p Effi'MffimiSl CORNELL UNIVERSITY. THE THE GIFT OF ROSWELL P. FLOWER FOR THE USE OF THE N. Y. STATE VETERINARY COLLEGE. 1897 COHNELL UNIVERSITY LIBRARY 924 104 226 216 Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/cletails/cu31924104226216 A TEXT-BOOK MATERIA MEDICA, THERAPEUTICS, AND PHARMACOLOGY. GEORGE FRANK BUTLER, Ph.G, M.D., Professor of Materia Medica and Clinical Medicine in the College of Physicians and Surgeons, Chicago; Professor of Materia Medica and Therapeutics, Northwestern University, Woman's Medical School ; Attending Physician to Cook County Hospital ; Member of the American Medical Association, Illinois State Medical Society, Chicago Medical Society, Chicago Pathological Society, and Fellow of the Chicago Academy of Medicine, etc., etc. liEPARTMENT OF PHARMACOLOGY. Miseris succurrere disco. PHILADELPHIA ; W. B. SAUNDERS, 925 Walnut Street. 1897. k • >u. ya i5 Copyright, 1896, By W. B. SAUNDERS, ELECTBOTYPED BY PRESS OF WESTCOTT & THOMSON. PHILADA. W. o. SAUNDERS, PHILADA. TO THE MEDICAL STUDENTS OF THE UNITED STATES, IN THE HOPE THAT IT MAY AID THEM IN ATTAINING A CORRECT KNOWLEDGE OF THE NATURE AND ACTION OF DRUGS AND THE RATIONAL TREATMENT OF DISEASE, ^ THIS WORK IS CORDIALLY INSCRIBED BY THE AUTHOR. ■TJk PREFACE. The present work has been undertaken with the immediate object of supplying the student of medicine with a clear, concise, and practical text-book, adapted for permanent reference no less than for the requirements of the class-room. The arrangement — embodying the synthetic classification of •drugs based upon therapeutic affinities — the author believes to be at once the most philosophical and rational, as well as that best calculated to engage the interest of those to whom the academic study of the subject is wont to offer no little perplexity. Should an intelligent and comprehensive understanding of Materia Medica and Therapeutics be facilitated by the author's* treatment of the theme, the deductions derived from his experience as a practitioner and instructor will not have been committed to print in vain. Special attention has been given to the Pharmaceutical section, which there is reason to hope will be found .exceptionally lucid and complete. It has been deemed advisable, however, in the general work to include in the descriptive enumeration only such drugs as experience has proved to be of unquestionable value and are of standard and authoritative acceptance in general prac- tice. In accordance with this plan, many new and comparatively untried remedies have been omitted, since, while of established efficacy in certain conditions, they are as yet too imperfectly known to warrant association with remedial agents bearing the sanction of exhaustive scrutiny. So, too, a few official drugs have been excluded because they are practically never used or are employed only in isolated instances. It will be observed that "Untoward Action" and "Poisoning" n 12 PREFACE. are treated under separate heads. By the former it is intended to record the effects of medicinal doses in developing certain symp- toms dependent more or less upon individual susceptibility, not necessarily assuming the aggravated form incident to toxic doses, which exert a definite influence regardless of idiosyncrasy. In giving the careful Latin accent and quantity of medicinal nomenclature (Foster), so far as practicable with the prosodial signs employed, the design has been to correct a prevalent dis- regard of proper pronunciation reflecting little credit upon those to whom a knowledge of the subject should be as exact as it is familiar. To the prescription-writer the appropriate Latin genitive, and in a few cases the accusative, will doubtless afford valuable assistance. During the preparation of the work many important text- books, periodicals, etc. have been freely consulted, and from the U. S. Pharmacopoeia chiefly, and from the National Dispensatory, have been adopted almost verbatim the "Origin" and "Description and Properties " of the Various drugs under consideration. In reviewing the progress of the present volume the author desires to express his cordial acknowledgments to Prof Carl S. N. Hallberg, Ph. G., whose exhaustive contribution of " Weights and Measures" and "Pharmaceutical Preparations" cannot fail to lend permanent interest to the work ; to Dr. Alfred C. Cotton, Dr. Wm. E. Quine, and Dr. James B. Herrick, for friendlj^ suggestions ; to Dr. D. Lee Shaw, Dr. Fred C. Zapffe, and Dr. Thomas J. Jack- son, for assistance in compilation. To Mr. Storrow Higginson the author's personal thanks are due for his scholarly assistance in the revision of the text. G. F. B. Chicago, III., 794 West Adams St., September, 1896. CONTENTS. PAGE INTRODUCTION 17 PHARMACOLOGY AND GENERAL THERAPEUTICS 21 Classification of Medicines 24 Administration of Medicines 29 Definitions 34 Weights and Measures 40 PHARMACEUTICAL PREPARATIONS 49 Solutions . 51 Aquse Medicatse — Medicated Waters 51 Liquores — Solutions S ' Spiritus — Spirits 57 Syrupi — Syrups 58 Elixiria — Elixirs 64 Glycerita — Glycerites 71 Liquid Mixtures — Internal 72 Misturse — Mixtures 72 Emulsa— Emulsions 76 Extractive Preparations 79 Infusa — Infusions 81 Decocta — Decoctions 82 Aceta — ^Vinegars 82 Vina — Wines 82 Tincturae — Tinctures , 84 Extracta Fluida — Fluid Extracts 90 Extracta — Extracts 95 Abstracta — Abstracts 96 Oleoresin^ — Oleoresins 97 Resinse — Resins . . 98 Solid Mixtures for Internal Use 99 Pulveres — Powders 100 Sales Effervescentes — Effervescent Salts 103 Confectiones — Confections 104 Trochisci — Troches .... 105 Massae — Masses 106 Pilulse— Pills 107 Unofficial Forms of Mixtures of Solids for Internal Use 112 Preparations for External Use 113 Linimenta — Liniments 114 Lotiones — Washes 115 Oleata— Oleates 116 13 14 CONTENTS. PAGE Olea Infusa— Infused Oils . . ;. Ii7 Collodia— Collodions . . II7 Unguenta — Ointments nS Cerata — Cerates 120 Suppositoria — Suppositories I2t Emplastra— Plasters . . 122 Chartae — Papers , 124 Poultice or Cataplasm . . . 125 Fomentations .... . 125 Plaster Mull . , .... 125 Bandages, Antiseptic Dressings . . . 125 Medicated Dressings ... 126 Medicated Cottons .... 126 Medicated Gauzes — Carbasa .... 126 Plaster-of-Paris Bandages . 127 CLASS I.— DISEASE MEDICINES 129 Division I. — Restoratives 129 Group I. — Digestants ... 129 Group II. — Fats and Oils . . . 132 Group III. — Mineral Acids 137 Group IV. — Vegetable Acids . 146 Group V. — Alkalies . , .... 149 Group VI. — Mineral Waters .... . . . 165 Group VII. — Bitters . . ... . ... 170 Simple Bitters 170 Aromatic Bitters 172 Group VIII. — Hematics 179 Animal Extracts (Organo-therapy) 217 Division II. — Specifics 221 Serum-therapy . . 269 CLASS XL— ANTISEPTICS 302 Aromatics Group I. — Antispasmodics Group III. — Anesthetics Group IV. — Hypnotics Group V. — Narcotics Group VI. — Motor Excitants . Group VII. — Motor Depressants . Bromides . . , Group VIII. — Cardiac Stimulants , Group IX. — Cardiac Sedatives . , Group X.' — Diaphoretics Group XI. — Emetics . . . Group XII. — Expectorants . Group XIII. — Diuretics . 357 CLASS III.— SYMPTOM MEDICINES 379 379 Group II. — Antipyretics ... 388 396 410 427 464 498 527 534 576 592 599 614 628 CONTENTS. 15 PAGE Group XIV. — Cathartics . . 656 Laxatives 664 Simple Purgatives . 672 Hydragogue Purgatives 682 Salines . 686 Drastic Purgatives 689 Group XV. — Anthelmintics . gg^ Group XVI. — Emmenagogues and Ecbolics . 702 Group XVII. — Astringents 708 Vegetable Astringents 710 Mineral Astringents 724 TOPICAL REMEDIES. Group XVIII. — Caustics or Escharotics 754 Group XIX. — Vesicants and Epispastics . 761 Group XX. — Rubefacients 769 Group XXI. — Emollients, Demulcents, and Protective Agents . . . 771 PRESCRIPTIONS 782 INDEX 8ii A TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS, AND PHARMACOLOGY. INTRODUCTION. The history of medicine since the time of Hippocrates is the record of a more or less continuous series of experimental re- searches, having for their paramount object a precise and compre- hensive knowledge of the nature of disease and the practical application of remedial science. Regarded sensu latiori, the various " schools " which have arisen from time to time are philosophically co-ordinate, their fundamental principles being ref- erable to one dominating thought — the art of healing. It is scarcely practicable here, even were it necessary, to review in detail the separate doctrines which have obtained during the evolution of sectarian therapy. From the earliest ideas promul- gated by the ancient priests of .^sculapius, through the subse- quent era of Hippocrates, Theophrastus, and the Alexandrian school, influenced by the crude, misguided notions prevailing ere science emerged from its infancy ; discernible in the Galenic and other tentative yet memorable systems, in the epoch of Paracelsus and the Monastic Medicine of the Mediaeval period, and in the radical theories of Rasori and Roeschlaub which attended the development of the last, and have left a passing impress upon the present, century, — ^through all, the gradual acceptamce of empiri- cism as a legitimate guide to therapeutic truth is manifest. Yet viewed with reference to their underlying animus, these varied expressions of scientific endeavor distinguishing the past are per- ceptibly linked with the ampler system which has emanated from the more rational methods of modern research. 2 17 l8 A TEXT-BOOK OF MATERIA MEDICA. The light of inductive reasoning and the marvellous progress in scientific knowledge which characterize the nineteenth century are a living appeal from the idealism of a less enlightened age. The release from tradition — anticipated in the labors of Bichat and others — to which later investigation owes so many signal triumphs has doubtless been profoundly affected by the realistic tendency of modern thought. It is to the startling advancement attained in the natural sciences, however, resulting in a chemical skill and in me- chanical appliances of incomparable value, that we must look for the originating impulse which has inspired the therapeutic know- ledge of the present day. It needs but little reflection to perceive the immeasurable superiority of actual acquirements over the vague, hesitating — though ardent and laborious — methods to which the theory and practice of medicine were so long subservient. We have said that, considered in the larger sense, the history of medicine has been a harmonious rather than an intermittent devel- opment. It is not to be supposed that, in the evolution of so momentous a scheme as the formulation of a remedial system applicable to the extensive catalogue of human ailments, there should not have occurred spasmodic and ill-adjusted theories, crystallizing in many a strange cultus, which, if ineffectual in retarding the onward sweep of rational progress, has, it may be safely averred, worked incalculable injuiy to the cause of medical truth. Mesmerism, astrology, spiritualism, even theosophy, how- ever incongruously conjoined, and similar vagaries have not failed to enlist among their votaries many enraptured, even noted, be- lievers ; nor is the mental strabismus with which they are afflicted amenable to any resource of rational treatment. We need, more- over, but contemplate the pitiable hallucinations which urge the pious pilgrimages to Marpingen, Lourdes, and Treves, and the criminal negligence and incredible offence to reason which stultify the so-called " Christian Scientists " (as ironical a misnomer as lan- guage permits), to realize that miraculous cures still hold bhghting yet potent sway over the minds of the ignorant and credulous. May not even the assumption of thaumaturgical powers be one day possible with those who arrogate to themselves a knowledge little short of omniscience, and to whose rudimentary intelligence the laws of nature convey no perceptible lesson ? As from the sublime to the ridiculous, so from faith to fanaticism, it is but a step, after all. It is appropriate here to emphasize the unfailing — nay, ever- INTRODUCTION. 19 increasing — importance of therapeutics in its relation to the wel- fare of mankind. Especially imperative is this obligation in an epoch of unprecedented achievement in every department of science which contributes to the perfection of the heaUng art, in which general advancement medicine has borne no inconspicuous a role. The rapid advance of experimental philosophy, however, applied to medical treatment, culminating in bacteriological discoveries of signal value to mankind, and the remarkable triumphs attending the development of operative surgery, have inevitably tended to disparage the equally noble and far more widely cultivated field of therapeutic science. This result is the more deplorable since it creates in the minds of the young and inexperienced an impression of contrast and divergence in departments of study naturally and indissolubly correlated. It is scarcely surprising that the marvels of the laboratory and the splendid achievements of the arena should possess for the tyro an entrancing interest. Yet it is to be borne in mind that the most brilliant triumphs of diagnostic and surgical skill might prove futile as the means of arresting disease were they not supplemented by the course of treatment which constitutes therapy. It must be confessed that medical art has too often been dis- credited by professional incompetence, and consequent failure to effect the cure that with the laity is wont to form, however ignor- antly, the only criterion of ability. In America especially — where from defective laws the widest latitude is given to incapacity and imposture — the lack of proper academical training is frequently the cause of serious consequences in practice, little calculated to enhance the popular confidence and esteem. It therefore behooves the student of medicine to master thoroughly the details of the remedial art, become practically conversant with physiological conditions and the manifold phenomena of morbid anatomy, and so familiarize himself with the varying indications of disease that in the presence of whatever malady, his diagnosis and treatrnent may command respect — not only from the laity, but, what is of far more consequence to him, from the profession. It is almost superfluous to lay stress upon pharmaceutical know- ledge as a powerful weapon in the armament of the medical prac- titioner. Yet no branch of therapeutic science has, perhaps, been more neglected than a practical acquaintance with the nature and uses of Materia Medica, their origin, potency, and characteristic value, as well as their physiological action, and the incompatible 20 A TEXT-BOOK OF MATERIA MEDICA. and synergistic agents upon which their efficacy often largely depends. Thanks to careful and competent training among pharmacists, the skilful preparation and dispensing of drugs relieve the physi- cian of much responsibility ; yet he should be keenly sensible of the fact that the larger share of public confidence is reposed in him, and by diligent study of the subject endeavor to command the minutiae of pharmacology, holding himself morally accountable for errors quite possible in the druggist's dispensary. It may not be irrelevant to add that in all medical procedure a sympathetic yet perfectly controlled nature, ready tact, and sterling common sense are cardinal requisites to professional triumph, it being gene- rally true, as was long since observed by Hufeland, that " success- ful treatment requires only one-third science and two-thirds savoir faire." Finally, the author would counsel the utmost seriousness in the pursuit of a calling which might aptly be termed " Christian Science " — ^the power to alleviate human suffering by means of curative agents with which the laboratory of nature has been mercifully stored. There can be no loftier, more practical mani- festation of love to men than is exemplified in the benignant eiTort to assuage the ills to which mortality is heir ; nor can any devotion be more privileged and inspiring than that which softens the shock of disease, illumines the darkness of mental and physical distress, and from the debris of misfortune, vice, and heredity creates anew the image of divine perfection. It is this uplifting, "consecrated zeal, akin to veneration for medical science, which has endeared to the world the masters of the profession — of which the same wise Hufeland said : " To him who fails to make a religion of the heal- ing art it is the most cheerless, wearisome, and thankless labor upon earth ; indeed, in him it must become the greatest frivolity and a sin." And for those — and they are many — to whom the material, possibly mercenary, aspect of their task appeals unduly it is enough to cite in rebuke the elevated maxim of Stigelius : Non omnia quae suscipiraus lucrum spectant. PHARMACOLOGY AND GENERAL THERAPEUTICS. Eemedies. — In a comprehensive sense every means of counter- acting, curing, or mitigating disease or bodily disorder may be termed a remedy or remedial agent. The mode of treatment may be preventive, reparative, or restorative ; but the agents employed by the physician are properly called remedies. Although their number is wellnigh as great as the multifarious causes of disease, the chief classes of remedies are comparatively few, and may be grouped mainly under the following heads : Prophylactic, whereby attention is directed to the immediate environment of the patient, with a view to secure proper sanita- tion and outward conditions more favorable to recovery sug- gested by hygienic laws. Sanitary, when hygienic treatment is combined, as it now usually is, with medical remedies, constituting what is known as regimen, including proper ventilation, temperature, diet, bathing, and exercise. Imponderable, as when the forces of light, heat, cold, and elec- tricity or magnetism are brought into requisition by the aid of science. Mechanical, pertaining to certain surgical methods and remedial applications, or a course of physical training, including the peculiar yet often efficacious treatment known as massage. Pharmaceutical, including a very large and varied class of remedies which, from their established curative properties and their signal importance to the physician (medicus), are technically termed medicines. They are designed to preserve or restore the health of the animal organism, promote recovery in cases of injury or disease, and, in short, perform every office proper to a palliative or remedial agent. > Pharmacology is, strictly speaking, the science which treats of the origin, nature, chemical affinities, and physiological action of drugs. For the sake of a clearer knowledge of its relations to 21 22 A TEXT-BOOK OF MATERIA MEDICA. remedial treatment, and to facilitate a practical understanding of so comprehensive a subject, pharmacology may be regarded as a union of two correlated themes of research : Materia Medica, which deals especially with the sources from which drugs are derived, their chemical and physical properties, their constituent elements, and their general function as substances or agencies in the practice of medicine. Pltarmacy, restricted to the analysis and determination of drugs, and the science of preparing and dispensing medicines in the forms in which they are best administered. Therapeutics (from the Greek word meaning to attend, to serve) is the science and practice of selecting and applying remedies for sickness and disease, and necessarily includes the proper care and treatment of invalids. " The ultimate aim of all medical research," it has been truly said, " is the treatment and prevention of disease." This constitutes the primary object of the therapeutist. In its amplest signification therapeutics embraces all that relates to the science and art of healing, and the application not only of medicines, but of every remedial agent likely to accomplish this paramount motive of the physician's labor. Under the general term of therapeutics, therefore, are included the action of natural forces, the varied resources of Materia Medica, and the contingent considerations of climate, food, clothing, etc., grouped under two principal divisions : Natural Therapeutics, being, as the term implies, a curative method dependent upon the laws of nature rather than the sub- sidiary arts of man. Applied Therapeutics, including the scientific application of palliative or remedial agents having no counterpart in the living organism, designed, through the art of medicinal administration, to assist nature in the process of restoring health. This division con- stitutes more properly the study of therapeutics and the domain of professional practice. Empirical Therapeutics implies the application of remedies to which experience has ascribed certain specific properties irre- spective of systematic value. It is not based upon scientific research, but rather upon formulae established by the accumula- tion of isolated facts — empiricism — and practical observation, apart from theoretical reasoning and the relations of physiological phenomena as revealed by modern methods of investigation. Were it possible to extend indefinitely the list of remedial agents PHARMACOLOGY AND GENERAL THERAPEUTICS. 23 so as to embrace the entire field of therapeutic knowledge, the empirical method might attain the dignity of an exact science. Such, however, is the complexity arising from the manifold, often contradictory, impressions drawn from human experience that for the evolution of a systematic scheme of therapeutics the empirical system must of necessity prove inadequate. Rational Therapeutics is based upon the use of medicines in accordance with a scientific knowledge of pathology and the physi- ological effects of remedial agents. Here nothing is left to chance, and the nostrums of the older system have but little weight com- pared with the methods of careful and intelligent diagnosis and a skilful administration of remedies suggested by well-known and accepted indications of disease. Every department of medical sci- ence has been illumined by the light of modern research, and the chemical and physical properties of Materia Medica submitted to severe and competent analysis, that Rational Therapeutics may establish a system through which the errors and uncertainty of empiricism may be supplanted by a more stable and philosophical method, and the chances of inaccuracy minimized. Through the college curriculum and the medium of professional intercourse, afforded by personal comparison of opinions and by innumerable publications throughout the world, the results of scientific experi- mentation are becoming widely diffused and the scope of serious investigation constantly enlarged. In connection with this subject it may be well to call the atten- tion of the student to the technical signification of the following terms : Pharmacopoeia is the descriptive list of drugs and their prepara- tions recognized by the medical profession of any locality or coun- try as official. In foreign countries pharmacopoeias are issued under government sanction and are strengthened by legal accept- ance. In the United States the work is published under the auspices of the medical and pharmaceutical professions, being revised every ten years by a convention called for that purpose. It may be added that the British Pharmacopoeia is in the main in conformity with that of our own country. In all, twenty-four countries issue pharmacopoeias, while thirteen have none. Official — Officinal. — Unnecessary confusion appears to prevail concerning the precise import of these terms. They are readily understood by reference to the Latin originals from which they are derived. 24 A TEXT-BOOK OF MA TEH I A MEDIC A. Official drugs are those which bear the stamp of professional i.e. official^sanction (Lat. officiiim, authority). They are prac- tically ordered by the Pharmacopoeia to be kept in all druggists' shops, the formuljE being supplied by the work revised in decennial conventions. Officinal drugs are those prepared or kept by the druggist upon his own responsibility, bearing only the authority of the shop (Lat. officina, a shop). Such preparations are often included in works on Materia Medica, and, together with those emanating from other individual formula, are marked " unofficial." The term " unofficinal," it will be seen, is a solecism ; and it fol- lows, moreover, that there are many preparations which are in pharmacy officinal, but not official, and that a pharmacopceial formula cannot possibly be officinal, although, speaking generally, all official drugs are officinal in that they are kept or prepared in the druggist's shop. Dispensatory. — This is a compilation of and commentary on one or more pharmacopoeias, enlarging the authoritative but re- stricted pharmacopceial formulae by including the medical and physical history of the various substances, with directions regard- ing dosage, together with observations on their physiological action and therapeutics. It also contains information concerning drugs not accepted by pharmacopceial authority, yet which are of occa- sional use or interest. The Dispensatory is in effect a private pub- lication and unofficial, in this respect differing essentially from a pharmacopcfiia. There are in the United States various works of this character, the United States and National Dispensatories being commonly in use. CLASSIFICATION OF MEDICINES. The classification of drugs and remedial agents is a theme regarding which the many writers upon and teachers of medicine have shown a wider diversity of opinion, perhaps, than upon the physiological action and medical uses of individual remedies. The fact that therapeutics is far from being an exact science, and the rapid advance in our knowledge of normal physiological processes, of pathological conditions, and the systematic action of drugs, are sufficient explanation of the ever-changing judgments of our best observers concerning the action of certain medicinal agents under given conditions. CLASSIFICATION OF MEDICINES. 25 It- follows that from time to time, as appears in reviewing the literature of the subject, different writers, in their attempt to keep pace with the advancement of knowledge, have devised various systems of classification. In earlier days, when the therapeutist culled from the fields his simples for the cure of disease, there was naturally created a strong tendency toward a botanical classification. So far was the system pushed that in certain so-called schools of medicine the authority of Scripture was invoked, it being proclaimed as an axiom that ■" the leaves of the tree were for the healing of the nations " (Rev. xxii. 2). The outgrowth of this eclecticism, strange as it may seem to-day, was the Thompsonian or Botanical system of thera- peutics. On the other hand, as an evolution of the old alchemic school, an attempt was made to found a classification by explaining the remedial action of all medicines upon a purely chemical basis. With the advent of more modern methods of study, applied to the physiological action of drugs upon the animal economy, came the physiological classification, in which the effects of remedial agents were explained upon rational grounds. It is hardly necessary to state that coexistent with these various endeavors to attain a philosophical method of classification, com- plicating them and perplexing their votaries, the dominating prin- ciple of empiricism held universal sway, setting at defiance in many instances the cardinal maxims of rational therapeutics, the rational therapeutist even to-day welcoming as a last resort the cruder, though often efficient, empirical method. Some authors, perceiving the inutility of the older systems, have contented themselves with a mere alphabetical arrangement of medicinal agents, regardless of their origin, mode of preparation, or physiological affinities. With due respect for the many able and worthy efforts at classification recorded in the history of modern therapeutics, the author believes that the main object of classifying medicinal reme- dies — viz. to facilitate the retention of a vast number of valuable yet isolated facts — is best accomplished by grouping them along the lines of greatest practical utility. Remembering that the medical student of to-day is animated by an earnest effort to fit himself for the noblest sphere of usefulness — knowledge applied to the relief of human suffering — the author holds that the most philosophical, as well as practical, synthesis and comparison of remedial agents, based upon manifest physical 26 A TEXT-BOOK OF MATERIA MEDICA. and physiological relationships, will afford to the pupil the widest grasp, from a therapeutical standpoint. With the object of aiding the student, in accordance with this con- viction the author has endeavored in this work to give emphasis ta a therapeutical classification, claiming for it no especial originality,' but assured that the method he has selected is alike the most judi- cious and the one best calculated to respond to the demands of daily, practical utility. The thoughtful and logical student of medicine must realize that there are two great classes of remedial agents : 1. Those used in cases which cannot be relieved by a single dose of any remedy, but require repeated and prolonged admin- istration. 2. Those employed in cases which are susceptible of immediate relief by the exhibition of a single dose. The remedies employed for the cure of the first class of cases; have been appropriately styled Disease-Medicines — an unscientific term, perhaps, yet useful to convey the intended idea, since they remove the cause of the departure from normal physiological action in the living organism — i. e. perversion of functional integrity, or disease. Upon reflection it will be seen that remedial agents in the second class are, by the nature of the case, designed for the relief of some manifestation or change in the system or in its functions indicating the character, locality, severity, etc. of a morbid process — a symp- tom of disease. The remedies in this class, therefore, are termed Symptom-Medicines , partly because of their specific virtue in reliev- ing symptoms, partly from the fact that they produce certain mani- festations characteristic of themselves. The classes named might be subdivided ad infinitum, yet it has seemed advisable to the author, for the sake of simplicity, to divide only the first class, Disease-Medicines, including the remedial agents employed therein under three general heads. Restoratives, Specifics, and Antiseptics. It is obvious to every reflecting physician that a class of reme- dies act as such by supplying some deficiency in the animal organ- ism, the agent in such cases being either itself the substance lacking, or its analogue, or by its presence restoring the deficient element or secretion. Iron or fats, for instance, act in certain forms ' This classification is adapted from one formerly used by Prof. William N. Thompson of New York. CLASSIFICA TION OF MEDICINES. 2/ of anemia in which these ingredients are wanting in the red blood- corpuscles; phosphorus or the earthy salts behave similarly in conditions where the tissues are deficient in these necessary constit- uents; and bitters, though not natural ingredients of the system, act upon the gastro-intestinal mucous membrane, stimulating the glands to secrete a larger quantity of normal digestive fluid. In view of the physiological action of the remedies pertaining to this division, the- term Restoratives so aptly expresses their general character that no apology is needed for its adoption. The second division. Specifics, can be administered without injurious results only in diseased conditions, in which the particular remedy combats in a specific and occult manner the prime etiologi- cal factor of the pathological derangement. These medicines act properly only upon diseased organisms, their peculiar effect never being obtained by the exhibition of a sin- gle dose, but only after prolonged administration. They normally produce no symptoms, the patient being unaware of their action save by a recognition of his gradually improved condition. Should, in fact, symptoms occur, they should serve as a warning that the remedy is not indicated or that the dose is unsuitable to the condition. To elucidate this principle, the use of morphine to allay the pain of gout may be cited. A single dose is usually sufficient, yet it is not curative; while lithia acts as a restorative through its well- known solvent and eliminative properties, reinvigorating the circu- lation and by continued treatment curing the disease. Again, caffeine may be employed to relieve anemic neuralgia, yet it requires hemic restoratives to alleviate the condition produ- cing the symptoms. A genuine specific is tolerated only by the system in which it antagonizes some disease. For instance, A and B are put under a prolonged course of mercury : A is salivated beyond recognition, while B's health improves — simply for the reason that B had syphilis, which A had not. At the present day the number of remedies which we are compelled to relegate to this class, Specifics, for want of accu- rate knowledge regarding their modus operandi, is quite limited. Quinine was formerly considered a specific in malaria, until the fact was recognized that the drug is analogous to a normal constituent of healthy bile in its action upon plasmodia malariae. The second great class of agents to which the name Symptom- 28 A TEXT-BOOK OF MA TERIA MEDICA. Medicines is applied embraces all medicinal substances which, being introduced into the system, may produce by a single dose abrupt or serious disturbances of function. From the earliest his- tory of medicine they have offered a tempting field to the thera- peutist, because of the absolute certainty of their action in allaying symptoms or producing manifestations pecuHar to themselves. It is perhaps superfluous to add that, owing to their extreme activity, the greater number of therapeutic errors may be ascribed to their use. To the young practitioner the charm of therapeutics lies in that •class of agents which produce immediate and tangible results. These are obtained most readily by the remedies affording instant relief of prominent symptoms of disease, such as pain, pyrexia, insomnia, etc. Yet the author is here constrained to add a word of caution to the amateur therapeutist, reminding him that, in the maturer knowledge derived from subsequent experience, he will have less to regret should he confine his study and practice to physiological medication — that is, to the examination and adminis- tration of legitimate restoratives and specifics — rather than yield to the allurements presented by the energetic action of a large number of agents classed among Symptom-Medicines. The members of this class of remedies have been variously divided and subdivided by different writers on therapeutics. Antiseptics are classed among Disease-Medicines on account of their property of restoring to their normal condition the tissues, fluids, and secretions of the body by destroying the germs or micro-organisms which by their presence excite pathological processes. This great class. Antiseptics, embraces some of our most important neurotics. Most of them are antipyretic, and many of them possess analgesic and hypnotic properties. Instance, chloral, a powerful antiseptic, hypnotic, antipyretic, and circulatory depressant. Con- sidered only as an antiseptic, it would be classed as a Disease- Medicine ; clinically, however, it is used more as a hypnotic, and therefore in this work it is ranked as a Symptom-Medicine — a neurotic in the subdivision of Hypnotics. Drugs, in fact, exhibit so many different actions that an arbitrary line of demarcation between them is practically impossible, the author merely desiring to assign a given remedy to the class to which its chief therapeutic uses would naturally attribute it. The principal use of opium, as we know, is to relieve pain. It ADMINISTRATION OF MEDICINES. 29 is the typical narcotic, yet it possesses astringent and hypnotic properties, and could therefore not inaptly be classed as an astrin- gent or hypnotic. It is already a question whether antipyrine should not be ranked in the division of Analgesics rather than Antipyretics, since, while formerly it was used almost exclusively for the reduction of tem- perature, we now know it to possess marked anodyne properties - so that it is actually doubtful which is its more important use — to lower temperature or to relieve pain. These few illustrations serve to show how varied are the actions of drugs, and how their several divisions overlap one another. Thus, the last division of Disease-Medicines, Antiseptics, imme- diately precedes the first group of Symptom-Medicines, Antispas- modics, so closely are they allied, the last-named class possessing properties similar to those of that interesting division of Antisep- tics—the Aromatics. The next group, Antipyretics, is logically followed by Anes- thetics, and this in turn by Hypnotics, Narcotics, etc., each group being succeeded by the one most closely resembling it in physio- logical and therapeutic action. The last group comprises the Astringents, classed under Symptom-Medicines, these agents occu- pying the borderland between external and internal medicines. Caustics, the first group under topical remedies, naturally follow Astringents, since they differ from the latter drugs only in degree perhaps, as is well shown in sulphuric acid, which when diluted is an asti-ingent, but undiluted an active caustic. A thoughtful study of drugs as classified in this work will, it is hoped, enable the student to become more familiar with the com- parative value of the various remedial agents than were possible had the author chosen an alphabetical arrangement, associating remedies having no possible relationship either in their actions or their medical uses. ADMINISTRATION OF MEDICINES. External Method of Application. — In order to utilize the absorptive power of the cutaneous surface for therapeutic pur- poses various methods have been adopted. The simplest of these, though by no means the most successful, is by Inunction, which consists in an outward application of the 30 A TEXT-BOOK OF MA TERIA MEDJCA. medicinal agent, without abrasion of the cutis, and compulsory absorption through the process of " rubbing in." The horny epidermis, however, presents an effectual barrier to the absorption of many drugs, and the Endermic Method has been found more serviceable. This plan consists- in producing, by means of a blister, a raw surface, which readily absorbs the medicinal agent — morphine, strychnine, atro- pine, quinine, etc. — with highly marked effect. The process is somewhat painful and necessarily slow in action, being now almost wholly superseded by the Hypodermic Method. — This consists in injecting the drug into the subcutaneous tissues by means of the hypodermic needle and syringe. Since absorption bythe tissues takes place readily, it will be seen that this method of application is far more efficacious than those previously mentioned. Not all drugs, it is to be observed, are available for administration by the hypodermic process of injection. The eminent success attending the operation, however, renders it of signal value to the physician. Parenchymatous Method. — This is a more heroic means of injection, by which the drug is deposited in the corporeal tissues. It is said to afford temporary relief in sciatica, but for various reasons is highly objectionable, chiefly because of the excruciating pain consequent to the operation. Intravenous Injection may be resorted to in desperate cases : its dangers are obvious, however, and, save for the purpose of trans- fusion after severe hemorrhage, it can seldom be attempted with impunity. Internal Administration. — The most obvious, and by far the most useful^ method of internal administration is hy th.Q_inouth ; yet care and discretion are to be used even in so ordinaiy a process, and the physician should consider thoughtfully the time, consequent effects, and chemical changes, that the drug may produce the most beneficial results. Inhalation is in many respects of the first importance as a method of internal administration. Its great facility in practice and its unquestionable efficiency — as in the case of anesthetics — render it readily available and highly beneficial, although the method has attained as yet only a limited use in therapeutics- beyond a resort to it in pulmonary diseases. Enemata. — A different class of administrative operations consists in injections into the rectum, which injections may be purgative. ADMINISTRA TION OF MEDICINES. 31 anodyne, nutrient, emollient, astringent, anthelmintic, etc. For speedy and efficient cleansing of the large intestine the purgative enema is of incomparable value, care being taken that the quantity of the injection be sufficient, that it be passed up as far as possible, and that it remain as long as the patient is able to retain it. Absorbable enemata are usually small in quantity ; they have proved useful in certain cases of diarrhea and dysentery, and are serviceable when the act of swallowing is precluded by affections of the esophagus or in cases where the stomach requires complete rest. The rectum, however, possessing no digestive capacity, the injection should consist of the simplest materials and contain pepsin and acid or pancreatic fluid. Another mode of securing beneficial results from internal admin- istration through the absorptive properties of the intestine is by means of suppositories, readily introduced within the sphincter ani and dissolving at the temperature of the body. Dosage. — The term dose implies the quantity of a medicinal agent which under certain conditions it is advisable to administer, many considerations entering into the question, to be weighed by the features of the individual case. Dosage may be regarded as perhaps the most vulnerable point in therapeutic science, yet one upon which the art of healing almost wholly depends. Since Heller in 1755 enunciated his philosophical maxims touching the rational method of testing the therapeutic effects of drugs, eminent clinicians have sought to solve the mysteries attend- ing the action of various remedies whose modus operandi remains to this day obscure. Indeed, so great is the diversity of operation pertaining to the commonest remedies, conditioned by the character and circumstances of the case, as well as the amount and quality of the drug, that it is next to impossible to predicate the precise effects of agents whose physiological properties are theoretically and even practically established. The dose may often determine the specific action of a remedy, yet medicinal doses are specific as regards each other, their true action being discoverable only by experience. The doses given in many text-books differ materially from those prescribed in actual practice, being intended to express only the average quantities to be administered, the exact amounts varying with the conditions of the particular case. These conditions may be classed under the heads of age, sex, temperament, idiosyncrasy, habit, state of the system, temperature of the body, time of administration, intervals 32 A TEXT-BOOK OF MATERIA MEDICA. between doses, cumulative action of the drug, and the contingent considerations of diet, climate, race, etc. — oftentimes a complicated problem even to the most skilful therapeutist. A few suggestions regarding the leading characteristics of dosage, as limited by these various circumstances, may be of value to the student. The influence exercised by Age is indubitable, as a rule the young requiring smaller doses than adults, the aged being least susceptible to therapeutic impressions. With regard to children several mathematical formulae have been devised, none being infallible, and the best of them based upon conditions of weight and preconceived estimates of physiological effects to the detri- ment of other factors than age, upon which infant development largely depends. Nor can deductions as to the efficacy of a given dose be drawn from the action of drugs with which the agent is naturally associated. A single drop of laudanum has been knowrt to produce the death of a child, whereas large doses of belladonna, conium, arsenic, and mercury have been taken with impunity. The most convenient rule (Young's) adds 12 to the child's age and divides by the age to get a denominator of a fraction whose numerator is i, this fraction representing the proportion between adult and infant doses. Thus, for a child three years old 3 + 12 — - — = 5, or \, the dose being one-fifth of that given to an adult. Temperament acts as an important agent in modifying the effect of medicinal remedies, phlegmatic subjects readily tolerating cer- tain medicines, such as opium, which those of nervous temperament are unable to bear. Stimuli act upon sanguineous patients forcibly, yet upon others their influence may be either tardy or ineffectual. The condition is one which discloses a wide field of inquiry, the mental, moral, and physical tendencies of the individual being involved in the practical administration of medicines. Closely allied to the foregoing is the question of Idiosyncrasy , the constitutional peculiarity which exerts a subtle influence, scarcely understood, as potent as it is obscure. Its characteristics cannot be formulated, but must be studied with the aid of experience — an odor, a taste, a casual or fixed impression, or hereditary instinct often determining their existence and manifestation. In tempera- ment and idiosyncrasy, indeed, the psychological rather than the physiological side of therapeutics is developed, requiring for its treatment a professional acumen not always at command. The influence of Habit is to diminish the susceptibility of the ADMINTSTRA TION OF MEDICINES. 33 organism to impressions which under normal conditions would be speedy and effectual. Only by gradually increasing the quantity of the dose can results be obtained which in ordinary circumstances require few exhibitions. Thus, patients accustomed to the use of alcoholic stimulants accept heroic doses of alcohol with little or no indication of effects quickly perceptible in temperate subjects. Bodily condition obviously affects the action of remedial agents. It is well established that in severe pain opium may be adminis- tered in quantities which in a healthy organism would produce untoward, perhaps fatal, results. The salivation occasionally caused by mercury is seldom apparent in febrile conditions. Yet in cases where sensibility is diminished great care is necessary to avoid the deleterious effects of over-stimulation or excessive dosage. Respecting Sex, although it is generally admitted that females require smaller doses than males, the exceptions to the rule are so numerous as almost to vitiate the accepted theory. The Time of Administration is closely connected with the Form of the Remedy given, as a rule remedies being withheld immedi- ately before and after meals. The practice, however, is subject to modifications, certain drugs acting best on an empty stomach, and others, such as local irritants, being more safely diffused when the stomach is full, in which case by mingling with the food they are not brought into irritating contact with the intestinal mucous membranes. With regard to Intervals between Doses it may be said, in brief, that they are to be determined by the special features of the case, the character and potency of the drug, and the degree of tolerance and assimilation evidenced by the patient. Every remedial agent, under normal conditions, produces a specific and definite action, the system by absorption and elimination limiting the period of its efficacy in cases of prolonged treatment, so that the drug is evi- dently to be renewed in order to secure perfect results. Failure to continue treatment has frequently proved disastrous, even fatal, to the patient, and it should be borne in mind that, in the absence of contraindications or untoward effects, a primary object of dosage is to create and maintain an impression upon the morbid system. Knowledge of therapeutic action and a thorough understanding of pathological conditions can best determine the interval requisite to attain the most beneficial effect of successive dosage. Other considerations — by some therapeutists ' held to be of , minor, by others of paramount, importance — affect the vital question 3 34 A TEXT-BOOK OF MATERIA MEDICA. of dosage. The emotions, for example, play an interesting part in the toleration or rejection of remedial agents. Strangely enough, too, the imaginative faculty is often a cause of idiosyncrasy, numer- ous instances being adduced by reputable authorities wherein either positive or fancied ills were affected through the agency of spurious remedies — bread-pills, deceptive concoctions, and the like — the ethical aspect of therapeutics being here left to the conscience of the physician. DEFINITIONS. There are certain general terms employed to signify specific actions of drugs which may properly be here defined. Acids. — Salts of hydrogen, of great value in medicine and sur- gery. They are marked by a high diffusive power when used externally, and act as depressants upon those glands whose normal secretion is acid, while stimulating those whose normal secretion is alkaline. Mineral acids act as astringents, and possess the power of arresting fermentation, some of them being characterized by strongly antiseptic properties. Alteratives. — Medicines having the power to produce favorable changes in the system or alter some abnormal condition. They are especially useful in specific or chronic diseases. Their modus operandi is unknown, and they require time to produce favorable results. Anesthetics. — Certain substances having the property of de- stroying sensation or producing anesthesia, either general or local. Various alcohols and ethers are used for this purpose, the degree of unconsciousness being regulated by the nature of the anesthetic and the method of administration. The invaluable properties of ether and chloroform are well known in connection with operative surgery. Analgesics or Anodynes. — Agents used to reduce or efface the sensation of pain, without necessarily inducing stupor, the sense of touch being usually unaffected. In this respect they offer a marked difference from anesthetics, which destroy all sensation. Anaphrodisiacs. — Agents whose action tends to reduce venereal desire and sexual power. They act by depressing the brain-centers or the spino-genital center, or by lessening the blood-supply to the genital organs. DEFINITIONS. 35 Anhydrotics. — Medicinal agents employed to check perspira- tion, acting either upon the sweat-glands and centers or upon the cutaneous circulation. Antacids or Alkalies. — Agents used to counteract acidity, neutralizing the strongest acids, and with weak acids forming salts 'having alkaline properties. When applied to the ducts of glands whose normal secretion is acid, they increase it, lessening the secretion from alkaline glands. They dissolve albumin, rendering the blood more alkaline, and consequently neutralize the acidity of the urine. Antidotes. — Remedies which either counteract the effect of poisons or by their action serve to eliminate or destroy the poison itself. Anti-emetics. — Medicines effecting a diminution of nausea and vomiting, either by reducing the irritability of stimulated centers or by sedative action upon the gastric nerves. Antigalactagogues. — Remedies which prevent, reduce, or arrest the secretion of milk. Antilithics or Lithontriptios. — ^Agents found to be efficacious in checking the formation of urinary and biliary calculi, or of dis- solving them when formed. Antiperiodios. — Medicines employed to prevent the periodical recurrence of paroxysmal symptoms, especially the attacks incident to febrile disorders. Antiphlogistics. — Agents used to reduce inflammation. The term is related to ancient practice — the methods of bloodletting, depressing regimen, etc. — the remedies holding but a subordinate place in modern therapeutics. Antipyretics. — Remedies designed for the reduction of an abnormally high temperature of the body, acting in various ways, some of which are still imperfectly understood, the principal modes of action being (i) by limiting the production of heat, and (2) by favoring the loss of heat. Antiseptics. — These prevent or check putrefaction and septic infection, destroying the germs which produce them or neutralizing the toxic products of these germs. Antisialics. — Medicines having the effect of reducing the secre- tions of the salivary glands or checking salivation. Certain drugs lessen reflex excitability, while others act through paralysis of the nerve-terminals or a reduction of the blood-supply to the salivary glands. 36 A TEXT-BOOK OF MA TERIA MEDICA. Antispasmodics. — Remedies used to allay spasms, whether the muscular action be voluntary or involuntary. They may act as stimulants to certain nerve-centers or as depressants upon others, according to the agent employed and the nature of the spasmodic disorders. Antizymotics. — Agents used as preventives in zymotic dis- eases, by arresting fermentative development. Aphrodisiacs. — Medicines whose effect is to stimulate sexual desire and power, acting either upon the cerebral or the spino- genital center. Astringents. — Agents which cause the contraction of living tissues, diminishing the amount of blood or other fluid in them, reducing hemorrhage, or, through constipating action, limiting the intestinal secretions, as well as those from mucous membranes generally. Cardiac Sedatives. — Agents designed especially to control palpitation or to reduce the action of the pulse in certain febrile conditions. They are employed to allay over-energetic action of the heart, a hypersystolic condition. Cardiac Stimulants. — Remedies acting upon the cardiac appa- ratus in depressed conditions, having the specific effect of length- ening and invigorating the contraction of the cardiac muscle, increasing the force and frequency of the heart's action. Cardiac Tonics. — Properly, these agents act directly upon the muscles of the heart, increasing its nutrition and giving tone both to the cardiac muscle and to the nervous mechanism of the heart, thereby increasing its capacity for work. Carminatives. — Chiefly aromatic agents, used for the purpose of expelling gas from the stomach and intestines, correcting flatulency. Cathartics. — Agents employed to promote intestinal evacuations. They are numerous, being divided into several groups according to their physiological effect : Purgatives, Laxatives, etc. Cerebral Depressants. — The effect of these remedies is to produce primarily cerebral stimulation, followed by functional de- pression. Among them are included Narcotics, Anesthetics, etc., some of which, such as chloroform and the like, should be admin- istered with great care, lest their powerful action induce dangerous conditions. Cerebral Excitants. — Medicines used to augment brain-activity without necessarily impairing the normal exercise of the cerebral DEFINITIONS. 37 functions. Their modtis operandi is through the heart — and, con- sequently, the circulatory system — or by direct action upon the brain. Ciliary Excitants. — By acting on the tracheal and bronchial cilia these agents assist the expectoration of bronchial secretions, the mucus being expelled by reflex stimulation of the upper respiratory tract. Demulcents. — Drugs possessing soothing properties, the local action of which, owing to their oily or mucilaginous nature, is that of a sedative and protective to. the parts under treatment. Many demulcents appear to affect favorably remote portions of the organ- ism, since they are frequently given internally to allay irritation of the respiratory, gastro-intestinal, and genito-urinary tracts. Dentifrices. — Various medicated powders or liquids used for cleansing the teeth and gums, an excellent basis for the powders being chalk. Antiseptics, as well as stimulants and disinfectants, are desirable, the lodgement of food frequently resulting in fer- mentation and the production of organic acids, with consequent injury to the dentine (caries). Deodorants. — Agents employed for the destriiction of noxious gases and foul odors. Diaphoretics. — Medicines intended to produce perspiration, affecting the sweat-glands of the skin either through local or cen- tral action or by relaxing the cutaneous blood-vessels. The name " sudorifics " has been applied to those agents causing profuse sweating. Diluents. — Agents which, being absorbed, perform the office of diluting the excretory fluids. Pure water is the simplest and best. Disinfectants. — Agents that prevent infection by destroying the specific germs of disease or rendering them innocuous. Diuretics. — A class of remedies tending to increase the secre- tion of the kidneys, thereby augmenting the urinary flow. Emetics. — Agents which produce vomiting, acting either by reflex or direct stimulation. Emollients. — These are medicinal substances which soften and relax the tissues in topical applications. By relieving tension they modify the pressure and guard the affected parts from irritation.. They usually, act upon the skin, whereas Demulcents are designed to act upon the mucous membrane. Emmenagogues. — Agents intended to restore or increase the menstrual function. 38 A TEXT-BOOK OF MA TERIA MEDIC A. Brrhines or Sternutatories. — Remedies used to promote nasal irritation and produce sneezing, causing the discharge of mucus. Bscharotics or Caustics. — Medicinal agents possessing caustic properties, destroying the tissue to which they are applied and pro- ducing a slough. Expectorants. — Designed to promote expectoration, modifying and facilitating the expulsion of the bronchial secretions. Galactagogues. — Agents used to increase the secretion of milk. Some of them are of doubtful efficacy, while others, such as the leaves of the castor-oil plant, have produced excellent results. Gastric Tonics or Stomachics. — These remecijes are service- able in aiding digestion and promoting appetite and the secretion of gastric juice. Hepatic Depressants. — Intended to reduce the secretion of bile in the liver by lowering hepatic activity, and thereby lessening the formation of urea and glycogen. Hepatic Stimulants. — Agents employed to increase the func- tional activity of the liver and the formation of bile, urea, and gly- cogen. Cholagogues are generally regarded as synonymous with Hepatic Stimulants, but their special office is to remove the accu- mulated bile from the duodenum, thus preventing its reabsorption, rather than for the purpose of increasing its secretion. Hypnotics. — Medicines designed to produce sleep, in a general sense embracing Anesthetics and Narcotics, yet lacking their specific or analgesic properties. Many agents are employed to cause artificial sleep besides those classed under simple hypnotics, their efficacy varying with the mental and physiological condition of the patient. Intestinal Astringents. — Remedies used to act upon the walls of the intestines, reducing exudation and rendering the feces less fluid, or acting by constriction of the intestinal mucous membrane. Irritants. — Applied to the cutaneous surface, these remedies produce vascular excitation. When the irritation occurs remote from the seat of application they are termed counter-irritants. Ischemics or Hemostatics. — Agents capable of arresting hem- orrhage. Local Stimulants. — Agents which increase nervous sensibility, acting upon the nerves or stimulating blood-circulation. Local Sedatives. — Remedies intended to produce effects the reverse of the foregoing. DEFINITIONS. 39 Local Anesthetics or Anodynes. — Medicines which so lower the susceptibility of the sensory nerves that they become incapable of transmitting impressions. The peculiar property of Anesthetics is to destroy or paralyze ; that of Anodynes, to temper. Motor Depressants. — Agents which reduce the activity of the motor apparatus and spinal cord. Motor Excitants. — Employed to stimulate the activity of the motor nerves. Mydriatics. — Agents used to produce mydriasis, or persistent dilatation of the pupil. Myotics. — Agents which contract the pupil. Narcotics. — Powerful agents which, acting on the brain, may produce sleep, stupor, coma, and death, the nerve-centers being at first stimulated and afterward paralyzed. Oxytocics or Bcbolios. — Medicinal agents employed to con- tract the muscular fibers of the womb during pregnancy. Pancreatic Stimulants. — Remedies used to increase the func- tional activity of the pancreas. Parasiticides. — Lotions and ointments of drugs employed to destroy animal and vegetable parasites infesting the human body. Protectives. — These are various substances, including medicinal agents, used to protect injured surfaces by excluding air, water, etc. Pulmonary Sedatives. — Agents used to lessen irritation of the respiratory tract, reducing cough and dyspnea. Refrigerants. — Medicines employed to quench thirst and cool the overheated system. Respiratory Depressants. — Agents which depress the action of the respiratory center, resulting in slow and shallow respi- rations. Respiratory Stimulants. — Agents which stimulate the respi- ratory apparatus, deepening and quickening the respirations. Restoratives. — Agents which act upon the tissues to restore exhausted or impaired activity, by supplying the deficiency through dietetic treatment or by means of various medicinal resources. They are natural ingredients of the system, or analogous to them, acting directly or indirectly to restore or renew some tissue or structure or to sustain or increase some vital action. Sedatives. — These remedies are of several classes, all tending to soothe the system by tempering functional activity. Sialagogues. — Agents used to promote secretion in the salivary glands, either topical or general in their action. 40 A TEXT-BOOK OF MATERIA MEDIC A. Styptics and Hemostatics.— Remedies designed to arrest hemorrhage, Styptics being those applied externally, and Hemo- statics those used for internal administration. Uterine Depressants.— Agents employed to restrain the con- tractions of the gravid uterus, thereby controlling its action. Uterine Tonics and Alteratives.— Remedies having, or sup- posed to have, a specific influence upon the uterus. Vascular Sedatives.— These have the effect of contracting the vessels and diminishing the circulation. They are useful in check- ing heniorrhage and allaying local inflammation. Vascular Stimulants. — Medicines which increase and equalize circulation, acting through dilatation of the cutaneous vessels and heart-stimulation. Vascular Tonics.— These tend to increase blood-pressure, acting upon the mechanism of the vessels through the vaso-motor nerves, lessening the caliber of the arterioles. Vesical Sedatives. — Agents employed in allaying irritation of the bladder and relieving pain. Vesical Tonics. — These increase the contractile force of the vesical muscles. Urinary Sedatives and Astringents. — Agents which, being administered internally, become incorporated with the urine, and thus act upon the entire urinary tract. They relieve irritation (sedative) or diminish or check abnormal secretion (astringent), the latter agents being usually applied locally in the form of an injection. WEIGHTS AND MEASURES. The history of Weights and Measures affords a striking example of the incongruity resulting from the absence of a uniform standard of stable value to science, and must be regarded as the strongest argument in favor of the Metric, or Decimal, System. An idea of the confusion prevailing under the old methods may be gained from an examination of their comparative units, by which we find that a pint is not a pound, an ounce not equal to a fluid- ounce, a drachm not equivalent to a fluidrachm, and a minim not commensurate with a grain. It was not until 1836 that the Secre- tary of the U. S. Treasury was directed by Congress to furnish each State in the Union with a complete set of revised standards, includ- WEIGHTS AND MEASURES. 41 ing the troypound of 5760 grains, from which the Apothecaries', or Troy, weight is derived, the latter term at present being applied only to the system used in weighing precious metals. For commercial purposes the following Weights and Measures are employed : Avoirdupois Weights: the Pound divided into 16 Ounces. Liquid Measures : the "Wine Measure," of which the U. S. Gallon represents a volume of 231 cubic inches; each cubic inch of water at the maximum density (4° C.) being equivalent to 252.892 grains, the weight of a Gallon being therefore 58,418 grains. The Gallon is divided into 8 Pints (octarius), and the Pint is divided into 16 Fluidounces, each containing 8 Fluidrachms, or 480 Minims, the Fluidrachm containing 60 Minims. The signs used to designate these units are — TH,, denoting minim or minims ; fS, fluidrachm or fluidrachms ; and f S, fluidounce or fluidounces. Apothecaries' (Wine) Measure. 20 grains (gr. granuni) = 1 scruple 9 (scrupulum). 60 grains, or 3 scruples = i drachm 3 {drachma). 480 grains, or 8 drachms = i ounce 3 {uncia). 5,760 grains, or 12 ounces = i pound ft {libra). Apothecaries' (Troy) Weight. 60 minims (TTl) = i fluidrachm f 3. 480 minims, or 8 fluidrachms = i fluidounce fg. 7,680 minims, or 16 fluidounces = I pint O {octarius). 61,440 minims, or 8 pints = i gallon C {congius). This lack of uniformity in the units and the denominations of the three systems of weights and measures is exemplified in the subjoined table. While the two weight systems have a unit in common, the grain, there is no correlation in the higher denomina- tions, ounces and pounds. The desirability of adopting a fixed standard, applicable in all cases where great accuracy in weights and measures is requisite, has been frequently emphasized by writers on therapeutics. As we have premised, the present diffi- culty forms a cogent argument in favor of the metric system, as wisely adopted in the U. S. Pharmacopoeia. A remarkable dis- parity is shown in the liquid measures, in which there is no unit in common : a minim is not a grain, nor " a pint a pound the world around." 42 A TEXT-BOOK OF MA TERIA MEDIC A. Table of Apothecaries' Weight and U. S. Liquid Measure, showing the equivalents of the various denominations (by reading from the left-hand column and referring to headings), the weight equivalent of liquid measures being for water at 15° C. ; Symbol. Minim. Granum. Scru- pulus. Drach- ma. Fluid- drachma. Av. ounce. Fluid- uncia. Uncia. Libra. Av. pound. Octa- rius. Con- gius. gr. 3 3 f3 av. oz. fl. S 1 lb. lb. av. 0. Cong. I 0.95 60 480 7,680, 61,440 0.95 1 20 60 57 437.5 456 4S0 5,760 7,000 7,292 20 1 3 24 238 350 57 60 3 i '% 96 1168 60 57 I ^28 1,024 437-5 I 16 480 4S6 '% ■A I 16 128 24 8 84 0.9115 1 14-58 288 96 ICX) I3i 12 I 0.823 7,000 350 Z16 iioi 16 14.58 1-215 I 7,680 7>3O0 I 8 61,440 58,400 1024 ^28. 3 I Minim. Grain. Scru- ple. Drachm. Fluid- drachm. Av. oz. Fluid- ounce. Apoth. or Tr. oz. Apoth. orTr. pound. Av. pound. Pint. Gal- lon. THE METRIC SYSTEM. The Metric System of Weights and Measures, destined to sup- plant all others, originated with Prince de Talleyrand, bishop of Autun, in 1 790. Its almost universal adoption by civilized nations, its legality, though not compulsion, in England and the United States, and its adoption by the U. S. Pharmacopoeia of 1890, require that it should be understood alike by the physician and the druggist. Save in the English-speaking world it is the only system used for governmental, statistical, and scientific purposes, and in the arts and manufactures its value has long since been recognized. Its extreme simplicity, its uniformity, and its facility of computation render it far superior to any other system of Weights and Measures, and it is highly probable that in the near future it will prevail in the transactions of every-day life, as it has already acquired international importance, and is in fact referred to as the International System. The starting-point is the unit of length, the meter {metre), which '^ the 4uooVQ TrTi- part of the earth's circumference around the poles.^ From this apparently irrelevant measure of length the unit of ' In 1806, Francois Arago and Blot were commissioned by the French government to complete the meridional measurements interrupted in 1804. The object of their survey was to determine, with as great nicety as possible, the ten-millionth part of a quadrant of the meridian passing "through Paris, which had been chosen by the National Convention as the standard unit of length, and named the niHre. It being impossible to measure from the poles, an arc of the meridian, equalling a quadrant, from Dunkirk to Barcelona was selected, and from their known difference of latitude the entire length of the arc was deducted. WEIGHTS AND MEASURES. 43 capacity, or volume, the liter, was established, it being the cube of ^ of a meter. With equal simplicity and clearness, from the meter was derived the unit of weight, the gramme, which is the weight of that quantity of pure water at the maximum density, 4° C. (39.2° F.), which will fill the cube of ^-^ part of a meter ^ (cubic centimeter). The Metric is also known as the Decimal System, because its multiples and subdivisions are obtained by ten (Lat. decern). The prefixes denoting multiplication are of Greek derivation, and are usually spelled with a capital letter: Deka 10, Hecto 100, Kilo 1000, Myria 10,000. Division of the units is indicated by Latin pre- fixes, not capitalized : deci -^, centi ■^-^, milli y^^. To distinguish readily one process from the other the word GILD has been aptly suggested as a mnemonic : GILD. Greek increases, Latin decreases. It may be observed that, strangely enough, while we still oppose the general adoption of the Metric System, our enumeration is decimal. We count from one to ten, and begin a new, yet similar, series of another ten units, and so on indefinitely,. We compute money in dollars, dimes, cents, and mills, decimally, and our record of time — years, decades, centuries— is in harmony with decimal arithmetic. Even the provision of the Federal Constitution declaring that a national census be taken every ten years is pertinent as a sugges- tion of decimal convenience ; and in the period prescribed for the State censuses, every five years, one-half of ten, there is no great deviation from the same principle of utility. Contrary to a prevalent opinion, the Metric System is easily mastered. A perfect acquaintance with the metric tables is, nat- urally, indispensable, and the abbreviations for the different weights and measures should be thoroughly at command. For the rest, the system is simply that of arithmetical decimals, requiring chiefly a correct use of the decimal point. Only a tyro would read .065 six and five-tenths hundredths instead of sixty-five thousandths ; so Gm. .065 would never be read by one acquainted with decimals 1 The unit of surface measure, the are, the square of ten meters, and the unit of the solid measure, the stere, having the c'apacity of a cubic meter, need not claim the atten- tion of the physician or the practical pharmacist. 44 A TEXT-BOOK OF MATERIA MEDICA. six centigrammes and five milligrammes, but sixtyfive grammes. Metric Table of Lengths. lo millimeters make i centimeter. milli- lo centimeters lo decimeters lO Meters lo Dekameters lo Hectometers lo Kilometers I decimeter. I Meter. I Dekameter. I Hectometer. I Kilometer. I Myriameter. Abbreviations for the different divisions and multiples of the Meter are herewith given, together with their equivalents in inches, showing that the written system depends wholly upon the place of the decimal point, the figures remaining unchanged. It may be noted that the first abbreviations cited are those commonly in use, although in certain cases the second are preferable : Metric Table of Linear Measure. I millimeter is written I mm., or M .001, equal in inches to .039370432, approx. i. I centimeter ' ' I cm., " M .01, .39370432, 0.4. I decimeter • ' I dm.. " M.I, 3.9370432, " 4- I Meter ' iM., " M I., 39.370432, " 40. I Dekameter ' I Dm., " M 10., 393.70432 X Hectometer I Hm. " M 100., 3937.0432 I Kilometer ' I Km., " M 1000., " 39370432 I Myriameter ' ' I Mm. " M 1 0000., " 393704-32 The term micromillimeter, one-thousandth of a millimeter {0.00000 1 ), is used, especially in microscopy, the abbreviations being mmm., mic, mkm., or the Greek letter //. Metric Table of Capacities. 10 milliliters make i centiliter. 10 centiliters 10 deciliters 10 Liters 10 Dekahters 10 Hectoliters 10 Kiloliters I deciliter. I Liter. I Dekaliter. I Hectoliter. I Kiloliter. I Myrialiter. Abbreviations for the different divisions and multiples of the Liter, with their corresponding equivalents in minims or ounces are as follows : WEIGHTS AND MEASURES. 45 1 milliliter is written I Cc. ' or L .001, equal in minims to 16.23 I centiliter " I d. " L .01, ( (( 162.3 I deciliter « idl. " L.I, < 1623. I Liter C( I L. " L I., ' fl. ounces 33-814 I Decaliter " I Dl. " L 10., ( (1 338-14 I Hectoliter (C I HI. " L IOC, i it 3381-4 I Kiloliter " iKl. " L 1000., . 33814- I Myrialiter (( I Ml. " L 10000., f « 338140. Metric Table of Weights. 10 milligrammes make i centigramme. 10 centigrammes " i decigramme. 10 decigrammes " i Gramme. 10 Grammes " i Dekagramme. 20 Dekagrammes " i Hectogramme. 10 Hectogrammes " i Kilogramme. 10 Kilogrammes " i Myriagramme. Abbreviations for the different divisions and multiples of the Gramme, with their corresponding equivalents in grains, are as follows : I milligramme is written i ing., or Gm. .001, equal in grains to (^y .015432 I centigramme " i eg., " Gm. .01, " " (^) -15432 I decigramme " 1 dg., " Gm. .1, " " I-S432 I Gramme " I Gm., " Gm. I., " " 15-432 I Dekagramme " i Dg., " Gm. 10., " " 154-32 I Hectogramme " i Hg., " Gm. 100., " " '543-2 I Kilogramme " i Kg., " Gm. 1000., " " 15432.3 I Myri^rarame " i Mg., " Gm. loooo., " " 154323.4 METHOD OF CONVERTING METRIC WEIGHTS, MEASURES, AND LENGTHS INTO THOSE IN COMMON USE, AND VICE VERSA. Approximate Table of Weights. I grain = ,,0165 Gm. (65 milligrammes). 15 J grains = i. Gm. I drachm = 3.9 Gm. I troy ounce = 31.1 Gm. Approximate Table of Capacities. I minim = .06 Cc. 16 minims = i. Cc. I fluidrachm = 3.75 Cc. I fluidounce = 30. Cc. 1 This is designated by Cc. instead of Ml, and in practice only cubic centimeters and Liters are employed. 46 A TEXT-BOOK OF MA TERIA MEDICA. Approximate Table of Lengths. I inch = .025 M. (25 millimeters). 40 inches = i. M. Weights. To Convert Grains into the Corresponding Metric Equivalents. — It has been seen that i grain is equal to Gm. .065. In order, then, to convert grains or fractions of a grain into the corresponding metric quantity, we have simply to multiply the number of grains by .065. 2 grains = 2 X .065, or .130 Gm. )0 grains = 60 X .065, " 3.9 Gm. \ grain. = \ of .065, " .0325, Gm. T grain = r^ of .065, " .00065 Gm., etc. To Convert Metric Quantities into their Equivalent in Grains. — Instead of multiplying as above, divide, using the same number, .065, as a divisor. Gm. .130 = .130 -^ .065, or 2 grains. Gm. 3.9 = 3.9 -;- .065, " 60 grains. Gm. .0325 = .0325 -i- .065, " .5 grain. Gm. .00065 = .00065 "^ -065, " .01 grain. It follows that to convert Apothecaries' drachms into Grammes we multiply the number of drachms by 3.9, the number of Grammes in I drachm ; and to convert Grammes into Apothecaries' drachms we divide the number of Grammes by 3.9. . The same rule applies to the conversion of Apothecaries' ounces into Grammes and Grammes into ounces, the multiplier and divisor being 31.1, the number of Grammes in i ounce. Volumes. To convert minims into the corresponding metric equivalents, multiply the number or fractions of minims by .06, this being the equivalent in Cc. of i minim ; and to convert the metric quantities into the corresponding equivalents in minims, divide the metric quantity by .06. To convert fluidrachms into Cc, multiply the number of drachms by 3.75, the number of Cc. in i fluidrachm; and to convert Cc. into fluidrachms, divide the number of Cc. by 3.75. To convert fluidounces into Cc, multiply the number of ounces by 30. Cc, the equivalent of i fluidounce; and to convert ^.Cc. into fluidounces, divide the number of Cc. by 30. WEIGHTS AND MEASURES. 47 For convenience of i-eady reference and to facilitate computa- tion the following tables are subjoined : Table of Metric Equivalents of Grains, Drachms, Minims, and Fluidrachms, 3 Grains. Milligrams, mg. Centigrams, eg- Decigrams, dcg. Grammes, Gm. Minims. Cubic centi- meters, Cc . I Tffir 0.65 0.065 0.0065 0.00065 ■l\ 0.8s 0.085 0.0085 0.00085 iz I. O.I O.OI O.OOI I 1-3 0.13 0.013 0.0013 2-S 0.25 0.025 0.0025 A 6.5 0.65 0.065 0.0065 \ 13- 1-3 0.13 0.013 J 16. 1.6 0.16 0.016 ^ 32. 3-2 0.32 0.032 I 65. 6.5 0.65 0.065 I 0.06 2 «3- 1-3 0.13 2 0.12 3 20. 2. 0.2 3 0.18 4 25- 2-S 0.25 4 0.24 S 30- 3- 0.3 5 0-3 7i so. S- o-S 8 o.s lO 65. 6.S 0.65 10 0.6 15 100. 10. I. 16 I. 20 13- 1-3 20 1.25 3° 20. 2. 32 2. ■.5J 6o 40. 4- 60 3-75 f3J lOO 65. 6.5 100 6. 3y 120 80. 8. 120 7-S fgy 150 100. 10. 150 9- S'ij 180 200 12. 13- 180 200 11.25 12. fSiiJ -3'v 240 16. 240 IS- feiv 3^ 300 20. 300 18. fgv 3vj 360 400 24. 26. 360 400 22.5 24- fsri 3vy 420 45° 28. 30- 420 450 26.25 27- f^vij gj 480 32. 480 3°- f|j Equivalents. Various methods have been proposed for adapting the metric weights to our apothecaries' weights used in prescription writing without entailing calculations in fractions. The method of taking 32 Grammes as equivalent to one troy ounce, and 30 Cc, or fluid Grammes, as equal to one fluidounce, seems to be the least objec- tionable. These equivalents are shown in the following : 32 Gm. = I ounce ; 32 -h 30 Cc. = I fluidounce ; 30 ^ i = 4. Gm. = I drachm. — 375 Cc. = I fluidrachm. The exact metric equivalent of i grain is obtained by dividing the unit by the Gramme equivalent in grains; thus, i. -^ 15-432 = •0.0648 Gramme (or 6|- centigrammes). 48 A TEXT-BOOK OF MATERIA MEDIC A. The metric equivalents of all the other denominations may be obtained by multiplying the grain equivalent by the number of grains in one drachm ; the number of drachms in a troy ounce, etc. The following exact Gramme equivalents are thus obtained : I grain. i drachm, i ounce av. i ounce troy. i H) troy. i R) av. 0.0648 3.888 28.349 3>io3 373-250 453-592 To convert avoirdupois or troy into metric weights, the equiva- lent of the Gramme in grains — 1 5 .432 — should be remembered, as it serves the purpose of a basis for obtaining the equivalent of all the higher denominations. Table of Metric Equivalents of Ounces (Apoth., Av.^and Fluid) in Grammes and Cubic Centimeters. Ounces, I Grammes, Fluidounces. Cubic centimeters. Exact Apoth., Grs. Gm. or G. f3 Cm. or Cc. equivalents. I 31 I 30 29-57 2 62 2 60 59-15 3 93 3 „ 90 88.72 3 103 100 3-38 100 4 124 4 120 "8.3 5 155 5 150 147-87 6 186 6 180 177-44 7 • 217 7 210 207.01 8 248 8 240 236-59 8 18 250 8-45 250 9 ' 280 9 270 266.16 10 311 10 300 295-73 II 342 II 33° 325-31 I R> 12 373 12 360 354-88 453-6 I pt. 16 '7A .480 "500 493-18 Av. Ounces. Grs. lib 16 17 278 500. 20 .600 591-47 20 566.8 24 ■720 709.77 24 680. 2pt. 32 960 946-35 28 793-2 34 A 1000 2 R) 32 ' 907-25 3pt. 48 1440 1419. 35 • 120 1000. 4pt. 64 1920 1892.71 3ft 48 1360. 68 A 2000 4 ib 64 1814.S 5 pt. 80 2400 2365.9 70 240 2000. 100 3000 2957-37 5ft 80 100 2268 2835 I gal. 128 3840 3785.43 10 lb 160 4536 It will be noted that in the Pharmacopoeia of 1 890 the Gramme (Gm.) and the Cubic Centimeter (Cc.) are the only metrical terms used. The reason of this is simply that these two terms express sufficiently the quantities ordinarily handled, the remaining ones being excluded to avoid confusion, Grammes and Cubic Centi- meters standing as perfect equivalents of ordinary weights and measures, as the foregoing tables indicate. PHARMACEUTICAL PREPARATIONS. 49 PHARMACEUTICAL PREPARATIONS. Preparations made by the pharmacist are called pharmaceutical preparations. Nearly one-half of the articles of the United States Pharmacopoeia are pharmaceutical ; formulas being given for their preparation, they are intended to be made in the pharmacy. A still greater number are unofficial, being chiefly such as are made according to the formulas or prescriptions of eminent medical practitioners and teachers. Such of the latter as have attained general use and proved of value have been incorporated in the National Formulary, a work pubhshed under the direction of the American Pharmaceutical Association. The importance of having a uniform standard for the prepara- tion and strength of this class of medicines has long been recog- nized, instead of the variation in strength and product inseparable from a number of manufactures with the consequent multiplicity in processes and formulas. These preparations of the National For- mulary, designated N. F., are included in this work, following the official preparations (U. S. P.) of the classes to which they belong. The pharmaceutical preparations may be divided as follows : I. Solutions. II. Liquid Mixtui'es — Internal. III. Extractive Preparations — Liquid and Solid. IV. Mixtures of Solids — Internal. V. Mixtures for External Use^ — Liquids and Solids. These groups are each divided into a number of Classes, each class having a distinct Latin title by which its members, or indi- vidual preparations, are officially designated and alphabetically arranged in the U. S. P. In addition to the Latin and English titles, each class is also known by an English name, besides various synonyms. There are altogether 34 of these Classes official, besides a number unofficial. official number. I. The Solutions are divided, according to the charac- ter of the solvent, into — Aqueous: Aquae — Waters 19 Liquores — Liquors (solutions proper) 24 Alcoholic: Spiritus — Spirits 25 Elixiria — Elixirs 2 Vina — Wines (by solution) 3 4 50 A TEXT-BOOK OF MATERIA MEDIC A. Official number. Saccharine: Syrupi — Syrups 32 Mellita — Honeys 2 Glycerin : Glycerita — Glycerites 6 II. The Liquid Mixtures — Internal : Misturae — Mixtures (proper) 4 Emulsa — Emulsions 4 III. Extractive Preparations : Liquid : Aqueous : Mucilagines — Mucilages 4 Infusa — Infusions 4 Decocta — Decoctions 2 Acetous : Aceta — Vinegars 2 Vinous: Vina — Wines 5 Alcoholic: Tincturae — Tinctures 71 Extracta Fluida — Fluid Extracts 89 Solid: Alcoholic: Extracta — Extracts 33 Abstracts (unofficial). Resinae — Resins 3 Semi-liquid : Ethereal: Oleoresinse — Oleoresins 6 IV. Mixtures of Solids — Internal : Pulveres — Powders 9 Trituratio — Trituration i Sales effervescentes — Salts, effervescent .... 4 Confectiones — Confections 2 Trochisci — Troches 15 Massse — Masses 3 Pilulse— Pills IS V. Mixtures of Solids — External : Liquid: Linimenta — Liniments 9 Oleata — Oleates 3 Collodia — Collodions 4 Solid: U-nguenta — Ointments 23 Cerata — Cerates 6 Suppositoria — Suppositories i Emplastra — Plasters 13 Chartae — Papers 2 Total ^ PHARMACEUTICAL PREPARATIONS. 51 AQU^ MEDICATE— MEDICATED WATERS. The Medicated Waters are solutions of volatile substances in Water. They comprise (i) the Aromatic Waters and (2) the Chemical Waters. The Aromatic Waters are made by dissolving the volatile oils of their respective drugs, or distilling the latter with Water ; two Waters are saturated solutions of other liquids than volatile oils — viz. Aqua Chloroformi and Aqua Creosoti. The following are official : Contains Cc. in /oo Cc, Aqua — or percentage by volume. Amygdalae Amarae bitter almond oil o.l Anisi , anise oil 0.2 Aurantii Florum Fortior saturated Aurantii Florum of the above 50. Camphorae camphor 0.8 Chloroformi^ chloroform 0.5 Cinnamomi cinnamon oil 0.2 Creosoti creosote i. Fceniculi fennel oil 0.2 Menthae Piperitae peppermint oil 0.2 Menthae Viridis spearmint oil 0.2 Rosae Fortior saturated Rosse of the above 50. The Chemical Waters are solutions of gases in Water. The fol- lowing are official : Contains gas, percent- Aqua — age by weight. Ammoniac NH3 10 Ammoniae Fortior NH3 28 Chlori CI 0.4 Hydrogenii Dioxidi (Hydrogen Peroxide) . . . HjOj 3. LIQUORES— SOLUTIONS. The Solutions (also termed Solutio, -nes, Lat.) are solutions of non-volatile substances in Water. The official Solutions are all solutions of inorganic salts. They are made either by simple solution (dissolving the particular salt in ' Chloroform Water, aside from its medicinal properties, is an efficient preservative agent, and forms a good solvent in place of water for preparing solutions intended to be kept free from micro-organisms, as, for example, those for hypodermic use. 52 A TEXT-BOOK OF MATERIA MEDICA. Water) or by chemical solution (reacting upon different substances, and obtaining the newly-formed salt in solution in the Water). The following 24 are official : The Arsenic Solutions : these are all of the same strength — viz. I per cent. ; 10 minims (0.6 Cc.) represent ^^5- grain (0.006 Gm.) of arsenic, the usual dose : Percentage Liquor^ or Gm. in 100 Cc. Acidi Arsenosi acid, arsenous i. Arseni et Hydrargyri lodidi arsenic iodide i. (Donovan's Solution). mercuric iodide i. Potassii Arsenitis . . . potas. bicarb. 2 ; acid, arsenous i. (Fowler's Solution) tinct. lavender comp. 3. Sodii Arsenatis sodium arsenate i. The Alkaline Salt Solutions, prepared by saturating an organic acid with an alkaline carbonate or bicarbonate, furnishing an agree- able and refreshing potion (also designated Saturatio, Potio, Lat.) charged with Carbonic Acid Gas. The dose is from 2 to 4 fluid- drachms (8-15 Cc), except Liq. Magnesiae Citratis : Liquor — Gm. in 100 Cc. Ammonii Acetatis (Spiritus Mindererus) ammon. carb. 5. acid, acetic, dil. 100. Ferri et Ammonii Acetatis . . . liquor ammon. acet. 20. (Basham's Mixture), acid, acetic, dil. 3.; tr. ferri chlor. 2. elix. arom. 12; glycerin 10; aqua ad 100. Magnesii Citratis . . . magnes. carb. 15.; acid, citric. 30. potas, bicarb. 25.; syrup, acid, citric. 60 Cc. ; aqua ad 350. Potassii Citratis (Neutral Mixture) . . potass, bicarb. 8. acid, citric. 6.; aqua ad 100. The Iron Solutions, containing ferric salts in the following pro- portions by weight : Gm. in 100, or Liquor — percentage by weight. Ferri Acetatis ferric acetate 31. Ferri Chloridi ferric chloride 37.8 Ferri Citratis ferric citrate 42.5 Ferri Nitratis ferric nitrate 6.2 Ferri Subsulphatis (Monsel's) . . ferric subsulphate 43.7 Ferri Tersulphatis ferric sulphate 28.7 PHARMACEUTICAL PREPARATIONS. 53 These are mostly used in producing other Iron preparations and compounds, particularly the Tincture of Ferric Chloride, the Ferric Hydrate (arsenical antidote), and the scaled salts of iron. The Alkali Solutions : Percentage by vol. Liquor — or ■weight. Calcis (Lime Water) calcium hydrate 0.17 Potassae potassium hydrate 5. Sodae sodium hydrate 5. Sodse Chloratse (Labarraque's) chlorine 2.6 Lime Water is given as an antacid (10-30 Cc); Labarraque's Solution is used as a powerful disinfectant. The Solutions of Metallic Compounds ; all but that of Iodine are used only externally : Percentage by vol. Liquor — or weight. lodi Compositus (Lugol's Solution) . . potass, iodid. 10. iodine 5. Hydrargyri Nitratis mercuric nitrate 60. Plumbi Subacetatis lead subacetate 25. Plumbi Subacetatis Dilutus .... of above solution 3. (Lead Water) distilled water to 100. Sodii Silicatis sodium silicate 50. Zinci Chloridi zinc chloride 50. The dose of Liq. lodi Comp. is 3-10 minims (0.2-0.6 Cc), preferably given in a little milk. Unofficial Liquors of the National Formulary. Liquor — , AciDi Phosphorici Compositus (Acid Phosphates). Alumini Acetatis (Alumini Acetici, Ph. Ger.). — Contains 8 per cent, of basic Aluminum Acetate. Alumini Acetico-tartratis. — Contains about 50 per cent. of dry, so-called Aluminum Acetico-tartrate, which may be obtained by evaporating the solution. AuRi ET Arseni Bromidi. — Ten minims contain -^ grain (0.002 Gm.) of Tribromide of Gold and ^ grain (0.004 Gm). of Tribromide of Arsenic. BiSMUTHi. — Each fluidrachm (4 Cc.) represents i grain (0.06 Gm.) Bismuth and Ammonium Citrate. Bromi (Smith's Solution of Bromine). — Bromine, 20 per cent. ; Potassium Bromide, 10 per cent. ; Water. 54 A TEXT-BOOK OF MATERIA MEDICA. Liquor — Calcis Sulphurate (Solution of Oxysulphuret of Calcium; Vleminck's Solution or Lotion). CuPRi Alkalinus (Fehling's Solution). I. The Copper Solution, Copper Sulphate, pure grains 505 . . 34,6390111. Distilled Water . enough to make fluidounces 16 . . 500 Cc. II. The Alkaline Solution. Potassium and Sodium Tartrate . grains 252 . . 173 Gm. Soda (U. S. P.) troy ounces 2 . . 60 Gm. Distilled Water . . enough to make fluidounces 16 . . 500 Cc. Keep both solutions, separately, in small well-stoppered vials, in a cool and dark place. For use, mix exactly equal volumes of both solutions by pouring the copper solution into the alkaline solution. Ten Cc. of the mixture prepared by metric weight and measure correspond to 0.05 Gm. of glucose. Of the mix- ture prepared by apothecaries' weight and measure, 210 minims correspond to I grain of glucose. I Electropoeicus (Battery-fluid). A. For the Ca7-bon and Zinc Battery. — I. (For ordinary use). — Potassium Bi- chromate, in powder, 6 troy ounces (180 Gm.) ; Sulphuric Acid, commercial, 6 fluidounces (180 Cc.) ; Water, cold, 48 fluidounces (1400 Cc). — II. (For use with the galvano-cautery). — Sodium Bichromate, in powder, 6^ troy ounces (185 Gm.) ; Sulphuric Acid, commercial, 14 fluidounces (420 Cc); Water, cold, 48 fluidounces (1400 Cc). Pour the Sulphuric Acid upon the powdered Bichromate and stir the mix- ture occasionally during one hour. Then slowly add the Water. Sodium Bi- chromate is more soluble than the Potassium Salt, and also much cheaper. When it cannot be obtained, the Potassium Salt may be substituted for it, weight for weight. B. For the Leclanchi Battery. — Ammonium Chloride, 6 troy ounces (180 Gm.) ; Water, enough to make 20 fluidounces (600 Cc.) ; dissolve tlie Salt in the Water. Ferri Oxysulphatis (Oxysulphate of Iron). Ferri Protochloridi (Solution of Ferrous Chloride). — Each fluidrachm (4 Cc.) represents about 20 grains (1.3 Gm.) of Protochloride of Iron (ferrous chloride). Hydrargyri et Potassii Iodidi (Solution of Iodide of Mer- cury and Potassium ; Channing's Solution). — Red Mercuric Iodide, 72 grains (5.0 Gm.) ; Potassium Iodide, 56 grains (3.8 Gm.) ; in Di.stilled Water, 16 fluidounces (450 Cc). Hypophosphitum. — Each fluidrachm (4 Cc.) contains 2 grains (0.12 Gm.) of Calcium Hypophosphite, \\ grains (0.75 Gm.) of Sodium Hypophosphite, and i grain (0.06 Gm.) of Po- tassium Hypophosphite. loDi Carbolatus (Boulton's Solution ; " French Mixture "). — PHARMACEUTICAL PREPARATIONS. 55 Liquor — Comp. Tincture of Iodine, no minims (7 Cc); Carbolic Acid, 40 grains (3.0 Gm.) ; Glycerin, 2\ fluidounces (loo.o Cc.) ; in 16 fluidounces (450 Cc). loDi Causticus (Iodine Caustic ; Churchill's Iodine Caustic). — Iodine, i troy ounce (3 1 Gm ) ; Potassium Iodide, 2 troy ounces (63 Gm.) ; in Water, 4 fluidounces (120 Cc). Magnesii Bromidi. — Each fluidounce (30 Cc.) contains about 7 grains (0.5 Gm.) of Magnesium Bromide. Morphine Citratis. — Each fluidrachm (4 Cc.) contains 2 grains (0.12 Gm.) of Morphine in the form of citrate. Morphine Hypodermicus (Magendie's Solution of Morphine).' — i6grains(i Gm.) Morphine Sulphate to i fluidounce (30 Cc). Pancreaticus (Pancreatic- Solution). — Each fluidrachm (4 Cc.) represents i grain (0.06 Gm.) of Pancreatin, effectually pre- served in Glycerin and a little Alcohol. Pepsini Aromaticum. — Each fluidrachm (4 Cc.) represents I grain (0.06 Gm.) of Pepsin. Phosphori (Thompson's Solution of Phosphorus). — Each fluid- drachm (4 Cc.) contains about ^ grain (0.0025 Gm.) of Phosphorus, preserved in Absolute Alcohol and Glycerin. Picis Alkalinus (Tar, Alkaline). Potass^ Chlorate (Solution of Chlorinated Potassa ; Javelle Water). — An effective and popular disinfectant. PoTASSii Arsenatis et Bromidi (Liquor Arsenii Bromidi; Clemens' Solution). — This solution contains an amount of Arsenic in combination corresponding to about i per cent, of Arsenous Acid. The title " Solution of Bromide of Arsenic " (Liquor Arsenii Bromidi), which is often applied to Clemens' Solution or similar preparation, is a misnomer, sinc^e bromide of arsenic cannot exist, as such, in presence of water, but is split up into hydrobromic and arsenous acids. The proportions of the ingre- dients, in the formula above given, have been adjusted as closely as practicable, so as to yield definite compounds — viz. arsenate and bromide of potassium. Saccharini (Solution of Saccharin). — Each fluidrachm repre- sents 4 grains of Saccharin. Intended to be used for sweetening liquids and solids when the use of sugar is objectionable, or when a sweet taste is to be imparted to a liquid without increasing its density. ' Particular care should be taken in prescribing and dispensing this solution, so that it may not be mistaken for the so-called United States Solution of Morphine (Liquor Morphiae Sulphatis, U. S. P. 1870). containing only i grain of Sulphate of Morphine in each fluidounce, which is still occasionally used. 56 A TEXT-BOOK OF MATERIA MEDICA. Liquor — Seriparus (Liquid Rennet). If this liquid is to be used merely for curdling milk, without separating the whey as a distinct layer, it should be added to the milk, previously warmed to a temperature of about 35° C. (95° F.), and the mixture should then be set aside undisturbed until it coagulates. If the whey is to be separated, the Liquid Rennet should be added to the milk while cold, and the mixture heated to about 35° C. (95° F.), but not exceeding 40° C. (104° F.). One part of the liquid should coagulate between 200 and 300 parts of cows' milk. Liquor Sodii Arsenatis, Pearson. — This Solution contains about ^ per cent, of anhydrous Sodium Arsenate. This preparation should not be confounded with the Liquor Sodii Arsenatis of the U. S. P., which is ten times stronger than the above. Pearson's Solu- tion is official in the French Pharmacopoeia, under the title Solute d'Arse- niate de Sonde (or Solution Arsenicale de Pearson). Sodii Boratis Compositus (Dobell's Solution). — Sodium Borate and Sodium Bicarbonate, each 1 20 grains (8.0 Gm.) ; Carbolic Acid, 24 grains (1.5 Gm.); Glycerin,^ fluidounce (15 Cc); in Water, 16 fluidounces (450 Cc). Sodii Carbolatis (Phenol Sodique). — Carbolic Acid, 50 per cent. ; Soda, 3 per cent. ; in Water. Sodii Citratis. — Saturatio (Potio Riveri, Ph. Ger.). — Citric Acid, 150 grains (lo.o Gm.); Sodium Bicarbonate, 190 grains (12.5 Gm.) ; in Water, 16 fluidounces (450 Cc). Sodii Citro^tartratis (Effervescing Saline Water). — Sodium Bicarbonate, Tartaric Acid, Citric Acid, Syrup, and Water, in about the same proportions as in Solution of Magnesium Citrate, for which it is a cheaper substitute. Sodii Oleatis (Oleate of Sodium). — Intended to be used in the preparation of oleates. Strychnine Acetatis (Hall's Solution of Strychnine). — Each fluidrachm (4 Cc.) contains \ grain (0.008 Gm.) Strychnine Acetate. The Ph. Br. directs a Liquor Strychninae Hydrochloratis (with synonym, Liquor Strychnise) which is much stronger, and should not be confounded with the above preparation. It should never be dispensed unless expressly designated. ZiNci et Ferri Compositus (Deodorant Solution). — A com- bination of Sulphates of Zinc and Iron, Naphthol, Oil of Thyme, and Hypophosphorous Acid, in Water. Used as a simple deodorant and antiseptic for common domestic use when it is unnecessary or impracticable to employ more powerful agents. PHARMACEUTICAL PREPARATIONS. 57 When a deodorant solution is required for purposes where iron is objection- able — as, for instance, when woven fabrics are to be steeped in it — the follow- ing preparation may be employed : Liquor Zinci et Alumini Compositus, in which the Iron Sulphate is replaced by Aluminum Sulphate. Liquor — ZiNGiBERis (Essence of Ginger). — A 25 per cent, preparation of Ginger for flavoring aqueous mixtures. SPIRITUS— SPIRITS. The Spirits are solutions of volatile substances in Alcohol. They comprise (i) the Natural Spirits; (2) the Aromatic Spirits, or so-called " Essences ; " and (3) the Medicinal Spirits. The Natural Spirits are produced by distillation, and include : Spiritus Frumenti (Whiskey), containing Alcohol 50-58 per cent, by volume. Spiritus Vini Gallici, (Brandy), containing Alcohol 46-55 per cent, by volume. Spiritus Juniperi Comp. (Gin), containing Alcohol 60-70 per cent, by volume. The Aromatic Spirits are made by dissolving the respective oils or aromatic principles in (deodorized) Alcohol: Cc. in 100 Cc, Spiritus — or percentage by vol. Amygdalae Amarae (water 20) . . bitter almond oil i . Anisi (alcohol deod.) anise oil 10. Aurantii " " orange oil 5. Aurantii Comp. (alcohol deod.) .... orange oil 20. oils, anise o. 5 , coriander 2 ; lemon oil 5 . Camphorae camphor 10. Cinnamomi cinnamon oil 10. Gaultheriae wintergreen oil 5. Juniperi .... juniper oil 5- Lavandulae (alcoholdeod.) lavender oil 5. Limonis lemon peel 5; oil 5. Menthae Piperitse peppermint herb i ; oil 10. Mentha Viridis . . . • . . spearmint herb i ; oil 10. Myrciae (Bay Rum) water 38; oil of bay 0.8 oils, orange, pimenta, each 0.05 Myristicae nutmeg (vol.) oil 5. These are chiefly used for flavoring purposes ; some are used 58 A TEXT-BOOK OF MATERIA MEDICA. medicinally as aromatic stimulants and carminatives in doses of from 15-30 minims (1-2 Cc); Spiritus Amygdalae Amarae con- tains Hydrocyanic Acid, and is never used internally except in very small quantities as a flavor. The Medicinal Spirits are made by solutions of the medicinal substance in Alcohol. The following are official : cc. in 100 Cc, Spiritus— or percentage by voL Athens ether (QHj)^ 32.5 ^theris Comp. (Hoffmann's Anodyne) . ethereal oil 2.5 ether 32.5 By weight. Athens Nitrosi (Sweet Spirit of Nitre) . ethyl nitrite 4. Ammonise ammonia gas 10. Ammonia Aromaticus . . water 14; ammonia water 9. ammonia carb. 3.4 oils, lavender, nutmeg, each 0.1 ; lemon oil i. Chloroformi chloroform 6. Glonoini ... nitroglycerin i. Phosphori absolute alcohol, phosphorus 0.12 The dose of these Spirits is from 30 to 60 minims (2 to 4 Cc. ; about 75 to 150 " drops"), except the Ammonia Spirit, used only in the preparation of Liniments (externally), and that of Phosphorus,, which is for the preparation of the Elixir. Unofficial Spirits of the Natio?ial Formulary. Spiritus — AciDi FoRMici (Spirit of Ants, Ph. Ger.). — A solution of 3 per cent, of Formic Acid in Water and Alcohol. Ophthalmicus (Alcoholic Eye-wash). — A solution of 10 min- ims (0.6 Cc.) Oil of Lavender and 30 minims (2 Cc.) Oil of Rosemary, in Alcohol i fluidounce (30 Cc). Saponatus (Spirit of Soap). SiNAPis (Spirit of Mustard, Ph. Ger.). — A solution of 2| per cent, of Volatile Oil of Mustard in Alcohol. SYRUPI— SYRUPS. Syrups are nearly saturated Solutions of Sugar in Water, in which aromatic or medicinal substances are dissolved. The official Syrup, Syrupns, contains 65 per cent, by weight, 85 per cent, by volume, of Sugar (about 7 pounds, average, in PHARMACEUTICAL PREPARATIONS. 59 I gallon) : with a smaller proportion of Sugar the syrup undergoes fermentation (spoils). The " Medicated Syrups " contain less sugar, owing to the solu- tion of the medicinal substances, which usually reduce the solubility of the sugar in the liquid from which the syrup is prepared. Syrups should be kept in a cool plac.e, in cork-stoppered bottles, in order to preserve them. The thirty-two official Syrups are made by different methods : by solution, or mixing the medicinal substance with the syrup; by dissolving the Sugar in the medicinal solution ; by extraction from the drug ; and by chemical reaction and solution. They may be divided into (i) the aromatic or adjuvant syrups, and (2) the medicinal syrups, comprising {a) those made from extractive drugs, including alteratives, astringents, cathartics, and expectorants, and {S) those made from chemicals, either by simple solution or by chemical reaction and solution, including the hypo- phosphites, iron, and other tonics. The Aromatic or Adjuvant Syrups are mostly used as additions to, or vehicles of, liquid mixtures containing Bromides, Iodides, Phosphates, or similar salts of disagreeable saline taste, desirable to disguise. The following are official : „ . „ ° Cc. tn 100 Cc, Syrupus — or percentage by vol. Acacise mucilage acacia 25. Acidi Citrici spin lemon, i ; acid, citric i. Althaeas marshmallow 5. Amygdalae . . (bitter almond 4, sweet almond 14) 18. orange flower water 10. Aurantii orange, fresh exterior rind 5. Aurantii Florum orange flower water 50. Rubi Idaei raspberry juice (fresh) 40. Tolutanus tolu balsam i. Zingiberis fluid extract of ginger 3. The Extractive Syrups are often made by mixing the Fluid Extract of the respective drugs with Syrup. Tinctures and Fluid Extracts of resinous drugs often precipitate when mixed with Syrups and aqueous solutions. In order to fur- nish clear mixtures it is therefore sometimes necessary to mix the extractive preparation with Water, clarify the mixture by filtration, and dissolve the sugar in the filtered hquid. 6o A TEXT-BOOK OF MA TERIA MEDICA. The following are official : ^^ ^^ ^^^^ Syrupus — 2» ^oo Cc. Allii vinegar of garlic 20. Ipecacuanhse fl. ext. ipecac 7. Krameriae fl. ext. rhatany 45. Lactucarii tinct. lactucarium 10. Picis Liquidse glycerite, tar 7.5 Pruni Virginianse wild cherry 15. Rhei fl. ext. rhubarb 10. Rhei Aromaticus .... tinct. rhubarb, arom. 15. Rosse fl. ext. red rose 12.5 Rubi fl. ext. blackberry bark 25. Sarsaparillse Comp fl. ext. sarsaparilla 20. fl. ext. glycyrrh., senna, each 1.5 oils, sassafras, anise, gaultheria, each o.oi Scillse vinegar of squill 45. Scillse Comp fl. exts. squill, senega, each 8. (Coxe's Hive Syrup) . . antimony and potass, tart. 0.2 Senegse fl. ext. senega 20. Sennse oil coriander 0.5 ; senna 25. The dose of the Syrups of Ipecac, Squill, Squill Comp., and Senega as an expectorant is from 5-30 minims (0.5-2 Cc); as emetic, from 1-2 fluidrachms (4-8 Cc). The Chemical Syrups are an elegant class of preparations in which the taste of the medicinal agents is greatly modified. They do not keep well unless put up in small bottles completely filled, ready for dispensing. Except the Syrup of Iodide of Iron, which is best preserved in bottles exposed to light, they should be kept in a cool and dark place. The dose is from i to 2 teaspoonfuls (4 to 8 Cc), except of the Syrup of Iodide of Iron, the ordinary dose of which is 10 drops, nearly equivalent to 10 minims (0.6 Cc). The Syrup of Iron, Quinine, and Strychnine Phosphates (Easton's Syrup, Ph. Br.) is almost identical with the well-known unofficial Elixir of that name. It contains -^ grain of Strychnine in 80 min- ims (i mg. in 5 Cc); the formula of the U. S. P. 1880 yielding a Syrup nearly three times as strong, care should be observed that the preparations of the two formulas be not accidentally confused with each other. A somewhat similar preparation is the Syrupus Hypophosphitum Compositus of the N. F. PHARMACEUTICAL PREPARATIONS. 6i The following are official : Percentage. Gm. or Cc. Syiupus — in loo. Acidi Hydriodici acid, hydriodic, by weight i . Calcii Lactophosphatis . . . calcium lactophosphate i. Calcis lime (calcium saccharate) i. Ferri lodidi ferrous iodide, by weight lo. Grains Percent- in I fluid- age by drachm [4 Cc.) . vol. Ferri, Quininae et Strychninse Phosphatum: ferric phosphate, soluble i\ 2. quinine sulphate 2 3. strychnine -^ 0.02 acid, phosphoric 3 4.8 Hypophosphitum . . . calcium hypophosphite 3 4.5 potassium and sodium hypophosphites, each I 1.5 spirit lemon 0.5 ; acid hypophos. dil. 0.2 Hypophosphitum cum Ferro . . ferrous lactate I. with potass, citrate i, in syrup hypophosph. Unofficial Syrups of the National Formulary. Unless otherwise stated, the dose is I to 2 fluidrachms or tea- spoonfuls (4-8 Cc). Syrupus — KciRB. CoMPOSiTus (Cimicifuga or Black Cohosh). — Contain- ing 2^ grains (0.15) each of Cimicifuga and Wild Cherry, \\ grains (0.07) Glycyrrhiza and Senega, and \ grain (0.04) Ipecac in each fluidrachm (4 Cc). AsARi CoMPOSiTUS (Canada Snake Root). — Each fluidrachm (4 Cc.) represents 3^ grains (0.2) of Asarum. Calcii Chlorhydrophosphatis (Chlorhydrophosphate of Lime). — Each fluidrachm (4 Cc.) contains i grain (0.06) of Calcium Phosphate. Calcii et Sodii Hypophosphitum (Hypophosphite of Lime and Soda). — Each fluidrachm (4 Cc.) contains 2 grains (o. 1 3), each, of Hypophosphites of Calcium and Sodium. Calcii Hypophosphitis (Hypophosphite of Lime). — Each fluidrachm (4 Cc.) contains 2 grains (0.13) of Calcium Hypo- phosphite. Calcii Iodidi (Iodide of Calcium). — Each fluidrachm (4 Cc.) contains about 5 grains (0.3) of Calcium Iodide. 62 A TEXT-BOOK OF MATERIA MEDICA. Syrupus — CalcIi Lactophosphatis cum Ferro (Lactophosphate of Lime with Iron).— Each fluidrachm (4 Cc.) contains \ grain (0.03) of Lactate of Iron and about \ grain (0.015) of Calcium Lactate (or about f grain (0.02) of so-called Lacto- phosphate of Calcium). Chondri Compositus (Irish Moss). — Containing i grain (0.06) each of Squill and Senega, -^ grain (0.004) each of Ipecac and Irish Moss, and if minims (o.i) Tincture Opium Camph. to each fluidrachm (4 Cc). CiNNAMOMi (Cinnamon, Ph. Ger.). — Chiefly used for flavoring. Codeine. — Containing \ grain (0.3) Codeine Sulphate in each fluidrachm (4 Cc). The Syrup of the French Codex is about one-fourth this strength. Coffee (Coffee). — Containing 15 grains (i.) of the choicest Coffee (Java and Mocha) in fluidrachm (4 Cc.) ; an elegant vehicle for Quinine and addition to nauseous mixtures. Eriodictyi Aromaticus (Yerba Santa; Syrupus Corrigens). — Chiefly intended as a vehicle for disguising the taste of Quinine and other bitter substances. Ferri Arsenatis. — Each fluidrachm (4 Cc) contains about •^ grain (0.00 1) of Arsenate of Iron (ferric). Ferri Bromidi (U. S. P., '80). — Containing 10 per cent, of Ferrous Bromide. Ferri Citro-iodidi (Tasteless Syrup of Iodide of Iron). — Each fluidrachm (4 Cc.) contains an amount of Iron corre- sponding to about 3.6 grains (0.25) of Ferric Iodide. The official Syrupus Ferri lodidi contains about 8 grains (0.5) of P'errous Iodide (Protiodide of Iron) in each fluidrachm (4 Cc). Ferri et Mangani Iodidi (Iodide of Iron and Manganese). — Each fluidrachm (4 Cc.) contains 6 grains (0.4) of Iodide of Iron (ferrous) and 3 grains (0.2) of Iodide of Manganese. Ferri Hypophosphitis (Hypophosphite of Iron). — Each fluid- drachm (4 Cc.) contains i grain (0.06) of Hypophosphite of Iron (ferric). Ferri Lactophosphatis (Lactophosphate of Iron). — Each fluidrachm (4 Cc.) contains i grain (0.06) of Lactate of Iron, or about i^ grains (o.i) of so-called Lactophosphate of Iron. Ferri Protochloridi (Ferrous Chloride). — Each fluidrachm PHARMACEUTICAL PREPARATIONS. 63 Syrupus — (4 Cc.) contains about i grain (0.06) of Protochloride of Iron. Ferri Saccharati Solubilis (Soluble Saccharated Iron; Saccharated Oxide of Iron, Ph. Ger.). — Each 75 minims (5 Cc.) represents approximately i grain (0.06) of Metallic Iron, or 3 grains (0.2) of Oxide of Iron. Glycyrrhiz^ (Liquorice). — Each fluidrachm (4 Cc.) repre- sents 30 grains (2.) of Glycyrrhiza. Hypophosphitum Compositus. — Each fluidrachrn (4 Cc.) con- tains 2 grains (0.12) of Calcium Hypophosphite, i grain (0.06), each, of the HypOphosphites of Potassium and Sodium, \ grain (0.008), each, of the Hypophosphites of Iron and Manganese, -^ grain (0.004) of Quinine Hydro- chlorate, and i^ minims (0.0 1) of Tincture of Nux Vomica. This Syrup should not be confounded with the official Syrupus Hypo- phosphitum (Syrup of the Hypophosphites: Calcium, Sodium, and Potassium). It is intended to replace a well-known proprietary article, for which it has been found by many physicians to be a satisfactory substitute. It is uniform in com- position and more stable and elegant than the patent article. Ipecacuanha et Opii (Syrup of Dover's Powder). — ^Each fluidrachm (4 Cc.) represents 5 grains (0.3) of Dover's Pow- der, or \ grain (0.03), each, of Ipecac and Opium. Manna (Syrup of Manna, Ph. Ger.). MoRPHiNA Compositus. — A preparation sometimes dispensed as Jackson's Pectoral Syrup, but, as it differs in essential particulars, the N. F. recommends that this preparation be dispensed only when expressly designated under this title. Each fluidrachm (4 Cc.) contains \ grain (0.008) Ipecac, 5 grains (0.3) Senega, i grain (0.06) Rhubarb, and -^ grain (0.002) Morphine, with Oil of Sassafras. MoRPHiNA SuLPHATis (Syrup of Morphine). — Each fluid- drachm (4 Cc.) contains \ grain (0.008) of Sulphate of Morphine. Papaveris (Poppy, Ph. Br. ; Diacodii, Ph. Ger.). — Similar to the preceding, but considerably weaker. Pectoralis (Jackson's Pectoral Syrup). — Each fluidrachm (4 Cc.) contains -^ grain (0.002), each, of Morphine and Oil of Sassafras. Phosphatum Compositus (Chemical Food). — Each fluidrachm (4 Cc.) contains about 2 grains (0.12) of Phosphate of 64 A TEXT- BOOK OF MATERIA MEDIC A. Syrupus — Calcium, i grain (0.06), each, of the Phosphates of Iron and Ammonium, and smaller quantities of the Phosphates of Potassium and Sodium. PiNi Strobi Compositus (White Pine Compound). — A com- bination of White Pine, Wild Cherry, Spikenard, San- guinaria, Chloroform, and Morphine, -^ grain (0.002) in a fluidrachm. Rhamni Cathartics (Buckthorn Berries; Syrupus Spinae Cervinae, Ph. Ger.). RuBi Aromaticus (Blackberry, Aromatic). — A combination of Rubus, Cinnamon, Nutmeg, Cloves, and Allspice. SanguinarijE (Bloodroot). — Each fluidrachm (4 Cc.) repre- sents 13 grains (0.8) of Sanguinaria. Senns Aromaticus (Senna, Aromatic). — Each fluidrachm (4 Cc.) represents 'j\ grains (0.5) of Senna, 3 grains (0.2) of Jalap, and i grain (0.06) of Rhubarb, with aromatics. Senns Compositus (Senna, Compound). — Each fluidrachm (4 Cc.) represents 8 grains (0.5) of Senna, 2 grains (0.12), each, of Rhubarb and Frangula. SoDii Hypophosphitis. — Each fluidrachm (4 Cc.) contains 2 grains (o. 12) of Sodium Hypophosphite. StillingIjE Compositus. — Each fluidrachm (4 Cc.) represents 1 5 minims ( i Cc.) of Compound Fluid Extract of Stillingia. OxYMEL SciLLiE (Oxymel of Squill, Ph. Br.). — ^A preparation of Honey containing about 5 grains (.32 Gm.) of Squill in each fluidrachm (4 Cc). ELIXIRIA— ELIXI RS. Elixirs are a class of elegant preparations similar to wines or cordials, composed of Water, Sugar, Alcohol, and Aromatics. The medicinal substances are usually in such proportion that an ordinary dose may be contained in one or two teaspoonfuls (4 to 8 Cc.) of the elixir. There are but two Elixirs official : Aromatic Elixir, which serves as a vehicle, and one medicinal, Elixir of Phosphorus. Elixir Aromaticum spirit of orange, comp. 12 Cc. mix with alcohol, deodorized, to make 250 Cc. to this solution add in several portions, agitating after each addition syrup 375 Cc. and in the same manner water 375 Cc. PHARMACEUTICAL PREPARATIONS. 65 mix the liquid with precipitated calcium phosphate 15 Gm. and filter, adding . . water 3 ; alcohol i ; to make 1 000 Cc. This illustrates the method by which Elixirs are made. The medicinal ingredients are dissolved in the Water, or Alcohol, as indicated by their solubilities, before mixing the Alcoholic Solution of Oils with the Saccharine Solution. Elixir Phosphori : glyc. 55 ; anise oil 0.2; sp. phosph. 21.Cc. mix by agitation ; then add . aromatic elixir, to 100 Cc. This Elixir contains of phosphorus 25 mg. in 1 00 Cc, or ^ grain (i mg.) in i fluidrachm (4 Cc), the ordinary dose. Some Salts and Fluid Extracts may be dissolved in or mixed with the Elixir itself For example : Potassii Bromidi 10. Elixir Aromatici q. s. ad 100.' Cc. This contains 15 grains (i Gm.) in 2\ fluidrachms (10 Cc), 6 grains in i fluidrachm or teaspoonful. Elixirs of the National Formulary. The value of pleasant vehicles to mask or modify the taste of bitter and nauseous drugs is recognized by every prescriber. The following Elixirs of the National Formulary have been carefully- selected, and embrace the most effective combinations of adjuvants and aromatics for disguising the different drugs for which they are recommended : Elixir — Anisi ; a combination of Anethol, Fennel, and Bitter Almond. CuRASSAO (Curagao Cordial) ; a combination of Curasao, Orris, and a little Citric Acid. Adjuvant Elixirs. — The following are intended as vehicles for Quinine and similar bitter substances, and as adjuvants for Tinctures and Fluid Extracts of bitter and resinous drugs, such as Cinchona, Cascara Sagrada, etc. They all contain Glycyrrhiza, which, in the form directed in the N. F. (Russian Licorice Root, peeled), is most effective in masking the bitter taste of Quinine, when it is directed to be simply suspended in the mixture without the use of acid for effecting solution. Acids precipitate the glycyrrhizin and -destroy its power of masking the bitter taste : Elixir— Adjuvans ; a combination of Orange, Wild Cherry, Glycyr- rhiza, Coriander, and Caraway. Except for the exhibition of Quinine this is the most effective of the adju- vant Elixirs. ' 5 66 A TEXT- BOOK OF MA TERIA MEDIC A. Elixir— Eriodictyi Aromaticum (Arom. Elixir Yerba Santa; Elixir Corrigens). — A solution of Yerba Santa in Comp. Elixir of Taraxacum, intended as a vehicle for Quinine and other bitter remedies. GlycyrrhiZjE (Elixir of Licorice) ; a solution of Licorice in Aromatic Elixir, the most effective vehicle for Quinine. Glycyrrhiz^ Aromaticum ; Elixir of Licorice, with the addi- tion of strong aromatics. Taraxaci Compositum ; an improved form of this well-known compound, useful as a mild adjuvant. Medicinal Elixirs. — These comprise the Elixirs mostly in use ; also, a number of preparations in which the prescriber will find satisfactory substitutes, designated by scientific titles and of definite strength and uniform composition, intended to replace various nostrums. Active Drug in I Fluidrachm, 4. Cc. Elixir — grains. Gm. AciDi Salicylici 5 0.3 Ammonii Bromidi 5 0.3 Ammonii Valerian atis 2 0.12 The odor and taste of the salt being well covered by the addition of vanilla and a little chloroform. Ammonii Valerianatis et Quinine. — The above, with Quinine Hydrochlorate .... \ 0.015 Apii Graveolentis (Celery Compound). — Con- taining Celery, Coca, Kola, and Viburnum, each 4 0.25 BisMUTHi. — Bismuth and Ammonium Citrate . 2 0.12 BucHu 'j\ 0.5 BucHu Compositum. — Buchu, Cubeb, Juniper, and Uva Ursi, combined 15 i. Buchu et Potassii Acetatis. — Elixir Buchu, with Potassium Acetate 5 0.3 Caffeine. — Caffeine (in solution in Hydro- bromic Acid) I 0.06 Calcii Bromidi c 0.3 Calcii Hypophosphitis 2 .12 PHARMACEUTICAL PREPARATIONS. 67 Active Drug in I Fluidrachm. 4 Cc. Elixir Grains. Gm. Calcii Lactophosphatis. — Calcium Lactate (in Phosphoric Acid) i 0.06 Catharticum Compositum. — Each fluidrachm (4 Cc.) contains Senna j\ grains (0.5) ; Podo- phyllum 4 grains (0.25); Leptandra and Jalap, each 3 grains (0.2) ; Rochelle Salts 7\ grains (0.5) ; and Sodium Bicarbonate i grain (0.06). The mixture should be shaken. Chloroformi Compositum. — A mixture of equal parts of Chloroform, Tincture of Opium, Spirit of Camphor, Aromatic Spirit of Ammonia, and Alcohol, flavored with Cin- namon. The old title, " Chloroform Pare- goric," is recommended to be abandoned for the above. Each fluidrachm (4 Cc.) contains I grain (0.06) of Opium and 1 1 minims (0.7) of Chloroform. Cinchona (Elixir Cahsaya). — This preparation is from the best Calisaya Bark, representing about 2 grains (0.12) in each fluidrachm (4 Cc). It is preferable to preparations made from Quinine and the cheaper alkaloids in being a more agreeable and effective anti- periodic tonic. Cinchona et Ferri (Calisaya and Iron ; Fer- rated Elixir of Calisaya). — Phosphate of Iron . 2 0.12 Cinchona et Hypophosphitum. — Calcium and Sodium Hypophosphites, each i 0.06 Cinchona, Ferri, Bismuthi et STRYCHNra^. — Phosphate of Iron 2 0.12 Bismuth and Ammonium Citrate i 0.06 Strychnine Sulphate y^ 0.0007 C1NCH0N.E, Ferri et Bismuthi. — Phosphate of Iron 2 0.12 Bismuth and Ammonium Citrate i 0.06 Cinchona, Ferri et Calcii Lactophosphatis. — Phosphate of Iron ij o.i Calcium Lactophosphate about i 0.06 68 A TEXT-BOOK OF MATERIA MEDICA. Active Drug in I Fluidrachm. 4 Cc. Elixir — Grains. Gvf. "■. CinchonjE, Ferri et Pepsini. — Phosphate of Iron ij 0.1 Pepsin - . . . . I 0.06 Cinchona, Ferri et StrychninjE. — Phosphate of Iron 2 0.12 Sulphate of Strychnine Y^^ 0.0007 CiNCHONiE, Pepsini et Strychnin^e. — Contain- ing smaller quantities of the Cinchona Alka- loids, Pepsin I grain (0.06), and Sulphate of Strychnine Y^ 0.0007 CoCiE (Coca). — Leaves, Erythroxylon Coca . . 7J 0.5 CoCjE et Guaran^. — Coca and Guarana, of each 7^ 0.5 CoRYDALis CoMPOSiTUM. — Containing of Cory- dalis, Stillingia, Iris, and Xanthoxylum, combined IS i- Potassium Iodide 3 0.2 DiGESTivuM CoMPOsiTUM. — Containing about 5 grains (0.3) of Pulvis Digestivus in each fluidrachm (4 Cc). Eucalypti. — Eucalyptus Globulus 7i 0.5 EuoNYMi (Wahoo). — Euonymus Atropurpureus 10 0.6 Ferri Hypophosphitis. — Hypophosphite of Iron (ferric) I 00.6 Ferri Lactatis i 0.06 Ferri Phosphatis. — Phosphate of Iron (U. S. P.) 2 o. 1 2 Ferri Phosphatis, Cinchonidin^ et Strych- nine. — Phosphate of Iron 2 O.I 2 . Cinchonidine \ 0.03 Sulphate of Strychnine Ysir 0.0007 Ferri Phosphatis, Quinine et Strychnin^e. — Phosphate of Iron, i grain (0.06) ; Qui- nine ._ \ 0.03 Sulphate of Strychnine -^ O.OOI Ferri Pyrophosphatis 2 0.12 Ferri, QumiNiE et Strychnine. — Ferric Chlo- ride, I grain (0.06) ; Quinine Hydrochlorate \ O.03 Sulphate of Strychnine j^ 0.0007 Frangule (Buckthorn). — Rhamnus Frangula . 15 i. PHARMACEUTICAL PREPARATIONS. 69 Active Drug in I Fluidrachm. 4 Cc. Elixir — Grains. Gm. Gentians 2 0.12 Gentians cum Tincture Ferri Chloridi. — Tincture Citro-chloride of Iron 5 0.3 Gentian^e et Ferri Phosphatis (ferrophos- phated). — Phosphate of Iron i 0.06 GRiNDELi-ffi. — Grindeha Robusta 4 0.25 GuARAN^. — Paullinia Cupana 12 0.75 HUMULI 72 O-S Hypophosphitum. — Calcium Hypophosphite . 3 0.2 Sodium and Potassium Hypophosphites, each i 0.06 Hypophosphitum cum Ferro. — Calcium and Sodium Hypophosphite, each i 0.06 Potassium and Iron Hypophosphites, each . \ 0,03 LiTHii Bromidi 5 0.3 LiTHii Citratis 5 0.3 LiTHii Salicylatis 4 5 0.3 Malti et Ferri. — Phosphate of Iron .... i 0.06 Mah Extract 15 i. Paraldehydi. — Paraldehyde 15 i. Pepsini. — Pepsin ■ . . . i 0.06 Pepsini, Bismuthi et Strychnine. — Elixir Pep- sin and Bismuth, and Strychnine .... y^ 0.0007 Pepsini et Bismuthi. — Pepsin i 0.06 Bismuth and Ammonium Citrate 2 o. 1 2 Pepsini et Ferri. — Elixir of Pepsin and Tinc- ture Citro-chloride of Iron 5. 0.3 Phosphori et Nucis Vomica. — Elixir Phos- phorus, with Tincture Nux Vomica .... 2 0.12 Picis CoMPOSiTUM. — A combination of Prunus Virginiana, Tolu, Methylic Alcohol, and Sul- phate of Morphine ^ 0.0015 Pilocarpi (Jaborandi). — Pilocarpus Selloanus . 4 o!2S Potassii Acetatis 5 0.3 PoTAssii Acetatis et Juniperi. — Elixir Potass. Acet. with Juniper 73 0.5 Potassii Bromidi. — Potassium Bromide, effect- ually masked in Adjuvant Elixir .... 10 0.6 An Elixir half this strength has also been used. 70 A TEXT-BOOK OF MATERIA MEDICA. Active Drug in I Fluidrachm. 4 Cc. Elixir — Grains. Gm. Quinine Compositum (Red). — Sulphates of Quinine, \ grain (0.008), Cinchonidine and Cinchonine, each YB" 0-004 Chiefly intended as a substitue for EUxir Cinchona when the administration of other constituents of the bark may be deemed ob- jectionable. • Quinine et Phosphatum Compositum. — Qui- nine Sulphate . . . . \ 0.015 Phosphate of Iron i 0.06 Calcium Lactophosphate f 0.05 Quinine Valerianatis et Strychnine. — Va- lerianate of Quinine i 0.06 Sulphate of Strychnine Y^ 0.0007 Rhamni Purshiane (Cascara Sagrada). — Rham- nus Purshiana, its bitterness effectually masked with Elixirs of Glycyrrhiza and Taraxacum Compound IS i. Rhamni Purshiane Compositum (Laxative EHxir; Elixir Purgans). — Cascara Sagrada . 7 J 0.5 Senna and Juglans, each 5 0.3 Associated with aromatics and correctives ; a most effective laxative in doses of from i to 2 fluidrachms (4-8 Cc). Rhei. — Sweet Tincture of Rhubarb, represent- ing Rhubarb 2j 0.15 Rhei et Magnesia Acetatis. — Magnesium Acetate, 4 grains (0.25) ; Rhubarb 7i 0-5 Rubi Compositum (Blackberry Compound). — Blackberry Root, Galls, and Cinnamon (Sai- gon), in equal proportions, combined .... 10 0.6 with smaller quantities of Cloves, Mace, and Ginger, in Blackberry Juice and Syrup. SoDii Bromidi. — Sodium Bromide, in Adjuvant Elixir 10 0.6 SoDii Hypophosphitum 2 0.12 SoDii Salicylatis (to be freshly prepared when required for use) 5 0.3 PHARMACEUTICAL PREPARATIONS. Jl Active Drug in J Fluidrachm. 4 Cc. Elixir— Grains. Gm. Stillingi^ Compositum. — Compound Fluid Extract of Stillingia, N. F 15 i . Strychnine Valerianatis -^ 0.0007 Turners (Damiana). — Turnera Aphrodisiaca .10 0.6 ViBURNi Opuli Compositum. — Viburnum Opu- lus, Aletris Farinosa, each 5 0.3 Trillium (Beth Root) 10 0.6 ViBURNi Prunifolii (Bkck Haw) 7i 0.5 . ZiNCi Valerianatis. — Zinc Valerianate . . i 0.06 CoRDiALE RuBi Fructus (Blackberry Cordial). — An aromatic Syrup of Blackberry Juice, used as a mild astringent in bowel complaints. Succus Limonis cum Pepsino (Lime Juice and Pepsin). — Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Pepsin. GLYCERITA— GLYCERITES. The Glycerites, or " Glyceroles," are solutions of substances in Glycerin. They are made either by direct solution, by heat, or by extrac- tion of a drug, as in Hydrastis ; one is made by chemical reaction — i. e. Boroglycerin. There are six official, comprising those used externally either alone or as additions to washes, gargles, injections, etc. : Percentage Qlyceritum — by weight. Acidi Carbolici acid, carbolic 20. Acidi Tannici acid, tannic 20. Boroglycerini boroglyceride 50. Hydrastis representing hydrastis 100. The following are used chiefly as pharmacal agents ; the Gly- cerite of Starch as an excipient for Pill-masses ; and the Glycerite of Egg-yolk as an emulsifying agent : Glyceritum — Amyli .... water 10, starch 10. Vitelli fresh egg-yolk 45. The Glycerite of Starch is sometimes used externally, and is 72 A TEXT-BOOK OF MATERIA MEDIC A. known as Glycerin Ointment, also as " plasma." The Glycerite of Egg-yolk, also known as " glyconin," has been used as an applica- tion to sore nipples. Unofficial Glycerites of the National Formulary. Glyceritum — Pepsini (Glycerole of Pepsin).— Each 4 Cc. (fluidrachm) repre- sents 0.3 (5 grains) of Pepsin. Picis Liquids (Tar). — Containing about 0.3 (5 grains) of Tar. Tragacanth^. — Containing about 1 2 per cent, of tragacanth. MUCILAGINES— MUCILAGES. The Mucilages are prepared by extracting a mucilaginous drug with Water or dissolving a Gum in Water. The following four are official : Gm. in lOo Cc.^ Mucilago — or percentage. Acaciae gum arable 34. Sassafras MeduUae sassafras pith 2. Tragacanthse glycerin 1 8 ; tragacanth 6. Ulmi slippery-elm bark 6. The Mucilages are chiefly employed as vehicles in Mixtures to aid in suspending insoluble substances ; as excipients in Pills and Troches ; and as emulsifying agents. They are sometimes used for their denlulcent effect. THE LIQUID MIXTURES— INTERNAL. MISTUR^— MIXTURES. The official Mixtures are liquid preparations, for internal use, pf medicinal substances dissolved or suspended in Water containing sugar, gum, or glycerin. They should be prepared extemporane- ously. The term Mixture is also applied to any combination of substances that cannot be otherwise classified. There are four official mixtures : Mistura — Gms. in 100 Cc. Cretse (Chalk Mixture) .... comp. chalk powder 20. cinnamon water 40 ; water, to 100. Ferri Comp. (Griffith's Mixt.) . . . myrrh, sugar, each 1.8 potass, carb. 0.8 triturate with gradual addition of rose water 70. ferrous sulphate, 0.6 ; spin lavend., 6 ; rose water, to 100. .THE LIQUID MIXTURES— INTERNAL. 73 Mistura — Gms. in 100 Cc. Glycyrrhizse Comp pure extract glycyrrhiza 3.0 (Brown Mixture) Spirit ether nitrous 3 wine antimony 6, tinct. opium, camph. 12 syrup 5 ; mucilage acacia 10; water, to 100. Rhei et Sodae sodium bicarbonate 3.5 fl. exts. ipecac 0.3, rhubarb 1.5 spirit peppermint 3.5 ; glycerin 35. ; water, to 100, Unofficial Mixtures of the National Formulary. Mistura — AcacIjE — (Mistura Gummosa, Ph. Ger.). — Acacia, pulv., Sugar, in Water. Should be freshly made when wanted for use. Adstringens et Escharotica (Villate's Solution). — Solu- tion of Lead Subacet. i^ fluidounces (45.) ; Sulphates of Copper, Zinc, each, i troy ounce (30.) ; Acetic Acid 1 3 fluid- ounces (360 Cc). Ammonii Chloridi (Mistura Solvens Simplex). — Ammonium Chloride, Purif. Ext. Glycyrrhiza, each 180 grains (12.), in Water 16 fluidounces (450 Cc). Mistura (or Mixturd) Solvens Stibiata is prepared by dis- solving 0.3 Antimony and Potassium Tartrate in 1000 Cc. of Mistura Ammonii Chloridi. Camphors Acida (Mistura Antidysenterica ; Hope's Mix- ture). — Nitric Acid 120 mins. (8 Cc); Tinct. Opium 80 mins. (5 Cc.) ; in Camphor Water 16 fluidounces (450 Cc). Camphors Aromatica (Parrish's Camphor Mixture). — Tinct. Lavender Comp. 4 fluidounces (120 Cc); Sugar 240 grains (15.); in Camphor Water 16 fluidounces (450 Cc). Carminativa (Dalby's Carminative). — Magnes. Carb. i troy ounce (30.); Potass. Carb. 20 grains (1.3); Tinct. Opium 180 mins. (12 Cc); Oils of Caraway, Fennel, Peppermint, each, 4 drops (o.i); Syrup 2\ fluidounces (75 Cc); in 16 fluidounces (450 Cc). Each fluidounce (30 Cc.) represents about I grain of Opium (0.06). Chloral et Potassii Brqmidi Composita (Mixture of Chloral and Bromide). — Each fluidrachm (4 Cc.) contains 15 grains (i.), each, of Chloral and Potassium Bromide, 74 A TEXT-BOOK OF MATERIA MEDICA. Mistura — and \ grain (0.008), each, of Exts. Indian Cannabis and Hyoscyamus. Chloroformi et Cannabis Indice Composita (Chloroform 'Anodyne). — Each fluidrachm (4 Cc.) represents 7 J minims (0.5 Cc), each, of Chloroform and Tinct. Indian Cannabis; 3f minims (0.25 Cc.) Tinct. Capsicum; and about \ grain (0.0 1 ) of Morphine Sulph. Contra Diarrhceam (Cholera Mixture). — Tinctures of Opium, Capsicum, Rhubarb, and Spirits of Camphor and Pepper- mint, each, equal volumes. The above formula appears to be that in most general use, also known under the name of " Sun Mixture." Of other similar preparations in more or less general use, the following may be mentioned here : 2. Loomis' Diarrhea Mixture. — Tincture Opium, \ fluid- ounce (15 Cc.) ; Tincture Rhubarb, 5 fluidounce (15 Cc); Tincture Catechu Comp., i fluidounce (30 Cc.) ; Oil of Sas- safras, 20 minims (1.3 Cc.) ; Tincture Lavender Comp., to make 4 fluidounces (120 Cc). 3. Squibb's Diarrhea Mixture: — Tincture Opium, i fluid- ounce (30 Cc) ; Tincture Capsicum, i fluidounce (30 Cc.) ; Spirit of Camphor, i fluidounce (30 Cc.) ; Purif. Chloroform, 180 minims (12 Cc.) ; Alcohol, enough to make 5 fluidounces (150 Cc). 4. Thielemann' s Mixture (Mixt. Thielemanni, Ph. Suec). — Wine Opium, i fluidounce (30 Cc.) ; Tinct. Valerian, \\ fluidounces (45 Cc); Ether, \ fluidounce (15 Cc.) ; Oil Peppermint, 60 minims (4 Cc.) ; Fl. Ex. Ipecac, 1 5 minims (i Cc); Alcohol, to make 4 fluidounces (120 Cc). 5. Velpeau's Diarrhea Mixture. — Tincture Opium, Tinc- ture Catechu Comp., Spirit Camphor, of each, equal volumes. Copaiba Composita — 1. Lafayette Mixture. — Copaiba, 2 fluidounces (60 Cc); Tinct. Lavender Comp., 2 fluidounces (60 Cc.) ; Solution Potassa, \ fluidounce (15 Cc.) ; Spirit Nitr. Ether, 2 fluid- ounces (60 Cc.) ; Syrup, 5 fluidounces (150 Cc); Mucilage Dextrin, to make 16 fluidounces (450 Cc). This mixture should be well agitated when used. Each fluidrachm con- tains 'j\ minims of Copaiba. 2. Chapman's Mixture. — Copaiba, 4 fluidounces (125 Cc.) ; THE LIQUID MIXTURES— INTERNAL. 75 Mistura — Tinct. Lav. Comp., 240 minims (15.5 Cc); Tincture Opium, 240 minims (15.5 Cc); Spirit Nitro. Ether, 4 fluidounces (125 Cc); Mucilage Acacia, i J fluidounces (45 Cc); Water, to make 16 fluidounces (450 Cc). ExPECTORANs, Stokes (Stokes' Expectorant). — Ammonium Carb., 120 grains (8.); Fl. Ext. Senega, \ fluidounce (15 Cc); Fl. Ext. Squill, \ fluidounce (15 Cc.) ; Tinct. Opium, Camph., 2.\ fluidounces (80 Cc); Water, \\ fluidounces (45 Cc.) ; Syrup Tolu, to make 16 fluidounces (450 Cc). GuAiACi (Guaiac Mixture, Ph. Br.). — Resin Guaiac, ^ugar, each, 190 grains (12.5); Acacia Powder, 100 grains (7.); Cinna- mon Water, 16 fluidounces (450 Cc). To be well agitated when used. Magnesia et Asafcetid^e (U. S. P. 1880.). — Dewees' Carmina- tive. — Magnesium Carbonate, 90 grains (6.0) ; Tinct. Asa- fcetida, 2 fluidrachms (8 Cc.) ; Tinct. Opium, 20 minims (1.2 Cc); Sugar, 180 grains (12.0); Water, to make 4 fluid- ounces (120 Cc). Olei Balsamica (Balsamum Vitae Hoffmanni, Ph. Ger.). — A solution of Oils of Lavender, Thyme, Lemon, Mace, Orange-flowers, Cloves, Cinnamon, and Balsam Peru in Alcohol. Olei Picis (Tar Mixture). — A mixture of Oil of Tar, \ fluid- ounce (15 Cc.) ; Chloroform, 75 minims (5 Cc.) ; Oil of Pep- permint, 20 minims (1.3 Cc), in Elixir, to make 16 fluid- ounces (450 Cc). Rhei Composita (Squibb's Rhubarb Mixture). — Fl. Ext. Rhubarb, 120 minims (6. Cc); Fl. Ext. Ipecac, 16 minims (i. Cc.) ; Sodium Bicarb., 330 grains (11.) ; Glycerin, 6 fluid- ounces (240.), in Peppermint Water, 16 fluidounces (450 Cc). Sassafras et Opii (Mist. Opii Alkalina ; Godfrey's Cordial). — A mixture of Oil of Sassafras, Tincture of Opium, and Potass. Carb. in Molasses, Alcohol, and Water. Each fluidrachm (4 Cc.) contains 2 minims (0.12) Tinct. Opium, correspond- ing to \ grain (o.oi) Opium. SoDjE et MentHjE (Soda Mint). — Sodium Bicarb., 320 grains (20.) ; Spirit Amrnonia Arom., 4 Cc. (60 minims) ; Spear- mint Water, 16 fluidounces (450 Cc). Sflenetica (Spleen Mixture; Gadberry's Mixture). — Iron Sulphate, Quinine Sulphate, Nitric Acid, each, 100 grains 76 A TEXT-BOOK OF MATERIA MEDICA. Mistura — (7.); Potassium Nitrate, 300 grains (20.), in Water, 16 fluid- ounces (450 Cc). SuLPHURiCA AciDA (Haller's Acid Elixir, Ph. Ger.). — Sul- phuric Acid, I part ; Alcohol, to make 4 parts, by weight. EMULSA— EMULSIONS. Emulsions are liquid preparations consisting of oily, fatty, resin- ous, or otherwise insoluble substances suspended in watery liquids by the intervention of gum, mucilage, or other viscid matter. For the internal administration of Oils it is often necessary to exhibit them in a palatable form, so that they may be borne by the stomach and their assimilation favored. This is usually effected by suspending the oil in a watery liquid or mixture by means of an emulsifying agent, such as acacia, etc. Many natural substances are intimate mixtures of oils or fats with water, in the form of an emulsion. Of animal products. Milk is a most perfect emulsion ; so is Egg-yolk. From the Milk-juice of some plants the water evaporates and the dried milk-juice col- lects in the seeds, as in almonds and other nuts, or exudes from other portions of the plant when the parts are wounded ; in this way the gum-resins of asafoetida, etc. are produced. From these substances Emulsions may be obtained by restoring the water lost by evaporation — that is, by rubbing them with water in a mortar. In this way the so-called natural Emulsions are made. Artificial Emulsions. These are made by mixing the Oil with a certain proportion of the emulsifying agent, adding Water, and triturating the mixture in a mortar or agitating it in a flask. There are various methods, but these are general rules : The emulsification of the oil should be complete before the mixture is made up to the required measure. When alcoholic liquids are to be added, they should first be diluted as much as possible. Salts should be dissolved before being added. No heat should be employed, as the oil separates when an emulsion is heated. Emulsions should he freshly prepared and be preserved in a co/a' place. The most common emulsifying agent is Powdered Gum Acacia (Acacia pulv.). The Oil is thoroughly mixed by trituration in a mortar with one-fourth its weight of powdered Acacia. To this one and a half times as much water as of gum is added at once, and the mixture is rapidly triturated with a rotary motion of the pestle THE LIQUID MIXTURES— INTERNAL. 77 until it becomes stiff and assumes a milk-white color. This so- called " mother-emulsion " may now be diluted to the required measure, and other substances, flavors, etc. be added. Powdered Tragacanth may be used in the same way or in the form of mucilage, but it does not produce so permanent emulsions as does gum acacia. Mucilage of Acacia or of Irish Moss is not so satisfactory as powdered gum : while it produces a good emulsion, the division of the oil-globules is not so thorough as in the preceding : emulsifica- tion being incomplete, the mixture more rapidly separates into a heavier, watery liquid and a lighter, thick, gelatinous emulsion, which requires thorough mixing before use. Extract of malt is an excellent emulsifying agent when its use is admissible. The Oil should be added to the Malt Extract contained in a capacious mortar, and incorporated in small quantities at a time. A good article will emulsify an equal volume of cod- liver oil. Condensed Milk and Egg-yolk produce the most perfect emulsions, and also the most palatable, but they rapidly ferment and spoil. Glycerin and sugar added to emulsions for the purpose of preservation and palata- bility induce separation, and their use is not advisable. Emulsification " by intervention " is the best and only reliable method to be employed with Ethereal Oils and all substances of themselves not emulsifiable. The process is illustrated in the official Chloroform Emulsion. Oil of Turpentine, for example, is emulsified by dissolving the Turpentine Oil in twice its volume of a bland fixed oil (Almond Oil), incorporating an equal weight of powdered Acacia, adding Water, and proceeding as with an ordinary emulsion. Pancreatin emulsionizes fats in preparing them for digestion, but it does not produce a permanent emulsion when used artificially. While, therefore, not a reliable emulsifying agent, it aids the assimilation of oils, and its addition to emulsions is sometimes therapeu- tically desirable. As it is only active in alkaline media, the Emulsion should be prepared with a little Sodium Bicarbonate. The addition of Alkalies to emulsions should be avoided. Soaps are not Emulsions, nor is the use of Soap-bark to be recommended. Of the four official Emulsions three are natural emulsions ; one is artificial : Gm. in loo Cc, Emulsum — or percentage by vol. Ammoniaci ammoniac 4 Amygdalae sweet almond 6. sugar 3 ; acacia i Asafoetida asafoetida, in select tears 6, Chloroformi .... tragacanth powd. 1.5 ; chloroform 4, expressed oil almond 6 ; water, to 100. 78 A TEXT-BOOK OF MATERIA MEDIC A. Shake the Chloroform and Tragacanth together in a dry bottle, incorporate 25 Cc. Water, then the Almond Oil in small quantities, and finally in the same way add the remainder of the Water. Unofficial Emulsions of the National Formulary. Emulsions should, of all pharmaceuticals, be prepared within a reasonable period previous to the time of dispensing. A true emulsion should contain the oil simply suspended in the form of a mechanical mixture, which, from its very character, cannot with- stand the effects of variation in temperature any better than a natural emulsion, such as milk or emulsions of almonds, gum- resins, etc., and consequently quickly degenerates or spoils. An emulsion may be perfect — that is, the oil-globules entirely extinguished — yet a separation similar to that occurring in milk will take place, which, though in its first stage not so objection- able, will eventually impair the medicinal value of the preparation. These reasons are, it is believed, sufficient to condemn the various " ready-made " or patent emulsions, and to justify the physician in prescribing such as are kept on hand by the pharmacist, in smaller quantities, prepared according to these formulas. A typical formula for emulsions, with Acacia, is — '&!„ Olei Morrhuse 120 Cc, siv; Acaciae pulv 30 Gm., |j ; Aquae q. s. ad 240 Cc, Iviij. Emulsify by trituration in a mortar, and add the flavoring. The following are flavors employed: (i) Gaultheria, (2) gaul- theria and sassafras, (3) aromatic spirit, (4) gaultheria, bitter almond, and coriander, (5) gaultheria, sassafras, and bitter almond, (6) gaul- theria and bitter almond, (7) oil of neroli, bitter almond, and cloves. Unless otherwise specified, that designated as No. 5 may be em- ployed in these Emulsions. The following formulas may be useful as indicating the form of prescription for any combination desired. Hypophosphite Salts or any medication desired may usually be dissolved in the water directed in the formula, should a preparation be indicated different from any of the following emulsions of the N. F. : Emulsio — Olei Morrhu^ cum Calcii et Sodii Phosphatibus. — Cal- cium Phosphate, Sodium Phosphate, of each, i grain in i fluidrachm (0.06 in 4 Cc). EXTRACTIVE PREPARATIONS. 79 Olei MoRRHUiE CUM Calcii Lactophosphate. — Calcium Lactophosphate, 3 grains in i fluidrachm (0.2 in 4 Cc). Olei Morrhu^ cum Calcii Phosphate. — Calcium Phos- phate, 2 grains in i. fluidrachm (0.12 in 4 Cc). Olei Morrhu^ cum Extracto Malti. — Contains 40 per cent. Extract of Malt. Olei Morrhu^ cum HypophosphitE. — The Hypophosphite Salt or any combination of the following : Calcium, Po- tassium, Sodium, or Iron, to be directed by the prescriber, 8 grains to the fluidounce (0.5 in 30 Cc). Olei Morrhu^ cum Pruno Virginiana. — Wild Cherry (Fluid Ext), \ fluidrachm to i fluidounce (2 Cc. in 30 Cc). Olei Ricini. — i fluidounce (30 Cc.) contains 2\ fluidrachms (10 Cc.) Castor Oil, disguised by the addition of Vanilla. Olei TEREBiNTHiNiE. — Contains i fluidrachm (4 Cc.) Oil of Turpentine i fluidounce (in 30 Cc), prepared according to the following formula: I|i. Olei Terebinthinse 3iv, 12.5 Cc; Acacise pulv gr. xxx, 2.0 Vitelli Ovi (Egg-yolk) ; Elixir Aromaticae .... ana giv, i S Cc. ; Aquae Cinnamomi . . q. s. ad Siv, 100 Cc. . Make an emulsion by trituration in a mortar. Phosphatica (Phosphatic Emulsion). — Prepared with Glycerite of Egg-yolk, and contains in i fluidounce (30 Cc.) Cod Liver Oil, 2 fluidrachms (8 Cc.) ; Dilute Phosphoric Acid, 22^ minims (1.5 Cc); Jamaica Rum, flavored with Bitter Almond and Orange Flower Water. EXTRACTIVE PREPARATIONS. The active medicinal constituents, or principles, of crude drugs are obtained by extraction. Extraction is effected either by macera- tion, expression, and filtration or straining, or by maceration with heat, when it is called digestion, or by percolation. The liquid employed, termed menstruum (pi. menstrua), may be Water or Al- cohol, or Alcohol and Water in various proportions, sometimes with Glycerin. A few drugs require alkaline menstrua, some acid menstrua, while the oleoresins are made with Ether. 8o A TEXT-BOOK OF MA TERIA MEDIC A. The Infusions and Decoctions are the simplest preparations made by extraction, and represent most nearly all the soluble constitu- ents of the drugs. But not all drugs are adapted to this method of extraction nor to this exceedingly effective, though not espe- cially elegant, form of exhibition. The most generally convenient and effective class of extractive preparations are the Tinctures. They are the simplest form of alco- holic preparations, and the other more concentrated preparations are usually first obtained as tinctures and then concentrated by evaporation, so as to yield the fluid extract, extract, or resin respectively. The only accurate method for determining the doses of extrac- tive preparations is to compare their drug-strength. Thus, the doses of the respective preparations of Nux Vomica, based upon their relative drug-strength, would be as follows : Average Dose of Drug. of Preparation. Tincture . . .20%, i in 5, 3 grains (0.2)= 15 minims (i. Cc). Fluid Extract 100^, i in i, 3 grains (0.2)= 3 minims (0.2 Cc). Extract . . . 1000%, 10 in i, 3 grains (0.2)=^ grain (0.02 Gm.). In the same way the doses of the preparations of Opium may be presented : Average Dose of Drug. of Preparation. Tincture of Opium . 10%, i grain (0.06) = 10 minims (0.6 Cc). " " deod. 10%, I grain (0.06) = 10 minims (0.6 Cc). Vinegar of Opium . 10%, i grain (0.06) = 10 minims (0.6 Cc). Wine of Opium . . 10%, I grain (0.06) -- 10 minims (0.6 Cc). Extract of Opium . 150%, i grain (0.06) = f grain (0.04). While the preparations of these two drugs are standardized according to their alkaloid percentage strength in the U. S. P., such strength is not as available for computing or estimating doses as is the drug-strength. The determination of alkaloidal percentage in preparations is a check upon their preparation, but is not of so much importance to the physician as it is that the preparations be made by a skilful and conscientious pharmacist, from the very best quality of material, in a thorough manner. EXTRACTIVE PREPARATIONS. 8 1 INFUSA— INFUSIONS. Unless otherwise directed, Infusions are prepared by the general official process : Of the Drug, coarsely comminuted 5 Gm. Boiling Water 100 Cc. Pour the boiling Water on the Drug in a suitable vessel, provided with a cover, and let it stand for half an hour ; strain, and add enough Water through the strainer to make 100 Cc. Caution. — The strength of Infusions of powerful drugs — e. g. Ipecac — should be especially prescribed. The following Infusions are official, being prepared of different strengths and by other processes than directed in the general formula: Gm, in 100 Cc. Infusum Digitalis . alcohol, 10; cinnamon water, 15; digitalis 1.5 Infusum Sennae Comp. (Black Draught) . . fennel 2 ; senna 6. manna, magnesium sulph., of each 12. Drugs whose active principles are volatile or changed by heat are prepared by percolation without heat, or cold Infusion : Gm. in 100 Cc. Infusum Cinchonae .... acid arom. sulph. i ; cinchona 6. Infusum Pruni Virginianse wild cherry 4. Unofficial Infusions of the National Formulary. Infusum — Bravery (U. S. P. 1880). — Brayera (Cusso), 6 ; Boiling Water, 100 Cc. To be dispensed without straining the mixture. Gentians Compositum Fortius. — For preparing Infusum Gentianae Compositum by mixing i volume with 3 volumes of water. Ros^ Compositum (Compound Infusion of Rose, Ph. Br.). — An infusion of Red Rose in diluted Sulphuric Acid, Sugar, and Water. The Species (Teas) are mixtures of drugs contused or bruised for the preparation of Cataplasms; or Infusions and Decoctions, sometimes designated as Haustus (Draught). The following are in the National Formulary : Species — Emollientes (Emollient Cataplasm, Ph. Ger.). — A mixture of Althaea Leaves, Mallow Leaves, Melilot Tops, Matricaria, and Flaxseed, equal parts of each. 82 A TEXT-BOOK OF MATERIA MEDICA. Species — Laxantes (St. Germain Tea, Ph. Ger.). — A mixture of Senna, Elder-flowers, Fennel, Anise, and Potassium Bitartrate. Pectorales (Breast Tea, Ph. Ger.). — A mixture of Althaea, Coltsfoot, Glycyrrhiza, Anise, Mullein Flowers, and Orris Root. Infusum Pectorale (Pectoral Infusion, or Infusion of Pec- toral Species) is made by infusing i troy ounce (30 Gm.) of the above in the usual manner, so as to obtain 10 fluid- ounces (300 Cc.) of strained product. DECOCTA— DECOCTIONS. Unless otherwise directed. Decoctions are prepared according to the following general process : Of the Drug, coarsely comminuted 5 Gm. Boiling water, to make 100 Cc. Pour the boiling Water on the Drug, contained in a suitable vessel provided with a cover, bring it to a boil, and let it boil for fifteen minutes; let it cool to 40° C. (104° F.), express, strain, and add cold Water through the strainer to make ICK) Cc. Caution as with Infusions. The following Decoctions are official, as being made of strengths and methods other than those directed in the general process : Gm. in too Cc. Decoctum Centrariae Iceland moss 5. Decoctum Sarsaparillae Comp. mezereum i ; sarsaparilla 10. glycyrrhiza, sassafras, guaiac wood, of each 2. Decoctum Aloes Compositum, N. F., is a mixture of Ext. Aloes, Myrrh, Saffron, Potass. Carb., Ext. Glycyrrh, Tinct. Cardamom Comp., and Water. — Extempore. ACETA— VINEGARS. The Vinegars are made by extraction with Dilute Acetic Acid. By maceration : Gm. in 100 Cc. Acetum Opii (Black Drop) . sugar 20; nutmeg 3 ; opium 10. Scillse squill 10. The Vinegars of Lobelia and Sanguinaria (U. S. P. 1880) were of the same strength. VINA— WINES. The Wines are made by solution, by maceration, or by macera- tion and percolation. The Menstruum is White Wine, to which from EXTRACTIVE PREPARATIONS. 83 10 to 15 per cent, of Alcohol is added to aid in the extraction and the preservation. There are ten Wines official. The Natural Wines : Vinum Album and Vinum Rubrum are treated under Alcohol. Vinum — Gm. in 100 Cc. Antimonii . . . antimony, potass, tart. (sol. water) 0.4 Colchici Radicis colchicum root 40. Colchici Seminis colchicum seed 15. Ergotse ergot 15. Ferri Amarum . . soluble iron and quinine citrate 5. (Bitter Wine of Iron) tinct. orange peel 1 5 ; syrup 30. Ferri Citratis .... iron and ammonium citrate 4. syrup 10; tinct. orange peel 15. Ipecacuanhae alcohol 10 ; fl. ext. ipecac 10. Opii cinnamon, cloves, each, I ; opium 10. The Dose of the Vinegar and Wine of Opium is the same, 10 minims (0.6) representing i grain (0.06) opii pulvis. The dose of the Wine of Colchicum Root is 10 minims (0.6), it being nearly three times the strength of the Wine of Colchicum Seed, of which the dose is 30 minims (2 Cc). Unofficial Wines of the National Formulary. The Wines, with a few exceptions, are prepared with White Wine (Vinum album., U. S.), usually with the addition of 10 per cent, of Alcohol, in order better to preserve the preparation. Vinum — Aloes (U. S. P. 1880). — Representing 6 per cent, of Aloes with Aromatics. AuRANTii. — Sherry Wine flavored with Orange. AuRANTii CoMPOSiTUM (EHxir Aurantiorum Compositum). — A combination of Bitter Orange Peel, Absinthium, Menyanthes, Cascarilla, Cinnamon, and Gentian, in Sherry Wine. Useful as a stomachic tonic in doses of i fluidrachm (4 Cc). Carnis (Beef and Wine). — Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Extract of Beef. The Extract of Beef in this and similar preparations is that which is pre- pared by Liebig's method. Carnis et Ferri (Beef, Wine, and Iron). — Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Extract of Beef and 2 minims (0.12) Tincture of Citro-chloride ("Tasteless" Tincture) of Iron. 84 A TEXT-BOOK OF MATERIA MEDIC A. Vinum — Carnis, Ferri et Cinchona (Beef, Wine, Iron, and Cinchona). —Each fluidrachm(4 Cc.) represents 2 grains (0.12) Extract of Beef, 2 minims (0.2) Tincture Citro-chloride of Iron, and small quantities of Cinchona alkaloids, in Angelica Wine. Coc^ (Erythroxyli).— Each fluidounce (30 Cc.) represents 30 grains (2 Gm.) of Coca in Claret Wine. Coc^ Aromaticum. — Each fluidounce (30 Cc.) represents 30 grains (2 Gm.) of Coca with Aromatics. Fraxini Americans (White Ash). — Each fluidrachm (4 Cc.) represents 30 grains (2 Gm.) of Fraxinus (bark). Pepsini (Pepsin). — Each fluidrachm (4 Cc.) represents i grain (0.06) of Pepsin. Picis (Tar). — A saturated solution of Tar, in Sherry Wine. Pruni Virginians (Wild Cherry). — Each fluidrachm (4 Cc.) represents 15 grains (i Gm.) of Wild Cherry, in Angelica Wine. Pruni Virginians Ferratum (Wild Cherry, Ferrated). — Each fluidrachm (4 Cc.) represents 5 minims (0.3 Cc.) of Tincture of Citro-chloride of Iron and 13! grains (0.9 Gm.) of Wild Cherry, in Angelica Wine. Rhei (U. S. p. 1880). — Representing 10 per cent, of Rhubarb and I per cent, of Calamus. TINCTUR.(E— TINCTURES. Tinctures are liquid preparations made by the extraction of Drugs with menstrua of Alcohol and Water in various propor- tions. They are prepared by maceration and filtration ; also by percolation : By maceration and filtration, those containing resins and oleo- resins. Musk, and tinctures of fresh herbs ; in a few instances with heat, the Tincture of Quillaja and Tincture of Strophanthus. 'Qy percolation, when prepared from dried vegetable drugs — i. e. barks, leaves, roots, etc., usually after brief maceration. By solution, mixing a solution (chloride of iron) or dissolving a solid in Alcohol (Iodine, Ext. Nux Vomica). Assayed Tinctures. — Two of the most important Tinctures are required to be of certain specified alkaloidal strengths, and their classification according to their respective drug-strengths is there- fore only approximately correct. Tinctura Opii is made so as to represent from 1.3 to 1.5 per EXTRACTIVE PREPARATIONS. 85 cent, of crystallized morphine, the proportion obtained from 10 per cent, of Opii Pulvis, U. S. Tinctura Nucis Vomicce is made by solution of 2 per cent, of the official Extract, representing about ten times its weight of the drug ; the Tincture therefore represents 20 per cent, of the drug, and con- tains 0.3 per cent, total alkaloids. TincturaB Herbarum Recentium, — Tinctures of Fresh Herbs, or " Green Tinctures," similar to the Homoeopathic or so-called " German Tinctures," also to the specific tinctures of the Eclectics, when not otherwise directed are to be prepared by the following general formula: Take of the fresh herb, bruised or crushed, 50 Gin. ; macerate for fourteen days in Alcohol 100 Cc. ; express the liquid and filter. Tinctures of the U. S. P. Name. Tinctura — Aconiti Aloes . Aloes et Myrrhse . Arnicas Florum Arnicae Radicis . . Asafoetidae .... Aurantii Amarse . . Aurantii Dulcis . Belladonnae Foliorum Benzoini .... Benzoini Composita (Turlington's Bal- sam). Bryoniae ... Calendulas . . Calumbae . . . , Cannabis Indicse . Canlharidis . . . Capsici Cardamomi . . , Cardamom! Composita } Gm. Drug. in 100 Cc. ■ Root 35 f Aloes .... lo ■ I Licorice .... 10 /■Aloes 10 ■ ] Myrrh lo I Licorice 10 . . Flowers 20 . Root 10 . Gum resin ... 20 . Bitter Orange peel 20 . Sweet 20 . Leaves ..... 15 . Balsam 20 'Benzoin .... 12 Storax 8 Tolu 4 - Aloes 2 . Root 10 Florets 20 Root .••... 10 Flower tops ... 15 Insect 5 Fruit S Fruit 10 Cardamom .... 2' Cassia Cinnam. . . 2 Caraway .... I Cochineal .... 0.5 Glycerin 50 Menstrua. Alcoholf Drug, per cent. Grains. Gm. 0.06 Average Dose. 70 SO 75 5° 65 100 60 100 50 100 100 100 60 100 100 95 50 50 3 3 6 6 6 6 Rep. Cc. 0.4 0.8 0.2 0.2 0.4 0.4 0.4 O.I 0.4 o-S 0.2 0.4 0.4 °-3 0.015 0.1 0.4 I. 2. 2. 2. 2. 0.6 2. 2. 2. 4- 2. 0-3 2. 4- Ttnci. Min. 3 60 60 '5 30 30 30 30 ID 30 30 30 30 60 30 5 30 60 60 86 A TEXT-BOOK OF MATERIA MEDIC A. Average Dose, Gm. Name. Drug, Menstrua, Alcohol, Tinctura — Catechu Composita Drug. 100 Cc, percent. Grains, Gm, Rep. Tinct, Cc. Mia. Chiratse CimicifugEe . . Cinchonce . . . . Cinchonte Composita (Huxham's Tinc- ture). Cinnamomi Colchici Seminis Croci . . . CubebK Digitalis . . Ferri Chloridi . Gallse . . . Gelsemii . . . Catechu . . Cinnamon . Herb . . Rhizome . . Bark. . . . ' Red Cinchona Bitter Orange peel Serpentaria . Glycerin Ceylon Seed Saffron . Fruit . Leaves . .Solution Nutgall Root . r Gentian Gentianae Composita J Bitter Orangi I Cardamom Guaiaci Resin . Guaiaci Ammoniata . . Resin Humuli Hops . Hydrastis Rhizome Hyoscyami ... . Herb lodi Iodine . I Ipecac . Ipecacuanhas et Opii ( Qpium deod Kino Insp. juice Kramerise Rhatany . Lactucarii Insp. juice -Oil Lavender Oil Rosemary Cinnamon . Cloves . . . Nutmeg . . Red Saunders Lobelia Herb . . . Matico Leaves . Moschi Musk . . . Myrrhse Gum resin . Nucis Vomicae .... Extract . . Opii Pulv. Opium Opium pulv. Opii Camphorata , (Paregoric.) Lavandulae Composita (For flavoring.) Acid Benzoic Camphor . . Oil Anise . Glycerin , . 10 I lO ) lO 20 20 8 2 7-SJ lO IS lO 20 IS 2SCc. 20 IS lO 4 I 20 20 20 20 IS 7 10 I 10] 10 20 SO 0.8 0.2 2. 0-5 I. I. 20 lO s 20 2 10 0.4 0.4 0.4 0.4 4- SO 65 ICO 67 85 7S 60 SO 100 SO 75 90 6S 60 SO 50 SO 100 20 65 50 SO 7S 50 SO SO I GO 75 SO 6 12 12 4 12 2i 12 6 12 12 5 0.8 0.4 0.8 0.8 0.8 0.4 0.3 0.4 0.8 CIS 0.25 0.8 0.15 0.8 0.8 0.4 0.8 0.8 03 4- 4- 4- Only externally, I 0.06 6 0.4 12 0.8 For syrup. 6 3 ij 6 0.4 0.2 0.1 0.4 0.02 0.06 2. 2. 2. 2. 1. 0.6 50 Opium 1 0.015 4- 60 60 60 60 60 60 30 60 60 15 IS 60 15 60 60 3° 60 60 30 60 60 30 30 30 30 30 IS 10 60 EXTRACTIVE PREPARATIONS. 87 Drug. Cm. in Menstrua Alcokoi, Average Dose. Name. Drug. Rep. Tinct. Tinctura — 100 Cc . per cent. Grains . Gm. Cc. Min. Opii Deodorata . . Opium . . . . 10 20 I 0.06 0.6 10 Physostigmatis . . . Calabar Bea n . . 15 too I 0.06 0.4 7 Pyrethri .... Pellitory . . . 20 100 Externally. Quassise Wood . . . . 10 3S 3 0.2 2. 30 Quillajse .... Soap Bark . . 20 3S 6 0.4 2. 30 Rhei [Rhubarb. (. Cardamom :. 'D ^ 8 o-S 4- 60 r Rhubarb . Cinnamon 20- • • 4 Rhei Aromatica . . Cloves . . ■ • 4 SO IS I. 4- 60 (For syrup.) Nutmeg . Glycerin . . . 2 . . 10. ' Rhubarb . . 10 Rhei Dulcis (Sweet | Tincture of Rhu- ' " Glycyrrhiza Anise . . • ■ 4 ■ . 4 50 , . a. 120 barb.) ■' Cardamom '- Glycerin . . I . . 10-' Sanguinarise .... Blood-root IS 60 5 0.3 2. 30 SciUae Squill . , • ■ IS 7S 2J 0.15 I. IS Serpentarise . . Rhizome . . 10 65 6 0.4 4- 60 Stramonii Seminis . Seed . . • • IS 50 H oiS I. 15 Strophanthi . . . Seed . . • s 65 i 0.015 °-3 s Sumbul Musk-root . . lO 6S 3 0.2 2. 30 Tolutana . ... Tolu . . . 10 100 3 0.2 2. 30 ValerianEe .... Root . . 20 7S 12 0.8 4- 60 Valerianae Ammoniatse Root 20 6 0.4 2. 30 Vanillse . . . Fruit . . . . 10 6S 3 0.2 2. 30 Veratri Viridi . . . Rhizome . 40 ICO 2 0.12 0.3 s Zingiberis . . . Ginger . . 20 100 6 0.4 2. 30 Unofficial Tinctures of the National Formulary. Tinctura — Amara (Bitter Tincture, Ph. Ger.). — Containing Gentian, Cen- taury, Bitter Orange Peel, Orange Berries, and Zedoary. Antacrida (Dysmenorrhcea Mixture ; Fenner's Guaiac Mix- ture). — A mixture of Guaiac, Canada Turpentine, Oil of Sas- safras, and -^ grain (0.02) Corrosive Mercuric Chloride in each fluidrachm (4 Cc). Dose, from 10 to 20 minims (0.6 to 1.3 Cc). Antiperiodica (Warburg's Tincture). — With Aloes: Rhubarb, Angelica Seed, of each, grains $6 (4.) ; Elecampane, Saf- fron, Fennel, of each, grains 28 (2.) ; Aloes (aq. ext.), Gen- tian, Zedoary, Cubeb, Myrrh, White Agaric, Camphor, of each, grains 14 (i.); Quinine Sulphate, grains 160 (10.); Diluted Alcohol, enough to make fluidounces 16 (473 Cc). 88 A TEXT-BOOK OF MATERIA MEDIC A. Tinctura — Antiperiodica (Warburg's). — The preceding without Aloes. Each fluidounce (30 Cc.) of either . tincture contains 10 grains (0.6) of Quinine Sulphate. Aromatica (Stomachic, Ph. Ger.). — A combination of Cinna- mon, Ginger, Galangal, Cloves, and Cardamom. Capsici et MyrrHjE (Hot Drops). — The preparation popularly known as " Number Six." Cinchona Detannat^. — For admixture with preparations containing Iron. CoNii (U. S. P. 1880). — Representing 15 per cent, of Conium. CoTO. — This preparation contains 'j\ grains (0.5) true Bolivian Bark in each fluidrachm (4 Cc). The Para Coto, frequently- employed, differs considerably from the above. Ferri Chloridi .(Etherea (Bestucheff's Tincture ; Lamott's Drops, Ph. Ger.). — Each fluidrachm (4 Cc.) represents about \ grain (0.3) Metallic Iron. Ferhi Citro-chloridi (Tasteless Tincture of Iron). — Practi- cally identical in the strength of Iron, but not in Alcohol, with the officinal Tincture of Chloride of Iron, containing an amount of Iron equivalent to 7J grains (0.5) of Dry Chloride of Iron in each fluidrachm (4 Cc). A convenient form of Iron for admixture with Tinctures of vegetable astringent drugs, such as Gentian and Cinchona, preparations of which it does not, unlike other iron com- pounds, discolor. Ferri Pomata (Ferrated Extract of Apples ; Malate of Iron, Ph. Ger.). — Each fluidrachm (4 Cc.) represents about | grain (0.025) of Metallic Iron. GuAiAci CoMPOSiTA (Dewccs' Tincture of Guaiac). — Each fluidrachm (4 Cc.) represents 7 J grains (0.5) Guaiac. Ignati^ (U. S. p. 1880). — Representing 10 per cent, of Ignatia. loDi (Churchill's). — A solution of 10 grains (0.6) Iodine in each fluidrachm (4 Cc), with Potassium Iodide in Alcohol. Not to be confounded with Churchill's Iodine Caustic (Liquor lodi Causticus). loDi Decolorata (Colorless Tincture of Iodine). — Contain- ing about I per cent, of Ammonium Iodide, with some other Iodine compounds, in alcoholic solution ; for external use. EXTRACTIVE PREPARATIONS. 89 Tinctura — jALAPiE (U. S. P. 1870). — Each fluidrachm (4 Cc.) represents about 10 grains (0.6) Jalap. jALAPiE CoMPOSiTA. — Each fluidrachm (4 Cc.) represents 7J grains (0.5) Jalap and about 2 grains (0.12) Scammony. Kino Composita — Tinctures of Kino, Opium, each . . minims 180 12. Cc. Spirit of Camphor ........ " 130 8.5 Oil of Cloves " 2\ 0.15 Aromatic Spirit of Ammonia . . " 15 i. Cochineal grains 16 i. Diluted Alcohol to make fluidounces 4 . . . .120. Each fluidrachm (4 Cc.) represents \ grain (0.03), each, of Kino and Opium. Papaveris (Poppy). — Each fluidrachm (4 Cc.) represents 30 grains (2.) of Poppy (Capsule). Pectoralis (Bateman's Pectoral Drops). — A popular mixture of Opium, Catechu, Camphor, and Oil of Anise, containing 2\ minims (0.15) Tincture of Opium {^ grain Pulv. Opium) in each fluidrachm (4 Cc). Persionis (Cudbear). — Intended as a coloring agent when a bright-red tint or color is to be produced, particularly in acid liquids. Persionis Composita. — A mixture of Cudbear and Caramel, intended as a coloring agent when a brownish-red tint or color is to be reproduced. Pimpinell^ (Pimpinella, Ph. Ger.). — Each fluidrachm (4 Cc). represents about 10 grains (0.6) Pimpinella Root. Rhei Aquosa (Rhubarb, Aqueous, Ph. Ger.). — Each fluid- drachm (4 Cc.) represents about 5f grains (0.4) of Rhu- barb, with alkalies, flavored with Cinnamon. Rhei et Gentian^e. — Each fluidrachm (4 Cc.) represents 5 grains (0.3) of Rhubarb and I grain (0.06) of Gentian. Rhei Vinosa (Rhubarb, Vinous, Ph. Ger.). — Each fluidrachm (4 Cc.) represents about 5 grains (0.3) Rhubarb, with Bitter Orange and Cardamom, in Sweet Sherry Wine. Saponis Viridis Composita. — A solution of about 15 per cent, of Green Soap and 2 per cent, of Oil of Cade. Tincture .^there^ (Ethereal Tinctures). — The drug, prop- • erly comminuted, troy ounces 2 (60 Gm.) ; Stronger Ether, I volume ; Alcohol, 2 volumes ; enough to make fluid- go A TEXT-BOOK OF MA TREIA MEDICA. Tinctura — ounces i6 (473 Cc). A general formula for the prepara- tion of Ethereal Tinctures of Belladonna, Castor, Digitalis, Lobelia, Valerian, and other drugs. Official in several European pharmacopoeias, and sometimes prescribed by- foreign physicians. ToLUTANA SoLUBiLis (Tolu, Soluble). — A so-called soluble essence of Tolu, for flavoring. Vanillini Composita. — A solution of Vanillin and Coumarin,, intended for flavoring. Zedoari^ Amara (Zedoary Comp.). — Similar to, but not identical with, the Tinctura Carminativa, Wedelii, etc., for- merly official in some Continental pharmacopoeias. Each fluidrachm (4 Cc.) represents 15 grains (i Gm.) of Zedoary, 7^ grains (0.5) of Aloes, and 3f grains (0.25), each, of Rhubarb, Gentian, White Agaric, and Saffron. EXTRACTA FLUIDA— FLUID EXTRACTS. Fluid Extracts may be defined as a class of concentrated tinctures of such strength as to represent the drug, volume for weight. The fluid extracts of the U. S. P. previous to 1880 represented I grain of drug in i minim, or i troy ounce in i fluidounce. In the U. S. P. of 1880 the standard adopted was i Gm. in i Cc, and this strength has been retained as the standard of the U. S. P. 1890. Fluid extracts are made by percolation, maceration, or digestion. Except on a large scale or by fractional percolation, they cannot be prepared by simple percolation without evaporation to concen- trate the percolate to the required measure. Fractional percolation or repercolation, or simultaneous frac- tional percolation, by employment of which the use of heat for concentrating the percolate is avoided, may be used to advantage when the quantity operated upon is sufficiently large to warrant the greater time and attention required. The following is the process chiefly employed : In proceeding to percolate 100 Gm. of the drug, according to directions, the first 80 to 90 Cc. are reserved, and percolation con- tinued until the exhaustion is completed. The weak percolate is evaporated to a soft extract (the alcohol being recovered) and dis- solved in the reserved percolate. Sufficient menstruum is then added to make the product measure 100 Cc. EXTRACTIVE PREPARATIONS. Official Name Extractutn Fluidum — of Drug, 91 Average Dose. Cc. Minints. Aconiti . Apocyni . . . Arnicse Radicis . Aromaticum . , . Asclepiadis . . . Aspidospermatis Aurantii Amari Belladonnse Radicis Buchu . ... Calami Calumbse .... Cannabis Indicee . Capsici ... Castaneae . . . Cliimaphilae . . . Cliiiatse Cimicifugae . . . Cinchonse .... Cocse. . . . Colchici Radicis . Colchici Seminis . Conii Convallkriae . . . Cubebse . . . Ciisso .... Cypripedii . . . Digitalis .... Dulcamaise . . . Ergotse ... Eriodictyi .... Eucalypti .... Eupatorii . . Frangulse . . . . Gelsemii . . . . Gentianae . . . . Geranii Glycyrrhizae . . . Gossypii Radicis , Grindeliae . . . . Guaranse , , Hamamelidis . . Hydrastis . . . , Hyoscyami . . . Ipecacuanhse . , Iridis . . Krameriae . . . - Lappse Leptandrse . . . Aconitum Napellus Tuber . Apocynum Cannabinum . . . , Root . Arnica montana Root ... Pulvis Aromaticus Asclepias tuberosa Root . . Aspidosperma Quebracho-bianco . Bark . , Citrus vulgaris Rind . . Atropa Belladonna Root . . , Barosma betulina Leaves . Acorus Calamus Rhizome , Jateorrhiza palmata Root . . , Cannabis sativa Fl. Tops Capsicum fastigiatum Fruit . . Castanea dentata Leaves . , Chimaphila umbellata Leaves . , Swertia Chirata Plant . . , Cimicifuga racemosa ... . Rhizome , Cinchona Calisaya Bark . Erythroxylon Coca Leaves . , Colchicum autumnale Corm Colchicum autumnale Seed . Conium maculatum Fruit . . . Convallaria majalis Rhizome Piper Cubeba Fruit . . Hagenia Abyssinica Inflor. . . Cypripedium pubescens Rhizome , Digitalis purpurea Leaves . , , Solanum Dulcamara Branches . . Claviceps Purpurea Sclerotium , Eriodictyon glutinosum Leaves . Eucalyptus globulus Leaves . Eupalorium perfoliatum .... Herb . . Rhamnus Frangula Bark . . Gelsemium sempervirens .... Rhizome Gentiana lutea . . .... Root . , Geranium maculatum Rhizome Glycyrrhiza glabra Root . Gossypium herbaceum Root Bark Grindelia robusta Leaves . FauUinia Cupana Seeds Hamamelis Virginiana Leaves . Hydrastis Canadensis Rhizome Hyoscyamus niger Herb Cephaelis Ipecacuanha Root . Iris versicolor Rhizome , Krameria triandra Root . . Arctium Lappa Root . . Veronica Virginica Rhizome . 0.06 . I. ,0.5 .0.5 . 2. , 2. , I. , 0.2 . 2. , 2. ,0.6 , 0.2 . 4- 2. 2. 2. , 2. 2. .0.3 0-3 0.25 0.6 2. 4- , 0.12 2. 2. . 2. I. 2. • 4- . 0.2 1-3 2. 4- 2. . 2. • 4- . 2. . 2. 0-3 . 0.06-2. . I. . 2. . 2. . 2. I 15 30 30 15 3 30 30 30 10 3 60 30 30 ■30 30 30 5 5 4 10 30 60 '5 2 3° 30 30 IS 30 60 3 20 30 60 3° 3° 60 30 3° S 1-30 IS 30 30 3° 92 A TEXT- BOOK OF MA TERIA MEDIC A. Average Dose. Ojffkial Name Extractum Fluidum Lobelise .... LupuUns . . . Matico .... Menispermi . . . . Mezerii Nucis VomicEe . . . Pareirae Phytolacca Radicis . Pilocarpi ... Podophylli . . . . Pruni Virginianae . Quassise Rhamni Purshianse . Rhei Rhois Glabra . . . Rosse Rubi Rumicis Sabinse Sanguinarias . . . . Sarsaparillae .... Sarsaparillae Com- positum Drug. Part. Cc. Scilte Scoparii . . . Scutellariae . . . SenegEe Senn^ .... SerpentariiE . . . Spigelise . . . StillingiEE . Stramonii Seminis Taraxaci .... Tritici Uvae Ursi .... Valerianae . . Veratri Viridis . . Viburni Opuli Viburni Prunifolii Xanthoxyli . . . Zingiberis .... Lobelia inflata Herb .... 0.6 Humuliis Lupulus Powder . . .0.6 Piper Angustifolium Leaves ... 4. Menispermum Canadense .... Rhizome . . 2. Daphne Mezereum Bark . . . 0.3 Strychnos Nux-vomica Seed .... 0.2 Chondodendrum tomentosum . , . Root .... 2. Phytolacca decandra .... Root' .... 0.5 Pilocarpus Selloanus (Jaborandi) . Leaves ... 2. Podophyllum peltatum . ... Rhizome . . 0.6 Prunus serotina Bark . . . 2. Picr^na excelsa Wood . . .0.5 (Cascara sagrada) Bark .... 2. Rheum officinale Root . . . .1. Rhus glabra Leaves ... 2. Rosa Gallica Petals ... 2. , Rubus villosus Root Bark . 2. Rumex crispus Root .... 4. . Juniperus Sabina Tops .... 0.5 , Sanguinaria Canadensis Rhizome . . 0.3 Smilax officinalis, etc Root .... 4. Sarsaparilla, 75 Glycyrrhiza, 12 Sassafras, 10 Mezereum, 3 Urginea maritima Bulb .... 0.3 Cytisus Scoparius Tops .... I. Scutellaria lateriflora Herb ... 2. Polygala Senega Root .... 0.3 . Cassia acutifoha and Angust. . . Leaves ... 4. Aristolochia Serpentaria Rhizome . .1. Spigelia Marilandica Rhizome . . 2. Stillingia sylvatica Root .... 2. Datura Stramonium Seed .... 0.2 Taraxacum officinale Root .... 4. Agropyrum repens Rhizome . . 4. Arctostaphylos Uva Ursi .... I^eaves . Valeriana officinalis Rhizome Veratrum viride Rhizome (Cramp bark) Bark . . (Black haw) Bark . . Xanthoxylum Americanum Zingiber officinale .... 2. 2. 0.12 2. 2. . Bark . . . . i. . Rhizome , . 0.6 Minims. 10 lo 60 30 5 3 30 g 30 10 30 8 30 IS 30 30 30 60 8 S 60 30 5 "5 3° 5 60 15 30 30 3 60 60 30 30 2 30 30 »S lo Unofficial Fluid Extracts of the National Formulary. Unless otherwise indicated, the dose of the following Fluid Ex- tracts is from ^ to i fluidrachm (2 to 4 Cc.) : EXTRACTIVE PREPARATIONS. 93 Extractum Fluidum — Adonidis. — Root of Adonis vernalis L. (Bird's Eye). Aletridis. — Rhizome of Aletris farinosa L. (Stargrass). Angelica Radicis. — Root of Archangelica L. (Angelica). Apii Graveolentis. — Seed of Apium graveolens L. (Celery). AralIjE RACEMOS.E. — Root of Aralia racemosa L. (American Spikenard). ARNiCiE Florum. — Flower heads of Arnica montana L. (Ar- nica). Berberidis Vulgaris. — Bark of the root of Berberis vulgaris L. (Barberry). BoLDi. — Leaves of Peumus Boldus Molina (Boldo). BucHU CoMPOSiTUM. — A Combination of Buchu, 10; Cubeb, 2 ; Juniper, 2 ; Uva Ursi, 2 parts. Calendula. — Flowering herb of Calendula ofificinahs L. (Marigold). Camellia. — Leaves of Camellia Thea Link (Tea). The best quality of commercial black tea, " Formosa Oolong," to be employed for this preparation. Caulophylli. — Rhizome and rootlets of Caulophyllum thalic- troides Mich. (Blue Cohosh). Coffee Viridis. — Unroasted seeds of Coffea Arabica L. Coffee Tost^. — Roasted seeds of Coffea Arabica L. The N. F. recommends equal portions of Java and Mocha to be employed in preparing the Fluid Extracts of Coffee. Convallari^ Florum. — Flowers of Convallaria majalis L. (Lily of the Valley). CoPTis. — Rhizome of Coptis trifolia Salisb. (Goldthread). CoRNUS CircinaTjE. — Bark of Cornus circinata L'Her. (Green Osier.) Cornus Florida (U. S. P. 1880). — Dogwood Bark. CoRYDALis. — Tubers of Dicentra Canadensis De C. (Turkey Corn). CoTO. — Coto bark, undetermined tree. Dose, from 5 to 15 minims (0.3 to i Cc). FucL — Thalus of Fucus vesiculosus L. (Bladder-wrack). Heliantheml — Herb of Helianthemum Canadense Mich. (Frost-wort). HuMULi. — Strobiles of Humulus lupulus L. (Hops). Hydrangea. — Root of Hydrangea arborescens L- (Seven Barks). 94 A TEXT-BOOK OF MA TERIA MEDICA. Extractum Fluidum — Jalaps. — Tuber of Exogonium purga Benth. (Jalap). Dose, from 15 to 20 minims (i to 1.3 Cc). JuGLANDis. — Bark of the root of Juglans cinerea L. (Butternut). JuNiPERi. — Fruit of Juniperus communis L. Kava. — Root of Piper methysticum Forster (Kava; Kava- Kava). Lactucarii (U. S. p. 1880). — Insp. juice of Lactuca virosa L. Malti.— (Fluid Extract of Malt). Menyanthis. — Leaves of Menyanthes trifoliata L. (Buckbean ; Trifolium fibrinum, Ph. G.). Mezerei (U. S. p. 1880). — Bark of Daphne mezereum L. Dose, from 5 to 10 minims (0.3-0.6 Cc). Petroselini Radicis. — Root of PetroseHnum sativum Hoff- man (Parsley). QuiLLAjA. — Bark of Quillaja Saponaria Molina (Soap Bark). Rhamni Purshian^ Aromaticum. — Cascara Sagrada de- prived of its bitter taste. Rhei Aromaticum. — A combination of Rhubarb, Cinnamon, Cloves, and Nutmeg. SenNjE Deodoratum (Aqueous Fluid Extract of Senna). — This preparation is free from the objectionable " griping " qualities of the ordinary fluid extract. Sterculi^. — Seeds of Sterculia acuminata R. Brown (Cola or Kola). StilllingIjE Compositum (Stillingia Comp.). — Stillingia, Cory- dalis, each, 4 parts ; Iris, Sambucus, Chimaphila, each, 2 parts ; Coriander, Xanthoxylum Berries, each, i part. Trillii. — Rhizome of Trillium erectum L. (Bethroot). TuRNERyE. — Leaves of Turnera microphylla De C. (Damiana). Urtice. — Root of Urtica dioica L. (Nettle). Verbasci. — Leaves (and flowers) of Verbascum Thapsus L. Verbena. — Root of Verbena hastata L. (Vervain). Ze^. — Stigmatum Maydis ; Corn Silk ; Stigmata of Zea Mays L. (Indian Corn). As a rule, a Fluid Extract is made of every vegetable drug which is a part of a plant. There are altogether about 500 Fluid Extracts. Relatively, the Fluid Extracts are not as strong as the Tinctures, but they have the great advantage over the latter in that they are more concentrated and of uniform drug-strength — the strength of the drug. EXTRACTIVE PREPARATIONS. 95 EXTRACTA— EXTRACTS. Extracts — or " solid " extracts as they are termed, to distinguish them from fluid extracts — are the soluble active principles of vege- table drugs, concentrated by evaporation to a soft solid or a plastic mass of pilular consistence. The strength of an extract depends upon the amount of the crude drug it represents. Hence, the smaller the percentage of extract obtained from a drug, the greater the relative strength of the extract, provided that the drug be exhausted with menstrua adapted to secure all the active principles in this form. The yield of extract is influenced by the character of the men- struum employed : with a few drugs like Rhubarb the quality of the drug sometimes governs the yield, the least percentage being obtained from the poorest quality. As a general rule, the more aqueous the menstrua, the greater the yield of extract ; conversely, the more alcoholic the menstrua, the smaller the yield of extract. To obtain the extracts, therefore, of official strength it is necessary to use official menstrua in the extraction. Thus the extracts of different drugs are as many times stronger than the drug as the quotient obtained by dividing the drug at 100 by the percentage yield. For example : Podophyllum yields 10 per cent, of extract ; then 100-5-10=10; that is, the extract is ten times as strong as the drug and the fluid extract, or o.i of the extract represents i Gm. of the drug or i Cc. of the fluid extract. The drug-strengths of the official Extracts, calculated by this method, as well as their relative doses based upon the amounts of drug they represent, are exhibited in the table given on page 96. The 33 official Extracts are made by extraction with alcoholic menstrua or with water, sometimes by the additiorf of acid or alkali. There are four extracts made by the addition of powders to the extracts, including the Extract of Colocynth, the Compound Extract of Colocynth, and the assayed extracts, made by the addi- tion of Sugar of Milk to represent a certain alkaloidal strength in the powdered extract. Extractum Nucis Vomicae contains 1 5 per cent, of total alka- loids ; I Gm. represents about 10 Gm. of drug. Extractum Opii contains 18 per cent, of crystallized morphine; I Gm. represents 2 Gm. of normal moist opium, about 1.4 Opii pulvis (14 per cent, morphine). q6 A TEXT-BOOK OF MATERIA MEDIC A. Table showing the Drug-strength and the Average Doses of the Official Extracts. Extractum. Parts of Drug in I part of Extract. Dose of Drug. Grains. Gm Dose of Extract. Grains. Gm, Aconiti Root . . Aloes (aqueous) .... .... Arnicse . . . .- Root . . Belladonnse Fol. Alcoholic. . Leaves . Cannabis Indicas . . . . Herb . . Cimicifugae Rhizome Cinchonse (Calisaya) . . . Bark . . Colchici (acetic) Corm . . Colocynthidis (powder) . . . Fruit . . [Ext. Colocynth, i6; Colocynthidis Com- Cardamom, 6 ; Aloes, positum (powder) 50; Soap,Scammony, L each, 14. Conii (acetic) Fruit . Digitalis Leaves Ergqtas Sclerot. Euonymi Bark . Gentianae (aqueous) .... Root . Glycyrrhizse (stick) Root . Glycyrrhizse Purum (ammon.) Root . Hsematoxyli (aqueous) . . Logwood Hyoscyami Herb . Iridis Rhizome Jalapas Tuber Juglandis Bark . Kramerise (aqueous) . . . Root . Leptandrse . ... Root . Nucis Vomicae (powder) . Seed . Opii (powder) Physostigmatis Calabar bean Podophylli Rhizome . Quassiae (aqueous) Wood Rhei Root . Stramonii Seed . Taraxaci (aqueous) Root . Uvae Ursi Leaves 5 2 5 5 10 10 6 3 6 4 4 5 5 4 3 3 4 6 7 6 6 5 5i 10 20 10 25 3 10 3 3 I 10 10 3 10 10 3° 5 3 4 2 30 30 20 30 60 10 6 7 IS IS IS IS 3 I I 10 s 30 3 30 30 .06 .65 .6S .2 .65 .6s 2. •3 .2 .25 .12 2. 2. 1-3 2. 4. .6s ■4 ■5 I. I. I. I. .2 .06 .06 •6S •3 2. .2 5 6 6 S 10 20 2' ^2 I I 3 3 3 3 1 y 3 I 1 I I 10 1 ¥ 10 10 .012 •32 .12 •03 .06 .06 ■3 .12 •03 .06 ■03 •4 ■4 ■3 .65 1-3 ■IS .06 .06 .2 .2 .2 .2 .02 .04 .01 .06 .06 .65 •IS ■6S .65 ABSTRACTA— ABSTRACTS. A class of powdered extracts, prepared from the extracts by the addition of sufficient Milk Sugar to make the product represent one-half its weight of the crude drug, was official in the U. S. P. VI. (1880) under the title of Abstracts. The Abstracts have a uniform relation to the drug viz. / grain represents 2 grains of the drug, just as the fluid extracts have the uniform relation of representing the drug measure for weight. In preparing an abstract the drug is exhausted, the extract obtained incorporated with its weight of Milk Sugar, the mixture EXTRACTIVE PREPARATIONS. 97 powdered, and enough Milk Sugar added to bring the product to one-half the weight of the drug employed. Abstracts must be pre- served in small, perfectly dry, and well-corked vials in a dry and cool place. Their uniformity alone should have favored the employment of Abstracts in preference to the Extracts, since they do not share the variability in strength of the extracts, the dose of the Abstract being exactly one-half that of the crude drug or Fluid Extract. This advantage was offset by the disadvantage that Abstracts are more bulky, and caused their deletion in the U. S. P. 1890. The Ab- stracts are therefore unofficial. The official Extracts of Jalap and of Nux Vomica have su- perceded the abstracts of these respective drugs in a more con- centrated and equally convenient form. Of the remaining nine Abstracts formerly official, Aconite, Belladonna, Conium, Digitalis, Hyoscyamus (Ignatia, superceded by Nux Vomica), Podophyllum, Senega, and Valerian, the five first mentioned, commonly but erroneously called the "narcotic extracts," may be prepared, in the powdered form, of such strength as to represent the same drug-strength as their respective official " solid extracts." ExTRACTUM Ferri Pomatum, N. F. — Ferri Malas Crudus (Fer- rated Extract of Apples, Ph. Ger.). ExTRACTUM Glycyrrhiz^ Depuratum, N. F. — Succus Liqui- ritiffi, Ph. Ger. (Purified Extract of Liquorice). OLEORESIN.^— OLEORESINS. To natural Oleoresins, derived as plant-exudations, belong the Turpentines and the Pitches. From similar exudations are ob- tained the Gum Resins, mixtures of Gum and Resins and sometimes Volatile Oils ; also the Balsams, which are Resins or Oleoresins associated with Benzoic or Cinnamic Acid. These are treated under their respective Drugs. The pharmaceutical Oleoresins are semi-liquid extracts, obtained by exhausting oleoresinous drugs with Ether. Ether extracts fixed and volatile oils from drugs, as well as^resin; these principles constitute therefore the oleoresins, which some- times also contain other active matter in solution or suspension. The menstruum (Ether), being easily volatilized, is recovered by distillation ; it is sometimes superseded by Alcohol, which yields an extract very similar to that obtained with ether. 7 98 A TEXT-BOOK OF MA TERIA MEDICA. The six following are official : Dose. Oleoresina — , ^ ■ » Aspidii; separates in two layers, to be mixed when used . . . i-2 drachms. 4.-8. Capsici ; separates fat, used only as corrective T5~i grain. 0.01-0.005 Cubebse; separates wax .... 1-2 grains. 0.06-0. i Lupulinae 2-3 grains. 0.1-0.2 Piperis ; separates piperine, to be rejected 1-2 grains. 0.08-0.1 Zingiberis ^— J grain. 0.02-0.01 RESIN.E— RESINS. The official Resins may be divided into the (i) Natural Resins, (2) Resins obtained from Oleoresins by separating the Volatile Oil by distillation, and (3) the Pharmaceutical Resins, prepared by pre- cipitation. When a concentrated tincture of a resinous drug is poured into a large quantity of cold water, the resinous matter becomes insoluble and is precipitated ; this, after being washed, dried, and sometimes powdered, is termed a resin. Resins are usually soluble in alkalies and insoluble in acids (dilute) ; for this reason the water used for precipitation is some- times rendered slightly acid to favor the separation. The three following are official : Per cent, yield from Drug. Dose. Rep. Drug. Resina — , • , , ■ , Jalapse 15 3 grains 0.2 20 grains 1.3. Podophylli 5 \ grain 0.03 10 grains 0.6. Scammonii 65 3 grains 0.2 5 grains 0.3. Resina and Resina Copaiba are obtained as residue in the dis- tillation of the respective Oleoresins, Turpentine and Copaiba. The natural Resins are obtained as exudates — e. g. R. Guaiac. The terms resin, resinoid, and concentration are also applied to a class of preparations used by eclectic physicians, prepared by this general process with some modifications. (See U. S. and Am. Disp.) They are named after their respective Drugs with the ending in, as in Glucosides, and must not be confused with the latter. While the Glucosides are usually the active medicinal constituents repre- senting the drug, the resinoids, with the exception of those made SOLID MIXTURES FOR INTERNAL USE. 99 from drugs whose active principles are resins, such as Cimicifuga and Podophyllum, are more or less inert, unreliable mixtures, too indefinite in their composition and strength for medicinal use. SOLID MIXTURES FOR INTERNAL USE. Mixtures of Solids for internal use embrace the following classes of preparations : Powders, Effervescent Salts, Confections, Troches, Masses, and Pills. Powders are substances reduced to a fine pulverulent condition to favor their administration and solution or absorption. A powder may be simple, such as a powdered drug, Pulvis opii, or a pow- dered salt — i. e. Quinines sulphas ; or it may be compound, a mix- ture of several substances. Sparingly soluble substances, when finely powdered (impalpable) and thoroughly mixed by trituration in a mortar with some inert powder (diluent) such as Milk Sugar, are rendered more soluble, since a greater surface is exposed to the solvent action of the liquids of the body, and prompter and fuller effects are obtained. The potency of calomel, of the resins, and of alkaloids is in this way considerably increased within certain limits, but not to the unreasonable extent advocated by Homoeopathic pharmacy, in which this process is carried to a reductio ad absurdum. It is an excellent and convenient method for dispensing and administering the more potent agents, such as arsenous acid, mercury com- pounds, and the alkaloids. Substances triturated in this way have been called Triturations, for whose preparation the U. S. P. gives a general formula : Take of the substance, for example, Elaterin . . . i Gm. Milk Sugar, in fine powder 9 Gm. First thoroughly triturate the medicinal substance (Elaterin) with an equal weight of Milk Sugar, then add the remainder of the Milk Sugar, and mix thoroughly by trituration (for about ten minutes). Unless otherwise specified, triturations should be of the official strength — i. e. \o per cent, of the drug. By the addition of about an equal weight of Alcohol to the triturate it becomes a soft mass, which, after being moulded into imUKi' jj) DEPARTMENT OF Pl-lABMACOU>G¥* lOO ^'^^TEJ^S^OOJi' OF MA TERIA MEDIC A. disks of about i grain (0.06) each, after the evaporation of the Alcohol, furnishes the so-called Tablet Triturates. These afford a convenient method of medication for such substances as are adapted to trituration, which is, however, confined, as indicated, to a comparatively limited number of agents. To represent in the form of these tablets every kind of medicinal agent of volatile cha- racter, or drugs otherwise susceptible to change through the inevi- table exposure to the atmosphere to which every such mixture is liable, is simply to invite error in practice. These tablets, more- over, with certain chemical substances, undergo chemical changes which render them entirely insoluble, and thus practically inert. In order to be effective and otherwise reliable, they should be pre- pared extemporaneously by the pharmacist, in order to ensure their solubility. They should always be dissolved in a little water before they are administered. When it is desired to obtain a mild and prolonged local effect of a medicinal agent in the mouth or throat, the substance is made into a soft mass (confection) with a diluent and excipient. Sugar and Mucilage, and flavor, and formed into round or oval-shaped disks, weighing from 8 to 30 grains (-^ to 2 Gm.), called variously Lozenges, Troches, Tablets, and Pastils. Troches. — When these are allowed to dissolve slowly in the mouth the diluent serves as a vehicle for the medicinal agent, and a gradual prolonged effect is obtained upon the mucous surfaces. This form of medication is adapted only to astringents, antacids, expectorants, and stomachics consisting of substances not especi- ally disagreeable to the palate. Tablets, or Lozenges, are not intended to be swallowed, nor adapted to exceedingly volatile, caustic, irritant, or otherwise un- palatable substances. For ingestion, medicinal agents should be made into a Mass [massd) with an excipient, and formed into small spheres, or balls, as a rule not over 5 grains (0.3) in weight, to be swallowed and slowly dissolved in the stomach or intestines. Such preparations are the so-called Pills {Pilules, from pila, ball). PULVERES— POWDERS. The nine official Powders are impalpable mixtures of one or more active drugs, usually with some nearly inert substance, such as Sugar, as a diluent, and Aromatics. They are made by trituration. SOLID MIXTURES FOR INTERNAL USE. lOi Pulvis — Gm. in loo. Antimonialis (James') . calc. phos. 67; antimon. oxide 33 Aromaticus .... cinnamon (Ceylon), ginger, each 35 cardamom (seed), nutmeg, each 15 Cretae Gompositus . acacia p. 20; sugar 50; prep, chalk 30. Glycyrrhizse Gompositus . . . senna 18; glycyrrhiza 24. fennel oil 0.4 ; sulphur, washed, 8 ; sugar 50, Ipecacuanhae et Opii . . . ipecac, opium pulv., each 10. (Dover's Powder) sugar of milk 80. Jalapse Gompositus . . . . potass, bitartrate 65 ; jalap 35 Rhei Gompositus . magnesia 65 ; ginger 10; rhubarb 25 In 60 grains. Pulv. Morphinse Gompositus . . camphor 10; morphine (Tulley's Powder) sulph. i. calcium carb., precip. ; glycyrrhiza p., each 20. I<'or 13 fow . ; in each, grains. Effervescens Gompositus . (Seidlitz Powder) potassium and sodium tartrate 93 Gm. 120 sodium bicarbonate 31 Gm. 40 acid tartaric. 27 Gm. 35 Many methods are in use for the purpose of disguising the taste of disagreeable remedies in the powder form. Of these the most elegant and effective method is that of enclosing the powder in a cachet or wafer. Originally wafers were made of starch-paste in thin sheets ; a piece about 0.5 dcm. (2 inches) square, immersed in water for a minute, being placed in a spoon, the powder poured into it, and then enwrapped by folding up the edges and swallowed with a little water. The cachets or " konseals " are wafer-disks consisting of two concentric halves, one of .which is filled with the powder, and the other half attached by moistening the edge and pressing the edges together by means of various devices. These cachets are of three sizes, the largest holding 5 grains (0.3) Quinine Sulphate. After one minute's immersion in water they can be swallowed without any effort. Unofficial Powders of the N. F. Pulvis — Acacia Gompositus (Pulvis Gummosus, Ph. Ger.). AcETANiLiDi Gompositus. — Containing 50 per cent. Acetan- I02 A TEXT-BOOK OF MATERIA MEDICA. Pulvis — ilid, 2 per cent. Caffeine, with Tartaric Acid and Sodium Bicarbonate. Aloes et Canell^ (Hiera Picra). Amygdala Compositus (Almonds Cpmp.) — A mixture of Sweet Almond, Sugar, and Acacia, in fine powder; i8o grains (lo Gm.), triturated with Water, yield about 4 fluid- ounces (119 Cc.) of Emulsum Amygdalae. Anticatarrhalis (Catarrh Snuff.) — Hydrochlorate of Mor- phine, I part; Acacia, 60 parts; Subnitrate of Bismuth, 180 parts, in fine powder. Catechu Compositus (Compound Powder of Catechu, Ph. Br.). — Catechu, 4 parts ; Kino, 2 parts ; Krameria, 2 parts ; Cinnamon, i part; Nutmeg, i part. CretjE Aromaticus. — A mixture of Cinnamon, Saffron, Nut- meg, Cloves, Cardamon, prepared Chalk, and Sugar. Cret^ Aromaticus cum Opio. — Aromatic Powder of Chalk, with I grain (0.06) of powdered Opium, in 40 grains (1.5) of the mixture. Official in the Ph. Br. Hydrargyri Chloridi Mitis et Jalaps (Calomel and Jalap). — A mixture of Mild Chloride of Mercury, 10 grains (0.6), and Jalap, 20 grains (1.3). When " Calomel and Jalap " is prescribed for an adult, without any specifi- cation of quantities, the N. F. recommends that the above mixture be dispensed as one dose. loDOFORMi Compositus (Iodoform and Naphthalin). — A mixture of Iodoform, 2 parts ; Boric Acid, 3 parts ; Naphthalin, 5 parts ; with Oil of Bergamot, in fine powder. This powder is used in many cases where a diluted preparation of Iodo- form, for external purposes, is desired. The odor is masked both by the Oil of Bergamot and by the Naphthalin. Kino Compositus. — A mixture of Kino and Cinnamon, with i grain (0.06) of Powdered Opium in each 20 grains (1.3). Myric^ Compositus (Composition Powder). — A mixture of Bayberry, Ginger, Capsicum, and Cloves. Pancreaticus Compositus (Peptonizing Powder). — ^A mixture of 20 parts Pancreatin and 80 parts Sodium Bicarbonate; 25 grains will peptonize i pint of milk. Pepsini Compositus (Pulvis Digestivus). — A mixture of Pep- sin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, with Milk Sugar to represent the gastric juice. SOLID MIXTURES FOR INTERNAL USE. 103 Pulvis — Rhei et Magnesi^e Anisatus (Compound Anise Powder.) — A mixture of Rhubarb, Heavy Magnesia, and Oil of Anise. Talci Salicylicus (Salicylated Powder of Talcum). — A mix- ture of Talcum with 3 per cent. Salicylic Acid and 10 per cent. Boric Acid, in fine powder. Powders are usually directed to be divided into papers {char- tulce) ; thus, for example, a formula for a prescription would be — ]^, Hydrargyri Chloridi Mitis . .1. Sacchari Lactis 9. Misce cum trituratio et in chartulae No. x. divide. Encapsuling powders by filling them in gelatin capsules is a very convenient and elegant form of administration. No mixture which is desired to be given in the form oi powder, however, should be made into a mass for facilitating the encapsuling process — a custom too frequently adopted. Many substances, especially Bismuth Subnitrate and Calomel, become exceedingly hard and quite insoluble when made into a mass. No dispenser should assume the prerogative of changing the form of medication pre- scribed. sales EFFERVESCENTES EFFERVESCENT SALTS. These are granulated mixtures of Salts with Sugar and Sodium Bicarbonate and Tartaric Acid, which decompose when the Salt is dissolved in Water and furnish agreeable aerated draughts. The following are official, the strength indicated being that con- tained in 90 grains (6 Gm.), a heaped teaspoonful being the ordinary dose, dissolved in about 6 fluidounces (180 Cc.) of water: Caffeina Citrata Effervescens caffeine 0.06 Lithii Citras Effervescens .... lithium citrate 0.06 Magnesii Citras Effervescens . magnesium citrate i.o Potassii Citras Effervescens . . . potassium citrate 3.0 Effervescent Salts (Granular^, N. F. The strength given for these is the quantity contained in 90 grains (6 Gm.), which represents about the quantity of these Salts contained in a heaped teaspoonful of ordinary size, the average dose. I04 A TEXT-BOOK OF MATERIA MEDICA. Ferri et Quinine Citras Effervescens, i grain (0.06) Citrate of Iron and Quinine. Ferri Phosphas Effervescens, 2 grains (0.12) Phosphate of Iron, PoTASSii Bromidum Effervescens, 20 grains (1.3) Potassium Bro- mide. PoTAssii Bromidum cum Caffein^e, 10 grains (0.6) Potassium Bro- mide and I grain (0.06) Caffeine. Sal Carolinum Factitium Effervescens (Effervescent Carlsbad Salt, artificial). — A solution of about 87 grains (5.5) in 6 fluid- ounces (178 Cc.) of Water represents an equal volume of Carlsbad Water (Sprudel). Sal Kissingense Factitium Effervescens (Effervescent Kissingen Salt, artificial). — A solution of about 80 grains (g Gm.) in 6 fluid- ounces (178 Cc.) represents an equal volume of Kissingen Water (Rakoczy). Sal Vichyanum Factitium Effervescens (Effervescent Vichy Salt, artificial). — A solution of about 57 grains (4 Gm.) in 6 fiuidounces (178 Cc.) of Water represents an equal volume of Vichy Water (Grand Grille). Salts {Non- effervescent). Sal Carolinum Factitium. — In two forms, Dry (Ph. Ger.) and Crystalline. A solution of about 16 grains'(i Gm.) of the Dry (27 grains (1.8) of the Crystalline) in 6 fiuidounces (178 Cc) of Water represents an equal volume of Carlsbad Water (Sprudel). Sal Kissingense Factitium. — A solution of about 24 grains (1.5) in 6 fiuidounces (178 Cc.) of Water represents an equal volume of Kissingen Water (Rakoczy). Sal Vichyanum Factitium. — A solution of about 14 grains (i Gm.) in 7 fiuidounces (207 Cc.) of Water represents an equal volume of Vichy Water (Grand Grille). CONFECTIONES— CONFECTIONS. Confections may be defined as flavored masses wherein the adhesive substance is Sugar in large proportions, serving as a vehicle for masking the taste of fhe drug. Confections, when made by beating a fresh drug, first reduced to pulp with sugar until of the proper consistence, are termed conserves. When made from powders or extracts they are called electuaries. SOLID MIXTURES FOR INTERNAL USE. 105 Only one representative of each class is official : Gm. in 100 Cc. Confectio Rosse rose water 16, red rose 8 (Conserve of Rose) sugar 64, honey 12 !oil coriander 0.5, senna 10 cassia fistula 16, fig 1 2, tamarind lO prune 7, sugar 55, water to 100 The Confection of Senna is a very agreeable laxative, especially adapted for constipation in women and children. It is exceedingly .agreeable to the taste. TROCHISCI— TROCHES. Troches, or lozenges, are confections made into various forms and then dried. The vehicle or excipient consists of Powdered Gum Tragacanth or -Sugar with flavoring — in some cases orange flower water, in others tolu, nutmeg, vanilla, etc. The active ingredients are mixed with the diluent or vehicle and made into a plastic mass with the particular excipient. Water or Syrup. The mass is rolled out to the requisite thickness, and the disks formed by cutting through it with a punch or troche-cutter. The troches are then dried by exposure. The size and weight of the troche are regulated by the thickness ■of the mass and the diameter of the cutter. The 15 official Troches vary in weight from Gm. 0.5 to 1.5. Trochisci — Acidi Tannici Ammonii Chloridi . . . . extract glycyrrhiza Catechu Cretae Cubebae .... oleoresin extract glycyrrhiza sassafras oil Ferri . . . ferric hydrate Glycyrrhizae et Opii ext. glycyrrhiza powd. opium Act ivE Drug. Gm. in Gvt. in Grains in 100 each each Troches. Troche. Troche 6. 0.06 I Orange flor. 10. O.I 4 Tolu. 25. 0.25 4 6. 0.06 I Orange flor. 25. 0.25 4 Nutmeg. 4- 0.04' 1 25. 0.25 4 I. 0.0 1 i 30. 0.3 s Vanilla. IS- 0.15 2i Anise. 0.5 mg.5. h lo6 A TEXT-BOOK OF MATERIA MEDIC A. Active Drug. Gm. in Gm. in Grains in loo each each Trochisci — Troches. Troche. Troche. Ipecacuanhse 2. 0.02 \ Orange. Krameriae .... extract 6, 0.06 i " flor. Menthse Piperitse ... oil i. o.oi \ Peppermint. Morphinse. morphine sulph. 0.16 mg. 16 -^ Gaultheria. et Ipecac, powd. ipecac 0.50 "5. -^ Potassii Chloratis .... 30. 0.3 5 Lemon. Santonini 3. 0.3 \ Orange flor. Sodii Bicarbonatis .... 20. 0.2 \ Nutmeg. Zingiberis . . tinct. ginger 20. 0.2 \ Ginger. Lozenges of Peppermint, Lemon, Musk, Vanilla, and Gaultheria may readily be prepared by saturating sugar lozenges with the respective essences or tinctures and permitting the alcohol to volatilize. MASS^E— MASSES. Masses are plastic mixtures of pilular consistence. They are made by incorporating the drug with adhesive substances, by chem- ical reaction, and sometimes by both processes. The Masses are intended to be formed into pills whenever they are to be dispensed. They are therefore often called Pil., Pilules, instead of Massa. There are only three official : Massa Copaibae .... water i, magnesia 6, copaiba 94. The Copaivic Acid combines with the magnesia, forming mag- nesium copaivate of pilular consistence. This is also known as "solidified copaiba." Massa Ferri Carbonatis f sodium carb., ferrous sulph., each icx). (Vallet's Mass) I honey 38, sugar 25, syrup to 100. By double decomposition between the Ferrous Sulphate and Sodium Carbonate ferrous carbonate is formed, which is incorpo- rated with Honey and Sugar to prevent oxidation and to render the mixture a plastic mass. The Pill of Ferrous Carbonate (Pil Blaudii) is preferable to this mass, as in the pill the ferrous car- bonate is better protected against oxidation. Massa Hydrargyri . glycyrrhiza 5, althaea 25, mercury 33. (Blue Mass) glycerin 3, honey of rose 34. SOLID MIXTURES FOR INTERNAL USE. 107 The mercury is extinguished by trituration with the rose honey and glycerin and the powdered glycyrrhiza ; the other ingredients are then incorporated. The usual dose is from 5 to 10 grains (0.3-0.6). PILUL.E— PILLS. Pills are spherical, more or less soluble masses of medicinal substances rendered cohesive, plastic, and firm in consistence by the addition of some substance (usually inert) termed an excipient. The kind of excipient employed varies with the nature of the medicinal substance. As a general rule, such substances are chosen as give to the mass, with the smallest proportion, the greatest plas- ticity, and also best preserve the spherical shape of the pills. The excipient must also, unless the contrary be directed for especial purposes, be indifferent in character, to avoid change in the medic- inal agents. Soluble substances are rendered adhesive by the action of sol- vents, and require, according to their solubilities, the addition of some liquid such as Water, Alcohol, Glycerin, etc. Others require the addition of adhesive substances, such as Syrup, Mucilage, Glu- cose, Glycerite of Starch or Tragacanth, etc. Drugs adapted for dispensing in the form of pills may be divided as follows : (i) The official Masses, Extracts, and Scaled Salts. Masses and extracts, being of pilular consistence, require no addition except when hard or dry ; Water should then be incor- porated to restore them to their original form. Abstracts and powdered extracts are best made into a mass with Water. (2) Vegetable Powders in which the dose does not exceed five grains. With these adhesive excipients are indicated, such as Syrup, Mu- cilage, Glycerite of Tragacanth, and Glucose. The last mentioned answers the requirements better than most other substances. Con- fection of Rose and Extracts of Gentian, Glycyrrhiza, and Taraxa- cum are also used when their color is not objectionable. (3) Salts not too deliquescent, and Alkaloids. Excipients for these must combine adhesive and absorbent quali- ties. They are first triturated with a dry powder — e. g. Althaea, Glycyrrhiza, or Milk Sugar — and then mixed with the adhesive substance — viz. Glucose or Glycerite of Starch or Tragacanth. No excipient must be used that will give to the mass a color different from that of the medicinal ingredients (the base). lo8 A TEXT-BOOK OF MA TERIA MEDICA. (4) Volatile Oils and Oleoresins. The quantity of these when dispensed in pills being compara- tively large, it is necessary to add some light absorbent substance, such as Magnesia or Starch, to which is added the adhesive material. The practice of adding wax or resin to oils is not to be recommended except as a last resort, since they tend to render the pill insoluble. (5) Resins and Gum Resins. These form an adhesive mass by the addition of a little Alcohol, with which more bulky excipients, such as Soap, may be incorpo- rated to preserve the shape of the pill. (6) Salts of the Cinchona Alkaloids, Quinine and Cinchonidine Sulphates, etc. These are often prescribed in pill form in large doses, and it is therefore desirable to reduce their bulk. For this purpose dilute Sulphuric Acid or Tartaric Acid is added in small quantity, which acts as a solvent upon the salt, thereby converting it into a mass. This mass is incorporated with a little Glycerite of Starch, other- wise it soon loses its plasticity; it must therefore be rolled into pills as soon as formed. (7) Substances easily decomposed by organic matter. Potassium Permanganate and Silver Nitrate are quickly " re- duced " when incorporated with the excipients usually employed. These should be mixed with an inorganic diluent not affected by them, such as Kaolin, Pipe Clay, or Fuller's Earth, and made into a mass with Water, Petrolatum, Resin Cerate, etc. In order to disguise the bitter or otherwise disagreeable taste of pills, th.ey are usually coated with sugar or gelatin. These coated pills are often objectionable on account of the coating, or the pill itself, becoming quite insoluble. When a coated pill is desired, it should be freshly made and enclosed in a gelatin capsule of the smallest size. Pills may also be coated extemporaneously by rolling them on a piece of filter-paper saturated with Mucilage of Acacia, and then in powdered Milk Sugar. Keratin-cozied pills are designed for solution in the duodenum, the pills being dipped in a solution of Keratin prepared from horn shavings treated with pepsin and hydrochloric acid. Concentric pills are made up of concentric layers of different ingredients, intended to dissolve and become active at various stages in their passage through the intestinal tract. The following 1 5 Pills are official : SOLID MIXTURES FOR INTERNAL USE. 109 Pilule. Aloes aloes purif., soap, each Aloes et Asafoetidse . aloes, asafoetida, soap, each Aloes et Feiri . . aloes, iron sulph., arom. powder Aloes et Mastiches (Dinner Pill) ..... aloes mastic red rose Aloes et Myrrhge . ... aloes myrrh arom. powder Antimonii Comp antimony, sulphurated (Plummer's Pills) mild mercurous chlor. guaiac Asafoetidse asafoetida Catharticse Comp ext. colocynth comp. mild mercurous chloride extract of jalap gamboge Catharticse Vegetabilis . , . ext. colocynth comp. exts. hyoscyam., jalap, each ext. leptandra, res. podophyll oil peppermint Ferri Carbonatis ferrous sulphate (Ferruginous, Chalybeate, Blaud's) potass, carb. sugar 4; tragac, althsEa, each Ferri lodidi ^ reduced iron iodine glycyrrh., sugar, each ext. glycyrrh., acacia, each Opii soap 2 ; opium pulv. Phosphori » phosphorus althzea, acacia, each Rhei soap 6; rhubarb Rhei Comp rhubarb aloes myrrh oil peppermint IN EACH. Gm. for 100. eg. grams. 13 13 2 9 9 •i 7 7 I 13 "3 2 4 4 1 3 3 \ 13 13 2 6 6 I 4 4 1 4 4 1 4 4 1 8 8 't 20 20 3 8 8 ^ 6 6 I 3 3 \ •S i-S \ 6 6 I 3 3 \ '■S i-S i 0.8 0.8 \ 16 6 I 8 I 4 6 I 5 4 I 6.^ 6.S I 0.06 0.06 Tfftr 6 , . 20 20 3 13 13 2 10 10 «i 6 6 I 0-5 Excipient. Glyc. water. Conf. rose. Water. Syrup. Castor oil. Soap. Water. Water. Glyc. water. Water. Glyc. water. Water. Unofficial Pills of the National Formulary. When a large number of pills are to be prepared in accordance with the given proportions, and the quantities of the ingredients are to be determined by multiplying with the number of pills re- quired, it is recommended that the nearest whole number, or near- est convenient fraction, in each case, be chosen. Pilulse— Ad Prandium (Dinner Pills).— When " Dinner Pills," under this or some other equivalent" name, are prescribed without further specification, the National Formulary recommends that the Pilulse Aloes et Mastiches of the U. S. P., also called " Lady Webster's Dinner Pills," be dispensed. 1 Coated with ethereal solution of Balsam Tolu. ^ Phosphorus dissolved in Chloroform. no A TEXT-BOOK OF MATERIA MEDICA. Pilulse— Of other combinations bearing similar names or used for similar purposes, the following appear to be those most commonly in use : Chapman's Dinner Pill.^Kloes, Mastic, each, grains ij (o.i); Ipecac, grain i (0.06); Oil of Fennel, grain \ (0.015). Cole's Dinner Pill. — Aloes, Mass of Mercury, and Jalap, each, grains i^ (0.075) ; Ant. and Potas. Tartrate, grain ^^5- (0.0013). Hall's Dinner Pill. — Aloes, Ext. of Glycyrrhiza, Soap, and Molasses, each, grain i (0.06). Aloes et Podophylli ComposiTjE (Janeway's Pills). — Aloes, grain i (0.06) ; Resin Podophyllum, grain \ (0.03) ; Ext. Bellad. Ale, Ext. Nux Vomica, each, grain \ (0.015). Aloini Composite. — Aloin, grain \ (0.03) ; Resin Podophyl- lum, grain \ (o.oi); Ext. Belladonna, grain \ (0.015). Aloini, SxRYCHNiNiE et Belladonna. — Aloin, grain \ (o.oi Gm.) ; Strychnine, alkaloid, grain j|^ (0.0005 Gm.) ; Alco- holic Extract of Belladonna, grain J (0.008 Gm.). Aloini, Strychnine et Belladonna Composite. — Aloin, grain \ (0.012); Ext. Bellad. Ale, grain \ (0.008 Gm.); Strychnine, alkaloid, grain y^-jj- (0.0005) ; Ext. Rham. Pursh., grain \ (0.03). Antidyspeptica. — Strychnine, alkaloid, grain -^ (0.0014) ; Ipecac, Ext. Bellad. Ale, each, grain ^ (0.006) ; Mass of Mercury, Ext. Colocynth. Comp., each, grains 2 (0.13). Antineuralgica. — I. Gross' Antineuralgic Pills: Quinine Sulphate, grains 2 (o. 1 3) ; Morphine Sulphate, grain -^ (0.003) ; Strychnine, alkaloid, grain -^ (0.002) ; Arsenous Acid, grain ^ (0.003) ; Ex. Aconite Leaves (U. S. P. 1870), grain \ (0.03). When " Antineuralgic Pills," or " Neuralgia Pills," with- out other specifications, are prescribed, it is recommended that the above preparation be dispensed. Sometimes the Morphine is directed to be omitted. 2. Brown- Se quard' s Antineuralgic (or Neuralgia) Pills: Extracts of Hyoscyamus and Conium, each, grain f (0.04) ; Extracts of Ignatia and Opium, each, grain \ (0.03) ; Ext. Aconite Leaves, grain \ (0.02) ; Ext. Stramonium, grain \ (o.oi); Ext. Indian Cannabis, grain \ (0.015); Ext. Bellad. Ale, grain \ (o.oi). SOLID MIXTURES FOR INTERNAL USE. ill Pilulse— Antiperiodic^ (Warburg's Pills). — i. With Aloes : Aqueous Extract of Aloes, grain i (0.06) ; Rhubarb, grain \ (0.03) ; Elecampane, Saffron, Fennel, each, grain \ (0.015); Zedo- ary, Cubebs, Myrrh, White Agaric, Camphor, each, grain \ (0.008); Quinine Sulphate, grains if (0.085); Extract of Gentian, a sufficient quantity. 2. Without Aloes : The same formula as above, with omis- sion of the Aqueous Extract of Aloes. These pills have been introduced for the purpose of facilitating the adminis- tration of Warburg's Tincture in a solid form. When " Warburg's Pills " or " Pills of Warburg's Tincture " are prescribed, without further specification, those containing Aloes are recommended to be dispensed — those without Aloes only when they are expressly demanded. Each Warburg's Pill represents about i fluidrachm (4 Cc.) of Warburg's Tincture. (See Tinctura Antiperiodica) CoLOCYNTHiDis ComposiTjE (Pilulse Cochia). — Extract of Colo- cynth, grain \ (ooi) ; Aloes, Resin of Scammony, of each, grains 2 (0.13); Oil of Cloves, min. \ (0.015). CoLOCYNTHiDis ET Hygscyami. — Extract of Colocynth, grain Yj- (0.006) ; Aloes, Resin of Scammony, Ext. Hyoscyamus, each, grains i\ (o.i); Oil of Cloves, min. \ (0.0 1). COLOCYNTHIDIS ET PoDOPHYLLi. — Compound Extract of Colo- cynth, grains i^ (0.16); Resin of Podophyllum, grain J (0.015). Ferri Composite (U. S. P. 1880). — Myrrh, i^ grains (o.i); Ferrous Sulphate, Sodium Carbonate, each, f grains (0.048). Galbani ComposiTvE (U. S. P. 1880). — Galbanum, Myrrh, each, i^ grains (0.1); Asafoetida, \ grain (0.03). Glonoini (Nitroglycerin). — Spirit of Glonoin (i per cent.), Athsea, each, grains 200 (13.0); Confection of Rose, a suf- ficient quantity. Make a mass and divide it into two hun- dred (200) pills. Each pill contains -j-^ grain (0.0007) of Glonoin (Nitro-glycerin). Laxative Post-partum (Barker's). — Ext. Colocynth. Comp., .grains if (0.1) ; Aloes, grain f (0.05) ; Res. Podoph., Ipecac, each, ^ grain (0.005) ! Ext. Nux Vomica, -f^ grain (0.03) ; Ext. Hyoscyamus, i^ grains (0.8). This is the formula generally employed by Dr. Fordyce Barker, except where special circumstances render modi- 112 A TEXT-BOOK OF MATERIA MEDIC A. Pilulse — fications necessary. The formula usually quoted in manu- facturers' lists and some formularies is not correct. Metallorum (Metallorum Amarse). — Reduced Iron and Quinine Sulphate, each, grain i (0.06) ; Strychnine and Ar- senous Acid, of each, grain -^-^ (0.003). Aitken's Tonic Pill is a similar combination : Reduced Iron, grain f (0.04); Quinine Sulphate, grain i (0.06); Strychnine, Arsenous Acid, each, grain -^ (0.0012). Opii et CAMPHORiE. — Powdered Opium, i grain (0.06) ; Cam- phor, grains 2 (0.13). Opii et Plumbi. — Powdered Opium and Acetate of Lead, each, grain i (0.06). PoDOPHYLLi, Belladonna, et Capsici (Squibb's Podophyllum Pills). — Resin Podophyllum, grain \ (o.oij); Capsicum, grain \ (0.03) ; Ext. Bellad. Ale, grain \ (0.008) ; Sugar of Milk, grain i (0.06); Acacia, Glycerin, and Syrup, each, a sufficient quantity. Quadruplices (Ferri et Quininae Compositae). — Ferrous Sul- phate, Quinine Sulphate, Aloes, each, grain i (0.06); Ext. Nux Vomica, grain \ (0.015); Ext. Gentian, sufficient. Triplices (Triplex). — Aloes, grains 2 (0.13); Resin Podo- phyllum, grain \ (0.015); Mass of Mercury, grain i (0.06). When Pilula Triplex, under this name or some equiva- lent, is prescribed without further specification, the N. F. recommends that the above preparation be dispensed. A formula devised by John W. Francis is also in use : 2. Francis's Triplex Pill. — Aloes, Scammony, Mass of Mercury, of each, grain \ (0.05) ; Croton Oil, -^ min. (0.003); Oil of Caraway, grain \ (0.015); Tincture of Aloes and Myrrh, a sufficient quantity. UNOFFICIAL FORMS OF MIXTURES OF SOLIDS FOR INTERNAL USE. Granules are small pills, less than i grain (0.06) in weight, usually sugar-coated and containing alkaloids and other active drugs. Parvules are identical with granules. They are usually colored red or pink. Globules {Orbiculce) are sugar pellets to be saturated with alco- holic solutions of medicinal agents, chiefly in Homoeopathy. PREPARATIONS FOR EXTERNAL USE. 1 13 Compressed Pills are made by compressing powders into disks not exceeding 5 grains (0.3) in weight, without any excipient. Friable Pills are made by aggregation, spreading the powdered mixture upon nuclei or sugar granules in a revolving pan until the pills are formed. Bolus is the name given to pills exceeding 5-10 grains (0.3-0.6) in weight, used in veterinary practice. A sugar-coated bolus is called a Dragee. RotulcB are disk-shaped forms of sugar about i^ grains (o.i) in weight, which may be flavored with alcoholic solution (spirits). Bacilli are cylindrical sticks, a form of lozenge (Licorice). Laniellce, thin squares of gelatin in which the active agent has been incorporated, intended for solution in the eye. PREPARATIONS FOR EXTERNAL USE. To this group belong the liquid preparations : Liniments, Oleates and Collodions, and the mixtures of solids: Ointments, Cerates, Suppositories, Plasters, and Papers. The Vehicle, some- times incorrectly called the " base," consists chiefly of fatty sub- stances which serve as protectives or facilitate absorption. The Collodions are, however, an exception. The solid mixtures may be classified according to their fusi- bility, or melting-points, because their therapeutic uses, as well as their pharmaceutical forms, are through this quality respectively determined. Ointments fuse at the body-temperature, and therefore produce an emollient effect, or induce absorption of the medicinal substance by the system. They are applied by rubbing or inunction. Cerates have a higher fusing-point, due to Wax they contain ; the medicinal agent is not so readily absorbed, and they are there- fore used to produce local effects, being spread on cloth and applied as dressings. Suppositories have the same fusibility as cerates, and may be said to be cerates intended for application to the orifices of the body, both for absorption and local effect. Plasters have a still higher fusibility ; they do not melt, but become adhesive by the body-temperature, and are intended to produce local effects and afford mechanical support to the parts affected. 114 A TEXT-BOOK OF MATERIA MEDICA. The fusibilities of these various preparations are likewise gov- erned by the respective vehicles employed. LINIMENTA— LINIMENTS. The Liniments are liquid preparations for external use, consistr ing of solutions of oily or resinous constituents in Alcohol or Oils, or mixtures of liquid Soaps. The nine official Liniments are prepared by simple admixture or solution. Linimentum — Ammonia . . cotton seed oil 60 Cc. ; ammonia water 35 Cc. ; alcohol 5 Cc. Belladonnae . . . fl. ext. belladonna 95 Cc. ; camphor 5 Gm. Calcis (Carron Oil) . . linseed oil 50 Cc. ; lime solution 50 Cc. Camphorae .... cotton seed oil 80 Gm.; camphor 20 Gm. Chloroformi .... soap liniment 70 Cc. ; chloroform 30 Cc. Saponis camphor 4.5, soap 7, rosemary oil i ; alcohol 75 ; water, to 100 Cc. Saponis Mollis, alcohol 35 Cc; lavender oil 2; soft soap 65 Gm. Sinapis Comp. . . . fl. ext. mezereum 20; mustard oil, vol. 3, camphor 6 ; castor oil 15; alcohol, to 100 Cc. Terebinthinse . . resin cerate 65 Gm.; turpentine oil 35 Gm. Unofficial Liniments of the National Formulary. Linimentum — AcoNiTi ET Chloroformi. — Tincture of Aconite, Chloroform, each, 2 fluidounces (60 Cc.) ; Soap Liniment, 12 fluidounces (355 Cc). Ammonii Iodidi. — Iodine, 30 grains (2.) ; Oil of Rosemary, Oil of Lavender, each, no minims (7 Cc); Camphor, 220 grains (15.); Water of Ammonia, if fluidounces (50 Cc); Alcohol, enough to make 16 fluidounces (473.17 Cc). On standing, it becomes colorless. Cantharidis (U. S. p. 1880). — Oil of Turpentine containing 15 per cent, of Cantharides. loDi (similar to Ph. Br.). — Iodine, 900 grains (60.) ; Potassium Iodide, 360 grains (24.); Glycerin, \ fluidounce (15 Cc); Water, i fluidounce (30 Cc.) ; Alcohol, enough to make 16 fluidounces (473.17 Cc). Opii Compositum (Canada Liniment). — Tincture of Opium, i^ fluidounces (45 Cc.) ; Camphor, 1 20 grains (8.) ; Alcohol, 4 fluidounces (118 Cc.) ; Oil of Peppermint, 180 minims PREPARATIONS FQR EXTERNAL USE. 1 15 Linimentum— (12 Cc); Water of Ammonia, 6 fluidounces (180 Cc); Oil of Turpentine, enough to make 16 fluidpunces (473.17 Cc). Plumbi Subacetatis (U.S. p. 1880). — Solution of Lead Sub- acetate, 35 parts ; Cotton Seed Oil, 65 parts. Saponato-camphoratum (Opodeldoc; Solid Opodeldoc). — White Castile Soap, i^ ounces (45.); Camphor, J ounce (15.); Alcohol, 20 fluidounces (592 Cc); Oil of Thyme, 30 minims (2 Cc.) ; Oil of Rosemary, 60 minims (4 Cc.) ; Water of Ammonia, Fort., i fluidounce (30 Cc). TerebinthinjE Aceticum (Linimentum Album., Stokes' Lini- ment ; St. John Long's Liniment). — Oil of Turpentine, 3 fluidounces (89 Cc.) ; Fresh Egg, i ; Oil of Lemon, 60 minims (4 Cc.) ; Acetic Acid, 300 minims (20 Cc.) ; Rose Water, 2^ fluidounces (75 Cc). TiGLii (Linimentum Crotonis, Ph. Br.). — Croton Oil, 2 fluid- drachms (8 Cc); Oil of Cajuput, 7 fluidrachms (27.5 Cc). TiGLii CoMPOSiTUM. — Croton Oil, i fluidounce (30 Cc); Oil of Sassafras, i fluidounce (30 Cc); Oil of Turpentine, i fluidounce (30 Cc); Oil of Olive, 2 fluidounces (60 Cc). LOTIONES— WASHES. Lotio — Adstringens (Warren's Styptic). — A mixture of Sulphuric Acid, Oil of Turpentine, and Alcohol. Flava (Yellow Wash, Aqua Phagedsenica Flava, Ph. Ger.). — Corrosive Mercuric Chloride, 24 grains (i-S), in Lime Water, 16 fluidounces (473 Cc). Nigra (Black Wash; Aqua Phagedaenica Nigra, Ph. Ger.). — Mild Mercurous Chloride, 64 grains (4.), in Lime Water, 16 fluidounces (473 Cc). Plumbi et Opii (Lead-and-Opium Wash). — Lead Acetate, 120 grains (8.); Tincture of Opium, J fluidounce (15 Cc); in Water, 16 fluidounces (473 Cc). To be shaken when dispensed. The following are unofficial solutions and mixtures for external use: Injectio, -ones. — Aqueous solutions for introduction by means of a syringe in the orifices of the body. Il6 A TEXT-BOOK OF MATERIA MEDICA. InjecUo Hypodermica. — Solution for hypodermic or subcu- taneous injection. Enema, -atis ; Clyster. — A warm solution of Soap or a muci- laginous mixture for injection in the rectum to produce evacuation, or for nutrition. Gargarisma, -atis ; Gargle. — A wash or lotion for the throat. Collyrium, -i ; "Eye-wash." — A weak solution for instillation in the eyes. Nebula, -cb ; Spray. — A liquid intended for application by means of an atomizer. Vapor, -oris; Inhalation. — Volatile agents to be added to boiling water and inhaled, to affect the air-passages. Balneum, -ei ; Bath. — Mixture to be added to water for bath- ing purposes. OLEATA— OLEATES. The official Oleates are solutions of oleates in Oleic Acid. They are distinct from the solid oleates, which are made by double decomposition of salts of the metals and alkaline earths and sodium oleate, or Soap. (See Soap}) The liquid Oleates are intended for endermic medication. They are applied by inunction, when the Oleic Acid favors the absorp- tion of the medicinal agent, the oleate in solution. When it is not desirable to administer remedies by the mouth, the Oleates afford an effective form of medication. The solid Oleates are either dry powders, well adapted for pro- tectives as dusting powders, or soft, pliable masses to be applied in the form of ointments or plasters. Three are official — two liquid, and one. Zinc Oleate, semi-solid. They are made by incorporating the sohd with the Oleic Acid, contained in a warm mortar, and effecting solution with a gentle heat: Percentage by weight. Oleatum Hydrargyri .... yellow mercuric oxide 20. Oleatum Veratrinae veratrine 2. Oleatum Zinci Oxidi zinc oxide 5. Unofficial Oleates of the National Formulary. The following are simply solutions of the alkaloids in Oleic Acid: PREPARATIONS FOR EXTERNAL USE. 117 Oleatum — AcONiTiN^. — Contains 2 per cent, of crystallized Aconitine (Duquesnel's). QuiNiNiE. — Contains 25 per cent, of Quinine (Alkaloid). Of the solid Oleates introduced by Dr. J. V. Shoemaker, the following have been recognized, but others may also be prepared as desired: Oleatum Plumbi. — Contains about 28 per cent, of Lead Oxide. It is of the consistence and general character of Lead Plaster, and suggests similar use. Oleatum Zinci. — In the form of a soft white powder, useful as a " dusting powder,'' or converted into a plaster or ointment by mixing it with such proportion of Oleic Acid as may be required. OLEA IN FUSA— INFUSED OILS. These preparations are obtained by infusing a dry herb, usually from the so-called narcotic plants, in five times its weight of a mixture of equal parts of Cotton Seed Oil and Lard Oil. Oleum Hyoscyami Infusum is the most familiar example. Oleum — Carbolatum. — A mixture of Cotton Seed Oil with S per cent, of Carbolic Acid. Hyoscyami Compositum (Balsamum Tranquillans). — Infused Oil of Hyoscyamus, with a small proportion of each of the Ethereal Oils of Absinth, Lavender, Rose, Sage, and Thyme. COLLODIA— COLLODIONS. The Collodions are solutions in Ether-Alcohol of Pyroxylin or Soluble Gun Cotton. Upon evaporation of the solvent the remain- ing film excludes the air, thus protecting abraded surfaces. Col- lodion is also used as a vehicle when a prolonged local effect is desired. The following forms are official : Collodium . . solution in ether 75 ; alco. 25 ; pyroxylin 3 Collodium Flexile . . . castor oil 3 ; Canada turpentine 5 Collodium Acidi Tannic! . . alco. 5 ; ether 25 ; acid tan. 20 Collodium Cantharidatum (Blistering Collodion) . (flex. collo.) cantharides 60 Il8 A TEXT-BOOK OF MATERIA MEDICA. Unofficial Collodions. Collodium — loDATUM (Iodized Collodion). — Contains 5 per cent. Iodine in Flexible Collodion. loDOFORMATUM (Iodoform Collodion). — Contains 5 per cent. Iodoform in Flexible Collodion. Salicylatum Compositum (Corn Collodion). — Contains 1 1 per cent. Salicylic Acid and 2 per cent. Ext. Cannabis Indica in Flexible Collodion. TiGLii (Croton Oil Collodion). — Contains 10 per cent. Croton Oil in Flexible Collodion. UNGUENTA— OINTMENTS. Ointments are mixtures of a fatty vehicle with which medicinal agents are incorporated, readily fusing at the body-temperature, 35° to 40° C. (95° to 104° F.). The vehicles used are : Benzoated Lard, Ointment (simple), Lard, and Wax or Spermaceti in different proportions, Lard Oil, Olive Oil, and Suet. Petrolatum and Wool-fat (Adeps Lance Hydrosus, U. S. P.) are employed in unofficial ointments. The medicinal ingredients must be minutely distributed through the vehicle in order that the ointment may not prove irritating, and that the greatest possible surface be presented to the epidermis with a view to quick and uniform absorption. For this reason the highest quality of an ointment (next to its proper melting-point) is smoothness. In the preparation of ointments care must therefore be taken that the method employed be such as to yield smooth products. The melting-point is governed by the fusibility of the vehicle used, which is either officially directed, as in official preparations, or in extemporaneous preparations prescribed by the physician. The twenty-three official Ointments are prepared (i) by me- chanical admixture, (2) by fusion, or (3) by chemical reaction. Mixing the medicinal substances with the fatty body in a mor- tar or on a slab is the process usually employed for solid sub- stances, especially when insoluble in the fat. Powdered drugs, acids, alkaloids, extracts, and salts (not attended by chemical union) are examples adapted to this process. The following points must be observed : Solids must be in a fine powder before being incorporated with the vehicle ; sometimes it is an advantage to triturate the solid with PREPARATIONS FOR EXTERNAL USE. 119 a small quantity of a bland fixed oil, as Almond Oil or Olive Oil, into a smooth cream before it is mixed with the vehicle proper — Lard, etc. Extracts should be reduced to a semi-hquid condition by tritura- tion with a little dilute Alcohol or Water. Substances soluble in fats, such as Carbolic Acid, Iodine, and Camphor, may be dis- solved directly in the fat by the aid of a gentle heat. The following are the official Ointments, with their drug- strengths, their respective vehicles being given in parentheses : Percentage Unguentum — of Drugs. Acidi Carbolici (ointment) 5 Acidi Tannici (benz. lard) 20 Aquae Rosae (Cold Cream) . . spermaceti 12.5 ; white wax, 12; expressed oil of almond 60 then incorporate borax 0.5 ; rose water 19 Belladonnae (dil. alcohol 5) extract . . . (benz. lard) 10 Chrysarobini (chrysophanic acid) " 5 Diachylon (Hebra's) lead plaster 50 oil lavender i ; olive oil 49 Gallae (benz. lard) 20 Hydrargyri (Blue Ointment) mercury 50 mercuric oleate 2 ; suet 23 ; lard 25 Hydrargyri Ammoniati (benz. lard) 10 Hydrargyri Oxidi Flavi (ointment) 10 Hydrargyri Oxidi Rubri (castor oil 5) . . . " 10 lodi (potass, iod. i, water 2 parts) .... (benz. lard) 4 lodoformi " 10 Picis Liquidae . . . yellow wax 12.5 ; lard 37.5 ; tar 50 Plumbi Carbonatis (benz. lard) 10 Plumbi lodidi " 10 Potassii lodidi (sod. hypo, sulph. i ; water 10) " 12 Stramonii (dil. ale. 5) Extract " 10 Sulphuris (washed) " 30 Veratrinae (olive oil 6) " 4 Zinci Oxidi " 20 Unofficial Ointments of the National Formulary. Unguentum Acidi Gallici (U. S. P. 1880). — Contains 10 per cent. Gallic Acid. I20 A TEXT-BOOK OF MATERIA MEDICA. Unguentum Calamine (Unguentum Zinci Carbonatis Im- puri; Turner's Cerate).— Contains 17 per cent. Zinc Car- bonate (Imp.). Unguentum Camphors (Unguentum Camphoratum). — Con- tains 20 per cent. Camphor. Unguentum Fuscum (Unguentum Matris; Mother's Salve). — Contains 50 per cent, of Camphorated Brown Plaster (N. F.). Unguentum Mezerii (U. S. P. 1880).— Represents 25 per cent. Mezereum. Unguentum Picis Compositum (Tar, Comp.). — Contains Oil of Tar, 4 per cent. ; Tincture of Benzoin, 2 per cent. ; and Oxide of Zinc, 3 per cent. Unguentum Sulphuris Alkinum (U. S. P. 1880). — Contains 20 per cent. Sulphur and 10 per cent. Potassium Carbonate. Unguentum Sulphuris Compositum (Wilkinson's Ointment; Hebra's Itch Ointment). — Precipitated Calcium Carbonate, 10; Sublimed Sulphur, Oil of Cade, of each, 15; Soft Soap and Lard, of each, 30 parts. The Lard is mixed with the Soft Soap and Oil of Cade; the Sublimated Sulphur and Precipitated Calcium Carbonate are then grad- ually incorporated. CERATA— CERATES. Cerates are mixtures of fats similar to the ointments, but of firmer consistence, because they contain Wax or Resin (having a higher melting-point than Lard) in greater proportion than do oint- ments. In the preparation of Cerates the same rules are to be observed as noted under Ointments. The six official Cerates are prepared by fusion or simple admix- ture, and one by extraction and digestion (Ceratum Cantharidis) : Percentage of Drugs. Ceratum (Simple) lard 70 ; white wax 30 Camphorae . camphor liniment 10; lard 60; white wax 30 Cantharidis (Blistering Cerate) . . .oil of turpentine 15 lard, 22 ; cantharides 32 yellow wax, resin, each 18 previously fused, and evaporate to 100 Cetacei . . . olive oil 55 ; white wax 35 ; spermaceti 10 PREPARATIONS FOR EXTERNAL USE. I3I Percentage of Drugs, Plumbi Subacetatis (Goulard's Cerate), camphor cerate 80 solution lead subacetate 20 Resinae (Basilicon) . . yellow wax 15 lard 50; resin 35 in cold weather yellow wax 12; lard 53 ; resin 35 In the " Blistering Cerate " the maceration in Turpentine Oil and subsequent digestion dissolve the vesicating principle of the Cantharides, and the preparation is therefore more active. Ceratum CAMPHORiE CoMPOsiTUM, N. F. (Camphor Ice). — Moulded into small cakes suitable for popular use as an appHca- tion to excoriated surfaces. It contains very small quantities of Benzoic and Carbolic Acids. Ceratum Extracti Cantharidis (U. S. P. 1880). — Repre- sents 30 per cent. Cantharides. Ceratum SabinjE (U. S. P. 1880). — Represents 25 per cent Sabine. SUPPOSITORIA— SUPPOSITORIES. Suppositories may be defined as variously shaped masses of medicated fat, possessing a consistence ensuring their quick fusion when introduced in the orifices of the body. The U. S, P. defines Suppositories with reference to their weights and shapes, corresponding to their several uses — i. e. for introduction in the respective orifices of the body — as follows : Rectal, cone-shaped, should weigh 15 grains (i Gm.). Urethral, pencil-shaped, should weigh 15 grains (i Gm.). Vaginal, globular, should weigh about 45 grains (3 Gm.). The vehicle is Cacao Butter {Oleum Theobromatis), which pos- sesses the property of melting at the temperature of the human body, 35" C. (95° F.), and yet remaining firm at ordinary tempera- tures. An addition of 10 per cent, of spermaceti has been recom- mended to raise the melting-point and thus give more stability to suppositories during the heated seasons of the year. The U. S. P. gives a general formula for preparing supposi- tories ; only one Suppository is official, and this is not made from Cacao Butter. The methods of preparing suppositories are quite numerous : any process may be employed by which the product is obtained uniform in size and shape and with the medicinal ingredients thor- 122 A TEXT-BOOK OF MATERIA MEDJCA. oughly incorporated. Moulds are usually employed ; the medici- nal ingredients, if solid, are first reduced to powder in a mortar, and mixed with a small quantity of the grated Fat ; the remainder of the Fat, previously melted and cooled to 35 ° C, is then gradually incorporated with this mixture, thoroughly mixed, and, if possible, without further heating, poured into the moulds, previously chilled. Another process consists in rolling the mass on a slab, cutting it as in making pills, and forming the cones with the fingers. By cold compression in a screw-press " machine," suppositories may be formed from the prepared mass. Urethral Suppositories are commonly called Bougies, or, more properly, Medicated Bougies. They are usually made with the addition of Wax, or from Glyco-gelatin mass. Suppositoria Glycerini. — Made by reaction of Sodium Carbonate 5 grains (0.3), in Glycerin i^ grains (6 Gm.), with Stearic Acid 8 grains (0.5), and heating until a solution of sodium stearate or soap is formed, which is poured into a mould. Upon cooling, the mixture gelatinizes and the suppository is wrapped in tin-foil. Uses. — Upon introduction into the rectum the mass melts, and the Glycerin, acting upon the feces, produces evacuation. Rectal suppositories are usually made twice the official size, or 30 grains (2 Gm.). 1 A formula for suppositories would be : Extracti Belladonnse FoL, ale, o.i ; Acidi Tannici, i .0 ; Olei Theobromatis, q. s. (20 Gm.). Ut fiat suppositoriae No. x. (2 Gm.). Each suppository would contain \ grain (o.oi) Ext. Belladonna and \\ grains (o.i) Tannic Acid. EMPLASTRA— PLASTERS. Plasters are mixtures of various fatty or resinous solids of such high melting-point as to be friable when cold, but rendered adhesive by the warmth of the body. The vehicles of plasters are : Lead plaster ; resinous substances, made adhesive by admixture with the medicinal ingredients ; and simple plasters, such as isinglass. The making of plasters does not differ materially from the pro- cess employed for ointments and cerates, since they are all prepared by melting the various substances and incorporating the inedicinal PREPARATIONS FOR EXTERNAL USE. 123 substances last. The spreading of plasters, though usually done on a large scale, may be easily effected by the pharmacist with the use of a plaster iron. The thirteen official Plasters may be divided into — (i) Lead Plasters ; (2) Pitch and Gum-Resin Plasters, and (3) Isinglass Plaster. (i) The most important plasters are made from Lead Plaster, or Lead Plaster mixed with Resin, the official Resin Plaster. Percentage or Emplastrum— P""-'' '" '°°- Plumbi (Diachylon) .... olive oil 60; lead oxide 32 mix, and add to water 10 Boil the mixture until the reaction has ceased and the plaster is of the right consistence, replacing water lost by evaporation from time to time. Resinae (Adhesive) yellow wax 6 ; resin 14 lead plaster 80 Saponis lead plaster 90 ; soap 10 From these the following are prepared : Emplastrum — Arnicae resin plaster 67 ; extract arnica root 33 Belladonnse ext. belladonna leaves 20 resin plaster, soap plaster, each 40 Capsici . . . resin plaster, oleoresin capsicum q. s. Hydrargyri, lead plaster 70 ; mercury oleate 1.2; mercury 30 Containing lead plaster and pitch : Emplastrum — Ferri (Strengthening) . . . olive oil, 5 ; ferric hydrate 9 Burgundy pitch 14; lead plaster 72 Opii . Burgundy pitch 18 ; lead plaster yS; ext. opium 6 Picis Cantharidatum (Warming) . . . Burgundy pitch 92 cerate cantharides 8 (2) Pitch and Gum Resin Plasters : Emplastrum — Ammoniaci cum Hydrargyro .... oleate mercury 0.8 mercury 18 ammoniac 72; dil. acetic acid, lead plaster, to 100 Picis Burgundicae olive oil 5 ; yellow wax 1 5 Burgundy pitch 80 124 A TEXT-BOOK OF MATERIA MEDICA. (3) Isinglass plaster (Emplastrum Ichthyocollae ; Court-plaster). — A solution of 10 Gm. Isinglass is dissolved in hot Water 120 Gm. ; one-half of the solution is spread upon silk (taffeta) in suc- cessive layers, and when dry the other half of the solution is spread on in a similar manner, after first having been mixed with Alcohol 40 Gm., Glycerin i Gm. The taffeta is then coated on the reversed side with Tincture of Benzoin to make it waterproof and antiseptic. Unofficial Plasters of the National Formulary. £mplastrum — Ammoniaci (U. S. p. 1880). — Gum- resin Ammoniac with Acetic Acid. Aromaticum (Spice Plaster). — Consisting of Cloves, Cinna- mon, and Ginger, each, 10 per cent.; Capsicum and Cam- phor, each, 5 per cent. AsAFCETiDiE (U. S. P. 1880). — Asafoetida 35 p.; Galbanum 15 p. ; with Lead Plaster. FuscuM Camphoratum (Matris Camphoratum, Ph. Ger.). — Camphorated Mother's Plaster. A plaster similar to lead plaster, and containing camphor, i per cent. Galbani (U. S. P. 1880). — Galbanum Plaster. Picis Canadensis (U. S. P. 1880). — Canada Pitch Plaster. Picis Liquids Comp. — A mixture of Resin and Tar, with Podo- phyllum, Phytolacca, and Sanguinaria, of each, 10 per cent. CHARTjE— PAPERS. There are two Papers official. One is made by saturating strips of white unsized paper in a 20 per cent, solution of Potassium Nitrate and diying; the other is paper coated with Mustard, used similarly to the Plasters : Charta Potassii Nitratis .... potass, nitrate 20 ; water 80. Vapors from incineration as inhalant. Charta Sinapis . . oil-free black mustard, 4 Gm. in 60 sq. cm. The Mustard is freed from the fixed oil by extraction with Ben- zin, and mixed with a solution of India Rubber in equal volumes of Benzin and Carbon Bisulphide, and spread upon Paper. This is the well-known Mustard Plaster or Mustard Paper. When applied, the paper should be immersed in lukewarm water for a few minutes, in order to render the vesicating principle active. Charta Cantharidis, U.S. P. 1880. — Cantharidis Paper (Blis- tering Paper). PREPARATIONS FOR EXTERNAL USE. 125 Poultice or Cataplasm (Lat. Cataplasm, -atis). — A coarsely ground substance or mixture of substances, such as flaxseed or elm-bark, made into a mass with hot water or some other liquid, spread upon cloth or filled into porous bags, and applied to the body while hot. Fomentations (Lat. Fometitum, -i). — Porous woollen cloths sat- urated with hot infusion or decoction of herbs, or other hot liquids or lotions, and apphed hot. Spongiopiline. — A thick cloth covered with layers of sponge for the saturation and retention of medicinal agents intended for absorption, the exterior being composed of waterproof material, such as rubber. Plaster-Mull. — A thin cloth made impervious with rubber or gutta-percha tissue, upon which is spread or painted medicinal agents in the liquid form, intended for local application. Caustics or Escharotics (Lat. Escharotica, -cb). — Substances, used to destroy tissue by chemical action or by heat, either semi- solid mixtures made into a paste with starch or other diluent, or chemicals fused and moulded into sticks called pencils or " crayons " (Lat. stilus, -i), to be apphed directly to the skin. Moxa is the name given to small cones of combustible substances which upon incineration do not inflame, but give off an intense heat, used for cauterization when heat is desired. Bandages; Antiseptic Dressings. — The material used for bandages is cellulose in various modifications, such as cotton, linen, jute, and other fibrous substances. Aside from the me- chanical support afforded, bandages also serve to keep wounds clean by absorbing and withdrawing secretions (pus) which would otherwise prove irritating, and by protecting them against extrane- ous matter serve to promote the healing process. These various substances may be used either plain or medi- cated, when they are called antiseptic. Gossypiuin Purificatum, U. S. P.; Absorbent Cotton. — The hairs of Gossypium herbaceum L., freed from oil and resinous substances by treatment with alkalies and bleaching agents. These hairs rep- resent microscopic ducts in which liquids are absorbed through capillarity. The freer from oily constituents, the more readily will watery liquids be taken up and retained ; hence the absorbability of cotton depends upon its purity. This is equally true with all other bandage material. Linen in the form of thin sheets, known as Muslin or Muslin- J26 A TEXT-BOOK OF MATERIA MEDICA. gauze, or purified similarly to cotton, when it is called Lint, is made from the bast-fibres of the Linum usitatissimum L., Flax. Hemp and Jute are the bast-fibres of their respective plants. Medicated Dressings. — These are made by saturating the ma- terial or vehicle in a solution of certain strength of the medicinal agent, or incorporating the latter in powdered form. In the appli- cation of a dressing which has been rendered aseptic or antiseptic by impregnating it with Phenol (Carbolic Acid), Salicylic Acid, Mercuric Chloride, or similar agent, it is desired to bring in con- tact with the wound a solution of certain strength — for example, a 5 or lo per cent, solution of Phenol, a ^^g- or ^ of i per cent, solution of Mercuric Chloride, etc. The quantity of material which conveys the agent is of no consequence, as the fabric simply serves as a vehicle for the medicinal or antiseptic agent. The strengths of such dressings should therefore be designated by the percentage^ strength of the solutions by which they are saturated, rather than by the percentage by weight of the medicinal agent the finished dress- ing may contain. In dressings of antiseptic agents that are usually applied in sub- stance, such as Boric Acid and Iodoform, the percentage-amount actually contained by weight in the finished dressing should be stated. Here the use of a vehicle is only a matter of convenience, and it is desirable to know just how much of the medicinal agent is contained in a certain quantity by weight or by area of the dressing. Medicated Cottons. — Purified cotton is saturated in a solution in Water, or Glycerin and Water, of the strength desired of the medicinal agent, and thoroughly expressed. The following are the usual strengths : Percentage. Gossypium Boratum acid boric S or 10 Carbolatum phenol 5 or 10 lodoformatum iodoform 10 to 20 Salicylatum acid salicylic 10 to 20 Stypticum Monsel's solution Sublimatum mercuric chloride ^ to -^ . Iodoform, being insoluble in Water, should be dissolved in Ether or, preferably, in a mixture of Alcohol and Glycerin. Medicated Gauzes ; Carbasa. — The material used for making Medicated Gauzes is a muslin gauze free from sizing or other ex- traneous matter. The gauze is thoroughly impregnated with the PREPARATIONS FOR EXTERNAL USE. 127 solution of the particular strength required, then forcibly expressed, after which it is ready for use ; or, if desired for future use, it should be tightly rolled, wrapped in parchment paper, and kept in closely covered boxes in a cool, dry place. The following are the most commonly used Gauzes and their strengths : Percentage. Carbasus Boratum acid boric 5-10 Carbolatum phenol 5-10 lodoformatum iodoform 10-20 Salicylatum acid salicylic 10-20 Sublimatum mercuric chloride ^(^ ^^ The Iodoform Gauze is made in the same way as the Cotton, by saturation with a solution of Iodoform in Alcohol and Glycerin. All the others, except the Mercurial Gauze, contain Glycerin. Mercuric Chloride is dissolved in Water with a little Acid Tartaric (5 parts for i of Mercuric Chloride), the presence of which in the Gauze prevents the formation of insoluble albuminate of mercury when it is brought in contact with the albuminous discharges from wounds. Plaster-of-Paris bandages are made by thoroughly incorpo- rating Calcium Sulphate (gypsum) into linen bandages. When applied, the bandage, after being dipped in water, sets hard and firm in a few minutes. CLASS I.-DISEASE MEDICINES. DIVISION I.— RESTORATIVES. GROUP I.— DIGESTANTS. [In the present work care has been taken to designate the proper pronunciation (Foster) of the names of drugs and their preparations common to Materia Medica and Therapeutics. The simplest and most efficient method appears to be that herein fol- lowed — namely, to indicate accent and quantity by a single sign ; for example, Pep- slnum (nom.) — Pepsini (gen.), in which the i is long and the accent upon the second syllable; Cflcculus — C6cculi, in which the o is short and the accent upon the first syllable. In nearly all cases the genitive, as used in prescription-writing, and the English equivalent, are given. When the accusative, not genitive, is adopted, tlje usage is marked by "(ace.)"; as Pilulse, Pilulas (ace), etc.] Pepsinum—PepsTni— Pepsin. U. S. P. Origin. — A proteolytic ferment or enzyme obtained from the glandular layer of fresh stomachs from healthy pigs, and capable of digesting not less than 3000 times its own weight of freshly coagulated and disintegrated egg albumen when tested by the process given in the United States Pharmacopoeia. Description and Properties. — A fine white, or yellowish-white, amorphous powder, or thin, pale yellow, or yellowish, transparent or translucent grains or scales, free from offensive odor, and having a mildly acidulous or slightly saline taste, usually followed by a suggestion of bitterness. It slowly attracts moisture when exposed to the air. Soluble, or for the most part soluble, in about 100 parts of water, with more or less opalescence ; more soluble in water acid- ulated with hydrochloric acid ; insoluble in alcohol, ether, or chlo- roform. Pepsin usually has a slightly acid reaction. It may be neutral, but should never be alkaline. Dose. — 5~6o gr. (0.3-4.0 Gm.). 9 129 130 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparations. Pepsinum Saccharatum — Pepsini Saccbarati — Saccharated Pepsin. Formula : Pepsin 10, Sugar of Milk 90 parts. Dose, 30 gr.-4 dr. (2.0-16.0 Gm.). Antagonists and Incompatibles. — Tannic and gallic acids are incompatibles. Mineral salts, alcohol, and alkalies precipitate pep- sin from solution, the two latter impairing its digestive property. The " Wine of Pepsin " is therefore unreliable. Synergists. — Diluted hydrochloric, lactic, acetic, and citric acids increase its digestive action. Physiological Action. — Its only influence seems to be upon the digestive system. Pepsin is a typical restorative, being a normal constituent of the gastric juice, and in the presence of hydrochloric acid digesting the nitrogenous elements of the food, converting them into peptones or albumoses. Therapeutics. — Externally and Locally. — Its digestive action is utilized to dissolve or digest the false membrane in diphtheria and croup. A solution of pepsin has also been injected into the blad- der to digest blood-clots. It has been further recommended as an application to cancer of the cervix uteri. Internally. — As a restorative, where there is a lessened secre- tion of gastric juice, atonic dyspepsia, apepsia of infants, cancer of the stomach, and gastric ulcer, pepsin has proved serviceable. It is also employed to favor digestion in convalescence from acute and long illness. It is frequently necessary to give pepsin, or " pepton- ized milk," in acute dyspeptic diarrhea of infants. Administration. — Pepsin should be given in powder or dis- solved in glycerin (Glycerol of Pepsin), or in water acidulated with hydrochloric acid, directly after meals. The drug should not be given continuously for too long a period, lest the function of the stomach become impaired from disuse, the artificial digestion having replaced the natural, normal process. Unless there be some direct indication for its use, rather than give pepsin it is better to stimulate the gastric glands to secrete a larger amount of their normal juice, that they may not lie idle, and their function be consequently impaired by disuse. Hydro- chloric acid administered with pepsin probably slightly promotes glandular activity. Often, however, pepsin must be given, and in certain cases the stomach is in such a condition that nutrient en- emata must be administered. Yet, since the rectum possesses very DIGESTANTS. 131 feeble powers of digestion, the food should always be predigested. Suppositories of peptonized meat are frequently used for this purpose. Pancreatlnum— Pancreatlni— Pancreatin. V. S. I*. Origin. — A mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog. Description and Properties. — A yellowish, yellowish-white, or grayish amorphous powder, odorless, or havipg a faint, peculiar, not unpleasant odor, and a somewhat meat-like taste. Slowly and almost completely soluble in water, insoluble in alcohol. Pancreatin digests albuminoids and converts starch into sugar. Prolonged contact with mineral acids renders it inert. Dose. — 10-20 gr. (0.6-1.2 Gm.). Antagonists and Incompatibles. — Mineral acids. Synergists. — Alkalies and the digestive ferments. Physiological Action. — The four ferments which it contains render it capable, in alkaline media, of digesting albuminoids ; emulsifying fats and oils, and resolving them into fatty acids and glycerin ; converting starch into sugar ; and curdling milk. Therapeutics. — Like pepsin, it is used as an artificial agent in certain disorders of digestion. Administration. — It may be given dry, in powder, capsules, or compressed pills, or in solution. It should be administered in combination with an alkali, as the activity of pancreatin is de- stroyed by acids, and should be given ordinarily from two to four hours after meals, when the chyme has entered the intestine. It •may also be administered immediately after eating or with the food, since there is an interval of from fifteen minutes to half an hour after the ingestion of food before the stomach-contents are ren- dered sufficiently acid by the gastric juice to interfere with the activity of the pancreatin. For rectal nourishment pancreatin is preferable to pepsin, be- cause of its superior action in predigesting food. Papain, Papoid, or Papayotin. Origin. — The inspissated juice of the unripe fruit of Carica Papaya. Description and Properties. — A whitish, slightly astringent powder, soluble in water. 132 A TEXT-BOOK OF MATERIA MEDICA. Dose. — 1-8 gr. (0.06-0.5 Gm.). Antagonists and Incompatibles. — Tannic and gallic acids. Lead salts and alcohol are incompatible with papain. Synergists. — The digestive ferments. Physiological Action. — In this it resembles pepsin, though dif- fering from the latter, as well as from paricreatin, in that it is equally active in neutral, alkaline, or acid media. It converts pro- teids into soluble peptones, and acts as a stimulant to the gastric glands. It converts starch into maltose, and upon false membranes acts more energetically than pepsin. It dissolves intestinal worms. Therapeutics. — Externally. — The uses of papain are more mani- fold than those of the digestive ferments previously mentioned. Like pepsin, it has been successfully employed to dissolve false membrane in diphtheria and croup. The juice of pineapple, which possesses a ferment (bromelin) similar to that of papain, is a val- uable domestic remedy in these diseases. Papain has been used with some benefit in indurated eczema and in syphilitic ulcerations of the tongue. It has been highly recommended by Johnston as a solvent oi cerumen: 15 drops (i.o Cc.) of a solution of 20 grains to I oz. (1.2 Gm-30 Cc.) of distilled water are dropped into the outer meatus, and the parts syringed an hour afterward with a solution of boric acid. Internally, papain may be used for the same purposes as pepsin and pancreatin ; yet, while theoretically superior, it is practically inferior to them, fortunately not having supplanted them in actual practice. Administration. — When used to aid digestion, papain should be given after meals, either in powders, capsules, compressed tablets, or aqueous solution freshly prepared. GROUP II.— FATS AND OILS. Oleum Morrhuae— Olei Morrhuae— Cod Liver Oil. V. s. p. Origin. — A fixed oil obtained from the fresh livers of Gadus Morrhua L. and other species of Gadus. Description and Properties. — A pale-yellow, thin, oily liquid, having a peculiar, slightly fishy, but not rancid odor, and a bland, slightly fishy taste. Specific gravity 0.920 to 0.925 at 15° C. (59° F.). Scarcely soluble in alcohol, but readily soluble in ether, FATS AND OILS. 133 chloroform, or carbon disulphide, also in 2.5 parts of acetic ether. It contains several glycerides, the principal one being olein, traces of iodine, bromine, chlorine, biliary salts, phosphoric and sulphuric acids, a peculiar principle (gaduin), and several alkaloids. MoRRHUOL, a name given by Chapoteaut to a mixture of the various alkaloids and important principlies of cod liver oil, occurs as an amber-brown, bitter, aromatic liquid. Dose. — 1-4 fluidrachms (3.8-15 Cc). Physiological Action. — Externally and Locally. — It possesses emollient properties, and may be applied to the skin and mucous membranes without causing irritation. It slightly reduces tempera- ture in fever when applied to the body. Internally. — Fat is a normal and necessaiy constituent of the body. It is the fuel used to supply force, and those tissues and organs which are the most energetic require the most fat. Conse- quently, nerves, muscles, and glands are more abundantly fur- nished with fat than cartilage, and in cases of starvation those structures demanding the greater supply must have it, at the ex- pense of the less highly organized and active tissues — as is seen in the great emaciation preceding the decline of mental powers. The blood contains about one-half of i per cent, of fat ; the muscles, 3 per cent. ; the brain, 8 per cent. ; and the nerves 22 per cent. In order, therefore, that the various cells of the body may possess sufficient vitality to withstand by physiological resistance the en- croachments of disease and the invasion of pathogenic micro-or- ganisms, this equilibrium must be maintained. Yet this necessary food, fat, is more frequently deficient than any other, from the difficulty either of obtaining a supply or of digesting and assimi- lating it. Dr. Hughes Bennett was near the truth in observing that " the main causes of tuberculosis are the dearness of butter and the abundance of pastry-cooks," intimating that the poor and underfed are unable to obtain sufficient fat, while the digestion of the wealthy class is deranged by pastries, so that they are unable to assimilate a proper amount of fat. Dr. Brunton cites the case of a barrister who before pleading a case invariably took a full dose of cod liver oil, believing that it rendered his mind more active. Before oils or fats can enter the various cells and act as food, and consequently a source of power, they must be digested and assimilated by the system. The value of an oil is based upon — (i) 134 A TEXT-BOOK OF MATERIA MEDIC A. Its rate of absorption ; (2) its rate of oxidation ; (3) its agreeable taste. Cod liver oil, while to many persons repugnant in taste, is more readily absorbed and oxidized than any other fat. It has already been prepared by the liver, and therefore partly elaborated, and, owing to the biliary salts which it contains, it passes more readily through animal membranes. Moreover, Naumann has shown that cod liver oil is more easily oxidized than any other oil, rendering . this substance almost an ideal ready-made food. Its actions upon the several systems are here considered. Digestive System. — Large doses disturb the stomach and may even occasion vomiting, but in medicinal doses alone, or in the form of an emulsion, it may be taken usually. without discomfort, in some cases even increasing the appetite. In the stomach cod- liver oil is unaffected, but in the intestines it meets the pancreatic juice, which resolves a portion of it into glycerin and fatty acids, the latter combining with the alkalies of the bile and the intes- tinal juice to form soaps, while the remaining, and larger, por- tion is emulsionized by the alkaline secretions of the intestines. Circulatory System. — The number of red corpuscles is increased and the quality of the blood is greatly improved. Nervous System. — This shares with the other tissues of the body the general amelioration, the drug being a food and tonic to the brain and nerves. Respiratory System. — No special action is noticeable other than the natural improvement in the respiratory power incidental to better blood and an increased functional activity of the nerves and muscles. Absorption and Elimination. — Cod liver oil can be absorbed only after it enters the intestines. The glycerin and fatty acids formed by the pancreatic juice, having a great affinity for water, readily diffuse through the mucous membrane; the soaps produced by the action of the bile and the intestinal juice are also readily ab- sorbed by osmosis. The oil remaining, as has been stated, is emulsionized — that is, it is subdivided into minute globules each enclosed in an envelope composed of alkaline albuminate and soap, which has a great affinity for the mucous membrane and carries the oil through the columnar epithelium of the intestinal villi into the lymph-spaces. The osmosis inward of the oil-emulsion is rendered still easier by the action of the bile with which the mucous membrane is bathed. FATS AND OILS. 135 Oils and fats which are absorbed and not needed for cell-food are deposited beneath the skin as subcutaneous fat.serving as a protection against external cold as well as a reserve supply in case the economy needs more fat than can be taken into the system and assimilated. The weight, therefore, is usually greatly increased under the administration of cod liver oil. It will be seen that much of the oil taken into the system is oxidized, being subsequently excreted as carbonic acid and water. Temperature. — When taken internally the temperature is unaf- fected, but, as has been observed, when applied to the epidermis the bodily heat is reduced. Untoward Action. — In addition to disturbances of digestion sometimes occasioned by moderate doses, cod liver oil at times produces a vesicular eczema which may spread over the entire body. This eruption is probably caused by the volatile fatty acids which the oil contains. Poisoning. — Cod liver oil possesses no poisonous action. Therapeutics. — Externally and Locally. — Cod liver oil is much used by dermatologists in diseases of the skin, being especially ser- viceable in softening the crusts of eczema. It has been applied to the skin to allay irritation and for the reduction of temperature in the exanthemata. In cases of marasmus and rachitis, and in wasting diseases generally, it is a valuable remedy to sustain the vital energy and improve nutrition, the oil being given in the form of baths. Daily inunctions are beneficial in chronic scaly skin diseases, while a local application to the chest has seemed at times to influ- ence favorably the course of pertussis. Local applications have also been adopted empirically, and with satisfactory results, in chronic rheumatism and rheumatoid arthritis. Internally. — For two or three centuries cod liver oil has been used both externally and internally for chronic rheumatism, but it is only since 184 1 that it has been employed in the treatment of tuberculosis. While to-day it does not receive the enthusiastic support which attended its introduction in the latter disease, it is nevertheless a standard and highly efficacious remedy in the various forms of the disorder. It is equally valuable in scrofulous affections, and even more potent in rachitis. Chronic bronchitis is perhaps more frequently relieved by its use than by any other internal remedy. Diseases resulting in anemia are usually more benefited by cod liver oil than, by other remedial agents. Chronic arthritis. 136 A TEXT-BOOK OF MATERIA MEDTCA. fistula, and abscess in the neighborhood of the joints have been greatly improved by its use. Atheroma of the arteries and many cutaneous diseases, particularly the strumous variety, and syphilo- dermata yield to its alterative and nutrient properties. Probably no single drug is employed in nervous diseases with effects so markedly beneficial as those of cod liver oil. While possessing no specific action, it increases the strength and vitality of the patient, enabling him to resist morbid tendencies more suc- cessfully, and, by augmenting the force-producing material and improving the condition of the nerves, lessens the liability to nervous derangement. Diabetes mellitus and Bright' s disease, with anemia yet unat- tended by marked digestive disturbance, are decidedly improved by the administration of cod liver oil. Should no gastric disorder supervene, this remedy should invari- ably be given in the last-named diseases. It certainly ^erves to maintain the general health, and is singularly efficacious in pro- longing the lives of the afflicted patients, enabling them to profit by hygienic measures, upon which great reliance should be placed. The tonic and nutritive properties of the drug have been strikingly shown in the rapid improvement of patients convalescing from acute diseases. In catarrhal conditions, especially in ozena and otitis following measles and scarlet fever, it is of marked benefit. Without entering upon specific considerations other than the above, it will be seen that cod liver oil is indicated whenever there is defective activity, whether inherited or acquired. Contraindications. — It is to be remembered that cod liver oil is a food and not a medicine : it is therefore contraindicated in all diseases where it proves detrimental to the appetite, causing eruc- tation, heartburn, diarrhea, etc. It is usually contraindicated in fevers, owing to the suspension of the secretions and impairment of digestion characteristic of acute febrile disorders. Administration. — In the early use of cod liver oil it is advis- able to prescribe small doses, that its toleration by the stomach may be gradually acquired. To many patients, however, it is ex- tremely distasteful, and the repugnance is increased rather than lessened by continued use. In such cases it is better, if possible, to disguise the taste and smell in some manner rather than to abandon so valuable a remedy when clearly indicated. Various means have been employed for this purpose. An emulsion may be made which obviates its disagreeable qualities. There are in MINERAL ACIDS. 137 the market soft capsules containing this oil, that serve an excellent purpose, being easily swallowed and disguising completely the taste and odor of the drug. Administration should occur ordi- narily some time after meals, that the oil may reach the intestines as soon as possible. GROUP III.— MINERAL ACIDS. Mineral Acids are classed here as Restorative Medicines, be- cause three secretions of the body — the perspiration, urine, and gas- tric juice — are normally of acid reaction, the last-named on account of its acidity to hydrochloric acid. Sulphuric and nitric acids are not normal constituents of the body, and are by some authors classed as astringents, although the action and medical uses of these inorganic acids will here be considered. There are, however, certain characteristics common to all mineral acids which claim pri- mary attention : 1. Concentrated mineral acids are caustic to a greater or less degree. 2. They combine with alkalies and alkaline earths to form salts, and unite with vegetable acids, setting them free from their com- bination with bases. 3. When in contact with the tissues of the body they combine with the protoplasm, neutralizing the alkalies which the latter con- tains and forming mineral salts. They also combine with the albu- min, forming acid albumin. 4. Upon the blood they precipitate the albuminous constituents and decompose the hemoglobin. 5. Acids stimulate the secretion of alkaline glands — salivary, duodenal, pancreatic, and hepatic. On the other hand, they depress the secretion from acid glands — gastric, sudoriparous, etc. 6. Mineral acids reduce the formation of urea, preventing the conversion of retrograde products into this substance. 7. They diminish the functional activity of the muscular and nervous systems. Applied locally in a concentrated form, or taken internally in poisonous doses, they tend to produce rigidity of the muscles by coagulating the myosin. 8. The alkalinity of the blood is lessened and the activity of the urine increased by the internal administration of all mineral acids save nitric, the great amount of nitrogen which the latter contains being converted into ammonia, an alkali. 138 A TEXT-BOOK OF MATERIA MEDICA. Acidum Hydrochloricum— Acidi Hydrochlorici— Hydrochloric Acid. V. S. P. (Muriatic Acid.) Origin. — A liquid composed of 3 1 .9 per cent, by weight of Abso- lute Hydrochloric Acid (HCL= 36.37) and 68.1 per cent, of Water. Description and Properties. — A colorless, fuming liquid, of a pungent odor and an intensely acid taste. Fumes and odor disap- pear on diluting the acid with 2 volumes of water. Specific grav- ity about 1. 163 at 15" C. (59° F.). Miscible in all proportions with water and alcohol. Hydrochloric acid should be kept in dark, amber-colored, glass-stoppered bottles. Dose. — 25 minims (0.12-0.3 Cc), well diluted. Official Preparations. Acidum Hydrochloricum Dilutum — Acidi Hydrochlorici Diluti — Diluted Hydrochloric Acid (Diluted Muriatic Acid). — Dose, 10-20 minins (0.6-1.2 Cc). Formula: Hydrochloric Acid, 100; Distilled Water, 219. Sp. gr. about 1.050. Acidum Nitrohydrochloricum— Acidi Nitrohydrochlorici — Nitrohydro- chloric Acid. — Dose, 2-5 minims (0.12-0.3 Co.), well diluted. (Described under , Nitric Acid.) Acidum Nitrohydrochloricum Dilutum — Acidi Nitrohydrochlorici Diluti — Diluted Nitrohydrochloric Acid. — Dose, 5-20 minims (0.3-1.2 Cc). (Described under Nitric Acid.) Acidum Pliosplioricum— Acidi Piiosphorici— Pliosphoric Acid. JJ. S. P. Origin. — A liquid composed of not less than 85 per cent, by weight of Absolute Orthophosphoric Acid (H3P04 = 97.8) and not more than 15 per cent, of Water. Description and Properties.^-A colorless liquid, without odor, but having a strongly acid taste. Specific gravity not below I.710 at 15° C. (S9° F.). Miscible in all proportions with water or alco- hol. Phosphoric acid should be kept in glass-stoppered bottles. Dose. — The diluted acid only is given internally. Official Preparation. Acidum PhosphSricum Dilutum— Acidi PhosphSrici Diluti (Diluted Phos- phoric Acid).— Z>oj^, yi-i fluidiachm (2.0-4.0 Co.). AROMATIC BITTERS. Anthemis— Anthemidis— Anthemis. V. S. JP. (Chamomile.) Origin. — The flower-heads of Anthemis nobilis L., a low peren- nial plant indigenous in Southern and Western Europe. Description and Properties. — Heads subglobular, about | inch (2 Cm.) broad, consisting of an imbricated involucre and numerous white, strap-shaped, three-toothed florets, and a few, if any, yellow BITTERS. 173 tubular disk-florets, inserted upon a chaffy, conical, solid receptacle ; of a strong, agreeable odor and an aromatic, bitter taste. Anthemis contains a bitter principle, a pale-blue or yellowish-brown volatile oil, and a trace of tannin, together with other unimportant con- stituents. Dose. — 15-60 grains (1.0-4.0 Gm.), in infusion or fluid extract. Cascarilla— Cascarillae— Cascarilla. TJ. S. JP. Origin. — The bark of Croton eluteria, Bennett, a small shrub indigenous in the Bahama Islands. Description and Properties. — Quills or curved pieces about -j^ inch (2 Mm.) thick, having a grayish, somewhat fissured, easily detached, corky layer, more or less coated with a white lichen, the uncoated surface being dull brown, the inner surface being smooth. The bark breaks with a short fracture, having a resinous and radially striate appearance. When burned it emits a strong, aro- matic, somewhat musk-like odor ; taste warm and very bitter. It contains a volatile oil, a bitter, crystalline principle, cascarillin, tannin, resin, etc. Dose. — 20-30 grains (1.2-2.0 Gm.), or \-2 fluidrachms (2.0-8.0 Cc.) of the fluid extract. Prunus Virginiana— Pruni Virginianse— Wild Cherry. V. S. JP. Origin. — The bark, collected in autumn, of Prunus serotina Ehr, a large forest tree indigenous . in North America. Description and Properties. — It is met with in curved pieces or irregular fragments -^ inch (2 Mm.) or more thick; outer surface greenish-brown or yellowish-brown, smooth and somewhat glossy, marked with transverse scars. If the bark is collected from the old wood and deprived of the corky layer, the outer surface is nut-brown and uneven ; inner surface somewhat striate or fissured. Upon maceration in water it develops a distinct bitter-almond odor. Taste astringent, aromatic, and bitter. It contains a volatile oil, hydrocyanic acid, tannin, a bitter glucoside, resin, etc. Dose. — ^i drachm (2.0-4.0 Gm.). Official Preparations. ExtrSctum Pruni Virginianae Fluidum— ExtrScti Pruni Virginianae Fliiidi —Fluid Extract of Wild Cherry.— Z»tfji?, 30-60 minims (z.0-4.0 Cc). 174 A TEXT-BOOK OF MATERIA MEDIC A. Infusum Pruni Virginianse — Infusi Pruni Virginianse — Infusion of Wild Cherry. — Dose, 1—2 fluidounces (30.0-60.0 Cc). Syrupus Pruni Virginianse — Syrupi Priini Virginianse — Syrup of Wild Cherry. — Dose, 2-4 fluidrachms (8.0-15. Cc). Serpentaria— Serpentariae— Serpentaria. JJ. S. I*. (Virginia Snake-root.) Origin. — The rhizome and roots of Aristolochia serpentaria L., and of Aristolochia reticulata Nutt., perennial herbs indigenous in the United States. Description and Properties. — The rhizome is about i inch (25 Mm.) long, thin, curved; on the upper side with approximate, short stem-bases ; on the lower side with numerous thin, branching roots about 4 inches (10 Cm.) long; dull yellowish-brown, inter- nally whitish ; the wood-rays of the rhizome are longest on the lower side ; odor aromatic, camphoraceous ; taste warm, bitterish, and camphoraceous. It contains \ per cent, of volatile oil, a bitterish principle, aristolqchine, tannin, resin, starch, etc. The roots of Aristolochia reticulata are coarser, longer, and less interlaced than those of Aristolochia serpentaria. Dose. — 5-30 grains (0.3-2.0 Gm.). Official Preparations. Extractum Serpentariae Fluidum— ExtrScti Serpentariae Fliiidi— Fluid Extract of Serpentaria. — Dose, 30 minims-l fluidrachm (2.0-4.0 Cc). Tinctura Cinchonae CompSsita — TinctQrae Cinchonse CompSsitae— Com- pound Tincture of Cinchona. — Dose, 1-4 fluidrachms (4.0-15. Cc) (2 per cent, of serpentaria.) Tinctura Serpentariae — Tinctiirae Serpentariae — Tincture of Serpentaria. — Dose, \-2 fluidrachms (2.0-8.0 Cc). Antagonists and Incompatibles. — The salts of iron, lead, and silver are incompatible with gentian and the aromatic bitters, though preparations of iron can be given with quassia and calumba. Boil- ing water impairs the virtues of wild cherry. Synergists. — The digestants, mineral acids, and, under certain conditions, alkalies, and the restorative agents generally, aid the action of vegetable bitters. Physiological Action. — Because of their action in augmenting the secretions from the salivary and gastric glands, aiding diges- tion and improving nutrition. Vegetable Bitters are classed among Restoratives. By increasing the activity of the various glands they BITTERS. 175 aid digestion, and by their effect upon the nerves they stimulate the appetite. Pure bitters act immediately upon contact; that is, their efficiency is due to their local action upon the mucous membrane of the gastro-intestinal tract, with which they are brought into direct contact. There are certain drugs, however — such as cin- chona, nux vomica, etc. — which act also upon the blood or remote parts of the system. When used as bitters we are concerned only with the local action of these agents. I. Bitters increase the secretion from the salivary glands. This effect is produced by stimulating the ends of the nerves of taste distributed in the mucous membrane of the mouth, from which nerves the im- pression is conveyed to the center in the medulla, and from there transmitted to the vaso-motor and secretory nerves sup- plying the salivary glands, increasing their blood-supply and activity, and at once promoting the secretion of saliva. Were salivary secretion stimulated by the drug •entering the circulation, and through the blood exciting the medulla and the glands, a much longer time would elapse before an increased flow of saliva would be pro- duced. It is therefore certain that the •rapid reflex excitation of the glands, and consequent immediate increase in the sal- ivary secretion, are due to direct contact with the nerve-endings in the mucous membrane of the mouth. The accompanying diagram (Fig. i) will serve to elucidate the .action named. II. Bitters increase the secretion from the gastric glands. The primary action is an augmented flow of gastric juice, caused by reflex stimulation from the mouth. It is well known that there is an intimate relationship between the stomach and the senses of taste and smell — the taste of victuals or the odor of a tempting dinner, or the familiar instance of a dog looking wistfully at a meat- stand, exciting the appetite and, reflexly, the flow of gastric juice. Bitters act in a similar manner. The nerves of taste are stimu- lated ; the impression is conveyed to the medulla, and from it trans- mitted not only to the salivary glands, but through the fibers of Fig. I. — Diagram illustrating the action of bittets on the salivary glands : i, nerve conveying the impression from the mucous mem* brane of the mouth (C) to the me- dulla (A) ; 2, secretory nerve trans- mitting the impression from the medulla [A) to the salivary gland t^B) ; 3, duct of the salivary gland. 176 A TEXT-BOOK OF MATERIA MEDICA. the vagus, increasing the blood-supply to the gastric glands and thereby promoting their functional activity. When the bitters have been swallowed, an increased secretion ensues, occasioned by direct stimulation of the mucous mem- brane of the stomach. Through the sen- sory fibers of the vagus the impression is conveyed to the center in the medulla, returning by the vaso-motor and secretory fibers, and increasing the functional activity of the glands. This action is well shown in the diagram (Fig. 2). When too large a dose of bitters has been taken, or under prolonged medicinal dosage — when contraindicated by an irri- table stomach — the effects are )a diminished secretion of gastric juice and a corre- sponding increase in the secretion of mucus. This effect of over-stimulation or irritation is well illustrated in persons addicted to the excessive use of alcohol, a moderate amount promoting the secretion of gastric juice and improving the appetite, while excess occa- sions nausea and the vomiting of glairy mucus. The theory governing the above action is that a medicinal dose of bitters is just sufficient to stimulate the functional activity of the gastric glands, but that immoderate or continuous dosage tends to convey the impression farther up in the medulla, causing stimulation of the vaso-constrictor fibers, con- tracting the blood-vessels, and lessening the blood-supply and the secretion from the glands. At the same time the secretory fibers supplying the mucous cells are stimulated, causing an increased secretion of mucus. Should the dose be sufficiently large to pro- duce vomiting, the action is due to the fact that the impression is conveyed still higher in the medulla, and from there transmitted to the nerves supplying the abdominal walls and diaphragm, the effect being to produce emesis. The diagram (Fig. 3) graphically illustrates this action. III. Bitters stimulate the peristaltic movements of the stomach by reflex action. The sensory nerves in the mucous membrane are Fig. 2. — Diagram illustrating the action of bitters on the gas- tric secretion : A^ medulla ; B, stomach ; C, gland ; D,D, blood- vessels supplying the gland; E^ nerves of taste ; t, vaso-motor fibers ; 2, secretory fibers ; 3, sen- sory fibers. BITTERS. 177 irritated, and an impression is conveyed by them to Auerbach's plexus between the muscles in the walls of the stomach, from which plexus, or ganglion, the influence is transmitted to the mus- cles themselves, causing increased activity or peristalsis. Another method by which peristalsis is stimulated occurs when the impression is conveyed by the sensory nerves directly to the center in the medulla, and from there through the motor fibers of the vagus to Auerbach's plexus, affecting the muscles in the man- ner above described. The cut (Fig. 4) will serve to illustrate the modus oi Fig 3. — Diagram illustrating the supposed nervous connections of the stomach. A gentle stimulus applied to the walls of the stomach is transmitted by the afferent nerves (^) to a nerve-center (5), and thence along the vaso-dilating nerves ( C) and the secreting nerves (/?) to the vessels of the mucous membrane and the cells of the gastric follicles. A stronger stimulus is transmitted up to the nerve- center {£), and thence along the vaso-constricting fibers (^) and the secreting fibers (£?) of the mu- cous follicles. A still stronger stimulus is transmitted to H, and thence along the motor nerves to the abdominal walls (A*. K)^ causing them to contract and produce retching or vomiting. IV. Bitters augment absorption by increasing the blood-supply to the mucous membrane of the stomach. It is a physjifelogical fact that the larger the blood-supply passing through tlje blood- vessels, and the greater the amount of lymph conveyed through the lymph-channels, the more rapid the absorption. V. Bitters are more or less antiseptic and arrest fermentation, both physiological and pathological The peptonization of food is 12 178 A TEXT-BOOK OF MATERIA MEDIC A. a physiological fermentative process, forming a contraindication to the administration of bitters during active digestion. Therapeutics. — Externally and Locally. — Calendula, in the form of a poultice, is an efficient and grateful application as a dress- ing to cancer of the breast. The tincture of calendula is recommended by many phy- sicians as an external application for contu- sions, sprains, etc., although not so efficient as tincture oC arnica. The drug has been used topicallpl in chronic pharyngitis and suppurative vMammation of the ear. Internally. i— The simple bitters are pecu- liarly useful in atonic and fermentative dys- pepsia, chronic gastric catarrh, and as a tonic in convalescence fro^n acute disease, in mala- rial fever, and in the anorexia following it. Infusion of quassia is a most efficacious injection to destroy seat-worms {Oxyuris ver- micularis), the infusion being injected into the rectum, which has been previously washed out with soap and water. The aromatic bitters are used to stimu- late the appetite and improve the condition of the digestive apparatus. The simple bit- ters are similarly used, but the former pos- sess more stimulating and tonic properties, owing to their volatile and astringent con- stituents. Chamomile, in addition to its action as a stimulant to the digestion, has been employed with benefit in delirium tremens and as an emmcnagogue, while in the form of hot poultices chamomile flowers serve as an efficient appli- cation for local pains of almost any description. Wild cherry might not inaptly be called a sedative tonic, its peculiarly bitter yet not unpleasant taste causing it to be well toler- ated by the stomach, and rendering it one of the best stomachic tonics, especially during convalescence, when its sedative action upon the heart allays febrile and cardiac excitement. The syrup of wild cherry is a common ingredient of " cough syrups." It is thought to quiet the cough and allay the irritability of the nervous system in bronchitis and phthisis. Serpentaria is considered an efficient expectorant in pneumonia Fig. 4. — Diagram illustrating the action of bitters upon peri- stalsis : A, medulla; B^ stom- ach; C, Auerbach's plexus; D, mucous membrane ; E, muscles ; I, motor fibers ; 2, sensory fibers. HEMATICS. 179 and capillary bronchitis. Next to its use as a stomachic its chief value seems to be as a stimulant in typhus and typhoid fevers, the compound tincture of cinchona being a most excellent remedy in the low forms of typhoid. The fluid extract of serpentaria is con- sidered somewhat of a sexual stimulant. It is a valuable apphca- tion for poisoning by Rhus toxicodendron. Oontraindications. — i. Bitters should not be given when the secretion of gastric juice is diminished as the result of organic disease. 2. They are contraindicated as stomachics during the course of acute disease, as in fevers. 3. When, after a reasonable time, they fail to improve the appetite, they should be discontinued. 4. In convalescence from acute disease, when the appetite is vora- cious, they are contraindicated. 5. In catarrhal conditions of the mu- cous membrane of the stomach — as in chronic gastritis and " drunk- ards' catarrh of the stomach " — alcoholic preparations of bitters, tinctures, etc. should not be administered, aqueous preparations only, like infusions, being permissible. 6. Should the digestion be impaired and the appetite good, it is an indication that the indiges- tion is intestinal, and therefore beyond the influence of bitters. Administration. — To improve the appetite bitters should be given from one-half to one hour before meals. When necessary to use them for a long time, one bitter should be substituted for another in the course of every week or two ; otherwise the stomach may rebel at the monotony. Bitters may be given in the form of a powder or a solid extract. Ordinarily, however, it is preferable to administer a liquid preparation — fluid extract, tincture, or infusion. A pleasant method of giving the latter preparation in the case of quassia is to allow water to stand over-night or for a few hours in a quassia-cup — purchasable at almost any drug-store — when the water will become impregnated with the bitter principle of the quassia. GROUP VIII.— HEMATICS. PREPARATIONS OF IRON. Ferrum Reductum— Ferri Reducti— Reduced Iron. V. s. p. (Iron by Hydrogen; Quevenne's Iron.) Origin. — Obtained by passing Hydrogen through a' hot closed tube containing freshly prepared and thoroughly washed Ferric Oxide. l8o A TEXT-BOOK OF MATERIA MEDICA. Description and Properties. — A very fine, grayish-black, lustre- less powder, odorless and tasteless ; permanent in dry air ; insolu- ble in water or alcohol. Dose. — 1-5 grains (0.5-0.3 Gm.). Ferri Carbonas Saccharatus — Ferri Carbonatis Saccharati — Saccharated Ferrous Carbonate. TJ. S. jP. Origin. — Prepared from Ferrous Sulphate, Sodium Bicarbonate, Sugar, and Distilled Water, by solution and filtration. Description and Properties. — A greenish-brown powder grad- ually becoming oxidized by contact with air ; without odor, and having at first a sweetish, afterward a slightly ferruginous, taste. Only partly soluble in water, but completely soluble in hydro- chloric acid, with copious evolution of carbonic-acid gas, forming a clear, greenish-yellow liquid. The product should be kept in small, well-stoppered bottles. Dose. — 2-10 grains (0.12-0.6 Gm.). Massa Ferri Carbonatis— Massse Ferri Carbonatis —Mass of Ferrous Carbonate. U.S. I*. (Vallet's Mass.) Origin. — Prepared by solution, filtration, and evaporation from Ferrous Sulphate, Sodium Carbonate, Clarified Honey, Sugar, Syrup, and Distilled Water. Description and Properties. — When recently prepared the mass is of a greenish-gray color, but on exposure it becomes greenish-black. Dose. — 3-5 grains (0.15-0.3 Gm.). Mistura Ferri Composita — Misturae Ferri Com- positae— Compound Iron IVIixture. U.S.I*. (Griffith's Mixture.) Origin.— Prepared by mixing Ferrous Sulphate, Myrrh, Sugar, Potassium Carbonate, Spirit of Lavender, and Rose Water. Description and Properties. — When newly prepared it is of a dirty greenish color, but slowly oxidizes on exposure to the air, and should therefore be freshly prepared when needed. Dos,e. — |-i^ ounces (i 5.-45 Cc). HEMATICS. i8i Ferri lodidum SaccharatuTn— Ferri lodidi Saccha- rati— Saccharated Ferrous Iodide. JJ. 8. P. Origin.— Prepared by solution, filtration, evaporation, and tritu- ration from Iron Wire, Reduced Iron, Iodine, Distilled Water, and Sugar of Milk. Description and Properties. — A yellowisli-white or grayish, hygroscopic, odorless powder, having a sweetish, ferruginous taste. Soluble in 7 parts of water, but only partially soluble in alcohol. It should be kept in a cool, dark place, in small, perfectly dry, securely-stoppered bottles. Dose. — 5-10 grains (0.3-0.6 Gm.). PTlulae Ferri lodidi— PTIulas (ace.) Ferri lodidi— Pills of Ferrous Iodide. U.S.I*. Origin. — Pills made of Reduced Iron, Iodine, Glycyrrhiza, Sugar, Extract of Glycyrrhiza, Acacia, Balsam of Tolu, Water, and Ether, evaporated to pilular consistence. Description and Properties. — These preparations are very un- stable, and should be kept from the light as much as possible. Dose. — One to two pills, each pill containing nearly i grain (0.061 Gm.) of ferrous iodide. Syrupus Ferri lodidi— S^rupi Ferri lodidi— Syrup of Ferrous Iodide. JJ. S. I*. Origin. — A syrup containing 10 per cent, of Ferrous Iodide. Description and Properties. — A transparent, pale-green liquid, having a sweet, strongly ferruginous taste and a neutral reaction. Dose. — 5-30 minims (0.3-2.0 Cc). Ferri Chloridum— Ferri Chloridi— Ferric Chloride. Origin. — Prepared by the action of Hydrochloric Acid and Distilled Water upon Iron Wire, subsequent filtration, addition of Nitric Acid, and crystallization. Description and Properties. — Orange-yellow, crystalline pieces, odorless or having a faint odor of hydrochloric acid, and a strongly styptic taste ; very deliquescent in moist air ; freely and completely soluble in water or alcohol, also in a mixture of i part of ether and 3 parts of alcohol. Ferric chloride should be kept in glass- stoppered bottles protected from light. Dose. — It is chiefly used topically, as an astringent and hemo- static. l82 A TEXT-BOOK OF MA TERIA MEDICA. Liquor Ferri Chloridi— Liquoris Ferri Chloridi— Solution of Ferric Cinloride. TJ- S. P. Origin. — An aqueous solution of Ferric Chloride (Fe2Cle = 323.98), containing about 37.8 per cent, of the anhydrous salt, corresponding to 62.9 per cent, of the crystallized salt, or about 13 per cent, of metallic iron. Description and Properties. — A reddish-brown liquid, having a faint odor of hydrochloric acid, an acid, strongly styptic taste, and an acid reaction. Dose. — 2-10 minims (o. 1 2-0.6 Cc), largely diluted. Tinctura Ferri ChI5ridi— Tincturae Ferri CFiloridi— Tincture of Ferric Ciiloride. U. S. P. Origin. — A hydro-alcoholic solution of Ferric Chloride, con- taining about 13.6 per cent, of the anhydrous salt, corresponding to about 4.7 per cent, of metallic iron. Description and Properties. — A bright, brownish liquid having a slightly ethereal odor, a very astringent, styptic taste, and an acid reaction. Dose. — 5-30 minims (0.3-2.0 Cc). Liquor Ferri Acetatis— Liquoris Ferri Acetatis— Solution of Ferric Acetate. 77. S. P. Origin. — An aqueous solution of Ferric Acetate, containing about 31 per cent, of the anhydrous salt, corresponding to about 7.5 per cent, of metallic iron. Description and Properties. — A dark, reddish-brown, clear liquid, of an acetous odor, a sweetish, acidulous, somewhat styptic taste, ^nd a slightly acid reaction. Dose. — 1-8 minims (0.06-0.5 Cc). Liquor Ferri et Ammonii Acetatis— Liquoris Ferri et Ammonii Acetatis— Solution of Iron and Ammonium Acetate. U. S. P. (Basham's Mixture.) Formula. — Prepared with Tincture of Ferric Chloride, 20 parts ; Diluted Acetic Acid, 30 ; Solution of Ammonium Acetate, 200 ; Aromatic Elixir, 100; Glycerin, 120; Water, to 1000. Dose. — 1-4 fluidrachms (4.0-15.0 Cc). Ferri CTtras— Ferri Citratis— Ferric Citrate. TI. 8. P. Origin. — Prepared by evaporating solution of Ferric Citrate on a water-bath at a temperature not exceeding 60° C. (140*^ F.). HEM A TICS. 183 Description and Properties. — Thin, transparent, garnet-red scales, without odor and having a slightly ferruginous taste. Slowly but completely soluble in cold water, and readily soluble in hot water, but diminishing in solubility with age. Insoluble in alcohol. Ferric citrate should be kept in well-stoppered bottles, protected from light. Dose. — 5-20 grains (0.3-1.20 Gm.), in solution. Liquor Ferri Citratis— Liquoris Ferri Citratis— Solution of Ferric Citrate. JJ. S. I*. Origin. — Prepared byi precipitating a solution of Ferric Sulphate in Water with Ammonia Water, adding Citric Acid, filtering, and evaporating the filtrate to the proper amount. Description and Properties. — A dark-brown liquid, odorless, of an acid reaction, and possessing a slightly ferruginous taste. Dose. — 5-15 minims (0.3-I.O Cc). VTnum Ferri Citratis— Vini Ferri Citratis— Wine of Ferric Citrate. U. S. I*. Composition. — Iron and Ammonium Citrate, Tincture of Sweet Orange Peel, Syrup, and Water. Dose. — J-i fluidrachm (2.0-4.0 Cc). Ferri et Ammonii Citras— Ferri et Ammonii Citratis —Iron and Ammonium Citrate. TJ. S. JP. Origin. — Prepared by evaporating a solution of Ferric Citrate and Ammonia Water. Description and Properties. — Thin, transparent, garnet-red scales, odorless, and having a saline, mildly ferruginous taste; deliquescent in moist air. Completely soluble in water, but insoluble in alcohol. Dose. — 5-10 grains (0.3-0.6 Gm.). Ferri et Quinlnse CTtras— Ferri et Quinlnae Citratis —Iron and Quinine Citrate. U. S. P. Origin. — Solution of Ferric Citrate in Distilled Water and solution of Quinine and Citric Acid in Distilled Water are mixed, evaporated on a water-bath to the consistence of syrup, and dried on plates of glass. Description and Properties. — Thin, transparent scales, of a i84 A TEXT-BOOK OF MATERIA MEDICA. reddish-brown color, without odor, and having a bitter, mildly- ferruginous taste ; slowly deliquescent in damp air. Gradually but completely soluble in cold water, more readily soluble in hot water, and but partially soluble in alcohol, its solubility diminishing with age. It should be kept in well-stoppered bottles, protected from light. Dose. — 2-IO grains (0.12-O.6 Gm.). Ferri et Quinlnae CTtras Solubilis— Ferri et Quinlnae Citratis Solubilis— Soluble Iron and Quinine Citrate. V. S. JP. Origin. — Prepared in the same manner as the above salt, but with the addition of Ammonia Water. Description and Properties. — Thin, transparent scales, of a greenish, golden-yellow color, odorless, and having a bitter, mildly ferruginous taste; deliquescent in damp air. Rapidly and com- pletely soluble in cold water, but only partially soluble in alcohol. It should be kept in well-stoppered bottles, protected from hght. Dose. — 2-10 grains (0.12-0.6 Gm.). Ferri et Strychnlnae Citras— Ferri et Strychnlnae Citratis— Iron and Strychnine Citrate. U.S.JP. Origin. — Solution of Iron and Ammonium Citrate in Distilled Water and solution of Strychnine and Citric Acid in Distilled Water are mixed, evaporated to the consistence of syrup by means of a water-bath, and dried on plates of glass. Description and Properties. — Thin, transparent scales, varying in color from garnet-red to yellowish-brown, without odor, and having a bitter, slightly ferruginous taste ; deliquescent in damp air. Readily and completely soluble in water, but only partly sol- uble in alcohol. It should be kept in well-stoppered bottles, pro- tected from light. Dose. — 1-3 grains (0.06-0.18 Gm.). VInum Ferri Amarum— VTni Ferri Amari— Bitter Wine of Iron. U.S.I*. Composition. — Soluble Iron and Quinine Citrate, Tincture of Sweet Orange Peel, Syrup, White Wine. Dose. — 1-2 fluidrachms (4.0-8.0 Cc). HEMATICS. 185 Syrupus Ferri, QuinTnae, et Strychnlnae Phospha- tum— Syrupi Ferri, QuinTnae, et Strychnlnae Piiospiiatum— Syrup of tiie Piiosphates of Iron, Quinine, and Stryclinine. JJ. S. J*. Dose. — 1-2 fluidrachms (4.0-8.0 Cc). Ferri Lactas— Ferri Lactatis— Ferrous Lactate. U. 8. I*. Description and Properties.— Pale, greenish-white crusts, con- sisting of small, needle-shaped crystals, having a slight, peculiar odor, and a mild, sweetish, ferruginous taste. Slowly but com- pletely soluble in 40 parts of water and in 12 parts of boiling -water; almost insoluble in alcohol. Ferrous lactate should be kept in well-stoppered bottles. Dose. — 1-3 grains (0.06-0.2 Gm.). syrupus HypophosphTtum cum Ferro— SS^rupi Hy- pophospiiTtum cum Ferro— Syrup of Hypopiios- phites witii Iron. U. S. JP. Ferrous Lactate and Potassium Citrate dissolved in Syrup of Hypophosphites. Dose. — |— I fluidrachm (2.0-4.0 Cc). Ferri Oxidum Hydratum— Ferri Oxidi Hydrati— Ferric Hydrate. U.S.JP. (Ferric Hydroxide — Hydrated Oxide of Iron.) Origin. — To a solution of Ammonia Water in Water is added a solution of Ferric Sulphate in Water, and the precipitate collected. Description and Properties. — A brownish-red magma, wholly soluble in hydrochloric acid, without effervescence. Dose. — ^4 drachms (16 Gm.), or ad libitum in case of arsenical poisoning. Ferri Oxidum Hydratum cum Magnesia— Ferri Oxidi Hydrati cum Magnesid— Ferric Hydrate with Magnesia. TJ. S. JP. Solution of Ferric Sulphate, Magnesia, and Water. Dose. — Amounts as necessary ad libitum. 1 86 A TEXT-BOOK OF MATERIA MEDIC A. Ferri et Ammonii Sulphas— Ferri et Ammonii Sul- phatis— Ferric Ammonium Sulphiate. V. S. F. (Ammonio-ferric Sulphate— Ammonio-ferric Alum.) Origin. — The crystals formed by adding Ammonium Sulphate to a boiling-hot solution of Ferric Sulphate. Description and Properties. — Pale violet, octahedral crystals, odorless, and having an acid, styptic taste ; efflorescent on exposure to the air. Soluble in 3 parts of water and in 0.8 part of boiling water ; insoluble in alcohol. The product should be kept in well- stoppered bottles. Dose. — 5-15 grains (0.5-1.0 Gm.). Ferri et Ammonii Tartras — Ferri et Ammonii Tar- tratis— Iron and Ammonium Tartrate. 17. S. JP. (Ammonio-ferric Tartrate.) Description and Properties. — Thin, transparent scales, varying in color from garnet-red to reddish-brown, without odor, and having a sweetish, slightly ferruginous taste ; slightly deliquescent in the air. Very soluble in water ; insoluble in alcohol. Iron and ammonium tartrate should be kept in well-stoppered bottles, pro- tected from light. Dose. — 10-30 grains (0.6-2.0 Gm.). Ferri et Potassii Tartras— Ferri et Potassii Tar- tratis— Iron and Potassium Tartrate. TJ. 8. P. (POTASSIO-FERRIC TARTRATE.) Description' and Properties. — Thin, transparent scales, vary- ing in color from garnet-red to reddish-brown, without odor, and having a sweetish, slightly ferruginous taste ; slightly deliquescent in the air. Very soluble in water ; insoluble in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose. — 5-20 grains (0.3-1.2 Gm.). Ferri Piiosphas Solubilis— Ferri Phosphatis Solu- bilis— Soluble Ferric Phosphate. TI. S. P. Description and Properties. — Thin, bright-green, transparent scales, odorless, and having an acidulous, slightly saline taste. The salt is permanent in dry air when excluded from light, becoming dark and discolored when exposed to it. Freely and completely HEMATICS. 187 soluble in water, but insoluble in alcohol It should be kept in dark amber-colored, well-stoppered bottles. Dose. — 5-10 grains (0.3-0.6 Gm.). Ferri Pyrophosphas Solubilis— Ferri Pyrophospha- tis Solubilis— Soluble Ferric Pyrophosphate, JJ. S. I*. Description and Properties. — Thin apple-green, transparent scales, without odor, and having an acidulous, slightly saline taste ; permanent in dry air if protected from light, and if exposed to it becoming dark and discolored. Freely and completely soluble in water, but- insoluble in alcohol. It should be kept in dark amber- colored, well-stoppered bottles. Dose. — 2-5 grains (0.1-0.3 Gm.). Ferri Hypophosphis— Ferri Hypophosphitis— Ferric Hypophosphite. U. S. -P. Origin. — The precipitate formed by mixing solutions of Sodium Hypophosphites and Ferric Chloride or Ferric Sulphate. Description and Properties. — A white or grayish-white pow- der, odorless and nearly tasteless, permanent in the air. Only slightly soluble in water. It should be kept in well-stoppered bottles. Dose. — 5-10 grains (0.3-0.6 Gm.). Ferri Valerianas— Ferri Valerianatis— Ferric Valerianate. TJ. S. T. Origin. — The precipitate obtained by adding to a cold solution of Ferric Sulphate or Ferric Chloride a cold solution of Sodium Valerianate. Description and Properties. — A dark, brick-red, amorphous powder, of somewhat varying chemical composition, having the odor of valerianic acid and a mildly styptic taste ; permanent in dry air. Insoluble in cold water, but readily soluble in alcohol. Boiling water decomposes it, setting free the valerianic acid and leaving ferric hydrate. It should be kept in small, well-stoppered bottles, in a cool, dark place. Dose. — 1-3 grains (0.06-0.18 Gm.). i88 A TEXT-BOOK OF MATERIA MEDICA. Ferri Sulphas— Ferri Sulphatis— Ferrous Sulphate. JJ. 8. JP. Origin. — Obtained by the action of Sulphuric Acid and Water upon Iron Wire. Description and Properties. — Large, pale bluish-green mono- clinic prisms, without odor, and having a saline, styptic taste; efflorescent in dry air ; on exposure to moist air the crystals rap- idly absorb oxygen, becoming coated with a brownish-yellow, basic ferric sulphate. Soluble in 1.8 parts of water and in 0.3 part of boiling water ; insoluble in alcohol. Dose. — 1-3 grains (0.06-0.18 Gm.). Ferri Sulphas Exsiccatus— Ferri Sulphatis Exsic- cati— Dried Ferrous Sulphate. U. S. P. Description and Properties. — A grayish-white powder, slowly but completely soluble in water. Dose. — |— 2 grains (0.03-0. 12 Gm.). Ferri Sulphas Gran ulatus— Ferri Sulphatis Granu- lati— Granulated Ferrous Sulphate. U. S. P. Description and Properties. — A pale bluish-green, crystallized powder, which should conform in every respect to the reactions and tests given under Ferri Sulphas in the U. S. P. Dose. — ^3 grains (0.03-0.18 Gm.). Liquor Ferri Subsulphatis— Liquoris Ferri Subsul- phatis— Solution of Ferric Subsulphate. U. S. P. (Solution of Basic Ferric Sulphate — Monsel's Solution.) Origin. — An aqueous solution of basic Ferric Sulphate — of varying chemical composition — corresponding to about 13.6 per cent, of metallic iron. Description and Properties. — A dark, reddish-brown liquid, odorless or nearly so, of an acid, strongly styptic taste, and an acid reaction. Miscible with water and alcohol in all proportions, without decomposition. Dose. — i-io minims (0.06-0.6 Cc), largely diluted — chiefly used, however, as a local styptic. HEMATICS. 189 Liquor Ferri Tersulphatis— Liquoris Ferri Tersul- phatis— Solution of Ferric Sulphate. TJ. S. I*. Origin. — An aqueous solution of normal Ferric Sulphate, con- taining about 28.7 per cent, of the salt, and corresponding to about 8 per cent, of metallic iron. Description and Properties. — A dark, reddish-brown liquid, almost odorless, having an acid, strongly styptic taste, and an acid reaction. Miscible with water and alcohdl in all proportions, with- out decomposition. Dose. — i-io minims (0.06-0.6 Cc), given in the same manner and for the same purposes as the preceding preparation. Pilulae Aloes et Ferri— Pilulas (ace.) Aloes et Ferri— Pills of Aloes and Iron. U. 8. JP. Described under Aloes. Dose. — 5-10 grains (0.3-0.6 Gm.), or two or three pills. Emplastrum Ferri— Emplastri Ferri— Iron Plaster. U. S. P. (Strengthening Plaster.) Formula : Ferric Hydrate, 90 ; Olive Oil, 50 ; Burgundy Pitch, 140; Lead Plaster, 720. For external use. Trochisci Ferri— TrochTscos (ace.) Ferri— Troches of Iron. U. S. P. Composition. — Ferric Hydrate ; Vanilla ; Sugar ; Mucilage of Tragacanth. Dose. — One to two troches, each troche containing 5 grains (0.3 Gm.) of ferric hydroxide. Liquor Ferri Nitratis— Liquoris Ferri Nitratis— Solution of Ferric Nitrate. U. S. JP. Origin. — An aqueous solution of Ferric Nitrate, containing about 6.2 per cent, of the anhydrous salt, corresponding to about 1.4 per cent, of metallic iron. Description and Properties. — A clear, amber-colored or red- dish liquid, odorless, having an acid, styptic taste, and an acid reaction. Dose. — 5-10 minims (0.3-0.6 Cc). I go A TEXT-BOOK OF MATERIA MEDIC A. Pilulse Ferri Carbonatis— Pilulas (ace.) Ferri Car- bonatis— Pills of Ferrous Carbonate. V. S. P. (Ferruginous Pills — Chalybeate Pills — Blaud's Pills.) Dose. — 2 to S pills, each pill containing i grain (0.064 Gm.) of ferrous carbonate. Unofficial Preparations. Tinctura Fferri Acetatis — Tincturse FSrri Acetatis — Tincture of Ferric Ace- tate, U. S. P. — Composition: Solution of Ferric Acetate; Alcohol; Acetic Ether. Description and Properties. — A clear, dark, reddish-brown liquid, transparent in thin layers, having the odor of acetic ether, an acidulous and astringent taste, and a slightly acid reaction. Miscible in all proportions with water, without becoming turbid. The tincture should be kept in the dark and in a cool place. Dose. — S-30 minims (0.2-2.0 Cc). FSrri Arsenas — F6rri Arsenatis — Iron Arsenate. — Description and Proper- ties. — A green or blue-green, amorphous powder, insoluble in water and in alcohol. Dose. — jij-^ grain (0.003-0.03 Gm.). FSrri Albutninas — FSrri Albuminatis — Albuminate of Iron. — Description and Properties. — Golden yellow, transparent scales, containing 3.34 per cent, of iron. Dose. — 5-30 grains (0.3-2.0 Gm.). A liquor and a syrup of albuminate of iron are used. FSrrum Dialysatum — FSrri Dialysati — Dialyzed Iron (Liquor Ferri Dia- LYSATUS — Liquor Ferri Oxychlorati). — Description and Properties. — Perfectly transparent, thin layers, of a deep brown-red color, inodorous, and almost destitute of styptic taste. Miscible with alcohol, glycerin, syrup, and distilled water, but not with spring-water or other, even dilute, saline solutions. Dose. — 10-30 minims (0.6-2.0 Cc). Liquor FSrri Peptonati — Liquoris FSrri Peptonati — Solution of Peptonate of Iron. — Dose, \-2 fluidrachms (2.0-8.0 Cc). Liquor Mangano-FSrri Peptonatus — Liquoris MSngano-FBrri Peptonati (Gude) — Solution of Peptonate of Iron and Manganese. — A proprietary prepa- ration from the formula of Dr. Gude. Dose. — 2-4 fluidrachms (8.0-15.0 Cc). Allied Compounds. Hsetnogallol. — Origin. — Prepared by the action of Pyrogallol on the coloring matter of the blood. Description and Properties. — A reddish-brown, tasteless powder. Dose. — 1-8 grains (0.06-0.5 Gm.). Hsmol. — Origin. — Prepared by the action of Zinc Dust on the coloring matter of the blood. Description and Properties. — A blackish-brown powder having a slight taste. Dose. — 1-8 grains (0.06-0.5 Gm.). Ferratin. — Origin. — A compound of Iron first obtained by Professor Schmiedeberg from hog's liver. Description and Properties. — A fine, reddish-brown powder containing about 7 per cent, of iron. One variety is insoluble, though the sodium ferratin is freely soluble in water. HEM A TICS. 191 Dose. — 10-20 grains (0.16-1.2 Gm.). Hsemalbumin. — A preparation said to contain two albuminoids and salts of the blood. Description and Properties. — A permanent powder, soluble in water and in alcohol. Dose. — S-15 grains (0.3-1.0 Gm.). liaemoglobin. — Said to be the coloring principle of the solid elements of the blood. Dose. — 1-3 grains (0.06-0.18 Gm.). HsemofeTTum, — Claimed to be a natural proteid compound of Iron obtained from hullock's blood. Dose. — 1-3 grains (0.06-0.18 Gm.). Iron Quinine Chloride. — A yellowish-red powder, soluble in water, alcohol, and glycerin. Dose. — 1-3 grains (0.06-0.18 Gm.). Used externally as a hemostatic. Antagonists and Incompatibles. — The ferric salts are incom- patible with tannic and gallic acids and vegetable astringents, and gelatinize mucilage of acacia. The carbonates are also incompatible ■with tannic and mineral acids and acidulous salts. The salts of the vegetable acids and the iodides are incompatible with mineral acids, tannic acid, and with alkalies and their carbon- ates. The tincture of the chloride of iron is also incompatible with tannic acid, vegetable astringents, alkalies and their carbon- ates, lime water, and the carbonates of calcium and magnesium. Synergists. — All the restorative medicines are synergistic. Physiological Action. — Iron is a typical restorative, being an essential element of the blood, there being i part of iron to 230 of red globules. It has also been found in the gastric juice, bile, lymph, chyle, milk, urine, pigment of the eye, etc. This omni- presence is readily accounted for when it is remembered that the food of man contains iron in variable quantities. Indeed, this use- ful metal may well be called a respiratory nutrient because of its property of increasing the oxygen-carrying power of the red blood- corpuscles — muscular force and functional activity generally being dependent upon the supply of oxygen, or proper respiration, as the motive power. When the system is in a normal, healthy condition, sufficient iron is furnished by the mixed diet to answer all physiological requirements. In many diseased conditions, however, there is a deficiency of iron, and it is necessary to restore this element in one way or another. The chief actions of iron are — I. To increase the oxygen- carrying powers of the blood ; 2. To convert the oxygen present in the tissues into ozone ; 3. To serve both as a local and general astringent. 192 A TEXT-BOOK OF MATERIA MEDIC A. The physiological effects upon the various systems, locally ana internally, now to be considered, are due directly or indirectly to- the principal actions above mentioned. Externally and Locally. — Neither the ferric nor the ferrous salts exert any action upon the unbroken skin. When applied, however, to mucous membranes or denuded surfaces, they are astringent and hemostatic, the ferric salts being the more powerful, coagulating albuminous fluids. When applied to bleeding surfaces the hemo- static action is due rather to the coagulation of the blood, forming a natural barrier to its escape, than to any direct action upon the walls of the^ vessels. The vegetable salts — scale preparations — possess so feeble astringent properties that they are rarely, if ever, used as local applications. The acid and astringent preparations of iron act upon the teeth. The ferric oxides are disinfectant, owing to their property of con- verting oxygen into ozone. Internally. — Digestive System. — The teeth and tongue are black- ened by the preparations of iron. In the stomach, when not con- traindicated and in small doses, its slightly irritant and astringent properties render iron quite a valuable stomachic tonic. Under excessive doses or prolonged administration the acid preparations especially are apt to cause gastric derangement — anorexia, nausea, and serious indigestion. The ferric chloride is particularly valu- able in that its ingestion does not, like that of other preparations of iron, diminish the supply of hydrochloric acid in the gastric juice. The scale salts, though disturbing the digestion less than the acid preparations, are ordinarily inferior to the latter. All the preparations of iron are probably converted into the chloride in the stomach. When entering the intestines they are converted into the ferric oxide, ferrous chloride, the alkaline albu- minate, and the insoluble sulphide and tannate. Most of the iron preparations are constipating, the phosphate and pyrophosphate being exceptions. They tend to diminish the bile and the secre- tions from the gastro-intestinal tract. Circulatory System. — The action of iron upon the blood is of great importance, since, the metal being a normal constituent of that fluid, its administration has a nutrient as well as a medicinal influence. A primary effect is to supply a deficiency of red cor- puscles and bring the hemoglobin up to the normal standard. Iron enables the red corpuscles to convey more oxygen to the tissues, converting that element into ozone and thereby rendering it HEM A TICS. 193 more active in promoting oxidation. The muscular power of the heart is increased, the arterioles slightly contracted, and arterial tension somewhat raised. Nervous System. — The general effect is tonic, the influence of iron and its salts being highly beneficial in strengthening the action of the nerves in cases of physical debility. With subjects inclined to plethora, however, certain untoward symptoms may result from administration of the stronger preparations, including a feeling of congestion in the cerebrum. Respiratory System. — No immediate action is perceptible under normal conditions, but in anemic states, by supplying the nerve- centers, muscles, and lungs with better blood, the respiratory power is increased. Absorption and Elimination. — Opinions differ regarding the form in which iron is absorbed. Probably much of it is converted into the soluble chloride and absorbed as such, while a portion, passing into the intestines, may there be converted into the insoluble alka- line albuminate capable of absorption. The larger portion of iron taken into the system-, however, is changed into the insoluble sul- phide and tannate, and excreted as such, giving to the feces a black color. Such part of the iron as enters the circulation com- bines with the red corpuscles. The salts of the organic acids are absorbed directly into the blood. Such careful pharmacologists as Bunge, Schmiedeberg, and Hamburger claim that inorganic preparations of iron are neither absorbed nor assimilated, maintaining that the blood and hemo- globin are influenced only by the organic compounds. Yet, not- withstanding these statements, clinical experience has fully demon- strated the value of such preparations as reduced iron, tincture of the chloride, carbonate, etc. ; and it is still perhaps a mooted ques- tion whether appreciable amounts of them are actually absorbed, or whether, according to Bunge, the inorganic prevent the decom- position of the organic salts of iron in the food by fixing the decomposing agents in the intestines. At all events, the beneficial results in anemia and chlorosis of large doses of the inorganic preparations are too manifest to justify abandonment of these agents because of our ignorance touching their modus operandi. Bunge's hypothesis would at least seem plausible when it is remembered that only traces of iron can be found in the urine when the drug is given by the stomach, while if injected into the circulation large quantities are eliminated by the kidneys. It is 13 194 A TEXT-BOOK OF MATERIA MEDICA. quite possible that the improvement in the red corpuscles, and the promotion of oxidation independent of them, take place in the portal circulation, and that when the iron reaches the Hver it is there intercepted and, together with the bile, turned back into the intestines. The amount of urea is increased and micturition rendered more frequent by preparations of this metal. Elimination takes place chiefly by the feces, to which a blackish color is imparted by the formation of ferrous sulphide. The bile, urine, and even the skin, as well as the mucous and serous mem- branes, share in the excretory process. Temperature. — The administration of iron tends to raise bodily heat. This, however, may be due only to the normal influence of the metal, the ozonizing power of which, affecting the promo- tion of tissue-waste, naturally causes an elevation of temperature. Untoward Action. — The continued use of ferruginous prepara- tions has a tendency to impair the normal digestive powers, occa- sioning even gastric oppression, nausea, and vomiting. Reduced iron, the phosphate, and the pyrophosphate produce less untoward action than other preparations, and the ferrous are better tolerated than the ferric salts. Not infrequently acne of the face, breast, and back is occasioned, while the prolonged administration of the drug may in rare cases be accompanied by hemorrhages from the mucous membranes and symptoms of plethora and vascular excitement. Large doses of the ferrous sulphate may occasion obstruction of the bowels. Poisoning. — The ferric preparations in a concentrated form pro- duce all the symptoms of an irritant poison — gastric pain, vomit- ing, etc. Treatment of Poi'soning. — The stomach should be emptied by an emetic or carefully cleansed, the treatment being followed by the administration of alkali solutions, tannic acid, and demulcent drinks, the procedure being similar to thafemployed in poisoning from niineral acids. Therapeutics. — Externally and Locally. — The astringent and styptic properties of chlorides and sulphates of iron have rendered them serviceable in controlling hemorrhage and as local astrin- gents in relaxed conditions oi \S\& pharynx and larynx and mucous membranes generally. The tincture of the chloride has been highly recommended as a local application to the throat in diph- theria, and chronic and indolent ulcers may often be benefited by HEMATICS. 195 a wash containing from 2 to 5 grains (0.12-0.3 Gm.) of the sulphate to I ounce (30.0 Cc.) of water. Internally. — The most important use of iron is to restore the number of red corpuscles. In nearly every form of anemia, there- fore, iron is indicated. In chlorosis, especially, it is of great value ; but in order that its effects may be most beneficial, cathartics, such as rhubarb and aloes, which do not weaken the intestines should accompany its use. Even the anemia due to hemorrhage calls for iron ; yet if the assimilative functions are not impaired, the drug should be reinforced by plenty of nutritious food, from which the constituents of the blood are normally elaborated. The anemia of scrofula and syphilis is benefited by some form of iron, care being taken in these cases to select the proper salts. In glandular scrofula, for instance, the iodide is to be preferred, and, theoretically, this salt is preferable also in syphilis, yet in the latter disease the efficacy of the salt depends less upon its particular radical than upon its restorative properties and its power of counter- acting the depressing and mischievous effects so often produced by excessive use of the specific. In the desquamative forms of Bright' s disease iron is of signal benefit. In this condition the blood-disks are rapidly destroyed by the urea ; moreover, certain preparations of iron possess quite a local action upon the kidney. Iron is also useful m jaundice where there is more or less cholemia, with destruction of the red corpuscles. Many nervous disorders dependent upon anemia are relieved by iron. Even in chorea and various neuralgias — especially those of an intermittent nature arising from an impoverished state of the blood — iron is of decided value. In many chronic nervous diseases, however, good judgment in the use of the drug is necessary, lest it prove more prejudicial than advantageous. In anemia of certain cardiac diseases iron is of unquestioned value, though the fact is well known to observant practitioners that in these cases iron alone is but a single element in the successful treatment of them. While iron is of great service in lessening the muco-purulent expectoration of chronic bronchitis, its influence in pulmonary tuber- culosis is less favorable. At times, it is true, the drug appears to improve the condition of phthisical patients, yet more frequently it induces hemoptysis and hastens the progress of the disease. In certain disorders of the genito-urinary tract — prolapsus uteri, incon- 196 A TEXT-BOOK OF MATERIA MEDICA. tinence of urine, seminal emissions, prostatorrhea, etc. — iron is an appropriate remedy. It is an important agent in the treatment of diabetes, though care should be taken to guard against its tendency to constipate the bowels. As observed later on, iron is contraindicated in febrile diseases, yet it is a matter of clinical experience that the drug acts favorably in modifying the course of idiopathic erysipelas, pyemia, septicemia^ and diphtheria. The astringent action of iron is available in the treatment of vaginal leucorrhea, hematemesis, and passive hemorrhages from the uterus, bladder, kidneys, etc. It has also proved highly beneficial in certain forms of chronic diarrhea and dysentery. In amenorrhea and menorrhagia, when due to a deficiency of normal blood, iron is an extremely valuable remedy. Contraindications. — Iron is usually contraindicated in fever and acute inflammatory conditions, in anemia of mahgnant disease, such as cancer, in Addison's, disease, and in the hemorrhagic diath- esis. Should the use of iron derange digestion or aggravate hemorrhoidal conditions, the drug should be discontinued or care- fully administered, being associated with stomachics or laxatives to mitigate its untoward effects. Administration. — If the appetite be poor, iron should be ad- ministered in small doses (invariably after meals) or preceded by vegetable bitters. The tincture of the chloride and the stronger preparations should be freely diluted with water. The citrate of iron is a mild preparation well adapted for children and persons of delicate stomach. Probably the salt richest in iron, yet of all the ferruginous preparations the most agreeable and least irritating, is the iron and potassium tartrate. The soluble ferric pyrophosphate is also a mild and pleasant preparation. The compound iron mixture pos- sesses special advantages in the treatment of chlorosis and chronic diseases of the skin, while the solution of iron and ammonium acetate (Basham's mixture) is the best preparation in albuminuria — particularly that accompanying tubular nephritis — it being agree- able and well tolerated. The best styptic is the ferric subsulphate or its solution. Dialyzed iron, being agreeable to the taste, was formerly a pop- ular remedy. Some of the allied compounds above mentioned are very useful. The ferratin especially is a most valuable compound of iron, while HEMATICS. 197 the liquor mangano-ferri peptonatus is an agreeable and efficient remedy, having no deleterious effect upon digestion, but, on the contrary, actually improving the appetite. Manganum-Mangani— Manganese. This metal is a normal constituent of the body, existing in ap- preciable though minute quantities in the blood, bile, etc. From the fact of its presence in the blood, and because of the similarity of its chemical affinities to those of iron, theorists, rather than careful and practical observers, have advocated its use as a worthy and efficient substitute for the latter agent. Its therapeutic uses as a restorative, or as an alternative or synergist to iron, are based more upon abstract deductions than upon clinical observation. Still, as its chemical character resem- bles that of iron — though the metal in its operation is often antagonistic to the latter — its salts are of sufficient therapeutic importance to merit brief mention here. Mangani Dioxidum— Mangani Dioxidi— Manganese Dioxide. TJ. S. JP. (Black Oxide of Manganese.) Origin. — Native, crude manganese dioxide, containing at least 66 per cent, of the pure dioxide. Description and Properties. — A heavy, grayish-black, more or less gritty powder, without odor or taste ; permanent in the air ; insoluble in water or alcohol. Dose. — 5-40 grains (0.3-3.0 Gm.). MS-ngani Sulphas— Mangani Sulpinatis— Manganese Sulphate. U. S. JP. Origin. — Obtained by heating Manganese Dioxide with suf- ficiently strong Sulphuric Acid, evaporation, and crystallization. Description and Properties. — Colorless or pale rose-colored, transparent, tetragonal prisms, odorless, and having a slightly bitter and astringent taste ; slightly efflorescent in dry air. Soluble in 0.8 part of water and in i part of boiling water ; insoluble in alco- hol. Manganese sulphate should be kept in well-stoppered bottles. Dose. — 2-5 grains (0.1-0.3 Gm.). (For Potassium Permanganate see section on Antiseptics^ Antagonists and Incompatibles. — The salts of lead, silver, and mercury are incompatible with manganese. 198 A TEXT-BOOK OF MATERIA MEDICA. Synergists. — Iron is theoretically synergistic, and the salts of zinc, copper, and silver are similar in their action on the nervous system. Physiological Action. — Externally and Locally. — The two salts above mentioned have no important local action. Internally. — In large doses these salts, especially the sulphate, irritate the gastro-intestinal tract, while excessive doses may even occasion gastro-enteritis. The sulphate acts as an emeto-cathartic and possesses cholagogue properties. As is the case with many other drugs of this character, small doses may even promote the appetite and improve the digestive function. Large doses, or the continued administration of these preparations, affects the system more like zinc than iron, pro- ducing great depression, muscular weakness and waste, diminishing the pulse-beat, weakening the heart, and lowering arterial tension. There is, moreover, a tendency to fatty degeneration of the muscles and liver. Therapeutics. — The manganese dioxide has been used in the treatment of gastralgia, pyrosis, and simple ulcer of the stomach. Its action probably resembles that of bismuth, though it is a much less efficient remedy than the latter drug. The sulphate is used occasionally as a cholagogue purgative in malarial jaundice, although why it should be preferred to many other and superior cholagogues it is difficult to understand. Gouty dyspepsia appears to have been much improved by the use of manganese. The association of iron and manganese makes a valuable combination in the treatment of chlorosis and many variations of anemia. Phosphorus— Phosphor!— Phosphorus. TJ. 8. P. Origin. — It exists, chiefly as phosphates, in many minerals and in all plants and animals. It is prepared by treating Calcined Bones with Sulphuric Acid, evaporation, and distillation. Description and Properties. — A translucent, nearly colorless solid, of a waxy luster, having at ordinary temperatures about the consistence of beeswax. When kept for some time the surface becomes red and occasionally black. Phosphorus has a distinctive and disagreeable odor and taste (tasting being allowable only in the form of extreme dilution). When exposed to the air it emits white fumes, visible in the dark, and having an odor somewhat resembling HEMATICS. ^ 199 that of garlic. Upon prolonged exposure to air it takes fire spon- taneously. Phosphorus is insoluble, or nearly so, in water, to which, how- ever, it imparts its characteristic disagreeable odor and taste. It is soluble in 350 parts of absolute alcohol, in 80 parts of absolute ether, and in about 50 parts of any fatty oil. It is very soluble in chloroform or in carbon disulphide, the latter yielding a solution to be handled with the greatest care to prevent accident from combus- tion. The drug should be carefully kept under water, in strong, well-closed vessels, in a secure and moderately cool place protected from light. . Dose. — ^\f^ gifl grain (0.0006-0.002 Gm.). Official Preparations. Oleum Phosphoratum— Olei Phosphorati— Phosphorated 0\\.—Dose, 1-5 minims (0.06-0.3 Cc). A clear, yellowish liquid, having the odor of phosphorus and of ether, but not phosphorescent in the dark. It should be perfectly free from particles of undissolved phosphorus. Pllulse Ph6sphori— PJlulas (ace.) Ph6sphori — Pills of Phosphorus.— iJow, one to two pills. Each pill contains ^-^ grain (0.0006 Gm.) of phosphorus. Splritus PhSsphori — SpKritus PhSsphori— Spirit of Phosphorus (Tincture OF Phosphorus). — Dose, 5-30 minims (0.3-2.0 Cc). Elixir PhSsphori — Elixir PhCsphori — Elixir of Phosphorus. — Dose, ^2 fluid- drachms (2.0-8.0 Cc). Antagonists and Incompatibles. — The principal chemical anti- dotes are hydrated magnesia, lime water, powdered charcoal, cop- per sulphate, and old acid turpentine. Sjrnergists. — Cod liver oil and the Restoratives generally aid the action of phosphorus. It is claimed that arsenic and sulphur are also synergistic. Physiological Action. — Externally and Locally. — Applied to the skin, phosphorus causes local inflammation, ulceration, and possibly gangrene. The fumes may produce the most serious results — even maxillary necrosis where dental caries is present, as well as great irritation of the conjunctivae and the respiratory mucous membrane. The graver systemic symptoms are confined to the conditions induced by toxic doses of the drug. Internally. — Digestive System. — Taken into the stomach, no special effect is apparent as a result of small doses, save that the drug acts as a functional stimulant. Larger amounts have been held to impede digestion by impairing the action of the gastric juice upon albuminoid materials. Immoderate dos^s occasion 200 A TEXT-BOOK OF MA TERIA MEDICA. great irritation of the stomach and intestines, accompanied by abdominal distress, vomiting, and purging. Jaundice is a not infrequent result of ingestion, due to obstruction of the biliary ducts. Minute quantities stimulate the nutrition of the tissues, especially that of the osseous system. Circulatory System. — The primaiy action is stimulating, the pulse rising and acquiring additional force, though not firmness. The facial capillaries are expanded, often congested ; the cutaneous circulation becomes more rapid; and diaphoresis is produced. Under toxic doses the action of the heart is strongly depressed. Nervous System. — In repairing the waste of tissue phosphorus acts upon the nervous system as a tonic, improving the nutrition of debilitated parts and restoring to normal conditions the func- tional activity of organs and tissues. Small or moderate doses act as stimulants to the entire nervous system, intellectual activity being promoted and the sexual appetite increased. Toxic effects include coma, and occasionally vertigo, with delirium, convulsions, insensibility, and collapse. Respiratory System. — The deleterious action of the fumes of phosphorus is exemplified in their irritating effect upon the broncho- pulmonary mucous membrane. Toxic symptoms are often accom- panied by serious disturbances, respiratory failui^e being among the immediate causes of death. Absorption and Elimination. — The modus operandi of absorption is a matter of some dispute. Probably a portion of the drug undergoes oxidation in the stomach, and the phosphoric acid formed, combining with the alkalies, enters the blood as phos- phates. A part of the phosphorus is dissolved in the fats and oils present in the stomach, probably entering the circulation as ele- mentary phosphorus. The drug, having undergone oxidation in the system, is elim- inated as phosphoric acid, chiefly by the urine, increasing the excretion of urinary phosphates. The liver shares in the excretoiy process. Temperature. — Owing to capillary expansion, the superficial temperature is at first slightly raised, being subsequently dimin- ished. Evaporation and radiation, arising from profuse diaphoresis, contribute to thermal reduction. Eye. — In chronic poisoning from phosphorus hemorrhages and patches of degeneration in the retina are sometimes visible, the ophthalmoscopic picture resembling the retinitis of albuminuria. HEMATICS. 20I Under medicinal doses no special effects upon the eye are reported, although, as has been stated, the vapor of phosphorus is highly irritant to the conjunctivae. Uterus. — The action of phosphorus tends to increase the men- strual flow. Untoward Action. — Small doses produce in some individuals severe gastric disturbance, and in rare cases diarrhea, tenesmus, and jaundice. The fatty degeneration of the retinal capillaries mentioned above — such as results from chronic intoxication affect- ing workers in match-factories — is an untoward manifestation to be guarded against by every available means. Poisoning. — The effects of a fatal dose of phosphorus are not immediate. After a lapse of several hours great weakness occurs, accompanied in a large majority of cases by vomiting. Abdominal pains follow, the symptoms becoming more acute, mucus and bile being present in the ejecta, which for a while retain the odor and luminosity of phosphorus. With the cessation of vomiting pain is abated, although it may extend over the entire abdominal region and even be attended with paroxysms. The foregoing symptoms are accompanied by pronounced anorexia, thirst and fever, a thickly-coated or whitish tongue, burning in the throat, and often signs of collapse. The temper- ature at first reaches nearly the maximum possible without proving fatal, subsequently sinking below the normal. After a few days jaundice sets in. The urine is diminished, becoming charged with albumin and urates, and even bloody, containing among other ingredients biliary acids and coloring matter. In fatal cases urea is almost wholly wanting. The stools may be normal, but the general condition is usually marked by diarrhea or constipation and flatulence; Hemorrhage often occurs, wounds bleeding pro- fusely, and as the severity of the symptoms increases delirium ensues, or coma terminating in convulsions. Serious nervous manifestations are frequently preceded by restlessness, insomnia, headache, and vertigo. In some delirious conditions wild, erotic states of the mind are the precursors of convulsive or comatose symptoms. Somnolence is not uncommon, with partial spasms and contraction or paresis of the voluntary muscles. Post-mortem examinations show that the liver, heart, kidneys, muscles, capillaries, and arterioles are implicated in the general effects of the poisoning, undergoing fatty degeneration. Sometimes the preponderating influence of the poison affects 202 A TEXT-BOOK OF MATERIA MEDICA. the bronchial and gastro-intestinal mucous membranes, or it rtiay visit the nervous system or be manifested in the circulatory sys- tem. In cases of acute poisoning the duration of the malady varies greatly, death occurring at times within a few days, or, again, being deferred for a few weeks. As a rule, recovery is retarded, the elimination of the drug requiring time. The symptoms of dironic poisoning are in some respects espe- cially marked, inhalation of phosphorus-fumes frequently resulting in pronounced conditions of necrosis, particularly of the lower max- illary, although it has been maintained that this feature of the poi- soning is contingent upon denuded surfaces of bone, disintegration or softening of tissues, caries of the teeth, or communicating wounds. Very rarely the palate and frontal bones are similarly attacked. Treatment of Poisoning. — Emetics and purgatives are of the first necessity. Copper sulphate is the most efficient emetic as well as the best chemical antidote. Hydrated magnesia, charcoal, and lime water have been suggested, yet their action is tardy, and a more efficient antidote is desirable. Several chemical and physio- logical agents have been employed to counteract the effects of the drug, among them old acid (oxygenated) oil of turpentine and potassium permanganate in a ^ per cent, solution, opium being used as a stimulant to the heart and the circulatory system. As prophylactic measures for the protection of workmen against phosphor-necrosis masks covering mouth and nose have been found serviceable, as well as inhalation of the vapor of turpentine obtained by suspending a small bottle of the fluid about the neck. The teeth should be kept constantly in good condition, since caries favors the tendency to necrosis. Therapeutics. — Phosphorus is not used externally, but inter- nally it is a food, especially of the nervous and osseous systems, stimulating protoplasmic activity, although, according to Gubler, " phosphorus is a rapid stimulant, but it acts by causing waste, and not by increasing power ; it impoverishes, and does not enrich ; it momentarily galvanizes, as it were, the torpid functions, but is incapable of renewing a dilapidated constitution or even a nervous system exhausted by chronic disease." Clinical experience has certainly demonstrated its utility as a nutrient tonic to the nervous and osseous tissues. In neurasthenia and chronic nervous exhaustion it is highly efficacious. Paraplegia, particularly when resulting from excessive venery, is usually bene- fited by this drug, while the cases of locomotor ataxia improved by HEMATICS. 303 phosphorus are numerous enough to deserve special consideration. Neuralgia, particularly of the fifth nerve and accompanied by great debility, is relieved by full doses administered every four hours. It is claimed by competent observers that certain cases of angina pectoris have been completely relieved by phosphorus.' It has even been recommended in epilepsy, but its value here becomes more than doubtful when no mention of it is made by the best authorities on this disease. In paralysis resulting from cerebral hemorrhage it has been found beneficial. It has proved of great value in osteomalacia and rachitis, and the drug is credited with the cure of pernicious anemia, though it is singular, if the drug possesses any real value in this disease, that the fact has been recognized by so few observers. Such able men as Fox and Broadbent praise its efficacy in lymphadenoma. The insomnia of the aged and the wakefulness of cerebral anemia and exhaustion usually yield to this remedy. As to its aphrodisiac effects there is great difference of opinion, some physicians believing it to be a most powerful agent in reliev- ing functional impotence, while others — among them so enthusiastic an advocate of phosphorus as Thompson — conclude that the drug is inefficient for this purpose unless given in larger doses than safety prescribes. The enthusiastic praise of its eulogists, however, as a remedy in impotence of a functional character is of so con- vincing a nature as to certainly justify an extended trial in this condition. Scarcely less is the testimony regarding its efficacy in chronic psoriasis, lepra, lupus, and acne indurata. Administration. — Since many persons have a peculiar suscepti- bility to phosphorus, its administration should begin with small doses, and, should it be thought necessary to prolong the adminis- tration for an indefinite period, the tendency of the drug to produce general steatosis should not be forgotten. The phosphorus pill is undoubtedly the best form in which to administer the drug, though it possesses the disadvantages of being insoluble in the intestinal fluids and of producing more or less irritation of the gastro-intestinal mucous membrane, though the latter effect is usually unnoticed under ordinary medicinal dosage on a full stomach. The liquid preparations of phosphorus are more unstable, tending to become rapidly inert by oxidation. The spirit of phosphorus is sometimes given in cod liver oil or the elixir of calisaya. 204 A TEXT-BOOK OF MATERIA MEDICA. Calcii Hypophosphis— Calcii Hypophosphltis— Cal- cium Hypophosphite. JJ. S. F. Origin. — Obtained by heating Phosphorus with Milk of Lime and exposing the mixture to the air. Description and Properties. — Colorless, transparent, mono- clinic prisms, or small, lustrous scales, or a white, crystalline powder; odorless, having a nauseous, bitter taste, and permanent in the air. Soluble in 6.8 parts of water and in 6 parts of boiling water; insoluble in alcohol. Dose. — 5-6 grains (0.3-0.4 Gm.). Calcii Phosphas Praecipitatus— Calcii Phosphatis Praecipitati— Precipitated Calcium Phosphate. V. 8. P. Origin. — Prepared by the action of Hydrochloric Acid and Water upon Bone-ash, the addition of Solution of Ammonia to render the mixture of an alkaline reaction, and washing and drying the precipitate. Description and Properties. — A light, white, amorphous pow- der, odorless and tasteless, permanent in the air. Almost insoluble in cold water ; partly decomposed by boiling water, which dissolves out an acid salt; almost insoluble in acetic acid, except when freshly precipitated ; easily soluble in hydrochloric or nitric acid ; insoluble in alcohol. Dose. — 10-30 grains (0.6-2.0 Gm.). Sodii Hypophosphis— Sodii HypophosphTtis— Sodium Hypophosphite. U. S. I*. Origin. — Prepared by adding Sodium Carbonate to a solution of Calcium Hypophosphite and evaporating the filtrate. Description and Properties. — Small, colorless, transparent, rec- tangular plates of a pearly lustre, or a white, granular powder, odorless, and having a bitterish-sweet, saline taste. Very deliques- cent on exposure to moist air. Soluble in i part of water and in 30 parts of alcohol, also in 0.12 part of boiling water and in i part of boiling alcohol ; slightly soluble in absolute alcohol ; insoluble in ether. Sodium hypophosphite should be kept in well-stoppered bottles. Dose. — 5-10 grains (0.3-0.6 Gm.). HEM A TICS. 205 Potassii Hypophosphis— Potassii Hypophosphitis— Potassium Hypophosphite. U.S. P. Origin. — Prepared in a similar manner to Calcium Hypophos- phite, or by double decomposition of Calcium Hypophosphite and Potassium Carbonate. Description and Properties. — White, opaque, hexagonal plates, or crystalline masses, or a granular powder, odorless, and having a pungent, saline taste; very deliquescent. Soluble in 0.6 part of water and in 7.3 parts of alcohol. Potassium hypophosphite should be kept in well-stoppered bottles. Dose. — 5-30 grains (0.3-2.0 Gm.). Acidum Hypophosphorosum Dilutum— Acidi Hypo- phosphorosi Diluti— Diluted Hypophosphorous Acid. U.S. P. Origin. — Prepared by decomposing Potassium Hypophosphite by Sulphuric Acid, filtering, and evaporating to a syrupy consist- ence. It contains 10 per cent, by weight of absolute hypophos- phorous acid. Description and Properties. — A colorless liquid, without odor, and having an acid taste. Specific gravity about 1.046. Miscible in all proportions with water. Dose. — It is never used as a therapeutic agent by itself, but in the syrup of the hypophosphites. Syrupus HypopiiosphTtum— Syrupi HypophospFiI- tum— Syrup of Hypopinosphites. Formula : Calcium Hypophosphite, 45 ; Sodium Hypophos- phite, 1 5 ; Potassium Hypophosphite, 1 5 ; Diluted Hypophos- phorous Acid, 2 ; Spirit of Lemon, 5 ; Sugar, 500 ; sufficient Water to make 1000. Dose. — 1-2 fluidrachms (4.0-8.0 Cc). SS^rupus Hypophosphltum cum Ferro— S^rupi Hy- pophosphltum cum Ferro— Syrup of Hypophos- phites with Iron. Formula: Ferrous Lactate, 10; Potassium Citrate, 10; Syrup of the Hypophosphites, to 1000. Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 2o6 A TEXT-BOOK OF MATERIA MEDIC A. ZTnci Phosphidum— ZTnci Phosphidi— Zinc Phosphide. TJ. S. JP. Origin. — Prepared from Vapor of Phosphorus in a current of Dry Hydrogen over heated Zinc, after all atmospheric air has been expelled. Description and Properties. — A gritty powder of a dark-gray color, or crystalline fragments of a dark, metallic luster, and having a faint odor and taste of phosphorus. In contact with air it slowly emits phosphorous vapor. Insoluble in water or alcohol. Zinc phosphide should be kept in small glass-stoppered bottles. Dose. — j3g_i grain (0.004-0.02 Gm.). Antagonists and Incompatibles. — The sodium and potassium hypophosphites are incompatible with the soluble salts of mercury and silver, and the soluble phosphates and carbonates are incom- patible with calcium hypophosphite. Zinc phosphide is decom- posed by mineral acids. Synergists. — Phosphorus, cod liver oil, and the Restoratives generally. Physiological Action. — Although not possessing the active and poisonous properties of phosphorus, the hypophosphites are similar in their effect to small doses of phosphorus — i e. in stimu- lating and regenerating the nervous system and those tissues which contain phosphorus and lime. The CALCIUM PHOSPHATE possesses no action superior to that of the hypophosphite, and its virtues are chiefly those of the hypo- phosphite. The phosphate is soluble to a slight extent in lactic and hydro- chloric acids, so that when taken by the stomach a portion diffuses into the blood. The ZINC PHOSPHIDE is more active, and resembles more closely the action of phosphorus, and in too large doses it irritates the stomach in the same manner as uncombined phosphorus. Therapeutics. — Externally and Locally. — The calcium phos- phate, combined with a little free phosphoric acid, has been recommended by Doubenski in the treatment of tuberculous ulcera- tions. " Cold abscesses and fistulous tracts were treated by packing with gauze soaked with a solution of 5 parts to 100." Internally. — The hypophosphites may be employed for the same conditions as those in which phosphorus is used. In chlorosis, anemia, scrofula, and tuberculosis they have been highly recom- mended. In the author's opinion, in the cachexiae mentioned the HEMA TICS. 207 benefit derived from their use is slight compared with that of cod hver oil and the hygienic influences rendered serviceable in these conditions. The praise bestowed upon calcium phosphate consists largely of assertions rather than evidence : if it possesses any therapeutic value, it is chiefly that of the hypophosphite. The ZINC PHOSPHIDE has medicinal virtues greatly superior to those of the preparations above mentioned. In nervous disorders dependent upon defective nutrition it is equal, if not superior, to phosphorus, and it may be employed for any condition in which the latter drug is useful. Administration. — The zinc phosphide is best given in pill form. The hypophosphites and calcium phosphate may be given in cap- sules, though the syrup of the hypophosphites is usually preferred. It is a question whether the sugar which the syrup contains may not tend to induce or aggravate the gastric fermentation so often present in cases requiring the use of a reconstituent. Cinchona— Cinchonas— Cinchona. V. S. J?. Origin. — The bark of Cinchona Calisaya Weddell, Cinchona officinalis L., and of their hybrids and those of other species of Cinchona, yielding, when assayed by the process given in the U. S. Pharmacopoeia, " not less than 5 per cent, of total alkaloids and at least 2.5 per cent, of quinine." The genus Cinchona as at present constituted consists of from thirty-one to thirty-six species, all of which are native to South America. The habitat of the tree follows the eastern slope of the Andes, beginning in Bolivia and extending through Peru. From about 2" south lati- tude in Ecuador it occupies also the eastern slope of the Western Cordilleras, until by two narrow belts it enters the highlands of New Granada, whence it spreads northeast and northward into Venezuela, reaching the vicinity of Caracas and the Caribbean Sea. The climate in which the most valuable species are found is, according to Karster (1858), characterized by a rainy season lasting for nine months, heavy rains falling principally during the night, alternating with sunshine and fog during the day. During the remaining three months of the year the nightly temperature fre- quently sinks below freezing-point, in the day-time, however, reaching 25° C. {77° F.), producing dense fogs. The Cinchonas are evergreen trees or shrubs, the most valuable 2o8 A TEXT-BOOK OF MATERIA MEDIC A. species attaining a height of from 40 to 80 feet (12 to 24 M.). They are not met with in the valleys, but are found at altitudes varying from 330 feet (100 M.) to 11,500 feet (3500 M.). Accord- ing to Weddell, the most valuable species grow at an altitude of 5300 to 7900 feet (1600 to 2400 M.). All the species are found in the primeval forests, either singly or in collections of a few specimens. The tree is cultivated in British Sikkin, Ceylon, Java, and Jamaica. Description and Properties. — In quills or in curved pieces, varying in length, and usually ^ ox \ inch (2 or 3 Mm.), or some- times \ inch (5 Mm.), thick ; the outer surface covered with a gray or brownish-gray cork, usually slightly wrinkled, marked with transverse and also intersecting longitudinal fissures {C. Calisayd), and sometimes with scattered warts and slight longitudinal ridges ; inner surface light cinnamon-brown, very highly striate; fracture of the outer layer short and granular, finely fibrous in the inner layer ; powder light- or yellowish-brown ; odor slight, somewhat aromatic; taste bitter and somewhat astringent. Cinchona Rubra— Cinchonae Rubra— Red Cin- chona. U. S. JP. Origin. — The bark of Cinchona succirubra Pavor, containing not less than 5 per cent, of its peculiar alkaloids. Description and Properties. — In quills or in curved pieces, varying in length, and from ^I^. to | or | inch (2 to 4 or 5 Mm.) thick ; the outer surface covered with a grayish-brown cork, more or less rough from warts and longitudinal warty ridges, and few, mostly short, transverse fissures; inner surface rpore or less deep reddish-brown and distinctly striate ; fracture short-fibrous in the inner layer ; powder reddish brown ; odor slight ; taste bitter and astringent. Among the various alkaloids found in cinchona the following are the most important: Quinine, quinidine, cinchonine, and cin- chonidine, the medicinal value of the bark depending almost exclu- sively upon the alkaloid quinine. Other less important ingredients are kinic and kinovic acids, kinovin, cinchotannic acid, cinchona-red, and a minute quantity of a butyraceous, volatile oil. The ash amounts to between i and 2 per cent, consisting chiefly of the carbonates of calcium and potas- sium. Dose of powdered cinchona, 15-60 grains (1.0-4.0 Gm.). HEM A TICS. 209 Official Preparations of Cinchona. ExtrSctum Cinchonae — ExtrScti Cinchonae — Extract of Cinchona. — Dose, 5- 30 grains (0.3-2.0 Gm.). Extractum Cinchonae Fluidum — ExtrScti Cinchonae Fliiidi — Fluid Extract of Cinchona. — Dose, 10-60 minims (0.6-4.0 Cc). Infusum Cinchonae — Infusi Cinchonae — Infusion of Cinchona (6 per cent.). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). Tinctiira Cinchonae — Tinctjirae Cinchonae — Tincture of Cinchona (20 per cent.). — Dose, 1-2 fluidrachms (4.0-8.0 Cc). Official Preparation of Cinchona Rubra. Tinctiira Cinchonae Comp6sita — Tinctiirae Cinchonae Compfisitae — Com- pound Tincture of Cinchona (10 per cent., with Bitter Orange Peel 8 per cent., and Serpentaria 2 per cent.). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). Official Alkaloids and Salts. Cinchonidinae Stilphas — Cinchonidinae Sulphatis— Cinchonidine Sulphate. — Description and Properties. — White, silky, acicular crystals, without odor and having a very bitter taste ; slightly efflorescent on exposure to air. Soluble in 70 parts of water and in 66 parts of alcohol. Dose. — 10-30 grains (0.6—2.0 Gm.). Cinchonina — Cinchonlnae — Cinchonine . — Description and Properties. — White lustrous prisms or needles, without odor, at first almost tasteless, but soon developing a bitter after-taste; permanent in the air; soluble in 3760 parts of water and in 116 parts of alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). Cinchoninae Stilphas — Cinchonlnae Sulphatis — Cinchonine Sulphate. — Description and Properties. — Hard, white, lustrous, prismatic crystals, without odor and of a very bitter taste ; permanent in the air ; soluble in 66 parts of water and in 10 parts of alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). Quinidinae Stilphas — Quinidinae Sulphatis — Quinidine Sulphate. — Descrip- tion and Properties. — White silky needles, odorless, and of a very bitter taste; per- manent in the air; soluble in 100 parts of water and in 8 parts of alcohol. It should be kept in well-stoppered bottles, in a dark place. Dose. — 5-30 grains (0.3-2.0 Gm.). Quinina — Quininae — Quinine. — Description and Properties. — A white^ flaky, amorphous or crystalline powder, odorless, and having a very bitter taste ; permanent in the air; soluble in 1670 parts of water and in 6 parts of alcohol. Quinine should be kept in well-stoppered bottles, in a dark place. Dose. — 1-60 grains (0.06-4.0 Gm.). Quininae Bistilphas — Quininae Bisulphatis — Quinine Bisulphate. — Descrip- tion and Properties. — Colorless, transparent, or whitish orthorhombic crystals or small needles ; odorless and having a very bitter taste ; efflorescent on exposure to the air. Soluble in 10 parts of water and in 32 parts of alcohol. It should'te Kept in well- stoppered bottles, in a dark place. Dose.— t-lS grains (0.06-1.0 Gm.). Quininae Hydrobromas— Quininae Hydrobromatis — Quinine Hydrobro- msite.— Description and Properties.— ^hite, light, silky needles ; odorless and of a very 14 J 3IO A TEXT-BOOK OF MATERIA MEDICA. bitter taste. The salt is liable to lose water on exposure to warm or dry air. Soluble in 54 parts of water and in 0.6 part of alcohol. It should be kept in well-stoppered bottles, in a dark place. Dose. — 1-20 grains (0.06-1.3 Gm.). Quininae Hydrochloras — Quinlnae Hydrochloratis— Quinine Hydrochlorate. — Description and Properties. — White, silky, light, and fine needle-shaped crystals, odorless, and having a very bitter taste. The salt is liable to lose water on exposure to warm air. Soluble in 34 parts of water and in 3 parts of alcohol. Quinine hydro- chlorate should be kept in well-stoppered bottles, in a dark place. Dose. — 1-15 grains (0.06-1.0 Gm.). Quininae SOlphas — Quinmae Sulphatis — Quinine Sulphate, — Description and Properties. — White, silky, light, and fine needle-shaped crystals, fragile and somewhat flexible, making a very light and easily compressible mass, lusterless from superficial efflorescence after being for some time exposed to the air; odorless and having a per- sistent, very bitter taste. The salt is liable to lose water on exposure to warm air, to absorb moisture in damp air, and to become colored by exposure to light. Soluble in 740 parts of water and in 65 parts of alcohol, also in 40 parts of glycerin and in about 680 parts of chloroform, nnd freely soluble in dilute acids. It should be kept in well- stoppered bottles, in a dark place. Dose. — 1-60 grains (0.06-4.0 Gm.). Quininae Valerianas — Quininae Valerianatis — Quinine Valerianate. — Description and Properties. — White or nearly white, pearly, lustrous, triclinic crystals, having a slight odor of valerianic acid, and a bitter taste ; permanent in the air ; soluble in 100 parts of water and in 5 parts of alcohol.' It should be kept in well-stoppered bottles, in a cool place. Dose. — 1-20 grains (0.06-1.3 Gm.). Unofficial Alkaloids and Salts. Chinoidinum— Chinoidini — Chinoidine. — Origin. — Obtained from the mother- liquor in the preparation of quinine sulphate, cinchonine, and the other alkaloids of cinchona. Description and Properties. — Cylindrical rolls or masses, of a more or less deep- brown or black color and a resin-like appearance. It has but a slight taste, being faintly bitter on mastication. Almost insoluble in water; freely soluble in alcohol. Dose. — 3-30 grains (0.2-2.0 Gm.). Cinchonidinae SalKcylas — Cinchonidinae Salicylatis — Cinchonidine Salicy- late. — Dose, 2-10 grains (0.12-0,6 Gm.). Cinchonina lodosfilphas— Cinchoninae lodosulphatis— Cinchonine lodosul- phate (Antiseptol) (50 per cent, of wSmt).— Description and Properties.— K light powder of a reddish-brown color; insoluble in water, but soluble in alcohol. Used principally as a substitute for iodoform. Chlnolin— Chinolin— Chinolin (Quinolin).— 0?-;;^««.— Prepared from Cincho- nine or Quinine by distillation, or obtained synthetically. Description and Properties.— K colorless liquid, with an aromatic, pungent odor; sligh^ soj^^jein water, freely soluble in alcohol. Dos'e. — 3-ilLminims (0.18-0.6 Cc). CM^ollfli^'rartras— Chlnolin Tartratis— Chinolin Tartrate.— Soluble in 70 or 80 parts of water. Dose, 5-15 grains (0.3-1.0 Gm.). Quinetum— Quineti— Quinetum.— A mixture of the alkaloids precipitated by an f alkali. Dose, l-6o grains (0,06-4,0 Gm.). HEMATICS. 2X1 Quininae Hydrochloras Carbamidata — Quininae Hydrochloratis Carbami- dStae. — Double salt of Quinine and Urea. Soluble in water. Dose, I-IO grains (0.06- 0.6 Gm.). Usually employed hypodermically. Antagonists and Inoompatibles. — Agents promoting waste — such as the salts of mercury, iodine, copper, zinc, and lead — are therapeutically antagonistic to cinchona. The cerebral effects of quinine are antagonized by morphine, while atropine opposes its action upon the nervous and circulatory systems, as well as its antipyretic powers. The incompatibles are free tannic acid, alkalies and alkaline earths, and iodine. Fowler's solution is incompatible with infusion and decoction of cinchona. Synergists. — The Restoratives and all agents promoting con- structive metamorphosis. The antipyretic action of quinine is enhanced by the antipyretics, salicyhc acid, and sortie of the anti- septics. Its antiperiodic action is aided by arsenic, eucalyptus, carbolic acid, and creasote. Quinine fully represents the crude drug. It is classed as^ a Restorative because it is analogous to taurocholate of sodium, taurin being a natural antiseptic and germicide, destroying or pre- venting the propagation of many pathogenic organisms entering the system. The name Cinchona given to Peruvian bark was accorded in honor of the countess of Chinchon, cured of tertian fever by the use of the drug, as early as the seventeenth century, the Spanish conquerors of the country having discerned the curative properties of the plant which scientific investigation has rendered invaluable as a therapeutic agent. The native Indians had long been ac- quainted with its medicinal virtue, and but for the inquisitorial bigotry of the age the beneficiary of its potency, upon her return to Spain, would have introduced it into Europe. Such, however, was the antagonism aroused among an over-zealous clergy, and so great the force of professional rivalry, that every- where the new discovery encountered opposition, one religious body formally spurning it as the invention of unenlightened sav- ages, although the countess was not deterred from employing it among the peasantry dwelling upon her estates (Markham). About the middle of the seventeenth century a large quantity of the bark received from America reawakened discussion, and finally a council of Jesuits held at Rome approved a distribution of the drug — called therefrom " Jesuits' bark." It quickly found 213 A TEXT-BOOK OF MATERIA MEDICA. its way to other parts of the Continent and to England ; yet still the opposition to its use was pronounced, and it was only when an English quack doctor succeeded in effecting cures among persons of rank by an employment of the drug that its services became general in malarial and typhoid fevers, as well as in various other diseases. The discovery of the active principles of cinchona, crudely es- tablished by Duncan in 1803, was perfected by Pelletier and Cav- entou in 1820 by the preparations of quinine and cinchonine. In 1833 quinidine became partially known, being completely isolated as an active principle in 1852, quinine a,nd cinchonine having been employed since 18 20-2 1. Until the researches of Marchiafava, Celli, Laveran, Golgi, and others had disclosed the true etiology of malaria, quinine was used empirically in malarial diseases, its precise action being unknown. Its efficacy is now ascertained to be due to its power of destroying the Plasmodia of malaria. In addition to this action, which renders the drug of the greatest value in malarial diseases, quinine pos- sesses many other important properties, which are here considered. . Physiological Action. — Externally and Locally. — The drug is a potent antiseptic, preventing putrefaction and fermentation by its destructive influence upon fungi and infusoria, a solution of i : 250 being sufficient for this purpose, while i : 500 is fatal to certain micro-organisms, and even so weak a solution as i : 1000 suffices to destroy some infusoria. Upon the unbroken skin it has little effect, other than to pro- duce occasionally a slight roughening of the surface. To raw surfaces, however, and to mucous membranes it is irritant. Internally. — Digestive System. — Its action resembles that of vegetable bitters, augmenting the secretions from the salivary and gastro-intestinal glands, stimulating peristalsis, and increasing the blood-supply to the stomach. Under moderate doses, therefore, the appetite and digestion are improved. Large dosage disturbs digestion, occasioning nausea, with, possibly, vomiting and diarrhea. The acidity of the stomach is said to be increased by quinine sul- phate. Circulatory System. — Small doses increase the force and fre- quency of the heart's action, excessive doses slowing and weaken- ing it, and, frequently in children, causing an intermittent pulse. Toxic doses paralyze the heart, arresting it in diastole. It is not certain whether these effects are due to an action on the cardiac HEMATICS. 313 muscle or on the ganglia. It is evident, though, that small doses elevate and large doses depress arterial tension. Quinine in a remarkable manner affects the constituents of the blood. The ameboid movements of the white blood-corpuscles are arrested; preventing their migration through the capillary walls in inflammation, while their number is diminished by full doses of the drug both in health and in inflammatory conditions. The red corpuscles are materially increased in number, at least in propor- tion to the white corpuscles, the size of the former being dimin- ished in febrile conditions. Quinine retards or impairs the ozonizing power of the blood, and lessens the oxygen-carrying capacity of the red corpuscles. Nervous System. — Small doses stimulate the cerebrum. Large doses occasion cerebral congestion, with a sensation of dizziness, fulness in the head, and other symptoms described at length under " Cinchonism." The reflex function of the spinal cord is reduced, and under toxic doses ultimately abolished, owing to stimulation of Setsche- now's inhibitory center, and later to direct depression of the spinal cord and nerves. In frogs the sensory nerves are first excited and subsequently paralyzed, through the influence of the drug upon the peripheral endings. The muscles are uninfluenced, though when appUed directly to muscular fiber the drug acts as an irritant, producing muscular contractions. Respiratory System. — Quinine exerts but little influence upon the respiration, small doses shghtly increasing and large doses depressing the respiratory movements. Absorption and Elimination. — The drug is quite rapidly absorbed from the stomach, but not from the intestines. While its presence may be detected in the urine within fifteen minutes afl:er the inges- tion of a full dose, many hours, or even days, may elapse before the drug is finally excreted. Much of the drug undergoes a change in the system, being oxidized in the Uver, yet it may be detected in the urine as quinine and various isomeric modifications of it. While chiefly eliminated by the kidneys, it may escape from the system by other channels, having been found in the milk, sweat, saliva, tears, bile, and in dropsical effusions. The excretion of uric acid, urea, and other nitrogenous material is considerably diminished under the use of quinine. Temperature. — In health the temperature is unaffected by qui- 214 A TEXT-BOOK OF MATERIA MEDICA. nine, but in febrile conditions, particularly in malarial fever, the drug acts as a powerful antipyretic. Yet it is doubtful whether the drug is a true antipyretic — i. e. through its action upon the thermo- genetic tissues or centers. It is a matter of clinical observation that intermittent, typhoid, and one form of puerperal fever are the only diseases which readily yield to the antipyretic influence of quinine, the temperature in such maladies as erysipelas, pneu- monia, pleurisy, etc. being comparatively unaffected even by large dosage, seeming to prove that the drug is an antipyretic only when it destroys or renders inert the infective agent producing the fever. Eye. — There have been recorded several cases of quinine amau- rosis, with transitory blindness, color-blindness, wide dilatation of pupils — irresponsive to light, but responding to accommodation effort — pallor of the optic disks, with extreme diminution of both retinal veins and arteries and contraction of the visual field. Quinine amaurosis, however, is probably very rare, but a lim- ited number of cases being recorded, although Rogers believes that " incomplete ocular cinchonism " is of quite frequent occur- rence. Uterus. — After the inception of labor quinine seems frequently to stimulate the uterine contractions. It also increases a scanty menstrual flow. There appears to be no authoritative evidence that quinine is an abortifacient. Untoward Action. — Besides the symptoms of cinchonism from which some persons suffer after the ingestion of a small dose, there are often occasioned various eruptions of the skin, often accom- panied by marked pruritus, the eruption produced by the drug at times strongly resembling scarlatina. Peculiar disturbances of vision and impaired hearing not infre- quently attend the administration of quinine. There have been recorded cases of renal and vesical irritation, varying in intensity, following the use of the drug. The administration of the salts of quinine in pill form is often followed by gastro-intestinal catarrh. The drug has also been known to occasion epistaxis and hem- optysis. Poisoning. — Excessive doses of quinine produce a series of symptoms collectively termed cinchonism. They are — a feeling of fulness in the head, ringing or buzzing in the ears, varying degrees of deafness, headache, with possibly delirium, disturbances of vision, vertigo, and muscular weakness. Should the dose be lethal, there may be marked cardiac and respiratory failure, and collapse. HEMATICS. 215 Treatment of Poisoning. — Potassium bromide and hydrobromic acid are the' best agents to relieve the symptoms of cinchonism, full doses of the latter given with quinine being said to prevent untoward results. Should the dose be sufficient to depress the heart and respira- tion in a marked degree, cardiac and respiratory stimulants would be indicated. Therapeutics. — Externally and Locally. — Powdered cinchona bark is an ingredient of many tooth-powders. Quinine also enters into the composition of many " hair tonics," and is highly recom- mended by some physicians in the treatment of alopecia. The drug has been employed with varying success in many diseases of the nose and throat, such as hay fever, whooping cough, ozena, tonsillitis, etc. Ledetsch has highly recommended quinine bisulphate, i part to 100 parts of water and glycerin, as an injection in gonorrhea. The drug has been used with tincture of ferric chloride as a paint to prevent the spread of erysipelas. A 2 per cent, solution has proved an efficient remedy in cystitis, effectually preventing the decomposi- tion of the urine. Internally. — Undoubtedly the principal use of quinine is in the treatment of malarial diseases. When we realize that quinine in I part to 20,000 is destructive of the plasmodium malarise, it is readily understood why the drug should be so efficient as an antimalarial remedy. Quinine is one of the most powerful antiperiodics, being of more or less value in many diseased conditions characterized by periodical exacerbations. All forms of malarial fever usually yield to the proper use of quinine. It seems to be equally efficient as a prophylactic. The pq|ibdical affections due to paludal miasm are peculiarly amenable to this drug, among these disorders being the various neuralgias, headache, asthma, hay fever, chorea, jaundice, diarrhea, dysentery, etc. Quinine is a potent antiphlogistic, being very efficient in check- ing inflammation and suppuration. - It is particularly beneficial in cases of prolonged suppuration, such as pulmonary phthisis, fistu- lous discharges, septicemia, pyemia, puerperal fever, etc. It favor- ably influences the formative stages of acute inflammations, as in the beginning of endocarditis, pneumonia, pleurisy, etc. As a tonic or restorative during the course of febrile diseases. 2i6 A TEXT-BOOK OF MATERIA MEDICA. as well as in convalescence, quinine is highly efficient. Its action upon the gastro-intestinal tract renders it valuable in many forms of dyspepsia, especially the atonic variety. In these cases, where anemia is present, the drug may be advantageously combmed with iron and nux vomica. Quinine is but little used now as a pure antipyretic, being of value in this respect, as previously stated, only when it destroys the infective cause of the fever. Its antipyretic influence is conse- quently more marked in intermittent fever. It is of value also in typhoid, although now seldom employed in this disease. The remedy has proved efficient in some cases of chorea and whooping cough. It is of decided value in the yeasty vomiting pro- duced by the sarcina ventriculi, and equally beneficial in impetigo ; while acne and ecthyma, when occasioned by reduced vitality and impaired nutrition, are greatly benefited by its internal use. Quinine is serviceable in stimulating the uterine contractions during labor and increasing the menstrual discharge in amenorrhea. Contraindications. — The drug is contraindicated in acute in- flammations of the genito-urinary and gastro-intestinal tracts, in acute or subacute inflammations of the middle ear, and in menin- gitis and cerebritis. It should not be given to infants suffering from eczema, nor to persons having a marked idiosyncrasy against the drug. Administration. — Because of its intensely bitter and disagree- able taste quinine should not be given in solution. It may be sus- pended in syrup of yerba santa or in the aromatic elixir of liquorice, which disguises the taste quite effectually, and for children is pref- erable, as a method of administration, to capsules or pills. In the case of adults the drug should be given in gelatin capsules or in the form of gelatin- or sugar-coated pills. The tannate of quinine is comparatively tasteless, and may be incorporated with chocolate in the form of lozenges, thus being readily taken by children. The drug may be also administered in a suppository by the rectum or incorporated in lard and rubbed into the skin, preferably in the axillae and the inner side of the thighs or over the abdomen. It has been employed to some extent hypodermically, the quinine hydrobromate and hydrochlorate being the salts preferred for this purpose. Injections should be made in the buttocks, and very slowly administered, since this method of administration depresses the heart to a considerable degree. ANIMAL EXTRACTS. 217 Occasionally in the treatment of malaria Warburg's tincture, containing numerous aromatics, is more efficient than quinine. In obstinate malarial affections aromatics and spices greatly enhance the effect of quinine, capsicum making one of the best adjuvants. The portal circulation is stimulated, rendering the absorption of the drug more rapid and its effects more lasting. As to the time and method of administration in malarial dis- eases, the student is referred to any standard work on the Practice of Medicine. The various tinctures and elikirs of cinchona are used exten- sively ; when employed as stomachics they should be given before meals. Quinine is best given on an empty stomach or after the active process of digestion is completed. ANIMAL EXTRACTS (ORGANOTHERAPY). The striking fact that various excretions and tissues of the living organism, when administered under certain conditions, possess a peculiar therapeutic value is now well established. The theory has long been the subject of studious attention, yet the practical application of organotherapy has in recent years acquired unprece- dented importance. Extracts derived from almost every portion of the human system, together with many animal secretions, have been prepared, one of the most original being the hypodermic injection of an extract from the recent testicles of mammals adopted by Brown-Sequard in 1889 in the treatment of senile debility. As a nutrient restorative spermini hydrochloras was found to be an efficacious remedy, abundant evidence showing that the functional activity of deteriorating organs of the animal economy was per- ceptibly improved, the nervous system responding favorably to the influence of the new agent. Cancer and chorea are said to have also been benefited by spermine. Subsequently neurasthenia, locomotor ataxia, and declining nervous force due to old age were successfully treated with a glycerin extract from the gray matter of a sheep's brain, the pro- cedure, as suggested by Paul, consisting of a nervous transfusion by hypodermic injection. The most rational and successful application of organotherapy, however, was that of Murray in 1891, who proposed the subcu- 2i8 A TEXT-BOOK OF MATERIA MEDIC A. taneous injection of a thyroid extract in the treatment oi myxedema, many cases of which have ameliorated, while others have been definitely cured, by the adoption of the remedy. The preparations in this case have included the ingestion of the dry powder, the injection of a glycerin extract, and the raw or partially cooked gland administered as food. The general testimony of writers amply attests the efficacy of the remedy, which now receives almost universal acceptance. Baumann has recently isolated from the thyroid glands of sheep an organic compound which he believes to be the essential prin- ciple of the gland and the efficient agent in the treatment of various forms of myxedema. Clinical observations by Ewald, Ross, and Treufel seem to prove the correctness of Baumann's opinion. In exophthalmic goiter the employment of thyroid gland has been held to be favorable, although authorities are not wanting who claim that its use tends to aggravate the symptoms. Especially interesting are the results of thyroid treatment in cretinism of infants — infantile myxedema — authentic reports offer- ing highly encouraging details of its successful application in this disease, eliciting from Sinkler the declaration : " It is too short a time since the introduction of the thyroid-feeding in cretinism to form any opinion as to the final results ; but since in all the cases reported remarkable changes have taken place, we have reason to rejoice in possessing a remedy which can accomplish so much as has already been done in these once worse than hopeless cases." It is to be observed that both the endemic and sporadic forms of the above malady have proved amenable to the thyroid treat- ment. Jackson concludes that " in myxedema and cretinism it is worth while to run a risk as to life in the hope of removing symptoms that make life, hardly worth living. In dermatoses, on the con- trary, life is generally little endangered, and we are not justified in resorting to too heroic measures." The remedy has been applied in insanity, with the effect of im- proving depressed, but intensifying maniacal, conditions, care being requisite in the presence of certain contraindications, such as tuberculosis, valvular disease of the heart, etc. Bramwell reports a case of tetamis resulting from thyroid extir- pation cured by doses of the gland ; another of idiopathic tetany yielding to the same treatment. With regard to thyroid treatment in skin diseases, Abraham ANIMAL EXTRACTS. 319 asserts that there is no constant effect in psoriasis and many other cutaneous affections, and that in a large number of cases the results are negative, and that untoward effects are alarmingly frequent. Improvement has been noted in several cases of malignant syphilis, Menzies considering that thyroid acts as a powerful skin- tonic and a useful adjuvant to mercury and potassium iodide in the treatment of this disease. With regard to thyroid, however, it must be admitted that, save in myxedema, simple goiter, and obesity, the remedy is of com- paratively slight value, and even in these affections only by con- tinued treatment have favorable results been obtained. The favorable results often attending the partial employment of animal agents in diseases of corresponding organs, and especially the noteworthy benefits derived from the application of the thyroid treatment in myxedema, have suggested the preparation of many extracts of varying efficacy. Among these are — Nucleins, compounds of proteid substances with nucleic acid, obtained by artificial digestion, among their sources being pus-cor- puscles, the spermatozoa of various animals, testicles, thyroid gland, yolk of hens' eggs, liver, brain, cows' milk, etc. A marked property of the blood, as has long been kn.own, is its germicidal power, and it has furthermore been satisfactorily determined that the basic force resides in a nuclein. The agent has consequently been essayed in the hope of establishing a bactericidal influence. Vaiighan reports that in tuberculosis the effect of moderate injec- tions has been to lower the temperature, without untoward mani- festations. Indolent ulcer, too, according to the same authority, has yielded completely to a similar treatment, the nuclein being derived from yeast. It is also stated upon high authority that the remedy is useful in " all forms of anemia, in chronic and recurrent malaria, in diges- tive disorders, and in acute and chronic pulmonary affections" (Aulde), the nuclein adopted being obtained from the thyroid and thymus glands. The latter author suggests the use of nuclein in the treatment of typhoid, in which disease the activity of leucdcy- tosis is defective. Bone-marrow has proved efficacious in anemia (Dickson, Frazer), and has also been employed by Filleau in tuberculosis. Brain-extract, besides its utility in locomotor ataxia and senile debility, has been reported as beneficial in certain organic and func- tional diseases of the nervous system — in epilepsy, hysteria, mi- 220 A TEXT-BOOK OF MA TERIA MEDICA. graine, hebephrenia, etc., as well as in bulbar palsy and general paralysis of the insane. Heart-extract has been recommended in cases of nervous prostration, it being claimed that its action tends to raise the blood-pressure and increase the number of red corpuscles; muscle-extract has served a useful purpose in affections of the corresponding tissues ; extract of pancreas, though with small success, has been employed in diabetes mellitus ; and among other preparations used with doubtful or auspicious results are medullin, from the cord ; renin, from the kidneys ; gastrin, from the stom- ach; and ovarin, from the ovaries. The subject is fraught with interest to the clinician, and, as in serum-therapy, the rapid progress of therapeutic knowledge bids fair to extend its value in the rational treatment of human disease. DIVISION II.— SPECIFICS. These drugs are unnatural to the system, though acting spe- cifically, and in some unknown way, against certain diseases or morbid conditions. They are given with a view to influencing the course of the disease itself, not for their effect upon the symptoms alone. If administered for any length of time, there is danger of causing an artificial disease, because of the characteristic action of these medicines, which differs essentially from their remedial influence. When used as specifics they do not produce or relieve symp- toms, except by renewal of health or by removing either the pathological condition or the disease. Whenever, therefore, these drugs produce symptoms when used specifically, it is a sign that they are contraindicated, or have been given for too long a time, or in too large doses. As they are unnatural, and consequently more or less poisonous to the system, their administration should be accompanied by restoratives to lessen their tendency to unto- ward manifestations and systemic depression. Mercury, being perhaps the most typical specific, will be first considered. Hydrargyrum— Hydrargyri— Mercury. U. S. P. (Quicksilver.) Origin. — The knowledge of this drug antedates the Christian era. It is found in Spain, Austria, Peru, and China, but is obtained principally from New Almaden, California. It occurs to some ex- tent in the metallic state in the form of minute or large globules ; also in combination with oxygen, chlorine, selenium, etc. ; but the principal ore from which it is extracted is cinnabar. Description and Properties. — A shining, silver-white metal, without odor or taste. It is liquid at the ordinary temperature, and easily divisible into spherical globules; but when cooled to — 39.38° C. ( — 38.88° F.), it forms a ductile, malleable mass. Specific gravity, 13.5584 at 15° C. (59° R). Insoluble in the ordinary solvents, also in concentrated hydro- chloric acid, and, at common temperatures, in sulphuric acid, but dissolving in the latter when boiled with it, and readily and com- pletely soluble in nitric acid. Mercury should be kept in strong, well-stoppered bottles. 221 223 A TEXT-BOOK OF MATERIA MEDIC A. Dose.— Mercury is seldom given internally except in the modi- fied form of blue pill. Hydrargyrum Ammoniatum— Hydrargyri Ammo- niati—Ammoniated Mercury. TJ.S.F. Origin. — Prepared by mixing solutions of Ammonia and Cor- rosive Mercuric Chloride. Filter and wash the precipitated am- moniated mercury. Description and Properties. — White, pulverulent pieces, or white, amorphous powder, without odor, and having an earthy, and afterward styptic and metallic taste. Permanent in the air. Almost insoluble in water or in alcohol. It should be kept in well- stoppered bottles, protected from the light. Used externally. Official Preparation. Ungu6ntum HydrSrgyri Ammoniati — UnguSnti Hydrargyri Ammoniati — Ointment of Ammoniated Mercury. — Formula: Ammoniated Mercury, lo; Ben- zoinated Lard, 90 parts. For external use. Hydrargyrum cum Creta— HydrS.rgyri cum Greta- Mercury with Chalk. JJ. S. P. Origin. — Obtained by trituration of Mercury, Prepared Chalk, Clarified Honey, and Water. Description and Properties. — A light gray, rather damp pow- der, free from grittiness, without odor, and having a slightly sweet- ish taste. It contains 38 per cent, of mercury. This preparation should be kept in well-stoppered bottles, protected from light. Dose. — 3-10 grains (0.18-0.6 Gm.). Massa Hydrargyri— MSssae Hydrargyri— Mass of Mercury. JJ. S. P. (PiLULA Hydrargyri— Blue Mass — Blue Pill.) Composed of Mercury, Glycyrrhiza, Althaea, Glycerin, and Honey of Rose. Dose. — |-io grains (0.03-0.6 Gm.). Unguentum Hydrargyri — Unguenti Hydrargyri — Mercurial Ointment. JJ. S. JP. (Blue Ointment.) Composition: Mercury, Lard, Suet, and Oleate of Mercuiy. Used externally. SPECIFICS. 223 Emplastrum Ammoniaci cum Hydrargyro — Em- plastrum (ace.) Ammoniaci cum Hydrargryro— Ammoniac Plaster witii Mercury. V, S. -P. Composition : Ammoniac, Mercury, Oleate of Mercury, Diluted Acetic Acid, and Lead Plaster. Used externally. Emplastrum Hydrargryri— Emplastri Hydrargyri— Mercurial Plaster. U. S. P. Composition : Mercury, Oleate of Mercury, and Lead Plaster. Used externally. O Hydr§.rgyri Chloridum Corro^wTn — Hydrargyri Chloridi CorrosTvi— Corrosive Mercuric Chloride. U. S. JP. (Corrosive Chloride of Mercury — Corrosive Sublimate.) Origin. — Prepared by heating a mixture of Mercuric Stilphate, Sodium Chlorate, and Manganese Dioxide. The corrosive chloride sublimes and is condensed. Description and Properties. — Heavy, colorless, rhombic crys- tals or crystalline masses ; odorless and having an acrid and per- sistent metallic taste. Permanent in the air. Soluble in 16 parts of water, in 3 parts of alcohol, in 2 parts of boiling water, in 1.2 parts of boiling alcohol, in 4 parts of e.ther, and in about 14 parts of glycerin. It should be kept in well-stoppered bottles. Dose. — ^^^ grain (0.001-0.008 Gm.). Hydrargyri Chloridum Mite — Hydrargyri Chloridi MTtis— Mild Mercurous Chloride. U. S. JP. (Calomel — Mild Chloride of Mercury.) Origin. — Obtained by triturating Mercuric Sulphate, Mercury, Sodium Chloride, and boiling Distilled Water. Sublime, and wash the sublimed calomel with boiling distilled water. Description and Properties. — A white, impalpable powder, be- coming yellowish-white on being triturated with strong pressure. It is odorless and tasteless, and permanent in the air. Insoluble in water, alcohol, or ether, and also in cold, diluted acids. When strongly heated it is wholly volatilized, without melting. Calomel should be kept in dark, amber-colored bottles. Dose. — ^^10 grains (0.002-0.6 Gm.). Calomel enters into the following 234 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. PJlulae Antimonii Comp6sitK— Pllulas (ace.) AntimSnii CompSsitas-Com- pound Pills of Antimony.— -Dojf, i or 2 pills. Pllute Catharticee Comp6sitae— PJlulas (ace.) CathSrticas Conip6sitas— Compound Cathartic V\\\s.—Dose, i to 3 pills. Hydrarg^yri Cyanidum— Hydrargyri Cyanidi— Mer- curic Cyanide. TJ. 8. P. Origin. — It may be obtained by boiling pure Ferrocyanide of Iron with Mercuric Oxide; the mercuric cyanide, entering into solution, is separated by filtration, evaporization, and crystallization from diluted alcohol. Description and Properties. — Colorless or white prismatic crystals ; odorless, and having a bitter, metallic taste (fhe salt is exceedingly poisonous), becoming dark-colored on exposure to light. Soluble in 12.8 parts of water and in 15 parts of alcohol. Dose. — j-^ o ' ^^ grain (o.ooo6hd.oo4 Gm.). Hydr^rg-yri lodidum Fiavum— Hydrargyri lodidi Fiavi— Yellow Mercurous Iodide. TJ. S. JP. (Hydrargyri Iodidum Viride — Protiodide of Mercury — Yellow (or Green) Iodide of Mercury.) Origin. — Prepared by mixing solutions of Potassium Iodide and Mercurous Nitrate with Nitric Acid and Distilled Water. The precipitate is washed and dried. Description and Properties. — A bright yellow amorphous powder, odorless and tasteless. By exposure to light it becomes darker in proportion as it undergoes decomposition into metallic mercury and mercuric iodide. Almost insoluble in water, and wholly insoluble in alcohol or ether. It should be kept in dark, amber-colored vials, with the least possible exposure to light. Dose. — \-\ grain (0.01-0.03 Gm.). Hydrargyri lodidum Rubrum -Hydrargyri lodidi Rubri— Red Mercuric Iodide. U. S. P. (BiNiODiDE OF Mercury — Red Iodide of Mercury.) Origin. — Prepared by mixing solutions of Corrosive "TVTercuric Chloride and Potassium Iodide ; filter, and dry the precipitated red iodide. Description and Properties. — A scarlet-red, amorphous pow- der, odorless and tasteless ; permanent in the air. Almost insoluble SPECIFICS. 235 in water, but soluble in 1 30 parts of alcohol. It should be kept in well-stoppered bottles, protected from light. Dose. — g \ j^ig grain (0.002-0.004 Gm.). This drug enters into the Official Preparation. Liquor Arseni et Hydrargyri lodidi — Liquoris Arseni et Hydrar'gyri I5didi — Solution of Arsenic and Mercuric Iodide. — (Described under Arsenic.') — Dose, 5 minims (0.3 Cc), gradually increased. Hydrargryri Oxidum Flavum— Hydrargyri Oxidi Flavi— Yellow Mercuric Oxide. JJ. S. I*. Origin. — Prepared by precipitating a solution of Corrosive Mercuric Chloride with Soda. Description and Properties. — A light orange-yellow, amor- phous, heavy, impalpable powder ; odorless, and having a some- what metallic taste. Permanent in the air, but turning darker on exposure to light. Almost insoluble in water or in alcohol. It should be kept in well-stoppered bottles, protected from light. Not used internally. Official Preparation. UnguSntum HydrSrgyri Oxidi Flavi — UnguSnti HydrSrgyri Oxidi Flavi — Ointment of Yellow Mercuric Oxide. — Formula: Yellow Mercuric Oxide, 10 ; Ointment, 90 parts. Used externally. Hydrargryri Oxidum Rubrum— Hydrargyri Oxidi RQbri— Red iVIercuric Oxide. TJ. S. I*. (Red Precipitate.) Origin. — Prepared by dissolving Mercury in Diluted Nitric Acid. Evaporate to dryness. Triturate the mercuric nitrate thus formed with mercury and heat. Description and Properties. — Heavy, orange-red crystalline scales, or a crystalline powder, becoming yellower the finer it is divided ; odorless, and having a somewhat metallic taste ; perma- nent in the air. Almost insoluble in water and in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose. — ^ij-^J^' grain (0.001-0.006 Gm.). Official Preparation. UnguSntum HydrSrgyri Oxidi Riibri — UnguSnti HydrSrgyri Oxidi Rubri — Ointment of Red Mercuric Oxide. — Formula: Red Mercuric Oxide, lo; Castor Oil, 5; Ointment, 85 parts. Used externally. 15 326 A TEXT-BOOK OF MATERIA MEDIC A. Hydrargyri Subsulphas Flavus— Hydrargyri Sub- sulphatis Flavi— Yellow Mercuric Subsulphate. JJ. S. I*. (Basic Mercuric Sulphate — Turpeth Mineral.) Origin. — Obtained by dissolving Mercury in Sulphuric and Nitric Acids. Add a sufficient quantity of Water. Decant and dry the residue. Description and Properties. — A heavy, lemon-yellow powder, odorless and almost tasteless ; permanent in the air. Soluble in about 2000 parts of water. Insoluble in alcohol. It should be kept in well-stoppered bottles, protected from the light. Dose. — 1-3 grains (0.015-0.18 Gm.). Liquor Hydrargyri Nitratis— Liquoris Hydrargyri Nitratis— Solution of Mercuric Nitrate. TT. S. P. A liquid containing about 60 per cent, of Mercuric Nitrate, together with about 1 1 per cent, of free Nitric Acid. Description and Properties. — A clear, nearly colorless, heavy liquid, having a faint odor of nitric acid and a strongly acid reac- tion. The product should be kept in glass-stoppered bottles. Used externally as a caustic. Unguentum Hydrargyri Nitratis — Unguenti Hy- drargyri Nitratis— Ointment of Mercuric Nitrate. U. S. I*. (Citrine Ointment.) Formula: Mercury, 70; Nitric Acid, 157; Lard Oil, 760 parts. Used externally. Unofficial Preparations. Hydrargyri SaHcylas— Hydrargyri Salicylatis— Mercurous Salicylate.— Dose of Mercurous Salicylate, \-\ grain (0.008-0.015 Gm.).—Dose of Mercuric Salicy- late, t'j-J^ grain (0.004-0.008 Gm.). Hydrargyri Formamidatum— HydrSrgyri Formamidati— Formamidate of Mercury. — Dose for hypodermic use, ■^■^-\ grain (0.005-0.01 Gm.). Hydrargyri Tannas— HydrSrgyri Tannatis— Mercurous Tannate.— £»«?, ^I grain (0.03-0.06 Gm.). Lotio Flava— Lotionis Flavae— Yellow Wash.— Coirosive Sublimate, 25 grains (1.5 Gm.), in Lime Water, 16 ounces (473.17 Cc). For external use. Lotio Nigra— Lotionis Nigrae— Black Wash.— Calomel, 64 grains (4.15 Gm.), in Lime Water, 16 ounces (473.17 Co.). For external use. Asparagin Hydrargyrate.- iPoj^, \ grain (o.oi Gm.), hypodermically. SPECIFICS. 227 Antagonists and Incompatibles. — Mercury with chalk is in- compatible with acids and acidulous salts. Calomel is incompatible with alkalies, alkaline earths, alkaline carbonates, iron, lead, copper, iodine, bromides, soaps, sulphydrates, and nitrohydrochloric acid, as well as hydrochloric acid, potassium, ammonium, and sodium chloride. Corrosive subhmate is incompatible with alkalies and their car- bonates, soap, lime water, tartar emetic, the iodides of potassium and sodium, acetate of lead, silver nitrate, the sulphides, albuminous liquids (as milk, etc.), many vegetable infusions, and compound syrup of sarsaparilla. In general, metallic preparations of mercury are incompatible with iodine and the chlorides. Synergists. — Potassium iodide enhances the antisyphilitic action of mercury. Depressants — such as antimony and alkalies — increase the physiological activity of mercury and its preparations. Tonic and resin-bearing purgatives — such as aloes, rhubarb, and podophyllum — aid the cathartic action of some of the mercurial preparations. Physiological Action. — Externally and Locally. — Liquid metal- lic mercury is inert. Most of the preparations applied to the skin are antiparasitic and antiseptic, corrosive mercuric chloride being one of the most important antiseptics and universal germicides known. Some of the mercurials are powerful irritants, the nitrate being an active caustic. The mercurous salts, even, possess slightly stimulating properties. Metallic mercury and its salts are readily absorbed with the aid of friction, at times producing a slight irritation resulting from their stimulating properties. Absorption may also take place from local application in the form of a fine vapor. The introduction of the drug into the system through the medium of the skin is attended with all the symptoms of mercurial poisoning. The local actions of the various preparations differ somewhat, yet they agree in certain physiological effects produced after absorption of the drug. A common feature of mercurial application is a slight, peculiar fetor in the mouth, accompanied by soreness of the teeth, swelling of the gums, and an increase of saliva, ptyalism being a marked symptom of mercurial disturbance. A disagreeable metallic taste is seldom absent. ^ These symptoms assume a serious phase if the 228 A TEXT-BOOK OF MATERIA MEDICA. application be continued, stomatitis and other graver conditions ensuing-. Ijiternally.— Digestive System.— SmzW doses have httle untoward effect; they may even prove tonic. Large doses act unfavorably upon the gastro-intestinal mucous membrane, causing diarrhea and possibly rnore serious derangement. As purgatives the mercurial preparations act by augmenting the secretions of the intestinal glands ; at the same time the pancreatic secretions are increased and there is marked activity of the absorbent system. The prin- cipal action is on the duodenum, hastening evacuation of the bile and preventing its reabsorption. While promoting excretion of bile, they act the reverse as to its secretion. This is particularly true of calomel, which actually diminishes that secretion, though it is alleged that the corrosive mercuric chloride is a direct chola- gogue, stimulating to some extent the hepatic secretory apparatus. Circulatory System. — Corrosive sublimate exerts a decided in- fluence upon the heart, its toxic effect tending to diminish cardiac action. The remaining preparations of mercury appear to be less active in this respect. The physical action of the drug upon the corpuscular constituents of the blood has been well ascertained, anemia, reduced cohesion, and final dissolution having been ob- served. It is to be noted that under prolonged or over-dosage the blood becomes impoverished, its ozonizing function is impaired, and the fibrin loses its coagulability. But when administered in minute doses the mercuric corrosive chloride acts as a tonic to the blood, increasing the number of red corpuscles and the body- weight. ^, Should " tonic doses " be continued for too long a period, there would be increased weight, owing to too great stimulation of the lymphatic system. Nervous System. — The full effects of mercury and its prepara- tions upon the nervous system are best seen when toxic doses are given. The effects are considered in extenso under the head of " Poisoning." Respiratory System. — The general tendency of mercury, in those who have been subject to prolonged dosage, is to depress the- cir- culation, rendering the breathing labored and debilitated, a sense of respiratory constriction being present. Absorption and Elimination. — When a ' preparation of mercury is taken internally it is converted in the stomach into a double chloride of sodium and mercury. This substance, uniting with the SPECIFICS. 229 albuminous juices, is soluble in an excess of albumin and sodium chloride, and, readily diffusing into the blood, is converted into, and exists in that fluid as, the oxyalbuminate of mercury. The absorption of this drug is gradual, yet, notwithstanding every secretion of the body contributes to its general expulsion from the system, its cumulative action is a well-established fact. Elimination occurs chiefly by the urine, the saliva, bile, sweat, milk, and feces. Even the semen shares in the process. Single doses may be eliminated in twenty-four hours, but the drug has been detected in the liver a year after the discontinuance of prolonged treatment. Mercury has been found in serum and in pus from ulcers. Calomel possesses marked diuretic action, greatly increasing the amount of urine. Temperature. — Save in a secondary manner, temperature is sel- dom affected. From over-stimulation or irritation the drug may produce local inflammatory conditions or even febrile symptoms. Eye. — Himly mentions that amaurosis mercurialis occurs in workers in mercury, while Galezowski reports an example of optic atrophy, and Square cites a case of optic neuritis, due to the toxic action of mercurial salts. Untoward Action. — Many affections of the skin manifest them- selves after the exhibition of mercury, erythema and eczema (eczema mercuriale) frequently occurring after either the ingestion or the external application of mercurial preparations. The author recalls one patient in whom \ grain (0.016 Gm.) of calomel excited an exanthematous eruption over the entire body, some edema of the face, together with fever and angina of the fauces. At another time similar symptoms were produced in this patient by immersing the hands in a i : 2000 solution of corrosive sublimate. In certain persons having an idiosyncrasy regarding this drug extreme salivation and stomatitis may be induced by the internal use or the external application of mercurial preparations in medici^ nal quantities. Medicinal doses may produce, in susceptible persons, marked disturbances of nutrition, sensation, and motion to such a degree as to suggest poisoning. Poisoning. — Although mercury in a metallic state is compara- tively innocuous, its vapor is capable of producing violent and dangerous symptoms. All the salts are active poisons, especially 230 A TEXT-BOOK OF MATERIA MEDICA. that known as corrosive sublimate. The symptoms following toxic doses of this preparation resemble those occasioned by arsenic. The salt, however, being more readily soluble, produces propor- tionately more speedy and pronounced effects. They are, briefly, a strong, metallic taste in the mouth, frequent and bloody evacua- tions, tenesmus, severe abdominal pains, vomiting, and labored res- piration. There may be suppression of urine, syncope, and perhaps insensibility and convulsions. One of the most obstinate features of mercurial poisoning is ptyalism or salivation. This condition is first manifested by tender- ness of the gums and teeth. The gums are inflamed and covered by a white, sticky substance, and bleed at the slightest provocation. The breath is very offensive. The teeth become loose, and may drop out. Necrosis of the maxillary bones may appear, and ex- tensive ulcerations of the gums and cheeks frequently occur. Accompanying these manifestations is an enormous increase in the amount of saliva secreted, which in some instances literally runs from the mouth night and day, often depriving the patient of sleep. Not infrequently a swelling of the lymphatic glands is also ob- served. Articulation and deglutition are interfered with from swell- ing of the tongue and ulceration of the gums, cheeks, palate, and tonsils. These symptoms, together with the fever, anorexia, mus- cular weakness, and headache which are constant accompaniments of ptyalism, render the condition of the patient very serious and tormenting. Chronic mercurial poisoning , or mercurial cachexia, is the effect produced by prolonged exposure to the fumes of mercury. The blood becomes thin and poor, with degeneration of the corpuscles. The person becomes emaciated, the heart is weak, and the whole muscular system impaired. Respiration is rapid and shallow, and the mental faculties are affected. Loss of memory, irritability of temper, melancholia, and, in rare cases, mania, may ensue. All the special senses are affected. Deafness, dimness of vision, impaired taste and sensation, as well as intestinal derangement, edema, articular pains, and generally disordered secretions, manifest them- ' selves. Mercurial cachexia frequently produces muscular tremors, usu- ally beginning in the upper extremities with gradual extension. Even paralysis of groups of muscles is often the result of chronic mercurial poisoning. Treatment of Poisoning. — In acute poisoning from corrosive sub- SPECIFICS. 231 limate or other active salt of mercury it is necessary to evacuate the stomach as quickly as possible, and give white of eggs freely. The after-treatment is similar to that of other corrosive poisons — the use of demulcents and opiates. For salivation, potassium chlorate probably occupies the first place as a prophylactic and curative agent. It is employed as a gargle and mouth-wash in a 2 to 3 per cent, solution. An astrin- gent wash is frequently necessary. Such drugs as tannin, myrrh, krameria, etc. may be used for this purpose. Where there is ex- tensive ulceration of the mouth disinfectant and antiseptic solutions will be found desirable. In cases of chronic mercurial poisoning it is of primary import- ance to remove all traces of the drug from the system by means of iodides, the dosage being limited in quantity, but continued for some time. Elimination of the poison from the tissues may be accomplished in various ways — the potassium iodide administered alternately with magnesium sulphate, laxatives, sulphur baths, and sulphur given internally. A change of air, liberal and nutritious diet, and tonics are also necessary. Therapeutics. — Externally and Locally. — As a germicide, anti- septic, and antiparasitic the preparations of mercury are extremely valuable, the corrosive chloride of mercury being extensively em- ployed as an antiseptic in general surgery in strengths of from 1 : 1000 to I : 10,000. In diseases of the skin due to animal or vegetable parasites there are no drugs so valuable as certain preparations of mercury, the ointment of ammoniated mercury being highly prized. Calomel in the form of an ointment, 5 to 20 grains (0.3-1.25 Gm.) to I ounce (32.0 Gm.) is an efficient remedy in eczema. Indolent venereal ulcers are much iniproved by dusting them with calomel, while the early inflammatory conditions of these sores may be greatly benefited by the use of black wash. Many diseases of the eye, ear, nose, and throat yield to various preparations of mercury. The ointment of the yellow oxide of MERCURY is particularly adapted to phlyctenular ophthalmia, pannus, keratitis, chronic blepharitis marginalis, etc. Inunction with mercurial ointment or with oleate of mer- cury is excellent for the constitutional treatment of syphilis. These two preparations are of great value in subacute synovitis, pelvic cellulitis, and syphilitic orchitis and epididymitis. 332 A TEXT-BOOK OF MATERIA MEDIC A. The OINTMENT OF THE RED IODIDE OF MERCURY has a reputation as an efficient remedy in goiter and enlargement of the spleen, as well as in pachymeningitis. The SOLUTION OF NITRATE OF MERCURY is an active and reli- able caustic in the treatment of phagedenic ulcerations and venereal ulcerations of the os uteri. The use of mercurials is usually attended with excellent results in promoting resolution of fibrous induration resulting from chronic inflammation. Internally. — The principal use of mercury is undoubtedly as an antisyphilitic. Mercury is an antidote against constitutional syphilis, being particularly efficient in the secondary stage. Many methods of mercurializing a patient have been adopted, mention of which will be made under " Administration." It is perhaps un- necessary to caution the therapeutist to make an accurate and positive diagnosis of syphilis before instituting the mercurial treat- ment, as otherwise the consequences may be disastrous. Mercury has been used in all stages of the disease, though, possibly from ignorance of its proper use, its employment has met with less favorable results in the primary than in the secondary form, while a careful study of syphilology leads one to believe that in tertiary syphilis it is inferior to the iodides, if not, indeed, actually contraindicated. The medical uses of mercurial preparations in disorders of the alimentary tract are very numerous. Chronic dysentery will frequently yield to -^ to -^ grain (0.0006-0.0001 Gm.) of CORROSIVE CHLORIDE OF MERCURY and diarrheas of children — particularly those characterized by pale, offensive stools— together with ileo-colitis of infants, are greatly benefited by small doses of calomel or gray powder, which will also allay obstinate vomiting. As a purgative in bilious attacks, hepatic congestion, and cirrhosis CALOMEL is an extremely valuable drug. Its action as a purgative will be more fully described under "Cathartics." This drug is also a remarkably efficient diuretic. The internal use of mercury is of great value in all nonsuppu- rative inflammations, as cirrhotic conditions in the glandular struc- tures, or in scleroses in the nervous system, such as hepatic cirrhosis, chronic interstitial nephritis, locomotor ataxia, chronic endarteritis, chronic affections of the lungs and pleura, etc. Many acute febrile and inflammatory conditions, such as menin- SPECIFICS. 233 gitis, pericarditis, and hepatitis, are sometimes benefited by the in- ternal administration of calomel, though in acute inflammations the chief value of the drug, whether specific or non-specific, is manifest in iritis and in acute bronchitis which shows a tendency to persist. Calomel given in frohi 10- to 20-grain (0.6-1. Gm.) doses in cases of pneumonia is esteemed very highly by some authorities. Calomel and opium have been used and recommended by some physicians in the treatment of Asiatic cholera. The internal use of bichloride of mercury is unquestionably of much value in the treatment of diphtheria, and the subsulphate of mercury is an old and veiy effective emetic in membranous laryngitis. The author has often successfully treated marasmus of infants with bichloride of mercury administered three times a day in doses of from ^-|-g- to 3-^ grain (0.0005-0.0006 Gm.). Contraindications. — Mercury is usually contraindicated in tuberculosis and in persons of strumous diathesis ; and, while it is of value when judiciously employed in chronic interstitial nephritis, it must nevertheless be given cautiously, and if the excretion of urine is diminished by its use, the drug should be immediately discontinued. Children, though not easily salivated, are very susceptible to other poisonous actions of calomel. Ordinarily, acute asthenic diarrhea and dysentery in adults would contraindicate the use of mercurials. Administration. — Mercuiy is introduced into the system by — 1 . Inunction. — ^The portion of the body upon which the prepa- ration is to be applied should first be thoroughly washed with soap and warm water, and the ointment well rubbed in with the palm of the hand. The best localities for application are the inner sides of the thighs, the sides of the chest, the axillae, abdomen, and back. An excellent way to mercurialize a child is to put the ointment on the abdomen beneath a flannel binder. An efficient means also of favoring absorption is to apply the ointment to the soles of the feet, when it will be rubbed in by walking. Mercurial ointment is ordinarily used for this purpose, 15 to 30 grains (1.0-2.0 Gm.) being required for each inunction. Oleate of mercury when applied externally should not be rubbed in, the simple application to the skin being sufficient. 2. Fumigation. — The iodide, mercuric sulphide, and calomel are used in this manner. The latter preparation, being preferable, is the 234 A TEXT-BOOK OF MATERIA MEDICA. one ordinarily used. From 5 to 20 grains (0.3-1.2 Gm.) of calomel are put in a plate or a porcelain dish over a lighted spirit-lamp. These are placed under a cane-bottomed chair, in which the patient sits, nude, enveloped in a blanket reaching to the floor and fastened loosely about the neck. The calomel is volatilized by the heat,, deposited in minute particles over the surface of the body, and read- ily absorbed. The fumigation should last fifteen to twenty minutes. 3. Endermically. — Mercurials may be absorbed by dusting calo- mel and certain other preparations on ulcers, open wounds, etc. 4. By the Rectum. — Mercury may be administered in .the form of a suppository containing 5 to 10 grains (0.3-O.6 Gm.) of mer- curial ointment. 5. Hypodermically. — From xS" to |- grain (0.005-0.01 Gm.) of the bichloride of mercury, dissolved in 5 to 10 minims (0.3-0.6- Cc.) of distilled water, is injected deeply into the muscles of the gluteal region or in the subcutaneous areolar tissue of the back. The solution of peptonate of mercury has been used for this pur- pose, though the preparation which is the least objectionable is the solution of the formamidate of mercury, 16 minims (i.o Cc), cor- responding to \ grain (o.i Gm.) of mercuric chloride. A I per cent, solution of asparagin hydrargyrate has been highly recommended by Neumann for hypodermic use, the dose being about 15 minims (i.o Cc), equivalentto \ grain (o.oi Gm.). Numerous other preparations have been recommended, but probably possess no advantage over those mentioned. 6. Internally. — In the treatment of syphilis nearly every prepara- tion of mercury has been employed, authorities differing in their choice. Bumstead prefers the bichloride, the mercurous iodide,, and the mercurial pill; Berkeley Hill, the red mercuric iodide; Fox, the cyanide ; Hutchinson, the gray powder, etc. It matters little which of these preparations is used. That which agrees best with the patient is advisable. Calomel, gray powder, blue pill, and corrosive subUmate are ordinarily used in disorders of the ali- mentary tract. As a rule, the first two are preferable. ARSENIC. Acidum Arsenosum — Acidi Arsenosi — Arsenous Acid. V.S.P. (Arsenic Trioxide — White Arsenic.) Origin.— Arsenic has been found in minute proportions in many mineral waters." It is obtained in large quantities by roasting SPECIFICS. 235 arsenical ores— cobalt, nickel, tin, and particularly arsenical iron pyrites — and purifying by resublimation. Description and Properties.— It is a heavy solid, occurring- either as an opaque white powder or in irregular masses, of two- varieties — the one, amorphous, transparent, and colorless, like glass ; the other, crystalline, opaque, or white, resembling porce- lain. Frequently the glassy variety is found enclosed in an opaque, white crust. Contact with moist air changes the glassy into the white, opaque variety. Both are odorless and tasteless. Both varieties dissolve very slowly in cold water, the. glassy variety requiring about 30, the porcelain-like about 80, parts of water at 15° C. (59° F.). Both are slowly but completely soluble in 1 5 parts of boiling water. Arsenous acid is but slightly soluble in alcohol, but is soluble in about 5 parts of glycerin. Oil of tur- pentine dissolves the glassy variety only. Both varieties are freely soluble in hydrochloric acid and in solutions of alkali hydrates and carbonates. Dose. — -^jp-j^ grain (0.001-0.003 Gm.). Official Preparations. Liquor Acidi Arsenosi — Liquoris Acidi Arsenosi — Solution of Arsenous- Acid. — Strength, i per cent, of arsenous acid. Description and Properties. — A clear, colorless liquid, odorless, having an -acidu- lous taste and an acid reaction. Dose. — 2-10 minims (0.12-0.6 Cc). Liquor PotSssii Arsenitis — LiqUoris PotSssii Arsenitis — Solution of potas- sium Arsenite (Fowler's Solution). — Strength, i per cent, of arsenous acid. Dose, — 2-10 minims (0.12-0.6 Cc). Arseni lodidum— Arseni lodidi— Arsenic Iodide. V. 8. P. Origin. — Prepared by triturating in a mortar finely-powd,fred metalhc Arsenic and Iodine until they are thoroughly mixed ; or by mixing solutions of Arsenous and Hydriodic Acids, and evapo- rating. . ; Description and Properties. — Glossy, orange-red, crystalline masses, or shining, orange-red, crystalline scales, having an iodine- like odor and taste ; gradually losing iodine on exposure to air and light. Soluble in 7 parts of water and in about 30 parts of alcohol. Arsenic iodide should be kept in glass-stoppered vials, in a cool place, protected from light. Dpse. — jl^-| grain (0.002-0.008 Gm.). 236 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparation. Liquor Arseni et Hydrargyri lodidi— Liquoris Arseni et Hydrargyri lodidi — Solution of Arsenic and Mercuric Iodide — (Donovan's Solution). — Strength: I per cent., each, arsenic iodide and mercuric iodide. Description and Properties. — A clear, pale-yellowish liquid, without odor, and having a disagreeable metallic taste. Dose. — i-io minims (0.06-0.6 Cc). Sodii Arsenas— Sodii Arsenatis— Sodium Arsenate. Z7. S. P. Origin.^Prepared by heating to redness Arsenous Acid, Sodium Nitrate, and Sodium Carbonate. Dissolve the fused mass in water, and crystallize. Dissolve crystals in water, and recrystallize. Description and Properties. — Colorless, transparent, mono- clinic prisms, odorless, and having a mild, alkaline taste (the salt is very poisonous). Efflorescent in dry air, and somewhat deliques- cent in moist air. Soluble in 4 parts of water, very soluble in boiling water, and slightly soluble in cold water. Soluble in 60 parts of boiling alcohol. Sodium arsenate should be kept in well- stoppered bottles. Dose. — ^Vtt grain (0.001-0.006 Gm.). Official Preparation. Liquor Sodii Arsenatis — Liquoris Sodii Arsenatis — Solution of Sodium Arsenate— (Pearson's Solution). — Strength: i per cent, of sodium arsenate. Dose. — i-io minims (0.06-0.6 Cc). Unoffiicial Preparations. Ciipri Arsenis— Ciipri Arsenitis— Cupric Arsenite— (Scheele's Green, Min- eral Green, Paris Green, eic.).—Dose, ^-^^ grain (0.0006 Gm.), daily, in divided doses. Liquor Arseni Bromidi — Liquoris Arseni Bromidi— Solution of Arsenic Bromide— (Clemens' Solution).— Strength : the equivalent of i per cent, of arsenous acid. Dose. — I-S minims (0.06-0.3 Cc). Liquor Arseni et Aiiri Bromidi— Liquoris Arseni et Attri Bromidi— Solu- tion of Arsenic and Gold Bromide.— Originated with, and recommended by, Dr. Barclay, and sold under the trade name " Arsenauro." Strength : 10 minims (0.6 Cc.) contain ^^ grain (0.002 Gm.) of each salt. Dose. — S~'5 minims (0.3-1.0 Cc). Antagonists and Incompatibles. — Arsenic is incompatible with the salts of iron, silver, magnesia, lime, copper, ammonium, and with vegetable astringents. SPECIFICS. 237 Synergists. — The Restoratives and nux vomica are synergistic to arsenic. Physiological Action. — Externally and Zoca//)/.— ^Applied to the skin, arsenic acts as a caustic, exciting violent inflammation. Its escharotic influence results in destruction of vitality in the aiifected parts, accompanied with sloughing. Internally. — Digestive System. — Except in very small doses arsenic acts as a severe gastro-intestinal irritant. Minute and medicinal doses stimulate the flow of gastric and intestinal juices, and augment peristalsis, improving the digestive and nutritive func- tions. When too long continued, the drug produces nausea, diar- rhea, and increased micturition, with a sensation of heat and dry- ness of the throat and stomach. Toxic doses are followed by violent gastro-enteritis. Indeed, in whatever manner introduced into the system, arsenic appears to have a marked selective action upon the gastro-intestinal tract. Circulatory System. — Cardiac action may be slightly stimulated by small doses, the experience of arsenic-eaters proving that the drug, so far from being necessarily deleterious, actually tends to invigorate the system. Large doses render the heart irritable and feeble and decrease the number of red corpuscles, rendering the blood less coagulable. Medicinal doses, while not increasing the number of red corpuscles, prevent their destruction in such dis- eases as pernicious anemia. Toxic doses induce, among other severe results, the characteristic arsenical symptom — fatty degen- eration of the cardiac muscle. Nervous System,. — The general effect of arsenic upon the brain and nervous system is that of a tonic — a property which is sup- posed to explain its antiperiodic nature , in which respect quinine alone is its superior. The cerebral functions are stimulated, even to the point of exhilaration. Experiments have shown that the sensory nervous apparatus is strongly and untowardly affected. The action finally involves the motor system, complete paralysis supervening. Medicinal amounts act as a nervous excitant, stimu- lating the trophic apparatus (Hare). Large doses produce dis- orders of motility and sensibility, tremors, and other serious symptoms. It has been noted that the continued use of arsenic produces tingling and a sensation of numbness in the tips of the fingers. Under prolonged use arsenic tends to accumulate to a greater extent in nervous than in other tissues. Thus, according to 238 A TEXT-BOOK OF MATERIA MEDIC A. Scolosuboff, if I part is found in fresh muscle, the proportion in the liver is 10.8 ; in the brain, 36.5 ; in the spinal cord, 37.3. Respiratory System.— Ox^mzxy amounts effect no special change in respiration other than increased power and stimulation of the respiratory center. It has been held, with authority, that small doses stimulate the peripheral endings of the pulmonary vagi. In toxic doses arsenic acts as a powerful respiratory depressant. Absorption and Elimination.— Arsenic is readily absorbed by the blood. Its presence has also been detected in the viscera, bile, urine, sweat, the bronchial and intestinal mucous membranes, and even in the parenchymatous tissues. It is eliminated slowly from the system by the intestines, and rapidly by the urine ; possibly, also, by the bile and the skin. The saliva, milk, and even the tears, are said to share in the process of elimination. Medicinal doses prevent tissue-change, while large doses in- crease nitrogenous metamorphosis. The therapeutic action is cer- tainly to modify and improve nutrition. Temperature. — The temperature is unaffected by medicinal doses. Toxic doses are accompanied by a considerable rise in bodily heat, though the extremities are often cold. Eye. — Large doses of arsenic are followed by injection of the conjunctivae, eczema, inflammation, and edema of the lids. Zehn- der asserts that the prolonged administration of arsenic has caused retrobulbar neuritis, and Hutchinson believes vitreous opacities may result from such a course. Untoward Action. — Differing from the characteristic symptoms of poisoning occasionally produced by medicinal doses in very susceptible persons, there are induced, not infrequently, restless- ness, headache, alopecia areata, bronchitis, hoarseness, disturbances of digestion, thirst, coryza, and, in rare cases, epistaxis, anaphro- disia, icterus, lacrymation, photophobia, amblyopia, dermatitis, •and various cutaneous eruptions, frequently followed by desqua- mation. An eruption resembling that of measles, produced by 3 drops (0.18 Cc.) of Fowler's solution, is reported by Macnal {Medical Times and Gazette, 1868). Falck reports a case in which arsenic produced a discolored sanguinolent eruption with erysipelatous swelling. Papules and erythematous pustules have also been observed. The variety of these eruptions is well, yet somewhat homeo- pathically, described by Imbert-Gourbeyre (quoted from Lewin) : SPECIFICS. 239 " Eruptions petechiales ou ecchymoses, eruptions papuleuses, ortiees, vesiculeuses, erysipelateuses, pustuleuses, . . . telles sont les formes principales de I'arsenic, exanthematogene dans ses mani- festations.a la peau." Poisoning. — Large doses of arsenic produce symptoms of acute poisoning, the drug almost immediately manifesting its character- istic effects upon the gastro-intestinal canal (to which it is a marked irritant), exciting active inflammation in its delicate membrane. Other symptoms are colicky pains in the stomach, looseness of the bowels, great pain in the esophagus, and edema of the face indicated by puffiness under the eyelids. The passages are at length similar to the " rice-water " discharges of cholera, although different from the latter in the presence of blood or serum. The purging becomes obstinate and exhausting. In certain cases other choleraic symptoms are especially manifested, as increasing cold- ness of the body and cramps. Among the more prominent symp- toms is violent vomiting, which, however, aids in eliminating the poison from the stomach. The effects of arsenic are somewhat variable, intestinal inflam- mation, as autopsies show, not always being present. The quan- tity requisite to produce poisoning is often dependent upon idio- syncrasy, minute doses having proved fatal, and large amounts followed by surprising recoveries. Frequently, in place of the usual symptoms, profound coma occurs from which the patient is, perhaps, never roused. Convulsions and localized paralysis have also been observed. It is well established, too, that absorption of arsenic from a wound or from injection into the blood causes stomachic and intestinal effects often as severe as those attend- ing its ingestion. Various cutaneous symptoms are recorded, and in some cases the effects of arsenical poisoning strongly resemble those of acute yellow atrophy of the liver. Chronic Poisoning. — This malady is frequently due to the fumes or powder of arsenic inhaled in certain processes connected with the arts and manufactures or from manufactured products, such as wall-paper, certain dyes, textile fabrics, etc. The symptoms are similar to those accompanying full doses of the drug, save that they appear occasionally in a more aggravated form. Ordinarily, loss of appetite occurs, with nausea, abdominal pains, vomiting, mild diarrhea, and headache. The conjunctivae are injected, the eyes and nose watery. In severer cases peripheral neuritis may be 240 A TEXT-BOOK OF MATERIA MEDICA. induced, as well as herpes zoster and paralysis of the muscles of the limbs, particularly the extensors of the hands and feet. Ataxic gait and darting pains, with rapid loss of muscular "power, are not infrequent. Death from arsenical poisoning, however, is commonly the result of gastro-enteritis or collapse. The post-mortem changes are usually characteristic of corrosive poisoning — ecchymoses, erosions, and softening of the mucous membrane. The lungs and bronchial membrane are frequently congested. There is also present marked fatty degeneration of the heart, kidneys, liver, and spleen. Treatment of Poisoning. — It is necessary that treatment be ex- peditious, and the agents and methods adopted carefully chosen. Vomiting often renders the use of the stomach-pump unnecessary, yet emetics are frequently serviceable, the cleansing of the stomach being of primary importance. Various antidotes have been suc- cessfully used, the best, chemically, being freshly prepared hydrated sesquioxide of iron, administered in water, 2 or 3 tablespoonfuls every fifteen or twenty minutes. Magnesia, chalk, and lime-water also serve as efficient antidotes. The temperature of the patient should be maintained, and demulcents (oil, milk, etc.) freely given. The after-treatment should include mucilaginous drinks, opiates if indicated, cathartics, and, in case of necessity, stimulants. Therapeutics.— £r/^r«a//K and Loca/fy.— The chief use of arsenic locally is as an escharotic. For this purpose it is employed to destroy malignant growths, such as cancer, sarcoma of the skin, and multiple sarcomatous degeneration of the lymphatic glands. In the latter affection the parenchymatous injection of 5 minims (0.3 Cc.) of Fowler's solution, diluted with fwice the amount of distilled water, is used. ' Many of the pastes and " quack " cancer remedies owe what- ever efficiency they possess to arsenic. Manec's paste contains arsenous acid, 15 grains (i.o Gm.); black sulphide of mercury, 75 grains (5.0 Gm.); burnt sponge, 35 grains (2.3 Gm.). The r\ote6. poudre caustique de Frere Cosme ou du Rousselot is a similar preparation, containing about the same quantity of arsenic. The solution of arsenous acid is an excellent local application to warts and corns. If these growths are very firm and horny, their removal may be facilitated by the previous application of solution of potassa. When used- over large surfaces arsenic should be applied in good strength and heroically, so that active inflam- mation may be excited and the danger of absorption lessened. SPECIFICS. 241 Internally. — Arsenic is a peculiarly efficient remedy in chronic scaly skin diseases. Like all other specifics, it influences diseases of a chronic nature more favorably than acute disorders, invariably aggravating acute skin diseases. This drug, therefore, is one of the most valued remedies in psoriasis, lepra, and chronic squamous eczema. While arsenic cannot, perhaps^ be classed as a specific in the above-mentioned diseases, it undoubtedly yields uniformly better results than any other single drug. The solution of potassa is a valuable synergist to arsenic in these conditions, especially in eczematous cases. Pemphigus, prurigo, acne, and lichen ruber have also been fa- vorably influenced by the continued administration of Fowler's solution. In the successful management of these chronic skin diseases it is necessary that the preparation of arsenic employed be given in as large doses as can be tolerated by the patient, and the treatment continued unremittingly for a long period. Lymphoma, whether superficial or occupying the great cavities, is frequently benefited greatly by similar treatment. Asthma and bronchitis, whether acute or chronic, accompanying or succeeding scaly skin diseases, are singularly amenable to this medicine when the dose is carried to the full physiological limit. Another condition, dysmenorrhea, frequently noticed in women with a tendency to asthma or subject to chronic diseases of the skin, is often cured or greatly benefited by arsenic. The obstinate and often incurable disease known as pernicious anemia yields better to arsenic than to any other known remedy. The effect of the drug in this disease is not due to its increasing the number and quality of the red blood-corpuscles, but rather to its preventing or delaying their destruction in the portal circulation. It should be given continuously and in gradually increasing doses until symptoms of arsenical poisoning appear, when the increase should cease and the same dose be maintained for some time. By carefully watching the indications and by the timely use of lax- atives the dosage may be easily adjusted so that the full benefit may be derived from this invaluable drug. The statements in the preceding paragraph are applicable also to leukemia, whether splenic, myelogenic, or lymphatic, and to Hodg- kin's disease. Arsenic ranks next to quinine in the treatment of malaria. 16 243 A TEXT-BOOK OF MA TERIA MEDICA. Chronic cases in which quinine has lost its power are generally- benefited in a marked manner by arsenic. It is a peculiar fact that relapses are fewer after the arsenic treatment than after the use of quinine. Moreover, arsenic can be administered in intermittent fever', frequently with as favorable results as quinine would give. Arsenic can be employed in cases of malaria at all times with- out regard to the presence or absence of fever or chills. The neuralgias, anemia, and headache of malarial origin are singularly amenable to this medicine. In the treatment of malaria with arsenic it must be remembered that the paroxysms of ague are not relieved at once, as is the case when quinine is the medicament used ; but they recur with less severity, and are of shorter duration, gradually declining until they disappear altogether. Fowler first reported the remarkable efficacy of arsenic in neuralgia of the intercostal and fifth pair of nerves. It is equally valuable in these cases whether the disease be due to malaria or to general debility. The author wishes to recommend urgently the use of arsenic in pulmonary phthisis. In certain forms of this disease he regards it equal, if not superior, to any other remedy. It is useful, however, only in those conditions which are characterized by excessive expectoration and a slow degenerative process. The good results of the arsenic treatment in thgse cases is shown in a conspicuous manner by a marked improvement in the general condition of the patient, there being a lessened pulmonary secretion, a reduction in temperature, improvement of the appetite, and consequent increase of the body-weight. Arsenic is contraindicated in phthisis when the cough is harsh and paroxysmal, with but scanty expectoration and a tendency to pulmonary hemorrhage. If this drug is specific in any one disease, it is so in chorea, very rarely failing to effect a cure when judiciously administered. It should be given in full doses, and increased as tolerance is established. This medicine seems to act equally well in gastralgia. It is also an efficient remedy in gastritis or the vomiting of gastritis, espe- cially in that occasioned by the excessive use of alcohol. Many irritative conditions of the stomach are relieved by minute doses of Fowler's solution. Excessive peristalsis, resulting in diarrhea, coming on immediately after taking food, is usually cured com- pletely by very small doses of Fowler's solution, alone or com- SPECIFICS. 243 bined with an equal quantity of tincture of opium. Arsenic has also been recommended in gastric ulcer and cancer. It has proved of great service in hay fever, spasmodic asthma, and acute coryza. It is often very serviceable in catarrhal pneu- monia and in chronic bronchitis. Bromide of arsenic is highly recommended in diabetes m,ellitus. Rheumatoid arthritis is more favorably influenced by the use of arsenic than by any other medi- cine. It should be employed in the treatment of chronic rheuma- tism. Even in secondary syphilis a combination of mercury and arsenic has produced better results, in some cases, than mercury alone. Anstie has recommended arsenic in angina pectoris, alleging that it mitigates the severity of the attacks. Chronic diarrhea, when induced by intestinal ferrrientation or chronic malarial infec- tion, is sometimes greatly benefited by this drug. Constipation, also, if due to deficient intestinal secretion, may frequently be relieved by the administration of small doses of arsenic. Albuminuria dependent upon imperfect digestion of albuminous substances is almost invariably relieved by Fowler's solution taken with meals. Certain nervous diseases of the aged, not due to malaria, such as melancholia and hypochondria, are often relieved by small doses of this drug. Finally, arsenic is a valuable adjunct to iron in the treatment of simple anemia and chlorosis. It is thought by some clinicians to retard the progress of epithelioma, and particularly gastric and uterine cancer. Contraindications. — In acute skin diseases and pulmonary tuberculosis with a tendency to hemoptysis. Administration. — Arsenic should be given ordinarily after meals. There are certain conditions, however, requiring its admin- istration in small doses before meals. When it is desired to give arsenic in pill form, the arsenous acid should be used ; and for solutions the liquor potassii arsenitis is usually preferred. In syphilitic disorders Donovan's solution is an excellent prepa- ration to use. Children are much less susceptible to the drug than adults, often being able to take adult doses with impunity. During a course of arsenic the patient should be instructed to watch carefully for the first untoward manifestations, such as puf- finess about the eyes, itching of the conjunctivae, nausea, diarrhea, or numbness of the fingers. Any one of these symptoms is an 244 A TEXT-BOOK OF MATERIA MEDICA. indication that the dose should not be increased ; and it may be necessary to lessen the- dose, or even to discontinue the remedy altogether, for a while. There are two methods of getting a patient thoroughly under the influence of the drug: 1. Begin with a full dose of Fowler's solution, and decrease i minim (0.06 Cc.) a day until a minim (0.06 Cc.) dose is reached ; then repeat the method. 2. Begin with a small dose of Fowler's solution, and increase i minim (0.06 Cc.) a day until untoward symptoms appear or the dose has reached 10 or 15 minims (0.6-1.0 Cc); then either re- peat the method or decrease the amount i minim (0.06 Cc.) a day. Enormous doses of arsenic can be given hypodermically, and it is then much less toxic than when given by the mouth. Equiva- lents of 20 (1.2 Cc), SO (3.2 Cc), and indeed 100, minims (6.5 Cc.) of Fowler's solution have been given in this manner at a single dose without toxic symptoms. Arsenic often acts more efficiently when given in this manner than when given by the mouth. The liver has a strong elective affinity for arsenic, but it is absorbed through the alimentary canal with considerable diffi- culty. The toxic action expends itself almost wholly upon the stomach and upper portion of the intestine. The hypodermic use of arsenic distributes the drug through the system just as mercury is distributed by inunction, carrying it immediately to all parts of the system by the circulation. The arsenite of sodium is free from any objection for hypodermic use : it never causes the least sign of irritation. Fowler's solution is objectionable : it invariably causes much irritation, and frequently forms an abscess. Careful study of the effects of the drug in each case will make it possible to guard its administration so that tolerance can be established — a result much to be desired in order to secure the maximum benefit. Considering the enormous doses to which the arsenocophagi become habituated, failure in the medicinal administration of arsenic argues the want of ability to employ it scientifically. I6dum—I6di— Iodine. TJ. S. I*. Origin. — It is found in the ashes of sea-weeds and is prepared from the mother-liquor obtained in the purification of Chili salt- petre. SPECIFICS. 245 Description and Properties. — Heavy, bluish-black, dry and friable rhombic plates, having a metallic luster, a distinctive odor, and a sharp and acrid taste. It imparts a deep-brown, slowly evanescing stain to the skin, and gradually destroys vegetable colors. Iodine is soluble in about 5000 parts of water and in 10 parts of alcohol, with a brown color ; also freely soluble in ether and in a solution of potassium iodide, with a brown color, and in chloroform or carbon disulphide, with a violet color. It should be kept in glass-stoppered bottles, in a cool place. Dose. — About \ grain (0.016 Gm.), although seldom given in substance. Official Preparations. Liquor lodi CompOsitus — Liquoris lodi Comp6siti — Compound Solution of Iodine (Lugol's Solution). — Iodine, S; Potassium Iodide, 10; Distilled Water, to make 100 parts. Strength, 5 per cent. Dose, l-io minims (0.06-0.6 Cc). Tincttira lodi — Tinctiirse lodi — Tincture of Iodine. — Iodine, 70; Alcohol, to 1000. Strength, 7 per cent. Dose, 1—5 minims (0.06-0.3 Cc). Ungufentum lodi — UnguSnti lodi — Iodine Ointment. — Iodine, 4; Potassium Iodide, l; Water, 2; Benzoinated Lard, 93. Strength, 4 per cent. For external use. S^rupus Acidi Hydriodidi— Sj^rupi Acidi Hydriodidi —Syrup of Hydriodic Acid. TI. S. P. A syrupy liquid containing about I per cent, by weight of hydriodic acid. Description and Properties. — A transparent, colorless, or only pale straw-colored liquid, odorless, and having a sweet and acidu- lous taste. Dose. — J-2 fluidrachms (2.0-8.0 Cc). Ammonii lodidum— Ammonii lodidi— Ammonium Iodide. U.S. P. Origin. It is prepared by dissolving Potassium Iodide and Ammonium Sulphate in boiling Water, adding Alcohol, filtering, washing the filtrate, and evaporating it to dryness. Description and Properties. — Minute, colorless, cubical crys- tals or a white, granular powder, without odor when colorless, but emitting a slight odor when colored, and having a sharp, saline taste. The salt is hygroscopic, and soon becomes yellow, or yellowish-brown, on exposure to the air and light, owing to the loss of ammonia and the elimination of iodine. Soluble in x part 246 A TEXT-BOOK OF MATERIA MEDICA. of water and in 9 parts of alcohol. Ammonium iodide should be kept in small, well-stoppered vials, protected from light. Dose. — 3-20 grains (o. 1 8-1.2 Gm.). Potassii lodidum— Potassii lodidi— Potassium Iodide. TJ. S. P. Origin. — Iodine is dissolved in a solution of Potassa in hot dis- tilled Water. The solution is evaporated, and the residue heated with charcoal. Dissolve in boiling Water, filter, wash the filtrate, and crystallize. Description and Properties. — Colorless, transparent or trans- lucent, cubical crystals, or a white, granular powder, having a pecu- liar, faint, iodine-like odor, and a pungent, saline, and afterward bitter taste. Permanent in dry air and but slightly deliquescent in moist air. Soluble in 0.75 part of water and in 18 parts of alcohol; also soluble in 2.5 parts of glycerin. Potassium iodide should be kept in well-stoppered bottles. Dose. — 2-30 grains (0.12-2.0 Gm.). Official Preparation. UnguSntum PotSssii lodidi — UnguSnti PotSssii lodidi — Ointment of Po- tassium Iodide. — Potassium Iodide, 12; Sodium Hyposulphite, I; Water, 10; Ben- zoinated Lard, 77. For external use. Sodii I5didum— Sodii I5didi— Sodium Iodide. TJ. S. P. Origin. — Prepared from a solution of Soda in a manner similar to the preparation of potassium iodide. Description and Properties. — Colorless, cubical crystals, or a white, crystalline powder, odorless, and having a saline and slightly bitter taste. In moist air it deliquesces and becomes partially de- composed into sodium carbonate and free iodine, assuming thereby a reddish color. Soluble in 0.6 part of water and in about 3 parts of alcohol. It should be kept in well-stoppered bottles. Dose. — 2-30 grains (o.i 2-2.0 Gm.). Strontii lodidum— Strontii lodidi— Strontium Iodide. V. s. p. Origin.— Prepared by neutralizing freshly prepared solution of Hydriodic Acid with Strontium Carbonate, concentrating the filtrate, and crystallizing. Description and Properties.— Colorless, transparent, hex- SPECIFICS. 247 agonal plates, odorless, and having a bitterish, saline taste ; deli- quescent and colored yellow by exposure to air and light. Soluble in 0.6 part of water, also soluble in alcohol, and slightly in ether. It should be kept in dark, amber-colored, glass-stop- pered vials. Dose. — 2-30 grains (0.12-2.0 Gm.). Zinci lodidum— ZTnci lodidi— Zinc Iodide. U.S.I*. Origin. — Obtained by dissolving Zinc Oxide or Carbonate in Hydriodic Acid, or digesting Granulated Zinc in 10 parts of Iodine and 20 parts of Water, and evaporating to dryness. Description and Properties. — A white, granular powder, odor- less, and having a sharp, saline, and metallic taste. Very deliques- cent, and liable to absorb oxygen from the air and to become brown from liberated iodine. Readily soluble in water, alcohol, or ether. Zinc iodide should be kept in small, glass-stoppered bot- tles. Dose. — 1-3 grains (0.06-0.18 Gm.). Sulphuris lodidum— Sulplnuris lodidi— Sulphur Iodide. U. S. P. Origin. — Prepared by heating Washed Sulphur and Iodine in a flask until the ingredients combine. Description and Properties. — Brittle masses, of a crystalline fracture and a grayish-black, metallic luster, having the odor of ipdine and a somewhat acrid taste. Almost insoluble in water; soluble in about 60 parts of glycerin ; very soluble in carbon di- sulphide. Alcohol and ether dissolve out the iodine, leaving the sulphur. Sulphur iodide should be kept in glass-stoppered bottles, in a cool place. Dose. — 1-5 grains (0.06-0.3 Gm.). Unofficial Preparation. UnguSntum Stilphuris lodidi — Ungu&nti Stilphuris lodidi — Ointment of Sulphur Iodide. — Sulphur Iodide, 30 grains (2.0 Gm.); Lard, i ounce (30.0 Gm.). For external use. Plumbi lodidum— Plumbi lodidi— Lead Iodide. U. S. F. Origin. — Mix solutions of Lead Nitrate and Potassium Iodide, filter, wash the precipitate with Distilled Water, and dry it at a gentle heat. 248 A TEXT-BOOK OF MA TERIA MEDICA. Description and Properties. — A heavy, bright-yellow powder, without odor or taste. Permanent in the air. Soluble in 2000 parts of water ; very slightly soluble in alcohol, but soluble, with- out color, in solutions of the fixed alkalies, in concentrated solu- tions of the acetates of the alkalies, of potassium iodide, and of sodium hyposulphites, and in a hot solution of ammonium chloride. Lead iodide should be kept in well-stoppered bottles, protected from light. Dose. — \ grain (0.013 Gm.), although, as a rule, this drug is employed externally. Arg-enti lodidum— Arg-enti lodidi— Silver Iodide. TJ. 8. P. Origin. — Aqueous solutions of Silver Nitrate and of Potassium Iodide are poured together ; the precipitate is then collected upon a filter and washed with Distilled Water and dried upon bibulous paper. Description and Properties. — A heavy, amorphous, light-yel- lowish powder, unaffected by light if pure, but generally becom- ing somewhat greenish-yellow, and having neither odor nor taste. Insoluble in water and alcohol. Dose. — \-2 grains (0.008-0. 13 Gm.). Allied Compounds. lodi Bromidum— lodi Bromidi— Bromide of Iodine.— Orz^w.— Obtained by heating together Iodine and Bromine. Description and Properties. — A dark, reddish-brown liquid, resembling bromine in appearance and sensible properties, but yielding a perfectly transparent, brown-red solu- tion with less than 6 parts of water. For external use. lodi Chloridum— lodi Chloridi— Iodine Chloride (Iodine Trichloride).— On^'w.- Prepared by passing dry Chlorine Gas over dry Iodine. Description and /'«/,?>-/««.— Orange-yellow needles, gradually changing to large, transparent, rhombic plates. It has a penetrating, pungent odor, resembling bromine. Soluble in 5 parts of water, and also in alcohol and ether. Dose.—\ grain (o.oi Gm.), and externally in ^1 per cent, aqueous solution. Antagonists and Incompatibles. — Iodine and the iodides are antagonized by most of the Restoratives. Iodine is incompatible with the alkaloids and most of the mineral salts and acids, and with ammonia. The iodides are incompatible with mineral acids and acid salts, bismuth subnitrate, alkaloids, silver nitrate, soluble lead salts, spirit of nitrous ether, potassium chlorate, liquorice, and SPECIFICS. 249 preparations containing starch. The tincture of iodine is incom- patible with water and aqueous preparations. Synergists. — The specifics, alkalies, and remedies increasing waste. Physiological Action. — Externally and Locally. — Iodine is a powerful disinfectant and rubefacient, as well as vesicant, caustic, parasiticide, and antiseptic. When applied to the skin or mucous membrane it produces a yellow, brown, or black stain, and is irri- tant, or caustic according to the strength and frequency of the application. The discoloration, however, can be easily removed by sodium hyposulphite or ammonia. It combines with the albumin of the tissues and prevents putre- factive changes. When tincture of iodine is frequently applied or large amounts are used, desquamation of the skin is produced, and sometimes rapid vesication, or perhaps sloughing. The blood- vessels of the organs subjacent to the area to which it is applied are reflexly dilated, rendering this drug an efficient counter-irritant. The vapor of iodine when inhaled produces considerable irrita- tion of the respiratory passages, exciting cough, sneezing, increased secretion of mucus, dyspnea, and more or less pain in the chest, although when inhaled in moderate amounts its antiseptic proper- ties exert a beneficial influence upon the bronchial tissues, prevent- ing decomposition of the secretions. The iodides have no local action. Internally. — Digestive System. — Taken internally in small doses, IODINE acts as a gastric tonic, minute doses acting as a sedative, allaying nausea. In other cases a single moderate dose may occa- sion gastric uneasiness, larger amounts intensifying the discomfort and causing violent vomiting, increased salivary flow, abdominal pains, and purging. The IODIDES in moderate doses produce a sense of warmth in the stomach, larger amounts acting like iodine, though less irri- tating to the gastro-intestinal tract than the latter drug. Owing to their rapid diffusibility, the iodides can be tasted in a few minutes after their ingestion, considerably increasing the flow of saliva. Circulatory System. — The effects of iodine and its salts have beerj variously reported, it being claimed that their tendency is to contract the vessels and cause increased cardiac action. Intro- duced into the veins, a slight increase, followed by decrease of pressure, has been observed. The rapidity of elimination from the 250 A TEXT-BOOK OF MA TERIA MEDICA. blood is doubtless an impediment to any marked action on the circulation. Trasbot claims that potassium iodide dilates the blood-vessels, thereby increasing glandular secretion. The iodides are all supposed to be converted into the sodium iodide in the blood, without modifying the composition of that fluid. Nervous System. — No special action is recorded, although the potassium iodide is known to occasion unpleasant symptoms, in- cluding distress of mind and depression of spirits, accompanied now and then by lassitude and muscular debility — symptoms due rather to the influence of potassium upon the spinal cord. Respiratory System. — Little or no effect from medicinal doses has been noted. Absorption and Elimination. — Iodine and the iodides are rapidly absorbed by the mucous membranes generally, being found in the blood, mainly in combination with sodium. Elimination takes place by various channels — ^the urine, saliva, milk, intestinal and nasal mucous membranes. Salivary elimina- tion appears to be even more active than the urinary process, although the drug escapes largely through the kidneys, increasing the amount of water, urea, uric acid, and phosphoric and sulphuric acids excreted. At the points of elimination the iodine escapes in its nascent state, setting free ozone, which occasions more or less irritation. Temperature. — No effects have been noted, the temperature appearing to remain stationary even in the presence of decidedly untoward symptoms. Eye. — Beyond a local congestion of the minute vessels of the sclerotic coat under certain conditions little effect has been ob- served. The symptoms of ocular iodism at times present are described under " Poisoning." Uterus. — Small doses may increase or hasten the menstrual flow and act as aphrodisiacs ; larger doses have a marked anaphro- disiac effect ; while prolonged administration may result in atrophy of the ovaries. It has been maintained with authority that the catamenia are liable to increase, and that during pregnancy the drug may cause abortion. Untoward Action. — The untoward manifestations, in susceptible patients, are identical with those of iodism. Poisoning.— T?i\ie.r\. in excessive doses, iodine acts as a poison, and has even produced death, though rarely. The symptoms of SPECIFICS. 251 acute poisoning are those of severe gastro-enteritis, characterized by distressing stomachic and abdominal pains, accompanied by painful irritation of the esophagus, followed by violent purging and vomiting. An early symptom is a strong metallic taste in the mouth, to- gether with increased salivation. Suppression of urine, hiccough, and dysenteric pain have been reported in a fatal case resulting from external application (Biddle, p. 460). Very immoderate doses are attended with rapid and feeble pulse, deathly pallor, severe renal irritation affecting urinary secretion, and final loss of vitaL power followed by respiratory failure. The condition induced by prolonged or excessive use of iodine or its salts is known as lodism. Together with a metallic taste there are present tenderness of the teeth and gums, nausea and coryza or symptoms of gastric irritation, acneiform eruptions — even a vesicular and purpuric variety not infrequently occurs — while under continued dosage the coryza becomes more pro- nounced, accompanied by edema of the eyelids, lacrymation, and ocular pains. Moreover, muscular twitchings, edema of the glottis,, neuralgic pains, and atrophy of mammae, testicles, and other tis- sues occasionally supervene. Anemia and even cachexia are often manifest. Treatment of Poisoning. — The use of large amounts of starch,, in the form of arrowroot or starch-water, has been successfully- adopted as an antidote. Hypodermic injections of ammonia, strychnine, digitalis, alcohol, and atropine have been employed with excellent results, as tending to restore the circulation and assist respiratory movements. More recently bicarbonate of so- dium has proved an efficient antidote. The use of the stomach-pump and the application of heit to the body and extremities are naturally of the first importance. Therapeutics. — Externally and Locally. — The tincture, com- pound SOLUTION, and ointment are extensively employed as coun- ter-irritants and as aids to the absorption of fluid! The tincture is an efficient application to joints in chronic rheumatism, gout, and synovitis, and in pleurisy, both for the purpose of aborting an attack and to aid the absorption of fluid when effusion has taken place. In neuritis, onychia, periostitis, venereal bubo, glandular swellings, etc. the tincture, applied externally, will ofl;en be of service. This same preparation is of marked benefit when hypodermi- .^52 A TEXT-BOOK OF MA TERIA MEDICA. tally injected in goiter, particularly of the soft or cystic variety, hydrocele, empyema, extensive serous arthritic effusion unaccompanied by inflammation, spinal meningocele, and anal fistula. The tincture is also a very efficient application in chronic metritis and chronic endometritis. In many diseases of the skin iodine serves a useful purpose as a discutient and parasiticide, lentigo, lupus, chloasma, tinea tonsurans, etc. especially indicating its use. Many chronic splenic and hepatic disorders are favorably influ- enced by an external application of the iodine ointment. The TINCTURE OF IODINE has been recommended as an efficient application in recession of the gums attendant upon pyorrhoea ulveolaris. The vapor of iodine is frequently employed in subacute ca- tarrhal deafness 'and in acute coryza. A mixture of tincture of iodine | fluidrachm (2.0 Co.), carbolic acid ID minims (0.6 Cc), glycerin and water, each, ij ounces (45.0 Cc), has been highly recommended by Samuel Johnston in the treatment of chronic pharyngitis. As an inhalant in chronic laryngitis and phthisis iodine in some form is highly esteemed by rnany physicians. Internally. — One of the principal and most important uses of iodine and the iodides is in the treatment of secondary and tertiary syphilis. All the manifestations of this disease, such as syphilitic periostitis, meningitis, endarteritis, gumjnata, paralysis, etc., are re- lieved by large doses of the iodides to saturation of the system. The more chronic the disease, the larger the dose required ; and the more acute the attack, the smaller the dose. Iodine is peculiarly useful in combining with and eliminating mercury from the system of patients suffering from mercurial cachexia, paralysis, etc. Other metals, lead, etc., are readily elim- inated by a course of potassium iodide. Potassium iodide is of marked utility in arresting the various manifestations of scrofula, such as inflammation and ulceration of cartilaginous structures and mucous catarrhs, and hastening the reso- lution of adenitis and enlargement of lymphatics. With regard to the use of iodine in the treatment of aneurysm of the aorta Walshe says : " Not only has relief of neuralgic pains and of the general distress followed its administration, but the local pressure-symptoms have been mitigated, and firm thrombosis has taken place within the sac, while the area of pulsation and of per- SPECIFICS. 255 cussion-dulness has exhibited sensible reduction." Other authori- ties have reported favorably of its use in this condition. As a cardiac tonic iodine is of undoubted value, being especially- serviceable in fatty degeneration of the heart, and in usually miti- gating the symptoms of chronic valvular diseases of the heart, especially those of the aortic orifice. It is a particularly useful remedy in chronic asthma and bronchitis, and to hasten the removal of inflammatory products of pneumonia, pleurisy, and pericarditis. The spasmodic asthma of adults and the bronchitis of children, both of which alternate with eczematous attacks, are greatly relieved by the potassium iodide. Even hereditary asthma occurs at less frequent intervals and in a milder form when the patient is kept constantly under the influ- ence of moderate doses of this drug. And if there is any remedy which has a beneficial influence in acute tubercular meningitis, it is potassium iodide. In the early stages of cirrhosis, whether of the liver or kidneys,, as well as in sclerosis of the cord, it is an efficient remedy. The dropsy of splenic or hepatic induration is relieved by iodine, while in the various forms of muscular rheumatism it is one of the most potent medicaments. It has been advocated as a successful remedy in sciatica and chronic gout. It unquestionably retards the changes in chronic interstitial nephritis, though the tincture of iodine in these cases is considered superior to the potassium iodide. Ammonium iodide is highly recommended as an efficient rem- edy in acute catarrhal pneumonia and capillary bronchitis. It is especially useful in catarrhal jaundice, and has, moreover, been suggested as a good remedy in hay fever and in malarial fevers. The SYRUP OF HYDRiODic ACID has been commended by Craig as a valuable agent in acute rheumatism. Contraindications. — The drug should be discontinued at once when symptoms of iodism appear. It is contraindicated also in pulmonary tuberculosis when there is rapid change taking place in the lung. The iodides should not be given immediately before or after the administration of quinine. Administration. — The sodium iodide is less active and toxic than the potassium salt. The strontium iodide may be used for the same purposes as the other iodides, and possesses the advantage of disturbing the stomach less, besides being less likely to produce iodism. 254 A TEXT-BOOK OF MATERIA MEDICA. The iodides should be given in a large quantity of liquid. Their unpleasant taste may be concealed to a considerable extent by dissolving them in carbonic-acid water or Vichy water. Milk, com- pound syrup of sarsaparilla, and currant and raspberry syrups have all been used for this purpose. It is said that tincture of belladonna or sodium bicarbonate prevents the coryza caused by the iodides. The syrup of hydriodic acid is quite pleasant to the taste, and has but little tendency to produce iodism or untoward effects. This preparation should always be administered upon an empty stomach. Colchicum— Colchici— Colchicum. JJ. S. J*. (Meadow Saffron.) Origin. — A plant indigenous in Europe, in the southern and central portions of which it is frequently found in pastures and meadows, flowering in September or October, and ripening its seeds in June following. The root and seeds are ofScial. Description and Properties. — TAe root is about i inch (25 Mm.) long, ovoid, flattish, with a groove on one side ; externally brownish and wrinkled, internally white and solid ; often in trans- verse slices reniform in shape, and breaking with a short, mealy fracture ; inodorous ; taste sweetish, bitter, and somewhat acrid. Dose. — 2-8 grains (0.12-0.5 Gm.) in powder. Official Preparations of the Root. Extractum C61chici RSdicis — Extracti CSlchici RSdicis — Extract of Col- chicum Root. — Dose, \-2 grains (0.03-0.12 Gm.). Extractum Cdlchici Radicis Fluidum— Extracti Cdlchici Radicis Fliiidi — Fluid Extract of Colchicum Root. — Dose, 2-8 minims (0.12-0.5 Cc). Vinum COlchici Radicis — Vini CSlchici Radicis — Wine of Colchicum Root. — Dose, 5-20 minims (0.3-1.2 Cc). Colchicum seeds are subglobular, about -^ inch (2 Mm.) thick, very slightly pointed at the hilum ; reddish-brown, finely pitted, internally whitish ; very hard and tough ; inodorous ; taste bitter and somewhat acrid. Both the root and seeds contain an active principle, colchicine, which is present in greater proportion in the root. Dose of the Powdered Seeds. — 1-5 grains (0.06^.3 Gm.). Dose of Colchicine. — ^^^ g^ grain (0.0012-0.001 Gm.). SPECIFICS. 255 Official Preparations of the Seed. Extractum Cttlchici SSminis Fluidum— ExtrScti Caichici Sgminis Fluidi— Fluid Extract of Colchicum Seed. — Dose, 1-5 minims (0.06-0.3 Cc). Tinctura COlchici S6minis— Tincture C61chici S6minis— Tincture of Col- chicum Seed. — Dose, 10-30 minims (0.6-2.0 Cc). Vinum CSlchici SSminis— Vini C61chici Sgminis— Wine of Colchicum Seed. — Dose, 10-30 minims (0.6-2.0 Cc.). Antagonists and Incompatibles. — Alcohol and opium antago- nize the cardiac depression produced by colchicum. Tannic acid and vegetable infusions containing it are incompatible, forming an insoluble tannate with the alkaloid. Sjmergists. — Diuretics, purgatives, emetics, and alkalies pro- , mote the therapeutic activity of colchicum. Physiological Action. — Externally and Locally. — Colchicum is a decided local irritant, and when appUed to the skin acts as a rubefacient. The dust when inhaled excites sneezing. Internally. — Digestive System. — In small medicinal doses colchi- cum slightly stimulates the salivary, gastric, biliary, and intestinal secretions. If these doses are repeated for several days, a sensa- tion of heat is experienced in the epigastrium, accompanied by loss of appetite and frequently by nausea. Full medicinal doses may produce purging and colic. Larger doses occasion profuse watery and choleriform or bloody evacuations from the bowels, severe abdominal pain and tenderness, excessive vomiting — in fact, all the symptoms produced by a violent gastro-intestinal irritant. Circulatory System. — Full medicinal or larger doses produce great depression of the circulation, with a small, rapid, and thready pulse. The marked cardiac depression and collapse which occur when poisonous doses of colchicum have been taken are more the result of the severe gastro-enteritis than of any direct action upon the heart. Nervous System. — The nervous system is unaffected by medici- nal doses. Even when poisonous doses have been taken the intellect usually remains unimpaired, though Toulrriouche has seen the drug induce marked cerebral excitement. Discordant state- ments have been made regarding the action of colchicum upon the nervous system. The drug evidently affects different persons dif- ferently. Thus numbness or prickling, muscular pains or spasms, and occasionally convulsions, have been noticed ; yet the recent investigations of Laborde and Houde upon the action of colchicine show that it has no influence upon the centers of intelligence and 256 A TEXT-BOOK OF MATERIA MEDIC A. volition, and does not induce paralysis of central origin, either motor or sensory, though the sensory nerves are considerably depressed. Respiratory System— \jax%& or poisonous doses of colchicum render the respiratory movements slow and shallow. This action is not due to any direct effect upon the respiratory center, but reflexly to the depression occasioned by the violent action of the drug upon the gastro-intestinal tract. Absorption and Elimination.— Colchicum is quite rapidly ab- sorbed, and is eliminated chiefly by the bowels and kidneys, the skin sharing to some extent in the excretory process. Some ob- servers allege that colchicum does not increase the amount of urine or the excretion of urea and uric acid, while others claim that these substances are increased. The author's experiments are sufficient to satisfy him that the excretion of all these sub- stances is considerably heightened under medicinal doses of col- chicum. Temperature. — Under moderate medicinal doses the temperature is unaffected, though doses large enough to produce emeto-cathar- sis are followed by a reduction of temperature. Untoward Action. — Many symptoms described under " Poison- ing" have been produced by very small doses. It is a matter of speculation whether these untoward manifestations were due to a decided idiosyncrasy on the part of the patient, or to the fact that- the preparation employed might have contained an unusually large percentage of the alkaloid. Poisoning. — The symptoms of poisoning by colchicum are vio- lent vomiting and purging, griping and intense pain in the abdomen, and at times excessive salivation or possibly convulsions. While death is for a time delayed under a poisonous dose, a fatal termina- tion is almost inevitable. Meanwhile the patient suffers excruci- atingly, being little relieved by treatment. Treatment of Poisoning. — All that can be done is to combat symptoms, giving opium for pain, oil and demulcent drinks for the irritation, and stimulants to counteract respiratoiy and cardiac depression. Washing out the stomach or the use of emetics may be required. Tannic acid serves as a partial antidote, precipitating the colchicine. Therapeutics. — Externally and Locally. — Colchicum has no local therapeutic action. I Internally. — Colchicum is the typical vegetable specific. Its SPECIFICS. 257, effects are in many ways analogous to those of mercury and iodine, even resulting in fatty degeneration of the liver, loss of hair, nails, teeth, etc. The drug is as valuable and certain a specific for gout as is mer- cury for syphilis. Gout in all its varied manifestations is relieved by this invaluable remedy. Diarrhea, dysentery, dyspepsia, bron- chitis, asthma, neuralgia, and eczema dependent upon a gouty condi- tion are singularly benefited by colchicum. This medicine, while quite efficacious in chronic rheumatism, and occasionally of some benefit in rheumatoid arthritis, is of no value in acute articular rheumatism. Its value is more apparent in acute than in chronic gout, and in the first attacks than in succeeding ones. Chronic gout, as well as chronic rheumatism, yields better to a combination of colchicum and potassium iodide than to colchicum alone. Some physicians recommend hypodermic injections of colchi- cine into the sheath of the nerve in sciatica. The author's quite limited use of this method has resulted in so much local irritation that he is prompted to caution the reader against the hypodermic employment of this drug. In combination with certain other agents colchicum serves an excellent purpose as a cholagogue, full doses being frequently very effective in relieving ascites due to obstructive diseases of the liver. ■ Colchicum is sometimes employed as a drastic purgative in cerebral and portal congestion, although when given in doses suf- ficient for this purpose it occasions considerable nausea and abdom- inal distress. Colchicum has also been recommended in the treatment of gonorrhea and chordee. In doses of -^ grain (o.OOi Gm.) colchicine has been suggested by Darier in certain inflammatory diseases of the eye. Hypochon- driasis resulting from renal insufficiency is frequently benefited by colchicum. Contraindications. — The drug would be contraindicated in acute inflammatory conditions of the gastro-intestinal tract. It should be cautiously administered to old people. Administration. — The liquid preparations are to be preferred, and, in order to secure the full curative effects of the drug, it is unnecessary to give it in doses sufficiently large to excite vomiting or purging. The initial dose, therefore, should be small, that it may occasion no gastric disturbance. 17 258 A TEXT-BOOK OF MA TERIA MEDICA. The beneficial effects of colchicum may be enhanced by first emptying the intestinal canal by means of a saline cathartic. The preparations of colchicum vary greatly in strength. The crude drug contains different percentages of the alkaloid, accord- ing to the season of the year in which the plant is gathered, the colchicum root collected in July and August containing the largest percentage of colchicine. Owing to this variation in strength the assayed tincture or the alkaloid is recommended as the best prepa- ration to use, though, because of its activity and poisonous prop- erties, the alkaloid should be given in very small doses at first — not to exceed -j^ of a grain (0.0005 Gm.) two or three times a day. Gualaci LTgrnum— Guaiaci LTgrni— Gualacum Wood. V. s. p. (Lignum Vit^.) Origin. — The heart-wood of Guaiacum officinale L. and of Guai- acum sanctum L., trees indigenous in the West Indies and on the northern coast of South America. The former is about 40 feet (12 M.) high, having evergreen pinnate leaves. Description and Properties. — The wood is heavier than water, hard, brown or greenish-brown, resinous, marked with irregular concentric circles surrounded by a yellowish alburnum ; splitting unevenly, when heated emitting a balsamic odor ; taste slightly acrid. It contains from 20 to 25 per cent, of resin, its most important constituent. Dose. — ^i drachm (i. 0-4.0 Gm.). Official Preparation. Guaiacum wood is contained in Decoctum Sarsaparillse Compositum, for which see Sarsaparilla. Guaiaci ResTna— Guaiaci Resinae— Guaiac. TJ. S. P. Origin. — The resin of the wood of Guaiacum officinale. Description and Properties. — Irregular masses or subglobular pieces, externally greenish-brown, internally of a glassy luster, and in recent guaiac usually reddish-brown, transparent in thin splinters, fusible, feebly aromatic, the odor becoming stronger upon heating ; taste somewhat acrid ; powder grayish, turning green on exposure to air. Soluble in potassium or sodium hydrate T. S. and in alco- SPECIFICS. 259 hoi, the alcoholic solution being colored blue by the addition of tincture of ferric chloride. The principal constituents of guaiac are — guaiaconic acid, guai- acic acid, guaiaretic acid, and a small amount of gum. These substances are insoluble in water, but soluble in alkalies. Dose. — 5-30 grains (0.3-2.0 Gm.). Official Preparations. PUulae Antimonii Compdsitse — Ptlulas (ace.) Antimonii Compdsitas — Com- pound Pills of Antimony (Plummer's Pills). — Dose, i or 2 pills. TinctOra Guaiaci — Tincturae Guaiaci — Tincture of Guaiac. — Dose, 30-60 minims (2.0-4.0 Cc). Tinctiira Guaiaci Ammoniata — Tinctiirse Guaiaci Ammoniatse — Ammoni- ated Tincture of Guaiac. — Dose, 30-60 minims (2.0-4.0 Co.). Unofficial Preparation. Gmillsum Guaiaci — Emtilsi Guaiaci — Guaiac Emulsion. — Dose, \-2 fluid- drachms (2.0-8.0 Cc). Antagonists and Inoompatibles. — Spirit of nitrous ether and the mineral acids are incompatible with guaiac. Water is pharma- ceutically incompatible with the tinctures, precipitating the resin. Synergists. — Many of the diaphoretics and diuretics aid the action of guaiac. Colchicum, sarsaparilla, mezereum, stillingia, sassafras, sanguinaria, and xanthoxylum are also synergistic. Physiological .^ction. — Externally and Locally. — Guaiac is antiseptic, and possesses mildly astringent properties, being used locally as a gargle. Internally.' — Digestive System. — It increases the flow of saliva and gastric juice, producing a sensation of warmth in the epigas- trium. It also augments the secretions from the intestinal canal, excessive doses even causing vomiting and purging. Circulatory System. — Guaiac increases the force and rapidity of the heart's action and dilates the cutaneous blood-vessels. Nervous System. — No special action has been observed. Respiratory System. — The drug is an expectorant, increasing the production and excretion of bronchial mucus. Absorption and Elimination. — Though a colloidal substance, it is absorbed into the blood with considerable facility, being excreted chiefly by the skin, exciting free diaphoresis. The bowels, kidneys, and bronchial mucous membrane assist in the excretory process. Temperature. — Under doses sufficient to cause free diaphoresis 26o A TEXT-BOOK OF MATERIA MEDIC A. the temperature may be reduced. Guaiac has, however, no direct influence upon the heat-center. Uterus. Large doses of guaiac induce contraction of the womb, the drug thus acting as an ecbolic. Untoward Action.— ^o special symptoms are manifest other than the gastro-intestinal disturbance mentioned, and occasionally headache and giddiness. Poisoning.— QiMzxa.c cannot be classed as a poisonous substance. Excessive doses act as a gastro-intestinal irritant, although no case of death is recorded resulting directly from this drug. Treatment of Poisoning.— This should be symptomatic, and similar to the treatment of poisoning from colchicum. Therapeutics. — Externally and Locally. — Guaiac in some form is an excellent application m follicular tonsillitis, rheumatic pharyn- gitis, and quinsy. For these cases the emulsion of guaiac serves as an efficient gargle, or the troches of guaiac may be used. Internally.— Yxom the sixteenth to the eighteenth century guaiac was renowned as a cure for syphilis, having been introduced into Europe from San Domingo. The heroic manner, however, in which the drug was employed rendered the results more injurious than beneficial, so that the guaiac treatment was condemned, one of its most vigorous opponents being Paracelsus, to whom the reintroduction of mercury for the treatment of syphilis is largely due. Since we have learned to use mercury and iodine and its preparations intelligently the guaiac treatment of this disease pos- sesses only a historic interest. Nevertheless, the drug possesses properties which render it exceedingly valuable in chronic muscular rheumatism, neuralgic dysmenorrhea, and atonic amenorrhea. Guaiac is considered to be an efficient remedy in lumbago and chronic gout. Its most important service, however, in therapeutics is in the treatment of quinsy. It is doubtful whether there is any drug which will modify the course of this disease or abort an attack of tonsillitis so readily as this medicine. The tincture of guaiac is the preparation usually employed for this purpose, \ fluidrachm (2.0 Cc.) being given in the form of an emulsion every three or four hours. Contraindications. — There are no marked contraindications to its use. Administration. — The tinctures are very acrid and disagreeable to the taste, and should be given in the form of an emulsion. The emulsion of guaiac, a formula for which is given in the Dispensa- SPECIFICS. 261 tories, is not unpleasant, and is altogether the best liquid prepara- tion to give. The lozenges of guaiac, allo/wed to dissolve slowly in the mouth, serve as an agreeable and efficient method of medicating the throat with this drug. Sarsaparilla— Sarsaparillae— Sarsaparilla. TJ. 8. P. Origin. — The root of Smilax officinalis Kunth and other species of Smilax growing in swampy forests in Mexico and as far south as the northern portion of Brazil. They are woody climbers, often attaining a great height. Description and Properties. — About -g- to J inch (3.17-6.35 Mm.) thick, very long, cylindrical, longitudinally wrinkled, exter- nally grayish- or orange-brown ; internally showing a whitish and mealy or somewhat horny cortical layer surrounding a circular wood-zone enclosing a broad pith ; nearly inodorous ; taste muci- laginous, bitterish, and acrid. The thick, woody, knotty rhizome, if present, should be removed. Sarsaparilla contains an active principle, parillin, an acrid gluco- side which froths with water and otherwise closely resembles sapo- nin in its action. Dose. — 30-60 grains (2.0-4.0 Gm.). Official Preparations. DecOctuni Sarsaparillse CompSsitum — DecScti Sarsaparillae Compftsiti — Compound Decoction of Sarsaparilla. — Dose, 4-6 fluidounces (118.-178. Cc). 10 per cent., with Sassafras, Guaiac-wood, GlycyiThiza, and Mezereura. ExtrSctum Sarsaparillse Fluidum — ExtrScti SarsaparlUae Fliiidi— Fluid Extract of Sarsaparilla. — Dose, J-2 fluidrachms {2.0-8.0 Co.). Extractum SarsaparlUae Fluidum Comp6situm — ExtrScti Sarsaparillse Fluidi Comp6siti — Compound Fluid Extract of Sarsaparilla. — Dose, ^-2 fluid- drachms (2.0-8.0 Cc). Syrupus Sarsaparillse Comp6situs — SJhrupi Sarsaparillae CompSsiti — Com- pound Syrup of Sarsaparilla. — Dose, 2-4 fluidrachms (8.0-16.0 Cc). A Fluid Extract, 20 per cent., with the J'luid Extracts of Glycyrrhiza and Senna, and the Oils of Sassafras, Anise, and Gaultheria. Antagonists and Incompatibles. — Alkalies and free iodine are incompatible with the official preparations of sarsaparilla. Corro- sive subHmate is said to be changed into calomel by the compound syrup of sarsaparilla. Synergists. — The specifics, diaphoretics, and diuretics. Physiological Action. — Sarsaparilla has no local influence. 263 A TEXT-BOOK OF MATERIA MEDICA. Internally its action is similar to that of guaiac, though not so energetic and irritant in large doses. Therapeutics. — As with guaiac, the history of sarsaparilla is full of interest. Introduced into Europe in the sixteenth century by the Spaniards, who had learned of its alleged virtues in consti- tutional syphilis in Peru, San Domingo, and Brazil, it retained its reputation as a specific in this disease for a century or more, when it was abandoned, only to be revived at the close of the eighteenth century. Since that time it has retained its place in medicine more through the wonderful virtues ascribed to it by nostrum-venders than to any real medicinal properties which it possesses. The consensus of competent opinion seems to be that sarsa- parilla can claim no special medicinal virtues other than its diuretic and diaphoretic properties. The compound decoction of sarsaparilla is probably the most useful official preparation, and appears to have been of some bene- fit in scrofula and strumous cutaneous affections. Indeed, some cases of constitutional syphilis have improved more rapidly under the administration of this preparation than when mercury or potas- sium iodide has been given alone. Contraindications. — There are none. Administration. — No special directions can be given for the administration of the various preparations. The compound syrup of sarsaparilla is quite pleasant to the taste, and is used extensively as a vehicle, particularly for potassium iodide. StillTng-ia— Stilllngfise— Stillingria. TJ. S. P. (QuEEN'.s Root.) Origin. — The root of Stillingia sylvatica L., a perennial herb growing in dry and sandy soil in the Southern United States as far north as Eastern Virginia. Description and Properties. — About i foot (30 Cm.) long and nearly 2 inches (5 Cm.) thick, subcylindrical, slightly branched, compact, wrinkled, tough, grayish-brown, breaking with a fibrous fracture, showing a thick bark and porous wood, inner bark and medullary rays having numerous yellowish-brown resin-cells. The odor is peculiar and unpleasant; the taste bitter, acrid, and pungent. The fresh root probably contains an active principle not yet determined. (Old roots are nearly inert.) It contains an acrid SPECIFICS. 263 resin, sylvacrol, a volatile and a fixed oil, resin, starch, gum, and tannin. Dose. — 15-30 grains (1.0-2.0 Gm.). Official Preparation. ExtrSctum StilHngiae Fluidum— ExtrScti StilHngise Flfiidi— Fluid Extract of Stillingia. — Dose, \-i fluidrachm (1.0-4.0 Cc). Unofficial Preparations. Decactum StilHngiae— DecScti StilHngiae— Decoction of Stillingia.— Z)»j,f, 1-2 fluidounces (30-60 Co.). Extractum StiU&igiae Fluidum Conip6situm -ExtrScti StilHngise Fluidi Comp6siti— Compound Fluid Extract of Stillingia.— Z)<;jf, 1-2 fluidrachms (4.0- 8.0 Co.). Stillingia, 130; Corydalis, 130; Chimaphila, 60; Iris, 60; Sambucus, 60; Xanthoxylum Berries, 30; and Coriander, 30; to make 500 parts Fluid Extract with Dilute Alcohol. Syrupus StilHngiae Comp6situs— SJ^rupi Stillingia CompSsiti— Compound Syrup of Stillingia. — Dose, i fluidrachm to i ounce (4.0-30 Cc). Compound Fluid Extract, I, to Simple Syrup, 3 parts. Tinctiira StilHngis— Tincturse StilHngia;— Tincture of Stillingia.— Z)ojf, ^i fluidrachm (2.0-4.0 Cc). Antagonists and Incompatibles. — There are none affecting Stillingia. Synergists. — The same as for sarsaparilla. Physiological Action. — The action of stillingia resembles that of sarsaparilla, the drug increasing the various secretions and stim- ulating the heart and circulation. Therapeutics. — The medical uses are the same as those of sarsaparilla. Sanguinaria— Sanguinariae— Sangruinaria. TJ. S. I*. ( Blood-root.) Origin. — The rhizome of Sanguinaria Canadensis L., a low perennial, a native of Canada and the United States, where it grows in open woods in a rich soil. The rhizome should be collected in autumn. Description and Properties. — Of horizontal growth, about 2 inches (5 Cm.) long and |- inch (i Cm.) thick, cylindrical, some- what branched, slightly annulate, wrinkled, reddish-brown; frac- ture short, somewhat waxy, whitish, with numerous small red resin-cells, or of a nearly uniform, brownish-red color ; bark thin ; odor slight ; taste persistently bitter and acrid. It contains a color- 264 A TEXT-BOOK OF MATERIA MEDICA. less alkaloid, sanguinarine , yielding red salts ; chelerythine, yield- ing lemon-yellow salts ; homochelidonine ; and protopine. Dose. — 2-20 grains (0.12- 1. 2 Gm.). Official Preparations. Extractum Sanguinariae Fluidum — Extracti Sanguinarise Fluidi— Fluid Extract of Sanguinaria. — Dose, 5-15 minims (0.3-1.0 Cc). Tinctiira Sanguinarise (15 per cent.) — Tinctiirse Sanguinariae — Tincture of Sanguinaria. — Dose, 10-60 minims (0.6-4.0 Co.). Unofficial Preparations. Acetum Sanguinariae — -Aceti Sanguinariae — Vinegar of Sanguinaria. — Dose, 15-40 minims (1.0-2.5 Cc.) ; as an emetic, 1-4 fluidrachms (4.0-16.0 Cc). Sanguinarine Nitrate. — Dose, xV" i grain (0.005-0.008 Gm.). Antagonists and Incompatibles. — The irritation and circu- latoiy depression occasioned by blood-root are antagonized by opium, atropine, etc., while the incompatibles are tannic and gallic acids, alkalies, and metallic salts. Synergists. — The Specifics and the mineral and vegetable emetics aid the action of sanguinaria. Physiologioal Action. — Externally and Locally. — Sanguinaria is an irritant and a feeble escharotic. When the powder of blood- root is inhaled it produces great irritation of the respiratory pas- sages, with excessive secretion and violent sneezing. Internally. — Digestive System. — Medicinal doses occasion a sense of constriction in the throat and heat in the epigastrium, increasing the secretions from the stomach, liver, and intestines. Excessive doses are followed by marked salivation, nausea, and vomiting, the drug acting as a systemic emetic. Very large doses cause great irritation of the intestines, producing hypercatharsis. Circulatory System. — At first the heart's action is increased and arterial tension raised, but these effects are followed by cardiac and circulatory depression. Poisonous doses sometimes result in car- diac paralysis. Nervous System. — Large doses diminish reflex excitability by paralysis of the spinal centers, occasionally producing convulsions of spinal origin. Respiratory System. — Medicinal doses of sanguinaria have no apparent effect upon the respiration; poisonous doses, however, render the breathing slow and shallow, death resulting from as- phyxia due to paralysis of the respiratory center.- The final col- SPECIFICS. 265 lapse is often preceded by convulsions arising from the accumulation of carbon dioxide in the blood from failure of respiration. Blood-root is a stimulant expectorant, increasing the secretion from the broncho-pulmonary mucous membrane. Absorption and Elimination. — The drug is quite rapidly ab- sorbed, and is eliminated by the intestines, stomach, skin, kidneys, and bronchial mucous membrane. Temperature. — Medicinal doses have no effect upon, but exces- sive doses lower, the temperature. Eye. — Poisonous doses produce dilatation of the pupils. Uterus. — Sanguinaria possesses emmenagogue properties. Untoward Action. — This does not differ from the poisonous action which follows. Poisoning. — Blood-root is an acro-narcotic poison, exciting sali- vation, violent vomiting, profuse watery evacuations from the bowels, and producing a,ll the symptoms of gastro-enteritis. The muscular system is greatly relaxed, the pulse is slow, weak, and irregular, the skin covered with cold sweat, and finally collapse of the vital powers supervenes. Convulsions may precede a fatal termination, which is due to paralysis of the respiratory or cardiac center. Treatment of Poisoning. — The stomach should be washed out and diffusible stimulants freely given. Strychnine may be admin- istered hypodermically, and digitalis and amyl nitrate given if necessary. The pain and nausea may be relieved by morphine and atropine. The normal temperature of the body should be main- tained by external warmth. Therapeutics. — Externally and Locally. — The nitrate of san- guinarine — \ grain (o.oi 5 Gm.) to i ounce (30 Cc.) of glycerin — has been recommended by Keyser in conjunctivitis granulosa. The powdered blood-root has been employed as a sternutatory, and when mixed with two or three times the amount of powdered acacia or starch it has proved beneficial, in the hands of some physicians, in the dry form of atrophic rhinitis. The pure powder is said to be an efficient escharotic to nasal polypi 2Lnd fungoid con- ditions of the mucous membrane. Some authorities claim it to be an effective remedy for cancer, and consider it a valuable stimulant for indolent ulcers. The decoction of sanguinaria has been employed as a gargle in scarlatinal angina. This drug is now seldom used locally, the irritation caused by 266 A TEXT-BOOK OF MA TERIA MEDICA. it being so great that patients can only with great difficulty be per-.- suaded to submit to the treatment. Internally. — While possessing alterative properties and classed among the Specifics, one of the principal uses of sanguinaria is in acute bronchitis, when the spasmodic element predominates and after the subsidence of the more acute symptoms. In atonic conditions of the stomach and bowels, with increased secretion of mucus, small doses of tincture of sanguinaria prove beneficial. The tincture is of equal value in duodenal catarrh with jaundice. As an emmenagogue and aphrodisiac blood-root has been suc- cessfully employed in functional amenorrhea and dysmenorrhea, as well as in functional impotence with relaxation of the genital organs and daily seminal losses. Sanguinarine has been recommended in hysteria, either alone or associated with podophyllum. Protracted muscular rheumatism has apparently been benefited by this drug. Tincture of sanguinaria has served as an emetic in spasmodic laryngitis, though its depressing and irritating action renders san- guinaria much less desirable than certain other emetics. The drug is considered to possess marked alterative proper- ties, and is still frequently employed in the treatment of syphilitic and strumous affections of a chronic nature. It certainly appears to be a mild stimulant to the vegetative sys- tem of nerves, improving the circulation, nutrition, and secretion. Contraindications. — No special contraindication exists, unless it be an acute inflammatory condition of the stomach and bowels. Administration. — The nitrate of sanguinarine is the best prepa- ration to use in diseases of the respiratory tract. As a gargle the vinegar of sanguinaria is to be preferred, while, if the drug is to be employed as an emetic, the infusion, given in tablespoonful doses at short intervals, serves the best purpose. For other purposes the tincture is the most desirable preparation. The sanguinarine nitrate is best administered in pill form ; the liquid preparations should be given well diluted with water. Mezereum— Mezerei— Mezereon.— C/; s. p. Origin. — The bark of Daphne Mezereum L. and other species of Daphne, small shrubs about 2-4 feet (0.6-1.2 .M.) high, indige- SPECIFICS. 267 nous in hilly and mountainous regions of Europe, extending to the Arctic Circle and eastward to Siberia. Description and Properties.— Long, thin bands, usually folded or rolled into disks, the outer surface yellowish or brownish-yellow, with transverse scars and minute blackish dots, underneath of a light greenish color ; inner surface whitish, silky. Bast in trans- verse layers, very tough; inodorous; taste very acrid. The im- portant constituent is an acrid resin, mezerin ; it also contains a crystalline glucoside, daphnin. Dose. — 1-5 grains (0.06-0.3 Gm.). Official Preparation. Extractum Mezerei Fluidum— ExtrScti Mezerei Fluidi— Fluid Extract of Mezereon. — Dose, 1-5 minims (0.06-0.3 Cc). Mezereon is also one of the ingredi- ents in Decoctum Sarsaparill^ Compositum, Extractum Sarsaparillae Fluidum Composi- tum, and Linimentum Sinapis Compositum. Antagonists and Incompatibles. — The glucoside is precipi- tated by tannic and free acids, and the resin by water, in which it is insoluble. Synergists. — All the vegetable specifics, with the exception of colchicum. Physiological Action. — Its action, both locally and internally, is quite similar to that of sanguinaria, but when applied to the skin it is more of a vesicant than an escharotic, and taken inter- nally it is more of a diuretic than sanguinaria, in poisonous doses causing severe urinary irritation and other symptoms produced by a violent gastro-intestinal irritant. The treatment of poisoning would be the same as that prescribed under poisoning by sanguin- aria. Therapeutics. — It is employed as a masticatory in paralysis of the tongue and the muscles of deglutition, and as a counter-irritant in the form of an ointment. Internally it is now seldom if ever used alone, but in combination with other vegetable specifics it is pre- scibed in chronic rheumatism and in chronic syphilitic and non- syphilitic cutaneous diseases. Contraindications. — Acute inflammation of the stomach, bow- els, and kidneys. Administration. — As it is never given internally alone, no spe- cial instructions for its administration are necessary. The fluid extract freely diluted with water would, however, be the only preparation to use. 268 A TEXT-BOOK OF MATERIA MEDIC A. X?Lnth6xylum— Xanthoxyli— Xanthoxylum . U. S. P. (Prickly Ash.) Origin. — The bark of Xanthoxylum Americanum Miller and of Xanthoxylum Clava-Herculis L. Both species are native to North America, the first being shrubby and attaining a height of lo or 12 feet (3-3.6 M.), while the second species is a small tree some- times 30 or 40 feet (9-12 M.) high. Description and Properties. — Xanthoxylum Americanum (Northern Prickly Ash) occurs in curved or quilled fragments about 2^5- inch (i Mm.) thick ; outer surface brownish-gray, with whitish patches and minute black dots, slightly furrowed, with some brown, glossy, straight, two-edged spines, linear at the base and about \ inch (6 Mm.) long; inner surface whitish, smooth; fracture short, non-fibrous, green in the outer and yellowish in the inner layer ; inodorous ; taste bitterish, very pungent. Xanthoxy- lum Clava-Herculis (Southern Prickly Ash) resembles the preced- ing, but is about -^-^ inch (2 Mm.) thick, and is marked by many conical, corky projections, sometimes ^ inch (2 Cm.) high, and by stout brown spines rising from a corky base. Xanthoxylum should not be confounded with the bark of Aralia spinosa L., which is nearly smooth externally, and beset with slender prickles in transverse rows. Prickly ash contains an acrid green oil, a colorless, crystalline resin, a bitter principle, sugar, ash, and tannic acid. Dose. — 10-30 grains (0.6-2.0 Gm.). Official Preparation. ExtrSctum XanthSxyli Fluidum— ExtrScti Xanth6xyli Fluidi — Fluid Ex- tract of Xanthoxylum. — Dose, 10-30 minims (0.6-2.0 Cc). Physiological Action. — The action of xanthoxylum is quite similar to that of sanguinaria, though it is more of a stomachic tonic, sialagogue, diuretic, and diaphoretic, and not so much of a local irritant. It increases the heart's action and raises arterial tension. Therapeutics. — It is used locally as a masticatory for the same purposes as mezereon, and the decoction has been highly recom- mended as a gargle in chronic pharyngitis. Internally its medical uses are the same as those of stillingia, mezereon, etc., although of more value in atonic dyspepsia. SPECIFICS. 269 Contraindications and Administration are the same as for sanguinaria. Serum-therapy. Among the marvels of scientifie research which have distin- guished our century no achievements are more remarkable, nor of greater moment to the welfare of mankind, than those pertain- ing to the field of biological, pathological, and therapeutic inves- tigation. Yet, brilliant as have hitherto been the triumphs of speculative thought and the deductions drawn from tireless ex- perimentation and practically applied to the curative art, the highest generahzations and most signal exhibitions of genius are perhaps related to the special phenomena revealed by the study of zymotic diseases. The limits of the present work preclude a detailed treat- ment of so extensive and complicated a subject ; yet a brief sum- mary, elucidating the theory and development of serum-therapy as exemplified in contemporaneous research, should be of interest as well as benefit to the student of modern therapeutics. A glance at the history of therapeutic procedure in the prophy- lactic treatment of infectious diseases shows that the general prin- ciple underlying all later discoveries was, however crudely, divined at a much earlier period than we are wont to suppose. In view of actual attainment it is natural that the mind should revert to the transcendent services rendered to mankind by Jenner ; yet it is known that the ancient Hindus and Persians, as well as the nomad tribes and caravans of Farther Asia, practised inoculation of equine virus, or horse-pox — the mammary pustule developed during early lactation in the horse, camel, and cow, and even in woman. The inoculation of human virus is of immemorial origin, proba- bly coeval with the importation of variola from Asia into Africa by the Saracens. Certain it is that as early as the tenth century the Arabs and Chinese adopted the custom of variolization, the inoc- ulation of small-pox, although the skeptical physicians of the age consigned the practice as a monopoly to women. In 17 17, Lady Montague, wife of the British ambassador at Constantinople, saw an old Thessalian woman whose immunity so impressed her that she practised the operation upon her own child. Writing from Adrianople, she says: "They take the small-pox here for diversion; I have tried it on my dear little son; I am going to bring this useful invention into fashion in England." In 270 A TEXT-BOOK OF MATERIA MEDICA. 1 7 18 her desire was realized, King George adopting the practice in the royal family. Three years later the custom was introduced in France, being accepted by Chirac and Helvetius, although the decrees of the Sorbonne and the Faculty of Medicine condemned the innovation as " illicite et contraire a la loi de Dieu ;" notwith- standing which official malediction the practice of inoculation con- tinued to spread until supplanted by vaccination proper in 1800. The French peasants knew in the last century that the act of milk- ing cows infected with mammary pustule, where there was any lesion of the epidermis on the hands, conferred immunity against small-pox ; and the mountaineers have long been accustomed to collect the crusts resulting from vaccine disease, macerating them in water, and inoculating their children with the solution. The success attending these rude experiments in France was communicated by a Frenchman, Rabault, in 1768, to Dr. Pew, an English physician, who reported the matter to his friend Jenner, who at once perceived the momentous import of the discovery. Meanwhile, in 1771, a Holstein schoolmaster vaccinated three pupils ; and in 1 774 an English farmer, having observed the pro- tection existing among his dairymaids, and having implicit con- fidence in the efficacy derived from inoculation of bovine virus, vaccinated his wife. It was reserved for Jenner, however, in 1 776, to commence the systematic and exhaustive study of the subject destined to prove inestimably beneficial to mankind. It was, in truth, the year celebrated for his declaration of scientific independence, which, after long contumely and scurrilous ridicule, was to wrest from his humiliated adversaries every weapon of derision and reproach. His early experiments were but a repetition of the empirical yet prophetic test of the English farmer ; yet with his gifted insight and indomitable courage the field of discovery was greatly ampli- fied, the results being in accordance with scientific methods inspired by Jenner's originality and force. He found in the northern counties of England a certain form of ulcer upon the hands of those employed in dairies and immune against small-pox ; observed that the malady resembled the pus- tules affecting the udder of the cow, having apparently been occa- sioned by contact; vaccinated an individual supposed to be un- protected against the disease, and subsequently exposed him to infection with triumphant impunity, i^'long interval of laborious investigation had led to this final test, and it was not until 1798 SPECIFICS. 271 that Jenner published his first paper upon the subject, vaccination being transported to America in the following year. Such is the brief yet eloquent record of an achievement which experience has proved to be of incalculable benefit to man. To- day there is no question among the more enlightened members of the profession that the operation, properly performed, is an absolute safeguard against the infection of small-pox. Strange indeed is it that a century of comparative quiescence should have elapsed since Jenner pointed the way to the startling accomplishment of the present epoch. Yet not until Pasteur, in 1880, announced to the world the issue of his labors touching the protective inoculation of animals was the broken thread of patho- genic research taken up anew, and the task of solving its mysteries resumed — be it said with profounder acumen and far more com- plete appliances than ever before. It is a matter of record how the French savant demonstrated that cultures of the bacilli of chicken-cholera, when thoroughly dried and long exposed to the air, lost their virulence, and that fowls inoculated with the attenuated virus were rendered insensible to the attacks of more energetic micro-organisms. It was, mutatis mutandis, a modification or development of the Jennerian principle : " L'histoire de la vaccine constitue la premiere etape d'une longue serie de travaux, qu'ont inspires les admirable decouvertes revelees par le genie de Pasteur. Le principe en est toujours le meme: attenuer un virus, et I'injecter a I'animal qu'on veut immuniser " (Bernheim). Yet in the far-reaching possibilities suggested by Pasteur's experiments the present was immeasurably in advance of previous attainment. The further application of this discovery to other animal infec- tions confirmed by indisputable evidence the validity of the savant's theories and the efficacy of their practical illustration. A new light was shed upon pathogenic study ; all Europe felt the impulse given to scientific thought in its relation to therapeutic progress, and in the sanctum of the laboratory many a fervent recluse sought to amplify the knowledge already attained. A striking departure from Pasteur's method by Salmon and Smith, in 1886-87, led indirectly to the latest evolution of inocula- tive therapy. They showed conclusively that animals may be ren- dered immune against certain infectious diseases by inoculating them with filtered cultures containing the toxic products of patho- genic micro-organisms entirely free from the living bacteria to 272 A TEXT-BOOK OF MATERIA MEDIC A. which they owe their origin. By this process immunity against the bacillus of hog-cholera was attained in pigeons, the disease being almost invariably fatal to these birds. A little later (1888) Roux, employing similar sterilized cultures, succeeded in protect- ing susceptible animals against the anthrax bacillus ; and more recently (1890) Behring and Kitasato have proved that immunity against the action of the tetanus bacillus may be conferred by the use of toxic products in solution freed from the presence of active germs — in a word, that purely chemical agents sufficed to attain the object hitherto deemed wholly dependent upon the influence of living bacteria. The significance of this discovery could hardly be over-estimated. By it the entire theory of causal phenomena — the protective force in which the immunizing property was supposed to reside — became modified. If not a living organism, but a chemi- cal substance, proved to be the immunizing agent, then resistance to toxic influences must proceed from some source other than bac- terial metabolism, some organic force inherent in the inoculated system. To ascertain the nature and operation of this bactericidal power and determine the rationale of acquired immunity now engaged the earnest attention of savants throughout the world. It was soon found that the lymph and blood of a normally healthy organism possessed in a degree this mysterious property of neutralizing the toxic effects of bacterial action, and gradually the truth which had thus far eluded the most searching investiga- tion was revealed. Finally, by a series of experiments involving the rarest skill and discrimination, the resistant energy developed by the infected organism was traced to certain albuminoids pertain- ing to or dissolved in the blood-serum, the acute and comprehen- sive insight of Behring, especially, sustaining the new hypothesis, which speedily passed from the realm of conjecture to the assurance of experimental proof, culminating in the establishment of serum- therapy as a legitimate and auspicious field of therapeutic science. It should be observed that the remarkable discoveries of Koch in his chosen domain of bacteriology had exercised no little influence in guiding and confirming the wider researches of his successors. Before entering upon a consideration of practical details it should be stated that the theory and practice of serum-therapy are based upon the condition of the system, whether in man or the lower animals, which renders it inhibitive of bacterial development by opposing an effective barrier to the propagation of pathogenic germs. This self-protective antagonism pertaining to the indi- SPECIFICS. 273 vidual organism is termed immunity, and may be either natural or acquired. By natural immunity is understood the absence of all personal predisposition toward certain infections or diseases, even under the most favorable exposure. A familiar example of this inherent, congenital unsusceptibility is found in poisoning by Rhus {R. toxico- dendron, R. venenata!), some persons handling the plants and even chewing the leaves with impunity, while upon others the mere proximity of the poison has a toxic effect. Acquired immunity may be either accidental or artificial. In the former case protection is secured by a previous access of the disease — as, for instance, a child recovered from scarlet fever, who is rarely prone to a second attack. In the latter case the suscept- ibility is obviated by protective inoculation, it being known, to illus- trate, that an animal inoculated by injections of anthrax-poison is, after recovery from transient symptoms of disease, rendered arti- ficially immune — a fact demonstrated by the thoroughly scientific experiments of Pasteur. An eminent authority, Schleich, has declared that natural or spontaneous immunity does not exist, but that the protective qual- ity is created by the animal kingdom — either through a previous malady or, as more frequently happens, through transmission from progenitors to offspring. Syphilis or tuberculosis in parents, he maintains, confers upon children immunity from these diseases; and the author cites in support of his theory that certain infections, such as plague and leprosy, have wholly disappeared from various countries because of the inoculation of succeeding generations and the consequent attenuation of the virus — exhaustion of the soil, as it were. Bernheim asserts that no animal is endowed with absolute immunity, but that, however strong may be the resistance of the particular organism, it must succumb to an excessive invasion of microbes or of toxic products. The doctrine of immunity has, not inaptly, been styled the theorem of which serum-therapy is the logical corollary ; yet it is only within a few years that the mystery which shrouded the entire subject has been dispelled. To-day, thanks to untiring researches in the fields of physiology, biology, and chemistry, we are ac- quainted, if not with its precise nature and origin, at least with many details intimately associated with its causation. Formerly supposed to be absolute in its relation to species and individuals, we now recognize that immunity is but relative, considerations of IS 274 A TEXT-BOOK OF MATERIA MEDIC A. climate, race, receptivity, character of pathogenic germs, and con- ditions of infection all entering as modifying factors into the devel- opment and exercise of this potent yet complex force. Chauveau has shown that Algerian sheep, relatively immune against anthrax, contract the disease under enormous hypodermic injections of culture ; on the other hand, a slight puncture of the aural epidermis is fatal to sheep in France, which, transported to Algeria, succumb to natural infection. Watson-Cheyne states that a single virulent bacillus may cause the death of a guinea-pig or induce septicemia in the mouse, provided these animals be pecu- liarly susceptible. Yet the guinea-pig is not affected by the injec- tion of a few bacilli from a septicemic mouse, while several thou- sands occasion only an abscess, although death ensues with higher dosage. Again, young white mice are quickly killed by the anthrax bacillus, while the same injection produces in the old only a local lesion. Cattle, though more amenable to infectious disease than sheep, are but slightly affected by hypodermic injections. Hogs are but slightly sensitive to anthrax, while the immunity of car- nivora is proverbial. Meat infected with anthrax is innocuous to the dog, the cat, and the fox. Again, anthrax has but little influence upon birds or fowls, especially chickens, yet it has proved fatal to sparrows and pigeons ; and Pasteur overcame the immunity of chickens by plunging their feet in water, heat and cold, according to M. Roger, predisposing animals to infection, less by moderating bodily temperature than by disturbing the general economy and diminishing the power of resistance. As with anthrax, so in the case of glanders, peculiar to horses — the varying susceptibility to infectious diseases is apparent, bo- vine animals being wholly immune, and the hog, dog, singing- birds, and pigeons but slightly affected. In tuberculosis experimental injection of the same culture is followed by results widely diverse, certain animals being seized with acute phthisis, while others show marked resistance to the poison, although under excessive doses none is completely immune. In this connection it may be noted that clinical experience demon- strates the same pathological diversity in human beings. The goat, dog, ass, and sheep are rarely affected by tuberculous disease, yet all are susceptible to pathogenic inoculation. The monkey, seldom contracting the disease in his native haunts, becomes upon transportation remarkably prone to phthisical affections. With the SPECIFICS. 275 exception of the dog, most of the carnivora are easily influenced by tuberculous contagion. On the other hand, cold-blooded ani- mals are singularly immune, inoculation of toxic germs producing no development of the disease, though fatal results may occur from systemic intoxication. These examples, which might be multiplied indefinitely, suffice to show the relative character of natural immunity. It may be added that the caprice of toxic infection becomes even more appa- rent in studying the physiological and pathological conditions of the same organism when subject to the modifying influences of climate, altitude, seasons, heat, cold, traumatism, diet, ventilation, etc., and the subjective considerations of age, sex, race, fatigue, splenetic influence, nervous lesions, alcoholism, auto-intoxication, and acquired or hereditary diathesis. Indeed, the pathological records of disease abound in curious, often inexplicable, data touching individual and racial immunity. The subject is important in its bearing upon serum-therapy, and furnishes a' theme of profit- able study in its relation to the practical treatment of infectious disease. With regard to the rationale of immunity, the theories advanced in explanation of this occult yet indubitable force are many, and often greatly at variance. Eliminating those which may be re- garded as too fantastic for serious consideration, the more plausible conjectures refer the phenomena in question to cellular, humoral, humor o-cellular, and vaso-motor agencies. Prominent among competent opinions is the doctrine of phago- cytosis proposed by Metchnikoff In 1883 Metchnikoff" established the existence of an intracellular digestion, showing that nomad cells were capable of absorbing vege- table filaments ; that mesodermic protoplasm possessed the same power over bacteria ; and that in the higher animals this phagocytic function had its analogue in the digestive property of leucocytes, or white blood-corpuscles. Gluge observed that in hemorrhage of the nervous centers these corpuscles digest the disintegrated myelin, and in a fresh-water crustacean, daphne, they have been seen to gather about the spores of algae, penetrating the meso- derm. Metchnikoff" multiplied these examples of cellular defence among invertebrates, distinguishing two sorts of leucocytes : the stationary (macrophages) and the mobile (microphages), the latter including the white globules of lymph, and especially of blood, of 276 A TEXT-BOOK OF MA TERIA MEDICA. which, together, they constitute about 20 per cent. It may be said that all organs contain elements of defence— macrophages. The experiments of Gabritschevsky, who has studied phagocy- tosis in diphtheria, are highly instructive. Injecting a pure culture of Loeffler's bacillus into the anterior chamber of a rabbit's eye, he saw the devastation wrought among the leucocytes, which appeared powerless to contend against the deadly germs. But after immu- nizing the rabbit with attenuated cultures previous to the injection of toxic bacilli, a battle-royal ensued, the phagocytic action of the leucocytes resulting in the signal triumph of the latter, so that at the end of eight hours not a single free bacillus was found in the chamber, all having been absorbed within the opposing globules. Yet, notwithstanding the plausibility of Metchnikoff's hypothe- sis and the striking significance of his experiments — embracing in epitome the whole theory of preventive inoculation — certain argu- ments of Behring and Kitasato, based upon experimental research, go far to disprove the validity of the doctrine he so zealously maintained. Still, although the substances which form the defen- sive property of phagocytes, and are so fatal to the pathogenic action of microbes, remain unknown to us, the fact of phagocyto- sis cannot be denied. It was natural in the light of new developments that investiga- tion should inquire whether the leucocytes constituted the only protective force within the organism. Then followed the theory that the humors in general possess microbicidal power — either through the presence of destructive elements and the secretion of soluble toxins or through the humoral capacity of withdrawing oxygen from the invading micro-organisms. To Buchner is chiefly due the early elucidation of the humoral theory, and of first recog- nizing in serum bactericidal properties, he being followed by Behring, to whom is to be credited the more important labor of extending experimentation and proving that animals naturally immune against a certain disease may furnish serum endued with neutralizing power. Behring found that the blood and blood-serum of the rat, which is naturally immune against anthrax, possesses strong bactericidal properties, while those of mice, cattle, etc., very susceptible to anthrax infection, have none. Further research resulted in Behring's all-important law, es- tablished by searching experiment, that "the blood and blood- serum of an individual which has been rendered artificially \xsvsxmri& against a certain infectious disease may be transferred into another SPECIFICS. 277^ individual, with the effect of rendering the latter also immune, no matter how susceptible this animal is to the disease in question." This formulated doctrine became the fundamental motive in all future investigations, the culminating achievement of inoculative therapy being the announcement of Behring and Kitasato in 1890 concerning the artificial immunity against tetanus and diphtheria conferred by blood-serum, including the first emphatic declaration that the power of rabbits and mice when rendered immune to re- sist tetanus-poisoning " is based upon the ability of blood-serum to neutralize the toxins produced by the tetanus bacilli." As Krieger well observes : " These toxins are the poisonous products of bac- terial metaboUsm, and are the causes of acute disease when circu- lating in the organism. Their effect is an intoxication of the system, while after the introduction of virulent germs the cause of the dis- ease is an infection." The moment had now arrived for applying the therapeutic test of serum to man. In every instance the validity of Behring's law was sustained, and, moreover, the invaluable discovery was made that the serum of individuals naturally immune against a certain disease possesses no immunizing properties for other individuals. This militated partly against previous theories, and proved conclu- sively that the protective agent is not a substance produced by nature in naturally immune animals, but the result of " an organic chemism " called into activity only by introduction of the corre- sponding poison or toxin. In diphtheria and similar infectious diseases, as in tetanus, the bacillus produces toxins, the effects of which can be neutralized only by the properly prepared antitoxin. It was even shown by Ehrlich that the law applied to intoxication by certain purely chemical poisons, such as ricin and abrin, injections of gradually increased doses of serum affording complete immunity. A third theory in regard to the causes of immunity^ the humoro- cellular, seeks to combine phagocytic and humoral agencies, on the ground that neither separately suffices to account for the phenom- ena observed. Such is the theory of alexins of Buchner — certain albuminoid substances in the blood which release the leucocytes at the point of infection, the bactericidal property being active rather than passive, as previously supposed. Although defended by able advocates, Hankin and others, the fallacy of certain prem- ises, as shown by Metchnikoff, served to invalidate the doctrine, while several eminent authorities have disproved the facts upon 278 A TEXT-BOOK OF MATERIA MEDICA. which the original hypothesis was founded. Nevertheless, so high an authority as Bernheim may be cited in its favor. Lastly, the vaso-motor theory of Bouchard and others asserts the claims of physiology in determining the causes of immunity. Admitting the fact of phagocytosis, they contend that the emigration of leucocytes from the vessels occurs only through the action of the vaso-motor centers, whether by exciting the dilator or paralyz- ing the constrictor muscles. From these varying opinions it is as yet difficult to form a rational conclusion entirely in accord with physiological phenom- ena. In this connection the remarks of Bernheim may be cited as those of a highly competent authority. He says, while inclining to the humoro-cellular hypothesis, " Be it as it may, we can safely aver that relative immunity exists among the majority of animals. Against certain diseases this immunity may even be absolute. Thus rats, mice, and dogs are naturally immune against the mini- mum mortal dose of the Loeffler bacillus ; yet the serum from these animals when injected into other individuals is powerless to prevent infection — a point having an important bearing upon serum-therapy. Moreover, we know that man is frequently ex- posed to contagion without contracting a taint, of infectious dis- ease. I myself, under the most unfavorable conditions occasioned by fatigue, have passed through epidemics of typhoid fever, cholera, and malignant influenza {la grippe) without the slightest contamination, and other practitioners have had a similar ex- perience. Meanwhile, it were folly to imitate those courageous experimenters who, wishing to prove their immunity against cer- tain diseases, have absorbed their pathogenic germs, not infre- quently with fatal results As many conditions tend to diminish the power of resistance in the human organism, so others fortify the system against the inroads of infection. Obedience to sound hygienic principles, a regulated and nutritious diet, and a healthy parentage render the individual capable of withstanding microbic influences which constantly assail him, his natural immu- nity being greatly reinforced by these favorable circumstances." Obscure as is the precise nature of the immunizing property possessed by serum, there is no question as to its marvellous potency. Behring and Kitasato showed that it was sufficient to mingle very small quantities of serum from an immunized subject with virulent toxins to inoculate with impunity animals sensible to infinitesimal amounts of pure toxins. In experiments made by SPECIFICS. 279 MM. Roux and Vaillard the resistant force of antitoxin passes imagination. During their researches concerning tetanus bacilli they employed cultures which, when filtered, killed guinea-pigs in doses of 0.005 c.cm. ; yet one cubic centimeter of equine serum served to neutralize thirty times its volume of toxin, so that by the addition of 0.000 1 c.cm. of serum it was possible to neutralize completely the action of a mortal dose. In order to render a mouse immune the requisite quantity of antitoxin is so infinitesimal as scarely to be computed. In fact, serum is obtainable possessing an activity of one-millionth, the immunizing unit being the quan- tity necessary to protect one gram of a mouse's weight ; that is, one cubic centimeter of serum suffices to confer immunity against fatal dosage in 1000 kilograms of mice, or 70,000 of these ani- mals, each weighing about 15 grams. It will readily be understood that the discovery of so protective a force soon awakened therapeutic hopes which, if not completely realized in tetanus — largely by reason of the difficulties attending any treatment of so fatal a disease — have, on the other hand, in the case of diphtheria, been even more happily fulfilled than was anticipated. It is to be regretted, en passant, that in the use of the term antitoxin needless ambiguity should have arisen in the public mind, a fancied identity between the antitoxic and prophylactic power of serum being widely diffused. The association of the term with the preventive property of the immunizing agent — antitetanic, antidiphtheritic — has contributed not a little to this confusion of characteristic properties. In reality, nothing could be more erro- neous, than to suppose coequal activities in the two forces, the pre- ventive property of serum being far more general than its antitoxin influence — as yet scarcely proven save in tetanus and diphtheria. In hog-cholera, typhoid fever, pneumonia, aviary septicemia, and cholera careful researches abundantly demonstrate that the serum of animals rendered immune against these diseases, while protect- ing the alien organism from microbic infection, has no power over bacterial products, or toxins. That the immunity is conferred apart from this latter agency is evidence that the protection is due to causes other than direct bactericidal action. It is because the present terminology is defective — antitoxin failing to denote the salient property of serum — that the more descriptive expression stimuline has been suggested on high author- ity as a substitute. It may be observed, moreover, that a still fur- 28o A TEXT-BOOK OF MATERIA MEDIC A. ther confusion prevails in giving the name antitoxin to the substance injected as well as to the defensive proteids formed by its action upon the organism — an ambiguity which the use of the term " stimuline " would obviate. In considering the prophylactic effect of antitoxin, so intimately allied to serum-therapy, it may be well to emphasize the distinction between vaccination as founded by Jenner and the new method. It was formerly sought to create immunity by inoculating the individual with the pathogenic micro-organism itself — the virulent germs of disease. To-day protection is found in the injection of soluble products secreted by the micro-organism, administered in progressive doses, or, as by the latest process, in the inoculation of serum taken from an animal previously rendered immune. Herein lies the essential difference between vaccination and immu- nization — a distinction too often ignored. Vaccination can at most but prevent infection ; immunization is curative. The vaccinal sub- stance possesses no power over the actual microbes and their products : the immunizing agent is endowed with the remarkable property of neutralizing the influence of pathogenic germs or of determining their destruction. Vaccination produces in the indi- vidual inoculated deterrent forces which serve to arrest bacterial development : in immunization the obstructive agents injected are prepared, as in the laboratory, by a separate organism. In this latter medium we have a true therapeutic remedy. If we seek to draw the line of demarcation between the two methods more closely, we recognize that the modern doctrine of immunity rests upon wholly new and original researches quite distinct from those formerly pursued. Doubtless the immunizing property of serum was divined by those who adopted free vene- section in cachectic patients, abstracting the vitiated blood and replacing it with venous injection of that supplied by a healthy organism. A certain antagonism had also been observed between infectious maladies mutually opposed in their development, one of which was prone to exert a curative action upon the other. Fehleisen in 1 880 cited the phenomenal case of a woman afflicted with cancer of the breast, which after three successive operations still redeveloped rapidly. Finally erysipelas affected the cicatricial wound of the amputated breast, the new malady proving beneficial to the patient, since carcinoma was not renewed. From this and similar data Emmerich inferred that it sufficed to inject the serum of animals immunized with the streptococcus of Fehleisen to treat SPECIFICS. 281 and cure (?) cancerous subjects, the toxins of streptococcus erysipe- latis preventing carcinomatous development. Having purposely dwelt at some length upon the evolution and general properties of serum-therapy, let us turn to the actual achievement of the method in its therapeutic relations to infectious disease. In view of well-authenticated and obvious records attest- ing the efficacy of the new treatment, the charge "not proven" cannot properly be sustained. Yet the observation of Achalme, that it is well to accept new theories salts cum grano, is not inap- plicable; and the wise admonition of Bacon in regard to books, that we should read " not to accept nor refute, but to weigh and consider," is equally apposite in estimating the value of scientific discoveries, however distinguished may be their claim to recog- nition. Tetanus. — The first proof that tetanus is an infectious disease, of bacillary origin, was furnished by Carle and Rattone, who in 1884 reproduced the symptoms in a rabbit by inoculation of pus taken from a human tetanus wound. The bacilli were found in the adjacent soil, but it was not until 1889 that Kitasato succeeded in isolating pure cultures, proving conclusively the microbic nature of the disease. The earliest case treated with antitoxin was reported in 1891 by a Bolognese physician. Dr. Gagliardi, the result being highly satisfactory. In the light of subsequent experiments it is of ab- sorbing interest. The patient, a man forty-five years of age, accidentally received a wound of the left foot while crossing a rice-field. Next day (May 12, 1891), the foot having swollen considerably, he consulted Dr. Gagliardi, who made an incision and applied antiseptics. May 19th the wound was healed, but four days later symptoms of trismus appeared, becoming acute May 24th. Injections of 5 per cent, carbolic acid in the vicinity of the wound produced no effect, and on June 3d opisthotonos and aggravated symptoms were manifested. The doctor now injected 0.25 c.cm. of Tizzoni's antitoxin, obtained from a strongly immunized dog, the treatment being followed by some im- provement. June 7th, relapse and tetanic spasms having super- vened, two more injections were administered, and the following day the patient gradually convalesced, being discharged as cured July 5th. The quantity of antitoxin sufficient to neutralize the tetanus-poison was less than i c.cm. In 1891-92 four other cases were treated with like favorable results, injections of 0.25 c.cm. 282 A TEXT-BOOK OF MA TERIA MEDIC A. twice a day, from two to six doses in all, being attended with com- plete recovery. When it is taken into consideration that the most authentic statistics of tetanus show a mortality of about 88 per cent, and that by the above procedure it was reduced to 20 per cent, it is small wonder that the issue in these cases should be regarded as simply marvellous. And yet we have, after devious- wanderings, reached but the threshold of the new science. In December, 1890, Behring and Kitasato demonstrated that the serum of animals rendered immune against tetanus by the injection of iodine trichloride in the blood was capable of neutral- izing tetanic poison, whether in the laboratory or in other animals,, the property not being possessed by organisms not inoculated- Not only did they succeed in preventing infection, but they recog- nized in the serum a curative power, as shown in the inoculation and cure of mice. At the same time it was observed by Vaillard that the immunity conferred by the serum was of short duration,, lasting only fifteen days. Kitasato's preventive injection — a mixture of living culture and gradually decreasing doses of iodine trichloride — was perfected by Behring, who successfully applied it to the mouse, rabbit, sheep,, and horse. Various results of experimental research ensued, elicit- ing among other interesting phenomena the fact that removal of the spleen renders immunization impossible. In 1891, Vaillard showed that the serum of animals naturally immune is not anti- toxic, becoming so only after a powerful dose of tetanic poison,, and that the spleen and the fluids of immunized subjects are devoid of antitoxic properties. One point in the doctrine advanced by Behring and KitasatO' awakened the liveliest discussion : whether it was possible to cure disease by the serum of inoculated individuals. Tizzoni and Cat- tani had failed to attain this result, and had, moreover, recognized that the condition of immunity was transient On the other hand, Behring had claimed the cure of tetanus in the sheep and horse, and Kitasato had obtained results equally positive in the case of mice. All doubt on this head was dissipated by Ehrlich in 1891, who proved by experiments with ricin and abrin that the antitoxic and immunizing property of serum varies greatly with the degree of immunity conferred. In seeking a favorable issue it was evident that in cases of failure the inoculation had fallen short of the degree requisite to render the serum curative. SPECIFICS. 285 It should be added that in subsequent treatment Tizzoni, Cat- tani, and Vaillard met with perfect success in effecting cures. Thus far, the employment of serum as a curative agent had been confined to experiments upon animals. The results obtained urged its application to human tetanus. The first attempt was made by Kitasato in 1891, the serum being taken from a rabbit. It was unsuccessful, the dose of serum employed being too feeble to cope with the gravity of the conditions presented. In 1892, Tizzoni and Cattani and others reported 8 cures with serum from immunized dogs. It was contended, however, that a comparatively- mild form of the disease was treated. In France the results of similar treatment in 1892 were wholly unfavorable, but in 1893 the cure of a peculiarly aggravated case was authentically announced, amelioration of symptoms having occurred in three, and complete restoration in twenty, days. The injection was subcutaneous in the abdominal region, 300 c.cm. of equine serum from an immun- ized animal being given. The injections are said to be in them- selves harmless. Finally, MM. Roux and Vaillard formulated the mode of prep- aration of antitetanic serum, together with an analysis of its prop- erties and its curative application in man and the lower animals.. It may reasonably be expected that future experiments with the antitoxin of tetanus, made with greater precision and untiring patience, will produce more favorable results. It is of primary importance to consider, first, whether sufficient amounts of immunizing serum are injected to combat the condi- tions of this most difficult disease, and, second, whether the doses are renewed often enough to arrest its progress or ensure immunity. These desiderata are sufficiently obvious, especially in view of the certainty that the antitoxin is wholly innocuous. Diphtheria. — It is in the treatment of this universal and terrible disease that serum-therapy has achieved its most signal triumphs, the marvels wrought by its influence attracting more and more the attention both of the medical profession and of the laity. The micro-organism of the malady was described by Klebs in 1883, his investigations being quickly followed by those of Loeffler, who confirmed Klebs' discovery and announced that it was possible not only to isolate, but also to produce, cultures of the microbe. Roux and Yersin, as well as other savants, have established the fact that the germ is found only in the false membrane— especially its surface — and in the saliva or contiguous mucous membrane. 284 A TEXT-BOOK OF MA TERIA MEDICA. never developing in the circulating fluid either of the lymph or any- other portion of the organism. The bacillus frequenting the false membrane is rarely unaccom- panied, but is found associated with other micro-organisms which ■exert great influence upon the progress of the disease. It propa- gates rapidly upon solidified serum, bouillon, and gelatin, though not on potato, preserving its virulence for several months. In direct contact with light and air it perishes within a few weeks. The false membrane is artificially formed by painting with pure ■culture the buccal ulcers of the mucous membrane in rabbits, dogs, guinea-pigs, and chickens, the symptoms produced being those of human diphtheria, and frequently fatal. The researches of Loeffler indicate that no direct action is attributable to the bacillus, the sys- temic effects of the poison being rather those of a general intoxi- cation of unknown nature — an opinion sustained by the researches of Roux and Yersin. The microbe may be ejected by the mouth together with the false membrane, but oftener it remains in an iso- lated state ensconced in buccal and nasal cavities, perhaps for sev- ■eral days or even weeks. Although the discovery of the pathogenic micro-organism of diphtheria is of quite recent date, no time has been lost in seeking to determine the means of conferring immunity against the disease. To Behring (1889) is due the credit of having first indicated the method of immunization in the disease, as well as in tetanus, his investigations leading him to affirm that the process of conferring immunity by- the soluble products of Loeffler's bacillus derived from immunized animals, combined with a solution of iodine tri- chloride, is positively innocuous and curative in diphtheria. Little progress was made by the experiments of earlier investi- gators, but, in 1 89 1, Aronson succeeded in immunizing rabbits against diphtheria by inoculation with cultures attenuated by the vapor of formaldehyde. The serum obtained possessed great im- munizing power, a single cubic centimeter sufficing to inoculate 4 kilograms of animal weight against the minimum mortal dose of virulent cultures. Subsequently, Aronson applied this therapeutic method to numerous children affected with diphtheri'a, and affirmed with Behr- ing that serum-therapy was inoffensive and a sovereign remedy in a large number of cases. He obtained the serum from dogs and sheep, but declared that large animals were preferable, especially the horse. SPECIFICS. 285 In order to formulate the dosage, Behring established a techni- cal scale in which one cubic centimeter of prepared serum is consid- ered a unit, the antitoxin supplied being of the strength of 60, 1 50, or 500 units according to the degree of immunity of the animal from which it is derived. The value of serum depends, he affirms, upon the difference between the original condition of, and the re- fractory state attained by, the animal under immunization. Notwithstanding the significance attaching to experiments hith- erto recorded, the thereapeutic apphcation of serum-therapy to diphtheria may be said to date from the communication of Roux to the Congress of Buda-Pesth (September, 1894). From this moment clinical observations multiplied and statistics were reported from all parts of the world. In this memorable address the author ably reviewed the entire subject of serum-therapy, stating the relations of serum to the general economy and offering advanced and cogent suggestions concerning the employment of antitoxins to arrest the ravages of infectious disease. The early failures to cure tetanus were explained by the fact that the symptoms of the disease are frequently not manifested until it is too late to stay its progress. On the other hand, in diphtheria the evident appearance of the characteristic false membrane rendered it possible to treat the malady from its inception. The most approved, though complicated, methods of preparing the toxin were minutely described — either through the medium of bouillon as a host in contact with dry air, or a similar process in a current of moist air — and explicit instructions given regarding the attenuation of the poison by means of iodine, and the modus operandi of administration in gradually intensified doses. " With regard to diphtheria associated with certain microbes," said M. Roux, "especially streptococcus, the results of sero- therapy have been far from satisfactory. I have often saved rab- bits treated six or eight hours after tracheal infection, although repeated injections of therapeutic serum were necessary : when treatment has been deferred twelve hours, the animals have inva- riably succumbed. " The efficacy of antidiphtheritic serum having been estabHshed experimentally, its application to the human malady was a natural consequence. All my experience occurred at the Hospital for Sick Children in conjunction with MM. Martin and Chaillou. From the 1st of February to the 24th of July, 1894, 448 children were ad- mitted to the diphtheritic ward, of whom 109 died — a mortality of 286 A TEXT-BOOK OF MATERIA MEDIC A. 24.33 psr cent. Now, the average mortality from 189O to 1895 was 51.71 per cent, in a tdtal of 3971 children. The advantage of serum-therapy, all conditions being equal, is 27.28 per cent, greater than under the former treatment. " Such are the gross statistics. It is necessary, however, to deduct from the foregoing 448 patients treated with serum 128 who, as the bacterial examination showed, were not affected with true diphtheria of the Klebs-Loeffler bacillus type, besides 20 desperate cases amenable to no possible treatment. The net statement, therefore, is 300 cases with 78 deaths — a mortality of 26 per cent., whereas a previous report, similarly computed, recorded a mortality of 50 per cent." M. Roux is quoted at length because his views are authoritative, embodying the most careful researches connected with serum- therapy in its application to diphtheria. With regard to the relative proportion of deaths, it is instructive to compare with his figures those of more recent investigators and medical practitioners. At an international Congress held in Munich in April, 1895, the merits of serum-therapy in diphtheria formed the subject of an interesting debate, eliciting reports from the most competent Continental authorities in which the efficacy of the new treatment was strikingly demonstrated. Dr. O. Heubner of the University of Berlin, comparing the statistics of the Berlin hospitals during 1894, stated that the mor- tality since the introduction of serum-therapy had been reduced to one-half of that recorded prior to that date, about 1500 cases being included in each period. Allowing for the condition of medium virulence which marked the disease. Prof Heubner believed that this factor alone could not account for the great difference in the mortality. Up to the present time, he said, reliable information of over 3000 cases had been obtained from all parts of the world in which the disease was treated with antitoxin serum. The average of cures was 80 per cent. Referring to clinical analysis of 300 cases of diphtheria coming under his own supervision, he declared that the disease could be diagnosed only by identification of the diphtheria bacilli. Of 207 cases so diagnosed and treated in the Berlin Charite, the mortality in simple attacks was 10 per cent., and in more complicated ones 1 3 per cent. From personal expe- rience the speaker regarded, as the specific results of serum-treat- ment, the improvement in the febrile symptoms and the quickened cleansing of the air-passages — facts first noted since the introduc- SPECIFICS. 287 tion of serum-therapy, and confirmed wherever the method was adopted. Prof. A. Baginsky of Berlin said that prior to the introduction ■of the treatment with serum the more difficult and sorrowful por- tion of his life had been spent in combating the disease, against which he felt absolutely helpless, the mortality for the past four years, in spite of every effort, having been 50, 33, 36, and 42 per cent, respectively. The deaths occurring under treatment of 525 cases with Dr. Aronson's preparation had been 1 5 per cent. Prof von Widerhofer of Vienna stated that in 300 cases of diphtheria coming under his cognizance the average mortality was 23.7 per cent. Excluding those that died within twenty-four hours, the disease having reached a ■ very advanced stage previous to treatment, the mortality falls to 14.3 per cent. Prof von Ranke of Munich reported that of 124 cases treated in the six months previous, 26 children, or 22.4 per cent, died, 102 cases presenting features of uncomplicated diphtheria. Compared with the mortality during the preceding eight years, the reduction was enormous, being less than half the minimum record for any year during that period. Prof von Mehring reported on 74 cases, all treated with serum on the first or second day, of which only 4 died, giving a mortality of 5 per cent. During the preceding five years 30 per cent, of his diphtheria patients had died. Prof von Noorden gave the results of his experience in 8 1 cases treated at the Frankfort Hospital. Most of them, unfortunately, were admitted at a late stage of the disease, generally on the third or fourth day, the severest symptoms being developed. Notwith- standing this obstacle, in place of the previous mortality of 45 per " cent., only 23 per cent, was recorded. Dr. G. Seiz of Constance stated that of 27 cases treated with serum he lost only i, or 3.3 per cent. Prof Sigel, in charge of the Olga Hospital at Stuttgart, reported that the general mortality for the five years previous to 1894 was 40.1 per cent, and 60 per cent, among those upon whom trache- otomy was performed in the first nine months of 1894 — in fact, up to the day on which the antitoxin treatment was commenced — the mortality rising to 50.3 and 70 per cent, respectively. During the three months of serum treatment in 1894 there was an astonishing decrease in the number of deaths, the mortality falling to 12 per ■cent, in general and 20.3 per cent, in tracheotomy cases. 28b A TEXT-BOOK OF MA TERIA MEDICA. The reports, emanating from authorities of the highest standing; were of themselves conclusive testimony in favor of serum-therapy in diphtheria as immensely superior to former methods of treatment. An interesting resume of statistics, compiled from the library of the Royal College of Surgeons, England, by Dr. G. C. CrandalL of St. Louis, Mo., emphasizes in comprehensive figures the explicit advance made within a few years in the scientific control of the dis- ease. The following table embodies the results of Dr. Crandall's timely study of the subject : Authorities. Locality. Cases treated with serum. Mortality in percent. Previous mortality in per cent. Vierordt ... ... Ganghofner .... ... Viederhofer Kossel Baginsky (quoted by Virchow) Sonnenburg Aroiison .... Ranke Soltmann Risel Roux, Martin, and Chaillou . . . Lebreton Moizard Washbourn, Goodall, Card, and others White Withington Total number of cases Average mortality, per cent Previous average mortality, per cent. Collective report of other observers in different countries Heidelberg Prague Vienna Berlin . Berlin . Berlin . Berlin . Munich Leipsic Halle . Paris . Paris . Paris London New York Boston 55 no 100 35° 303 107 190 85 122 114 300 258 231 195 32 80 2632 14.6 12.7 25-3 16.7 13.Z 20.6 14.0 18.8 18.0 8.0 26.0 1 2.0 147 18.6 25.0 16.0 4022 16.8 17.1 58.0 50.0 42.8 34-7 47-8 27.6 37-0 48.S 517 50.0 311 42.7 45-0 42.0 The official report from the Imperial German Health Depart- ment up to June 20, 1895, records 2228 cases, with a percentage of mortality of 17.3; and further German statistics (August 10, 189s) include 10,240 cases in hospitals and private practice, 5790 of which were treated with antitoxin serum, the number of deaths being 552 — a mortality of 9.5 per cent. Prof Eulenburg, the author of this report, reiterated the import- ance of early recourse to antitoxin, stating that when used within the first forty-eight hours the mortality was only 4.2 per cent. : delayed beyond this period, the percentage was increased to 16.8. In America the merits of serum-therapy have been amply attested by reports from various sections of the country, one of SPECIFICS. 289 the most recent and instructive being that of the resident physi- cian of the South Department of the Boston City Hospital, as follows : "In the Boston City Hospital, from Feb. i, 1894, to Jan. 31, 1895, before antitoxin was used, 698 cases of diphtheria were treated, with 266 deaths — a mortality of 38.1 per cent. Since the opening of the South Department, from Sept. i to Nov. 30, 1895, inclusive, when antitoxin was used in every case, 332 cases were treated, with 41 deaths — a percentage of 12.3. Of these 41 deaths, 23 occurred within twenty-four hours of entrance. Eliminating these, there were 309 cases with 18 deaths — a mortality of 5.8 per cent." Finally, the statement of Prof Welch of Johns Hopkins Uni- versity, published in July and August, 1895, contains statistics of 7166 cases of diphtheria treated with antitoxin, in which the mor- tality was 17.0 per cent., and 2276 cases treated otherwise with a death-rate of 42 per cent. The foregoing figures, selected from a mass of corroborative testimony, must certainly be regarded as an eloquent tribute to the virtues of serum-therapy. They are at least a striking illustration of what Virchow has called the " brute force " of the numerical argument. Touching the method of administration and collateral manifes- tations, Roux, in the communication previously cited, says : " The serum I have employed, derived from immunized horses, had an active strength of 50,000 to 100,000. To all diphtheritic patients entering the hospital 20 cubic centimeters of this serum, in a single dose, are systematically administered, the injection being in the subcutaneous tissue, and not renewed should bacteriological examination prove that the disease was other than diphtheria. Should the existence of the disease be fully established, I have never observed the slightest discomfort resulting from the dose. " The injection is painless, and if made antiseptically should be attended with no accident. Twenty-four hours after the first injec- tion a second is made of 10 or 20 cubic centimeters, these two inoculations sufficing, as a rule, to ensure recovery. " Should the temperature continue high, a third injection of 10 or 20 cubic centimeters is given. The average weight of chil- dren being 14 kilograms, the total dose constitutes one-thou- sandth, or in exceptional cases one-hundredth, part of their weight. Untoward sequelae are less frequent under the use of serum, 19 290 A TEXT-BOOK OF MATERIA MEDICA. although I have observed symptoms of paralysis. Eruptions, also, allied to urticaria may be occasioned by the antitoxin. " The physiological effect of the serum is apparent in its action upon the false membrane, which ceases to develop within twenty- four hours after the first injection, being detached after twenty-six, forty-eight, or, at most, sixty hours. In 7 cases only have I known it to persist longer. Let me add, in conclusion, that in treatment with serum I have studiously avoided the use of local applications, simply irrigating the throat with boiled water, to which was added perhaps 50 grams (per liter) of Labarraque's solution." In commenting upon the address of M. Roux, Dr. Behring added that "the specific action of antidiphtheritic serum is the surer and more rapid in proportion to the heroic nature of the dose. Since the injection is positively harmless, it may be adopted with impunity even in simply suspected cases of the disease." The prophylactic property of equine serum is well attested by Aronson, who employed antidiphtheritic injections to immunize children in families where the disease was established. One cubic centimeter of prepared serum sufficed for his purpose, of 130 chil- dren thus treated preventively only 2 being affected with a very mild form of the disease. It is impossible, says Bernheim, to assign a definite duration to the antitoxic property of serum. It may last several weeks, or even months, according to the strength of the injection and the species of animal under treatment. But, he adds, when definite immunity has been attained the protective power of serum may be prolonged by the injection of a small quantity of toxin every fourteen days. Concerning the various untoward complications arising from the use of serum and authentically reported, it is fair to say that the same phenomena are observed in diphtheritic patients treated by other methods than serum-therapy. Notwithstanding the eminent success of the method herein con- sidered, it should be said, in conclusion, that several important features are as yet but imperfectly formulated or even understood.' ' In a paper upon the subject "Antitoxin," Prof. A. C. Cotton, M. D., of Rush Medical College, Chicago, puts the case thus strongly : " "What we do not know is how much antitoxin exactly is necessary to neutrahre u given quantity of toxin at somewhat lengthened periods precedent. What we do not know, and what we most particularly desire to know, inasmuch as it is about the only phase of the entire subject that has any practical beai-ing upon our profession as life- savers, is what number of antitoxin units is neeessary to neutralize an indefinite amount SPECIFICS. 291 It is of paramount interest to ascertain, for example, the precise prophylactic power of the immunizing serum. Behring has already directed his attention to this problem, advising the injection of 5 cubic centimeters of serum in children under ten years of age, and 10 cubic centimeters in older patients. Crouzon, who has prac- tised these preventive injections in 230 cases, reports but two light attacks of the disease. A similar experience is that of Baginsky in Berlin. Bernheim asserts that he has personally injected serum in 28 subjects exposed to diphtheritic infection without noting a single case of the malady. The dose employed was somewhat in excess of that proposed by Behring, being from 10 to 20 cubic centimeters, as recommended by Hilbert, the injection being twice repeated at intervals of twenty days. From a careful consideration of the subject in its relations to diphtheria, we may safely conclude — 1st. That immunized serum forms a remedy which experience proves to be wholly innocuous and eminently adapted for use in human infection. 2d. That antidiphtheritic serum has in every respect corre- sponded with the most sanguine hopes of its advocates, its employ- ment being attended with astonishing success wherever properly used and in sufficient quantities. 3d. Finally, that it is incontrovertibly established that by means of injecting serum temporary immunity from infection may be readily conferred, permanent protection being contingent merely upon a renewal of treatment. ^ In view of the extraordinary rapidity with which recent discov- eries have been made, it is unwise to presume that we have by any means exhausted the possibilities of serum in its dominion over this dread disease. Resources of science undreamed of in the past are now concentrated upon the momentous problem of infection. What new light future investigation may shed can be regarded only as a theme for hopeful conjecture. Tuberculosis. — It may be stated, in general terms, that the microbic nature of tuberculosis was admitted by nearly all writers upon the subject before the discovery of the pathogenic micro- organism. Villemin in 1866 had established by experiment the of diphtheria toxin of unknown virulence that has invaded at a prior indefinite time, and is presumably houriy continuing to invade, in unknown strength and quantity, from a patch of recurrent and extending culture of Klebs-Loeffler bacillus on an unknown extent of mucous surface of a human being of unknown susceptibility ."— W^ Corpuscle, Dec, 1895. 292 A TEXT-BOOK OF MA TERIA MEDICA. infectious character of the malady ; but in France the idea seemed almost revolutionary, creating no enthusiasm, it being reserved for Germany, through the indefatigable labors of Robert Koch, to develop and elucidate the theory conceived by Villemin. Koch discovered the bacillus of tuberculosis, and even succeeded in iso- lating and cultivating it, the pure cultures obtained by him always producing tuberculosis in every form. His original communication, addressed to the Physiological Society of Berlin, bore date of April 10, 1882, and at once stimulated experimental research in others, who fully confirmed his discovery. The tubercle bacillus is aerobic, its existence depending wholly upon the supply of oxygen — a fact readily explaining its predilec- tion for the pulmonary tissue. The bacillus may affect all warm- blooded animals, although in different degrees, the microbe being somewhat differentiated in the lesions of birds and those of man and the mammalia in general. Spontaneous tuberculosis is extremely frequent in man, it being estimated that one-fifth of all fatalities are due to phthisis in its various forms. It is equally common among cattle, in which the progress of the disease and its lesions are precisely similar to those observed in human beings — a fact demonstrated by the admirable studies of Koch respecting pulmonary lesions and their character- istic pathogenic micro-organisms. Like other microbes, the bacillus tuberculosis secretes a large amount of soluble products. These toxins, which of late years have been subjected to careful experiment, are derived from cul- tures of human bacilli, modified or not by aviary germs and the tuberculous products produced in the organism itself Koch's tuberculin, now known throughout the world, is simply a soluble product, prepared by a special process, consisting of a glycerized extract drawn from pure cultures of tubercle bacillus, its activity depending, upon the virulence of the germs, those derived from man being more dangerous than aviary cultures. Various methods of inoculation have been adopted in tubercu- losis : I , inoculating the patient with another disease ; 2, inocula- tion with attenuated tuberculosis or that proceeding from a different species, as from birds ; 3, inoculation of the soluble bacillar prod- ucts — tuberculin; 4, injection of bloOd taken from animals often immune against tuberculosis; 5, injection of serum drawn from inoculated animals ; 6, finally, injection of serum taken from immunized animals. With the last two of these methods we are SPECIFICS. 293 properly concerned. The fifth has been scientifically adopted by" Babes, Richard, and Hericourt, who have treated a large number of cases in which various cures have been effected. The main obstacle of the procedure lies in the difficulty of successful inocu- lation, the greater part of the animals employed dying of infectious nephritis. By the sixth method, as employed by Bernheim, this fatality is largely obviated, a careful procedure with the serum of immunized animals proving the most efficacious hitherto devised. The pro- cess of immunizing consists in injecting the toxic products nor- mally secreted by Koch's bacillus, and is, in effect, that adopted by Behring in preparing the antitoxin of diphtheria. In experiment- ing upbn a large number of animals, suffice it to say that the results obtained by Bernheim were eminently satisfactory, every case indicating improvement and the actual cures being about 40 per cent. So convinced was he of the sovereign value of his method that he emphatically declared it to be the only rational procedure possible in tuberculosis: "Je puis meme affirmer que I'avenir de la therapeutique antituberculeuse reside tout entier dans cette maniere d'immuniser les animaux et d'utiliser leur serum." Applied to tuberculosis in man, there are as yet few signs of encouragement in the inoculation with the product of specific germs. The tuberculin of Koch has not responded to the hopes of its ad- vocates, the danger from untoward symptoms and relapse attending its use offsetting effectually any temporary benefit. Yet it is quite possible that the discovery of so powerful an agent may lead to others of more established efficacy. Pneumonia. — All the pulmonary symptoms which characterize this disease are produced by a single microbe, suspected by Klebs, described by Koch and others, and discovered by Pasteur in the bucco-pharyngeal cavity, its habitual haunt, whence it carries in- fection to the lungs. The pneumococcus does not confine its attacks to man, the rabbit and guinea-pig being especially sensitive to its influence. It has been observed that the microbe is a fre- quent prey to leucocytosis. It thrives in a total absence of oxygen, its vitality and virulence, so far from diminishing, being sensibly increased by anaerobic conditions. Pure cultures are easily obtain- able. Repeated inoculations of attenuated virus readily confer immunity, reduction of virulent germs being attained by the use of desiccated pneumonic viscera. The saliva of a patient, collected after defer- 294 A TEXT-BOOK OF MATERIA MEDICA. vescence, ensures protection to the mouse, the same being true of blood-serum. Immunization of animals was inaugurated by Em- merich and Fovitsky in 1 89 1, subsequent investigators confirming their experiments under varying conditions, Foa and Scabia finally employing human serum in the inoculation of rabbits with marked success. It had been supposed that the spleen was the seat of an im- munizing product possessing greater activity, but a glycerized extract of human spleen injected into the veins of refractory rabbits failed to arrest death. The general deduction drawn from a care- ful scrutiny of the subject tends to prove that the production of the neutralizing force in the system — the antipneumotoxin — is shared by all the elements of the organism, including the spleen. The therapeutic interest of the subject centers in the application of inoculation to man. The early experiments of Foa and Scabia were without result, neither reaction nor ameHoration attending their treatment; but in 1892, Klemperer reported favorably con- cerning immunization in 40 cases of human pneumonia. In January, 1893, Lava communicated to the Academy of Med- icine in Turin the application of serum-therapy with auspicious results. He inoculated 10 subjects — 5 with from 4 to 9 cubic cen- timeters of rabbit's blood-serum ; 4 with a like dose of glycerized extract of the viscera of immunized rabbits ; and i with from 4 to 5 cubic centimeters of canine seruni. There is no reaction at the point of inoculation, no general disturbance of the system, nor any influence upon temperature or respiration. On the contrary, the pulse is favorably influenced, as is also the general progress, as shown by Lava's experiments. Moreover, the injection hastens the crisis of the disease, conducing rapidly to complete restoration. Rozzolo also reported 5 cases treated with serum, 4 of which were cured. No influence upon the pulse, heart, or kidneys was noted. The effect of animal serum is fugacious ; that of the human product lasts several days. In all cases the serum of immunized subjects possesses a therapeutic but not an antitoxic power. It does not diminish the virulence of pneumococci, which, injected in an inoculated organism, retain their pathogenic activity about eighteen hours, after which, indeed, their vitality is manifested by the production of toxins producing positive chemotaxis in the phagocytes. Among other curative methods in pneumonia may be cited the SPECIFICS. 295 hypodermic injection of blood taken from convalescents and the infusion of blood from similar patients. The former resulted fav- orably (Audeoud), and the latter (Hughes of Philadelphia), an intravenous operation, was no less successful. Audeoud explains the natural crisis in pneumonia by the theory of Klemperer — that the antipneumotoxin formed in the blood of an inoculated subject by neutralizing the pneumotoxin cures the infection. Cholera. — The microbe of this terrible disease had been sought since 1848, yet the subject had never been profoundly studied until Koch succeeded in isolating the germ. Being associated with other micro-organisms, the bacillus had remained undetected, being distinguishable, in fact, only in fulminant attacks of the disease, as was noted by Strauss and Roux. Stagnant water is particularly favorable to the propagation of germs. In distilled water the bacillus survives but twelve hours ; in drinking-water, seven days (Babes) ; while in river or well-water it may live for seven months (Wolfhiigel). As a rule, the acids are injurious to the bacilli, bichloride of mercury, sulphate of copper, and quinine being very powerful antiseptics in presence of the germs. Cholera has been observed in man alone, although Koch easily imparted the disease to guinea-pigs, to which it was fatal. Inocu- lation of choleraic virus has never produced the malady in man. The pathogenic power of the bacillus is well demonstrated by the fact that in one of the Berlin hospitals, of 207 patients attacked by cholera nostras (cholerine) in which no germ was manifest, but one case proved fatal; and, notwithstanding vigorous oppo- sition, Koch's original thesis appears to be sustained by observation. A singular fact in connection with cholera germs is that they may be ingested at times, if not with impunity, at least without in- ducing the disease. Pettenkofer, having taken large doses of alkali, absorbed a considerable quantity of the poison with only the effect of a diarrhea during five days, there being no disturbance of the general system or of the kidneys. Emmerich, ingesting the tenth part of Pettenkofer's dose, was seized with diarrhea twenty-four hours afterward, and became seriously ill. Purging lasted four days, and on the eleventh day the bacilli disappeared from the stools. It were beside the purpose of the present work to relate in detail the many interesting experiments upon animals undertaken 296 • A TEXT-BOOK OF MA TERIA MEDICA. with a view to the application of serum-therapy in the treatment of human cholera. Although the experimental investigations of recent years foreshadow the possibility of immunization in man, it must be confessed that, as in the case of tuberculosis, they have been thus far barren of definite results. It is announced that Behr- ing has discovered a practical method of combating the disease : until the results of his later researches are known the therapeutic problem must apparently remain unsolved. The result of Haff- kin's investigation in India will be awaited with interest. Septicemia. — The streptococcus of Fehleisen (erysipelatis), which causes erysipelas, was discovered by Nepveu in France and Hiiter in Germany (1868-80), and has been the subject of careful study by Klemperer and others in the hope of determining its availability as an immunizing agent. Employing the serum of immunized rabbits, it has been found possible by intravenous injec- tion to cure the disease in mice, the serum proving efficacious only against the disease with which the animal supplying it was inocu- lated. Subsequent experiments have been attended with varying results, Marmoret in February, 189S, having succeeded in obtain- ing a germ of streptococcus so virulent that the hypodermic injec- tion of ^ Q d^^ D (, of a cubic centimeter was fatal to the rabbit in thirty hours. Inoculation with this microbe or its toxins conferred im- munity upon rabbits, which furnished a preventive and curative serum. Encouraged by previous experimentation, Charrin and Roget now sought to apply the method of serum-therapy in the treat- ment of puerperal fever. Having satisfied themselves of the cura- tive property of the serum of a mule inoculated with the microbe of erysipelas, collected fifteen days after the eighth inoculation, they injected subcutaneously 8 cubic centimeters of serum in a woman affected with the fever. The report is as follows : " The next day no improvement. A second injection of 8 cubic centi- meters. Next day condition slightly improved, but still serious. Third injection of 25 cubic centimeters. Result on the following day rapid improvement; decline of fever; general good health; and early establishment of convalescence." Syphilis. — The pathogenic source of syphilis is still unknown. The disease being contagious, attempts have long been made to discover its specific microbe, yet the highest authorities agree that as yet all researches have proved abortive. No lower animal is known to be susceptible to the malady, and, although various experiments SPECIFICS. 297 have seemed to prove the contrary, it is now determined that the lesions primarily indicating contraction of syphilis were the result ■of septicemia induced by some agent infected with the syphilitic virus. The sero-therapeutic methods employed in the treatment 'of the disease consist of inoculation with the blood of naturally immune or of syphilitic subjects. Of all animals, the horse is perhaps the only one capable of syphilization. Tommasoli in 1892-93 essayed inoculation of public women, .affected with acute secondary syphiHs, with lamb's serum, the results being, according to his report, highly favorable — even to the cure of syphilitic infection. Many untoward symptoms, how- ever, have attended the inoculations thus made. Mozza (1893) instituted a series of experiments, employing blood from the carotid artery of a lamb or dog, and another series in which injections were made of serum drawn from sheep inoculated with serum from syphilitic subjects in whom the disease was latent. His records indicate no very satisfactory results, yet he demonstrated that aseptic precautions allow the application of serum-therapy without local or general reaction. Finally, Hericourt and Richet attempted, with dubious success, the experimental injection of syphilitic serum, the results, in their therapeutic- importance, being inconsequential. Typhoid Fever. — The bacillus of this disease was first detected in the kidneys by Bouchard in 1879. The name was given by Eberth, who studied the germ in 1880-81. Old cultures contain an exceedingly toxic ptomaine, besides a soluble substance capable of inoculating animals. The vigor of the bacillus of Eberth is re- markable, Grancher and Deschamps having shown that it sur- vives five and a half months at a depth of 50 centimeters in damp soil. Infection may occur through the medium of the pulmonary tract, and the microbe is transmissible from the mother to the fetus. All animals yet submitted to experiment are naturally immune, the first effort to inoculate them dating from 1862 (Murchison); the attempt proved futile. Other experiments in this direction were attended with like failure until Vidal and Chantemesse suc- ceeded in inoculating with very virulent cultures 30 white mice, 17 of which succumbed within twenty-four hours. Later experiments have proved the extreme virulence of serum derived from a typhoid human subject, fatality speedily resulting 298 A TEXT-BOOK OF MA TERIA ' MEDICA. from its injection, caused not by the microbe itself, since none are found after death, but by its toxic products. Among the phenomena observed in varied experimentation the inexplicable fact was revealed that the serum of certain persons never having contracted typhoid fever conferred immunity upon guinea-pigs. Casual experiments followed without favorable progress, other than the reduction of temperature. In January, 1895, however, M. Legrain, turning his attention to typhus — so closely allied to true typhoid fever — met with encouraging success. Injecting suc- cessively increased doses of serum from typhus convalescents, besides the reduction of temperature within three hours after the operation it was noted that stupor, coma, and even hemiplegia of a toxic nature, disappeared after an injection of 10 cubic centimeters. In a case of grave typhus the injection of 14 cubic centimeters on the fourth day of the infection resulted in lowering the temperature and inaugurating recovery within two days. In other serious cases, where the injection was delayed until the sixth or eighth day of the infection's course, the disease, though not arrested, was marked by mitigated symptoms. The serum of convalescents was taken after one week's remission of febrile manifestations. Relying upon the fact that an attack of typhus confers immunity against a second access of the disease, Stern sought to ascertain whether the serum of individuals cured was endowed with immu- nizing properties. The results were partially successful, eliciting the curious fact that the protective power of the serum appeared most active in those who finally succumbed to the disease. It also seemed problematical, to judge from these and other instantes, whether immunized serum employed in this disease possesses either bactericidal or antitoxic properties. Influenza. — Although the disease has occurred at intervals since the serious epidemic of 1830-33, the earliest microbiological studies of influenza date from the epidemic of 1889-90. Investigation at that time revealed no microbes in the sputum and viscera, save those which habitually frequent the bucco-pharyngeal cavity — streptococcus, pneumococcus, pneumo-bacillus, and staphylococcus — which diversity of germs might induce the behef that "la grippe" is not due to any single micro-organism, but to several. Notwithstanding this and similar suppositions, the majority of microbiologists maintain that these bacteria are but the result of a secondary infection, and that the true germ of influenza is still SPECIFICS. 299 unknown, although many investigators have thought they had iso- lated the specific microbe. One deduction is constant as the result of their studies : the great importance of secondary infections in the course of the disease. Failure to discover the germ was in reality due to a deficiency of technique — inadequate methods of staining. Pfeiffer devised a new method, by which he detected it, and Kitasato (1892) suc- ceeded in isolating and cultivating the identical microbe. Animals do not contract the disease spontaneously, although the saliva of cats and dogs contains a bacillus having a pathogenic influence upon rabbits, the character of which closely resembles that of the Pfeiffer bacillus. Monkeys and rabbits contract the malady when inoculated with the pure culture of this germ. In man the port of entry, so to speak, of this microbe is the pulmonary tract, where it often produces lesions of suppurating broncho-pneumonia. The general phenomena observed in the disease are held by Pfeiffer to be the result of intoxication, the microbes being localized ; Cauch, on the contrary, considers them due to the presence of the microbe in all the organs, even the blood. The latest investigations confirm the opinion of Pfeiffer. Brischettini has demonstrated that the propagation of the Pfeiffer bacillus is not checked by the action of serum from immunized animals, being limited to diminishing the toxicity of its soluble products. The immunity caused by the injection of these products is augmented by the injection of the culture. The injection of serum of an immunized animal neutralizes in vitro the toxins secreted by the bacillus, and in a healthy organ- ism establishes immunity, whether against infection or intoxication. It is therefore assured that in future use the serum may be em- ployed at once as an inoculative and curative agent. Reptile Poisons. — It has long been known that certain animals (reptiles) possess natural immunity against their own venom. The poison of the toad having been detected in his blood, the reptile's immunity was at .first thought to be due to tolerance, the same condition existing in the salamander and viper. The relation between the blood and the venomous glands demon- strates the internal secretion of these glands. The idea of an anal- ogy between microbic virus and reptilian venom was deduced from the existence of soluble microbic toxins, as elucidated by Chauveau. The attenuating power of heat upon the venom of serpents has 300 A TEXT-BOOK OF MATERIA MEDIC A. also its analogue in the similar susceptibility of micro-organisms. A mortal dose of venom subjected for five minutes to a heat of 100° C. may be injected with impunity into a guinea-pig weighing 500 grammes. The reaction of the organism engenders an antitoxin which, in- jected into a healthy animal, is preventive of fatal inoculation. The precise nature of this antitoxin is undetermined, yet its protective power is evident. Certain it is that the serum of a rabbit inocu- lated against viperous venom, when injected an hour and a half before the poison, completely neutralizes the latter. Curiously •enough, this preventive serum of rabbits inoculated against the poison of vipers also confers immunity against cobra-venom. So far as affects man, Calmetti announces that he has employed serum with success in the treatment of snake-bites, even to the ■extent of curing them. Carbuncle (Anthrax). — The bacterium of anthrax, of the genus bacillus, has proved a subject of elaborate and interesting experi- ment, many features of which are of absorbing interest alike to the bacteriologist and the clinician. The animals subjected to inocula- tion have been chosen with great care, and those supplying the immunizing serum include many species. The general results of protective inoculation have been treated briefly early in the discus- sion of serum-therapy. Rabies. — In January, 1881, Galtier announced that intravenous inoculation of rabid saliva confers immunity upon sheep, confirm- ing his experiments later in the year by injecting the fluid into nine sheep and one goat. Pasteur, Chamberland, Roux, and Thuiller pursued experiments in a similar line, with somewhat negative results. By passing the virus successively from dogs to monkeys Pasteur was able to attenuate its virulence, and finally, by transferring the poison from monkeys to rabbits, a serviceable immunizing agent was obtained, still further experiments perfecting the method in view. Satisfied with his success, Pasteur now turned his attention to the inoculation of man against hydrophobia. The first operation (in 1885) was attended with auspicious results, and from that moment the savant's laboratory was invaded by affected individuals demanding cure. Institutes were founded in various parts of the world, that in Paris being the center of bacteriological study in France. In America the subject has received wide attention, but SPECIFICS. 3or in many instances the benefits derived from Pasteur's inoculative procedure have been of doubtful importance among intelligent observers. It has been impossible to present within a necessarily limited space the entire field covered by this profoundly interesting subject. For a multitude of details, embodying a wide range of experimen- tation, and for many expressions of individual opinion awakened by a consideration of so absorbing a theme, the student is referred to the extensive bibliography relating to every phase of serum- therapy. It may be readily imagined what would have been the discus- sion of Jenner's vaccination had our bacteriological and chemical knowledge and delicate appliances for investigation existed in his day. It is scarcely surprising, therefore, that the renewal of similar studies, after an interval of unprecedented scientific progress, should elicit from all parts of the world a zeal and enthusiasm impossible in any previous epoch, together with a mass of concurrent or dis- senting testimony touching new discoveries proportionate to the greatly increased number of competent investigators. Whatever be the limitations of serum-therapy, the consensus of opinion among thoughtful observers is that its rationale and purpose are deeply rooted in the eternal laws of matter and the methods of great Nature. " Vestigium nullum retrorsumi" it cries to us, and we must be guided by its light or still remain in darkness. CLASS II.-ANTISEPTICS. Acidum Carbolicum— Acidi Carbolici— Carbolic Acid. U.S. P. Origin. — A constituent of Coal-tar, obtained by fractional distil- lation and subsequently purified. Description and Properties. — Colorless, interlaced, or sepa- rate, needle-shaped crystals, or a white, crystalline mass, some- times acquiring a reddish tint, having a characteristic, somewhat aromatic odor, and, when copiously diluted with water, a sweetish taste, with a slightly burning after-taste. Deliquescent on exposure to damp air. Soluble in about 1 5 parts of water, the solubility varying accord- ing to the degree of hydration of the acid ; very soluble in alcohol, ether, chloroform, benzol, carbon disulphide, glycerin, and fixed and I volatile oils. It is liquefied by the addition of about 8 per cent. [ of water. The vapor of the acid is^ highly inflammable. Carbolic acid is faintly acid to litmus-paper. Jt should be kept in dark amber-colored, well-stoppered bottles. Dose. — \-2 grains (0.03-0. 12 Gm.). If Hquefied, 1-2 minims (0.03-0.12 Cc). Official Preparations. Glycerltum Acidi Carb61ici— Glyceriti Acidi CarbSlici — Glycerite of Car- bolic Acid (25 per cent.). — For external use. UnguSntum Acidi Carbaiici — UnguSnti Acidi CarbSlici— Ointment of Car- bolic Acid (10 per cent.). — For external use. Unofficial Preparations. Aqua Acidi CarbOlici — Aquae Acidi Carb61ici — Carbolic Acid Water. — Strength, 2 drachms in I pint (8.0-473.17 Cc). Dose, 1-2 fluidrachms (4.0-8.0 Cc). Oleum Acidi CarbSlici— Olei Acidi Carb61ici — Carbolated Oil. — i in 20 of Olive or Cotton Seed Oil. For external use. CSrbasus Acidi Carb51ici — CSrbasi Acidi Carb&lici — Carbolic Acid Gauze. — Gauze containing Carbolic Acid, i ; Resin, 5 ; Paraffin, 7 parts. Used as a surgical dressing. 302 ANTISEPTICS. 303 Empiastrum Acidi Carb61ici — Emplastrum (ace.) Acidi CarbSlici — Car- "bolic Acid Plaster. — Composed of Carbolic Acid, 25; Shellac, 75 ; coated with Gutta- percha dissolved in Carbon Bisulphide. For external use. Camphora Carbolisata — Camphorse Carbolisatse — Camphorated Carbolic Acid (Phenol-camphor). — Camphor, 2; Carbolic Acid, i ; allow to liquefy. A color- less, oily liquid, having the odor of camphor, soluble in fixed oils, alcohol, and ether, nearly insoluble in water and glycerin. Used as a local anesthetic, chiefly for toothache. Liquor Sodii Carbolatus — Liquoris Sodii Carbolati — Phenol-Sodique. — Composed of Carbolic Acid, 188 grains (12.5 Gm.) ; Caustic Soda, 31 grains (2.06 Gm.) Distilled Water, 4 ounces (118.29 Cc). For external use. Liquor Sodii Boratis CompSsitus — Liquoris Sodii Boratis Comp6siti — Cobell's Solution. — Composed of Borax and Sodium Bicarbonate, of each, 2 drachms (15.0 Gm.) ; Carbolic Acid, 24 grains (1.8 Gm.) ; in Water, I pint (473.17 Cc). Used externally in spray. Acidum Carb61icum lodatum (N. F.) — Acidi Carb61ici lodati — Iodized Carbolic Acid (Phenol Iodatum). — Composed of Iodine, 20 parts; Carbolic Acid, 76 parts ; Glycerin, 4 parts. The iodine, the acid which has been previously melted, and the glycerin are put in a flask, digested at a gentle heat, and frequently agitated until the iodine is dissolved. It should be kept in glass-stoppered bottles in a dark place. Used locally, especially in gynecological practice. Allied Compounds. Creasols. — Obtained by distilling Coal-tar between 200° and 210° C. ; also obtained by fusing Toluene Sulphonic Acid with Potash. The familiar compounds of creasols are Crealin, Lysol, Solutol, Saprol, etc. They are powerful disinfectants and germi- cides, and less poisonous than carbolic acid. Aseptol, or orthophenol-sulphonic acid, is a commercial article, a straw-colored, slightly caustic liquid. It is a powerful antiseptic. Antagonists and Incompatibles. — Bromine, metallic salts, antipyrine, collodion, alkalies, saccharate of lime or lime, and soluble sulphates like Epsom or Glauber salts, are incompatibles. Atropine is a phystologisal antagonist. Synergists. — All members of the carbolic-acid group, antisep- tics, and motor depressants. Physiological Action. — Externally. — Carbolic acid is a local anesthetic, and, applied in full strength to animal tissues, acts as a caustic, but does not produce vesication. In weaker solutions it produces a burning and reddening of the skin. It acts more severely upon mucous membranes. It coagulates albumin, and therefore its caustic action is limited. The eschar is first whitish, subsequently becoming brownish. It is readily absorbed through the skin or through raw surfaces, and toxic effects have been thus produced. Weak solutions are anti-/ pruritic and gratefully cooling and anodyne. It is a disinfectant, a ■deodorant, and a parasiticide. 304 A TEXT-BOOK OF MATERIA MEDIC A. Internally. — Digestive System. — In small doses it is cooling and sedative to the stomach. In large or poisonous doses it is a pow- erful gastro-intestinal, irritant. Ordinary medicinal doses are con- verted by the gastric contents into the sulphocarbolates. Circulatory System. — Medicinal doses have no apparent effect on the circulation. Large doses first depress and later accelerate the heart. Poisonous doses powerfully depress the heart, stopping it in diastole. The arterial tension is lowered by lethal doses, from paralysis of the vaso-motor center in the medulla. Nervous System. — Medicinal doses have no special effect upon the nervous system. Large or poisonous doses depress the cere- brum. Vertigo may first be noticed, which is soon followed by stupor. Owing to stimulation of the anterior cornua of the spinal cord, there may be muscular trembling or convulsions. The cornua are ultimately depressed, causing abolition of reflexes and paralysis. Respiratory System. — Small doses do not affect the respiration. Large doses first accelerate the respiratory movements, rendering them full, but shallow respirations soon follow. This action is due to stimulation of the vagi, both at the periphery and at the center. If the dose has been a poisonous one, there is great depression, and ultimately paralysis of respiration, due to depression of the centers. Absorption and Elimination. — It is absorbed from the stomach, and diffuses into the blood with great facility, circulating in that tissue probably as an alkaline carbolate. It is eliminated by all the secretions — chiefly by the kidneys and lungs — and appears in the urine as salts of sulphocarbolic and i glycuronic acids, and the oxidated products hydrochinon and pyrocatechin. To the last substance is mainly due the peculiar smoky or olive-green color imparted to the urine after large or continued doses have been taken. (There is also, probably, some other factor causing this change, for pyrocatechin can exist only in alkaline urine.) When a very large amount of carbolic acid has been taken, some of it can be found in the urine unchanged. Temperature. — It is not specially affected by small doses. Full medicinal doses tend to lower bodily temperature in fever, while poisonous doses lower the temperature several degrees. The re- duction of temperature is due to its diminishing heat-production and increasing heat-dissipation. ANTISEPTICS. 305 Eye. — Poisonous doses almost invariably cause the pupil to be minutely contracted, due, probably to paralysis of the radiating fibers, the circular fibers being unaffected. Untoward Action. — Headache, either in the frontal or the occip- ital region, heaviness and a sensation of fulness in the head, dizzi- ness, and the appearance of rings before the eyes, muscular weak- ness, especially of the legs, profuse sweating, formication. Where there is an idiosyncrasy on the part of the individual against this drug, small doges even may produce the symptoms of poisoning. Poisoning. — Carbolic acid is one of the most deadly poisons, often equalling hydrocyanic acid in its rapidity of action. The patient is rendered rapidly unconscious or may drop dead within a very few moments from paralysis of respiration. Should the dose be insufficient to produce so sudden a death, the patient suffers from all the symptoms of gastro-enteritis — intense pain, with ' violent vomiting and purging. Fibrillary trembling maybe present. Stertorous breathing appears, with cold, clammy skin, pinched face, anxious expression, abolition of reflexes, weak, thready, and often imperceptible pulse, feeble respiration, and frequently dyspnea, and death finally occurs from failure of respiration. As toxic symptoms may be produced by the external applica- 1 tion of solutions of carbolic acid, as in surgical dressings or vaginal ' or intra-uterine douches, the toxicity of this drug should be appre- ciated, and patients carefully watched for the first untoward mani- festations, such as pain in the lumbar region, smoky urine, nervous- ness, and cerebral disturbance, when the drug should be immedi- ' ately withdrawn. Treatment of Poisoning. — The immediate administration of mag- nesium sulphate (Epsom salts) and warm demulcent drinks should be resorted to. The application of external heat. Atropine and ( strychnine hypodermically. Digitalis and coffee may also be re- quired. Opium, or some preparation of it, for the relief of pain. If the patient is seen soon after the drug has been taken, the stom- ach should be washed out, after which the above treatment should be followed. Therapeutics. — Externally and Locally. — For some time after it was so prominently brought forward by Lister carbolic acid was thought to be indispensable in antiseptic surgery. It is now known that the solutions which are safe to use are inefficient, ordinarily, beyond the mere mechanical effect of washing. 20 3o6 A TEXT-BOOK OF MATERIA MEDIC A. The benumbing influence produced on the hands of the sur- geon, and the discoloration of bright instruments and rapid impair- ment of their cutting surfaces, render strong solutions for disinfect- ing instruments impracticable, and indeed of less value for this purpose than the prolonged boiling in distilled water rendered slightly alkaline with sodium bicarbonate. The pain of superficial burns is relieved by applying strong solutions of carbolic acid, care being taken to prevent absorption. It is an extremely valuable drug as an antipruritic, and is hence of great utility in the treatment of certain diseases of the skin — pruritus, chronic eczema. In • chilblains, tinea tonsurans, t. capitis, t. circinata, favus, etc. it is of great value. Chronic laryngitis, cha- racterized by diminished secretion, is greatly benefited by the direct application to the parts of a solution of \ drachm to i ounce of glycerin (2.0-30.0 Cc). A spray containing from 2 to 5 grains (0.12-0.36 Gm.) to I ounce (30.0 Cc.) of water is an efficient appli- cation in the treatment of acute and chronic inflammation of the throat and nose. Camphorated carbolic acid (campho-phenique) is a useful appli- cation in toothache due to an exposed and inflamed pulp. As a deodorant it is valuable to correct the fetor arising from syphilitic ulcerations, carcinoma, gangrene of the lungs, bronchorrhea, pneumothorax, etc. It reduces the discharge and relieves the pain in acute otitis media: a 10 per cent, solution in glycerin should be used. It is also of value in the treatment of otorrhea and in acute perforations of the tympanic membrane, but should be used in much weaker solutions — I or 2 per cent. A lotion, 8 to 15 grains (0.5-1.0 Gm.) to i ounce (30.0 Cc), is an efficient antiseptic in foul and indolent ulcers. The pure acid is used as a cauterant in chancroids, lupus, gan- grene, bites of rabid animals, etc. The iodized carbolic acid is a valued local remedy in endometri- tis, chronic endocervicitis, and tdcers of the cervix. Huter in 1878 advocated the use of hypodermic injections of a 3 per cent, solution of carbolic acid for erysipelas, the punctures to be made at intervals upon the edge of the inflammation. Great improvement has taken place in goitre after the treatment by hypodermic injections into the tumor of a 5 per cent, solution of carbolic acid. Internally. — While inferior to salicylic acid to check fermentation, ANTISEPTICS. 307 it is nevertheless used for that purpose in dilatation of the stomach and so-called fermentative or flatulent dyspepsia. In nervous and irritative vomiting it may be given in doses of from I to 2 minims (0.06-0.12 Cc), well diluted and repeated at intervals of from one to four hours according to the symptoms of the case. It has been used in acute and chronic dysentery, and as an anthel- mintic against ascarides and tcenia solium,. It has also been advocated as a remedy for typhoid fever and in malarial cachexia, but purely upon theoretical grounds, no clinical results having thus far justified its use in these disorders. Administration. — It may be given internally in pills or capsules, mixed with powdered liquorice-root as an excipient, or dissolved in glycerin and well diluted with sweetened water. For external use various strengths are used (from 1:10 to 1 : 500), and the various preparations mentioned may be used according to the case and indications. Sodii Sulphocarbolas— Sodii Sulphocarbolatis— Sodium Sulphocarbolate. TJ. S. J*. Description and Properties. — Colorless, transparent, rhombic prisms, odorless, having a cooling, saline, slightly bitter taste. Somewhat effervescent in dry air. Soluble in 4.8 parts of water, 132 parts of alcohol, 0.7 part of boiling water, and in lO parts of boiling alcohol. The aqueous solution is neutral to litmus-paper. Dose. — 10-30 grains (0.60-2 Gm.). Allied Compounds. PotSssii Sulphocarbolas— PotSssii Sulphocarbolatis— Potassium Sulpho- carbolate. Caicii Sulphocarbolas— Caicii Sulphocarbolatis— Calcium Sulphocarbolate. Magnesii Sulphocarbolas— Magnesii Sulphocarbolatis— Magnesium Sul- phocarbolate. Zlnci Sulphocarbolas— Zlncii Sulphocarbolatis— Zinc Sulphocarbolate. All of the above have been employed, but the zinc sulphocarbolate is believed to be preferable to check diarrhea and render the stools less foul. It is best given in pills, in doses of 2-3 grains (0.1-0.15 Gm.). Physiological Action. — In medicinal doses sodium sulphocar- bolate occasions no special symptoms, and in three or four times the medicinal dose it causes only slight lightness of the head. It is changed in the system into carbolic acid and sodium sul- 3o8 A TEXT-BOOK OF MATERIA MEDIC A. phate, the latter being eliminated with the urine. The carbolic acid set free exerts its characteristic action and influence. Therapeutics. — Externally and Locally. — In the strength of J drachm (2.0 Gm.) to 8 ounces (237.0 Cc.) of water it forms a valuable gargle in relaxed conditions of the throat. Solutions of different strengths have been used in diphtheria, acute tonsillitis, aphthcz of children, and nasal catarrh. 30 grains (2.0 Gm.) in 2 ounces (60.0 Cc.) each, of water, and hydrogen peroxide make an efficient injection in gonorrhea. Internally. — It is a mild intestinal antiseptic, and may be used internally for the same purposes as carbolic acid in such disorders as diarrhea, fermentative dyspepsia, etc. It arrests the growth of thrush, and is considered by some physicians to exert a favorable action in anginose scarlatina, diphtheria, and typhoid fever. The ZINC SULPHOCARBOLATE is One of the best intestinal antiseptics to use in cases of dyspeptic diarrhea of children. Administration. — Sodium sulphocarbolate is best given in solution. Creasotum— Creasoti— Creasote. TJ. 8. P. Origin. — ^A mixture of phenols, chiefly Guaiacol and Creasol, obtained during the distillation of wood-tar, preferably that of beech. Description and Properties. — An almost colorless, yellowish or pinkish, highly refractive, oily hquid, having a penetrating smoky odor, and a burning, caustic taste ; usually becoming darker in tint on exposure to light. Soluble in about 150 parts of water, but without forming a perfectly clear solution. With 120 parts of hot water it forms a clear liquid which on cooling becomes turbid, from the separation of minute oily drops. Soluble in all propor- tions in absolute alcohol, in ether, chloroform, benzin, carbon disul- phide, acetic acid, and in fixed and volatile oils. Creosote is in- flammable, burning with a luminous, smoky flame. It is neutral, or only faintly acid, to litmus-paper. Tests. — Carbolic acid is often substituted for creosote, and the following tests. for the detection of carbolic acid are important: 1. If the suspended liquid is mixed with collodion, a coagulum will form if carbolic acid be present. 2. Carbolic acid produces a violet color with ferric chloride and ammonium hydrate, creosote producing a green color passing to brown. Dose. — 1-5 minims (0.06-0.3 Cc). ANTISEPTICS. 309 Official Preparation. Aqua Creosoti — Aquae Creosoti — Creosote Water. — Dose, 1-4 fluidrachms (4.0-15.0 Cc). Incompatibles. — Strong sulphuric and nitric acid. It reduces , silver salts, and explodes when combined with oxide of silver. Synergists. — The same as for carbolic acid. Physiological Action. — Externally. — It has the same action as carbolic acid. Internally. — Its action upon the digestive, circulatory, nervous, and respiratory systems is practically the same as that of carbolic acid. It does not stimulate the spinal cord so much as carbolic acid, and differs also from the latter drug in increasing the coagulability of the blood. Poisonous doses act like those of carbolic acid, but with more marked nervous symptoms. Absorption and Elimination. — It is eliminated by the bronchial , mucous membrane, but the process takes place by the kidneys as guaiacol sulphate and creosol sulphate of potassium. It is a stimulant expectorant. It has the peculiar property when applied to meat of preserving : it, whence its name {creas, flesh, sohzote, preserve). Poisoning. — The symptoms and treatment of poisoning from creosote are the same as described under Carbolic Acid. Therapeutics. — Externally and Locally. — Creosote is superior , to carbolic acid as an antipruritic, although not so generally used as the latter, on account of its acrid and penetrating odor. It can be used externally for the same purposes as carbolic acid. It is a valuable hemostatic, and the creosote water may be used for this purpose. Inhalations of creosote are recommended in phthisis, chronic bronchitis,, and chronic congestion of the larynx and trachea. It is a ' powerful local anesthetic, and is largely used by dentists and the ' laity for aching teeth. It is used to preserve dead animal matter for dissection, etc. Internally.— Creosote can be used internally for the same pur- poses as carbolic acid, having the advantage over the latter drug in , being one of the most efficient remedies in pulmonary tuberculosis. \ Probably no one remedy exerts so favorable an action upon the , night-sweatsi cough, and expectoration as creosote, or guaiacol, | which is preferred by many physicians. It is of less value in cases 3IO A TEXT-BOOK OF MATERIA MEDIC A. accompanied by high temperature and hemoptysis, and often aggravates these symptoms. It must be remembered that many of the cases alleged to have been cured by creosote have been treated with cod liver oil, tonics, and hygienic methods as well. Contraindications. — The same as for carbolic acid. Administration. — Pure beech-wood creosote alone should be used. It may be given in the form of creosote water, emulsion, or pills, or in capsules mixed with cod liver oil. Capsules are the least offensive way of administration. Some persons prefer to take the drug in milk. In the treatment of phthisis large doses are necessary. A tol- erance can usually be established by gradually increasing doses. If the patient manifest any untoward symptoms, the drug must be reduced in quantity or discontinued altogether. Guaiacolum— Guaiacoli— Guaiacol. Origin. — As before stated, creosote consists chiefly of Guaiacol, Creosols, and Cresols, and of these guaiacol is present to the extent of from 60 to 90 per cent. Guaiacol is obtained by fractional distillation of beechwood-tar Creosote, treated with Ammonia to remove acid compounds, and again fractionated. Guaiacol is rarely met with absolutely pure. Description and Properties. — A colorless, slightly refractive liquid, of strongly aromatic odor. Specific gravity at 15" C. (59° F.) is I.I 17. Sparingly soluble in water, but readily soluble in alcohol and ether. It is soluble in solutions of sodium and potassium hydroxides, forming unstable compounds known as sodium- and potassium-guaiacol. Tests. — Pure guaiacol will separate rapidly if shaken with twice its weight of benzene, whereas the impure article forms a clear solution. " If a trace of ferric chloride is added to an alcoholic solution of guaiacol, a blue color is developed, which changes to emerald- green upon the adclition of more ferric chloride." ' Dose. — 2-10 minims (0.12-0.6 Cc). The following derivatives have been introduced : Guaiacoli B6nzoas — Guaiacoli Benzoatis — Guaiacol Benzoate (Benzosol). — Origin, by heating on a watev-bath Potassium Guaiacol with Benzosol-chloride : the impure benzosol-guaiacol formed is purified by recrystallization from Alcohol. ANTISEPTICS. 3" Description and Properties.— Co\ox\ess,, tasteless, and odorless crystalline powder, almost insoluble in water, but readily soluble in ether, chloroform, and hot alcohol. Dose. — 10-150 grains (0.60-10 Gm.) daily. Guaidcoli Carbonas — Guaiacoli Carbonatis— Guaiacol Carbonate. — Origin, this substance is prepared by passing Phosgene Gas (carbonyl chloride) into Guaiacol previously dissolved in soda solution. The guaiacol carbonate is formed and is purified and crystallized from Alcohol. Description and Properties. — White, neutral, crystalline powder, nearly void of odor and taste, insoluble in water, slightly soluble in cold and readily soluble in hot alcohol, also in ether, chloroform, and benzene, and sparingly ' soluble in glycerin and fixed oils. Dose. — 3-60 grains (0.2-4 Gm.) daily, gradually increased. GuaiScoli Di-iodidum — GuaiScoli Dl-iodidi — Guaiacol Diodide. — Origin, by adding a solution of Iodine in potassium iodide to an aqueous solution of Sodium- guaiacol as long as precipitation continues. Description and Properties. — Reddish-brown salt, having the odor of iodine, soluble in alcohol and fixed oils, and readily decomposed. Dose. — i!-I5 grains (o.io-l Gm.). GuaiScoli SaHcylas— Guaiacoli Salicylatis— Guaiacol Salicylate (Guaiacol- SALOL). — Origin, by the action of Phosphorous Oxychloride on a mixture of Sodium- guaiacol and Salicylate. It is analogous to salol. Description and Properties. — White, crystalline, odorless, and tasteless powder, in- soluble in water, but soluble in alcohol, ether, and chloroform. Dose. — 10-150 grains (0.60-10 Gm.) daily. • Physiological Action of Guaiacol and its Derivatives. — Guaiacol produces an action very similar to that of creosote. It is not caustic when applied in full strength. It possesses marked antipyretic properties. It is readily absorbed through the unbroken skin, and rapidly reduces febrile temperature when applied in this manner. The reduction of temperature lasts from four to six hours. It is a diaphoretic and diuretic. It is excreted by the sweat, saliva, and urine, but is only sHghtly thrown out by the expired air, though small amounts of the drug have been found in the lung-tissue. As it is eliminated as a salt of ethyl-sulphuric acid, it must combine with albuminous bodies in the blood, and chiefly through the sulphur present in the albumin molecules. It can be found in the urine within fifteen minutes after administration or external application in the form of a substance giving the reaction of phenol. It is more agreeable to the stomach than creosote, and fre- quently improves the appetite, though to some patients it is very disagreeable and acts as an irritant. ' The GUAIACOL CARBONATE is usually much better borne by the stomach, and is therefore a useful and efficient substitute. 312 A TEXT-BOOK OF MATERIA MEDICA. Benzosol, guaiacol benzoate, contains 54 per cent, of guaia- col. It is usually well borne by the patient, and seldom occasions any digestive disturbance. In the intestinal canal it resolves into guaiacol and benzoic acid, and is excreted by the urine as combi- nations of these substances. Therapeutics. — Guaiacol is used for the same purposes as creosote — less likely to irritate the intestinal canal and kidneys. Guaiacol causes a marked reduction of the temperature in cases of tubercular disease when applied locally, nor is the antipyretic action when thus employed confined to tuberculous cases. It has given satisfactory results in other pyrexias. It is a very active antipyretic in erysipelas. The temperature begins to fall within fifteen or twenty minutes after the application of the drug. As with all antipyretics, the depressing action of guaiacol must be borne in mind. Raymond first suggested the local application of guaiacol in tonsillitis. It undoubtedly exerts a favorable action on the disease. Guaiacol, or some one of its derivatives, has been substituted for creosote in "the tr&dX'm&vA o{ phthisis and other wasting forms of tuberculosis. Guaiacol itself has no advantage over creosote. The BENZOSOL and guaiacol carbonate possess the only advan- tage of being tasteless. Piatkowski of Vienna recommends benzosol in diabetes mellitus. There have been conflicting reports regarding its efficacy, yet suf- ficient is known in its favor to justify a further trial of this drug in diabetes. Contraindications. — The same as for creosote. Administration. — The application of guaiacol for the reduction of temperature may be made upon any portion of the skin — the back, breast, arms, thighs, or abdomen — without causing any appre- ciable difference. From \ to i drachm (2.0-4.0 Cc.) is applied with a brush, and the part covered with cotton or gutta-percha tissue. The application may be repeated as often as necessary for the reduction of the fever. Other than a decided taste of guaiacol and free diaphoresis, the patient usually complains of no untoward symptoms, although in some cases quite marked nervous disturbances and other unfavor- able manifestations have been observed. It may be inhaled from hot water for certain conditions in doses of from 5-10 minims (0.3-0.6 Cc). ANTISEPTICS. 313 The solid derivatives of guaiacol may be given in powders or capsules. Guaiacol itself may be given in the same manner as creosote — preferably, mixed with cod liver oil or enclosed in cap- sules. Acidum Salicyiicum— Acidi Salicylici— Salicylic Acid. jj.s.:p. Origin. — An organic acid, existing naturally in combination in various plants like Spircea ulmaria (meadow-sweet), Gaultheria procumbens (wintergreen), etc., but chiefly prepared synthetically by combining the elements of pure Carbolic Acid with dry Car- bonic Acid and purifying. Description and Properties. — Light, fine, white prismatic needles, or a light white crystalline powder, odorless, having a sweetish, afterward acrid taste ; permanent in the air. It is soluble in about 450 parts of water, in 2.4 parts of alcohol, and in 14 parts of boiling water. The addition of 2 parts of sodium sulphite or I part of ammonium phosphate renders it much more soluble in water. Test. — The addition of ferric chloride to a saturated solution produces a fine bluish-violet color. Dose. — 3-60 grains (0.25-4.0 Gm.). Lithii Salicylas— LTthii Salicylatis— Litinium Salicy- late. V. S. J». Origin. — Obtained by heating Salicylic Acid, Lithium Carbonate, and Water until effervescence ceases, filtering, and evaporating. Description and Properties. — A white or grayish-white pow- der, odorless, having a sweetish taste, deliquescent on exposure to air, very soluble in water and alcohol. Dose, — 5-60 grains (0.3-4.0 Gm.). S5dii Salicylas— Sod ii Salicylatis— Sodium Salicy- late. U. S. -P. Origin. — Prepared by acting on Sodium Carbonate with Salicylic Acid, straining, and heating the solution. Description and Properties. — A white amorphous powder, odor- less, sweetish, saline taste, permanent in air, soluble in 0.9 part of water, in 6 parts of alcohol, and in glycerin. Dose. — S-60 grains (0.3-4.0 Gm.). 314 A TEXT-BOOK OF MATERIA MEDICA. Antagonists and Inoompatibles.— The arterial and cerebral stimulants are antagonistic to salicylic acid and the salicylates. The incompatibles are the mineral acids, alkalies, metallic salts, particularly the ferric salts. Synergists. — The carbolic-acid derivatives, anesthetics, cardiac depressants, and cerebral sedatives. Physiological Action. — Externally and Locally. — Salicylic acid is antiseptic, parasiticide, irritant to mucous membranes ; possesses the power to soften the epidermis ; checks perspiration when locally applied (anhydrotic). Internally. — Digestive System. — Small doses stimulate the stom- ach ; larger doses act as an irritant. It is an antiferment. Circulatory System. — Small doses of salicylic acid have no very appreciable effect upon the circulation. Full medicinal doses first cause the heart to beat faster and stronger, increasing arterial tension ; later the arterial pressure is lowered, and excessive or toxic doses cause the pulse to become slow and labored. Its tend- ency ultimately, even in medicinal doses, is to depress rather than stimulate the heart. Its effect upon the blood is to restrain the migration of the white corpuscles. Nervous System. — In toxic doses, and in some susceptible per- sons in full medicinal doses, salicylic acid causes cerebral conges- tion, indicated by a feeling of tension in the cerebrum, headache, confusion of thought, tinnitus aurium, vertigo, and sometimes delirium. Toxic doses may occasionally produce cerebral con- vulsions. It lessens the reflexes, but does not affect the peripheral nerves, either motor or sensory. Respiratory System. — Small doses stimulate the respiratory cen- ter and the pulmonary vagi, making the respiration quicker and deeper. Toxic doses paralyze the center and vagi, causing slow and labored respiration and death from asphyxia. Absorption and Elimination. — Salicylic acid is converted by the gastro-intestinal secretions into the sodium salicylate, in which form it enters into the circulation. It increases the urinary flow, and the proportion of urea, uric acid, and phosphoric acid. It appears in the urine as sali- cyluric acid. The color of the urine is changed to a dark olive- green after large doses have been taken. This change is due to the presence of indican and pyrocatechin, produced by the action of the pancreatic juice upon the salicylic acid in the intestine. ANTISEPTICS. 315 It is a powerful diaphoretic, large doses often causing exhaust- ing sweating. It also increases the secretion of milk and the amount of sugar in that secretion. Elimination takes place slowly by all the emunctories, but chiefly through the kidneys and skin. Temperature. — Febrile temperature is markedly reduced by large doses of sahcylic acid. The reduction takes place usually within half an hour after a dose has been taken, and lasts several hours. The antipyretic action varies in degree according to the cause of the pyrexia and the individual susceptibility of the patient. The reduction of temperature is produced by lessening heat-production and increasing heat-dissipation. Untoward Action. — Erythema, urticaria, or petechise, accom- panied by intense itching, occasionally edema of the eyelids and lower extremities, mental depression, muscular weakness, motor disturbances, sweating, and buzzing in the ears, as mentioned under Poisoning, but to a less degree. Poisoning. — There are roaring in the ears, deafness, intense headache, vertigo, and possibly delirium, profuse and exhausting sweating, subnormal temperature, very weak, compressible pulse, feeble and shallow respirations, dimness of vision, ptosis, and often strabismus. The blood is disorganized, and the corpuscles rapidly break down. The urine and feces pass involuntarily. Death usually results from respiratory failure. Treatment of Poisoning. — Diffusible stimulants, atropine, strych- nine — the same treatment as in poisoning by acetanilid. Therapeutics. — Externally and Locally. — Salicylic acid has been satisfactorily employed, in the strength of J to i drachm in i ounce (2.0 to 4.0 in 32.0 Gm.) of cosmoline, in the treatment of erysipelas. In the treatment of chancroid salicylic acid has been extensively employed. The powdered acid should be thoroughly dusted over the surface. The- peculiar action of salicylic acid in softening and loosening thickened masses of epidermis and favoring the normal prolifera- tion of epithelium renders the drug especially useful in the treat- ment of indurated eczema, particularly of the palm and sole, ver- ruca, tylosis, callositas, corns, warts, etc. It is one of the most useful drugs in the different varieties of eczema, impetigo contagiosa, psoriasis, lupus, parasitic affections, and in non-parasitic sycosis it has been employed by Heitzmann with 3i6 A TEXT-BOOK OF MATERIA MEDICA. marked success. It has been used successfully in the treatment of acne, comedones, and pruritus. A 3 per cent, solution has been recommended in aspergillus of the outer auditory meatus. A wash, 3 grains to i ounce (0.2 to 30.0 Cc.) is efficient in otorrhea. Solutions of various .strengths are frequently useful in acute coryza, diphtheria, inflammation of fauces, catarrhal stomatitis, and to cor- rect offensive expectoration, especially in phthisis and gangrene of the lung. Internally.— Thtre is no better example of empiricism in thera- peutics than the employment of salicylic acid in acute articular rheumatism. Used at first in this disease to reduce temperature, it was found that while it exerted marked antipyretic action, it also lessened the pain and swelling, and in the majority of cases short- ened the duration of the disease. It cannot be classed as a " specific " in any sense of the word, but merely reUeves certain symptoms — fever, pain, and swelling. Other symptoms — or com- plications, according to some authors — such as heart affections, are uninfluenced by this medicine. Indeed, when so-called cardiac complications exist salicylic acid is certainly contraindicated. It has no power to prevent either affections of the heart or relapses. In the author's opinion, it is doubtful if saHcylic acid alone is equal to the alkaline treatment or greatly superior to acetanilid or anti- pyrine. Rheumatic tetanus, irido-choroiditis , and sclerotitis are alleged to have been cured by this drug. It is useless in gotit, according to the best English authorities, and is of no value in chronic or gonorrheal rheumatism, rheumatic arthritis, or rheumatic hyper- pyrexia. It is credited with being quite efficient in chorea of rheumatic origin, and in relieving the pains of herpes zoster and neuralgic headache. It is a drug to be tried in many diseases of rheumatic origin, unless some distinct contraindication to its use exists. It surpasses any drug, with the possible exception of guaiac, in the treatment of quinsy, and particularly rheumatic tonsillitis. The medicine is highly regarded by competent advocates as a remedy in diphtheria. Lumbago often yields to its influence, and it has also been recom- mended in sciatica, although in Cook County Hospital the author has seen a great number of cases of the latter treated with salicylic acid without any apparent improvement. He also regards it as valueless in typhoid and intermittent fevers. ANTISEPTICS. 317 It is a useful antizymotic to prevent putrefactive fermentation and flatulence, and lessen thereby the tendency to crapulous diar- rhea. Owing to the similarity of its action to that of quinine, it has been used, and with some success, in periodical neuralgias which have not responded to the latter drug. It has been found of use in influenza, and is an efficient anti- septic remedy in chronic gastric catarrh, diarrhea, cholera, and entero-colitis. By some eminent clinicians it is considered to be one of the most effectual remedies in pleurisy with effusion. It has been recommended as an effectual anthelmintic, both for tape- and round-worms. Contraindications. — Salicylic acid should not be given in large doses to persons who have a weak heart or are otherwise greatly debilitated, at least not without counteracting its toxical tendencies with nutrients and diffusible stimulants. Administration. — Owing to its irritant action upon the mucous membranes, it is best given in a solution of glycerin and some aro- matic water, after meals. So concentrated a form as a pill or cap- sule is not recommended. Many of the untoward cerebral effects may be relieved by giving 20 grains (1.3 Gm.) of sodium or potassium bromide. Many of the toxical effects have been attributed to an impurity in the manufactured acid. If any benefit is to be derived from salicylic acid in acute artic- ular rheumatism, it must be used early in the disease and in heroic doses at comparatively frequent intervals — not less than 20 grains (1.3 Gm.) every two, three, or four hours for an adult. If too serious gastric and cerebral symptoms manifest themselves, the drug may be decreased in amount or discontinued until the unpleasant action subsides. It is better, except in acute articular rheumatism, to give a small dose, repeated frequently, than to administer a full dose at once. The physiological action and therapeutics of lithium salic- ylate are practically the samfe as those of salicylic acid or sodium salicylate. It is, however, richer in salicylic acid than the sodium salt, and in gout and chronic rheumatism has been found to be of more value than salicylic acid. It should be given in solution. Sodium salicylate 'is identical in physiological action and 3l8 A TEXT-BOOK OF MA TERIA MEDICA. uses with salicylic acid, with the exception that it is less irritating to the stomach, and is therefore ordinarily to be preferred to the acid. It may be prescribed in aromatic water, in syrup, or in powder, pills, or capsules. Salol— Salol— Salol. V. S. -P. (Phenyl Salicylate.) Origin. — The Salicylic Ether of Phenol, prepared by heating Salicylic Acid with Phenol in the presence of Phosphorus Penta- chloride. Description and Properties. — A white, crystalline powder, odorless, or having a faintly aromatic odor, and almost tasteless. Permanent in the air. Almost insoluble in water ; soluble in lo parts of alcohol ; also in 0.3 part of ether, and readily in chloro- form and in fixed or volatile oils. Dose. — 3-15 grains (0.19-1.0 Gm.). Physiological Action. — Externally and Locally. — It is a more powerful antiseptic than either of its constituents. Nencki claims that it is not a germicide, as it will not destroy bacteria when present, although it prevents their formation. It is not, like sali- cylic acid,, irritating to the mucous membranes. Internally. — The action of salol is essentially like that of salicylic acid, but it is a more powerful antipyretic, analgesic, and cerebro- spinal sedative. It reduces temperature much more promptly, the antipyretic action occurring within fifteen minutes after a full medi- cinal dose has been taken. The effect, however, is not prolonged, repeated doses being required to maintain the reduction of tem- perature. The circulation is, perhaps, not so much depressed as by sali- cylic acid. The respirations are at first quite rapidly increased, and are rendered very shallow, requiring some time to resume their normal condition. It is converted by the pancreatic and intestinal juices into its original constituents — salicylic acid and carboHc acid. It is usu- ally absorbed and eliminated very rapidly, having been detected in the urine in the form of salicyluric acid and phenol-ether-sul- phuric acid within thirty minutes after its ingestion by the stomach. To the latter acid is due the dark, smoky color of the urine which sometimes exists under large or continued doses of salol. Therapeutics. — Externally and Locally. — Salol is especially ANTISEPTICS. 319 recommended as an antiseptic dressing for wounds, burns, venereal ulcers, and buboes. Powdered salol or an ointment — i part to 150 parts of petrolatum — has been used in cases of tubercular laryngitis and ozena. Like salicylic acid, it is also of value in eczema and sycosis simplex. Internally. — It is an efficient remedy in all diseases benefited by the internal administration of salicylic acid. In addition to these services it is a valuable remedy in acute and chronic cystitis, gonor- rhea, intestinal catarrh, especially duodenal catarrh and catarrhal jaundice, and to relieve the pains of neuritis and myalgia. Salol is much more useful than salicylic acid in diarrhea, cholera morbus, and cholera, the latter disease yielding better, perhaps, to this remedy than to any other. Administration. — It may be given in pills, capsules, powders, emulsion, or suspended in milk. The compressed tablets of this drug so extensively used at present are not recommended, owing to their slow and difficult solution. SalicTnum— SalicTni— Salicin. TJ. 8. P. Origin. — A neutral principle obtained from several species of Salix (willow) and Populus (poplar). Description and Properties. — Colorless or white, silky, shining, crystalline needles, or a crystalline powder, odorless and having a very bitter taste. Permanent in the air. Soluble in 28 parts of water, 30 parts of alcohol, 0.7 part of boiling water, and in 2 parts of boiling alcohol. Dose. — 10 grains-2 drachms (0.6-8.0 Gm.). Physiological Action. — Its physiological effect is analogous to that of salicylic acid, but is much less active than the latter. It does not disturb digestion, but in moderate doses promotes appe- tite and acts Hke other bitters. It is rrtore rapidly absorbed than salicylic acid, is partly decomposed, and is found in the urine, as salicin and salicylic acid, in from fifteen to thirty minutes after the ingestion of a single dose. Therapeutics. — While inferior to salicylic acid in most respects, salicin is frequently used for the same purposes. It is superior to, and safer than, salicylic acid in acute rheumatism characterized by a weak heart and depressed vaso-motor system. It is an excellent stomachic tonic, and may be used like other bitters in the treatment of atonic dyspepsia and other conditions benefited by this class of drugs. 320 A TEXT-BOOK OF MATERIA MEDICA. Contraindications. — In acute inflammatory affections of the brain and ear. Administration. — Salicin may be administered in powders, cap- sules, or solution. Owing, however, to its bulk and intensely bitter taste, it is perhaps best given in suspension in the aromatic elixir of liquorice or in syrup of yerba santa. Naphtallnum— Naphtallni— Naphtalin. TJ. 8. P. Origin. — A hydrocarbon obtained from coal-tar. Description and Properties. — Colorless, shining, transparent laminae, having a strong, characteristic odor resembling that of coal-tar, and a burning, aromatic taste ; slowly volatilized on expo- sure to air. Insoluble in water, but when boiled in it imparting a faint odor and taste. Soluble in 15 parts of alcohol, and very soluble in boiling alcohol ; also very soluble in ether, chloroform, carbon disulphide, and in fixed or volatile oils. Naphtalin vola- tilizes slowly at ordinary temperatures, but rapidly when heated. Its vapor is inflammable, burning with a luminous and smoky flame. It should be kept in well-stoppered bottles. Dose. — 2-10 grains (o.i 2-0.6 Gm.). Naphtol— Naphtol— Naphtol. V. S. P. (Beta-naphtol.) Origin. — A phenol occurring in coal-tar, but usually prepared artificially from naphtalin. Description and Properties. — Colorless or pale buff-colored, shining, crystalline laminae, or a white or yellowish-white crystal- line powder, having a faint, phenol-like odor, and a sharp, pungent, but not persistent taste. Permanent in the air. Soluble in about 1000 parts of water, in 0.75 part of alcohol, in about 75 parts of boiling water, and very soluble in boiling alcohol, ether, chloro- form, and solutions of caustic alkalies. It should be kept in dark amber-colored, well-stoppered bottles. Dose. — 2-10 grains (0.12-0.6 Gm.). Allied Compounds. Altimnol. — An almost colorless, non-hygroscopic powder; readily soluble in cold water or glycerin, less soluble in alcohol, and insoluble in ether. It is employed as a local remedy in solutions varying in strength from I to 50 per cent. Used externally. Asaprol. — A colorless, neutral crystalline powder, soluble in i^ parts of water and in 3 parts of alcohol. — Dose, 15-60 grains (1.0-4.0 Gm.). BenzonSphtol. — Obtained by the action of Benzoic Chloride on Beta-naphtol in a ANTISEPTICS. 321 sand-bath. It is an odorless, tasteless, white, crystalline powder, or occurs in the form of long needles. Insoluble in cold water. Dose, 4-8 grains (0.18-0.5 Gm.). Betol (Napht'Osaiol — Salinaphtol) . — A substance analogous to salol, and pre- pared in the same manner, except that sodium-naphtol is used instead of sodium-phenol. It occurs as a colorless, odorless, tasteless, lustrous crystalline powder. Insoluble in water or glycerin, and with difficulty soluble in cold alcohol. Dose, 2-5 grains (o.i2- 0.3 Gm.). Camphorated Naphtol. — Obtained by mixing I part of Beta-naphtol with 2 parts of Camphor. It is a brownish, transparent, syrupy liquid. Hydronaphtol. — A derivative of beta-naphtol, obtained by the action of reducing agents. It occurs in scale-like crystals, of a silvery white or grayish hue, of slightly aromatic odor and taste. Soluble in 1 100 parts of water, and freely soluble in alcohol, ether, glycerin, benzene, chloroform, and fixed oils. Dose, 2-3 grains (0.12-0.18 Gm.). Antagonists and Inoompatibles. — Physiological antagonists of NAPHTALiN are the same as for other members of this group. Naphtol is incompatible with subacetate of lead. Ssniergists. — Carbolic acid and its derivatives. Physiological Action. — Naphtalin is antiseptic, antifermenta- tive, disinfectant, and deodorant. Its action is quite similar to salol, it being insoluble in the gastric juices, but soluble in the in- testines, where it acts as an antiseptic, deodorizing the stools and often imparting to them its own odor. It is absorbed to some extent, and is eliminated by the lungs and kidneys, but escapes principally in the feces. It is broken up into naphtol or phenol, and acts as a local antiseptic and disinfectant at points of elimina- tion, but does not occasion any local irritation unless quite large doses have been taken : " 15 grains (i.o Gm.) daily have occasioned frequent micturition, with burning pain, vesical tenesmus, and red- ness of the urethral orifice." Purdy states that in certain cases of genito-urinary disease he has known a dose of 5 grains (0.32 Gm.) to cause severe suffering along the whole urinary tract. It is a stimulant expectorant, and differs from other members of the group in that it possesses no antipyretic action. Naphtol is quickly absorbed when apphed locally. It produces considerable irritation when used in solution, but has no irritating effect when applied in the form of ointment. Toxic effects may result from its absorption by the skin, their character resembling the action of carbolic acid. Aliimnol. — An astringent antiseptic. Asaprol. An antipyretic, analgesic, and antiseptic. It is considered superior to the salicylates in these respects, having the advantage of neither exciting vomiting nor disturbing the brain or the auditory apparatus. Benzonaphtol. — Antiseptic, diuretic, and but slightly poisonous. 21 322 A TEXT-BOOK OF MATERIA MEDICA. Betol. — Action almost identical with that of salol. Hydronaphtol. — A powerful non-irritating, non-corrosive, and non-poisonous anti- septic, said by Dr. Fowler to possess " antiseptic properties fifteen times greater than carbolic acid." ' Dr. Levis claims that it is thirty times as antiseptic as salicylic acid, and that this property exceeds that of boric acid sixty times, of alcohol six hundred times, and that in this respect it ranks next to mercuric chloride. Therapeutics. — Externally and Locally. — Naphtalin in alcoholic solution is advised by Henri Laserre in the treatment of chronic abscesses and adenitis. It is also recommended in the treatment of scabies and other parasitic skin diseases. Internally. — It is used in typhoid fever and in the gastro-intestinal and genito-urinary disorders for which salol and carbolic acid are administered, such as chronic diarrhea and dysentery, acute or chronic cystitis, etc. The internal uses of naphtol are the same as those of naphtalin, while externally it may be employed, like carbolic acid or creasote, as a general antiseptic in cutaneous disorders, whether organic or parasitic, Aliimnol. — An efficient remedy in many acute and chronic inflammatory diseases of the skin, and in gonorrhea, chancres, syphilitic ulcers, balanitis, etc. A I per cent, solution may be injected in gonorrhea, while stronger solutions (10-50 per cent.), or alumnol plaster, are recommended in chronic diseases of the skin. Asaprol. — Given for the same purposes as salicylic acid and the salicylates, although it is not so uniformly successful in acute articular rheumatism, while having the advan- tage of causing less heart-depression. Betol. — Used chiefly in the bowel complaints of children. It may be administered either by the mouth or through the rectum, associated with bismuth or antacids. It has been used also in acute articular rheumatism and bladder affections. Camphorated naphtol is considered by some practitioners to be superior to all other remedies to prevent suppuration in acute tonsillitis. Fernet has employed it successfully in tubercular ulcerations of the tongue, while Reboul of Marseilles and others have adopted it with good effect hypodermically in tuberculous adenitis and tuberculosis of the testis. It has also been used in tuberculosis of the bladder, joints, etc. Ruault claims it to be an efficient local application to the turbinated bones in ozena. Hydronaphtol. — Considered by many physicians to be superior to carbolic acid, since it is without disagreeable odor and can be used without exciting irritation or danger of toxic impression. Dockrell employs it in the form of a plaster for destroying the trichophyton fungus of tinea tonsurans, and believes it to be superior to mercuric chloride as a germicide. It has been used as a preventive of dental caries, and in the treatment of gingivitis, pyorrhoea alveolaris, diphtJieria, etc. Internally it has been recommended in dysentery, diarrhea, pulmonary tuberculosis, and typhoid fever. ' New York Med. Journ., Oct. 3, 1885. ANTISEPTICS. 323 Contraindications. — These preparations should not be given internally when the functional activity of the kidneys is defective. Administration. — Naphtalin is best given internally in the form of pills or in capsules. When it is necessary to use it topi- cally, the offensive odor of the drug may be disguised, it is said, by triturating, it with a small quantity of the oil of bergamot. Naphtol should be given in capsules, in the dose recommended, three times a day or oftener if necessary. Asaprol, betol, and hydronaphtol are best given in capsules, although betol, which is tasteless and insoluble in water, may be administered in the form of powders. ResorcTnunn— ResorcTni— Resorcin. JJ. S. P. Origin. — Prepared by melting Galbanum, Ammoniac, or Guai- acum Resin with Potassa. It is also prepared in a similar manner from Asafetida, Sagapenum, Ascaroid Resin, and from Phenol- sulphonic Acid and other derivatives of Phenol. Description and Properties. — Colorless or faintly reddish, needle- shaped crystals, or rhombic plates, having a faint, peculiar odor, and a disagreeable sweetish and afterward pungent taste. Resorcin acquires a reddish or brownish tint by exposure to light and air, and should be kept in dark amber-colored vials. It is soluble in 0.6 part of water, 0.5 part of alcohol, very soluble in boiling water and in boiling alcohol, readily soluble in ether and in glycerin, and very slightly soluble in chloroform. The aqueous solution is neutral or only faintly acid to litmus-paper. Dose. — 3-8 grains (0.2-0.5 Gm.). Allied and Derivative Compounds. Hydroquinol — Hydroquinone — Hydrochinone — Paradioxybeftzene. — Color- less, odorless, dimorphous crystals, having a sweetish taste. Soluble in 17 parts of water, and very soluble in hot water, alcohol, and ether. Dose, 1^5 grains (0.03-0.30 Gm,). Catechol — Pyrocatechin — Orthodioxybenzene. — Acicular crystals, readily solu- ble in water, alcohol, and ether. Other allied compounds are — Thioresorcin, Resopyrine, and Fluorescein. Antagonists. — Cerebral excitants, cardiac and respiratory stim- ulants. Ssmergists. — Salicylic acid, quinine, carbolic acid. Physiological Action. — Externally and Locally. — Resorcin is an antiferment, antiseptic, deodorant, a feeble analgesic, and a parasiti- cide. Applied to the unbroken skin, it is non-irritating, is not ab- 324 A TEXT-BOOK OF MATERIA MEDICA. sorbed by it, and when injected into the subcutaneous tissues produces but little irritation, with no suppuration. Applied to the moistened mucous membrane, its action is similar to that of car- bolic acid, producing vesication, etc.- Internally. — The physiological properties of resorcin.are allied to those of carbolic acid. It possesses more marked antipyretic and diaphoretic actions than carbolic acid, but when used to pro- duce these effects it greatly depresses the heart. Its chief action is on the nervous system, which it first power- fully stimulates and then depresses. It is niainly and rapidly ehminated by the urine, which it colors an olive-green or bluish-violet hue. Poisoning. — Poisonous doses produce vertigo, ringing in the ears, deafness, disturbance of vision, weak, rapid, and irregular pulse, respiration at first convulsive and jerking, afterward accelerated, shallow, and weak, death resulting finally from respiratory failure. There are great mental anxiety, epileptiform convulsions, collapse, and unconsciousness. Just before death there is a rise in temper- ature, doubtless due to excessive muscular action, although the temperature may fall below normal if there is quiet narcosis, as there may be in some instances. Treatment of Poisoning. — Hypodermic injections of atropine. The administration of diffusible stimulants. Artificial respiration. Therapeutics. — Externally and Locally. — Resorcin is especially useful in certain subacute or chronic skin affections, and may be used like salicylic acid in indurated eczema. It is of great value in psoriasis, seborrhoea sicca, pityriasis capitis, sycosis, acne rosacea, etc. A 5 to I o per cent, solution is an efficient application in pharyn- gitis, diphtheria, and ulcerative laryngitis. An ointment of resorcin is an excellent application to foul ulcers, sloughing wounds, and syphilitic ulcers. Condylomata have been cured by dusting upon them powdered resorcin. A mixture of powdered resorcin and boric acid (i : 20 or i : lo) has been used with brilliant results in suppuration of the middle ear. A 2 per cent, solution has been found useful in the form of a spray in whooping cough, while stronger solutions of 10 or 20 per cent, have been used with some success in hay fever. Solutions of resorcin have been used in gonorrhea and cystitis. Internally. — Resorcin is preferable to carbolic acid for internal administration, especially in digestive disorders such as gastralgia. ANTISEPTICS. 325 chronic gastritis, ulcer of the stomach, znd fermentative dyspepsia, so called. Owing to its sedative and antifermentative properties, it is of value in acute diarrhea of children. It has been used with some success in intermittent fever, but not with .good results sufficiently uniform to justify the exclusion of quinine. As an antipyretic it may be used when a drug of that character is indicated, but it is not equal to antipyrine or acetanilid, and in doses sufficient to produce the desired reduction of temper- ature it is too depressant to the heart. Its chief therapeutic value is for external or local use, and internally for the digestive disorders above mentioned. Administration. — It should be given in pills or capsules. Ichthyolum— Ichthyoli— Ichthyol. (Unofficial.) Origin. — It is obtained by the destructive distillation of bitumin- ous rock found near Seefeld in the Tyrolese Alps, which contains enormous quantities of semi-fossilized fishes and marine animals. Description and Properties. — It occurs in the form of a brown- ish-yellow, transparent, oily liquid, containing about 10 per cent, of sulphur. Upon being treated with concentrated sulphuric acid ichthyol is converted into ichthyol-sulphonic acid, which readily combines with ammonia and other alkalies, as well as with lithium, zinc, mercury, etc., forming the ammonium ichthyol, sodium ichthyol, zinc ichthyol, etc. Ammonium ichthyol occurs as a clear reddish-brown, syrupy liquid with a bituminous odor and taste. Soluble in water and in a mixture of equal volumes of ether and alcohol. Dose. — 2-10 minims (0.12-0.6 Cc). The other salts of ichthyol-sulphonic acid occur as brownish or black tar-like masses, the sodium salt being the most important, as it is the one most employed when ichthyol is desirable in pill form. Dose. — Sodium ichthyol, 2-4 grains (0.1-0.25 Gm.). Allied Drugs. Thiolum—Thioli— Thiol.— Or^fw.— This substance is prepared by heating brown-colored paraffin or gas oils with Sulphur, and extracting the sulphurated, unsatu- rated hydrocarbons with Alcohol. Description and Properties .—Vi occurs as a neutral, solid body, non-hygroscopic and soluble in water, and of a dark-brown color, or in the form of a dark reddish- brown, syrupy liquid, containing about 40 per cent, of thiol. 336 A TEXT-BOOK OF MATERIA MEDICA. Dose. — \-\ grain (0.03-0.06 Gm.). Tumenolum — Tumenoli — Tumenol. — Origin. — It is obtained from purified mineral oils by the direct action of concentrated sulphuric acid, without previous sul- phuration, being a mixture of sulphones and sulphonic acids. Description and Properties. — A dark-brown or blackish-brown liquid of a syrupy consistency. Dose. — It is used only externally, in strengths of from 5 to 10 per cent. Antagonists and Inoompatibles. — Ichthyol possesses marked reducing properties, and should not therefore be combined with substances, like potassium permanganate, which part readily with oxygen. Synergists. — Most members of this group, particularly the tars, carbolic acid, creasote, etc., aid its action. Physiological Action. — Externally and Locally. — Ichthyol is ischemic, sedative; parasiticide, and possesses antiseptic and prob- ably disinfectant properties. When applied to the skin in full strength it produces some irri- tation. It is readily absorbed, having the power to penetrate the skin, affecting the deeper tissues beneath. Internally. — Digestive System. — Very large doses produce con- siderable gastro-intestinal irritation. Circulatory System. — It has the power in medicinal doses of contracting the caliber of the arteries, and in large doses it increases the migration of the white blood-corpuscles. The physiological action has not been fully studied, and it is not yet positively known what action it has upon the nervous and respiratory systems and upon temperature. Therapeutics. — Externally and Locally. — Ichthyol was intro- duced by Unna as a valuable remedy in certain diseases of the skin. It is particularly useful in erythematous eczema, erysipelas, lupus erythematosus, irritable acne, and certain forms of acne rosacea. Agnew has employed it with advantage in lymphatic enlarge- ments. It has also been found useful in synovial inflammations, in- flammatory conditions of the female genital organs, and in certain diseases of the ear and nose. Thiol, although inferior, is similar to ichthyol in its therapeutic action. It has been found to be valuable in the treatment of herpes zoster, dermatitis herpetiformis, and erythema multiforme. Administration. — Ichthyol, when given internally, should be dispensed in capsules, while thiol may be given in capsules, pills, or wine. Externally, ichthyol may be employed in solution, dissolved in ANTISEPTICS. 337 chloroform or in a mixture of alcohol and ether, and applied with a brush ; or in the form of an ointment mixed with soft petrolatum or lanolin in from 1-4 to 8 drachms (4.0-15.0 Cc. to 32.0 Gm.). It is used also in the form of a soap in from 5 to 20 per cent, strength. Thiol is used locally in powder form, or as an ointment of 5 to 10 per cent, of the liquid, or in collodion containing 5 per cent, of the powder, or in solutions of glycerin and aqueous solutions con- taining from 5 to 50 per cent, of the powder. lodoformum—Iodoformi— Iodoform. TJ. S. -P. Origin. — It is obtained by the action of Iodine, in the presence of fixed alkalies or alkali carbonates, upon Alcohol or Acetic and other easily-saponifiable Ethers. Description and Properties. — Small, lemon-yellow, lustrous crystals, of the hexagonal system, having a peculiar, very pene- trating, and persistent odor, somewhat resembling that of saffron and iodine, and an unpleasant, slightly sweetish, and iodine-like taste. It is very slightly soluble in water, to which, however, it imparts its odor and taste; soluble in about 52 parts of alcohol, in about 12 parts of boiling alcohol, or in 5.2 parts of ether, and very soluble in chloroform, benzin, and iixed and volatile oils. Iodoform is sUghtly volatile, even at ordinary temperatures, and in boiling water distils slowly over with its vapor. It should be kept in well-stoppered bottles, in a cool and dark place. Iodoform contains 96.69 per cent, of its weight as iodine. Dose. — 1-3 grains (0.06-0.2 Gm.). Official Preparation. UnguSntum lodoffirmi — UnguSnti lodofSrmi — Ointment of Iodoform. — 16 per cent. Used externally. Allied Compounds. AntisSptol — Cinchonine lodosulphate. — Origin. — It is prepared by mixing an aqueous solution of Cinchonine Sulphate with an aqueous solution of Iodine and Potas- sium Iodide, and washing and drying the resulting precipitate. Description and Properties. — It occurs as a light reddish-brown powder, insoluble in water, but soluble in alcohol and chloroform. It contains about 50 per cent, of iodine. Dose. — 1-3 grains (0.06-0.2 Gm.). Arfatol^^Dithymol Di-iodide. — Origin. — It is obtained by adding a solution of iodated Iodide of Potassium to an aqueous solution of Hydrate of Sodium containing thymol. The resulting precipitate is washed and subsequently dried at ordinary tem- perature. Description and Properties. — A dark, brownish-red, amorphous, almost tasteless powder, of a slight, pecuhar, iodine-like odor, insoluble in water and glycerin, sparingly 328 A TEXT-BOOK OF MATERIA MEDICA. soluble in alcohol, but readily soluble in ether, collodion, and chloroform. It is also taken up by fixed oils, petrolatum, etc. Aristol is decomposed by heat and light, and it should be kept in dark amber- colored, well-stoppered bottles. It contains 45.8 per cent, of iodine. Dose. — It is not given internally. Eiirophen. — Prepared in a manner analogous to that of preparing aristol, except that isobutylorthocresol is used in place of thymol. Description and Properties. — An amorphous, yellow powder, having an odor resem- bling safifron ; soluble in ether, chloroform, and fixed oils ; insoluble in water and glycerin. It is permanent in dry air, but when moistened with water resolves into iodine, form- ing a new soluble iodine compound. When heated to 110° C. (230° F.) it melts, forming a clear brown liquid. It contains 27.6 per cent, of iodine. Dose. — j-ij grains (0.016-0.09 G™-)- ■"■' '^ "^^oj?, 1-2 fluid- drachms (4.0-8.0 Cc). Official Preparations of Lupulin. Extractum Lupulini Fmidum-Extracti LupulJni Fluidi— Fluid Extract of Lupulin. — Dose, 5-30 minims {0.12-2.0 Co.). Oleoresina Lupulini— Oleoresinse Lupulini— Oleoresin of Lupulin.— ZJwf, 1-5 grains (0.06-0.3 Gm.). Unofficial Preparations. Infusum Hiimuli— Infusi Humuli— Infusion of Hops.— Z)w«, 1-4 ounces (30-125 Cc). Tinctura Lupulini— Tincturse Lupulini— Tincture of Lupulin. — Dose, )^-2 fluidrachms (2-8 Cc). Antagonists and Incompatibles. — Mineral acids and metallic salts. Synergists. — Alcohol; opium, lactucarium, and many other narcotics. Physiological Action. — Externally and Locally. — Hops are sedative and astringent. Internally. — Digestive System. — The action of hops is similar to that of vegetable bitters, augmenting the secretions from the sali- vary and gastric glands, thereby promoting appetite and digestion. Circulatory System. — The heart's action is slightly increased, the remedy also raising arterial tension and exciting the cutaneous cir- culation. Nervous System. — Like opium, hops primarily stimulate the brain, and secondarily act as a mild soporific. These effects are increased if the preparation be an alcoholic one, such as beer. The hypnotic action is due partly to the volatile oil which the hops contain. Respiratory System. — They slightly stimulate the respiration. Absorption and Elimination. — ^The active principles of hops are chiefly eliminated by the skin and kidneys, increasing considerably the sweat and urine. NARCOTICS. 445 Temperature is unaffected. Untoward Action. — None is noticeable, although the drug pos- sesses marked aphrodisiac properties. Therapeutics. — Externally and Locally. — The sedative action of hops is utilized in what are known as hop poultices in superficial and abdominal infiammations , in orchitis, and as a preventive of chordee. A hop pillow is frequently employed to induce sleep and allay the pain of earache, while, if the pillow be moistened with weak vinegar and the fumes inhaled, the result is found to be efficacious in the treatment of inflammatory conditions of the upper respiratory passages. Internally. — Its stomachic and carminative properties render this remedy valuable in atonic dyspepsia, so called, and m flatulent colic. Preparations of hops are also useful in febrile restlessness. Priapism, perverted sexual appetite, spermatorrhea, etc. may be relieved by lupulin. The combined tinctures of lupulin and capsicum serve as ex- cellent substitutes for alcoholic stimulants during the treatment of alcoholism, as well as being useful remedies in mild attacks of delirium tremens. Administration. — Lupulin and oleoresin of lupulin are best given in pills and capsules respectively. The tincture and fluid extract should be administered in syrup. Lactucarium— Lactucarii— Lactucarium. TJ. S.JP. Origin. — The concrete milk-juice of Lactuca virosa L., a bien- nial rank-smelling herb growing in Europe. Description and Properties. — It occurs in sections of plano- convex, circular cakes, or in irregular, angular pieces, externally grayish-brown or dull reddish-brown, internally whitish or yellow- ish, of a waxy lustre, heavy, narcotic odor, and somewhat bitter taste. It contains lactucin, lactucopicrin, lactucic acid, lactucerin, and wax. Dose. — 5-60 grains (0.3-4.0 Gm.). Official Preparations. Tinctura Lactucarii — Tincturae Lactucarii — Tincture of Lactucarium. — Dose, J-2 fluidrachms (1.0-8.0 Co.). SJrupus Lactucarii — Syrupi Lactucarii — Syrup of Lactucarium. — Dose, i- 4 fluidrachms (4.0-15.0 Co.). 446 A TEXT-BOOK OF MATERIA MEDICA. Synergists. — The same as for opium. Physiological Action and Therapeutics. — Its action closely resembles that of opium, save that it is very feeble, in adults never producing alarming symptoms. It is slightly soporific and anodyne, and also diuretic, which properties, especially in the syrup form, render it of some value in cases of irritating cough, as well as in sleeplessness and nervousness of children. Lactucin may be given in doses of from i to 5 grains (0.06-0.3 Gm.) as a mild sedative and hypnotic. Cannabis Indica— Cannabis Indicae— Indian Can- nabis. TJ. S. I*. (Indian Hemp.) Origin. — The flowering tops of the female plant of Cannabis sativa L., grown in the East Indies. Description and Properties. — The article of commerce con- sists of bundles of a few flowers, the branches and bracts, and nearly ripe fruit, the whole more or less agglutinated by a resinous exudation. Of a brownish-green color, peculiar, narcotic odor, and slightly acrid taste. The drug contains a resin, cannabin, a brown, amorphous powder soluble in absolute alcohol, and a vola- tile oil. The crude drug is commonly called in India " gunjah." " Bhang," " siddhi," or " hashish," the term usually employed — from whose toxic effects, frequently inciting to murder, is said to be derived our word " assassin " — is another form of cannabis appearing as the Arabian confection prepared by mixing aromatics with fruits and dried leaves. Dose. — 2-5 "grains (0.12-0.3 Gm:). Official Preparations. Extractum Cannabis Indies — ExtrScti Cannabis Indicae— Extract of In- dian Cannabis. — Dose, J-i grain (o.oi5-o'.o6 Gm.). Extractum Cannabis Indicae Fliiidum — Extracti Cannabis Indicae Fliiidi — Fluid Extract of Indian Cannabis. — Dose, 3-6 minims (0.18-0.36 Co.). Tinctura Cannabis Indicse (15 per cent.)— Tincturae Cannabis fndicae— Tincture of Indian Cannabis. — Dose, 5-20 minims (0.3-1.2 Cc). Unofficial Preparations. ' Cannabine Tannate. — Dose, 2-10 grains (0.13-0.60 Gm.). Cannabinone. — Dose, J-I grain (0.03-0.06 Gm.). NARCOTICS. ^^y Antagonists and Incompatibles. — Strychnine, caustic alkalies, acids, and aqueous preparations are pharmaceutical incompatibles, precipitating the resin. Ssmergists. — ^Alcoholics, ether, bromides, cocaine, and members of the present group enhance its cerebral effects. Physiological Action. — Externally and Locally. — Its only local ' action is that of a feeble sedative. Internally. — Digestive System. — It is slightly sedative to the \ stomach, in many persons appearing to promote the appetite and / aid digestion. Its use is not followed by constipation or other i gastro-intestinal disturbance. Circulatory System. — A slight acceleration of the pulse is notice- ,1 able, probably due more to the stimulation of the nervous system ■j than to any direct action upon the circulatory apparatus. Nervous System. — Like opium, it primarily stimulates the brain, large doses producing a peculiar exhilaration and subsequent reac- tion more fully described under Poisoning. The period of excita- tion is more prolonged than with opium, but is eventually succeeded by sleep — almost always disturbed by dreams and spectral illusions. The coma resulting from cannabis is never so profound as in the case of opium. It is like the latter drug as an analgesic, but feebler in its action. It is unlike opium in producing a sensation of tingling and numb- ness, through its effect upon the sensory nerves, followed by cutaneous anesthesia, accompanied by muscular debility and fre- quently a cataleptic condition. Respiratory System. — No marked or uniform action upon the respiration has been observed, it being at times quickened and again retarded, though the effects are less pronounced than with opium. Absorption and Elimination. — Cannabis is slowly eliminated, though in what manner is unknown, the effects of the drug some- times persisting for twenty-four or thirty-six hours. Of all the secretions, the urine alone is affected, the amount being increased. Temperature. — Cannabis has no direct depressing action upon temperature, which, however, may rise during the period of excita- tion and be diminished somewhat during sleep. Eye. — The drug differs from opium in that it dilates the pupil and produces exaggerated vision. Uterus. — It is considered to be a powerful uterine stimulant, and like properties are usually ascribed to it as an aphrodisiac, though 448 A TEXT-BOOK OF MA TERIA MEDICA. its effect upon sexual desire is not always manifest. It undoubtedly increases the energy of the uterus, though possessing no power to inaugurate uterine contractions when once suspended. Untoward Action. — The uncertain effects of different prepara- tions, together with varying susceptibilities to the drug, render it almost impossible to cite any characteristic untoward symptoms. Certain of the effects described under Poisoning may be present even under small doses in persons having an idiosyncrasy against the remedy. Poisoning. — Large doses of cannabis Indica are wont to produce toxic effects which in their manifestations present a singular study of psychological phenomena, varying with the temperament and idiosyncrasies of the subject, yet in certain characteristics common to all who experience the full force of the drug. The transition from the influence of medicinal doses to that exerted by poisonous absorption is often gradual, many features of the conditions result- ing therefrom being strikingly similar. Moderate administration, however, is seldom attended by unto- ward effects, whereas toxic doses, in place of emotional delight — among the earlier sensations — develop an intensity of mental anxiety which even contemplates death as the inevitable issue of the malady. The buoyancy of spirit, the soothing calm and insouciance, the. ecstasy of an ethereal mood by which finer natures are swayed, — these have given place to a mental and physical oppression best described as " a sensation as of the brain boiling over and lifting the cranial arch like the lid of a tea-kettle." Not infrequently the blissful nirvana induced by moderate doses is rudely broken by an intemperate use of the drug, extreme vio- lence and even murderous thoughts supplanting calmer reveries and the intellectual solace of passive emotions. Especially is this true among Oriental nations— the Hindustanis, for example- addicted to excessive indulgence in bhang or hashish, the form of the drug generally employed, its effects upon the grosser passions rivalling those of opium among the Malays. Among the .most curious and striking of the psychological phenomena attending immoderate doses of hashish is the abolition of space and time. So manifold are the images which throng the imagination, and so rapid and intense the impressions made upon the mind, that the sense of proportion and the normal relations of material objects become wholly lost. Thus, the furniture in the room may appear infinitely removed to the distorted vision, while NARCOTICS. 449 a few seconds of time may be prolonged by the disordered fancy into hours, days, weeks, and even years. These hallucinations, strangest of all, are not accompanied by corresponding loss of reasoning power, the intellect taking cognizance frequently of the true relations of external things, as if aware of its own abnormal condition. Nor is volition seriously affected, the mental lesion, so to speak, existing rather in lack of coordination between con- sciousness and the imaginative faculty. These spasmodic or persistent hallucinations are often associated with a haunting sense of dual existence, in which all trace of per- sonal id,entity is for the time either obliterated or hopelessly con- fused. During a certain stage of poisoning, moreover, the conviction of impending death takes possession of the mind ; fear and des- peration seize upon the bewildered faculties, intensified by an im- pression of physical dissolution ; and the subject endures unspeak- able anguish, in which gloomy forebodings of disaster contrast terribly with the buoyancy, the temporary joy, and peals of laughter accompanying the earlier effects of the drug. Upon regaining his normal condition the hashish-eater is either wholly oblivious of the events which have transpired during the interval of intoxication, or recalls vividly the scenes and incidents through which he has passed. As in the case of opium, the pecu- liar influence of the drug is largely dependent upon temperament, sex, age, and idiosyncrasy. A refined and noble intellect, like De Quincey's, might readily be moved to gentler emotions and sensi- bilities suffused with human sympathy and love. A baser, more unfeeling nature might exhibit latent symptoms of ungovernable passion manifested in sensual or criminal conduct scarcely con- ceivable either to himself or to others. The physiological symptoms characteristic of cannabis-poisoning are well marked, the drug acting reflexly yet powerfully upon the mental state. Loss of consciousness, followed by collapse or stupor, or in some cases resulting in catalepsy and convulsions, in all cases complete anesthesia, and in very many a depression of the pre- cordium, a sensation of arterial contraction, and cardiac palpitation, are among the prominent features of the malady. The sight and hearing are perceptibly rendered more acute; the pupils are dilated,, although contracting to light ; the reflexes are lowered by stimu- lation of inhibitory centers ; and an oppressive sense of paralysis; in the extremities induces horror and despair. The urinary se- cretions are augmented, although constipation seldom occuirs, 29 450 A TEXT-BOOK OF MATERIA MEDICA. and a ravenous appetite almost invariably attends the toxic phe- nomena. Occasionally there is experienced great difficulty in breathing, as if the lungs were on the point of bursting. An increase of sexual desire is common, although the aphrodisiac properties of the drug are ' not always present. The after-effects of hashish indulgence vary with the physiolog- ical and mental peculiarities of the individual. As a rule, they are not disagreeable, though it requires time to eradicate the effects of the poison. Death directly attributable to the drug has not been recorded. Treatment of Poisoning. — Among antidotes, lemon-juice, coffee, and tobacco have been favorably mentioned. The best treatment appears to be similar to that adopted in cases of chloral- and opium-poisoning. Therapeutics. — Externally and Locally. — Cannabis is very seldom used locally, although it is an ingredient of a powder recommended by W. H. Beverly for insufflation in hay fever. Internally. — Cannabis has been discarded as a remedy in many disorders for which it was formerly used. It is, however, still employed to a considerable extent as an hypnotic in melancholia and mania and for its anodyne and anesthetic action in neuralgia and pruritus. As a uterine tonic and anodyne it has been found efficient, either alone or in combination with other medicines, in subinvolution, chronic metritis, dysmenorrhea, menorrhagia, etc. Probably there is no remedy superior to cannabis Indica in functional impotence, its action in this disorder being aided by com- bining it with ergot and nux vomica. It is a valuable adjuvant to cough-mixtures intended to relieve tickling or irritation of the throat, as well as to quiet the excessive cough of bronchitis or phthisis, being superior to opium in this respect, since it disturbs the stomach less and does not produce constipation. It has been used in spasm of the bladder, and in go7iorrhea and chordee it has been found to be a most valuable remedy. In considering the therapeutics of cannabis Indica reference should be made to its efficacy in migraine and headaches, particu- larly those present at the menopause. Although as a remedy for the former disorder cannabis has been largely superseded by the adoption of antipyrine and agents of its class, the old use of tine- NARCOTICS. 451 ture of gelsemium, combined with tincture of cannabis, serves an important purpose in aborting the distressing attacks of migraine. Administration. — The extract should be given in pill form ; the tincture and fluid extract, in an alcoholic menstruum. As has been already intimated, different samples vary greatly in strength ; it is therefore best to begin with the minimum dose until the force and quality of the preparation be ascertained. It is advisable to prescribe invariably the preparations of that particular manufacture which experience has shown to produce samples of uniform strength. The following drugs — Belladonna, Stramonium, Hyoscyamus, Duboisia, and Dulcamara — belong to the Solanacese, and are by some authors classed as Mydriatics, on account of their character- istic action on the pupil. It has been thought best in the present work to include them in the subdivision of Narcotics, because of their narcotic properties, utilized clinically in the treatment of dis- eased conditions. Belladonna is considered the type of the Mydriatic Narcotics, and claims the first attention. Two portions of the plant are used — ^the leaves and the root. Belladonnae Folia— Belladonnae Foliorum— Bella- donna Leaves. ?7. S. JP. Origin. — ^The leaves of Atropa Belladonna L., a nearly glabrous, herbaceous, perennial plant, from 4 to 6 feet (1.2-1.8 M.) high, bearing dark-purple, bell-shaped flowers and shining purplish- black berries of the size of a cherry. It is found in the woods, chiefly in the mountainous districts, of Central and Southern Eu- rope, and as far east as Asia Minor, Caucasia, and Central Asia. It is cultivated in Europe and in the United States to some extent, being known by the common name of " deadly nightshade." Description and Properties. — The leaves are from 4 to 6 inches (10-15 Cm.) long and about one-half as broad, broadly ovate, equilaterally narroWed into a petiole, tapering at the apex, entire on the margin, smooth, thin, the upper surface brownish- green, the lower surface grayish-green, both surfaces whitish punc- tate ; odor slight, taste bitterish and disagreeable. Belladonna leaves contain from 0.2 to 0.6 per cent, of atropine, the most important alkaloid, belladonnine (probably anhydro-atro- 452 A TEXT-BOOK OF MA TERIA MEDICA. pine), besides an alkaloid identical with hyoscyamine, duboisine, daturine, atropamine — sometimes present — and chrysatropic acid (scopaline). Dose. — 1-5 grains (0.06-0.30 Gm.). Official Preparations. Extractum BelladSnn^ Foliorum AlcohSlicum — ExtrScti Bellad6nnse Fo- liorum AlcohSlici — Alcoholic Extract of Belladonna Leaves. — Dose, J-| grain (0.008-0.048 Gm.). EmplSstrum BelladSnnaE (20 per cent.) — Empiastrum (ace.) BelladSnnae — Belladonna Plaster. — For external use. Formula: Alcoholic Extract of Belladonna Leaves, 200; Resin Plaster, 400; Soap Plaster, 400. Tinctura BelladSnnae Foliorum (15 percent.) — Tincturae BelladOnnae Folio- rum — Tincture of Belladonna Leaves. — Dose, 5-20 minims (0.3-1.2 Cc). Ungu6ntum BelladOnnae (10 per cent.) — Ungufinti Belladonnae — Belladonna Ointment. — For external use. Formula: Alcoholic Extract of Belladoipa Leaves, 10; Diluted Alcohol, 5; Ben- zoinated Lard, 85. Belladonnae Radix— Belladonnae Radicis— Bella- donna Root. TJ. S. J*. Description and Properties. — The root of Atropa Belladonna occurs in cylindrical, somewhat tapering, longitudinally wrinkled pieces, ^ inch to i inch (12-25 Mm.) thick; externally brownish- gray, internally whitish ; fracture nearly smooth and mealy, not radiating or showing medullary rays in the thicker roots, except in the layer near the bark ; nearly inodorous, of sweetish taste, after- ward bitterish and strongly acrid. The root contains the same constituents as the leaves, with -the exception of chrysatropic acid — which is wanting — and in addition a red coloring principle, atrosin, found also in the berries. Official Preparations. Extractum Bellad6nnse RSdicis Fluidum— Extract! Belladannae Radicis Fluidi— Fluid Extract of Belladonna V.ooX.—Dose, 1-3 minims (0.06-0.18 Cc). LinimSntum BelladSnnae (95 per cent.)— LinimSnti BelladSnnae— Bella- donna Liniment. — For external use. Formula: Camphor, 50; Fluid Extract of Belladonna Root, 950. The important alkaloid of belladonna is — AtropTna—AtropTnae— Atropine. V. S. JP. Description and Properties. — White acicular crystals, or a more or less amorphous white powder, odorless, having a bitter,. NARCOTICS. 453 acrid taste, gradually assuming a yellowish tint on exposure to air. Soluble in 130 parts of water, 3 parts of alcohol, 16 parts of ether, 4 parts of chloroform, and about 50 parts of glycerin. ^°s®- — 1^0 ' 4^0 ^rdin (o.cx)os-o.ooi6 Gm.). Atroplnae Sulphas— Atroplnae Sulphatis— Atropine Sulphate. JJ, S. JP. Description and Propertiee. — A white, indistinctly crystalline powder, odorless, having a very bitter, nauseating taste, permanent in air. Soluble in 0.4 part of water, 6.2 parts of alcohol, 3270 parts of ether, and 694 parts of chloroform. Dose. — ^ 2 ' id g""^'" (0.0005-0.0016 Gm.). HOMATROPINA HOMATROPIN^ HOMATROPINE. An unofficial and derivative alkaloid, obtained by the action of dilute hydrochloric acid on amygdalate of tropin. The hydrobro- mate of homatropine is used only as a mydriatic. Allied Plants. AtTOpa MandrSgoTa L., Mandrake, closely resembles Atropa Belladonna. It pos- sesses marked anesthetic properties, and contains a mydriatic alkaloid. It is especially interesting because of its ancient history, its action having been fully described by Dioscorides and Pliny. Historians and poets have alike celebrated its peculiar and wonderful properties. SciSpola CamiSlica and Scopola Japonica both resemble belladonna physically, and somewhat In their physiological action, the roots and leaves of these plants having been found mixed with those of belladonna. Antagonists and Incompatibles. — Muscarine antagonizes the action of belladonna in nearly every particular, and physostigmine, pilocarpus, and aconite counteract many of its effects. Opium an- tagonizes its action on the cerebrum, pupil, heart, respiration, arterial tension, and kidneys. Atropine is incompatible with caustic alkalies, tannin, and vege- table infusions containing tannin, an insoluble tannate of the alka- loid being formed. Ssmergists. — The mydriatic drugs mentioned above aid the action of belladonna. Physiological Action. — The action of belladonna is dependent upon the amount of atropine it contains. Externally and Locally. — When locally applied atropine is anodyne, antispasmodic, resolvent, antisecretory, and mydriatic. 454 A TEXT-BOOK OF MA TERIA MEDICA. When thus used, in combination with absorbable substances — such as alcohol, camphor, animal fats, glycerin, etc. — it diminishes the sensibility of the sensory nerves, and when absorbed from raw surfaces of the skin or from the subcutaneous tissue it is capable of producing systemic effects. Internally. — Digestive System. — Even small doses produce dry- ness of the mouth, owing to the greatly diminished secretion of saliva and mucus. The salivary secretion is lessened through paralysis of the peripheral endings of the chorda tympani nerve in the submaxillary gland. The drug probably diminishes the secretions from the stomach, liver, pancreas, and intestines in a similar manner. It is reasonable to suppose that it produces these effects, since it checks all other secretions, with the possible exception of the urine. The sweat is diminished through paralysis of the peripheral nerve-endings in the sudoriparous glands. The secretion of milk is reduced by paral- ysis of the peripheral terminations of the secretory nerves in the mammary glands. The secretion from the bronchial mucous mem- branes is lessened through the depressing influence of the drug upon the nerve-endings. The peristaltic movements of the intestines are increased by small doses, large doses checking them. The intestines contain a complicated nervous mechanism : 1. Auerbach's plexus, located between the muscular walls of the intestine, and possessing the function of maintaining rhythmical vermicular movements of the intestines. 2. Two sets of nerves — the accelerator and inhibitory, situated outside of the intestines, but connected with Auerbach's plexus, their function being to coordinate peristalsis. When a small dose of belladonna is administered it paralyzes the peripheral terminations of the inhibitory nerves, so that, the inhibition being interfered with, peristalsis is increased. On the other hand, a large dose paralyzes Auerbach's plexus, interfering with the transmission of impressions from the accelerator nerves to the intestinal walls, thereby diminishing peristalsis. The action of belladonna, therefore, upon the intestines may at first sight appear paradoxical, its tendency being to remove constipation and to check diarrhea, although a correct understanding of the matter will serve as a rational explanation of these apparently contradictory effects. Circulatory System. — Medicinal doses of atropine or belladonna - at first retard the pulse, but it is quickly accelerated and rendered NARCOTICS. 455 firmer, with increased arterial pressure. The primary transitory action is 4ue to a sHght stimulation of the vagi roots, the subse- quent quickening of the pulse resulting from depression of the peripheral ends of the pneumogastric nerve distributed in the car- diac muscle. The inhibition being thus removed, the heart re- sponds to the influence of the accelerator nerves. The center for these nerves in the medulla is also stimulated by the drug, increas- ing still further the rapidity of the heart's action. The cardiac muscle itself, being stimulated, renders the contractions of the heart more forcible. Arterial tension is increased not only by the greater rapidity and force of the heart, but also by the contraction of the arterioles arising from stimulation of the vaso-motor center. Very large or poisonous doses lower arterial pressure. This effect is produced by exhaustion of the vaso-motor center from over-stimulation, resulting in dilatation of the cutaneous arterioles, which lowers arterial tension and flushes the skin. Overwhelming doses may weaken the cardiac muscle itself from over-stimulation, weakening the heart's contractions, as well as paralyzing the terminal nerve- filaments in the muscles of the vessel-walls, and even the muscular fibers. Nervous System. — A full medicinal dose of belladonna stimulates the brain, while large doses — and, in susceptible persons, medicinal ones — may produce hallucinations and delirium, accompanied by spectral illusions. The delirium may be mild, joyful, and talkative, or it may assume a violent type. It may, moreover, persist for a long time, after which the patient sinks to sleep, induced either by exhaustion from the delirium or a secondary depressing action of the drug. True coma, like that produced by opium, rarely if ever occurs. The spinal cord shares in the stimulation caused by belladonna. The reflexes are at first slightly exaggerated, being afterward diminished. Very often under poisonous doses there is complete motor paralysis, the loss of power occurring first in the lower extremities. The sensory nerves are depressed, especially when the drug is locally applied, the influence being exerted on their terminal fila- ments. For this reason belladonna is of little service as an ano- dyne when given internally. Respiratory System. — Medicinal doses quicken and deepen the respirations, owing to stimulation of the respiratory center. The I i 456 A TEXT- BOOK OF MATERIA MEDIC A. peripheral nerve-filaments of the pulmonary vagi are, however, depressed ; which, were it not for the increased action of the center, would retard respiration. Poisonous doses over-stimulate, and consequently exhaust or paralyze, the respiratory center, the result being slow and shallow breathing or perhaps death from asphyxia. Absorption and Elimination. — Atropine is rapidly absorbed and eliminated, chiefly by the kidneys, but also to some extent by the bowels. It is said that part of the drug is destroyed by the liver. Te^nperature . — Large doses increase bodily heat, probably by increasing the circulation and respiration, consequently augmenting combustion. Some authors maintain that belladonna stimulates the heat-center. In cases of severe poisoning from the drug the temperature rapidly falls. Eye. — Belladonna dilates the pupil, whether locally applied or taken internally, its effect differing from that of cannabis Indica in that the pupil cannot be made to contract by stimulation of the third nerve, although excitement of the muscle itself causes pupil- lary contraction. The manner in which atropine dilates the pupil is not yet satisfactorily explained, the prevailing opinion being in favor of Jessup's theory that the action is due to a stimulation of the ends of the sympathetic nerve-filaments distributed to the iris, and paralysis of the peripheral ends of the oculo-motor nerves. Atropine increases intraocular tension, rendering it a dangerous drug in glaucomatous conditions. Untoward Action. — Very frequently there appears, especially in children, an erythematous or scarlatinal eruption, oftener noticeable on the face and neck, but sometimes affecting the entire surface of the body. Redness and pain in the throat may also be present, but no fever, with itching of the skin or desquamation. Occasionally instillation of atropine into the eye produces pro- fuse lacrymation, edema of the eyelids, and blepharo-conjunctival irritation. When taken internally in medicinal doses it sometimes occasions in certain persons vertigo, turgescence of the face, hallucinations, erethistic debility, and impaired assimilation. Homatropine has caused dizziness, uncertainty of gait, fatigue', difficulty in deglut4^ion, and loquacious delirium. Poisoning. — The poisonous actions of belladonna may be sum- marized as follows : The skin is dry and hot; the conjunctivae are congested, with. NARCOTICS. 457 possibly, edema of "the eyelids and pupils widely dilated; the face is swollen, while the whole body may be covered with an erythem- atous rash, and there is a sensation of heat and pain in the throat and difficulty in swallowing. Rapid respirations, muscular weakness, and incoordination of movements appear ; the patient becomes dizzy or mildly or violently delirious, continually talking, shouting, or laughing. While there is a constant desire to micturate, there is an inability to pass any urine. At this stage the respirations are slow and shallow. Finally, convulsions may occur, and the patient sink into a coma- tose condition and die from asphyxia and cardiac exhaustion. Treatment of Poisoning. — Wash out the stomach with solutions of tannic acid, pursuing the treatment with the cautious adminis- tration of physostigmine, opium, or the hypodermic injection of pilocarpine. Should cardiac failure be pronounced or the patient lapse into a state of stupor, stimulants and the subcutaneous injec- tion of caffeine are indicated, the patient being aroused meanwhile and kept awake if possible, respiration being maintained by the use of strychnine and by artificial means when necessary. Should the temperature fall below normal, external heat must be applied. Atropine compared with Morphine. Atropine stimulates respiration ; morphine is a powerful respi- ratorj"- depressant. Atropine dilates the pupil ; morphine contracts it. Atropine increases bodily heat, and frequently reddens the surface of the skin ; morphine produces pallor of the skin and lowers temperature. Atropine augments peristaltic movements of the bowels ; mor- phine checks them. Atropine reinforces the functional activity of the kidneys ; morphine lessens it. On the other hand, atropine checks the secretion from the skin, while morphine increases it. The remaining secretions are diminished by both drugs, but in different ways. Atropine, for instance, checks secretion by depress- ing the peripheral terminations of the secretory nerves ; morphine, by depressing the secretory center in the medulla. Both drugs depress the sensory mechanism, yet again by differ- ent actions, atropine depressing the function of the sensory nerve- terminations, and morphine depressing the center mainly, although to some extent influencing the entire sensory tract. Atropine acts rather as a cerebral excitant, producing delirium, hallucinations, and disturbed sleep ; morphine is more of a cerebral 458 A TEXT-BOOK OF MATERIA MEDIC A. depressant, the period of mental excitation being comparatively- brief, while sleep is longer and more profound. In medicinal doses atropine contracts the arterioles ; morphine dilates them. Again, while morphine, like atropine, causes the heart to beat faster and stronger, it is by no means so powerful a cardiac stimulant as atropine. In many respects these drugs are mutually synergistic. Both relieve pain, though morphine is much the more powerful anodyne. Both cause incoordination of muscular movements and mental confusion. Although in many respects antagonistic, they are frequently- combined when an anodyne action is desired. As has been forcibly suggested, their reciprocal influence, when administered together, modifies in a remarkable manner their physiological effects. Therapeutics. — The many uses for which belladonna has been employed would render it a difficult, perhaps useless, task to enumerate them. As in the case of opium, there are cer- tain general and important actions in disease which the physician can utilize in daily practice, a succinct mention of which is ap- pended : 1. Belladonna is serviceable in relaxing spasms of invol- untary MUSCLES, as in asthma, spasmodic colic, lead colic, spasmodic dysmenorrhea, laryngismus stridulus, etc. 2. In DIMINISHING SECRETION, as in acute coryza, bronchitis, night- sweats of phthisis, and to check the secretion of milk, mercurial ptyalism, etc. 3. In RELIEVING PAIN, either combined with opium or morphine, or alone, particularly where it can be applied locally, as in lumbago, neuralgia, pleurodynia, etc. 4. Belladonna is used to stimulate the circulatory system in cases of a weak heart and low arterial tension, as in fevers, etc. 5. For its peculiar action upon the eye in ophthalmo- LOGicAL practice, to dilate the pupil, prevent adhesion, remove congestion, relieve pain, and afford rest. While, as has been said, it is impossible to mention in detail the manifold uses of belladonna, its more important therapeutic services may be here mentioned : Externally and Locally. — Belladonna ointment is useful in the treatment of boils, carbuncles, chronic inflammatory conditions about the articulcflions, chronic synovitis of the kneefoint, its efficiency in the latter condition being enhanced by combining it with mercurial NARCOTICS. 459 ointment. Orchitis is greatly relieved by covering the testicle with belladonna ointment. Suppositories containing extract of bella- donna are beneficial in the treatment of hemorrhoids and in anal fissure. A rigid os may be made to dilate, hastening delivery, by smearing the cervix with the ointment of this drug. Eczema and excessive sweating of certain areas of the skin, such as the palms and soles, are benefited by a local application of the tincture or the dried and powdered extract mixed with some inert desiccant powder like powdered talcum. Belladonna plaster is one of the most useful applications in cases of acute or chronic muscular rheumatism, and in certain forms of neuralgia. In its power to arrest the secretion of milk the drug is perhaps without an equal. Should inflammation have already set in and the breasts be swollen and painful, the ointment is to be applied and the breasts covered with hot flaxseed poultices, the parts being entirely supported by wide bandages. Internally. — Belladonna is combined with opium to relieve the pain of gastralgia and enteralgia, while its combination with strych- nine and iron is useful in anemic neuralgia. Next to bromoform, it is the most efficient remedy in whooping cough; the spasmodic manifestations of hysteria are also favorably affected by full doses of tincture of belladonna. Nocturnal incontinence of urine in children, when resulting from supersensitiveness of the mucous membrane of the bladder, derives signal benefit from this drug. By depressing the ends of the sen- sory nerves distributed to the bladder belladonna prevents the irri- tation of the accumulated urine from being conveyed to the center in the cord, and from there reflexly exciting the detrusor muscle of the sphincter and causing micturition. Belladonna combined with strychnine stimulates the respiration and checks the sweating in phthisis. A similar union with some laxative drug makes an exceedingly useful pill in habitual constipa- tion, while the obstinate constipation due to lead-poisoning \?, greatly relieved by belladonna. This drug, as well as the other mydriatic narcotics, is one of the most reliable remedies we possess to relieve the symptoms of spas- modic asthma. It is highly recommended also by many physicians in typhoid fever to support the circulation and relieve many dis- tressing symptoms of the disease. In scarlatina, too, it is thought to be a useful remedy. Cardiac pain and distress due to over-action of the heart are 460 A TEXT-BOOK OF MATERIA MEDIC A. alleviated by the application of belladonna plaster over the cardiac region or by the internal use of the drug. Intestinal, hepatic, and renal colic, cystitis, prostatitis, spermator- rhea, exophthalmic goiter, cerebral and spinal hyperemia, sea-sickness, facial erysipelas, and menorrhagia have all apparently been favor- ably influenced by belladonna. Atropine subcutaneously injected is a powerful antidote to clilo- roform-, physostigma-, aconite-, and jaborandi-poiso7ting, as well as that contracted from toadstools. Administration. — The crude drug, leaves, and root are seldom if ever used. Owing to its action in diminishing secretion, it is better to time the internal administration of belladonna so as to interfere as little as possible with the process of digestion. Children are peculiarly insusceptible to this drug, tolerating even larger doses than adults. When atropine is used hypodermically in cases of sciatica or neuralgia, the injection should be made deeply in 'close proximity to the affected nerve-trunk. The part of the body to which a belladonna plaster is to be applied should be first thoroughly cleansed and dried, the exact area to be covered being specifically designated by the physician. Caution should be exercised in the application, lest too large a space be covered by the plaster and dangerous symptoms super- vene from absorption of its more active constituents, a result which may also occur from too prolonged contact, from three to five days being usually sufficient. Should it be desirable to continue the influence of the drug, the application of fresh plaster from time to time will produce better results than too long use of a single one. Stramonii Folia— Stramonii Foliorum— Stramonium Leaves. TJ. S. I*. (Thorn-apple; Jamestown or Jimson Weed.) Origin. — The leaves of Datwa Stramonium L., a coarse-look- ing annual weed, believed to be a native of Asia, but found grow- ing in waste places and along roadsides throughout the greater part of the world. Description and Properties.— From 3 to 8 inches (7-20 Cm.) long, petiolate, dark-green, smooth, ovate, pointed, unequal, espe- cially at the base, coarsely and sinuately toothed ; thin, brittle and nearly inodorous ; taste unpleasant, bitter and nauseous. Stramo- NARCOTICS. 461 nium leaves contain about 0.2 per cent, of a mixture of atropine and hyoscamine known as daturine. Dose. — 1-5 grains (0.06-0.3 Gm.). Stramonii Semen— Stramonii Seminis— Stramo- nium Seed. U. S. JP. Origin. — The seed oi Datura Stramonium L. Description and Properties. — About \ inch (4 Mm.) long, reniform, flattened, pitted and wrinkled, testa dull brownish-black, hard, enclosing a cyhndrical, curved embryo imbedded in a whitish, oily perisperm ; of an unpleasant odor when bruised, and of an oily and bitter taste. The seeds contain a larger proportion of daturine than the leaves, besides scopalimine, resin, fixed oil, etc. . Dose. — 1-3 grains (0.06-0.2 Gm.). Official Preparations. ExtrSctum Stramonii S£tninis — ExtrScti Stramonii S&minis^ — Extract of Stramonium Seed. — Dose, J-J grain (0.02-0.03 Gm.). ExtrSctum Stramonii S6minis Fliiidum — ExtrScti Stramonii Sfeminis Fluidi — Fluid Extract of Stramonium Seed. — Dose, 1-3 minims (0.06-0.2 Cc). Tinctiira Stramonii S6minis — Tinctjirse Stramdnii SSminis — Tincture of Stramonium Seed (:5 per cent.). — Dose, 5-10 minims (0.3-0.6 Cc). UnguSntum Stramonii — Ungu6nti Stramonii — Stramonium Ointment (10 per cent, of extract). — For external use. Antagonists and Incompatibles and Synergists are the same as for belladonna. Physiological Action. — The action of stramonium is almost identical with that of belladonna, the main difference being the influence of stramonium upon the sympathetic system, the motor and sensory nerves being less powerfully affected than by bella- donna. Stramonium is more apt to occasion irregular action of the heart, and the involuntary muscle-fibers of the bronchial tubes are relaxed more by stramonium than by belladonna. It usually occasions more delirium and is more of an aphrodisiac than bella- donna. Poisoning and Treatment of Poisoning are precisely the same as described under Belladonna. Therapeutics. — The medical uses of belladonna are applicable to this drug, although stramonium is much the better remedy in spasmodic asthma. The stramonium ointment appears to be 462 A TEXT-BOOK OF MA TERIA MEDICA. superior to that prepared from belladonna as an application to painful hemorrhoids. Administration. — No special directions are necessary, any of the preparations being serviceable. For asthma the leaves may be smoked in a pipe or in the form of cigarettes, this method of em- ploying the drug to relieve bronchial spasm being probably superior to internal administration. Hyoscyamus— Hyoscyami— Hyoscyamus. TJ. S. P. (Henbane.) Origin. — The leaves and flowering tops of Hyoscyamus niger L., collected from plants of the second year's growth. Henbane is a biennial growing in sandy soil and waste places throughout the greater portion of Europe and Asia, and naturalized in North America. Description and Properties. — Leaves ovate or obovate-oblong, up to 10 inches (25 Cm.) long and 4 inches (10 Cm.) broad; sinu- ate-toothed, the teeth large, oblong, or triangular ; grayish-green, and, particularly on the lower surface, glandular-hairy; midrib prominent ; flowers nearly sessile, with an urn-shaped, five-toothed calyx and a light-yellow, purple-veined corolla ; odor heavy, nar- cotic ; taste bitter and somewhat acrid. The active constituents are hyoscyamine and hyoscine, and a very poisonous volatile oil is obtained by distillation of the leaves, which contain also a small percentage of potassium nitrate. Dose of the Leaves. — 5-15 grains (0.3-1.0 Gm.). Official Preparations. Extractum Hyoscyami — ExtrScti Hyoscyami — Extract of Hyoscyamus. — Dose, 1-3 grains {0.06-0.2 Gm.). Extractum Hyoscyami FlQidum — Extract! Hyoscyami Fluidi — Fluid Ex- tract of Hyoscyamus. — Dose, 5-15 minims (0.3-1.0 Co.). Tinctiira Hyoscyami — Tincturae Hyoscyami — Tincture of Hyoscyamus (15 per cent.). — Dose, 10-60 minims (0.6-4.0 Cc). Hyoscinae Hydrobromas— HyoscTnae Hydrobro- matis— Hyoscine Hydrobromate. JJ. S. -P. Origin. — The hydrobromate of an alkaloid obtained from Hy- oscyamus. Description and Properties. — Colorless, transparent, rhombic crystals, odorless, and having an acrid, slightly bitter taste ; perma- NARCOTICS. 463 nent in the air. Soluble in i .9 parts of water and in 1 3 parts of alcohol. It should be kept in small, well-stoppered vials. Dose. — r^^p-^ grain (0.0006-0.001 Gm.). Hyoscyamlnae Hydrobromas— Hyoscyamlnae Hy- drobromatis — Hyoscyamine Hydrobromate. V. 8. P. Origin. — The hydrobromate of an alkaloid obtained from Hy- oscyamus. Description and Properties. — A yellowish-white, amorphous, resin-like mass or prismatic crystals, having, particularly when damp, a tobacco-like odor and an acrid, nauseous, and bitter taste. Deliquescent on exposure to the air ; soluble in about 0.3 part of water and 2 parts of alcohol. It should be kept in small, well- stoppered vials. ' Dose. — r^^y— rir grain (0.0006-0.0015 Gm.). Hyoscyami Sulphas— Hyoscyami Sulphatis— Hyos- cyamine Sulphate. ?7. S. F. Origin. — The neutral sulphate of an alkaloid obtained from Hyoscyamus. Description and Properties. — White, indistinct crystals or a "white powder, without odor, and of a bitter, acrid taste ; deliques- cent in damp air. Soluble in 0.5 part of water and 2.5 parts of alcohol. It should be kept in small, well-stoppered bottles. Dose. — i^ a - ib grain (0.0006-0.0015 Gm.). Antagonists, Incompatibles, and Synergists the same as for belladonna. Physiological Action. — The action of hyoscyamus is analo- gous to that of belladonna, with the following differences : 1. Hyoscyamus increases the peristaltic action of the intestines more than belladonna, while at the same time it is more efficient in relieving the griping and pain occasioned by the rougher cathartics. 2. It is less powerful than belladonna as a cardiac stimulant, though stronger than stramonium. 3. It does not occasion nearly so much mental excitement as belladonna, on account of the hyoscine it contains, which is a powerful hypnotic and cerebral and spinal sedative. 464 A TEXT-BOOK OF MA TERIA MEDICA. 4. As a urinary sedative hyoscyamus is greatly superior to belladonna. 5. It differs from belladonna in affecting the respiration less powerfully. Untoward Action, Poisoning, and Treatment of Poisoning are the same as for belladonna. Therapeutics. — Hyoscyamus may be used for the same pur- poses as belladonna, but is considered superior to the latter drug as a urinary sedative in the treatment of incontinence of urine^ vesical tenesmus, cystitis, prostatitis, etc. For the relief of colic of various forms, and to allay the griping produced by certain purgatives, hyoscyamus is better than bella- donna. In mental and convulsive diseases, such as delusional insanity,, delirium tremens, acute and febrile mania, insomnia, chronic dementia^ hysterical convulsions, chorea, paralysis agitans, etc., hyoscyamus,. particularly hyoscine, is superior to belladonna. Hyoscyamus and its alkaloids are fully equah to belladonna in the treatment of asthma, whooping cough, neuralgia, enteralgia, etc. As an anodyne and hypnotic for children hyoscyamus is safer than, and frequently as efficient as, opium. Contraindications.— The same as for belladonna. Administration. — Like belladonna, this drug should be admin- istered tentatively. Any of the preparations may be given. The salts of the alkaloids may be administered either subcutaneously or internally. The hyoscine is tasteless, and may be easily given in various, drinks. When used internally its action is slower, but more pro- longed, than when given hypodermically, though the dose under the former method should be twice that of the latter. GROUP VI.— MOTOR EXCITANTS. The drugs belonging to this group excite the functional activity of the spinal cord and the sympathetic nervous system. They serve to stimulate muscular contraction and the functional opera- tions of the heart, lungs, and secretory apparatus. It is difficult to separate by sharply-defined limits the remedies having these actions, and group them according to their analogous therapeutic uses. MOTOR EXCITANTS. 465 In the present group, for instance, are placed ergot and gossyp- ium, chiefly used for their action upon the uterus, while those drugs which, although excito-motors, are employed principally for their action upon the circulatory system are placed in the group. Cardiac Stimulants. The motor excitants are exceedingly valuable remedies, the typical member of the group being Nux Vomica, and therefore first considered. Nux Vomica— Nucis Vomicae— Nux Vomica. JJ. 8. P. Origin. — The seeds of Strychnos Nux Vomica L., a small tree common in many parts of Hindustan, Farther India, some of the East Indies, and in some parts of Australia. Description and Properties. — Nux vomica is about i inch (25 Mm.) in diameter, orbicular, grayish or greenish-gray; soft- hairy, of a silky luster, with a slight ridge extending from the center of one side to the edge ; internally horny, somewhat trans- lucent, very tough, with a large circular cavity, into which the heart-shaped, nerved cotyledons project. It is inodorous and per- sistently bitter. Nux vomica contains two important alkaloids — strychnine and brucine, the former being in excess. The seeds also contain iga- suric acid, with which these alkaloids are combined. Of total alkaloids the drug should contain from 2.5 to 5 per cent. Dose. — 1-5 grains (0.06-0.3 Gm.). Official Preparations. ExtrSctum Nucis Vttmicse — ExtrScti Nucis VSmicae — Extract of Nux Vomica. — Dose, |-J grain (0.008-0.03 Gm.). ExtrSctum Nucis VOmicae Fliiidum — ExtrScti Nucis VSmicae Fliiidi — Fluid Extract of Nux Vomica. — Dose, 1-5 minims (0.06-0.3 Cc). Tinctiira Nucis V&micavTincturse Niicis Vttmicae — Tincture of Nux Vomica. — Dose, 5-20 minims (0.3-1.2 Cc). Strychnina—StrycFinlnse— Strychnine. V. 8. P. Origin. — An alkaloid obtained from Nux Vomica, and also derived from other plants of the natural order Loganiacece. Description and Properties. — Colorless, transparent, octahedral or prismatic crystals, or a white, crystalline powder, odorless and having an intensely bitter taste, perceptible even in highly dilute (i to 700,000) solution. Permanent in the air. Soluble at 15° C. 30 466 A TEXT-BOOK OF MA TERIA MEDIC A. (59° F.) in 67(X) parts of water, in no parts of alcohol, in 2500 parts of boiling water, and in 12 parts of boiling alcohol; also soluble in 7 parts of chloroform, but almost insoluble in ether. Dose. — ^Vt^ grain (0.001-0.004 Gm.). Strychnine enters into the following preparations : FSrri et Strychninae CJtras. Syrupus F6rri, Quinlnae et Strychninae Phosphatum. (See Ferrum, page 185.) Strychninae Sulphas— Strychninae Sulphatis— Strychnine Sulphate. V. 8. P. Description and Properties. — Colorless or white, prismatic crystals, odorless, and having an intensely bitter taste, perceptible even in highly dilute (i in 700,000) solution. Efflorescent in dry air. Soluble at 15" C. (59° F.) in 50 parts of water and in 109 parts of alcohol ; also soluble in 2 parts of boiling water and 8.5 parts of boiling alcohol. Almost insoluble in ether. Dose. — ii--i6 grain (0.001-0.OO4 Gm.). Antagonists and Incompatibles. — Chloral, tobacco, potassium bromide, chloroform, and ether antagonize the toxic action of strychnine, the first-named drug being the best antagonist. Phy- sostigma, curare, conium, opium, hydrastine, and oil of chamomile are also antagonistic. The incompatibles are tannic acid, bromides, iodides, and chlo- rides. Synergists. — The motor excitants, ergot, ustilago, electricity, and cold. Physiological Action. — Since strychnine fully represents the physiological action of nux vomica, that of the former is here given. Externally and Z(?- ~"'^Sk"- SI^Hlfe ^Hffi^v' ' l^_^ fe? '■''' J £SHS('^^^^A li^^ 1^1 ^H ■B ^^^ ■'"''■' -y/'-'-"'-' "Wf^ H| H^^?^^P^4 ,; ,,;,^j. :.4^. H| ■1 i^Hlut'^f^^.^V. .'./. Strychnine-poisoning. MOTOR EXCITANTS. 469 Absorption and Elimination. — Strychnine is rapidly absorbed and slowly excreted, and consequently accumulates in the system. It is eliminated mainly by the kidneys, appearing in the urine as strychnine and strychnic acid, a product of oxidation. The sali- vary and cutaneous channels share in the excretory process. Temperature. — Ordinary doses have little or no effect upon tem- perature, but toxic doses, by producing spasms and tetanic convul- sions, raise arterial pressure, thereby increasing bodily heat. Eye. — The general nervous stimulation produced by strychnine affects the mechanism of the eye, vision, as has been remarked, being rendered more acute. Uterus. — Strychnine exerts some influence upon the muscular uterine tissues and assists the catamenia. Untoward Action. — Certain peculiar manifestations, having but slight resemblance, or none vi^hatever, to the characteristic symp- toms of poisoning, have followed the ingestion of small doses of strychnine, such as the presence of a scarlatiniform eruption; cramps followed by perspiration, resembling in some respects the tertian type of intermittent fever ; redness of the eyes ; formication ; a peculiar heaviness and stiffness of the limbs ; persistent and painful priapism ; and gastric uneasiness. Children are exceedingly susceptible to the untoward effects of strychnine, its administration requiring extreme caution. The author, however, is familiar with a case resulting beneficially in the practice of Dr. Alfred C. Cotton of Chicago, when -^ grain (0.036 Gm.) of strychnine sulphate was given hypodermically every three hours to a child three years of age seriously ill with pneu- monia. Such heroic dosage is nevertheless seldom advisable. Poisoning. — As is the case with other active poisons, strychnine in lethal doses produces varying effects dependent upon tempera- ment, idiosyncrasy, and physiological conditions. Generally speak- ing, the absorption of large doses is followed by rigidity of the lower maxillary, dilatation of the pupils, increased action of the reflexes, and spasmodic and distressing muscular contraction, affect- ing the extensors particularly. Finally, the respiratory muscles are affected with tetanic rigidity, death resulting from asphyxia. In many cases the earliest symptoms of poisoning are restlessness and anxiety, twitching of the muscles, and stiffness of the neck. Spinal convulsions are manifested, the patient assuming the position of opisthotonos, so that he rests upon his head and his heels. The slightest external irritation at this stage, even a movement 470 A TEXT-BOOK OF MA TERIA MEDICA. of the bed-clothes, is sufficient to cause a recurrence of convulsions. Notwithstanding these grave symptoms, the mind remains unaf- fected until carbonic-acid poisoning sets in, and the stomach is usually retentive. Accompanying the usual symptoms in cases of acute poisoning is the distortion of the features, which assume a ghastly grin {risus sardonicus). The action upon the genito- urinary tract is quite marked, involuntary ejaculations of semen frequently taking place, together with incontinence of urine. The earlier paroxysms attendant upon the effects of the drug are seldom fatal, but in the intervals of repose the patient's mind is oppressed with a sense of impending dissolution, intensified by each renewed access of spasm and increasing severity of pain. Treatment of Poisoning. — Emetics and cleansing of the stomach are naturally of the first importance. Animal charcoal and tannic acid should be freely administered, while copious anal injections containing potassium bromide and chloral are often efficacious in relieving the spasms. Amyl-nitrite inhalations may prove serviceable as an aid to restore failing respiration when artificial means are required. The chemical antidote to strychnine is tannin, which should be given immediately, perhaps best in the convenient form of strong, unstrained decoctions of tea or coffee, the stomach being subse- quently well cleansed. Catheterism should be performed frequently to favor elimination, care being taken not to create a recurrence of spasm and consequent convulsions, which may often be obviated by the use of nitrite of amyl or chloroform. The bowels should be evacuated, croton oil per rectum, being an efficient agent. As has been stated, potassium bromide, chloral, and physostig- mine are serviceable physiological antidotes. Opium and conium may also be used to counteract the effects of the drug. Paralde- hyde has been preferred to chloral, and tobacco and alcohol have been suggested, even in heroic doses, should the malady refuse to yield to other remedial agents. Therapeutics. — Externally and Locally. — M. Mackenzie has rec- ommended strychnine in ^j^- ^^ grain (0.0027-0.004 Gm.) doses in some harmless and inert medium as an insufflation in anosmia, and lint saturated with the tincture of nux vomica and applied to the perineum has been advised in incontinence of urine. Internally. — There is no more efficient remedy in atonic dys- pepsia than nux vomica or strychnine. Both possess all the prop- erties of the simple bitters, besides stimulating the nerve-centers. MOTOR EXCITANTS. 471 rendering the co-ordination of the digestive process more perfect and enabling the stomach to respond more readily when the stim- ulus of food is applied to it. The gastric catarrh of inebriates is especially benefited by this drug, which also serves a useful purpose in the vomiting of preg- nancy and of phthisis. Its tonic action upon the intestinal muscles renders it an invalu- able remedy in habitual constipation, atonic diarrhea, and prolapsus of the rectum, the latter condition being frequently observed in children and aged persons, especially the latter, who are often men- tally depressed by this infirmity, and who are relieved by strych- nine, either given internally or injected as a solution into the sub- cutaneous tissue of the rectum, toning up the muscles and at the same time stimulating the cerebrum, relieving the melancholia and inspiring the patient with hope. Strychnine is a most valuable cardiac tonic, having a marked action on the cardiac nervous system. In pneumonia, typhoid fever, and other diseases accompanied by dyspnea and feeble heart-action no more valuable drug can be employed. It differs from alcohol and other cardiac stimulants in that its use is not followed by depression. The hypodermic injection of full doses of strychnine ordinarily renders the pulse full and strong, even when it is scarcely perceptible and death appears imminent. Many clinicians have un- doubtedly tided pneumonic patients over the critical period by the heroic use of strychnine, when, but for the drug, they would have died. The functional irregularity of the heart's action accompany- ing hysteria, hypochondriasis, and pregnancy is greatly relieved by moderate doses of tincture of nux vomica. As a tonic in chlorosis and anemia strychnine is an esteemed rem- edy, being, in the author's opinion, the best we possess in general efficiency. It improves the appetite, prevents putrefactive changes, and aids digestion, thereby enabling the patient to partake of and assimilate more nutriment. It also increases the force of the heart, quickens the circulation, and raises arterial tension, nourishing all parts of the body and rendering the condition more favorable for oxidation in the tissues and for the removal of waste products. The amount of urine is increased, constipation is relieved, and thus elimination of these products facilitated. Oxidation is further enhanced by the increased respiratory movements, rendering the blood richer in oxygen and increasing the number of the red corpuscles. 473 A TEXT-BOOK OF MA TERIA MEDICA. The potent action of strychnine upon the nervous system stimu- lates the spinal cord, giving the patient greater strength, and, by invigorating the brain, animating him with cheerfulness and con- fidence and a disposal to exercise. Strychnine, then, is at once a gastric, vascular, nervous, mus- cular, and respiratory tonic, being an invaluable remedy in debility from any cause. In bronchial and neurotic asthma, as well as in many forms of neuralgia, particularly the visceral variety, the drug is an efficient remedy. In bronchitis also, and to relieve the coughs of neurotic origin, it is of great value. Paralysis of spinal on^m— paraplegia, etc. — and hemiplegia pre- vious to degeneration, with complete relaxation of the muscles, are benefited by strychnine, although in the latter affection it is of little if any value in recent cases or when the muscles do not respond to the electric current. The sphincters of the body, although belonging to the unstriped muscles, are more or less under the control of the will ; still, when there is an atonic condition of these structures, as in incontinence of urine, due to weakness of the sphincter, strychnine is a very powerful remedy. For the same remedial properties it is equally valuable in retention of urine when the detrusor muscle is too weak to empty the bladder. Probably no other drug equals strychnine in diphtheritic paraly- sis, the form of the disease most benefited by the remedy. It is of use, however, in all varieties oi functional paralysis, such as those resulting from hysteria, mental emotion, alcohohsm, venereal ex- cesses, the abuse of opium, lead-poisoning, gout, rheumatism, concussion of the spinal marrow, etc. Jewell claims that strychnine has caused an improvement in myelitis after the failure of other remedies. The weak and semi-paralyitic condition sometimes induced by bromides is improved by strychnine. The drug has found a few supporters in the treatment of tetanus, epilepsy, tic douloureux, and chorea, though it has not been gener- ally adopted as a remedy in these diseases. Strychnine is exceedingly efficacious in amaurosis due to exces- sive use of alcohol or tobacco, being also valuable in paresis of the ocular muscles. Night-blindness is also greatly benefited by this drug. It is of undoubted merit in delirium tremens, as well as in pre- MOTOR EXCITANTS. 473 venting the usual effects of alcoholic intoxication ; in fact, the drug is one of the best remedies in the treatment of alcoholism, the strychnine nitrate being usually employed, hypodermically. Ac- cording to the best authorities on dipsomania, strychnine seems to be a true antagonist to the untoward action of alcohol, and it is probably the important constituent of the numerous " cures " for the alcohol habit. No less valuable is strychnine in the treatment of acute poisoning by chloral, morphine, and physostigmine. As an aphrodisiac it is of unquestioned value in functional sper- matorrhea, and it is thought to produce contractions of the gravid uterus and cause abortioti or premature delivery. When a predis- position to post-partum hemorrhage exists, the administration of strychnine may prove of great service. Finally, strychnine has been highly recommended in the night- sweats of phthisis and in diabetes m.ellitus. Contraindications. — Strychnine is contraindicated or of no value in true voluntary muscular paralysis, where the region is : directly under the control of the cerebrum. It is also contraindi- cated in acute inflammatory conditions of the spinal cord and excessive reflex irritability. Administration. — The extract of nux vomica, the tincture, the fluid extract, or the alkaloid strychnine may be given and gradually increased, a tolerance by the system being rapidly established. The salts of strychnine are preferable to other preparations, the crude drug and its preparations vaiying greatly in strength, 10 minims (0.6 Cc.) of one tincture sometimes containing as large a percent- age of strychnine as 20 minims (1.2 Cc.) of another. The drug should be cautiously administered to children, the initial dose for a child five or six years of age not exceeding x^ grain (0.0006 Gm.). In using strychnine hypodermically the soluble hypodermic tablets should be freshly dissolved in distilled water. The solutions of strychnine and of the other alkaloids should not be kept in stock, as they become contaminated with microscopic plants. Cocculus— Cocculi— Cocculus Indicus. (Fish Berry.) Origin. — The dried fruit of Anamirta Cocculus Wright and Arnott, a climbing shrub in Eastern India, native to the Malabar coast. 474 A TEXT-BOOK OF MA TERIA MEDIC A. Description and Properties. — A globular, kidney-shaped, one- celled berry, about \ inch (6 Mm.) in diameter and f inch (lO Mm.) in length, blackish-brown and wrinkled. The seed is very bitter, but the pericarp is tasteless. The chief constituent is picrotoxin, the poisonous principle contained in the kernel and first isolated by BouUay in 1819. The crude drug is not used internally. Unofficial Preparations. Tinctura C6cculi— Tincturae CScculi— Tincture of Cocculus.— Z)(;i^, 2-20' minims (0.12-1.2 Cc). Extractum C6cculi Fluidutn— ExtrScti CScculi Fliiidi— Fluid Extract of Cocculus. — Dose, 1-3 minims (0.06-0.2 Co.). Picrotoxinum—Picrotoxini— Picrotoxin. TJ. S. P. Origin. — A neutral principle obtained fi-om the seed of Ana- mirta paniculata Colebrooke. Description and Properties. — Colorless, flexible, shining, pris- matic crystals, or a micro-crystalline powder, odorless and having a very bitter taste ; permanent in the air. Soluble in 240 parts of water and in 9 parts of alcohol. Dose. — ^^~%w*, 2-10 grains '(0.12-0.06 Gm.). MOTOR EXCITANTS. 477 Extractum Brgotse Fluidum — ExtrScti Ergots Fluidi— Fluid Extract of Ergot. — Dose, 15-60 minims (:.o-4.o Cc). Vinum Ergotae— Vini Ergotse— Wine of Ergot.— Z»oi?, 1-3 fluidrachms (4.0- 12.0 Cc). Unofficial Preparations. Tinctiira Ergotae— Tincturae Ergotae— Tincture of Ergot. — Dose, \-2 fluid- draclims (2.0-8.0 Cc). Ergotin (Bonjean's). — Dose, 2-8 grains (0.012-0.5 Gm.). Antagonists and Incompatibles. — The cardiac and motor depressants antagonize the action of ergot. Caustic alkalies and metallic salts are chemically incompatible. Synergists. — Its action upon the circulation is aided by digitalis and belladonna; upon the nervous system by strychnine; while ustilago, hydrastine, gossypium, and the emmenagogues enhance its influence upon the uterus. Physiological AatioTn.^Externally and Locally. — Ergot has no distinctive action upon the skin, but upon mucous membranes its influence is that of an astringent, possessing hemostatic properties. Internally. — Digestive System. — In large doses it is a gastro- intestinal irritant, occasioning considerable heat and dryness of the throat, accompanied by thirst and succeeded by pain in the stom- ach and bowels, vomiting, and occasionally purging, with violent peristalsis, although constipation is the commoner sequence. Circulatory System. — Repeated medicinal doses increase the blood-pressure, although rendering the pulse slower and smaller, the result either of stimulation of the peripheral endings of the inhibitory vagi or the inhibitory ganglia, and excitation of the vaso- motor system, contracting the arterioles. A poisonous dose lowers arterial tension, causing the pulse to beat faster and softer — an effect due to exhaustion from over- stimulation or to direct depressant action upon the heart-muscle. It is claimed by competent authority that there is no active and actual contraction of the arteries, the result of stimulation of the vaso-motor system, but that the arteries contract because of the fulness of the veins, there not being sufficient blood to fill both systems, marked arterial anemia consequently resulting. It must be admitted that the true physiological action upon the circulatory system is not yet generally understood, being still sub judice, since equally competent pharmacologists maintain that the arterial pres- sure is increased as explained above. It is an undisputed fact, however, that the cardiac muscle is 478 A TEXT-BOOK OF MATERIA MEDICA. actually contracted by ergot. Indeed, Willebrand claims that " the normal or hypertrophied heart so contracts under the action of ergot that the difference in size is appreciable by percussion" {Bartholow). If any changes are produced by this drug in the composition ■of the blood, they have not been ascertained. Nervous System. — Medicinal doses have no especial action, though excessive doses sometimes depress the sensory mechanism, producing general cutaneous anesthesia. The action of toxic doses on the nervous system will be described under " Poisoning." Respiratory System. — Medicinal doses produce no particular effect. Large doses depress the respiratory center, rendering the breathing shallow. This action is manifest from the first, there being no primary stimulation of the respiration. Death from an overdose of ergot usually results from paralysis of the respiratory center. Absorption and Elimination. — The active constituents of ergot are rapidly absorbed into the blood, and are eliminated principally by the kidneys, increasing the urinary flow. Temperature. — No special action has been observed. Eye. — The caliber of the retinal and nutrient opticus blood- vessels is reduced, resulting in marked pallor of the disk, transitory amblyopia, and pupillary anemia. Uterus. — Probably the most important action of ergot is upon this organ. It produces in full doses tetanic, tonic contraction of the uterine muscle, the uterus becoming hard and pale, and forcing the blood out of the uterine arterioles. The organ is more sensi- tive to the action of the drug during pregnancy. The precise manner in which ergot affects the uterus is still a matter of discussion, although Hemmeter's experiments would seem to prove that the uterine contractions are the result of stimu- lation of the centers in the lumbar portion of the spinal cord. The drug causes a contraction of involuntary muscles throughout the body. It is doubtful if any drug in our Materia Medica has been more carefully studied than ergot, and, if opinions differ widely as to its modus operandi, it is because we have to deal with a very complex substance, the nature, and even the number, of whose constituents are as yet inadequately known. Many principles of the drug are unstable and variable in their action, certain preparations differing MOTOR EXCITANTS. 479 ■decidedly from others in their influence, as, for instance, Tanret's ergotinine, which has no effect upon the uterus. Bonjean's ergotin is a powerful ecbohc, and has a marked action, moreover, upon the vascular system, whereas Wigger's ergotin is inert. Untomuard Action. — In addition to the gastro-intestinal disturb- ances already described, there are occasionally produced headache, mental confusion, dizziness, a feeling of chiUiness, muscular weak- ness, dilatation of pupils, and glimmering before the eyes. Poisoning. — There are two varieties of ergot-poisoning, acute and chronic. Under the administration of immoderate doses pecu- liar symptoms appear, known collectively as acute ergotism. Rest- lessness, mental worry, headache, tinnitus aurium, dilatation of the pupils, pallor and coldness of the skin, and other effects are present. At times cutaneous anesthesia is manifest or general formication. Epileptiform spasms, great reduction of respiration and temperature, may occur, while obstruction of cardiac movements, with sudden nausea and violent vomiting, and other alarming manifestations, attest the untoward properties of the drug. Chronic ergotism is confined chiefly to Europe, where ergotized rye is used in bread-making. The disease is marked by convulsive or gangrenous conditions. The first variety, the convulsive, is characterized by paroxysmal spasms of the flexor muscles, which later become continuous, re- sulting in opisthotonos or emprosthotonos. There is dimness of vision, while an increasing intensity of symptoms develops affection of other special senses, those of hearing and smell being either impaired or temporarily lost. Violent abdominal cramps also occur, together with painful dyspnea, death resulting from asphyxia or coma. The second (gangrenous) form is signalized by severity of local phenomena, profound dyscrasia, formication or cutaneous anes- thesia, impairment of special senses, and numbness of the muscles or extremities, followed by sloughing or atrophy of the diseased parts and mummification or dry or moist gangrene. Fatal results of chronic ergotism are usually traceable to the convulsions, although moist or dry gangrene may in certain cases produce death. ' Treatment of Poisoning. — Symptoms of acute poisoning may be alleviated by hot baths and the administration of tannic acid and cardiac stimulants. For the treatment of chronic ergotism hygienic measures and symptomatic remedies are indicated. 48o A TEXT-BOOK OF MATERIA MEDIC A. * Therapeutics. — Externally and Locally. — Ergot, in an impalpa- ble powder, has been recommended as an external application in the treatment of carbuncle and epithelioma. In the form of lozenges or diluted fluid extract the drug has been employed in acute pharyngitis. The hypodermic injections of ergotin are valua- ble in nasal hypertrophies, prolapsus of the rectum, hemorrhoids, enlargement of the prostate gland, aneurysm, varicocele, and vari- cose veins. Internally. — The most important medical use of ergot is to promote uterine contractions in labor. The preponderance of testimony among the most experienced obstetricians is in favor of its use only after the expulsion of the uterine contents. This is a rule, however, which cannot be invariably followed. While the employment of the drug is contraindicated in the first stage of labor, it may be safely employed during the second stage, when there is uterine inertia, provided all the parts be in a normal condition and there exists no mechanical impediment to the rapid delivery of the child. Ergot is of service also when the placenta is retained owing to inefficient and feeble uterine contractions. With these exceptions it is customary — and the author concurs in the procedure — to delay the administration of the drug until the expulsion of the placenta, when a full dose of the fluid extract is given, or ergotin hypodermically. When ergot is administered during the second stage of labor, it should be given in small doses, so as to promote intermittent rather than continuous contractions of the uterus. No drug possesses so energetic and prompt an action as ergot in post-partum and uterine hemorrhage. It is an exceedingly efficacious remedy also in subinvolution and in uterine fibroids and polypi. The accompanying diagrams will illustrate the control of hemor- rhage through the contraction of the uterine muscle and arterioles, and the influence of ergot upon submucous fibroid tumors by mechanical compression and consequent diminution of their blood- supply. It is obvious that the location of a subperitoneal tumor is such that the drug cannot influence its growth as it can a sub- mucous fibroid. This remedy is also extremely useful in the treatment of ple- thoric amenorrhea, congestive dysmenorrhea, menorrhagia, chronic metritis, etc. Dilatation of the cardiac cavities without valvular lesion is much improved by the administration of ergot ; the remedy has MOTOR EXCITANTS. 481 also been employed with considerable success in chronic diarrhea and dysentery. Incontinence of urine — depending either upon enlarged prostate, irritability, or a paretic or paralytic condition of the bladder- is Fig. 6. — Diagram showing how ergot reduces uterine hemorrhage; At uterine muscle; B, Bj arteries. Fig. 7. — Diagram showing how ergot reduces the size of a submucous fibroid, but has no effect upon a subperitoneal fibroid ; A, uterine muscle ; B, subperitoneal fibroid ; C, submucous fibroid ; D, D, arteries. greatly relieved by this remedy. The atonic form of spermatorrhea is palliated or cured by ergot. The drug is of value also in cerebral hyperernia and consequent mania, as well as in cerebrospinal meningitis, congestion of the spine, myelitis, and congestive headaches. Ergot has been highly recommended, notably by Dr. J. M. Da Costa, in diabetes insipidus, and by such authorities as Heltzmann and D'Enslow in prurigo, erythema, urticaria, and acne rosacea. Owing to the peculiar action of ergot upon unstriped muscular fiber it is a valuable drug in various forms of hemorrhage. The diseases mentioned as being favorably influenced by the local application yield as readily perhaps to the internal administra- tion of ergot. Finally, this remedy has met with some success in the treatment of leticorrhea, galactorrhea, hypostatic congestion of the lungs, whoop- ing cough, the different varieties oi purpura, colliquative sweats, splenic enlargements, and exophthalmic goiter. Contraindications. — During the first stage of labor and in cerebral or spinal anemia. Administration. — For its action upon the uterus a valuable 31 482 A TEXT-BOOK OF MATERIA MEDICA. fluid extract is the best preparation as an internal remedy; for hypodermic use the aqueous extract (ergotin) or some of the non-alcoholic fluid preparations manufactured by certain reliable pharmacists for this particular purpose, should be employed. Ergotin may be incorporated in suppositories when for any reason it is desirable to administer the drug per rectum. Gossypii Radicis Cortex— Gossypii Radicis Corticis— Cotton Root Bark. TJ. 8. P. Origin. — The bark of the root of Gossypium herbaceum L. and of other species of the genus, indigenous in the tropical and sub- tropical regions of Asia and Africa. The plant has been cultivated in the United States and other countries from a very early period, many characteristic varieties having been produced. Description and Properties. — It occurs in thin, flexible bands or quilled pieces, the outer surface brownish-yellow, with slight longitudinal ridges or meshes, small, black circular dots, or short, transverse lines, and dull, brownish-orange patches, from the abra- sion of the thin cork ; inner surface whitish, of a silky lustre, finely striate ; bast-fibers long, tough, and separable into papery layers ; inodorous ; taste very slightly acrid and faintly astringent. It contains a fixed oil, a small quantity of tannin, sugar, and starch, a yellow resin, and, in the fresh bark, a pale-yellow chromo- gene, soluble in alcohol, which on exposure to air becomes red and resinous. Dose. — 15-60 grains (1.04-4.0 Gm.). Official Preparation. Extractum Gossypii Radicis Flflidum— Extracti Gossypii Radicis Fliiidi— Fluid Extract of Cotton Root Bark.— Zloj?, J-i fluidrachm (1.8-3.7 Cc). Antagonists and Inoompatibles. — The same as for ergot. Synergists. — Ergot and its synergists. Physiological Action. — Identical with that of ergot, but infe- rior in certainty of action. Therapeutics. — Cotton root bark is employed only for its action upon the uterine system, in which respect it is identical with ergot An exception may possibly be in its use in the treatment of subin- volution and tumors of the utems, in which cases it is less efficient than ergot. Contraindications. — The same as for ergot. Administration. — The fluid extract only should be employed. MOTOR EXCITANTS. 483 Hydrastis— Hydrastis— Hydrastis. TJ. S. JP. (Golden Seal.) Origin. — The rhizome and roots of Hydrastis Canadensis. L., a perennial native to Canada and the United States east of the Mis- sissippi, growing in rich woodlands and in the Southern States, confined to mountainous districts. Description and Properties. — The rhizome is from i to 2 inches (2-5 Cm.) long and about \ inch (6 Mm.) thick, oblique, with short branches, somewhat annulate and longitudinally wrinkled; externally brownish-gray; fracture short, waxy, red- dish-yellow, with a thickish bark, about ten narrow wood-wedges, broad medullary rays, and large pith. Roots thin, brittle, with a thick yellow bark and subquadrangular woody centre. Odor slight, taste bitter. The principal constituents are hydrasiine (colorless and slightly acrid) and berberine (yellow and intensely bitter), the latter alkaloid being also found in berberis, Colombo, menispermum, coptis, etc. There is a yellow resinoid (hydrastin) on the market which should not be confounded with the active alkaloid hydrastine. Dose. — The crude drug is not given internally. Official Preparations. ExtrSctum Hydrastis Fluidum — Extract! Hydrastis Fluidi — Fluid Extract of Hydrastis. — Dose, 10-30 minims (0.6-2.0 Co.). Glycerltum Hydrastis — Glyceriti Hydrastis — Glycerite of Hydrastis. — Used externally. Tinctura Hydrastis — Tincturae Hydrastis — Tincture of Hydrastis. — Dose, 30-60 minims (2.0-4.0 Co.). Hydrastina — Hydrastinae — Hydrastine (unofficial). — An alkaloid obtained from Hydrastis. Origin, Description, and Properties. — Colorless, very brilliant, glassy crystals ; taste slightly acrid ; fully soluble in ether and chloroform, but freely soluble in water. Dose. — yV"i grail (0.002-0.03 Gm.). Hydrastinae Hydrochloras — Hydrastinae Hydrochloratis — Hydrastine Hy- drochlorate. U. S. P. — Origin. — The hydrochlorate of an artificial alkaloid derived from Hydrastine. Description and Properties. — Light-yellow, amorphous granules, or a pale-yellow crystalline powder, odorless, and having a bitter, saline taste ; deliquescent on exposure to damp air. Soluble in 0.3 part of water and in 3 parts of alcohol. The product should be kept in well-stoppered vials. Dose. — j-\j-4 g^^" (0.005-0.03 Gm.). Antagonists and Incompatibles. — The alkalies, mineral acids, and tannic and other vegetable acids are incompatible with prepara- tions of hydrastis. The physiological antagonists are chloral, potassium bromide, and the motor depressants. 484 A TEXT-BOOK OF MATERIA MEDICA. Synergists. — Quinine and the vegetable bitters aid its action upon the digestive tract, ergot upon the uterus, and strychnine upon the spinal cord. Physiological Action. — Externally and Locally. — Hydrastine possesses considerable anesthetic action when applied locally, and upon the eye its effect is to contract and afterward dilate the pupil. Internally. — Digestive System. — Its action resembles that of strychnine, though excessive doses produce greater gastric dis- turbance, almost invariably occasioning vomiting. Circulatory System. — Its influence is similar to that of strych- nine, but not so powerful. In its effect upon the white blood-cor- puscles it resembles quinine, arresting their movements. Nervous System. — Here also the action of hydrastis is analogous to that of strychnine, although it is much less powerful, while more persistent. It differs from its congener, however, in its effect upon the sensory nerve-fibers, very large doses impairing their func- tional activity, and, when locally' applied, producing anesthesia. Respiratory System. — In its action upon the respiratory system it resembles strychnine, differing in no essential particular. Absorption and Elimination. — It is slowly absorbed, tending to accumulate in the system. It is eliminated chiefly by the kidneys, increasing slightly the urinary flow. Temperature. — Medicinal doses have no effect ; poisonous doses decrease bodily heat. Eye. — It has no particular action upon the eye, other than to first contract and then dilate the pupil when directly applied. Uterus. — Hydrastine is a feeble oxytocic, affecting the womb in a manner similar to, though much less powerful than, ergot. Untoward Action. — The untoward manifestations are essentially those of poisoning. Poisoning. — The symptoms are almost identical with those of strychnine. Treatment of Poisoning. — The same as that of poisoning by strychnine. Therapeutics. — Externally and Locally. — Hydrastin (the yellow resinoid) — in the proportion of 5 grains (0.3 Gm.) to i ounce (30.0 Cc.) of water, or the fluid extract of hydrastis, 15 to 20 minims (1.0-1.2 Cc.) to4 ounces (118 Cc.) of water — makes an efficient injection in gonorrhea. Hydrastine (the alkaloid), or, preferably, hydrastine hydro- MOTOR EXCITANTS. 485 CHLORATE — 3 grains (1.2 Gm.) to i ounce (30.0 Cc.) of glycerin — affords great relief in certain forms of chronic conjunctivitis. Hydrastis is a valuable remedy in catarrh of the upper respira- tory tract. The TINCTURE — I fluidrachm (3.7 Cc.) to i ounce (30.0 Cc.) of water — is a valuable mouth-wash in all indolent and offensive ulcera- tions of the mouth and throat, such as syphilitic and mercurial affec- tions, follicular pharyngitis, etc. The FLUID EXTRACT serves a useful purpose in the local treatment of anal fissure and of rectal ulcer, vaginal and uterine ulcerations, and leucorrhea. Indolent ulcers anywhere, and chancres and chan- croids, are stimulated to a healthier condition by the application of this preparation. An ointment of hydrastine hydrochlorate, in strength vary- ing from 5-30 grains (0.3-2.0 Gm.) to i ounce (32.0 Gm.) of simple ointment, affords an efficient local application in acne and seborrhea sicca, and the same preparation makes a serviceable dressing for ulcerated carcinoma and bromidrosis. The distilled extract of witch-hazel with hydrastine hydro- chlorate is recommended in hyperidrosis. Palmer has successfully employed inhalations of a solution of i part of the extract to 3 parts of salt water in tubercular and simple bronchitis.. The topical action of hydra^s and its preparations is that of an antiseptic and tonic, strengthening the circulation and nutrition, rendering the drug peculiarly valuable in diseases of mucous sur- faces. Internally. — ^As a remedy for diseased conditions of the stomach and bowels it is of much the same value as the vegetable bitters, ai^d may be used for the same purposes. Hydrastine possesses considerable antiperiodic power, having been employed in intermittent fever and chronic m.alaria, though much inferior to quinine, and probably also to arsenic. Its bene- ficial action in these conditions is undoubtedly due to its power to iflicrease the functional activity of the liver, this influence also ren- dering it valuable in chronic constipation induced by hepatic inac- tivity — catarrhal jaundice, too, being frequently relieved by the remedy. Hydrastine, more especially hydrastine hydrochlorate, acts upon the uterus very much like ergot, and has been highly recom- mended by well-known authorities in uterine hemorrhage and other 486 A TEXT-BOOK OF MATERIA MEDIC A. uterine disorders for which ergot is used. By careful observers, of experience with the drug, it is considered superior to ergot in the hemorrhage of puberty and the menopause, as well as in congestive dysmenorrhea. Bossi, who has employed hydrastis Canadensis extensively in obstetrical practice, regards it as a valuable hemostatic, believing it to be much safer than ergot in the hands of ignorant individuals and midwives. Koniger has treated hemoptysis successfully with the fluid EXTRACT in 20- or 30-minim (1.2-2.0 Cc.) doses, repeated several times a day. The drug has proved equally beneficial in arresting the night-sweats of phthisis, and is an efficient substitute for alco- holic stimulants when their use is abandoned. Hydrastine hydrochlorate has recently been favorably men- tioned as a remedy for epilepsy, strychnine-poisoning, and hydro- phobia. Contraindications. — The same as for vegetable bitters, strych- nine, and ergot. Administration. — When taken for its action upon the stomach and bowels it should be given before meals ; for its effect on the uterus it is best administered in divided doses or the hydrastine hydrochlorate hypodermically. Rhus Toxicodendron— Rhois Toxicodendri— Rhus Toxicodendron. JJ. S. JP. (Poison Ivy.) Origin. — The fresh leaves of Rhus radicans L., a climbing shrub indigenous in Canada and the greater part of the United States westward to the Rocky Mountains. Description and Properties.— Long-petiolate, trifoliate, the lat- eral leaflets sessile or nearly so, about 4 inches (10 Cm.) long, obliquely ovate, pointed; the terminal leaflets stalked, ovate or oval, pointed, with a wedge-shaped or rounded base ; the leaflets entire and glabrous or variously notched, coarsely toothed, or lobed, more or less downy ; when dry papery and brittle ; inodorous ; taste somewhat astringent and acrid. The fresh leaves abound in an acrid juice which darkens on exposure to air, and when applied to the skin produces inflammation and swelling. The leaves should therefore not be touched with the bare hands. The fresh leaves contain a volatile acid (toxicodendric), which MOTOR EXCITANTS. 487 is almost entirely absent in the dried leaves. In addition to this active constituent the leaves contain tannin. Dose. — 1-5 grains (0.06-0.3 Gm.). Unofficial Preparation. Tinctura Rhtis Toxicodfindri — Tincturae Rhois Toxicodgndri — Tincture of Toxicodendron. — Dose,^^-2.xa\xi\Tas, (0.006-0.12 Cc). Prepared from fresh plants — I part of fresh leaves to 2 parts of alcohol. Physiological Action. — Externally and Locally. — The fresh leaves of this common plant are extremely irritant to the skin, generally acting as a marked vesicant and establishing severe local inflammation, manifested by acute dermatitis, excessive edema, and hyperemia. In many cases these effects are much less pronounced, while in certain individuals they are never occasioned by contact with or even chewing the leaves. As with poison sumach — Rhus venenata — the toxic influence of the plant derived from local appli- cation is apparently more virulent during the period of florescence. The inflammation somewhat resembles erysipelas, being rapidly diffused and accompanied by a general systemic disturbance, in- cluding abdominal pains, nausea, and vomiting, with perhaps diar- rhea, diuresis, and serous passages. Profuse diaphoresis and lum- bar and articular pains may also result. These symptoms cease after about ten days or a fortnight without other sequel than desquamation of the affected surface. Internally. — The effects of the drug administered internally are to cause gastro-intestinal inflammation, with drowsiness and stupor, and occasionally delirium and convulsions. Vertigo, nausea, chilli- ness, thirst, weak and irregular cardiac movements, diaphoresis, muscular debility, and diuresis are also reported. Dilatation of the pupils is also a result of ingestion or internal absorption, and an illustration of the virulence of the drug is seen in the fact that even air impregnated with exhalations from the leaves may cause epi- dermic eruption, while the berries have produced serious symptoms in the spinal and cerebral systems, and in an authentic case the root has proved notably fatal. 1 Treatment of Poisoning. — Many remedies have been used, with varying efficacy, to allay the toxic effects of the drug. Dermal poisoning has been relieved by glycerite of carbolic acid or alkaline lotions. In the earlier stage of external irritation warm soapsuds and sodium bicarbonate have been successfully applied. Alum- curd, ammonia in weak solution, solution of chlorinated soda, and 488 A TEXT-BOOK OF MA TERIA MEDICA. many other agents have been employed to meet the requirements of certain stages of the affection. A solution of cocaine, 4 to 8 per cent., quickly relieves the cutaneous irritation ; a liquid prepara- tion of grindelia robusta makes a grateful application ; while opium, coffee, and laxatives would be indicated. Therapeutics. — Externally and Locally. — The diluted tincture — 8 minims (0.5 Cc.) to 4 ounces (118 Cc.) of water — has met with some favor, as has been stated, in the treatment of sprains, burns, etc. In weak solution with alcohol the remedy has been used as a stimulating application in cases of sprains, chilblains, burns, insect-stings, etc. Internally. — It has been recommended in rheumatic affections of fibrous tissues, paralysis, erysipelas, herpes zoster, pemphigus, eczema, and erythema. Dr. Rothrock believes it to be a valuable cerebro-spinal stimu- lant. It has been supported as a strong palliative or cure in inconti- nence of urine depending upon atony of the bladder. It is evident that the drug needs to be much more thoroughly investigated, there being widely diverse opinions regarding its thera- peutic value. There is, however, sufficient testimony in its favor from competent authorities to justify further examination and use of this extremely active remedy. Contraindications. — The meager knowledge we possess re- specting its true action in disease renders it impossible to mention any special contraindication to its employment. Administration. — The tincture is the only preparation used, and should be cautiously administered. Coca— Cocae— Coca. TJ. 8. -P. Origin. — The leaves of Erythroxylon Coca Lam., a shrub about 6 feet (1.8 M.) high, with " numerous spreading purplish-brown branches, bearing bright green leaves varying in size according to the nature of the plant or of the soil in which it grows. The flowers, found either alone or in clusters, are small, regular, her- maphrodite, white or greenish-yellow, being succeeded by small scarlet berries. Coca is indigenous in the mountains of Peru and Boliva, and on the eastern slopes of the Andes is cultivated in damp, warm valleys from 3000 to 6000 feet (914.5-1829 M.) above the sea- MOTOR EXCITANTS. 489 level, being also grown in some parts of Colombia, Brazil, the Argentine Republic, and the island of Java. The province of La Paz in Bolivia produces the largest crops, the article being more highly esteemed than the Peruvian variety. Cocaine, how- ever, is obtained from leaves of the Javanese plant. Description and Properties. — In size and shape the leaves resemble those of tea, ovate, lanceolate, or obovate-oblong, from f to 2 or 2| inches (2-5 or 7 Cm.) long and i to i J inches (25- 37 Mm.) broad ; short-petiolate, entire, rather obtuse or emarginate at the apex, slightly reticulate on both sides, with a prominent midrib, and on each side of it a curved line running from base to apex ;' odor slight and tea-like, taste somewhat aromatic and bitter, when chewed temporarily benumbing the lips and tongue. The active constituent is the alkaloid cocaine. The plant also contains two other alkaloids — ecgonine and hygrine, and a peculiar tannin, coca-tannic-acid, having a green reaction upon salts of iron. Dose. — J-4 drachms (2.0-16.0 Gm.). Official Preparation. Extrdctum C5cx Fluidum — ExtrScti Cocse Fluidi — Fluid Extract of Coca. — Dose, 20 minins-l fluidrachm (1.2-4.0 Co.). Cocaina — Cocalnse — Cocaine (unofficial). — Description and Properties. — Color- less, prismatic crystals, of a strongly alkaline reaction. The taste is bitterish and pro- duces a transient numbness of the tongue. Soluble in 704 parts of water, in much less alcohol and ether, aMd in fixed oil. Dose. — \-\ grain (0.03-0.06 Gm.). Cocalnae Hydrochloras— Cocainse Hydrochloratis— Cocaine Hydrochlorate. V. S. JP. This is the only official salt of cocaine, and the one almost invariably used in medicine. Description and Properties. — Colorless, transparent crystals or a white, crystalline powder, odorless, of a saUne, slightly bitter taste, and producing upon the tongue a tingling sensation followed by numbness of some minutes' duration. Permanent in air, soluble in 0.48 part of water and 3.5 parts of alcohol; very soluble in boiling water and in boiling alcohol. Dose. — -1—2 grains (0.008-0.12 Gm.). Cocainx Phenas — Cocainse Phenatis — Cocaine Phenate (unofficial). — This salt contains about 75 per cent, of the alkaloid. Description and Properties. — It occurs as a yellow, viscid mass. Soluble in alcohol, insoluble in water. Dose. — j'j-J grain (0.005-0.01 Gm.). 490 A TEXT-BOOK OF MATERIA MEDICA. Antagonists and Incompatibles. — Morphine, chloral, amyl- nitrite, alcohol, chloroform, and ether are physiological antagonists. The most direct opponents are chloral and morphine. Cocaine is incompatible with caustic alkalies and the alkaline carbonates and bicarbonates, as well as with bichloride of mercury, iodine and the iodides, ammonia, zinc chloride, and borax. Synergists. — Medicinally, its cerebral effects may be enhanced by the cerebral stimulants, such as alcohol, cannabis Indica, and belladonna, while its analgesic and anesthetic action may be aided by carbolic acid, atropine, opium, and conium. When used as a mydriatic atropine serves as a valuable synergist. Physiological Action. — For our first knowledge of the physio- logical properties of coca we are indebted to its empirical use among the natives of Peru. The history of the drug is replete with interest and romance. It was regarded as the living repre- sentation of the Deity, the ground whereon it grew being held , sacred. During the reign of the Incas its use was a royal privi- lege, the people being compelled to obtain permission from the governor to avail themselves of its benefits. Later it was adopted indiscriminately. The native coqueros (coca-chewers) have learned from experi- ence that they can climb the Andes, work laboriously in the mines, and endure fatigue and hunger more hardily when chewing the leaves of the plant, and from time immemorial the drug has been recognized by observers as possessing powerful nutritive, stimulant, and restorative properties. In describing the action of the crude drug the author can add little to the words of Linnffius, who long ago wrote that coca possessed "the penetrating aroma of vegetable stimulants, the astricting and fortifying virtues of an astringent, the antispasmodic qualities of bitters, and the mucilaginous, nutritive properties of analeptics or of alimentary plants." " This leaf," he adds, " ex- hibits with energy its action on all parts of the animal economy. Ohdo in nervos, sapidq in fibras, utroque in fluido!' Since the isolation of the alkaloid cocaine, to which the drug owes its physiological and medical properties, by Gaedeke in 1855, and the subsequent study of it by eminent pharmacologists and therapeutists, we have learned more of the physiological action of coca. Its effect upon different systems are here described in detail. Externally and Locally. — Cocaine is analgesic, anesthetic, and MOTOR EXCITANTS. . 491 ischemic. Upon the unbroken skin it has no action, but upon mucous membranes or the subcutaneous tissue it produces com- plete local anesthesia. The surface to which it is applied becomes paler than normal, owing to contraction of the blood-vessels, but afterward reddens and acgears turgescent through secondary dila- tation of th^|gselSj^^Ii^^l^iDrndon of the drug by mucous membranes ^W^PHE^fc^cgS^^S^ which it is applied — with difficulty from the conjmctrva,^^feT^tj^^great readiness from the Schneiderian membrane, producing its characteristic constitutional effects. Applied to the conjunctiva, or even taken internally, cocaine causes a transitory contraction of the pupil, soon followed by dila- tation. The accommodation is impaired, but not completely de- stroyed, the ocular tension being lowered. The anesthetic action of cocaine applied locally is due to the depression of the ends of the sensory nerves. It dilates the pupil by stimulating the ends of the sympathetic nerve, which innervates the radiating fibers of the iris. «,^ In addition to its local analgesic action the drug possesses the power of destroying the functions of the', nerves of special sense, so that taste and smell, as well as the tactile sense, are abolished. When applied locally or taken internally it primarily checks many of the secretions, though those from the pancreas and liver seem to be uninfluenced by its internal use. The secondary impression of cocaine, however, when the blood-vessels become dilated, is accompanied by^SMflSfd secretion. Frangois-Fra^pP^mo has made an exhaustive study of the local action o^^^aine, contends that it is " a powerful paralyzfrig poison, acting alike, on saispry and motor nerve-endings, on all kinds of peripheral ne^^^Ji^erve-centers, muscles, epithelium, leucocytes, vegetable "protoplasm, micro-organ^ etc." Internally. — Digestive System. — On account of its stimulant action upon the constrictor fibers of the great sympathetic nerve, under the influence of moderate doses peristalsis is largely increased in the stomach and intestines, very large or poisonous doses, on the contrary, causing great sluggishness of the bowels. Although it has been shown by experiments upon animals that cocaine is incapable of sustaining life, it diminishes in man the sen- sation of hunger, owing to its local anesthetic action upon the mucous membrane of the stomach, so that the coqueros are able to 492 A TEXT-BOOK OF MATERIA MEDIC A. abstain from food for days, thirst also being allayed. This diminu- tion of hunger does not seem to impair appetite and digestion, since food is subsequently relished and digested as well as, if not better than, if coca had not been used. Circulatory System. — Medicinal doses of cocaine increase the force and frequency of the cardiac contractions, and also arterial pressure. Large or poisonous doses render the pulse slow, soft, and weak, and lower arterial tension. The exact modus operandi is not fully determined, such eminent authorities as Mosso, Von Aurep, Vulpian, Ott, Nikolsky, and others differing as to its action upon the circulatory apparatus. It is quite probable that its action is similar to that of atropine in this respect. Nervous System. — When given internally its first action is upon the brain, moderate doses greatly stimulating the intellectual facul- ties and producing a feeling of ecstasy and well-being, in many respects akin to the sensations experienced under the action of cannabis Indica. In the course of a few hours the stage of cere- bral excitement is succeeded by mental, moral, and muscular depression. Toxic doses result in incoherent speech and wild delirium, accompanied by swaying of the head, followed by epileptiform con- vulsions and narcosis. The convulsions are of cerebral origin, the effect of cocaine upon the spinal cord being yet but imperfectly understood. The sensory nerves are depressed by small and paralyzed by lethal doses. The motor nerves are also depressed by large doses, this action, however, being subordinate to that exerted upon the sensory nerves. The muscles are stimulated by medicinal doses through impression upon the motor tracts, although large doses greatly depress muscular activity. The chewing of coca, as prac- tised by the natives of Peru and Bolivia, undoubtedly appears to augment muscular strength and powers of endurance. Mosso claims that small doses of cocaine serve as a power- ful muscular stimulant in cases of exhaustion from hunger or fatigue. Laffont states that cocaine possesses an " excito-functional action on the great sympathetic constrictor nerve, consequently an exalta- tion of the functional action of all the non-striated muscles or muscles of organic life which are subordinated to it." Respiratory System. — Medicinal doses powerfully stimulate the respiratory center, increasing the rapidity and depth of the respira- MOTOR EXCITANTS. 493 tions. Poisonous doses paralyze the center, the result being dys- pnea, feeble breathing, and death from respiratory failure. Absorption and Elimination. — Cocaine is quickly absorbed, being eliminated principally by the kidneys in a form differing from its original nature. Much of it undergoes oxidation in the body. The amount of urine is increased, though the nitrogenous ele- ments are diminished. The habitual use of the drug lessens urinary secretion. Cocaine possesses no cumulative action, although its effects become more marked under repeated dosage, due probably to some special dynamic action upon the nervous system. Temperature. — Medicinal doses have no influence on bodily heat, but poisonous doses usually raise the temperature, owing, according to Reichert, to an increase of heat-production. Eye. — Cocaine produces a noticeable dilatation of the pupil, as already explained under " Local Action," the maximum change being reached in about an hour, and the normal state regained in from twelve to twenty-four hours. Cocaine-poisoning. — Among the more prominent physiological symptoms resulting from the ingestion of excessive doses of coca- ine or repeated and continued injections are a tendency to coma or collapse ; a feeble, thready pulse, often running extremely high ; great emaciation ; anorexia and impairment of the digestive powers ; and increased frequency, and again alarming depression, of respira- tion. There are other symptoms, scarcely less serious, which, as the majority of observations show, render cocaine one of the most generally deleterious of drugs, opium not excepted. Dropsy, ma- rasmus, numbness, syncope, profound malaise, muscular twitchings with mild convulsions, insomnia, amblyopia, mydriasis, visual hal- lucinations, headache, vertigo, dangerously elevated temperature, dental decay, and fetid breath, — even this admonitory catalogue of ills fails to complete the recorded phenomena attending poisoning from cocaine. Yet, grave as are the foregoing physical changes incident to an immoderate use of the drug, the mental and, above all, the moral effects of cocaine-poisoning are far more deplorable. It is a melan- choly but indubitable fact that to one fully committed to the so-called " cocaine habit " there appears at times no principle of honor or deco- rum to which the vitiated sensibilities are amenable. The enfeeble- ment of the intellectual faculties, the loss of memory, inability to coordinate or control ideas, a consciousness occasionally merged 494 A TEXT-BOOK OF MATERIA MEDICA. in pronounced mania, possibly with homicidal inclination, and an intense selfishness of thought and purpose, in which apathy, neg- lect of domestic obligations, and complete debasement of nobler qualities are developed, — these lamentable accompaniments mani- fest too clearly the degenerating influences exerted by a constant resort to the use of this ill-fated, if not fatal, drug. An instance coming under the author's personal observation will serve to illustrate the entire lapse of the subject's morale. The case is that of a well-known, successful, and highly esteemed practitioner, who, becoming addicted to the employment of cocaine as an alleviation for bodily and mental depression, reiached at last a stage of moral degradation in which he neither shrank from lying and stealing nor considered any means of gratifying his dis- eased appetite too abject — the persuasions of friends, the considera- tions of professional duty and social position, and the distracted appeals of his own family being alike unavailing to arrest the passion to which he had succumbed. It is grateful to record that from his moral turpitude the subject at length emerged triumphantly, to-day occupying a proud position reflecting honor upon himself and his profession. A still more distressing case, in that it was attended with fatal results, is that of a physician personally known to the author who, contracting the cocaine habit, in blind folly administered the drug to ' his wife and child, all dying within the period of a few months. The desperation to which the cocaine habitue may be driven in his temporary madness is shown in the case of a young man scarcely twenty years of age, son of an eminent surgeon, who, the author is authentically informed, during a journey by rail in which he was deprived of the customary facilities for hypodermic injection, ripped open his arm with- a pocket-knife and poured the drug into the wound. In such cases the salient features of the malady may be prop- erly regarded as allied to those of acute mania, the treatment being exceedingly difficult — the more so because of the absence of deter- rent motives prompted by conscience, which in the course of the indulgence becomes torpid or perverted. There is, moreover, with cocaine-poisoning always danger of deliberate or involuntary relapse. It frequently happens that cocainism arises from a desire to relieve effects produced by the immoderate use of opium. Yet the ■ latter drug, being taken to offset the influence of cocaine, in reality MOTOR EXCITANTS. 495 but aggravates the evil, the two agents interacting and still further lessening the chances of recovery. Treatment of Poisoning. — Several antidotes have been favorably adopted — amyl nitrite, caffeine, atropine, and inhalations of ammonia. Chloroform, ether, subcutaneously injected, and strychnine have also proved more or less efficient remedies. With regard to the withdrawal of cocaine, equally competent authorities appear to differ, the immediate cessation of the drug being advocated, and again this course condemned as liable to produce collapse. The author is of the opinion that, as in other respects, the procedure followed in the treatment of the opium habit is the wisest and safest. The disease, however, at least during its more serious manifes- tations, is essentially allied to insanity, and permanent cure must look to the rationale of the conditions, with the paramount object of restoring to its normal activity the moral tone of the patient's thought and desire. That complete regeneration of mind and body may be reasonably contemplated is amply attested by the case above cited ; nor should discouragement deter the physician from his task, nor measures of untimely severity be suffered to exas- perate and confirm an untoward mental state possibly susceptible of intelligent control. Therapeutics. — Externally and Locally. — The indications for the local anesthetic action of cocaine are very numerous. The general surgeon will find many opportunities to employ the drug advantageously ; indeed, in many instances it has replaced all other anesthetics. In many operations on the genito-urinary tract, rectum, nose, throat, ear, and eye it serves a most valuable pur- pose. The urethra can be rendered perfectly insensible to pain by the application of a 2 to 4 per cent, solution, repeated two or three times at intervals of fiye or ten minutes. Even the sensibihty of the bladder itself can be benumbed to a great extent by the local application of a cocaine solution, so that sounding for stone may be painlessly accomplished. A case of lithotrity is reported in which, without suffering, an operation was performed in fifteen minutes, the only anesthetic used being a solution of cocaine applied to the parts. Urethral caruncles may be removed successfully and without inconvenience to the patient by the injection of a 4 per cent, solu- tion at the lines of attachment. An injection of a small amount -of the same solution into the cellular tissue of the prepuce pre- 496 A TEXT-BOOK OF MA TERIA MEDICA. vents pain in circumcision and in the operation for phimosis. In the treatment of fistula in ano, hemorrhoids, both internal and external, and other diseases of the rectum, cocaine is of signal value. An OINTMENT OF COCAINE, 4 per cent, strength, affords a grateful anodyne dressing for burns, it being borne in mind that in all cases where ointments of this drug are used the alkaloid cocaine, and not its salts, is to be employed. Cocaine is an important anesthetic in many minor operations, such as opening of felons, abscesses, etc. ; it is also highly service- able in dentistry and for the removal of small neoplasms. Prob- ably its most extensive use in this respect is in operations upon the eye, nose, and throat, its widest field of usefulness being in operative ophthalmic surgery. The following prescription makes an efficient application for the relief of many of the distressing symptoms of acute coryza and hay fever : R. Cocainse hydrochloratis, gr. x (0.6 Gm.); Menthol, gr. xij (0.72 Gm.) ; Pulveris camphorae, gr. iij (0.2 Gm.) ; Pulveris magnesise, Sacchari lactis, aa. gij (8.0 Gm.). M. — Sig. Use a small portion as a snuff twice a day. A small quantity of morphine sulphate is sometimes an excellent addition to the above. The peculiar qualities of cocaine render it one of the safest, as well as most convenient and serviceable, mydriatics. It quickly dilates the pupil, which regains its normal condition in from ten to twenty hours. The dilatation, too, is easily overcome by the application of eserine, a solution of \ grain (0.03 Gm.) to i ounce (30.0 Cc.) of the latter drug being strong enough to neutralize the effects of a 4 per cent, solution of cocaine. It should be remembered that local applications to the conjunc- tivjE, nares, and fauces may produce in susceptible persons systemic effects. Cocaine combined with atropine forms a mydriatic which for many purposes is superior to either drug separately, the mydriasis being of longer duration than that produced by cocaine, while the paralysis of the accommodative apparatus is briefer than that occasioned by atropine. The PHENATE OF COCAINE is less toxic than the hydrochlorate. MOTOR EXCITANTS. 497 owing to its power of coagulating albumin, and thereby being less readily absorbed. It is also more agreeable to the taste. While it does not produce anesthesia so readily as the hydrochlorate, its effect is more permanent, and, in addition, it possesses powerful antiseptic properties. By many physicians it is preferred in laryn- gological work. Internally. — Coca has been successfully used in gastralgia and to improve the digestion. Cocaine is frequently an efficient remedy in sea-sickness and to allay excessive vomiting. Bartholow has highly recommended the drug in chorea, asthma, paralysis agitans, and alcoholic and senile tremor. It has also been suggested as a cure for the opium., alcohol, and tobacco habits. The WINE OF COCA is an excellent tonic during convalescence from acute disease and in debilitated conditions generally. It has been extensively employed in melancholia. Cocaine combined with atropine is said to make an efficient hypnotic. Contraindications. — No special or distinct contraindication to its use exists. In diseases of the kidneys with diminished urinary flow it should be cautiously administered, lest cumulative effects ensue. With subjects suffering from weak or diseased heart similar caution is to be used. Administration, — For hypodermic use solutions of from 2 to 5 per cent, are generally employed. It should be noted that children and females require smaller doses of the drug. It is altogether probable that many of the coca wines on the market contain varying quantities of cocaine. The reckless and indiscriminate prescription of these preparations, therefore, is liable to induce the cocaine habit. It is questionable, indeed, whether the admini-stration of cocaine with a view to curing the intemperate use of opium, alcohol, or tobacco is wise. It frequently happens that patients thus treated lose their craving for the latter drugs only to acquire an inordinate appetite for cocaine, which, as has been shown, is possibly more dangerous than either of them in its physical and moral effects. 32 498 A TEXT-BOOK OF MA TERIA MEDIC A. GROUP VII.— MOTOR DEPRESSANTS. Conlum— Conli— Conium. U.S. I*. (Hemlock.) Origin. — The full-grown fruit of Conium maculatum L., gath- ered while yet green. Spotted hemlock is a biennial indigenous in the temperate regions of Asia, Europe, and Northern Africa, and naturalized in some portions of New England, New York, and South America. It grows in waste places and along streams. Description and Properties. — About \ inch (3 Mm.) long, broadly ovate, laterally compressed, grayish-green, often divided into two mericarps, each with five crenate ribs, without oil-tubes, and containing a seed grooved on the face ; odor and taste slight When triturated with solution of potassium or sodium hydrate conium gives off a strong, disagreeable, mouse-hke odor. The most important constituent is a volatile liquid alkaloid, coniine. It also contains methyl-coniine, conhydrine, and its isomer pseudo-conine. Dose. — 1-5 grains (0.06-0.3 Gm.). Official Preparations. Extractum Conii — ExtrScti Conii — Extract of Conium. — Dose, \-i grain (0.03-0.06 Gm.). ExtrSctum Conii Fliiidum — ExtrScti Conii Fliiidi — Fluid Extract of Co- nium. — Dose, 1-5 minims (0.06-0.3 Cc). Unofficial Preparations. Tinctiira Conii — Tincturae Conii— Tincture of Conium (15 per cent.).— Z>ok, 10-30 minims (0.6-1.8 Co.). Sttccus Conii — Silccus Conii — Conium Juice. — Dose, \-2 fluidrachms (1.8-7.4 Co.). The juice expressed from fresti leaves, and \ volume of alcohol added to pre- serve it. Coniina — Coniinae— Coniine. — Description and Properties. — A colorless, inflam- mable, oily liquid, having a strong alkaline reaction and a penetrating, suffocating odor. It is soluble in all proportions in alcohol, ether, chloroform, benzene, benzin, and fixed oils. It requires 100 parts of cold water for solution, the liquid becoming turbid on warming. Dose. — j'^j-l minim (0.006-0.06 Cc). Coniinse Hydrobromas — Coniinae Hydrobromatis — Coniine Hydrobro- mate. — Description and Properties. — It occurs in colorless, transparent prisms ; soluble in water and alcohol in the proportion of I to 2 parts ; very slightly soluble in ether. Dose. — ylj-l grain (0.002-0.06 Gm.). Antagonists and Incompatibles. — Nux vomica and its alka- MOTOR DEPRESSANTS. 499 loids, cocculus and picrotoxin, are antagonistic to conium. Tannic acid and the alkalies are chemically incompatible. Synergists. — The motor depressants and morphine. Physiological Action. — Externally and Locally. — Coniine, the active principle of conium, has no effect upon the unbroken skin. Applied to bruised surfaces, it has been thought to possess anes- thetic or analgesic properties. The specific behavior of the drug, however, renders the above action problematical, according to some authorities. Internally. — Digestive System. — Conium increases the salivary- secretion, and when taken into the stomach exerts no special action upon the digestive system, other than an occasional disturbance of the gastro-intestinal tract, possibly resulting in vomiting and diar- rhea under full dosage. Circulatory System. — Although when ingested coniine is rapidly absorbed by the blood ; circulating in the system unchanged, its action is not clearly defined, though it has been held that the cir- culation is first accelerated and then retarded, with a lowering of arterial pressure preceded by a decided increase. From its capacity to paralyze the terminal vagi it is natural to suppose that it increases the rapidity of the cardiac movements, yet a characteristic feature of the absorption of coniine is the appar- ent absence of cardiac derangement, the heart, as well as the mind, remaining unaffected in the presence of alarming symptoms. Nervous System. — The brain is unaffected, consciousness being preserved to the last; muscular irritability is uninfluenced; and even under large doses there is little impression made upon the nerves beyond a slight impairment of their conductivity, although the motor mechanism is peculiarly susceptible to the effects of the drug, which acts as a powerful depressant upon their functional energy. This latter influence is first manifested in the peripheries, gradually ascending until the spinal cord is involved, the reverse process marking the effects of methyl-coniine. Respiratory System. — Large or poisonous doses act as depres- sants upon the respiratory center in the medulla, and, although the breathing may at first be normal, paralysis and asphyxia may finally result from immoderate ingestion. Absorption and Elimination. — The drug is readily absorbed, elimination taking place by various channels, but chiefly through the kidneys and by expiration. Coniine has been detected in con- siderable quantities in the liver, lungs, and spleen. 500 A TEXT-BOOK OF MATERIA MEDICA. Temperature. — It has been held that bodily temperature is per- ceptibly lowered by conium, proportionately with the extent of the paralysis occasioned. High authorities, however, assert an increase of temperature under both therapeutic and toxic doses. Eye. — Heaviness of the eyelids, dilated pupils, accompanied by double or confused vision and occasionally entire loss of sight, have been noted among the symptoms incident to the administra- tion of active dosage. The effects thus recorded have been ascribed to paralysis of the third nerve rather than to stimulation of the sympathetic. Poisoning. — A frequent symptom of conium-poisoning is ptosis, arising from paralysis of the oculo-motor nerves. Staggering gait, general muscular relaxation, impairment of vision, nausea, and ver- tigo are also not infrequent. The severer symptoms are marked by muscular paralysis of the extremities, derangement of vocal organs resulting in difficulty of speech, and dilatation of the pupils. The brain meanwhile remains unaffected until overcome by the accumulation of carbonic-acid gas in the blood, when delirium and coma may ensue, and finally cerebral convulsions and fatal collapse through respiratory failure. With regard to the effect of toxic doses upon the heart conflict- ing statements are recorded, experiment having proved that in warm-blooded animals the cardiac movements speedily cease, it being authoritatively stated, on the other hand, that the drug exerts no influence upon the heart. Treatment of Poisoning. — The stomach should be evacuated by means of emetics or lavage, after which tannic acid and the phys- iological antidotes may be administered — tetanizing agents, such as strychnine and picrotoxin, with alcoholic stimuli if necessary. Coffee and also hypodermic injections of atropine have been highly recommended. Muscular exercise has been known to delay the action of the poison, and free counter-irritation by mustard may be serviceable. Therapeutics. — Externally and Locally. — In many respects the medicinal operation of conium bears no relation to its physio- logical action. Experimentation shows that it exerts but a feeble action upon the sensory nerves, yet clinical experience establishes its value in mitigating the pain of cancer when locally appUed. In ulcerating cancer of the breast especially, poultices composed of conium leaves afford wonderful relief from pain and greatly improve the condition. A similar application has proved beneficial MOTOR DEPRESSANTS. 501 in scrofulous glandular sores. Dewees has recommended an injec- tion composed of the extract 3 parts to water 16 parts in uterine cancer. Ovarian menorrhagia is well treated by inserting in the vagina once or twice daily a suppository containing i or 2 grains (0.06- 0.12 Gm.) of CONIUM. Acute laryngitis may be greatly relieved by the inhalation of a solution containing 2 fluidrachms (7.4 Cc.) of succus conii to 16 or 20 ounces (473-591.5 Cc.) of water and 20 grains (1.2 Gm.) of sodium carbonate. The vapor of coniine inhaled is an efficient palliative of the cough of phthisis and acute bronchitis. The peculiar mouse-like odor renders the use of conium in dis- eases of the respiratory tract objectionable to many persons. Internally. — Its action upon the motor mechanism gives value to the drug in diseases characterized by excessive motor activity. Conium is therefore an efficient remedy in allaying the motor excitement of acute mania. Advantage has been taken of its action in the treatment of asthma, and in chorea and paralysis agitans it certainly serves a useful purpose. It has been claimed that whooping cough yields to its influence. It has proved beneficial in other spasmodic affections, such as tetanus and blepharospasm accompanying many acute inflamma- tions of the eye. Coniine has even been suggested as a remedy in hydrophobia and strychnine-poisoning. Coniine hydrobromate has been proposed by Wolfenden as an efficient remedy in epilepsy. Conium has also been suggested in puerperal convulsions, while in infantile convulsions the drug has been employed with great benefit, being well tolerated by children. Coniine has been used hypodermically and with marked success to relax the muscles in dislocations of the joints, as well as in pneu- monia and pleurisy. In the latter diseases the drug so depresses the ends of the motor nerves that the impulse exciting the respira- tory muscles is interfered with and the cough greatly relieved, a reduction of the pulse-rate and temperature usually accompanying the cessation of coughing. Contraindioations. — Conium should not be given to persons suffering from great exhaustion and debility or from diseases inter- fering with the rhythm of the heart. Administration. — The preparations of conium are very unreli- 502 A TEXT-BOOK OF MATERIA MEDIC A. able, the fluid extract being perhaps the one to be depended upon most uniformly. Owing to the uncertainty of their strength, the administration should begin with small doses gradually augmented until interference with involuntary motion is observed, when further increase should be stopped. The effects of the drug are weakened by repeated doses, rendering an increase in the dose necessary from time to time. Coniine and morphine greatly aid each other, and this combination is a particularly efficient one in the treatment of painful muscular spasms and acute mania with excessive motor activity. Dr. Squibbs has stated that there is danger in diluting the fluid extract, a precipitate being formed containing the active principle. Gelsemium— Gelsemii— Gelsemium. TJ. S. J*. (Yellow Jasmine.) Origin.— The rhizome and roots of Gelsemium sempervirens (L.) Pers., a pl^nt indigenous in the southern United States, growing in moist woods. Description and Properties. — Cylindrical, long or cut in sec- tions about I inch (25 Mm.) in length, externally Ught yellowish- brown, with purplish-brown longitudinal lines ; tough, fracture splintery ; bark thin, with silky bast-fibers closely adhering to the pale-yellowish, porous wood, which has five medullary rays, and in the rhizome a thin pith ; odor aromatic, heavy ; taste bitter. It contains an alkaloid, gelsemine, which forms its active princi- ple, gelseminine, gelseminic acid, volatile oil, resins, gallic acid, etc. Dose. — 2-10 grains (0.13-0.6 Gm.). Official Preparations. Bxtractum Gelsemii Fluidum— ExtrScti Gelsemii Fluidi— Fluid Extract of Gelsemium. — Dose, 5-15 minims {0.3-1.0 Cc). Gelsemina (unofficial) — Gelseminae — Gelsemine. — Description and Proper- ties. — A brittle solid, transparent, crystallizable mass, converted into a colorless liquid at 45° C. (113° F.). Insoluble in cold water, but soluble to a slight extent in hot water, as well as in alcohol ; taste bitter. Dose. — i^^ grain (0.0003-0.001 Gm.). Antagonists and Incompatibles. — The cardiac and diffusible stimulants are antagonistic; tannic acid and caustic alkalies are incompatible, precipitating the alkaloid. Synergists. — The motor depressants. Physiological Action. — Externally and Locally. — It is a mild sedative and astringent, the alkaloid being a mydriatic. MOTOR DEPRESSANTS. 503 Internally. — Digestive System. — No special action has been noted, though when excessive doses have been taken nausea and vomiting may ensue.' Circulatory System. — Medicinal doses of gelsemium produce no marked effect, but toxic doses reduce the heart's action, rendering the pulse slower and weaker and lowering arterial tension. Nervous System. — The drug has no effect upon higher cerebral centers, the mind remaining clear to the last. In large doses it paralyzes the roots of the motor cerebral nerves and the motor areas of the spinal cord, with consequent paralysis of all the mus- cles of the body. This condition is succeeded by cutaneous anes- thesia, due to depression of the receiving center and the sensory tract in the spinal cord. The motor nerves and muscles are unaf- fected. Convulsions rarely result in man from a poisonous dose, but occur in animals, with backward movements. The exact cause of this action is undetermined. Respiratory System. — The breathing is rendered slower and shallower, being frequently irregular. Death results from asphyxia, caused by depression and ultimate paralysis of the respiratory center. Absorption and Elimination. — Gelsemium is speedily absorbed and readily excreted, chiefly by means of the kidneys. Untoward symptoms produced by immoderate amounts of the drug prac- tically subside within three hours after ingestion. Fig.' 8.— Diagram showing how gelsemium produces convergent strabismus '. A,A, superior rectus ; B B, external rectus— too weak; C,C, internal rectus; D,D, third nerve; E,By sixth nerve; F,F, optic nerve; G,G, lesser wing. Temperature. — Poisonous doses cause a reduction in temper- ature. Eye. — Under full dosage the pupil is widely dilated and diplopia and marked ptosis ensue. The mydriasis and ptosis are caused by 504 A TEXT-BOOK OF MATERIA MEDIC A. paralysis of the third nerve. The sixth, which innervates the ex- ternal rectus muscle, is often depressed more than the third nerve, supplying the internal rectus, producing convergent strabismus, as shown in Figure 8. The diplopia is caused by the squint and incoordination of the ocular movements. In strabismus the eyes are not directed exactly to the object, and the image does not fall on corresponding parts of the retinse ; consequently, two perceptions are received in the visual center and two objects apparently seen. Uterus. — No important action has been observed. Untoward Action. — This does not essentially differ from that observed in poisoning, though the symptoms may be of a milder form. Poisoning. — In toxic doses gelsemium is quickly fatal. The early symptoms include drooping of the eyelids, wide dilatation and immobility of the pupils, extreme muscular weakness, affecting first the muscles of the upper extremities, and incoordination of movements. Diplopia and dimness of vision may ensue, accom- panied by difficulty of speech, coldness of the body surface, and general cutaneous anesthesia, with decidedly lower temperature. Meanwhile, there is marked diminution in the force and frequency of the pulse and respiration. While the patient may be drowsy, the mind is unaffected until carbonic-acid necrosis supervenes. Death is usually the result of respiratory failure, due to paralysis of the muscles of respiration. (See Plate I.) Treatment of Poisoning. — The evacuation of the stomach is of the first importance, either by the stomach-pump or by the use of emetics. Washing out with a solution of tannic acid is probably the best method to pursue. External heat should be applied and diffusible stimulants administered, followed by digitalis and strych- nine. The hypodermic injection of morphine and atropine is highly recommended in gelsemium-poisoning. Therapeutics. — Externally and Locally. — The drug is seldom used externally, although it has been employed by ophthalmolo- gists as a mydriatic. Internally. — Clinically, gelsemium is now considered less valu- able than formerly. It has been favorably mentioned by certain authors in the treatment of tetanus, mania with motor excitement, and paralysis agitans. Theoretically, it would seem to be of value m certain convulsive^ disorders, like chorea, pertussis, etc., yet its PLATE II. Gelsemium-poisoniiig. MOTOR DEPRESSANTS. 505 use has not met with the success which its action upon the mus- cular system would indicate. The drug appears to be more serviceable in trifacial neuralgia, and it seems to be even more efficient in neuralgia with involve- ment of the inferior dental nerve. In these disorders, as in ovarian neuralgia, dysmenorrhea, etc., for which it has been employed with some success, the drug should be pushed to its physiological limit. Bartholow praised the action of gelsemium in cerebrospinal meningitis and " acute inflammations of the lungs and pleura!' Bulkley is responsible for its use in pruritus and eczema, the itching of which it certainly appears to alleviate. The therapeutics of gelsemium would perhaps be incomplete without mentioning hemoptysis, remitte7it fever, acute coryza, mi- graine, Meniere's disease, and spermatorrhea, in all of which the drug has been used and recommended. Contraindications. — Diseases accompanied by exhaustion and great muscular weakness. Administration. — Any of the preparations may be given, the initial dose being small, and the amount increased gradually until dilatation of the pupil or drooping of the eyelids is manifest. Grindelia— Grindeliae— Grindelia. JJ. S. J*. Origin. — The leaves and flowering tops of Grindelia robusta Nutt, and of Grindelia squarrosa Dunal, herbaceous or suffi-uticose perennials indigenous in the western part of North America and Mexico. Description and Properties. — Leaves about 2 inches (5 Cm.) long, varying from broadly spatulate or oblong to lanceolate, sessile or clasping, obtuse, more or less sharply serrate, often spinous- toothed or even laciniate-pinnatifid, pale-green, smooth, finely dotted, thickish, brittle; heads many-flowered, subglobular or somewhat conical, the involucre hemispherical, about f inch (10 Mm.) broad, composed of numerous imbricated, squarrose- tipped, or spreading scales ; ray-florets yellow, liqulate, pistillate ; disk-florets yellow, tubular, perfect ; pappus consisting of two or three awns of the length of the disk-florets ; odor balsamic ; taste pungently aromatic and bitter. The principal constituent is probably a resinous substance. It also contains an alkaloid principle, grindeline, and a volatile and a fixed oil. Dose. — 10-60 grains (0.6-4.0 Gm.). 5o6 A TEXT-BOOK OF MATERIA MEDIC A. Oficial Preparation. Extractum Grindeliae Fluidum — Extracti Grindelise Fluidi — Fluid Extract of Grindelia. — Dose, 10-60 minims (0.6-3.7 Cc). Antagonists and Incompatibles. — The motor excitants and cerebral stimulants are antagonistic. Aqueous preparations, the caustic alkalies, and mineral salts are incompatible. Synergists. — The motor depressants. Physiological Action. — Externally and Locally. — ^The drug is sedative and mildly astringent. Internally. — Digestive System. — When ingested it excites a sense of warmth in the epigastrium, and in moderate doses increases the secretion of the gastric juice, stimulating the appetite and improv- ing digestion. Circulatory System. — It differs somewhat from conium in that the heart is slowed by medicinal doses through stimulation of the inhibitory center. The blood-pressure, however, is raised and maintained by stimulation of the vaso-motor center. Nervous System. — Grindelia possesses considerable hypnotic power. Its effect upon the motor mechanism is similar to that of conium, the muscular weakness affecting first the lower extremi- ties. The sensory nerves are first depressed, there being quite marked cutaneous anesthesia. The drug depresses the reflex mechanism in the spinal cord, so that the reflex movements are greatly lessened : it is said that it also depresses the phrenic nerve. Respiratory System. — Small doses have little effect upon the respiratory movements ; large doses retard the breathing ; while toxic doses may produce death through paralysis of the respiratory- muscles. The drug slightly increases the secretion from the pulmonary mucous membrane, and relaxes the circular fibers of the bronchial muscles through depression of the ends of the motor fibers of the vagus distributed to these muscles and of the reflex center in the medulla. The ends of the sensory nerves distributed to the pul- monary mucous membrane are also depressed. Absorption and Elimination. — Grindelia is readily absorbed, and is eliminated chiefly by the kidneys, increasing the urinary flow, the lungs sharing in the excretory process. Temperature is unaffected. Eye. — Large doses cause dilatation of the pupil. Uterus. — No effect has been noticed. Untoward Action. — Excepting drowsiness,- reduction of cutane- MOTOR DEPRESSANTS. 507 ous sensibility, slight gastric disturbance, and a feeling of weakness no symptoms have been recorded. Poisoning. — The drug is feebly toxic; excessive doses, how- ever, act as a gastro-intestinal irritant. The patient is sleepy and complains of muscular weakness ; there is a numb or anesthetic condition of the skin, while the pupils are dilated and the pulse and respiratory movements slow and feeble. Should death occur, it will be from paralysis of the muscles of respiration. Treatment of Poisoning. — The same as in poisoning from conium — diffusible stimulants, strychnine, etc. Therapeutics. — Externally and Lo- cally. — Grindelia is a very efficient ap- plication to the skin in rhus-poisoning. Indeed, it serves as a soothing lotion in many acute inflammations of the skin, such as eczema, etc. The fluid extract used should be well diluted and applied on cloths. Indolent ulcers are well treated by a diluted solution of the drug. It also serves as an efficient injection in gonor- rhea, leucorrhea, and vaginitis. Internally. — Grindelia has acquired an enviable reputation as a remedy for spasmodic asthma, its action upon the bronchial muscles rendering it singu- larly beneficial in this disorder. It acts upon every possible point to relax the spasm of the bronchial muscles, as is shown in Fig- ure 9. The drug has no influence, however, in preventing a recur- rence of the paroxysms. The drug has been highly recommended in acute and chronic bronchitis, hay fever, whooping cough, and in spasmodic cough of whatever nature. It has even been suggested as a palliative remedy in pneumonia ^nd cardiac and pulmonary dyspnea. There are no special Contraindications or directions for Ad- ministration, save that the fluid extract is pharmaceutically incom- patible with aqueous preparations. Fig. 9. — Diagram showing how grin- delia relaxes spasm of the bronchial muscles in asthma. The sensory nerves (5) in the mucous membrane of the bronchial tubes are depressed, so that there is less irritation transmitted to the medulla, to be returned by the motor fibers supplying the bronchial muscles, thus exciting bronchial spasm. The respiratory center {A) is depressed, together with the ends of the motor nerves ( C), limiting the amount of irri- tation in the bronchial muscles {K). The diaphragm {F) is relaxed through depression of the phrenic nerve (Z7), 5o8 A TEXT-BOOK OF MA TERIA MEDICA. Physostigrma— Physostigmatis— Physostigrma. V. s. p. (Calabar Bean.) Origin. — The seed of Physostigma venenosuin Balfour, a lofty, half-shrubby, climbing plant (somewhat resembling the scarlet- runner or Spanish bean of our gardens) growing near the mouths of the Niger and Old Calabar River in Western Africa, and attain- ing a height of 40 or 50 feet (12-15 M.). Description and Properties. — The seeds are about i to i^ inches (25-30 Mm.) long, f to | inch (15-20 Mm.) broad, and f to •finch (10-15 Mm.) thick; oblong and somewhat reniform; testa granular, chocolate-brown, with a broad black groove extending the entire length of the convex edge ; embryo with a short, curved radicle and two large, white concavo-convex cotyledons ; inodor- ous ; taste bean-like. The drug contains an alkaloid, physostigmine (also known as eserine), which is the principal constituent ; calabarine, to which the drug owes its tetanizing properties ; and eseridine (a laxative and motor excitant) ; besides a neutral principle, physosterin, related to cholesterin. Dose. — 1-4 grains (0.065-0.25 Gm.). Official Preparations. Extractum Physostigmatis— ExtrScti Physostlgmatis — Extract of Physo- stigma. — Dose, -jJj-J grain (0.004-0.01 Gm.). Tinctiira PhysostJgmatis— Tincturse Physostitgmatis— Tincture of Physo- stigma. — Dose, 5-10 minims (0.3-0.6 Cc). The allcaloid, Physostigmine, is not official. It occurs in colorless or slightly pink- ish crystals; sparingly soluble in water; readily soluble in alcohol.— Z?o.jf, ^^-^ grain (0.0006-0.003 Gm.). The salicylate and sulphate of physostigmine are official. Physostigminae SaKcylas— Physostigmlns Salicylatis— Physostigmine Salicylate (Eserine Salicylate). U. S. P. Description and Properties. — Colorless or faintly yellowish, shining, acicular, or' short, columnar crystals, odorless, and of a bitter taste ; acquiring a reddish tint when exposed to light and air; soluble in 150 parts of water and 12 parts of alcohol. The salicylate should be kept in small, dark amber-colored, and well-stoppered vials. Dose. — Y^j-Tf*^ grain (0.0005-0.002 Gm.). Physostigminae Siilphas— Physostigminae Sulphatis— Physostigmine Sul- phate (Eserine Sulphate). U. S. P. Description and Properties.— K white, or yellowish-white, micro-crystalline pow- der, odorless, and of a bitter taste. It is very deliquescent when exposed to moist air, gradually turning reddish in air and light. Very soluble in water'and alcohol; still more so at the boiling-point of these liquids. It should be kept in small, dark amber- colored, and well-stoppered vials. Dose.—^\^^^ grain (0.0005-0.002 Gm.). MOTOR DEPRESSANTS. Unofficial Preparation. 509 Physostigmlnse Hydrobromas — Physostigminae Hydrobromatis — Physo- stigmine Hydrobromate. — Dose, xirs-^V gi^^i" (0.0005-0.002 Gm.). Antagonists and Incompatibles. — The action of physostigma upon the heart, respiration, and pupils is antagonized by atropine ; that on the spinal cord by chloral ; while, in a general way, the motor excitants, particularly the tetanizing agents, are therapeuti- cally antagonistic. The caustic alkalies and tannic acid are chemically incompatible. Synergists. — The motor depressants. Physiological Action. — Externally and Locally. — No external Fig. zo. — Diagram illustrating the mechanism of secretion. An impression is transmitted over the aflferent nerve (5) to the medulla (.(4), and thence over the secretory nerve (C) to the secretory cells (iir, K) of the gland {F). At the same time the vaso-motor nerves (.E) are stimulated, causing a con- traction of the arterioles (/) supplying the gland ; hence, as soon as the lymph in the lymph-spaces {H) is consumed, the secretion from the gland is diminished for lack of material necessary to the secretory cells in elaborating their normal secretions. -action of physostigma and its preparations is noted, unless it be its effect upon the pupil, which outward application contracts, and the slight abolition of functional activity in the motor and sensory 5IO A TEXT-BOOK OF MATERIA MEDICA. nerves, occasioned, it is said, by a strong solution of physostig- mine. Internally. — Digestive System. — The administration of the drug tends to stimulate the saUvary, gastric, and intestinal secretions, followed by lessened secretion (see Figure lo), and, by acting upon the muscular coats of the stomach and intestines, to increase peristalsis. Nausea, retching, vomiting, and purging may result. The rationale of its action is doubtless direct stimulation of the unstriped muscle-fibers. Circulatory System. — No influence on the blood has been de- tected. Small doses increase arterial tension, the heart's action becoming slower and stronger. Although the effect upon the heart is somewhat obscure, it appears that under poisonous doses the 'cardiac pulsations are greatly reduced, being slow and feeble, and finally ceasing alto- gether. It is reasonably supposed that this action is due to pri- mary stimulation of the peripheral vagi, influencing the cardiac ganglia, and also to the effect upon the vaso-motor centers. The subsequent exhaustion and relaxation of the arteries are doubtless the result of a similar influence. There is marked elevation of blood-pressure under moderate doses, although there may occur a brief period of depression. Toxic doses are accompanied by a notable decrease of arterial ten- sion, the cardiac ganglia being seized with paralysis and the heart finally arrested in diastole. Nervous System. — As with conium, the mind is comparatively unaffected by physostigma, remaining lucid even to the verge of final collapse. The spinal cord, however, appears to bear the prin- cipal shock, the total abolition of reflex activity indicating a selective action of the drug. To the effect on the motor nerves, occasioning a diminution of power, must be attributed the muscular debility and paralytic symptoms manifest under the administration of toxic doses. Respiratory System. — No interference with respiration is caused by moderate doses of the drug. Larger amounts primarily de- press the respiratory centers, stimulate the peripheries of the pul- monary vagi, and contract the caliber of the bronchial tubes, even to the extent of serious constriction, death usually resulting from asphyxia. The breathing is first quickened and then retarded, the effect of the drug upon the respiration being more powerful than its circu- MOTOR DEPRESSANTS. 511 latory influence, the heart continuing to beat for some time after pulmonary action has ceased. Absorption and Elimination. — The active principles of physo- stigma and its alkaloids are rapidly diffused in the blood. They are largely excreted by the kidneys, the bile and saliva contributing to the process of elimination, and have been detected in the gastric juices after intravenous injection. Temperature. — A slight depression has been noted. Eye. — Applied locally to the conjunctiva or introduced into the circulation, whether by ingestion or injection, physostigmine causes myosis or contraction of the pupil by stimulating the peripheral endings of the oculo-motor nerves, possibly by a depression of the sympathetic fibers. Other prominent symptoms present are spasm of accommoda- tion and decreased intraocular tension and myopia. Irritation of the third nerve is the principal cause of these phenomena : they have also been attributed to the stimulating action of the drug upon the muscular fibers of the iris rather than to any paralyzing influence upon the sympathetic, pupillar dilatation being manifest under excitation of the latter nerve. The intraocular pressure is lowered (i) by lessening the blood- supply to the eye through contraction of the blood-vessels ; (2) by diminishing the secretion of the aqueous humor from the glands on the surface of the ciliary body ; (3) by contracting the iris, so that the aqueous humor can more readily pass through the canal of Schlemm. Uterus. — The full influence of the drug tends to produce uterine contraction. Untoward Action. — When eserine is applied to the eye it occa- sionally produces a nervous contractile pain in the entire eyeball, which extends in a manner similar to ciliary neurosis along the course of the supraorbital -nerve, resembling migraine. Small doses have in some individuals produced nausea and general uneasiness, and occasionally intense pain in the epigas- trium. Poisoning. — Taken in poisonous doses, physostigma causes nausea, giddiness, and muscular tremors and weakness, followed by complete muscular relaxation. Cardiac action is diminished ; the reflexes are in abeyance; the respiration is retarded; and myosis and motor paralysis are manifest. The pupils visibly con- tract, and purging and vomiting may ensue. Fatal results are 512 A TEXT-BOOK OF MATERIA MEDICA. possible through paralysis of the respiratory center and consequent asphyxia. The more rapid collapse succeeding the administration of lethal doses is due to cardiac syncope. Treatment of Poisoning. — The stomach should be evacuated, the process being followed by the hypodermic injection of a solution of atropine, which may prove an efficient physiological antidote. Tannic acid may be used as a chemical antagonist. Diffusible stimulants, such as ether or ammonia, may serve to arrest cardiac and respiratory failure. Digitalis and alcohol have also been suc- cessfully employed. Temperature should be maintained by the application of external heat. Therapeutics. — Externally and Locally. — Physostigmine and ESERiNE SULPHATE are the preparations usually employed, their only action of importance being in diseases of the eye. They are of value in breaking up adhesions of the iris to the cornea or lens, strengthening the muscle of accommodation, reducing intraocular pressure, and removing the effects of atropine, although Jessup claims that complete ciliary paralysis by atropine and the mydriasis induced by hyoscine are unaffected by eserine. In certain cases of ulcer of the cornea uncomplicated with iritis and sloughing keratitis, where there is little inflammation or ciliary irritation, eserine sometimes produces prompt improvement when atropine has failed. Paralytic mydriasis and paralysis of accommodation are tempo- rarily relieved by this drug, and weak solutions have been employed with varying success in accommodative asthenopia without refrac- tive errors. The remedy is of unquestioned value in the early stages of glaucoma, but only at the commencement of an acute attack and contraindicated in the hemorrhagic form. Should the drug fail to contract the pupil when used for glaucoma, it may induce irritating spasm of the ciliary muscles by increasing the blood-supply to the iris. Physostigmine is sometimes employed to prevent prolapsus of the iris, following peripheral perforation of the cornea or cataract extraction, particularly without iridectomy. The remedy serves a useful purpose also in coal-miners' nys- tagmus, one drop of a collyrium containing \ grain (0.096 Gm.) of PHYSOSTIGMINE SULPHATE in I ounce (30.0 Cc.) of distilled water being dropped into the eye three times a day. Eserine is also em- ployed in neuralgia of the eyeball and photophobia. MOTOR DEPRESSANTS. 513 Internally. — Physostigma has proved efficacious in constipation due to an atonic condition of the intestines with deficient secretion. The state of the muscular intestinal layer frequently allows gas to accumulate in the bowels, with consequent troublesome flatulence. The drug, by imparting tone to the muscles and increasing peri- stalsis, greatly relieves this unpleasant condition. Gastric and intestinal dilatation have been successfully treated by Hare with this remedy. It is valuable in chronic bronchitis with dilatation of the bronchial tubes, and is said to relieve bronchial asthma and emphysema. Progressive paralysis of the insane is sometimes relieved by PHYSOSTIGMA, while its good reputation in tetanus is well estab- lished. It has been used, but with less favorable results, in chorea, epilepsy, infantile convulsions, and other spasms. Some authorities have recommended it in the treatment of paraplegia due to myeh- tis, renal hemorrhage, night-sweats of phthisis, and locomotor ataxia. Contraindications. — The same as for conium. Administration. — The extract or the tincture is usually pre- ferred for internal administration, although the alkaloid fully repre- sents the drug and may be given either by the mouth or hypo- dermically. For application to the eye the salts of the alkaloid are used. A convenient form of eserine in ophthalmic practice is -the medicated gelatin disks. Curare— Curare— Curare. (WOORARI.) Origin. — An extract of uncertain composition prepared by the natives of South America as an arrow-poison. Dr. Jobert reported to the French Academy in 1878 that the poison was prepared chiefly from Strychnos Castelnceana and other species of Strychnos, and Cocculus toxiferus, containing also variable quantities of other poisonous plants, such as Didelphys cancrivora, etc. It is alto- gether probable that its ingredients include the poison of venomous reptiles. Description and Properties. — The extract is a blackish-brown, friable solid, brittle or hygroscopic, of a very bitter taste ; almost completely soluble in dilute alcohol. Cold water dissolves about 75 per cent., which portion contains the poisonous alkaloids and is insoluble in ether and but sparingly soluble in absolute alcohol. Two alkaloids have been obtained from this substance — curarine and curine. 514 A TEXT-BOOK OF MATERIA MEDIC A. Dose. — 2iy~i grain (0.003-0.03 Gm.), hypodermically given. Dose of Curarine. — g-B-j-yFC grain (0.0003-0.0006 Gm.), hype dermically. Antagonists and Incompatibles. — The excito-motors are ai tagonistic. Tannic acid and the caustic alkahes are chemical] incompatible. Synergists. — The depresso-motors. Physiological Action. — When applied to the denuded skin it : a powerful irritant ; introduced into the circulation hypodermicallj it exerts a very decided and characteristic action. Circulatory System. — Medicinal doses render the pulse fulle and exceedingly rapid ; there is marked dilatation of the blooc vessels of the skin and the various glands ; while the blood-pres sure, though little affected by small doses, is decidedly lowered b large ones. The action on the circulation is due to diminishe inhibition on the heart, owing to paralysis of the ends of the vag while the accelerator nerves are stimulated. Nervous System. — Immoderate doses cause great muscula weakness and paralysis of all the voluntary muscles. The end of the motor and sensory nerves are paralyzed, the former beini soonest affected. Beyond a slightly diminished contractility th voluntary muscles are but little influenced. The spinal cord ma; be paralyzed under toxic doses, although the brain-centers remai unaffected until carbonic-acid narcosis sets in. Respiratory System. — Curare is a powerful respiratory depress ant, paralyzing the ends of the motor nerves distributed to th respiratory muscles. When lethal doses have been given th paralysis becomes central, finally producing death by its action o the respiratory muscles. Absorption and Elimination. — When ingested the process absorption is exceedingly slow, but when injected into the circula tion the drug is rapidly absorbed. It is quickly eliminated by the kidneys, causing sugar to appea in the urine. A portion of the poison is also excreted with th feces. The sweat, saliva, nasal mucus, and tears, although thai secretion is greatly increased by the drug, do not seem to share i the process of elimination. Temperature. — The temperature is elevated. Eye. — Under poisonous doses there is marked ptosis, disordere vision, protrusion of the eyeballs, and, as a late ocular sympton myosis. MOTOR DEPRESSANTS. 515 Poisoning. — Curare is a rapid and active poison. The move- ments of the heart are greatly accelerated ; the pulse is weak and dicrotic ; the temperature is elevated, and the respiration corre- spondingly depressed ; extreme muscular weakness ensues, with incoordination of movements ; the urine becomes saccharine. Finally, paralysis of the extremities and the respiratory muscles supervenes, death occurring from respiratory paralysis. Treatment of Poisoning. — The same as in the treatment of poi- soning from conium, with catheterization of the bladder to favor elimination, and artificial respiration. Therapeutics. — While of great scientific interest and of value for experimental purposes in ascertaining the effect of certain drugs upon animals, the therapeutic uses of curare are quite limited, being confined to certain spasmodic diseases, particularly hydrophobia. The remedy has also been used with varying success in chorea, tetanus, and epilepsy, but when the convulsions are due to excessive activity of the cerebral motor areas the bromides are superior to curare. Contraindications. — The same as for conium. Administration. — The crude drug or the alkaloid curare should be given hypodermically. Aspidosperma— Aspidospermatis— Aspidosperma; V. S. JP. Origin. — The bark oi Aspidosperma Quebracho-bianco Schlech- tendal, a large evergreen tree, of exceedingly hard wood (Sp. quebrar, to break, and hacha, an axe), indigenous in the Argentine Republic. Description and Properties. — Occurring in nearly flat pieces about \ to i^ inches (12.0-30.0 Mm.) thick; the outer surface yel- lowish-gray or brownish, deeply fissured, inner surface yellowish- brown or reddish-brown, distinctly striate ; fracture displaying two sharply-defined strata of about equal thickness, both marked with numerous whitish dots and striae arranged in tangential lines ; the fracture of the outer lighter-colored layer rather coarsely granu- lar, and that of the darker-colored inner layer short-splintery; inodorous ; taste very bitter and slightly aromatic. Six alkaloids have thus far been isolated from aspidosperma, the most important being aspidosp ermine and quebrachine, the former occurring in colorless prismatic crystals insoluble in water and soluble in 48 parts of alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). 5i6 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Extractum AspidospSrmatis Fluidum— Extract! AspidospSrmatis Fluidi— Fluid Extract of Aspidosperma. — Dose, 5-30 minims (0.3-1.8 Co.). Aspidospermine (unofficial). — Dose, J-J grain (0.016-0.03 Gm-)- Quebrachine (unofficial). — Dose, 1-2 grains (0.06-0.12 Gni.). Physiological Action. — Externally and Locally. — No important action has been noted. Internally. — Digestive System. — It is a stomachic, having an action analogous to the vegetable bitters. Circulatory System. — Aspidosperma depresses the heart, render- ing its action slower, with reduction of arterial tension. Nervous System. — In its action it resembles conium. It de- presses the motor mechanism by its influence on the motor centers, and lessens the reflexes through its influence on the spinal cord. Excessive doses cause vertigo and headache, together with paraly- sis of the extremities, the lower being first affected. Respiratory System. — Medicinal amounts of aspidosperma retard the breathing, but deepen the inspirations ; aspidospermine, on the contrary, increases the respiratory movements. Toxic doses para- lyze the respiratory center, death resulting apparently from asphyxia and convulsions. Absorption and Elimination. — It readily passes into the blood, and is excreted chiefly by the urine, the saliva and sweat sharing in the process of elimination. Temperature. — It is antipyretic, febrile temperature being re- duced by full doses of the drug. Poisoning. — Aspidospermine is an active respiratory poison, the toxic symptoms being vertigo, headache, free diaphoresis and sali- vation, great muscular weakness, with paralysis of the lower extremities, slow and weak heart, reduction of temperature, marked depression of the respiration, and death from respiratory failure. Treatment of Poisoning. — The same procedure is advisable as in cases of poisoning from the other motor depressants. Therapeutics. — Aspidosperma is not employed locally, its chief value being in the treatment of dyspnea of whatever variety, though it is fair to state that Pluzoldt considers it contraindicated in cardiac dyspnea. The drug is equal, if not superior, to grindelia inthe treatment of spasmodic disorders of the respiratory apparatus. By some clinicians it is claimed to be an efficient remedy in pneumonia, being especially useful in relieving cyanosis. MOTOR DEPRESSANTS. . 517 AspiDOSPERMiNE has been highly recommended as an anti- periodic in malaria, and has appeared to modify the symptoms of acute articular rheumatism. Administration. — Both the fluid extract and the alkaloid may be given internally, although a favorite and efficient method of administering the alkaloids is by hypodermic injection. Sumbul— Stimbul— Sumbul. TJ. S. P. Origin. — The root of Ferula sumbul (Kauffmann) Hooker fil, a perennial about 8 feet (2.4 M.) high, indigenous in regions north and east of British India. Description and Properties. — It occurs in transverse segments, varying in diameter from i to 3 inches (2-7 Cm.), and in length from 6 to 12 inches (14-30 Cm.); light spongy, annulate or longi- tudinally wrinkled ; bark thin, brown, more or less bristly fibrous ; the interior whitish, with numerous brownish-yellow resin-dots and irregular, easily separated fibers; odor strong, musk-hke; taste bitter and balsamic. It contains sumbulic and valerianic acids, a small quantity of volatile oil, and two balsamic resins to which its odor is due. Dose. — 15-30 grains (1.0-2.0 Gm.). Official Preparation. Tinctura Sflmbul — Tincturae Stimbul — Tincture of Sumbul. — Dose, 15-60 minims (1.0-3.7 Cc). The drug has not yet been carefully studied. It is unknown just what substances are incompatible with it, though the motor excitants are probably antagonistic. The exact physiological action is not definitely understood, yet so far as it has been investigated it seems to possess some of the properties of both the motor de- pressants and antispasmodics, having a sedative action upon the brain and spinal cord. ■ Therapeutics. — The drug is valuable in the various manifesta- tions of hysteria, and has been employed with some success in ovarian neuralgia and dysm.enorrhea. It is similar to, though not so efficient as, grindelia in spasmodic coughs. Indeed, most of the disorders benefited by the antispas- modics yield to the influence of sumbul. In neurasthenia with anemia the extract of sumbul, combined with iron and arsenic, sei^ves a very useful purpose. 5l8 ^ TEXT-BOOK OF MATERIA MEDIC A. Administration. — It may be given in the form of the tincture, or the extract may be administered in pill form. Viburnum Prunifolium— Viburni 'Prunifolii— Black Haw. V. S. JP. Origin. — The bark of Viburnum prunifolium L., a tall shrub or small tree lO to 20 feet (3-6 M.) high, growing in thickets through- out the greater portion of the United States east of the Mississippi. Description and Properties. — Thin pieces or quills, glassy purplish-brown, with scattered warts and minute black dots ; when collected from old wood, grayish-brown, the thin corky layer easily removed from the green layer ; inner surface whitish, smooth ; frac- ture short ; inodorous ; somewhat astringent and bitter. It contains a bitter principle (viburnin), a bitter resin, valerianic acid, besides tannic, oxalic, citric, and malic acids. Dose. — 30-60 grains (2.0-4.0 Gm.). Official Preparation. Extractum Vibtirni Prunifolii Fluidum — Extracti Vibiirni Prunifolii Fluidi —Fluid Extract of Black Haw.'— Z)o«, %-\ fiuidrachm (1.8-3.7 Cc). Antagonists and Incompatibles. — It is chemically incompatible with iron and other substances affected by tannic acid. Ssmergists. — Antispasmodics and uterine sedatives. Physiological Action and Therapeutics. — The action of black haw is not thoroughly understood. It appears to have a sedative action upon the spinal centers, similar in many respects to that of conium. It acts as an antispasmodic, diuretic, nervine, and tonic, being especially useful in various uterine disorders, such as spas- fnodic and membranous dysmenorrhea. The various vaso-motor disturbances and the menorrhagia inci- dent to the menopause are frequently relieved by this remedy. It is also of some value in the prevention of abortion. Its sedative properties render it serviceable in relieving the severity of after- pains. Liquor Sedans (P., D. & Co.) is superior to the fluid extract of black haw for the disorders mentioned. Contraindications and Administration require no special com- ment or suggestion. 1 Parke, Davis & Co. of Detroit manufacture a preparation called Liquor Sedans, intended as a substitute for certain secret preparations. The formula is given on the label of each bottle, and the remedy is composed of black haw, golden seal, and Jamaica dogwood, combined with aromatics, in the form of an elixir. MOTOR DEPRESSANTS. 519 Viburnum Opulus— Viburni Opuli— Cramp Bark. V. S. JP. Origin. — The bark of Viburnum Opulus L., a small tree 10 to 15 feet (3-4.5 M.) high, indigenous in Canada, the Northern United States, Europe, and Northern Asia. Description and Properties. — Flattish or curved bands, or occasionally quills, sometimes 12 inches (30 Cm.) long and from ^ to yi^ inch (1-1.5 Mm.) thick; outer surface ash-gray, marked with somewhat transversely scattered, elongated warts of a brown- ish color, due to abi;asion, and marked more or less with blackish dots, with black, irregular lines or thin ridges, arranged chiefly in a longitudinal direction; underneath the easily-removed corky layer of a pale-brownish or reddish-brown color ; the inner surface dingy white or brownish ; fracture tough, the tissue separating in layers ; inodorous ; taste somewhat astringent and bitter. Dose. — 1-2 drachms (4.0-8.0 Gm.). Official Preparation. Extractum Vibiirni Opuli Fluidum — ExtrScti Vibfirni Opuli Fluidi — Fluid Extract of Cramp Bark. — Dose, 1-2 fluidrachms {3.7-7.3 Cc). j, ' The general observations upon Viburnum prunifoliuni are appli- cable to this drug. Acidum Hydrocyanicum Dilutum— Acldi Hydrocy- anic! Diluti— Diluted Hydrocyanic Acid. U.S. P. (Prussic Acid.) Origin. — A liquid composed of 2 per cent, by weight of abso- lute Hydrocyanic Acid and 98 per cent, of Water, prepared by distilling a mixture of Potassium Ferrocyanide, Sulphuric Acid, and Water into Distilled Water. Description and Properties. — A colorless liquid, of a charac- teristic odor and taste, resembling those of bitter almonds. As it is very poisonous, great care should be taken in tasting it. It should be kept in small, dark-amber colored, cork-stoppered bottles, in a cool place. Dose. — 1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles. — Atropine is a physiological antagonist, the diffusible stimulants also couftteracting the effects of the drug. The metallic salts, particularly cobalt nitrate, are chemically incompatible. 520 A TEXT-BOOK OF MA TERTA MEDICA. Synergists. — The cardiac and motor depressants. Physiological Action. — Externally and Locally. — Applied lo- cally to the unbroken skin, its first effect is slightly irritating, but soon after sedative and anesthetic, because of its influence in causing paralysis of the sensory nerve-endings. It is very rapidly absorbed from raw surfaces, even toxic effects resulting from its application. Internally. — Digestive System. — Being quickly absorbed by the mucous membranes, hydrocyanic acid acts as an anesthetic and sedative upon the stomach, moderate doses having little influ- ence upon a healthy organism. Toxic doses may be followed by vomiting and the terribly lethal action of the drug, the peculiarly sudden and violent activity of which renders it the most fatal poison known. Circulatory System. — Prussic acid passes very readily into the blood, upon which it acts with physical effects variously reported, it having been observed that the blood is at first changed to a bright red or arterial tint, soon changing to a dark venous color. Upon the heart its influence, though in small doses sedative through stimulation of the vagus center, in toxic doses is particu- larly active, suspending its movements and arresting it in diastole. A temporary, yet doubtful, increase, followed by a decline, of arterial pressure has been noted. In lethal doses the decrease of tension is unquestionable. Observations upon the physiological effects of prussic acid have been attended with considerable dif- ficulty : a slow and frequently irregular pulse, however, is among the authenticated phenomena. By its action on the respiratory functions of the red blood-corpuscles the supply of oxygen to the circulation is impeded. Nervous System. — Medicinal doses have no appreciable effect save to occasion a depression of the sensory fibers of the vagus. The cerebral effects of large doses are giddiness and stupor, often accompanied by total insensibility or coma. Toxic doses produce marked cutaneous anesthesia, beginning in the lower extremities, caused by paralysis of the sensory ends and sensory tracts. The motor mechanism shares in the general influence, which causes excessive muscular weakness, resulting from depression of the spinal motor areas, the ends of the motor nerves, and the mus- cles respectively. Respiratory System. — Very small doses of hydrocyanic acid have no effect upon respiration. Full or large doses have been observed MOTOR DEPRESSANTS. 521 to render the breathing labored and irregular. Under toxic doses the respiration becomes enfeebled, finally ceasing altogether, death ■ensuing from asphyxia due to paralysis of the respiratory move- ments by direct action upon the center. It has been noted that lethal doses are so quickly fatal that the respirations cannot be counted. Absorption and Elimination. — As has been remarked, absorption takes place with great rapidity, elimination being probably through the kidneys, salivary glands, and lungs, the process being accel- erated by means of the drug's exceeding volatility. In case of poisoning, should death be averted for half an hour there is chance of recovery. Temperature. — No special influence has been observed. Eye. — The pupils are, as. a rule, visibly dilated under serious dosage, a temporary hemianopia having been also observed in a case of poisoning with recovery. Untoward Action. — There are no untoward manifestations save those described under " Poisoning." Poisoning. — The celerity of action characteristic of prussic acid is evidenced by the fact that death may be instantaneous, the sub- ject falling with a gasp and momentary convulsion, followed by immediate collapse. In such cases the countenance is cyanotic, the teeth fiirmly set, the eyes wide open, and the lips covered with bloody froth. In less violent cases the symptoms may take the form of reduced respiration, impairment of cardiac movements, and cerebral disturbance. A third stage is marked by wide dilatation of the pupils, loss of consciousness, delirious cries, accompanied by strong convulsions, vomiting, incontinence of urine, involuntary defecation, and even erections of the penis and ejaculations of semen (Hare). In still another stage asphyxia, collapse, and death occur in rapid succession. Treatment of Poisoning. — Owing to the physical action of prussic acid upon the blood, artificial respiration is generally pow- erless to avert fatal results (Ringer). Efficient antidotee are ammonia and its carbonate, to be administered whenever prac- ticable. Alcoholic stimuli may prove of service, yet the fearful rapidity of the drug's action renders poisoning by prussic acid rarely amenable to systematic treatment. A vigorous recourse to alternately warm and cold affusions, together with inhalations of ammonia, has been recommended as of primary importance. Secondary means of allaying-toxic effects 522 A TEXT-BOOK OF MA TERIA MEDICA. may be found in the internal administration of chlorine water or of potassium carbonate, followed by the sulphates of iron. More recently the subcutaneous injection of atropine has been suggested as the true physiological antidote (Farquharson), while Dr. Antal considers cobalt nitrate the best chemical antagonist. So long as the faintest pulsation is discernible no efforts at recovery should be remitted. Therapeutics. — Externally and Locally. — Hydrocyanic acid is a valuable antipruritic, being frequently employed to relieve the itching of various diseases of the skin, such as eczema, erythema, urticaria, pruritus vulvee, etc. It is commonly applied in strengths of ^ fluidrachm (1.8 Cc.) to I ounce (30.0 Cc.) of water. Inhalations of a solution containing 3 minims (0.18 Cc.) of diluted hydrocyanic acid to 8 ounces (236.6 Cc.) of water at a temperature of 120° F. have been recommended by Mackenzie and others in asthma and the irritative cough of phthisis. Internally. — Its sedative properties render the drug an efficient remedy in obstinate vomiting and gastric pain from whatever cause. It is also valuable to relieve coughs of a dry, hacking nature, whooping cough, and various neuroses of the respiratory organs. Macdonald reports a case of night cough of a child that yielded promptly to hydrocyanic acid after every other treatment had been tried in vain. The drug has also been employed in neuralgia and acute mania and m.elancholia. In irritable conditions of the heart it serves as a useful palliative, and it is also of some value in relieving the distress of irritative dyspepsia. Contraindications. — Extreme muscular weakness and the last stages of valvular heart disease. Administration. — Owing to the exceedingly rapid elimination of prussic acid the dose should be frequently repeated — every hour or two. In the early administration the minimum dose should be first prescribed, the amount being gradually increased to the maximum or until the patient complains of constriction about the throat or other untoward manifestation, when the dosage should be discontinued. Whenever a fresh supply is prescribed it is best to begin with the minimum dose, owing to the variations in strength in the different samples. Hydrocyanic acid may be given in syrup, water, or glycerin, or in some effAvescent draught. MOTOR DEPRESSANTS. 523 Potassii Cyanidum— Potassil Cyanidi— Potassium Cyanide. V. S. F. Origin. — Prepared by heating in an iron crucible a mixture of exsiccated Potassium Ferrocyanide 8 parts and Potassium Carbon- ate 3 parts until effervescence ceases. Description and Properties. — White, opaque, amorphous pieces, or a white, granular powder, odorless when perfectly dry, but in moist air exhaling the odor of hydrocyanic acid. The taste is sharp and somewhat alkaline, but should be ascertained with great care, as ike salt is very poisonous. In moist air it deliquesces ; soluble in about 2 parts of water and sparingly soluble in alcohol. Potassium cyanide should be kept in well-stoppered bottles. Dose. — \^ - \ grain (0.004-0.008 Gm.). Cyanide of potassium differs from hydrocyanic acid, with which it generally assimilates, in being less rapid in its action, producing dermatitis or eczematous eruption by local application to the epi- dermis, and in its possibly fatal results from free contact with abraded surfaces. The therapeutic uses are practically those of hydrocyanic acid. Amyl NTtris— Amyl Nitrltis— Amy! Nitrite. TJ.S.F. Origin. — Obtained by the action of Nitric Acid upon Amylic Alcohol — a liquid containing about 80 per cent, of amyl (princi- pally iso-amyl) nitrite, together with variable quantities of unde- termined compounds. Description and Properties. — A clear yellow or pale-yellow liquid, of a peculiar, ethereal, fruity odor and a pungent, aromatic taste. Almost insoluble in water ; miscible in all proportions with alcohol or ether. In alcoholic solution it gradually decomposes, with formation of ethyl nitrite and amylic alcohol. It should be kept in small, dark-colored, glass-stoppered bottles, in a cool and dark place, remote from lights and fire. Dose. — J-I minim (0.03-0.06 Cc.) internally ; for inhalation I-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles. — The motor excitants antago- nize the action of amyl nitrite. Synergists. — The motor depressants. Physiological Action. — Externally and Locally. — Its action is that of a mild irritant when applied to the skin. 524 A TEXT-BOOK OF MATERIA MEDICA. Internally. — The following actions apply to ingestion or inhala- tion of the drug. Digestive System. — No important action has been observed. Circulatory System. — Almost immediately after inhalation of amyl nitrite there is a marked increase in the heart's action and great dilatation of the arteries, with lowering of arterial pressure. The rapidity of the pulse is due to depression of the vagus and the removal of inhibition from the low arterial tension. The exact cause of dilatation in the arterial system is undetermined, some experimenters believing it to be due to depression of the muscular coat of the vessels or ganglia, while others suppose its action to be on the vaso-motor center. The inhalation of large amounts renders the heart very weak, toxic doses arresting that organ in diastole. The functional activ- ity of the hemoglobin is checked, giving to the arterial and venous blood a dark chocolate color. Nervous System. — Among the effects are cerebral oppression, flushing of the head and face, vertigo, headache, and confusion of ideas, with diminished reflex excitability, muscular weakness, and unsteadiness of gait, both the voluntary and involuntary muscles being relaxed. These actions are due to the depressing influence of the drug upon the motor areas of the brain and spinal cord. Respiratory System. — Small doses quicken the respiration by lowering arterial pressure and possibly by stimulation of the cen- ter. Immoderate or toxic amounts render the breathing slow and labored from depression of the respiratory center and arrest of the corpuscular action of the blood. Absorption and Elimination. — Amyl nitrite is rapidly absorbed, being eliminated chiefly by the kidneys, increasing the amount of urine, uric acid, and urea excreted. Sugar may frequently be de- tected in the urine, probably resulting from the action of the drug in dilating the hepatic vessels and increasing the circulation in the liver. Temperature.— '?,o^\\y heat is reduced both in health and in fever, due to dilatation of the peripheral blood-vessels and a reduc- tion of the oxygen-carrying power of the red blood-corpuscles. ^«'.— There is marked dilatation of the retinal vessels and hyperemia of the papilla, producing chromatopsia of the parti- colored variety and hallucinations of vision. These effects are usually transitory, and disappear with the elimination of the drug. Uterus. — The uterine muscle is relaxed. MOTOR DEPRESSANTS. 525 Untoward Action. — In addition to the symptoms described under " Poisoning," there have been noted gastric disturbance, nausea and vomiting, dryness of the mouth and trembling of the lips, irritation of the throat, defective vision, and subjective sensations of color, usually yellow vision. Poisoning. — The toxic effects of amyl nitrite include an exceed- ingly rapid and weak heart, final retardation of the pulse, cyanosis of the face, slow and shallow respiration, cold extremities, subnor- mal temperature, great muscular weakness, abolished reflexes, vertigo, intense headache, and disordered vision. Death results from cardiac or respiratory failure. Treatment of Poisoning. — Strychnine and digitalis are required to sustain the heart ; ergotin or atropine may be administered sub- cutaneously, together with cold applications to the head, diffusible stimulants, and artificial respiration if necessary. Sodii NItris— Sodii Nitritis— Sodium Nitrite. TJ. S. P. Origin. — Obtained by heating Sodium Nitrate with Lead, the oxygen from the nitrate being abstracted by the lead oxide formed. Description and Properties. — White, opaque, fused masses, usually in the form of pencils, or colorless, transparent, hexagonal crystals ; odorless, and of a mild, saline taste. When exposed to the air the salt deliquesces and is gradually oxidized to sodium nitrate. Soluble in about 1.5 parts of water; slightly soluble in alcohol. It should be kept in well-stoppered bottles. Dose. — 2-5 grains (o. 1 2-0.3 Gm.). Spiritus GlonoTni— SpTritus GlonoTni— Spirit of Gio- noin. U.S. P. (Spirit of Nitroglycerin.) An alcoholic solution of i per cent, of nitroglycerin. Origin. — Nitroglycerin is obtained by gradually adding Dehy- drated Glycerin to a mixture of Nitric and strong Sulphuric Acid, the nitroglycerin formed being washed with water and dilute soda solution to remove all acid. Description and Properties. — Nitroglycerin occurs as a clear, colorless liquid possessing the odor and taste of alcohol. It should be tasted and handled with great caution, since it is apt to produce violent headache, whether ingested or applied to the skin. It explodes with great force, and should be kept in a cool place, remote from lights or fire. 526 A TEXT-BOOK OF MA TERIA MEDICA. Dose. — 1-3 minims (0.06-0.18 Cc.) of the spirit. The actions of sodium nitrite and nitroglycerin are very similar to those of amyl nitrite, although they are less prompt, while more persistent. Nitroglycerin produces a frontal headache of much greater intensity than that caused by amyl nitrite. This is also true of sodium nitrite, though the headache it occasions is less severe than that resulting from nitroglycerin. Both the sodium nitrite and nitroglycerin are preferable to the amyl nitrite for internal administration. Therapeutics. — Externally and Locally. — The nitrites are not used for external purposes. Internally. — The property of amyl nitrite in suddenly lowering arterial pressure and dilating the arterioles renders it of inestima- ble value as a relief for the terrible precordial pain in angina pectoris. Epileptic seizures may often be aborted by the instant inhalation of amyl nitrite upon the first indication of the aura epileptica. The drug has also been successfully employed for the relief of asthma, particularly the uremic form, as well as for cardiac dyspnea and puerperal eclampsia. , Like many other motor depressants, it has been used in the treatment of tetanus and strychnine-poisoning. It has proved an efficient preventive for the chill occurring in virulent malarial fever, and has served as a valuable antidote in poisoning from chloroform. The drug is indicated in all conditions of high arterial tension, as in chronic nephritis, etc. It is also beneficial in congestive dys- menorrhea. The SODIUM NITRITE IS used for the same purposes as the amyl nitrite, though superior to it for internal administration, as in cases of abnormally high arterial tension. Nitroglycerin is specially adapted for the treatment of cardi- opathies occurring after middle life. The tendency to increase of peripheral resistance in the vessels after adult life is attained renders possible the favorable administration of doses of nitroglycerin intol- erable in early life. The drug is often of marked benefit in the arrhythmia of slightly enlarged atid degenerated hearts with arteriosclerosis. It is also of considerable value in relieving the pseudo-anginas which are frequently a feature of vascular disease. It should be given in doses of -^-^ to Y^ir grain (0.00032-0.0006 Gm.) twice or four times daily. MOTOR DEPRESSANTS. 527 Osier recommends the prolonged administration of nitroglycerin in locomotor ataxia, affirming that it lessens the frequency of the crises and relieves the neuralgic pains. The drug is of use in sciatica, and frequently relieves obstinate hiccough. It has been recommended for the same diseases for which amyl nitrite is used. BROMIDES. Potassii Bromidum— Potassii Bromidi— Potassium Bromide. V. S. P. Origin. — Prepared by adding Bromine to a solution of Potassa, evaporating to dryness, mixing with Charcoal, heating to redness, dissolving in Water, and crystallizing. Description and Properties. — Colorless or white, cubical crys- tals or granules, odorless, with a pungent, saline taste ; permanent in air; soluble in about 1.6 parts of water and in 200 parts of alcohol. Dose. — 5-60 grains (0.3-4.0 Gm.). Sodii Bromidum— Sodii Bromidi— Sodium Bromide. u. s. p. Origin. — Obtained from a solution of Soda in the same manner as Potassium Bromide. Description and Properties. — Colorless or white, cubical crys- tals, or a white, granular powder, odorless, and with a saline, slightly bitter taste. From air the salt abstracts moisture without deliquescing. Soluble in 1.2 parts of water and in 13 parts of alcohol. It should be kept in well-stoppered bottles. Dose. — 10-60 grains (0.6-4.0 Gm.). Ammonii Bromidum— Ammonii Bromidi— Ammo- nium Bromide. U. S. JP. Origin. — Obtained by neutralizing Hydrobromic Acid with Ammonia or Ammonium Carbonate, evaporating, and crystallizing. Description and Properties. — Colorless, transparent, prismatic crystals, or a white, crystalline powder, odorless, and of a pungent, saline taste; permanent in the air. Soluble in 1.5 parts of water and in 30 parts of alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). 528 A TEXT-BOOK OF MATERIA MEDICA. LTthii Bromidum— Lithii Bromidi— Lithium Bromide. JJ. S. JP. Origin. — Prepared by a solution of Ferrous Bromide and Lithium Carbonate, the cool liquid being evaporated and crystallized. Description and Properties. — A white, granular salt, odorless, and having a sharp, slightly bitter taste ; very deliquescent. Solu- ble in 0.6 part of water and very soluble in alcohol. It should be kept in well-stoppered bottles. Dose. — 5-20 grains (0.3-1.2 Gm.). Calcii Bromidum— Calcii Bromidi— Calcium Bro- mide. U. S. JP. Origin. — Prepared by dissolving pure Calcium Carbonate in Hydrobromic Acid and evaporating. Description and Properties. — A white, granular salt, odorless, of a sharp, saline taste and very deliquescent. Soluble in 0.7 part of water and in i, part of alcohol. It should be kept in well- stoppered bottles. Dose. — 10-30 grains (0.6-2.0 Gm.). ZTnci Bromidum— ZTnci Bromidi— Zinc Bromide. U. S. JP. Origin. — Prepared by digesting Granulated Zinc in Hydrobromic Acid, concentrating the solution, acidulating with Hydrobromic Acid, and drying upon a water-bath. Description and Properties. — A white, granular powder, odor- less, and having a sharp, saline, and metaUic taste. Very deliques- cent. Readily soluble in water and alcohol. Dose. — 1-5 grains (0.06-0.3 Gm.). Strontii Bfomidum— Strontii Bromidi— Strontium Bromide. U. S. J>. Origin. — Obtained by neutralizing Hydrobromic Acid with Strontium Carbonate, filtration, and evaporation. Description and Properties. — Colorless, transparent, hexagonal crystals, odorless, and having a bitter, saline taste. Very deUques- cent. Soluble in 1.05 parts of water and readily soluble in alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). MOTOR DEPRESSANTS. 529 Acidum Hydrobromicum Dilutum— Acidi Hydro- bromici Diluti — Diluted Hydrobromic Acid. TT. 8. JP. Origin. — A liquid composed of 10 per cent, by weight of Abso- lute Hydrobromic Acid and 90 per cent, of Water. Description and Properties. — A clear, colorless liquid, odor- less, and having a strongly acid taste. Miscible in all proportions with water and alcohol. It should be kept in glass-stoppered bottles, protected from light. Dose. — 20 minims-2 fluidrachms (1.23-7.39 Co.). Bromoformum— Bromoformi—Bromoform (Unofficial). Origin. — Obtained by the action of Bromine upon equal parts of Methylic Alcohol and Caustic Potash. Description and Properties. — A colorless, limpid liquid with an agreeable odor and sweet taste. Insoluble in water, but soluble in alcohol and ether. It should be kept in well-stoppered, dark, amber-colored bottles. Dose. — 1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles. — The bromides are antago- nized by the motor excitants and cardiac stimulants. The incom- patibles are acids, acidulous and metallic salts. Spirit of nitrous ether is incompatible with the ammonium bromide. Synergists. — Their action upon the brain is enhanced by opium and the hypnotics, while the cardiac depressants increase their effect upon the circulatory system. Physiological Action. — The action of potassium bromide is here given, that being the type of the group : later the comparative actions of the various members will be considered. Externally and Locally. — Potassium bromide is slightly seda- tive to mucous membranes when applied locally, lessening the reflex irritability, particularly of the pharynx. Internally. — Digestive System. — No effect is produced by mod- erate amounts. Excessive doses have occasioned a sense of cold- ness in the epigastrium, with nausea and looseness of the bowels. Circulatory System. — The bromides depress the circulation, causing the pulse to become slower, softer, and weaker, and short- ening the systole while prolonging the diastole of the heart. The caliber of the vessels is diminished, although arterial pressure is 34 53° A TEXT-BOOK OF MATERIA MEDICA. lowered. Arterial anemia of the brain is present, owing to the contraction of the blood-vessels and diminished arterial pressure. Toxic doses of potassium bromide cause dilatation of the heart and paralysis in diastole. The exact points where the bromides act to cause this circula- toiy depression are undetermined. Nervous System. — When given for a long time or under large dosage the bromides depress the cerebral cells, producing somno- lence, reducing the excitability of the brain, and, if long continued, impairing the memory and intellect. Under their influence there is marked depression of the motor mechanism, resulting in muscular weakness. Every possible point of the apparatus is depressed — the cerebral and spinal motor areas, the spinal motor tracts, the ends of the motor nerves, and even the muscles themselves. Bromides also lessen greatly the reflex excitability of the spinal cord. As in their action upon the motor mechanism, they depress every part of the reflex apparatus — the ends of the afferent and efferent nerves and the reflex center wherever it may be. The sensory mechanism is therefore impaired, causing dimin- ished sensibility of the skin and mucous membranes. The functional activity of the sexual organs is considerably less- ened by these drugs. Respiratory System. — Under full doses the respirations are slower and shallower, owing to depression of the respiratory center, paralysis of which usually causes death, although fatal paralysis may affect the heart because of the poisonous influence of the potassium upon the cardiac muscle. Absorption and Elimination. — The bromides are very rapidly absorbed, having been found in the urine ten minutes after their ingestion (Dujardin-Beaumetz), and are quickly eliminated, chiefly by the kidneys, increasing the flow of urine, and also by the skin, saliva, intestinal and mammary glands, and the bronchial mucous membrane. The sulphur and nitrogen in the urine are increased and the amount of phosphorus decreased. Notwithstanding the rapid elimination of the bromides, under prolonged administration they tend to accumulate in the system, being found abundantly in the nerve-centers. Temperature. — Immoderate doses cause a reduction of temper- ature, due to depression of the circulation and lessening of tissue- change. MOTOR DEPRESSANTS. 531 Eye. — There may occur dilatation of the pupil, conjunctival catarrh, diplopia, amblyopia, dimness of vision, and dilatation of the retinal blood-vessels. Uterus. — A diminution of the catamenia may sometimes be present. Untoward Action. — The susceptibility of individuals to the un- toward action of the bromides is extremely variable. The symp- toms observed are — gastric uneasiness with eructation, nausea and vomiting, analgesia of the epiglottis and pharynx, bronchial catarrh, hoarseness and cough, acute coryza and conjunctivitis, offensive breath, dysuria, diminished sensibility of the genito-urinary mucous membrane, and a variety of cutaneous eruptions. Poisoning. — Bromism,3.s the symptoms of poisoning are termed, may be divided into acute and chronic. Acute bromism, resulting from a single toxic dose, is manifested by violent frontal headache, great muscular weakness, incoordi- nation of movements, abolition of reflexes, somnolence, slow and shallow breathing, subnormal temperature, lustreless eyes, and very slow and weak pulse, death resulting from either respiratory or cardiac failure. Chronic bromism, caused by prolonged use of the bromides, is characterized by mental apathy, constant drowsiness, hallucination or melancholia, considerable cutaneous anesthesia, muscular weak- ness, poor circulation, cold extremities, marked anemia, impairment of the sexual function, deranged digestion, and cutaneous eruptions of various forms collectively designated as " bromine acne.'' Treatment of Poisoning. — The drug should be immediately withdrawn and methods adopted to hasten elimination, such as the administration of diuretics, cathartics, etc. Tonics, such as strych- nine, iron, and the cardiac stimulants, should be given, while exer- cise and change of scene may counteract the psychical symptoms. It is claimed that the daily administration of Fowler's solution causes a rapid disappearance of the bromine eruption. Comparative Action of the Bromides. — Potassium bromide contains 66 per cent, of bromine. It is the least hypnotic and most toxic to the heart and muscular system. Sodium bromide, 78 per cent, of bromine, is more hypnotic, but much less toxic, than the potassium salt. Its effect upon the cir- culation is the most pronounced of all the bromides. Ammonium bromide is less toxic and more stimulating than potassium bromide, though resenibling it in other respects. 532 A TEXT-BOOK OF MA TERIA MEDICA. Lithium bromide is the richest in bromine, containing 92 per cent., and is probably the most hypnotic of all. Its action more nearly resembles that of the sodium salt. Calcium bromide, while resembling them in its action, is less energetic than the other bromides. Zinc bromide is the most irritant, and is supposed to possess both tonic and sedative properties. Strontium bromide is the mildest of all, being less prone to cause bromism. ' Diluted hydrobromic acid in its action resembles the bro- mides, though much less depressant than the potassium salt, and less likely to occasion symptoms of chronic poisoning. Therapeutics. — Externally and Locally. — Pharyngitis is relieved by a gargle containing potassium bromide and potassium chlorate. A solution of potassium bromide diminishes the sensibility of the throat, so that examinations are more easily made. A solution of 4 parts of potassium bromide in 20 parts of glycerin affords a soothing lotion in painful hemorrhoids. It is asserted that the powdered salt has been dusted over indolent ulcers with benefit. Internally. — The bromides are especially useful in allaying excessive brain activity, the insomnia (particularly the sleeplessness de- pendent upon nervous excitement, exhaus- tion, and irritability) and headache of cerebral congestion yielding readily to these remedies. They are undoubtedly the most efficient medicinal agents for the relief of epilepsy, being given either alone or in combination with some vegetable bitter. Fere combines with them an intestinal antiseptic, asserting that the union lessens the tendency to bro- mism. Bechterew highly recommen ds a com- bination of the bromides with Adonis vernalis. Being such marked depressants of the reflex centers, they are of decided benefit in nervous spasmodic disorders, and particu- larly valuable in infantile convulsions. During dentition children suffer from various disturbances due to irritation of the dental nerve — convulsions, cough, indigestion, diarrhea, strabismus, etc.— in all of which the bromides, being Fig. II. — Diagram, showing how irritation of the dental nerve in teething, by stimulating the sensitive reflex mechanism of the infant, may produce strabismus (5), cough (2?, K), indigestion (Z.), diarrhea {M), and convul- sions {N). MOTOR DEPRESSANTS. 533 powerful depressants of the reflex mechanism, prove of great value. (See Diagram 1 1 .) Whenever there is increased reflex excitability the bromides are indicated. They are therefore valuable in the reflex disturbances of the menopause, spasmodic asthma, laryngismus stridulus, whooping cough, and other coughs of reflex origin. They have also been used in tetanus and strychnine-poisoning. Excessive nervous irritability is quickly relieved by these reme- dies, either singly or in combination with some of the antispas- modics, such as asafetida, valerian, etc. Because they depress the sexual mechanism they are of decided benefit in spermatorrhea of the plethoric or in the condition arising from irritation of the deep urethra. Menorrhagia resulting from excessive ovarian excitement is frequently relieved by these agents, while nymphomania and delirium tremens are often greatly benefited by full doses of the bromides. The AMMONIUM BROMIDE has been employed with benefit, it is said, in diabetes of nervous origin. Cerebral vomiting and the vomiting of pregnancy are sometimes singularly amenable to the influence of the bromides. The author is quite partial to a combination of sodium bromide, spirit of nitrous ether, and tincture of aconite, in anise water, as a remedy in acute febrile attacks of children with delirium. Small doses are given at frequent intervals until there is a decided im- provement in the symptoms. The bromides are claimed to be of value in acute and muscular rheumatism. The lithium salt is undoubtedly of service in these cases and in the uric-acid diathesis. The sedative action upon the circulatory apparatus exerted by the bromides renders them valuable in cardiac irritability when not due to anemia. They are particularly useful in quieting the heart's action in exophthalmic goiter. Augagneur advises the use of the bromides together with the iodides in the treatment of syphilis, believing that their administra- tion prevents such untoward manifestations as dysphonia, aphonia, or dyspnea in laryngeal syphilis. The STRONTIUM BROMIDE is highly recommended m fermentative dyspepsia due to decomposition of food. Bromoform ranks to-day superior to all other remedies in the treatment of whooping cough, an overwhelming amount of authori- tative evidence tending to prove that the drug not only greatly 534 A TEXT-BOOK OF MATERIA MEDICA. curtails the duration of the disease, but mitigates the severity of the paroxysms and renders them less frequent. Bromoform has also been highly recommended in acute mania and delirium tremens. Diluted hydrobromic acid is used for the same purposes as the bromides, some clinicians preferring it to the latter to quiet the delirium, of simple continued fevers. It is employed extensively to relieve the symptoms of cinchonism. Contraindications. — The bromides are contraindicated in con- ditions of great debility, anemia, or fatty or weak heart with low arterial pressure. Administration. — The bromides should be given in solution, and when long continued, as in the treatment of epilepsy, they should be accompanied by restorative agents. Carbonated waters, milk, and aromatic elixir serve as efficient vehicles to disguise the taste of these salts. Children acquire a remarkable tolerance for the bromides, so that large doses may be given them with but little danger. Bromoform may be dropped into a spoonful of water and ad- ministered in this simple manner, or it may be dissolved in gly- cerin. P. W. Bedford has originated a formula which makes an exceedingly palatable and perfect solution : Bromoformi, tlflxvj (i.o Cc); Alcohohs, Tincturse Cardamom! Compositse, aa. f gij (7.39 Cc.) ; Glycerini, q. s. ad. gij (60.0 Cc). Each fluidrachm contains i minim (0.06 Cc.) of bromoform. The diluted hydrobromic acid should be given in water or syrup. GROUP VIII.— CARDIAC STIMULANTS.* Cardiac remedies may be divided into Cardiac Tonics, Cardiac Stimulants, and Cardiac Sedatives or Depressants. The grouping is a rational one, both from a clinical and a physiological point of view, although the Cardiac Sedatives are at present much more 1 The author is indebted to Joseph M. Patton, M. D., Professor of Medicine in the Chicago Policlinic, for valuable assistance in preparing the present group, his obiierva- tions on therapeutics being occasionally cited verbatim. CARDIAC STIMULANTS. 535 limited in their clinical application than they were a few years ago, being used principally in sthenic fevers with excessive cardiac action. Cardiac Tonics. — By these are implied those drugs which add tone to the cardiac muscle and the nervous mechanism of the heart, increasing the nutrition of that muscle, and consequently augment- ing its capacity for work. The cardiac tonics have little or no effect upon the dynamic force exerted through the contraction of the heart-muscle, herein lying their essential distinction from cardiac stimulants, which affect per se the muscular contractile force. The proper period for the employment of cardiac tonics antici- pates that where the exhibition of cardiac stimulants becomes neces- sary. They are, moreover, prophylactic against the latter contin- gency, preventing the development of a hyposystolic condition of the heart. They are also indicated subsequent to the temporary use of cardiac stimulants to improve the nutrition of the heart and maintain the beneficial results of stimulation. Cardiac tonics should be given in small doses and the admini.s- tration prolonged. The principal members of the group are — strychnine, the IODIDES, ARSENIC, and IRON, to which should be added mercury in small doses. The most useful are strychnine and the iodides, and they are well adapted for combined administration. Since most cases requiring the exhibition of this class of remedies occur after middle life, they are especially benefited by the action of strychnine on the cardiac nervous system and the increased nutrition to the heart-muscle through the effect of the iodides on the smaller vessels. The progressive tendency of after- lifetime toward loss of elasticity and a contraction of the smaller arteries is opposed by the action of the iodides in dilating these vessels. The advantage of prolonged administration of mercury in small doses in chronic cardiopathies during or after middle life is probably due to the stimulating effect of the drug on the func- tions of ehmination. Mercury is adapted to nearly all senile cardiopathies, particu- larly in conditions of general vascular sclerosis, the most desirable form being the bichloride or red iodide in doses of -^ grain (o.ooi Gm.) three times daily. Arsenic may be used in the form of the arsenic iodide or as 536 A TEXT-BOOK OF MATERIA MEDICA. Fowler's solution. It is of special value in anemic conditions associated with cardiopathies in young persons. The most eligible form of iron for cardiac patients, especially after middle life, when elimination is an important consideration, is the LiQ. FERRi ET AMMONii ACETATis (Basham's mixture), or tlie so-called tasteless tincture of iron, with which the tincture of nux vomica may be well combined. The physiological action and further medical uses of these cardiac tonics are more fully described under their respective heads. Cardiac Stimulants. — As cardiac stimulants are designated those drugs endued with the specific property of lengthening and invigorating the contraction of the cardiac muscle. This effect would necessarily be more or less temporary, and, while some permanent benefit may be derived from improved nutrition result- ing from a better blood-supply afforded by these agents, they are adapted only for passing administration and are not true cardiac tonics. The general indication for the employment of this class of remedies rests in the presence of dynamic insufficiency of the muscle, which may be either actual or relative, as is the case of increased peripheral resistance to the blood-current. In the latter instance it is evident that the extracardiac obstruction must be removed before the salutary effects of cardiac stimulants can be obtained. It is in actual failure of the contractile force of the cardiac muscle that these stimulants display their most beneficial influence. This failure is due to a greater quantity of blood in the cavity than the muscle is able to cope with. The amount of dynamic force required at each contraction to expel this quantity is so great that - the muscle is unable to withstand the pressure without stretching, and consequently dilatation is developed. Here the favorable action of cardiac stimulants is manifest, since by stimulating the muscle to more vigorous contraction the equilibrium of the circu- lation is maintained until compensatory increase in muscular power has had time to develop. The principal cardiac stimulants are — Digitalis, Strophan- THus, Caffeine, Alcohol, Ammonia, Spartein, Cactus grandi- FLORA, Adonis vernalis, and Convallaria, all fully described under their respective heads. In addition to these, strychnine, opium, and nitroglycerin are CARDIAC STIMULANTS. 537 sometimes used as cardiac stimulants. They are fully described under their respective heads. Digitalis is the typical medicament of the group, after many years still retaining its place as the most trustworthy and generally useful cardiac stimulant. Digitalis— Digitalis— Digitalis. TJ. S. P. (Fox-glove.) Origin. — The leaves of Digitalis purpurea L., collected from plants of the second year's growth. The plant is a biennial, 2-5 feet (0.6-1.5 M.) high, indigenous in Southern and Central Europe, and growing wild as far north as Norway. It is also found in Madeira and the Azores, and is well known everywhere as an •ornamental garden plant. Description and Properties. — From 4 to 12 inches (10-30 Cm.) long, ovate or ovate-oblong, narrowed, with a petiole, crenate, dull green, densely and finely pubescent, wrinkled above, paler and reticulate beneath, midrib broad near the base ; odor slight, some- what tea-like ; taste bitter, nauseous. The leaves of mullein. Inula ^oryza and Inula helenium, are sometimes mixed with those of fox-glove. It is yet undecided what the chief constituents are. Five prin- ciples, however, have been isolated, neither of which represents the crude drug. They are — digitalin (soluble in alcohol, insoluble in water) ; digitalein (soluble in water and alcohol) ; digitonin, the most active diuretic principle (soluble in water, insoluble in alcohol) ; digitin, an inert substance; and digitoxin, the most active con- stituent (insoluble in water and sparingly soluble in alcohol). AH save digitoxin are glucosids. Dose. — 1-2 grains (0.03-O.12 Gm.). Official Preparations. ExtrSctum Digitalis — ExtrScti Digitalis — Extract of Digitalis. — Dose, \-\ grain (0.01-0.03 Gm.). Extractum Digitalis Fluidum — Extract! Digitalis Fliiidi — Fluid Extract of Digitalis. — Dose, ^-2 minims (0.03-0.12 Cc). Infusum Digitalis — Infusi Digitalis — Infusion of Digitalis (i^ per cent.). — Dose, 1-4 fluidrachms (3.7-lS Cc). Tinctura Digitalis — Tinctiirse Digitalis — Tincture of Digitalis (ij per cent.). — Dose, 5-20 minims (0.3-1.2 Cc). Unofficial Preparations. Digitalinutn — Digitalini — Digitalin. — Description and Properties. — An amor- phous, yellowish-white, crystalline powder or scales, or light, white crystalUne tufts of 538 A TEXT-BOOK OF MATERIA MEDIC A. needles, odorless and of an intensely bitter taste. Insoluble in water, soluble in alcohol. Dose.—^-^^-^ grain (0.0006-0.002 Gm.). DigitSxin— DigitSxin — 'D\%\Xoyia.— •Description and Properties. — A white, crys- talline body, of a bitter taste ; insoluble in water, soluble in chloroform. Dose.—^^-T^-^ grain (0.0003-0.0006 Gm.). Antagonists and Inoompatibles. — The most complete antag- onist is saponine, the active constituent of Saponaria officinalis. The cardiac depressants antagonize the action of digitalis upon the heart, morphine and the emetics possessing a similar property, though in less degree. The inoompatibles are the ferric chloride and sulphate, prepara- tions of cinchona, tannic acid and preparations containing it, and the subacetate and acetate of lead. Synergists. — The cardiac action of digitalis is aided by other members of the group (cardiac stimulants), and also by belladonna and ergot. Physiological Action. — Externally and Locally. — Digitalis pos- sesses mild sedative properties when locally applied, and is readily absorbed by the skin. Internally. — Digestive System. — Small doses ordinarily produce no effect upon the stomach. Large doses act as a gastro-intestinal irritant, exciting nausea, vomitifig, and diarrhea. These effects may follow the prolonged administration even of small doses. Circulatory System. — The principal effects of digitalis are upon the circulatory apparatus, the action of the drug varying according to the size of the dose. Medicinal doses cause the pulse to beat stronger, firmer, and slower, the strength of the beat being due to stimulation of the cardiac ganglia and the muscular fibers them- selves. Arterial pressure is raised through stimulation of the vaso- motor center in the medulla and the ganglia situated in the mus- cular coats of the blood-vessels, causing a contraction both of the arteries and arterioles. This increase of arterial tension gives firmness to the pulse-beat: its slowness is due to lessened frequency in the heart-beat, caused by stimulation of both the roots and ends of the cardiac vagus, and consequent lengthening of the diastolic period. Large doses may cause the pulse to beat faster and still increase arterial pressure. The rapid cardiac action is due to over-stimula- tion of the pneumogastric nerve and consequent exhaustion. The inhibition being removed and the heart acting under the influence of the sympathetic nerves, its beats are more frequent. The arterial CARDIAC STIMULANTS. 539 tension is still high, because the mechanism presiding over the caliber of the arterioles is not so easily over-stimulated as the vagus, and contracts still more, which, with the increased action of the heart, tends to increase arterial tension. Toxic doses render the pulse very rapid, irregular, soft, and weak. The irregular action of the heart is due to exhaustion of the motor ganglia in the heart-muscle from over-stimulation, one of the functions of these ganglia being to induce regular cardiac contraction. The pulse is soft because of lowered arterial pressure, the arterioles under these doses being dilated from exhaustion of the vaso-motor mechanism. The weak pulse is due to exhaustion of the muscular power of the heart from over-stimulation. Death usually occurs with stoppage of the heart in diastole, though under a lethal dose there may ensue a sudden tetanic car- diac contrfiction, the patient dying in a very few minutes because the heart, being rigidly contracted, cannot be relaxed. Nervous System. — No effect is produced by medicinal doses. Immoderate doses, however, occasion headache and vertigo, to- gether with lessened reflex activity — ^by stimulating Setchenow's inhibitory center and depressing the motor nerves. The muscles themselves may be paralyzed, the sensory nerves being unaffected. Respiratory System. — Medicinal doses have no effect upon the system; toxic doses slow the respiration. Absorption and Elimination. — Digitalis is rapidly absorbed and slowly eliminated, probably by the kidneys, under certain conditions increasing the urinary flow and the amount of solids excreted, ex- cept urea and uric acid, which are diminished. Its diuretic action is due to the increase of blood-pressure in the glomeruli of the kidneys, being therefore more pronounced in conditions of low arterial pressure. Very large doses, instead of increasing the amount of urine, may diminish or even wholly suppress it. The action of digitalis upon the kidneys is elucidated by the diagram (Fig. 12). It is claimed that two constituents of digitalis, digitoxin and digitalein, dilate the renal arteries, while digitalin has no effect upon the renal blood-vessels, but contracts those of the general system. The true action of digitalis, however, is as yet undetermined. It is an extremely complex drug, and its various constituents pos- 540 A TEXT-BOOK OF MATERIA MEDICA. sess different properties when therapeutically employed. It is obvious, therefore, that the action upon the heart and kidneys will depend largely upon the particular preparation administered. Temperature. — Medicinal amounts have no appreciable effect Fig. x2, — Af heart; B, veins; C, efferent vessels; D, artery; E^ capillary system; P, afferent vessels ; G, kidney ; Hj glomemles of the kidney. upon the temperature; large doses cause a reduction of bodily heat in febrile conditions, while toxic doses reduce temperature even in health. The action of digitalis upon the circulatory system is retarded by high temperature. Eye. — Medicinal amounts have no effect. Large or poisonous doses may cause dimness of vision, amblyopia, diplopia, or mydri- asis. In a case of poisoning by digitalis recorded by Jeanton there was xanthopsia for two days. Uterus. — Large doses stimulate contraction in the uterine muscles. Untoward Action. — Erysipelatous and papular eruptions have been produced by the drug, there having been also observed nausea and a feeling of weakness in the stomach, dimness of vision, headache, heaviness of the head, sleeplessness, and debility. Poisoning. — Toxic symptoms may occur either from the inges- tion of a single poisonous dose or the accumulation of the drug under prolonged administration. There are marked disturbances of the gastro-intestinal tract, abdominal pains, vomiting and purging, a rapid, irregular, and compressible pulse — often imper- ceptible at the wrist — and syncope, more frequently occurring when the patient is raised up. Other symptoms are — feeble respiration, dilated pupils and occasionally double vision, headache, delirium and stupor, and CARDIAC STIMULANTS. 541 possibly convulsions just before death, which occurs from cardiac failure. Digitalis is not a rapid poison, the fatal collapse being usually deferred from ten to forty-eight hours. Treatment of Poisoning. — Lavage of the stomach should be immediate, emetics being too depressing, if the heart is already affected by the poison. A solution of tannic acid should be intro- duced into the stomach as the best chemical antidote. Diffusible stimulants may be required, the horizontal position should be maintained, and external heat applied, particularly to the abdomen. Saponin, aconite, and opium are physiological antidotes, and one or more of them should be employed. Therapeutics. — Externally and Locally. — Poultices made of DIGITALIS LEAVES have been employed with some success in acute inflammation of the joints, and when applied over the loins act as an efficient sedative and diuretic in congestion of the kidneys. Internally. — Digitalis is one of the most important drugs known to medicine. The remedy is indicated in deranged conditions of the circulatory system itself, and, moreover, where, although the cir- culatory mechanism be normal, an abnormal state of other organs .may be improved by changing the circulation in them. Digitalis is indicated in any case where there is actual failure in the dynamic power of the heart-muscle, irrespective of the nature of any primary valvular lesion inducing the hyposystolic condition. Of course the rational use of the drug presupposes the absence of extensive fatty degeneration or interstitial myocarditis, since, should these conditions be advanced, there is danger of producing permanent asystole. It is difficult to estimate the integrity of the heart-muscle, and many cases presumably intolerant of the drug bear digitalis well. There has been considerable objection to the use of digitalis in cardiac ataxia resulting from aortic regurgitation, on the ground that the latter action is more forcible and extensive under its influence. This argument is generally advanced by those who believe that the dilatation of the left ventricle in aortic regurgitation is due mainly to the effect of the counter-current upon the relaxed ventricle while in diastole. The regurgitant stream has probably little or no influence in producing the dilatation, since the' cubic area of the ventricular cavity covered by the stream is so much ' greater than that of its inlet that it is difficult to see how great pressure could be exerted in this way. The phenomenon is, rather, 543 A TEXT-BOOK OF MA TERIA MEDICA. mainly due to the greater pressure necessary to empty the ventricle of its superfluous blood. That there is any marked increase in the amount of regurgi- tated blood through reduced action of the heart is not sustained by the clinical results of the administration of digitalis in cases of aortic regurgitation. Indeed, they respond to the use of the drug as promptly as any other lesion, save that it is at times necessary to give larger doses, often twice the quantity administered in other valvular lesions. As to the cumulative effect of digitalis, so much feared by the older writers on its action, the evil may be ascribed to improperly selected cases or faulty administration. Under proper conditions the drug may be given for months without ill effect. It is asserted that the action of digitalis may be manifested for some time upon discontinuance of a brief dosage. With regard to the specific effect of the drug upon the heart- muscle this is not true, since the influence of the drug lasts but a few days, indirectly, through the additional muscle-power devel- oped during a few weeks' administration. During or after middle life, if the vascular tension be increased, and especially if there be any sclerosis of the vessels, the administration of digitalis should be combined with that of vaso-dilators, to prevent contraction of the vessels and consequent increase of peripheral resistance. Of these adjuncts, opium is generally the most useful, from 2 to 5 drops (0.1-0.3 Cc.) of the deodorized tincture or ^^g- to -3^ grain (0.003-0.005 Gm.) of morphine sulphate being given (Patton). In mitral regurgitation digitalis is an exceedingly efficient rem- edy. As shown in the diagram (Fig. 13), there is a deficiency of blood in the systemic arteries, and consequently an over-accumula- tion in the pulmonary vessels and systemic veins. Owing to this venous hyperemia, there is congestion of the lungs, stomach, liver, -and the entire digestive tract, together with the attendant symp- toms — dyspnea, bronchitis, deranged digestion, constipation, edema, etc. Digitalis by improving the pumping power of the heart equalizes the circulation, fills the systemic arteries, and relieves the venous congestion with its accompanying symptoms. Digitalis is valueless in the presence of compensatory hyper- trophy, but after dilatation occurs is wonderfully effective, the size of the heart being often perceptibly diminished by a proper admin- istration of the drug. CARDIAC STIMULANTS. 543 Digitalis may act indirectly as a tonic by improving the nutri- tion of the heart through the prolonged diastole and contraction of the cardiac muscle it occasions. The longer the period of dia- stole, the more time is allowed for the coronary arteries to fill and nourish the heart by the better blood-supply. The increased arte- rial tension produced by the drug causes the blood to be sent into the coronary arteries with greater force during the cardiac diastole. The forcible contraction of the heart occasioned by this drug expels the blood from the veins of the cardiac mus- cle, improved nutrition of the muscle resulting from this me- chanical action. The prolonged diastole pro- duced by digitalis allows the heart to rest, conserving its energy and rendering the drug of great value in many acute diseases accompanied by ex- cessive cardiac action. In many valvular diseases of the heart there is marked irregularity, an irritability in its action being often more serious than the mere leakage of blood. Digitalis by stimulating the vagus and motor ganglia reduces the irritative influence, causing the heart to beat more regularly. The drug is therefore of great service in exophthalmic goiter. In any condition of low arterial tension, whether resulting from hemorrhage, general debility, or whatever cause, digitalis by increas- ing the force of the heart and raising arterial pressure serves a useful purpose. In collapse from shock, poisoning, or cholera, where the great veins are dilated, it has proved an efficient agent. The functional activity of the various organs in anemia and other deranged conditions of the system may be improved by the administration of this remedy. The circulation being improved, there is increased absorption Fig. 13. — Diagram showing how digitalis relieves the symptoms of mitral disease : i, right heart ; 2 left heart ; 3, lungs ; 4, systemic arteries ; 5, capil- laries : 6, systemic veins ; 7, liver ; 8, intestines ; 9, lymphatics. 544 A TEXT-BOOK OF MATERIA MEDIC A. of fluid from the tissues, as well as greater circulation of fresh intercellular fluid, favoring combustion and functional activity, while the waste products are more readily removed. This action renders digitalis valuable as a tonic. In the second stage of pneumonia it is of the greatest importance, being of use here to stimulate the contractile force of the cardiac muscle when the intraventricular pressure becomes stronger than the unaided muscle can resist, and dilatation is imminent if not already begun. The main indication for the drug is the increase in intensity of the second pulmonic sound. In congestion of the lungs during the course of exhausting fevers,. such as typhoid, and in the first stage of meningitis, bronchitis, cellu litis, etc. before transudation takes place, it is considered by many physicians to be a valuable remedy in relieving the venous stasis Digitalis is singularly beneficial in scarlet fever to slow . the heart and by its action upon the kidneys prevent renal com- plications. Mr. Jones was among the first to recommend large doses of digitalis in delirium tremens. The author has found it to be won- derfully effective in this condition, particularly where there is low arterial pressure, at the same time having observed that smaller or stimulant doses are more beneficial than the larger ones suggested by Jones. The drug is undoubtedly less serviceable in delirium tremens characterized by high arterial tension. Digitalis has been successfully employed in acute mania and' epilepsy, Gowers recommending it in the latter disease as an adju- vant to the bromides, associated with belladonna. It is fair to state that in maniacal conditions the preponderance of testimony is in favor of large doses — \ to 4 fluidrachms (1.8-15. Cc.) of the tincture. Through its action in contracting the caliber of the arterioles digitalis serves as a valuable hemostatic in hemoptysis, epistaxis,. menorrhagia, etc. The drug is thought to enhance the influence of ergot in post- partum hemorrhage, and when associated with iron it is of value in purpura hemorrhagica. According to Harold Henry, digitalis and strychnine have proved beneficial in the diarrhea complicating remittent fever. The drug, combined with ergot or potassium bromide according- to the indications, has been successfully employed in spermatorrhea- and nocturnal emissions. CARDIAC STIMULANTS. , 545 It is said that absorption of pleuritic effusion is hastened by the continued administration of digitalis. Clifford Allbutt recommends it in sufficient doses to reduce the pulse to 45 or 50 in aneurysm. This method of treatment, how- ever, has not been widely adopted. Digitalis is one of the best antidotes to aconite- and muscarine- poisoning. The remedy is invaluable as a diuretic to relieve cardiac or renal dropsy, its efficiency being more apparent in the former variety, although acute renal dropsy usually yields to its influence. Should the renal structure be impaired, the drug is less serviceable, al- though, when combined with other appropriate remedies, it is decidedly beneficial in chronic Bright' s disease with cardiac dilata- tion. In the early stages of the malady, accompanied by cardiac hypertrophy and high arterial tension, it is doubtful whether digitalis is indicated, either alone or in combination. In conclusion, it should be stated that digitalis is recommended by all authors in every valvular disease of the heart, with the pos- sible exception of aortic regurgitation, some writers supposing it to be harmful in this condition because of the prolonged diastole it occasions. The author's experience leads him to differ with those who con- sider aortic insufficiency a contraindication to the use of this important drug. The excellent and logical reasons advanced by Professor Patton for the use of the remedy in aortic regurgitation coincide entirely with the author's views. Contraindications. — Digitalis should not be given when there is marked degeneration of the heart-muscle or of the arterial walls. In simple hypertrophy, apoplexy, high arterial pressure, or vascular excitement the use of the drug is inadvisable. Many physicians regard aneurysm as a contraindication to the use of digitalis. Administration. — Any of the official preparations may be given, or the powdered leaves in pills or capsules — not at too frequent intervals, however, from four to eight hours elapsing between the doses, lest the drug accumulate in the system, producing poisonous symptoms. When digitalis has been administered for some time to a patient suffering from ascites, and the fluid is removed by paracentesis, poisoning may ensue. It is well, therefore, to discontinue the remedy for two or three days before tapping the patient. 35 546 A TEXT-BOOK OF MATERIA MEDIC A. It is wise to give always only such amounts of digitalis as may be requisite to produce the desired effect. The rapidity of the drug's action upon the heart depends upon the presence or absence of a febrile state. The stimulant action upon the heart is usually observable in from twenty-four to thirty- six hours. The effects of the drug commonly continue from three to seven days after its discontinuance. The powdered digitalis, though the most irritant to the stomach, fully represents the drug, which is true of none of the preparations. Of the active constituents, digitalin is usually preferred, notwith- standing its uncertain action. The infusion of digitalis, being an aqueous preparation and con- taining, therefore, a larger proportion of digatonin, is superior for diuretic purposes ; while the alcoholic preparations, like the fluid extract and tincture, being richer in digitalin and digitalein, are preferable when an action upon the heart is desired. Ordinarily, therefore, digitalis should be given in solution, the tincture and infusion being the most reliable preparations ; care being taken in the selection of the crude drug upon the character of which the strength of the preparation depends. In uncomplicated cases of cardiac failure, the result of valvular lesion, the tincture is most ehgible. In cardiac failure associated with, or resulting from, kidney lesions the infusion, combined with some other diuretic, should be used. Strophanthus— Strophanthi— Strophanthus. TJ. S. jP. Origin. — The seed of Strophanthus hispidus D. C, deprived of its long awn. The plant is a woody climber, ascending to the tops of high trees, from which it hangs in festoons. It is found in tropical Africa, where it is used to prepare an arrow-poison termed kombi. Description and Properties. — The seeds are about | inch (is Mm.) long and i to ^ inch (4-5 Mm.) broad, oblong-lanceolate, flattened and obtusely-edged, grayish-green, covered with appressed silky hairs, one side extending into the attenuated, pointed end; kernel white and oily, consisting of a straight embryo having two cotyledons, and surrounded by a thin layer of perisperm ; nearly inodorous ; taste very bitter. Strophanthus contains a glucosid, stropJianthin, upon which its medicinal properties depend. It also contains kombic acid. Another CARDIAC STIMULANTS. 547 active principle, ouabain, is obtained from a similar species of Strophanthus. Official Preparations. Tinctura Strophanthi— Tincturae Strophanthi— Tincture of Strophanthus (S per cent.). — Dose, 2.-10 minims (0.12-0.6 Cc.). Unofficial Preparations. Strophanthin— Strophanthin— Strophanthin. Origin. — A glucosid obtained from the seeds of several species of Strophanthus, chiefly from Strophanthus hispidus. Description and Properties. — A white, amorphous or crystaUine powder, of an acid- ulous, intensely bitter taste ; soluble in water and in alcohol. Dose. — j-^^ to ^\y grain (0.0006-0.001 Gm.). Ouabain — Ouabain — Ouabain. — Origin. — A glucosid obtained from Acocan- thera ouabaio and Strophanthus glabrus. Description and Properties. — A white, transparent, crystalline powder, inodorous and of a slightly bitter taste. Soluble in hot water, sparingly soluble in cold water, insoluble in alcohol. Dose. — -^-^ to 3^^ grain (0.000032-0.00012 Gm.). Antagonists and Incompatibles. — Probably the same as for digitalis. Synergists. — Digitalis, spartein, adonidin, etc. Physiological Action. — Externally and Locally. — The tincture of strophanthus has no local action of importance. Strophanthin and ouabain, however, possess marked sedative properties, the latter being much the stronger. They paralyze the ends of the sensory nerves and are powerful local anesthetics, in this respect surpassing even cocaine in their influence upon the cornea, the anesthesia produced by the glucosids being of much longer dura- tion than that caused by cocaine. When poisonous amounts of ouabain are applied locally the motor nerves are paralyzed. These substances apparently have no action upon the central nervous system. Externally. — Digestive System. — Strophanthus is similar in its action to digitalis, though less apt to disturb digestion in small doses ; on the contrary, its bitter taste tends to improve the appetite. Ouabain increases peristalsis and acts as an emetic by centric influence. Circulatory System. — Upon the heart its action is identical with 548 A TEXT-BOOK OF MATERIA MEDICA. that of digitalis, though differing from the latter drug in its effect upon arterial tension and the arterioles. Strophanthus does not contract the arterioles and the arterial pressure is but slightly raised, the elevation being due to the increased force of the heart, toxic doses paralyzing it in systole. The glucosidal principle, ouabain, on the other hand, increases arterial tension and contracts the principal vessels in the same manner as digitalis. Nervous System. — Strophanthus affects the nervous system even less than digitalis. Poisonous doses, while not influencing the motor nerves so much as digitalis, act as a direct muscle- poison. Ouabain paralyzes both the sensory and motor nerves and abolishes reflex action,, being a direct poison to the striated muscles. Respiratory System. — It has no' important action. Ouabain primarily increases and secondarily diminishes respiration through its actioiv upon the center. Absorption and Elimination. — Strophanthus is rapidly absorbed,, and more readily eliminated than digitalis, possessing no cumulative action. It is principally excreted by the kidneys, increasing the amount of urine by the strengthened heart's action. Unlike digi- talis, the drug has no influence upon the caliber of the renal vessels. Temperature. — Very large doses of strophanthus cause a slight reduction of temperature, not, however, to the extent of digitalis. Eye. — Excessive doses contract the pupil and increase intra- ocular tension. Uterus. — It resembles digitalis, though more feeble in its action upon the uterus. The symptoms and treatment of Poisoning are similar to those described under Digitalis, although strophanthus is more apt to occasion diarrhea. Therapeutics. — Externally and Locally. — Strophanthin has been occasionally employed as a local anesthetic, but the testimony in its favor is hardly sufficient to encourage its use. Internally. — Strophanthus is a cardiac remedy, being indicated in the same varieties of heart disease as digitalis. It is of particular value in stenosis of the mitral orifice, having a happy influence in controlling the irregular rhythm, nervous dyspnea, and intermittent pains distinctive of this lesion. The drug is also well adapted in CARDIAC STIMULANTS. 549 subduing functional irregularities of rhythm in cases of imtable or tobacco heart. Theoretically, strophanthus is superior to digitalis in certain stages of Bright s disease and' heart failure of elderly people with slightly degenerated arteries. Shoemaker advocates the use of strophanthus in the treatment of psoriasis, combining it with the fluid extract of hoang-nan. While in the majority of cardiac diseases digitalis should be first tried, where it fails strophanthus is the proper recourse. It is a peculiarly efficient drug in the cardiac diseases of children, accord- ing to the majority of observers being safer than digitalis for young patients. Strophanthin has been used hypodermically with some success for the relief of chills due to malaria, shock, or nervousness. Dr. Gemmell and other observers claim that ouabain in doses of from -^-^^ to -^^ grain (0.00006-0.00003 Gm.) greatly reduces the number and severity of the paroxysms in whooping cough. Contraindications. — The same as for digitalis. Administration. — Of the preparations of strophanthus, the tincture is preferable, both for convenience and safety. Should strophanthin or ouabain be desirable, a solution is to be pre- ferred. Scoparius— Scoparii— Scoparius. TJ. 8. I*. (Broom.) Origin. — The tops of Cytisus scoparius L., a shrub 3 to 6 fed; (.9-1.8 M.) high, found in Western Siberia and the greater part of Europe. It is sometimes cultivated, and is occasionally met with wild in some of the Middle and Southern States. Description and Properties. — Occurring in thin, flexible, branched twigs, pentangular, winged, dark green, nearly smooth, tough, usually free from leaves ; odor peculiar when bruised ; taste disagreeably bitter. The constituents of scoparius are an oily, bitter substance, spar- teine, a cardiac stimulant, and a neutral, crystalline principle, scopa- rin, to which the diuretic action of the drug is due. Dose. — \-\ drachm (2.0-4.0 Cc), in infusion. Official Preparations. Extractum Scoparii FlQidum — Extracti Scoparii Fliiidi— Fluid Extract of Scoparius. — Dose, yi-i fluidrachm (2.0-4.0 Cc). 55° A TEXT-BOOK OF MATERIA MEDIC A. Sparteinse StSlphas — Sparteinae Sulphatis— Sparteine Sulphate. — The neu- tral sulphate obtauied from the alkaloid sparteine. Description and Properties. — Colorless, white, prismatic crystals, or a granular powder, odorless, and having a slightly saline and somewhat bitter taste; liable to attract moisture when exposed to damp air; very soluble in water and alcohol. Dose. — 5J-2 grains (0.003-0.1 Gm.). Unofficial Preparation. Scoparine — Scoparine — Scoparine. — Description and Properties. — Amorphous or in small crystals, of a pale-yellow color, inodorous and tasteless. Dose. — 1-15 grains (0.06-1.0 Gm.), as a diuretic. Antagonists and Incompatibles. — The antagonists are the same as for digitalis, and tannic acid and potassium iodide are incompatibles. Synergists. — Digitalis, strophanthus, adonidin, etc. Physiological Action. — Externally and Locally. — No action observed. Internally. — Digestive System. — Sparteine sulphate acts like bit- ters in improving the appetite and digestion. Large doses, as with digitalis, produce vomiting and purging. Circulatory System. — Its, effect upon the heart and blood-vessels is similar to that of digitalis. It is more rapid, however, in its action, its effect upon the heart being manifested within half an hour, and an increase of arterial pressure within one hour, after ingestion of the drug, though the arterioles are not contracted, as is the case with digitalis. An abnormally slow pulse is quickened under the influence of sparteine, it being claimed that even very small doses accelerate the pulse, while full doses retard the cardiac rate. Toxic doses affect the circulatory system like digitalis. Nervous System. — Sparteine resembles coniine rather than digi- talis in its action upon the nervous system, depressing the brain and spinal cord, and lowering reflex action through paralysis of the motor tracts. Under toxic doses there is also extreme mus- cular weakness, often complete paralysis. Respiratory System. — Medicinal doses produce no effect. Toxic doses slow and weaken the respiration, death being possible from paralysis of the respiratory center. Absorption and Elimination. — It is rapidly absorbed and as read- ily eliminated, and, unlike digitalis, has no cumulative action. In disease it is an active diuretic, particularly the infusion or fluid CARDIAC STIMULANTS. 551 extract or the alkaloid scoparin. Sparteine, on the other hand, is not an active diuretic. Scoparius therefore increases the flow of urine and the excre- tion of urea. The drug has no direct action upon the renal struc- ture, diuresis being produced by increased blood-pressure. It also possesses diaphoretic properties. Poisoning. — The following symptoms occur : Small, rapid, and irregular pulse, dyspnea, great muscular weakness, incoordination of movement, and muscular tremors, followed possibly by clonic and tonic convulsions, which are replaced by marked depression of the nervous and muscular systems, and collapse, death usually resulting from paralysis of the respiratory center. Treatment of Poisoning. — The respiration should be stimulated by hypodermic injections of strychnine and atropine. It may even be necessary to apply electricity over the vagi or practise artificial respiration. Potassium iodide or solutions of tannic acid should be given, and the free use of diuretics or diluents to favor elim- ination. Therapeutics. — Externally and Locally. — No influence is ex- erted. Internally. — Scoparius is used for the same purposes as digi- talis. It is particularly serviceable in some cases of nephritis with weak, irregular heart-action, and in chronic Bright's disease with cardiac hypertrophy and high arterial tension. It is also useful in the nervous, irregular heart of opium habitues. Sparteine sulphate has been recommended in paralysis agi- tans and asthma. Like strophanthus, it is of more value in mitral than in other valvular diseases. For some reason scoparius is generally less esteemed than digitalis, although, while competent clinicians consider it of minor importance as a cardiac remedy, the drug is not without enthusi- astic advocates among those of authority. Oontraindications. — Practically the same as for digitalis, though less definite. Administration. — The fluid extract of scoparius may be given, or the decoction, " made by adding \ an ounce (16.0 Gm.) of the broom-tops to i pint (J liter) of water and boiling them down to \ pint (250 Cc). Of this i ounce (32.0 Cc.) should be taken every three hours. This decoction is one of the most efficient diuretics in cardiac dropsy" (Hare). The sparteine sulphate is usually employed when an action on 552 A TEXT-BOOK OF MA TERIA MEDICA. the heart is desired : it may be administered either hypodermically, in pill, capsule, or aqueous solution. Cactus— Cacti— Cactus. (Night-blooming Cereus.) Origin. — The stems and flowers of Cactus grandiflorus L., a plant indigenous in tropical. America and frequently cultivated for ornament. Preparations. Extractum CScti Fluidum — ExtrScti Cacti Fluidi— Fluid Extract of Cac- tus. — Dose, 5-10 minims (0.3-0,6 Co.). Tinctura Cacti — Tincturae Cacti — Tincture of Cactus. — Dose, 15-20 minims (I. -1. 2 Cc). Physiological Action and Therapeutics. — Cactus differs from digitalis in its less disturbing influence upon the digestive appa- ratus. Its action upon the circulation is to elevate arterial pressure and increase the strength and rapidity of the heart's action when given in medicinal doses. Toxic doses, on the contrary, diminish both the blood-pressure and the pulse-rate, rendering the heart irregular in its action and arresting it in systole. Moreover, the reflexes are increased by poisonous doses, death being preceded by clonic and tetanic convulsions of spinal origin. Therapeutically, cactus probably possesses no advantages over digitalis. It has, however, been highly recommended by certain physicians in myocarditis, aortic regurgitation, functional disorders of the heart, severe arrhythmia, angina pectoris, and cardiac weak- ness following typhoid fever. Dr. Wilcox considers mitral stenosis a contraindication to its use. It is asserted that it produces no cumulative effects or untoward symptoms. Adonis Vernalis— Adonidis Vernalls— False Helle- bore. (Pheasant's Eye.) Origin. — A perennial herb attaining a height of about lo inches (25 Cm.), indigenous in Europe. Description and Properties. — It has but httle odor and a some- what acrid and bitter taste. The plant contains a glucosid, adoni- CARDIAC STIMULANTS. 553 din, to which it owes its medicinal properties. This constituent is a light-colored, crystalline powder, of a bitter taste and soluble in water and alcohol. Dose of Adonidin. — ^^-\ grain (0.003-0.01 Gm.). Antagonists, Inoompatibles, and Sjmergists. — The same as for digitalis. Physiological Action and Therapeutics. — The action of adoni- din is similar to that of digitalis, although more nearly resembling that of digitalin, save that it is not cumulative. It is used for the same purposes as digitalis, being peculiarly valuable in relieving the pains of heart disease, and is by some physicians preferred to digitalis in the treatment of aortic and mitral insufficiency, cardiac asthma, z.nd functional irregularity of the heart. Convallaria— Convallariae— Convallaria. JJ. 8. F. (LlI.Y OF THE VaLI.EY.) Origin. — The rhizome and roots of Convallaria majalis L., a stemless perennial indigenous in Europe, Northern Asia, and North America. Description and Properties. — Of horizontal growth and some- what branched, about \ inch (3 Mm.) thick, cylindrical, wrinkled, whitish, marked with a few circular scars ; at the annulate joint with about eight or ten thin roots ; fracture somewhat fibrous, white ; odor peculiar, pleasant ; taste sweetish, bitter, and somewhat acrid. Convallaria contains two glucosids" convallamarin, the cardiac- acting principle ; and convallarin, an emeto-cathartic principle. Offi,cial Preparations. Extractum Convallariae Fluidum — Extract! Convallariae Fluidi — Fluid Ex- tract of Convallaria.— iJoji', 15-30 minims (1-2 Co.). Unofficial Preparations. ExtrSctum Convallariae — Extracti Convallariae— Extract of Convallaria. — Dose, 5-15 grains (0.3-1.6 Co.). Infiisum Convallariae — Infilsi Convallariae — Infusion of Convallaria. — Dose, i-2 ounces (15-60 Co.) (25 parts in 75 parts of water). Convallamarinum — Convallamarlni — Convallamarin. — Description and Properties. — A whitish-brown, amorphous powder, soluble in water and alcohol. Dose. — J -2 grains (0.016-0.12 Gm.). Convallarinum — Convallarini — Convallarin. — Description and Properties. — A ■crystalline body insoluble in water, soluble in alcohol. Dose. — 2-4 grains (0.12-0.24 Gm.). 554 A TEXT-BOOK OF MA TERIA MEDICA. Antagonists and Incompatibles. — The antagonists are the same as for digitalis ; tannic acid precipitates the convallamarin. Synergists. — The cardiac stimulants enhance its cardiac action ; emetics and cathartics aid its emeto-cathartic effects. Physiological Action. — Almost identical with that of digitalis,, but less powerful and possessing no cumulative action. Prepara- tions free from convallarin do not disturb the stomach nor affect the cerebro-spinal functions. It is asserted that convallaria has stronger diuretic properties than digitalis. Convallamarin in some cases has produced, among other un- toward symptoms, hemoptysis and dyspnea. Convallarin is a drastic purgative, and in full doses occasions nausea and gastric pain. Therapeutics. — Convallaria is used for the same purposes ex- actly as digitalis. The only advantage it possesses over the latter drug is that it has no cumulative action. By some physicians it is considered superior to digitalis as a diuretic and cardiac stimulant after failure of compensation, the diuresis it occasions persisting for some time after the withdrawal of the drug. It has been employed with sortie benefit in various forms of neuralgia, and has even been recommended to calm the restlessness- and relieve the insomnia of fever. Contraindications. — The same as for digitalis. Administration. — The fluid extract is the best preparation to- use, although the infusion is highly recommended by many physi- cians. Caffeina—Caffeinae— Caffeine. U. 8. P. Origin. — A feebly basic, proximate principle obtained from the dried leaves of Thea Sinensis (tea) L., or from the dried seeds of Coffea Arabica (coffee) L., and found also in other plants. It may also be prepared synthetically from theobromine by the introduction of a third methyl group. Description and Properties. — Fleecy masses of long, flexible, white crystals, having a silky luster, without odor and of a bitter taste; permanent in the air; soluble in 8o parts of water and 33 parts of alcohol. Dose. — 2-5 grains (0.12-0.3 Gm.). Official Preparations. Cafieina Citrata — Caffeina Citrats — Caffeine Q.\\xa.\^.— Description ani Properties. — A white powder, odorless, having a purely acid taste and an acid. CARDIAC STIMULANTS. 555 reaction. I part of citrated caffeine forms a clear, syrupy solution with about 3 parts of water. Dose. — 2-5 grains (0.12-0.3 Gm.). Caffeina Citrata Effervgscens — Caffeina Citrata EffervescSntis— Efferves- cent Citrated Caffeine. — Dose, 1-4 drachms (4.0-16.0 Gm.). Allied Compounds. Guaranine. — The alkaloid obtained from the seeds of Paullinia cupana. Theine. — An alkaloid obtained from tea. Theobromine. — An alkaloid obtained from cacao seeds. Sodio-theobromine Salicylate (Diuretin). — An active diuretic described under the group " Diuretics." Guaranine, theine, and theobromine, while chemically almost identical with caffe- ine, differ from it somewhat in their physiological action. Guaranine depresses first the sensory and afterward the motor nerves, affecting them from the center toward the periphery. Its primary effect in toxic doses is to pro- duce general hyperesthesia, succeeded by convulsions of spinal origin. Theine in its action very closely resembles guaranine, save that when injected it causes local anesthesia. It lowers the temperature, while caffeine tends to raise bodily heat. Theobromine differs in no essential from caffeine. Antagonists and Incompatibles. — Cerebral and cardiac de- pressants antagonize the action of caffeine. Synergists. — Members of this group and the Cerebral and Motor Excitants. The action of caffeine upon the digestive tract may be enhanced by the vegetable bitters. Physiological Action. — Externally and Locally. — Caffeine pos- sesses no very important local action, though freshly roasted coffee is slightly analgesic and deodorant, as well as antiseptic — a prop- erty due to the empyreumatic oils developed by roasting rather than to the caffeine which it contains. Internally. — Digestive System. — In moderate amounts caffeine, like tea and coffee, stimulates the appetite, improving the digestion, and relieving the sense of plenitude in the stomach. All of them increase peristalsis and (particularly coffee) act as mild laxatives and stimulate the secretion of bile. Immoderate and continued dosage of caffeine or the excessive use of tea and coffee profoundly disturbs the digestive function, resulting in gastric catarrh, indigestion, hepatic congestion, consti- pation, and hemorrhoids. Circulatory System. — Medicinal doses of caffeine strengthen the cardiac contraction and lengthen the duration of the systole. The rapidity of the heart's action is increased, shortening the dia- stolic period, the drug in this respect differing from digitalis ; at the same time the arterial pressure is elevated. 556 A TEXT-BOOK OF MATERIA MEDIC A. The precise modus operandi of caffeine in its action upon the circulatory system is still a disputed question, some investigators claiming that its whole and only influence proceeds from a direct stimulation of the heart-muscle, while others consider its action to be upon the nervous system. So far as relates to arterial pressure, the preponderance of testimony seems to prove that the tension is raised independently of any action on the vaso-motor centers. Excessive doses depress the heart, causing an irregular, slow, and weak pulse. Nervous System. — The drug is a decided cerebral excitant, stim- ulating the mental function, occasioning wakefulness, and under large doses producing hallucinations and delirium. There is a marked difference between the effects upon the brain caused by caffeine and those occasioned by opium. The former renders the reasoning and imaginative powers more acute, enabling the person to perform increased and prolonged mental work. Moreover, the cerebral excitation caused by caffeine is not suc- ceeded by mental depression and sleep ; while opium occasions an incoordination of mental activity, the brain being incapable of performing active practical and physiological work, and the reason- ing powers rendered subservient to the imaginative. The opium habitue thus becomes a visionary, his mental powers inclining more to revery than to action. The primary excitation induced by the drug, however, is soon succeeded by lethargy and sleep. The moderate use of tea or coffee increases muscular endu- rance; large doses, on the other hand, occasion muscular trem- bling and marked weakness. Excessive doses lessen the activity of the spinal reflex centers. In moderate amounts coffee possesses some aphrodisiac action. Respiratory System. — Medicinal doses slightly stimulate, while toxic doses depress, the respiration. Absorption and Elimination. — Caffeine is freely absorbed, and is chiefly eliminated by the kidneys, although the greater portion is oxidized in the body. The primary effect of the drug upon the kidneys is to contract, the later to engorge, these organs. The urine, therefore, is at first diminished in quantity, although its amount is soon greatly augmented. Caffeine is a direct stimulant to the secreting structure of the kidney, the diuresis being prin- cipally the result of this action, though partly due to the increased renal blood-supply. Ordinarily, caffeine lessens tissue-waste ; the elimination of urea. CARDIAC STIMULANTS. 557 however, is not uniform, being in some cases increased and in others diminished. Temperature. — Under large doses of the drug the temperature is slightly elevated, the result of combined increase of heat-pro- duction and heat-dissipation. Toxic doses first raise and then depress temperature. Eye. — Strong solutions of caffeine applied to the cornea act as a mild mydriatic and anesthetic. Hutchinson records a case of amblyopia produced by the drug. Untoward Action. — Caffeine occasionally causes marked cere- bral congestion, insomnia, and embarrassment of respiration, while the untoward effects of an immoderate use of coffee are described by Guilliot (Nat. Disp., p. 363) as follows : " The skin is pale or dusky, the expression is dull, and the features have the look of premature old age, and sometimes are slightly swollen. The flesh wastes, the eyes have a glassy look, the pupils are dilated, the lips and tongue are tremulous ; the appetite is lost ; there is insomnia or else disturbed sleep ; dyspep- sia accompanies constipation or diarrhea ; neuralgia affects the stomach and other parts ; headache and vertigo are common, and spasms or general convulsions may occur." According to the same writer, " habitual excess of coffee induces in men sexual apathy and impotence, and in women leucorrhea. Sometimes it produces pruritus ani aut vulvce." Poisoning. — A case has been reported by Liell where 18 grains (1.16 Gm.) of citrated caffeine taken by a woman were in an hour and a half accompanied by the following symptoms : " Delirium, semi-consciousness, absence of headache, pulse 5 5 and irregular, cold extremities and general clammy perspiration, normal temperature (?), anesthesia, slight paresis of hands, feet, and tongue, and a reeling gait. Convulsions followed of a teta- noid character ; the pupils were normal, the vision dim ; some vomiting took place ; there was abdominal colic, but no opening of the bowels ; and urination was frequent and copious." Treatment of Poisoning. — This should include the use of emetics and eliminants, together with diffusible stimulants and the applica- tion of external heat. Therapeutics. — Externally and Locally. — Burning coffee in a room deodorizes the air, and micro-organisms can be destroyed by allowing a bowl of coffee to stand in it. Powdered coffee is used to disguise the offensive odor of iodoform, and is frequently asso- 558 A TEXT-BOOK OF MA TERIA MEDICA. dated with it in the form of an ointment in the treatment of aural eczema. Equal portions of pulverized coffee and boric acid have been recommended by Guerder as an insufflation in whooping cough. Internally. — The chief value of caffeine is as a diuretic and cardiac stimulant, being peculiarly useful in cases of senile cardi- opathies associated with nephritis, in which, from degeneration of the heart-muscle, digitalis is not well tolerated. In some instances the primary effect of caffeine is to increase the pulse-rate ; usually, however, if the remedy be adapted to the case, there is a secondary slowing of the heart's action. The drug is considered by some physicians to be superior to digitalis as a cardiac stimulant in valvular disease accompanied by fatty heart. It is an efficient remedy to counteract the cardiac depression in low fevers, and is a comparatively safe drug in myocarditis. It is a remarkably efficacious remedy in cardiac and renal dropsy and to remove pleuritic effusion, etc. Its action upon the digestive system renders caffeine of great value as a stomachic tonic. Migraine, due either to gastric catarrh or nervousness, frequently yields to this drug. Its value in the treatment of headaches may be enhanced by administering it together with antipyrine or sodium bromide. Choleraic diarrhea, the result of nervous depression, is often markedly benefited by citrated caffeine. It has also been used with some success in the diarrhea of phthisis. The pains of locomotor ataxia have been greatly relieved by the hypodermic injection of from ^ to ■!■ grain (o.or-0.03 Gm.) of THEINE. Sodio-benzoate of CAFFEINE in doses of 5 to 10 grains (0.32- 0.64 Gm.) is considered by Misrachi to be superior to ergot in post-partum hemorrhage. Caffeine possesses a considerable repu- tation as a remedy for asthma. It is a matter of frequent observation that strong coffee cer- tainly modifies the effects of alcoholic intoxication. Hiccough is often relieved by coffee. Caffeine or strong coffee has unquestionably proved valuable in the reduction of strangulated hernias after taxis has failed. The medical uses of caffeine would be incomplete without mention of its extreme value in opium-poisoning. Here a salt of caffeine may be used hypodermically or a strong infusion of coffee given by the mouth or rectum. CARDIAC STIMULANTS. 559 In conclusion, it may not be out of place, in comparing this drug with digitalis, to quote aigain from the National Dispensatory, 5th ed., p. 365 : " Unlike digitalis, whiqh affects only certain invol- untary muscles, caffeine, like alcohol, stimulates the entire muscu- lar and vascular systems. It has been repeatedly said that caffeine and digitalis cannot be therapeutically substituted for one another — that the former acts where the latter ceases to act ; and the ex- planation of this fact resides in their very dissimilar modes of action. When digitalis fails, it is because the heart is either posi- tively or relatively incompetent to propel the blood, and the medi- cine has no power of strengthening except by tonically contracting it ; but coffee or caffeine stimulates the nervous centers which are the source of the heart's power, and temporarily restores the regu- larity and efficiency of its function, and so permits the removal of the dropsies, etc. which immediately threaten the extinction of life." Contraindications. — Ordinarily, caffeine is contraindicated in acute inflammations, particularly of the kidneys. Administration. — The alkaloid may be given by the stomach, but when hypodermic medication is desired caffeine is unavailable, a fresh salt for hypodermic use being properly employed, made by combining caffeine with salicylic acid, cinnamic acid, or sodium benzoate. The latter salt — sodio-benzoate of caffeine — is probably the most eligible and contains 45 per cent, of caffeine. The citrated caffeine should be given in pills, capsules, or tablets ; the effervescent citrate, in water. A valerianate of caffeine is prepared which has been employed with success, it is asserted, in hysterical vomiting and whooping £ough in doses of from J to 2 grains (0.03-0.12 Gm.). Strong coffee serves as a most excellent substitute for the alka- loid, and may be given by the mouth or as an enema. Alcohol— Alcoholis— Alcohol. V. 8. P. Origin. — A liquid composed of about 91 per cent, by weight or 94 per cent, by volume of Ethyl Alcohol, and about 9 per cent, by weight of Water. Description and Properties. — A transparent, colorless, mobile, and volatile liquid, of a characteristic, rather agreeable odor, and a burning taste. Miscible with water, ether, or chloroform in all pro- portions. It is inflammable, and readily volatilized even at low temperatures. Alcohol should be kept in well-closed vessels, in a cool place, remote from lights or fire. ' 560 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparation. Alcohol Dilutum — Alcoholis Diluti — Diluted Alcohol. — A liquid composed of about 41 per cent, by weight, or about 48.6 per cent, by volume, of absolute Ethyl AlcohoJ, and about 59 per cent, by weight of Water. It should be kept in well-closed vessels, in a cool place, remote from lights or fire. Alcohol Absolutum— Alcoholis Absolut!— Absolute Alcohol. V.S.F. Origin. — Ethyl Alcohol, containing not more than i per cent, by weight of Water. Description and Properties. — A transparent, colorless, mobile, and volatile liquid, of a characteristic, rather agreeable odor, and a burning taste. Very hygroscopic. It should be kept in well- stoppered bottles or tin cans, in a cool place, remote from lights or fire. Alcohol Deodoratum— Alcoholis Deodorati— De- odorized Alcohol. TJ. S. JP. Origin. — A liquid composed of about 92.5 per cent, by weight,, or 95.1 per cent, by volume, of Ethyl Alcohol, and about 7.5 per cent, by weight of Water. Description and. Properties. — As given and described under Absolute Alcohol. SpTritus VTni Gallic!— SpTriti VTn! Gallic!- Brandy. U. S. P. Origin. — An alcoholic liquid obtained by the distillation of the fermented, unmodified juice of fresh grapes, and at least foyr years, old. Description and Properties. — A pale amber-colored liquid,^ having a distinctive odor and taste and a slightly acid reaction. Its specific gravity should not be more than 0.941, nor less than 0925, corresponding, approximately, to an alcoholic strength of 39 to 47 per cent, by weight or 46 to 55 per cent, by volume. Spiritus Frumenti— SpTritus Frumenti— Whiskey. 77. S. I*. Origin. — An alcoholic liquid obtained by the distillation of the mash of fermented grain — usually mixtures of Corn, Wheat, and Rye — and at least two years old. CARDIAC STIMULANTS. 561 Description and Properties. — An amber-colored liquid, having a distinctive odor and taste, and a slightly acid reaction. Its specific gravity should not be more than 0.930 nor less than 0.9 1 7, corresponding, approximately, to an alcoholic strength of 44 to 50 per cent, by weight or 50 to 58 per cent, by volume. Vinum Album— VTni AIbi— White Wine. TI. S. JP. Origin. — An alcoholic liquid made by fermenting the juice of fresh grapes, the fruit of Vitis vinifera (nat. ord. Vitacece), freed from seeds, stems, and skins. Description and Properties. — A pale amber-colored or straw- colored liquid, having a pleasant odor, free from yeastiness, and a fruity, agreeable, slightly spirituous taste, without excessive sweet- ness or acidity. It should contain not less than 10 nor more than 14 per cent, by weight — equivalent to 12.4 to 17.3 per cent, by volume — of absolute alcohol. Vinum Rubrum— VTni Rijbri— Red Wine. U.S. p. Origin. — An alcoholic liquid made by fermenting the juice of fresh, colored grapes, together with their skins. Description and Properties. — A deep red liquid, having a pleasant odor, free from yeastiness, and a fruity, moderately astrin- gent, pleasant, andslightly acidulous taste, without excessive sweet- ness or acidity. It should contain not less than 10 nor more than 14 per cent, by weight — equivalent to 12.4 to 17.3 per cent, by volume — of absolute alcohol. Unofficial Alcoholic Preparations. Splritus Rectificatus — SpJritus Rectificati — Rectified Spirit contains 85 per cent, by weight of absolute alcohol. Proof Spirit contains 49 per cent, by weight of absolute alcohol, together with a peculiar volatile oil and other foreign material. Gin is usually distilled in Holland from rye or barley, and flavored with juniper ber- ries and hops. It contains about 42 per cent, by weight of absolute alcohol, and is probably more diuretic than other liquors because of the oil of juniper it contains. Rum is obtained by distilling feimented molasses, having about the same alcoholic strength as gin. Port Wine is prepared by adding spirit during the process of manufacture, bring- ing the alcoholic strength up to 30 or 40 per cent. Sherry Wine is a dry wine, having from 20 to 35 per cent, of alcohol. Sparkling Wines contain from 8 to lo per cent, of alcohol. They are more or less sweet wines, and are charged with carbonic acid, being bottled before fermentation is completed, the gi-ape-sugar, in consequence, not undergoing conversion into alcohol, The sparkling wines are Champagne, Hock, and Sparkling Catawba. 36 562 A TEXT-BOOK OF MATERIA MEDIC A. Sweet Wines are those in which the sugar has not all been converted into alcohol, the alcoholic strength being therefore relatively low — from 6 to 7 per cent. Among the sweet wines may be classed Angelica, Madeira, Malaga, Muscatel, Tokay, etc. Dry Acid Wines are those in which the fermentation is complete, the alcoholic strength varying from 5 to 7 per cent. They are such as California Hock, Ohio and Kelly Island Catawba, Rhine and Moselle wines, Hochheimer, Durkheimer, Deides- heimer, etc. Light Red Wines contain 5 to 7 per cent, of alcohol, and are astringent, contain- ing tannic acid and the coloring matter of the grape. They are Claret, Red Rhine, Concord, Hungarian, etc. Beer, Ale, and Porter aie prepared by fermenting malted grain with hops and adding other bitters. Beer contains from 2 to 3 per cent, of alcohol ; ale and porter, from 4 to 6 per cent., besides carbonic and lactic acids, malt extract, various aromatics, and potassium and sodium salts. Antagonists and Incompatibles. — The motor, cerebral, and cardiac depressants are antagonistic to moderate amounts of alcohol. Synergists. — The motor excitants, atropine, ether, and the dif- fusible stimulants. Physiological Action. — Few drugs have occasioned such di- versity of opinion regarding their physiological action and uses as alcohol. With those who — as Nathaniel asked, "_Can any good thing come out of Nazareth ?" — question whether any benefit can accrue from alcohol, being honestly convinced that the drug pos- sesses no value in medicine, the author begs leave to take respect- ful yet decided issue. Indeed, extensive reading, experimentation, and clinical experience have alike proved to him conclusively that we have in alcohol a drug endued with peculiar and invaluable properties, rendering its efficacy inferior to that of no remedy in the range of materia medica. Like opium and other powerful agents, the drug may prove noxious or beneficial according to the manner and judgment with which it is employed. The physiological action as here given agrees with the best authorities on the subject. Externally and Locally. — Alcohol is a powerful antiseptic and disinfectant. It possesses also rubefacient, astringent, and anhi- drotic properties. When applied in full strength to the skin it pro- duces a sensation of coldness, due to rapid evaporation. Should the drug be diluted, the sensation of cold is greatly diminished. If evaporation be prevented, the effect is that of heat or burning, owing to the penetration of the drug through the epidermis and its chemical influence upon the tissues beneath. Its effect upon mucous membranes is similar to that upon the CARDIAC STIMULANTS. 563 skin, save that the former are more readily affected. The mucous membrane becomes whitened and corrugated, because of the coagu- lation of albumin and the abstraction of water. The white film, which is the precipitated albumin, later disappears as the albu- min is redissolved in liquids present, although the prolonged action of alcohol upon mucous membranes produces a permanent co- agulation. When the drug is applied to the skin the secretion of sweat is lessened and the cutaneous blood-vessels contracted. Internally. — Digestive System. — The local action upon the mu- cous membrane of the mouth is as above described. There is a burning sensation, and marked increase of saliva due entirely to reflex action. When ingested a sense of warmth is experienced in the stomach, the blood-vessels of which are dilated, with accom- panying increase in the secretion of gastric juice, as well as stimu- lation of peristaltic action. As a consequence, moderate amounts of the, drug, when taken before meals, improve the appetite and favor digestion : if taken during the active period of digestion, the process is retarded. It will be observed that the action of alcohol upon the digestive system is quite similar to that of vegetable bitters, immoderate amounts checking the flow of gastric juice and increasing the secre- tion of mucus, producing a catarrhal condition ; while excessive doses or the daily and intemperate use of the drug frequently occasions nausea and vomiting. Upon the intestines alcohol acts as an astringent, brandy being an efficient agent in checking diarrhea. Small amounts of the drug act as an hepatic stimulant, while large quantities change the character of the bile, at the same time lessening its amount. Circulatory System. — Taken into the stomach, alcohol reflexly and rapidly stimulates the heart before absorption can take place, the effect upon the circulation persisting after the drug is absorbed. Cardiac action is rendered more rapid and forcible by stimulation of the heart-muscle and motor ganglia, as well as of the accelerator center in the medulla. Arterial tension is raised, although the blood-vessels are dilated, especially those of the skin, owing to depression of the vaso-motor center and the ganglia located in the vessel-walls. Toxic doses depress the heart and still further dilate the arterioles, greatly lowering the blood-pressure. This action of alcohol, in causing the heart to beat stronger and faster, at the same time dilating the blood-vessels — particularly those of the 564 A TEXT-BOOK OF MATERIA MEDICA. peripheries — renders the drug one of the most valuable diffusible stimulants. Excessive doses of alcohol greatly depress or paralyze the heart, while an enormous amount, when taken upon an' empty stomach, by reflex action occasioning cardiac paralysis, may pro- duce instantaneous collapse. The ameboid movements of the white blood-corpuscles are tem- porarily increased, though subsequently diminished. The function of the red corpuscles is impaired, preventing the oxyhemoglobin from parting with its oxygen, consequently retarding oxidation in the tissues. It is a matter of observation that persons addicted to the habitual use of alcohol are frequently obese, on account of the imperfect combustion of fat and its consequent accumulatiori in the tissues. Experiments have conclusively shown that moderate amounts of alcohol are oxidized during their circulation in the body. Alco- hol must, then, serve as a food to a certain extent. Indeed, experi- ments have irrefutably proved that the body-weight of an animal may be maintained for a considerable period upon alcohol alone. This peculiar and apparently paradoxical property, of lessening and at the same time undergoing oxidation, renders the drug of eminent value in certain conditions. Nervous System. — Moderate amounts of alcohol stimulate the nervous system, particularly the brain, chiefly through the increased supply of blood to the parts, although the drug probably exerts some influence also upon the nerve-cells. The highest nerve- centers are first affected, so that a person who has taken alcohol displays a keener intelligence, a brighter wit, and possesses a sense of general mental and physical power. Should the dose have been large, depression is wont to succeed the feeling of exaltation, the functions in general sharing in the change, which passes from the highest to the lowest centers in regular succession, the order of functional disturbance being that of the cerebrum, cerebellum, spinal cord, and, lastly, the medulla oblongata. It will be observed that in this descending scale of functional derangement the mental faculties, being the highest, are earliest affected, resulting in failure of coordination in reasoning power and loss of control in the logical sequence of ideas, although the imagination, the emotions, and the faculty of speech may still re- tain their normal energy and exercise. Soon, however, the will- power succumbs ; the emotions, while yet stimulated, are no longer CARDIAC STIMULANTS. 565 subject to mental command ; the imagination becomes disordered ; and the patient laughs and weeps hysterically, and, as a final result accompanying this stage of intoxication, the power of speech is merged in spasmodic, incoherent, or almost inaudible utterances or perhaps total dumbness. The muscular system, being less highly organized, may still retain its activity ; yet it at last yields to the influence of the poi- son, the movements becoming wholly incoordinate, until the patient sinks into a condition of drowsy, helpless stupor, in which he is incapable of the slightest effort dependent upon muscular energy. Consequent to this stage is the influence upon the spinal cord, the reflex centers in which are abolished, the patient micturating and defecating involuntarily. Meanwhile the respiratory center, hitherto unaffected, shares the general influence of the drug. The breathing is difficult, or even paralyzed, and the face livid. At length the cardiac movements are involved, and, the paralysis affecting its functions — at first stimulated — fatal collapse ensues. A frequent phenomenon incident to the depression of the reflex centers is found in the fact that injuries which under normal condi- tions might prove fatal to the subject have little or no effect upon the system saturated with alcohol, the heart and respiration being for the time immune against reflex action. Respiratory System. — Medicinal amounts deepen and accelerate respiration ; large doses render the breathing slow and shallow, — these effects being due to stimulation or depression of the respira- tory center. Death from a toxic dose of alcohol usually results from paralysis of respiration. It may be noted that under toxic dosage of the drug the amount of carbonic acid exhaled is dimin- ished. Absorption and Elimination. — Alcohol is very rapidly absorbed, and ■' eliminated unchanged in small proportion to the quantity in- gested," owing to the fact that the greater proportion of it is oxi- dized in the body. The kidneys, lungs, skin, and liver share in the excretory process. The quantity of urine is greatly increased, principally on account of increased arterial pressure, although the amount of urea, sodium chloride, and uric, phosphoric, and sulphuric acids in the urine is diminished by alcohol. When taken internally the amount of sweat is slightly increased, due partly to a direct stimulation of the sweat-glands, and partly to the dilatation of the cutaneous blood-vessels. 566 A TEXT-BOOK OF MA TERIA MEDICA. Temperature. — Alcohol is an antipyretic of considerable power. This action is owing (i) to lessening of tissue-oxidation ; (2) to the cooling of the blood through dilatation of the cutaneous blood- vessels, subjecting the warm blood from the interior of the body to the cooling influence of the atmosphere ; (3) to the cooling of the surface of the body from the evaporation of sweat. The power to resist cold is diminished by the habitual use of alcohol. The drug would be useful in stimulating warmth in a person who had been long exposed to cold, but only in a warm room. Then, by rapidly dilating the blood-vessels of the skin and allowing the blood to flow to the surface, the subject is favorably affected by the external heat, while there is less danger of congestion in some internal organ. Eye. — The excessive use of alcohol may produce amblyopia, watery eyes, and congested conjunctivae. Untoward Action is fully described under " Poisoning." Poisoning. — The untoward or poisonous action of alcohol may be divided into what are known as Acute and Chronic Alcoholism. The former has been described in detail under the effect of alcohol upon the Nervous System, and doubtless most readers are too familiar, from observation, with the effects of alcoholic intoxi- cation to require further enlightenment as to its general phe- nomena. A serious and altogether too frequent accompaniment of acute alcoholism is delirium tremens, the symptoms of which are as fol- lows : The malady is usually announced by marked anorexia, insomnia, and restlessness ; tremor, especially of the tongue ; dis- orders of vision and hearing ; great mental depression ; a soft and weak pulse ; and cold extremities. These manifestations are succeeded in a day or two by active delirium, even passing into wild mania and horrible hallucinations, in which the distorted imagination conjures up the most loathsome images of reptiles, the vivid spectacle of which preys upon the mind with pitiable terror and dismay. Even the tenderest offices in behalf of the sufferer are perveiled by the disordered reason, which becomes possessed only with the sentiment of abject, agonizing fear. The muscles are in a constant tremor, and the patient talks in- cessantly and incoherently. The pulse is usually rapid, feeble, and dicrotic, and insomnia is continuous. The patient may even pass into a state of coma-vigil, which is generally the precursor of death, or fatal collapse may occur suddenly and unexpectedly. In other CARDIAC STIMULANTS. S^J cases the sufferer may relapse into a sound sleep, when the delirium subsides and convalescence is established. It should be observed that alcoholic coma may be confounded with uremic coma, apoplexy, opium-narcosis, sunstroke, epileptic coma, or asphyxia. Diabetic or hysterical coma may also be confounded with alco- holic coma. So far as the odor of the breath is concerned, it is not pathognomonic, since a person in a comatose condition from other causes may have previously taken sufficient alcohol to impart to the breath a distinct odor of the drug. It is often, in fact, extremely difficult to make a positive diagno- sis of true alcoholic coma. It may sometimes happen that the patient is suffering from the combined action of alcohol and opium or noxious gases, or that he has been seized with cerebral hemor- rhage or sunstroke. Chronic alcoholism is generall^r the result of the continuous and excessive use of alcohol. The symptoms vary according to the individual case. There maybe (i) the moderate, daily drinker; (2) the periodical inebriate, usually the highly gifted, sensitive, and sympathetic, who drinks to excess at certain distinct intervals with a deliberation and moral perversity expressed by the declaration of a noted British general : " By the blessing of God, I intend to get gloriously drunk next Saturday night ;" (3) the immoderate, im- pulsive, maniacal inebriate, who, during his usually brief existence after the establishment of the disease, is subject to constant and excessive indulgence, incapacitating him from the simplest duties of a rational life. ■ The habitual drinker sooner or later suffers from disturbed digestion, gastric catarrh, and irregularity of the bowels ; his face is usually puffed and bloated, while the capillaries, especially of the cheeks and nose, become permanently dilated, marked acne rosacea not infrequently developing in the latter organ. The excessive use of alcohol predisposes the subject to cirrhosis of the liver, other conditions being arterio-sclerosis, fatty degenera- tion of the heart and liver, paralysis, peripheral neuritis, Bright's disease, amaurosis, ataxia, epilepsy, insanity, etc. Treatment of Acute Alcoholic Poisoning. — The stomach should be emptied of all unabsorbed alcohol ; cautious inhalations of am- monia should be given, accompanied by the internal administration of the aromatic spirit of ammonia and black coffee. Capsicum and vinegar also have the power to stimulate the patient and counteract 568 A TEXT-BOOK OF MA TERIA MEDICA. the ill effects of alcohol, while it is said that ammonium chloride, in a dose of 30 grains (2.0 Gm.) given in 8 ounces (236.59 Cc.) of water, is an exceedingly efficient antagonist. Should there be great depression of respiration, faradism of the muscles of respiration may be necessary, with warm applications to the extremities and cold to the head. Hot milk and other forms of nutritious liquid food form an essential element in the restoration of the patient. Treatment of Delirium Tremens. — The management of this phase of alcoholism requires great skill and judgment, the student being referred for details to any standard work on the Practice of Medi- cine. The indications are to quiet the patient and sustain his physical strength. This has been accomplished by the adminis- tration of chloral and potassium bromide or opium, these drugs, together with digitalis, strychnine, and other cardiac stimulants, having proved highly efficient remedies. Gastric sedatives may be required, such as bismuth, carbolic acid, hydrocyanic acid, etc. Nutritious and easily digested food should be given, and, in case of gastric intolerance, enemata should be adopted. Treat7nent of Chronic Alcoholism. — A thoughtful and extended experience with inebriates has convinced the author that the great majority of dipsomaniacs suffer from a disease possessing usually a distinct and traceable etiology and resulting from either inher- ited or acquired neurosis. In many cases the malady is charac- terized by uniform development, progress, symptomatology, and termination. The author makes this statement with the full knowledge that he will be regarded as a "sentimentalist" by many professedly " practical " men. Yet a careful scrutiny of numerous cases and a consideration of the means adopted in the. treatment of them will, he believes, convince the thoughtful physician that he has to deal with a thoroughly diseased organism rather than with the victim of a " vicious drug habit " readily overcome by a moderate exercise of the will. The medicinal agents most serviceable in the treatment of chronic alcoholism are stiychnine, atropine, small doses of the alteratives, arsenic, potassium iodide, and mercury, while phos- phorus and other restoratives and tonics will frequently be found useful. The hygienic surroundings should be of the best, and the treat- ment should include a nutritious, non-stimulating diet taken with CARDIAC STIMULANTS. 569 regularity, and the free use of fruits and vegetables. Close atten- tion should be paid to the condition of the bowels and skin, and, among other remedial influences, should be mentioned laxatives when necessary, frequent Turkish baths, and, above all, change of scene and engaging mental occupation. From time to time various drugs have been heralded as specifics in the treatment of alcoholism, certain " cures " (sic) acquiring an influence among the ignorant and unscientific wholly at variance with the therapeutic value of these vaunted remedies. It is super- fluous to say that to a skilled and enlightened professional judg- ment the rationale of intemperance and the agents serving to miti- gate the malady present a problem far too complicated to be grasped by the empirical understanding, operating even under the most ingenuous motives. Therapeutics. — Externally and Locally . — Alcohol is an efficient application for contusions, sprains, and indolent ulcers, and is also serviceable in hardening the skin and preventing the formation of bed-sores. It is a useful hemostatic to check capillary oozing, and, being a powerful antiseptic, is available in all wounds. Uterine hemorrhage is controlled by inserting in the cavity of the uterus a tampon saturated with the drug. Its local anesthetic properties render alcohol valuable in relieving irritation of the skin in urticaria, frost-bite, etc. ; it also serves as an efficient gargle in diphtheria and acute pharyngitis. Alcohol, or brandy, has been successfully employed to harden nipples and prevent their cracking. A very efficient means of reducing temperature in fever is to bathe the skin with alcohol, the method being also useful to check excessive sweating. The absorption of inflammatory exudates may be aided and the pain of muscular rheumatism relieved by rubbing the affected area with TINCTURE of CAMPHOR or SOAP LINIMENT, both of which Con- tain alcohol. Internally. — Alcohol, in the form of wine, beer, or ale, taken before or during meals, is an efficient stomachic. Atonic dyspepsia and the weakened digestion attendant upon convalescence from acute diseases are greatly benefited by some form of alcohol. When digestion becomes impaired as the result of physical or mental exhaustion the drug serves a useful purpose as a tonic. The wisdom of using the drug, however, in the above condi- tions may be questioned, because of the danger of establishing the 570 A TEXT-BOOK OF MATERIA MEDIC A. desire or habit, particularly in the case of neurotic women and those whose debilitated energies call for renewed and increasing quantities of the drug. Frequently the physical or mental depression, the peculiar, irre- sistible craving for stimulants, the insomnia and fitful appetite and disposition which urge recourse to alcoholic indulgence, are but the early manifestations of a brain-and-nerve degeneration, the impulse to drink being only the physical demand for relief. There is less danger attending the administration of alcohol in conditions of lowered vitality and weakened digestion in old people than in the young and middle-aged. The drug is decidedly contra- indicated in persons of average health and fair digestion, although beneficial in the aged, whose powers are failing from natural decline. The anesthetic and sedative properties of alcohol, especially in the form of champagne, which contains carbon-dioxide gas, may frequently control obstinate vomiting. Gastralgia and the pain arising from, flatulence are often readily relieved' by brandy, and the same remedy may be used efficiently in checking simple diarrhea. As a pure cardiac stimulant, alcohol is remarkably serviceable in syncope, asphyxia, exhausting hemorrhages, diphtheria, and col- lapse where death seems imminent. In counteracting the effects of narcotic poisons it is almost indispensable ; it is, moreover, un- doubtedly the most efficient antidote to the poison of venomous reptiles. It is a common practice with some surgeons to precede the inhalation of chloroform with the administration of i or 2 ounces (30.0-60.0 Cc.) of WHISKEY or BRANDY, for the twofold purpose of sustaining the heart and prolonging the anesthesia. In certain stages of various acute diseases, such as typhoid, typhus, small-pox, pneumonia, cerebrospinal meningitis, capillary bronchitis, etc., alcohol is one of the most potent and valuable rem- edies. It should be employed in these cases only when there is marked depression of the circulatory apparatus, characterized by a weak, rapid, soft, and irregular pulse, with a feeble sound of the heart and threatened syncope or delirium. Alcohol is beneficial in such cases as the foregoing when by its use the tongue is moistened, the pulse and respiration is slowed, the restlessness and delirium quieted, and the skin becqmes less parched. CARDIAC STIMULANTS. 5/1 Should the drug increase the pulse and intensify the nervous manifestations, it is an indication that the dosage is excessive, in which event it may be well to discontinue the administration alto- gether. Even where the action of the drug is favorable, it is doubtful whether it should ever be given in fevers throughout the twenty-four hours, administration being advisable rather when the muffled or absent first sound of the heart indicates impending cardiac failure. This usually occurs during the interval between midnight and 7 a.m. Stimulation should therefore begin before midnight, and full doses — say i fluidounce (30 Cc.) — be given every three hours, full doses being of more service than repeated smaller amounts. It should be remembered that alcohol generates no new energy, but simply enables a person to utilize in a short period all his available reserve force. The utmost discrimination and judgment are requisite to the proper administration of the drug. In pyemia, septicemia, erysipelas, and diphtheria alcohol is fre- quently one of our most efficient remedies, while clinical experi- ence has fully demonstrated its value in retarding the progress of phthisis. Tubercular patients acquire a marked tolerance for the drug, being often able to assimilate enormous quantities without deleterious results. Small quantities of alcohol appear to exert a favorable action in functional impotence. Its sedative action, or possibly its property of increasing intra- cranial blood-pressure, renders alcohol valuable as a hypnotic in neurasthenia. A very common remedy for anemia and chlorosis is red WINE. Acute coryza or a cold may often be wholly aborted by taking a good quantity of hot whiskey or hot "gin sling" upon retiring. The statement made by so prominent a physician as Mr. Law- son Tait, " I am fully persuaded, after thirty years of life as hard in work and as full of responsibility as well could be, that the mod- erate use of alcohol is a necessity in our modern life," is, in the author's opinion, too strong. Physicians, of all men, should realize the ill effects of over-work, as well as those of alcohol. Is it not wiser to limit the amount of labor than to attempt undue exertion under the stimulus of so seductive and dangerous a drug ? Sta- tistics show that of those addicted to the excessive use of alcohol and other pernicious drugs, by far the largest percentage is among 572 A TEXT-BOOK OF MA TERIA MEDICA. physicians — a sad commentary on their wisdom and professional knowledge. Contraindications. — Alcohol should not be given when the urine is of high specific gravity. It is ordinarily contraindicated in nephritis and diseases of the liver, gout, gleet, gonorrhea, and urethritis. The malt liquors and sweet wines should not be given in diabetes nor to persons suffering from eczema. Alcohol is also dangerous in hypertrophy of the heart and excessive cardiac action. Administration. — When possible, alcohol should always be taken with food. Brandy is the best astringent, and brandy and champagne are the best preparations to allay nausea. Whiskey is the least constipating, and gin the most diuretic. As regards their sedative action, there is no preference, whichever is most agreeable to the patient and least affects the head being advisable. As stomachics either claret, beer, or ale is most efficacious in im- proving the appetite. In cases of fermentative dyspepsia sweet wines and malted liquors are more injurious than beneficial, whiskey or brandy being preferable. When desired as diffusible stimulants in cases of cardiac failure brandy or whiskey only should be employed, which preparations may be given hypodermically. PREPARATIONS OF AMMONIUM. Aqua Ammonii Fortior— Aquae Ammonii Fortioris— Stronger Ammonia Water. JJ. S. JP. Origin. — An aqueous solution of ammonia (NH, = 17.01), con- taining 28 per cent, by weight of the gas. Description and Properties. — A colorless, transparent liquid, having an excessively pungent odor and a very acrid and alkaline reaction. It should be kept in strong, glass-stoppered bottles. Dose. — 3-6 minims (0.18-0.3 Cc). Official Preparation. Spilritus Ammdnise — Splritus Ammoniae — -Spirit of Ammonia. — Origin. — An alcoholic solution of ammonia, containing 10 per cent, by weight of the gas. Description and Properties. — A colorless liquid, having a strong odor of ammonia and a specific gravity of about 0.810 at 15° C. (59° F.). It should be kept in glass- stoppered bottles, in a cool place. Dose. — 10-60 minims (0.6-3.7 Cc). CARDIAC STIMULANTS. 573 Aqua Am moniae— Aquae Ammoniae— Ammonia Water. TJ. S. P. Origin. — ^An aqueous solution of ammonia, containing lo per cent, by weight of the gas. Description and Properties. — A colorless, transparent liquid, having a pungent odor, an acrid, alkaline taste, and a strongly alkaline reaction. It should be kept in glass-stoppered bottles, in a cool place. Dose. — 10-20 minims (0.6-1.2 Cc.) well diluted. Official Preparations. Linim£ntum Ammoniae — L.inim£nti Ammoniae — Ammonia Liniment (Am- monia Water, 350; Alcohol, 50; Cotton-seed Oil, 600). — For external use. SpKritus Ammonise AromSticus — Spiritus Ammoniae AromStici. See Am- monium Carbonate. Ammoniae Carbonas— Ammoniae Carbonatis— Ammonium Carbonate. TJ. S. P. Origin. — Prepared by subjecting to sublimation and resublima- tion a mixture of Ammonium Sulphate or Chloride and Calcium Carbonate. Description and Properties. — White, hard, translucent, striated masses, having a strongly ammoniacal odor without empyreuma, and a sharp, saline taste. On exposure to air the salt loses both ammonia and carbonic acid, becoming opaque, and is finally con- verted into friable, porous lumps or a white powder. Slowly but completely soluble in about 5 parts of water ; decomposed by hot water, with the elimination of carbonic acid and ammonia. Ammonium carbonate should be kept in well-stoppered bottles, in a cool place. Dose. — 2-15 grains (0.12-1.0 Gm.). Official Preparation. Spiritus Ammoniae Aromaticus— Spiritus Ammoniae AromStici— Aromatic Spirit of Ammonia (Ammonium Carbonate, 34; Ammonia Water, 90; Oil of Nut- meg, I ; Oil of Lemon, 10 ; Alcohol, 700 ; Oil of Lavender Flowers, I ; Water, to make \ooa).— Description and Properties.— P>. nearly colorless liquid when freshly pre- pared, but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor and taste. It should be kept in glass-stoppered bottles, in a cool place. Dose.—yi-T. fluidrachms (1.8-7.3 Cc). Antagonists and Incompatibles. — The cardiac sedatives are 574 A TEXT-BOOK OF MA TERIA MEDICA. antagonistic. The incompatibles are the vegetable and mineral acids, the earthy salts, lime water, and solutions of acidulous salts. Synergists. — Cardiac and diffusible stimulants, antispasmodics, and capsicum internally. The local action of ammonium prepara- tions is enhanced by cantharides and counter-irritants. Physiological Action. — Externally and Locally. — When solu- tions of ammonia are applied to the skin or mucous membranes they act as irritants, rubefacients, or vesicants according to the strength of the solution and the freedom or confinement of the vapor. When inhaled the vapor occasions great irritation of the respi- ratory passages, together with a sense of suffocation and spasmodic closure of the glottis. There are also produced marked irritation of the conjunctivje, lacrymation, and a watery secretion from the nose. Internally. — Digestive System. — Small doses act like alkalies upon the gastro-intestinal tract, augmenting the flow of gastric juice when given before meals and neutralizing it when given after meals. Excessive doses occasion violent and destructive inflammation of the mouth, esophagus, and stomach, possibly resulting in stric- ture of the esophagus and stenosis of the pyloric orifice. Circulatory System. — These preparations, whether ingested or injected into the system, cause a temporary fall of arterial pressure, quickly followed by a decided increase and acceleration of the pulse, owing to stimulation of the accelerator muscle of the heart. Their precise action upon the blood is not known, though they certainly lessen the oxygen-carrying power of the red corpuscles and dimin- ish the tendency to coagulation of the blood. Nervous System. — Other than their action upon the sensory nerves when locally applied, these preparations affect the nervous system only in stimulating the motor centers of the spinal cord, excessive doses causing convulsions. Respiratory System. — They stimulate the respiratory center, greatly increasing the number of respirations. Absorption and Elimination. — ^The preparations of ammonium are rapidly absorbed, being oxidized in the system and eliminated chiefly by the kidneys, increasing the acidity of the urine and aug- menting its amount, as well as increasing the proportion of nitric acid, uric acid, and urea excreted. The continued use of ammo- nium preparations therefore promotes tissue-waste. CARDIAC STIMULANTS. 575 Temperature is unaffected by medicinal amounts. Poisoning. — In toxic doses these preparations are powerful cor- rosive poisons, exciting violent inflammation of the gastro-intestinal tract, labored respiration, great cardiac depression, muscular weak- ness, and possibly convulsions. Treatment of Poisoning. — Similar to that of poisoning by the corrosive alkalies — evacuation of the stomach, the internal admin- istration of vinegar or other vegetable acids, followed by oil and demulcent drinks, opium being indicated for the relief of pain. Therapeutics. — Aqua ammonite is a valuable ingredient of " hair tonics " in premature alopecia. The ammonia liniment is a favorite remedy for chilblains. The AROMATIC SPIRIT OF AMMONIA is of valuc in many diseases of the scalp, such as pityriasis, etc., and, when well diluted with water, has been recommended in acute pharyngitis. The ammonium CARBONATE posscsses an action similar to that of salicylic acid in its property of dissolving epidermic scales, rendering it of value in preparing the skin for the subsequent local treatment of psoriasis. As a counter-irritant ammonia water — or, preferably, the am- monium liniment — is efficient in chronic rheumatism and joint affections. Ammonia water relieves the irritation caused by bites of insects ; its vapor inhaled acts as a rapid restorative in cases o{ fainting. , Internally. — The ammonium preparations here mentioned are serviceable in lessening excessive acidity of the stomach. The aromatic spirit of ammonia is frequently beneficial in allaying the distress of nervous headache, and is also an efficient remedy to counteract the effects of an immoderate use of alcoholic stimulants, having proved in many cases valuable in the treatment of delirium tremens. The most important uses of these preparations are, perhaps, as powerful diffusible stimulants to the circulatory, respiratory, and spinal systems. They are of undoubted value in sudden cardiac failure arising from any cause, such as poisoning from chloroform, noxious gases, hydrocyanic acid, etc. Taken internally or by intra- venous injection, they counteract the poisonous effects resulting from the bites of venomous reptiles. The carbonate is an excellent stimulant to sustain the heart and respiration during the course of pneumonia, eruptive and con- tinued fevers, etc. In all dynamic conditions of the heart this preparation should be given in small doses, frequently repeated. 576 A TEXT-BOOK OF MA TERIA MEDICA. The carbpnate is also a valuable stimulant expectorant in chronic bronchitis and broncho-pneumonia. The preparations of ammonia have been recommended in threatened thrombosis. The condition being established, however, the only effective method of treatment is by intravenous injection, when the thrombi may be redissolved through direct contact with the remedy. Contraindioations. — Acute gastritis and conditions of excessive acidity of the urine. Conditions of anemia and great emaciation would contraindicate the prolonged use of these preparations. Administration. — The liquid preparations should always be well diluted, and the carbonate should invariably be given in solu- tion. The fluid extract of glycyrrhiza disguises the taste very well. Owing to the rapid elimination of these drugs, the dosage should be frequently repeated. GROUP IX.— CARDIAC SEDATIVES. Aconltum—Aconiti— Aconite. TJ. S. JP. Origin. — The tuber of Aconitum, Napellus L., a plant about 40 inches (i M.) high, met with throughout the greater portion of Asia and Europe, mostly in mountainous regions. Description and Properties. — From f to f inch (10-20 Mm.) thick at the crown, and from 2 to 3 inches (50-75 Mm.) long, with scars or fragments of radicles ; dark brown externally, whitish in- ternally ; with a rather thick bark, the central axis about seven- rayed ; without odor, taste at first sweetish, soon becoming acrid, and producing a sensation of tingling and numbness lasting for some time. It contains an acrid alkaloid, aconitine. Dose. — 1—2 grains (0.03-0. 12 Gm.). Official Preparations. Extractum Aconiti — ExtrScti Aconiti— Extract of Aconite. — Dose, -f^ grain (0.006-0.01 Gm.). ExtrSctum Aconiti Fluidum — ExtrScti Aconiti Fliiidi — Fliiid Extract of Aconite. — Dose, -y^-^ minims (0.006-0.12 Cc. ). Tinctiira Aconiti — Tinctiirae Aconiti — Tincture of Aconite. — Dose, \-$ min- ims (0.008-0.3 Cc). CARDIAC SEDATIVES. 577 'Unofficial Preparation. Fleming's Tincture of Aconite is nearly twice as strong as the official tincture, the dose being correspondingly smaller. Aconitlna— Aconitlnae— Aconitine. (Unofficial.) Origin. — An alkaloid principle extracted from Aconite. Description and Properties. — The alkaloid exists in two forms, crystalline and amorphous ; white or yellowish-white, odorless, with a strong acrid taste characteristic of aconite. The crystalline form is soluble in alcohol, ether, and chloroform, and partially so in water. The alkaloid is one of the most powerful of poisons, rivalling in virulence hydrocyanic acid. The various aconitines are of different strengths, so that only the minimum dose of a new sample should at first be employed. Dose. — 1 0^0 2^0 grain (o.oooo6-o.ooo?5 Gm.). Oleatum Aconitmse — Oleati Aconitinx — Oleate of Aconite. — A 2 per cent, solution of Aconitine in Oleic Acid. For external use. Antagonists and Incompatibles. — The cardiac stimulants, atropine, morphine, and ether, antagonize the action of aconite. Synergists. — All members of this group and cold enhance the action of the drug. Physiological Action. — Externally and Locally. — Applied to mucous membranes or to the skin for any length of time, aconite first stimulates and then depresses the ends of the sensory nerves, producing respectively tingling, numbness, and local anesthesia. Internally. — Digestive System. — Except when given in very di- lute solutions, aconite produces tingling and numbness of the lips and mouth, with increased secretion from the salivary glands. Large doses cause great irritation, together with a sense of con- striction in the fauces. Under normal conditions of the stomach aconite may act upon that organ as a sedative, augmenting its secretions. Large doses occasion pain, nausea, and vomiting. Circulatory System. — Upon the heart aconite acts almost imme- diately as a depressant, although it is thought to accelerate cardiac action within a very brief period. It slows the heart by stimulat- ing the roots of the vagus, and weakens the force of the cardiac contractions by depressing the motor ganglia. The arterioles are 37 578 A TEXT-BOOK OF MATERIA MEDIC A. dilated and the blood-pressure lowered through the depressing effects of the drug upon the vaso-motor center. Toxic doses accelerate the pulse, causing it to become irregular and thready through over-stimulation and consequent exhaustion of the inhibitory nerve-roots, so that the motor ganglia are too profoundly depressed to maintain the regular contractions. The arterial tension is consequently greatly lowered, so that the radial pulse may be imperceptible. Death usually occurs from cardiac paralysis, the heart stopping in diastole. Nervous System. — Moderate doses have no important action upon this system ; excessive doses depress the terminations of the sensory nerves, and, possibly, the sensory side of the spinal cord. This action is followed by a depression of the motor mechanism, affecting first the peripheral endings of the motor nerves, giving rise to great muscular weakness. Respiratory System. — The respiration is slowed by moderate doses ; under large doses it is rendered both shallow and slow. The breathing is retarded, because the peripheral endings of the vagi distributed to the lungs are depressed. Under large doses there is depression of the respiratory center, paralysis of which may be occasioned by lethal amounts. Absorption and Elimination. — Aconite is rapidly absorbed, but its channels of elimination are not definitely known, although it is probably excreted by the kidneys, and to some extent by the skin, the drug acting as a mild diaphoretic. Temperature. — Aconite is a decided antipyretic, the reduction of temperature being probably due to increased heat-dissipation. Eye. — Toxic amounts of the drug have produced mydriasis, misty vision, and diplopia. Untoward Action. — Besides the symptoms described under " Poisoning," there have been observed pustular and erythematous eruptions, vertigo, and dimness of vision. Poisoning. — The first effect of toxic doses is to cause marked tingling of the tongue and lips, which sensation soon extends to the fingers and may even affect the entire cutaneous surface. There is extreme muscular weakness, particularly noticeable in the lower ejftremities. The pulse, at first slow and weak, soon becomes rapid and almost imperceptible. The respirations are quite feeble and shallow, and there may be marked dyspnea. , The countenance is anxious and the skin pallid, cold, and cov- ered with sweat, with great reduction of temperature. These CARDIAC SEDATIVES. 579 symptoms are accompanied by dimness of vision, the pupils usually being widely dilated. Rarely there are present epileptiform con- vulsions. Death may be postponed for some time, or it may rapidly follow a Ifethal dose. Treatment of Poisoning. — The patient should be placed in a horizontal position, better with the feet raised slightly. The stomach should be thoroughly evacuated ; bodily heat should be maintained by external warmth ; diffusible stimulants, such as ether and alcohol, should be given hypodermically, the treatment being followed by administration of digitalis. Atropine and strychnine hypodermically are indicated to stimulate the respiration and assist in stimulating the heart. Therapeutics. — Whether locally applied or given internally ACONITE is, an excellent remedy in neuralgice, particularly in tic douloureux. The tincture, aconite liniment, or an ointment of ACONITINE may be applied to the course of the affected nerve. The TINCTURE OF ACONITE frequently proves beneficial in herpes zoster, ■chilblain, pruritus, etc., and its extended application has even been recommended to allay the pain of chronic rheumatism. Internally. — Aconite is an exceedingly efficacious remedy in many febrile diseases, particularly the s the f lie fevers of children and those fevers resulting from inflammation, such as tonsillitis, laryn- gitis, pharyngitis, quinsy, etc. The drug seems to exert a pecu- harly beneficial influence on mucous membranes, all acute inflam- matory conditions of the throat, bronchial tubes, or intestinal canal — characterized by fever, a small, wiry pulse, and rapid cardiac action — being greatly improved by the remedy. As previously indicated, aconite is one of the most efficient sedatives in the irritative fevers of children. It is equally valuable in ^e: first stage of pneumonia and va pleurisy, and is an invaluable adjunct to opium in the treatment oi peritonitis. Pericarditis is often favorably influenced by this drug, while it is also of great service in allaying nervous palpitation of the heart or that due to excessive cardiac hypertrophy. The injection into the rectum of 8 or lo minims (0.5-0.6 Cc.) of the TINCTURE OF ACONITE, while perhaps producing a slight pro- lapsus of the rectum, quickly affects an irritable stricture of the urethra, so that a catheter may be passed with little difficulty, although the operation may have been previously found impos- sible. 580 A TEXT-BOOK OF MA TERIA MEDICA. Probably there is no better combinatipn to "break up a cold" than aconite and Dover's powder, the tincture of aconite, given at frequent intervals for a few hours, being followed, preferably at bed- time, with 8 or ID grains (0.5-0.6 Gm.) of Dover's powder. Aconite has been favorably recommended in the acute stages of cerebrospinal meningitis and as a cardiac sedative in aneurysm. Contraindications. — Aconite is always contraindicated in sub- acute or chronic conditions or when the heart's action is weak. It is also intolerable in catarrhal conditions of the stomach.- Administration. — A good, reliable tincture is the best prepara- tion for internal use. Moreover, better results are obtained by giving the drug in fraction of minim doses — ^from ^ to \ minim (0.006-0.03 Cc.) in a teaspoonful of water every fifteen minutes — than by larger dosage. The most desirable influence of the drug appears to be realized by this method. Veratrum Viride— Veratri VTrldis— Veratrum Viride. V. s. p. (American Hellebore.) Origin. — The rhizome and roots of Veratrum viride Solander, a plant growing in swampy places and damp thickets in Canada, and in the United States as far south as Georgia. The plant closely resembles V. album of Europe, and is also allied to a species found in Eastern Siberia. Description and Properties. — Rhizome upright, obconical,, simple or divided, from 2 to 3 inches (50 to 75 Mm.) long; exter- nally blackish-gray, internally grayish-white, showing numerous short, irregular wood-bundles. Many shrivelled, light yellowish- brown roots issue from all parts of the rhizome. The drug is inodorous, but strongly sternutatory when pow- dered, the taste being bitterish and very acrid. Veratrum viride contains the following alkaloids : jervine, pseu- dojervine, rubijervine , and cervadine. The first named is the cardiac depressant principle of the drug, and the remaining three are ster- nutatory'. Veratrina (U. S. P.) is not found in this drug, as formerly sup- posed, Sabadilla being its principal source. Veratroidine, once supposed to be a distinct alkaloid, is probably only a mixture of rubijervine and a toxic resin. Dose. — ^5 grains (0.01-0.3 Gm.). CARDIAC SEDATIVES. 581 Official Preparations. ExtrSctum Veratri Vfridis Fluidum— ExtrScti Veratri VKridis Fluidi — Fluid Extract of Veratrum Viride. — Dose, \-t, minims (0.01-0.3 Cc). Tinct&ra Veratri Viridis — Tinctiirse Veratri Vfridis — Tincture of Veratrum Viride (40 per cent.). — Dose, J-5 minims (0.01-0.3 Cc). Allied Drugs. Veratrum Album — Veratri Albi — White or European Hellebore. Sebadnia— Sebadnis— Cevadilla. The seeds of this plant yield the following official alkaloid, known as Veratrine : Veratrina— Veratrlnae— Veratrine. TJ. S. P. Description and Properties. — A white or grayish-white, amor- phous or semi-crystalline powder ; odorless, but causing intense irritation and sneezing whenever even a minute quantity reaches the mucous membrane ; of an acrid taste, and leaving a sensation of tingling and numbness on the tongue ; permanent in the air ; very slightly soluble in hot or cold water, soluble in 3 parts of alcohol. Dose. — ^5— f grain (0.0016-0.016 Gm.). Official Preparations. Oleatum Veratrinae — Oleati Veratrlnae — Oleate of Veratrine (2 per cent.). For external use. Ungugntum Veratrinae — Ungufinti Veratrlnae — Veratrine Ointment (4 per cent.). For external use. Antagonists and Incompatibles and Synergists are the same as for Aconite. Physiological Action. — The following remarks refer only to the crude drug, the actions of Jervine, the mixture Veratroidine , and Veratrine being given separately. Externally and Locally. — Veratrum is more of an irritant than aconite, exciting some inflammation of the skin when applied locally, and when in contact with the nasal mucous membrane producing violent sneezing. Internally. — Its effects are in every respect analogous to those of aconite, with the following exceptions, in the several systems : Digestive System. — Veratrum is more apt to occasion nausea and vomiting. Circulatory System. — The drug is a more powerful depressant to the circulation, small doses, while not materially affecting the 582 A TEXT-BOOK OF MA TERIA MEDICA. pulse-rate, greatly reducing its force, large doses rendering the pulse very weak, almost indistinguishable, and very rapid. Nervous System. — It does not, as does aconite, affect the sen- sory nerves, but in large doses paralyzes the motor system cen- trally, impairing the reflexes. Under moderate doses there is extreme muscular weakness. Respiratory System. — Veratrum depresses the respiration less than aconite. Absorption and Elimination. — The drug is absorbed with great facility, and is eliminated chiefly by the bowels. It possesses much feebler diuretic and diaphoretic properties than aconite. Temperature. — In medicinal doses it is not so powerful an anti- pyretic as aconite. Untoward Action. — Veratrum occasionally produces an erythem- atous or pustular eruption. Poisoning. — Except that the drug causes no cutaneous anesthe- sia or diminution of sensation, the symptoms of poisoning are almost identical with those occasioned by aconite. Treatment of Poisoning. — The same as prescribed for aconite. The Physiological Actions of jervine, veratroidine, and vera- trine are as follows : Externally and Locally. — ^Jervine is a mild irritant when applied to the skin or mucous membranes. Veratroidine is less irritating when similarly applied. Veratrine is a powerful irritant when applied by inunction, producing a tinghng or prickling sensation, followed by pain and finally by numbness. Internally. — Digestive System. — Jervine has no noticeable effect upon the stomach and bowels, but produces marked salivation. Veratroidine in full doses occasions vomiting and purging. Vera- trine excites great irritation of the gastro-intestinal tract, causing profuse salivation, with vomiting and purging and severe epigas- tric pain. Circulatory System. — Jervine renders the pulse slower, softer, and fuller, with marked reduction of arterial pressure. This action is due to direct depression of the cardiac muscle or of the motor ganglia, the dilatation of the arterioles being the result of a de- pressant effect upon the vaso-motor center. Veratroidine retards the heart's action by stimulating the pneu- mogastrics. The arterial pressure is lowered by weakening of the heart. The vaso-motor center is not depressed, nor are the arte- rioles dilated. CARDIAC SEDATIVES. 583 Veratrine markedly retards cardiac action, lengthening the sys- tolic period. The blood-pressure is increased because of the addi- tional force of the heart's contractions. Under poisonous doses, however, when the cardiac movements are very slow, arterial ten- sion is diminished. Nervous System. — Jervine causes great muscular weakness, with abolition of reflexes, owing to its depressing action upon the motor areas of the spinal cord. Upon the cerebral motor areas, however, its influence is that of a stimulant, so that poisonous doses of this alkaloid produce convulsions of cerebral origin. The muscles themselves and the motor nerves are unaffected, though in the later stage of poisoning numbness is present, showing that some portion of the sensory mechanism is depressed. Veratroidine manifests the same action as jervine. Veratrine. — This alkaloid affects neither the brain nor the spinal cord. The motor- and sensory nerves, on the other hand, betray its influence, being first stimulated and then paralyzed. The pain primarily produced by the local application of vera- trine is due to excessive stimulation of the peripheral endings of the sensory nerves. Respiratory System. — Jervine is a powerful depressant to the res- piration, death occurring from asphyxia when lethal doses are taken. Veratroidine affects the system in like manner with jervine. Veratrine. — Small doses accelerate the respiratory movements. Large doses retard and finally arrest respiration — the former amounts acting as stimulants, and the latter causing paralysis of the peripheral vagi and respiratory center. Temperature. — Moderate amounts of jervine and veratro- idine have no marked effect upon, while poisonous doses depress, temperature. Veratrine in large doses is more of an antipyretic than either jervine or veratroidine. Poisoning. — The symptoms of poisoning from either one of the above alkaloids would be a combination of the effects produced by lethal amounts, as stated, separately. Treatment of Poisoning. — The same as prescribed under Vera- trum Viride. Therapeutics. — Externally and Locally. — Veratrum viride is seldom, if ever, used locally. Veratrine, though in rare cases given internally, is wellnigh restricted to external or local appli- cation. 584 A TEXT-BOOK OF MATERIA MEDICA. The OLEATE or ointment of veratrine when applied over the affected nerve is exceedingly efficacious in neuralgia, particularly in tic douloureux and orbital neuralgia. In the latter affection great care should be taken in administration, lest some portion of the drug enter the eye, in which case violent and persistent conjuncti- vitis would ensue. Internally. — Veratrum viride may be employed for the same conditions for which aconite is recommended, although it is doubt- ful whether it possesses any advantages over the latter drug ; in- deed, by many competent physicians it is considered inferior to, and more dangerous than, aconite. Moreover, the nausea and vomiting which in many patients are likely to follow the ingestion of this drug render its use objectionable. Contraindications. — The same as for aconite. Administration. — The tincture of veratrum viride only should be given, beginning with small doses, as recommended for aconite, and cautiously increasing the amount. Veratrine may be applied in the form of an ointment, oleate, or in solution together with alcohol and glycerin. Phytolaccae Fructus— Phytoiaccae Fructus— Phyto- lacca Fruit. TJ. 8. J*. Origin. — The fruit of Phytolacca decandra L., a perennial herb indigenous in North America, growing in waste places. Description and Properties. — A depressed-globular, dark- purple compound berry, about \ inch (8 Mm.) in diameter, com- posed of ten carpels, each containing one lenticular black seed ; juice purplish-red, inodorous; taste sweet, slightly acrid. The fruit contains phytolaccin, phytolaccic acid, tannin, gum, sugar, and a coloring matter. Dose. — 5-30 grains (0.3-2.0 Gm.). Phytolaccae Radix— Phytolaccae Radicis— Phyto- lacca Root. IT. S. P. (Poke-root.) Origin. — The root of Phytolacca decandra L. Description and Properties. — Large, conical, branched, and fleshy ; mostly in transverse or longitudinal slices, wrinkled, gray- ish, hard; fracture fibrous, the wood-bundles in several distinct concentric circles; inodorous; taste sweetish and acrid. It con- tains resin, gum, fixed oil, tannin, starch, sugar, and a glucosid. Dose. — 5-30 grains (0.3-2.0 Gm.). CARDIAC SEDATIVES. 585 Official Preparation. EztrSctum PhytoUccs Radicis Fluidum— ExtrScti Phytoiaccae RSdicis ■piuidi — Fluid Extract of Phytolacca Root. — Dose, 5-30 minims (0.3-2.0 Cc). Antagonists and Incompatibles. — The cardiac stimulants, ■opium, and ether oppose the action of phytolacca. Synergists.— All the members of this group; the motor- depressants and emetics also enhance the action of the drug. Physiological Action. — Externally and Locally. — The pow- dered root is extremely irritating to mucous membranes, in certain •subjects occasioning an erythematous eruption and excoriations. Internally. — Digestive System. — Phytolacca possesses emeto- ■cathartic properties. It occasions much nausea, with great de- pression, persisting for some time before vomiting occurs. The ■drug augments the secretion of bile and acts as a laxative. Circulatory System. — Like aconite, it reduces the force and fre- ■quency of the heart's action and lowers arterial tension. Nervous System. — Poke-root is a powerful motor depressant, acting as a direct paralyzant to the spinal cord and medulla, ■although the muscles and motor nerves are unaffected. Respiratory System. — Phytolacca is a respiratory depressant. Tendering the breathing slow and shallow. Toxic doses produce death by paralysis of the respiratory center, preceded by tetanic ■convulsions. Absorption and Elimination. — The drug is readily absorbed, and is eliminated chiefly by the kidneys. Temperature. — Medicinal doses have no effect on temperature. Poisoning. — The symptoms of poisoning are quite similar to those produced by veratrum, though the nausea and vomiting are postponed longer after the ingestion of phytolacca. Treatment of ■ Poisoning. — The same as recommended under Aconite and Veratrum. Therapeutics. — Externally and Locally. — Preparations of phyto- lacca have been successfully used to allay inflammation, as in cases of follicular pharyngitis , tonsillitis, mastitis, ulcers, buboes, burns, abscesses. The drug is also useful in chronic eczema, sycosis, favus, etc. The. FLUID EXTRACT may be applied, or the powdered root incorporated in ointment either singly or associated with other medicinal agents. Internally. — The drug has proved an efficient remedy in chronic rheumatism, its alterative properties rendering it also of some service in the treatment of scrofula, syphilis, and chronic diseases of the skin. 586 A TEXT-BOOK OF MATERIA MEDICA. In mastitis, follicular pharyngitis, tonsillitis, etc. the internal use of the drug is indicated, mastitis especially often yielding readily to the internal use of the fluid extract, combined with the local, application of an ointment containing phytolacca. It has been recommended in obesity, possessing undoubted efficacy in this respect. It is claimed that the proprietary prep- aration known as "Anti-fat" is a resinoid preparation of the berries. Contraindications. — The same as for veratrum viride. Administration. — No special directions are necessary. The powder, tincture, or fluid extract may be given internally; for topical use an ointment may be prepared. Pulsatilla— Pulsatillae— Pulsatilla. V. S. I*. Origin. — The herb of Anemone Pulsatilla and Anemone pra- tensis L,, collected soon after flowering. Description and Properties. — Leaves radical, petiolate, silky- villous, twice or thrice deeply three-parted or pinnately cleft, with linear, acute lobes, appearing after the large purple flowers; in- odorous, \'feVy acrid. It contains a peculiar, acrid, crystallizable principle known as anemonin. Dose. — 1-5 grains (0.06-0.3 Gm.). Unofficial Preparations. Extractum Pulsatillae— ExtrScti Pulsatillae — Extract of Pulsatilla.— Z>d«, J-3 grains (0.03-0.2 Gm.). Tinctiira Pulsatillae — Tincturae Pulsatniae— Tincture of Pulsatilla. — Dose, 10-20 minims (0.6-1.2 Co.). Anemonin. — Occurring in crystalline, colorless needles, soluble in warm alcohol, insoluble in water. — Dose, \-\ grain (0.05-0.01 Gm.). Antagonists and Incompatibles and Synergists the same as for Aconite. Physiological Action. — Externally and Locally. — Pulsatilla is a decided irritant to the skin, the bruised plant when rubbed upon it even producing vesication. In the mouth it produces a sensation of burning, succeeded by numbness. Internally. — The action of the drug is identical with that of aconite, though Pulsatilla possesses greater emetic properties. Therapeutics. — The drug may be employed for the same pur- poses as aconite, though as a cardiac sedative it is less efficient. It has been recommended as a useful emmenagogue. CARDIAC SEDATIVES. -587 Arnicae Flores— Arnicae Florum— Arnica Flowers. V. S. J*. Origin. — The flower-heads of Arnica montana L., a plant in- digenous in the mountainous regions of Europe and Northern Asia, and also found in the northwestern part of America. Description and Properties. — Heads about i to 2 inches (25-50 Mrn.) in diameter, depressed-roundish, consisting of a scaly in- volucre in two rows, and a small, nearly flat, hairy receptacle, bearing about sixteen yellow, strap-shaped, ten-nerved ray-florets and numerous yellow, five-toothed, tubular disk-florets, with slen- der, spindle-shaped akenes crowned by a hairy pappus. Odor feeble and aromatic ; taste bitter and acrid. Arnica flowers contain a glucosid (?), arnicin, a volatile oil, capronic and caprylic acids, resins, tannin, etc. Dose, — 5-30 grains (0.3-2.0 Gm.). Official Preparation. Tinctura Arnicae Florum — Tincturse Amies Florum — Tincture of Arnica Flowers (20 per cent.).— /?»«, 10-30 minims (0.6-2.0 Cc). Chiefly, however, used externally as a vulnerary. Arnica Radix— Arnicae Radicis— Arnica Root. JJ. 8. JP. Origin. — The rhizome and roots of Arnica montana L. Description and Properties. — The rhizome is horizontal, some- what contorted, 2 to 3 inches (5-7 Cm.) long, and ^ or |- (3 or 4 Mm.) or less in diameter, externally brown, rough from leaf-scars, internally whitish, with a rather thick bark containing a circle of resin-cells surrounding the short, yellowish wood-wedges, and a large, spongy pith. The roots are numerous, thin, fragile, grayish- brown, with a thick bark containing a circle of resin-cells. Odor somewhat aromatic ; taste pungently aromatic and bitter ; the con- stituents the same as those of the flowers. Dose. — 5-30 grains (0.3-2 Gm.). Official Preparations. BxtrSctum Arnicae R^dicis Flufdum — ExtrScti Arnicee RSdicis Fliiidi — Fluid Extract of Arnica Root. — Dose, 5-30 minims (0.3-2.0 Cc). ExtrSctum Arnicae Radicis — Extrilcti Arnicae RSdicis — Extract of Arnica Root. — Dose, 2-S grains (0.13-0.3 Gm.). ^ EmplSstrum Arnicae — EmplSstri Arnicae — Arnica Plaster (33 per cent, of extract). For external use. 588 A TEXT-BOOK OF MATERIA MEDIC A. Tinctura Arnicse RSdicis — Tincturse Arnicae RSdicis — Tincture of Arnica Root (lo per cent.). — Dose, 20-30 minims (1.3-2.0 Cc). Antagonists and Incompatibles and Synergists are the same as for Aconite. Physiological Action. — Externally and Locally. — The local action of both the root and flowers is irritant, that of the latter being the more powerful. Occasionally tinfcture of arnica flowers produces marked inflammation of the skin, resembling erysipelas. Internally. — The internal effects of arnica are as yet imperfectly understood, it being difficult to assign the drug to its proper group. Digestive System. — Small doses slightly stimulate the digestive apparatus. Large amounts produce nausea, vomiting, and diarrhea of a choleraic character. Circulatory System. — Small doses stimulate the heart and in- crease arterial pressure ; full or large doses retard the pulse and depress the circulation. Nervous System. — Large amounts cause headache, with great- depression of the nerve-centers. Toxic amounts occasion motor and sensory paralysis, coma, at times convulsions, collapse, and death. Respiratory System.- — The respiration is slowed, although under small doses there may be temporary acceleration. Absorption and Elimination. — The active principle of arnica dif- fuses readily into the blood, the drug being eliminated chiefly by the kidneys, though the skin shares in the excretory process. Tempera^ture. — Large doses cause a reduction of temperature. Untoward Action. — The topical appUcation of arnica may cause in susceptible persons violent cutaneous inflammation and the pro- duction of pustules, or even distinct bullae, attended with marked constitutional symptoms. When taken internally the drug occa- sions a sensation of burning in the mouth and throat, violent pain in the stomach, tenesmus, and choleraic diarrhea, intense headache, and dizziness. Poiso7iing. — In addition to the above-named symptoms there are great cardiac depression, decided muscular weakness, slow and shallow respiration, paralysis of the nervous system, and death resulting from collapse. Treatment of Poisoning. — The treatment should be much the same as that prescribed under Aconite. Atropine is probably the best physiological antidote. Therapeutics. — Externally and Locally. — Arnica enjoys a well- CARDIAC SEDATIVES. 589 deserved reputation as an efficient remedy for the relief of bruises, sprains, and external inflammations generally. It has been recom- mended also as a topical application in myalgic rheumatism. The local application of the tincture causes the rapid disappearance of ecchymoses. Equal parts of the tincture of arnica and glycerin, diluted with water, have been recommended as a stimulant in inflammation of the mucous membrane of the mouth. Internally. — Arnica is not a very popular remedy for internal administration. It has, however, been used with varying success in idiopathic mania, delirium tremens, and rheumatic gout. It has also been beneficially employed in exhausting diarrhea, chronic dys- entery, epistaxis, hemoptysis, and paralysis of the bladder. Contraindications. — Externally when there exists any acute skin disease ; internally in cases of inflammation of the gastro-in- testinal tract, fatty or valvular disease of the heart, and in all asthmatic conditions. Administration. — The tincture of arnica is the form generally preferred for external and internal use. In applying any prepara- tion externally the susceptibility to the irritating properties of the drug peculiar to certain persons should be remembered. Pota.ssii Nltras— Potassii Nitratis— Potassium Nitrate. V.8.P. (Nitre; Saltpetre.) Origin. — Purified from native Saltpetre. Description and Properties. — Colorless, six-sided, rhombic prisms, or a crystalline powder; odorless, and having a cooling, saline, and pungent taste. Permanent in the air. Soluble in 3.8 parts of water, very sparingly soluble in alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). Oflicial Preparations. ArgSnti Nitras Dilutus^Arg6nti Nitratis Diliiti — Diluted Silver Nitrate. — Used externally. Jb V ChSrta PotSssii Nitratis — Ch^Ss (ace.) PotSssii Nitratis — Potassium Nitrate Paper. — Intended for burning, the fumes to be inhaled. Antagonists and Incompatibles. — Cardiac and diffusible stim- ulants antagonize tlje action of potassium nitrate upon the heart. Mineral acids and metallic salts are incompatible. Synergists. — The cardiac depressants, diuretics, and agents increasing waste aid the action of potassium nitrate. 59Q A TEXT-BOOK OF MATERIA MEDIC A. Physiological Action. — Externally and Locally. — The drug has no important local action. Internally. — Digestive System. — Large doses occasion nausea and vomiting; poisonous doses produce violent gastro-intestinal inflammation and diarrhea, blood sometimes being vomited and passed with the stools. Circulatory System. — Small doses have no marked influence on the circulatory system ; full doses act as a cardiac depressant, slow- ing and weakening the pulse ; poisonous doses produce great weak- ness, syncope, and death from cardiac failure. Nervous System. — No special action is noticeable, although poi- sonous doses produce tremulousness, insensibility, and convulsions. Respiratory System. — Large doses retard respiration. Absorption and Elimination. — Potassium nitrate passes rapidly, . into the blood unchanged, and is eliminated by the kidneys un'%| changed. Small doses are actively diuretic, stimulating the renal cells. Large amounts, from too free stimulation, are apt to irri- ■ tate and inflame the kidneys, even so far as to produce hematuria. The drug is also eliminated to some extent by the skin, being therefore a rtiild diaphoretic. ^ Temperature. — Unaffected by medicinal amounts, but lowered" by poisonous doses. Poisoning. — There is violent gastro-intestinal inflammation, with vomiting and purging, blood being present in the ejecta and feces. Other symptoms are — subnormal temperature, coldness of the ex- tremities, a weak and thready pulse, slow and shallow respiration, tremulousness and great muscular weakness, dimness of vision or totaj|:blindness, deafness, insensibility, and possibly convulsions^ The urine is diminished or suppressed. Should the patient recover from an immoderate dose of the ,drug, he suffers for some time from dysuria, irritability of the stomach, colic, muscular weakness, and a sensation of chilliness in the back and limbs. Treatment of Poisoning. — Therrf^s no special antidote for nitre ; cases of poisoning, therefore, are to be treated symptomatically, measures for relief including evacuation of the stomach, de- mulcents, opiates for pain, and cardiac and respiratory stim- ulants. Therapeutics. — Externally and Locally. — Solutions of this drug have been found serviceable as applications to bruises and abrasions. The last stage of pharyngitis is greatly relieved by a gargle of a CARDIAC SEDATIVES. 59I SOLUTION OF POTASSIUM NITRATE, in the proportion of I drachm (4.0 Gm.) to I pint (473 Cc.) of water. It is claimed that a paste of powdered nitre and water appHed to the face night and morning is an effective method of removing freckles. The difficuhy of breathing in cases of spasmodic asthma may be greatly relieved by the inhalation of the fumes of burning NITRE- PAPER. Internally. — The drug was formerly much used in acute artic- ular rheumatism and as a refrigerant and sedative in inflammations, pneumonia, and various fevers. It is employed to a considerable extent as a diuretic and diaphoretic, although greatly inferior to the acetates and citrates. Administration. — It should be given in solution, though the powder is sometimes used in combination with calomel, tartar ■emetic, or Dover's powder. The potassium-nitrate paper, as has been stated, should be burned and the fumes arising therefrom inhaled. Sodii NTtras— Sodii Nitratis— Sodium Nitrate. TJ. S. P. Origin. — It is found in great quantities imbedded in clay and- sand in certain districts of Chili and Peru. Description and Properties. — Colorless, transparent, rhombo- hedral crystals, odorless, having a cooling, saline, and slightly bit- ter taste; deliquescent in moist air. Soluble in 1.3 parts of water and in about 100 parts of alcohol. Sodium nitrate should be kept in well-stoppered bottles. Dose. — J-i ounce (15.5-3 1. oGm.). Physiological Action. — The action of the salt resembles closely -^at of potassium nitrate, though it is much feebler than the latter difug, while possessing greater purgative properties. Therapeutics. — Externally and Locally. — A solution of the salt possesses some power as a solvent of false membranes, and has been used in the form of a spray to diminish fibrinous exudations in the pharynx and larynx. Internally. — It may be employed for the same purposes as the potassium nitrate, and has been advantageously adopted as a laxa- tive in, diarrhea and dysentery. Administration. — Sodium nitrate is best given dissolved in a large quantity of water. 592 A TEXT-BOOK OF MA TERIA MEDICA. GROUP X.— DIAPHORETICS. Diaphoretics — or sudorifics, as they are also called — are medi- cines which promote diaphoresis or sweating. Their action in stimulating transpiration by the skin may be enhanced by exer- cise, external warmth, nauseants, and drugs which dilate the vessels,, determining more blood to the cutaneous blood-vessels. Diaphoretics are employed principally for their evacuant, revul- sive, and alterative effects, and to promote absorption. Pilocarpus— Pilocarpi— Pilocarpus. JJ. S. P. (JABORANDI.) Origin. — The leaflets of Pilocarpus selloanus Engler (Rio Janeiro- Jaborandi) and oi Pilocarpus Jaborandi Holmes (Pernambuco Jabo- randi). Description and Properijies. — About 4 to 6 inches (10-15 Cm.), long and \ to 2\ inches (4-6 Cm.) broad, short-stalked, oval or ovate-oblong, entire and slightly revolute at the margin, obtuse and slightly emarginate, unequal at the base ; dull-green, coriace- ous, pellucid punctate, mostly smooth; when bruised, slightly aromatic; taste somewhat bitter and pungent. Pilocarpus contains a volatile oil and two alkaloids, pilocarpine- and jaborine, the latter being chemically isomeric with the former,, although directly antagonistic in physiological action. Dose. — 5-60 grains (0.3-4.0 Gm.). Official Preparation. ExtrSctutn Pilocarpi Pluidum — ExtrScti Pilocarpi Fluidi — Fluid Extract. of Pilocarpus. — Dose, 5-60 minims (0.3-4.0 Co.). Unofficial Preparation. Infusum Pilocarpi — Infusi Pilocarpi— Infusion of Pilocarpus.— Z)oj^ 2 fluid- drachms-4'fluidounces (8.0-118.3 Cc). PIlocarpTnae Hydrochloras— PilocarpTnae Hydro- cFiloratis- Pilocarpine Hydrochlorate. U.S. P. Origin. — The hydrochlorate of an alkaloid obtained from Pilo- carpus. Description and Properiiies. — Small, white crystals, odorless- and of a faintly bitter taste ; deliquescent on exposure to damp air.. DIAPHORETICS. 593 Very soluble in water and in alcohol. It should be kept in small, well-stoppered bottles. Dose. — -^x~k grain (0.001-0.03 Gm.). JABORINE is a yellow, amorphous alkaloid, isomeric with pilocarpine and closely resembling atropine in its physiological action. The varying effects which occasionally follow the use of the commercial pilocarpine are due to the presence of jaborine, which antagonizes the action of pilocarpine in almost every particular. It is highly important, therefore, when administering pilocarpine or any of its prep- arations to obtain the drugs free from jaborine, which is not used medicinally. Antagonists and Incompatibles. — Atropine is a perfect physi- ological antagonist to pilocarpine, being directly opposite in its action throughout its entire range, -3-^ grain (0.0006 Gm.) being sufficient to counteract \ grain (0.0 1 Gm.) of pilocarpine. Morphine relieves the nausea. The incompatibles are tannic acid, caustic alkalies, and the ferric and metallic salts. Synergists. — The cardiac depressants, particularly aconite and veratrum viride, gelsemium, sarsaparilla, spirit of nitrous ether, and drugs which paralyze the vaso-motor system, enhance the activity of pilocarpus. Physiological Action. — Externally and Locally. — There is no action of importance. Internally. — Digestive System. — The action of pilocarpine is here given, since the; alkaloid fully represents the drug. When pilocarpine is taken into the mouth, the ends of the chorda tympani and secretory nerves are stimulated, causing an increased secretion of saliva. Should large doses be taken, there is a feeling of tenderness in the mouth and severe salivation is produced. The gastric glands are stimulated by the drug, their normal secretion being augmented. By stimulating the unstriped muscle- fibers pilocarpine increases peristalsis, both of the stomach and the intestines, in large doses acting as a cathartic. Immoderate amounts may also induce vomiting. The bile and pancreatic juice are not affected by moderate amounts of the drug. Circulatory System. — At first the vaso-motor nervous system is depressed, resulting in an acceleration of the cardiac movements, with dilatation of the blood-vessels. The heart, however, is soon slowed and the arterial pressure lowered, so that pilocarpine is in reality a cardiac depressant rather than a cardiac stimulant. Pilocarpine acts directly upon the heart, either by stimulating 38 594 A TEXT-BOOK OF MATERIA MEDIC A. the terminations of the vagus or by depressing the motor centers in the heart-muscle or the muscle itself. Nervous System. — In medicinal amounts pilocarpine has no per- ceptible action on the central nervous system, although stimulating the nerve-terminations of involuntary muscles — i. e. those of the stomach, intestines, heart, spleen, bladder, uterus, etc. Poisonous doses have produced (in the frog) tetanic convulsions, followed by paralysis, the result of depression of the muscles and spinal centers, the nerves apparently being unaffected. Respiratory System. — ^The respiratory movements are unaffected by medicinal amounts, but the bronchial secretion is augmented. Absorption and Elimination. — Pilocarpine is rapidly absorbed, and is eliminated principally by the skin, occasioning free, and under large doses excessive, diaphoresis. The sweat is at first alkaline, then neutral, and finally alkaline in reaction. The diaphoresis produced by pilocarpine is due to stimu- lation of the secretory nerves supplying the glands. The kidneys, under small doses, are stimulated, there being a slight increase in the urine, while in disease the amount of urea is considerably augmented. The drug is also eliminated by the salivary glands, there being frequently an enormous increase in the salivary secretion. Under the influence of pilocarpine there is an increase in the gastric, bronchial, and lacrymal secretions, even the secretion of milk being notably augmented. Temperature. — Succeeding a very brief and slight elevation of temperature there is a decided diminution of bodily heat, resulting from the dilatation of cutaneous blood-vessels and the evaporation of the perspiration. Eye. — Whether applied locally to the eye or taken internally, pilocarpine produces marked contraction of the pupil by stimulating the peripheral endings of the iridal nerves. The drug also pro- duces an increased tension of the eyeball. Uterus. — There is authority for the statement that pilocarpine stimulates the gravid uterus, inducing uterine contractions or in- creasing the energy of those already established. The effect of the drug upon the uterus, however, is more pro- nounced and apparent in cases of eclampsia, seeming to prove the fallacy of the statement that pilocarpine is a true ecbolic. Untoward Action. — Nausea and vomiting are of quite frequent occurrence, the vomiting being preceded by long and distressing DIAPHORETICS. 595 nausea. Occasionally the patient complains of severe pain in the urethra and in the lumbar region, with frequent desire to micturate. There have often been present headache, vertigo, hiccough, dimness of vision, gastric and abdominal pains, stupor, and chilli- ness. There may occur even collapse. Poisoning. — The symptoms produced by poisonous doses of pilocarpine are exaggerations of those described above, together with diarrhea, exhausting and excessive sweating and salivation, marked cardiac and respiratory depression, and collapse. Treatment of Poisoning. — If the drug has been ingested, the stom- ach should be immediately cleansed with a solution of tannic acid. To counteract the untoward effects of pilocarpine, whether the drug has been ingested or given by subcutaneous injection, atro- pine is undoubtedly the most complete physiological antagonist, and should be given hypodermically. Morphine is indicated to control the nausea^ and vomiting, while some of the cardiac stimu- lants may be required to counteract cardiac depression. Therapeutics. — Externally and Locally. — Pilocarpine, or the FLUID EXTRACT OF JABORANDI, has been highly recommended for alopecia. By the use of pilocarpine the hair becomes darker. The FLUID EXTRACT OF PILOCARPUS has been employed as a local appli- cation in erysipelas and eczema. Lozenges containing -^ grain (o.ooi Gm.) of pilocarpine are efficient in relieving dryness of the throat. As a myotic pilocarpine is used in many diseases of the eye. Internally. — The principal internal use of pilocarpine is as a diaphoretic in Brighfs disease. In cardiac dropsy it is not a safe remedy, because of its depressing influence upon the heart. The drug is very efficient in removing pleuritic effusion, while in uremic poisoning it is unquestionably the most valuable remedy we possess. The hypodermic injection of small doses of pilocarpine has been highly recommended as an efficient remedy in erysipelas, particularly during the first stages of the disease. The drug has been successfully used to abort malarial paroxysm, and has proved beneficial in tobacco and alcoholic amblyopia. Pilocarpine has been found useful in humid asthma, bronchor- rhea, and hiccough, and, in small doses, in arresting the sweating of phthisis and for the relief of ptyalism. The drug is an efficient galactogogue, and has been used with success in mumps, chronic en- largement of the cervical glands, and adenitis of the inguinal glands. 596 A TEXT-BOOK OF MATERIA MEDIC A. Pilocarpine materially lessens the flow of urine in diabetes in- sipidus, and in many diseases of the eye and ear the internal use of the drug serves a useful purpose. The property possessed by pilocarpine of stimulating the glands of the skin renders this remedy of great service in many chronic diseases of the skin characterized by a dry, scaly condition. It is a peculiarly valuable agent in phthiriasis, psoriasis, certain forms of eczema, pruritus senilis, etc. Pilocarpine or fluid extract of jABORANDi may be useful in breaking up a cold. Finally, pilocarpine has been highly recommended in catarrhal jaundice, and is one of the most efficient antidotes to belladonna- poisoning. Contraindications. — The drug should never be employed when the heart is weak from thinning and atrophy of its walls or from fatty degeneration, nor where there is a tendency to pulmonary conges- tion and edema. The drug is also contraindicated in asthenic fevers, such as typhoid fever, etc. Administration. — Pilocarpine is superior to the crude drug, being far more reliable in its action and less liable to produce nausea and vomiting. Pilocarpine is usually given hypodermically, although it is frequently administered by the mouth, in solution, or in troches. Of all the preparations of the crude drug, the fluid extract and infusion are commonly employed, the latter being less apt to cause profuse salivation. An elixir of pilocarpus is prescribed consider- ably. Should preparations of jaborandi be given upon an empty stomach, they are less apt to occasion nausea. This inconvenience may be also avoided by giving an infusion by enema. Liquor Ammonii Acetatis— Liquoris Ammonii Ace- tatis— Solution of Ammonium Acetate. V. S. P. (Spirit of Mindererus.) Origin. — An aqueous solution of Ammonium Acetate, contain- ing about 7 per cent, of the salt, together with small amounts of Acetic and Carbonic Acids. .Description and Properties. — A clear, colorless liquid free from empyreuma, of a mildly saline, acidulous taste and an acid reaction. This preparation when required should be freshly made. Dose. — |-i fluidounce (i 5.0-30.0 Cc), in sweetened water. DIAPHORETICS. 597 Official Preparation. Liquor F6rri et Amtnonii Acetatis — Liquoris FSrri et Ammonii Acetatis — Solution of Iron and Ammonium Acetate (Basham's Mixture). — Described under " Preparations of Iron." Antagonists and Incompatibles. — The metallic sulphates, the salts of lead and silver, lime water, the carbonates of potassium and sodium, and acids are incompatible. Synergists. — Spirit of nitrous ether, potassium citrate, and many of the refrigerants and diaphoretics. Physiological Action and Therapeutics. — Solution of am- monium acetate is both a mild diaphoretic and diuretic, according as the action is governed by other more powerful agents. For instance, if the skin is warm and the cutaneous blood-vessels dilated, the preparation acts as a diaphoretic, while if the condition of the skin is the reverse, the action of the drug is directed to the kidneys. Should the preparation be given with aconite or spirit of nitrous ether, its action would be that of a diaphoretic, but if the drug were associated with digitalis or squill, it would act as a diuretic. In any case the action of the drug is due to a stimulation of the secretory cells or nerves. The principal medical use of solution of ammonium acetate is as a diaphoretic in febrile conditions, such as acute coryza, influenza, acute pharyngitis, etc. It is a very efficient remedy in muscular rheumatism, and in the eruptive fevers when the eruption is re- tarded. It is frequently associated with other remedies in the treatment of scarlatinous dropsy. Owing to its property of stimulating the heart and circulation,, the remedy has been recommended in low forms of fever, in the belief that it helps to sustain the powers of life, in lowering the pulse and temperature, moistening the tongue, and quieting the deHrium. In migraine and in alcoholic intoxication few remedies are so successful, the drug frequently dissipating the effects of acute alcoholism at once. The remedy has been found efficacious in dysmenorrhea and menorrhagia, and has been employed externally and locally as a discutient in mammary engorgements, glandular swellings, contu- sions, incipient abscesses, etc. Administration. — The preparation, as has been said, should be freshly made when wanted, and should be administered well diluted with sweetened water. 598 A TEXT-BOOK OF MA TERIA MEDICA. SpTritus y^theris Nitrosi— SpTritus ,<^theris Nitrosi —Spirit of Nitrous Ether. TJ. S. I*. (Sweet Spirit of Nitre.) Origin. — An alcoholic solution of Ethyl Nitrite, yielding, when freshly prepared and tested in a nitrometer, not less than eleven times its own volume of nitrogen dioxide. Description and Properties. — A clear, mobile, volatile, and inflammable liquid, of a pale-yellowish or faintly greenish-yellow tint, having a fragrant, ethereal, and pungent odor free from acridity, and a sharp, burning taste. It should be kept in dark amber-col- ored, well-stoppered bottles, remote from lights and fire. Dose. — 1-2 fluidrachms (2.0-8.0 Cc). Antagonists and Incompatibles. — The incompatibles are po- tassium iodide, ferric sulphate, antipyrine, mucilage of acacia, tinc- ture of guaiacum, and gallic and tannic acids. Synergists. — Diaphoretics, diuretics, antispasmodics, tincture of aconite, potassium citrate, etc. Physiological Action and Therapeutics. — When applied to the skin and allowed to evaporate spirit of nitrous ether produces a slight anesthetic effect. Internally, its action is very similar to that of the ammonium acetate. It dilates the blood-vessels more than the latter preparation, besides being more of a diffusible stim- ulant, stomachic, and carminative. Like the solution of ammonium acetate, spirit of nitrous ether acts either as a diaphoretic or diuretic, the effect depending upon the manner in which it is administered. For its diuretic action it should be given in ice-water and the patient kept cool ; to produce diaphoresis its administration should be accompanied by warm drinks and the patient be well covered. Spirit of nitrous ether is used for about the same purposes as the solution of ammonium acetate, being particularly serviceable in febrile affections to promote critical sweating, employed either alone or in combination with tincture of aconite. It is frequently given as a diuretic in Brigkt's disease, congestion of the kidneys, and pain- ful affections of the urinary apparatus. It is a serviceable remedy to relieve flatulent distention of the stomach, to allay nausea, and to quiet nervous agitation. As an antispasmodic the remedy is frequently employed to relieve the pain of dysmenorrhea, and it may be inhaled for the relief of cough- ing. It enters into many expectorant mixtures, and is a soothing application to the forehead in neuralgic headache. EMETICS. 599 Administration. — The dose and manner of administering spirit of nitrous ether depend upon the action desired. As an anti- pyretic in febrile affections it should be given in doses of 20-30 minims (1.30—2.0 Cc), in sweetened water, every half hour. To produce diuresis the drug should be associated with some other diuretic and given in larger doses, J-i fluidrachm (2.0-4.0 Cc), every three or four hours. If the remedy is desired for its diapho- retic action, it should be given in hot water, in doses of 20 or 30 minims (i. 30-2.0 Cc), repeated every half hour, the patient being well covered. Should the drug be given as a nervous stimulant, the dose should not be less than i fluidrachm (4.0 Cc). Care should be exercised in the selection of spirit of nitrous ether that it be reliable and of full strength. If the preparation has been kept in large bottles exposed to light and air, the drug will be more or less inert and should not be prescribed. GROUP XL— EMETICS. Emetics are agents which produce vomiting or emesis. Vomiting is the result of the following actions : i. The relaxa- tion of the cardia ; 2. The contraction of the pylorus ; 3. The con- traction of the gastric muscles ; 4. The contraction of the dia- phragm; 5. The contraction of the abdominal muscles. The effect of these coordinate acts is to compress the stomach, expelling its contents through the relaxed cardia. The nervous mechanism involved in the act of vomiting is under the control of the medulla. The vomiting center may be stimulated in various ways — reflexly, through the sense of sight or taste, the stomach, peritoneum, biliary passages, kidneys, heart, or lungs, or by irritation of the pharynx or esophagus. The dia- gram (Fig. 14) serves to explain the mechanism of emesis. This is the nervous mechanism directly involved in the act of vomiting, regardless of the cause of the emesis. The vomiting center and a portion of the respiratory center intimately connected with it act simultaneously, either by way of the stomach or reflexly through other parts of the body — as is illustrated in certain' injuries or diseases — or by direct stimulation of the center by some sub- stance carried to it in the blood. 6oo A TEXT-BOOK OF MA TERIA MEDICA. Fig. 14. — ^^,.(4, abdominal walls ; .5, respiratory muscle : r, respiratory center; 2, vomiting center ; 3, stomach; 4, afferent nerve passing from mucous membrane in stomach to vomiting center in me- dulla ; 5, efferent nerve passing from vomiting center to muscular fiber of cardia, relaxing it ; 6, efferent nerve passing from medulla to pylorus, contracting it ; 7, efferent nerve, influencing gastric muscles to contract ; 8, efferent nerve, causing contraction of diaphragm ; 9, efferent nerve, causing abdominal muscles to contract. The Local or Gastric Emetics' are — * Alum ; * Yellow Mercuric Sulphate ; * Copper Sulphate ; * Sodium Chloride ; * Zinc Sulphate ; * Ammonium Carbonate ; * Mustard. (The drugs marked with an asterisk (*) are considered elsewhere in the present work.) The Direct or Systemic Emetics are — Apomorphine Hydrochlorate ; Antimony and Potassium Tartrate ; Ipecacuanha ; Lobelia. Local or gastric emetics are the more rapid in their action, producing emesis in from two to five minutes. The systemic emetics must be absorbed and pass to the medulla before they produce vomiting, consequently requiring more time to exert their ' Some authors reverse the nomenclature, considering those drags which act only on the stomach " direct," and those affecting the medulla " indirect." EMETICS. 6oi influence. Moreover, the action of the latter class of emetics is of much longer duration and followed by greater depression of the muscular and circulatory systems, together with greater consti- tutional disturbance. Some emetics act both locally and centrally. Tartar emetic and ipecacuanha affect the stomach locally, but, since their action is chiefly upon the vomiting center through the circulation, they are classed as systemic emetics. Zinc sulphate and copper sul- phate, on the other hand, while to a slight extent acting on the medulla, are classed as local emetics, because their principal action is upon the mucous membrane of the stomach. Within a few minutes after an emetic has been ingested there is a feeling of nausea and distress, with decided muscular relaxation. The circulatory system is depressed ; the pulse is small and irregu- lar, and a sensation of faintness ensues. The flow of saliva is increased, and vomiting soon follows. During emesis the arterial tension is raised, the face is flushed, and there is an increase in bodily heat. When vomiting has subsided there is a reduction of temperature, with cardiac and muscular weakness, the skin being bathed in perspiration. Occasionally fatal syncope has followed the use of emetics. Antagonists. — Drugs known as Anti-emetics are used to allay nausea and check vomiting. Like emetics, these agents are divided into Local Anti-emetics or Gastric Sedatives and Direct or Sys- temic Anti-emetics, according to their action. Among the most important Anti-emetics are the following : Local Anti-emetics or Gastric Sedatives. (AH save Ice are treated elsewhere in the present work.) Alcohol (especially champagne) ; Ether ; Arsenic (small doses) ; Ipecac (small doses) ; Belladonna; Ice; Bismuth subnitrate and subcar- Opium ; bonate ; Hydrocyanic acid ; Carbolic acid ; Menthol ; Cerium oxalate ; Potassium nitrate ; Chloroform ; Silver nitrate ; Cocaine ; Sulphocarbolates ; Creasote ; Tincture of iodine (small doses). Calomel (small doses) ; 6o3 A TEXT-BOOK OF MATERIA MEDICA. Direct or Systemic Anti-emetics or Gastric Sedatives. Alcohol ; Chloral ; Ammonium; Hydrocyanic acid; Amyl nitrite ; Nitroglycerin ; Bromides ; Opium. It will be observed that some drugs are both local and direct Anti-emetics. There are certain measures which may be adopted to allay nausea and relieve vomiting, such as a recumbent posture and injection of large quantities of aerated water into the rectum. 'Synergists. — The emetics are of course mutually synergistic. Emetics are adjuncts to antiperiodics and expectorants, although the latter do not particularly enhance the action of the former. Emetics are used — 1. To empty the stomach in cases where the presence of undi- gested food occasions pain, headache, etc., or to expel some poi- sonous substance from the stomach. For this purpose the local emetics are preferable. In cases of poisoning the local emetics are the more reliable. 2. To remove foreign bodies from the esophagtis. For this pur- pose the direct or systemic emetics should be used. 3. To remove foreign bodies from the larynx, as in cases of membranous croup, laryngeal diphtheria, etc., the 'effort of vomit- ing being sometimes sufficient to dislodge and remove the mem- brane or other foreign substance. 4. To remove the bronchial secretion in cases of bronchitis and catarrhal pneumonia. In these cases the direct emetics should be employed, preferably ipecacuanha or apomorphine, because they possess more expectorant properties. 5. To empty the gall-bladder in cases of biliousness or malaria, or where small gall-stones are present in the gall-duct, the com- pression of the liver between the diaphragm and the abdominal muscles expelling the bile from the liver into the duodenum and forcing the gall-stones through the duct. 6. To relax spasm of the pharyngeal muscles in cases of spas- modic laryngitis. For this purpose the systemic emetics are pref- erable. Contraindications. — Emetics should not be given to persons suffering from aneurysm, hernia, peritonitis, prolapse of the uterus or rectum, atheroma, or where there is very high arterial tension, a EMETICS. 603 tendency to hemorrhage from the lungs or uterus, or a tendency to abortion. The emetic drugs which have not been elsewhere discussed in the present work are here given in detail: Apomorphmse Hydrochloras— Apomorphinae Hy- drochloratis — Apomorphine Hydrochlorate. V. 8. J*. Origin. — The hydrochlorate of an artificial alkaloid prepared from Morphine or Codeine. Description and Properties. — Minute, grayish-white, shining, acicular crystals, without odor, having a faintly bitter taste, and acquiring a greenish tint upon exposure to light and air. Soluble in about 45 parts of water and about 45 parts of, alcohol. It should be kept in small, dark, amber-colored vials. If the prepa- ration imparts to 100 parts of water when slightly shaken an emerald-green color, the drug should be rejected. Dose. — io - io grain (0.003-0.006 Gm.) by the mouth ; ■^■g-^ grain (0.0025-0.01 Gm.) hypodermically. Physiological Action. — Externally and Locally. — None. Internally. — Digestive System. — From five to twenty minutes after ingestion — according to the dose and the manner of adminis- tration — vomiting ensues, being repeated three or four times at intervals of about fifteen minutes. The emesis is preceded and attended by a slight nausea, with but moderate depression. Apo- morphine is a typical direct or systemic emetic, its entire action being exerted upon the vomiting center in the medulla. It is per- haps the most powerful and certain emetic we possess. Circulatory System. — Small doses have no perceptible effect upon the circulation. Full doses increase the rapidity and force of the heart's action and raise arterial pressure, owing to stimulation of the accelerator nerves and vaso-motor center. Large or toxic arnounts depress the circulatory system or paralyze the cardiac muscle. Nervous System. — Full doses stimulate the brain and may even occasion delirium. Poisonous amounts produce convulsions, prob- ably of spinal origin, succeeded by paralysis of the motor and sen- sory nerves, and consequently of the muscles. Respiratory System. — Small amounts do not affect the respira- tory movements, although the secretion from the bronchial mucous membrane is increased. Full doses accelerate and deepen respira- tion, while toxic amounts cause depression. 6o4 A TEXT-BOOK OF MA TERIA MEDIC A. Absorption and Elimination. — Apomorphine is readily absorbed, and is excreted through the gastro-intestinal tract, as well as by the broncho-pulmonary mucous membrane, the kidneys, and the skin. Temperature is unaffected by small doses, but may be lowered by large amounts. Poisoning. — The symptoms would be violent vomiting, delirium or convulsions, and marked cardiac and respiratory depression, death resulting from asphyxia; Treatment of Poisoning. — The systemic gastric sedatives and cardiac stimulants. Therapeutics. — Apomorphine is the most reliable emetic to use when prompt emesis is necessary or in cases where swallowing is difficult or impossible. It is extremely useful as an emetic in cases of poisoning, though it frequently happens in narcotic poisoning that the vagus center is so blunted by the poison that apomorphine fails to act. Should it be necessary to provoke emesis when the stomach is in a state of acute inflammation, apomorphine is preferable to any other emetic. Given by the mouth in small doses — from ^ grain (o.ooi Gm.) to ^ grain (0.003 Gm.) every three or four hours — this drug is an exceedingly efficient remedy in acute bronchitis. It is equally beneficial in relieving the dry, hacking cough of chronic bronchitis, chronic catarrhal pneuinonia, and tuberculosis. Contraindications. — The same as for emetics generally. Administration. — Apomorphine when given as an emetic should invariably be administered hypodermically, and the solu- tion be always freshly prepared. When the drug is used as an expectorant it should be given by the mouth. Great care should be taken in administering the drug to children, as they bear the remedy very badly. Antimonii et Potassii Tartras— Antimonii et Potas- sii Tartratis— Antimony and Potassium Tartrate. V. S. JP. (Tartar Emetic; Tartrated Antimony.) Origin. — Antimony Trioxide is mixed with Acid Potassium Tartrate and Water to the consistence of a paste, allowed to stand for twenty-four hours, boiled in water, and crystallized. Description and Properties. — Colorless, transparent crystals of the rhombic system, becoming opaque and white on exposure EMETICS. 605 to air, or a white, granular powder, without odor and having a sweet, afterward disagreeable, metallic taste. Soluble in 17 parts of water and in 3 parts of boiling water, but insoluble in alcohol, which precipitates it from its aqueous solution in the form of a crystalline powder. Dose. — As an emetic, 1-2 grains (0.06-0.12 Gm.) ; as a cardiac depressant, \-\ grain (0.03-O.06 Gm.); as a diaphoretic and expectorant, -gV^ grain (0.003-0.01 Gm.). Official Preparations. Syrupus Scillae CompSsitus — Syrupi Scillse Comp6siti — Compound Syrup of Squills (Hive Syrup). — Formula: Fluid Extract of Squill, 80; Fluid Extract of Senega, 80; Antimony and Potassium Tartrate, 2; Sugar, 750; Precipitated Calcium Phosphate, 10; Water, to 1000. Dose. — 5-60 minims (0.3-4.0 Cc). Vinum Antimonii — Vini Antimonii — Wine of Antimony. — Formula : Anti- mony and Potassium Tartrate, 4 ; Boiling Distilled Water, 65; Alcohol, 150; White Wine, to 1000. Dose. — 5-60 minims (0.3-4.0 Cc). Antagonists and Incompatibles. — Opium, alcohol, and the cardiac stimulants and antispasmodics generally are antagonistic. Tannic and gallic acids and the lead salts are incompatible. Synergists. — Emetics, cathartics, and cardiac depressants pro- mote the action of tartar emetic. Physiological Action. — Externally and Locally. — Tartar emetic is a powerful irritant when applied to the skin, producing a fol- licular inflammation followed by a papular eruption, becoming vesicular, and later forming pustules with a central umbilication, desiccation finally occurring, the pustules closely resembling those of small-pox. Internally. — Digestive System. — ^Upon the mucous membrane of the gastro-intestinal tract, as upon the skin, antimony and potas- sium tartrate acts as a powerful irritant. Small doses, occasioning only a sensation of warmth in the stomach, soon produce an in- creased secretion of saliva and gastric juice, as well as of secretions from the intestines, liver, and pancreas, more or less nausea fre- quently accompanying these symptoms. A little larger dosage excites vomiting, due at first to the irri- tating action of the drug upon the mucous membrane and nerves of the stomach, and, as soon as the drug is absorbed, affecting directly the vomiting center in the medulla. Full or large doses irritate the intestines, producing diarrhea, the discharges, if the dose 6o6 A TEXT-BOOK OF MA TERIA MEDICA. has been excessive, strikingly resembling those of cholera. Ac- companying the foregoing symptoms are severe cramps and epigastric pain. Circulatory System. — Tartar emetic is a powerful cardiac de- pressant, even in small doses slowing and weakening the heart's action, and simultaneously lowering arterial pressure by direct de- pression of the heart-muscle and of the vaso-motor mechanism in the walls of the blood-vessels. Poisonous doses of the drug profoundly depress the heart, which is finally arrested in diastole. Nervous System. — Antimony and potassium tartrate in small doses and under certain conditions exerts a sedative influence upon the brain. Indeed, its action is that of a depressant to the entire nervous system, particularly the spinal cord, small doses depressing' the sensory side, while poisonous doses paralyze both the motor and sensory centers of the cord. Under the administration of antimony, therefore, reflex excita- bility is diminished and the muscular system is depressed, the drug acting as an antispasmodic, probably by its influence both upon the muscles and the nervous system. Respiratory System. — Very small doses have no effect upon the respiratory movements, but increase the secretions from the bronchial mucous membrane. Full doses depress the respiratory movements, shortening the inspiration, but prolonging expiration. Toxic doses render the breathing extremely irregular and greatly lengthen the pause between inspiration and expiration, while there is an enormous increase in the bronchial secretion. The action of tartar emetic upon the respiratory system is very complex. The explanation as given by Hare is : " Primarily the respiratory center in the medulla is depressed, and the governing nerves of breathing, the pneumogastrics, are also rendered inactive ; secondarily, the cardiac failure readily causes pulmonary conges- tion ; and, thirdly, the drug causes such an outpouring of liquid and mucus into the bronchial tubes that the patient is drowned in his own secretion, which he is too weak to expel." Absorption and Elimination. — Tartar emetic rapidly enters the blood, and is eliminated by many channels, principally by the bowels, but also by the bile, milk, sweat, and urine. The drug is an active diaphoretic, expectorant, and cholagogue. Temperature. — Small doses do not affect temperature percep- tibly ; large doses lower bodily heat, chiefly by depressing the EMETICS. 607 circulation, although the drug may possibly influence the heat- center to some extent, lessening heat-production. Untoward Action. — The untoward manifestations produced by medicinal amounts of tartar emetic in individuals having a marked susceptibility to the drug do not differ essentially from the symp- toms of poisoning next described. Poisoning. — Tartar emetic produces all the symptoms of an irritant poison — severe burning sensation in the esophagus and stomach and violent and repeated vomiting, the ejecta, in addition to undigested food, containing mucus, bile, and frequently blood. These symptoms are attended with severe colicky pains in the abdomen and serous purging, the discharges resembling those of cholera, the analogy with the latter disease being rendered the more striking by the presence of cramps in the extremities — a cha- racteristic feature of poisoning by tartar emetic. Together with these gastro-intestinal symptoms there is extreme prostration, accompanied by an irregular, weak, almost impercep- tible pulse, great muscular relaxation, depressed respiration, pinched and livid countenance, cold, clammy skin, reduction of tempera- ture, and scanty and bloody urine. Death may be preceded by stupor, wild delirium, or convulsions. Treatment of Poisoning. — If the poison has not been entirely ejected in the act of vomiting, the stomach should be immediately washed out with a solution of tannic acid, after which strong coffee should be administered, together with demulcent drinks, anodynes, and respiratory and cardiac stimulants should they be necessary. ■ Therapeutics. — Externally and Locally. — Tartar emetic was formerly used as a rubefacient, being still so employed to some extent. The tendency of the drug, however, to produce extensive papular eruption and destruction of tissue renders its external use unsafe. Hebra considers that the external use of tartar emetic is a "useless, injurious procedure, and occasionally even dangerous to life." S. Hartwell Chapman has recommended the use of a lozenge containing 2^5- grain (0.0003 Gm.) of tartar emetic and ^-^ grain (0.00 1 Gm.) of codeine in acute inflammation of the throat when accompanied with fever. Internally. — The medical uses of tartar emetic are constantly becoming more restricted. Because of its slow and depressing action the employment of the drug as an emetic has been prac- tically abandoned. It is still used as a sedative antiphlogistic in 6o8 A TEXT-BOOK OF MA TERIA MEDICA. various acute inflammations. It is beneficial in the early stages of acute laryngitis and bronchitis, but its administration should be dis- continued after a free secretion of bronchial mucus is established. The remedy is occasionally given for its diaphoretic influence in VA.x\o\!iS fevers, and has even been recommended as a cholagogue. The COMPOUND SYRUP OF SQUILLS is a useful expectorant, being a popular and efficient remedy for croup. Administration. — As an emetic the action of the drug is facili- tated and enhanced by associating it with ipecacuanha, the reme- dies together being given in powdered form. As a diaphoretic and expectorant small doses of the wine of antimony are preferable, repeated every two or three hours. Ipecacuanha— Ipecacuanhae— Ipecac. TJ. S. I*. Origin. — The root of Cephiielis Ipecacuanha (Brotero) A. Rich- ard, a plant indigenous in the damp forests of Brazil, New Granada, and the northeastern portion of Bolivia. It is cultivated to some extent in India and Sikkim. According to the National Dispensatory, " The drug first be- came known in Europe in 1672, and a few years after was success- fully employed by Helvetius, a Dutch physician living in Paris, from whom (1688) Louis XIV. purchased the secret for 1000 louis. d'or and made it public." Description and Properties. — The older roots are in pieces of 2 to 6 inches (5-15 Cm.) in length and about \ inch (4 Mm.) thick,, mostly simple, contorted, dull grayish-brown or blackish, finely wrinkled, closely and irregularly annulated and often transversely fissured ; bark thick, brittle, brownish, easily separated from the thin, whitish, tough, Hgneous portion ; odor slight, peculiar, nau- seous; taste bitterish, acrid, nauseating. When ipecac is sound and free from mouldiness its quality is proportionate to the thick- ness of the bark and the thinness of the Hgneous portion. The active principle of ipecac is emetine, of which there is present I to 2 per cent. The drug also contains ipecacuanhic or cephaelic acid, starch, resin, etc. Dose. — As an emetic, 15-30 grains (i. 0-2.0 Gm.); as an expec- torant, \-2 grains (0.03-0.12 Gm.). Official Preparations. Bxtractum Ipecacuanhae Fluidum— ExtrScti IpecacuSnhse Fluidi — Fluid Extract of Ipecacuanha. — Dose, as an emetic, 15-30 minims (0.2-0.5 Cc); as an expectorant, ^5 minims (0.03-0.3 Cc). EMETICS. 609 Pillvis IpecacuSnhse et Opii — Ptilveris IpecacuSnhx et Opii — Powder of Ipecac and Opium. (See Opium, p. 428.) Syrupus IpecacuSnhse — Sj^rupi IpecacuSnhse — Syrup of Ipecac. — Formula : Fluid Extract of Ipecac, 75; Acetic Acid, 10; Glycerin, 100 ; Sugar, 700; Water, to 1000. — Dose, as an emetic, 2-6 fluidrachms (7.39-22.50 Cc.) ; as an expectorant, 5-30 minims (0.3-2.0 Cc). Tinctura Ipecacuanhas et Opii — Tinctiirae IpecacuSnhse et Opii — Tincture of Ipecac and Opium. (See Opium, p. 428.) Trochlsci IpecacuSnhse — Trochiscos (ace.) IpecacuSnhae — Troches of Ipe- cac. — Composition : Each troche contains about \ grain (0.02 Gm.) of Ipecac, together with Tragacanth, Sugar, and Oil of Orange. Dose. — I to 6 troches. Trochlsci Morphinae et IpecacuSnhse — Trochiscos (ace.) Morphinae et Ipe- cacuSnhse. (See Morphine, p. 429.) Vinum IpecacuSnhse — Vini IpecacuSnhse — Wine of Ipecac (10 per cent.). — Dose, 1-60 minims (0.06-4.0 Cc). Antagronists and Incompatibles. — The gastric sedatives and narcotics generally hinder the emetic properties of ipecac. The in- compatibles are tannic acid and vegetable infusions containing it, metallic salts, and caustic alkalies. Sjmergists. — The emetics, sedative expectorants, warm drinks, are synergistic, and opium aids the diaphoretic properties of the drug. Physiological Action. — Externally and Locally. — Ipecac is a powerful irritant to the mucous membranes of the respiratory tract when the powdered drug is inhaled. The prolonged application of ipecac to the skin occasions much irritation, even producing vesication, pustulation, and ulceration. Ipecac also possesses some antiseptic properties. Internally. — Digestive System. — In small doses ipecac acts as a stimulant to the stomach. The salivary and gastric glands are stimulated, the action of very small doses of the drug resembling that of vegetable bitters. Large doses are powerfully irritant and emetic, the emesis being the result of both a local irritation upon the stomach and a direct action upon the vomiting center in the medulla. The vomiting is preceded by and attended with but little if any nausea, although there is usually a marked increase in the secretion of bile and intes- tinal mucus, full doses of the drug acting not only as an emetic, but as a purgative and cholagogue. Circulatory System. — Except in occasioning the ordinary depres- sion incident to the act of vomiting, ipecac in moderate a:mounts , has no influence upon the heart. Enormous doses, however, par- 39 6lO A TEXT-BOOK OF MATERIA MEDICA. ticularly if injected into the jugular vein, have destroyed the ufe of dogs by cardiac paralysis. Nervous System. — Save in stimulating that portion of the me- dulla oblongata which presides over the act of vomiting, and a slight diminution of the reflex activity of the spinal cord, ipecac has no important action upon the nervous system. Respiratory System. — So far as the respiratory movements are concerned, they are unaffected by moderate doses of ipecac. The bronchial mucous membrane is stimulated, augmenting the se- cretion of bronchial mucus, and therefore reflexly stimulating coughing. Absorption and Elimination. — The active principle of ipecac is rapidly absorbed, being eliminated chiefly by the gastro-intestinal mucous membrane, although the other secretions share in the excretory process, the skin being especially affected by this drug, which acts as a mild diaphoretic. Temperature . — Under medicinal doses the temperature is un- changed. Poisonous doses reduce temperature. Untoward Action. — Rarely, in persons peculiarly susceptible to the drug, intense cutaneous irritation and conjunctival inflammation, accompanied by neuralgia of the face and scalp, have been produced. Even soiling the hand with a few drops of the tincture of ipecac has occasioned unfavorable results. The general untoward symptoms are those of poisoning. Poisoning. — There is violent vomiting and purging, the ejecta containing bile and frequently blood. Among the graver symp- toms are abdominal pain, marked cardiac depression, muscular weakness, and greatly diminished reflex irritability. The skin is cold and bathed in perspiration. Treatment of Poisoning. — Tannic acid should be given as the chemical antidote. Opium, belladonna, and cardiac stimulants may be necessary. Therapeutics. — Externally and Locally. — Troches of ipecac and spray inhalations of wine of ipecac are used to allay the cough and expectoration in acute bronchitis and obstinate " winter cough!' Powdered ipecac has been successfully employed as a dressing in anthrax, the drug being capable of destroying the anthrax bacilli, although having no effect on the spores. Internally. — Ipecac in proper doses is a very efficient emetic, and is frequently employed as such, particularly when it is desir- able through the act of vomiting to empty the air-passages, as in EMETICS. 6 11 croup, bronchitis, tracheitis, and the early stages of diphtheria. The action of the drug is so tardy, however, that it is not the most de- sirable emetic to use when it is necessary to empty the stomach quickly, as in cases of poisoning. When the stomach contains a quantity of undigested food, causing pain, headache, etc., ipecac is a valuable emetic to empty the stomach, since the drug occasions no marked nausea or de- pression. Paradoxical as it may seem, minute doses of ipecac, such as i to 4 minims (0.06-0.2 Cc.) of the wine or -j^jj- to J grain (0.006-0.01 Gm,) of the powdered drug, act as an efficient gastric sedative and stomachic, frequently arresting vomiting when other drugs have failed. The statement, however, that minim doses of the wine of ipecac allay the nausea and vomiting of pregnancy is probably apocryphal. Ipecac in small doses is an excellent adjuvant to other chola- gogues to relieve the distress of hepatic dyspepsia. The drug is equally advantageous in atonic dyspepsia, attended with flatulence, depression of spirits, etc. The notoriety and pecuniary profit which Helvetius secured in connection with ipecac — or Radix antidysenterica, as it was origi- nally named by its propagator — were due to its apparent specific action in dysentery. The drug is peculiarly efficient in dysentery of a bilious type, acute dysentery other than bilious yielding less readily to the rem- edy. It is true that in these last-named cases ipecac and opium have been advantageously employed, though it is probable that the opium had the larger influence in modifying the course of the dis- ease. Whatever the form of dysenteric attack may be, ipecac is the more efficient the earlier it is administered. The drug, in order to exert any beneficial influence in bilious dysentery, must be given in large doses — 60 to 90 grains (3.88- 5.83 Gm.)in a single dose or 20 grains (1.29 Gm.) every four hours. These doses of course will at first produce emesis, but the repeti- tion of them tends to establish a tolerance of the remedy, an early attainment of which is most desirable. Various methods have been employed to aid the stomach in retaining the drug, such as the administration of opium or other gastric sedative, a sinapism placed upon the epigastrium, etc. Ipecac has been highly recommended in infantile diarrhea. It has been successfully employed in hematemesis and uterine hemor- 6i2 A TEXT-BOOK OF MATER/A MEDICA. rhage, it being customary in the former complaint to give at first, an emetic dose, succeeded by smaller and nauseating amounts. Like other emetics, ipecac has proved efficient in expediting labor by relieving rigidity of the os uteri. The drug has been found beneficial in relieving hemoptysis, and it is of unquestioned value in many affections of the lungs and bronchial tubes. In pneumonia, particularly in the congestive and declining stages of the disease, it' has proved serviceable. In bronchitis and phthisis, especially when the secretion is scanty, and in chronic bronchitis with much cough and but a moderate amount of expectoration, ipecac is a valuable remedy. It has been found valuable in spasmodic asthma. Ipecac is an important adjuvant to quinine in the treatment of remittent and intermittent fevers, the latter disease having been cured, it is claimed, by ipecac alone in doses of i or 2 grains (o.o6k3.I2 Gm.), given every three or four hours. Contraindioations. — Ipecac is not permissible for patients suf- fering from aneurysm, hernia, prolapse of uterus or rectum, etc.. Administration. — The drug is notoriously uncertain in its action, probably because of the variation in the percentage of eme- tine, the freshly powdered root being ordinarily more reliable. For purposes of emesis the freshly powdered root is preferable,, to be taken with plenty of warm water. An infusion or decoction is frequently employed to produce emesis. As a diaphoretic the powder is also preferable, though in any; case the fluid extract may be substituted for the powdered form. As an expectorant the syrup and wine are the preparations usually employed. Children are very tolerant of ipecac, the syrup being the prepa- ration usually given to them. Emetine, though not official, is an important remedy, and may be administered as an emetic in doses of j^ to :|^ grain (0.005-0.01 Gm.), and in correspondingly small doses when a diaphoretic or expectorant action is desired. Lobelia— Lobeliae— Lobelia. TJ. S. P. (Indian Tobacco.) Origin. — The leaves and tops of Lobelia inflata L., collected after a portion of the capsules have become inflated. The plant is indigenous in the United States. Description and Properties. — As it appears in the market emetics: 613 lobelia consists of fragments of green leaves, stems, rather elon- :gated dried flowers, and portions of the membranous capsules. The odor is very irritating, and the taste pungent and persistently- acrid. The plant contains a yellowish acrid liquid alkaloid, lobeline, besides lobelic acid, lobelacrin, resin, fixed oil, gum, etc. Dose. — i-io grains (0.065-0.6 Gm.). Official Preparations. ExtrSctum Lobelise Fluidum — ExtrScti Lobelise Fluidi — Fluid Extract of Lobelia. — Dose, 1-5 minims (0.06-0.3 Cc). Tinctiira Lobelise — Tinctiirae Lobelise — Tincture of Lobelia (20 per cent.). — Dose, 8-15 minims (0.5-1.0 Cc). Antagonists and Incompatibles. — The effects of lobelia on the circulatory system are antagonized by the cardiac stimulants ; its influence on the nervous system is counteracted by strychnine and other motor excitants. The incompatibles are all caustic alkalies. Synergists. — The motor depressants and emetics enhance the effects of lobelia. Physiological Action. — Externally and Locally. — Although the drug is readily absorbed through the skin, there is no action of importance. Internally. — Digestive System. — Lobelia produces symptoms similar to those of ipecac, save that lobelia is more powerful, occa- sioning more distressing nausea and intense prostration. Circulatory System. — Lobelia is a powerful cardiac depressant, its action being due both to direct depression of the heart and paralysis of the vaso-motor centers. Under poisonous doses the heart stops in diastole. Nervous System. — Full doses depress the motor centers of the spinal cord. Poisonous doses are necessary to afiect the higher cerebral centers, when coma and convulsions are produced. The muscles and nerves themselves are unaffected by lobelia. Respiratory System. — The muscular coats of the bronchi are relaxed by the drug. The respiration is slowed even by small ■doses. Large or toxic doses profoundly depress the respiratory center, death resulting from respiratory failure. . Absorption and Elimination. — The active principle of lobelia is readily absorbed, and is excreted chiefly by the kidneys and skin, the drug acting as a diuretic and diaphoretic. Under emetic doses much of the drug is eliminated by way of the stomach and intestines. 6i4 A TEXT-BOOK OF MATERIA MEDICA. Temperature. — Full doses lower the temperature. ■ Untoward Action. — Does not differ essentially from the effects of poisoning. Poisoning. — The symptoms include — violent vomiting and purging, a very weak and irregular pulse, an anxious, livid coun- tenance, skin cold and bathed in perspiration, respiration slow and very feeble, contracted pupils, and possibly coma or convulsions preceding death, which occurs from respiratory failure. Treatment of Poisoning. — The symptoms should be counter- acted by cardiac and respiratory stimulants, employing such drugs as atropine, strychnine, alcohol, ammonia, etc., hypodermically. Therapeutics. — Externally and Locally. — None. Internally. — While formerly lobelia was used extensively as an emetic, at the present day, owing to the intense nausea and great depression occasioned by the drug, it has been practically sup- planted by other less dangerous emetics. Its principal use nowadays is as a remedy in spasmodic asthma and as an expectorant in certain cases of bronchitis. Contraindications. — The same as for emetics in general. Administration. — The powder, fluid extract, or tincture may be used. The taste of the fluid preparations may be agreeably disguised by aromatic elixir or aromatic elixir of liquorice. GROUP XII.— EXPECTORANTS. Expectorants are drugs which stimulate, depress, or modify the secretion from the bronchial or laryngeal membrane and pro- mote its expulsion. There are many drugs not classed as expectorants which, under certain conditions, may be used to serve one of these purposes. Thus, opium and chloral, by the depressing influence which they exert upon the respiratory center and the reflex mechanism, may relieve reflex and purposeless cough, or, as is the case with the former drug, check excessive secretion or render it more viscid. Demulcents, such as gum acacia, flaxseed, elm, etc., and other drugs like potassium chlorate, sodium chloride, etc., either lessen or excite the tracheal and bronchial cilia, retarding or promot- ing expectoration of bronchial mucus. The classification usually adopted seems to be the most reasonable — viz. that of dividing expectorants into two classes: i. Nauseant or Sedative. 2. Stim- ulating. EXPECTORANTS. 615 Among the more important Nauseant or Sedative Expectorants are — Alkalies ; Ipecacuanha ; Antimony and Potassium Tar- Lobelia; trate (Tartar Emetic) ; Pilocarpus ; Apomorphine ; Potassium Iodide ; Grindelia ; Quebracho ; all of which are considered in detail elsewhere. The important Stimulating Expectorants are — * Acids ; Oil of Scotch Fir (Oleum Pini * Ammonium Carbonate; Sylvestris); Ammonium Chloride ; Oleum Pini Pumilionis ; * Balsam of Peru ; Onion ; Balsam of Tolu ; Saccharine Substances ; * Benzoin and Benzoic Acid ; Senega (Saponin) ; * Copaiba ; * Sulphur ; * Cubeb ; * Squill ; Garlic ; Tar ; Liquorice ; Terebene ; * Nux Vomica Terpin Hydrate ; (Strychnine) ; * Turpentine. (Those marked with an asterisk (*) are elsewhere given in detail.) As a rule, Sedative Expectorants are permissible only in acute stages of bronchitis, when, as is the case in the beginning of all in- flammations, there is complete or partial suspension of function, absence of secretion, and much irritation in the bronchi, with dis- tressing, harsh, and dry cough. In these conditions of the respiratory passages the nauseating sedative expectorants serve a useful purpose in lowering arterial tension, lessening the blood-supply to the inflamed parts, and increasing the secretion of mucus. In sufficiently large doses to produce emesis the same expecto- rants are frequently employed to expel an accumulation of mucus mechanically by the act of vomiting. Stimulating expectorants are more serviceable in chronic and relaxed conditions of the mucous mernbrane. They are usually employed to diminish or disinfect an abnormally increased secre- tion. These remedies generally increase blood-pressure and facili- tate expectoration, being eliminated to a great extent by the mucous membranes which they stimulate. 6l6 A TEXT-BOOK OF MA TERIA MEDICA. The alkalies are especially useful in lessening the viscidity of mucus, rendering it more fluid, less tenacious, and therefore more easily expelled. It requires considerable skill to combine expectorants so as to best suit the various conditions found in practice. The diseases of the respiratory passages gradually merge, so that in the treatment of them it is often difficult to decide which remedy will be of more service, a sedative or a stimulant expectorant. The physician should carefully examine each individual case and decide whether he wishes to diminish or increase the blood-supply to the respira- tory tract ; to stimulate or depress the respirations ; to overcome spasm of the bronchial muscles ; to diminish, increase, or disinfect the bronchial secretion. A thorough knowledge of the patient's condition and of the physiological action of the various remedies at command will enable the observant practitioner to combine expectorants in such manner as to yield ordinarily highly satisfactory results. Ammonii Chloridum— Ammonii Chloridi — Ammo- nium Chloride. JJ. S. -P. Origin. — Ammonium sulphate is first formed by neutralizing Gas Liquor with Sulphuric Acid. After crystallization sublime with Sodium Chloride. Description and Properties. — A white, crystalline powder, without odor, having a cooling, saline taste, and permanent in the air. Soluble in 3 parts of water ; almost insoluble in alcohol. Dose. — 1-30 grains (0.06-2.0 Gm.). Official Preparation. Trochlsci Ammonii Chloridi — TrocWscos (ace.) Ammonii Chloridi— Troches of Ammonium Chloride. — Each troche contains 2 grains (0.12 Gm.). — Dose, I to 6 troches. Antagonists and Inoompatibles. — Therapeutically, ammonium chloride is antagonized by the cardiac depressants. The incom- patibles are — alkalies, alkaline earths and their carbonates, tartaric acid, mineral acids, and the soluble lead and silver salts. Synergists. — The expectorants, emetics, and diaphoretics en- hance the action of the drug. Physiological Action. — Externally and Locally. — Ammonium chloride is irritant and resolvent. EXPECTORANTS. 617 Internally. — In medicinal doses the drug increases the secretions from the gastro-intestinal glands, acting as a cholagogue. The ■solid constituents of the blood are diminished. The drug appears to have a special action upon the mucous membranes, augmenting their normal secretions and promoting nutritive changes and epithelial exfoliation. Ammonium chloride is readily absorbed, and is eliminated by the kidneys, skin, bronchi, and mucous membranes generally, the drug being a feeble diuretic, diaphoretic, and expectorant Save uric acid, which is slightly diminished, all the solids of the urine are increased under the use of ammonium chloride. The drug is not considered poisonous. Therapeutics. — Externally and Locally. — Ammonium chloride possesses a wide range of therapeutic applications. Solutions of various strengths have proved markedly efficient as local applica- tions in indolent buboes, epididymitis, orchitis, bruises, inflammatory swellings, suppurative mastitis, etc. Senile gangrene is much bene- 'fited by immersing the foot in a bath containing 8 ounces (249.0 Gm.) of the drug. A solution of 3 drachms (12.0 Gm.) of ammonium chloride to I pint (473.17 Cc.) of water is an efficient remedy in vaginitis. The lotion may be used as an injection or a tampon saturated with the fluid and applied to the parts. Lozenges, solutions, or the nascent fumes of the drug have been found serviceable in many diseases of the nose, throat, and ear, such as corysa, chronic laryngitis and pharyngitis, chronic aural catarrh, etc. Internally. — Few remedies are more efficient than ammonium CHLORIDE in bronchitis that has passed its inflammatory stage. In chronic bronchitis, particularly that form occurring in old people and persons of a feeble habit of body, the drug is very valuable, either given alone or associated with stimulant expectorants. The remedy has appeared to be somewhat beneficial in whooping cough. Ammonium chloride has been employed in intermittent fever z.x\A ■ to promote the eruption in the exanthematous fevers. It is certainly of great utility in goiter, and has proved beneficial in amenorrhea and dysmenorrhea. The drug is considered an efficient remedy in glandular enlargements, as in those of the prostate, liver, etc. It assuredly stimulates the functional activity of the liver and is fre- quently given as a cholagogue. Ammonium chloride usually exerts a prompt and salutary 6l8 A TEXT-BOOK OF MATERIA MEDICA. action in neuralgias, particularly the neuralgia affecting the fifth pair, the intercostal nerves, and the sciatic nerve. The remedy has been also advantageously employed in myalgia and chronic mus- cular rheumatism. ' Contraindications. — Inflammation of the stomach, aggravated dyspepsia, marked emaciation, and anemia contraindicate the drug. Administration. — Ammonium chloride is best given in solution, its disagreeable taste being wrell disguised by the addition of some preparation of liquorice, such as the syrup, fluid extract, or the aromatic elixir of liquorice. In bronchial diseases the virtues of the drug are enhanced by this association. Balsamum Tolutanum— Balsami Tolutani— Balsam of Tolu. TJ. S. I*. Origin.^ — A balsam obtained from Toluifera Balsamum L., an evergreen tree from 60 to 80 feet (18-24 M.) high, growing in the high, rolling country of Venezuela and New Granada. Description and Properties. — A yellowish-brown, semi-fluid, or nearly solid mass, becoming more brittle when exposed to cold ; transparent in thin layers, having an agreeable odor, recalling that of vanilla, but distinct from it, and a mild, aromatic taste ; readily and completely soluble in alcohol, chloroform, and solutions of the fixed alkalies ; almost wholly soluble in ether, but nearly insoluble in water or carbon disulphide. The drug contains a volatile oil (chiefly toluene), cinnamic and benzoic acids, and a resin. Dose. — 8-30 minims (0.5-2.0 Cc). Official Preparations. Syrupus Tolutanus— Syrupi Tolutani— Syrup of Tolu (l per cent.).— Z»ow, 2-6 fluidrachms (8-24 Cc). Tinctura Tolutana— Tincturae Tolutanse— Tincture of Tolu (10 per cent.). — Dose, Yi-z fluidrachms (2-8 Cc). Tinctura Benzolni Coinp6sita— Tincturae Benzoini CompSsitae— Compound Tincture of Benzoin (4 per cent.).— Described under Benzoin. Antagonists and Incompatibles. — Aqueous preparations are pharmaceutically incompatible with the tincture of tolu. Synergists. — The balsams, aromatic drugs, volatile oils, and stimulant expectorants. Physiological Action. — Balsam of tolu is antiseptic, disinfec- tant, and stimulant when applied to the skin and to raw surfaces. It is a pleasant carminative and stomachic. EXPECTORANTS. 619 The drug is excreted principally by the mucous membranes, the secretions from which it stimulates and disinfects. The skin and kidneys also share in the excretory process. Therapeutics. — Inhalations of the vapor of tolu have been suc- cessfully employed in the treatment of chronic pharyngitis, and a pigment composed of i part of tolu to 5 parts of ether or alcohol has been beneficially applied to diphtheritic deposits on the tonsils and pharynx. Its agreeable flavor, together with its stimulating and expector- ant properties, renders tolu an efficient and eligible ingredient of cough mixtures, lozenges, vapors, etc. employed to modify the course of subacute and chronic bronchitis. Administration. — Tolu is usually administered in the form of syrup, although the tincture may be given in emulsion. Inhala- tions of tolu vapor are employed and lozenges containing tolu are frequently used. Allium— Allii— Garlic. V. S. JP. Origin, — The bulb of Allium sativum L., a bulbous plant indig- enous in Central Asia and the basin of the Mediterranean, and cultivated for culinary purposes in Europe and North America. Description and Properties. — Bulb subglobular, compound, consisting of about eight compressed, wedge-shaped bulblets, arranged in a circle about the base of the stem and covered by several dry, membranaceous scales. Odor pungent and disagree- able ; taste warm and acrid. Garlic should be used without having been dried. The drug contains about \ per cent, of a volatile oil, to which its odor and taste are due. Dose, of bruised or chopped garlic or of the expressed juice, about 30 grains (2.0 Gm.). Official Preparation. Syrupus Allii— Syrupi Allii— Syrup of GaxWxi.—Dose, 1-2 fluidrachms {4.0- 8.0 Cc). Allied species. Allium Cepa L.— Allii Cepse— Onion. Physiological Action. — Both garlic and onion are stimulants to the part to which they are directly applied, garlic being the stronger of the two. 620 A TEXT-BOOK OF MATERIA MEDIC A. Internally they are carminative and stomachic, and are used as condiments and as foods. Like all substances which stimulate the digestive apparatus, in excessive amounts they may occasion nausea, -vomiting, colic, and diarrhea. The active constituents of these drugs are eliminated by the mucous membranes, skin, kidneys, and respiratory tract. The taste and odor of the drugs are imparted to the milk of nursing women. Both garlic and onion are rapidly absorbed and about as quickly eliminated. Therapeutics. — An onion poultice is a valuable domestic rem- edy for chronic or acute bronchitis in children, abscesses, and to relieve strangury when applied to the perineum, in which case it proves to be singularly efficient. The core of a roasted onion is said to quickly relieve earache when inserted in the auditory canal. Syrup of garlic or onion is an invaluable expectorant in chronic catarrhs of the respiratory passages in children and infants, and is quite an efficient remedy in the decline of whooping cough. A synthetical substance known as Allyl Tribromide (Tribrom- hydrin), closely allied to oil of garlic, has been highly recommended in spasmodic asthma, infantile convulsions, hysteria, angina pectoris, and other spasmodic disorders. It should be administered in cap- sules in doses of from i to 5 minims (0.06-0.3 Cc). Administration. — When garlic or onion is used for poultices, it should be boiled. Internally, the expressed juice made into a syrup with sugar or the official syrup of garlic is the form in which these drugs are usually given. GlycyrrhTza— Glycyrrhlzae— Glycyrrhiza. V. S. P. (Liquorice Root.) Origin. — The root of Glycyrrhiza glabra L. and of the variety glandulifera (Waldstein et Killaibel) Regel et Herder, a perennial plant indigenous in the countries lying on the northern and south- ern shores of the Mediterranean and farther east through the Cau- casus, Northern Persia, Afghanistan, and Southern Siberia to China, and cultivated to some extent in England, France, Germany, and the United States. Description and Properties. — In long, cylindrical pieces from \ to I inch (6-25 Mm.) thick, longitudinally wrinkled, externally grayish-brown, warty ; internally tawny yellow, pliable, tough ; EXPECTORANTS. 621 fracture coarsely fibrous ; bark rather thick ; wood porous, but dense in the narrow wedges ; medullary rays linear ; taste sweet, somewhat acrid. The underground stem, which is often present, has the same appearance, but contains a thin pith. The drug derived from the variety glandulifera (so-called Rus- sian liquorice) consists usually of roots or root-branches i to 4 inches (2-10 Cm.) thick and 8 to 12 inches (15-30 Cm.) long, fre- quently deprived of the corky layer, the wood rather soft and usually more or less cleft. Liquorice contains a glucoside, glycyrrhizin, besides asparagin, glycyramarin, an acrid resin, starch, etc. Dose. — 15-60 grains (1-4 Gm.). Official Preparations. Extr^ctutn Glycyrrhizae Fluidum — ExtrScti Glycyrrhizse Fluidi — Fluid Extract of Glycyrrhiza. — Dose, 1 5-60 minims (1.0-4.0 Cc). ExtrSctum Glycyrrhizae — ExtrScti Glycyrrhizae — Extract of Glycyrrhiza. — Dose, freely. (Extract of Glycyrrhiza is contained in Trochisci Ammonii Chloridi and Trochisci Glycyrrhizae et Opii.) ExtrSctum Glycyrrhizae Purum — ExtrScti Glycyrrhizae Pfiri — Pure Extract of Glycyrrhiza. — Dose, freely. Glycyrrhizinum Ammoniatum — Glycyrrhizini Ammoniati — Ammoniated Glycyrrhizin. — Description and Properties. — Dark-brown or brownish-red scales, with- out odor and having a very sweet taste ; readily soluble in water and in alcohol. Dose. — 5-15 grains (0.3-1.0 Gm.). Mistura Glycyrrhizae Compdsita — Mistiirae Glycyrrhizae Compdsitae — Com- pound Mixture of Glycyrrhiza (Brown Mixture). — Formula: Pure Extract of Glycyrrhiza, 30; Sugar, 50; Mucilage of Acacia, 100 ; Camphorated Tincture of Opium, 120; Wine of Antimony, 60; Spirit of Nitrous Ether, 30; Water, to looo. Dose. — 1-4 fluidrachms (4.0-15.0 Cc). Ptilvis Glycyrrhizae Compfisitus — Ptllveris Glycyrrhizae Compdsiti — Com- pound Povyder of Glycyrrhiza. (See Senna, p. 681.) Besides the foregoing compounds, glycyrrhiza forms a more or less important ingredient of eleven other official preparations. Physiological Action and Therapeutics. — The drug when chewed increases the flow of saliva. It is demulcent and laxative, and possesses slight stimulating properties when locally applied. It favors the secretions of the congested mucous membrane of the respiratory passages. Liquorice is used chiefly for its demulcent properties in sore throat, hoarseness, pharyngeal cough, acute bronchitis, etc. An in- fusion of the root is an agreeable and useful drink in febrile catarrhal affections and in irritative disorders of the bowels and urinary organs attended with fever and great thirst. 622 A TEXT-BOOK OF MA TERIA MEDIC A. The various preparations of liquorice are serviceable in conceal- ing the taste of nauseous and bitter medicines and as an excipient for pills. Administration. — There are no special directions to be given — any of the preparations may be used. Oleum Plni Sylv6stris — Olei Pini SylvSstri — Oil of Scotch Fir (unofiScial).— Origin, Description, and Properties. — A volatile oil distilled from the leaves of Pinus Sylvestris, colorless, fragrant. Used by inhalation or locally. The drug is used in various sprays and inhalations in nasal catarrh, acute coryza, and many diseases of the respiratory passages. Oleum Templmum — OleiTemplIni — Oil of Pine (unofficial). — Origin, Descrip- tion, and Properties, — A volatile oil distilled from the shoots of Pinus Pumilio. A col- orless or yellovifish-green oil, of an agreeable, somevchat terebinthinate odor. Oleum Templinum is used in the same manner and for the same purposes as Oil of Scotch Fir. Pix LTquida— PTcis LTquidae— Tar. U. S. I*. Origin. — An empyreumatic oleoresin obtained by the destructive distillation of the wood of Pinus palustris Miller, and other species of Pinus. Description and Properties. — Thick, viscid, semi-fluid, black- ish-brown, heavier than water, transparent in thin layers, becoming granular and opaque with age ; odor empyreumatic, terebinthinate ; taste sharp, empyreumatic. Tar is slightly soluble in water; solu- ble in alcohol, fixed and volatile oils, and solution of potassium or sodium hydrate. The drug contains many substances, chief among which are an empyreumatic, volatile oil, pyrocatechin, acetone, xylol, toluol, cresols (creasote), guaiacol, phenol, etc. Dose. — 15-60 grains (1-4 Gm.). Official Preparations. Syrupus PIcis Liquids — Syrupi PIcis Liquidse — Syrup of Tar (7.5 percent.). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). UnguSntum PIcis Liquids — Ungufinti Picis Liquids — Tar Ointment (50 per cent.). — Used externally. Oleum Picis Liquids — Olei Picis Liquids — Oil of Tar. U. S. P. — Origin. — A volatile oil distilled from tar. Description and Properties. — An almost colorless liquid when freshly distilled, but soon acquiring a dark reddish-brown color and having a strong tarry odor and taste. It is readily soluble in alcohol. — Dose, 1-5 minims (0.065-0.3 Cc). Unofficial Preparations. Squa Picis Liquids — Aqus Picis Liquids — Tar Water. — Dose, i pint (473.17 Cc.) in the course of a day. EXPECTORANTS. 633 Glyceritum Picis Liquids — Glyceriti PIcis Llquidse— Glycerite of Tar.— Dose, J-2 fluidrachtns (2.0-8.0 Cc). Vinurri Picis (N. F.) — Vini Picis— Wine of Tar (a saturated solution in sherry wine). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). Derivatives and Allied Drugs. Lysol. — Prepared by the action of alkalies on tar-oils and fats. A brownish, oily liquid with a feeble, aromatic creasote-like odor, containing 50 per cent, of cresols and readily niiscible with water. Used as a disinfectant and antiseptic. Pixol. — A compound of tar soap and caustic potash or soda. Used as a disinfec- tant and antiseptic. Pix BStuls — Picis BStulae — Birch Tar (Oleum Rusci). — Origin. — Prepared in Russia from the wood and bark of Betula alba L. Description and Properties. — Resembling wood-tar in appearance, but remaining liquid, and having the peculiar, penetrating odor of Russia leather, in the manufacture of which it is used. For the most part employed externally. Oleum Cadinum — Olei Cadini — Oil of Cade. U. S. P. — Origin. — A product of the dry distillation of the wood of Juniperus oxycedrus L. Description and Properties. — An empyreumatic, brownish or dark-brown, clear, thick liquid, possessing a tarry odor and an empyreumatic, burning, somewhat bitter taste. Almost insoluble in water; partially soluble in alcohol. Dose. — 2-6 minims (0.12-0.3 Cc). Chiefly used externally. Antagonists and Incompatibles. — There are none of special importance. Synergists. — The aromatics, carbolic acid, creasote, and many of the antiseptics, turpentine, and the stimulant expectorants. Physiological Action. — Externally and Locally. — Tar is a stim- ulant, astringent, antipruritic, antiseptic, and parasiticide. It is readily absorbed from the skin, and when applied too freely may produce a papular eruption. Internally. — The action of tar closely resembles that of turpen- tine, although creasote is perhaps a more perfect analogue. Small doses stimulate the circulation and increase secretions generally. Immoderate dosage or the prolonged administration of tar impairs the appetite, deranges digestion, and depresses the circulatory and nervous systems. While the drug is not considered poisonous, the ingestion of excessive quantities of oil of tar has been attended with a few fatal results. The symptoms following imprudent dosage are nausea, vomiting, severe abdominal pain, diarrhea, headache, and dizziness. The urine is colored blackish-brown, and may contain blood or albumin and emit the peculiar odor of tar. There may be present erythema, or the skin may be covered with papules or vesicles attended with intense itching. Therapeutics. — Externally and Locally. — With the possible 624 A TEXT-BOOK OF MATERIA MEDIC A. exception of sulphur and mercury, tar is the most universally employed remedy for cutaneous diseases, the drug having for cen- turies held an important place among the efficient topical agents in the treatment of diseases of the skin, unhealthy ulcers, fissured nipples, boils, excoriations, etc. In chronic eczema the drug is peculiarly serviceable, and it has proved beneficial in chronic psoriasis and scabies. The OIL OF CADE and oil of birch are used for the same pur- poses as tar, being usually preferred by expert dermatologists. The tarry preparations are valuable antipruritics, and of service in pruritus and various itching diseases of the skin, although their tendency to produce irritative and inflammatory effects when con- tinuously and injudiciously applied should not be overlooked. The benign and emollient effects of tar are best obtained when the drug is mixed with some soothing or astringent powder, such as chalk. The valuable properties of tar in the treatment of cutaneous diseases are often nullified by the ignorance of the physician and lack of proper administration of the drug. Prof. James Nevins Hyde has truthfully observed that " the skill of a physician en- trusted with the management of a disease of the skin might also be measured by his success in the use of tar." Lozenges containing tar, the vapor of oil of tar, and sprays containing tar are extensively employed in the treatment of various diseases of the nose and throat. Internally. — Tar has long possessed an enviable reputation as a remedy for chronic pulmonary complaints, being very efficient in the treatment of chronic bronchitis and the advanced stages of obstinate acute bronchitis, lessening the expectoration, allaying the oppression and distress in the chest, and soothing the cough. These symptoms, which attend many cases of pulmonary phthisis, are frequently relieved by some preparation of tar. Not only is this remedy of value in catarrhal conditions of the respiratory passages : it is equally efficient in similar conditions of mucous membranes elsewhere. Thus tar water has been employed with great benefit in gleet, leucorrhea, vesical catarrh, etc., being given both by the mouth and in the form of an injection. Administration. — ^Tar may be given in milk or beer or in pill form, although the most palatable forms are the syrup, glycerite, wine, and tar water, the last of which may be given to the extent of I or. 2 pints (473-17 or 946.35 Cc.) daily. EXPECTORANTS. 625 Senega— Senegae— Senega. V. 8. P. Origin. — The root of Polygala Senega L., a plant indigenous in North America, from Canada southward to South Carolina and westward to Wisconsin. Description and. Properties. — About 4 inches (10 Cm.) long, with a knotty crown and spreading, tortuous branches, keeled when dry, fleshy and round after having been soaked in water ; externally yellowish-gray or brownish-yellow ; bark thick, white within, enclosing an irregular, porous, yellowish wood ; odor slight, unpleasant ; taste sweetish, afterward acrid. Senega contains sene- gin, also known as saponin, and polygalic acid, an acrid principle to which the medicinal property of the drug is due, besides a fixed and a volatile oil. Dose. — 10-30 grains (0.6-2.0 Gm.). Official Preparations. ExtrSctum SSnegse Fluidum — ExtrScti S£negae Pluidi — Fluid Extract of Senega. — Dose, 10-30 minims (0.6-2.0 Cc). Synipus S&negse — Sjrrupi SSnegse — Syrup of Senega (20 per cent, of fluid extract). — Dose, 30-60 minims (2.0-4.0 Cc). Syrupus Sclllse Conip6situs — Syrupi ScKUae CompSsiti — Compound Syrup of Squill (contains 8 per cent, of Senega). (Described under Scilla, p. 635.) Physiological Action. — Externally and Locally. — The active principle of senega is a decided irritant to the skin and mucous membranes, causing violent sneezing and cough, with marked hydremia and increased secretion from the bronchial and nasal mucous membranes when the powder is inhaled. Internally. — Digestive System. — Small doses stimulate the mu- cous membranes of the mouth and stomach, augmenting the sali- vary and gastric secretions, although frequently occasioning indi- gestion. Large doses irritate the alimentary canal, producing vomiting, diarrhea, and abdominal pain. Circulatory System. — The active principle of senega circulates in the blood unchanged, affecting the heart and blood-vessels after the manner of digitalis, though with less power and certainty. Nervous System. — Under medicinal doses no important action has been noted. Very large doses depress the nervous system. Respiratory System. — It is here that senega appears to exert its most important influence. The excretion of the drug through the bronchial mucous membrane irritates the respiratory passages, oc- casioning hyperemia, increased secretion, and, reflexly, cough. Absorption and Elimination. — The active principle of senega is 40 626 A TEXT-BOOK OF MATERIA MEDICA. absorbed with difficulty, being excreted through the bronchial mucous membrane and the kidneys, irritating these structures during the process, and consequently acting as a stimulant, expec- torant, and diuretic. The drug also possesses some diaphoretic virtue, being partially excreted by the skin. Temperature. — The body-heat is uninfluenced. Uterus. — It is believed that senega possesses emmenagogue properties. Untoward Action. — Immoderate, and in certain susceptible sub- jects small, doses of senega have produced irritation and burning in the throat, salivation, impaired appetite, a sense of oppression in the stomach, nausea, vomiting, colicky pains, and profuse diarrhea. Poisoning. — Senega is not regarded as a poisonous drug, exces- sive doses producing symptoms analogous to those of " Untoward Action," save that they are intensified. Treatment of Poisoning. — Elimination is to be favored, and the symptoms treated as they appear, ga;stric sedatives, anodynes, and cardiac stimulants being employed. Therapeutics. — Externally and Locally. — No action has been observed. Internally. — The principal use of senega is that of a stimulating expectorant. The reputation of the drug originated with its efficacy in typhoid pneumonia, and it is still considered a valuable remedy in asthenic pulmonary diseases. It is highly beneficial in subacute bronchitis when the power to cough is feeble. In like manner senega is useful in bronchorrhea and chronic bronchitis with profuse expectoration, though less valu- able when the mucus is tough and scanty. The simple catarrhal laryngitis following croup is greatly relieved by the administration of senega. The drug is an appropriate remedy in amenorrhea the result of passive uterine congestion, and senegin has been recommended as a remedy for uterine hemorrhage. According to some authorities, the drug has proved beneficial in chronic rheumatism. Contraindications. — Senega is inadmissible in acute bronchitis and indigestion, or when there is marked irritation and inflamma- tion of the gastro-intestinal tract. Administration. — The syrup of senega is the preparation usually employed as an expectorant. Senegin may be given in doses of 2 grains (0.13 Gm.) in capsules. EXPECTORANTS. 627 Terebenum— Terebeni— Terebene. Xf. S. JP. Origin. — A liquid consisting chiefly of Pinene, and containing only very small proportions of Terpinene and Dipentene ; obtained by the action of Sulphuric Acid upon Turpentine, and distillation. Description and Properties. — A colorless or slightly yellow- ish, thin liquid having rather an agreeable thyme-like odor and an aromatic, somewhat terebinthinate taste. Only slightly soluble in water, but soluble in an equal volume of alcohol. Terebene should be kept in well-stoppered bottles, in a cool place protected from light. Dose. — 5-15 minims (0.3-1.0 Cc). Physiological Action. — When applied externally terebene acts as a stimulant, germicide, antiseptic, and astringent. Internally, small doses act as a stimulant to the gastro-intestinal tract, large amounts being irritant and producing effects similar to those of turpentine. The drug is eliminated by the kidneys, bronchial mucous mem- branes, skin, bowels, etc., acting as a mild astringent and antiseptic at the points of elimination. Therapeutics. — Externally and Locally. — The inhalation of terebene — 20 minims (1.23 Cc.) daily — allays the cough oi laryngeal phthisis and has proved beneficial in irritative bronchial cough, while a spray of terebene mixed with oil of eucalyptus and alcohol has been advised in whooping cough. Equal parts of terebene and olive oil have been recommended by Vaucher and Bertin in the treatment of uterine cancer. Tere- bene has been successfully employed as a general antiseptic dress- ing of wounds, ulcers, burns, etc. Internally. — Whether inhaled or taken into the stomach, terebene is a powerful stimulant, antiseptic expectorant in chronic bronchitis. The drug is of service in affections of either the upper or lower respiratory passages. In winter cough, bronchorrhea, emphysema, and even in phthisis, it is an efficient remedy. Not only in bronchial affections is the drug valuable, but it has been used with striking success as a substitute for copaiba and oil of sandalwood in genito-urinary diseases. It has even been claimed to influence favorably the course oi puerperal fever and to relieve the symptoms oi flatulent dyspepsia. Administration. — Terebene may be given in emulsion or in mixtures associated with other expectorants and enclosed in cap- sules or dropped upon sugar. ' 628 A TEXT-BOOK OF MATERIA MEDICA. TerpTni Hydras— TerpTni Hydratis— Terpin Hydrate. 77. S. F. Origin. — The hydrate of the diatomic alcohol Terpin, prepared by- mixing rectified Oil of Turpentine, Alcohol, and Nitric Acid, allow- ing the mixture to stand for three or four days in shallow porcelain dishes, collecting the crystals which have formed, drying on ab- sorbent paper, and recrystallizing in a cold solution of alcohol. Description and Properties. — Colorless, lustrous, rhombic prisms, nearly odorless, and having a slightly aromatic and some- what bitter taste. Permanent in the air. Soluble in about 250 parts of water and in 10 parts of alcohol. Terpin hydrate should be kept in well-stoppered bottles. Dose. — 2-30 grains (0.12-2.O Gm.). Physiological Action. — Terpin hydrate is a powerful antiseptic, its action resembling that of turpentine, though inferior in strength. Therapeutics. — Externally and Locally. — The drug is used in the form of lozenges and as an inhalant in chronic tracheitis and chronic bronchitis. Internally. — Terpin hydrate may be used for the same purposes as terebene, being considered by some physicians superior to the latter drug in bronchial affections. It has been recommended as an efficient remedy in asthma, hay fever, nephritis, and neuralgia. Admi n istration. — Terpin hydrate may be given in lozenges, emulsion, or aromatic elixir, although the most judicious method of administration perhaps is in capsules. Terpinol is obtained by boiling terpin hydrate with dilute mineral acids. It occurs as an oily body with a hyacinthine odor. Insoluble in water, but readily soluble in alcohol and in ether. Terpinol is a valuable bronchial stimulant, and may be used for the same diseases of the respiratory passages for which terpin hydrate is recommended. It is best given in capsules, in doses of about 2 grains (0.12 Gm.) each, repeated from four to six times a day. GROUP XIII.— DIURETICS AND SUBSTANCES ACTING ON THE KIDNEVS AND THE URINARY SYSTEM. Diuretics are drugs which increase the flow of urine. Con- sidered in a broader sense, however, these agents augment the secretion and modify the character of the urine — I. By increasing the amount. DIURETICS. 629 2. By rendering the urine acid. 3. By rendering the urine alkahne. 4. By removing waste products or increasing the sohd con- stituents of the urine. 5. By preventing the decomposition of the urine. The last-named action is pecuhar to benzoic * and saHcylic * acids, cubeb, copaiba, uva-ursi, oil of sandalwood, volatile oils,* saccharin, and saloL' The following medicines affecting the urinary system are called Lithontriptics, because of their power to prevent the formation of concretions in the urinary passages or to dissolve them when formed : Piperazin, potassium salts,* lithium salts,* ammonium benzoate,* benzoic acid,* dilute nitric acid.* Among the principal drugs which render the urine acid are — benzoic * and salicylic * acids and many of their salts, immoderate amounts of the vegetable acids,* and sour wines.* The alkahes,* particularly the potassium and lithium salts, when taken internally, render the urine alkaline in reaction. Diuretics may be either Direct or Indirect — i. e. they may act on the kidneys themselves or upon certain structures outside the kidneys. The structures in the kidneys which have to do with the elimination of water, solids, etc. are — i. The Malpighian cor- puscles, which eliminate principally water, but also mineral salts and certain pathological and foreign substances which may be present. 2. The glandular epithelium lining the convoluted tubules, which excretes waste products, such as urea, etc. 3. The con- stricted portion of the tubules, seri-^ing to prevent the too rapid escape of water, thus allowing time for its absorption in cases where it is desirable that the water be retained in the . system. The functional activity of these various structures is regulated by the nervous mechanism. For example, the supply of blood to the glomeruli is influenced largely by the size of the blood-vessels, regulated by the vaso-constrictor and vaso-dilator nerves, and the activity of the secreting cells is increased or diminished according as they are controlled by the secretory or inhibito-secretory nerve-fibers. Diuretics act — 1 . By increasing the general blood-pressure. 2. By causing local dilatation of the renal arterioles. ' The drugs marked with an asterisk are described elsewhere in the present work. 630 A TEXT-BOOK OF MA TERIA MEDICA. 3. By stimulating the glandular secreting renal structures. 4. By simple mechanical force. The following table, modified from Brunton's work on Pharma- cology, Therapeutics, and Materia Medica, serves to elucidate the methods by which the various diuretic agents probably exert their influence : Increased cardiac action. Raise arterial pressure. Generally . Locally on kidneys. Contract effer- ent vessels. Dilate efferent vessels. General vascular contraction. Act on the vaso- motor centers. Locally on kidney. ■ Act either on vaso- motor centers or locally on renal vessels. Act on secreting nerves and renal cells. Increase water excreted Increase water and solids excreted . By simple mechanical action Digitalis,* Alcohol.* ■ Digitahs,* Strophanthus,* Squill, Spartein,* Convallaria,* Strychnine,* Caffeine,* Erythrophleum (cold to the skin). Same as above ? Scoparius,* Buchu, Uva Ursi, Juniper, Turpentine, Copaiba, Cantharides.* Nitrites,* Alcohol.* Urea, Caffeine,* Diuretin, Calomel.* Colchicum,* Liquor Potassse,* Potassium Acetate,* Potassium Citrate,* Potassium Nitrate,* Sodium Citrate * and other salines. Water, local bleeding, dry cupping, warm fomentations. The secretion of urine is considerably influenced by the activity of the skin and bowels ; for instance, when the cutaneous glands are stimulated and there is free perspiration, a diminished urinary secretion ensues. The functional activity of the skin and sudo- DIURETICS. 631 riparous glands depends greatly upon the amount of blood sup- plied to them. Whatever augments the flow of blood to these structures increases the secretion of the sweat-glands. Conse- quently, external warmth dilates the cutaneous blood-vessels and promotes diaphoresis, while cold contracts the cutaneous vessels, diverting the flow of blood to the internal organs, thereby increas- ing the secretion from the kidneys and lessening that from the skin. It will be seen, therefore, that the functions of the skin and kidneys are compensatory, the compensation being also partially observable in the mutual relations between the bowels and kidneys. It is well known that when there is active purgation, with frequent watery movements from the bowels, the amount of urine secreted is proportionally diminished. Any drug which increases the general blood-pressure and forces a larger blood-supply into the kidneys augments the pressure in the glomeruli, distending the capsule and enlarging the area of the osmotic membrane, which action, combined with an increase in the circulation, promotes and facilitates osmosis, thereby augmenting the amount of urine. The membrane lining the inner capsule of the glomerulus is covered with a single layer of cubical epithe- lium possessing a secretory function, rendered more active in accordance with the physiological fact that the greater the blood-supply to a gland or secreting structure, the greater its functional activity. The blood-pressure in the glom- eruli, as has been said, may be in- creased by additional pressure in the general circulation. It may be raised also locally through dilatation of the afferent blood-vessel supply- ing the Malpighian corpuscle, or con- traction of the efferent vessels, allowing a smaller quantity of blood to escape from the glomeiules. Fig. 15. — A, glomerules of capillary blood-vessels ; B^ cubical or secreting cells covering the membrane surrounding the capillary plexus ; C, space between the two layers opening into a convoluted tu- bule; D, the exte/nal layer covered by flattened epithelial cells ; E, convoluted tubule lined with a single layer of nucle- ated polyhedral epithelium ; F, afferent ar- tery entering the Malpighian corpuscle, dividing in the interior into a dense, con- voluted capillary plexus, which finally leads out of the corpuscle by G, a small, efferent vessel comparable to a vein, at a point op- posite to that where the afferent vessel enters the Malpighian corpuscle. 632 A TEXT-BOOK OF MATERIA MEDIC A. By referring to the foregoing tabular view we may ascertain the drugs acting upon the general and those affecting the local circulation. The preceding diagram (Fig. 15) will serve to elucidate the action taking place in the glomeruli. The secreting structures of the convoluted tubules are stimu- lated not only by the increased blood-pressure, but also by the influence of certain drugs which are carried in the blood, acting as excitants upon the secreting cells or the secretory nerves supply- ing them. By reference to the table it will be seen what diuretics act upon these structures. The subjoined diagram (Fig. 16) shows the structures concerned with the functional activity of the kidney. Fig. 16. — I, Malpighian corpuscle ; 2, convoluted tubule with capillary plexus from efferent vessel; 3, constricted portion of the tubule ; 4, unstriped muscle-fibers surrounding the constricted portion ; 5, afferent blood-vessel leading into the Malpighian body ; 6, efferent vessel leading out of the Mal- pighian corpuscle ; 7, the collecting tube. The imbibition of large amounts of water, while increasing the blood-pressure to some extent, has mainly a mechanical effect upon the kidneys, simply flushing the tubuli uriniferi, allowing secretion to be re-established, and acting as a diluent to the unne. In congested conditions of the kidneys certain remedial meas- ures — such as local venesection, dry cupping, warm fomentations, etc. — promote renal secretion. Therapeutics. — i. To remove excessive accumulation of fluid in DIURETICS. 633 the tissues and serous cavities of the body when the blood-pressure is low. For this purpose the most efficient service is derived from the use of drugs which act by increasing the systemic blood-pressure, contracting the efferent and dilating the afferent vessels, and stimu- lating the convoluted tubules. Ordinarily, the agents most beneficial in cardiac dropsy or drop- sies due to venous congestion are digitalis, calomel, scoparius, squill, diuretin, etc. 2. To remove excess of fluid from the body when the blood-pressure is about normal, as in cases of hepatic cirrhosis with dropsy. The remedies found to be most efficient in these conditions are diuretin, copaiba, and calomel, although frequently hydragogue cathartics, by ridding the peritoneal cavity of excess of water and preventing the accumulation of fluid by lowering the abnormally high blood-pressure in the portal circulation, prove more beneficial than diuretics. 3. To remove water from the blood when the arterial pressure is abnormally high. For this purpose diuretics are indicated in the early stages of many acute diseases, such as the eruptive fevers, tonsillitis, bron- chitis, etc. In these cases agents which dilate the cutaneous blood- vessels, such as spirit of nitrous ether, etc., should be employed. Diaphoretics and cathartics are likewise beneficial. 4. To remove from the blood injurious waste products and poi- sonous substances. For this purpose drugs which stimulate the convoluted tubules and increase oxidation should be given, such as potassium nitrate and bitartrate, the lithium salts, turpentine, juniper, caffeine, and the remedies mentioned under " Lithontriptics." The foregoing remedies will be found useful in diseases asso- ciated with rheumatic, gouty, and uric-acid diatheses, as well as in many acute diseases where there is rapid accumulation of deleteri- ous, retrograde material. 5. To lessen the acidity of the urine. The alkalies are the most useful agents for this purpose, being serviceable in such conditions as gonorrhea and acute inflammatory states of the genito-urinary tract. In debilitated conditions there is quite often an excessive acidity of the urine, irritating the mucous membrane and causing frequent micturition. In such cases the alkaline diuretics or alkaline mineral waters are of service. 634 A TEXT-BOOK OF MATERIA MEDICA. 6. To increase the acidity of the urine. This is necessary when, from any cause, there is ammoniacal decomposition of the urine, as in cystitis. In such cases benzoic acid is probably the most beneficial remedy, though the salicylates^ salol, and the volatile oils, etc. may also prove useful. 7. To prevent the formation of urinary concretions or to dissolve them when formed, as in cases of renal calculi, etc. For these purposes the drugs included under " Lithontriptics " are the most efficient. 8. To dilute the urine. This process is necessary to prevent the deposit of urinary solids from f ~irming calculi in the kidneys or bladder. For this purpose water ur the alkaline mineral waters, taken in large quantities, will prove most useful. Administration. — Diuretics are often very uncertain in their action, in health many of them apparently exerting no influence upon the kidneys, and in diseased conditions not infrequently proving inert. They are more certain in their action when em- ployed in combination — that is, a union of drugs which act both generally upon the systemic circulation and locally upon the various secreting structures of the kidneys. Diaphoretics, being diverse in their action, should not be given with diuretics. When administered, diuretics should be freely diluted with water. The' patient's skin should be kept cool and the bowels prevented from acting too freely, in order that the full benefit of this class of remedies may be obtained. The diuretic drugs not described elsewhere in the present work are herewith considered in detail. ScTlla—ScilIae— Squill. JJ. S. I*. Origin. — The bulb of Urginea maritima (L.) Baker, a plant in- digenous in the basin of the Mediterranean from Syria westward to the coast of the Atlantic. The bulb is deprived of its dry, mem- branaceous outer scales and cut into thin slices, the central por- tions being rejected. Description and Properties. — Occurring in narrow segments about 2 inches (5 Cm.) long, slightly translucent, yellowish-white or reddish, brittle and pulverizable when dry, tough and flexible afl:er exposure to damp air ; inodorous ; taste mucilaginous, bitter, and acrid. The drug contains three active principles — scillipicrin, DIURETICS. 635 scillitoxin (both acting upon the heart), and scillin (an emetic prin- ciple) — together with various unimportant substances, such as mu- cilage, sugar, etc. Dose. — 1-2 grains (0.06-0.13 Gm.). Official Preparations. Acetum Scllla — Aceti Scnise— Vinegar of Squill (10 per cent.). — Dose, 10-30 minims (0.6-2.0 Cc). Extractum SclUse Flfiidum— ExtrScti Scflte Fliiidi— Fluid Extract of Squill. — Dose, 1-4 minims (0.065-0.25 Cc). Syrupus Sclillae — Syrupi ScIUse — Syrup of Squill (45 per cent, of the Acetum). — Dose, 30-60 minims (2.0-4.0 Cc). Syrupus Sclllse CompSsitus— Syrupi ScKUse Compdsiti — Compound Syrup of Squill. — Dose, 15 minims-2 fluidraclims (1.0-8.0 Cc). Fluid Extract 8 per cent., with Fluid Extract of Senega 8 per cent, and Tartar Emetic 2 per cent., or \ grain (.ooS Gm.) to I fluidrachm (4.0 Cc). Tinctura SciUae — Tincturae Scfllae — Tincture of Squill (15 per cent.). — Dose, 5-20 minims (0.3-1.3 Cc). Antagonists and Incompatibles. — The action of squill upon the circulatory system is antagonized by the cardiac depressants. Tannic acid is incompatible. Synergists. — The diuretic action of squill is enhanced by the diuretics and many of the cardiac stimulants. As an expectorant the drug is aided by senega and tartar emetic. Physiological Action. — Externally and Locally. — There is no action of special importance. Applied to mucous " membranes, however, squill acts as an irritant. Internally. — Digestive System. — Large doses of the drug excite nausea, vomiting, and purging. Excessive amounts may produce gastro-enteritis. Circulatory System. — The action of squill upon the heart and blood-vessels resembles that of digitaUs, although as a cardiac stimulant digitalis is the more powerful. Nervous System. — Poisonous doses produce marked cerebral symptoms, and in warm-blooded animals may occasion paralysis and convulsions. Respiratory System. — The bronchial mucus is increased and expectoration facilitated by small doses of squill. Toxic doses render the respiration rapid and shallow. Absorption and Elimination. — The active principles of squill are quickly diffused through the blood, being eliminated chiefly by the kidneys and bronchial mucous membrane. In the passage of squill through the kidneys the latter are 636 A TEXT-BOOK OF MATERIA MEDIC A. stimulated by the drug, which influence, together with the drug's action upon the systemic circulation, renders squill an active and valuable diuretic, increasing not only the amount of urine, but also the quantity of inorganic solids. Very large doses irritate and inflame the kidneys, resulting in strangury and hematuria, with occasionally entire suppression of urinary flow. Untoward Action. — This does not differ essentially from the symptoms of " Poisoning." Poisoning. — In toxic doses squill acts as an acro-narcotic poison. The symptoms produced by excessive doses are — nausea, violent vomiting, serous and bloody diarrhea, severe griping, a sensation of burning in the throat, vesical tenesmus accompanied by pain, bloody urine, and perhaps entire suppression of the urinary flow. The pulse is feeble and slow or sometimes rapid, the symptoms terminating in collapse and death, occasionally preceded by convul- sions. Treatment of Poisoning. — The stomach should be evacuated and demulcent drinks freely given. Opium may be necessary to relieve ■ pain, while diffusible stimulants serve to counteract cardiac and respiratory depression. Therapeutics. — Squill is not used externally and locally. It has been employed internally as a diuretic in dropsy. When asso- ciated with digitalis and calomel it is an exceedingly active diuretic in cases of cardiac dropsy, chronic pleurisy, and pericarditis with effusion. Squill is an efficient expectorant, the vinegar, syrup, and com- pound SYRUP OF SQUILL being useful preparations in subacute and chronic forms of bronchitis, particularly when the sputum is tena- cious and with difficulty expelled. Contraindications. — Squill should not be employed in cases of acute diseases of the kidneys. It is also inadmissible in acute bronchitis and in phthisis. Administration. — Any of the preparations of the drug may be given, to be prescribed well diluted with syrup or glycerin. Inasmuch as the diuretic action of squill ceases afl:er a while, the doses should be repeated and gradually enlarged until some untoward action supervenes, when further increase should be sus- pended. Because of its too irritating properties the drug is seldom given alone when desired for its diuretic action. DIURETICS. 637 Owing to the free acetic acid which it contains, syrup of squill is incompatible with ammonium carbonate and other alkalies. Erythrophleum— Erythrophlei— Erythrophleum. (Casca Bark.) Origin. — A glucosid obtained from the bark of Erythrophlceum Guinense Don, known under the names of Casca bark. Sassy bark, and Ordeal bark. The tree is a native of West Africa, the plant being used by the natives as an ordeal in witchcraft. Description and Properties. — Erythrophlein hydrochloride, the salt usually employed, occurs in the form of whitish crystals, soluble in water. Dose. — i^ - xi grain (.001-005 Gm.). Physiological Action and Therapeutics. — The powdered bark when inhaled causes violent sneezing. The tincture of the bark, or the glucosid, when taken in poisonous doses occasions nausea, vomiting, purging, intense headache, intoxication, convulsions, and death. In medicinal doses the drug affects the circulatory system after the manner of digitalis, and acts upon the kidneys as an active diuretic. It was at one time supposed to be a powerful local anes- thetic ; further examination, however, has proved the claim to be unfounded. Casca bark or its glucosid has been employed in intermittent fever, diarrhea, dysentery, and dyspepsia. Its chief medical uses are in valvular diseases of the heart and as a diuretic in cardiac and renal dropsies. Administration. — A tincture of the bark (10 per cent, strength) may be given internally, diluted with water, in doses of 5-10 min- ims (0.3-0.6 Cc). Erythrophlein hydrochlorate is usually given hypodermically. Buchu— Buchu— Buchu. TJ. 8. P. Origin. — The leaves of Barosma betulina (Thunberg) Bartling et Wendland, and Barosma crenulata (L.) Hooker, plants or shrubs attaining a height of several feet, indigenous in the southern por- tion of Africa, particularly in various parts of Cape Colony. Description and Properties. — The leaves are ^ to f inch (12 to 19 Mm.) long, roundish-obovate, with a rather wedge-shaped base, or varying between oval and obovate, crenate or serrate, with a gland at the base of each tooth, dull yellowish-green, thickish, 638 A TEXT-BOOK OF MATERIA MEDIC A. pellucid-punctate ; odor and taste strongly aromatic, somewhat mint-like, pungent, and bitterish. Buchu contains from i to 1.56 per cent, of a volatile oil, which, on exposure to a low temperature, releases barosma camphor or diosphenol, a stearopten. The bitter principle of buchu is rutin ; resin is also present. Dose. — 15-30 grains (1.-2. Gm.). Official Preparation. Extractum Buchu Fluidum— ExtrScti Buchu Fluidi — Fluid Extract of Buchu. — Dose, 15-60 minims (1.-4. Cc). Physiological Action and Therapeutics. — Externally and locally buchu has no action of importance. When ingested it acts as a carminative, in small doses occasioning a feeling of warmth, but in excessive doses acting as an irritant. Upon the circulation the influence of the drug is that of a mild stimulant. Its active constituents are rapidly diffused through the blood, and are eliminated principally by the kidneys, the bronchial mucous membrane sharing in the excretory process. Buchu increases the fluid and solid constituents of the urine, imparting to it a peculiar aromatic odor. The drug acts as a tonic astringent and disinfectant to the mucous membranes, from which it is eliminated, diminishing the secretions. If taken for too long a period, irritation and inflammation of the kidneys are apt to ensue because of excessive stimulation. The drug is chiefly employed as a stimulant diuretic and expecto- rant in catarrhal conditions of the genito-urinary organs and bron- chial tiibes. Buchu is therefore of service in urethritis, gonorrhea, gleet, chronic cystitis, incontinence of urine due to want of muscular tone, pyelitis, etc. The drug has also proved beneficial in certain cases of chronic bronchitis, and has even been recommended in chronic rheumatism and lithemia. Contraindications. — Buchu is contraindicated in acute inflam- mation of the kidneys. Administration. — The fluid extract and the infusion are the only preparations employed. They should be given freely diluted with water. Uva Orsi— Uvae Orsi— Uva Ursi. ZJ. S. P. (Bearberry.) Origin. — The leaves of Arctostaphylos Uva JJrsi (L.) Sprengel., a trailing evergreen plant distributed throughout the northern por- DIURETICS. 639 tion of North America, extending as far south as New Jersey and westward to Colorado. The plant is also found in most parts of Europe and in Northern Asia. Description and Properties. — Leaves very short-stalked, obovate or oblong-spatulate, coriaceous, about f inch (2 Cm.) long and \ \.o\ inch (6 to 8 Mm.) wide, obtuse, with slightly revolute edges, upper surface with depressed veins, lower surface distinctly reticulate ; odor faint, hay-like ; taste strongly astringent and some- what bitter. Uva ursi contains two bitter glucosids, arbutin and ericolin, and a tasteless principle, urzone, besides tannic and gallic acids. Dose. — 15-60 grains (1.-4. Gm.). Official Preparations. Extractum Ovse Ursi— Extract! Uvae Ursi — Extract of Uva Ursi. — Dose, 5-15 grains (0.3-1.0 Gm.). ExtrSctum Uvae Ursi Fluidum— ExtrScti Uvae Ursi Fluidi— Fluid Extract of Uva Ursi. — Dose, 15-60 minims (J-4 Cc). The Physiological Action and Therapeutics of uva ursi are analogous to those of buchu. JunTperus— J unTperi— Juniper. (Juniper Berries.) Origin. — The fruit of Juniperus communis (L.), an evergreen tree indigenous in the northern hemisphere and found in the United States and Canada and in Europe. Description and Properties. — Berries globular, about the size of a large pea, externally of a glossy, purplish-black color, covered with a grayish bloom. They have an aromatic, balsamic odor, and a sweet terebinthinate, bitterish, and slightly acrid taste. Juniper contains a volatile oil; also juniperin, sugar, wax, fat, etc. Dose. — 15-60 grains (1.-4. Gm.). Oleum JunTperi— Olei JunTperi— Oil of Juniper. V. S. JP. Origin. — A volatile oil distilled from the fruit of Juniperus communis. Description and Properties. — A colorless or faintly greenish- yellow liquid, becoming darker and thicker through age and exposure to air, having the characteristic odor of juniper and 640 A TEXT-BOOK OF MA TERIA MEDICA. a warm, aromatic, somewhat terebinthinate and bitterish taste. Sol- uble in about four times its volume of alcohol, forming a more or less turbid liquid, which is neutral or slightly acid to, litmus-paper. Dose. — 5-15 minims (0.3-1. Cc). Official Preparations. Spfritus Juniperi— Spfritus JunJperi— Spirit of Juniper.— Z>o.ff, 1-8 fluidrachms (4.0-30.0 Cc). Formula: Oil of Juniper, 5; Alcohol, 95 parts. Spiritus Juniperi CompSsitus— Splritus Juniperi CompSsiti— Compound Spirit of Juniper.— Formula : Oil of Juniper, 8 ; Oil of Caraway, I ; Oil of Fennel, I; Alcohol, 1400; Water sufficient to make 2000 parts.— Z»o«, 2-4 fluidrachms- (8.0-15.0 Cc). Unofficial Preparations. Extractum Juniperi Frtlctus Fluidum — ExtrScti Juniperi Frfictus Fliiidi— Fluid Extract of Juniper Berries. — Dose, ^-2 fluidrachms (2.0-8.0 Cc). Infiisum Juniperi— Infusi Juniperi — Infusion of Juniper. — i ounce (31. Gm.) of Juniper to I pint (473. Cc.) of Water. — Dose, 2-4 fluidounces (60.-118. Cc). Physiological Action and Therapeutics. — Juniper in its action resembles buchu, being a stimulant diuretic. Under certain condi- tions it acts as a diaphoretic. It is a tonic to the stomach and a mild aphrodisiac. The volatile oil, which is the active constituent of juniper, diffuses through the blood with great facility, stimulating the heart, and, in dropsical conditions, increasing the 'flow of urine. In health, however, the amount of urine is diminished, while that of urea is augmented. Juniper is used for the same purposes as buchu — being superior to the latter drug perhaps — especially in various dropsies and passive congestion of the kidneys. Contraindications. — The same as for buchu. Administration. — Any of the preparations may be given, gin being a popular diuretic. Oleum TerebinthTna— Olei Terebinthlnae— Oil of Turpentine. V. S. -P. Origin. — A volatile oil distilled from turpentine — a concrete oleoresin obtained from Pinus palustris Miller and other species of Pinus. Description and Properties. — A thin, colorless liquid, of a characteristic odor and taste, both of which become stronger and less agreeable with age and exposure to air. Soluble in three DIURETICS. 641 times its volume of alcohol. Oil of turpentine should be kept in well-stoppered bottles, protected from light. Dose. — S-15 minims (0.3-1.0 Cc), in emulsion. Official Preparations. LinimSntum Terebinthinae — Linimfinti Terebinthlnse — Turpentine Lini- ment (35 per cent, with resin cerate). For external use. Dleum Terebinthinae Rectificatum — Olei Terebinthinae Rectiiicati — Rec- tified Oil of Turpentine. — Dose, 5-15 minims (0.3-1.0 Cc). Antagonists and Incompatibles. — The motor depressants and agents increasing waste therapeutically antagonize the action of turpentine. Bromine, iodine, and nitric and sulphuric acids are incompatible, explosion occurring with the first two, and combus- tion taking place by mixture with the acids named. Ssrnergists. — The therapeutic actions of turpentine are enhanced by buchu, cubeb, copaiba, oil of sandalwood, and the diffusible and alcoholic stimulants. Physiological Action. — Externally and Locally. — Oil of turpen- tine is antiseptic, hemostatic, irritant, counter-irritant, rubefacient, vesicant, and a parasiticide. Its action resembles closely that of the volatile oils as described under " Aromatics." When applied to the epidermis the drug dilates the cutaneous blood-vessels, occasioning a sensation of heat and producing red- ness of the skin, and, if the oil be applied with inunction for any length of time, vesication ensues, with, occasionally, intractable ulcerations. The fumes of oil of turpentine when inhaled cause great irritation of the eyes and the respiratory passages. The drug is readily absorbed from the unbroken skin. Internally. — Digestive System. — When taken into the mouth turpentine produces a burning, pungent taste and an immediate and augmented salivary secretion. Swallowed in immoderate amounts, the drug occasions a sensation of heat in the epigastrium, with in- creased peristaltic action and secretion. The intestines are simi- larly affected, the intestinal peristalsis being greatly augmented, the drug acting as an efficient carminative. Large doses of turpentine produce severe, burning pain in the stomach and bowels, accompanied by nausea, vomiting, and purg- ing, the feces often containing blood. The drug is an efficient anthelmintic for tape-worm. Circulatory System. — Turpentine is a cardiac stimulant, increasing the force and rapidity of the heart's action and raising arterial ten- 41 642 A TEXT-BOOK OF MA TERIA MEDICA. sion by direct cardiac influence. The blood-vessels are contracted by the drug, which may account for its hemostatic properties. Very large doses slow the heart by stimulating the vagus inhibitory center. Nervous System. — Small doses increase and large doses dimin- ish reflex excitability. Large doses produce giddiness, mental exhilaration, and incoherence of ideas, followed by dulness and occasionally coma. There is incoordination of movements, resulting in unsteady gait, great muscular weakness, and diminished sensation, usually preceding the impairment of voluntary motion. Respiratory System. — The effect of inhaled oil of turpentine on the respiratory passages has been described. When ingested the drug increases and disinfects the bronchial secretion. Small doses increase and large doses diminish the respiratory movements. Absorption and Elimination. — Oil of turpentine is rapidly diffused in the blood, in moderate doses stimulating the kidneys and in- creasing the flow of urine, to which it imparts the odor of violets. Large doses irritate the kidneys, lessening the amount of urine, rendering it highly colored, and in some cases producing albu- minuria, hematuria, and even total suppression. There are present priapism and a frequent desire to micturate. Turpentine is rapidly eliminated from the system, not only by the kidneys, but by the skin, and bronchial and intestinal mucous membranes as well. ' Temperature . — The drug is a mild antipyretic. Untoward Action. — Erythema and eczematous eruptions are produced by both the ingestion and the local application of turpen- tine. In susceptible individuals small doses may occasion serious disturbances of the genito-urinary and gastro-intestinal tracts, such as strangury, painful erections, salivation, and stomatitis. The administration of repeated doses of oil of turpentine may produce peculiar nervous manifestations, such as headache, drowsi- ness, dizziness, and a sense of mental vacuity. Poisoning. — Few cases are recorded of death resulting- from the ingestion of excessive amounts of turpentine, owing to the fact that the greater amount of the drug passes away through the bowels. The symptoms produced by very large doses are — great mus- cular weakness, abolition of reflexes, and violent vomiting and purging, with bloody evacuations from the bowels. There is great DIURETICS. 643 irritation of the genito-urinary tract, with constant efforts to mic- turate, hematuria or entire suppression of urine, painful priapism, and violent strangury. The skin is moist, and the face flushed or cyanosed, while dila- tation of the pupils, slow, labored, and stertorous breathing, and occasionally paroxysms of convulsive coughing, may be attendant symptoms. Either great mental excitement or profound insensibility may be present. The heart and circulatory system are greatly depressed, death, when occurring, being usually the result of cardiac failure. Treatment of Poisoning. — The stomach should be at once evacu- ated, and elimination favored by every possible means. The free administration of demulcent drinks is advisable, while to relieve pain opium may be given. Other symptoms should be treated according to their indications. Therapeutics. — Externally and Locally. — Oil of turpentine is an efficient counter-irritant, being employed as such in lumbago, my- algia, neuralgia, rheumatic pains, bronchitis, pleurisy, and various forms of chronic inflammation. A turpentine stupe is perhaps the most effective method in the local application of the drug. It is appUed as follows: (i) A flannel is wrung out of hot water, sprinkled well with the oil and allowed to remain in contact with the affected part from five to twenty minutes, as indicated by the sensibility of the skin. Care must be taken in the preparation of the flannel lest the patient be chilled or scalded. (2) A vessel containing the oil is placed in hot water and a flannel wrung from the oil applied as desired. A turpentine stupe is perhaps the most grateful and efficient local application in peritonitis. Owing to its antiseptic and hemostatic properties the oil of turpentine is frequently and beneficially employed as a dressing for lacerated wounds. The drug is an active parasiticide, and has been used success- fully in the treatment of tinea tonsurans, etc. It has also been favorably recommended, when diluted with some bland oil, as a remedy for alopecia areata and psoriasis. Turpentine serves a useful purpose in many diseases of the ear and throat. Cecchini uses turpentine in the treatment of caries of the tem- poral bone. J. Solis Cohen recommends the vapor of turpentine as an 644 '4 TEXT-BOOK OF MATERIA MEDICA. efficient means of allaying the cough and irritation occasioned by acute laryngeal catarrh. Erichsen employs the drug as a hemostatic to check bleeding after excision of the tonsils. The inhalation of the oil of turpentine lessens pulmonary hyperemia and excessive bronchial secretion. The drug has been recommended as a local application in diphtheria after the removal of the membranes. Internally. — Turpentine is a valuable remedy for gastric or intestinal flatulence, particularly when the condition arises from an atonic state of the muscles of the stomach or intestines. The drug is frequently employed in typhoid fever, not only for the relief of tympanitis, but also to check intestinal hemorrhage. In chronic intestinal catarrh, as well as in a catarrhal condi- tion of any mucous membrane, turpentine is a valuable remedial agent. The drug is an effectual hemostatic when given internally, having been successfully employed in hemoptysis, hematemesis, hematuria, menorrhagia, purpura hemorrhagica, etc. Turpentine is a very powerful anthelmintic against tape-worm. When given for this purpose it should be administered in a single large dose, from 4-8 fluidrachms (i 5.-30. Cc), together with a large dose of some purgative like castor-oil to ensure the prompt elimination of the turpentine from the bowels. As a cardiac stimulant turpentine is often employed in low and depressed conditions of the circulatory system, such as typhoid, yellow, and puerperal fevers, pneumonia, capillary bronchitis, trau- matic erysipelas, etc. As has been suggested, the drug has a decided and beneficial influence upon relaxed and chronic catarrhal conditions of mucous membranes, rendering this remedy of great value in bronchorrhea, chronic bronchitis, emphysema with marked bronchial catarrh, etc. This action upon the mucous membranes, together with the diu- retic properties of the drug, renders turpentine an exceedingly valuable remedy in the treatment of gleet, subacute gonorrhea, chronic cystitis, spermatorrhea, prostatorrhea, pyonephrosis, etc. Old ozonized oil of turpentine is one of the best antidotes and prophylactics in cases of phosphorus-poisoning. So-called atonic incontinence of urine is frequently benefited by the drug ; and Durand has highly recommended oil of turpen- tine as a solvent of biliary calculi. DIURETICS. 645 Contraindications. — Oil of turpentine should never be given to patients suffering from Bright's disease or acute inflammation of the gastro-intestinal and genito-urinary tracts. The drug should be withheld in cases of active hemorrhage in plethoric subjects ; and, while some authorities recommend turpen- tine in hematuria, others class this condition as a contraindication. If given in the latter condition, the dose should be small and cautiously repeated. Administration. — Small doses of turpentine may be given on lumps of cut sugar, but usually preference is given to administra- tion in the form of a capsule or an emulsion, i fluidrachm (4. Cc.) of mucilage of acacia, if properly manipulated, emulsifying \ fluid- drachm (2. Cc.) of oil of turpentine with i fluidounce (30. Cc.) of water. Flavoring substances can be incorporated in the emulsion, rendering the preparation not unpleasant to the taste. In giving turpentine its tendency to produce untoward manifes- tations, particularly of the genito-urinary tract, should be remem- bered, care being invariably exercised in the administration of the drug. For external use the drug may be used in full strength, diluted with some bland oil or ointment, or applied in the form of stupes. Turpentine is sometimes employed as an enema, in which case it should, of course, be mixed with some bland oil and mucilage of acacia in the form of an emulsion. Copaiba— Copaibae— Copaiba. TJ. S. JP. (Balsam of Copaiba.) Origin. — The oleoresin of Copaiba Langsdorffii (Desfontaines) O. Kuntze, and other species of Copaiba, lofty forest trees, natives of Central America. Description and Properties. — A transparent or translucent, more or less viscid liquid of a pale-yellow to brownish-yellow color, having a peculiar aromatic odor and a bitter acrid taste. Insoluble in water ; readily soluble in absolute alcohol, ether, chlo- roform, carbon disulphide, benzin, and fixed and volatile oils. Copaiba contains a volatile oil, two resins, copaibic acid (soluble in absolute alcohol and in ammonia), and a bitter principle. The term " balsam " is a misnomer, since the drug contains neither benzoic nor cinnamic acid. Dose. — 5-30 minims (0.3-2.0 Cc), in emulsion or in capsule. 646 A TEXT-BOOK OF MATERIA MEDIC A. Official Preparation. Massa Copaibse — MSssse Copaibs — Mass of Copaiba. — Formula: Copaiba, 94; Magnesia, 6; Water, a sufficient quantity. — Dose, 5-30 grains (0,3-2.0 Gm.). Oleum Copaibse— Olei Copalbae— Oil of Copaiba. Z7. 8. P. Origin. — A volatile oil distilled from Copaiba. Description and Properties. — A colorless or pale-yellowish liquid, having the characteristic odor of copaiba and an aromatic, bitterish, and pungent taste. Soluble in about ten times its volume of alcohol, forming a slightly turbid liquid, which is neutral to litmus-paper. The drug should be kept in well-stoppered bottles, in a cool place. Dose. — 5-15 minims (0.3-1 Cc). ResTna Copalbae— ResTnae Copalbae— Resin of Copaiba. U. S. JP. Origin. — The residue left after distilling off the volatile oil from Copaiba. Description and Properties.' — A yellowish or brownish-yellow, brittle resin, having a slight odor and taste of copaiba. Soluble in alcohol, ether, chloroform, carbon disulphide, benzol, and amylic alcohol. Dose. — 5-15 grains (0.3-1.0 Gm.). Antagonists and Incompatibles. — Copaiba is antagonized by the same drugs which antagonize turpentine. It is pharmaceuti- cally incompatible with aqueous preparations. Synergists. — The same as for turpentine. Physiological Action. — Externally and Locally. — Copaiba has no influence of importance, being but slightly stimulant to the skin. Internally. — Digestive System. — Its action is analogous to that of turpentine and the volatile oils. The ingestion of the drug, even in small doses, is almost always succeeded by eructations tasting of copaiba. Copaiba exerts no special influence upon the circulatory, ner- vous, and respiratory systems. Absorption and Elimination. — The drug enters the circulation with facility, and is, slowly eliminated by the skin and mucous membranes generally, although chiefly by the kidneys. The resin which the drug contains is a powerful stimulant of the genito- DIURETICS. 647 urinary structures, increasing the quantity, and to some extent the solid constituents, of the urine. Large doses irritate the kidneys, occasionally producing strangury, bloody urine, pain in the blad- der, etc. Under the use of copaiba albumin is sometimes found in the urine. Frequently the nitric-acid test with urine may give a reac- tion as if for albumin, the conclusions being then erroneous, since the resin of copaiba eliminated in the urine is by the action of nitric acid precipitated as a milky cloud, readily diiiferentiated from albumin by heating the urine or mixing it with alcohol, by both of which means the resinous precipitate is dissolved. Copaiba acts as a stimulant and disinfectant at the points of elimination, in medicinal amounts increasing secretion and impart- ing to the secretion from the kidneys, bronchial mucous membrane, and skin a peculiar, fragrant odor. Untoward Action. — It often happens that after a few days' ad- ministration of copaiba there is produced in certain individuals an eruption, usually resembling roseola, which later may be trans- formed into true papules. Or the eruption may be scarlatiniform in character or a true eczema ensue. These eruptions are first noticeable on the upper and lower extremities, backs of the hands and knees, malleoli, etc., and are attended with intense itching. Under the prolonged use of the drug there may occur serious disturbances of the digestive and genito-urinary tracts. Poisoning. — In addition to the untoward manifestations already mentioned, very large doses of copaiba produce symptoms similar to those described under Turpentine. Cases have been recorded in which excessive amounts occasioned paralysis and tetanoid attacks. Treatment of Poisoning. — This should be the same as prescribed under Turpentine. Therapeutics. — Externally and Locally. — The use of copaiba has recently been revived by Dr. Beach of Boston as a protectant antiseptic and antiphlogistic dressing for the treatment of chronic and indolent ulcers. It has been advocated as an excellent application in many chronic diseases of the skin, such as psoriasis, lupus, etc. The drug has proved valuable in frost-bites, while Shoemaker mentions it as a useful remedy to apply to " thickened and irritable conditions of the tongue, mouth, rectum, vagina, uterus, and urethra" The same authority affirms that the drug sometimes completely re- 648 A TEXT-BOOK OF MATERIA MEDICA. moves the discharge of gleet when applied directly to the ure- thra. Internally. — The principal use of copaiba is as a stimulant and disinfectant of the genito-urinary tract in cases of gleet, subacute gonorrhea, vaginitis, cystitis, pyelitis, etc. In ascites and dropsical conditions, particularly those due to hepatic and cardiac disease, the resin of copaiba proves a very efficient and reliable diuretic. Under prolonged use, however, a tolerance appears to be established. Copaiba is a valuable remedy in chronic bronchitis and bronchor- rhea with offensive expectoration. The drug has been at times given internally with good results in psoriasis, urticaria, etc., although the internal use of copaiba in these disorders is less common than formerly. The drug has found enthusiastic advocates as a remedy in chronic diarrhea and dysentery, and has also been recommended in chronic proctitis and chronic intestinal catarrh. Contraindications. — The same as for turpentine. Administration. — The methods of administration recommended for turpentine are applicable to this drug. It is claimed that many of the untoward manifestations produced by copaiba may be pre- vented by giving the drug with an alkali. With this object in view copaiba was associated with magnesia in the " Massa Copaibse." Yet, while this preparation is perhaps less likely to produce unto- ward results, it is undoubtedly less active therapeutically than the single drug. Oleum Santali— Olei Santali— Oil of Santal. V. 8. P. (Oil of Sandalwood.) Origin. — A volatile oil distilled from the wood of Santalum album L., a small tree indigenous in Southern India and portions of the East Indies. Description and Properties. — A pale-yellowish or yellow, somewhat thickish liquid, having a peculiar, strongly aromatic odor and a pungent, spicy taste ; readily soluble in alcohol. It is frequently adulterated with oil of cedar. Dose. — 5-20 minims (0.3-1.2 Cc). Physiological Action and Therapeutics. — The action of oil of sandalwood resembles closely that of copaiba, and it may be given for the same purposes as the latter drug, although oil of sandal- DIURETICS. 649 wood is more popular, and ordinarily a more efficient remedy, for gonorrhea, particularly in the early stages. Administration. — The same as in the case of copaiba. Cubeba— Cubebae— Cubeb. V. S. F. Origin. — The unripe fruit of Piper Cubeba Linn, fil., a climbing diecious shrub about 20 feet (6 M.) high, indigenous in Java. Description and Properties. — Globular, about ^ or |- inch (4 or 5 Mm.) in diameter, contracted at the base into a rounded stipe about i or f inch (6 or 10 Mm.) long, reticulately wrinkled, blackish-gray, internally whitish and hollow ; odor strong, spicy ; taste aromatic and pungent. It contains from 5 to 15 per cent, of a volatile oil, an odorous principle, cubebin, and a diuretic prin- ciple, cubebic acid, besides resin, fat, wax, and starch. Dose. — 5-60 grains (0.32-4.0 Gm.). Official Preparations. Extractum Cubebae Fluidum — ExtrScti Cubebee Fluidi — Fluid Extract of Cubeb. — Dose, 5-60 minims (0.32-4.0 Cc). Oleoreslna Cubebae — Oleoresinae Cubebae — Oleoresin of Cubeb. — Dose, 15- 30 minims (0.32—2.0 Cc). Tinctura Cubebae — Tincturae Cubebae — Tincture of Cubeb (20 per cent). — Dose, ^-2 fluidrachms (2.0-8.0 Cc). Trochlsci Cubebae — TrocMscos (ace.) Cubebae — Troches of Cubeb. (Each troche contains % minim (.043 Cc.) of the oleoresin.) — Dose, I to 6 troches. Oleum Cubebae— Olei Cubebae— Oil of Cubeb. TJ. S. P. Origin. — A volatile oil distilled from Cubeb. Description and Properties. — A colorless, pale-greenish, or yellowish liquid, having the characteristic odor of cubeb and a warm, camphoraceous, aromatic taste. Soluble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a cool place, protected from light. Dose. — 5-15 minims (0.3-1.0 Cc). Antagonists and Incompatibles. — The motor depressants and cardiac stimulants antagonize the action of cubeb. Sjmergists. — Buchu, copaiba, oil of santal, black pepper, and many of the aromatics and volatile oils. Physiological Action. — Externally and Locally. — Like the aromatics and drugs containing a volatile oil, cubeb is irritant and rubefacient when applied by inunction. 650 A TEXT-BOOK OF MATERIA MEDICA. Internally. — Digestive System. — In medicinal amounts cubeb is an aromatic stomachic, increasing the appetite and improving digestion. As is the case with other drugs of this class, large dos- age or the too prolonged use of small amounts irritates the stomach and deranges digestion, cubeb acting as a laxative and occasioning a sensation of heat and discomfort about the rectum. Circulatory System. — Like other members of the Pepper family, cubeb enters the blood with facility, and increases the force and frequency of the heart's action. Nervous System. — No important action has been noted. Respiratory System. — There is no perceptible effect when the drug is given in medicinal doses. Absorption and Elimination. — Cubeb is absorbed and eliminated with considerable rapidity. It escapes from the system chiefly by the urine, though the skin and bronchial mucous membrane share in the excretory process. The drug acts as an active stimulant and disinfectant to the structures by which it is excreted, and is consequently a diuretic expectorant and mild diaphoretic. The urine and the amount of uric acid are increased by cubeb, the drug appearing in the urine as a salt of cubebic acid, which may be precipitated by nitric acid, the precipitate resembling that of albumin. Untoward Action. — Cubeb occasionally produces great disturb- . ance in the gastro-intestinal tract, colicky pains, and diarrhea. The most frequent untoward manifestations, however, are various cutaneous eruptions, appearing in the form of papules, and often- | times as a diffuse erythema. No febrile symptoms attend these eruptions, which usually disappear shortly after the suspension of the drug. Poisoning. — Although cubeb is not regarded as a poison, very large doses may be followed by all the symptoms of severe gastro- intestinal irritation. Treatment of Poisoning. — The indications are to empty the stomach, favor elimination, and treat the patient symptomatically by the use of demulcents, anodynes, stimulants, etc., as necessary. Therapeutics. — Externally and Locally. — The drug is a de- servedly popular remedy in many diseases of the nose and throat. The insufflation of an impalpable powder of cubeb or the inhala- tion of smoke from the burning drug is an efificient palliative to the sense of oppression arising from turgescence of the nasal mucous membrane. DIURETICS. 651 The troches of cubeb are extensively used for coughs, hoarse- ness, etc. The oil of cubeb is used as an inhalant and as a local application in many diseases of the throat and respiratory passages. Intertially. — Cubeb is used internally for about the same pur- poses as copaiba, although by many physicians considered to be inferior to the latter drug in genito-urinary disorders. The drug has been recommended in certain nervous disorders, such as headache, impaired memory, vertigo, and fainting, and has even been thought to prove beneficial in certain cases of paralysis. Contraindications. — The same as for copaiba. Administration. — Any of the preparations may be given. The oleoresin is best administered in capsules or emulsion. Diuretin— Diuretin— Diuretin. (SODIO-SALICYLATE OF THEOBROMINE.) Origin. — The name indicates the origin, the drug being a chemi- cal combination of Theobromine (49.7 per cent.) and Salicylic Acid (38.1 per cent.). It is, in reality, a deiinite double compound of Sodium Theobromine and Sodium Salicylate. Description and Properties. — A white powder, soluble in less than half its weight of hot water, the solution remaining perfect on cooling. Sparingly soluble in cold water ; soluble in warm alco- hol ; insoluble in chloroform or ether. The drug has a disagree- able, soap-like taste, and undergoes decomposition when exposed to the air. Dose. — 15 grains (i.o Gm.); 45 to 105 grains (2.9-7.0 Gm.) may be given in divided portions in twenty-four hours. Antagonists and Inoompatibles. — The properties of diuretin being as yet imperfectly known, it is impossible to enumerate all the antagonists, incompatibles, and synergists. The action of the drug would certainly be retarded by the cardiac and motor de- pressants. Acids, both mineral and vegetable, are incompatible. Synergists. — The therapeutic influence of the drug would theoretically be enhanced by caffeine, digitalis, and many of the cardiac stimulants and diuretics. Physiological Action. — Externally and Locally. — There is none. Internally. — Digestive System. — Diuretin has no important ac- tion, though in many cases it may cause disturbance of digestion, impair the appetite, and even occasion nausea, vomiting, and diarrhea. Circulatory System. — There is some difference of opinion regard- 652 A TEXT-BOOK OF MATERIA MEDIC A. ing the effect of diuretin upon the heart and blood-vessels. Pa- winski concluded, from a study of over 50 cases, that the drug does not regulate the heart's action through any influence on the nerves of that organ, its effect upon it bteing due entirely to the action of diuretin in diminishing the edema by its diuretic property, thereby removing the obstacles to be overcome by the heart. This view is entertained by Cohnstein, Gram, and Schroeder, and, to judge from a few careful experiments, the author is of the same opinion. On the other hand, authorities so eminent as Pfeffer, Kress, Hoffman, Geissler, Babcock, and Herrick believe that the drug strengthens the heart's action after the manner of digitalis. Nervous System. — Large and continued doses frequently occa- sion headache, somnolence or insomnia, with buzzing in the ears, and symptoms resembling those produced by the salicylates. Respiratory System. — Diuretin exerts no direct influence upon the respiratory system. Yet dyspnea, bronchitis, etc., the result of a dropsical condition, are relieved by the administration of the drug. Absorption and Elimination. — Diuretin is somewhat rapidly ab- sorbed, being eliminated mainly by the kidneys, the process greatly . stimulating the renal epithelium. It is proper to state, however, that some authors attribute the diuretic power of the drug to its action upon the circulation, rather than to any effect upon the secreting structures of the kidney. The author's experience leads him to incline to the opinion that the principal action of the drug is upon the kidneys. In cases where diuretin is indicated the amount of urine is increased from three- to sixfold in twenty-four hours, under its administration the diuretic action of the drug gradually reaching its maximum between the second and third days. In the case of healthy persons diuretin has little influence upon the amount of urine excreted. Untoward Action. — In certain individuals the drug causes great disturbance of the gastro-intestinal tract, such as nausea, vomiting, diarrhea, palpitation of the, heart, headache, and slight fever ; occa- sionally cutaneous eruptions may be present. Poisoning. — No cases of poisoning are recorded. Therapeutics. — The drug is used exclusively as a diuretic in cases of dropsy, ascites, pleuritic effusion, etc. Diuretin is worthy of a thorough trial for the removal of drop- sical fluids, irrespective of the cause. DIURETICS. 653 Dr. Herrick of Chicago, who has not only devoted much study to the literature of the subject, but has also had a wide experience with the remedy, in a recent paper on " Diuretin " sums up the medical uses of the drug as follows : " Diuretin is a diuretic acting by direct stimulation of the renal epithelium, and best suited to cases in which there is general drop- sical effusion. It is the best medicinal remedy for removing drop- sical fluid due to valvular disease of the heart after digitalis and pure cardiac tonics have failed. Diuretin has oftentimes a bene- ficial effect in other circulatory diseases with dropsy, as myocarditis, pericarditis, aneurysm, arteriosclerosis. Its action is here more uncertain than in valvular disease. In the dropsy of nephritis it can be used without danger of irritating the kidney, the effects in acute nephritis being more certain than in chronic nephritis. Where the renal epithelium has undergone too extensive degeneration the drug may fail to act. In the dropsy of portal obstruction, arid especially of cirrhosis of the liver, it usually fails to give good results." Contraindications. — There are no special contraindications to the use of diuretin, unless it be in cases of marked gastric irritation, when the drug would undoubtedly aggravate the symptoms. Administration. — Diuretin may be given in capsules or dis- solved in some aromatic water or in milk. It should never be dispensed in powders, since it absorbs carbonic acid from the air and undergoes decomposition. It is preferable to give the drug in solution ; and it can be easily associated with digitalis and similar remedies, but when used with the cardiac remedies the doses of diuretin should be smaller. When giving this drug in cases of marked ascites, or for the removal of large quantities of dropsical fluid, the first doses should be small and gradually increased to the maximum amount or until the desired effect be produced, lest by a too sudden removal of the fluid alarming collapse ensue. As acids are incompatible with the drug, diuretin should not be given immediately after meals, but its administration postponed for about three hours, to avoid unpleasant symptoms arising from the action of the gastric juice upon the remedy. The practice of adding fruit syrups or juices to a solution of diuretin for the purpose of rendering it more palatable should be strictly avoided, since the theobromine is precipitated by the vege- table acids as a thick white sediment. 654 A TEXT-BOOK OF MATERIA MEDIC A. The maximum daily amount which can be safely administered is 150 grains (9.72 Gm.). The average daily amount is 45 to 105 grains (2.9-7.0 Gm.), given in divided doses of about 15 grains (i.o Gm.) each. If diuresis is not increased in six days, the use of the drug should be suspended and recourse to other treatment adopted. Piperazlnum— Piperazini— Piperazin. (PiPERAZIDINE; ETHYLENEIMINE; DiETHYI.ENEDIAMINE ; DiSPERMINE.) Origin. — Obtained by the action of Ammonia on Bromide or Chloride of Ethylene. Description and Properties. — It occurs as a crystalline solid, exceedingly soluble in water, the solution being practically taste- less. When exposed to the air the drug is very deliquescent, becoming completely liquefied on long exposure. Dose. — 5-15 grains (0.3-1. o Gm.). Antagonists and Incompatibles. — The incompatibles are alka- loids, tannic acid, preparations of cinchona, salts of iron, alum, Donovan's solution, acetanihd, phenacetine, and sodium salicylate. Synergists. — Lithium and its salts and the lithontriptics enhance the therapeutic action of piperazin. Physiological Action and Therapeutics. — The drug apparently has no effect whatever upon either the Digestive, Circulatory, or Respiratory Systems. Excessive doses, however, have affected the Nervous System, producing certain untoward manifestations, such as muscular tremors, hallucinations, and clonic spasms. The drug is non-irritating when apphed to mucous membranes. Piperazin is rapidly absorbed from the stomach, circulates in the blood unchanged, and reaches the concretions of urates and gouty deposits, neutralizing and dissolving them, thus hastening their removal from the body. Piperazin may be detected in the urine two hours after ingestion. The only important action of piperazin is its property of dis- solving uric acid, with which it forms a neutral and exceedingly soluble salt, piperazin urate, said to be seven times more soluble in water than lithium urate. The superiority of piperazin over lithium carbonate as a uric- acid solvent has been indubitably established. Under the administration of piperazin there is an enormous in- crease in the amount of urea, with a corresponding decrease in the elimination of uric acid, indicating that there is active oxidation. DIURETICS. 655 While greatly increasing the amount of urea eliminated, neither the volume of urine nor the acid reaction of that fluid is ordinarily- influenced. Moreover, while in certain cases diuresis is consider- ably augmented, the specific gravity of the urine is lowered, al- though the urine never becomes alkaline or even neutral. Therapeutics. — Externally and Locally. — A solution of pipera- zin (i to 2 per cent.) in a mixture of water and alcohol (i to 4, re- spectively) has been applied locally to gouty joints and swellings with beneficial results. A similar solution is equally effective in relieving the pain, allaying the inflammation, and hastening the healing of gouty sores. Solutions of piperazin may be injected into the bladder in order to dissolve vesical calculi. The drug has been recommended for local hypodermic injection in gout, although Wittsock, who used it in this manner consider- ably, claims that the subcutaneous administration of piperazin is painful and dangerous, causing inflammation with tendency to abscess. Internally. — Piperazin is one of the most useful remedies in gout. Its efficacy in this disease is said to be enhanced by combining with it phenocoU hydrochloride or phenacetin. Renal and vesical calculi of the uric-acid variety are dissolved by the free administration of piperazin. It has even proved bene- ficial in chronic cystitis and chronic rheumatic arthritis. Gruber has advocated the use of the drug in diabetes mellitus, and it has proved to be of service in renal colic and hematuria. It is in the uric-acid diathesis, however, that the drug is par- ticularly useful. The pruritus of this condition and other manifes- tations so frequently resulting from imperfect elimination of nitrog- enous material are promptly relieved by the internal administra- tion of this remedy. Contraindioations. — None of importance can be named. Administration. — Piperazin is best given in aerated water, al- though it may be acceptably administered in distilled water and syrup, orange flower water, or other agreeable vehicle. Saccharlnum—Saccharini— Saccharin. (Anhydro-ortho-sulphamin-benzoic Acid ; Benzoyl-sulphonic-imide ; Gluside ; Glucusimide.) Origin. — A derivative of the aromatic series, prepared by a complicated process from Toluene. 656 A TEXT-BOOK OF MA TERIA MEDICA. Description and Properties. — A white, crystalline powder, of an acid reaction, a faint, amygdaloid odor, and an intensely sweet taste. One part of saccharin in 70,000 parts of water will impart to the solution a decidedly saccharine flavor, the drug being nearly 300 times sweeter than cane-sugar. Saccharin is slightly soluble in water, 1 : 400 ; soluble in 30 parts of alcohol ; and freely soluble in glycerin. The commercial article is usually very impure. Dose. — \—2 grains (0.03-0. 12 Gm.). Physiological Action. — In a neutral or alkaline medium sac- charin acts as an antiseptic. Internally it exerts no notable influ- ence. It is said that when mixed with food it interferes with the action of saliva upon starch, and it is thought to retard the action of the other digestive ferments. The drug is not decomposed in the body, and is ehminated by the kidneys unchanged, increasing the amount of chlorides excreted in the urine, which fluid is so influenced by the drug that it does not so readily undergo fer- mentation. Therapeutics. — Externally and Locally. — Saccharin is used as a mouth-wash, being especially beneficial in aphthce. Felici of Rome highly recommends the application of a solution of saccharin in ozena. Internally. — The principal use of the drug is as a substitute for sugar in cases of diabetes. > Dr. James Little recommends saccharin in chronic cystitis with ammoniacal urine. The drug is extensively used in various elixirs, syrups, etc. to overcome the bitterness of quinine and other bitter alkaloids. Administration. — Saccharin should be given in solution. GROUP XIV.— CATHARTICS. Cathartics or Purgatives are substances which produce in- testinal evacuations— either (i) by increasing peristalsis, (2) by augmenting secretion, or (3) by diminishing absorption. Physiological Action. — In order to produce evacuations from the bowels drugs act (i) locally — {a) Upon the muscles and glands of the intestines ; {B) Auerbach's and Meissner's ganglia ; (c) Ends of the afferent nerves in mucous membranes of the CATHARTICS. 657 intestines, passing respectively to Auerbach's and Meiss- ner's ganglia ; (fl?) Ends of local efferent nerves, passing from Auerbach's and Meissner's ganglia to the intestinal muscles and glands. (2) They act through the coordinating mechanism— (a) By acting upon the peripheral endings of the afferent nerves which pass from the intestinal mucous membrane to the six intestinal centers in the brain ; {U) Upon the six centers in the brain ; if) Upon the six sets of efferent nerves which pass from the six centers in the brain through the various abdominal ganglia to the intestine, terminating in Auerbach's and Meissner's ganglia in the walls of the arterioles ; (d^ Probably by acting upon certain abdominal ganglia, such as the suprarenal and mesenteric plexuses and similar ganglia. Intestinal peristalsis may be increased by stimulation of — 1 . The intestinal muscles (moderate stimulation) ; 2. The afferent nerves connecting the intestinal mucous mem- brane with Auerbach's ganglia; 3. Auerbach's ganglia ; 4. The ends of the efferent nerves passing from Auerbach's ganglia to the intestinal muscles; 5. The ends of the afferent nerves passing from the. intestinal mucous membrane to the brain ; 6. The motor centers in the brain ; 7. The ends of the motor nerves terminating in Auerbach's ganglia. Depression of — 8. The inhibitory motor center ; 9. The ends of the inhibitory motor nerves terminating in Auerbach's ganglia; 10. The inhibitory motor center in the suprarenal plexus. It will be seen that any substance which stimulates the motor apparatus or depresses the inhibitory motor mechanism will increase peristalsis. Intestinal secretion may be promoted by stimulation of — 1 . The secretory cells ; 2. The ends of the afferent nerves passing from the intes- tinal mucous membrane to Meissner's plexus ; 42 658 A TEXT-BOOK OF MA TERIA MEDIC A. 3. Meissner's ganglia; 4. The ends of the efferent nerves passing from Meissner's ganglia to the intestinal glands ; 5. The ends of afferent nerves in the intestinal mucous membrane which pass from the secretory center in the brain ; 6. The secretory center in the brain ; 7. The ends of the secretory fibers from the brain terminat- ing in Meissner's ganglia. Depression of — 8. The inhibitory secretory center in the brain ; 9. The ends of the inhibitory secretory fibers from the brain terminating in Meissner's plexus ; 10. The inhibitory secretoiy center in the superior mesenteric plexus ; 11. The afferent nerves in the intestinal mucous membrane which pass to the vaso-constrictor center in the brain ; 12. The vaso-constrictor center in the brain; 13. The ends of the vaso-constrictor nerves from the brain terminating in the ganglia in the walls of the arterioles. Similar actions upon the vaso-dilator apparatus would affect intestinal secretion. It is obvious that intestinal secretion may be promoted by any substance which serves to stimulate the secretory or the vaso- dilator apparatus, or to depress the inhibitory secretory or vaso- constrictor mechanism. The methods by which absorption is diminished are not thor- oughly understood, but it is known that — I . By increasing peristalsis and hastening the removal of fluid from the bowels absorption takes place less rapidly ; 2. By giving drugs — e. g. magnesium sulphate — having high osmotic equivalents, with a great affinity for water, the absorption of fluid is prevented ; 3. Substances which in some manner affect the columnar epithelium of the intestinal glands retard absorption ; 4. Drugs which diminish the circulation in the intestinal mucous membranes act as deterrents to the absorptive process. Cathartics may be classified according to their various actions, the following table serving to show how and where the various drugs exert their several influences : CATHARTICS. 659 /. Classification according to their Mode of Action. Laxatives. Cassia. Castor oil. Cascara sagrada. * Glycerin. * Magnesia. * Magnesium carbonate. Manna. Sulphur. Taraxacum. There are certain drugs which are not classed as cathartics, which are some- times prescribed by physi- cians as laxatives, such as — Belladonna.* Ergot.* Hyoscyamus.* Nux vomica.* Physostigma.* Stramonium.* Certain articles of diet are laxative, such as bran bis- cuit, brown bread, ginger- bread, oatmeal, figs, honey, molasses, prunes, raspber- ries, strawberries, tama- rinds, olive oil, etc. Simple purgatives. Aloes. Calomel.* Cascara sagrada (full doses). Castor oil (full doses). Ox-gall. Rhubarb. Euonymus. Iris. Juglans. Leptandra. Senna. Hydragogue purgatives. Croton oil (small doses). Elaterin. Gamboge. Salines. Magnesium citrate. Magnesium sulphate. Potassium bitartrate.* Potassium sulphate. Potassium tartrate.* Potassium and sodium tartrate. Sodium phosphate. Sodium sulphate. Drastic purgatives. Cathartic acid (hy- podermically). Colocynth. Croton oil. Elaterin. Gamboge. Jalap. Scammony. Podophyllin 2. Classification according to their Manner of reaching the Intestinal Mechanism. By first contact. Nearly all the drugs used as cathartics. By circulation contact. Belladonna.* Morphine.* Muscarine.* Physostigma.* Pilocarpine.* Strychnine.* By excretion contact. Aloes. Castor oil. Croton oil. Colocynth. Elateriura. Podophyllin. Rhubarb. Senna. 3- Conditions of the Intestines affecting the Action of Drugs. Drugs requiring the presence of an alkali or bile to act. Aloes. Elaterium. Gamboge. Jalap. Drugs requiring the presence of an acid to act. Magnesium carbonate.* Magnesia.* Drugs not requiring the presence of either alkali, bile, or acid. Castor oil. Colocynth. Croton oil. Euonymin. (Drugs marked with an asterisk (*) are here given in detail ; others are described elsewhere.) 66o A TEXT-BOOK OF MATERIA MEDICA. Drugs requiring the presence of an allcali or bile to act. Scammony. Sulphur. Drugs not requiring the presence of either alkali, bile, or acid. Iris. Leptandra. Magnesium citrate. Magnesium sulphate. Podophyllin. Potassium and sodium tar- trate. Rhubarb. Senna. Sodium phosphate. Classification according to the Anatomical Portion of the Intestinal Canal on which they Act. Small intestine :. Colon. Descending colon and rectum. Calomel.* Colocynth. Aloes. Castor oil. Croton oil. Jalap. Elaterium. Leptandra. Gamboge. Podophyllin. Magnesium citrate. Rhubarb. Magnesium sulphate. Scammony. Potassium bitartrate.* Senna. Potassium sulphate. Potassium tartrate.* Potassium and sodium tartrate. Sodium sulphate. J. Classification of Cathartics according to 1 Other Actions. Stomachics. Hepatic stimulants and Galactagognes. cholagogues Rendering the Increasing milk menstrual purgative. flow. Aloes. Aloes. Castor oil. Aloes. Aloes. Cascara sagrada. Colocynth. Castor oil. ^uonymin. Colchicin. Rhubarb. Leptandrin. Euonymin. Senna. Iridin. Iridin. There are Rhubarb. Leptandrin. Podophyllin. Sodium phosphate. Sodium sulphate. Cholagogues. Aloes. Mercury with chalk.* Calomel.* Pil. hydrargyri.* Colocynth. Podophyllin. Euonymin. Rhubarb. Iridin. probably some other cathartics that affect the milk. (Drugs marked with an asterisk (*) are here given iti detail; others are described elsewhere.) CATHARTICS. 66i It is apparent that certain drugs produce various effects, and that their mode of action varies according to the size of the dose and occasionally with the idiosyncrasy of the patient. Nearly all cathartic drugs act by some local influence upon the intestinal mucous membranes previous to absorption ; others, again, affect the bowels after they have entered the circulation — strych- nine, for example, physostigmine, pilocarpine, etc., acting in this manner. Certain other drugs, such as podophyllin, colocynth, etc., if in- jected into the circulation are excreted by the mucous membrane of the intestines, and by their irritation produce catharsis. The condition of the intestinal canal has much to do with the activity of certain drugs. Thus certain medicines produce cathar- sis regardless of the reaction of intestinal fluids ; others are inert without the presence of bile or other alkaline fluids or salts ; and still a third class occasion catharsis only when after ingestion they come in contact with an acid. Of the last mentioned, magnesium carbonate is an excellent example, the drug being inert unless it be acted upon by an acid in the stomach or bowels. It is a remarkable fact that, as is shown in the tables, different cathartics act more energetically upon different portions of the in- testines. The action of calomel, for instance, is almost entirely confined to the duodenum, while aloes acts only upon the descend- ing colon and the rectum. In selecting a cathartic, therefore, a knowledge of the part of the intestinal canal to be acted upon and the locality in which the drug operates is necessary in order to secure the most satisfactory results. Many cathartics contain principles which render them tonic to the stomach ; others greatly stimulate the secretion of bile (hepatic stimulants) ; while the cholagogues merely hasten the expulsion of bile from the intestinal canal, preventing its absorption. Certain drugs, being excreted in the milk, which it renders purgative, are well adapted for administration to the nursing mother in order to produce catharsis in the infant. Castor oil, greatly augmenting the secretion of milk, is an excellent medium as a -laxative in such cases. Aloes increases the menstrual flow ; other drugs promote the secretion of urine, etc. Therapeutics. — Cathartics are employed — I. To remove feces and produce a simple evacuation of the bowels. The Laxatives are best adapted for this purpose. 662 A TEXT-BOOK OF MATERIA MEDICA. 2. For the relief of chronic constipation. For this purpose great judgment is requisite in the selection of a drug or combination of agents, it being important to determine whether there is diminished peristalsis or secretion ; whether there exists an atonic condition of the intestinal muscles ; or whether the disorder is located in the small intestine, the colon, or the rectum. 3. To remove frorn the bowels noxious substances or pathogenic matter. For this purpose the mercurial preparations, calomel or gray powder, are best, since they are not only active cathartics, but bactericides as well. 4. To stimulate the torpid liver. For this purpose the hepatic stimulants would naturally be employed. 5. To lessen the activity of the liver, s.sv!\\y^\o\x's, CQT\dcAAor\s. In such cases the cholagogue cathartics should be used. 6. To deplete the gastro-duodenal mucous membrane, where the congested and swollen mucous membrane obstructs the outflow of bile, resulting in jaundice. In this condition the salines, especially the sodium salts, are the most efficient cathartics. 7. To promote absorption and remove dropsical effusions in cer- tain diseases of the heart, liver, and kidneys. Here active cathar- sis is necessary, the hydragogue cathartics being indicated. 8. To remove urea, etc., from the blood. Occasionally in certain renal diseases the functional activity of the kidneys is so defective that waste matter, urea, etc., rapidly accumulates in the system, occasioning uremic convulsions, coma, or other serious symptoms. In such cases it may be necessary to give a drastic purgative, such as croton oil, which acts rapidly, causing profuse watery stools. 9. To lower the blood-pressure where high arterial tension aggra- vates a malady, as at the onset of many acute diseases, and in cerebral hemorrhage, meningitis, etc. In these conditions it is necessary to employ such drugs as, by dilating the intestinal blood- vessels, drain the blood away from other organs and cause abun- dant watery discharges from the bowels. Hydragogue or drastic purgatives answer the required purpose. 10. For the relief of hemorrhoids, in which cases the mild laxa- tives, such as sulphur, senna, etc., are serviceable. 11. To aid the restoration of the catamenia. For this purpose aloes is usually employed, particularly if it be necessary to deter- mine more blood to the pelvic organs. If depletion be required, the selection should be made from the hydragogue cathartics. 12. To purge the nursing infant through the mother's milk. For CATHARTICS. 663 this purpose such drugs as rhubarb, senna, and castor oil may be administered to the mother. 13. To lower the temperature in fever, in which cases the sahne cathartics may be advantageously employed. Contraindications. — Active catharsis by the more powerful hydragogue or drastic purgatives would be contraindicated in ap- pendicitis, peritonitis, typhlitis, intussusception, pregnancy; and typhoid fever, or Where there is inflammation of the mucous mem- brane of the gastro-intestinal tract. Administration. — Probably no group of medicines demands greater judgment in administration than Cathartics. Ordinarily, the efficiency of these agents is increased and their operation rendered less irritant by associating drugs acting upon different portions of the alimentary canal. Their action, too, is more prompt and certain when the remedies are given upon an empty stomach and the efficiency of their operation is enhanced by exercise and diminished by sleep. The action of cathartics is promoted by the addition of small doses of emetics, mydriatics, quinine, and bitters, quinine especially strengthening the action of magnesium sulphate. Mild diluent beverages also promote the activity of cathartics. Cold applied to the abdomen, enemata, massage of the abdominal walls, and electricity, all act as adjuvant measures in the employment of purgative medicines. As has been previously suggested, a knowledge of the portion of the intestinal canal upon which the various cathartics act is of primary importance. Thus, if it be necessary to influence only the duodenum, calomel or podophyllin should be used ; if the small intestine, senna or jalap ; if the descending colon or rectum, aloes, — the drugs acting upon these organs alone. Moreover, due consideration should be given to the proper time for the administration of the different cathartics, the resinoid pur- gatives acting best when taken at night or before dinner, and the salines when taken in the morning before breakfast. The mode of administration is also of great importance, in order to obtain from these agents the fullest benefit. The salines, for instance, act best when given in solution in either very cold or very hot water, their activity being enhanced by association with bitters, iron, or sulphuric acid. On the other hand, the resinoid drugs should be administered in the form of pills, and if, for any reason, it is desirable that the drug should enter the intestine with- 664 A TEXT-BOOK OF MATERIA MEDICA. out coming in contact with the mucous membrane of the stomach, the drug may be given in the form of pills coated with keratin, which is unaffected by the gastric juice, but readily dissolved in the alkaline intestinal juices. In the following detailed description cathartic drugs are grouped according to their modus operandi, the mildest drugs or laxatives being first considered. LAXATIVES. Certain substances never produce active purgation, but simply unload the bowels by slightly increasing both peristalsis and secre- tion, expelling the feces in a softened though solid and formed condition, without irritation and without perceptibly affecting the general system. These agents are especially useful where we wish to evacuate the bowels with the least possible local derangement, as in simple constipation from dyspepsia, in children, pregnant women, con- valescents from acute disease, or patients affected with hemorrhoids, hernia, affections of the rectum or womb, typhoid fever, early simple diarrhea, or in inflammation or surgical operations about the abdomen and pelvis. Besides the laxative drugs mentioned below there are many articles of diet which by purely mechanical action produce catharsis, such as oatmeal, brown bread, whole flour, molasses, < prunes, figs, etc. Cassia Fistula— Cassiae FTstulae— Cassia Fistula. XT. S. P. (Purging Cassia.) Origin. — The fruit of Cassia Fistula L., a tree 30 to 50 feet (9-15 M.) high, indigenous in the East Indies. Description and Properties. — Cylindrical, i J to 2 feet (45-60 Cm.) long, nearly i inch (25 Mm.) in diameter, blackish-brown, somewhat veined, the sutures smooth, forming two longitudinal bands ; indehiscent, internally divided transversely into numerous cells, each containing a reddish-brown, glossy, flattish-ovate seed imbedded in a blackish-brown sweet pulp ; odor resembling that of prunes. Dose. — 1-2 drachms (4.0-8.0 Gm.). CATHARTICS. 665 Official Preparation. ConfSctio SSnnae — Confectionis SSnnae — Confection of Senna. — Described Tinder Senna, p. 681. Physiological Action and Therapeutics. — Cassia is a mild and pleasant laxative. It is seldom given alone, however, but forms an ingredient in the confection of senna. Oleum Riclni— Olei RicTni— Castor Oil. TJ. S. P. Origin. — A fixed oil expressed from the seed of Ricinus com- munis L., a plant indigenous in Southern Asia and cultivated in temperate countries for ornament and other purposes, remaining a large annual. Description and Properties. — A pale-yellowish or almost color- less, transparent, viscid hquid, having a faint, mild odor and a bland, afterward slightly acrid and generally offensive taste. Solu- ble in an equal volume of alcohol and in all proportions in abso- lute alcohol. Castor oil should be kept in well-stoppered bottles. Dose. — \-2 fluidounces (8.0-60. Cc.) Physiological Action. — Externally and Locally. — Castor oil — like other bland fixed oils, such as almond oil, olive oil, etc. — is sedative and protective when applied to the skin or mucous membranes. Internally. — The only important action is upon the gastro- intestinal tract, the effects of the drug being those of a mild yet efficient purgative. Castor oil requires from four to six hours to. operate, its action being usually attended with little pain. Indeed, the author is inclined to attribute anodyne properties to the drug, since it has frequently occurred to him in practice that a dose of castor oil given to a child suffering with colicky pains, while pro- ducing no movement of the bowels, served to allay the distress and cause the patient to sink into a quiet sleep. The purgative principle of castor oil rapidly enters the blood, increasing the secretion of the mother's milk and imparting to it purgative properties. The leaves of the castor-oil plant, applied to the breasts in the form of a poultice, greatly augment the secretion of milk. Castor beans have in several cases caused the death of persons who have eaten them. The symptoms were — violent abdominal pain, vomiting, purging, collapse, and fatal results. Post-mortem examinations have revealed evidences of severe inflammation in the stomach and intestines. 666 A TEXT-BOOK OF MA TERIA MEDICA. Castor oil should not be used as an habitual laxative, its con- tinual employment being liable to occasion constipation with all its attendant evils. Therapeutics. — Castor oil is used alone or associated with bal- sam of Peru as a sedative protectant dressing for superficial ulcera- tions. The drug is also serviceable in various diseases of the skin and mouth. It is probably superior to all other laxatives, and is applicable to all conditions for which laxatives are employed. In large doses it is one of the best purgatives to give in conjunction with an anthelmintic. Administration. — The unpleasant taste of castor oil is the only objection to its use. Yet it can be rendered quite palatable by mixing it with an equal quantity of glycerin, to which may be added a few drops of oil of cinnamon or oil of wintergreen. Various other devices for disguising the taste have been adopted,, such as enveloping the oil in the froth of beer, ale, o/ porter, or washing out the mouth with brandy or whiskey previous to admin- istration, and allowing the patient to swallow the oil quickly, when it will not adhere to the mouth and fauces, especially if followed by a drink of some alcoholic Hquid. In the form of an emulsion the taste of the oil is well disguised. There are also soft capsules of castor oil which are of course taste- less, yet they are too bulky to be popular. Castor-oil emulsion may be used as an enema when a mild injection is required. Rhamnus Purshiana— Rhamni Purshianae-Cas- cara Sagrada. JJ. S. I*. Origin. — The bark of Rhamnus Purshiana D. C, a shrub or small tree 15 to 20 feet (4.5-6 M.) high, indigenous on the Pacific coast of North America from the British possessions southward to Northern California. Description and Properties. — Quills or curved pieces about i to 4 inches (3-10 Cm.) long and about -^ inch (2 Mm.) thick; outer surface brownish-gray and whitish, the young bark with numerous, rather broad, pale-colored warts ; inner surface yellow- ish to Hght brownish, becoming dark brown with age ; smooth or finely striate, fracture short, yellowish, in the inner layer of thick bark somewhat fibrous ; inodorous ; taste bitter. The bark contains red, yellow, and brown resins, tannic, malic. CATHARTICS. 667 and oxalic acids, a volatile oil, and a neutral, crystalline sub- stance. Dose. — 30-60 grains (2.0-4.0 Gm.). Official Preparation. ExtrSctum Rhamni Purshianae Fluidum— ExtrScti RhSmni Purshianse Fluidi— Fluid Extract of Rhamnus Purshiana.— Z>oj.', %-\ fluidrachm r I 0-40 Cc). ^ ' Unofficial Preparations. Certain pharmaceutical cliemists, in order to overcome the bitter taste of cascara have devised various preparations, such as — Cascara Cordial. Aromatic Fluid Extract of Cascara. Elixir of Cascara, etc. Messrs. Parke, Davis & Co. of Detroit offer a concentrated preparation of the drug, known as Cascarin, which is almost tasteless and soluble in water. Dose, %-%, grain (0.01-0.03 Gm-)- Physiological Action. — Cascara sagrada is a peculiarly efficient laxative, although in certain individuals it appears to be inert unless associated with other purgatives. The bitter principle it contains gives to the drug stomachic properties, and it is also said to stimu- late slightly the functional activity of the liver. The action of cascara is seldom attended with irritation or un- pleasant symptoms, the drug requiring from six to ten hours to operate. Therapeutics. — Cascara is a very valuable laxative, being em- ployed chiefly to overcome habitual constipation due to simple tor- por of the colon without associated disease. The drug is not adapted for rapid evacuation of the bowels, but rather for regulating their action. Administration. — The fluid and solid extracts are usually em- ployed, although the cascara cordial and the aromatic fluid extract, while requiring larger doses, are so palatable that they have become deservedly popular. Whatever be the preparation used in cases of habitual consti- pation, it should be given in small but repeated doses, gradually diminished until a natural action of the bowels shall have been established. The drug should , be administered upon an empty stomach and in as diluted a condition as possible. Mag-nesia—Mag-nesiae— Magnesia. JJ. S. I*. (Light Magnesia; Calcined Magnesia.) Origin, description, and properties given under "Alkalies," p. 1 56. Dose. — 5-60 grains (0.32-4.0 Gm.). 668 A TEXT-BOOK OF MATERIA MEDIC A. Magnesii Carbonas— Magnesii Carbonatis— Magr- nesium Carbonate. TJ. S. P- Origin, description, and properties given under " Alkalies," p. 156. Dose. — ^2 drachms (1.0-8.0 Gm.). Physiological Action. — Both magnesia and magnesium car- bonate are mild antacid laxatives, requiring the presence of an acid in the stomach and bowels to render them active. Occasion- ally, when there is marked acidity of the stomach, magnesium carbonate occasions flatulence. When taken in large amounts or for a long time magnesia tends to accumulate in the intestines. This untoward effect may be pre- vented by administering with the drug lemonade, the acid of which increases the solubility of the magnesia. Therapeutics. — Magnesium carbonate as a protective powder is an effective agent in the treatment of dermatitis of the external auditory passage. The drug is a valuable antidote to counteract the effects of phosphorus-poisoning in the throat. Both MAGNESIA and magnesium carbonate are mild alkalies, and may be used for the same purposes as the alkalies. They are serviceable antidotes to poisoning from mineral and oxalic acids and many mineral salts. They are pleasant laxatives, being ex- tensively employed for children. Manna— Mannae— Manna. U.S. P. Origin. — The concrete, saccharine exudation of Fraxitius Ornus L., a slender tree indigenous on the northern shore of the Mediter- ranean from Asia Minor west to Spain. Description and Properties. — Flatfish, somewhat three-edged pieces, about 8 inches (20 Cm.) long and 2 inches (5 Cm.) broad (usually smaller), friable, externally yellowish-white, internally white, porous, and crystalline; or fragments of different sizes, brownish-white and somewhat glutinous on the surface, internally white and crystalline ; odor honey-like ; taste sweet, slightly bitter, and faintly acrid. Manna contains a resin, the purgative principle, besides mannite, fraxin, and sugar. Dose. — ^i ounce (16.0-32.0 Gm.), dissolved in hot water. Official Preparation. Infusum SSnnae CompOsitum — Infusi SSnnae CompSsiti— Compound Infu- sion of Senna.— See Senna, p. 681. CATHARTICS. 669 Physiological Action and Therapeutics. — Manna is a laxative, cholagogue, and nutrient. Its mild laxative action renders the drug peculiarly efficient in constipated conditions of pregnant women, and children and persons suffering from piles or irritation of the genito-urinary tract. The drug is slow in its action, tending to confine the bowels after the primary laxative effect. Sulphur Sublimatum— Sulphuris Sublimati— Sub- limed Sulphur, v. S. JP. Origin. — Obtained from Crude Sulphur by sublimation. Description and Properties. — A fine yellow powder, having a slight characteristic odor and a faintly acid taste. Insoluble in water ; slightly soluble in absolute alcohol ; more readily soluble in benzin, benzol, oil of turpentine and many other oils, as well as in ether, chloroform, and boiling aqueous solutions of alkaline hydrates. Dose. — 15-60 grains (1.0-4.0 Gm.). Official Preparations. SfilphurLotum — Sfllphuris Loti — Washed Sulphur. — Origin. — Sublimed Sul- phur, loO; Water, 100; Ammonia Water, 10; digested, filtered, drained, and dried. Description and Properties. — A fine yellow powder without odor or taste. Insoluble in water, but soluble in the substances which dissolve sulphur. Dose. — 15-60 grains (1.0-4.0 Gm.). UnguSntum Stilphuris — Ungu6nti Siilphuris— Sulphur Ointment. — Washed Sulphur, 300 ; Benzoinated Lard, 700. For external use. Washed sulphur is an ingredient of compound liquorice powder. Sulphur Praecipitatum— Sulphuris Prsecipitati— Precipitated Sulphur. V. S. I*. (Milk OF Sulphur ; Lac Sulphur.) Origin. — Sublimed Sulphur is boiled with Slaked Lime and Water. To the solution is added Hydrochloric Acid, which throws down Sulphur as a fine precipitate, the powder being washed and dried. Description and Properties. — A fine amorphous powder of a pale-yellow color, without odor or taste. Insoluble in' water. Dose. — 15-60 grains (1.O-4.O Gm.). Physiological Action. — Externally and Locally. — Sulphur is an active parasiticide, antiseptic, and keratoplastic agent. Upon the skin the drug of itself has no influence ; a portion of it, however. 670 A TEXT-BOOK OF MA TERIA MEDIC A. is converted into hydrogen sulphide, which acts as a mild cutane- ous irritant. Internally. — As observed, sulphur proper has no action either externally or locally, although it is a normal constituent of nearly all the solids and fluids of the body. When ingested some of it is converted into hydrogen sulphide and other sulphides, which increase the intestinal secretions and promote peristalsis. The drug is chiefly excreted with the stools, which are rendered soft and semi-liquid. A portion of the hydrogen sulphide formed is eliminated through the kidneys, lungs, skin, and milk-glands. The drug is usually found in the urine as sulphate. There is imparted to the breath the offensive odor of hydrogen sulphide, and the minute portion eliminated through the skin is suf- ficient to discolor silver ornaments in contact with the body-surface. While hydrogen sulphide is a powerful poison, decomposing the blood and paralyzing the nervous and muscular systems, the amount formed and absorbed under the administration of sulphur is too small to produce marked toxic symptoms, even when large amounts of sulphur have been ingested, there is produced only violent vomiting and purging, a slight elevation of temperature, and a distinct odor of hydrogen sulphide in the breath. When sulphur is used in full doses for a long time, it tends to impair the quality of the blood and produce muscular weakness. Occasionally untoward manifestations, such as miliary eruption and eczema, accompany either the external application or the ingestion of the drug. As a laxative sulphur is slow and mild, although it occasionally causes considerable flatus, in some cases rendering the drug objec- tionable as a purgative. Therapeutics. — Externally and Locally. — While classed among laxative drugs, sulphur is a most eiificient remedy in many diseases of the skin, nose, throat, etc., the external uses of sulphur being very numerous. The drug is perhaps the most serviceable parasiticide we possess in scabies, sulphur ointment well rubbed into the skin being usually sufficient to destroy the parasite. Even diseases induced by vegetable parasites, such as tinea versicolor, etc., are cured by inunctions of sulphur ointment. The drug is successfully employed in the treatment of infil- trated eczema, impetigo, sycosis, ecthyma, acne, comedo, and psoriasis. The flowers of sulphur is an old domestic remedy, and quite CATHARTICS. 671 an eiificient one, in diphtheria and pharyngitis. Finally, Coroden and Duchane have both reported the successful treatment of sciatica by enveloping the affected limb in precipitated sulphur, the profuse sweating induced being followed by a decided allevi- ation of pain. When SULPHUR is burned sulphur dioxide is formed, a powerful germicide. By the fumes rooms and clothing may be disinfected, fumigation by sulphur being a common procedure to destroy the germs of typhoid fever, tuberculosis, cholera, diphtheria, small- pox, etc. Internally. — The principal internal use of sulphur is as a mild laxative, the drug being especially indicated for persons afflicted with hemorrhoids or anal fissure. Lozenges are prepared containing sulphur and cream of tartar, which, if taken daily for some time, will overcome habitual consti- pation, being especially serviceable in constipation due to disease of the liver. Sulphur has been used internally, and occasionally with con- siderable success, in bronchitis, chronic rheumatism, and ecser7ta attended with much itching. Administration. — Sulphur may be given in the form of loz- enges or mixed with molasses — either alone or associated with cream of tartar, which is said to enhance the action of sulphur. Milk and syrup have been used as vehicles in the administration of the drug. Sulphurous baths, both natural and artificial, have been em- ployed in the treatment of rheumatism, gotit, and some cutaneous affections. Not only for these purposes, but for their laxative influence as well, sulphurous waters are held in great repute. Taraxacum— Taraxaci— Taraxacum. JJ. S. r. (Dandelion.) Origin.— The root of Taraxacum officinale Weber, a perennial, acaulescent herb found in most countries of the northern hemi- sphere. Description and Properties.- Slightly conical, about 12 inches (30 Cm.) long and \ to i inch (12-25 Mm.) thick above, crowned with several short, thickish heads, somewhat branched, dark brown, longitudinally wrinkled ; when dry breaking with a short fracture, showing a yellowish, porous central axis surrounded by a thick,' 673 A TEXT-BOOK OF MATERIA MEDICA. white bark containing numerous milk-vessels arranged in con- centric circles ; inodorous ; bitter. The drug contains a bitter principle, taraxdcin, besides inulin,_ resin, sugar, and mucilaginous substances. Dose. — 1-4 drachms (4.0-1 5.0 Gm.). Official Preparations. Extractum TarSxaci — ExtrScti TarSxaci — Extract of Taraxacum. — Dose, 5-60 grains {0.3-4.0 Gm.). ExtrSctum TarSxaci Fluidum — ExtrScti TarSxaci Fluidi — Fluid Extract of Taraxacum. — Dose, 1-4 fluidrachms (4.0-15.0 Cc). Physiological Action and Therapeutics. — Taraxacum is a stomachic tonic, diuretic, laxative, cholagogue, and feeble hepatic stimulant. It has been a popular remedy for constipation associated with hepatic congestion and atonic dyspepsia, yet the drug is now less employed than formerly, in actual practice being usually united with other laxatives. The extract or fluid extract may be given, the latter and the expressed juice being the more active. SIMPLE PURGATIVES. These difier from laxatives only in degree, the former being more active, exciting greater peristaltic action and causing a larger secretion from the intestinal glands. Simple purgatives usually oc- casion one or more copious and somewhat liquid stools, frequently accompanied by considerable irritation and griping. Aloe— Aloes— Aloes. TJ. S. P. Origin. — The inspissated juice of the leaves of Aloe {A. vera (L.) Webb; A. Perryi Baker), a plant resembling the so-called century plant {Agave Americana), indigenous in India and North- eastern Africa, and naturalized along the shores of the Mediter- ranean and in the West Indies. Official Varieties. Aloe BarbadSnsis — Aloes BarbadSnsis — Ba'rbadoes Aloes (CuRAgoA. Aloes). — Origin. — Prepared from Aloe vera. Habitat. — Island of Barbadoes. Description and Properties. — Hard masses, orange-brown, opaque, translucent on the edges; fracture waxy or resinous, somewhat conchoidal; odor saffron-like; taste strongly bitter. CATHARTICS. 673 Dose. — \-\o grains (0.03-0.6 Gm.). Aloe Socotrina — Aloe Socotrmse — Socotrine Aloes. — Origin. — Obtained from Aloe Perryi, Habitat. — Island of Socotra in the Strait of Bab-el-Mandeb. Description and Properties. — Hard masses, occasionally soft in the interior, opaque, yellowish-brown, orange-brown, or dark ruby-red, not greenish, translucent on the edges ; fracture resinous, somewhat conchoidal. When breathed upon it emits a fragrant, saf- fron-like odor. Taste peculiar, strongly bitter. Almost entirely soluble in alcohol and in 4 parts of boiling water. The aqueous solution becomes turbid on cooling and yields a deposit. Examined under the microscope, Socotrine aloes exhibits numerous crystals. The active principle of the various Aloes is alo'in, a neutral prin- ciple, varying in chemical composition and physical properties according to the species from which it is derived ; thus the sub- stance from Barbadoes aloes (barbaloin) is soluble in 60 parts of water, 20 parts of alcohol, and 470 parts of ether ; that from Soco- trine aloes (socaloin) is soluble in 60 parts of water, 30 parts of absolute alcohol, and 380 parts of ether. Natalo'in, obtained from the unofficial Cape aloes, may be distinguished from the official aloin by heating the former with a drop or two of sulphuric acid and exposing it to the vapor of nitric acid, when nataloin changes to a blue color; barbaloin and soca- loin are unaffected by this test. Nitric acid applied to barbaloin gives a crimson color, which rapidly fades ; the crimson color imparted to nataloin is permanent, while no color is produced when nitric acid is applied to socaloin. Dose. — \-\o grains (0.03-0.6 Gm.). Official Preparations. ExtrSctum Aloes — Extract! Aloes— Extract of Aloes. — Dose, J-6 grains (0.03-0.4 Gm.). Aloe Purificata — Aloes Purificatae — Purified Aloes. — Dose, ^-10 grains (0.03- 0.6 Gm.). Extrilctum Colocynthidis Cotnp6situin — ExtrScti Colocynthidis Compfisiti — Compound Extract of Colocynth. — Dose, 5-25 grains (0.3-1.6 Gm.). The following official preparations are prepared from purified aloes : Pllulae Aloes — Pllulas (ace.) Aloes — Pills of Aloes. — Dose, i to 4 pills. Pilulse Aloes et Asafcetidse — Pllulas (ace.) Aloes et Asafoetidse — Pills of Aloes and Asafetida. — Each pill contains about i\ grains (0.085 Gm.) of each. — Dose, I to 5 pills. PHulae Aloes et F6rri— Pilulas (ace.) Aloes et FSrri— Pills of Aloes and Iron. — Each pill contains about i grain (0.06 Gm.), each, of Aloes, dried Ferrous Sul- phate, and Aromatic Powder. — Dose, I to 4 pills. Pllulje Aloes et Mastiches— Pllulas (ace.) Aloes et Mastiches— Pills of Aloes and Mastich.— Each pill contains about 2 grains (0.12 Gm.), together with Mastich and Red Rose. — Dose, I to 3 pills. PJlulse Aloes et Myrrhae— Pilulas (ace.) Aloes et Myrrhae— Pills of Aloes and Myrrh.— Each pill contains 2 grains (0.12 Gm.), together with Myrrh and Aromatic Powder. — Dose, I to 3 pills. 43 :; 674 A TEXT-BOOK OF MA TERIA MEDICA. Pllulae Rhei CompSsitae — Pllulas (ace.) Rhei CompSsitas— Compound Pills of Rhubarb. — Each pill contains i grain (0.06 Gm.) of Aloes. — Dose, I to 3 pills. Tinctura Aloes — Tincturae Aloes — Tincture of Aloes (10 per cent.). — Dose, \-\ fluidrachm (2.0-4.0 Cc). Tinctura Aloes et MJ^rrhse — Tinctiirse Aloes et Myrrhse — Tincture of Aloes and Myrrh (10 per cent, of each, with Glycerin 10 per cent.). — Dose, 1-2J fluidrachras (2.0-10.0 Cc). Tinctiira Benzoini CompSsita — -Tinctiirae Benzoini CompSsitae — Compound Tincture of Benzoin (2 per cent, of Aloes). — Dose, 10-40 minims (0.6-2.6 Cc). Aloinum — Aloini — Aloin. U. S. P. — Origin. — A neutral principle obtained from several varieties of Aloes. Description and Properties. — Minute, acicular crystals, or a micro-ciystalline pow- der, varying in color from yellow to yellowish-brown ; odorless or possessing a slight odor of aloes, of a characteristic, bitter taste, and permanent in the air. The solubilities of barbaloin and socaloin are given above. Dose. — J-2 grains (0.03-0.12 Gm.). Physiological Action. — Aloes has no local action, although the drug is readily absorbed from ulcers or abraded surfaces. Internally, it is stomachic, increasing the secretions from the gastro-intestinal tract. It pi:obably increases the secretion of bile. Its principal action appears to be upon the colon, the muscular coat of which it stimulates, besides augmenting the secretion from the large intestine. In from ten to fifteen hours after the ingestion of the drug it causes soft, dark-colored evacuations, its action being usually attended with more or less griping pain. The blood-supply to the lower bowel and pelvic viscera is increased by aloes ; and the drug, if used habitually, may bring on or aggravate hemorrhoids. The menstrual function is stimu- lated, the drug being quite a decided emmenagogue. Aloes is readily absorbed ; it is thrown off through the bowels and kidneys, and is found also in the milk. Therapeutics. — The principal use of aloes is as a purgative in habitual constipation due to a torpid condition of the large intestine. Jaundice resulting from hepatic congestion is well treated with aloes and blue pill. Pills of aloes and iron are useful adjuvants to other remedies in the treatment of chlorosis. Amenorrhea, which is such a common condition in chlorosis, is relieved by aloes. Pills of aloes and iron are equally valuable in menorrhagia arising from debility. Contraindications. — Aloes is ordinarily contraindicated in hem- orrhoids, although those cases attended with a mucous discharge are frequently benefited by it. The drug is considered objection- CATHARTICS. 675 able in pregnancy, in persons of plethoric, bilious, or hemorrhagic constitution, and in menorrhagia of the strong and full-blooded. Administration.— When desired as a purgative, aloes in pill form is preferable to the liquid preparations, and the drug may be given alone or associated with other purgatives, tonics, or antispasmodics. Aloin is perhaps to be preferred to aloes, as it gripes less and may be given in smaller doses. As a purgative aloes ranks between rhubarb and senna. Fel Bovis— Fellis Bo vis— Oxgall. V. S. B. (Fel Tauri.) Origin. — The fresh bile of Bos Taurus L. Description and Properties. — A brownish-green or dark-green, somewhat viscid liquid, having a peculiar, unpleasant odor and a disagreeable, bitter taste. Dose. — S-15 grains (0.3-1.0 Gm.). Official Preparation. F6I Bovis Purificatum— Fgllis Bovis Purificati— Purified 0-!i%a\S..— Descrip- tion and Properties. — A yellowish-green, soft solid, having a peculiar odor and a partly sweet and partly bitter taste. Very soluble in water and in alcohol. Dose. — 5-15 grains (0.3-1.0 Gm.). Physiological Action and Therapeutics. — Like bile, oxgall augments the duodenal secretions, emulsionizes fats, and increases intestinal peristalsis. The drug liquefies the bile, and acts as a cholagogue and purgative. It is a useful cathartic when the stools are very offensive and of a light clay color, indicating a deficient biliary secretion. The drug is serviceable in jaundice due to obstruction of the common duct by inspissated bile or mucus. Impacted feces are readily removed by an enema containing 1 5 or 20 grains (i. 0-1.3 Gm.) of oxgall. The drug is an efficient intes- tinal antiseptic, and may be beneficially employed for that purpose in typhoid fever and intestinal fermentation. Oxgall is usually given in pill form. Rheum— Rhel— Rhubarb. TJ. 8. P. Origin. — The root of Rheum officinale Baillon, a plant indigen- ous in the western and northwestern portions of China. Description and Properties. — In cylindrical, conical, or flattish 676 A TEXT-BOOK OF MATERIA MEDIC A. segments, deprived of the dark-brown, corky layer, smoothish or somewhat wrinkled, externally covered with a bright yellowish- brown powder, marked with white, elongated meshes, containing a white, rather spongy tissue, and a number of short, reddish- brown or brownish-yellow striae ; compact, hard ; fracture uneven ; internally white, with numerous red, irregularly-curved, and inter- rupted medullary rays, which are radially parallel only near the cambium line ; odor somewhat peculiar, aromatic ; taste bitter, some- what astringent. When chewed, rhubarb feels gritty between the teeth and imparts a yellow color to the saliva. Rhubarb which is very porous, or has a prominently mucilaginous taste, or is of a dark-brown color internally, should be rejected. The drug contains the following constituents : chrysophan (and chrysophanic acid), emodin, aparetin, phaeoretin, erythroretin, rheumic acid, and rheotannic acid, besides starch, calcium oxalate, etc. Dose. — 5-30 grains (0.32-1.94 Gm.). Official Preparations. ExtrSctum Rhei — Extracti Rhei — Extract of Rhubarb.-T-Z'oj^, 3-15 grains (o.ig-i.o Gm.). ExtrSctum Rhei Fliiidum— Extracti Rhei Fliiidi— Fluid Extract of Rhubarb (this preparation is used in Mistura Rhei at Sodae and in Syrupus Rhei). — Dose, 5-60 minims (0.3-4.0 Cc). PJlulse Rhei — Pllulas (ace.) Rhei — Pills of Rhubarb. — Each pill contains 3 grains (0.19 Gm.). Dose, i to 5 pills. Pllulae Rhei Compdsitae — Pllulas (ace.) Rhei CompSsitas — Compound Rhubarb Pills. — Each pill contains about 2 grains (0.12 Gm.) of Rhubarb, with puri- fied Aloes l^ grains (0.09 Gm.), Myrrh, and Oil of Peppermint. Dose, I to 3 pills. Pfilvis Rhei Comp&situs — Piilveris Rhei CompSsiti — Compound Rhubarb Powder (Gregory's Powder) — (25 per cent., with Magnesia and Ginger). — Dose, ^- I drachm (2.0-4.0 Gm.). Tinctiira Rhei — Tinctiirae Rhei — Tincture of Rhubarb (10 per cent., with Cardamom). — Dose, ^-4 fluidrachms (2.0-15.0 Cc). Tinctiira Rhei AromStica — Tinctiirae Rhei AromSticae — Aromatic Tincture of Rhubarb (20 per cent., with Cassia, Cinnamon, Cloves, and Nutmeg). — Dose, 1-3 fluidrachms (4.0-12.0 Cc). This preparation is used to malje Syrupus Rhei Aromaticus. Tinctura Rhei Diilcis — Tinctiirae Rhei Diilcis — Sweet Tincture of Rhubarb (10 per cent., with Glycyrrhiza, Anise, and Cardamom). — Dose, %.-^ fluidrachms (2.0- 15.0 Cc). Mistura Rhei et Sodae — Mistiirae Rhei et Sodae— Mixture of Rhubarb and Soda. — Formula: Sodium Bicarbonate, 35; Fluid Extract of Rhubarb, 15; Fluid Extract of Ipecac, 3; Glycerin, 350; Spirit of Peppermint, 35; Water, to 1000. — Dose, %-2 fluidounces (8.0-60.0 Cc). syrupus Rhei — Syrupi Rhei — Syrup of Rhubarb. — Formula: Fluid Extract CA THAR TICS. 677 of Rhubarb, 100 ; Potassium Carbonate, 10 ; Spirit of Cinnamon, 4; Glycerin, 50; Water and Syrup, to 1000.— Dose, 1-4 fluidrachms (4.0-15.0 Cc). Syrupus Rhei AromSticus — Syrupi Rhei Aromatici— Aromatic Syrup of Rhubarb.— Formula : Aromatic Tincture of Riiubarb, 150; Syrup, 850. — Dose, yi-2 fluidrachms (2.0-8.0 Cc). Physiological Action and Therapeutics. — Rhubarb in mod- erate doses is a stomachic, acting similarly to the aromatic bitters, increasing secretion, peristalsis, vascularity, and absorption, thereby aiding digestion and serving as a tonic. In larger doses it is a mild cathartic, producing in from four to eight hours a soft yellow- ish-brown evacuation, not watery, which is not infrequently accom- panied by griping. It undoubtedly shghtly increases the secretion of bile, though it is by no means an active cholagogue. After full doses of rhubarb have been taken the purgative action is succeeded by quiescence of the bowels, the constipation being the result of the action of the astringent constituents of the rhu- barb. Small doses, however, taken daily, serve a useful purpose in relieving habitual constipation, without in the least impairing digestion. The drug is excreted with the feces, urine, perspiration, and milk; the urine is slightly increased in amount, and together with the perspiration and milk, is colored yellow. The milk acquires a bitter taste and purgative properties. Rhubarb is one of the best purgatives for children suffering from diarrhea caused by irritating ingesta in the bowels or to cold ; it is also of value in some cases of dysentery. Summer diarrhea vf children is often cured by some preparation of rhubarb alone, the diarrhea ceasing after a free purge by the drug. As a simple laxative for children it is a valuable remedy, owing to its secondary tonic and astringent effects, and is recommended as a laxative to expel thread-worms. When hemorrhoids are connected with constipation, much relief may be obtained by the gentle action of rhubarb. Administration. — Rhubarb is seldom given alone, because of the griping it occasions. For children the syrups are excellent preparations, and the mixture of rhubarb and soda is an appropri- ate remedy when the secretions of the stomach and bowels are unduly acid. In habitual constipation of adults the simple rhubarb pill is an efficient preparation. 678 A TEXT-BOOK OF MA TERIA MEDICA. The choice of the preparation will depend largely upon the individual case. Euonymus— Euonymi— Euonymus. V. S. -P. (Wahoo.) Origin. — The bark of the root of Euonymus atropurpureus Jacquin, a shrub 6 to 10 or 14 feet (1.8 to 3 or 4.2 M.) high, found growing in shady woods of the northern and middle section of the United States east of the Mississippi. Description and Properties. — In quilled or curved pieces ^ to \ inch (2 to 5 Mm.) thick ; outer surface ash-gray, with blackish patches, detached in thin and small scales ; inner surface whitish or slightly tawny, smooth ; fracture smooth, whitish, the inner layers of a laminated appearance ; nearly inodorous ; taste sweet- ish, somewhat bitter and acrid. The chief constituent of the drug is a resin, euonymin. Dose. — 1-2 drachms (4.0-8.0 Gm.). Official Preparation. Extractum EuSnymi — ExtrScti Eu6nymi — Extract of Euonymus. — Dose, 1-5 grains (0.06-0.3 Gm.). Eu6nymin (unofficial). — Origin. — A resin from the root and stem-bark of Euonymus atropurpureus Jacquin. Description and Properties. — A brown or greenish-brown hygroscopic powder with a feebly bitter taste, soluble in water, almost insoluble in alcohol and ether. Dose. — 1^-3 grains (0.01-0.19 Gm.). Physiological Action and Therapeutics. — Euonymus resem- bles rhubarb in its action, but is milder, small doses being stimu- lant to the stomach. The drug is an active hepatic stimulant, increasing the secretion of bile and facilitating its excretion into the intestine. It is excreted by the kidneys and broncho-pulmonary mucous membrane, being a mild diuretic and expectorant. Euony- mus is an excellent cathartic, particularly in cases of constipation attended with impaired functional activity of the liver. Euonymin is the preparation usually employed, although the official extract of euonymus is a reliable preparation. Tris— Tridis— Iris. TJ.8.P. (Blue Flag.) Origin. — The rhizome and roots of Iris versicolor L., found growing in wet and swampy meadows from Canada southward to Florida and westward to Minnesota and Arkansas. CATHARTICS. 679 Description and Properties. — Rhizome of horizontal growth, consisting of joints 2 to 4 inches (5 to 10 Cm.) long, cylindrical in the lower half, flattish near the upper extremity, and terminated by a circular scar, annulated from the leaf-sheaths, grayish-brown ; roots long, simple, crowded near the broad end ; odor slight ; taste acrid and nauseous. The drug contains an acrid resin, iridin, fixed oil, starch, gum, tannin, sugar, and indications of an alkaloid. Dose. — 10-30 grains (0.6-2.0 Gm.). Official Preparations. ExtrSctum Iridis — Extract! Iridis — Extract of l-n^.—Dose, 1-3 grains (0.06- 0.2 Gm.). ExtrSctutn Iridis Fluidum — ExtrScti Iridis Fliiidi — Fluid Extract of Iris. — Dose, 10-30 minims (0.6-2.0 Cc). Iridin (unofficial). — Dose, 1-3 grains (0.06-0.2 Gm.). Physiological Action and Therapeutics. — Iris is similar in its action to euonymus, although it is more apt to disturb the stomach and occasion nausea. It is actively purgative and possesses diu- retic properties. Like euonymus, it is a hepatic stimulant, and may be used for the same purposes as the former drug. It may be used in dropsy, and has been found to be an efficient cathartic in malarial and catarrhal jaundice and bilious remittent, fever. It exerts a specific influence in enlargement of the thyroid gland. The dried drug is inert, the fluid extract and iridin being the most reliable preparations to use. Juglans— Jugrlandis— Juglans. TJ. S. -P. (Butternut.) Origin. — The bark of the root of Juglans cinerea L., a tree 30 to 40 feet (9-12 M.) high, growing in forest and bottom-lands, in Canada, and the greater portion of the United States westward to Missouri and Arkansas. Description and Properties. — In flat or curved pieces, from \ to \ inch (3 to 6 Mm.) thick ; the outer surface dark gray and nearly smooth or deprived of the soft cork, and deep brown ; the inner surface smooth and striate ; transverse fracture short, deli- cately checkered, whitish and brown ; odor feeble ; taste bitter and somewhat acrid. The drug contains a bitter, oily extractive, juglandic acid, two other acids, and various salts. Dose. — 1-2 drachms (4.0-8.0 Gm.). ,68o A TEXT-BOOK OF MA TERIA MEDICA. Official Preparation. ExtrSctum JuglSndis — ExtrScti JuglSndis —Extract of Juglans. — Dose, 5-30 grains (0.3-2.0 Gm.). Physiological Action and Therapeutics. — The action and medical uses of this drug are analogous to those of euonymus. Leptandra— Leptandrae— Leptandra. U. S.T. (Culver's Root.) Origin. — The rhizome and roots of Veronica virginica L., a plant indigenous in Canada, and in the United States as far west as the Mississippi Valley. Description and Properties. — Of horizontal growth, from 4 to 6 inches (10 to 15 Cm.) long and about \ inch (6 Mm.) thick, some- what flattened, bent and branched, deep blackish-brown, with cup- shaped scars on the upper side, hard, of a woody fracture, with a thin, blackish bark, a hard, yellowish wood, and a large, purplish- brown, about six-rayed pith; roots thin, wrinkled, very fragile; inodorous ; taste bitter and feebly acrid. Leptandra contains a crystalline glucosid, leptandrin, besides tannin, gum, and a small quantity of volatile oil. Dose. — 15-60 grains (1.0-4.0 Gm.). Official Preparations. ExtrSctum Leptandrae — Extract! Leptandrae — Extract of Leptandra. — Dose, 1-5 grains (0.06-0.3 Gtn.). ExtrSctum LeptSndrae Fluidum— Extract! Leptandrse Fluidi — Fluid Ex- tract of Leptandra. — -Dose, 15-60 minims (1.0-4.0 Co.). The Pilulae Catharticse Vegetabiles contain ^ grain (o.oi Gm.) of Extract of Leptandra to eacli pill. Leptandrin (unofficial). — Dose, 1-3 grains (0,06-0.2 Gm.). Physiological Action and Therapeutics. — The action of lep- tandra is similar to the actions of euonymus, iris, and juglans, the green root, however, being more of an irritant to the gastro-intes- tinal tract, possessing marked emeto-cathartic properties. It is an active hepatic stimulant, and may be advantageously employed for the same purposes as euonymus, iris, etc. Senna— Sennse— Senna. JJ. S. I*. Origin. — The leaflets of Cassia acutifolia Delile (Alexandria senna) and of Cassia angustifoHa Vahl (India senna), small shrubs CATHARTICS. 68i found in Upper Egypt and southward to Nubia, Sennaar, and Kor- dofan, and farther westward in tropical Africa (Cassia acutifolid), and in Southwestern Arabia, along the Somali coast of Africa, and east- ward in Northern India {Cassia angustifolid). Description and Properties. — Alexandria senna consists of leaflets about i inch (25 Mm.) long and \ inch (10 Mm.) broad, lanceolate or lance-oval, subcoriaceous, brittle, rather pointed, un- equally oblique at the base, entire, grayish-green, somewhat pubes- cent ; of a peculiar odor and a nauseous, bitter taste. India senna consists of leaflets i to 2 inches (2.5-5 Cm.) long and f to \ inch (10-15 Mm.) broad, lanceolate, acute, unequally oblique at the base, entire, thin, yellowish-green or dull green, nearly smooth ; odor peculiar, somewhat tea-like ; taste mucilagi- nous, bitter, and nauseous. Senna contains a sulphuretted glucosid, cathartic acid, to which the purgative properties of the drug are due. Senna also contains ^hrysophan, besides sennacrol and sennapicrin (two bitter princi- ples), catharto-mannite, mucilage, etc. Dose. — 10 grains-3 drachms (0.6-12.0 Gm.). Official Preparations. ConfSctio SSnnse — Confectionis Sfennae — Confection of Senna. — 10 per cent., with Cassia Fistula, Tamarind, Prune, Fig, Sugar, and Oil of CoriandeV. Dose, 1-3 drachms (4.0-12.0 Gm.). Extractum S6nnE Fluidum — ExtrScti S6nna Fliiidi — Fluid Extract of Senna. — Dcse, 10 minims-3 fluidrachms (0.6-11.09 Cc). Infusum S6nnae CompSsitum— Infusi S6nnae Comp6siti— Compound Infu- sion of Senna. — 6 per cent., with Manna and Magnesium Sulphate, each, 12 per cent., and Fennel 2 per cent. Dose, 1-2^ fluidounces (30.0-75.0 Cc). PClvis Glycyrrhizae Comp6situs — Pfilveris Glycyrrhizae Comp5siti — Com- pound Powder of Glycyrrhiza. — Formula; Senna, 180; Glycyrrhiza, 236; Oil of Fennel, 4; Washed Sulphur, 80; Sugar, Joo. Dose, yi-2 drachms (2.0-8.0 Gm.). Sj^rupus SSnnse — Syrupi S6nnae — Syrup of Senna (25 per cent.).— Z'o.ff, }^-x fluidounce (8.0-3.0 Cc). Cathartic Acid, Cathartinic Acid (unofficial).— On;f2».— An active principle obtained from the leaves of various species of Cassia. Description and Properties. — It occurs as brown, hygroscopic scales, freely soluble in water and in alcohol. Dose. — 2-6 grains (0.12-0.38 Gm.). Physiological Action and Therapeutics.' — Senna is an active purgative, acting upon nearly the entire intestinal tract, increasing both peristalsis and intestinal secretion, although having but little effect upon the biliary secretion. It is apt to occasion much flatu- lence and griping unless it is associated with aromatics. Full doses 682 A TEXT-BOOK OF MATERIA MEDIC A. open the bowels in from four to eight hours, producing one or more copious liquid, yellow stools, but never occasioning hyper- catharsis, and the purgation is not followed by constipation. An infusion of senna, if injected into the veins, excites both vomiting and purging. Some persons are so susceptible to the influence of senna as to be purged even by its odor. The drug, or some constituent of it, is eliminated by the urine, to which it imparts a red color, and by the milk, rendering it pur- gative. The various preparations of senna are very efficient purgatives in cases of simple constipation or in cases oi fecal accumulation in the colon. Infusion of senna is an admirable purgative with which to suc- ceed the administration of blue pill. In cases of biliousness there is probably no better treatment than calomel or blue pill at night and infusion of senna in the morning. Habitual constipation and the constipation of pregnancy are safely and agreeably treated by compound liquorice powder. Administration. — Senna is seldom given alone, but is generally associated with some corrective to prevent griping. The infusion, compound liquorice powder, syrup, and confection of senna are employed. The compound liquorice powder and the confection being the mildest and pleasantest, the latter preparation, when coated with chocolate, is readily taken by children, and in this form is the well- known laxative " Tamar Indien." HYDRAGOGUE PURGATIVES. These drugs are more active than the preceding class, pro- ducing an abundant secretion from the intestinal mucous mem- brane, removing a large quantity of water from the blood-vessels, and producing several copious, watery stools. Oleum Tiglii— Olei TTglii-Croton Oil. TI. 8. JP. Origin.— A fixed oil expressed from the seed of Croton Tiglium L., indigenous in Hindostan and some of the East Indian and Philippine islands. Description and Properties.— A pale-yellow or brownish-yel- low, somewhat viscid, and slightly fluorescent liquid, having a slight, fatty odor, and a mild, oily, afterward acrid and burning, taste CATHARTICS. 685 {^great caution is necessary in tasting). Croton oil should be kept in small, well-stoppered bottles, and should be handled with caution, for when applied to the skin it produces rubefaction or a pustular eruption. When fresh, croton oil is soluble in about 60 parts of alcohol,, the solubility increasing by age. The drug contains several volatile acids, of which tiglinic acid is the characteristic one ; besides this, it contains lauric, myristic, palmitic, stearic, formic, acetic, isobutyric, and isovalerianic acids. Dose. — \-2 minims (0.01-0.12 Cc.) on a lump of sugar or mixed with some bland oil. Physiological Action. — Externally and Locally. — Croton oil is a powerful irritant when applied to the skin, exciting inflammation and quickly producing vesication, which rapidly merges into pus- tules closely resembling those of variola, and perhaps lasting sev- eral days. In many cases permanent cicatrices mark the site of these pustules. If the drug be rubbed over the abdomen, it may produce pur- gation. Internally. -^'Wh&n a drop or two of croton oil is taken into the stomach it occasions a sense of heat in the epigastrium, which is soon succeeded by griping and abdominal pain, and in from half an hour to two hours after the ingestion of the drug there are pro- duced profuse watery stools, with considerable burning and irrita- tion about the anus. The drug greatly increases the vascularity of, and the secretion from, the gastro-intestinal tract, without specially influencing the biliary secretion. Large doses produce violent gastro-enteritis, hypercatharsis,. with great prostration and collapse resembling that of cholera. In case of poisoning the stomach should be immediately evacu- ated, and demulcent drinks freely given. Opium and stimulants may be necessary. Therapeutics. — Externally and Locally. — The external use of croton oil is comparatively limited. It is occasionally painted over the seat of pain in intercostal neuralgia, while a liniment of croton oil applied to the chest is said to be beneficial in phthisis and chronic bronchitis. The same prep- aration is recommended as a local application in congestive dysmen- orrhea and chronic congestion of the uterus. ' Croton oil has been put to many other uses, but the results 684 A TEXT-BOOK OF MATERIA MEDICA. obtained are so unsatisfactory that it is needless to enumerate them. Internally. — The drug is used as a purgative, as a rule only in cases of emergency, and then a single dose is usually sufficient. It is employed in such cases as intestinal obstruction from accumu- lated feces produced by torpor of the bowels, diseases of the nervous system, lead-poisoning, etc. In lead colic it is probably superior to all other purgatives. Croton oil is sometimes employed for its revulsive action in apoplexy. As a purgative it is frequently given to lunatics, because, on account of the smallness of the dose, it may be easily placed on the back of the tongue, where it is quickly swallowed reflexly. Contraindications. — The drug should never be given to preg- nant women, to children, nor to patients suffering from hemor- rhoids, peritonitis, gastritis, or enteritis. Administration. — Croton oil may be given in emulsion, or mixed with some bland oil, or dropped on a piece of loaf sugar, or in pill form. The best excipient for pills of croton oil is breadcrumb. ElaterTnum— Elaterlni— Elaterin. TJ. S. J*. Origin. — A neutral principle obtained from Elaterium, a sub- stance deposited by the juice of the fruit of Ecballium elaterium L., commonly known as " squirting cucumber," a vine growing in the Mediterranean regions of Europe, Africa, and Asia. Description and Properties. — Minute, white, hexagonal scales or prismatic crystals, without odor, and having a slightly acrid, bitter taste; permanent in the air; soluble in 4250 parts of water and 337 parts of alcohol. Dose. — -^^-^ grain (0.002-0.005 Gm.). Official Preparation. Trituratio Elaterlni— Triturationis Elaterlni— Trituration of Elaterin.— Dose, about f grain (0.05 Gm.). Physiological Action and Therapeutics. — Elaterin is the most powerful hydragogue purgative known. The drug greatly increases the salivary, gastric, and intestinal secretions, as well as those from the liver and pancreas. It is a violent purgative, whether given internally or injected CATHARTICS. 685 subcutaneously, producing abundant watery evacuations attended with much griping pain and great prostration. Elaterin is indicated where profuse serous discharges are de- sired, as in cases of congestion of the brain and lungs, ascites, and chronic nephritis. Contraindications. — The drug is not permissible in inflamma- tory conditions of the gastro-intestinal tract, nor in pregnancy, and it should be administered with much care, if at all, in heart disease. Administration. — The drug may be given in pill form, in alco- holic solution, or in the form of the trituration. Elaterin varies greatly in strength, which suggests caution in its use. Cambogia— Cam bogiae— Gamboge. V. S. J*. Origin. — A gum-resin obtained from Garcinia Hanburii Hooker filius, a medium-sized tree, indigenous in Siam, Cambodia, and Cochin China. Description and Properties. — In cylindrical pieces, sometimes hollow in the center, i to 2 inches (2 to 5 Cm.) in diameter, longi- tudinally striate on the surface ; fracture flattish-conchoidal, of a waxy luster, orange-red; in powder bright yellow; inodorous; taste very acrid; the powder sternutatory. Gamboge is partly soluble in alcohol and in ether. Dose. — 1-5 grains (0.06-0.32 Gm.). Official Preparation. PUulae Cathartics Comp6sitse — PUulas (ace.) Cath^rticas CompOsitas — Compound Cathartic Pills. — Dose, 1-3 pills. Physiological Action and Therapeutics. — Gamboge is a vio- lent hydragogue purgative, exciting active peristalsis and greatly augmenting the secretion from the intestinal glands, although not increasing the secretion of bile. Small and repeated doses are slightly diuretic, coloring the urine yellow. Gamboge is seldom given alone, being usually associated with other purgatives. It is used in combination when a hydragogue action by the kidneys as well as the bowels is desired. It is thought to be of use in hepatic congestion arising from malarial causes. The drug is an efficient anthelmintic, and is occasionally prescribed with vermicide medicines. 686 A TEXT-BOOK OF MA TERIA MEDICA. SALINES. Magnesii Citras Effervescens— Magrnesii Citratis Effervescentis— Effervescent Magnesium Ci- trate. V. S. I*. Formula: Magnesium Carbonate, lo ; Citric Acid, 46 ; Sodium Bicarbonate, 34 ; Sugar, 8 ; , Alcohol and Distilled Water, a suf- ficient quantity. Description and Properties. — A white, coarsely granular salt, without odor, and having a mildly acidulous, refreshing taste. Deliquescent on exposure to the air. Soluble, with copious effer- vescence, in 2 parts of water; almost insoluble in alcohol. The product should be kept in well-closed vessels. Dose. — |-i ounce (8.0-32.0 Gm.). Liquor Mag^nesii Citratis— Liquoris iVlagnesii Citratis —Solution of IVIagrnesium Citrate. U. S. JP. Formula: Dissolve Magnesium Carbonate, 15, in a solution of Citric Acid, 30 ; add Syrup of Citric Acid, 60 ; then Crystals of Potassium Bicarbonate, 25. Cork the bottle and wire immediately. The product effervesces when uncorked. Dose. — 2-8 fluidounces (60.0-237.0 Cc). Magnesii Sulphas— Magnesii Sulphatis— Magne- sium Sulphate. U. 8. -P. (Epsom Salt.) Origin. — Obtained by the action of Sulphuric Acid upon native Magnesium Carbonate, treated with Water, filtered, and the filtrate evaporated to crystallization. Description and Properties.— Small, colorless, rhombic prisms or acicular crystals, without odor, and having a cooling, saline, and bitter taste; slowly efflorescent in dry air. Soluble in 1.5 parts of water ; insoluble in alcohol. Dose. — |-i ounce (8.0-32.0 Gm.). Antagonists and Incompatibles.— Magnesium sulphate is in- compatible with alkaline carbonates, phosphoric acid, phosphates, lead acetate, silver nitrate, and lime water. Synergists. — Saline purgatives. Potassii Sulphas— Potassii Sulphatis— Potassium Sulphate. U. S. I*. Origin.— Prepared by adding Potassium Carbonate to Acid Potassium Sulphate. CA THAR TICS. 687 Description and Properties. — Hard, colorless, transparent, six- sided, rhombic prisms terminated by pyramids, or in white powder ; odorless, and having a somewhat bitter, saline taste. Permanent in the air. Soluble in about 9.5 parts of water, insoluble in alcohol. Dose. — J-4 drachms (2.0-16.0 Gm.). Potassii et Sodii Tartras— Potassii et Sodii Tartrdtis —Potassium and Sodium Tartrate. TI. S. JP. (RocHELLE Salt.) Origin. — Prepared by adding Acid Potassium Tartrate to a hot solution of Sodium Carbonate. Description and Properties. — Colorless, transparent rhombic prisms, or a white powder, odorless, and having a cooling, saline taste. The crystals slightly effloresce in dry air. Soluble in 1.4 parts of water, almost insoluble in alcohol. Dose. — 30 grains-i ounce (2.0—32.0 Gm.). Official Preparation. Ptilvis EffervSscens Compftsitus — Ptilveris Effervesc6ntis CompSsiti — Compound Effervescing Powder (Seidlitz Powder).— Each powder has of Ro- thelle Salt, 120 grains (8.0 Gm.) ; of Sodium Bicarbonate, 40 grains (3.0 Gm.), mixed in a blue paper; and of Tartaric Acid, 35 grains (2.26 Gm.), in a white paper. Dose. — One or two of each dissolved separately in separate quantities of water, the solutions poured together and drunk while effervescing. Sodii PliospFias— Sodii PFiospViatis— Sodium Piios- phate. TJ. 8. JP. (Sodium Orthophosphate.) Origin. — Prepared by digesting Bone Ash with Sulphuric Acid. The solution is filtered, and to it is added Sodium Carbonate, and the filtrate evaporated to crystallization. Description and Properties. — Large, colorless, monoclinic prisms, odorless, and having a cooling, saline taste. The crys- tals effloresce in the air, and gradually lose S molecules of water of crystalHzation. Soluble in 5.8 parts of water; insoluble in alcohol. Sodium phosphate should be kept in well-stoppered bottles, in a cool place. Dose. — 5 grains-i ounce (0.32-32.0 Gm.). 688 A TEXT-BOOK OF MATERIA MEDIC A. Sodii Sulphas— Sodii Sulphatis— Sodium Sulphate. JJ. S. P. (Glauber's Salt.) Origin. — The residue left in the manufacture of Hydrochloric Acid from Salt is neutralized with Sodium Carbonate. Description and Properties. — Large, colorless, transparent, monoclinic prisms or granular crystals ; odorless, and having a bitter, saline taste. The salt effloresces rapidly in the air, and finally loses all its water of crystallization. Soluble in 2.8 parts of water and in glycerin ; insoluble in alcohol. Dose. — 1-8 drachms (4.0-32.0 Gm.). Physiological Action and Therapeutics of the Salines. — These preparations greatly augment the intestinal secretions, their activity depending upon the nature and amount of the salt and the strength of its solution ; the greater the amount of the solution, the sooner the purgative action is produced. Save the sulphate and phosphate of sodium, which are mild hepatic stimulants, the salines have no effect upon the biliary secretions. The sodium salts are more efficient than the potassium salts as purgatives, owing to the slower absorption of the former, which enables them to act more directly upon the intestinal canal. Purgation by the salines is painless, and occurs usually in from two to three hours after administration, there being ordinarily two or three watery evacuations. In cases of habitual constipation, particularly that associated with tht gouty diathesis, there are no better purgatives than the salts OF SODIUM or mineral waters containing them, such as Carlsbad, Marienbad, Hunyadi Janos, etc. For -children there is no better purgative than sodium phos- phate, especially where the stools show a deficiency of bile. In duodenal catarrh excellent results are obtained by this drug ; also in chronic rheumatism, and to retard the formation of biliary calculi. Concentrated saline purgatives are efficient remedies for the removal of dropsical and pleuritic effusions. Magnesium sulphate, combined with dilute sulphuric acid, is the most efficient treatment in cases of chronic lead-poisoning. RocHELLE salt and Seidlitz powder are pleasant and useful purgatives in cases of biliousness, migraine, etc. Solution of mag- CA THAR TICS. 689 NESiUM CITRATE is uscd for the same purpose, but, while very- palatable and acceptable to the stomach, is not always reliable, besides being apt to occasion slight griping. Administration. — The salines should be taken dissolved in plenty of water, and ordinarily should be administered in the morning, when the stomach is empty. DRASTIC PURGATIVES. These drugs are even harsher in their action than hydragogue purgatives, exciting violent peristalsis, and in large doses producing gastro-enteritis and all the symptoms occasioned by an irritant poison. The evacuations produced by these drugs are numerous, copious, and watery, attended with much griping pain, tenesmus, and borborygmi. ColocJ^nthis— Colocynthidis-Colocynth. U. S. I*. Origin. — The fruit of Citrullus Colocynthis Schroder, deprived of its rind. The colocynth plant is indigenous in Japan and is cultivated and naturalized in Spain. Description and Properties. — From 2 to 4 inches (5-10 Gm.) in diameter; globular; white or yellowish-white, light, spongy; readily breaking into three wedge-shaped pieces, each containing, near the rounded surface, many flat, ovate, brown seeds ; inodor- ous; taste intensely bitter. The active constituent of colocynth is colocynthin, a glucosid, of which there is present about 2 per cent. Colocynth also con- tains resin, gum, and an amyloid principle. Dose. — 5-10 grains (0.3-0.6 Gm.). Official Preparations. ExtiSctum Coloc5^nthidis — ExtrScti Colocynthidis — Extract of Colocynth. Dose, J-2 grains (0.03-0.13 Gm.). Extractum Colocj^nthidis Comp6situm — ExtrScti Colocynthidis Compfisiti — Compound Extract of Colocynth. — Extract of Colocynth 16 per cent., with Aloes, Scammony, Cardamom, and Soap. Dose. — 5-25 grains (0.3-1.6 Gm.). Compound Extract of Colocynth enters into the following pills : PHulae CathSrticse CompSsitae (8 per cent.). PUulse Cath^rticse Vegetabiles (5 per cent.). Physiological Action and Therapeutics. — The action of colo- cynth is very similar to that of elaterin. In small doses, however, 44 690 A TEXT-BOOK OF MATERIA MEDICA. it rather acts as a stomachic, improving the appetite and augment- ing the secretions of the whole gastro-intestinal tract. Colocynth is quite a decided hepatic stimulant and cholagogue. Pills containing colocynth are useful to produce abundant watery evacuations, as is necessary sometimes in the treatment of hepatic and renal diseases where there is constipation and ascites. The drug should be employed only when there is some marked indication for its use, as colocynth, like the other drastics, is too irritant for habitual use. Gastro-intestinal inflammation, pregnancy, etc., would contra- indicate its use. Jalapa—Jalapae— Jalap. V. S. I*. Origin. — The tuberous root of Ipomcea Jalapa Nuttall, a twin- ing herbaceous perennial growing in damp and shady woods on the eastern slope of the Mexican Andes. It has been introduced into India and Jamaica. Description and Properties. — Napiform, pyriform, or oblong, varying in size, the large roots incised, more or less wrinkled, dark brown, with lighter-colored spots and short, transverse ridges; hard, compact, internally pale grayish-brown, with numerous con- centric circles composed of small resin-cells ; fracture resinous, not fibrous ; odor slight, but peculiar, smoky, and sweetish ; taste sweetish and acrid. Jalap contains two resins, one hard, the other soft, the former, termed jalapin or convolvulin, being the active principle of the drug. According to the U. S. Pharmacopoeia, there must be not less than 12 per cent, of resin, of which not less than 10 per cent, must be soluble in ether. Dose. — 5-30 grains (0.32-2.0 Gm.). Official Preparations. ExtrSctum Jalapse — Extracti Jalapse — Extract of Jalap. — Dose, 2-5 grains (0.13-0.3 Gm.). Pfilvis Jalapse Comp6situs — Pfilveris Jalaps Coinp6siti — Compound Jalap Powder (35 per cent., with Potassium Bitartrate). — Dose, 15-60 grains (1.0-4.0 Gm.). Resina Jalapse — Resinae Jalapse — Resin of Jalap. — Description and Proper- ties. — Yellowish-brown or brown masses or fragments, breaking with a resinous, glossy fracture, translucent at the edges, or a yellowish-gray or yellowish-brown powder, having a slight, peculiar odor, and a somewhat acrid taste. Pennanent in the air. Soluble in alcohol in all proportions. Dose. — 2-5 gi-ains (0.13-0.3 Gm.). Extract of Jalap is one of the ingredients of Pllulae Catharticse Comp&sitse and PKlulse Catharticse Vegetabiles. CATHARTICS. 691 Physiological Action and Therapeutics. — The purgative action of jalap is developed in the duodenum, where it comes in contact with the bile. The secretion from the intestinal glands is greatly augmented, as well as the vascularity and peristalsis of the intestines. The biliary flow is but little affected. Purgation is produced by jalap in three or four hours, the evacuations being profuse and watery and attended with griping pain. Jalap — or, preferably, the compound jalap powder — is a reliable hydragogue cathartic for the removal of dropsical effusions, being especially appropriate for nephritic patients. Small doses of jalap are serviceable in constipation due to de- ficient intestinal secretion. The drug is frequently associated with anthelmintic medicines as a vermifuge. Scammonium— Scammonii— Scammony. TJ. S. P. Origin. — A resinous exudation from the living root of Convol- ■vulus Scammonia L., a herbaceous, twining perennial, growing in Syria, Asia Minor, and Greece. Description and Properties. — Occurring in irregular angular pieces or circular cakes, greenish-gray or blackish, internally por- ous, and breaking with an angular fracture, of a resinous luster ; odor peculiar, somewhat cheese-like ; taste slightly acrid ; powder gray or greenish-gray. It contains a resin, jalapin, which is the active principle, besides gum, starch, etc. Dose. — 1-15 grains (0.06-1.0 Gm.). Official Preparation. Resina Scammonii — Resinae Scammonii — Resin of Scammony. — Descrip- ■tion and Properties. — Yellowish-brown or brownish-yellow masses or fragments, break- ing with a glossy, resinous fracture, translucent at the edges, or a yellowish-white or grayish-white powder, having a faint, peculiar odor, and a slight, peculiar taste. Soluble in alcohol in all proportions. Dose. — 1-8 grains (0.06-0.5 Gm.). Physiological Action and Therapeutics. — The action of scam- mony is identical with that of jalap, save that it stimulates the muscular coat of the intestines more, producing more irritation and griping than jalap, though not increasing secretion so much .as the latter drug. 692 A TEXT-BOOK OF MATERIA MEDICA. The therapeutics are the same as for jalap. The drug may be given in powder, emulsion, or in milk, but is inactive in pilular form. PodophJ^llum—PodophS^Ui— Podophyllum. XJ. S. P. (May Apple.) Origin. — The rhizome and roots of Podophyllum peltatum L., an herbaceous perennial growing in rich woodlands in Canada and the United States. Description and Properties. — Of horizontal growth, consisting of joints about 2 inches (5 Cm.) long, flattish cyhndrical, about \ inch (6 Mm.) thick, but somewhat enlarged at the end, which has a circular scar on the upper side, a tuft of about ten nearly simple, fragile roots on the lower side, and is sometimes branched laterally ; smooth or somewhat wrinkled, orange-brown, internally white and mealy, with a circle of small wood-bundles ; pith large; nearly inodorous ; taste sweetish, somewhat bitter and acrid. Podophyllum contains a resin, podophyllin, composed princi- pally of podophyllotoxin, which is probably a mixture of picropodo- phyllin, the purgative principle, and podophyllinic acid, an inactive resin acid. Among other constituents of the drug are several minor resins and a coloring principle. Dose. — 5-20 grains (0.32-1.29 Gm.). Official Preparations. , Extrdctum PodophyUi — Extr^cti Podophylli — Extract of Podophyllum. — Dose, 1-3 grains (0.06-0.2 Gm.) ExtrSctum Podophylli Fluidum — Extrdcti PodophyUi Fluidi — Fluid Ex- tract of Podophyllum. — Dose, 5-20 minims (0.32-1.29 Co.). Resina Podophylli — Resinae PodophJ^Ui — Resin of Podophyllum. — Descrip- tion and Properties. — An amorphous powder, varying in color from grayish-white to pale greenish-yellow or yellowish-green, turning darker when exposed to heat; having a slight peculiar odor and a peculiar, faintly bitter taste; permanent in the air; soluble in alcohol in all proportions. Dose. — \-\ grain (0.008-0.06 Gm.). Podophyllotaxin (unofficial). — Dose, yJ^-jV gi'ain (0.0006-0.006 Gm.). Physiological Action and Therapeutics. — The powdered root is an irritant to the skin, and when inhaled occasions a decided irritation of the eyes and respiratory passages. It is absorbed when applied to ulcers and raw surfaces, producing its character- istic purgative effects. The drug is a gastro-intestinal irritant, being ANTHELMINTICS. 693 apt to excite nausea, in full doses producing salivation and greatly augmenting the intestinal secretions, and especially the bile. Under full doses of podophyllum there is marked peristalsis, attended with severe griping pains, and in the course of ten or twelve hours there is produced a complete evacuation of the bowels, the feces being liquid and deeply stained with ' bile. The drug being one of the most active hepatic stimulants and cholagogues in the Pharmacopoeia, it is a peculiarly appropriate remedy iri that condition known as torpor of the liver. The con- stipation attending hepatic cirrhosis and cancer, as well as that from any hepatic disorder, is well treated by podophyllum. The slowness and completeness of its action, together with its property of stimulating the functional activity of the liver, renders the drug extremely serviceable in the treatment of habitual consti- pation from any cause. It should, however, be associated with antispasmodics, such as hyoscyamus or belladonna, to overcome its griping. When asso- ciated with other purgatives care should be exercised to select those only which, like itself, are tardy in their action. Owing to the susceptibility of certain persons to the drug, the dosage should be small at first and gradually increased as necessary. GROUP XV.— ANTHELMINTICS. Anthelmintics are remedies which kill or expel intestinal worms. Those drugs which kill the parasites are called vermi- cides, and those which simply promote their expulsion are called vermifuges} The vermicides are — Aspidium, Kamala, Chenopodium, Oleum Terebinthinse,* Cusso, Pepo, Granatum, Santonica. The vermifuges are — Calomel,* Spigelia. Hydragogue Purgatives,* Anthelmintics are here divided according to the kind of intesti- nal parasite against which they are employed. The Oxyuris vermicularis is the small worm, often called seat- 1 Drugs marked with an asterisk (*) are considered elsewhere. 694 A TEXT-BOOK OF MATERIA MEDICA. worm or thread-worm, that infests the large intestine and rectum. The Ascaris lumbricoides is the common round-worm, found chiefly in the small intestine. The T(2ni(B are the tape-worms. Remedies employed against the Oxyuris vermicularis : A weak solution of Carbolic Acid,* Lime Water,* Infusion of Quassia,* Calomel,* Decoction of Aloes.,* Oleum Terebinthinse.* Remedies employed against the Ascaris lumbricoides : Chenopodium, Calomel,* Santonica, Hydragogue Purgatives,* Spigelia, Oleum Terebinthinse.* Remedies employed against the Tcenia Solium and other varieties of Tcenia: Aspidium, Kamala, Cusso, Pepo, Granatum, Oleum Terebinthinse.* Chenopodium— Chenopodii— Chenopodium. JJ. S.F. (American Wormseed.) Origin. — The fruit of Chenopodium ambrosioides L., and the variety anthelminticum Gray, plants indigenous in the West Indies, and Central and South America, and naturalized in the United States. Description and Properties. — Nearly ^ inch (2 Mm.) in diam- eter, depressed globular, dull greenish or brownish, the integu- ments friable, and containing a lenticular, obtusely-edged, glossy, black seed. It has a peculiar, somewhat terebinthinate odor, and a bitterish, pungent taste. It contains a volatile oil, to which its medical properties are due. Dose. — 15-30 grains (1.0-2.0 Gm.). Oleum Chenopodii— Olei Chenopodii— Oleum Che- nopodii. U.S.I'. (Oil of American Wormseed.) Origin. — A volatile oil distilled from Chenopodium. Description and Properties. — A thin, colorless or yellowish liquid, having a peculiar penetrating, somewhat camphoraceous odor, and a pungent and bitterish taste. Dose. — 2-10 minims (0.12-0.6 Cc). ANTHELMINTICS. 695 Physiological Action and Therapeutics. — Both the powdered SEED and the oil are efficient anthelmintics, particularly useful to expel round-worms {Ascarides lumbricoides) from children. The drug should invariably be followed by a brisk cathartic. The powder may be given suspended in molasses, or the oil may be given dropped upon loaf-sugar, or in the form of an emulsion, or enclosed in capsules. Santonica— Santonicae— Santonica. TJ. S. P. (Levant Wormseed.) Origin. — The unexpanded flower-heads of Artemisia pauciflora Weber, a plant growing in Asia and exclusively collected in North- ern Turkestan. Description and Properties. — From yj- to ^ inch (2 to 3 Mm.) long, oblong-ovoid, obtuse, smooth, somewhat glossy, grayish- green, after exposure to light brownish-green, consisting of an in- volucre of about twelve to eighteen closely imbricated, glandular scales with a broad midrib, enclosing four or five rudimentary florets ; odor strong, peculiar, somewhat camphoraceous ; taste aromatic and bitter. The drug contains about 2 per cent, of a neutral principle, santonin, to which its anthelmintic properties are due. It also contains about i per cent, of an unimportant volatile oil. ' Dose. — 10-60 grains (0.6-4.0 Gm.). Santonlnum—Santonlni— Santonin. TJ. 8. P. Origin. — A neutral principle obtained from Santonica. Description and Properties. — Colorless, shining, flattened, pris- matic crystals, odorless, and nearly tasteless when first put into the mouth, but afterward developing a bitter taste ; not altered by ex- posure to air, but turning yellow on exposure to light. Nearly insoluble in cold water ; soluble in 40 parts of alcohol. Santonin should be kept in dark, amber-colored vials, and should not be exposed to light. Dose. — \-i grain (0.016-0.06 Gm.) for a child; 1-5 grains (0.06-0.32 Gm.) for an adult. Official Preparation. Trochlsci Santomni— Trochifscos (ace.) Santonini — Troches of Santonin. — Each troche contains \ grain (0.03 Gm.). — Dose, 2 (child) to 10 troches (adult). 696 A TEXT-BOOK OF MATERIA MEDICA. Physiological Action and Therapeutics. — In full or large doses santonin may excite nausea or vomiting, with abdominal pain, diarrhea, eructations, borborygmi, and great thirst. It readily enters the blood, where it exists as sodium santoninate. Large doses may cause giddiness, headache, hallucinations of smell and taste, tremors, and a species of depression, the combination of symptoms forming what is called santonin intoxication. The drug is chiefly eliminated through the kidneys, small amounts of santonin even imparting to the urine a distinct yellow color if the urine is acid, and a decided purplish or even red color if the urine is alkaline. Under certain circumstances when the urine is decidedly alkaline, as in cases of cystitis, the administra- tion of santonin may produce so marked a discoloration of the urine as to suggest hematuria. Probably the most remarkable phenomenon attending the inges- tion of medicinal doses of santonin is that of xanthopsia or yellow vision, which may continue for several hours. According to Rose, " there occasionally appears before the peculiar yellow sight, after large doses of santonin, a violet color of the field of vision : the intensity of this color is in proportion to the darkness of the objects looked at. All light objects, such as windows, paper, etc., appear actually yellow. Red and blue appear often in their complementary colors, orange and green, so that carmine-red appears pale, madder- red a bronze color, and the sky and blue objects green. This, however, is not always the case, and it has been noticed after the employment of santonin that red appears violet or light, and dark objects appear orange to one person, and to another green." (Quoted from Lewin.) This peculiar effect of santonin is due, according to Rose, to a nervous change in the retina or in the brain. Affections of the skin — e. g. urticaria — have occasionally fol- lowed the administration of santonin. Decidedly poisonous effects have sometimes been produced by comparatively small amounts of the drug. The symptoms of a fatal case from over-dose of santonin were convulsions accompanied by unconsciousness, twitching of the eyeballs, dilated pupils, cold sweat, weak pulse, feeble respiration, and, after some hours, sudden death. In case of poisoning by santonin the remedial measures are in- ternal and external stimulants, eliminants, and artificial respiration. Santonin is certainly a most efficient remedy against the ascaris, and to a less extent it is of use against the oxyuris. It has no effect on the tcznia. ANTHELMINTICS. 697 The drug should be given on an empty stomach, either alone or associated with calomel, and followed in two or three hours by -castor oil or other brisk cathartic. It may be administered in the form of a powder mixed with sugar or jelly, or in pills or cap- sules. Troches of santonin are much used and are very efficient. Spigelia— Spigeliae— Spigelia. TJ. S. JP. (PiNKROOT.) Origin. — The rhizome and roots of Spigelia marilandica L., a plant growing in rich shady woods, chiefly in the southern part of the United States, but found as far northward as Pennsylvania and Wisconsin. Description and Properties. — Of horizontal growth, about 2 inches (5 Cm.) or more long, about -I- inch (3 Mm.) thick, dark purplish-brown, bent, somewhat branched on the upper side, with cup-shaped scars ; on the lower side with numerous thin, brittle, light-colored roots about 4 inches (10 Cm.) long; the rhizome internally with a whitish wood and a pith which is usually dark colored or decayed ; odor somewhat aromatic ; taste sweetish, bitter, and pungent. It contains a volatile alkaloid, spigeline, which is the active principle. Dose. — |— 2 drachms (1.0-8.0 Gm.). Official Preparation. Extractum Spigeliae Fltiidum — Extract! Spigelise Fltiidi — Fluid Extract •of Spigelia. — Dose, J-2 fiuidrachms (1.0-8.0 Cc). Physiological Action and Therapeutics. — Spigelia is a pow- erful anthelmintic, being a decided vermifuge against the Ascaris lumbricoides. When given alone and in full doses it may produce symptoms of narcotic poisoning. This may be obviated by asso- ciating it with cathartics and aromatics. The drug may be administered in the form of a tea, associated "with senna, fennel, or other aromatics. The fluid extract is a reli- ■able preparation. Remedies employed against the different varieties of Tcenia : AspTdium— AspTdii— Aspidium. U. S. J*. (Male Fern.) Origin. — The rhizome of Dryopteri? Filix mas Schott and of Dryopteris marginalis Gray, plants indigenous in North America, 698 A TEXT-BOOK OF MA TERIA MEDICA. a portion of South America, Asia, Europe, and some parts of Africa. Description and Properties. — From 3 to 6 inches (7 to 15 Cm.) long, -I to I inch (12 to 25 Mm.) thick, and, together with the closely imbricated, dark-brown, roundish, and slightly curved stipe-remnants, 2 to 3 inches (50 to 75 Mm.) in diameter; densely covered with brown, glossy, transparent, and soil, chaffy scales ; internally pale green, rather spongy ; vascular bundles about ten {Dryopteris Filix mas) or six {Dryopteris marginalis) in number, arranged in an interrupted circle; odor slight, but disagreeable; taste sweetish, acrid, somewhat bitter, astringent, and nauseous. Aspidium contains filicic acid, tannaspidic acid, pteritannic acid, filicin (filicic acid anhydride), fixed oil, a trace of volatile oil, and chlorophyl. Dose. — \-2 drachms (2.0-8.0 Gm.). Official Preparation. Oleoresina Aspldii— Oleoreslnae AspMii — Oleoresin of Aspidium. — Dose, \-\ fluidraclim (1.0-4.0 Cc). Note. — Oleoresin of aspidium usually deposits, on standing, a granular crystalline substance. This should be thoroughly mixed with the liquid portion before use. The oleoresin should be kept in well-stoppered bottles. Physiological Action and Therapeutics. — Aspidium is the most reliable tceniacide known to materia medica. Though it is employed against both the armed and unarmed varieties of tape- worm, it is nevertheless against the latter that it is specially effec- tive. In the cases of armed taeniae special precautions must be taken to ensure success. The drug possesses tonic and astringent properties, and if taken in very large doses may occasion nausea, vomiting, diarrhea, and gastric and abdominal pains. Several fatal cases of poisoning have occurred, and it is believed that the fatalities were due not so much to excessive dose as to increased absorption of the drug through the influence of the castor oil that had been administered with it. When given for the expulsion of tape-worm the bowels should first be emptied by a castor-oil purge, and then the oleoresin be administered in gelatin capsules or in emulsion. Previous to the exhibition of the anthelmintic the patient should for at least twenty-four hours live on exceedingly spare diet, and the medicine then be given in the morning fasting. A few hours ANTHELMINTICS. 699 later an active purge of about i ounce (30.0 Cc.) of castor oil or calomel and jalap should be given to expel the dead worm, which should be carefully examined for the head. If the head did not pass, the treatment should be repeated the following day or soon after. Cusso— Cusso— Kousso. TJ. S. J». (Brayera.) Origin. — The female inflorescence of Hagenia Abyssinica (Bruce) Gmelin, a handsome tree 40 to 50 feet (12 to 18 M.) high, in- digenous on the table-land and in the mountainous districts of Abyssinia. Description and Properties. — In bundles, rolls, or compressed clusters consisting of panicles about 10 inches (25.0 Cm.) long, with a sheathing bract at the base of each branch ; the two round- ish bracts at the base of each flower and the four or five obovate outer sepals are of a reddish color, membranous and veiny ; calyx top-shaped, hairy, enclosing two carpels or nutlets; odor slight, fragrant, and tea-like; taste bitter, acrid, and nauseous. It contains a neutral active principle, kosin, a tasteless and an acid resin, and about 24 per cent, of tannin. Dose. — 2-4 drachms (8.0-16.0 Gm.). Official Preparation. Extractum Ciisso Fluidum — ExtrScti Ctisso Fluidi — Fluid Extract of Cusso. — Dose, 1-4. fluidrachms (4.0-15.G Cc). Kosin — Koussein (unofficial). — Origin. — The active principle from the flowers and unripe fruits of Hagenia Abyssinica (Bruce) Gmelin. Description and Properties. — An amorphous yellowish crystalline powder having a pungent bitter taste. Insoluble in water, but readily soluble in alcohol and in ether. Dose, 15-30 grains (1.0-2.0 Gm.), to be divided into four doses and taken at inter- vals of half an hour. Physiological Action and Therapeutics. — The action of kousso upon the digestive tract, under large doses, is similar to the action of aspidium. It is a reliable anthelmintic for all species of tape- worm. The fluid extract should be given in the form of an emul- sion, the patient having previously fasted, and the exhibition of the drug followed in a few hours by a large dose of castor oil. Granatum—Granati— Pomegranate. TJ. 8. F. Origin. — The bark of the stem and root of Punica Granatum L., a shrub or small tree about 20 feet (6 M.) high, indigenous in Southwestern Asia from Northern India to Palestine. 700 A TEXT-BOOK OF MA TERIA MEDICA. Description and Properties. — In thin quills or fragments from 2 to 4 inches (5 to 10 Cm.) long and from -^^ to \ inch (i. to 3. Mm.) thick ; outer surface yellowish-gray, somewhat warty or longitudinally and reticulately ridged ; the stem-bark often partly covered with blackish lichens ; the thicker pieces of the root-bark more or less scaly externally ; inner surface smooth, finely striate, grayish-yellow ; fracture short, granular, greenish-yellow, indis- tinctly radiate ; inodorous ; taste astringent, very slightly bitter. It contains as its active constituent a liquid alkaloid, pelletierine, with its three allied alkaloids, methyl-pelletierine, pseudo-pelletierine, and iso-pelletierine , besides mannite and punico-tannic acid. Dose. — J-iJ drachms (2.0-6.0 Gm.). Unofficial Preparations. Pelletierine. — Origin. — An alkaloid derived from tlie root-bark of Punica gratia- iu7n L. Description and Properties. — A colorless liquid. Soluble in 20 parts of water and miscible in all proportions with alcohol. It forms crystalUne salts with acids, the prin- cipal one being the tannate. There are also the sulphate, hydrobromate and hydrochlorate. Pelletierinae TSnnas — Pelletierlnse Tannatis — Pelletierine Tannate. — De- scription and Properties. — A yellowish, hygroscopic, odorless powder, with a pungent astringent taste. Soluble in 700 parts of water and in 80 parts of alcohol. Dose. — 1-5 grains (0.06-0.32 Gm.). Physiological Action and Therapeutics. — Locally pomegran- ate is astringent. In large doses it excites vomiting, acts as a purgative, paralyzes the motor nerves, but does not affect sensa- tion, and dilates the capillaries. Pomegranate and its alkaloid, pelletierine, are efficient anthel- mintics for tape-worm. Like other anthelmintics, the drug should be given on an empty stomach, and if the bowels are not freely moved by the remedy, an active cathartic should follow its administration. A decoction of the bark may be used, but, owing to the diffi- culty in obtaining the fresh drug, which alone possesses anthel- mintic properties, the tannate of pelletierine, which is always reliable, is usually administered. Kamala— Kamalae— Kamala. TJ. S. P. (ROTTLERA.) Origin. — The glands and hairs from the capsules of Mallotus Philippinensis (Lamarck) Mueller, Arg., a large shrub or small tree ANTHELMINTICS. 701 growing wild in Australia, Eastern China, India, Southern Arabia, and Abyssinia. Description and Properties. — A granular, mobile, brick-red or brownish-red powder, inodorous and nearly tasteless, imparting a deep-red color to alkaline liquids, alcohol, ether, or chloroform, and a pale yellow tinge to boiling water. Under the microscope it is seen to consist of stellately arranged, colorless hairs, mixed with depressed-globular glands, containing numerous red, club-shaped vesicles. It contains a resinous coloring matter, rottlerin, and several resins. Dose. — 1-2 drachms (4.0-8.0 Gm.). Physiological Action and Therapeutics. — Kamala is a gastro- intestinal irritant and purgative, and an efficient anthelmintic against the Tcenia solium, as well as the Oxyuris vermicularis and the Ascaris lumbricoides. The drug should be taken suspended in syrup, and followed by a full dose of castor oil. Pepo—Peponis— Pumpkin Seed. TJ. S. I*. Origin. — The seed of Cucurbita Pepo L., the common pumpkin, indigenous in tropical Asia and America, and cultivated through- out the temperate zones. Description and Properties. — About f inch (2 Cm.) long, broadly-ovate, flat, white or whitish, nearly smooth, with a shallow groove parallel to the edge ; containing a short, conical radicle and two flat cotyledons ; inodorous ; taste bland and oily. It contains an acrid resin, supposed to be the active principle, and from 30 to 35 per cent, of a thick red fixed oil. Dose. — 1-3 ounces (32.0-94.0 Gm.). Physiological Action and Therapeutics. — Pumpkin seed ranks next to aspidium as a remedy for the destruction of tape-worm, and has the advantage of being free from any disagreeable taste or unpleasant action. For administration the fresh pumpkin seeds should be beaten into a paste with powdered sugar and diluted with milk or water to about i pint (473.17 Cc). Previous to its administration the patient should fast for twenty-four hours, when the bowels should be flushed out with a large saline purgative.' A portion of the emulsion of pumpkin seed is then to be taken, preferably in the morning, and the balance taken in two doses at intervals of about two hours, the patient meanwhile remaining in bed to prevent, as far as possible, disturbance of the stomach. 702 A TEXT-BOOK OF MA TERIA MEDICA. Three or four hours after the last dose of the emulsion has been taken the patient should be given a full dose of castor oil. GROUP XVI.— EMMENAGOGUES AND ECBOLICS. Emmenagogues are remedies which restore or increase the men- strual flow. They are divided, according to their action, into two classes. Those which act upon the uterine muscle or mucous membrane are said to be direct ; those which influence the uterus by afiecting the general health of the body, or by altering the blood-supply of the parts, or by influencing the nervous system, are said to be indirect. The principal Direct Emmenagogues are — Ergot, Borax, Digitalis, Rue, Savine, Hydrastis, Quinine, Caulophyllum, Asafetida, Tansy, Myrrh, Apiol, Guaiac, Hedeoma. Cantharides, The Indirect Emmenagogues are — Iron and the Hematics, Cinnamon, Cod Liver Oil, Aloes. Strychnine, ( Hot foot-bath. Baths I Hot hip-bath. I Mustard bath. Leeches /i;°g^"^tals. y To thighs. c Baths. Mustard I Poultices to thighs. ( Stupes. EcBOLics or Oxytocics are remedies which act directly upon the uterine muscular fibers, inducing uterine contraction, and are chiefly used during or immediately after parturition to produce or increase uterine action. They, are therefore contraindicated before parturi- tion, lest they induce abortion, although they are often used crimi- nally for this purpose. The exact manner in which ecbohcs act is unknown, but it is EMMENAGOGUES AND ECBOLICS. 703 supposed that they act directly by stimulating the uterine center in the cord or reflexly through uterine congestion. In small doses many of the acholics are emmenagogue, while many of the direct emmenagogues are ecbolic. The only justifiable uses for ecbolics are in parturition, with uterine inertia and unobstructed and well-dilated maternal parts, when it is desired to hasten the delivery of the child, or, second, to induce firm contraction of the uterus, and thus prevent or check uterine hemorrhage after the birth of the child. The principal Ecbolics are — Ergot, Oil of Rue, Ustilago, Borax, Hydrastis, Pilocarpine, Savine, Potassium Permanganate, Quinine, Strong Purgatives. Cotton Root Bark, Drugs which have not been considered elsewhere in the present -work will now be described. Sablna—Sablnae— Savine. TJ. S. JP. Origin. — The tops of Juniperus Sabina L., a small ever- green procumbent or erect shrub, distributed throughout the greater portion of Europe, Siberia, Canada, and the Northern United States. Description and Properties. — Short, thin, subquadrangular branchlets ; leaves rather dark green, in four rows, opposite, scale- like, ovate-lanceolate, more or less acute, appressed, imbricated, on the back with a shallow groove containing an oblong or round- ish gland ; odor peculiar, terebinthinate ; taste nauseous, resinous, and bitter. It contains 2 per cent, of a volatile oil, tannin, resin, gum, etc. Dose. — 5-15 grains (0.3-1.0 Gm.). Official Preparation. ExtrSctum Sabinse Fluidum — ExtrScti Sablnae Fluidi — Fluid Extract of Ravine. — Dose, 5-15 minims (0.3-I.0 Cc). Oleum Sablnae— Olei Sabinse— Oil of Savine. V. S. J?. Origin. — A volatile oil distilled from Savine. Description and Properties. — A colorless or yellowish liquid 704 A TEXT-BOOK OF MATERIA MEDIC A. having a peculiar terebinthinate odor and a pungent, bitterish, and camphoraceous taste. It becomes darker and thicker by age and exposure to the air. Soluble in an equal volume of alcohol. Dose. — 1-5 minims (0.06-0.3 Cc). Physiological Action and Therapeutics. — The action of savine depends on the presence of the volatile oil, and this oil differs in its local external effect from the oil of turpentine merely in that the oil of savine is more active. It occasions much irritation, vesi- cation, and even pustulation when applied to the skin. Taken internally in small doses, it produces a sensation of heat in the epigastrium, with flatulence and frequently nausea. Toxic doses excite violent gastro-enteritis. The drug stimulates the circulation, and later, under full me- dicinal doses, depresses it. It is rapidly absorbed, and is excreted by various channels, increasing the urinary and bronchial excre- tions. These excretions, as well as the sweat and breath, smell strongly of the drug. Savine is a decided irritant to the uterus and ovaries, inducing marked hyperemia of those organs, and promoting contractions of the pregnant uterus. Toxic doses produce symptoms similar to those occasioned by oil of turpentine — violent gastro-enteritis, suppressed or bloody urine, great depression, etc. The treatment in poisoning by oil of savine would be full doses of Epsom salt, demulcents, anodynes, and stimulants if necessary. Savine in the form of an ointment is used as a stimulant appli- cation to keep up the discharge from blisters. An alcoholic solu- tion of oil of savine, 5-30 minims (0.3-1.8 Cc.) to i ounce (30.0 Cc), is used in alopecia pityroides. Oil of savine is a very efficient remedy in amenorrhea, and is also of benefit in certain cases of menorrhagia due to an enlarged and passively congested uterus. The hemorrhage following abor- tion is usually well controlled by this remedy. The powder or fluid extract may be given, but the oil is the most effective preparation, and may be prescribed in capsules, pills, or emulsion. It should be given cautiously. Ruta— Rutae— Rue. (Unofficial.) Origin. — The leaves of Ruta graveolens L., an herbaceous or suffruticose perennial 2 or 3 feet (60 or 90 Cm.) high, indigenous in Southern Europe. EMMENAGOGUES AND ECBOLICS 705 Description and Properties. — The leaves are ternate, the leaf- lets being obovate-oblong, yellowish-green, thickly dotted with minute, transparent oil-vesicles. They have a peculiar, strongly balsamic odor, and possess an aromatic, bitter, and acrid taste. The principal constituent of rue is a volatile oil. Dose. — 5-20 grains (0.3-1.3 Gm.). Oleum Rutae— -Olei Rutae— Oil of Rue. (Unofficial.) Origin. — A volatile oil distilled from Ruta graveolens L. Description and Properties. — A colorless or greenish-yellow liquid with the peculiar odor of the plant, and a pungent, some- what acrid, bitterish taste. Soluble in an equal weight of alcohol. Dose. — 2-5 minims (o.i 3-0.3 Cc). Physiological Action and Therapeutics. — The action of oil of rue is analogous to that of oil of savine, though less powerful. It is used for the same purposes also, and has occasionally been employed in hysteria. The oil should be administered in capsules. Caulophyilum— Caulophylli— Caulophyllum. V. S. JP. (Blue Cohosh.) Origin. — The rhizome and roots of Caulophyllum Thalictroides (L.) Michaux, a smooth and glaucous perennial, found in rich woodlands from Canada south to Carolina and Kentucky. Description and Properties. — Rhizome of horizontal growth, about 4 inches (10 Cm.) long and about i to |- inch (6 to 10 Mm.) thick, bent; on the upper side with broad, concave stem-scars and short, knotty branches ; externally grayish-brown, internally whitish, tough, and woody. Roots numerous, matted, about 4 inches (lo Cm.) long and -^-^ inch (i Mm.) thick, rather tough; nearly inodorous ; taste sweetish, slightly bitter, and somewhat acrid. Caulophyllum contains an odorless, colorless, and tasteless alka- loid, caulophyllin, besides resins, tannin, starch, gum, etc. Dose. — 5-30 grains (0.3-2.0 Gm.). Physiological Action and Therapeutics. — Blue cohosh is em- menagogue, antispasmodic, diuretic, and demulcent. It is quite an efficient remedy to increase the force of uterine contractions, and is of service in the treatment of spasmodic dysmenorrhea. It is usually given in the form of a decoction. 45 7o6 A TEXT-BOOK OF MA TERIA MEDICA. Tanacetum—Tanaceti— Tansy. U. 8. P. Origin. — The leaves and tops of Tanacetum vulgare L., a perennial herb indigenous in Europe and Central Asia, and nat- uralized in many parts of North America. Description and Properties. — Leaves about 6 inches (15.24 Cm.) long, bipinnatifid, the segments oblong, obtuse, serrate, or incised, smooth, dark green, and glandular; flower-heads corym- bose, with an imbricated involucre, a convex, naked receptacle, and numerous yellow tubular florets; odor strongly aromatic; taste pungent and bitter. It contains a volatile oil and a bitter principle, tanacetin, besides tannin, resin, etc. Dose. — 15-60 grains (1.0-4.0 Gm.), in infusion. Physiological Action and Therapeutics. — In moderate doses tansy acts as an aromatic bitter. Excessive amounts produce all the symptoms of an irritant narcotic — vomiting, purging, severe abdominal pain, loss of consciousness, convulsions, and great car- diac and respiratory weakness, death usually resulting from paral- ysis of respiration. The drug is regarded as an efficient remedy in amenorrhea, and is extensively employed in domestic practice in hysteria and colic, and topically for bruises, sprains, muscular rheumatism, etc. It is used in the rural districts to promote or restore menstrua- tion, and occasionally is employed with criminal intent as an abor- tifacient, but usually with negative results. The drug may be given in the form of an infusion, i ounce to I pint (32.0 Gm.-473.17 Cc), of which i or 2 ounces (30.0 or 60.0 Cc.) may be taken at a dose. The oil of tansy is occasionally prescribed in doses of 1-5 minims (0.06-0.3 Cc). PetroselTnum—PetroselTni— Parsley. Origin. — The root of Pctrosclinum sativum (Hoffmann), Apium Petroselinum L., a plant indigenous in Southern Europe, and much cultivated for culinary purposes. Description and Properties. — The root is tapering, from 4 to 8 inches (10-20 Cm.) long, about | inch (12 Mm.) thick; exter- nally yellowish or light brown ; odor aromatic ; taste sweetish and aromatic. It contains a volatile oil and apiol, the chief constituent. Dose. — 30-60 grains (2.0-4.0 Gm.). EMMENAGOGUES AND ECBOLICS. 707 Apiolum — Apioli — Apiol (Unofficial). — Origin.— h. camphor obtained from the fruit of Petroselinuin sativum Hoffmann. Description and Properties. — White needles, of a, feeble, parsley odor. Insoluble in water, but freely soluble in alcohol and in ether. Dose. — 10-15 grains (0.6-1.0 Gm.). Physiological Action and Therapeutics. — The root is carmin- ative, laxative, and diuretic. Apiol is an active emmenagogue. Given in excessive doses, it occasions severe frontal headache, dizziness, and ringing in the ears. It causes a rapid rise of blood- pressure, due to increased cardiac action and stimulation of the vaso-motor centers. Apiol, or Chapoteaut's apioline, is usually prescribed, and is an efficient remedy in amenorrhea, dysmenorrhea, and as an anti- periodic in malarial affections. As an emmenagogue in cases of scanty or deficient menstruation apioline is very effective. The drug is best given in capsules, as prepared by Chapoteaut,* one or two capsules being taken after meals three times a day. Hedeoma— Hedeomse— Hedeoma. TJ. S. -P. (Pennyroyal.) Origin. — The leaves and tops of Hedeoma pulegioides (L.) Per- soon, an annual herb indigenous in North America. Description and Properties. — Leaves opposite, short-petioled, about \ inch (12 Mm.) long, oblong-ovate, obscurely serrate, glan- dular beneath ; branches roundish-quadrangular, hairy ; flowers in small, axillary cymules, with a tubular-ovoid, bilabiate, and five- toothed calyx, and a pale-blue, spotted, bilabiate corolla, containing two sterile and two fertile exserted stamens ; odor strong, mint-like ; taste warm and pungent. Its virtues depend upon a volatile oil. Dose. — 15-60 grains (1.0-4.0 Gm.) in infusion. Oleum Hedeomae— Olei Hedeomae— Oil of Hede- oma. Tf. S. P. (Oil of Pennyroyal.) Origin. — A volatile oil distilled from Hedeoma. Description and Properties. — A pale-yellowish, limpid liquid, having a characteristic, pungent, mint-like odor and taste. It should ' M. Chapoteaut has prepared from the alcoholic solution of a petrol-ethereal extract a thick reddish liquid, to which he has given the name Apioline. This substance he claims to be the true active principle, and it is dispensed in capsules containing 3 minims (0.18 Cc.) each. 7o8 A TEXT-BOOK OF MATERIA MEDIC A. be kept in well-stoppered bottles, in a cool place, protected from light. Dose. — 2-IO minims (0.1-0.6 Cc). Physiological Action and Therapeutics. — Hedeoma is aro- matic, stimulant, caripinative, and emmenagogue, while the oil is rubefacient if rubbed into the skin. The herb is given in the form of a hot infusion to bring on retarded or suspended menstruation and for the relief oi flatulent colic, pharyngitis, bronchitis, etc., as well as to dissipate congestions of various parts. The OIL OF HEDEOMA is an active emmenagogue, and is used to increase the rubefacient effect of various embrocations. GROUP XVII.— ASTRINGENTS. Astringents are medicines which cause the contraction of living tissues, diminishing the amount of blood or other fluid in them, and reducing hemorrhage, or, through their constipating action, limiting the intestinal secretions as well as those from mucous membranes generally. They act chemically upon the tissues, and, when taken inter- nally, their influence is similar to that of tonics, invigorating the various structures of the body, their principal use being, in cases of relaxed conditions of the muscles and fibers or of the mucous membranes characterized by excessive secretion. Astringents are more or less irritating, and should therefore not be employed, as a rule, in acute inflammatory conditions. There are, however, four exceptions — lead acetate or subacetate, bismuth subnitrate or subcarbonate, cerium oxalate, and silver nitrate— which are sedative astringents and would be indicated in acute inflammatory states. Astringents vary in the intensity of their action, their strength being directly proportionate to the condensation of tissue. Herein lies the chief difierence between astringents and caustics. If the heavy metals be arranged according to their astringent properties, the feeblest at one extreme and the strongest at the other, it will be observed that the least astringent is the most caustic, and the most astringent the least caustic, the order being as follows : lead (astringent), iron, zinc, copper, silver, tin, mercury {caustic), lead being the most astringent and least caustic, and mercury the most caustic and least astringent. ASTRINGENTS. 709 The explanation of these diverse properties is that the astrin- gents expel the fluid from the protoplasm, contracting or constring- ing the tissue and causing, it to occupy less space ; whereas the caustics relax the eschar, reducing the space it occupies. The caustic action of a mineral salt depends both upon the nature of the base and the acid radical. In other words, the salt and the products of its action must both be somewhat soluble in water, otherwise the eschar will be firm, and the drug will therefore act as an astringent. The chlorides of the heavy metals are usually soluble, and are generally the more caustic, as, for instance, zinc chloride, mercuric chloride (corrosive sublimate), etc. Should a chloride be insoluble in water, it will not act as a caustic — as, for example, the insoluble, and consequently inert, silver chloride. Certain drugs which in a concentrated state are caustic are, if sufficiently diluted, astringent, as is the case with sulphuric acid. An astringent drug employed to check hemorrhage is called a styptic, the subsulphate of iron being extensively used as such. Astringents differ in some respects from other groups of medi- cines, in that they do not, as a rule, assist one another by combi- nation. They are divisible into — (i) Vegetable astringents ; (2) mineral astringents. The vegetable astringents mentioned in this group, beginning with the type, are — Tannic Acid, Kino, Rhus Glabra, Gallic Acid, Krameria, Rosa Gallica, Galla, Hematoxylon, Rubus. Quercus Alba, Hamamelis, Catechu, Geranium, Cinnamon also possesses considerable astringent properties, but is classed among the Aromatics. The mineral astringents, beginning with the type, are — Lead, Silver, Bismuth, Zinc, Alum, Cerium Oxalate. Copper, Certain salts of iron are powerfully astringent, although classed with iron under the Restoratives. Diluted sulphuric and nitric acids also possess marked astringent properties. (See Mineral Acids.) Antagonists and Inoompatibles. — The vegetable astringents are incompatible with the salts of iron (ferric and ferrous), and also with the salts of lead, silver, antimony, and copper ; with the alka- 7IO A TEXT-BOOK OF MATERIA MEDICA. loids, the glucosids, and gelatin ; and with the alkalies and mineral acids and emulsions. Spirit of nitrous ether is incompatible with gallic acid. Synergists. — Tonics and bitters, and also agents increasing waste, favor the action of vegetable astringents. VEGETABLE ASTRINGENTS. Acidum Tannicum— Acidi Tannici— Tannic Acid. V. S. I*. Origin. — An organic acid obtained from Nutgall. Description and Properties. — A light-yellowish, amorphous powder, usually cohering in the form of glistening scales or spongy masses ; odorless or with a faint characteristic odor and a strongly astringent taste ; gradually turning darker when exposed to air and light. Soluble in about i part of water and in 0.6 part of alcohol ; very soluble in boiling water and in boiling alcohol ; also soluble in about i part of glycerin with the assistance of a moderate heat ; freely soluble in diluted alcohol and sparingly in absolute alcohol ; almost insoluble in absolute ether, chloroform, benzol, or benzin. Dose. — 1-20 grains (0.06-1.2 Gm.). Official Preparations. Collodium Stypticum — CoUodii StJ^ptici — Styptic Collodion. — Used exter- nally and locally. (Tannic Acid, 20; Alcohol, 5; Ether, 25; Collodion, to 100.) Glyceritum Acidi Tannici — Glyceriti Acidi Tannici — Glycerite of Tannic Acid. — Used externally and locally. (Tannic Acid, 20; Glycerin, 80.) Trochlsci Acidi TSnnici — Trochiscos (ace.) Acidi TSnnici — Troches of Tannic Acid. — Dose, i to 3 troches. UnguSntum Acidi Tannici — UnguSnti Acidi TSnnici — Ointment of Tannic Acid.— Used externally and locally. (Tannic Acid, 20; Benzoated Lard, 80.) Physiological Action. — Externally. — Tannic acid has little if any effect upon the unbroken skin. Upon raw surfaces, however, it acts as a powerful astringent, contracting the tissues and coagu- lating the albumin. Urticaria and erythema sometimes follow its use. Internally. — Digestive System. — By coagulating the albumins tannic acid imparts a dryness to the mouth, accompanied by a sen- sation of puckering. It partially paralyzes the sensory nerve- endings, thus blunting the sense of taste. Large doses produce vomiting by an irritant action, while diarrhea, followed by consti- pation, may be present. ASTRINGENTS. 711 By its action on the stomach pepsin is precipitated, albumin co- agulated, and the secretion of gastric juice diminished, all of which actions tend to impair the digestive function. There is a partial conversion of the tannic acid into gallic and pyrogallic acids. To facilitate absorption there must be a preliminary conversion of tannic into gallic acid, and this reaction takes place in the intestine. A diminution of peristalsis is followed by constipation. Circulatory System. — Its astringent property makes tannic acid a valuable hemostatic. It arrests hemorrhage by contracting the blood-vessels. The blood absorbs it as gallic acid, and is not affected by it. Nervous System. — No special effect has been observed. Respiratory System. — Save in arresting hemorrhage of the lungs, no influence is known. Absorption and Elimination. — Being absorbed as gallic acid, the kidneys eliminate it in that form. A doubtful action ascribed to it by some authorities is that of diminishing albuminuria. Uterus. — No special influence other than arresting hemorrhage has been noted. Untoward Action. — A dose of 3 grains (0.2 Gm.) may cause pain in the stomach and intestines. Following such a dose, there may be coating of the tongue, thirst, eructation of gas, and tenes- mus. A tendency to hemorrhoidal congestion is enhanced. Therapeutics. — Externally and Locally. — Tannic acid is a val- uable application for bed-sores and ulcers. Its astringent property is of use in cases of intertrigo, impetigo, sycosis, sore nipples, and eczema of the chronic, desquamating variety. It is beneficial in hyperidrosis of the hands and feet, of the axillcs and genitals. A solution of the acid has been found of advantage in erysipelas and lymphangitis. The GLYCERiTE OF TANNIN, applied locally in cases of otorrhea and ozena as sequelae of scarlet fever or measles, is of great benefit. The same preparation or a powder may be used in stomatitis, ton- sillitis, and pharyngitis, as well as in cases of spongy or ulcerous gums. The lozenges are beneficial in whooping cough. Sup- positories OF TANNIC ACID ^lxq &Xi^\oy e.di iox hemorrhoids, fissure, prolapse, and rectal ulcers. An AQUEOUS SOLUTION OF TANNIC ACID is vcry useful in leucor- rhea. The glycerite and iodoform tannin are excellent agents in inflammation of the cervix uteri. Tannic acid also dispels the odor and allays the discharges in carcinoma uteri, being applied as a 712 A TEXT-BOOK OF MATERIA MEDIC A. vaginal douche. It is useful as a lotion in herpes and alopecia cir- cumscripta. Injection of the acid or insufflation of the powder into the urethra is of some value in gonorrhea. In hemoptysis an aque- ous solution (5—10 grains to the ounce of water) may be used as a spray. In acute dysentery much benefit may be derived from an enema of 10 grains of tannin added to a 4 per cent, solution of boric acid. It lessens pain and tenesmus and controls hemorrhage. Internally. — For other than local action gallic is preferable to tannic acid, the latter not being absorbable. Tannic acid is styptic in hematemesis and intestinal hemorrhage and checks diarrhea. It forms tannates when given as an antidote for poisoning by alkaloids and tartar emetic. Since these tannates are more or less soluble, however, some drug should be given as a purgative. Contraindications. — From comparative absorbability of tannic and gallic acids the former is preferable for local, the latter for systemic, effects. Administration. — For hematemesis powders of I0-20 grains are given. For effect upon the intestines it should be administered in pills, 3-5 grains, or it may be dissolved in the stomach. Locally it may be applied as a solution, glycerite, powder, suppository, or an ointment. Styptic collodion is a protection to lacerated or incised wounds. Acidum Gallicum— Acidi Gallici— Gallic Acid. V. S. JP. Origin. — An organic acid usually prepared from Tannic Acid. Description and Properties. — White or pale fawn-colored, silky, interlaced needles or triclinic prisms; odorless, having an astringent or slightly acidulous taste ; permanent in the air. Sol- uble in 100 parts of water and in 5 parts of alcohol. Dose. — 5-20 grains (0.3-1.2 Gm.). Physiological Action. — Gallic acid resembles tannic acid in its action, but does not coagulate albumin, and therefore does not possess the local influence of the latter. It is eliminated by the kidneys as gallic acid. Therapeutics. — Externally and Locally. — Gallic acid is seldom used externally. Locally, tannic acid is preferable, but gallic acid is effectual applied as a glycerite, i drachm- 1 ounce (4.0-32.0 Gm.), in cases of tonsillitis and pharyngitis. Gallic acid and stramonium ointment in equal parts form an unguent for hemorrhoids. In alcoholic solution it is applied to the membrane of diphtheria. ASTRINGENTS. 713 Internally. — Gallic acid is chiefly serviceable in hemorrhage from the stomach, intestines, lungs, and kidneys, It is employed in men- orrhagia, but ergot is better. It reduces albumin in some forms of Bright s disease, and is useful in checking excessive sweating and bronchorrhea. In chronic phthisis it relieves the night-sweats and reduces profuse expectoration. Cystitis, dysentery, and chronic diar- rhea are benefited by its use. It checks suppuration and stays the progress oi pyelitis asid pyelo-nephritis. Used in conjunction with opium, it has been found beneficial in diabetes insipidus. Pyrogallic acid is of use in acne, but produces a discoloration of the skin. Pyrogallol, 2 grains (.12 Gm.), is used in internal hemorrhage. As an ointment, i drachm-i ounce (4.0-32.0 Gm.), it is palliative in psoriasis, and it is also beneficial in lupus and epithelioma. Gallanol, the analid of gallic acid, is a bactericide, and is use- ful m psoriasis in the form of a powder or in an ointment (i to 30). It is also used in alcoholic solutions of 10 per cent, strength. It relieves the pruritus of chronic eczema. In favus and tricophytosis a mixture is used consisting of gallanol 10 parts, ammonia i part, and alcohol 50 parts. Gallicine, methyl ether of gallic acid, applied in finely divided form with a brush, is of benefit in keratitis and conjunctivitis, as well as in eczema of the eyelids. Administration. — Gallic acid is not to be combined with iron. It is administered in powder or pill form. The glycerite and the ointment are used locally. Galla— Gallse— Nutgall. V. S. P. Origin. — An excrescence on Quercus Lusitanica Lamarck, caused by the punctures and deposited ova of Cynips galla tinctoria Olivier. Quercus Lusitanica is a small tree, or oftener a shrub, 4 to 6 feet (1.2- 1. 8 M.) high, indigenous in the basin of the Mediter- ranean. Description and Properties. — Nutgalls are subglobular, about I inch (25 Mm.) in diameter, more or less tuberculated above, otherwise smooth, heavy, hard; often with a circular hole near the middle communicating with the central cavity containing either the partly developed insect or pulverulent remains of it ; inodor- ous ; taste strongly astringent. Galla in substance is seldom given internally. 714 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Tinctura GaUse— Tincturae GSllae — Tincture of Nutgall.— i?oJ«, i to 2 fluid- drachms {4.0-8.0 Gm.). UnguSntum CSlla — UnguSnti GSUae — Ointment of Nutgall. — Used exter- nally. Physiological Action. — Its action is that of tannic acid, which is derived from galls. Therapeutics. — Externally and Locally. — Galla, in combination with stramonium liniment or i drachm (4.0 Gm.) of powdered opium to each ounce (32.0 Gm.) of nutgall ointment, is an excellent application for external hemorrhoids. For ecsema of the scalp, herpes, fissured nipples, indolent ulcers, and chilblains nutgall oint- ment has proved beneficial, as well as for alopecia circumscripta and rectal prolapse. One part of powdered galls to seven or eight of vaseline is a most excellent application for lessening the cica- tricial contraction following extensive burns. Galla is used little locally, but is recommended as a gargle and wash, being applied to the relaxed mucous membranes of the mouth, vagina, and rectum. Internally. — Tannic and gallic acids are preferable in severe diarrhea and dysentery, an infusion or decoction being used as an enema. Administration. — Galls are used mostly in the form of an infusion or ointment. The tincture is seldom employed. QuSrcus Alba— Quercus Albsg— White Oak, u. s. p. Origin. — The bark of Quercus alba L. The oaks are shrubs or trees growing chiefly in the temperate zone, often forming exten- sive forests. The white oak is a stately tree, 60 to 80 feet (18-24 M.) high, found from Canada to Florida and west to Wisconsin and Eastern Texas. Description and Properties. — In nearly flat pieces deprived of the corky layer, about \ inch (5 Mm.), pale brown ; inner surface with short, sharp, longitudinal ridges; tough and of a coarse, fibrous fracture, a faint, tan-like odor, and a strongly astringent taste. As found in the shops, it is usually an irregularly coarse fibrous powder, which does not tinge the saliva yellow. Dose. — Seldom given in substance. A decoction is sometimes given internally, but the chief use of the drug is for external or local application. ASTRINGENTS. 715 Physiological Action. — The general action is that of tannic acid. Therapeutics. — Externally and Locally. — It is used for chapped nipples, gangrene, ulcers, and dermatitis venenata. It is of value as an ointment in hemorrhoids, prolapsus ani, anal fissure, and leu- corrhea. The drug is also serviceable in relaxed uvula and as a tooth-powder. It stains the linen, however, which somewhat limits its use. Pessaries made of the bark have been used to check uterine hemorrhage. For hernia the concentrated fluid extract is injected into the tissues for the purpose of exciting inflammation and consequent contraction of the hernial ring. Internally. — It reduces bronchial discharge, hemoptysis, serous diarrhea, and dysentery. Administration. — Externally it is used as a poultice — chiefly in the form of the powdered bark. The decoction is employed almost exclusively as an injection and for internal administration. The laity were formerly wont to roast the acorns and chew them, or grate them and mix the gratings with cocoa or chocolate, behaving them to be a cure for diarrhea as well as for flatulent dyspepsia and scrofula. Catechu— Catechu— Catechu. JJ. 8. P. Origin. — An extract prepared from the wood of Acacia catechu (Linn, fil.) Willd., a ti;ee 30 to 40 feet (9-12 M.) high, indigenous in the East Indies and Ceylon. Description and Properties. — Occurring in irregular masses, containing fragments of leaves ; dark-brown, brittle, somewhat porous and glossy when freshly broken. It is nearly inodorous and has a strongly astringent and sweetish taste. Dose. — 10-30 grains (0.6-2.0 Gm.). Official Preparations. Tinctura CStechu CompSsita — Tincturse CStechu CompSsitae — Compound Tincture of Catechu.— i^Mf, \-2 fluidrachms (2.0-8.0 Cc). (Catechu, 100; Cassia Cinnamon, 50; by maceration and percolation with Diluted Alcohol to 1000.) Trochisci Catechu— Trochiscos (ace.) CStechu— Troches of Catechu.— Dose, I to 6 troches. (Each troche contains I grain (0.06 Gm.) of catechu.) Physiological Action. — Catechu does not differ in its action from tannic acid. It is to be preferred to kino, however, since its operation is more energetic. Therapeutics. — Externally and Locally. — Though used but little externally, it is a very efficient remedy for ulcerated nipples 7l6 A TEXT-BOOK OF MATERIA MEDICA. and chronic ulcers, the form employed being that of a lotion, used either alone or in combination with copper sulphate or alum. Catechu is of service in constringing relaxed tissues, and is used as a mouth-wash in spongy gums, ptyalism, and relaxation of the uvula. It is also of use as a gargle in pharyngitis and chronic sore throat of public speakers and users of tobacco. In gonorrhea and leucorrhea an injection of 2-3 drachms (8.0-12.0 Gm.) of the tincture in 5-6 ounces (160.0-192.0 Gm.) of water is beneficial. Catechu has been used by persons suffering from pyrosis. It is claimed that chewing a small pellet of the drug diminishes the coating of mucus on the mucous membrane of the stomach. It is applied to aphthce in stomatitis. Internally. — Its prevailing use is in chronic serous diarrheas, but the administration must be preceded by a saline purge in order to secure the fullest effect. Catechu checks uterine hemor- rhage and the secretions in bronchitis and chronic phthisis. Administration. — The troche is best used in chronic pharyn- gitis and relaxed buccal mucous membranes, or a piece of the drug may be chewed with beneficial results. For diarrhea the compound tincture, with a little morphia or the official chalk mixture, is the best form for use. Kino— Kino— Kino. TI. 8. JP. Origin. — The inspissated juice of Pterocarpus marsupianum Roxburgh, a tree (called buja in Bengal) 60 to 80 feet (18-24 M.) high, indigenous in India and Ceylon. Description and Properties.— Small, angular, dark brownish- red and transparent; inodorous, very astringent and sweetish, coloring the saliva deep red. Soluble in alcohol, nearly insoluble in ether, and only slightly soluble in cold water. Dose. — 10-20 grains (0.6-1.2 Gm.). Official Preparation. Tinctura Kino— Tincturae Kino— Tincture of •K.vaa.—Dose, i_2 fluidrachms (1.0-8.0 Cc). Physiological Action.— Its action is similar to that of tannic acid. It colors the saliva red. Therapeutics.— £rfer««//j/ and Locally.— Kino is an efficient dressing for _^abby, indolent ulcers, acting as a stimulant. Yet the other astringents deserve precedence. As a gargle in pharyngitis and relaxed uvula kino is valuable, but, owing to its disagreeable ASTRINGENTS. 717 taste, krameria is to be preferred. Owing to its speedy action, it checks the hemorrhage in epistaxis where other astringents fail. In leucorrhea and gonorrhea an infusion or injection is serviceable. Internally. — In the polyuria of diabetes, in menorrhagia, the sweating of phthisis, and pyrosis it has been used to some advan- tage ; also in dysentery and chronic diarrheas with profuse serous discharges. It is less irritating than the other astringents. Administration. — The powder is used as an insufflation in epistaxis, and is dusted on ulcers. In diarrhea it is best to use kino in combination with opium or chalk mixture. The tincture is used internally. Krameria— Krameriae— Krameria. TI. S. JP. (Rhatany.) Origin. — The root of Krameria triandra Ruiz et Pavon, and of Krameria ixina L., a low shrub with spreading branches, native to Bolivia and Peru, growing in sandy localities in the mountains at an altitude of 3000 to 8000 feet (900-2440 M.). Description and Properties. — From i to \\ inches (25-38 Mm.) thick, knotty and several-headed above, branched below, the branches long ; bark smooth, or in the thinner pieces scaly, deep rust-brown,- Jij—^ inch (1-2 Mm.) thick, very astringent, inodor- ous; wood pale, brownish-red, tough, with fine medullary rays, nearly tasteless. The root of Krameria ixina (Savanilla rhatany) is less knotty and slenderer, and has a dark purplish-brown bark about \ inch (3 Mm.) thick. Dose. — 8-30 grains (0.5-2.0 Gm.). Official Preparations. Extractum KrameriEe — Extracti Krameriae— Extract of Krameria.— ZJ^f, S-IO grains (0.3-0.6 Gm.). ExtrSctum Krameriae Fluidum— ExtrScti Krameriae Fluidi— Fluid Extract of Krameria. — Dose, 5-30 minims (0.3-2.0 Cc). Tinctura Kramerise- Tincturae Krameriae— Tincture of Krameria. — Dose, \~2 drachms (2.0-8.0 Co.). TrocMsci Krameriae— Troch&cos (ace.) Krameriae— Troches of Krameria. — Dose, I to 5 troches. (Each troche contains I grain (0.06 Gm.). Syrupus Krameriae— SJ^rupi Krameriae— Syrup of Krameria.— /?««, ^-4 fluidrachms (2.0-16.0 Cc). Physiological Action. — The action of krameria is identical with that of tannic acid. Therapeutics. — Externally and Locally. — Its value as a topical application is of little consequence, but it has served satisfactorily 7l8 A TEXT-BOOK OF MATERIA MEDICA. as an ointment for hemorrhoids. It is used as an infusion or injec- tion of the diluted tincture or fluid extract in leiicorrhea, gleet, and especially in anal fissure, for which it has been highly recom- mended, since it checks the accumulation of feces in the rectum by constricting its walls, rendering defecation less painful and prevent- ing the formation of ulcers. The powder is used in epistaxis and rectal bleeding, also in prolapsus ani and ozena of a non-specific nature. It is used extensively in the preparation of tooth-powders, being especially beneficial where the gums display a tendency to bleed readily. A mouth-wash and gargle are used in ptyalism, spongy gums, pharyngitis, and relaxation of the uvula. Internally. — Krameria has gained a wide reputation for allaying habitual, but not profuse, uterine hemorrhage. It may be used, to check intestinal hemorrhages, hematuria, hematemesis, and hemopty- sis, but the other astringents are preferable. It is a good tonic for debilitated patients. It is also used in chronic diarrhea and dysen- tery and in incontinence of urine. Administration. — The powder is used in the nose and rectum either by insufflation or by means of a pledget of cotton. As an injection and enema the fluid extract is used. In fissure of the anus the rectum must be emptied first by an enema ; then a solu- tion of the extract, i drachm (4.0 Gm.) to i ounce (30.0 Cc.) of water, is emptied into the bowel and allowed to run out, repeating the process several times. This procedure is .very painful at first, but as the fissure gradually heals the operation will cause the patient little if any pain. Keep the bowels open with a mild saline laxative. The success attending the operation warrants any discomfort which the patient may experience. The nasal douche is best in ozena, followed by an insufflation of the powder. Haematoxylon— Haematoxyli— Haematoxylon. TJ. 8. P. (Logwood.) Origin. — The heart-wood of Hcematoxylon Campechianum L., a tree 30 to 40 feet (9-12 M.) high, indigenous on the shores of the Gulf of Campeachy and in certain parts of South America. Description and Properties. — Heavy, hard, externally pur- plish-black, internally brownish-red, marked with concentric cir- cles, splitting irregularly; odor faint, agreeable, taste sweetish, astringent. When chewed it colors the saliva dark pink. Only the preparations of Hasmatoxylon are used internally. ASTRINGENTS. 719 Official Preparation. Extractum Haemat6xyli — Extracti Haematttxyli — Extract of Hsematoxy- lon. — Dose, 5-15 grains (0.3-1.0 Gm.). Physiological Action. — Its astringent properties are due to the tannin which haematoxylon contains. Therapeutics. — Externally and Locally. — It is a valuable anti- septic, as well as a healing application in gangrene and foul- smelling sores. It is also beneficial as an injection in leucorrhea. Internally. — Haematoxylon has a very agreeable, sweetish taste ; hence it is well taken by children. It is of marked benefit in in- fantile diarrhea, but has the disadvantage of coloring the dis- charges and diaper blood-red, causing much alarm to the mother. The urine is also colored. It arrests internal hemorrhage and sweating, and is also used in dysentery, tuberculous diarrhea, and atonic dyspepsia. Some authorities claim that h^matoxylon causes phlebites. Administration. — In diarrhea a decoction with a little aromatic sulphuric acid is the best preparation. To it may be added a little syrup of ginger and camphorated tincture of opium. The decoc- tion is, in fact, the best preparation to use. Hamamelis— Hamamelidis— Hamamelis. TJ. S. JP. (Witch-hazel.) Origin. — The leaves of Hama^nelis Virginica L., a shrub 6 to 10 feet (1.8-3.0 M.) high, growing in damp woods and thickets in Canada and the United States. Description and Properties. — Short-petiolate, about 4 inches (10 Cm.) long, obovate or oval, slightly heart-shaped and obHque at the base, sinuate-toothed, thickish, nearly smooth, inodorous ; taste astringent and bitter. Official Preparation. Extractum HamamSlidis Fluidum— Extract! HamamSlidis Fluidi — Fluid Extract of Hamamelis. — Dose, ^-2 fluidrachms (2.0-8.0 Cc). Physiological Action. — The action of tannic acid is also that of hamamelis, save that the latter has a somewhat different influ- ence upon the circulation. Circulatory System. — Hamamelis acts on the muscular fibers of the veins, the modus operandi, however, not being satisfactorily •determined. Large doses produce severe throbbing headache. 720 A TEXT-BOOK OF MATERIA MEDICA. Therapeutics. — Externally and Locally. — For sprains and bruises hamamelis is a favorite application, although some authorities re- gard it merely as a placebo. Locally, the fluid extract, with the addition of one-third its volume of glycerin, has been used in urticaria, rhus-poisoning, and phlegmasia dolens. Owing to its marked sedative properties, hamamelis ointment is extremely beneficial in varicose ulcers, ecsema, herpes, seborrhea, and acne rosacea, as well as in checking excessive secretions. It is also efficient in carbuncle, freckles, hyperidrosis, lupus erythematosus, burns, and frost-bites. The local action of the drug is important. The distilled EXTRACT, diluted with alcohol or water, is applied to inflamed gums, the nasal mucous membrane after removal of polypi, and in pharyn- gitis as a spray. As a suppository or applied by means of a piece of cotton or wool soaked with the fluid extract, hamamelis affords a most grateful relief in bleeding piles, especially the internal vari- ety. In cystitis and hemorrhage from the bladder an injection of the diluted fluid extract or distilled extract is very valuable, besides being a most reliable topical application in capillary hemor- rhage from wounds, epistaxis, and bleeding after extraction of teeth. The ointment is used in rectal fissures and ulcers, and the lotion has been employed to some extent in chronic rheumatism, since it relieves the pain and stiffness in the muscles and joints. The decoction, with a little boric acid and a i per cent, solution of creasote, has been recommended as a gonorrheal injection. Internally. — Given internally, hamamelis enhances the results obtained by the local application in bleeding piles, leucorrhea, and gonorrhea, and, owing to its peculiar action upon the veins, in varicose veins. It lessens the pain of dysmenorrhea, while by its use in menorrhagia the flow is remarkably diminished. It i§ highly beneficial in internal hemorrhages, hemoptysis, hematuria, hemateme- sis, and especially in uterine hemorrhages. It reduces suppuration in pyelitis and the excessive morbid discharge in chronic bronchitis. It is a valuable remedy in purpura hemorrhagica, chronic enteritis, diarrhea, dysentery, and varicocele. Hamamelis also prevents abortion. Administration. — The best preparation, both for internal and external use, is the distilled extract, although it is not official. The ointment and lotion are used externally, and the fluid extract internally. The preparations of hamamelis to be found in drug- stores are unreliable unless they be perfectly fresh. Some of the ASTRINGENTS. 731 proprietary preparations are concocted with extreme care and accuracy, and are often much more efficient than the official articles which have been standing in the shops for a long while, possibly exposed to the air. Geranium— Geranii— Geranium. V. S. JP. (Cranesbill.) Origin. — The rhizome of Geranium maculatum. L., a perennial herb with a stem 2 to 3 feet (30-60 Cm.) high, very common in Canada and the United States westward as far as Kansas. Description and Properties. — Growth horizontal, cylindrical, 2 to 3 inches (5-7 Cm.) long and about \ inch (i Cm.) thick; rather sharply tuberculated, longitudinally wrinkled, dark brown ; bark thin ; wood-wedges yellowish, small, forming a circle near the cambium line; medullary rays broad, central pith large; roots thin, fragile, inodorous ; taste strongly astringent. Dose. — 20-40 grains (1.2-2.40 Gm.). Official Preparation. ExtrSctum Geranii Fluidum — ExtrScti Geranii Fluidj — Fluid Extract of Geranium. — Dose, 20-40 minims (1.2-2.40 Cc). Physiological Action. — The action of geranium corresponds with that of tannic acid. Therapeutics. — Externally and Locally. — Geranium is not used externally. Its local action is varied. It is serviceable as an astringent gargle in sore throat ; as a mouth- wash in aphthous stomatitis ; in relaxed conditions of the rectum, vagina, and throat ; in buccal ulcer, metrorrhagia, and anal fissure ; in prolapsus ani and epistaxis. It has also proved valuable as an injection in leucorrhea,^ gonorrhea, and gleet. Internally. — Owing to its agreeable taste, it is useful in infantile diarrhea and for persons having weak stomachs. In the early stages of phthisis it is very beneficial, as it reduces the fever and pulse-rate, at the same time checking the night-sweats, cough,, expectoration, and hemoptysis. Under it the patient's appetite im- proves and he gains in weight. The fluid extract, in combination with an aromatic, gives perceptible temporary relief in rapid a£Ute- phthisis attended with severe, distressing cough and debilitating; night-sweats. It has also been used to advantage in internal. 46 722 A TEXT-BOOK OF MATERIA MEDIC A. Administration. — Locally, the powdered root and fluid extracts are used, but the fluid extract diluted with water is preferable. For an injection a decoction, i ounce (32.0 Gm.) to 1-2 pints (512.0-1024.0 Gm.) of water, is used, and the decoction in milk is of service in infantile diarrhea. Prof Johnson claims that gera- nium contains mucilaginous material which, acting as a demulcent, makes the decoction a much more desirable preparation than a simple solution of tannin. Rhus Glabra— Rhois Glabrae— Rhus Glabra. TJ. S. JP. (Sumach.) Origin. — The fruit of Ukus glabra L., a shrub or suffruticose plant about 12 feet (3.6 M.) high, growing in rocky or barren soil in North America. Description and Properties. — Subglobular, about \ inch (3 Mm.) in diameter, drupaceous, crimson, densely hairy, containing a roundish- oblong, smooth putamen ; inodorous ; taste acidulous. Dose. — The preparations only are used internally. Official Preparation. ExtrSctum Rhois Glabrae Fluidum — Extrdcti Rhois Glabrae Fliiidi — Fluid Extract of Rhus Glabra. — Dose, \-i fluidrachm (1.0-4.0 Cc). Allied Species. Rhtis AromStica — Rhtis AromSticae — Sweet Sumach. Unofficial Preparation. Extractum Rhois AromSticae Fliiidum — ExtrScti Rhois AromSticae Fluidi — Fluid Extract of Rhus Aromatica.— iJof^, 5 minims-i fluidrachm (0.3-4.0 Cc). Physiological Action. — The action of Rhus glabra resembles that of tannic acid. Therapeutics. — Externally and Locally. — An infusion or the FLUID EXTRACT is used as a topical application for ulcers and in- flamed wounds. The infusion is an excellent mouth-wash in spongy gums, ptyalism, pharyngitis, aphthous stomatitis, and tonsil- litis. It can be used alone, but is much more efiicient when com- bined with potassium chlorate and glycerin, adding a little menthol, 2-3 grains (.12-20 Gm.), to make the mixture more agreeable. It is also of service as an injection in leucorrhea. Internally. — Rhus glabra acts well in staying incontinence of urine and hematuria. A dose of 10-30 drops of the fluid extract. ASTRINGENTS. 723 taken two or three times daily, has produced complete temporary- suspension of nocturnal eneuresis of children, as well as senile eneuresis. Administration. — The fluid extract is used exclusively. Rosa Gallica— Rosae Gallicae— Red Rose. TJ. S. I*. Origin. — The petals of Rosa gallica L., collected before ex- panding. Description and Properties. — Usually occurring in small cones consisting of numerous imbricated, roundish, retuse, deep purple- colored, yellow-clawed petals, having a roseate odor and a bitterish, slightly acidulous, and distinctly astringent, taste. Official Preparations. ConfSctio Rosse — Confectionis Ross — Confection of Rose. — Used as an excipient in pill masses. ' Extr^ctum Rosae Fluidum — ExtT^cti RosEe Fliiidi — Fluid EiKtract of Rose. — Used chiefly as a vehicle. Physiological Action. — It acts like tannic acid. Therapeutics. — Externally and Locally. — The ointment is used for chapped lips and hands, and also for superficial burns and in erythema. The FLUID EXTRACT is used as an application to inflamed eyes, buccal, aural, and anal ulcers, and in aphthous stomatitis. It has been employed in conjunction with sodium salicylate to prevent the pitting of small-pox. Its chief use, however, is as a vehicle and flavoring extract. Internally. — It is practically -of but little value as an internal agent, although it exerts some action in checking profuse sweats and in uterine hemorrhages. Administration. — The fluid extract is mainly used, an infusion of which is given internally. The fresh leaves, crushed, are ser- viceable as a poultice. Rubus—Rubi— Blackberry. TJ. S. P. Origin. — The root-bark of Rubus villosus Ait., Rubus Canaden- sis L., and Rubus trivialis Mx., common shrubby North American plants. Description and Properties. — Thin, tough, flexible bands, outer surface blackish or blackish-gray, inner surface pale-brownish, some- 724 A TEXT-BOOK OF MA TERIA MEDICA. times with strips of whitish, tasteless wood adhering ; inodorous ; taste strongly astringent, somewhat bitter. Official Preparation. ExtrSctum Rubi Fluidum — ExtrScti Rubi Fluidi — Fluid Extract of Rubus. — Dose, \^2 fluidrachms (2.0-8.0 Cc). Physiological Action. — Identical with that of tannic acid. Therapeutics. — Internally. — The fluid extract is used in the summer diarrhea of children — practically its only employment. An infusion of the leaves is claimed by Popoff to be an excellent remedy for debility of the bladder. Administration. — The fluid extract and the infusion are used as medicinal agents. The syrupus rubi idaei is used only as a vehicle. Blackberry cordial and blackberry brandy are favorite modes of administration. It is commonly beheved by the laity that the various blackberry and raspberry preserves are efficacious as remedies ; on the contrary, they are highly irritating, because of the seeds present in them. MINERAL ASTRINGENTS. Plumbum— Plumbi— Lead. The salts of lead only are used in medicine. Plumbi Acetas— Plumbi Acetatis— Lead Acetate. V. S. I>. (Sugar of Lead.) Origin. — Metallic Lead is dissolved, in the presence of air, in Acetic Acid, or Lead Oxide is dissolved by the aid of a gentle heat in Acetic Acid and Water, the solution being filtered, evaporated, and crystallized. Description and Properties. — Colorless, shining, transparent, monoclinic prisms or plates, or heavy, white, crystalline masses, or granular crystals, having a faintly acetous odor and a sweetish, astringent, and afterward metallic taste. On exposure to the air efflorescent and absorbing carbon dioxide. Soluble in 203 parts of water and in 21 parts of alcohol, in 0.5 part of boiling water, and in i part of boiling alcohol. Lead acetate should be kept in well-stoppered bottles. Dose. — ^5 grains (0.03-0.3 Gm.). ASTRINGENTS. 725 Official Preparations. Liquor Plflmbi Subacetatis— Liquoris PWmbi Subacetatis— Solution of Lead Subacetate (Goulard's Extract).— Used externally and locally. (The solu- tion contains about 25 per cent, of Lead Subacetate.) Liquor Plttmbi Subacetatis Dilutus— Liquoris Plfimbi Subacetatis Diluti .r, —Diluted Solution of Lead Subacetate (Lead Water).— Used externally and locally. (It contains 3 per cent, of Lead Subacetate.) Ceratum Pltimbi Subacetatis— Cerati Pltimbi Subacetatis— Cerate of Lead Subacetate (Goulard's Cerate).— Used externally and locally. (Goulard's Extract, 20; Camphor Cerate, 80 parts.) Unofficial Preparation. Linimgntum Pltimbi Subacetatis— Linimenti Pltimbi Subacetatis— Lini- ment of Lead Subacetate. — Used externally and locally. (40 parts of Lead Sub- acetate to 60 p.arts of Cotton Seed Oil.) Plumbi Carbonas— Plumbi Carbonatis— Lead Car- bonate. TJ. S. JP. (White Lead.) Origin. — Obtained by passing Carbon-dioxide Gas througii a solution of Lead Acetate, or by adding an Alkali Carbonate to a solution of a Neutral Lead Salt. Description and Properties. — A heavy, white, opaque powder or a pulverulent mass, without odor or taste. Permanent in the air. Insoluble in water or alcohol, but soluble in acetic or diluted acetic acid, with effervescence. Lead carbonate should be kept in well-stoppered bottles. Used externally and locally. Official Preparation. UnguSntum Pltimbi Carbonatis — UnguSnti Pltimbi Carbonatis — Ointment of Lead Carbonate (10 per cent.). — Used externally and locally. Plumbi lodidum— Plumbi lodidi— Lead Iodide. TJ. S. P. Origin. — Obtained by mixing a solution of Lead Nitrate and Potassium Iodide, and drying the precipitate. Description and Properties. — A heavy, bright-yellow powder without odor or taste. Permanent in the air. Soluble in about 2000 parts of water and in about 200 parts of boiling water, sep- arating from the latter solution in brilliant golden-yellow spangles or crystalline lamins. Very slightly soluble in alcohol, but sol- uble, without color, in solutions of the fixed alkalies, in concen- 726 A TEXT-BOOK OF MATERIA MEDICA. trated solutions of the acetates, of the alkalies, potassium iodide, and sodium hyposulphite, and in a hot solution of ammonium chloride. Lead iodide should be kept in well-stoppered bottles. Dose. — \ grain (o. 1 3 Gm.). Official Preparation. Ungu6ntum Pliimbi lodidi— Ungufinti Pliimbi lodidi— Ointment of Lead Iodide (10 per cent.). — Used externally and locally. Plumbi NTtras— Plumbi Nitratis— Lead Nitrate. V. S. I*. Origin. — Prepared by dissolving Lead in Diluted Nitric Acid. Description and Properties. — Colorless, transparent, octahedral crystals, or white, nearly opaque crystals, without odor and having a sweetish, astringent, and afterward metallic taste. Permanent in the air! Soluble in 2 parts of water ; almost insoluble in alcohol. Used externally and locally. Plumbi Oxidum— Plumbi Oxidi— Lead Oxide. u. s. r. (Litharge.) Origin. — Obtained by roasting Lead in air. Description and Properties. — A heavy, yellowish or reddish- yellow powder or minute scales, without odor or taste. On expo- sure to the air it slowly absorbs moisture and carbon dioxide. Almost insoluble in water and insoluble in alcohol. Soluble in acetic or diluted nitric acid and in warm solutions of the fixed alkalies. Lead oxide should be kept in well-closed vessels. Used externally and locally. Official Preparations. Empiastrum Pliimbi — Ei. ,>?iastri Pliimbi — Lead Plaster (Diachylon Plas- ter). — Used externally and locall^. (Lead Oxide or Lead Plaster is contained in Empiastrum Ammoniaci cum Hydrar- gyro and in Emplastra Ferri, Hydrargyri, Opii, Resinae, and Saponis.) UnguSntum Diachylon — Ungufinti Diachylon — Diachylon Ointment. — (Lead Plaster, 500; Olive Oil, 490; Oil of Lavender Flowers, 10.) Used externally and locally. Physiologipal Action. — Lead per se is practically inert ; some of its salts, however, particularly the acetate, possess valuable therapeutic properties. ASTRINGENTS. . 727 Externally and Locally. — Applied to the unbroken skin, lead salts have little if any effect, yet they act readily upon denuded surfaces, blanching the tissue of the parts by contraction of the small blood-vessels. In sores and ulcers they coagulate the albumin of the discharge and the protoplasm of the neighboring superficial cells, thus forming a protective coating for the healthier structure beneath. These salts have likewise a sedative action because of the decreased local circulation and the presumably depressant effect upon the nerve endings. Moreover, by virtue of their astringency they furnish valuable hemostatic and antiphlogistic remedies. In some cases the skin is discolored by their use. Internally. — Digestive System. — Lead acts immediately in the mouth, causing a sweet, styptic taste and coagulating the mucus. It contracts the cells and vessels of the entire alimentary canal, inducing dryness by diminished secretion. Consequent to the dis- turbed physiological functions of the digestive tract, the peristaltic movements diminish, and constipation necessarily ensues. Circulatory System. — The heart's action is slowed through the branches of the vagus by irritation of the cardiac inhibitory center. The pulse is lessened in volume and frequency, and lacks regularity. The blood takes up the lead as an albuminate, which soon passes into the tissues. While yet in the vascular system it inter- feres with the nutritive function of the corpuscles, producing by their destruction a watery condition of the blood. This explains the anemia usually present in cases of plumbism or lead-poisoning. Nervous System. — Both sensory and motor functions become deranged, especially the latter. This central irritation causes a dis- turbance, and finally paralysis, of various muscles. The involun- tary muscles appear to be most affected, and of these primarily the intestinal ; hence, with the assistant local effect, arise distressing abdominal pains and spasms. The cardiac center and vagal branches to the heart are influenced, as already stated. Respiratory System. — The irritation produced in the respiratory centre has an inhibitory action through the vagus upon the respira- tion. Absorption and Elimination. — The preparations of lead are con- verted in the stomach into an albuminate, and thence taken up by the blood, very little absorption taking place in the intestine, where the lead is converted into an insoluble sulphide. It is absorbed by the abraded skin, and enters directly into combination with the 728 A TEXT-BOOK OF MATERIA MEDICA. albumin of the tissues. A portion of the lead albuminate is elimi- nated by the liver with the bile into the intestine, where, being con- verted into a sulphide, it is excreted in that form with the feces. The skin, kidneys, and mammary glands assist in its elimination. Lead is not easily removed from the whole system, owing to its retention by the ubiquitous albumin ; consequently some alterative, such as potassium iodide, should be administered. Uterus. — Under the influence of lead, abortion is liable to occur or the child be still-born. This is probably due to a disturbance of the quality and quantity of the blood-supply to the affected parts. Untoward Action. — Undesirable results have followed the ad- ministration of medicinal doses of lead acetate, evidently arising from insufificient elimination. Baker observed loss of appetite, ^as- tralgia, constipation, and paralysis of three weeks' duration. This last symptom occurred in the hand of a man who had taken i grain (.06 Gm.) of lead acetate twice daily for four days to relieve hema- turia. In another case attacks of colic, lasting several months, fol- lowed the exhibition of 4 grains (.25 Gm.) of the same salt for three days. Tanquere des Planches suggests caution in too free an administration of lead preparations, as being prone to occasion disagreeable symptoms. The external application of lead solutions and ointments some- times produces unpleasant effects, such as discoloration of the skin. In the mucous membrane lead rarely excites symptoms of poison- ing, a single case being reported where lead water compresses were applied to the eye. Gastric pains have occurred after re- peated applications of such compresses to a contused shoulder, the pains ceasing with their withdrawal and reappearing with a renewal of the treatment. Colic and paralysis of the member have fol- lowed washing of a large ulcer of the leg with lead water, these symptoms disappearing upon a withdrawal of the drug. In still another case a sweetish, styptic taste in the mouth and stiffness of the neck resulted from the external use of the solution. Poisoning. — Cases of acute poisoning are in therapeutics for- tunately rare, the acetate — the form generally given — producing emesis, thus preventing toxic effects of the drug. The first symptom of poisoning is a sweetish, metallic taste, soon followed by nausea and vomiting of a white, milky fluid con- taining curdy material — the result of a combination of the exces- sive lead with the hydrochloric acid of the gastric juice, and the ASTRINGENTS. 729 formation of lead chloride. Constipation and subsequent diarrhea usually occur, with black passages, the discoloration being caused by the sulphide of lead formed in the intestinal canal. There is severe, persistent pain in the abdominal muscles, which are rigid and contracted, while a retraction of the abdominal walls is clearly perceptible. There are great thirst, and possibly cramps in the calves of the legs, neuralgic pains, muscular twitchings, vertigo, stupor, anesthesia, and paralysis. Tenesmus is present, and the face is pale and the lips livid. A blue line, due to a deposit of the sulphide, is usually found on the gums near the incisor teeth. As a rule, the liver is retracted and often diminished in size. The pulse is rapid and tense at first, becoming weak, compressible, and slow. Treatment of Poisoning. — Evacuation of the stomach is impera- tive? the process being more or less assisted by the emetic property of the drug. Some sulphate should be administered in order to form an insoluble lead compound. Epsom and Glauber's salts are the best antidotes, since they are readily soluble and easily ob- tained; acting, moreover, as a purge, they empty the intestinal canal. Opium will serve to relieve pain and irritation, while to maintain bodily temperature hot applications can be used on the feet and abdomen. Chronic Poisoning. — The acute form of poisoning just considered is alw.ays produced by a soluble lead salt ; chronic plumbism, on the contrary, is invariably caused by an insoluble salt. The symp- toms are numerous and manifold, there being no physiological dis- turbance of the acute which is not present in the chronic condition. The train of untoward symptoms is occasioned by long-continued medicinal use of lead preparations. Very frequent sources of poisoning are : drinking water conveyed in lead pipes, and foods colored with chrome yellow and those contained in cans soldered with lead. It is especially liable to occur among painters (colica pictonum), manufacturers of lead salts, color-grinders, and type- setters and founders. Wrist-drop, bilateral, resulting from paralysis of the extensor muscles of the forearm, is one of the most prominent symptoms, although not a constant occurrence. The supinator longus, being also a flexor, usually escapes this influence. Colic, sharp abdom- inal pains, chiefly in the umbiUcal region, retraction of the abdom- inal muscles and cramps, and paralysis of the calves of the legs may be present in plumbism — or " saturnism," as it is sometimes termed, a word transmitted to us from medieval alchemy. Obsti- 730 A TEXT-BOOK OF MA TERIA MEDICA. nate constipation, with the passage of clay-colored stools, as has been stated, necessarily occurs ; and anorexia, gastralgia, and arthralgia are seldom absent. The liver, the most important me- dium in the elimination of the poison, in severe cases becomes overtaxed and reduced in size. The tongue is white and coated, and the skin, lips, and mucous membranes are discolored. A blue line on the anterior gums is pathognomonic, although it may be absent in those who take special care of the teeth. Headache, deHrium, and epileptiform convulsions, constituting encephalopathia saturnina, may occur, being usually due to uremia induced by insufficient elimination of the poison. Albuminuria, cirrhosis, and contraction of the kidneys, with diminished excretion of uric acid, are present, and amblyopia and amaurosis may be in- cluded among the symptoms. The heart and the entire vascular system are, as has been said, considerably deranged. Multiple neuritis, anterior poliomyelitis, and atrophy of the nerve-trunks, with resultant muscular wasting and loss of power, gradually mani- fest themselves. Gout sometimes occurs, and, as noted in acute poisoning, miscarriage is liable to take place. Treatment of Poisoning. — The sulphates are given for their chemical and purgative effects, yet in chronic plumbism the hepatic purgatives — calomel, gamboge, jalap, etc. — are preferable. Opium and morphine relieve pain and spasms, being claimed by some authorities as specifics in lead-poisoning. Sulphuric-acid lemonade and plenty of milk have been found beneficial. Potassium iodide in ten-grain doses, three times daily, has an eliminative effect. The cerebral symptoms may be alleviated by a diaphoretic, such as pilocarpin or an alcohol sweat. In progressive paralysis strychnine is widely employed. Fara- dization of the muscles, if they respond, or otherwise galvanization, should be used to increase muscular force and prevent atrophy. Plumbi Acetatis. — This being the typical lead salt, its action will be first considered. Therapeutics. — Externally and Locally. — It acts as a sedative as well as an astringent in acute inflammations, such as eczema (not chronic), impetigo, lichen, and erythema ; but it must not be used stronger than lo grains (0.64 Gm.) to i ounce (30.0 Cc.) of water. It is of service as an injection in gonorrhea, leucorrhea, gleet, and otorrhea. In combination with opium it makes a good topical application for hemorrhoids, hs, a gargle it is of some value, and is also serviceable in orchitis, synovitis, and paronychia. ASTRINGENTS. 731 Internally. — Its most important use is in checking hemorrhages, in which it is associated with opium, although it is chemically in- compatible with that drug. It is of service in hemorrhage in typhoid fever, yellow fever, hemoptysis, and gastric ulcer. It lowers the heart's action, constringing the arterioles, in this respect resembling digitalis, combined with which drug it is beneficial in hypertrophy of the heart. Morbid discharges, such as the night-sweats and diarrhea of phthi- sis and the diarrhea of typhoid, dysentery, cholera infantum, secretions in bronchorrhea, and serous diarrhea, are effectually checked by the acetate of lead and opium, which diminishes the pain, griping, and tenesmus attending the respective affections. By far its most fre- quent use, however, is in serous diarrheas, the drug acting very quickly and efficiently, and being both sedative and astringent. Given in chronic gastritis with pain, lead acetate affords marked relief It was at one time advocated in internal aneufjsm, but is of little if any value in this respect. Liquor Plumbi Subacetatis. — This preparation is used exten- sively for bruises, sprains, acute eczema, and as a cooling application in ecthyma, erysipelas, and all kinds oi inflammations ; it should be well diluted. It also relieves the itching of urticaria, pruritus pudendi, and eczema. A felon may be aborted by saturating bread-crumbs with Goulard's solution, making a poultice, and placing it over the finger. Plumbi Iodidi. — Used very little. It acts beneficially when employed as an ointment applied^to enlarged lymphatic glands and spleen ; also for psoriasis and chronic eczem.a. It is given in 1-2 grain- (0.06-0. 12 Gm.) doses to reduce malarial spleen. Carbonate of lead is used only externallj'-, in the form of an ointment, for burns, scalds, erysipelas, and intertrigo. It should never be applied to abraded surfaces, as it is rapidly absorbed. It should be mixed with linseed oil. Plumbi Oxidum. — Hebryre commends an application of equal parts of lead plaster and linseed oil for sweating of the feet. It is chiefly used in the preparation of diachylon or lead-plaster, emplas- trum saponis and emplastrum resinae being also prepared with the oxide. Plumbi Nitras. — Used with good results in onychia and also in the manufacture of Ledoyne's disinfectant. It is an excellent remedy for fissured nipples, care being taken to wash the nipple 732 A TEXT-BOOK OF MATERIA MEDICA. before suckling. Should the fissures be deep, it is well to wash the nipple with morphine sulphate or a little cocaine, as the lead application is exceedingly painful. It destroys the fetid odor arising from gangrenous sores and offensive discharges from the ears, nostrils, rectum, and vagina. It has also proved serviceable in epithelioma. Chloride of lead and tannate of lead have been used ex- ternally as ointments — the chloride to allay /«?'« and arrest morbid growths, and the tannate in threatening bed-sores. Administration. — Locally a watery solution of lead acetate, lo grains (0.64 Gm.) to i ounce (30.0 Cc), is used. Powdered opium can be added, i drachm to the pint of water. Applied to mucous membranes or used as an injection, 2 grains (0.12 Gm.) to i ounce (30.0 Cc.) of water, or 5 grains (0.32 Gm.) of the acetate and 5 (0.32 Gm.) of zinc sulphate in i ounce (30.O Cc.) of water — rose-water, for instance — proves a most efficient application. Suppositories for hemorrhoids may contain i grain (0.06 Gm.) of opium to 3-5 grains (0.19-0.32 Gm.) of the acetate. The pilulae plumbi cum opio — lead acetate 3 grains (0.19 Gm.), opium i grain (0.06 Gm.) — is mostly used internally, one pill being taken every three hours. In dysentery and cholera infantum an enema containing 5 grains (0.32 Gm.) of lead acetate to i grain (0.06 Gm.) of opium, or \ grain (0.03 Gm.) of morphine to i ounce (30.O Cc.) of water, gives excellent results. Should there be any abrasion of the skin, lead subacetate must not be used, as it prevents healing by constringing the edges of the wound. It is not used internally. Solution of subacetate of lead is most frequently used in union with opium, forming the well-known L. and L., or lead-water-and* laudanum, solution. It is also used in conjunction with glycerin, I ounce of each, or as Goulard's cerate, consisting of 20 parts Goulard's extract to 80 parts camphor cerate. For ulcers, fissured nipples, and epithelioma lead nitrate is used, chiefly in the powdered form. In the nose, ears, vagina, and rectum a douche (2-5 grains (o. 1 3-0.3 2 Gm.) to i ounce (30.0 Cc.) of water) is used. A solution of 10 grains (0.64 Gm.) to i ounce (30.0 Cc.) of glycerin or brandy is a very good application for sore nipples. Zincum— ZTnci — Zinc. U. S. I*. Origin. — Obtained by roasting the native Zinc Sulphide or Car- bonate, tod reducing the resulting oxide with charcoal. ASTRINGENTS. 733 Description and Properties. — A bluish-white metal, showing a crystalline fracture and having a specific gravity ranging from 6.9 when it is cast to 7.2 after it is rolled. Soluble in diluted sulphuric or hydrochloric acid, with evolution of hydrogen gas. Metallic zinc occurs in the form of thin sheets or in irregular, granulated pieces, or moulded into thin pencils, or in a state of fine powder. The following salts of zinc are ofiScial : ZKnci Acetas — ZInci Acetatis — Zinc Acetate. — Origin. — Obtained by dissolv- ing Zinc Acetate in Acetic Acid and Water and boiling : zinc acetate crystallizes out. Description and Properties. — Soft, white, six-sided, monoclinic plates, of a pearly luster, having a faintly acetous odor and an astringent metallic taste. Exposed to the air, the salt gradually effloresces and loses some of- its acid. Soluble in 2.7 parts of water and 36 parts of alcohol. Zinc acetate should be kept in well-stoppered bottles. Dose. — As a tonic, ^-2 grains (0.03-0.12 Gm.) ; as an emetic, 10-30 grains (0.6-2.0 Gm.); but principally used externally and locally. Zlnci Carbonas Praecipitatus — Zinci Carbonatis Praecipitati — Precipitated Zinc Carbonate. — Origin. — Prepared by pouring together solutions of Zinc Sulphate and Sodium Carbonate, and drying the precipitated zinc salt. Description and Properties. — An impalpable white powder, of somewhat variable chemical composition, without odor or taste ; permanent in the air. Insoluble in water or alcohol. Dose. — 2-3 grains (0.12-0. 1 8 Gm.). Chiefly used externally. Zinci lodidum— Zinci lodidi— Zinc Iodide.— 0?7^;«.— Prepared by dissolving Zinc Oxide or Carbonate in Hydriodic Acid. Description and Properties. — A white, granular powder, odorless, having a sharp, saline, and metallic taste. Very deliquescent, and liable to absorb oxygen from the air, becoming brown from liberated iodine. Readily soluble in water, alcohol, or ether. Zinc iodide should be kept in small glass-stoppered bottles. Dose. — ^-2 grains (0.03-0.12 Gm.). Also used externally. Zinci Oxidum— ZKnci Oxidi— Zinc Oxide.— On^».— Prepared by heating Zinc Carbonate to redness in a crucible. Description and Properties.— K-a amorphous white powder without odor or taste. Insoluble in water or alcohol. It should be kept in well-stoppered bottles. Dose. — J^-S grains (0.015-0.3 Gm.). Official Preparations. Ungugntum Zlnci Oxidi— UnguSnti Zinci Oxidi— Ointment of Zinc Oxide (20 per cent.). — Used externally and locally. Zlnci Stilphas— Z!nci Sulphatis— Zinc Sulphate.— On^w.— Prepared by dis- solving Granulated Zinc in Sulphuric Acid, certain precautions being taken to remove impurities. Description and Properties.— Colorless, transparent, rhombic crystals, without odor, and having an astringent, metallic taste. Efflorescent in dry air. Soluble in 0.6 part of water and in 3 parts of glycerin ; insoluble in alcohol. Zinc sulphate should be kept in well-stoppered bottles. Dose.—l-T, gr^ns (0.06-0.18 Gm.); as an emetic, 10-60 grains (0.6-4.9-Qip.), Antagonists and Incompatibles. — The salts of zinc areVmcom- 734 A TEXT-BOOK OF MA TERIA MEDICA. patible with the vegetable astringents, alkalies and their carbonates, lime water, the sulphides, silver nitrate, lead acetate, and milk. Synergists. — The same as for lead. The metallic form is not used in medicine. Physiological Action. — Externally and Locally. — The zinc salts resemble the lead salts in their action, but they are less pow-erful astringents. They are also to a slight extent hemostatic. The chloride is exceedingly caustic. Internally. — Digestive System. — The sulphate of zinc and, in a slight degree, the carbonate are specific emetics, causing rapid emesis, with but little nausea or depression. Their modus operandi is not definitely known, but it is believed that their effects are partly due to local action on the stomach, and partly to stimulation of the vomiting center in the medulla. Vomiting is also produced by injecting a solution of the salt into the circulation ; but this is doubtless owing to the fact that the salt is excreted by the stomach, and that it also exerts an influence on the medullary center. The salts of zinc also act as astringents upon the gastro-intes- tinal mucous membrane. Circulatory System. — Practically nothing is known of the action of zinc salts on the heart, blood, and vessels. They exist in the blood as albuminates, in close relation with the red corpuscles. Nervous System. — Zinc valerianate acts as a sedative, but this action is wholly dependent upon the valerian. The salts are also astringents and possess some tonic properties. They may cause transverse myelitis. Absorption and Elimination. — The zinc salts are absorbed from the stomach or enter directly into the circulation when injected. They are eliminated by the liver and kidneys, but mainly by the intestinal glands. Zinc salts do not accumulate so rapidly as mer- cury, lead, and copper. Untoward Action. — 3-5 grains (0.19-O.32 Gm.) have produced nausea and gastric oppression, while if the zinc salt reaches the intes- tines diarrhea results. When taken on a full stomach the salts form an insoluble albuminate which undergoes the regular digestive process. Repeated small doses, 3 grains (0.19 Gm.), have produced gastric oppression, eructations, slight confusion of thought, dizziness, bodily exhaustion, thirst, gastralgia, vomiting, and diarrhea. Zinc dyscra- sia may follow, characterized by obstinate constipation, emaciation, and anemia. ASTRINGENTS. 735 Poisoning. — Continued use or excessive doses of zinc will pro- duce poisoning, with symptoms resembling those of lead-poisoning. Chronic zinc-poisoning is rare. Treatment of Poisoning. — Chemical antidotes are the bicarbon- ates of soda and potassium. Flour and water, soapsuds, and milk are also beneficial. Morphine given hypodermically relieves the vomiting. Laxatives and potassium iodide may serve later to assist in eliminating the zinc. Therapeutics. — Zinc Oxide. — Externally and Locally. — The ointment or powder is used in chronic eczema, intertrigo, burns, fis- sured nipples, anal fissure, ulcers, and skin diseases. In combination with linseed oil the oxide has also been used in erysipelas. The drug has proved useful as an injection in leucorrhea. Internally. — Associated with bismuth, sodium bicarbonate, or belladonna, it is very effective in diarrhea — particularly the summer diarrhea of children — and dysentery. It is a most excellent remedy for colliquative sweating and the sweating of phthisis, and also serves to check the profuse secretion of bronckorrhea, although its use may occasion disordered diges- tion, since zinc is but sparingly soluble. It has been used extensively in the treatment of hysteria, spas- modic asthma, chorea, and epilepsy ; yet, even though it is claimed to be a specific, its action as such is exceedingly doubtful. Zinc oxide has proved highly beneficial in whooping cough^ de- lirium, tremens, and chronic alcoholism — especially the two latter, which are attended with considerable nervousness. The oxide is also valuable in gastralgia. Zinc Acetate. — It is used only externally and as an injection in gonorrhea and leucorrhea. In conjunctivitis it is useful as a collyrium. Zinc Sulphate. — Externally and Locally. — The external use is chiefly in weeping eczema, pruritus, and ulcers. Locally it is of ser- vice as a wash in ophthalmia and conjunctivitis, and as an injection in gonorrhea, leucorrhea, vulvitis, and otitis. It is also used in gan- grenous stomatitis, cancrum oris, and as a gargle in enlarged tonsils and relaxed sore throat. In nasal polypi the powder is insufflated, the solution being applied to the stump after removal of the poly- pus. It dries up soft tumors near the vagina, anus, and female urethra. It is also used in lupus exedens and cancer of the breast, but does not act upon parts covered by epithelium. Its application is very painful, but the eschar does not tend to spread, and sepa- rates much more readily than those of many other caustics. 736 A TEXT-BOOK" -.OF MATERIA MEDICA. Internally. — Its chief use is that of an emetic after ingestion of poison, irritating foods, and especially narcotics, as well as where the air-passages are obstructed, as in croup and diphtheria. It acts as an astringent in chronic diarrhea and dysentery when associated with opium and ipecac. It is serviceable in typhoid fever ^ flatulent dyspepsia, coursing oxularia, spasmodic asthma, and whoop- ing cough. Like the other zinc salts, it has also been used in hysteria, chorea, epilepsy, and angina pectoris. Zinc Carbonate. — This preparation is used only externally, for blisters, weeping eczema, and intertrigo. It is employed in the form of a powder, but generally as an ointment — cardamine ointment. Zinc Iodide. — This salt is but little used, but is of some value as a gonorrheal injection, as an application to enlarged and indu- rated tonsils, and in scrofulous glands. Zinc phosphide and zinc valerianate are used only for the benefit derived from the phosphide and valerian, and may properly be omitted here. Administration. — Externally the powder or ointment of zinc oxide is used, or the drug may be mixed with powdered starch, lycopodium, or acacia. Before applying these preparations it is well to wash the parts with a weak solution of carbolic acid. Internally, \ grain (o.oi Gm.) zinc oxide and 3 grains (0.19 Gm.) sodium bicarbonate are given in diarrhea, or, if preferable, bismuth subnitrate 10 grains (0.64 Gm.), pepsin (Sheffer's) 3 grains (0.19 Gm.), and zinc oxide \-\ grain (0.03-0.06 Gm.), with a little opium added. As an injection a combination of 10 grains (0.64 Gm.) each of zinc sulphate and lead acetate is used, the two salts interacting and pro- ducing lead sulphate — which is precipitated and insoluble — and zinc acetate. Locally and externally the dry powder of zinc sulphate is used, or a mixture of zinc sulphate 10 grains (0.64 Gm.), aqua rosse 4 ounces (118.29 Cc), and glycerin i drachm (4.0 Cc), as a lotion. As an injection it is associated with lead acetate, forming the zinc acetate and lead sulphate. In ophthalmia neonatorum zinc sulphate 5 grains (0.32 Gm.), morphine sulphate 3 grains (0.19 Gm.), and aqua rosse i ounce (30 Cc), perhaps with atropine added, form an excellent mixture. Internally, in dyspepsia 1-2 grains (0.06-0.12 Gm.) may be given, and fq'^ intestinal affections i grain (0.06 Gm.) each of the sulphate, powdered opium, and ipecac three times daily. To produce emesis- 5 grains (0.32 Gm.) are sufficient. ASTRINGENTS. 737 The collyrium consists of J grain (0.03 Gm.) of the salt in i ounce (30 Cc.) of rose water. Cupri Sulphas— Cupri Sulphatis— Copper Sulphate. TI. 8. P. Origin. — Prepared by heating Copper and Sulphuric Acid to- gether, dissolving the soluble product in hot Water, and evaporating. Description and Properties. — Large, transparent, deep blue triclinic crystals, odorless, of a nauseous, metallic taste ; slowly efflorescent in dry air. Soluble in about 2.6 parts of water and in 0.5 part of boiling water ; almost insoluble in alcohol. Dose. — \-^ grain (0.008-0.03 Gm.), as an astringent; as an emetic, 2-20 grains (0.12-1.2 Gm.). Antagonists and Incompatibles. — Alkalies and their carbon- ates, the sulphides, mineral salts (except the sulphates), lime water, the iodides, and vegetable astringents. Synergists. — The same as for lead. Physiological Action. — Copper sulphate^ is the salt mostly used, and the only official preparation. Its action is therefore given as characteristic of that of cuprum. Externally. — Applied to the unbroken skin, it produces little effect, but on raw surfaces or mucous membranes it acts as a pain- ful caustic and astringent. It also possesses antiseptic properties. Internally. — Digestive System. — It acts as an irritant, causing vomiting of greenish matter, though nausea does not follow the emesis. The secretions are augmented, and salivation and purging of blood and mucus are attendant consequences of its ingestion. Should emesis be delayed, the stomach should immediately be emptied, otherwise the copper is liable to produce inflammation. Circulatory System. — Copper exists normally in the blood, and acts as a tonic, being present in the circulation as an albuminate. It depresses the heart's action, causing a small, weak, rapid pulse. Nervous System. — It acts as a depressant. Respiratory System. — Its influence is to hasten and depress the respiratory movements. Absorption and Elimination. — Copper salts are slowly absorbed, tending to accumulate in the liver. The drug is eliminated by the liver, kidneys, salivary glands, and intestinal canal. Poisoning. — ^Acute poisoning results from the inhalation of cupreous fumes, eating fruits cooked in copper vessels, or from an overdose of a copper salt. 47 738 A TEXT-BOOK OF MA TERIA MEDICA. When inhaled the first symptoms are those of bronchial catarrh and irritation. Internally administered, the symptoms do not usually appear at once, but after an hour's interval there are manifest a strong metallic taste in the mouth, burning and constriction of the pharynx and fauces, salivation and vomiting of greenish matter, and purging, the passages after a while containing mucus streaked with blood. There are present also burning in the epigastrium and griping, colicky pains. Copper enters the circulation quickly, it being highly diffusible. A characteristic symptom of poisoning is a green line on the gums. Sometimes jaundice may be present, and headache, convulsions, suppression of urine, cardiac depression, and hurried respiration are among the graver symptoms. Treatment of Poisoning. — A chemical antidote should be given at once, potassium ferrocyanide being the best, as it forms an in- soluble copper cyanide. Other recourses are white of egg, milk, sweet oil, emetics, and the use of the stomach-pump. A mustard plaster, with a little opium added to allay the pain and irritation, may be applied over the pit of the stomach as a counter-irritant. Should vomiting have already occurred, emetics should be with- held. Chronic poisoning usually results from long-continued use of the medicine. The symptoms are the same as those of acute poi- soning, with the following superadded : paresis of the limbs, paral- ysis, incoordination of muscles, atrophy of the liver, with fatty degeneration of the liver-cells, and proliferous growth of the con- nective tissue. There may also be present congestion of the lungs and fatty degeneration of the kidney, together with bronchial catarrh. The treatment is the same as for acute poisoning. Therapeutics. — Externally and Locally. — Copper sulphate stimulates old, flabby, granulating ulcers. Ring-worm, scabies, and tinea sycosis derive great benefit from its use. The crystal or solution, 2 grains to i ounce (0.12-32.0 Gm.) of water, is used extensively in conjunctivitis, tinea tarsi, and trachoma , condylomata, and as a gargle in relaxed sore throat. The aphthse in aphthous stomatitis are benefited by touching with the copper- sulphate solution. It is also used as an injection in gonorrhea and gleet, 2 grains to i ounce (0.12-32.0 Gm.). It is also valuable in mercurial sore mouth and gangrene of the pharynx. Internally. — Copper sulphate is the chemical antidote for phosphorus-poisoning, yet it should be given with great caution, ASTRINGENTS. y;^^ lest of itself it produce acute poisoning. It is a speedy emetic, since it acts directly upon the stomach. If emesis is not produced by the first dose, sulphate of zinc or mustard may be employed. It is used as an emetic in croup. In chorea, hysteria, and epilepsy copper is beneficial. In chronic dysentery and diarrhea an enema of a pint of water (512.0 Gm.) and 10 grains (0.6 Gm.) of sulphate of copper is an efficient remedy, being by some authors considered the best metallic astringent in chronic dysentery. Copper associated with arsenic is highly beneficial in anemia, building up the blood and adding firmness to the flesh. Oleate of copper is used in the skin aflfections mentioned. Nitrate and acetate of copper act like the sulphate. Arsenite of copper has been suggested as a remedy in anemia, and has been used in doses of -^ grain (0.0006 Gm.) in diarrhea and cholera infantum. Administration. — For an enema in diarrhea and dysentery it maybe combined with opium — 2 grains to i ounce (0.12-32.0 Gm.) of water being used. For eye affections the crystal or solution is employed. In addition to the enema copper sulphate, i grain (0.06 Gm.) may be united with magnesium sulphate i ounce (32.0 Gm.) and i drachm (4.0 Gm.) diluted sulphuric acid in 4 ounces (128.0 Gm.) of water, a tablespoonful of the mixture being given every three or four hours. To produce emesis 10-15 grains (0.6-1 Gm.) are dissolved in about 5 ounces (160.0 Gm.) of water, a tablespoonful being given every ten minutes until vomiting is produced. Argrenti Cyanidum— Argenti Cyanidi— Silver Cya- nide. JJ. S. P. Origin. — Obtained by distilling a solution of Potassium Ferro- cyanide acidulated with Sulphuric Acid, the distillate passing into a receiver containing a solution of Silver Nitrate. The process should be continued until the distillate no longer produces a precipitate in the receiver. The precipitate is finally washed with distilled water and dried. Description and Properties. — A white powder, without odor or taste ; permanent in dry air, but gradually turning brown on exposure to light. Insoluble in water, alcohol, or cold nitric acid ; soluble in boiling nitric acid, ammonia water, and solution of 740 A TEXT-BOOK OF MATERIA MEDIC A. sodium hyposulphite or potassium cyanide. It should be kept in dark, amber-cplored vials, protected from light. Not used internally. Official Preparation. Acidum Hydrocyanicum Dilutum— Acidi HydrocySnici Diluti— Diluted Hydrocyanic Acid (Prussic KaT,).—Dose, 2-5 minims (0.12-0.3 Gm.). (Described under Hydrocyanic Acid, page 519.) Argenti lodidum— Argent! lodidi— Silver Iodide. V. 8. P. Origin. — Prepared from Silver Nitrate and Potassium Iodide, washing and drying the precipitate. Description and Properties. — A heavy, amorphous, light-yel- lowish powder, unaltered by light if pure, but generally becoming somewhat greenish-yellow; without odor or taste. Insoluble in water and alcohol. Silver iodide should be kept in dark, amber- colored vials, protected from light. Dose. — ^i grain (0.015-0.06 Gm.). Argenti NTtras— Argenti Nitratis— Silver Nitrate. U. 8. P. Origin. — Obtained by dissolving Silver in Nitric Acid with the aid of heat, evaporating, and crystalhzing. Description and Properties. — Colorless, transparent, tabular, rhombic crystals, becoming gray or grayish-black on exposure to light in presence of organic matter. Without odor, but having a bitter, caustic, and strongly metallic taste. Soluble in 0.6 part of water and in 26 parts of alcohol. It should be kept in dark, amber-colored vials, protected from light. Dose. — J-i grain (0.0.15-0.06 Gm.). Official Preparations. Arggnti NItras Dilfltus — ArgSnti Nitratis Diliiti — Diluted Silver Nitrate (Mitigated Caustic). — Origin. — Prepared by fusing together Silver Nitrate 30, and Potassium Nitrate 60, and casting in suitable moulds. Description and Properties. — A white, hard solid, generally in the form of pencils or cones of a finely granular fracture, becoming gray or grayish-black on exposure to light in the presence of organic matter; odorless, having a caustic, metallic taste, neutral to litmus-paper. It should be kept in dark, amber-colored vials. Used externally. Arggnti NItras Fiisus — ArgSnti Nitratis Fiisi — Moulded Silver Nitrate (Lunar Caustic). — Origin. — Obtained by melting Silver Nitrate 100, Hydrochloric Acid 4, and pouring the melted mass into suitable moulds. Description qnd Properties. — A white, hard solid, usually cone- or pencil-shaped, of ASTRINGENTS. 741 a fibrous fracture, becoming gray or grayish-black on exposure to light in presence of organic matter ; odorless, having a bitter, caustic, and strongly metallic taste. Soluble in 0.6 part of water and in 26 parts of alcohol. The product should be kept in dark, amber-colored vials, protected from light. Used externally and locally. Argenti Oxidum— Argrenti Oxidi— Silver Oxide. U. 8. I*. Origin. — Prepared by shaking a solution of Silver Nitrate with solution of Potassa and washing the precipitate. Description and Properties. — A heavy, dark, brownish-black powder, liable to reduction by exposure to light ; odorless, with a metallic taste; very slightly soluble in water and insoluble in alcohol. Dose. — |— 2 grains (0.03-0.12 Gm.). Antagonists and Incompatibles. — The silver nitrate is incom- patible with the alkalies and their carbonates, chlorides, hydro- chloric and tannic acids, potassium iodide, solutions of arsenic, and many of the organic acids. Silver oxide is rapidly oxidized, forming explosive compounds with chlorides and organic substances. Synergists. — Preparations of copper, lead, and zinc aid the action of silver salts. The silver nitrate and its preparations and the silver oxide are the only salts which possess any value as astringents or caustics. The silver nitrate is the typical astringent salt, and its physiological action will be hereafter considered. Physiological Action. — Metallic silver is practically of no use in medicine, though of great value in surgery, because of its inert- ness. Silver nitrate is the salt of silver chieily employed. Externally and Locally. — It is a powerful caustic, but does not wound very deeply, as it forms an eschar by coagulating the albu- min of the tissue, thus protecting the underlying structures. The eschar is white, but on exposure to light very soon becomes black, owing to the fact that the silver is reduced to its metallic state. Like lead salts, silver salts are hemostatic. They are severely irritant to mucous membranes when used in solution. Internally. — Digestive System. — The drug causes increased secre- tion of intestinal glands and larger flow of bile. Silver salts are changed in the stomach into peptonates and albuminates. Under 743 A TEXT-BOOK OF MA TERIA MEDIC A. ordinary doses nutrition is promoted ; by large doses it is impaired, with resulting loss of flesh and weight. Circulatory System.— The heart is stimulated by small doses, and the blood becomes darker and contains less fibrin. The red corpuscles lose shape and color and the hemoglobin is con- verted into hematin. Large doses depress cardiac action, while thrombosis and embolism may ensue. Nervous System. — In small doses silver salts are tonic ; in large doses they produce epileptiform convulsions and paralysis of centric origin. Respiratory System. — The primary effect of the drug is to stim- ulate respiration. Large doses, however, cause death by paralysis of the respiratory center. Absorption and Elimination. — It is absorbed from the stomach . and eliminated very slowly, chiefly by the feces, a small portion being excreted by the kidneys. Temperature. — At first increased ; afterward, through the blood- changes, lowered. Untoward Action. — Long-continued use of silver nitrate pro- duces discoloration of the skin — either general or more pronounced in particular spots, such as the face. Even when the skin is per- fectly intact the application of nitrate of silver will discolor it, \ grain (.016 Gm.) having caused palpitation of the heart and irreg- ular pulse. Silver is very apt to accumulate in the tissues. Poisoning. — A poisonous dose of silver nitrate produces a violent gastro-enteritis. The earliest symptom is an intense pain in the abdomen, followed by vomiting and purging. The abdominal muscles are hard and retracted, the face livid and covered with perspiration and wearing an anxious expression. The lips are blanched, gradually becoming black ; the vomited matter is black- ish and sometimes resembles milk-curds. Epileptiform convulsions, delirium, and paralysis ensue, the latter symptom being of centric origin. Death results from cessation of respiration, due to the centric paralysis. A large amount of mucus is thrown into the bronchial tubes by the lining mucosa. Treatment of Poisoning. — The chemical antidote is common salt. It is essential to protect the mucous membrane of the esophagus and stomach, and at the same time dilute the poison as much as possible, for which purposes large quantities of salt water and soap water or milk are valuable. Opium allays the pain and irritation. ASTRINGENTS. 743 Chronic poisoning, or argyria, results from prolonged medicinal use of silver nitrate or its employment as a hair-dye for any length of time. The drug is deposited in all parts of the body, being especially manifest in a slaty, permanent discoloration of the skin. The first symptoms are discoloration of the sclerotic conjunctivae and a dark hne on the inner side of the lips. Ulcerative stomatitis may occur, or even gastric ulcer. . Treatment of Chronic Poisoning. — Iodide of potassium or hypo- sulphite of soda will aid in eliminating the poison. Baths of the hyposulphites or lotions of cyanide of potassium may produce absorption and excretion of the silver deposits, but the discolora- tion is rarely removed in any way. Therapeutics. — Externally and Locally. — A very important use of SILVER NITRATE is that of preventing ophthalmia neonatorum, a 2 per cent, solution being dropped into the eyes. For adults a 2 to 4 per cent, solution is used in various forms of conjunctivitis, the eyelids being painted with a camel's-hair brush, and the solution being washed off immediately to prevent discoloration. The nitrate- of-silver stick may also be used. Felons, boils, and bed-sores may be aborted by the use of a strong solution — 20 grains to i ounce — of silver nitrate. An injection of 2-3 grains (.12-20 Gm.) is beneficial in subacute gonorrhea and leucorrhea. This may also be used as a wash in pruritus ani and vulvcz, to relieve the itching. The stick may be applied to uterine ulcers. As a caustic it is used in indolent ulcers and chancroids, stimu- lating them and producing a healthy granulating surface. A solution painted over the eruption of variola is supposed to prevent pitting. The vesicles may also be punctured with a needle and the silver nitrate then introduced. The pain and swelling of orchitis and epididymitis are consid- erably relieved by painting the scrotum with a solution of this salt. After a cold, when the throat feels raw and sore, a gargle of 60 grains (4.0 Gm.) to the ounce (30.0 Cc.) is very gratifying, and the same may be used in inflammations of the pharynx, fauces, and mouth. A spray of 40 grains (2.59 Gm.) to the ounce (30.0 Cc.) is very effective in laryngeal croup, trachitis, chronic ulceration of the larynx, and whooping cough. The caustic pencil is used in tonsil- litis, sore nipples, mercurial sore mozith, and poisoned, lacerated, and punctured wounds. A solution of 1-2 grains (.06— .12 Cc.) to the 744 A TEXT-BOOK OF MATERIA MEDIC A. ounce (30.0 Cc.) is valuable in otorrhea, vesical catarrh, and balanitis. Internally. — Dr. Pepper recommends this salt in intestinal ulcer- ations, given in keratin-coated pills. It is a cure for gastric ulcer, in which it may be combined with opium. Gastralgia and chronic gastritis, ulceration of the rectum, dysentery, and diarrhea of typhoid have been remarkably benefited by its use. For stomach affections \-\ grain (.01-016 Gm.) is given, and for intestinal an enema of 3-10 grains (.20-.64 Gm.) to the ounce (30.0 Cc). It has been used in congested conditions of the cord, locomotor ataxia, epilepsy, and chorea. It is the only remedy of any value in locomotor ataxia ; but, owing to the discoloration it produces, it cannot be used continuously, and in many cases it fails entirely. Argentic iodide was once used extensively in the treatment of syphilis, but is now obsolete. Argentic oxide is not so active as the nitrate. It has been employed for checking sweats, and, owing to its less caustic action, it may be preferable to the nitrate in gastric idcer and gastralgia. Administration. — The dose of silver nitrate is \-\ grain (.01- .016 Gm.), and for a constitutional effect should always be given in pill form during the process of digestion. The keratin-coated pill is to be administered for intestinal dis- orders, and when a local action on the alimentary canal is desired an ordinary pill should be given one to two hours before meals. It is well to discontinue the drug for a short time after three or four weeks' treatment, the salt being so slowly eliminated that its prolonged use is very apt to result in argyria. Pi.-c%an:va..— Origin. — A soluble compound of Silver and Casein, first prepared by Rohmann and Liebreich. Description and Properties. — A dilute solution of this substance in water is opales- cent; opaque when concentrated, but immediately cleared by the addition of ammonia or carbonate of soda. Used externally and locally. Physiological Action and Therapeutics. — Argonin is a very powerful, non-irritating germicide. The addition of a little ammonia to a solution of argonin vastly increases its bactericidal power, but deprives the drug of its bland, non-irritating character. It appears to lack astringent properties, and concentrated solutions are neither corrosive nor irritant. From experimental research Meyer concludes that argonin has a strong disinfectin" influence upon certain bacteria, particularly the gonococcus, investigation having shown that a 1 : 30,000 solution of ammoniacal argonin completely suspended the growth of this microbe for five minutes. Jadassohn, who has had an extensive experience with argonin in the treatment of gonorrhea, draws the following conclusions : ( I ) i .5 to 2 per cent, solutions exert a rap- idly destructive action upon gonococci. (2) Strong solutions are devoid of inflammatory ASTRINGENTS. 745 or corrosive action, and are consequently adapted to the treatment of acute gonorrhea of the anterior and posterior urethra in men, and of the uterus and urethra in women. (3) It appears to lack astringent properties, so that purely anticatarrhal treatment will indicate the assistance of other remedies. Alumen— AlQminis— Alum. JJ. S. JP. Origin. — Prepared by a complicated process from a mixture of Aluminum Silicate and Iron Sulphide by roasting, lixiviating with water, concentrating the solution, and, while hot, mixing with Po- tassium Chloride. Upon cooling the alum separates as a crystal- line powder, which is puriiied by one or two recrystallizations. Description and Properi;ies. — Large, colorless, octahedral crys- tals, sometimes modified by cubes, or crystalline fragments, without odor, but having a sweetish and strongly astringent taste. On exposure to the air the crystals are liable to absorb ammonia and acquire a whitish coating. Soluble in 9 parts of water and 0.3 part of boiling water ; also freely soluble in warm glycerin. Insoluble in alcohol. Dose. — 5-40 grains (0.3-2.60 Gm.) ; as an emetic, 1-2 drachms (4.0-8.0 Gm.). Official Preparation. Alumen Exsiccatum — Aluminis Exsiccati — Dried Alum (Burnt Alum). — ■ Origin. — Alum heated until it is deprived of its water of crystallization. Description and Properties. — A white, granular powder, without odor, possessing a sweetish, astringent taste and attracting moisture from the air. Very slowly but com- pletely soluble in 20 parts of water, and quickly soluble in 0.7 part of boiling water. Dose. — 1-5 grains (0.06-0.3 Gm.). Unofficial Preparation. Aluminis Glycerftum — Aluminis Glyceriti — Glycerite of Alum (20 per cent, alum). — Used externally. Allied Compounds. Aliimnol — Altlmnol — Alumnol. — Origin. — This substance was discovered by Filehne of Breslau, and is a mixture of Aluminum Salts of Naphthol-sulphonic Acid, containing about J per cent, of aluminum and 15 per cent, of sulphur. Description and Properties. — It occurs as a light, odorless, white or reddish-white, non-hygroscopic powder. It possesses a sweetish and astringent taste, and is readily soluble in water or glycerin, less so in alcohol, and insoluble in ether. While becoming darker on exposure to the air, its properties are unaffected. Used externally and locally. Aluminum Aceto-tartrate. — Origin. — First prepared by Athenstadt by dissolving . 5 parts of Basic Aluminum Acetate in a suflScient quantity of water by the aid of 2 parts of Tartaric Acid, and evaporating the solution to dryness. 746 A TEXT-BOOK OF MA TERIA MEDICA. Description and Properties.— \1 occurs in shining, almost colorless, amorphous, masses, with a faint, acetous odor and an acidulous astringent taste. Soluble m water; insoluble in alcohol. Used externally and locally. Aluminum Boroformate.— O^^m.— Prepai-ed by heating together Bono Acid, Formic Acid, and Alumina. Antagonists and Incompatibles.— The alkalies and their car- bonates ; lead, mercury, and iron salts ; tartrates and tannic acid. Synergists.— The vegetable and mineral astringents. Alumini Hydras— Alum ini Hydratis— Aluminum Hydrate. V.8.T. Origin. — This substance is found in nature as the rare crystal- line mineral gibbsite of North America — the diaspore of Eastern Europe. The aluminum hydrate may be prepared by precipitating the solution of an aluminum salt with an alkali or alkali carbonate. Description and Properties. — A white, light, amorphous pow- der, odorless and tasteless, permanent in dry air. Insoluble in water or alcohol, but completely soluble in hydrochloric or sul- phuric acid, and also in potassium or sodium hydrate T. S. Dose. — 3-6 grains (0.2-0.4 Gm.). Alumini Sulphas— Alumini Sulphatis— Aluminum Sulphate. V. S. P. Origin. — It is occasionally found as an efflorescence near vol- canoes and upon alum-slate. For medicinal use it should be pre- pared from Aluminum Hydrioxide, by dissolving it in the requisite quantity of Dilute Sulphuric Acid. Description and Properties. — A white, crystalline powder, having a sweetish and afterward astringent taste ; permanent in the air. Soluble in i .2 parts of water, and much more freely in boiling water ; insoluble in alcohol. Used externally. Description and Properties. — It occurs in pearl-like crystals or crystalline scales, which are very soluble in water. It contains 33.5 per cent, of alumina. Used externally and locally. Sozal, — Origin. — Obtained by dissolving Aluminum Hydrate in Phenol-sulphonic Acid. Description and Properties. — A crystalline substance having an astringent taste and a faint odor of carbolic acid. It is freely soluble in water, glycerin, and alcohol. Used externally and locally. Physiological Action. — Externally and Locally. — Alum con- tracts the small blood-vessels and coagulates the albumin in the ASTRINGENTS. 747 tissues, but in order to have any effect it must be applied to a denuded surface. It is also mildly escharotic. Applied to the unbroken skin, it thickens and hardens it. Internally. — Digestive Systeni.-^Ws, first effect when taken into the mouth is to excite the salivary secretion, the albumin in it, as well as that of the buccal mucous membrane, being precipitated. When its astringent action takes effect the secretions are dimin- ished and the mucous membrane of the mouth and toneue is blanched and puckered. The enamel of the teeth is affected, breaking under its influence. The digestive juices are diminished in quantity and the pepsin precipitated. Constipation follows, though it may be preceded by a slight diarrhea. Taken in large doses, alum produces nausea, vomiting, purging, and abdominal pain. Circulatory System. — Notwithstanding the fact that alum coag- ulates albumin, it is nevertheless absorbed into the blood-vessels, and by contracting them lessens all the secretions and arrests hemorrhage. When injected directly into the blood it produces thrombi and .emboH. Nervous System. — Spasms are relieved by alum, but this action is in all probability dependent upon contraction of the blood- vessels. Absorption and Elimination. — As stated, alum is absorbed by the blood-vessels ; it is eliminated by the kidneys and liver. Untoward Action. — The prolonged use of alum is very apt to produce a cough in persons having sensitive bronchi. Therapeutics. — Externally and Locally. — Alum is used to de- stroy exuberant granulations and verrucosities. It is an excellent hemostatic in epistaxis and bleeding from the gums, vagina, rectum, bladder, bites, and sockets of extracted teeth. It is much used for sore throat by public speakers and singers, and is also efficient in tonsillitis, particularly the follicular form, gangrenous pharyngitis, stomatitis ulcerosa, relaxation of the uvula and pharyngeal mucous mem.brane, swollen and overriding gums, and mercurial ptyalism. The destructive effect of alum upon the teeth must always be borne in mind : the alum stick or a swab is preferable whenever possible. If a mouth-wash or gargle be necessary, wash and brush the teeth well immediately after using the alum. Five grains (.32 Gm.) to i ounce (30.0 Cc.) of water is an excel- 748 A TEXT-BOOK OF MATERIA MEDICA. lent preparation for ophthalmia, conjunctivitis, and trachoma, but must not be used if there is any corneal inflammation, as it is apt to cause ulcers. By adding milk or white of egg to the mixture its efficiency is greatly increased. This preparation is also very serviceable in preventing the discoloration of a " black eye." An injection of 5-10 grains (.32-.64 Gm.) to the ounce (30.0 Cc.) of water is much used in gonorrhea, leucorrhea, and gleet, and also for washing the vulva in pruritus. Sweating of feet, hands, and axillcB, when excessive and fetid, is checked by the application of a lotion or powdered alum. Soaking a piece of cotton or lint with alum and placing it under an ingrowing toe-nail affords marked relief Chilblains, old sores, and ulcers are also benefited by the use of alum. A spray, gargle, or insufflation has been used with good results in diphtheria, bronchorrhea, chronic laryngitis, aphonia due to atony, bronchitis, and whooping cough. Internally. — Alum operates advantageously as an astringent in arresting gastric and intestinal hem.orrhages, hematuria, and inenor- rhagia. The diarrheas of typhoid fever and chronic dysentery, and occasionally the acute forms, are strikingly benefited by an alum enema. It has been used in polyuria and diabetes mellitus, though in the later affection it is of little value. Although alum produces, it also relieves, constipation when flatus has existed for some time, and atony of the bowel diminished peristalsis. Given in emetic doses in membranous croup, it loosens the membrane, and as this is expelled it lessens the chance of another one forming by constringing the mucosa and blood-vessels, and thus preventing further exudation. By checking absorption and producing emesis alum serves as an antidote for lead-poisoning, and is an efficient remedy in lead colic. Alumen exsiccatum is employed chiefly as an escharotic for fungous growths, and to stimulate indolent ulcers and mucous membranes with morbid secretions. Whenever the drug is used as a powder externally or for insuf- flation, powdered dried alum is the form to use. Administration.— The emetic dose of alum is 1-2 drachms (4.0-8.0 Gm.) in syrup. Warm water will increase its action when retching begins. ASTRINGENTS. 749 For internal use, 5-10 grains (.32-.64 Gm.), mixed with a little simple syrup or syrup of orange peel to prevent nausea, will be found beneficial. For coUyria, 2-3 grains (.12-.20 Gm.) in i ounce (30.0 Cc.) of water, or the alum curd, as already mentioned, may serve best. The curd may be separated by adding 2 drachms (8.0 Gm.) of alum to i pint (473. Cc.) of milk, boiling, and straining. The gargle and injection can be used in strengths of 5-20 grains (.32-1.29 Gm.) to I drachm (4.0 Gm.). For insufflation the dried alum is employed. Bismuthi CTtras— Bismuth! Citratis— Bismuth Ci- trate. V. S. JP. Origin. — Bismuth Subnitrate and Citric Acid are boiled in suf- ficient Water, and the precipitate washed and dried. Description and Properties. — A white, amorphous or micro- crystalline powder, odorless and tasteless, permanent in the air. Insoluble in water or alcohol, but soluble in ammonia water and in solutions of the citrates of the alkalies. Dose. — 1-3 grains (0.06-0.2 Gm.). Official Preparation. Bismuthi et Ammonii Citras — Bistnuthi et Ammonii Citratis — Bismuth and Ammonium Citrate. — Origin. — Prepared by mixing Bismuth Citrate with Dis- tilled Water to make a paste, adding sufficient Ammonia Water to make a solution, filter- ing, evaporating, and drying on plates of glass. Description and Properties. — Small, shining, pearly, or translucent scales, odorless, with a slightly acidulous and metallic taste, becoming opaque on exposure to the air. Very soluble in water, but sparingly soluble in alcohol. The product should be kept in well-stoppered bottles, protected from light. Dose. — l-io grains (0.06-0.6 Gm.). Bismuthi Subcarbonas— Bismijthi Subcarbonatis— Bismuth Subcarbonate. ?7. 8. P. Origin. — Obtained by dissolving purified Bismuth in Nitric Acid and Water, decanting and filtering, mixing with Ammonia Water, washing the precipitate and dissolving in Nitric Acid. The solution is then mixed with a solution of Sodium Carbonate, and the resulting precipitate collected and washed. Description and Properties. — A white or pale yellowish-white powder, of somewhat varying chemical composition, odorless and tasteless, permanent in the air. Insoluble in water or alcohol, but 750 A TEXT-BOOK OF MATERIA MEDIC A. completely soluble in nitric or hydrochloric acid, with copious effervescence. Dose. — 5-20 grains (0.3-1.2 Gm.). Bismuthi Subnltras— Bismuthi Subnitratis— Bis- muth Subnitrate. U.S. P. Origin. — Prepared by dissolving purified Bismuth in Nitric Acid and Water, concentrating by evaporation, adding more water, stir- ring well, and washing and drying the precipitated bismuth sub- nitrate. Description and Properties. — A heavy white powder, of some- what varying chemical composition, odorless and almost tasteless, permanent in the air. Nearly insoluble in water and insoluble in alcohol, but readily soluble in nitric or hydrochloric acid. Dose. — 5-20 grains (0.3-1.2 Gm.). Allied Compounds. Bismuthi SaHcylas — Bismiithi Salicylatis — Bismuth Salicylate. — Dose, i- 20 grains (0.06-1.2 Gm.). BismQthi Subiodidum — Bismiithi Subiodidi — Bismuth Subiodide. — Used externally. Bismuth Naphtholate. — Dose, 15-30 grains (1.0-2.0 Gm.). Bismuth Tribromphenate. — Dose, 60-75 grains (4.0-5.0 Gm.). Dermatol (Bismuth Subgallate). — Description and Properties. — A finesaffton- yellow powder, odorless, non-hygroscopic, unaffected by exposure to air or light, insoluble in water, alcohol, or ether. Dose. — 15-30 grains (1.0-2.0 Gm). Dermol (Bismuth Chrysophanate). — Description and Properties. — An amor- phous yellow powder, neutral in reaction, insoluble in water or alcohol. Used externally and locally. Thioform. — A combination of Bismuth, Sulphur, and Salicylic Acid. Description and Properties. — A Ught, grayish-yellow powder, odorless and tasteless, insoluble in water, alcohol, or ether. Used externally and locally. Antagonists and Incompatibles. — The salts of bismuth are insoluble, and should not be prescribed with other agents in solution. Synergists. — The sedative action of bismuth upon the stomach may be increased by calomel and cerium oxalate, and pepsin may be given as a substitute for this purpose. The astringency of the bismuth salts may be enhanced by opium and tannic acid. Physiological Action. — Externally. — Bismuth salts are mildly astringent, but have no effect upon the unbroken skin. Internally. -^Digestive System, — Bismuth is insoluble in the ASTRINGENTS. 751 gastro-intestinal juices. It coats the mucous membrane, lessening secretions and absorbing excess of free acids, at the same time act- ing as a sedative and feeble astringent. The tongue and stools are tinged a dark clay color, due to conversion into the sulphide. The soluble salts are absorbed very slowly, and increase thfe appetite and digestion, constipation being the result. Circulatory System. — A minute quantity passes into the blood, acting as a tonic. Nervous System. — Bismuth salts are sedative to the peripheral nerve-endings. Absorption and Elimination. — The salts of bismuth are absorbed into the circulation, and are eliminated by the urine, liver, and feces. Untoward Action. — Odier noticed nausea, and Weenesk vomit- ing, colicky pains, diarrhea, or constipation, headache, sensation of heat, dizziness, and general debility. Poisoning. — It has always been assumed that cases of poisoning are due to the lead and arsenic contained in the bismuth prepara- tions, but Carnot and Riche found these metals present in such quantities as to be practically inert. The symptoms are similar to those of lead-poisoning. Large concretions may be found in the intestines, and sloughs in the mouth and gastro-intestinal canal may be present, as well as desquamative nephritis and albuminuria. Treatm,ent of Poisoning. — Lavage, demulcents, and chemical anti- dotes for arsenic, magnesium, and calcium ; best of all, freshly precipitated hydrated oxide of iron. Therapeutics. — Externally and Locally. — Bismuth subnitrate is serviceable in intertrigo, erythema, acne rosacea, as a protective dressing for wounds, ulcer's, and epithelioma, and as an application for chapped nipples and hands, relieving the smarting and itching. It is also of use in fissure, prolapsus ani, and superficial burns. It is used as an injection in gonorrhea, leucorrhea, and ozena, and was formerly used as an insufflation in acute nasal catarrh, ■ being abandoned because of the arsenic which it sometimes con- tains. „.It serves as a wash in aphthous stomatitis, mild cases of mercurial salivation, and cancrum oris, as well as for the fetid sweating of feet and other parts, and for chancres and phlegmonous erysipelas. It has also proved beneficial in chronic conjunctivitis and granular lids or trachoma. Internally. — It allays irritation, and is consequently useful in irritative vomiting and diarrhea. Gastric pain is relieved by it. 753 A TEXT-BOOK OF MA TERIA MEDICA. It is valuable in pyrosis, chronic diarrhea, gastric ulcer, chronic dysentery, diarrhea of typhoid, early stages of cholera and cholera infantum, and in the gastritis due to alcohol. The CITRATE OF BISMUTH AND AMMONIUM is very solublc, and should be used only for local applications. The OXIDE is insoluble, and combined with morphine has been used as a snuff in ozena and nasal catarrh. SuBCARBONATE OF BISMUTH is not used in medicine. Salicylate of bismuth reduces the pulse and temperature in typhoid fever, and also corrects the fetid stools. Bismuth subgallate, or dermatol, was first used by Heintz and Liebrecht, being intended as a substitute for iodoform ; but it is very astringent, although not irritating. The preparation is used in weeping eczema, otitis media, herpes, wounds, burns, diarrhea, and dysentery. In stagnant ulcers it is of no service, since they need stimulation. Bismuth citrate is insoluble, and is of no service medicinally. Besides the foregoing preparations there is a tannate of bis- muth, used to some extent in diarrhea, gonorrhea, leucorrhea, and ophthalmia. Phosphate of bismuth is the least soluble of all the bismuth compounds, a:nd is used, but rarely, in diarrhea, dysentery, gastral- gia, and dyspepsia. Subiodide of bismuth is used as a substitute for the subnitrate, and is of special value in chronic ulcers. It is supposed to be slightly anesthetic. Valerianate of bismuth is of no medicinal value. Subbenzoate of bismuth is mildly escharotic. Administration. — The drug is used externally as a powder or ointment in combination with naphthalin or vaseline, to which a little morphine may be added. Belladonna, opium, and oleate of bismuth are also used. For gastralgia and dyspepsia, pepsin or magnesium and calcium phosphate may be combined with bismuth. If a cathartic is desir- able, rhubarb may be added. Bismuth, aromatic powder, and carbonas liqui make an excel- lent combination in flatulent dyspepsia. In infantile diarrhea and summer complaint bismuth i grain (.06 Gm.), syrupus aurantii 15 minims (.92 Cc), and calumba 15 minims (.92 Cc.) are efficacious, particularly as they allay the alternating pain. ASTRINGENTS. 753 Bismuth, 5-15 grains (.32-1.0 Gm.), is given for stomach affec- tions, and 15 grains (i.o Gm.) to i drachm (4.0 Gm.) for intestinal disorders, one to two hours after meals as the stomach is emptied. Cerii Oxalas— Cerii Oxalatis— Cerium^Oxalate. 17. S. P. (Cerous Oxalate.) Origin. — Prepared by a complicated process by the action of acids, etc. upon the powdered mineral. Description and Properties. — A white, granular powder, with- out odor or taste, and permanent in the air. Insoluble in water, alcohol, or ether. Dose. — 1-8 grains (0.06-0.5 Gm.). Physiological Action. — The physiological action of this drug is imperfectly understood : it is supposed to be a nervous sedative. Therapeutics. — Internally. — Its widest application is in the vom- iting of pregnancy, but it also controls the emesis of uterine disease and of dyspepsia, due to gastric acidity or deranged innervation of the stomachj as in sea-sickness. It does not derange digestion, and is therefore of value in checking the cough of phthisis and bronchitis, especially when accompanied by vomiting. Simpson regarded it as almost a specific in chorea. In combi- nation with bismuth it is useful in checking diarrhea. Administration. — Cerium oxalate is usually administered in pill form, 1-3 grains (.06-.20 Gm.) three times daily, but the powder is used when the drug is associated with other remedies. 48 TOPICAL REMEDIES. GROUP XVIIL— CAUSTICS OR ESCHAROTICS. Caustics are medicines which destroy the tissues to which they are appHed. They excite inflammation and vascular dilatation of the surrounding area. The eschar produced by these drugs is separated from the living tissues by the inflammation and suppura- tion produced. When a drug acts as a caustic — that is, when it destroys a cir- cumscribed portion of living tissue — it penetrates deeper in pro- portion as the product of its action (?'. e. the eschar) is looser, and is shallower in proportion as the eschar is firmer or more com- pact. This is the essential difference between Astringents and Caustics ; the former contract the tissues, causing the protoplasm to be firmer and occupy less space ; the latter cause th.e protoplasm to be softer and occupy more space. It will be seen, therefore, that the more caustic a drug is, the less astringent it is, and vice versd. The caustic action of a drug depends upon whether the drug and its products are both soluble in water ; for if the medicine is not soluble in water, it cannot have a caustic action, and if the products of the caustic action are not soluble in water, the eschar will be firm, the drug acting more as an astringent than as a caustic. For example, the chlorides of the heavy metals, such as mer- curic chloride, zinc chloride, etc., are usually freely soluble in water, and are, as a rule, the most caustic of the metallic salts. Should a metallic chloride be insoluble in water, it will have no caustic action — e.g. silver chloride. If the heavy metals be arranged in a series, placing at one end the most astringent salts, and at the other the least astringent, it will be noticed that those salts which are the least astringent are the most caustic, becoming less and less caustic as they are more and more astringent. Most Astringent. Least Astringent. Lead, Iron, Zinc, Copper, Silver, Tin, Mercury. Least Caustic. Mg^t CausHc. 754 CAUSTICS OR ESCHAROTICS. 755 Caustics act — 1. By abstracting the water of the tissues ; 2. By combining with the albumin of the tissues ; 3. By corrosive oxidation. The important caustics, arranged according to their mode of action, are enumerated below. Caustics which act by abstracting the water from the tissues : Arsenious Acid, Potassa and Lime, Antimony Chloride, Caustic Soda, Carbolic Acid, Glacial Acetic Acid, Chromic Acid, Lime, Caustic Potash, Mineral Acids. Caustics which act by combining with the albumin of the part : Alum (burnt). Mercuric Oxide, Copper Sulphate, Silver Nitrate, Mercuric Chloride, Zinc Chloride, Mercuric Nitrate, Zinc Sulphate. Caustic which acts by corrosive oxidation : Bromine. Caustics are employed — 1. To destroy excrescences on the skin or mucous membranes, and to effect the destruction or removal of malignant growths, as in cases of warts, condylomata, polypi, hipus, epithelioma, etc. ; 2. To open abscesses, or to maintain a chronic irritation, or to stimulate indolent sinuses, ulcers, etc. ; 3. To destroy and prevent the absorption of the virus from the bites of rabid and venomous animals, and for the destruction of chancres and malignant pustules. Those escharotics which have not been discussed elsewhere will now be considered in detail : Liquor Antimonii Chl5ricli— Liquoris Antimonii Chloridi— Solution of Antimony Chloride. (Unofficial.) (Butter of Antimony.) Origin. — Prepared by the action of Hydrochloric Acid upon Purified Black Antimony. Description and Properties. — A yellowish or yellowish-red liquid, having the specific gravity 1.47, and yielding with water a white precipitate of antimonious oxychloride {powder of Algaroth). Used externally as a caustic. 756 A TEXT-BOOK OF MA TERIA MEDICA. Physiological Action and Therapeutics. — Solution of anti- mony CHLORIDE is one of the most powerful caustics employed m surgery. It is a violent corrosive poison, toxic doses producmg complete general collapse, corroding and charring any living tissue with which it comes in contact. The treatment of poisoning by butter of antimony would be— chalk, magnesia, demulcent drinks, tannic acid, anodynes, and stimulants if necessary. Solution of chloride of antimony may be used as a caustic for the bites of rabid animals and venomous reptiles, chancres, con- dylomata, malignant pustules, etc. The preparation should be cautiously applied with a camel's- hair pencil. Acidum Chromicum— Acidi Chromici— Chromic Acid. V.8.P. (Chromic Trioxide; Chromic Anhydride.) Origin. — Dissolve Potassium Bichromate in Sulphuric Acid and Water; decant, heat with more Sulphuric Acid; cool, and crystallize. Description and Properties. — Small, needle-shaped crystals or rhombic prisms, of a dark purplish-red color and metallic luster; odorless; destructive of animal and vegetable tissues; deliquescent in moist air. Very soluble in water, forming an orange-red solution. When brought in contact with alcohol, ether, glycerin, and other organic solvents decomposition takes place, sometimes with dangerous violence. Chromic acid should be kept in glass-stoppered bottles, and great caution should be observed to avoid bringing it in contact with organic substances, such as cork, tannic acid, sugar, alcohol, etc., as dangerous acci- dents are liable to result. Used externally. Physiological Action and Therapeutics. — Chromic acid is a powerful caustic, deodorant, and disinfectant. It coagulates albumin and oxidizes organic matter. Its action is slow, and the pain following its application is usually of shorter duration than that of most caustics. Weak solutions are stimulant, astringent, and alterative. Chromic acid is used in the form of a paste or in solutions of various strengths for the removal of syphilitic warts, vegetations, condylomata, etc. As a caustic and stimulant application in many diseases of ear, nose, and throat it serves a valuable purpose, as in nasal polypi, enlarged tonsils, chronic and syphilitic laryngitis, laryn- CAUSTICS OR ESCHAROTICS. 757 geal papillovtata, chronic superficial glossitis, tuberculosis of the tongue, ozena, ulcerations of the mouth, etc. A lo per cent, solution of chromic acid has been found service- able in the treatment of hyperidrosis. A solution of i part of chromic acid in 40 parts of water makes an efficient lotion for disinfecting foul ulcers and as an injection in gonorrhea, leucorrhea, etc. Sessile piles and salivary fistulce are efficiently treated by touch- ing the parts with pure chromic acid. Potassa— Potassae—Potassa. JJ. S, JP. (Potassium Hydrate; Potassium Hydroxide; Caustic Potash.) Origin. — Prepared by evaporating Liquor Potassae, fusing the residue, and pouring into clean cylindrical moulds which have been previously warmed. Description and Properties. — Dry, white, translucent pencils, or fused masses, hard and brittle, showing a crystalline fracture ; odorless or having a faint odor of lye, and of a very acrid and caustic taste. Because of its active effect upon organic tissues it should be tasted and handled with exceeding care. Exposed to the air, it rapidly absorbs carbon dioxide and moisture, and deliquesces. Soluble in about 0.5 part of water and in 2 parts of alcohol. Potassa should be kept in well-stoppered bottles made of hard glass. Used externally. Potassa cum Calce— Potassae cum Calce— Potassa with Lime. U.S.I'. (Vienna Caustic or Vienna Paste.) Origin. — Prepared by rubbing together equal parts of Potassa and Lime in a warm iron mortar. Description and Properties. — ^A grayish-white powder, deli- quescent, having a strongly alkaline reaction. Used externally. Soda— Sodse— Soda. U. S. JP. (Sodium Hydrate; Sodium Hydroxide; Caustic Soda.) Origin. — Prepared from a solution of Soda in the same manner as described under Potassa. Description and Properties. — Dry, white, translucent pencils or fused masses, showing a crystalline fracture, odorless, and having an acrid and caustic taste. Great caution is necessary in 758 A TEXT-BOOK OF MA TERIA MEDICA. tasting and handling it, as it rapidly destroys organic tissues. Exposed to the air, it rapidly deliquesces, absorbs carbon dioxide, and becomes covered with a dry coating of carbonate. Soluble in 1.7 parts of water, very soluble in alcohol. Soda should be kept in well-stoppered bottles made of hard glass. Used externally. Physiological Action and Therapeutics.— Potassa is one of the strongest and most penetrating, caustics known. It possesses the property of abstracting water from the tissues, neutraUzing free acids, decomposing nitrogenous compounds, and of forming solu- tions of fibrin, albumin, and gelatin. When applied to the soft tissues it occasions severe pain, and produces a moist, ashen, and then black, leathery slough, which leaves a granulating ulcer behind it. When potassa is taken internally in immoderate doses it pro- duces all the symptoms of corrosive poisoning. Small doses, freely diluted, have the same action as the alkalies. As a caustic, potassa is used for the same purposes as the caus- tics previously described. Potassa with lime in its operation is similar to, but milder than, potassa. The action and therapeutics of soda are identical with those of potassa, save that soda is less depressing to the heart, muscular and nervous systems. It is not used so much as potassa, the latter preparation usually being preferred as a caustic. To limit the caustic action of these drugs a piece of adhesive plaster should be applied first, with an aperture of the size desired. Upon the skin exposed in the hole in the plaster the caustic is placed, the skin having been previously moistened. The caustic action may be arrested at any time by wetting the part with vinegar. Acidum Aceticum Glaciale— Acidi Acetici Glacialis —Glacial Acetic Acid. JJ. S. JP. Origin. — Prepared by distilling dry Sodium Acetate with strong Sulphuric Acid. Description and Properties. — A clear, colorless liquid, of a strong, vinegar-like odor, and a very pungent, purely acid taste. Its specific gravity at 15° C. (59° F.) should not be higher than 1.058, corresponding to at least 99 per cent, of absolute acid. Used externally. Physiological Action and Therapeutics. — Glacial acetic acid is a powerful corrosive poison, having an action similar to that of the CAUSTICS OR ESCHAROTICS. 759 mineral acids. The drug is principally used as a caustic for the removal of warts and corns, and occasionally for blistering the skin. Caix— Calcis— Lime. TJ.S.P. Origin. — Obtained by burning White Marble, Oyster Shells, or the purest varieties of natural Calcium Carbonate. Description and Properties. — Hard, white or grayish-white masses, which, in contact with air, gradually attract moisture and carbon dioxide, and fall to a white powder ; odorless ; of a sharp, caustic taste. Soluble in about 750 parts of water; insoluble in alcohol. Used externally. Physiological Action and Therapeutics. — Quicklime when used undiluted is caustic, producing effects similar to those de- scribed under Potassa. For caustic purposes it is usually mixed with potassa (potassa cum calce). When lime is given in diluted solution, it acts as an astringent and antacid. (See Liquor Calcis, p. 155.) The conditions for which lime is employed as a caustic are men- tioned under Potassa. ZTnci Chl5ridum— ZTnci Chloridi— Zinc Chloride. TI. S. P. Origin. — Prepared by dissolving Zinc in boiling Hydrochloric Acid. To the solution is added first Nitric Acid, then Zinc Car- bonate to precipitate the impurities. Filter and finally evaporate. Description and Properties. — A white, granular powder or porcelain-like masses, irregular or moulded into pencils ; odorless ; of such intensely caustic properties as to make tasting dangerous, unless the salt be dissolved in much water, when it has an astrin- gent, metalHc taste. Very deliquescent ; soluble in about 0.3 part of water, forming a clear solution ; very soluble in alcohol. Zinc chloride should be kept in small, glass-stoppered bottles. Used externally. Physiological Action and Therapeutics. — Zinc chloride is caustic, antiseptic, disinfectant, excitant, astringent, and slightly hemostatic, according to the strength of the preparation. Its caus- tic action is painful, yet, while the drug penetrates very deeply, limited to the seat of application. Poisoning by zinc chloride is evidenced by all the symptoms produced by a violent corrosive irritant poison. 760 A TEXT-BOOK OF MA TERIA MEDIC A. The drug formerly enjoyed quite a reputation as a remedy tor cancer, especially epithelioma, in which case it was used m the form of " caustic arrows " inserted in the base of the growth so as to separate it from the healthy tissues. It is used as a paste and lotion for morbid growths, lupus exedens, putrid ulcers, ncevi, and syphilitic sores. Solutions of zinc chloride are injected into polypi and scrofu- lous glands, and for the destruction of the pulp of decayed teeth. A weak solution of zinc chloride is an efficient injection in gonorrhea, leucorrhea, and hemorrhagic endometritis. For caustic purposes the zinc chloride itself may be used, or a paste prepared with starch, gypsum, flour, anhydrous sulphate of lime, or powdered althea. Mayet's paste consists of zinc chlo- ride 8 parts, zinc oxide i part, dried wheat flour 7 parts, and water I part. The cuticle must always be removed before applying the paste, strong water of ammonia answering for this purpose. Bromum—Bromi— Bromine. TI.S.F. Origin. — It is found both in sea-water and in saline springs, but is chiefly obtained from the mother-liquors of salt-works in the United States and at Strassfurth, Germany. Description and Properties. — A heavy, dark brownish-red, mobile liquid, evolving, even at ordinary temperatures, a yellowish- red vapor, highly irritating to the eyes and lungs, and having a peculiar suffocating odor, resembling that of chlorine. Soluble in 30 parts of water and readily soluble in alcohol or ether. Bromine should be kept in glass-stoppered bottles, in a cool place. Used externally. Physiological Action and Therapeutics. — Bromine is a power- ful corrosive irritant, the fumes of which occasion severe irritation of the eyes and respiratory passages, with cough, hoarseness, and dyspnea. When taken into the stomach it produces all the symp- toms of corrosive poisoning. The drug is an active caustic, deodorant, and disinfectant. It was formerly extensively employed, particularly during the Civil War of the United States, for the treatment of hospital gangrene, for which it is a most efficient remedy. Bromine has also been used as an injection (i part to 3 of alcohol) in various forms of cancer. Owing to the pain attending the operation, however, the treatment has not been generally adopted. Bromine is an efficient disinfectant, and has been employed to VESICANTS AND EPISPASTICS. 761 ■ And pleasantly. or Diluent The hackneyed rule of Asclepiades that medicines should always be so combined as to cure quickly, safely, and pleasantly (curare, cito, tuto, et jucunde) has resulted in the adoption of the above form of inscription. The theoretical prescriber writes by rule, religiously avoids incompatibles, and would be shocked by, and have little respect for, a physician who should deliberately include in the same pre- scription the names of substances directly antagonistic to each other physiologically. The subject will be further discussed here- after. As a general rule, we . prescribe only one drug to provoke emesis, and a combination of several if we wish a diuretic. A purgative is usually multiple, but if the selection be castor oil or croton oil, it will be single. After we have selected the Basis, or chief ingredient, of our prescription, the next point to determine is whether we can add anything which will in any manner be of real assistance to that Basis. This ingredient, or Adjuvant, as it is called — has usually a physiological action similar to that produced by combining two cathartics or two diuretics acting upon different portions of the intestines or kidneys. Sometimes, however, an Adjuvant may differ in its effects — as sulphuric acid serves as an Adjuvant to quinine, by favoring its absorption and thereby hastening and increasing its action, as mercury assists the action of squills upon the kidneys, or iron acts as an Adjuvant to a cardiac stimulant. The Adjuvant, as a rule, should not be directly opposed in its action to that of the Basis, as chloral k to strychnine, a diuretic to a diaphoretic, or a typical cardiac stimulant to a cardiac depressant. Having chosen the Adjuvant, the next point to consider is whether the action of the drugs selected may not be rendered more kindly through the addition of some other substance as a PRESCRIPTIONS. 785 corrective. A substance may be added which will correct some disagreeable effect of the active agents by producing a medicinal impression upon the patient. Extract of belladonna or hyoscya- mus relieves the griping occasioned by some of the more violent cathartics, like podophyllin, and other well-known instances of this kind are those of the aromatic spirit of ammonia, which mitigates the unpleasant symptoms of iodism, and hydrobromic acid, which lessens the untoward action of quinine. Again, a corrective may act by producing some chemical effect upon the Basis — as salicylic acid is rendered more soluble and less irritating by combining it with sodium carbonate or bicarbonate, forming the sodium salicylate. Great care and thought should ht given not only to the Basis, Adjuvant, and Corrective, but also to the Vehicle, which claims equal attention. A prescription is often rendered more kindly, and no less efficient, through the medium of some substance producing a more agreeable taste. It is a mistaken idea that medicines, in order to be effective, should be repulsive to the patient. The homeopath's success is largely due to the very agreeable taste of his remedies. The mere caprice of the patient, however, should not be considered in the choice of a remedy when, in the best judgment of the physician, it is indicated. Still, it is well to study carefully the art of prescribing agreeable doses, so far as may be compatible with fidelity to science. It is to be noted that pleasant- ness of taste is far "more important in the case of fluids than in that of solids. Aromatic elixirs, syrups, aromatic waters, etc. are in frequent use as Vehicles, yet it must be remembered that oftentimes a sen- sitive patient repudiates sweets and syrupy mixtures. In many cases simple syrup or pure water serves, after all, as the best vehi- cle, although the physician's choice must be governed mainly by experience. It will be observed that in the body of the present work, in the majority of cases, the method of administration is fully explained. It may here be noted that liquids are much more readily absorbed than soHds, yet adults usually prefer to take medicines in the solid form, such as pills, capsules, powders, and tablets. In illness the patient's condition is often such that the gastric and intestinal secre- tions are greatly reduced, and there may not be sufficient fluid to dissolve the solid, so as to render it in a condition to be absorbed. It frequently happens, for instance, that pills are voided with the 50 786 A TEXT-BOOK OF MA TERIA MEDICA. stools unchanged, and, on the other hand, solid substances, such as pills or capsules, may remain in the intestinal canal until the secre- tions are restored, when the accumulated medicine will all be acted on at once, and, passing into solution, be absorbed in excessive doses. Such is the frequent cause of the cumulative effect which sometimes occurs, not without serious consequences. Even alkaloidal salts, which are readily soluble, are, perhaps, in many instances, best given in solution. Infants require liquid medicines, water or syrup being the best vehicle. Bitter medicines, like quinine, may be given in aromatic elixir of liquorice or syrup of yerba santa. As a general rule the metals and their compounds should be administered in the form of pills or in a small quantity of fluid. The purgative salts, potas- sium iodide, and the diuretics, are best given in large quantities of fluid. Prof H. C. Wood, M. D., has written so clearly upon the art of combining, or, more correctly speaking, associating, medicines that we cannot do better than quote his observations verbatim: " The art of combining medicines is not a difficult one, but in practice certain principles should not be lost sight of Chief of these are, to prescribe as few remedies as possible, and to use no powerful drug without a very distinct idea of what it is intended to do. Whenever it is desired to give a powerful remedy in increasing doses until its physiological effect is produced, it should always be given by itself Thus, it may be necessary to give arsenic so as to impress the system, at the same time that iron is indicated ; but the two remedies should be given separately, so that the dose of either can be increased or diminished independently of the other." The principles of combination formulated below were long ago enunciated by Dr. Paris, but are^ to-day as imperative as ever. Medicines are combined — "First. To augment, correct, or modify the action of a medicine. Thus, purgatives act much more kindly when a number of them are united together. The chief reason of this probably is that, as different remedies affect different portions of the gut, the whole in- testine is best reached by a union of the diverse substances. It may take an intense irritation of the mucous membrane to purge as actively as does a mild irritation of both the mucous membrane and the muscular coat. " There are powerful medicines which act similarly upon some parts of the organism, but dissimilarly upon other parts. By com- PHESCR/PTIONS. 787 billing such remedies powerful effects can be obtained at the points where the two hnes of action cross each other, without influencing to a great extent other portions of the system. Thus, chloral pro- duces sleep by its action upon the brain, and also has a distinct influence upon the heart, but none upon the intestinal tract. Mor- phine acts upon the brain, and does not influence the heart, but has a powerful effect upon the intestinal tract. By combining chloral and morphine we get an overwhelming conjoined influence upon the brain in producing sleep, with the least possible disturbance of the heart and of the intestinal tract. " Second. To obtain the joint action of two or more diverse remedies. Thus, in a cough-mixture morphine may be included to quiet the cough, whilst ipecacuanha and squill (in accordance with the first principle) are added to affect the mucous membrane. The appHcation of this principle requires caution, or the practitioner will be led into that chief abomination — polypharmacy. It is worse than futile to attempt to prescribe for every symptom. It is the underlying cause of the disorder, or the under-stratum of bodily condition, which must be sought out and prescribed for simply. " Third. To obtain a special combination which is really a new remedy, or which experience has shown acts almost ds a new remedy. Thus, when to potassium iodide in solution corrosive sublimate is added a new chemical compound (potassio-mercuric iodide) is formed, which experience has shown to be of great value in syphilitic diseases. Griffith's antihectic mixture (mistura ferri comp.) is another instance of the use of chemical changes, the protocarbonate of iron (ferrous carbonate) being formed out of the sulphate of the metal and the potassium carbonate. In the famous Dover's powder no chemical change occurs, but the ordi- nary action of opium upon the skin is so enhanced by the ipecac that the combination may be looked upon almost as a new remedy. "Fourth. To afford a suitable form. Thus, acacia is added to make an emulsion, or confection of rose to make a pill. In the choice of excipients care should be exercised to select a substance free from medicinal properties, having no chemical incompatibility with the medicinal agent and of suitable physical character. Bread- crumb often makes a good excipient for pills, but with silver nitrate it is chemically incompatible, on account of the sodium chloride it contains. " When writing a prescription the utmost care should be taken to use. such excipients that the combination should not only be 788 A TEXT-BOOR' OF MA TERIA MEDICA. attractive to the eye, but also as little repulsive to the palate as may be. Whenever possible the pill form should be employed with bitter or disagreeable medicines. The pill may be readily- coated with silver-foil; tonic pills may be coated with iron hy shaking or rolling them in ferri pulvis while soft and sticky. Sugar-coated pills and ' compressed pills ' are apt to get so hard and insoluble that their use requires caution. In regard to mixtures,, flavoring oils should be freely used, and the power of glycerin to conceal the disagreeable taste of many substances should be remembered." ' As vehicles for liquid mixtures for internal use the following classes of official preparations are best adapted — The aromatic waters : rose, anise, fennel, and the mints when flavor alone is desired, the most delightful flavor of all being orange flower water. The aromatic syrups : orange, orange flower, and tolu when it is desired to disguise the taste and to suspend resinous or otherwise sparingly soluble substances in the mixture. The elixirs when in addition to agreeable flavor it is desirable to employ a vehicle as a solvent for certain salts not readily soluble in water or syrups. The elixirs containing about 25 per cent, of alcohol, they are useful vehicles for tinctures and fluid extracts of resinous drugs such as cubeb, buchu, uva ursi, valerian, viburnum, etc. When flavor alone is desired the elixir aromaticum, U. S. Ph.,. a delightful combination of orange and other aromatics, should be used. To disguise the taste of bitter drugs, as in the last men- tioned, elixirs of licorice, or of eriodictyon (yerba salita) are mostly employed. Incompatibility. Due regard is to be paid to the mutual chemical, pharmaceutical,, and therapeutical relations of the drugs combined in a prescription. When different substances, whether liquid or solid, are com- bined or associated and undergo a more or less complete change,, they are said to be incompatible, the incompatibility consisting of three kinds : chemical, pharmaceutical, and therapeutical, although the last division is not scientifically correct, since one substance cannot be therapeutically incompatible with another, although it may be a physiological antagonist. The incompatibles and antagonists of the different substances are fully mentioned under the respective drugs. The principles governing incompatibility, however, may well be considered here. ' Therapeutics, 7th edition, pp. 108 et seq. PRESCRIPTIONS. 789 Chemical incompatibility is of the most importance. The commonest forms of chemical incompatibility occur under the following conditions : 1. When a new and insoluble salt is formed, resulting from a mixture of solutions of soluble salts. Example (i) : mixing solutions of lead acetate and zinc sulphate, both soluble salts, but producing by chemical decomposition a new and insoluble salt, the sulphate of lead, which is precipitated. 2. By the addition of a strong acid to solutions of salts of weak or volatile acids, such as carbonates and bicarbonates, with resulting decomposition. Example (2) : ammonium carbonate, the salt of a weak acid radical, added to syrup of squills, containing acetic acid, causes decomposition to take place, with effervescence and the liberation of carbonic acid gas. 3. Salts of a feeble or volatile base are decomposed by the addition of a strong alkali. Example (3) : the evolution of ammonia when a strong alkali is added to ammonia alum, and when chloral hydrate is decomposed by alkalies, such as aromatic spirit of ammonia, lime solution, etc. 4. Alkaloids, or their salts, are thrown out of solution or pre- cipitated from their solutions by the addition of alkalies or alkaline salts. Example (4) : sulphate of strychnine in solution is precipitated as the insoluble bromide of strychnine by the addition of a larger proportion of potassium bromide. Quinine sulphate is precipitated as insoluble quinine acetate when mixed with a solution of potas- sium acetate. 5. Tannic and gallic acids and preparations containing them, as well as many other vegetable acids, produce discoloration or precipitation of iron and many of its compounds. Example (5) : ink is the best illustration of this incompatibility. Writing fluids are usually combinations of tannic or gallic acid with some preparation of iron. Add the tincture of ferric chloride to tincture of cinchona, and notice the discoloration. There are certain preparations of iron, like the compounds with ammonium or sodium citrate (see tinct. ferri citro-chloride, N. F., tasteless tincture of iron) which produce little discoloration with vegetable astringents, and none at all with vegetable preparations containing no tannic or gallic acid. Pharmaceutical incompatibility is the production of fewer or more insoluble substances in mixtures or preparations of vegetable drugs, associated or not with any chemical compounds. Pharma- 790 A TEXT-BOOK OF MA TERIA MEDICA. ceutical incompatibility may occur in liquids or solids, although much more frequent in liquid mixtures, causing a separation of either inert or active ingredients. Examples : vegetable tinctures of resinous drugs with water, such as tincture of guaiac and water; copaiba and oils with aqueous preparations ; spirit of nitrous ether with mucilage of acacia, etc. The separation or precipitation may frequently be prevented by the intervention of some viscid sub- stance, such as syrup, glucose, glycerin, mucilage of acacia, etc. Incompatibility may be both chemical and pharmaceutical. In the following list the substances which cannot be classed as incom- patible under any of the above divisions are given for reference : Substance. Incompatible with ji ■ f Alcohol, alcoholic and ethereal tinctures ; * borax ; ferric l chloride; lead salts. Acids in general . chloride; lead salts. Alkalies, alkaline solutions; metallic oxides. Acid. Arsenous. Salicylic . . . Tannic . . Bismuth. Subnitrate . . Chloral. Hydrate . . . Iodine ... Lead. Acetate . . Alercury. Bichloride . . Mild chloride . (Calomel) Potassium. Chlorate . . . Iodide . . Permanganate . Sodiutn. Bicarbonate . . Bromide . . Silver. Nitrate .... I ■J Ferric hydrate; magnesia; lime water. Iron compounds ; potassium iodide ; * lime water. Alkalies, carbonates and bicarbonates ; lime water; chlorine water; albumin; gelatin. < Calomel;* sulphur; tannin. r Alkalies, carbonates ; * ammonium and mercury compounds ; I potassium bromide and alcohol. f Ammonia;* alkalies, carbonates; chloral; metallic salts; I starch.* {Acacia; acid hydrochlor. ; acid sulphuric and sulphates; ammon. chloride; carbonates; lime water, iodine; potas- sium iodide; tannin. •j Potassium iodide ;_* salts, carbonates ; tannin ; borax. f Acids, acid salts; alkalies, carbonates; ammon. chloride; \ iodine ; potassium iodide ; ferric chloride, iodide ; sulphur. J Acids, mineral ; calomel ; organic substances ; sulphur. f Acids, acid salts ; alkaloids ; iron ; lead and mercury salts ; I potassium chlorate ; silver nitrate ; chlorine water. ( Ammonia, salts ; alcohol ; glycerin ; ethereal oils ; organic / substances. j Acids, acid salts ; acid, tannic; alkaloids; metallic salts. \ Acids, mineral ; chlorine water ; mercury compounds. ( Acids, acetic, hydrochloric, hydrocyanic, sulphuric, tartaric, and ■j their salts; alkalies, carbonates; iodine; potass, iodide, *■ bromide; sulphur. Those marked with an * are sometimes directed to be compounded for the purpose of effecting some special change or producing new compounds. PRESCRIPTIONS. 791 Among the above, potassium permanganate forms an explosive mixture with glycerin ; so does chromic acid. Chlorates of potas- sium, etc. explode when triturated with sulphur. The strong acids, nitric and sulphuric acids, and especially mixtures of these, react so strongly with volatile oils (hydrocarbons) as to cause explosion. Iodine affects these oils in the same way — fulminates. It not infrequently happens that the physician intentionally writes a chemically incompatible prescription. " Black wash " and " yellow wash " are examples. Other instances are such pharma- copceial preparations as liquor ammonii acetatis, mistura ferri com- posita, and liquor magnesii citratis. Physiological antagonists are often given together, as atropine and morphine, or aconite and digitalis in certain cases of cardiac arrhythmia. No general rule can be laid down for the avoidance of so-called therapeutical incompatibility. Some of our most valuable drugs contain active principles which are physiologically opposed to each other in their action ; instance : jaborandi, which contains two abso- lutely antagonistic alkaloids, pilocarpine and jaborine, the latter in small quantity, yet sufficient to control the action of the former. Digitalis contains several distinct principles, one of which, digi- tonin, is the direct antagonist of the others. Opium is a conspicuous example of a complex remedy, con- taining, besides gum, sugar, etc., eighteen different alkaloids, two neutral principles, and two peculiar acids ; so that a prescriber of this drug, while he may, perhaps, flatter himself that he is con- forming strictly to the present notions of pharmaceutical simplicity, is in effect a polypharmacist of most pronounced type. Moreover, not only are the constituents of opium very numerous, but, like , others mentioned, the drug affords in its theba'ine and morphine a further illustration of direct physiological antagonism. The author cannot too strongly recommend that physicians ignorant of the physiological action of drugs in large and small doses, if they prescribe at all, should avoid including many reme- dies in one prescription. Such practitioners had best adhere to a single remedy or adopt homeopathy. But, given a competent and thorough knowledge of the action of drugs and the exact condi- tion of the patient, the physician is justified in giving one or twenty drugs in the same prescription, since he is perfectly familiar with the several agents of relief, and can foretell with nicety the effect to be produced by their combination ; and in all cases a physician 792 A TEXT-BOOK OF MATERIA MEDIC A. should be as certain of the action, strength, and reliabiHty of the drugs he administers as the surgeon of the aseptic condition of his hands and instruments. Estimation of Amounts in a Prescription. Having decided upon the various ingredients which are to enter into the prescription, the next consideration is the amount of each desirable. In the first place, do not prescribe more than the prognosis seems to call for. If in your judgment the patient will not require medicine more than five or six days, and not oftener than three times a day, a two-ounce mixture should be prescribed if a liquid, or the required number of pills, powder, capsules, etc. if a solid, is desired. In prescribing liquid medicines note must be taken of the several sizes of medicine-vials, their capacities being in this coun- try 1,2, and 4 fluidrachms, and i, 2, 3, 4, 6, 8, 12, and 16 fluid- ounces. In the larger cities vials may also be had of metric capacities — 30, 60, 90, 120, 240, and 500 Cc. While it is not essential, it is in much better taste to have a prescribed mixture aggregate just a bottleful of one of the above sizes. Where two different mixtures for the same person are prescribed, or differ- ent mixtures for different persons in the same house or family, it is well to order them put up in vials of different sizes to avoid confusing the medicine. This is especially desirable when both internal and external remedies are prescribed for the same person. The amounts of the ingredients requisite for any given prescrip- tion are determined in various ways. The amount of the active , ingredients will of course be the product of two factors, the quan- tity of dose and the number of doses required ; and the quantities must be such as can be expressed in the system of weights and measures adopted, and indicated by round numbers such as best conform to the relation between the denominations of the particular system followed in the prescription. There is no difficulty, in computing the amounts in a solid mix- ture, powders, pills, or suppositories, especially if ten or its multiple is prescribed, nor in external preparations, where the strength is expressed by percentage, and are therefore most conveniently and accurately prescribed according to the metric system ; but many additional considerations occur in estimating amounts in fluid mixtures. PRESCRIPTIONS. 793 Frequently solids like salts, etc. are prescribed in solution, but their bulk may be safely disregarded in the estimation of amounts of the hquid measure ; for a solid in the quantity usually prescribed increases the whole volume of the solution but very little. Ordi- narily a fluidrachm (4.0 Cc), or a teaspoonful, should not contain over 5 grains (33 Gm.), nor a tablespoonful, or 4 fluidrachms (15.0 Cc), over 20 grains (1.29 Gm.), of a solid in solution, unless the substance be very bland, when twice these quantities are permissible. The following is a very simple rule for estimating amounts in Apothecaries' Measure : In an eight-ounce mixture, the dose being a drachm, take as many drachms of the medicine as there are wanted minims or grains to the dose. It will be observed that in this case the basis is an ^^f^^ounce mixture, yet it typifies the rule, which, when thoroughly understood, may easily be applied to a four-ounce or a two-ounce mixture, one-half or one-fourth as many drachms ; "while if the dose is to be a dessertspoonful, or two drachms, it is only necessary to take one-half as many drachms to an eight-ounce mixture, reducing for smaller mixtures in accordance with the rule. If the dose be a tablespoonful, or four drachms, one-fourth as many drachms must be taken to an eight-ounce mixture as there are minims or grains to the dose. This rule, while not fractionally «xact, is sufficiently accurate for all practical purposes. Examples : We desire to give an eight-ounce mixture, with a drachm for a dose, each dose to contain 12 grains of potassium bromide and 10 grains of chloral, the vehicle to be syrup of orange and water. We have here, then, 64 doses of a drachm each : to be ■exact, therefore, we should have 768 grains of potassium bromide, or 1 2 drachms and 48 grains ; but, following the rule, we put in the mixture 12 drachms, since we desire 12 grains to the dose. Of chloral we would require exactly 640 grains, or 10 drachms and 40 grains, but we use the round number, 10 drachms, in the mixture. We see that in each case there is but the fraction of a grain short in the dose. The prescription would consequently be written as follows : 'Sf. Potassii bromidi, 3xij ; Chloralis, 3x ; Syrupi aurantii, |iv ; Aquae, q. s. ad |viij. M. et ft. sol. Sig. Teaspoonful for a dose. 794 A TEXT-BOOK OF MA TERIA MEDICA. This is more of each ingredient than should be prescribed in a, fluidrachm. It were better, then, that the dose should be a dessert- spoonful, or two drachms; and in order that the two teaspoonfuls should contain only 12 grains of potassium bromide and 10 grains of chloral, the whole amount of the medicament must be divided by 2 — i. e. the prescription should read : "Sf. Potassii bromidi, 3vj ; Chloralis, 3v ; Syrupi aurantii, Siv ; Aquse, q. s. ad gviij. M. et ft. sol. Sig. A dessertspoonful for a dose. In case the prescription be for a four-ounce mixture, with a dessertspoonful for a dose, the amounts of the solid substances would, of course, be one-half, and if for a two-ounce mixture, one- fourth of the above. When writing a prescription put down first all the ingredients which are to enter into the combination, and after the last one, which is usually the vehicle, write the whole amount ; i. e. if it is to be a four-ounce mixture, write after the name of the vehicle " q. s. ad f §iv." Then begin with the Basis, the first ingredient, and write the amount required in the whole mixture. In other words, decide upon the doses to be given after the medicines have been selected. It is important to adopt as a golden rule to carefully and delib- erately read over the entire prescription before it is handed to the patient, and more especially to scrutinize each item and the quanti- ties to guard against transposition of the latter, which otherwise may result in a fatal error. The next thing to be determined is the manner in which the medicine should be measured out to the patient for internal use. A graduated medicine-glass is always preferable to a domestic measure, and should be ordered in all cases.. Teaspoons, as well as dessertspoons and tablespoons, vary considerably, besides, owing to adhesion, may, according to the manner in which they are filled, show a variation of nearly 50 per cent, in their capacity. A teaspoonful, considered to be equivalent to one fluidrachm, may contain from one-half to two fluidrachms ; a dessertspoonful, which should be equivalent to two fluidrachms, and a tablespoonful, equal to one-half fluidounce, vary almost as much in capacity. It is necessary to be exact in the administration of medicines, it PRESCRIPTIONS. 795 H,ppppppppppppppoooo o\Chd) M N HI *M b b 6 b b b 6 b b b b tfi (-n Uj 0^U» cii-tiHOOOOOO l« M OvOJ 0\ M "-> I-. O O Ui (^OJ 00 o> 9 1 s pi s s- r P 1 ■a 1 ^? p Si I; Si 5S-. Si Si 1 ;§ 1 1 1 1 1 §^^ . = . = =o <,,= = ...! Ol Ul Ul M _td M *H p>OJ MhNMpNjO'^MOO 3 ^^ O ^J^ 4^ C^ N ^ « tCiM»HMOiM^Mj^M^gH-;^M5M 0^1 JO _»-• M p p p p p p p p p p p p p p O d> ' h^Cn -p»> io to w b b b b b b b b o b ij\ U) ONOJ nmn-ooooo c 1 1 2, s- i 5' a i g c 5' 1 1 a V a 9 3^ ►1 * ' u» * -^i a*u> oj N M b b b b b b b b b <^ -^ UiOJUJMOOOOO Ui ONJUOJ NwwOOOOOOOOOOOOO •8 p oiyiw MM^Mpppppppoooo * i>i ' * ui * uj * b^Ul li i-i U b b b b b b Wv M 0\0J OMO M « O O Uit^OJ 00 0^ 01 Ui 00 ON-f^ Oo JO >^ _iM p p p o o o o o o o o CnCnui bo4^ N m ^ o b b b b b t« Uj OOOJ t-i -h m Cn M 00 ? yip'^-f^'OJOjwwwppopppopoo 'Oiui4ii'\bCn'i>iKjM*-^bbbbb Or Oi W M M M >-i en poM\pyi-r^u)jo>-«Mpppppppppp ' ' ' 4^ Or ON^j bo to a^oJ Mbt-ibbbbb LnH.N4;>.tON-wMi 00 <-n Ln ootJi M •8 p Oj _0 p^^^ A JO JO w p p p p p p p p p p Oi * oj b^oJ k) io It b b b b b M ON ' to * bo ' Oi a\ bo-t*- d) M M b b b b b tn O* O^O0 to N •-" s Q p^'^'^i a>w u» JO _M p p p p p p p p p * 61 ■ « Ui to M 00 p yi p M p poyi ^jowppppppppp Wi di O^f-n ^ to It to 00 w ^ ^ JO \c poui ooN^oooop pppp M * Oi * ON " ' to Ox bo c^On d» -^ b b b b to \D <7»^ 10 to M M M p\ JO po\p 4*. vp to a^w '-';-'t-'Oppppb ' -t* ■ ' ' » On ' Oi It bs to ' ON to M b b ON oi^ to^o 00-P^ 1 Q ON^nU) to to M It pwip pyxpw p pNOJ MitMpppppp Oi to OnOJ OS M It M 00 ON Ln Ui Oj Oi Ln en to It It 8 *0 8 0^^ 0* OJ ONOJ totowooooo ^^tOON'OiOilOtoIt^ i 796 A TEXT-BOOK OF MATERIA MEDIC A. being well known that the action of drugs varies greatly with the size of the dose, small doses in their action being often directly opposite to large doses. Ordinarily, it is unwise to prescribe medicines to be dropped out, since a drop varies greatly in dimension according to the vis- cosity and specific gravity of the fluid, the shape, size, and charac- ter of the neck and lip of the bottle, as well as its degree of fulness, and the steadiness of the hand in dropping. In computing doses of powerful medicines, therefore, always estimate for minims instead of drops. Direct the use of a " dropper " or minim pipette for the admin- istration of liquids by drop doses, such as Fowler's solution, collyria, etc. There are exactly sixty minims of any fluid to one fluidrachm, while sixty drops may be fewer or more than one drachm, as the following list shows : Drops in f Sj Weight of f 5j . (60 M.). Gr. Gm. Acidum Carbolicum m 59 3-82 Acidum Sulphuricum Aromaticum .... 146 53 3-43 ^ther Fortior 176 39 2-52 Chloroformum Purificatum 250 80 5.18 Creasotum 122 56| 3.66 Ext. Belladonna Fluidum 156 57 3-69 Ext. Colchici Radicis Fluidum 160 55 3-S6 Ext. Digitalis Fluidum 134 62 ^.o\ Liq. lodi Compositus 63 59 3.82 Liq. Potassii Arsenitis 57 55 3-5^ Oleum. Caryophylli 130 57 3.69 Oleum Tiglii 104 50 3.24 Spiritus Ammonise Aromaticus 142 48 3. 1 1 Syrupus Ferri lodidi 65 77 4-98 Syrupus Scillse Compositus 102 70 4.53 Tinctura Aconiti 146 46 2.98 Tinctura Belladonnse 137 53 3-43 Tinctura Cantharidis 131 51 3.33 Tinctura Ferri Chloridi 150 53 3.43 Tinctura Nucis Vomicae 140 44 2.85 Tinctura Opii 130 53 3.43 Tinctura Veratri Viridis 145 46 2.98 Vinum Colchici Seminis 1 1 1 54 3-49 Language and Grammatical Construction of Prescriptions. A prescription is written partly in Latin, partly in English. The name of the patient and the date should be in English ; the super- scription in Latin abbreviations ; the inscription in Latin ; the sub- PRESCRIPTIONS. 797 scription in Latin or Latin abbreviations; and the signature, or directions to the patient, in English. A prescription properly and unmistakably written is a cardinal requisite to the successful administration of medicine, no less than to its correct preparation by the druggist. Every practitioner and pharmacist should possess some knowledge of Latin grammar, yet by the observance of a few simple rules one wholly ignorant of the language may acquire a proper use of the forms generally adopted ; and a little study, aided by constant practice, will soon fix in the memory the peculiarities of gender, case, and number, together with the agreement of adjectives, to be met with in all prescriptions. It is to be observed that the Latin tongue has been chosen as the medium of medical and pharmaceutical instructions because of its conciseness, stability, and universal acceptance by the scien- tific world. Moreover, the Latin name is specific, while the English name may refer to several drugs of entirely different properties : for instance, "Snake root," applied by residents of this or that locality to Cimicifuga racemosa, Aristolochia serpentaria, Asarum Canadense, Eupatorium aromaticum, Polygala Senega, etc. To begin with, then, the prescription-writer must endeavor to lay aside English and familiarize himself with various Latin verbs (most of them in the imperative, or commanding, mood) ; a long list of drugs and medicines, to be correctly written and pronounced ; a limited number of adjectives, agreeing in gender, case, and number with the nouns they qualify ; a few prepositions governing certain fixed cases ; and a small number of terms and phrases of general importance. Let us consider them seriatim. Verbs. The first item of a prescription is a verb : recipe, " take," the sign being 'Sf. One need not know the conjugation of the Latin reclpere to understand the import of this order. Such imperatives simply signify the instructions of the physician. A very few verbs are used in the subjunctive mood, having the force of the imperative, such as flat, pi. fiant, " let it, or them, be made (into, in pllulas) ; or " let be made," as in the ex- pression /z«/ mistura, "let a mixture be made"; sufflclat, "may suffice," as in the common instruction, abbreviated " q. s.," quantum sufflciat, " as much as may be required " ; ne repetatur, " do not let it be repeated," or " do not repeat "; balliat, " let it boil." 798 A TEXT-BOOK OF MA TERIA MEDICA , A future passive participle is also frequently used : dividendus, like an adjective agreeing with the noun in gender, case, and num- ber, and signifying " to be divided (into)," as in the order in tro- chlscos dividenda (mSssa), " to be divided into troches," though the imperative divide, '' divide into," is often used. Nouns. These form by far the largest vocabulary, including all official and nearly all unofficial drugs and medicines, together with their compounds. A considerable number, ending in a, are of the first declension, all feminine.' Example : Si}tg'u/ar. Nominative. — Oliva — Olive (subject). Genitive. — Ollvae — of Olive. Accusative. — Olivam — Olive (object). Ablative. — Oliva — with Olive. Plural. Nom. — Ollvae — Olives (subject). Gen. — Olivarum — of Olives. Ace. — Ohvas — Olives (object). Abl. — Olivis — with Olives. [The Latin dative and vocative cases are never used, and the plural number rarely.] An extensive list of medical agents ends in us (generally masculine) or urn, on (neuter), and are of the second declension. (Prinos, masc, is exceptional.) Example: Sifigular. Nom. — Oleum — Oil (subject). Gen. — Olei — of Oil. Ace. — Oleum — Oil (object). Abl. — Oleo — with Oil. Plural. Nom. — Olea — Oils (subject). Gen. — Oleorum, Oleiim — of Oils. Ace. — Olea — Oils (object). Abl. — Oleis — with Oils. ' The genders of nouns are given as a guide to the agreement of adjectives. PRESCRIPTIONS. 799 It may be noted, in passing, that the genitive singular is almost exclusively used in prescription-writing. We are now prepared to analyze a simple prescription and understand its elements. Referring to the foregoing examples, suppose we wish the drug- gist to supply three drachms of olive oil. We prescribe as follows : IJs. Olei Ollvae giij. Recipe, Take of oil of olives three drachms. It must be borne in mind that the direct object of the imperative recipe in this example, as well as in all similar cases, is not the medicine oleum, but the amount of it prescribed, as indicated by the Roman numerals and the symbol of Apothecaries' weight, which, written in full, would be tres drachmas (ace). In this class of prescriptions, therefore, including nearly all in use, we need con- sider only the genitive, the accusative or grammatical object of the verb being expressed in the quantity symbolically indicated. It will be noted, moreover, that the construction, or order, of the Latin words is the reverse of English usage. Yet it is evi- dent that a grocer's clerk, for instance, might well, and frequently does, employ the same mode of expression : (of) Granulated Sugar lbs 10 — a construction precisely analogous to that of the above prescrip- tion, which simple form may be taken as a type for all, subject to such modifications as the nature of the drug and the treatment may require. Nouns of the second declension ending in on, all neuter, are of Greek derivation, and are declined like oleum. Example : Singular. Nom. — Toxicodendron. Gen. — Toxicodendri. Ace. — Toxicodendron. Abl. — Toxicodendro, etc. Pnnos, also of Greek origin, is declined: Nom. — Prmos. Gen. — Prini. Ace. — Prinon. Abl. — Prmo, etc. 8oo A TEXT-BOOK OF MA TERIA MEDICA. The remaining nouns of the second declension all end in us (with four exceptions, masculine), and are declined like the follow- ing example : Nom. — Juniperus. Gen. — Juniperi. Ace. — Juniperum. Abl. — Junipero, etc. Indeed, all prescription nouns ending in us are of the second declension, save seven : Nom. Gen. Rhus, Rhois, 3d fern. CSrnus, Cornus, K^h fern. Quercus, J Qufircus, Fructus, Frflctus, ~v HaQstus, Haustus, Potus, ■D_. > 4th masc. Potus, 1 ^ Spiritus, Spiritus, . The four exceptions to tt le masculine gender mentioned are : Juniperus, " Prunus, - all fem. Sambucus, Ulmus , J With these — to be committed to memory — the second declen- sion ends, so far as it concerns the prescription-writer. While touching upon the fourth declension it may be well to- complete the study of it, there being but six nouns, ending is u^, of this declension (Rhus is of the third). They are, as already enumerated : COrnus, Quercus, Fructus, Haustus, Potus, Spiritus, and are thus declined : Singular. Nom. — Spiritus. Gen. — Spiritus. Ace. — Spiritism. Abl. — Spiritu. PRESCRIPTIONS. 8oi. Plural. Nom. — Spiritus. Gen. — Spiritum. Ace. — Spiritus. Abl. — Spiritibus. We now come to the third declension, to which belong all nouns not included in the foregoing first, second, and fourth, the fifth Latin declension, like the dative and vocative cases, not being used in prescriptions. All nouns, with seventeen exceptions, having terminations other than a (except four), us, um, and on, are of the third declension. Here the changes from nominative to genitive and other cases are quite variable, and may be best remembered by arranging the nouns in groups according to their nominative endings, with ex- amples of their several declensions. Group I. — Thirty-three nouns ending in as make the genitive in aits. All are masculine save Asclepias (Gen. Asclepiadis), which is feminine, and all are names of salts. Example : Singular. Nom. — Nitras. Gen. — Nitratis. Ace. — Nitratem. Abl. — Nitrate, etc. Group II. — Nouns ending in is : {a) Genitive unchanged ; all feminine. Ex. Nom. Cannabis ; Gen. Cannabis. {b) Genitive changing into ttis, all masculine. Ex. Nom. Arsenis ; Gen. Arsenitis. {c) Genitive changing into idis, all feminine. Ex. Nom. Hamamelis; Gen. HamamSlidis. {d) Genitive changing into eris, one only, masculine. Ex. Nom. Pulvis ; Gen. Pfllveris; Group III. — Nouns ending in o, all feminine except Carbo, Pepo, and Sapo, which are masculine: {a) Genitive ending in onis. Ex. Nom. Lotio ; Gen. Lotionis. (J?) Genitive ending in inis. Ex. Nom. Mueilago ; Gen. Mucilaginis. 51 8o2 A TEXT-BOOK OF MA TERIA MEDICA. Group IV. — Nouns ending in x, masculine or feminine : {a) Genitive ending in els. Ex. Nom. Borax ; Gen. BOracis. {b) Genitive ending in els, and the last vowel of the nomina- tive {/) changed to i. Ex. Nom. Rum^x; Gen. Rumzcis. Group V. — Nouns ending in r, masculine or neuter : Genitive simply adds Is. Ex. Nom. Liquor; Gen. Liquoris. Group VI. — Nouns ending in a, all neuter : Genitive ends in Atis. Ex. Nom. Enema ; Gen. Enematis. Group VII. — Nouns ending in s, masculine or feminine : Genitive ends in is. Ex. Nom. Adeps ; Gen. Adipis. Group VIII. — Nouns ending in /, all neuter : («) Genitive simply adds Is. Ex. Nom. Chloral; Gen. Chloralis. (^) Genitive doubles / and adds is. Ex. Nom. Mel ; Gen. MeUis. Group IX. — Nouns ending in n, all neuter : («) Genitive ending in onis (nominative in oil). Ex. Nom. Limon ; Gen. Limonis. (Jj) Genitive ending in inis (nominative in en). Ex. Nom. Semen ; Gen. Seminis. [Erigeron has the genitive ErigerOntis.J Group X. — One noun ending in c, neuter : Genitive simply adds Is. Ex. Nom. Lac; Gen. Lactis. In conclusion, there are a number of indeclinable nouns, such being all neuter, of various endings and derivations. PRESCRIPTIONS. 803 Adjectives. These are many, and, as has been said, their agreement in gender, case, and number with the nouns they qualify is of para- mount importance in correct prescription-writing. They are de- clined like nouns of different declensions, having the same cases and numbers, and may be divided into two classes. Class I. includes all but fourteen of the adjectives used in pre- scriptions. The nominative has three distinct endings : us, mascu- line, declined like the second declension of nouns ; a, feminine, declined like the first declension ; and um, neuter, declined like the second declension. Example : Singular. (2d ded.) (ist decl.) (2d decl.) Masc. Fern. Neut. Nom. Fluidus, Fluida, Fluidum. Gen. Fluidi, Fluidse, Fluidi. Ace. Fluidum, Fluidam, Fluidum. Abi. Fluido, Fluida, Fluido. Plural. Nom. Fluidi, Fluidse, Fluida. Gen. Fluidorum, Fluidarum, Fluidorum. Ace. Fluidos, Fluidas, Fluida. Abl. Fluidis, Fluidis, Fluidis. Class II. includes the remaining fourteen adjectives in use. These, with few exceptions, have two, instead of three endings : one in is for both mascuHne and feminine genders, and another in e for the neuter. Adjectives of this class are declined like nouns of the third declension. Example : Singular. Masc. and Fern. Neut. Nom. Dulcis, Dulce. Gen. Dalcis, DQlcis. Ace. Dulcem, Dolce. Abl. DQlci, Dulci. (The form Dalce is sometimes wrongly used for the ablative.) 8o4 A TEXT-BOOK OF MA TERIA MEDICA. Plural. Nom. Dulces, DQlcia. Gen. Dulcium, Dalcium. Ace. Dulces, Dulcia. Abl. Dulcibus, DQlcibus. The exceptions in nominative endings are — (I) Nom. Gen. Ace. Abl. Singular. Masc. and Fern. Effervescens, Effervescfintis, Effervescgntem, Neut. Effervescens. Effervescentis. Effervescens. Effervescente, or -i, Effervescente, or u Plural. Nom. Effervescentes, Gen. Efifervescentium, Ace. Effervescentes, Abl. Effervescentibus. Effervescentia. Effervescentium. Effervescentia. Effervescentibus, Singular. (2) Nom. Tricolor, Gen. Trieoloris, Aec. Tricolorem, Abl. Tricolore, or -i. Tricolor. Trieoloris. Tricolor. Tricolore, or -i. Plural. Nom. Trieolores, Gen. Tricolorum, Aec. Trieolores, Abl. TricolOribus, Singular. Masc, and Fern. (3) Nom. F6rtior, Gen. Fortioris, Ace. Fortiorem, Abl. Fortiore, or -i, Trieolora. Tricolorum. Trieolora. TricolSribus. Neut. Fortius. Fortioris. Fortius. Fortiore, or -i. PRESCRIPTIONS. 805 Plural. Nom. Fortiores, Fortiora. Gen. Fortiorum, Fortiorum. Ace. Fortiores, Fortiora. Abl. FortiOribus, FortiOribus. Numerals as far as quatuor are declined like adjectives of three terminations : Singular. Masc. Fern. Neut. (i) Nom. Unus, Una, Unum. Gen. Unius, Unius, Unius. Ace. Unum, Unam, Unum. Abl. Uno, Una, Plural Uno. (2) Nom. Duo, Duae, Duo. Gen. Duorum, Duarum, Duorum. Ace. Duos, Duas, Duo. Abl. Duobus, Duabus, Plural Duobus. Masc. Fern. Neut. (3) Nom. Tres, Tres, Tria. Gen. Trium, Trium, Trium. Ace. Tres, Tres, Tria. Abl. Tribus, Tribus, Tribus. [The ordinal numbers, primus, secflndus, tgrtius, etc., are not used in prescription-writing.] Conjunctions — Adverbs. Conjunctions are rare, except it, and. Adverbs are very seldom employed. Prepositions. Three prepositions govern the accusative case : dd, to, up to ; In, into ; and supra, upon. Others are rarely used. Two prepositions, oftenest used, govern the ablative case : cUm, with, s.ndpro, for. 8o6 A TEXT-BOOK OF MA TERIA MEDICA. Words and Phrases. Ad libitum, at pleasure. Ad saturdnduui, to saturation. Ana, aa, of each. Bene, well, Bis, twice. Bis indies, twice a day. Clbus, food. Cochleare medium, a dessertspoon(ful). Cochleare magnum, a tablespoon(ful). Cochleare pdrvuni, a teaspoon(ful). Collutorium, a mouth-wash. Dein, afterward. Dimldius, half Dosus, a dose. Et, and. Extlnde supra, spread upon. Gradatim, gradually. Gutta, a drop. Guttdtim, drop by drop. Hora, an hour. In dies, daily. Lagena, a bottle. Libra, a pound. Llnteum, lint. Mane, in the morning. J/««f pruno, early in the morning. i!/z<:« />««w, a breadcrumb. iV5«, not. NOcte, at night. Numerus, a number. Numei'o, in number. Octarius, a pint. Partes cequales, in equal parts. /V5 r^ «a^«, as required. Quantum sufficiat, q. s., as much as is necessary. Quaqua hord, every hour. Saturatus, saturated. Scdtula, a box. Seinel, once. PRESCRIPTIONS. 807 Semlssis, ss., a half. Semidrdchma, half a drachm. Simul, together. Sine, without. Stdtim, immediately. Tales, such. Tales doses, such doses. Tere simul, rub together. Ter in die, three times a day. These complete the list of Latin parts of speech, conjugations, declensions, etc., with which the prescription-writer is likely to be concerned. There are niceties of Latin construction which, to one acquainted with that idiom, will readily occur in scanning the order of words in certain medicinal compounds. Having the sanction of professional usage, the departure from the classic arrangement is of slight importance, and it is certainly in accordance with the clearer, more direct English form. Instance the construction in what are known as " Galenical Preparations " (an objectionable adjective, by the way, being at variance with the rules of etymology, since the c of the derivative is wanting in the parent word Galen). In writing these the nominative — UnguSntum, Mistura, Tinctura, etc. — is placed first, as, Ungufintum Zinci Oxidi, etc. Oleum Mdrrhuae is also an example, and others are not uncommon, apart from the Galenical order. The practical difficulties in writing prescriptions correctly are largely eliminated by the almost exclusive use of the genitive. Yet it is necessary to understand clearly the use of the accusative in all cases where the medicine is prepared from the mass according to certain established formulae, and moulded in certain forms, if not already prepared, as in the condition of pills, troches, etc., which are the immediate object of the imperative recipe, and cannot be placed in the genitive. Example : 'Sf. Pilulas (not Pilularum) Ferri lodidi (a number). Where the mass is mentioned or implied in the prescription, the general rule of the genitive is followed, as : I^s. Ungugnti Bella- donnae (a portion) ; and where the terms flat, fiant are expressed, the nominative is naturally used, as, for example. 8o8 A TEXT-BOOK OF MA TERIA MEDICA. I|«. Massae hydrargyri, gr xxx ; Flant pilulse No. x. Sig. Take one at bed-time. Here pllulce is the subject of the Latin irregular verb signifying " to be made," no case save the nominative being admissible. It has been presumed in the foregoing pages that all prescrip- tions are to be written in full— a practice which, could it meet with universal acceptance, would not infrequently be of vital importance alike to patient and practitioner. Custom, however— and in certain cases advantageously — has authorized the extensive use oi abbrevia- tions, although the dangers of carelessness or ignorance in their employment will be apparent if we consider that, for example, Amman, may mean either Ammonia or Ammoniacum; Chlor., Chlorum, Chloral, Chloroformum, Chloras, or Chloridum ; Hyd. Chlor., Hydrate of Chloral or Hydrargyri Chloridum Corrosivum or Mite ; Sulph., Sulphur, Sulphas, Sulphidum, or Sulphis ; Zinc. Pkos., Zinci Phosphas or Zinci Phosphidum. These are but few of the many instances of ambiguity occa- sioned by inadvertence or want of familiarity with the full Latin form, or at least its recognized and unmistakable abbreviation. In conclusion, let the writer of prescriptions be warned against too great haste and a chirography which none but its author 'can decipher — a deficiency for which he alone is responsible, though the onus may fall upon the luckless druggist or his bewildered clerk. With regard to form, it has been our object to show that there is really little difficulty in writing good prescription Latin, and where the slightest chance of error exists the ampler expression, as we have strongly urged, should be used. A clear, business-like method, deliberately chosen and consistently pursued, will render this important item of the physician's labor simple, agreeable, and efficient. It is necessary not only that the directions to the patient should be written in perfectly legible English and in full, but that they should contain the exact dose, time for, and method of taking, and, in short, every detail which it may be advisable for the patient and nurse to know, clearly and intelligibly expressed. A physician is seldom justified in writing merely "As directed," the full directions being the only clue to the safety of the medicine. Moreover, verbal instructions to the patient or attendant may be partially or PRESCRIPTIONS. 809 €ven wholly forgotten, or confounded with directions relating to other matters connected with the case, and thus the welfare of the patient be endangered. All preparations intended for external or local application or for injections should be marked accordingly, " For External Use," etc. ; and if the agent be a poisonous mixture, a " Not-to-be-taken " label should be attached to the bottle. If a mixture is ordered contain- ing an insoluble substance, a " Shake-well " label should be used. Should it be necessary to prescribe an extraordinary dose of sonie powerful drug, the name of the remedy should be under- scored or attention called to it by a X, referring to the bottom of the prescription, where should be written : " Large dose intended," or " Dose of above correct," or something to indicate to the phar- macist that the writer is fully aware of the unusual amount, and thus save delay in consulting with the physician — which a careful and competent druggist would otherwise do. Should it, in the ■opinion of the physician, be undesirable to repeat the prescription, he should write at the bottom, " Do not repeat," or the customary Latin, " Ne repetatur." Every prescriber should be supplied with suitable prescription- blanks arranged in the form of pads conveniently carried in the pocket, a suitable size being four by five inches. The paper should be of linen, of good quality; otherwise it is liable to become detached from the druggist's files and lost. It is certainly advisable for the physician to write his prescrip- tions invariably in ink, since pencil is easily erased, and a pre- scription thus perishable would be of little use in medico-legal emergencies. Besides, an unscrupulous druggist who had been careless in compounding the remedy might easily change the pencil instructions to conform to his mistake. Finally, the pencil-writing is always liable to be erased or partially obliterated when carried for some time or subjected to frequent handling. The prescription-blank should have printed neatly upon one margin or the back the physician's residence and office, together with hours for consultation, and telephone number if he has one. This advertises the physician to some extent in a legitimate way, besides enabling the patient or druggist to communicate with him readily if necessary. It is a matter of personal taste whether the druggist's name should appear upon the blank. Considerations of courtesy and the possible event of loss or of legal contingencies may weigh with 8lO A TEXT-BOOK OF MATERIA MEDIC A. some practitioners, though others are of the opinion that it is un- desirable to print anything on the blank save the physician's name, office, hours, and telephone number. The prescription should always be signed by the writer in full, that professional responsibility and identity jnay be assured, the academic " M. D." being preferable as a title td^" Dr.," which is applicable to various professions — often of questionable repute and authenticity. In concluding these practical hints, the author cannot too strongly impress upon the student the importance of always writing as clear, legible, complete, and classical a prescription as possible. In a new community the reputation of the recent graduate is often dependent upon the character of the prescription he writes. The druggist invariably scans his instructions from the new doctor criti- cally, and the laity and the profession will soon learn the young aspirant's proficiency or ignorance by his pubhc committal in a pre- scription. No matter how able a diagnostician, pathologist, or bac- teriologist he may be, if his first effort in prescription-writing be illegible, poor Latin or for a hopelessly incompatible mixture, the druggist will label, classify, and measure him with the keenness of professional insight ; the judgment will go forth quietly; and years of successful practice may not serve to eradicate that first unfavor- able impression. CLINICAL INDEX. Abrasions — Isinglass, 781 Potassium nitrate, 590 Protectives, 772 Abscess — Calcium phosphate, 206 Cocaine, 496 Cod liver oil, 136 Onion poultice, 620 Phytolacca, 585 Solution of ammonium acetate, 597 Acidity of Stomach — Alkalies, 162 _. Ammonium preparations, 575 Acne — Fowler's solution, 241 Hydrastine ointment, 485 Ichthyol, 326 Phosphorus, 203 Pyrogallic acid, 713 Quinine, 2i6 Salicylic acid, 316 Sulphur, 670 Acne Rosacea — Bismuth subnitrate, 751 Ergot, 481 Hamamelis, 720 Ichthyol, 326 Resorcin, 324 Aconite-poisoning — Atropine, 460 Digitalis, 545 Adenitis — Camphorated naphtol, 322 Pilocarpine, 595 Potassium iodide, 252 After-pains — Black haw, 518 Camphor, 387 Albuminuria — Arsenic, ,243 Alcoholic Tremor — Cocaine, 497 Alcoholism — Aromatic spirit of ammonia, 575 Cocaine, 497 Coffee, 558 Solution of ammonium acetate, 597 Strychnine, 473 Tincture of lupulin, 445 Zinc oxide, 735 Alopecia — Aqua ammonia, 575 Capsicum, 365 Nutgall ointment, 714 Pilocarpine, 595 Quinine, 215 Savine, 704 Tannic acid, 711 Tincture of cantharides, 765 Turpentine, 643 Amaurosis — Strychnine, 472 Amblyopia — Pilocarpine, 595 Amenorrhea — Aloes, 674 Ammonium chloride, 61 7 Apioline, 707 Ergot, 480 Guaiac, 260 Iron, 196 Quinine, 216 Sanguinaria, 266 Savine, 704 Senega, 626 Tansy, 706 Tincture of cantharides, 765 Anal Fissure — Belladonna ointment, 459 Bismuth subnitrate, 751 Chloral, 417 Cocaine, 496 Fluid extract of hydrastis, 485 Geranium, 721 Glycerin, 774 Iodoform, 331 Krameria, 718 Red rose, 723 Sulphur, 671 Tannic acid, 711 Tincture of iodine, 252 White oak, 715 Zinc oxide, 735 Anemia — Arsenic, 242 Bone marrow, 219 Cod liver oil, 135 Copper, 739 Digitalis, 543 Hypophosphites, 206 Iron, 195 811 8l2 CLINICAL INDEX. Anemia — Manganese, 198 Nuclein, 219 Phosphoric acid, 143 Potassium chlorate, 351 Potassium permanganate, 347 Red wine, 571 Strychnine, 471 Aneurysm — Digitalis, 543 Diuretin, 653 Ergot, 480 Iodides, 252 Lead acetate, 731 Angina Pectoris — AUyl tribromide, 620 Amyl nitrite, 526 Arsenic, 243 Cactus, 552 Chloral, 418 Compound spirit of ether, 400 Hydrogen dioxide, 352 Phosphorus, 203 Zinc sulphate, 736 Anginose Scarlatina — Sodium sulphocarbolate, 308 Anorexia — Simple bitters, 178 Anosmia — Strychnine, 470 Anthrax — Serum-therapy, 300 Aortic Regurgitation — Adonidin, 553 Cactus, 552 Digitalis, 541 Apepsia — Pepsin, 130 Aphonia — Alum, 748 Blisters, 761 Bromides, 533 Nitric acid, 143 Potassium bichromate, 349 Aphthae — Borax, 345 Catechu, 716 Magnesia, 164 Red rose, 723 Rhus glabra, 722 Saccharine, 656 Sodium bicarbonate, 1 62 Sodium sulphocarbolate, 308 Apoplexy — Croton oil, 684 Arrhythmia — Cactus, 552 Nitroglycerin, 526 Arsenical Poisoning — Hydrated sesquioxide of iron, 240 Lime water, 164 Magnesia, 240 Arterio-sclerosis — Diuretin, 653 Arterio-sclerosis — Nitroglycerin, 526 Arthritis, Chronic — Cod liver oil, 135 Ascarides — Carbolic acid, 307 Ascites — Colchicum, 257 Colocynth, 690 Copaiba, 648 Diuretin, 652 Elaterin, 685 Aspergillus — Salicylic acid, 316 Asphyxia — • Alcohol, 570 Mustard, 768 Asthenopia — Physostigmine, 512 Asthma — Adonidin, 553 AUyl tribromide, 620 Amyl nitrite, 526 Arsenic, 241 Belladonna, 459 Bromides, 533 Caffeine, 558 Chloral, 418 Cocaine, 497 Colchicum, 257 Conium, 501 Grindelia, 507 Hydrogen dioxide, 352 Hyoscyamus, 464 Iodides, 253 Ipecac, 612 Lobelia, 614 Nitre-paper, 591 Opium, 438 Physostigma, 513 Pilocarpine, 595 Quinine, 215 Spartein sulphate, 551 Stramonium, 461 Strychni/ie, 472 Terpin hydrate, 628 Zinc oxide, 735 Zinc sulphate, 736 Atheroma — Cod liver oil, 136 Aural Catarrh — Ammonium chloride, 61 7 Balanitis — Alumnol, 322 Silver nitrate, 744 Bed-sores — Alcohol, 569 Emollients, 772 Glycerin, 774 Lead tannate, 732 Protectives, 772 Silver nitrate, 743 Tannic acid, 711 CLINICAL INDEX. 813 Belladonna-poisonings Pilocarjjine, 596^ Biliary Calculi — ' Sodium phosphate, 688 Turpentine, 644 Biliousness — Calomel, 232 Citric acid, 149 Seidlitz powder, 688 Senna, 682 Bites of Insects — Ammonia water, 575 Olive oil, 776 Rhus toxicodendron, 488 Bites of Rabid Animals — Carbolic acid, 306 Solution of chloride of antimony, 756 Sulphuric acid, 142 Bites of Venomous Reptiles — Solution of chloride of antimony, 756 Bladder, Chronic Catarrh of — Tincture of cautharides, 765 Bladder, Debility of— Fluid extract of blackberry, 724 Tincture of cantharides, 765 Bladder, Paralysis of — Arnica, 589 Bladder, Spasm of — Cannabis, 450 Blepharitis Marginalis — Yellow-oxide-of-mercury ointment, 231 Blepharospasm — Coniiim, 501 Boils- Belladonna ointment, 458 Cantharidal blister, 764 Glycerin, 774 Menthol, 375 Silver nitrate, 743 Tar, 624 Brain, Congestion of — Elaterin, 685 Bright's Disease — Alkalies, 163 Cod liver oil, 136 Digitalis, 545 Gallic acid, 713 Iron, 195 Pilocarpirre, 595 Scoparius, 551 Spirit of nitrous ether, 598 Strophanthus, 549 Bromidrosis — Chloral, 417 Hydrastine ointment, 485 Potassium permanganate, 347 Bronchitis — Acetanilid, 391 Alum, 748 Ammoniacum, 387 Ammonium carbonate, 576 Ammonium chloride, 617 Ammonium preparations, 164 Apomorphine, 604 Bronchitis — Arsenic, 241 Asafetida, 387 Balsam of tolu, 619 Benzoic acid, 335 ■ Buchu, 638 Burgundy-pitch plaster, 770 Calomel, 233 Cannabis, 450 Catechu, 716 Codeine, 443 Cod liver oil, 135 Colchicum, 257 Copaiba, 648 Creosote, 309 Croton oil, 683 Demulcents, 772 Digitalis, 544 Eucalyptus, 343 Grindelia, 507 Hamamelis, 720 Hedeoma, 708 Hydrastis, 485 Hyposulphites; 355 Iodides, 253 Iron, 195 Lime water, 164 Liquorice, 621 Lobelia, 614 Myrrh, 337 Nitric acid, 143 Onion poultice, 620 Opium, 438 Physostigma, 513 Sanguinaria, 266 Senega, 626 Squill, 636 Strychnine, 472 Sulphur, 671 Syrup of garUc, 620 Tar, 624 Tartar emetic, 608 Terebene, 627 Terpin hydrate, 628 Turpentine, 644 Wild cherry, 178 Wine of ipecac, 610 Bronchorrhea — Alum, 748 Asafetida, 387 Carbolic acid, 306 Copaiba, 648 Eucalyptus, 343 Gallic acid, 713 Lead acetate, 731 Myrrh, 337 Pilocarpine, 595 Senega, 626 Terebene, 627 Turpentine, 644 Zinc oxide, 735 Bruises — Ammonium chloride, 617 Arnica, 589 8i4 CLINICAL INDEX. Bruises — Camphor liniment, 386 Hamamelis, 720 Olive oil, 776 Potassium nitrate, 590 Solution of lead subacetate, 731 Tansy, 706 Buboes — Ammonium chloride, 617 Hydrogen dioxide, 352 Iodoform, 330 Phytolacca, 585 Salol, 319 Tincture of iodine, 251 Buccal Ulcer — Geranium, 721 Red rose, 723 Burns — Acacia, 778 Bismuth subgallate, 752 Bismuth subnitrate, 751 Carbolic acid, 306 Cocaine ointment, 496 Hamamelis, 720 Lead carbonate, 732 Lime water, 162 Linseed oil, 777 Menthol, 375 Nutgall ointment, 714 Ointment of rose, 723 Olive oil, 776 Phytolacca, 585 Protectives, 772 Rhus toxicodendron, 488 Salol, 319 Sodium bicarbonate, l6l Terebene, 627 Zinc oxide, 735 Calculi — Ammonium benzoate, 336 Callositas — Salicylic acid, 315 Cancer — Arsenic, 240 Bromine, 760 Calendula, 178 Carbolic acid, 306 Conium, 500 Hydrastine ointment, 485 Nitrate of sanguinarine, 265 Podophyllum, 693 Spermine, 217 Sulphuric acid, 142 Zinc chloride, 760 Zinc sulphate, 736 Cancer of Cervix — Nitric acid, 142 Cancer of Stomach — Arsenic, 243 Pepsin, 130 Cancer of Tongue — Potassium permanganate, 347 Cancer of Uterus — Chloral, 416 Pepsin, 130 Potassium permanganate, 347 Tannic acid, 711 Cancer of Vagina — Potassium permanganate, 347 Cancrum Oris — Bismuth subnitrate, 751 Zinc sulphate, 736 Capillary Bronchitis — Alcohol, 570 Ammonium iodide, 253 Serpentaria, 179 Turpentine, 644 Carbuncle — Belladonna ointment, 458 Cantharidal blister, 764 Ergot, 480 Glycerin, 774 Hamamelis, 720 Serum-therapy, 300 Cardiac Depression — Caffeine, 558 Cardiac Irritability — Bromides, 533 Cardiac Pain — Belladonna, 460 Caries of the Temporal Bone- Turpentine, 643 Catarrh — Benzoic acid, 335 Borax, 345 Boric acid, 345 Dobell's solution, 162 Eucalyptus, 341 Hydrastis, 485 Potassium permanganate, 347 Sodium sulphocarbolate, 308 Catarrh of Stomach — Capsicum, 365 Cellulitis — Digitalis, 544 Cerebral Anemia — Phosphorus, 203 Cerebral Hemorrhage — Phosphorus, 203 Cerebral Hyperemia — Belladonna, 460 Colchicum, 257 Ergot, 481 Cerebro-spinal Meningitis — Aconite, 580 Alcohol, 570 Blisters, 761 Ergot, 481 Gelsemium, 505 Cerumen, Impacted — Glycerin, 774 Liquor potasSEe, 161 Papain, 132 Cervix, Erosion of — Glycerin, 774 CLINICAL INDEX. 815 Chafing of the Skin — Lycopodium, 781 Chancre — Acetanilid, 390 Alumnol, 322 Bismuth benzoate, 335 Bismuth subnitrate, 751 Fluid extract of hydrastis, 485 Iodoform, 330 Solution of chloride of antimony, 756 Sulphuric acid, 142 Chancroid — Acetanilid, 390 Bismuth benzoate, 335 Carbolic acid, 306 Fluid extract of hydrastis, 485 Iodoform, 330 Potassium bichromate, 349 Salicylic acid, 315 Silver nitrate, 743 Chapping — Bismuth subnitrate, 75 1 Camphor ice, 386 Compound tincture of benzoin, 335 Glycerin, 774 Ointment of rose, 723 Tragacanth, 780 Chilblain — Aconite, 579 Alum, 748 Ammonia liniment, 575 Camphor liniment, 386 Capsicum, 365 Carbolic acid, 306 Nutgall ointment, 714 Rhus toxicodendron, 488 Chills— Strophanthus, 549 Chloasma — Nitric acid, 142 Tincture of iodine, 252 Chloroform-poisoning — Ammonia, 575 Amyl nitrite, 526 Atropine, 460 Strychnine, 473 Chlorosis — Aloes, 674 Arsenic, 243 Hypophosphites, 2o5 Iron, 195 Manganese, 198 Potassium chlorate, 351 Red wine, 571 Sti7chnine, 471 •Cholera — Bismuth subnitrate, 752 Calomel and opium, 233 Camphor, 387 Chloral, 418 Opium, 438 Salicylic acid, 317 Salol, 319 >>enim-therapy, 295 Cholera — Sulphur, 671 Sulphuric acid, 144 Cholera Infantum — Bismuth subnitrate, 752 Lead acetate, 731 Cholera Morbus — Chloral, 418 Opium, 438 Salol, 319 Chordee — Camphor, 386 Cannabis, 450 Colchicum, 257 Hop poultice, 445 Monobromated camphor, 387 Chorea — Acetanilid, 391 Arsenic, 242 Asafetida, 387 Cerium oxalate, 753 Chloral, 417 Cocaine, 497 Conium, 501 Copper sulphate, 739 Curare, 515 Exalgine, 395 Gelsemium, 504 Hyoscine, 464 Iron, 1 95 Opium, 438 Physostigma, 513 Picrotoxin, 475 Quinine, 215 Salicylic acid, 316 Silver nitrate, 744 Spermine, 217 Strychnine, 472 Zinc oxide, 735 Zinc sulphate, 736 Cinchonism — Diluted hydrobromic acid, 534 Cirrhosis of Kidneys — Potassium iodide, 253 Cirrhosis of Liver — Calomel, 232 Iodoform, 331 Potassium iodide, 253 Colchicum -poisoning — Potassium permanganate, 348 Colds- Aconite, 579 Citric acid, 149 Fluid extract of pilocarpus, 596 Mustard bath, 768 Colic — Belladonna, 460 Chloral, 417 Ginger, 372 Hedeoma, 708 Hyoscyamus, 464 Tansy, 706 Collapse — Alcohol, 570 8i6 CLINICAL INDEX. Collapse — Digitalis, 543 Coma — Mustard, 768 Comedo — Salicylic acid, 316 Sulphur, 670 Condylomata — Chromic acid, 756 Copper sulphate, 738 Resorcin, 324 Solution of chloride of antimony, 756 Congestion of Lungs — Ergot, 481 Congestive Chill — Opium, 438 Conj unctivitis — Alum, 748 Bismuth subnitrate, 751 Boric acid, 345 Copper sulphate, 738 Gallicine, 713 Hydrastine hydrochlorate, 485 Morphine sulphate, 438 Nitrate of sanguinarine, 265 Silver nitrate, 743 Zinc acetate, 735 Zinc sulphate, 736 Constipation — Aloes, 674 Arsenic, 243 Asaferida, 386 Belladonna, 459 Cascara sagrada, 667 Cassia fistula, 664 Castor oil, 666 Colocynth, 6go Euonymus, 678 Glycerin, 775 Hydrastine, 485 Jalap, 6gi Magnesia, 668 Magnesium carbonate, 668 Manna, 669 Oxgall, 675 Physostigma, 513 Podophyllum, 693 Rhubarb, 677 Senna, 682 Sodium salts, 688 Strychnine, 471 Sulphur, 671 Taraxacum, 672 Contusions — Alcohol, 569 Calendula, 178 Solution of ammonium acetate, 597 Convalescence- Alcohol, 569 Cod liver oil, 136 Simple bitters, 178 Wine of coca, 497 Convulsions — Chloral, 417 Corneal Ulcer — Physostigmine, 512 Corns — Acetic acid, 148 Arsenic, 240 Glacial acetic acid, 759 Potassium bichromate, 349 Salicylic acid, 315 Corrosive Poisoning — Olive oil, 776 Coryza — Ammonium chloride, 617 Antipyrine, 392 Camphor, 386 Camphoric acid, 387 Cocaine, 496 Dover's powder, 439 Gelsemium, 505 Glycerin, 774 Iodine, vapor of, 252 Oil of Scotch fir, 622 Salicylic acid, 316 Solution of ammonium acetate, 597 Whiskey, S7I Cough — Apomorphine, 604 Benzoic acid, 335 Bromides, 532 Cannabis, 450 Cerium oxalate, 753 Coniine, 501 Cubeb, 65 1 Geranium, 721 Grindelia, 507 Hydrocyanic acid, 522 Ipecac, 610 Lactucarium, 446 Linseed tea, 777 Liquorice, 621 Spirit of nitrous ether, 598 Strychnine, 472 Sumbul, 517 Terebene, 627 Turpentine, 644 Cracked Nipples — Bismuth subnitrate, 751 Brandy, 569 Chloral, 417 Compound tincture of benzoin, 335 White oak, 715 Cretinism — Thyroid extract, 2i8 Croup — Alum, 748 Ipecac, 611 Lactic acid, I46 Papain, 132 Pepsin, 130 Senega, 626 Silver nitrate, 743 Tartar emetic, 608 Zinc sulphate, 736 Crusts, Removal of — I Olive oil, 776 CLINICAL INDEX. 817 Cuts — Isinglass, 781 Cystitis — Antipyrine, 392 Belladonna, 460 Benzoic acid, 335 Boric acid, 345 Buchu, 638 Camphoric acid, 387 Copaiba, 648 Demulcents, 772 Elm, 779 Gallic acid, 713 Hamamelis, 720 Hydrogen dioxide, 352 Hyoscyamus, 464 Lactic acid, 146 Myrrh, 337 Piperazin, 655 Quinine, 215 Resorcin, 324 Saccharin, 656 Salol, 319 Turpentine, 644 Deafness — Iodine, vapor of, 252 Deglutition, Painful — Olive oil, 776 Delirium of Fevers — Diluted hydrobromic acid, 534 Delirium Tremens — Arnica, 589 Aromatic spirit of asnmonia, 575 Bromides, 533 Bromoform, 534 Camphor, 387 Chamomile, 178 Digitalis, 544 Hyoscine, 464 Strychnine, 472 Tincture of lupnlin, 445 Zinc oxide, 735 Dementia — Eucalyptus, 341 Hyoscine, 464 Dermatitis — Ichthyol, 326 Magnesium carbonate, 1 62 White oak, 715 Diabetes Insipidus — Ergot, 481 GalHc acid, 713 Lime water, 164 Pilocarpine, 596 Tincture of cantharides, 765 Valerian, 388 . Diabetes Mellitus — Alum, 748 Ammonium bromide, 533 Antipyrine, 392 Arsenic, 243 Cod liver oil, 136 Extract of pancreas, 220 52 Diabetes Mellitus — Glycerin, 775 Guaiacol, 312 Hydrogen dioxide, 352 Iodoform, 331 Iron, 196 Lactic acid, 146 Phosphoric acid, 144 Piperazin, 655 Saccharin, 656 Strychnine, 473 Thymol, 377 Valerian, 388 Diarrhea — Alum, 748 Arnica, 589 Arsenic, 242 Bismuth phosphate, 752 Bismuth subgallate, 752 Bismuth subnitrate, 752 Bismuth tannate, 752 Borax, 346 Boric acid, 346 Brandy, 570 Bromides, 532 Caffeine, 558 Camphor, 387 Catechu, 716 Cerium oxalate, 753 Chalk mixture, 164 Colchicum, 257 Copaiba, 648 Copper sulphate, 739 Demulcents, 772 Digitalis, 544 Elm, 779 Ergot, 481 Erythrophleum, 637 Eucalyptus, 341 Fluid extract of blackberry, 724 Gallic acid, 713 Ginger, 372 Hamamelis, 720 Hematoxylon, 719 Hope's camphor mixture, 143 Hydronaphtol, 322 Infusion of nutgall, 714 Ipecac, 611 Iron, 196 Kino, 717 Krameria, 718 Lactic acid, 146 Lead acetate, 731 Lime vifater, 164 Pepsin, 130 Prepared chalk, 164 Quinine, 215 Resorcin, 325 Rhubarb, 677 Salicylic acid, 317 Salol, 319 Sodium nitrate, 591 Sodium sulphocarbolate, 308 Strychnine,. 47 1 8i8 CLINICAL INDEX. Diarrhea — Sulphuric acid, 144 Tannic acid, 712 Thymol, 377 White oak, 715 Zinc oxide, 735 Zinc sulphate, 736 Zinc sulphocarbolate, 308 Digestive Disorders — Nuclein, 219 Digestive Organs, Inflamed Condi- tions of — Althjea, 779 Dilatation of Heart — Digitalis, 542 Ergot, 480 Dilatation of Stomach — Carbolic acid, 307 Physostigma, 513 Diphtheria — Alcohol, 570 Alum, 748 Balsam of tolu, 619 Bichloride of mercury, 233 Chloral, 417 Chlorine water, 356 Eucalyptus, 343 Gallic acid, 712 Hydrochloric acid, 142 Hydronaphtol, 322 Hyposulphites, 355 Ipecac, 611 Iron, tincture of chloride of, 194 Lactic acid, 146 Papain, 132 Pepsin, 130 Potassium permanganate, 347 Resorcin, 324 Salicylic acid, 316 Serum-therapy, 283 Sodium sulphocarbolate, 308 Sulphur, 671 Sulphurous acid, 353 Tartaric acid, 149 Thymol, 377 Turpentine, 644 Zinc sulphate, 736 Diphtheritic Paralysis — Strychnine, 472 Dropsy — Caffeine, 558 Copaiba, 648 Digitalis, 545 Diuretin, 652 Iris, 679 Jalap, 691 Juniper, 640 Potassium bitartrate, 163 Potassium iodide, 253 Salines, 688 Solution of ammonium acetate, 597 Squill, 636 Dryness of the Mouth — Glycerin, 774 Duodenal Catarrh — Salol, 319 Sanguinaria, 266 Sodium phosphate, 688 Dysentery — Acacia, 778 Alum, 748 Arnica, 589 Bismuth phosphate, 752 Bismuth subgallate, 752 Bismuth subnitrate, 752 Carbolic acid, 307 Colchicum, 257 Copaiba,, 648 Copper sulphate, 739 Corrosive chloride of mercury, 232 Demulcents, 772 Elm, 779 Ergot, 481 Erythrophleum, 637 Gallic acid, 713 Geranium, 721 Hamamelis, 720 Hematoxylon, 719 Hydronaphtol, 322 Infusion of nutgall, 714 Ipecac, 611 Iron, 196 Kino, 717 Krameria, 718 Lactic acid, 146 Lead acetate, 731 Lime water, 164 Olive oil, 776 Opium, 438 Quinine, 215 Rhubarb, 677 Silver nitrate, 744 Sodium nitrate, 591 Tannic acid, 712 Thymol, 377 White oak, 715 Zinc oxide, 735 Zinc sulphate, 736 Dysmenorrhea — Acetanilid, 391 Ammonium chloride, 617 Amyl nitrite, 526 Apioline, 707 Arsenic, 241 Black haw, 518 Camphor, 387 Cannal)is, 450 Caulophyllum, 705 Croton oil, 683 Ergot, 480 Gelsemiuni, 505 Guaiac, 260 Hamamelis, 720 Hydrastine, 486 Picrotoxin, 476 Sanguinaria, 266 Solution of ammonium acetate, 597 Spirit of nitrous ether, 598 CLINICAL INDEX. 819 Dysmenorrhea — Sumbul, 517 Dyspepsia — Alcohol, 569 Alkalies, 162 Ammonium preparations, 164 Asafetida, 386 Bismuth phosphate, 752 Carbolic acid, 307 Cerium oxalate, 753 Colchicum, 257 Erythrophleum, 637 Hematoxylon, 719 Hops, 445 Hydrochloric acid, 142 Hydrocyanic acid, 522 Ipecac, 6i i Lactic acid, 146 Manganese sulphate, 198 Myrrh, 337 Pepsin, 130 Potassium bichromate, 349 Quinine, 216 Resorcin, 325 Simple bitters, 178 Sodium sulphocarbolate, 308 Strontium bromide, 533 Strychnine, 470 Sulphurous acid, 354 Taraxacum, 672 Terebene, 627 Xanthoxylum, 269 Zii^c sulphate, 736 Dysphonia — Bromides, 533 Dyspnea — Amyl nitrite, 526 Aspidosperma, 516 Bromides, 533 Grindelia, 507- Hydrogen dioxide, 352 Ear, Diseases of — Aristol, 331 Calendula, 178 Ichthyol, 326 lodoforra, 331 Liquor potassse, 161 Nitric acid, 142 Sodium bicarbonate, 162 Earache — Hops, 445 Oil of cloves, 368 Onion, 620 Ecchymoses — Arnica, 589 Eclampsia, Infantile — Picrotoxin, 475 Ecthyma — Quinine, 216 Solution of lead subacetate, 731 Sulphur, 670 Eczema — Anderson's powder, 386 Eczema — Arsenic, 241 Belladonna, 459 Bismuth subgallate, 752 Black wash, 162 Calomel, 231 CarboMc acid, 306 Cod liver oil, 135 Coffee, 558 Colchicum, 257 Eucalyptus, 341 Fluid extract of pilocarpus, 595 Galla, 714 Gallicine, 713 Gelsemium, 505 Glycerite of starch, 754 Grindelia, 507 Hamamelis, 720 Hydrocyanic acid, 522 Ichthyol, 326 Lead acetate, 730 Lead iodide, 732 Lycopodium, 781 Menthol, 375 Papain, 132 Phytolacca, 585 Potassium chlorate, 351 Prepared chalk, 162 Resorcin, 324 Rhus toxicodendron, 48S Salicylic acid, 315 Salol, 319 Sodium carbonate, 162 Solution of lead subacetate, 731 Sulphur, 670 Tannic acid, 711 Tar, 624 Yellow wash, 162 Zinc carbonate, 736 Zinc oxide, 735 Zinc sulphate, 736 Edema of the Prepuce — Glycerin, 774 Emphysema — Physostigma, 513 Terebene, 627 Turpentine, 644 Empyema — Hydrogen dioxide, 352 Tincture of iodine, 252 Endarteritis — Iodides, 252 Marcury, 232 Endocarditis — Blisters, 761 Carbolic acid, 306 Quinine, 215 Endometritis — Carbolic acid, 306 Glycerite of tannic acid, 774 Hydrogen dioxide, 352 Solution of zinc chloride, 760 Tincture of iodine, 252 820 CLINICAL INDEX. Enlarged Tonsils — Chromic acid, 756 Enteralgia — Belladonna, 459 Hyoscyamus, 464 Enteritis- — Demulcents, 772 Hamamelis, 720 Entero-colitis — Salicylic acid, 317 Enuresis — Camphoric acid, 387 Rhus glabra, 723 Epididymitis — Ammonium chloride, 617 Mercurial ointment, 231 Silver nitrate, 743 Epilepsy — Acetanilid, 391 Amyl nitrite, 526 Borax, 346 Brain-extract, 219 Bromides, 532 Chloral, 418 Coniine hydrobromate, 501 Copper sulphate, 739 Curare, 515 Digitalis, 544 Hydrastine hydrochlorate, 486 Hydrogen dioxide, 352 Phosphorus, 203 Physostigraa, 513 Picrotoxin, 475 Silver nitrate, 744 Strychnine, 472 Zinc oxide, 735 Zinc sulphate, 736 Epistaxis— Acetanilid, 390 Acetic acid, 148 Alum, 747 Arnica, 589 Digitalis, 544 Ether, 400 Geranium, 721 Hamamelis, 720 Kino, 717 Krkmeria, 718 Sulphuric acid, 142 Epithelioma — Arsenic, 243 Bismuth subnitrate, 751 Ergot, 480 Lead nitrate, 732 Nitric acid, 142 Pyrogallol, 713 Zinc chloride, 760 Erysipelas — Alcohol, 571 Belladonna, 460 Bismuth subnitrate, 751 Carbolic acid, 306 Fluid extract of pilocarpus, 595 Glycerin, 775 Erysipelas — Guaiacol, 312 Hyposulphites, 355 Ichthyol, 326 Iron, 196 Lead carbonate, 732 Lycopodium, 781 Prepared chalk, 162 Quinine, 215 Rhus toxicodendron, 488 Salicylic acid, 315 Solution of lead subacetate, 731 Tannic acid, 711 Turpentine, 644 Zinc oxide, 735 Erythema — Anderson's powder, 386 Bismuth subnitrate, 751 Ergot, 481 Hamamelis, 720 Hydrocyanic acid, 522 Ichthyol, 326 Lead acetate, 730 Rhus toxicodendron, 488 Exanthemata — Acetanilid, 390 Acetic acid, 148 Ammonium carbonate, 575 Ammonium chloride, 617 Camphor, 387 Cod liver oil, 135 Opium, 440 Solution of ammonium acetate, 597 Excoriations — Acacia, 778 Glycerin, 774 Olive oil, 776 Protectives, 772 Tar, 624 Exophthalmic Goiter — Belladonna, 460 Bromides, 533 Digitalis, 543 Ergot, 481 Thyroid extract, 218 Eye, Diseases of — Fluid extract of red rose, 723, Iodoform, 331 Physostigmine, 512 Fainting — Ammonia water, 575 Cubeb, 651 Fatty Heart- Caffeine, 558 Fauces, Inflammation of — Salicylic acid, 316 Favus — Carbolic acid, 306 Gallanol, 713 Hyposulphites, 355 Phytolacca, 585 Febrile Affections — Acacia, 778 CLINICAL INDEX. 821 Febrile Affections — Acetanilid, 390 Aconite, 579 Citric acid, 149 Demulcents, 772 Hydrochloric acid, 143 Opium, 439 Potassium nitrate, 591 Sodium bromide, 533 Spirit of nitrous ether, 598 Tartar emetic, 608 Felons — Chloral, 417 Cocaine, 496 Silver nitrate, 743 Solution of lead subacetate, 731 Fermentation — Salicylic acid, 317 Fissured Nipples — Galla, 714 ■Glycerin, 774 Lead nitrate, 732 Tar, 624 Zinc oxide, 735 Fistula- Calcium phosphate, 206 Cantharidal blister, 764 Cod liver oil, 136 Hydrogen dioxide, 352 Iodoform, 331 Fistulous Discharges — Quinine, 215 Fistulous Openings, to Dilate — Elm, 779 Flatulence — Anise, 360 Asafetida, 386 Brandy, 570 Camphor, 387 Compound spirit of ether, 400 Ginger, 372 Glycerin, 775 Hops, 445 Physostigma, 513 Salicylic acid, 317 Spirit of nitrous ether, 598 Turpentine, 644 Freckles — Hamamelis, 720 Potassium nitrate, 591 Frost-bite — Alcohol, 569 Compound tincture of benzoin, 335 Hamamelis, 720 Galactorrhea — Ergot, 481 Gall-stones — Olive oil, 776 Gangrene — Ammonium chloride, 617 Bromine, 760 Carbolic acid, 306 Hematoxylon, 719 Gangrene — Lead nitrate, 732 Nitric acid, 142 White oak, 715 Gangrene of Lungs — Carbolic acid, 306 Eucalyptus, 343 Hyposulphites, 355 Salicylic acid, 316 Gangrene of Pharynx — Alum, 747 Copper sulphate, 738 Gangrenous Sores — Solution of chlorinated soda, 357 Gastralgia — Acetanilid, 391 Arsenic, 242 Belladonna, 459 Bismuth phosphate, 752 Brandy, 570 Coca, 497 Compound spirit of ether, 400 Manganese dioxide, 19S Menthol, 375 Resorcin, 324 Silver nitrate, 744 Silver oxide, 744 Zinc oxide, 735 Gastric Acidity — Glycerin, 775 Gastric Catarrh — Iodoform, 331 Salicylic acid, 317 Simple bitters, 178 Strychnine, 471 Gastric Fermentation — Hyposulphites, 355 Potassium permanganate, 347 Gastric Pain — Hydrocyanic acid, 522 Gastric Ulcer — Arsenic, 243 Bismuth subnitrate, 752 Lead acetate, 731 Manganese dioxide, 198 Potassium bichromate, 349 Silver nitrate, 744 Silver oxide, 744 Gastritis — Acacia, 778 Arsenic, 242 Bismuth subnitrate, 752 Demulcents, 772 Lead acetate, 73 1 Resorcin, 325 Silver nitrate, 744 Gastrodynia — Codeine, 443 General Debility — Digitalis, 543 Gingivitis — Borax, 345 Boric acid, 345 Hydronaphtol, 322 823 CLINICAL INDEX. Glandular Enlargements — Ammonium chloride, 617 Solution of ammonium acetate, 597 Gleet- Alum, 748 Buchu, 638 Copaiba, 648 Copper sulphate, 738 Geranium, 721 Krameria, 718 Lead acetate, 730 Tar water, 624 Tincture of cantharides, 765 Turpentine, 644 Glossitis — Chromic acid, 757 Goiter — Ammonium chloride, 617 Carbolic acid, 306 Red-iodide-of-mercury ointment, 232 Tincture of iodine, 252 Gonorrhea — Acetic acid, 148 Alum, 748 Alumnol, 322 Argonin, 744 Bismuth subnitrate, 751 Bismuth tannate, 752 Boric acid, 345 Buchu, 638 Cannabis, 450 Catechu, 716 Chloral, 416 Chromic acid, 757 Colchicum, 257 Copaiba, 648 Copper sulphate, 738 Geranium, 721 Glycerin, 774 Grindelia, 507 Hamamelis, 720 Hydrastin, 484 Hydrogen dioxide, 352 Kino, 717 Lead acetate, 730 Oil of santal, 648 Potassium permanganate, 347 Quinine bisulphate, 215 Resorcin, 324 Salol, 319 Silver nitrate, 743 Sodium sulphocarbolate, 308 Solution of zinc chloride, 760 Tannic acid, 711 Turpentine, 644 Zinc acetate, 735 Zinc sulphate, 736 Gout — Alkalies, 162 Arnica, 589 Colchicum, 257 Guaiac, 260 Lactic acid, 146 Lithium carbonate, 162 Gout— Piperazin, 655 Potassium iodide, 253 Salicylic acid, 316 Tincture of iodine, 25 1 Gouty Diathesis — Lithium preparations, 164 Sodium salts, 688 Gouty Sores — Piperazin, 655 Granular Lids — Bismuth subnitrate, 751 Granulations — Alum, 747 Nitric acid, 142 Gummata — Iodides, 252 Hay Fever — Ammonium iodide, 253 Arsenic, 243 Cannabis, 450 Cocaine, 496 Grindelia, 507 Quinine, 215 Resorcin, 324 Terpin hydrate, 628 Headache — Acetanilid, 391 Aromatic spirit of ammonia, 575 Arsenic, 242 Bromides, 532 Butyl-chloral hydrate, 422 Caffeine, 55^ Cannabis, 450 Cubeb, 651 Ergot, 481 Menthol, 375 Quinine, 215 Salicylic acid, 316 Spirit of nitrous ether, 598 Valerian, 388 Heart, Fatty Degeneration of — Iodine, 253 Heart, Functional Disorders of — Cactus, 552 Heart, Functional Irregularity of- Adonidin, 553 Strychnine, 471 Heart, Valvular Diseases of — Iodine, 253 Hebephrenia — Brain-extract, 220 Hematemesis — Alum, 748 Gallic acid, 712 Hamamelis, 720 Ipecac, 61 1 Iron, 196 Krameria, 718 Sulphuric acid, 144 Tannic acid, 712 Turpentine, 644 CLINICAL INDEX. 833 Hematuria — Alum, 748 Hamamelis, 720 Krameria, 718 Kperazin, 655 Rhus glabra, 722 Turpentine, 644 Hemiplegia — Strychnine, 472 Hemoptysis — Acetanilid, 390 Arnica, 589 ' Digitalis, 544 Fluid extract of hydrastis, 486 Gallic acid, 712 Gelsemium, 505 Geranium, 721 Hamamelis, 720 Iodoform, 331 Ipecac, 612 Krameria, 718 Lead acetate, 731 Tannic acid, 711 Turpentine, 644 White oak, 715 Hemorrhage — Alcohol, 570 Alum, 747 Digitalis, 543 Geranium, 721 Hamamelis, 720 Iron, 196 Lead acetate, 731 Opium, 439 Pyrogallol, 713 Turpentine, 644 Hemorrhage, Intestinal — Gallic acid, 712 Sulphuric acid, 144 Hemorrhage, Renal — Gallic acid, 712 Hemorrhage, Uterine — Nitric acid, 142 Sulphuric acid, 144 H emorrhoids — Belladonna ointment, 459 Chromic acid, 757 Cocaine, 496 Ergot, 480 Galla, 714 Gallic acid, 712 Hamamelis, 720 Iodoform, 331 Krameria, 718 Lead acetate, 730 Manna, 669 Menthol, 375 Nitric acid, 142 Potassium bromide, 532 Rhubarb, 677 Stramonium ointment, 462 Sulphur, 671 Tannic acid, 711 White oak, 715 Hepatic Cirrhosis— Podophyllum, 693 Hepatic Congestion — Calomel, 232 Gamboge, 685 Taraxacum, 672 Hepatic Disorders — Nitric acid, 143 Hepatitis — Calomel, 233 Hernia — Caffeine, 558 Fluid extract of white oak, 715 Herpes — Aconite, 579 Bismuth subgallate, 752 Galla, 714 Hamamelis, 720 Ichthyol, 326 Lycopodium, 781 Rhus toxicodendron, 488 Salicylic acid, 316 Tannic acid, 711 Herpes of Buccal Cavity — Potassium chloraffe, 351 Hiccough — Chloral, 418 Coffee, 558 Compound spirit of ether, 400 Infusion of mustard, 768/ Nitroglycerin, 527 Pilocarpine, 595 Hoarseness — Borax, 345 Boric acid, 345 Compound tincture of benzoin, 335 Cubeb, 651 Licorice, 621 Potassium bichromate, 349 Hodgkin's Disease — Arsenic, 241 Hydrocele — Chloral, 416 Tincture of iodine, 252 Hydrocyanic- Acid-poisoning — Aminbnia, 575 Potassium permanganate, 348 Hydrophobia — Coniine, 501 Curare, 515 Hydrastine hydrochlorate, 486 Opium, 438 Hydrothorax — Cantharidal blisters, 764 Hyperidrosis — • Chloral, 417 Chromic acid, 757 Hamamelis, 720 Hydrastine ointment, 485 Tannic acid, 711 Hyperpyrexia, Rheumatic — Salicylic acid, 316 Hypertrophy of Heart — Aconite, 579 824 CLINICAL INDEX. Hypertrophy of Heart — Lead acetate, 731 Hypochondria — Arsenic, 243 Colchicum, 257 Diluted nitrohydrochloric acid, 143 Valerian, 388 Hysteria — AUyl tribromide, 620 Asiifetida, 386 Belladonna, 459 Brain-extract, 219 Compound spirit of ether, 400 Copper sulphate, 739 Oil of rue, 705 Sanguinaria, 266 Sumbul, 517 Tansy, 706 Valerian, 388 Zinc oxide, 735 Zinc sulphate, 736 Hysterical Convulsions — Hyoscine, 464 Hysterical Paralysis — Blisters, 761 Ileo-colitis — Calomel, 232 Gray powder, 232 Impetigo — Hyposulphites, 355 Lead acetate, 730 Quinine, 216 Salicylic acid, 315 Sulphur, 670 Tannic acid, 711 Impotence — Alcohol, 571 Cannabis, 450 Phosphorus, 203 Sanguinaria, 266 Tincture of cantharides, 765 Incontinence of Urine — Ammonium benzoate, 336 Belladonna, 459 Buchu, 638 Ergot, 481 Hyoscyamus, 464 Iron, 196 Krameria, 718 Rhus glabra, 722 Rhus toxicodendron, 488 Tincture of cantharides, 765 Tincture of nux vomica, 470 Turpentine, 644 Indigestion — Bromides, 532 Hydrochloric acid, 143 Infantile Convulsions — Allyl tribromide, 620 Asafetida, 386 Bromides, 532 Chloral, 417 Conium, 501 Infantile Convulsions — Physostigma, 513 '■ Inflamed Gums — Hamamelis, 720 Inflammation of Nose — Carbolic acid, 306 Inflammation of Throat — Carbolic acid, 306 Inflammations — Hop poultice, 445 Linseed poultice, 777 Mercury, 232 Inflammatory Exudates, to Hasten Absorption of — Rubefacients, 769 Influenza — Acetanilid, 391 Salicylic acid, 317 - Serum-therapy, 298 Solution of ammonium acetate, 597 Ingrowing Toe-nail — Alum, 748 Liquor potassas, 161 Insanity — Hyoscine, 464 Sulphonal, 425 Thyroid extract, 218 Insomnia — Bromides, 532 Chloral, 417 Chloral formamide, 421 Convallaria, 554 Hyoscine, 464 Opium, 438 Paraldehyde, 426 Phosphorus, 203 Intermittent Fever — Ammonium chloride, 617 Antipyrine, 392 Ai-senic, 242 Erythrophleum, 637 Hydrastine, 485 Ipecac, 612 Nitric acid, 143 Phenocoll, 394 Quinine, 216 Resorcin, 325 Salicylic acid, 316 Intertrigo — Bismuth subnitrate, 751 Lead carbonate, 732 Lycopodium, 781 Tannic acid, 711 Zinc carbonate, 736 Zinc oxide, 735 Intestinal Catarrh — Copaiba, 648 Salol, 319 Turpentine, 644 Intestinal Dilatation — Physostigma, 513 Intestinal Fermentation — Oxgall, 675 Sulphurous acid, 354 CLINICAL INDEX. 825 Intestinal Hemorrhage — Alum, 748 Hematoxylon, 719 Krameria, 718 Tannic acid, 712 Intestinal Obstruction — Croton oil, 684 Intestinal Torpor — Picrotoxin, 475 Intestinal Ulcerations — Silver nitrate, 744 Irido-choroiditis — Salicylic acid, 316 Iritis — Calomel, 233 Irritable Conditions of the Heart — Hydrocyanic acid, 522 Strophanthus, 549 Irritation, Relief of — Cod liver oil, 135 Jaborandi-poisoning — Atropine, 460 Jaundice — Aloes, 674 Citric acid, 149 Hydrastine, 485 Iodoform, 331 Iris, 679 Iron, 195 Manganese sulphate, 198 Oxgall, 675 Pilocarpine, 596 Quinine, 215 Salol, 319 Joints, Inflammation of — Digitalis, 541 Rubefacients, 769 Keratitis — Gallicine, 713 Yellow-oxide-of-mercury ointment, 231 Kidneys, Congestion of — Digitalis, 541 Juniper, 640 Spirit of nitrous ether, 598 Laryngeal Catarrh — Compound tincture of benzoin, 33S Turpentine, 644 Laryngeal Papillomata — Chromic acid, 757 Laryngismus Stridulus — Bromides, 533 Chloral, 417 Laryngitis — Acacia, 778 Aconite, 579 Alum, 748 Ammonium chloride, 617 Camphor, 386 Carbolic acid, 306 Chromic acid, 756 Glycerin, 774 Laryngitis — Iodine, 252 Resorcin, 324 Salol, 319 Sanguinaria, 266 Senega, 626 Subsulphate of mercury, 233 Succus conii, 501 Tartar emetic, 608 Larynx, Chronic Ulceration of- Silver nitrate, 743 Larynx, Congestion of — Creasote, 309 Lead-poisoning — Alum, 748 Croton oil, 684 Magnesium sulphate, 688 Sulphuric acid, 144 Lentigo — Tincture of iodine, 252 Lepra — Arsenic, 241 Phosphorus, 203 Leucorrhea — Alum, 748 Bismuth subnitrate, 751 Bismuth tannate, 752 Boric acid, 345 Catecliu, 716 Chromic acid, 757 Cocculus, 476 Ergot, 481 Fluid extract of hydrastis, 485 Geranium, 721 Glycerite of tannic acid, 774 Grindelia, 507 Hamamelis, 720 Hematoxylon, 719 Iron, 196 Kino, 717 Krameria, 718 Lead acetate, 73° Lime water, 162 Myrrh, 337 Potassium permanganate, 347 Rhus glabra, 722 Silver nitrate, 743 Solution of zinc chloride, 760 Tannic acid, 711 Tar water, 624 White oak, 715 Zinc acetate, 735 Zinc oxide, 735 Zinc sulphate, 736 Leukemic — Arsenic, 241 Lichen — Fowler's solution, 241 Lead acetate, 730 Sulphuric acid, 144 Lithemia — Alkalies, 163 Buchu, 638 Lactic acid, 146 826 CLINICAL INDEX. Lithemia — Nitric acid, 143 Lithiasis — Potassium permanganate, 347 Liver, Torpor of — Podophyllum, 693 Locomotor Ataxia — - Acetanilid, 391 Brain-extract, 219 Caffeine, 558 Mercury, 232 Nitroglycerin, 527 Phosphorus, 202 Physostigma, 513 Silver nitrate, 744 Lumbago — Acetanilid, 391 Burgundy-pitch plaster, 770 Capsicum, 365 Guaiac, 260 Salicylic acid, 316 Turpentine, 643 Lungs, Chronic Affections of— Mercury, 232 Lungs, Congestion of — Digitalis, 544 Elaterin, 685 Lungs, Inflammation of — Gelsemium, 505 Lupus- Carbolic acid, 306 Chloride of zinc, 760 Copaiba, 647 Hamamelis, 720 Ichthyol, 326 Phosphorus, 203 Pyrogallol, 713 Salicylic acid, 315 Tincture of iodine, 252 Zinc sulphate, 736 Lymphadenoma — Phosphorus, 203 Lymphangitis — Tannic acid, 711 Lymphatic Enlargements — Ichthyol, 326 Lead iodide, 732 Lymphoma — Arsenic, 241 Malaria — Antipyrine, 392 Apioline, 707 Carbolic acid, 307 Citric acid, 149 Eucalyptus, 342 Hydrastine, 485 Nuclein, 219 Pilocarpine, 595 Quinine, 215 Malarial Fever — Ammonium iodide, 253 , Amyl nitrite, 526 Quinine, 215 Malarial Fever — Simple bitters, 178 Malignant Pustule — Iodoform, 330 Solution of chloride of antimony, 756 Mammary Glands, Enlarged and Painful- Olive oil, 776 Solution of ainmonium acetate, 597 Mania — Acetanilid, 391 Arnica, 589 Bromoform, 534 Camphor, 387 Cannabis, 450 Conium, 501 Digitalis, 544 Gelsemium, 504 Hydrocyanic acid, 522 Hyoscine, 464 Marasmus — Bichloride of mercury, 233 Cod liver oil, 135 Mastitis — Ammonium chloride, 617 Phytolacca, 585 Measles — Mustard bath, 768 Melancholia — Arsenic, 243 Cannabis, 450 Diluted nitrohydrochlorlc acid, 145 Hydrocyanic acid, 522 Wine of coca, 497 Meniere's Disease — Gelsemium, 505 Meningitis — Calomel, 232 Digitahs, 544 Iodides, 252 Menopause, Disturbances of — Bromides, 533 Menorrhagia — Aloes, 674 Alum, 748 Belladonna, 460 Black haw, 518 Bromides, 533 Cannabis, 450 Conium, 501 Digitalis, 544 Ergot, 480 Gallic acid, 712 Hamamelis, 720 Iron, 196 Kino, 717 Savine, 704 Solution of ammonium acetate, 597 Tincture of cantharides, 765 Turpentine, 644 Menses, to Restore or Increase — Emmenagogues and ecbolics, 702 Hedeoma, 708 Mustard sitz-bath, 768 CLINICAL INDEX. 827 Mercurial Sore Mouth — Silver nitrate, 743 Metritis, Chronic^ Cannabis, 450 Ergot, 480 Tincture of iodine, 252 M etrorrhagia — Geranium, 721 Migraine — Butyl-chloral hydrate, 422 Caffeine, 558 Cannabis, 450 Gelsemium, 505 Picrotoxin, 476 Seidlitz powder, 688 Solution of ammonium acetate, 597 Mitral Regurgitation — Adonidin, 553 Digitalis, 542 Mitral Stenosis — Strophanthus, 548 Moles — Nitric acid, 142 Morbid Growths — Zinc chloride, 760 Morphine-poisoning — Potassium permanganate, 347 Strychnine, 473 Mouth, Diseases of — Potassium citrate, 161 -..^^^ Potassium tartrate, 161 "" Mouth, Ulcerations of — Chromic acid, 757 Mucous Membranes Inflamed Con- ditions of — Demulcents, 77? Mucous Patches — Potassium chlorate, 351 Mumps — Pilocarpine, 595 Muscarine-poisoning — Digitalis, 545 Potassium permanganate, 348 Myalgia — Ammonium chloride, 618 Salol, 319 Turpentine, 643 Myelitis — Ergot, 481 PhenocoU, 394 Strychnine, 472 Myocarditis — Cactus, 552 Caffeine, 558 Diuretin, 653 Myxedema — Thyroid extract, 218 Narcotic Poisoning — Alcohol, .570 Mustard, 768 Rubefacients, 769 Nasal Catarrh — , Bismuth oxide, 752 Nasal Catarrh — Bismuth subnitrate, 751 Glycerin, 774 Oil of Scotch fir, 622 Nasal Polypi — Chromic acid, 756 Nitrate of sanguinarine, 265 Zinc sulphate, 736 Nausea — Compound spirit of ether, 400 Hydrochloric acid, 143 Menthol, 375 • Spirit of nitrous ether, 598 Neoplasms — Cocaine, 496 Nephritis — Amyl nitrite, 526 Elaterin, 685 Mercury, 232 Potassium bitartrate, 163 Potassium iodide, 253 Scoparius, 551 • Terpin hydrate, 628 Tincture of cantharides, 765 Nervous Debility — Rubefacients, 769 Nervous Diseases — Cod liver oil, 136 Iron, 195 Nervous Excitement — Rubefacients, 769 Nervous Irritability — Bromides, 533 Nervousness' — Lactucarium, 446 Neuralgia — - Acetanilid, 391 Aconite, 579 Ammonium chloride, 618 Arsenic, 242 Belladonna plaster, 459 Blisters, 761 Butyl-chloral hydrate, 422 Camphor-chloral, 386 Camphorated chloral, 417 Cannabis, 450 Cantharidal blister, 764 Capsicum, 365 Chloral, 418 Colchicum, 257 Convallaria, 554 Croton oil, 683 Ether, 400 Gelsemium, 505 Hydrocyanic acid, 522 Hyoscyamus, 464 Iron, 195 Oil of cloves, 368 PhenocoU, 394 Phosphorus, 203 Quinine, 215 Rubefacients, 769 Salicylic acid, 317 Strychnine, 472 828 CLINICAL INDEX. Neuralgia — Terpin hydrate, 628 Veratrine ointment, 584 Neurasthenia — Alcohol, 571 Brain-extract, 217 Phosphoric acid, 143 Phosphorus, 202 Sumbul, 517 Neuritis — Acetanilid, 391 Salol, 319 Tincture of iodine, 251 Nevi — Chloride of zinc, 760 Nitric acid, 142 Night-blindness — Strychnine, 472 Night-sweats — Camphoric acid, 387 Fluid extract of Hydrastis, 486 Gallic acid, 713 Geranium, 721 Lead acetate, 731 Physostigma, 513 Picrotoxin, 475 Strychnine, 473 Nocturnal Emissions — Digitalis, 544 Noma — Hydrochloric acid, 141 Nose, Diseases of — Aristol, 331 Ichthyol, 326 Iodoform, 331 Nitric acid, 142 Nymphomania — Bromides, 533 Nystagmus — Physostigmine sulphate, S 1 2 Obesity— Phytolacca, 586 Thyroid extract, 219 Offensive Discharges — Lead nitrate, 732 Onychia — Lead nitrate, 732 Tincture of iodine, 251 Ophthalmia — Alum, 748 Bismuth tannate, 752 Potassium permanganate, 347 Silver nitrate, 743 Zinc sulphate, 736 Opium Habit — Cocaine, 497 Opium -poisoning — Caffeine, 558 Picrotoxin, 475 Orchitis — Ammonium chlor^ide, 617 Belladonna ointment, 459 Hop poultice, 445 Orchitis — Lead acetate, 730 Mercurial ointment, 231 Silver nitrate, 743 Os Uteri, Rigidity of — Ipecac, 612 Osteitis — Hydrochloric acid, 142 Osteomalacia — Lime vifater, 164 Phosphorus, 203 Otitis — Antipyrine, 392 Bismuth subgallate, 752 Cantharidal blister, 765 Carbolic acid, 306 Cod liver oil, 136 Zinc sulphate, 736 Otorrhea — Carbolic acid, 306 Le^d acetate, 730 Salicylic acid, 316 Silver nitrate, 744 Tannic acid, 711 Ovarian Neuralgia — Sumbul, 517 Ovaritis — Cantharidal blister, 765 Oxalic- acid -poisoning — Potassium peimanganate, 348 Oxaluria — Lactic acid, 146 Nitric acid, 143 Zinc sulphate, 736 Ozena — Bismuth oxide, 752 Bismuth subnitrate, 751 Camphor, 386 Camphorated naphtol, 322 Chromic acid, 757 Cod liver oil, 136 Krameria, 718 Myrrh, 337 Potassium permanganate, 347 Quinine, 215 Saccharin, 656 Salol, 319 Solution of chlorinated soda, 357 Tannic acid, 711 Pachymeningitis — Red-iodide-of-mercury ointment, 232 Pain — Ether, 400 Opium, 438 Palpitation of Heart — Aconite, 579 Compound spirit of ether, 400 Palsy— Brain-extract, 220 Pannus — Yellow-oxide-of-mercury ointment, 231 Paralysis — Biain-extract, 220 CLINICAL INDEX. 829 Paralysis — Cocculus, 475 Cubeb, 651 Iodides, 252 Mezereum, 267 Phosphorus, 203 Rhus toxicodendron, 488 Strychnine, 472 Paralysis Agitans — Borax, 346 Cocaine, 497 Conium, 501 Gelsemium, 504 Hyoscine, 464 Sparteine sulphate, 551 Paralytic Mydriasis — Physostigmine, S'2 Paraplegia — Phosphorus, 202 Physostigma, 513 Strychnine, 472 Parasitic Skin Diseases — Chlorine water, 356 Cocculus, 475 Salicylic acid, 315 Sulphurous acid, 353 Paronychia — Lead acetate, 730 Pelvic Cellulitis — Mercurial ointment, 231 Pemphigus — Fowler's solution, 241 Rhus toxicodendron, 488 Pericarditis — Blisters, 761 Calomel, 233 Cantharidal blister, 764 Diuretin, 653 Iodides, 253 Squill, 636 Periodical Fevers — Nitric acid, 143 Periostitis — Cantharidal blister, 765 Iodides, 252 Tincture of iodine, 251 Peritonitis — Aconite, 579 Opium, 439 Turpentine, 643 Pernicious Anemia — Arsenic, 241 Phosphorus, 203 Phagedenic Sores — ' Potassium chlorate, 351 Solution of nitrate of mercury, 232 Pharyngitis — Acacia, 778 Aconite, 579 Alcohol, 569 Ammonium chloride, 617 Aromatic spirit of ammonia, 575 Balsam of tolu, 619 Borax, 345 Pharyngitis — Boric acid, 345 Calendula, 178 Camphoric acid, 387 Capsicum, 365 Catechu, 716 Ergot, 480 Gallic acid, 712 Glycerin, 774 Guaiac, 260 Hamamelis, 720 Hedeoma, 708 Kino, 716 Krameria, 718 Myrrh, 337 Phytolacca, 585 Potassium bichromate, 349 Potassium bromide, 532 Potassium chlorate, 351 Potassium nitrate, 590 Resorcin, 324 Rhus glabra, 722 Sodium benzoate, 336 Sodium bicarbonate, 161 Solution of ammonium acetate, 597 Sulphur, 671 Sulphurous acid, 353 Tannic acid, 711 Tincture of hydrastis, 485 Tincture of iodine, 252 Xanthoxylum, 269 Pharynx, Catarrhal Affections of — Compound tincture of benzoin, 335 Phimosis — Cocaine, 496 Phlegmasia Dolens — Hamamelis, 720 Phlyctenular Ophthalmia — Yellow-oxide-of-mercury ointment, 231 Phosphorus-poisoning — Magnesium carbonate, 668 Ozonized oil of turpentine, 644 Potassium permanganate, 348 Photophobia — Physostigmine, 512 Phthiriasis — Pilocarpine, 596 Phthisis — Acetanilid, 390 Alcohol, 571 Arsenic, 242 Benzoic acid, 335 . ' Catechu, 716 "^ Codeine, 443 Creasote, 309 Croton oil, 680 Gallic acid, 713 Geranium, 721 Guaiacol, 312 Iodine, 252 Iodoform, 331 Quinine, 215 Salicylic acid, 316 Sulphurous acid, 353 830 CLINICAL INDEX. Phthisis- Tar, 624 Terebene, 627 Thymol, 377 Wild chei-ry, 178 Physostigmine-poisoning — Atropine, 460 Strychnine, 473 Pityriasis — Acetic acid, 148 Aromatic spirit of ammonia, 162 Resorcin, 324 Pleura, Chronic Affections of— Mercury, 232 Pleurisy-*- Aconite, 579 Blisters, 761 Burgundy pitch plaster, 770 Cantharidal blister, 764 Coniine, 501 Gelsemium, 505 Iodides, 253 Opium, 439 Quinine, 215 Salicylic acid, 317 Squill, 636 Tincture of iodine, 251 Turpentine, 643 Pleuritic Effusion — Caffeine, 558 Digitalis, 545 Diuretin, 652 Pilocarpine, 595 Salines, 688 Pneumonia — Acetanilid, 390 Aconite, 579 Alcohol, .570 Ammonium carbonate, 575 Ammonium iodide, 253 Apomorphine, 604 Arsenic, 243 Aspidosperma, 516 Calomel, 233 Cantharidal blister, 764 Coniine, 501 Digitalis, 544 Grindelia, 507 Hydrogen dioxide, 352 Iodides, 253 Ipecac, 612 Potassium nitrate, 591 Quinine, 215 Senega, 626 Serpentaria, 178 Serum-therapy, 293 Strychnine, 471 Turpentine, 644 Pneumothorax — Carbolic acid, 306 Poisoning — Apomorphine, 604 Poisoning from Noxious Gases — Ammonia, 575 Poisoning from Venomous Reptiles- Alcohol, 570 Ammonia, 575 Polypi— Hamamelis, 720 Zinc chloride, 760 Polyuria — Alum, 748 Kino, 717 Portal Congestion — Colchicum, 257 Post-partum Hemorrhage — Digitalis, 544 Ergot, 480 Ether, 400 Sodio-benzoate of caffeine, 558 Strychnine, 473 Priapism — Lupulin, 445 Prickly Heat — Citric acid, 148 Proctitis — Copaiba, 648 Progressive Paralysis of the Insane- Physostigma, 513 Prolapsus Ani — Bismuth subnitrate, 751 Ergot, 480 Geranium, 721 Krameria, 718 Nitric acid, 142 Strychnine, 471 Tannic acid, 711 White oak, 715 Prolapsus of Iris — Physostigmine, 512 Prolapsus Uteri — Iron, 19s Prostate Gland, Enlargement of — Ergot, 480 Prostatitis — Belladonna, 460 Hyoscyamus, 464 Prostatorrhea — Iron, 196 Tincture of cantharides, 765 Turpentine, 644 Prurigo — Ergot, 481 Fowler's solution, 241 Sulphuric acid, 144 Pruritus — : Aconite, 579 Alum, 748 Camphorated chloral, 417 Cannabis, 450 Carbolic acid, 306 Ether, 400 Gallanol, 713 Gelsemium, 505 Hydrocyanic acid, 522 Menthol, 375 Nitric acid, 142 Pilocarpine, 596 CLINICAL INDEX. 831 Pruritus — Piperazin, 655 Salicylic acid, 317 Solution of lead subacetate, 731 Tar, 624 Zinc sulphate, 736 Pruritus Ani — Silver nitrate, 743 Pruritus Vulvae — Silver nitrate, 743 Psoriasis — Ammonium carbonate, S7S Arsenic, 241 Copaiba, 647 Eucalyptus, 341 Gallanol, 713 Lead iodide, 732 Phosphorus, 203 Pilocarpine, 596 Pyrogallol, 713 Resorcin, 324 Salicylic acid, 315 Strophanthus, 549 Sulphur, 670 Thyroid extract, 21 9 Turpentine, 643 Ptyalism — Alum, 747 Bismuth subnitrate, 751 Catechu, 716 Copper sulphate, 738 Krameria, 718 Myrrh, 337 Pilocarpine, 595 Potassium chlorate, 351 Rhus glabra, 722 Puerperal Eclampsia — Amyl nitrite, 526 Conium, 501 Puerperal Fever — Opium, 439 Quinine, 215 Terebene, 627 Turpentine, 644 Pulmonary Affections, Chronic — Cetraria, 778 Nuclein, 219 Turpentine, 644 Purpura — Digitalis, 544 Ergot, 481 Hamamelis, 720 Sulphuric acid, 144 Turpentine, 644 Putrid Sore Throat — Potassium permanganate, 347 Pyelitis — Benzoic acid, 335 Buchu, 638 Copaiba, 648 Gallic acid, 713 Tincture of cantharides, 765 Pyelo-nephritis — Gallic acid, 713 Pyemia — Alcohol, 571 Iron, 196 Quinine, 215 Pyonephrosis — Turpentine, 644 Pyorrhea Alveolaris — Hydronaphtol, 322 Tincture of iodine, 252 Pyrosis — Bismuth subnitrate, 752 Catechu, 716 Glycerin, 775 Kino, 717 Manganese dioxide, 198 Rabies — Serum-therapy, 300 Rachitis — Cod liver oil, 135 Lime water, 164 Phosphorus, 203 Rectal Bleeding— Krameria, 718 Rectal Fissure — Hamamelis, 720 Rectal Prolapse — Nutgall ointment, 714 Rectal Ulcer — Fluid extract of hydrastis, 485 Hamamelis, 720 Potassium chlorate, 351 Silver nitrate, 744 Tannic acid, 711 Relaxed Uvula — Capsicum, 365 White oalt, 715 Remittent Fever — Gelsemium, 505 Ipecac, 612 Iris, 679 Renal Calculi — Piperazin, 655 Renal Colic — Piperazin, 655 Renal Hemorrhage — Physostigma, 513 Respiratory Organs, Inflamed Condi- tions of— Althaea, 779 Restlessness of Fever — Convallaria, 554 Retention of Urine — Strychnine, 472 Rheumatic Affections — Rhus toxicodendron, 488 Rheumatic Arthritis — Piperazin, 655 Salicyhc acid, 316 Rheumatic Pains — Turpentine, 643 Rheumatism — Acetanilid, 390 ' ^ >i Aconite, 579 832 CLINICAL INDEX. Rheumatism — Alkalies, 163 Ammonia liniment, 575 Ammonium chloride, 618 Arnica, 589 Arsenic, Z43 Asaprol, 322 Aspidospermine, 517 Belladonna plaster, 459 Betol, 322 Bromides, 533 Buchu, 638 Burgundy-pitch plaster, 770 Camphoric acid, 387 Citric acid, 149 Cod liver oil, 135 Colchicum, 257 Guaiac, 260 Hamamelis, 720 Mezereon, 267 PhenocoU, 394 Phytolacca, 585 Potassium iodide, 253 Potassium nitrate, 591 Salicylic acid, 316 Sanguinaria, 266 Senega, 626 Sodium bicarbonate, 161 Sodium phosphate, 688 Solution of ammonium acetate, 597 Sulphur, 671 Tansy, 706 Tincture of camphor, 569 Tincture of iodine, 251 Rheumatoid Arthritis — Alkalies, 163 Arsenic, 243 Cod liver oil, 135 Colchicum, 257 Rhinitis — Nitrate of sanguinarine, 265 Rhus-poisoning — Grindelia, 507 Hamamelis, 720 Serpentaria, 1 79 Ringworm — Acetic acid, 148 Compound tincture of benzoin, 335 Copper sulphate, 738 Salicylic acid, 317 Salivary Fistula — Arsenic, 240 Chromic acid, 757 Scabies — Copper sulphate, 738 Hyposulphites, 355 Sulphur ointment, 670 Scales, Removal of — Olive oil, 775 Scarlatina — Belladonna, 459 Scarlatinal Angina — Sanguinaria, 265 Scarlet Fever — Digitalis, 544 Mustard bath, 768 Sciatica — Acetanilid, 391 Bhsters, 761 Cantharidal blisters, 764 Colchicine, 257 Ether, 400 Nitroglycerin, 527 PhenocoU, 394 Potassium iodide, 253 Salicylic acid, 316 Sulphur, 671 Sclerosis — Mercury, 232 Potassium iodide, 252 Sclerotitis — Salicylic acid, 316 Scrofula — Cod liver oil, 135 Hypophosphites, 206 Iron iodide, 195 Phytolacca, 585 Potassium iodide, 252 Sarsaparilla, 262 Scrofulous Glands — Zinc chloride, 760 Scrofulous Sores — Conium, 501 Phosphoric acid, 142 Scurvy — Citric acid, 149 Sulphuric acid, 144 Sea-sickness — Acetanilid, 391 Belladonna, 460 Chloral, 418 Chloral foramide, 422 Cocaine, 497 Seat-worms — Quassia, 178 Sebaceous Cysts — Ether, 400 Seborrhea — Hamamelis, 720 Hydrastine ointment, 485 Resorcin, 324 Seminal Emissions — Iron, 196 Senile Debility^ Brain-extract, 219 Spermine, 217 Senile Gangrene — Camphor, 387 Septicemia — Alcohol, 571 Iron, 196 Quinine, 215 Serum-therapy, 296 Sequestra — Hydrochloric acid, 142 Sexual Excitement — Monobromated camphor, 387 CLINICAL INDEX: 833 Shock- Digitalis, 543 Ether, 400 Opium, 439 Skin, Diseases of — Acetic acid, 148 Aristol, 331 Cod liver oil, 135 Eucalyptus, 341 Hydrochloric acid, 143 Iodoform, 331 Liquor potassae, 161 Potassium carbonate, 161 Sulphuric acid, 144 Skin, Irritable and Inflamed Condi- tions of — Althaea, 779 Sleeplessness — Lactucarium, 446 Small-pox — Alcohol, 570 Sulphur, 671 Sore Nipples — Silver nitrate, 743 Tannic acid, 711 Sore Throat — Acetic acid, 148 Alum, 747 Hydrochloric acid, 141 Liquorice, 621 Sores, Foul-smelling — Hematoxylon, 719 Spasmodic Rigidity of Os Uteri — Belladonna ointment, 459 Chloral, 418 Spermatorrhea — Belladonna, 460 Bromides, 533 Camphoric acid, 387 Digitalis, 544 Ergot, 481 Gelsemium, 505 Lupulin, 445 Strychnine, 473 Tincture of cantharides, 765 Turpentine, 644 Spinal Congestion — Belladonna, 460 Ergot, 481 Spinal Diseases — Acetanilid, 391 Spinal Meningitis — Blisters, 761 Splenic Enlargements — Ergot, 481 Lead iodide, 732 Red-iodide-of-mercury ointment, 232 Spongy Gums — Catechu, 716 Krameria, 718 Myrrh, 337 Rhus glabra, 722 Tannic acid, 711 Tincture of benzoin, 335 ■ 53 Sprains — Alcohol, 569 Arnica, 589 Calendula, 178 Camphor liniment, 386 Hamamelis, 720 Olive oil, 776 Rhus toxicodendron, 488 Solution of lead subacetate, 731 Tansy, 706 Sthenic Fevers — Chloral, 419 Stomatitis — Alum, 747 Bismuth subnitrate, 751 Chlorine vifater, 356 Copper sulphate, 738 Geranium, 721 Salicylic acid, 316 Tannic acid, 711 Thymol, 377 Zinc sulphate, 736 Strabismus — Bromides, 532 Strangury- Demulcents, 772 Onion poultice, 620 Stricture — Aconite, 579 Olive oil, 776 Strumous Affections — Sanguinaria, 266 Strychnine-poisoning — Amyl nitrite, 526 Bromides, 532 Chloral, 418 Coniine, 501 Hydrasline hydrochlorate, 486 Potassium permanganate, 348 Subinvolution — Cannabis, 450 Ergot, 482 Glycerite of tannic acid, 774 Sweating- Alcohol, 569 Alum, 748 Belladonna, 459 Bismuth subnitrate, 75' Camphoric acid, 387 Ergot, 481 Gallic acid, 713 Hematoxylon, 7 19 Kino, 717 Lead oxide, 732 Pilocarpine, 595 Red rose, 723 Silver oxide, 744 Sulphuric acid, 144 Zinc oxide, 735 Swellings, Glandular — Tincture of iodine, 251 Swellings, Inflammatory — Ammonium chloride, 617 Hyposulphites, 355 834 CLINICAL INDEX. Sycosis — Phytolacca, 585 Resorcin, 324 Salicylic acid, 315 Salol, 319 Sulpiiur, 670 Tannic acid, 711 Sympathetic Cough — Asafetida, 387 Syncope — Alcoiiol, 570 Mustard, 768 Synovitis — Belladonna ointment, 458 Cantharidal blister, 765 Ichthyol, 326 Iodoform, 330 Lead acetate, 730 Mercurial ointment, 231 Tincture of iodine, 25 1 Vesicants, 761 Syphilis — Arsenic, 243 Bromides, 533 Chloride of zinc, 760 Chromic acid, 756 Cod liver oil, 136 Guaiac, 260 Iodides, 252 lodofonn, 331 Iron iodide, 195 Mercurial preparations, 231 Mezereon, 267 Nitric acid, 143 Papain, 132 Phytolacca, 585 Sanguinaria, 266 Sarsaparilla, 262 Serum-therapy, 296 Silver iodide, 744 Thyroid extract, 2ig Tabes Dorsalis — Acetanilid, 391 Tape-worms — Carbolic acid, 307 Ether, 400 Kousso, 699 Male fern, 698 Pomegranate, 700 Pumpkin seed, 701 Salicylic acid, 317 Tetanus — Acetanilid, 391 Amyl nitrite, 526 Bromides, 533 Chloral, 418 Conium, 501 Curare, 515 Gelsemium, 504 Opium, 438 Physostignia, 513 Salicylic acid, 316 Serum-therapy, 281 Tetanus — Strychnine, 472 Thyroid extract, 219 Tetany— Thyroid extract, 218 Thirst, to Quench — Demulcents, 772 Thread-worms — Rhubarb, 677 Throat, Acute Inflammation of — Tartar emetic, 607 Throat, Diseases of — Aristol, 331 Iodoform, 331 Liquor potassse, 161 Nitric acid, 142 Pilocarpine, 595 Throat, Relaxed — Myrrh, 337 Thrombosis — Ammonia, 576 Thrush- Sodium bicarbonate, 162 Sodium sulphocarbolate, 308 Thyroid Gland, Enlargement of — Iris, 679 Tic Doloureux — Aconite, 579 Butyl-chloral hydrate, 422 Strychnine, 472 Veratrine ointment, 584 Tinea Capitis — Carbolic acid, 306 Tinea Circinata — Cantharidal blister, 765 Carbolic acid, 306 Tinea Sycosis — Copper sulphate, 738 Tinea Tarsi — Copper sulphate, 738 Tinea Tonsurans — Cantharidal blister, 765 Carbolic acid, 306 Hydronaphtol, 322 Tincture of iodine, 252 Turpentine, 643 Tinea Versicolor — Sulphur ointment, 670 Toadstool-poisoning — Atropine, 460 Tobacco Habit — Cocaine, 497 Strophanthus, 549 Tongue, Fissure of — Glycerin, 774 Tongue, Tuberculosis of — Chromic acid, 757 Tonsillitis — Aconite, 579 Alum, 747 Camphorated naphtol, 322 Gallic acid, 712 Guaiac, 260 Guaiacol, 312 CLINICAL INDEX. 835 Tonsillitis — Phytolacca, 585 Quinine, 215 Rhus glabra, 722 Salicylic acid, 316 Silver nitrate, 743 Sodium bicarbonate, 161 Sodium sulphocarbolate, 308 Tannic acid, 711 Tonsils, Enlarged — Zinc iodide, 736 Zinc sulphate, 736 Toothache — Campho-phenique, 306 Camphorated chloral, 41 7 Capsicum, 365 Creosote, 309 Oil of cloves, 368 Torticollis — Capsicum, 365 Trachea, Congestion of — Creosote, 309 Tracheitis — Ipecac, 611 Silver nitrate, 743 Terpin hydrate, 628 Trachoma — Alum, 748 Bismuth subnitrate, 751 Trichophytosis — Gallonal, 713 Tubercular Joints — Iodoform, 330 Tuberculosis — Benzoyl-eugenol, 369 Bone-marrow, 219 Camphorated naphtol, 322 Cantharidin, 765 Cod liver oil, 135 Creosote, 309 Guaiacol, 312 Hydronaphtol, 322 Hypophosphites, 206 Iron, 195 Nuclein, 219 Phosphoric acid, 142 Serum-therapy, 291 Sulphur, 671 Tuberculous Ulceration — Calcium phosphate, 206 Lactic acid, 146 Turgescence of Nasal Mucous Mem- brane — Cubeb, 650 Tylosis — Salicylic acid, 315 Tympanitis — Asafetida, 387 Turpentine, 644 Tyfrhoid Fever — .^6acia, 778 . Alcohol, 570 Bismuth salicylate, 75^ Borax, 346 Typhoid Fever — Camphor, 387 Carbolic acid, 307 Digitalis, 544 Eucalyptus, 342 Hydrochloric acid, 143 Hydronaphtol, 322 Hyposulphites, 355 Nuclein, 219 Oxgall, 67s Potassium chlorate, 351 Quinine, 216 Salicylic acid, 316 Serpentaria, 179 Serum-therapy, 297 Sodium sulphocarbolate, 308 Strychnine, 471 Sulphur, 671 Thymol, 377 Turpentine, 644 Zinc sulphate, 736 Tjrphus Fever — Alcohol, 570 Camphor, 387 Serpentaria, 179 Ulcerated Nipples — Catechu, 715 Ulceration, Phagedenic — Nitric acid, 142 Ulcerations, Superficial — Castor oil, 666 Ulcer of Cervix — Carbolic acid, 306 Ulcer of Stomach — Pepsin, 130 Resorcin, 325 Ulcerous Gums — Tannic acid, 711 Ulcers — Alcohol, 569 Alum, 748 Alumnol, 322 Aristol, 331 Bismuth benzoate, 335 Bismuth subgallate, 752 Bismuth subiodide, 752 Bismuth subnitrate, 751 Camphor ointment, 386 Cantharidal Ulster, 764 Carbolic acid, 306 Catechu, 715 Chloral, 416 Chloride of zinc, 760 Chromic acid, 757 Copaiba, 647 Copper sulphate, 738 Fluid extract of hydrastis, 485 Galla, 714 Grindelia, 507 Hydrogen dioxide, 352 Iodoform, 330 Iron sulphate, 194 Kino, 716 836 CLINICAL INDEX. Ulcers — Lycopodium, 781 Nitrate of sanguinarine, 265 Nuclein, 219 Phytolacca, 585 Potassium bromide, 532 Potassium chlorate, 351 Potassium permanganate, 347 Resorcin, 324 Rhus glabra, 722 Silver nitrate, 743 Solution of chlorinated soda, 357 Tannic acid, 711 Tar, 624 Terebene, 627 Vesicants, 761 White oak, 715 Zinc oxide, 735 Zinc sulphate, 736 Ulcers of Mouth and Throat — Tincture of hydrastis, 485 Ulcers, Syphilitic — Carbolic acid, 306 Resorcin, 345 Ulcers, Venereal — Calomel, 231 Uremia — Opium, 438 Pilocarpine, 595 Uremic Convulsions — Chloral, 418 Urethral Caruncles — Cocaine, 495 Urethritis — Buchu, 638 Elm, 779 Uric-acid Diathesis — Lithium bromide, 533 Lithium preparations, 164 Urinary Organs, Inflamed Conditions of— Althsea, 779 Urticaria — Alcohol, 569 Anderson's powder, 386 Citric acid, 148 Copaiba, 648 Ergot, 481 Ether, 400 Hamamelis, 720 Hydrocyanic acid, 522 Menthol, 375 Solution of lead subacetate, 731 Uterine Cancer — Conium, 501 Iodoform, 330 Terebene, 627 Uterine Contraction, to Stimulate — Quinine, 216 Uterine Fibroids — Ergot, 480 Uterine Hemorrhage — Alcohol, 569 Catechu, 716 Uterine Hemorrhage — Cinnamon, 362 Ergot, 480 Hamamelis, 720 Hydrastine, 485 Ipecac, 611 Krameria, 718 Red rose, 723 Senegin, 626 White oak, 715 Uterine Polypi — Ergot, 480 Uterine Tumors — Ergot, 482 Uterine Ulcerations — Fluid extract of hydrastis, 485 Iodoform, 330 Uterus, Congestion of — Croton oil, 683 Glycerite of tannic acid, 774 Uterus, to Dilate Neck of — Elm, 779 Uvula, Relaxation of — Alum, 747 Catechu, 716 Kino, 716 Krameria, 718 Vaginal Ulcerations — Fluid extract of hydrastis, 485 Vaginitis — Ammonium chloride, 617 Copaiba, 648 Grindelia, 507 Lime water, 162 Valvular Diseases of Heart — Convallaria, 554 Digitalis, 541 Sparteine sulphate, 551 Strophanthus, 54S Varicocele — Ergot, 480 Hamamelis, 720 Varicose Ulcers — Hamamelis, 720 Varicose Veins — Ergot, 480 Hamamelis, 720 Variola — Glycerite of starch, 774 Venereal Sores — Black wash, 162 Hydrogen dioxide, 352 Salol, 319 Solution of nitrate of mercury, 232 Yellow wash, 162 Venereal Warts — Nitric acid, 142 Verruca — Alum, 747 Salicylic acid, 315 Vertigo — Cubeb, 651 Valerian, 388 CLINICAL INDEX. 837 Vesical Calculi — Piperazin, 655 "Vesical Catarrh — Silver nitrate, 744 Tar water, 624 Thymol, 377 "Vesical Tenesmus — Hyoscyamus, 464 Vomiting — Ammonium bromide, 533 Bismuth subnitrate, 751 Calomel, 232 Cantharidal blister, 765 Champagne, 570 Cocaine, 497 Cray powder, 232 Hydrochloric acid, 143 Hydrocyanic acid, 522 Ipecac, 611 Lime water, 162 Menthol, 375 Quinine, 216 Strychnine, 471 Vomiting of Pregnancy — Ammonium bromide, 533 Cerium oxalate, 753 Chloral, 418 Strychnine, 471 Vomiting of Uterine Disease- Cerium oxalate, 753 Vulvitis — Zinc sulphate, 736 Warts — Acetic acid, 148 /Arsenic, 240 Glacial acetic acid, 758 Potassium bichromate, 349 Salicylic acid, 315 Wasting Diseases — Cod liver oil, 135 Phosphoric acid, 143 Whooping Cough — Acetanilid, 391 Alum, 748 Ammonium chloride, 617 Asafetida, 387 Belladonna, 459 Bromides, S33 Whooping Cough — Bromoform, 533 Chloral, 417 Cod liver oil, 135 Coffee, 558 Conium, 501 Ergot, 481 Gelsemium, 504 Grindelia, 507 Hydrocyanic acid, 522 Hyoscyamus, 464 Ouabain, 549 Quinine, 216 Resorcin, 324 Silver nitrate, 743 Syrup of garlic, 620 ~ Tannic acid, 711 Terebene, 627 Zinc oxide, 735 Zinc sulphate, 736 Worms — Anthelmintics, 693 Chenopodium, 695 Kamala, 701 Olive oil, 776 Santonin, 696 Spigelia, 697 Wounds — Alcohol, 569 Bismuth subgallate, 752 Bismuth subnitrate, 751 Campho-phenique, 386 Chlorine water, 356 Compound tincture of benzoin, 334 Glycerin, 774 Iodoform, 330 Olive oil, 776 Resorcin, 324 Rhus glabra, 722 Salol, 319 Silver nitrate, 743 Sulphurous acid, 353 Terebene, 627 Turpentine, 643 Yellow Fever — Hyposulphites, 35s ■ Turpentine, 644 GENERAL INDEX. Note. — The bold-face figures indicate the pages on which the drugs are treated in extenso. Absolute alcohol, 560 Abstracta, 96 Abstracts, 96 Acacia, 771, 777 Aceta, 82 Acetanilid, 388 Acetanilidum, 388 Acetic acid, 146 glacial, 761 ether, 408 Acetum opii, 428 sanguinarise, 264 scilla, 63s Acid phosphates, 53 Acidum aceticum, 146 dilutum, 147 glaciale, 758 arsenosum, 234 benzoicum, 332 boricum, 344 camphoricum, 381 carbolicum, 302 iodatum, 303 chromicum, 756 citricum, 147 gallicum, 712 hydrobromicum dilutum, 529 hydrochloricum, 138 dilutuni, 138 hydrocyanicum dilutum, 519) 74^ hypophosphorosum dilutum, 205 lacticum, 144 dilutum, 138 nitricum, 139 dilutum, 139 nitrohydrochloricum, I38, 139 dilutum, 138, 139 phosphoricum, 138 salicylicum, 313 sulphuricum, 138 aromaticum, 139 dilutum, 136 sulphurosum, 353 tannicum, 710 tartaricum, 147 Aconite, 576 Aconitine, 577 Aco'nitum, 576 Adeps benzoinatus, 332 Adhesive plaster, 123 Adonis vernalis, 552 ^ther, 397 Albuminate of iron, 190 Alcohol, 559, 602, 769 absolutum, 560 deodoratum, 560 Alcoholic extract of belladonna leaves, 452 eye-wash, 58 Ale, 562 Alkali solutions, 53 Alkalies, 149, 615 Alkaline salt solutions, 52 Allium, 619 cepa, 619 Allspice, 369 Almond, 771 oil, 771 Almonds, comp., 102 Aloe, 672 barbadensis, 672 purificata, 673 socatrina, 673 Aloes, 672, 702 Aloin, 674 Aloinum, 674 Althsea, 779 Alum, 709, 745 (burnt), 755 Alumen, 745 exsiccatum, 745 Alumini hydras, 746 sulphas, 746 Aluminis glyceritum, 745 Aluminum aceto-tartrate, 745 boroformate, 746 hydrate, 746 sulphate, 746 Alumnol, 320-322, 745 American hellebore, 580 wormseed, 694 Ammonia, 769 (confined vapor), 761 liniment, 573 water, 573 Ammoniac, 380 plaster with mercury, 223, 380 Ammoniacum, 380 Ammoniated glycyrrhizin, 621 mercury, 222 tincture of guaiac, 259 of valerian, 382 Ammonii benzoas, 332 840 GENERAL INDEX. Ammonii bromidum, 527 carbonas, 156, 573 chloridum, 616 valerianas, 382 Ammonio-ferric alum, 186 sulphate, r86 tartrate, 186 Ammonium, 602 benzoate, 332 bromide, 527 carbonate, 156, 573 chloride, 615, 616 iodide, 245 iodidum, 245 valerianate, 382 Amyl nitris, 523 nitrite, 523, 602 Amylene hydrate, 410 Anemonin, 586 Anesthetics, 396 Anhydro-ortho-sulphanin-benzoic acid, 655 Animal charcoal, 772 extracts, 217 Anise, 359 water, 360 Anisum, 359 Anthelmintics, 693 Anthemis, 172 Antimonii et potassii tartras, 604 Antimony chloride, 755 and potassium tartrate, 5oo, 601, 615 Antipyrine, 392 Antiseptol, 327 Antispasmodics, 379 Apiol, 702, 707 Apiolum, 707 Apomorphine, 615 hydrochlorate, 600 Aqua acidi carbolici, 302 ammonia fortior, 572 ammonise, 573 anisi, 360 camphorse, 381 chlori, 355 chloroformi, 403 cinnamomi, 362 creasoti, 309 eucalypti, 339 foeniculi, 364 hydrogenii dioxidi, 351 menthae piperitas, 374 viridis, 376 picis liquidse, 622 Aquae medicatse, 5 1 Aqueous fluid extract of senna, 94 Argenti cyanidum, 739 iodidum, 248, 740 nitras, 740 dilutus, 589, 740 fusus, 740 oxidum, 741 Argonin, 744 Aristol, 327 Arnica, 769 Arnica floras, 587 flowers, 587 plaster, 587 radix, 587 root, 587 Aromatic bitters, 172 powder, 361, 371 of chalk, 154 and opium, 154 spirit of ammonia, 573 sulphuric acid, 139 syrup of rhubarb, 677 tincture of rhubarb, 676 waters — official, 51 Aromatics, 357 Arsem iodidum, 235 Arsenic iodide, 235 solutions, 52 trioxide, 234 Arsenious acid, 755 Arsenous acid, 234 Asafetida, 379, 702 Asaprol, 32O-322 Asparagin hydrargyrate, 226 Aspidium, 693, 694, 697 Aspidosperma, 515 Aspidospermine, 516 Astringents, 708 Atropa mandragora, 453 Atropina, 452 Atropinse sulphas, 453 Atropine, 452 compared with morphine, 457 sulphate, 453 Bacilli, 113 Balsam of copaiba, 645 of Peru, 337 of tolu, 615, 618 Balsamum Peruvianum, 337 tolutanum, 618 tranquillans, 117 Bandages — antiseptic dressings, 125 Barbadoes aloes, 672 Barker's pills, 1 1 1 Barley, 771 Basham's mixture, 52 Basic mercuric sulphate, 226 Basilicon, 121 Bateman's pectoral drops, 89 Baths, 702 Battery-fluid, 54 Bay rum, 57 Bearberry, 638 Beef and wine, 83 wine, and iron, 83 wine, iron, and cinchona, 84 Beer, 562 Belladonna, 659 leaves, 45 1 liniment, 452 ointment, 452 plaster, 452 root, 452 GENERAL INDEX. 841 Belladonnas folia, 451 radix, 452 Benzoate of bismuth, 333 of menthol, 333, 375 Benzoated lard, 332 Benzoic acid, 332 Benzoin, 331 Benzoinum, 331 Benzonaphtol, 320, 321 Benzosal, 310 Benzoyl-eugenol, 368 Benzoyl-sulphonic-imide, 655 Bestucheff's tincture, 88 Beta-naphtol, 320 Betol, 321, 322 Biniodide of mercury, 224 Birch tar, 623 JSismuth, 709 and ammonium citrate, 749 chrysophenate, 750 citrate, 749 naphtholate, 750 salicylate, 750 . subcarbonate, 749 subgallate, 750 subiodide, 750 subnitrate, 750 tribromphenate, 750 Bismuthi et ammonii citras, 749 benzoas, 333 citras, 749 salicylas, 750 subcarbonas, 749 subiodidum, 750 subnitras, 750 Bitter wine of iron, 184 Bitters, 170 Black cohosh, 61 draught, 81 drop, 82 haw, 71, 618 mustard, 766 oxide of manganese, 197 pepper, 366 wash, 226 Blackberry, 723 aromatic, 64 cordial, 71 Bland oils, 771 Blaud's pills, 109, 190 Blistering cerate, 1 20 collodion, 117, 762 paper, 124 Blood-root, 263 Blue cohosh, 705 flag, 678 mass, 106, 222 ointment, 119, 222 pill, 222 Bolus, 113 Bone-marrow, 219 Boracic acid, 344 Borax, 343, 702. 703 Bougies, 122 Boulton's solution, 54 Brain-extract, 219 Bran, 771 Brandy, 57, 560 Brayera, 699 Bread, 771 Bromide of iodine, 248 Bromides, 527, 602 Bromine, 756, 760 Bromoform, 529 Bromum, 760 Broom, 549 Brown mixture, 73, 621 Brown-S^quard's antineuralgic pills, 1 10 Buchu, 630, 637 Buckthorn, 68 berries, 64 Burgundy pitch, 770 -pitch plaster, 770 Burnt alum, 745 Butter of antimony, 755 Butternut, 679 Butyl-chloral hydrate, 422 Cacao butter, 771 Cactus, 552 Caffeina, 554 citrata, 554 effervescens, 555 Caffeine, 554 citrate, 554 Calabar bean, 508 Calamus, 372 Calcii bromidum, 528 carbonas prsecipitatus, 154 hypophosphis, 204 phosphas prsecipitatus, 204 sulphocarbolas, 307 Calcined magnesia, 156, 667 Calcium bromide, 528 hypophosphite, 204 sulphocarbolate, 307 Calendula, 1 71 Calomel, 223, 659 and jalap powder, 102 Calumba, 171 Calx, 759 chlorata, 356 Cambogia, 685 Camphor, 380, 769 ice, 121 liniment, 381 water, 381 Camphora, 380 carbolisata, 303 monobromata, 381 Camphorated carbolic acid, 303 chloral, 410 naphtol, 321, 322 tincture of opium, 381, 428 Camphoric acid, 381 Canada liniment, 114 -pitch plaster, 124 snake-root, 61 842 GENERAL INDEX. Cannabin tannate, 411 Cannabine tannate, 446 Cannabinone, 446 Cannabis Indica, 446 Cantharidal collodion, 762 pitch plaster, 770 Cantharides, 702, 761, 762 cerate, 762 Cantharidis paper, 124 Cantharis, 762 Capsicum, 364, 769 plaster, 365 Caraway, 377 Carbasus acidi carbolici, 302 Carbolated oil, 302 Carbolic acid, 302, 755 Carbolic-acid gauze, 302 plaster, 303 water, 302 Carbon tetrachloride, 408 Cardamom, 370 Cardamomum, 37O Cardiac stimulants, 534 Carron oil, 114 Carum, 377 Caryophyllus, 367 Casca bark, 637 Cascara sagrada, 70, 666 Cascarilla, 173 Cassia cinnamon, 361 fistula, 664 Castor oil, 665 Catarrh snuff, 102 Catechol, 323 Catechu, 709, 715 Cathartic acid, 681 Cathartics, 656 Cathartinic acid, 681 Caulophyllum, 702, 705 Caustic potash, 755, 757 ■ soda, 755, 757 Caustics (escharotics), 125, 754 Cayenne pepper, 364 Celery compound, 66 Cerata, 120, 121 Cerate of lead subacetate, 725 Cerates, 120 Ceratum cantharidis, 762 plumbi subacetatis, 725 Cerii oxalas, 753 Cerium oxalate, 709, 753 Cerous oxalate, 753 Cetraria, 771, 778 Cevadilla, 581 Ceylon cinnamon, 361 Chalk mixture, 72 Chalybeate pills, 1O9, 190 Chamomile, 172 Channing's solution, 54 Chapman's dinner pill, no mixture, 74 Charcoal, 772 Charta potassii nitratis, 589 sinapis, 767 Chemical food, 63 waters, official, 51 Chenopodium, 693, 694 Chinconidinse sulphas, 209 Chinoidine, 210 Chinoidinum, 210 Chinolin, 210 tartras, 210 tartrate, 210 Chirata, 172 Chloral, 410, 692 Chloral ammonium, 411 butylicum, 422 formamide, 420 formidatum, 420 glycerite, 410 menthol, 375 phenol, 410 urethane, 411, 420 Chloralamide, 420 Chloralofee, 411, 420 Chlor-ammonium, 420 Chloride of lime, 356 Chlorinated lime, 356 Chlorine water, 355 Chlorodyne, 403 Chlorofortn, 403, 769 anodyne, 74 emulsion, 403 liniment, 403 water, 403 Chloroformum, 463 Chlorohydrophosphate of lime, 6r Cholera mixture, 74 Chromic acid, 755, 756 anhydride, 756 triOxide, 756 Churchill's iodine caustic, 55 tincture of iodine, 88 Cimicifuga, 61 Cinchona, 207 rubra, 208 Cinchonidinse salicylas, 210 Cinchonidine salicylate, 210 sulphate, 209 Cinchonina, 209 Cinchoninse iodosulphas, 210 sulphas, 209 Cinchonine, 209 iodosulphate, 327 sulphate, 209 Cinnamomum, 360 Cinnamon, 360, 702 water, 362 Cinnamyl-eugenol, 368 Citric acid, 147 Citrine ointment, 226 Clemens' solution, 55 Cloves, 367 Coca, 68, 488 Cocaina, 489 Cocainse hydrochloras, 489 phenas, 489 Cocaine, 489 GENERAL INDEX. 843 Cocaine hydrochlorate, 489 phenate, 489 Cocculus, 473 Indicus, 473 Codeina, 429 Codeine, 429 Cod liver oil, 132, 702 Coffee, 62 Colchicum, 254 Cold cream, 119 Cole's dinner pill, 1 10 CoUodia, official, 117 Collodion, 772 Collodium stypticum, 710 cantharidatum, 762 Colocynth, 689 Colocynthis, 689 Colorless tincture of iodine, 88 Columbo, 171 Comparative action of alkalies, 160 Composition powder, 102 Compound anise powder, 103 cathartic pills, 685 chalk powder, 154 decoction of sarsaparilla, 261 effervescing powder, 687 extract of colocynth, 673, 689 fluid extract of sarsaparilla, 261 of stillingia, 263 infusion of senna, 363, 668, 681 iron mixture, 180, 336 jalap powder, 690 liniment of mustard, 767 liquorice powder, 364 mixture of glycyirhiza, 621 pills of antimony, 259 of rhubarb, 674 powder of glycyrrhiza, 621, 681 of jalap, 151 of morphine, 429 of rhubarb, 372 rhubarb pills, 676 powder, 676 solution of iodine, 245 spirit of aether, 397 of juniper, 363, 364, 378, 640 syrup of sarsaparilla, 261 of squill, 605, 625, 635 of stillingia, 263 tincture of benzoin, 332, 618, 674 of cardamom, 361, 370, 378 of catechu, 361 of cinchona, 174, 209 - of gentian, 171 of lavender, 361, 373 Compressed pills, 113 Confectio rosse, 723 sennae, 363 Confection of rose, 723 of senna, 363, 681 Confectiones, 104, 105 Confections, 104 Coniina, 498 Coniinse hydrobromas, 498 Coniine, 498 hydrobromate, 494 Conium, 498 juice, 498 Conserve of rose, 105 Convallamarin, 553 Convallamarinum, 553 Convallaria, 553 Convallarin, 553 Copaiba, 630, 645 Copper, 709 sulphate, 737, 755 Coriander, 362 Coriandrum, 362 Corn collodion, 118 Corrosive chloride of mercury, 223 mercuric chloride, 223 sublimate, 223 Cotton root bark, 482, 703 Court plaster, 772, 780 Coxe's hive syrup; 60 Cramp bark, 519 Cranesbill, 721 Cream of tartar, 151 Creasote, 308 water, 309 Creasotum, 308 Creosols, 303 Creta prseparata, 154 Croton chloral, 422 collodion, 118 oil, 682, 761 Cubeb, 649 Cubeba, 648 Culver's root, 680 Cupri arsenis, 236 sulphas, 737 Cupric arsenite, 236 Curapoa aloes, 672 cordial, 65 Curare, 513 Cusso, 693, 694, 699 Daley's carminative, 73 Damiana, 71 Dandelion, 669 Decocta, 82 Decoction of cetraria, 778 of stillingia, 263 Decoctions, 82 Decoctum cetrariae, 778 sarsaparillse corapositnm, 261 stillingise, 263 Definitions, 34 Demulcents, 771 Denarcotized opium, 428 Deodorant solution, 56 Deodorized alcohol, 560 opium, 428 Dermatol, 75° Dermol, 750 Dewees' carminative, 75 tincture of guaiac, 88 Diachylon, 123 844 GENERAL INDEX. Diachylon ointment, 726 plaster, 726 Dialyzed iron, 190 Diaphoretics, 592 Diethylendiamine, 654 Diethyl-sulphon-diethyl-methane, 423 Diethyl-sulphon-methyl-ethyl-methane, 423 Digestants, 129 Digitalin, 537 Digitalinum, 537 Digitalis, 537, 702 Digitoxin, 538 Diluted acetic acid, 147 hydrobromic acid, 529 hydrochloric acid, 138 hydrocyanic acid, 519, 740 hypophosphorous acid, 205 nitric acid, 139 nitrohydrochloric acid, IBS, 139 phosphoric acid, 138 silver nitrate, 589, 740 solution of lead subacetate, 725 sulphuric acid, 139 Dimethyl ether, 408 Dinner pill, 109 Disease medicines, 129 Dispensatory, 24 Dispermin, 654 Dithymol di-iodide, 327 Diuretin, 555, 630, 651 Dobell's solution, 56, 303 Donovan's solution, 52, 236 Dover's powder, loi, 428 Drastic purgatives, 689 Dried alum, 745 ferrous sulphate, 188 sodium carbonate, 153 Dry acid wines, 562 Dysmenorrhea mixture, 87 EcBOLics, 702 Effervescent Carlsbad salt, 104 citrated caffeine, 55s Kissingen salt, 104 magnesium citrate, 686 salts, 103 Vichy salt, 104 Effervescing saline water, 56 Elaterin, 684 Elaterinum, 684 Electuar. sennse, 105 Elixir aurantium compositum, 83 calisaya, 67 of paraldehyde, 426 of phosphorus, 199 paraldehydi, 426 phosphori, 199 purgans, 70 Elixiria, 64-71 EUxirs, 74 medicinal, 66 Elm, 778 Emetics, 599 Emmenagogues, 702 Emollients, 771 Emplastra, 122-124 Emplastrum acidi carbolici, 303 ammoniaci cum hydrargyro, 223, 380 arnicae, 587 belladonnae, 452 capsici, 365 ferri, 189, 77° hydrargyri, 223 ichthyocollae, 772, 780 opii, 428, 770 picis Burgundicae, 77° cantharidatum, 762, 770 plumbi, 726 Emulsion of ammoniac, 380 of asafetida, 379 Emulsiones, 77~79 Emulsions, 76 Emulsum ammoniaci, 380 asafoetidse, 379 chloroformi, 403 guaiaci, 259 Epispastics, 761 Epsom salt, 686 Ergot, 476, 659, 702, 703 of rye, 471 ' Ergota, 476 Ergotin, 477 Erythrophleum, 630, 637 Escharotics, 754 Eserine salicylate, 508 sulphate, 508 ■ Essence of ginger, 57 of nutmeg, 367 of peppermint, 374 of spearmint, 376 of wintergreen, 373 Ether, 769 Ethereal tinctures, 89 Ethyl bromide, 407 carbamate, 41 1 chloride, 407 iodide, 407 urethane, 411 Ethylene bichloride, 407 bromide, 407 chloride, 407 iodide, 407 Ethylenimine, 654 Ethylidene chloride, 407 Eucalyptol, 339 Eucalyptus, 338 water, 339 Eugenol-acetamide, 368 Euonymin, 678 Euonymus, 678 European hellebore, 581 Europhen, 328 Exalgine, 395 Expectorants, 614 Expressed oil of almond, 776 Extract of aconite, 576 of aloes, 673 of arnica root, 587 GENERAL INDEX. 845 Extract of cinchona, 209 of colchicum root, 254 of colocynth, 689 &f conium, 498 of convallaria, 553 of digitalis, 537 of ergot, 476 of euonymus, 678 of gentian, 171 of glycyrrhiza, 621 of hematoxylon, 719 of hyoscyamus, 462 of iris, 679 of jalap, 690 of juglans, 680 of krameria, 717 of leptandra, 680 , of nux vomica, 465 of opium, 428 of pancreas, 220 of physostigma, 508 of podophyllin, 692 Of Pulsatilla, 586 of quassia, 170 of rhubarb, 676 of taraxacum, 672 of uva ursi, 639 Extracta, 95 fluida, 90-94 Extractive preparations, 79 Extracts, 95 official, table of average doses, 96 Extractum aconiti, 576 .fluidum, 576 aloes, 673 arnicae radicis, 587 fluidum, 587 aspidospermatis fluidum, 516 belladbnnse foliorum alcoholicum, 452 radicis fluidum, 452 cacti fluidum, 552 calami fluidum, 372 calendulae fluidum, 172 calumbae fluidum, 171 cannabis indicje, 446 fluidum, 446 capsici fluidum, 365 chiratse fluidum, 172 cinchonse, 209 fluidum, 209 cocse fluidum, 489 cocculi fluidum, 474 colchici radicis, 254 fluidum, 254 seminis fluidum, 255 colocynthidis, 689 cpmpositum, 673, 689 conii, 498 fluidum, 498 convallarise fluidum, 553 cubebse fluidum, 649 cusso fluidum, 699 digitalis, 537 fluidum, 537 Extractum ergotae, 476 fluidum, 477 eucalypti fluidum, 338 euonymi, 678 gelsemii fluidum, 502 gentianse, 171 fluidum, 171 geranii fluidum, 721 glycyrrhiza;, 621 fluidum, 621 purum, 621 gossypii radicis fluidum, 482 grindelise fluidum, 506 hsematoxyli, 719 hamamelidis fluidum, 719 hydrastis fluidum, 483 hyoscyami, 462 fluidum, 462 ipecacuanhae fluidum, 608 iridis, 679 fluidum, 679 jalapse, 690' juglandis, 680 juniperi fructus fluidum, 640 kramerise, 717 fluidum, 717 leptandrae, 680 fluidum, 680 lobelize fluidum, 613 lupulini fluidum, 444 mezerei fluidum, 267 nucis vomicse, 465 fluidum, 465 opii, 428 physostigmatis, 508 phytolaccae radicis fluidum, 585 pilocarpi fluidum, 592 podophylli, 692 fluidum, 692 Pulsatilla, 586 quassiae, 170 fluidum, 170 rhei, 676 fluidum, 676 rhois aromaticEe fluidum, 722 glabrae fluidum, 722 rosje fluidum, 723 rubi fluidum, 724 sabiuse fluidum, 703 sanguinariae fluidum, 264 sarsaparillae fluidum, 261 compositum, 261 scillse fluidum, 635 scoparii fluidum, 549 senegae fluidum, 625 sennse fluidum, 681 serpentariae fluidum, 174 spigelise fluidum, 697 stillingise fluidum, 263 compositum, 263 stramonii seminis, 461 fluidum, 461 taraxaci, 672 fluidum, 672 346 GENERAL INDEX. Extractum uvfe ursi, 639 fluidum, 639 Valerianae fluidum, 382 veratri viridis fluidum, 581 viburni opuli fluidum, 519 prunifolii fluidum, 518 xanthoxyli fluidum, 268 zingiberis fluidum, 371 False hellebore, 552 Fats and oils, 132 Fehling's solution, 54 Fel bovis, 675 pufificatum, 675 tauri, 67s Fennel, 363 water, 364 Fennel's guaiac mixture, 87 Ferrated extract of apples, 88 Ferratin, 190 Ferri albuminas, 190 arsenas, 190 carbonas saccharatus, 180 chloridum, 181 citras, 182 et ammonii citras, 183 sulphas, 186 tartras, 186 et potassii tartras, 186 et quininas citras, 1 83 solubilis, 184 et strychninse citras, 184, 466 hypophosphis, 187 iodidum saccharatum, 181 lactas, 185 oxidum hydratum, 185 cum magnesise, 185 phosphas solubilis, 186 pyrophosphas solubilis, 187 sulphas, 188 exsiccatus, 188 granulatus, 188 valerianas, 187, 382 Ferric ammonium sulphate, 186 chloride, l8i citrate, 1 82 hydrate, 185 with magnesia, 185 hydroxide, 185 hypophosphite, 187 valerianate, 187> 382 Ferrous chloride, 62 lactate, 185 1 sulphate, 188 Ferruginous pills, 109, 190 F'errum dialysatum, 190 reductum, 179 Figs, 771 Fish berry, 473 Flaxseed, 771 Flour, 771 Fluid extract of aconite, 576 of arnica root, 587 of aspidosperma, 516 Fluid extract of belladonna root, 452 of black haw, 518 of cactus, 552 of calamus, 372 of calendula, 172 of calumba, 171 of capsicum, 365 of chirata, 172 of cinchona, 209 of coca, 489 of cocculus, 474 of colchicum root, 254 seed, 255 of conium, 498 of cotton-root bark, 482 of cramp bark, 519 of cubeb, 649 of cusso, 699 of digitalis, 537 of ergot, 477 of eucalyptus, 338 of gelsemium, 502 of gentian, 171 of geranium, 721 of ginger, 371 of glycyrrhiza, 621 of grindelia, 506 of hamamelis, 719 of hydrastis, 483 of hyoscyamus, 462 of Indian cannabis, 446 of ipecacuanha, 608 of iris, 679 of juniper berries, 640 of krameria, 717 of leptandra, 680 of lobelia, 613 of lupulin, 444 of mezereon, 267 of nux vomica, 465 of Phytolacca root, 585 of pilocarpus, 592 of podophyllum, 692 of quassia, 170 of rhubarb, 676 of rhus aromatica, 722 glabra, 722 of rose, 723 of rubus, 724 of sanguinaria, 264 of sareaparilla, 261 of savine, 703 of scoparius, 549 of senega, 625 of senna, 681 of serpentaria, l^ of spigelia, 697 of squill, 635 of stillingia, 263 of stramonium seed, 461 of taraxacum. 672 of II va ursi, 639 of valerian, 382 of veratrum viride, 581 GENERAL INDEX. 847 lid extract of xanthoxylum, 268 lid extracts, 90 lorescein, 323 miculum, 363 mentations, 125 rmamidate of mercury, 226 rmic ether, 408 tier's solution, 52, 235 iglove, 537 incis's triplex pill, 112 rench mixture," 54 able pills, 113 dberry's mixture, 75 Ibanum plaster, 124 lla. 709, 713 Ilic acid, 709, 712 mboge, 685 rlic, 61S, 619 3tric sedatives, 6oi strin, 220 latin, 771 Isemina, 502 Isemium, 502 iitian, 170 Qtiana, 170 ranium, 709, 721 ', 57, 561 iger, 371 icial acetic acid, 755, 758 luber's salt, 688 >bules, 112 icusimide, 655 iside, 65s 'cerin, 659, 771, 772 'cerinum, 772 'cerita, 71, 72 'cerite of alum, 745 if boroglycerin, 344 if carbolic acid, 302 if glyceryl borate, 344 if. hydrastis, 483 if starch, 773 if tannic acid, 710 if tar, 623 if yolk of egg, 773 ceritum acidi carbolici, 302, 773 tannici, 710, 773 myli. 773 oroglycerini, 344, 773 ydrastis, 483, 773 icis liquidee, 623 item, 773 cerole of pepsin, 72 conin, 773 cyiThiza, 620 cyrrhizinum ammoniatum, 621 Ifrey's cordial, 75 den seal, 483 isypii radicis cortex, 482 ilard's cerate, 121, 725 xtract, 725 natum, 693, 694, 699 nulated ferrous sulphate, 1 88 Granules, 112 Green iodide of mercury, 224 Griffith's mixture, 72, 180 Grindelia, 505, 615 Gross's antineuralgic pills, 110 Guaiac, 258, 702 emulsion, 259 Guaiaci lignum, 258 resina, 258 Guaiacol, 310 benzoate, 310 carbonate, 311 di-iodide, 311 di-iodidum, 311 salicylate, 3 1 1 Guaiacoli benzoas, 310 carbonas, 311 salicylas, 311 Guaiacolum, 310 Guaiacum wood, 258 Guaramine, 555 Gum Arabic, 777 H^MALBUMIN, 191 Hsemoferrum, 191 Haemogallol, I go Haemoglobin, 191 Haemol, 190 Hall's dinner pill, no solution of strychnine, 56 Hamamelis, 709, 719 Heart-extract, 220 Hebra's ointment, 119 Hedeoma, 702, 707 Heliotropin, 366 Hematics, 179, 702 Hematoxylon, 709, 718 Hemlock, 498 Henbane, 462 Hiera picra, 102 Hive syrup, 605 Hoffman's anodyne, 58, 397 Homatropina, 453 Honey, 771 Hope's mixture, 73 Hops, 443 Hot drops, 88 Humulus, 443 Huxham's tincture, 86 Hydragogue purgatives, 682 Hydvargj'ri chloridum mite, 223 corrosivum, 223 cyanidum, 224 formaraidatum, 226 iodidum flavum, 224 rubrum, 224 viride, 224 oxidum flavum, 22$ rubrum, 225 salicylas, 226 subsulphas flavus, 226 tannas, 226 Hydrargyrum, 221 ammoniatum, 222 848 GENERAL INDEX. Hydrargyrum cum creta, 154, 222 Hydrastina, 483 Hydrastinse hydrochloras, 483 Hydrastine, 483 hydrochlorate, 483 Hydrastis, 483, 702, 703 Hydrated oxide of iron, 185 ^ Hydrochloric acid, 138 Hydrocyanic acid, 602 Hydrogen peroxide, 51 Hydronaphtol, 321, 322 Hydroquinol, 323 Hydroquinone, 323 HyosciuEe hydrobromas, 462 Hyoscine hydrobromate, 411, 462 Hyoscyami sulphas, 463 Hyoscyaminse hydrobromas, 463 Hyoscyamine hydrobromate, 463 sulphate, 463 Hyoscyamus, 462, 659 Hypnal, 411, 420 Hypophosphite of iron, 62 of lime, 61 and soda, 61 Ice, 601 Iceland moss, 778 Ichthyocolla, 780 Ichthyol, 325 Ichthyolum, 325 Indian tobacco, 612 Infusa, 81, 82 Infused oils, 117 Infusion of cinchona, 209 of convallaria, 553 of digitalis, 537 of hops, 444 of juniper, 640 of pilocarpus, 592 of wild cherry, 174 Infusions, 81 Infusum cinchonse, 209 convallarise, 553 digitalis, 537 humuli, 444 juniperi, 640 pilocarpi, 593 pruni Virginians;, 174 sennas compositum, 363, 668, 681 lodi bromidum, 248 chloridum, 248 Iodide of calcium, 61 of iron and manganese, 62 Iodine, 244, 761, 769 caustic, 55 chloride, 248 ointment, 245 trichloride, 248 Iodized collodion, 118 carbolic acid, 303 Iodoform, 327 collodion, 118 and naphtalin powder, 102 lodoformum, 327 lodol, 328 lodum, 244 Ipecac, 608, 761 Ipecacuanha, 600, 608, 61 5 Iridin, 679 Iris, 678 Irish moss, 62 Iron, 702 and ammonium tartrate, 1 86 citrate, 183 and potassium tartrate, 186 and quinine citrate, 183 and strychnine citrate, 1 84 arsenate, 190 by hydrogen, 179 plaster, 189 quinine chloride, 191 solutions, 52 Isinglass, 771, 780 plaster, 780 Jaborandi, 69, 592 Jaborine, 593 Jackson's pectoral syrup, 63 Jalap, 690 Jalapa, 690 James's powder, loi Jamestown weed, 460 Janeway's pills, 1 10 Javelle water, 55 Jimson weed, 460 Juglans, 679 Juniper, 630, 639 berries, 639 Juniperus, 639 Kamala, 693, 694, 700 Kino, 709, 716 Kosin, 699 Kdussein, 699 Koussa, 699 Krameria, 709, 717 Labarraque's solution, 53, 356 Lac sulphur, 669 Lactic acid, 144 Lactophosphate of lime with iron, 62 of iron, 62 Lactucarium, 445 Lady Webster's dinner pills, 109 Lafayette mixture, 74 Lamellae, 113 Lard, 771 Laudanum, 428 Laughing gas, 409 Laxative elixir, 70 Laxatives, 664 Lead, 709, 724 acetate, 724 carbonate, 725 iodide, 247, 725 nitrate, 726 oxide, 726 plaster, 726 GENERAL INDEX. 849 ad water, 53, 725 eches, 702 ptandra, 680 ptandrin, 680 vant wormseed, 695 ;ht magnesia, 156j 667 red wines, 562 jnum vitae, 258 iy of the valley, 553 me, 755, 759 juice and pepsin, 71 liniment, 155 water, 53, 155 niment of lead subacetate, 725 nimenta, 114, 115 niments, 114 nimentum album, 115 ammoniae, 573 belladonnee, 452 calcis, 15s camphorae, 381 chloroformi, 403 plumbi subacetatis, 725 saponis, 381 sinapis compositum, 767 nseed meal, 771 oil, 771, 777 quid mixtures — internal, 72 rennet, 56 quor acidi arsenosi, 235 ammonii acetatis, 596 antimonii chloridi, 755 arseni bromidi, 236 arsenii bromidi, 55 et auri bromidi, 236 et hydrargyri iodidi, 225, 236 calcis, 15s ferri acetatis, 182 chloridi, 182 citratis, 183 dialysatus, 190 et ammonii acetatis, 182, 597 nitratis, 189 oxychlorati, 190 peptonati, 190 subsulphatis, 188 tersulphatis, 189 hydrargyri nitratis, 226 iodi compositus, 245 magnesii citratis, 686 mangano-ferri peptonatus, 1 90 plumbi subacetatis, 725 dilutus, 725 potassae, 150 arsenitis, 235 sedans, 518 sodse, 152 chloratae, 356 sodii arsenatis, 236 boratis compositus, 303 carbolatus, 303 quores, 51 unofficial, 53-57 quorice, 63, 615, 620, 771 , 54 Liquorice root, 620 Litharge, 726 Lithii bromidum, 528 benzoas, 333 carbonas, 155 citras, 155 effervescens, 156 salicylas, 313 Lithium bromide, 528 benzoate, 333 carbonate, 155 citrate, 155 salicylate, 313 Lobelia, 600, 605, 612 Local anti-emetics, 601 Logwood, 718 Loomis's diarrhea mixture, 74 Losophene, 328 Lotio flava, 226 nigra, 226 Lotiones, 115, 116 Lugol's solution, 53 Lunar caustic, 740 Lupulin, 443 Lupulinum, 443 Lycopodium, 772, 781 Lysol, 623 Mace, 366 Macis, 366 Magendie's solution of morphine, 55 Magnesia, 659, 667 Magnesii carbonas, 156, 668 sulphas, 686 effervescens, 686 sulphocarbolas, 307 Magnesium carbonate, 156, 659, 668 sulphate, 686 sulphocarbolate, 307 Male fern, 697 Mandrake, 453 Manganese, 197 dioxide, 197 sulphate, 197 Mangani dioxidum, 197 sulphas, 197 Manganum, 197 Manna, 668 Marigold, 171 Marshmallow, 771, 779 Mass of copaiba, 646 of ferrous carbonate, 180 of "mercury, 222 Massa ferri carbonatis, 180 copaibse, 646 hydrargyri, 222, 773 Massae, 106 Masses, 106 May apple, 692 Meadow-saffron, 254 Medicated cottons, 126 dressings, 126 gauzes — carbasa, 126 waters, 51 850 GENERAL INDEX. Medicines, administration of, 29 classification of, 24 disease, 26 dosage, 31 symptom, 26 Medullin, 220 Mentha piperita, 374 viridis, 375 Menthol, 375, 769 benzoas, 333 Mercurial ointment, 222 plaster, 223 Mercuric chloride, 75S cyanide, 224 nitrate, 75S oxide, 7SS Mercurous salicylate, 226 tannate, 226 Mercury, 221 with chalk, 154, 222, 660 Metallorum amarse, 112 Methyl chloride, 407 Methylacetanilide, 395 Methylal, 408 Methylen, 408 Methylene bichloride, 407 Methylic ether, 408 Metric system, 42 Mezereon, 266, 761, 7^9 Mezereum, 266 Mild chloride of mercury, 223 mercurous chloride, 223 Milk of sulphur, 669 Mineral acids, 137, 755 astringents, 709, 724 waters, 165 Mistura antidysenterica, 73 ferri composita, 180, 336 ' glycyrrhizse composita, 621 opii alkalina, 75 ~" rhei et sodae, 153, 676 solvens simplex, 73 Misturs, 72-76 Mitigated caustic, 740 Mixture of chloral and bromide, 73 of rhubarb and soda, 153, 676 Monobromated camphor, 381 Monsel's solution, 52, 188 Morphina, 429 MorphinEe acetas, 429 hydrochloras, 429 sulphas, 429 Morphine, 659 acetate, 429 hydrochlorate, 429 .(^ sulphate, 429 Mother's salve, 120 Motor excitants, 464 Moulded silver nitrate, 740 Mucilage of acacia, 777 of elm, 779 of sassafras pith, 780 of tragacanth, 780 Mucilages, 72 Mucilagines, 72 Mucilago acacise, 777 sassafras meduUae, 780 tragacanthffi, 773, 780 ulmi, 779 Muriatic acid, 138 Muscarine, 659 Muscle-extract, 220 Mustard, 702, 766, 769 paper, 767 volatile oil, 761 Myristica, 366 Myrrh, 336, 702 Myrrha, 336 Naphtalin, 320 Naphtalinum, 320 Naphtol, 320 Naphto-salol, 321 Native mineral springs, list of, 168 Neutral mixture, 52 Nitre, 389 Nitric acid, 139 Nitroglycerin, 602 pills. III Nitrohydrochloric acid, 138, 13!) Nitrous oxide, 409 Nutgall, 713 Nutmeg, 366 Nux vomica, 465, 659 Oatmeal, 771 Official — officinal, 23 Oil of allspice, 369 of American wormseed, 694 of anise, 359 of cade, 623 of cajuput, 369, 769 of caraway, 378 of chenopodium, 694 of cinnamon, 361 of cloves, 368 of copaiba, 646 of coriander, 363 of cubeb, 649 of eucalyptus, 338 of fennel, 364 of flaxseed, 777 of hedeoma, 707 of juniper, 639 "of lavender flowers, 373 of nutmeg, 367 of pennyroyal, 707 of peppermint, 374 of pine, 622 of rue, 703, 705 of sandalwood, 648 of savine, 703 of Scotch fir, 615, 622 of tar, 622 of turpentine, 769 of wintergreen, 373 Ointment of ammoniated mercury, 222 of carbolic acid, 302 GENERAL INDEX. 851 Ointment of iodoform, 327 of lead carbonate, 725 iodide, 726 of mercuric nitrate, 226 of potassium iodide, 246 of red mercuric oxide, 225 of sulphur iodide, 247 of tannic acid, 710 of yellow mercuric oxide, 225 of zinc oxide, 733 Oleata, official, 116 unofficial, 117 Oleate of aconite, 577 of sodium, 56 of veratrine, 581 Oleates, 116, 117 Oleatum aconitinse, 577 veratrinse, 581 Oleoresin of aspidium, 697 of capsicum, 365 of cubeb, 649 of ginger, 371 of lupulin, 444 of pepper, 366 Oleoresina aspidii, 697 capsici, 365 cubebae, 649 lupulini, 444 piperis, 366 zingiberis, 371 Oleoresinae, 97 Oleoresins, 97 Oleum acidi carbolici, 302 amygdalae expressum, 776 anisi, 359 cadinum, 623 cajuputi, 369 cari, 378 caryophylli, 368 chenopodii, 694 cinnamomi, 361 copaibae, 646 coriandri, 363 cubeb^, 649 eucalypti, 338 foeniculi, 364 gaultherise, 373 hedeoma, 707 juniperi, 639 lavandul^ florum, 373 lini, 777 menthse piperitse, 374 morrhuse, 132 myristicse, 367 olivse, 775 phosphoratum, 199 picis liquidse, 622 pimentse, 369 pini sylvestris, 615, 622 ricini, 665 rusci, 623 rutfe, 705 sabinee, 783 santali, 648 Oleum sinapis volatile, 767 templinum, 622 tiglii, 682 Olive oil, 771, 775 Onion, 615, 619 Opii pulvis, 428 Opium, 427, 602 compared with its alkaloids, 442 deodoratum, 428 plaster, 428 Opodeldoc, 115 Organotherapy, 217 Orthodioxylbenzene, 323 Ouabain, 547 Ovarin, 220 Oxgall, 67s Oxysulphate of iron, 54 Oxytocics, 702 Pancreatic solution, 55 Pancreatin, 131 Pancreatinum, 131 Papain, 131 Papers, 124 Paradioxybenzene, 323 Paraffin, 771 Paraldehyde, 425 Paraldehydum, 425 Paregoric, 86, 428 Parrish's camphor mixture, 73 Parsley, 706 Parvules, 112 Pearson's solution, 236 Pelletierinae tannas, 700 Pelletierine, 700 tannate, 700 Pennyroyal, 707 Pental, 408 Pepo, 693, 694, 701 Pepper, 366 Peppermint, 374 Pepsin, 129 Pepsinum, 129 saccharatum, 130 Peptonizing powder, 102 Petrolatum, 771 Petroleum, 771 Petroselinum, 706 Pharmaceutical preparations, 49 Pharmacology, 21 Pharmacopoeia, 23 Pheasant's eye, 552 Phenacetin, 393 PhenocoU, 394 Phenol-camphor, 303 iodatum, 303 -sodique, 56, 303 Phenyl salicylate, 318 Phosphatic emulsion, 79 Phosphorated oil, 199 Phosphoric acid, 138 Phosphorus, 198 Physostigma, 608, 6S9 Physostigminse hydrobromas, 509 852 GENERAL INDEX. Physostigminse, salicylas, 508 sulphas, 508 Physostigmine hydrobromate, 509 salicylate, 508 sulphate, 508 Phytolacca fruit, 584 root, 584 Phytolaccse fructus, 584 radix, 584 Picrotoxin, 474 Picrotoxinum, 474 Pills, 107 of aloes, 673 and asafetida, 379, 673 and iron, 189, 673 and mastich, 673 and myrrh, 336, 673 of asafetida, 379 of ferrous carbonate, 190 iodide, 181 of opium, 428 of phosphorus, 199 of rhubarb, 676 Pilocarpinas hydrochloras, 592 Pilocarpine, 592, 659, 703 hydrochlorate, 592 Pilocarpus, 592, 615 Pilulee, 107-112 aloes, 673 et asafoetidae, 379, 673 et ferri, 189, 673 et mastiches, 673 et myrrhas, 336, 673 antimonii composite, 259 asafoetidae, 379 catharticse compositse, 685, 689, 690 vegetabiles, 680, 689, 690 Cochia, III ferri carbonatis, 190 iodidi, l8i et quininse compositas, 112 hydrargyri, 222, 660 official, 109 opii, 428 phosphori, 199, 773 rhei, 676 compositas, 674, 676 unofficial, 109-I12 Pimenta, 369 Pinkroot, 697 Piper, 366 Piperazidine, 654 Piperazinum, 654 Piperin, 366 Piperinum, 366 Piperonal, 366 Pitch, 769 Pix betulEE, 623 Burgundica, 770 liquida, 622. Pixol, 623 Plaster-mull, 125 Plaster-of- Paris bandages, 127 Plasters, 122 Plumbi acetas, 724 carbonas, 725 iodidura, 247, 725 nitras, 726 oxidum, 726 Plumbum, 724 Plummer's pills, 259 Plummet's pills, 109 Podophyllotoxin, 692 Podophyllum, 692 Poison ivy, 486 Poke root, 584 Pomegranate, 699 Port wine, 561 Porter, 562 Potassa, 757 and hme, 755 with lime, 757 Potassii acetas, 150 bicarbonas, 150 bichromas, 348 bitartras, 151 bromidum, 527 carbonas, 151 chloras, 349 citras, 151 cyanidum, 523 et sodii tartras, 687 hypophosphis, 205 iodidum, 246 nitras, 589 permanganas, 346 sulphas, 686 sulphocarbolas, 307 tartras, 152 Potassio-ferric tartrate, 186 Potassium acetate, 150 and sodium tartrate, 687 bicarbonate, 150 bichromate, 348 bitartrate, 151, 659 bromide, 527 carbonate, 151 chlorate, 349 citrate, 151 cum calcii, 757 cyanide, 523 hydrate, 757 hydroxide, 757 hypophosphite, 205 iodide, 246, 615 nitrate, 589 paper, 589 permanganate, 346, 703 sulphate, 686 sulphocarbolate, 307 tai-trate, 152, 659 Poultice (cataplasm), 125 Powder of ipecac and opium, 428, 609 Powdered opium, 428 Powders, 100 unofficial, loi Precipitated calcium carbonate, 154 phosphate, 204 GENERAL INDEX. 853 Precipitated sulphur, 669 zinc carbonate, 733 Preparations for external use, 1 13 of ammonium, 156 of calcium, 154 of iron, 179 of lithium, 155 of magnesium, 156 of sodium, 152 Prepared chalk, 154 Prescription-writing, 796 Prescriptions, 782 Prickly ash, 268 Proof spirit, 561 Protective agents, 771 Protoxide of mercury, 224 Prunus Virginiana, 173 Prussic acid, 519, 740 Pulsatilla, 586 Pulveres, 100-103 Pulvis aromaticus, 361, 371 cretse aromaticus, 154 cum opio, 154 compositus, 154 digestivus, 102 effervescens compositus, 687 glycyrrhizse compositus, 364, 621, 681 ipecacuanhse et opii, 428, 609 jalapae compositus, 151, 690 morphinae compositus, 429 rhei compositus, 372, 676 Pumpkin seed, 700 Purging cassia, 664 Purified aloes, 673 cotton, 772 oxgall, 67s Pyrocatechin, 323 Quassia, 170 Quebrachine, 516 Quebracho, 615 Queen's root, 262 Quercus alba, 709, 714 Quevenne's iron, 179 Quicksilver, 221 Quinetum, 210 Quinidinae sulphas, 209 Quinidine sulphate, 209, 210 Quininse bisulphas, 209 hydrobromas, 209 hydrochloras, 210 carbamidata, 211 sulphas, 210 valerianas, 2 ID Quinine, 209, 702, 703 bisulphate, 209 hydrobromate, 209 hydrochlorate, 210 valerianate, 210 Rectified spirit, 561 Red cinchona, 208 iodide of mercury, 224 mercuric iodide, 224, 225 Red precipitate, 225 rose, 723 wine, 561 Reduced iron, 179 Remedies, 21 Renin, 220 Resin of copaiba, 646 of jalap, 690 of podophyllum, 692 of scammony, 691 Resina copaibae, 646 jalapK, 690 podophyUi, 692 scammonii, 691 Resinas, 98 Resins, 98 Resopyrine, 323 Resorcin, 323 Resorcinum, 323 Restoratives, 129 Rhamnus Purshiana, 666 Rhatany, 717 Rheum, 675 Rhubarb, 675 Rhus aromatica, 722 glabra, 709, 722 toxicodendron, 486, 761 Rochelle salt, 687 Rosa gallica, 709, 723 Rottlera, 700 Rotulae, 113 Rubefacients, 769 Rubi compositum, 70 Rubus, 709, 723 Rue, 702, 704 Rum, 561 Ruta, 704 Sabina, 703 Saccharated ferrous iodide, 181 carbonate, 180 Saccharin, 655 Saccharine substances, 615 Saccharinum, 655 Salicin, 319 Salicinum, 319 Salicylated powder of talcum, 103 Sahnaphtol, 321 Salol, 318 Saltpetre, 589 Sanguinaria, 263 Sanguinarine nitrate, 264 Santonica, 693-695 Santonin, 695 Santoninum, 695 Saponin, 615 Sarsaparilla, 261 Sassafras medulla, 780 pith, 771, 780 Savine, 702, 703 Scammonium, 691 Scammony, 691 Scilla, 634 Scoparine, 550 854 GENERAL INDEX. Scoparius, 549 Scopola carniolica, 453 japonica, 453 Sebadilla, 581 Seidlitz powder, loi, 687 Senega, 615, 625 Senna, 680 aromatic, 64 compound, 64 Serpentaria, 174 Serum-therapy, 269 Sherry wine, 561 Silver, 709 cyanide, 739 iodide, 248, 740 nitrate, 740, 755, 761 oxide, 741 Simple bitters, 170 cerate, 120 purgatives, 672 Sinapis alba, 766 nigra, 766 Slippery elm, 771, 778 Smith's solution of bromine, 53 Soap liniment, 381, 771 Socotrine aloes, 673 Soda, 757 mint, 75 Sodii acetas, 152 arsenas, 236 benzoas, 333 bicarbonas, 152 bisulphis, 354 boras, 343 bromidum, 527 carbonas, 153 exsiccatus, 153 hypophosphis, 204 hyposulpliis, 354 iodidum, 246 nit-ras, 591 nitris, 525 phosphas, 687 '~~- salicylas, 313 sulphas, 688 sulphis, 354 sulphocarbolas, 307 Sodio-salicylate of theobromine, 651 Sodio-theobromine salicylate, 555 Sodium acetate, 152 arsenate, 236 benzoate, 333 bicarbonate, 152 bisulphite, 354 borate, 343 bromide, 527 carbonate, 153 hydrate, 757 hydroxide, 757 hypophosphite, 204 hyposulphite, 354 iodide, 246 nitrate, 591 nitrite, 525 Sodium orthophosphate, 687 phosphate, 687 salicylate, 313 sulphate, 688 sulphite, 354 sulphocarbolate, 307 Solid mixtures, internal use, 99 opodeldoc, 115 Soluble.ferric phosphate, 186 pyrophosphate, 187 iron and quinine citrate, 184 saccharated iron, 63 Solution of ammonium acetate, 596 of antimony chloride, 755 of arsenic and gold bromide, 236 and mercuric iodide, 225, 236 bromide, 236 of arsenous acid, 235 of basic ferric sulphate, 188 of boroglyceride, 344 of calcium hydrate, 155 of chlorinated lime, 356 potassa, 55 of ferric acetate, 182 chloride, 182 citrate, 183 nitrate, 189 subsulphate, 188 sulphate, 189 of ferrous chloride, 54 of gutta-percha, 772 of hydrogen dioxide, 351 of iodide of mercury and potassium, 54 of iron and ammonium acetate, 182j 597 of lead subacetate, 725 of liine, 155 of magnesium citrate, 686 of mercuric nitrate, 226 of oxysulpliuret of calcium, 54 of peptonate of iron, 190 and manganese, 190 of potash, 150 of potassium arsenite, 235 of saccharin, 55 of soda, 152 of sodium arsenate, 236 hydrate, 152 silicate, 772 Solutions, 51 of metallic compounds, 53 Sozal, 746 Sozoiodol, 328 Spanish flies, 762 Sparkling wines, 561 Sparteine sulphas, 550 Sparteine sulphate, 550 Spearmint, 375 water, 376 Spermaceti, 771 Spice plaster, 124 Spigelia, 693, 694, 697 Spirit of ammonia, 572 of anise, 360 of camphor, 381 GENERAL INDEX. 855 Spirit of chloroform, 403 of cinnamon, 362 of ether, 397 of gaultheria, 373 of glonoin, 525 of juniper, 640 of lavender, 373 of nitroglycerin, 525 of nitrous ether, 598 of nutmeg, 367 of peppermint, 374 of phosphorus, 199 of soap, 58 of spearmint, 376 Spirits, 57, 58 Spiritus aetheris, 397 compositus, 397 nitrosi, 598 ammonias, 572 aromaticus, 157, 573 anisi, 360 auiantii compositus, 360 camphorse, 381 chloroformi, 403 cinnamomi, 362 frumenti, 560 gaultheriae, 373 glonoini, 525 - juniperi, 640 compositus, 363, 364, 378, 640 lavandulse, 373 menthse piperitae, 374 viridis, 376 Mindererus, 52 myristicK, 367 phosphori, 199 rectificatus, 561 vini gallici, 560 Spleen-mixture, 75 Spongiopiline, 125 Squibb's podophyllum pills, 112 rhubarb mixture, 75 Squill, 630, 634 Starch, 771 Stillingia, 262 comp., 94 St. John Long's liniment, 115 Stokes's expectorant, 75 liniment, 115 Stramonii folia, 460 semen, 461 Stramonium, 659 leaves, 460 seed, 461 Strengthening plaster, 123, 189 Stronger ammonia vpater, 572 Strontii bromidum, 528 iodidi, 246 Strontium bromide, 528 iodide, 246 Strophanthin, 547 Strophanthus, 546 Strychnine, 465, 659, 702 Styptic collodion, 710 Sublimed sulphur, 669 Succu's conii, 498 Sugar of lead, 724 Sulphaminol, 328 Sulphonal, 423 Sulphur iodide, 247 lotum, 669 ointment, 669 prsecipitatum, 669 sublimatum, 669 Sulphuric acid, 138 Sulphuris iodidum, 247 Sulphurous acid, 353 Sumach, 722 Sumbul, 517 Sun mixture, 74 Suppositoria, 121, 122 glycerini, 773 Suppositories, 121 of glycerin, 773 Sweet flag, 372 spirit of nitre, 58, 598 sumach, 722 tincture of rhubarb, 87, 676 wines, 562 Syrup of acacia, 778 of althaea, 779 of calcium lactophosphate, 145 of citric acid, 147 of Dover's powder, 63 of ferrous iodide, 181 of garlic, 619 of ginger, 372 of hydriodic acid, 245 of hypophosphites, 205 with iron, 185, 205 of ipecac, 609 of lactucarium, 445 of morphine, 63 of phosphates of iron, quinine, and strychnine, 185 of rhubarb, 676 of senega, 625 of senna, 68 1 of squill, 635. of tar, 622 of tolu, 618 of wild cherry, 174 Syrups, 58 Syrupus acacias, 778 acidi citrici, 147 hydriodici, 24S allii, 619 althffise, 779 calcii lactophosphatis, 145 corrigens, 62 ferri iodidi, 181 quininae, et strychninse phosphatum, 185, 466 hypophosphitum, 205 cum ferro, 185, 205 ipecacuanhse, 609 krameria, 717 lactucarii, 445 856 GENERAL INDEX. Syrupus picis liquidse, 622 pruni Virginianse, 174 rhei, 676 aromaticus, 677 sarsaparillse compositus, 261, 360 scillse, 635 compositus, 60S, 625, 635 senegas, 625 sennse, 681 stillingise compositus, 263 tolutanus, 618 zingiberis, 372 Systemic anti-emetics, 602 Tanacetum, 706 Tannic acid, 709, 710 Tansy, 702, 706 Tar, 72, 615 alkaline, 55 compound ointment, 120 mixture, 75 ointment, 622 water, 622 Taraxacum, 669 Tartar emetic, 604, 761 Tartaric acid, 147 Tartrated antimony, 604 Tasteless syrup of iodide of iron, 62 tincture of iron, 88 Terebene, 615, 627 Terebenum, 627 Terpene hydrate, 615 Terpin hydrate, 628 Terpini hydras, 628 Terpinol, 628 Tetrochlormethane, 408 Tetronal, 423 Theine, 555 Theobromine, 555 Therapeutics, 22 Thielmann's mixture, 74 Thioform, 750 Thiol, 325 Thiolum, 325 Thioresorcin, 323 Thompson's solution of phosphorus, 55 Thorn apple, 460 Thymacetin, 376 Thymol, 376 Tinctura aconiti, 576 aloes, 674 and myrrhse, 336, 674 arnicas fiorum, 587 radicis, 588 asafoetidje, 379 belladonnse foliorum, 452 • benzoini, 332 composita, 332, 618, 674 cacti, 552 calendulse, 172 calumbse, 171 cannabis indicfe, 446 cantharidis, 762 capsici, 365 Tinctura cardamom!, 370 composita, 361, 370, 378 catechu composita, 361, 715 chiratse, 172 cinchonae, 209 composita, 174, 209 cinnamomi, 361 coccuh, 474 colchici seminis, 255 conii, 498 cubebae, 649 digitalis, 537 ergotae, 477 eucalypti, 339 ferri acetatis, 190 chloridi, 182 gallse, 713 gentianas composita, 171 guaiaci, 259 ammoniata, 259 humuli, 444 hydrastis, 483 hyoscyami, 462 iodi, 245 ipecacuanha et opii, 428, 60^ kino, 716 krameriae, 717 lactucarii, 445 lavandulae composita, 361, 373- lobeliae, 613 nucis vomicae, 465 opii, 428 camphorata, 360, 381, 428 deodorati, 428 physostigmatis, 508 pulsatillae, 586 quassiae, 170 rhei, 676 aiomatica, 676 dulcis, 676 rhois toxicodendri, 487 sanguinaris, 264 scillae, 635 serpentaris, 174 stillingiae, 263 stramonii seminis, 461 slrophanthi, 547 sumbul, 517 tolutana, 618 Valerianae, 382 ammoniata, 382 veratri viridis, 581 zingiberis, 372 Tincture of aconite, 576 of aloes, 674 and myrrh, 336, G74 of arnica flowers, 587 root, 588 of asafetida, 379 of belladonna leaves, 452 of benzoin, 332 of cactus, 552 of calendula, 172 of calumba, 171 GENERAL INDEX. 857 Tincture of cantharides, 762 of capsicum, 365 of cardamom, 370 of chirata, 172 of cinchona, 209 of cinnamon, 36 1 of cocculus, 474 of colchicum seed, 255 of conium, 498 of cubeb, 649 of cudbear, 89 of deodorized opium, 428 of digitalis, 537 of Dover's powder, 428 of ergot, 477 of eucalyptus, 339 of ferric acetate, 190 chloride, 182 of ginger, 372 of guaiac, 259 of hops, 444 of hydrastis, 483 of hyoscyamus, 462 of Indian cannabis, 446 of iodine, 245 of ipecac and opium, 4:28j 609 of kino, 716 of krameria, 717 of lactucarium, 445 of lobelia, 613 of lupulin, 444 of nutgall, 713 of opium, 428 of phosphorus, 199 of physostigma, 508 of poppy, 89 of Pulsatilla, 586 of quassia, 170 of rhubarb, 676 of rhus toxicodendron, 487 of serpentaria, 1 74 of squill, 635 of stillingia, 263 of stramonium seed, 461 of strophanthus, 547 of sumbul, 517 of tolu, 618 of valerian, 382 of veratrum viride, 581 Tinctures, 84 Tolu solubile, 90 Topical remedies, 754 Tragacanth, 771, 779 Tragacantha, 779 Trional, 423 Triplex pills, 112 Trituratio ekterini, 684 Trituration of elaterin, 684 Troches, 105 of ammonium chloride, 616 of catechu, 715 of chalk, 154 of cubeb, 649 of ginger, 372 Troches of ipecac, 609 of iron, 189 of krameria, 717 of liquorice and opium, 428 of morphine and ipecac, 429, 609 of peppermint, 374 of potassium chlorate, 349 of santonin, 695 of sodium bicarbonate, 153 of tannic acid, 710 Trochisci acidi tannici, 710 ammonii chloridi, 616 catechu, 715 cretse, 154 ferri, 189 glycyrrhizae et opii, 360, 428 ipecacuanhse, 609 kramerise, 717 menthse piperitse, 374 morphinse et ipecacuanhse, 429, 609 potassii chloratis, 349 santonini, 695 sodii bicarbonatis, 1 53 zingiberis, 372 TuUey's powder, loi Tumenol, 326 Tumenolum, 326 Turlington's balsam, 85 Turner's cerate, 120 Turpentine, 630 Turpeth mineral, 226 Ulmus, 778 Unguenta, 1 18- 120 Unguentum acidi carbolici, 302 tannici, 710 belladonnse, 452 camphoratum, 120 diachylon, 726 hydrargyri, 222 ammoniati, 222 nitratis, 226 oxidi flavi, 225 rubri, 225 iodi, 245 iodoform!, 327 matris, 120 picis hquidse, 622 plumbi carbonatis, 725 iodidi, 726 potassii iodidi, 246 stramonii, 461 sulphuris, 669 iodidi, 247 veratrinae, 581 zinci carbonatis impuri, 120 oxidi, 733 Ural, 411, 420 Uralium, 41 1 Urea, 630 Urethane, 411, 420 Ustilago, 703 Uva ursi, 630, 638 GENERAL INDEX. Valerian, 381 Valeriana, 38 1 Vallet's mass, 106, 180 Vaseline, 771 Vegetable acids, 146 astringents, 709 Velpeau's diarrhea mixture, 74 Veratrina, 581 Veratrine, 581 ointment, 581 Veratrum album, 581 viride, 580 Vermicides, 693 Vermifuges, 693 Vesicants," 761 Viburnum opulus, 519 prunifoliura, 518 Vienna caustic, 757 paste, 757 Villate's solution, 73 Vina, 82-84 Vinegar of opium, 428 of sanguinaria, 264 of squill, 635 Vinegars, 82 Vinum album, 561 antimonii, 605 ferri amarum, 184 citratis, 183 colchici radicis, 254 seminis, 255 ergotae, 477 ipecacuanhse, 609 opii, 428 picis, 623 rubrum, 561 Virginia snake root, \ 74 Vleminck's solution or lotion, 54 Volatile oil of mustard, 767 oils, 769 Wahoo, 68, 678 Warburg's pills, ill tincture, 87, 88 Warming plaster, 123, 770 Washed sulphur, 669 Washes, 115 Weights and measures, 40 Whiskey, 57, 560 White arsenic, 234 ash, 84 hellebore, 581 lead, 725 White mustard, 766 oak, 714 of egg, 771 pine compound, 64 wine, 561 Wild cherry, 84, 173 ferrated, 84 Wilkinson's ointment, 120 Wine of antimony, 605 of colchicum root, 254 seed, 255 of ergot, 477 of ferric citrate, 183 of ipecac, 609 of opium, 428 of tar, 623 Wines, 82 Woorari, 513 Xanthoxylum, 268 Yellow iodide of mercury, 224. jasmine, 502 mercuric oxide, 225 subsulphate, 226 mercurous iodide, 224 wash, 226 Verba santa, 62 Zedoary comp., 90 Zinc, 709, 732 acetate, 733 bromide, 528 chloride, 755, 759 iodide, 247, 733 oxide, 733 phosphide, 206 sulphate, 733, 7SS sulphocarbolate, 307 valerianate, 382 Zinci acetas, 733 bromidum, 528 carbonas prsecipitatus, 733 chloridum, 759 iodidum, 247, 733 oxidum, 733 phosphidum, 206 sulphas, 733 sulphocarbolas,. 307 valerianas, 382 Zincum, 732 Zingiber, 371 o Si e 95 S5 I ^ I PUBLISHED BY W. g. gauHslep^, ^25 Walnut gbeet, J)l7ilaslelpl2ia. lUTR. SAUNDERS, in presenting to the profession thefol-t A"l lowing list of publications, begs to state that the aim has been to make them worthy of, the confidence of medical book-buyers by the high standard of authorship and by the excellence of typography, paper, printing, and binding. ■ The works indicated in the Index (see next page) with an asterisk (*) are sold by subscription {not by booksellers), usually through travelling solicitors, but they can be ob- tained direct from the office of publication (charges of ship- ment prepaid) by remitting the quoted prices. Full descrip- tive circulars of such works will be sent to any address upon application. All the other books advertised in this catalogue are commonly for sale by booksellers in all parts of the United States; but any book will be sent by the publisher to any address (post-paid) on receipt of the price herein given. COISTTE^TS. Anatomy. page Haynes, Manual of Anatomy 24 Nancrede, Anatomy and Manual of Dissection . 16 Nancrede, Essentials of Anatomy . , .26 Bacteriology. Ball, Essentials of Bacteriology 26 Crookshank, A Text-Book of Bacteriology . 13 Frothingham, Laboratory Guide 20 McFarland, Text-Book of Pathogenic Bacteria . 15 Botany.. Eastin, Laboratory Exercises in Botany ... .20 Chemistry and Pliyslcs. Brockway, Essentials of Physics 26 Wolff, Essentials of Chemistry . . . 26 Children. *An American Text-Book of Diseases of Children 8 Griffith, Care of the Baby 21 Powell, Essentials of Diseases of Children 26 Clinical Charts, Diet, and Biet liists. Hart, Diet In Sickness and in Health . . 22 Keen, Operation Blank . .... 19 Lain6, Temperature Chart 16 Meigs, Feeding in Early Infancy . . 14 Starr, Diets for Infants and Children 22 Thomas, Detachable Diet Lists, etc. ... 22 Biag^nosis. Cohen and Eshner. Essentials of Diagnosis . . . 26 MacDonald, Surgical Diagnosis and Treatment . 27 Vierordt and Stuart. Medical Diagnosis .... 10 Corwin, Essentials 'of the Physical Diagnosis of the Thorax . . ... 18 Bictionaries, Keating and Hamilton, New Pronouncing Dic- tionary of Medicine 10 Morten, Nurses' Dictionary of Medical Terms . 22 Saunders' Pocket Medical Lexicon , , . . .17 Ear. Gleason, Essentials of Diseases of the Ear . 26 Electricity. Stewart and Lawranee, Essentials of Medical Electricity . . 26 Embryology. Heisler, Text-Book of Embryology . . . 27 Eye, Nose, and Throat. De Schweinitz, Diseases of the Eye 14 Jackson and Gleason, Essentials of Diseases of Eye, Nose, and Throat 26 Kyle, Manual of Diseases of Nose and Throat . . 24 Oenito-nrinary. Hyde, Syphilis and the Venereal Diseases ... 24 Martin, Essentials of Minor Surgery, Bandaging and Venereal Diseases 26 Saundby, Renal and Urinary Diseases ... 27 Oynecology. *An American Text-Book of Gynecoloev 1 Cragm, Essentials of Gvnecology . ' 26 Garrigues, Diseases of Women . " ' ' ' is Long, Syllabus of Gynecology . ..!!!!.'! 19 Histology. Clarkson, Text-Book of Histology .... 15 Eifc Insurance. Keating, How to Examine for Life Insurance . . 21 Materia Medica and Therapeutics. ''■^"j^^merican Text Book of Applied Therapeu- Butler, Text-Book of Materia Me'dica, 'Therapeu- ^ tics, and Pharmacology . 27 Cerna, Notes on the Newe^ Remedies '.'.'' 17 ttcs Materia Medlca and Therapeu- Morris, Essentials of Materia Me'dica, etc. ' 26 2 pag: Saunders' Pocket Medical Formulary J Stevens, Manual of Therapeutics - . ■ - -. • • ■ 1 Thornton, Dose-Book and Prescription- Wntmg. 2 Warren, Surgical Pathology and Therapeutics . 1 Medical Jurisprudence. Chapman, Medical Jurisprudence and Toxi- cology 2- Semple, Essentials of Legal Medicine, etc. . . . 2( Medicine. *An American Text-Book of Practice ; ■^Gould and Pyle, Anomalies and Curiosities of Medicine z Lockwood, Manual of the Practice of Medicine 24 Morris, Essentials of the Practice of Medicine . 26 Saunders' American Year-Book of Medicine and Surgery 28 Stevens, Manual of the Practice of Medicine . . 16 Nervons Diseases and Insanity. Burr, Manual of Nervous Diseases 24 Shaw,EssentialsofNervousDiseasesand Insanity 26 JKnrsing'. Griffith, Care of the Baby 21 Hampton, Nursing : its Principles and Practice 21 Stoney, Practical Points in Priyate Nursing ... 13 Obstetrics. *An American Text-Book of Obstetrics 5 Ashton, Essentials of Obstetrics . . 26 Boisliniere, Obstetric Accidents . . . . . . 20 Dorland, Manual of Obstetrics 24 Norris, Syllabus of Obstetrical Lectures . ... 19 Pattaologry. Semple, Essentials of Pathology and Morbid Anatomy 26 Senn, Pathology and Surgical Treatment of Tumors n Stengel, Manual of Pathology ....'.'.'' 24 Warren, Surgical Pathology and Therapeutics . 11 Pharmacy. Sayre, Essentials of Pharmacy 26 Physiology. *An American Tex^Book of Physiology . . .3 Hare, Essentials of Physiology ........ 26 Raymond, Manual of Physiologr 12 26 Stewart, A Manua^ of Physiology Sbiagraphy. Rowland, Archives of Clinical Skiagraphy Skin. ''Pictorial Atlas of Skin Diseases . . Stelwagon, Essentials of Diseases of the Skin Surgery. ''An American Text-Book of Surgerv 6 Beck, Surgical Asepsis . ...... " ' " ' 24 DaCosta, Manual of Surgery ' ' " ' 24 Keen, Operation Blank 19 MSSri^4lSK/l'^?|e7/^""°^ '-^^'^^^^^ ■ i Martin, Essentials of Minor Surgery, etc " 26 Pye, Elementary Bandaging and Surgical Dress- „ '"g , 27 Saunders' American Year-Book of Medicine and Surgery 28 Senn, Pathology and Surgical Treatment of Senn, Syllabus of Surgery . ' 19 Warren, Surgical Pathology and Therapeutics '. 11 Urine. Wolff, Essentials of Examination of Urine 26 Miscellaneous. Gross, Autobiography of Saunders' New Aid Series of Manuals" Saunders' Question Cumpends Thresh, Water and Water Supplies . . . 12 . 23,24 25,26 . . 15 CA TALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by William H. Howell, Ph. D., M. D., Professor of Physiology in the Johns Hopkins University, Baltimore, Md. One handsome octavo volume of 1052 pages, fully illustrated. Prices: Cloth, ;j6.oo net; Sheep or Half- Morocco, ^7.00 net. This work is the most notable attempt yet made in America to combine in one volume the entire subject of Human Physiology by well-known teachers who have given especial study to that part of the subject upon which they write. The completed work represents the present status of the science of Physiology, par- ticularly from the standpoint of the student of medicine and of the medical practitioner. American teachers of physiology have not been altogether satisfied with the text-books at their disposal. The defects of most of the older books are that they have not kept pace with the rapid changes in modern physiology, while few if any of the newer books have been uniformly satisfactory in their treatment of all parts of this many-sided science. Indeed, the literature of experimental physiology is so great that it would seem to be almost impossible for any one teacher to keep thoroughly informed on all topics. The collaboration of several teachers in the preparation of an elementary text- book of physiology is unusual, the almost invariable rule heretofore having been for a single author to write the entire book. One of the advantages to be derived from this collaboration method is that the more limited literature necessary fbr consultation by each author has enabled him to base his elementary account upon a comprehensive knowledge of the subject assigned to him ; another, and perhaps the most important, advantage, is that the student gains the point of view of a number of teachers. In a measure he reaps the same benefit as would be obtained by following courses of instruction under different teachers. The different stand- points assumed, and the differences in emphasis laid upon the various lines of pro- cedure, chemical, physical, and anatomical, should give the student a better insight into the methods of the science as it exists to-day. The work will also be found useful to many medical practitioners who may wish to keep in touch with the development of modern physiology. The main divisions of the subject-matter are as follows : General Physiology of Muscle and Nerve— Secretion— Chemistry of Digestion and Nutrition— Movements of the Alimentary Canal, Bladder, and Ureter— Blood and Lymph— Circulation— Respiration— Animal Heat— Central Nervous System— Special Senses— Special Muscular Mechanisms— Reproduction— Chemistry of the Animal Body. CONTRIBUTORS: HENEY P. BOWDITCH, M. D., Professor of Physiology, Harvard Medical School. JOHN G. CUETIS, M. D., Professor of Physiology, Columbia University, N. Y. (College of Physicians and Surgeons). EENKY H. DONALDSON, Ph. D., Head-Professor of Neurology, University of Chicago. W. H. HOWELL, Ph. D., M. D., Professor of Physiology, Johns Hopkins University. FSEDEEIC S. LEE, Ph. D., Adjunct Prof, of Physiology, Columbia University, N. Y. (College of Physicians and Surgeons), WAREEN P. LOMBARD, M. D., Professor of Physiology, University of Michigan. GRAHAM LUSK, Ph.D., Professor of Physiology, Yale Medical School. W. T. PORTER, M. D., Assistant Professor of Physiology, Harvard Medical School. EDWARD T. REICHEET, M. D., Professor of Physiology, University of Pennsylvania. HENEY SEWALL, Ph. D., M. D., Professor of Physiology, Medical Department, Uni- versity of Denver. W. B. SAUNDERS' ILLUSTRATED For Sale by Subscription. AN AMERICAN TEXT-BOOK OF APPLIED THERAPEU- TICS. For the Use of Practitioners and Students. Edited by James C. Wilson, M. D., Professor of the Practice of Medicine and of Clinical Medicine in the Jefferson Medical College. One handsome octavo volume of 1326 pages. Illustrated. Prices: Cloth, ^7-oo net; Sheep or Half- Morocco, ;g8.oo net. The arrangement of this volume has been based, so far as possible, upon mod- ern pathologic doctrines, beginning with the intoxications and following with infections, diseases due to internal parasites, diseases of undetermined origin, and finally the disorders of the several bodily systems — digestive, respiratory, circu- latory, renal, nervous, and cutaneous. It was thought proper to include also a consideration of the disorders of pregnancy. The list of contributors comprises the names of maiiy who have acquired dis- tinction as practitioners and teachers of practice, of clinical medicine, and of the specialties. CONTRIBUTORS: Dr. I. E. Atkinson, Baltimore, Md. Sanger Brown, Chicago, 111. John B. Chapin, Philadelphia, Pa. William C. Dabney, Charlottesville, Va. John Chalmers DaCosta, Phila., Pa. I. N. Danforth, Chicago, 111. John L. Dawson, Jr., Charleston, S. C. F. X. Dercum, Philadelphia, Pa. George Dock, Ann Arbor, Mich. Robert T. Edes, Jamaica Plain, Mass. Augustus A. Eshner, Philadelphia, Pa. J. T. Eskridge, Denver, Col. F. Forchheimer, Cincinnati, O. Carl Frese, Philadelphia, Pa. Edwin E. Graham, Philadelphia, Pa. John Guiteras, Philadelphia, Pa, Frederick P. Henry, Philadelphia, Pa. Guy Hinsdale, Philadelphia, Pa. Orville Horwitz, Philadelphia, Pa. W. W. Johnston, Washington, D. C. Ernest Laplace, Philadelphia, Pa. A. Laveran, Paris, France. Dr. James Hendrie Lloyd, Phila., Pa. John Noland Mackenzie, Bait., Md. J. W. McLaughlin, Austin, Texas. A. Lawrence Mason, Boston, Mass. Charles K. Mills, Philadelphia, Pa. John K. Mitchell, Philadelphia, Pa. W. P. Northrup, New York City. William Osier, Baltimore, Md. Frederick A. Packard, Phila., Pa. Theophilus Parvin, Philadelphia, Pa. Beaven Rake, London, England. E. O. Shakespeare, Philadelphia, Pa. Wharton Sinkler, Philadelphia, Pa. Louis Starr, Philadelphia, Pa. Henry W. Stelwagon, Phila., Pa. James Stewart, Montreal, Canada. Charles G. Stockton, Buffalo, N. Y. James Tyson, Philadelphia, Pa. Victor C. Vaughan, Ann Arbor, Mich. James T. Whittaker, Cincinnati, O. J. C. Wilson, Philadelphia, Pa. The articles, with two exceptions, are the contributions of American writers. Written from the standpoint of the practitioner, the aim of the work is to facili- tate the application ot knowledge to the prevention, the cure, and the alleviation of disease. The endeavor throughout has been to conform to the title of the book— Applied Therapeutics— to indicate the course of treatment to be pursued at the bedside, rather than to name a list of drugs that have been used at one time or another. While the scientific superiority and the practical desirability of the metric system of weights and measures is admitted, it has not been deemed best to discard entirely the older system of figures, so that both sets have been eiven where occasion demanded. • ^ CATALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK OF OBSTETRICS. Edited by Rich- ard C. NoRRis, M. D.; Art Editor, Robert L. Dickinson, M. D. One handsome octavo volume of over looo pages, with nearly 900 colored and half-tone illustrations. Prices: Cloth, I7.00; Sheep or Half-Morocco, ^8.00. The advent of each successive volume of the series of the American Text- Books has been signalized by the most flattering comment from both the Press and the Profession. The high consideration received by these text-books, and their attainment to an authoritative position in current medical literature, have been matters of deep international interest, which finds its fullest expression in the demand for these publications from all parts of the civilized world. In the preparation of the " American Text-Book of Obstetrics " the editor has called to his aid proficient collaborators whose professional prominence entitles them to recognition, and whose disquisitions exemplify Practical Obstetrics. While these writers were each assigned special themes for discussion, the correla- tion of the subject-matter is, nevertheless, such as ensures logical connection in treatment, the deductions of which thoroughly represent the latest advances in the science, and which elucidate the best modern methods of procedure. The more conspicuous feature of the treatise is its wealth of illustrative matter. The production of the illustrations had been in progress for several years, under the personal supervision of Robert L. Dickinson, M. D., to whose artistic judg- ment and professional experience is due the most sumptuously illustrated work of the period. By means of the photographic art, combined with the skill of the artist and draughtsman, conventional illustration is . superseded by rational methods of delineation. Furthermore, the volume is a revelation as to the possibilities that may be reached in mechanical execution, through the unsparing hand of its publisher. CONTRIBUTORS : Dr. James C. Cameron. Edward P. Davis. Robert L. Dickinson. Charles Warrington Earle. James H. Elheridge. Barton Cooke Hirst. Henry J. Garrigues. Charles Jewett. Dr. Howard A. Kelly. Richard C. Norris. Chauncey D, Palmer. Theophilus Parvin. George A. Piersol. Edward Reynolds. Henry Schwarz. " At first glance we are overwhelmed by the magnitude of this work in several respects, viz. : ■ First, by the size of the volume, then by the array of eminent teachers in this department who have taken part in its production, then by the profuseness and character of the illustrations, and last, but not least, the conciseness and clearness with which the text is rendered. This is an entirely new composition, embodying the highest knowledge of the art as it stands to-day by authors who occupy the front rank in their specialty, and there are many of them. We cannot turn over these pages without being struck by the superb illustrations which adorn so many of them. We are confident that this most practical work will find instant appreciation by practitioners as well as students."— New York Medical Times. Permit me to say that your American Text-Book of Obstetrics is the most magnificent medical work that I have ever seen. I congratulate you and thank you for this superb work, which alone is su£5cient to place you first in the ranks of medical pubhshers. With profound respect I am sincerely yours, Alex. J. C. Skene. IV. B. SAUNDERS ILLUSTRATED For Sale by Subscription. AN AMERICAN TEXT-BOOK OF SURGERY, Edited by Wil- liam W. Keen, M. D., LL.D., and J, William White, M. D., Ph. D. Forming one handsome royal-octavo volume of 1250 pages (10x7 inches), with 500 wood-cuts in text, and 37 colored and half-tone plates, many of them engraved from original photographs and drawings furnished by the authors;. Prices : Cloth, ;?7.oo ; Sheep or Half-Morocco, ^8.00 net. SECOND EDITION, REVISED AND ENLARGED, * With a Section devoted to "The Use of the Rontgen Rays in Surgery." The want of a text-book which could be used by the practitioner and at the same time be recommended to the medical student has been deeply felt, especially by teachers of surgery ; hence, when it was sug- gested to a number of these that it would be well to unite in preparing a text-book of this description, great unanimity of opinion was found to exist, and the gentlemen below named gladly consented to join in its production. Especial prominence has been given to Surg- ical Bacteriology, a feature which is believed to be unique in a surgical text-book in the English language. Asepsis and Antisepsis have received particular attention. The text is brought well up to date in such important branches as cere- bral, spinal, intestinal, and pelvic surgery, the most important and newest operations in these departments being described and illustrated. The text of the entire book has been sub- mitted to all the authors for their mutual criti- cism and revision — an idea in book-making that is entirely new and original. The book as a whole, therefore, expresses on all the im- portant surgical topics of the day the consensus of opinion of the eminent surgeons who Jiave joined in its preparation. One of the most attractive features of the book is its ill.ustrations. Very many of them are original and faithful reproductions of photographs taken directly from patients or from specimens, and the modern improvements in the art of engraving have enabled the publisher to produce illustrations which it is believed are superior to those in any similai; work. specimen Illustration {largely reduced). CONTRIBUTORS: Dr. Charles H. Burnett, Philadelphia. Phineas S. Conner, Cincinnati. Frederic S. Dennis, New York. William W. Keen, Philadelphia. Charles B. Nancrede, Ann Arbor, Mich. Roswell Park, Buffalo, N. Y. Lewis S. Pilcher, Brooklyn, N. Y. Dr. Nicholas Senn, Chicago. Francis J. Shepherd, Montreal, Canada. Lewis A. Stimson, New York. William Thomson, Philadelphia. J. Collins Warren, Boston. J. William White, Philadelphia. it ;= „f text-book IS a fair reHex of the present position of American surgery, we must admit hi 1 '^'ly-'t °'''^"" °^ "'"'' ^°<1 *^' English*^ surgeons will have to ifok very carefuU^o their laurels if they are to preserve a position in the van of surgical ^^x^c&<,^."-LondInlaml artl^JJ'lf ^°™^"^^^ °f '.*>« teachings contained in this work needs no stronger guarantee than is alforded by the names of its authors."— jMsfAVa/ News, Philadelphia. CATALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK ON THE THEORY AND PRACTICE OF MEDICINE. By American Teachers. Edited by William Pepper, M. D., LL.D., Provost and Professor of the Theory and Practice of Medicine and of Clinical Medicine in the University of Pennsylvania. Complete in two handsome royal- octavo volumes of about looo i^kges each, with illustrations to elucidate the text wherever necessary. Price per Volume : Cloth, ^5.00 net ; Sheep or Half- Morocco, g6.oo net. VOLUME I. CONTAINS: Hygiene. — Fevers (Ephemeral, Simple Con- tinued, Typhus, Typhoid, Epidemic Cerebro- spinal Meningitis, and Relapsing). — Scarlatina, Measles, Rotheln, Variola, Varioloid, Vaccinia, Varicella, Mumps, Whooping-cough, Anthrax, Hydrophobia, Trichinosis, Actinomycosis, Glan- ders, and Tetanus. — Tuberculosis, Scrofula, Syphilis, Diphtheria, Erysipelas, Malaria, Chol- era, and Yellow Fever. — Nervous, Muscular, and Mental Diseases. VOLUME II. CONTAINS: Urine (Chemistry and Microscopy). — Kidney and Lungs. — Air-passages (Larynx and Bronchi) and Pleura. — Pharynx, CEsophagus, Stomach and Intestines (including Intestinal Parasites), Heart, Aorta, Arteries and Veins. — Peritoneum, Liver, and Pancreas. — Diathetic Diseases (Rheu- matism, Rheumatoid Arthritis, Gout, Lithsemia, and Diabetes). — Blood and Spleen. — Inflamma- tion, Embolism, Thrombosis, Fever, and Bacte- riology. The articles are not written as though addressed to students in lectures, but are exhaustive descriptions of diseases, with the newest facts as regards Causation, Symptomatology, Diagnosis, Prognosis, and Treatment, including a large number of approved formulae. The recent advances made in the study of the bacterial origin of various diseases are fully described, as well as the bearing of the know- ledge so gained upon prevention and cure. The subjects of Bacteriology as a whole and of Immunity are fully considered in a separate section. Methods of diagnosis are given the most minute and careful attention, thus enabling the reader to learn the very latest methods of investigation without con- sulting works specially devoted to the subject. CONTRIBUTORS: Dr. J. S. Billings, Philadelphia. Francis Delafield, Nevif York. Reginald H. Fitz, Boston. James W. Holland, Philadelphia. Henry M. Lyman, Chicago. William Osier, Baltimore. Dr. William Pepper, Philadelphia. W. Gilman Thompson, New York. W. H. Welch, Baltimore. James T. Whittaker, Cincinnati. James C. Wilson, Philadelphia. Horatio C. Wood, Philadelphia. " We reviewed the first volume of this work, and said : ' It is undoubtedly one of the best text' books on the practice of medicine which we possess.' A consideration of the second and last Tolume leads us to modify that verdict and to say that the completed work is, in our opinion, the BEST of its kind it has ever been our fortune to see. It is. complete, thorough, accurate, and clear. It is well written, well arranged, well printed, well illustrated, and well bound. If is a model of what the modern text-book should be."— ^ra/ York Medical Journal. " A library ujfcn modern medical art. The work must promote the wider diffusion of sound knowledge." — American Lancet. " A trusty counsellor for the practitioner or senior student, on which he may implicitly rely."— Sdinburgh Medical Journal. W. B. SAUNDERS' ILLUSTRATED For Sale by Subscription. AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL- DREN. By American Teachers. Edited by Louis Starr, M. D.j assisted by Thompson S. Westcott, M. D. In one handsome royal-8vo vol- ume of 1 190 pages, profusely illustrated with wood-cuts, half-tone and colored plates. Prices: Cloth, g 7. 00 net ; Sheep or Half-Morocco, ^8.00 net. The plan of this work embraces a series of original articles written "by some iixty well-known paediatrists, representing collectively the teachings of the most arominent medical schools and colleges of America. The work is intended to be I PRACTICAL book, suitable for constant and handy reference by the practitioner md the advanced student. One decided innovation is the large number of authors, nearly every jirticle Deing contributed by a specialist in the line on which he writes. This, while entailing considerable labor upon the editors, has resulted in the publication of a iVOrk THOROUGHLY NEW AND ABREAST OF THE TIMES. Especial attention has been given to the consideration of the latest accepted :eaching upon the etiology, symptoms, pathology, diagnosis, and treatment of the iisorders of children, with the introduction of many special formulae and thera- peutic procedures. Special chapters embrace at unusual length the Diseases of the Eye, Ear, Nose md Throat, and the Skin ; while the introductory chapters cover fully the important subjects of Diet, Hygiene, Exercise, Bathing, and the Chemistry of Food. Trache- Jtomy, Intubation, Circumcision, and such minor surgical procedures coming (yithin the province of the medical practitioner, are carefully considered. CONTRIBUTORS: Dr. S, S. Adams, Washington. John Ashhurst, Jr., Philadelphia. A. D. Blackader, Montreal, Canada. Dillon Brown, New York. Edward M. Buckingham, Boston. Charles W. Burr, Philadelphia. W. E. Casselberry, Chicago. Henry Dwight Chapin, New York. W. S. Christopher, Chicago. Archibald Church, Chicago. Floyd M. Crandall, New York. Andrew F. Currier, New York. Roland G. Curtin, Philadelphia. J. M. DaCosta, Philadelphia. I. N. Danforth, Chicago. Edward P. Davis, Philadelphia. John B. Deaver, Philadelphia. G. E. de Schweinitz, Philadelphia. John Doming, New York. Charles Warrington Earle, Chicago. Wm. A. Edwards, San Diego, Cal. F. Forchheimer, Cincinnati. J. Henry Fruitnight, New York. Landon Carter Gray, New York. J. P. Crozer Griffith, Philadelphia. W. A. Hardaway, St. Louis. M. P. Hatfield, Chicago. Barton Cooke Hirst, Philadelphia. H. lUoway, Cincinnati. Henry Jackson, Boston. Charles G. Jennings, Detroit. Henry Koplik, New York. Dr. Thomas S. Latimer, Baltimore. Albert R. Leeds, Hoboken, N. J. J. Hendrie Lloyd, Philadelphia. George Roe Lock wood. New York. Henry M. Lyman, Chicago. Francis T. Miles, Baltimore. Charles K. Mills, Philadelphia. John H. Musser, Philadelphia. Thomas R. Neilson, Philadelphia. W. P. Norlhrup, New York. William Osier, Baltimore. Frederick A. Packard, Philadelphia. William Pepper, Philadelphia. Frederick Peterson, New York. W. T. Plant, Syracuse, New York. William M. Powell, Atlantic City. B. Alexander Randall, Philadelphia. Edward O. Shakespeare, Philadelphia. F. C. Shattuck, Boston. J. Lewis Smith, New York. Louis Starr, Philadelphia. M. Allen Starr, New York. J. Madison Taylor, Philadelphia. Charles W. Townsend, Boston. James Tyson, Philadelphia. W. S. Thayer, Baltimore. Victor C. Vaughan, Ann Arbor, Mich. Thompson S. Westcott, Philadelphia. Henry R. Wharton, Philadelphia J. William White, Philadelphia. J. C. Wilson, Philadelphia. CATALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL AND SURGICAL, for the use of Students and Practitioners. Edited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume, with 360 illustrations in text and 37 colored and half-tone plates. Prices : Cloth, ;g6.oo net; Sheep or Half-Morocco, $7.00 net. In this volume all anatomical descriptions, excepting those essential to a clear understanding of the text, have been omitted, the illustrations being largely depended upon to eluci- date the anatomy of the parts. This work) which is thoroughly practical in its teachings, is intended, as its title implies, to be a working text-book for physicians and students. A clear line of treatment has been laid down in every case, and although no attempt has been made to discuss mooted points, still the most important of these have been flbted and explained. The ope- irations recommended are fully illustrated, so that the reader, having a pic- ture of the procedure de- scribed in the text under his eye, cannot fail to grasp the idea. All ex- traneous matter and dis- cussions have been care- fully excluded, the attempt being made to allow no unnecessary details to cumber the text. The subject-matter is brought up to date at every point, and the work is as nearly as possible the combined opinions of the ten specialists who figure as the authors. The work is well illustrated throughout with wood-cuts, half-tone and colored plates, mostly selected from the authors' private collections. specimen Illustration. CONTRIBUTORS: Dr. Henry T. Byford. John M. Baldy. Edwin Cragin. J. H. Etheridge. William Goodell. Dr. Howard A. Kelly. Florian Krug. E. E. Montgomery. William R. Pryor. George M. Tuttle. " The most notable contribution to gynecological literature since 1887 and the most com- plete exponent of gynecology which we have. No subject seems to have been neglected and the gynecologist and surgeon and the general practitioner, who has any desire to practise diseases of women, will find it of practical value. In the matter of illustrations and plates the book sur- passes anything we have seen." — Boston Medical and Surgical Journal. W. B. SAUNDERS' ILLUSTRATED IJKW PRONOUNCING DICTIONARY OF MEDICINE, with Phonetic Pronunciation, Accentuation, Etymology, etc. By John M. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila- delphia; Vice-President of the American Paediatric Society; Ex-President of the Association of Life Insurance Medical Directors ; Editor " Cyclopaedia of the Diseases of Children," etc. ; and Henry Hamilton, Author of a "A New Translation of Virgil's ^neid into English Rhyme;" Co- Author of "Saunders' Medical Lexicon," etc. ; with the Collaboration of J. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D. With an Appendix, containing Important Tables of Bacilli, Micrococci, Leucomaines, Ptomaines; Drugs and Materials used in Antiseptic Surgery ; Poisons and their Antidotes ; Weights and Measures ; Thermometric Scales ; New Official and Unofficial Drugs, etc. One volume of over 800 pages. Second Revised Edition. Prices: Cloth, $5.00; Sheep or Half-Morocco, J6. 00 net ; Half- Russia, ^6.50 net, with Denison's Patent Ready-Reference Index ; without Patent Index, Cloth, ^4.00 net; Sheep or Half-Morocco, ^5.00 net. " I am much pleased with Keating's Dictionary, and shall take pleasure in recommending it my classes." ,, , ,. t^ Henry M. Lyman, M. D., Professor of Principles and Practice of Medicine, Ru:h Medical College, Chicago, III. " I am convinced that it will be a very valuable adjunct to my study-table, convenient in size id sufficiently full for ordinary use." C. A. LiNDSLEY, M. D., Professor of Theory and Practice of Medicine, Medical Deft. Yale University; Secretary Connecticut State Board of Health, New Haven, Conn. iIEDICAL DIAGNOSIS. By Dr. Oswald Vterordt, Professor of Medi- cine at the University of Heidelberg. Translated, with additions, from the Second Enlarged German Edition, with the author's permission, by Francis H. Stuart, A.M., M. D. Third and Revised Edition. In one handsome royal-octavo volume of 700 pages, 1 78 fine wood-cuts in text, many of which are in cqlors. Prices: Cloth, ^4.00 net; Sheep or Half-Morocco, $%.oo net; Half- Russia, ls.50 net. In this work, as in no other hitherto published, are given full and accurate xplanations of the phenomena observed at the bedside. It is distinctly a clinical ?ork by a master teacher, characterized by thoroughness, fulness, and accuracy, t is a mine of information upon the points that are so often passed over without xplanation. Especial attention has been given to the germ-theory as a factor in he origin of disease. This valuable work is now published in German, English, Russian, and Italian. The issue of a third American edition within two years indicates the favor with which t has been received by the profession. " Rarely ig a book published with which a reviewer can find so little fault as with the volume lefore us. All the chapters are full, and leave little to be desired by the reader. Each particular tem in the consideration of an organ or apparatus, which is necessary to determine a diagnosis of ,ny disease of that organ, is mentioned ; nothing seem^ forgotten. The chapters on diseases of the irculatory and digestive apparatus and nervous system are especially full and valuable. Not- withstanding a few minor errors in translating, which are of small importance to the accuracy if the rest of the volume, the reviewer woijld repeat that the book is one of the best — probably, he best — which has fallen into his hands. An excellent and comprehensive index of nearly one lundred pages closes the volume." — University Medical Magazine, Philadelphia. CATALOGUE OF MEDICAL WORKS. PATHOLOGY AND SURGICAL TREATMENT OF TUMORS. By N. Senn, M. D., Ph. D., LL. D., Professor of Surgery and of Clinical Surgery, Rush Medical College ; Professor of Surgery, Chicago Polyclinic ; Attending Surgeon to Presbyterian Hospital ; Surgeon-in-Chief, St. Joseph's Hospital, Chicago. 710 pages, 515 engravings, including full-page colored plates. Prices: Cloth, ^6.00 net; Half- Morocco, $7.00 net. Books specially devoted to this subject are few, and in our text-books and systems of surgery this part of surgical pathology is usually condensed to a degree incompatible with its scientific and clinical importance. The author spent many years in collecting the material for this work, and has taken great pains to present it in a manner that should prove useful as a text-book for the student, a work of reference for the busy practitioner, and a reliable, safe guide for the surgeon. The more difficult operations are fully described and illustrated. More than one hundred of the illustrations are original, while the remainder were selected from books and medical journals not readily accessible to the student and the general practitioner. " The appearance of such a work is most opportune. ... In design and execution the work is such as will appeal to every student who appreciates the logical examination of facts and the prac- tical exemplification of well-digested clinical observation." — Medical Record, New York. " The most exhaustive of any recent book in English on this subject. It is well illustrated, and will doubtless remain as the principal monograph on the subject in our language for some years. The book is handsomely illustrated and printed and the author has given a notable and lasting contribution to surgery." — Journal of American Medical Association, Chicago. SURGICAL PATHOLOGY AND THERAPEUTICS. By' John Collins Warren, M. D., LL. D., Professor of Surgery, Medical Depart- ment Harvard University ; Surgeon to the Massachusetts General Hospital, etc. A handsome octavo volume of 832 pages, with 136 relief and litho- graphic illustrations, 33 of which are printed in colors, and all of which were drawn by William J. Kaula from original specimens. Prices: Cloth, ^6.00 net; Half-Morocco, ^7.00 net. " The volume is for the bedside, the amphitheatre, and the ward. It deals with things not as we see them through the microscope alone, but as the practitioner sees their effect in his patients ; not only as they appear in and affect culture- media, but also as they influence the human body ; and, following up the demon- strations of the nature of diseases, the author points out their logical treatment" {New York Medical Journal). " Indeed, the volume may be termed a modern medical classic, for such is the position to which it has already risen ' ' {Medical Age, Detroit), " and is the handsomest specimen of bookmaking * * * that has ever been issued from the American medical press ' ' {American Journal of the Medicaf Sciences, Philadelphia) . "Without Exception, the Illustrations are the Best ever Seen in a Work of this Kind. " A most striking and very excellent feature of this book is its illustrations. Without exception, from the point of accuracy and artistic merit, they are the best ever seen in a work of 'h'S kind. * * * Many of those representing microscopic pictures are so perfect in their coloring and detail as almost to give the beholder the impression that he is looking down the barrel of a microscope at a well-mounted section." — Annals of Surgery, Philadelphia. W. B. SAUNDERS' ILLUSTRATED UTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Professor of Surgery in the Jefferson Medical College of Philadelphia, with Reminiscences of His Times and Contemporaries. Edited by his Sons, Samuel W. Gross, M. D., LL.D., late Professor of Principles of Surgery and of Clinical Surgery in the Jefferson Medical College, and A. Haller Gross, A. M., of the Philadelphia Bar. Preceded by a Memoir of Dr. Gross, by the late Austin Flint, M. D., LL.D. In two handsome volumes, each con- taining over 400 pages, demy 8vo, extra cloth, gilt tops, with fine Frontis- piece engraved on steel. Price, ^5.00 net. This autobiography, which was continued by the late eminent surgeon until thin three months before his death, contains a full and accurate history of his rly struggles, trials, and subsequent successes, told in a singularly interesting d charming manner, and embraces short and graphic pen-portraits of many of e most distinguished men — surgeons, physicians, divines, lawyers, statesmen, ientists, etc. — with whom he was brought in contact in America and in Europe ; e whole forming a retrospect of more than three-quarters of a century. " Dr. Gross . . . was perhaps the most eminent exponent of medical science that America has yet )duced. His Autobiography, related as it is with a fulness and completeness seldom to be foimd such works, is an interesting and valuable book. He comments on many things, especially, of irse, on Medical Men and Medical Practice, in a very interesting way. Details of profes- nal life have also much in them that will be new." — The Spectator, London, England. HE PICTORIAL ATLAS OF SKIN DISEASES AND SYPH- ILITIC AFFECTIONS (American Edition). Translation from the French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Physician to, and Physician to the department for Diseases of the Skin at, the Middle- sex Hospital, London. Photo-lithochromes from the famous models of der- matological and syphilitic cases in the Museum of the Saint-Louis Hospital, Paris, with explanatory wood-cuts and text. In 12 Parts, at $3.00 per Part. Parts I to 8 now ready. " The plates are beautifully executed."— Jonathan Hutchinson, M. D. (London Hospital). " I strongly recommend this Atlas. The plates are exceedingly well executed, and will be great value to all studying dermatology."— Stephen Mackenzie, M. D. (London Hospital). "The plates in this Atlas are remarkably accurate and artistic reproductions of typical ex- ples of skm disease. The work will be of great value to the practitioner and student."— [LLIAM Anderson, M. D. (St. Thomas Hospital). " If the succeeding parts of this Atlas are to be similar to Part I, now before us, we have no Bitation m cordially recommending it to the favorable notice of our readers as one of the finest rmatological atlases with which we are acquainted."— Cto^ow Medical Journal, Aug., 1895. "Of all the atlases of skin diseases which have been published in recent years, the present one jmises to be of greatest interest and value, especially from the standpoint of the gen*al practi- aex."— American Medico- Surgical Bulletin, Vth. 22, i?,g(). " The introdiiction of explanatory wood-cuts in the text is a novel and most important feature nch greatly furthers the easier understanding of the excellent plates, than which nothing, we ven- e to say, has been seen better in point of correctness, beauty, and general merit."— A^«« Yorik tdtcal Journal, Feb. 15, 1896. "An interesting feature of the Atlas is the descriptive text, which is written for each picture by ; physician who treated the case or at whose instigation the models have been made. We pre- t for this truly beautiful work a large circulation in all parts of the medical world where the Ties St. Louis and Baretta have preceded W'—Medical Record, N. Y., Feb. i, 1896. CATALOGUE OF MEDICAL WORKS. 13 PRACTICAL POINTS IN NURSING. For Nurses in Private Practice. By Emily A. M. Stoney, Graduate of the Training-School for Nurses, Lawrence, Mass. ; Superintendent of the Training-School' for Nurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely illustrated with 73 engravings in the text, and 9 colored and half-tone plates. Cloth. Price, $1.75 net. In this volume the author explains, in popular language and in the shortest possible form, the entire range of /nVa/s nursing as distinguished irom hospital nursing, and the nurse is instructed how best to meet the various emergencies of medical and surgical cases when distant from medical or surgical aid or when thrown on her own resources. An especially valuable feature of the work will be found in the directions to the nurse how to improvise everything ordinarily needed in the sick-room, where the embarrassment of the nurse, owing to the want of proper appliances, is fre- quently extreme. The work has been logically divided into the following sections : I. The Nurse : her responsibilities, qualifications, equipment, etc. 11. The Sick-Room : its selection, preparation, and management. III. The Patient : duties of the nurse in medical, surgical, obstetric, and gyne- cologic cases. IV. Nursing in Accidents and Emergencies. V. Nursing in Special Medical Cases. VI. Nursing of the New-born and Sick Children. VII. Physiology and Descriptive Anatomy. » The Appendix contains much information in compact form that will be found of great value to the nurse, including Rules for Feeding the Sick; Recipes for Invalid Foods and Beverages ; Tables of Weights and Measures ; Table for Com- puting the Date of Labor ; List of Abbreviations ; Dose-List ; and a full and com- plete Glossary of Medical Terms and Nursing Treatment. " There are few books intended for non-professional readers which can be so cordially endorsed by a medical journal as can this one." — Therapeutic Gazette, Aug. 15, 1896. " This is a well-written, eminently practical volume, which covers the entire range of private nursing as distinguished from hospital nursing, and instructs the nurse how best to meet the various emergencies which may arise and how to prepare everything ordinarily needed in the illness of her patient." American Journal of Obstetrics and Diseases of Women and Children, Aug., 1896. " It is a work that the physician can place in the hands of his private nurses with the assurance of benefit."— O/4/o Medical Journal, Aug., 1896. A TEXT-BOOK OF BACTERIOLOGY, including the Etiology and Prevention of Infective Diseases and an account of Yeasts and Moulds, Haematozoa, and Psorosperms. By Edgar M. Crook- shank, M. B., Professor of Comparative Pathology and Bacteriology, King's College, London. A handsome octavo volume of 700 pages, illustrated with 273 engravings in the text, and 22 original and colored plates. Price, $6.50 net. This book, though nominally a Fourth Edition of Professor Crookshank's "Manual of Bacteriology," is practically a new work, the old one having been reconstructed, greatly enlarged, revised throughout, and largely rewritten, forming a text-book for the Bacteriological Laboratory, for Medical Officers of Health, and for Veterinary Inspectors. W. B. SAUNDERS' ILLUSTRATED [SEASES OF THE EYE. A Hand-Book of Ophthalmic Practice. By G. E. DE ScHWEiNiTZ, M. D., Professor of Ophthalmology in the Jetter- son Medical College, Philadelphia, etc. A handsome royal-octavo volume of 679 pages, with 256 fine illustrations, many of which are original, and 2 chromo-lithographic plates. Prices: Cloth, $4-00 net; Sheep or Half- Morocco, ^S-oo net. The object of this work is to present to the student, and to the practitioner who ..„,^..^^_ is beginning work in the fields of ophthal- "^°°^^"""° mology, a plain description of the optical defects and diseases of the eye. To this end special attention has been paid to the clinical side of the question; and the method of examination, the symptoma- tology leading to a diagnosis, and the treatment of the various ocular defects have been brought into prominence. SECOND EDITION, REVISED AND GREATLY ENLARGED. Specimen Utustration. The entire book has been thoroughly revised. In addition to this general re- vision, special paragraphs on the following w matter have been introduced : Filamentous Keratitis, Blood-staining of the )rnea. Essential Phthisis Bulbi, Foreign Bodies in the Lens, Circinate Retinitis, mmetrical Changes at the Macula Lutea in Infancy, Hyaline Bodies in the pilla, Monocular Diplopia, Subconjunctival Injections of Germicides, Infiltra- in-Anaesthesia, and Sterilization of Collyria. Brief mention ofi.Opfhthalmia jdosa. Electric Ophthalmia, and Angioid Streaks in the Retina also«finf s place. 1 Appendix has been added, containing a full description of the method of deter- ining the corneal astigmatism with the ophthalmometer of Javal and Schiotz, d the rotations of the eyes with the tropometer of Stevens. The chapter on perations has been enlarged and rewritten. "A clearly written, comprehensive manual. . . One which we can commend to students as a iable text-book, written with an evident knowledge of the wants of those entering upon the study this special branch of medical science." — British Medical Journal. " The work is characterized by a lucidity of expression which leaves the reader in no doubt as the meaning of the language employed. . . . We know of no work in which these diseases are ;alt with more satisfactorily, and indications for treatment more clearly given, and in harmony with e practice of the most advanced ophthalmologists." — Maritime Medical News. " It is hardly too much to say that for the student and practitioner beginning the study of phthalmology, it is the best single volume at present published." — Medical Neitis. " The latest and one of the best books on Ophthalmology. The book is thoroughly up to date, id is certainly a work which not only commends itself to the student, but is a ready reference for e busy practitioner." — International Medical Magazine. 'EEDING IN EARLY INFANCY. By Arthur V. Meigs, M. D. Bound in limp cloth, flush edges. Price, 25 cents net. Synopsis : Analyses of Milk — Importance of the Subject of Feeding in Earlj [ifancy— Proportion of Casein and Sugar in Human Milk — Time to Begin Arti- cial Feeding of Infants— Amount of Food to be Administered at Each Feeding — Qtervals between Feedings— Increase in Amount of Food at Different Periods of nfant Development — Umuitableness of Condensed Milk as a Substitute for Moth- r's Milk — Objections to Sterilization or ''Pasteurization" of Milk — Advances lade in the Method of Artificial Feeding of Infants. CATALOGUE OF MEDICAL WORKS. 15 A TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC- TICAL. For the Use of Students. By Arthur Clarkson, M. B., C. M., Edin., formerly Demonstrator of Physiology in the Owen's College, Manchester; late Demonstrator of Physiology in the Yorkshire College, Leeds. Large 8vo, 554 pages, with 22 engravings in the text, and 174 beautifully colored original illustrations. Price, strongly bound in Cloth, |6.oo net. The purpose of the writer in this work has been to furnish the student of His- tology, in one volume, with both the descriptive and the practical part of the science. The first two chapters are devoted to the consideration of the general methods of Histology ; subsequently, in each chapter, the structure of the tissue or organ is first systematically described, the student is then taken tutorially over , the specimens illustrating it, and, finally, an appendix affords a short note of the methods of preparation. TEXT-BOOK UPON THE PATHOGENIC BACTERIA. Spe- cially written for Students of Medicine. By Joseph McFarland, M. D., Professor of Pathology and Bacteriology in the Medico-Chirurgical College of Philadelphia, etc. 359 pages, finely illustrated. Cloth. Price, I2.50 net. The Book presents a concise account of the technical procedures necessary in the study of Bacteriology. It describes the life-history of pathogenic bacteria, and the pathological lesions following invasions. The wMJi^^tended to be a text-book for the medical student and fo? the practitic^^^^^^KS had no recent laboratory training in this department of med- ical scie^^^^HI instructions given as to needed apparatus, cultures, stainings, microscoj^^^^fcinations, etc. are ample for the student's needs, and will afford to the phn^^^W much information that will interest and profit him. "The author has succeeded admirably in presenting the essential details of bacteriological technics, together with a judiciously chosen summary of our present lounts nf method of Brand in the treatment of Typhoid Fever. ^^^ ^ g'^en in i^^^ CATALOGUE OF MEDICAL WORKS. 17 MANUAL OF MATERIA MEDICA AND THERAPEUTICS. By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the Uni- versity of Pennsylvania, and Demonstrator of Pathology in the Woman's Medical College of Philadelphia. 445 pages. Price, Cloth, ^2.25. SECOND EDITION, REVISED. This wholly new volume, which is based on the last edition of the Pharma- copmia, comprehends the following sections: Physiological Action of Drugs; Drugs; Remedial Measures other than Drugs; Applied Therapeutics; Incom- patibility in Prescriptions ; Table of Doses ; Index of Drugs ; and Index of Dis- eases ; the treatment being elucidated by more than two hundred formulae. NOTES ON THE NEWER REMEDIES: their Therapeutic Appli- cations and Modes of Administration. By David Cerna, M.D., Ph.D., Demonstrator of and Lecturer on Experimental Therapeutics in the Univer- sity of Pennsylvania. Post 8vo, 253 pages. Price, ^1.25. SECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED. The work takes up in alphabetical order all the newer remedies, giving their physical properties, solubility, therapeutic applications, administration, and chem- ical formula. SAUNDERS' POCKET MEDICAL FORMULARY. By William M. Powell, M. D., Attending Physician to the Mercer House for Inivalid Womei^^Atlantic City. Containing 1750 Formula, selected from se^ral hun^^^^^K best-known authorities. Forming a handsome and convenient poc^^^^^Hnion of nearly 300 printed pages, with blank leaves for additions ; with^^^^^endix containing Posological Table, Formulae and Doses for HypocBB^ Medication, Poisons and their Antidotes, Diameters of the Female Pelvis and Foetal Head, Obstetrical Table, Diet List for Various Dis- eases, Materials and Drugs used in Antiseptic Surgery, Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Third edition, revised and greatly enlarged. Handsomely bound in morocco, with side index, wallet, and flap. Price, ^1.75 net. " This little book, that can be conveniently carried in the pocket, contains an immense amount of material. It is very useful, and as the name of the author of each prescription is given is unusually reliable." — New York Medical Record. SAUNDERS' POCKET MEDICAL LEXICON; or, Dictionary of Terms and Words used in Medicine and Surgery. By John M. Keating, M. D., Editor of "Cyclopedia of Diseases of Children," etc. ; Author of the "New Pronouncing Dictionary of Medicine," and Henrv Hamilton, Author of "A New Translation of Virgil's ^neid into English Verse;" Co- Author of a "New Pronouncing Dictionary of Medicine." A new and revised edition. 32mo, 282 pages. Prices: Cloth, 75 cents; Leather Tucks, $\.oa. " Remarkably accurate in terminology, accentuation, and definition."— >a«»a/ 0/ American Medical Association. ,8 W. B. SAUNDERS' ILLUSTRATED DISEASES OF WOMEN. By Henry J. Garrigues, A. M., M. D-, ^'^°' fessor of Obstetrics in the New York Post-Graduate Medical School and Hos- pital ; Gynecologist to St. Mark's Hospital, and to the German Dispensary, etc., New York City. One octavo volume of nearly 700 pages, illustrated by 300 wood-cuts and colored plates. Prices: Cloth, $4.00 net; Sheep, ^5.00 net. A PRACTICAL work on gynaecology for the use of students and practitioners, written in a terse and concise manner. Th^ importance of a thorough knowledge of the anatomy of the female pelvic organs has been fully recognized by the author, and considerable space has been devoted to the subject. The chapters on Operations and on Treatment are thoroughly modern, and are based upon the large hospital and private practice of the author. The text is elucidated by a large number of illustrations and colored plates, many of them being original, and forming a complete atlas for studying embryology and the anatomy of the female genitalia, besides exemplifying, whenever needed, morbid conditions, instruments, apparatus, and operations. EXCERPT OF CONTENTS. Development of the Female Genitals. — Anatomy of the Female Pelvic Organs. — Physiology. — Puberty. — Menstruation and Ovulation. — Copulation. — Fecundation. — The Climacteric. — Etiology in General. — Examinations in General. — Treatment in General. — Abnormal Menstruation and Me- trorrh^ia. — Leucorrhea. — Diseases of the Vulva. — Diseases of the Perineum. — Diseases of the Vagina. — Diseases of the Uterus. — Diseases of the Fallopian Tubes. — Diseases of the Ovaries. — Diseases of the Pelvis. — Sterility. The reception accorded to this work has been most flattering. In the short period -which has elapsed since its issue, it has beMM^pted and recommended as a text-book by more than 60 of the Me(|^^^|K<^lB ^°<^ Universities of the United States and Canada. b^lM^pte sb^^^Khe in ^HBKttrac " One of the best text-books for students and practitioners which has b^^^^Hlhed in the English language ; it is condensed, clear, and comprehensive. The profoun^^^^ng and great clinical experience of the distinguished author find expression in this book in ^BBBittractive and mstructive form. Young practitioners, to whom experienced consultants may not be available, will find in this book invaluable counsel and help." Thad. a. Reamy, M. D., LL.D., Professor of Clinical Gynecology, Medical College of Ohio ; Gynecologist to the Good Samaritan and to the Cincinnati Hospitals. ESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THO- RAX. By Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diagnosis in the Rush Medical College, Chicago ; Attending Physician to the Central Free Dispensary, Department of Rhinology, Laryngology, and Diseases of the Chest. 200 pages. Illustrated. Cloth, flexible covers. Price, ^1.25 net. This book was originally published for the use of students, but its rapid absorn tion by the practitioner made it appear that a wider field had been reached Tn this edition the author has added to his revision of the text a section setting 'f^rth the signs found in each of the diseases of the chest, thereby increasing its vfi,i» f^ the general practitioner for post-graduate study. ° " It IS excellent. The student who shall use it as his guide to the careful sturti, f 1, ■ , exploration upon normal and abnormal subjects can scarcely fail to acquire a eood »Ji ■ P^jy^'^^^l ledge of the %-ah]ec\.."~ Philadelphia Polyclinic. 1 s u workmg know- CATALOGUE OF MEDICAL WORKS. 19 SYLLABUS OF OBSTETRICAL LECTURES in the Medical Department, University of Pennsylvania. By Richard C. Norris, A. M., M. D., Demonstrator of Obstetrics in the University of Pennsylvania. Third edition, thoroughly revised and enlarged. Crown 8vo. Price, Cloth, interleaved for notes, ^2.00 net. "This work is so far superior to others on the same subject that we take pleasure m callmg attention briefly to its excellent features. It covers the subject thoroughly, and will prove invaluable both to the student and the practitioner The author has mtroduced a number of valuable hints which would only occur to one who was himself an experienced teacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially pleased with the portion devoted to the practical duties of the accoucheur, care of the child, etc. The paragraphs on antiseptics are admirable ; there is no doubtful tone in the directions given. No details are regarded as unimportant ; no minor matters omitted. We venture to say that even the old practitioner will find useful hints in this direction which he cannot afford to despise." — Medical Record. A SYLLABUS OF GYNECOLOGY, arranged in conformity with " An American Text-Book of Gynecology." By J. W. Long, M. D., Professor of Diseases of Women and Children, Medical College of Virginia, etc. Price, Cloth (interleaved), ^i.oo net. Based upon the teaching and methods laid down in the larger work, this will not only be useful as a supplementary volume, but to those who do not already possess the Text-Book it Avill also have an independent value as an aid to the jfrac- titioner in- gynecological work, and to the student as a guide in the lecture-room, as the subject is presented in a manner systematic, succinct, and practical. A SYLLABUS OF LECTURES ON THE PRACTICE OF SUR- GERY,' arranged in conformity with " An American Text-Book of Surgery." By Nicholas Senn, M. D., Ph. D., Professor of Surgery in Rush Medical College, Chicago, and in the Chicago Polyclinic. Price, |2.oo. This excellent work of its eminent author, himself one of the contributors to "An American Text-Book of Surgery," will prove of exceptional value to the advanced student who has adopted that work as his text-book. It is not only the syllabus of an unrivalled course of surgical practice, but it is also an epitome of, or supplement to the larger work. AN OPERATION BLANK, with Lists of Instruments, etc. re- quired in Various Operations. Prepared by W. W. Keen, M. D., LL.D., Professor of Principles of Surgery in the Jefferson Medical College, Philadelphia. Price per pad, containing Blanks for fifty operations, 50 cents net. SECOND EDITION, REVISED FORM. A convenient blank (suitable for all operations), giving complete instructions regarding necessary preparation of patient, etc., with a full list of dressings and medicines to be employed. On the back of each blank is a list of instruments used — viz. general instruments, etc., required for all operations; and special in- struments for surgery of the brain and spine, mouth and throat, abdomen, rectum, male and female genito-urinary organs, the bones, etc. The whole forming a neat pad, arranged for hanging on the wall of a surgeon's office or in the hospital operating-room. W. B. SAUNDERS' ILLUSTRATED LABORATORY EXERCISES IN BOTANY. By Edson S. Bastin, M. A., Professor of Materia Medica and Botany in the Philadelphia Col- lege of Pharmacy. Octavo volume of 536 pages, vv^ith 87 plates. Price, Cloth, $2.50. This work is intended for the beginner and the advanced student, and it fully covers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers, bulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross , and microscopical structure of plants, and to those used in medicine. The illus- trations fully elucidate the text, and the complete index facilitates reference. » Trailing Arbutus (Epigea repens). Specimen lUustrtition. LABORATORY GUIDE FOR THE BACTERIOLOGIST. By Langdon Frothingham, M, D. V., Assistant in Bacteriology and Veterinary Science, Sheffield Scientific School, Yale University. Illustrated. Price, Cloth, 75 cents. The technical methods involved in bacteria-culture, methods of staining and microscopical study are fully described and arranged as simply and concisely as possible. The book is especially intended for use in laboratory work. OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA- TIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of Ob- stetrics in the St. Louis Medical College. 381 pages, handsomely illustrated. Price, g2.oo net. "For the use of the practitioner who, when away from home, has not the opportumty of consulting a library or of calling a friend in consultation He then, being thrown upon his own resources, will find this book of benefit in guiding and assisting him in emergencies." CA TALOGUE OF MEDICAL WORKS. HOW TO EXAMINE FOR LIFE INSURANCE. By John M. Keating, M. D., Fellow of the College of Physicians and Surgeons of Phila- delphia ; Vice-President of the American Paediatric Society ; Ex-President of the Association of Life Insurance Medical Directors. Royal 8vo, 211 pages, with two large half-tone illustrations, and a plate prepared by Dr. ' McClellan from special dissections \ also, numerous cuts to elucidate the text. Price, in Cloth, ;g2.oo net. " This is by far the most useful book which has yet appeared on insurance examination, a sub- ject of growing interest and importance. Not the least valuable portion of the volume is Part II., which consists of instructions issued to their examining physicians by twenty-four representative companies of this country. As the proofs of these instructions were corrected by the directors of 1 the companies, they form the latest instructions obtainable. If for these alone the book should be at the right hand of every physician interested in this special branch of medical science." — The Medical News, Philadelphia. THE CARE OF THE BABY. By J. P. Crozer Griffith, M. D., Clftii- cal Professor of Diseases of Children, University of Pennsylvania ; Physician to the Children's Hospital, Philadelphia, etc. 392 pages, with 67 illustrations in the text, and 5 plates. i2mo. Price, $1.^0. A reliable guide not only for mothers, but also for medical students and prac-' titioners whose opportunities for observing children have been limited. " The whole book is characterized by rare good sense, and is evidently viritten by a master hand. It can be read with benefit not only by mothers, but by medical students and by any prac- titioners who have not had large opportunities for observing children." — American yournal of Obstetrics, July, 1895. " The best book for the use of the young mother with which we are acquainted. . . . There are very few general practitioners who could not read the book through with advantage." — Archives of Pediatrics, Aug., 1895. " No better book of its kind has come under our notice for some time. Although intended primarily for mothers and nurses, it will well repay perusal by medical students." — Birmingham Medical Review, Oct., 1895. " This is one of the best works of its kind that has been presented to the people for many a day." — Maryland Medical Journal, Aug. 13, 1895. NURSING: ITS PRINCIPLES AND PRACTICE. By Isabel Adams Hampton, Graduate of the New York Training School for Nurses attached to Bellevue Hospital ; Superintendent of Nurses, and Principal of the Training School for Nurses, Johns Hopkins Hospital, Baltimore, Md. ; late Superin- tendent of Nurses, Illinois Training School for Nurses, Chicago, 111. In one very handsome i2mo volume of 484 pages, profusely illustrated. Price, Cloth, ;g2.oo net. This original work on the important subject of nursing is at once compre- hensive and systematic. It is written in a clear, accurate, and readable style, suit- able alike to the student and the lay reader. Such a work has long been a deside- ratum with those intrusted with the management of hospitals and the instruction of nurses in training-schools. It is also of especial value to the graduate nurse who desires to acquire a practical working knowledge of the care of the sick and the hygiene of the sick-room. JV. B. SAUNDERS' ILLUSTRATED CATALOGUE. NURSE'S DICTIONARY of Medical Terms and Nursing Treat- ment, containing Definitions of the Principal Medical and Nursing Terms and Abbreviations ; of the Instruments, Drugs, Diseases, Accidents, Treat- ments, Physiological Names, Operations, Foods, Appliances, etc. encountered in the ward or in the sick-room. Compiled for the use of nurses. By HoNNOR Morten, Author of "How to Become a Nurse," "Sketches of Hospital Life," etc. i6mo, 140 pages. Price, Cloth, ^i.oo. This little volume is intended merely as a small reference-book which can be consulted at the bedside or in the ward. It gives sufficient explanation to the nurse to enable her to comprehend a case until she has leisiire to look up larger and fuller works on the subject. DIET IN SICKNESS AND IN HEALTH. By Mrs. Ernest Hart, formerly Student of the Faculty of Medicine of Paris and of the London School ■ of Medicine for Women ; with an Introduction by Sir Henry Thompson, F. R. C. S., M. D., London. 220 pages; illustrated. Price, Cloth, ^1.50. Useful to those who have to nurse, feed, and prescribe for the sick. ... In each case the accepted causation of the disease and the reasons for the special diet prescribed are briefly described. Medical men will find the dietaries and recipes practically useful, and likely to save them trouble in directing the dietetic treatment of patients. " We recommend it cordially to the attention of all practitioners ; . . . . both to them and to their patients it may be of the greatest service." — -Medical Journal, New York. DIETS FOR INFANTS AND CHILDREN IN HEALTH AND IN DISEASE. By Louis Starr, M. D., Editor of "An American Text- Book of the Diseases of Children. ' ' 230 blanks (pocket-book size), per- forated and neatly bound in flexible morocco. Price, ^1.25 net. The first series of blanks are prepared for the first seven months of infant life ; each blank indicates the ingredients, but not the quantities, of the food, the latter directions being left for the physician. After the seventh month, modifications being less necessary, the diet lists are printed in full. FormulcB for the prepara- tion of diluents and foods are appended. DIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas, M. D., Visiting Physician to the Home for Friendless Women and Children and to the Newsboys' Home ; Assistant Visiting Physician to the Kings County Hospital; Assistant Bacteriologist, Brooklyn Health Department. Price, ^1.50. Send for sample sheet. There is here offered, in portable form, as an efficient aid to the better practice of Therapeutics, a collection of detachable Diet Lists and a Sick-room Dietary. It meets a want, for the busy practitioner has but little time to write out Systems of Diet appropriate to his patients, or to describe the preparation of their food. Compiled from the most modern works on dietetics, the Dietary offers a variety of easily-digested foods. " A convenience that will be appreciated by the physician."— i¥i?rfzVo/ Journal, New York. "The work is an excellent one, and ought to be welcomed by physician, patient, and nurse alike." — Indian Lancet, Calcutta. Practical, Exhaustive. Authoritative. SAUNDERS' NEW AID SERIES OF MANUALS. FOR STUDENTS AND PRACTITIONERS. Mr. Saunders is pleased to announce the successful issue of several volumes of his NEW AID SERIES OF MANUALS, which have received the most flattering commendations from Students and Practitioners and the Press. As publisher of the Standard Series of Question Compends, and through intimate relations with leading members of the medical profession, Mr. Saunders has been enabled to study progressively the essential desiderata in practical " self-helps " for students and physicians. This study has manifested that, while the published "Question Compends" earn the highest appreciation of students, whom they serve in reviewing their studies preparatory to examination, there is special need of thoroughly reliable handbooks on the leading branches of Medicine and Surgery, each subject being compactly and authoritatively written, and exhaustive in detail, without the intro- duction of cases and foreign subject-matter which so largely expand ordinary text- books. The Saunders Aid Series will not merely be condensations from present literature, but will be ably written by well-known authors and practitioners, most of them being teachers in representative American Colleges. This new series, therefore, will form an admirable col- lection of advanced lectures, which will be invaluable aids to students in reading and in comprehending the contents of " recommended " works. Each Manual will further be distinguished by the beauty of the new type ;' by the quality of the paper and printing ; by the copious use of illustrations ; by the attractive binding in cloth; and by the extremely low price at which they will be sold. 23 Saunders' New Aid Series of Manuals. VOLUMES PUBLISHED. PHYSIOLOGY, by Joseph Howard Baymond, A. M., M. D., Professor of Phyd- ology and Hygiene and Lecturer on Gynecology in the Long Island College Hos- pital ; Director of Physiology in the Hoagland Laboratory ; formerly Lecturer on Physiology and Hygiene in the Brooklyn Normal School for Physical Education; Ex-Vice- President of the American Public Health Association ; Ex-Health Ommis- sioner, City of Brooklyn, eta Illustrated, fl.25 net. SURGERY, General and Operative, by John Chaimees DaCosta, M. D., Demon- strator of Surgery, Jefferson Medical College, Philadelphia; Chief Assistant Sur- geon, Jefferson Medical College Hospital ; Surgical Registrar, Philadelphia Hospital, etc. 188 illustrations and 13 plates. (Double number.) $2.50 net DOSE-BOOK AND MANUAL OF PRESCRIPTION-WRITING, by E. Q. Thobnton, M. D., Demonstrator of Therapeutics, Jefferson Medical College, Phila^ delphia. Illustrated. Price, cloth, $1.25 net. SURGICAL ASEPSIS, by Cabl Beck, M. D., Surgeon to St. Mark's Hospital and to the New York German Poliklinik, etc. Illustrated. Price, cloth, $1.25 net. MEDICAL JURISPRUDENCE, by Henbt C. Chapman, M. D., Professor of Insti- tutes of Medicine and Medical Jurisprudence in the Jefferson Medical College of Philadelphia ; Member of the College of Physicians of Philadelphia, of the Acade- my of Natural Sciences, of the American Philosophical Society, and of the Zoologi- cal Society of Philadelphia. Illustrated. ^1.50 net. SYPHILIS AND THE VENEREAL DISEASES, by Jambs Nevins Hyde, M.D., Professor of Skin and Venereal Diseases, and Frank H. Montgomery, M. D., Lecturer on Dermatology and Genito-Urinary Diseases, in Bush Medical College, Chicago. Profusely Illustrated. (Double number.) $2.50 net. PRACTICE OF MEDICINE, by George Eoe Lockwood, M. D., Professor of Practice in the Woman's Medical College of the New York Infirmary; Instructor of Physical Diagnosis of the Medical Department of Columbia College; Attending Physician to the Colored Hospital; Pathologist to the French Hospital; Member of the New York Academy of Medicine, of the Pathological Society, of the Clinical Society, etc. Illustrated. (Double number.) $2.50 net. MANUAL OF ANATOMY, by Irving S. Haynes, M. D., Adjunct Professor of Anatomy and Demonstrator of Anatomv. Medical Department of the New York University, etc. Beautifully Illustrated. (Double number.) Price, $2.50 net. MANUAL OF OBSTETRICS, by W. A. Newman Dorland, M. D., Asat. Demon- strator of Obstetrics, University of Pennsylvania; Chief of Gynecological Dispen- sary, Pennsylvania Hospital; Member of Philadelphia Obstetrical Society etc Profusely illustrated. (Double number.) Price, $2.50 net. VOLUMES IN PREPARATION. ^^^^^^??.,°^ WOMEN, by J. Bland Sutton, F. E. C. S., Assistant Surgeon to the Middlesex Hospital, London, and Arthur Edward Gjles, M. D. Hand- somely illustrated. (Double number.) , NOSE AND THROAT, by D. Beaden Kyle, M. D., Chief Laryngologist of the St. Agnes Hospital, Philadelphia; Bacteriologist of the Orthopedic Hospital and Inhrmary for Nervous Diseases; Instructor in Clinical Microscopy and Assistant Demonstrator of Pathology in the Jefferson Medical College, etc. NERVOUS DISEASES, by Charles W. Burr, M. D., Clinical Professor of Nervous Diseases Medico-Chirurgical College, Philadelphia ; Pathologist to the Orthopjedic Hospital and Infirmary for Nervous Diseases; Visiting Physician to the St. Joseph thP*»,,^wlpf= nf rhfi.fJi^''??^'^ ^''i *'^® ^^? ^«''«S' «•* "lose intervals, earefhUy-prepared works on the subjects of Children, Gynecology, Hygiene, etc., by prominent specialists. ^ ^ "^ ""'^'^ °" 24 SAUNDERS' QUESTION COMPENDS. Arranged in Question and Answer Form. THE LATEST, CHEAPEST, AND BEST ILLUSTRATED SERIES OP COMPENDS EVER ISSUED. Now the Standard Authorities in Medical Literature WITH Students and Practitioners in every City of the United States and Canada. THE REASON ^VHY They are the advance guard of "Student's Helps" — that do help; they are the leaders in their special line, well and authoritatively written by able men^ who, as teachers in the large col- legeSy know exactly what is wanted by a student preparing for his examinations. The judgment exercised in the selection of authors is fully demonstrated by their professional elevation. Chosen from the ranks of Demonstrators, Quiz-masters, and Assistants, most of them have become Pro- fessors and Lecturers in their respective colleges. Each book is of convenient size (5x7 inches), containing on an average 250 pages, profusely illustrated, and elegantly printed in clear, readable type, on fine paper. The entire series, numbering tvifenty-three volumes, has been kept thoroughly revised and enlarged when necessary, many of them being in their fourth and fifth editions. TO SUM UP. Although there are numerous other Quizzes, Manuals, Aids, etc. in the market, none of them approach the " Blue Series of Question Compends ;" and the claim is made for the following points of excellence ; r. Professional distinction and reputation of authors. 2. Conciseness, clearness, and soundness of treatment. 3. Size of type and quality of paper and binding. *4t* Any of these Compends will be mailed on receipt of price (see over for List). 2S 26 IV. B. SAUNDERS' ILLUSTRATED Saunders' Question-Compend Series. -~* » > — je@» Price, Cloth, ai.OO per copy, except when otherwise noted. 1 ESSENTIALS OF PHYSIOLOGY. 3d edition. Illustrated. Revised and enlarged. By H. A. Hare, M. D. (Price, JSi.oo net.) 2 ESSENTIALS OF SURGERY. Sth edition, with an Appendix on Antiseptic Surgery. 90 illustrations. By Edward Martin, M. D. 3. ESSENTIALS OF ANATOMY. 5th edition, with an Appendix. 180 illustrations. By Charles B. Nancrede, M. D. 4 ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND INORGANIC. 4th edition, revised, with an Appendix. By Lawrence Wolff, M. D. 5. ESSENTIALS OF OBSTETRICS. 3d edition, revised and enlarged. 75 illustrations. By W. Easterly Ashton, M. D. 6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. 6th thousand. 46 illustrations. By C. E. Armand Semple, M. D. 7 ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, AND PRE- SCRIPTION-WRITING. 4th edition. By Henry Morris, M. D. 8 Q ESSENTIALS OF PRACTICE OF MEDICINE. By Henry Morris, M. D. ' An Appendix on Urine Examination. Illustrated. By Lawrence Wolff, M. D. 3d edition, enlarged by some 300 Essential Formulae, selected from eminent authorities, by Wm. M. Powell, M. D. (Double number, price $2.00.) 10. 'ESSENTIALS OF GYN.ffiCOLOGY. 3d edition, revised. With 62 illustrations. By Edwin B. Cragin, M. D. 11. ESSENTIALS OF DISEASES OF THE SKIN. 3d edition, revised and enlarged. 71 letter-press cuts and 15 half-tone illustrations. By Henry W. Stelwagon, M. D. (Price, $1.00 net.) 12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND VENEREAL DISEASES. 2d edition, revised and enlarged. 78 illustrations. By Edward Martin, M. D. 13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE. 130 illustrations. By C. E. Armand Semple, M. D. 14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND THROAT. 124 illustrations. 2d edition, revised. By Edward Jackson, M. D., and E. Baldwin Gleason, M. D. 15. ESSENTIALS OF DISEASES OF CHILDREN. 2d edition. By William M. Powell, M. D. i5. ESSENTIALS OF EXAMINATION OF URINE. Colored " VoGEL Scale," and numerous illustrations. By Lawrence Wolff, M. D. (Price, 75 cents.) 17. ESSENTIALS OF DIAGNOSIS. By S. Solis-Cohen, M. D., and A. A. Eshner, M. D. 55 illustrations, some in colors. (Price, $1.50 net.) 18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E. Sayre. 2d edition, revised and enlarged. 20. ESSENTIALS OF BACTERIOLOGY. 2d edition. 81 illusbrations. By M. V. Ball, M. D. ai. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. 48 illustrations. 2d edition, revised. By John C. Shaw, M. D. 22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d edition, revised- By Fred J. Brockway, M. D. (Price, $1.00 net.) 23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations. By David D. Stewart, M. D., and Edward S. Lawrance, M. D. 24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Gleason, M. D. 89 illustrations. CATALOGUE OF MEDICAL WORKS. 27 JUST PUBLISHED. A TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS, AND PHARMACOLOGY. By George F. Butler, Ph. G., M. D., Professor of Materia Medica and of Clinical Medicine in the College of Physicians and Surgeons, Chicago ; Professor of Materia Medica and Thera- peutics, Northwestern University, Woman's Medical School, etc. 8vo, 858 pages. Illustrated. Prices : Cloth, ^4.00 net ; Sheep or Half-Morocco, $S-°° ^'^'^■ A clear, concise, and practical text-book, adapted for permanent reference no less than for the requirements of the class-room. The arrangement (embodying the synthetic classification of drugs based upon therapeutic affinities) is believed to be at once the most philosophical and rational, as well as that best calculated to engage the interest of thoge to whom the academic study of the subject is wont 'to offer no little perplexity. Special attention has been given to the Pharmaceutical section, which is exceptionally lucid and complete. LECTURES ON RENAL AND URINARY DISEASES. By Robert Saundby, M. D. Edin., Fellow of the Royal College of Physicians, London, and of the Royal Medico-Chirurgical Society; Physician to the General Hospital; Consulting Physician to the Eye Hospital and to the Hospital for Diseases of Women ; Professor of Medicine in Mason College, Birmingham, etc. 8vo, 434 pages, with numerous illustrations and 4 colored plates. Price, Cloth, $2.50 net. In these Lectures, which are a re-issue in one volume of the author's well- known works on Bright' s Disease and Diabetes, there is given, within a modest compass, a review of the present state of knowledge of these important affections, with such additions and suggestions as have resulted from the author's thirteen years' clinical and pathological study of the subjects. The lectures have been carefully revised and much new matter added to them. There has also been added a section dealing with "Miscellaneous Affections of the Kidney," making the book more complete as a work of reference. ELEMENTARY BANDAGING AND SURGICAL DRESSING, with Directions concerning the Immediate Treatment of Cases of Emergency. For the use of Dressers and Nurses. By Walter Pye, F. R. C. S., late Surgeon to St. Mary's Hospital, London. Small i2mo, with over 80 illus- trations. Cloth, flexible covers. Price, 75 cents net. This little book is chiefly a condensation of those portions of Pye's " Surgical Handicraft ' ' which deal with bandaging, splinting, etc. , and of those which treat of the management in the first instance of cases of emergency. Within its own limits, however, the book is complete, and it is hoped that it will prove extremely useful to students when they begin their work in the wards and casualty rooms, and useful also to surgical nurses and dressers. " The directions are clear and the illustrations are good." — London Lancet. " The author writes well, the diagrams are clear, and the book itself is small and portable, although the paper and type are good." — British Medical Journal. " One of the most useful little works for dressers and nurses. The author truly says that it is ' a very little book,' but it is large in usefulness." — Chemist and Druggist. JUST ISSUED. SOLD BY SUBSCRIPTION. ANOMALIES AND CURIOSITIES OF MEDICINE. BY GEORGE M. GOULD, M. D., AND WALTER L. PYLE, M. D. Several years of exhaustive research have been spent by the authors in the great medical libraries of the United States and Europe in col- lecting the material for this work. Medical literature of all ages and all languages has been carefully searched, as a glance at the. Bibliographic Index will show. The facts, which will be of extreme value to the author and lecturer, have been arranged and anno- tated, and full reference footnotes given, indicating whence they have been obtained. In view of the persistent and dominant interest in the anomalous and curious, a thorough and systematic collection of this kind (the first of which the authors have knowledge) must have its own peculiar sphere of usefulness. As a complete and authoritative Book of Reference it will be of value not only to members of the medical profession, but to all persons interested in general scientific, sociologic, and medico-legal topics ; in fact, the general interest of the subject and the dearth of any complete work upon it make this volume one of the most important literary innovations of the day. An especially valuable feature of the book consists of the Indexing. Besides a complete and comprehensive General Index, containing numerous cross-references to the subjects discussed, and the names of the authors of the more important reports, there is a convenient Bibliographic Index and a Table of Contents. The plan has been adopted of printing the topical headings in bold-face type, the reader being thereby enabled to tell at a glance the subject-matter of any particular paragraph or page. Illustrations have been freely employed throughout the work, there being 165 relief cuts and 130 half-tones in the text, and 12 colored and half-tone full page plates— a total of over 320 separate figures. The careful rendering of the text and references, the wealth of illus- trations, the mechanical skill represented in the typography, the print- ing, and the binding, combine to make this book one of the most attractive medical publications ever issued. Handsome Imperial Octavo Volume of S6S Pages. PRICES: Cloth, $6. GO net; Half Morocco, $7. DO net. IN PREPARATION FOR EARLY PUBLICATION. AN AMERICAN TEXT-BOOK OF QENITO-URINARY AND SKIN DISEASES. Edited by L. Bolton Bangs, M. D., Late Professor of Genito-Urinary and Venereal Dis- -i: i,;,_ eases, New York Post-Graduate Medical School and Hospital, and William A. Hard- AWAY, M. D., Professor of Diseases of the Skin, Missouri Medical College. AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, EAR, NOSE, AND THROAT, Edited by G. E. de Schweinitz, M. D., Professor of Ophthalmology in the Jefferson Medical College, -and B. Alexander Randall, M. D., Professor of Diseases of the Ear in the University of Pennsylvania and in the Philadelphia Polyclinic. MACDONALD'S SURGICAL DIAGNOSIS AND TREATMENT. Surgical Diagnosis and Treatment. By J. W. Macdonald, M. D., Graduate of Medicine of the University of Edinburgh ; Licentiate of the Royal College of Surgeons, Edinburgh; Professor of the Practice of Surgery and of Clinical Surgery, Minneapolis College of Physicians and Surgeons. ANDERS' THEORY AND PRACTICE OF MEDICINE. A Text=Book of the Theory and Practice of Medicine. By James M. Anders, M. D., Ph. D., LL.D., Professor of the Theory and Practice of Medicine and of Clinical Medicine, Medico-Chirurgical College, Philadelphia. SENN'S GENITO=URINARY TUBERCULOSIS. Tuberculosis of the Genito=Urinary Apparatus, Male and Female. By Nich- olas Senn, M. D., Ph. D., LL.D., Professor of the Practice of Surgery and of Clinical Surgery, Rush Medical College, Chicago. PENROSE'S GYNECOLOGY. A Text-Book of Gynecology. By Charles B. Penrose, M. D., Professor of Gyne- cology, University of Pennsylvania. HIRST'S OBSTETRICS. A Text=Book of Obstetrics. By Barton Cooke Hirst, M. D., Professor of Obstet- rics, University of Pennsylvania. MOORE'S ORTHOPEDIC SURGERY, A Manual of Orthopedic Surgery. By James E. Moore, M. D., Professor of Orthopedics and Adjunct Professor of Clinical Surgery, University of Minnesota, College of Medicine and Surgery. HEISLER'S EMBRYOLOGY. A Text=Book of Embryology. By John C. Heisler, M. D., Prosector to the Pro- fessor of Anatomy, Medical Department of the University of Pennsylvania. New Volume in Saunders' Aid Series. SUTTON AND GILES' DISEASES OF WOMEN, Diseases of Women. By J. Bland Sutton, F R.C.S., Assistant Surgeon to the Middlesex Hospital, and Surgeon to the Chelsea Hospital for Women, London; and Arthur E. Giles, M. D., B. Sc. Lond., F. R. C. S. Edin., Assistant Surgeon to the Chelsea Hospital for Women, London. Handsomely Illustrated. NOW READY— VOLUMES FOR 1896 AND 1897. SAUNDERS' American Year-Book of Medicine and Surgery COLLECTED AM) ARRANGED BY EfflNEFT AMERICAN SPECIALISTS AND TEACHERS, UNDER THE EDITORIAL CHARGE OF GEORGE M. GOULD, M. D. Notwithstanding the rapid multiplication of medical and surgical works, still these publications fail to meet fully the requirements of the general physician, inasmuch as he feels the need of something more than mere text-books of well- known principles of medical science. Mr. Saunders has long been impressed with this fact, which is confirmed by the unanimity of expression from the profession at large, as indicated by advices from his large corps of canvassers. This ' deficiency would best be met by current journalistic literature, but most practitioners have scant access to this almost unlimited source of informa- tion, and the busy practiser has but little time to search out in periodicals the many interesting cases, whose study would doubtless be of inestimable value in his practice. Therefore, a work which places before the physician in convenient form an epitomization of this literature hy persons competent to pronounce upon The Value of a Discovery or of a Method of Treatment cannot but command his highest appreciation. It is this critical and judicial ftinction that will be assumed by the Editorial stafi" of the " American Year-Book of Medicine and Surgery." It is the special purpose of the Editor, whose experience peculiarly qualifies him for the preparation of this work, not only to review the contributions to American journals, but also the methods and discoveries reported in the leading medical journals of Europe, thus enlarging the survey and making the work characteristically international. These reviews will not simply be a series of undigested abstracts indiscriminately run together, nor will they be retro- spective of "news" one or two years old, but the treatment presented will be synthetic and dogmatic, and will include only what is new. Moreover through expert condensation by experienced writers, these discussions will be Comprised in a Single Volume of about 1200 Pages. The work will be replete with original and selected illustrations' skilfully reproduced, for the most part, in Mr. Saunders' own stni-s established for the purpose,, thus ensuring accuracy in delineation, affording eflScient aids to a right comprehension of the text, and adding to the attractiveness of thr volume. Prices: Cloth, $6.50J^ t7H^lfM orocco, $7.50 net. W. B. SAUNDERS, Publisher, 925 "Walnut Street, Philadelphia. F^