjunctivitis, purulent. Antipyonine (strong solution), i, 120. Argonin, ii, 197. Silver nitrate, ii, 195. Conjunctivitis, scrofulous, of children. Zinc-oxide applications, ii, 406. Conjunctivitis, subacute. Cupper arsenite, i, 305. Constipation. Aloes, i, 48. Asafcetida, i, 147. Baths, cold, i, 169. Cannabis indica, i, 207. Castor oil, i, 220. Cathartinic acid, i, 225. Cetrarin, i, 230. Colocynth. i. 296. Cream, i, 222. Croton oil, i, 318. Electricity applied to the abdomen, i, 368. Ephedra, "i, 385. Frangula, i, 429. Glycerin injections, i. 450, Hunyadi Janos, i, 474. Ichthyol, ii, 448. Juglans, i, 563. Leptandra, i, 580. Licorice, compound powdered, i, 581. Lobelia, i. 587. Nux vomica, ii, 28. Oatmeal, ii. 31. Olive oil, ii, 35. Constipation. Ox-gall, ii, 49. Podophyllin, ii, 93. Rhamnus purshiana, ii, 129. Rhubarb, ii, 130. Rye, ii, 137. Scammony, ii, 157. Seidlitz powders, ii, 161. Senna, ii, 162. Sesame oil, ii, 190. Sodium sulphite, ii. 208. Splenic extract, ii, 218. Sulphur and cream of tartar, ii, 241. Taraxacum, ii, 265. Water, i, 222, 479. Waters, chlorinated (externally and inter- nally), ii, 365. Waters, mineral, ii, 376. Constipation, chronic. Hunyadi Janos, i, 474. Nux vomica (extract), ii, 28. Oatmeal, ii, 31. Ox-bile, ii, 49. Rhamnus purshiana, ii, 129. Rye, ii, 137. Sesame oil. ii, 190. Sulphur and cream of tartar, ii. 241. Waters, mineral, ii, 379. " simple thermal (internally), ii, 364. Constipation, obstinate. Baths, cold, i. 169. Croton oil, i. 318. Ichthyol, ii, 443. Scammony, ii, 157. Consumption. See Tuberculosis. Pulmonary. Contractions, uterine, induction of. Faradaism, i, 366. Mammary irritation, ii, 56. Contusions. Alcohol, i, 29. Collodion, saturnine, i, 293. Convalescence. Canella, i, 206. Chamomile, i, 231. Guarana, i, 461. Convalescence from fevers. Nutrose, ii, 449. Convalescence of acute disease. Kumyss, i, 567. Convalescence of prolonged disease. Wines, ii, 225. Convalescence, tardy. Ergot and sodium phosphate, i, 389. Convulsions. Ammonium succinate, i, 58. Amvl nitrite, i, 528. Baths, hot, i. 166. (of adults), Bloodletting, i, 188. Chloral hydrate, i, 237. Chloroform inhalation, i, 245. Curare, i, 321. Lobelia, i, 587. (of dentition), Sulphonal, ii, 239. Valerian, ii, 345. Convulsions, infantile. Amber, oil of (applied to the spine), i. 52. Chloral hydrate, i, 237. Ether (subcutaneously), i, 397. Tribromhydrin, ii, 330. 5G0 INDEX OF DISEASES AND REMEDIES. Convulsions, infantile. Water applied to the head, i, 349. Wines, ii, 894. Convulsions of epilepsy. Chloral hydrate, i, 237. Convulsions, puerperal. Bloodletting, i, 188. Chloral hydrate, i, 237. Chloroform, i, 528. Croton oil, i, 318. Paraldehyde, ii, 02. Transfusion, depletory, ii, 328. Convulsions, uremic. Amyl nitrite, i, 528. Chloroform, i, 528. Morphine, ii, 37. Warm bath, i, 166. Convulsive diseases. Bromal hydrate, i, 191. Corneal opacities. Calomel (by insufflation), i, 556. Thiosinamine, ii, 280, 281. Corns. Acetic acid, i, 5. Chelidonium, i, 233. Collodion, salicylic-acid and zinc-chloride, i, 293. Copper oleate, i, 305. Potassium bichromate, ii, 95. Salicylic acid, ii, 143. Silver nitrate, ii, 457. Sodium ethylate, ii, 207. Tannic-acid ointment, ii, 257. Corpulence. See Obesity. Coryza. Aconite, i, 8. Ammonium-chloride inhalations, i, 57. Arsenic, i, 146. Boric acid, i, 191. Camphor (internally and by inhalation), i, 205, 529. Carbonic-acid inhalation, ii, 430. Castor oil, i, 220. Chamomile, i, 231. Chloroform, i, 528. Glycerin and carbolic acid, i, 450. Horehound, i, 478. Iodoform inhalation, i, 540. Magnolia, i, 592. Quinine, ii, 119. Salicylic acid, ii, 143. Sodium bicarbonate, ii, 205. Tannigene, ii, 260. Tannin, ii, 256. Waters, chlorinated alkaline, ii. 381. Zinc oleostearate with camphor and menthol, ii, 409. Coryza, acute. Carbonic-acid inhalation, ii, 430. Chloroform, i, 528. Cubeb cigarettes, i. 430. Glycerin and carbolic acid, i, 450. Quinine (as a spray), ii, 119. Salicin, ii, 140. Silver nitrate, ii, 195. Tannigene, ii, 260. Coryza, chronic. Tannigene, ii, 260. Tannin, ii, 256. Coryza, infantile. Ammonium acetate, i, 54. Coryza of hay fever. Boric acid (saturated solution), i, 191. Coryza of influenza. - Chloroform, i, 528. Cough. Anhalonium Lewinii, ii, 416. Benzene, i, 176. Bromides, i, 194. Butyl chloral hydrate, i, 197. Cajiiput, ii, 426. Cannabis indica, i, 207. Catechu lozenges, i, 221. Cerium oxalate, i, 229. Codeine, i. 286. Conium vapour, i, 299. Grindelia, i, 456. Hydrobromic acid, i, 492. Linseed tea, ii, 269. Lobelia, i, 587. Meconarceine. i, 611. Muscarine, i, 645. Nux vomica, ii, 28. Opium, fumes of, i, 529. Phellandrium, ii, 71. Primus virginiana. ii, 105. Pulsatilla, ii, 108. ' Stramonium, ii, 229. Stupes, hot, to the front of the neck, ii, 233. Terebene, ii, 271. Cough and pain of acute pulmonary and pleuritic diseases. Dry cupping applied to the back and chest, i, 320. Cough, bronchial. Lobelia, i, 587. Cough, broncho-pulmonary. Meconarceine. i. 611. Cough, convulsive. Stramonium, ii, 229. Cough, irritable. Codeine, i, 286. Conium, vapour inhalations, i, 299. Pulsatilla, ii, 108. Cough, nervous. Anhalonium Lewinii, ii, 416. Codeine, i, 286. Hydrobromic acid, i, 492. Nux vomica, ii, 28. Valerian, ii, 345. Cough, reflex. Bromides, i, 194. Chamomile oil, i, 231. Cough, spasmodic. Grindelia, i, 456. Muscarine, i, 645. Cough, tickling. Catechu lozenges, i, 221. Cough, whooping-. See Whooping-cough. Cough, winter. Benzene, i, 176. Cough, winter, of bronchitis. Terebene. ii, 271. See also Coryza. Cramp, abdominal. Strychnine, ii, 28. Cramp, pianist's. Faradaism and galvanism, i, 367. INDEX OF DISEASES AND REMEDIES. 5G1 Cramp, pianist's. Massage, i, 608. Cramp, telegrapher's. Massage, i, 608. Cramp, writer's. Electricity, i, 865. Massage, I. 608. Cramps, muscular. Sulphonal, ii, 289. Cretinism. Thyreoid treatment, i, 79; ii, 290. Croup. Aconite, i, 8. Alum (by insufflation or irrigation), i, 50. Calomel fumigation, i, 625. Copper-arsenite inhalation (or in form of a spray), i, 304. Ipecac, i, 418. Lactic acid, i, 567. Menthol inhalation, i, 529. Mercurial fumigation, i, 430. Oxygen, ii, 52. Pilocarpine, ii, 85. Squill, ii, 221. Steam, i, 528. Storax, ii, 228. Sulphur powder (by insufflation), ii, 241. Croup, membranous. Ipecac, i, 542. Steam, i, 528. Storax, ii, 228. Zinc sulphate (as an emetic), ii, 407. Croup, spasmodic. Belladonna, i, 175. Ipecac, i, 878. Lobelia, i. 587. Crnsta lactea. Viola, tricolor, ii, 360. Curvature, lateral, of the spine. Exercise, i, 416. Massage, i. 610. Cystic irritation. Piperazine, ii, 89. Cystinuria. Ammonium carbonate, i, 56. Cystitis. Alkalies, i, 44. Alphol, i, 49. Antipyrine (as a local anodyne), i, 124. Baths, hot, i, 166. Benzoic acid and the benzoates, i, 177. Beta-naphthol salicylate, ii, 145. Betol, i, 179. Boric acid, i, 190. Buchu, i, 197. Camphor irrigations of the bladder, i, 205. Calcium iodate irrigations, i, 201. Cantharides, i, 208. Copper arsenite, i, 804. Corn silk, i, 306. Cubeb, i. 819. Formaldehyde, i, 428. Glycerin and carbolic-acid applications, i, 450. Grindelia, i, 456. . Iodine, i, 586. Kava, i. 564. Linseed tea, ii, 269. Matico. i, 611. Methylene blue, i, 630. Cystitis. Naphthalene, ii. 1. Nitric acid, ii, 7. Pareira, ii. 63. Pichi, ii, 82. Pix liquida, ii, 92. Pyoctanine, ii, 108. Quinine injections, ii, 120. Salol, ii, 150. Sodium bicarbonate, ii, 366. Sozal, ii, 215. Sulphur, ii, 240. Terpin hydrate, ii, 272. Triticum, ii, 333. Turpentine oil, ii. 336. Urotropine, ii, 343. Uva ursi, ii, 343. Waters, Buffalo lithia, ii, 372. " mineral, ii. 374, 377. Cystitis, ammoniacal. Beta-naphthol salicylate, ii, 145. Boric acid, i, 190. Formaldehyde, i, 428. Cystitis, chronic. 'Glvoerin and carbonic-acid applications, i, 450. Grindelia, i, 456. Iodine, externally, i. 536. Methylene blue, i, 630. Pareira, ii, 63. Pix liquida, ii, 92. Silver citrate, ii, 198. " nitrate, ii, 196. Terpin hydrate, ii, 272. Uva ursi, ii, 343. Waters, mineral, ii, 377. Cystitis, gonorrhoeal. Alphol, i, 49. Cantharides, i, 208. Cystitis, prostata-, following gonorrhoea. Pichi, ii, 82. Cystitis, purulent. 'Formaldehyde, i, 428. Cystitis, tuberculous. 'Formaldehyde, i, 428. Cystitis, without decomposition. Alkalies, i, 44. Cystocele. Tannin tampons, ii, 256. Cystorrhoea. Cubeb, i, 318. Cysts. Silver nitrate (injections), ii, 196. Cysts, hydatid. Iodine (injections), i, 536. Cysts, ovarian. Iodine injections, i, 536. Dacryocystitis. Pyoctanine, ii, 108. Silver nitrate (injections), ii, 195. Dandruff. Egg and limewater, i, 856. Deafness. Baths, condensed-air, i. 27. IIva>nanchin, i, 474. Massage of the ear, i, 610. Deafness, catarrhal. Baths, condensed-air, i, 27. Pulsatilla, ii, 107. 562 INDEX OF DISEASES AND REMEDIES. Deafness from quinine. Ergot, i, 389. Deafness from salicylic acid. Ergot, i, 389. Debility. Alcohol, i, 31. Baths, mud, i, 172. Calcium phosphate, ii, 78. Cashew nut, i, 219. Champagne, ii, 393. Cold plunge, i, 481. Flacourtia, i, 422. Guarana, i, 461. Ilvgiama, ii, 442. Iron sulphate, i, 549. Nucleins, ii, 24. Orchitic liquid, i, 76. Quinine, i, 254. Splenic extract, ii, 218. Stimulants, spinal, ii, 226. Sumbul, ii, 243. Testicle juice, i, 76. Waters, mineral, ii, 884. Wine, Burgundy, ii, 394. Hungarian (red), ii, 394. " port, ii, 393. '• sherry, ii, 393. Debility, cerebral. Iron phosphates, i, 551. Debility, general. Cashew nut, i, 219. Flacourtia, i, 422. Nucleins, ii, 24. Stimulants, spinal, ii, 226. (of dyspepsia). Wines, Burgundy or red Hun- garian, ii, 394. Debility of old age. Champagne, ii, 393. Debility of the young. Calcium phosphate, ii, 78. Debility, senile. Wine, sherry, ii, 393. Debility, sexual. See Impotence. Debility with nervous symptoms. Sanguinal, ii, 154. Decomposition, ammoniacal, of the urine. Boric acid, i, 190. Deficiency of hydrochloric acid in the gastric juice. Sodium bicarbonate, ii, 204. Deficiency of lime and phosphorus. Calcium phosphate, i, 202. Deformities, nail. Salicylic acid, ii, 145. Thyreoid treatment, ii, 292. Delirium (due to biliousness). Ammonium acetate, i, 54. Anhalonium Lewinii, ii, 416. Antipyrine, i, 123. Morphine, ii, 37. Trional, i, 509. Delirium of alcoholism. See Delirium tremens. Delirium of fever. Bath, half, i, 169. Chloral hydrate, i, 236. Delirium of nervous exhaustion of acute fever. Morphine, ii, 37. Delirium, sthenic noisy. Tartar emetic and opium, i, 114. Delirium tremens. Ammonium chloride, ii, 415. " succinate, i, 58. (early stages), Bromides, i, 194. Camphor, i, 205. Capsicum, i, 209. Chloral hydrate, i, 237. (tremors), Cimicifuga, i, 250. Cold bath, i, 488. " plunge, i, 488. Coniine, i, 299. Digitalis, i, 342. Humulus, i, 474. (early stages), Paraldehyde, -ii, 67. Strychnine, ii, 7. Sulphonal, ii, 239. Sumbul, ii, 7, 243. Urethane, ii, 342. Delirium with depression. Valerian, ii, 345. Dementia, primary. Thyreoid treatment, ii, 291. Dementia, secondary. Thyreoid treatment, ii, 291. Depression, mental. Faradization, general, i, 366. Depression, mental and physical. Spinal stimulants, ii, 226. Depression, sudden nervous. Musk, ii, 6. Depression, simple. Cocaine, i, 283. Dermatitis. Bismuth subnitrate (as a dusting powder), i, 181. Pixol, ii, 92. Dermatitis, acute. Laurel, i, 571. Dermatitis, erythematous. Atropine, i, 156. Dermatitis exfoliativa. Thyreoid feeding (dry powder), i, 79. Dermatitis venenata. Zinc sulphate, ii, 408. Desquamative eruptions. Salicylic-acid applications, ii, 144. Diabetes. Alkaline mineral waters, i, 45. Alum whey, i, 50. Ammonium hydrosulphide, i, 57. Arsenic, i, 145. Baths, hot-air, i, 168. Codeine, i, 286. Conium, i, 299. Creosote, i, 314. Dulcin, i, 353. Ergot, i, 389. Gluten bread, i. 449. Iodoform, i, 537. Iron valerianate, i, 552. Jaborandi, i, 559. Jambul, i, 561. Lactic acid, i, 567. L^yulose (as a sweetening agent), ii, 445. Muscarine, i, 645. Naphthalan, ii, 448. Oxygen, ii, 57. INDEX OF DISEASES AND REMEDIES. 563 Diabetes. Ozone, ii, 58. Pancreatic extract, i, 80, Peanut meal, ii, 418. Phosphoric acid, ii, 77. Picric acid, ii, 458. Piperazine, ii, 89. Potassium permanganate, i, 596. Saccharin, ii, 138. Sodium bicarbonate, ii, 204. " sozoiodolate, ii, 208. Soja hispida, ii, 209. Spermine, ii, 217. Strontium bromide, ii, 229. Sulphonal, ii, 289. Thymol, ii, 238. Uranium nitrate, ii, 338. Vichy water, ii, 358. Waters, Buffalo lithia, ii, 372. " saline, ii. 368. Wet pack, i, 490.' Yeast, ii, 400. Zinc sulphoichthyolate, ii, 412. Diabetes, hepatic. Alkaline mineral waters, i, 45. Carbolic acid, i, 212. Diabetes insipidus. Ergot (hypodermically), i, 389. Iron valerianate, i, 552. Jaborandi, i, 559. Muscarine, i, 645. Diabetes mellitus. Codeine, i, 286. Gluten bread as a food, i, 449. Morphine, ii, 37. Picric acid, ii, 453. Saccharin, ii, 138. Uranium nitrate, ii, 338. Waters, Buffalo lithia, ii, 372. Diabetes, pancreatic. Pancreatic extract, i, 80. Diarrhoea. Alkalies, i, 44. Alum (in pills), i, 50. Arsenic, i, 146. Barium sulphocarbolate, i, 162. Bismuth, i, 180. " tannate, ii, 259.( Bitters, i, 183. Boric acid, i, 190. (of children), Calcium salicylate, ii, 145. Calomel, i, 624. Camphor salicylate, ii, 45o. Carbolic acid and bismuth, i, 212. Castanea leaves, i, 219. Castor oil, i. 220. Cerium oxalate, i, 229. Cetraria, i, 230. Chalk, i, 230. Charcoal, i, 282. Chloroform, i, 241. Cinnamon, i, 259. Copper arsenite (minute doses), i, 303. Coto bark, i, 309. Creolin, i, 313. Creosote, i. 314. Cupric sulphate, i, 306. Diet, i, 336. Ephedra, i, 385. Erigeron, oil of, i, 390. Diarrhoea. Flacourtia, i, 422. Flour gruel, i, 423. Galls, i, 433. Geranium, i, 438. Gnaphalium, i, 451. Grape cure, i, 455. Haematoxylon, i, 464. Humulus. i. 474. Ichthyol, ii, 443. Iodine enema, i, 536. Ipecac, i. 542. Iron nitrate, i, 551. Irrigation, i, 554. Kino, i, 565. Krameria, i, 566. Lactic acid, i, 567. Laurel, i, 571. Lead acetate and opium, i, 577. Licorice and flaxseed, i, 581. Linseed, infusion of, i, 584. Magnesia and rhubarb, i, 591. Matico, i. 611. Menthol, i, 614. Mercury, i. 619. with chalk, i, 622. Morphine (small doses), ii, 38. Moss, Irish, i, 247. Mustard plaster (applied to the abdomen), i, 647. Naphthalene, ii, 1. Naphthol, ii, 2. Nitric acid, ii, 8. (due to atony of the bowels). Nux vomica, ii, 28. Oak bark, ii, 31. Opium, ii, 36. Peppermint poultice, i, 613. Paregoric, ii, 63. Pepsin and bismuth, ii, 69. Physostigmine salicylate, ii, 146. Picric acid, ii, 433. Quinine, i, 255. Rhubarb, ii, 130. Rubus, ii, 136. Salacetol, ii, 139. Salol, ii, 150. Sandal-wood oil, ii, 153. (of dentition), Sea air, ii, 275. Serum, cow's, ii. 163. Sesame oil, ii, 190. Silver nitrate, ii. 197. '• oxide, ii, 197. Sodium bicarbonate, ii, 204. " carbolate (as an intestinal antiseptic), ii, 206. Sodium phosphate, ii, 79. " salicylate, ii. 146. Sulphuric acid, ii, 242. Sumbul, ii, 243. Tannalbin, ii, 254. Tannigene, ii. 260. Tannin, ii, 257. Tannoform. ii. 260. Toast water, i, 851. Tolu balsam, ii, 309. Ulnius, ii. 337. Viburnum prunifolium. ii, 357. (late stages). Uva ursi. ii, 343. Waters, mineral, ii, 374, 379. 504 INDEX OF DISEAS1 <:s AND REMEDIES. Diarrhoea. Zinc acetate, ii, 402. " sulphate, ii, 407. '• tannate, ii. 412. Zincohaunol, ii, 412. Diarrhoea, acid. Antacids, i, 86. Diarrhoea, acid (of children). Sodium bicarbonate, ii, 204. Diarrhoea, acute. Bismuth, i, 180. Diet, i, 336. Diarrhoea, atonic. Laurel, i, 571. Rubus, ii, 186. Diarrhoea, choleraic. Charcoal, i, 282. Salacetol, ii, 139. Diarrhoea, chronic. Baths, cold, i, 169. Bismuth, i, ISO. Camphor salicylate, ii, 455. Cerium oxalate, i, 229. Diet, i, 336. Galls, i, 483. Grape cure, i, 455. Iodine, enema of, i, 536. Iron nitrate, i, 551. Picric acid, ii, 433. Tannigene, ii, 260. Tannin, ii, 257. Tolu balsam, ii, 309. Waters, mineral, ii, 374, 379. Diarrhoea, colicky. Viburnum prunifolium, ii, 357. Diarrhoea, colliquative. Barium sulphocarbolate, i, 162. Nitric acid, ii, 8. Diarrhoea from undigested food. Castor oil, i. 224. Diarrhoea, infantile. Baked flour (as a food), i, 423. Calomel, i, 024. Creolin, i, 313. Irrigation of the rectum and colon, i, 554. Toast water, i, 351. Diarrhoea, infectious. Betol, i, 179. Diarrhoea, lienteric. Creosote, i, 314. Pepsin, ii, 69. Diarrhoea of phthisis. Sesame oil, ii, 190. Diarrhoea of typhoid fever. Alum whey, i, 50. Hydrochloric acid, i, 493. Opium, ii, 36. Diarrhoea, putrid. Picric acid, ii, 453. Diarrhoea, subacute. Rhubarb, ii, 130. Tannigene, ii, 257. Diarrhoea, summer. Benzonaphthol and bismuth salicylate, ii, 3 Bismuth, i, 180. Irrigation of the stomach, i, 491. Nitric acid, ii, 8. Salol, ii, 150. Serum, cow's, intravenous injections, ii, 163. Tannigene, ii, 260. Diarrhoea, summer. Xeroform (internally), ii, 397. Zinc oxide, ii, 406. Diarrhoea with intestinal catarrh. Calcium salts, ii, 872. Dilatation of the stomach. Electricity, i, 368. Lavage, i, 491, 572. Massage, abdominal, i, 608. Naphthol, ii, 2. Papain, ii, 60. Dilatation of the heart. See under Heart. Diphtheria. Alum (by insufflation), i, 50. Antidiphtherine, i, 107. Benzene, i, 176. Benzoic acid, i, 178. Bromal, i, 197. Calomel powder (by insufflation), i, 625. fumigation, i, 530. Capsicum and hot water (as a gargle), i, 209. Chlorine water, i, 240. Cold baths, i, 488. Copper-arsenite inhalation (or in form of a spray), i, 304. Creosote, i, 314. Cubeb, i, 319. Eucalyptol inhalation, i, 529. Gavage, i, 436. Hydrogen dioxide, i, 503. Iron chloride (tincture), i, 548. Jaborandi, i, 559. Lactic acid, i, 567. Lime, inhalation of the vapour of, i, 582. Menthol inhalations, i, 529. Mercuric cyanide, i, 322. Mercury bichloride (in spray), i, 626 ; ii, 221. Myrrh, tincture of, i, 652. Nosophene, ii, 19. Nucleins, ii, 23, 25. Oxygen, ii. 52. Ozone, i, 445. " inhalation, ii, 58. Papain, ii, 60. Pepsin in solution (by spray), ii, 69. Peroxide of hydrogen, ii, 221. Pilocarpine, ii, 85. Potassium chlorate, ii. 96. permanganate, i, 596 ; ii, 70. " " (as a gargle), i, 597. Pyoctanine, ii, 108. Quinine, ii, 119. Resorcin (topically), ii, 126. Salicin, ii, 140. Serum treatment, i, 83 ; ii, 170, 171. Steam, i, 220. 528. Steresol. ii, 223. Storax, ii, 228. Sulphur powder (by insufflation), ii. 241. Trypsin (as a solvent for diphtheritic mem- brane), ii, 88,4. Zinc chloride applications, ii, 405. Diphtheria, laryngeal. Calomel fumigation, i, 530. Mercurial fumigation, i, 430, 530. Steam spray, ii, 220. Diphtheria, nasal. Myrrh, i, 682. Nosophene, ii, 19. INDEX OF DISEASES AND REMEDIES. Dipsomania. See Alcohol habit. Distichiasis. Collodion, i, 294. Dizziness. See Vertigo. Dropsy. Alkaline carbonates, i, 45. Aspiration, i, 152. Baths, hot, i, 489. Caffeine, i, 201. Cahinca, i, 201. Chimaphila, i, 234. Convallaria, i, 300. Croton oil, i, 318. Digitalis, i, 342. Dulcamara, i, 353. Elaterin, i, 857. Gold, i, 451, 453. Horseradish, i, 473. Hunyadi Janos, i, 474. Iodine injections, i, 536. Jaborandi, i, 559. Jalap, i, 560. Juniper, i, 563. Kava, i, 564. Ligusticum, i, 581. Nitrohydrochloric acid, ii, 16. Potassium salts, i, 845. " tartrates, ii, 100. Salines, ii, 147. Scammony, ii, 157. Scarification, ii, 158. Scillain (subcutaneously), ii, 158. Squill, ii, 221. Sodio-theobromine salicylate, ii, 202. Strophanthus, ii, 231. Theobromine, ii, 277. Ulexine, ii, 337. Dropsy, cardiac. Squill, ii, 221. Strophanthus, ii, 231. Theobromine, ii, 277. Ulexine, ii, 337. Dropsy, due to acute nephritis. Potassium tartrates, ii, 100. Dropsy, hepatic. Alkaline carbonates, i, 45. Nitrohydrochloric acid, ii, 16. Dropsy of the joints. Iodine injection, i, 536. Dropsy, renal. Digitalis, i, 842. _ Potassium salts, i, 345. Dropsy, splenic. Alkaline carbonates, i, 45. Dropsy, subcutaneous. Scarification, ii, 158. Drowning. Heat, i, 469. Stimulants, heart, ii. 226. Tongue traction, i, 64. Drunkenness. Treatment of, i, 34. Dysentery. Alum (in pills), i, 50. Arsenic, i, 146. Baths, hot, i, 166. Benzonaphthol. ii, 426. (with tenesmus), Bismuth injections, i, 181. Dysentery. Calomel, i, 624. Calotropis, i, 203. Camphor salicylate, ii, 455. Carbonic-acid gas, i, 214. Castor oil, i, 221. Charcoal, i, 232. Chirata, i, 234. Cinnamon, i, 259. Copper arsenite, i, 305. " " (minute doses), i. 303. Creosote, i, 314. Cupric sulphate (by the mouth or by ene- mata), i, 306. Cvdonium, i, 323. Ergot, i, 388. Erigeron, oil of. i. 390. Flour gruel, i, 423. Geranium, i, 438. Glycerin enema, i. 451. Gnaphalium, i, 451. Iodine, enema of, i, 536. Iodoform, i. 537. Ipecac, i, 542. Irrigation of the rectum and colon, i, 491. Krameria, i, 566. Lead, compound suppositories, i, 577. Linseed, infusion of, i, 584 ; ii, 269. Lysol injections, i. 590. (early stages), Magnesium sulphate, i, 592. Matico, i, 611. Morphine, ii, 38. Moss, Irish, i, 247. Naphthalene, ii, 1. Naphthol, ii, 2. Nitrohydrochloric acid, ii, 16. Papain, ii, 60. Physostigmine salicylate, ii, 146. Quinine, i, 255. Salicylic-acid enema, ii, 143. Saligenin, ii, 147. Silver nitrate, ii, 194. Sodium nitrate, ii, 207. Strychnine, ii, 28. Sumbul, ii, 243. Tannigene, ii, 260. Tannoform, ii, 260. Trichlorphenol, ii, 330. Tvlophora. ii. 337. Ulmus, ii, 887. Viburnum prunifolium, ii, 357. Water (rectal applications), i, 479. Zinc sulphate, ii, 407. Dysentery, acute. Cinnamon, i, 259. Glycerin enema, i, 451. Ipecac, i, 542. Irrigation of the rectum and colon, i, 491. Silver nitrate, ii, 194. Water (rectal applications), i, 479. Dysentery, amoebic. 'Methylene blue, i, 630. Quinine injections, rectal, ii, 120. rectal irrigation with, i. 254. Dysentery, chronic. Baths, cold, i, 169. Camphor salicylate, ii, 455. Carbonic-acid gas, i, 214. Iodoform, i, 587. Ipecac, i, 542. 506 INDEX OF DISEASES AND REMEDIES. Dysentery, chronic. 'Water (rectal applications), i, 479. Dysentery, epidemic. Charcoal, i, 232. Dysidrosis. Salicylic acid, ii, 144. Dysmenorrhoea. Aconite, i, 9. Amyl valerianate, i, 62. Anemonin, i, 70. Antipyrine. i, 124. Apiol, i, 137. Arnica, fluid extract of (small doses), l, 141. Baths, cold, i, 169. •' hot, i, 166. " hot hip, i, 375. Belladonna and morphine, i, 67. Butyl chloral hydrate, i. 197. Cajeput, i, 201. Camphor, i, 205. Canella, i, 206. Cannabis indica, i. 207. Cimicifuga, i, 250. Croton oil (applications to the abdomen), i, 318. Cupping (applied to the thighs), i, 375. Douches, hot vaginal, i, 375. Gelsemium, i, 437. Gin, i, 449. Glycerin suppositories, i, 450. Oxalic acid, ii, 49. Peppermint, infusion of, i, 613. Piscidia, ii, 91. Pulsatilla, ii, 107. Salix, ii, 149. Senecin, ii, 161. Senecio, ii, 162, 456. Silver iodide, ii, 197. " oxide, ii, 197. Sodium salicylate, ii, 146. Splenic extract, ii, 218. Stypticin, ii, 233. Trional, ii, 333. Viburnum prunifolium, ii, 356, 357. Waters, Buffalo lithia, ii, 372. " mineral, ii, 383. Zinc cyanide, ii, 408. Dysmenorrhoea, congestive. Aconite, i, 9. Arnica, fluid extract of (in small doses), i, 141. Canella, i, 206. Dysmenorrhoea, nervous. Antipyrine, i, 124. Dysmenorrhoea, spasmodic. Amyl valerianate, i, 62. Belladonna and morphine, i, 67. Piscidia, ii, 91. Dysmenorrhoea, virginal. Viburnum prunifolium, ii, 357. (with menorrhagia), Viburnum prunifolium, ii, 356. Dyspepsia. Acids, mineral, i, 6. Alcohol, i, 33. Alkalies, i, 44. Alkaline waters, i, 45. Ammonium carbonate, i, 55. Antizymotics, i, 135. Apone, i, 139. Dyspepsia. Asafcetida, i, 147. Bitters, i, 183. Charcoal, i. 232. Chirata, i, 234. Cinnamon, i, 259. Cubeb, i, 319. Frigotherapy, i, 429. Glycerin (internally), i, 451. Horseradish, i, 473. Humulus, i, 473. Hunyadi Janos water, i, 474. Hydrochloric acid, i, 492. Lactic acid, i, 567. Leptandra (as a tonic), i, 580. Lycopodium, i, 590. Lysol, i, 590. (with constipation), Mustard and molasses, i, 646. Pepsin, ii, 69. Ptyalin. ii, 106. Pulsatilla, ii. 107. Quinine, i, 254. Rhubarb, ii, 130. Saccharin, ii, 138. Salvia, ii, 152. Sarracenia purpurea, ii, 156. Spermine, ii, 217. Strontium lactate, ii, 230. (with hyperacidity), Waters, alkaline, ii, 366. Waters, alkaline carbonated, ii, 375. Buffalo lithia, ii, 372. mineral, ii, 376, 379, 384. Yolk of egg and tincture of ginger, i, 855. Zinc sulphate, ii, 407. " tannate, ii, 412. Dyspepsia, acid. Chirata, i, 234. Hydrochloric acid, i, 493. Limewater, i, 582. Potash, ii, 94. Dyspepsia, acute. Lavage, i, 572. Tartar emetic, i, 114. Dyspepsia, amylaceous. Taka-diastase, ii, 254. Dyspepsia, atonic. Alcohol, i, 33. Alkalies (before eating), i, 44. Alkaline mineral waters, i, 45. Ammonium carbonate, i, 55. Bitters, i, 183. Calamus, i, 201. Capsicum, i, 209. Cubeb, i, 319. Horseradish, i, 473. Lactic acid, i, 567. Lumbar douches, i, 349. Pepsin, ii, 69. Quinine, i, 254. Rhubarb, ii, 130. Salvia, ii, 152. Sarracenia purpurea, ii, 156. Tannin, ii, 257. Taraxacum, ii, 265. Dyspepsia, biliary. Wines, white, ii, 394. Dyspepsia, chronic. Solanum paniculatum, ii, 210. INDEX OF DISEASES AND REMEDIES. 567 Dyspepsia, fermentative. Asaprol, i, 148. Dermatol, i, 329. Sulphurous acid, ii, 243. Dyspepsia, flatulent. Canella, i, 206. Carbolic acid, i, 212. Nux vomica, ii, 28. Strontium salicylate, ii, 147, 230. Dyspepsia, functional. Diet, i, 335. Massage, general, i, 608. Dyspepsia, gastric. Waters, alkaline sulphuretted, ii, 368. " mineral, ii, 374. Dyspepsia, hepatic. Waters, mineral, ii, 375. Dyspepsia, intestinal. Aloes, i, 48. Arsenic, i, 146. Creosote, i, 314. Flour, boiled, i, 423. Gamboge, i, 433. Mercury, i, 619. Ox-bile," ii, 49. Sodium phosphate, ii, 79. Dyspepsia, irritable. Silver oxide, ii, 197. Dyspepsia, nervous. Damiana, i, 324. Faradaism, i, 366. Gold chloride, i, 454. Menthol, i, 614. Oxygen, ii, 52. Dyspepsia of hard drinkers. Capsicum, i, 208. Dyspepsia, with acid eructations. Charcoal and bismuth, i, 232. Dyspepsia with phosphatic urine. Nitric acid, ii, 8. Dyspnoea. Air, condensed, inspiration into, i, 28. Amyl-nitrite inhalation, i, 61. Arsenic, i, 146. Cajuput, ii, 426. Cupping, dry, i, 320. Digitalis, i, 342. Ethyl-iodide inhalation, i, 528. Grindelia, i, 456. Morphine, ii, 37. Nitroglycerin, ii, 10. Oxygen inhalation, ii. 226. Potassium cobaltonitrite, i, 273. Quebracho, ii, 112. Strophanthus, ii, 231. Strychnine, ii, 28. Thymus extract, ii, 285. Tribulus lanuginosus, ii, 330. Dyspnoea, cardiac. Ainvl-nitrite inhalation, i, 61. Dry cupping, i, 320. Nitroglycerin, ii, 15. Oxygen inhalation, ii, 226. Strophanthus, ii. 231. Dyspnoea of asthma. Amyl nitrite, i. 61. Dyspnoea of phthisis. 'Menthol solution (by injections), i, 615. Dyspnoea, pulmonary. Oxygen inhalation, ii, 226. Dyspnoea, pulmonary. Strychnine, ii, 28. Dyspnoea, spasmodic. Ethyl iodide inhalation, i, 528. Dyspnoea, uraemic. Amyl nitrite, i. 61. Morphine, ii, 37. Dystocia. Quinine, ii, 55, 116. Thyreoid treatment, to check the growth of the foetus, ii, 299. Dystrophies, muscular. Muscle extract, i, 81. Dysuria. Ammonium hydrosulphide, i, 57. Cantharides. i, 208. Conium, i, 298. Earache. Chamomile fomentations, i, 231. Chloroform vapour, i, 533. Cloves, oil of, i, 272. Delphinine, ii, 221. Ether, as a spray, i. 397. Hop poultice, i, 474. Leeching, i, 578. Pulsatilla, ii, 107. Echinococcus, hepatic. Aspiration, i, 151. Eclampsia, puerperal. See Convulsions, Puerperal. Ecthyma. Cod-liver oil and iron, i, 288. Cupric-sulphate solution, i, 306. Ectropion. Thiosinamine, ii, 281. Eczema. Alumnol applications, i, 51. Arsenic, i, 144. Barium chloride, i, 162. Benzene, i, 176. Benzoin (compound tincture), i, 179. Bran, i, 191. Calomel ointment, i, 625. Camphor powder (with starch), or ointment, i, 204. Carron oil, i, 582. Cashew nut (topically), i, 219. Chalk powder, i, 230. Chrysarobin, i, 116. Cod-liver oil, i, 288. Creosote, i, 314. Dermatol, i, 829. Gallanilide, i, 432. Gelanthum, ii, 349. Gelsemium, i. 437. Ichthyol, i, 522. Iron, i, 547. Lead-oxide ointment, i, 578. Limewater as a lotion, i, 582. Losophan, i, 589. Lysol, i, 590. Mercury nitrate (ointment), i, 623, 628. Nosophene, ii, 19. Nucleins, ii, 24. Phosphorus, ii, 77. Phytolacca, ii, 81. Picric acid, ii, 83. Potassium permanganate, i, 596. Pulsatilla, ii, 107. 503 INDEX OF DISEASES AND REMEDIES. Eczema. Pyrogallic acid, ii, 111. Resorcin, ii, 126. Salicylic-acid ointment, ii, 143, 144. Silver nitrate, ii, 196. Soap, green, ii, 200. StPSLiTi ii 22'3. Sulphur fumes, i. 430 ; ii, 241. Talc powder, ii, 254. Tannin, ii. 256. Tar, ii, 92. 263. Tartarlithine, ii, 265. Thiol ointment, ii, 278. Thymol, ii, 284. Thyreoid treatment, ii, 293. Traumatol, ii, 325. (itching of), Tumenol tincture, ii, 334. Tumenol sulphonic acid, ii, 334. Turpentine liniment, ii, 335. Viola tricolor, ii, 360. Waters, Buffalo lithia, ii, 372. Xeroform, ii, 396. Zinc oxide, ii, 406. " sulphate, ii, 408. " sulphichthyolate (as a liniment), ii, 412. Eczema, acute. Gallobromol (by a compress), i, 433. Laurel, i, 571. Picric acid, ii, 452. Eczema, acute dry. Rye flour, ii, 137. Eczema, chronic. Calomel ointment, i, 625. Cod-liver oil, i, 288. Creosote, i, 314. Gallanilide, i, 432. Iron, reduced, i, 547. Naphthalan, ii, 448. Nucleins, ii, 24. Phosphorus, ii. 77. Phytolacca, ii, 81. Steam, ii, 222. Thyreoid feeding, i. 79. Zinc sulphydrate, ii, 412. Eczema, dry. Barium chloride, i, 162. Gelanthum (Unna's treatment), ii, 349. Eczema, erythematous. Salicylic-acid ointment, ii, 144. Eczema impetiginodes. Xeroform, ii, 397. Eczema madidans. Xeroform, ii, 397. Eczema marginatum. Ichthyol, i, 522. Pyrogallic acid, ii, 111. Eczema, nervous. Ichthyol, i, 522. Eczema of the anus and genitals. Lead liniment, i, 577. Eczema of the external auditory canal. Silver nitrate, ii, 195. Zinc sulphocarbolate, ii, 412. Eczema of the eyelids. Silver nitrate, ii, 195. Eczema of the hand (in very dry skin). Gelanthum (Unna's treatment), ii, 349. Eczema of the hands, knees, and face. Tumenol-sulphonic acid, ii, 334. Eczema of the lids. Mercury oxide (ointment), i, 623. Eczema of the nostrils. Myrrh, i, 652. Eczema, old. Ichthyol, i, 522. Eczema, papular. Salicylic acid, ii. 144. Eczema, parasitic. Ichthyol, i, 522. Eczema, pustular. Salicyiic-acid ointment, ii, 144. Eczema rubrum. Salicylic-acid ointment, ii, 144. Eczema rubrum of the leg. Soap, green, ii, 200. Eczema seborrhoicum. Chrysarobin, i, 116. Ichthyol, i, 116. Mercury bichloride, i, 116. Resorcin, i, 116. Sulphur, i, 116. Eczema, squamous. Salicylic acid, ii, 144. Eczema, traumatic weeping. Nosophene, ii, 19. Eczema, vesicular. Salicylic-acid ointment, ii, 144. Effusion, serous. Sodio-theobromine salicylate, ii, 203. Elephantiasis. Ichthyol, i, 522. Elytritis. Bismuth, i, 181. Boric acid, i, 180. Grindelia, i, 456. Ichthyol, i, 523. Kava, i, 564. Tannin and alum douche, ii, 256. " injections, ii, 256. Vaginal douches, i, 349. Elytritis, acute. Ichthyol, i, 523. Elytritis, gonorrhceal. Tannin and alum douche, ii, 256. " injections, ii, 256. Emissions (involuntary), seminal. See Spermatorrhoea. Emphysema. Apomorphine, i, 139. Arsenic, i, 146. Baths, condensed-air, i, 27. Convallaria, i, 300. Expiration into rarefied air, i, 28. Ipecac, i, 542. Iron chloride, i, 548. Ozone inhalation, ii, 58. Quebracho, ii, 112. Quillaia, ii, 113. Terebene, ii, 271. Emphysema, pulmonary. Apomorphine, i, 139. Arsenic, i, 146. Baths, condensed-air, i, 27. Quillaia, ii, 113. Emphysema with ansemia. Iron chloride (tincture), i, 548 Empyema. Aspiration (Dieulafoy's method), i, 151 Lavage, i, 436. INDEX OF DISEASES AND REMEDIES. 569 Empyema. Quinine injections, ii, 120. Encephalitis. Blisters to the back of the neck, i, 312. Cupping, i, 320. Ice applications, i. 520. Endarteritis, cerebral. Phosphorus, ii, 76. Endocarditis after rheumatism. Baths, Nauheim, ii, 423. Schott treatment, ii, 423. Serum, antistreptoeoccus, ii, 178. Endocarditis, ulcerative. Serum, antistreptoeoccus, ii, 178. Endometritis. Camphor, i, 204. Chromic acid, i, 248. Euphorim, i, 402. Glycerin suppositories, i, 450. Ichthyol, i, 523. Nitric acid, ii, 7. Picric acid, ii, 83. Pyoctanine (internally), ii, 109. Salol and antipyrine, ii, 150. Silver nitrate, ii, 196. Steam, ii, 222. Stypticin, ii, 233. Traumatol, ii, 329. Zinc oxychloride, ii, 410. Endometritis, cervical. Camphor, i, 204. Euphorin, i, 402. Glycerin suppositories, i, 450. Ichthyol, i, 523. Silver nitrate, ii, 196. Steam, ii, 223. Endometritis, chronic. Chromic-acid applications, i, 248. Endometritis, chronic cervical. Nitric acid, ii, 7. Endometritis, fungous. Picric acid, ii, 83. Salol and antipyrine, ii, 150. Stypticin, ii, 233. Endometritis, hgemorrhagic. Zinc oxychloride, ii. 410. Endometritis, hyperplastic. Steam, ii, 222. Endometritis, septic puerperal. Steam, ii, 223. Endotrachelitis. See Endometritis, Cervical. Engorgement, hepatic. Baths, cold sitz, i, 169. Waters, Buffalo lithia, ii, 372. chlorinated alkaline (externally and internally), ii, 371, 381. Waters, sodium-sulphate, ii, 368. Engorgement of the pelvic viscera (in women). Waters, sulphuretted, ii. 371. Engorgement of the portal circulation. Gamboge, i, 433. _ Grape cure, i. 455. Engorgement, uterine. Waters, mineral, ii, 383. JEnarorgeinent, venous. Bloodletting, i, 187. Digitalis, i, 345. Scoparius, i, 345. Engorgement, venous. Squill, i, 345. Enlargements, chronic, and stiffness of the joints. Veratrine, ii, 350. Enlargements, chronic, of the lymphatic glands, ii, 99. Enlargements, fluctuating, of joints. Aspiration, i, 152. Enlargements, glandular. Cod-liver oil, i. 288. Iodine (internally), ii, 214. Enlargements, giandnlar, of children. Calcium sulphide, i, 203. Thiosinamine, ii, 280. Enteritis. Baths, narcotic, i, 172. Copper arsenite, i, 304. 305. Cubeb, i, 319. Eucalyptol, i, 400. Hydrastis, i, 475. Limewater, i, 582. Nutmeg, ii, 25. Somatose, ii, 212. Tannigene, ii. 260. Thioform, ii, 278. Vichy water, ii, 358. Enteritis, acute. Tannigene, ii, 260. Thioform, ii, 278. Enteritis, chronic. Hydrastis, i, 475. Enteritis, gastro-. Somatose, ii, 212. Enteritis, membranous. Copper-arsenite enema, i, 304. Enteritis, mucous. Limewater, i, 582. Enteritis, pseudo-membranous. Cubeb, i, 319. Enteritis, ulcerative. Tannalbin, ii, 254. Enterocolitis. Copper arsenite, i, 303. Hydroeotyle asiatica, i, 493. Enteroptosis. Yeast, ii, 401. Entropion. Collodion, i, 294. Enuresis. Belladonna, i, 175. Ergot, i, 388. Enuresis, nocturnal. Belladonna, i, 175. Faradization, vesical, i, 366. Hypnotism, i, 515. Iron iodide, i, 551. Stimulants, spinal, ii, 226. Sulphonal, ii, 239. \ Epididymitis. Ethyl chloride, ii, 434. Ice applications, i, 520. Mercury iodide, i, 622. Pulsatilla, ii, 107. Epilepsy. Acetanilide, i, 4. Ammonium carbonate, i, 56. Amyl nitrite, i, 61. Baths, cold, i, 488. Blisters (to abort an attack), i, 185. 570 INDEX OF DISEASES AND REMEDIES. Epilepsy. Borax, i, 189. Brain and spinal cord substance (hypoder- mically), i, 80. Bromalin, i, 191. Bromated haemol, ii, 426. Bromhaemol, ii, 426. Calcium bromide, i, 202. Calotropis, i, 203. Cannabis indica, i, 207. Cerium oxalate, i. 229. Chloralamide, i, 238. Cod-liver oil, i, 288. Conium, i, 298. Cupric sulphate, i, 306. Curare, i, 321. Ergot (to increase the action of bromides), i, 388. Ethylene bromide, i, 899. Gallobromol (internally), i, 433. Gold bromide, i, 454. Hydrobromic acid and the bromides, i, 492. Lobelia, i, 587. Nerium, ii, 5. Picrotoxin, ii, 84. Rest-cure, ii, 127. Rubidium and ammonium, ii, 136. Rue, ii, 137. Sclerotic acid, ii, 158. Senecio, ii, 162. Silver iodide, ii, 197. " nitrate, ii, 194. Simulo, ii, 198. Solanum carolinense, ii, 209. Strontium bromide, ii, 229. Strychnine, ii, 28. Sulphonal, ii, 239. Thyreoid treatment, ii, 292. Zinc salts, ii, 401. Epiphora. Alumnol (in solution), i, 51. Episcleritis (chronic form). Eserine, i, 392. Epistaxis. Aconite, i, 9. Agaric (for plugging the nose), i, 17. Ambrosia, i, 52. Baths, cold hand, i, 170. Digitalis, i, 342. Ergot, i, 388. Erigeron, oil of, i, 390. Europhene, i, 402. Hamamelis, i, 467. Ipecac, i, 542. Iron chloride (tincture), i, 548. Kino, i, 565. Matico, i, 611. Silver nitrate, ii, 195. Sodium chloride, ii, 206. Tannin, ii, 256. Zinc sulphate, ii, 407. Epithelioma. Arsenic, i, 144. Bismuth salicylate, i, 182. Collodion, salicylic- and lactic-acid, i, 293. Lactic acid, i, 568. Pyrogallic acid, ii, 111. Salicylic-acid and zinc-chloride collodion, i, 293. Salicylic-acid ointment, ii, 145. Epithelioma of the serous membranes. Silver-nitrate applications, ii, 457. Erethism, nervous and circulatory, of the pelvic organs. Baths, hot sitz, i, 169. Erethism, sexual. Humulus, i, 474. Erosions of the os uteri. Silver nitrate, ii, 196. Thymol, ii, 284. Zinc oleate and iodoform, ii, 405. Eructations, acid. Chalk, i, 230. Erysipelas. Aconite, i, 8. Atropine, i, 156. Bath, hot, i, 166. Benzoic acid, i, 178. Bromine, i, 195, 445. Camphor, i, 204. Carbolic acid (parenchymatous injections), i, 213. Chalk and lard ointment, i, 230. Cold baths, i, 488. Collodion, ferruginous, i, 293. flexible, i, 294. Creosote, i, 314. Ergotole (local applications), i, 889. Guaiacol (external application), i, 460. Ichthyol. i, 522. Iodine, i, 536. Iron, i, 546. " chloride (tincture), i, 548. Jaborandi, i, 560. Lead-and-opium wash, i, 577. Mentho-phenol, i, 616. Picric acid, ii, 83 ; ii, 453. Quinine, i, 255 ; ii, 119. Resorcin, ii, 126. Rye flour, ii, 137. Serum, antistreptoeoccus, ii, 175. Silver lactate, ii, 197. " nitrate, ii, 196. Sulphur ointment, ii, 241. Thiol ointment, ii, 278. Toxines, ii, 313. Trichlorphenol applications, ii, 330. Turpentine liniment, ii, 335. (of traumatic origin), Turpentine oil, ii, 336. Vaseline, ii, 349. Zinc sulphichthyolate (as a liniment), ii, 412. Erythema. Bismuth subnitrate (as a dusting powder), i, 181. Laurel, i, 571. Salicylic acid, ii, 144. Silver nitrate, ii. 196. Thiol ointment, ii, 278. Zinc-acetate ointment, ii, 402. Zinc sulphate, ii, 408. Erythema, chronic. Collodion, i, 204. Erythrasma. Anthrarobin, i, 103. Exanthemata. Ammonium acetate, i, 54. Saffron tea (as a diaphoretic), ii, 269. Exanthemata, acute. Asclepias tuberosa, i, 148. INDEX OF DISEASES AND REMEDIES. 571 Exanthemata, chronic. Waters, alkaline (externally), ii, 372. Excitement, circulatory. Bloodletting,, i, 188. Excitement, maniacal. Bath, hot. i, 166. Excitement, mental. Sulphonal. ii, 289. Excitement, nervous. Valerian, ii, 345. Excitement of insanity. Chloral hydrate, i, 287. Excitement, sexual. Camphor, i. 205. Humulus, i. 474. Excoriations. Dermatol, i, 829. Lycopodium powder, i, 590. Tannic-acid ointment, ii, 257. Waters, mineral, ii, 875. Excoriations of the anus. Tannin (solution), ii, 256. Excoriations of the scrotum. Tannin (solution), ii, 256. Exhaustion. Chirata, i. 284. Stimulants, cardiac, ii, 226. Exhaustion, cerebral. Damiana, i, 824. Exhaustion from nervous disease. Rest-cure, ii, 127. Exhaustion from over-excitement. Zinc phosphate, ii, 410. Exhaustion from overwork. Phenacetine, ii, 71. Exhaustion, mental or nervous. Rest-cure, ii, 127. Exhaustion, nervous. Castor, i, 219. Damiana, i, 324. Glycerophosphates, ii, 439. Lavandula, i, 572. Nitrous-oxide inhalation, ii, 18. Sumbul, ii, 7. Exhaustion, senile. Ergot and sodium phosphate, i, 389. Exhaustion, sexual. Cereus grandiflorus, i. 229. Exudates, inflammatory. Potassium iodide, ii, 98. Exudations, serous. Thiosinamine, ii, 280. Fainting. See Svncope. Fatigue, muscular. Baths, hot, i, 166. Fatty liver. See Liver, Fatty. Favus. Alumnol applications, i, 51. Carbolic-acid ointment, i, 212. Cod-liver oil, i. 288. Felons. , , , . ,„ Alkalies (poultice of hard-wood ashes), i, 45. Fermentation, gastric. Ammonia water, i, 58. Creosote, i, 314. Diaphthol, i. 333. Hyposulphites, i, 519. 80 Fermentation, gastric. Naphthol, ii. 2. Fermentative changes in the intestines. Strontium salicylate, ii, 147. Fever, acute. Kumyss, i, 567. Fever, adynamic. Camphor, i. 204. Fever, algidity of. Ergot and sodium phosphate, i, 389. Fever, catarrhal. Aconite, i, 8. Fever, eruptive. Mustard bath, hot, i, 647. Fever, hay. See Hay fever. Fever, hectic. Calotropis, i, 203. Fever, hectic, of phthisis. Quinine, ii, 49. Fever, intermittent. See Intermittent fever. Fever, low. Camphor, ii, 6. Opium (as a stimulant), ii, 225. Opium (as a supporting and stimulating agent), ii, 225. Strophanthus, ii, 231. Turpentine oil (internally), ii, 335. Fever, malarial. Calomel, i, 624. Chirata, i, 234. Cinchona, i, 254. Cornus, i, 307. Curcuma, i, 322. Pyoctanine (internally), ii, 109. Quinine, i, 254; ii, 174. Sabbatia, ii, 187. Saligenin, ii, 147. Serum, antidiphtheritic, and quinine, ii, 174. Thuja, ii, 282. Vieiric acid. ii. 358. Fever of children. Aconite, i, 8. Fats by inunction, i, 420. Magnesium citrate, i, 591. Potassium tartrates, ii, 100. Fever of influenza. Phenocoll, ii. 72. Fever of phthisis. Opium, ii, 36. Phenocoll, ii, 72. Fever of tuberculosis. Aconite, i, 9. Fever, paludal. See Fever, Malarial. Fever, puerperal. Copper-arsenite solution, i, 304. Quinine, ii, 119. Salufer, ii, 450. Serum, antistreptoeoccus, ii, 175. Tartar emetic, i. 114. Turpentine oil (internally and locally), ii, 336. Fever, relapsing. Salicylic acid, ii, 143. Fever, remittent. See Remittent fever. Fever, rheumatic. Euphorin, i, 402. Malakin, i, 592. (2 INDEX OF DISEASES AND REMEDIES. Fever, scarlet. See Scarlet fever. Fever, septic. Sesame oil, ii. 190. Fever, surgical. Euphorin. i. 402. Quinine, i. 256. Fever, typhoid. See Typhoid fever. Fever, typhus. See Typhus fever. Fever, urethral. Aconite, i, 9. Quinine, i, 256 ; ii, 120. Fever, yellow. See Yellow fever. Fevers. Acetanilide, i, 2. Acetylamido phenol, i, 5. Aconite, i, 8. Alcohol (sponging with), i, 421. Antipyrine, i, 123. Arnica, fluid extract of (internally), 141. Bath, sheet, i, 169. Baths, cold, i, 486. Calomel, i, 624. Camphor, ii, 6. Chamomile, i, 231. Cimicifuga, i. 250. Cinchona, i, 255. Cold affusions (Currie's method), i, 16. " water (internally), i, 479. Copper-arsenite solution, i, 304. Cornus, i, 307. Curcuma, i, 822. Ergot and sodium phosphate, i, 389. Euphorin, i, 402. Gelsemium, i, 436. Guaiacol, i, 457. Hydrocotyle asiatica, i, 493. Injections of iced water, i, 480. Kairine, i, 563. Kumyss, i, 567. Lithium salicylate, ii. 145. Magnesia citrate, i, 591. Malakin, i, 592. Nitre, i, 421. Phosphergot, i, 389. Pyoctanine, ii, 109. Quinine, i,.255 ; ii, 174. Resorcin, ii, 126. Salicylic acid, ii, 142. Sabbatia, ii, 137. Scammony, ii, 157. Serum antistreptoeoccus, ii, 175. Sesame oil, ii, 190. Sodium tartrate, ii, 209. Sponge bath, i, 491. Tartar emetic, i, 114. Thalline, ii, 276. Turpentine oil, ii, 336. Vinegar solution, sponging with, ii, 359. Water, rectal enema of, i, 479. Wine, sherry, ii. 393. Fibroids, uterine. Cimicifuga. i, 250. Ergot. i.li88. Galvanism, i, 368. Nitric acid, ii, 7. Fissures. Gelanthum (Unna's treatment), ii, 349. Iodoform, i, 538. Zinc oxide, ii, 406. Fissures, anal. Benzoin, i, 178. Glycerin injections, i, 450. Tannin, ii, 257. Fissures, eczematous. Cantharides, tincture of (topically), i, 208. Fissures of the lips and tongue. Silver nitrate, ii, 195. Fissures of the nipples. Alcohol applications, i, 31. Borax, i, 189. Collodion, i. 294. Ichthyol, i, 528. Lead nitrate, i, 578. Limewater as a lotion, i, 582. Picric acid, ii, 83. Fissures of the rectum. Bismuth injections, i, 181. Iodoform, i, 538. Fissures of the tongue. Papain, ii, 60. Fistula. Collodion, i, 293. Creosote, i, 314. Silver nitrate, ii, 195. Flat foot. Exercise, i, 416. Flatulence. Ammonia water, i, 54. Ammonium carbonate, i, 55. Asafcetida, i, 147. Boric acid, i, 190. Calamus, i, 201. Chirata, i, 234. Chloroform, i, 241. Cinnamon, i, 259. Gamboge, i, 433. Glycerin, i, 451. Horseradish, i, 473. Lavandula, i, 572. Nux vomica, ii, 28. Peppermint infusion, i. 613. (eructations), Pepsin, ii, 69. Permanganates, ii, 70. Pimenta, ii, 87. Salicylic acid, ii, 143. Terebene, ii, 271. Terpin hydrate, ii, 272. Flatulence of children. Asafcetida. i, 147. Flatulence of infants. Valerian, ii, 345. Flooding. See HAEMORRHAGE. Flushing of the face. Cimicifuga, i, 250. Flushings, painful. Bromides, i, 194 Foetor of the feet. Boric acid, i, 191 Foetor of the urine. Cinnamon, oil of, i 259 Fractures. Massage, i. 609. Fractures of the jaw. Gutta percha, i, 462. INDEX OF DISEASES AND REMEDIES. 5T.1 Freckles. See Lentigo. Freezing of the extremities. Transfusion, peripheral, ii, 823. Frostbite. Baths, cold foot, i, 170. Benzoin, compound tincture of, i, 179. Cold affusions, i, 17. Phulluah, ii, 79. Potassium permanganate, i, 596. Storax, liquid, ii, 229. Fungous growths. See Growths. Fungus haematodes. Chromic acid, i, 248. Furuncles. See Boils. Galactorrhoea. Camphorated oil, i, 204. Ergot, i. 388. Gallstones. See Calculus, Biliary. Ganglion. Carbolic-acid injections, i, 213. Gangrene. Bromine, i, 195, 227, 445. Camphor, i, 204. Carbolic-acid inhalation, i, 213. Charcoal poultice, i, 232. Chlorine, i, 445. Citric acid, i. 260. Creosote, i, 314. Guaiacol, i, 459; ii, 439. Lemon-juice, i, 260. Nitric acid, ii, 7. Oxygen, ii, 51. Permanganates, ii, 70. Peat (as a dusting powder), ii, 65. Potassium permanganate, i, 597. Gangrene, hospital. Bromine, i, 195, 227, 445. Nitric acid, ii, 7. Permanganates, ii, 70. Salicylic acid, ii, 143. Turpentine oil, ii, 336. Gangrene, idiopathic. Camphor, i, 204. Gangrene, local. Turpentine liniment, ii, 335. Gangrene of the lung. Carbolic-acid (solution) inhalation, i, 213. Creosote (by inhalation), i, 314. Guaiacol, i, 459 ; ii, 439. Salicylic-acid inhalation, ii, 143. Turpentine oil, vapour of, ii, 336. Gastralgia. Acetanilide, i, 3. Camphor, i, 205. Cerium oxalate, i, 229. Galvanization, anodal, i, 366. Lavage, i, 572. Manganese oxide, i, 596. Myrrh, tincture of (internally), i, 651. Nitroglycerin, ii, 15. Nutmeg, ii, 25. Pepsin and codeine, ii, 69. Phenacetine, ii, 71. Wines (by enema), ii, 394. Zine cyanide, ii, 408. Gastric disease, chronic. Douche, cold, i. 491. Silver iodide, ii, 197. Gastric pain. Bismuth, i, 180. Gastritis. Copper arsenite, i. 305. Diet, careful, i, 885. Geosite, ii, 438. Hellebore, white, i, 470. Ipecac, i, 542. Lavage, i, 491, 572. Moss, Irish, i, 247. Myrrh, i, 651. Pepsin, ii, 69. Silver-nitrate irrigation, ii, 194. Silver oxide, ii, 197. Strontium bromide, ii, 229. Vichy water, ii, 358. Waters, chlorinated, ii, 365. Gastritis, acute. Copper arsenite, i. 305. Diet, careful, i, 335. Geosite. ii, 438. Hellebore, white, i, 470. Ipecac, i, 542. Strontium bromide, ii, 229. Gastritis, catarrhal. Myrrh, tincture of, i, 651. Gastritis, chronic. Copper arsenite, i, 305. Lavage, i, 491, 572. Silver nitrate (by irrigation of the stomach), ii, 194. Waters, chlorinated, ii, 365. Gastritis, mucous. Pepsin, ii, 69. Gastritis, subacute. Copper arsenite, i, 305. Diet, i, 335. Pulsatilla, ii, 107. Gastrodynia. Manganese oxide, i, 596. Gastro-enteritis. Infusion, ii, 324. Tannigene, ii, 260. Waters, mineral, ii, 376. Gastro-enteritis, chronic. Infusion, ii, 324. Gastro-enteritis, chronic catarrhal. Waters, mineral, ii, 376. Gastro-neuroses. Ammonia, foetid spirit of, i, 53. Genital neuroses and psychoses. Faradization, general, i, 366. Genitourinary irritation. Baths, cold sitz, i, 488. Capsicum, i, 209. Conium, i, 298. Iodoform, i, 538. Larix, i, 570. Terebene, ii, 271. Gingivitis. Catechu, infusion or tincture, i, 221. Cupric oxide, i, 305. Glanders. Copper arsenite (locally and internally), i, 304. Glands, caseous. Iodol, i, 540. 574 INDEX OF DISEASES AND REMEDIES. Glands, indurated. Gold, i, 453. Ichthyol, i. 522. Iodine, i, 536. Iodoform, i, 535, 536. Glaucoma. Eserine (in solution), i, 391. Quinine, ii, 120. Sodium salicylate, ii, 146. Suprarenal capsule, ii, 247. Glaucoma, acute. Quinine, ii, 120. Gleet. See GONORRHCEA, CHRONIC Glossitis. Copper-arsenite solution, i, 304. Glossitis, syphilitic. Chromic acid (as a wash), i, 248. Goitre. Aconite, i, 9. Arsenic, i, 146. Chromic-acid injections, i, 248. Digitalis, i, 342. Exercise, i, 415. Galvanization, i, 366. Gold bromide, i, 454. Iodine, i, 586. " (externally), i, 536. " (hypodermic injections), i, 536. " (internally), ii, 214. Iodoform (hypodermically), i, 538. Rest-cure, ii, 127. Salicylic acid, ii, 146. Strophanthus, ii, 232. Thyreoid treatment, i, 178; ii, 297. Veratrum viride, ii, 353. Goitre, cystic. Arsenic, i, 146. Goitre, exophthalmic. Aconite (tincture), i, 9. Digitalis, i, 342. Exercise, systemic passive respiratory, i, 415. Galvanization, stabile, i, 366. Gold bromide, i, 454. Rest-cure, ii, 127. Salicylic acid, ii, 146. Strophanthus, ii, 232. Thyreoid feeding, i, 78. Veratrum viride, ii, 853. Gonorrhoea. Aconite (tincture), i, 9. Alkalies, i, 44. Aloes, i, 49. Aluminum tannate, ii, 259. Alumnol injections, i, 51. Argentamine, i, 140. Argonin, ii, 197. Baths, hot. i, 166. • Benzoic acid, i, 177. Bismuth injections, i. 181. " tannate, ii, 259. Boric acid (2-per-cent. solution), i, 19L Buchu, i, 197. Cadmium-salicylate injections, i, 200. Camphor, i. 205. Catechu injections, i, 221. Chloral-hydrate injection, i. 237. Copaiba, i, 301. Copper-arsenite solution, i, 304. Corn silk, i, 300. Gonorrhoea. Creosote and boric acid by injection, i, 314. Cubeb, i, 319. Cupric acetate (topically), i, 303. sulphate solution (injections), i, 306. Ephedra antisyphilitica, i, 385. " trifurcata as a styptic, i, 385. Erigeron, oil of, i, 390. Ferropyrine, i, 422. Formaldehyde, i, 428. Gallobromal (by injection), i, 433. Geranium (topically), i, 438. Gurjun balsam, i, 462. Hydrastine (internally and by injection), i, 476. Hydrogen-dioxide injections, i, 503, 531. Ichthyol injections, i, 522. Iodine, i, 536. Kava. i, 564. Lafayette mixture, i. 301. Lanolin injection, i, 569. Lysol, i, 590. Matico, i, 611. Mercury bichloride (injections), i, 531. Methylene blue, i, 630. Palmetto wine, ii, 58. Potassium permanganate (injections), i, 531, 597. Pyridine injections, ii, 110. Pyoctanine, ii, 108. " (internally), ii, 109. Quinine injections, ii, 126. " hydrochloride (locally), i, 254. Salol, ii, lo0. Sandal-wood oil, ii, 153. Silver citrate, ii, 198. '* nitrate, ii, 196. " oxide, ii, 197. Storax, ii, 228. (in pregnant women), Tannin and alum douche, ii, 256. Tannin injections, ii, 256. Terpin hydrate, ii, 272. Thalline injections, ii, 276. Traumatol, ii, 329. Tribulus lanuginosus, ii, 330. Triticum, ii, 333. Turpentine oil, ii, 336. Water, i, 105. Zinc acetate (as a local astringent), ii. 402 " oxide, ii, 407. " permanganate, ii, 410. " sozoiodolate, ii. 410. " subgallate, ii, 411. ' sulphate injection, ii, 407. " sulphocarbolate, ii, 412. Gonorrhoea, acute. Aluminum tannate. ii, 259. Gonorrhoea, chronic. Cadmium sulphate, i, 200. Cantharides, i, 208. Catechu injections, i, 221. Copper arsenite. i, 804. Ironri?"^4Phate Solution (inJec'tions). i, 306. " chloride (tincture), i, 548. Kava, i, 564. Silver nitrate, ii, 196. Tannin injections, ii, 256. Thalline injections, ii, 276. INDEX OF DISEASES AND REMEDIES. 575 Gonorrhoea, chronic. Uva ursi, ii, 343. Waters, Buffalo lithia, ii, 372. " mineral, ii, 877. Gonorrhoea, subacute. Potassium-permanganate injection, i, 597. Gonorrhoea, vaginal. Formaldehyde, i, 428. Gurjun balsam, i, 462. Traumatol, ii, 329. Gout. Aconite (as an anaesthetic), i, 9. Alkaline mineral waters, i, 45. Amber, oil of, i, 52. Baths, Nauheim. ii, 420. " pine, i, 172. Cod-liver oil, i, 288. Colchicum, i, 291. Dulcamara, i, 353. Ephedra, i, 885. Glycerophosphates, ii, 439. Guaiac, i, 456. Guaiacol and glycerin, i, 461. Ichthyol, i, 522. Kava, i, 564. Lithium, i, 586. Lycetol, i, 589. Magnolia, i, 592. Mercury, i, 619. Methylene blue, i, 629. Muscarine, i, 645. Oxygen, ii, 52. Ozone, ii, 58. Piperazine, ii, 89. Potash, ii, 94. Quinine salicylate, ii, 455. Salicin, ii, 140. Salicylic acid, ii, 143. Salines, ii, 147. Salophene, i, 125. Strontium lactate, ii, 230. Sulphur, ii, 241. Tartarlithine, ii, 265. Tetrethylammonium, ii, 273. Uricedin, ii, 342. Urotropine, ii, 343. Waters, alkaline, ii, 367, 372. " chlorinated, ii, 365. mineral, ii, 374, 375, 377, 379. " simple thermal (internally), ii, 364. " sulphur, or vapours, ii, 371. Wet-pack, i, 490. Gout, acute rheumatic. Pulsatilla, ii, 107. Gout, chronic. Guaiac wood, i, 457. Iodine salts, i, 536. Mercury iodide and arsenic, i, 627. Savine, ii, 157. Gout, rheumatic. Arsenic, i, 145. Cod-liver oil, i. 288. Massage, i, 608. Granular lids. _ Atropine, i, 155. Boric acid, i, 190. Granulating sores. Sponge-grafting, ii, 219. . Granulation of the eyelids. Jequirity, i, 502. Granulations, exuberant. Silver nitrate, ii, 195. Granulations, intrauterine. Nitric acid, ii, 7. Granulations, vascular. Silver nitrate, ii, 195. Gravel. See Lithiasis. Grippe. See Influenza. Growths, intra-uterine. Chromic-acid applications, i, 248. Growths, malignant. Zinc chloride, ii. 403. Growths, nasopharyngeal. Chromic-acid applications, i. 248. Growths, sloughing malignant. Potassium permanganate, i, 597. Growths, soft. Iron chloride, i, 548. Growths, superficial cutaneous. Hydrochloric acid, i, 227. Gums, spongy. Borax, myrrh, and honey, i, 189. Copper-arsenite solution, i, 304. Myrrh, tincture of, i, 651, Haematemesis. Calcium chloride, ii, 428. Catechu lozenges, i, 221. Iron sulphate, i, 550. Matico, i, 611. Haematocele. Electricity, i, 368. Haematoma. Bryonia, i, 197. Electricity, i, 368. Hematuria. Corn silk, i, 306. Ergot, i, 388. Gallic acid, i, 432. Matico, i, 611. Physostigma, ii, 81. Pichi, ii, 82. Quinine, i, 255; ii, 120. Rhus aromatica, ii, 131. Silver nitrate, ii, 196. Tannic acid, ii, 257. Haemophilia. Gallic acid, i, 432. Marrow, i, 598. Tannin, ii, 257. Haemoptysis. Air, condensed, inspiration of, i, 28. Bryonia, i, 197. Cupric sulphate and opium, i, 306. Ergot, i, 388. Erigeron. oil of, i, 390. Gallic acid, i, 432. Ipecac, i, 542. Iron sulphate, i. 550. Lead acetate, i, 577. Matico, i, 611. Opium, ii, 35. Podophyllin, ii, 93. Senecin, ii, 161. Senecio, ii, 162. Tannin, ii, 257. Terebene, ii, 271. Waters, sulphuretted, ii, 371. 57G INDEX OF DISEASES AND REMEDIES. Haemorrhage, passive. Iron chloride (tincture), i, 548. Kino, i, 565. (from the stomach and intestines), Tannic acid, ii, 257. Haemorrhage, post-partum. Boussingaulthia basselloides, i, 191. Bryonia, i, 197. Canella, i, 206. Cimicifuga, i, 250. Ei-got. i, 888. Faradization, i, 368. Hot saline solutions (injections), i, 467. Ice, i, 520. Injections of iced water, i, 480. Ipecac, i, 542. Iron chloride, i, 548. " sulphate, i, 550. Lemon-juice, i, 260. Sponge tents (impregnated with vinegar), ii, 219. Turpentine oil, ii, 336. Vinegar, ii, 219. Haemorrhage, pulmonary (of the plethoric). Bloodletting, i, 188. Ergot, i. 388. Hainamelis, i, 467. Pneumatic cabinet, ii, 413. Silver oxide, ii, 197. Haemorrhage, rectal. See HAEMORRHAGES FROM THE RECTUM. Haemorrhage, renal. Hamamelis, i, 467. Haemorrhage, slight. Salicylic acid, ii, 143. Haemorrhage, uterine. Boussingaulthia baselloides, i, 191. Creosote, i, 314. Ergot, i, 388. Erigeron, oil of, i, 390. Erodium cicutarium, ii, 433. Hamamelis, i, 467. Ice, i, 520. Quinine ferrichloride. ii, 455. Salol and antipyrine applications, ii, 150. Stypticin, ii, 233. Tannic acid, ii, 257. Urtica, ii, 343. Viscum album, ii, 361. Haemorrhage's. Antipyrine, i, 466. " and tannin, ii, 257. Baths, warm, i, 489. Calcium carbide, ii, 426. " chloride, ii, 428. Cimicifuga, i, 250. Cinnamon, i. 259. Cornutine, i, 307. Creosote, i, 314. Cupric-sulphate solution (locally), i, 306 Digitalis, i, 342. Electricity, i, 368. Ergot, i, 388. Erigeron, oil of, i, 390, Ferropyrine, i, 422. (from tooth extraction), Ethyl chloride, ii 434. Gallic acid (internally), i, 432. Geranium, i. 438. Hamamelis, i, 467. Haemorrhages. Heat, i, 468. Hydrastine (internally), i, 476. Hydrastis, i, 476. Ice, i, 520. Infusion, ii, 323. Injection of hot salihe solution, i, 467. Ipecac, i, 542. Iron chloride (solution), i, 548. " sulphate, i, 550. Kino, i, 565. Lead acetate, i, 577. Ligation of arteries in, i, 465. Nitric acid, ii, 7. Opium, ii, 36, 450. Pichi, ii, 82. Pneumatic cabinet, ii, 413. Posture in the arrest of, i, 465. Rhubarb, ii, 131. Saline solution (by the rectum), ii, 227. Salt, ii, 206. Sclerotic acid, ii, 158. Silver oxide, ii, 197. Sodium chloride, ii, 206. (during operations), Steam, ii, 222. Stypticin, ii, 230. Sulphur and cream of tartar, ii, 241. Sulphuric acid, ii, 242. Suprarenal capsule, ii, 247. Surgical means for arresting, i, 464, 465. Tannic acid and antipyrine, ii, 257. Torsion or twisting as a means of arresting, i, 465. (from traumatism), Transfusion and infusion, ii, 322. Turpentine oil. ii, 336. Urtica, ii, 343.' Veratrum viride, ii, 353. Vinegar, i, 5; ii, 219. Viscum album, ii, 361. Water, hot (by the mouth or the rectum), ii, 227. ; Wines, strong, as a tonic, ii, 394. Haemorrhages, abdominal. Saline cathartics, ii, 147. Haemorrhages after labour. Ergot, i, 388. Haemorrhages, bronchial (of the plethoric). Bloodletting, i, 188. Haemorrhages, capillary. Ice (topically), i, 520. Sodium chloride, ii, 206. Haemorrhages, cerebral. Baths, warm, i, 489. Haemorrhages, climacteric. Stypticin, ii, 233. Haemorrhages, external. Iron sulphate (solution), i, 550. Haemorrhages from fibroids. Stypticin. ii, 233. Hemorrhages from leech bites. Creosote, i, 314. Haemorrhages from the extraction of teeth Turpentine oil, ii, 336. Haemorrhages from the rectum. Hydrastis, i, 476. Rhubarb, ii, 181. Sulphur and cream of tartar, ii °41 Haemorrhages from the stomach. Lead acetate, i, 577. INDEX OF DISEASES AND REMEDIES. 5?T Haemorrhages from typhoid ulcer. Opium, ii, 36. Haemorrhages, gastric. Infusion, ii, 323. Silver oxide, ii, 197. Haemorrhages, internal. Sclerotic acid, ii, 158. Haemorrhages, intestinal. Erigeron, oil of, i, 390. Hydrastis, i, 476. (of typhoid fever), Infusion, ii, 323. Krameria, i, 566. Lead acetate, i, 577. Haemorrhages, nasal. Ferropyrine, i, 422. Haemorrhages of malarial fever. Quinine, ii, 118. Haemorrhages of scurvy. Ergot, i, 388. Haemorrhages, vesical. Cinnamon, i, 259. Krameria, i, 560. Haemorrhoids. Apone, i, 139. Arsenic, i, 146. Baths, cold, i, 169. " cold sitz, i, 489. (strangulated). Baths, hot sitz, i, 169. Baths, narcotic, i, 172. Carbolic-acid injections, i, 213. Chromic-acid applications, i, 248. Ergot, i, 388. Galls, i, 433. Glycerin injections, i, 450. Grape cure, i, 455. Hamamelis, i, 467. Iron sulphate, i, 550. Lappa, i, 570. Nitric acid, ii, 7. Oak bark (enema), ii, 31. Piscidia, ii, 91. Rhus toxicodendron, ii, 133. Sulphur and cream of tartar, ii, 241. Tannic-acid ointment, ii, 256. Tannin suppositories, ii, 256. Water (rectal applications), i, 479. " in form of an ascending douche, i, 349. Waters, mineral, ii, 371, 375. Zinc subgallate, ii, 411. Haemothorax. Aspiration, i, 151. Hallucinations. Galvanism and Faradaism, i, 866. Hay fever. Blennostasine, ii, 426. Copper-arsenite solution, i, 304. Formaldehyde, ii. 436. Glycerin and carbolic acid, i, 450. Grindelia, i, 456. Ipecac, i, 542. Menthol solution (by injection), i, 614. Quinine hydrochloride (either by spray or painted on the mucous membrane), i, 253; ii, 119. Salicin, ii, 140. Salicylic acid, ii, 143. Sulphurous acid, ii, 243. Tannigene, ii, 260. Terpin hydrate, ii, 272. Hay fever. Zinc valerianate, ii, 347. Headache. Acetanilide, i, 3. Acetic acid (by inhalation), i, 5. Alcohol, i, 30." (of anaemia), Amyl nitrite, i, 61. Anhalonium Lewinii, ii, 417. Antipyrine, i, 201. . Blisters, i, 185. Bromoform, i, 196. Caffeine, i, 201. Camphor, ii, 6. Chloralose, i, 239. Cicuta maculata, i, 250. Cocaine, i, 283. Coffee, i, 290. Croton oil, i, 318. Ether, i, 397. Eucalyptus, oil of, i, 400. Exalgine, i, 403. Galvanization, stabile, i, 366. Guarana, i, 461. Hydrobromic acid, i, 492. Lavandula, i, 572. Magnesia, i, 591. Massage of the neck, i, 608. Menthol, i, 614. Migrainin, i, 631. Mustard foot-bath, i, 647. Nitroglycerin, ii, 15. Nux vomica, ii, 28. Phenacetine, ii, 71. Potassium cvanide, i, 323. Pulsatilla, ii", 107. Pyrethrum, ii, 109. Salipyrine, ii, 148. Splenic extract, ii, 218. Thymacetine, ii, 282. Thymol, ii, 283. Valerian, ii, 345. Headache, chronic. Croton oil, by application to the nape of the neck, i, 318. Headache due to anaemia of the brain. Nitroglycerin, ii, 15. Headache due to intracranial lesions. Blisters, i, 185. Headache, febrile. Pyramidone, ii, 454. Headache, frontal. Anhalonium Lewinii, ii, 417. Cocaine, i, 283. Galvanization, stabile, i, 366. Nux vomica, ii, 28. Headache, hysterical. Chloralose, i, 239. Headache, menstrual. Senecio, ii, 456. Headache, nervous. Anhalonium Lewinii, ii, 416. Cannabis indica, i, 67. Caffeine and antipyrine, i, 201. Cicuta maculata, i. 250. Ether, as a spray, i, 397. " (internally), i, 397. Exalgine, i, 403." Pulsatilla, ii, 107. Thymacetine, ii, 282. Valerian, ii, 345. 578 INDEX OF DISEASES AND REMEDIES. Headache, occipital. Anhalonium Lewinii, ii, 417. Galvanization, stabile, i, 366. Headache of indigestion. Ammonia water, i, 53. Ammonium valerianate, ii, 346. Magnesia, i, 591. Mustard foot-bath, i, 647. Headache of influenza. Ethyl chloride, ii, 484. Migrainin, i, 631. Headache of melancholia. Exalgine, i, 408. Headache, sick. See Mioraine. Heart affections. Hydrocyanic acid, i, 495. Strychnine, ii, 28. Heart, dilatation of the. Air, condensed, expiration into, i, 28. Digitalis, i, 341. Heart disease. Adonis, i, 16. Alcohol, ii, 225, 227. Amyl nitrite, i, 60; ii, 227. Aspiration, i, 150. Baths, hot, ii, 225. " Nauheim, ii, 419. Bromides, i, 194. Caffeine, i, 201. Cardine, i, 218. Carpaine, i, 218. Cereus grandiflorus, i. 229. Cimicifuga, i, 250. Convallaria, i, 300. Corn silk, i, 306. Digitalis, i, 341. Hydrochloric acid, i, 493. Mercury, i, 620. Morphine, ii, 36. Nux vomica, ii, 28. Opium, ii, 36. Pulsatilla (as a sedative), ii, 106. Saline infusion, ii, 227. Schott treatment, ii, 419. Sodio-theobromine salicylate, ii, 202. Sparteine, ii, 216. Squill, i, 345. St rophanthus, ii, 232. Strychnine, ii, 28. " injections, ii, 450. Veratrum viride, ii, 353. Heart disease, valvular. Aspiration, i, 150. Barium chloride, i, 161. Heart disease with deflcient compensa- tion Hydrochloric acid, i, 493. Heart failure (sudden). Alcohol (subcutaneously), ii, 227. Amyl nitrite, ii. 227. Ether (subcutaneously), i. 397. Nux vomica, ii, 28. (in acute delirium of some forms of insanity) Wine, ii, 394. Heart failure during anaesthesia. Strychnine injections, ii, 450. Heart, fatty. Cimicifuga, i, 250. Iron, i, 217. Heart, flagging of the. Counter-irritation, ii, 227. Saline infusion, intra-arterial or intra- venous, combined with strychnine, ii, 227. Heart, irregular. Sodium salicylate, ii, 146. Heart, irritable. Digitalis, i, 342. Strophanthus, ii, 232. Veratrum viride, ii. 353. Heart, nervous excitement of the. Bromides, i, 194. Heart, organic disease of the. Caffeine, i, 201. Heart, palpitation of the. See Palpitation of the heart. Heart, smoker's. Aconite (tincture), i, 9. Heart, weak. Alcoholic stimulants, ii, 225. Cimicifuga, i, 250. Corn silk, i, 306. Digitalis, i, 345. Scoparius, i, 345. Squill, i, 345. Wine, port, ii, 394. Heartburn. See Dyspepsia, Acid. Hemicrania. See Migraine. Hemiplegia. See Apoplexy. Hepatitis. Veratrum viride, ii, 352. Hepatitis, congestive. Aspiration, i, 151. Hepatitis, suppurative. Aspiration, i, 151. Hernia. Aspiration, i, 152. Iodine injection, i, 536. Hernia, strangulated. Bath, hot, i, 166, 489. Collodion, i, 294. Ice (topically), i, 519. Lobelia, infusion of, i, 587. Oxalic acid, ii, 49. Tartar emetic, i, 114. Tobacco-smoke enema, i, 304. Hernia, umbilical. Collodion, i, 294.. Herpes. Acetanilide, i, 3. Baths, sulphurous, i, 173. Blisters, i, 186. Collodion, i, 294. (for pain), Ethyl chloride, ii, 434. Euphorin (as a local disinfectant), i, 403. Grindelia, i, 456. Resorcin, ii, 126. Salicylic acid, ii, 143. Zinc-acetate ointment, ii, 402. Zinc oxide, ii, 406. Herpes labialis. Collodion, i, 294. Herpes praeputialis. Collodion, i, 294. Herpes zoster. See Zoster. INDEX OF DISEASES AND REMEDIES. 579 Hiccough. Apomorphine, ii, 417. Chloral hydrate, i, 287. Chloroform, spirit of, i, 241. Conium, i, 298. Muscarine, i, 645. Musk, ii, 6. Nitroglycerin, ii, 15. Sulphonal, ii, 289. Hip-joint disease. Nucleins, ii, 24. Hives. See Urticaria. Hoarseness. Catechu lozenges, i, 221. Flacourtia, i, 422. Potassium chlorate, ii, 96. Hodgkin's disease. Arsenic, i, 144. Hydrocele. Chloroform (injection), i, 241. Claret (bv injection), ii, 394. Electricity, i, 368. Iodine injections, i, 536. Silver nitrate, ii, 196*. Sodium chloride, ii, 163. Zinc-chloride injections, ii, 404. Hydrocephalus. Croton oil, i, 318. Iodine injection, i, 536. Hydrocephalus, acute. Infusion, ii, 324. Hydrocephalus, chronic. Aspiration, i, 150. Hydrocephalus, congenital. Collodion, i, 294. Hydropericardium. Aspiration, i, 151. Hydrophobia. Conium, i, 229. Curare, i, 321. Serum treatment, i, 84. Hydrops articulorum intermittens. Quinine, ii, 120. Hydrosalpinx. Electricity, i, 368. Hydro thorax. Aspiration, i, 151. Jaborandi. i, 559. Hyperacidity, gastric. See Dyspepsia, Gastric. Hyperaemia. Baths, cold, i, 169, 170. " condensed-air, i, 27. " warm, i. 489, Collodion, i, 294. Ergotole (local application), i. 389. Ichthyol. i, 522. Viburnum prunifolium, ii, 356. Hyperaemia, cerebral. 'Baths, cold, i, 169, 170. " warm, i, 489. Hyperaemia, ocular. Collodion, i. 294. Hyperaemia of the pelvic organs. Viburnum prunifolium, ii, 356. Hyperaemia, pulmonary. Baths, cold, i, 169. Hyperesthesia. 'Baths, hot sitz, i, 169. Hvperaesthesia. Electricity, i, 368. Salix. ii, 149. Hvperaesthesia, ovarian. Electricity, i. 368. Hyperidrosis. 'Belladonna, i. 103. (after influenza), Camphoric acid, ii, 428. Coto bark, i. 309. Dover's powder, i, 103. Ergot, i, 102. Gallic acid, i, 432. Hydrastine, i, 476. Mineral acids, i, 103. Muscarine, i, 103. Naphthol (in solution), ii, 2. Nux vomica, i, 102. Oak bark, ii. 31. Picrotoxin, i, 103. Salicylic acid, ii, 144. Salvia, ii, 456. Silver oxide, i, 197. Strychnine, i, 102. Sulphuric acid, ii, 242. Tannic acid, ii, 257. Tannoform, ii, 260. Zinc oleate, ii, 405. " oxide, i, 102. Hyperidrosis of the feet. Boric acid, i, 102. Potassium permanganate, i, 597. Tannic acid, ii, 257. Tannoform, ii. 260. Hyperidrosis, partial. Sulphur, i, 103. Hyperpyrexia. See Fevers. Hypertrophy of the heart. Veratrum viride, ii, 353. Hypertrophy of the liver. Iodine salts, i, 536. Hypertrophy of the lymphatic glands. Iodine injections, i, 586. Hypertrophy of the nose. Ignipuncture, i, 524. Hypertrophy of the prostate. Aspiration, i, 152. Iodine (injection), i, 536. Hypertrophy of the spleen. Ammonium fluoride, i, 57. Grape cure, i, 455. Lead-iodide ointment, i, 57. Waters, mineral, ii, 366. Hypertrophy of the testicles. Guaiacol applications, ii, 439. Iodine salts, i, 536. Hypertrophy of the tongue. Gold, i, 453. Hypertrophy of the tonsils. Catechu, infusion or tincture, i, 221. Ignipuncture, i, 524. Iodine (injections), i, 536. Tannin, glycerite of, ii. 256. Trichloracetic acid, ii, 330. Hypertrophy, uterine. 'Galvanism, i, 368. Iodine salts, i, 536. Hypochondriasis. Anhalonium Lewinii, ii, 416. Electricity, i, 366. 580 INDEX OF DISEASES AND REMEDIES. Hypochondriasis. Faradization, general, i, 366. (told, i, 453. Oxygen, ii, 52. Rest-cure, ii, 127. Strychnine, ii, 28. Hysteria. Allyl tribromide, ii, 414. Ammonia, fcetid spirit of, i. 53. Ammonium carbonate, i, 56. " succinate, i, i)S. Amy! nitrite, i, 61. Anhalonium Lewinii, ii, 416. Apomorphine, ii, 418. Asafcetida, i, 147. Bromides, i, 193. Caffeine valerianate, ii, 346. Camphorated oil, ii, 6. Castor, i, 219. Chamomile, i. 231. Cineraria, i, 258. Cocaine (internally), i, 284. Cold affusions, i, 17. Creosote, i, 314. Croton-oil application to the spine, i, 318. Faradaism, i, 367. Galbanum, i, 432. Gold bromide, i, 454. Iron chloride (tincture), i, 549. " valerianate, ii, 346. Orchitic liquid, i, 76. Paraldehyde, i, 509. Phosphoric acid, ii, 77. Piscidia, ii, 91. Quinine valerianate, ii, 347. Rest-cure, ii, 127. Rue, ii, 137. Sumbul, ii. 243. Tansy, ii, 261. Valerian, ii, 345. Viburnum prunifolium, ii, 357. Waters, thermal (externally and internally), ii, 364. Hysteria, vomiting of. See Vomiting, Hysterical. Hystero-epilepsy. Amyl nitrite, i. 61. Bromides, i, 193. Orchitic liquid, i, 76. Valerian, ii, 345. Viburnum prunifolium, ii, 357. Ichthyosis. Baths, alkaline, i, 171. Cupric-sulphate solution, i, 306. Naphthalan, ii, 448. Salicylic-acid ointment, ii, 144. Thyreoid feeding, i, 79. Icterus. See Jaundice. Impaction, faecal Glycerin injections, i, 451. Lobelia (enema of the infusion), i, 587. Ox-bile enema, ii, 49. Tobacco-smoke enema, ii, 304. Water (rectal applications), i, 479, Impetigo. Cod-liver oil, i, 288. Salicylic acid, ii, 241. Sulphur fumes, ii, 241. lllipt-ligu. . .. . Tumenol oil and oxide of zinc, n, 884. Impetigo contagiosa. Salicylic acid, ii, 145. Impotence. Apiol, i, 137. Asafcetida, i, 147. Cantharis, i, 136. Carbonic-acid gas, i, 214. Carrot seeds, i. 137. Cashew nut, i, 219. Cimicifuga, i, 187, 250. Damiana, i, 824. Douches, hot and cold, i, 137. Electricity, i, 137. Ergot, i, 137. Flagellation, i, 137. Gold chloride, i, 187. Juniper, oil of, i, 137. _ Lotions, stimulating, i, 137. Nux vomica, i, 137. Orchitic liquid, i, 76. Pepper (black and red), i, 136. Phosphorus, i, 137; ii, 77. Polygonum hydropiperoides, i, 137. Rue, oil of, i, 137. Sanguinaria, ii, 154. Savine, oil of, i, 137. Strychnine, i, 137. Testicle juice, i, 76. Turpentine, i, 137; ii, 336. Wines, i, 137. Zinc phosphide, i, 137. Inanition. Transfusion, ii, 323. Incontinence of urine. Ammonium benzoate, i, 177. Cantharides, i, 208. (in young boys), Collodion, i, 294. Humulus, i, 474. Kava, i, 564. Lycopodium tincture, i, 590. Massage (Brandt's method), i, 609. (from vesical atony), Rhus aromatica, ii, 131. Rhus toxicodendron, ii, 133. Turpentine oil, ii, 336. (from nervousness), Zinc valerianate, ii, 347. Incontinence, nocturnal, of urine (in chil- dren). Baths, cold, i, 169. Belladonna, i, 175. Orchitic liquid, i, 76. Santonin, ii, 155. Testicle juice, i, 76. Indigestion. See Dyspepsia. Indurations, glandular. Calcium chloride, i, 202. Cupric oxide, i, 305. Manganese sulphate (ointment), i, 596. Inebriety. See Alcohol habit. Inertia, intestinal. • Massage, abdominal, i, 605, 608. Inertia, uterine. Abdominal binder, ii, 56. Cold applications, ii, 56. Cimicifuga, ii, 55. Cornutine, i, 307. Cotton root, extract of, ii, 55. INDEX OF DISEASES AND REMEDIES. 581 Inertia, uterine. Electricity, ii, 55. Ergot, i, 388. Glycerin (intra-uterine injections), i, 450: ii, 55. Heat, i, 468; ii, 56. Hydrastis canadensis, ii, 55. Mammary irritation, ii, 56. Quinine, i, 256; ii, 116, 120. Rue, ii, 137. Sugar, ii, 234. Infiltrations. Atropine, i, 154. Inflammation. Aconite, i, 9, 118. Ammonium chloride, i, 56. Arnica, i, 141. Arsenic, i, 146. Baths, hot, i, 166. Belladonna and morphine injections, i, 67. ointment, i, 173. Bismuth, i, 181. Boric acid, i, 196. Brucine, ii, 29. Caffeine, i, 201. Carbolic acid, i, 212. Collodion, salicylated, i, 293. " saturnine, i, 293. Copper arsenite, i, 305. Croton oil, i, 318. Cupping, i, 320. Digitalis, i, 342. Goose grease, i, 455. Ice (topically), i, 519. Iodoform collodion, i, 293. Linseed tea, ii, 269. Opium, ii, 37. Phytolacca, ii, 81. Poultices, ii, 101. Pulsatilla, ii, 107. Salines, ii, 147. Scopolamine, ii, 159. Silver nitrate, ii, 194, 195. Tannin, ii, 250. Taraxacum, ii, 265. Terebene, ii, 271. Thymol, ii, 284. Veratrum viride. i, 118; ii, 352. Waters, mineral, ii, 872. Wines, ii, 394. Xanthoxylum, ii, 396. Verba santa, ii, 401. Zinc iodide, ii, 405. Inflammation, abdominal. Salines, ii, 147. Inflammation, acute, of the serous mem- branes. Aconite, i, 9. Inflammation, acute sthenic. Aconite, i, 118. Veratrum viride, i, 118. Inflammation, chronic, of the intestines. Silver nitrate, ii, 194. Inflammation, chronic, of the joints. Croton oil, i, 318. Inflammation, chronic pulmonary. Verba santa, ii, 401. Inflammation, chronic purulent, of the middle ear. Silver nitrate, ii, 195. Inflammation, chronic uterine. See Metritis, Chronic. Inflammation, intracranial. See Encephalitis and Meningitis. Inflammation, local. Digitalis, i, 342. Inflammation of joints. See Rheumatism. Inflammation of muscles. See Rheumatism. Inflammation of nerves. See Neuritis. Inflammation of the dental pulp. Thymol, ii, 284. Inflammation of the external ear. See Otitis, External. Inflammation of the eyelids. See Blepharitis. Inflammation of the iris. See Iritis. Inflammation of the kidney. See Nephritis. Inflammation of the liver and spleen. Taraxacum, ii, 265. Inflammation of the lymphatic glands. See Adenitis. Inflammation of the mammary glands. See Mastitis. Inflammation of the middle ear. See Otitis media. Inflammation of the mouth. See Stomatitis. Inflammation of the mucous membranes. Zinc iodide, ii, 405. Inflammation of the mucous membrane of the Eustachian tube. Silver nitrate, ii, 195. Inflammation of the pelvic cellular tissue. See Cellulitis. Pelvic. Inflammation of the pharynx. See Pharyngitis. Inflammation of the respiratory, gastro- intestinal, and urinary membranes. Linseed tea, ii, 269. Inflammation of the serous membranes. Quinine, ii, 119. Xanthoxylum, ii, 396. Inflammation of the uterus. See Metritis. Inflammation of the vagina. See Elytritis. Inflammation of the vermiform appendix. Waters, Buffalo lithia, ii, 372. Inflammation, parenchymatous. Veratrum viride. ii, 352. Inflammation, perimetric. See Perimetritis. Inflammation, pseudo-membranous. Carbolic acid, i, 212. Inflammation, purulent. Wines, ii, 394. Inflammation, rheumatic. See Rheumatism. Inflammation, serous: Veratrum viride, ii, 352. Inflammation, subacute rheumatic. Goose-grease liniment, i, 455. Inflammatory, chronic, thickening and deposits. Cold and hot affusions, i, 17. 5S2 INDEX OF DISEASES AND REMEDIES. Inflammatory cutaneous affections. LTmus (local applications), ii, 338. Inflammatory deposits. Thiol ointment, ii, 278. Inflammatory derangements of the mucous membranes of the body. Copper arsenite, i, 304. Inflammatory processes. Turpentine, ii. 885. Inflammatory processes, acute. Wine, ii, 393. Inflammatory throat affections. Xanthoxylum (as a gargle), ii, 396. Influenza. Acetanilide, i, 3. Ammonium acetate, i, 54. Antikamnia, i, 112. Antitetraizine, i, 184. Asaprol, i, 148. Blennostasine. ii, 426. Calcium sulphide, ii, 428. Camphor and sweet-almond oil (internally), i, 205. J Cinnamon, oil of, i. 259. Copper-arsenite solution, i. 304. Goose grease (internally), i, 454. Guaiacol, i, 460. Lactophenine, i, 568. Naphthol, ii, 2. Nucleins, ii, 24. Pambotano, ii, 58. Phenacetine. ii. 72. Pilocarpine, ii, 86. Saligenin, ii, 147. Salol, ii, 150. Salophene, ii. 151. Scopolamine hydrobromide, ii, 159. Serum therapy, i, 85. Sodium bicarbonate, ii, 205. Wine, ii, 394. Insanity. Baths,'cold, i, 488. Camphor, i, 205. Chemical restraint, i, 233. Exercise, i, 413. Forced feeding, i, 43. Hyoscyamus, i, 504. Marrow, bone, ii, 445. Paraldehyde, ii, 62. Thyreoid feeding, i, 79 ; ii, 296, 299 Zinc phosphate, ii, 410. Insanity during convalescence fevers. Zinc phosphate, ii, 410. Insanity, puerperal. Thyreoid treatment, ii, 291. Insanity, stuporous. Thyreoid treatment, ii, 299. Insolation. Affusions, cold, i, 16. Atropine, hypodermicallv, i. 156. Baths, cold, i, 165. 486; ii, 225. Bloodletting, i, 188. Ethyl chloride, ii, 484. Ice applications, i, 16. Quinine, hypodermically, ii, 126. Insolation of the eyes. Nux vomica (injections), ii, 29. Insomnia. Alcohol, i, 506. from Insomnia. Ammonium valerianate, ii, 346. Amylene hydrate, i, 507. Bath, half, i, 169. •' hot, i, 166. Baths, vapour, i, 171. Bromides, i, 194, 507. Calcium bromide, i, 201. Cannabis indica, i, 207. 507. Chloralamide, i, 238, 507. Chloral ammonium, i, 285. hydrate, i, 236, 507. Chloralose, i, 239. Chlorobrom, i, 240. Codeine, i, 286. Croton chloral, i, 508. Exalgine, i, 403. Hyoscine, i, 504, 508. Hyoscyamus, i, 504, 508. Hypnone, i, 5. Hypnotics, i, 506. Massage, i, 608. Meconarceine, i, 611. Methylal, i, 629. Morphine, i, 508. Opium, i, 508; ii, 36. Oxygen, ii, 52. Paraldehyde, i, 409 ; ii, 62. Phenacetine, ii, 71. Phosphorus, ii, 76. Piscidia, i, 509 ; ii, 91. Sodium lactate, ii, 207. Scopolamine hydrobromide, ii, 159. Somnal, ii, 213. Sulphonal, i, 509 ; ii, 239 Tetronal, ii, 273. Trional, i, 509 ; ii, 332. Urethane, ii, 342. Waters, thermal, ii, 364 Whisky, i, 506. Wine, port, ii, 394. Insomnia from pain. Anhalonium Lewinii, ii, 416 Insomnia, nervous. Chloral hydrate, i, 236. Codeine, i, 286. Exalgine, i, 403. Opium, i, 508. Piscidia, ii, 91. Sulphonal, ii, 239. Tetronal, ii, 273 "?SJS? «■*««•» abases. Insomnia of anaemia. Phosphorus, ii, 76 IX"niiia308f8cl'ronic ,,cart "ls<™<>- 'S^"""™ «* Miction. Trional, ii, 333. SSrnfed!fT80f,l'eut' •' inspiration of, i, 28. " rarefied, expiration into, i, 28. Arsenic, i, 146. Balsamic fumes, i, 529. Baths, condensed-air, i, 27. Benzosol, i, 179. Boric acid, i, 191. Cannabis indica, ii, 429. Cantharidic acid, i, 208. Carbon dioxide, i, 527. •' (by insufflation), l, 533. Cinnamic acid, i, 259. Creosote, by inhalation, i, 314. " internally, i, 315. Ergot and sodium phosphate, i, 389. Ethyl iodide inhalations, i, 528. Guaiacol, i, 457-460. Hydrofluoric acid, i, 527. Hydrogen, i, 527. Hygiama, ii, 442. Ichthyol, ii, 443. Iodine, i, 527. " vapour, i, 536. Lignosulphite, i, 581. Monochlorophenol (in form of a spray), i, 246. Myrrholin, i, 652. Nitrogen monoxide, i, 528. Oxygen inhalation, ii, 52. Ozone inhalation, ii, 58. Peppermint, inhalation of the vapour of, i, 614. Phosphergot, i, 389. Piperidine, ii, 453. Potassium sulphocyanate, ii, 236. Pyoctanine injections, ii, 109. Quillaia, ii, 113. Serum, horse (subcutaneous injections), ii, 163. Sodium cantharidate, ii, 206. Strophanthus, ii, 231. Strychnine, ii, 449. Sulphonal. ii, 239. Sulphuretted hydrogen (Bergeon's treat- ment), ii, 371. Taraxacum, ii, 264. Terebene, creosote, eucalyptol, and chloro- form, equal parts, inhalation of, i, 529. Tuberculin, i, 81. Turpentine oil, inhalation of steam from, i, 530. Whisky, ii, 385. 'vVines, ii, 394. Zinc chloride (hypodermic injections), ii, 403. Tuberculous deposits. Calcium chloride, i, 202. Sulphaminol, ii, 236. Tuberculous ioints. Iodoform, i, 538. Sulphur, ii, 241. INDEX OF DISEASES AND REMEDIES. 609 Tuberculous tracts. Calcium-phosphate solution (for was out), i, 202. Tumours. Electricity, i, 361. Toxines, ii, 313. Vienna paste, i, 228. Tumours, cancerous. See Cancer. Tumours, cystic, of the ovaries. Aspiration, i, 152. Tumours, fibroid. See Fibroids, Utertne. Tumours of the broad ligament of uterus. Aspiration, i, 152. Tumours of the gums and tongue. Potassium chlorate, ii, 96. Tumours, ovarian. Calcium chloride, i, 202. Iodine (hypodermic injection), i, 536. Tnmours, uterine. Calcium chloride, i, 202. Thyreoid treatment, ii, 298. Tympanites. Copper-arsenite solution, i, 304. Thymol, ii, 283. Typhlitis. Blisters, i, 185. Eucasin, ii, 430. Typhoid fever. Acetanilide, i, 3. Alcohol, as a stimulant, ii, 225. Antipyrine, i, 123. Asaprol, i, 148. Bath, half, i, 168. " reducing or graduated, i, 170. Baths, cold, i, 600. Bismuth and pepsin, i, 181. Brand treatment, i, 600. Bromol, i, 197. Calcium bromide, i, 202. Camphoric acid (as an intestinal antiseptic), ii, 428. Carbolic acid and iodine, i, 212. Castor, i, 219. Cold bath, i, 486. Creosote, i, 314. Cupric sulphate, i, 306. Digitalis, i, 342. Eucalyptol, i, 400. Gavage, i, 436. Guaiacol (topical applications), i, 459, 460. " carbonate, i, 461. Hydrochloric acid, i, 493. Hygiama, ii, 442. Iodine (as an intestinal antiseptic), i, 536. Lactophenine, i, 568. Limewater, i, 582. Massage (Brand's treatment), i, 600. Naphthalene, ii, 1. Naphthol, ii, 1. Pambotano, ii, 58. (incipient stage), Paraform, ii, 61. Pyoctanine (internally), ii, 109. Quinine, ii, 119. Saligenin, ii, 147. Salipyrine, ii, 148. Serum treatment, i, 84. Sesame oil, ii, 190. Typhoid fever. Sodium carbolate (as an intestinal antiseptic), ii, 206. Sodium paracresotate, ii, 207. Sulphonal, ii. 239. Thalline, ii, 276. Thymol, ii, 288. Thymus extract, ii. 285. Transfusion (with lamb's blood), ii, 323. Turpentine oil (internally), ii, 335. Water (copious drinks), ii, 361. Wine, port, ii, 393. Zinc sulphocarbolate, ii, 411. Typhus fever. '■ Cold bath, i, 488. Emetics, i, 374. Quinine, ii, 118. " salicylate, ii, 455. Serum, artificial, ii, 165. Somatose, ii, 212. Wine, port, ii, 393. Ulceration. See Ulcers. Ulcer of the rectum. Glycerin injections, i, 450. Hydrastis, i, 476. Silver nitrate (locally), ii, 194. Ulcer of the stomach. Arsenic, i, 146. Bismuth and morphine, i, 180. Blisters, small flying, i, 180. Charcoal, i, 232. Diet in, i, 335. Haemalbumin, i, 463. Papain, ii, 60. Pepsin, ii, 69. Sesame oil, ii, 190. Silver nitrate, ii, 194. Somatose, ii, 212. Water, i, 479. Ulcer, rodent. Salicylated camphor, i, 204. Ulcers. Alcohol, i, 31. Alum, i, 50. Alumnol (as a dressing), i, 51. Alveloz, i, 52. Antiphthisin, i, 120. Antipyonine, i, 120. Aristol, i, 140. Atropine, i, 155. Benzophenoneid, i, 179. Bismuth salicylate, i, 180, 182. Borax, i, 189. Boric acid, i, 190. Calcium phosphate, i, 202. Carbolic acid, i, 213. Chalk powder, i, 230. Charcoal poultices, ii, 103. Chlorine, i, 240, 445. Chromic acid, i, 248. Cinchona powder, i, 253. Condurango, i, 297. Copper oleate, i, 305. Cupric-sulphate solution (locally), i, 306. Diaphtherin, i, 332. Elemi, as a stimulant application, i, 369. Eucalyptus, oil of, i, 400. Euphorbium, i, 401. G10 INDEX OF Ulcers. Gallic acid, i, 432. Geranium, i. 488. Glutol, ii, 488. Hydrastine, i, 476. Iodine, i, 536. Iodoform collodion, i, 293. Iodol, i, 540. Kerosene, i, 565. Kino, i, 565. Massage, i, 609. Monochloracetic acid, i. 225. Myrrh, tincture of, i, 657. Naphthalene, ii, 1. Naphthol, ii, 2. Nuclein, yeast, ii, 24. Oak bark, ii, 31. Oxygen (as a stimulant), ii, 51. Paraform (diluted), ii, 61. Peat, ii, 65. Phosphoric acid, ii, 77. Phytolacca, ii, 81. Potassium permanganate, i, 597. " sozoiodolate, ii, 215. Pulsatilla, ii, 107. Pyoctanine, ii, 108. Quinine, ii, 121. Resorcin, ii, 126. Rosemary, ii, 135. Rosinol, ii, 135. Salol (as a dressing), ii, 150. Sozoiodol-potassium, ii, 215. Spermine, ii, 217. Sugar, ii, 234. Tannic-acid ointment, ii, 259. Tannin, ii, 256. Tannoform ointment, ii, 260. Terebene (as a dressing), ii, 271. Thioform, ii, 278. Thiol ointment, ii, 278. Trichloracetic acid, i, 225. Tumenol and zinc oxide, ii, 334. Turpentine oil, ii, 835. Waters, mineral (externally and internally), ii, 364. Xeroform, ii, 397. Zinc chloride, ii, 403. " sulphate, i, 228. Ulcers, aphthous. Potassium chlorate, ii, 96. Tannin, ii, 256. Ulcers, atonic. Camphor (externally), i, 204. Kerosene, i, 565. Ulcers, cancerous. See Cancer. Ulcers, chronic. Phosphoric acid, ii, 77. Pyoctanine, ii, 108. Spermine, ii, 217. Ulcers, corneal. Antipyonine, i, 120. Atropine, i, 155. Benzophenoneid, i, 179. Cadmium sulphate, i, 200. Lactic acid, i, 568. Thioform, ii, 278. AVater, hot, applications of, i, 213. Ulcers, foul. Trichlorphenol applications, ii, 330. DISEASES AND REMEDIES. Ulcers, foul. Carbolic acid, i, 212. Charcoal poultices, ii, 103. Naphthol, ii, 2. Rosinol, ii, 135. Peat (as a dusting powder), n, 6o. Ulcers, fungous. Alum, i, 50. Camphor, i, 204. Ulcers, gangrenous. Bromine, i, 195. Zinc chloride, ii, 403. Ulcer, gastric. See Ulcer of the stomach. Ulcers, herpetic, of the cornea. Pyoctanine, ii, 108. Ulcers, indolent. Basilicon ointment, ii, 135. Bismuth salicylate, i, 182. Cupric-sulphate solution (locally), i, 306. Elemi, as a stimulant application, i, 369. Euphorbium, i, 401. Geranium, i, 438. Hydrastine, i, 476. Kerosene, i, 565. Monochloracetic acid, i. 225. Myrrh, tincture of, i, 657. Nuclein, yeast, ii, 24. Oxygen (as a stimulant), ii, 51. Pulsatilla, ii, 107. Rosemary, ii, 135. Tannic-acid ointment, ii, 259. Trichloracetic acid, i, 225. Ulcers, laryngeal. Creosote, i, 314. Menthol, i, 614, 615. Silver nitrate, ii, 196. Ulcers, malignant. See Cancer. Ulcers of the leg. Naphthalan, ii, 448. Thioform, ii, 278. Thiosinamine, ii, 280. Ulcers of the mouth. Silver nitrate, ii, 195. Ulcers of the nasal saeptum. Silver nitrate, ii, 195. Ulcers of the uterus. Carbolic acid, i, 213. Euphorin (in powder, or an alcoholic solu- tion), i, 402. Gold, i, 453. Iodized cotton tampons, i, 310. Mercury nitrate, i, 628. Ulcers, phagedaenic. Bromine, i, 195. Mercury nitrate, i, 628, Nitric acid, ii, 7. Ulcers, putrid. Bromine, i, 445. Tar, ii, 263. Ulcers, scrofulous. Gold, i, 453. Ulcers, sloughing. Bromine, i, 195. Creosote, i, 314. Papain and sodium bicarbonate, ii, 60. Ulcers, suppurating. Potassium sozoiodolate, ii, 215. permanganate, i, 446. INDEX OF Ulcers, syphilitic. Alveloz, i, 52. Aristol, i, 140. Calcium salicylate, ii, 145. Europhene, i,"402. Mercury nitrate, i, 628. red iodide of, i, 627. " sozoiodolate, ii, 215. Papain, ii, 60. Salicylic acid, ii, 145. Sodium sozoiodolate, ii, 208. Zinc oleostearate, ii, 409. Ulcers, tuberculous. Antiphthisin, i, 120. Lactic acid, i, 568. Naphthol, camphorated, ii, 2. Oxygen, ii, 52. Starch, iodized, i, 537. Tannalbin, ii, 255. Ulcers, unhealthy. Benzoic acid, i, 178. Charcoal poultices, ii, 103. Chlorine poultices, ii, 103. Potassium chlorate (externally), ii, 96. Rhubarb powder, ii, 130. Ulcers, varicose. Traumatol, ii, 329. Ulcers, venereal. Black wash, i, 025. Cupric-sulphate solution, i, 306. Euphorin (as a local disinfectant), i, 402. Mercuric nitrate, i, 228. Mercury, red oxide of, i, 623. Nitric acid, i, 227. Uraemia. Baths, hot-air, i, 100. Chloroform, i, 528. Elaterium, i, 358. Hot-air bath, i, 468. Infusion, intramuscular, ii, 325. Jaborandi, i, 559. Potassium cobaltonitrite, i, 273. Strophanthus, ii, 231. Transfusion, depletory, ii, 323. Waters, Buffalo lithia, ii, 372. Uraemia, vomiting of. Baths, hot-air, i, 100. Ureteritis. Sodium bicarbonate, ii, 366. Urethritis. See Gonorrhoea. Uric-acid diathesis. Benzoic acid, i, 177. Glycerophosphates, ii, 439. Lycopodium tincture, i, 590. Phosphates, ammonium, ii, 78. Piperazine, i, 586; ii, 89. Potash, ii, 94. Potassium citrate, ii, 96. Tartarlithine, ii, 265. Uricedin, ii, 342. Urotropine, ii, 343. Waters, alkaline, ii, 367, 368. Urica'inia. See Lith.umia. Urine, retention of. Aspiration, i, 152. Baths, acid, i, 171. Corn silk, i, 306. Croton oil, i, 318. DISEASES AND REMEDIES. Gil Urine, retention of. Kava-kava, i, 564. Kidney extract, i, 181. Massage, abdominal, i. 608. Stimulants, spinal, ii, 226. Urticaria. Alumnol applications, i, 51. Benzoin, compound tincture of, i, 179. Calcium chloride, ii, 427. Chloroform (as a lotion), i, 241. Emol in itching of, i, 376. Jaborandi, i, 560. Salicylic acid, ii, 145. Urticaria, chronic. Arsenic, i, 144. Salicylic acid, ii, 143. Vaginismus. Belladonna, i, 174. Camphor suppositories, i, 204. Electricity, i, 365. Vaginitis. See Elytritis. Varicosities. Iron-chloride (tincture) injections, i, 549. Variola. See Smallpox. Vegetations. Carbolic acid, i, 213. Catheretics, i, 225. Iron chloride, i, 548. Veins, varicose. Barium-chloride ointment, i, 162. Ergot, i, 388. Vertigo. Bromoform, i, 196. Vertigo of the aged. Cod-liver oil, i, 288. Strophanthus, ii, 232. Vertigo of seasickness. Amyl nitrite, i, 61. Vomiting. Aconite, i, 100. Amyl nitrite, i, 99. Arsenic (Fowler's solution), i, 99, 146. Bismuth subnitrate, i, 180. Bitters, i, 183. Bromides, i, 99. Caffeine, valerianate, ii, 346. Calomel (small and repeated doses), i, 99. Calumba, i, 100. Camphor, i, 205. Carbonated waters, i, 99. Carbonic-acid gas, i, 214. Champagne, iced, i, 99; ii, 225, 392. Chlorobrom, i, 100, 240. Chloroform, i, 99, 241. Cocaine, i, 99. Creosote, i, 314. Emetics, i, 98. Ether, i, 99, 397. Gavage, i, 436. Ice, i, 520. Ingluvin, i, 526. Iodine (small doses), i, 536. " tincture of. i, 99. Ipecac, wine of, i, 542. Kephir, i, 98. Kumyss, i, 98. Limewater and milk, i, 582. 012 INDEX OF DISEASES AND REMEDIES. Vomiting. Matzoon, i, 98. Milk and limewater, i, 98. " cerium oxalate and sodium bicarbon- ate, i, 98. Milk, peptonized, i, 98. Mustard plasters applied to the epigastrium, i, 98. Nitrate of silver, i, 99. Nitroglycerin, i, 99. Nux vomica, ii, 22. Opium, ii, 37. Pepsin, ii, 69. Podophyllin, i, 100. Salicylic acid, i, 100. Serpentaria. i, 100. Silver nitrate (by irrigation of the stomach), ii, 194. Silver oxide, ii, 197. Sulphonal in milk, i, 99. Vinegar fumes, ii, 359. Vomiting after anaesthesia. Champagne, ii, 394. (with chloroform), Vinegar fumes, ii, 359. Vomiting, hysterical. Camphor, i, 205. Creosote, i, 314. Galvanization, i, 367. Vomiting, morning, of drunkards. Arsenic, i, 146. Bitters, i, 100, 183. Calumba, i, 100. Gentian, i, 100. Nux vomica, ii, 28. Serpentaria, i, 100. Vomiting, nervous. Caffeine valerianate, ii, 346. Galvanization, i, 367. Ipecac, i, 542. Vomiting, obstinate. Bitters, i, 183. Chlorobrom, i, 240. Gavage, i, 436. Opium, ii, 37. Silver nitrate, ii, 194. Vomiting of cerebral disease. Bromides, i, 99. Vomiting of chronic gastric disease. Alum, i, 99. Nitrate of silver, i, 99. Vomiting of gastric atony. Ipecac, i, 542. Vomiting of indigestion. Pepsin, ii, 69. Vomiting of pregnancy. Aconite, i, 9. Arsenic, i, 146. Bismuth, i. 180. Bitters, i, 183. Bromides, i, 194. Carbonic-acid gas, i, 214. Cerium oxalate, i, 229. " valerianate, ii, 346. Champagne, ii, 394. Creosote, i, 314. Ether (internally), i, 397. Ingluvin, i, 526. Ipecac, i, 542. " wine of (in small doses), i, 99. Nux vomica, ii, 28. Vomiting of seasickness. Amyl nitrite, i, 99. Bitters, i, 183. Champagne, ii, 394. Chlorobrom, i, 100, 240. Nitroglycerin, i, 99. Vomiting of uraemia. Baths, hot-air, i, 100. Vomiting of uterine disease. Cerium oxalate, i, 229. Vomiting, reflex. Nitroglycerin, ii, 15. Warts. Acetic acid, i, 5. Arsenic (internally), i, 144. Chelidonium, i, 233. Chromic acid, i, 248. Collodion, salicylic acid, and zinc chloride, i, 293. Copper oleate, i, 305. Creosote as a caustic, i, 314. Monochloracetic acid, i, 225. Nitric acid, i, 227; ii, 7. Potassium bichromate, ii, 95. Salicylic acid, ii, 143. Silver nitrate, ii, 196. Sodium ethylate, ii, 207. Trichloracetic acid, i, 225. Zinc sulphate, ii, 407. Weakness of old age. Stimulants, cardiac, ii, 227. Weakness, seminal. See Spermatorrhea. Whitlows. Alkalies (poultice of hard-wood ashes), i, 45. Whooping-cough. Acetanilide, i, 4. Allyl tribromide, ii, 414. Amber, oil of, i, 52; ii, 414, Anemonin, ii, 108. Antipyrine, i, 124. Antispasmin, i, 133. (paroxysms), Asafcetida, i, 147. Balsamic fumes, i, 529. Baths, condensed-air, i, 27. Belladonna, i, 174. Benzoic acid, i, 178. Bromoform, i, 196. Bryonia, i, 197. Caffeine valerianate, ii, 346. Carbolic-acid (solution) inhalation, i, 213. Carbonic-acid gas. i, 214. Castanea leaves, Chestnut leaves, i, 219. Chloral hydrate, i, 237. Coccus, Cochineal, i, 284. Codeine, i, 286. Conium, i, 298. Copper dioxide, i, 527. Eucalyptol inhalation, i, 529. Eucalyptus and terebene, oils of, i, 400. Formaldehyde, ii, 436. Gelsemium, i, 437. Hydrocyanic acid, i, 495. Ipecac, i, 542. Lobelia, i, 587. Menthol (by spray), ii, 445. " inhalation, i, 529. Mercury-bichloride applications, ii, 446. Muscarine, i, 645. INDEX OF DISEASES AND REMEDIES. 613 Whooping-cough. Naphthalene, ii, 1. Nitric acid, ii, 8. Nitrogen monoxide, i, 528 Nitroglycerin, ii, 15. Opium, fumes of, i, 529. Ouabain, ii, 48. Ozone inhalation, ii, 58. Piscidia (as an antispasmodic), ii, 91. Quinine, ii, 119. " insufflation, i, 253. " tannate, ii, 259. Resorcin (by spray), ii, 126. Silver-nitrate solution (by spon2-in°- throat), ii, 196. ° Sodium salicylate, ii, 146. " sozoiodolate, ii, 208. Sulphur fumes, ii, 241. Terpin hydrate, ii, 272. Thymol, ii, 283. Turpentine oil, ii, 336. Tussol, ii, 337. Valerian, ii, 345. Zinc cyanide, ii, 408. " sulphate (as an emetic), ii, 407. Worms, intestinal. Aloes, i, 102. Ammonium embellate, i, 57. Aspidium, i, 102. Bitters (injections), i, 183. Carbolic-acid injections, i, 102. Kamala, i, 563. Quassia, i, 102. Savine, ii, 157. Thymol, ii, 284. Worms, lumbricoid. Andira, i, 70. Chenopodium, i, 234. Ether, i, 397. Naphthalene, ii, 1. Papain, ii, 60. Spigelia, ii, 217. Quassia, ii, 112. Tea, worm, ii, 269. Worms, seat. See Ascarides. Wounds. Alcohol, i, 29. Alumnol (irrigation), i, 51. Amyloform (as a deodorizer), ii, 415. Antiseptics, i, 129. Benzoin, i, 179. Boric acid, i, 196. Bromine, i, 195. Bromol, i, 196. Chloral hydrate (locally), i, 237. Cinchona powder, i, 253. Cinnamon oil (as a dressing), i, 259. Collodion, saturnine, i, 293. Cydonium, i, 323. Diaphtherin, i. 332. Diiodoform, i, 343. Eucalyptus, oil of, i, 400. Eucasin, ii, 435. Formaldehyde, ii, 436. Glutol (as an antiseptic), ii, 438. Hydrochloric acid, i, 492. the Wonnds. Hydrogen dioxide, i, 502. Insufflation, i, 533. Iodine, i, 537. Iodoform, i, 538. Irrigation, i, 555. Izal, i, 556. Mentho-phenol and warm water, i, 616. Naphthalene, ii, 1. Olive oil, ii, 35. Oxygen, ii, 51. Phenol sodique, ii, 73. Piper nigrum, ii, 90. Pixol, ii, 92. Potassium permanganate, i, 446. Sanoform, ii, 154. Solphinol, ii, 211. Sozoiodol-potassium. ii, 215. Sugar, ii, 234. ' Sulphaminol, ii, 236. Tannoform, ii. 154. " ointment, ii, 260. Terebene (as a dressing), ii, 271. Traumatol, ii, 329. Xeroform, i, 397. Zinc oleastearate, ii, 409. " oxychloride, ii, 410. " subgallate, ii, 411. Wounds, gunshot, chronic suppurating. Waters, mineral (externally and internally), ii, 364. Wonnds, infected. Antiseptics, i, 129. Oxygen, ii, 51. Xeroform, ii, 397. Wounds, poisoned. Alcohol, i, 30. Cydonium, i, 323. Wounds, septic. Iodoform powder, i. 538. Zinc subgallate, ii, 411. Wounds, suppurating. Iodoform, i, 538. Potassium sozoiodolate, ii, 215. Wounds, sutured. Zinc oxychloride, ii, 410. Wounds, unhealthy. Cinchona powder, i, 253. Permanganate of potassium, i, 446. Quinine, ii, 120. Wryneck. See Torticollis. Xanthelasma. Nitrohydrochloric acid, ii, 16. Xerodermia. Thyreoid feeding (dry powder), i, 79. Yellow fever. Calomel, i. 624. Copper-arsenite solution, i, 304. Zoster. Acetanilide, i, 3. Blisters, i, 186. Grindelia, i, 426. Salicylic acid (for pain), ii, 143. LIST OF AUTHORS CITED. Abbe, R., ii, 53. Abbott, F. C, ii, 177. Abercrombie, P. H., ii, 347. Abernethy, R., i, 592. Abrahams, R., ii. 457. Abrajanoff, ii, 29. Adams, G., ii, 874. Agnew, H., i, 195, Ahlfeld, ii, 122. Albertoni, ii, 447. Alexander, W. S., ii, 436. Allen, A. H.. ii, 109. Allen, B. W., ii, 133. Allen, C. W., ii, 116. Anderson, T. P., i, 273. Anstey, i, 395 Anthoire, i, 400. Arendt, E.. i, 609. Arnheim, A., ii, 154. Aronson, II., ii, 61. Atkinson, ii, 116. Attfield, ii, 140. Aubert, ii, 419. Auerbach, ii, 47. Aulde, J., i, 303; ii, 23, 24,133. Babcock, R., ii, 421. Babcock, W. L., ii, 292. Babes, i, 84. Baccelli, ii, 322. Bailey, P., ii, 290. Baldwin, E. R., i, 614. Ballance, C. A., ii, 177. Balm, E., ii, 417. Balz, i, 309. Barber, C. F., ii, 209. Barbour, J. F., ii. 60. Barcklay, J., ii, 293. Bard, ii, 185. Bardet, i, 428; ii, 456. Barker, F.. ii, 353. Barr, G. W., ii, 38. Barrows, C. C, ii, 354. Barth, i, 294. Bartholow, i, 286, 451; ii, 15, 98. Barton, ii, 18. Baruch, i, 448. Barwell, ii, 29. Bassi, ii. 165. Bates, W. H., ii, 246. Battey, R., ii, 73. Baumann, ii, 300. Baumler, ii, 241. Bechtine, P., i, 385. Beclere, A., ii. 179. Beddell, AV. M. O., ii, 79. Behring, i, 84. Bell, J., ii. 381. Bellamy, R., ii, 332. Berg, H. W., i. 625. Beringer, G. M., ii, 132. Berman, ii, 150. Bicente, ii, 98. Bidder, ii, 278. Bigelow, S. L., i, 292. Biggs, H. M., i, 84. Billings, J. S., i, 599. Binz, ii, 120. Blackford. B.. ii, 383. Blackweil, ii, 132. Blake, F. It., ii, 376. Blake, J. E., ii, 18. Blakely, G. A., ii, 432. Blanc, ii, 73. Bleyer, J. M., ii, 23. Blickensderfer, ii. 376. Bloch, Dr. O., i, 524. Blondel, ii, 456. Blum, i, 429. Boal, ii, 357. Boas, ii, 365. Bocquillon-Limousin, i, 343; ii, 230. Boeck, C, i, 577; ii, 126, 186. Bohland, ii, 89. Bondurant, ii, 209. Bontor, S. A., ii, 445. Boody, G., ii, 445. Bosc, ii, 325, 398. Bossi, ii, 234. Boucher, ii, 206. Bowen, J. T., ii, 150. Boyer, H. P., ii, 332. Bradbury, J. B., ii, 8. Bramwell, B., i, 79. Braun, ii, 365, 371. 373. Brocq, i, 291; ii, 453. Brodie, B., i, 586. Brodier, i, 343 ; ii, 165. Bronowsky, i, 302. Brouowski, ii, 229. Brown, E. H., i. 400. Browne, L., ii, 437. Brown-Sequard, i, 74; ii, 162, Bruce, L. C, ii, 290. 614 Brunton, T. L., i, 54, 341; ii, 80. Buchheim, ii, 368. Buiza, i, 570. Bulkley, L. D., ii, 205. Bunge, i, 545. Burcq, i, 303. Buzzi, ii, 201. Cabot, R. C, ii, 245. Caille, A., i, 191; ii, 58. Calmette, A., ii, 188. Cantani, ii, 258. Cantrell, J. A., i, 302; ii, 144. Cao, i, 402. Carfield, C. A., ii, 131. Carleton. ii, 359. Carpenter, J. S., i, 460. Carrasquilla, J. de Dios, ii, 184, Carron. i. 432. Carselli, ii, 229. Carter, ii, 22, 435. Carter, R. W., i, 459. Cassaet, ii, 400. Castex, i, 609. Cattaneo, ii, 182. Cauchard, ii. 329. Cautley, E., i, 635. Cerna, D., i, 563. 628. 645; ii, 60, 109, 208, 273, 417. Cesaris, P., i, 403. Chadwick, ii, 857. Chalke, E. L., ii, 441. Championr.iere, i, 461; ii, 164. Chandler, W. J., ii, 355. Chantemesse, i, 84; ii, 171. Chaplin, A., ii. 453. Chappell, W. F., i, 316, 409, 426. Charcot, i, 491. Charteris, ii, 330. Chaumier, E., ii, 46. Cheatham, W., ii, 454. Cheron, ii, 83. Chilret, ii, 146. Chittenden, R. H., ii, 392. Claiborne, J. H., ii, 372. Claisse, A., ii, 165. Clapton, i, 303. Clark, A., i. 450. Clark, H. M., i, 55. Clark, J. A., ii, 426. Clark, L. P., ii, 292. t LIST OF AUTHORS CITED. 615 Claus, ii, 47, 333. Clendinnen, F. J., ii, 397. Clouston, ii, 62. Coblentz, V., ii, 162, 166, 265, 431, 483, 436. Coghill, J. S., ii, 428. Cohen, G., ii, 97. Cohn, A., ii, 435. Cohnstein, AV., ii, 218. Cole, ii, 53. Coley, F. C, i, 615. Colombini, ii, 150. Combemale, i, 029; ii, 35, 108. Comstock, A. J., i, 590. Conway, J. R., i, 315. Cook, A. B., ii, 62. Cooper, A., ii, 402. Comet, ii, 438. Cottam, G. G., ii, 216, 415. Courmont, J., ii, 85; Cozzolino, i. 631. Crede, ii, 192,. 197. Crespin, ii, 58. Csatary, ii, 231. Cumston, C. G., i. 399. Cunningham, R. II., i, 427. Curgenven, J. B., i, 400. Curtis, B. F., ii, 53, 313. Curtis, C, i, 402. Curtis, H. H., i, 417. Czerny, ii, 313. Dabney, W. C, ii, 384. Da Costa, i, 397, 459. Dahman, M., i, 463. Daish, W. C, ii, 416, 434. Dalche, ii, 456. Dana, i, 403. D'Arsonval, i, 71. Darwin, i, 645. Davies, N. W., i, 596. Dawbarn, ii, 328. Day, ii, 52. Debove, i, 435. De Bueck, ii, 278. De Hart, I. M., ii. 54. De Jaworski, ii, 417. Delage, ii, 439. Delepine, S., i, 556. Dels'henkoff, i. 568. De Mentyel, M., i, 403 ; ii, 213, 282. De Minicis, ii, 174. Demontporcelet, ii, 161. De Nencki, ii, 417. Denissenko, ii, 431. De Renzi, ii, 398. Derville, L., ii, 404. De Sanctis, ii, 41o. De Schweinitz, ii, 188. Desnos, i, 630. Despeignes, V., n, 398. De Weeker, i. 562. _ Dhargalkar, L. B. n, 447. Dillard, J. AV., n, 383. Dittrich, J. C, n, 58. Dobell, II., ii, 59. Dodd, A., ii, ^24. Dori, i, 553. . Dornbluth, O., n, 1^4- Doukalsky, ii, 92. Downie. J. AV., i. 614. Drews, R., ii, 152. Druitt, ii, 393. Dubois, ii, 38, 185. Duchesne, G., ii, 432. Duclos, i, 423. Duhring, ii, 264. Dujardin-Beaumetz, i, 335, 487. Dumarest, F., ii, 325. Dumontpallier, ii, 96, 164. Dunwody, J. A., ii, 163. Ebstein, L., ii, 143. Eddowes, A., ii, 429. Edgar. J. C, ii, 355. Edson, C, i, 84. Ehrlich. P.. i, 629. Elder, T. A., ii, 73. Elkins, F. A., ii, 62. Elliot. R. H., ii, 30. Engelhardt, i, 474. England, J. W., ii, 432. Escherich, ii, 259. Etienne, ii, 451. Evans, B. D., ii, 62. Evans, H., ii, 231. Evenhoff, ii, 450. Ewald, ii, 300, 368. Fafiourse, ii. 145. Faulder, F., ii, 456. Fawcett, ii, 89. Fenwick, E. H., i, 590. Fenwick, W. S., i, 520. Ferguson, J., ii, 448. Ferrand, i, 451. Ferreira, C., i, 630. Feulard, i, 85. Filehne, ii, 454. Finsen, i, 463. Flemming, C, i, 239. Flexner, J. A., ii, 343. Flint, A., i, 630. Flint, W. II., ii, 62. Floershein, ii, 329. Flourens, i, 395. Forlanini, ii, 194. Fothergill, W. E., ii, 456. Fox, G. H., ii, 209. Fox, T., ii. 409. Fraenkel, E., ii, 285. Francois, i. 629. Francois-Franck. i, 340. Friinkel, S.. ii, 287. Fraser, T. R., i, 598. Fullerton, E. B., ii, 121. Fullington, C. P., i, 588. Furneaux, J., i, 311. Gaethgens, i, 496. Gahn, i, 595. Gallois, i, 637. Gambier, F.. i, 588. Garrod, A. B.. ii, 371. Gaucher, i, 637. Gepner, i, 428. Gerdes, ii, 212. Gerster, A. G., ii, 313. Gibbs, AV.. i, 273. Gibier, P.. i, 74; ii, 175. Gibney, A'. P., ii. 441. Gihon, A. L.. ii, 223. Gillette, i, 292, Giovanni, ii, 81. Girdner, J. H., i, 567. Girtnert, i, 458. Glass, ii, 86. Glenn, J. H., ii, 322. Gompertz, i, 616. Goodman, ii, 81. Gordon, J.„ i, 403. Gorl, ii, 435. Gorman, A., i, 588. Gossett, W. B.. ii, 415. Gottlieb, ii, 254. Gottschalk, S., ii, 233. Gowers, ii, 15. Gracomeni, i, 407. Gradeau, ii, 366. Graham, i, 610. Grant, C. G., i, 259. Grawitz, ii, 302, 346. Greene, R. H., ii, 316. Gregg, W. H, i, 458. Grinnell, F., ii, 355. Grisvvold, G., i, 63. Gruening, ii, 115. Griitzner, ii, 865. Grilzdeff, V. S., i, 389. Guinard, ii, 426. Guintsburg, ii, 443. Guladze, ii, 284. Gull, W. W., ii, 288. Giinzburg, A., ii, 401. Guttmann, P., i, 630; ii, 151. Haegler, ii, 414. Hagnos, i, 597. Haig, ii, 140. Hallopeau, i, 343. Halsted, G., ii, 372. Hamilton, A. McL., i, 599; ii, 18. Hammarsten, ii, 20. Hammond, L. M., i. 571. Hardwicke, W. W.. i, 400. Hare, H. A., i, 384, 485; ii, 448, 450. narold, J., i, 422. Harrington, i, 631. Harrison, C. H. R., i, 50. Harrison, R., ii, 82. Hartmann, ii, 284. Haubold, II. A., ii, 416. Hayem, ii, 415. Hearder, F. P.. ii, 63, 238. Hederich, i, 422. Hendley, H., ii, 446. Hennig, ii, 148. Hermann. T. T., ii. 344. Hern, i, 275. Herrick, J. B., ii, 293. Hertz, ii, 397. Heuss, E., ii, 897. Hewitt, F., ii, 415. Hiller. i, 496. Hinton, J., ii. 357. Hirschfeld, E., ii, 314. GIG LIST OF AUTHORS CITED. nitchcoek, C. W., ii, 24. Hohn, ii, 451. Hood, ii, 146. Hopkins. T. S., ii, 377. Iloppe-Seyler, i, 496. Horing, ii, 108. Ilorton. E. G., ii, 436. Howell, W. II., ii, 48. Hrdlicka, A., i, 304: ii, 291. Huchard, i, 493; ii, 245, 277. Humphrey, ii, 63. Huntley, W., ii, 428, 450. Hurty, J. W, ii, 436. Hutinel, ii, 171. Ignatieff, ii, 63. Isaac, R., ii, 447. Jacobi, A., ii, 121. Jacobi, C, ii, 216. Jacobsohn, AV., ii, 25. Jamieson, W. A., i, 376. Jankau, L., ii, 305. Joal, ii, 430. Jolly, ii, 452. Joseph, ii, 357, 448. Josias, ii, 178. Jouin, ii, 298. Kahn. i, 652. Kampffer, i, 590. Kanasz, J., i, 272. Kane, E. O'N., ii, 419. Kappeler, i, 395. Keay, J., ii, 240. Kestner, G., ii, 260. Ketchart, i, 458. Keyes, E. L., ii, 98. Khmelewsky, ii, 313. Kibbe, A. B", ii, 399. Kidd, P., ii, 450. Kiesel, ii, 435. Kirsch, E., ii, 431. Kitasato, i. 84: ii, 185. Kloman. AV. C. i. 389. Knapp, ii, 115, 120. Knapp, C. P., ii, 25. Kobert, ii, 113. Koch, i, 306. Kocher, ii, 288, 297. Koenig, i, 285, 631. Kohos, ii. 308. Kolisko, i. 398. Kolle, P. S., ii, 398. Koller, K., i, 275. Komarovitch, ii, 433. Korff, i, 588. Kossmann, R., ii, 122. Koster, ii, 349. Krafft-Ebing. ii, 62. Krahn, ii, 456. Krauss, W. C, ii, 16. Krieger, G. E„ ii, 217. Krogius, i, 279. Kronig, ii, 72. Labbe, ii. 58. Labit, ii, 87. Laborde, i, 611. Ladeire, ii, 329. Ladenburg, A., i, 503. Lafout, ii, 17. Laidley, J. B., ii, 133. Lamarque, i, 428. Lambert, A., ii, 286. Landerer, ii, 431. Landois, ii, 318, 323. Lane, ii, 241. Langmaid, S. W., ii, 307. Lannois, i, 459. Lashkevich. i, 55. Laubinger, ii, 119. Le Conte, J. L., ii, 384. Lederer, ii, 140, 147. Leech, D. J., i, 59, 60, 273; ii, 11. 15, 62. Lee, R.. ii, 331. Leeds, i, 631, 642. Lees, R. C, ii, 429. Leichtenstern, ii, 364. Leistikow, L., ii, 120, 349. Leith, R. F. C, ii, 424. Lepine, ii, 205, 298. Leppmann, A., i, 629. Le Tanneur, ii, 443. Letzel. i, 433. Levi-Dorn, ii, 298. Leventhal. G., i, 630. Lewin, i, 390, 359. Lilienthal, H., ii, 54. Linossier, i, 459 ; ii, 204. Livet, ii, 427. Lodeman, E. G., ii, 132. Loffler, ii. 309. Loomis, H. P., i, 339. Lourier, A., ii, 187. Love, ii, 354. Lowenthon, v., i, 581. Lustgarten, ii, 259. Luton, A., i, 303, 389. Lydston, G. F., i, 454. Macalister, C. J., ii, 52. Macallum, A. B., i, 545. Mackenzie, H. W. G., i, 78. MacKenzie, T., ii, 61. Maclennan, ii, 452. MacMunn, J., i. 259. Maher, S. J., ii, 401. Maillart H., ii, 361. Mairet, i, 629. Maisch, A., i, 629. Maitland, C. B., ii, 295. Maldaresco, ii, 439. Mann, J. D„ i, 598. Mann, W. O., ii, 445. Manotti, i, 272. Maragliano, E., ii, 179. Marcuse, ii, 399. Marinesco, ii, 91. Markoe, F. H., ii, 18, 53. Marsden, A., i, 145. Maslovsky, ii, 113. Matagne," ii, 313. Maurel, i, 540. Maxwell. A., ii, 209. Ma vet, i, 343. Mavne, N., ii, 336. Mays, T. J., ii, 449. McCosh, A. J., ii, 54. McKinlock, J., ii, 89. Meisels, i, 429. Mellinger, i, 432. Meltzer, S. J., ii, 289, 820. Mendel, L. B., ii, 392. Mendelsohn, i, 585. Mengus, ii, 103. Menzies, J. D., i, 79. Metral, ii, 229. Milkhalkine, ii, 15. Miller, R. E., i, 383. Miloslawski, i, 652. Mitchell, C. L., i, 470. Mitchell, S. W., i, 607; ii, 126. Mittra, ii, 60. Mobley, H. A., ii, 133. Molliere, H., ii. 86. Moncorvo, i, 403 ; ii, 126. Mond, ii, 451. Montgomery, D. W., ii, 425. Monti, ii, 432. Moor, W., i, 597. Moorman, J. W., ii, 132. Morgan, F. P., ii, 416. Morgan, J. D., ii, 381. Morris, E. K., ii, 440. Morris, L. R., ii, 376. Morton, J., ii, 330. Morton, T. S. K., ii, 53. Morton, W. J., ii, 56. Mueller, A., ii, 29. Mulhall, J. C, ii, 306. M tiller, G. J., i, 569. Murray, W., i, 620; ii, 194, 288. Murrell, W., ii, 15,159, 270,329, 414. Musmeci, M., ii, 435. Mya, i, 630. Myers, O. M., i, 199. Nakawaga, ii, 187. Nemann, J., i, 651. Nesbitt, ii. 140. Netter, ii, 2, 99. Newcomb, J. E., ii, 307. Newton, R. C, ii, 354. Nicolaier. i, 84; ii, 342. Notkin, J. A., ii, 301. Noyes, H. D., i, 275. Oberlander, ii, 200. Ochsner, A. J., i, 30. Olderogge, W. W., ii, 159. Oliver, C. A., ii, 159. Oliver, G., ii, 244. Ormsby, O. B., i, 587. Orthmann, ii, 149. Osier, W., i, 487. Otis, W. K.. i, 540; ii, 444. Ott, I., ii, 380. Ottinger, W, ii, 444. Oudin, ii, 58. Overlach, M., i, 631. Owen, D., ii, 284. Pander, H., i, 247. Panecki, ii, 223. Paquin, P., ii, 183. Park. R., i, 647; ii, 457. Parker, L., i, 430. LIST OF AUTHORS CITED. 61? farker, W. R., ii, 293. Parkes, i, 440 Paul, C, i, 680. Pavesi, i, 2*7. Payne, R. L., ii, 857. Peale, A. C. ii, 373. Pearse, II. S., ii, \~A. Pease, C. G., ii, is. Pelzer, i, 450. Penhallow, D. P., ii. 134. Penzoldt, ii, 112, 272. Peroni, ii, 329. Personali, i, 629. Peterson, F., i, 277; ii, 62, 232, 290. Petrasko, J., ii, 440. Petrone, ii. 13. Pettit, ii, 287. Peyrot, ii, 426. Pfister, E., ii, 432. Philpots, E. P., ii, 371. Phisalix, ii, 189. Pictet, R., i, 429. Piffard, II., ii, 191, 360. Pinard, ii, 164. Pincus, L,, ii, 222. Poehl, A., ii, 217. Poggi, ii, 99. Poole, i, 337. Poppi, ii, 338. Porteous, J. L., ii, 23. Porter, I. AV., ii, 58. Post, S. E., i, 409. Potter, S. O. L., ii, 39. Pottevin, i, 428. Potts, C. S., ii, 209. Poulet, ii, 48, 86. Powell, B., ii, 133. Power, F. B„ i, 588. Pozzi, ii, 164. Preisach, i, 429. Prentice, C, ii, 442. Prentiss, D. W., ii, 416. Preyer, i, 496. Purdon, H. S., ii, 161. Purdy, ii, 74. Quimby, C. E., ii, 413. Rabinschek, ii. 446. Radcliffe, II., ii, 144. Rademaker, C. J., ii, 94. Raymond, ii, 47. Rehn, ii, 337. Reichert, i, 59, 492. Reich-Hollender, G., ii, 120. Reilly, F. J„ ii, 206. Reinach, O., ii, 163. Reinbach, ii, 285. Rekowski, L„ ii, 186. Rendu, ii, 458. Rennie, S. J., ii, 189. Reynier, ii, 150. Rh'azes, ii, 386. Rice, C. i. 283. Richardiere, i, 459. Richardson, B. W., i, 276, 490 ; ii. 50, 53, 203. Richardson, D. A„ ii, 417. Rio bet, i, 610. Richter, ii, 280. Rieck. ii, 437. Ringer, S.. i, 636 ; ii, 256. Rives. W. C„ ii, 419. Roberts, i, 586. Roberts; W.. ii, 367, 371. Robertson, AV., i, 176. Robin, ii, 438. Robinson, W. J., ii, 443. Rochard, J., i, 593. Roche, A., ii. 229. Roger, ii, 178. Rogers, J. G., ii, 298. Rohrig, ii, 370. Roosa. D. B. St. J., i, 650. Roosevelt, J. AV., i, 273. Rose, A., i, 214. Rotch, i, 631. Rothschild, ii, 337. 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Videll, i, 84, Vierordt, ii, 254. Vinci, G., ii, 484. Vintras, ii. 203. Vogl, i, 487. r LIST OF AUTHORS CITEI Vogt. ii, 333. Volintzeff, ii, 418. Vollert, ii, 485. Aton Engel, ii, 254. A'on Generisch, ii. 258. Aton Graefe, ii, 115. Aton Merin^, J., ii, 7. Aton Mosettg-Moorhof, ii, 273. Aron Noorden, i, 544; ii, 19, 424. 436, 447. Von Ruck, ii, 69. A'on Ziemssen, i, 490 ; ii, 324. Vulliet, i, 31. AVade, J. P., i, 240. AVade. W. C. i, 51. Wadleigh, W. K., ii. 232. Wagner, i, 276 ; ii, 145. Warden, i, 561. Waterhouse, AV. D., i, 76. Waterman, J. H., ii, 441. Waters, B. H., ii, 151. AVatson. C, i, 588. Wuinrich. M., ii. 432. AVeir, R. F., i, 393. AAreisbecker, ii, 178. Welch, E. A., i, 189. Welch. J. W., ii. 134. Werler, 0., ii. 198. West. S., ii, 888-842. Wheeler. G. A., i, 199. Whipple, T. S.. i. 587. White, AV. J., ii, 97. Whitehead, J. B., ii, 134. Whittaker. J. T., i, 403. Williams, J. D., ii, 175. Williamson, R. T., ii, 431. Willis, F. P., ii, 355. Wilson, E., i, 294. AVinkler, F., ii, 298. Witte, ii, 122. Wood, H. C. i, 31, 50. 59, 194, 311,430,485.486,597; ii, 14, 91, 230, 351. Wvss, i, 458. Yeo, i, 338 ; ii, 14. Younger, E. G., i, 403. Zaeslein, ii, 179, 180. Ziegenspeck, R., i, 609. Ziegler, i, 322. Zi'ihoff, i, 597. END OF VOLUME II. 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