THERAPEUTICS AND MATERIA MEDICA. STILLE'S THERAPEUTIC S-lSTew Edition-Lately Issued. THERAPEUTICS AND MATERIA MEDICA : A Systematic Treatise on the Action and Uses of Medicinal Agents, including their De- scription and History. By Alfred Stille, M.D.. Professor of the Theory and Practice, and of Clinical Medicine, in the University of Pennsylvania, etc. Fourth edition, revised and enlarged. In two large and handsome octavo volumes of nearly 2000 pages : cloth, $10; leather, $12. It is unnecessary to do much more than to announce the appearance of the fourth edition of this well-known and excellent work. — Brit, and For. Med.-Chir. Biv., Oct. 1875. We can hardly admit that it has a rival in the multitude of its citations and the fulness of its research into clinical histories, and we must assign it a p'ace in the physician's library ; not. indeed, as fully representing the present state of knowledge in pharmacodynamics, but as by far the most complete treatise upon the clinical and practical side of the question.— Bost. Med. and Surg Journ., Nov. 5, 1874. The magnificent work of Professor Stille is known wherever the English language is read, and the art of medicine cultivated: known so well that no encomiums of ours could brighten its fame, and no unfavorable criticism could tarnish its reputation. — Pltila. Med. Times, Dec. 12, 1874. The prominent feature of Dr. Stille's great work is sound good sense. It is learned, but its learning is of inferior value compared with the discriminating judgment which is shown by its author in the discussion of his subjects, and which renders it a trust- worthy guide in the sick-room. — Am. Practitioner, Jan. 1875. STILLE & MAISCH'S DISPENSATORY-Preparing for early Publication. THE NATIONAL DISPENSATORY. Embracing the Chemistry, Bot- any, Materia Medica, Pharmacy, Pharmacodynamics and Thera- peutics of the Pharmacopoeias of the United States and Great Britain. For the Use of Physicians and Pharmaceutists. By Alfred Stille, M.D., LL.D. , Prof, of Theory and Praotice and Clin. Med. in University of Pennsylvania, and John M. Maisoh, Ph.D., Prof, of Materia Medica and Botany in the Phila. Coll. of Pharmacy, Secretary to the Am. Pharm Association. With nume- rous illustrations. In one handsome octavo volume. The want has long been felt and expressed of a work which, within a moderate compass, should give to the physician and pharmaceutist an authoritative exposition of the pharmacopoeias from the existing stand- point of medical and pharmaceutical science. For several years the authors have been earnestly engaged in the preparation of the present volume, with the hope of satisfying this want, and their labors are now sufficiently advanced to enable the publisher to promise its appearance during the coming season. Their distinguished reputation in their re- spective departments is a guarantee that the work will fulfil all reasonable expectation as a guide in the selection, compounding, dispensing, and medicinal uses of drugs, complete in all respects, while convenient in size, and carefully divested of all unnecessary and obsolete matter. HENRY C. LEA-P>iiladelpliia. A GUIDE TO THERAPEUTICS AND MATERIA MEDICA. ROBERT FARQUH ARSON, M.D. Edin., F.R.C.P. Lond., LECTURER ON MATERIA MEDICA AT ST. MARY'S HOSPITAL MEDICAL SCHOOL, ETC. ENLARGED AND ADAPTED TO THE U. S. PHARMACOPOEIA BY FRANK WOODBURY, M.D., MEMBER OF THE ACADEMY OF NATURAL SCIENCES, PHILA., ETC. PHILADELPHIA: HENRY C. LEA. 1877. \ ^ <^1> Eatered according to the Act of Congress, in the year 1877, by HENRY C. LEA, in the Office of the Librarian of Congress. All rights reserved. COr-LINS, PRINTER. EDITOR'S PREFACE There is no more encouraging evidence of progress in medical science than the growing desire of the pro- fession for exact information concerning the action of remedial agents. A tendency towards empiricism, springing from too exclusive a reliance upon clinical teachings, finds its natural correction in increased familiarity with ascertained facts respecting the influ- ence of drugs upon the human system in health and disease; and no argument is needed to show that if therapeutics is ever to attain the precision of a science it must be based upon the fullest attainable knowledge of this kind. The present volume, though small in bulk, is an intelligent effort in this direction, containing, as it does, in moderate compass, such well-digested facts concerning the physiological and therapeutical action of remedies as are reasonably established up to the present time. By a convenient arrangement the corresponding effects in health and disease of each article are presented in parallel columns, not only ren- dering reference easier, but also impressing the facts more strongly upon the mind of the reader. A* (V) Vi EDITOR'S PREFACE. In reproducing the " Guide to Therapeutics," very considerable additions have been found desirable to adapt it thoroughly to the wants of the American stu- dent — additions which have seemed to warrant the in- sertion of the words " Materia Medica" in the title-page. Without altering the peculiar features of the original, some changes have been made in the arrangement, and very copious notes have been introduced, embodying the latest revision of the U. S. Pharmacopoeia, together with the antidotes to the more prominent poisons, and such of the newer remedial agents as seemed necessary to the completeness of the whole. All matter thus added will be found distinguished from the text by brackets []. It is hoped that the volume in its present shape will prove to be well suited to the wants of the student and junior practitioner, from its compendious form, and the clearness with which the leading facts of therapeutics and the materia medica are set forth. Philadelphia, November, 1877. PREFACE. In these days of profuse publication, a preface coming from any one who ventures to write a text-book must assume, in great measure, an apologetic tone. Elaborate and comprehensive works on Therapeutics now crowd our shelves, and the question may not unnaturally arise, what excuse can be given for adding another item to the rapidly increasing list ? In reply to this I can only express a hope that room may be found for a smaller handbook than those more elaborate treatises which reflect so faithfully the progress of modern science, and that my little bark may float peacefully by the side of more richly laden vessels without being entirely sub- merged by their waves. I cannot, of course, expect either to supersede or to rival the classical manuals of Ringer, Wood, and others, and all I aim at is to present the subject in briefer compass, in perhaps more sys- tematic form, and unencumbered by any botanical or pharmaceutical detail. Space has not enabled me to acknowledge the sources from which I have been enabled to compile the follow- (vii) Vlll PREFACE. ing pages ; and I can only express in general terms my grateful sense of the labors of many able and industrious workers in the field of Therapeutics. I have freely drawn much valuable material from the systematic works of Stille, Neligan, Garrod, Ringer, Wood, Bar- tholow, Phillips, Thorowgood, Nothnagel, Royle, and Christison ; and I have also derived important instruc- tion from the writings of Brunton, Handheld Jones, Fraser, Fothergill, John Harley, Anstie, Broadbent, Liebreich, and many others who have contributed important aid to the progress of our subject in later years. For many of my prescriptions I am more especially indebted to Bartholow, and to the very handy little " Lessons on Prescribing" by Dr. Hansell Griffiths. 23 Brook Street, Grosvenor Square, W. April, 1877. CONTENTS. Introduction . . . 13 General Rules for Pre- scribing . . .15 Preliminaiy considerations 15 Combination of Drugs . 16 Form of Administration . 17 Proper time for Exhibition 18 Dosage . . . 19 Interval between Doses . 21 Individual Peculiarities . 22 Idiosyncrasy . . .22 Habit . . . .22 Constitutional or Toxic effect from small doses . Chemical and Physiological Incompatibilities . Prescribing for Children Prescription-writing . Weights and Measures Observations upon Doses . General rule for Doses General Plan of Arrange- ment .... 24 25 26 28 29 30 3i 3 2 SECTION I. Remarks on certain Classes of Remedies. Antidotes . Acids .... Anthelmintics . Antipyretics and Refrig- erants . Antiseptics and Disinfect- ants Remedies comprised in the Primary List of the United States Pharmacopoeia and their Preparations. • 37 Counter-Irritants . . 47 ■ 38 Diaphoretics . . .48 . 42 Diuretics . . . .50 G- Emetics . . . . 51 • 44 Emmenagogues andEcbolics 54 T- Expectorants . . -55 • 45 Purgatives . . -56 SECTI ON II. Those marked * are not officinal. Absinthium Acacia Syrupus Acaciae Mucilago Acaciae Acetum Acetum Destillatum . Acidum Aceticum Acidum Aceticum Dilutum Aceta .... Acidum Arseniosum . Acidum Carbolicum Impur Acidum Carbolicum . Glyceritum Acidi Carbolici Unguentum Acidi Carbolici Suppositoria Acidi Carbolic Aqua Acidi Carbolici 61 61 61 61 62 62 62 62 62 64 64 64 64 64 64 64 Acidum Chromicum . Acidum Citricum Syrupus Acidi Citrici Acid. Hydrocyanic. Dil Acidum Lacticum Acidum Nitricum Acidum Nitricum Dilutum Acidum Nitro - Muriaticum Acid. Nitro-Muriat. Dilut Acidum Oxalicum Acidum Tartaricum . Ferri et Ammonii Tartras Pulveres Effervescentes Pulv. Efferv. Aperientes Acida Aconitum . (ix) 67 69 73 73 73 75 75 75 75 75 75 75 76 76 CONTENTS Aconiti Folia . Aconiti Radix . Aconitia . Extractum Aconiti Emplastrum Aconiti . Linimentum Aconiti . Tinctura Aconiti Radicis Adeps .... Ceratum . Unguentum Unguenta . ./Ether /Ether Fortior . Spiritus iEtheris Compositus ^Etherea Alcohol ... Alcohol Dilutum Alcohol Fortius Vinum Xericum Vinum Portense Spiritus Vini Gallici . Spiritus Frumenti Spiritus Myrciae Spiritus Genevae* Spiritus ^Etheris Nitrosi Spiritus ^Etheris Compos Spiritus Alcohol Amylicum . Amyl Nitris* . Allium Syrupus Allii . Aloe .... Aloe Barbadensis Aloe Capensis . Aloe Socotrina . Aloe Purificata . Pilulae Aloes Pilulae Aloes et Assafcetidae Pilulae Aloes et Mastiches Pilulae Aloes et Myrrhae Pilulae Rhei Compositae Pulvis Aloes et Canelhe Tinctura Aloes . Tinctura Aloes et Myrrhae Vinum Aloes Suppositoria Aloes . Alth^.a . Alumen Alumen Exsiccatum . Aluminii et Pot. Sulphas Aluminii Sulphas Ammoniacum 76 76 76 76 76 76 76 80 80 81 81 81 81 81 81 84 84 84 84 84 84 84 84 84 91 9 1 9i 91 92 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 97 97 97 98 98 98 Mistura Ammoniaci . Pilulae Scillae Compositae . Emplastrum Ammoniaci Emp. Am. cum Hydrarg. Ammonium Aqua Ammoniae Fortior Aqua Ammoniae Linimentum Ammoniae Liquor Ammoniae Acetatis. Spiritus Ammoniae Spirit. Amnion. Aromaticus Tinct. Guaiaci Ammoniata Tinct. Valerianae Ammon Ammonii Benzoas Ammonii Bromidum . Ammonii Carbonas . Ammonii Chloridum . Ammon. Chlor. Purificatum Ammonii Iodidum Ammonii Nitras Ammonii Sulphas Ammonii Valerianas. Cuprum Ammoniaturn Ferri et Ammonii Citras Ferri et Ammonii Sulphas Ferri et Ammonii Tartras Hydrargyrum Ammoniaturn Nitrous Oxide Gas* . Amygdalus. Amygdala Amara Amygdala Dulcis Mistura Amygdalae . Oleum Amygdalae Amarae 01. Amygdalae Expressum Aqua Amygdalae Amarae Syrupus Amygdalae . Amylum Angustura . Infusum Angusturae . Anisum Aqua Anisi Oleum Anisi Spiritus Anisi . Anthemis . Infusum Anthemidis . Oleum Anthemidis* . Antimonium Antimonii Sulphuretum Antimonii Oxidum . Antimonii et Pot. Tartras Antimonium Sulphuratum Antimonii Oxysulphuretum 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 104 105 105 105 105 105 105 105 io 5 105 106 106 106 106 106 106 106 106 106 107 107 107 107 107 107 CONTENTS. XI Pil. Aritimonii Compositae Vinum Antimonii Emplastrum Antimonii Unguentum Antimonii Syr. Scillae Compositus Aqua .... Aqua Destillata Aquae .... Argentum . Argenti Cyanidum Argenti Nitras . Argenti Nitras Fusa . Argenti Oxiclum Arnica Extractum Arnicae Emplastrum Arnicae . Tinctura Arnicas Arsenicum. Acidum Ai-seniosum . Arsenici Iodidum Liq. Arsen. et Hydrar. Iod Liquor Arsenici Chloridi Liquor Potassii Arsenitis Sodii Arsenias . Liquor Sodii Arseniatis ASSAFCETIDA Mistura Assafcetidae . Tinctura Assafcetidae . Pilulae Assafcetidae Pilulae Aloes et Assafcetidae Suppositoria Assafcetidae Emplastrum Assafcetidae Pilulae Galbani Compositae AURANTIUM. Aurantii Amari Cortex Aurantii Dulcis Cortex Aurantii Flores. Aqua Aurantii Florum Syrupus Aurantii Florum Confectio Aurantii Corticis Syrupus Aurantii Corticis Tinctura Aurantii Aven^ Farina . Balsamum Peruvianum Balsamum Tolutanum Syrupus Tolutanus Tinctura Tolutana Barii Carbonas . Barii Chloridum Liquor Barii Chloridi Belladonna Belladonnae Folia 107 107 107 107 107 in in 114 115 "5 "5 115 ii5 116 116 116 116 117 117 117 117 117 117 117 117 121 121 121 121 121 121 121 121 122 122 122 122 122 122 122 122 122 123 123 123 123 123 123 124 124 124 124 Belladonnae Radix . Tinctura Belladonnae. Extractum Belladonnae Ext. Belladonnae Alcoholic Ext. Bellad. Radicis Fluid Emplastrum Belladonnae Unguentum Belladonnae Suppositoria Belladonnae Atropia Atropiae Sulphas Benzoinum . Acidum Benzoicum . Ammonii Benzoas Tinctura Benzoini Tinct. Benzoini Composita Unguentum Benzoini Oleum Bergamii . BlSMUTHUM . Bismuthi Subcarbonas Bismuthi Subnitras . Brominium . Ammonii Bromidum. Potassii Bromidum . Buchu Ext. Buchu Fluidum . Infusum Buchu . Cadmium . Cadmii Sulphas Caffea Caffeine* . Oleum Cajuputi . Calcium Calcii Chloridum Calcii Hypophosphis . Calx Calx Chlorinata Calcii Carbonas Praecipitata Calcii Phosphas Praecipitata Creta . . . . Creta Praeparata Hydrargyrum cum Creta Trochisci Cretae Mistura Cretae . Testa Praeparata Liquor Calcii Chloridi Liquor Calcis . Linimentum Calcis . Potassa cum Calce Calumba Extract. Calumbae Fluidum Infusum Calumbae Tinctura Calumbae Xll CONTENTS. Camphora . Oleum C amphorae Aqua Camphora? Linimentum Camphora? Spiritus Camphora? . Tinctura Opii Camphorata Linimentum Saponis . Mistura Chloroformi . Cerat. Plumbi Subacetatis Canella Pulvis Aloes et Canella? Canna. Cannabis Americana . Ext. Cannabis Americana? Cannabis Indica . Extractum Cannabis Indica? Tinctura Cannabis Cantharis . Tinctura Cantharidis . Ceratum Cantharidis . Ceratum Ext. Cantharidis Charta Cantharidis . Collodium cum Cantharid Linimentum Cantharidis Emp. Picis cum Canth. Unguentum Cantharidis Charta? Capsicum . Infusum Capsici Oleo-resina Capsici . Tinctura Capsici Carbo Animalis . Carbo Animalis Purificatus Carbo Ligni Cardamomum Tinctura Cardamomi . Tinct. Cardamomi Comp. Ext. Colocynthidis Comp. Pulvis Aromaticus Confectio Aromatica Carum Oleum Cari Caryophyllus . Infusum Caryophylli . Oleum Caryophylli . Cascarilla . Infusum Cascarilla? . Cassia Fistula . Cassia Marilandica . Castoreum . Tinctura Castorei Cataria 139 139 139 139 139 139 139 139 139 141 141 141 141 141 142 142 142 143 143 143 H3 143 143 143 143 H3 143 146 146 146 146 147 147 147 149 149 149 149 149 149 149 149 149 150 150 150 150 150 150 150 150 151 Catechu .... Infusum Catechu Comp. Tinctura Catechu Cera Flava Cera Alba .... Cerata .... Cerii Oxalas Cetaceum .... Ceratum Cetacei Unguentum Aqua Rosas Cetraria .... Decoctum Cetrariae . Chenopodium Oleum Chenopodii . Chimaphila Decoctum Chimaphila? Extractum Chima. Fluidum Chiretta . Chloral Chloral- Camphor* Croton- Chloral* Aqua Chlorini . Acidum Muriaticum . Acidum Muriat. Dilutum . Chloroformum . Chloroformum Venale Chloroformum Purificatum Mistura Chloroformi . Spiritus Chloroformi . Linimentum Chloroformi . Chondrus .... ClMICIFUGA .... Extractum Cimicifugse Flu. Cinchona .... Cinchona Flava Cinchona Pallida Cinchona Rubra Cinchoniae Sulphas . Decoctum Cinchona; Flavae Extractum Cinchona? Extractum Cinchona? Flu. Infusum Cinchona? Flava? . Quinia? Sulphas Pilulas Quinia? Sulphatis Tinctura Cinchona? . Decoctum Cinchona? Rubra? Infusum Cinchona? Rubra? . Tinct. Cinchona? Composita 170 Cinnamomum . . .179 Oleum Cinnamomi . . 179 Tinctura Cinnamomi . 180 Aqua Cinnamomi . .180 151 151 151 152 152 152 152 152 152 152 153 153 153 153 153 153 J 53 154 154 159 159 160 162 162 163 163 163 163 163 163 169 169 169 170 170 170 170 170 170 170 170 170 170 170 170 170 170 CONTENTS Xlll Spiritus Cinnamomi . Pulvis Aromaticus Confectio Aromatica . Coccus Golchicum . Colchici Radix . Colchici Semen Extract. Colchici Aceticum Ext. Colch. Radicis Fluid Vinum Colchici Radicis Ext. Colch. Seminis Fluid Tinctura Colchici Vinum Colchici Seminis COLOCYNTHIS Extractum Colocynthidis Ext. Colocynthidis Comp. Pilulge Cathartica; Compos Confectiones CONIUM Conii Folia Conii Fructus . Ext. Conii Fructus Fluidum Extractum Conii Ext. Conii Alcoholicum Succus Conii Tinctura Conii . Copaiba Oleum Copaiba; Pilube Copaiba; Coptis coriandrum Cornus Florida Decoctum Cornus Florida; Ext. Cornus Florida; Fluid Creasotum . Aqua Creasoti . Unguentum Creasoti . Creta Crocus Cubeba Extractum Cubeba; Fluidum Oleo-Resina Cubeba; Oleum Cubeba; Tinctura Cubeba; Trochisci Cubeba; CUPRUM Cupri Subacetas Cupri Sulphas . Cuprum Ammoniatum Decocta Digitalis . Digitalinum B 1 80 180 180 180 180 180 180 180 180 180 l8l i8i 181 182 182 182 182 183 183 183 183 183 183 183 183 186 186 186 189 189 190 190 190 190 190 190 190 190 190 190 190 191 191 191 191 191 191 191 193 193 193 Extractum Digitalis . . 193 Ext. Digitalis Fluidum . 193 Infusum Digitalis . . 193 Tinctura Digitalis . . 193 Dulcamara . •. .199 Decoctum Dulcamara; . 199 Extractum Dulcamara; . 199 Ext. Dulcamara; Fluidum . 199 Elaterium .... 200 Elaterin* . . . . 200 Emplastra .... 200 Ergota . . . .201 Extractum Ergota; Fluidum 20 1 Vinum Ergota; . . .201 Ergotine*. . . . 201 Erigeron .... 204 Erigeron Canadense . . 204 Ext. Erigerontis Can. Fluid. 204 Oleum Eriger. Canadensis 204 Eupatorium . . . 204 Infusum Eupatorii . . 204 Extracta .... 205 Extracta Fluida . . . 205 Farina* . . . -205 Fermentum . . . . 206 Ferrum .... 206 Ferri Hypophosphis . . 206 Ferri Sulphuretum . . 206 Ferri Chloridum . . 206 Liquor Ferri Chloridi . 206 Tinctura Ferri Chloridi . 206 Ferri Citras . . . 206 Liquor Ferri Citratis . . 206 Ferri et Ammonii Citras . 206 Ferri et Ammonii Sulphas 206 Ferri et Ammonii Tartras . 206 Ferri et Potassii Tartras . 206 Ferri et Quiniae Citras . 206 Ferri et Strychnia; Citras . 206 Ferri Ferrocyanidum. . 206 Ferri Lactas . . . 206 Ferri Oxalas . . . 206 Ferri Oxidum Hydratum . 206 Ferri Phosphas . . . 206 Ferri Pyrophosphas . . 206 Ferri Subcarbonas . . 206 Emplastrum Ferri . . 206 Trochisci Ferri Subcarb. . 206 Ferri Sulphas . . . 206 Mistura Ferri Composita . 206 Ferri Sulphas Exsiccata * 207 Ferrum Redactum . . 207 XIV CONTENTS. 207 207 207 207 207 207 207 211 211 211 212 212 212 213 2I 3 213 21 Pilula Ferri Carbonatis Pilulae Ferri Compositae Pilulae Ferri Iodidi . Syrupus Ferri Iodidi Liquor Ferri Nitratis Liquor Ferri Subsulphatis Liquor Ferri Tersulphatis Ficus .... Filix Mas . Oleo-resina Filicis Fgeniculum . Oleum Foeniculi Aqua Foeniculi . Galbanum . Emp. Galbani Compositum 213 Pilulse Galbani Compositae . 213 Galla. Acidum Gallicum Acidum Tannicum Tinctura Gallae . . -213 Unguentum Gallae . -213 Unguentum Acidi Tannici . 213 Glyceritum Acidi Tannici . 213 Glyceritum Acidi Gallici . 213 Suppositoria Acidi Tannici 213 Trochisci Acidi Tannici . 213 Gambogia . . . .214 Gaultheria . . .216 Oleum Gaultheria . .216 Gelsemium . . . .216 Ext. Gelsemii Fluidum . 216 Gentiana . . . .217 Extractum Gentianae . . 217 Ext. Gentianae Fluidum . 217 Infusum Gentianae Comp. 217 Tinct. Gentianae Composita 217 Geranium . . . .218 Extractum Geranii Fluidum 218 Glycerina . . . .218 Glycerita . . . .219 Glycyrrhiza . . .219 Ext. Glycyrrhizae Fluidum . 219 Ext. Glycyrrhizae . 219 Mistura Glycyrrhizae Comp. 219 Troch. Glycyrrhizae et Opii 219 Gossypii Radicis Cortex . 220 Ext. Gossypii Radicis Fluid. 220 Gossypium . . . .220 Pyroxylon . . . 220 Collodium . . . 220 Collodium cum Cantharide 220 Collodium Flexile . . 220 Guaiacum . . . .221 Guaiaci Lignum . .221 Guaiaci Resinae. . .221 Tinctura Guaiaci . _ . 222 Tinct. Guaiaci Ammoniata 222 Gutta-Percha . . .222 Liquor Gutta-Perchae . 222 Hematoxylin . . .222 Decoctum Haematoxyli . 222 Extractum Haematoxyli . 222 Hedeoma .... 223 Oleum Hedeoma . . 223 Helleborus . . .223 Extractum Hellebori . . 223 Tinctura Hellebori . . 223 HORDEUM .... 223 Decoctum Hordei . . 223 Humulus . . . .224 Infusum Humuli . .. 224 Tinctm-a Humuli . . 224 Lupulina .... 224 Ext. Lupulinae Fluidum . 224 Oleo-Resinae Lupulinae . 224 Tinctura Lupulinae . . 224 Hydrargyrum . . . 224 Emp. Amnion, cum Hydr. 224 Emplastrum Hydrargyri . 224 Hydrargyrum cum Creta . 224 Pilulae Hydrargyri . . 224 Unguentum Hydrargyri . 224 Hydrarg. Oxidum Rubrum 224 Ung. Hydrarg. Oxidi Rubri 224 Hydrarg. Oxidum Flavum. 224 Ung. Hydrarg. Oxidi Flavi 224 Hydrargyri Sulph. Rubrum 224 Hydrarg. Chloridum Mite . 224 Pil. Antimonii Compositae . 225 Pil. Catharticae Compositae 225 Hydr. Chlor. Corrosivum . 225 Hydrargyrum Ammoniatum 225 Ung. Hydrarg. Ammoniati 225 Hydrarg. Iodidum Rubrum 225 Ung. Hydrarg. Iodidi Rubri 225 Liquor Arsenici et Hydrar- gyri Iodidi . . . 225 Hydrarg. Iodidum Viride . 225 Hydrargyri Cyanidum . 225 Liquor Hydrarg. Nitratis . 225 Ung. Hydrarg. Nitratis . 225 Hydrargyri Sulphas Flava . 225 Hydrastis . . . -233 Extract. Hydrastis Fluidum 233 CONTENTS. XV Hyoscyamus 233 Spiritus Lavandula; . 244 Hyoscyami Folia 233 Spiritus Lavandula; Comp. 244 Hyoscyami Semen 233 Leptandra . . . . 245 Extractum Hyoscyami 233 Limones . 245 Ext. Hyoscy. Alcoholicum 233 Limonis Cortex 245 Ext. Hyoscyami Fluidum . 233 Limonis Succus . 245 Tinctura Hyoscyami . 233 Oleum Limonis . . 245 ICHTHYOCOLLA 234 Spiritus L'monis . . 245 Ignatia .... 234 Syrupus Limonis 245 Extractum Ignatia; . 234 Acidum Citricum 245 Infusa. .... 235 Syrupus Acidi Citrici 245 IODINIUM .... 235 Linimenta . 246 Tinctura Iodinii 235 LlNUM . 246 Tinctura Iodinii Composita 235 Oleum Lini 246 Liquor Iodinii Compositus 235 Lini Farina 246 Unguentum Iodinii . 235 Infusum Lini Compositun I 247 Ung. Iodinii Compositum . 235 Linimentum Calcis . 247 Liq. Arsen. et Hydrar. Iod. 235 Lithium . 248 Syrupus Ferri Iodidi 235 Lithii Carbonas 248 Pilulae Ferri Iodidi . 235 Lithii Citras 248 lODOFORMUM 237 Lobelia 249 Ipecacuanha 237 Acetum Lobelia 249 Ext. Ipecacuanhas Fluidun t 237 Tinctura Lobelia 249 Pulvis Ioecacuanhae Comp 237 Liquores . 250 Trochisci Ipecacuanha; 237 Lycopodium 25 1 Troch. Morph. et Ipecac. 237 Magnesium . 25 1 Syrupus Ipecacuanhas 237 Magnesii Carbonas . 251 Vinum Ipecacuanha; . 237 Magnesii Sulphas 251 Jalapa .... 241 Magnesia . 251 Extractum Jalapa; 241 Trochisci Magnesise . 251 Pulvis Jalapa; Compositus 241 Liquor Magnesia; Citratis 251 Resinae Jalapa; . 241 Manganesium . 253 Tinctura Jalapa; 241 Manganesii Oxidum Nigrur 1253 JUGLANS .... 242 Manganesii Sulphas . 253 Extractum Juglandis . 242 Manna ' . ■ 253 JUNIPERUS . . . 242 Maranta . . • 253 Infusum Juniperi 242 M ARMOR .... ■■ 253 Oleum Juniperi 242 Marrubium 254 Spiritus Juniperi Compos. 243 Mastiche . 254 Spiritus Juniperi 243 Pilulae Aloes et Mastiches . 254 Kino .... 243 Matico • 254 Tinctura Kino . 243 Extractum Matico Fluidun 1 254 Krameria . 244 Matricaria . 254 Extractum Krameria; . 244 Mel .... • 254 Ext. Krameria; Fluidum ■ 244 Mel Despumatum . 254 Infusum Krameria; . 244 Mellita • 255 Syrupus Krameria; . . 244 Mentha Piperita . 255 Tinctura Krameria; . . 244 Aqua Mentha; Piperita; . 255 Lactucarium . 244 Oleum Mentha; Piperita; • 255 Syrupus Lactucarii . 244 Spiritus Mentha; Piperita; . 255 Lavandula • 244 Trochisci Mentha; Piperita e 255 Oleum Lavandula; • 244 Mentha Viridis . ♦ 255 XVI CONTENTS. Aqua Menthae Viridis Oleum Menthse Viridis Spiritus Menthse Viridis Mezereum . Extractum Mezerei Fluidu Unguentum Mezerei . Misturae MONARDA . Oleum Monardas Moschus . . Mucilagines Myristica . Spiritus Myristicas Oleum Myristicas Macis . . . . Myrrh A Tinctura Myrrhse Tinctura Aloes et Myrrh as Pilulas Aloes et Myrrhas Nectandra Nux Vomica Tinctura Nucis Vomicae Extractum Nucis Vomicae Strychnia . Strychnias Sulphas Olea .... Oleum ^Ethereum Oleum Morrhu^e Oleum Oliv/e Oleum Ricini Oleum Succini . Oleum Succini Rectificatum Oleum Theobrom^ . Suppositoria Oleum Thymi Oleum Tiglii Opium .... Acetum Opii Confectio Opii . Extractum Opii Emplastrum Opii Suppositoria Opii Suppositoria Plumbi et Opii Pilulas Opii Pilula Saponis Composita Pulvis Ipecac. Compositus Tinctura Opii . Tinctura Opii Acetata Tinctura Opii Camphorata Tinctura Opii Deodorata Trochisci Glycyr. et Opii Trochisci Morph. et Ipecac 255 255 255 255 255 255 256 256 c 5 6 256 256 256 256 256 257 257 257 257 257 258 259 259 259 259 259 262 262 262 265 265 267 267 267 268 268 268 270 270 270 270 270 270 270 270 270 270 270 270 270 270 270 270 Liquor Morphias Sulphatis 270 Suppositoria Morphias 270 Vinum Opii 270 Morphia . 270 Morphias Acetas 270 Morphias Murias 270 Morphias Sulphas 270 Codeia* . 279 Narceia* . 279 Cryptopia* 279 Paramorphia or Tbebaia* . 279 Narcotina"* 279 Papaverina* 279 Meconin*. 280 Apomorphia* . 280 Origanum . 280 Oleum Origani . 280 Os 280 Ovum . 280 Pa paver . 280 Pareira . 280 Ext. Pareirae Fluidum 280 Infusum Pareirae 280 Pepg* . 281 Phosphorus 281 Acid. Phosphor. Glaciale . 285 Acidum Phosphoricum Dil. 285 Physostigma 285 Extractum Physostigmatis . 285 Pilulae. 288 PlMENTA . 289 Oleum Pimentas 289 Piper 289 Oleo-resina Piperis . 289 PlX BURGUNDICA . 289 Emp. Picis Burgundicae 289 Pix Canadensis . 289 Emp. Picis Canadensis 289 PlX LlQUIDA 290 Glyceritum Picis Liquidas . 290 Infusum Picis Liquidas 290 Unguentum Picis Liquidas . 290 Plumbum . 291 Plumbi Oxidum 291 Emplastrum Plumbi . 291 Liquor Plumbi Subacetatis 291 Liq. Plumbi Subacet. Dil. 291 Ceratum Plumbi Subacetatis 291 Lin. Plumbi Subacetatis . 291 Plumbi Acetas . 291 Suppositoria Plumbi . 291 Suppositoria Plumbi et Opii 291 CONTENTS. XV11 Plumbi Carbonas . 291 Infusum Quassiae • 3" Ung. Plumbi Carbonatis . 291 Tinctura Quassiae • 3ii Plumbi Nitras . . 291 Quercus Alba . 312 Plumbi Iodidum . 291 Decoctum Quercus Alba . 312 Unguentum Plumbi Iodidi 291 Quercus Tinctoria . . 312 Podophyllum • 295 Resina • 3 12 Extractum Podopbylli • 295 Ceratum Resinae . 312 Resina Podophylli • 295 Ceratum Resinae Comp. . 312 Potassium . . 296 Emplastrum Resinae . . 312 Potassa . 296 Resinae . 312 Liquor Potassae. . 296 Oleo-Resinae • 3 12 Potassa cum Calce . 296 Rheum • 3*3 Potassii Acetas . . 296 Extractum Rhei • 3*3 Potassii Carbonas Impura . 296 Extractum Rhei Fluidum • 3i3 Potassii Carbonas . 296 Infusum Rhei . • 313 Potassii Carbonas Pura . 296 Pilulae Rhei • 3*3 Potassii Bicarbonas . . 296 Pilulae Rhei Compositas • 3*3 Liquor Potassii Arsenitis ■ 297 Pulvis Rhei Compositus • 3*3 Potassii Bitartras . 297 Syrupus Rhei . 3*3 Potassii Chloras ■ 297 Syrupus Rhei Aromaticus • 3*3 Trochisci Potas. Chloratis . 297 Tinctura Rhei . ■ 3*3 Potassii Citras . 297 Tinct. Rhei et Sennae • 3*3 Liquor Potassii Citratis 297 Vinum Rhei • 3*3 Mistura Potassii Citratis • 2 97 Rosa Centifolia 3 J 4 Potassii Cyanidum 297 Rosa Gallica • 314 Potassii Ferrocyanidum 297 Oleum Rosse ■ 314 Potassii Hypophosphis 297 Aqua Rosae • 3H Ung. Potassii Iodidi . 297 Confectio Rosae 3 J 4 Potassii Nitras . 297 Infusum Rosas Comp. 3H Potassii Permanganas 297 Mel Rosae 3 J 4 Liquor Potassii Permang. . 297 Syrupus Rosae Gallicae • 3H Potassii Sulphas 297 Unguentum Aqua Rosae 3H Potassii Sulphis 297 Rosmarinus 315 Potassii Sulphuretum. 297 Oleum Rosmarini 315 Potassii et Sodii Tartras . 297 Rubus .... 3*5 Potassii Tartras. 297 Extractum Rubi Fluidum 3*5 Antim. et Potassii Tartras 297 Syrupus Rubi . 3*5 Ferri et Potassii Tartras 297 Ruta .... 3*5 Potassii Bichromas . 302 Oleum Rutae 3*5 Potassii Bromidum 303 Sabadilla . 316 Potassii Iodidum 305 Veratria 316 Prunum . . . 310 Unguentum Veratriae 316 Prunus Virginiana 310 Sabina . 3*7 Ext. Pruni Virgin. Fluid. . 310 Ceratum Sabinae 3*7 Ijnfusum Pruni Virginianae . 310 Extractum Sabinae Fluiduir ' 3*7 Syrupus Pruni Virginianae . 310 Oleum Sabinae . 3*7 Pulveres . 3 11 Saccharum . . . . . 318 Punica Granatum 3 11 Syrupus . 318 Granati Fructus Cortex 3 11 Syrupus Fuscus 318 Granati Radicis Cortex 3" Syrupi . 318 Quassia . 3" Saccharum Lactis 318 Extractum Quassiae . 3 11 1 Sago 318 XVlll CONTENTS. Salvia Infusum Salviae Sambucus . Sanguinaria Acetum Sanguinariae Tinctura Sanguinariae Santalum . Santonica . Santoninum Trochisci Santonini Sapo . Ceratum Saponis Emplastrum Saponis Linimentum Saponis Pilula Saponis Compositae Sarsaparilla Decoct. Sarsaparillae Comp Extract. Sarsaparillae Fluid Ext. Sarsap. Comp. Fluid Syrupus Sarsaparillse Comp Sassafras . Oleum Sassafras Sassafras Medulla Mucilago Sassafras Medulla Scammonium Resina Scammonii Ext. Colocynthidis Compos Scilla Acteum Scillae . Syrupus Scillae . Pilulae Scillae Compositae Syrupus Scillae Compositus Tinctura Scillae Extractum Scillae Fluidu Scoparius . Senega Decoctum Senegae Extractum Senegae Extractum Senegae Fluidum Syrupus Senegae Serpentaria Extr. Serpentariae Fluidum Infusum Serpentariae Tinctura Serpentariae Senna Confectio Sennae Extractum Sennae Fluidum Infusum Sennae Tinctura Rhei et Sennae Sevum Sinapis Alba Sinapis Nigra . Charta Sinapis . 319 319 3*9 3 : 9 3*9 3 J 9 319 320 320 320 322 322 322 322 322 323 3 2 3 3 2 3 323 323 324 324 324 324 324 324 3 2 4 325 325 325 3 2 5 325 325 325 326 327 327 327 327 327 328 328 328 328 328 328 328 328 328 329 329 329 329 Sodium Sodii Acetas Sodii Bicarbonas Venalis Sodii Boras Glyceritum Sodii Boratis Mel Sodii Boratis Sodii Carbon as . Sodii Chloridum Sodii Hypophosphis . Sodii Hyposulphis Sodii Nitras Sodii Sulphas . Sodii Sulphis . Soda Liquor Sodae Sodii Arsenias . Liquor Sodii Arseniatis Sodii Bicarbonas Trochisci Sodii Bicarb. Sodii Carbonas Exsiccata Sodii Phosphas . Liquor Sodae Chlorinatae Spigelia Extract. Spigeliae Fluidum Extractum Spigeliae et Sennae Fluidum Infusum Spigeliae Spiritus Frumenti spiritus myrci.e Spiritus Vini Gallici Statice Stillingia . Extract. Stillingiae Fluidum 334 Stramonium Stramonii Folia Stramonii Semen Extr. Stramonii Foliorum Extr. Stramonii Seminis Tinctura Stramonii . Unguentum Stramonii Styrax Sulphur Sulphur Lotum Sulphur Sublimatum . Unguentum Sulphuris Sulphur Praecipitatum Sulphuris Iodidum . Ung. Sulph. Iodidi . Acidum Sulphurosum Acidum Sulphuricum Acidum Sulph. Aromat. Acidum Sulphuricum Dil Succi .... CONTENTS. XIX Tabacum • 340 Ext. Valerianae Fluidum • 348 Infusum Tabaci • 34o Infusum Valerianae . . 348 Oleum Tabaci . • 34o Oleum Valerianae . 348 Unguentum Tabaci . • 34o Tinctura Valerianae . . 348 Vinum Tabaci . • 34o Tinct. Valerianae Ammon. 348 Tamarindus • 342 Acidum Valerianicum • 349 Tapioca . 342 Ammonii Valei'ianas . • 349 Taraxacum. . 342 Quiniae Valerianas ■ 349 Extractum Taraxaci . • 342 Vanilla 349 Ext. Taraxaci Fluidum ■ 342 Veratrum Album . 348 Infusum Taraxaci • 342 Veratrum Viride 350 Succus Taraxaci • 342 Extract. Verat. Vir. Fluid 35° Terebinthina 343 Tinctura Veratri Viridis • 35° Terebinthina Canadensis • 343 Vina .... 35i Oleum Terebinthinae . • 343 Zincum 35i Linimentum Terebinthinae • 343 Zinci Oxidum . - 35i Ceratum Resinae Comp. • 343 Ung. Zinci Oxidi 35i Collodium Flexile • 343 Zinci Oxidum Venale 35 1 Testa. • 346 Zinci Chloridum 35i Testa Praeparata 346 Liquor Zinci Chloridi 35i Tinctura . 346 Zinci Acetas 35i Tragacantha 347 Zinci Carbonas Praecipitate L 351 Mucilago Tragacantha • 347 Cerat. Zinci Carbonatis • 351 Trochisci . 347 Zinci Sulphas . 351 Ulmus. 347 Zinci Valerianas 351 Mucilago Ulmi . 347 Zingiber . 353 Uva Passa .... 347 Ext. Zingiberis Fluidum 353 Uva Ursi .... 347 Infvfsum Zingiberis . 353 Decoctum Uvae Ursi . 347 Oleo-resina Zingiberis 353 Ext. Uvae Ursi Fluidum 347 Syrupus Zingiberis . 354 Valeriana .... 348 Tinctura Zingiberis . 354 Extractum Valerianae 348 Trochisci Zingiberis . 354 S ECTK 3N III. Remedies in Frequent Usi :, BUT not included in the Prii tfARY I .1ST, t J. S. P. Apiol 364 Laurocerasi Folia 3 6 3 Acidum Salicylicum . 365 Leeches . 368 AZEDARACH .... 355 Liquor Ferri Dialysatus . 362 Areca .... 356 Mori Succus 3^3 Brayera .... 355 Pepsin . 363 Bel^: Fructus . . 356 Petroselinum 364 Curcuma .... 356 PlLOCARPIA . 358 Eucalyptus Globulus . 356 Rhamni Succus . 364 Fel Bovinum Purificatum . 357 ROTTLERA . 3(>3 Goa Powder 357 Salicin . . . 364 Jaborandi .... 357 SUMBUL 367 Kamala .... 363 Trimethylamine and ITS Laricis Cortex . 363 Hydro-Chlorate. ' 368 Questions for the Student : . 369 Index of Diseases and the] R REI dEDIES . . 375 39 1 A GUIDE TO THERAPEUTICS INTRODUCTION. Previous to the study of the individual articles com- prised within our national Pharmacopoeia, the temptation is very strong to launch forth into a disquisition on the general principles of therapeutics. So many interesting physiological considerations are involved in the actions and uses of drugs, and so many important illustrations might readily be drawn from the wide field of practical medicine, that little apology would really be needed for consuming some of our space in this way. Therapeutics has lately shown a systematic vitality which amply redeems its credit from the old-fashioned accusation of want of progress, and perhaps in no other department of our profession have more solid and satisfactory advances been made. But this very condition of vigor renders far more laborious and responsible the task of attempting to reduce to any- thing like precision the laws on which we are henceforth to prescribe our drugs, or to draw complete generalisations from the enormous mass of complicated material now at our disposal. Progress may occasionally cause temporary confusion by disturbing old beliefs, and furnishing vast legions of sometimes unconfirmed and possibly ill-digested facts ; and our present subject is by no means exempt from this almost inevitable tendency of true science. A careful study of the many exhaustive works on thera- peutics published within the last twenty years brings before us a strange medley of experimental evidence, confusing and contradictory it may be at times, but giving most en- 2 (13) 14 INTRODUCTION. couraging proofs of the large amount of honest and per- severing work now being devoted to the elucidation of this the most important department of the materia medica. In the following pages we must necessarily assume a dog- matic attitude, and if the extreme precision with which our plan compels us to lay down the actions of drugs offends many whose faith is undeveloped or wavering, we can only excuse ourselves by a conscientious desire to contribute something towards a more scientific scheme of arrangement. Although the time has not yet fully come for a complete explanation of all the therapeutical effects of medicinal agents by their proved physiological properties, I have ventured to take a step in this direction, and must only hope that my very defects and failures may be of use in helping others to develop my principles with greater success. I shall give no systematic sketch of the different ways in which drugs enter the system, as they will be sufficiently indicated in the pages which follow, and as the student will derive much greater benefit by drawing up a scheme of the kind for himself than by lazily running his eye over the cut-and-dried conclusions of a text-book. I am anxious, if possible, to relieve my little work from the ac- cusation of being a mere grinding manual; for although I am not without hope that the systematic arrangement ad- opted may be of some service for examination purposes by putting the student's ideas and recollections in orderly iorm, I should also venture to anticipate that practitioners may also be able to turn to its pages for suggestion and instruction. Although I have not, as a rule, given the doses of every drug and every preparation, I have in most cases finished my account of each by a prescription, which will not only embody the average quantity usually employed, but will also indicate the best and most pal- atable way of combining the special remedial agent. Another feature of some importance I should consider the series of questions with which my work concludes, and which aim at being in the light of ' puzzles' as Mrs. Faucett expresses it in her admirable little manual of 'Political Economy,' or of suggestive teachings on the border- land between therapeutics and medicine, than as the sort of somewhat sapless query and reply affected by educational treatises. RULES FOR PRESCRIBING. 15 GENERAL RULES FOR PRESCRIBING. Preliminary Considerations. — It will be well, before proceeding further, that I should lay down some broad rules which may guide us in the construction of prescrip- tions ; and it seems best to introduce this subject here, instead of placing it, according to more usual custom, at the end of the book, as it is to be our aim and object to devote much care and attention throughout to the best modes of ordering drugs. Much professional credit may be derived from a good prescription, and as much damage done to the practitioner who orders for his patients mix- tures which are neither agreeable to the eye nor palatable to the taste. It is well worthy of the student's attention to consider the most pleasant, effectual, and convenient way of ordering the drugs which are required by the sick, and at first he will no doubt consider this a very difficult task. This will partly depend on the fact that he has had the subject of doses and therapeutical actions presented to him in such concentrated form that he will find some awkward- ness in using practically the theoretical knowledge which he has presumably obtained. The time at his teacher's disposal is so short that he has to run hurriedly from one drug to another, and bring into immediate relation reme- dies which differ so widely in their effects as to excite some not unnatural confusion in the minds of his hearers. It is therefore not an uncommon thing to hear students say that they do not think they will ever be able to remember the doses of the principal medicines. Then we must remember that, during attendance on out-patient practice, prescribing is either done on very routine principles, or considerations of time and convenience render it advisable to order most drugs according to registered formulae, which are merely referred to on the patient's letter by name. Thus, although the student may know that dyspepsia may be treated by mist. alk. amara, or debility by mist, quiniae, he would perhaps experience some difficulty in writing a prescription suitable for either case. In the wards, of course, he sees much more prescribing, but is perhaps not often called upon to do it for himself, so that, when he settles down on his own account, it will be some time before he can handle medicines with that ease, confidence, and certainty, which can alone conduce to the comfort of his patients and his l6 INTRODUCTION. own ultimate success. Now it cannot be out of place to urge upon him here the great importance of frequently exercising himself in this art. Let him put problems to himself, let him run his eye through his text-books, and endeavor to order the various drugs in varied combination ; when he meets with the recommendation to treat a certain disease in a certain way, let him there and then expand these more or less. vague directions into the form of a prescription ; and so at last due blending of ingredients, with the avoidance of incompatibles and the concealment of nauseous properties, will come to him with perfect ease and efficiency. i. Combination of Drugs. — The first thing to be con- sidered in writing a prescription is the object for which we order this certain combination of drugs, which symptoms in our patient's case do we wish to alter or modify, what is to be our principal ingredient, and in what quantity. This being duly settled in our minds, we reflect whether it is better to give this particular article by itself, or to combine it with other substances, which may possibly as- sist or mitigate its action, or may at all events conceal its more or less nauseous taste. Now it is a very commonly given recommendation that in our prescriptions we should aim at simplicity as much as possible, and this certainly holds good within certain limits. The old-fashioned cus- tom used to be to string together a long list of ill-under- stood substances in the hope that some one or other of them might hit the right nail on the head, and even now traces of this polypharmacy linger about medical practice. When, however, we are tolerably certain of the action of our drug, and more especially when we are making scien- tific observations on its mode of action, it is often of great importance that we should not obscure its effects by the addition of any other active substances, but order it either simply in distilled water, or merely combined with other ingredients for flavoring purposes. But we must remember not to carry this principle too far. No fact is more tho- roughly proved in therapeutics than the value, under certain conditions, of due combination, and the way in which one drug may assist the action of another. Thus, taking the case of diuretics, we know well that a prescription containing three or four members of this group will often act where one produces little or no effect, and RULES FOR PRESCRIBING. 17 that mercury is of undoubted service in assisting the in- fluence of squill and digitalis over the urinary secretionk Cough medicines are always best given in combination with a variety of drugs, and the same holds good of pur- gatives; for we all know how hyoscyamus or belladonna will both aid and hold in check the action of colocynth, how a little sulphuric acid and iron will promote that of sulphate of magnesia, how jalap aids the peristaltic intestinal contraction to remove the watery fluid which cream of tar- tar drains into the bowels. Several alkaline medicines given together seem to act better in rheumatic fever than the simple administration of one member of the group. Tonics, such as quinine and iron, are blended with advantage. Then again, we add one drug to another for the purpose of counteracting some unpleasant physiological effect; thus spiritus ammonii aromat. mitigates the unpleasant symptom of iodism, and atropia lessens the chances of discomfort which attend the subcutaneous injection of morphia. Instances like this might be multiplied almost ad infinitum j but we shall de- velop the subject further as we go on, and refer frequently to the laws which should guide us in considering whether the various drugs are best ordered singly or in combination. 1 2. Form of Administration. — We must take into con- sideration whether we ought to administer our drug in a concentrated or diluted form, and here again we shall find it necessary to act very differently under different circum- stances. As a general rule, we may lay down that the metals are best given either in pill or in a small quantity of fluid, and this remark applies more especially to those which have very active physiological properties. Thus we generally give arsenic and perchloride of mercury [corro- ' sive sublimate] in a state of only moderate dilution. Salts, on the other hand, and more especially the purgative salts, act best when taken in large quantities of fluid, and we 1 As well-known examples of this rule we have to remind our readers of the composition of the ext. coloc. co. and pil. coloc. co. [Ph.B.], both of which contain aloes and scammony in addition to the ingredient which gives its name to the mass — the idea being, no doubt, to secure the combined and harmonious action of several purgatives acting on different tracts of intestine; this harmony, so to speak, being aided, and griping obviated, by the addition of aromatics, such as cardamoms and cloves respectively. l8 INTRODUCTION. V shall find in practice that iodide of potassium is decidedly- more efficacious when freely diluted, that sulphate of mag- nesia follows the same rule, and that in the case of diuretics also we may aid their action by combining the directly flooding or mechanically sluicing effect on the kidney, of large quantities of watery fluid. 3. Proper Time for Exhibition. — The period of ad- ministration is also welT deserving of careful study, and we may indicate one or two useful rules with regard to the action of alkalies and acids. As acids check acid secre- tions, and alkalies have a similar influence over those with alkaline reaction and vice versa, we can readily understand the effect which they may exercise over digestion. Thus an acid given directly before a meal must interfere with the due assimilation of the nitrogenous articles of diet by- checking the supplies of gastric juice, whereas an alkali given at the same time must theoretically produce the best results by stimulating that secretion. If, on the other hand, we give an alkaline medicine after food, we do harm by directly neutralizing the acid on which some part at least of the active principles of the gastric juice depends. 1 Drugs which have a distinctly lowering or irritating effect on the system are best given with or after meals, so as to prevent these results as far as possible; thus we always give arsenic or corrosive sublimate at these times, and find that they are well borne by persons who could not take them on an empty stomach. For a different reason, again, we generally find it convenient to prescribe cod-liver oil after food, not only because it is less likely to cause sick- ness when given in that way, but because oily matters being absorbed by the lacteals are most readily taken up when these structures are in full working order. Again, when we wish to imitate or excite a normal phy- [' An important point for the student to learn at the outset is, that nothing can be more fallacious than a priori reasoning concerning the therapeutical effects of remedies. Cases of atonic dyspepsia with acidity of the stomach are frequently benefited by dilute mineral acids; and a combination of muriatic acid (gtt. iij.) with pepsin (gr. x.) in water (f^ss.) given directly before meals, is constantly prescribed with good results for patients with impaired or weak digestion. Indigestion with pyrosis, or flatulence, may be relieved by alkalies after meals, as in the pleasant preparation known as soda mint (see Sodii bicarb.), to which may be conveniently added tincture of nux vomica, or syrup of rhubarb, according to the judgment of the prescribe! - .] RULES FOR PRESCRIBING. 19 siological action, we must time our drug accordingly. Opium or any other narcotic is much more likely to pro- duce sleep when taken at night than at other times, and*/ a mild purgative in the morning will often stimulate the y peristaltic movement of the intestines to evacuate the bowels at the time when they are accustomed to act. The efficacy of purgatives is also markedly aided by a due consideration of the periods at which they ought to be given. A resinoid cathartic principle contained in pill is usually of slow and deliberate action, and may be given indifferently with meals — as in the case of dinner- pills — or on an empty stomach before bed-time ; but saline purgatives generally act best when given fasting, as the veins of the intestinal tract are then less full and more predisposed to rapid absorption. As an illustra- tion of this we need only refer to the much more potent effect of an ordinary seidlitz powder given before than after breakfast. Anthelmintics, again, are always best given after as long a fast as possible, so that the parasites which they attack » may not be shielded by food or mucus, and we find in practice that night, just before bed-time, is the most con- venient period for their administration. 4. Dosage. — The relative efficiency of large and small doses is the next point which has to be taken into consider- ation ; and here we are at once confronted by some of the most delicate and difficult questions in therapeutics — del- icate because they border closely on the dangerous ground of homoeopathy, difficult on account of their often unsettled nature. We cannot pretend to give any exhaustive dis- cussion to this branch of our subject, because the mate- rials for it are not forthcoming, but we can all contribute somewhat to its solution by experimental trials of various drugs given in these different ways. This much, however, we do know, that in many cases we get much more satis- factory results [in special emergencies, or temporary con- ditions] by giving one tolerably large dose at one time; and especially is this the case with narcotics, small quan--- tities of which only excite and annoy, whilst a full dose satisfactorily brings about the desired result of sleep. Pur- gatives and emetics, again, are also best given in one con- siderable dose; tonics, astringents, diuretics, &c, require to be steadily repeated at certain short and regular intervals 20 INTRODUCTION. [in order to have a sustained and continued effect]. But the true point at which we wish to arrive is this : Can we best obtain rapidly and efficiently the constitutional action of a drug such as belladonna, or aconite, by administer- ing in average quantities two or three times a day, or by ordering it to be taken in very small doses often repeated? Now supposing we are called upon to treat a case of acute tonsillitis or catarrhal febrile disturbance, which we wish to remove as rapidly as possible, and we elect aconite as the special remedy to be used, we are taught by Ringer and others that the most reliable method for its administration s is in drop or even half-drop doses every hour, half-hour, or even ten minutes. General experience has pretty well confirmed this teaching, and has extended it to other .medicines, such as prussic acid, which will thus more effectually control urgent sickness than when given at longer intervals in the more orthodox way; to tartar emetic, which in very small and often-repeated quantities exercises a re- markable effect over infantile bronchitis; to ipecacuanha, which in minim doses will frequently check obstinate vomit- ing; to calomel and grey powder, which in minute doses, every half-hour, will often stop irritability of the stomach when nothing else will succeed. Instances of this sort will be multiplied as our consideration of the individual articles of the Pharmacopceia goes on, the principle being steadily kept in mind that we may often bring the system much more efficiently under the special influence of a drug, by ordering it in small quantity often repeated, than by giving full doses two or three times a day; and this necessarily applies with special force to those drugs which are rapidly thrown out of the system, and whose action upon the struc- ture or function they are particularly supposed to effect, is thus kept up and, so to speak, perpetuated by very frequent administration. On the other hand, we must not forget that certain medicines must be given in very large quantities before their physiological properties are obtained. Thus it would be useless to expect succus conii to tranquillise ir- regular muscular movement in less doses than f5j. [Ph.B. The succus conii, U. S., cannot be safely given in such large amounts, as its strength is variable. Dose, to begin with, fjss.-j.], and frequently we require to give even more than this ; belladonna is of no use in nocturnal inconti- \ RULES FOR PRESCRIBING. 21 ence of urine unless boldly pushed up to f5j- or fjjss. of the tincture. [In this connection it should be borne in mind that the tincture of belladonna of the U. S. Pharma- copoeia is twice the strength of the British.] Arsenic acts best in chorea when prescribed with no timid hand. Another point of interest in connection with this enquiry is that, drugs often display different and even opposing actions, according as they are given in large or small doses. Thus we have seen that drop doses of vin. ipecac, will often check vomiting, whereas it is well known that a teaspoonful, or even less, will almost immediately evacu- ate the stomach ; sulphate of zinc, in twenty or thirty grain doses, is prized as our best emetic, whilst it is equally established that from one to six grains is a valuable ner- vine tonic, much used by some physicians in the treatment of chorea. Small doses of opium excite, whilst large soothe into sleep; half-ounce doses of [infusion of] digitalis may be more safely given than those of f 5j. [more frequently repeated] ; the neutral ',salts of potash and soda are, as a rule, purgative in large, diuretic in small doses ; and the other instances of this principle — which will afterwards be given — must be borne in the mind of the prescriber before he can pretend to make most efficient use of the weapons t his disposal. 5. The Interval between Doses. — The next heading to which reference is usually made is regarding how often we ought to repeat our dose of medicine ; but this is so far involved in what has gone before, that very little remains to be said. The ordinary rule is to order our mixture to be taken three times a day, or every four hours, unless spe- cial circumstances, such as we have already indicated, render it advisable to repeat more frequently. Although many sick persons look forward to the time of taking their physic, and feel moral as well as physical support from the mere act of attending to their doctor's orders, the greater proportion are not so favorably impressed, and would willingly be relieved from the necessity of swallow- ing the often nauseous compounds they receive. Homoeop- athists, no doubt, derive much of their success from the tasteless nature of their medicines, and we have not yet devoted sufficient attention to the elegances and refine- ments of pharmacy. It is well) therefore, to direct our tonics and astringents, and drugs whose action is to be 22 INTRODUCTION. spread over some considerable time, to be taken three times a day, always bearing in mind those important ex- ceptions which recent investigation has done such good service in impressing upon our attention. 6. Individual Peculiarities ; Idiosyncrasy; Habit. — When the student has been fairly emancipated from the leading-strings of his teachers, and enters practice on his own account, he will often be disappointed at the way in which drugs play their allotted parts. The necessarily cut-and-dried and dogmatic descriptions of the text-books have led him to believe that such and such a medicine will always act in a particular way, and he accordingly prescribes it with full confidence in a given case. But not only may the proper effects fail of development, but very unpleasant and almost unlooked-for symptoms may follow its use, which will be productive of much discomfort and uncertainty, and may even tend to shake his professional credit. The influence of that strange individual peculia- rity, usually termed idiosyncrasy, and of which no rea- sonable explanation has ever been given, must be very carefully taken into account in prescribing, and we shall refer to it on all suitable occasions. Sometimes it renders our patient unduly susceptible to the action of drugs, and thus we may find one person seriously salivated by one grain of calomel, another who dare not touch quinine, a third who is furiously excited by opium, whilst a fourth may be poisoned by a single grain of morphia. Phosphorus and bromide of potassium also cause their peculiar effects in very small doses. A good precaution, therefore, is, before prescribing any of these drugs, to ascertain from the patient whether he has ever taken any of them before, and whether no uncomfortable effects could be in any way attributable to their use. But, on the other hand, our patient's constitution may be such that very large quanti- ties of drugs will alone succeed in acting ; and remarkable stories are told by Christison and others of the immense quantities of opium which persons quite unaccustomed to its use have been occasionally able to take with impunity. Purgatives act very differently on different people, and others require immense quantities of anaesthetic vapor be- fore full insensibility is obtained. Although, as I have iust said, we may often anticipate uncomfortable effects by "due preliminary inquiry, it too often happens that they RULES FOR PRESCRIBING. 23 come on suddenly, and quite unexpectedly. Idiosyncrasy is so wide-spread and deep-rooted in the human constitu- tion, in almost every function and action, that we can hardly hope ever to obtain the key to its mysteries. Why, may we ask, do particular articles of diet disagree with special persons? Why does one person, on exposure to cold, take a simple catarrh, whilst a second becomes a prey to rheumatic fever, and a third escapes unharmed ? Why do we all differ from 'one another in some minor de- gree in almost everything that we do ? Until we can clear up these problems, it is vain for us to attempt to explain why we require to adapt our doses so carefully to indivi- dual constitution and peculiarity ; and the reason why the student is at first perplexed by all this is that we meet with these differences much more frequently in the upper ranks of society. The hospital or dispensary patient swallows any dose, however nauseous, with much satisfaction, and is much less often affected by those troubles of irregular phy- siological action which so frequently harass the family medical attendant in more aristocratic circles. The influence of habit on therapeutics is also worthy of every consideration, for we shall find in practice that medicines often lose their effect when continued for any lengthened period. More especially is this the case with opiates and narcotics generally, the dose of which requires to be gradually increased from time to time. Arsenic has the same peculiarity, as is shown in the case of the arsenic- eaters of Styria, who, by long continuance in the use of that substance, are at last able to consume quantities which would inevitably prove fatal to a novice. And this leads to the question of toleration, an old-fashioned term dating from the days of heavy dosing with irritating metallic sub- stances, but having sufficient bearing on modern practice to justify its consideration here. We have said that the term toleration savors somewhat of antiquity, because the great illustration of this principle used to be afforded by tartar emetic, which was then much more freely used than now in acute inflammations ; and when I say antiquity I do not refer to anything more remote than perhaps half a century ago. Then the contra-stimulant treatment of pneumonia was in full swing, and the curious fact became gradually known that, although the first doses of tartar emetic often caused much nausea and depression, subse- 24 INTRODUCTION. quent larger quantities were well borne ; and this was ex- plained by what was called toleration of the drug being established in the system. It will be seen, when we come to consider in detail the actions and uses of tartar emetic, that a very sufficient and scientific explanation can be given of this somewhat mysterious effect. In these days, inflam- matory action is treated on somewhat different principles, and antimony is comparatively little used ; but the prin- ciple of toleration can be recognized in the use of other drugs. Thus, in dysentery, quantities of ipecacuanha are given which would infallibly produce violent vomiting in a healthy subject ; arsenic is better borne in skin disease than in a state of health ; choreic patients are able to swallow almost emetic doses of zinc sulphate without the action of vomiting being induced. Digitalis is well known to be given freely in delirium tremens, and there is little doubt that the experiment of prescribing half an ounce of the tincture to a person in ordinary health would be productive of serious if not fatal consequences. Further instances of toleration might readily be adduced, but it will be much more to the advantage of the student to recom- mend him to pick out other examples for himself than to provide him with a cut-and-dried list of all that is known on the subject. 7. Constitutional, or Toxic, Effect from Small Doses. — We next come to what is commonly known as accumulation, the theory of which is that certain drugs rest or become stored up in the system until they reach a dangerous quantity, when inconvenient or poisonous symptoms may result. Thus we know that after a certain continuance in the use of digitalis, faintness and depression have often been observed, that strychnia may cause uncom- fortable twitchings after it has been taken for some time, that bromide of potassium only begins to cause annoyance when the system seems to have become saturated with the salt. Does this really mean that these substances have reached the point beyond which their poisonous action is neutralised, so to speak, by the symptoms which their therapeutical powers attack, or is the defect in the organs of elimination which fail to expel them efficiently from the system? It is probable that both these and the numerous other examples which our subsequent pages will contain depend on both these causes in some degree, in addition RULES FOR PRESCRIBING. 25 to another, and that is that the organ or tissue towards which the physiological action of the drug is directed is, after long-continued stimulation by repeated small doses, worked up into a certain condition of special excitement or depression, and discharges accordingly. Thus we find the twitchings from strychnia, the cardiac depression of digitalis, the nervous weakness and ataxy from bromide of potassium, the paralysis resulting from alcohol. The metals, as mercury, arsenic, &c, on the other hand, no doubt act by being stored up within the tissues, and brought into excessive action by some defect of elimina- tion. And the practical outcome is, that in prescribing many of these drugs, and more especially digitalis, strychnia, and bromide of potassium, it is well to have an occasional break, to omit our prescription for a day or two, so as to give the parts a rest, and enable the remedy to act after- wards with better effect in even diminished dose. 8. Chemical and Physiological Incompatibilities. — And now we come to the doctrine of incompatibility, which is of all-essential importance in therapeutics, con- sisting as it does of the principles which we require to know in order to avoid that amount of clashing of the different ingredients of our prescription which may either alter or destroy their action. Now incompatibility may be of different sorts, and is generally divided into chemi- Ucal and physiological. Of these we will first consider chemical incompatibility. This consists in the chemical reactions of one drug on another, which may result in the formation of a new com- pound when they are mixed. Thus the addition of iron . to decoction of cinchona will produce an unsightly, black mixture; strychnia and perchloride of mercury will not v go with gelatine; sulphuric acid and lead form an insoluble sulphate. A good deal of this incompatibility, however, is inconvenient, principally, because the resulting solution is often thick, turbid, and unsightly, and therefore repug- nant to the patient. Many most incompatible mixtures are therapeutically efficient, and some are even prescribed deliberately. Quite otherwise is it, however, with the second group, or the physiological incompatibles, the rationale of which is that the action of one drug is so far antagonistic to that of another that the mixture of the two 26 INTRODUCTION. is necessarily inert. Thus the combination of belladonna and opium is in some degree opposed, atropia and prussic acid, aconite and digitalis, strychnia and Calabar bean, and, most markedly of all, caustic alkalies with belladonna, hy- oscyamus, stramonium, or tobacco, all of whose active principles are thus absolutely destroyed. But, as already hinted, we often prescribe an incom- patible mixture for the purpose of actually deriving thera- peutic advantage from the resulting compound. Thus what is a more generally used and, I may confidently say, \ more useful prescription than perchloride of mercury and iodide of potassium, making an iodide of mercury which is much more efficacious than that salt itself as prepared by more elaborate chemical agency? 1 Again, the far- famed mist, ferri co. derives much of its charm from the freshly prepared carbonate of iron which results from the due combination of ferri sulph. and pot. carb. Black wash is another example; and although corrosive subli- mate and decoction of bark are undoubtedly incompatible, no better means is known of counteracting the depressing effects of this preparation of mercury. 9. Prescribing for Children. — A few words may now be said on the art of prescribing for children, a subject which is only incidentally touched upon in our ordinary books, and is then treated in a somewhat misleading man- ner. Elaborate tables have, however, been drawn up for the regulation of doses according to age, and in all of these it is assumed that young children necessarily require much smaller doses of most drugs than adults; and this is true in so far that it is seldom advisable to deal out our mixtures to them in the time-honored tablespoonful or two tablespoon- fuls of their elders. But the important fact which these systems invariably ignore is this, that children can often take, not only with impunity but even with decided benefit, quantities of active remedies which will correspond to a full adult dose. And the reason of this may be looked for in the much greater destruction and construction of tissue 1 [Theoretically these salts in solution are chemically incompatible, as a reaction takes place, and a precipitate is formed. This precipitate, however, is soluble in an excess of iodide of potassium, forming an uncertain compound, which may be looked upon as a hydrargyro- potassic iodide, dissolved in a solution of potassic chloride, with other compounds not yet determined.] RULES FOR PRESCRIBING. 27 in early life, whereby the organs of elimination are in unusual activity, and hence disposed to excrete medicinal substances with special promptitude. Whether we accept this explanation or not, however, I may warn the young practitioner that an adherence to the rules usually laid down for children's prescriptions will cause him serious disappointment, and that he will be surprised at the ben- eficial results which will follow the adoption of a bolder course [in special instances]. To furnish a few examples of this proposition, I will begin with belladonna, which may be used very freely in childhood, and the dose of which I have pushed in a v/ child of 10 suffering from incontinence of urine to f3ij- ! with good effect, and the development of only very mild forms of physiological disturbance. I commonly begin with nrxx. 1 in a child of 2 or 3, and have prescribed n^x. 1 in an infant of six months with remarkable benefit; and the result of my experience undoubtedly is, that children bear belladonna actually better than grown-up persons, and that in them really poisonous symptoms rarely if ever occur. I may add that this strange insusceptibility of chil- dren to belladonna was first pointed out by the late Dr. Fuller, and has since been abundantly confirmed by Dick- inson, Ringer, Kelly, and others. Arsenic may also be freely given to children, and, at the age of 5 or 6, I should have no hesitation in beginning with tt^v. [of Fowler's solution] and pushing even up to nrx. if necessary. Prussic acid [dilute] may be given in ny. to nyij. doses at the same age. Strychnia is also well borne. Tinct. ferri may be taken in large quantities, and I have seen excellent results follow the administration of f5j- ter die, in a little girl of 6. Children will often require large purgative doses, more especially of pulv. jalap, co., and of ipecacuanha as an emetic. I have often ordered quantities which have startled the dispenser and induced him to come for ex- planation under the idea that I had made a mistake. Bromide of potassium may also be freely given, and other instances will be noted as we go on, remembering always the sound old advice to be very careful with opium at an early period of life. Every practitioner has 1 [British Pharmacopoeia.] 28 INTRODUCTION. no doubt seen cases in which ill results have unexpectedly followed laudanum prescribed before the age of i year, and I cannot do more than reiterate the warnings on this subject which every manual of materia medica most pro- perly contains. Other points must also be attended to in prescribing for children. [A philosophical method of graduating doses for chil- dren has been proposed by Prof. Clarke. It is based upon the weight of the subject, the full, adult dose being considered as appropriate to a weight of one hundred and fifty pounds. The proportion of a full dose in each case would thus be represented by a fraction whose denom- inator should be 150 and the numerator the weight of the patient. Perhaps a more practical rule is this, proposed by Dr. Cowling. "The proportional dose for any age under adult life is represented by the number of the follow- ing birthday divided by twenty-four;" thus, for one year fz == T V; for five years & = J, etc.] It is always well to make our dose as small as possible, one or two teaspoonfuls being usually sufficient, and great pains must be taken, by means of well-adjusted flavoring ingredients, to disguise the too often nauseous taste of our drugs. Various syrups and aromatic waters here stand us in good stead, and it is well if possible, when dealing with very young infants, so to reduce the bulk of the medicine as to enable it to be mixed unobserved with milk, veal broth, beef-tea, or some sort of confection. In this there is nothing really antagonistic to the principle which has just been developed, as we can readily enough give con- siderable quantities of belladonna, arsenic, etc., in com- paratively small quantities of water, or even in none at all. Children are, however, somewhat strangely capricious in their taste; for whilst they object decidedly to bitter or acid substances, they will take oils readily, and generally seem to derive satisfaction from sucking in cod-liver oil. Nauseous powders which would seem inexpressibly revolt- ing to their elders, they often take well, and by a little contriving and consideration we can generally manage to persuade them to consume their dose with philosophic composure, if not with actual relish. 10. Prescription Writing. — We next come to the con- struction, or what we may call the anatomy, of the pre- scription itself, how it is put together, and how its com- RULES FOR PRESCRIBING. 29 ponent parts are arranged ; and we commence with the ' R' with which it begins, and which really means an old invocation to Jupiter. But conventionally it has been held to imply the verb recipe, which governs the quantity in the accusative, the name of the medicine being put in the genitive. Thus, Recipe (take) pulveris (of powder) sca?n?nonice (of scammony) scrupiilum, &c. Other direc- tions are laid down in books which deal with this question, and much valuable information is contained in Pereira's ' Selectae Praescriptis' and the clear and instructive little work of Dr. Griffith, of Dublin ; but it is hardly necessary to reproduce these here, as students beginning their medi- cal curriculum are presumably sufficiently well grounded in classics to enable them to understand the very moderate amount of Latin required for their use in prescribing. As a rule, medical men generally write their directions now- a-days in English ; and this has not only the advantage of limiting the chance of mistake, but it does away with much of that mystery which beyond anything else has tended to keep back the progress of our art. In these enlightened times, when even more than a smattering of physic is com- monly possessed by the laity, we do not find our patients quietly consenting to be kept in the dark as to what medi- cines they are taking. Rather we find them showing a keen interest in our prescriptions, anxious to enquire, and argue, and if possible understand, all about the line of treatment we have determined to pursue. The cases are very rare in which it is necessary to conceal from them the presence of any particular drug in their mixture, and Latin direc- tions are therefore not only unnecessary, but pedantic in the highest degree. It is still, however, the custom at the examining boards to ask the candidates either to write or read, or both, prescriptions fully constructed according to this custom, and in the prescriptions which we shall fre- quently add to our descriptions of the various drugs we shall invariably give the directions in Latin of the' usual form. 11. Weights and Measures. — It only remains for us, then, to add the signs and symbols in general use, which are as follows : — 3° INTRODUCTION. gr., granum . 9, scrupulum (scruple) 5, drachma (drachm) jf , uncia (ounce troy) lb., libra (pound) . tt^, minimum (minim) gtt., gutta (drop) = a grain. = 20 gr. = 3 scruples, or 6o grains. = 480 grains [or 8 drachms]. = 12 ounces troy [5760 grs.] = ^jth part of a fluid drachm, usually about ]/ 2 minim. [f3,fluidrachma(fluiddrachm)=- 60 minims.] [fj§, fluiduncia (fluid ounce) = 8 fluid drachms.] O, octarius (pint) . . = [16 fluid ounces, U. S. P.] 20 oz. [Imperial measure] C, congius (gallon) . = [8 pints.] In the British Pharmacopoeia the time-honored drachm and scruple weights have been discarded, and all who prescribe or dispense medicines are recommended to dis- continue their use ; but old fashioned customs are not so readily swept away, and we accordingly find these most convenient terms flourishing as much as ever. In domes- tic practice we find a much more rough and ready mode of prescribing, the generally received measurements being as follows : — Teaspoonful . Desertspoonful Tablespoonful Wineglassful . Teacupful Breakfast-cupful Tumbler = 1 fluid drachm. = 2 fluid drachms. = 4 fluid drachms. = \y 2 to 2 fluid ounces. = 5 fluid ounces. = 8 fluid ounces. = 10 to 12 fluid ounces. Of all domestic modes of measurement, however, none can equal the drop in fallacy and danger. The size of a drop is influenced first by the shape of the bottle, and secondly by the quality of the fluid itself, and hardly two substances will be found to contain the same number of drops in a given quantity. Tablespoons, teaspoons, and all domestic measures are most absurdly variable in size, and we shall do well steadily to discountenance their use in all cases, and to insist that our patient shall carefully regulate his dose by means of those graduated glasses which are within the reach of all but the very poorest. 12. Observations upon Doses. — Now, although it would manifestly be lulling our readers into a false secu- RULES FOR PRESCRIBING. 31 rity, were we to attempt to lay down any absolute rules respecting dosage, we may venture to state some broad principles which will help the memory. Students often complain of the great difficulty they experience in remem- bering doses, and at first sight it would appear a most irksome task for a person not in the habit of prescribing to carry in his mind the major and minor quantities of drugs which he may safely order. But by giving a few rules, and adding exceptions, as in the Latin grammar, we hope to show that there is no real difficulty here, but that we may safely group substances in such a way as to asso- ciate their doses with one another with tolerable simplicity. But first let me say one word about the British Pharma- copoeia. Constructed as it was by official authority several years ago, it is naturally looked upon as our vade meatm, and every student is supposed to possess a copy and to make himself familiar with its contents. Now, in the first edition no doses were given, and in the next, although these were added in deference to a universal request, it was expressly stated that they were not to be considered authoritative, or specially enforced by the Medical Council. But the Pharmacopoeia, being the only official guide, has now been forced into a position respecting dosage which it did not intend or desire, and we therefore find that in any case of difficulty its authority is invariably appealed to. It lies on every druggist's counter, it is the standard in courts of justice, and, this being the case, it ought to reflect the most advanced researches on its subject. But this is not so; on many points its recommendations are hopelessly at variance with modern practice, and we are hence exposed to the annoyance and possible discredit of having our prescription sent back or cut down by druggists who are afraid of exceeding the dose sanctioned by au- thority. Thus the maximum dose of succus conii is fixed by the Pharmacopoeia at f3j., of quinine at gr. x., digitalis f 5j- ; and when we come to consider the various substances in succession, we shall find many other examples of a dis- crepancy between my teaching and its statements, which this explanation will clear up. [These difficulties are happily avoided by the United States Pharmacopoeia, the doses of remedies being judiciously omitted.] 13. General Rule for Doses. — We may now proceed to indicate the natural system of grouping, by which some 32 INTRODUCTION. order may be given to the arrangement of the doses of drugs in the already crowded brain of the student or the young practitioner. Thus let him remember that, as a general rule, tinctures may be prescribed in doses of from f^ss. to f3ij., infusions and decoctions from f^ss. to f^ij., powders from two to ten grains, pills four to ten grains; and although there are numerous and very important exceptions to this, the recol- lection of the principle will spare us from the drudgery of placing the exact dose after every preparation whose action we shall examine. [The following are the important exceptions to this rule, the dose of each of which should be learned separately. Tinctura aconiti radicis, U. S. P. Tinctura nucis vomicae, U. S. P. " belladonnse, " " opii, " " cannabis, " " " acetata, " " cantharidis, " " " deodorata, " " colchici, " " scillae, " " conii, " " stramonii, " " digitalis, " " veratri viridis, " " ferri chloridi, " Infusum digitalis," " " hyoscyami,"* " " capsici, " " iodinii, " " tabaci, " ] " ioctinii composita, " These rules may be borne in mind in a general way, and we shall now go on to consider very briefly the plan of arrangement to be pursued when we come to consider the various medicinal substances seriatim. Our object will be to balance, as far as possible, their physiological against their therapeutical action, arranging them in corresponding columns in diagrammatic form ; and it will greatly assist this arrangement, as well as aid the memory of the student, if we adopt the following order in stating what we know respecting the properties of each drug. Take, first, its local or external action. Then its influence on the brain and on the spinal and sympathetic system of nerves. This will lead us up gradually to the effects on the heart and bloodvessels, whose functions are presided over, and ruled bv, nervous influence. GENERAL PLAN OF ARRANGEMENT. 33 The effects of the drug on respiration and temperature will next be considered, and we then proceed to the alte- rations of secretion in the following order: urinary, intes- tinal, salivary, cutaneous, &c. 9 Then other actions which come under no heading, and which may be called specific. Finally, we must consider the various modes of elimi- nation from the body, the antidotes, contra-indications, and best modes of prescribing, winding up, in most cases, with a prescription which will, as far as possible, combine efficiency and elegance with palatability. It will of course often happen that we cannot accurately balance the physiological against the therapeutical action of a drug, either from want of sufficient knowledge or from an excess of facts of more or less conflicting nature. We must remember that our therapeutical evidence is de- rived from clinical observation on man, and that experiment on the lower animals has supplied us with most of our knowledge respecting the action of medicinal agents on the healthy organism. Fallacies may readily creep into both these methods of investigation, and it is evident how the clinical method may be hampered by our want of full knowledge of the natural history of disease. Although late years have done a good deal in showing how various acute maladies behave, when uncomplicated in their course, by active medication, we are still much in the dark, and too prone to confuse the propter with the post. And the results of the very elaborate system of experimentation which has lately been carried on in Germany and else- where cannot be accepted as fully conclusive of the physio- logical action of the various drugs on man. One source of fallacy undoubtedly lies in the very differing suscepti- bility of certain members of the brute creation to certain drugs. Thus rabbits freely digest belladonna as well as opium ; it is difficult to poison pigeons with strychnia, or fowls with prussic acid ; and other instances of this curious law have been placed on record. It is therefore reason- able to suppose that the special structure and habits of the lower animals exercise an equally modifying influence with regard to the special action of medicinal substances on special organs and functions, so that we must be prepared to receive some facts drawn from this source with a certain amount of reserve. In addition to this, the shock and 34 INTRODUCTION. general damage inflicted on the victims of experiment by the necessary manipulations must frequently alter so seriously the conditions of secretion as to render any deductions on this score very inconclusive; whilst, finally, it is well known that drugs which appear to have no action on a special organ whilst in health may very materially modify its condition when congestion or any other form of morbid action has set in. In looking over, therefore, the large mass of evidence furnished by the industry of able physiologists, we cannot fail to be struck by the dis- crepancy which exists occasionally between the results obtained. Different observers experimenting in different ways now and. then get different results, and in no case has this been more distinctly shown than by the way in which the labors of the celebrated Edinburgh Committee have been practically set aside by later investigators, who have shown that mercurials, as well as other drugs, actually do increase the biliary secretion. We must therefore bear all this in mind, and endeavor so to sift all our evidence as to place on our tables only that which the opinion of our best authorities has thoroughly and fully endorsed. Regarding the method in which the following pages will be arranged, a few words may be said. Different modes of grouping drugs have been adopted, and by some the preference is given to the purely physio- logical plan, by which all the medical substances having a particular action are placed under that special heading ; thus we have purgatives, narcotics, astringents, etc., as different varieties, with their attendant species. No doubt such a plan has the merit of scientific precision, and, had each drug only one medicinal action, nothing could be simpler or more effective than this arrangement, of which Neligan is the chief exponent. But an unfortunate ele- ment of complication is introduced by the fact that one drug may act in many and indeed opposing ways. Thus, whilst opium is an astringent, it has every right, under certain circumstances, to be called a purgative ; its stimu- lant action is as evident as its narcotic; it is a diaphoretic, a sedative, an antiphlogistic; and the confusion inseparable from hunting it about among its various headings must necessarily be perplexing to the mind of the student, as well as occasion loss of time. Many other drugs behave in the same way; so it has been thought best to adopt the GENERAL PLAN OF ARRANGEMENT. 35 arrangement of Garrod and other popular text-books, in which the inorganic substances are placed alphabetically, and the organic in accordance with the natural orders to which they belong. We shall only venture to make one modification, and that will be to remove the. general prin- ciples of therapeutics from its usual position at the end of the book, and scatter its classification systematically through our pages. For instance, after treating of the leading member of the purgative or narcotic group, we shall use that as a peg on which to hang a general description of that class of substances in general, and in this way we may hope to relieve that tedium which is apt to arise when too many deductions and generalizations are presented en masse. [In preparing an American edition it has been deemed advisable to adhere strictly to the alphabetical arrange- ment just mentioned. In the following pages, every remedy included in the Primary List of the Materia Medica of the United States Pharmacopoeia is presented in regular order, new titles being introduced when necessary in order to make the list complete. When botanical or chemical definitions are given in the Pharmacopoeia, they also are herein reproduced, the customary doses affixed to remedies adapted to internal use, and, wherever practicable, the composition and strength of the officinal preparations are also indicated. Some prominent remedies of the U. S. Secondary List, with others not yet officinal, are arranged in like manner in a separate section. In order to render the plan of the work more harmonious and consistent, and add to its essentially practical character, it has been con- sidered proper to collect together the scattered paragraphs upon the principles of therapeutics and to group them to- gether, devoting a special chapter to their consideration under the title of Remarks on Certain Classes of Reme- dies.] REMARKS ON CERTAIN CLASSES OF REMEDIES. ANTIDOTES. The first thing to be done in any case of poisoning is to empty the stomach, and to eliminate the poisonous sub- stance from the tissues. The next stage in our pro- ceedings must be to obviate the tendency to death, ac- cording to the various vital processes attacked by the poison. 4 This may be effected in the first place by emetics, and more especially those of the direct class ; but it will often happen, particularly^ in narcotic poisoning, that emetics will not act, and that we are forced to have re- course to the stomach-pump. Caution in the use of this instrument, however, is re- quisite in cases of irritant poisoning in which the mu- cous membrane of the sto- mach is softened or partially destroyed. When evacua- tion of the stomach has been completed, we may employ gentle purgatives and diure- tics in addition to such reme- dies as iodide of potassium which favor the elimination of metallic substances. Thus, if cardiac syncope be the main symptom, we must give stimulants ; if the respiratory centre seems in danger of becoming para- lyzed, we must excite respi- (37) 3» ACIDS Having got so far, we must then proceed to use our anti- dotes proper, which may be divided into (i) Chemical, which directly neutralize the action of the poison by de- stroying its properties; and (2) Physiological, which have distinctly antagonistic properties, being, indeed, in many cases, absolute coun- ter-poisons. ratory action by cold affu- sion, irritation of the skin, and the employment of arti- ficial respiration, and give atropia, which stimulates the origin of the pneumogastric nerve in the medulla; if nar- cosis prevail, we must endea- vor to rouse the brain ; and if irritation of any particular organ arises, we must soothe it by appropriate remedies. 1. Among the first class we may rank alkalies in acid poisoning, animal charcoal as rendering the vegetable alkaloids innocuous, and li- quor potassae as depriving belladonna and its conge- ners of all physiological power. 2. The second contains all those various substances which have been described here and there in these pages as directly antagonistic to one another, as opium within certain limits to belladonna, Calabar bean to atropia and strychnia, aconite to digi- talis ; and this class, of anti- dotes has the advantage over the more purely local or chemical, that they are able to pursue their foe into the blood, and attack it boldly and successfully there. ACIDS. We next come to the consideration of acids, and, before enumerating the therapeutic properties of each individual member of the group, it will save time and repetition if we ACIDS. 39 draw attention to the collective actions and uses of acids in general. External Action. Physiological. Acids, being possessed of high diffusive power, rapidly permeate tissues to which they may be applied, coag- ulate their albumen, and, if concentrated, absorb their watery constituents and cause their destruction. Therapeutical. Acids, if used in concen- trated form, therefore, act as caustics, eating away and destroying animal tissues. When more diluted they are astringents, hardening and constringing weakened parts and checking unhealthy se- cretions. Internal Action. i. On Circulation. — It is stated that phosphoric and acetic acids diminish the force and frequency of the pulse, and reduce the num- ber of blood corpuscles. All the acids, however, have the property of increas- ing the acidity of the blood, probably rather by setting free another acid than by a direct action on that fluid ; for by the time they enter the circulation they are themselves converted in great measure into salts by the various alkaline secre- tions with which they have come in contact. They may also contract the smaller blood-vessels by reflex action, or by directly astringing them locally. 2. No special effects on the respiration or nervous system have been noted, but phos- The action of acids in checking hemorrhage is thus explained, as there is no doubt that coagulation [of fibrin in the vessels is pre- vented, and its fluid condi- tion normally maintained and] encouraged by an alka- line condition of the blood. They are useful in inter- nal hemorrhage, and to check excessive perspira- tion. 4o ACIDS, phoric and acetic acids are said slightly to lower the temperature. 3. Their action on secre- tion is interesting, and has been specially pointed out by Ringer. It appears that an acid applied to the orifice of a gland secreting an acid fluid will check that secre- tion, and thus any member of this group taken into the stomach before or at the be- ginning of the process of di- gestion will tend to act un- favorably by stopping the flow of gastric juice. This physiological action points to a valuable bearing on therapeutics. Some cases of dyspepsia depend on a de- ficient production of gastric juice, enough of this fluid not being secreted under the stimulus of food to dissolve and digest the albuminous constituents. This condition may be remedied by me- chanically supplying the want by a little acid given some time after food. But again, still more cases of dis- ordered digestion are caused by an excessive formation of gastric juice, the surplus sup- ply of acid teasing and wor- rying the mucous membrane of the stomach, and causing pain, sour eructations, and general distress. Here our physiological law comesinto play, and we check the over- secretion by giving the acid immediately before the meal. Or again, discomfort may result from irregular or ex- cessive fermentation of food giving rise to the formation of a large quantity of acetic, butyric, and lactic acids ; and this undue fermentation is found to be itself directly controlled by acids given in this case after food. Possi- bly some of their influence in checking acid perspira- tion may be due to this law. ACIDS. 41 But if acids arrest secre- tions having their own chemical reaction, they stimulate those which are alkaline, markedly increas- ing their quantity. 4. On the Urine. — Acids increase somewhat the acid- ity of the normal urine, but have no power of rendering an alkaline urine acid. This property is alone possessed by benzoic and citric acids, which are not true acids in the chemical sense. Acids, by their astringent properties, brace up relaxed mucous membranes, and check unhealthy secretion. We can thus explain what has been called the refriger- ant action of acids, or their undoubted influence in re- lieving thirst and imparting a fictitious sensation of cool- ness. By stimulating the secretion of the salivary glands, we moisten the dry parched mouth of our fever patient, and quench his thirst perhaps better than in any other way. It is probable also that some at least of the benefi- cial influence exerted by acids on chronic biliary de- rangement is due to their directly increasing the flow of alkaline fluid from the liver. They are therefore good tonics, and act well in diar- rhoea and profuse sweating. Disadvantages. The prolonged use of acids is apt to exercise a very un- favorable influence on digestion, rendering persons pale and languid, and causing a good deal of emaciation ; and this was no doubt the secret of the action of vinegar in reducing corpulence, which used to be so highly prized in the Byronic days, and by incautious indulgence in which 42 ANTHELMINTICS. so many ignorant people have at various times ruined their health. Poisonous Effects. The symptoms consist of very violent burning pain in the stomach and intestines, vomiting, purging, intense prostration, and death either by shock or by the results of secondary inflammation. On post-mortem examination, intense inflammation of the stomach and intestines is found, with ulceration of the mucous membrane, and even per- foration into the peritoneal cavity ; and if the case is of a more lingering character, fatty degeneration of various internal organs, but more especially the kidneys, becomes gradually developed. ANTHELMINTICS. The human body being infested with various parasites whose presence is inconvenient and even dangerous, it is necessary for us to be provided with means for their safe and speedy removal. Some of these unwelcome guests are, unfortunately, out of the range of medicine, but others are so placed that they can readily be destroyed ; and we shall arrange them in classes, according to the special drugs which act specially upon them. i. Tape-worms, as the i. The best remedy for taenia solium, derived from the taeniae is now allowed to eating measly pork ; the be male-fern oil given on an taenia medio-canellata, from empty stomach; but if this veal or beef ; and the taenia should possibly fail, we may lata, from salmon. These have recourse to kousso, tur- occupy the small intestines, pentine, pomegranate root, and give rise to various ill- or areca nut. defined but uncomfortable We must remember that, sensations. although these remedies kill the worms, they do not necessarily expel them from the intestines, and that a purgative may be required for this purpose ; and it is also essential to find the head of the tape- worm be- ANTHELMINTICS. 43 2. The round-worm, or ascaris lumbricoides, in- habiting the small intestine, and occasioning a long array of nervous symptoms, more especially in children. They are supposed to be intro- duced into the system by impure water. 3. The thread-worm, or oxyuris vermicularis, found in the caecum or colon, and causing much itching and irritation. They are almost universal among the children of the poor, but opinions differ as to whether they must be re- garded as the cause or the effect of the peculiarly ca- chectic condition with which their presence so often coincides. Other forms of parasitic intrusion within the various tissues are well known, but are generally incurable ; and the trichina spiralis, the vari- ous forms of hydatid dis- ease, &c, must usually be permitted to run their de- structive course unchecked. fore we can assure our pa- tient that he is freed from his tormentor. 2. Santonin acts as a true specific in at once destroy- ing these troublesome para- sites. 3. It would seem rather a roundabout practice to at- tack parasites in the lower gut by drugs administered through the mouth ; and although purgatives, such as scammony, calomel, jalap, &c. , are of use in these cases, our chief reliance must be placed on enemata of quas- sia, tincture of iron, lime- water, common salt, &c. In the general treatment of parasites, we must not trust entirely, however, to the use of anthelmintics, but must also exclude all possi- bility of infection by forbid- ding raw or underdone meat or fish, and by insuring general cleanliness and an efficient water-supply. In addition to this, we must remedy the unhealthy con- dition of mucous membrane, which favors their develop- ment, by giving alkaline re- medies and bitter tonics in various forms of combina- tion. 44 ANTIPYRETICS AND REFRIGERANTS. In prescribing our remedies for the expulsion of the tape-worm, it is well to insure a thorough evacuation of the intestines, so that the parasite may not be in any way shielded from the action of the drug by food or mucus. After a preliminary purge, we direct our patient to fast for a few hours, and then administer the fern oil in milk, either at bed-time or in early morning. ANTIPYRETICS AND REFRIGERANTS. Antipyretics. Antipyretics are remedies which reduce the bodily tem- perature, some acting only against the preternatural heat of febrile conditions, whilst others can also cool down the natural warmth below the normal standard. We may thus divide their action : — Class i. Those which act by directly cooling the sur- face of the body by local application. Class 2. Those which act by internal administration, either lessening oxidation, In this country we are not much in the habit of regard- ing the temperature, per se, as a special element of dan- ger, unless it goes beyond a certain height, and we there- fore do not, as a rule, treat this symptom very energeti- cally. Foreign experience seems to show that, although we may reduce the actual heat in acute disease, we do not necessarily alter the course of the attack, and we therefore usually confine our efforts to supporting our pa- tient and looking out for complications. On the other hand, however, when the thermometer registers 105 °, and still tends upwards, we are bound to interfere. 1. This is undoubtedly our most effectual antipyretic means, and may be carried out by cold affusion, wet pack, or, best of all, by the carefully graduated cold bath. 2. This class consists of the antipyretic drugs, pro- perly so called, such as qui- ANTISEPTICS AND DISINFECTANTS 45 or exerting some special in- fluence on the nervous sys- tem. Class 3. Those which act by dilating the superficial vessels and enabling a larger sheet of blood to be spread over the cutaneous surface, and thus brought in contact with the cooling influence of the air. The chilling effect then produced by the return of the circulating fluid to the heated centres, although very transient, may become considerable by repetition. Class 4. Remedies which act by bracing up and strengthening the nervous system, and removing some of that enfeebled and semi- paralyzed condition on which febrile temperatures have been supposed to de- pend. nine, digitalis, veratria, al- cohol, salicylic acid, &c. ; but, with the exception of the last-named, they are not much used for this purpose. 3. Under this heading we must include the whole class of diaphoretics, as well as chloral hydrate, the warm and Turkish bath, &c. 4. A rising temperature being often an indication of debility, we may then check it by tonics, good food, small doses of alcohol, &c. Refrigerants. Refrigerants, of course, necessarily include all remedies which actually lower the bodily temperature, but the con- ventionally accepted meaning of the term merely implies anything which alleviates thirst. Thus we find that the mere sipping of any fluid moistens the dry tongue and lessens the thirst of fever, whilst acids, by stimulating the secretion of saliva, may fulfil the same indication in a more scientific and effectual way. ANTISEPTICS AND DISINFECTANTS. Dr. Parkes proposed that the term disinfectant should be restricted to those substances which arrest the spread of specific disease depending on the entrace into the body of 46 ANTISEPTICS AND DISINFECTANTS. a special agent ab externo, and that agents acting in other ways should be called air purifiers and sewage deodorants. It would seem well, however, to adhere in these pages to the nomenclature most commonly in use in our received text-books of Materia Medica, and, whilst willingly con- ceding the palm of scientific precision to Professor Parkes, I shall adopt the following division of the subject into dis- infectants and antiseptics. Disinfectants are those substances which act by destroy ■ ing offensive animal or vegetable effluences, arresting putrefaction, and stopping the spread of infectious and epidemic disease by destroying the particles on which the poison of these diseases is supposed to depend. How they do this is not matter of absolute certainty, but they act in many cases by direct chemical agency, by deoxidising, or by taking up hydrogen and water ; and the theory of the modus operandi of various substances here enumerated will be considered when each of them comes separately under review. Adopting, then, in some measure the nomencla- ture of Parkes, disinfectants may be divided into i. Air purifiers, which we may again subdivide into — (i) Solid air purifiers, of which charcoal is the best, also dried earth, quick lime, &c. (2) Liquid air purifiers ; Condy's fluid, zinc chloride, lead nitrate, and, (3) Gaseous air purifiers ; such as zinc, chlorine, iodine, bromine, nitrous acid, sulphurous acid, and carbolic acid. 2. We may next include the sewage deodorants, of which charcoal, dry earth, as in Moule's patent system, iron perchloride, quick lime, potassic permanganate, car- bolic acid, with the various powders, such as M'Dougall's and Calvert's, which are prepared from it, are the most prominent. 3. Finally we have what Dr. Parkes calls disinfectants proper, which arrest contagious disease by destroying the particles of matter which pass away from the bodies of the sick. Of these heat is a valuable member, it being now well known that a dry heat, as of an oven, at over 212 will completely disinfect clothes. Chlorine is effectual, but irritating ; nitrous acid vapor has been recommended, carbolic acid is of undoubted service, but sulphate of iron seems to be of very doubtful utility. COUNTER-IRRITANTS. 47 Antiseptics are those substances which arrest the spread of disease and decomposition generally, not by chemical action, but by a poisonous effect on the minute animal or vegetable germs on which these processes depend. It is therefore clear that they dovetail very essentially with the preceding group, more especially as it is difficult to draw a hard and fast line between those disinfectants which act chemically and those which arrest putrefaction and infec- tive processes in other ways. The term antiseptic, there- fore, is superfluous, and would probably have dropped altogether out of use had it not been for the term antisep- tic surgery, which has been so extensively employed by Mr. Lister and his school, the theory being that putrefac- tion and pyaemia depend upon the presence of innumerable germs from which these substances free the air. The principal are carbolic acid, zinc chloride, boracic acid, salicylic acid, sulphurous acid, corrosive sublimate, and perchloride of iron. The term parasiticide has also been employed as indi- cating those substances which specially act as poisons to the minuter animal or vegetable life, and are used medi- cinally with this view. Thus sulphurous acid and per- chloride of mercury are used with success as local appli- cations in various forms of parasitic skin disease, and sul- phurous acid is beneficial in those classes of vomiting which depend on the irritation of low forms of crypto- gamic vegetation imbedded in the mucous glands of the stomach. COUNTER-IRRITANTS. The theory of the action of epispastics and rubefacients has given rise to much interesting physiological spec- ulation, but we are not yet able to lay down, with absolute precision, the laws on which the beneficial action of these remedial agents depends. We know this much, however, that blisters may occasionally act locally on deeper seated parts, as we are told that redness and inflammation of pleura and peritoneum may be produced by the vesicating influ- ence of cantharides applied to the cutaneous surface super- ficial to these structures. Then, again, vascular connection may explain other phenomena, and more especially may this be traced in the 48 DIAPHORETICS. chest between the pericardial vessels and those of the skin immediately over the heart, and in the lumbar region between the superficial vascular supply and that which furnishes to the kidneys their due allowance of arterial blood. These more direct and obvious explanations of various interesting therapeutical phenomena do not, however, lead us very far, and we are compelled to fall back upon much more abstruse considerations. Into these neither our space nor the scope of the present volume will permit us to enter very far, and we only very briefly draw a slight outline of those branches of the question which seem to have reached something of vigorous growth. Now for the relief of pain, counter-irritation may act, ist, by removing or modifying the structural condition on which the reflected suffering depends, as we often cure a facial neuralgia by extracting a carious tooth ; or 2nd, the end organs of the sensory nerves may be modified in mole- cular arrangement ; or 3rd, the trunks of the nerves them- selves, or the nuclei or the nervous centres, may be altered in some unexplained way by the stimulus applied to the seat of pain. For other purposes, also, counter-irritation may act by altering or redistributing blood supply, as by actually emp- tying the deeper vessels and filling the more superficial arte- rioles at their expense ; or special function or nutrition may be profoundly affected by influencing the trophic or other nerves which more especially preside over these departments of physiology. The practical applications of counter-irritation in the treatment of disease are both numerous and interesting; but when considering iodine, mustard, and cantharides, we have already devoted some space to the consideration of the principles which should guide us to their successful use. DIAPHORETICS. This class of remedies has Diaphoretics are used the property of increasing freely in practice at the out- the secretions of the skin, set of acule diseases, to relax and is usually divided into the contracted vessels and (1) the stimulating and (2) relieve the hot dry skin, and DIAPHORETICS. 49 the sedative. Under the first heading we include those drugs which stimulate the cutaneous circulation, among the principal of which are ammonia, alco- hol, the cold bath, phos- phorus, &c. ; and, second- ly, we speak of the sedative class, which act by dilating the superficial vessels, these being ipecacuanha, tartar emetic, jaborandi, aconite, the warm bath, and all the nauseating and emetic sub- stances, the depressing ac- tion of which is invariably attended by free perspira- tion. Then again we must refer to what are known as adjuvant remedies, such as warmth to the surface, diluent drinks, &c. in pneumonia this line of treatment has produced good results. The sedative class would seem to be best adapted for this purpose ; but the cold bath, which more naturally belongs to No. i, has been freely used abroad in febrile disorders, and part of its beneficial effects must no doubt be due to its action on the skin. In eruptive fevers, when the eruption is not sufficient- ly developed, we endeavor to excite the function of the skin, and thus favor the local manifestation of the poison, by warm baths, cold packing, and possibly by phosphorus. We also use diaphoretics to favor absorp- tion, as in various dropsies, and to relieve the kidneys, between which and the skin so much sympathy exists. They are also of service by assisting to eliminate morbid products from the blood. When the various internal organs, whose duty it is to get rid of certain effete and hurtful matters, are temporarily or perma- nently off work, we may hope to supply their place in some measure by the skin, and in Bright' s disease we may thus relieve the system of some urea, in jaundice of biliary products, &c. 5° DIURETICS DIURETICS. Diuretics stimulate and increase the flow of watery fluid through the kidneys in various ways, which we may con- veniently classify under the following headings : — Class i. Stimulating diu- retics, which act by directly exciting or irritating the glandular secreting struc- tures of the kidney. Class 2. Those drugs which stimulate the circu- lation, causing increased arterial tension, and thus greater pressure on the walls of the Malpighian bodies, by which means transuda- tion of watery fluid is me- chanically favored. Class 3. We next come to the saline diuretics, which, in addition to some slightly stimulating influence, have a special power of absorbing and holding watery fluids, which they then carry with them in their exit from the body. Class 4. Mechanical diu- retics must next be included in the list, and among the principal of these we may mention water, which acts by washing the urinary tubules clear from epithe- lium or casts, which block them under certain condi- 1. These are cantharides, turpentine, colchicum, &c, and they are rarely used, as they are liable to produce pain, strangury, and even haemorrhage. Cantharides has, however, been recom- mended in some forms of chronic albuminuria and in pyelitis. 2. The principal of these are digitalis, belladonna, squill, and ergot ; and they are of service in various dropsies, and perhaps most especially in those which depend on disease of the heart. 3. In this group we in- clude the lithia, potash, and soda salts, and most of them possess a double action, being diuretic in small, and purgative in large doses. They are also used with ad- vantage in anasarca and dropsical accumulations. 4. Dr. Dickinson has shown how well copious draughts of water act in the acute desquamative nephri- tis of children, on the mere mechanical principle of sluicing or washing out the obstructed tubules. The indirect diuretics are often EMETICS. 51 tions, and so allowing secre- of most service in renal tion to be re-established, disease. Under this heading we may also group those remedial means which act indirectly by relieving the kidneys in various ways. Thus, when congestion is present, local bleeding, dry cupping, warm fomentation, &c, may be the best diuretics. When the kidneys are pressed upon by ascitic fluid, a renewal of their full func- tion frequently follows the operation of tapping, and in many cases we may give these organs temporary rest by handing some part of their duties over to the skin or the bowels. Diuretics are notoriously uncertain remedies, and many of them have not the slightest power of increasing the flow of urinary water during health. They also vary much in their power of promoting the elimination of urea and other products of excretion by the kidneys. They may be given either by the mouth or by vapor, in which way oil of juni- per acts well ; or, as in the case of digitalis, they may be efficiently used by cutaneous absorption. In their admin- istration we must observe the following rules. Give them freely diluted, and, as a rule, combined with one another, as several remedies of the class seem to act better than one, as in the famous Guy's pill. Keep the patient cool, so as to avoid any action on the skin, and endeavor to prevent the bowels from coming too freely into play. EMETICS. The object of an emetic is to stimulate the so-called vomiting centre in the medulla oblongata, close to the origin of the pneumogastric nerve, and induce it to call forth the complicated series of muscular acts which termi-' 52 EMETICS nates in evacuation of the stomach. Emetics act in two ways, and are thus classed, as : Direct. Where the drug irritates the filaments of the pneumo- gastric nerve distributed to the mucous membrane of the stomach, and this irrita- tion, being transmitted to the centre, is reflected in motor impulses through the pneumogastric, phrenic, and intercostal nerves. The direct emetics are prompt in their action, and cause little nausea and depression ; and the principal members are sulphate of zinc, sulphate of copper, carbonate of ammonia, mustard, common salt, &c. The reflex chain then being established by which the muscular apparatus causes vomiting, we must next con- sider the various steps of the process. Indirect. Emetics of this class are conveyed directly by the medium of the blood to the vomiting centre, and act well by injection without coming into contact with the stomach. They are less prompt and more depressing than those of the other class. Principal members : Ipecac- uanha, tartarized antimony, apomorphia, veratria, del- phinia, &c. Physiology of Vomiting. i. In the first place the cardiac sphincter must be relaxed, or no vomiting can take place, and the persist- ent contraction of this struc- ture may account for many cases of distressing retching. 2. The actual contraction of the walls of the stomach itself must be supplemented by that of the abdominal parietes. 3. The diaphragm de- scends and becomes fixed. Therapeutics. Emetics are used to empty the stomach in cases of poisoning, and here we in- variably employ the direct class, such as sulphate of zinc, mustard, salt, &c. They are also of service in some forms of dyspepsia and to clear the stomach in in- toxication, and for the relief of the convulsions of infancy, which often depend on irri- tating articles of diet. EMETICS 53 4. The glottis is closed, so that the various muscles compressing the stomach act between two fixed points. 5. As vomiting cannot be effectually accomplished if the stomach is quite empty, under these circumstances the patient generally swal- lows a certain quantity of air, so as to distend the viscus. [Where the direct emetics are contra-indicated, we may resort to the indirect, which act by absorption. Emetia and apomorphia will cause vomiting if injected hypo- dermically.] 1. Action on the Brain and Nervous System. — Emetics may cause some congestion of the brain by the obstructed venous return from the neck during the act of vomiting. 2. Circulation and Respi- ration. — They have a seda- tive action on the heart. As the respiratory is close to the vomiting centre, the breathing generally becomes sighing and irregular during the act of vomiting ; but in addition to this there is an increase of secretion from the pulmonary mucous membrane, and the com- pression of the lungs forces retained mucus out of the bronchial tubes. 3 . Organs of Secretiofi . — By the pressure exerted on the intestines, some slight purgative action may result, and prolonged vomiting always leads to the discharge of bile from the stomach by the mechanical squeezing of the liver and gall-bladder. 1. We must therefore avoid their use in apoplectic cases. 2. Emetics are of great service in clearing the lungs in bronchitis, and in getting rid of the false membrane in croup and diphtheria, and they may thus be said to act as expectorants. We had here best use such emetics as ipecacuanha and tartarised antimony, which combine an expectorant action. 3. Emetics may therefore be said to act as cholagogues, and may be of great service in stimulating the action of the liver, and removing inspissated secretions from the gall-bladder. Some authorities hold that it is good practice to give an 54 EMMENAGOGUES AND ECBOLICS. 4. Cutaneous. — Emetics invariably cause free perspi- ration daring their action, as well as an increased flow of saliva. emetic as early as possible at the outset of fevers, such as enteric ; and it has been suggested that the fever poison is retained at this stage in the bile, and may be expelled along with it from the system. EMMENAGOGUES AND ECBOLICS. Of these we may consider, first, Ecbolics. Physiological Action. Ecbolics are substances which cause such violent contraction of the pregnant uterus as to effect the expul- sion of its contents. It is not quite certain whether the principal members of the group act specially on the muscular structures of the organ, or whether a primary intervention of nervous in- fluence through the spinal cord is necessary. Therapeutical Action. Ecbolics are used exten- sively in obstetric practice when it becomes necessary to stimulate the flagging powers of an exhausted ute- rus — the principal being ergot, digitalis, savin, bo- rax, quinine. We are also compelled, under certain circumstances, to have re- course to the induction of premature labor, as when dangerous sickness goes on unchecked, or when weak- ened abdominal or thoracic viscera are injuriously com- pressed by the pregnant uterus. In such cases, how- ever, it is generally found best to use mechanical means. EMMENAGOGUES May be direct or indirect. EXPECTORANTS. 55 Physiological Action. Direct emmenagogues act merely by restoring the nor- mal functions of the uterus when these are suspended. Indirect emmenagogues act by removing some con- stitutional condition which interferes with the due per- formance of the uterine functions. Thus amenor- rhcea very frequently de- pends on anaemia, or con- stipation may require re- moval before our more spe- cial remedies will act. Therapeutical Action. Most of the ecbolic drugs act as emmenagogues when given in small doses to a non-pregnant patient, and to the list we may add rue and castor. Of all these, however, ergot is by far the most effectual. The different preparations of iron, in combination with aloetic or other purgatives, act well, and we may aid our chances of success by all hygienic means, as well as by warm hip-baths, leeches, and mustard stupes, at the normal menstrual periods. EXPECTORANTS. These are remedies which expulsion of secretion from may thus be divided : — i . The emetic class, which are the most efficient of all, removing and softening the mucus, causing the trans- udation of watery fluids, and relaxing the muscular walls of the bronchial tubes. 2. Nauseants may also be of service as expectorants. 3. We then have what are called the stimulating ex- pectorants, acting either on the general vascular system, facilitate in various ways the the bronchial tubes. They 1. There can be no doubt that, when the lungs are choked with secretion, a good emetic often acts like a charm, as in bronchitis, whooping-cough, &c. We must here use the in- direct emetic agents, as am. carb., ipecacuanha, &c. 2. These are merely the indirect emetic drugs given in small doses, as antimony, ipecacuanha, &c. 3. These are senega, am. carb., &c. ; but it is evident that any tonic or stimulating remedy may frequently act 56 PURGATIVES. or specially on the nervous and muscular structures of the lungs. 4. Those remedies which promote secretion from a dry and swollen mucous membrane. 5. Expectoration is often rendered difficult by tenacity of the mucus, which is coughed up, only after much straining and effort, and great relief follows every drug which can thin or li- quefy the secretion. 6. Spasmodic contraction of the smaller bronchial tubes may interfere with free expectoration. indirectly as an expectorant, by improving the tone of the circulation and giving the patient strength to cough and clear his lungs. The stimulating expectorants are more especially used in the later stages of pulmonary disease. 4. In the earlier stages of bronchitis much discomfort occurs from the dry hard cough and difficulty of breathing arising from swell- ing of the bronchial mucous lining. Great relief is ex- perienced when free expec- toration is established, and this may be promoted by inhalation of steam, liq. am- monii acet. , lobelia, and the class of nauseants generally. 5. We find that alkalies act well here, and, if any gouty tendency exists, more especially potassic iodide. 6. Here we may hope to obtain relief by the use of opium, belladonna, stramo- nium, tobacco, &c. PURGATIVES. Purgatives may be divided, first, into two classes de- pending on their origin, and these are : — 1. The inorganic substances, comprising chiefly the mercurials and salines. 2. Those derived from the vegetable kingdom, and which depend for their therapeutical action on the pre- sence of resins or oils. PURGATIVES. 57 Their actual modes of operation, however, are much more varied, and they will best be considered by division under various headings, according to their physiological and therapeutical properties. i . Laxatives. — These sub- stances act by causing a slight increase in the peris- taltic movements of the in- testines, with softening of the faeces, which are then expelled in a solid and formed condition. 2. Purgatives produce more decided effects both in stimulating movement and secretion ; but it is difficult to separate them entirely from either class, No. i or No. 3. 3. Drastic Purgatives. — These run by insensible gra- dations into the preceding class. Their action depends on an irritation of the mu- cous membrane of the in- testines, and not only an actual increase of secretion from their glands, but the 1. The principal of these are sulphur, castor-oil, mag- nesia, &c. ; but in addition to actual drugs we may in- clude various articles of diet, as oatmeal, brown bread, whole flour, figs, prunes, &c, which act purely me- chanically. Laxatives are useful when- ever we desire a mild and unirritating effect, as in sim- ple constipation from dys- pepsia, pregnancy, conva- lescence from acute diseases, sedentary habit, and other causes. Castor-oil acts well in the early stages of diarrhoea, by sweeping away the irritating cause. 2. Rhubarb, senna, aloes, and jalap, are reckoned among the chief of these, and they are used in various dyspeptic conditions, rhu- barb being more especially stomachic, and aloes em- menagogue in their proper- ties. 3. In this class we include jalap, scammony,colocynth, gamboge, and croton oil, and they are principally used either in obstinate con- stipation, or to produce a derivative or species of counter-irritant effect in va- rious forms of brain disease. 58 PURGATIVES. withdrawal of watery fluids from the blood. An over- dose, therefore, may be at- tended by serious depres- sion, discomfort, and even by death from inflammation of the bowel. 4 . Hydragogue purgatives cause very free secretion from the mucous membrane of the bowels, and empty the veins by withdrawing fluids from the blood. 5. Saline Purgatives. — We have already, when treating of sulphate of mag- nesia, considered the action of this class, and have pointed out how, from their low diffusive power, they pass with difficulty into the blood, and how, whilst in the intestine, they not only absorb, retain, and carry away the watery fluids which they find in the intes- tine, but also directly with- draw fresh supplies from the blood itself. 6. Cholagogue Purga- tives. — Much experiment has recently been expended on the action of this class, and those recently conduct- ed on improved principles by Prof. Rutherford have given us very precise and reliable indications for practice. Cholagogues act either by directly stimulat- ing the secretion of the bile, 4. These are elaterium, cream of tartar, &c, and they are most useful in as- cites and other dropsical conditions, and for the re- lief of a feeble and laboring heart by diminishing the actual volume of the blood. 5. Sulphate of magnesia and many of the salts of potash and soda must here be included. They are best given 111 a state of free dilu- tion, and form very efficient habitual purgatives, more especially in the form of various natural purgative waters, such as Friedrichs- hall, and Pullna. [Hunjadi Jan os, Congress Water, &c] 6. The principal members of this group are mercury, podophyllin, rhubarb, aloes, jalap, etc. They are used for the relief of various functional affections of the liver, to remove what is commonly known as ' biliousness,' and to obvi- ate portal congestion. PURGATIVES 59 or by contracting the gall- bladder and irritating the duodenum, so as to sweep the bile out of the intestine as fast as it is poured in by the hepatic ducts. In addition to drugs be- longing to the actual purga- tive class, we have many indirect remedies which act with considerable efficiency. Thus we may use enemata, cold to the abdomen, me- chanical kneading of the parietes, electricity; we may stimulate the muscular tissues to contraction ; or we may cause a purgative action by relieving spasm. Among the stimulating class we may mention strychnia, nux vomica, er- got, sulphate of iron, etc., and these are very efficient, in combination with mild purgatives, where constipa- tion depends on a lax or weakened state of the intestinal walls. When spasm or irregular contraction prevents free action of the bowels, we must have recourse to opium, belladonna, or acetate of lead, which, under these conditions, may be looked upon as true cathartics. In administering purgatives, we must consider the vari- ous parts of the intestinal canal on which they act.- Thus senna, jalap, &c, act on the small intestine, aloes on the large, podophyllin on the duodenum, &c. We must also consider the time of their administration, as we find that the slowly acting resinoid substances are best given at night or before dinner, whereas the salines are best taken on an empty stomach, and more especially before breakfast. The mode of administration is also worthy of note, the resinoids being best taken in the form of pill, whereas the salines act best in solution with free dilution and in com- bination with bitters, iron, or sulphuric acid. REMEDIES COMPRISED IN THE PRIMARY LIST OF THE UNITED STATES PHARMACOPCEIA. ABSINTHIUM— WORMWOOD. [ The tops and leaves of Artemisia Absinthium, U. S.~\ Wormwood was formerly used as a bitter tonic and an- thelmintic, but it has now quite disappeared from practice. Its prolonged use as a beverage, in the form of liquor, has been shown to produce a condition of enfeeblement and irritability of the nervous system, with a tendency to epi- leptiform convulsions. [In combination with other herbs, it is sometimes used in domestic practice under the name of German Tea. Wormwood entered into the composition of the once famous "thieves' vinegar," Vinaigre des qualre voleurs (IVysten. Diet, de Med.'). The plant contains a volatile oil, which gives name and flavor to absinthe, a highly- pernicious but popular drink in France.] ACACIA— GUM ARABIC. \_A gummy exudation from Acacia vera and other species of Acacia, U. S. Officinal Preparations, U. S. Syrupus Acaciae, used as a vehicle. Mucilago Acaciae, used as a vehicle. Also enters into Mistura Amygdalae, Mistura Cretae, and Mistura Glycyrrhizse Composite, 1 and is used as an ex- cipient and dusting-powder for pills.] 1 [Commonly called Brown Mixture.] 6 (61) 62 VINEGAR ACETIC ACID. Gum is demulcent, and in the form of mucilage is much used for the suspension of bulky and insoluble powders, as well as to prevent the precipitation of the resin, which en- sues when such substances as tincture of myrrh, tinct. cannabis Indicse, &c, are added to water. [Gum-Arabic water may be given as a demulcent drink in fevers^ in angina, in gast?'o- enteric inflammation, and dysentery. It has some slight nutritive properties.] [ACETUM—VINEGAR. Impure dilute acetic acid prepared by fermentation, U. S. Officinal Preparations, U. S. Acetum Destillatum, used in making Tinctura Opii Acetata. External and Internal Uses. Vinegar, more or less diluted, is a favorite domestic application in headache, sprains or bruises, and sun-burn; it is also used as a clyster against ascarides. It may be given as a refrigerant drink in fevers ; and in these cases it is frequently applied to the surface of the body, with a sponge, as a means of reducing high temperature. In small amounts vinegar aids digestion, but in excess pro- duces degeneration of the gastric tubules and thickening of the coats of the stomach. It is supposed to act on the blood by influencing its crasis, and reducing the propor- tion of fibrin. It has been found an efficient remedy in scurvy, in combination with nitre (§j. to Oj.), of which an ounce may be given four times daily.] ACIDUM ACETICUM— ACETIC ACID. [Acetic acid of specific gravity 1. 047, U. S. Officinal Preparations, U. S. Acidum Aceticum Dilutum. (f^ij. in Oj.) Dose Also enters into Acetum Lobelice, 1 Acetum Opii, 1 Acetum Sanguinarise, 1 Acetum Scillse 1 (Syrupus Scillse), Emplastrum 1 [These four, with Acetum Destillatum, comprise the class of Vine- gars, or Aceta, of the Pharmacopoeia.] ACETIC ACID. 63 Ammoniaci, Extractum Colchici Aceticum, Extractura Ergotas Fluidum, Liquor Ammonii Acetatis, Syrupus Allii, Potassii Acetas, and Zinci Acetas. Antidotes. In poisoning by acetic acid, alkalies or their carbonates may be given, properly diluted, and vomiting encouraged by large draughts of warm water containing soap.] External Action. Strong, or glacial acetic acid, is a favorite and very suc- cessful application to warty groiuths, whether of venereal origin or not. The little tumor is touched several times with a glass rod, or brush, or a piece of wood dipped in the acid, care being taken that none of the fluid trickles down over the neighboring structures. A few repetitions of this process will generally prove effectual. It is also topically used in some obstinate forms of skin disease, and more especially the varieties of tinea comprised under the term ringworm. The acid probably acts by directly attacking and destroying the parasitic growth on which the trouble- some affections depend. Acetic acid is also occasionally applied to corns. Another mode of local use was proposed by Dr. Broad- bent some years ago, and strong hopes were then enter- tained that a remedy had been at last found for cancer. Observing the destructive influence of the acid on cancer elements out of the body, Dr. Broadbent very reasonably expected that a similar effect might be produced within the living organism, and advised the injection of diluted acetic acid into the substance of the cancerous mass. Some evidence seemed to be adduced in its favor, but its action being painful, tedious, and uncertain, the process has now fallen into perhaps unmerited oblivion. Internal Use. Acetic acid is seldom used internally, although it forms an agreeable and effectual remedy for the checking of night sweats, and Graves used thus to prescribe it. The varieties of acetic acid are : Acidum aceticum, from which are prepared acidum aceticum dilutum and oxymel, 64 ARSENIOUS ACID CARBOLIC ACID. the doses being of acid. acet. dil. f5j- to f 5 i j - > oxymel [Br.] f 5j- to f5ij- '} an d acidum aceticum glaciale. Then we have vinegar, the strength of which corresponds pretty accurately with the dilute acid, and which is purely a domestic remedy for headache, hysteria, and other allied conditions. ACIDUM ARSENIOSUM— ARSENIOUS ACID. \_Siiblimed arsenious acid in masses, U. S. See ARSENIC.~\ [ACIDUM CARBOLICUM IMPURUM. Impure carbolic acid, U. S. Used only as an external remedy or for disinfecting purposes . ] ACIDUM CARBOLICUM— CARBOLIC ACID. \_A solid sttb stance obtained from the products of the distillation of coal- tar, betzoeen the temperatures of 300 and 400 , U. S. Dose, gtt. i.-ij., in pill or solution. Officinal Preparations, U. S. Glyceritum Acidi Carbolici. Dose -n^x.-xl. Unguentum Acidi Carbolici (5j. to 3j.). Antidotes. There are no direct antidotes to poisoning by carbolic acid. Alkalies, soap, or the fixed oils may be given, with demulcent drinks, and the stomach evacuated with a pump or syphon, as the local effect of the acid will generally prevent emetics from acting.] Local Action. Physiological Effects. Therapeutical. Carbolic acid is, in the It is therefore much used first place, an antiseptic, as an antiseptic and deodor- from its power of destroying ant for the treatment of 111- the minuter forms of animal smelling drains, etc., or to and vegetable life. destroy the infectious pro- perties of various secretions or discharges from the sick. It may also be useful as a lotion or injection to foul sores. CARBOLIC ACID. 65 Carbolic acid is an irri- tating substance, and, if applied sufficiently long to the skin, will cause slough- ing. It has, however, un- doubted anaesthetic proper- ties. It is also readily absorbed through the skin. Although carbolic acid may be of use in correcting fcetor, it is too irritating to make a good lotion for wounds or ulcers, [unless properly diluted, with oil (1 in 24) or water (3j. to Oj.), when it forms an admirable dressing.] It has been used as a caustic in some ulcera- tive affections, as lupus. It has been recommended as a local anaesthetic during small operations, and to deaden the pain of some caustic applications. [The pain of opening a. felon may be greatly reduced by pre- viously immersing the finger for a few minutes in a 3 to 5 per cent, solution of car- bolic acid.] We must therefore re- member that symptoms of poisoning may readily be produced by the application of carbolic acid over any considerable cutaneous area. Antiseptic System of Prof. Lister. 6* Its principal application, however, in surgery, is in enabling us to carry out the far-famed antiseptic system of Prof. Lister. This eminent surgeon, adopting the views of Pas- teur, and believing that sup- puration, pyaemia, and vari- ous other inconveniences connected with open wounds, arise from the 66 CARBOLIC ACID, irritation of minute germs contained in the air, has devised a process in which the atmospheric air, before reaching the raw surface, is filtered through carbolic acid and thus deprived of its irritating properties. The acid itself, being extremely irritating, is pre- vented from coming in con- tact with the wound or sore by a protection of oiled silk, over which are super- posed several layers of gauze impregnated with paraffin i6 parts, resin 4 parts, and carbolic acid 1 part ; and this dressing need not necessarily be changed oftener than every two or three days. Mr. Lister prevents the access of air during opera- tions by surrounding the part with an antiseptic atmosphere, composed of a sprayed watery solution of carbolic acid of 1 to 40, and the instruments and fingers of the surgeon are carefully washed with car- bolized oil, whilst the arte- ries are tied with carbolized cat-gut ligatures, cut off short. By adopting these precautions, and attending most rigorously to the care- ful dressing of wounds, he has obtained excellent re- sults, not only after ordi- nary operations, but in chronic abscesses wherever CHROMIC ACID. 6 7 situated, compound frac- tures, and various diseased conditions connected with joints, whose cavities he is enabled to open and explore with perfect safety. Internal Action. Carbolic acid, if adminis- tered in sufficient quantity, is very poisonous in its ope- ration, causing failure of the heart's action, spinal con- vulsions, gastro-intestinal irritation, and lowered tem- perature. Its antiseptic properties sufficiently ex- plain its internal use. Carbolic acid has occa- sionally caused death by being accidentally drunk in mistake for beer, or by being incautiously applied to the skin. The best antidotes are olive oil and saccharated lime. It is occasionally given internally to counteract flatulence and s arduous vomiting; but the sulpho- carbolates, and more espe- cially that of soda, are the most convenient forms for its administration in doses of 15 to 30 grains. [Car- bolic acid has been recom- mended for tenia, in pill- form, taking three to five grains in the course of the day.] Absorption and Mode of Elimination. Carbolic acid is rapidly absorbed, and quickly and entirely given off by the urine, to which it imparts a pecu- liar greenish-black hue and its own peculiar smell. [ACIDUM CHROMICUM— CHROMIC ACID. No Officinal Preparations, U. S. Effects and Uses. Chromic acid is an escharotic and antiseptic ; it rapidly oxidizes organic matter and is the most energetic disinfectant 68 CITRIC ACID . known. A strong solution (gr. c. to f*j.) may be applied with a glass rod, to destroy warts, condylomata, and excres- cences, or to reduce enlarged tonsils. Greatly diluted (gr. ss. to f^j.) it forms a detergent wash for mercurial stomatitis, scurvy, diphtheria, oedema of the glottis, ulcers, and phage- dena. On account of the difficulty of limiting its effect it should not be applied in substance, as when used in this manner to destroy warts on the fingers it has been known to eat into the joint and require amputation of a phalanx.] [ACIDUM CITRICUM— CITRIC ACID. Officinal Preparations, U. S. Liquor Ferri Citratis, Liquor Magnesias Citratis, Liquor Potassii Citratis, Lithii Citras, Potassii Citras, Syrupus Acidi Citrici, and in preparing Ferri Pyrophosphas. Dose. gr. xx.-xxx. Effects and Uses. As a refrigerant in fevers, citric acid solution is used in the form of lemonade, neutral mixture (mistura potassii citratis), or the citrates. It has been used in scurvy, liver disease, and rheumatism, and as an application to the throat in diphtheria (gr. viiss. to f,lj.). Dr. H. Bence Jones believes that lemon juice and citric acid increase the acidity of the urine ; they consequently are contra-indi- cated in lithuria, and should not be given for a length of time, continuously, in the gouty diathesis.] External Use. Citric acid was proposed a few years ago as a soothing local application to cancerous sores. Internal Use. Citric acid is used chiefly as a cheap and convenient substitute for lemon juice in effervescing draughts, which are very extensively prescribed on account of their cool- ing and refreshing properties in feverish conditions, and for the soothing influence of their carbonic acid when the stomach is irritable. Whenever lemon juice can be procured, it should be used in preference; but at periods of the year when this DILUTE HYDROCYANIC ACID 6 9 fruit is out of season, citric acid will act well, and we here give a table from Squire, showing the proportions in which the acid and alkali should be prescribed to insure exact saturation. ' 25 grs. bicarbonate of potash. 20 " carbonate of potash. 20 35 15 13 Acidumtartaricum, being cheaper than citric acid, is often used to construct effervescing draughts. 17 grs. of cit- ric acid, or half a fluid ( ounce of fresh lemon juice will neutralize bicarbonate of soda, carbonate of soda. carbonate of ammonia, carbonate of magnesia. ACIDUM HYDROCYANICUM DILUTUM— DILUTE HYDROCYANIC ACID. \_A tzvo per cent, sohition of Hydrocyanic acid in water. Antidotes. Chlorine or ammonia may be cautiously administered, accompanied by cold affusions to the spine, and artificial respiration. As a chemical antidote, sulphate of iron (gr. x.), and tincture of the chloride of iron (f5j-)> dissolved in a fluid ounce of water, may be given immediately, to be fol- lowed by twenty grains of carbonate of potassium, like- wise in solution, forming with the poison insoluble Prus- sian blue.~\ External Action. Physiological. Prussic acid, applied to the skin in a concentrated form, may cause at first slight irritation, but second- arily diminishes its sensibi- lity, acting in some degree as an anaesthetic, probably from a benumbing influence on the extremities of the sensory nerves. Therapeutical. It is therefore used exter- nally, largely diluted, to re- lieve neuralgic pain and allay itching, more espe- cially in skin disease. We may thus hope to alleviate the tormenting irritation often attending prurigo and eczema; but we must be careful never to let the lo- tion come in contact with any abrasion on the surface, as prussic acid is very rea- dily and rapidly absorbed. 7° DILUTE HYDROCYANIC ACID. H; Internal Action. 'ydrocyanic acid, being the most powerful and speedy poison with which we are acquainted, requires to be pre- scribed with very great caution. Physiological. i . On the Nervous System . — Prussic acid has some ef- fect on the brain, causing giddiness and slight stupor; the respiratory centre in the medulla next becomes weak- ened, and the motor nerves are more or less paralyzed, causing excessive muscular feebleness. 2. The respiration be- comes slow and irregular, and finally ceases, death in cases of poisoning being generally due to suffocation. The sensory nerves are also enfeebled in their conduct- ing power. 3. Prussic acid has a pow- erful sedative action on the heart, the circulation be- coming slow, feeble, and ir- regular under the influence of poisonous doses ; and this arises both from an influence on the nerves and on the Therapeutical. 1. It is used with great benefit in those forms of dys- pepsia attended with epigas- tric pain and vomiting fol- lowing food, and whether depending on gastric ulcer or on mere irritation of the mucous membrane. It has also been given in whooping- cough; but in my experience its action is here very uncer- tain, and I have been unable to satisfy myself that it is a remedy of much value. In some forms of chronic and spasmodic cough it does good, but it is essentially in dyspepsia that we obtain real advantage from its use. 3. It has been successfully employed in nervous palpi- tation [or irritable heart]. DILUTE HYDROCYANIC ACID. 71 muscular structures of the heart itself. It also acts directly on the blood, combining with the haemoglobin of the red cor- puscles, and preventing them from properly fulfilling their duty of carrying oxygen to the tissues. 4. Prussic acid has no special influence on the tem- perature or on secretion, save that the saliva is generally increased in quantity. Prussic acid is very rapidly eliminated from the system, probably by the breath, and half an hour may be sufficient for this purpose, so that in a case of poisoning we may have good hopes of recovery, if we can sustain the powers of life during this period. Poisonous Effects. — In a large dose prussic acid kills immediately, the victim fre- quently uttering a loud cry, and expiring from cardiac syncope. If the quantity taken be smaller, symptoms of suffocation supervene from paralysis of the respi- ratory centre, and, if the process of poisoning be more gradual, from deficient" sup- ply of oxygen in the blood ; other symptoms noted being convulsions, great muscular prostration, dilatation of pu- pils, and quick, feeble, irre- gular pulse. In fatal cases, post-morteni examination shows nothing characteris- tic. If the poison be taken in Antidotes. — Considering the great rapidity of the ac- tion of hydrocyanic acid, it is comparatively seldom that we have any opportunity of employing antidotes ; but supposing we see a case suf- ficiently early to do so, we should have vigorous re- course to cold affusion and the inhalation of ammonia and chlorine water. Artifi- cial respiration should be then steadily persisted in, and if we can thus counter- act the tendency to death by suffocation, and tide the patient over the first half- hour, we may look forward to success, never despairing as long as the faintest pulsa- tion can be felt in the heart. 72 DILUTE HYDROCYANIC ACID. a concentrated form, death may ensue very rapidly, in less probably than a minute ; and Preyer, who has devo- ted special attention to the subject, has observed a gui- nea-pig to be apparently dead one second after inhal- ing some gaseous acid, all efforts at breathing having finally ceased in fifteen sec- onds. He, therefore, consid- ers this to be the most deadly mode of its administration ; but no matter through which channel it enters the body, it speedily kills any animal, and, curiously enough, it is equally destructive to plants. Secondary auxiliary means exist in the internal adminis- tration of ammonia, of chlo- rine water, or of carbonate of potash, followed by the mixed sulphates of iron, which convert the poison into prussian blue ; and re- cently the subcutaneous in- jection of atropia has been proposed as the true physio- logical antidote. Dose and Mode of Administration. One grain of anhydrous acid has caused death, and of this the preparation used in medicine contains 2 per cent., the old Scheele's, which is now obsolete, having contained 4 per cent. In consideration of the rapid way in which the acid is thrown out of the system, we must repeat the dose fre- quently, from every hour to every three hours ; and it is well not to order too large a quantity at one time, not be- cause the acid tends to float on the top, as was formerly supposed, but because there is always a chance of an over- dose being given through ignorance or carelessness. We may safely prescribe from 2 to 6 minims [beginning always with gtt. j.], suspending it if the patient complains of any constriction about the throat. For external use f3ij. niay be dissolved in 8 ounces of water or rose water. $.. Acidi hydrocyanici diluti f5\j- ; Glycerini f^j. ; Aquae rosse ad f^viij. Misce, fiat lotio. In a case of troublesome itching. LACTIC ACID — NITRIC ACID. 73 R. Acidi hydrocyanici diluti TT^xij. ; Misturae amygdalae ^I v j« Misce, fiat mistura. Capiat cochlearia duo magna tussi admodum ingravescente. For a case of irritable cough. R. Acidi hydrocyanici dil. tt\_xxv. ; Bismuthi subnitratis £ss. ; Syrupi aurantii f § j . ; Gentianae infusi ad f gviij . Capiat cochlearia magna ter in die ante cibum. In a case of irritative dyspepsia. Or, a few drops of prussic acid may be added to the ordinary effervescing draught with good effect. [ACIDUM LACTICUM— LACTIC ACID. Officinal Preparation, U. S. Ferri Lactas. Dose gr. v. A syrupy, nearly transparent liquid, with slight odor and a very sour taste, obtained from sour milk. It exists normally in the gastric juice, and hence is a useful addi- tion to preparations of pepsin. It has been given in dyspepsia (f3j- s. t. d.) in sweetened water at meal-time. Locally it has been employed (diluted four-fifths) as an application to the false membrane in croup and diphtheria. According to Prout, rheumatism is connected with an excess of lactic acid in the blood ; and this fact accounts for the benefit derived from the alkaline treatment.] ACIDUM NITRICUM— NITRIC ACID. \_Nitric acid of the specific gravity 1.420, U. S. Officinal Preparations, U. S. Acidum Nitricum Dilutum (f^iij. to Oj.). Dose, nrv.-xxx. Also enters into Acidum Nitro-muriaticum, Argenti Nitras, Bismuthi Subnitras, Liquor Ferri Nitratis, Liquor Hydrargyri Nitratis, Spiritus ^Etheris Nitrosi, Unguentum Hydrargyri Nitratis, and in the preparation of Acidum Phosphoricum Dilutum, Antimonii Oxidum, Bismuthi Subcarbonas, Cadmii Sulphas, Hydrargyri Oxidum Ru 7 74 NITRIC ACID . brum, Liquor Ferri Chloridi, Liquor Ferri Subsulphatis, Liquor Ferri Tersulphatis, Liquor Zinci Chloridi, and Pyroxylon. Antidotes. The same treatment as indicated for poisoning by Muri- atic Acid and the other mineral acids. Nitric acid stains the skin yellow. ] External Use. Nitric acid is undoubtedly the best form of local applica- tion in all forms of sloughing or phagedenic ulceration, whether of venereal origin or otherwise. In these rapidly destructive forms of disease, we shall do well to place our patient under the influence of an anaesthetic, and then apply the strong acid freely and thoroughly to all parts of the affect- ed surface, and we shall thus often succeed in arresting a process which would otherwise go on to severe and even fatal disorganisation. It is also used locally in the treatment of piles, more especially those flat irritable forms of tumour which do not come readily within the reach of the clamp or ligature. In the proportion of 10 or 20 minims to an ounce, nitric acid forms a good astringent lotion in cases of indolent or unhealthy sores; and it has been recommended by Dr. Roberts, of Manchester, as an injection into the bladder for the solution of phosphatic calculi. Internal Use. Given internally, nitric acid has tonic properties, and, in combination with bark and opium, acts well in cases of foul or sloughing ulceration. Again, in constitutions broken down by syphilis or by chronic hepatic disease, we may very beneficially give our patient from 15 to 20 minims of the dilute acid three times a day, its action on the liver being by some supposed to have somewhat of a specific character. J&. Acidi nitrici diluti f^U- 5 Tincturee opii ttL x h ; Tincturas cinchonas f §ss. ; Decocti cinchonas ad f§viij. Misce, capiat f§j. ter in die. In a case of foul or sloughing ulcer. OXALIC ACID — TARTARIC ACID. 75 ACIDUM NITRO-HYDROCHLORICUM.— [NITRO-MURIATICUM, 3 to 5. Dose, 5 to to minims, well diluted. Acidum Nitro-Muriaticum Dilutum (f^iv. to Oj.). Dose r^x.-xv.] This is supposed to have some special action on the liver, and is most extensively used in chronic functional affections of that organ. It has also been highly recom- mended, in the form of bath, in various hepatic disorders in the proportion of 6 fluid ounces to each gallon of water. I£. Acidi nitro-muriatici diluti f^ii- ; Succi [extract] taraxaci f §>s. ; Spiritus chloroformi [Br.] f3) ss - > Aquae ad fgviij. M. Capiat f^i. ter in die. In a case of sluggish liver. [ACIDUM OXALICUM— OXALIC ACID. Officinal Preparation, U. S. Ferri Oxalis. Dose, gr.ij.-iij. Antidotes. Magnesia and lime form insoluble precipitates with oxalic acid, therefore compounds containing chalk or mag- nesia would constitute chemical antidotes. Tooth-powder, lime-water, oxide and carbonate of magnesia, or "the scrapings of the ceiling with a fire-shovel," may be given with propriety in cases of poisoning; which are not infre- quent, since, owing to the resemblance between oxalic acid and Epsom salts, one may be accidentally substituted for the other. Effects and Uses. Oxalic acid has been used, in small doses, internally, in scurvy and phthisis, but has nothing particular to com- mend it.] [ACIDUM TARTARICUM— TARTARIC ACID. Officinal Preparations, U. S. Ferri et Ammonii Tartras. Dose gr.x-xxx. Pulveres Effervescentes. (Soda powders.) Pulveres Effervescentes Aperientes. (Seidlitz pow- ders.) 76 ACONITE. Antidotes. The alkalies, magnesia, lime, soap, or the alkaline car- bonates. Internal Use. It has been stated that tartaric acid, in 10-20 grain doses, given thrice daily will render the urine acid. The tartrate of magnesium has been recommended as a cheaper substitute for the citrate, as an aperient, and is considered quite as efficient. In sweetened solution, tartaric acid is sometimes used as a refrigerant drink in fevers. The tar- trates are laxative and diuretic] [List of Acida, or acids, officinal in the U. S. Pharma- copoeia : — Acidum Aceticum Acidum Nitricum Dilutum " " Dilutum " Nitro-Muriaticum " Arseniosum " " Dilutum " Benzoicum " Oxalicum " Carbolicum " Phosphoricum Dilutum " " Impurum " " Glaciale " Chromicum " Sulphuricum " Citricum " " Aromaticum " Gallicum " " Dilutum " Hydrocyanicum Dilutum " Sulphurosum " Lacticum " Tannicum " Muriaticum " Tartaricum " " Dilutum " Valerianicum.] " Nitricum ACONITUM— ACONITE. [Aconiti Folia. — The leaves of Aconitum Napellus, U. S. Aconiti Radix. — The root of Aconitum Napellus, U. S. Officinal Preparations, U. S. Aconitia (from the root). Not given internally. Extractum Aconiti (of the leaves). Dose gr. ss. Emplastrum Aconiti (from the root). Linimentum Aconiti (from the root). Tinctura Aconiti Radicis. (gvj. to Oj.) gtt. j.-v. {Fleming's tincture of aconite root contains §xss. to Oj.) ACONITE. 77 Antidotes. Finely powdered animal charcoal, tannin, astringent infusions, and hot alcoholic stimulants, are useful. The stomach should be carefully washed out, and subsequent symptoms met pro re nata.~\ Poisonous Properties. Aconite may kill either by direct cardiac syncope, or, if the action is less rapid, by respiratory failure. Great muscular weakness is noted, the heart's action becoming feeble and irregular, the face pale, the body bedewed with clammy sweat, the pu- pils first contracted and then dilated, shortly before death closes the scene. The re- semblance of aconite root to horse-radish has afforded several opportunities of studying lamentable cases of accidental poisoning. Therapeutical. In poisoning by aconite, we must endeavor to sustain the flagging action of the heart by giving stimulants, and keeping the patient most rigidly in the re- cumbent posture, as death has occurred from syncope produced by suddenly sit- ting up in bed. Digitalis has been proposed as the physiological antidote, bracing up and restoring the contractility of the heart muscle (Fothergill). [20 minims of tincture of digitalis may be adminis- tered hypodermically.] Local Action. Physiological. Aconite, locally applied, causes a sensation of tingling, followed by numbness of the skin, from a paralysing influence, no doubt, on the sensory nerves. It may also bring about some local vaso- motor paralysis. Therapeutical. Aconite is a most valuable local sedative in painful nervous affections, and more especially in facial neural- gia , where the tincture or liniment, applied along the course of the affected nerve, will often allay and even remove suffering. Constitutional Action. Physiological. Therapeutical. I. On Nervous System. — 1. Brain. — In poisoning by 78 ACONITE. aconite, the intellectual faculties are usually quite unaffected, but in some cases stupor has been observed. 2. Spinal Cord. — Aconite paralyses both the reflex and the motor activity of the cord, as evidenced by almost total loss of power in the muscular system. The respiratory centre also eventually becomes paralysed, and death may result by suffocation. 3. Although this loss of voluntary movement is sup- posed to be primarily spinal in origin, it is believed that the motor nerves themselves are secondarily affected, the paralysing influence begin- ning at their peripheral extremities. The inhibitory cardiac ganglia are first stimulated, and secondly depressed, and a sedative effect is produced on the sensory nerves, the earliest indication of the action of the drug being tingling fol- lowed by numbness and anaesthesia of the lips and throat. Opinions differ as to the influence of aconite on the vaso-motor nerves, and it is not believed by many authorities to have any special operation over this system. Dr. Bagshawe, however, has published some cases of facial sympathetic paralysis, with injection and 3. Aconite is one of our best remedies in facial neu- ralgia, given either alone or in combination with quinine. In sick headache also it is of service, and here it will be prescribed along with tinc- ture of Indian hemp. ACONITE. 79 sweating, following the local application of aconite, and the diaphoretic action, so often noted, must proceed from this cause. Experi- mental evidence, however, is very conflicting in this, as well as in other points, respecting the physiological actions of aconite. II. Circulating Apparatus . Aconite is essentially a car- diac sedative, slowing the action of the heart at first from inhibitory stimulation, but then causing an increase in the rapidity of the pulsa- tions, with feebleness and irregularity, ending in death by arrest of all movement in diastole. At the same time the arterial pressure falls in very marked degree. III. Respiration and Tem- perature. — The respiratory movements tend to become slow, finally irregular, and in some cases, and almost universally in the lower animals, death results from cessation of breathing. The temperature falls decidedly. IV. Digestive and Secret- ing Apparatus. — Aconite has no special influence on digestion. It increases somewhat the salivary secre- tion, and augments largely II. Aconite is an excellent antiphlogistic, cutting short inflammatory processes in their early stages. Thus in pneumonia, pleurisy, perito- nitis, erysipelas, rheumatic fever, and in the short sharp feverish affections of child- ren, it is of signal service, and seems to have a directly curative action. In coryza and in acute tonsillitis, also, it has been much praised for the way in which it checks the full development of these troublesome affec- tions. III. Some part of the good effect of aconite in these febrile affections must be due to its power in slow- ing the breathing and re- ducing the temperature. 80 LARD. the action of the perspira- tory apparatus of the skin, Aconite is therefore an bringing out in some in- excellent diaphoretic, stances an irritable vesicular eruption. The urine is also somewhat increased in quantity. Absorption and Mode of Elimination. Aconite is rapidly absorbed, and given out probably by the urine. Cautions and Modes of Administration. The very poisonous nature of aconite renders caution necessary in its use, and we must prescribe it with great care in old persons, or where any suspicion exists of feeble- ness of the heart's action. In sound constitutions, how- ever, and more especially in the case of children, we may use it with freedom, often obtaining really extraordinary results. It is essential to encounter the inflammation at an early stage, before structural changes have set in; and it is im- portant to combine a little stimulant with the drug. In very acute cases, our best practice will be to give the tinc- ture in small and very often repeated doses, carefully watching the effect on the pulse. One drop every ten minutes, half-hour, or hour, will be the best arrangement during the first day, after which every two hours will be a sufficient interval, the thermometer giving us meanwhile reliable information regarding the progress of the inflam- matory condition. In facial neuralgia, also, we shall ob- tain the best results by drop doses repeated at very short intervals, and in no case is it well to overstep a maximum dose of 5 minims. The alkaloid aconitia is occasionally used as a external application [in ointment, containing gr. i.-ij. to the ounce]. [ADEPS— LARD. The prepared fat of Sus Scrofa, U. S. Lard is emollient and is sometimes used in frictions, but is chiefly employed in Pharmacy in the preparation of ointments and cerates. In obstetrical or gynaecological ETHER. 8l practice, lard is considered to be a universal lubricant, and is rarely absent from the lying-in chamber, where it is also used as a detergent to remove the vernix caseosa from the new-born. Washed lard is occasionally employed to pre- vent the eyelids from adhering in catarrhal conjunctivitis. List of Unguenta or ointments officinal in the U. S. Pharmacopoeia : — Unguentum (Unguentum Adipis, Unguentum Hydrargyri Oxidi Flavi U.S.P. Ed. i860.) " " " Rubri " Acidi Carbolici " Iodinii " Acidi Tannici " " Compositum " Antimonii " Mezerei " Aquae Rosae " Picis Liquids " Belladonnae " Plumbi Carbonatis " Benzoini " " Iodidi " Cantharidis " Potassii Iodidi " Creasoti " Stramonii " Gallae " Sulphuris " Hydrargyri " " Iodidi " " Ammoniati " Tabaci " " Iodidi Rubri " Veratrise " " Nitratis " Zinci Oxidi.] /ETHER— ETHER. 1 [Used in preparing Acidum Tannicum, Ceratum Sabi- nae, Oleoresina Capsici, Oleoresina Cubebse, Oleoresina Filicis, Oleoresina Lupulinse, Oleoresina Piperis, and Tinctura Opii Deodorata. Officinal Preparations, U. S. ^Lther Fortior — pure ether (for producing anaesthesia). Spiritus /Etheris Compositus(HorTmann's Anodyne). tt^x.-xxx. Ether fortior is used in preparing Aconitia, Atropiae Sulphas, Collodium, Collodium cum Cantharide, Oleum yEthereum, and Oleoresina Zingiberis.] Local Action. Physiological. Th erapeutica l. The projection on the skin Advantage has been taken of a very fine spray of spe- of the insensibility to pain 1 [The class of ./Etherea, U. S. P., comprises /Ether, iEther Fortior, Chloroformum Purificatum, and Oleum ^Ethereum. ] 82 ETHER. cially pure ether, by means of Dr. Richardson's ingeni- ous instrument, causes at first a sensation of extreme cold, attended occasionally by the formation of ice. In about a minute, or even less, to this succeeds asudden blanching of the surface, the skin be- coming hard and quite in- sensible, and a sharp cutting pain, like a burn, being at the same time experienced. If this action is kept up for some time, redness, tingling, vesication, and even sloughing may be pro- duced. Be careful always to pro- cure the pure anaesthe- tic ether, which has a high boiling point, and evapor- ates rapidly, as ordinary qualities of the drug are of no use for local anaes- thesia. produced by the ether spray, to use it extensively during the performance of many minor operations, and more especially in those which consist merely of a single cut or prick. Under these conditions it acts admirably, but the hard and brawny state of the integument pro- duced by its action renders it of little or no aid where dissection or manipulations of deep-seated structures are required. Further objec- tions to its use are the acute pain attending application, and the subsequent redness, tingling, and irritation of the skin. It has also been recom- mended as a sedative in neuralgia, and as a con- venient means of applying intense cold ; and cases of its successful employment in chorea, applied to the upper part of the spine, have been recorded. Internal Actions. Ether, when taken inter- It is therefore a useful nally, is stimulant and anti- remedy in hysteria, flatu- spasmodic. lence, spasmodic asthma, etc. Combined Internal Physiological. Ether has powerful anaes- thetic properties, and differs from chloroform in the fol- lowing respects. It increases instead of diminishing the and External Use. Therapeutical. The stimulant action of ether on the heart has caused its use to be warmly advocated as in all respects superior to chloroform. It ETHER. 83 arterial pressure, and acts as cannot, however, be con- a tonic to the heart, which sidered absolutely safe, and continues to pulsate in fatal it labors under several dis- eases after the arrest of advantages, such as the breathing. The following greater length of time re- is the order of involvement quired to produce anses- of the nerve centres : — thesia, the violent struggling 1. The cerebrum. occasionally observed, the 2. The sensory centres of disagreeable smell of the the cord. drug, &c. ; and it is there- 3. The motor centres of fore doubtful whether it will the cord. ever effectually displace the 4. The sensory centres of more commonly-used anaes- the medulla oblongata. thetic [*]. 5. The motor centres of the medulla. Mode of Administration. It is most important that no air be admitted during ether administration, as most violent resistance and dangerous struggling supervene if the vapor be not inhaled in a state of purity. Non-attendance to this point caused ether to fall into discredit soon after its original introduction, and it is only lately that we have been fully convinced that, by using this simple precaution, we may readily obtain com- plete anaesthesia and perfect muscular relaxation in from three to eight minutes. Various inhalers have been de- vised to fit tightly over the mouth and nose, and it is here essential that some instrument of the kind should be used. When operating by artificial light, do not forget the in- flammable nature of the vapor of ether. 1 [These strictures must be considered as the criticism of an English author upon English ether, which is declared to be of very inferior quality, by those who have had an opportunity of personally compar- ing it with the American. This explains the adherence of the English to chloroform, in spite of its acknowledged greater danger; and at the same time prevents them from understanding the popularity of ether in the United States. The fact is that the washed ether (aether fortior, U. S. P.) as made by Dr. Squibb, Powers & Weightman, and others, is perfectly free from the objections just stated; it is pure, nearly odorless, and efficient in almost the same doses as chloroform, while it is incomparably safer than its rival. ] 84 ALCOHOL. ALCOHOI ALCOHOL. {Spirit of the specific gravity 0.835, &• ■$• Officinal Preparations, U. S. Alcohol Dilutum. Diluted one-half with water. Alcohol Fortius. Spirit of the specific gravity 0.817. Spiritus /Etheris Nitrosi. Dose f5ss.-ij. Vinum Xericum. Sherry wine (about 19 per cent, alcohol). Vinum Portense. Port wine (about 23 per cent, alcohol). Spiritus Vini Gallici. Brandy (about 50 per cent, alcohol). Spiritus Frumenti. Whiskey (about 50 per cent, alcohol). Spiritus Myrcise. Bay rum (for external use). (Spiritus Geneva, gin, is not officinal; the Spiritus Juniperi Compositus of the Pharmacopoeia may be re- garded as its equivalent.)] Antidotes. The treatment of acute alcoholic poisoning must consist in removing all the spirit from the stomach by means of the stomach-pump, and endeavoring to rouse the patient from his perilous state of coma by cold affusion, strong coffee, surface stimulation, and galvanism, whilst artificial respiration may be employed to stimulate the flagging breathing powers. In more chronic cases, withdraw all stimulant absolutely and at once ; insure sleep by chloral and bromide of potassium ; and try to diminish the morbid craving by capsicum, nux vomica, the mineral acids, and a liberal and varied diet. Local Actions. Physiological. Th erapeutical. Alcohol has some exter- This hardening process nal astringent properties has been turned to practical from its power of hardening account for the prevention albumen and thus condens- of bedsores, and alcohol is ing the tissues, whilst, from also a usual ingredient in the its rapid evaporation, it now somewhat old fashioned produces a cooling effect. spirit or evaporating lotions. ALCOHOL. 85 Internal Actions and Uses. 1 . On Brain and Nervous System. — Alcohol primarily stimulates the cerebral cen- tres by dilating their arte- ries, and so admitting more blood ; secondly, excite- ment supervenes with im- paired muscular co-ordina- tion, and finally coma, which may prove fatal if the dose taken be sufficient- ly large. Whilst it may also in small doses stimulate the spinal cord, in larger quan- tities it undoubtedly weakens the functions of that struc- ture, causing indisposition for active exertion, as well as actual want of power. This has been proved by the. experience of campaigns, but more especially that in Ashantee, where it was found that alcohol distinctly di- minished the power of bear- ing fatigue, and also by the experiments of Parkes, which showed most conclu- sively that 2 or 3 ounce doses of spirit given several times per diem to a couple of healthy men engaged in laborious work, caused a slight primary increase of energy, but a secondary well-marked indisposition for muscular exertion, with actual diminution of bodily vigor. Dr. Wilks has also drawn attention to a remark- able series of cases in which 8 1. A moderate quantity of alcohol stimulates the mental faculties, whilst lar- ger doses become narcotic and even anaesthetic. In chronic nerve debility, as neuralgia, we may often re- lieve pain by the use of stimulants; but these are precisely the class of cases in which habits of intem- perance are most readily formed. Nothing seems better proved than the fact that alcohol lessens the capacity for active muscular exer- tion, and it is therefore well to advise sportsmen, sol- diers, and others who are about to undergo severe bodily fatigue, to reserve all stimulant until their day's work is over, when it may be of real service. In the Ashantee campaign a ration of rum on reaching camp at night seemed to revive the men after their labors. In those cases of chronic alcoholic poisoning de- scribed by Wilks, we must follow his advice, and en- tirely cut off all supplies of strong drink. 86 ALCOHOL. paraplegia, with numbness, anaesthesia, and violent shooting pains, have been caused by the excessive and long-continued use of alco- hol. On the sympathetic sys- tem the effects are somewhat varied ; for although the di- latation of certain vascular areas must depend on para- lysis of these nerves, there seems no doubt that, as Binz has shown, alcohol in inflammatory conditions stimulates the sympathetic, contracts the arterioles, and prevents that migration of the white corpuscles which constitutes the essence of this morbid process. The chronic abuse of alcohol causes nervous tremors and debility, gradually leading up to that semi-maniacal state known as delirium tremens, in which the vic- tim is haunted by the con- stant presence of spectral illusions, preventing sleep, and finally wearing him out if unchecked. The brain, like most of the internal or- gans of the body, suffers in alcoholism from the con- traction of new areolar tis- sue pressing upon and ob- literating some of the nerv- ous elements. 2 . On Heart and Circula- tion. — Alcohol in moderate doses has a stimulating in- This is, no doubt, one explanation of the bene- ficial action of alcohol in some cases of acute inflam- mation. II. To its action on the circulation, however, we must ascribe a good deal of ALCOHOL, 87 fluence on the heart, and dilatation of the peripheral vessels and of those of the brain is produced. In chronic alcoholism we find adegenerated condition of the larger vessels, known as atheroma. 3. Respiration and Tem- perature. — The old observa- tions of Liebig seemed to show that alcohol was a res- piratory food, and was largely burnt off in the lungs, thus aiding in the production of animal heat. It is now found, however, that under its use the car- the beneficial influence of alcohol in the treatment of disease. When the powers of life show signs of failing, when the first sound of the heart grows weak, the pulse feeble, compressible, and irregular, when syncope threatens, and delirium is beginning, the indications for the administration of al- cohol are complete, and it will be found to act well when the tongue moistens, the pulse gains in volume and regularity, sound re- freshing sleep is obtained, and the temperature falls. It is, of course, difficult to lay down exact rules as to the precise stage of fevers at which we may best pre- scribe alcohol, but ordina- rily we should do so in ty- phus about the seventh day, in typhoid the twelfth, in smallpox when the second- ary fever is developed, and in acute inflammations, gen- erally, when the heart begins to fail, and the nervous sys- tem to show indications of debility. III. This lowering of temperature must also be explained by diminished tis- sue metamorphosis, and by a partial arrest of the oxy- gen-bearing function of the red corpuscles of the blood. It is therefore evident that we must warn persons about to be exposed to severe cold 88 ALCOHOL. bonic acid given off from the lungs is diminished, and that the body heat is lowered. When but small doses are taken, only a slight cooling effect is produced, whilst large quantities may reduce the temperature by two or three degrees, the explana- tion being partly that the dilatation of the cutaneous vessels enables more blood to be removed from the heat-producing centres, spread out and cooled in the wide sheet of the super- ficial circulation, and then returned, to abstract more warmth from the internal organs. Another curious fact is that alcohol also diminishes the power of re- sistance to cold ; and this has been proved not only by the experience of Arctic voyagers, but by the follow- ing experiment : If we place two animals, one of which has been dosed with alcohol, in a chamber of which the temperature has been re- duced to io° below freezing point, both will speedily be benumbed to sleep ; but whilst the healthy animal will be supported by the combustion of its tissues and survive the shock, its com- panion will perish from this heat-producing process being interfered with by the spirit. 4. Iniestmal Tract. — In of the fallacious nature of the old notion that alcohol furnishes true warmth. There can, however, be no doubt that we may often alleviate the evil effects of a chill by a dose of spirit [es- pecially in the form of a hot toddy], which releases the capillaries of the skin from their state of morbid con- traction, and thus prevents congestion of internal or- gans. IV. Alcohol is often bene- ALCOHOL. 8 9 small doses, alcohol stimu- lates the appetite and in- creases the supply of gastric juice ; but if given in larger quantities, this secretion is checked, nausea is produced, and the desire for food dis- appears. In the advanced stages of chronic alcoholism, the stomach is injured by the contraction of the new areolar tissue obliterating its glands, and hence we find dyspepsia with morning vomiting a very common symptom in drunkards. 5. Secreting Organs. — Alcohol stimulates the liver, and this organ is one of the first to suffer from chronic abuse of stimulant, the are- olar tissues being irritated, and an increased formation taking place, which gives a primary enlargement to the organ. These newly formed structures, however, having the tendency to shrink or contract, gradually obliter- ate the true secreting ele- ments of the gland, which grows smaller and harder, ascites eventually following from pressure on the portal vein and obstructed return of blood from the abdomi- nal circulation. Kidneys. — Alcohol has no specially well-marked effect on the urinary secretion, but the kidneys may also suffer from the cirrhotic degene- ration just described. ficial in the case of weakly persons, and more especially at the extremes of life, by giving tone to the digestive organs and aiding the due assimilation of food. Al- though its use is by no means essential to the healthy, it is of great service to dwellers in large towns, and others whose mode of life involves much mental strain. [Spirits should never be taken into an empty stomach, but should be accompanied by food.] 8' 90 ALCOHOL. Mode of Elimination. Alcohol very rapidly enters the blood, and is rapidly given out, in small part at least, by the breath, but it prob- ably 'undergoes combustion to a great degree in the body, maintains or increases the body weight, and prolongs life on an insufficient diet. It is therefore entitled to be reckoned as a food' (Brunton). Much discussion has been expended on its elimination or otherwise, and some years ago the hopes of temperance agitators were much raised by the apparent result of experiments put forward by two French observers, which seemed to prove that all the ingested alcohol is given out unchanged in the uri- nary secretion. Anstie and Dupre, however, showed the fallacy of this by pointing out that even the urine of the most rigid abstainers contains a substance which cannot, by the chromic acid test, be distinguished from acohol, and it has since been asserted that this may actually be alcohol derived from converted liver sugar. The most recent researches of Binz seem to establish the conclu- sion that, unless the quantity of spirit taken be very large, little or none is really eliminated by the urinary secretion. As regards the dose of alcohol it is manifestly impossi- ble to lay down any hard and fast rules, as we must of necessity be guided by the constitution of the patient and the symptoms of his special case. As a rule we may say that about 8 oz. of brandy may be sufficient in typhus or any acute illness, and that 16 oz. may be looked upon as the quantity which it is well not to exceed. In a state of health, 2 oz. of absolute alcohol per diem is usually con- sidered a maximum allowance. But we must always re- member the golden maxim, never to permit stimulants to enter the stomach save in combination with food. It is of some importance to consider the forms of alco- hol best adapted for varying cases, and we may say, gen- erally, that champagne acts well in sudden and rapid sink- ing, whilst good whiskey or brandy may be recommended in ordinary acute illness. Port and Madeira are well suited for cases of debility ; and in convalescence from acute illness and digestive feebleness, malt liquors and Burgundy will often be found to be of great service ; but we must always beware of the possibility of leading our patients AMYLIC ALCOHOL. 91 into disastrous habits of self-indulgence by a lack of pre- cision in our directions as to quantity. [By the action of sulphuric and nitric acids upon stronger alcohol, nitrous ether is produced, which in com- bination with alcohol is called — ] SPIRITUS ^ETHERIS NITROSI. This preparation, in doses of from ^ fl. drachm to 2 fl. drachms, is diuretic and diaphoretic, and is much used in feverish conditions. [SPIRITUS ^STHERIS COMPOSITUS. This is an alcoholic solution of ether, impregnated with oil of wine, and is popularly known as Hoffmann's anodyne liquor. It is used in hysteria and nervousness. Dose f 5ss.-ij. Spiritus. The officinal spirits are : — Spiritus iEtheris Compositus Spiritus Juniperi Compositus " Nitrosi ' ' Lavandulae Ammoniae ' ' " Comp " Aromaticus ' ' Limonis Anisi ' f Menthae Piperitse Camphorae ' 1 " Viridis Chloroformi ' ' Myrciae Cinnamomi ' ' Myristicae Frumenti ' ' Vini Gallici.] Juniperi [ALCOHOL AMYLICUM— AMYLIC ALCOHOL. Syn. Fusel Oil. A peculiar alcohol obtained from fermented grain or potatoes by continuing the process of distillation after the ordinary spirit has ceased to come over. U. S. Amylic alcohol is an active irritant poison, for which no direct antidote is known. Officinal Preparations, U. S. Ammonii Valerianas and Quinise Valerianas. In addition to valerianic acid and its salts, amylic alco- hol is used in the manufacture of the non-officinal nitrite 9 2 AMYL NITRIS. of amyl, which has become of sufficient interest to war- rant extended notice. It has come into general use, although not yet accepted by the Pharmacopoeia.] AMYL NITRIS. [Not Officinal.] Local Action. Nitrite of amyl is not possessed of any local irritant or sedative propeities. Internal Actions. Physiological. I. Nervous System. — i. On Brain. — No special ef- fect is produced on this or- gan beyond that resulting from dilatation of the cere- bral vessels, and consisting of a sensation of fulness and oppression in the head. 2. On Spinal Cord. — A distinct lowering of reflex ir- ritability has been observed. II. Vascular System. — i . On Heart. — After a brief inhalation of this drug, the action of the heart becomes excessively rapid, the face flushes, and a violent throb- bing in all the arteries is ex- perienced; and if its admin- istration is pushed up to Therapeutical. I. — i. It has been recom- mended as a remedy for epi- lepsy, in virtue of its dilating powers releasing the vessels of the brain from that con- dition of partial spasm which is said to be the cause of the disease. There is at present, however, no satisfactory cli- nical evidence in its favor. 2. It has been theoreti- cally recommended in cases of tetanus and strychnia poi- soning, and in neuralgia its inhalation has apparently been followed by relief. II. — i. The nitrite of amyl has been proposed as an an- tidote in chloroform poison- ins:. AMYL NITRIS. 93 poisonous limits, there is much weakening of the car- diac pulsations. 2. The effect on the arte- rial system is one of marked dilatation, the vessels enlarg- ing, as proved not only by general flushing, but by con- gestion of the retina, and by the free flow of blood from cupped surfaces which had previously yielded only a few drops. The arterial ten- sion becomes much lowered, and this enlargement of the calibre of the vessels has been proved to depend on a direct action of the drug on the muscular coats of the ar- teries, and not on any inter- vention of the vaso-motor system. It has also been proved that oxidation is diminished, that the haemoglobin of the blood is checked in its func- tion of absorbing and giving up oxygen, and that, pre- vious to death, the color of the arterial and venous blood becomes almost precisely alike. III. On Respiration and Temperaticre. — During the early stage of amyl inhala- tion the respiration is hur- ried, but when the adminis- tration is further pushed the breathing becomes slower, and finally extinguished, from the arrest of the cor- puscular action noted above, 2. In consequence of this dilating effect on the vessels, amyl has been most success- fully used in angina pectoris. The essential condition here is supposed to be one of spasmodic contraction of the smaller pulmonary and sys- temic vessels, against which the heart, generally weak- ened, as it is in this disease, by mal-nutrition of its mus- cular structures, finds itself unable to cope, and hence the agonizing distress. In- halation of the drug releases the spasm, and so gives ease; and this result follows whe- ther there be actual valvular disease or not. III. Amyl has been suc- cessfully used during the pa- roxysm of spasmodic ast/ima, acting, no doubt, by relaxing the muscular walls of the bronchial tubes. 94 GARLIC. and from a paralyzing effect on the respiratory nervous centre. The temperature tends to fall, from the dimi- nution in the process of oxi- dation. IV. On the Digestive Sys- IV. Amyl has been the- tem. — The presence of sugar oretically recommended in in the urine has been ob- cholera, but there is no spe- served during amyl inhala- cial evidence in its favor, tion, this being probably due to dilatation of the he- patic vessels. Amyl is now known to act more speedily and effectually when inhaled than when taken by the mouth, and from 2 to 5 drops placed on a handkerchief are cautiously drawn into the lungs until the characteristic flushing is produced. No special accidents are recorded as having arisen from its use ; but the caution seems a reasonable one, not to recommend it rashly to old persons with brittle or calca- reous arteries, as the sudden alteration of calibre might be attended with danger. Possibly also it might be advisa- ble not to recommend it to very plethoric patients, whose brains are already fully filled with blood. Anaemic patients seem to be specially tolerant of its use. [ALLIUM— GARLIC. The bulb of Allium sativum, U. S. {Dose of the fresh bulbs 5j--ij-) Officinal Preparation, U. S. Syrupus Allii. Dose f 3j. (for an infant nrv.-x.). Garlic is a stimulating expectorant, and is used with good effect in the latter stages of catarrhal bronchitis, or suffocative catarrh in young children, in which cases it may also be used as a poultice to the chest. These poul- tices composed of the fresh bulbs pounded into a mass, used either alone or with an equal quantity of linseed meal, may also be used in infantile convulsions, applied to the back and legs, or the oil of garlic may be used as a rubefacient. ALOES. 95 The following would be an appropriate formula for the catarrhal bronchitis of infants : — u. Syr Aim fSi-; <( Ipecacuanhae f5*ij. <( Tolutani f5v.5 a Acacise ■ fSyj-j Tinct. opii camphorata q- s. ad f^iij. M. S. Dose TT|_xx to f 3j.] ALOE— ALOES. [Aloe Barbadensis, Barbadoes Aloes. The inspissated juice of the leaves of Aloe vulgaris, U. S. Aloe Capensis, Cape Aloes. The inspissated juice of the leaves of Aloe spicatae, and of other species of Aloe. Aloe Socotrina, Socotrine Aloes. The inspissated juice of the leaves of Aloe Socotrina. Officinal Preparations, U. S. Aloe Purificata, purified aloes. Dose gr. v.-x. Pilulse Aloes. (Aloes and soap, aa i part.) 2 grs. aloes in each pill. Pilulse Aloes et Assafcetidse. (Aloes, assafcetida, and soap, aa 1 part.) ij/3 grs. aloes in each pill. Pilulse Aloes et Mastiches. (Aloes 4 parts, mastic and rose, aa 1 part.) 2 grs. in each pill. Pilulse Aloes et Myrrhae. (Aloes 4 parts, myrrh and aromatic powder, aa 1 part.) 2 grs. in each pill. Pilulse Rhei Compositse. (Aloes gr. jss., rhubarb gr. ijO Pulvis Aloes et Canellse. (Aloes 4 parts, canella 1 part.) Tinctura Aloes. (gss. to Oj.) Dose fjj.-iij. Tinctura Aloes et Myrrhae. (aa 3 jss. in Oj.) Dose f3i.-ij. Tinctura Benzoini Composita. Dose n^x.-xxx. Vinum Aloes (aloes, cardamom, and ginger, in sherry wine). Dose f5j. Suppositoria Aloes. Each containing gr. ij. of puri- fied aloes.] Physiological Action. Therapeutical Action. Aloes acts on the lower Aloes is a very certain, part of the large intestine, efficient, and mild purga- 9 6 ALOES stimulating its peristaltic movements, and causing the evacuation of formed and only slightly softened faeces. It also increases the secre- tion of bile, and some au- thorities hold that its purga- tive action is merely second- ary to this. A good deal of congestion about the rectum is produced, and a sympa- thetically stimulating effect may extend to the uterus, and tend to excite its func- tions. tive [in doses of ten to twenty grains], acting, how- ever, rather slowly, and seldom producing its effect before from six to twelve hours. It occasionally, however, gripes, and is therefore usually given in combination with other remedies which diminish this tendency, and, from its action on the lower bowel, it must be avoided in any local inflammatory con- dition, or in the acuter forms of haemorrhoids. Its mild and slow action has caused it to be much used in dyspepsia ; it forms a principal constituent of most dinner pills ; and it is also a popular remedy in habitual constipation. It has also emmenagogue properties, depending part- ly, no doubt, on the sympa- thy of contiguity ; and in the form of pill or decoc- tion, and given, as laid down by Graves, at the time when the catamenia are naturally expected, it often proves most efficient. [The puri- fied aloes should be used, as the commercial aloes contains impurities.] Dose, &c. The most useful preparations of aloes are, the compound decoction, dose f^j. to f^ij.; 1 the pil. aloes et myrrhae ; and aloes and iron, dose 5 to 15 grains. 1 [This is a favorite preparation of the British Pharmacopoeia. It MARSHMALLOW — ALUM. 97 TALTH^EA— MARSHMALLOW. The root of Althcea officinalis, U, S, Marshmallow is a demulcent, as it contains chiefly mucilage and starch. It is occasionally exhibited as a decoction in fevers, or in inflammation of mucous mem- branes. In the form of a confection it is popular as a pectoral.] ALUMEN— ALUM. [Aluminii et Ammonii Sulphas, U. S. Alumen Exsiccatum. Dried alum.] Local Action. Alum. Physiological, Alum, used externally, tends, like most astringents, to contract the blood-vessels and condense the tissues by coagulation of their albu- men. Therapeutical. It is therefore much em- ployed as an astringent lotion in conjunctivitis, leucorrhcea, gonorrhoea, and as a gargle in sore throat. [Dried alum is a mild escharotic for exu- berant granulations, etc.] Internal Actions and Uses. i. On Nervous System. — Alum seems to have some power in relieving spasmodic action. 2 . Circulation. — This, no doubt, is intimately connect- ed with No. i, as the con- i. It is therefore beneficial in some cases of whooping- cough, and in colica pictonum. [In whooping-cough it is given in small doses — gr. j. -ij. — in syrup and water several times daily. It is also one of the best direct emetics in croup. Dose 3ss. , repeated every half-hour if necessary.] 2. Alum has been used for internal haemorrhage, and to check excessive sweating, contains aloes, licorice, carbonate of potassa, myrrh, saffron, and tinc- ture of cardamom, and is gently cathartic. Suppositories of aloes are used against ascarides.] 9 98 AMMONIAC. traction of the blood-vessels and its action in whooping- and internally astringent ef- cough is also largely due to fects which follow the use of its astringent properties, as alum are probably depend- it is most useful in the later ent on nervous influence. stages, when profuse secre- tion has been established. 3. On Secretion. — Alum 3. This also explains its occasionally acts both as an use in colica pictonum. emetic and as a purgative. Dose. In lotion, gr. ij. ad x. : — R. Aluminis gr. x. ; Aquae rosae f^iv. M. Lotion in catarrhal ophthalmia. Internally, gr. x. ad xx. : — J£. Aluminis 5'j- > Acidi sulphurici dil. 15J- > Syrupi limonis i"§ j . j Aquae ff'ij- M. Dose f 5jss. secunda quaque hora. In colica pictonum. As purgative, gr. xl. ad lx. [Dried alum may be given in pill (gr. ij.) in h Ext. glycyrrhizoe §ss. ; Syrupi tolutani f §j. ; Aq. cirmamomi ad ffviij. M. §j. quartis horis. In neuralgia. It has also, but with little real foundation, been sup- posed to possess some power of absorbing lymphatic and glandular enlargements, and has been regarded as a good remedy in chronic liver disease. Ammonii bromidum seems to have an occasional and uncertain influence over whooping-cough, and is thought by some to be a good substitute for bromide of potassium in epilepsy and other nervous disorders. Dose 10 to 20 grs. Liquor ammonias acetatis and liquor ammoniac citratis. Diaphoretic in doses of from f5ij. to f 3j. R. Liq. am. acetatis f §ij. ; Syrupi limonis f ^j. ; Sp. oeth. nit. f 5iij. ; Infusi serpentarias adi^viij. M. Dose f §j. quartis horis. Diaphoretic mixture. Ammonias benzoas, ammonias nitras, and ammonias phosphas are seldom if ever used. NITROUS OXIDE GAS. (Not Officinal.) [Made from nitrate of ammonia by heat.'] Physiological Action. Therapeutical Action. Nitrous oxide, or the old Nitrous oxide gas is very laughing-gas, has been valuable for the performance recently introduced as an of such small operations as anaesthetic, a very brief tooth extraction ; but anass- inhalation causing perfect thesia cannot safely be kept insensibility, preceded oc- up long enough to render it casionally by slight excite- available during more pro- ment, and attended by an longed surgical manipula- amount of lividity which at tions. During its adminis- first sight seems most alarm- tration we must rigidly ex- ing. It has been shown elude all atmospheric air, that this insensibility is and thus prevent those vio- simply a condition of modi- lent and varied evidences fied asphyxia, as during of excitement which have so ALMOND STARCH. 105 narcosis only two-thirds of often caused amusement the normal amount of car- during the old-fashioned bonic acid is given off, and inhalation of laughing-gas. immediately after recovery only one-third. AMYGDALUS— ALMOND. [Amygdala Amara. The kernel of the fruit of Amyg- dalus Communis, variety amara, U. S. Amygdala Dulcis. The kernel of the fruit of Amyg- dalus Communis, variety dulcis, U. S. Officinal Preparations, U. S. Mistura Amygdalae (used as a vehicle). Oleum Amygdalse Amarae. Dose gtt. y^ , in emulsion . Oleum Amygdalse Expressum (dulcis). Aqua Amygdalae Amarae. Dose f^ss. Syrupus Amygdalae (Orgeat syrup). Dose f 3J- to 3ss. Unguentum Aquae Rosae (from oil of sweet almonds). Antidotes. The antidotes to poisoning by the preparations of bitter almonds are the same as those of hydrocyanic acid.] The bitter almond, being uncertain and dangerous, is never used in medicine ; but sweet almonds, in the form of the mixture or powder, are of value as agreeable vehi- cles for the mixture or suspension of other drugs, and Dr. Pavy has taken advantage of their nutritive properties to propose them as a substitute for bread in saccharine diabetes. [The effects of the oil of bitter almonds upon the system are identical with those of hydrocyanic acid, upon the presence of which its activity depends, but it is about four times the strength of the officinal Acidum Hydrocyanicum Dilutum. Bitter almond water, and the syrup, are used as vehicles for cough mixtures.] AMYLUM— STARCH. [The feculum of the seed of the Triticum vulgar e, U. S. Starch is used medicinally as an antidote to iodine, or as a demulcent in corrosive poisoning. In the form of a dusting powder it is applied to the skin of infants to pre- vent chafing or excoriation.] Io6 ANISE — CHAMOMILE. Starch is a demulcent used with advantage to some irri- table conditions of skin in the form of the glycerine of starch, and also as a medium for enemata. ANGUSTURA— ANGUSTURA BARK. [ The bark of Galipea officinalis, U. Si\ Cusparia is a light tonic, rarely used. [It has fallen into disrepute, from the fact that it was occasionally found to be adulterated with nux vomica bark.] ANISUM— ANISE. \_The fruit of Pimpinella Anisitm, U. S. Officinal Preparations, U. S. Aqua Anisi. As a vehicle. Oleum Anisi. Dose gtt. v.-xv. Spiritus Anisi. (Oil f.^j. in Oj.). Anise is carminative and stomachic, and is a favorite flavoring ingredient in medicines for children.] Anise, Fennel, Coriander, Caraway, and Dill are agree- able aromatics, stomachics, and carminatives. ANTHEMIS— CHAMOMILE. \_The flowers of Anthemis Nobilis, U. S. Officinal Preparations, U. S. Infusum Anthemidis. Dose f^ij. as a tonic; as an emetic ad lib. Oleum Anthemidis. Dose gr. v.-xv. An agreeable aromatic, in small doses it is drunk as a tonic, and in large doses the hot infusion is taken as an emetic. A poultice is sometimes made of the boiled flow- ers.] Chamomile has usually been considered a substance of no special therapeutic interest, being principally used by country people in the form of infusion as a remedy for dyspepsia; but within more recent years various German authorities, quoted by Phillips, have stated that the oil has a powerful lowering action on the reflex irritability of the spinal cord, and have proposed its use in cases of strychnia poisoning. ANTIMONY. I07 ANTIMONIUM— ANTIMOiNY. [Officinal Preparations, U. S. Antimonii Sulphuretum — the purified tersulphide (used in making the oxide). Antimonii Oxidum. Dose gr. ij.-iij. Antimonii et Potassii Tartras. Dose gr. T ^ to j. Antimonium Sulphuratum (sulphurated antimony). Dose gr. j.-xx. Antimonii Oxysulphuretum (Kermes mineral). Dose gr. ss-j. Pilulse Antimonii Compositae. (6 grs. of the mass contains one gr. each of calomel and sulphurated anti- mony.) Plummer's Pills. Vinum Antimonii — gr. ij. ad f £j. Dose gtt. x. ; as an emetic fjj. Emplastrum Antimonii (Tartrate of Antimony and Potassium 1 part in 4). Ungaentum Antimonii (do. do. 1 to 4). Syrupus Scillse Compositus (contains Tartar Emetic gr. j. ad 5j.).] Antidotes. Emetics, tea, coffee, tannin, stimulants, &c. Local Action. Physiological. Therapeutical. Externally applied, tartar Tartar emetic used to be emetic causes redness and extensively employed in the inflammation of the skin, form of ointment as a coun- followed by an eruption of ter-irritant, but was found papules becoming vesicular, occasionally to cause inflam- and finally forming pustules mation, and to leave un- closely resembling those of sightly scars, smallpox. Internal Actions and Uses. I. Brain and Nervous Sys- I. Its use was originally tern. — Tartar emetic under recommended by Graves, certain conditions, and more and has been endorsed by io8 ANTIMONY. especially when combined with opium, exerts a sedative influence on the brain. When given in poisonous doses, paralysis, probably of spinal origin, and attended with diminished reflex irrita- bility, sets in. II. Circulation and Respi- ration. — Antimony is seda- tive in its operation on the heart and vascular systems, the heart's action becoming slow, weak, and finally ir- regular, the arterial tension lowered, and the pulse soft and compressible. The res- piration also grows slower, and an increased secretion takes place from the bron- chial mucous membrane. Murchison, in the violent delirium of typhus, and it has also been employed with benefit in delirium tremens. General muscular relaxa- tion is observed. II. The depressing influ- ence of tartar emetic on the circulation caused it to be very generally used in for- mer years in acute inflam- mations, and more especially pneumonia; but this practice has now been almost gene- rally abandoned, as it was found that such treatment, whilst exerting no real influ- ence over the course of the disease, tended to reduce the strength of the patient, and Cause lingering convales- cence. Small doses, how- ever, are found useful in croup \_spasm of the larynx"], and in the bronchopneumo- nia of children where great dyspnoea and fever exist with excessive bronchial secre- tion, and it is a good gene- ral expectorant in asthma, [the first stage of] bronchitis, &c. Its relaxing effects on the muscular system were for- merly taken advantage of for the reduction of hernia and dislocations ; but it has of course been quite super- seded by chloroform and other anaesthetics. ANTIMONY. I09 III. On Secreting Organs. 1. Stomach and Intestines. — Antimony is an effectual emetic, its action being slow, however, and attended by a good deal of depression. It acts either when swallowed, or by subcutaneous injec- tion; but the balance of ex- periment goes to show that in either case the effect is produced by reflex action following irritation of the nerves of the stomach. Some increase of secretion from the intestines and consequent diarrhoea are occasionally observed. 2. In poisonous doses an- timony causes irritation and inflammation of the stomach and intestines. 3. Skin. — Antimony has a powerful diaphoretic action. Poisonous Action. — Death may occur from the collapse following prolonged vomit- ing and purging, or may be the result of gastro-intestinal inflammation. Post-mortem examination of a protracted case generally discovers pa- renchymatous degeneration of the liver and other inter- nal organs. 10 1. Antimony is too slow and depressing an emetic to be used in cases of poisoning, but it is of service in croup, whooping- cough, bronchitis, &c, where we wish to relax the bronchi and get rid of accumulated secretions. In former years, when an- timony was freely given, what was called tolerance used to be an interesting therapeutic result. That is to say, in feverish conditions, it was found that large quan- tities of the drug might be taken without producing vo- miting ; and this has been explained by the observation that antimony, to act as an emetic, must previously be dissolved in the gastric juice, a secretion which is in great measure checked during fe- ver. 3. Antimonial wine is a common adjunct to diapho- retic mixtures. iio antimony. Preparations. Antimonium tartaratum. [Antimonii et Potassii Tar- tras.] Dose, j 1 ^ gr. to ^ gr. ; as emetic, i to 3 grs. In the bronchitis of children, from ^\ gr. to T \ gr. Vinum Antimonii. Dose, 15 to 40 minims. Ung. Antimonii tartarati. [Unguentum Antimonii, U. S. P.] Pulvis Antimonialis. This is the well-known patent preparation known as James's powder, which used to be more popular than it is now. None of the other preparations of antimony have any therapeutic value. Mode of Elimination, &c. Tartar emetic rapidly enters the blood, and is elimi- nated by the bile, milk, sweat, urine, as well as the gastro- intestinal glands. Prescriptions, &c. Tartar emetic, on account of its tastelessness, may be well given dissolved in simple distilled water; and Ringer tells us, and I have amply confirmed his statements, that we may do much good, in some forms of acute bronchitis in children, by dissolving a grain of the salt in a pint of water, and giving a teaspoonful every quarter of an hour for the first hour, and then hourly. In the case of adults, when we wish to avoid the nau- seating effects of the drug, we may best do so by the fol- lowing formulae : — I£. Antimonii tartarati [Br.] gr. ij. ; Acidi hydrocyanici cliluti ir^xxx. ; Tincturse [spiritus] lavandulse comp. * f §ss. ; Aquse destillatae ad f §vj. M. Dose 1 §ss. quartis horis. • 1^. Liq. opii sed. 2 f5j-; Antimon. et pot. tartratis gr. j. ad gr. ij. ; Mist, [aquae] camph. f §vj. M. Sumat semunciam omni hora donee somnus supervenerit. 1 [Each dose contains two and one-half minims of dilute hydrocyanic acid. This being the case, the first doses should not exceed f 3J. ; nor should this be exceeded unless for good reasons.] 2 [Battley's solution, non-officinal.] WATER. Ill Highly recommended by Graves and Murchison in the insomnia and delirium of typhus fever. AQUA— WATER. \_Natural water in the purest attainable state, O. S. Aqua Destillata. Distilled water.] Water, both in its external and internal applications, enters so largely into medical practice as well as into domestic economy, that we cannot begin our studies better than by considering very briefly what is definitely known regarding its physiological and therapeutical pro- perties. Local Action. It will be found difficult, if not impossible, to balance the physiological and therapeutical actions of water in the manner followed generally throughout this work, and we shall therefore give a short collective sketch of the influ- ence exerted by it on the various functions of the body. It is not necessary for us to do more than refer to the universal use of water for washing and bathing purposes, but a word or two on the physiological effects of cold baths is required. We find that the action of the heart is increased, the respiration may become panting and irregu- lar, the temperature falls, and the destructive metamor- phosis of these tissues is augmented, as indicated by an increased excretion of urea; occasionally albumen appears in the urine, and so much mental shock is produced, more especially by sea-bathing, as to render this usually excel- lent tonic unadvisable in those of feeble constitution, in the very young and old, and in pregnant women, whilst the tendency to vascular strain must prescribe caution towards those in whom we have any reason to suspect a degene- rated state of the arterial system. Occasionally, during sea-bathing, the hair falls off, the process of digestion becomes impaired, and sleeplessness is experienced ; and this, no doubt, arises from the pro- cess of tissue destruction not being thoroughly balanced by repair. As regards the external uses of cold water in medical practice, we may refer to the beneficial action of water- 112 WATER. dressing and irrigation in surgery, to cold affusion in lary?igismus stridulus, chorea, hysteria, the stupor of fevers and drunkenness, and, most of all, to the wonderful re- frigerant action of cold baths in cases of abnormally high temperatures. It is generally held that a fatal result almost inevitably occurs in any case where the [bodily] temperature remains above 107 [for several days at a time], and until very recently we were powerless to check the destructive influ- ence of this complication. Within the last few years, how- ever, Dr. Wilson Fox and others have shown that we may safely and effectually bring down this excessive heat in rheumatism, where it principally occurs, by placing the patient in a bath at 95 ° and gradually adding cold water or ice until 6o° Fahr. is reached. In this way a reduction of from seven to twelve degrees may be readily effected, but we must remember one practical point, that the patient's temperature continues to fall, as much even as six degrees, for forty or fifty minutes after he has been removed to bed. Four or five baths may be required during the first day of treatment, the patient remaining immersed during twenty or thirty minutes ; there can be no doubt that by watching our cases of rheumatism carefully, and adopting this mode of treatment whenever the ther- mometer registers more than 105 Fahr., we may save many lives. The Germans use the cold bath very freely in all febrile disorders, but there is no evidence that their success is greater than under the treatment pursued in this country, which has the merit of being agreeable to the feelings of the sufferer. Cold packing is an excellent stimulant to the skin, and is extensively employed at our hydropathic establishments. Warm water is also very serviceable, and we may men- tion the soothing action of warm fomentation, the warm douche in early joint disease, and the use of the warm bath in the convulsive diseases of children, for the relief of colic, spasmodic stricture, hernia, gall or renal calculi, and in cases of extensive burns or moist- skin diseases, employed after the manner of Hebra, whose patients fre- quently remain in a state of continuous soaking for days together. Ice is a most valuable application for relieving pain and WA T E R . 113 checking inflammation in orchitis, bubo, meningitis, &c, as well as for the arrest of haemorrhage, and to allay thirst and obstinate vomiting. Vapor is often used as a soothing and relaxing applica- tion in tonsillitis, bronchitis, croup, &c, and, in the form of bath, to cause diaphoresis. Constitutional Action. When water is taken internally, it acts in some measure as a purgative by supplying moisture to the faeces ; it pro- motes digestion by stimulating the secretion of gastric juice, and aiding the passage of peptones into the blood (Ringer) ; and it is in some measure a diuretic, increasing temporarily the excretion of chloride of sodium, and more permanently the elimination of urea, phosphoric and sulphuric acids by the urine. It is, of course, the univer- sal solvent, and its importance in the animal economy is shown by the fact that it constitutes about sixty-eight of the hundred parts which build up our entire bodily frame, and that five pints are given out from the body of one average-sized adult in the twenty-four hours. The urgent necessity for its purity is further proved by the leading part it has always taken in the spread of epidemics ; for not only cholera, but enteric fever, has thus been largely propagated, whilst entozoa are thus introduced into the system, and the presence of other impurities may give rise to dysentery, diarrhoea, goitre, and yellow fever. [The most dangerous adulteration of drinking water is that occa- sioned by the presence of decaying organic or albumi- noid matter. During epidemics of bowel affections, all water should be boiled previous to drinking.] Specific adulterations also, like lead, have frequently occasioned very painful and even fatal attacks of illness. But we may derive great benefit in practice from the use of some of those very impure waters, deeply impreg- nated with various mineral ingredients, which are known as mineral waters, and which are met with in such profu- sion and variety both at home and abroad. Fashion, no less than undoubted success attending their use, has recently brought these naturally adulterated waters prominently forward, and it is very essential that every practitioner should have some knowledge of their chief constituents and 114 WA T E R . the principal health resorts where they can be partaken of in greatest perfection. Our present limits, however, will only permit a very bare enumeration of the principal classes into which mineral waters have been divided. ist. We have the chalybeate or ferruginous class, which contains iron in varying proportion, in the form either of carbonate, as at [Excelsior Rock Spring, Saratoga,] Spa, Tunbridge Wells, and Harrowgate ; or of sulphate, as at [Bedford Springs, Pa., Fairmount Park, Phila.,] Brighton, Isle of Wight, &c. They are possessed of tonic properties, and whilst we generally find them best borne as carbonate, we must be cautious of their use in very plethoric and full- blooded patients. 2nd. Acidulous or carbonated. These are agreeable and sparkling, holding in solution carbonates of lime, soda, and magnesia. They are met with at [Gettysburg,] Seltzer, and Carlsbad, and are serviceable in gout and dys- pepsia. 3rd. Saline, some of which are purgative by containing the sulphates of magnesia and soda, as at [Saratoga, Con- gress Spring,] Cheltenham, Leamington, Friedrichshall, &c. ; others, as Buxton, Bath, and Bristol, are impreg- nated with carbonate and sulphate of lime ; others with chlorides, as Weisbaden, Baden-Baden ; whilst a fourth class, as at Vichy and Ems, owe their properties to the alkaline carbonates which they contain. [Apollinaris and Hunyadi Janos waters belong to this class.] 4th. Sulphuretted or hepatic waters contain sulphuretted hydrogen in solution, and possess a very offensive taste and smell. They are chiefly met with at Horrowgate, Moffat, Cheltenham, Aix-la-Chapelle, [Virginia Sulphur Springs,] &c, and are principally used in chronic skin diseases. [The class of Aquae in the U. S. Pharmacopoeia includes the following: — Aqua Acidi Carbolici Aqua Cinnamomi " " Carbonici " Creasoti " Ammonia? 1 " Destillata " Amygdalae Amarse " Foeniculi " Anisi " Mentha; Piperita " Aurantii Florum " Mentha? Viridis " Camphorae " Rosa?.] " Chlorinii 1 [Aqua Ammonii Fortior is included in the primary list, and hence does not appear among the preparations.] SILVER. 115 ARGENTUM— SILVER. [Argenti Cyanidum — for making Acidum Hydrocyan- icum Dilutum. Argenti Nitras. Dose, gr. }&-i]., in pill. Argenti Nitras Fusa — for external use. Argenti Oxidum. Dose, gr. ss.-ij., in pill. Antidote to Nitrate of Silver — Table salt. Metallic silver is inert. As it occasions no chemical irritation in the tissues, canulae are made of it for use in empyema to wash out the chest, &c. Silver wire is also used in surgery to unite the fractured ends of bones where there is delayed union, and for sutures in wounds of the scalp and elsewhere. The salts of silver are best admin- istered in pill form, for which gum Arabic is probably the best excipient, as with vegetable extracts, or glucose, they are apt to explode.] Local Action. Physiological. The nitrate of silver hard- ens primarily, but seconda- rily destroys the cuticle, and condenses the tissues by co- agulating their albumen. Its application may cause ulcer- ation of the healthy skin, and checks the activity of granulating surfaces. Th erapeutical. Nitrate of silver, either in substance or solution, has been used to check the spread of erysipelatous in- flammation, to arrest the pitting of smallpox, and to avert the formation of bed- sores. It is a good injection for gonorrhoea, or collyrium for conjitnctivitis, and a strong solution is one of our best remedies for various relaxed or ulcerated conditions of the fauces. In substance, lunar caustic forms a good application to simple vene- real sores, ulcerated tonsils, or to any ulcerating or gran- ulating tissue, when we wish to repress exuberant granu- lations or excite a new and more healthy action. Il6 ARNICA. Internal Actions and Uses. Silver is now but little employed internally. It formerly enjoyed a certain empirical reputation in the treatment of epilepsy and other nervous disorders; but when it was found that not only no benefit resulted from its use, but that an indelible and peculiarly unsightly bluish-gray discoloration was occasionally developed on the skin, it became evident that the wisest course in future would be to discard nitrate of silver altogether as a constitutional remedy. [The oxide has been highly recommended as a nervous sedative, and as a haemostatic in menorrhagia.] ARNICA— ARNICA. \_Thefloivers of Arnica Montanum, U. S. Officinal Preparations, U. S. Extractum Arnicse. Dose, grs. v.-x. Emplastrum Arnicae (extract }£)■ Tinctura Arnicse (Sfiij.-Oj.); used externally.] External Actions. If applied to the skin for Some practitioners value some time, arnica causes red- arnica highly for the power ness and irritation, and in which they believe it to pos- some susceptible subjects sess of absorbing bruises and most violent erysipelatous relieving sprains. Dr. Gar- inflammation, even ending rod, on the other hand, as- in death, has resulted. It serts that any power it seems must therefore be used with to exercise in dispersing ex- caution, travasations of blood is sim- ply due to the spirit which the tincture contains. Dr. Phillips, again, tells us that the irritating effects never follow the use of an aqueous solution, which contains none of the arnicine or vol- atile oil. Internal Actions. The physiological and medicinal actions of arnica can only be balanced with difficulty, as the evidence regarding ARSENIC. 117 the former is very conflicting, and the opinions on the latter certainly err in the direction of over-confidence. As it is rarely, if ever, used as a medicinal agent save by homoeopathic practitioners, it does not seem necessary to say more about its asserted virtues. ARSENICUM— ARSENIC. [Acidum Arseniosum. Sublimed arsenious acid in masses, U. S. Dose, gr. 2V Officinal Preparations, U. S. Arsenici Iodidum. Dose, gr. }£. Liquor Arsenici et Hydrargyri Iodidi (tt^xx. con- tains arsenic gr. j^l) Donovan's solution. Dose, tti^x. Liquor Arsenici Chloridi. (Acid, arsen. gr. iv. ad f^j.) Dose, nrv. Liquor Potassii Arsenitis. (Acid, arseniosum, gr. iv. ad f.f j.) Fowler's solution. Dose, n^v. Liquor Sodii Arseniatis. (Sodii arseniat. gr. iv. ad f^j.) Dose, tti^v. Sodii Arsenias. Dose, gr. T ^. Metallic arsenic is inert, and is not used in medicine. Arsenious acid is sometimes termed white arsenic, or, simply, arsenic, as in the following remarks. Antidotes. The chemical antidotes to arsenious acid are freshly prepared hydrated sesquioxide of iron, and magnesia, freshly calcined. When Fowler's solution has been taken, the ferric salts are the antidotes.] Local Action. Physiological. Th erapeutical. Externally applied, arse- Arsenic has been era- nic causes redness and in- ployed as a caustic in cancer flammation of the skin, and allied diseases ; but not followed by ulceration and only is its action difficult to sloughing. regulate, but dangerous symptoms of poisoning have resulted from the very ready way in which it is absorbed by the skin. n8 ARSENIC. Internal Actions and Uses. I . On Brain aiid Nervous System. — Arsenic has a tonic influence on the nervous system generally. Secreting II. Circulation and Re- spiration. — In small doses arsenic may stimulate cardiac action in a slight degree ; and the experience of the arsenic-eaters of Styria shows that its use improves their wind, and enables them to undergo great exer- tion without fatigue I'll. On the Organs. — i. Digestive Tract. In small doses arsenic stimu- lates the appetite and in- creases the digestive powers, but if used more freely symptoms of irritation set in, which may terminate in gastro-enteritis. [Some pa- tients cannot take the smallest doses without great systemic disturbance. It is advisable to begin with minute doses and cautiously increase, watching the ef- fect.] I. This may in some measure explain its anti- periodic properties, for it is well known that arsenic is only second to quinine in its power of arresting the various manifestations of ague. It is also a valuable remedy in neuralgia, and chorea may frequently be cured by full doses. II. Arsenic is of service in asthma, hay-asthma, and some forms of chronic bron- chitis. III. Ringer recommends small doses of arsenic — i. In a form of irritative dys- pepsia with red tongue and prominent papillae, in the morning vomiting of drunk- ards, and in that variety of diarrhcea which leads to the evacuation of the bowels immediately after eating. It is now thoroughly estab- lished that the inhabitants of Styria eat arsenic to the extent of gr. j. to gr. ij., and thrive on it, becoming fat and ruddy, and that it is occasionally given to horses with the view of improving their coats. ARSENIC. 119 2. Cutaneous. — Arsenic occasionally causes irritation and tingling of the skin, and even the appearance of ecze- matous eruptions. 3. Liver. — Arsenic in poi- sonous quantities causes, like phosphorus, fatty or paren- chymatous degeneration of the liver. 4. On Urine. — Nothing special has been described [except that the kidneys are the principal channel for the discharge of the poison from the system.] Poisonous Effects. — Poi- soning by arsenic is ushered in by [burning] pain in the stomach, vomiting, diar- rhoea, headache, fever, and disturbed sleep, followed by more acute symptoms and death from collapse — a train of symptoms much resem- bling those met with in cases of true cholera. [Such phe- nomena occurring in the ab- sence of any epidemic of Asiatic cholera, and coming on soon after eating, in a previously healthy person, 2. In dry scaly affections of the skin, such as psoriasis, in the dry stages of eczema and impetigo, in pemphigus, and in lichen, arsenic acts most admirably ; but we must be careful never to give it during the acute stage of any skin affection, as in these circumstances, it is invariably found to aggravate the symptoms. Arsenic is much valued by Balfour and others in chronic rheumatism, and more espe- cially rheumatoid arthritis. Antidotes. — After evacua- tion of the stomach, we must give light magnesia or the [fresh] hydrated sesquioxide of iron [followed by castor oil to evacuate the bowels. The case should then be treated on general princi- ples]. 120 ARSENIC. should excite suspicion of arsenical poisoning.] After death, in addition to the usual pathological ap- pearances of gastro-enteritis, we find fatty degeneration of the heart and muscles, and parenchymatous degenera- tion of the liver, kidneys, &c. [Arsenic may generally be detected in the liver or contents of the stomach by Reinsch's or Marsh's Test.] Mode of Elimination. Arsenic is rather slowly removed from the body by the intestines, the urine, and perhaps the bile. Mode of Administration, Cautions, &c. Persons vary much in their susceptibility to arsenic, and we must invariably begin its use with caution, keeping in mind that children bear it well, and that a child of five can bear with impunity as large a dose as an adult. [Two grains of arsenious acid has caused death, according to Dr. Taylor.] We must also remember that, although the Styrian peas- ants can accustom themselves to large and increasing doses, the experience of medical practice shows that, after a cer- tain time, patients taking this drug are liable to show some of the following symptoms: — Smarting and itching about the conjunctivae, with oedema, pain in the stomach, vomiting and diarrhoea, white tongue, and general digestive derangement; and when these indications of "accumula- tion" occur, it is not necessary to suspend the remedy altogether, but merely to diminish the dose. The probabilities of these unpleasant symptoms are much lessened, however, by advising that the dose should always be taken after a meal. The mode in which arsenic is usually given is in the form of liq. arsenicalis [Fowler's Solution— Liq. Potass. Arse- nitis, U. S.], which is merely a solution of arsenious acid in carbonate of potash flavored with sp. lavand. co., con- taining gr. ss. in f3J-> and of which the dose is, as a general ASSAFETIDA. 121 rule, from rtr.ij. to n^v. ; but in some obstinate affections, like chronic rheumatic arthritis, it is requisite to push the quantity as far as ttlx. or even ttlxv. Being almost taste- less, liq. arsenicalis is best given simply in water. The liquor arsenici hydrochloricus, sodse arsenias, and ferri arsenias are rarely used, their respective doses being 2 to 8 minims and ^ gr. to ^ gr. ; and the liquor arsenici et hydrargyri hydriodatis [Donovan's Solution], which was supposed to have a special influence over syphilitic skin diseases on account of its combination of arsenic with iodine and mercury, has gone much out of fashion in these days. Dose, 10 to 30 minims. [The iodide of arsenic is sometimes used as an ointment in skin affections — gr. iij. to 3j.] ASSAFGETIDA— ASSAFETIDA. \_A gum-resinous exudation, obtained by incision from the root of Narthex Assafetida, U. S. Dose, gr. v.-x. Officinal Preparations, U. S. Mistura Assafcetidse (3iv. to Oj.) Milk of Assafetida. Dose, f^ss.-j. Tinctura Assafcetidae (gij. to Oj.) Dose, fjss.-j. Pilulae Assafcetidse (each gr. iij.). Dose, 2 to 4. Pilulae Aloes et Assafcetidae (each gr. )Yi). Pilulae Galbani Compositae (each gr. y 2 ). Suppositoria Assafcetidae (each 5 grains, or ni^xv. of the tincture). Emplastrum Assafcetidae.] Physiological Actions. Therapeutical. A good deal of digestive Assafcetida has been used disturbance seems to follow and recommended in a con- the administration of this siderable variety of affec- drug to healthy persons; but tions, but practically it is the evidence is too conflict- now only prescribed in flat- ing to enable us to lay ulent dyspepsia and in hys- down any exact scheme of teria, where its excessively its influence on the various nauseous smell and taste are functions of the body. supposed to give it an ad- vantage over other drugs of the same class. 1 1 [Prof. H. C. Wood states that " assafetida is one of the most efficient of the so-called antispasmodics, and may be given to fulfil the same 11 122 ORANGE AURANTIUM— ORANGE. [Aurantii Amari Cortex. The rind of the fruit of Citrus vulgaris. Aurantii Dulcis Cortex. The rind of the fruit of Citrus aurantium. Aurantii Flores. The flowers of Citrus aurantium and Citrus vulgaris. Officinal Preparations, U. S. Aqua Aurantii Florum. Used as a vehicle. Syrupus Aurantii Florum. Used as a vehicle. Confectio Aurantii Corticis. Used as a vehicle. Syrupus Aurantii Corticis. Used as a vehicle. Tinctura Aurantii. Dose, f3j- _ ij- Infusum Gentianse Compositum. Dose, f^ss.-ij. Tinctura Cinchonse Composita. Dose, f3j.-ij. Tinctura Gentianae Composita. Dose, f3j.-iv.] Properties. The various preparations of orange require no detailed comment, for beyond the fact that those made from the rind are mildly tonic in virtue of their bitterness, and that the syrup and the orange-flower water are agreeable flavor- ing additions to a prescription, we have no evidence of their special therapeutic properties, if any exist. [The volatile oil of the flowers, obtained by distillation, is called, in commerce, oil of Neroli, and orange-flower water is hence sometimes termed Neroli water.] indications as valerian in functional spasm, in hysteria, and nervous- ness. It differs from valerian in having a much more decided action upon the mucous membranes. It is an excellent carminative, and in the form of injection is constantly used for the relief of ty?npanitis. It also in small doses increases the appetite and affords relief in dys- pepsia, with flatulent colic and costiveness, of the aged or hysterical. As a stimulating expectorant and antispasmodic, it is useful in whooping- cough and chronic catarrh. It is especially efficient in palliating the latter affection as occurring in old people, when the difficulty of breath- ing is paroxysmally increased by spasm of the bronchial tubes. In infantile convulsions and in severe infantile colic, assafetida enemata (3\j. to §ss. of the milk) are exceedingly useful and harmless." Thera- peutics, 2d ed., p. 191.] CARBONATE OF BARIUM. 123 [AVENGE FARINA— OATMEAL. The meal prepared from the seeds of Avena Saliva, U. S. Extensively used as an aliment in the form of gruel. It is nourishing and slightly laxative. Three varieties are met with in the Middle States, the Ohio, the Canadian, and the Scotch oatmeal ; the latter, being imported, brings a higher price, and is considered by some to be better, perhaps solely on that account. Its taste is less pleasant than the others, which are probably equally as good. Thin oatmeal gruel, strained and sweetened, forms a valuable and popular infants' food.] BALSAMUM PERUVIANUM— BALSAM OF PERU. \_A11 empyreumatic liquid balsam obtained from Myrospermum Perui- fertim, U. S.~\ Local Action. Peruvian balsam tends to It may therefore be used, check copious and unhealthy like myrrh, as an application secretions. to foul and unhealthy sores. Constitutional Action. Like the other gum bal- It has therefore been pre- sams, it acts on the mucous scribed to restrain excessive membranes, and more espe- discharges in bronchitis, &c. cially on the bronchial tubes. [Dose, fjss. in emulsion.] BALSAMUM TOLUTANUM— BALSAM OF TOLU. \A semi- liquid balsam obtained from Myrospermum Toluiferum, U.S. Officinal Preparations, U. S. Syrupus Tolutanus. (Tinct. fsij.toOj.) Dose, f^ss.-j. Tinctura Tolutana. (Jjss. in Oj.) Dose, f 5>j- Tinctura Benzoini Composita. (Tolu 5ss. in Oj.)] This agreeable preparation is almost exclusively used as a flavoring addition to cough mixtures, in the form of the syrup. [BARII CARBONAS— CARBONATE OF BARIUM. Only introduced into the Pharmacopoeia in order to provide a source for the — 124 BELLADONNA. Officinal Preparations, U. S. Barii Chloridum, and Liquor Barii Chloridum. Dose, gtt. xxx.-l. Antidotes. Sulphate of magnesia, or dilute sulphuric acid. Internal Effects. Barium is only used in medicine in the form of liquor barii chloridum, which is recommended by Prof. Gross as an alterative in sci-ofula, particularly in cases dis- tinguished by a tumid upper lip.] BELLADONNA— BELLADONNA. [Belladonnas Folia. The leaves of Atropa Bella- donna, U. S. Belladonnas Radix. The root of Atropa Belladonna, from plants more than two years old, U. S. Officinal Preparations, U. S. Tinctura Belladonnas. (From the leaves, §ij. to Oj.) Dose, gtt. x.-xx. Extractum Belladonnas. (Inspissated juice of the leaves.) Dose, gr. ss.-ij. Extractum Belladonnas Alcoholicum. (Of the leaves.) Dose, gr. ss.-ij. Extractum Belladonnas RadicisFluidum. Dose, Trrij. Emplastrum Belladonnas. (From the root.) Unguentum Belladonnas. (From ext. belladonnas, 3J- in 3j.) Suppositoria Belladonnas. (From ext. belladonnas ale, gr. ss.) Atropia. (From the root.) ( Dose, gr. ^, or hypo- Atropias Sulphas. { dermically gr. T J^. Antidotes. Chemical. Fresh animal charcoal, tannin, vegetable astringents, &c. Physiological. Opium, Calabar bean, tartrate of anti- mony and potassa. Note. — In the treatment of belladonna-poisoning, the irritating emetics, such as mustard, ipecacuanha, and sulphate of zinc, should be exhibited to remove from the stomach any excess of the poison remain- BELLADONNA. 125 ing unabsorbed. Apomorphia might be useful hypoclermically (gr. ^q, repeated). Purgatives containing the chemical antidotes should then be given to neutralize any of the drug in the intestines. Symp- toms of narcotism should be treated as they arise, by artificial respira- tion, douches, counter-irritants, and diffusive stimulants. The physio- logical antidotes, being counter-poisons, should be used with the greatest care.] Local Action. Belladonna is used externally, on account of its soothing properties, in various forms of neuralgic and rheumatic pains, in which cases the liniment, applied either alone or in combination with chloroform liniment, often gives re- lief. It is also a good application in acute rheumatism, placed on cotton-wool and thus encasing the swollen and tender joints. Belladonna is also useful, as has been espe- cially pointed out by Mr. Heath, in boils and abscesses, where the suppurative process may be prevented or even arrested by its use. It is also a good application to in- flamed piles and fissure of the rectum. It is also applied to the skin to check localised sweating, to the breast to arrest the secretion of milk, and to the neighborhood of the eye to dilate the pupil ; but its actions here are so intimately associated with the theory of its internal administration, that we will say no more on the subject at present. Belladonna is very readily absorbed through the un- broken cuticle, and symptoms of poisoning have occasion- ally been caused by its local application. Internal Administration. Physiological Action. Therapeutical Application. 1. On the Brain. — After i. Belladonna may be full doses of belladonna, a cautiously used as a hypnotic tendency to delirium sets in, when other remedies fail, usually of a joyful character, and attended by hallucina- tions and spectral illusions. Sleep generally follows. 2. On the Spinal Cord. — 2. It is used in some spinal In frogs this action is very affections in accordance with decided, for when atropia is the principles of Dr. Brown- injected below the skin the Sequard, explained under animal is at first paralyzed, another section. lying quite motionless, with It is also of value in check- 11 * 126 BELLADONNA. arrested breathing, which period of inaction is sud- denly interrupted in about from one to eighteen hours by the occurrence of violent tetanic spasms. 3. Belladonna paralyses the terminal filaments of the third nerve supplied to the circular or sphincter fibres of the iris, and thus allows the sympathetic, which rules over the radiating fibres, to come into unchecked play, and so dilate the pupil. At the same time we observe a diminution in ocular tension and imperfect vision, espe- cially for near objects, due to paralysis of the power of accommodation. ing the tendency which oc- casionally exists to noctur- nal seminal emissions, when these become of exhausting frequency. 3. Belladonna; used more conveniently in the cleaner form of atropia, is in very extensive use in eye diseases to facilitate ophthalmoscopic examinations, to keep the pupil freely dilated in iritis, and so lessen the risk of ad- hesion of its free margin to the lens, with subsequent contraction, distortion, and impairment of vision. It is also used to obviate protrusion of the iris through any hole in the cornea made by ulceration or accident, and it forms a soothing ap- plication in various painful affections. To dilate the pupil the liq. atropiae [Br., gr. iv. ad f 5j] is now generally used, care being taken only to in- troduce a very small drop into the eye ; for if a larger quantity is applied, the re- sulting effects and inconve- niences may last from a week to ten days, much to the annoyance of the patient. [Although weaker solutions take a little longer time to dilate the pupil and para- lyse the accommodation, yet these effects are more tran- sient and therefore more satisfactory to the patient. A gr. ^ solution is strong BELLADONNA I27 4. The action of bella- donna on the sympathetic nervous system is somewhat irregular, and to this is no doubt due some at least of that action on certain secre- tions which we shall shortly note more fully. But one symptom often observed, more especially in children, probably proceeds from va- so-motor paralysis, and that is transient flushing and sweating of the face now and then following a dose. 5. The influence of bella- donna on the circulation is due to another nervous influ- ence. Under the use of this drug we observe increased rapidity and force of cardiac action, and this is explained by a paralysing action which it exerts on the terminal in- hibitory filaments of the pneumogastric nerve distri- buted to the intimate struc- ture of the heart. It is proved by experiment that the sympathetic nerve sup- ply has the power of causing very rapid action of the heart; but a rein is kept on enough for ordinary use, and will dilate the pupil in about half an hour after instilla- tion.] Belladonna being so read- ily absorbed, however, dila- tation of the pupil will ensue on application of the extract or liniment for any length of time to any part of the body. 5. Belladonna is an excel- lent cardiac tonic, increasing the regularity and strength of the contractions of the heart. It is also a very soothing remedy in cases of irritable palpitation, and the old- fashioned belladonna plaster is certainly of use in these conditions. 128 BELLADONNA. this, and the proper balance of motive force is sustained by the pneumogastric nerve, which inhibits or restrains the impetuous action of the sympathetic. By paralysing these inhibitory filaments, then, belladonna hands the heart over to the sympa thetic, which, without rein or drag, runs riot, and we accordingly find that exces- ive increase in the heart's rapidity follows the injection of a moderate quantity of atropia. Coincident with this we get raised arterial tension. 6. Belladonna contracts the small vessels, probably not from nervous influence, but from a direct action upon the unstriped muscular fibres surrounding the arterioles. 7. On Respiration. — Bel- ladonna tends to increase the rapidity of the breathing by stimulation of the respir- atory centre. 8. It has the power of contracting unstriped mus- cular fibre in other situations than the arterial tubes. It 6. Dr. Brown-Sequard re- commends the use of bella- donna in those cases of chro- nic inflammation of the spine leading to paralysis, where it acts well by contracting the vessels and diminishing the supply of blood to the affect- ed part; and he gives it in- ternally, and applies a plas- ter along the spine. To this contracting influ- ence on the small vessels is probably due the effect of belladonna in checking local inflammatory conditions. 7. Atropia has been re- commended as an efficient remedy in asthma. 8. Belladonna is an excel- lent remedy for the noctur- nal incontinence of urine of children ; but in order to do BELLADONNA. 129 probably does so both in the bladder and intestines. Action on Secretion. — 9. Salivary It checks the sa- livary secretion, causing a peculiar sensation of dryness in the mouth and throat; and this is believed to be due to a remarkable select- ive action on the secretory branches supplied from the chorda tympani nerve to the submaxillary ganglion. 10. Cutaneous. — Bella- donna most effectually ar- rests the action of the skin, and occasionally under its use a vivid red eruption, not unlike scarlet fever, breaks out. any good it must be boldly pushed, and I have been obliged to give as much as fjjss. or even f3ij. of the tincture [Ph. B.] before suc- cess was attained. 1 From its tonic influence on the muscular structures of the intestines, it is an excel- lent adjunct to purgative pill masses, from *£ to ^ grain acting well in combination with colocynth ; or, even given alone with ext. gen- tian se, it will often secure a regular action of the bowels. It is also very useful by relieving spasm, as in colic. 9. Belladonna has been used to check excessive sali- vation. 10. It is an excellent rem- edy for undue sweating, whe- ther general, as in phthisis or rheumatism, or local, as about the head of rickety children or the feet of some individuals. It maybe either given in the form of succus, extract, or tincture, or bet- ter by the subcutaneous in- jection of atropia. 1 [The Tincture of Belladonna, U. S., is about 2^£ times the strength of the English preparation. ] 13° BELLADONNA. 11. It also checks the se- 11. It is a most valuable cretion of the milk, either remedy in cases where in- locally or by internal use. flammation threatens in a breast, when the child has died or cannot suck, and the gland becomes congested from retention of its secre- tion. Here the external application of belladonna speedily diminishes the red, tense, shining aspect, relieves the wearing pain, and arrests the milk. 12. On the solid urinary 12. It may therefore be constituents no special action recommended as a good di- has been noted, but it in- uretic. creases the flow, by raising the tension in the glomeruli of the Malpighian bodies. Belladonna is also used under one or two conditions which cannot accurately be grouped under any specific heading. Thus it has been vaunted in whooping-cough, but after careful and repeated trials with large and small doses, I am compelled to agree with Dr. Kelly that its action in this disease is too uncertain to be of much use. But in certain forms of spasmodic cough, simulating pertussis, or when the cough is merely an occasional loud clanging bark, I have derived much benefit from belladonna. In epilepsy and chorea it has been tried, but without marked success. The subcutaneous injection of atropia is said by Dr. Anstie to be of great service in lumbago, sciatica, and chronic rheumatism, and to be the best of all remedies for pain in the pelvic viscera. It has also been recently observed that the addition of a little atropia to the ordi- nary morphia injection tends to obviate the distressing faintness, pallor and nausea, which occasionally mar the efficacy of the subcutaneous mode of administering this valuable drug. Ringer recommends its use in irritative dyspepsia, giving from \ to \ gr. of the extract night and morning, and gradually increasing the dose. [A solution BELLADONNA. I3I of atropia, i in ioo, if applied to an exposed nerve-pulp, is said to relieve toothache immediately.] Drawbacks to the Use of Belladonna. Poisonous Symptoms and Antidotes. — Occasionally the use of atropine drops to the eye causes an erysipelatous inflammation about the lids and face, and patients often complain of the disfigurement and inconvenience arising from a widely-dilated pupil. Idiosyncrasy may also here be the source of inconvenience, and we may find persons affected with dryness of the mouth and throat after very small doses. This is always the first indication of the physiological action of belladonna, and is followed by a peculiar sensation of thirst and feverishness, without heightened temperature, rapid pulse and breathing, red tongue j the face then flushes, delirium sets in, with great weakness, very hurried breathing, convulsions, and finally coma, which ends the scene. The antidotes are opium, which, within certain limits, is antagonistic to belladonna, animal charcoal, the fixed alkilies, which destroy its poison- ous properties, and Calabar bean, which has recently been shown to be the physiological antidote. One curious point about belladonna is that, although so poisonous to man, its destructive influence is very various on other animals. The carnivora are much more readily affected by it than the herbivora, many of whom browse on it with impunity. Thus a horse has been known to eat eight pounds of the leaves without injury ; blackbirds feed freely on the berries; and 15 grains of atropia are required to poison a rabbit. Dose and Mode of Administration. Extractum belladonnas gr. \ to gr. j.; tinct. belladon- nas [Br.] Tr^x. ad f5ij. ', succus n^v. to f5ss. Atropia is seldom if ever used internally, and -^ gr. would to be a safe medium dose. It is well to note that children take not only without in- jury, but with benefit, much larger doses than adults, and, whilst I have seen a woman display well-marked physio- logical symptoms after a few 10 minim doses, I have often prescribed 20 minims of the [English] tincture for a child of two years without anything of the kind. I32 BENZOIN — OIL OF BERGAMOT. BENZOINUM— BENZOIN. \_A solid balsam obtained from Styrax Benzoin, U. S. Officinal Preparations, U. S. Acidum Benzoicum. (Enters into Tinctura Opii Camphoratae.) Dose, gr. x.-xxx. Ammonii Benzoas. Dose, gr. x.-xxx. Tinctura Benzoini. Dose, f 5ss.— f 5j- Tinctura Benzoini Composita. Dose, f3j--ij- Unguentum Benzoini. (Adeps Benzoatus, Br.] Local Action. Physiological. Th erapeutical. Tincture of benzoin is a It is therefore occasionally- stimulant to raw surfaces, used as an application to [Benzoin has the property foul or indolent sores, of preventing rancidity in ointments, &c, in hot weather.] Internal Action. Benzoin has the stimulat- Benzoin may be pre- ing influence on mucous scribed with effect in ad- membranes possessed by vanced cases of bronchitis, most of the gum-balsams, and in some conditions of During its passage through chronic irritation about the the blood it becomes con- bladder, verted into hippuric acid, It may be conveniently and increases in some raea- given in the form of the sure the acidity of the urine, benzoate of ammonia. R. Tincturce benzoini composite fgvj. ; Mucilaginis acacise f §j. ; Syrupi zingiberis f §ss. ; Aquae menthae piperitse f§ v j- M. S. Capiat unciam unam quarta quaque hora. For advanced bronchitis. [OLEUM BERGAMII— OIL OF BERGAMOT. 77/,? volatile oil obtained from the fruit of Citrus Limetta (Be Candolle), U. S. ' Used almost exclusively as a perfume.] BISMUTH 1 33 BISMUTHUM— BISMUTH. [ Commercial bismuth of good quality, U. S. Officinal Preparations, U. S. Bismuthi Subcarbonas. Dose, gr. xv.-xlv. Bismuthi Subnitras. Dose, gr. v.-xxx.] Local Action. Physiologic a I. Bismuth has no action on the unbroken cuticle, but, applied to a raw or mucous surface, it is sedative and astringent. Th erapeutical. It is a good application to intertrigo, ulceration about the mouth, and as an injection in gonorrhoea and leucon'hcea. It has lately been recom- mended as a snuff to check cold in the head, and the liquor has been praised as an application to prolapsus ani (Cleland). Internal Actions and Uses. On Digestive Tract. — Bismuth is sedative to the stomach, and exerts an astringent influence over the intestines, probably in virtue of its local effects. Bismuth is one of our most valued remedies in many forms of dyspepsia, the main indications for its use being pain and vomiting. When a patient suffers acute pain after eating, with or without sickness, the tongue being clean and much flatu- lence present, we may give bismuth with much confi- dence, and it is also of ser- vice in the vomiting of drunkards, m pyrosis, and in many forms of diarrhoea, more especially that met with in children. Mode of Elimination. Very little bismuth is absorbed, and it is principally thrown out of the system by the intestines, to whose secre- 12 134 BROMINE. tion it imparts a blackish hue, from the formation of a sulphide. Mode of Administration, &c. The subnitrate of bismuth, which is the most effective preparation, may be given simply in powder, either by itself or in combination with charcoal or soda ; or it may be given in solution with hydrocyanic acid, gentian, &c, the dose being from 5 to 20 grs., and large doses being preferable. R. Bismuthi subnitratis 5*1- ; Mucilaginis [acacice] f^j. ; Acidi hydrocyanici diluti Tr\x.-xx. ; Infusi gentianae ad f ^ v j . M. Sumat f §ss. ter die. R. Liquoris bismuthi et ammonias citratis [Br.] f 5iv. ; Syrupi aurantii f ^v. ; Infusi calumba; f §v- Misce. Sumat unciam unam ter in die. The carbonate and oxide of bismuth are seldom used, but an agreeable preparation, less effectual, however, than the subnitrate, is known as the liquor bismuthi et ammoniae citratis, which contains gr. iij. of the oxide to the drachm; and lozenges, containing each gr. ij. of the subnitrate, are also included in the [British] Pharmacopoeia. BROMINIUM— BROMINE. \A liquid, non-metallic element, obtained from sea-water. Dose, gtt. ij.-iij., largely diluted with water. Officinal Preparations, U. S. Ammonii Bromidum. Dose, gr. xx.-xxx. Potassii Bromidum. Dose, gr. x.-xxx. Antidote. Ammonia, followed by the customary treatment for irritant poisons.] Bromine has been used as a lotion by Dr. Routh and others. Bromine in a free state being never used [to any extent] in medicine, we shall consider its properties under Bromide of Potassium. [Bromine is a valuable caustic, and is sometimes used BUCHU — CADMIUM. 135 in gynaecology as an application to the uterus. It is said that its mixture with glycerine is liable to explode. It is useful in hospital gangrene both as a caustic, and in dilute solution as an antiseptic wash. Used internally, it resem- bles iodine in its effects as an alterant.] BUCHU— BUCHU. [ The leaves of Barosma Crenata and other species of Barosma, U. S. Officinal Preparations, U. S. Extractum Buchu Fluidum. Dose, f^ss.-j. Infusum Buchu (fjj. to Oj.). Dose, f^j.-ij.] Physiological Action. Therapeutical. The physiological action Buchu has long been val- of buchu is principally if not ued by surgeons as a useful entirely expended on the remedy in chronic catarrh of mucous membrane of the the bladder and the various genito-urinary organs. It is mucous discharges from the probable that the volatile oil genito-urinary organs de- which it contains, being rap- pending on a relaxed condi- idly taken into the blood and tion of the affected parts, as rapidly excreted by the [It is largely employed in kidneys, acts locally through the treatment of subacute the urine on the lining mem- or chronic gonorrhoea, re- brane of the bladder and sembling turpentine in its urethra. [It is also, to some effects, although far less stim- extent, diaphoretic] ulating. In incontinence or The urine is impregnated retention of urine, depend- with the peculiar odor of the ing upon want of tone in the drug, and is perhaps slightly bladder, it is a most useful increased in quantity. agent.] CADMIUM — CADMIUM. [Officinal Preparation. Cadmii Sulphas. Used externally. The sulphate of cadmium strongly resembles the cor- responding zinc salt in its properties, and is occasionally employed as an astringent collyrium (gr. i.-iv. to rose- water fsj.)- The iodide of cadmium is officinal in the British Pharmacopoeia, but] is only used in the form of unguentum cadmii iodidi [Br. gr. lxij. to £j.] in some I36 COFFEE — OIL OF CAJUPUT. cases of skin disease [making an admirable substitute for the iodide of lead]. CAFFEA— COFFEE. [ The seed of Caffea Arabic a, U. S.~\ Tea, coffee, guarana, and coca, substances containing the same alkaloid, caffeine, have much the same effect. CAFFEINE is a very active substance, causing at first increase, but later diminution, of the reflex functions of the cord, with nervous convulsions and muscular rigidity, the motor nerves not being affected. The heart's action is first ac- celerated, but afterwards retarded. The excretion of urea is lessened. The frequent and prolonged use of tea and coffee causes, in some persons, a variety of nervous sensa- tions, sleeplessness, numbness, and tingling of the extrem- ities, with irritability of the heart ; and there is no doubt that much loss of appetite and flatulent dyspepsia originate in the habit of drinking tea shortly before or after meals. The invigorating and restorative effects of tea and coffee are well known, and valued by persons undergoing much bodily fatigue. The therapeutic indications for tea and coffee are almost restricted to the administration of the latter substance in cases of opium-poisoning. Guarana in 20-grain doses has been found a useful remedy for migraine or sick headache, and the chewed leaves of the coca plant have been highly recommended by Sir R. Christison and others as a nervine and muscular stimulant. Although the respected Baronet found great benefit from this plant during severe exertion, Weston, the well-known pedestrian, gives his opinion as tending quite to the opposite conclusion. [OLEUM CAJUPUTI— OIL OF CAJUPUT. The volatile oil obtained from the leaves of Melaleuca Cajuputi {Roxburgh, Trans. Lond. Medico- Botan. Socy.), U. S. Cajuput oil is highly-prized in the East Indies as a stim- ulant carminative. The ordinary dose is gtt. ij.-v. , but it has been given with great success in the collapse of cholera, in doses of gtt. xv. to f 5j- It is also used as a rubefacient counter-irritant, diluted with olive oil. Like CALCIUM. I37 other oils of this class, it relieves toothache when intro- duced into a carious tooth.] CALCIUM— CALCIUM. [Calcii Chloridum — Chloride of calcium prepared by fusion, U. S. Calcii Hypophosphis — Hypophosphiteof lime. Dose, gr. x.-xxx. Calx — Lime recently prepared by calcination, U. S. Calx Chlorinata — A compound resulting from the ac- tion of chlorine on the hydrate of calcium and containing at least 25 per cent, of chlorine, U. S. Officinal Preparations, U. S. Calcis Hydras. Used in pharmacy. Calcii Carbonas Praecipitata. Dose, gr. xx.-3j. Calcii Phosphas Praecipitata. Dose, gr. x-xxx. Creta Praeparata. Dose, gr. x.-xv. Hydrargyrum cum Creta (mercury 3 pts., chalk 5 pts.). Dose, gr. v.-xxx. Trochisci Cretae. Mistura Cretae. Dose, fgss. Testa Praeparata. Dose, gr. x.-xv. Liquor Calcii Chloridi. Dose, fjss.-j. Liquor Calcis (lime-water). Dose, f 3j.-iv. Linimentum Calcis (lime-water f^viij., linseed oil fSvij.). Potassa cum Calce. Used as a caustic. Also used in the preparation of ^Ether Fortior, Ammo- nii Valerianas, Aqua Ammonise, Liquor Potassae, Liquor Sodse, Liquor Sodas Chlorinatse, Quinise Sulphas, Santoni- num, Spiritus Ammonise, Strychnia, and Sulphur Praecipi- tatum.] Local Action. Physiological. Therapeutical. Some of the preparations Lime is used as a soothing of lime, used externally, are application to burns, as in sedative or soothing; others the linimentum calcis; and are astringent. lime-water makes a good injection for lencorrhoea, or enema for the destruction of thread-worms. 12* l$8 COLUMBO. Internal Uses. Lime, taken internally, It is therefore used with neutralises acid secretions, benefit in some forms of and has astringent proper- dyspepsia and in diarrhoea, ties. liquor calcis being the most generally employed prepa- ration. Lime-water is also of great service in prevent- ing the curdling which often causes milk to disagree with patients of weak digestion. Chalk is more astringent than lime, and is an excellent remedy, either alone or in combination with opium, for diarrhoea. Chloride of calcium has been highly praised in 20-grain doses as a remedy for various forms of scrofula. [The dose of chloride of lime (calx chlorinata) is gr. j.-v., but it is rarely prescribed, being principally used as a disinfectant.] Phosphate of lime has been highly praised by Ringer in doses of from 1 to 2 grs. in rickets, where it acts by im- proving the general nutrition of the system, and supplying structural elements in which the growing bones of badly nourished children are often deficient. [Thehypophosphite of lime has been highly recommended in consumption.] CALUMBA— COLUMBO. [The root of fateorrhiza palmata (lifters'), Cocctdus palmatus (De Candolle); and jateorrhiza Calumba {Alters), Cocctdus palmatus {Wallich Catal. noti D. C), U. S. Officinal Preparations, U. S. Extractum Calumbae Fluidum. Dose, nrxv.-xxx. Infusum Calumbae (root foss. to Oj.). Dose, f^j.-ij. Tinctura Calumbae (root gij. to Oj.). Dose, f5j.-ij.] Local Action. Calumba has no local action. Constitutional Action. Physiological. Therapeutical. 0?i the Digestive Fitnc- Calumba is a good tonic tions. — Like all bitter tonics, in deficient appetite from in- calumba stimulates the appe- digestion or simple want of CAMPHOR. 139 tite, and increases slightly tone, in various dyspeptic the secretion of saliva and conditions, and in most en- the gastric juice. It is lighter feebled states of the consti- and more agreeable than tution, from whatever cause some others of the class, and they may arise. [As it does has been believed to have not contain tannic acid, it sedative properties, in virtue maybe given in combination of which it may be bene- with iron.] ficially given in sickness and vomiting ; but of this we have been unable to obtain reliable evidence. Mode of Administration. Calumba is usually given in combination either with iron, with alkalies, or with other tonics. Thus: — 1&. [Ferri et potassii tartratis] gjss ; Potassii bicarbonatis 5'j- j Syrupi hemidesmi [Br.] f^j. ; Infusi calumbae f" ^ v i j . Misce, fiat mistura. Capiat unciam unam bis in die. R. Pulveris calumbae gr. x. ; Sodii bicarb. gr. xx. ; Pulv. rhei gr. v. ; Pulv. zingiberis gr. x. M. Fiat pulvis bis in die sumendus ante cibum. A useful powder in some forms of dyspepsia. CAMPHORA— CAMPHOR. \^A peculiar, concrete substance, derived from Camphora officinarum, and purified by sublimation, U. S. Oleum Camphorse (Oil of Camphor). Dose, gtt. ij.-iij. Officinal Preparations, U. S. Aqua Camphorae (3j. to Oj.). Dose, f^ss-ij. Linimentum Camphorse (camphor 1 pt., olive oil 6 pts.). Linimentum Saponis. Mistura Chloroformi (chloroform fjfss., camphor 3j- in f^vj.). Spiritus Camphorae (^ij. to Oj.). Dose, f3ss.-j. Tinctura Opii Camphorata (Paregoric). Dose, f^ss. Ceratum Plumbi Subacetatis (Goulard's Cerate). 140 CAMPHOR. Antidotes. Opium and stimulants.] Local Effects. Physiological. Th erapeutical. Camphor has some rube- Camphor forms an ingre- facient properties, redden- dient of most of the lini- ing and irritating the skin. ments in common use. Internal Action. 1. Brain and Nervoits System. — Camphor in large doses causes a good deal of giddiness and confusion of ideas, even amounting in some cases to delirium. Muscular weakness is at first observed, but this rap- idly gives way to violent epi- leptiform convulsions and almost maniacal excitement. In frogs, well-marked lower- ing of the reflex irritability of the spinal cord has been observed. 2. Circulation. — In small doses camphor seems to stimulate the heart's action, but after the administration of larger quantities great cardiac prostration has been observed by Dr. Geo. John- son and others. 1. Camphor is not used [in large doses] on account of its action on the nervous system, and the results of the few experimenters who have been bold enough to try the effects of large doses on themselves have not been of a very encouraging nature. [It is moderately stimulating and diaphoretic, and pos- sesses undoubted anodyne and narcotic influence. In the spasmodic and nervous complaints of women cam- phor is extensively em- ployed.] 2. Camphor has been found of service in the early stages of coryza, but must be here used with caution, as the homoeopathic tincture, which is generally pre- scribed [outside of the reg- ular profession], is now known to be a very strong preparation, and Dr. Geo. Johnson and others have described cases in which ex- cessive weakness and faint- ness, with great cardiac and muscular prostration, fol- lowed doses of from 15 to CANELLA — AMERICAN HEMP. 141 20 minims [and several fatal cases of poisoning by it have been reported]. 3. Respiration and Tem- perature. — No influence on the respiration is noted, but there is a marked lowering of temperature. 4. Digestive and Secreting 4. Camphor is said to be Organs. — In large doses, a good remedy in summer some irritation of the gastro- diarrhoea. intestinal mucous membrane has been observed, with dia- phoresis, and the sexual ap- petite seems to be dimin- It is a popular antidote to ished. chordee. [CANELLA— CANELLA. The bark of Canella alba, U. S. Officinal Preparations, U. S. Pulvis Aloes et Canellse. Dose, gr. x.-xx. Vinum Rhei (rhubarb .^ij., canella 5j- to Oj.). Dose, f5j.-iv. Uses. Canella is an aromatic tonic, but is rarely prescribed alone. It contains no tannin, and may be given with a chalybeate. The powder of aloes and canella is a pop- ular remedy for amenorrhea under the title of Hiera Picra.] [CANNA— CANNA. The fecula fro7n the rhizome of an undetermined species of Canna, U. S. Canna-starch may be used like arrowroot as a bland nourishment for invalids.] [CANNABIS AMERICANA— AMERICAN HEMP. The flowering tops of Cannabis Sativa, cultivated in North America, U. S. Officinal Preparation, U. S. Extractum Cannabis Americanae. Dose, gr. j£ to 142 INDIAN HEMP. CANNABIS INDICA— INDIAN HEMP. [ The flowering tops of the female plant of Cannabis Sativa, variety Indica, CI. S. Officinal Preparations, U. S. Extractum Cannabis Indicse. Dose, gr. y 2 . Tinctura Cannabis (gr. iij. ad f 3 j . ) . Dose, gtt. x.-xx.] Local Action. Indian hemp is never used locally. Internal Actions. Physiological. 1 . On Brain and Nervous System. — Indian hemp, like opium, possesses a double exciting and sedative action, the brain being stimulated into pleasant exhilaration before sleep sets in. This preliminary effect, however, is more powerful and lasting than in the case of opium, and the subsequent condi- tion of slumber is usually disturbed by dreams and spectral illusions. Various authors have given graphic descriptions of the intellect- ual disturbance produced by this drug, dwelling more especially on a peculiar feel- ing of double consciousness, leading on, in some cases, to partial catalepsy. We also find indications of some special affection of the sensory nerves, a marked degree of numbness and tingling, ushering in cutane- ous anaesthesia and diminu- tion of the muscular sense. Therapeutical. 1. Indian hemp may be used as a narcotic when other remedies fail ; but its action is so uncertain and irregular, and the difficulty of procuring reliable prepa- rations so great, that our present knowledge does not enable us to lay down any practical rules for its employ- ment. Dr. Clouston, how- ever, has obtained valuable assistance in acute mania by prescribing the tincture in combination with bromide of potassium. Although later experience has not confirmed the pretentions of those who formerly vaunted Indian hemp as a cure for hydrophobia, chorea, tetanus, and allied nervous ailments, we may sometimes produce good results in neuralgia and migraine by its cautious use. CANTHARIDES. 143 2. Circulation. — Some increased rapidity of pulse has been observed during the action of Indian hemp ; but it is probable that this is only due to the condition of nervous excitement which we have just described. 3. Digestive System. — No special effect seems to be produced on the stomach or intestinal canal, and the absence of constipation fol- lowing its use gives Indian hemp one advantage over opium. Dose and Mode of Administration. R. Tincturae cannabis In dicae f3J-> Mucilaginis acaciae f §j. ; Syrupi zingiberis f ^ss. ; Aquas menthas piperitae ad f §vj. Misce, fiat mistura. Capiat unciam unara quarta quiique hora. In neuralgia, &c. CANTHARIS— CANTHARIDES. \Cantharis vesicatoria, Lytta vesicatoria (Fabrichis), U. S. Officinal Preparations, U. S. Tinctura Cantharidis. Dose, n^iij.-v. Ceratum Cantharidis. (For spreading blisters.) Ceratum Extracti Cantharidis. Charta Cantharidis. (Blistering papers.) 1 Collodium cum Cantharide. Linimentum Cantharidis. Emplastrum Picis cum Cantharide. Unguentum Cantharidis (5ij. in gj.). Antidote. There is no antidote for cantharides.] 1 [Charta Cantharidis and Charta Sinapis form the class of Chartae, U. S. P.] 144 CANTHARIDES. External Actions. Physiological. The first effect of the application of cantharides to the skin is tingling and smarting, speedily followed by vivid redness and severe burning pain. To this suc- ceeds the formation of large blebs containing a watery fluid rich in albumen and fibrine ; and if the blister be allowed to remain for any lengthened period in contact with the skin, ulceration and sloughing may supervene. It has been found that the moderate counter-irritant action of cantharides causes the copious exudation of white blood-corpuscles into the subcutaneous areolar tissue, with engorgement of the more superficial structures underlying the skin, whilst the deeper strata look pale, anaemic, and flabby ; the lungs even being affected in this way. It has also been shown that the irritant action of cantha- rides may penetrate through the skin, and cause redness and inflammation of the pleura and peritoneum. The first constitutional effect of a blister is a slight eleva- tion and subsequent depres- sion of the temperature, with weakening of the action of the heart. It not uncommonly hap- Th erapeutica I. Blisters are used to fulfil the following indications : — i. To relieve pain. There can be no doubt that blisters frequently check pain most effectually, as in subacute pleurisy, pleurodynia, gas- tralgia, sciatica, and neural- gia, it being important that in this last-named affection the counter-irritant should be placed as near as possible to the root of the affected nerve. 2. To check inflammatory conditions. There is no doubt that some local in- flammations may be checked by blistering a neighboring vascular area. Thus, in iritis and some other inflam- matory affections of the eye, benefit may be procured in this way ; and in acute rheiwiatism blisters applied immediately above the in- flamed joints rapidly remove pain and swelling. On this principle, also, Mr. F. Jordan recommends his iodine treatment of localised surgical affections already referred to. In how far inflammations of internal organs may thus be treated with advantage is a somewhat open question ; for although the withdrawal of blood from the deeper structures might theoreti- CANTHARIDES 145 pens that cantharides may be absorbed through the skin, and cause kidney irri- tation. cally be considered benefi- cial, it is practically found that the pain and annoyance of blisters add to the feverish discomfort of the victims of acute disorders. 3. To promote absorption. Blisters are supposed to aid the absorption of effused products, fluid or solid, and are therefore much used in thoracic dropsy ', either pleu- ral or pericardial, the latter stages of pneumonia, chronic joint- disease, &c. 4. To stimulate and alter vascular or nervous func- tions, &c. Blisters may be employed to rouse patients from the stupor of typhus, or narcotic poisoning, or vari- ous brain affections, to check obstinate vomiting, and un- der various other conditions laid down in works on practical medicine. Internal Actions. Physiological. Cantharides is a gastro- intestinal irritant, and also a renal irritant and diuretic, causing an increased flow of urine, but frequently giving rise to a good deal of strangury, with painful, fre- quent, and difficult mictu- rition, and bloody urine. This irritation may spread by sympathy to other allied organs, and uterine excite- ment on the one side, or excess of venereal appetite 1 3 Th erapeutical. Cantharides is not much used internally, on account of its irritating properties. It is, however, occasionally prescribed in pyelitis and some chronic affections of the kidney, and in chronic diseases of the spine. Some authorities also have praised it highly in psoriasis. It has also been used for the purpose of procuring abor- tion, and it possesses em- menagogue properties. 1 46 CAPSICUM. with chordee and seminal emissions on the other, may follow the administration of large doses. 1 Cautions. Mode of Administration. We must use blisters with caution under the following circumstances: — In the aged, infirm, or very young, where troublesome ulceration is apt to ensue. In acute inflammatory conditions, and more especially those of the kidney. To cicatricial tissue, or to parts deprived of some of their vitality by the withdrawal of nervous influence, as in paraplegia. Blisters are usually kept on from ten to twenty hours, but we may well limit the period to six or eight hours, and develop the blebs by a subsequent poultice. When the desired effect has been produced, let out the watery fluid, and apply a thick layer of cotton-wool. CAPSICUM— CAPSICUM. \_Syn. Cayenne and African Pepper. The fruit of Capsicum annuum, Capsicum fastigiatum (Blum), and other species of Capsicum, U. S. Officinal Preparations, U. S. Infusum Capsici. Dose, f,?ss. Oleo-Resina Capsici. Dose, gtt. j. Tinctura Capsici. Dose, f3j--ij-] This is a topical stimulant to the mucous membranes, exciting the appetite in small doses, but in larger quanti- ties causing gastro-enteritis. In some forms of sore throat, as in the early stage of tonsillitis, or in simple relaxation of the mucous membrane, it forms a useful addition to a gargle [as infusum capsici]. Recently it has been highly praised by Dr. Lyons, of 1 [The tincture of cantharides, U. S. P., is more than twice the strength of the English preparation.] CARBON. 147 Dublin, in ten-minim doses of the tincture before meals, for the relief of the nausea, depression, and drink-craving of confirmed dipsomaniacs. ]$. Tincturae capsici n\x. ; Tincturae nucis vomicae H|x. ; Acidi nitrici cliluti Tu. xx. ; Aquae ad f §j. Fiat haustus ter die sumendus. Useful in drink-craving. CARBO— CARBON. [Carbo Animalis — Charcoal prepared from bone, U. S. Used in preparing Cinchoniae Sulphas, Morphia, Quinise Sulphas, and Santoninum. Carbo Ligni — Charcoal prepared 'from wood, U. S. Used in preparing Acidum Sulphurosum and Potassii Iodidum. Officinal Preparation. Carbo Animalis Purificatus. Used in making Acidum Gallicum, Digitalinum, Strych- nia, and Veratria.] Local Actions. Physiological. Th erapeutical. Charcoal has no purely 1. In virtue of its absorbing local action on any tissue powers, charcoal is used in with which it is brought in many of those cases of dys- contact, and as it is quite pepsia where large quantities insoluble it can exert no of gas are formed by prema- general influence on the ture decomposition of the functions of the body. It is food, and where much pain, therefore simply a mechan- nausea, and want of appetite ical agent, and acts in virtue are experienced by the pa- of the following properties, tient. In consumption and 1. It not only freely ab- many chronic stomach dis- sorbs gases within its pores, orders charcoal acts well by but oxidises and destroys relieving the falulence which those of an offensive and is often the chief discomfort injurious nature, as sulphu- of the sufferer. Charcoal is retted hydrogen ; and fur- also an excellent deodoriser ther, it also deodorises, by and antiseptic, and is used oxidation, and destroys or- for these purposes in the 148 CARBON. game impurities of all kinds, decolorising solutions which contain them. 2. Animal charcoal pos- sesses the power of render- ing various vegetable poisons inert by placing them in a form of combination beyond the absorptive powers of the stomach. construction of filters, con- tact for four months being- sufficient to purify the foul- est and most deeply stained waters ; and if the organic matter present does not ex- ceed from i to 2 grains per gallon the charcoal will per- manently retain its cleansing properties. It may also be of great service in absorbing and destroying offensive ef- fluvia in the neighborhood of sewers or drains, and it used to be a fashionable ap- plication to unhealthy ul- cers j but cleaner and equally effectual antiseptics have now entirely displaced it from popular favor. It is also occasionally em- ployed in the formation of respirators and as an adjunct to tooth powders, and Dr. Thorowgood advises its pre- scription in teaspoonful doses in bleeding piles. 2. If we are called very early to a case of poisoning by opium, aconite, strychnia, or other vegetable poison, we may hope to do some good by charcoal, provided that absorption of the poi- sonous agent has not yet taken place to any extent. Mode of Administration. As a medicinal agent vegetable charcoal alone is used, and may be given in doses of from a tea- to a table-spoon- ful, great care being taken to insure perfect freshness, as its absorptive powers are seriously impaired by keeping. It may be combined effectively with bismuth, or given in CARDAMOM — CARAWAY CLOVES. 149 sandwich form between bread and butter, or moistened with spirit in a wineglass before suspension by water ; but in any case its unsightly appearance, gritty consistence, and insolubility interfere with its prescription in elegant form, and we may advise our patients with advantage to make use of Bragg's biscuits or Belloc's lozenges. As an antidote, animal charcoal must be given in con- siderable doses, as it is calculated that half an ounce is required to neutralise one grain of vegetable alkaloid. As an antiseptic it may be placed in shallow pans close to the outlet of drain or sewer ventilating shaft. CARDAMOMUM— CARDAMOM. \_The fruit of ' Elettaria Cardamomum, U. S. Officinal Preparations, U. S. Extractum Colocynthidis Compositum. Dose, gr. v.-xxx. Pulvis Aromaticus. Dose, gr. x.-xxx. Tinctura Cardamomi. Dose, f 5j.-ij. Tinctura Cardamomi Composita. Dose, f 3j.-iv. Tinctura Gentianse Composita. Dose, f 3j.-ij. Tinctura Rhei. Dose, f 3j.-iv. Vinum Aloes. Dose, f 3j--f 3j-] This is an agreeable stimulant and flavoring adjunct. [CARUM— CARAWAY. The fruit of Carum Carui, U. S. Officinal Preparations, U. S. Oleum Cari. Dose, gtt. j.-x. Tinctura Cardamomi Composita. Dose, f3j.-f Iss. Caraway is an agreeable aromatic, used as a stomachic, or to prevent the griping of other medicines. The oil is most frequently employed, but an infusion may be made containing 3 i j - to Oj.] CARYOPHYLLUS— CLOVES. [ The unexpanded flowers of Caryophyllus Aromaticus, U. S. 13* 150 CASCARILLA — CASTOR. Officinal Preparations, U. S. Infusum Caryophylli (3ij. to Oj.). Dose, fgij. Oleum Caryophilli. Dose, gtt. ij.-vj. Spiritus Lavandulae Compositus. Dose, f5j.-ij. Syrupus Rhei Aromaticus. For infants, f5j. Vinum Opii. Dose, gtt. xv.-xxx. Cloves are a stimulating stomachic, and may be given in substance in doses of gr. v.-x.] Cloves, pimento, and oil of cajuput are carminative and perhaps antispasmodic, and may be useful in flatulent colic, hysteria, &c, more especially as adjuncts to other remedies. CASCARILLA— CASCARILLA. \_The bark of Croton E Inter in, U. S. Officinal Preparation, U. S. Infusum Cascarillae. Dose, f.lij.] Cascarilla is a light and agreeable tonic. [CASSIA FISTULA— PURGING CASSIA. The fruit of Cassia Fistula, U. S. Cassia pulp is laxative in doses of one or two drachms, but is rarely used except in the officinal combination, Confectio Sennas, which is a favorite remedy against con- stipation in pregnancy. Dose, 5j--ij-] CASSIA MARILANDICA— AMERICAN SENNA. [ The leaflets of Cassia Marilandica, U. S. This is a competent substitute for the imported senna as a cathartic, but must be administered in rather larger doses. It is much used in the form of infusion, combined with fennel or some other aromatic to prevent griping.] CASTOREUM— CASTOR. \_A peculiar concrete substance obtained fron Castor Fiber, U. S. Officinal Preparation, U. S. Tinctura Castorei. Dose, fjss.-ij.] CATNEP — CATECHU. 151 Castoretim and musk possess much the same properties, the only difference being in the greater strength of the latter. They are stimulant and antispasmodic; but cas- toreum is rarely if ever used, and even musk, which was formerly much valued in France, and by Graves of Dub- lin, in typhus, pneumonia, and other diseases tending to assume an adynamic type, has now also fallen into com- parative disuse. [CATARLA— CATNEP. The leaves and tops of Nepeta Cataria, U. S. Infusion of catnep (catnep tea) is a favorite remedy for flatulent colic in infants, but is rarely used for any other purpose in regular practice, although a hot infusion is a domestic remedy for amenorrhea and hysteriaJ\ CATECHU— CATECHU. An extract prepared principally from the wood of Acacia Catechtt, U. S. Officinal Preparations, U. S. Infusum Catechu Compositum. Dose, f^j.-iij. Tinctura Catechu. Dose, f3j.-iij. Internal Effects. Physiological. Therapeutical. Catechu has powerful as- It is a much-used drug in tringent properties. the relaxed conditions of various mucous membranes, but more especially in diar- rhea, and it constitutes an essential ingredient in the mixtures generally prescrib- ed for the relief of that con- dition. R. Tincturse catechu f5 v J-5 Pulveris cretse aromatici [Br.] £ij.; Tincturae opii f.^ij-; Mucilaginis fgj.; Aquae cinnamomi ad flvj. Misce, fiat mistura, cujus sumat semunciam post singulas dejectiones liquidas. 152 WAX — CERIUM — SPERMACETI. CERUM— WAX. [Cera Alba. Yellow wax bleached, U. S. Cera Flava. A peculiar concrete substance prepared by Apis mellifica, U. S. Wax is a good excipient, and is the basis of the cerates. It also enters into pills, ointments, plasters, and supposito- ries. It is an ancient remedy for dysentery. Cerata. List of Cerates officinal in the U. S. Pharmacopoeia: — Ceratum (formerly Ceratum adi- Ceratum Resinoe. pis). " Resinas Compositum. Ceratum Cantharidis. " Sabinse. " Cetacei. " Saponis. " Extracti Cantharidis. " Zinci Carbonatis.] " Plumbi Subacetatis. CERIUM— CERIUM. [Cerii Oxalas — Oxalate of Cerium.] The oxalate of cerium, in doses of from gr. j. to gr. ij., is a popular remedy in the vomiting of 'pregnancy , its mode of action being quite unexplained, and its success being, according to my own experience, greatly exaggerated. It is generally prescribed in the form of pill. ]£. Cerii oxalatis gr. xxiv.; Extracti gentianse gr. xxxvj. Misce, fiant pilutae duodecim, quarum capiat unam bis in die. [Disappointment from the use of this drug may be ex- plained by the fact that the commercial oxalate of cerium often contains salts of lanthanum, didymium, and other impurities. The chemically pure oxalate of cerium is probably one of the most efficient remedies against the vomiting of pregnancy that we possess; given in powder, in pill, or suspended in mucilage.] CETACEUM— SPERMACETI. [ A peculiar concrete substance obtained from Physeter macroccphalus, U. S. Officinal Preparations, U. S. Ceratum Cetacei, Charta Cantharidis, Unguentum Aquse Rosae.] ICELAND MOSS — PIPSISSEWA. 153 Requires no special notice. [Its internal use has been generally abandoned. The ointment, a perfectly bland preparation, may be used as a dressing to blistered surfaces. The unguentum aquae rosse, or cold cream as it is called, is much used for chapped hands and lips, and excoriated surfaces.] CETRARIA— ICELAND MOSS. \Cetraria Islandica (Acharius, Lichen Univ.), U. S. Officinal Preparation, U. S. Decoctum Cetrarise. Dose, f|ss.-iv.] This plant is supposed to have nutritious properties [and formerly enjoyed a great reputation as a demulcent and tonic in pulmonary affections']. [CHENOPODIUM— WORMSEED. The fruit of Chenopodium Anthelminticiun, U. S. Dose, in substance, gr. xx.-xl. Officinal Preparation. Oleum Chenopodii. Dose for a child, gtt. v.-x. Internal Effects. A popular remedy against lumbricoid worms. It may be given night and morning for two or three days, then to be followed by a brisk cathartic] [CHIMAPHILA— PIPSISSEWA. The leaves of Chimaphila umbellata (Picrsh, Flor. Amer. Sept.'), U. S. Officinal Preparations, U. S. Decoctum Chimaphilse. Dose, f Jij.-iv. Extractum Chimaphilse Fluidum. Dose, ttlxx.-xI. Wintergreen is an Indian remedy for scrofula, rheuma- tism, and nefhritic affections, and it enjoys some reputation as an alterative in regular practice, and has been recom- mended as a diuretic in dropsy. It is also tonic and astringent.] !54 CHIRETTA CHLORAL [CHIRETTA— CHIRETTA. The herb and root of Agathotes Chirayta, U. S. Not much used in this country. See note under Gentian . ] CHLORAL— CHLORAL. \Syn. Hydrate of Chloral, U. S. Treatment of Poisoning. There is no direct antidote for chloral, but the treatment must be conducted on general principles for narcotic poi- soning, by evacuants, counter-irritants, stimulants, and maintaining bodily heat.] Local Actions. Physiological. When applied externally, chloral has been by some authorities supposed to have sedative properties, and it is also an undoubted antiseptic. Tli erapeutical. It has been recommended as an external application in neuralgia, ' rheumatism, and other painful affections. Used as a dressing to ulcerated surfaces, it seems to act well by removing the fcetor of discharges and lessening pain ; and it has been successfully employed, in solution, for the preserva- tion of anatomical prepara- tions. Constitutional Actions. I . Nervous System . — i . Brain. — Chloral [acts as a sedative to the nervous cen- tres and secondarily to the heart. In small doses it pro- bably] produces an anaemic condition of the brain, and thus causes sleep by imitat- ing the natural anatomical i. Chloral is an excellent hypnotic, causing sound and refreshing sleep, without the digestive disturbance which usually follows the use of opium. It may be given in simple insomnia from mental worry, overwork, or other causes, and it is a remedy of CHLORAL. 155 arrangement of that process. The resulting slumber begins very quickly after the dose is swallowed, it is usually sound and dreamless, and the patient wakes in seven or eight hours, well re- freshed, and without any marked feelings of malaise or digestive disturbance. Exceptions to this, however, have been observed, and in these chloral has caused preliminary excitement ; but it is more than probable that an explanation may be found in the use of the impure specimens of the drug too often retailed. Liebreich believes that chlo- ral exerts its hypnotic influ- ence by undergoing trans- formation in the blood into chloroform and formic acid ; but this is improbable for the following reasons : — (1) The alkali of the blood is too feeble to liber- ate the chloroform, and the albumen is considered an- tagonistic to such a process. (2) No smell of chloro- form can be observed in the breath, and no anaesthetic effect is produced on the sleeper by moderate doses. 2. Spinal Cord. — The reflex irritability of the spinal cord is very decidedly lessened, and the respiratory centre becomes weakened, and eventually paralysed. great value in all diseases in which dangerous depression is apt to follow the continu- ous want of sleep. Thus, in typhus, in delirium tre- mens, where it must be pushed boldly in conjunction with an absolute suspension of all alcohol, in phthisis, acute mania, &c, we may prescribe it with much con- fidence of success. It has also been recommended in France as an anaesthetic by subcutaneous [intravenous] injection ; from 2 to 4 drachms, thus made to enter the veins, being there sup- posed to yield chloroform, which then exerts its usual influence. There is no reason, however, to believe that anaesthesia thus pro- duced is in any degree safer than the old mode of inha- lation ; and as the patient is thus exposed to the addi- tional risks of thrombosis, inflammation of the veins, and the entrance of air, one cannot wonder that this process has found no favor in this country. 2. Chloral is of service in some spasmodic diseases, as chorea, who oping- coitgh, asth- ma, ijicontinence of uri?ie, labor afterpains , &c. It is also undoubtedly useful in [trismus nascenlium, puer- 3 5 6 CHLORAL. 3. Sympathetic and general Nervous System. — The vaso- motor system is enfeebled, but no special effect seems to be produced on other nervous structures, unless we believe a part of the loss of muscular power, some- times observed in those who have taken chloral for some time, to be due to an action on the motor nerves. 1 1 . Circulatory System . — Chloral has a powerful action on the heart, lowering and weakening its action by paralysing its contained sympathetic ganglia. That this effect is not produced through the medium of the vagi is shown by the fact that it comes on even after these nerves are cut, and their terminal cardiac fila- ments paralysed by atropine. Along with this slowing of the pulse we get lessened arterial tension from dilata- tion of the superficial vessels. [Professor Wood 1 states that it would seem most probable that the chloral influences the heart through the centres at the base of the brain.] peral convulsions, and] cases of tetanus, several of which have recovered during its administration, and it may also be given as an antidote to strychnia. 3. Chloral, having no influence over sensory nerves, has no power, per se, of allaying pain, and is therefore useless in that class of cases where opium is of such signal service. II. Chloral, weakening cardiac action, must not be given where we have any reason to suspect an en- feebled state of^he heart muscle. 1 [Therapeutics and Materia Medica, 2d ed., Phila. 1877, p. 321.] CHLORAL, 157 III. Respiration and Tem- perature. — The breathing tends to become slower, and finally to cease, from paralysis of the respiratory centre ; but urgent dyspnoea has occasionally been ob- served, and this has been ascribed to dilatation of the pulmonary vessels, causing an increased afflux of blood to be directed suddenly to the lungs. The temperature falls, and this is no doubt due to surface evaporation pro- duced by the dilated cutane- ous vessels. IV. Secreting a?zd Diges- tive Systems. — No special influence is produced on any of these, but occasionally vomiting and purging have followed the use of chloral. III. This effect on the respiratory centre naturally suggests caution in pre- scribing chloral in cases of advanced bronchitis with rapidly accumulating mucus secretion and deficient oxy- genation of the blood. Absorption and Mode of Elimination. Chloral is rapidly absorbed by the blood, and given out probably by the urine. Poisonous Effects. Chloral may kill by car- diac syncope, and, as this effect has been known to follow a single dose of 30 grains, considerable caution must be exercised in its use ; or again, death may ensue from paralysis of the respi- ratory centre, with coma and gradual suffocation ; and, finally, a series of cases has been recorded in which 14 Antidotes. Here our efforts must first be directed to obviating the tendency to death. We must endeavor to restore the heart's action by warmth and stimulants ; promote breathing by irritation of the surface, galvanism, and arti- ficial respiration; counteract the rapidly-lowering tempe- rature, on which so much danger depends, by warmth; 158 CHLORAL. symptoms arose akin to and finally employ physio - blood poisoning, with pur- logical antidotes, such as puric and scorbutic erup- atropia and strychnia, tions, ulceration of gums, and great prostration, end- ing in death. Cautions, Mode of Administration, Dose, &c. [It is recommended that re-crystallized chloral should only be prescribed, as the commercial article is liable to be contaminated with impurities, and the results of decom- position.] The use of chloral requires caution, as many instances of death from its employment are on record, and other cases have been noted in which very serious symptoms followed doses varying from 30 to- 50 grains. We must also be mindful of other physiological peculiarities. Thus great muscular prostration, more especially affecting the legs, and causing staggering, not very unfrequently follows its continued use. Various skin eruptions, usually confined to the face, beginning as spots of roseola, coalescing to form patches of erythema, and the very peculiar deep flushing of the face following the use of stimulants and due no doubt to vaso- motor paralysis, have been carefully described by Dr. Crichton Browne and other observers. Considering the undoubted fact that not only dangerous symptoms, but even death, have followed a dose of 30 grains [and even of 10 grains], we must begin, as a rule, with 20 grains [or a smaller quantity], to be repeated as occasion requires. We must remember, however, that the narcotic action of chloral is not invariably exhausted in the single sleep to which it originally gives rise, but may be held over until next night, so that our best practice will be to give a full dose only once in the forty-eight hours. The taste and smell of chloral being pungent and disagree- able, we must endeavor to render our prescription as palatable as we can. The syrup contains 10 grs. to the drachm. Or we may use the following formula: — I£. Chloral hydratis gr. xx. ; Syrupi aurantii f ^j ; Aq. menth. pip. ad f^ij. M. Fiat haustus bora somni sumendus. CRO TON-CHLORAL J 59 [The addition of gr. v. of chloral to a small dose of morphia greatly adds to its hypnotic effect, and prevents unpleasant results that sometimes are produced by morphia alone. Note. — Chloral-Camphor. By rubbing together gum camphor and chloral, a fluid is produced resembling simple syrup. This has been recommended as a local anaesthetic in neuralgia, applied with a brush to the external skin. It is rubefacient, but not vesicating.] CROTON-CHLORAL. (Not Officinal.) \_A chlorated aldehyde of crotonic acid, made by the action of chlorine upon aldehyde.^ Local Action. None has been described. Constitutional Action. Physiological. I. Nervous System. — i. Brain. — Croton-chloral causes sleep in from fifteen to twenty minutes. Th erapeutical. I. Croton-chloral has been highly praised by its disco- verer, Liebreich, as a nar- cotic, being given by him in doses of from 15 to 30 grains. There is little En- glish experience to quote on this heading, as the doses used here are far too small to produce sleep ; but as the drug has no depressing ac- tion on the heart like chlo- ral, there is no doubt that we may prescribe it with comparative freedom. [Sub- sequent experience contra- dicts this view, as dangerous and even fatal symptoms have been produced by or- dinary doses in cases of organic heart disease. It appears to resemble chloro- form in its uncertainty and danger.] i6o CHLORINE. 2. Spinal Cord. — No ac- tion is produced on the spinal cord, nor consequent muscular relaxation. Some paralysing influence is event- ually exerted on the me- dulla. 3. Sympathetic and other Nervous Systems. — No influ- ence seems to be exerted on the vaso-motor nerves, but on the fifth a well-marked sedative effect is noted, indi- cated by anaesthesia of the head and face, loss of irri- tability of the eyeball, and failure of the nerve-trunk itself to respond to galvanic stimulation. II. Circulation. — Croton- chloral has no tendency to weaken or lower the action of the heart [in health]. III. Respiration and Tern- perature. — Croton -chloral tends to lower the rate of breathing, and eventually kills by paralysing the respi- ratory centre. 3. The anaesthetic influ- ence of croton-chloral would naturally suggest its use in facial neuralgia, and a good deal of success has been thus obtained in dealing with this troublesome affection, doses of from 2 to 6 grains having generally been prescribed. [Before administering this remedy the heart should al- ways be examined, as croton- chloral is contra-indicated by cardiac disorder.] III. [Croton-chloral close- ly resembles chloral hydrate in its action upon the system, except in possessing greater danger. For this cause its use has been afmost entirely discontinued in this coun- try.] CHLORINUM— CHLORINE. [Aqua Chlorini,U. S. Chlorine water. Dose,f£j.-iv.] The use of chlorine is almost entirely confined to its external application. Physiological A ction. TJi erapeutical A ction. 1. Concentrated chlorine 1. It is never, however, gas directed upon the skin used as a counter-irritant. CHLORINE 161 causes redness and smarting, followed by a pustular erup- tion and even erysipelatous inflammation. 2. It is an excellent dis- infectant, decomposing sul- phuretted hydrogen and am- monium sulphide at once and more effectually than any other gas, and also de- stroys organic matter in the air, as it bleaches organic pigments and destroys odors, either by abstracting hydro- gen or by oxidising (Parkes). 3. The inhalation of chlo- rine gas is stimulating or irritating to the lungs. 2. It is therefore exten- sively used as given off by chloride of lime to purify the air from offensive efflu- via, and to destroy infectious germs. In the form of lotion it is also used to cleanse foul or sloughing sores. 3. It has therefore been used in some forms of chro- nic bronchitis and phthisis, but is not now much em- ployed. [It may be used in strychnia-poisoning, ] Internal Use. Chlorine used to be given internally in medicine in va- rious infectious fevers with a view to disinfection, but this has now become quite obsolete. Dose and Mode of Administration. As a disinfectant it may be obtained by acting on chloride of lime with water or dilute sulphuric acid, or by pouring four parts by weight of strong hydrochloric acid on one part of powdered binoxide of manganese, or mixing four parts of common salt and one of binoxide of manganese with two parts by weight of sulphuric acid and two of wa- ter, varying the quantities according to the size of the room. Vapor chlori is used for inhalation, and liquor chlori may be employed diluted as a lotion, or n|,x. to n^xxx. be given internally. Disadvantage. The great drawback of chlorine is the very irritating nature of its vapor, rendering it unsuitable for general use in rooms actually inhabited by the sick. 14* 1 62 MURIATIC ACID. ACIDUM MURIATICUM— MURIATIC ACID. \An aqueous solution of hydrochloric acid gas, of the specific gravity i, 1 60, U. S. Officinal Preparations, U. S. Acidum Muriaticum Dilutum. Dose, n^x.-xx. Also enters into the preparation of Acidum Hydrocyan- icum Dilutum, Antimonii Oxidum, Calcii Phosphas Praa- cipitata, Carbo Animalis Purificatus, Quinise Sulphas, Strychnia, Sulphur Prsecipitatum, and Acidum Nitromuri- aticum, Aqua Chlorini, Barii Chloridum, Ferri Chloridum, Liquor Arsenici Chloridi, Liquor Calcii Chloridi, Liquor Ferri Chloridi, Liquor Zinci Chloridi, Morphias Murias, and Resina Podophylli. Antidotes. The same as the other mineral acids, the alkalies and their carbonates: magnesia, soap, and bland drinks may be freely given. Muriatic acid stains the mouth and lips black, when taken undiluted.] External Use. Hydrochloric acid is a good form of application to diph- theriavfYizn. it is used combined with equal parts of honey. Internal Use. Of all the acids used in medicine, this has undoubtedly the most beneficial action in dyspepsia, on account prob- ably of its forming one of the normal constituents of the gastric juice. In cases where we suspect the formation of an excessive quantity of this fluid, we may, on the princi- ples already enunciated, limit its secretion by prescribing the acid immediately before meals. When the epigastric pain comes on immediately after eating, the condition is no doubt due to an irritable or perhaps ulcerated con- dition of the stomach itself, and we may best hope for success by carefully regulated diet and the use of bismuth, soda, or hydrocyanic acid. But when the pain does not set in with severity until from an hour to a couple of hours after food has been swallowed, the explanation probably is that an abnormal excess of gastric juice has been secreted, and a recurrence of this will best be checked by giving a little of the acid before meals. CHLOROFORM. 163 Hydrochloric acid has also been much recommended by Dr. Chambers and others in typhoid fever, and it will gen- erally be found that 20-minim doses of the dilute acid are very grateful to the patient, as quenching the thirst and moistening the tongue. Dr. George Johnson has recent- ly taken exception to this, on the ground that the acid irritates the ulcerated surfaces of Peyer's patches ; but not only does mere empirical experience demonstrate the harmlessness as well as the convenience of this mode of treatment, but it is quite evident that the contact of at least three alkaline secretions must considerably modify the reaction of the acid before it reaches the seat of disease, and prevent it from retaining much irritating power, and I should therefore look upon these views of Dr. Johnson as having little practical value. Dose. In dyspepsia rrrxx. ad xxx. In typhoid fever nrxx. every two hours. $.. Acidi hydrochlorici dil. Til_xx. ; Sp. chloroformi rr^xv. ; Gentianse infusi f §j. M. S. Ter in die. In dyspepsia. CHLOROFORMUM— CHLOROFORM. [Chloroformum Venale, U. S. Commercial Chloro- form. Chloroformum Purificatum, U. S. Purified Chloro- form. Officinal Preparations, U. S. Mistura Chloroformi (f^ss. in fjvi.). Dose, f^ss. Spiritus Chloroformi (f.lj. to Alcohol f^vj., U. S.). 1 Dose, f5ss.-j. Linimentum Chloroformi (f chloroform, | olive oil). Liquor Gutta-Perchae. And in preparing Atropia. t Poisoning. In the treatment of chloroform-narcosis when there is failure of the circulation, vigorous and prompt measures 1 [Spiritus Chloroformi, Br., contains one part in twenty.] 164 CHLOROFORM. are called for. The surface of the chest should be smartly slapped with the fringe of a towel dipped in ice-water, a piece of ice may be introduced into the rectum, the head must be lowered and the legs elevated, and ammonia held to the nose; an assistant meanwhile practising artificial respiration. This treatment Prof. Gross has found to be invariably effective, and he has not lost a patient out of more than 5,000 cases of chloroform-anaesthesia.] Local Action. Physiological. Chloroform, when allowed to remain for some time in contact with the skin, acts as an irritant, causing redness and smarting, followed by vesication. It has also, however, some sedative properties. ' Chloroform is an excel- lent solvent of caoutchouc, gutta percha, and many fats and resins, and it also greatly assists the cutaneous absorp- tion of most of the alkaloids. Th erapeutical. The locally sedative ac- tion of chloroform has led to its extensive use as an appli- cation for the relief of rheu- matic or neuralgic pains, the liniment being a convenient form. It is also a useful remedy for allaying the itching of some chronic forms of skin disease. Constitutional Action. Chloroform, when taken internally, may act as a stim- ulant, sedative, and anti- spasmodic. It is a useful remedy in hysteria, asthma, and nervous palpitation, for the arrest of sea-sickness and other forms of vomiting, and for the soothing and quieting of some forms of irritable cough. Combined Local and Constitutional Effect. Under this heading it may be convenient to discuss the anaesthetic properties of chloroform, and this we will now proceed to do on the plan adopted generally throughout these pages. CHLOROFORM. 165 Physiologic a l. 1. On Brain and Nervous System. — Chloroform has first a stimulating, and sec- ondly a sedative, action on the brain, a good deal of excitement and struggling taking place during the early- stages of inhalation, whilst, during the later, narcosis is complete, and the patient lies quiet and motionless. This condition resembles natural sleep in being asso- ciated with anaemia of the brain, but differs by its ren- dering the patient quite in- sensible to external impres- sions, including the most severe cutting operations, this effect being due to a paralysing influence of the drug on the ganglionic cen- tres of the sensory nerves. The reflex functions of the cord are also lulled to slum- ber, and, if the inhalation is pushed too far, paralysis of the respiratory centre may • ensue. 2 . Heart and Circulation. — On the heart the influence of chloroform is at first slightly stimulating, the pulse becoming quickened ; but secondary depression fol- lows from a paralysing in- fluence on the sympathetic ganglia, the pulse now grow- ing slower, and the arterial tension becoming lowered. 3. Respiration and Tein- perature. — The respiration Th erapeictical. In the early stage of in- halation the patient usually feels confused and giddy, his eyes are suffused, his face congested, and the heart beats rapidly. This is often followed by apparent insen- sibility, from which, how- ever, he can readily be roused, and very frequently a stage of violent excitement ensues, during which he struggles violently and with remarkable muscular force, talking and singing incohe- rently meanwhile. This stage has been described as that of alcoholic intoxica- tion. Succeeding to this we have that of ' anaesthesia,' in which he is profoundly insensible, with contracted pupils ; and finally we reach that of ' narcosis,' in which the face becomes congested, the pupils dilate, and sterto- rous breathing sets in. Chlo- roform inhalation is [only] used during its first stage to alleviate the pain of child- birth, it being found that full anaesthesia under these circumstances is apt to relax the uterine muscular tissues, and not only to check their contraction, but to predis- pose to future haemorrhage. During the second stage chloroform is used for the purpose of obtaining full and complete insensibility to pain during the performance i66 CHLOROFORM. tends at first towards in- creased rapidity, but if the inhalation is pushed so far as to affect the respiratory- centre, the breathing grows slower, and finally ceases. We usually observe some tendency to perspiration at- tending chloroform inhala- tion, and a consequent slight reduction of temperature. 4. On the digestive and secreting organs chloroform seems to exert no marked influence, the sickness so fre- quently observed during re- covery being purely reflex in character. of operations ; and this inva- luable property has deprived the practice of surgery of much of its former horrors. We also employ it freely to relax muscular tension and spasm, and so facilitate the reduction of hernia and dislocation ; for diagnostic purposes, in order to dispel phantom uterine tumors, as well as to enable us to make a careful examination of ex- tremely painful parts. It is also of service for the relief of various forms of spasmodic affections, as whooping-cough, infantile and puerperal convulsions, cho- rea, and to alleviate pain, in cancer, during the passage of renal or biliary calculi, and under many other condi- tions. Poisonous Properties. Chloroform may kill in two ways. (1) By primarily paralysing the heart, and this has generally been consider- ed to be due to the inhalation of air too highly charged with chloroform vapor, Mr. Clo- ver holding that over 5 per cent, must be considered dangerous. Dr. Brunton, however, explains very inge- niously how it is that small doses are more apt to pro- duce this effect than large, and thus shows us, what could hardly be understood before, why so considerable During chloroform-inha- lation we must watch the , pulse, and specially note en- feeblement, irregularity, or cessation of its beats. Sud- den pallor of the face, livid- ity, and gasping for breath are signs of ill omen. If the action of the heart seems to fail, we must administer stimulants by the mouth or rectum, and excite the cuta- neous surface. Galvanism seems more likely to exhaust than excite the contractility of the heart muscle ; and galvano-puncture, so much CHLOROFORM. 167 a proportion of chloroform deaths have occurred during the performance of very tri- vial operations. It seems highly probable, however, that, in accordance with the views of Syme, Lis- ter, Chiene, &c, fatal acci- dents from chloroform are not so liable to proceed from the heart as (2) from the respiratory function; and this mode of fatal accident has been again subdivided into two headings : 1st. Death by apncea, or stoppage of the breathing from nervous in- fluence or mechanical causes. 2ndly. By suffocation from excessive formation of car- bonic acid in the blood. Of these, the first is by far the more common, and is often caused by falling back of the tongue, closing the glottis. It therefore follows that, whilst engaged in the admin- istration of chloroform, the breathing must be very care- fully watched. Absorption and Elimination. Chloroform is rapidly absorbed and rapidly given off by the breath and urine, in which secretion it can be readily detected. Mode of Administration. Fatal accidents from chloroform have become so alarm- ingly frequent of late, that some surgeons even consider its use unjustifiable ; but it is on the whole by far the best anaesthetic, and, by adopting the following precautions, we may hope to imitate the success of the Edinburgh School, where danger or inconvenience rarely occurs, vaunted by foreign observ- ers, has not been tried in this country. Chloroform accidents de- pending, in a great majority of cases, on failure of respi- ration, we must endeavor to re-excite this function by cold sprinkling or ammonia vapor, but most hopefully by the steady and persevering use of artificial respiration. Always, however, see that no mechanical hindrance to breathing exists, and more especially take care to draw the tongue well forward. Galvanic stimulation of the phrenic nerve has been recommended, and several apparently hopeless cases have been saved by the pro- cess of inversion as origi- nally proposed by Nelaton. l68 CHLOROFORM. Mr. Syme having met with no death during 8,000 admin- istrations. i. Never permit inhalation to take place in a sitting pos- ture, and see that the patient's neck is free from all con- striction. 2. Give strict orders that no solid meal be taken for at least two or three hours previously [solid food should not be eaten for at least twelve hours, as a safe precaution], but a little beef-tea may be allowed, and a small sip of brandy is useful just before the operation. The sickness which so frequently attends a loaded stomach is not only inconvenient, but has proved fatal by suffocation from the drawing of vomited matters into the air-passages. And, in addition to this danger, vomiting is attended with special risks after such operations as ovariotomy and cata- ract extraction, and after the first of these it occasionally continues with exhausting pertinacity. 3. Use no special form of inhaler, but pour the chloro- form freely on a towel or other porous material, and give it without fear [allowing a free admixture of the vapor with sufficient atmospheric air]. Tell the patient to close his eyes and to inspire deeply, and when the period of excitement comes on do not suspend the inhalation, but keep the towel firmly applied to the face until calm sleep is produced, or the slightest indication of stertor is heard. Complete anaesthesia is proved by abolition of reflex action, as shown by insensibility of the eye [when the cornea is lightly touched with the finger], by muscular relaxation, and by insensibility to pain. When the operation is over, let the patient recover naturally, and do not disturb his sleep by the purposeless towel flickings so frequently to be seen in operating thea- tres. [But the patient should be carefully watched for at least an hour after administration.] As regards the quantity of chloroform to be used for each inhalation, it is impossible to lay down any rule, for the inconveniences occasionally met with seem to bear no sort of proportion to the dose of the anaesthetic. [A couple of drachms may be poured from a dropping bottle upon the towel, and a few drops added from time to time to replace loss by evaporation. The chloroform should never be trusted to any but a skilled assistant.] If the chloroform be of good quality, it is safer, as shown IRISH MOSS — BLACK SNAKEROOT. 169 by Brunton, to give it freely, and it is better to trust to our own care and skill than to the fancied safety of in- halers. It can never be possible to deprive an unnatural condition like profound anaesthesia of all dangers, and even the theoretically safe instrument of Clover, with its guaranteed 3 per cent, of chloroform vapor, has been shown to be not absolutely free from risks. It would be very satisfactory could we lay down any laws for our guidance in anticipating danger from chloro- form inhalation in any special class of cases, but this un- fortunately we cannot do. It is now well known that neither organic disease of the heart nor conditions of ex- treme debility are contra-indications ; and although fatty heart is frequently discovered post mortem, we cannot absolutely state that this is not a mere coincidence, nor can we pretend to diagnose such degeneration with any certainty during life. Some authorities believe that chlo- roform is more dangerous to the old than the middle-aged or young, and there seems no doubt that habitual topers are brought under its influence with considerable difficulty. Chloroform is most generally given internally under the form of the spiritus chloroformi, or chloric ether, in doses of from ttlx. to f3j- [or as Mistura Chloroformi]. [CHONDRUS— IRISH MOSS. Chon dr us crispus, U. S. Carrageen is demulcent and nutritive, and is used in decoction Qfss. to Oiij.) flavored with lemon, as a ptisan or drink for the sick. Boiled with milk it makes carra- geen blanc mange, an acceptable and nourishing article of diet for an invalid.] CIMICIFUGA— BLACK SNAKEROOT. [ The root of Cimicifuga racemosa, U. S. Officinal Preparation, U. S. Extractum Cimicifugae Fluidum. Dose, f^ss.-j. The decoction, although not officinal, has been used to a considerable extent, and with benefit, in the treatment of chorea in children. It is sedative and antispasmodic, and in large doses vomits.] 15 170 CINCHONA. This drug was introduced into practice in this country [England] some years ago by Sir"]. Simpson, who praised it highly in chronic rheumatism, lumbago, and hypochon- driacal depression. It has been found useful in America as an emmenagogue , but has never taken any real hold upon professional attention at home. Dose of the tincture [Br.], 10 to 30 minims. CINCHONA— CINCHONA. \_Syn. Peruvian Bark ; Cinchona Bark: The bark of all species of /he genus Cinfhona, containing- at least two per cent, of the proper cinchona alkaloids, which yield crystalline salts, U. S. Varieties. Cinchona Flava. The bark of Cinchona calisaya, U. S. Cinchona Pallida. The bark of Cinchona Condami- nea, and of Cinchona micrantha, U. S. Cinchona Rubra. The bark of Cinchona succirubra, U. S. Officinal Preparations, U. S. Of the Yellow Bark: — Cinchoniae Sulphas. Dose, gr. ij.-xxx. Decoctum Cinchonae Flavae. Dose, f.^ij.-iv. Extractum Cinchonae. Dose, gr. v.-xv. Extractum Cinchonae Fluidum. Dose, gtt. v.-xv. Infusum Cinchonae Flavae. Dose, f^ij, Quiniae Sulphas. Dose, gr. ij.-xx. Pilulae Quiniae Sulphatis (each gr. j.). Tinctura Cinchonae. Dose, f 3j. — ij. Of the Red Bark:— Decoctum Cinchonae Rubrae. Dose, fgij.-iv. Infusum Cinchonae Rubrae. Dose, f^ij. Tinctura Cinchonae Composita. Dose, f3j--ij-] Effects and Uses. In any comparative estimate of the absolute importance of various drugs to the human species, cinchona would probably take the second place, the first being, by univer- sal consent, accorded to opium. The actual bark itself, however, is not now of so much importance as in former years, when it was our sole dependable remedy for the CINCHONA. 171 poison of ague, and was then given in such enormous quantities as to be very embarrassing to the weak stomachs of feverish patients. This difficulty is now happily removed, and much greater precision and efficiency given to our treatment, by the introduction of quinine, the discovery of which in 1820 inaugurated a true era in therapeutics. The preparations of cinchona are now used almost exclu- sively on account of their tonic properties, and in many cases of general debility, want of appetite, and loss of tone, most gratifying results are obtained by their employ- ment either singly or in combination. Quinine itself, however, has a higher and wider therapeutic range, and has in recent years obtained so much of the careful atten- tion of physiologists that we are bound to consider its properties with as much care and precision as the present state of science allows. Local Action. Quinine is occasionally, although rarely, used as a local application; but the theory of this is so intimately bound up with its internal use, that we need not refer specially to it at present. Internal Action. Physiological. Therapeutical. I. Nervous System. — 1. I. The subcutaneous injec- Brain. — Quinine in large tion of quinine has been doses causes curious brain highly recommended by symptoms, such as partial Surgeon-Major Hall in sun- blindness, well-marked deaf- stroke. ness and ringing in the ears, This mode of administer- giddiness, and frontal head- ing the drug, however, is not ache, associated with a pecu- unfrequently followed by in- liarly dull, heavy expression flammation and even abscess of countenance. Binz has at the seat of puncture, suggested that some at least The oxytocic action of of these phenomena may be quinine must be, in part at due to partial anaemia of the least, due to its action on the brain, caused by enfeebled nervous system ; but its un- action of the heart. doubted power in contract- It contracts the uterus. ing the uterus has not yet 2. Spinal System. — In been much used in medicine, frogs, quinine acts power- [It appears to be appreciated 172 CINCHONA. fully in reducing the reflex irritability of the cord, the animal lying motionless, quite insensible to external impressions, the stillness be- ing only broken by occa- sional tetanic spasms. II. On Vascular System — Moderate doses of quinine increase the frequency of the pulse, but, if larger quantities be given, the rate of pulsation falls, the arterial tension diminishes, and death may even ensue from convulsions or sudden collapse following depres- sion of the heart's action. Quinine has a direct ac- tion on the white corpuscles of the blood, checking their amoeboid movements, and arresting their tendency to migrate through the walls of the capillaries under inflam- matory conditions. It also prevents, in some degree, the due giving up of oxygen by the red corpus- cles, and may thus interfere with the oxygenation of the tissues. III. Respiration and Tem- perature. — No influence on the respiratory function has been observed. On the temperature of a person in full health but little lowering effect is produced ; when fever is present, however, the temperature may be brought down by giving large doses. Opinions differ in the United States. Here it is frequently used as a parturifacient in single doses of gr. x.-xv.] II. Quinine has therefore some stimulating properties. An essential part of in- flammation and suppuration is now known to be extrusion of the white blood corpuscles from the capillaries, and their subsequent transformation into pus- cells. Quinine may therefore be of great service in localised inflammations, and in checking exhausting discharges from abscesses or wounds. III. The antipyretic pro- perties of quinine are much prized in Germany, and it is there largely used in the treatment of typhus, typhoid, acute rheumatism, and pneu- monia. Immense doses, even reaching 75 grains, have been given, and it is ob- served that tolerance of the CINCHONA 173 so much as to the explana- tion of this effect, that it is impossible to speak with any confidence on the ques- tion. [According to Hen- bach the cause of death in animals poisoned with quinia is a paralytic arrest of respi- ration.] IV. On Secretion. — In moderate doses, quinine in- creases the secretion of saliva, and augments, like most bitters, the flow of gastric juice, stimulating the appetite at the same time. If larger quantities, how- ever, are taken, an exactly opposite effect is produced ; hunger is blunted, and the alkaloid, acting as an irri- tant to the mucous mem- drug is undoubtedly present [in fever], and that very much larger quantities can be taken than in a state of health. It is only when very freely given, however, that it has any cooling influence ; and we are advised to pre- scribe from 25 to 45 grains in divided doses within the first half hour, as the effect would be diminished by spreading it over a longer time. In this country we do not make very extensive use of quinine in febrile disorders, for the resulting diminution of temperature is only tem- porary, and has no influence on the progress of the dis- ease. When a really dan- gerous degree of pyrexia is reached, we know that we can hold it readily in check by cold baths. [But where hydropathic treatment is in- admissible, quinia in full doses is an efficient anti- pyretic] IV. Quinine is the best tonic we possess, increasing the appetite, and bracing up the intestinal mucous mem- brane. It is given, there- fore, in all states of the system where debility is present, in simple loss of appetite, in some forms of dyspepsia, in neuralgia, es- pecially of the supra-orbital nerve, in convalescence from acute disease, to arrest 174 CINCHONA. brane of the stomach, checks the gastric juice. The urine is found to be unaltered in quantity, but the amount of uric acid and probably of urea given off is decidedly diminished. V. Quinine is an excellent antiseptic, preventing and ar- resting decomposition. This it does in virtue of its poi- sonous influence over minute organisms, for we know that the process of decay is caused by the formation and rapid multiplication, within the pu- trefying fluid, of microscopic bodies called microzymes. Quinine in small doses para- lyses, and in larger destroys, these creatures, and so at once arrests further destruc- tive action. the nocturnal sweating of phthisis, &c. V. In virtue of this poison- ous influence over proto- plasm and minute germs, it has been recommended in large doses in whooping- cough, on the ground of de- stroying the vitality of the thick and tenacious mucus which causes so much irrita- tion in the bronchial tubes, or, as others hold, by de- stroying the minute fungus on which the disease de- pends. [Henke.] Again, in hay -fever, which is now proved to result from the local action on the Schnei- derian mucous membrane of the pollen of particular grass- es, Professor Helmholtz has lately pointed out that qui- nine applied in the form of snuff or strong solution [gr. j.-f^j.], will effect a speedy cure. Some authorities have also been inclined to ex- plain its remarkable influ- ence over ague by theoreti- cally supposing that the es- sence of the malarial poison really consists in a minute germ or vegetable cell derived from the marshy land where the pestilence breeds, and that the antisep- tic property of the drug is CINCHONA. 175 here the true explanation of its therapeutic success. But this is far-fetched and barely- probable. Specific Action. Quinine has what, for want of a better explanation, we must call a specific control over all malarial fevers and diseases which display any periodical tendency. Now quinine may act as a prophylactic, and, given in moderate doses at regular intervals, may ward off attacks; and this fact is extensively taken advantage of by African travellers and troops stationed in malarial districts, to whom rations of quinine are invariably served out. When the disease, however, is fairly developed, quinine will keep it in check and even arrest its progress ; and this either in smaller doses frequently repeated, or in one con- siderable dose taken shortly before the attack is expected. The periodical return of the paroxysms of shivering, heat, and sweating, enables us to calculate with accuracy the very hour of the day at which to expect their recur- rence ; and experience has determined that the best mode of treatment is to give one full dose of 10 or 20 grains half an hour before the attack comes on. The remarkable enlargement of the spleen which at- tends intermittent fever is often so rapidly diminished by quinine as to make it probable that the reduction of bulk is due to an active contraction of the substance of the organ itself. Another curious point about the action of quinine is, that whilst it may check the rigors and rise of tempera- ture attending the aguish paroxysm, the quantity of urinary water and urea excreted may be as much increas- ed as they always are during the attack. Quinine is also an invaluable agent in some of those affections which, without belonging directly to the aguish category, have something of the intermittent quality impressed on them ; for example, we often find that neu- ralgia and various forms of headache are distinctly perio- dic, and return at regular intervals. In such cases quinine ' works wonders, and may effect a cure with almost magical rapidity. 176 cinchona. Mode of Elimination. Quinine, being possessed of considerable diffusive power, rapidly enters the blood, and is rapidly given out, the elimination beginning two hours after the drug is swallow- ed, and being nearly completed in six hours, by which time nearly all the quinine has been thrown out of the system. Although traces of its presence have been found in the saliva, sweat, and intestinal secretion, it is by the urine that the greater part is given off. Disadvantages of its Use. In addition to the headache, deafness, ringing in the ears, and other physiological phenomena, already noted, some cases have been recorded of a peculiar bright-red, scarlatinoid eruption, accompanied by intolerable itching and smarting, and followed by copious desquamation. And we must remember that idiosyncrasy here plays an important role, and that some persons cannot take a single grain without inconvenience. Therefore, as before advised, it is always well, before prescribing quinine, to ask our patient if he has ever taken it before. Mode of Administration and Dose. This drug is best prescribed in mixtures with a little nitric [or dilute sulphuric] acid, as tinctures do not dis- solve it well ; though, as Ringer says, it is really unneces- sary to combine acid, as the quinine is readily soluble in the acid of the gastric juice. But a little acid makes a more elegant mixture, by removing that turbidity which a certain quantity of the undissolved alkaloid necessarily imparts to a solution. The dose varies from about gr. j., which is the usual tonic dose, to 10, 20, 30 grains, or even more ; and although in this country a larger quantity than 10 grains is perhaps rarely prescribed, it is clearly absurd to put the maximum dose, as in the British Pharmacopoeia, so low as this. [To avoid the bitter taste of quinia is absolutely neces- sary in some cases. For this purpose it is sometimes ordered in sugar-coated pills, or inclosed in cachets de pain. The powder may be given to children in a spoonful of syrup of red orange, or mixed with honey or molasses ; CINCHONA. 177 it may also be taken in coffee, or simply suspended in cold water. The quinia may be enveloped in tissue paper and twisted tightly into a ball ; a little practice will enable an adult to deftly swallow such a bolus without tasting, and with but little inconvenience. The aromatic elixir of gly- cyrrhizin has been recommended as the best vehicle for the administration of the sulphate of quinia ; x but prepara- tions containing licorice, such as the officinal fluid extract of taraxacum, or the compound licorice mixture, are quite satisfactory for this purpose. Tannin has the power of disguising the taste of quinia, and, according to Rolander, it does not detract from its therapeutic properties. The following formulae will be found useful for the administra- tion of quinia in solution. For children — I£. Quinise sulphatis gr. xxiv. ; Acidi tannici gij. ; Syr. cinnamomi f § i i j . M. Capiat cochleare parvum ter in die. Or, as the disulphate — I£. Quiniae sulphatis Acidi sulphurici dil. Tr. cardamomi co. Syrupi q. s. Dose, f 5j. gr. xxiv. ; 1 OJ • > adfgiij. M. Or, in a cough mixture — ]$.. Quinise sulphatis Acidi sulphurici dil. Mist, glycyrrhizoe co gr. xxiv. ; q. s. ad solve . ad. fgiij. M Dose, a teaspoonful. In the declining stage of whooping-cough. For adults, any of the preceding prescriptions may be used, or we may give the following : — I£. Quiniae sulphatis gr. xlviij. ; Acidi sulphurici dil. q. s. ; Syr. limonis f^ij- j Aqua? q. s. ad f^vj. M. each drachm containing one grain of quinia. A more pleasant preparation would probably be obtained by sub- stituting Curacoa cordial for the lemon syrup. As a tonic 1 Remington, Med. and Surg. Rep., vol. xxxvii. p. 88. Phila., 1877. 178 CINCHONA. carminative, the following proves very acceptable in weak- ened digestion : — I£. Quiniae sulphatis gr. xlviij. ; Acidi sulphurici dil. q. s. ad solve ; Tr. gentianae comp. f §iv. ; Syr. zingiberis q. s. ad ffvj. M. Dose, a dessertspoonful before meals. Wine of aloes may be appropriately added, should con- stipation be present in the case.] R. Quiniae sulphatis gr. viij. ; Acidi nitrici diluti f 5ss. ; Tincturee aurantii f ^ss. ; Syrupi aurantii f|j. ; Aquae ad f § viij. M. Dose, f§j. ter die sumend. For a case of debility and want of appetite. Some persons, who object to sweets, prefer the syrup to be left out ; but it will usually be found an agreeable addi- tion. Quinine may also be given in the form of simple powder, dissolved in a glass of sherry, and when a large dose, such as 10 grs., is prescribed, it is more conveniently taken in simple suspension in distilled water. A very common plan is to order quinine with acid infusion of roses, but Squire has pointed out that a turbid and unsightly mixture is thus produced from the resulting tannate of qui- nine being insoluble in sulphuric acid ; whereas if the infusion be made with nitric acid, the mixture is ' bright and attractive in appearance.' Preparations. Pilulse quiniae. Containing sulphate of quinine and [honey, U. S., or] confection of hips [Dog Rose, Br.]. Dose, 2 to 10 grs. Tinctura quiniae [Br.]. A solution of quinine in tincture of orange-peel in the proportion of 1 in 60. Dose, f 3j- ad fjjss. This is a useful preparation. Vinum quiniae [Br.]. A solution of sulphate of quinine and citric acid in orange wine, the proportion being 1 in 480. Dose, fjjss. ad f^j. In addition to quinia, however, other alkaloids and sub- stances have been detected in bark, some of which are of use in medicine. We have : — 1. Quinic or kinic acid. 2. Quino-tannic acid. CINNAMON. 179 3. Cinchona red. 4. Kinovin. These four have no therapeutic significance. 5. Cinchonia has some febrifuge power. 6. Quinidia has been reported as nearly equal to qui- nine in the foregoing respect [and is an efficient substitute for the more expensive salt]. 7. Cinchonidia is only a little less efficacious, but causes an unpleasant dryness of the mouth. None of these preparations have been able to take the place of quinine, as they are weaker, less certain in action, and less agreeable ; and quinine, notwithstanding its com- paratively high price, still retains its position as our most reliable antiperiodic. The preparations of cinchona, as we said before, are principally used for their tonic properties ; and there is perhaps no more pleasant and effectual medicine of this class than the ordinary tincture of bark, whilst the decoc- tion or infusion is in very general use as a vehicle for more active drugs. Of the yellow bark we have the powder given in 15 gr. doses. 1. Decoctum cinchonas [flavas], 1 in 16. Dose, f^j. ad 2. Extractum cinchonas liquidum [Br.]. Dose, 10 to 30 minims. 3. Infusum cinchonas [flavas], 1 in 16. Dose, f^j. ad f ^ij. 4. Tinctura cinchonas, 1 in 5. Dose, f3j. ad f3ij. [The elixir of cinchona flava, though not officinal, is an elegant preparation, and is much used. Dose, f^j.-iij.] Of the pale bark there is the powder. Dose, 10 to 60 grs. _ Tinctura cinchonas composita. [Huxham's tincture.] Containing powdered [red] bark, bitter orange-peel, ser- pentaria, saffron, cochineal, proof spirit. Dose, ^ to 2 drachms. CINNAMOMUM— CINNAMON. \_The prepared bark of Cinnamomum Zeylanicum (Nees Laurin), and of Cinnamonmm aromaticum [A T ees, ibid.), U. S. Oleum Cinnamomi. Dose, gtt. i.-ij. ISO COCHINEAL — COLCHICUM. Officinal Preparations, U. S. Tinctura Cinnamomi (Jjss. to Oj.). Dose, f3j.-ij. Aqua Cinnamomi — as a vehicle. Pulvis Aromaticus (cinnamon and ginger each 2 parts, cardamom and nutmeg each 1 part). Dose, gr. x.-xx. Confectio Aromatica (pulv. aromat. and honey). Spiritus Cinnamomi (oil |j. in Oj.). Dose, f3j.-ij. Also enters into : — l Acidum Sulphuriciim Aromaticum, Infusum Catechu Compositum, Spiritus Lavandulae Compositus, Syrupus Rhei Aromaticus, Tinctura Cardamomi Composita, Tinc- tura Catechu, and Vinum Opii.] Cinnamon is principally used for flavoring purposes, but also seems to have slight astringent properties, which make it useful in diarrhoea. [It has been also strongly recom- mended in uterine hemorrhage, given in substarfce, dose, gr. v.-x., or as a decoction made with milk.] [COCCUS— COCHINEAL. The female of Coccus cacti, U. S. It enters into Tinctura Cardamomi Composita. Cochineal has been considered to possess antispasmodic and anodyne properties, and has been recommended in wlwoping-cough (gr. yj,, s. t. d., to infants) combined with carbonate of potassium. It is also used in neuralgia. In pharmacy it is used as a coloring agent.] [COLCHICUM— COLCHICUM. Colchici Radix. The corm of Colchicum autumnale, U.S. Colchici Semen. The seed of Colchicum autumnale, U.S. Officinal Preparations, U. S. Extractum Colchici Aceticum (of the root). Dose, gr. j.-ij. Extractum Colchici Radicis Fluidum. Dose, nv.ij.- iv. Vinum Colchici Radicis (^vj. to Oj.). Dose, gtt. x.~ xv. As a purgative, nrxxx. COLCHICUM. 181 Extractum Colchici Seminis Fluidum. Dose, n^ij. -vj. Tinctura Colchici (of the seeds, =§ij. to Oj.). Dose, f5ss.-j. Vinum Colchici Seminis (of the seeds, ^ij. to Oj.). Dose, 3ss.-jss.] Internal Action. Physiological. The leading physiological action of colchicum is un- doubtedly directed to the intestinal canal, large doses causing free vomiting and copious purging of yellow- ish faeces containing a large quantity of bile. The action of the heart is usually some- what depressed, and it has been stated that the urinary secretion is augmented, but of this there is no very clear proof. [Colchicum increases the proportion of the urea and uric acid, as well as the amount of urine excreted by the kidneys, according to Prof. Christison, Dr. Mac- lagan, and others. The active principle is an alkaloid, colchicia, which is from 80 to 100 times stronger than the fresh corm.] Therapeutical. As the experiments of Rutherford have shown that colchicum increases the bil- iary secretion, it may be a useful adjunct to cholagogue pills, although its own pur- gative action is too violent to be encouraged. Its principal use is as a remedy for gout, more espe- cially the acuter forms, and here it never fails to remove pain rapidly, without, how- ever, in any way lessening the tendency to future at- tacks. How it acts is un- known, and we can only call it a specific. It is also very valuable in various diseases of gouty parentage, as in some forms of dyspepsia, bronchitis, &c. ; but in acute rheumatism it has been proved to exert rather a noxious than a beneficial influence. Dose and Mode of Administration. Colchicum may be given either in one or two full doses, or in smaller quantities spread over a longer time. Of these plans the former is probably the more effectual in - an acute attack of gout. The following formulae are suitable for various gouty conditions : — 16 162 COLOCYNTH. ]J. Tinctura? colchici seminis T>|xx. ; Potassoe bicarbonatis gr. x; Aquae pimentse [Br.] f §j. Misce, fiat haustus ter die sumendus. I£. Tinctura? colchici seminis n\xv. ; Magnesia? carbonatis gr. vj.; Magnesia? sulphatis gr. xxx. ; Aqua? mentha? piperita? ad f§j. M. S. Ter die sumendus. I£. Extracti colchici acetici gr. x.; Pulveris digitalis, Extracti colocynthidis comp. aii £)j. Misce, fiant pilula? xx. Sumat unam bis terve in die. I£. Potassii iodidi, Ammonii carbonatis aa 9J- > Vini colchici f5j. ; Tinctura? scilla?, Tinctura? hyoscyami aii f5U- ; Aqua? camphora? ad f^iij. M. S. f^ss. ter die. Dr. Greenhow's formula for gouty bronchitis. [Scudamore's mixture: — I£. Magnesia? sulphatis §j . — Ij . ; Magnesia? 5lJ-> g r - x h > Aceti colchici f§j.— jss. ; Syrupi croci [Br.] f § j . ; Aqua? mentha? pip. f §x. M. Dose, f§ss.-jss. repeated every 2 hours in a paroxysm of gout until from four to six evacuations are produced in the 24 hours. The Acetum colchici was omitted from the Pharmaco- poeia in the last revision. It was made from the conn, and was only one-third the strength of the officinal wine of colchicum root.] COLOCYNTHIS— COLOCYNTH. \_The fruit, deprived of its rind, of Citrullus Colocynthis, U. S. Officinal Preparations, U. S. Extractum Colocynthidis (alcoholic). Used only in combination. Extractum Colocynthidis Compositum. gr. v.-xxx. Pilulae Catharticse Compositae. 1-3 pills.] Physiological A ction. Therapeutical A ciion. Colocynth produces a Colocynth is a drastic good deal of irritation of purgative, rapid and efficient the large intestine, causing in its action, and much used CONFECTIONS — HEMLOCK. 183 profuse watery evacuations, as an ordinary remedy in and, if given in excessive habitual constipation and dose, even proving fatal by various dyspeptic condi- inflammationand ulceration, tions. It is found, however, that its drastic action, as well as the griping to which it occasionally gives rise, may be obviated by combination with aromatics and other purgatives. Mode of Administration. Colocynth is rarely, if ever, prescribed alone. The compound extract or pill, containing, in addition, aloes and scammony, is a useful formula; but the best mode of combination is undoubtedly that with either hyoscyamus or belladonna. [Confectiones. The officinal Confections are: — Confectio Aromatica Confectio Rosse " Aurantii Corticis " Sennas.] " Opii CONIUM— HEMLOCK. [Conii Folia. The leaves of Conium maculatum, U.S. Conii Fructus. The full-grown fruit of Conium macu- latum, gathered while yet green and carefully dried, U. S. Officinal Preparations, U. S. Extractum Conii Fructus Fluidum. Dose, n^i.-v. Extractum Conii (of the leaves). Dose, gr. i.-ij. Extractum Conii Alcoholicum (of the leaves). Dose, Succus Conii. 1 Dose, f 3ss.— j. Tinctura Conii (^ij. to Oj.). Dose, fjss.-j. Antidote. Atropia has been suggested as a physiological antidote.] 1 [The class of Succi, U. S. P., only comprises Succus Conii and Succus Taraxaci.] 184 HEMLOCK. Local Action. Conium has been occasionally used in the form of poul- tice as an application to cancerous sores or tumors, and it is said that the severe lancinating pain common to these affections may thus be mitigated. Internal Actions. Physiological. 1. On NervoiLs System. — i. Brain. — No effect is pro- duced on the brain proper, it having been observed in cases of poisoning, and notably in that of Socrates, and in a patient under Prof. Bennett's care, that the intellectual faculties are quite unimpaired to the last. Dr. John Harley, how- ever, is of opinion that a considerable portion of the action of conium is expended on the motor ganglia, and more especially the corpus striatum. 2. Spinal Cord. — Pure conium has no special influ- ence on the spinal nervous system, but an alkaloid, conia, which it usually con- tains, has been proved to cause first exaltation, and finally depression, of the reflex function of the cord. [Dr. Christison thinks "that it acts upon the spinal mar- row, directly prostrating the nervous power, producing paralysis of the voluntary muscles, and destroying life by arresting respiration." — U. S. D.] Th erapeuticaL I. To this action Dr. Harley ascribes the benefi- cial influence of conium in chorea. Although in many cases we may derive real advantage from this remedy, it often fails, and in order to insure the full amount of benefit we must use large doses, and see that the drug is pure. Dr. Harley also recommends it in the nerv- ous twitchings met with in some cases of hemiplegia. Conium has been given with some benefit in the convul- sions of children. [From 10 to 15 drops of the alkaloid has caused death.] HEMLOCK. I8 5 3 . On the Nerves. — Herein lies the true physiological action of conium. It acts firstly on the third nerve, causing drooping of the eye- lid, dilatation of the pupil, and sluggish and impaired movement of the eyeball. The influence then spreads to all the other motor or afferent nerves. A sensation of weight and enfeeblement of the legs, followed by staggering, is first experi- enced, and finally total paralysis is developed, the victim being entirely unable to move ; and so complete may this become, that asses in Italy which have fed on hemlock have been flayed alive without the possibility of resisting in any way. This paralysing influence is at first confined to the termi- nal extremities of the nerves. The sensory nerves are quite unaffected. II. Vascular System. — No effect is produced on the heart or circulation. III. Respiration and Tem- perature. — The breathing is at first unaffected, but, as the poisonous action of the drug goes on, the paralysis spreads to the respiratory centre, and death ensues from asphyxia. Some lowering of the tem- perature has been observed. IV. Secretion. — No influ- ence on secretion has been noted. 3. Dr: Harley recom- mends its use in the violent spasm of the orbicularis met with in keratitis, but I have been unable to confirm this after careful trial. The remarkable power of conium in effecting muscular relaxation would indicate its use in a variety of spasmodic conditions. Thus, in laryn- gismus stridulus, trismus, spasmodic wry neck, spas- modic stricture, [hysteria, and insanity, ~\ and perhaps in the reduction of hernia and dislocation where any contra- indication to the use of anaesthetics exists, it seems worthy of trial ; and Dr. Handheld Jones recom- mends it highly in paralysis agitans. It must, however, be confessed that the thera- peutical success of conium by no means comes up to its physiological promise. 6* l86 COPAIBA. Mode of Elimination. The presence of conium has been detected in the blood, and its elimination is effected by the breath and urine. Mode of Administration, Cautions, &c. It having been satisfactorily proved that the succus is the only reliable preparation of hemlock, it is not neces- sary for us to say anything about the tincture, extract, va- por, or compound pill. Unfortunately, however, it is often difficult to obtain an efficient succus, as it keeps ill, and cannot always be satisfactorily made. Disappoint- ments frequently occur both from this cause and from the smallness of the dose often given in accordance with the recommendation of the Pharmacopoeia. In order to ob- tain any decisive effect we must give [of some prepara- tions, as much as] from half an ounce to 3 or even 4 ounces, as. has been done by Dr. Harley, remembering that the limit of safety is reached when any interference with in- voluntary movement is observed, this being best indicated by enfeeblement of deglutition. Children bear conium remarkably well* I have given ounce doses to a girl of eight, and the late Dr. Anstie pre- scribed even larger quantities to a younger child, without the slightest development of physiological symptoms. [On account of the uncertainty of the strength of juice, it is best to begin with small doses, and carefully increase them until some narcotic effect is produced. Death has been caused by 150 minims of Squibb's fluid extract.] COPAIBA— COPAIBA. [ The oleo-resin of Copaifera mnltijuga {Haym} and of other species of Copaifera, U. S. Officinal Preparations, U. S. Oleum Copaibse. Dose, rr^viij.-xv. Pilulae Copaibse (each contains gr. jvss.). 3-5 pills.] Local Action. Physiological. llierapentical. Copaiba locally applied It has been used in this seems to act as a slight way in certain obstinate af- stimulant to the skin. fections of the skin, such as psoriasis; and in India it COPAIBA. I8 7 seems to have been employ- ed with some success in lep- rosy and lupus, bearing as it does a considerable analogy to the gurjun oil which has lately acquired so high a re- putation in the treatment of the first-mentioned disease. Its nauseous smell, however, must always be a serious bar- rier to its use. Constitutional Action. 1. Brain and Nervous Sys- tem. — No influence is exerted by copaiba on the brain, spinal cord, or nerves. II. Heart and Circula- tion. — No effect is produced on these organs, or on the respiration and temperature. III. Digestive and Secret- ing Organs. — 1. Stomach and Intestines. — Copaiba fre- quently causes most violent vomiting and purging. 2. It has a stimulating ef- fect on mucous membranes generally, but more especi- ally on those of the genito- urinary tract, in virtue of which, after slight prelimi- nary irritation, it checks and finally arrests excessive dis- charges. 3. Kid?ieys. — Copaiba, and more particularly the resin, increases very con- siderably the water of the urine without specially affect- ing the solid constituents. 4. Copaiba, by internal ad ministration, seems to stim- Copaiba is an excellent remedy (t.) in gonorrhoea, where it may be given with great effect as long as the discharge continues thick and puriform. When the earliest inflammatory symp- toms have been subdued by alkalies and diluents, it will prove our best remedy, and it seems to act neither purely locally nor constitutionally, but in both ways conjointly, being altered in some way in the blood, and then exerting a topical influence on the affected mucous tract. (2.) 155 COPAIBA. ulate the skin, and occa- It is also of service in chronic sionally produces an erup- cystitis, and in the later stages tion of bright red papules, of bronchitis, when profuse not unlike measles, usually and exhausting discharges beginning on the hands, have been established from spreading over the body, and the bronchial tubes. (3.) causing much tingling and As a diuretic, the resin has itching. been most highly praised by Dr. Wilks and Dr. F. Taylor in the dropsy of heart disease, in ascites, and in some forms of renal affections. (4.) Dr. Liveing, more especially, has drawn attention to the value of copaiba in psoriasis and other obstinate skin diseases. Absorption and Mode of Elimination. Copabia is very rapidly absorbed into the blood, as indicated by the communication of its nauseous smell to the breath and urine, by which channels it is principally eliminated. On the addition of nitric acid to the urine of patients taking copaiba, a milky appearance is produced by precipitation of the resin, and this is distinguished from albumen by the action of heat, which melts the resin and removes the deceptive cloud. Peculiarities. Mode of Administration. The digestive disturbance occasionally caused by copaiba prevents some persons from taking it at all, and the almost invincibly nauseous nature of its flavor and odor is a seri- ous drawback to its use. Capsules both of sugar and gelatine have been devised, which are frequently well borne ; but we must remember not only that these are often too large to be swallowed with comfort" by nervous persons, but that their use is apt to be followed by dis- agreeable eructation. No means have been proposed to obviate the measly and irritable rash which not unfre- quently appears on the skins of patients under the influence of copaiba; but various forms of prescriptions are in general use, and some of these are moderately effectual in concealing the offensive flavor of this useful drug. GOLDTHREAD — CORIANDER. 189 R . Copaibae Liquoris potassae Misce, agitando, et adde — f5ss.; f3ss.; Mucilaginis acaciae Spiritus aetheris nitrosi Tincturae opii Aquae [menthae pip.] Fiat haustus ter die sumendus. f3ss.; ad f §j. For gonorrhoea. J£. Copaibae Syrupi tolutani Pulveris acaciae Acidi sulphurici aromat. Aquae destillatae S. f §ss. ter in die. f §ss. ; f §ss. ; §ss. ; I5ss.; For gonorrhoea. R. Resinae copaibae Alcohol Chloroformi f5J»; Mucilaginis acaciae Aquae Capiat semunciam ter in die. ad f ^xij. Formula for copaiba as a diuretic. M. M. [COPTIS— GOLDTHREAD. Coptis irifolia, U. S. Goldthread is an indigenous tonic bitter resembling quassia, for which it may be substituted. It may be given in substance (gr. x.-xxx.), infusion (3j.-0j. ; dose, fsj.- ij.), and tincture (3J.-OJ. ; dose, f3j.-ij.)- It contains berberina, but no tannin nor gallic acid, being a simple bitter without astringency.] [CORIANDER— CORIANDER. The fruit of Coriandrum Sativum, U. S. Enters into Confectio Sennas, Infusum Gentianse Com- positum, Infusum Sennae, and Tinctura Rhei et Sennas. Uses. Coriander seed is aromatic and stomachic (dose, 9j. to 3J.) j it is rarely used except in combination.] I90 DOGWOOD — CUBEB. [CORNUS FLORIDA— DOGWOOD. The bark of Cornus Florida, U. S. Officinal Preparations. Decoctum Cornus Floridae. Dose, f^ij. Extractum Cornus Floridae Fluidum. Dose, f 3ss. Dogwood is an indigenous, astringent tonic, and has been recommended as an antiperiodic as a substitute for cinchona.] CREASOTUM— CREASOTE. \_A peculiar substance obtained from wood-tar, U. S. Officinal Preparations, U. S. Aqua Creasoti (nriij^. to foj)- Dose, f3j.-iv. Unguentum Creasoti (f 3ss. to lard 5j-)-] This drug [dose, gtt. i.-ij., diluted] is now but little used [owing to the difficulty of obtaining it pure, the com- mercial article being largely contaminated with impure carbolic acid] ; but is a useful remedy in some forms of sickness and vomiting, as an inhalation for ozczna and various lung diseases with foetid expectoration, and as a local application. in toothache. The mistura creasoti [Br.], containing nij. to the ounce, is a convenient mode of administration. [The ointment is used in scaly eruptions. ~\ [CRETA— CHALK. Native friable carbonate of calcium, U. S. {for preparations, see Calcium.}] [CROCUS— SAFFRON. The stigmas of Crocus sativa, U. S.~\ Saffron is never used, save as a coloring agent. CUBEBA— CUBEB. [The unripe fruit of Cub eb a officinalis, (Miguel), Piper Cubeba (Linn.), U. S. Officinal Preparations, U. S. Extractum Cubebae Fluidum. Dose, fjss.-ij. Oleo-Resina Cubebae (8 times the strength of the powder). Dose, t^x.-xxx. COPPER. 191 Oleum Cubebse. Dose, gtt. x.-xij. Tinctura Cubebae. Dose, f5ss.-ij. Trochisci Cubebse (each contains gtt. j. of the oleo- resin).] Physiological Action. Therapeutical Action. Cubebs also has a stimu- Cubebs is occasionally used lating action on mucous in cystitis, but it has long membranes, and more par- been known as one of the ticularly on that of the blad- most efficient and generally der and urethra. In large prescribed remedies for gon- doses it causes considerable orrhcea, acting best during gastro-intestinal irritation. the acute stage of the disease. It has also been found use- ful when given in the form of lozenges for the relief of relaxed sore -throat. Dose of the powder 30 to 120 grs. ; tincture f3ss. ad f3ij. ; or of the oil nrv.-xx. CUPRUM— COPPER. [Cupri Subacetas. Impure subacetate of copper, U. S. Cupri Sulphas. Sulphate of copper, U. S. Cuprum. Copper wire, U. S. Officinal Preparations, U. S. Cuprum Ammoniatum. Dose, gr. %-%. Copper is also used in preparing Sp. iEtheris Nitrosi.] Antidotes. Albumen, ferrocyanide of potassium, followed by prompt evacuation of the stomach. Local Actions. Physiologic a I. Therapeutical. Copper has caustic and In the form of the familiar astringent properties both blue-stone, or sulphate of in substance and solution. copper, it is used as an ap- plication to venereal sores, 192 COPPER. ulcers in the throat, granular lids, to check exuberant gran- ulations, &c. ; and in solu- tion it is a good lotion for various ulcerative surfaces, gleet, &c. Internal Actions and Uses. Physiological. 1 . Brain and JVervous Sys- tem. — Copper probably acts in some measure as a nervine tonic, but when given in larger doses peculiar symp- toms set in, not unlike those of lead poisoning, and con- sisting of headache, neural- gic pains, cramps, and even paralysis. 2. Circulation and Respi- ration. — No special effect. 3. Secreting Organs. — Copper causes prompt and effectual evacuation of the contents of the stomach, act- ing as a direct emetic. It has an astringent influence over the stomach and intes- tines, and this, if pushed too far, may end in gastroente- ritis. Th erapeuticaL 1. Copper has been used in small doses in chorea, epi- lepsy, &c, but with no spe- cially marked benefit. 3. Copper is not so much used, however, for an emetic as sulphate of zinc, because, if by any chance it be not rejected by vomiting, it is liable to cause inflammation of the stomach. Sulphate of copper is a good astringent in advanced and obstinate diarrhoea. Mode of Elimination. Copper is eliminated chiefly by the liver and kidneys, the intestinal canal, and the salivary glands. Poisonous Effects. — As al- ready seen, copper may act as a poison by causing in- flammation of the stomach and intestines, as well as re- mote nervous symptoms. Sulphate of copper is the only salt of the metal used in medicine, and is prescribed in the following doses: — DECOCTIONS FOXGLOVE. 193 I£. Cupri sulphatis Pulveris opii aa gr. ss. ; Extracti gentian se gr. iij. ; Misce, fiat pilulse nocte maneque sumenda. In a case of obstinate diarrhoea. [As an emetic, sulphate of copper is given in doses of gr. ij.-v.] [Decocta. The officinal Decoctions are — Decoctum Cetrariae, Decoctum Hsematoxyli, " Chimaphilae, " Hordei, " Cinchonae Flavse, " Quercus Albae, " Cinchonae Rubrse, " Sarsaparillae Comp., " Cornus Floridse, " Senegae, " Dulcamarae " Uvae Ursi.] DIGITALIS— FOXGLOVE. [ The leaves of Digitalis purpurea, from plants of the second year'' s growth, U. S. Dose, in substance, gr. ss.— ij. Officinal Preparations, U. S. Digitalinum (active principle). Dose, gr. ^. Extractum Digitalis. Dose, gr. ^ i/_i 2 Extractum Digitalis Fluidum. Dose, nrj.-ij. Infasum Digitalis (3ij. to Oj.). Dose, f3ij.-iv. Tinctura Digitalis (^ij. to Oj.). Dose, ni^v.-x.] Antidotes. After evacuation of the stomach and the administra- tion of tannin, we must ob- viate the tendency to death by stimulants, and by keep- ing the patient rigidly to the horizontal posture, as syncope is readily excited by suddenly sitting up. Aconite and atropia have been recommended as phy- siological antidotes, but we have as yet no evidence of their efficacy. 17 i94 foxglove. Local Action. Physiological. Digitalis has been said to possess sedative properties when locally applied, and there is no doubt that it is rapidly and efficiently ab- sorbed by the skin. Th erapeutical. Digitalis has been used as a local sedative in cases of joint-inflai7imation, and the application to the legs of spongio-piline soaked in a strong infusion has been found to produce diuresis where other remedies have failed. Constitutional Action. I. Brain and Spinal Cord. — On the brain no direct ef- fect is produced, but the re- flex irritability of the spinal cord seems to be somewhat lessened under the toxic ac- tion of the drug. Stimulation of some por- tions of the vaso-motor and pneumogastric nerves seems to take place, as we shall explain more fully when treating of the influence of digitalis over the heart. II. Heart and Circulation. Digitalis exerts a decidedly tonic and strengthening in- fluence on the heart, render- I. Although no direct ac- toin is produced on the brain tissue, it is reasonable to sup- pose that some alteration in cerebral function may follow the alterations in the vascular system produced by digitalis, and perhaps this may in part explain the remarkable re- sults obtained by Mr. Jones, of Jersey, in the treatment of delirium tremens by the use of this drug. He found that half- ounce doses of the tinc- ture quieted the delirium, reduced fever, and caused sleep. But this treatment can hardly be recommend- ed, as several sudden deaths have been thus produced, and as it seems not improba- ble that the absence of toxic effects in many cases is due to the very partial absorp- tion of the remedy. II. The undoubted effect of digitalis in slowing and strengthening the action of the heart, would seem to in- FOXGLOVE. 195 ing its beats slower and more forcible, and lengthening the period of systole. This result seems to depend partly on a direct action on the heart's muscle itself, but also in some degree on stimulation of the cardiac inhibitory fibres of the vagus, which thus hold more forcibly in check the rapid rate of pulsation pro- duced by the sympathetic nerves. If, however, the administration of the remedy be too long continued, ex- haustion of the pneumogas- tric is apt to follow this over- stimulation, and the heart, being now handed over to the unrestrained power of the vaso-motor nerve supply, runs riot in excessively rapid and feeble contractions. The tonic influence of digi- talis is attended by well- marked rise of arterial ten- sion, and this is supposed to depend on stimulation of the sympathetic centres directly supplying the smaller vessels; and at the same time the heart is induced to act more powerfully, to overcome the increased resistance in front. dicate its use in certain dis- eased conditions of that or- gan, but it is only recently that this tonic influence has been recognized. In former years digitalis was looked upon as essentially a cardiac sedative, and was used to quiet the tumultuous palpita- tion of hypertrophy ; but we now know that it may be prescribed with much greater success under the following circumstances : — 1 . In palpitation and irre- gular action of the heart, whether depending on or- ganic disease or not, an im- portant indication for its use being intermittence, or the occurrence of frequent beats which do not reach the pulse. 2. In mitral disease, where the cardiac action is feeble, and apparently unable effect- ually to propel the blood, where lividity and dropsy are setting in, the lungs be- coming engorged, and the right heart oppressed. Here we shall derive the mostsignal service from digi- talis given in moderate doses, and combined with a little iron. Dr. B. Foster ascribes some of the good effect of digitalis in mitral disease to its slowing action, giving more time for the auricle to empty itself fully of its con- tained blood. The contracting effect of digitalis on the arterioles would naturally suggest its 19* FOXGLOVE. use in haemorrhage, and it has accordingly been found of service both in haemoptysis and Menorrhagia ^ although in neither is it so efficacious as ergot. 3. In dilatation of the heart, where the weak and thin muscle acts feebly and irregularly, giving rise to palpitation and breathless- ness, and causing temporary bruits by unequal and in- effectual closure of the mitral and tricuspid valves. 4. In aortic disease, when compensation has not been made complete by hyper- trophy. In short, we may use digitalis whenever the heart is acting feebly and irregu- larly, but by its use we can- not expect to spur on a normally constituted heart with sound muscle to over- come difficulties in front, and we must avoid its regu- lar use in the compensatory hypertrophy of aortic dis- ease, and in fatty degenera- tion, where its tightening effect on the smaller vessels throws an injuriously-in- creased amount of work on the structurally -damaged organ. 5. Ringer has drawn at- tention to the beneficial ac- tion of [the temporary use of] digitalis in relieving the distressing attacks of palpita- tion so often due to hyper- trophy of the heart. FOXGLOVE. 197 III. Respiration and Tem- perature. — On respiration no effect is produced, and al- though, in a state of health, digitalis does not lower the body heat, it undoubtedly possesses this influence over febrile conditions, Wunder- lich and others bringing ample evidence to prove its power of reducing tempera- ture in pneumonia, enteric fever, acute rheumatism, and other acute disorders. IV. Digestive and Secret- ing Organs. — 1 . Siom ach and Intestines. —From its bitter taste, digitalis might be cre- dited with some tonic proper- ties ; but it is really much more likely to disorder than to increase the appetite, by causing vomiting. It does not seem to affect the intestinal tract in any way, save in the later stages of poisoning, when diar- rhoea may supervene. 2. Kidneys. — Digitalis in- creases, under certain condi- tions, the flow of urine with- out altering in any essential III. Digitalis has been found of great service in those cases of bronchitis which are so frequently associated with a weak and dilated right heart, and where stimulation of the cardiac muscle leads to a better arrangement of circu- lation through the lungs. For the reduction of tem- perature, digitalis is seldom used in this country, but in Germany its antipyretic vir- tues are prized. It seems, however, to lower the body heat without influencing the course of the disease ; and as it must be given in large doses, which may derange the digestive functions even if they do not prove directly dangerous, there does not seem to be any real benefit following its employment. 2. Digitalis is a good diu- retic, more especially in car- diac and acute renal dropsy, and acts best in combination i7 : ig8 FOXGLOVE. respect the quantity or pro- portion of its solid ingredi- ents. Its diuretic action depends partly on the tight- ening effect on the arterioles, raising the blood pressure in the renal glomeruli, and partly on the increased power and regularity of the heart, improving the general con- ditions of circulation within the kidneys. One curious point in this connection is, that digitalis will seldom produce diuresis in healthy persons, but always acts best when dropsical accumula- tions have to be removed. V. Uterus. — Digitalis, from its action on unstriped muscular fibre, has the pro- perty of stimulating the ute- rus to contraction. Poisonous Effects. — Digi- talis kills by tetanising the heart muscle, causing rapid and irregular action, follow- ed by arrest of action. The face grows pale, the pupils dilate, vomiting and diar- rhoea supervene, and death usually occurs by syncope. Cases of poisoning, however, are rare, and most of our knowledge under this head- ing has been derived from experiments on animals. with squill and mercury, as in the famous Guy's pill. The theory of this action, depending on heightened blood pressure within the Malpighian tufts, explains the frequent failure of digi- talis to augment the quantity of the urine in chronic kid- ney disease, where the arte- rial tension is already high. V. It has therefore been used to contract the uterus and thus check flooding or me?wr?'hagia, and it may also act by restoring its normal functions when these are sus- pended, as in amenorrhoza. Cautions, Mode of Administration, &c. In prescribing digitalis, we are generally advised to sus- pend its use from time to time, lest ' accumulation' lead BITTERSWEET. I99 to poisonous symptoms ; but Dr. Fothergill, an excellent authority, repudiates this notion, and his experience in this direction is large. [See Physiological Effects, p. 195.] As regards the best form for its administration, the freshly made infusion is usually preferred, given in doses of from 2 to 4 fluid drachms. Of the tincture we may give from 5 to 10 minims ; of the powdered leaves, ^ gr. to 2 grs. R. Tinct. digitalis m,x.; Sp. seth. nit. f 3*. ; Inf. buchu f Ij- M S. Ter in die. Recommended by Fothergill in simple cardiac debility with scanty flow of urine. R. Pulv. digitalis gr. xxx. ; Ferri sulph. exsic. gr. xv. ; Pulv. capsici gr. xl. ; Pil. aloe et myrrhse gij. M. In pil. lx. div. Una bis in die. Recommended by Fothergill in cardiac debility, gastric catarrh, and inactivity of the bowels. R. Tinct. ferri chloridi TJIxv. ; Glycerin i f 5i- ; Infusi digitalis ^5'j-j Syrupi limonis f ^ i j . ; Infusi calumbse ad f^j. M. S. Ter die sumend. Cardiac tonic. DULCAMARA— BITTERSWEET. [The young branches of Solatium Dulcamara, U. S. Officinal Preparations, U. S. Decoctum Dulcamarse (ij. to Oj.). Dose, fjjss.-ij. Extractum' Dulcamarae (alcoholic). Dose, gr. x.-xx. Extractum Dulcamarae Fiuidum. Dose, f 5ss.-ij. Dulcamara is a feeble narcotic, formerly recommended in mania, rheumatism, and cutaneous diseases. At present it] is never used [to any great extent in regular practice]. 200 ELATERIUM — PLASTERS. ELATERIUM— ELATERIUM. [A substance deposited by the juice of the fruit of Momordica elaterhtm, Ecbalium agreste (jRichard), CI. S. Elaterium. Dose, gr. (Dose of Clutterbuck's elaterium, gr. Elaterin (not officinal). Dose, gr. t V _ tV] Physiological Ac lions. Elaterium produces irrita- tion of the intestine, ending in inflammation where in- cautiously pushed, and causes the evacuation of large quantities of watery fluid. It purges equally powerfully when injected below the skin or taken by the mouth, but it is stated that solution in the bile is necessary to develop its full action. In some of the lower animals, peculiar nervous symptoms follow its use, and vomiting and great depression are liable to be produced in the human sub- ject even by moderate doses. [It is probably our most efficient cathartic, in the treatment of dropsical dis- eases, especially after the failure of other remedies.] Therapeutical Effects. Elaterium is the most powerful hydragogue ca- thartic with which we are acquainted, and as such has been used to withdraw watery fluids from the intes- tines in various forms of cardiac disease, lightening the labors of the heart by lessening the volume of the blood, and relieving the cellular tissue and various cavities of dropsical accu- mulations. As, however, it is uncertain and very depressing in its action, it is now rarely used, in com- parison with compound jalap powder, which seems to fulfil the same useful indications without an equal chance of seriously weaken- ing the patient. Emplastrum Aconiti " Ammoniaci [Emplastra. The officinal Plasters are : — Emplastrum Hydrargyri Opii Picis Burgundicas " Canadensis " cum Cantharide Plumbi Resinae Saponis.] " cum Hy- Antimonii [drargyro Arnicas Assafcetidse Belladonnas Ferri Galbani Compositum ERGOT. 20I ERGOTA— ERGOT. \_The sclerotium of Claviceps purpurea (Tulasne), replacing the grain of Sec ale cereale, U. S. Officinal Preparations, U. S. Extractum Ergotse Fluidum. Dose, n^x.-f5j. Vinum Ergotae (f^ij. fid. ext. in Oj). Dose, f§ss.— ij. (Ergotine — not officinal, is a purified extract. Dose, jr. v.-x.).] External Action. Ergot has no local action. Internal Actions. Physiological. i. On Nervous System. — No special action on any part of the nervous system has been proved. 2. On Vascular System. — Ergot slightly depresses the action of the heart, and re- duces the number of its pul- sations, and it is said that the arterial tension is at first low- ered in some slight degree. This effect, however, rapidly passes away, and a decided rise in arterial tension follows the contracting influence of the drug on the arterioles. On examining the web of an er- gotised frog's foot, we may distinctly observe the gra- dual contraction of the small- Th erapeutical. i. Dr. Brown-Sequard ad- vises the use of ergot in some forms of paraplegia, unat- tended by irritation, and where inflammatory symp- toms have subsided, believ- ing that it acts well by con- tracting the dilated vessels. Dr. Crichton Browne has recently prescribed ergot with success in some forms of chronic mania. 2. Ergot is now allowed to be by far the best astrin- gent in cases of internal 'hem- orrhage, and more especially in menorrhagia, hemoptysis, and epistaxis, the use of the liquid extract having quite su- perseded the older treatment by means of acids, gallic acid and the like, whilst, if a more rapid action is required, we may subcutaneously inject ergotine. [It has also been injected into internal haem- orrhoids with success.] It is also a valuable remedy 202 ERGOT. er vessels up to absolute obliteration of their calibre ; and this is believed to be due to a primary action of the ergot on their muscular walls rather than to the interven- tion of the vaso-motor sys- tem. Thus we observe a di- rect contrast to the action of the nitrite of amyl. 3. Respiration and Tem- perature. — No special action. 4. Urina7'y Functions. — Ergot, from its specific action on unstriped muscular fibre, tends to contract the bladder, and, by raising the tension in the Malpighian bodies of the kidneys, it increases the urinary flow. 5. Digestive Organs. — Ergot occasionally causes sickness, vomiting, and di- arrhoea ; but constipation is more likely to follow its use, from its contracting influence on the intestinal capillaries. 6. Uterine Functions. — Ergot has a remarkable and almost selective influence on the uterus, contracting its muscular walls, promoting its functions, and encourag- ing the expulsion of its con- tents. in purpura. Von Langen- beck, of Berlin, has advo- cated the injection of ergo- tine for the obliteration of aneurismal 'sacs, ,but sufficient evidence has not yet been brought forward of the suc- cess of this practice ; and it has also been advised in the case of old varicose veins. The gangrenous form of er- gotismus is doubtless due to arterial contraction cutting off the supplies of blood to the extremities. 4. Ergot has been used successfully, and more espe- cially when combined with iron, in that most trouble- some affection, i?icontinence of urine; but, in my own ex- perience, belladonna is more deserving of confidence. Ergot has been recommend- ed as a diuretic. 5. Ergot has been success- fully prescribed in cases of diarrhoea and dysentery. 6. Ergotactsasanecbolic, expelling the contents of the uterus by causing contrac- tion of its muscular walls. It must only be used, however, where no disproportion ex- ists between the child and the maternal passages, and where we are prepared to render in- strumental aid at once, if ERGOT. 203 necessary, when the pains have been aroused. We must also remember that its pro- longed use is apt to endanger the life of the child by cut- ting off its supplies of blood through the placenta. Ergot is also of service in flooding, in reducing the size of hypertrophied or subin- voluted wombs, and in pro- moting the destruction of submucous polypi, either by cutting off their supply of blood, or by squeezing them out of the uterine cavity. It is also an excellent remedy for amenorrhea and some forms of leucorrhoea. Mode of Administration, Dangers, Cautions. In those countries where ergotised rye largely prevails, two forms of disease attend its use. 1. The gangrenous form of ergotismus, where extensive dry gangrene of the nose, face, and extremities supervenes; and, 2. The spas- modic variety, where the victim is afflicted with most violent and agonising spasms. The therapeutic use of ergot, however, is of course never productive of any such symptoms, and the only inconvenience occasionally ob- served is some digestive derangement, with colicky ab- dominal pain. Three preparations are officinal: — Extractum ergotse liquidum [fluidum]. Dose, n^x. ad f3j. Infusum ergotse [Br.]. Dose, f^j. ad f ^ij. Tinctura ergotse [Br.]. Dose, tii,x. ad f 5j- The powder is also used in doses of from 20 to 30 grs., and many experienced authorities recommend a fresh in- fusion made with the powder and swallowed. Ergotine may be employed by subcutaneous injection in doses of 4 grains, but this process has the drawback of causing a painful, black, and unsightly lump at the seat of puncture. 204 FLEABANE THO ROUG H WO RT . ]$.. Extracti ergotas liquidi [Br.] f5'j«> Decocti aloes compositi [Br.] ad f §viij. M. Fiat mistura, de qua capiat unciam unam bis in die. Useful in amenorrhea. J$l. Pulveris ergotae ^j.; Sacchari 5^ v « j Aquae bullientis f §iij. M. Capiat cochlearia duo magna quarta quaque parte horse ad effectum. In a case of labor. In a case of amenorrhoea from anaemia we may add a little ergot to any chalybeate mixture. [ERIGERON— FLEABANE. The leaves and tops of Erigeron heterophyllum and of Erigeron Philadclphicum , U. S. Erigeron Canadense. The leaves and tops of Erige- ron Canadense, U. S. Officinal Preparations, U. S. Extractum Erigerontis Canadensis Fluidum. Dose, fgss.-j. Oleum Erigerontis Canadensis. Dose, gtt. v. Is diuretic, tonic, and astringent. It is chiefly used in hemorrhage in the form of the oil (dropped on sugar) gtt. v.-xx., repeated every two or three hours; or a tincture may be employed. An infusion has also been used in dropsy, and in genito-nrinary affections. ~\ [EUPATORIUM— THOROUGHWORT. The tops and leaves of Eupatorium perfoliatum, gathered after flowering has conunenced. U. S. Officinal Preparation, U. S. Infusum Eupatorii. Dose, f^j.-ij. Thoroughwort (Boneset) is a bitter tonic and sudorific, and in large doses produces vomiting and purging. The hot infusion has been largely given for "colds" muscular rheumatism, and catarrh. The infusion is emetic in doses of a pint. Dose of the powder as a tonic, in dyspepsia, gr. xx-xxx.] EXTRACTS — WHEAT FLOUR. 205 [Extracta. The officinal Extracts are: — Extractum Aconili Arnicae Belladonnse " Alcoholicum " Radicis Fluidum Buchu Fluidum Calumbae Fluidum Cannabis Americanse " Indicae Chimaphilae Fluidum Cimicifugae Fluidum Cinchonae " Fluidum Colchici Aceticum " Radicis Fluidum " Seminis Fluidum Colocynthidis " Compositum Conii " Alcoholicum " Fructus Fluidum Cornus Floridse Fluidum Cubebse Fluidum Digitalis " Fluidum Dulcamaras " Fluidum Ergotas Fluidum Erigerontis Canadensis [Fluidum Gelsemii Fluidum Gentianas " Fluidum Geranii Fluidum Glycyrrhizas " Fluidum Gossypii Radicis Fluidum Haematoxyli Hellebori Hydrastis Fluidum Hyoscyami Extractum Hyoscyami Alcoholicum " Fluidum Ignatias Ipecacuanhas Fluidum Jalapae Juglandis Kramerias '" Fluidum Lupulin33 Fluidum Matico Fluidum Mezerei Fluidum Nucis Vomicae Opii Pareirae Fluidum Physostigmatis Podophylli Pruni Virginianae Fluid. Quassias Rhei " Fluidum Rubi Fluidum Sabinae Fluidum Sarsaparillae Fluidum " Compositum Flu. Scillae Fluidum Senegae " Fluidum Sennas Fluidum Serpentariae Fluidum Spigeliae Fluidum " et Sennae Fluid. Stillingiae Fluidum Stramonii Foliorum " Seminis Taraxaci " Fluidum Uvae Ursi Fluidum Valerianae " Fluidum Veratri Viridis Fluidum Zingibei'is Fluidum.] FARINA TR1TICI— WHEAT FLOUR. Flour is only of dietetic importance. (Mica panis) is used as a vehicle for pills. 18 Bread-crumb 206 YEAST — IRON. [FERMENTUM -YEAST. A peculiar insoluble product of the fermentation of malt liquors, U. S. Yeast is tonic, stimulating, slightly nourishing, and lax- ative. It contains alcohol, gluten, carbonic acid, and bitter extractive from hops, and has been given, in doses of a pint, daily in low fevers attended with irritable stomach. It has also been used in diabetes and boils. Mixed with flaxseed meal or other farinaceous substances, it forms the yeast poultice, which is much used in gangrenous ulcers. ~\ FERRUM—IRON. [Ferri Hypophosphis. Hypophosphite of iron. Dose, gr. v.-x. Ferri Sulphuretum. Protosulphuret of iron prepared by melting together sublimed sulphur andiron in small pieces, If. S. (Used only to make Hydrosulphuric acid.) Officinal Preparations, U. S. Ferri Chloridum. Dose, gr. v.-x. Liquor Ferri Chloridi. Dose, n^ij.-x. Tinctura Ferri Chloridi. Dose, nvx.-xl. Ferri Citras. Dose, gr. v.-xx. Liquor Ferri Citratis. Dose, r^x.-xl. Ferri et Ammonii Citras. Dose, gr. v.-x. Ferri et Ammonii Sulphas. Dose, gr. iij.-xij. Ferri et Ammonii Tartras. Dose, gr. x.-xxx. Ferri et Potassii Tartras. Dose, gr. x.-xxx. Ferri et Quinise Citras. Dose, gr. v.-xv. Ferri et Strychniae Citras. Dose, gr. iij.-v. Ferri Ferrocyanidum (Prussian blue). Dose, gr. v. Ferri Lactas. Dose, gr. ij.-x. Ferri Oxalas. Dose, gr. ij.-v. Ferri Oxidum Hydratum. Dose, gr. v. (As an an- tidote, gr. xx. for each grain of arsenious acid swallowed.) Ferri Phosphas. Dose, gr. v.-x. Ferri Pyrophosphas. Dose, gr. ij.-vj. Ferri Subcarbonas. Dose, gr. v.-xx. Emplastrum Ferri. Trochisci Ferri Subcarbonatis. Ferri Sulphas. Dose, gr. i.-v. Mistura Ferri Composita. Dose, f^ss. IRON 207 Ferri Sulphas Exsiccata. Dose, gr. i.-ij. Ferrum Redactum. Dose, gr. ij.-v. Pilula Ferri Carbonatis (Vallet's Mass). Dose, gr. x.-xx. Pilulae Ferri Compositse. Dose, 2 to 6 pills. Pilulae Ferri Iodidi (each contains gr. i. iodide of iron, and gr. J of reduced iron). Syrupus Ferri Iodidi (gr. vi].yi to f3j-)- Dose, nrxx. -xl. Liquor Ferri Nitratis. Dose, ni x.-xx. Liquor Ferri Subsulphatis (Monsel's Solution). Dose, irtij.-x. Liquor Ferri Tersulphatis (used to prepare hydrated sesquioxide). Potassii Ferrocyanidum. Dose, gr. x.-xv. Iron is also used in preparing Potassii Bromidum, Atn- monii Bromidum, and Ferri Bromidum (not officinal). Dose, gr. x.-xx.] Local Effects. Physiological. Certain of the stronger preparations of iron are very astringent, corrugating and hardening the tissues by co- agulating their albumen, and also contracting the smaller bloodvessels. Therapeutical. In the form of the per- chloride [chloride], iron is one of our most generally used astringents for the ar- rest of hemorrhage, as in epistaxis, leech - bites, in flooding (injected into the uterus, as advised by Dr. Barnes), or, in fact, in any variety of passive hemor- rhage. It is also a valuable appli- cation to relaxed mucous membranes ; thus, in many forms of sore throat, equal parts of tinct. ferri and gly- cerine will act well. It forms a good injection for leucor- rhoe.a, and is extensively em- ployed as an enema for the destruction of thread-worms. 208 IRON. Velpeau recommended the application of a strong solu- tion of sulphate of iron to the inflamed skin in erysipe- las, and Ricord considers that tartrate of iron has an almost specific influence over the destructive ulcerative process of syphilitic phage- dena . Internal Actions and Uses. . Physiological. i . Brain and Nervous Sys- tem. — Iron has a tonic in- fluence over the nervous system, but occasionally, in plethoric persons, the stronger preparations will cause an uncomfortable sensation of fulness and throbbing in the head. 2. Circulation and Respi- ration. — Iron acts as a tonic to the muscular structures of the heart, probably by supplying the stimulus of a larger supply of healthy blood. It is well known that iron not only augments the quantity of red coloring matter in the red corpuscles of the blood, but actually increases their number, this fact being proved by an ingenious instrument which enables us to calculate the proportion of red corpuscles Therapeutical. i. Iron is much used as a tonic in all conditions of nervous exhaustion and de- bility. Thus in neuralgia, which consists in a weakened state of the roots of certain sensory nerves, it is invalu- able. In chorea, which generally coincides with de- bility, and in all cases depending in any way on want of nerve tone, it is a remedy of real value. 2. This increase in the red corpuscles of the blood, and, as a consequence, in the extent to which these important bodies carry out their function of bearing oxygen to the tissues, and finally converting it into ozone, explains further the marvellous tonic influence of iron. In anaemia, in protracted convalescence from acute disease, in gene- ral feebleness or debility, in chlorosis where it also acts by giving increased IRON. 209 which any given quantity of blood contains. 3 . On Secreting Organs. — On the stomach, iron acts by bracing up the raucous membrane, and improving the appetite and digestive tone. Its astringency tends to cause constipation. Urine. — Iron increases the amount of urea given off by the urine, and occasion- ally irritates the bladder, causing frequency of mictu- rition. tone to the uterine functions, in struma, rickets, secondary syphilis, &c, iron forms the basis of every method of treatment. 3. Here we have another explanation of its tonic properties. This action is utilised in the treatment of diarrhoea, where some of the more astringent preparations, as the pernitrate [nitrate, U. S.], are often of service. [But in ordinary tonic doses, the tincture of the chloride relieves vesical irritability , strangury, and spasmodic stricture ; and is much used in gleet and chronic Bright 's disease. ] On Temperatu re. — I r o n raises the temperature partly by increasing the waste of the tissues, but partly also in virtue of its ozonising properties. Specific Action. Iron has a very marked influence in checking erysipelas, which must be called specific. We here use the tincture of the perchloride [chloride], and give it in doses of from fjss. to f5j- every three or four hours. It is also of ser- vice in diphtheria ; and Dr. Russell Reynolds has lately brought the evidence of over sixty cases to show that in acute rheumatism, given in large doses, it rapidly dimin- ishes the pain and fever. Mode of Absorption and Elimination. The more soluble forms of iron are readily absorbed, 18* 2IO IRON. and become combined as albuminates with the albumen of the blood, whilst the insoluble preparations must first undergo solution in the gastric juice. When they have played their part within the organism, they are thrown out principally by the fseces, to which they impart a blackish color, but also in some measure by the urine and by albumi- nous secretions such as those of the bile, and all mucous and serous membranes. Modes of Administration. Drawbacks. We have seen that various inconveniences may attend the use of iron, such as headache, irritability of bladder, constipation, nausea, &c, and it further has the disadvan- tage of blackening the tongue and teeth ; but many of these evils may be avoided by using the lighter or less astringent preparations, such as the citrate of quinine and iron, yinum, saccharated carbonate, by combining with some aperient, and by giving each dose after a meal. But if no contra-indication exists, there is no doubt that the astringent properties of the per-salts [sesqui-salts] stand us in good stead, and in particular, no preparation is so useful on the whole as the old muriated tincture. In secondary syphilis the syrup of the iodide is of service, and children will always take steel wine or the saccharated carbonate well ; whilst in cases of chlorosis with disorder- ed menstrual function we shall find the mist, ferri com- posita to be very efficacious in improving the quality of the blood and gently stimulating the uterus to resume its neglected duties. The sulphate of iron has some influ- ence in aiding the action of some purgative salts, as the sulphate of magnesia. The preparations of iron are so very numerous that no one but a student on the very brink of an examination would think of burdening his memory with them all ; and we shall only refer, therefore, to those which form part of the daily stock-in-trade of the practical physician. Vinum ferri [Br.] may be given in doses of from f 3j. to f 5ij. ; mistura ferri aromatica [Br.] f^j. ad f Jij. ; mis- tura ferri composita f|j. ad f^ij. ; ferri carbonas saccha- rata [Br.] gr. v. ad $j.; syrupus ferri iodidi n^x. ad f 3j- ', ferri et ammonias citras gr. v. ad x. ; ferri et quinise citras gr. v. ad xx. Or in combination : — FIG — MALE FERN. 211 {£. Tincturse ferri perchloridi [chloridi] Tl\x. ; Spiritus chloroformi TT^xv. ; Glycerini f 5 SS - 5 Infusi calumba? ad f ^j. M. Ter die sumend. Chalybeate mixture. R. Misturae ferri composite, Decocti aloes compositi [Br.] aa f§ss. M. Fiat haustus ter die sumendus. R. Magnesia; sulphatis §ij.; Ferri sulphatis gr. xxiv. ; Acidi sulphurici diluti f gij. ; Infusi calumbae ad f §viij. M. Fiat mistura. Capiat cochlearia duo magna omni mane. Ferruginous aperient. Iron, as a rule, is best taken after a meal, but we must warn our patient to avoid the neighborhood of tea, as the mixture of these two ingredients forms a species of ink which is both nauseous and unsightly. As the more as- tringent preparations not only stain but injure the teeth, they may be conveniently sucked through a glass tube. FICUS— FIG. \_The dried fruit of Ficus Carica, U.S.'] Figs are slightly laxative, [and enter into Confectio Sennse, U. S.] FILIX MAS— MALE FERN. [ The rhizome covered with portions of the stipes of Aspidium Filix mas. When used only such portion of the rhizome as has retained its green color should be employed, and the stipes, being inert, should be re- moved. U. S. Officinal Preparation, U. S. Oleoresina Filicis. Dose, rr^v.-xv.] Local Action. Fern oil has no local action. Constitutional Action. Physiological. Th erapeutical. The only marked action Fern-oil is used in medi- of the male fern is that of cine purely as an anthelmin- 212 FENNEL — GALEA NUM. killing tape-worms. It oc- casionally produces a little nausea and diarrhoea, but in most cases it can be taken without discomfort. [Its vir- tue resides in an oleoresin, which is the officinal title in the U. S. P., but which is termed a fluid extract in the Ph. Br. ; it is also sometimes spoken of simply as the oil of male fern.] tic. Its destructive influence over all varieties of toenice has been effectually proved by a great mass of evidence, and one or two doses gene- rally succeed in dislodging the entire worm. It is essen- tial that the draught should be taken on an empty sto- mach, and, the intestines having been first cleared by a purgative, we direct our patient to fast for a few hours before bed-time, when he is advised to take a drachm of the liquid extract [oleoresin] suspended in milk. Or we may avail ourselves of the following formula, which acts well in concealing the nauseous flavor of the drug : R. Extracti filicis liquidi [oleoresinse filicis] f.^jss. ; Mucilaginis tragacanthae f §ss. ; Syrupi zingiberis ^3U- '■> Aqnoe ad f| jss. Misce, fiat haustus nocte vel primo mane sumendus. [FCENICULUM— FENNEL. The fruit of Fceniculum dulce (De Candolle*), U. S. Officinal Preparations, U. S. Oleum Fceniculi. Dose, n^v.-xv. Tinctura Rhei et Sennae. Dose, f^ss.-ij. Aqua Fceniculi (oil ttlxv. to Oj.). Much used in infusion as an aromatic carminative, for flatulent colic in infants.] GALBANUM— GALBANUM. [The gum- resin of an undetermined plant, U. S. Dose, in substance, gr. x.-xx. NUTGALL. 213 Officinal Preparations. Emplastrum Assafcetidae. Emplastrum Galbani Compositum (containing tur- pentine, Burgundy pitch, and lead plaster). Pilulae Galbani Compositse (each, galbanum, gr. jss.j myrrh, gr. jss.; assafcetida, gr. ss.).] Galbanum and ammoniacum are substances of no special theoretical value, [but are ranked as expectorants, anti- spasmodics, and stimulants.] GALLA— NUTGALL. [A morbid excrescence upon Quercus infectcria, U. S. Officinal Preparations, U. S. Acidum Gallicum. Dose, gr. v.-xx. Acidum Tannicum. Dose, gr. j.-iv. Tinctura Gallae ("3 Ij . to Oj.). Dose, f5j -f3iij- Unguenturn Galls (1 to 7 of lard). Unguentum Acidi Tannici (5ss. to gj.). Glyceritum Acidi Tannici (3ij- to f 3j.)« Glyceritum Acidi Gallici (5ij. to gj-)- Suppositoria Acidi Tannici, each gr. v. Trochisci Acidi Tannici, each i.] External Action. Physiological. Therapeutical. Tannic acid has a power- Tannic acid is a better ful local astringent action, topical astringent than gal- owing partly, no doubt, to lie, and may be used to arrest its power of coagulating al- hemorrhage, or diarrhoea, or bumen, and "tanning," in as an injection for gonorrhoea some degree, any part to and leucorrhcea. Combined which it may be applied. with glycerine, in the form •of the glycerite of tannin, it is very useful as an appli- cation in various forms of sore throat, and to arrest the discharge in some chronic affections of the os uteri, in the chronic-weeping stage 214 GAMBOGE. of eczema, in ozcena, and chronic otorrhce.a. It may also soothe and restrain some of those irritable coughs which depend on chronic irritation about the pharynx. Galls are used, in the form of ointment, as an applica- tion to haemorrhoids. Internal Action. Tannic and gallic acids Tannic acid is rarely used are both powerful astrin- internally, but gallic acid is gents, but as tannic acid is serviceable in various forms rapidly converted in the of haemorrhage, such as hoz- system into gallic acid, it is mofttysis, hcematemesis, and preferable to use the latter. Menorrhagia; but in all of This conviction is proved these it must yield the palm by the fact that if we take to ergot, and it is more espe- the urine of a patient to cially in haemorrhage from whom tannic acid has been the kidney that its curative given, we find that it will not action comes into play. It precipitate gelatine, but that has also been used with suc- it strikes a blackish tint with cess to check the excretion the persalts of iron. of albumen in chronic renal disease. R. Acidi gallici 5J- '■> Glycerini f§ss. ; Aquae destillatse f§ v j- M. S. f§j. terdie. For haemorrhages. GAMBOGIA— GAMBOGE. [A gum-resin derived from Garcinia Morella (Desrozcsseaux), var. pedicellata, U. S. Dose, in substance, gr. ij.-iij. It enters into Pilulae Catharticae Compositae.] Local Action. Gamboge has no local action, and differs from some other remedies of the same class by not exerting its pur- gative effects when applied to a raw surface or injected into the cellular tissue. GAMBOGE 215 Constitutional Action. Th erapentical. Gamboge is a drastic, hy- dragogue cathartic, formerly much used where free purga- tion of watery fluid seemed to be indicated, as in cardiac dropsy ; but it is not only disagreeable and irritating, but uncertain, and has there- fore been in great measure superseded by other reme- dies on which more depend- ence can be placed. Physiological. On the Digestive and Se- creting Organs. — Gamboge exerts a good deal of irri- tating effect, acting more especially on the small intes- tine, and producing the dis- charge of large quantities of watery fluid. If given in sufficient quantity, inflam- mation and ulceration of the stomach and intestines may supervene, and death has followed the administration of a single drachm of the powder. It is also usually looked upon as a diuretic, but no trustworthy evidence has been given of its efficacy in this direction. Absorption, Mode of Elimination, &c. In order to insure its full absorption it seems necessary that gamboge must be previously dissolved in the bile, as we have seen that local application does not produce any purgative effect. It is, of course, thrown out in great measure by the intestines, but the coloring matter is ex- creted by the urine, to which it imparts a bright yellow tinge. Mode of Administration, Dose, &c. The great objection to the use of gamboge is its uncer- tainty, as we can never precisely foresee the cases in which it will cause troublesome vomiting and purging. To try and obviate this, therefore, as well as to conceal its acrid taste, we generally combine it with other drugs ; but on the whole I think I am justified in saying that gamboge has no therapeutic advantage which cannot be obtained more conveniently and agreeably by the use of other pur- gative drugs. We may most conveniently prescribe the compound pill, 2l6 YELLOW JASMINE. which contains gamboge, aloes, cinnamon, hard soap, and syrup, and of which the dose is from 5 to 15 grains. [The compound cathartic pill U. S. P. contains calomel gr. j. ; jalap gr. j. ; compound extract of colocynth gr. )yi. ; and gamboge gr.^. Dose, 1 to 4 pills.] [GAULTHERIA— PARTRIDGE-BERRY. The leaves of Gaultheria procumbens, U. S. Officinal Preparations, U. S. Oleum Gaultheria, Syrupus Sarsaparillae Compositus, and Trochisci Morphise et Ipecacuanhas. Winter-green, or tea-berry, is an aromatic astringent tonic, but is chiefly used as a flavoring addition to mixtures.] GELSEMIUM— YELLOW JASMINE. [ The root of Gehemium sempervirens ( Gray's Manual of Botany} , U. S. Officinal Preparation, U. S. Extractum Gelsemii Fluidum. Dose, gtt. n^v.-x. The tincture is generally kept in the shops, but is not officinal. Dose, gtt. x.-xl.] Constitutional Action. Physiological. Therapeutical. 1. Brain and Nervous 1. Gelsemium has been System. — Large doses of prescribed with success in gelsemium cause vertigo neuralgia of the fifth nerve, and double vision. A para- intercostal, and ovarian neu- lysing influence is exerted on ralgia, and myalgia. the spinal cord, the power of voluntary movement be- ing finally quite abolished, numbness and staggering being preliminary symp- toms. Reflex irritability is also suspended, the pupil di- lates, and at a later stage the sensory columns of the cord are also paralysed, produc- ing complete anaesthesia (Bartholow). GENTIAN. 217 Ringer tells us that large doses of the alkaloid [Gel- semia, of which gr. I has caused death], at first para- lyse, and then excite teta- nus, which in a short time gives way to paralysis. 2. Heart and Circulation. — A slightly weakening effect on the heart is noted. [It diminishes the pulse-rate by lessening the irritability of the excito-motor ganglia of the heart, and the arterial pressure by diminishing car- diac irritability and vaso- motor tonus. 1 ] 3. Respiration and Te7?i- perature. — The respirations become labored, shallow, and irregular, from dia- phragmatic paralysis, death ensuing from asphyxia. The temperature falls, probably in consequence of the pro- fuse perspiration which en- sues. It has been recommended as a remedy for tetanus. 3. Bartholow recommends gelsemium in various forms of convulsive or spasmodic cough, and in acute inflam- mations of the lungs and pleura he thinks it may do good by diminishing the activity of the respiratory functions. Dose, &c. We may give from 20 to 30 minims of the tincture every three hours, until drooping of the eyelid, dilatation of the pupil, and muscular languor are noted. GENlTANA— GENTIAN. [ The root of Gentiana lutea, U. S. Officinal Preparations, U. S. Extractum Gentianae. Dose, gr. ij.-iv. Extractum Gentianae Fluidum. Dose, tt^x.-xxx. Infusum Gentianae Compositum. Dose, fsj.-ij. Tinctura Gentianae Composita. Dose, f 3j.-iv. 1 [Dr. Ott, Phila. Med. Times, vol. v.] 19 2l8 CRANESBILL — GLYCERINE. Gentian is the type of the simple bitters, and is largely employed in cases where a tonic of this kind is indicated. As it contains no astringent element, it may readily be exhibited in combination with iron.] Gentian and chiretta may be grouped together, as their action is almost precisely similar. They are both light, agreeable tonics, with pleasant aromatic bitter flavor, and may be used freely in dyspepsia and debility with loss of appetite. Gentian has always, however, been much more generally employed than chiretta, and this may be partly due to the very agreeable compound preparations of the former drug. [GERANIUM— CRANESBILL. The rhizome of Geranium maculatum, U. S. Officinal Preparation, U. S. Extractum Geranii Fluidum. Dose, fjss.-j. Crowfoot, or cranesbill, is an indigenous astringent tonic, containing tannic and gallic acids, and may be used with advantage in bowel complaints, and as a styptic. A decoction in milk is sometimes given to children.] GLYCERINA— GLYCERINE. \_A color/ess, inodorous, syrupy liquid, of a sweet taste, and having the sp. grav. 1. 25, U. S. Used in preparing the officinal Extracta Fluida, and the glycerita.] This useful substance is almost exclusively used exter- ternally. It moistens and softens the skin, and both pre- vents and cures the painful and unsightly cracks known as " chaps" on the hands. It is a serviceable application, either alone or combined with other drugs, in various forms of skin disease. It may soothe an irritable cough by moistening the dry- ness of the throat, and it is stated to be the most efficient means at our command for the prevention of bedsores. In addition to this, it forms an excellent vehicle for the solution of various drugs, as seen in the five glycerites of LICORICE. 219 the Pharmacopoeia, having this additional advantage, that its adhesive nature enables the active ingredient to remain longer than it otherwise would in contact with the affected surface. It is also a good solvent of the alkaloids, dis- solving them freely, and, being decidedly antiseptic, it is now used for the preservation of vaccine lymph. Internal Use. It was thought at one time that glycerine might prove an agreeable and efficient substitute for cod-liver oil ; but this has not been confirmed, and glycerine is now seldom used internally. [Glycerita. The officinal Glycerites are — Glyceritum x\cidi Carbolici Glyceritum Picis Liquidse " Acidi Gallici " Sodii Boratis. " Acidi Tannici Their uniform strength is 3lj- to the ounce, except gly- cerite of tar, which is 3ss. to fsj.] GLYCYRRHIZA— LICORICE. [ The root of Glycyrrhizce glabra, U. S. Enters into the manufacture of Decoctum Sarsaparillas Compositum, Extractum Glycyrrhizae, Extractum Sarsa- parillae Fluidum Compositum, Infusum Lini Compositum, Pilulae Hydrargyri, and Syrupus Sarsaparillae Compositus. Officinal Preparations, U. S. Extractum Glycyrrhizae Fluidum (for flavoring). Extractum Glycyrrhizae. Liquorice.] This is only used as a flavoring ingredient, and [enters into the Mistura Glycyrrhizae Composita, Pilulae Ferri Iodidi, Tinctura Aloes, Tinctura Rhei et Sennae, Trochisci Glycyrrhizae et Opii, and Trochisci Cubebae. Liquorice is an excellent demulcent, and in the form of decoction is used in catarrhal affections and diarrhoea. It is largely used as a flavoring ingredient, and is perhaps the best adjuvant to quinia, to disguise the bitter taste of that drug.] 220 COTTON COLLODION. [GOSSYPII RADIOS CORTEX— BARK OF COTTON ROOT. The bark of Gossypiiim herbaceum, and of other species of Gossypuim, U. S. Officinal Preparation, U. S. Extractum Gossypii RadicisFluidum. Dose, f5ss.-j. This is an efficient oxytocic and emmenagogue, largely employed in the south, in the form of decoction (f^jv. to Oj.) as a parturifacient. A tincture is also used.] GOSSYPIUM— COTTON. \A filamentous substance separated from the seed of Gossypit/m herbacetim, and of other species of Gossypium, U. S. Officinal Preparations, U. S. Pyroxylon. Gun Cotton. Collodium. Pyroxylon dissolved in ether and alcohol.] This useful substance is employed in various inflamma- tory conditions, with the view of excluding air and sup- plying warmth and slight support. Thus in burns, and more especially in those of a superficial nature, the imme- diate application of a thick layer of cotton-wool relieves the smarting pain and promotes recovery ; and the same treatment may be recommended to a blister after the watery fluid has been removed from the bulla. In acute rheuma- tisni, also, the patient may derive much relief from the careful and equable encircling of his inflamed joints with cotton-wool, secured in position by a few turns of flannel bandage. It is also believed by some aurists to form the best mate- rial for the construction of an artificial membrana tympani. [COLLODIUM— COLLODION. Collodium cum Cantharide. Blistering Collodion. Collodium Flexile. Flexible Collodion.] Collodion is used to fulfil two indications: — i. To exclude the action i. For this purpose it is of the air from inflamed parts, used to paint over the pus- and to prevent the patient tules of smallpox, in the hope from scratching and irritat- of preventing pitting. Also, ing the surface. in herpes zoster and in ery- sipelas it may be applied with advantage. GUAIAC. 221 2. To exert a moderately 2. Dr. Hare tells us that, astringent effect from the at the very early or papular contraction which follows stage of a boil, we may avert its drying. subsequent suppuration by the application of collodion. Sir D. Corngan recom- mends sealing up the ex- tremity of the prepuce by collodion to remedy the nocturnal form of inconti- nence of urine in children, and it may be of service in haemorrhage depending on capillary oozing, and more especially in the troublesome bleeding frequently follow- ing leech-bites. Finally, its application may facilitate the healing process in small cuts and wounds, as after the ope- ration for harelip, and in the troublesome condition known as cracked nipples. Under all these conditions the best results may be ob- tained by using the flexile collodion, in which the com- bination with castor-oil pre- vents the too rapid cracking or peeling away of the pro- tecting film. [GUAIACUM— GUAIAC. The heart-wood of Guaiacum officinale, U. S. Guaiaci Lignum. Guaiaci Resinse. A peculiar resin obtained from Guaiacum officinale, by spontaneous exudation, by incision, by dry heat, or by decoction of the comminuted wood, U. S. 19* 222 GUTTA-PERCHA — LOGWOOD. Officinal Preparations, U. S. Tinctura Guaiaci. Dose, f 3j.-ij. Tinctura Guaiaci Ammoniata. Dose, f 3j.-ij. Also enters into Decoctum Sarsaparillae Compositum, Syrupus Sarsaparillae Compositus, and Pilulae Antimonii Composite. Uses. Guaiac is alterative, and is largely employed in chronic rheumatism, rheumatoid arthritis, and syphilis. The ammo- niated tincture is the best preparation, and should be given in milk.] GUTTA-PERCHA— GUTTA-PERCHA. \_Thc concrete juice of Isonandra gutta {Hooker. Loudon's Journal of Botany, 1848), U. S. Officinal Preparation, U. S. Liquor Gutta-Perchse (in chloroform). Used in making charta sinapis.] Gutta-percha is only adapted for external use, and is of service mechanically as a material for splints, being readily softened in hot water and moulded to the affected joint or limb. It furnishes a cheap and efficient rival to oiled silk, and its solution in chloroform forms a good and impervi- ous covering in smallpox, erysipelas, and other affections where it is of importance to protect the skin from the action of the air. H^EMATOXYLON— LOGWOOD. \The heart-wood of Hcematoxylon Campechianum, U. S. Officinal Preparations, U. S. Decoctum Haematoxyli. Dose,, f^ij. Extractum Hsematoxyli. Dose, gr. x.] Logwood has astringent It is an agreeable and properties. efficient remedy in diarrhoea, [It may be combined for and is well taken by chil- children as in the following dren. We must remember formulae : — ] that it imparts its pink color to the faeces, and to the urine should that secretion chance to be alkaline. AMERICAN PENNYROYAL BARLEY. 22 J I£. Extracti haematoxyli gr. x. ; Tincturse catechu f ^ss. ; Syrupi f&j. ; Aquae carui ad f §ss. M. Ter die. IJ. Pulveris cretae aromatici [Br.] 5i- '■> Tincturae opii f 3j- \ Syrupi zingiberis f ^j. ; Decocti haematoxyli ad f §vj. M. Fiat mistura, cujus sumat unciam imam post singulas dejectiones liquidas. [HE DEOMA— AMERICAN PENNYROYAL. The leaves and tops of Hedeoma Pidegioides, U. S. Officinal Preparation. Oleum Hedeoma. Dose, gtt. ij.-x. Hedeoma is a gentle stimulant aromatic used in flatu- lent colic, sick stomach, and in amenorrhea. In recent suppression of the menses, it is a popular domestic remedy, given in warm infusion.] [HELLEBORUS— BLACK HELLEBORE. Root of Helleborus niger, U. S. (The dose of the powdered root is gr. ij.-iij., as an alterative; or gr. x.-xx. as a purge.) Officinal Preparations, U. S. Extractum Hellebori. Dose, as a purgative, gr. x. Tinctura Hellebori. Dose, as a purgative, f3ij- Chiefly interesting on account of its popularity among the ancients as a hydragogue cathartic, but as it is harsh and uncertain in its action, it is rarely, if ever, used at present.] HORDEUM— BARLEY. [ The decorticated seed of Hordeum distichon, U. S. Officinal Preparation, U. S. Decoctum Hordei (%). to Oj.) ad lib. "\ In the form of decoction, barley is used as a demulcent drink. [Malt extract is largely used as nourishment, given preferably in milk.] 224 HOPS — MERCURY. HUMULUS— HOPS. [ The strobiles of Hunmlus lupuhis, U. S. Lupulina. The yellow powder separated from the stro- biles of Humulus lupuhis, U. S. Officinal Preparations, U. S. Infusum Humuli (]§ss. to Oj.). Dose, ad lib. Tinctura Humuli (Hijss. to Oj.). Dose, f^ss.-ij. Extractum Lupulinae Fluidum (£xvj. toOj.). Dose, f5ss.-ij. Oleoresinae Lupulinae. Dose, nrx-f5j. Tinctura Lupulinae (Jij. to Oj.). Dose, fgss.-ij.] Hops are tonic and probably narcotic, more especially in the form of the old-fashioned hop-pillow. Internally they are rarely prescribed. [They are much used as an anodyne cataplasm, either alone or with Indian meal. The preparations of lupulin are sometimes administered in delirium tremens as a sedative tonic] HYDRARGYRUM— MERCURY. \_A silver-white metal, liquid at common temperatures, and having the sp. grav. 13.5, U. S. Officinal Preparations, U. S. I. In the Metallic State. Hydrargyrum. Emplastrum Ammoniaci cum Hydrargyri. Emplastrum Hydrargyri. Hydrargyrum cum Creta (mercury 37^ per cent."), gr. v-xxx. Pilulse Hydrargyri (mercury 2>zV^> P er c -)> 3 S r - pills. Unguentum Hydrargyri (mercury 50 per cent.). II. Oxidized. Hydrargyri Oxidum Rubrum. Used externally. Unguentum Hydrarg. Oxidi Rubri (5j--3vij.)« Hydrargyri Oxidum Flavum. Used externally. Unguentum Hydrarg. Oxidi Flavi (3j- - 3vij.). III. Sulphuretted. Hydrargyri Sulphuretum Rubrum. For fumigating. IV. As Protochloride (subchloride?). Hydrargyri Chloridum Mite. Dose, gr. ss.-x. MERCURY. 225 Pilulge Antimonii Compositse (calomel 16^3 perct.). Pilulae Cathartica Compositse (each pill contains, calomel, ext. jalap, aagr. j.; ext. colocynth. comp. gr. j.ji; and gamboge, gr. }(). Dose, 1 to 4. V. As Bichloride (proto-chloride ?, perchloride, Br.). Hydrargyri Chloridum Corrosivum, gr. t V~"to- Hydrargyrum Ammoniatum. Used externally. Unguentum Hydrarg. Ammoniati (gr. xl.-^j.). VI. With Iodine. Hydrargyri lodidum Rubrum (biniodide), gr. T ^-. Unguentum Hydrargyri Iodidi Rubri (gr. xvj. to Sj-)- Liquor Arsenici et Hydrargyri Iodidi (Donovan's Solution). Dose, r^v.-x. Hydrargyri lodidum Viride (protiodide). Dose, gr. j£. VII. With Cyanogen. Hydrargyri Cyanidum. Dose, gr. T V~/^« VIII. With Acids. Liquor Hydrargyri Nitratis. As a caustic. Unguentum Hydrargyri Nitratis (Citrine ointment). Hydrargyri Sulphas Flava. Dose,gr. %-}4 (Turpeth Mineral). As an emetic, gr. ij. Antidotes. Acute poisoning produced by corrosive sublimate re- quires albumen (white of eggs, blood, or flour and water) and demulcents. Milk may be freely drunk, and vomit- ing encouraged. Gold leaf and iron-filings form a chemi- cal antidote, decomposing the chloride and depositing the mercury.] Local Actions. Physiological. Th erapeutical. One preparation, the acid The acid nitrate is used nitrate, is a very powerful as an application in lupoid caustic. ulcerations, and in ulcera- Other preparations are tions about the os and cervix occasionally used externally uteri. for skin diseases, syphilitic Calomel dissolved in lime- ulcerations, &c, and in vir- water [3j. to Oj.], and tue of the destructive power forming the familiar black- 226 MERCURY. which they all (but more especially corrosive subli- mate) exert over the lowest forms of animal and vege- table life. Mercury, being readily absorbed by the skin, is frequently introduced into the system by this channel. wash, is of great service in venereal ulcerations, either primary or secondary ; and the same salt, in the form of powder, may be dusted on condylomata or corneal ulcerations with advantage. Corrosive sublimate, in the form of lotion, often checks troublesome ulcerations of the throat j and both this and the various forms of mercurial ointment are almost infallible remedies for pediculi or for favus, tinea tonsurans, and other skin diseases which are known to depend on the presence of minute vegeta- ble growths. We must remember, however, that dangerous symptoms, and even death, have occasion- ally been caused by the absorption of the mineral when thus applied. Many chronic skin dis- eases may be well treated by citrine ointment. Goitre frequently yields in India to the inunction of the binio- dide, and Mr. Marshall has highly recommended the oleate of mercury as an application to various joint affections. The external application of mercury, by the calomel vapor bath, or blue ointment, having for its object the production of constitutional effects, will be considered further on. MERCURY. 227 Internal Actions and Uses. 1. Brain and Nervous System. — Mercury, pushed up to the development of poisonous symptoms, pro- duces a curious condition of nervous debility and tre- mors, which is occasionally met with in workmen who have been freely exposed to its fumes in silvering glass. 2. Circulation and Respi- ration. — One form of mer- cury, the perchloride, or corrosive sublimate, acts as a cardiac poison, distinctly lowering the action of the heart, but the other prepa- rations have no such influ- ence. Mercury causes anae- mia by destroying the red corpuscles of the blood. [But in minute doses, gr. t Jq to T -Jo, given thrice daily for a length of time, corrosive sublimate acts as a tonic and increases the number of the red-blood corpuscles, par- ticularly in syphilitic anoz- mia.~\ 3. Secreting Organs — Sto- mach and Intestines. — Mer - curial preparations, and more especilly calomel, act as purgatives, causing re- peated grayish or greenish evacuations; the duodenum being the portion of the gut primarily acted upon. The action of mercury on the liver has provoked a good deal of controversy; and, 1. Mercury has been found of most signal service in some forms of advanced syphilitic disease affecting the brain. 3. In that form of vomiting common in children, where the stomach rejects every- thing suddenly and violent- ly, 3/3 gr. of hyd. cum cret& or Ye gr. of calomel every hour will often cure, as Ringer has shown. Calomel and blue pill are frequently used as adjuncts of other purgative drugs. Clinical evidence has most 228 MERCURY. whereas it was formerly held that the biliary secretion was directly stimulated, the ex- periments of Bennett and the Edinburgh Committee seem to show that, on the con- trary, the flow of bile is actually checked or dimin- ished by calomel. Two ob- vious fallacies underlie these experiments — the first being that the dogs, kept for con- siderable periods with bili- ary fistula, were so affected not only by the shock of the operation, but by the result- ing inconvenience, general discomfort, and gradual starvation, that secretion must of necessity have been in great measure suspended ; and, secondly, it is well known that a remedy which has no effect on a healthy organ may powerfully mod- ify its condition when in a state of congestion or func- tional derangement. Kidneys. — Mercury, and more especially blue pill, has the power of promoting the action of diuretics. Saliva. — Mercury is well known to stimulate the ac- tion of the salivary glands, large quantities of their secretion being poured out when the drug is pushed far enough. The fluid, at first thick and containing much albumen, subsequently be- comes thin and watery. distinctly proved, not only that the well-known symp- toms of biliousness may be most effectually removed by the old-fashioned blue pill and black draught, but that an increase of bile may also be thus produced in the mo- tions. This has been ex- plained by the irritating in- fluence of the mercury on the duodenum, and the con- sequent sweeping away of the secreted bile, which, un- der ordinary circumstances, is well known to undergo reabsorption from the intes- tines. Mercury has been sup- posed also to act by stimu- lating the gall-bladder to contract. Thus, in the form of the old pill, containing blue pill, squill, and digitalis, we ob- tain a most marked diuretic effect. The old-fashioned notion is now happily exploded, that we must measure the efficacy of our mercurial treatment by the amount of salivation. MERCURY. 229 Skin. — Inunction of ung. hydrargyri is apt to bring out a crop of irritable pim- ples, and one of the symp- toms of mercurial poisoning is an eczematous eruption. Mercury is supposed to Mercury was accordingly stimulate absorption by invariably given, in former rendering effused fibrine less days, in all cases where any cohesive, by promoting its effusion of fibrine was sup- disintegration, and by re- posed to have taken place, tarding cell-growth. such as the second stage of pneumonia. Specific Action. Mercury may be said to act as a specific in syphilis, and more especially in the primary and secondary stages of that insidious malady. When we are satisfied that we have to deal with an infecting sore, the sooner we begin our mercurial treatment the better ; and it is well to push it in small doses for a considerable time, until the gums are slightly affected. For this purpose moderate doses of blue pill and opium are perhaps the most effectual ; but we may also derive much benefit now and then from rub- bing in 5ss. to 3j- of blue ointment night and morning. The whole train, also, of seondary eruptions of the skin, sore throat, condylomata, iritis, &c, must also be subjected to mercurial treatment, and the calomel vapor bath and the bichloride of mercury will here do us good service. It is doubtful whether, by the most careful and scientific treatment of a primary sore, we can altogether prevent the development of secondary symptoms ; but if we can- not do this we can at least postpone them, and render them less severe. In the congenital syphilis of young children, the local ap- plication of a little blue ointment, either rubbed into the skin or smeared over a bit of flannel wound round the waist, is eminently satisfactory in its results. Mercury was formerly believed to have a specific influ- ence in checking the inflammations of serous membranes, and was consequently invariably used in peritonitis, peri- carditis, and pleurisy ; but faith in this conviction has been a good deal shaken of late, and the conventional 20 230 MERCURY. calomel and opium does not so often appear in prescrip- tions as formerly. On the continent much importance is attached to con- siderable doses of calomel in the early stages of typhoid fever, but statistics do not seem to prove any decided advantage as accruing from this mode of treatment. Drawbacks, Mode of Administration, &c. It is important to be familiar with the signs which indi- cate when the mercurial treatment has been carried far enough. The gums generally give the first token in a delicate red line running along their margin, followed by pulpy thickening of the interdental portions, and finally retraction from the teeth. To this succeed [a coppery taste in the mouth], an increased flow of saliva and a peculiar fcetor of breath, and we generally find that the very slightest 'touching' of the gums is sufficient to show that the physiological effect of the mineral has been attained. Whilst a patient is undergoing a mercurial course, we must keep up his constitution well with good diet, iron, and perhaps a little stimulant ; for experience shows that mercury far more speedily exerts its debilitating influence on weak persons or those who are enfeebled by fasting. We must therefore beware Of its use in consumptive or strumous persons, or in those who are suffering from Bright's disease or diabetes, and recollect that idiosyncra- sy may here play an important part, and that some persons are much more readily salivated than others, without known cause. Children, more especially those under the age of two years, are rarely if ever salivated, and only show the influ- ence of the drug by peculiar greenish stools ; but we must beware of using it in them too freely, as Mr. Hutchinson has traced a peculiar malformation of the teeth to the incautious use of grey and other so-called ' teething' pow- ders in early life. [But where salivation does occur in children it is apt to be uncontrollable, and to be followed by destructive ulceration, or gangrene of the mouth and lips with ugly cicatrices.] Mode of Elimination, &c. Mercury is eliminated principally by the urine, but also in smaller degree by the saliva and the biliary and intes- tinal secretions. mercury. 23i Mode of Administration, Dose, &c. In the treatment of syphilis, mercury may be given by inunction, in which from 3 SS - to Jj. of blue ointment is rubbed into the skin once or twice a day, varying the place of application so as to avoid that cutaneous irritation which may otherwise result. This method, although very effectual, is dirty, and rather liable to cause excessive salivation. Fumigation is also extensively employed, but it is only of real service in the cutaneous affections dependent on secondary syphilis, where the actual deposition of the vaporised calomel on the skin produces a beneficial local influence. Twenty grains of calomel are used at each sitting, and are diffused along with watery vapor by a spirit lamp, and brought in contact with the patient, as he sits covered with a blanket, on a perforated chair, over the fumigating apparatus. Corrosive sublimate has been used by subcutaneous injection, but in this way it creates great local irritation, and is much better given by the mouth, acting especially well in secondary syphilis, combined with iodide of potas- sium. Thus : — R. Hydrarg. perchlor. [chlor. corrosiv. ] gr. ss. ; Potassii iodidi H ss -» Decocti cinchonse f ^viij . M. S. f§j. ter die post cibum. R. Hydrarg. perchlor. [chlor. corrosiv.] gr. ij. ; Acidi hydrochlorici diluti f £ij. ; Mellis depurati f §j. ; Aquoe destillatoe ad f ^x. M. An excellent gargle for syphilitic throat ulceration. Opinions vary considerably regarding the best form of mercury for internal administration in the treatment of syphilis. Mr. Hutchinson prefers hydrarg. cum creta in doses of from gr. iij. to gr. v. two or three times a day. Ricord, on the other hand, advises gr. j.-iij. of the green iodide, whilst others are content to employ the pil. hydrarg. in gr. j.-iij. doses in pill, keeping its purgative properties in check by a little opium. R. Pil. hydrargyri gr. ij. ; Pulveris opii gr. j^ ; Confectionis rosas q. s. Ut fiat pilula quarta quaque hora sumenda. 232 MERCURY. B.. Hydrarg. subchlor. [chlor. mitis] gr. xij. ; Mannse gr. vj. ; Pulveris tragacanthse compositce [Br.] gr. vj. M. Divide in pilulas sex. Capiat duas pro re nata. A good purgative formula. For purgative purposes the blue pill is generally pre- scribed in 5 grain doses, taken overnight, and aided by some fluid aperient in the morning. As a diuretic the following is the useful old combination, sometimes known as the ' Guys,' and sometimes as 'Baillie's Pill : ' — R. Pilulas hydrargyri gr. iij. ; Pulveris scilla? gr. jss. ; Pulveris digitalis gr. ss. M. Fiat pilula bis terve die sumenda. [Unguentum hydrargyri nitratis, citrine ointment, is much used as a stimulant and alterative application in chro- nic skin-diseases and ophthalmia. It generally requires to be diluted with lard. The decoction of Zittmann may be used with great ad- vantage as a gentle diaphoretic and alterative in secondary syphilis, either alone or as an adjuvant to mercurials. It has been also used with advantage in scrofulous conditions of the system, in chronic rheumatism, in skin-diseases, and obstinate ulcerative affections. The formula of the Prussian Pharmacopoeia is as follows : — Take of sarsaparilla 12 ounces, spring water 90 pounds. Digest for twenty-four hours ; then introduce, enclosed in a small bag, l 1 /^ ounces of sugar of alum (equal parts alum and white sugar), T / 2 ounce of calomel, and a drachm of cinnabar. Boil to thirty pounds, and near the end of the boiling add aniseed, fennel-seed, of each half an ounce, senna 3 ounces, and liquorice root 1^ ounces. Put aside the liquor under the name of The Strong Decoction. To the residue add 6 ounces of sarsaparilla and 90 pounds of water. Boil to 30 pounds, and near the end add lemon-peel, cinnamon, cardamom, liquorice, of each 3 drachms. Strain, and set aside, the liquor under the name of The Weak Decoction. Mercury was detected by Wiggers in this decoction in very small proportion. It should not be prepared in metallic vessels lest the mer- curial in solution should be decomposed. The decoction may be drunk freely. — U. S. Dispensatory, 14 ed. } Phila. 1877, p. 1 1 40, note.'} HYDRASTIS — HENBANE. 233 [HYDRASTIS— HYDRASTIS. The root of Hydrastis Canadensis, U. S. Officinal Preparation, U. S. Extractum Hydrastis Fluidum. Dose, f3ij.-iv. Hydrastis is an indigenous bitter tonic, containing the alkaloids berberina and hydrastia, and is said to have de- cided diuretic properties. A decoction has been used as an injection in gonorrhoea. Its exact therapeutic place among remedies does not appear to be well defined.] HYOSCYAMUS— HENBANE. [Hyoscyami Folia. The leaves of Hyoscyamus niger, U. S. Hyoscyami Semen. The seed of Hyoscyamus niger, U. S. Officinal Preparations, U. S. Extractum Hyoscyami (from the juice). Dose, gr. i.-iij. Extractum Hyoscyami Alcoholicum (dried leaves). Dose, gr. i.-iij.] Extractum Hyoscyami Fluidum (leaves). Dose, n^v. Tinctura Hyoscyami (dried leaves, Jij. to Oj.). Dose, fjss.-ij. Hyoscyamus is, like belladonna, a liypnotic and mydri- atic, and owns the same antidotes.] The remarks made with reference to stramonium are equally applicable to hyoscyamus, which also contains an alkaloid, hyoscyamia, probably identical with atropia. The main point of difference, then, from belladonna, is the superior narcotic powers of hyoscyamus, which have been especially prized and developed in lunacy practice. It is also a favorite remedy in painful and irritable affections of the bladder, where it seems to exert a marked soothing influence, and, as an expectorant, it is an excellent addition to cough mixtures. R. Extracti belladonnse gr. iij. ; Camphorse gr. xij.; Extracti hyoscyami gr. xv. Misce, fiant pilulae sex, quarum sumat unam hora decu- bitus. Narcotic. 20* 234 ISINGLASS — IGNATIA. &. Tincturse hyoscyami TTixxx. ; Potassii carbonatis gr. x. ; Syrupi papaveris [Br.] f 5'i- ; Aquae camphorce ad f^jss. Misce, fiat haustus hora somni sumendus. Narcotic. R. Vini ipecacuanhas f 5ij. ; Succi hyoscyami [ext. hyoscyami fluid.] f3J. ; Tincturse scillse f §ss. ; Syrupi tolutani f§j. ; Aquae carui ad f^vj. Misce. Cap. semunciam ter quaterve in die. Cough mixture. Dr. Robert Lawson, late of the West Riding Asylum, has recently made a large variety of very interesting phy- siological and therapeutical observations on the actions and uses of hyoscyamia, the alkaloid of hyoscyamus. He has found that it produces "a. subdued form of mania, accom- panied by almost complete paralysis of the voluntary mus- cles, and ending in quiet and refreshing sleep;" and he thinks that this might advantageously be substituted for many forms of extreme excitement occurring among the insane. He has derived great benefit from the drug in "the treatment of recurrent, acute, and subacute mania, and the monomania of suspicion," and recommends the following formula: — R. Hyoscyamiae gr. j. ; Sp. aetheris Triviij.; Alcohol TTi xxiv. ; Aquas fontis ad f Sjj. Misce, ut fiat haustus. [ICHTHYOCOLLA— ISINGLASS. The swimming-bladder of Acifiencer Huso, and of other fishes, U. S. Isinglass is only used in medicine as an article of diet for the sick, and as the basis of court-plaster. ~\ [IGNATIA— IGNATIA. The seed of Strychnos Ignatia, U. S. Officinal Preparation, U. S. i/_i/ Extractum Ignatia. Dose, gr. y± Is used for the same purpose as Nux Vomica, but the extract, containing more strychnia, is a somewhat stronger preparation.] INFUSIONS IODINE. 235 [Infusa. The officinal Infusions are: — Infusum Angusturas Infusum Lini Compositum " Anthemidis " Pareiras " Buchu " Picis Liquidas " Calumbas " Pruni Virginianas " Capsici " Quassias " Caryophylli " Rhei " Cascarillas " Rosas Compositum " Catechu Compositum " Salvias " Cinchonas Flavas " Sennas " Cinchonas Rubrae " Serpentarias " Digitalis " Spigelias " Eupatorii ' ; Tabaci " Gentianas Compositum " Taraxaci " Humuli " Valerianae " Juniperi " Zingiberis.] " Kramerias IODINIUM— IODINE. \_A bluish gray non-metallic element obtained principally from the ashes of sea-zveeds. It rises in purple vapor when heated. Officinal Preparations, U. S. Tinctura Iodinii (iodine 3j. to Oj.). For external use. Tinctura Iodinii Composita (iodine ^ss. ; potass, iod. Jj.; alcohol Oj.). Dose, gtt. x.-xx. Liquor Iodinii Compositus (iodine 3vj.; potass, iod. ^jss. ; water Oj.). Dose, gr. v.-x. Unguentum Iodinii. Unguentum Iodinii Compositum. Liquor Arsenici et Hydrargyri Iodidi (Donovan's Solution). Dose, gtt. v.-x. Syrupus Ferri Iodidi (iodide of iron, 7^ gr. to f5j.)- Dose, n^x.-xxx. Pilulse Ferri Iodidi (ferri iodid. gr. j.; ferri redact. J). Also enters into Sulphurislodidum, Unguentum Sulphuris Iodidi, Arsenici Iodidum, Hydrargyri Iodidum Rubrum, Unguentum Hydrargyri Iodidi Rubri, Hydrargyri Iodidum Viride, Plumbi Iodidum, Potassii Iodidum, and Unguent- um Potassii Iodidi. Antidotes. Starch and demulcents. 236 IODINE Incompatibles. With Iodine. — Alkalies and alkaloids (quinia and strych- nia); extracts containing starch; water precipitates the iodine from tinctura iodinii. The compound tincture may be diluted with water without precipitation. With Potassii Iodidum. — Acids, acetate of lead, and the metallic salts generally. With Ferri Iodidum. — Lime-water, alkalies, and the vegetable astringents.] Local Actions. Physiological. Iodine in substance is never used save for its anti- septic properties. Dissolved in spirit, however, it is an excellent counter-irritant, producing itching and smart- ing of the skin, with desqua- mation of cuticle, and even blistering if the application be too frequently repeated. It has been shown that this local action of iodine is at- tended by a very free extru- sion of colorless blood cor- puscles into the subcutaneous cellular tissue. Experiment has proved that iodine is not absorbed into the system through the unbroken cuticle. [But fatal poisoning has resulted from absorption of a solution of iodine, which had been in- jected into an ovarian cyst. Iodine and the soluble iodides are incompatible with the alkaloids as well as with most metallic salts in solution.] Therapeutical. It is therefore of some- value for the correction of foetor in drains, &c. The tincture or liniment of iodine is very extensively used as a counter-irritant application to enlarged glands, chronic abscesses, swollen joints, chilblains, and to various forms of skin disease, more especially the common varieties of ring- worm, which speedily yield to this treatment. It is very useful when painted over the chest in chronic pneumonia and fibroid and tubercular affections of the lungs; and Mr. Jordan, of Birmingham, has recently drawn attention to the great success attained by him in the dispersion of boils, carbuncles, and suppu- rating glands by iodine freely applied to a neighbor- ing vascular area. It is also an excellent in- jection into various secreting cavities, curing hydrocele by obliterating the sac of the IODOFORM IPECACUANHA. 237 tunica vaginalis, acting well on the same principle in some rare cases of ovarian d?'opsy and bronchocele, and deo- dorising and lessening dis- charges in empyema and suppurating glands. [In scrofula Lugol's solution may be injected directly into the enlarged glands, with great benefit.] [For the Constitutional Effects, see Iodide of Potas- sium.] [IODOFORMUM— IODOFORM. In yellow, scaly crystals having the odor of saffron. It is insoluble in water, but soluble in alcohol, ether, and the fixed and volatile oils. By a heat above 2500^ it is decomposed, giving off violet vapors. U. S. It is prepared by decomposing an alcoholic solution of iodide of potassium with lime. As a local anaesthetic, it is applied in powder to painful ulcers, whether chronic, cancerous, or syphilitic, where it relieves pain and pro- motes cicatrization. Suppositories (gr. v.-x.) are used in hcemorrhoids and uterine cancer. In ethereal solution (20 per cent.), it has been highly recommended as an applica- tion in chronic i?ifiammation of the throat. x ~\ IPECACUANHA— IPECACUANHA. [ The root of Cephcelis Ipecacuanha, U. S. Officinal Preparations, U. S. Extractum Ipecacuanhse Fluidum. Dose, gtt. xxx. Pulvis Ipecacuanhas Compositus. Dose, gr. x. Dover's powder (ipecac. 1 pt., opium 1 pt., carb. potass. 8 pts.)- Trochisci Ipecacuanhas. Trochisci Morphise et Ipecacuanhas (Morphia gr. ^ ). Syrupus Ipecacuanhas (f^ij. extract to syrup xxx.). Dose, f 3J-— f ^ss. Vinum Ipecacuanhas (f^ij. extract to sherry wine fjfxxx.). Dose, f 5j-— iv.] 1 [Phila. Med. Times, vol. iv. p. 4, 1873.] 2 3 8 IPECACUANHA. Local Actions. Physiological. The prolonged applica- tion of ipecacuanha to the skin causes some irritation, followed by the appearance of vesicles, pustules, and even troublesome ulceration. In some persons the pow- dered root causes violent irritation of the respiratory passages, ranging from symptoms resembling hay- fever up to a spasmodic condition analogous to true asthma. Therapeutical. The use of the slowly acting and pustulating forms of counter-irritation has fallen out of fashion, as they are not only disfiguring, but give less relief than more sedative applications. The only way in which we find ipecacuanha employed locally is in the form of spray, which Prof. Ringer has found very useful in chronic bronchitis. Constitutional Actions. 1. Brain and Nervous System. — i. No effect seems to be produced on the brain. 2. Ipecacuanha has a mark- edly stimulating influence on that centre in the medulla oblongata Which presides over the action of vomiting. Whether by subcutaneous injection, or by being taken into the stomach, it causes, within a moderate period, a decided but mild emetic ef- fect; and as this may arise either from irritation of the mucous membrane of the sto- mach, or from a primary stim- ulation of the vomiting cen- tre itself, ipecacuanha must be ranked among both the di- rect and the indirect emetics. It maybe said generally to occupy a middle place be- tween sulphate of zinc and 2. Ipecacuanha cannot be recommended in cases of poisoning, for not only does it act too slowly, but its nau- seating and depressing influ- ence may be injurious. It is of great service, however, in many of those affections of the throat or respiratory organs where we wish to empty the lungs or detach foreign bodies or false mem- branes from the larynx or trachea, as in bronchitis, croup, diphtheria, &c. A most remarkable fact in the action of this drug is its power, when given in small doses, of checking vomiting. Thus, in the vomiting of pregnancy, in the irritability IPECACUANHA. 2 39 tartar emetic, being neither so prompt as the first, nor so nauseating as the second. II. Circulation. — Ipecacu- anha has no direct influence on the heart or circulation, save the usual depression fol- lowing nausea and vomiting. III. Respiration and Tem- perature. — No effect is pro- duced on the rapidity of the respiratory function, save the temporary acceleration usu- ally accompanying the act of vomiting. There seems no doubt, however, that ipeca- cuanha causes an increased secretion from the mucous membrane of the bronchial tubes. After poisoning by ipecacuanha, the lungs have generally been found in a bloodless condition. IV. Digestive and Secret- ing Organs i. Stomach and Intestines. — As already noted, ipecacuanha causes some irritation of the termi- minal filaments of the pneu- mogastric nerve distributed to the stomach, and thus sets in motion the reflex machin- ery necessary to produce of stomach of children, and in other dyspeptic condi- tions, a drop of ipecacuanha wine taken every hour will often prove truly curative. At present this must be look- ed upon as one of the enig- mas of therapeutics. III. Ipecacuanha is there- fore a most useful expecto- rant, thinning and diluting the pulmonary mucus, and thus facilitating its expulsion. It is hence almost universally employed in bronchitis, com- mon catarrh, winter cough, &c. It was formerly used, and with some alleged suc- cess, in hemoptysis, 5 -grain doses repeated at short inter- vals exerting a marked de- pressing effect, and thus checking the tendency to bleeding; but with the. intro- duction of more effectual re- medies, this mode of treat- ment has now fallen into disuse. IV. — 1. Ipecacuanha is indicated in some overload- ed conditions of the stomach, caused by excessive indul- gence either in food or drink; and the dull aspect, coated tongue, foul breath, head- ache, and nausea, may be promptly relieved by a good emetic dose. 240 IPECACUANHA. vomiting. On the mucous lining of the intestinal canal, also, its effects are undoubt- ed, as indicated by its action in disease \ but we are at pre- sent unable to give any satis- factory explanation of its often marvelous influence over dysentery in its various forms. 2. Liver. — Ipecacuanha seems to have some stimu- lating power over the hepatic secretion. 3. Skin. — Ipecacuanha promotes slightly the cuta- neous secretion, independ- In acute dysentery, ipeca- cuanha is now looked upon as a never-failing specific. It must here be taken in full doses, from 15 to 20 grains being given at once and re- . peated in two hours ; and al- though the first dose may be rejected by the stomach, toleration is speedily estab- lished, and no more vomiting is produced. Some authori- ties recommend a previous administration of laudanum to quiet the stomach. Under this treatment the pain and tenesmus rapidly subside, the motions regain natural color and consist- ence, and the patient makes a satisfactory recovery. In cases of dysenteric diar- rhoea so often met with in this country, and more espe- cially in children, ipecacu- anha in much smaller doses is also a very effectual re- medy, the indications for its use being any appearance of blood or mucus in the stools, with pain and straining. In the more ordinary forms of diarrhoea, however, it is quite useless. 2. It has therefore been given in the form of pill, and combined with other reme- dies, to relieve the sluggish digestion caused by a defici- ency of bile. 3. Ipecacuanha combined with opium, in the form of ''Dover's Powder," is a JALAP. 241 ent of the tendency to per- well-known and tolerably spiration usually attending effectual diaphoretic, much the action of emetics. used in chronic rheumatism and feverish attacks. Mode of Elimination, &c. It is probable that as much of the ipecacuanha as remains after the action of vomiting is eliminated from the system by the biliary and intestinal secretions. Mode of Administration. The action of ipecacuanha wine is so notoriously uncer- tain, that, when we wish to obtain the full emetic effect of the drug, it is best to have recourse to the freshly powdered root (15 to 30 grains), remembering, however, that chil- dren will bear unusually large doses. In the treatment of dysentery also, we shall derive most advantage from the use of the powder, and in ordinary cases of dysenteric diarrhoea we may give from ^ to 2 or 3 grains in combination with compound tragacanth powder. Vinum ipecacuanhas, in doses of from n^x. to 5j-> is an almost invariable ingredient of cough mixtures. [Emetia, the alkaloid of ipecacuanha, is not officinal, but is an efficient emetic in doses of gr. j\ to ^.] JALAPA— JALAP. [ The tuber of Exogonium purga {Bentham, Botanical Register), Ipomoea Jalapa [Ahittall), U. S. Dose, in substance, gr. x.-xxx. Officinal Preparations, U. S. Extractum Jalapae. Dose, gr. v.-x. Pulvis Jalapae Compositus (jalap 1 pt., cream of tar- tar 2 pts.). Dose, gr. xx.-3j. Resina Jalapae. Dose, gr. ij.-iv. Tinctura Jalapae (powder ^iij.-Oj.). Dose, 3j--ij-] Physiological Action. Therapezttical Action. The action of jalap resem- Jalap is undoubtedly one bles that of scammony, only of our best hydragogue ca- differing in being less irri- thartics, and is much used in tant and more effectual in cerebral lesions, in kidney 21 242 BUTTERNUT — JUNIPER. promoting the flow of watery disease, where the excretion fluids from the bowels. of effete products threatens to become suspended, and when dropsy is setting in ; in such cases smart purgation by pulv. jalap, co. will often produce striking benefit. In cardiac disease also, when the right side of the heart is engorged by emphy- sema or bronchitis , free ca- tharsis will unload the dis- tended and laboring organ, and relieve the condition of intense dyspnoea, with the cold and livid surface and indications of approaching death. Jalap also acts well as an ordinary or habitual purgative, and is generally prescribed in the form of the compound powder, contain- ing cream of tartar. [JUGLANS— BUTTERNUT. The inner bark of the rsot of Juglans cinerea, U. S. Officinal Preparation, U. S. Extractum Juglandis. Dose, as a laxative, gr. v.-x.; as a purgative, gr. xx.-xxx. Juglans is an indigenous cathartic resembling rhubarb in its property of evacuating without debilitating the bowels. Mild and efficient in its action, it is well adapted to habit- ual constipatio?i. It may be given in decoction, or in the form of the officinal extract.] JUNIPERUS— JUNIPER. [ The fruit of Juniperus communis, U. S. Officinal Preparations, U. S. Infusum Juniperi (berries 3j. to Oj.). Dose, f^iv.-Oj. Oleum Juniperi. Dose, gtt. v.-xv. KI NO. 243 Spiritus Juniperi Compositus (oil f3jss. in Oviij.). Dose, fjij.-iv. Spiritus Juniperi (oil f 3J. in Oiij.). Dose, fjss.-j.] Physiological Action. Juniper stimulates the action of the kidneys, but, lik° many other remedies of its class, only increases the flow of urine where dropsy exists. It has been shown that in a healthy man the quantity of the urine is actually diminished, whilst the urea is increased. [When an overdose is given, even strangury and total suppression may result. In small doses it is a gentle stimulant to the kidneys.] I£. Spiritus juniperi Potassii acetatis Spiritus ?etheris nitrosi Decocti scoparii [Br.] S. Dose, f^j. ter die Therapeutical Action. Juniper is a good diuretic, generally used in combina- tion with other drugs, and acting either when swal- lowed, or inhaled in the form of vapor. f ^ss. ; 5i ss - ; 'Si- ; f §viij. M. Diuretic mixture. KINO— KINO. [ The inspissated juice of Pterocarpus Marsupium {De Candol/e), and of other plants, U. S. Officinal Preparation. Tinctura Kino (^jss. to Oj.). Dose, f3j.] Physiological Action* Kino is astringent in vir- tue of the tannin which it contains. Therapeutical Action. It may therefore be used in diarrhoea and other cases where astringents are indi- cated, but it seems to have no special advantage over other remedies of the same class. 244 RHATANY — LAVENDER, KRAMERIA— RHATANY. \_The root of Krarneria triandra (De Cando/fe), U. S. Dose, in substance, gr. xx. Offtcinal Preparations, U. S. Extractum Kramerise. Dose, gr. v.-x. Extractum Krameriae Fluidom. Dose, gtt. xx. Infusum Krameriae (Jj. to Oj.). Dose, fgj.-ij. Syrupus Krameriae. Dose, f^ss. Tinctura Krameriae (^iij. to Oj.). Dose, foj.-ij.] Physiological Action. Therapeutical Action. Krarneria has powerful Rhatany has been used astringent properties, due, with success in dysentery and no doubt, to the tannin diarrhoea, but is probably which it contains. [It is inferior to many other also gently tonic, and is remedies of the same class, much esteemed in Peru in and is therefore but seldom treatment of bowel affec- employed. [It is frequently tions.] added to chalk mixture, in the treatment of diarrhoea of relaxation.] [LACTUCARIUM— LACTUCARIUM. The concrete juice obtained from Lactuca sativa, by incision and spontaneous evaporation, U. S. Dose, gr. xx. Officinal Preparation, U. S. Syrupus Lactucarium (,fj. to Oj.). Dose, f^ss. Lettuce-opium is a feeble narcotic, and is considered slightly laxative and diuretic. It has been used as a sub- stitute for the other narcotics in phthisis and in diseases of children.~\ [LAVANDULA— LAVENDER. The flozvers of Lavandicla vera {De Cando/ie), U. S. Officinal Preparations, U. S. Oleum Lavandulae. Dose, gtt. iij.-x. Spiritus Lavandulae. Dose, f^ss.-j. Enters into Mistura Ferri Composita. Spiritus Lavandulae Compositus. Dose, 5J-~i v - LEPTANDRA — LEMON. 245 Lavender is a carminative, but is rarely used except in combination. The compound spirit is its most elegant preparation, and is a very agreeable stomachic and cordial. The oil is used in perfumery.] LEPTANDRA— LEPTANDRA. The root of Leptandra Virginica, U. S. Culver's root is emetic and cathartic, and is also con- sidered cholagogue. Dose of the powdered root, gr. xx. to 3j. In small doses (gr. ij.-v.), it is said to resemble rhubarb. The fluid extract (not officinal) is aperient in doses of T7r,x. to f3j.] LIMONES— LEMON. [ The fruit of Citrus Limonum, (J. S. Limonis Cortex. Lemon Peel. Limonis Succus. Lemon Juice. Dose, f^j.-iv. Oleum Limonis. Acidum Citricum. Officinal Preparations, U. S. Spiritus Limonis. Used for flavoring purposes. Mistura Potassii Citratis. Neutral Mixture. Dose, Syrupus Limonis. As a vehicle. Spiritus Ammoniae Aromaticus, Dose, f3ss.-j. Syrupus Acidi Citrici. As a vehicle.] Constitutional Action. Lemon-peel is in some measure tonic and antispasmodic, and is a useful flavoring ingredient, but lemon-juice has some important properties which are purely therapeutical, and cannot be explained by any action which it possesses over the healthy organism. In the first place we must rank its antiscorbutic virtues, acting as it does both by preventing and by curing the dis- ease, and by its universal use afloat almost stamping out the ravages of what used to be an almost invariable attend- ant on long voyages at sea. The occurrence of scurvy to any extent on board ship is now looked upon as a clear indication that the regular administration of lime or lemon juice has been neglected, and that the crew has been at- 21* 246 LINIMENTS — FLAXSEED. tacked by a painful and dangerous disease, the absolute preventability of which experience has amply confirmed. Various explanations have been given of the cause of scurvy, and there is no doubt that it is usually associated with an absence of fresh meat and vegetables from the diet scale. Dr. Garrod, however, goes further, and teaches that the essence of the disease lies in a deficiency of the potash salts; whilst Mr. Morgan, of Dublin, is no less convinced that the absence of phosphoric acid is the real cause — both agreeing in this, however, that the presence of this special ingredient in lemon-juice explains its supe- riority over citric acid, which is in no degree an antiscor- butic. It is unfortunate that lime-juice is bulky, and liable to become solid at low temperatures, and must be also administered in such considerable doses as to give some excuse for its occasional neglect on expeditions where every ounce of extra weight entails increased toil and dan- ger. It is to be hoped that some more convenient and portable means of using this invaluable drug may yet be introduced. Lemon-juice was formerly vaunted as a specific for acute rheumatism, and although this has not been confirmed by experience, there is no doubt that persons afflicted with chronic rheumatic pains may often derive benefit from tak- ing a tablespoonful of this agreeable remedy two or three times a day with their meals. Lemon-juice has also been called a refrigerant, but its sole claim to this title rests upon the great facility with which we may construct refreshing effervescing draughts by its aid. [Linimenta. The officinal Liniments are : — Linimentum Aconiti Linimentum Chloroformi " Ammonise " Plumbi Subacetatis " Calcis " Saponis " Camphorse " Terebinthinse ] " Cantharidis LINUM— FLAXSEED. [ The seed of Linum usitatissimum, U. S. Oleum Lini. Flaxseed oil (Linseed oil). Lini Farina. Linseed meal. FLAXSEED. 247 Officinal Preparations, U. S. Infusum Lini Compositum. As a demulcent. Dose, flj-iv. Ceratrum Resinae Compositum. Deshler's Salve. Linimentum Calcis. Carron oil. For burns.] Local Action. Physiological. Linseed meal, in the form of poultice, is the most con- venient and effectual way of applying continuous moist warmth to the surface of the body. Thus used, it re- lieves pain, relaxes spasm, and is generally soothing and agreeable to the feelings of the patient. By relaxing the superficial vessels, a poultice may be in some measure an- tiphlogistic, and may also relieve the congestion of internal organs by drawing blood to the cutaneous sur- face and promoting perspi- ration there. Th erapeutical. A linseed poultice is a very soothing and effectual appli- cation in all acute affections of the lungs. Not only does it relieve pain, but it keeps up a warm equable temper- ature, and rests the affected organ by restricting in some degree the movements of the chest walls. It may also be used with advantage in peritonitis, in colic, in vari- ous inflammatory affections of the throat, and in boils, abscesses, &c , where, if it does not succeed in arresting the suppurative process, as occasionally happens, it fa- cilitates and hastens the breaking down of inflamma- tory products into pus, and thus encourages the process of ripening. After the open- ing of the abscess, poultices cannot be recommended, as they are nauseous and dirty, and we would much rather advise the case to be treated on the antiseptic principles of Mr. Lister. Linseed oil is an old-fash- ioned treatment for burns, and, combined with lime- 248 LITHIUM. water, was formerly exten- sively used under the name of carron oil. Internal Use. An infusion of linseed is Under the name of linseed rather soothing in character, tea, this infusion is much probably owing to the mu- used in domestic medicine cilage which it contains. as a soothing remedy for coughs. Mode of Administration. When used as an application in pleurisy or pneumonia, a poultice must extend fairly round the chest, must be at least half an inch thick, and must be changed not seldomer than every two hours, as it soon tends to become dry, hard, and uncomfortable. It is best made by boiling the meal for a few minutes, and afterwards incorporating with it a certain amount of olive oil, which prevents its adhering to the surface. Occasionally its use seems to irritate the skin, and cause a crop of small boils and painful pustules, and it must therefore, as a general rule, be avoided in moist cutaneous affections. LITHIUM— LITHIUM. [Lithii Carbonas. Carbonate of Lithia. Dose, gr. iij. -vi. Lithii Citras. Citrate of Lithia. Dose, gr. v.-x.] General Physiological Effects. Th erapeutical. Lithia forms a very soluble Lithia is therefore a valu- salt with uric acid, probably able remedy for gout and in the blood, and therefore uric acid gravel, given either prevents the deposition of in the form of effervescing chalky formations in the lithia water, lithiae carbonas, tissues. or lithiae citras. It also causes an increase It therefore acts as a diu- in the urinary secretion. retic perhaps more power- fully than any of the other alkaline salts. LOBELIA. 249 LOBELIA— LOBELIA. [ The leaves and tops of Lobelia injlata, U. S. Officinal Preparations, U. S. Acetum Lobelia (fsij. to Oj.). Dose, from gtt. x. to Tinctura Lobelia (^ij. to Oj.). Dose, from gtt. x. to f5j-ij. Antidote. The stomach should be washed out with warm solution of tannic acid, and symptoms of collapse treated as they arise, by stimulants, frictions, counter-irritants, sinapisms, and anodynes.] Local Action. Lobelia possesses no local action. Internal Actions. Physiological. 1. Brai7i and Nervous System. — In large doses lobelia frequently causes headache and giddiness, and may eventually extin- guish life by paralysing the respiratory centre. 2. Heart and Circula- tion. — Lobelia depresses the action of the heart, and in this respect has a powerful affinity to tobacco. 3. Respiralio?i and Tem- perature. — As already men- tioned, lobelia in large doses is a respiratory depressant, but in ordinary medical practice it seems to relieve spasmodic conditions of the bronchial tubes. It lowers the temperature Therapeutical. 3. Lobelia is only used in medicine in this country as a remedy for various respi- ratory affections, and more especially spasmodic asthma. Its action here is apt to be uncertain, and it may un- expectedly cause much nau- sea and discomfort ; but 25° L 1 Q U O R S in some measure, on account of its diaphoretic action. Ringer tells us that we may employ it with great confi- dence by giving much larger doses than are usually pre- scribed. Remember that its action in no way prevents the asthmatic attack, but merely cuts it short. 4. Lobelia is never used as an emetic, being slow, uncertain [harsh], and ex- hausting. 4. Secreting and Digestive Organs. — Lobelia has un- doubted emetic properties, and frequently causes vomit- ing, accompanied by much nausea and general depres- sion. Skin. — Lobelia excites the action of the skin. Kidneys. — Lobelia is said to promote the excretion of watery fluids by the kidneys. Dose. Ringer tells us that the dose laid down in our usual text- books is much too small, and that we may freely administer a drachm of the ethereal tincture [same strength as tinct. lobelia, U. S.] every hour, or 10 minims every ten minutes, with advantage, immediately before and during the asth- matical paroxysm. [The vinegar of lobelia is the best preparation for internal use.] The great drawback to its use is the occasional unpleasant symptoms following its administration, and which can be, unfortunately, neither foreseen nor prevented. [Liquores. The officinal Liquors are : — Liquor Ammonii Acetatis " Arsenici Chloridi " " et Hydrarg. Iodidi " Barii Chloridi " Calcii Chloridi " Calcis " Ferri Chloridi Liquor Ferri Citratis " " Nitratis " " Subsulphatis " " Tersulphatis " Gutta-perchse " Hydrargyri Nitratis " Iodinii Compositus LYCOPODIUM — MAGNESIUM. 251 Liquor Magnesii Citratis Liquor Potassii Citratis " Morphia Sulphatis " " Permanganatis " Plumbi Subacetatis " Sodse " " " Dilutus " " Chlorinatae " Potassae " Sodii Arseniatis " Potassii Arsenitis " Zinci Chloridi.] [LYCOPODIUM—LYCOPODIUM. The sporules of Lypoc odium davatum, and other species of lycopodium, U. S. Lypocodium is an extremely fine, very light powder, of a delicate yellow color, inodorous, tasteless, and very inflammable, so that it flashes like gunpowder when thrown into the flame. It is used as a dusting powder for exco- riated surfaces, and to coat pills in pharmacy.] MAGNESIUM— MAGNESIUM. . [Magnesii Carbonas. Carbonate of Magnesia. Dose, £ss.-3j. Magnesii Sulphas. Sulphate of Magnesia (Epsom salts). Dose, §ss.-j. Officinal Preparations, U. S. Magnesia. Dose, §j.-3iv. Trochisci Magnesise (each containing gr. iij.). Liquor Magnesise Citratis. Dose, f^ij.-iv.] Internal Uses. Magnesia and its carbo- They are therefore antacid, nate have a great capacity and relieve pain or heart- for saturating and neutralis- burn, and are also gentle ing acid, and secondly, on purgatives, much used, more becoming converted into bi- especially for children, carbonate by the carbonic Their tendency, however, to acid of the intestines, they form concretions, when em- produce a mildly laxative ployed too long, limits their effect. use in this respect. Sulphate of magnesia acts Sulphate of magnesia is a much more powerfully, and very commonly used purga- causes profuse watery evacu- tive in doses of from 3j- to ations, and its action maybe §ss. in simple constipation, thus explained : — in the early stages of small- 252 MAGNESIUM. In virtue of its low diffu- pox and feverish conditions, sive power, it does not rea- in chronic lead-poisoning, dily find its way into the and, combined with iron, in blood, but, remaining in the many atonic conditions of intestines, it attracts and the system, firmly retains the watery fluid it finds there, and thus pre- vents its reabsorption. But, in addition to this, recent experiment has shown that it also actually withdraws fluid from the veins, as proved by the rapid way in which a small portion of in- testine isolated from the rest of the tube becomes filled with watery fluid after the introduction of sulphate of magnesia. Mode of Administration. As sulphate of magnesia is not only very nauseous, but, when taken alone, may cause griping, straining, or uncom- fortable abdominal distension, it is usually prescribed in combination with senna, cardamoms, and liquorice, as in the mist, sennse co. [Br.], or with a little acid and sulphate of iron, both of which seem to increase its purgative proper- ties ; and it is well to remember that free dilution also seems to enhance its effects. The following are good for- mulae : — R. Magnesias sulphatis §'j-j Syrupi zingiberis 1 §ss. ; Infusi rosae [comp. ] ad f ^viij. M. S. §j. tertiis hons. R. Magnesise sulphatis §ij-j Ferri sulphatis gr. xxiv. ; Acidi sulphurici diluti f 5U- > Infusi quassias ad f §viij. Misce, fiat mistura, cujus capiat unciam unam omni mane. B.. Magnesias sulphatis §ij. ; Magnesias carbonatis 3 lb > Syrupi zingiberis ffj-J Aquae menthae piperitse ad f §viij. Misce, fiat mistura. Sumat unciam unam quartis horis ad efFectum, phiala prius bene agitata^ MANGANESE MARBLE. 253 [MANGANESIUM— MANGANESE. Manganesii Oxidum Nigrum. Black oxide of manga- nese (used in making oxygen, chlorine, and aqua chlo- rini) has been administered in doses of gr. iij.-xx. Manganesii Sulphas. Sulphate of Manganese. Dose, gr. v.-xx. Internal Effects and Uses. Sulphate of manganese acts as a purgative in doses of 5j.-ij., and in smaller doses has cholagogue properties. Dr. Hammond reports its successful use in chorea. In divided doses it has been given m gastr a Igia, pyrosis, and indigestion^ MANNA— MANNA. [ The concrete saccharine exudation in flakes of Fraxinus Omits, and of Fraxinus rotundifolia, U.S.~\ Internal Effects and Uses. Has very slight purgative properties. [It is generally given in infusion combined with senna, but may be used alone boiled in milk for children, to whom its sweet taste makes it acceptable. Dose, for a child, 3j-- n j-] [MARANT A— ARROWROOT. The fecula of the rhizome of Mar ant a Arundinacea, U. S. Enters into Trochisci Ipecacuanhas. Uses. Arrowroot is demulcent, and forms an agreeable article of diet for the sick and for infants. A tablespoonful to a pint of water, flavored with lemon and sugar, may be used for invalids, or a decoction in milk for children.] [MARMOR— MARBLE. Native, white, granular Carbonate of Calcium. Used as a source for Carbonic Acid Gas and in making Aqua Acidi Carbonici, and Liquor Calcii Chloridi. (See Calcium.)] 22 254 HOREHOUND — HONEY. [MARRUBIUM— HOREHOUND. The leaves and tops of' Marrubhwi vulgar e, U. S. Used as a domestic remedy for catarrh, in the form of decoction (3j.°to Oj.), syrup, and candy.] MASTICHE— MASTIC. [ The concrete resinous exudation from Pistacia Lentiscus, U. S. Enters into Pilulae Aloes et Mastiches.] This is only used as a filling for decayed teeth in dental surgery. MATICO— MATICO. \_The leaves of Artanthe elongata (Miguel), U. S. Officinal Preparation, U. S. Extractum Matico Fluidum. Dose, f3ss.-j.] Matico is only used externally as a local application for the arrest of hce?norrhage j and it is generally believed that it acts mechanically by the roughly-reticulated under- surface of the leaf entangling the blood and forming clots. No success has attended its internal administration. [In the form of the fluid extract, Matico has been highly re- commended in hemorrhages and diseases of mucous mem- branes, including gonorrhoea and leucorrhoea.~\ [MATRICARIA— GERMAN CHAMOMILE. The flowers of Matricaria Chamomilla, U. S. Resembles chamomile in its properties, but is rarely used in America.] [MEL— HONEY. A saccharine liquid prepared by Apis mellifica, U. S. Officinal Preparation, U. S. Mel Despumatum. Uses. Enters into Confectio Aromatica, Confectio Opii, Con- fectio Rosse, Oxymel (Br.), Mel Rosas, Mel Sodii Boratis, PEPPERMINT MEZEREON. 255 Pilula Ferri Carbonatis, Pilulse Quinise Sulphatis, Tinctura Cardamomi Composita, and Tinctura Opii Composita. The agreeable taste and demulcent qualities make honey a useful vehicle for distasteful powders, and render it an acceptable addition to gargles. Purified honey is a good excipient for pills, and forms the basis of the Mellitse. 1 ] [MENTHA PIPERITA— PEPPERMINT. The leaves and tops of Mentha piperita, U. S. MENTHA VIRIDIS— SPEARMINT. The leaves and tops of Mentha viridis, U. S. Officinal Preparations, U. S. Aqua Menthse Piperitse. Used as a vehicle. Oleum Menthse Piperitse. Dose, gtt. iij.-x. Spiritus Menthse Piperitse. Dose, gtt. x.-xx. Trochisci Menthse Piperitse. Aqua Menthse Viridis. Used as a vehicle. Oleum Menthse Viridis. Dose, gtt. iij.-x. Spiritus Menthae Viridis. Dose, gtt. x.-xx. Peppermint and spearmint are favorite stimulant stom- achics, and are much used as vehicles in mixtures. The troches of peppermint are a popular carminative.] MEZEREUM— MEZEREON. \_The bark of Daphne Mezereum and of Daphne Gnidium, U. S. Officinal Preparations, U. S. Decoctum Sarsaparillse Compositum. Dose, f^iij. -iv. Extractum Mezerei Fluidum (used in Ung. Mezerei). Extractum Sarsaparillse Compositum Fluidum. Dose, 5ss.-j. Unguentum Mezerei (a stimulant dressing).] This drug is never used save as a constituent of the decoctum sarsaparillse co. 1 [The class of Mellitse, or Honeys, comprises Mel Rosse and Mel Sodii Boratis, which are used chiefly in washes for the throat and mouth.] 256 HORSE MI NT NUTMEG. [Misturae. The officinal Mixtures are: — Mistura Ammoniaci Mistura Cretse " Amygdalae " Ferri Composita " Assafoetidse " Glycyrrhizse Composita " Chloroformi " Potassii Citratis.] [MONARDA— HORSEMINT. The leaves and tops of Monarda punctata, U.S. Officinal Preparation, U. S. Oleum Monardae. Dose, gtt. ij.-iij. Effects and Uses. The oil is used in domestic practice for sick stomach and flatulent colic j like the other mints, it is stimulant and carminative. Applied to the skin it is rubefacient, even vesicant, and has been employed as counter-irritant in chronic rheumatism t infantile paralysis, and in low fevers .] [MOSCHUS— MUSK. A peculiar concrete substance obtained fro7?i Moschus Mbschiferus, U. S. Internal Effects. Has undoubted antispasmodic powers, but has been almost entirely discarded on account of its high price and frequent adulteration. It may be given in doses of gr. v. -xv., in hysterical convulsions ', hiccough, in low fevers and delirium treme?is. Castoreum makes an efficient substitute for musk.] [Mucilagines. The officinal Mucilages are: — Mucilago Acacise Mucilago Tragacanthae " Sassafras Medullae " Ulmi.] MYRISTICA— NUTMEG. [The kernel of the fruit of Myristica fragrans (Houttuyn, Nat. Hist.), U. S. Officinal Preparations, U. S. Spiritus Myristicae. Dose, f5j. Oleum Myristicae. Volatile Oil of Nutmegs. Dose, gtt. ij.-iij. MACE MYRRH. 257 MACIS— MACE. The aryllus of the fruit of Myristica fragrans (Houttuyn, Nat. Hist.), U.S. Enters into Acetum Opii, Pulvis Aromatictis, Spiritus Ammoniae Aromaticus, Spiritus Lavandulae Compositus, Spiritus Rhei Aromaticus, Trochisci Cretae, Trochisci Mag- nesias, and Trochisci Sodii Bicarbonatis.] Nutmeg is rarely used in medicine save as a flavoring ingredient. [The dose of Nutmeg or Mace in substance is gr. xv. With its aromatic qualities, nutmeg unites con- siderable narcotic power, and in doses of 3ij--iij- has pro- duced stupor and delirium.] MYRRHA— MYRRH. \_A gum-resinous exudation from B alsamodendron Myrrha^ (Nees, Beschreib. OfflcineL Pfianzen). Dose, in substance, gr. x.-xxx., U. S. Officinal Preparations, U. S. Tinctura Myrrhae (^jss. to Oj.). Dose, f5ss.-j. Tinctura Aloes et Myrrhae. Dose, f5j--ij- Also enters into Mistura Ferri Composita, Pilulae Aloes et Myrrhae; Pilulae Ferri Compositae, Pilulae Galbani Com- positae, and Pilulae Rhei Compositae.] Local Uses. Physiological. Therapeutical. Myrrh is astringent, and It is a useful addition to checks excessive secretion gargles in relaxed or ulce- from mucous surfaces. rated conditions of the throat ; it is a good applica- tion to spongy or unhealthy gums, as in mercurial saliva- tion ; and it often forms one of the active constituents of lotions for foul ulcers ; where it gently stimulates the gran- ulating surface, and corrects the fcetor of discharges. 22* 2 5 8 bebeeru bark, Internal Uses. Like all the gum balsams and resinous substances, myrrh may possess in some degree the power of stimu- lating mucous surfaces. Tra- dition and the habit of pre- scribes have also invested it with some supposed influ- ence over the uterus ; but no trustworthy evidence has ever been brought forward on this point, and it is more than probable that its em- menagogue influence is quite secondary to the other drugs in combination with which it is prescribed in these cases. R. Aluminis Tincturce myrrlice Infusi rosae [comp.J Misce, fiat gargansma. Myrrh has occasionally been used as a stimulant in chronic bronchitis, but practi- cally its application in medi- cine is now restricted to the administration of the various forms of pill in amenorrhoza ; and here it is impossible to separate its action from the aloes with which it is invari- ably combined. 5u- ; ad f^x. NECTANDRA— BEBEERU BARK. \The bark of Nectandra Rodiei [Sckomburgh), U. S.~\ The bebeeru bark possesses some of the physiological properties of quinine. Thus it arrests the movements of the white blood-corpuscles, and checks the development of bacteria; but unfortunately it does not in any way fulfil the same therapeutical indications, save acting as a tonic, in virtue of its bitterness. [Like cinchona, it contains several alkaloids, the princi- pal one having received the name of beberia, a sulphate of which is officinal in the Ph. Br., but not officinal in the United States. The antiperiodic dose of the sulphate of beberia is gr. xx.~3j. (It should not be confounded with berberina, the active principle of the simple bitters.)] NUX VOMICA. 2 59 NUX VOMICA— NUX VOMICA. \_The seed of Strychnos Nux Vo?nica, U. S. Officinal Preparations, U. S. Tinctura Nucis Vomicae (^iv.-Oj.). Dose, nrx. Extractum Nucis Vomicae. Dose, gr. % to ^. Strychnia and Strychniae Sulphas. Dose, gr. ^V - !-] Antidotes. In a case of strychnia poisoning, we may first administer tannin, which places the drug in an insoluble form, then, after evacuation of the stomach, it will be necessary to try the physiological antidotes. These are chloral, bromide of potassium, Calabar bean, and nicotia [or tobacco ene- mata], although the use of the last-mentioned remedy must be conducted with extreme caution. Finally, we may have recourse to artificial respiration. Local Action. No special local action has been noted. Constitutional Action. i . Brain and Nervous Sys- tem. — No effect is produced on the brain, the cerebral functions remaining unim- paired almost up to the close of a case of strychnia-poison- ing. The spinal cord, however, is early attacked, and vio- lent and distressing tetanic spasms prove the irritating influence of the drug, more especially on the reflex exci- tability of that organ. In large doses, strychnia also paralyses the efferent (motor) nerves, causing loss of power of voluntary move- ment. The sympathetic system is stimulated. i. Nux vomica, and more especially strychnia, are ex- cellent nervine tonics, acting well in simple debility, ner- vous exhaustion, and inconti- 7ience of urine, and promot- ing the return of function after some forms of paralysis. When all inflammatory symptoms have subsided, strychnia may be prescribed in the hope of stimulating the spine to resume its duties, and restoring tone to mus- cles which long remained 260 NUX VOMICA. 2. Heart and Circulation. Strychnia causes rise of arterial pressure and con- traction of the capillaries. 3. Respiration and Tern- perature. — The interference with breathing observed in strychnia - poisoning, and which usually terminates the life of the victim, is due to spasmodic fixation of the diaphragm and respiratory muscles, 4. Digestive and Secret- ing Organs. — Strychnia has a tonic influence over the digestive process. in a state of inactivity. Thus, in paraplegia, hemiplegia, diphtheritic paralysis, and wrist-drop, strychnia may well go hand in hand with galvanism when all evidence ' of irritation of the nervous structures has completely disappeared. Mr. Barwell has proposed subcutaneous injections of strychnia in in- fantile paralysis, using a large dose ( T V to T V gr.), and forcing the fluid freely into the muscular structures. [To begin with, a much smaller dose should be ex- hibited. One-half a grain, by the mouth, has killed an adult.] 4. Strychnia, and more especially nux vomica, are excellent tonics, improving the appetite in a marked degree ; but, in addition to this, nux vomica is of great service in various dyspeptic conditions, relieving heart- burn, nausea, and. flatulence, and being also a reliable NUX VOMICA. 261 remedy in sick headache and the vomiting of pregnancy. It is an excellent addition to purgative pill masses, improving the tone of the muscular wall of the intes- tines and relieving constipa- tion. Poisonous Effects. As already stated, strychnia kills by inducing hyper- excitability of the reflex functions of the spine, with vio- lent tetanic spasms, leading to death by exhaustion or suffocation. The fatal event may take place in a few minutes if the dose be a large one, and the minimum quantity required to destroy life is about half a grain. Contrary to the habit of other poisonous drugs, strychnia acts most rapidly and efficiently when given by the rectum. Dose, Mode of Administration, &c. The dose of strychnia may be put at from -^ to T \ gr., and the liquor is a convenient form, in doses of from 5 to 10 minims, added to any ordinary tonic mixture. We are usually advised to suspend its administration from time to time, as it is stated that uncomfortable twitchings and ri- gidity about the jaw may suddenly arise, giving evidence of the so-called 'accumulation' of the drug. The dose of mix vomica is, of the tincture 5 to 10 min- ims, of the extract gr. ^ to gr. ij. By hypodermic injection we are usually taught that gr. t Jq is the proper dose, and it is therefore difficult to explain why no poisonous results followed Barwell's some- what heroic medication. I£. Ferri sulph. exsic. gr. xl. ; Quiniae sulph. gr. xl. ; Strychniae sulph. gr. ss. ; Mannae q. s. M. Fiant pilulae xx. Sumat unam ter die. A useful tonic pill. I£. Tinct. nucis vomicae f 5i. ; Acidi [nitrO-muriatici] diluti f5'J-5 Spiritus chlorofbrmi f 5l- ; Infusi gentianae ad f ^vj. M. S. Dose, f ^j. ter die sumend. For flatulent colic, taken after meals. 262 COD-LIVER OIL fy. Ferri sulph. Ext. nucis vomicae Ext. aloes Barb. Fiat pil. ante cibum sumend. A good " dinner pill." aa gr. ss. ; gr. iij. M. [Olea. The officinal Oils are :- Oleum ^Ethereum " Amygdalae Am arse " " Expressum " Anisi " Bergamii " Cajuputi " Camphorse " Cari " Caryophylli " Chenopodii " Cinnamomi " Copaibae " Cubebae " Erigerontis Canadensis " Fceniculi " Gaultherise " Hedeomae " Juniperi " Lavandulae " Limonis " Lini " Menthae Piperitae Oleum Menthae Viridis " Monardae " Morrhuae " Myristicae " Olivae " Origani " Pimentae " Ricini " Rosse " Rosmarini " Rutae " Sabinae " Sassafras " Sesami " Succini " " Rectificatum " Tabaci " Terebinthinae " Theobromae " Thy mi " Tiglii " Valerianae.] [OLEUM ^ETHEREUM— ETHEREAL OIL, U. S. Heavy oil of wine is a limpid, almost colorless, volatile fluid, of a pungent taste and vinous odor. Its solution in alcohol and ether is officinal as Spiritus ^Etheris Composi- tus (see page 91), but it is never prescribed alone.] OLEUM MORRHUA— COD-LIVER OIL. [ The fixed oil obtained from the livers of Gadus Morrhua and of other species of Gadus, U. S.~\ Local Action. Cod-liver oil is not used in virtue of any local action, as its nauseous smell effectually prevents it from forming the basis of ointments or liniments. Being very readily COD-LIVER OIL. 263 absorbed by the skin, however, it is occasionally intro- duced into the system by this channel when the patient is unable to take it by the mouth. [It has been used in ophthalmic practice, instilled into the eye, to remove slight opacity of the cornea.] Constitutional Actions. Physiological. 1 . Brain and Nervous Sys- tem. — Cod-liver oil can only be said to act on the nervous system by improving its nu- trition and supplying the fatty ingredients necessary for growth and repair. 2. Circulation. — It has a tonic influence on the circu- lating organs, by improving the quality of the blood and strengthening the heart-mus- cle. 3. Respiration and Te7?i- perature. — No special physi- ological influence is exerted on either of these functions. [In addition to its value as a hydro-Carbon in simply nourishing the body, it is alterative by virtue of a small proportion of iodine, bro- mine, and phosphoric acid which-it contains, associated with certain biliary princi- ples, in a manner, perhaps, best adapted to secure their absorption and assimilation.] 4. Digestive and Secreting Organs. — It has been proved by experiment that animal Therapeutical. 1. It is therefore specially indicated in all nervous affec- tions dependent on debility, such as neuralgia, some forms of insanity, asthma, whooping-cough, &c. 2. It is therefore much used in simple debility, in convalescence from acute ill- ness, in ancemia, and other weakened conditions of the system. 3. Under this heading we may place, for convenience, the wonderfully restorative effects of cod-liver oil in chronic lung disease, but more especially in the va- rious forms of pulmonary phthisis. It is beneficial in asthma and chronic bronchi- tis, but in consumption it really seems to be directly curative. It may be given with advantage in all stages, and under its use patients often rapidly gain flesh, and not only manage to hold the disease at bay, but even oc- casionally seem to escape from its clutches. 4. Cod-liver oil is most invaluable in diseases de- pending on defective nutri- 264 COD-LIVER OIL. are much more digestible than vegetable oils, and cod- liver oil is the most readily- assimilated of all. After being emulsified by the pan- creatic juice, it comes in contact with the bile, which distinctly increases its power of passing through moist ani- mal membranes ; and it is probable also that the biliary principles incorporated in its own structure aid in en- abling it to be easily ab- sorbed by the lacteals. Its action on the system now is to improve the general con- stitutional tone, to evolve force and heat, and to aid in supplying those fatty ele- ments which are so essen- tially requisite for the con- struction and repair of the tissues. Cod-liver oil occasionally causes nausea, vomiting, and diarrhoea, and it has been shown to increase in some measure the biliary secre- tion. Mode of Elimination. The greater part of the oil is absorbed into the system, but a little is given off by the faeces ; and it is well to watch the evacuations of children under its influence, to see whe- ther any undigested oil escapes, this indicating an overdose. Drawbacks. Mode of Administration. Cod-liver oil occasionally produces so much nausea, eructation, and discomfort, as to compel us to suspend its administration ; but most patients, and more especially children, speedily grow accustomed to its use. It is advisable to prescribe it in small doses directly after meals or at bed-time, to give it with some light tonic, and to tion, as in all scrofulous conditions, such as strumous ophthalmia, caries of bones, chronic joint- affections, glan- dular enlargements, &c. ; also in rickets and all the wasting disorders of child- hood, in senile atrophy and decay, in chronic rheuma- tism, in all the ulcerative varieties of skin disease, and in advanced co?istitutio?ial syphilis. Various attempts have been made to explain the actions of the oil by means of certain special in- gredients which it contains ; but none of these have been successful, and we cannot at present do more than attri- bute its restorative influence to its ready digestibility and nutritive properties. OLIVE OIL CASTOR OIL. 265 suspend it from time to time, more especially in hot wea- ther or when bilious symptoms supervene. It may well be given in combination with a little alcohol, beaten up with the froth of porter, with mucilage, or lemon-juice, or with from n^x. to f 3j- of aether purus, which, Dr. B. Fos- ter tells us, aids digestion by stimulating the pancreatic secretion ; but if the pale oil is used, very few persons will be found entirely rebellious to its use. Children, as a rule, take it well, but if they prove obstinate we may give it with orange wine, or in the following combination : — R. Olei morrhuse f^ss. ; Mucilaginis acacise ff'j-5 Sacchari 5U-5 Tincturse lavandulse comp. "H\xx. ; Aquse f§ss. M. f"5j. pro dosi. Black coffee forms a good medium for adults, or we may give the oil floating [on beer, porter, or] on the following mixture: — R. Acidi nitrici diluti TT^x. ; Acidi hydrocyanici [dilut.] T)lJ.-ij.; Tincturae aurantii f;5ss.; Aquas f§ss. M. The dose should never exceed half an ounce. [A pancreatic emulsion of cod-liver oil, and an emulsion with the lacto-phosphate of lime, or with lime-water (soap) flavored with oil of bitter almonds, are largely used for children, although not officinal.] OLEUM OLIV^E— OLIVE OIL. [ The fixed oil obtained from Olea -Europcea, U. S. Olive oil is nutritious and laxative, and is occasionally used for children as a substitute for castor oil. Dose, for an adult, f ^ij.-iv. It is a useful remedy for all kinds of irritant poisoning except from phosphorus in substance. It is used largely in pharmacy.] Olive oil is only used externally as an emollient appli- cation, and as the basis of various liniments. OLEUM RICINI— CASTOR OIL. The fixed oil obtained from the seeds of Ricinus communis, U. S. Enters into the Officinal Preparations, Collodium cum Cantharide and Collodium Flexile. 23 266 CASTOR OIL External Uses. Castor oil is a substance of such bland and unstimulat- ing quality, that, were its smell less offensive, it might form a valuable external agent in certain cases. It is, however, occasionally used as a soothing application to the eye when extreme temporary irritation has been set up by abrasion of the corneal epithelium. Castor oil will purge when rubbed into the skin. Internal Uses. Physiological. Castor oil gently stimu- lates the peristaltic move- ments of the intestinal canal, and slightly augments the fluid secretions of the gut. Some amount of astringent action generally follows the purgative action of the drug. The seeds are very irri- tating, and cause gastro- intestinal irritation, three having proved fatal to an adult. Th erapeulical. Castor oil is a mild and efficient cathartic, emptying the intestines without causing griping or discomfort. It is therefore useful in all cases where we simply wish to unload the bowels ; but it is not a good habitual purgative from the subse- quent constipation pro- duced. This astringent action, however, gives it a special advantage in the treatment of diarrhaia, many cases of which depend on the presence of irritating matters in the intestinal canal; and under such circumstances, common sense naturally indicates the propriety of expelling the exciting cause. Dr. Geo. Johnson, however, goes further than this, and advo- cates the " eliminative" treatment of all diarrhoeas, as well as cholera. Dose and Mode of Administration. Although the best castor oil has but little actual flavor, it leaves a greasy, sickly sensation on the palate, which is CACAO BUTTER. 267 exceedingly unpleasant. It is therefore important to give it in some form of combination, and we find floating the dose in a glass between two strata of whiskey or brandy [and cinnamon water] to be an effectual plan, or we may make use of the following formulae: — I£. 01. ricini f §ss. ; Mucilaginis acacias, Syrupi simplicis aa f 5ij. ; Aquae cinnamomi ad f §ij. M. Fiat haustus statim sumendus. I£. 01. ricini f.^iij- '■> Tinct. opii W\, x - ; Syrupi zingiberis ^7i)-\ Aquas menth. pip. ad f §ij. M. Fiat haustus statim sumendus. A good prescription for the diarrhoea of irritation. [OLEUM SUCCINI— OIL OF AMBER. The volatile liquid obtained by the destructive distillation of amber, U. S. Officinal Preparation, U. S. Oleum Succini Recti ficatum. Dose, gtt. x.-xx. The oil of amber is stimulant and antispasmodic, and has been recommended in bronchitis, hysteria, and obsti- nate hiccough, and is also used externally, diluted with sweet oil, as a sedative and rubefacient for whooping-cough, or for infantile convulsions, as in the mixture recommended by Dr. Jos. Parrish : — R. Olei succini rectificati, Tincturas opii aa f §ss. ; Olei olivas, Spiritus vini gallici aa f §ij. M. Fiat lotio. To be rubbed along the spine.] OLEUM THEOBROM^E— CACAO BUTTER. \_The concrete oil of the kernels of the fruit of Theobroma Cacao, U. S.~\ Oil of theobroma, being a firm, solid, and agreeable substance, is much used in the manufacture of suppositories. 268 CROTON OIL. [Suppositoria. The officinal Suppositories are : — Suppositoria Acidi Carbolici (each gr. j.) " " Tannici " gr. v. " Aloes " Assafcetidse " Belladonnse " Morphise Opii " Plumbi " Plumbi et Opii gr. v. gr. v. gr. % extract. gr. j. extract, gr. iij. plumbi acetatis. gr. iij. plumbi acetatis and gr. V 2 extract, opii.] [OLEUM THYMI— OIL OF THYME. The volatile oil obtained from Thymus vulgaris, U. S. Thyme is said to furnish the commercial oil of origanum. It is aromatic and counter-irritant, the oil being used almost exclusively as a local application, and is an ingredient in opodeldoc, the linimentum saponis camphoratum of former editions of the Pharmacopoeia.] OLEUM TIGLII— CROTON OIL. [ The fixed oil obtained from the seed of Croion Tiglium, U. S. ] Local Action. Physiological. The topical application of croton oil to the skin causes a good deal of irritation, fol- lowed by the appearance of a copious crop of papules, gradually developing into pustules. Dr. Tilbury Fox has described a symmetrical erythema of the face follow- ing this local employment ; and it is said that the addi- tion of an alkali favors the development of the counter- Th erapetttical. The local application of liniments containing croton oil was in former years a fa- vorite mode of using coun- ter-irritation in various chro- nic lung-affections, and it is still employed, more espe- cially in public practice. But its drawbacks are, that it has a tendency to overact on tender or irritable skins, and the pustules are liable to leave cicatrices, so that it CROTON OIL. 269 irritant properties of the is difficult to believe it in any drug. way superior to other and milder applications. Internal Action. When taken internally, Croton oil, then, is adras- croton oil produces much tic purgative, valuable in irritation of the intestines, certain cases on account of running on, if the dose be its rapid and powerful action, sufficiently large, into a very Thus in apoplexy and other fair imitation of the symp- cerebral affectio?is, where it toms of cholera-poisoning, is of importance to obtain with vomiting, extreme pur- an immediate and thorough ging, collapse, and acute in- evacuation of the bowels, flammation of the intestines, and in some conditions of obstinate constipation, we find considerable advantage from its cautious use. Mode of Administration, &c. Croton oil has an acrid and irritating flavor, and is best given in the form of pill [or rubbed up with sugar]. Gar- rod, however, tells us that it may well be prescribed in combination with castor oil, and, in case the patient is unable to swallow, it may be placed on the back of the tongue. In an extreme case we might expect to obtain some purgative effect from rubbing it into the skin, as it appears to act by absorption through this channel. R. Olei crotonis Ti\ij . ; Micse panis q. s. M. Fiat pilula, statim sumenda, et horis duabus repetenda si opus sit. Or we may endeavor to keep its irritating properties in check by prescribing it in the following combination : — $. 01. crotonis TrT^_i ij . ; Ext. colocynth. comp. gr. xx. ; Ext. belladonnae gr. iij. Misce, divide in pil. vj., quarum sumat imam si opus sit. For external use, a very good liniment is contained in the British Pharmacopoei-a. 23* 270 OPIUM. OPIUM— OPIUM. \_The concrete pace obtained from the unripe capsules of Papaver som~ niferum, by incision and spontaneous evaporation. U. S. Officinal Preparations, U. S. Acetum Opii (black drop) (gr. j. in nrvjss.). Dose, nvv.-vij. Confectio Opii (gr. 1 in 36). Dose, 5ss. Extractum Opii (double strength of opium). Dose, gr. ss. Emplastrum Opii (extract 1 in 16). Suppositoria Opii (extract of opium gr. ss.). Suppositoria Plumbi et Opii (plumb, acet. gr. iij. ; opium ext. gr. ss.). Pilulse Opii (each, gr. j.). Pilula Saponis Composita (mass 20 per cent, opium). Pulvis Ipecacuanhse Compositus (Dover's Powder, gr. 1 in 10). Dose, gr. x. Tinctura Opii (gr. j. in n^xiij.). Dose, ffLxiij. Tinctura Opii Acetata (gr. j. in n^x.). Dose, n^x. Tinctura Opii Camphorata (gr. j. in fjss.). Dose, f 3j- to iv. Tinctura Opii Deodorata (gr. j. in nrxiij.). Dose, n^xiij. Trochisci Glycyrrhizae et Opii (gr. 1 in 20). Trochisci Morphiae et Ipecacuanhse (each, gr. ^.) Liquor Morphias Sulphatis (gr. j. inf^j.). Dose, 13J. Suppositoria Morphise (each, gr. ss.). Vinum Opii (gr. j. in rr^viij.). Dose, nLviij. ( Morphiae Acetas ") Morphia^ Morphiae Murias > Dose, gr. T V-i-] (_ Morphiae Sulphas ) Antidotes. When summoned to a case of opium poisoning, the first indication must be to evacuate the stomach, and this is best effected by the stomach-pump, as the vomiting centre is too much paralysed by narcosis to allow of its effective stimu- lation by emetics. We then try to counteract the tendency to sleep by cold affusion, irritation of the skin, strong cof- fee, galvanism, and walking the patient about, and finally we may cautiously use atropine as the physiological anti- OPIUM. 271 dote. Although some good evidence comes to us from China of opium-poisoning checked by the antagonistic action of atropine, reports and opinions differ much on this head, and some authorities hold that atropine in cer- tain proportions may even intensify the action of morphia. Professor Bennett believes that atropia may be of service by contracting the vessels of the brain, and limiting the tendency to cerebral congestion. As a last resource, we may have recourse to artificial respiration. Local Action. Physiological. It seems very doubtful whether opium can be ab- sorbed through the unbroken cuticle. We are told that opium inspectors in India will remain for hours with their arms plunged up to the elbows in the inspissated extract, and that no narcotic effect is produced ; but it is difficult, on the other hand, to believe that opium is en- tirely devoid of a property which belladonna possesses in so remarkable a degree. Sir Henry Thompson is also strongly of opinion that the bladder cannot absorb opium. Th erapeutical. Fomentations with the de- coction of poppy-heads, and with other preparations of opium, have long been re- cognized as efficient means for the relief of pain in vari- ous inflammatory conditions, as haemorrhoids, erysipelas, conjunctivitis, &c. ; but as we cannot bring forward evidence of absorption of the drug, we must merely attribute this soothing influ- ence to the thorough appli- cation of moist heat. Internal Actions. I. On Nervous System. — 1. Brain. — In small quantity, or in a less degree as the occasional preliminary ac- tion of a truly narcotic dose, opium is gently exciting to the brain, the intellectual faculties becoming generally I. — 1. Opium, being the most certain narcotic known, is very largely prescribed in a great variety of cases. In simple insoimtia, in worn-out conditions of the nervous system, in acute feveis, such as typhus and typhoid, where 272 OPIUM. stimulated, and the imagina- tion more vivid. To this, however, rapidly succeeds a dulling or deadening effect, drowsiness supervenes, and deep sleep finally sets in, from which the patient wakes within a period of time pro- portioned to the quantity of the drug administered. Headache, dryness of the mouth, and digestive dis- turbance are frequently ex- perienced, and idiosyncrasy may in some rare cases in- terfere materially with sleep by bringing into special prominence the exciting or stimulating properties of opium. It is not quite clear in what precise way the nar- cotising influence is in this instance produced ; but an- alysis would lead us to be- lieve that contraction of the cerebral vessels imitates na- tural sleep by inducing an anaemic condition of the grey matter of the brain. The resulting contraction of the pupil is probably central in origin, as it cannot be pro- duced by any local applica- tion of opium in any form. 2. The conductivity and irritability of the sensory nerves are much diminished, so that pain is felt with less intensity. delirium and sleeplessness constitute truly dangerous complications, in delirium tremens, in the later stages of severe smallpox, in meningi- tis, acute mania, and in nu- merous other diseased con- ditions, which the reader can readily recall, this invaluable drug does most essential service by procuring sound and refreshing sleep. 2. And even when not given in truly narcotic doses, it may also lull the sufferer into slumber by benumbing the sensory nerves and re- moving pain. As a sedative, anodyne, or analgesic, it is indispensable in many pain- ful conditions, such as neu- OPIUM. 273 3. The reflex function of the spinal cord is at first slightly increased, but sub- sequently becomes lessened in degree, and the respiratory centre is weakened and final- ly paralysed. In cold-blood- ed animals, as the frog, in which the cerebral are sub- ordinated to the spinal functions, opium causes most violent tetanic convulsions. [This happens occasionally in children.] 4. The sympathetic sys- tem of nerves is also prima- rily excited, and secondarily depressed. II. Vascular System. — The action of the heart is at ralgia, sciatica, cancer, bili- ary or renal calculi, labor after-pains, colic, &c, and, as we shall presently see, the subcutaneous injection of morphia is the most effectual, as it certainly is the most rapid and convenient, mode of obtaining this action of the drug. Opium is also an excellent antispasmodic, and acts well by relieving irregular mas- cular contraction, as in the intestine causing colic, in the uterus tending to abortion or exhausting after-pains , in spasmodic urethral stricture; and its remarkable influence over some forms of obstinate ulceration must also be due to some nervous influence. 3. Opium, having the pro- perty of arresting the mus- cular action of various or- gans, is our sheet-anchor in those terrible cases where rupture of the intestine, blad- der, or uterus, has occurred, and where the only possible chance of recovery consists in most perfect rest of the viscus, encouraging the heal- ing process, and preventing the escape of irritating secre- tions into the peritoneal ca- vity. II. The subcutaneous in- jection of morphia has been 274 OPIUM. first slightly quickened, but afterwards its beats become slower, the pulse fuller and firmer, and the arterial ten- sion raised, this effect being considered due to an influ- ence on the cardiac inhibi- tory nerves. It is noted, however, that shortly before death, in cases of opium-poi- soning, the pulse becomes feeble, rapid, and irregular. The stimulating action on the sympathetic nerves causes some contraction of the smaller vessels to accom- pany the use of moderate doses of opium. III. Respiration and Tem- perature. — The breathing tends to become slow from the paralysing influence of opium on the respiratory centre, and at the same time the secretion from the bronchial tubes is lessened. The temperature at first rises a little, but finally falls when sweating is established. IV. Digestive aiid Secret- ing Organs. — i. Nausea occasionally follows the use of opium, and constipation invariably results from dimi- nution of the intestinal se- cretions, no less than arrest advised by Dr. Clifford All- butt in angina pectoris, pal- pitation, and various painful cardiac conditions. Its con- tracting influence on the small vessels explains the antiphlogistic effect of opium in cases of peritonitis and other inflammatory condi- tions, as well as its power of checking coryza in its early stage. It also acts well as an astringent in some forms of hemorrhage, and more especially that from the lungs. III. Opium is the most soothing remedy for coughs of all kinds, but more es- pecially that of phthisis. It is a valuable aid in spas- modic asthma and the early stages of acute pneumonia, but in the later stages we must beware of its power of checking secretion, and in bronchitis it may do harm by slowing the respiratory movements, causing sleep to interfere with the due emptying of the bronchial tubes, and thus leading on to imperfect aeration of the blood and final suffocation. IV. — t. Opium is an ex- cellent astringent in diar- rhoea, dysentery, and British [or sporadic] cholera, often succeeding where other remedies fail, and for the relief of pain and tenesmus, OPIUM, 275 of the peristaltic movements of the canal. 2. The salivary secretion is also diminished, causing dryness of the tongue. 3. The urine is lessened in quantity, but opinions differ as to the effect pro- duced on its solid ingredi- ents. 4. The biliary secretion is checked. 5. The secretion of the skin is increased, perspira- tion generally resulting, and we may say generally that opium checks all secretions but that of the skin. nothing is better than the enema of the [Br.] Pharma- copoeia. In the diarrhoea of ulcerative processes, such as typhoid and phthisis, and the later stages of dysentery, it is truly invaluable. 3. Opium is of great service in some cases of diabetes, checking the crav- ing appetite, and lessening the secretion of sugar. We must beware of its use, however, in advanced cases of renal disease, where it acts injuriously by check- ing secretion and encourag- ing the retention of urea in the blood. 5. Opium in some forms, and more especially Dover's powder,, acts as an efficient diaphoretic. Poisonous Action. When opium has been given in a poisonous dose, the resulting sleep gradually grows deeper, the breathing be- comes heavy and stertorous, the face is flushed, swollen, and dusky, the pupils contracted to mere points, distension of the right side of the heart still further prevents the return of blood from the engorged lungs, and paralysis of the re- spiratory centre finally causes death by suffocation. Much difficulty may occasionally attend the diagnosis of opium- poisoning from (1) alcoholic coma, where, however, the pupils are usually dilated ; (2) from uraemic coma, where an examination of the urine, if practicable, might clear 276 OPIUM. up our doubts ; and (3) from apoplectic effusion in the pons Varolii, where the symptoms are usually so simi- lar as to render an absolute diagnosis, under certain cer- cumstances, impossible. After death we find well-marked congestion of the brain. Cautions and Modes of Administration. In giving opium we must remember that human beings, like the lower animals, are diversely susceptible to its influence. Thus ducks and pigeons can swallow large quan- tities with impunity, whilst the horse and the dog rapidly fall under its influence ; and although we can hardly lay down any general rules to guide us in practice, we shall find that some persons can take Very heavy doses, whilst others are poisonously affected with unexpected rapidity. We must specially remember that children always bear opium badly, one drop of laudanum having proved fatal to an infant, that anaemic persons also are said by Traube to be readily susceptible. To guard ourselves as far as possible from risk, we shall do well to begin with a moder- ate dose, and invariably to ask our patient whether he has ever taken it before. As the system seems rapidly to accustom itself to the use of opium, we require gradually to increase the dose, and so completely do persons habituate themselves to the pleasurable sensations derived, that they willingly brave the resulting languor and digestive disturbance, and take it in enormous quantities. De Quincey used to take as much as 320 grains daily, and from half a pint to a pint of laudanum is by no means an uncommon daily allow- ance. Although the Turks and Chinese are the principal victims of this habit, much opium is also consumed in this way in some parts of England, and moderate opium-eaters abound in all ranks of society. We must therefore be very careful to warn our patients from time to time of the absorbing nature of this practice, and of its enervating effects on mind and body ; and although it seems evident that [continued] good health is altogether incompatible with [even] moderate opium-eating, and that its use by smoking is far more deleterious, still there is abundant evidence of the generally lowering tendency of the habit- ual use of this drug as an act of mere self-indulgence. As regards the various pharmaceutical preparations of OPIUM. 277 opium, when we wish to produce sleep we generally pre- scribe the tincture in a medium dose, the pil. saponis co., or the extract ; whereas, if we merely wish to relieve pain, smaller doses may prove sufficient. The astringent action is best secured by small doses, which bring the stimulant properties of the drug into play; and an incipient coryza may often be checked by 5 or 10 minims of laudanum, taken at bed-time. For diaphoretic purposes the combination with ipecacu- anha, as in Dover's powder (pulvis ipecacuanhas composi- tus), is of service ; and, for the relief of diarrhoea, we also call to our aid the astringent properties of chalk and kino, as in the pulvis cretae aromaticus cum opio [Br.], and the pulvis kino compositus [Br.] ; or the enema opii [Br.] may be soothing both in this condition and as allaying, by nervous sympathy, various painful conditions of the uterus and bladder. As an adjunct to cough mixtures, and as forming their really effective ingredient, we most conveniently prescribe opium under the form of either the tinctura camphorae com- posite or of the tinctura opii ammoniata [Br.], as in Prof. Christison's well-known formula: — I£. Syrupi scillse f §ij. ; Aq. menth. pip. fgij. ; Tmct. opii ammoniatae [Br.] f§ ss - J Tinct. [spiritus] lavandulse comp. f §ss. ; Syrupi f^j. M. Dose, f Jss. ter die. In diabetes we must push the [crude] drug boldly, to the extent even of from 6 to 8 grains a day. The many-sided actions of opium, which we have just described, are due to its complex constitution and to the large number of alkaloids which it contains. Of these, morphia is by far the most generally used, and in the form either of hydrochlorate [muriate, the sulphate], or the acetate, but more especially of the former, it has in very considerable measure superseded the crude drug, on which we were formerly obliged to depend. Its princi- pal differences from opium are as follows : — It is less astringent and antiphlogistic, and, by interfer- ing less with secretion, its use is not attended by so much headache, constipation, and dryness of tongue. It is more directly narcotic and anodyne, and is therefore 24 278 OPIUM. a more convenient remedy when we wish merely to pro- mote sleep or relieve pain. Its bulk is smaller than that of opium, and it is devoid of smell. The action of the heart becomes slower, and the arterial tension is raised. The respiration may become irregular from a depressing action on the vagi. The functions of the spinal cord are stimulated, and hence we occasionally meet with restlessness and muscu- lar twitchings, which in some of the lower animals run on into true convulsions. Irritability of the bladder is often observed, and trouble- some itching of the skin, depending, in some cases, on the development of a minute papular or vesicular eruption. Some years ago a favorite mode of using morphia was by what is known as the endermic method, in which the pow- der was sprinkled over the- raw surface of a blister ; but this has now been almost entirely superseded by the hypo- dermic syringe. This ingenious little instrument enables us to inject a small quantity of morphia in solution beneath the skin, and the relief to suffering is usually immediate, and sometimes permanent. It matters little whether we introduce the remedy into the immediate neighborhood of the painful spot, our only caution being to avoid the vicinity of large blood-vessels or nerves, and to plunge the nozzle [needle] of the syringe fairly through the skin into the adjacent cellular substance. Some smart- ing usually follows the entrance of the fluid, and inflam- mation and abscess may occasionally be produced ; but these accidents are rare, and the sting of the primary puncture may readily be obviated by freezing the skin with ether-spray. These injections are now very largely prac- tised for the relief of pain, and more especially in facial neuralgia, sciatica, lumbago, in the passage of biliary or renal calculi, in cancer, and in a vast range of diseases where acute suffering is the main symptom, we are en- abled to give our patients temporary, and sometimes per- manent, relief. So great, indeed, is the popularity of this mode of treatment, that a new school of opium-eating, so to speak, has been formed, and morphia-injections have unfortunately been practised to a great extent as a mere development of self-indulgence. We must, of course, be OPIUM. .279 very careful not to give even the most casual or indirect encouragement to such disastrous habits. Some caution is always requisite in prescribing these in- jections for the first time, as not only severe sickness and vomiting have followed their use in many cases, but great prostration, with failure of the heart's action, and even death. We must therefore carefully watch our patient for some time after the completion of the little operation. We must never begin with a larger quantity than the sixth of a grain : and we are told, on good authority, that the combination of ^ of atropia to one part of morphia will effectually obviate all risk of these unpleasant consequences. For injection we may use either the injectio morphise hypo- dermica [Br.], containing 1 gr. of the acetate in every 12 minims, or the elegant and convenient gelatine disks pre- pared by Messrs. Savory and Moore at the suggestion of Dr. Sansom, remembering that morphia acts in this way three times more powerfully than when taken by the mouth. For internal use we may prescribe either salt, remember- ing, however, the varying susceptibilities of different per- sons, and the fact that so small a quantity as half a grain has caused death ; or we shall find the liquor morphiae hydrochloratis [Br.] or acetatis [Br.], containing half a grain to the drachm, a convenient preparation. Most of the other alkaloids contained in opium are merely subjects for physiological curiosity. 1. Codeia, however, is now frequently used, not for its narcotic properties, which are feeble and transient, but for an undoubted soothing influence which it exerts over various painful affections of the kidney. It is also an es- tablished remedy in cases of diabetes, checking the secre- tion of sugar, and arresting, in some measure, the progress of the disease. Dose 1 to 3 grs. 2. Narceia possesses only one-eighth of the narcotic properties of morphia, and is never used in medicine. 3. Cryptopia is one-fourth as powerful as morphia, and in addition to its hypnotic properties it causes in the lower animals peculiar illusions of vision, with a tendency to convulsive action. It also is never used. 4. [Paramorphia or] Thebaia is purely excitant, and in doses of 1 grain it causes tetanic spasms. 5. Narcotina has no narcotic properties, but has some power as an antiperiodic. 6. Papaverine is narcotic. 280 PAREIRA BRAVA. 7. Meconine is feebly narcotic. 8. Apomorphia is a powerful emetic, generally used by subcutaneous injection, in doses of - r l F gr. [ORIGANUM— COMMON MARJORAM. The herb of Origanum vulgare, U. S. Officinal Preparation. Oleum Origani. Dose, gtt. ij.-v. The oil of origanum is rarely used, being largely super- seded in commerce by the oil of thyme. It is an aromatic stimulant. Origanum in infusion has been used as a dia- phoretic and emmenagogue, and externally as a fomenta- tion.] [OS— BONE. Introduced as the source of Calcii Phosphas Prsecipitata and Sodii Phosphas.] OVUM— EGG. \_The egg of Phasanius G alius, U. S. Used in pharmacy in making emulsions, and is an ingre- dient in Mistura Chloroformi.] White of egg is of use as an antidote to various conosive poisons, as perchloride of mercury, and the yolk (vitellus) has nutritive properties. [PAPA VER— POPPY CAPSULES. The nearly ripe capsules of Papaver somniferum, U. S. Occasionally, though rarely, employed in decoction or cataplasm; and the Syrupus Papaveris (Br.) is sometimes given to children, but is an uncertain preparation.] PAREIRA— PAREIRA BRAVA. [ The root of Cissampelos Pareira, U. S. Officinal Preparations. Extractum Pareirse Fluidum. Dose, fjss.-j. Infusum Pareirae. Dose, foj.-ij.] PHOSPHORUS. 281 Local Action. Pareira has no local action. Constitutional Actions. Therapeutical. Pareira is used iri various chronic bladder - affections, but it seems to be very un- certain in its action. Physiological Digestive and Secreting Organs. — Pareira acts in some measure as a diuretic, but its main influence is di- rected to the bladder, which it appears to stimulate and strengthen, improving the tone of its mucous lining, and lessening abnormal se- cretions. — — — [PEPO— PUMPKIN SEEDS. The seeds of Cucurbita Pepo, U. S. Pumpkin-seeds are an efficient taenicide in doses of one or two ounces. The decorticated seeds, beaten into a paste with sugar or milk, are given in the morning fasting, followed, in an hour or two, by a dose of castor oil.] PHOSPHORUS—PHOSPHORUS. Dose, in substance, gr. ^ to ^. Antidotes. There is no direct antidote, but turpentine is said to act as a prophylactic. [Old oil of turpentine is considered an antidote to phosphorus, followed by demulcents and evacuants.] (Phosphorus is not used externally.) Physiological Action. Therapeutical Action. 1. Its action on the nerv- 1. Phosphorus is therefore ous system is tonic and stim- a valuable agent in nervous ulant, repairing the waste of tissue. debility, where the brain is weakened by anxiety, worry, overwork, or sexual excess- es, and where too great amount of phosphates is ex- creted by the urine ; and 24^ 282 PHOSPHORUS. 2. On the circulation it acts in the first place as a stimulant ; the pulse rises and gains in fulness but not firmness, the face flushes, and eventually signs of peri- pheric capillary expansion ensue, ending in free perspi- ration . In large doses, how- ever, it depresses to a dan- gerous degree the heart's action. 3. The temperature dur- ing the administration of phosphorus at first rises slightly, next becomes sec- ondarily lowered by three or four degrees in conse- quence of the dilatation of the superficial capillaries and resulting evaporation from the skin. 4. On the urine phospho- rus exerts the following in- fluence : Its quantity is increased, it becomes red- dish, clouded with lithates, acquiring a violet smell, and, according to B. von Bauer, its proportion of urea is markedly increased. still more markedly in neu- ralgia, which has been shown by Anstie to depend on a feeble state of nerve tissue. It is also useful, like arsenic, in certain obstinate forms of skin disease, as psoriasis, &c. Hammond has advised its use in the early stages of brai?i- softening from over- exertion. 2. Phosphorus may be given with decided benefit as a stimulant in typhoid con- ditions' where great feeble- ness exists, and as a general tonic it is of marked value, the appetite being sharpened and a general sensation of well-being felt. PHOSPHORUS. *&S Hematuria results from a poisonous dose. 5. On the intestinal secre- tion no effect is produced by small doses ; but, in the event of a large quantity being taken, great and per- sistent irritation of the stomach and intestines re- sults, causing pain, vomit- ing, and purging. Jaundice is also a symptom of its poisonous action, and after death fatty degeneration of the liver is generally found. 6. To the skin, phospho- rus acts in some measure as an irritant. 7. Its effects on the osse- ous tissue are remarkable, as it has the property of causing necrosis of the jaw-bone, and this used to be common in lucifer-match makers. Some interesting experiments by Wegner have recently shown a marked influence of phos- phorus in promoting the formation of bone ; for when given to growing animals the cancellous tissue was rapidly transformed into hard bone, and, even in the case of those fully develop- ed, the medullary canal was 5. Much discussion has recently arisen respecting the remedial powers of phosphorus in leucocythcemia and pernicious ancemia, but the evidence is too conflict- ing to enable us to come to any decided opinion at present. The remedy is well worth trying, however, in these otherwise desperate cases, and Broadbent has recorded one remarkable success. 6. On this account, and also because of its stimulat- ing the cutaneous circula- tion, phosphorus has been given with success in the eruptive fevers, such as scarlet fever, measles, &c, to develop an insufficiently developed, or prematurely faded, eruption. 7. The experiments of Wegner would indicate its use in rickets. 284 PHOSPHORUS. sensibly diminished by its use. Also, in cases of arti- ficial fracture, not only was the resulting repair more rapid, but the quantity of bone thrown out was far in excess of the usual amount. Poisonous Effects. These we have seen to consist of intestinal irritation, cardiac syncope, and death from exhaustion, the post-mor- te?n disclosing fatty and parenchymatous degeneration of liver, muscles, and tissues generally. 1^ gr. has proved fatal . Phosphorus is given out from the system principally by the urine, the drug being oxidised in the system and eliminated as phosphates. CONTRA-INDICATIONS AND DISADVANTAGES. We must generally feel our way in prescribing phospho- rus, and begin with small doses, for some persons are more susceptible than others to its over-action, and Anstie records a case in which three or four j4 gr. doses gave rise to long-continued epigastric pain. Nor must we for- get its tendency to cause fatty degeneration of internal organs. Mode of Administration and Dose. Much of our success, however, in giving phosphorus depends on the mode in which it is prescribed, and, as a general rule, capsules containing 3^ grain are found to be a convenient medium. It also goes well with cod-liver oil, but it is very difficult indeed to devise any liquid form- ula by which it is prevented from becoming rapidly inert by oxidation. Most of the pill-masses are useless from being made with insoluble materials which pass through the bowels unchanged. The dose, speaking generally, is from g\ to ^ grain ; or we may give the phosphide of zinc, a very convenient and reliable preparation, much praised by Ashburton Thompson, [in pills containing] from T 1 ^ to ]4, grain. CALABAR BEAN. 285 ACIDUM PHOSPHORICUM GLACIALE— GLACIAL PHOSPHORIC ACID. [Officinal Preparation, U. S. Acidum Phosphoricum Dilutum. Dose, rrrx.-xl.] This acid was formerly held to be of advantage in dia- betes, but more recent investigation has shown that instead of diminishing it actually tends to increase the amount oi sugar given off by the urine. It therefore cannot be held to have any special significance from a therapeutic point of view, but may be adopted as an agreeable mode of in- troducing acid into the system, as its flavor is agreeable. We may take occasion, however, to mention a mistake which is not uncommonly made in prescribing, and that is to prescribe phosphoric acid with the view of obtaining the medical influence of phosphorus. Now it is well known that only from phosphorus in a free condition do we obtain any real benefit, and of this phosphoric acid contains no trace. [It has, however, been used as a tonic and alterative in rickets and scrofula ; and is an excellent adjuvant to cough-mixtures, or tonics, for elderly patients.] PHYSOSTIGMA— CALABAR BEAN. ^The seed of Physostigma venenosum (Balfour}, U. S.~\ The ordeal bean of Old Calabar. [Officinal Preparation. Extractum Physostigmatis. Dose, gr. J-J^.] Antidotes. In addition to the general principles of treating this form of poisonous action, we have here physiological remedies at command — (i) atropia, which directly antagonises the respiratory depression; and possibly (2) strychnia, which stimulates the cord. Local Actions. Physiological. Th erapeutical. When applied to the sur- Calabar bean is therefore face of the body, Calabar of use in ophthalmic surgery, 286 CALABAR BEAN. bean exerts no special influ- ence, but when introduced to the eye it causes very- complete contraction of the pupil. to counteract the dilating effect of belladonna, and to prevent prolapse of the iris in cases of corneal injury or ulceration. Constitutional Actions. 1. On Nervous System. — i. The brain is quite un- affected, the mind, in cases of poisoning, remaining clear almost to the last. 2. The spinal cord, how- ever, is specially attacked, and to a diminution of its motor power are due the muscular enfeeblement and final paralysis which affect those brought fully under the influence of this drug. A still more remarkable result, however, is the total abolition of all reflex activity, the most energetic stimula- tion failing to elicit the slightest response. 2. The depressing action of Calabar bean on the re- flex powers of the spinal cord led Fraser to propose it as a remedy for tetanus, and this mode of treatment has proved very satisfactory in alleviating the symptoms and checking the course of this terrible disease. It is of great importance that the drug should be early used and vigorously pushed, as there is every reason to be- lieve that the cord is free from marked pathological changes during the first period of the disease. Calabar bean has been tried without success in chorea, epilepsy, and other nervous disorders ; but recently Dr. Crichton Browne has expressed his conviction, founded on the observation of a few cases, that it may prove useful in the general paralysis of the insane. It has also been found to act as an effective antidote in strychniapoisoning. CALABAR BEAN. 287 3. Although, in the first stage of Calabar-bean ac- tion, the motor nerves are unaffected, a secondary les- sening of their conductivity is noted, and, with reference to the sympathetic system, an early excitation is fol- lowed by a secondary de- pression. The contraction of the iris noted above, which takes place equally on local or in- ternal administration, is con- sidered due to paralysis of the peripheral vaso- motor nerve fibres, and to stimu- lation of the terminal fila- ments of the third nerve. II. Circulating Appara- tus. — Under small doses of Calabar bean, the heart's action becomes slower and stronger, and the arterial tension is notably increased ; but when the system is brought more fully under the poisonous influence of the drug, the cardiac pulsa- tions become feeble and irregular, and finally cease. These results are believed to be due to stimulation and subsequent exhaustion of the peripheral cardiac filaments of the vagi, and the primary contraction and subsequent relaxation of the arteries are explained in the same way. III. Respiration and Tem- perature. — The breathing usually becomes slow and irregular, and the tempera- ture falls a little. 288 PILLS. IV. Secreting Organs. — Calabar bean tends to cause vomiting, with violent and painful contraction of the stomach and increased peri- staltic movement of the in- testines. Increase in the salivary and cutaneous secretions has also been observed. Poisonous Action. Cautions. Mode of Administration. Calabar bean in small doses destroys life by paralysing the respiratory centre and causing suffocation, but in larger quantity it proves more speedily fatal by cardiac syncope. Caution is of course necessary in dealing with so poison- ous a substance as this. It is seldom used internally, for in tetanus the functions of the stomach are suspended in great measure, and drugs are probably only very partially ab- sorbed. Subcutaneous injection is therefore our best method, and we use a solution of the extract (from \ to \ gr.), neutralising its irritating acidity by the addition of a little soda. The alkaloid eserina [the active principle] is unstable and difficult to extract, and is therefore practically useless. [The sulphate of eserina is ten times the strength of the extract.] [Pilulse. The officinal Pills are: — Pilulse Aloes Pilulse Ferri Iodidi " " et Assafoetidse " Galbani Compositse " " et Mastiches " Hydrargyri " " et Myrrhse " Opii " Antimonii Compositse " Quinise Sulphatis " Assafoetidse " Rhei " Catharticse Compositse " " Compositse " Copaibse " Scillse Compositse. " Ferri Compositse Two Pill-masses are officinal: Pilula Ferri Carbonatis and Pilula Saponis Composita.] CANADA PITCH. 289 [PIMENTA— PIMENTO (ALLSPICE). The unripe berries of Eugenia Pimenta [De Candolle), U. S. Officinal Preparation. Oleum Pimentse. Dose, gtt. iij.-vj. Pimento is a warm, aromatic stimulant, but is more used as a condiment than as a medicine. As a carminative, the dose is from ten to forty grains.] PIPER— BLACK PEPPER. \The unripe berries of Piper nigrum, U. S. Officinal Preparation. Oleo-resina Piperis. Dose, nrj.] Pepper is an acrid stimulant, acting more especially on mucous membranes, and hence, as a condiment, it is sup- posed to excite the secretion of the gastric juice. In for- mer years it also acquired some reputation as a remedy for hemorrhoids. [Piperin, not officinal, is sometimes added to antiperiodic pills, but probably owes its effects to an impurity, the active oil of pepper.] PIX BURGUNDICA— BURGUNDY PITCH. \_A prepared resinous exudation from Abies excelsa {Lamarck' 's Ency. Method), U. S. Enters into Emplastrum Antimonii, Emp. Ferri, Emp. Galbani Compositum, Emp. Opii, Emp. Picis Burgundicae, and Emp. Picis cum Cantharide.] Pitch is used externally in the form of plaster. [PIX CANADENSIS— CANADAPITCH (HEMLOCK). The prepared resinous exudation from Abies Canadensis ( Michaux, N. A?n. Silvd), U. S. Officinal Preparation. Emplastrum Picis Canadensis. Used only in the form of the plaster. The oil of the Abies, or Pinus, Canadensis, or Hemlock Spruce (oil of spruce, oil of hemlock), has been given to produce abor- tion. A fluid extract of the bark (Ext. Pinus Canadensis fluid.), not officinal, is largely used as an astringent for gar- gles, vaginal douches, &c] 2 5 290 TAR PIX LIQUIDA— TAR. [ The impure turpentine from the wood of Pinus palustris, and of other species of Pinus prepared by burning, U. S. Officinal Preparations, U. S. Glyceritum Picis Liquidae (n^xxx, in fsj.). Dose, f3j.-iv. Infusum Picis Liquidae (Tar 20 percent.). Dose,foss.-j. Unguentum Picis Liquidae (Tar, 50 per cent. ).] External Actions. Physiologica l. Tar acts as a stimulant to the skin, and is apt to pro- duce an irritable papular eruption. It is rapidly ab- sorbed, and if allowed to remain in contact with the surface of the body, or if applied over an extensive cutaneous area, feverish symptoms ensue, with an abundant discharge of black- ish urine, smelling strongly of tar. Therapeutical. Tar is an excellent appli- cation in cases of chronic scaly skin disease, as psori- asis. To lessen the risk of ex- citing an undue amount of irritation, it is well to wash the skin perfectly clean be- fore renewing the applica- tion, and it is important to rub in the ointment tho- roughly until it nearly dis- appears. Internal Actions. Tar seems to have a stim- ulating action on mucous membranes when taken in- ternally. [Tar contains a certain proportion of crea- sote, upon which some of its therapeutic effects depend.] The vapor of tar used to be a remedy of some reputa- tion in chronic bronchitis, and recently Prof. Ringer has re- commended two-grain pills, three times a day, as a most efficient remedy in winter- cough. The internal use of tar has also been praised by Dr. McCall Anderson in chronic skin diseases. [The syrup of tar (5j- in f^iv.) is not officinal, but may be given in advanced bronchitis, LEAD. 291 in half-ounce doses. The infusion is stimulant and diu- retic.] PLUMBUM— LEAD. [Officinal Preparations, U. S. Plumbi Oxidum (Litharge). Emplastrum Plumbi (Lead-plaster). Emp. Assafcetidae (Assafcetida plaster). Emp. Ferri. Emp. Galbani Compositum. Emp. Hydrargyri. Emp. Opii. Emp. Resinas (Adhesive plaster). Emp. Aconiti. Emp. Arnicae. Emp. Belladonnae. Emp. Saponis. Ceratum Saponis. Liquor Plumbi Subacetatis (Goulard's extract). Liq. Plumbi Subacetatis Dilutus (lead-water). Ceratum Plumbi Subacetatis (Goulard's cerate). Linimentum Plumbi Subacetatis. Plumbi Acetas (Sugar of lead). Dose, gr. ij.-v. Suppositoria Plumbi (each gr. iij.). Suppositoria Plumbi et Opii (each gr. iij., and Ext. Opii gr. ss.). Plumbi Carbonas. Unguentum Plumbi Carbonatis (5j- in iij.)- Plumbi Nitras (used as a disinfectant — Ledoyen's solu- tion). Plumbi Iodidum. Unguentum Plumbi Iodidi. Antidotes. Sulphuric acid forms an insoluble compound with lead, and, therefore, the soluble sulphates (alum, Epsom salts) are chemical antidotes to lead-poisoning; they are often given combined with sulphate of morphia to relieve pain and relax spasm.] 292 LEAD. Id poisoning by lead, we must give sulphate of magne- sia, iodide of potassium, sulphur baths, and remove its after-effects by galvanism of the paralysed muscles ; but it is stated that sulphuric-acid lemonade, and a liberal indulgence in fatty articles of diet, may act in some degree as prophylactics. Local Actions. Physiological. Th erapeutical. The external action of Lead, in the form of sub- lead is partly sedative and acetate, is much used as a partly astringent. [AH the lotion for erysipelas, acute preparations of lead are used eczema, and various ulcera- externally, but the acetate tive conditions, appears to be the only one It forms a good collyrium adapted for internal use.] in the more superficial in- flammations of the eye; but we must remember that its tendency to deposition may cause a permanent white patch in corneal ulcers. The powder of nitrate of lead has been shown to be a good application in onychia maligna. Internal Actions and Uses. 1. Brain and Nervous System. — When lead is given in poisonous doses, a curious train of nervous symptoms show themselves, beginning with violent neuralgic pains and giddiness, and running on into delirium, with epi- leptiform convulsions, and subsequent melancholia. Sclerosis of the areolar tis- sue, with diminution of the nervous elements, has been found in certain of the sympathetic ganglia, but LEAD 293 more especially the coeliac and cervical ganglia. Atro- phy of the optic nerve is an occasional, though rare, complication of lead-poison- ing. 2. Heart and Circulation. During the action of lead, the heart becomes slow, and the pulse smaller and harder, indicating a condition of contraction and tension of the arterial system ; and this is by some supposed to be due to a primary effect on the sympathetic, whilst others hold that lead has a direct influence over un- striped muscular fibre, and most powerfully over that which encircles the arteries. Lead tends to produce pal- lor by destroying the red blood-corpuscles. 3. Intestinal Tract. — A prominent symptom of chronic lead - poisoning is obstinate constipation, de- pending probably on con- traction of the small intes- tine, and associated with violent colicky pain around the umbilicus. The appetite at the same time becomes bad, the tongue loaded, and nausea and even vomiting are observed. Gastro-enteritis is generally one of the symptoms of acute poison- ing. Urinary System. — Lead has the curious property of obstructing the elimination 25 : 2. This contractile influ- ence of lead over the smaller vessels explains its action in i?iternal hemorrhage, as we know that hozmoptysis, more especially, may be very successfully treated by ace- tate of lead in doses of from ^ gr. to 3 grs. 3. Acetate of lead is an excellent astringent in diar- rhoea, more especially that of phthisis, and British [or sporadic^ cholera. Dr. Thorowgood has ob- tained good results from lead in obstinate obstruction of the bowels. 294 LEAD. of uric acid from the blood through the kidneys, and may thus cause gout in painters and others who are exposed to the effects of the metal. Muscular. — Lead causes violent pains in the muscles, with a peculiar form of paralysis affecting the exten- sors of the fore-arms, and causing the well known wrist-drop ; and post-mortem we find fatty degeneration of the muscular structures. The contracting power of lead overunstriped muscular fibre probably explains the tendency to abortion noted during its poisonous influ- ence. Poisonous Effects. The first sign of chronic lead-poisoning is a bluish line running along the free margin of the gums composed of minute dots, and depending on the actual deposition of lead in the mucous membrane. To this succeed colic, wrist-drop, and the other symptoms mentioned above, the post-morten disclosing chronic catarrh of the stomach and intestines, with the deposition of the metal in the bones, liver, kidney, brain, nervous and muscular tissues. Chronic lead-poisoning has occasionally resulted from adulterated cider or from water, and indeed in a variety of ways, but it is most common in painters, who are brought much in contact with the carbonate in the prac- tice of their business. Mode of Elimination. Lead is thrown out of the system by the urine, skin, bowels, and milk. MAY-APPLE. 2 95 Mode of Administration, &c. If we wish to administer lead internally, we generally prescribe either the acetate or pil. plumbi cum opii [Br.] (i gr. of opium in 8), dose, 4 to 8 grs. Externally we find the liquor plumbi subacetatis dilutus the most convenient form. PODOPHYLLUM— MAY-APPLE. [ The rhizome of Podophyllum peltatum, U. S. Officinal Preparations, U. S. Extractum Podophylli. Dose, gr. v.-xv. Resina Podophylli (incorrectly called podophyllin). Dose, gr. fe-%.\ Local Action. Podophyllin cannot penetrate the unbroken cuticle, but experiment has shown that it exerts its purgative influence when applied to a raw surface. Constitutional Actions. Physiological. The only marked physio- logical property of this drug is that of irritating the duodenum and causing a profuse flow of watery evacuations, largely mixed with bile. Some controversy has taken place as to whether podophyllin can be called a cholagogue in virtue of any direct stimulation of the secreting structures of the liver, experimental evidence seeming to show that it probably acted by contract- ing the gall-bladder, and thus favoring the expulsion of its contents, and by ex- citing the duodenum to sweep away the bile effused into it by the hepatic ducts. Th erapeutical. Podophyllin is a valuable remedy in jaundice and in the various forms of func- tional liver -affection. It may be used in simple chronic constipation, in the constipation of children attended with the painful and difficult evacuation of hard, dry faeces, and in the opposite condition of diar- rhoea with pale and frothy motions. In sick headache it also acts well. [Podophyllum is an effi- cient substitute for jalap, and may be used for all pur- poses for which the latter drug has been recom- mended.] 296 POTASSIUM. The more recent experi- ments of Rutherford and Vignal, however, have re- instated podophyllin in its old position as a true stimulant of the biliary secretion. Cautions and Mode of Administration. We must remember that podophyllin is an uncertain drug, acting well in some cases, very slightly in others, whilst in a third class it causes much discomfort and grip- ing. It is advisable, therefore, always to begin with small doses, as ^ gr. or y 2 g r - , and to prescribe it in the form of pill, combined with other ingredients which may restrain its irritating action. Thus : — I£. Resinse podophylli gr. ij. ; Extracti belladonnse gr. iij.; Pil. colocynthidis compositse gr. xxxvj. M. Fiant pilulse duodecim, quarum capiat imam omni nocte. Ringer recommends a very convenient way of prescrib- ing podophyllin for children, by dissolving a grain in a drachm of rectified spirit, and giving 5 or 6 drops three or four times a day on a lump of sugar [or painted on a bun]. POTASSIUM—POTASSIUM. [Officinal Preparations, U. S. Potassa. Caustic Potassa. Liquor Potassae. Dose, n^x.-xxx. Potassa cum Calce (equal parts), used as a caustic. Potassii Acetas. Dose, gr. xx.-3j. Potassii Carbonas Impura (Pearlash). Potassii Carbonas. Dose, gr. x.-xxx. (Extractum Spigeliae et Sennae Fluidum, Mistura Ferri Composita, Potassii Bicarbonas, Potassii Sulphuretum, and in making Chloroformum Purificatum and Spiritus ./Etheris Nitrosi.) Potassii Carbonas Pura. Dose, gr. x.-xxx. (Used in making the Bromide and Cyanide, and Mis- tura Potassii Citratis.) Potassii Bicarbonas. Dose, gr. x.-5j. POTASSIUM. 297 (Liquor Magnesia Citratis, Liquor Potassae, Liquor Po- tassii Arsenitis, Liquor Potassii Citratis, Mistura Po- tassii Citratis, Potassii Acetas, Potassii Carbonas Pura, Potassii Citras.) Potassii Bichromas (as an alterative). Dose, gr. J. (Used in preparing Sodii Valerianas.) Potassii Bitartras (Cream of Tartar). Dose, 5}.-iv. Antimonii et Potassii Tartras, Ferri et Potassii Tartras, Potassii et Sodii Tartras, Potassii Tartras, Pulvis Ja- lapse Compositus. Potassii Bromidum. Dose, gr. xx.-3j. Potassii Chloras. Dose, gr. v.-xx. Trochisci Potassii Chloratis. Potassii Citras. Dose, gr. x.-xxx. Liquor Potassii Citratis. Dose, f^ss. Potassii Cyanidum. Dose, gr. yi. Potassii Ferrocyanidum. Dose, gr. x.-xv. (Used in making Acidum Hydrocyanicum Dilutum, Argenti Cyanidum, Ferri Ferrocyanidum, Hydrargyri Cyanidum, Potassii Cyanidum.) Potassii Hypophosphis. Dose, gr. x.-xxx. Potassii Iodidum. Dose, gr. x.~3j- (Ammonii Iodidum, Hydrargyri Iodidum Rubrum, Li- quor Iodinii Compositus, Plumbi Iodidum, Tinctura Iodinii Composita, Unguenturn Iodinii, Unguentum Iodinii Compositum, Unguentum Potassii Iodidi (5j- to SJOO Potassii Nitras. Dose,' gr. x.-xv. Potassii Permanganas. Dose, gr. j.-v. Liquor Potassii Permanganatis (gr. iv. to f^j-)* Potassii Sulphas. Dose, gr. xx.-Jiv. Pulvis Ipecacuanhas Compositus. Dose, gr. x. Potassii Sulphis. Dose, gr. xv.-5j. Potassii Sulphuretum. Dose, gr. ij.-v. Potassii et Sodii Tartras (Rochelle Salt). Dose, §ss.-j. Potassii Tartras. Dose, 3J- - 3j- Antidotes. Vinegar and lemon-juice. 298 POTASSIUM. Local Actions. Physiological. Caustic potash is a most powerful escharotic, with- drawing water from the tis- sues, and thus destroying them. It has, however, the disadvantage of being very- deliquescent, and this ten- dency to spread, beyond the part we wish to attack, has led to its practical abandon- ment as a local application. The permanganate of pot- ash, or Condy's fluid, oxi- dises and destroys many or- ganic substances. Therapeutical, Caustic potash, either in sticks or combined with lime in the form of potassae cum calce, was formerly used in the treatment of various forms of ulceration, and for the production of issues, which barbarous relics of antiquity are now fortunately discarded from practice. Liquor potassae has been re- commended to soften the great toe-nail and facilitate its removal when ingrowing ; and the bicarbonate of pot- ash forms a good lotion in acute eczema, and as an in- jection in leucorrhoea, and as an application to rheu- matic joints. It is therefore antiseptic, and a good application to unhealthy ulcerations. Internal Actions and Uses. Physiological. 1 . Brain and Nervous Sys- tem. — Potash salts, and more especially the nitrate, when given in large doses, exert a paralysing action on the spi- nal cord, producing great muscular weakness and final abolition of reflex sensibility. 2. Heart and Circulation. Moderate doses of the ni- trate raise the arterial tension and slow the heart's action, Th erapeutica I. POTASSIUM. 2 99 and if the drug is further pushed, the pulsations be- come weaker, still slower, and finally irregular, before the total arrest of movement supervenes. Potash salts cause the blood, and secondarily, the urine, to become alkaline, and any excess of uric acid may thus become neutral- ised. 3 . Intestinal Tract. — Chlo- rate of potash moderates ex- cessive action of the salivary glands, and assists the heal- ing of ulceration about the gums, mouth, and throat. The salts of potash generally neutralise free acid in the stomach and intestines, and the nitrate in full doses may cause death by gastro-ente- ritis. Most of the potash salts are slightly purgative, but only the acid tartrate has any very decided action of this kind, causing as it does the abstraction of a large quantity of watery fluid, without, however, stimulat- 2. This has been supposed to explain the beneficial ac- tion of potash in acute rheu- matism, which is held to de- pend on an excess of uric acid. Much controversy has taken place with reference to the alkaline treatment of this disease, but I am decidedly of opinion that if large doses of bicarbonate of potash do not shorten its duration, they relieve symptoms, and lessen the tendency to cardiac com- plications. Potash acts well also in gout and chronic rheu- matism by forming a soluble salt with uric acid. 3. Chlorate of potash, in doses of from 5 to 20 grains, is an admirable remedy in {true croup\ mercurial sali- vation, in various aphthous conditions, and in sore throat, whether produced by scarlet fever or ordinary tonsillar inflammation, and a wash or gargle may well be combined with its internal administration. In doses of from 120 to 300 grains, cream of tartar is a good purgative, but is principally used in combi- nation with jalap, which, by stimulating the muscular movements of the small in- 3°° POTASSIUM. ing the peristaltic movement of the intestines. The sul- phate is also aperient in its action. 4. On Secreting Organs. — It will be remembered that, in speaking of acids, we re • ferred to a law which has been more especially devel- oped by Ringer, and which explains their power of checking acid secretions. Alkalies have precisely the opposite effect, arresting the activity of glands furnishing alkaline fluids, whilst they directly stimulate those whose secretion partakes of the opposite character. Kidneys. — Most of the salts of potash, but more especially the acetate, ni- trate, citrate, and acid tar- trate, are diuretic, and the acetate, bicarbonate, and ci- trate, being converted into carbonate, speedily render the urine ^alkaline. Elabo- rate experiments have been made on the more precise alterations effected in the urine by the salts of potash. Prof. Parkes tells us that liquor potassse increases the destructive metamorphosis of the nitrogenous tissues, and their elimination as urea, as well as that of the sulphur in the form of sulphates. The acetate has been shown testines, prevents the proba- ble reabsorption of the wa- tery fluid. 4. We can therefore read- ily explain, on physiological principles, why alkalies are so useful in hepatic conges- tion, why they may also stim- ulate the pancreatic secre- tion, and why their action is so beneficial in cases of dys- pepsia depending on defi- cient supplies of gastric juice. On these principles, also, we may readily under- stand the very striking power possessed by a weak solution of potash in arresting the alkaline secretion so freely poured out by the skin in acute eczema. Potash salts are therefore good diuretics in heart dis- ease, chronic kidney affec- tions, and various dropsical accumulations; and their ac- tion is much more marked under these conditions than when administered to healthy subjects, since we have seen that the acetate, which is perhaps the most active of the diuretic group, may even check the elimination of wa- ter from the kidneys during health. Dr. Roberts, of Manchester, has proposed to dissolve uric acid calculi by keeping the urine alkaline for months with citrate of potash. POTASSIUM. 30I to diminish the water, urea, and earthy salts ; whereas the citrate, according to Dr. Nunneley, increases the wa- ter, but diminishes the urea and solids. Potash may be used under other conditions. Thus in asthma the inhalation of the fumes from burnt blotting- paper soaked in a strong solution of nitrate of potash is often effectual , chlorate of potash is a useful ingredient in a cough linctus; the citrate is an agreeable febrifuge, and is valuable in many of the feverish and dyspeptic affections of children. Scurvy is held by some to be dependent on a deficiency of potash salts in the blood. Poisonous Action. Partly from depression of the heart and partly from inflammation of stomach and intestines. Mode of Elimination. The potash salts, having a high diffusive power, pass readily into the blood, and are given out by the urine, in which the nitrate, chlorate, and sulphate reappear un- changed. R. Liquoris potassae f 5U- > Tincturae calumbse f 31J. ; Infusi calumbse f§ v j- M. Fiat mist, f §j. ter in die. Antacid mixture. R. Potass i i bicarbonatis 5J- > Potassii acetatis gr. xv. ; Potassii nitratis gr. x. ; Aquse f^ij- M. Fiat haustus quartis horis sumend. This constitutes the " full alkaline" treatment recom- mended by Dickinson for acute rheumatism, and may be prescribed in effervescence. [R. Potassii chloratis S l i> Syrupi limonis 1 ^j . ; Aquae f^iij- M. Dose, according to the age of the child : if under two years f5j-> from two to ten f3ij-> over ten f^ss., given 26 302 BICHROMATE OF POTASSIUM. every three hours, or every half hour in urgent cases. Recommended as almost specific in diphtheritic croup by Dr. T. M. Drysdale, of Philadelphia. 1 ] R. Potassii chloratis gj. ; Aquae fgvj. M. S. f §j. ter die. In ulcerated mouth or gums, or mercurial salivation. R. Potassii bicarbonatis 5ss. ; Aquae Qj. M. A good lotion in acute eczema. R. Potassii acetatis 3Jss. ; Aceti scillae f £iv. ; Decocti scoparii [Br.] ad f§vj. M. Fiat mist. Dose, f §j. quartis horis. Diuretic mixture. R. Spiritus aetheris nitrosi f 3U- 5 Potassii nitratis gr. xx. ; Decocti scoparii [Br.] f §iv. M. Fiat mist. Dose, f §j. ter die. Diuretic. R. Potassii [bi-]tartratis 3 l 'j- j Succi scoparii [Br.] 5 v j- '■> Aquae t|vj. M. Dose, f §j. ter die. Diuretic. R. Potassii chloratis gr. xl. ; Glycerini f §ss. ; Morphiae hydrochlorat. [muriat.] gr. jss. ; Syrupi ad f§iv. M. S. f 3J. prout res poscit. Dr. Douglas Powell's linctus for the chronic throat irritation of consumptive patients. [Potassii bichromas. Bichromate of potassium, in powder or strong solution, is a good escharotic and antiseptic application to warts, and venereal excrescences. It has been used internally in secondary syphilis, as an alterative, given in pill-form, with some bitter extract. Occasionally it produces salivation. It acts as an emetic in doses of % gr. In large doses it is an irritant, corrosive poison. Antidotes, soap, mag- nesia, and bicarbonate of sodium.] 1 [Phila. Med. and Surg. Rep., March, 1877, vol. xxxvi. p. 238.] BROMIDE OF POTASSIUM, 3°3 Potassii Bromidum. (Bromide of Potassium is not used externally.) Physiological Action. i. On Nervoics Function. Long continuance in the use of pot. bromid. tends to cause a sense of fatigue and general muscular prostra- tion, with giddiness and staggering. Brain. — The functions of the brain are lessened, and sleep results. [Observation has shown that the bromides actually reduce the amount of blood in the brain.] Spinal Cord. — It has been proved by experiments on animals that the reflex irri- tability of the cord is less- ened, as indicated by the anaesthetic effect which is produced on the palate. It has also been observed that the power of voluntary movement persists after the abolition of reflex function, proving that the influence of the drug is exerted probably either upon the different nerves or upon those por- tions of the cord which- transmit the impulse from these nerves to the cells presiding immediately over motion. Sympathetic System. — Pot. bromid. is supposed to have a sedative influence over the sympathetic system of nerves ; but on this point the evidence is very contra- dictory. Therapeutical Actioii. i. Pot. bromid. has gained great repute within the last few years in the treatment of a large series of convulsive and spasmodic affections, and most especially in epi- lepsy, it being now thorough- ly established that if we get our case sufficiently early we may absolutely cure it, and even if it is too con- firmed for this result we may keep it in check. The cases most under the influence of the drug are those known as the hant mal, where violent struggling is followed by comatose sleep ; on the other hand, in the petit mal, where the attack is indicated merely by passing unconsciousness, or when the seizures occur principally at night, the remedy will frequently dis- appoint us. Pot. bromid. is believed to act in epilepsy by relieving the spasmodic contraction of a vessel supplying a special vascular brain area which is thus deranged in function. It is also of great benefit in the various convulsive seizures of children, in la- ryngismus stridulus, night terrors, and also in those spasmodic symptoms which depend on meningitis or or- ganic brain disease. 3°4 POTASSIUM. 2. Effects on Circulation, — No special action on the heart has been observed save some slight lowering of its action. The smaller arteries have been said to be con- tracted, the pulse becoming smaller ; and we may thus explain the hypnotic action of the drug, the brain being rendered anaemic as in phy- siological sleep. 3. Its influence on diges- tion is not marked ; for although it sometimes seems to lessen the appetite, this is not a constant result. 4. The effects on the uri- nary secretion have not been thoroughly made out. 5. Bromide of potassium has an undoubted influence over the generative organs, lowering their excitability, and even in large doses sus- pending their action. It is of service in incon- tinence of urine, pertussis, cramp of lower limbs, cho- rea, in delirium tre??iens, and in many of those forms of mental depression, nervous headache, and vague sensa- tions, indicating nervous disturbance, which are so distressing to some women about the change of life. It is said to be a good remedy in sea-sickness, from the sedative effect on the centre concerned in the re- flex act of vomiting. 2. Bromide of potassium is an excellent narcotic, and causes refreshing sleep, more especially in cases of worry, mental anxiety,or overwork, a full dose being given at bedtime; and in acute mania its use in combination with chloral is highly praised by Clouston. 4. It has been much prais- ed by Begbie in diabetes. 5 . It is useful in priapism, and in those forms of Menor- rhagia which depend on ova- rian irritability. IODIDE OF POTASSIUM. 305 Potassium bromide is eliminated from the system by the urine, breath, sweat, and milk (a case being recorded in which the child of a suckling mother taking this salt became covered with acne). Disadvantages and Contra-indications. We have already noted the peculiar nervous symptoms occasionally caused by pot. bromid. — giddiness, general muscular fatigue, even amounting to actual staggering in some cases. But in addition to this an unpleasant erup- tion of acne often breaks out on the face, and may arise from a very small dose. If, in spite of this, the remedy is persisted in, the whole body may eventually be covered with large and unsightly blotches. Dose and Mode of Administration. The dose for epilepsy ranges from 10 to 60 grains, it being necessary to increase the quantity gradually, and continue its use for long periods, even years, occasionally leaving it off for a week or so, after which it seems to regain some of its lost effect. Dose as a hypnotic gr. xx. ad xxx. In other cases about gr. xx. as an average. Children bear it well, and we may give a child 2 or 3 gr. with good effect. As its taste is rather nauseous, we must disguise it, thus : — ty. Potassii bromidi gr. xxx. ; Syrupi aurantii f£j. ; Aquae aurantii flori ad f§ij. Fiat haustus hora somni sumendus [Or give it simply dissolved in water.] [Potassii lodidum — Iodide of Potassium.] Constitutional Action. Physiological. Therapeutical. t. On Brain and Nervous 1. Iodide of potassium is System. — No special action of great service in many on the nervous system has brain-diseases, and most es- been observed, unless we pecially those in connection hold that the uncomfortable with tertiary syphilis, where sensations of misery and de- gummata, and other forms of pression occasionally fol- tumor, cause those excruciat- 26* 306 IODIDE OF POTASSIUM. lowing its use may be thus explained. 2. The effects of iodine on the circulation have never been properly estimated, but some observers say that it tends to contract the vessels and cause increased rapidity of the heart's action. Potas- sic iodide has very swift dif- fusive power, entering the blood very rapidly, being given off within ten minutes after ingestion. 3. On respiration and tem- perature no effects have been noted. 4. Effects on secretion. a. Intestinal. — Nothing special save occasional loss of appetite and dis- ordered digestion. |3. U?inary. — Potassic io- dide has some diuretic action, more especially in connection with other drugs. y. The salivary secretion is often markedly increas- ed, true salivation being sometimes produced. 5. It is also believed that the iodide of potassium has some special action on glandular tissues in general, increasing their absorptive powers, and even exciting them to absorb themselves; and ing pains and varying nerv- ous phenomena which have been so ably described by Drs. Broadbent and Buz- zard. 2. Potassic iodide has been used with great benefit by Dr. Balfour and others in aortic aneurism, several suc- cessful cases having been re- ported. It is difficult to explain the raiio?iale of its action, but it is essential that large doses (twenty grains) [ter in die] be prescribed and continued regularly for a year or more. /3. Potassic iodide is oc- casionally used to heighten the diuretic action of other drugs. 8. The iodide of potas- sium is often given to facili- tate and hasten the absorp- tion of inflammatory lymph in the later stages of pleu- risy, pneumonia, pericardi- tis, &c. IODIDE OF POTASSIUM. 3°7 in support of this last proposition it has been stated that, under its use, the mammae and testi- cles have been observed to waste and disappear. This conclusion has probably been arrived at, however, by confus- ing the post with the propter hoc, and it is probable that the re- medy does not so much actually stimulate the absorbents as reduce effused lymph to a con- dition more favorable for elimination. 5. It also has the power of removing various metallic substances from the tissues, — mercury and lead, for in- stance, being occasionally deposited in the form of an insoluble albuminate, and released from this condition by the action of the drug. 6. Finally, this salt has an irritating action on mucous membranes, causing redness, tingling, and free secretion, resembling much an ordi- nary catarrh, and also thin- ning and liquefying tena- cious, pathological, mucoid secretions. 5. In [cases of] chronic leadpoisoning, so often met in house-painters, or [where we wish] to remove mercury from the system, we gene- rally prescribe potassic io- dide, and in the latter case we must not be surprised if our patient is suddenly seiz- ed with profuse salivation. This is explained by the re- leased mercury finding its way back into the circula- tion, and exerting its usual influence on the salivary glands. 6. Potassic iodide is often prescribed in cases of bron- chitis where the expectora- tion is thick, tenacious, and difficult of expulsion, and it here acts well by thinning the sputa. 3 o8 IODIDE OF POTASSIUM 7. There are other impor- tant uses of potassic iodide which cannot be arranged tinder the preceding catego- ries, and which must there- fore be called specific. These are its influence over syphi- lis, gout, chronic rheuma- tism, and simple periostitis. 7. In cases of tertiary syphilis, this salt often acts like a charm. In the primary and secondary forms, it is of little or no use, but when the deeper tissues begin to be af- fected, and when we meet with deep rupial or other ulcerations of the skin, ulcers in the throat, periostitis, and head symptoms, we may then prescribe iodine with the certain expectation of relief. In chronic gout it is also of service, and in chronic rheu- matism, more especially in those cases where we meet with tenderness to pressure and nocturnal increase of pain. In simple periostitis of the head, sternum, or tibia, which often results from exposure to cold, io- dide of potassium has an almost magical effect, and will often bring about a cure after two or three days' treatment. Potassic iodide is eliminated from the body by the urine, saliva, tears, milk, &c. ; it can be detected in the urine in ten minutes after being swallowed, and it is rapidly given out, so that the whole may be recovered from the various secretions. Disadvantages and Contra-indications. As regards its disadvantages and contra-indications, we must remember the possible occurrence of iodism, to which unpleasant symptom some persons are much more susceptible than others. These consist, in the first place, of irritation about the mucous membranes, running at the eyes and nose, sneezing, frontal headache, swelling of the eyes, and salivation; an eruption not unlike nettle-rash is IODIDE OF POTASSIUM. 309 sometimes observed ; occasionally acne may be the result, and Ringer has described a peculiar petechial eruption affecting the legs. Quite recently Mr. J. Hutchinson has expressed his belief that the formidable pustular eruption known as hydroa is really caused by iodide of potassium, but in my own experience and that of others who have freely prescribed the drug, these various uncomfortable effects are comparatively seldom observed, a curious point being that iodism seems to be much more readily excited by small than by large doses of the drug. In some persons a good deal of depression and digestive derangement is caused. Antidote [to Iodism]. Some few years ago, Sir James Paget observed that the addition of spiritus ammonise aromat. to potassic iodide not only lessened the chances of iodism, but enabled us to limit ourselves to a smaller dose, and this has come very generally into use. Dose, and Mode of Administration. [The iodide of potassium should be prescribed alone, or only in combination with other preparations of iodine, or with corrosive sublimate. See note, page 26. This salt may be given simply dissolved in water, or its taste may be well disguised by administering it in combi- nation with compound syrup of sarsaparilla, or compound infusion of gentian.] Potassic iodide as an anti-syphilitic [maybe given in doses of] from 3 to 30 grains, or even 60, according to the judgment of prescribers, it being necessary in obstinate cases to push the drug very freely. [Dr. Taylor, at the meeting of the American Dermatolo- gical Association held recently (Sept. 4-6) at Niagara Falls, said that patients would tolerate an ounce and a half daily and grow fat on it, the only physiological result being increased urination. He mentioned a case of nodes, where fourteen drachms daily were administered ; nothing less would give the patient relief at night. He thought that in similar cases the addition of bromide of potassium, one drachm to seven of the iodide, would be of advantage. He also remarked that he had observed pains in the joints occasionally, even when small doses of iodide were 310 WILD -CHERRY BARK. being administered, which were considered as being due to the remedies employed. He offered a practical suggestion in reference to the prevention of these pains (which are diurnal and not nocturnal), which was that tincture of colchicum and tincture of hyoscyamus, com- bined with small doses of the iodide of potassium, would obviate them. Occasionally it is necessary to use cam- phorated oil, or some warming application externally. The joint trouble is sometimes poly-articular, sometimes mon -articular.] Professor Syme, however, used to say that all good effects can be obtained by two or three grains, and in ordi- nary cases of syphilis or periostitis, rheumatism, &c, this will [in his opinion] be found a sufficient dose, copious dilution aiding its effects. In aneurism we must give at least twenty grains, and in advanced syphilitic affections even larger doses are well borne. JjL. Potassii iodidi gr. xl. ; Spiritus ammonii aromatici f§ss. ; Syrupi aurantii f §j. ; L'ecocti sarsaparilloe compositi ad l^viij. M. S. Capiat unciam unam ter in die. PR17NUM— PRUNES. [ The dried 'fruit of Primus domestica, U. S. Enters into Confectio Sennae.] Prunes are slightly pur- gative. [PRUNUS VIRGINIANA— WILD CHERRY. The bark of Cerastes Serotina (De Candolle), U. S. Officinal Preparations, U. S. Extractum Pruni Virginianae Fluidum. Dose, fjj. Infus am Pruni Virginianae. Dose, f^ij.-iij. Syrupus Pruni Virginianae. Dose, fsss. Wild-cherry bark is tonic and sedative, the preparations containing a small amount of hydrocyanic acid. The syrup, from its pleasant flavor, is much used as an ingre- dient in cough syrups for phthisis or chronic bronchitis.'] POMEGRANATE — QUASSIA, 3 11 [Pulveres. The officinal Powders are : — Pulveres Effervescentes. — Soda or effervescing powders. " " Aperientes. — Seidlitz powders. Pulvis Aloes et Canellse. — Hiera Picra (holy bitter). " Aromaticus. — Spice powder. " Ipecacuanhas Compositus. — Dover's powder. " Jalapae Compositus. — Jalap and cream of tartar. " Rhei Compositus. — Rhubarb, magnesia, and ginger.] PUNICA GRANATUM- [Granati Fructus Cortex. Punic a Granaium, U. S. Granati Radicis Cortex. Punica Granatum, U. S^\ -POMEGRANATE. The rind of the fruit of The bark of the root of Physio logic a I A ction . Pomegranate bark de- stroys a tape-worm, accord- ing to Kiichenmeister, in three hours. [Contains gallo-tannic acid, and may be used in decoction (^ij. to Oj.) as an astringent wash.] Therapeutical. It is much used as an anthelmintic in veterinary practice [and is sometimes given in infusion as a gargle, and as an injection in gonor- rhoea^. QUASSIA— QUASSIA. \_The wood of Simaruba exceha, U. S. Officinal Preparations, U. S. Extractum Quassise. Dose, gr. j.-iij. Infusum Quassise (3ij. to Oj.). Dose f^j.-ij. Tinctura Quassise (3j. to Oj.). Dose, gtt. xx.-f3j.] Physiological Actions. The action of quassia is directed to the gastro- intestinal mucous mem- brane, and it is probable that its intensely bitter taste may stimulate the secretion of gastric juice, as it certainly increases the appetite. llierapeutical Actions. Quassia is much used as a tonic in dyspepsia, want of appetite, and general debil- ity. Having no aromatic flavor, it is sometimes badly borne by weak stomachs, but, being very cheap, it is largely prescribed in dis- 312 OAK RESIN. pensary practice, more especially in combination with iron. Quassia is destructive to It is therefore of service, many of the lower forms of given as an enema, for the animal life. destruction oitliread-worms. QUERCUS— OAK. [Quercus Alba. The inner bark of Quercus alba, U.S. Quercus Tinctoria. The inner bark of Quercus tine- tor ia, U. S. Officinal Preparation, U. S. Decoctum Quercus Alba (§j. to Oj.). Dose, fsiv.] Oak bark contains tannic and gallic acids, and is there- fore of some value as a topical astringent in relaxed throat, leucorrhcea, &c. [RESINA— RESIN. The residue afler the distillation of the volatile oil from the turpentine of Pinns palustris, and of other species of Pinus, U. S. Enters into Ceratum Cantharidis, Ceratum Extracti Cantharidis, Ceratum Resinse, Ceratum Sabinse, Ceratum Resinse Compositum, Emplastrum Hydrargyri, and Emplastrum Resinse. Has no therapeutic interest.] [Resinse. The officinal Resins are : — Resin a Jal apse Resina Scammonii.] " Podophylli [Oleo-resinae. The officinal Oleo-resins are : — Oleo-resina Capsici Oleo-resina Lupulinoe " Cubebse - " Piperis " Filicis " Zingiberis.] RHUBARB 313 RHEUM— RHUBARB. [ The root of Rheum palmatum, and of other species of Rhetim, from China, Chinese Tartary, and Thibet, U. S. Officinal Preparations, U. S. Extractum Rhei. Dose, gr. x.-xxx. Extractum Rhei Fluidum. Dose, gtt. x.-xxv. Infusum Rhei (3iv. to Oj.). Dose, fgij.-iv. Pilulae Rhei (each, gr. iij.). Dose, 4 to 8 pills. Pilulse Rhei Compositae (Rhei gr. ij., Aloes gr Dose, 2 to 4 pills. f Rhubarb jfiv. ") Pulvis Rhei Compositus -< Magnesia ^xij (Ginger gij. Syrupus Rhei (^iss. to Oj.). Dose, f^ss.-j. Syrupus Rhei Aromaticus (3ijf to Oj.) infant, f3j. Tinctura Rhei (^iss. to Oj.). Dose, fsss.-j. Tinctura Rhei et Sennae (E}i to Oj.). Dose, f^ss.-j Vinum Rhei (^ij. to Oj.). Dose, f3j.-iv.] Constitutional Action. iss.). Dose, 3ss.-j. Dose, for Physiological. Like castor oil, rhubarb combines some astringent properties with its undoubt- ed cathartic effects ; and whilst the first [mentioned] action is no doubt due to the tannin which it contains, in- vestigators have not yet de- termined on what special ingredient its purgative pow- ers depend. When taken in consider- able doses, it not only stim- ulates the peristaltic move- ments of the small intestine, and more especially the du- odenum, but it moistens and softens the faeces, and in- creases most decidedly the secretion of bile. Therapeutical. The astringent action of rhubarb renders it most use- ful in those forms of diar- rhoea depending on the pre- sence of indigestible matters in the alimentary canal, and where removal of the excit- ing cause, followed by rest of the irritated intestine, is sufficient to effect a cure. It is a good tonic in some cases of dyspepsia, and forms a good purgative for chil- dren, more especially when combined with magnesia, as in the well-known Gregory's Powder [Pulv. rhei coinp.]. Prof. Rutherford's expe- riments on its cholagogue action would indicate its 3 J 4 ROSE. employment in jaundice and deficient secretion of bile. The chrysophanic acid, or yellow coloring matter of rhubarb, is readily absorbed, and rapidly given out by the intestines, milk, sweat, and urine, to which latter se- cretion it imparts a yellow tinge, turning red on the addi- tion of an alkali. Dose, Mode of Administration, &c. The smell and flavor of rhubarb are excessively nauseous, and, although we cannot effectually disguise either, we may at least render the drug moderately palatable by the following formulae: — fy.. Infusi rhei f §ij. ; Potassii bicarb. 5J > Tinct. cinnamomi i5'J-> Syrupi simplicis f ^Jvj. M. Dose, f5j. secunda quaque hora. In the diarrhoea of children. I£. Pulveris rhei gr. xxx. ; Sodii bicarbonatis gr. xv.-; Spiritus myristicoe TT^xxx. ; Syrupi zingiberis f5j-j Aquae menthce piperita? ad f §iss. Misce, fiat haustus nocte sumendus. Antacid and purgative. ROSA— ROSE. [Rosa Centifolia. The petals of Rosa centifolia, U. S. Rosa Gallica. The petals of Rosa Gallica, U. S. Oleum Rosse. The volatile oil obtained from the petals of Rosa centifolia, U. S. Officinal Preparations, U. S. Aqua Rosse (Rosa centifolia). As a vehicle. Confectio Rosse. As a vehicle. Infusum Rosse Compositum (containing sulphuric acid). As a vehicle. Mel Rosse. As a vehicle. Syrupus Rosse Gallicse. As a vehicle. Unguentum Aquse Rosse (cold cream). ROSEMARY — RUE. 315 Also enters into Pilulse Aloes et Mastiches, and Syrupus Sarsaparill?e Compositus.] The various preparations of roses have little therapeu- tical significance. The cabbage-rose is used in the form of rose-water as an elegant vehicle ; the red rose petals as confection constitute a convenient basis for a pill mass, whilst, combined with sulphuric acid in the acid infusion, they make an excellent gargle, either alone or with alum, whilst they may occasionally be of service in concealing the nauseous flavor of sulphate of magnesia. Hips [dog-rose, rosce canince fructus, Br.] are also slight- ly astringent. ROSMARINUS— ROSEMARY. [ The leaves of Rosmarinus officinalis, U. S. Oleum Rosmarini. Used in perfumery. Is rarely used in this country except in perfume.] Rosemary, lavender, and peppermint are agreeable car- minatives, much used in combination with other stimulant drugs. [RUBUS— BLACKBERRY. The bark of the root of Rubus Canadensis and of Rubnsvillosus, U. S. Officinal Preparations, U. S. Extractum Rubi Fluidum. Dose, fjss. Syrupus Rubi. Dose, f3j.-ij. Much prized as a tonic and astringent, and particularly adapted to the diarrhoea of relaxation. A decoction is also made in domestic practice (3j. to Oiss., boiled down to a pint), of which f^j.-ij. may be given three or four times daily.] [RUTA— RUE. The leaves of Ruta Graveolens, U. S. Oleum Rutae. Dose, gtt. iij.-vj. Rue is stimulant, and, in large doses, is an acro-narcotic poison. Moderate doses have some emmenagogue effects, and, in cases of poisoning, miscarriage generally occurs.] 3'6 CEVADILLA VERATRIA. SABADILLA— CEVADILLA. \_The seed of Veratrum Sabadilla {Retzius), U. S. Officinal Preparations. Veratria. Not used internally. Unguentum Veratriae (gr. xx. to 3j.). Antidotes. Vegetable astringent infusions, containing tannic acid, should be freely administered, the stomach washed out, followed by stimulants and an opium suppository, or ene- ma. Tincture of digitalis would seem to be a physiological antidote. Whiskey may be given hypodermically on the approach of collapse.] External Actions. Physiological. Therapeutical. The application of vera- Veratria has been used tria to the skin causes first with success as a local appli- pricking and tingling, fol- cation in cases of neuralgia lowed by redness and acute of the fifth nerve, but its irri- darting pain. To this sue- tating properties must al- ceeds numbness, due, in all ways be a barrier to its ex- probability, to some local tensive employment. [The anaesthetic influence on the officinal ointment generally extremities of the sensory requires dilution y 2 to ^. nerves. When used, care should be The slightest contact of taken not to rub the eyes veratria with the nasal rail- with the greasy fingers, as cous membrane causes vio- violent irritation may re- lent irritation and prolonged suit.] sneezing. Internal Actions. Veratria is never used internally in this country. Brain anal Nervous System. — No action on the brain. Spinal Cord. — A good deal of elaborate, but unfortu- nately conradictory, experimental evidence has been ad- duced by various observers with reference to the effects of veratria on voluntary movement. In the first place con- vulsions and even tetanic spasms may be produced by the administration of the drug, but these are speedily followed SAVINE. 317 by paralysis and complete muscular prostration ; and the balance of testimony goes to show that this is due to a pri- mary exciting and secondary paralysing action on the mus- cular structures themselves. Heart cnid Circulation. — Veratria first increases the action of the heart by stimulating its motor ganglia, but secondary slowing and depression rapidly ensue from an exciting action on the vagi. Respiration is at first quickened, but subsequently retard- ed by the lowering effect of the drug on the respiratory centre. The temperature of the body falls. Digestive and Secreting Organs. — Veratria often causes troublesome vomiting and purging. SABINA— SAVINE. [ The tops of Juniperus Sabina, U. S. Dose, in substance, gr. v.-xv. Officinal Preparations, U. S. Ceratum Sabinse (fluid extract, fjiij. ; resin cerate, gxij.). Extractum Sabinse Fluidum. Dose, gtt. v.-xv. Oleum Sabinae. Dose, gtt. ij.-v.] Local Effects. Savin used to be applied in the form of ointment to blis- tered surfaces, with the view of encouraging suppuration, but this barbarous process is now happily abandoned. [It is stimulant and rubefacient, and is sometimes applied to warts, ulcers, and diseases of the scalp.] Internal Uses. Physiological. Th erapeutical. Savin is a gastro-intestinal Savin is sometimes used irritant, causing in large with criminal intent to pro- doses vomiting and purging ; cure abortion, and death has and it has also a powerful occasionally resulted from its stimulating influence on the irritant action. It is rarely uterus. used in medicine, although some authorities express faith in its emmenagogue powers. 27* 318 SUGAR SAGO. SACCHARUM— SUGAR. \_The sugar of Saccharum offccinarum, refined, U. S. SYRUPUS FUSCUS— MOLASSES. The impitre dark-colored syrup, obtained in making sugar from Saccharum officinarum, U. S. Officinal Preparations. Sugar enters into Pilula Ferri Carbonatis, Pilulse Ferri Iodidi, and the various syrups.] Sugar is principally used in the form of syrup as a fla- voring adjunct. [Syrupi. The officinal syrups are : — Syrupus Acacias Syrupus Pruni Virginianas " Acidi Citrici " Rhei " Allii " " Aromaticus " Amygdalae " Rosoe Gallicas " Aurantii Corticis " Rubi " " Florum " Sarsaparillse Comp. " Ferri Iodidi " Scillse " Fuscus " " Compositus " Ipecacuanhas " Senegas " Krameriae " Tolutanus " Lactucarii " Zingiberis.] " Limonis SACCHARUM LACTIS— SUGAR OF MILK. \_A crystalline substance obtained from whey, U. S.~\ Milk and sugar of milk have no special therapeutical properties [apart from their nourishing qualities]. [SAGO— SAGO. The prepared fecula of the pith of Sagus Rumphii, and other species of Sagzis, U. S. Used as an article of diet for the sick, thoroughly boiled in water (tablespoonful to the pint) and flavored with sugar, lemon, spice, or wine, according to taste.] SAGE — RED SAUNDERS. 319 [SALVIA— SAGE. The leaves of Salvia officinalis, U. S. Officinal Preparation, U. S. Infusum Salvias (£ss. to Oj.). Used as a gargle. Sage is tonic, astringent, and aromatic. It has been used as a carminative in debility of the stomach with flatu- lence, and the infusion is a useful gargle, to which honey, alum, or vinegar may be added, but it strikes a black color with iron (tannic acid). A weak infusion is sometimes used as a drink in fevers to allay nausea.] SAMBUCUS— ELDER. [The flowers of Sambitcus Canadensis, U. S.~\ Only used in the form of the aquae sambuci [Br.], which is a cooling and pleasant lotion. SANGUINARIA— BLOODROOT. \_The rhizome of Sanguinaria Canadensis, U. S. Officinal Preparations, U. S. Acetum Sanguinarise (^ij. to Oj.). Dose, nrxv.-xxx. Tinctura Sanguinariee (^ij. to Oj.). Dose, gtt. xx.-xl.] This is a substance of energetic physiological properties, causing clonic convulsions of spinal origin, diminishing reflex action, weakening the force of the heart, and less- ening arterial tension, lowering the temperature, dilating the pupil, and finally causing death by respiratory para- lysis. It also possesses [violent] emetic properties, and stimulates hepatic secretion. It has been used more espe- cially in America, and has been found useful in atonic dyspepsia and duodenal jaundice, in chronic catarrh, and some stages of bronchitis, and may be given in doses of 5 to 10 minims of the tincture three times a day. [The root has been used as an escharotic in epithelial cancer.] [SANTALUM— RED SAUNDERS. The wood of Pterocarpus santalinus, U. S. Used only in pharmacy as a coloring agent, and enters into Spiritus Lavandulae Compositus.] 3 2 ° SANTONICA. SANTONICA— SANTONICA. \_The tinexpanded flowers of Artemisia Cina. (Willfcomm Botanischt Zeitung, 1872, No. 9), U. S. Officinal Preparations, U. S. Santoninum. Dose, gr. ss.-iij. Trochisci Santonini (each, gr. ss.).] Local Action. Santonin has no local action. Internal Actions. Physiological. I. Brain and Nervous Sys- tem. — It is no doubt due to some influence on the brain that the peculiar derange- ment of vision [which is sometimes found] accom- panying the use of santonin, depends ; as no staining of the ocular media has been observed, and slight hyper- semi a of the retina is the only apparent local effect. Some observers note the first stage to be an exaggerated appreciation of the violet rays of the spectrum, but the most evident alteration in sight consists in very distinct yellow vision, all white ob- jects being seen in a more or less pronounced saffron tinge, which begins about half an hour after the drug is swallowed. Associated with this we find a dimin- ished or even abolished ap- preciation of the violet rays of the spectrum. A good deal of lassitude and mental Th erapeutical. I. Santonin has been re- commended as a remedy for some affections of the optic nerve, but no trustworthy evidence has yet been ad- duced of its efficacy. Santonin has not been used in any form of nerve disease, but it seems at least possible that it might prove of service in some forms of so-called color-blindness. SANTONICA. 321 depression usually follows the use of this medicine, and it must be cautiously pushed, as large doses have occasion- ally proved fatal from teta- nic spasms and coma. II. Respiration and Circu- lation. — No special influence on these functions has been noted. [In poisoning there is accelerated and feeble pulse and rapid respiration.] III. Secreting Organs. — Slight digestive disturbance is usually experienced, indi- cated by nausea, headache, and general malaise. Urinary Organs. — Re- markable effects are here noted, consisting of a bright yellow coloration of the urine, beginning five min- utes after a few grains have been swallowed, persisting for two or three days, and communicating a stain to linen, as in the case of jaun- dice. Should the urine hap- pen to be alkaline, the color assumes a blood-red tinge, and the same change follows the addition of ammonia to the acid secretion. At the same time the flow of urine is increased, the patient ex- periences an irresistible de- sire to micturate, and in the case of children this may even give rise to complete temporary incontinence. III. The real use of san- tonin in practice consists in its effect on the round worm, or as can's lumbricoides, which it speedily destroys. It appears to have no influ- ence over the tape-worm, and it is an open question with regard to its service in cases of ascaris vermicularis. Santonin has been recom- mended as a remedy for incontinence of urine, and is said to succeed occasionally in cases of this troublesome affection after other remedies have failed. Mode of Elimination. Santonin is supposed to combine with the soda in the blood, and to be given out, in part at least, by the urine. 322 SOAP. Cautions. Mode of Administration. [Prof. Binz has related a case of santonin-poisoning in which, apparently, a small dose produced serious symp- toms. Two lozenges, containing less than a grain, were followed, 10 hours afterwards, by a convulsive attack which recurred several times during the next few days. The child never had convulsions before. It would seem as if the troches must have contained more of the drug than was suspected. 1 ] As already observed, serious symptoms have been ob- served to follow the use of santonin, and we shall do well to warn our patients of the urinary irritability which is invariably experienced in greater or less degree. Dr. Sieveking has also drawn attention to the occurrence of urticaria following the administration of santonin, and Drs. Dyce and Ogson have given a suggestive hint by pointing out that its long-continued use causes the devel- opment of cataract in young animals. [When retained in the system santonin becomes con- verted into xanthopsin, which appears in the urine. Poi- sonous symptoms are produced by this new substance, and they may be prevented by combining the santonin with a purgative, and in practice it is found that they are never produced when the santonin is combined with calomel.] Its taste is not unpleasant, but as it is insoluble in water it may be mixed with jam or treacle, or simply sprinkled on bread and butter. SAPO— SOAP. [ Soap made with soda and olive oil, U. S. Officinal Preparations, U. S. Ceratum Saponis. Emplastrum Saponis. Linimentum Saponis. Pilulse Saponis Compositae. Enters into Extractum Colocynthidis Compositum, Pilulse Aloes, Pil. Aloes et Assafcetidae, Pil. Assafcetidse, Pil. Opii, Pil. Rhei, Pil. Rhei Compositae, and Pil. Scillae Compositae.] 1 [Phil. Med. Times, Aug. 1877, p. 551.] SARSAPARILLA. 323 Soap is not applied to any therapeutical purpose, except the hard variety, which enters into the construction of some pill masses, and both the hard and soft aid in the construction of liniments and plasters. [Soft, or potassa-soap, sometimes termed green soap, sapo viridisy has been recommended by Hebra in alcoholic solution, under the name of spiritus saponatus kalinis (2 pts. soap, 1 pt. alcohol), in the treatment of chronic eczema.] SARSAPARILLA— SARSAPARILLA. [The root of Smilax officinalis [Humboldt aizd Bonplandt}, and of other species of Smilax, U. S. Officinal Preparations, U. S. Decoctum Sarsaparillse Compositum (sarsaparilla, sassafras, guaiac, mezereon, and liquorice). Dose, f^iv. Extractum Sarsaparillse Fluidum. Dose, f3ss. Extractum Sarsaparillse Compositum Fluidum. Dose, f3j. Syrupus Sarsaparillse Compositum (giv. to Oj.). Dose, foss.] Internal Actions. Physiological. Therapeutical. Sarsaparilla has been ere- Nor is it easier to give dited with diaphoretic, any decided opinion regard- diuretic, and other powers; ing its therapeutical merits; but none of these have stood for whilst some surgeons, the test of rigid investigation, like the late Mr. Syme, and it is difficult to find any hold it to be quite useless, convenient heading under others believe it to be of which to class this popular service in constitutional drug, unless we shelve the syphilis, chronic skin disease, difficulty by calling it an &c. One point of difficulty "alterative." in arriving at any decided conclusion is, that it is usually prescribed along with three other drugs in the compound decoction ; but the late Mr. Gascoyne used to say that he had found great benefit in the treatment of the tertiary 3?4 SASSAFRAS — SCAMMONY, forms of syphilis by giving full doses of the freshly made infusion. SASSAFRAS— SASSAFRAS. \_The bark of the root of Sassafras officinale, U. S. S ass af r as Medulla. The pith of th e stems of Sassafras officinale, U. S. Oleum Sassafras. Dose, gtt. ij.-x. Officinal Preparation, U. S. Mucilago Sassafras Medullae (3ij. to Oj.). As a col- lyrium. Enters into Extractnm Sarsaparilloe Compositum Flui- dum, and Decoctum Sarsaparillae Compositum.] This plant seems only to have acquired any therapeutic importance by reason of its combination with other drugs in the decoctum sarsaparilise comp. SCAMMONIUM— SCAMMONY. [A resinous exudation from the root of Convolvulus Scammonia, U. S. Dose, in substance, gr. v.-xv. Officinal Preparations, U. S. Resina Scammonii. Dose (given in milk), gr. iv.-viij. Extractum Colocynthidis Compositum. Dose, gr. v. -xxx.] Internal Effects. Physiological. Therapeutical. Scammony causes a good Scammony is a purgative deal of irritation of the ali- used in cerefiraland dropsical mentary canal, and produces affections; and, being corn- copious watery stools, often paratively tasteless, it is well attended with griping. For adapted for children, form- its proper action, previous ing a convenient purgative solution in the bile, and com- for the removal of ascarides. bination with its soda, are requisite. SQUILL. SCILLA— SQUILL. [The bulb of Scilla maritima, U. S. Dose, in substance, gr. ij. 3 2 5 Officinal Preparations, U. S. Acetum Scillse (^ij. to Oj.). Dose, nrx.-xx. Syrupus Scillse. Dose, f^ss. Pilulse Scillae Compositse (squill gr. ss., ammoniac and ginger each gr. j.). Dose, 3 to 5 pills. Syrupus Scillse Compositus (tartar emetic gr. i f5j.). Dose, gtt. x.-f5j. Tinctura Scillse (*ij. to Oj.). Dose, tr^x.-xx. Extractum Scillse Fluidum. Dose, nuj.-iij.] in Internal Effects. Physiological. In large doses, squill may- act as an emetic, and cause violent vomiting with purg- ing. It also stimulates the bron- chial mucous membrane, and increases the urinary- secretion. Therapeutical. Squill is never used as an emetic [except for children in the form of i 'Hive Syrup,' ' Syrupus Scillae Compositus, which has been recommend- ed in spasmodic croup. To be repeated at short intervals, until vomiting occurs]. It is, however, a good ex- pectorant, increasing the bronchial secretions, and is one of the most universal additions to prescriptions for the relief of various chronic lung affections, as bronchitis, and also in whooping-cough. It is also a tolerably effi- cient diuretic, only to be used, however, when no irri- tation exists about the kid- neys. 28 326 BROOM. SCOPARIUS— BROOM. \_The tops of Sarothamnus Scoparius ( Wi??wier), U. S.~\ Local Effects. No local action has been described. Constitutional Actions. Scoparius is an excellent diuretic, and is largely used for the purpose of removing dropsical accumulations. If we can succeed in stimulat- ing the kidneys effectually by a combination of this and other drugs, we may hope to hold in check and disperse the anasarca of cardiac and chronic kidney-disease, and to aid the removal of the watery fluid of hydrothorax and ascites. Scoparius has some influ- ence over the digestive and secreting organs, causing, in large doses, vomiting and purging, but in smaller in- creasing very considerably the urinary water. Two act- ive principles have been ex- tracted from the drug, re- garding whose physiological actions some difference of opinion exists. Thus scopa- rin is believed by one class of observers to be the diu- retic factor in broom-tops, whilst others assert that it has no such property. Spar- tein has also been very va- riously described, but the balance of testimony goes to show that it has very de- finite toxic powers, lowering the reflex action of the spinal cord, paralysing the motor nerves, suspending the elec- trical excitability of the va- gus, and finally causing death by respiratory paralysis. Dose and Mode of Administration. Scoparius is seldom prescribed alone, but is most usually made the basis of diuretic mixtures, on the well-known principle of combination, which is here of essential service. fy. Potassii acetatis 5J SS - > Aceti scillse * 5' v - 5 Decocti scoparii [Br.] ad f^vj. M. Fiat mistura. Capiat unciam unam quartis horis. $. SENEKA. Tincturoe digitalis l^x.; Spiritus aetheris nitrosi, Spiritus juniperi Succi scoparii [Br.] Aquae Ter die sumend. aa f 5 SS - 5 f5j.;. ad f^j. 3 2 7 M. SENEGA— SENEKA. [ The root of Polygala Senega, U. S. Dose, in substance, gr. xx. Officinal Preparations, U. S. Decoctum Senegae (3j. to Oj.). Dose, f^j. Extractum Senegse (alcoholic). Dose, gr. j.-iij. Extractum Senegae Fluidum. Dose, tttx.-xxx. Syrupus Senegae. Dose, f 3j. Syrupus Scillae Compositus.] Local Effects. No external or local action has been described. Constitutional Actions. Physiological. Therapeutical. The principal action of Senega is of great service senega is that of stimulating in the more chronic condi- the mucous membrane of the tions of pneumonia and bronchial tubes, and possi- bronchitis, where it seems bly, by a tonic influence on to help the patient to get their muscular tissues, facili- rid of the large quantities of tating the expulsion of their secretion frequently accu- contents. It has also been mulated within the lungs, accredited with diaphoretic, Theoretically at least, its diuretic, and emmenagogue stimulating properties would properties, but is seldom contra-indicate its use in the employed in any other more acute pulmonary affec- capacity than as an expec- tions, but in the later stages torant. of bronchitis, and more especially those cases occur- ring among the very old and young, it is of real value. Dose and Mode of Administration. The infusion is the preparation most commonly em- 3 2 $ SENNA. ployed, and it is generally combined with carbonate of ammonia and other expectorants. Thus : R. Ammonii carbonatis gr. iv. ; Tincturse scillse TT^xv. ; Tinct. camphorse comp. [Br.] T»|xxv. ; Extracti glycyrrhizge gr. v. ; Infusi senegas [Br.] ad f §j. M. Fiat haustus ter die sumendus. SENNA— SENNA. [The leaflets of Cassia acutifolia (D elite), of Cassia abovata (Be Can- dolle), and of Cassia elongata (Lemaire, Journ. de P/iarm.. vii., 345), U. S. Officinal Preparations, U. S. Confectio Sennse. Dose, 3j.-ij. Extractum Sennse Fluidum. Dose, f 5j.-iv. Infusum Sennse (gj. to Oj.). Dose, fgij.-iv. Tinctura Rhei et Sennse. Dose, fgss.-ij. And enters into Syrupus Sarsaparillae Comp.] Internal Effects. Physiological. Therapeutical. Senna irritates the small Senna is a most useful intestine, causing copious, purgative, ranking among thin, yellow evacuations, and the cathartics with slightly stimulating the peristaltic drastic tendencies, and it movements of the bowel. may be prescribed in simple constipation, in dyspepsia, and in a large variety of condi- tions where rapid and effec- tual unloading of the bowels is required. Dose and Mode of Administration. Senna is seldom prescribed alone, as it is then apt to cause irregular contraction of the intestines and griping. It is therefore usually combined either with other purga- tives, as mag. sulph. [black draught], or with various aromatics, as in the confection and compound mixture. Cassia and tamarinds have both a slightly purgative action, but are only used as ingredients in various com- pound preparations, as the confection of senna. SNAKEROOT — MUSTARD. 329 SERPENTARIA— VIRGINIA SNAKEROOT. [ The root of Aristolochia Serpentaria , of Aristolochia reticulata, and of other species of Aristolochia, U. S. Officinal Preparations, U. S. Extractum Serpentarise Fluidum. Dose, gtt. xx. Infusum Serpentariae (Jss. to Oj.). Dose, f,5j.-iv. Tinctura Serpentarise (§ij. to Oj.). Dose, f3j--ij-] This drug is probably a gentle tonic, but the other virtues with which it has been credited seem to rest on no very stable foundation. [It belongs to the class of the aromatic bitters, and is a good addition to other tonics, as in the popular Huxham's tincture — Tinctura Cinchonoe Comp.] [SEVUM— SUET. The prepared suet of Ovis Aries, U. S. Used only in pharmacy, and as an ingredient in Cera- tum Resinse Compositum, Unguentum Hydrargyri, and Ung. Picis Liquidse.] SINAPIS— MUSTARD. [Sinapis Alba. The seed of Sinapis alba, U. S. Sinapis Nigra. The seed of Sinapis nigra, U. S. Officinal Preparation, U. S. Charta Sinapis. Mustard papers, 4 inches square.] Local Actions. Physiological. Th ei'apeutical. Mustard applied to the Mustard is used, firstly, for skin causes a vivid redness, the relief of pain, and there with violent smarting and can be no doubt of the bene- itching, and, if the applica- fit thus derived in manyner- tion be continued too long, vous, rheumatic, and in- vesication may follow, and flammatory affections. In even troublesome ulcera- neuralgia, lumbago, sciatica, tion. pleurodynia, pleurisy, pneu- monia, peritonitis, colic, and a vast variety of painful 28* 330 MUSTARD. disorders, we may expect to alleviate suffering in some measure by the use of sina- pisms, and at other times we use this mode of drawing blood to the surface, and so relieving the congestion of deeper parts, on the principle referred to under the head- ing of "Counter-irritation." Mustard poultices are most valuable in arousing patients from the dangerous coma- tose condition into which they occasionally drift in the course of some of the acute inflammations; and sinapisms applied to the feet and calves are of service in the stupor of narcotic poison- ing and in urcemic coma. Mustard baths may be employed to bring back the eruption of some abortive cases of the exanthemata, or as a stimulant in acute bronchitis or in the convul- sions of children. Constitutional Actions. Physiological. Therapeutical. Digestive Organs. — Mus- Mustard is extensively tard increases the appetite used as a dietetic condiment, by irritating the mucous membrane of the stomach, but does not increase the secretion of gastric juice. It acts as a prompt and This emetic power is of effectual emetic of the direct great value in cases of poison- class, ing, as mustard is always at hand, and can be used at once. SODIUM. 33I Mode of Administration. A mustard poultice must be made with cold water, for we know that hot water dissipates the volatile oil on which the counter-irritation depends, vinegar destroys it, and alcohol prevents its formation. It must be kept on from twenty minutes to half an hour, according to circumstances. SODIUM— SODIUM. [Sodii Acetas. Acetate of Sodium. Dose, gr. xx.-3ij. Sodii Bicarbonas Venalis. (In making Aqua Acidi Carbonici, and Sodii Bicarbonas.) Sodii Boras (Borax). Dose, gr. x.-xl. Mel Sodii Boratis (3j. to fgj.). Glyceritum Sodii Boratis (J5ij. to f^j.)- Sodii Carbonas. (In making Aluminii Sulphas, Anti- monii Oxysulphuretum, Bismuthi Subnitras, Cadmii Sul- phas, Bismuthi Subcarbonas, Calcii Carbonas Prsecipitata, Ferri Subcarbonas, Liquor Sodse, Liquor Sodas Chlorinatae, Pilula Ferri Carbonatis, Pilulse Ferri Composite, Potassii et Sodii Tartras, Sodii Carbonas Exsiccata, Sodii Phosphis, and Zinci Carbonas Praecipitata.) Sodii Chloridum (table-salt). (In making Calomel and Corrosive Sublimate.) Sodii Hypophosphis. Dose, gr. x.-xxx. Sodii Hyposulphis. Dose, gr. x.-xx. Sodii Nitras. (In making Sodii Arsenias.) Sodii Sulphas (Glauber's Salt). Dose, .fss.-j. (In making Sodii Carbonas.) Sodii Sulphis. Dose, 3j- Officinal Preparations, U. S. Soda. Caustic Soda. Liquor Sodse. Dose, well diluted, n^v.-x. Sodii Arsenias. Dose, gr. y^—J. Liquor Sodii Arseniatis. Dose, nyij.-v. Sodii Bicarbonas. Dose, gr. x.-xx. Pulveres Effervescentes. Soda powders. Pulveres Effervescentes Aperientes. Seidlitz powders. Trochisci Sodii Bicarbonatis. S3 2 SODIUM. Sodii Carbonas Exsiccata. (Used in making Sodii Arsenias.) Sodii Phosphas. Dose, as a cholagogue, gr. xx.-xl. ; as a purgative, oj--ij- (Used in making Ferri Phosphas and Ferri Pyrophosphas.) Liquor Sodae Chlorinatae (Labarraque's Solution). Dose, f 3ss.— ij. , well diluted.] Effects and Uses. The soda salts have none of the depressing action on the heart which we have seen to be possessed by potash. Locally, we may use soda in acute eczema; or the hypo- sulphite in parasitic skin-disease, where it acts in virtue of the contained sulphurous acid; and the biborate, or borax. as a gargle, as a lotion in pruritus and various skin diseases, and as an application to ulcerations about the mouth. Soda is not so much used internally as a remedy for gout and rheumatism, because the urate of soda is less solu- ble than the urate of potash ; but it is one of our best reme- dies in those forms of dyspepsia with pain after food, weight at the stomach, red fissured tongue, cough, and palpita- tion. The hyposulphite is useful in sarcinous vomiting. Chloride of sodium is a good emetic ; the phosphate and tartrate are purgative, and none of the preparations appear to be decidedly diuretic in their action. Seidlitz Powder. [Pulvis Effervescens Aperiens,U. S.] R. Sodae tart. [Br.] [Potassii et Sodii tart.] gij. ; Sodae bicarbonatis gr. xl. Misce, ut fiat haustus effervescens cum Acidi tartarici gr. xxxv. et aquae f §iv. Statim sumendus. IJ. Sodii bicarbonatis gr. xx. ; Tinct. calumbae rr^xx; Syrupi zingiberis f.^ss. ; Infusi gentianae compositi ad f ^j. Misce, ter die sumend. Useful draught in dyspepsia. [The following is a pleasant antacid combination, known as — MARSH-ROSEMARY. 333 Scda-Mint. R. Sodii bicarbonatis, Sacchari aa 5'j '■> Spiritus ammonii aromatic! H|xl. ; Aquae menthse piperitse q. s. ad f §viij. M. S. Dose, a tablespoonful after meals. Used in flatulent dyspepsia. It admits the addition of tr. nux vomica or syrup of rhubarb.] [SPIGELIA— PINKROOT. The root of Spigelia Marylandica, U. S. Dose, in substance, 3j- Officinal Preparations, U. S. Extractum Spigelise Fluidum. Dose, fjj.-ij. Extractum Spigeliae et Sennse Fluidum. Dose, f3ij.-iv. Infusum Spigeliae (£ss. to Oj.). Dose, f^iv.-viij. ; for a child, f 5ij--f 3J« Spigelia is an efficient remedy against the round worms, or lumbricoids, and, in moderate doses, is entirely safe ; but in overdoses has narcotic properties. It is given in infu- sion or syrup, morning and evening, for two or three days, followed by a brisk cathartic] [SPIRITUS FRUMENTI— WHISKEY. Spirit obtained from fer7nented grain by distillation, and containing from 48 to 56 per cent, by volume, of absolute alcohol, U. S. SPIRITUS MYRCIiE— BAY-RUM. The spirit obtained by distilling ru?n with the leaves of Myrcia acris, {Schwartz), U. S. SPIRITUS VINI GALLIC!— BRANDY. The spirit obtained from fermented grapes by distillation, and contain- ing from 48 to 56 per cent, by volume, of absolute alcohol, U. S. For effects and uses, see Alcohol.] [STATICE— MARSH-ROSEMARY. The root of Statice Limonium, variety Caroliniana, U. S. Statice is a powerful, indigenous astringent, and may be 334 STRAMONIUM. used as a substitute for kino and catechu. It has been quite popular as an application to ulceration of the throat. In scarlatina, it is used both as an internal and local remedy. The infusion or decoction is generally employed.] [STILLINGIA— STILLINGIA (QUEEN'S-ROOT). The root of Stillingia sylvatica, U. S. Dose, in substance, gr. xx. Officinal Preparation, U.- S. Extractum Stillingiae Fluidum. Dose, nrxx.-xl. Stillingia is highly esteemed as an alterative in secondary syphilis, skin-diseases, and scrofula. In large doses it is emetic and cathartic. As an alterative, it is frequently given in combination with sarsaparilla. A decoction (^j. to Oiij. boiled to Oj.), dose, f^j.-ij.; and a tincture (,$ij. to Oj.), dose f5j-> are largely used in the South, but are not officinal.] STRAMONIUM— STRAMONIUM. [Stramonii Folium. The leaves of Datura stramo- nium, U. S. Stramonii Semen. The seed of Datura stramonium, U. S. Officinal Preparations, U. S. Extractum Stramonii Foliorum. Dose, gr. ^~^- Extractum Stramonii Seminis. Dose, gr, %- T /2- Tinctura Stramonii (seeds ^ij. to Oj.). Dose, nrx.-xx. Unguentum Stramonii (extract 3j- to ^j.). Antidotes. Same as for belladonna-poisoning.] * After the careful description already given of the actions and uses of belladonna, it is unnecessary to say much about stramonium. Modern investigation has shown that the active principle, datura, is identical with atropia ; and the only marked difference between the two plants seems to consist in the more decided antispasmodic properties of STORAX — SULPHUR. 335 stramonium, which cause it to be much prized as a remedy for asthma. In the purely spasmodic varieties of that disease, and most efficiently when inhaled in the form of smoke, it seldom fails to give relief. [STYRAX— STORAX. A balsam prepared from the bark of Liquidambar orientate {Lamarck), U. S. Storax has been recommended as a substitute for copaiba in the treatment of gonorrhoea and gleet; and mixed with olive oil, equal parts, is effectual in the treatment of scabies. It is ranked as a stimulating expectorant, but is chiefly used as an ingredient in the compound tincture of benzoin.] SULPHUR— SULPHUR. [Sulphur Lotum. Sublimed sulphur, thoroughly washed with water, U. S. Sulphur Sublimatum. Sublimed sulphur, U. S. Officinal Preparations, U. S. Sulphur Praecipitatum. Dose, 5j--iij- Sulphuris Iodidum. Not used internally. Unguentum Sulphuris (i part sulphur, 2 parts lard). Unguentum Sulphuris Iodidi (gr. xxx. to ^j.). Sublimed sulphur is used in making Emplastrum Ammo- niaci cum Hydrargyro, Hydrargyri Sulphuretum Rubrum, Potassii Sulphuretum, Sulphur Praecipitatum, and Sulphuris Iodidum.] External Use. Sulphur is used externally as a stimulant in various forms of chronic skin-disease, such as acne faciei, and more especially in itch, a disease dependent on the pre- sence of a minute insect, the acarus scabiei, the male of which ranges freely over the skin, whilst the female re- tires with her eggs to oblique burrows in the cuticle. These receptacles having been broken up by soap and water, sulphur ointment is carefully spread over all the patient's body at bed-time, and washed away by a warm bath next morning. Two or three applications of this sort 33 6 SULPHUR are sufficient to cure the disease, and if the patient's skin will bear the unguentum sulphuris, one smearing with this may be sufficient. The rationale of the treatment is, not that sulphur acts as a direct poison to the acarus, but that it forms with lard a very tenacious and adhesive substance which suffocates the insect by blocking up its air-pores. [The sulphur ointment should generally be diluted j^J to y^, as it is apt to produce too great irritation.] Sulphur is also in great favor as a popular remedy for rheumatism, sprinkled on new flannel and applied to the painful part, and there is no doubt that some beneficial action may thus be caused. Lastly, sulphur makes a use- ful bath in some forms of chronic skin disease. Internal Use. Physiological Action. i. It has been supposed to exert a stimulating influ- ence on the mucous mem- branes and skin. 2. It causes slight increase of the peristaltic movements of the bowels. Therapeutical Action. i. In virtue of this, it used to be occasionally pre- scribed in chronic bronchitis and phthisis, and also used externally in skin-diseases. To its action on the skin may be attributed its un- doubted power of aiding, — more especially in the form of bath, — the elimina- tion of lead and mercury from the system. Sulphur has lately been recom- mended as the best means of preventing mercurial sali- vation. 2. It acts, therefore, as a gentle laxative, slightly softening the faeces, and from the mildness of its action it is specially useful in piles and all irritable conditions about the rectum. Its purgative action is in- creased by its being dissolved and formed into a sulphide by the alkali of the bile. SULPHUROUS ACID. 337 3. Sulphur has well- 3. Burnt in a room with marked antiseptic properties closed doors and windows, in consequence of its de- it is the best way to remove structive power over the the germs of infection from lower forms of vegetable the air by fumigation, life. Sulphur is given off from the system principally by the bowels, ^.but also by the milk, the sweat, and the skin, in the form of sulphuretted hydrogen, and by the urine as a sulphate. Strong applications of sulphur frequently irritate the skin, and bring on troublesome eczema. The disadvan- tage of sulphur as an aperient is the offensive odor which the sulphuretted hydrogen communicates to the faeces. The confection [Br.] is the best purgative form [con- taining sulphur ifiv., and cream of tartar ^j., in syrup of orange-peel f^iv.], in tea- or tablespoonful doses, and for external use the ointment is generally prescribed. ACIDUM SULPHUROSUM— SULPHUROUS ACID. [An aqueous solution of 'sulphurous acid gas, having the odor of burn- ing sulphur, and a sulphurous, sour, a?zd somewhat astringent taste. Its specific gravity is about 1.035.] Dose, f3ss. ad fjj. [Largely diluted with water.] External Use. The therapeutic properties of this acid depend in part on its very poisonous influence on the lowest forms of ani- mal and vegetable life. Thus it forms a good application to those varieties of skin disease, as tinea tonsurans, chlo- asma, &c, which depend on the presence of a minute cryptogamic plant ; and Dr. Dewar some years ago pub- lished a pamphlet in which he ascribed to this acid powers little short of marvellous. Going on the theory that a very great number of diseased conditions depend on the irrita- tion of germs, Dr. Dewar most confidently advised its use in affections ranging from rheumatic fever to chilblains. Although experience has naturally not borne out his ex- travagant assertions, we have to thank him for making known to us the undoubtedly good effect of sulphurous acid in various forms of sore throat, used in considerable dilution either as spray or gargle. It is also a good dis- 29 338 SULPHURIC ACID. infectant, as we know that the antiseptic properties of sul- phur, when burnt for purifying purposes, depend on its formation. Internal Use. Sulphurous acid has been recommended by Dr. Lawson in pyrosis, the dyspeptic symptoms attending which are due to various forms of leptothrix and' vegetable growths burrowing in the mucous membrane of the stomach ; and in flatulence it is also deserving of a trial. ACIDUM SULPHURICUM— SULPHURIC ACID. \_Salphuric acid of the specific gravity 1.843, ^ S. Officinal Preparations, U. S. Acidum Sulphuricum Aromaticum. Dose, n^v.-xx. Acidum Sulphuricum Dilutum (foij. to Oj.) Dose, n^v.-xx. Also enters into the manufacture of Acidum Sulphuro- sum, Aluminii Sulphas, Atropiae Sulphas, Cadrnii Sulphas, Ferri Sulphas, Hydrargyri Sulphas Flava, Liquor Ferri Subsulphatis, Liquor Ferri Tersulphatis, Oleum ^Ethereum, Quinise Sulphas, Acidum Hydrocyanicum Dilutum, ^Ether, Argenti Cyanidum, Chloroformum Purificatum, Hydrar- gyri Chloridum Corrosivum, Hydrargyri Chloridum Mite, Hydrargyri Cyanidum, Pyroxylon, Sodii Phosphas, Spiri- tus iEtheris Nitrosi, and Veratria. Antidotes. Alkalies, which should be given in milk or soapsuds, though much water would be improper. Care should be taken not to rupture the stomach by the tube of the stomach- pump or by inducing severe efforts at vomiting. The acid, when concentrated, discolors the mouth and lips, making a black slough. When administered medicinally it should be taken much diluted through a glass tube, in order to protect the teeth.] External Use. Strong sulphuric acid is the most powerful caustic of this group, rapidly charring and desiccating the tissues, from its great affinity for water. M. Velpeau, of Paris, strongly recommended its use in cancer, the acid being made into SULPHURIC ACID — JUICES. 339 a paste with saffron, and applied to the morbid growth, it being found, after detachment of the sloughs, that a clean ulcerating surface remained ; and Professor Syme pro- posed a modification of this plan, on the score of economy, by using sawdust instead of saffron. Ricord, of Paris, also advises the application of sulphuric acid in combination with charcoal to [primary] syphilitic ulcers, holding that, if this process is effectually carried out before the fourth day, we may hope to avert the evil consequences of con- stitutional infection. Mr. Pollock has advised the local use of strong sulphuric acid in caries and necrosis and suppurating synovial mem- brane of joints, either applied on a glass rod, or injected, or brought in contact on lint with the diseased surfaces, in the proportion of one part of acid to two, three, or six parts of water ; and this plan of treatment has been used with good success in St. George's Hospital {vide "Lancet," May 28, 1870, and "Medical Times and Gazette," De- cember 11, 1875). Internal Use. Diluted sulphuric acid is a good astringent, and as such is extensively used [in night sweats and] in diarrhoea, more especially that which is so common in summer. It has also been advised, in the form of lemonade, as a prophy- lactic against painters'' colic, and there is no doubt that it heightens materially the action of purgative salts, probably by increasing their solubility. Ijt,. Magnesii sulphatis §ij. ; Ferri sulphatis gr. xxiv. ; Acidi sulphurici diluti f t ~ij ; Infusum calumbae ad ffviij. Misce, fiat mistura. Capiat cochlearia duo magna omni mane. R. Acidi sulphurici diluti f5'j ss - > Tincturse opii f 5l- ; Syrupi aurantii f§j. ; Aquse ad ffviij. M. S. Capiat unciam unam ter in die post singulas sedes liquidas. [Succi. The class of officinal Juices, U. S. P., consists of Succus Conii and Succus Taraxaci.] 34° TOBACCO. TABACUM— TOBACCO. [The commercial dried leaves of Nicotiana Tabaciim, U. S. Officinal Preparations, U. S. Infusum Tabaci (3j. to Oj.). Dose, f3ij.-iv. Oleum Tabaci. Not used internally. Unguentum Tabaci. (Watery extract of leaves ,^j. to Sjxvj. of lard.) Vinum Tabaci. Dose, gtt. xx. Antidotes. Strychnia and diffusible stimulants may be regarded as physiological antidotes to tobacco ; and, after thoroughly washing out the stomach, tincture of digitalis may be ex- hibited to counteract the depressing influence of the poison on the heart, and the tendency to collapse. Respiration should be stimulated by ammonia, frictions, and even maintained artificially. Sulphate of strychnia may be given hypodermically, and stimulating enemata injected.] Effects and Uses. Tobacco is now rarely, if ever, used in medicine, on account of its poisonous properties ; but it is a substance in such general domestic use, and therefore of so great physiological interest, that we must devote some little space to considering the results of modern experiment on its action. Local Action. Physiological. Therapeutical. Tobacco is readily ab- Tobacco has been used as sorbed by the skin, and a local application in prurigo symptoms of poisoning have and other skin diseases, but followed the application of is too readily absorbed to strong infusions to the un- deserve recommendation for 'to broken cuticle. this purpose. Internal Action. i . Brain and Nervous Sys- i . Before the introduction tem. — The brain seems to be of chloroform, advantage little affected, but some ex- was taken of the depressing citement of the spine is an and relaxing influence of TOBACCO. 341 early symptom of the poi- sonous action of the drug, speedily followed, however, by muscular relaxation and paralysis, also of spinal ori- gin. The sensory nerves are not affected, but we find lowering of the functional activity of the motor nerves. The pupil is contracted. 2. Circulation and Respi- ration. — It is not necessary for us to go into the elaborate and contradictory series of experiments made to prove the fact that tobacco is a powerful depressant of the heart's action. The temper- ature usually falls in tobacco- poisoning, and death ensues from respiratory paralysis. [Excessive use of tobacco produces functional disor- der of the heart, which may result in hypertrophy, dila- tation, and organic disease.] 29 tobacco on the muscular sys- tem to employ the enema in strangulated hernia and dis- locations. Any occasional success, however, was amply counterbalanced by the in- conveniences and even dan- gers which too often result- ed; and this application of the drug has now fallen into well-merited oblivion. In consequence of its low- ering action on the reflex function of the spinal cord, it has been proposed as a remedy for tetanus and an antidote for strychnia, and the alkaloid nicotia will be found most convenient for these purposes. The use of tobacco is be- lieved to have some injurious effect on vision ; and Hutch- inson and others have re- corded instances of atrophy of the optic nerve and total blindness thus produced. 2. Tobacco-smoking has been known to give relief in asthma and chronic bron- chitis. 342 TAMARIND — DANDELION 3. Digestive and Secreting Organs. — Tobacco usually causes nausea and vomiting, as most smokers can testify ; but toleration is soon estab- lished, and even considera- ble doses then fail to disturb the equanimity of the diges- tive organs, save a slightly purgative action on the bow- els. It is stated, however, that in habitual smokers some symptoms of dyspepsia may be detected, indicated by furred tongue and loss of appetite ; and there is also some generally-diffused, gra- nular irritation about the pharynx. [TAMARINDUS— TAMARIND. The preserved fruit of Tamarindus Jndica, U. S. Tamarinds are laxative, and are used in making a re- frigerant drink for the sick. They enter into the Confectio Sennse.] [TAPIOCA— TAPIOCA. The fe cut a of the root of Janipha Manihot (Bot. Mag. 3071), U. S. Tapioca, the starch of the Cassava plant, is used like arrowroot as an article of diet.] TARAXACUM— DANDELION. [ The root, gathered in the autiwin, of Taraxacum Dens-leonis (De Candolle), U. S. Officinal Preparations, U. S. Extractum Taraxaci. Dose, gr. xx.-xxx. Extractum Taraxaci Fluidum. Dose, f5j--ij- Infusum Taraxaci (gij. to Oj.). Dose, f^iv. Succus Taraxaci. Dose, f3ij.— iv.] Taraxacum is usually prescribed as a matter of routine TURPENTINE. 343 in sluggish liver and the various forms of dyspepsia depend- ing on a supposed deficiency of bile ; but although it may have some mild tonic, [diuretic, and aperient] properties, there is not the slightest evidence for asserting that it ex- erts any real influence over the hepatic functions. U. Succi taraxaci f5J-> Acidi nitro-muritici dil. U1_x. ; Tincturse lupulinse TT^xx. ; Aquae ad f§j. M. S. Ter die sumend. TEREBINTHINA— TURPENTINE. [The concrete oleo-resin obtained from Pinus pahisiris, and from other species of Pinus, U. S. TEREBINTHINA CANADENSIS— CANADA TURPENTINE. The liquid oleo-resin obtained from Abies balsamea (Lindley, Flor. Med.), U. S. Enters into Ceratum Resinse Compositum, Emplastrum Galbani Compositum (of Turpentine), and Charta Can- tharidis and Collodium Flexile (of Canada Turpentine). OLEUM TEREBINTHINA— OIL OF TURPENTINE. The volatile oil distilled from the turpentine of Pinus palustris and of other species of Pinus, U. S. Dose of oil of turpentine rtvx.-xx., given 3 or 4 times daily, in typhoid fever or chronic dysentery, or f3j. to f^ss. as a vermifuge. Officinal Preparation, U. S. Linimentum Terebinthinae. And enters into Linimentum Cantharidis.] Local Action. Physiological. Therapeutical. Turpentine, when applied This effect of turpentine to the skin, causes redness, causes it to be much used as tingling, and irritation, lead- a counter-irritant in those ing on to acute inflammation cases where we wish to re- and blistering, if not removed lieve congestion of internal within a limited period. organs by driving the blood 344 TURPENTINE to the surface. Thus, in peritonitis, pneumonia, bron- chitis, and asth7?ia, it is fre- quently employed, either sprinkled on hot flannel, or in the form of thelinimentum terebinthinae of the Pharma- copoeia. Constitutional Actions. Physiological. i. On the Brain. — Tur- pentine produces, in large doses, giddiness, and other symptoms somewhat resem- bling alcoholic intoxication, and even ending in coma in rare instances. 2. Circulation. — Turpen- tine acts at first as a stimulant to the heart, and has undoubt- ed astringent properties, partly, no doubt, from its coagulating influence on the albumen of the tissues, but also by causing contraction of the smaller vessels. 3 . Digestive and Secreting Organs. — Turpentine is dis- tinctly irritating to the ali- mentary canal, frequently causing vomiting and diar- rhoea, and it has the property of checking mucous secre- tions from the various ca- nals. It is also a very certain diuretic of the stimulating class, but must be used with Therapeutical. 2. As an astringent, tur- pentine is valuable in various forms of haemorrhage, but more especially in that from the kidney and in purpura hemorrhagica [but is now rarely used as a haemostatic, oil of erigeron Canadense, ergot, and the mineral as- tringents, being more reli- able, and less irritating]. 3. Turpentine is a valua- ble astringent in some forms of diarrhoea, and more espe- cially that which results from the later and ulcerative stage of enteric \_typhoid~\ fever. It is highly recommended in the same disease by some authorities when abdominal pain and distension coincide with a raw, clean, dry tongue, and in ordinary tympanites TURPENTINE. 345 caution, as it is apt to cause frequent and painful mictu- rition with bloody urine, and eventual suppression of the secretion, [strangury,] and acute inflammation of the kidneys. it makes a good addition to a purgative enema. It has been recommended by Dr. King Chambers as an enema in sciatica, where it is supposed to act locally on the affected nerve, which, at one part of its course, lies directly in contact with the large intes- tine, and it has long enjoyed a well-deserved reputation as an anthelmintic in cases of tape-worm. Turpentine has also been given in small doses to check the excessive secretion in some forms of bronchitis, and it may also be of service in chronic cystitis, gleet, and pyelitis. It has also been used in iritis with alleged success, though it is difficult to see on what principle. Mode of Elimination. Turpentine is rapidly absorbed into the blood, and as quickly passes out, principally by the lungs and kidneys, imparting to the urine a peculiar violet odor. [Old oil of turpentine is considered an efficient antidote against phosphorus-poisoning.] Dose and Mode of Administration. Be. Olei terebinthinae f^j. ; Mucilaginis f ^v. ; Mistura amygdalae, Aquae laurocerasi [Br.] aa f^ss. M. S. f 3j • P r o dosi quartis horis. A few drops may be given on a lump of sugar, in hae- morrhage. As an anthelmintic, half an ounce may be prescribed [combined with an ounce of castor oil, and is very effective against round worms as well as tamice]. ;46 OYSTER- SHELL — TINCTURES. [TESTA— OYSTER-SHELL. The shell of Ostrea ediilis, U. S. Officinal Preparation, U. S. Testa Prseparata. Dose, gr. x.-xl. Calcined oyster-shell, consisting of 98 percent, of carbo- nate of calcium, is used in impalpable powder as an antacid in dyspepsia. Castillon's powders consisted of sago, salep, tragacanth, each in powder, aa 3j«» prepared oyster- shell 3j., and some cochineal as a coloring ingredient. A decoction of this powder in milk (5j. to Oij.) may be used freely as an article of diet in bowel-affections. ~\ [Tinctura. The officinal Tinctures are: — Tinctura Aconiti Radicis Tinctura " Aloes «« " et Myrrhae " Arnicse " Assafcetidae ' ' Aurantii " Belladonnae " Benzoini " " Composita '* Calumbae '.' Cannabis " Cantharidis " Capsici " Cardamomi " " Composita " Castorei " Catechu " Cinch on ae " " Composita " Cinnamomi " Colchici " Conii " Cubebse " Digitalis " Ferri Chloridi " Gallae " Gentianae Composita " Guaiaci " " Ammoniata Hellebori Humuli Hyoscyami Iodinii " Composita Jalapae Kino Krameriae Lobeliae Lupulinae Myrrhae Nucis Vomicae Opii " Acetata " Camphorata " Deodorata Quassiae Rhei " et Sennae Sanguinariae Scillae Serpentariae Stramonii Tolutana Valerianae " Ammoniata Veratri Viridis Zingiberis.J TRAGACANTH BEARBERRY. 347 TRAGACANTHA— TRAGACANTH. \A gummy exudation from Astragalus vertis ( Olivier}, and fr w om other species of Astragalus, U. S. Officinal Preparations, U. S. Mucilago Tragacanthse, as a vehicle. Trochisci Acidi Tannici, Trochisci Ipecacuanhas, Tro- chisci Potassii Chloratis, Trochisci Santonini, and Trochisci Zingiberis.] Tragacanth is of service as a vehicle for the suspension and division of various powdered drugs. [Trochisci. The officinal Lozenges are: — Trochisci Acidi Tannici Trochisci Menthae Piperitas " Cretas " Morph. et Ipecacuanhas " Cubebse " Potassii Chloratis " Ferri Subcarbonatis " Santonini " Glycyrrhizae et Opii " Sodii Bicarbonatis " Ipecacuanhas " Zingiberis.] " Magnesias ULMUS— SLIPPERY-ELM. \_The inner bark of Ulmus fulva {Michaux), U. S. Officinal Preparation, U. S. Mucilago Ulmi.] Elm bark is probably tonic and astringent, but is rarely if ever used [except as an emollient application in external inflammations, such as erysipelas]. [UVA PASSA— RAISINS. The dried fruit of Vitis Vinifera, U. S. Raisins are laxative, and are used as a flavoring to demulcent beverages. They enter into the tincture of rhubarb and senna.] UVA URSI— BEARBERRY. [ The leaves of Arctostaphylos Uva Ursi (Sprengel, Syst., II. 287), U. S. Officinal Preparations, U. S. Decoctum Uvse Ursi (Jj. to Oj.). Dose, f,liv. Extractum Uvse Ursi Fluidum. Dose, f5j.] 348 VALERIAN. Uva ursi is astringent and possibly diuretic. [It is also tonic and antilithic, and is believed to favor uterine contraction.] The astringency of this drug being principally di- rected to the genito-urinary mucous membrane, it is held by surgeons to be of some service in various chronic affections of these parts. VALERIANA— VALERIAN. [ The root of Valeriana officinalis, U. S. Officinal Preparations, U. S. Extractum Valerianae. Dose, gr. x.-xxx. Extractum Valerianae Fluidum. Dose, f3j. Infusum Valerianae (f^ss. to Oj.). Dose, f Jij.-iv. Oleum Valerianae. Dose, gtt. iv.-v. Tinctura Valerianae (£ij. to Oj.). Dose, f 3 j . — Ij . Tinctura Valerianae Ammoniata (gij. to Oj.). Dose, f 5j--ij-] Effects and Uses. Various elaborate investi- gations have been made in Germany on the physiologi- cal actions of valerian, but they have not much bearing on its practical application, and the drug itself is hardly of sufficient importance to justify us in devoting much time to its consideration. We may therefore say, generally, that acceleration of the action of the heart, mental hallucinations, gid- diness, and some digestive derangement are among the principal of the symptoms described most fully by Phillips. The more important therapeutic applications of valerian have not stood the test of time and experience, and its use is now practi- cally restricted to hysteria and the various nervous conditions depending there- on. [In nervous headache, the ammoniated tincture is a reliable resource in doses of f5ij. The oil is the active prin- ciple.] WHITE HELLEBORE. 349 [ACIDUM VALERIANICUM— VALERIANIC ACID. A colorless liquid, of an oily consistence, a penetrating disagreeable odor, and caustic taste. Its specific gravity is 0.935. ^* •$. Officinal Preparations, U. S. Ammonii Valerianas. Dose, gr. ij.-v. Quiniae Valerianas. Dose, gr. j.-iij. Zinci Valerianas. Dose, gr. j.-ij. Properties. Valerianic acid is an example of an organic acid made by synthesis, through the oxidation of amylic alcohol (fusel oil) by chromic acid. The valerianate of the oxide of amyl makes an artificial fruit-essence, when largely diluted. Valerianic acid resembles valerian in its effects, and, in the form of the valerianates, may be used in nervous head- ache, neuralgia, and hysteria. The salts are best given dissolved in simple elixir or in pill.] [VANILLA— VANILLA . The prepared unripe fruit of Vanilla aromatica, U. S. Used as a flavoring ingredient in Trochisci Ferri Sub- carbonatis, and Trochisci Potassii Chloratis.] VERATRUM ALBUM— WHITE HELLEBORE. [ The rhizome of Veratrum album, U. S.J White hellebore possesses some of the physiological pro- perties of veratrum viride, but much of its energy is ex- pended on the alimentary canal, and violent vomiting and purging often follow its use. It is, therefore, now quite discarded from medical practice. When applied to the nostrils, it causes intense sneezing. Two alkaloids [in addition to veratria] have been dis- covered in the root-stalk, one of which has been called jervia, and the other veratralbia. [For Veratria see Sabadilla.] 3° 35o AMERICAN HELLEBORE. VERATRUM VIRIDE— AMERICAN HELLEBORE. [ The rhizome of Veratrum viride, U. S. Officinal Preparations, U. S. Extractum VeratriViridisFluidum. Dose, gtt. j.-iij. Tinctura Veratri Viridis (oviij. to Oj.). Dose, gtt. iij.-vj. (Dr. Norwood's tincture is of the same strength as the officinal tincture.)] Some local action has been observed, of an irritant na- ture, somewhat resembling that of veratria. . Constitutional Actions. Physiological. 1. Brain and Nervous Sys- tem. — i. Green hellebore has no action on the brain. 2. Spinal Cord. — A very decidedly depressing effect is exerted on the spine, in- dicated by extreme muscu- lar prostration. II. Heart a?id Circulation. Veratrum viride is also a powerful vascular depres- sant, the pulse rate being lowered, and the arterial tension diminished ; these effects being due both to a direct action of the drug on the heart muscle and to stimulation of the cardiac in- hibitory nerves. III. No effect is produced on the respiration, but a dis- tinct lowering of tempera- ture has been observed. Th erapeutical. II. Veratrum viride has been extensively used in America on account of its depressing influence on the circulation, and it is stated that we may get good results by prescribing it in the early stages of pneumonia and other inflammatory condi- tions. Little or no English experience, however, has yet been brought to bear on the discussion of this ques- tion. WINES — ZINC. 35 E IV. Digestive and Secret- [IV. The nauseating and ing Organs. — Veratrum vi- depressing effects are best ride has emetic properties, counteracted by opium and and frequently causes vomit- alcoholic stimulants.] ing; and purging, also, not unfrequently follows its use. Two alkaloids exist in veratrum viride, jervia and vera- troida, the main difference between which seems to be, that the latter is apparently responsible for the digestive disturbance which occasionally results. [Vina. The officicinal Wines are : — Vinum Aloes Vinum Opii " Antimonii " Portense " Colchici Radicis " Rhei " " Seminis " Tabaci " Ergotse " Xericum.] " Ipecacuanhae ZINCUM— ZINC. [Officinal Preparations, U. S. Zinci Oxidum. Dose, gr. ij.-viij. Zinci Oxidum Venale. Unguentum Zinci Oxidi (i to 5). Zinci Chloridum. As a caustic and astringent. Liquor Zinci Chloridi. (Burnett's Disinfecting Fluid.) Zinci Acetas. As a collyrium, gr. ss.-ij. to f^j. Zinci Carbonas Prsecipitata. Ceratum Zinci Carbonatis (1 to 5). Zinci Sulphas (white vitriol). Dose, as an emetic, gr. x.-xxx. Zinci Valerianas (given in pill). Dose, gr. i.-ij. Antidotes. The alkalies and alkaline carbonates are the chemical antidotes to the salts of zinc. Evacuation of the stomach and bowels should be followed by the exhibition of eggs and milk. The retching, colicky pains, and diarrhoea, may be relieved by morphia hypodermically.] 35 2 ZINC. Local Actions. Physiological. Chloride of Zinc is an exceedingly powerful cans- tic, and, in weak solution, has astringent properties. The sulphate and oxide are also astringent in varying proportions. Th erapeutical. Chloride of Zinc has been used as a caustic for the treatment of cancerous and other ulcerations, either in strong solution, sub- stance, or arrow - shaped masses made with flour, and inserted into incisions around the base of the mor- bid mass. It has turned out to be the principal ingre- dient in all so-called cancer curers' nostrums, and is em- ployed in legitimate surgery as an application to wounds from which cancerous growths have been removed, and also (in the strength of gr. lx. ad fjj.) to the raw surface after ordinary opera- tions, with the view of pre- venting pyaemia. Sulphate of Zinc is a much-valued astringent lo- tion in conjunctivitis, and makes an excellent injection in gonorrhoea and leucor- rhoea; and the oxide, either in powder or ointment, is one of the most useful applications in chronic skin- disease. Internal Actions and Uses. Physiological. i . Action on Nervous Sys- tem. — This is probably tonic in character, and some astringent properties may also be noted. Therapeutical. i. We can thus explain the benefit which sometimes results from the use of sul- phate of zinc in chorea. We here .begin with a grain, and continue in gradually in- GINGER. 353 creasing doses up to 6 or 8 grains, tolerance being rapidly established, and the emetic action of the drug avoided. Oxide of zinc, in doses from i to 5 grains, is an excellent remedy in the night-sweats of phthisis, and it is also a valuable aid to treatment in the diarrhxa of children. 2. On Digestive System. — 2. It is therefore our most Sulphate of zinc promptly reliable direct emetic, in- and effectually empties the valuable in cases of poison- stomach, without causing ing, in doses of from 20 much depression or nausea, to 30 grains. R. Zinci sulphatis gr. xxx. ; Aquae f^iij- M. Fiat haustus emeticus statim sumendus. R. Zinci chloridi g r - j- ; Aquae rosae f§iv. M. A good injection in gonorrhoea. R. Zinci oxidi 5y«; Glycerini Liquor plumbi subacetatis Aquae calcis Fiat lotio. f5ij.; f5iss. ; ad f §vj. M. Useful in impetigo. R. Zinci valerianatis gr. xxiv. ; Confectionis rosae q. s. Fiat massa in pilulas duodecim dividenda. Deaurentur pilulae. Nervine tonic. ZINGIBER— GINGER. \The rhizome of Zingiber officinale (Roscoe, Trans. Linn. Soc), U. S. Dose, in substance, gr. x.-xv. Officinal Preparations, U. S. Extractum Zingiberis Fluidum. Dose, n^x.-xx. Infusum Zingiberis (Jss. to Oj.). Dose, f^ij.-iv. Oleo-resina Zingiberis. Dose, n^ss.-ij. 3°* 354 GINGER. Syrupus Zingiberis. As a vehicle. Tinctura Zingiberis (%iv. to Oj.). Dose, f3ss.-j. Trochisci Zingiberis (each containing nyj. of the tincture.). Also enters into Acidu'm Sulphuricum Aromaticum, Pilulae Scillge Compositae, Pulvis Aromaticus, Pulvis Rhei Compositus, and Vinum Aloes.] Ginger is an agreeable stimulant and carminative. Having now completed the study of the various articles contained in the national Pharmacopoeia, we shall proceed to give a brief resume of the properties of the most useful among those drugs which have not yet received full official sanction. Among these will be found some very import- ant remedies, in addition to plants of great physiological interest, whose active medicinal powers have not yet been fully tested in practical medicine, and whose investigation opens up a valuable field for clinical observation. REMEDIES IN FREQUENT USE, BUT NOT INCLUDED IN THE PRIMARY LIST OF THE MATERIA MEDICA, U. S. P. [AZEDARACH— AZEDARACH. The bark of the root of Melia Azedarach, U. S. Secondary. The bead-tree, or Pride of China, is largely used in the Southern States as an anthelmintic, resembling spigelia in its effects. The decoction (^ij. to Oij. boiled to Oj.) is generally employed; the dose to a child being a table- spoonful frequently repeated, until it purges.] BRAYERA— KOOSSO. [The flowers and unripe fruit of Br ay era antheimintica, U. S. Secondary. ] Effects. Physiological. Th erapeutical. The action of kousso is It is therefore occasionally poisonous to the tape-worm, used as an anthelmintic, and without exerting any irritat- with moderately good effect ing or purgative effect. when given on an empty sto- mach, according to the rules generally laid down. Mode of Administration, &c. It is well not to use the officinal tincture [Br.], but to get the fresh flowers, boiling about half an ounce in 3 or 4 oz. of water, adding a little lemon peel, and directing the patient to swallow the whole draught, dregs and all. A little vomiting sometimes follows, but is seldom trouble- some. [A brisk cathartic should follow in 3 or 4 hours.] 356 EUCALYPTUS GLOBULUS. ARECA— [BETEL NUT, Ph. B.]. This nut possesses some astringent properties, and has been used with success as an anthelmintic. BEL^E FRUCTUS— INDIAN BAEL [Ph. B.]. Indian bael, containing tannin, has astringent proper- ties, and has been highly praised as an effectual cure for the more chronic forms of dysentery. Only partial con- firmation is given by home experience to the evidence furnished from abroad ; but this may be explained not only by the limited opportunities of testing its efficacy in this country, but because the drug is probably much more active when used in a perfectly fresh state. CURCUMA— TURMERIC. \_The rhizome of Curcuma longa, U. S. Secondary. ] Turmeric is not used in medicine. It forms the coloring ingredient in curries, and the theory has recently been broached that the yellowish tint so often observed on the skin of Anglo-Indians results from the absorption of the pigment of this substance. EUCALYPTUS GLOBULUS [Ph. B.]. Eucalyptus is an excellent antiseptic, proving rapidly destructive to infusoria. It paralyses the spinal cord and medulla, a period of preliminary excitement rapidly giving way to profound muscular weakness, loss of reflex activity, and finally death from respiratory failure. The pulse loses in force, the temperature is lowered, and the excretion of urea is increased. As regards the therapeutics of the drug, it appears to have been used with success as an antiperiodic ; and there seems to be no doubt that the presence of the plant in large numbers deprives malarious districts of much of their virulence. It has also been recommended in bronchitis and asthma. Dose of the tincture, f 3ss. to f 3ij. [The fluid extract may also be used, but the oil is the best preparation. Dose, gtt. v.-x.] JABORANDI. 357 FEL BOVINUM PURIFICATUM- OX-BILE [Ph. B.]. -PURIFIED Bile is well known to act as a laxative, to aid the di- gestion of the fatty and amy- laceous constituents of our diet, and to prevent the de- composition of food within the intestines, with conse- quent flatus and digestive disturbance. It has therefore been sup- posed that when a deficiency of bile is suspected, we may hope to derive advantage from ox-gall administered in gelatine capsules, so that its action may be deferred until it reaches the small intes- tines. In some forms of dys- pepsia and in chronic diar- rhoea it is said to be a useful remedy, but little clinical evidence on this point can be adduced. GOA POWDER— [ARAROBA]. Has been extensively used in the East, recommended by Sir Joseph Fayrer in cases of ringworm and psoriasis. We may dissolve a scruple in an ounce of hot lard to make an ointment. Prof. Attwood having discovered that chrysophanic acid is the principal ingredient of Goa powder, Mr. Balmanno Squire has proved the efficacy of this substance in the same class of cases, making an ointment also with hot lard in the proportion of 3U- t0 %)• JABORANDI. Constitutional Action. Physiological. Within ten or twelve min- utes after jaborandi has been taken, the face flushes deep- ly, and profuse perspiration follows, accompanied by a great increase of salivary secretion. The loss of fluid thus produced is very con- siderable, and the sweat has been proved to contain a Therapeutical. The powerful diaphoretic action of jaborandi, no less than its power in aiding the elimination of urea, would seem to suggest its use in various chronic kidney-dis- eases [Bright's disease], as well as febrile conditions. But its action is too short, sharp, and sudden, and too 358 JABORANDI, much depression and incon- venience are produced, to render us very hopeful of its ultimate success in practice. It has been prescribed in diabetes insipidus, and for the purpose of augmenting the secretion of milk. large excess of urea. This action on the skin is consi- dered due to vaso- motor paralysis and consequent dilatation of the cutaneous arterioles, and the sialagogue effects of the drug are attri- buted to stimulation of the periphery of the nerves sup- plied to the salivary glands. Jaborandi increases some- what the action of the heart; and contraction of the pupil, with impaired accommoda- tive power, has been noted to attend its use. A good deal of nausea, depression, and general dis- comfort result, and have been graphically described by Mr. Martindale in the " Lancet." Atropia appears to be in many respects an exact phy- siological antidote to jabo- randi. [The alkaloid of Jaborandi possessing both the diapho- retic and sialagogue actions of the drug, has received the name of — Pilocarpia — Pilocarpin. Constitutional Effects. Physiological Effects. Dr. Popow (St. Petersb. Med. Woch., Aug. 4), re- porting upon the results de- rived from the hypodermic injection of pilocarpin in men in health and suffering from fever, and in experi- ments upon animals made in Prof. Suschtschinsky's labo- Therapentic Uses. From some comparative trials which he has made with the internal adminis- tration of pilocarpin, Dr. Curschmann believes that the in frequency with which it causes vomiting, as com- pared with jaborandi, is prin- cipally due to its being used JABORANDI. 359 ratory, comes to the follow- ing conclusions : — i. Pilocarpin produces the same effect as an infusion of the leaves of jaborandi. 2. An injection of from o.oi to 0.02 gramme (gr. y§ to yz) induces abundant sweating, without causing the unpleasant effects (gid- diness, vomiting, cephalal- gia) produced by jaborandi, and is, therefore, better suited for therapeutical em- ployment. 3. The temperature di- minishes without any prior exaltation, from one hour and a half to four hours, and reaches its minimum soon after the cessation of the sweating. 4. The increased excretion of saliva is observed alike in the healthy and the sick, after doses of from 0.01 to 0.015 gramme (gr. ]/& to %). Sweating only occurs in such doses in the healthy; fever patients, e. g., typhus, requiring 0.02 gramme (gr. Vs). 5. The quickening of the heart's action produced by the pilocarpin continues a pretty long time after small doses, but when large ones are employed, this is soon replaced by retardation. 6. On the direct introduc- tion of pilocarpin into the veins a retardation of the heart's action takes place hypodermically, and there- by avoiding direct irritation of the stomach. Some per- sons, especially those who have been weakened by prior disease, complain of a sense of debility, but this usually soon passes off; but in others a complete state of collapse is produced, which may or may not be connected with prior vomiting. The possi- bility of this occurrence must always be borne in mind. It is dependent upon the amount of the dose and the susceptibility of the indi- vidual. It is oftenest met with in women, and in those whose strength has been greatly reduced ; and when the patient's constitution is not known, the first dose of the medicine should not ex- ceed 0.02 (gr. yi), while its effect should be watched for a quarter or half an hour. As far as the trials have gone, pilocarpin does not seem to act dangerously on the sub- jects of heart-disease, and, indeed, can be employed when no other diaphoretic procedure, for so long a pe- riod, would be ventured upon. Indeed, as a thera- peutical agent for the pro- duction of diaphoresis, it is superior to any other method in use, being more easily em- ployed, while its action is more certain and more com- plete, without being more, 360 JABORANDI. suddenly, without any prior acceleration. 7. Doses not exceeding 0.03 gramme (gr. j4) do not exert any particular ef- fect on the alimentary canal ; but large doses, 0.05 to 0.10 gramme (gr. f to gr. jss.) induce purging, or even bloody stools, with intestinal movements, and the devel- opment of gases. 1 or even as dangerous, as most of these. Its superior- ity over the various sweat- ing-baths in ascites, hydro- thorax, asthma, etc., is most marked. It is true that dia- phoretic treatment is thought less of than formerly ; but in several cases the difficulty of its application, rather than its inefficacy, is the cause of its not being resorted to. Speaking from his own ex- perience, Dr. Curschmann has found the pilocarpin very useful in oedema, in dropsy of the cavities from heart or lung disease, and in chronic nephritis, etc., and that after diuretic, drastic, and other means have failed. He believes that a large field for its employment may be found in pleurisy, accompa- nied by serous exudation, both in promoting the ab- sorption of this, and in pre- venting its re-accumulation after paracentesis. It is evidently indicated in chro- nic rheumatic affections, at least so far as these are ame- nable to diaphoretic treat- ment. 2 Mode of Action on Salivary Glands. Mr. J. N. Langley (Journal of Anatomy and Physio- logy, Oct. 1876) gives the following as the results of ex- 1 [Medical News and Library, Fhila., Oct. 1877, p. 154; from the Med. Times and Gaz., Aug. 25, 1877.] 2 [Phila. Med. and Surg. Reporter for Oct. 6, 1877.] JABORANDI. - 361 periments made by him to determine the action of pilo- carpin on the submaxillary gland of a dog : — "In small doses, i. e. up to 30 mgr. (gr. ^), pilocar- pi exerts an action on the gland very similar to that pro- duced by stimulation of the chorda tympani. "It causes a rapid secretion and a considerable increase of blood-flow ; both secretion and blood-flow gradually declining. "Its effects are little if at all altered by sections of the chorda tympani or of the sympathetic nerve. Stimulation of the chorda tympani increases the pilocarpin effects, i. e. the nerve is functionally unaltered. Stimulation of the sym- pathetic diminishes its effects, so that this nerve, too, is functionally unaltered. The secretion is stopped by in- jecting atropia (a fact for some time known), but a quan- tity of atropia sufficient to paralyze the chorda tympani does not prevent a relatively large quantity of pilocarpin from producing its ordinary results. In fact, the secretion or absence of secretion is dependent on the relative quantity of the two poisons present, just as in the stand-still or beat of the heart. "In larger doses, instead of causing a stronger saliva- flow, it causes none at all, and further prevents the chorda tympani from producing any secretion. It considerably diminishes the blood-flow through the gland, as well as the effects of the chorda tympani on the blood-flow. "It does not, however, stop the sympathetic secretion. The action indeed is not very dissimilar to that of atropia; this agrees with its action on the vagus and inhibitory apparatus of the heart, where in large doses it prevents any inhibition of the heart from stimulation of the vagus, or of the junction of sinus venosus, just as atropia does." 1 Mode of Administration, and Dose. The infusion of the powdered leaves is a good method of exhibiting the drug. A drachm should be steeped in half a pint of hot water, and when sufficiently cool stirred up and one-half the quantity drunk, half an hour later the remainder should be taken, without strain- ing the infusion. This is generally sufficient to cause profuse sweating within an hour. Ptyalism is less con- 1 [Am. Journ. Med. Sci., Jan. 1877.] 3 1 362 SOLUTION OF DIALYSED IRON. stant in its occurrence. Drs. Tyson and Bruen 1 have de- termined that the amount of urine and the excretion of urea are both increased during the twenty-four hours succeeding the administrations. The ordinary dose of pilocarpin is gr. y 2 . Gerrard also found that the nitrate and hydrochlorate of pilocarpin in doses of one-half a grain, also produced the full effects of jaborandi in substance. The fluid extract of jaborandi is now largely used, the dose being a fluid-drachm, representing a drachm of the leaves. An elixir is also made by some pharmacists con- taining the virtues of one drachm in six fluid-drachms. Dose f3j.-f ^ss.] [LIQUOR FERRI DIALYSATUS — SOLUTION OF DIALYSED IRON. ' (Not officinal.) This preparation, of recent introduction, is rapidly coming into favor. It is a clear, neutral, very deep wine- colored liquid, free from taste and apparent astringency, and bearing perfectly dilution with pure water. 2 It is a pure and powerful chalybeate with all the advantages of iron in the usual form ; it is borne well by the stomach, and does not cause constipation nor distress the diges- tion. Chemically it would appear to be a ferric hydrate kept in solution by a small quantity of ferric chloride. It is made by precipitating ferric chloride with dilute water of ammonia, washing the ferric hydrate precipitated, dis- solving it in a solution of ferric chloride, and placing the result in a dialyser. Graham, the inventor of the process, believed that muriatic acid passes through the dialyser, mainly, and that the iron is left in the form of the soluble, colloidal, ferric hydrate; but in practice it has never been obtained entirely free from the chloride. Dialysed iron would seem to furnish us with an efficient substitute for the hydrated sesquioxide in the treatment of poisoning by arse- nious acid. It is precipitated by various salts, and should be administered alone in doses of from ten drops to half a drachm, after meals. It claims to contain about the same 1 [Am. Journ. Med. Sci., July 1, 1877.] 2 [Phila. Med. Times, vol. vii. p. 492, article on Dialysed Iron.] KAMALA — PEPSIN. $6$ proportion of iron as the muriated tincture, and, as it is said not to injure the teeth, it proves an admirable substi- tute for it, in chlorosis, anozmia, and allied conditions.] ROTTLERA— KAMALA, U. S. Secondary. [ The glandular powder and hairs obtained from the capsules of Rottlera tinctoria (Roxburgh), U. S. Dose, 5j -iij.] Effects. Physiological. Therapeutical. Kamala is a vermicide, Kamala is an efficient an- killing the tape-worm rapid • thelmintic, differing from ly ; it also possesses purga- other remedies of the class tive properties. in its cathartic action. LARICIS CORTEX— LARCH BARK [Ph. B.]. Larch bark is seldom if ever used in medicine. LAUROCERASI FOLIA— CHERRY-LAUREL LEAVES [Ph. B.]. This drug contains prussic acid, but, as it is very variable in strength, its use cannot be advised. MORI SUCCUS— MULBERRY JUICE [Ph. B.]. Is only used as a flavoring ingredient. [PEPSINA PORCI]— PEPSIN. Pepsin is the most import- There can be little doubt ant digestive element of the that many dyspeptic condi- gastric juice, and more espe- tions are due to a deficiency cially reduces the albumi- of gastric juice, and attempts noid and proteinaceous con- may be made to supply this stituents of food to a fit state by prescribing pepsin, pre- for absorption. ferably in combination with dilute hydrochloric acid. In atonic dyspepsia, in va- rious ancemic and cachectic conditions, in the diarrhoea of children, in some forms of 3^4 PARSLEY — SALICIN. spasmodic asthma, its use seems to be attended with good results; but we may well share Dr. Wood's scep- ticism as to the possibility of materially aiding the diges- tion of food by the small doses usually prescribed. Pepsin has also been re- commended as an addition to nutritious enemata, so as to insure some preliminary digestion of the injected food. Dose, 2 to 5 grains. Or we may use Prof. Liebreich's Pepsin-Essenz. [It may be conveniently prescribed in the form of Saccharated Pepsin, Liquor Pepsini, Boudault's Acid Pepsin, or as Lacto-peptine.] [PETROSELINUM— PARSLEY. The root of Petroselinum sativum (Lindtey, Flor. Med.), U. S. Secondary. The neutral, active principle, Apiol, has attained some reputation in the treatment of intermittents, and is also used in neuralgia and dysmenorrhea. Its nauseating taste requires it to be given in capsule (gr. 3 T 9 ^). Dose, one to four.] RHAMNI SUCCUS— BUCKTHORN [Ph. B.]. Buckthorn has some purgative properties, but is never used in modern practice. SALICIN. Salicin acts as a bitter tonic, and has some antiseptic and antiperiodic qualities, which have caused it to be used, with only partial success, in the treatment of 7nalarial affections. Recently, however, it has been most exten- sively employed, on the recommendation of Dr. Maclagan, as a remedy for acute rheumatism, in which disease from io to 30 grains, every two, three, or four hours, in powder mixed with water, generally succeeds, within forty-eight hours, in relieving pain and reducing temperature. SALICYLIC ACID. 365 ACIDUM SALICYLICUM— [SALICYLIC ACID]. Local Action. Physiological. Salicylic acid is an excel- lent antiseptic, delaying pu- trefaction and preventing decomposition. Being Therapeutical. less irritant than carbolic acid, it has been proposed as a substitute for that substance in carrying out Lister's antiseptic sys- tem. It has also been rec- ommended as a good lotion to raw surfaces ; but Callen- der has shown that it not only tends to irritate the wounds, but frequently brings out a crop of irritable vesicles in their neighborhood. Constitutional Action. Salicylic acid is an anti- septic and antipyretic, rap- idly reducing temperature in feverish conditions, al- though, in a state of health, the drug seems to be without influence on the body heat. Some headache, giddiness, and ringing in the ears have been observed, but the car- diac and respiratory func- tions are not sensibly affect- ed. Elimination principally takes place by the urine. Salicylic acid is now uni- versally allowed to be a most efficient remedy in acute rheumatism, very rapidly reducing temperature, re- lieving pain, and, in fact, cutting short the disease. By shortening the duration of the joint inflammation, it naturally limits the tendency to cardiac complication ; but it seems to have no influ- ence over developed peri- carditis, or in averting or ar- resting conditions of hyper- pyrexia. Dose, Mode of Administration, &c. We may give salicylic acid in 20-grain doses, repeated hourly for six hours on two consecutive days, and continued at shorter intervals, if the disease resists forty-eight hours' medication. The disadvantages attending its use are an unpleasant burning sensation in the throat, with the occasional devel- 3 T * 366 SALICYLIC ACID. opment of catarrhal symptoms; gastro-intestinal irritation, resulting probably from an impure preparation containing carbolic acid ; and a peculiarly irritable erythematous and vesicular inflammation of the skin. A still more formida- ble objection, however, to its long-continued use, is the property it seems to possess of softening the long bones, and injuriously affecting the teeth by abstracting their salts of lime. Salicylic acid is very insoluble, and it is difficult to find a ready medium for its administration. Messrs. Savory and Moore have devised a very elegant granular, efferves- cent preparation, or we may use the salicylate of soda in 10-grain doses. The following are good formulae: — JJ. Acidi salicylici 3J-j Olei amygdalae [expressi] i 5 V - ; Pulv. acaciae 5i)ss. ; Syrupi amygdalae 1 5 v j- ; Aquae aurantii flores ad f Sp. rect. i 3>j ss « > Dissolve. Potassii citratis f5J-> Syrupi aurantii f 5513. ; Aquae f^djss. Mix the two solutions and filter, and then dilute with water to taste. [Note. — Prof. Germain S6e has just read at the Academy of Medi- cine, an elaborate memoir (which is published in detail in the Union Medicale of July 3 et seq.~) entitled "Studies on Salicylic Acid and the Salicylates ; and on the Treatment of Acute and Chronic Rheumatism, Gout, and various Affections of the Sensory Nervous System, by the Salicylates," in which he speaks of this new article of the materia med- ica in most enthusiastic terms. He treats at full length of the history, chemistry, physiological and therapeutical action of this substance; but we have only space for transcribing his conclusions as to its therapeu- tical effects. "1. As an external antizymotic agent, salicylic acid has an incon- testable action, but in no wise superior to that of carbolic acid, its only advantage being its privation of odor. As an internal antiseptic, it manifests no appreciable effect in either purulent affections or contagious and parasitical diseases — as diphtheria, or muguet, or gangrene, or finally in diabetes. "2. As an antipyretic, salicylic acid and the salicylates possess only transitory and doubtful properties, even when specific, miasmatic, viru- SUMBUL. 367 lent fevers, etc., are in question. Even the salicylate of quinia occu- pies no definite position in the treatment of marsh fevers. Powerless in the treatment of smallpox, the salicylate of soda has not been suffi- ciently tried in typhoid fever. Its febrifuge power is exceedingly limited. "3. It is in acute articular rheumatism that the most certain and most prompt effects are observed — so much so that we may promise with almost certainty the cure of febrile or apyretic acute rheumatism within a space of from two to four days. Fifty-one cases may be adduced in proof of this. "4. In simple chronic rheumatism the trials which I have made have proved most satisfactory. The same maybe said of the acute crises which manifest themselves from time to time in simple rheumatism or in chronic rheumatic arthritis, the painful attacks of which cease as soon as in acute rheumatism. Moreover, the articular tumefactions consider- ably diminish, and the motions of the joints may become free even after years of pain, rigidity, and immobility — on the condition that the bony lesions have not become too deep-seated or too advanced. Twelve cases of chronic rheumatism either cured or ameliorated are adduced. "5. But it is in acute and chronic gout that the results are the most remarkable. From the commencement of my observations I was struck by the promptitude with which the most painful acute paroxysms were arrested. Within the space of two or three days the pains, the articular fluxion, the redness of the skin, and the sensibility to touch had all dis- appeared. Chronic gout is just as amenable to the salicylic treatment. Continued, even in moderate doses, it affords the patients absolute se- curity from an acute attack. The tophi of the joints diminish in size, and cease to become inflamed — in a word, the cure is complete, and that without the production of any metastasis to the heart, stomach, respiratory organs, or the brain. Not once have I been able, among the twenty-one cases I have watched, to observe the slightest retroces- sion of gout inwardly. No other inconvenience has been produced than the production of some disturbances in the ear, and sometimes a certain amount of debility or narcotism. The two latter phenomena disappear when the dose is diminished ; but the perturbations of audition are much more persistent. Among affections which are often of a gouty nature, gravel may be mentioned. This is favorably modified, or rather more easily eliminated, by the aid of salicylate of soda, which also has the advantage of allaying the nephritic pains. " 6. The salicylic treatment has seemed to be of advantage in certain facial neuralgias; but its action in this affection is not definitively estab- lished, and the same may be said with regard to sciatica. " 7. In painful affections of the spinal cord, the salicylate of soda produces calming effects which are distinctly appreciable; but by the continuance of its employment a certain amount of debility is pro- duced."]! SUMBUL Has antispasmodic properties, but is very rarely pre- scribed. 1 [From the Monthly Abstract of Medical Science, Philadelphia, for September, 1 87 7.] 368 LEECHES. TRIMETHYLAMINE AND ITS HYDRO- * CHLORATE. Lowering of temperature and pulse is said to follow the use of this drug, and it has been much recommended as a remedy for acute rheumatism. Dose of the hydrochlorate, 3 to 10 grains. LEECHES. \_Hirudo. Sanguisuga Officinalis.] Leeches are undoubtedly the most convenient means for the local abstraction of blood, and are used to relieve pain, which they do very effectually in certain local inflamma- tions, as pleicrisy, pericarditis, orchitis, iritis, hepatitis, peritonitis; and there is reason to believe that, when ap- plied sufficiently early, they may even moderate the inflammatory process. Their action, no doubt, may fre- quently be explained by direct vascular communication between superficial vessels and those of deeper parts. Each leech may contain about iyi dr. of blood, and subsequent fomentation may draw so much more from the skin as to raise the total amount up to half an ounce. Should the subsequent bleeding prove difficult of arrest, as sometimes happens, we may succeed in staunching the flow by means of pressure, cold, various astringents, the application of solid nitrate of silver, or the twisted suture. [The American only takes about y$ as much blood as the imported leech, and, on this account, is preferred by some in the treatment of diseases of children.] Special cautions in the use of leeches are — never to apply them, if possible, to any part over which firm pressure can- not subsequently be made, as the larynx; not to apply them in the evening, when, for some unexplained reason, the bleeding is more apt to be troublesome ; and, of course, never to allow their use in any victim of the hsemorrhagic diathesis. If leeches will not bite, we must smear the skin with cream or freshly-drawn blood, or immerse the animal itself in porter, which seems to have a stimulating effect ; and should one be unfortunately swallowed, we can kill it, and cause its expulsion from the stomach, by common salt. QUESTIONS. In submitting a series of questions to the consideration of the student, I have endeavored to place various sug- gestive points before him in interrogative form, and to approach the border line between practical medicine and therapeutics by introducing a few short illustrative cases. The principle seems to me worthy of further development, and a systematic collection of typical diseases, with varia- tions and exceptions and bed-side gleanings, might lead the way profitably up to those diffuse collections of symp- toms which are occasionally rolled into concrete form by our examining boards. It would not be difficult to expand my collection of que- ries to an almost unlimited extent ; but the conscientious attempt to answer those already constructed will at all events encourage the young reader to think for himself, and to emancipate his mind and memory from the ener- vating trammels of the more grinding forms of manuals. i. A child is under treatment for whooping-cough, and the mother states that after each dose of his medicine his face flushes, and he complains of his throat being very dry. What drug is most likely to produce these symptoms? 2. Mention the different remedies to be employed in the various stages of syphilis. 3. A case of acute eczema presents itself for treatment; there is much moist exudation, with smarting and tingling and almost erysipelatous redness. It is proposed to give arsenic. Would this meet with your approval, and what would be your line of practice? 4. A patient comes to you in great alarm, thinking that he is paralysed, his legs feeling weak and heavy, and his gait becoming staggering. At the same time you observe a few pimples of acne on his forehead, and you learn that he has lately been suffering from sleeplessness. To what would your suspicions point as the cause of his symptoms? 370 QUESTIONS. 5. Give directions for disinfecting a room which has been occupied by scarlatinous patients. 6. Mention a drug which seems to have a specific influ- ence over the poison of erysipelas, and write a prescrip- tion, with full directions for its use. 7. Write a prescription for an effervescing draught con- taining carbonate of ammonia. 8. Point out the error in the following prescription : — I£. Tinct. hyoscyami f 5 SS - 5 Liq. potasses Ti|xx. ; Mucilaginis f 5j- ; Gentianae infusi f |j. Ter die. 9. You are called to a very severe case of delirium tremens. It seems inadvisable to give opium, and chlo- ral has already failed. What course, therefore, would you pursue ? 10. Mention the antidotes for prussic acid, strychnia, arsenic, and opium, with the general line of treatment to be pursued in a case of poisoning by each of these sub- stances. 11. You are called to the following case. A middle- aged man has been known to suffer from heart-disease, and on applying your ear to his chest you hear a well- marked mitral-regurgitant bruit. His face is pale, with a tendency to lividity, his feet are beginning to swell, his pulse is weak and irregular, and does not accurately cor- respond to the beat of the heart, many of whose pulsations are not transmitted to the wrist. There are great anxiety and breathlessness, and ordinary stimulants have given only temporary relief. State your line of practice in such a case, and more especially the drug from which you would expect to derive speedy benefit. 12. Mention the various drugs which have been of ser- vice in tetanus, with your opinion of their relative effi- ciency, and give the dose of each. 13 Explain the action of the principal anaesthetic agents, and state which you consider to be most worthy of confidence. 14. Mention the remedies which act on the pupil, and divide them into those which act locally and constitutionally. 15. What is the advantage of the following prescrip- tion ? — QUESTIONS. 371 I£. Tincturae opii TlXx. ; Acidi sulphurici diluti Tr\_xx. ; Decocti hsematoxyli f^j. M. Ter die sumend. 16. Write a soothing cough-medicine for a case of phthisis, and include chlorate of potash and morphia. Dose, one teaspoonful. 17. State the general treatment of a case of chorea, with the principal drugs which have been found useful, and give your opinion of their respective merits. 18. What are the indications by which we know that conium, arsenic, and strychnia are beginning to produce their physiological effects ? 19. Mention those drugs which are most readily absorb- ed through the unbroken cuticle. 20. Enumerate the principal cholagogue cathartics. 21. State the principal differences between the action of opium and morphia. 22. You are called to see a case of severe sprained ankle, and hear that a friend is about to apply tincture of arnica. On inquiry you find that this remedy has never been used to this patient before. Would you sanction the treatment ? 23. Enumerate those drugs which stimulate, and those which depress, the action of the heart. 24. State which drugs are most worthy of confidence in cases of neuralgia of the fifth nerve. 25. A patient presents himself with the following symp- toms : Constipation and violent colicky pain in the belly, some loss of power in the extensor muscles of the arms, a bluish line along the margin of the gums, and anaemia. What is the cause of, and the proper treatment for, his com- plaint; and what prophylactic means would you recommend him to adopt ? 26. Mention the various means of lowering the bodily temperature in health and disease, and explain their action, more especially enumerating those remedies which act only in conditions of pyrexia. 27. You have been attending a case of rheumatic fever, and all has gone on well until you are told one morning that the patient has had a disturbed night, has been restless and delirious, but that at the same time, the pain in the joints has subsided. You find him looking dull, confused, and 37 2 QUESTIONS. only partially conscious. The temperature registers 105 , and in another hour has gone up to 106 . What treat- ment would you advise? 28. State the principal dangers to be anticipated in chloroform administration, with their appropriate remedies. 29. Mention the unpleasant effects which sometimes follow the use of quinine. 30. What do you mean by ' accumulation' in therapeu- tics? 31. A young married woman comes to ask relief for troublesome sickness and vomiting, recurring at intervals throughout the day, but always worse on first rising in the morning. What would you advise in the way of treat- ment, and how can you explain her symptoms ? 32. Write a prescription for an alkaline lotion in a case of acute eczema. 33. Mention the best narcotics to be used under the following circumstances : — 1. Sleeplessness from overwork or worry. 2. Delirium tremens. 3. The fierce delirium of typhus. 4. Acute mania. 34. Write a prescription for iron in combination with potassium iodide and a vegetable bitter. 35. Mention the various drugs which produce eruptions on the skin, and describe the forms of eruption produced. 36. Mention the drugs which impart a peculiar color to the urine, with the varieties of tint produced. 37. Contrast the paralysing effects of conium, Calabar bean, and veratria. 38. State the physiological phenomena which may follow comparatively small doses of quinine, potassium iodide, potassium bromide, chloral, and mercury. 39. State what you mean by a refrigerant. 40. You are called to see a patient in an advanced stage of phthisis, in whom the night-sweats are causing serious exhaustion. All astringent remedies having failed, what drug would you recommend to be employed, and in what doses? 41. A patient is seized with acute tonsillitis, and it is of great importance that he should recover his voice in a short time. Mention a drug which you might prescribe with good hopes of speedy benefit. questions. 373 42. An elderly man is attacked with acute bronchitis, the cough and dyspnoea being urgent, and the sputa brought up with difficulty. The blood is beginning to be imperfectly aerated, the skin looking dusky and the lips blue, and although he is occasionally drowsy by day, he can obtain no sleep in the night from the constant and irritating cough. His family are much distressed at this insomnia, and having persuaded the doctor to give him something to make him sleep, a full dose of opium is ordered. State the probable result of this line of practice. 43. You are summoned to see a case of ague. The patient cannot take bark or quinine in any form. What drug would you recommend in their place? 44. A case of diarrhoea presents itself, characterised by furred tongue, cramping pains in the abdomen, sickness, and tenesmus, with the expulsion of rather scanty but thin and frequent evacuations. It is proposed to arrest this by means of astringents. State whether this treatment would meet with your approval, and what your own plan would be. 45. You are called to a bad case of haemoptysis — all the usual astringents and styptics have failed. What drug would you recommend, and how would you administer it? 46. State the best remedies for nocturnal incontinence of urine. 47. Mention the principal medicines used for hypo- dermic injection, and the mode of performing the opera- tion. 48. Give instances of toleration of drugs. 49. Describe your treatment of purpura hsemorrhagica. 50. State the rules which would guide you in prescribing acids and alkalies in dyspepsia. 51. Write a prescription for a lotion containing hydro- cyanic acid. 52. Mention the uncomfortable effects sometimes result- ing from the subcutaneous injection of morphia, and sug- gest some means for obviating them. 53. Have any bad effects been recorded as following the subcutaneous injection of quinine ? 54. You are called to a case of diarrhoea in which the motions are largely composed of blood and mucus, and much pain and tenesmus follow each evacuation of the 32 374 QUESTIONS. bowels. Ordinary astringents having failed, what special drug would you advise ? 55. Give proof of the rapid absorption of drugs into the blood. 56. Give instances of the different, and even opposite, effects of drugs in large and in small doses. 57. Mention drugs which check, and others which pro- mote, the salivary secretion. 58. Mention appropriate remedies for migraine. 59. Mention those drugs which depress, and those which excite, the action of the spinal cord. 60. Which preparation of conium is most deserving of confidence, and in what dose should it be given ? 61. Which diuretics act more especially by influencing the renal circulation ? 62. Mention those drugs which destroy, and those which aid in the construction of, the red corpuscles of the blood. 63. Have any drugs the power of raising the tempera- ture of the body? 64. Enumerate the secondary action of emetics, and explain them physiologically. THERAPEUTIC SUGGESTIONS ; OR, INDEX OF DISEASES Abscesses belladonna, 125 carbolic acid, 65 cod liver oil, 263 flaxseed poultice, 247 ice, 113 iodine, 236 Acne faciei arsenic, 1 19 sulphur, 335 Acute mania bromide of potassium, 304 chloral, 155 dulcamara, 199 hyoscyamus, 234 Indian hemp, 142 opium, 272 After-pains (see Labor) Ague apiol, 364 arsenic, 1 18 quinia, 175 Ague-cake (see Spleen, enlarged) Albuminuria (see Bright's disease) Amaurosis strychnia, 259 Amenorrhcea aloes, 96 apiol, 364 cantharides, 145 catnep, 15 1 ergot, 203 guaiac, 222 hiera picra, 141 iron, 208 marjoram, 280 myrrh, 258 pennyroyal, 223 rue, 315 Amenorrhcea — savin, 317 turpentine, 344 Anaemia cod-liver oil, 263 iron, 208, 210 solution of dialysed iron, 363 (See also Pernicious anaemia and Leucocythemia) Aneurism ergot, 202 iodide of potassium, 306 Angina (see Sore throat) Angina pectoris opium, 274 hypodermic injection of mor- phia, 278 nitrite of amyl, 93 Animal poisoning (see Poisoning) Aphthous sore mouth borax, 332 chlorate of potassium, 299 sulphite of sodium, 332 sulphurous acid, 337 Apoplexy croton oil, 268 Arsenical poisoning (see Poison- ing) Ascarides (see Worms) Ascites (see Dropsy) Asthma antimony, 108 arsenic, 118 belladonna, 128 chloral, 155 chloroform, 164 cod-liver oil, 263 ether, 82 eucalyptus globulus, 356 (375) 376 INDEX OF DISEASES. Asthma — lobelia, 249, 250 nitrite of amyl, 93 opium, 274 pepsin, 364 pilocarpin, 360 potassium-nitrate papers, 301 stramonium, 335 tobacco-smoking, 341 turpentine stupes, 344 Atheroma digitalis, 197 Biliary colic (see Gall-stones) Biliousness acids, 41 blue pill, 228 nitro-muriatic acid, 75 ipecacuanha, 240 (See Hepatic disorders) Bites caustic potassa, 298 nitrate of silver, 1 15 (See also Animal poisoning) Bladder affections (see Cystitis) Boils (see Abscesses) Bowel affections (see Diarrhoea and Constipation) Brain affections blisters, 145 bromide of potassium, 303 iodide of potassium, 305 (See also Meningitis and Syphilis) Brain softening phosphorus, 282 Bright's disease alkalies, 300 compound jalap powder, 241 cream of tartar, 302 diaphoretics, 49 gallic acid, 214 iron, 209 jaborandi, 357 pilocarpin, 360 pipsissewa, 153 potash salts, 300 scoparius, 326 water, 50 Bronchitis ammonia, 100, 102 ammoniac, 99 antimony, 108 Bronchitis — arsenic, 118 assafcetida, 122 balsam of Peru, 123 benzoin, 132 chloride of ammonium, 102 cimicifuga, 169 cod-liver oil, 263 copaiba, 188 cubebs, 191 digitalis, 197 eucalyptus, 356 garlic, 94 iodide of potassium, 307 ipecacuanha, 238 lobelia, 250 myrrh, 258 oil of amber, 267 opium, 277 seneka, 327 squill, 325 steam, 113 tar, 290 tartar emetic, 20 turpentine, 345 turpentine stupes, 344 wild-cherry bark, 310 Bronchocele (see Goitre) Broncho-pneumonia antimony, 108 (See Bronchitis) Bubo ice, 113 iodoform, 237 (See also Abscesses) Burns carbolic acid, 64 carbonate of lead, 292 carron oil, 137, 247 collodion, 220 cotton, 220 lime, 137 warm bath, 112 Calculus (phosphatic) nitric acid, 74 potassa, 300 (See also Gravel) Cancer acetic acid, 63 arsenic, 117 blood-root, 319 INDEX OF DISEASES. 377 Cancer — chloride of zinc, 352 chloroform, 166 citric acid, 68 iodoform, 237 opium, 273 Cancrum oris nitric acid, 74 Carbuncles tr. iodine, 236 (See Abscesses) Cardiac disease (see Heart disease) Cardiac dropsy (see Dropsy) Cardiac palpitation (see Heart dis- ease) Caries cod-liver oil, 264 sulphuric acid, 339 Catarrh (see Coryza) Catarrh (chronic) assafcetida, 122 (See also Coryza) Cerebral disorders (see Brain affections) Chafing (see Excoriation) Chancre (see Syphilis) Chapped hands collodion, 274 glycerine, 218 Chilblains tr. iodine, 236 Chills and fever (see Ague) Chloasma sulphurous acid, 337 (See also Skin disease) Chlorosis solution of dialysed iron, 363 (See also Anaemia) Cholera cajuput oil, 136 camphor, 140 hypodermic injections of mor- phia, 278 nitrite of amyl, 94 sulphuric acid, 339 Cholera infantum (see Diarrhoea) Cholera morbus acetate of lead, 293 opium, 274 (See also Diarrhoea) Chordee camphor, 141 3 Chorea arsenic, 1 18 bromide of potassium, 304 bromide of iron, 208 cimicifuga, 169 chloral, 155 chloroform, 166 conium, 184 cold affusion, 112 copper, 192 ether, 82 hemlock, 184 iron, 208 oxide of zinc, 352 physostigma, 285 manganesium sulphate, 253 sulphate of zinc, 352 Chronic mania cimicifuga, 170 cod-liver oil, 263 ergot, 201 hemlock, 185 Chronic nephritis (see Blight's disease) Colds (see Coryza) Colic assafoetida, 122 belladonna, 130 cajuput oil, 136 catnep, 151 chloroform, 164 cloves, 150 ether, 82 fennel tea, 212 ginger, 354 oleum monardae, 256 mustard, 329 opium, 273 pennyroyal, 223 warm bath, 112 Colica pictonum (see Painter's colic) Color-blindness santonin, 320 Condylomata black-wash, 226 carbolic acid, 64 chromic acid, 68 (See also Syphilis) Congestion of brain compound jalap powder, 242 elaterium, 200 >* 378 INDEX OF DISEASES Congestion of spinal cord ergot, 20 1 Conjunctivitis alum, 97 atropia, 126 cod-liver oil, 264 silver nitrate, 115 sulphate of zinc, 352 Constipation aloes, 96 alum, 98 assafcetida, 122 belladonna, 129 castor oil, 266 colocynth, 183 croton oil, 269 gamboge, 215 jalap, 242 juglans, 242 lead, 293 nux vomica, 261 podophyllum, 295 senna, 328 strychnia, 260 Consumption (see Phthisis) Convulsions, epileptic (see Epi- lepsy) Convulsions, hysterical (see Hys- teria) Convulsions, infantile assafcetida, 122 bromide of potassium, 303 chloral, 155 chloroform, 166 ether, 82 garlic, 94 hemlock, 184 mustard baths, 330 oil of amber, 267 warm bath, 112 Convulsions, puerperal chloral, 156 chloroform, 166 Convulsions, uraemic (see Ursemic coma) Corneal ulcer black-wash, 226 Corns acetic acid, 63 (See Warts) Coryza aconite, 79 Coryza — alcohol, 88 assafcetida, 122 . boneset tea, 204 camphor, 140 creasote, 190 cubebs, 191 Dover's powder, 277 glycerite of tannin, 213 horehound, 254 licorice, 219 opium, 274 Cough, spasmodic belladonna, 130 chloroform, 164 gelsemium, 217 Cracked nipples benzoin, 132 flexible collodion, 221 tannic acid, 213 Croup, pseudo-membranous alum, 98 antimony, 108 chlorate of potash, 299 ipecacuanha, 238 lactic acid, 73 lime-water, 137 mercury, 229 steam, 113 (See also Diphtheria and Spasm of the larynx) Cystitis buchu, 135 copaiba, 188 cubebs, 191 hyoscyamus, 23 iron, 259 juniper, 243 pareira, 281 turpentine, 345 uva ursi, 348 Debility alcohol, 89 cod-liver oil, 263 iron, 208, 363 phosphorus, 281 quinia, 173 strychnia, 259 (See also Anaemia) Delirium tremens antimony, 108 INDEX OF DISEASES 379 Delirium tremens — bromide of potassium, 304 chloral, 155 digitalis, 24, 194 lupulin, 224 musk, 256 opium, 272 veratrum viride, 350 Diabetes almonds, 105 bromide of potassium, 304 glycerine, 218 opium, 275 phosphoric acid, 285 yeast, 206 Diabetes insipidus ergot, 201 jaborandi, 358 opium, 275 Diarrhoea acetate of lead, 293 alum, 97 arsenic, 1 18 bismuth, 133 blackberry, 315 cajuput oil, 136 camphor, 141 Castillon's powders, 346 castor oil, 266 catechu, 151 cinnamon, 180 copper, 192 ergot, 202 geranium, 218 gum arabic, 62 ipecacuanha, 240 kino, 243 licorice, 219 lime-water, 138 logwood, 222 nitrate of iron, 209 opium, 274 ox-bile, 357 oxide of zinc, 353 pepsin, 363 podophyllum, 295 rhatany, 244 rhubarb, 313 sulphuric acid, 339 tannic acid, 213 turpentine, 344 Diphtheria ammonia, 1 01 carbolic acid, 64 chlorate of potassa, 302 chlorine water, 161 chromic acid, 68 citric acid, 68 ipecacuanha, 239 lactic acid, 73 lime inhalations, 137 muriatic acid, 163 tincture of iron, 207 Diphtheritic croup chlorate of potassa, 302 Diphtheritic paralysis strychnia, 260 Dislocations chloroform, 166 hemlock, 185 Drink-craving tincture of capsicum, 147 Dropsy blisters, 145 colocynth, 182 comp. jalap powder, 242 copaiba, 188 cream of tartar, 300 digitalis, 197 elaterium, 200 gamboge, 215 infusion of erigeron, 204 juniper, 243 pilocarpin, 360 potash salts, 300 scoparius, 326 squill, 325 spirits of nitre, 91 Dysentery ergot, 202 gum arabic, 62 Indian bael, 356 ipecacuanha, 240 opium, 274 rhatany, 244 Dyspepsia acids, 40 aloes, 96 arsenic, 1 18 assafostida, 121 belladonna, 130 bismuth, 133 carbolic acid, 67 3 8o INDEX OF DISEASES. Dyspepsia — chamomile, 106 charcoal, 147 columbo, 138 ether, 82 ' emetics, 52 gentian, 218 hydrocyanic acid, 70 lactic acid, 73 lime water, 138 magnesia, 251 muriatic acid, 162 mix vomica, 260 ox-bile, 357 pepsin, 363 quassia, 31 1 quinia, 173 rhubarb, 313 senna, 328 soda, 332 soda-mint, 333 sulphurous acid, 338 sulphate of manganese, 253 taraxacum, 343 thoroughwort, 204 Eczema arsenic,. 119 bicarbonate of potassium, 298 glycerite of tannic acid, 214 hydrocyanic acid, 70 lead-water, 292 soda, 332 (See also Skin diseases) Empyema tr. iodine, 237 Epilepsy bromide of ammonium, 104 bromide of potassium, 303 Calabar bean, 286 copper, 192 nitrite of amyl, 92 oxide of zinc, 352 physostigma, 285 silver, 116 Epistaxis ergot, 201 (See Haemorrhage) Erysipelas aconite, 79 carbolic acid, 65 collodion, 220 Erysipelas — elm-poultice, 347 lead-water, 292 liquor gutta-perchae, 222 quinia, 171 sulphate of iron, 208 tincture of iron, 209 Excoriations bismuth, 133 chalk, 137 lycopodium, 251 starch, 105 (See Skin diseases) Facial neuralgia gelsemium, 216 (See also Neuralgia) Fainting (see Syncope) Favus black-wash, 226 (See Skin disease) Felon carbolic acid, 65 nitrate of silver, 115 Fetid expectoration creasote, 190 salicylic acid, 365 Fever, intermittent (see Ague) (See also Typhus, Typhoid) Fevers aconite, 79 effervescing draughts, 68 gum arabic, 62 quinia, 175 salicylic acid, 366 vinegar, 62 yeast, 206 Fissure of rectum belladonna, 125 Flatulence carbolic acid, 67 charcoal, 147 ether, 82 .soda-mint, 333 (See also Dyspepsia) Flooding, post-partum ergot, 203 iron injections, 207 (See also Haemorrhages) Gall-stones belladonna, 129 INDEX OF DISEASES 38l Gall-stones — chloroform, 166 hypodermic injections of mor- phia, 278 opium, 273 warm bath, 112 Gastralgia blisters, 144 manganesium sulphate, 253 (See also Colic) Gastro- enteric inflammation gum arabic, 62 (See also Diarrhoea and Dysen- tery) Glandular enlargements cod-liver oil, 264 (See also Scrofula) Gleet copper sulphate, 192 iron, 209 storax, 335 turpentine, 345 (See also Gonorrhoea) Goitre biniodide of mercury, 226 tincture of iodine, 237 Gonorrhoea alum, 97 bismuth, 133 buchu, 134 copaiba, 187, 189 cubebs, 191 fluid extract of matico,. 254 hydrastis Canadensis, 233 infusion of pomegranate, 3 1 1 silver nitrate, 1 15 storax, 335 sulphate of zinc, 352 sulphate of copper, 192 tannic acid, 213 turpentine, 345 Gout colchicum, 181 iodide of potassium, 307 lithium, 248 potash, 299 salicylic acid, 367 Granular lids sulphate of copper, 192 Gravel lithia, 248 salicylate of soda, 367, Haematemesis gallic acid, 214 (See also Haemorrhage) Haematuria turpentine, 344 Haemoptysis acetate of lead, 293 alum, 98 digitalis, 196 ergot, 201 gallic acid, 214 Haemorrhage alum, 98 ergot, 201 ice, 113 iron, 207 matico, 254 opium, 274 tannic acid, 213 turpentine, 344 (See also Menorrhagia, etc.) Haemorrhoids belladonna, 125 charcoal, 148 ergot, 201 iodoform, 237 ointment of galls, 214 nitric acid, 74 pepper, 289 sulphur, 336 Hay-asthma or Hay-fever arsenic -, 118 quinia, 174 Headache aconite, 78 podophyllum, 295 valerian, 348 valerianate of ammonia, 349 vinegar, 62 (See also Neuralgia) Heartburn magnesia, 251 (See also Dyspepsia) Heart-clot ammonia, IOI Heart-disease aconite, 79 belladonna, 127 chloroform, 164 comp. jalap powder, 242 digitalis, 195-199 hydrocyanic acid, 70 382 INDEX OF DISEASES. Heart-disease — morphia, 274 potash-salts, 300 veratrum viride, 350 Hepatic disorders blue pill, 228 citric acid, 68 ipecacuanha, 240 leeches, 368 nitric acid, 74 nitro-muriatic acid, 75 podophyllum, 295 rhubarb, 314 sodium bicarbonate, 332 Hernia chloroform, 166 hemlock, 185 warm bath, 112 Herpes zoster collodion, 220 (See Skin disease) Hiccough musk, 256 oil of amber, 267 Hydrocele tr. iodine, 236 Hydrothorax pilocarpin, 360 (See also Pleurisy) Hypochondriasis cimicifuga, 170 (See Acute and Chronic mania) Hysteria assafoetida, 121 catnep, 151 chloroform, 164 cloves, 150 cold water, 112 ether, 82 hemlock, 185 musk, 256 oil of amber, 267 valerian, 348 valerianate of zinc, 349 Hysterical convulsions musk, 256 Impetigo arsenic, 119 (See Skin disease) Impotence phosphorus, 281 Incontinence of urine belladonna, 21, 128 bromide of potassium, 304 buchu, 135 chloral, 155 collodion, 221 ergot, 202 santonin, 321 strychnia, 259 Indigestion (see Dyspepsia) Infantile convulsions (see Convul- sions, infantile) Insanity (see Acute and Chronic mania) Insomnia chloral, 154 opium, 271 Intertrigo bismuth, 133 (See Excoriation) Iritis atropia, 126 blisters, 144 leeches, 368 turpentine, 345 Irritable heart belladonna, 127 chloroform, 164 hydrocyanic acid, 70 (See also Heart disease) Irritable stomach calomel, 20 effervescing draught, 68 grey powder, 20 (See also Vomiting) Itch (see Scabies) Jaundice podophyllum, 295 rhubarb, 314 soda, 332 (See also Hepatic disorder) Joint-affections blisters, 145 cod-liver oil, 264 mercurial ointment, 226 Kidney-complaint pipsissewa, 153 (See Bright's disease) INDEX OF DISEASES. 383 Labor chloral, 155 cotton-root bark, 220 ergot, 207 opium, 273 quinia, 171 Laryngismus stridulus (see Spasm of the larynx) Leprosy copaiba, 187 (See Skin diseases) Leucocythemia phosphorus, 283 (See also Anaemia) Leucorrhoea alum, 97 bicarbonate of potassium, 298 bismuth, 133 ergot, 203 fluid extract matico, 254 iron injections, 207 lime-water, 137 sulphate of zinc, 352 tannic acid, 213 white-oak bark, 312 Lichen arsenic, 119 (See Skin diseases) Liver disease (see Hepatic dis- orders) Lumbago (see Myalgia) Lumbricoids (see Worms) Lupus carbolic acid, 65 copaiba, 187 (See Skin diseases) Malarial fevers quinia, 175 (See Ague) Mania (see Acute mania) Mastitis belladonna, 130 Mastodynia belladonna, 130 Measles phosphorus, 283 Meningitis blisters, 145 ice, 113 opium, 272 Menorrhagia bromide of potassium, 304 cinnamon, 180 digitalis, 196 ergot, 201 gallic acid, 214 oil of erigeron, 204 oxide of silver, 116 (See also Haemorrhage) Migraine (see Neuralgia) Mitral disease (see Heart disease) Myalgia ammonia, 101 atropia injections, 130 cimicifuga, 170 conium, 185 gelsemium, 216 morphia injections, 278 mustard plasters, 329 Myelitis, chronic belladonna, 128 Narcotic poisoning blisters, 145 (See also Poisoning) Nervous debility phosphorus, 281 (See also Debility) Nervous exhaustion strychnia, 259 Nervous headache valerianate of ammonium, 349 valerian, 348 (See also Headache) Nervous insomnia chloral, 154 (See also Insomnia) Nervousness assafcetida, 122 (See Hysteria) Neuralgia aconite, 77, 78 alcohol, 85 ammonia, 10 1 ammonium chloride, 103 arsenic, 118 belladonna, 125 blisters, 144 cannabis Indica, 142 chloral, 154 chloral-camphor, 159 chloroform, 164 3§4 INDEX OF DISEASES. Neuralgia — cochineal, 1 80 cod-liver oil, 262 croton-chloral, 160 ergot, 201 ether, 82 guarana, 136 gelsemium, 216 hydrocyanic acid, 70 hypodermic injections of mor- phia, 278 Indian hemp, 142 iodoform, 237 iron, 208 mustard plaster, 329 nitrite of amyl, 92 opium, 273 quassia, 173 salicylic acid, 367 turpentine stupes, 344 valerianate of quinia, 349 veratria ointment, 316 (See also Headache, Toothache, Myalgia, and Pleurodynia) Night sweats acetic acid, 63 atropia, 129 ergot, 201 oxide of zinc, 353 quinia, 173 sulphuric acid, 339 Nipples, sore (see Cracked nipples) (Edema (See Dropsy) CEdema of glottis chromic acid, 68 Onychia maligna nitrate of lead, 292 Ophthalmia (see Conjunctivitis) Ophthalmology atropia in, 126 Orchitis ice, 113 leeches, 368 Otorrhcea glycerite of tannic acid, 214 Oxyuris vermicularis (see Worms) Ozaena creasote, 190 glycerite of tannic acid, 214 potassium permanganate, 298 (See also Coryza) Painters' colic alum, 97 belladonna, 129 chloroform, 166 Epsom salt, 252 iodide of potassium, 307 sulphuric acid, 336 Palpitation of the heart chloroform, 164 digitalis, 1 15 hydrocyanic acid, 70 (See also Heart disease) Paralysis ergot, 207 strychnia, 259 Paralysis agitans hemlock, 185 Paralysis of the insane physostigma, 286 Paraplegia (see Paralysis) Parturition (see Labor) Pediculi black wash, 226 Pemphigus arsenic, 1 19 Pericarditis blisters, 145 leeches, 368 " mercury, 229 Periodical affections quinia, 175 (See Ague) Periostitis iodide of potassium, 307 Peritonitis aconite, 79 blisters, 145 flaxseed poultices, 247 leeches, 368 mercury, 229 mustard, 329 opium, 274 turpentine stupes, 344 Pernicious anaemia phosphorus, 283 (See also Anaemia) Phagedena chromic acid, 68 iron, 208 nitric acid, 74 Phthisis chloral, 155 INDEX OF DISEASES 385 Phthisis — cod-liver oil, 263 hypophosphite of lime, 138 opium, 274 oxalic acid, 75 wild-cherry bark, 310 Piles (see Haemorrhoids) Pleurisy aconite, 79 blisters, 144 mercury, 229 mustard, 329 pilocarpin, 360 turpentine stupes, 344 Pleurodynia blisters, 144 mustard, 329 (See also Neuralgia) Pneumonia aconite, 79 ammonia, 100-102 antimony, 108 blisters, 145 diaphoretics, 49 flaxseed poultices, 248 mercury, 229 mustard, 329 opium, 274 quinia, 172 senega, 327 turpentine stupes, 344 veratrum viride, 350 Poisons and Antidotes (for general remarks on Antidotes see page 37) Acid poisoning, treatment of, 42 Aconite poisoning, treatm't of, 77 chloral, 148 Alcohol poisoning, treatment of, 84 ammonia, 100 Alkaline poisoning (see Ammo- nia, Potassa, etc.) Ammonia poisoning, treat., 102 acids, 101 Amylic-alcohol poisoning, treat- ment of, 91 Animal poisoning (bites, stings, etc.), treatment of, 38 alcohol, 85 ammonia, 1 00 liquor potassae, 38 33 Poisons and Antidotes — Antimonial poisoning, treat, of, 109 (see Tartar emetic poi- ' soning ) Arsenical poisoning, treatm't of, 117-119 hydrated sesquioxide of iron, liquor ferri dialysatus, 362 saccharated sesquiox. iron, 119 Belladonna poisoning, treatment of, 124-131 Calabar bean, 288 charcoal, 124 opium, 271 tannin, 124 tartar emetic, 109 Bitter almonds, 105 (See Hydrocyanic acid) Calabar-bean poisoning, treatm't of, 288 alcohol, 84 atropia, 285 strychnia, 259 Carbolic acid poisoning, treatm't of, 67 _ Chloral poisoning, treatment of, I54-I57 . Chloroform poisoning, treatment of, 163-166 nitrite of amyl, 92 Conium poisoning, treat, of, 186 atropia, 183 stimulants, 87, 100 Copper poisoning, treat, of, 192 albumen, 191 ferrocyanide of potassium, 191 Corrosive sublimate poisoning, treat, of (see Mercurial poi- soning) Hydrocyanic acid poison'g, treat- ment of, 71 cold affusions, ^8 Iodine poisoning, tream't of, 335 starch, 335 Lead poisoning, treatment of, 292 alum, 291 Epsom salts, 252 iodide of potassium, 307 sulphuric acid, 336 Lobelia poisoning, treat, of, 249 Malarial poisoning (see Ague) 3 86 INDEX OF DISEASES. Poisons and Antidotes — Mercurial poisoning, 225 albumen, 225 chlorate of potassium, 299 gold leaf and iron filings, 225 Narcotic poisoning, treat, of, 38 alcohol, 87 ammonia, 100 apomorphia injections, 53, 280 atropia, 38 blisters, 145 caffeine, 136 charcoal, 148 electricity, 270 emetia injections, 53, 241 emetics, 37, 270 mustard, 330 stimulants, ^8 stomach-pump, ^y sulphate of copper, 192 sulphate of zinc, 352 Opium poisoning, treat, of, 271 belladonna, 271 (See also Narcotic poisoning) Oxalic acid poisoning, treatment of, 75 chalk, 137 magnesia, 75 Phosphorus poisoning, treat, of, 281 magnesia, 251 oil of turpentine, 345 Physostigma poisoning (see Cal- abar bean poisoning) Prussic acid poisoning (see Hy- drocyanic acid poisoning) Rhus toxicodendron poisoning, treatment of, 38 alkalies, 37 infusion of lobelia, 250 sweet spirits of nitre, 91 Snake poison (see Animal poi- soning) Strychnia poisoning, 259—261 anaesthetics, 261 bromide of potassium, 259 chamomile, 106 charcoal, 148 chloral, 259 chlorine, 161 nicotia, 259 nitrite of amyl, 92 Poisons and Antidotes — Strychnia poisoning — oleum anthemidis, 106 physostigma, 288 tannic acid, 213 Tartar-emetic poisoning, treatm't of, 107 coffee, 107 stimulants, 107 tannic acid, 109, 214 tea, 107 Tobacco poisoning, treat, of, 340 Veratria poisoning, treat, of, 316 Polypi, uterine ergot, 203 (See also Menorrhagia) Polyuria (see Diabetes insipidus) Priapism bromide of potassium, 304 camphor, 141 Prolapsus ani bismuth, 133 Prurigo hydrocyanic acid, 70 soda, 332 (See also Skin diseases) Psoriasis arsenic, 1 19 chrysophanic acid, 357 copaiba, 186-188 phosphorus, 282 tar ointment, 290 Puerperal convulsions (see Convul- sions) Pulmonary complaints Iceland moss, 153 (See Phthisis, Pneumonia, and Pleurisy) Purpura ergot, 202 turpentine, 344 (See also Scurvy) Pyaemia alcohol, 84 quinia, 172 Pyelitis cantharides, 145 turpentine, 345 Pyrosis bismuth, 133 manganesium sulphate, 253 (See also Dyspepsia) INDEX OF DISEASES. 387 Quinsy (see Tonsillitis) Rachitis cod-liver oil, 264 iron, 209 phosphate of lime, 138 phosphoric acid, 285 phosphorus, 283 Renal calculus warm bath, 1 12 (See also Calculus) Rheumatism aconite, 79 arsenic, 119 belladonna, 125 blisters, 144 bromide of ammonium, 101 chloral, 154 cimicifuga, 170 citric acid, 68 cod-liver oil, 264 dulcamara, 199 guaiac, 222 iodide of potassium, 305 ipecacuanha, 241 iron, 209 lemon-juice, 246 oil of cajuput, 136 pilocarpin, 360 pipsissewa, 153 potassium bicarbonate, 298, 299 quinia, 172 salicin, 364 salicylic acid, 365, 366 sulphur, 336 trimethylamine, 368 (See also Myalgia) Rheumatoid arthritis arsenic, 119 Rickets (see Rachitis) Ringworm acetic acid, 63 (See also Skin disease) Rupture of bladder opium, 273 Rupture of intestine opium, 273 Rupture of uterus opium, 273 Salivation belladonna, 129 Salivation — chlorate of potash, 299 Sarcinous vomiting carbolic acid, 67 hyposulphite of soda, 332 (See also Vomiting) Scabies arsenic, 120 storax, 335 sulphur ointment, 336 Scarlet fever aconite, 79 ammonia, 103 antipyretics, 44 belladonna, 129 chlorate of potassium, 299 chlorine water, 16 1 phosphorus, 283 quinia, 175 rosemary, 334 Sciatica atropia injections, 130 blisters, 144 hypodermic injections of mor- phia, 278 mustard, 329 opium, 273 turpentine enema, 345 (See also Neuralgia) Scrofula barium chloride, 124 calcium chloride, 138 cod-liver oil, 264 camp, tinct. of iodine, 237 iodine, 236 iron, 209 phosphoric acid, 285 pipsissewa, 153 stillingia, 334 Scurvy chromic acid, 68 citric acid, 68 ergot, 202 lemon-juice, 245 oxalic acid, 75 turpentine, 344 vinegar and nitre, 62 Sea-sickness bromide of potassium, 304 chloral, 155 chloroform, 164 Sick-headache (see Headache) 3 88 INDEX OF DISEASES. Skin disease acetic acid, 63 arsenic, 119 bismuth, 133 black-wash, 226 cadmium salts, 136 carbolic acid, 65 chloroform, 164 cod-liver oil, 264 collodion, 220 copaiba, 187 creasote, 190 dulcamara, 199 Goa powder, 357 hydrocyanic acid, 70 hyposulphite of soda, 332 lycopodium, 251 nitrate of lead, 292 oxide of zinc ointment, 352 phosphorus, 282 soda, carbonate of, 332 starch, 105 stillingia, 334 sulphur baths, 336 sulphurous acid, 337 tar ointment, 290 warm bath, 112 (See Acne faciei, Eczema, Ery- sipelas, Excoriations, Favus, Herpes zoster, Impetigo, Lep- rosy, Lichen, Lupus, Onychia maligna, Pemphigus, Prurigo, Psoriasis, Ringworm, Scabies, Small-pox, and Tinea Tonsu- rans) Sloughing nitric acid, 74 Smallpox alcohol, 87 quinia, 175 Smallpox pitting collodion, 220 liquor gutta-perchse, 222 mercurial ointment, 229 silver nitrate, 115 Snake-bite ammonia, 100 Sore throat alum, 97 chlorate of potash, 299 compound infusion of roses, 315 - glycerite of tannic acid, 213 Sore throat — gum arable, 62 iodoform, 237 iron, 207 rosemary, 334 sage -tea, 319 (See also Tonsillitis) Spasm of the larynx antimony, 108 bromide of potassium, 303 cold affusions, 112 compound syrup of squill, 325 conium, 185 Spleen, enlarged bromide of potassium, 303 fluid extract of ergot, 202 quinia, 175 Sprains and bruises laudanum, 271 lead-water, 292 vinegar, 62 Stings of insects ammonia, 1 00 (See Animal poisoning) Stomatitis, mercurial chromic acid, 68 (See Mercurial poisoning) Stone in the bladder (see Calculus) Stricture, spasmodic hemlock, 185 opium, 273 warm bath, 112 Stupor (see Uraemic coma and Nar- cotic poisoning) Suffocative catarrh garlic, 94 (See Bronchitis) Summer complaint (see Diarrhoea) Sunburn vinegar, 62 Suppurating glands (see Scrofula) Sweating acids, 39 alum, 98 atropia, 129 Sweating of phthisis (see Night- sweats) Syncope ammonia, 100 Syphilis bichromate of potassium, 302 black-wash, 226 INDEX OF DISEASES 389 Syphilis — chromic acid, 68 cod-liver oil, 264 corrosive-sublimate injections, 231 iodide of potassium, 305 iron, 209, 210 mercury, 229, 231 nitric acid, 74 sarsaparilla, 324 stillingia, 334 Zittmann's decoction, 232 Syphilitic brain- disease mercury, 227 Syphilitic sore throat black-wash, 226 corrosive sublimate gargle, 231 Syphilitic ulcer iodoform, 237 sulphuric acid, 339 Taenia (see Worms) Tapeworm (see Worms) Tetanus bromide of potassium, 303 cannabis Indica, 142 chloral, 156 conium, 185 gelsemium, 217 nitrite of amyl, 92 physostigma, 286 tobacco, 341 Tinea tonsurans black- wash, 226 sulphurous acid, 337 (See also Skin disease) Tonsillitis aconite, 20, 79 capsicum-gargle, 146 steam, 113 Tonsils, enlarged chromic acid, 68 Toothache atropia, 13 1 cajuput oil, 137 creasote, 190 Trismus nascentium chloral, 155 Trismus hemlock, 185 (See also Tetanus) 33 Tympanites assafetida, 122 turpentine, 344 Typhoid condition ammonia, 100 phosphorus, 282 Typhoid fever alcohol, 87 ammonia, 102 calomel, 230 digitalis, 195 ergot, 202 muriatic acid, 163 opium, 271 quinia, 172 salicylate of soda, 367 turpentine, 344 veratrum viride, 350 Typhus alcohol, 87 antimony, 108, ill blisters, 145 chloral, 155 chlorine- water, 161 opium, 271 quinia, 172 Ulcerated surfaces bismuth, 133 silver nitrate, 1 15 Ulcers acid nitrate of mercury, 225 carbolic acid, 65 charcoal poultices, 148 chromic acid, 68 copper sulphate, 192 iodoform, 237 nitrate of silver, 115 potassium permanganate, 298 Uraemic coma cathartics, 57 croton oil, 269 diaphoretics, 49 diuretics, 50 mustard poultices, 330 Uterine cancer iodoform, 237 (See Cancer) Varicose veins ergot, 202 * 39° INDEX OF DISEASES. Vesical catarrh buchu, 135 (See Cystitis) Vesical irritations hyoscyamus, 23 pareira, 281 Vesical irritability iron, 259 sodium bicarbonate, 332 (See Calculus) Vomiting arsenic, 118 bismuth, 133 carbolic acid, 67 creasote, 190 hydrocyanic acid, 70 ice, 113 Vomiting, persistent calomel, 20, 227 effervescing draught,, 68 grey powder, 20 ipecacuanha, 20, 239 (See also Sarcinous vomiting) Vomiting of pregnancy bromide of potassium, 303 ipecacuanha, 238 oxalate of cerium, 152 tincture of nux vomica, 261 Warts acetic acid, 63 chromic acid, 68 nitric acid, 74 Whooping-cough arsenic, 118 assafcetida, 122 belladonna, 127 bromide of ammonium, 104 bromide of potassium, 304 camphor, 140 chloral, 155 chloroform, 166 Whooping-cough — cochineal, 180 cod-liver oil, 263 ergot, 201 hydrocyanic acid, 70 oil of amber, 267 quinia, 174 squill, 325 Winter- cough tar, 290 (See Bronchitis) Worms (for general remarks on An- thelmintics see page 42) Ascaris lumbricoides (RoUnd worms) azedarach, 355 oil of wormseed, 153 santonin, 320 spigelia, ^33 turpentine, 345 Oxyuris vermicularis (Seat worms) enemata of iron, 207 enemata of lime-water, 137 enemata of quassia, 312 enemata of vinegar, 62 Taenia (Tape-worms), 42-44 carbolic acid, 67 filix mas, 212 kamala, 363 koosso, 355 pumpkin seeds, 281 rottlera, 363 turpentine, 345 Trichina spiralis general treatment, 43 Wrist-drop strychnia, 260 (See Lead-poisoning) Wry neck hemlock, 185 (See Myalgia) GENERAL INDEX. Absinthe, 6 1 Absinthium, 6 1 Acacia, 6 1 Accumulation of digitalis, 199 of medicines, 24 of strychnia, 261 Aceta, 62 Acetic acid, 62 Acetum, 62 destillatum, 62 lcbelise, 62, 249 opii, 62, 270 sanguinarise, 62, 319 scillae, 62, 325 Acida, 76 Acids in biliary derangement, 41 disadvantages of, 41 effect on circulation, 39 effects on secretion, 40 effects on temperature, 40 effects on the urine, 41 external effects, 39 internal effects, 39 officinal, 76 poisonous effects of, 42 remarks on, 38 stimulating alkaline secretions, 41 Acidum aceticum, 62 aceticum dilutum, 62 arseniosum, 64, 117 benzoicum, 132 carbolicum, 64 carbolicum impurum, 64 chromicum, 67 citricum, 68, 245 gallicum, 213 hydrocyanicum dilutum, 69 lacticum, 73 muriaticum, 162 muriaticum dilutum, 162 nitricum, 73 nitricum dilutum, 73 nitro-muriaticum, 75 Acidum nitro-muriaticum dilutum, 75 oxalicum, 75 phosphoricum dilutum, 285 phosphoricum glaciale, 285 salicylicum, 365 sulphuricum, 338 sulphuricum aromaticum, 338 sulphuricum dilutum, 338 sulphurosum, 337 tannicum, 213 tartaricum, 75 valerianicum, 349 Acne from bromides, 305 Aconite, 76 in fever, 20 leaves, 76 root, 77 Aconitia, 77 Aconiti folia, 76 radix, 77 Aconitum, 76 Action of antipyretics, 44 of drugs changed with dose, 21 Adeps, 80 Administration, forms of, 17 of antimony, no of opium, 277 of purgatives, 59 of quinia, 176 /Ether, 81 fortior, 81 JEthevea., 81 Alcohol, 84 amylicum, 91 dilutum, 84 fortius, 84 Alcohol as a food, 90 Allium, 94 Allspice, 289 Almond, 105 as food in diabetes, 105 mixture, 105 (39 1 ) 39 2 GENERAL INDEX. Aloe, 95 Barbadensis, 95 Capensis, 95 compound, decoction of, 96 purificata, 95 Socotrina, 95 Althaea, 97 Alum, 97 Alumen, 97 exsiccatum, 97 Aluminii et ammonii sulphas, 97 et potassii sulphas, 98 sulphas, 98 Amber, 267 American hellebore, 350 American leeches, 368 Ammonia, 99 Ammoniac, 98 Ammoniacum, 98 Ammoniated copper, 99 mercury, 99 Ammonii benzoas, 99, 132 bromidum, 99, 134 carbonas, 99 chloridum, 99 chloridum purificatum, 99 iodidum, 99 nitras, 99 sulphas, 99 valerianas, 99, 349 Ammonio-ferric alum, 99 Ammonio-tartrate of iron, 75 Ammonium benzoate, 132 Amygdala amara, 105 dulcis, 105 Amygdalus, 105 Amyl nitris, 92 Amylic alcohol, 91 Amylum, 105 Anaesthesia by chloroform, 165 by ether, 83 by nitrous oxide gas, 104 Anaesthetic, local, 65 Angustura, 106 Anise, 106 Anise-seed, 106 Anisum, 106 Anthelmintics, 42 how to give, 19 Anthemis, 106 Antidote, acetic acid, 63 aconite, 77 Antidote, alcohol, 84 ammonia, 99 arsenious acid, 117 barium, 124 belladonna, 124 bitter almond, 105 bromine, 134 camphor, 140 carbolic acid, 64 chemical, 38 chloral, 154, 157 copper, 191 corrosive poisoning, 105 corrosive sublimate, 225 digitalis, 193 Fowler's solution, 117 hydrocyanic acid, 69 iodine, 235 lead, 291 lobelia, 249 muriatic acid, 162 nitrate of silver, 115 nitric acid, 74 opium, 270 oxalic acid, 75 phosphorus, 281 physiological, 38 physostigma, 285 potassa, 297 stramonium, 334 strychnia, 259 sulphuric acid, 338 tartar emetic, 107 tartaric acid, 76 tobacco, 340 veratria, 316 zinc, 351 Antidotes, theory of, 37 Antimonial powder, no wine, 107 Antimonii et potassii tartras, 107 et potassii tartras, in infantile bronchitis, 20 et potassii tartras, toleration of, 23 oxidum, 107 oxy sulphur etum, 107 sulphuretum, 107 Antimonium, 107 sulphuratum, 107 Antimony, 1 07 Antipyretics and refrigerants, 44 GENERAL INDEX. 393 Antiseptic system of Lister, 65 Antiseptics, action of, 47 and disinfectants, 45 properties of charcoal, 147 solution of chloral as an, 154 Apiol, 364 Apomorphia, 280 Appollinaris water, IT4 Aqua, in acidi carbolici, 64 acidi carbonici, 253 ammoniae, 99 ammoniae fortior, 99 amygdalae amarae, 105 anisi, 106 aurantii florum, 122 camphorae, 139 chlormi, 160 cinnamomi, 180 creasoti, 190 destillata, 1 1 1 foeniculi, 212 menthae piperita?, 255 menthae viridis, 255 rosae, 314 Aquae, 114 Araroba, 357 Areca nut, 356 Argenti cyanidum, 115 nitras, 115 nitras fusa, 115 oxidum, 115 Argentum, 115 Arnica, 116 Arrowroot, 253 Arsenic, 117 constitutional effects of, 120 in childhood, 27 in skin disease, toleration of, 24 white, 117 Arsenic-eating in Styria, 23, 118 Arsenicum, 117 Arsenici iodidum, 117 Arsenious acid, 64, 117 Ascaris lumbricoides, 43 Assafoetida, 121 Atropia, 124 Atropiae sulphas, 124 Aurantii amari cortex, 122 dulcis cortex, 122 flores, 122 Aurantium, 122 Avenae farina, 123 Azedarach, 355 Balsam of Peru, 123 of Tolu, 123 Balsamum Peruvianum, 123 Tolutanum, 123 Barbadoes aloes, 95 Barii carbonas, 123 chloridum, 124 Bark, cinchona, 170 Barley, 223 Bath, nitric acid, 75 Baths, therapeutic effects of, 1 1 1 Bay rum, 84 Bearberry, 347 Bebeeru bark, 258 Belae fructus, 356 Belladonna 124 effects on animals, 131 effects on rabbits, ^^ in childhood, 27 leaves, 124 root, 124 poisoning, 124 (See Poisoning in Index of Dis- eases) Belladonnae foliae, 124 radix, 124 Benzoate of ammonium, 99 Benzoated lard, 132 Benzoic acid, 132 Benzoin, 132 Benzoinum, 132 Betel nut, 356 Bichromate of potassium, 302 Bismuth, 133 subcarbonate of, 133 subnitrate of, 133 Bismuthi subcarbonas, 133 subnitras, 133 Bismuthum, 133 Bitter almond, 105 Bittersweet, 199 Blackberry, 315 Black draught, 328 Black drop, 270 Black hellebore, 223 Black-wash, 225 Blistering collodion, 143, 220 papers, 143 Blisters, caution in use of, 146 394 GENERAL INDEX. Blisters, therapeutic indications for, 144 Blood affected by acids, 39 Bloodroot, 319 Bone, 280 Boneset tea, 204 Borax, 331 Brandy, 84 Bray era, 355 Bromide of ammonium, 99 Bromine, 134 Brominium, 134 Broom, 326 Buchu, 135 Buckthorn, 364 Burgundy pitch, 284 Burnett's disinfecting fluid, 351 Butternut, 242 Cacao butter, 267 Cadmii sulphas, 135 Cadmium, 135 Caffea, 136 Caffeine, 136 Calabar bean, 285 Calcii carbonas praecipitata, 137 chloridum, 137 hypophosphis, 137 phosphas praecipitata, 137 Calcis hydras, 137 Calcium, 137 Calomel, 224 Calumba, 138 Calx, 137 _ Calx chlorinata, 137 Camphor, 139 Camphora, 139 Canada fleabane, 204 Canada pitch, 289 Canada turpentine, 343 Canella, 141 Canna, 141 Cannabis Americana, 141 Cannabis Indica, 142 Cantharides, 143 Cantharis, 143 Cape aloes, 95 Capsicum, 146 Caraway, 106 Caraway-seed, 149 Carbo, 147 animalis purificatus, 147 Carbo ligni, 147 Carbolic acid, 64 ointment, 64 Carbon, 147 Carbonate of ammonium, 99 of barium, 123 Carbonated waters, 114 Cardamom, 149 Cardamomum, 149 Carrageen, 169 Carron oil, 137, 247 Carum, 149 Caryophyllus, 149 Cascarilla, 150 Cassia fistula, 150 Cassia Marilandica, 150 Castillon's powders, 346 Castor, 150 Castoreum, 150 Castor oil, 265 Cataria, 151 Catechu, 151 Catnep, 151 Catnep-tea, 151 Caustic, bromine as a, 134 Caution in regard to chloral, 168 in regard to chloroform, 168 in regard to opium in bronchitis, 274 Cayenne pepper, 146 Cera alba, 152 flava, 152 Cerata, 150 Cerate of cantharides, 143 of extract of cantharides, 143 Cerates, officinal, 152 Ceratum cantharidis, 143 cetacei, 152 extracti cantharidis, 143 plumbi subacetatis, 291 resinae, 312 resinae compositum, 312 sabinae, 317 saponis, 322 zinci carbonatis, 351 Cerii oxalas, 152 Cerium, 152 oxalate, 152 Cerum, 152 Cetaceum, 152 Cetraria, 153 Cevadilla, 316 GENERAL INDEX, 395 Chalk, 137, 190 Chalk-lozenges, 137 Chalybeate waters, 114 Chamomile, 106 Chamomile, German, 254 Charcoal, purified animal, 147 wood, 147 Charta cantharidis, 143 sinapis, 329 Chartae, 143 Chemical antidotes, 38 Chenopodium, 153 Cherry-laurel leaves, 363 Children, how to prescribe for, 26 Chimaphila, 153 Chiretta, 154 Chloral, 154 caution in bronchitis, 157 contra-indicated in heart disease, 156 Chloral-camphor, 159 Chloral hydrate, 154 Chloric ether, 169 Chloride of ammonium, 99 of ammonium, purified, 99 of barium, 124 of lime, 137 Chlorine, 160 Chlorine water, 160 Chlorinated lime, 137 Chlorinum, 160 Chloroform, 163 Chloroformum, 163 Chloroformum purificatum, 163 venale, 163 Cholagogue, colchicum as a, 181 Cholagogue purgatives, 58 Cholagogues, emetics as, 53 Chondrus, 169 Chorea, toleration of sulphate of zinc in, 24 Chromic acid, 67 Cimicifuga, 169 Cinchona, 170 Cinchona fiava, 170 pallida, 170 rubra, 170 Cinchona-red, 179 Cinchonia, 179 Cinchoniae sulphas, 170 Cinchonidia, 179 Cinnamomum, 179 Cinnamon, 179 Citrate of iron and ammonium, 99 Citric acid, 68 Citrine ointment, 225 Clarke's rule, doses for children, 28 Cloves, 149 Coca, 136 Coccus, 180 Cochineal, 180 Codeia, 279 Coddiver oil, 262 when to give, 18 Coffee, 136 Colchici radix, 180 semen, 180 Colchicum, 180 Cold affusions, 112 Cold baths in fever, 112 Cold cream, 105, 314 Colic, 130 Colica pictonum, 97 Collodion, 220 Collodium, 220 Collodium cum cantharide, 143,220 Collodium flexile, 220 Collyrium, cadmium sulph. as a, 135 Colocynth, 182 Colocynthis, 182 Columbo, 138 Combination of drugs, 16 Compound cathartic pills, 225 Compound spirit of ether, 81, 91 Confectio aromatica, 180 aurantii corticis, 122 opii, 270 rosae, 314 sennae, 328 sulphuris, 337 Confectiones, 183 Confections, officinal, 183 Confection of orange peel, 122 Congress-spring water, 114 Conii folia, 183 fructus, 183 Conium, 183 Constipation, 199 Constitutional effects from small doses, 24 Copaiba, 186 Copper, 191 Coptis, 189 Coriander, 106, 189 39 6 GENERAL INDEX. Cornus Florida, 190 Corrosive sublimate, 225 Cotton, 220 Cotton-root bark, Cough-medicines, how combined, 1 7 Counter-irritation, theory of, 47 Counter-irritants, 47 Court-plaster, 234 Cowling's rule, doses for children, 28 Cranesbill, 218 Cream of tartar, 297 Creasote, 190 Creasotum, 190 Creta, 190 Creta praeparata, 137 Crocus, 190 Croton-chloral, 159 Croton oil, 268 Cryptopia, 279 Cubeb, 190 Cubeba, 190 Culver's root, 245 Cupri subacetas, 191 sulphas, 191 Cuprum, 191 Cuprum ammoniatum, 99, 191 Curcuma, 356 Cusparia, 106 Daturia, 334 Decocta, 193 Decoction of aloes, 96 of Iceland moss, 153 of pipsissewa, 153 Decoctions, officinal, 193 Decoctum cetrariae, 153 chimaphilae, 153 cinchonas flavae, 170 cinchonas rubras, 1 70 cornus Floridae, 190 dulcamaras, 199 hasmatoxyli, 222 hordei, 223 quercus albas, 312 sarsaparillae compositum, 323 senegas, 327 uvas ursi, 347 Zittmanni, 232 Deodorized tincture of opium, 270 Diagnosis between cholera and arsenical poisoning, 119 of opium poisoning, 275 Dialysed iron, 362 Diaphoretic effect of antimony, 109 Diaphoretics, action of, 49 classes of, 48 Digitalinum, 193 Digitalis, 193 accumulation of, 24 hints on prescribing, 25 toleration of, 24 Dill, 106 Dilute acetic acid, 62 alcohol, 84 hydrocyanic acid, 69 nitric acid, 73 Diseases from drinking water, 113 Disguising taste of drugs, 28 Disinfectant, chlorine as a, 161 Disinfectants, antiseptics and, 45 classes of, 46 theory of, 46 Disinfecting by sulphur, 337 Distilled vinegar, 62 water, n 1 Diuretic, copabia as a, 188, 189 effect of digitalis, 194 Diuretics, action of, 50 classes of, 50 how to aid, 18 Dogrose, 315 Dogwood, 190 Donovan's solution, 117, 225 Dosage, 19 Dose, action of drugs altered with, 21 constitutional effects from small, 24 exceptions to rule, 32 for children, 26, 28 general observations upon, 30 general rule for, 31 interval between, 21 of medicines, 19 Dosing, principles of, 31 Dover's powder, 237, 270 Drachma, 30 Drastic purgatives, 57 Dried alum, 97 Dropsy, 200 Drugs, chemical and physiological incompatibilities of, 25 combination of, 16 proper time of giving, 1 8 GENERAL INDEX 397 Drysdale, treatment of croup, 302 Dulcamara, 199 Earth as a disinfectant, 46 Ecbolics, action of, 54 Effect, constitutional or toxic, 24 Effervescing draughts, 69 Egg, 280 Elaterin, 200 Elaterium, 200 Elder, 319 Elixir of cinchona flava, 179 Emesis by apomorphia (hypoder- mically), 280 Emetia, 241 Emetic action of copper, 192 alum as an, 98 chamomile tea, 106 mustard as an, 330 Emetics, action of, 51 as antidotes, 37 as cholagogues, 53 direct, 52 effects of antimony, 109 effects on circulation of, 53 effect on nervous system of, 53 effects on secretion of, 53 free perspiration caused by, 54 indirect, 52 Emmenagogue, aloes as an, 96 cotton-root bark, 220 effect of cimicifuga, 1 70 Emmenagogues and ecbolics, 54 direct, 55 indirect, 55 Emplastra, 200 Emplastrum aconiti, 77 ammoniaci, 63, 98 ammoniaci cum hydrargyro, 224 antimonii, 107 arnicae, 1 16 assafcetidae, 121 belladonnae, 124 ferri, 206 galbani compositum, 213 hydrargyri, 224 opii, 270 picis Burgundicse, 289 picis Canadensis, 289 picis cum cantharide, 143 plumbi, 291 resinae, 291, 312 34 Emplastrum saponis, 322 Emulsion of cod-liver oil, 265 Endermic application of morphia, 278 Ergot of rye, 201 Ergota, 201 Ergotine, 201 Ergotism, 203 Erigeron, 204 Canadense, 204 Erysipelas cured by arnica, 116 Escharotic, alum as an, 97 Eserina, 288 Ether, 81 Ethereal oil, 262 Ethers, officinal, 81 Eucalyptus globulus, 356 Eupatorium, 204 European worm-seed, 320 Excoriation, starch for, 105 Expectorants, action of, 55 classes of, 55 emetics as, 53 Extract of pipsissewa, fluid, 159 Extracta, 205 Extracts, officinal, 205 Extractum aconiti, 77 arnicae, 116 belladonnas, 124 belladonnae alcoholicum, 124 belladonnae radicis fluidum, 124 buchu fluidum 135 calumbae fluidum, 138 cannabis Americanae, 141 cannabis Indicae, 142 chimaphilae fluidum, 153 cimicifugae fluidum, 169 cinchonae, 170 cinchonae fluidum, 170 colchici aceticum, 63, 180 colchici radicis fluidum, 180 colchici seminis fluidum, 181 colocynthidis, 182 colocynthidis compositum, 182 conii, 183 conii alcoholicum, 183 conii fructus fluidum, 183 cornus Floridae fluidum, 190 cubebae fluidum, 190 digitalis, 193 digitalis fluidum, 193 dulcamara?, 199 398 GENERAL INDEX. Extractum dulcamaras fluidum. 199 ergotae fluidum, 63, 201 erigerontis Canadensis fluidum, 204 gelsemii fluidum, 216 gentianas, 217 gentianas fluidum, 217 geranii fluidum, 218 glycyrrhizas, 219 glycyrrhizas fluidum, 219 gossypii radicis fluidum, 220 haematoxyli, 222 hellebon, 223 hydrastis fluidum, 233 hyoscyami, 233 hyoscyami alcoholicum, 233 hyoscyami fluidum, 233 ignatiae, 234 ipecacuanhas fluidum, 237 jalapae, 241 juglandis, 242 kramerias, 244 kramerias fluidum, 244 lupulinse fluidum, 224 matico fluidum, 254 mezerei fluidum, 255 nucis vomicae, 259 opii, 270 pareirse fluidum, 280 physostigmatis, 285 pinus Canadensis fluidum, 212 podophylli, 295 pruni Virginianae fluidum, 310 quassiae, 311 rhei, 313 rhei fluidum, 313 rubi fluidum, 315 sabinae fluidum, 317 sarsaparillae fluidum, 323 sarsaparillae fluidum compositum, 323 scillae fluidum, 325 senegas, 327 senegas fluidum, 127 sennas fluidum, 328 serpentarias fluidum, 329 spigelias fluidum, 333 spigeliae et sennas fluidum, ^^^ stillingias fluidum, 334 stramonii foliorum, 334 stramonii seminis, 334 taraxaci, 342 Extractum taraxaci fluidum, 342 uvas ursi fluidum, 347 Valerianae, 348 Valerianae fluidum, 348 veratri viridis fluidum, 350 zingiberis fluidum, 353 Farina tritici, 205 Fel bovinum purification, 356 Fennel, 106, 212 Fermentation of food checked by acids, 40 Fermentum, 206 Ferri chloridum, 206 citras, 206 dialysatus, liquor, 362 et ammonii citras, 99, 206 et ammonii sulphas, 99, 206 et ammonii tartras, 75, 99, 206 et potassii tartras, 206 et quiniae citras, 206 et strychniae citras, 206 ferrocyanidum, 206 hypophosphis, 206 lactas, 73, 206 oxalas, 75, 206 oxidum hydratum, 206 phosphas, 206 pyrophosphas, 68, 206 subcarbonas, 206 sulphas, 206 sulphas exsiccata, 207 sulphuretum, 206 Ferrum, 206 redactum, 207 Fever, baths in, 112 diaphoretics in eruptive, 49 (See Index of Diseases) Ficus, 211 Fig, 211 Filix mas, 21 1 Flaxseed, 246 Fleabane, 200 Fluidrachma, 30 Fluiduncia, 30 Fly-blisters, 143 Fceniculum, 212 Fomentations, warm water, 112 Form of administering drugs, 17 Fowler's solution, 117 Foxglove, 193 Fusel oil, 91 GENERAL INDEX 399 Galbanum, 212 Gallae, 213 Gamboge, 214 Gambogia, 214 Garlic, 94 Gastric juice checked by acids, 40 Gaultheria, 216 . Gelsemium, 216 Gentian, 217 Gentiana, 217 Geranium, 218 German chamomile, 254 Gettysburg water, 114 Gin, 84 Glauber's salt, 331 Glycerina, 218 Glycerine, 218 Glycerita, 219 Glycerites, officinal, 219 Glyceritum acidi carbolici, 64 acidi gallici, 213 acidi tannici, 213 picis liquidae, 290 sodii boratis, 331 Glycyrrhiza, 219 Goa-powder, 357 Goldthread, 189 Gossypii radicis cortex, 220 Gossypium, 220 Goulard's cerate, 139, 291 Goulard's extract, 291 Granati fructus cortex, 311 radicis cortex, 311 Granum, 30 Greenhow's, Dr., formula for gouty bronchitis, 182 Green soap, 323 Gregory's powder, 316 Griffith's mixture, 206 Gross, Prof., treatment of chloro- form poisoning, 164 Gruel, oatmeal, 123 Guaiac, 221 Guaiaci lignum, 221 resinse, 221 Guaiacum, 221 Guarana, 136 Gum arabic, 61 Gun cotton, 220 Gutta, 30 Gutta percha, 222 Habit, 22 Haematoxylon, 222 Halford, Dr., ammonia injection for snake-bites, 103 Heart disease(see Index of Diseases) caused by tobacco, 341 croton - chloral contra - indicated in, 150 Heat as a disinfectant, 46 Hebra, treatment of eczema, 323 Hedeoma, 223 Helleborus, 223 Hemlock, 183 Hemlock spruce, 289 Hemorrhage checked by acids, 39 Hemostatic effects of iron, 307 Hemp, American, 141 Indian, 142 Henbane, 233 Hiera picra, 95, 141 Hips, 315 Hirudo, 368 Hoffman's anodyne, 81, 9 1 Honey, 254 Honeys, officinal, 255 Hop-pillow, 224 Hops, 224 Hordeum, 223 Horehound, 254 Horsemint, 256 Humulus, 224 Hunyadi Janos water, 114 Huxham's tincture, 179 Hydragogue purgatives, 58 Hydrargyri chloridum corrosivum, 225 Hydrargyri chloridum mite, 224 idiosyncrasy in regard to, 22 Hydrargyri cyanidum, 225 Hydrargyri iodidum rubrum, 225 viride, 225 Hydrargyri oxidum flavum, 224 rubrum, 224 Hydrargyri sulphas flava, 225 sulphuretum rubrum, 224 Hydrargyrum, 224 ammoniatum, 99, 225 Hydrargyrum cum creta, 20, 137, 224 Hydrastis, 233 Hydrated lime, 137 oxide of iron, 206 400 GENERAL I NDEX, Hydrocyanic acid in oil of bitter almonds, 105 Hydrocyanic acid, effects of, on chickens, 33 Hydropathic treatment, 1 12 Hyoscyami folia, 233 semen, 233 Hyoscyamia, 234 Hyoscyamus, 233 Hypnotic effect of chloral, 156 Hypodermic injection of apomor- phia, 280 of atropia and opium, 279 of morphia, 278 of strychnia, 262 Hypophosphite of lime, 137 Ice for relieving pain, 112 Iceland moss, 153 Icthyocolla, 234 Idiosyncrasy, 22 in regard to calomel, 22 in regard to opium, 22 in regard to quinine, 22 Ignatia, 234 Impure carbolic acid, 64 Impurities of water, 1 13 Incompatibilities, chemical and physiological, 25 Incompatibility of caustic alkalies and alkaloids, 26 of drugs, 25 of iodide of potassium and cor- rosive sublimate, 26 of iron and cinchona, 23 of strychnia and corrosive subli- mate, 25 of sulphuric acid and lead salts, Incompatibles with iodine, 236 Indian bael, 356 Individual peculiarities, 22 Infusa, 235 Infusions, officinal, 235 Infusum angusturae, 106 anthemidis, 106 buchu, 135 calumbae, 138 capsici, 146 caryophylli, 150 cascarillae, 150 catechu compositum, 151 Infusum cinchonae flavae, 170 cinchonae rubrae, 170 digitalis, 193 eupatorii, 204 gentianae compositum, 217 humuli, 224 juniperi, 242 kramerise, 244 lini compositum, 247 pareira, 280 picis liquidae, 290 pruni Virginianae, 310 quassiae, 311 rhei, 313 rosae compositum, 314 salvia, 319 sennae, 328 serpentariae, 329 spigeliae, 333 tabaci, 340 taraxaci, 342 Valerianae, 348 zingiberis, 353 Interval between doses, 21 Intravenous injection of chloral, 155 Inunction of mercury in congenital syphilis, 229, 231 Iodide of ammonium, 99 of arsenic, 117 Iodine, 235 Iodinium, 235 Iodism, 307 to prevent, 17 Iodoform, 237 Iodoformum, 237 Ipecacuanha, 24, 237 Irish moss, 169 Iron, 206 hypophosphite, 206 sulphide of, 206 Isinglass, 234 Jaborandi, 357 Jalap, 241 Jalapa, 241 James's powder, no Jervia, 349, 351 Johnson, Dr. Geo., treatment of diarrhoea, 266 Juglans, 242 Juices, officinal, 339 Juniper berries, 242 GENERAL INDEX. 401 Juniperi, 242 Kamala, 363 Kermes mineral, 107 Kinic acid, 178 Kino, 243 Kinovin, 179 Koosso, 355 Krameria, 244 Labarraque's solution, 332 Lactate of iron, 73 Lactic acid, 73 Lactophosphate of lime and liver oil, 265 Lactucarium, 244 Larch bark, 363 Lard, 80 Laricis cortex, 363 Laudanum, 270 in infancy, 28 Laughing-gas, 104 Laurocerasi folia, 363 Lavandula, 244 Lavender, 244 Laxative effects of water, 113 Laxatives, 57 Lead, 291 in drinking-water, 113, 294 plaster, 291 water, 291 Ledoyen's disinfecting solution Leeches, 368 Lemon, 245 juice, 68 Leptandra, 245 Lettuce-opium, 244 Libra, 30 Licorice, 219 Lime, 137 water, 137 Limones, 245 Limonis cortex, 245 succus, 245 Lini farina, 246 Linimenta, 246 Liniments, officinal, 246 Linimentum aconiti, 77 ammonige, 99 calcis, 137, 247 camphorae, 139 cantharidis, 143 cod- 291 34 Linimentum chloroformi, 163 plumbi subacetatis, 291 saponis, 139, 322 terebinthinae, 343 Linseed meal, 246 oil, 246 Linum, 246 Liquor ammonii acetatis, 63, 99 arsenici chloridi, 1 17 arsenici et hydrargyri iodidi, 117, 225, 235 barii chloridum, 124 calcii chloridi, 137 calcis, 137 ferri chloridi, 206 ferri citratis, 68, 206 ferri dialysatus, 362 ferri nitratis, 207 ferri subsulphatis, 207 ferri tersulphatis, 207 gutta-perchae, 163, 222 hydrargyri nitratis, 225 iodinii compositus, 235 magnesiae citratis, 68, 251 morphiae sulphatis, 270 plumbi subacetatis, 291 plumbi subacetatis dilutus, 29 1 potassae, 296 potassii arsenitis, 1 17 potassii citratis, 68, 297 potassii permanganatis, 297 sodae, 331 sodae chlorinatae, 332 sodii arseniatis, 117, 331 zinci chloridi, 351 Liquores, 250 Liquors, officinal, 250 Lister's antiseptic system, 65 Lithii carbonas, 248 citras, 68, 248 Lithium, 248 Lobelia, 249 Logwood, 222 Lumbago, hypodermic injections of morphia in, 278 Lupulina, 224 Lycopodium, 251 Mace, 257 Macis, 257 Magnesia, 251 Magnesii carbonas, 251 402 GENERAL INDEX Magnesii sulphas, 251 Magnesium, 251 Male fern, 211 Malt extract, 223 Manganese, 253 Manganesii oxidum nigrum, 253 sulphas, 251 Manganesium, 253 Manna, 253 Maranta, 253 Marble, 253 Marjoram, 280 Marmor, 253 Marrubium, 254 Marshmallow, 97 Marsh-rosemary, 333 Mastic, 254 Mastiche, 254 Materia medica, primary list of, 61 Matico, 254 Matricaria, 254 May-apple, 295 Measures, domestic, 30 Meconine, 280 Mel, 254 despumatam, 254 rosae, 314 Mellita, 255 Mentha piperita?, 255 viridis, 255 Mercurial baths in syphilis, 229, 231 Mercurialisation, 230 Mercury, 224 Mezereon, 255 Mezereum, 255 Milk of almonds, 105 of ammoniac, 99 of assafetida, 121 Mineral waters, 113 Minimum, 30 Misturae, 256 Mistura ammoniaci, 98 amygdalae, 61, 105 assafcetidse, 121 chloroformi, 139, 163 cretae, 61, 137 ferri composita, 206 glycyrrhizse composita, 61, 219 potassii citratis, 245 Mixtures, officinal, 256 Molasses, 318 Monarda, 256 Mori succus, 363 Morphia, 270 Morphia? acetas, 270 murias, 270 sulphas, 270 Moschus, 256 Mucilages, officinal, 256 Mucilagines, 256 Mucilago acaciae, 61 sassafras medullar, 324 tragacanthae, 347 ulmi, 347 Mulberry-juice, 363 Musk, 151,256 Mustard, 329 poultice, how to make, 331 Mydriasis by belladonna, 126 Mydriatic, hyoscyamus as a, 233 Myristica, 256 Myrrh, 257 Myrrha, 257 Narceia, 279 Narcotic effects of alcohol, 85 Narcotics, when to be given, 19 Narcotina, 279 Nectandra, 258 Neroli water, 122 Nitrate of ammonium, 99 Nitric acid, 73 Nitrite of amyl, 92 Nitro-muriatic acid, 75 Nitrous oxide gas, 104 Norwood's, Dr., tincture of vera- trum viride, 350 Nutgall, 213 Nutmeg, 256 Nux vomica, 259 Oak, 312 Oat-meal, 123 Octarius, 30 Oil of almonds, expressed, 105 of amber, 267 of anise, 106 of bergamot, 132 of bitter almonds, 105 of cajuput, 136, 150 of camphor, 1 39 of caraway, 149 of chamomile, 106 GENERAL INDEX. 403 Oil of cloves, 150 of neroli, 122 of sweet almonds, 105 of thyme, 268 of wormseed, 153 Oils, officinal, 262 Ointment, antimony, 107 belladonna, 124 benzoin, 132 cantharides, 143 carbolic acid, 64 rose-water, 105 Ointments, 81 Olea, 262 Oleo-resinae, 312 Oleo-resina capsici, 146 cubebae, 190 filicis, 211 lupulinae, 224 piperis, 289 zingiberis, 353 Oleo-resin of capsicum, 146 Oleo-resins, officinal, 312 Oleum aethereum, 262 amygdalae amarse, 105 amygdalae expressum, 105 anisi, 106 anthemidis, 106 bergamii, 132 cajuputi, 136 camphorae, 139 cari, 149 caryophylli, 150 chenopodii, 153 cinnamomi, 179 copaibae, 186 cubebae, 191 erigerontis Canadensis, 204 fceniculi, 212 gaultheriae, 216 hedeomae, 223 juniperi, 242 lavandulae, 244 limonis, 245 lini, 246 menthae piperitae, 255 menthae viridis, 255 monardae, 256 morrhuae, 262 myristicae, 256 olivae, 265 origani, 280 Oleum pimentae, 280 ricini, 265 rosae, 314 rosmarini, 315 rutae, 315 sabinae, 317 sassafras, 324 sesami, 364 succini, 267 succini rectificatum, 267 tabaci, 340 terebinthinae, 343 theobromae, 267 thymi, 268 tiglii, 268 Valerianae, 348 Olive oil, 265 Opium, 270 effect on rabbits of, 33 idiosyncrasy in regard to, 22 in childhood, 27 Opodeldoc, 268 Orange, 122 flowers, 122 Orange-peel, bitter, 122 sweet, 122 Orgeat syrup, 105 Origanum, 280 Os, 280 Ovum, 280 Oxalate of cerium, 152 Oxalic acid, 75 Oxide of antimony, 107 Oxymel, 63 Oxysulphuret of antimony, 107 Oyster-shell, 346 prepared, 137 Pain relieved by counter-irritants, Painters' colic, 294 Papaver, 280 Papaverina, 279 Paramorphia, 279 Paraplegia, alcoholic, 86 Parasiticides, 47 Paregoric, 270 Pareira, 280 brava, 280 Parsley, 364 Partridge -berry, 216 Pearl-ash, 296 404 GENERAL INDEX. Peculiarites, individual, 22 Pennyroyal, American, 223 Pepo, 281 Pepper, 289 Peppermint, 255 Pepsin, 363 Pepsina porci, 363 Perspiration caused by emetics, 54 Peruvian bark, 170 Petroselinum, 364 Phosphorus, 281 Physiological antidotes, 38 Physiology of vomiting, 52 Physostigma, 285 Pill, Guy's, 232 Plummer's, 107 Pills, officinal, 288 Pilocarpia, 358 Pilula ferri carbonatis, 207 saponis composita, 270, 322 Pilulae, 288 aloes, 95 aloes et assafcetidae, 95, 121 aloes et mastiches, 95 aloes et myrrhae, 95, 257 antimonii compositae, 107 assafcetidae, 121 catharticae compositae, 225 copaibae, 186 ferri compositae, 207 ferri iodidi, 207, 235 galbani compositae, 121, 213 hydrargyri, 224 opii, 270 quiniae sulphatis, 1 70 rhei, 313 rhei compositae, 95, 313 scillae compositae, 98, 325 Pimenta, 289 Pimento, 150, 289 Pinkroot, ^33 Pint, imperial, 30 Piper, 289 Piperin, 289 Pipsissewa, 153 Pix Burgundica, 289 Canadensis, 289 liquida, 290 Plan of arrangement, 32 Plaster, warming, 143 Plasters, officinal, 200 Plumbi acetas, 291 Plumbi carbon as, 291 iodidum, 291 nitras, 291 Plumbum, 291 Podophyllin, 295 Podophyllum, 295 Poisoning, 37 (see Index of Dis- eases) by acids, 42 by alcohol, 85 by ammonia, 101, 102 by amylic alcohol, 91 by antimony, 199 by arsenic, 1 17 by belladonna, 131 by bitter almonds, 105 by carbolic acid, 67 by chloral, 154, 157 by chloroform, 163 by copper, 192 by corrosive sublimate, 225 by hemlock, 186 by hydrocyanic acid, 71 by iodine, 235 by lead, 292 by opium, 270, 275 by phosphorus, 281, 284 by physostigma, 288 by santonin, 324 by strychnia, 259, 261 by tartar emetic, 107 by tobacco, 340 by veratria, 316 vegetable, 148 Pomegranate, 311 Poppy capsules, 280 Port wine, 84 Potassa, 296 Potassa alum, 98 Potassa cum calce, 137, 296 with lime, 137 Potassii acetas, 63, 296 bicarbonas, 296 bichromas, 297, 302 bitartras, 297 bromidum, 134, 297, 303 hints on prescribing, 25 carbonas, 296 carbonas impura, 296 pura, 296 chloras, 297 citras, 68, 297 GENERAL INDEX. 405 Potassii cyanidum, 297 et sodii tartras, 297 ferrocyanidum, 207, 297 hypophosphis, 297 iodidum, 297, 305 iodidum and hydrargyri chlori- dum corrosivum, 26 nitras, 297 permanganas, 297 sulphas, 297 Potassium, 296 Potassium bromide, 134 sulphis, 297 sulphuretum, 297 tartras, 297 Poultice, hop, 224 yeast, 206 Powders, officinal, 311 Precipitated carbonate of lime, 137 phosphate of lime, 137 Prepared chalk, 137 Prescribing, rules for, 15 for children, 26 Prescription writing, 28 Prescriptions, how to write, 15, 28 Proper time for exhibiting drugs, 18 Prunes, 310 Prunum, 310 Prunus Virginians, 310 Prussian blue, 206 Pulveres, 311 effervescentes, 75, 331 effervescentes aperientes, 75, 332 Pulvis aloes etcanellae, 95, 141 aromaticus, 180 ipecacuanhge comp., 237, 270 jalapae compositus, 241 rhei compositus, 313 Pumpkin-seeds, 281 Punica granatum, 311 Purgative, action of, 57 alum as a, 98 classes of, 56 combination of, 59 for children, 27 when to be given, 19 Purging cassia, 150 Purified aloes, 95 ox-bile, 357 Pyroxylon, 220 Quassia, 311 Queen's-root, 334 Quercus alba, 312 tinctoria, 312 Questions, 369 Quicklime, 137 Quinia, administration of, 177 idiosyncrasy m regard to, 22 sulphas, 170 valerianas, 349 Quinic acid, 178 Quinidia, 179 Quino-tannic acid, 178 Raisins, 347 Red saunders, 319 Refrigerants, antipyretics and, 44 Remedies, certain classes of, 37 officinal, 61 . Resin, 312 Resina, 312 jalapae, 241 podophylli, 295 scammonii, 324 Resinse, 312 Resins, officinal, 312 Rhamni succus, 364 Rhatany, 244 Rheum, 313 Rheumatoid arthritis, 222 Rheumatism, pathology of, 73 Rhubarb, 313 Rochelle salt, 297 Rosa centifolia, 314 gallica, 314 Rose, 314 Rosemary, 315 Rosmarinus, 315 Rottlera, 363 Rubus, 315 Rue, 315 Rules for prescribing, 15 Ruta, 315 Sabadilla, 316 Sabina, 317 Saccharum, 318 lactis, 318 Saffron, 190 Sage, 319 Sago, 318 Salicin, 364 Salicylic acid, 365 406 GENERAL INDEX. Saline purgatives, 58 waters, 114 Salvia, 319 Sambucus, 319 Sanguinaria, 319 Sanguisuga officinalis, 368 Santalum, 319 Santonica, 320 Santonium, 320 Sapo, 322 viridis, 323 Saratoga water, 114 Sarsaparilla, 323 Sassafras, 324 medulla, 324 Savine, 317 Scammonium, 324 Scammony, 324 Scheele's solution, 72 Scilla, 325 Scoparius, 326 Scrupulum, 30 Scudamore's mixture, 182 Secretion altered by acids, 40 Seidlitz powders, 75, 332 Seltzer water, 114 Senega, 327 Seneka, 327 Senna, 328 American, 150 Serpentaria, 329 Sevum, 329 Sherry wine, 84 Silver, 115 cyanide of, 115 fused nitrate of, 115 in surgery, 115 nitrate of, 115 oxide of, 115 pills of nitrate of, liable to ex- plode, 115 toleration of, 1 16 Sinapis alba, 329 nigra, 329 Skin discoloration from silver salts, 116 Slippery-elm, 347 Snakeroot, 169, 329 Soap, 322 Socotrine aloes, 95 Soda, 331 mint, 333 Soda powders, 75, 331 Sodii acetas, 331 arsenias, 117, 331 bicarbonas, 331 bicarbonas venalis, 331 boras, 331 carbonas, 331 carbonas exsiccata, 332 chloridum, 331 hypophosphis, 331 hyposulphis, 331 nitras, 331 phosphas, 332 sulphas, 331 sulphis, 331 Sodium, 331 arseniate of, 117 Solution of acetate of ammonium, 99 of ammonia, 99 of arseniate of sodium ,117 of arsenite of potassium, 117 of carbolic acid, 64 of chloride of arsenic, 117 of chloride of barium, 124 of chloride of lime, 137 of iodide of arsenic and mercury, 117 of lime, 137 Spanish-fly, 143 Spearmint, 255 Specific action of quinia, 175 Spermaceti, 152 cerate, 152 Spigelia, 333 Spirit of ammonia, 99 of ammonia, aromatic, 99 of camphor, 139 Spirits, officinal, 91 Spiritus aethens compositus, 81, 9 1 aetheris nitrosi, 84, 91 ammonise, 99 ammonise aromaticus, 99 anisi, 106 camphorae, 139 chloroform! , 1-63 cinnamomi, 180 frumenti, 84, 333 Geneva?, 84 juniperi, 243 juniperi compositus, 243 lavandulae, 244 GENERAL INDEX 407 Spiritus lavandulas compositus, 244 limonis, 245 menthas piperitas, 255 menthas viridis, 255 myrciae, 84, 333 myristicas, 256 saponatus kalinis, 323 vini Gallici, 84, 333 Spurred rye, 201 Squill, 325 Starch, 105 of carina, 141 Statice, 333 Stillingia, 334 Stimulant, ammonia as a, 102 Stimulants, alcoholic, 85 Stomach, calomel in irritable, 20 gray powder in irritable, 20 Stomach-pump, caution in regard to, 37 Storax, 335 Stramonium, 334 Strong alcohol, 84 Stronger aether, 81 Strychnia, 259 eaten by pigeons, 33 hints on prescribing, 25 injections, 260 poisoning, chamomile in, 106 Strychniae sulphas, 259 Strychnos ignatia, 234 nux vomica, 259 Styrax, 335 Styria, arsenic-eating in, 23 Succi, 183, 339 Succus conii, 183 taraxaci, 342 Suet, 329 Sugar, 318 of lead, 291 milk, 318 Sulphate of aluminium, 98 of aluminium and ammonium, 97 of aluminium and potassium, 98 of ammonium, 99 ofatropia, 124 of iron and ammonium, 99 Sulphur, 335 baths in skin diseases, 336 lotum, 335 praecipitatum, 335 sublimatum, 335 Sulphurated antimony, 107 Sulphuret of antimony, 107 Sulphuretted waters, 114 Sulphuric acid, 338 Sulphuris iodidum, 335 Sulphurous acid, 337 Sumbul, 367 Suppositoria, 267 acidi carbolici, 64 acidi tannici, 213 aloes, 95 assafcetidae, 121 belladonnas, 124 morphias.. 270 opii, 270 plumbi, 291 plumbi et opii, 270, 291 Suppositories, aloes, 95 assafcetida, 121 belladonna, 124 carbolic acid, 64 officinal, 267 Sweet almond, 105 Sweet spirit of nitre, 84, 91 Syphilis, 222 Syrup, orgeat, 105 Syrupi, 318 Syrups, officinal, 318 Syrupus acacias, 61 acidi citrici, 68, 245 allii, 63, 94 amygdalae, 105 aurantii corticis, 122 fiorum, 122 ferri iodidi, 207, 235 fuscus, 318 ipecacuanhas, 237 kramerias, 244 lactucarii, 244 limonis, 245 papaveris, 280 pruni Virginianas, 310 rhei, 313 aromaticus, 313 rosas Gallicas, 314 rubi, 315 sarsaparillae composition, 323 scillas, 325 compositus, 107, 325 senegas, 327 tolutanus, 123 zingiberis, 354 4o8 GENERAL INDEX. Tabacum, 340 Table-salt, 331 Taeniae, varieties of, 42 Tamarind, 342 Tamarindus, 342 Tapioca, 342 • Tnr, 290 Taraxacum, 342 Tartar emetic, 107 Tartaric acid, 75 Tartrate of antimony and potas- sium, 107 of iron and ammonia, 99 Tea, 136 Teaberry, 216 Temperature affected by acids, 40 reduced by baths, 112 Terebinthina, 343 Canadensis, 343 Testa, 346 praeparata, 137 Thebaia, 279 Theobroma, 267 Therapeutic deductions from physi- ological experiments, 33 Thieves' vinegar, 61 Thoroughwort, 204 Tinctura, 346 Tinctura aconiti radicis, 76 aloes, 95 aloes et myrrhse, 95, 257 arnicae, 116 assafcetidae, 121 aurantii, 122 belladonnas, 124 benzoini, 132 benzoini composita, 95, 123, 132 calumbae, 138 cannabis, 142 cantharidis, 143 capsici, 146 cardamom i, 149 composita, 149 castorei, 150 catechu, 151 cinchonas, 170 composita, 170 cinnamomi, 180 colchici, 181 conii, 183 cubebae, 191 digitalis, 193 Tinctura ferri chloridi, 206 gallae, 213 gentianae composita, 217 guaiaci, 222 guaiaci ammoniata, 222 hellebori, 223 humuli, 224 hyoscyami, 233 iodinii, 235 iodinii composita, 235 jalapae, 241 kino, 243 krameriae, 244 lobeliae, 249 lupulinae, 224 myrrhae, 257 nucis vomicae, 259 opii, 270 opii acetata, 62, 270 opii camphorata, 139, 270 opii deodorata, 270 quassias, 31 1 rhei, 313 rhei et sennae, 212, 313 sangumariae, 319 scillae, 325 serpentariae, 329 stramonii, 334 tolutana, 123 Valerianae, 348 Valerianae ammoniata, 348 veratri viridis, 350 zingiberis, 354 Tinctures, officinal, 346 Tobacco, 340 Tolerance of antimony, 109 of quinia, 172 of zinc sulphate, 353 Toleration of drugs, 23 Tonics, acids as, 41 Tragacanth, 347 Tragacantha, 347 Treatment of belladonna-poisoning, 124 Trimethylamine, 368 hydrochlorate of, 368 Troches, officinal, 347 Trochisci, 347 acidi tannici, 213 cretae, 137 cubebae, 191 ferri subcarbonatis, 206 GENERAL INDEX Trochisci glycyrrhizae et opii, 219, 270 ipecacuanhae, 237 magnesiae, 251 menthae piperitae, 255 morphiae et ipecacuanhae, 270 potassii chloratis, 297 santonini, 320 soclii bicarbonatis, 331 zingiberis, 354 Turmeric, 356 Turpentine, 343 Turpeth mineral, 225 Typhoid fever propagated by water, US Ulmus, 347 Uncia, 30 Unguenta, 81 Unguentum acidi carbolici, 64 acidi tannici, 213 antimonii, 107 aquae rosae, 105, 314 belladonnae, 124 benzoini, 132 canthaiidis, 143 creasoti, 190 gallae, 213 hydrargyri, 224 hydrargyri ammoniati, 225 hydrargyri iodidi rubri, 225 hydrargyri nitratis, 225 hydrargyri oxidi flavae,. 224 hydrargyri oxidi rubri, 224 iodinii, 235 iodinii compositum, 235 mezerii, 255 picis liquidae, 290 plumbi carbonatis, 291 plumbi iodidi, 291 potassii iodidi, 297 stramonii, 334 sulphuris, 335 sulphuris iodidi, 335 tabaci, 340 veratriae, 316 zinci oxidi, 351 Urine, affected by acids, 41 Uva passa, 347 Uva ursi, 347 Valerian, 348 35 ' 409 Valerianate of ammonia, 99 Valerianic acid, 349 Vallet's mass, 207 Vanilla, 349 Vapor of steam in therapeutics, 113 . Veratralbia, 349 Veratria, 316 Veratroidia, 351 Veratrum album, 349 viride, 350 Vienna paste, 137 Vina, 351 Vinegar, 62 Vinum aloes, 95 antimonii, 107 colchici radicis, 180 colchici seminis, 181 ergotae, 201 ipecacuanhae, 237 opii, 270 Portense, 84 rhei, 141, 313 tabaci, 340 Xericum, 84 Virginia Sulphur Springs, 1 14 Vomiting, physiology of, 52 therapeutics of, 52 Warm bath in children's com- plaints, 112 Warner's gout cordial, 313 Water, 1 1 1 ammonia, 99 ammonia, stronger, 99 anise, 106 bitter almond, 105 camphor, 139 orange-flower, 122 Wax, 152 white and yellow, 152 Weights and measures, 29 Wheat flour, 205 hellebore, 349 Whiskey, 84 Wild cherry, 310 Wines, officinal, 351 Wintergreen, 153, 216 Wistar's cough lozenges, 270 Wormseed, 153 Wormwood, 61 Wrist-drop, 294 4io GENERAL INDEX. Yeast, 206 Yellow jasmine, 216 Zinc, 351 Zinci acetas, 63, 351 carbonas praecipitata, 35 1 chloridum, 351, 352 oxidum, 351 Zinci oxidum venale, 351 sulphas, 351 sulphas in chorea, toleration of, 24 valerianas, 349, 351 Zincum, 351 Zingiber, 353 Zittmann's decoction, 232 PARRISH'S PHARMACY— New Edition— Lately Issued. A TREATISE ON PHARMACY. Designed as a Text-book for the Student, and as a Guide for the Physician and Pharmacist. By Edward Parrish, late Professor of Materia Medica in the Philadel- phia College of Pharmacy. Fourth edition, thoroughly revised and enlarged, by Thomas S. Wiegand In one handsome octavo vol. of 977 pages, with 280 illustrations : cloth, $5 50 ; leather, $6 50. Of Dr. Parish's great work on pharmacy it only remains to be said that the editor has accomplished his work so well as to maintain, in this fourth edition, the high standard of excelh-nce which it had attained in previous editions, under the editor- ship of its accomplished author This has not been accomplished without much la- bor, and many additions and improvements, involving changes in the arrangement of the several parts of the work, and the addition of much new matter. With the modifications thus effected, it constitutes, as now presented, a compendium of the science and art indispensable to the pharmacist, and of the utmost value to every practitioner of medicine desirous of familiarizing himself with the pharmaceutical preparation of the articles which he prescribes for his patients. — Chicago Med Journ., July, 1S74. The work is eminently practical, and has the rare merit of being readable and in- teresting, while it preserves a strictly scientific character. The whole work reflects the greatest credit on author, editor, and publisher. It will convey some idea of the libe- rality which has been bestowed upon its production when we mention that there are no less than 280 carefully executed illustrations In conclusion, we heartily recom- mend the work, not only to pharmacists, but also to the multitude of medical prac- titioners who are obliged to compound their own medicines. It will ever hold an hon- ored place on our own book-shelves. — Dublin Mtd. Press and Circular, Aug. 12, 1874. Perhaps one, if not the most, important book upon pharmacy, which has appeared in the English language, has emanated from the transatlantic press. •' Parrish's Pharmacy" is a well-known work on this side of the water, and the fact shows us that a really useful work never becomes merely local in its fame. Thanks to the judicious editing of Mr. Wiegand, the posthumous edition of ■' Parrish" has been saved to the public with all the mature experience of its author, and perhaps none the worse for a dash of new blood.— London Pharm. Journ., Oct. 17, 1874. GRIFFITH'S UNIVERSAL FORMULARY -New Edition-Lately Issued. A UNIVERSAL FORMULARY ; Containing the Methods of Preparing and Administering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceutists. By Robert E. Grif- fith, M.D. , etc. Third Edition, thoroughly Revised, with nume- rous additions, by John M. Maisch, Professor of Materia Medica in the Phila. College of Pharmacy. In one large and handsome octavo volume of about 800 pages : cloth, $4 50; leather, $5 50. To the druggist a good formulsry is simply indispensable, and perhaps no formu- lary has been more extensively used than the well-known work before us. Many physicians have to officiate also as druggists. This is true e?pecially of the country physician, and a work which shall teach him the means by which to administer or combine his remedies in the most efficacious and pleasant manner, will always hold its place upon his shelf. A formulary of this kind is of benefit also to the city phy- sician in largest practice. — Cincinnati Clinic, Feb. 21, 1874. A more complete formulary than it is in its present form the pharmacist or physi- cian could hardly desire. To the first some such work is indispensable, and it is hardly less essential to the practitioner who compounds his own medicines. Much of what is contained in the introduction ought to be committed to memory by every stu- dent of medicine As a help to physicians it will be found invaluable, and doubtless will make its way into librai-ies not already supplied with a standard work of the kind. — The American Practitioner, Louisville, July, 1874. 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