Class _I BM ia il Book /imj Copyright If. COPYRIGHT BEPOSIIi A TEXT-BOOK OF PHARMACOLOGY, THERAPEUTICS AXD MATERIA MEDICA. / A TEXT-BOOK OF PHARMACOLOGY, THERAPEUTICS and ^J~^~~ MATERIA MEDICA. / BY T. LAUDER BRUNTON, M.D., D.Sc, F.R.S., Fellow of the Royal College of Physicians ; Assistant Physician and Lecturer on Materia Medica at St. Bartholomeio 's Hospital ; Examiner in Materia Medica in the University of London, in the Victoria University, and in the Royal College of Physicians, London; Late Examiner in the University of Edinburgh. ADAPTED TO THE UNITED STATES PHARMACOPEIA BY FRANCIS H. WILLIAMS, M.D., Boston, Mass. PHILADELPHIA LEA BROTHERS & CO 1885 «>' ^ &* Entered according to the Act of Congress, in the year 1885, by LEA BROTHERS cV CO., in the office of the Librarian of Congress. All rights reserved. A. T. ZEISIXG A (0., PRINTERS. TO THE MEMORY OF SIR ROBERT CHRISTISON, Bart., &c. HIS HONORED TEACHER, AND TO CARL LUDWIG, HIS EELOVED MASTER, This Book is gratefnlly Dedicated BY THE AUTHOR, PREFACE. Some apology is required for the long delay in the appearance of this work, for a number of years have now elapsed since it was advertised as being in the press. More than fifteen years ago, I had a work on Materia Medica completely written out and ready for the printer. Some time afterwards, all the arrangements had been made for its publication, and in the course of a few weeks it was to have been issued from the press. Just as I was about to send it to the printer, however, I asked for a little delay in order that I might make some improvements and remove some redundancies, for the work as it then stood was considerably larger than the present one. As I went through it, I found so many unsatisfactory statements and uncertainties regarding the mode of action of drugs, which I thought I could decide by a few experiments, that I wished for a little time in order that those doubtful points might be settled; but as I went on the labor grew, other engagements became pressing, and longer and longer delay was required. From greater experience as a teacher and examiner also, I came to the conclusion that the plan of the work might be altered with advantage ; and so finally the whole manuscript was thrown aside, and the book entirely rewritten. In the original work I discussed the physiological and therapeutical actions of each drug separately, in the same way as in the third part of the present work, though on a much more extended scale. I found, however, that this plan necessitated a good deal of repetition regarding the experimental methods by which the action of the drugs had been ascertained. Moreover, the physician does not want to know only what the actions of any one drug are ; he rather requires a knowledge of drugs, and of (?) 8 PREFACE. the manner in which the actions of the individual members of a class differ from each other. He requires, in fact, a knowledge of the ways in which the various functions of the body can be influenced by drugs both in health and disease, in order that he may restore health to his patients. It has appeared to me, therefore, better to devote a complete section of the work to a discussion of the methods by which the action of drugs is determined ; to the manner in which each function of the body can be modified by drugs ; and to the general rationale of the use of drugs in disease, i.e., to devote a section to general pharmacology and general therapeutics. Considerable experience both in teaching and examining has shown me that students sometimes find a difficulty in applying physiology to pharmacology and therapeutics, and I find that many others are, like myself, apt to forget those parts of physiology which they are not con- stantly studying. I have therefore thought it well, for the sake both of students and practitioners, to give a short account of the normal functions of the different parts of the body, before I proceed to discuss the altera- tions which are produced in them by drugs, or which they undergo in disease. In the case of the heart and the kidneys also, where the action of drugs is complicated and difficult, I have found it necessary to enter a little more fully into the physiology of these organs than is done in the ordinary text-books. I have found that a similar difficulty occurs with pathology as with physiology, and I have therefore occasionally discussed pathological ques- tions when 1 have thought that by doing so I could render the action of drugs in disease more intelligible, and thus aid the student of rational therapeutics. In the second pari of the work on general pharmacy, I have classed her the various pharmaceutical preparations and given lists of them for reference. li is by no means my intention that these should be Learned by bearl by any student, and indeed I think it is well to take this opportunity of protesting against the injustice of the demands which are sometimes made upon the memories of students. It is probable thai the majority of the best and most successful prac- titioners would be yery much puzzled if they were required to state the PEEFACE. y exact quantity of every ingredient in each pill or each ointment that they prescribe, or the exact quantity of the crude drug from which the infu- sions or tinctures which they use have been made. They know the action of the pill or ointment, they know the action of the infusion or tincture, and they do not trouble themselves about details which are only useful to the chemist who is making up the preparation. It is very greatly to be regretted, for it is a stumbling-block in the way of true progress, that students who have afterwards to become med- ical practitioners and not pharmaceutical chemists, should be asked at examinations the quantities of crude drugs from which particular prepa- rations are made — quantities which even the manufacturing chemist him- self would never dream of carrying in his memory, but would obtain by reference to his books whenever he required them. As the late Pro- fessor Sharpey used very truly to say, "You may as well require of a medical student a knowledge of the whole art of cutlery before you set him to dissect." Medical science is now advancing in every direction, and unless we cut off some of the less useful kinds of information, which medical students were formerly obliged to acquire, it becomes impossible for them to learn all that is truly valuable. In Materia Medica we now oblige them to learn the physiological action of drugs, a subject regard- ing which, until quite recently, little or nothing was known, and to oblige them to learn all this, in addition to what they were formerly expected to know, is to treat them as Pharaoh treated the Israelites, and compel them to make the same number of bricks, while giving them no straw. I am so much impressed with the necessity of lessening the amount of unnecessary work sometimes required as a preparation for examina- tions, that at first I omitted from this book all reference to the compo- sition of pharmaceutical preparations. But as it is intended not only as a itxc-book for students, but also for the use of practitioners, I afterwards considered that it might be convenient to have the composition of some pharmaceutical preparations, at least, for the purpose of reference. I have omitted the composition of such preparations as are likely to be got ready made from a chemist, but have inserted the composition of infu- sions which often need to be prepared when required. I have also given the composition of various compound pills, but only for the purpose of reference. 10 PREFACE. In the preparation of this work I have to acknowledge my obligations to the admirable works of Bartholow, Binz, Buchheim, Dujardin-Beau- metz. Edes, Husemann, Nothnagel, and Rossbach, Ringer, Schmiedeberg, and H. C. Wood. Messrs. Chapman, Soutter, Spencer, Steinthal, Stubbs, Wells, and Wright for the excellent notes. they took of my lec- tures; to Dr. D'Arcy Power for the verification of references; to Dr. Mitchell Bruce, Mr. T. W. Shore, and Mr. H. W. Gardner for much kind assistance in the preparation of the work, and to Prof. Matthew Hay, of Aberdeen, whose criticisms and suggestions have been invaluable. To Dr. Francis H. Williams, of Boston, Mass., I am indebted for the adaptation of this work to the United States Pharmacopoeia, which, by tending to familiarize medical men on each side of the Atlantic with the preparations employed in both countries, may, I trust, tend to facilitate the introduction of an International Pharmacopoeia. T. Lauder Bruntox. March, 16-5. CONTENTS. PAGE INTRODUCTION 33 SECTION I. GENERAL PHARMACOLOGY AND THERAPEUTICS. CHAPTER I. General Relations between the Organism and Substances Affecting it, pp. 35-52. List of Elements 35 Nature of Elements 37 Classification of Elements 41 Organic Radicals 47 Chemical Reactions and Physiological Reactions 47 Relation between Atomic Weight and Physiological Action .... 49 Relation between Spectroscopic Characters and Physiological Action . . 49 Relation between Isomorphism and Physiological Action . . . . 51 CHAPTER II. Circumstances which Affect the Action of Drugs on the Organism, pp. 52-67. Interaction of Various Functions .52 Direct and Indirect Action 53 Local and Remote Action 53 Relation of Effect to Quantity of Drugs 53 Homoeopathy 54 Dose 54 Size .55 Mode of Administration 55 Cumulative Action 57 Effect of Different Preparations 58 Effect of Fasting . 58 Effect of Habit 58 Effect of Temperature 59 Effect of Climate 62 Effect of Time of Day 62 Effect of Season 62 Effect of Disease 63 Use of Experiments 63 Comparative Pharmacology 63 Idiosyncrasy 64 Objections to Experiment 65 Erroneous Deductions from Experiments ' 67 (ii) 12 CONTEXTS. CHAPTER III. Action of Drugs on Protoplasm, Blood, axd Low Organisms, pp. 68- Action of Drugs on Albumen Action of Drugs on Protoplasmic Movements .... Method of Experimentation Movements of Leucocytes in the Blood Vessels ... Movements of Red Blood Corpuscles Action of Drugs on Infusoria Relations of Motions and Oxidation Oxidation of Protoplasm Oxygen Carrying Power of Protoplasm Ozonizing Power of Protoplasm Action of Drugs on Oxidation Action of Drugs on Blood Catalysis — Fermentation — Inorganic Ferments Ferments. Organic and Organized Action of Drugs on Enzymes Zymogens Organized Ferments Feasts ........... Moulds Bacteria Actions of Drugs on the Movements of Bacteria Actions of Drugs on the Reproduction of Bacteria . Mode of Experimenting on the Action of Drugs on the Reproduction Actions of Drugs on Particular Species of Bacilli . Actions of Drugs on the Development and Growth of Bacilli Iniluence on Antiseptics of the Solvent . Influence on Antiseptics of the Admixture Iniluence on Antiseptics of the Temperature Alterations in Bacteria by Heat and Soil le Identity of Different Forms Action of Bacteria and their Products on the Animal Alkaloids formed bj Putrefaction — Ptomaines of Drugs on the Action of Bacteria in the Animal Body Antiseptics — Antizymotics — Disinfectants — Deodorizers i of Am iseptics . Disinfectants A m iix riodics Body of Bacteria -109. PAGE 68 70 70 72 73 73 75 77 78 78 79 79 82 83 85 87 88 89 89 91 93 93 97 97 99 100 101 101 101 102 103 103 104 105 106 108 108 108 Action m <t' I ►rage on Moll Ascidians on of I>i uiM "ii Annulosa CHAPTEE IV. r Dbugs on Invebtebbata, pp. 109-116. CHAPTEE V. Lcnos "i Dei os <>\ Mi bole, pp. 116 138. ■ •: I tragi on Voluntary Muscle lit v <-i Muscle 109 114 114 115 116 117 CONTENTS. 13 Contraction of Muscle Latent Period of Muscle Summation of Stimuli Curve of Muscular Contraction Effect of Fatigue and Temperature Contracture . . . Tetanus Muscular Poisons .... Propagation of the Contraction Wave in Muscle Ehythmical Contraction of Muscle . Connection between Chemical Constitution and Physiological Action in Action of Drugs on Muscle is Eelative and not Absolute Action of Drugs on Involuntary Muscular Fibre Effect of Stimuli Relation of Contractile Tissue to the Nerves Propagation of Contraction Waves Artificial Rhythm Hypothetical Considerations regarding the Action of Drugs on Muscle CHAPTER VI. Action of Drugs on Nerves, pp. 138-147. Action of Drugs on Motor Nerves . Paralysis of Motor Nerve-endings by Drugs . Irritation of Motor Nerve-endings . Action of Drugs on the Trunks of Motor Nerves Action of Drugs on Sensory Nerves Local Sedatives and Local Anaesthetics . CHAPTER VII. Action op Drugs on the Spinal Coed, pp. 147-167. Action on the Conducting Power of the Cord Action of Drugs on Reflex Action .... Direct, Indirect and Inhibitory Paralysis of the Spinal Indirect Paralysis .... Direct Paralysis .... Spinal Depressants and their Uses Inhibitory Paralysis Nature of Inhibition Interference in Nervous Structures Effect of Altered Rate of Transmission Opposite Conditions Produce Similar Effects The Same Conditions may Cause Opposite Effects Stimulation and Inhibition merely Consequences of Relation Test of the Truth of the Author's Hypothesis regarding Inhibition Explanation of the Action of Certain Drugs on this Hypothesis Stimulating Action of Drugs on the Reflex Powers of the Cord Localization of the Action of Strychnine by Magendie . Spinal Stimulants . . . CHAPTER VIII. Action of Drugs on the Brain, pp. 167-196. Functions of the Brain in the Frog Functions of the Brain in the Higher Animals PAGE . 117 . 118 . 120 . 120 . 121 . 122 . 123 . 124 . 128 . 128 . 128 Muscle 130 . 131 . 132 . 133 . 134 . 134 . 135 . 136 138 140 143 144 144 146 Cord by Drugs 147 151 151 152 152 153 153 154 156 156 157 157 157 157 158 163 163 167 167 168 11 CONTEXTS. Action of Drugs on Motor Centres in the Brain Irritant Action of Drags on Motor Centres in the Brain Convulsions - on the Sensory and Psychical Centres in the Brain a which Increase the Functional Activity of the Brain ilantfl i 81 imnlants .... which Lessen the Functional Activity of the Brain Hypnotics or Soporifics .... Anodyne- or Analgesics .... Adjuncts to Anodynes .... Anaesthetics - of their Action .... 81 • tdcs .... Mode of Administering Anaesthetics iic.-ia in Animals .... ofthe Discovery of Anaesthesia . Antispasmodics Actio: on the Cerebellum . PAGE 171 172 172 175 176 176 176 178 179 182 183 184 185 188 189 190 191 192 193 195 CHAPTER IX. ; Drugs on the Organs of Special Sexse, pp. 196-207 Action of I h ogs on the Eye Action of DmgS on the Conjunctiva m of Drags on the Lachrymal Secretion I ction of thi Eyeball - on the Pupil . Action of Drags On the Accommodation . d of Drags on the Intra-ocnlar Pressure Ol Mydriatics and Myotics m ol Drags on the Sensibility ofthe Eye d of ! tarugs in Producing Visions on Bearing on Smell CHAPTER X. " N "' DBUGS ON RE8PIBATION, pp. 207-228. ■ the Respiratory Centre piratory Centre ipiratorj Nervt bines nchia] Secretion [( onanism CHAPTER XI. " lM: LTION, pp. 229 300. 196 196 196 197 197 201 202 203 204 204 205 206 206 207 214 218 219 220 220 223 225 227 228 229 229 CONTENTS. Fainting and Shock Scheme of the Circulation . . . Circulation in the Living Body . Mode of Ascertaining the Blood-pressure Fallacies Alterations in Blood-pressure Relation of Pulse Rate and Arterioles to Blood-pressure Effect of the Arterioles on Pulse Curves . Investigation of the Action of Drugs on the Arterioles Method of Measurement by Rate of Flow Action of Drugs on Vaso-motor and Vaso-dilating Nerves Action of Other Parts on the Blood-pressure . Peflex Contraction of Vessels Action of Drugs on Reflex Contraction of Vessels . Comparative Effect of Heart and Vessels on Blood-pressure in Different Animals Influence of Nerves on Blood-pressure Causes of Alteration in Blood-pressure and Pulse Rate Action of the Heart on Blood -pressure . Effect of Drugs on the Pulse Rate .... Action of Drugs on the Cardio-inhibitory Action of the ' Reflex Stimulation of the Vagus .... Causes of Quickened Pulse Action of Drugs on Vagus Roots . . Action on Accelerating Nerves .... Stimulating Effect of Asphyxial Blood on the Medulla Stimulation of the Heart by Increased Blood-pressure Palpitation The Heart of the Frog Action of Drugs on the Heart of the Frog Action of Drugs on its Muscular Substance Differences Between the Heart Apex and the Heart Action of Drugs on Inhibition of the Heart Theories Regarding the Mode of Action of Drugs on the Drugs which Act on the Vagus Centre . Drugs which Act on the Accelerating Centre . Drugs which Act on the Vaso-motor Centre . Drugs which Act on the Vagus Ends in the Heart . Drugs which Act on the Inhibitory Ganglia . Drugs which Act on the Motor Ganglia . Drugs which Act on the Cardiac Muscle . Drugs which Act on the Vaso-motor Nerves . Drugs which Act on the Capillaries Stannius's Experiments General Considerations regarding the Heart . Regulating Action of the Nervous System Inhibition in the Heart Therapeutic Uses of Drugs acting ou the Circulation Cardiac Stimulants Vascular Stimulants Cardiac Tonics Risks Attending the Administration of Digitalis and other Cardiac Tonics Vascular Tonics Pathology of Dropsy . . . Heart 15 PAGE 230 232 233 234 235 236 237 240 243 246 248 249 250 251 252 253 257 258 259 260 261 261 261 262 262 262 283 263 265 269 272 274 275 279 279 279 280 280 280 281 281 282 282 285 286 290 291 291 292 293 296 297 297 16 Cardiac Sedatives Vascular .Sedatives CONTEXTS. PAGE 299 300 Remedies Acting on Irritants and Counter-irritants Rubefacients nta . Postulants Caustics .... Emollients and Demulcents Astringents Styptics .... CHAPTER XII. the Surface of the Body, pp. 301-310. CHAPTER XIII. on the Digestive System, pp. Action of Drugs Action of Drugs on the Teeth Bialagogues Hon by the Saliva . i rants Pathology of Thirst . Antisialics Gastric Tonics . Appetite .... Action of Drugs on Secretion in the Stomach . Action of Drugs on the Movements of the Stomach Absorption from the Stomach .... Antacids Emetics Gastric Sedatives and Anti-emetics . Carminatives Action of Drugs on the Intestines [ntestinal Movements and Secretion Paralytic Secretion Constipation Action of Drugs on Absorption from the Intestines : ill Astringents Purgatives A-age .... Inunction Endermic Application of Drugs Hypodermic Administration of Drugs Objections to Hypodermic Injections Application of Drugs to the Eye Application of Drugs to the Ear Application of Drugs to the Nose . Application of Drugs to the Larynx Application of Drugs to the Lungs . Application of Drugs to the Mouth and Pharynx Masticatories — Gargles . Application of Drugs to the Stomach Stomach-pump .... < rflstric Syphon .... Application of Drugs to the Intestine Enemata Suppositories Application of Drugs to the Urethra Application of Drugs to the Vagina and Uterus PAGE 402 402 402 403 403 403 403 403 403 404 404 404 404 405 406 406 407 407 408 409 409 410 411 412 413 413 414 414 414 415 415 415 415 415 CHAPTER XVIII. Antidotes, pp. 416-421. Antidotes to Poisonous Gases Antidotes to Acids Antidotes to Alkalies ...... Antidotes to Metallic Salts, Alkaloids, &c. 416 417 417 418 CHAPTER XIX. An i ioonistic Action of Dkigs, pp. 422-425. CHAPTER XX. Dosage, p. 120. CONTENTS. 19 SECTION II. GENERAL PHARMACY. CHAPTER XXI. Phaemaceutical Pkepakations, pp. 427-454. PAGE Abstracta — Abstracts . . 428 Aceta — Vinegars 429 Alkaloidea— Alkaloids 429 Aquas — Waters 430 Cataplasmata — Poultices 431 Cerata — Cerates 431 Chartse— Papers 431 Coll odia— Collodions 432 Confectiones — Confections — Electuaries 432 Elixiria — Elixirs 433 Emplastra — Plasters 433 Enemata — Injections— Enemas — Clysters 433 Essentia — Essences : 434 Extracta — Extracts 434 Glycerina — Glycerita — Glycerines 437 Infusa — Infusions 437 Injectio Hypodermica — Hypodermic Injection 439 Linimenta — Liniments — Embrocations 439 Liquores — Solutions 440 Massse — Masses 441 Mellita — Honeys 441 Misturse — Mixtures 441 Mucilagines — Mucilages ' 442 Olea— Oils, Fixed and Volatile 442 Oleata— Oleates 443 Oleoresinse — Oleoresins 443 Oxymel 444 Pilulse— Pills 444 Pulveres — Powders 444 Resinre — Resins 445 Spiritus — Spirits 445 Suppositoria — Suppositories 446 Succi — Juices 447 Syrupi — Syrups 447 Tincturse — Tinctures 448 Triturationes — Triturations 451 Trochisci — Lozenges 451 Unguenta — Ointments 452 Vapores — Vapors — Inhalations • . 453 Vina — Wines 453 20 CONTENTS. SECTION III. INORGANIC MATERIA MEDICA. CHAPTER XXII. Hydrogex, Oxygex, Ozoxe, Caebox, Sulphur, axd the Halogexs, pp. 455-472. PAGE Hydrogen 455 Oxygen . Ozone Peroxide of Hydrogen Carbon Sulphur . Sulphuretted Hydrogen Halogen Elements — General Source and Character General Action Chlorine . Chlorinated Lime Chlorinated Soda Bromine . Iodine Iodide of Sulphur Action of Iodine CHAPTER XXIII Acids, pp. 472-494 General Characters of Acids General Preparation of Acids General Action of Acids Sulphuric Acid Sulphurous Acid Hydrochloric Acid . Nitric Acid NUro-hydrochloric Acid Acid Phosphoric Acid Tartaric Acid . I Acid d * Sallic Arid rid p. 877) Tain, •1 'id . icid . . i p. 61 1 I CONTENTS. 21 CHAPTER XXIV. Metals, pp. 495-546. General Classification of the Metals .... General Tests tor Acid Radicals in Metallic Salts . Metals of the Alkalis. Their Characters and Reactions . General Physiological Action of the Alkalis . General Physiological Action of the Alkaline Group of Salts General Physiological Action of the Chlorides Group of Salts General Physiological Action of the Sulphates Group of Salts Comparative Action of the Alkaline Metals Monad Metals, Group I., Potassium, Sodium, Lithium . Potassium, General Sources and Reactions of its Salts Preparation of Potash Salts General Action of Potash Salts Characters, Action and Uses of Officinal Potash Salts Sodium, General Sources and Reactions of its Salts Preparation of its Salts General Impurities, Tests and Action .... Characters, Actions and Uses of Soda Salts Lithium, Sources, Reactions, Impurities and Tests of its Salts Actions Characters, Actions, and Uses of Officinal Lithium Salts Monad Metals, Group II., Ammonium .... Nature of Ammonium Salts Sources, Reactions and Preparation .... Impurities, Tests and Actions Characters, Actions and Uses of Officinal Ammonium Salts PAGE . 495 . 496 . 498 . 499 . 499 . 502 . 504 . 504 . 505 . 505 . 506 . 507 508-522 . 522 . 523 . 524 524-534 . 534 . 535 535, 536 . 536 . 537 537, 538 . 539 540-546 CHAPTER XXV. Metals (continued), Class II., Dyad Metals — Geoup I., Metals of the Alkaline Earths; Appendix, Metals of the Earths, pp. 546-562. Reactions of the Metals in Class II. 547 Class II., Group I., Metals of the Alkaline Earths 547 General Action of Metals of the Alkaline Earths 547 Calcium, Reactions, Preparation, Impurities and Tests of its Salts . . 548, 549 Characters, Action and Uses of Officinal Lime Salts .... 549-555 Class II., Group I., Appendix — Aluminium ....... 555 General Sources, Preparation, Reactions, Impurities and Tests of Alum Salts 555 Characters, Actions and Uses of Officinal Alum Salts .... 555-558 Cerium, Action and Uses of its Oxalate 558 Class II., Group II., Magnesium 559 Sources, Reactions and Preparation of Magnesium Salts 559 Impurities, Tests- and Action of Magnesium Salts 560 Characters, Actions and Uses of Magnesium Salts 560-562 CHAPTER XXVI. Metals (continued), The Heavy Metals, Class II., Groups III. and IV. and Class IV., pp. 562-600. General Actions of Heavy Metals 562 General Actions of Class II., Group III., Zinc, Copper, Cadmium and Silver . 565 Zinc, its Sources 566 22 CONTEXTS. General Reactions and Preparation of Zinc Salts General Impurities, Tests and Action of Zinc Salts Characters, Action and Uses of Officinal Zinc Salts Copper, its Sources, Reactions, Impurities and Tests Characters, Actions and Uses of Officinal Salts of Copper Cadmium, Characters, Action and Use of its Iodide Silver, Characters, Action and Uses of its Salts Class II., Group IV., Mercury General Sources and Reactions of Salts of Mercury- General Impurities, Tests and Action of Salts of Mercury Characters, Actions and Uses of Officinal Salts of Mercury Class IV., Tetrad Metals, Lead and Tin .... General Actions Lead, its Sources, Reactions, Impurities, Tests and Action Characters, Actions and Uses of Officinal Salts of Lead . Tin. Action and Uses of its Chloride .... PAGE . 567 . 568 568-572 . 572 572-574 . 574 574-578 . 578 . 578 . 579 583-593 . 593 . 593 . 594 596-600 . 600 CHAPTER XXVII. Class V., Pentad Elements— Nitrogen, Phosphorus, Arsenic, and Bismuth, pp. 600-623. Nitrogen and its Compounds Nitrous Oxide Phosphorus, its Preparation, Characters and Action Uses of Phosphorus Arsenic, its Sources and Tests General Action of Arsenic Prohahle Mode of Action of Arsenic in Phthisis Characters, Actions and Uses of Officinal Preparations of Arsenic Antimony, its Sources and Reactions ..... Genera] Action Characters, Action and Uses of its Officinal Preparations Bismuth, its Action Sources, Reactions, Preparation and Uses of its Salts Character, Action and Uses of its Officinal Preparations Antimony, 601 601 602 605 605 606 609 611, 612 613 613 617-621 621 621 622, 623 CHAPTER XXVIII. Metals (continued), Class VIII., Iron, Manganese, pp. 624,642 Iron, it- Sources and Reactions .... Impurities, Tests and Preparation of its Salts . ( teneral Action I racter, Action and Uses of its Officinal Preparations Manganese Class VIII., Group II., Gold and Platinum . Gold, Preparation and characters of its Chloride Platinum, Preparation, Uses and Action of its Chloride . 624 . 625 . 627 629-640 . 640 640 640 641 SECTION IV. ORGANIC MATERIA MEDIC A. (If \ITKK XXIX. Cabbok Compoi nds— Fatty Beeies, pp. 643-683. Chemistry of Carbon Compounds d Action of Carbon Compounds 643 644 CONTEXTS. 23 PAGE Bisulphide of Carbon 644 Hydro-Carbons 645 Benzin 646 Petrolatum. (Vaseline) 647 Alcohol 647 Methyl Alcohol 649 Alcohol, General Sources and Preparation 649 General Impurities, Tests and Action 649 Effect of Impurities on its Action 653 Chronic Alcoholic Poisoning . 653 Causes and Treatment of Alcoholism . . . 654 Uses of Alcohol 655 Officinal Alcoholic Preparations . . 657-660 Aldehydes, Ethylaldehyde and Paraldehyde 660 Simple Ethers, Ether 660 Saline Ethers 663 Ethereal Oil and Hoffman's Anodyne 663, 664 Acetic Ether 664 Nitrites of Ethyl and Amyl 664 Nitro-glycerine 668 Haloid Compounds 669 Bromide of Ethyl . 669 Iodide of Ethyl 669 Chloral Hydrate, its Preparation and Characters 670 Its Action 670 Treatment of Chloral Poisoning 672 Bromal Hydrate . ■ 673 Butyl Chloral Hydate 673 Bichloride of Methylene 673 Chloroform, its Preparation, Characters, Impurities and Tests . . . 674 Action of Chloroform 675 Dangers of Chloroform 678 Precautions in Using Chloroform . . 678 Uses of Chloroform • 680 Iodoform 681 CHAPTEE XXX. Caebon Compounds — Aeomatic Seeies, pp. 683-696. General Chemistry of the Aromatic Series . 683 General Action of the Aromatic Series . 687 Carbolic Acid 687 Creasote .... 690 Eesorcin .... 1 691 Hydroquinone . Pyrocatechin . Salicylic Acid . Naphthylin Naphthol Hydrochlorate of Eosanaline Chinoline 692 692 692 694 694 695 695 Kairin .... 695 Antipyrin 695 24 CONTENTS. SECTION V. VEGETABLE MATERIA MEDICA. CHAPTER XXXI. Sub-Kingdom I., Phanerogams. Class Exogens, Division I., Axgiospebms, Sub-Class I., Thalamifloe.e, pp. 697-752. Kanunculacea? Aconite Staphisagria . Pulsatilla Adonis Vernalis Cimicifuga Podophyllum Hydrastis Magnoleacese . Illicium Oil of Anise Menispermaceec Menispermuni Calumba Pareira Picrotoxin BerberidaceiC . Caulophyllum Papaveracese . Poppy Capsules Opium . Preparations of Opium Morphine Apomorphine Codeine Action of Opium Diagnosis of Opium Poisoning Treatment of Opium Poisoning Circumstances Modifying the Action of Opium Action of the Alkaloids of Opium <>!' Opium Rhoeas — Bed Poppy guinaria— Blood Boot lidoninm Celandine Crncifene .... Sinapie Mustard Armoracia Borseradish Viola Pansy Linseed Qeraniaceae .... ilium Cram -hill . CONTENTS. Polygalacese Senega . Krameria — Rhatany Sapindacese Guarana Erythroxylacese Erythroxylon — Coca — Cuca Malvaceae Gossypium — Cotton Pyroxylin — Gnn Cotton Collodion Althaea — Marshmallow Aurantiacese Orange . Oil of Bergamot Lemon . Bael Fruit Sterculiaceae (Byttneriacese) Theobroma — Cacao Ternstromiacese Tea Caffeine Guttiferse Cambogia — Gamboge Canellacese Canella Alba Vitaceas . Uv83 — Eaisins Vinum Xericum Vinnm Eubrum Zygophyllacese Guaiacnm Meliacese Azedarach Rutacese . Rutese . Oil of Sue Cusparia Diosmeae Buchu Xanthoxylese Xanthoxylum — Prickly Pilocarpus — Jaborandi Simarubacese . Quassia Ash 25 PAGE 730 730 731 732 732 732 732 734 734 735 735 736 737 737 739 739 741 741 741 742 742 742 744 744 744 744 745 745 745 745 745 745 746 746 747 747 747 747 747 747 748 748 749 752 752 CHAPTER XXXII. Class I., Exogenjs, Sub-Class II., Calyciflorje, pp. 753-792. Rhamnacese 753 Rhamnus — Frangula — Buckthorn 753 Cascara Sagrada . . . 753 Celastracese 753 Euonymus — Wahoo 753 26 CONTEXTS. Aquifoliacea? . Prinos — Black Alder Terebinthacece Anacardisa Mastiche Rhus Glabra — Sumach Rhus Toxicodendron — Poison Ivy Amyridacere or Burseracese Myrrh . Elemi Leguminosse Papilionacese . Glycyrrhiza — Liquorice Scoparius — Broom Tragacanth . Pterocarpus — Santalum — Red Sandal-wood Kiuo Balsam of Peru . Balsam of Tolu . Abrus — Jequirity Physostigma — Calabar Bean Hamatoxylon — Logwood Chrysarobinum — Chrysophanic Acid — Goa Caesalpinse .... Senna .... Cassia — Purging Cassia Tamarind . Copaiba — Copaiva Piscidia Erythrina — Jamaica Dogwood Mimoseaj Acacia Catechu Ery throphh cum — Casca — Sassy . Indigo Pomese Cvdonium— Qujnce Dryadeae Bubus— Blackberry liubus [daBus— Raspberry . Rosea Oil of Rose Rosa Centifolia — Cabbage Rose — Pale Rose i (tallica Red Rose Canina Dog Rose Cosbo Brayera .... Qaillaia -Soap Bark Amygdaleae Amygdala Dnlcia- Bweel Almond Amygdala Amara Bitter Almond Prune l'niiiiis Virginiana Wild Cherry r Americannm — Common Frankincense Turpentine ' )il of Turpentine . Oil of Scotch Fir . Sanitaa ■ Oleum Succini— Oil of Resin Larch Bark Burgundy I'itcli . ( lanada Pitch Tar oil of Tar Thuja Arbor Vii.r lllll 882 882 882 882 882 884 884 884 884 885 885 885 886 886 886. CONTENTS. 31 Coniferse — (continued Juniper . Savin PAGE 887 887 CHAPTEE XXXVI. Class II., Endogexs. Smilacere .... Sarsaparilla . Liliacere .... Allium — Garlic Squill . Aloe . . . Veratruin Viride . Cevadilla — Sabadilla — Veratrine Colchicum Orchidacese Vanilla Cypripedium Zingiberaceae . Zingiber— Ginger . Turmeric Iridacese .... Crocus — Saffron Iris Palmacese Areca Aracese .... Calamus — Sweet Flag Graminaceaa Wheat — Flour — Bread — Starch Couch Grass . Pearl Barley- Malt Sugar Treacle . Oatmeal 888 890 890 893 895 897 899 899 899 900 900 901 902 902 902 903 903 903 903 903 903 904 904 905 905 906 906 CHAPTER XXXVII. Sub-Kixgdom II., Cryptogams. Filices Male Fern Lichenes . Cetraria — Iceland Moss Litmus . Fungi Ergot Ustilago Beer Yeast Algse Chondrus — Irish Moss 907 907 907 907 908 908 908 911 912 912 912 32 CONTENTS. SECTION VI. ANIMAL KINGDOM. CHAPTEE XXXVIII. Class Mammalia .... Order Rodentia Castor .... Order Euminantia Musk .... Suet .... Curd Soap . Milk — Koumiss — Milk Sugar Pepsin Ox Gall Keratin Order Pachydermata Lard .... Order Cetaceae Spermaceti Class Aves Order Gallinae Egg Albumen and Yolk Class Pisces Order Sturiones . Ichthyocolla — Isinglass Order Teleosteae— Family Gadidse Cod-liver Oil Class Insecta Order Hymenoptera Honey Wax^ .... Order Hemiptera . Coccus — Cochineal order Coleoptera . Cantharis— Spanish Flies 1 Lnnelida .... Hirudo— the Leech GENERAL [NDEX [NDEX or DISEASE8 AND REMEDIES BIBLIOGRAPHICAL [NDEX PAGE 913 913 913 913 913 914 914 914, 915 916 916 918 918 918 919 919 920 920 920 920 920 920 921 921 922 922 922 923 924 924 925 927 027 !>31 977 1015 MATERIA MEDICA AND THERAPEUTICS. INTRODUCTION. By Materia Medica we understand a knowledge of the remedies employed in medicine. This knowledge may be subdivided into several divisions : Materia Medica proper, Pharmacy, Pharmacology and Thera- peutics. By Materia Medica proper we mean an acquaintance with the remedies used in medicine, the places whence they come, the crude sub- stances or plants which yield them, the methods by which they are obtained, and the means of distinguishing their goodness or purity, or of detecting fraudulent adulteration. By Pharmacy we mean the methods by which drugs are prepared and combined for administration. Pharmacology is a knowledge of the mode of action of drugs upon the body generally, and upon its various parts. It is of comparatively recent growth, but is now one of the most important subdivisions of Materia Medica. By Therapeutics we understand a knowledge of the uses of medi- cines in disease. Therapeutics may be either empirical or rational. By empirical we mean that drugs are tried hap-hazard, or with little knowledge of their action in some cases, and, being found successful, are again administered in other cases which seem to be similar. Perhaps the best example of the empirical use of a remedy is that of quinine in ague. We do not know with certainty what the pathological conditions are in this disease, nor how quinine acts upon them; all we know is that it has proved useful in cases of ague before, and therefore we give it again. Rational therapeutics consists in the administration of a drug because we know the pathological conditions occurring in the disease, and know also that the pharmacological action of the drug is such as to render it probable that it will remove or counteract these conditions. As an example, we may take the use of nitrite of amyl in certain forms of angina pectoris. The obvious symptoms in this disease are 3 (33) 34 INTRODUCTION. intense pain in the region of the heart, and fear of impending death. Sphygmographic tracings of the pulse taken during this condition show that the tension within the heart and vessels begin to increase as the pain comes on. and reaches such a height that the heart can barely empty itself. Observations on animals have shown that nitrite of amyl lessens the tension of the blood in the vessels; and we therefore give it in angina pectoris with the expectation that it will diminish the tension and remove the pain, and we find that it succeeds. But this example shows us only the first stage of rational therapeu- tics. We have removed by a remedy the pathological condition which immediately gives rise to the pain and danger of the patient, but the antecedent alterations of the heart, blood-vessels, and nervous system, which led to the occurrence of the pain,' are unaltered by the remedy. In order that our therapeutics should be completely successful, we must seek still further for something which will restore the circulation and nervous system to its normal condition and bring the patient back to a state of perfect health. But sometimes this is impossible. The organic changes which have occurred in the course of the disease may be so great, that we can hardly hope that any remedy will ever be discovered sufficiently powerful to remove them. We must therefore try to pre- vent them. Preventive medicine, or prophylaxis, is daily becoming more im- portant, and, probably before the end of this century, medical men will be employed more to prevent people from becoming ill than to cure them when disease has become fairly established. The advance of this branch of medicine has been greatly aided by the recent increase in our knowledge of the life-history of microbes and their action in causing disease. Our power to prevent disease will become greater when we know accurately the action of various drugs in destroying these microbes or preventing their growth. Pharmacology has made such rapid advances of late years that it is exceedingly difficult for many men who are engaged in practice to understand thoroughly either the methods by which it is studied, or its results. Many students also, although they may be able to pass a good examination in physiology, find it difficult to apply their physiological knowledge to pharmacology; and therefore in discussing the action of drugs upon the various functions of the body, I have sometimes entered more fully into the physiology of those functions than may seem to some at all either necessary or advisable. In discussing pharmacological questions, we are accustomed to speak of the action of a drug on the body, or on its various parts, but we remember the effect produced is not due to a one-sided action — that what we actually mean is the Re-action between the drug and the Various part- of the body. In some instances we know that the drug itself is changed in the body, as well as the function of the body modified by the drug; and in thoa where the drug itself is eliminated from the body apparently unaltered, it is probable that it lias entered into various chemical combinations within the body while circulating in the blood or :it in the tissues. SECTION I. GENERAL PHARMACOLOGY & THERAPEUTICS. CHAPTER I. GENERAL RELATIONS BETWEEN THE ORGANISM AND SUBSTANCES AFFECTING IT. In discussing the inter-action between the animal organism and the substances which act upon it, it may be well to take a slight glance first at the substances which compose its environment, although these will be afterwards considered more in detail. Of the elements composing the earth on which we live we at present know about seventy whose existence appears well established. They are as follows : — l Name of Element. Symbol. Atomic weight. Atomic weight very accurately determined. * 2 Aluminum, ^H Al 27 27-009 s Antimony, A?°senic, Sb As 120 75 119-955 74-918 Barium, Ba 136-8 136-763 4 Bismuth, Bi 207-5 207-523 5 JBoron, B 10-9 10-941 6 Brornme, Br 79-8 79-768 7 Cadmium, Cd 111-8 111-835 8 C8esium, Cs 132-6 132-583 •„.*.„„ CIA T?A • •• rnj,„ ^, . 1 From Remsen's Theoretical Chemistry, 2d Ed., xi-xii. The non-metallic ele- ments are distinguished by italics. *The following atomic weights accepted in Great Britain differ from those adopted in the United States : 2 27'3— 3 122-0— 4 210'0— 5 11'0— 6 79'75— 7 111'6— 8 133-0. (35) 36 PHARMACOLOGY AND THERAPEUTICS. Atomic Name of Element. Symbol. Atomic weight. weight very accurately determined. * Calcium, .... Ca 40 39-99 Carbon, C 12 11-9736 l) Cerium, Ce 140-4 140-424 Chlorine, . CI 35-4 35-37 10 Chromium, Cr 52 52-009 "Cobalt, Co 58-9 58-887 Columbium, Cb 93-8 93-812 l2 Copper, Cu 63-2 63-173 l3 Didvmium, Di 145-4 145-4 14 Erbium, . E 166 165-891 lr> Fluori?ie, . F 19 18-984 1(i Galliuni, . Ga 70 69-9 17 Glucinum, (Beryl lium) Gl(Be) 9 9-085 Gold, Au 196-2 196-155 Holmium, . — — — Hydrogen, . H 1 1 Indium, In 113-4 113-398 Iodine, I 126-6 126-557 13 Iridium, Ir 192-7 192-651 Iron, Fe 56 55-913 19 Lanthanum, La 138-5 138-526 Lead, Pb 206-5 206-471 Lithium, Li 7 7-0073 Magnesium, Mg 24 23-959 20 Manganese, Mn 54 53-906 Mercury, Hg 199-7 199-712 Molybdenum, Mo 95-5 95-527 21 Nickel, Ni 58 • 57-928 Niobium, . Nb 94-0 Nitrogen, . N 14 14-021 "'-'< Osmium, Os 198-5 198-494 Oxygen^ 16 15-9633 Palladium, . Pd 105-7 105-737 Phosphorus^ P 31 30-958 -'Platinum. . Pt 194-4 194-415 -'Potassium, . K 39 39-019 Rhodium, . Rh 104 104-055 Rubidium, . Rb 85-3 85-251 ^Ruthenium, Ru 104-2 104-217 Samarium, , Sm 150 150-021 Scandium, . Sc 44 43-98 S( h a I a in. . Se 78-8 78-797 - Si 1 iron. Si 28-2 28-195 The following atomic weights accepted Ln Great Britain differ firoi i those adopted in 1 lie United Slate- "1 1 12— 10 52'4— ' '58-6— 12 63'0— 13 147'0— u 1690— 15 19-1— 1,! 68-?— 1 '1!JG 7 — ly 1390- - w 54-( 3— "58 6- -"198-6— ' 23 196 7— 2 '39-04— 25 1 03-5— 2(5 78'0 — 27 28-0. GENERAL RELATIONS. 37 Atomic Name of Element. Symbol. Atomic weight. weight very accurately determined. * Silver, Ag 107-7 107-7 Sodium, Na 23 22-998 28 Strontium, Sr 87-4 87-374 Sulphur, S 32 31-984 Tantalum, Ta 182 182-144 Tellurium, Te 128 127-96 Terbium, — Thallium, Th 203-7 203-715 29 Thorium, Th 233-4 233-414 Thulium, — — 30 Tin, . Sn 117-7 117-698 31 Titanium, Ti 49-8 49-846 32 Tungsten, W 183-6 183-61 Uranium, U 239-8 239-8 Vanadium, V 51-3 51-256 Ytterbium, Yb 172-8 172-761 ^Yttrium, Y 89-8 89-816 Zinc, . Zn 65 64-9045 ^Zirconium, Zr 89-4 89-367 Nature of the Elements. Considerable additions have been made to the number of elements during late years. The reason of this is that the spectroscope has indicated the presence of metals previously unknown, and by the use of proper means they have been obtained in a separate condition. These substances are termed elements because we do not at present know how to split them up in such a manner as to prove that they are compounds. But it is not improbable that they are compounds, just as we now know that potash and soda are compounds; although before Sir Humphrey Davy split them up into oxygen and a metal, they were supposed to be elements. Indeed, recently much evidence has been brought to show that the substances which we call elements are really compounds. It is from an examination of the spectroscopic character of the elements at different degrees of temperature that Lockyer has been able to obtain sufficient data to justify the definite formulation of the hypothesis that all the elements we know are really compounds, or to speak perhaps more precisely, are really different forms of aggregation of one kind of matter. 1 Accord- ing to this hypothesis the matter of which the universe is composed was at one time equally distributed through space, and uniform in kind. The atoms then coalesced in various groups of two, three, or more ; and these, again grouping themselves together still further, formed aggregates of more and more complex composition. These aggregates are, it is supposed, the elements with which we are acquainted. Most of those complex molecules are perfectly stable at ordi- nary temperatures ; and so their composition remains constant under the condi- tions usual at the surface of this earth. *The following atomic weights accepted in Great Britain differ from those adopted in the United States: 28 87'2— 29 231'5— 30 117-8— 31 48'0— 32 184*0— 33 93-0— 34 90-0. 1 Lockyer, Phil. Trans., 1874, p. 492, &c. 38 PHARMACOLOGY AND THERAPEUTICS. But when they are subjected to increased temperatures in the laboratory, rising from that of the Bunsen lamp to the electric arc, and then to the electric spark or to still higher temperatures in the sun, their spectroscopic appearances give evidence of decomposition into simpler molecules. When the elements are subjected to cold and pressure the molecules which compose them come closer together, and we get them forming a solid substance. Heat tends by communi- cating vibrations to them to shake the molecules further apart, and to produce a liquid condition. Still greater heat shakes the molecules further apart still, and produces a gaseous condition. In all those conditions the molecules of the element become more complex by reduction of temperature or increase of pressure, and simpler by increase in temperature or reduction in pressure. 1 Exceedingly great heat or electricity appears to shake apart still further the constituents of the element, so as to resolve it into simpler combinations of the elementary substance of which, according to the hypothesis, it is composed. This shaking apart of the component elements is known to exist in compounds, and to it the name of dissociation has been given. Thus when chalk or limestone is exposed to the action of heat it becomes dissociated into carbonic acid and lime, CaC0 3 == CaO -j- C0 2 . This process is readily reversible by reversing the conditions. Thus the lime and carbonic acid which are dissociated by heat readily recombine in the cold CaO -j- C0 2 = CaC0 3 . When matter is solid the molecules of which it is composed are supposed to be large and close together. When in the state of vapor or gas, these mole- cules are smaller and much further apart. Solid, liquid, or densely gaseous matter, when its molecules are agitated by heat, gives a continuous spectrum. Gaseous and vaporous matters, when their molecules are agitated at lower pressures or higher temperatures by heat or elec- tricity, give a discontinuous spectrum consisting of bands or lines. Between those extremes we have, as a rule, three other intermediate kinds of spectra : first, a continuous spectrum in the red ; next, a continuous spectrum in the blue ; next, a fluted spectrum, and after that the line spectrum already mentioned. In all those kinds of spectrum, however, we are supposing that the elementary molecules are still intact, they are only more or less separated. Compound bodies, like simple bodies, give definite spectra. The spectrum of a simple metal consists of lines which increase in number and thickness as the pressure of the vapor or its quantity in a given space is increased. The Bpectrum of a compound body consists chiefly of channelled spaces and bands which increase in the same manner. The greater the number of molecules in a cubic inch or cubic millimetre, and the more violently they are agitated, the more complex is the Bpectrum until it becomes continuous. The smaller the number of molecules in a given space, the more simple is the spectrum, which then consists of a few lines only. When a compound is exposed to heat, so as to dissociate it into its component parte, the spectroscopic bands characteristic of the compound become thinner, and the lines of* the metal increase in number, as shown in the accompanying d iagra m, where the bands exhibited by calcium chloride in the flame of a Bun- burner disappear, and are replaced by lines only, when an electric spark is ording to another hypothesis, bodies are supposed to have molecules of one degree of complexity, and the difference between solid, liquid, and gaseous bodies la supposed to depend on the difference in the free path of the molecule. But ac- cording to the new riew, the difference in Hie complexity of the molecule itself is sufflcienl to explain the phenomena. GENERAL RELATIONS. 39 used. When an element is treated with more and more heat and electricity it likewise gives exactly the same kind of evidence of dissociation — bands dis- i m 1 |j 1 Fig. 1.— Spectrum of calcium chloride. (1) In the flame of a Bunsen's burner, showing the chan- nelled spaces and bands of a compound. (2) In an electric spark, showing the lines of the element calcium. (After Eoscoe). appearing, and lines becoming thinner. Besides this, new lines make their appearance with every large increase of temperature. This behavior of the element appears to show that it is also a compound, but that it is stable under ordinary conditions, and is only dissociated at a high temperature. Other proofs of this hypothesis are derived from a comparison of the spectra of the elements as observed in our laboratories with their spectra in the sun. A comparison of the two hypotheses shows us that as on the old hypothesis each element represents a species and is unvariable, its spectrum ought to be always the same in our laboratories and in the sun ; and the same in sun-spots as in prominences, and the same at all periods of the sun's activity. Under the new hypothesis the spectra of metals in our laboratories and in the sun should not resemble each other ; they should be different in sun-spots and in prominences, because the spot is cooler than the prominence ; and they should vary at the time of the sun's activity because the sun is hotter at the maximum of the sun-spot period, and therefore there should be a greater amount of dissociation amongst the elements at that period. As a matter of fact we find that the spectra in our laboratories and in the sun do not resemble each other (Fig. 2) ; that those of the same element § Q FEEBLE SPARK Fig. 2. — Diagram of the spectrum of lithium under various conditions of temperature. (After Lockyer, Boy. Soc. Proc, Dec. 12, 1878). in the sun-spot and prominences are as dissimilar as of any two elements ; and that the spectra of the elements in the sun do vary with the maximum of the sun-spot period. On the old hypothesis the spectra of prominences should also consist of lines familiar to us in our laboratories, because solar and terrestrial elements are the same, while, according to the new hypothesis, the spectra of prominences should be unfamiliar, because the prominences represent outpourings from a body hot enough to prevent the atoms of which our elements are composed from coming together. As a matter of fact, the lines in the prominences, with the exception of those of hydrogen, magnesium, calcium, and sodium, are either of unknown origin, or are feeble lines in the spectra of known elements. Spectroscopic observation, therefore, leads to the belief that the so-called elements are really compounds, the component parts of which are kept apart by high temperatures in the sun and stars, but unite when the temperature decreases. 40 PHARMACOLOGY AND THERAPEUTICS. By the powerful vibrations imparted to them by the electric spark, they may be dissociated in the laboratory, but, as no means has yet been devised of sepa- rating the components, they again unite to form the original body, just as hydrogen and oxygen, into which steam is dissociated by passing it through a strongly heated tube, almost instantly again combine to form water unless they are separated by means of the more rapid diffusion of hydrogen through a porous tube. The difficulty in accepting this evidence lies in the fact that we have hitherto been unable to isolate the substances into which the elements are supposed to be dissociated ; as these after their dissociation at once recombine and again form the original substance. One proof, however, that the supposed components of the element calcium may remain permanently separated, is afforded by the fact that in the spectra of two stars, Sirius (Fig. 3) and a Lyrae, which are very bright, and probably very hot, only one of the ultra-violet lines of calcium is represented. But we have also other evidence of the compound nature of the elements, which, although it was not sufficient of itself to force us to abandon our old ideas of their simple nature, is yet strongly corroborative of the spectroscopic evidence. Thus we find that oxygen is broken up by electricity, and that the atoms of which its molecules are composed, rearrange themselves so as to form what is to all intents and purposes a new element, ozone, having a much closer resemblance to chlorine than to oxygen in its activity, although its compounds with metals appear to be identical with those of oxygen. ,i ARC I FLAME~ Fig. 3.— Diagram of the spectrum of calcium under various conditions of temperature. In the spec- trum of Sirius the line K is absent, while it is very strongly marked in the solar spectrum. At a high temperature its atoms are again dissociated, and recombine to form ordinary oxygen. When it combines with other substances, the heat of com- bination appears to be sufficient to dissociate the atoms of ozone (0 3 ), so that in the compound we meet with simple oxygen, 0. Phosphorus also affords us an example of an element which occurs in two forms, so different that we should call them distinct bodies, were it not that we find that one can be transformed into the other. The two forms, red and yellow phosphorus, differ from each other, not only in their color, but in their density, specific heat, readiness of combustion, and beat of combustion. They differ also in the yellow phosphorus being ex- ceedingly poisonous, whereas the red phosphorus is not poisonous. They arc in many respects, then, different bodies, but we have hitherto been content to call them allotropic forms of the same element. In combination we find that phosphorus is sometimes pentad and sometimes triad', that its compounds with oxygen are sometimes poisonous, at other times not. Thus orthophosphoric acid. BLP0 4 , is not poisonous; pyrophosphoric acid, II Pj0 7 j and metaphosphoric arid, III'O,, are both poisonous. The most striking example, however, is carbon, which we not only find in throe forms, differing enormously from each other, as diamond, charcoal, and graphite, but which we find in various compounds playing the most varied parts. This we .it preeenl explain by saying that carbon unites with itself in the form- ation of the various radicals: and thus comes to form what are practically new elements. GENERAL RELATIONS. 41 Another example is afforded us by ammonia, the salts of which are just as well characterized as those of potash or soda. The amalgam which it forms with mercury possibly indicates that we have in it also a real metal, ammonium, corresponding to sodium or potassium, though this is uncertain. The three metals, sodium, potassium, and ammonium (if it exist), agree in the readiness with which they are oxidized, so that it is difficult to preserve the pure metal, although the oxide is stable. They differ, however, in the oxides of potassium and sodium being solid, and that of ammonium gaseous. Ammonium has not been isolated, and it is put down in the text-books as a hypothetical sub- stance, but ammonium salts are tangible enough, and the question which we have to keep before us is, whether potassium, sodium, and all the other so-called elements, are not in reality compounds like ammonium. Some people still regard species as immutable, and look upon Darwin's hy- pothesis of evolution as unproven. The evidence in favor of the evolution of elements from one simple form of matter, is as yet, perhaps, much less strong than that in support of the evolu- tion of species ; but it has this advantage, that it explains certain phenomena which have hitherto been very perplexing. It may be at least convenient in discussing the physiological action of drugs to bear this hypothesis in mind, and to remember that what we have hitherto been accustomed to call elements, may be really like the so-called organic radicals in constitution, with this difference, that we can split up organic radicals with toler- able facility, while we cannot do this — at least to any great extent — with elements. It also shows us that we must as pharmacologists pay attention to molecular as well as to empirical composition and take into consideration crystalline form and physical aggregation in all observations regarding the relations between elements or compounds and living organisms. It is not sufficient for example to speak of the action of phosphorus on the organism as if this were invariable, for it varies with the molecular composition of the body in the red or yellow form, and iso- meric organic substances may be utterly different in action. Classification of tlie Elements. The vegetable and animal kingdoms are divided into various groups. For- merly, men tried to arrange them in linear succession so that there should be an unbroken line from the lowest to the highest members of the vegetable king- dom, thence to the lowest member of the animal, and onwards up to the highest member of the animal kingdom. Such an arrangement as this, however, was found to be unnatural. Instead of the highest members of the vegetable king- dom being connected with the lowest members of the animal kingdom, it is found that the lowest members of each kingdom are closely connected, and that the divergence becomes greater as development proceeds towards the highest mem- bers in each kingdom. The doctrine of evolution at once rendered this ar- rangement natural and easily understood. Starting from one common point of origin in structureless protoplasm, the various organisms became more and more unlike in each successive stage of development, their resemblance being at all only recognizable in their embryonic condition. Yarious attempts have been made to arrange inorganic substances in natural orders. One mode of arrangement is according to their atomic weight — as in the following table : — 42 PHARMACOLOGY AXD THERAPEUTICS. it '3 m 3 'So -• £ § £ e £ % c ^ ^ = ~ 5 p s — p - .0 R C — Sp 5 03 O — <; "" — < " w < " S <; P H 1 Ca 40 1 Ce 92 2-5 V 137 Li 7 6 Ti 50 10 La 92 Ta 138 1 Gor\ Be j 9 Cr 52-5 2-5 Di 96 4 W 184 46 Mn 55 2-5 Mo 96 Nb 195 11 B 11 2 Fe 56 1 Eo 104 8 Au 196 1 C 12 1 Co 5S-5 2-5 Eu 104 Pt 197 1 N 14 2 Ni 58'5 Pd 106-5 2-5 It 197 16 2 Cu 63-5 a 108 1-5 Os 199 2 Fl 19 3 Y 64 0-5 112 4 Hg 200 1 Na 23 4 Zn 65 1 Sn 11s 6 Tl 203 3 Mg 24 1 As 75 10 U 120 2 Pb 207 4 Al 27-5 3-5 Se 79-5 4-5 Sb 122 9 Bi 210 3 Si 23 0-5 Br 80 0-5 I 127 Th 238 28 P 31 3 Rb 85 5 Te 129 2 S 32 1 Sr S7'5 2-5 Cs 133 4 CI 35-5 3-5 Zr 89-5 2 Ba 137 4 K 39 3-5 From this it will be seen that the atomic weights of the different elements form a series, the members of which in most cases differ from one another by 1, 2, 3. or 4. There are a few exceptions in which the differences are much greater, and these probably represent blanks which may yet be filled up as our knowledge of the elements increases. This mode of classification, however, reminds us of the Linnasan system in plants, and is artificial rather than natural. In it, the elements which are placed close together possess very different properties, whereas those which are separated from each other present considerable resemblances. The first important attempt at a natural classification of the elements was made by Xewlands in 1864. 1 He then arranged them in groups, between the members of which there was a close connection in regard to their chemical properties, and a curious relation in regard to their atomic weights. These presented differences which were generally multiples of the atomic weight of hydrogen, and generally equal to, or multiples of. that of oxygen. Difference. Member of a Group One immediately above the preceding. haviDgLowest Equivalent. H = I. = 1. Magnesium 24 Calcium 40 16 1 Oxygen 16 Sulphur 32 16 1 Lithium 7 Sodium 23 16 1 Carbon 12 Silicon 28 16 1 Fluorine 19 Chlorine 355 165 1031 Nitrogen 14 Phosphorus 31 17 1062 Lowt-M term of Triad Highest term of Triad. Lithium 7 Potassium 39 32 2 MaLMH-siuni 24 Cadmium 112 88 55 Molybdenum 96 Tungsten 184 88 5*5 Phosphorus 31 Antimouv 122 91 5687 Chlorine 35*5 Iodine 127 915 5718 Potassium '.'<■> 1 -nun 133 94 5-875 Sulphur Tellurium 129 97 6062 Calcium 40 Barium 137 97 6062 New-lands, Chemical Jlfaw, July 30, 1864. GENERAL RELATIONS. 43 A curious relationship had also been pointed out by M. Dumas 1 between the members of the potassium group, their atomic weights being equal to multiples of those of lithium and potassium added together. Li + K = 2Na, or in figures, 7 + 39 = 46 Li + 2K = Eb " " 7 + 78 = 85 2Li + 3K = Cs " " 14 + 117 = 131 Li + 5K = Tl " " 7 -f- 195 = 202 3Li + 5K = 2Ag " " 21 + 195 = 216 A similar relation was also pointed out by Mr. Newlands between lithium and the calcium group ; as follows : Li + Ca = 2Mg, or in figures, 7 + 40 = 47 Li + 2Ca= Sr " " 7+80= 87 2Li + 3Ca = Ba " " 14 + 120 = 134 Li + 5Ca = Pb " " 7 -f 200 = 207 But Mr. Newlands's most important table is the following one, in which he has arranged the elements in ten series : — Triad. Lowest Highest term. term. I. Li 7 + 17 -Mg 24 Zn 65 Cd 112 II. B 11 Aul96 III. C 12 + 16 = Si 28 Sn 118 IV. N 14 + 17 =P 31 As 75 Sb 122 + 88 = Bi 210 V. O 16 + 16 = S 32 Se 79-5 Te 129 + 70 = Os 199 VI. F 19 + 16-5 = CI 35-5 Br 80 T 127 VII. Li 7 4- 16 = Na 23 + 16 =K 39 Kb 85 Cs 133 + 70 = Tl 203 VIII. Li 7 + 17 = Mg 24 + 16 = Ca 40 Sr 87-5 Ba 137 + 70 = Pb 207 IX. Mo 96 V 137 W 184 X. Pd 106-5 Pt 197 Seven of these series nearly correspond in their first members with those of Mendelejeff, to whom and to Lothar Meyer we owe the complete development of this mode of classification. Mr. Newlands also pointed out that the eighth element starting from a given one, was a kind of repetition of the first, like the eighth note of an octave in music. 2 Mendelejeff has not only greatly developed this system of classification, but has afforded convincing proof of its value by not only predicting the existence of an unknown element, but actually describing its physical characters and chemical reactions — a prediction the correctness of which was proved by the discovery of gallium, and by the agreement of its characters and reactions with those which Mendelejeff had foretold. The various members of the animal kingdom can all be arranged in a few series: Protozoa, Coelenterata, Annuloida, Annulosa, Molluscoida, Mollusca, and Vertebrata. These series all differ^ more or less from one another, but a certain agreement is observed between their members, and similarly the elements may be arranged in series. Mendelejeff points out, that if we take those elements having the lowest atomic weight, and omit hydrogen, between which and lithium there is a great 1 Dumas, quoted by Newlands, op. cit. 2 Chem. News, Aug. 20th, 1864, p. 94. 44 PHARMACOLOGY AND THERAPEUTICS. gap, the seven elements, lithium, glucinum, boron, carbon, nitrogen, oxygen, and fluorine, may be regarded as typical elements forming a series representing the lowest members of seven groups. The next seven elements may be arranged in a similar way : — Li = 7 : G = 9-4 : B = 11 : C = 12 : N = 14 : O = 16 : F = 19 Na = 23 : Mg = 24 : Al = 2T3 : Si = 28 : P = 31 : S = 32 : CI = 35*5 To each group of seven elements Mendelejeff gives the name of a sniall period or series. In each series the characters of the elements vary gradually and regularly as their atomic weights increase. This variation is periodical, i. e., varies in the same way in each series, so that the elements which have corresponding places in each series, correspond also to a certain extent in their properties, and form similar compounds. The atomicity is least in the first, and greatest in the last members of each series. Thus the first members of the series form monochlorides, the second dichlorides, the third trichlorides, and so on. In the accompanying table R represents radical or element, and R 1 indicates that the element is monatomic, so that one atom combines with one of CI to form a monochloride, RC1. R u indicates that the element is diatomic, and so on. -* CO "* 00 i> C5 to CO o o OS OS II II r-t r-l rH rH II II 1 II II 1— 1 1— 1 1— 1 > ss r-l * 1 "3 1 ft II 1 3 2 Pntf coos lO lO is " r-t 1 OS OS rH rH II II II II 1 II II O • -h P^H. CQ -+J fe£ KPh OPh V 3 o i> 1 LO 00 CM 1 l-H oiflOO =>-p 'P -p gpHp3tf O CO r-( II II II II Ci 03 II H o 00 II O CM II o 3 1 £ P T-i lO CM 1 °° CO i> CM o II PL. II CO r-l CM MO O gpHpHpH" rH ^ II II " a ! 1 M o II II ,Q c3 fc > £ 1 H 1 00 cm 00 1 *> CM }> rH o II w. II 00 II T-\ CM ftWoo CM r-t II s d II o II I II II S rH CO CM II e II 03 c8 (H O J r3 o H CsJ o- i>. H CO 00 CO 1 "* i-5 r-t tH CM II < CO II -* 1 II 00 II 00 fl II M 00 CO r-i II o CM 00 II - I II ^ O • II II 4^ •iH S-l 1 !* P H 1 w 1 o- o-. c>- 1 "* •* lO CM 1 ° di CM CO II T-{ 1 s i— i ft -? s oo O :3 iS II pq II II oo O rH II 5 «rt tl o II II II O tH m C3 PQ i 1 r- CO ^^ _, _ v t s CM CO 00 1 00 Ci O rH rH rH CM a 02 »fH ^^ .SO ^° «+H >> d o O f« c3 © O^ ^ Ph «^ OCfl 02 a O 03 i ^ %% ■*= d p ce 03 bJD^ •S d p c3 p 03 r^ a OS c8 % d^ o -H r- 1 1— 1 p^ M o > Ph O P o p O ^d 03 p "~ p OS 42 <13 03 P c5 0) rP P < c +3 'd p e8 ■V 03 tl Ph < 03 d k» u p o3 * s p 46 PHARMACOLOGY AND THERAPEUTICS. But a difference is to be observed between trie even and the uneven series. Corresponding members of even series, such as the fourth and sixth, agree with each other, and members of uneven series like the fifth and seventh agree. This agreement is greater than between the members of an even series, such as the fourth, and those of an uneven series like the fifth, although the fifth is more closely placed to the fourth than the sixth is. Thus Ca and Sr belong- ing to the fourth and sixth series, have a greater resemblance to each other than they have to Zn or Cd, which belong to the fifth and seventh series, and these metals on the other hand have a greater resemblance to each other than they have to Ca or Sr. The members of even series are less metalloidal or more metallic than those of uneven series, e. g., Mn of the fourth series is less metal- loidal than Br of the fifth series. In the even series the metallic or basic char- acter predominates, whilst the corresponding members of the uneven series rather exhibit acid properties. The members of the even series, so far as we know, form no volatile compounds with hydrogen or alcohol radicals, while the corresponding members of the uneven series do form such com- pounds. The last members of the even series resemble in many respects (in their lower oxides, etc.), the first members of the uneven series, thus chromium and manganese in their basic oxides are analogous to copper and zinc. But there are great differences between the last members of the uneven series (haloids) and the first members of the next even series (alkali metals). Now between the last members of the even series there occur, according to the order of atomic weights, all those elements which cannot be included in the small periods. Thus between Cr and Mn in the one series, and Cu and Zn in the next, there come the elements Fe, Co, Ni, and in a similar way after the sixth series come Ru, Rh, Pd, and after the tenth Os, Ir, Pt. Mendelejeff gives the name of a long" period to two such series with three intervening members, forming seventeen in all. From the difficulty of arranging all the elements in this system, it cannot be regarded as yet perfect, but the fact that Mendelejeff was able so correctly to foretell the properties of gallium, shows that it must contain a large element of truth. At the time that he drew up his table there was a blank in the third group of the fifth series. The relationships of the metal which Mendelejeff believed would fill this gap will be more easily seen by omitting the even series on either side of it, and taking only the odd series with which it will, as already mentioned, the more closely correspond. Series. Group II. Group III. Group IV. Group V. 3 Mg Al Si P 5 Zn — — As 7 Cd In Sn Sb Aa it -lands between zinc with an atomic weight of sixty-five, and arsenic with one of seventy-five, while it is separated from the latter by a blank, its atomic ireigkl mnsl be about sixty-eight. As it is atom-analogous with Al, its Balta Bhould have a similar constitution. It should form an oxide x„0 3 , and a sulphide s ■ S .. \t will bo precipitated from its solution by ammonium sulphide. The metal Bhould be easily reduced by carbon or sodium, it should have a spe- cific- gravity of 5*9, and decompose water at a red heat. As it belongs to an odd series, it Bhould, like /inc. form volatile compounds with organic radicals, and form also anhydrous chlorides. On the discovery of the metal gallium, it was found to agree in almost every re- Bpect with the predictioD of Mendelejeff, and this fact is not interesting to chemists GENERAL RELATIONS. 47 only, but also to pharmacologists. For the great object of pharmacology is to obtain such a knowledge of the relations between the physical and chemi- cal characters of bodies, and their actions upon the living organism, that we may be able to predict their actions with certainty, and to know the modifications which alterations in their physical and chemical characters will produce on their physiological action. Mendelejeff's present classification is imperfect, because we find that by it the members of some natural groups, such as those of the earthy metals, are separated from one another, although they agree in their chemical characters. We find also that metals having similar pharmacological actions, as copper, zinc and silver, do not fall naturally together in this arrangement. But, on the other hand, we find also that by this classification, elements are brought together which do not at first seem to have any resemblance to each other, and are yet found by recent investigations to have a physiological connection. Thus mer- cury and calcium do not appear to resemble one another, yet Prevost has shown that in acute poisoning by mercury, the calcareous matter disappears from the bones, and in the process of elimination by the kidneys produces calcification of these organs. 1 Organic Radicals. — Whether the so-called elements be compounds or not, it is certain that several of them have the power of uniting with themselves and with others in such a way as to form bodies called com- pound radicals, which resemble elements in many respects. These groups of atoms may enter into and again pass out of combination with other substances just as elements do. These radicals are not known in the free state. The chief of them are hydroxyl, OH, from which may be formed, by replacement of the hydrogen, potassoxyl, KO, and zincoxyl, OZnO; amidogen, NH 2 ; imidogen, NH; nitroxyl, N0 2 ; sulphuryl, S0 2 ; and phosphoryl, PO. Then come innumerable compounds of carbon, among which may be mentioned cyanogen, CN; the radicals of CO ] the marsh-gas series, methyl, CH 3 , etc. ; carbonyl, CO ; carboxyl, tt f 0, important in the formation of acids, &c. Chemical Reactions and Physiological Reactions. — Each element and each of its compounds has chemical reactions special to itself, by which it can be recognized and distinguished from all others. The number of these chemical reactions is therefore very great, but there are a few reactions which are common to a great number of the ele- ments. We shall find that something similar occurs in their physio- logical reactions. The number of possible actions which may be exerted on the body by the elements and their compounds is very great, yet we shall find that there are certain physiological reactions which are common to so many that their repetition under the head of each drug becomes monot- onous. Varied as the chemical reactions of the metallic elements are, we find that they can be at once divided into two groups by the use of hydrogen sulphide or ammonium sulphide, for all of them, with the 1 Prevost, Eevue Medicale de la Suisse Bomande, p. 553, Nov. 15th ; p. 605, Dec. 15th, 1882; p. 5, Jan. 15th, 1883. 48 PHARMACOLOGY AND THERAPEUTICS. exception of ammonium, lithium, potassium, sodium, magnesium, barium, calcium, and strontium, are precipitated by one or other of these reagents. These groups can be subdivided by the use of other reagents into sub- groups. The small group, already mentioned, which is not precipitated either by hydrogen sulphide or ammonium sulphide, can be divided into two sub-groups by the use of carbonate of ammonia, which precipitates barium, calcium, and strontium, and does not precipitate the others. The other large group, which is precipitated by H 2 S or (NH 4 )HS, can also be subdivided in a similar manner. The individual members of each sub-group, again, can all be dis- tinguished from one another by further reactions. The physiological reactions which occur between the elements or other compounds and the tissues of the body can also be divided into large groups. Thus we find that a very great number of substances, when used in large quantity, paralyze muscles and motor nerves. This large group can again be subdivided into those which paralyze muscle, while affecting the nerves but slightly, or those which paralyze the nerves and leave muscle uninjured. Another large group is that which acts specially on nerve-centres, and has little effect either on muscles or motor nerves. This contains sub-groups of substances which affect the brain, medulla, or spinal cord by exciting, paralyzing, or disturbing the functions. Another group is that which affects the secretions, with sub-groups of substances affecting the secretions from the sweat and mammary glands, salivary, gastric, or intestinal glands, liver, or kidneys. Another group still is that which acts chiefly upon the circulation. These groups are all more or less distinct, although they, to a certain extent, may run into, or overlap, each other. Individual members of the same group may differ very widely in their physiological action, even when they all finally paralyze muscle, nerves, and nerve-centres. For while they may produce the same final result, the course of their action will be different, and the symptoms they occasion will depend very greatly upon the part of the organism which they affect first. Thus atropia and curare both completely paralyze motor or efferent nerves, but, while a very large dose of curare is re- quired to paralyze the cardiac and vascular nerves, a very small dose paralyzes those going to the muscles, and produces increasing weakness, gradually passing into death. On the other hand, an enormous dose of atropine ifl required to paralyze the motor nerves of muscles, but very small doses are sufficient to affect the nerves of the heart and other in- voluntary muscles, and thus we get rapid circulation, dilated pupil, and restless delirium. The physiological action of any drug depends to a great extent, not merely on its genera] affinities for classes of tissues, but upon its partic- ular affinity, or power of acting on one tissue or organ first. The organ firsl affected may, through its functional activity, greatly alter the effects of the drug upon the others. A- an example of this we may take the effects produced by very large and by moderate doses of veratrine on the frog. A moderate dose GENERAL RELATIONS. 49 will produce great stiffness of the muscles, while a very large dose may have comparatively little effect. Yet if the large dose were applied directly to the muscles it would act more powerfully than the moderate dose. The reason that it does not do so in the living body is that the large dose paralyzes the heart so quickly that the circulation stops, and therefore the poison, not being conveyed to them, has no action on the muscles. Relation between Atomic Weight and Physiological Action. As long ago as 1841, Blake thought that the toxic action of inorganic sub- stances increased in proportion to their atomic weight, and this idea was again advanced by Rabuteau. Both of them afterwards qualified this when they found it was incorrect, by saying that the poisonous action increased with the atomic weight amongst elements belonging to the same group. Thus potassium is more poisonous than sodium, and barium than calcium. But it has been shown by Husemann that lithium is much more poisonous than sodium or potas- sium, and his results have been confirmed by Bichet. It is evident that the relationship between atomic weight and physiological action is no simple one. But indeed, on looking into the matter more closely, we could hardly expect it would be. For the toxic action of an element may depend upon its effect on the muscles, nerves, nerve-centres, blood, or on the digestive or excreting sys- tems. These differ from one another in their composition, and while it is possi- ble that the elements belonging to a certain group may have relations varying with their atomic weight to individual organs or structures, we can hardly expect those relationships to be the same to all organs. Thus an element with one atomic weight may prove fatal, by affecting the muscular power of an animal, while another with an atomic weight either higher or lower, may be still more deadly by affecting the nervous system or heart. What we want, therefore, is not a general relationship between atomic weight and toxic action, but a knowledge of the particular relationships of each group of elements to each organ and tissue of the body. Relation between Spectroscopic Characters and Physiological Action. The quickness with which a pendulum oscillates is greater or less in propor- tion to its length, a long one oscillating slowly, and a short one quickly. The vibrations of a string or pipe are also slow or quick, and the note which it yields is low or high, according as it is long or short. Similarly, according to Lecoq de Boisbaudran, the rate of vibrations of mole- cules, and the wave-lengths of the light which they emit, are determined by their weight. When the molecular weight is high, the vibrations of the mole- cules are slow, and the light which they emit has long wave-lengths, and is situated towards the red end of the spectrum. When the weight is low the vibration of the molecules is rapid ; and the light they emit lies towards the violet end of the spectrum. In the same family of elements the mean length of the wave of light which they emit is a function of their atomic weight, so that for bodies of the same chemical type the general form of the spectrum persists, but is gradually modi- fied by the mass of the molecules. As the atomic weight diminishes, the spectrum will tend to ascend towards the violet, and, as it increases, the spectrum will tend to descend towards the red. 4 50 PHARMACOLOGY AND THERAPEUTICS. Until recently, our observations on the spectra of bodies were limited to the visible spectrum, but the application of photography now enables us to extend our observations both above and below the visible spectrum, and to ascertain the presence of definite spectra in the ultra-red and ultra-violet, when nothing of the sort is visible to the eye. In most musical sounds besides the fundamental note we have a number of harmonics having a much greater rapidity of vibra- tion than it. Similarly, in the spectrum there appear harmonics as well as the fundamental spectral lines, and so instead of one line or band there may be a number. According to the author already quoted, the corresponding harmonies in a series of analogous spectra have mean wave-lengths which increase in pro- portion to the weight of the molecules. It might appear therefore, that a relation might be observed between the spectroscopic characters and physiological action of an element, and this idea was propounded by Papillon. His idea was, however, to a great extent based on the experiments of Kabuteau, already alluded to, and just as no definite relation can be at present traced between the atomic weight and the toxic action of a metal, so no definite relation can be observed between its spectroscopic characters and its physiological action. Further consideration, however, will show us that this is not at all to be wondered at, for in physiological experiments we are not working with the same molecules which yield the spectrum. In spectral analysis, when line spectra are in question, according to one view we are in presence of phenomena produced by the chemical atom, whereas this atom exists only molecularly combined at lower temperatures. According to another view, that put forward by Lockyer, we are in presence of phenomena pruduced by a series, possibly a long series, of simplifications, brought about by the temperature employed, and this simplification can begin at very low tempera- tures, and is indeed indicated by Dalton's law of multiple proportions. Such molecular simplifications and differences are represented by ozone and oxygen, ordinary and amorphous phosphorus, the various forms of sulphur and so on, and it is therefore at this lower range of temperature — one studied, chiefly by absorption, and not by radiation — that we must look for connections between molecular structure and physiological action if any such connections exist. Some of the absorption bands which occur in the spectra of bodies at ordinary temperatures may be in the visible spectrum, like those observed in alcoholic and aromatic substances; 1 but others may be quite invisible, and only recogniz- able by the aid of photography in the ultra-red or ultra-violet. 2 Connection between Chemical Constitution and Physio- logical Action. — It has long been known that different metals exercise different actions on the body; that mercury, for example, causes salivation, and antimony sickness. But an immense step has been made of late years in our knowledge of the relation between chemical constitution and physiological action by the discoveries of Crum-Brown, Fraser, and Schroff, who have shown that by modifying artificially the chemical constitution of a drug, it is possible to modify also its physio- logical action. And not only so, but they have shown that similar modifications in the chemical constitution of various drugs induce similar modifications in the action of their derivatives ; thus they have found that by introducing methyl into tlic molecule of strychnine, brucine, and 1 Russell and Lapraik, Journ. Chan. Soc, April, 1881. -' Abncy and Festing, Phil. Trans., 1882, p. 887. GENERAL RELATIONS. 51 thebaine, the convulsive action exerted by these substances on the spinal cord was changed into a paralyzing one exerted on the ends of the motor nerves. Other alkaloids, also, which do not exhibit a convulsive action, nevertheless exhibit a paralyzing one when their constitution is altered by means of methyl; thus methyl-codine, methyl-morphine, methyl- nicotine, methyl-atropine, methyl-quinine, methyl-veratrine, and several others, all exhibit this paralyzing action. From a number of experiments on this subject by Cash and myself, we find as a general rule that most of the compound radicals formed by the union of amidogen with the radicals of the marsh-gas series possess a paralyzing action on motor nerves. The subject of the connection between chemical constitution and physiological action is the most important one in pharmacology, and we shall have to return to it in considering the actions of various groups of organic substances. Relation between Isomorphism and Physiological Action. — From a number of experiments made by Dr. Blake, he concluded that when inorganic salts were injected directly into the circulation, the in- tensity of their physiological action increased in proportion to their molecular weight, but only in those groups of elements where the salts were isomorphic, or, in other words, crystallized in the same forms. Thus groups whose salts were crystallized in different forms had quite different physiological actions. He divided the elements into nine groups, the physiological action of the different groups differing in kind, whilst that of the individual members of the same group agree in kind but differ in degree. Thus he states 1 that the salts of the first group increase in activity in the order mentioned, silver being the most active, and lithium the least. These groups are as follows : — Group 1. Lithium, sodium, rubidium, thallium, caesium and silver. Accord- ing to him they produce death by acting on the lungs and impeding the pulmonary circulation. None of them affect the nervous system excepting caesium ; nor do any affect the pulmonary circulation excepting silver. Group 2. Magnesia, ferrous salts, manganous salts, nickel, cobalt, copper, zinc and cadmium, are increasingly lethal in the order mentioned. They kill by arresting the action of the heart. Group 3. Beryllium, alumina, yttria, cerium and ferric salts both impede the systemic and pulmonary circulation. Group 4. Calcium, strontium, barium, and lead salts kill by paralyzing the ventricles of the heart. Group 5. Palladium, platinum, osmium, and iridium act on the heart, respiration, circulation, and blood. Group 6. Ammonia and potash paralyze the heart and cause convulsions. Group 7. Hydrochloric, hydriodic, bromic, and iodic acids impede the circulation and kill by arresting the circulation. Group 8. Phosphoric acid, arsenic acid, and antimony kill by arresting the pulmonary circulation. Group 9. Sulphuric and selenic acid impede the pulmonary circulation. 1 Blake, American Journal of Science and Arts, vol. vii., March, 1874 (corrected reprint). 52 PHARMACOLOGY AND THERAPEUTICS. These experiments are open to the same objections as those of Rabuteau. The author's statements regarding their mode of action, show that their physiological action has not been clearly investigated, and his results as to the lethal dose are probably only approximate and may want reinvestigation ; but while we cannot accept at present all his results or conclusions as final, yet his last and chief conclusion is one of great interest, viz. : — that in living matter we possess a reagent capable of aiding us in our investigations on the molecular properties of substances. CHAPTER II. CIRCUMSTANCES WHICH AFFECT THE ACTION OF DRUGS ON THE ORGANISM. The Inter -action of various functions in the body is one of the greatest difficulties in the way of our readily understanding the action of drugs. One function alters another, and the second reacts upon the first, so that in some cases it is almost impossible to say precisely how far the alteration in any function is due to the direct effect of the drug upon it, and how far to some indirect action. Thus curare when applied to a wound usually kills without producing any convulsion whatever. It paralyzes the ends of the motor nerves, so that all the muscles in the body become powerless. But when it is given by the stomach, and ex- cretion through the kidneys prevented, death is preceded by convulsions. These convulsions are not caused by any direct irritating action of the curare itself upon the nerve-centres, they are due to irritation of these centres by a venous condition of the blood. This venosity of the blood is due to imperfect respiration, produced by paralysis of the respiratory muscles through the action of curare on the motor nerves. 1 The effect of curare is a purely paralyzing one, both when the ani- mal dies quietly and when it dies with convulsions. In both cases it paralyzes the motor nerves of the respiratory muscles and of the extrem- ities. In both cases it causes death by arresting the respiration and producing asphyxia. But in the latter case the motor nerves of the extremities being only partially paralyzed when asphyxia occurs, they respond by convulsive movements to the irritation of the nerve-centres, which the renous blood produces. In the former, the paralysis of the limbs being complete, the muscles remain perfectly quiet, notwithstand- ing the irritation of the nerve-cenl 1 Hermann, Arch.f. Ann/, u. Physiol., 18G7, 64, 650. ACTION OF DRUGS ON THE ORGANISM. 53 Convulsions also sometimes occur previous to death from narcotic poisons ; and in a description of the action of these poisons we frequently meet with the phrase, "coma, convulsions, and death." In such cases the convulsions are also caused by the irritation of the nerve-centres by asphyxial blood. The drug causes the coma ; the coma causes imperfect respiration ; imperfect respiration renders the blood venous ; and the venous blood causes convulsions. Direct and Indirect Action. — The direct action of a drug is the effect it produces on any organ with which it comes in contact. Thus sulphuric acid applied to the skin, or taken into the stomach, will, ac- cording to its degree of concentration, irritate or destroy the mucous membrane which it touches. Its direct action upon them is therefore that of an irritant or caustic. Curare, when applied to the ends of a motor nerve in a muscle, para- lyzes them. It does this either when the muscle is soaked in a solution of curare, or when the curare is carried through the substance of the muscle by means of the blood circulating in it. Paralysis is therefore the direct effect of curare on the motor nerves. Indirect Action. — The convulsions which sometimes occur in poisoning by curare are caused by its indirect action. It has no stimu- lating effect on the nerve-centres, when applied to them directly or car- ried to them by the blood, but by paralyzing the muscles of respiration, and thus causing asphyxia, it indirectly irritates the nerve-centres and causes convulsions. Local and Remote Action. — The local action of a drug is that which it exerts on the part to which it is applied. Thus sulphuric acid has a direct irritant or destructive action, and when applied to the skin or mucous membrane will produce local redness, inflammation, or slough- ing. When swallowed, it produces weakness of the circulation, stoppage of the heart, and death. This effect on the circulation is not due to the direct action of the acid upon the heart, the vessels, or the nervous system, after its absorp- tion : it is due to the reflex action exerted upon them by the irritation of the nerves of the stomach which the sulphuric acid produces. This action on different parts through the nervous system is termed its remote action, in contradistinction to the local action of the acid upon the gastric mucous membrane. Relation of Effect to Quantity of the Drug". — The effect of drugs varies very much according to the quantity employed. Some- times this is due to the inter-action of different parts of the body on one another as already mentioned in regard to veratrine (page 48). Some- times it is due to the different effects upon individual cells or tissues. Thus we find, very generally, that any substance or form of energy, whether it be acid or alkali, heat or electricity, which in moderate quan- tity increases the activity of cells, destroys it when excessive. But varying closes do not always produce opposite effects. We some- times find that exceedingly small and exceedingly large doses have a similar effect, which differs from that produced by moderate closes. Thus very minute quantities of atropia render the pulse somewhat slow:. 54 PHARMACOLOGY AND THERAPEUTICS. larger quantities make it exceedingly rapid, and very large quantities again render it slow. Moderate quantities of digitalis slow the pulse, larger quantities quicken it, and still larger quantities render it slow again. We find a similar effect produced by variation in temperature. Great cold dis- turbs the mental faculties, so that men exposed to it present symptoms which cannot be distinguished from those of intoxication. Ordinary temperatures do not disturb the functions of the brain, but high tempera- tures do, as we see in the delirium of fever, which in many cases imme- diately ceases when the temperature of the patient is reduced by cold bath?. Homoeopathy. — This opposite action of large and small doses seems to be the basis of truth on which the doctrine of homoeopathy has been founded. The irrational practice of giving infinitesimal doses has of course nothing to do with the principle of homoeopathy — similia simili- bus curantur : the only requisite is that mentioned by Hippocrates, when he recommended mandrake in mania ; viz., that the dose be smaller than would be sufficient to produce in a healthy man symptoms similar to those of the disease. Now in the case of some drugs this may be exactly equiv- alent to giving a drug which produces symptoms opposite to those of the disease ; and then we can readily see the possibility of the morbid changes being counteracted by the action of the drug and benefit resulting from the treatment. For example, large doses of digitalis render the pulse extremely rapid, but moderate ones slow it. 1 The moderate administra- tion, when there is a rapid pulse, is sometimes beneficial : this might be called homceopatJdc treatment, inasmuch as the dose administered is smaller than that which would make the pulse rapid in a healthy man, but it might also be called antipathic, inasmuch as the same dose admin- istered to a healthy person would also slow the pulse. Homoeopathy can, therefore, not be looked upon as a universal rule of practice, and the adoption of any such empirical rule must certainly do harm by leading those who believe in it to rest content in ignorance, instead of seeking after a system of rational therapeutics. Dose. — The amount of a drug, which actually comes in contact with and affects the tissues, depends upon several conditions — (1) the quan- tity actually given; (2) its proportion to the body-weight; (3) the rapidity of its absorption by the blood from the place of introduc- tion ; (4) the condition of the circulation in various parts of the body, which determine the quantity of the drug carried to each ; (5) the rate of its absorption by the tissues ; (6) the rapidity of excretion. The word dose, as employed in medicine, usually means the quantity given mi one time, bul sometimes this maybe very different from what actually produces any effect. It is the amount of the drug existing in tin- blood iii any given time, or rather the proportion of it that actually comes in contad with or is absorbed by the tissues, which really acts. We must therefore consider more in detail the circumstances which affect this proportion. 1 Vidi Traube, Med. Oenir. Ztg., w\.. p. 94,1861, and Brunton On Digitalis, p. 21. ACTION OF DRUGS OX THE ORGANISM. 55 Size. — As the action which a drug has on the body is not dependent on its absolute amount, but on the proportion it bears to the body on which it is to act, an amount which is a small dose for one person is a very large one for another. 1 Thus if a grain of some active substance be in- jected at the same time into the veins of a full-grown man and into those of a boy of only half his weight, it will be distributed through twice as much blood in the man as in the boy, and each tissue will only receive half as much of it. The dose of a drug must therefore be regulated by the weight of the patient ; and thus women, being lighter, require a smaller amount than men, and children less than adults. Though it would be more exact, it is not always convenient, to weigh patients ; but in experiments on animals we usually weigh the animal carefully and describe the dose in terms of the body-weight. For example, in describ- ing the lethal dose of physostigmia, we do not say that it is so many grains for an animal, but that it is 0*0-1 grains per pound weight of a rabbit. This relation, however, is not always an exact one, and other circumstances must be taken into account. Thus the species of the animal must be considered, for the same dose which would kill one kind of animal will not kill another. In animals of the same species the state of nutrition must be taken into account, for two animals of the same species which would be nearly of the same size when equally nour- ished, may have very different weights if the one is fat and the other is lean. But the fat is a comparatively inner tissue, and if we give to each animal a dose regulated by its body-weight, the vital organs, brain, heart, and spinal cord of the fat animal will get a larger share in proportion than those of the lean one. In testing the action of poisons on frogs, also, it must be remembered that a female frog with a quantity of spawn will be very heavy, but the spawn, like the fat, is not to be reckoned as tissue ; and a dose given in proportion to the actual weight would be much larger than the same pro- portion given to the frog after spawning. Mode of Administration. — If a substance be injected into the veins, the whole of it mixes with the blood and becomes active im- mediately, and the maximum effect is thus at once obtained and will again diminish as the substance is excreted. But the case is different if it be injected suocutaneously, and if it be given by the stomach or any other mucous cavity the difference is still greater ; for as soon as some of it is absorbed excretion begins, and thus one portion of the drug is passing out of the blood while another portion is being taken in. The amount in the blood is, then, only the difference between that absorbed and that excreted in a given time, and absorption may be so slow, or excretion so quick, that there is never a sufficient amount of the sub- stance in the blood to produce any effect. Thus Bernard found that a dose of curare which would certainly paralyze an animal when injected into the veins, or even subcutaneously, would have no effect when intro- duced into the stomach ; 2 and showed that this was due to the kidneys 1 Buchheini, Arzneimittellehre, 3d edit., p. 54. 2 Bernard, Leeons sur les Effets des substances toxiques, p. 282. 56 PHARMACOLOGY AXD THERAPEUTICS. excreting the poison as fast as it was absorbed from the stomach, by ex- tirpating the kidneys, 1 when the animal became paralyzed as surely as if the poison had been introduced at once into the veins, though not so quickly. Hermann also discovered, without being acquainted with Ber- nard's observations, that curare taken into the stomach would produce paralysis if excretion were prevented by ligature of the renal vessels. Vessels of lung. Veins of general surface of — body. I Liver. Veins of stomach. —\..J& Biliary circulation Veins of intestines, Arteries going to nerve- centres. Arteries to muscles. Arteries to stomach. Arteries to intestines. Kidney. Excretion by kidney. FIG. 4.— Diagram to illustrate absorption and excretion. The arrows show the direction of the cur- rents. The absorbents from which the blood passes directly into the general circulation are repre- sented diagrammatically by the veins of the lungs and of the general body surface in the figure. The absorbents by which the drug must pass through the liver, and possibly be partly excreted or dest royed, are represented by the veins of the stomach and intestine. The excreting channels by which the drug may pass directly from the body without re-absorption occurring, are represented by the vessels of the lung and by the ureter. Those by which excretion takes place into cavities from which much re-absorption "may occur, are represented by the arteries to the intestine and the stomach. The absorption of drugs from the stomach and intestines may be considerably retarded, and their action diminished, by the liver. Before reaching the general circulation, drugs absorbed from the intestinal canal must all pass through the liver (Fig. 4). In their passage they may be partly arrested and excreted again into the intestine along with the bile. They may be also partially destroyed. A larger quantity of a drug may thus be necessary to produce similar effects when intro- duced by the stomach than when injected directly into the circulation or under the skin, (1) because it may be absorbed more slowly by the vessels of the gastric or intestinal mucous membrane, (2) because a part of it may be arrested in the liver and excreted into the intestine along with the bile, (3) because a part of it may be actually destroyed in the liver. The more rapid the absorption or the slower the excretion of any drug, the greater will be its effect. Thus the effect produced by the same dose of a medicine will be in proportion to the rapidity of its absorption from the different parts to which it has been applied, unless tin- differences be bo Blight that there has not been time for the excretion of any considerable quantity from the blood during the process. On this account we must diminish the dose of a medicine in order to obtain the cflcct. according to the rapidity of absorption from the place to which we apply it. Absorption is quickest from serous membranes, next Bernard, Rmu det Coura Scientiftques, 1865. ACTION OF DRUGS ON THE ORGANISM. 57 from intercellular tissue, and slowest from mucous membranes. The vascularity and rate of absorption from intercellular tissue is greater on the temples, breast, and inner side of the arms and legs than on their outer surfaces, or on the back. 1 It should not be forgotten that any drug introduced into the stomach, but not absorbed into the blood, is as much outside the body as if it were in the hand, for any effect it will have on the system, provided always it have no local effect on the gastric walls. For if it act directly on the walls of the stomach, it may have an effect which it would not have when held in the hand or applied to the skin. Thus mustard, which would produce redness and burning of the skin, will cause vomiting when swallowed ; but opium, which does not act on the stomach itself, except by diminishing its sensibility, pro- duces no apparent effect until after it has been absorbed. By the difference between absorption and excretion under different circumstances or in different individuals, 2 the cumulative action of drugs, the effect of idiosyncrasy, habit, climate, condition of body, as fasting, &c, disease, and form of administration, can, to a certain extent, though not entirely, be explained ; but experiments on some of these points are deficient, and the explanations now given are to some extent theoretical. Cumulative Actiou. — If a substance be naturally so slowly ex- creted from the body that the whole of the dose in ordinary use is not excreted before another is given, the amount present in the body will gradually increase, just like the curare in Hermann's experiment, and will produce an increasing or cumulative effect. Examples of this are to be found in metallic preparations, such as those of mercury or lead, which are excreted very slowly; or in some of the organic alkaloids, if given in sufficiently large and frequent doses. The size of the dose and the frequency with which it must be repeated in order to produce a cumu- lative effect, will differ according to the rapidity with which the drug is excreted; for, if excretion be rapid, a larger dose or more frequent repetition will be required. Sometimes the symptoms of the physiologi- cal action of a drug instead of increasing gradually may do so suddenly, and it is to this kind of action that the term cumulative action is most usually applied. This may sometimes be due to a sparingly soluble drug accumulating in the intestinal canal, and being suddenly dissolved and absorbed on account of some change occurring in the intestinal con- tents ; at other times it may be due to arrest of excretion, as in the case of the two vegetable active principles, digitalin and strychnine, to which an especial cumulative action is ascribed. After moderate doses of these drugs have been taken for some time, it is found that instead of the effects they produce increasing gradually, as we would expect from a gradual accumulation in the blood, the symptoms of poisoning become suddenly developed, in somewhat the same way as if the dose had been suddenly increased. It is evident that a diminution in the quantity ex- creted will produce this effect as readily as an increase in the quantity taken, and this is probably the true cause of the phenomenon. When 1 Eulenburg, Hypodermatische Injection der Arzneimittel, 3d edit., p. 65. 2 Children absorb more quickly than adults, so opium is more dangerous to them. Marx, Lehre von den Giften, vol. ii., p. 117. 58 PHARMACOLOGY AND THERAPEUTICS. digitalin has been taken for some time and accumulated to a certain ex- tent in the blood, it causes a diminution in the amount of urine excreted, and this diminution is either accompanied or quickly followed by the other symptoms of poisoning. 1 The effect, indeed, seems exactly the same as Hermann would have obtained in his experiment if he had only partially compressed the renal arteries instead of ligaturing them com- pletely. For digitalin appears to diminish the secretion of urine by causing a powerful contraction of the renal vessels, 2 and in large, doses may completely arrest the secretion of urine, 3 and probably also the circulation through the kidneys. Strychnine has a similar action on the vessels. 4 Effect of different preparations. — When a drug is given in a soluble form, and in small bulk, it is more quickly absorbed and will have greater effect than when given in a less soluble form or much diluted. Thus drugs given in solution as tinctures will act, as a rule, more quickly than when given in the form of pill or powder. Effect of Fasting-. — When a drug is given upon an empty stomach, it is usually absorbed much more rapidly. Thus the same quantity of alcohol which would have no effect on a man if taken during or after dinner, might intoxicate him if taken on an empty stomach, and especially if he were thirsty, so that absorption occurred rapidly. Curare, although it is usually inert when placed in the stomach, is sometimes absorbed so rapidly from an empty stomach as to produce a certain amount of paralyzing effect. Besides the effect of absorption, we have to consider also the local effects on the stomach itself, and the reflex effects which may be pro- duced through its nerves on other organs. Thus where we give a drug for its local action on the stomach itself, it is administered with the greatest effect during fasting, as it will come in contact with all parts of the gastric mucous membrane. An example of this is the use of a small dose of arsenic for gastric neuralgia or lientery. But when we wish to prevent local action on the stomach, as, for example, when we give arsenic for its general effect on the system, in cases of skin disease, we administer it after meals, so that it may be di- luted by the food, and not irritate the stomach too much. Effecl of* Habit. — The tissues seem to have a certain power of adapting themselves to changes in their surroundings. Thus salt-water amoebae will die when placed at once in fresh water, but if the fresh water be added very gradually, they may by and by become accustomed to live in it. Fresh-water amoebae also have the power of becoming gradually accustomed to increasing quantities of salt gradually added to the water in which they live, and which would at once kill them if added suddenly. A similar power seems to be possessed by the tissues of the higher ani- mal-, in regard to some drugs at least, Thus the arsenic eaters of Styria 1 Brunton, On Digitalis^ p. 39. Brunton and Power. Proceedings of Royal Soc. 1874, No. 153, and Centralblatl d. Med. Wit ,1874, p. 197. ( Ihrisl i-Mu. r.din. Med. Journ., \ii., 11!>. 1 Grutzner, Pjtiiger 1 * An-hir. L876, I'.d. si., p. 601. Giirt ner, Separat Abdruck a. d. box. Bd. d. k. Akad. d Wiu. 1 1 1. Ai.t. Dec. Heft. Jahrg. 1879. ACTION OF DKUGS ON THE ORGANISM. 59 are able to consume — not only without injury, but with apparent bene- fit to themselves — a quantity of arsenic which would prove fatal to one unaccustomed to it. The same is the case with opium and morphia. With these latter drugs there seems to be hardly any limit to the quan- tity which can be taken after the habit has been once established, and after a certain dose has been exceeded. It is possible, however, that in addition to a process of accommoda- tion going on in the tissues, there is a slower absorption, and perhaps more rapid excretion, going on at the same time ; for it is observed in the case of opium that sometimes the effect is not only diminished, but the time which elapses before it occurs is lengthened when persons have become accustomed to the drug. In regard to the possibility of very slow absorption we must remem- ber the power of the liver to arrest and excrete, or to destroy poisons, especially as it is chiefly in the case of vegetable poisons that their power is lessened by habit, which has much less effect on inorganic substances. The tolerance of some inorganic drugs, and especially of tartar emetic in disease or after repeated doses, may be due to fever or the drug itself lessening the acidity of the stomach, and consequently the action of the drug which acts most strongly in presence of an acid. The Effect of Temperature. — The effect of temperature on the action of drugs is very great. At different temperatures the administra- tion of the same drug may be followed by different results, and it is probable that a great number of the contradictory observations which we find in pharmacological works are due to this most important factor having been neglected in making the experiments. It is of the greatest importance to the physician also, as many of the cases of dis- ease which he has to treat are accompanied by a rise in temperature which may have a very important effect upon the action of the drugs which he administers. The alteration produced in the effect of drugs by warmth was first noticed by Alexander von Humboldt, who observed that warmth not only acted as a stimulant to the heart in increasing the power and rapidity of its contractions, but noticed that warmth increased the rapidity with which alcohol destroyed the irritability of a nerve, and potassium sulphide that of a muscle. Bernard observes generally that poisons act slightly on frogs when cooled down, and become more active the higher the tem- perature. The effect of warmth in stimulating the movements of proto- plasmic structures, such as amoebae and cilia was investigated by Kiihne ; and, in an important research, Luchsinger has experimented on the influence of warmth on the action of poisons on many organs, and found that the ciliary motion in the pharynx of the frog becomes paralyzed by chloral, potassium carbonate, and tartrate of copper and soda more and more quickly in proportion to the rise in temperature. On cooling down, the ciliary movement again returned. Dr. Cash and I have found that the action of veratrine or barium on muscle is very much altered by heat and cold. At ordinary tempera- tures contraction is greatly prolonged, but under the influence of either great heat or great cold the contraction again becomes nearly or quite normal. 60 PHARMACOLOGY AND THERAPEUTICS. Many, if not all, muscular poisons act more quickly with increased temperature; and frogs poisoned with chloral, copper, manganese, potash, and zinc, are paralyzed more quickly when the temperature is high, than when it is low, whether the alterations be produced artificially, or be due to differences in the season at which the experiments are made. Rabbits poisoned with copper or potash also die more quickly when placed in a warm chamber, than when left at the ordinary tem- perature. The terminations of motor nerves in the muscles are also greatly affected by temperature. Guanidine produces in the frog fibrillary twitchings of the muscles, which persist even in excised muscles, but are removed by curare, and are therefore in all probability dependent on an affection of the terminal ends of the motor nerves in the muscle. Luchsinger has found that when four frogs are poisoned in this way, and one is placed in ice-water, another in water at 18°, a third at 25°, and a fourth at 32°, the fibrillary tAvitchings soon disappear from the muscles of the frog at 0°, and only return when its temperature is raised to about 18°. In the one at 18° convulsions occur, which are still greater in the one at 25°. In the frog at 32°, on the other hand, no abnormal appearance is to be remarked, and five times the dose may be given without doing it any harm. This poison then resembles veratrine in acting only at ordinary temperatures, and in its action being abolished by excess of heat or cold. The effect of temperature on secreting nerves is well marked. When the sciatic is stimulated in an animal, the corresponding foot usually begins to sweat, but the sweating is very much less if the foot is cooled down than if it is warm. A similar action is exerted by tempera- ture upon the sweating produced by pilocarpin — a drug which appears to act by stimulating the ends of the secreting nerves. When the animal is cooled, this drug is much less powerful than when it is warm. < Overheating appears to have an opposite action, and when the foot is heated up to a certain temperature it does not secrete nearly so readily, even though the glands themselves are not injured, and secretion may commence after the lapse of a little time. The influence of poisons on the heart of the frog is also modified by temperature. Kroneeker found that its beats were arrested by ether easily and quickly when the temperature was high, but with great diffi- culty when it was low. Ringer found that a small dose of veratrine atly a fleet- I lie ventricle at a moderate or high temperature, but at a low temperature produces no effect, 1 Luchsinger noticed that when the frog's heart had been arrested by passing dilute solutions of chloral, copper, or potassium carbonate through ;it 25° C, the pulsations again began when the temperature was reduced to \~> I '. When, on the contrary, the heart had been arrested m a similar manner, at a temperature of 5° C, pulsations could then be induced by warming it to 15°. 1 Singer, Archives of Medicine, vol. vii., Feb., 1882, p. 5. ACTION OF DKUGS ON THE ORGANISM. 61 Some extraordinary observations on the effect of temperature upon the action of drugs on the spinal cord have been made by Kunde and Foster, who have found that, in a number of frogs poisoned with strychnia and exposed to different temperatures, raising the temperature diminishes the convulsions, while cold increases them if small doses are employed. Raising the temperature, indeed, may not only diminish but entirely abolish the convulsions, while putting a frog in ice may bring them on, when they would not otherwise appear, and cause them to last for no less than twenty-four hours. When large doses are employed the opposite effect is produced; raising the temperature then increases the convulsions, while cooling the frog down to 0° abolishes them. An observation similar in some respects, though differing in others, has been made on the effect of temperature on the action of picrotoxin by Luchsinger. 1 When this poison is given to three frogs, and they are then placed in water at 0°, 15°, and 32°, in a few minutes the convul- sions occur in the one at 32°, shortly afterwards in that at 15°, while the one at 0° remains for a long time completely unaffected, and only exhibits signs of convulsion when the dose has been very great indeed, or when it is taken out of the cold bath. The effect of warmth in accelerating death from muscular poisons has already been mentioned. The power of warmth to preserve life in narcotic poisoning was ob- served by Hermann in relation to alcohol, which rabbits bear better when they are somewhat warmed. 2 Its extraordinary effect in preventing death in animals poisoned with chloral was noticed by Strieker, and more thoroughly worked out by myself at his suggestion. 3 Death by chloral appeared from my experiments to be in a great measure due to continued loss of heat from the animal. This seems to be the case also in metallic poisoning by copper, manganese, mercury, platinum, potassium, thal- lium, tungsten and zinc. Its cause appears to be twofold : (1) The poi- sons lessen combustion in the body, and the amount of heat produced, as is shown by their diminishing the amount of carbonic acid excreted. (2) Besides disturbing the production, they also disturb the regulation of heat, so that animals poisoned by them have less power of resisting the influence of external temperature, and therefore the temperature rises more quickly when they are put in a warm chamber, as well as sinks more quickly when they are exposed to cold. All these things show that the definition of the action of a drug", already given, p. 34, must be still further modified, and we must define it as the reaction between the drug and the various parts of the body at a certain temperature. Thomas 4 found that digitalis has sometimes no action on the pulse in pneumonia. As the slowing of the pulse produced by this drug is to some extent effected through the vagi, it occurred to me that its want of action in this disease might be due to the paralysis of these nerves by 1 Luchsinger, Physiologische Studien, Leipzig, 1882. 2 Hermann, Arch. f. Anat. u. Physiol., 1867, p. 64. 3 Lander Brunton, Journal of Anatomy and Physiology, vol. viii. 4 Arch.f. Heilk., vol. iv., 329, 1865. 62 PHARMACOLOGY AND THERAPEUTICS. heat. On testing the action of heat, however, on the vagus, I found that it was not paralyzed in rabbits deeply chloralized, at a temperature just sufficient to kill the animal. 1 The reason why digitalis does not reduce the pulse in some cases of pneumonia has, therefore, still to be determined. The abnormal effect which opium has in some cases of fever — causing excitement instead of sleep — is occasionally most distressing to the phy- sician. It is possible that this may be partly due to the temperature, and that the combination of tartar emetic with the opium may owe some of its utility to its effect in lowering temperature, although not im- probably both it and another useful combination with chloral also act more perfectly on account of the depressing action on the circulation. These are points, however, on which further observations are greatly needed. Climate. — It is said that the action of narcotic drugs is greater in warm climates than in cold, and that smaller doses are therefore required to produce a similar effect. If this statement be true, it is in all proba- bility due to the higher temperature, for Crombie has shown that in India the average temperature of the body is about half a degree higher than in England. Time of Day. — In healthy persons fluctuations occur. The lowest temperatures occur at night between 10 p. M. and 1 A. M., and in the early morning between 6 and 8 a.m. The highest temperature occurs between four and five in the afternoon. The action of drugs may be partially altered by the slight variations in temperature which occur within the body, and perhaps still more by the variations in tissue change, of which these fluctuations of tempera- ture are the indication. Thus the necessity for great attention to the administration of stimulants in the early hours of the morning in cases of threatening collapse has long been recognized. Effect of Season. — The action of drugs is altered by the changes in temperature due to the seasons. Galen supposed that the quantity of blood in the Body was increased in spring, and in this country, till within recent years, it was a common custom for people to be regularly bled every spring. Purgatives were not unfrequently also administered at the same time. There are, no doubt, changes corresponding with the seasons in the human organization, although these are better marked in the lower animals, e.g., deer; where the antlers bud regularly in spring and reach perfection just at the breeding season. It is possible that the abolition of the practice of bleeding in spring and the changes in other plans of treatment formerly adopted, may not be altogether due, as some suppose, to increased knowledge on our part, but rather to the occurrence of a change <>(' type not only in diseases but also in slight ailments, and to the need for such treatment having disappeared. Formerly, be- fore the introduction of coaches, and still more of railways, locomotion was difficult and transportation was expensive; in consequence of this the food consumed by the generality of people was different in character, loaf bread being rery little used, and salt meat often used for weeks and months together during the winter, with comparatively few vegetables. 1 St. Bartholomew's "Hospital Reports, 1871, p. 210. ACTION OF DRUGS ON THE ORGANISM. 63 Such a diet might naturally lead to a condition of body which would be benefited by bleeding and purgatives. Effect of Disease. — The direct and indirect, the local and remote actions of drugs upon the complicated mechanism of a mammalian body is so perplexing, that the attempt to ascertain the precise mode of action of a drug by its simple administration either to a healthy man, or to healthy animals, and observation of its effects upon them is hopeless. Moreover the object that we really wish to attain is the power to re- lieve the human suffering, and to avert the premature death due to dis- ease. But in disease we have new factors, changes are produced by it in the functions of the body, and the reaction of the diseased organism to the drugs which we administer is oftentimes different from that of a healthy one. To a man suffering from cholera, for example, enormous doses of drugs have been given without the least effect ; and, in the wake- fulness of fever, the opium which ought to produce sleep may simply cause excitement and delirium. Use of Experiments. As we have seen, the problems put before us are too complicated to be solved directly, and we must therefore simplify them. This is done in four ways : — 1st, by observation of the effects of drugs on animals with a simpler organism than our own, such as amoeba or frogs ; 2ndly, by applying- the drug to some part of an animal body more or less completely separated from the rest, such as, for example, the muscle and nerve, or the heart of a frog separated from the body ; and, 3dly, by preventing* it from reaching- one part of the body while it acts on the others, as by ligaturing an artery as in Bernard's or Kolliker's experiments on curare. 4thly, by producing artificial changes in the relations of the various parts of the body of higher animals, either before or after administration of a drug, as, for example, by dividing the vagi, in order to ascertain how far the change produced in the beats of the heart by a drug is due to its action upon it by these nerves. Comparative Pharmacology. — It may seem almost absurd to those unacquainted with the subject, that so much attention should be devoted to experiments on the effect of drugs on the lower animals, when our object is, as we have just stated, to ascertain their action upon human beings, and their mode of employment in the diseases of man. But in the study of Pharmacology, just as in Histology, very much is to be learned by comparative studies. In his lectures, Ranvier ad- mirably defines General Anatomy as Comparative Histology, limited to a single organism. He illustrates this by showing that the different modes of movement which occur in some of the lower classes of the 64 PHARMACOLOGY AND THERAPEUTICS. animal kingdom are to be found united in the highest. Thus leucocytes of the blood move about like amoeba. The epithelium of the respiratory passages is provided, like infusoria, with cilia ; and while some muscles have the power of rapid contraction, others contract slowly, like those of some invertebrata. 1 We have thus in certain parts of the bodies of the higher animals and of man, anatomical elements whose functions are performed in a way resembling that of organisms low in the scale of existence, and, by examining the effect of drugs upon these low organisms, we acquire knowledge which aids us in determining the action of drugs upon simi- lar anatomical elements in the human body. In his admirable lecture on Elementary Pathology, Sir James Paget draws attention to the distinction between the conditions of life and the essential properties of living things ; and to the fact that, while the va- rious parts of a complicated organism like the human body are closely connected together, and made to work in harmony for the common good of the organism in health, yet each part retains its own mode of life, and may sometimes develop to an excessive extent at the expense of the rest, and may destroy the organism, and itself as well. We see the power which each part possesses of carrying on individual life apart from the rest best in lower organisms, or in inorganic substances, where the parts are less dependent on the welfare of the whole. Thus, in crystals, a chip which has been broken off is replaced, and the form of the crystal restored by putting it in a solution which will yield it the proper kind of material required. When a hydra is cut in two, each part grows into a perfect individual : a tail growing to the head part, and a head growing to the tail part. When a claw has been broken off a crab or lobster, a new one will by and by grow ; but if the animal be divided in two, unlike the hydra, it will die. As we ascend in the scale of existence, the power of repair becomes less perfect. But even in the human being we see that the different parts retain their individual life, and if put into proper conditions may live, although the original body from which they were obtained were to die. Teeth, for example, which have been extracted from one person have been transplanted and grown in the jaws of another ; and the transplantation of hair, skin, or of periosteum, is perfectly practicable. Idiosyncrasy. — In their onward development from the lowest forms of life, man and the higher animals have not only permanently retained in their bodies certain parts which resemble organisms low in the scale of existence, but every now and again a tendency to reversion appears in certain individuals, and we thus get anatomical abnormalities and mal- formations. These were formerly inexplicable, but the doctrine of evolution has thrown much light on their probable causation. Now and again we also meet with peculiarities in the reaction be- tween drugs and parts of the human body in certain individuals. w/ id'anatomu gSnSraleaur le syetdme musculctire, par L. Ranvier. Paris, 1880, ].. 48. ACTION" OF DRUGS ON THE ORGANISM. 65 Some persons, for example, are like pigeons — only slightly affected by opium — and can take enormous doses of it without any apparent effect. Others, again, are peculiarly sensitive to the action of certain medicines, and a dose of a mercurial preparation which would have but a slight purgative action on one, will produce intense salivation in another. These personal peculiarities in regard to the action of drugs, or idiosyncrasies, as they are termed, have been, and are still, very per- plexing to the medical practitioner. It is probable, however, that a more complete study of comparative pharmacology will enable us, to some ex- tent at least, to recognize these, and thus to avoid the inconvenience which they occasion. Objections to Experiment. — Some people object entirely to experiments upon animals. They do this chiefly on two grounds. The first is that such experiments are useless, and the second, that even if they were useful, we have no right to inflict pain upon animals. The first objection is due to ignorance. Almost all of our exact knowledge of the action of drugs on the various organs of the body, as well as the physiological functions of these organisms themselves, has been obtained by experiments on animals. The second objection is one which, if pushed to its utmost limits and steadily carried out, would soon drive man off the face of the earth. The struggle for existence is constantly going on, not only between man and man, but between man, the lower animals and plants, and man's very being depends upon his success. We kill animals for food. We destroy them when they are danger- ous like the tiger or cobra, or destructive like the rat or mouse. We oblige them to work for us, for no reward but their food; and we urge them on by whip and spur when they are unwilling or flag. No one would think of blaming the messenger who should apply whip and spur to bring a reprieve, and thus save the life of a human being about to die on the scaffold, even although his horse should die under him at the end of the journey. Humane people will give an extra shilling to a cab-man in order that they may catch the train which will take them to soothe the dying moments of a friend without regarding the consequences to the cab-horse. Yet if one-tenth of the suffering which the horse has to endure in either of the cases just mentioned were to be inflicted by a physiologist in order to obtain the knowledge which would help to relieve the suffering and lengthen the life, not of one human being only, but of thousands, many persons would exclaim against him. Such objections as these are due either to want of knowledge or want of thought on the part of people who make them. They either do not know the benefits which medicine derives from experiment, or they thoughtlessly (some- times, perhaps, wilfully) ignore the evidence regarding the utility of experiment. One of the most important objections that has been raised to this mode of experiment is that the action of drugs on the lower animals is quite different from their action on man. This objection has a certain 5 66 PHARMACOLOGY AND THERAPEUTICS. amount of truth, but is in the main groundless. The action of drugs on man differs from that on the lower animals, chiefly in respect to the brain, which is so much more greatly developed in man. Where the structure of an organ or tissue is nearly the same in man and in the lower animals, the action of drugs upon it is similar. Thus we find that carbonic oxide and nitrites produce similar changes in the blood of frogs, dogs and man, that curare paralyzes the motor nerves alike in them all, and veratria exerts upon the muscles of each its peculiar stimulant and paralyzing action. Where differences exist in the structure of the various organs, we find, as we would naturally expect, differences in their reaction to drugs. Thus the heart of the frog is simpler than that of dogs or men, and less affected by the central nervous system. We consequently find that while such a drug as digitalis has a some- what similar action upon the hearts of frogs, dogs and men, there are cer- tain differences between its effect upon the heart of a frog and on that of mammals. In all it seems to affect the muscular substance and cause increased contraction. But while the frog almost invariably dies with the heart in a state of tetanic contraction, this is not the case with dogs or men, where the heart sometimes is found in diastole after death. Ipecacuanha or tartar emetic will cause vomiting in man, but does not do so in rabbits. The reason of this is that the position of the stomach in the rabbit is different from that in man, and is such that the animal cannot vomit. In dogs, however, the position of the stomach agrees with that of man, and tartar emetic or ipecacuanha causes vomit- ing in both. Belladonna offers another example of apparent difference in action — a considerable dose of belladonna will produce almost no apparent effect upon a rabbit, while a smaller dose in a dog or a man, would cause the rapidity of the pulse to be nearly doubled. Yet in all three — rabbits, dogs and men — belladonna paralyzes the power of the vagus over the heart. The difference is, that in rabbits the vagus nor- mally exerts but little action on the heart, and the effect of its paralysis is consequently slight or hardly appreciable, the pulse being normally almost as quick as it is after the vagus is paralyzed. In dogs and men, on the contrary, the vagus is constantly exerting considerable restrain- in g power over the heart, and the effects of its paralysis at once direct attention. An example of the apparent difference in the effect of a drug on different animals is afforded by nitrite of amyl. If we measure the pressure of the blood in the arteries of a rabbit and of a dog, and then cause them to inhale nitrite of amyl, we find that the small vessels have become widened and allow the blood to pass easily out of the arterial in into the veins, so that the pressure sinks considerably in the rabbit, whereas it sinks only slightly in the dog. The action seems at first sight different; but when we examine it more closely, we find that the heart of the dog is no longer beating slowly, but very quickly, SO :"- to keep up the pressure, notwithstanding the rapid flow of blood through the widened vessels, while the heart of the rabbit was going so fast before thai it could not L r o much more quickly. If we cut the vagi iu the (Jog, BO that the heart goes as quickly as in the rabbit before it ACTION OF DRUGS ON THE ORGANISM. 67 begins to inhale, the blood-pressure sinks during the inhalation, just as it does in the rabbit. 1 By means of experiments upon animals, then, we are able to ascertain the action of drugs upon those organs of the body which are alike in man and animals ; and the very differences which exist between various sorts of animals, help us to understand the action of drugs more thoroughly. Erroneous Deductions from Experiments. — A great fault- — and one which is only too common in the works of experimental pharma- cologists — is that of drawing general conclusions from limited data. One experimenter tries the effects of a drug, let us say tartar emetic, upon rabbits. He finds that they do not vomit, and instead of drawing the only warrantable conclusion, viz., that tartar emetic does not cause vomiting in rabbits, he draws the general one — tartar emetic does not cause vomiting in animals. Another tries it upon dogs, and he finds they all vomit. Instead of the limited conclusion that tartar emetic makes dogs vomit, he draws the general conclusion that it makes animals in general vomit. The two observers are equally positive in regard to their facts — each is assured that he himself is right, and that the other is totally wrong. The reason of the discrepancy is simply that the con- ditions'under which the experiments have been performed were different^ but the observers have not taken these differences into account when drawing their conclusions. A third observer then comes, perhaps, and by further experiments reconciles the apparently contradictory state- ments. Thus one experimenter tries the effect of caffein upon frogs : he finds that it produces rigor mortis in the muscles. Another tries the same drug and finds no such result. These two observations are com- pletely contradictory, until a third tries the effect of the drug upon two species of frog, and finds that while the muscles of the rana esculenta are but slightly affected, those of the rana temporaria are rendered rigid. 2 These apparent contradictions in the results of different observers are exceedingly puzzling to the student, but nothing is more instructive to those who are actually working at the subject. The utility of apparent exceptions was fully recognized by Claude Bernard, who says: "In physiological studies we must always carefully note any fact which does not accord with received ideas. It is always from the examination and the discussion of this exceptional fact that a discovery will be made, if there is one to make." 3 1 Lauder Brunton, "Action of Nitrite of Arnyl on the Circulation," Journal of Anatomy and Physiology, vol. v., p. 95. 2 Schmiedeberg, Arch. f. Exper. Path. u. Pharmak. Bd. ii., p. 62. 3 Bernard, Liquides de Vorganisme, torn, i., p. 258. 68 PHARMACOLOGY AND THERAPEUTICS. CHAPTER III. ACTION OF DRUGS ON PROTOPLASM, BLOOD, AND LOW ORGANISMS. Action of Drugs on Albumen. In all living bodies we find that the protoplasm is of a more or less albuminous nature. Albuminous substances possess a very complex intra-molecular group- ing, and very high atomic weights. Many different forms are found in animals, and along with albumens we must associate bodies like mucin, which probably have a very important relation to it, inasmuch as a body nearly, if not quite, identical with mucin, forms the nucleus of the red blood corpuscles in fowls, and a substance of an allied nature also occurs in the circulating fluid which represents the blood in the echinoder- mata. The albumen of serum may be taken as a representative of such substances; it is soluble in water, but, when boiled, is coagulated and precipitated. It is coagulated also by alcohol, but if the coagulum is quickly placed in water it redissolves ; if allowed to remain for some time exposed to the action of the alcohol, it becomes permanent and insoluble. An insoluble precipitate also falls on the addition of tannic acid, lead acetate, mercuric chloride. These just mentioned precipitate almost all the albumens, even from somewhat dilute solutions ; in strong solutions precipitates are also formed by silver nitrate, copper sulphate, and zinc chloride. When these are added to albumen containing only a small quantity of water, as for example, the white of an egg, they form with it a solid mass of albuminate. A small quantity of strong potash added to the white of egg produces a solid transparent jelly of albu- minate of potash, and a similar but opaque jelly is formed by the use of caustic lime or baryta in the place of potash: these albuminates are, however, soluble in water. Albumen dissolves in alkalies and may be partly precipitated by neutralizing. The alkaline solution is not coagulated by heat, and, in fact, the substance present in the solution is no longer serum albumen, but a compound of the albumen with the alkali or alkali-albu- rn in ate. Albumen is precipitated by a small quantity and dissolved by excess of most mineral acids, forming with them acid albuminates; thus a watery solution of albumen is precipitated by concentrated nitric, sul- phuric, or hydrochloric acid. It is also precipitated by acetic acid along with a considerable quantity of a neutral salt of an alkali or alkaline earth, or of gum-arabic or dextrin. This precipitation is perhaps best marked with nit lie acid, but it only occurs with moderate quantities of nitric acid. When a minute quantity only of the acid is added, no pre- cipitation takes place, and the solution remains clear; but a nitric-acid- albuminate containing a small quantity of acid is formed, and if the solution is dow boiled, do coagulum will form. On the addition of more acid, however, a second Qitric-acid-albuminate, insoluble in water, is pro- duced, and a precipitate falls. On the addition of more acid still, the precipitate is redissolved, and a third nitric-acid-albuminate is formed, soluble in water, and not precipitated on boiling. ETC. 69 The temperature at which albumen coagulates is altered by acids and alkalies. Alkalies generally tend to raise the temperature of coagu- lation, and when added in large quantities prevent it altogether. Very dilute acetic and phosphoric acid, on the other hand, tend to lower the coagulating point, although large quantities may interfere with coagulation. Neutral salts, such as sodium chloride or sulphate, also lower the coagulating point. The organic alkaloids which have such a powerful action on the animal body appear to resemble acids rather than alkalies in their effect upon albumen, because, according to Rossbach, they lower considerably instead of raising the point of coagulation. Albumen undergoes an extraordinary change in consequence of the action of ozone, and becomes, after exposure to it, uncoagulable by boil- ing, and by acids, excepting in large quantities, and by metallic salts, with the exception of basic acetate of lead, and of alcohol. The action of alkaloids upon this ozonized albumen is even more remarkable than upon ordinary albumen, for when mixed with it in small quantity, they restore its coagulability to the albumen and cause it to coagulate far under the boiling point. When added to the albumen before exposure to a stream of ozone, they prevent the albumen being altered by it, in the way which it would otherwise be, and it remains coagulable by heat, in the same way as if it had not been exposed to the action of ozone at all. It is therefore evident that the alkaloids not only increase the coagulability of ordinary albumen at a high temperature, but that they act upon it at ordinary temperatures (30°-40° C.) and destroy its affinity for ozone. This action will naturally interfere with the processes of oxidation, but the methods of examining this action will be described later on (page 79). When a solution of pure albumen is added to a mixture of guaiac and vegetable protoplasm, it greatly lessens the blue color, which would otherwise be produced. The cause of this appears to be that albumens or albuminous substances have such an affinity for ozone that they take it up instead of allowing it to act on the guaiac. This affinity for ozone is diminished by the action of alkaloids. This is shown by taking several tubes containing an albuminous solution of a certain strength. Reserving one as a standard, the alkaloids are added to the others, and after a certain time has elapsed, so as to allow the alkaloid to affect the albumen, a small quantity of lettuce water is mixed with each, and then a little guaiac. In the standard one the color will be least, because the albumen not having been acted upon by the alkaloids will interfere with the reaction of the lettuce water and the guaiac upon each other. In the others a blue color will appear with greater or less intensity, according as the albumen has been more or less affected by the alkaloid. This experiment, however, is not free from fallacy, because there is to be considered not merely the action of the alkaloid upon the albumen, but its action on the protoplasm as well, and it is therefore advisable to use it in a quantity which is small as compared with the amount of albumen employed. 1 1 Rossbach, Verhandl. d.phys. med. ges zu Wiirzburg, N. F., 3 Band., p. 346. <0 PHARMACOLOGY AXD THERAPEUTICS. Action of Drugs on Protoplasmic MoAenients. The amoeba consists of a small mass of structureless protojDlasrn, without any distinct cell-wall. It contains numerous granules and nucleus, with nucleolus, as well as one or more vacuoles, which appear to be small spaces filled with fluid. Some amoeba live in salt water, others in fresh water ; and, although it may be impossible with the microscope to detect any marked differ- ence between them, they exhibit a great difference in their reactions to drugs — the salt-water amoeba being only slightly affected by them, while fresh-water amoebae are readily susceptible to their action. It is nourished by simply adhering to any particle of food, closing over it and digesting it, again opening out and ejecting the residue. This protoplasmic mass is almost constantly altering in shape, push- ing out projections at one point and drawing them in at another. By this means, also, it moves about from place to place. 3Iethocl of Experimentation on Amoebae and Leucocj tes. — In experimenting on amoebae, take a drop of the slimy sediment, such as found in the tanks of hothouses, and place it on the covering-glass of a microscope ; this may then either be put on an object-glass, the excess of water removed by filter- paper, or still better, it may be inverted over the opening of a Strieker's warm stage. When it is simply laid on the object-glass, a solution of any drug is added by putting a drop across the edge of the covering-glass, and allowing it to be drawn gradually underneath by capillary attraction. Gases are best applied by means of a Strieker's stage, and it is also conve- nient for experiments on solutions. In experimenting on leucocytes with its aid, a covering-glass is applied to the cut surface of a newt's tail, or to the surface of a drop of blood, so that a very minute quantity of blood adheres to it. The drug to be tested is kept dissolved in a -6o--*J5 per cent, solution of common salt (Na CI). The salt solution of this strength is often called simply normal Ball .-olution, and is used instead of water, because water itself has a very destructive action on those forms of protoplasm, which are usually nur- ished by saline solutions, like blood or serum. A drop of the salt solution containing the drug is placed over the blood on the covering-glasSj ami inverted over the warm stage as already described. If the experiment is to continue long, a rim of oil should be drawn around the edge of tli.' covering-glass with a camel-hair pencil, so as to prevent evaporation. The advantage of using such a small quantity of blood is, first, that it mixes rapidly and perfectly with the solution ; and secondly, that it does not dilute the solution <>f tin- drug, and we thus know the strength of the drug used. If we used a large drop of blood, we should have to employ a solution of the din- twice the strength we desire, so that when a drop of equal size was added t<> the blood the mixture would contain the proper proportion. The effect of \u-.\i and cold upon the movements is very marked, cold rendering then slow, or arresting them altogether. Heat at first lv quickens their movements, but, when raised to 35° C. it causes them to fall into a state of tetanic contraction and assume a spherical form. ETC. 71 This state is one of heat tetanus, and if the temperature is now re- duced the movements will again reappear. At a temperature of 40° C. they also become spherical and motion- less. But their movements do not return when the temperature is reduced ; they are in a state of heat rigor, the high temperature having coagulated the protoplasm. Slight electrical shocks from a coil increase the rapidity of the protoplasmic movements ; stronger ones cause tetanic contraction ; and numerous or powerful ones produce coagulation. Common salt in very small quantity (a drop of 1 per cent, solution slowly added) first quickens the protoplasmic movements and then causes sudden tetanic contraction, and the expulsion of any food they may con- tain at the moment, and sometimes even expulsion of the nucleus. When water is added so as again to dilute the mixture the amoebae resume their movements. Both acids and alkalies, when very dilute, increase the protoplas- mic movements and afterwards arrest them. Hydrochloric acid has a more powerful action than a solution of potash of a similar strength. It causes the amoebae to contract and form a ball with a sharp double contour. In it, twitching movements first occur, which expel any food present. It then becomes pale and lumpy, and breaks up. Potash causes them to swell up and assume the form of large pale vesicles, which quickly burst. A constant current of electricity causes contraction and im- perfect tetanus ; and, if powerful and long kept up, the positive pole produces in the amoebae near it the same changes as dilute hydrochloric acid, and the negative pole the same changes as are produced by an alkali such as potash. Oxygen appears to be necessary for their life ; its removal by means of hydrogen deprives the amoebae of their power of motion, and finally causes contraction and coagulation. Carbonic Acid alone has a similar action to removal of oxygen, and produces this effect both in the presence and absence of oxygen, but takes a longer time to do so when oxygen is present. 1 Leucocytes. — In their appearance and movements leucocytes strongly resemble amoebae : they are affected in a similar manner by heat, electricity, and drugs. Their resistance to the action of drugs varies somewhat in different animals. Those obtained from the blood of the newt for example are more resistant than those of the guinea-pig ; and those of the female newt more resistant than those of the male to the action of quinine. 2 Heat and cold affect the movement of leu- cocytes in very much the same way as those of amoebae. The movements of leucocytes, like those of amoebae, are of two kinds, viz., movements of the protoplasmic pseudopods, while the leu- cocyte remains in situ. The pseudopods in this instance are generally of a waxy look and knoblike form. 1 Kiihne, Protoplasma und Contractilitat, pp. 28-53. 2 Geltowsky, Practitioner, vol. viii., pp. 325-330. 72 PHARMACOLOGY AND THERAPEUTICS. Secondly, movements of migration from place to place ; these move- ments are accompanied, or accomplished, through the projection of numerous fine filaments. Effect of Drugs. — Cinchona alkaloids — quinine, quinidine, cin- chonine and cinchonidine have a remarkable power of arresting these movements in the proportion of 1 in 1,500. They quickly stop the mi- gratory movements of leucocytes from the newt, and in a much larger proportion will arrest the movements of the knoblike pseudopods. No very marked difference is observed in the strength of the cinchona alkaloids, though quinine seems to be somewhat the most powerful. Sulphate of bebirine is almost as powerful as the cinchona alkaloids. Strychnine is very much less powerful than any of the alkaloids mentioned. Potassic picrate and sesculin have but little action. 1 Movements of Leucocytes iu the Blood-vessels. — In the processes of inflammation leucocytes pass in great numbers through the walls of the capillaries. The effect of quinine in arresting their movements, when mixed with them directly, naturally leads one to expect that it may arrest their mi- gration from the capillaries, when injected into the blood, and this anticipation has been realized in the experiments of Professor Binz. To observe this phenomenon, the brain of a frog is to be destroyed, and a little curare injected under the skin, in order to abolish any spinal reflex move- ments. It is then laid on a piece of cork, such as that shown in Fig. 5, with a hole at one side, over which a piece of glass is fastened about half an inch higher, FlO. 1— Apparatus for examining the mesentery of the frog under the microscope. by means of two other pieces of cork and some sealing-wax. On this a piece of sheet cork of the form shown in the figure, and a round piece of glass are ce- mented bo as to form a channel, in which the intestine lies. The body of the frog is fixed to the cork, the abdomen opened, the intestines drawn out, and the mesentery fastened with very fine pins over the aperture. In half an hour, or two hours, the leucocytes pass rapidly through the walls of the capillaries, and afterwards wander through the tissues. The drug may then be injected into the lymph sac, or locally applied to the mesentery. When quinine is applied locally to the mesentery in this condition it 3ts the movements of the leucocytes, which have already emerged, but Dot prevent those which are still within the vessels from going out — they therefore form a dense accumulation around the vessel (Fig. 6, b). Ba< hanan Baxter, Practitioner, vol. xi., p. 321. ACTION OF DRUGS ON PROTOPLASM, ETC. 73 When injected into the circulation, on the contrary, the leucocytes which are in the vessels are prevented from passing from the capillaries, Fig. 6. — Diagram to illustrate the action of quinine on leucocytes, modified from Binz (Das Wesen der Chininwirkung, Berlin, 1868). The thick lines represent the walls of the blood-vessel, and nu- merous leucocytes are shown both inside it and outside distributed through the adjoining tissues. a represents the vessel before, and b after the local application of quinine. The leucocytes outside the vessel have their movements arrested, and cannot wander on through the tissues, while those inside are not affected and continue to emigrate, c represents the effect of quinine injected into the circulation or lymph sac. The leucocytes inside the vessel are here aflected first, and their emigration stopped, while those outside still continue to travel onwards. while those which have already passed out continue to wander onwards, and thus a clear space is left outside the vessel (Fig. 6, c). The quantity of quinine necessary to produce this effect is 25 jj 0Q th to 2Q jj 00 th of the animal's weight. If quinine were given to stop the exit of leucocytes from the vessels in peritonitis, three or four grammes would be required to be given within a short time, to a man weighing 150 lbs. In guinea-pigs a dose of quinine sufficient to kill the animal does not stop the movements of the leucocytes in its blood, which are seen to go on, when a drop of it is examined after death. Red Blood Corpuscles. — The size of the red corpuscles is dimin- ished by warmth, either applied locally on the hot stage of a microscope, or acting on them in the vessels of an animal suffering from fever, by carbonic acid and by morphia. It is increased by cold, oxygen, hydrocyanic acid, and quinine ; and an increase occurs also in cases of anaemia. 1 The red corpuscles pass out of the capillaries like the white, but they do so very slowly indeed, and in small numbers, under ordinary circum- stances. Excess of sodium chloride in the blood causes them to pass out much more quickly ; 2 and rattle-snake poison, when locally applied, pro- duces such sudden extravasation that it is impossible to follow the process : the whole field of the microscope becoming suddenly covered with blood. 3 Action of Drugs on Infusoria. Among the infusoria, like the amoebae, each individual consists of a single mass of protoplasm, and not of a number of distinct cells ; but the protoplasm 1 Manassein, Ueber die Dimensionen der Blutkurperchen unter verscJuedenen Einfliissen. Ttibingen, 1872. 2 Prussak. Wiener. AJcad. Sitzungsber., lvi., 1867 (Abth. 2), p. 13. 3 Brunton and Fayrer, Proc. Roy. Soc., February, 1875, p. 271. 74 PHARMACOLOGY AND THERAPEUTICS. is differentiated. Round the greater part of the animal it seems to be some- what harder, so as to form a sort of skin, excepting at one place which is softer than the rest, serving for the ingress of food and the egress of egesta. Instead of throwing out pseudopods, the body is either covered entirely with cilia or they are arranged round the mouth. Once it has entered by the mouth, the food finds its way all through the protoplasm of the body. A contractile vesicle exists, which pulsates rhythmically. 3Iode of Experimentation. — For the purpose of examining the action of drugs upon infusoria an infusion of hay is prepared some days previously. Two small pipettes are then made, which will deliver drops of equal size. f Fig. 7. — Diagram to show the way of making small pipettes. This is done by heating a piece of glass tubing in the middle, drawing it out and cutting it across by a scratch with a triangular file (Fig. 7). With one of these a drop of hay-infusion is placed on the covering glass, which is inverted on a Strieker's stage and examined. In order to ascertain the lethal strength of a drug, a drop of a solution of the poison of a definite strength is then mixed with it, and the infusoria are examined again after a certain time. If they continue moving, another experiment is made with a stronger solu- tion ; but if they have completely stopped, it is repeated with a weaker one until the solution is of such a strength that the movements become very slight, and cease almost immediately after mixing, and cannot be restored by the addition of water. As the two drops of fluid were of equal size, the lethal strength of the solution is just one-half of that which was last added. By repeating the experi- ments in exactly the same way with different drugs, their relative poisonous properties are ascertained. Heat increases the rapidity both of the rhythmical contractions of the vesicle and of the ciliary motion and consequently of the movements from place to place of the infusoria. It seems as if the cilia were not equally affected by heat, those which produce a longitudinal movement appearing to be acted upon more quickly than those which cause a move- ment of rotation. Both kinds are first stimulated and then paralyzed. At temperatures between 25° and 30° the contractions of the vesicle are greatly quickened, and the animal moves with great rapidity in a longitudinal direction. Between 30° and 35° its movements are still very rapid, but it seems to have lost the power of direction ; all the cilia seem in full action, and the movements of* the individual arc determined simply by their anatomical arrangement. Above H)° the cilia, which act longitudinally, appear to have stopped and the animal rotates, at first very rapidly, then slower and slower until all move- ment .ml the protoplasm appears to become fluid; but when the heat is still farther raised it coagulates. 1 ibach, ' J)i<- rii> thmisciicn Bewegunggerecheinungen der einfachsten Organ- ismen," Ferh, d. Wiirzburger phyrik-med. Gcsellsch, N.F., Bd. ii., Separatabdruck, S. 23. This work contains a number of exceedingly interesting and valuable observations on the subject. ACTIOX OF DRUGS OX PROTOPLASM, ETC. <0 Cold lessens the quickness of the rhythmical contractions of the vesicle, of the ciliary motion and of the movements from place to place. Weak electrical currents first quicken the ciliary motion and cause movements of rotation, then swelling of the protoplasm, slower move- ments, and finally apparent solution of the protoplasm. Moderate currents produce a tetanic contraction of the protoplasm and of the cilia, while the contractile vesicle is unaffected. Strong currents cause liquefaction of the protoplasm. Saline solutions appear rather, if we may say so, to alter the con- ditions under which the infusoria live than to affect the protoplasm itself. Strong solutions cause them to shrivel and then to swell up and become motionless. This effect appears to be due to the solution altering the quantity of. water which the protoplasm contains. "Weaker saline solutions, on the contrary, quicken their movements, and instead of causing them to shrivel, make them swell up at once. Chloride of sodium, chloride, bromide, and chlorate of potassium, as well as alum, all have this effect. Acids in minute quantities cause contraction both of the body and of the vesicle. The ciliary motion is at first quickened and then retarded ; the rate of contraction of the vesicle is at once diminished. Moderate quantities cause coagulation of the protoplasm with swell- ing and liquefaction after death. Strong acids at once destroy the protoplasm. Alkalies in minute quantities cause swelling of the protoplasm, dilatation and slowness of the contractile vesicle. Moderate quantities at once arrest the movements, cause liquefaction of the protoplasm, and destroy its differentiation, the contractile vesicles and vacuoles disappearing. They then cause swelling, and finally solution. In large quantities they produce immediate liquefaction of the whole body. Other drugs appear to affect the protoplasm itself, and arrest its movements without producing any apparent change in it. The most active are chlorine, bromine, corrosive sublimate, iodine and permanganate of potash, and creasote. Quinine is much less powerful than these, though it is much more so than most other organic alkaloids. Strychnia has only one-fourth the power of quinine. Cobra poison at first greatly quickens the movements of infusoria and then arrests them, causing just before death a contraction of the protoplasm, which then expands to its ordinary size. Relations of Motion and Oxidation. All animals, from the lowest to the highest, evidence their life by motion at one time or another ; and the energy required for this motion is maintained by processes of combustion. The materials for this combustion, viz., oxygen, and fuel of some sort, or food, are derived from the external medium in which the animal lives ; and in order to enable these substances to be available for each i 1 1 PHARMACOLOGY AND THEEAPEUTICS. part of the animal body, we must have some kind of respiration and cir- culation going on in it. In unicellular organisms, consisting of a single mass of protoplasm, the oxygen is derived from the water in which they swim, and both it and the nutritive material derived from the digestion of inclosed masses are circulated through the protoplasm by contractile vacuoles. In sponges, where the organism no longer consists of one but of several cells united into a community, some of these are furnished with cilia, in order to send a current containing oxygen and food to the other cells having a less favored position. In higher animals, where many cells are built up to form one or- ganism, we find a circulatory and respiratory apparatus fully developed. The medium in which unicellular organisms live is the water in which they swim. The medium in which the cells composing the main parts of the bodies of higher animals, such as man, live, is not the air which sur- rounds the body, but the intercellular fluid in which the cells themselves are bathed. Aa Claude Bernard points out with his usual clearness, the cells of the human body and the lowest unicellular organisms alike live in a liquid medium. From the layer of fluid surrounding it, the cell takes up the gen and food which this layer can yield. The supply being exhausted, an unicellular organism can move on elsewhere, but the cells in higher animals, being fixed and unable to move, require fresh portions of oxygen and of nutritive fluid to be brought to them. This is effected by the slow circulation of the lymph in which the cells themselves are bathed and by the supply to the lymph of oxygen and nutritive material from the blood. The circulation of the lymph is aided in many lower organisms by the motion of cilia, and this is found persisting in some parts of the higher animals, e. pectrum. Solutions of hemoglobin when boiled are completely decomposed into haematin and a proteid body or bodies. I Ill-matin gives a single band, which differs according as the solution is alkaline or acid, and according as the solvent is water or ether. Acids split up hemoglobin into hematin and a proteid. It is some- times possible to get these to recombine and to again form hemoglobin, but this is far from being always the case. Methaemoglobin appears either to be a product of the incomplete decomposition of hemoglobin or of its excessive oxidation. Some think that it contains more oxygen than hemoglobin, but less than oxyhemo- globin. Others think that it is a per-oxyhemoglobin containing more _ r -ii than oxyhaemoglobin. At all events the oxygen is more firmly combined in methaemoglobin than it is in oxyhemoglobin. This body is distinguished by a spectroscopic band nearly in the Same place as that of acid haematin. W hen the solution is made alkaline by ammonia this band disappears and is replaced by another fine one near D. Methaemoglobin appeal- to be converted again into hemoglobin by the action of reducing agents and subsequent oxidation. When its solution is treated with reducing agents, it -hows the spectrum of reduced hemo- globin; and on shaking this with air oxyhaemoglobin is formed, as Bhown by the appearance of it- characteristic bands. When blood ia allowed to stand for a length of time, it assumes a brownish color and gires the bands of methaemoglobin. When nitrites are mixed with freshly-drawn blood, they impart to it a chocolate color, and it then exhibits the hands of methaemoglobin. ACTION OF DRUGS ON" PROTOPLASM, ETC. 81 As the oxygen in methiemoglobin is more firmly combined with it than in oxyhemoglobin, substances such as the nitrites interfere with in- ternal respiration, and thus in large doses will cause symptoms of asphyxia; but their action differs from that of carbonic oxide in one very important particular, viz., that it is altered by asphyxia, whilst that of carbonic oxide is not. Reducing substances are constantly present in the blood and tissues, and these accumulate to a greater extent during the process of asphyxia. Carbonic-oxide haemoglobin, being a stable compound, re- mains unaffected by these, and the blood continues to circulate unchanged. 111 HI II If 1 l \:<: f ■ h.llH 1 1 ] - ill 1 s 1 ,11. .. ! M I ill f,f It :||,:; !;: »f\j 38 fill S " i .,-■ ■■■,!- - -Til 1- Oxyhemoglobin Hsenioglobin Carbonic-oxide hsemoglobin Sulpha? inoglobin Ditto, oxygenated Metheeinoglobin Blood treated witb nitrite ) of amyl and alcohol J Acid haematin (alcoholic) solution) j Alkaline hpematin (alco-1 holic solution) J Blood treated with cyan- ide of potassium or hy drocyanic acid Ditto, oxidized C D E b F Fig. 9. — Chart showing the spectroscopic absorption-bands of haemoglobin and its derivatives. (After McMunn). But methsemoglobin, which is produced by the action of the nitrites, becomes reduced by these substances and forms the normal reduced hae- moglobin ordinarily present in venous blood. When this reaches the lungs it again takes up oxygen, forming normal arterial blood, by which the internal respiration is again restored. Thus, unless new supplies of ni- trites are constantly added to the blood, the asphyxia they occasion quickly passes away. That caused by carbonic oxide, on the contrary, is much more permanent. It is not removed by artificial respiration, and in order to save the life of the animal or person poisoned by it, a quantity of the poisoned blood must be withdrawn from the veins and healthy blood in- troduced by transfusion. A method of ascertaining the effect of drugs on oxidation in the Mood consists in estimating the rate at which acid is developed in it after its removal from the body. In this way Binz and his scholars, Zuntz, Scharrenbroich and Schulte, have found that both quinine and sodium nitropicrate stop the formation of acid ; cinchonine lessens it. 1 The alterations effected in the interchange between blood and the air have also been observed by simply allowing the blood mixed with the 1 A very complete list of the literature of this subject is given by Binz in his work, Das Chinin, Berlin, 1875. 82 PHARMACOLOGY AXD THERAPEUTICS. drug to stand for a certain time in a closed receiver, partially filled with air. and afterwards analyzing the gases which the receiver contains at the end of the experiment. By this mode of experimentation, Harley 1 found that hydrocyanic acid diminished or arrested the processes of oxidation in the blood. Alcohol, chloroform, quinine, morphia, nicotin, strychnia, and brucia, all had a similar action, though varying in extent, all of them diminishing both the amount of oxygen absorbed and of carbonic acid given out. Uric acid and snake poison had a contrary eifect, increasing the ab- sorption of oxygen and the evolution of carbonic acid. Curare appeared to lessen the absorption of oxygen, but increased the evolution of car- bonic acid. Mercuric chloride lessened the carbonic acid, but increased the absorption of oxygen. Arsenious acid and tartar emetic diminished the absorption of oxygen, but arsenious acid appeared also to lessen the evolution of carbonic acid, while tartar emetic appeared to increase it. Catalysis. — Fermentation.— Inorganic Ferments. There are many examples of chemical reactions which only occur be- tween two bodies when a third is present, which may nevertheless be found unchanged at the end of the process. Notwithstanding the fact that the third body is found unchanged at the end of the process, it may have undergone changes during the continuance of the process. Thus alcohol is not converted into ether and water by boiling alone, but it does undergo this conversion by boiling with sulphuric acid. The acid is found unchanged at the end of the process, but is changed during it into ethyl sulphuric acid, which, combining with alcohol, again yields sulphuric acid along with ether. In other eases, however, we cannot show that the substance has un- dergone change. Thus starch is converted into dextrin and sugar and cane-sugar into grape-sugar by boiling with acids, but we do not at present know that the acid has undergone any change during the process as it does in the preparation of ether. Peroxide of hydrogen is rapidly decomposed by finely-divided platinum or silver, and finely-divided platinum will, on the other hand, cause oxygen and hydrogen to unite rapidly. Such actions, where the third substance seems to act by its mere contact with the other substances, and without undergoing change itself^ are called catalytic. They are probably due to an attraction of some kind bordering both on chemical and physical between the molecules. Thus Borne organic substances would resist the oxidizing action of the :nr for ;i considerable time, but they are readily oxidized by charcoal. It is usually -aid thai the charcoal has the power of attracting oxygen and condensing this gas upon its surface. It does not unite with the Zen chemically so as to form C0 2 , but merely attracts it, holds it for a •rpile, and then gives it off readily to any oxidizable substance. Platinum, palladium, rhodium, and iron absorb hydrogen, palladium doing • .in enormous extent, especially when it is" in a, spongy form. The Harley, Phil. Trans., 1 -Go, ,,. u78. ACTION OF DRUGS ON PROTOPLASM, ETC. 83 hydrogen is supposed by some to be simply condensed within the metal, while others think that the hydrogen and metal unite to form a hydride. The hydrogen is given off from the metal in a nascent form, and has very strong affinities. Thus palladium-hydrogen readily reduces ferric to ferrous salts, the hydrogen taking oxygen from the ferric salt and forming water. But when the hydrogen is liberated from palladium or rhodium in presence of oxygen, it appears to convert the oxygen into ozone, and greatly increases its oxidizing power. Thus palladium- hydrogen with oxygen colors a mixture of potassium iodide and starch paste blue, and oxidizes haemoglobin to metheemoglobin and ammonia to nitric acid. Spongy rhodium, or iridium saturated with hydrogen, cause formic acid to be oxidized to carbonate, calcium formate being changed into calcium carbonate. Exactly the same action is possessed by an organic ferment, and in the conversion of the formic into carbonic acid the ferment and the spongy rhodium or iridium are alike unchanged. Spongy platinum, palladium, rhodium, and iridium may thus be regarded as inorganic ferments. 1 Ferments Organic and Organized. The mechanical energy displayed in the movements of protoplasm is supplied by processes of chemical change, and chiefly of oxidation. By these processes some of the substances contained in the proto- plasm are destroyed, and their place must be supplied by fresh material. This material is obtained from the food, but, in order to render it avail- able for the protoplasm, its atoms must be more or less disintegrated in order that they may again be assimilated. As Hermann very well puts it, the bricks of which the old house is built must be pulled asunder before they can be built up again into the new. In the present case, the bricks are the atoms of protoplasm in some other organism, living or dead, which is being used as food by some larger mass of protoplasm, as, for example, a bacillus which has been absorbed by an amoeba (Fig. 10). ^A Fig. 10. — An amoeba figured at two different periods during movement. n, nucleus : i, ingested bacillus. In order to render the protoplasm in the bacillus available for the nutrition of the amoeba, the atoms of which it is composed must be, to some extent, decomposed. This process appears to be effected by enzymes, or, as they are sometimes called, organic ferments. 1 Hoppe-Seyler, Ber. d. Deutsch. Chem. Gesellsch., 1883, Feb. 12, p. 117. 8 i PHARMACOLOGY AND THERAPEUTICS. Ferments are bodies which split up carbon compounds at moderate temperatures and lead to the formation of other carbon compounds, most of which are of a simpler constitution than the first. In this definition we require to introduce the term "moderate tem- perature," because excessive heat alone will cause the atoms of a complex carbon compound to fly asunder and form simpler compounds, as in the process of dry distillation. A less heat than this, but aided by the aetion of powerful chemicals, will also produce the same effect. For example, fibrine heated with diluted hydrochloric acid under pressure yields peptones; but the same change is effected at the temperature of the mammalian body by the aid of pepsin. Trypsin from the pancreas effects a similar change when mixed with water alone without the aid of an acid, though its action is certainly aided by alkalies. Neither pepsin nor trypsin are alive, but they contain carbon, and are therefore called organic ferments. But this term easily leads to confusion with ordinary living or organized ferments, and so the term enzymes has been lately introduced to signify ferments such as diastase, ptyalin and pepsin, which, though they contain carbon and are therefore called organic, are not alive and have no definite structure, or, in other words, are not organized. The term unformed ferments has also been applied to them. By organized ferments we mean minute living organisms, which in the course of their life-processes cause decomposition of the substances in which they live. They have also been called formed ferments. Ex- amples of these are yeast and bacteria. The processes of fermentation have been divided by Hoppe-Seyler into two kinds : — ( 1 ) Those in which water is taken up ; and (2) those in which oxygen is transferred from the hydrogen to the carbon atom. The hydration in the first case is produced by the ferment acting cither (a) like a dilute mineral acid at a high temperature, as in diastatic and investive ferment- and in the decomposition of glucosides : or (7>) like caustic alkalies at a high temperature, as in the splitting up of fats or the decomposition of amide compounds. These processes of fermen- tation by hydration are chiefly carried on by enzymes. 'I In- second class of fermentative changes by the transference of gen from the hydrogen to the carbon, as in lactic and alcoholic fer- itation and In putrefactive processes, are chiefly produced through the agency of organized ferments. The action of the latter may be to a 1,1 extent imitated by spongy platinum, which absorbs oxygen. lily, and readily gives it off again to oxidizable substances. Thus c fermentation usually produced by an organized ferment may be rough! ah. nit by spongy platinum." The products formed by the action of organized ferments on the media in which they live are poisonous to them; and when these pro- ducts accumulate above a certain proportion they kill flic ferments. Just fire will be smothered in its own ashes, or an animal in a confined space will be poisoned by the carbonic acid which it has itself produced, plant, when living in a solution of sugar, is killed by the alcohol, whieli it produces, as won as this amounts to 20 per cent., and other organized ferments have their lives limited in a similar way. ACTION OF DKTJGS ON PKOTOPLASM, ETC. 85 Action of Drug's on Enzymes. — Although, with the exception of a kind of pepsin in the naked protoplasm of jEthalium septicum, a species of myxomycetes, 1 enzymes have not been shown to be present in the protoplasm of the lowest organisms, it is probable that the processes of life in all living beings, from the lowest to the highest, are carried on by their means. A ferment, which is evidently of the greatest impor- tance in the animal economy, has been recently discovered in the blood by Schmiedeberg. He has given to it the name of Histozyme, and he believes that its function is to split up nitrogenous substances prepara- tory to their oxidation. 2 The chief enzymes in the animal body are the following : — f Diastase from malt. Which convert starch | Ptyalin from saliva. and amyloids into -j Amylopsin from pancreas, maltose | Other ferments having a similar action [ from other parts of the body. DlASTATTC OE Amylolytic Inveesive Feements Which convert maltose) -r, ,, . , ,. into glucose ,} From small intestine. Which convert cane f Invertin from the intestinal juice, sugar into dextrose < " " mucin of the mouth. and levulose { " " tissue of the testis. i Which decompose glu- f Emulsin from bitter almonds. [ cosides \ Myrosin from mustard. Decomposing sugar Rennet. Decomposing fats j £ rom stomach - _ F & I From pancreas (Stearopsm). [ Pepsin from stomach. Peoteolytic f Which decompose pro- J Trypsin from pancreas. Feements \ teids and form peptones J Others from saliva. [ Histozyme. The action of drugs on enzymes is ascertained by taking two portions of a solution containing the enzyme and the substance to be acted upon. To one of these a quantity of the drug to be tested is added ; the other acts as a standard with which to compare it. If the drug is in solution, a corresponding quantity of water must be added to the standard solution in order that both may be alike. They are then placed in a warm chamber and the rapidity of digestion is noted. The action of some of the more important drugs on the action of en- zymes will be readily seen from the following table from Wernitz, quoted by Meyer. 3 In it the proportion is shown of the drugs which arrest in watery solution the action of the enzymes ; thus, one part of chlorine in 8,540 parts of a watery solution will arrest the action of ptyalin upon starch paste, while creasote has no action on it even in saturated solu- tion, and corrosive sublimate is so enormously destructive as to arrest its action, even in one part in 52,000. 1 Krukenberg, Untersuch. a. d. physiol. Inst. d. Univ. Heidelberg, Bd. II. , 1878, p. 273. 2 Schmiedeberg, Arch. f. exper. Path. u. Pharm. Bd. xiv. s. 379. 3 Hermann Meyer, " Ueber das Milchsaureferment u. sein Verhalten gegen Anti- septica," Inaug. Diss., Dorpat, 1880. 86 PHARMACOLOGY AXD THERAPEUTICS. I g I I I 32 = 9! - v. 3 ►2 z I 1 I I I I I I I I I I I I I I I I L- Is S I I I I I I I I I § £ I I I I I I I - § S3 2 2 S I s s V* ^ -7 a CO - c- i £ d o ifi ■g IO OS I § r- or S: I Bacillus (straight) \ g. ££«&' lobacteria (larger rod like or thread-like cells) J Spirobacteria (twisted or spiral-cells) B. malariae (8). B. tuberculosis (12). B. leprae. C Vibrio (wavy) ] Vibrio serpens (9). Spirochaeta (long, flexi- I ble, close-wound spi- J Spirocbreta b e r - rals) J meyeri (10). [ Sl Sfe (sb0rt ' Stiffl ° pen \ S. volutans spirals). J (11). These moulds vary considerably according to the soil in which they . and the amount of oxygen present. Thus, if the spores of the COmmoD white mould, mucor inucedo, are sown in a liquid containing U :md expose I to the air, they grow on the surface, forming branched hyphae without septa, and the liquid absorbs oxygen. But if the myce- lium be immersed, or the oxygen withdrawn, septa develop in the hyphne, and they break up into segments which multiply by budding, forming a • w itli large e«-lk and, like the true yeast, decomposing sugar unto alcohol and carbonic acid. They may be trained to thrive on substances on which they do not usually grow by gradually altering the composition of the soil. Thus, ACTION" OF DRUGS ON PROTOPLASM, ETC. 91 the commonest of all moulds, penicillium glaucum, although it does not usually grow on blood, may be trained to do so by transplanting it from bread to peptone, and then to blood. Heat destroys them, but a much higher temperature is required to kill the spores than the perfect plant, and in order to destroy the spores a temperature of 110°— 115° C, kept up for an hour, is requisite. The mould fungi cause some local diseases in the body, and especi- ally skin diseases such as favus, tinea tonsurans, tinea versicolor, tinea sycosis, and onychomycosis, and the madura foot or fungus foot of India. They also occur in the fur of the tongue. Bacteria, or Schizomycetes. — Bacteria are every day becoming more and more important on account of the relation in which they are found to stand to various diseases. Anthrax, diphtheria, phthisis and typhoid fever, are probably all due to various species of bacteria intro- duced into the body, and affecting various organs in it. It is, therefore, of the greatest possible importance that their life history should be learned, and that we should know what the conditions are under which they thrive best, and what the conditions are which will destroy their life and prevent their development. They appear to increase in two ways : First, by simple multiplication of their parts, and secondly, by forming spores. Bacteria require water, organic matter and salts, for their life. Some of them also require the presence of free oxygen, others do not, hence they have been divided by Pasteur into two classes : aerobious and anaerobious. To the anaerobious bacteria oxygen is not merely unnecessary but hurtful, and even the aerobious bacteria, although they require oxygen in a certain quantity, are injured or destroyed by it when it is in excess. The soil which is most favorable to different classes of bacteria varies with each class. .A struggle for existence goes on between bacteria and other organized ferments, and between different kinds of bacteria themselves, just as it does amongst higher plants. Just as an abundant crop of one kind of higher plants will occupy a whole field and choke other plants, so that kind of bacterium which grows most readily in a particular soil will choke others and prevent them growing at the same time with itself. During their growth they alter the soil or substance in which they grow, either by exhausting the nutriment it affords, or by forming in it new substances which are injurious to themselves, and thus they gradually die out. But the soil which is no longer suitable for one kind of bacterium then becomes suitable for another, and the spores, which may have lain without germinating during the time the first kind was growing, now be- gin to grow actively. Thus, if a number of germs of different classes of fungi be added at the same time to a saccharine solution, the bacteria only will grow and set up lactic fermentation. If a small quantity of tartaric acid be now added (J per cent.) the yeast alone will grow and alcoholic fermentation begins. If more lactic acid is added (4-5 per cent.) the alcoholic fer- mentation stops, and mould begins to grow. In this process neither the bacteria nor the yeast are killed by the addition of tartaric acid, which, 92 PHARMACOLOGY AND THERAPEUTICS. in different proportions, merely renders the liquid more favorable for the growth of the yeast and mould respectively, and enables them to flourish best, although the others are still present. In fresh grape juice many germs are present, but the composition of the liquid being more favorable to the growth of the yeast plant than to other fungi, it alone grows. When it has converted the sugar into alco- hol its growth stops, and bacteria may then multiply and convert the alcohol into acetic acid. This in turn checks the growth of the bacteria, and mould fungi then find the soil favorable. In their growth they con- sume the lactic acid, and the liquid once more affords a favorable soil for bacteria, which may then grow and cause putrefaction. The same struggle for existence occurs between the different species of bacteria themselves. Thus micrococci may be prevented from growing by micro-bacteria, and bacilli may be killed by bacterium termo when the supply of oxygen is insufficient for both. 1 It is to be noted, however, that in the struggle for existence the for- mation of poisonous products by bacteria may be, and probably is, bene- ficial to them. No doubt these poisonous products check their own growth and finally destroy them ; but in the struggle for existence be- tween bacteria and living tissues these poisons may be beneficial to the bacteria by killing the tissues, and thus giving the bacteria a more ample supply of nutriment. In investigating any problem, it is always best to take the simplest ca.se, and if we look at the struggle for existence between bacilli and an amoeba, or white blood-corpuscle, we shall see that the formation of poi- sonous products by the bacteria may enable them to destroy the amoeba or leucocyte instead of their being destroyed by it (Fig. 10, p. 83). These poisonous products in fact may prepare the soil for bac- teria, and this supposition is confirmed by the observations of Rossbach and Rosenberger. Rossbach found that when papain was injected into the vessels, micrococci developed in the blood with extraordinary rapidity, the ferment seeming to have altered the blood to such an extent that it me an exceptionally favorable soil for the micrococci. A similar re- sult was observed by Rosenberger from the injection of sterilized septic blood. In this blood the bacteria themselves were destroyed, but the poisonous Bubstances which they had formed were present, and these ed to have a similar action to the papain. The septic poisoning which occurs from wounds is not due merely to bacteria entering the blood from them, but is due chiefly to the absorp- tion of the poisons which the bacteria have formed in the wound. The dead or enfeebled tissues which occur in the wound afford a soil favorable to the growth of the bacteria, and for the formation of their deadly pro- ducts. W hen these are absorbed they not only poison the tissues gener- ally, but, by doing BO, convert the whole body into a soil suitable for the _ .tli and development of bacteria, as is Bhown by the fact that the tis- sues of animals killed by the injection of sepsin decompose very quickly, and Bwarm with bacteria shortly after dean. Pathological Anatomy* translated and edited by MacAlister, p. 272. w, "l< «ra1 ry lucid and complete account of disease-germs. ACTION OF DRUGS OX PROTOPLASM, ETC. 93 Action of Drugs on the Movements of Bacteria. Mode of Experimenting-.— In order to test the effect of a drug on the movements of bacteria already developed, a drop of the solution containing bacteria may be mixed under the microscope with a drop of the solution of a drug in the way already described at page 74, and the strength of solution neces- sary to destroy their movements estimated in the same manner. In order to combine experiments on the movements, and on the reproduc- tion, so as to ascertain whether the bacteria which have been rendered motion- less by heat or drugs, are really dead, or are only torpid, the covering-glass in the experiment just described is taken up with a pair of sterilized forceps, and dropped into some sterilized Cohn's solution (vide p. 94). It is then put along with the standard solution into a warm chamber, and left for a day or two. If the bacteria have been destroyed, it will remain clear like the standard solution, but if they have only become torpid, it will be more or less opalescent or milky. In performing this experiment, great care must be taken that the solution of the drug has been sterilized by boiling ; and that the covering-glass, glass slide, all the instruments, and indeed everything used in the experiments, have been also thoroughly sterilized by heating. The bacteria grown in different fluids are not all equally sensitive to drugs. A temperature of 66° to 70° C. usually arrests the movements of bacteria, and if continued for an hour, destroys adult organisms though not spores. A temperature of 100° C. usually destroys the spores as well, but this is not always the case. If the bacteria are moist, this temperature generally kills them, but not if they happen to be dry, and a much higher temperature is then required. They may become dry, before being killed, by a little solution containing them having flowed or spurted into the higher part of the tube or flask, where the water evaporates and leaves them dry before the temperature has been sufficiently raised to destroy them. The most destructive substances to bacteria are corrosive sublimate, chlorine, bromine, and iodine. Quinine and the other cinchona alkaloids also destroy bacteria, their power diminishing in the following order : — quinia, quinidia, and lastly cinchonia. Bebeerin is nearly as powerful, and potassic picrate is even superior to quinine when used with Cohn's solution. When bacteria are culti- vated in beef-tea instead of Cohn's solution, potassic picrate is less powerful. Sulphocarbolates and strychnia have considerable power, though a good deal less than quinia : bebeerin and lesculin have hardly any power to destroy bacteria at all. Sodic hyposulphite has very little action : sodic sulphate has a destructive action, but it is about ten times less strong than quinine. Action of Drugs on the Reproduction of Bacteria in General. The spores of bacteria have very enormous resisting power to agents destructive of vitality, very much greater than that of the fully-developed bacteria ; and thus it happens that a quantity of an antiseptic, which is 94 PHARMACOLOGY AND THERAPEUTICS. quite sufficient not only to prevent the spores of bacteria from develop- ing so long as they remain in it, but to destroy fully-formed bacteria, wiTl not destroy the vitality of the spores or hinder them from germina- ting as soon as they are removed from the influence of the antiseptic and transferred to a proper soil. Yet the power to destroy the vitality of the spores completely is what is required in an antiseptic, for we wish to destroy the infectious mate- rial, and prevent it from causing disease, rather than to administer sub- stances to an animal which will hinder the germs from developing in the blood after their introduction into it; although this maybe desirable when infection has already taken place. It is therefore necessary to test the effect of drugs in destroying the germs completely. 3Iethod of Experimenting. — This is done by adding to a fluid, contain- in g bacteria and their spores, varying quantities of an antiseptic, and allowing the mixture to stand for a longer or shorter time. A drop of this fluid is then introduced by a sterilized platinum wire or glass pipette into some sterilized Conn's fluid or beef-tea. This is watched to see whether bacteria will develop in it or not. If they do develop, it is clear that the spores have not been killed by the admixture with the disinfectant in the original fluid ; if they do not de- velop, then the disinfectant has been sufficiently powerful to destroy them. The plan usually employed is to take a number of test-tubes, plug their ori- fices with cotton-wool, and destroy any germs that may be attached to them by thoroughly heating them to about 300° F. in a hot chamber, or in the flame of a Bunsen'a lamp. They are then allowed to cool, and a small quantity of a liquid (about 5 cc.) in which bacteria readily grow is placed in each. This also must Ik- previously thoroughly boiled, in order to destroy any germs which may be present in it. The liquid recommended by Colin consists of ammonium tartrate one gramme, potassic phosphate and magnesic sulphate of each five grammes, cak-ic phosphate '05 grammes, distilled water 100 cc. This is filtered and boiled before ose. To the tubes the different agents to be tested are added, the -"liiti<.n- <>{' each having been carefully sterilized by boiling, and the pipette u-. -d being super-heated in each case before it is employed. If the drugs are added in solution, a similar quantity of boiled water must be added to the first tube, whi.h is to serve as a standard. To each of them is then added a single drop of a liquid containing bacteria. The mouths of the tubes are then stopped with the cotton-wool and placed for a few days in a warm chamber at about 40° C. The standard liquid will then be found to be opalescent or milky. The degree of the opalescence in the other tubes will be less according to the effect of the drug which has been added, in preventing the development of bacteria, W here it has completely hindered the development, the solution will remain quite clear, and as it- strength diminishes, the opalescence will become greater, until it i- equal to that of the standard. In performing this experiment it is best t<> use one definite form of bacte- rium, instead of a mixture of several unknown kinds. This is referred to again in speaking of tin- experiments of Dr. Koch, who generally employs the micro- ns prodigiosus as an example of an organism easily acted upon, and the • bacillus anthracis, or of a bacillus found in earth, as examples of It i-; found by tlii- mode of experiment that a smaller quantity of poison will prevent tin- development of bacteria than will destroy them after they are developed. ACTION OP DRUGS ON PROTOPLASM, ETC. 95 By experiments on the comparative action of different drugs on bac- teria the results contained in the following table have been obtained by N. de la Croix, and these have been to a considerable extent confirmed by Koch. It will be seen by looking at the table that the exact limit of the power of each drug to destroy bacteria is not determined, but that two concentrations of each antiseptic are given, one of which is sufficient to do it, and the other is insufficient. The disinfecting limit therefore lies between the two experiments. But the limit of disinfection is not an invariable one for each drug, as its power to destroy bacteria is modified not only by the concentration of the solution employed, but by the length of time during which it acts, and by the temperature. 96 PHARMACOLOGY AND THERAPEUTICS. •jou oa CO © © L~-hi— WCOOO'S'lMOfrlCO i-cwcON«eooeoeoTj*oooeo^iOOO 1^~-CM^hIOCOCM©COt-i-©©i-l©LO;CM i-c*J«©Tfr~T-'THC~IOeOC © CO . <•. in water) Ferric chloride ; 5 i>. c. in water i Potassium bromide (5 p. c. in water)... Potassium iodide .") ]). c. in water) ... Corrosive sublimate 1 1 p, c in water)... Arsenic l p. c in water) Lime water Chloride of lime 5 p. <•. m water) Sulphuric acid l p. c in watei I Zinc sulphate 5 p. c. in water) Coppei sulphate [5 p. c. In water) i- Sulphate 5 p. c in water) Sulphate of aluminium (5 p, c. in water) Mum I p. c in water, ... a chromate 5 p. c. in water)... lium bichromate 5 p. <■ in wa1 < lnoine alum 6 p. e. in w;it< i ... Chromic acid 1 p. c, in \\ ater ... ■mi pei manganate 5 p. <•. m water; i '"• do. l p. c. in water) 5 2f 5 5 1 1 5 t 5 5 5 5 5 5 5 10 6 10 10 2 6 10 2*f 3 5* 5* 6 5 5 2 2 o 10 10 10 10 20 45 25 25 lO 15*f 5 10* 10* 10* 12 12 25 20 40 100 80 20*f 20* ACTION OF DRUGS ON PROTOPLASM, ETC. 99 Potassium chlorate (5 p. c. in water) Osmic acid (1 p. c. in water) Boracic acid (5 p. c. in water) not quite dissolved ... Borax (5 p. c in water) Sulphuretted hydrogen water Ammonium sulphide Oil of mustard with water Formic acid (sp. gr. 1*120) Acetic acid (5 p. c. in water) Potassium acetate (saturated solution) Lead acetate (5 p. c. in water) Soft (potash) soap (2 p. c. in water) Lactic acid (5 p. c. in water) Tannin (5 p. c. in water) Trimethylamine (5 p. c. in water) Chloropicrin (5 p. c. in water) Benzoic acid (saturated solution in water) Benzoate of sodium (5 p. c. in water) Cinnamic acid (2 p. c. in water 60 and alcohol 40 parts) Indol (in excess in water) Skatol (in excess in water) Leucin (| p. c. in water) ... Quinine (2 p. c. in water and 40 alcohol 60 parts) ... Quinine (1 p. c. in water with HC1) Iodine (1 p. c. in alcohol) Valerianic acid (5 p. c. in ether) Palmitic acid (5 p. c. in ether) Stearic acid (5 p. c. in ether) Oleic acid (5 p. c. in ether) Xylol (5 p. c. in alcohol) Thymol (5 p. c. in alcohol) Salicylic acid (5 p. c. in alcohol) Salicylic acid (2 p. c. in oil) Oleum animale (Dippel's oil, 5 p. c. in alcohol) 01. menth. pip. (5 p. c. in alcohol) From this table it appears that the ordinary method of separating between formed and unformed ferments by precipitation with alcohol and solution in glycerine cannot be relied upon as a trustworthy means of separating them, since neither alcohol nor glycerine destroy the activity of formed ferments. It is remarkable that ether and turpentine oil, which are both ozone carriers, should have such a marked action in comparison with other fluids. This is in harmony with some recent observations of Paul Bert and Regnard, that oxygenated water in sufficient quantity destroys the bacteria of anthrax. The spores of anthrax bacilli resist in an extraordinary way the ac- tion of certain substances which usually are fatal to life, as hydrochloric acid (2 per cent.), salicylic acid (1 per cent.), concentrated solutions of chloride of sodium, chloride of calcium, metallic solutions, borax, boracic acid, chloride of potassium, benzoic acid, benzoate of sodium, cinnamic acid, and quinine. Action of Drugs on the Development and Growth of Bacilli. — In order to test the action of disinfectants on the development and growth of bacteria, Koch put into a number of small watch-glasses, or rather crystallization 2 6 1 1 2 6f 10f 5 10 15 1 5* 1 2 5 1 5 10* 1 2 4 IO 1 5 1 4 10 1 5 12 1 5 12 1 2 5 1 5 10 1 5 12 1 2 6 12 1 5 10 45 90 1 2 5 10 1 3 5 10 1 5 10 25 80 1 5 10 25 80 1 5 10 l*f ■ 5*f 1 5 io ETHER , OE OIK 1* 2* 1 5 1 5 1 5 1 5 1 5 30 50 90 1 6 10 15 1 6 10 15 5 10 20 80 1 5 12 1 5 12 PHARMACOLOGY AND THERAPEUTICS. see with flat bottoms, a few drops of blood-serum, or a solution of extract of meat and peptone, mixed with varying quantities of the disinfectant. Into each of these a silk thread, which had been dipped in the fluid containing bacteria and dried, was placed. In one glass serum alone, without any disinfectant, was placed, in order to ascertain, by comparison with the growth which takes place in it. how the disinfectant in the other classes had interfered with the growth of the bacilli. In experiments of this sort a difference was found between anthrax bacilli and other microzymes. A dilution of carbolic acid 1 in 1,250 and 1 in 850 sufficed to prevent the growth of anthrax bacilli, while a strength of 1 in 500 was required to prevent the growth of others. Other species are therefore more resistant than anthrax bacilli to the action of carbolic acid. The following table shows the strength of vari- ous disinfectants required to hinder or entirely prevent the development of anthrax bacilli: — Prevents. 1 to 300,000 1 to 33,000 Hinders. Iodine 1 to 5,000 Bromine 1 to 1,500 Chlorine 1 to 1,500 Osmic acid 1 to 1,500 Permanganate of potash 1 to 3.000 Corrosive sublimate 1 to 1.000.000 Ally] alcohol 1 to 167,000 Oil of mustard 1 to 330,000 Thymol 1 to 80,000 Peppermint oil ... 1 to 33,000 Oil of turpentine 1 to 75,000 Oil of cloves 1 to 5,000 Arsenite of potash 1 to 100,000 Chromic acid 1 to 10,000 Picric acid 1 to 10,000 Hydrocyanic acid 1 to 40,000 he following are about the same strength as Fluid. Hinders. Boracic acid 1 to 1,250 Borax 1 to 2,000 Hydrochloric acid 1 to 2,500 Salicylic acid 1 to 3,300 Benzoic acid 1 to 2,000 Camphor .... 1 to 2,500 Encalyptol 1 to 2,500 Sofl soap .... 1 to 500 Quinine 1 to 830 Hydrate of chloral 1 to 1,000 Chlorate of potash 1 to 250 Acetic acid 1 to 250 »ate of Boda 1 to 200 Alcohol 1 to 100 1 to 60 No action. ( Ihloride of sodium 1 to 64 1 to 10,000 1 to 5,000 1 to 8,000 Prevents. 1 to 800 1 to 700 1 to 1,700 1 to 1,500 1 to 5,000 1 to 625 1 to 125 Influence of the Solvent. — Although a 5 per cent, solution of carbolic acid in water has a well-marked destructive action on the spores, and a strong destructive action on fally-developed anthrax bacilli, a similar solution in oil or alcohol has not the Least disinfectant action. A similar influence with regard to iodine is observable in the previous tables. ACTION OF DRUGS OX PROTOPLASM, ETC. 101 Effect of tlie Fluid witli which Disinfectants are inixed. — This is sometimes very marked, especially in the case of free iodine, bromine, or chlorine. These in watery solutions are powerful disinfec- tants, but when mixed with fluids which contain alkalies, as e.g., blood- serum, they are converted into bromides, iodides, and chlorides, and their action is very greatly diminished. The action of corrosive subli- mate, however, and of ethereal oils is not altered. Influence of Temperature on the Action of Antiseptics. — The action of antiseptics is greatly increased by a high temperature. Spores of anthrax bacilli exposed to the vapor of carbolic acid at lo°-20° C. remain unchanged even after 45 days' exposure. When exposed to the vapor of carbolic acid at a temperature of 55° C. the case is very different. Half an hour's exposure does not seem to harm them at this temperature, but many are destroyed by an exposure of an hour and a half, and very few will stand 3 hours' exposure, so that probably an exposure of 5 or 6 hours would destroy the whole of them. Alterations in Bacteria by Heat and Soil. — By careful cultiva- tion of a slip taken from a wild fruit-tree through successive generations, the chemical processes of growth may be so modified in it that the fruit will lose its acrid character, and become edible and pleasant. What is true of higher plants is true also of lower in this respect, and bacilli are much modified by the conditions under which they are cultivated; for example, Pasteur has found that the bacilli of anthrax develop and multiply in beef-tea best at 25°-40° C. Their development is retarded at higher or lower temperatures than these, and is completely arrested at 15° and 45° C. When cultivated at a temperature where development occurs with difficulty, such as 42°-43°, the bacilli no longer form rest- ing spores, but only grow into long threads. Fresh bacilli injected into an animal rapidly cause death from anthrax, but the longer they have been previously kept at this high tem- perature the more does their virulence decrease, and at the end of four or six weeks they die. When some of the first crop of bacilli are put into fresh beef-tea, the second crop retains the degree of virulence of the first, and a third crop taken from the second, and again grown in fresh beef-tea, has exactly the same morbific power, and so on. When the bacilli are cultivated at 35°, the microzymes not only multi- ply quickly, but they form spores of a definite degree of virulence, and these spores may be kept unaltered for years in sealed tubes, whereas the threads of developed bacilli die when air is excluded. When an animal is inoculated with anthrax bacilli whose virulence has been diminished by cultivation at a high temperature, they produce merely temporary illness instead of death. By the growth of these non- virulent bacteria in the body, its constitution appears to undergo some alteration, and virulent bacteria subsequently injected have a much less powerful action on it. If the first injection be made with bacteria having a very slight amount of virulence, the animal may still die if infected a second time with virulent bacteria, but if inoculated first with a non-virulent bacteria and a second time with bacteria rather more powerful, a slight disturbance is produced by each inoculation, and a subsequent injection of virulent bacteria no longer causes death. PHARMACOLOGY AND THERAPEUTICS. The changes which are produced by inoculation with modified anthrax or with vaccine matter in the blood and tissues, although prob- ably very slight, are sufficient to confer on the organism immunity from further infection. This is usually permanent, although the immu- nity may diminish with the course of years, unless the advancing age of the animal in itself tends to lessen its liability to infection. A similar immunity against infection with different bacilli is some- times conferred by age. Thus young dogs are easily infected with anthrax, but old ones are not. A difference of species also confers immunity. Thus rats and field mice are not liable to infection with anthrax, while house mice are highly so. Algerian sheep also resist infection with anthrax, while French sheep do not. We do not as yet know whether it is possible by the action of drugs to alter the blood and tissues in such a way as to render the animal proof against infection by pathogenic bacteria; but this is one of the directions in which further research is likely to yield interesting results. Possible Identity of Different Forms of Bacteria. It has already been mentioned that we are not quite certain whether all the species, genera, or even orders of bacteria are natural divisions, <>r whether the same organism under various conditions of nutrition and development may not present such different appearances as to be in- cluded in different orders and under different names. Yet this is a matter of very great importance in regard to the causation of disease, for if it be true that organisms which are usually innocuous may undergo an opposite process to that which occurs in anthrax bacilli by cultiva- tion, and may in certain conditions of soil be changed from innocuous into pathogenous forms, we can understand how diseases may appear to originate de novo. It has been stated by Naegeli that bacteria may be so modified by cultivation as to form entirely different fermentative products. Thus he - that the bacterium which produces lactic acid fermentation in milk may bo changed by cultivating it in extract of meat and sugar, so that it will do Longer produce a lactic but an ammoniacal decomposition in milk. II<- considers also that innocuous may be transformed into viru- lent bacteria, and back again into an innocuous form, and Buchner thinks that he has succeeded in transforming the ordinary hay-bacillus (bacillus Bubtilis) into anthrax bacillus by cultivating it for a number of ins in Liebig's meat extract, peptone, and sugar. This obser- vation is denied by Klein 1 and others, but observations which partly support Buchner and partly Klein have been made by F. Kohler, 2 who finds that, while the ordinary hay-bacillus (bacillus subtilis) is not altered in its appearance by repeated cultivations, it acquires a progressive viru- lence which renders it BO lata] to animals as to resemble the anthrax illufl in it- deadly properties. Klein, Quarterly Journ, of Microscopic 8cience, .Ian. 1883. Inaugural Dissertation (Gottingen), 1881. ACTION OF DRUGS ON PROTOPLASM, ETC. 103 H. C. Wood and Formad 1 have also come to the conclusion that the micrococci found in diphtheria resemble those on furred tongues in all respects excepting in their greater tendency to grow. When cultivated successively, they lose their contagious power and grow less readily. These authors, therefore, consider that circumstances outside the body are capable of converting the slower growing or common micrococcus into the rapidly growing micrococcus of diphtheria, which, when cultivated again, reverts to the common type. Action of Bacteria and their Products on the Animal Body. — When bacteria are injected into the animal body they produce different effects, according to the original nature of the bacteria or ba- cilli, the conditions under which they have been cultivated, and the quantity introduced. There is probably another factor of no less im- portance which, however, still requires to be investigated, viz., the con- dition of the body into which they are introduced. In considering the effect of an injection into the living body of a solution containing bacilli, we must be careful to distinguish between the effect of the bacilli themselves, after their introduction into the circulation upon the tissues and organs of the body, and the effect of the substances which they have already formed in the solution before their injection. We must distinguish between those two things in the same way as we would have to distinguish between the effects of the particles of the yeast plant and the effects of the alcohol which it had formed if we were to inject a solution in which yeast was growing into the veins of an animal. The yeast or the bacteria would have one effect upon the animal, the alcohol or the septic products of the bacteria would have another. Solutions of putrid organic matter containing numerous bacteria cause high fever and often death. The course of the fever depends on the specific nature of the bac- teria, e. g., septic bacteria, anthrax bacilli, &c. It is difficult at present to ascertain exactly how far all the following diseases are due to the presence of microbes or their products \ but it has been found that micrococci cause erysipelas, a'cute necrosis, gonor- rhoea, gonorrhoeal ophthalmia, contagious ophthalmia, ophthalmia neano- torum, and are present in pyaemia, puerperal fever, ulcerative endocar- ditis, infective myositis, and contagious pneumonia. When malignant oedema or traumatic gangrene occur, bacilli are usually found. Micro- cocci are also supposed by some to be the cause of vaccinia and of diph- theritic inflammation. The bacillus anthracis produces anthrax ; bacil- lus septicsemise, blood poisoning ; bacillus malaria, ague and malarious diseases ; bacillus tuberculosis, phthisis ; bacillus leprae, leprosy ; and another bacillus is the cause of glanders. In relapsing fever the spi- rochaeta obermeyeri is found in the blood, and is probably the cause of the disease. Alkaloids formed by Putrefaction. — Ptomaines. From de- composing organic matter substances can be separated which have all National Board of Health Bulletin, Supplement No. 17, Jan. 21, 1882. 104 PHARMACOLOGY &KD THEEAPEUTICS. the characters of alkaloids. Thus albuminous substances yield during putrefaction various poisons which have different physiological actions according to the stage of decay at which they are produced. Some of these, like the sepsin separated from putrefying yeast by Bergmann and Schmiedeberg cause vomiting, diarrhoea, and bloody BtOols. The extract from putrefied maize has a tetanic and narcotic action which appears to be due to two different substances. These are not present in the same proportion, so that sometimes the tetanizing action, and at other times the narcotic action is most marked. Another alkaloid, resembling atropine in its action, has been sepa- rated by >onnenschein and Zuelzer from decomposing animal matter; and this has also been found in the bodies of persons dying from typhus fever. Another which resembles curare in its action has been separated by (xuareschi and Mosso 1 from putrefying brain. Another substance causing tetanic symptoms has also been obtained from animal matter. These alkaloids produced by decomposition are known by the name of ptomaines. Effect of Drugs on the Action of Bacteria in the Animal Body. So long as bacteria are outside the body, we may use drugs of any strength we please to destroy them, but the case is quite different when they have once gained entrance, and are no longer outside but inside the body, because then the nature of the drug and the amount we can em- ploy is limited by its effect on the organism itself, and we cannot admin- ister very large doses of antiseptics lest we should injure or kill the pa- tient at the same time that we destroy the bacteria which are causing the di-ea-e. All that we can hope to do is to turn the scale, if possible, in favor of the organism in the struggle for existence between the cells which compose it and the bacteria which have invaded it. < >ur hope of doing this rests on the fact that drugs which may be injurious both to the tissues and to the bacteria, are not equally so to each. Thus excess of temperature is injurious to the organism, but it is destructive to bacteria ; and. as Fokker 2 has pointed out, the febrile reaction whirl! occurs on the introduction of bacteria into the blood may be a means of destroying the microbes and preserving the animal. There i- often a genu of truth in apparently foolish plans of treatment, and the old practice of treating scarlet fever, small-pox, and measles by warm drinks, hoi rooms, and abundant clothing, may have been a blind effort to aid the natural processes of cure, just as the irritating ointment '/!' thr Middli eems to have been an attempt at antiseptic surgery. raordinary destructive power of corrosive sublimate, and the fact that it continues to ad in blood-serum jusl as it does in distilled water, to indicate thai it might be used to destroy bacilli in the body, Turin, L8£ International Medi< », [881. ACTION OF DEUGS ON PROTOPLASM, ETC. 105 especially as Schlesinger has found that it may be injected subcuta- neously into rabbits and dogs daily for several months without doing them any harm, even in doses of 1 cc. of a J per cent, solution. Koch's experiments on this point, however, have as yet led to a nega- tive result, the animals inoculated with anthrax dying of the disease, notwithstanding the injection of the sublimate. The extraordinary effect of allyl alcohol, and the less powerful but still great action of ethereal oils, indicate, however, that we may look forward with hope to the discovery of some organic substances which may so hinder the development of bacteria in the body after their inocu- lation, as to allow of their gradual destruction in the organism, and prevent the sickness or death which they would otherwise have occa- sioned. In relation to this, the observations of the late Dr. W. Farr in his Report are very interesting : " Alcohol appears to arrest the action of zymotic diseases, as it prevents weak wines from fermenting ; like cam- phor, alcohol preserves animal matter — this is not now disputed. But may it not do more ? May it not prevent the infection of some kinds of zymotic disease ? " Experiments have shown that alcohol itself has but a slight power in destroying bacilli, but it is possible that even the slight traces of the ethers which are present in wine or spirits may have some beneficial action in cases of septic poisoning. Antiseptics, Antizymotics, Disinfectants, Deodorizers. These classes of remedies are often confounded together. It is well, however, to distinguish their meanings : — Antizymotics are remedies which arrest fermentation. It has already been mentioned (p. 83) that fermentative processes may depend upon either enzymes, or organized ferments, and that or- ganized ferments may be subdivided into several classes, such as those consisting of yeast, innocuous bacteria, and pathogenic bacteria. The class of antizymotics includes all substances which arrest fer- mentative processes due to these bodies. It contains two sub-classes : antiseptics and disinfectants. Antiseptics are remedies which arrest septic decomposition. They do this by preventing the development, or completely destroying the bacilli on which septic decomposition depends. Disinfectants are remedies which destroy the specific poisons of communicable diseases. Many of those poisons, perhaps all of them, belong to the class of microbes, and so disinfectants may be regarded as a sub-class of antizymotics. Deodorizers or deodorants are remedies which destroy disa- greeable smells. Such smells often accompany the decomposition of various organic substances, which septic organisms cause. These foul- smelling products may be injurious to health in themselves by acting as poisons ; but they are not to be confounded with the bacteria which produce them. Moreover, the disagreeable nature of the smell is not always to be relied upon as an index of its poisonous nature. M. Gustav 106 PHARMACOLOGY AND THERAPEUTICS. le Bon made some experiments with hashed meat and water, over which he put some small animals. As the meat decomposed, the liquid teemed with organisms, was very fatal when injected into an animal, and emitted a very foul smell, which, however, did not seem to be very injurious. Afterwards the organisms present in the liquid died, and the foul smell became much less disagreeable, but the emanations from the liquid ap- peared to become much more poisonous, although the liquid itself, when injected into an animal, had no longer the same virulent power as at first. I fees of Antiseptics. — Antiseptics are employed externally in order to destroy microbes before their entrance into the body, and are administered internally with a like object, or for the purpose of at least preventing the free development and multiplication of the microbes. They are employed externally in surgical operations, with the object of destroying any organisms which might find a nidus in the wound, and there give rise to the formation of poisonous substances. Both these substances and the bacteria themselves will not only have an injurious local action in the wound, but by undergoing absorption may prove injurious or fatal to the organism as a whole. The antiseptic plan of treatment has been empirically practised in a limited manner for a very long period without its principle being recognized : for the well- known Friar's balsam has antiseptic properties. It is to Lister that we owe the introduction of such a mode of treatment, not based upon mere empiricism, but upon scientific knowledge. The reason why it had fallen into disuse probably was, that some of the antiseptic substances used for dressing wounds in the Middle Ages were irritants, as well as antiseptics. Those who employed them did not know the reason why they were beneficial, and supposed that their virtue was due to their irritating properties. The ointments were accordingly made more and more irritating; and thus more harm than good was done, until they were discarded by Ambrose Pare. The antiseptic most commonly em- ployed is carbolic acid. Not only are all the instruments to be em- ployed disinfected, but the operation itself is conducted under a spray of the dilute acid, so a- to render innocuous any organisms wdiich may be present in the air. The wound is then covered with an antiseptic dress- in::. Whenever this requires to be removed, it must always be done under the -pray. The reason of these great precautions is obvious: if any germs, however few, gain an entrance they will soon multiply and prove as deadly as a great number, the only difference being one of time. Tie- greal danger which may arise from an exceedingly minute por- tion of septic matter renders great caution necessary on the part of those who might, by a little indiscretion, convey it from one to another. Thus a number of years ago a medical man was nearly driven mad by an epi- demic of puerperal feverwhich he had in his practice: one patient dying after the other. In order to gel rid of any infection, he burnt all his clothes and \wiit away for three months. During his absence, every- thing wmt well. On his return, the epidemic again broke out: on tnl investigation, he found the only tiling he had forgotten to burn his gloves, and these had acted as a reservoir of infection. The hands, imperfectly cleaned in the first instance, had conveyed the septic ACTION OF DRUGS ON PROTOPLASM, ETC. 107 matter into the gloves, and there it remained, reinfecting the hands every time the gloves were put on. In the same way a thermometer case may prove a cause of continual reinfection unless the thermometer be carefully washed, and if necessary disinfected, each time it is used and before it is put into the case. In a similar manner it has been found that gonorrhoeal matter may remain in the vagina and infect sev- eral persons without the woman herself ever suffering. One of the best antiseptics for disinfection in such cases is permanganate of potash. This may be used to wash out abscesses, if there is any fear of danger from absorption of carbolic acid ; and also as a lotion for ulcers or wounds about the mouth, the urethra or anus, where the carbolic acid might be too irritating ; as is evident from Koch's experiment, however (vide page 98), a solution of the strength ordinarily used — one per cent., i.e., four grains to the ounce — is not sufficient to destroy the septic organism, although one of five times the strength will do so. Another way in which septic poisoning may be produced is by the introduction of a catheter into the bladder, where this cannot be com- pletely emptied naturally on account either of paralysis, enlarged pros- tate, or stricture. So long as the contents of the bladder have not come in contact with any foreign matter they may remain in the bladder for some time without undergoing decomposition, but if a dirty catheter should be passed, and thus a few organisms introduced into the bladder, decomposition may set up in the urine and septic poisoning ensue. A solution of carbolic acid in oil is sometimes trusted to for the disinfection of catheters, but, as Koch's experiments (page 100) show that such a so- lution has little or no antiseptic power, the catheters should be disinfected by a strong solution of carbolic acid in water and afterwards oiled before their introduction. The use of antiseptics internally is limited by the resistance of the organism itself, as already mentioned (page 104). In the stomach anti- septics are used for the purpose of preventing decomposition, and by thus lessening the production of irritating products they diminish irrita- tion of the stomach and arrest vomiting. Those which are chiefly em- ployed for this purpose are creasote, carbolic acid, and sulphurous acid, but all bitter tonics seem to have this effect to a greater or less extent. In the intestine antiseptics are useful in arresting putrefaction, and thus preventing the harm caused locally to the intestine by the products of decomposition as well as the injury due to their subsequent re-absorp- tion. They therefore tend to check diarrhoea and dysentery. It is probably to its antiseptic action that corrosive sublimate owes its curative power in cases of infantile dysentery, and it is not improbable that the beneficial action of calomel is due to a similar action, for it has been found by Wassilieff greatly to retard the decomposition due to low or- ganisms. The beneficial action of mercurials in such cases may be partly due to their antiseptic power not being greatly diminished by admixture with fiecal matters as that of other antiseptics. After absorption into the blood antiseptics are chiefly employed in febrile conditions, in order, if possible, both to lessen the growth of the septic organism and to remove the danger to the individual which the fever itself would occasion. The 108 PHARMACOLOGY AND THERAPEUTICS. principal antiseptics used for this purpose are alcohol, eucalyptol, qui- nine, salicine, salicylic acid, and salicylates. Carbolic acid and creasote can hardly be used, as their action on the organism is too poisonous, but hydro-ijuinone, cresotinic acid, kairine, pyrocatechin, and resorcin are not markedly poisonous, and are antipyretic. They may thus be useful although not largely employed at present (vide also Antipyretics). Eu- calyptol has sometimes appeared to me to be more beneficial in cases of septic poisoning than quinine ; at any rate, I have seen patients recover under its use who had not been benefited by quinine. Disinfectants. — These are generally employed in order to destroy the germs of disease in the excreta of a patient suffering from an infec- tious disease, or those germs which may be adhering to articles of cloth- ing or to furniture or to walls of a room in which the patient has been lying. Probably the most efficient and generally applicable to articles of clothing is heat. The heat employed is usually from 230° to 250° F., but as a general rule it should be as hot as the fabrics will bear without injury, and should be continued as long as is necessary to raise the central parts of the articles to be disinfected to the temperature of the chamber in which it is placed. As the presence of moisture aids the destructive action of heat upon septic organisms, superheated steam appears to be the best disinfectant under ordinary circumstances. The only disinfec- tant that seems to be really trustworthy for destroying septic organisms when it is simply washed over them, is corrosive sublimate : even in a dilution of one to a thousand it appears to destroy microzymes and their spores by a single application for a few minutes. Deodorizers. — Deodorizers are mainly strong oxidizing and deoxi- dizing substances, as chlorine and its oxides, sulphurous acid, nitrous acid, ozone, peroxide of hydrogen, permanganate of potash. Charcoal, in addition to oxidizing, absorbs and condenses the foul-smelling gas. Those which are most commonly used as deodorizers for the air of rooms are chlorine or its oxides set free from chlorinated lime. For removing smells from the hands, carbolic acid is to be preferred to others, and for deodorizing frecal matters, permanganate of potash, carbolic acid, or charcoal. A mixture of eight or nine parts calcined dolomite (magnesia and lime) with one or two of peat or wood charcoal • t only an excellent deodorizer, but increases the value of the fiecal matters ;i- manure. Antiperiodics. These are remedies which lessen the severity or prevent the return oi attacks of certain diseases which tend to recur periodically. The chief of these are : Cinchona bark and it- alkaloids : — Quinine. Arsenic. Cinchonine. Salicylic Acid. Quinidine. Salicylates. ' achonidine. Salicin. ••in bark and it- alkaloid : — Bebeerine. Eucalyptol. ACTION OF DRUGS ON INVERTEBRATA. 109 Action. — The mode in which antiperiodics act is not at present de- finitely ascertained, nor yet is the pathology of the diseases which they prevent. Remittent fever, however, has been shown to depend upon the presence of a spirillum in the blood, and there is considerable evidence for considering that malarious conditions are connected with the presence of a bacillus. The periodical return of the attacks in such diseases would appear, then, to be associated with the growth of successive crops of these protophytes, and the action of antiperiodics might be explained by supposing that they interfere with the development of these pathogenic organisms. Uses. — Quinine and cinchona bark are often regarded as almost specific in the various affections due to malarious poisoning, i. £., inter- mittent fevers, periodic headaches, neuralgias, etc. In tropical remittent fever of malarious origin, quinine is also the best remedy we possess. It must be given in very large doses however, and is less certainly curative than in intermittent fever. The other cinchona alkaloids have a similar action to quinine, but are not quite so powerful ; they, as also quinine, may be used as prophylactics in order to prevent the recurrence of ague in persons travelling through or living in malarious districts as well as for the purpose of curing malarious conditions already present. Arsenic is sometimes even more powerful than quinine, but as a rule it answers best in malarious conditions which are sometimes known as masked or latent malaria, and which manifest themselves in neuralgia and nervous or digestive disturbance rather than in well-marked ague fits. Adjuncts. — Emetics and purgatives aid the action of antiperiodics and sometimes, indeed, can replace them and cure ague without their aid. Antiperiodics rarely succeed if the functions of the liver are disturbed unless they are aided by emetics or purgatives, and especially cholagogues. CHAPTER IV. ACTION OF DRUGS ON INVERTEBRATA. The study of the action of drugs on invertebrata has not been carried out methodically to any great extent, but it offers a very promising field for investigation, and probably in the course of a few years may yield very valuable results. Action of Drugs upon Medusae. This subject has been worked at almost exclusively by Romanes 1 and Kru- kenberg. 2 At present it has little practical bearing, but it promises to be of 1 Romanes, Phil. Trans., vol. clxvi., part 1, and vol. clxvii., part 2, 1866 and 1867. 2 Krukenberg, Vergleichend. Physiologische Studien, Heidelberg, 1880. HO PHARMACOLOGY AND THERAPEUTICS. -reat service by enabling us to understand better the action of drugs on con- tractile structures generally, and on the heart in particular. In medusae the swimming organ consists of a bell-shaped mass of contractile Bubstance, within which the polyp hangs like the clapper. Around the margin of this bell are a number of ganglia connected with one another by nervous filaments. Bell. Lithocyst and ganglion H )|i«|d HPolypite. Tentacles ■ 'IUHh Fig. 15.— Medusa iSarsia) natural size. In the normal state of the animal, the bell alternately contracts and dilates rhythmically, so that the animal is propelled through the water. When the marginal strip containing the ganglia is removed, the bell becomes entirely motionless. The bell thus resembles, as we shall see afterwards, the ventricle of the frog's heart, both in the relation of ganglia to it, and in its rhythmical movements. Oxygen accelerates, and carbonic acid slows and finally stops, the rhythmical movements. When the bell, paralyzed by the removal of the ganglia which supply its normal stimulus to motion, is momentarily stimulated by a single induction -hock, it invariably responds by a single contraction. When successive shocks are employed at regular intervals the effect of each 3es until the maximum is reached. - iows the in> n asing contractions of the tissue of medusa when stimulated by repeated -weak intensity. Thefirsl two shocks had no apparent effect, and the first • .mi in the figure was caused by the third -hoik. (From paper by Romanes in But if .-in additional constant stimulus is supplied to it by the addition cid to the water in which it Lb floating; by the passage of a constant or of an interrupted electrical current through it: or by alcohol or glycerine dropped up. ui its Burfaoe, it oommi ncea to beat regularly, rhythmically and continuously. When rhythmical action is thus artificially induced in the paralyzed bell, its Le increased by raising the temperature and reduced by cooling it. Tem- peratures below -<» or above 85 arrest the rhythm. When the marginal Btrip containing the ganglia is cut off and left attached only at one point, a Btimulua applied to its end travels along the strip and finally ACTION OF DRUGS OX IXYEETEBEATA. Ill causes the bell to contract. The stimuli which pass along may be of two kinds — they may occur separately or together. This first kind is a wave of contraction in the contractile tissue of the strip itself. If the stimulus is applied to a portion of the strip the contraction will pass along like a wave until it reaches the bell, which it excites to contraction. The second is a rudi- mentary form of nervous activity. This may occur along with the contraction wave, and when this is the case it is seen to pass along in front of the contrac- tile wave. But it may also occur when no wave of contraction takes place. Its occurrence is rendered visible by the movements of the tentacles which fringe the strip, and are much more sensitive than the contractile tissue of the strip itself. This wave of stimulation without contraction passing along the strip, will Strip of contractile tissue with fringe of tentacles Fig. 17.— Diagram of a medusa (tiaropsis), about one-third natural size, with a strip of contractile tissue cut froru the bell, hut left attached at one end. cause the bell to contract on reaching it, provided there is a marginal ganglion in the bell, but not if the bell is paralyzed. The wave of stimulation is more easily excited than that of contraction, so that it may occur from stimuli too weak to excite a wave of contraction. The passage of stimuli along the strip may be impeded or prevented altogether by compressing the strip, by making trans- verse incisions into it so as to narrow the band of tissue by which the wave is transmitted, or by injuring the tissue by straining. Sometimes the contraction wave may be blocked by the injury before the stimulus wave, and sometimes the stimulus wave may be blocked before the contraction wave. When the block is only partial it frequently happens that two or three waves will pass along the strip up to the block without being able to cross it, but after a long time their effect appears to penetrate so that a wave at last crosses it. As Gaskell has shown, a similar occurrence takes place in the frog's heart, and stimuli proceeding from the auricle to the ventricle may also be blocked by compression. The influence of poisons can be studied either upon the bell containing the ganglia, or upon this marginal strip. In healthy medusas chloroform first arrests the spontaneous movements of the bell. When now irritated it answers by a single contraction, instead of by a series, to such stimulation. After the bell has ceased to respond, nipping its margin causes the polyp to contract. After stimulation of any part of the bell ceases to produce response in any part of the organism, the polyp will respond to stimuli directly applied to it. Nitrite of amyl also produces effects which in many respects are similar to those of chloroform. There are, however, certain exceptions; the first is that, before the spontaneous movements are abolished, the rhythm becomes quickened, and the strength of the pulsations is diminished. The movements also die out more gradually than under chloroform, and before they entirely cease they become localized to the muscular tissue close to the margin. When the dose is large, spasmodic contractions are produced which obliterate the gradual paralyzing action of the drug. Caffeine first causes an increase in the rate of pulsation, and diminishes its strength after a few seconds. This 112 PHARMACOLOGY AXD THERAPEUTICS. condition passes off, and the spontaneous movements become gradually abolished. They still remain for a long time sensitive to stimulation, and at first respond by st veral feeble contractions to each stimulus; afterwards by a single response ; and afterwards they do not respond at all. As medusae paralyzed by removal of the ganglia never respond to a single stimulus with more than a single contraction, the increased number of contrac- tions which at first appear after the application of the stimulus, are probably due to increased reflex irritability. Caffeine causes the tentacles and polypi to lose their tonus, and become relaxed, which is not the case with chloroform. Medusae anesthetized with chloroform when put into a solution of caffeine also lose their tonus, but their irritability is restored, though their spontaneity is not. The effects of strychnine differ in different species of medusa. In Sarsia it accelerates the rhythmical contractions which occur in groups separated by inter- vals of quiescence. This quiescence finally becomes continuous, and during it, it d<»es not respond to irritation of the tentacle, but does so to direct muscular stimulation. Yeratrine causes first increase both in the number and power of the contrac- tion.-: afterwards it diminishes both. Digitalin first quickens them, then renders them regular, causes persistent spasms, and produces death in strong systole. Atropine causes first acceleration, then convulsions, then feeble contractions, and finally death in systole. Nicotine causes violent and continuous spasm, with numerous minute rapid contractions superimposed upon it. These latter soon die away, leaving the bell in strong systole. After spontaneous movements have disappeared, the bell no longer responds to stimulation of the tentacles, but responds to direct stimulation. Alcohol first greatly increases the rapidity of the contractions, so much so that the bell has no time to expand properly between them, and they are in consequence feeble and gradually die out. The reflex stimulation shortly ceases to produce any effect, but muscular irritability is longer maintained. Cyanide of potassium first quickens and then enfeebles the contractions; spontaneous movements rapidly cease, and the bell soon becomes irresponsive either to irritation of the tentacles, or to direct irritation. For a long time after it has become irresponsive, the nervous connections between the tentacles and polyp remain intact, as also do the nervous connections of these organs, with all parte of the bell. The sensory organs are therefore not paralyzed by this drug. The effects of poisons on medusae were localized by Romanes in two ways: one way was to divide the medusa almost into two halves, connected only by a narrow strip of tissue. These halves were plunged into two beakers filled with water, pure in one and poisoned in the other. The connecting strip rested upon the edges of the beaker. When curare was employed as a poison in this way, it w;l- found to have an action similar to that which it exerts on mammals: appar- ently paralyzing the motor nerves, while it left the sensory nerves capable of action. Thus, on nipping the half of a medusa which was plungedin the curare tion, it remained absolutely motionless, while the other half at once responded by a peculiar contraction to the stimulus. Here, also, however, just as in mam- mals, the sensory fibres are also paralyzed by a large dose, so that if much poison be used, irritation of the poisoned par! will have no effect either upon it or up. .11 the unpoisoned part. When experimenting in this way with strych- nine, Krukenberg found thai the excitability of the poisoned part was increased inched the connecting strip lightly with a needle no effect was ACTION OF DRUGS ON INVERTEBRATA. 113 produced on the unpoisoned half, but the poisoned half responded by several energetic contractions. Veratrine had a similar action to that of curare, so that irritation of the poisoned half caused no movement in it, but caused movement in the unpoisoned half. The irritability of the contractile tissue is also dimin- ished so that it no longer reacts so readily in the poisoned half to electrical stimuli. Nicotine appears to paralyze the ganglionic structures and not the nerves. It has already been mentioned that the rhythmical movements of medusse depend upon the ganglia : when these are all cut off the movements cease, but even if one be left the movements continue. In the medusa divided into two halves, as already described, it is evident that if the ganglia are removed from one-half, or one-half rendered functionally inactive by poison, that half will still continue to contract, so long as it remains connected with the other half, but will cease to move when it is completely divided from the half which still con- tains ganglia. The effect of nicotine is such as one would expect if the poison paralyzes the ganglia, for it is found that when one-half of a medusa is steeped in water containing nicotine, both halves still continue to pulsate rhythmically ; so soon as the connecting band of tissue is divided, the poisoned half at once ceases to move, while the other half continues to pulsate. The second way in which Romanes localized the action of poisons on medusse was by applying them to a strip of contractile tissue. He found that various poisons applied to the strip, or injected into it, caused a blockage of contractile waves, preceded by a progressive slowing of the rate of transmission along the poisoned part. Chloroform, ether, alcohol, morphine, strychnine, and curare, all have this effect. General Results. — The most marked results of experiments on medusae are, that the contractile tissue contracts rhythmically when stimulated by ganglia. It ceases to do so when the ganglia are removed and the contractile tissue left under ordinary conditions, but a constant stimulus, either chemical or electrical, applied to it after the removal of the ganglia, will cause it to beat rhythmically, just as if the ganglia were present. This appears to show that the rhythmical contractile power is a function of the contractile tissue and not merely of the ganglia. Be- sides its power of contracting once on the application of a single stimulus or rhythmically from continued stimulation, the contractile tissue also possesses the power to conduct stimuli. This is seen in the passage of the contraction wave along a strip of medusse which, on reaching the bell, causes it to contract. When two contraction waves travelling along the contractile strip in opposite directions meet one another they arrest each other. This mutual extinction may be regarded either as a process of inhibition or interference, or as a consequence of exhaustion of the tissue which possibly may be unable to contract twice with such a short interval between. The power of the contractile tissue to transmit stimuli is diminished or destroyed by cutting it more or less completely across, by compression, by stretching, by very high or low temperatures, and by poisons, such as chloroform, morphine, nitrite of amyl, caffeine, strychnine, curare, and indeed almost any foreign substance added to the water in which the strip is immersed. There are, however, two conducting- channels, along which stimuli may be transmitted ; the first, already mentioned, is the contractile 114 PHARMACOLOGY AND THERAPEUTICS. tissue ; the second is the nervous tissue. The passage of stimuli along the second is rendered evident by the movements of the tentacles. These nervous or tentacular waves and the contractile waves may exist either together or separately. These nervous waves are excited by stimuli which are too weak to excite contraction waves, and it is to be particu- larly remarked that when this is the case they only travel at half the rate at which a contraction wave travels, although when the stimulus is strong enough to excite a contraction wave also, both the nervous and the contractile waves travel at the same rate, the nervous one being a little ahead of the other. The passage of nervous stimuli may also be diminished or com- pletely blocked by section or compression, just as in the case of contrac- tion waves. The transmission of stimuli along nerves is also affected by poisons. It appears to be destroyed by anaesthetics, though more slowly than that of the contractile tissue. The ganglia may be paralyzed, e. g., by nicotine, before the transmission of nervous stimuli from them is diminished. The contractile tissue alone may be paralyzed. Action of Drug's on Mollusca. In the lamellibranchiata, instead of a chain of ganglia as in the medusas, we have three pairs of ganglia: cerebral at the mouth, pedal in the foot, and parietal splanchnic supplying the bronchial apparatus and viscera. The heart has distinct chambers, but apparently consists of protoplasmic substance without distinct nerves or ganglia. The application to it of an interrupted current will arrest the rhythmical pulsation and cause stoppage in diastole. 1 This effect is prevented by atropine. Warmth up to 104° quickens the heart, when raised higher it destroys reflex movement in the animal, and afterwards arrests the heart also. Pure water without salts quickly paralyzes the muscles and causes death in salt-water mollusks. Curare in small doses has no effect, large doses quicken, but do not abolish movement, and do not affect the heart. Strychnine somewhat stimulates movement, and may cause some local contractions, but never any general tetanus. Nicotine acts in a similar way, but in large doses appears to paralyze the muscles and cause death ; it also appears to cause contraction of the vessels, so that the heart becomes more bulky and beats more quickly. Veratrine baa a Bimilar action. Digitalis has no action, excepting when applied to the heart directly, and then it renders the beats slower and sometimes stops them. Antiariiir. like digitalis, has no general action, but stops the heart if ap- plied to it directly. Muscarine generally causes muscular contractions in the body: first acceleration, quickly followed by retardation of the cardiac beats. Sulphocyanide of potassium diminishes reflex action, but has little effect on the itabilityof the nerves. A small dose somewhat quickens the cardiac action; ;i 1;i1 topa the bear! in diastole, and if it is directly applied to the heart is permanent. Action of Drugs on Ascidians. The bearl in ascidians consists of a tube open at both ends, and which, by its contraction, drives the visceral fluid alternately towards the viscera and away from then). Its action .does not seem to depend M. Poster, Pfliiger's Archie, v., 191. ACTION OF DRUGS ON INVERTEBRATA. 115 on the nervous ganglion lying between the oral and anal sac, or indeed upon nervous influence at all. The application of an induced current causes it to beat for some time in one direction instead of alternately, but does not arrest its pulsa- tions. 1 According to Krukenberg, it is not affected either by atropine or muscarine. It is paralyzed by veratrine, quinine and strychnine : these poisons rendering the beats gradually weaker and more irregular. No evidences of tetanus are to be seen from the action of strychnine. The mode of action of the heart is affected by helleborin and nicotine : helleborin increases the number of the advisceral beats, while nicotine diminishes them. Camphor and strychnine have possibly an action in this respect resembling helleborin. Action of Drug's on Annulosa. In annulosa the nervous system consists of ganglia in each segment united together by nervous bundles. These bundles in general appear- ance correspond with the gangliated cord of the sympathetic in higher animals, and the spinal cord is absent. We might therefore expect that drugs which act specially on the spinal cord in vertebrates would not have the same marked action on annelida, and this appears to be the case. It was found by Moseley that strychnine had no action on cock- roaches ; 2 and leeches, when placed in water containing strychnine, be- come elongated but do not exhibit signs of tetanus. Some years ago I noticed that ants sprinkled with insect-powder died in violent convul- sions, and it occurred to me that possibly substances which excite move- ments of the intestine in the higher animals might have a somewhat convulsant action on invertebrates. I therefore tried the effect of oil of peppermint on leeches, and it produced in them violent excitement. This appears to be of a somewhat convulsant' nature : the animal at first flying rapidly hither and thither through the water, and afterwards, when it becomes quiet and nearly exhausted, there is a constant rhyth- mical twitching movement in the body which appears to last nearly until death. But if my idea had been correct, all carminatives should excite convulsions in annulosa. This is not the case, for the oils of pepper- mint, caraway and anise have no apparent effect on black-beetles other than that of making them sluggish. Chloroform, ether, and other sub- stances belonging to the alcohol group, act as anaesthetics on mammals, temporarily abolishing the functional activity of the brain, spinal cord, and medulla. On leeches they have a different effect, coagulating the muscular substance and rendering it stiff and hard before affecting the nerves. This has been shown in an ingenious way by Krukenberg, who applied chloroform to the middle part of the leech while he protected the two ends of the animal from the action of the vapor. The middle part then became stiff and rigid, but the movements of the two ends of the animal were perfectly co-ordinated, so that its actions were that of a single animal having a stiff girdle surrounding its middle. Ether and 1 Dew-Smith, Boy. Soc. Proc, March 18, 1875, p. 336. 2 Moseley, unpublished experiment made in C. Ludwig's laboratory. 116 PHARMACOLOGY AXD THERAPEUTICS. alcohol had a similar result. The co-ordination of the two ends showed that although the muscles had been rendered rigid by chloroform, the nerves which passed through the middle part of the body were still func- tionally active. When the middle part of the body was coagulated by the application of hot water, the muscles became rigid but the nerves were also destroyed, and the movements of the two ends of the animal were no longer co-ordinated, so that they appeared like two distinct animals connected by a rigid cylinder. Atropine has a similar action to chloroform, ether and alcohol, on the muscles of the leech. Veratrine appears to some extent to affect the muscles, so that after contraction they relax slowly. It appears also, however, to affect the nerve-centres, and according to Krukenberg paralyzes more especially the sensory centres. Camphor, strychnine, morphine, caffeine, copper sulphate, and mercuric chloride, act chiefly on the nervous system of leeches, although they also affect the muscles when applied for a length of time. Caffeine renders the muscles in the leech also rigid. CHAPTER V. ACTION OF DRUGS ON MUSCLE. Action of Drugs on Voluntary Muscle. In the bodies of animals we find the protoplasmic masses or cells of which they are composed variously modified, in order to perform special functions. In Borne the power of nutrition is chiefly developed: and these we find in glands. In others the power of contractility is developed: and these we find in muscles, striated and non-striated. I n the course of special development towards the fulfilment of a particular function, the protoplasm of the muscular cells undergoes marked changes But it must always be borne in mind that the protoplasmic elements of the body, however different from one another, always tend more or to retain all the functions which are seen in an organism consisting of B Bingle cell, a reference to which may sometimes throw much light upon the mode of life of the more highly organized tissues. In amoeba or leucocytes the protoplasm contracts in any direction. In muscle it contract* chiefly in one direction, riz., that of its length, though the probability of its contraction in a transverse direction also is to be borne in mind. We distinguish in musole its elasticity, a physical property; and its contractility, a vital property. word elasticity is applied to the tendency of the body both to • change of its form, and to regain it when 'this change has been ACTION OF DRUGS ON MUSCLE. 117 effected : so that ivory may be taken as the type of a very strongly elas- tic body. Indiarubber, on the other hand, is regarded as a feebly elastic body, because it does not strongly resist changes of form, although it tends very strongly to regain its original form after such changes. It is, however, popularly regarded as the perfect type of an elastic body. In talking of the elasticity of muscle, confusion is apt to occur; it is better then to avoid the term elasticity and to use the words suggested by Marey — extensibility and retractility. The extensibility of mus- cle is of two kinds — immediate and supplementary. When a weight is attached to it, it extends considerably : this is its immediate extensi- bility: it then goes on slowly and gradually lengthening for a consid- erable time, and this is supplementary extensibility. When the weights are removed the retractile power of the muscle again becomes evident, and there is immediate retractility and supplementary retractility, the muscle at once contracting to a considerable extent, and then con- tinuing to do so slowly and gradually for some time afterwards. The extensibility of a muscle is increased by stimulation, so that if a weight be hung on a muscle while it is contracted in consequence of stimulation, it will produce a greater extension than it would if applied to the same muscle in a state of rest. If a muscle, too, is loaded with a weight too great for it to raise, stimulation of it, instead of causing contraction, causes elongation. Heat renders the muscle less extensible and more retractile; cold has an opposite effect, rendering it more extensible and less retractile. Section of the nerve has a similar effect to that of cold. Fatigue increases the extensibility. Alkalis (potash or soda), in very dilute solutions, diminish extensibility ; dilute acids (lactic acid) increase it. By the alternate application of alkalis and acids the muscle may be made to yield curves which, when recorded on a very slowly-revolving cylinder, are similar in form to the normal contraction curve recorded on a rapidly-revolving cylinder. Irritability of Muscle. — In order to ascertain the irritability of muscle itself or the readiness with which it responds to various stimuli independently of the nerves within it, the muscle is first poisoned by curare, and then exposed to various conditions or to the action of drugs. The muscle thus poisoned by curare, woorara, woorali, or urari (for the poison has all these names), is much less sensitive to the action of fara- daic currents. The readiest way of testing its excitability is by the making and breaking of a constant current, the strength of which can be estimated very exactly by using du Bois Reymond's rheochord. The excitability of muscles is increased by heat and diminished by cold. It is increased by physostigmin and diminished by most poisons which par- alyze muscle. 1 Contraction. — When the ends of the muscle are not kept apart by force too great for it to overcome, and it is stimulated by heat, mechani- cal injury, chemical irritants, or electricity, it contracts and then relaxes. The form of this contraction varies according to the species of ani- mal, and the particular muscle tested. 1 Harnack and Witkowski, Arch.f. exp. Path. u. Pharm., v., 1876, p. 402. 118 PHARMACOLOGY AND THERAPEUTICS. In cold-blooded animals, as a rule, the contraction is slower than in warm-blooded animals. It is not alike in all the muscles of the body of mammals. Thus in the rabbit there are two kinds of muscles — red and white: the white muscles contract more quickly and relax more quickly than the red ones. The muscle usually employed in experiments is the ocnemius of the frog, freshly prepared with the nerve and end of the femur attached to it. The femur is fixed in a clamp, and the lower end of the muscle is attached to a writing lever usually loaded with a weight (Fig. 18). The end of this lever writes upon a revolving cylinder, (Fig. 19), 18.— Apparatus for registering muscular contraction. It consists of an upright stand on which. two horizontal bar- may be moved by a rack and pinion. The upper bar ends in a clamp, the es a delicate lever, the part near the hinge being of metal, and the part hevond of light tipped with quill or tinfoil. a, a, wires for exciting muscle; 6, muscle; c, writing lever. In jure no arrangement i- shown fur exciting the nerve, and for the sake of simplicity the ■ i- shown directly under the muscle. In actual experiment, however, the weight should be applied dose to the a\le, or on it, so as to lessen oscillation due to the inertia of the lever. which is made to rotate with greater or less rapidity. The rate of revolution is usually ascertained by marking the time upon it by means of an electro-magnet (Fig. 20), communicating with a clock or metronome, or, when the revolution is quick, with a large tuning-fork, vibrating LOO times or more per second. When the cylinder is not in motion each contraction of the lever makes a straight line upon it (Figs. 21 a and 27); when the cylinder is moving, the lever describes a curve more or less elongated, according to the rapidity of the cylinder's rota- tion (Figs. 21 and 22). Latent Period of the Muscle. — The mechanical energy devel- oped by muscle during its contraction is derived from chemical energy liberated by changes m the constituents of the muscle itself. These <> the nature of oxidation, and during them oxygen is used up, and r \ irl I '- liberated. But the oxygen is not necessarily present either around the muscle, or in the blood circulating through the muscle; it i- Btored up in some loose form of combination within the muscle. 1 appeal tint this force-yielding Bubstance, or muscle-dynamite, as we 1,1 lt »« ""' presented least b large quantity,in the muscles in a form in ACTION OF DEUGS ON MUSCLE. 119 The form in which it is stored up has been compared by Ludwig to gunpowder, a small quantity of which is fired off at each contrac- tion. One of the final products is carbonic acid ; but there are interme- diate products, one of them being sarcolactic acid ; and these products tend to cause muscular fatigue. -Screw. Framework. Clockwork. Fig. 19.— Revolving cylinder for recording movements. The screws at the top are for fixing the cylin- der in position. The brass pin is for making or breaking a current at a given time in the revolu- tion. It does this by striking against a small key. The curve is described by the lever, Fig. 18. The abscissa, or zero line, is drawn by a fixed point, and serves to show the height of the contrac- tion. When they are washed out of the muscle by a current of blood, or of simple saline solution, the fatigue of the muscle is removed ; and this removal is effected even more perfectly when the internal oxidation which it can be at once fired off. There appears rather to exist a substance yielding- it, or dynamogen, which may be looked upon as corresponding to the zymogen of the glands, while the muscle-dynamite may be regarded as corresponding to the ferments of glands. Irritation of a nerve appears both to liberate muscle-dynamite and to explode it, if we may so term it. The passage of a constant current through the muscle appears to liberate the muscle-dynamite from the dynamogen, but causes no expulsion except at the moment when the current is made or broken, or its strength altered. It must be carefully borne in mind that the idea of a muscle- dynamogen is at present simply theoretical, and must be looked upon not as a fact, but rather as a means of remembering facts. According to A. Schmidt, however, the contraction and relaxation of muscle is closely connected with formation and destruction of a ferment. 120 PHARMACOLOGY AND THERAPEUTICS. is rendered more complete by adding permanganate of potash to the solution, or by the addition of minute quantities of potash. A mere trace of veratrine has also a similar effect in restoring the muscle after fatigue. We find that the muscle does not immediately respond to a stimulus, but that a period elapses between the stimulus and the commencement of the contraction, which is on the average about the 100th of a second. This is termed the latent period. During this period a chemical change is probably going on in the muscle, and it is evidenced by an electrical change known as the nega- tive variation, or diminution in the natural current which passes from the longitudinal to the transverse section of the muscle. The latent period is altered by fatigue. Loading the muscle short- ens the latent period, until the load is just sufficient to extend the muscle. An increase of load above this lengthens the latent period. Cold lengthens it; heat shortens it. Small doses of strychnine or vera- trine shorten the latent period. Large doses of strychnine or veratrine, and also curare, lengthen it. Summation of Stimuli. — During the latent period, the stimulus applied to a muscle excites chemical changes which result in contraction ; Electro-magnet. flndiarubber thread to draw < back the writing-point when (released by the magnet. Ik.. 2o.— Electro-magnet (after Marey) for recording time on a cylinder. When used to record time, the current is made and broken alternately by clockwork or by a tuning-fork. It may by used ftlBO to record the time of irritating or dividing a nerve, or of injecting a poison, &c. but if the stimulus be very small, the chemical changes may be so slight that contraction does not occur. If the stimulus, however, be repeated era! times, the changes which it induces in the muscle become suffi- r to produce at first a slight contraction, and then one greater and greater, until the maximum effect is produced — this is called summation. It occurs not only in voluntary muscles, but in other contractile tissues, Bucfa as those of the medusae, vide Fig. 16, p. 110. A similar phenome- non occurs also in the heart, and has there received the name of "the Btaircfl ContractioD of Muscle. — In the muscular curve we notice (1) the rapidity of its rise, winch Indicates the rapidity of contraction of the muscle; (2) its length, indicating the duration of contraction ; (3) its height, indicating power of contraction; and (4) slowness of fall, indi- cating the condition of extensibility. The muscular contraction is modified by numerous conditions. One of these is the strength of stimulus. The stimulus usually applied is electricity, as its strength can be more easih regulated, and h does not destroy the muscle so readily as mechanical or chemical irritants. ACTION OF DRUGS ON MUSCLE. 121 With a weak current, making (closing) has no action on the muscle, but breaking (opening) causes contraction. Fig. 21. — Muscle curves, showing the different appearances they present according to the rate at which the recording cylinder revolves, a is a curve with a very slowly revolving cylinder ; 6, c, and d are curves with increasing speed of rotation, c is written witb a lever pointing in the opposite direction from that with which a and b are recorded, and the curve therefore inclines to the other side. A moderate current gives contraction both in making and breaking, but that of making is comparatively small (Fig. 22). With a strong current no difference is observed. Fig. 22.— Shows effect of making and breaking shocks. These are normal muscle curves with a still quicker rotating cylinder than in Fig. 21. The first is caused by irritating the muscle by making (closing) a constant current, and the second by breaking (opening) it. The more intense the stimulus, the higher and longer is the curve. The increase in height is shown in Fig. 23. Fig. 23.— Tracing of the contractions of a muscle with stimuli of varying strength. The numbers indicate the distance in centimetres of the secondary from the primary coil in the induction apparatus. As and Des indicate the ascending and descending direction of the current. Cold renders contraction slower, lower, and more prolonged (Fig. 24 b). Heat renders it quicker, higher, and shorter (Fig. 24 a). Fatigue. — Fatigue makes the ascent slow, the height less, and the descent slow (Fig. 25). Exhaustion of the animal has a similar action ; and dilute acids applied to the muscle produce the same effect. 122 PHARMACOLOGY AjS'D THERAPEUTICS. The effect of fatigue is probably due in a considerable measure to the accumulation of acid products of muscular waste. When these are Fig. 24. -Effect of heat and cold. In a the muscle has been artificially warmed, and in b it has cooled. been washed out by passing a weak solution of chloride of sodium through the vessels of the muscle, or removed to some extent by kneading, it regains to a great extent its normal power of contraction. Fig. 25.— Effect of fatigue. Oxidizing agents, such as permanganate of potash, added to the salt solution increase this power, and restore the muscle even more quickly and completely. 1 Deprivation of blood has a similar action on the muscle to fatigue : and free circulation of blood tends to remove the effects of fatigue. Contracture. — When the stimulation is exceedingly strong, the re- laxation after contraction may become very slow, and the descent of the curve may be divided into two parts. At first it descends for a short time pretty (prickly, and then falls very slowly indeed. This long con- traction of the muscle is known as contracture. It is very strongly marked in muscles poisoned by veratrine or barium. It occurs, though to a less extent, in muscles poisoned by salts of calcium and strontium, by ammonia, and by the chloride, iodide, nitrite, nitrate, and cyanide of am- monium.' The cause of contracture is not known ; it is considered not to be a tetanic contraction, because, unlike an ordinary tetanized muscle, it does Dot give rise to secondary tetanus in another frog's muscle when the nerve of the latter is placed upon it. It is, however, an active contraction, not a mere alteration in the elasticity of the muscle preventing its relaxation ; for, as Pick and Boehm have shown, a much greater amount of heat is developed during the long-continued contracture than in an ordinary contraction. Sometimes, and indeed not unfrequently, the contracture, instead of consisting of a single prolonged contraction, appears in the l" 1 "'" of a prolonged contraction added on to an ordinary contraction be- fore relaxation has had time to occur. This gives rise to a peculiar hump 1 Kronecker, Ludwig's Arbetten, 1871, p. 183. Brunton and Cash, Roy. Soc. rw., \m\\. ACTION OF DRUGS ON MUSCLE. 123 in the curve, as is well seen in the middle curve in Fig. 30. This appears to show that the contracture is really a double phenomenon, like the two Fig. 26. — Secondary contraction in the muscle of a crayfish. The thick part of the lower line shows the time during which the muscle was irritated by a tetanizing current. It will be noticed that the secondary contraction occurs after the irritation has ceased, and after the tetanus caused by it has relaxed. It is not a simple continuous rise, but exhibits several waves indicative of a kind of rhythm. (After Eichet). contractions observed after a single stimulation in the muscle of the cray- fish by Eichet (Fig. 26). How far the contracture may depend upon irritation of the muscle by its own current has yet to be determined. Tetanus. — If instead of a single stimulation a number of stimuli rapidly succeeding each other are applied either directly to the muscle itself or to its motor nerve, we get, in place of a single contraction, a continued contraction or tetanus. As this is due to a fresh contraction of the muscle occurring before the previous one has had time to relax, it is evident that the number of stimuli requisite to produce this will vary with the length of each single contraction in a muscle : thus in the muscles of the tortoise, which contract and relax very slowly, tetanus may be produced by 3 stimuli per second, while in the white muscles of rabbits 20 may be necessary, and in some muscles of birds 70 stimuli per second are insufficient. It has been said that with as rapid stimuli as 250 per second the tetanus ceases, and after a single initial contraction a muscle goes to rest just as if a constant instead of an interrupted current had been used. Kronecker and Stirling have shown that with no less than 22,000 inter- ruptions per second, still tetanus is obtained ; but when such extremely rapid stimuli are applied, the muscle still contracts about the ordinary rate of 20 per second ; and this is also the case when chemical stimuli are applied to the nerve, or when the muscle is irritated by the nerve centres, either voluntarily or by artificial stimuli applied to them. It seems, therefore, probable that the number of contractions of the muscles in tetanus are not due to the number of stimuli sent down from the nerve centres, but that the rate is determined either by the ends of the nerve in the muscle or by the muscle itself. 1 The form of a tetanus curve may be modified very considerably by the action of drugs: thus substances which diminish the contractile power of muscle cause the tetanus curve to fall very rapidly notwithstanding 1 Wedenskii, Archivf. Anat. «. Physiol. Phys., Abthlg., 1883, p. 325. 124 PHARMACOLOGY AND THERAPEUTICS. the continued application of stimuli either to the muscle itself or to its nerve (vide Ammonia). Sfuscular Poisons. — We may distinguish several groups of muscu- lar poisons, but at present the classification is difficult, and the division into six groups, based on that of Robert, which I have adopted, although it possesses some advantages, is far from satisfactory, and can only be regarded as temporary. Group I. — Leaves the irritability of the muscle unaffected, but diminishes the total amount of work it is able to do. Group II. — Diminishes the excitability of the muscle as well as its ca- pacity for work. Group III. — Diminishes the capacity for work, and produces marked irregularity in its excitability. Group IV. — Alters the form of the muscular curve. Group V. — Increases the excitability. Group VI. — Increases the capacity for work. Fie. 27.— Tracings showing the gradual loss of contractile power from fatigue in a normal muscle, a, and in one poisoned by carbolic acid, b. Each section, 0'— 1', &c, shows the contractions in one minute. (After Gies). The poisons in Group I. do not alter the muscle curve, so that if the action of the poison were tested by a single contraction only, it would be -apposed that the muscle was unaffected; they lessen, however, the amount of work which the muscle can yield. The amount of work is estimated by the weight which a muscle raises multiplied into the number of times it is lifted and the height it is raised cadi time. These are ascertained by registering the contractions on a slowly revolving drum, as in Fig. 27, which shows the rapid exhaustion of a muscle poisoned by carbolic acid as compared with a normal one. The rapid exhaustion of muscles may also be observed in the form of the tetanus curve, which, under the influence of such poisons, falls much more rapidly in heighl than that of the normal muscle. This group contains a number of drugs having an emetic action. 1 These are: apomorphine, asclepiadine, cyclamine, delphinine, sanguinar- ine, and saponine, copper, zinc, and cadmium. Antimony has a some- what similar action, hut only in large doses, and after a great length of time. Arsenic, platinum, and probably mercury, act in the same way as antimony. 1 Tin, nickel, 8 cobalv manganese, 2 aluminium, and magnesium, have little or do action on muscle. Large doses of iron are nearly as FTarnack, Archivf, exp. Path, u, Pharm. Bd. ii., p. 299, and iii., p. 44. Kobert, Arch./, exp. Path u. Pharm. Bd. \\\, p. 22, and xvi., p. 361. AndenoD Stuart, journ. of Anat and Physiol, vol. xvii.,.p. 89. ACTION OF DRUGS ON MUSCLE. 125 powerful as arsenic, but in small doses it rather increases the amount of work the muscle can do. Carbonic oxide at the atmospheric pressure does not affect muscular contractility, but abolishes it at a pressure of five atmospheres. Perhaps we may take as a subdivision of this group those poisons which lessen the contractile power of the muscle without altering its irri- tability. When a muscle poisoned by one of these is stimulated, it may Fig. 28.— (After Harnack). Shows the action of lead on muscle, a shows the contraction of a normal muscle after eighty stimulations ; 6, the irregular contractions of a muscle poisoned by lead after ten to fifty stimulations; c shows the slow relaxation of the muscle after contraction in a muscle poisoned by lead after numerous stimulations. contract quite as readily as a normal muscle, provided the weight that it has to raise is but slight, but it cannot raise such a heavy weight as a normal muscle. This is tested by loading it with a given weight, and the slightest contraction is ascertained by adjusting the lever of the myo- graph in such a way that if raised in the very least it breaks a connection in an electrical current and causes a bell to ring. In this way contrac- tions quite imperceptible to the eye are readily appreciated. Digitalis has an action of this sort, as I found in some experiments carried on under the direction of Professor J. Rosenthal in 1868, but not published. Group II. contains salts of potassium, lithium, ammonium, quinine, cinchonine, oil of mace, alcohol in large doses, chloroform, etc. Chloral, chloroform, and ether, also belong to this group, but they might also be reckoned as belonging to Group IV., for they slow the ascent, lessen the height, and prolong the descent of the curve. Curare has a similar action. It is usually stated that curare, while it paralyzes motor nerves, leaves the excitability of the muscles unaffected, but this appears not to be quite correct, for, when very weak currents are employed, the muscle loses its excitability by them before the nerve, and the contractions of the muscle at the same time become unequal. It is perhaps not yet perfectly certain how far these appearances are due to the curare and how far to the gradual death of the muscle. 1 Group III. contains poisons of which lead is a typical example. These poisons cause the muscular contractions to become very unequal, although the stimuli are equal and regular. Emetine and cocaine have a similar action to lead. This action is probably due only to the gradual death of the muscle. It is produced also by ptomaines, and it may occur in muscles which are simply dying without being poisoned at all. 2 1 Marey, 'iravaux da Laboratoire, 1878, p. 157. 2 Mosso, Les Ptomaines. Turin, 1883. 126 PHAKMACOLOGY AND THERAPEUTICS. Group IV. contains poisons which alter the form of the curve to a marked extent. The action of veratrine is very peculiar : it does not lessen the rapid- itv of contraction, and even increases the height of the curve, but it prolongs the descent to an enormous extent. Fi«.. 21'.— Tracing of the contraction curve of a muscle poisoned by veratrine, showing enormous pro- longation of the contraction, the recording cylinder making many complete revolutions before the muscle is completely relaxed. This action of veratrine is most marked at moderate temperatures. It is much diminished, and sometimes entirely removed, by cold ; and it disappears also when the temperature of the muscle is consider- ably raised. When the muscle which has been cooled or heated is again brought back to a moderate temperature, the contracture sometimes re- turns, but occasionally does not, the effect of veratrine on the muscle appearing to be sometimes, but by no means always, destroyed by the heat or cold to which the muscle has been exposed. 1 The result of this exceedingly prolonged contraction is that a frog poisoned with veratrine is able to jump with considerable power, but the extensor muscles, by which the movement is executed, remain contracted instead of relaxing. The animal therefore lies extended and stiff, and is only able very slowly to draw its legs up towards the body. After they have been drawn up, the flexors in their turn remain contracted for a while, and so the animal is unable to jump until some time further has elapsed. Another remarkable point about the action of veratrine on muscle is, that although a single contraction lasts so long as seriously to interfere with the power of co-ordinated movement, yet if the muscle is made to contracl a fewtimes in rapid succession, the effect of the veratrine disap- pears, and it again acts normally. After a short rest the effect of vera- fcrine again reappears. \ similar action to that of veratrine is exerted by salts of barium, which, when locally applied, cause the muscle to describe a curve resem- bling that of reratrine, not only in its form, but in the alterations pro- duced I n MvuHcdfam Braunschweig, 1862, p. 62. ACTION OF DRUGS ON MUSCLE. 129 becomes still more marked after the influence of the central nervous sys- tem has been destroyed. In the case of the sphincter ani, for example, the rhythm is strong and regular, especially after the nerves have been divided and the muscle subjected to some mechanical distension by the introduction of the finger. In voluntary muscle the tendency to large rhythmical pulsations is slight, although we see rapid contractions occurring in tetanus. It is usually supposed that eighteen or twenty contractions per minute of the muscle when tetanized by stimulation of nerve centres is due to this number of stimuli being sent to it from the nerve centres. From the observations of Wedenskii that irritation of the motor nerve of a muscle by exceedingly rapid stimuli still produces the same number of contractions in the muscle, it seems probable that this rate of contrac- tion is due to the constitution either of the muscle itself, or of the nerve- endings within it. Under certain circumstances, however, the voluntary muscle may be made to contract with a slow rhythmical movement of considerable extent and closely resembling that of involuntary muscular fibre. Thus voluntary muscle treated by veratrine tends to remain con- tracted for a length of time like an involuntary muscle; heat has a tendency to cause its relaxation, and sometimes, as is seen in the accom- panying figure, these contending influences produce in the voluntary muscle a tendency to marked rhythmical contraction (Fig. 31). A still more remarkable phenomenon has been noticed by Kiihne, 1 who finds that when the uninjured sartorius of a frog is placed in a solution of 5 grammes NaCl, and 2*5 grammes of common alkaline crystallized phosphate of soda in a litre of water, it begins to contract at once, and after it has been transversely divided, it beats with the regularity of the heart. The action of various substances on the rhythmic action of muscle treated in this way has been investigated by Biedermann. He finds Fig. 31. — Tracing of the contraction curve of a muscle poisoned by veratrine and exposed to a high temperature. The poison tends to cause prolonged contraction, and the high temperature to cause rapid relaxation of the muscle. The result is a somewhat rhythmical spontaneous contraction. The muscle was only irritated at the very beginning of tbe first contraction. that the best fluid for the sartorius is 5 grammes NaCl, 2-2*5 grammes of Na 2 HP.0 4 , -04- 05 grammes of Na 2 C0 3 , in a litre of water. A low 1 Untersuchungen aus dem PhysiologiscJien Institute der Universitat Heidelberg. Son- derabdruck, 1879, p. 16. 130 PHARMACOLOGY AND THERAPEUTICS. temperature not rising above ten degrees is best. The lower the tem- perature the slower is the rhythm and the more extensive the contrac- tion. Heat quickens the rhythm and lessens the contraction. At about 18° to 20° C. the contractions become rapid and indistinct. When caustic soda is used instead of carbonate, the effect is similar, but the muscle dies much more quickly. Potassium carbonate and other potash salts only cause pulsations when greatly diluted. Lactic acid stops the pulsations : alkaline NCI solution again restores them. Veratrine and digitaline in a solution of NaCl also cause pulsations. 1 Schonlein finds that, with a certain strength of current interrupted about 88<> times in a second, the muscles of the water beetle are not tetanized but contract rhythmically from two to six times in a second. 2 Biedermann has succeeded in making a voluntary muscle, such as the sartorius, contract rhythmically by applying a solution of sodium bicarbonate ('2 per cent.) to the tibial end, and then passing a constant ascending current through the muscle. 3 Connection between Chemical Constitution and Physiological Action on Muscle. I have already mentioned (page 49) that one can hardly look for a general relation between the atomic weights of metals and their lethal activity, so that what we want is really a knowledge of the particular relationship of each group of elements to the organs and tissues of the body. In such an investigation it seems natural to take the muscles first, then the motor nerves, afterwards the nerve centres and individual organs. A number of experiments have been made by Cash and myself in order to do this for the alkalies and alkaline earths, and we have found that the contractile power of muscle, as shown by the height of the curve, is increased by rubidium, ammonium, potassium, and caesium. It is Blightly increased or unaffected by sodium, excepting in large doses, and i- almost invariably diminished by lithium. The duration of* contraction, as shown by the length of the curve, is increased by rubidium in large doses, ammonium, sodium, and caesium. It i- shortened by ammonium, lithium, rubidium, in small doses, and potassium. The contracture, or viscosity, is increased by rubidium in large doses, ammonium, lithium, and sodium. It is diminished by rubidium in small doses, ammonium, caesium, and potassium. Both ammonium and rubidium have two actions on muscle of an opposite character, sometimes increasing and sometimes diminishing both the duration of the contraction and of the contracture, or viscosity, which remains after the ordinary contraction has ceased. In the case of rubidium, this appears to depend upon the dose, but we were not satis- fied thai it was so entirely in the case of ammonium salts. ngsber. d. Wiener .W.W., Ixxxii., AMh. Hi., pp. 257-275. ulein, «Im Boie Re\ mond'a Archiv, 1882, s. 357. tber. '/. Wien. Ikad. Bd., lxxxvii., Abt, iii., March, 1883. ACTION OF DRUGS ON MUSCLE. 131 In regard to the action of the alkaline-earths and earths, we found that the contractile power of muscle is increased by barium, erbium, and lanthanum. It is sometimes increased and sometimes diminished by yttrium and calcium. It is diminished by didymium, strontium, and beryllium. The duration of contraction is increased by barium, calcium, stron- tium, yttrium, and erbium. It is unaffected, or slightly diminished, by beryllium, didymium, and lanthanum. Contracture is increased by barium, calcium, strontium, yttrium, and beryllium. The contracture produced by barium is enormous, resembling that produced by veratrine. It is, like that of veratrine, diminished by heat, cold, and potash, and may be abolished by these agents. It is by no means so well marked when the drug is injected into the circulation as when locally applied to the muscle. The action of some of the more important of those drugs can be graphically represented by a spiral, the terminal members of which are potassium and barium, and these two are to a certain extent connected by ammonium as an intermediate link. K Rb Li Na Sr Ca Rb Ba NHo Increase or diminish after action or contracture. Increase, o Diminish. Increase or diminish altitude. Diminish, o Increase. Shorten or lengthen curve. Lengthen. Shorten. The effect of one member of one of these groups may be diminished or increased by the subsequent application of another. Potassium shortens the elongated curves caused by barium, calcium, sodium in large doses, and lithium, and reduces the contracture which these sub- stances cause. The veratrine-like curve of barium is counteracted by almost all the substances which produce a shorter curve than itself. Action of Drugs on Muscle is Relative and not Absolute. In considering the action of drugs on muscle, the first point which comes clearly out is that the action of a drug on the muscle is not abso- lute but merely relative. Thus veratrine and salts of barium are not to be regarded as absolute muscle poisons — they are only poisons under certain conditions of quantity and of temperature. An exceedingly small dose of veratrine instead of acting as a poison to muscle, acts rather as a food, and restores it when exhausted. Caffeine likewise in small doses has a restorative action, while in large doses it is a powerful poison. Veratrine and barium in moderate doses and at moderate temperatures are powerful muscular poisons, but at low 132 PHARMACOLOGY AND THERAPEUTICS. temperatures and at high temperatures their action is to a great extent, or even completely, abolished. Nay more, moderate quantities of barium salts at moderate temperatures are poisonous to the normal muscle, but they are restorative to the muscle whose composition and functions have been already altered by rubidium. Acids and alkalies also produce an effect on muscle, but their effect depends upon whether they are applied to the normal muscle or to one previously treated with a sub- stance having an opposite reaction. It is evident then that the whole question of the action of drugs on muscle is one involving the relation of the drug to the muscle at the time of application, and we must expect that if the temperature is different from the normal, or if the composition of the muscle should vary, the action of the drug will vary likewise. Now the composition of all the mus- cles in the body is not the same, as has been shown by Toldt and Nowak, 1 and the composition of the ash obtained by the combustion of different animals is also different, as has been shown by Lawes and Gilbert. 2 We may therefore expect that muscular poisons will not act alike at the normal temperature and in febrile conditions, nor alike upon all the muscles of an animal; nor will they always have the same action upon different animals — the relations being different the effects will be different. The effect of poisons upon muscles will also vary according to their chemical composition at the time. This composi- tion may probably to a certain extent be altered by feeding — at least as far as regards the proportions of inorganic ingredients. We know that the quantity of sodium chloride in the body can be increased, for if an animal be fed with a larger quantity of salt than usual, it does not at once begin to excrete it, but stores it up for two or three days, and then the excretion rises. After the administration of the sail has been stopped the excretion still continues large for two or three days, and then returns again to the lower standard. It seemed probable that similar retention would take place with potash, and if this were so, we might expect to counteract to a great extent the effect of barium by feeding an animal on potash for some time before administering the barium. I )n trying this, Cash and I have found that this is the case to a on extent, and although we have not been able completely to coun- teracl the effect of a large dose of barium so as to prevent death from a lethal dose, we have been able to modify and diminish its action by the administration of potash for several days previously, so that the charac- teristic symptoms of barium poisoning do not occur until some hours after they would otherwise do so, and thus life is prolonged though not preserved. \< tiou of Drugs on Involuntary Muscular Fibre. Contraction. — Involuntary muscles, with the exception of the heart, differ from voluntary not only in their anatomical structure but in their functional activity: instead of contracting or relaxing rapidly, both their oted bj Seegen, ir-,„. !/.„,/. Ber., lxiii., Abt. ii., 11-43. •' A'oy. 80C. I'm, ., , x v"., p. 344. ACTION OF DRUGS ON MUSCLE. 133 contraction and relaxation are slow. We have seen that although vol- untary muscle occasionally exhibits spontaneous rhythmical contractions, yet these occur only under exceptional circumstances, and but rarely. Involuntary muscle, on the other hand, has a much greater tendency to rhythmical contraction, although it may be regarded as doubtful whether some stimulus, however slight, is not required to induce this rhythm even in involuntary muscle. It has been already mentioned that the contractile tissue of medusa will beat rhythmically so long as it is con- nected with motor ganglia. When these ganglia are removed, the con- tractions cease, but will again reappear, notwithstanding the absence of the ganglia, if a constant stimulus be applied to the contractile tissue itself. This shows that the conditions for rhythm are contained in con- tractile tissue itself — that the rhythm may be independent of the gan- glia with which the contractile tissue is connected (p. 110). The same appears to be the case with involuntary muscular fibre generally. The ventricle of the frog's heart, containing ganglia, will beat rhyth- mically for a length of time after its removal from the body. If the ganglia which lie close to the auriculo-ventricular groove are cut off, the rhythmical action will cease just as in the medusa when the marginal ganglia are removed ; but if a constant stimulus be applied to the apex of the heart, as for example by passing a constant current through it, or by distending it with serum, its rhythmical movement will again com- mence, mechanical distension appearing to have upon it the same excit- ing action that a little acid added to the water has upon the nerveless bell of the medusa. Effect of Stimuli. — Mechanical distension appears to be one of the most powerful of all stimuli to excite rhythmical contraction in in- voluntary muscular fibre. Luchsinger observed distinct pulsation in the veins of a bat's wing twenty hours after the death of the animal, if artificial circulation was kept up. This appears to show that the power of rhythmical contraction resides in the muscular fibres of the veins as it does in the nerveless apex of the frog's heart, and the contractile tissue of the medusa ; but here also an external stimulus appears to be required to induce contraction. When the pressure by which artificial circulation was maintained fell to zero, the pulsation stopped, but if it were raised to forty or fifty centi- metres of water, so as to distend the vascular wall, rhythmical pulsation again commenced. It appears possible, however, that when involuntary muscular fibre is perfectly healthy and possessing the highest degree of irritability, it may contract rhythmically without any extra stimulus. Thus Englemann 1 observed that the ureter, in which he could find no nerves at all, contracted rhythmically when freshly exposed, although it was not distended or subjected to any mechanical irritation ; but if arti- ficial respiration has been long kept up, and the animal is exhausted, so that the excitability of the ureter is diminished, then the effect of min- imum distension in increasing its rhythm becomes very evident. Cold causes the isolated non-striated muscles of animals to relax. Heat causes them to contract. 2 1 Pfliiger's Archiv, 1869, Bd. 11, p. 251. 2 Luchsinger and Sokoloff, Pfliiger''s Archiv, Bd. 26, p. 465. 134 PHARMACOLOGY AND THERAPEUTICS. The influence of heat and cold, however, does not seem to be con- stant, and in the non-striated muscle of frogs they have an opposite con- nection to that just described. It is probable that the different results may depend to a great extent upon the amount of heat or cold applied, and its relation to the condition of the tissues at the time of application ; for mechanical stimulation has also an opposite effect, according to its amount ; and while gentle stimulation of involuntary muscular fibre, such as that of the small blood-vessels, causes dilatation, more powerful irritation produces contraction. 1 The influence of various drugs upon involuntary muscular fibre, as seen in the contraction of the blood-vessels, will be described when con- sidering the circulation. The Relation of the Contractile Tissue to the Nerves is dif- ferent in voluntary and involuntary muscular fibre. In the latter there are no end plates, but the terminal twigs form a plexus around the fibres. The motor nerves of involuntary muscular fibre appear to be affected by atropine and its congeners in a similar way to those of voluntary muscle by curare. There appears also to be a certain relationship between the atropine and curare group. Small doses of atropine paralyze the motor nerves of involuntary muscle, while very large doses of curare are re- quired. The converse is the case with voluntary muscle. These effects arc usually supposed to be due to a definite paralyzing action on the nerves themselves. There are difficulties, however, in the way of this hypothesis, and a more probable one, perhaps, is that these drugs disturb the relations between the nerves and the muscular fibres which they ex- cite. On the idea of a specific action it seems hard to explain the results obtained by Szpilman and Luchsinger, 2 who found that atropine produces paralysis of the motor fibres of the vagi supplying the oesophagus, only in those parts of it where involuntary muscular fibre is present. Thus, the oesophagus of the frog and the crop of birds consist of involuntary muscular fibre, and atropine destroys the motor power of the vagus over them. The oesophagus of the dog and rabbit contains striated muscular fibre, and atropine does not paralyze the motor nerves. The oesophagus of the eat contains striated muscular fibres in its upper three-fourths, and non- Btriated in its lower fourth : atropine destroys the motor action of the vagus upon the upper part, but not upon the lower fourth. 3 Propagation pf Contraction Waves. — Although involuntary muscular fibre consists of short cells and not of long fibres like voluntary muscle, yet the contraction wave may be propagated along a strip of in- voluntary muscular tissue in both directions from the point of irritation, just as in voluntary muscle or in the contractile tissue of medusae. This transmitted more slowly in involuntary than in voluntary muscle ; and it- rate in the involuntary muscle of the heart, though slower than in ordinary Btriated muscle, is quicker than in unstriated muscle, so that in this respect the heart is intermediary between the two. 4 :1111ml Mcv. r. Hermann's Eandb, (;, p. 459. Szpilman ;hh1 Luchsinger, Vfliiger 9 * ArcMv,Bd. 2(>, p. 240. Hermann* Eandbueh d, Phgsiologie, Bd. 1. p. 56. ACTION OF DRUGS ON MUSCLE. 135 The passage of contraction waves in involuntary muscular fibre is affected by the same conditions as voluntary muscle, the conduction of the contractile wave being rendered slower by fatigue and cold, while it is quickened by heat. Cold and fatigue also render the rhythmical pulsations smaller and longer, while heat has an opposite effect. The passage of the contraction wave may also be diminished or arrested by section or pressure, just as in the contractile tissue of medusae, 1 so that instead of each contraction wave passing the block produced by the sections or compression, only one out of several, or none at all, may pass. The proportion passing the block depends upon its completeness. If the tissue forming the bridge be dry as well as narrow, the block becomes more complete, and may be again diminished by moistening. Variations in the strength of the stim- ulus do not affect the passage of the contraction wave over the block, so that it would appear that the injury caused by the section, along with the narrowing of the conduction path, retards the re-establishment of the conductive power. In experiments made upon the heart of a tortoise cut into a strip, it has been found by Gaskell that stimulation of the vag-us removes the block, quickens the recovery of the tissue, and causes every contraction wave to pass. The effect upon the muscle therefore seems to be trophic. A weak interrupted current applied to the muscle directly has the same action as stimulation of the vagus, i.e., it increases the conduct- ing power of the muscle. Sometimes, however, both the vagus and a weak interrupted current have an opposite effect, and diminish instead of increasing the conducting power. An artificial rhythm may be induced in a strip of involuntary muscular fibre cut from the heart of the tortoise by passing a weak in- terrupted current through it and then stimulating it at one end by induc- tion shocks, at intervals of about five seconds. After a while, if the induction shocks are discontinued, the muscle still continues to contract rhythmically at the same time. These contractions, at first weak, after- wards become strong, and may last for many hours. Both the conducting and the contractile power of the muscle is diminished by muscarine. When a strip of it is stimulated by induction-shocks applied to one end, the contraction wave passes quickly along, but muscarine appears to block its transmission, so that while the part of the muscle between the electrodes contracts at every shock, the rest of the muscle contracts only at every second one. A weak interrupted current then sent through the muscle may lower its conducting power and still further reduce the force of the contractions, and not only block the passage of most of the con- traction waves from the point of excitation, but may even prevent the contraction of the excited part itself. Atropine has an opposite action and appears to increase the conduct- ing power of involuntary muscle, so that when applied to a strip of the heart, the conducting power of which has been diminished by muscarine, the contractility is at once increased, and each contraction wave passes 1 Englemann, Pfliiger's Archiv, 1875, Bd. 11. p. 465; Gaskell, Journal of Physiology, vol. iii., p. 367. 136 PHARMACOLOGY AND THERAPEUTICS. over the whole muscular strip each time that a single point is irritated. Large doses, however, appear to have a depressant action on the muscle. Hypothetical Considerations regarding- the Action of Drugs on Muscle. The modifications which drugs produce in the functions of the animal body and of its parts, are so numerous and varied that we are unable fully to explain them on the basis of our present physiological knowledge. The results of pharm- acological experiment furnish us indeed with a number of additional facts regard- in- the functions of organs and tissues which will ultimately lead us to a more correct and thorough knowledge of their physiology. At present, however, we can <»nly explain them hypothetic-ally, and indeed, in many cases we can do little more than guess at the explanation. The advantage to be gained from hypothetical explanations is, that hypotheses nut only lead to further experiment, but serve as guides for experiments, by which, if false, they may be soon disproved, or if true, may be maintained. The disadvantage of hypotheses is, that they are sometimes apt to be taken for tacts, and being made use of as bases for further speculation, may lead more and more astray from the truth. While bearing in mind the danger of speculation, it may be useful to make some guesses at the mode of action of drugs upon the muscle as guides to further research. The most striking point about muscle is the motor function which it exercises l»y contracting, and the nature of its contraction must engage our attention. Throughout the universe we find that motion of nearly all sorts resolves itself into a series of vibrations, and the question arises whether the motion of muscle cannot be explained in the same way. When a muscle is stimulated it contracts and relaxes once, describing a wave-like curve upon the revolving cylinder. Fre- quently this first wave is followed by a second, and sometimes even by a third, which are usually ascribed to the simple elasticity of the muscle. Sometimes we • an notice that the single contraction wave appears really to consist of two or more partially superimposed on each other, and sometimes we may find two dis- tinct waves arise from one stimulation. When a muscle is in a state of tetanic contraction it appears to the eye to be perfectly quiet, yet we know that during this period of apparent rest the muscle is in a state of vibration, alternately tending to contract and elongate. These vibrations may succeed one another with a rapidity such that the muscle appears to the eye to he motionless, while a tracing taken upon the revolving cylinder shows distinct successive waves. If the vibrations are still more rapid, the waves may disappear, and we get the muscle describing a straight line. Bui even when a muscle is entirely relaxed, its parts may be in a state of vibra- tion quite a- continuous as in tetanic contraction. This is seen by examining muscular fibre under the microscope. The phenomenon which then presents itself was described by Porret and is often known by his name. On passing a constant current through a thin muscular slip a contraction is seen when the current is closed. During the whole time of the passage of the current, the muscle to tin- naked eye appears to he perfectly at rest, but under the micro- scope it- part- are seen t<> be in constant motion, presenting an appearance almost exactly similar to the waving of a field of corn on a windy day, or to the motion of rows of cilia, At the Bame time an actual transference of material takes place in the muscle: the end next the positive pole growing smaller, and th.- .-ml next th.- negative pole growing larger. When the current is suddenly i sudden contraction of the whole muscle takes place, and it then returns to apparent rest, but microscopic observation shows the same cilia-like motion a- before, hut in an opposite direction. ACTION OF DRUGS ON MUSCLE. 137 This phenomenon reminds one very strongly of the crowding together of carriages in a railway train when it is set in motion or stopped by the locomotive pushing behind or stopping in front. We know that the apparent steady move- ment of the train is due to the backward and forward vibration of the piston in the cylinders of the locomotive, and the question occurs whether the contraction of the muscle as a whole at the moment of opening and breaking the current, is not due to an interference with the rhythmical vibration of its parts. The question also arises whether these vibrations are not to a great extent dependent upon the molecular weight of its constituents. This seems to a certain extent to be indicated by the curious relations between the effects of the alkalies, alka- Hne earths, and certain metals upon muscle. Thus Cash and I have found that potassium and calcium neutralize each other's action upon muscle, and if the hypothesis just expressed be correct we should expect that metals having a similar molecular weight to a mixture of calcium and potassium would have no action upon muscle. This appears to be the case. In researches made in Professor Schmiedeberg's laboratory, Anderson Stewart found that nickel and cobalt had no action upon muscle, and White found that tin also had little or none. On comparing then the atomic weights of potassium (39) calcium (40) nickel (59) cobalt (59) and tin (118) we get the following relationships : K 2 (78) + Ca(40) = Ni 2 (118,) or, Co 2 (118,) or, Sn(118). Sodium in large doses lengthens the curve and increases the contracture when applied to a normal muscle. It adds to the length of the long curves caused by calcium and strontium. Rubidium in large doses produces a long curve with enormous contracture almost like that of barium. One would naturally have expected that the rubidium and barium would have increased each other's effect like sodium, calcium, or strontium, but the reverse is the case, for the abnormal curve caused by rubidium is reduced to the normal by the application of barium. If barium be applied to a greater extent than is sufficient to antagonize rubidium, it first abolishes the prolonged rubidium curve, reducing it to the normal, and then again elongates it, producing its own characteristic curve. Calcium and strontium, which also prolong the curve, though to a less extent than barium, do not antagonize one another's effect — they rather increase it ; but calcium reduces the barium curve to the normal before causing its own peculiar curve. At first sight these results seem to be independent of any rule, but a curious relation is to be observed between the atomic weights of these substances. Thus we have seen that rubidium in large doses has the same effect as barium in causing a veratrine-like curve, but barium destroys the effect of rubidium before producing its own effect. On comparing the atomic weights of these elements we find that eight atoms of rubidium have nearly the same weight as five of barium, and by subtracting one from the other we »et almost no remainder. Thus r^ Ba 137 X 5=685. Rb 85-4 X 8=683-2. Potassium is, as we know, an important constituent of muscle, and it seems possible that the reduction in the barium curve which calcium causes may be due to their union having resulted in a substance whose molecular weight is a multiple of that of potassium. Thus Ba 137 X 2=274 — Ca 40=234. K 39 X 6= 234. The alterations which occur in voluntary muscle from the action of such substances as calcium or barium appear to approximate it to some extent to 138 PHARMACOLOGY AND THERAPEUTICS. involuntary muscle. Voluntary muscle is chiefly characterized by sudden and rapid contraction and relaxation. Involuntary muscle usually contracts and relaxes slowly. In the slowness of its relaxation, at least, the muscle poisoned by barium or calcium approaches involuntary muscle. The power of summation which contractile tissues possess is strongly sug- gestive of the idea that rhythmical vibrations of gradually increasing intensity going on within the tissue even before any movement becomes visible. A pendulum very gently struck at proper intervals will gradually begin to oscillate through a larger and larger arc. If touched on one side while oscillating, the effect of the touch will depend upon the time at which the touch is applied, for at one period of oscillation it will tend to impede, and at another to assist the oscillation. Possibly some unseen rhythm in the muscle itself may be the cause of the curious variations in excitability observed in dying muscles and in muscles poisoned by lead. Two pendulums connected together will swing har- moniously if their rate of oscillation is the same, but if one be loaded so as to alter its rate of oscillation they will interfere with each other. Possibly the effect of poisons in paralyzing nerves may be due rather to alteration in the relative rhythms of the nerve and muscle than to any specific destructive power on the terminations of the nerve itself. The opposite effects which Gaskell has noticed the vagus nerve and a weak induced current to produce upon the conducting power of the cardiac muscle, sometimes increasing and sometimes diminishing it, may be due to the inter- ference or co-incidence of rhythm such as are discussed more fully further on under the head of Inhibition. It is impossible to say at present what the true cause of the curious rhyth- mical contractions of voluntary muscle is ; and it must be borne in mind that the eonsiderations contained in this section are purely hypothetical, and their only use is to indicate the direction in which we may possibly look for an explanation of the action of medicines on muscle. CHAPTER VI. ACTION OF DRUGS ON NERVES. Action of Drugs on Motor Nerves. In low organisms the contractile protoplasm fulfils the functions of both oerve and muscle, but as we ascend in the scale differentiation be- ro,n ' and more complete. From their original common origin, however, we mighl expect that the poisons which act on the muscles would also art on the motor nerves, and viceversd, and we should hardly expect any poison to act entirely on the one without affecting the other. This i- to a considerable extent the case, for very many substances par- *lyze ttam both. lint, as one would also expect from the differentiation they have under-one muscle and nerve are not equally affected in tin- higher animals. Thus we find that although most of the salts of ACTION OF DRUGS ON NERVES. 139 ammonia, and the iodides, chlorides, and sulphates of the compound ammonias into which methyl and ethyl enter, paralyze both muscle and nerve, yet they paralyze the nerve before the muscle. In some cases the nerve is aifected so much before the muscle that at first sight it might appear that the nerve alone was paralyzed and the muscle left unaffected. More careful observation, however, shows us that most of the compound ammonias, and probably most of the organic alkaloids, affect muscle, motor nerves, and nerve centres, and if their action can be continued long enough, will paralyze all three. The symptoms they produce may, however, be entirely different, because these depend upon the order in which the different parts of the nervous system are affected, as has already been pointed out at page 48. The symptoms produced for example by strychnine and methyl-strychnine are utterly different, the former causing tetanic convulsions and the latter gradually increasing torpor, weakness and paralysis. Strychnine stimulates the spinal cord, and methyl- strychnine paralyzes the motor nerves ; yet if their action continue long enough it is found that both of them will ultimately cause paralysis of both spinal cord and motor nerves. The final result is thus the same in both cases, but the order in which the various parts of the nervous sys- tem are affected is different. The readiness with which a muscle responds to a stimulus depends both on the condition of the muscle itself and on the terminations of motor nerves within it. A faradaic current readily stimulates the nerve endings, but does not act at all readily on the muscle. The making and breaking of a constant current, on the other hand, has comparatively slight action on the nerves, but a powerful action on the muscle. One of the questions which arises most constantly in connection with the action of drugs is : — whether or not they paralyze the ends of the motor nerves in muscle. This question was fully worked out by Bernard and also in- dependently by Kolliker, in relation to curare. The same methods of experiment were adopted by both. They were twofold, and consisted, First, in preventing the poison from reaching the part on which it probably acted : Secondly, in applying the poison to that part alone. The first of these methods was employed by ligaturing the artery of one leg in a frog, so as to prevent the poison from reaching the muscles and motor nerves in that leg (Fig. 34); the second was carried out by the local application of the drug to the muscles and motor nerves them- selves (Figs. 32 and 33). Both methods possess advantages of their own : the advantage of the first being that it affords information regarding the action of the poison upon the other parts of the nervous system, as well as upon the motor nerves. It also gives the order in which the poison affects the various nervous structures, and shows whether the quantity of poison conveyed to the nerves by the circulation is sufficient to paralyze them or not. For some substances, directly applied to the ends of the motor nerves, may paralyze them, although they do not have this effect when injected into the blood. The reason is that the quantity applied to the nerves directly, may be much greater than what reaches them through the circulation. 140 PHARMACOLOGY AND THERAPEUTICS. The effect of drugs in paralyzing motor nerves is chiefly investigated on frogs as the action conies out much more distinctly in them. Warm-blooded animals may die from paralysis of the motor nerves while the nerves still respond readily to faradaic stimuli applied to them, the faradaic stimulus being much greater than what is normally sent along the nerves from the nerve-centres. Thus after an animal has been killed by paralyzing it with curare, its muscles will still respond readily to irri- tation of the motor nerves. A fallacy to be guarded against in experiments on the results of prevent- ing a poison from reaching one part of the body is that caused by diffusion. Even when the circulation is stopped in a frog's leg by ligature of the artery, poison introduced into the dorsal lymph sac may pass down the limb by dif- fusion and affect the parts below the ligature. This may be to a great extent prevented by ligaturing the whole limb en masse, but carefully excluding the sciatic nerve from the ligature. Diffusion may also occur although circulation has been stopped throughout the whole body by removal of the heart and other viscera, and the anterior part of the spinal cord may be affected before the posterior when the poison is injected into the dorsal lymph sac. The advantage of the second method, viz., that of local application, is that it allows us to deal with only one organ at a time, and the results are therefore less complicated than those of the first method. In some respects it is better to begin with the second method and work back from the simpler to the more complex organs. Paralysis of Motor ^erve Endings. — Curare produces symptoms of paralysis. Paralysis may be due to the action of the drug on the muscles themselves, on the motor nerves which set them in action, or to the nerve centres which originate motor impulses. In order to decide this, Bernard applied electricity to the nerves and to the muscles of a frog poisoned by curare administered subcutaneously. He thus I i'.. ;2.— Shows the method of applying a drug in solution locally to the trunk of a nerve. found thai when the nerve was irritated no effect was produced on the jcles; but thai when the muscle itself was stimulated, it contracted I i... 58. Shows the method of applying a drug in solution locally to a muscle and theendsof motox oervea within it. lily. In order to decide whether this loss of irritability in the nerve was due to B change in the nerve trunk, or in the terminations within the muscle, Bernard employed the method of local application. He ACTION OF DRUGS ON NERVES. 141 placed a solution of curare in two watch-glasses ; in one he immersed the trunk of the nerve, Fig. 32, and in the other the muscle, so that the solution penetrating between the fibres could reach the nerve endings, Fig. 33. He then irritated the nerve attached to both muscles, and found that irritation caused contraction readily enough in the case where the nerve trunk had been steeped in the solution of curare, but had no effect when the curare had been allowed to reach the nerve ends by immersion of the muscle in the solution. The irritability of the muscle itself to mechanical stimuli or to the making and breaking of a constant current directly applied to it remained quite unaltered, so that the muscular fibre had evidently not been affected by the action of the'poison. The other mode of testing the action of drugs upon motor nerves is to allow the drug to be carried to the muscles and nerve endings by the circulating blood in one leg of a frog, while it is prevented from reaching the other either by ligaturing (Fig. 34) the blood-vessels alone, or liga- turing the whole leg with the exception of the sciatic nerve. After some time has elapsed, the sciatic nerve is stimulated on each side. If the muscles of the poisoned limb do not contract at all or do so more feebly Fig. 34.— Diagram of the mode of experimenting on motor and sensory nerves in the frog. — The shaded part shows where the poison has been carried by the circulation. The unshaded left leg shows where the tissues have been protected from the poison by ligature of the artery just above the knee . The unbroken lines with arrows pointing to tbe spinal cord indicate the sensory nerves. Tbe broken line with arrows pointing outwards indicates the motor nerve to the unpoisoned leg. than in the unpoisoned limb, it is evident that the poison has paralyzed either them or the motor nerves. In order to decide whether the nerves or the muscles are paralyzed the muscle is next stimulated directly ; if it then contracts normally it is evident that the paralysis observed when the nerve was irritated is due to the action of the drug on the nerve 142 PHARMACOLOGY AND THERAPEUTICS. endings. If the muscle is completely paralyzed no definite conclusion can be drawn regarding the nerve endings, but if the muscle shows only par- tial paralysis, and the paralysis is greater when the nerve is stimulated than when the muscle is stimulated directly, we conclude that the drug has acted upon both the muscular substance itself and the motor nerve- endings within it. It is not so easy to prove positively that a drug has increased as that it has diminished the excitability of motor nerves. The fact that the nerves of the poisoned leg are found to be more excitable than those of the ligatured one in such experiments as those just described, does not prove it, for it must be borne in mind that the arrest of the circulation in the ligatured leg lessens the excitability of the muscles and the nerves in it. This effect of the ligature strengthens the proof that a drug has 1 .induced paralysis when we find that in spite of the freer circulation the poisoned leg is less irritable than the ligatured one, but it prevents our concluding that the drug has increased excitability when we find that the poisoned leg responds more readily to stimuli than the ligatured one. To try whether a drug increases excitability we treat two muscles with saline solution, and after ascertaining that their excitability is alike we add the drug to be tested to the saline solution in which one muscle is steeped, and after some time test the excitability again. If the muscle in the poisoned saline solution becomes more excitable than the other, we conclude that the increase is due to the action of the drug. In order to test the effect of drugs on nerve centres we use the method of ligature. The muscles and ends of the motor nerves being thus protected in the ligatured leg from the action of the poison while it still remains in connec- tion with the nerve centres by means of the sciatic nerve, it serves as an in- dex to sh< )\v what is going on in the nerve centres. Thus in a frog poisoned by curare it is found that the ligatured leg moves on irritation of the sen- sory nerves, while all the poisoned parts remain perfectly still. This shows that the afferent nerves are still capable of conveying impressions to the spinal cord, and the cord itself of reflex action, although the poisoned limbs give no indication of the changes which are occurring in the nerve centres. By and by irritation of a sensory nerve or root ceases to produce any movement even in the ligatured limb. This effect is shown to be due to paralysis of the nerve centres by observing the effect of irritation of the nerves in the ligatured limb, for the muscles still respond readily to irri- tation of the nerve by a moderate stimulus. We may conclude with tolerable certainty that the motions have ceased in the limbs because the nerve centres have become paralyzed. Many other drugs have an action somewhat similar to that of curare upon the motor nerves : — Ammonium cyanide. 1 iodide. Ethyl ammonium chloride. 1 Ainvl ammonium chloride." iodide. 1 Di-methyl ammonium chloride. 1 " " iodide. 1 " k ' sulphate. 1 Di-ethyl k ' chloride. 1 " * " iodide. 1 : BraxitOD and Cash, Roy. Soc. Proc. ACTION OF DRUGS ON NERVES. 143 Amyl ammonium sulphate. 1 Di-ethyl ammonium sulphate, Tri-methyl " iodide. 2 Curarine. 6 Tri-ethyl " chloride. Curare. 7 " " " iodide. Ditaine. 8 " " sulphate. Methyl-delphinine. 3 Tetra-m ethyl " iodide. Echium. 3 Tetra-ethyl " " Erythrina coralledendron. 9 Anchusa. 3 Guachamacha 10 Methyl aniline. 4 Lobeline. Ethyl " 4 Methyl morphine. 2 Amyl " 4 Methyl nicotine. 2 Methyl atropine. 2 Ethyl " 3 Methyl brucine. 2 Ptomaines. 11 Ethyl " 3 Methyl quinine. 3 Camphor. " quinidine. 3 Methyl cinchonine. 3 " piperidine. Amyl " 3 Saponine. Chloroxethylene. Sparteine. Methyl codeine. 2 Methyl strychnine. 2 12 Collidine. Ethyl strychnine. 2 Conine. Methyl thebaine. 2 Di-methyl conine. 2 Methyl veratrine. 3 Cotarnine. 3 Amyl " 3 Cynaglossine. 5 Although the substances mentioned in the above list have all the power of paralyzing motor nerves, they do not possess the same power as curara. In the case of the salts of ammonium and the compound ammonias, the curara-like action is accompanied by a paralyzing effect upon the muscular substance and on the nerve centres. When salts of these substances are employed, their effect is somewhat modified by their acid radical, although this is not the case to the same extent in the salts of the compound ammonias and in the salts of ammonia itself. Thus, the iodide of ammonium has a much stronger paralyzing action on the nerves than bromide, chloride, sulphate, or phosphate, and this is observed also, though to a less extent, in the salts of the compound ammonias. Irritation of Motor Nerve- endings by Drugs. — The peri- pheral terminations of motor nerves in muscle appear to be irritated by 1 Brunton and Cash, Boy. Son. Proc. 9 Crum-Brown and Fraser, Trans, of Boy. Soc. of Edinburgh. 3 Buchheim and Loos, Eekhard's Beitrdge, Bd. v. 4 Jolyet and Cahours, Compt. Bend., lxvi., p. 1181. 5 Diedulin, Med. Centralbt., 1868, p. 211. 6 Preyer, Gottingen Ztschr. f. Chemie, 1, p. 381. 7 Bernard and Kolliker. 8 Harnack, Arch. f. Exp. Path. u. Pharm., vii., p. 126. 9 Harnack, Buchheim's Pharmacologic, 3d edition, p. 615. 10 Sachs, Archiv, f. Physiol, 1877, p. 91 ; Schiffer, Deutsch. Med. Wochenschr., 1882, No. 28. 11 Several authors quoted by Guareschi and Mosso, Les Ptomaines, 1883. 12 Schroff, Wochenblait d. Ztschr d. Aerzte zu Wien., No. 14, 1866. 144 PHARMACOLOGY AND THERAPEUTICS. certain poisons, so that the excised muscle exhibits fibrillary twitchings. This micht be due to irritation of the muscular structure itself, but as they are gradually abolished by curare they are supposed to depend upon irritation of the terminations of motor nerves. The poisons which produce this effect are : aconitine, camphor, guanadine, nicotine, pilo- carpine, pyridine. Physostigmine produces it most markedly in warm- blooded animals, but does not seem to cause it in frogs. Action of Drugs on tlie Trunks of Motor Serves. — Nerve trunks are as a rule very much less affected by poison than the end plates ; but they may, nevertheless, be also acted upon by strong solu- tions of poison. It appears necessary to apply the poison locally to them, and they are probably little if at all affected by poisons introduced into the system generally. The action of poisons is tested by placing a small piece of gutta-percha tissue under the nerve trunk, usually the sciatic of the frog, and applying the poison directly to it, or dipping the nerve into a weak solution of common salt, or of sodium phosphate, to which the poison has been added, and comparing the poisoned nerve with one dipped into a similar saline solution without the poison. There are two methods of comparison. The first consists in using the contraction of the corresponding muscle as an index of the func- tional power of the nerve. The second, in ascertaining the effect of the poison on the normal electrical current in the nerve. The motor fibres of a nerve appear to have their excitability abol- ished more readily than that of sensory nerves by changes in the body generally, and sometimes also by the local application of drugs to them. Thus in wounded nerves the motor function may be destroyed, while the sensory function is little altered, and where both sensibility and motion have been destroyed by a bruise of the nerve trunk, the sensibility may reappear, while the motor power does not. In rheumatic neuralgia there is do1 unfrcipiently motor paralysis with exaggerated sensibility. When lution of physostigma is applied locally to the nerve trunk for a while, and the nerve is then irritated beyond the point of application, it is found that it will produce reflex movements of the body after it has ceased to do so in the limb supplied by the nerve, which shows that the sensory fibres can still conduct impressions, though the motor fibres can- not. Longer application of the poison will destroy the sensory fibres also. When a paste of theine is applied to the sciatic nerve, or the nerve is -lipped in a solution of opium, similar results are observed. By dipping nerves in a solution of poison Mommsen finds that atropine diminishes the irritability of the nerves, affecting first the intra- muscnlar endings, and afterwards the trunks. Alcohol, ether, and chloroform, first increase and then diminish the irritability. Action of Drugs on Sensory Nerves. The general action of a drug on sensory nerves is much more difficult to ascertain with precision than its effect upon motor nerves, because the evidences of sensation we have in the lower animals are cries, and movements either of the limbs or involuntary muscles, such u the iris, arteries or bladder, which ensue on irritation of sensory ner . ACTION OF DRUGS ON NERVES. 145 In the production of these movements or cries, many structures are concerned, viz., sensory nerves, nerve centres, spinal or cerebral motor nerves, and muscles. It is comparatively easy to ascertain the local action of the drug upon sensory nerves, for in this case these other structures are not affected. By applying the substance to one part of the body, either by painting it upon, or injecting it under, the skin, and then comparing the effect of stimulation produced by pinching or by the application of heat or electricity upon that and other parts of the surface, we can see whether or not the sensibility of the sensory nerves has been affected by the drug. But when the drug is absorbed into the circulation, it may affect all the other structures already mentioned, as well as the sensory nerves, and thus it may be impossible to decide with certainty whether these nerves are affected or not. But even here definite results are sometimes obtainable, as in the case of curare. The method of experimenting is to ligature the sciatic artery of a frog and arrest the circulation in one leg. The animal is then poisoned with curare, or any drug the action of which is to be ascertained. The poison is carried by the circulation to all other parts of the body excepting the ligatured leg. In the case of curare the motor nerves are paralyzed by the drug, and it would be impossible to ascertain whether irritation of the sensory nerve produced any effect at all, were it not that the ligatured limb, retaining its irritability, serves as an index to the condition of the nerve centres. At first it is found that pinching the poisoned foot will cause movements in the non-poisoned leg. This shows that the sensory nerves retain their irritability and transmit the stimulation up to the spinal cord, whence it is reflected down the motor nerves to the non-poisoned foot. As the poisoning becomes deeper, however, pinching the poisoned leg produces much less effect. This might be due to paralysis of the spinal cord, but it is shown that this is not the case by pinching the ligatured leg just above and below the ligature. It is found that a pinch just below the ligature causes marked reac- tion, while a pinch just above has little or no effect. In this experiment all the structures concerned in the movement have been alike subjected to the action of curare with the exception of the ends of the sensory nerves below the ligature. It is thus evi- dent that the diminished reaction from pinching above the ligature is due to paralysis of the ends of the sensory nerve, in the part of the body to which the poison has had access, and which is shaded dark in the engraving (Fig. 34). In the experiment just mentioned, the first of the two methods already described in the reference to motor nerves is employed, and the action of the drug on the ends of the sensory nerves is ascertained by preventing the poison from reaching them ; but the second method may also be em- ployed and the action ascertained by applying the poison to the ends of the sensory nerves, while the nerve-trunks and nerve-centres are protect- ed from its action. Thus, in the experiments of Liegeois and Hottot upon the action of aconitine on the sensory nerves, they ligatured the 10 146 PHARMACOLOGY AXD THERAPEUTICS. vein and injected the poison into the artery of a frog's leg; the poison was thus carried to the ends of the sensory nerves in the skin, while it was prevented from reaching the nerve centres. In this way they found that irritation of the poisoned skin ceased to produce any reflex action, while stimulation of the trunk of the nerve distributed to that leg still caused well-marked reflex action. Normally the terminations of a sensory nerve in the skin are much more sensitive than the trunk of the nerve; and this experiment therefore proves that aconitine paralyzes the ends of the sensory nerves. The local action of drugs on the sensory nerves in man is ascer- tained by producing, when applied locally, either diminution in pain which may be present at the time, or insensibility, which is usually ascer- tained by the ivsthesiometer. This is simply a pair of compasses with blunt points and a scale by which the distance of the points from one another can be read off. When the sensation is acute, the points are distinctly felt as two, even when they are but slightly separated from one another ; but when the sensation is blunt, they are felt as one, when they are at a considerable distance apart. In frogs it is ascertained by dipping one leg for some time in the so- lution to be tested, and then comparing the effect of irritating correspond- ing points in the two feet or legs by pinching, or the application of acids, or a faradaic current. Where the drug is very powerful, and a sufficient quantity, its action on the nerve centres might complicate the result; if a sufficient quantity should be absorbed into the blood, the circulation may be entirely arrested by excision or ligature of the heart. In this way it has been ascertained that hydrocyanic acid has a powerful local action in paralyzing sensory nerves. Local Sedatives and Local Anaesthetics. — Local sedatives are substances which diminish, and local anaesthetics are substances which destroy, the sensibility of the skin for the time being. Local Sedatives. Local Anaesthetics. Aconite. Extreme cold. Atropine. Ice. Belladonna. Ether spray. Carbolic acid. Erythroxylon. Chloroform. Cocaine. Chloral. Carbolic acid. Morphine. < tpinm. Veratrine. Action. — Their effect in some degree is due to a paralyzing action upon th<- terminal branches of the cutaneous nerves. It is probably, to Borne extent, also due to an effed upon the vessels and tissues analogous to that which is produced by rubbing or scratching, which, as every one Jhk>! temporary relief to itching. Sweating also relieves the itch- ing, which ia sometimes felt just before it begins. [ Be8( — i, 1M . ;i ] aedativea arc employed to relieve itching and to lessen pain, whether it be due to neuralgia or inflammation. Local anesthetics ACTION OF DRUGS ON THE SPINAL CORD. 147 are employed temporarily to abolish the sensibility of the skin, and allow slight incisions or operations to be made painlessly. Stimulating- Action of Drugs on the Peripheral Ends of Sensory Serves. — The peripheral terminations of sensory nerves ap- pear to become more sensitive when the supply of blood to the part is increased. This is markedly seen, not only in inflammation, where the part becomes exceedingly tender, but in cases where turgescence of the vessels occurs under physiological conditions. Besides the class of irri- tants which act on the peripheral terminations of sensory nerves so as to cause pain when locally applied, there are several drugs which appear to have a special irritant action on the ends of sensory nerves when intro- duced into the circulation : these are aconite and aconitine, which give rise to a peculiar tingling and numbness in the tongue, lips, cheeks, and indeed in all parts supplied by the fifth nerve. Yeratrine also causes peculiar sensations in the sensory nerves when taken internally, but these are felt more in the fingers and toes, and in the joints, than in the tongue. 1 CHAPTER VII. ACTION OF DRUGS ON THE SPINAL CORD. In the spinal cord we have to distinguish three functions: that of conduction, that of reflex action, and that of origination of nerve force, as in the sweat centres, &c, contained in it. The spinal cord transmits sensory or afferent impulses upwards to the medulla and brain; and motor impulses downwards to the muscles as well as other efferent impulses to the glands. It transmits reflex impulses across, either from behind forwards, or laterally from one-half of the cord to the other. Transmission from behind forwards occurs when the impulse passes from the sensory to the motor columns on the same side, as in the case of reaction of a sensory stimulus on the same side of the body. It occurs laterally when the sensory stimulus produces motion, not on the same side, but on the opposite side of the body. Action on the Conducting Power of the Cord. — Its con- ducting power for motor impulses is assumed to be impaired when it is noticed that any drug causes partial paralysis of the hinder extremi- ties of an animal before the anterior extremities. It is usually tested by irritating the spinal cord at its upper end, either mechanically with the point of a needle, or by a galvanic or faradaic current passed through electrodes inserted into it close together, and observing whether irritation of the cord itself in this way causes contraction in the muscles of the legs. 1 Von Schroff, Pharmacologic, 4th Ed., p. 584. 148 PHARMACOLOGY AXD THERAPEUTICS. When no contraction is produced by irritation of the cord itself, while direct irritation of the motor nerves can still produce vigorous contrac- tion, it is evident that the cause of the paralysis must be that the spinal cord has lost its power to conduct motor impulses. These experiments may be made in a frog, the cerebrum of which has been previously destroyed ; and they may be confirmed in warm-blooded animals where sensibility has been destroyed by a section of the cord, just below the medulla, and respiration is kept up artificially. The spinal cord is then exposed, and the anterior columns are irritated in the ways already mentioned. The power of the cord to conduct sensory impressions is ascer- tained by exposing it under anaesthetics and allowing their influence to pass so far off that the animal is capable of giving evidence of sensa- tion. The posterior roots are then irritated before and after the injec- tion of the poison into the circulation. When it is found that after the poison is injected, the irritation of the posterior roots which previously caused evidence of sensation, no longer produces any effect, while irritation of the anterior columns still produces motion : the conclusion appears to be just, that the poison has paralyzed the conducting power of the sensory columns of the cord. This action appears to be possessed by caffeine, for Bennett found that while irritation of the posterior roots of the cord caused violent struggles and loud cries in a rabbit before the injection of caffeine into the circulation, similar irritation, after the injection, caused only a slight quiver. That this effect was not due to motor paralysis was shown by the fact that irritation of the anterior columns caused violent muscular contractions after the injection as well as before it. 1 The action of drugs on the power of the spinal cord to conduct reflex stimuli both transversely and longitudinally has been carefully investigated by Wundt. He first ascertains the time which elapses between the application of a stimulus to a motor nerve and the contrac- tion of a muscle, the nerve used being the sciatic, and the muscle the ocnemius of a frog. This time, which includes that requisite for the stimulus to travel down the motor nerve and to set the muscle in action, lie terms the direct latency. He next stimulates a sensory root of the Bpinal cord at the same level and on the same side as the motor nerve, taking care that the stimulus does not act on the motor nerve directly but only reflexly through the cord. The time between the application of the stimulus and the commencement of contraction he terms the total latency. By deducting the direct latency from the total latency he ascertains the time required for the stimulus to pass through the grey matter of the cord from the posterior to the anterior horn of the same side. This he calls the reflex time. Th<- time required for transverse conduction is ascertained by applying the stimulus to a posterior root on the other side and compar- ing the latency with that of stimulation to a posterior root on the same Bughee-Bennett, Edin. Med. Journ., Oct.. 1-7:;. ACTION OF DRUGS ON THE SPINAL CORD. 149 The time required for longitudinal conduction is ascertained by applying a stimulus to the brachial nerve, so that it has to travel down the greater part of the length of the spinal cord before it can excite the sciatic nerve. By comparing the latent period of excitation in the brachial nerve with that of the sciatic on the same side 1 the length of time required for longitudinal transmission of stimuli in the cord is ascer- tained. The mode of ascertaining the time of ordinary reflex and trans- verse transmission in the cord is shown diagrammatically in Fig. 35. 1STER10R ROOT o RVE, fS^yk SECTION OF ) r\ M SPINAL {SJAJJ CORD . MUSCLE f=^ ' — OLEI/ER CYLINDER Fig. 35 —Diagram to show the method of investigating reflex and transverse conduction in the spinal cord. The motor nerve is first irritated at 1. As the cylinder revolves at a known rate ; and a mark is made upon it by an electro-magnet at the instant the nerve is irritated, the distance between this mark and the commencement of the muscle curve indicates the time required for the irritation to travel down the motor nerve to the muscle and set it in action. The irritation is next applied to the posterior root on the same side (2). The distance between the commence- ment of contraction in this case and in that where the motor nerve was irritated gives the time required for simple reflex transmission of the stimulus from the posterior to the anterior horn of the cord. The stimulus is then applied to the posterior root on the opposite side at 3, and the distance between tbe commencement of the consequent contraction and that of the curve obtained by irritating at 2 gives the time required for transmission across the cord. The differences in the latent period and in the form of the muscle curve obtained by irritation of the motor nerve, and by simple trans- verse, and longitudinal reflex stimulation, are shown diagrammatically Fig. 36.— Diagram to show the difference between the length of the latent period and form of the curve in contraction induced, b, by direct irritation of the motor nerve; c, by simple reflex from irritation of the cord on the same side ; and d, by cross reflex from irritation of the cord on the opposite side to that from which the motor nerve proceeds, as shown in Fig. 35. e shows com- bined transverse and longitudinal reflex ; a indicates the moment at which the stimulus^was applied in each case.;; in Fig. 36. Wundt found that when a motor nerve was irritated at the point distant from the muscle the resulting contraction had not only a 1 For convenience' sake both the sciatic and the brachial nerves are taken in this experiment on the opposite side from the muscle, so that the time of longitudinal conduction is ascertained by deducting the transverse from the combined transverse and longitudinal conduction. 150 PHARMACOLOGY AXD THERAPEUTICS. longer latent period but was less in height and longer in duration than when the nerve was irritated close to the muscle. From a comparison of the curves it will be seen that a small portion of grey matter has a similar effect upon the stimulus which passes through it that a great length of nerve fibre would have. In all reflex actions, therefore, in the normal animal, the contraction of the muscle has a longer latent period, less height, and longer duration than that produced by direct irritation of the motor nerve. The increase in the latent period, diminution in height, and longer duration are greater in the case of transverse than of simple reflex, and greater still in the case of combined transverse and longitudinal reflex. In the normal frog a stronger stimulus is necessary to produce reflex contraction than would be sufficient if it were applied directly to the motor nerve, and strong and weak stimuli will produce strong and weak muscular contractions. The spinal cord has a power of summation similar to that already referred to in the case of contractile tissue of medusa}, so that a stimulus which would be powerless to produce a reflex contraction if applied once to a posterior root or to a sensory nerve will be effectual if repeated several times in close succession. Strychnine has an effect on the conducting power of the spinal cord which we should hardly expect, and so have other convulsant poisons. It increases the excitability so much that slighter stimuli than before will produce reflex action, and it destroys to a considerable extent the power of summation, so that instead of each stimulus producing a contraction in proportion to its strength, all have the same effect — a weak one which is just strong enough to produce an effect at all causing as great a contraction as the most powerful. The time required for the transmission of stimuli through the cord is enormously increased, so that the latent period of ordinary reflex, and still more of transverse and longitudinal reflexes, is greatly increased, sometimes, indeed, to as much as ten times the normal. The retardation of transverse conduction is not absolutely greater than of longitudinal conduction, but, as the distance through which the stim- ulus has to pass in the former case is much greater than in the latter, it follows that strychnia increases the resistance more transversely than longitudinally. Morphine in small doses has no very marked action upon the cord, but larger doses have an action almost exactly like that of strychnine, causing increased reflex irritability, tetanic contractions, and prolonged latency. Veratrine has a similar action. Nicotine and con'ine in Bmall doses have a similar action to strychnine, but this is quickly masked by the rapid appearance of paralysis. When large doses are used, paralysis occurs almost immediately, and is usually accom- panied by fibrillary twitohings. Atropine has at first an action similar to strychnine in causing increased excitability, prolonged latency, and tetanic contraction. It differs from strychnine in causing more rapid diminution in the irritability of the grey substance of the spinal cord and in diminishing the conducting power of peripheral nerves. In con- sequence of this, irritation of the sciatic nerve in a frog poisoned by atropine causes two contractions, one direct and one reflex, separated from each ether by a distinct interval, whereas, in a frog poisoned by Imme. these two contractions begin almost at the same moment and appear Buperimposed upon each other. ACTION OF DRUGS ON THE SPINAL CORD. 151 Ordinary impressions of touch, temperature, and muscular action are transmitted through the posterior roots of the spinal cord to the ganglia of the posterior horn of the grey substance, and thence upwards by the fibres of the lateral columns. Painful sensations, however, appear to be transmitted upwards through the grey substance of the cord. The af- ferent nerves, which transmit impressions from one part of the cord to another so as to produce co-ordinated reflex movement, are contained in the posterior columns of the cord. It is evident that any injury or poison which chiefly affects the grey matter so as to diminish its conducting power may abolish pain while reflex action still persists. This condition may be produced by division of the grey matter of the cord, and it occurs also at a certain stage of the action of anaesthetics, such as chloroform and ether. Fig. 37.— Diagram to show the effect of chloroform, chloral, and other anaesthetics on conduction of painful impressions in the spinal cord. Action of Drugs on the Reflex Action of the Cord. — The action of drugs upon the reflex action of the spinal cord is usually estimated by the time which elapses between the application of a stimulus and the occurrence of reflex action, before and after the administration of a drug. Longer time indicates diminished, and shorter time increased, excitability of the cord. Method of Experimenting-. — The method usually employed is called Tiirck's method. The cerebral lobes in a frog are destroyed, and after some time has elapsed so as to allow it to recover from the shock, it is suspended either by the head or fore-legs, so that the hind-legs hang down. A very dilute solu- tion of sulphuric acid, the acid taste of which can be little more than perceived by the tongue, is put in a small beaker and raised until one foot of the frog is completely immersed in it. The time is then counted by means of a metronome, between the immersion of the foot in the acid solution, and the time when the leg is drawn up out of it. As soon as the foot is drawn up, the acid is carefully washed off with some fresh water in order to prevent any injury to the skin, and after a minute or two, the experiment may be repeated. When the time seems constant the drug is injected into the lymph sac, and the experiment is repeated again. The greater or less time which is required for the withdrawal of the foot from the acid after the injection of the poison, as compared with the time required before, shows the extent to which the reflex action of the spinal cord has been diminished or increased by the poison. Direct, Indirect, and Inhibitory Paralysis of the Spinal Cord by Drugs. — When it is found that the reflex action of the cord is greatly diminished or apparently entirely abolished, it must not be at 152 PHARMACOLOGY AND THERAPEUTICS. once concluded that this is necessarily due to the direct paralyzing action of the drug itself upon the nervous substance of the cord. This may be the case, and is so when methyl-conine is employed, but it may be clue to the indirect action of the drug upon the heart, weakening the circulation, and lessening the function of the cord by interfering with its blood supply. In order to ascertain whether this is the case or not, it is usual to take two frogs as nearly alike as possible, to destroy the brain in each, and after waiting until they have recovered from the immediate shock of the operation, to inject into one the drug to be tested, and, at the moment when it stops the beating of the heart, to tie a ligature around the heart of the other. The persistence of reflex action is then tested in the usual manner, and if it is found that it disappears much sooner in the poisoned frog than in the other one where the heart has been ligatured, it is concluded the drug has paralyzed the substance of the cord itself Indirect Paralysis. — The spinal cord is very rapidly paralyzed in mammals if the blood supply to it is stopped. This is readily shown by Stenson's experiment of gently compressing the abdominal aorta in a rabbit with the thumb or finger, so as to arrest the circulation for four or five minutes. On releasing the animal its hinder extremities are found to be paralyzed, and this paralysis, though it may be partly due to inter- ference with the blood supply of the muscles and nerves of the lower ex- tremities themselves, is chiefly due to the arrest of circulation in the spinal cord. The spinal cord in frogs is less rapidly affected, but if the circulation be arrested for half an hour or so symptoms of paralysis usually begin to appear, the time varying, however, with the temperature and other conditions. Indirect paralysis is produced by aconitine, di- gitalin, and large doses of quinine, which arrest the circulation. It is frequently difficult to decide how far paralysis is due to the action of a drug on the circulation and how far to its direct action on the spinal cord itself. Direct Paralysis. — Paralysis of reflex movement is produced by a number of substances, some of which produce little or no previous ex- citement ; others, however, markedly increase the excitability of the spinal cord first, and are thus classed as spinal stimulants. Spinal Depressants. — The following drugs belong to this class: — DepreM without marked previous Excite first and afterwards paralyze. excitement. Antimony. Ammonia. Emetine. Apomorphine. Ergot. Alcohol. Bydrocyanic acid. Arsenic. Methylconine. Camphor. Saponine. Morphine. Physostigmine. Carbolic acid. Turpentine. Chloral. Zinc. Nicotine. Silver. Potassium. Sodium. Veratrine. Lithium. Mercury. uin. ACTION OF DRUGS ON THE SPINAL CORD. 153 Uses of Spinal Depressants. — Such substances as morphine, chloral, &c, which diminish the conducting power of the grey matter of the cord for painful impressions, are useful as anodynes, though their action in lessening pain is probably often due to their effect on the brain as well as on the spinal cord. Spinal depressants which lessen reflex action are employed in diseases where there seems to be increased exci- tability of various parts of the cord, as evidenced by spasm either tonic or clonic. They are therefore employed in tetanus, trismus neonatorum, chorea, writer's cramp, and paralysis agitans. The pathology of many nervous diseases is imperfectly known, and as the action of spinal depress- ants is frequently a complex one of combined stimulation and depression, some of the drugs included in this class are used in paraplegia due to myelitis, locomotor ataxy, and general paralysis. They are also used as antagonists in cases of poisoning by spinal stimulants like strychnine. Inhibitory Paralysis. — The higher parts of the nervous system have the power of lessening the action of the lower, and in the frog this power seems to be especially marked in the optic lobes. Irritation of these either mechanically by a needle, chemically by a grain of salt laid upon them, or electrically, will lessen or entirely abolish the reflex ac- tion in the cord, but this again returns when the irritation is removed, or when its influence is destroyed by cutting the cord across, below the point of irritation. This fact was discovered by Setschenow, and thus parts of the optic lobes concerned in this inhibitory action are known as Setschenow's centres. An inhibitory action appears to be exerted by the cranial centres in higher animals also, for McKendrick observed that on decapitating a pigeon the body lies comparatively still for a second or two, and then violent convulsions set in. If the body be held firmly during these con- vulsions, and a moderately strong faradaic current be applied to the upper part of the spinal cord, the convulsions may be altogether arrested while it continues, again commencing when it stops. In this experiment the application of the current to the cut end of the cord is regarded as supply- ing a stimulus in place of that which would normally pass downwards from the brain. Quinine causes great depression of reflex excitability, and this was stated by Chaperon to be due to the action of the drug on Setschenow's centres. Fig. 38.— Nervous system of a frog, showing the cerebral and optic lobes, the medulla oblongata, and the spinal cord with nerve-roots. The brain is shown on a larger scale at p. 170. Almost immediately after injection of quinine into the dorsal lymph sac, the reflex excitability of the frog becomes very greatly reduced or 154 PHARMACOLOGY AND THERAPEUTICS. almost entirely abolished, but if the spinal cord be now cut across at its upper part, just below the medulla oblongata, the reflex excitability be- comes as great, or even greater, than the normal. This loss of excitability has been ascribed by Binz to the action of quinine on the heart, causing weakening of the circulation, and thus in- directly producing paralysis of the cord. This kind of paralysis does occur with large doses and after considerable time, but it is quite differ- ent from the inhibitory paralysis described by Chaperon, which comes on almost immediately after the injection of the drug into the lymph sac, and disappears immediately on section of the cord below the medulla. I have repeated Chaperon's experiments, and can fully confirm their accuracy. In doing so, however, it struck me that the result was most marked when a solution of quinine was concentrated and somewhat strongly acid. It therefore appeared probable that the inhibition was not due to the direct action of the quinine upon Setschenow's centres after it had been carried to them by the blood, but only to its reflex action upon them. It irritates locally the sensory nerves of the lymph sac into which it is injected, and this stimulus being transmitted to the optic lobes excites them so that they produce inhibition of that reflex action which would usually occur in the cord when the foot is irritated by acid. On testing this hypothesis by injecting acid alone into the lymph sac, Mr. Pardington and I found that it also caused reflex inhibition like that pro- duced by quinine. "We may therefore conclude that there is nothing special in the action of quinine upon the inhibitory centres ; it merely acts like other irritants on sensory nerves. 1 Probably digitalis and sanguinaria also act in a similar way. NATURE OF INHIBITION. Inhibition and the action of drugs on inhibitory centres play a very important part indeed in pharmacology, and on the present hypothesis they are very puzzling. By inhibition we mean the power of restraining action which some part- of the nervous centres possess. At present it is usually supposed that certain parts of the nerve centres, instead of having a sensory or. motor function, have an inhibitory one peculiar to themselves. As it is found, however, that inhibitory powers are not confined to Setschenow's centres, already mentioned, page 153, but that almost any part of the nervous Bystem may have an inhibitory action on other parts, it becomes almost necessary to abandon the old hypothesis. It is found, for example, thai not only is reflex action more active in the frog when the optic lobes are removed, but that when the spinal cord is taken away in successive slices from above downwards, the reflex action in the part below goes on increasing. On the old hypothesis we are almost obliged to assume that each nerve cell has two others connected with it, one of which has the function of increasing or stimulating, and the other of inhibiting its action. bfosl of the phenomena which we find can be explained in a much simpler way by supposing that nervous stimuli consist of vibra- tion in the nerve fibres or nerve cells, just as sound consists of vibrations. St. Bartholomew's Bxpttal Reports, 1876, p. 155. ACTION OF DRUGS ON THE SPINAL CORD. 155 Interference. — In the case of both sound and light we find that if two waves should fall upon one another so that their crests . coincide, the intensity of the sound or light is increased (Fig. 39), while if they fall Fig. 39. — Diagram to show increased intensity of vibration by coincidence of waves. Fig. 40.- -Diagram to show abolition of vibration by interference of waves. on each other so that the crest of one wave fills up the trough of the other, they interfere so as to destroy each other's effect (Fig. 40) ; and thus two sounds produce silence, or two waves of light, darkness. This is shown in the case of sound by a tube (Fig. 41), which divides into © — v- p- Fig. 41. — Diagram of apparatus for demonstrating the interference of waves of sound, a and b, branches of a tube ; c, sliding piece by which the branch b can be lengthened or shortened at will; d, tuning-fork ; e, the ear. two branches, and these again re-unite. The length of one branch may be altered at will so that the sound travelling through one branch has further to go than the other. It may thus be retarded so far as to throw it half a wave-length behind the other, and silence is produced. If Fig. 42. — Diagram showing the beats or alternate increase and diminution of the wave-heights by the interaction of two systems of waves of different wave-lengths. At a two systems, having a rela- tion to each other of 3 to 1, are indicated separately by dotted and complete lines. At b the result- ant of the interaction of the two systems is shown. With such a relation as that shown in the diagram, and with those of a vibrating rod generally, such as n, 3n, 5n, &c, the interference of the systems is not complete, and silence cannot be produced by the interference of sounds. (From Ganot's Physics.) lengthened still further, so as to throw the one sound a whole wave- length behind the other, the crests again coincide, and the sound is again 156 PHARMACOLOGY AND THERAPEUTICS. heard. Increasing the length still further, so that the one sound is thrown a wave-length and a half behind the other, they again interfere, and silence is again a second time produced. This may be repeated ad infinitum, silence occurring whenever the one sound falls behind the other, by an odd number of half wave-lengths. In the case just mentioned, the waves are of the same length, but if they are of different lengths, instead of constantly reinforcing and inter- fering with others, they may sometimes strengthen and sometimes weaken each other. The result is more or less rhythmical increase and diminu- tion of action, or, as it is termed, "beats." This is shown in the accom- panying diagram (Fig. 42). Instances of rhythm occur in the body, which strongly remind us of this condition, for example, the different rhythms of the heart under various conditions. Interference in Xervous Structures. — Supposing nervous stimuli to consist of vibrations like those of light or sound, the action which any nerve cell would have upon the others connected with it would be stimulant or inhibitory according to its position in relation to them. If its relation be such that a stimulus passing from it to another cell will there meet with a stimulus from another quarter in such a way that the waves of which they consist coincide, the nervous action will be doubled : but if they interfere, the nervous action will be abolished. If they meet so as neither completely to coincide nor to interfere, the nervous action will be somewhat increased, or somewhat diminished, according to the degree of coincidence or interference between the crests of the waves. Thus if the relations of the nerve cells s, s r and M, u ; in the diagram (Fig. 43) are such that when a stimulus passes from a sensory nerve s i" Illustrate Inhibition in the spinal cord, s, s', and s" are sensory nerves, m, iri, and B" are sensory eell^, m, m', and m" are motor cells in the spinal -'■n-orv and KB R motor cell in the brain. motor aerve //>. «. 11( . part of it travels along the path s, S, M, m, and ther along \i. w, or s, s, s\ m', m, m, at such a rate that the Its of the wav.s coincide at the motor cell M, they will increase each other's effect, [f thej interfere, the effect of both will be diminished or . inhibition will occnr. Effect of Utered Elate of Transmission.— But it is evident that the coincidence or interference of nervous stimuli travelling along ACTION OF DRUGS ON THE SPINAL COED. 157 definite nerve paths, will vary according to the rate at which they travel, so that when stimuli, which ordinarily interfere with one another, are made to travel more slowly, one may be thrown a whole wave-length, instead of half a wave-length, behind the other : and thus we get coinci- dence and stimulation, instead of interference and inhibition. When stimuli, whose waves ordinarily coincide and strengthen each other's action, are made to travel more slowly, one may be thrown half a wave- length behind the other, and thus we shall have interference and inhibi- tion instead of stimulation. On the other hand, when the stimuli travel more quickly, the one which was half a wave-length behind the other, and interfered with it, may be thrown only a small fraction of a wave-length behind it. It will thus, to a great extent, coincide and cause stimulation, while the one which normally coincides with, and helps another, may, by travelling with increased rapidity, get half a wave-length in front of the other, and cause inhibition. Opposite Conditions Produce Similar Effects. — We see then that results, apparently exactly the same, may be produced by two oppo- site conditions, increased rapidity or greater slowness of transmission of stimuli. The Same Conditions may Cause Opposite Effects. — We see also that the same conditions may produce entirely opposite effects, by acting more or less intensely. Thus, the application of cold, or of any agent which will render the transmission of stimuli along nervous chan- nels slower than usual, may throw one which ordinarily coincided with another a small fraction of a wave-length behind it, then half a wave- length, then three-quarters, next a whole wave-length, and then in addi- tion to the whole wave-length it will throw it as at first a small fraction or a half wave-length behind, and so on. We will thus have the normal stimulation passing into partial, then into complete inhibition, which will gradually pass off as the crests of the waves come more nearly together, until they coincide, when we will again have stimulation as at first. As the action proceeds, this second stimulation will again pass into inhibition. In the same way a gradual retardation of transmission will cause impulses which normally interfere, gradually to coincide until inhibition gives place to complete stimulation, and this again passes into inhibition. By quickening the transmission and throwing one wave more or less in advance of another, various degrees of heat will likewise produce opposite effects. Stimulation and Inhibition on this Hypothesis are merely Consequences of Relation. — They are not due to any particular stimulating or inhibitory centres, they are merely dependent on the wave-length of nervous stimuli or the rapidity of transmission, and on the length of the paths along which they have to travel. Any nerve cell may therefore exercise an inhibitory or stimulating action on any other nerve cell, and the nature of this action will be merely a question of the length and arrangement of its connections, and the rapidity with which stimuli travel along them. Test of the Truth of the Hypothesis. — If the hypothesis be true we ought to be able to convert inhibition into stimulation, and vice 158 PHARMACOLOGY AND THERAPEUTICS. /". by either quickening or slowing the transmission of stimuli. We can quicken transmission by heat, and we can render it slower by cold. On this hypothesis we would expect to find that either excessive quickening or" excessive slowing of the passage of stimuli between the cells of the nerve centres might cause a number of stimuli which would ordinarily interfere to coincide and produce convulsions. This is what actually "does occur, for extreme heat and extreme cold both cause con- vulsions. But it is unsafe to lay too much stress upon this point, as the cause of convulsion may be very complex. We find, however, that, as we would expect on this hypothesis, the inhibitory action of the vagus is destroyed by cold. 1 Explanation of the Actions of Certain Drug's on this Hypothesis. There are certain phenomena connected with the action of drugs on the spinal cord which are almost inexplicable on the ordinary hypothesis, but which are readily explained on that of interference. Thus belladonna when given to frogs causes gradually increasing weakness of respiration and movement, until at length voluntary and respiratory movements are entirely abolished, and the aiferent and efferent nerves are greatly weak- ened. Later still, both afferent and efferent nerves are completely par- alyzed, and the only sign of vitality is an occasional and hardly perceptible beat of the heart, and retention of irritability in the striated muscles. The animal appears to be dead, and was believed to be dead, until Fraser made the observation that if allowed to remain in this condition for four or five days, the apparent death passed away, and was succeeded by a state of spinal excitement. The fore-arms passed from a state of com- plete tlaccidity to one of rigid tonic contraction. The respiratory move- ments reappeared : the cardiac action became stronger, and the posterior extremities extended. In this condition a touch upon the skin caused violent tetanus, usually opisthotonic, lasting from two to ten seconds, and succeeded by a Beries of clonic spasms. A little later still the convulsions change their character and become emprosthotonic. These symptoms arc due to the action of the poison upon the spinal cord itself, for they continue independently in the parts connected with each segment of the cord when it has been divided. This action may be imitated by a combination of a drug which will paralyze the motor nerves with one which will excite the spinal cord. Fraser concludes that the effects of large doses of atropine just described, »re due to a combined stimulant action of this substance on the cord, and a paralyzing one on the motor nerves. The stimulant action on the cord is masked by the paralysis of the motor nerves, and only appears after the paralysis has passed off. lie thinks that the difference in the rela- tion- of these effects to each other, which are seen in different species of a in ma Is ina v ho explained by this combination acting on special varieties of organization. In Bupporl of his views he administered to frogs a mix- chnine whir}, stimulates the spinal cord, and of methyl Horwatli. Pfliiger'a Archiv, 1876, ACTION OF DRUGS ON THE SPINAL CORD. 159 strychnine, which paralyzes the motor nerves, and found that the mixture produced symptoms similar to those of atropine. Notwithstanding this apparently convincing proof it would appear that the paralysis in the frog is due to the action of the atropine on the spinal cord, and not to a paraly- zing effect on the motor nerves. For Ringer and Murrell have found that when the ends of the motor nerves in one leg are protected from the action of the poison by ligature of the artery there is no difference between it and the unpoisoned leg, while if Eraser's ideas were correct the un- poisoned leg ought to be in a state of violent spasm. A condition very nearly similar to that caused by atropine is produced by morphine. When this substance is given to a frog, its effects are ex- actly similar to those produced by the successive removal of the different parts of the nervous system from above downwards. Goltz has shown that when the cerebral lobes are removed from the frog, it loses the power of voluntary motion, and sits still ; when the optic lobes are removed, it will spring when stimulated, but loses the power of directing its move- ments. When the cerebellum is removed, it loses the power of springing at all ; and when the spinal cord is destroyed, reflex action is abolished. Now these are exactly the effects produced by morphine, the frog poisoned by it first losing voluntary motion, next the power of directing its movements, next the power of springing at all, and lastly, reflex ac- tion. But after reflex action is destroyed by morphine, and the frog is apparently dead, a very remarkable condition appears, the general flaccid- ity passes away, and is succeeded by a stage of excitement, a slight touch causing violent convulsions just as if the animal had been poisoned by strychnine. 1 The action of morphine here appears to be clearly that of destroying the function of the nerve centres from above downwards, causing paralysis first of the cerebral lobes, next of the optic lobes, next of the cerebellum, and next of the cord. But it seems probable that the paralysis of the cord first observed is only apparent and not real, and in order to explain it on the ordinary hypothesis we must assume that during it the inhibi- tory centres in the cord are intensely excited so as to prevent any motor action, that afterwards they become completely paralyzed, and thus we get convulsions occurring from slight stimuli. Ammonium bromide also causes first complete loss of voluntary movement and reflex action, but at a later stage in the poisoning convul- sions accur. On the hypothesis of interference, the phenomena produced both by atropine and by morphine can be more simply explained. These drugs, acting on the nervous structures, gradually lessen the functional activity of the nerve-fibrils which connect the nerve- cells together ; the impulses are retarded, and thus the length of nervous connection between the cells of the spinal cord, which is calculated to keep them in proper rela- tion in the normal animal, just suffices at a certain stage to throw the impulses half a wave-length behind the other, and thus to cause com- plete inhibition and apparent paralysis. 1 Marshall Hall, Memoirs on the Nervous System, p. vii. (London, 1837). Wit- kowski, Archiv.fiir exper. Path, und Pharm., Band, vii., p. 247. 160 PHARMACOLOGY AND THERAPEUTICS. As the action of the drug goes on, the retardation becomes still greater, and then the impulses are thrown very nearly, but not quite, a whole wave-length behind the other, and thus they coincide for a short time, but gradually again interfere, and therefore we get, on the appli- cation of a stimulus, a tonic convulsion followed by several clonic ones, and then by a period of rest. This explanation is further borne out by the fact observed by Fraser, that the convulsions caused by atropine occurred more readily during winter, when the temperature of the laboratory is low and the cold would tend to aid the action of the drug in retarding the transmission of impulses. 1 The effect of strychnine in causing tetanus is very remarkable ; a verv small dose of it administered to a frog first renders the animal most sensitive to reflex impulses, so that slight impressions which would normally have no effect, produce reflex action. As the poisoning pro- ceeds, a slight stimulus no longer produces a reflex action limited to a few muscles, but causes a general convulsion throughout all the body, all muscles being apparently put equally on the stretch. In man the form assumed by the body is that of a bow, the head and the heels being bent backwards, the hands clenched, and the arms tightly drawn to the body. My friend Dr. Ferrier has shown that this position is due to the different strengths of the various muscles in the body. All being con- tracted to their utmost, the stronger overpower the weaker, and thus the powerful extensors of the back and muscles of the thighs keep the body arched backwards and the legs rigid, while the adductors and flexors of the arms and fingers clench the fist and bend the arms, and draw them close to the body. 2 The convulsions are not continuous, but are clonic ; a violent convulsion coming on and lasting for a while, and then being seeded by an interval of rest, to which after a little while another convulsion succeeds. The animal generally dies either of asphyxia during a convulsion, or of stoppage of the heart during the interval. When the animal is left to itself, the convulsions — at least in frogs — appear to me to follow a certain rhythm, the intervals remaining for -Mine little time of nearly the same extent. A Blight external stimulus, however, applied during the interval — <>r at least during a certain part of it — will bring on the convulsion. B this i^ not the case during the whole interval. Immediately after each convulsion has ceased I have observed a period in which stimulation applied t<» the surface appears to have no effect whatever. It is rather extraordinary, also, that although touching the surface produces convulsions, irritation of the skin by acid does not do so. 3 The cause of those convulsions was located in the spinal cord by Magendie in an elaborate series of experiments, which will be described I Other observers have tried to discover whether any change in the pheral aervee also took part in causing convulsion; but from further TWmftft Hont Of the Royal Society of Edinburgh, vol. xxv., p. 467. /Iran,. \<,\. i\ .. \>. 313. i:< kii.o.i. Bermann'a Eandb. rf. Physio!.. Band ii. Th. 2, p. 43. ACTION" OF DRUGS ON THE SPINAL COED. 161 experiments it appears that the irritability of the sensory nerves is not increased. 1 According to Rosenthal, strychnine does not affect the rate at which impulses are transmitted in peripheral nerves ; according to him. how- ever, it lessens the time required for reflex actions. Wundt came to the conclusion that the reflex time was on the contrary increased. In trying to explain the phenomenon of strychnine tetanus on the hypothesis of interference, one would have been inclined by Rosen- thal's experiments to say that strychnine quickened the transmission of impulses along those fibres in the spinal cord which connect the differ- ent cells together. The impulses which normally by travelling further round fell behind the simple motor ones by half a wave-length, and thus inhibited them, would now fall only a small fraction of a wave-length behind, and we should have stimulation instead of inhibition. Wundt' s results, on the other hand, would lead to the same result by supposing that the inhibitory wave was retarded so as to fall a whole wave-length behind the motor one. On the assumption, however, that the fibres which pass transversely across from sensory to motor cells, and those that pass upwards and downwards in the cord connecting the cells of successive strata in it, are equally affected, we do not get a satisfac- tory explanation of the rhythmical nature of the convulsions. By sup- posing, however, that these are not equally affected, but that the resist- ance in one — let us say — that in the transverse fibres is more increased than in the longitudinal fibres, we shall get the impulses at one time thrown completely upon each other, causing intense convulsions, at another half a wave-length behind, causing complete relaxation, which is exactly what we find. This view is to some extent borne out by the different effect produced by a constant current upon these convulsions, according as it is passed transversely or longitudinally through the spinal cord. Ranke found that when passed transversely it has no effect, but when passed longi- tudinally in either direction it completely arrests the strychnine con- vulsions, and also the normal reflexes which are produced by tactile stimuli. Ranke's observations have been repeated by others with varying re- sult, and this variation may, I think, be explained by the effect of tem- perature. The effect of warmth and cold upon strychnine tetanus is what we would expect on the hypothesis of interference. With small doses of strychnine warmth abolishes the convulsions, while cold increases them. When large doses are given, on the contrary, warmth increases the con- vulsions and cold abolishes them. 2 We may explain this result on the hypothesis of interference in the following manner : — 1 Bernstein, quoted by Eckhard, op. cit., p. 40. Walton, Ludwig's Aroeiten, 1882. 2 Kunde and Virchow, quoted by Eckhard, op. cit., p. 44 ; Foster, Journal of Anat- omy and Physiology, November, 1873, p. 45. 11 162 PHARMACOLOGY AND THERAPEUTICS. If a small dose of strychnine retard the transmission of nervous im- pulses so that the inhibitory wave is allowed to fall rather more than half a wave-length, but not a whole wave-length, behind the stimulant wave, we should have a certain amount of stimulation instead of inhibition. Slight warmth, by quickening the transmission of impulses, should coun- teract this effect, and should remove the effect of the strychnine. Cold, on the other hand, by causing still further retardation, should increase the effect. With a large dose of strychnine the transmission of the in- hibitory wave being still further retarded, the warmth would be sufficient to make the two waves coincide, while the cold would throw back the inhibitory wave a whole wave-length, and thus again abolish the con- vulsions. The effect of temperature on the poisonous action of guanidine is also very extraordinary, and is very hard to explain on the ordinary hy- potheses, although the phenomena seem quite natural when we look at them as cases of interference due to alterations in the rapidity with which the stimuli are transmitted along nervous structures. Another cause of tetanus that is difficult to understand on the ordi- nary hypothesis of inhibitory centres is the similar effect of absence of oxygen and excess of oxygen. When an animal is confined in a closed chamber without oxygen, it dies of convulsions ; when oxygen is gradually introduced before the convulsions become too marked, it recovers. But when the pressure of oxygen is gradually raised above the normal, the animal again dies of convulsions. This is evidently not the effect of mere increase in atmospheric pressure, but the effect of the oxygen on the animal, inasmuch as twenty-five atmospheres of common air are re- quired to produce the oxygen convulsions, while three atmospheres of pure oxygen are sufficient. This effect is readily explained on the hy- pothesis of interference, by supposing that the absence of oxygen retards the transmission of impulses in the nerve-centres ; so that we get those which ought ordinarily to inhibit one another, coinciding and causing con- vulsions. Increased supply of oxygen gradually quickens the transmis- sion of impulses until the waves first reach the normal relation, and then, the normal rate being exceeded, the impulses once more nearly coincide, and convulsions are produced a second time. 1 The effect of various agents also in arresting or inhibiting muscular action suggests the possibility that such inhibition is due to interference with vibrations in muscle. The vibrations of the parts which occur in the muscle during the passage of a constant current have already been mentioned. Winn a constant current is passed for a length of time and then Stopped, tetanic contraction of the muscle occurs and lasts for some 'i' 1 "- but it can be at once arrested by again passing the constant current through the muscle. The idea that coincidence or interference of contractile waves in muscle have much to do with the presence or absence of contraction of a i or other observations on interference as a cause of inhibition, vide Wundt, Un- o- M-rhmnk <{,,- Nerven und Nerven centren. 1876. (Stuttgart: T. ; Ranvier, Lecona tPAnatomie QSnSrale. A nn/e 1877-78. (Paris: J. B. Bail- and Lauder Brunton, " On the Nature of Inhibition and the Action ol Drngi upon it. -- [Nature, March, L883, and reprint.) ACTION OF DRUGS ON THE SPINAL CORD. 163 muscle has been advanced by Kiihne in order to explain the phenomenon observed by A. Ewald. When the sartorius of a frog is stimulated at each end by electric currents passing transversely through the ends, the secondary contraction which can be obtained from it is strongest in the middle of the muscle, while the points exactly intermediate between the middle and the end, do not produce any secondary contraction at all. This absence of secondary contraction Kiihne thinks is due to interfer- ence, and the powerful secondary contraction from the middle to coin- cidence of waves. 1 Inhibition may also be produced by direct irritation of involuntary muscular fibre. Thus I have noticed under Ludwig's direction that stimulation of veins as a rule very frequently causes dilatation at the point of irritation, and if the muscular fibre of a frog's heart be injured by pinching at one point, that point is apt to remain dilated when the rest is contracted. Protoplasmic structures appear to be similarly af- fected, and the passage of an interrupted current through the heart of a snail will arrest its rhythmical pulsations, although the heart in this an- imal appears to be a continuous protoplasmic structure and destitute of nerves. 2 Stimulating* Action of Drugs on the Reflex Powers of the Cord. The reflex action of the cord is greatly increased by certain drugs, more especially by ammonia and by strychnine. The action of strychnine was first investigated by Magendie, and his research is not only the first example of the systematic investigation of the physiological action of a drug leading to its therapeutical employment, but is such a model of this method of research that it is worth giving in detail. He first introduced a little of the upas poison, of which strychnine was the essential ingredient, under the skin of the thigh of a dog, and found that for the first three minutes no symptoms at all were produced. Then the action of the poison began to manifest itself by general malaise succeeded by marked symptoms. The animal took shelter in a corner of the laboratory; and almost immediately afterwards convulsive con- traction of all the muscles of the body occurred, the fore-feet quitting the ground for a moment on account of the sudden extension of the spine. This contraction was only momentary, and almost immediately after- wards ceased ; the animal remained calm for several seconds, and was then seized with a second convulsion, more marked and prolonged than the first. These convulsions succeeded each other at short intervals, grad- ually becoming more severe. The respiration was hurried, the pulse quick, and it was observed that each time the animal was touched a con- vulsion immediately followed. Finally, death occurred at an interval increasing with the age and strength of the animal. These symptoms suggested to Magendie the following explanation of the action of the poison. It was, he thought, absorbed from the wound into the blood, by which it was carried to the heart, and thence to all the organs of the 1 Untersuchungen a. d. Physiolog. Inst., Heidelberg, 1879. SonderabdrucJc, p. 40. 2 M. Foster, Pfliiger's Archiv. 164 PHARMACOLOGY AND THERAPEUTICS. body. On arriving at the spinal cord it acted upon it as a violent excitant, producing the same symptoms as mechanical irritation or the application of electricity. Magendie was not content until he had tested his theory by experiment. The first question to be settled was whether the poison were absorbed or not. To test this supposition he applied the poison first to the serous membranes, the peritoneum and pleura, from which, as he had learned by previous experience, absorption takes place with extreme rapidity. The result showed that his supposition was correct. The symptoms appeared almost immediately after the injection of the poison into the pleura, and within twenty seconds after it had been injected into the peritoneum. In order to ascertain whether absorption took place from mucous as well as from serous surfaces, he isolated a loop of small intes- tine, by means of two ligatures, and injected a little of the poison into the part between them. In six minutes symptoms of poisoning appeared, showing that absorption had occurred, but they were less intense than when the poison was applied to a serous surface. Further experiments showed that absorption took place from the large intestine, from the bladder, and from the vagina; but that it was comparatively feeble and slow. When introduced into the stomach along with food upas invariably caused death; but the symptoms did not appear until half an hour after it had been taken. This delay might have been due either to absorption from the stomach having taken place very slowly or not at all, so that the drug had passed on to the small intestine, and thence been absorbed into the blood. To determine this point, he isolated the stomach by ligatures applied to its cardiac and pyloric orifices, and then injected a little of the poison into its cavity. Under such conditions, symptoms of poisoning were only observed after the lapse of an hour. This showed that while absorption from the stomach did occur, it was much slower than from the small intestine. The second question was, Does the poison act through the circulation? If so, reasoned Magendie, the first symptoms of the action of the poison will come on more slowly when it has far to travel to the spinal cord from the point of introduction, and vice versa. On testing this by experiment he found that when the poison was injected into the jugular vein tetanus occurred almost instantaneously, and death took place in less than three minutes, for the upas had only to pass through the pulmonary circulation and heart to the arteries of the cord. When injected into the femoral artery (at D, Fig. 44) the distance to be elled before reaching the cord would be greatly increased, for the poison must first pass through the artery itself, through the capillaries, and along the vena cava, traversing the whole distance marked DAB in Fig. 1 \ before it reached the point where it entered the circulation when il was injected into the jugular. Under these conditions the action should he slow, and experiment showed this to be actually the . for no symptoms appeared until seven minutes after the injection. Although these experiments of Magendie's appear to prove completely that the upas poison acts through the circulation, a number of persons nevertheless considered that the symptoms were produced through the nervous system by means of 30-called sympathy. In order to remove ACTION OF DRUGS ON THE SPINAL CORD. 165 their doubts, Magendie narcotized a dog by means of opium, and then divided all the structures of one leg with the exception of the artery and MUSCLES OF FORE LEC jlfifi Fig. 44.— Diagram illustrating Magendie's method of investigating the mode of action of upas (strychnine), a, femoral vein; b, peritoneum; c, pleura; D, femoral artery; e, f, g, spinal cord, to which small arteries are seen passing from the aorta. At f is indicated a"point of section of the cord. vein. Into this almost isolated limb he then introduced a little of the poison. This was followed by the usual symptoms almost exactly as if the limb had been intact. By pressing upon the vein which passed from the limb to the body when the symptoms of tetanus appeared he was able to arrest their further development, and by releasing the vessel and allowing circulation to have free course, the symptoms reappeared. Lest by any chance the poison might have acted through nerves or lymphatics contained in the walls of the artery and vein, he divided these structures also, connecting their several ends by means of quills through which circulation then took place. When the poison was applied to the severed limb connected with the body only by these quills, the same succession of phenomena occurred as when the limb was uninjured. The possibility of the action being due to sympathy between the nervous system and the point of application of the poison was thus completely excluded, and the operation of the poison through the circulation triumphantly demonstrated. The next question was whether the convulsions were caused hy the action of the drug* on the brain or the cord. To ascer- tain its action upon the brain, a little of the solution was injected into the carotid artery. The effects produced were the same as those of any irritating liquid. The intellectual faculties disappeared, the head was laid between the paws, and the animal rolled over and over like a ball. These effects passed off as the circulating blood removed a quantity of the drug from the brain, and were succeeded by the ordinary tetanic con- vulsions when sufficient time had elapsed for it to reach the spinal cord. The question whether it really acted upon the cord, still remained to be put to a crucial test. If its effects were really due to its action upon the spinal cord they ought to cease upon the destruction of that part of the nervous system, and to occur when the drug was applied to it alone. The cord was therefore destroyed by running a piece of whalebone down the vertebral canal at the moment of injection. When this was done no tetanus occurred. In another experiment, Magendie waited until the 166 PHARMACOLOGY AND THERAPEUTICS. tetanic spasms had been induced by the upas, and then destroyed the spinal cord by slowly pushing the whalebone down the vertebral canal. As the whalebone advanced, the tetanus disappeared, first in the fore- legs, when the dorsal part of the cord was destroyed, and then in the hind-legs, when the whalebone had reached the lumbar vertebrae. In another experiment, an animal was narcotized by means of opium, and the spinal canal laid freely open. The upas was then directly placed on a part of the spinal cord. Tetanus immediately occurred in that part of the body, and in that part only to which the nerves arising from this portion of the cord were distributed. When the poison was successively applied to other parts of the cord, the convulsions spread to the corres- ponding regions of the body. The question whether a drug- exercises a convulsant action through the brain or spinal cord is now frequently tested, not by destroying the whole cord as Magendie did, but simply by dividing the spinal cord transversely between the occiput and the atlas. Convulsions depending upon stimulation of the motor centres in the brain and medulla oblongata then cease after section, while those dependent upon the spinal cord do not. The experiment of dividing the spinal cord transversely about its middle is also sometimes performed in order to test whether the convul- sions are of really spinal origin. If they are, they should persist in both the anterior and posterior parts of the body, but if they are of cerebral origin, they occur in the anterior but not in the posterior part. The effect of strychnine and allied substances upon the cord is usually ascribed to increased excitability of the nerve cells, but it is not improb- ably due partly to alteration in the comparative rate at which stimuli are transmitted from one cell to another ; but this subject has already been more fully discussed under "Inhibition," q.v. Some curious results obtained by Dr. A. J. Spence may be explained od the latter hypothesis which would be inexplicable on the former. After removing the blood from the body of a frog, and exposing the brain, lie placed some nux vomica upon it, so that it could gradually diffuse along the spinal cord. As it passed downwards he observed that at first irritation of the fore-feet caused spasm only in them ; later it caused spasm of* both front and hind-feet, while irritation of the hind-feet still produced ordinary reflex ; and later still irritation of the fore-feet caused no spasm in the hind-legs while irritation of the hind-feet would still cause spasm in the fore-legs. 1 The action of strychnine on the conducting power of the spinal cord has already been discussed. It diminishes or abolishes the power of bui ation, but Increases the reflex excitability, so that stimuli will produce reflex action which are too feeble to do so when the spinal cord is in its normal condition. The difference between the reaction to strong and weak stimuli is also to a great extent abolished, and both produce tetanic contractions. This condition, however, is absent for a short time after the application of each stimulus, and then strong and weak stimuli pro- duce corresponding Strong and weak action, much as in the normal cord. 2 Edin. Med. Journ. t July, 1866. Ludwig and Walton, Ludwig'a Arbcitm, 1*8:2. ACTION OF DRUGS OX THE BRAIN. 167 The effect of nicotine as a spinal stimulant is very extraordinary ; for Freusberg found that when frogs had been decapitated for twenty- four hours, and reflex action was almost entirely gone, the injection of a small quantity of the poison increased the reflex excitability so much that irritation of the skin caused well-marked movements. This increase lasted from one to three days, and the bodies of frogs poisoned by nico- tine retained a fresh appearance for a long time. Spinal Stimulants. Spinal stimulants are remedies which increase the functional activity of the spinal cord. Ammonia. Thebaine. Strychnine. Gelsemine. Brucine. Buxine. Absinthe. Calabarine Nicotine. The most marked of these are strychnine, brucine, and thebaine, which in small and moderate doses greatly increase the reflex excita- bility, and in large doses cause tetanic convulsions. Besides these there are some others, such as opium, morphia, and belladonna, which, although they appear at first to have a sedative action, when given in very large doses produce convulsions. Uses. — The want of an exact knowledge of the intimate pathology of spinal diseases renders the rational use of spinal stimulants difficult. They are employed in cases of general debility without any evidence of distinct disease, and in paralysis where there is no evidence of inflamma- tion ; this paralysis may be local, or affect the whole side of the body, as in hemiplegia, or the lower half, as in paraplegia. When strychnine is given in cases of paralysis until it begins to ex- hibit its physiological action in slight muscular twitches, these twitches begin sooner and are more marked in the paralyzed than the healthy parts. CHAPTER VIII. ACTION OF DRUGS ON THE BRAIN. We are able to judge to a certain extent of the order and kind of action of drugs upon the different parts of the nerve centres, by watching their effect upon the movements of animals after their injection. By removal of successive portions of the nervous system in the frog, Goltz has shown that the cerebral lobes have the function of voluntary 168 PHARMACOLOGY AND THERAPEUTICS. movement, so that when they are removed, the animal lies quiet, unless acted upon by some external stimulus. The optic lobes, which correspond to the corpora quadrigemina of the higher animals, have the function of directing and co-ordinating move- ments but not of originating them, so that a frog in which they are uninjured, but from which the cerebral lobes have been removed, will remain perfectly quiet, except on the application of an external stimulus, when it will leap like a normal frog. As the optic lobes have the power of directing and co-ordinating movements, when they are destroyed the animal will jump, but will be unable to direct its movements. The cerebellum has also the power of co-ordination, so that when it is removed the animal cannot jump at all, although one leg may answer by a kick or other motion to the application of a stimulus. But even when all those parts have been removed, the frog will still recover its ordinary position after it has been laid upon its back. The co-ordination requisite for this pow T er of retaining or recovering its ordinary position appears to be situated in the medulla oblongata, for when this is removed the frog will lie upon its back, and will not attempt to recover its ordinary position. The legs will still respond by movements to irritation applied to the foot, but when the spinal cord is now destroyed these reflex movements also cease. In frogs poisoned by opium, the movements are gradually abolished in the order just mentioned, and we therefore conclude that opium affects the nerve-centres in the order of their development, the highest being paralyzed first, and the lowest last. This order is usually not quite the same in higher animals, inasmuch as the last centre to be paralyzed by opium or other anaesthetics is usually the medulla oblongata, and more icially that part of it which keeps up the respiratory movements. b we shall afterwards see, however, the respiratory centre is really a lower or more fundamental centre than either the brain or spinal cord. In higher animals, such as rabbits and guinea-pigs, the cerebral hemispheres are comparatively much more developed than in the frog, and their removal interferes very much with the animal's motions. At it is utterly prostrate, but after some time its power of movement returns to some extent, though it remains much less than in the normal animal. As we should expect, the weakness is most marked in those parts of the body that are most under the control of the cerebrum, and • in those whose movements are regulated by the lower centres. Thus m rabbits the fore-paws are capable of being used for complex motions ;ir the will of tin- animal, Buch as washing the face, holding food, and so "ii, :md in ill. in the weakness caused by removal of the cerebrum is much more marked than in the hind limbs, which are simply used for pro- i U. After the operation the animal can still stand, although it is unsteady, and the fore-legs tend to sprawl out. When pinched it bounds forward, but, unlike the frog, it is unable to avoid any obstacle in its path. If it be pinched at all severely, it not only moves, but will cry Loudly and plaintively, and this condition is frequently noticed in rabbits under chloroform, although they have received no injury whatever. The ACTION OF DRUGS ON THE BRAIN. 169 pupils contract on the stimulus of light, and the eyes wink if the finger is brought near them. Bitter substances cause movements of the tongue Effects of removing the part of brain included in brackets. Voluntary motion lost. Cannot direct movements. Cannot jump Cannot recover position when laid on its back Olfactory nerves. Olfactory lobes. Cerebral lobes. Pineal gland. Optic thalamus. Optic lobes. Cerebellum. Rhomboid sinus. Medulla oblongata. Fig. 45.— Diagram of the higher nerve-centres of the frog. and mouth, and ammonia to the nostrils may cause the head to be drawn back, or the animal to rub its nostrils with its toes. 1 1 Ferrier, Functions of the Brain, p. 38 170 PHARMACOLOGY AND THERAPEUTICS. 1 >> § •~ 3 s 5 ^2 o 1 S 2 «« o o tt- o i ■be O <0 .2 o c 5 > o 1 s 2 += 1 a 1 § v* s~ 5 a: o B o <» £ o o ^ o o as 2 1 rt TS H Of 03 P 3* ACTION OF DRUGS ON THE BRAIN. 171 Where the cerebral hemispheres are still more developed, as in cats, dogs, and. monkeys, their removal causes so much prostration, and inter- feres so greatly with motor power as almost entirely to destroy equilib- rium and co-ordinate progression. The motor and sensory centres of the brain have been more exactly localized in monkeys by Ferrier, Fritsch, Hitzig, and others, and the re- sults of their experiments, especially those of Ferrier, agree so well with those of pathological observation in men that we may assume that there is a general agreement between the position of the centres in man and monkey. The motor centres are arranged along the two sides of the fissure of Rolando, the order of their arrangement being exactly what is required for the purpose of (1) seeing food ; (2) conveying it to the mouth ; (3) masticating it ; (4) throwing away the refuse ; and (5) advancing to get more 1 (vide Fig. 46, brain of monkey). The sensory centres lie in the posterior and lower parts of the brain. The centre for sight is situated in the angular gyrus and is marked 14 and 15 in the diagram : that for hearing is situated in the superior temporo-sphenoidal and is marked 16 in the diagram ; those for smell and taste lie at the tip of the temporal sphenoidal lobe, and the centre for general sensation appears to be towards the interior of the brain, in the hippocampal region. When the motor centres in the monkey are slightly irritated by a faradic current, a single co-ordinated movement is produced, but if the irritation be continued longer, and especially if a strong current be used, epileptiform convulsions may occur, succeeded by choreic movements after the current has ceased. Epileptic convulsions are easily produced by irritation of the cerebral cortex in the cat and dog, as well as the monkey. It is difficult to produce them by cortical irritation in the guinea-pig or rabbit, and impossible in birds, frogs, and fish. 2 Depressant Action of Drugs on the Motor Centres. The excitability of the brain may be altered either by conditions which modify the nerve cells or the circulation. A deficient circulation greatly depresses the excitability, and it is very low when much haemor- rhage has occurred. One method of investigating the action of drugs on the excitability of the brain consists in trephining so as to expose the cortical substance and then stimulating it by a faradaic current before and after the admin- istration of a drug, either by inhalation or injection. Another method has been employed by Albertoni, who first trephines on one side, and having estimated the strength of current sufficient to produce an epileptic convulsion when applied to a motor centre, he allows the wound to heal, and then gives for a length of time the drug on which he wishes to ex- periment. He then exposes the corresponding motor area on the other 1 Lauder Brunton, "On the Position of the Motor Centres in the Brain in regard to the Nutritive and Social Functions," Brain, vol. iv., p. 1 2 Francois Franck and Pitres, Arch, de Physiol, July, 1883, p. 39. 1 i 2 PHARMACOLOGY AND THERAPEUTICS. side and observes whether the strength of current required to produce an epileptic convulsion is greater or less than before. The excitability of the motor centres is greatly lowered by anaesthetics, so that as anesthesia becomes deeper, irritation of the motor centres has less and less effect, and when anaesthesia is very profound, such irritation has no action whatever. 1 The motor centres, however, are less affected than the sensory ones by anaesthetics, so that they will still re-act to faradic irrita- tion when the sensation of pain has been completely abolished. Alcohol also diminishes the excitability of the motor centres, so that the epileptic convulsions which usually follow the application of strong currents to the cortex are less readily produced after its administration, as well as after ether and chloroform. 2 Bromide of potassium, according to Albertoni, when given for several weeks together, greatly diminishes the excitability of the motor centres so that when dogs are thoroughly under its influence it is almost impossible to produce epileptic convulsions by irritation of the cortical substance. Atropine in small doses increases the excitability of the brain in monkeys, but in large doses paralyzes it. It greatly increases the tendency to epi- leptic convulsions in dogs, so that they can be produced by very much slighter stimuli than usual, and strychnine, absinthe, and cannabine have a similar action in this respect. 3 Physostigma appears to increase the excitability of motor centres in the brain; for when guinea-pigs have been rendered epileptic by section of a sciatic nerve, the administration of physostigma greatly increases the number of fits. Irritant Action of Drugs on Motor Centres in the Brain. Certain drugs when administered to animals or taken by man produce convulsions. The muscular actions which occur in these convulsive movements may be induced by (a) irritation of the motor centres in the spinal cord, (7/) the motor centres in the medulla oblongata and pons varolii, cerebral cortex. These centres maybe irritated directly by the action of the drug upon them, or they may be stimulated indirectly by the drug causing the blood in them to become venous through its action on the respiratory or circulatory organs. Convulsions of this sort, al- though caused by the administration of a poison, are really asphyxia!, and milar in character to those produced by suffocation. Convulsions are usually ascertained to be of spinal origin by di- viding tin- cord either at the occiput or lower down in its course and finding that they still persist in those parts of the body which derive their innervation from the spinal cord below the point of section. If they cease in parts of the body innervated by the spinal cord alone, but continue in the parts which retain their nervous connection with the brain, they are irded as of cerebral origin. T1 ' rved in the case of ether by Hitzig, Untcrsuchunrjcn iiber das Gehirn, Berlin, 1874. I have had Beveral opportunities of observing the same tiling in regard to chloroform when assisting my friend Dr. Ferrier in experiments on the brain. Franck and Pitres, op, i it. ich and Pitres, Arch. . 39. ACTION OF DEUGS ON THE BKAIN. 173 It has already been mentioned that irritation of the motor areas in the cortex of the brain will produce epileptic convulsions, but it is probable that such cortical irritation acts through lower ganglionic centres and especially through the medulla oblongata and pons varolii. Epileptic convulsions can be still more readily produced by irritation of this part of the brain than by irritation of the cerebral cortex, and may be induced by slight lesion of the pons and medulla by a needle. It is to irritation of this part of the brain by venous blood that asphyxial convulsions are due, for they can still be induced by suffocation or by ligature or com- pression of all the arteries leading to the brain after all the parts of the brain above the pons have been removed, and they cease when the spinal cord is divided just below the medulla, or the medulla itself divided at its lower end. It is evident that, if the spinal cord be paralyzed the con- vulsions will not occur though the medulla and pons be irritated : and it has been found that, if its blood-supply is stopped at the same time as the circulation in the pons by ligaturing the aorta in place of the cerebral vessels alone, convulsions do not occur. Probably the absence of convul- sions in slow asphyxia is due, at least in some degree, to gradual paralysis of the cord by the long-continuecl circulation of venous blood through it. The centre for convulsions in the frog appears to be in the medulla oblongata. Asphyxial convulsions are usually of an opisthotonic character, because, all the muscles being stimulated at once by the action of the venous blood on the motor centres, the stronger overpower the weaker, and the extensor muscles of the back being more powerful than the flexors bend the spine backwards. Asphyxial convulsions only occur in warm- blooded animals and not in frogs, where the respiratory processes are slow, and entire stoppage of the respiration for a length of time does not render the blood sufficiently venous to act as a powerful irritant. If any drug therefore produces convulsions in the higher animals and not in frogs, the probability is that its convulsive action is indirect and the convulsions it produces are asphyxial. If on the other hand it produces convulsions in frogs as well as higher animals, its convulsive action is in all probabil- ity due to the direct effect of the drug upon the nerve centres. In order to ascertain this definitely, however, the usual plan is to see (1) whether the convulsions which occur after the drug has been injected disappear when artificial respiration is commenced, and (2) whether these convul- sions are prevented by artificial respiration begun before the injection of the drug and kept up during its action. But even this does not entirely show whether the convulsive action of a drug is direct or indirect, for artificial respiration will not prevent asphyxial convulsions if these should depend upon the action of the drug in stopping the heart and thus arrest- ing the circulation. If it is found that the convulsions occur very shortly after the heart stops, the usual plan is to paralyze the vagus in the heart by atropine, and ascertain whether the convulsive action then occurs. If the drug still produces convulsions when respiration is kept up and the heart is not stopped, it is almost certain that its action is direct upon the nerve centres. Experiments to ascertain whether convulsions are asphyxial or not may be conveniently made upon fowls, for the venous or arterial condition 17^ PHARMACOLOGY AND THERAPEUTICS. of the blood is readily ascertained by the color of the comb. Thus, in fowls killed by cobra poison, the convulsions come on at the moment the comb becomes livid, and when artificial respiration is begun the con- vulsions disappear as the comb again regains its normal color. It is evident that the color of the comb will indicate the condition of the blood supplying the brain, even though a venous condition of it should be due to stoppage of the heart and not to failure of the circulation. Camphor has a curious exciting action both upon the brain and upon the medulla. It produces first rapid succession of ideas, great desire to move, hallucinations which are generally agreeable, and a wish to dance and laugh. In animals it has a similar action, causing wild excitement and constant motion, succeeded by clonic epileptiform convulsions during which death often occurs. Usually, if they survive the convulsions, they recover ; but in man the convulsive stage may be succeeded by paralysis, coma, and death, the parts of the nervous system which are first excited being apparently finally paralyzed. The action upon frogs is different from that in warm-blooded animals, for in them it produces such rapid paralysis both of the spinal and motor nerves that convulsions do not occur. Among other drugs having a powerful convulsant action due to irri- tation either of the cortical centres or of the medulla and pons are picro- toxine (the active principle of Anamirta cocculus or Cocculus indicus), cicutoxine (the active principle of Cicuta virosa), and the active principle of the nearly-allied ((Enanthe crocata, coriamyrtine (from Coriaria myrti- folia), digitaliresin and toxiresin, which are products of the decomposition of the active principles of digitalis. The method of localizing- the parts of the brain upon which cer- tain drugs exert a convulsant action, consists in extirpating- some of the motor centres and then giving these drugs, such as picrotoxine, cinchonidine, and quinine, 1 which produce epileptic convulsions. 2 The results of these experiments are that the epileptic convulsions produced by these poisons appear to have a two-fold origin, (a) in the brain, and (6) in the medulla, the centre in the brain being the most sensitive to the action of the poison. In consequence of this, when the poison is given after the destruction of the motor centres on one side in such quantities as not to cause general convulsions, the weakness of the opposite Bide, due to the lesions, becomes still more evident, probably from the motor excitability of the sound side being increased. When convulsions axe produced they are unsymmetrical. Those of the sound side arc much stronger, are generally clonic, and apparently arise from irritation of the cerebral centres. Those of the paralyzed side are much weaker, are more tonic, and apparently arise from irritation of the medulla. I have Been a case in which an epileptic convulsion appeared to be caused by iindiiinal d086fl of <|iii i) i ih-. BoTighi e Santini, Publicazioni del R. IneKt. di stud, superiori in Firenze Sizione U h nadir. 1882, b. 1. ACTION OF DRUGS ON THE BRAIN. 175 ACTION OF DRUGS ON THE SENSORY AND PSYCHICAL CENTRES IN THE BRAIN. The effect of drugs upon the higher mental functions can only be ascertained satisfactorily in man. These functions vary in complexity from simple choice to the highest efforts of genius. The effect of drugs upon the time required for mental pro- cesses is observed by ascertaining, first, the time required for the performance before and after the administration of a drug, and com- paring these two times with one another. The processes generally investigated are, (a) the time required for simple reaction; (b) for discrimination; (c) for selection. The simple reaction is ascertained by marking on a chronograph the time when a signal is made, such as for example the exhibition of a colored flag. As soon as this is seen by the individual experimented upon he marks the time upon the same chronograph by placing a finger upon a key which is connected with the registering electro-magnet. The difference of time between the exhibition of the flag and the time registered by the electro- magnet is equal to the time required for the transmission of the sensory impulse to the brain, for its transmission from the sensory to the motor tracts of the brain, for its passage down the motor nerves, and the latent period of the muscles. The time required for selection is ascertained in the same way, but either a red or blue flag may be shown, and he has to discriminate between them, and only to press when the one previously agreed upon is shown. The difference between the time of this experiment and the former gives the time required for discrimination. The time required for decision is ascertained in the same way as the previous one, excepting that a different signal is to be made on the appearance of the red and of the blue. Simple reaction has been found by Kraepelin 1 to be little affected by nitrite of amyl : sometimes it is a little quicker and sometimes a little slower than normal. It is rendered slower by ether and much slower by chloroform, although exceptionally it may be quickened by chloro- form, probably when used in small doses. The time required for discrimination is not definitely affected by nitrite of amyl, being sometimes increased and sometimes diminished. It is generally increased, though it may be diminished, by small doses of ether and also by chloroform. The time for selection is sometimes increased and sometimes dimin- ished by nitrite of amyl. It is increased by ether and also by chloro- form : and if the quantity given be great, the increase may be very large. The influence of alcohol upon psychical processes is curious; for, while it renders them much slower, the individual under its influence believes them to be much quicker than usual. 1 Kraepelin, Ueber die Einwirhung einiger medicamentose Stoffe auf die Bauer ein- f acker psychischer Vorgdnge, 1882. Abstract in Bevista Sperimentale di Freniatria, anno ix., 1883, p. 124. 176 PHARMACOLOGY AND THERAPEUTICS. Drugs which Increase the Functional Activity of the Brain. Nerve Stimulants. These are remedies which increase the nervous activity of the cerebro-spinal system. They are subdivided into those which act on the cerebrum, or cerebral stimulants, and those which affect the spinal cord, or spinal stimulants. Spinal stimulants have been already discussed (p. 167). Cerebral Stimulants. In popular language the name of stimulant is generally applied to drugs which have the power to increase the activity of the brain. From their producing a feeling of comfort and mirth they are also called exhilarants. The functional activity of the brain, like that of other organs, depends upon the tissue change which goes on in the cells and fibres which compose it, and the amount of tissue change is regulated to a great extent by the quantity and quality of the blood supplied to the organ. A free supply of blood to the brain may be obtained by general excitement of the circulation, i.e., more powerful and rapid action of the heart and contraction of the vessels in other parts of the body driving blood into the brain, or by local dilatation of the cerebral arteries allow- ing blood more ready access to the brain, or by a combination of these factors. Free circulation through the cerebral arteries may be induced to some extent by posture : thus, some men can think best when the head is low, and almost every one naturally assumes the sitting posture with the head bowed down and held between the hands when suffering from the effects of mental depression. This posture is not, as is often sup- 1. merely consequent on the depressed condition of the nerve centres ; it is voluntarily assumed because it affords an actual sense of relief. In r conversation also the body generally stoops forward and the head is held low bo as to allow of a free supply of blood to the brain. 1 &M& pidity of circulation in the carotid of a horse during masti- . (After M Local dilatation of the- arteries of the brain appears to be pro- I m animals by the movements of mastication and probably also ." food or irri bstances in the mouth. It is probably on i the human brain is admirably shown by a tracing tnrein the sknll by Francois Franck and 1 "in. iii.. p. 147. ACTION OF DRUGS OX THE BRAIN. 177 this account that so many substances are chewed for their stimulant action, such as tobacco, betel nut, cola nut, and raisins. The effect of smok- ing is probably to a great extent due also to its action on the cerebral cir- culation through the stimulating effect of the smoke on the nerves of the mouth and nares, and so is the use of alcohol in sips by men such as journalists, who are engaged in writing. It is probable that tea and coffee also cause local dilatation of the arteries supplying the brain. Suction also causes an increased supply of blood to the brain. 1 The effect of local dilatation of the cerebral vessels is very greatly increased, if in addition to it the general circulation is increased and the blood-pressure raised by contraction of the arterioles in the body gener- ally, or by more vigorous action of the heart. General excitement of the circulation is induced by exercise short of fatigue, and a brisk walk will sometimes remove a condition of low spirits. Sometimes the supply of blood to the brain is but slightly increased during continuous exercise, as a large portion of the blood is then diverted to the muscles; but after the exertion is over, the excite- ment of the circulation continues for some time, and then the supply to the brain is increased. In some persons a cold wind acts as an exhila- rant, causing contraction of the vessels with consequent increase in the general blood-pressure and increased circulation in the brain. In per- sons who are debilitated and feeble, on the contrary, the cold may have an opposite effect by depressing the action of the heart. Some men can think best when walking about, on account of the ex- citement in the circulation which the exertion produces, but many such people, when they come to a very difficult point, will stand still or sit down, so as to allow the blood to flow more to the head and less to the muscles. Where the circulation is feeble, so that the heart is not much stimu- lated by walking about, men often find that they can think better when lying down, or sitting with their head in their hands, so as to gain the advantage of the greater flow of blood to the head in these positions. Stimulation of the mucous membrane of the nose by smelling the vapor of strong ammonia, carbonate of ammonia, or acetic acid, raises the blood-pressure generally throughout the body by reflexly stimulating the vaso-motor centre, and thus increases the circulation of blood in the brain. Smelling salts or aromatic vinegar are therefore frequently employed, not only to enable people to attend more readily to any sub- ject in which they are engaged, and to prevent them from falling asleep, but also to arouse them from syncope. The action of sipping is a powerful stimulant to the circulation, for, as Kronecker has shown, the inhibitory action of the vagus on the heart is abolished while the sipping continues, and the pulse rate is very greatly increased. A glass of cold water slowly sipped will produce greater acceleration of the pulse for a time than a glass of wine or spirits taken at a draught. Sipping cold water has been recommended to allay the craving for alcohol in drunkards endeavoring to reform, and probably its 1 Frangois Franck, Marey's Travaux, 1876, p. 354. 12 178 PHARMACOLOGY AND THERAPEUTICS. use is owing to this stimulant action on the heart. It is sometimes said that a single glass of ale sucked through a straw will intoxicate a man, although three times the quantity would not do so if taken in large draughts. If this be true, the more rapid intoxication caused by suck- ing is probably due to the conjoined effects of the alcohol and of tempo- rary paralysis of the vagus caused by the suction. One of the most typical stimulants is alcohol. In small quantities it increases the arterial tension by locally stimulating, first the sensory nerves of the mouth, and afterwards those of the stomach, and thus causing reflex contraction of the vessels, and reflex acceleration of the beats of the heart. This effect occurs before its absorption, and is best marked when the alcohol is strong, and is but slightly marked when it is diluted. It is possible that by inducing local dilatation of the cerebral arteries while the heart still continues active, it may have a stimulant action on the cerebral functions, besides that which it induces by merely exciting the circulation generally. Any stimulant action on the brain beyond what may be explained in this way is very slight, if indeed it exist at all. Its further actions are those of paralysis exerted on the nerve centres in the order of their de- velopment, the higher centres being paralyzed first. At or about this point its stimulating action ceases and its narcotic action commences. Its exhilarating 1 effect, however, may be most marked just at this point, because it is just here, while the circula- tion of the brain remains increased, the restraining or inhibitory parts of it begin to be paralyzed. Thus, imagination and emotion are more readily excited and expression is free and unrestrained ; external circumstances are less attended to, and a boyish or childish hilarity occurs. It is probable that some substances, such as strychnine, increase the mental powers by a direct action on the brain tissue itself, and possibly caffeine may do so also. Drugs which lessen the Functional Activity of the Brain. These drugs are soporifics or hypnotics ; narcotics ; anodynes or analgesics; and anaesthetics. Most of the substances belonging to those classes have a certain re- semblance to one another in their action. Most of them stimulate the mental functions when given in very small doses. In larger doses they have also a stimulating action at first, i. e., while only a small quantity has beeD absorbed, but later on they diminish or abolish the mental facul- ties. The same drug, as, for example, opium or alcohol, in different doses may thus ad as a stimulant, narcotic, soporific, and anaesthetic. In a certain stage of their action opium and alcohol do not merely Lessen the functional activity of the brain, but they disturb the normal relations of one part to another, so as to produce disorder of the mental functions. Bromide of potassium, on the other hand, appears simply to lessen the functional activity of the brain without disturbing the relation of one part to another. Wo do not know what the cause of this differ- ence in their action is, bul with some degree of probability we may jider thai Buch substances as bromide of potassium, or the normal ACTION OF DRUGS ON THE BRAIN. 179 products of tissue-waste, such as lactic acid, simply diminish the functional activity of the nerve- cells without disturbing the nervous paths by which they communicate with one another, so that we have merely a general and even diminution of the mental faculties, as in natural sleep. Such sub- stances as alcohol, on the other hand, may be supposed not only to diminish the functional activity of the cells, but to disturb the rate at which the impulses pass from one cell to another, or to alter the direction in which these impulses are sent, so that instead of the mental activity being les- sened in degree but natural in kind, as after the administration of bro- mide of potassium, we have a disturbance of the functions resembling that which we find in delirium or madness. Hypnotics or Soporifics. These are remedies which induce sleep. Although many of them are also narcotic, yet we may distinguish between hypnotics and narcotics. Pure hypnotics are substances which in the doses necessary to produce sleep do not disturb the normal relationship of the mental faculties to the external world. In sleep the cerebro-spinal system, with the exception of the medulla oblongata, is to a great extent functionally inactive, and even the respir- atory centre and the vaso-motor centre in the medulla, undergo a diminu- tion in their functional activity, so that the respiration becomes slower, the vessels of the surface dilate, and the arterial tension falls. Certain parts of the nervous system may still remain functionally active, so that, for example, when the nose is tickled with a hair, reflex movements of the face or hand may occur without awaking the sleeper ; and certain parts of the brain may also be active, so that dreams occur, which may be afterwards remembered as distinctly as real occurrences, or may produce at the time various movements of the body. But while individual parts may be active, the whole cerebro- spinal system is not active together, and thus any co-ordination which may occur between either sensations or motions is incomplete ; the dreams are incoherent and the motions do not affect the whole body, as is seen in sleeping dogs, where the legs make a movement of running, but the animal continues to lie on its side. The functional inactivity of the whole or of the greater part of the cerebro-spinal system is associated with a condition of anaemia, and probably depends to a certain extent upon it. At the same time it is probable that sleep depends also on func- tional inactivity of the cerebral cells due to accumulation of the products of tissue waste in or around them. The arteries of the brain during sleep are contracted, the brain is anaemic, and its bulk is small. On awaking, the arteries become dilated, the circulation becomes rapid, and the brain increases in bulk. Where parts of the brain are active, as in dreaming, increased circulation occurs, but probably this is local and not general. In considering the circulation of the brain, however, a marked distinction must be drawn between the condition of the arteries and veins. So long as the blood is in the arteries it is available for the nutrition of the nervous structures, but once it is in the veins, it is no longer available, 180 PHARMACOLOGY AND THERAPEUTICS. and its accumulation there will tend to impair nutrition, both by the pressure it exerts on the nervous structures, and by its interference with the supply of arterial blood. In normal sleep the arteries and veins are both contracted, and the brain appears anaemic. In the very act of waking the brain may slightly contract, and this has been thought by Mosso, to whom we owe the ob- servation, to show that sleep does not depend upon anaemia of the brain ; but this contraction may be due to the removal of venous blood, prepara- tory to further arterial supply. Observations on the brain by trephining appear to show that during ordinary sleep, whether it has come on naturally, or has been induced by narcotics, such as a small dose of opium, the brain is anaemic. During functional activity, either of the whole or of its parts, there is arterial dil- atation, with a free supply of blood. During coma the veins become dilated and the brain congested. 1 This congestion, however, is utterly different from the arterial congestion of functional activity, for in coma the blood, though abundant in quantity, is stagnating in the veins, and useless for the tissues. In order to produce sleep, then, two things are necessary : — 1st. To lessen the circulation in the brain as much as possible by diverting blood from it or quieting cardiac action. 2d. To lessen the functional activity of the organ. Blood may be diverted from the brain by dilating the vessels else, where. In weak conditions of the body, with feeble vascular tone, this may occur simply from -position, and such persons become drowsy when standing or Avalking about, or when sitting. As soon as they lie down, however, the cerebral vessels also having little or no tone, the blood floods the brain, and they are unable to sleep. In such persons, sleep may be sometimes obtained by raising the head with high pillows. In such cases, also, vascular tonics, such as digitalis, by increasing the contractile power of the arteries leading to the brain, may enable them to resist the increased pressure in the recumbent position and thus prevent the brain being Hooded with blood and allow sleep to be obtained. The largest vascular area into which the blood may be drawn away from the brain is that of the intestinal canal. When the vessels in the intestine are contracted, it is almost impossible to obtain sleep. Conse- quently both man and animals, when exposed to cold which, acting through the thin abdominal walls, would cause contraction of the intestinal vessels and drive the blood to the brain, instinctively keep the intestines warm bv curling themselves up before going to sleep, and thus covering the abdomen with the thick muscles of the thighs. Warmth to the abdomen also by means of a large poultice outside, will tend to produce Bleep; or, in place of a poultice, a wet compress, consisting of linen or flannel wrung out of cold water, and covered with oil-silk, and with two thicknesses of dry flannel placed above it, tends greatly to in. luce sleep and is most useful for this purpose, especially in children. Hammond, On Wakefulness, 18(50, ]). 20. ACTION OF DRUGS ON THE BRAIN. 181 Warmth to the interior of the stomach has a somewhat similar action, but it differs from warmth to the exterior in this, that it may, to a certain extent, stimulate the heart as well as dilate the abdominal vessels. Stim- ulation of the heart is of course objectionable, as it tends to maintain the activity of the brain. On this account the food or drink should be tolerably warm, but not very hot. Warm milk, either alone, or with bread soaked in it, warm gruel, thin corn-flour, or ground rice, sago, or tapioca, warm beef-tea or soup, or a glass of hot wine and water or spirits and water at bed time, may all act as soporifics by withdrawing the blood from the brain to the stomach. In the sleeplessness of fever a wet pack, by restraining the movements and by diverting blood from the brain to the body generally, is often an efficient soporific. Cold feet also tend to keep up the tension in the vessels and prevent sleep, and therefore they ought to be warmed either by the use of an india-rubber bag filled with hot water, and covered with flannel, or by rubbing them briskly in cold water and drying them thoroughly before going to bed, or by both means combined. Cardiac excitement may be lessened by sedatives, one of the most useful of which is cold. After hours of weary tossing, sleep may some- times be induced by walking about in a night-dress until cool, or by sponging the surface either with cold or hot water. The chief hypnotics or soporifics are — Opium. Bromide of potassium. Morphine. Bromide of sodium. Chloral-hydrate. Bromide of calcium. Butyl-chloral-hydrate (croton- Bromide of zinc. chloral). Monobromo-camphor. Hyoscyamus. Hop. Cannabis. Lettuce. Paraldehyde. Lactic acid. The most powerful hypnotics that we possess are undoubtedly opium and morphia, and they seem to act by depressing the functional activity of the brain itself, although along with this depression an anaemic condition of the organ sets in. Besides their action in pro- ducing sleep, even in health opium and morphine have the power of lessening pain and thus removing the effect which painful stimuli have in maintaining a wakeful condition. Bromide of potassium and bromide of ammonium in large doses have also a hypnotic action, and even in smaller doses, when they would not of themselves produce sleep, they appear to lessen cerebral excitement and allow sleep to come on when other conditions are favorable. Chloral probably causes sleep both by acting on the brain itself and by causing dilatation of the vessels gene- rally. It is therefore a useful hypnotic in persons suffering from Bright' s disease, in which there is high tension of the vessels and con- sequently a tendency to sleeplessness. A combination of hypnotics sometimes answers much better than any one singly. Thus morphine or opium alone sometimes simply cause 182 PHARMACOLOGY AKD THERAPEUTICS. excitement, but when chloral is given, either along with, or after them, the excitement is quieted and sleep occurs. A combination also of small quantities, such as five or ten minims, of solution of opium or morphine with five grains of chloral and ten to thirty of bromide of potassium, is sometimes more useful than any one of the three used alone. Indian hemp also is sometimes used to procure sleep, and lettuce and lactucarium are also said to have a hypnotic action. Lettuce certainly does seem to have such an action, but how much of it depends upon the juice and how much upon the mechanical effect of the indigestible fibres of the lettuce upon the stomach in drawing blood to it, it would be hard to say. Hops are said to be hypnotic, and their combination with lettuce in the form of a supper consisting chiefly of beer and salad has some- times a very marked soporific action. Narcotics. Narcotics are substances which lessen our relationships with the external world. They are closely related, as I have already stated, to stimulants ; and alcohol, in the various stages of its action, affords us a good example of both stimulant and narcotic action. Alcohol at first excites the cerebral circulation and then begins to paralyze various parts of the brain in the inverse order of their development. But this order differs in different individuals, for in watching the growth of children we find that the order of development of the nerve centres in them is not always the same ; some talking before they can walk, and others walking before they can talk. In all, however, the powers of judgment and self-restraint are among the last to be com- pletely developed. While the circulation of the brain is still active, the restraining or depressing effect of present external circumstances, and the restraining effect of training, during previous life, which is stored up as it were in the inhibitory centres, are lessened. The fancy is thus allowed free play and a condition of joyousness and volubility like that of a child occurs. The imagination and memory fail next in some, while the emotions become prominent, and to this follows paralysis or paresis of the power of co-ordi- nation. In others the power of co-ordination is impaired before the mental faculties are much affected, the speech becomes thick and the walk in-- becomes staggering and uncertain. At this stage reflex action Mill persists, hut afterwards it diminishes, and finally paralysis of the respiratory centre occurs. The effect of other drugs, such as ether and chloroform, is much the same as that of alcohol. In tie- case of opium and Indian hemp, however, there is but little excitement of the circulation, and their effects appear to be due more to alterations in the relative functions of the different parts of the brain. Belladonna, hyoscyamus, stramonium, and their allies, have a curious effect They produce delirium of an active character, the patient having a constant desire to speak, move about, or be doing something, while at the same time he feels great languor. It is probable that this effed is due to the combined stimulant action of these drugs on the ACTION" OF DRUGS ON THE BRAIN. 183 nerve centres in the brain and spinal cord and their paralyzing action on the peripheral ends of motor nerves. Anodynes or Analgesics. Anodynes are remedies which relieve pain by lessening the ex- citability of nerves or of nerve centres. They are divided into local or general : — Local Anodynes. General Anodynes. Cold — Anaesthetics in small doses. Cold water. Atropine. Ice bags. Belladonna. Warmth — Butyl chloral. Poultices. Chloral. Fomentations. Conium. Aconite. Conine. Acupuncture. Gelsemium. Atropine. Hyoscyamus. Belladonna. Hyoscyamine. Blood letting — Lupulus. Leeches. Lupuline. Cupping. Morphine. Carbolic acid. Opium. Carbonic acid. Stramonium. Creasote. Conium. Gelsemium. Hydrocyanic acid. Morphine. Opium. Action. — The sensation of pain is due to a change in some part of the cerebrum, and is usually excited by injury to some part of the body. According to Ferrier the hippocampal region is the seat of sensation. Pain may be of central origin, for if these convolutions should from any cause undergo changes similar to what usually take place in them on the application of a painful stimulus to a nerve, pain will be felt, even although no injury whatever has been done to the body. Something of this sort appears to occur in certain cases of hysteria. Conversely, if the changes which ordinarily occur in these convolu- tions on severe irritation of a sensory nerve are prevented from taking place, pain will not be felt, however great the stimulus to the nerve may be. The sensory nerves of the head pass directly to the brain, but all other sensory nerves have to pass for a greater or less distance along the spinal cord before they reach the brain. The transmission of painful impressions along the spinal cord occurs in the grey matter, and the effect of anaesthetics in preventing the trans- mission of painful impressions while tactile stimuli are still conducted has been already discussed. 184 PHARMACOLOGY AXD THERAPEUTICS. Pain may be occasioned by irritation applied to nerves anywhere be- tween the brain and the periphery ; and whatever its point of application may be, it is usually referred to the peripheral distribution of the nerve. Sometimes irritation of a nerve, instead of being referred by the brain to the proper spot, is referred to a branch of the same nerve going to a different point. Pain maybe caused by violent stimulation of the peripheral distri- bution of a nerve, of its trunk, of the spinal cord through which the fibres pass to the brain, or of the encephalic centres themselves. Pain may be relieved by (a) removing the source of irritation, (b) by preventing the irritation from affecting the cerebrum. Thus, if necrosis of the jaw should give rise to intense pain, the pain will at once cease on dividing the sensory nerve by which the impulses are transmitted to the brain. It may be relieved, also, while the source of irritation still remains by lessening the excitability of the peripheral terminations of the sensory nerves which receive the painful impression ; or of the nerve trunks ; or of the spinal cord along which the impression travels ; or of the cerebral centres in which it is perceived. Opium probably acts on them all, diminishing the excitability of the cerebral centre, of the spinal cord, and of the sensory nerves ; and bro- mide of potassium is also supposed to affect all these structures, though to a much less degree than opium. Chloral, butyl-chloral, lupulin, gelsemium, and cannabis indica proba- bly act on the cerebral centres. Belladonna and atropine lessen the excitability of the sensory nerves, and probably this is effected also by hyoscyamus, stramonium, aconite, aconitia, and veratrine. Uses. — It is evident that if the nerve centre by which pain is per- ceived is deadened, the pain will cease wherever its seat may be ; and, therefore, opium and morphia are used to relieve pain, whatever may be cause. Cannabis indica and bromide of potassium, having likewise a central action, may also be employed, but they are very much less efficient than opium. Chloral and butyl-chloral have an anaesthetic action when given in very large doses, but in moderate doses their power to relieve pain is not so marked as their hypnotic action. Butyl- chloral, however, seems to have a special sedative action on the fifth nerve, and sohasgel- Beminm ; consequently both of them are used in the treatment of facial neuralgia. As belladonna, aconite, and veratrine have a local action on the peri- pheral ends of the sensory nerves, they are usually applied directly to the painful purl in the form of ointment, liniment, or plaster. Local injections of morphine, atropine, and ether, in the neighborhood of the painful part, are often of the greatest service. Adjuncts <<» Anodynes. — As pain depends on the condition of the cerebral centre by which it is perceived as well as on irritation of nerves, it is obvious that it may vary with the condition of these centres, although the irritation remains. Thus a decayed tooth does not alwayi cause toothache, and when the toothache comes on, it. may fre- quently be removed bv means of a brisk purgative, even although the be not extracted. It is possible that the purgative may act partly ACTION OF DEUGS ON THE BKAIN. 185 by lessening congestion around the tooth, but partly also by altering the condition of the cerebral centres. When the attention is fixed upon other things, also, the pain may be to a great extent, or even completely, abolished, as in mesmerism or hypnotism. The sensory stimuli, also, which would usually produce pain, may be diverted voluntarily or involun- tarily into motor channels. Thus, during the heat of action, the pain of a wound is not felt ; and the pain felt during the extraction of a tooth is lessened by the employment of violent muscular effort, as in grasping the arms of the dentist's chair. Other most powerful adjuncts are electricity applied along the course of the nerves, and counter- irritation, especially by means of the actual cautery to the painful part, and, when other means fail, stretching the nerve may succeed. Cold, also, applied to the surface over a painful part, will relieve pain, and so may dry heat, applied by a sand-bag or hot cloth, or moist heat in the form of a poultice: for the mode of action of these vide "Action or Irritants." Pain has been ascribed by Mortimer Granville to vibrations of nerves or of the sheaths ; and, in order to lessen it, he proposes to pro- duce vibrations of a different nature : this he does by percussing over the painful nerve with a small hammer, worked either with clockwork or electricity. For a dull heavy pain he uses quick and short vibrations of the hammer, and for a sharp lancinating pain he uses large and slow vibrations. Anaesthetics. Anaesthetics are remedies which destroy sensation. It has already been mentioned that both sensation and pain require for their perception a certain condition of the cerebral centres and of the sensory nerves and spinal cord by which impressions are conveyed to these centres. The difference between anaesthetics and anodynes is to a great extent one of degree. Anodynes affect more particularly the cerebral centres by which pain is perceived, or the conducting paths by which painful impressions are transmitted, and thus in moderate doses lessen pain with- out destroying reflex action. They only affect the ordinary centres for reflex action when the dose is considerably increased. Anaesthetics, on the other hand, affect the cerebral and spinal centres more equally, and so abolish pain, ordinary sensation, and reflex excitability more nearly at the same time, though their abolition is by no means completely simul- taneous. According to Eulenberg, in chloroform narcosis the patellar reflex is abolished first, then reflex from the skin, then from the conjunctivae, and lastly from the nose. As the anaesthesia passes off they return in the inverse order, patellar reflex being the last to reappear. A stage of ex- citement generally precedes the disappearance of patellar reflex, both in man and animals. Narcosis by ether differs from that of chloroform in the much greater increase of patellar and other tendon reflexes, both in extent and dura- tion. 186 PHARMACOLOGY AND THERAPEUTICS. Chloral hydrate and potassium bromide have an action like chloro- form, but much weaker. Like chloroform, they paralyze patellar reflex before corneal reflex, but butyl-chloral (croton-chloral) paralyzes the corneal reflex before the patellar. In ordinary sleep, reflexes disappear in the same order as in chloro- form narcosis, but in mesmeric sleep the reflexes are increased as in narcosis from ether. In hysterical conditions diminution of the cerebral reflexes from nose and cornea with persistence of patellar reflexes has been observed. The reflex power of the vaso-motor centre is very quickly paralyzed by chloroform, so that irritation of a sensory nerve will no longer raise the blood-pressure. Its reflex power is much less affected by ether. 1 Anesthetics may be divided into local and general. The local are those which abolish the sensibility of the peripheral nerves of a par- ticular area. The general are those which act on the central nervous system in the way already described, and abolish sensation throughout the whole body. The chief local anaesthetics are cold and carbolic acid. Iodoform is also employed as a local anaesthetic. For the purpose of producing local anaesthesia, cold is generally applied by means of ether spray, until the part is all but frozen and is insensible, when slight operations may be made without the patient feel- ing any pain. The ether may perhaps have itself a certain amount of physiological effect in diminishing sensibility when applied in this manner. Carbolic acid painted over the surface also causes it to become white and to lose its sensibility, and may thus be used to lessen the pain of opening an abc General anaesthetics are — Nitrous oxide. Trichlorhydrin. Ether. Bi-chloride of methylene. Chloroform. Paraldehyde. Bromoform. Bi-chloride of ethidene. Tetrachloride of carbon. Bromide of ethyl. With the exception of nitrous oxide they all belong to the class of alcohols and ethers, and the substitution-compounds having an anaesthetic action arc probably almost indefinite in number. Even alcohol itself produces general anaesthesia when volatilized and inhaled. General anaesthetics may destroy the sensibility of the nerve (•••ntre- indirectly or directly. Anaesthesia is induced indirectly by Btopping the circulation in the brain, and thus arresting the process of oxidation and tissue change in the nerve cells which are necessary for their functional activity. This result may be produced by draining the blood from the head into other parte of the body. Thus in some of the hospitals at Paris, before anaesthetics were introduced, a plan was sometimes employed of rendering If I'. Bowdltch and C. B. Mi not, Boston Med. and Surg. Journ., May 21, 1874. ACTION OF DRUGS ON THE BRAIN. 187 a patient insensible before an operation, by laying him flat on the ground, and then lifting him very suddenly to a standing posture by the united efforts of six or eight men. Local arrests of the circulation to the brain by ligature or by com- pression of the arteries has a similar effect. Waller has recommended diminution of the cerebral circulation, by the combined effects of simul- taneous pressure on the carotid arteries and vagi nerves, as an easy means of producing anesthesia for short operations. Slight anaesthesia, usually accompanied by some giddiness, may be produced by taking a number of deep breaths in rapid succession. This may be used in order to lessen the irritability of the pharynx in laryn- goscopy examinations, and to lessen the pain of opening boils or abscesses. The anesthesia thus produced may perhaps depend on anemia of the brain, although this is not certain. Anesthesia may also be produced by diminishing the internal respiration of the nerve cells through a gradually increasing venous condition of the blood. Thus gradual suffocation by charcoal fumes or carbon monoxide causes complete insensibility, and the inhalation of nitrogen and of nitrous oxide has a similar action. Anesthesia may be caused by the direct action of drugs on the nerve cells themselves. Chloroform, ether, and other allied substances belonging to the alcohol series appear to act in this way. Although their action is generally exerted through the blood by which they are conveyed to the brain when inhaled, yet they will also produce a similar action if locally applied to the nerve centres. Thus Prevost 1 found that chloroform applied directly to the brain of a frog narcotizes it when the aorta is tied. When the aorta is again unligatured, so that the current of blood can again wash the chloroform away, the narcosis disappears. Chloroform and ether when inhaled appear to act like alcohol, producing paralysis of the nerve centres, commencing with the highest and pro- ceeding downwards. The rate of paralysis, though the same in order, is more rapid than that caused by alcohol. These anesthetics are, however, not nerve poisons only, they are protoplasmic poisons affecting simple organisms, such as amoebe and leucocytes, and destroying also the irritability of muscular fibre. Their action upon muscular fibre is much more marked in lower than in higher animals, although it exists in both. In leeches they appear to destroy muscular irritability, and to coagulate the muscles, rendering them rigid before they affect the nervous system. This has been shown by some experiments of Krukenberg, in which he applied two ligatures to a leech, so as to divide it into three parts. The middle part, being immersed in a mixture of water with ether or chloroform, became per- fectly rigid, and its muscular fibres no longer contracted when stimu- lated electrically. The conducting power of the nerves in this part appeared, however, unimpaired, so that the two ends of the leech acted co-ordinately. When the middle part of a leech similarly ligatured, was rendered rigid by hot water, both muscles and nerves were destroyed, 1 Prevost, Practitioner, July, 1881. 188 PHARMACOLOGY AND THERAPEUTICS. and the two ends of the leech then acted independently of each other, and not in accordance with one another, as they did when chloroform was used. This action of chloroform and ether upon muscular fibre is one of considerable importance in reference to the occasional stoppage of the heart and consequent death during the administration of anaesthetics. The action of anaesthetics may be divided into four stages : — 1st. The stimulant stage. 2d. The narcotic and anodyne stage. 3d. Anaesthetic stage. 4th. Paralytic stage. Stimulant stage. — Chloroform and ether, as already mentioned, resemble alcohol in their actions, and like it in small doses will produce a condition of stimulation and acceleration of the circulation passing gradu- ally into one of narcosis, in which the action of the higher nervous centre is more or less abolished, while that of the lower centres still remains. In small quantities chloroform and ether are sometimes taken, either internally or by inhalation, for their stimulant effect. They are useful in lessening pain and spasm, as in neuralgia, and biliary, renal, or intestinal colic, when given till the stimulant is just passing into the nar- cotic stage. Narcotic stage. — When pushed still further, sensibility becomes more impaired, reflex action still continues, and sometimes, just as in drunkenness, there is a form of wild delirium and great excitement. This is much less marked in feeble or debilitated persons than in strong men. In the latter the struggles which occur in this condition are some- times exceedingly violent, the patient raising himself forcibly from the couch, and his muscles being in a state of violent contraction, the face livid, the veins turgid, and eyeballs protruding. Usually this condition quickly subsides and passes into the third stage — that of complete anaesthesia. In order to lessen the pains of labor, anesthesia is usually carried to the commencement of the second stage. Anaesthetic stage. — The third stage differs from the second, in the functions of the spinal cord being abolished, as well as those of the brain; ordinary reflex is consequently abolished, and the most common way of ascertaining whether this stage has set in or not is by drawing up the eyelid and touching the conjunctiva. If no reflex contraction of the eyelid occurs, the anaesthesia is complete. By careful and judicious administration pf the anaesthetic, this condition may be kept up for a length of time, even for hours, or days; but if the inhalation be carried far, the anaesthetic passes into the fourth stage. The third stage is the one employed for surgical operations. Paralytic Stage. — In the fourth the respiratory centre becomes paralyzed, respiration ceases, and the beats of the heart become feebler and ' je altogether. ACTION OF DRUGS ON THE BRAIN. 189 Uses of Anaesthetics. Anaesthetics are used not only to lessen pain but to relax muscular action. They are chiefly employed to lessen pain in surgical operations, in labor, and in biliary and renal colic. They are used to lessen mus- cular action and spasm in tetanus, in poisoning by strychnine, in hydro- phobia, and in the reduction of dislocations, fractures, and hernia. They are also of assistance in diagnosis, by allowing careful examination to be made of parts which are too tender or painful to be examined without it, and by causing the phantom tumors due to spasmodic contraction of the muscles to disappear. Dangers of Anaesthetics.— (1) One danger is that just men- tioned of paralysis of the respiration from an overdose. This, however, is one of the least of the dangers, and if the enfeeblement of the respiration be observed in time, it is generally possible to save the patient by stopping inhalation, and keeping up artificial respiration for a little while if necessary. (2) Another danger is from paralysis of the heart by a too con- centrated chloroform vapor. This is indicated by a sudden stoppage of the heart, paleness of the face, and dilatation of the pupil, while the respiration may continue. If this accident should occur, the body of the patient should be inclined so that the head should be lower than the feet, and artificial respiration should be kept up briskly, the expiratory movements being made by pressure on the thorax and especially over the cardiac region, so that the mechanical pressure should stimulate the heart if possible to renewed action. The vapor of nitrite of amyl may also be administered by holding a piece of blotting-paper or cloth, on which a few drops have been sprinkled, before the nose, while artificial respiration is kept up. The inspiratory movements may be made by drawing the arms back- wards over the head, as in Sylvester's plan. (3) A third danger arises from stoppage of the heart by a combina- tion of chloroform narcosis and shock. This is one of the most dangerous conditions. It may occur even during full chloroform nar- cosis in animals from operations on the stomach; but it is much more common in men from imperfect anaesthesia. In very many cases of so-called death from chloroform during operations, we find it noted as a matter of surprise that death should have occurred, as the quantity of chloroform given was so small. The reason that death occurred prob- ably was because the quantity of chloroform given was so small. Had the patient been completely anaesthetized, the risk would have been very much less. The reason why imperfect anaesthesia is so dangerous is, that chloroform does not paralyze all the reflexes at the same time. A very large proportion of the deaths from chloroform occur during the extraction of teeth, and we may take this operation as a typical one in regard to the mode of action, both of the sensory irritation and of the chloroform. When a tooth is extracted in a waking person, the irrita- tion of the sensory nerve produced by the operation has two effects : — 1st, it may, acting reflexly through the vagus, cause stoppage of the heart and a consequent tendency to syncope. 2d, it causes reflex 190 PHARMACOLOGY AND THERAPEUTICS. contraction of the arterioles, which tends to raise the blood-pressure and counteract any tendency to syncope which the action of the vagus might have produced. In complete anesthesia all these reflexes are paralyzed, and thus irritation of the sensory nerves by the extraction of the teeth has no effect either upon the vagus or upon the arterioles. In imperfect anaes- thesia, however, the reflex centre for the arterioles may be paralyzed (vide p. 188), while the vagus centre is still unaffected. The irritation caused by the extraction of the tooth may then cause stoppage of the heart, and there being nothing to counteract the tendency to faint, syncope occurs and may prove fatal. With nitrous oxide there is very much less danger, inasmuch as the nitrous oxide causes a venous condition of the blood, with consequent contraction of the arterioles and rise in the blood-pressure, so that any tendency to syncope through vagus irritation is efficiently counteracted. With ether, also, the danger is very much less, probably because it has a more equal effect on the centres (vide p. 188). (4) Another danger is that of suffocation from blood passing into the trachea in operations about the mouth or nose, or from the contents of the stomach being drawn into the larynx when vomiting has occurred during partial anaesthesia. In consequence of this, it is better, instead of giving chloroform or ether during the whole of an operation on the mouth or nose, to give it only at the commencement, and to administer along with it, or before it, a hypodermic injection of one-sixth to one- third of a grain of morphine. The chloroform anaesthesia thus passes into the morphine narcosis, and the operation can be finished without pain and without danger. To prevent the occurrence of vomiting, it is advisable not to give solid food for some hours before an operation, though if necessary a little beef-tea or stimulant may be given half an hour or so before the administration of the anaesthetic. Mode of Administering' Anaesthetics. — In order to obtain the 4 PHARMACOLOGY AND THERAPEUTICS. refractive media of the eye in cases of astigmatism, or in cases where the patients either suffer from spasm of the ciliary muscle or are unable voluntarily to relax the accommodation. Myotics are useful in cases of commencing glaucoma, from their power to lessen intra-ocular tension, and in such cases mydriatics on the other hand are injurious and may hasten the appearance of the disease. In glaucoma the tension within the anterior chamber is greatly in- creased, and the increase, according to Tweedy, is due to the natural channel of escape for the aqueous humor through the spaces of Fontana and the canal of Schlemm being blocked by the iris lying against the cornea. This condition is relieved by myotics, which, by causing con- traction of the pupil, draw the iris away from the cornea, and thus allow the fluid to escape through the spaces of Fontana. When the anterior chamber of the eye is shallow and the iris is lying close to the cornea, so as nearly, though not quite, to obstruct the spaces of Fontana, atropine may bring on an attack of glaucoma by dilating the pupil and thus packing the tissue of the iris into the angle between it and the cornea, so as to render the obstruction to the spaces of Fontana complete. Action of Drugs on the Sensibility of the Eye. — The sensi- tiveness of the eye to impressions is increased by strychnine, the field of vision becoming larger, and the sight more acute, so that objects can be distinctly observed at a greater distance, and the field of color is increased for blue. This action appears to be to a certain extent local, as it occurs more distinctly on that side where the strychnine has been injected hy- podermically. The sense of color is affected in a remarkable way by santonin, which at first causes objects to appear somewhat violet and after- wards of a greenish yellow. The yellow color has been ascribed to stain- ing of the media of the eye by santonin, as it becomes yellow when exposed to the light ; others again have supposed the alteration in the apparent color of objects to be due, first to a stimulation, and then to a paralysis of those constituents of the retina by which the violet color is perceived. The sensibility of the eye for red and green appears to be sometimes diminished by physostigmine. Action of Drugs in Producing Visions. — It may be well here to mention the effect of some drugs in causing subjective sensations of Bight, although these probably depend rather upon the action of the drugs on the brain, than on the eye itself. The centres for sight, according to Fender, are the angular gyrus (14 and 15, Fig. 46, p. 170), and the occipital lobes. In delirium tremens arising from alcoholic excess the patients often complain much of visions of the most disagreeable charac- ter, which often take the form of demons or of animals. Cannabis indica produces in some persons, though not in all, visions which may he pleasant or laughable. These chiefly occur just before Bleep. 1 Salicylate of soda in some persons tends to cause most disagreeable visions whenever the eyes are shut, and I have seen it have this effect Compere Schroff, Pharmacologic, lth edition, p. 535, and Wood, Materia dfedica, 3d i -in ion, p. •-i.',< l . ACTION OF DRUGS ON SPECIAL SENSE. 205 even in such a small dose as five grains. Large doses of digitalis may cause subjective sensations of light, and after taking nearly one grain of digitalin in the course of forty-eight hours, I suffered from the centre of the field of vision being occupied by a bright spot surrounded by rainbow colors. Digitalin when introduced into the eye locally causes at first smarting and lacrymation, which soon passes off, but after four or five hours, when a light is looked at, a halo is seen surrounding it which is not improbably due to some opalescence in the cornea. 1 Action of Drugs on Hearing*. The sense of hearing depends on the transmission of sonorous vibra- tions from the air to the auditory nerve by means of the membrana tympani and the ossicles of the ear, and upon the perception of those vibrations by the brain. The centre for hearing, according to Ferrier, is in the superior tem- poro-sphenoidal convolution (16, Fig. 46, p. 170). It is probable that subjective sounds not depending on disturbance of the auditory apparatus, such as the sounds of voices, &c, heard in delirium or mania, or as the prodromata of an epileptic fit in certain individuals, or during intoxica- tion by cannabis indica, are due to irritation of these centres. The sense of hearing may be dulled by any interference with the passage of the sound into the ear, as by wax in the auditory meatus, by disease of the auditory nerve or of the brain itself. The hearing may be rendered more acute by the removal of any ob- stacle in the way of transmission of sound to the auditory nerve, or by drugs which increase the excitability of the auditory nerve or of the brain ; thus the wax may be removed by simply syringing ; thickness and catarrh of the Eustachian tube which interfere with vibrations in the middle ear may be lessened by the inhalation of camphor and ammonia, or by the application of a solution of ammonium chloride and sodium bi-carbonate to the posterior nares either by the spray or nasal douche. The excita- bility of the auditory nerve or of the brain is increased by strychnia which renders the hearing more acute. Subjective noises in the ear, such as humming, buzzing, or ringing, are often very troublesome. Bubbling noises may be due to mucus in the Eustachian tube. Buzzing or humming are probably generally caused by vascular congestion either of the external^meatus, of the middle ear, or of the Eustachian tube. Where the bubbling noises are due to the presence of mucus they may be to a considerable extent removed by washing out the mucus with a solution of carbonate of soda applied by a nasal douche. Noises in the ears due to hyperemia may be lessened or removed by cholagogue purgatives and by hydrobromic acid. Where chronic thickening of the membrane is present, relief is usually afforded by iodide of potassium, or iodide of ammonium, both applied locally and taken internally. Subjective noises in the ears are caused by quinine in large doses, and also by salicylate of soda. Both of these drugs have their effect upon the ear to a great extent neutralized by hydrobromic 1 Lauder Brunton, On Digitalis, &c. 206 PHARMACOLOGY AND THERAPEUTICS. acid, and ergot 1 is said to have a similar power to prevent or remove the unpleasant singing. It is uncertain whether the singing caused by qui- nine and salicylates is due to their action on the auditory apparatus, or the cerebral centres, but the fact that in larger doses they may cause de- lirium indicates that even the earlier symptom of buzzing in the ears may be due in part at least to their action on the cerebral centres. Action of Drug's on Smell. Many drugs, such as musk and ethereal oils, have a marked and characteristic smell due to their effect upon the terminal branches of the olfactory nerve. This nerve is soon exhausted, so that in a very short time the smell is no longer perceived with anything like the intensity it was at first. Such smells as these just mentioned cannot be perceived by persons suffering from anosmia, but certain drugs, such as ammonia or acetic acid, can be recognized by them. The reason of this is that although such persons are incapable of perceiving any true smell, the nasal branches of the fifth nerve are irritated by pungent vapors, and thus produce a certain kind of sensation. The power of distinguishing smells seems to be increased by strychnine ; which appears at the same time to render such disagreeable odors as those of assafoetida, garlic, and valerian agreeable. This effect may be due to the action of strychnine on the olfactory apparatus, but it is very probably due rather to the ac- tion of the drug on the cerebral centre for smell, which, according to Ferrier, is situated at the tip of the temporo-sphenoidal lobe. The power to distinguish smells is diminished by such drugs as lessen the sensibility of the brain, or by those which cause alterations in the nasal mucous membrane, as, for example, iodide of potassium given in such doses as to produce coryza. Action of Drugs on Taste. Most of the substances used in medicine have a strong taste, and many a very unpleasant taste. What is usually termed taste frequently depends on a mixture of taste and smell, and if the sense of smell is abolished for the time being, the characteristic taste of the substance cannot be distinguished. This 18 the reason why castor-oil, which owes its nauseous taste almost entirely to its odor, can be swallowed without being so readily distinguished if the nose is held during the act of swallowing. In addition to the taste they produce in the mouth, certain substances leave an impression termed "after-taste" on the tongue after they have been swallowed or ejected; and this is sometimes quite different from that of the taste of the Bubstance itself: thus bitters leave a sweet after-taste in the mouth. [f quinine is taken in a nearly neutral solution, it leaves a persistent hitter taste from the sparingly soluble alkaloid being precipitated on the tongue and remaining there for a length of time, but if the quinine be taken with excess of acid, so as to keep it entirely in solution, and Schilling, Aertzl. Inlelligenzblatt, 1883. ACTION OF DRUGS ON RESPIRATION. 207 washed out of the mouth immediately with a draught of water, it leaves a sweet after-taste. Some substances after their entrance into the blood are excreted by the saliva and may cause a somewhat persistent taste in the mouth ; this is observable in the case of iodide of potassium. Iodine appears also to have the power of causing other substances to be excreted by the saliva, when they are combined with it, and thus Bernard found that iodide of iron was secreted by the saliva, though lactate of iron was not ; and I have sometimes thought that iodine has a similar effect upon quinine, because I have very frequently noticed patients complain of a persistent bitter taste in their mouth when I have given quinine combined with iodide of potassium, although they did not complain of this when either of the drugs has been given without the other. CHAPTER X. ACTION OF DRUGS ON RESPIRATION. Respiratory Stimulants and Depressants. It is usually supposed by naturalists that in the descent of man from some organism low in the scale of existence, he has passed at a remote period through a stage resembling the Ascidians or Tunicata. In these animals respiration is maintained by water being driven through a per- forated sac in the meshes of which the nutritive fluids of the animal circulate. The contractile motions of the sac by which the circulation of fluid is maintained probably depend on a nervous ganglion situated between the oral and anal apertures as represented in the diagram (Fig. 51). We do not know whether or not this ganglion may influence the circulation which is maintained by the rhythmical contractions of the simple tube which serves as a heart. These drive the fluid first in one direction, and then after a while the action of the tube is reversed, and its contractions drive the fluid in the opposite direction. This ganglion in its functions would correspond with the medulla oblongata in the vertebrata, and thus the medulla oblongata may be looked upon as a lower and more fundamental centre than the brain or spinal cord. We see this more distinctly perhaps by looking at the two diagrams (Figs. 52 and 53) representing an amphioxus and a fish. In the am- phioxus respiration is kept up in much the same way as in the ascidian, the water passing from the pharyngeal to the atrial sac and through the atrial aperture or abdominal pore. There is no head and no organs of special sense, and so we have no brain whatever. But the body is elon- gated so as to remind us of an ascidian, having its ganglion and the part 208 PHABMACOLOGY AXD THERAPEUTICS. of the body wall containing it so much extended as to remove the anal considerably from the oral aperture. The muscles of this elongated body require innervation, and thus the ganglionic mass is elongated into a cord called the myelon, which represents the spinal cord as well as the medulla oblongata. In ascidians then we have a mass corresponding to the medulla : in the amphioxus we have a mass corresponding to medulla and spinal cord. Body wall Nerves passing from the ganglion. Pharyngeal sac. General body cavity. Heart. Intestine. — .__ Oral aperture. Part of body wall containing ganglion. — - Branchio-anal or atrial aperture. \o\JL f Branchial openings in the sep- r JsL-lL_ ~{ turn between the pharyngeal " ll_ (. and anal sac. Fig. 51.— Diagram of an Ascidian. Oral aperture, Medulla. Branchial Branchial aperture, abdominal pore Anal aperture '-'.— Diagram of Amphioxus. The water enters the oral aperture, passes through the openings in the pharyngeal sac into another cavity, whence it escapes by the abdominal pore. Fig. 53.— Diagram of fish. In a fish the pharyngeal or branchial sac, instead of opening into the atrial Bac, opens directly into the surrounding water. We haveahead and organs of special sense, and therefore we have a large nervous mass or brain. In these throe members of the animal kingdom, therefore, we have the medulla as the lowest or fundamental centre, next the spinal cord, and lastly the brain. We might therefore expect that notwithstanding tin- apparently higher position and greater nearness of the medulla to the brain than to the spinal cord, the medulla would be less readily affected bj many drugs than the cord or the brain, and this is find in the case of such drugs as alcohol, ether, or morphia, ACTION OF DRUGS OX RESPIRATION. 209 which appear to paralyze the nervous centres in the inverse order of their development, the brain first, spinal cord next, and medulla last. There are some drugs, however, e.g., aconite, gelsemium and hydro- cyanic acid, which seem to have a special paralyzing action on the respiratory centre. If we look at the ganglionic mass in an ascidian, represented in the diagram, we shall see that it sends some fibres to the pharyngeal sac and some to the anal sac. If these two sacs were to contract together they would oppose each other's action, and thus the passage of water through the branchial apertures would be stopped, and respiration consequently arrested. They must therefore act alternately, and this alternate action is regulated by the ganglion. This ganglion consists of numerous nerve cells and fibres. As some of these have a more special connection with the pharynx, the group which they form may be called the pharyngeal centre or inspiratory centre. Similar arrangements occur in higher animals, and the terms used in regard to their nervous system may lead to some confusion of thought ; thus we speak of the respiratory, of the inspiratory, of the expiratory, and of the vomiting centres. By nerve centres we simply mean the groups of cells and fibres which are concerned in the performance of certain acts. They are not necessarily entirely distinct from one another, and the same group of glanglionic cells may form a part of several centres. Thus in the accompanying diagram, the respiratory centre includes both inspiratory and expiratory centres, and the vomiting centre includes some ganglionic groups which form part of the inspiratory, and others forming part of the expiratory centres, besides other ganglion groups which are concerned with the simultaneous dilatation of the cardiac orifice of the stomach. On analyzing this subject still further also we find that the inspiratory centre affects many muscles, and that it does not always affect them to the same extent. Thus in men the diaphragm takes a more active share in inspiration during the day than the thoracic muscles. During sleep the diaphragm takes a much less active part, and may be entirely quiet, while the thoracic muscles are more active, and the chest rises and falls more than during waking. The inspiratory centre might be thus still further divided into tlioracic inspiratory centre, and diaphragmatic inspiratory centre. Such subdivisions appear absurd if we imagine that each centre represents a distinct nervous mass, and we become puzzled to under- stand how the medulla oblongata can contain so many distinct centres in a small bulk. But if we remember that the word " centre" simply indicates a group of cells and fibres connected with the performance of a particular act, and that two centres may be formed by the same gangli- onic groups, and differ from one another only by having a few ganglion cells more or less which alter the function they perform, no harm is done by the use of the term. The act of respiration consists in the alternate enlargement and diminution of the thoracic cavity, so that the air is alternately inspired and expired. 14 210 PHARMACOLOGY AND THERAPEUTICS. The muscles by which this is effected in ordinary respiration are the diaphragm and intercostal and scaleni muscles. The diaphragm descends, and the intercostal and scaleni muscles raise the ribs during inspiration. Vomiting centre. Respiratory centre. Fig. 54.— Diagrammatic representation of various groups of ganglion cells, or "centres," in the medulla oblongata. The arrows indicate the direction in which the nerve-currents pass. Those pointing to the cells indicate sensory, those pointing from the cells indicate motor, nerves. Expiration is normally a passive act, 1 and is not performed by muscular action, but simply by the tendency of the diaphragm and thoracic walls to return to the position of equilibrium from which they had been removed during inspiration, and to the contraction of the elastic walls of the air-vesicles distended by inspiration. When the supply of oxygen is deficient, other muscles are called in to aid the inspiration. Expiration appears to be a passive act not merely in ordinary respiration but even in dyspnoea caused by the absence of oxygen. In some experiments by Bernstein 2 the inspiration and expiration were equally increased in a rabbit, when the air which it had breathed was replaced by hydrogen. But expiratory efforts are required both for the production of voice, and for the removal of irri- tants from the air passages by coughing or sneezing; and forcible expiration is produced when an irritant is applied to the mucous mem- brane of the nose, of the larynx, trachea, or bronchi. As every one who has drunk a hottle of soda-water knows, carbonic acid is an irritant of considerable power to these mucous membranes, and when it is breathed instead of air or hydrogen the expiration becomes much more powerful, and is no longer a passive action, but an active one, performed by active muscular exertion. Bernstein, Archiv f. Aunt. u. Physiol., 1882, p. 322. Bernstein, Op. ration .' j Cutaneous Nerves of Face * Nasal Branch of Fifth Nerve. Superior Laryngeal Nerve. Inferior Laryngeal Nerve... Larynx Cutaneous Nerves of the Chest I dory Fibres of Vagus excited b J distension of Lung ofYagusexolted by collapse of Lung Eespiratory Centre in Medulla and Cord. Spinal cord. Ion of respiratory centre, and the afferent nerves which influence >t. lasfUM • lndi< ated by plain, and expiratory by dotted, lines. ACTION OF DRUGS ON RESPIRATION. 217 On the hypothesis that the various actions of respiration depend upon individual centres, inspiratory, expiratory, and inhibitory, it is exceed- ingly difficult, or impossible, to understand the contradictory results of various experimenters, but the question seems much less intricate when we regard it as due to the interference of stimuli passing at different rates in different directions, or to different distances according to the strength of the stimulus and the irritability or exhaustion of the nervous system. In regard then to inhibitory or slowing, and to stimulating or accel- erating nerves or fibres, it must be carefully borne in mind that the same fibres may possibly have either the one or the other action, according to the conditions under which it is acting. If we keep this carefully in view we may continue to use the terms ac- celerating and slowing or inspiratory and expiratory nerves as a convenient means of expression. These are shown in the accompanying diagram. The movements of respiration are not only more easily counted than in any other way, but their depth and the relation of inspiration to expiration are best noted by causing them to register themselves on a revolving cylinder. Various means of doing this have been suggested by different authors. One of the simplest consists of a needle pushed into the diaphragm, and connected by a thread with one of Marey's levers. Marey's pneumograph consists of a cylinder of soft India- rubber, enclosing a spiral spring, whose extremities are connected with two pieces of metal which form the ends of the cylinder. A band is passed round the thorax of the animal, and attached to the ends of the cylinder. The interior of the cyl- inder is brought into communication with one of Marey's levers, and as each respiratory movement draws the ends of the cylinders wider apart, or allows them to approach, the air is rarefied or compressed, and a corresponding movement is transmitted to the lever. Bert has modified this, and made it more sensitive by making the cylinder itself of metal, and its ends of Indiarubber. Another method — one more ordinarily employed — is to introduce one limb of a T-tube into the nostril or trachea of an animal, or connect it with a tracheal cannula. The re- spired air passes through the other end, and the third limb is connected with one of Marey's levers. In the attempt to find out whether the alteration in respiration pro- duced by any drug is due to its action on the respiratory centre, or on some of the nerves which influence it, we may find the following table useful by showing at a glance the chief ways in which the respirations may be rendered quicker or slower : — ( Stimulation of the vagus. f Excitement of nerves, -j Stimulation of optic nerve. The respiratory | [ Stimulation of acoustic nerve, movements may j f Action of brain (voluntary), be quickened by | Greater excitement of J Increased temperature of blood. L respiratory centre. 1 Increased venosity of blood. [ Action of drugs. f Diminished excite- f Diminished venosity of blood, ment of respiratory \ Action of drugs. The respiratory centre. ( Action of brain (voluntary), movements may | f Paralysis of vagi. be rendered slow -| I Stimulation of superior laryngeal nerves. j Stimulation of inferior laryngeal nerves. 1 Stimulation of nasal nerves. j Stimulation of cutaneous nerves. ( Stimulation of splanchic nerves. *y Nervous influences. 218 PHARMACOLOGY AND THERAPEUTICS. If the drug to be experimented on be injected subcutaneously or into the veins, the actions on the respiratory centre and on the vagi are the chief points which require attention ; but if we are experimenting with a vapor, its local action on the nasal, laryngeal, and possibly, also, on the pharyngeal nerves 1 must be carefully attended to, as it may greatly mod- ify its general action on the respiratory centres. Thus Kratschmer has found that tobacco smoke inhaled by a rabbit through its nostrils, or blown upward into the nasal cavity from an aperture in the trachea, will cause arrest of breathing in a state of expiration from the irritating effect of the vapor on the nasal branches of the fifth, while it has no such effect when blown into the lungs. Ammonia, when inhaled, also arrests the respiratory movements in the same way ; but Knoll 2 has observed that if it be blown into the lungs while the nostrils are carefully pro- tected from its influence, it causes accelerated and shallow breathing, alternating with slow and deep respiration, and occasional stoppages in the position of expiration, obviously from its action on the different fibres of the vagi. Action of Drugs on the Respiratory Xerves. In experiments regarding the effect of drugs upon the respiration, the voluntary influence of the brain is excluded by the use of ether, chloroform, opium, or chloral, or by section of the crura cerebri. In the case of such poisons as cause sickness allowance must be made for the effect of gastric irritation. It will usually be found that before vomiting occurs the respiratory movements are very rapid, but they become slower after vomiting has taken place. As the chief afferent fibres from the stomach are contained in the vagus, the effect of irritation of the gastric, as well as of other fibres contained in these nerves, is prevented by their division. Sometimes the action of a drug on the peripheral ends of the vagus and upon its roots in the medulla may produce exactly opposite effects upon the respiration. Thus atropine appears to lessen the excita- bility of the respiratory fibres of the vagus, while it stimulates the re- spiratory centre. Such an action may be to a certain extent inferred from the respiration becoming slower almost immediately after the injec- tion of the drug into the jugular vein, and while it is still passing through the lungs, and by this slowing being quickly succeeded by accel- eration when the drug begins to circulate through the medulla. There are two kinds of experiment by which such a conclusion may be tested The one is to apply the drug first to the medulla by inject- ing it into the carotid artery, and seeing whether acceleration occurs at once and afterwards becomes less when the drug has had time to pass round again to the lungs. The other way is to divide the vagi before the injection and observe the effect. Any alteration in the respiration in the way of either quickening or slowing which the drug produced in the uninjured annual Bhould remain the same after division of the Kroun-S.'qii.iid, ArchitH - of Scientific and Practical Medicine, p. 94. :- ggF «&kS--> —Spleen Fig. 56.— Diagram of the afferent nerves by which cough may be excited. These nerves are shown passing to the respiratory centre in the following order from above downwards — from the auditory meatus, pharynx, upper part of oesophagus, larynx and trachea, bronchi, lung, costal pleura, liver, and spleen. the portion of the septum immediately opposite. 2 The sudden application of cold to the skin on various parts of the body will sometimes cause coughing. Probably the cough in this case is not due to the stimulus being conveyed directly to the respiratory centre by the cutaneous nerves, but to its causing congestion of the air passages as in Rossbach's experi- ments. The congestion then causes irritation of the sensory nerves of the bronchi, and occasions cough. I have seen irritation of the liver and spleen, induced by percussion over them, in a man suffering from chronic enlargement due to malaria, likewise cause coughing. 3 In addition to those nerves, however, it appears that irritation of the glossopharyngeal branches distributed to the pliar- ynx, where the digestive and respiratory tracts coincide as they cross one another, may not only excite coughing, but may also act as an auxiliary to irritation of the branches of the vagus. The combined action of the two mav thus induce cough, when irritation of the vagus alone would not 1 Kohts, Virchoic's Archiv, 66, 191. 2 On Nasal Cough, by John N. Mackenzie, M. D., reprint from The American Jour- nal of the Medical Sciences, July, 1883. 3 These observations were made in January and April, 1879, but not published. Naunyn, in a paper published in the Deutsch Archiv f. Klin. Med. in March. 1379, recorded similar observations. 222 PHARMACOLOGY AND THERAPEUTICS. do so. Thus we find that many persons begin to cough as soon as they lie down, but that sometimes by lying round partially on the face, the cough ceases. In these persons the uvula is often found to be long and much congested, and the tickling which it produces as it rests upon t le pharynx or pillars of the fauces seems to aid the irritation in the respiratory passages, and produce cough. Cough due to irritation of those parts of the respiratory tract where the nerves are chiefly expiratory, as the pharynx, larynx, trachea and large bronchi, is usually, as might be expected, loud, explosive, and prolonged ; while cough due to irritation of those parts where the nerves are chiefly inspiratory is short and hacking. Cough produced by irritation of the pharynx where the respiratory and digestive passages cross one another, is not only violent, noisy, and barking, but, as we would naturally expect, is not unfrequently accom- panied by retching or vomiting. Pharyngeal irritation may accompany dyspepsia, and it is probably the origin of the so-called stomach-cough. Irritation of the stomach itself, or of its nerves, causes vomiting, but does not produce cough. Nevertheless there is a rationale for the common expression " stomach- cough." In some experiments on the reflex origin of cough, R. Meyer 1 has noticed that when some part, from which cough can be reflexly induced, is already in a state of irritation, cough can be brought on with great ease by irritation of a neighboring part which would not by itself cause cough. Something of this kind appears to occur with the stomach, for although irritation of the stomach alone will not cause coughing, yet it will do so if irritation of the larynx and trachea are already present. Thus I have observed violent spasms of coughing occur, along with acidity and heartburn, some time after a meal, in a person suffering from congestion of the pharynx, larynx, or trachea. The connection between the cough and the acidity was shown by the cough ceasing as soon as the acidity was relieved by a dose of alkali and the consequent removal of the irritation to the stomach, which the acidity had produced. Soothing- remedies applied to the pharynx greatly relieve cough, although they do not reach so far down as the epiglottis. Mucilaginous remedies are very useful for this purpose, and they may either be em- ployed alone or as vehicles for the local application of sedatives such as morphia. Thus, a piece of extract of liquorice allowed to dissolve in the month, a marsh-mallow lozenge, a gum-jujube, or a sip of linseed-tea, by covering the back of the throat with a mucilaginous coating, will lessen cough to a great extent. Such remedies are especially useful where the cough depends on congestion of the pharynx and trachea. In such cases uo abnormal Bound at all may be heard in auscultation, and the cough being due to irritation of the parts supplied by the superior laryngeal nerve, has a peculiarly convulsive expiratory character often termed "barking. Other remedies lessen cough by diminishing congestion of the reepiratoi and thus lessening the irritation which causes the : K. Heyer, Oo rmp o nd enzblatt d. Schweber, Aerzte, No. 1, 1876. ACTION OF DRUGS ON RESPIRATION. 223 cough. Many of these, also, however, come under the class of ex- pectorants, inasmuch as the diminished congestion is frequently associated with increase of the expectoration. Others, again, although they diminish cough, are included rather under the head of "cardiac tonics, " or sedatives. Digitalis is an example of this. In the conges- tion due to cardiac disease, and even in that due to bronchitis, the digi- talis, by strengthening the heart and by contracting the vessels, may lessen the congestion in the lungs, and give the patient relief. Squill and a number of other drugs have an action on the blood-vessels similar to that of digitalis. Other remedies, such as the vapor of hydrocyanic acid, conium, stramonium, and tobacco, have a local sedative action on the lung, and may lessen cough; they also are used in order to diminish local spasm of the bronchioles, and thus to relieve spasmodic asthma. The chief drugs which diminish the excitability of the respiratory centre are opium and its principal alkaloid, morphia. Hydrocyanic acid has also a sedative action on it, but is by no means so powerful as the others. Belladonna and stramonium have a rather peculiar action, stimula- ting the respiratory centre, and at the same time appearing to lessen the excitability of the ends of the vagi in the lungs. Morphine and opium have a double action in lessening cough : they not only lessen the excitability of the respiratory centre, but they diminish the secretion of mucus in the bronchial tubes, and probably thus also lessen the irritation. Atropine has but a very slight and uncertain action on the respira- tory centre in preventing cough, if indeed it has any at all. It has, however, a powerful effect — much more powerful than that of opium, — in completely arresting the secretion from the bronchial tubes. The cases in which it is useful are therefore those where the cough depends upon excessive secretion. In cases where the mucous membrane is already too dry, it would be injurious rather than beneficial. When apomorphine and morphine are given together they do not destroy each other's action, so that from the combination we get increased secretion from the mucous membrane, with diminished irritability of the respira- tory centre, and consequently lessened cough. The cases in which this combination, then, is useful, are those where there is difficulty of breath- ing, continual cough, and thick, tenacious mucus. When morphine and atropine are given together, also, they do not destroy each other's action; and thus dryness of the mucous membrane is produced along with diminished irritability of the centre for coughing. This combina- tion is therefore useful in cases of catarrh, emphysema, and phthisis, where there is copious secretion of mucus. In phthisis it is especially indicated on account of the beneficial action of atropine in also lessening sweating. Where the copious expectoration depends upon the presence of a cavity, and not on excessive secretion from the bronchi, it will not be much affected by the use of these remedies. Expectorants. Expectorants are remedies which facilitate the removal of secre- tions from the air passages. The secretion may be rendered more 224 PHARMACOLOGY AND THERAPEUTICS. easy of removal, either by an alteration in its character rendering it less adhesive and more easily detached from the air passages, or by increased activity of the expulsive mechanism. Our knowledge of the use of expectorants is founded chiefly on empiricism. We are almost entirely indebted to the recent experiments of Rossbach for any precise information as to their mode of action. 1 The secretion from the air passages, like other secretions, depends partly upon the condition of the circulation, and partly on the secreting cells themselves. In healthy conditions the increased secretion and increased circula- tion of blood in the mucous membrane go together, but just as in the case of the sweat glands, these two factors may occur independently of each other, and secretion may take place rapidly when the circulation is diminished and the mucous membrane is anaemic, and, on the other hand, it may stop altogether when the vessels are dilated and the mucous membrane is congested. The latter happens both in cases of disease and in animals poisoned by atropine. The secretion from the normal respiratory mucous membrane con- sists of a thin solution of mucin which dries very slowly, and is only secreted in sufficient quantity to keep the mucous membrane moist. It is slightly adhesive, and any particles of dust, &c, which may have found their way into the trachea, will stick to the walls of the air passages and will be gradually moved up towards the mouth by the cilia with which the cells of the mucous membrane are furnished. Any excess of mucus secreted in consequence of irritation will also be moved upwards by the cilia in a similar manner. In the ciliated cells of the mucous membrane we recognize a structure which is frequently met w T ith in ani- mals lower down in the scale of existence, and the mucous membrane of the respiratory passages appears to resemble the parts of lower organ- isms, in being very slightly controlled by the central nervous system. When not irritated it secretes slowly and regularly; when irritated locally the secretion is increased, but irritation of the nerves passing to it. such as the vagus, the superior or inferior laryngeal, or the sympa- thetic, does not cause any increase as it does in the case of the submaxil- lary gland. These nerves, however, can influence it indirectly through the circulation, for when they are divided an increased dilatation of the -■•Is occurs in the mucous membrane of the trachea, a freer circulation of blood occurs, and increased secretion is thus indirectly produced. When tlicv arc irritated, however, and anaemia of the trachea produced, the secretion is not arrested but continues. The circulation in the mucous membrane is readily affected reflexly by irritation of other parts of the body. When, for example, a warm poultice is laid for five or ten minutes on the belly of an animal, and then afterwards replaced by ice, the mucous membrane of the trachea and larynx becomes in half a minute deadly pale from contraction of its vessels. Though the ice is still allowed to remain on the belly, the tracheal mucous membrane quickly changes color, and to the paleness succeeds ■ft rift der .In li a s- Maximilian- Universltiit zu Wurzburg, Leipzig. ACTION OF DRUGS ON RESPIRATION. 225 first slight redness, then deep red congestion, and in five or ten minutes lividity. This lividity shows that the congestion is not arterial but venous, and that the circulation instead of being quicker, is really slower. Along with the increase of congestion in the mucous membrane, the amount of mucus secreted increases. When the ice is removed for half an hour, and again replaced by a warm poultice, the bluish red color of the mucous membrane almost immediately disappears and gives place to a rosy color which is, however, redder than normal. Ice again applied will cause a second contraction of the vessels and paleness, though much less than before. These experiments show how sensitive is the mucous membrane of the trachea to reflex stimulation of other parts of the body by heat or cold, and enable us to understand more readily how a draught of cold air on some part of the body should cause inflam- mation of the respiratory organs. Action of Drugs on the Secretion. — Alkalies, such as carbo- nate of soda, injected into the blood, lessen, or in large quantity completely arrest, the secretion of mucus from the trachea. This experimental result is in contradiction to the teaching of clini- cal experience, which shows us that alkalies increase the amount of secretion, and render it more fluid. The results of clinical observation are quite as certain as those of Rossbach's experiments, for we may not only remark the greater quantity of expectoration, and its greater fluidity in persons taking alkalies, but one may note the alteration which they occasion in the amount and nature of the moist rales heard within the lungs. This can be observed most readily in persons suffering from phthisis, especially round the margin of a cavity. After catching a slight cold an extension of consolidation may be remarked, in which moist rales readily occur on the administration of dilute alkalies. When these are continued until the expectoration has been free for a day or two and the rales diminish, acids may be given with advantage so as to dry up the expectoration still more. But if the acid is given too soon the expectoration diminishes, but the cough increases and becomes trou- blesome to the patient. In all probability the difference between the results of clinical obser- vation and Rossbach's experiments depends upon the difference of dose, the quantity usually given to a patient being proportionately much smaller than that which he employed. We are able to observe a similar differ- ence between the effects of small and large doses in the case of iodide of potassium ; a small dose of a grain and a half, taken by a healthy man three times a day, will almost certainly cause the nose to run freely, while if the dose be increased to ten, twenty, or thirty grains, the exces- sive secretion will almost certainly be arrested. The local application of a one to two per cent, solution of sodium carbonate has very little action. The local application of strong liquor ammonise causes both congestion and increased secretion of mucus. Very strong solutions cause a croupous exudation from the surface of the mu- cous membrane. The local application of dilute acetic acid (three per cent, solution) has a similar action to weak solutions of ammonia: the mucous membrane becoming redder and secreting more mucus. 15 226 PHARMACOLOGY AND THERAPEUTICS. "When acetic acid was given internally, Rossbach observed in one case that the mucus which was before watery and clear, became gelatinous and opalescent. This result agrees with what one finds clinically, that acids dry up the secretion and make it harder to expectorate. Among astringents Rossbach tried tannin, alum, and nitrate of silver ; the first two when locally applied made the mucous membrane appear paler by altering the epithelium of the mucous membrane and rendering it opaque, so that the vessels underneath could hardly be seen ; at the same time they arrested the secretion of mucus almost entirely. A four per cent, solution of nitrate of silver also caused opacity of the epithelium, arrest of secretion, and dryness of the mucous membrane. There appears to be a difference in the action of nitrate of silver on the mucous membrane of the nose and on the trachea, as when the inside of the nose is touched by it, it causes a profuse secretion, whereas it causes dryness in the trachea. The vapor of oil of turpentine mixed with air arrests the secretion of mucus, while a current of air alone, without admixture with oil of turpentine, will act as an irritant to the mucous membrane and increase secretion. Here again, however, a marked difference is to be seen in the effect of small and large doses, for when a watery solution containing from one to two per cent, of oil of turpentine was dropped directly on the mu- cous membrane, it became less vascular, but the secretion was at once increased, instead of being diminished as it was by the vapor. This action of oil of turpentine is of great therapeutical importance, inasmuch as in many cases of bronchitis we have profuse secretion with vascular congestion, a condition likely to be removed by the vapor of oil of turpentine. Apomorphine, emetine, and pilocarpine, when given internally, all cause a great increase of the secretion of mucus, but they do not alter the vascularity of the mucous membrane. The most powerful of all these is pilocarpine, and after it come apomorphine and emetine. One would therefore expect that pilocarpine would be the best remedy in catarrhal conditions, but this is not the case, for its other actions on the salivary and sweat glands and on the heart render its administration unpleasant for the patient. Sometimes also in children oedema of the lungs has followed its use. Apomorphine, on the contrary, has been found by Rossbach to be of the greatest service in catarrh of the larynx, trachea, and bronchia, both in adults and in children. Ipecacuanha has long been recognized as one of the most useful expectorants, but the dose given 18 often tOO small. Rossbach's experiments have shown that the consequence of sudden changes of heat and cold applied to a part of the body is congestion of the respiratory mucous membrane with diminished circulation and /nation of blood in the veins. A similar condition occurs in many of chronic bronchitis, and in them we not unfrequently find great benefit from vascular tonics such as digitalis, which, in addition to Stimulating the vaso-motor centre, increase the activity of the heart, and thus tend to maintain the pulmonary circulation. In what way cod-liver oil affects the bronchial mucous membrane it i- perhaps hard to say, but there is no doubt whatever that it is one of ACTION OF DKUGS ON EESPIRATION. 227 the most efficient expectorants that we possess, and in cases of chronic bronchitis it affords more relief than any of the ordinary expectorants. It is possible that, being a form of fat which is readily assimilated, it is taken up by the young epithelial cells of the respiratory mucous mem- brane, and thus enables them to grow and maintain their attachment to the mucous membrane, instead of being at once shed in an undeveloped form as pus cells in the expectoration. Action of Drugs on the Expulsive Mechanism. — The expectorants which act by increasing the activity of the expulsive ap- paratus may be divided into — (1) Those which increase the rapidity of the ciliary motion in the tracheal mucous membrane. (2) Those which increase the activity of the respiratory centre. We have no direct experiments or observations on the rapidity of the ciliary motion in the bronchial mucous membrane of the higher animals, but ammonia has been found to increase its rapidity in the mucous mem- brane of the frog. The remedies which increase the activity of the respiratory centre are : strychnine, ammonia, emetine, ipecacuanha, belladonna, atropine, senega, and saponine. They are used more especially in cases of bronchitis, where the expectoration is imperfect. The chief expectorants have been divided into depressant and stimu- lant. They are as follows : — Depressant Expectorants. Stimulating Expectorants. Increasing secretion and gen- Generally increasing blood-pres- erally tending to lessen blood- sure and diminishing secretion, pressure. Antimonial preparations. Acids. Tartar emetic. Ammonium chloride. Alkalies. Ammonia. Ipecacuanha. Strychnine. Emetine. Nux vomica. Lobelia. Senega (saponine). Lobeline. Onion. Jaborandi. Garlic. Pilocarpine. Squill. Apomorphine. Tar. Quebracho. Benzoin. Aspidospermine. Benzoic acid. Potassium iodide. Balsam of Tolu. Balsam of Peru. Wood tar. Turpentine. Oleum Pini Sylvestris. Oleum Pini Pumilionis. Sulphur. Saccharine substances. Liquorice. 228 PHARMACOLOGY AND THERAPEUTICS. Adjuncts. — One of the most powerful adjuncts to expectorants is an emetic, which frequently will clear the lungs and save life in cases of chronic bronchitis with impending suffocation, when ordinary expectorants have completely failed. One of the emetics most commonly employed in such cases is ipecac- uanha either alone or combined with squill, e. g., half a fluid ounce each of ipecacuanha wine and oxymel of squills. When there is great de- pression, however, and the circulation is very feeble, carbonate of ammonia is to be preferred. Another powerful adjunct is warmth and moisture in the room in which the patient is living, and this is best secured by means of steam brought well into the room from a kettle placed upon the hob. The kettle used should either be furnished with a very long spout, as in the case of the ordinary "bronchitis kettle, or a long tube made of a piece of stout brown paper tied around with a string may be used to con- vey steam into the room from the nozzle of an ordinary kettle. Respirators are also serviceable, by preventing the entrance of cold air into the trachea. Many persons, forgetting that the mouth is part of the digestive tract, and that the nose is the proper entrance to the respira- tory tract, breathe through their mouth ; the consequence is, that the cold air passes down the trachea without being previously warmed. In the nose we have a special arrangement for warming the air. The tur- binated bones present an enormous warming surface, like some recently- invented stoves, and, moreover, a special arrangement is made for allowing a free flow of blood through this mucous membrane by its being loosely instead of firmly attached to the turbinated bones. Its vessels are there- fore capable of great and rapid distension, so as to allow the air to be readily warmed in cold weather. Most respirators are made simply to go over the mouth, and their advantage is that they force people to breathe through their nose, or warm the air if they cannot do so, and continue to breathe through the mouth. In many persons the same end may be gained by forcing them to wear an invisible respirator. An instrument is sold bearing this name, consisting of a thin plate of metal ; but what is perhaps quite as good, or better, is ivereigD or half sovereign placed between the lips and teeth. Patients are thus forced to keep the mouth shut in order to prevent it from falling out, and its value makes them careful about losing it. It is often forgotten too that passages and disused rooms are nearly •Id as the external air, and many delicate people who would never dream of going outside in cold weather will, without thinking, walk through cold passages and in rooms without fires. Warm clothing', especially over the shoulders, neck, and chest, is very useful, and its utility i- recognized by the common employment of so-called chest protectors made of chamois leather and red flannel. Other adjuncts arc friction to the chest with stimulating liniments ; mustard Leaves, warm poultices, and the application of plasters; the emplastrnm calefaciena (B. P.) or emplastrum picis cum cantharide I . 8. P.) is especially useful in chronic bronchitis. ACTION OF DRUGS ON CIRCULATION. 229 CHAPTER XL ACTION OF DRUGS ON THE CIRCULATION. It has already been mentioned that the cells of which higher organisms are composed live in the intercellular fluid or lymph which bathes them. This nutritive fluid is continually being renewed by fresh supplies exuding from the blood-vessels into the lymph spaces which surround the cells, the excess being removed by absorption either by the veins or by the lymphatics. Besides this, an interchange of gases (internal respira- tion) and of solids takes place by diffusion between the lymph and the blood. When the circulation stops, internal respiration is arrested, and the cells die. But they do not all die at the same time, for some are able to live longer without fresh supplies of oxygen than others. The order in which they die is (1) the cells of the initiative nerve-centres, as the brain ; (2) those of the automatic and reflex centres ; (3) nerve fibres (which are modified nerve-cells); (4) unstriated muscles; (5) striated muscles. Arteries and Veins. — It is important in this respect to remember that it is only so long as blood is in the arteries that it is available for the nutrition of cells. Once in the veins it is useless for nutrition ; and were it not that it readily passes from the veins into the arteries again, it might as well be outside the body for any purposes of nutrition. The veins are very capacious, and when dilated to their utmost, they can alone hold all the blood the body contains, and more. During life they are constantly kept more or less in a state of contraction by the action of the nervous system, but when they become completely dilated, as after death, all the blood flows into them, leaving the arteries empty. It is therefore possible, as Ludwig has well expressed it, to bleed an ani- mal into its own veins. Schiff has shown that when the blood-vessels relax as they do after section of the medulla oblongata, the whole of the blood of another animal as large as the one experimented upon must be introduced in addition to its own, in order to raise the pressure within the vessels to the normal. Even this is insufficient to keep up the pres- sure, for the vessels go on still dilating, and the pressure falls, notwith- standing the large quantity of blood which is present in them. It is therefore evident that the normal action of the vaso-motor centres is more than equivalent, for the purposes of circulation, to as much blood again as the animal possesses. Weakened power of these centres is to a certain extent equivalent to bleeding, and increased power has a similar effect to an increase in the quantity of blood in the vessels. Blood-Pressure. — The continuity of the circulation of blood through the capillaries is not maintained by the heart alone ; the elastic pressure of the arteries on the blood within them plays a most important part, and indeed during the cardiac diastole the circulation is maintained entirely by this elastic pressure. If the arterioles or capillaries through which the arterial system empties itself into the veins are much contracted, so that the blood can flow only slowly through them, the heart may stop, and yet the blood-pressure may remain for many seconds almost unchanged. But if the arterioles 230 PHAEMACOLOGY AND THERAPEUTICS. or capillaries are dilated, the arteries quickly empty themselves into the veins, arterial pressure rapidly falls, and circulation soon stops. I use the words arterioles and capillaries as synonymous, because it is almost certain that the capillaries do contract. In most cases where contraction has occurred in the peripheral vessels, it is difficult or im- possible to say whether its seat is in the capillaries or arterioles. Fig. 57.— Diagram to illustrate the effects of the horizontal and vertical position on the circulation of the frog in shock, a, normal circulation in the upright position, b, circulation after dilatation of the veins has been produced by a blow on the intestines. The blood does not reach the heart, and it beats empty, so that the circulation stops, c shows the circulation in a horizontal position after the veins have been dilated, as in b. The veins are still dilated, but the blood reaches the heart, and the circulation is carried on. Fig. c is perhaps too diagrammatic, as it appears to show an empty space or air in the veins. In reality the veins, being very thin-walled, collapse. Fig. b is open to the same objection, but if we suppose ourselves to be looking at the vein from the front instead of in section, 6 represents almost exactly what I have myself seen in repeating Goltz's experiment. The action of the heart is to pump the blood out of the veins into the arteries, and this it can only do when the blood reaches it. If the veins are much dilated and the animal is in an upright position, no blood, or so little blood may reach the heart, that its pulsations are practically use- less. This is seen in the frog when dilatation of the large veins has been reflexly produced by striking the intestines (Fig. 57). When the animal is laid flat, the blood flows into the heart, and then it works normally. It is probable that a similar condition occurs in man, as one of the factors in shock, and in this condition, as well as in fainting, or failure of the heart's action from the effect of drugs, as chloroform or other causes, the person should be laid flat, with the limbs raised so that the blood may flow out of them into the heart, and with the head low (either perfectly level with the body or depressed below it), in order to permit of an in- creased supply of blood to the inter-cranial nerve-centres. Fainting and Shock. — In fainting- there is sudden unconscious- lies-, which appears to be caused by sudden arrest of the supply of blood to the brain. This arrest may be due to a rapid fall in blood-pressure, either from stoppage of the heart, rapid dilatation of the arterioles, or sudden removal of pressure from the larger vessels. It is possible that these conditions may be associated with spasmodic contraction not only of the vessels of the face and surface generally, but of those supplying the brain itself. The effect of sudden change from horizontal to an upright are in producing syncope has already been mentioned, p. 187. Sudden removal of external pressure from the great vessels acts upon both arteries and veins. It removes external support from the arteries, and allows them to yield more readily to the influence of the blood- pressure, and by their dilatation to lessen it. It allows the large veins also to dilate and blood to stagnate in them. Its influence is readily seen when fluid is removed too suddenly from the abdomen, and external ■nre bya bandage not supplied in its place, as in cases of ascites. ACTION OF DEUGS ON CIRCULATION. 231 It is seen, perhaps, even more strikingly, where the bladder has been allowed to become distended and is suddenly emptied. The effect of this is shown in Fig. 58. In a the bladder is represented as full, and, the Carotid artery (full). Aorta tense. Veins tense and moderately ) full./ Bladder (full). Carotid artery (empty), Aorta lax. Veins lax and full. Bladder (empty). Fig. a b -Diagram to show the effects on the cerebral circulation of rapidly emptying the bladder. pressure within the abdomen being considerable, the veins are prevented from dilating, the heart is well supplied with blood, and the circulation in the brain is active. In b, the bladder is represented as empty, and the abdominal contents being diminished, so that the intra-abdominal pressure is lessened, not only do the aorta and other vessels become lax from loss of the external pressure but the veins dilate, the heart is imperfectly supplied with blood, the cerebral circulation fails, and syncope ensues. This occurs more readily just after waking, before the vaso-motor centre has recovered its usual tone, so that one of the most favorable conditions for its occurrence is when a man jumps suddenly into the upright position and empties his bladder immediately on waking. The consequence of this sometimes is that he falls down suddenly, quite insensible, during the act of micturition. I have seen one case in which the tendency appeared to be increased by the practice of opium-eating, probably from the dimin- ished excitability of the vaso-motor centre produced by the drug. It is evident that the danger will be increased if the intervals between the systoles of the heart are prolonged, and it is the combination of the natural tendency to syncope, produced by large doses of digitalis, with that caused by the sudden assumption of the upright posture, and by the rapid emptying of the bladder, which renders micturition in the upright posture so excessively dangerous in persons under the action of digitalis, and leads so frequently to death. It is evident that fainting may be prevented by increasing the blood- pressure in the brain locally, or throughout the body generally. To in- crease it locally the head of a fainting person should be allowed to lie level with the body, or a little below it, and on no account raised even by pillows. A fainting fit may indeed often be prevented by sitting with the head hanging between the knees. It may also be prevented or removed by such conditions as raise the general blood-pressure, e.g.,& draught of cold water, which causes contraction of the gastric vessels, or a sniff of am- monia or acetic acid, which stimulates the nasal nerves and causes reflex contraction of the vessels generally. In some parts of India the natives 232 PHARMACOLOGY AND THERAPEUTICS. are accustomed to bring persons round from a faint by compressing the nostrils and holding the hand over the mouth, so as completely to stop respiration. The accumulation of carbonic acid in the blood irritates the vaso-motor centre, raises the blood pressure, and thus probably tends to bring the person round. In shock there is no unconsciousness, but the failure of the circu- lation is even more profound than in syncope. Its pathology is not per- haps exactly ascertained, but it probably depends to a great extent on a paralytic distension of the great veins, as in Goltz's experiments. I have found that in shock produced in a similar manner in a rabbit the blood- pressure could be raised from two inches up to two and a half by the inhalation of ammonia. Schema of the Circulation. — In order to understand the action of drugs on the circulation it is absolutely necessary to have a clear idea regarding the effect of the heart and capillaries in maintaining the blood-pressure. This is best obtained by using a schema, which can be easily made from a spray-appa- ratus. By removing the glass or metal tube from one of these, and attaching a nozzle with a small stopcock to the India-rubber tube in its stead, we obtain a very good schema of the circulation ; and, by imitating on it the changes which occur in the heart and vessels, we may form a much clearer idea of them than we could otherwise do. The India-rubber ball will represent the heart; the elastic bag, surrounded by netting, will represent the elastic aorta and larger -Hruj.Ie schema of the circulation, consisting of a spray-producer, bladder, and mercurial lastic ball represents the heart, the elastic bag covered with netting to prevent manometer. real distension represents the aorta and arterial system °and the bladder represents the j tarn. arteries; and the stopcock, which regulates the size of the aperture through which the air escapes, will represent the small arteries and capillaries, whose contraction or dilatation regulates the flow of blood from the arteries into the veins. We may judge of the tension in the arteries by the distension of the or still better, we mav connect the tube between it and the stopcock with a mercurial manometer, and estimate the tension by the height of the mercurial column which it Hi>t;im.^. If we turn the stopcock so as to present some resist- ance to the escape of air. and then compress the India-rubber ball, very little air will issue from the Btopcock oven while wo are squeezing the ball; the greater part of il j'-s to distend the bag; and, when we cease to compress the bail, very ACTION OF DRUGS ON CIRCULATION. 233 little air passes through the stopcock. At the next squeeze the bag becomes a little more distended : and a little more air passes through the stopcock, not only while we are compressing the ball, but even when we relax our grasp. At each squeeze of the ball, the elastic bag becomes tighter, till it is so tense, and con- tracts so strongly on the air inside, that it can press all the extra amount of air, forced into it when the ball was compressed, through the stopcock during the time when the ball is relaxed. When this is the case, every time we squeeze the ball we see the bag become a little fuller, and air issue more quickly from the nozzle. At each relaxation, while the ball is refilling, the bag gets a little slacker, and the air passes out of the nozzle a little more slowly, but never stops entirely. During the time the ball is filling, the valves between it and the bag and nozzle are closed, and cut it off from any connection with them. All this time, then, the stream of air from the nozzle must be entirely independent of the ball ; it is produced by the contraction of the elastic bag, and by it alone. The bag may be stretched, and the tension of its walls increased in consequence, in two ways ; first, by working the ball more quickly, or compressing it more com- pletely ; second, by lessening the opening of the nozzle, and thus hindering the passage of air through it. One trial will, I think, be enough to show how much easier it is to alter the pressure by changing the size of the nozzle, than by any alteration in the working of the ball, and to prove that alterations in blood- pressure probably depend much more on alterations in the lumen of the small arteries than on changes in the action of the heart. But our schema, as it at present exists, is not a perfect representation of the heart and vessels ; for it draws its air from an inexhaustible reservoir, the atmos- phere, and is not obliged each time to use that amount alone which it had pre- viously driven through the nozzle ; while the heart can only use the blood which has been forced by it through the capillaries, and returned to it by the veins. In order to make our schema complete, we must connect its two ends by tying them into a bladder or large thin caoutchouc bag (such as is used, after inflation, as a toy for children), so that the air shall pass into it from the nozzle, and be sucked out of it by the elastic ball. This will represent the veins. If we then repeat the experiment just described, we shall find that, when we begin to work the ball and stretch the elastic bag representing the arteries, the bladder representing the veins, becomes empty and collapsed ; and just in proportion as we fill the bag do we empty the bladder. If we now stop, the air will gradually escape from the bag to the bladder, till the air in both is of equal tension as at first, Circulation in the Living Body.— The phenomena of the cir- culation in the heart and vessels are very much the same as in the schema. When the heart stands still (as when the vagus is strongly galvanized), the blood flows from the arteries into the veins until the arteries are nearly empty and the pressure within them falls to zero. If the heart now begin to beat, it forces blood into the elastic aorta and arteries at each systole, and distends them, just like the elastic bag of the schema ; while at the same time it takes blood from the veins, and they become empty in proportion as the arteries become full. During every diastole of the heart, the distended aorta and other arteries, in virtue of their elasticity, contract on the blood they contain, and keep it flowing on through the capillaries till another systole occurs ; the heart, meanwhile, being completely shut off from the aorta by the sigmoid valves (just as the ball of the schema was shut off from the elastic bag). In general, the diastole is longer than the systole ; so that for the greater part the circulation through the capillaries is carried on by the elasticity 234 PHARMACOLOGY AND THERAPEUTICS. of the arteries, and not directly by the heart. The arteries, which we have supposed to be at first empty, gradually become distended by the heart, just as the elastic bag was by the ball, and exert more and more pressure on the blood in them (so that it would spout higher and higher, if one of them were cut), till they are able during the diastole to press the same amount of blood through the capillaries into the veins as had been pumped into them during the systole. The more tensely they are stretched, the greater is the pressure they exert on the blood they con- tain ; and the amount of this is termed the arterial tension or blood- pressure. These two terms mean the same thing, and we use one or other just as the fancy strikes us. At each systole, the fresh supply of blood pumped in by the heart stretches them more; that is, the arterial tension rises. During each diastole, the blood escapes into the wide and dilatable veins, and the arteries become less stretched; that is, the arterial tension falls. This alternation of rise and fall constitutes the pulse. Besides the oscillations which take place in the blood-pressure at each beat of the heart, a rise and fall in the form of a long wave occurs at each respiration. The wave begins to rise just after inspiration has begun, reaches its maximum just after the beginning of expiration, and then begins to fall again till a new wave succeeds it. The heart- beats are generally quicker during inspiration, and slower during expira- tion. The blood-pressure thus oscillates up and down at each heart-beat and rises and falls with each respiration, and the average between the highest and lowest points is called the mean arterial tension or mean blood-pressure. Besides the oscillations in blood-pressure due to the pulse and to the respiration, there are slowly rising and falling waves to which the name of Traube's curves is given. These are due to alternate contraction and relaxation of the arterioles and capillaries. Rhythmical contraction of the arterioles has been observed in almost all parts of the body of rabbits, and probably occurs both in the lower animals and in man. The blood-pressure is not equal throughout the whole arterial system. It is greater in the large and less in the smaller arteries in which it be- come- diminished by the friction between the blood and the arterial walls. It is also modified by gravity, so that the position of a limb may alter the pressure in its arteries. Method of ascertaining- the Blood-Pressure. The blood-pressure is usually estimated in animals by connecting a large artery, such as the carotid or femoral, with a bent tube containing mercury by means of a connecting tube, which is filled with a solution of carbonate of soda to prevent coagulation. The pressure is estimated by the height at which the mercurv Btands in the outer limbof the tube. The height may either be read off with the eye, <>r. what is much better, it may be registered on a revolving cylinder bj means of b long float which rests upon the surface of the mercury, and bears on its upper end a brush or pen. This method, which is important both in itself and as being the introduction of the graphic method into physi- ology, we owe to 0. Ludwig. The apparatus is known as the kymograph. ACTION OF DRUGS ON CIRCULATION. 235 Tracings may be taken upon paper with a varying speed ; it is usual to take them upon paper travelling rapidly, so that quick and small oscillations due to the cardiac beats may not be lost or obscured by fusion. The great disadvantage of this is that it is impossible to use the curves directly ; they must be reduced, and this is a work requiring much time and labor. When taken on a slowly re- volving cylinder we get the general results of the action of a drug on the blood- pressure shown us at a glance ; and its effects on the form and rapidity of the pulse may by a little arrangement be recorded from time to time on another cyl- inder revolving more rapidly. This method gives us both the blood-pressure and the oscillations which it undergoes on account of the cardiac pulsations and respiration. If we wish to get the mean blood-pressure unaffected by these oscillations, it is done by simply narrowing at one point the calibre of the tube containing the mercury, either by a stopcock, or by reducing the tube to a capillary bore. Fallacies of Mercurial Manometers. — The oscillating mercurial column does not give the variations in blood-pressure quite truly, because the oscillations are compounded of these variations and of the oscillations due to the inertia of the mercury itself. In order to obtain the exact form of variation we employ Fick's kymograph, or Roy's tonometer, in which the apparatus is made very light, and all oscillations due to its own inertia are as far as possible avoided. Writing-point. Piston to lessen oscil- lation of point Tube filled with gly- cerine Syringe for altering the pressure in the mano- meter. Flat metal tube forming the manometer. Tube to connect the ma- nometer and artery. Fig. 60.— Fick's kymograph. It consists of a flat metal tube, bent into a nearly circular form, filled with alcohol, and connected with the artery bv means of a leaden tube, filled with a solution of sodium carbonate. When the pressure increases within it, the tube straightens, and when the pressure diminishes it bends. These changes are magnified and recorded on a cylinder by a light lever. The vibrations of the lever are lessened by a piston, which works in a tube filled with glycerine. Fallacies from Anaesthetics. — Even if the instrument be free from fallacy, we still have difficulty in ascertaining the real action of the drug on the circulation, inasmuch as the blood-pressure is much affected by movements, and by anaesthetics. If the animal is not anaesthetized we may get untrustworthy results from the straining or movements it may make, and if it is anaesthetized, the anaesthetic may greatly alter the power of the heart, or the sensibility of the nerve centres, either to the direct action of the drugs upon them, or to its reflex action through the afferent nerves. In order to get rid of movement, and at the same time to prevent the vascular centres from being much depressed, curare 236 PHARMACOLOGY AND THERAPEUTICS. is sometimes used instead of an ansesthetic. Perhaps, almost equally good re- sults may be obtained by using ether as the anaesthetic, carefully regulating the supply so as to abolish sensation without greatly affecting the medulla. The reasons why this is possible are discussed at p. 185. In order to regulate the supply of ether, we use a stopcock, by which pure ether, or pure air, or an ad- mixture of both in any desired proportion, can be passed into the lungs, Fig. 48, p. 191. Other fallacies arise from the mode of injecting the drug, and this has sometimes led to false results : thus drugs are not unfrequently injected into the jugular vein, as it is very conveniently situated for the purpose. In this way, however, they are carried directly to the heart, and act much more strongly upon it than they would do if absorbed from other parts of the body. In the case of irritant salts, for example, time is not afforded for their irritant properties becoming lessened by chemical combination with the constituents of the blood. If the solution injected contain particles which will not pass through the pulmo- nary capillaries, or if it is likely to cause coagulation of the blood, it may plug up the pulmonary vessels and give rise to dyspnoea and convulsions. Both these objections are avoided when the drug is injected unde£ the skin, or into the peritoneal cavity. Absorption from the skin is slower than from the peritoneum. In some experiments this is a disadvantage : in others, however, it is an advantage. Another fallacy sometimes arises from the solution of carbonate of soda used to prevent coagulation. In order to prevent the blood from passing too far into the tube connecting the artery with the kymograph, it is usual to introduce the solution of carbonate of soda into the tube by a syringe (vide Fig. 60) or other- wise, under a pressure very little less than the usual blood-pressure of the animal experimented on. If the blood-pressure be lowered much by stoppage of the heart or dilatation of the vessels, the solution of carbonate, or bicarbonate of soda, runs into the arteries, and may cause convulsions and death. Thus stop- page of the heart by irritation of the vagus, or by the action of a drug, may sometimes appear to be followed by results which are not really due to it, but only to the conditions under which the experiment has been made. Alterations in Blood-Pressure. In speaking of blood pressure, arterial blood-pressure is always meant, unless otherwise stated. As the blood pressure depends on the difference between the quantity pumped into the arterial system by the heart at one end, and the quan- tity flowing out through the arterioles into the veins at the other in a given time, it is evident that — The blood-pressure will remain constant when these quantities remain equal to each other. It will rise when — (a). More blood is purnped in by the heart. (b). When less flows out through the arterioles in a given time. Ir will Call — When less is pumped in by the heart, or: More flows out through the arterioles; or to look at it another way:— II I more active. Blood-pressure rises. i Less " - « falls. i contracl " " rises. i dilate " " falls. Arterioles ACTION OF DRUGS ON CIRCULATION. 237 The heart may throw more blood into the arteries, either by pulsat- ing more rapidly, or by pulsating more vigorously and more completely, so that at each contraction a larger amount of blood is expelled. But increased activity can only affect the blood pressure so long as there is a free supply of blood entering the heart. If there exist any obstruction to its entrance the increased cardiac action will have no effect. Hence obstruction of the pulmonary circulation will also lower the blood- pressure. The causes of alteration in the blood-pressure may be tabulated as follows: — Blood-pressure. May be raised- 1. By the heart beating more quickly. 2. By the heart beating more vigorously and more completely, and sending more blood into the aorta at each beat. 3. By contraction of the arte- rioles, retaining the blood in the arterial system. May be lowered- 1. By the heart beating more slowly. 2. By the heart beating less vigorously and completely, and sending less blood into the aorta at each beat. 3. By dilatation of the arte- rioles, allowing the blood to flow more quickly into the veins. 4. By deficient supply of blood to the left ventricle, as from con- traction of the pulmonary vessels, or obstruction to the passage of blood through them, or from stag- nation of blood in the large veins, e.g. in shock. The influences on the pressure exerted by (a) the number of beats, and (b) by the amount of blood sent out by the heart at each beat, to a certain extent, though by no means completely, counteract each other; for, when the heart is beating quickly, it has not time to fill completely, and so sends out little blood at each beat ; but, when beating slowly, it becomes quite full during each diastole, and sends out a larger quantity of blood at each contraction. It is evident that the amount of blood which the heart can send into the arteries at each beat will depend also upon the completeness with which the ventricle relaxes during diastole. If the relaxation be incom- plete very little blood will enter the ventricle, and thus a drug which increases the contractile power of the heart may, by unnecessarily pro- longing the systole, lower the blood-pressure as much as a drug which paralyzes the heart and prevents the ventricle from expelling its contents. Relation of Pulse-Kate and Arterioles to Blood-Pressure. Although we are unable, from the mere fact that the blood-pressure rises or falls after the administration of a drug, to say whether the result is due to the action of the drug on the heart or on the arterioles, yet we 238 PHARMACOLOGY A^D THERAPEUTICS. can come to some general conclusion regarding its mode of action by comparing the alterations which it has produced in the blood-pressure with those which occur in the pulse-rate. For in the normal condition of an animal, when all the nerves are intact, a rise in the blood-pressure renders the pulse slow by increasing the normal tone of the vagus centre in the medulla, and a fall of blood-pressure quickens the pulse by dimin- ishing the tone. This mechanism tends in the normal animal to keep the blood-pressure more or less constant. We find, therefore, that when alterations in blood-pressure and pulse- rate are depicted graphically, so that a rise in one curve indicates a rise in blood-pressure, and a rise in the other indicates quickening of the pulse, the two curves run in opposite directions if the alteration in blood-pressure is due to the arterioles, but they run parallel when the alteration is due to the heart. Thus, if the vagi be cut, we find that the pulse-rate rises, and in consequence of this the blood-pressure also rises. Here the alteration in pressure is due to the heart, and the Fig. 61.— Diagram of a pulse and blood-pressure curve, where the alterations are due at first to the action of a drug on the heart, as in the case of atropine. The unbroken line indicates the blood- pressure, and the dotted line the pulse. After the injection shown by the vertical line the vagus is paralyzed, the pulse becomes very rapid, and the blood-pressure rises. At a the vaso-motor centre becomes paralyzed, the arterioles dilate, and the pressure falls. From a to b the action of the heart continues nearly uniform, notwithstanding the fall in blood-pressure, but at b the heart begins to become paralyzed, and the pulse-rate and blood-pressure both continue to fall steadily tilldeath. two curves are therefore parallel. If the vagi be irritated the pulse-rate falls, and in consequence of this the blood-pressure also falls. Here again the alteration is due to the heart, and the two curves are parallel. If, on the other hand, the arterioles are made to contract the pressure rises, but the increased pressure stimulates the vagus roots in the medulla and the pulse-rate falls, so that the curves run in opposite directions. fagram of pulse and blood-pressure curves, where the alterations are due at first to the anion of a drug on the arterioles, The unbroken line indicates the blood-pressure, thedotted line Stea the pulse The upright line indicates the time of injection of the poison. This is followed traction of the arterioles and consequent rise of blood-pressure. This rise stimulates the roots, and causes slowness of the pulse. At b the vagus becomes paralyzed, the pulse becomes quick, and the pr< ill higher between a and H. At iJ the vaso-motor centre becomes paralyz.d, tin- arterioles dilate, and the pressure falls, notwithstanding the rapidity of the pulse. the heart Itself begins to be paralyzed, its beats become slow, and both pulse and pressure fall -leadily till death. If the arterioles dilate the pressure falls, and the vagus tone being les- I ill- pulse-rate rises; so the curves are again in opposite directions. ACTION OF DRUGS ON CIRCULATION. 239 An example of this is seen in the accompanying curve (Fig. 63), which illustrates the action of erythrophloeum — a substance similar in action to digitalis — on the circulation. After the injection of the drug the vessels contract, and the blood-pressure consequently rises and pro- duces some slowness of the pulse. In a little while the vagus becomes paralyzed, the pulse becomes quicker, and the pressure rises still further. At a later stage the heart becomes slow, apparently from the action of the drug upon it, and the blood-pressure then falls again. At first then, Efl __ HEsSi ■BUBi l9kl3 H9B HJ| 'SB diagram all hypotheses regarding separate motor and accelerating glia have been disregarded.] I\ . Vaso-motor Nerves, which cause the smaller arteries, and probably also the capillaries, to contract. These belong to the sym- pathetic system; and the most important of them are contained in the splanchnics, which when stimulated produce contraction of the intestinal ACTION OF DRUGS ON CIRCULATION. 255 vessels. As these vessels can, under certain circumstances, hold all the blood in the body, the influence of the splanchnics over the blood- pressure is very great ; and division of them can lower it, or stimulation of them increase it, very much. The intestine being much longer in herbivora than carnivora, the splanchnics have a greater influence over the blood-pressure in the former. The chief centre of the whole vaso- motor system seems to be in the medulla oblongata ; and it is generally in constant action, keeping up a certain amount of contraction or tone in the vessels. There are also, however, subsidiary centres in the spinal cord, and possibly also in the ganglia of the sympathetic system. The activity of the vaso-motor centres may be increased, and the vessels made to contract — 1. By direct irritation of these centres. 2. By reflex irritation through (a) the cervical sympathetic, (5) the vagus, when the brain is intact, and the animal not narcotized, (c) sen- sory nerves, including the splanchnics themselves. When the medulla is separated from the rest of the body by dividing the spinal cord at the atlas, it can, of course, no longer exert any influence over the vessels ; they consequently become dilated throughout the whole body, and the blood-pressure usually sinks very low. If the lower end of the divided cord be then irritated, the vaso-motor nerves which pass through it from the medulla to the body are stimulated, and the blood-pressure rises. It is probable that the peripheral ends of the vaso-motor nerves in the vessels themselves may be either stimulated or paralyzed by the action of drugs conveyed to them by the general circulation. V. Depressor nerves. — Irritation of these nerves is conducted to the vaso-motor centres, and acts on them in such a way as to cause a reflex dilatation of the small vessels, either (1) generally throughout the whole body, or (2) locally in one particular part of it. 1. The chief nerve which causes dilatation, especially affecting the intestinal vessels, is one which runs froin the heart to the medulla, and is called, from its power of diminishing blood-pressure, the depressor nerve. Its fibres seem to be included in the vagus in the dog ; but in the rabbit it generally runs separate from the heart to the level of the thyroid cartilage ; here it divides into two so-called roots, one root going to the superior laryngeal, and the other to the vagus nerve. These are generally called roots, though, as the nerve conveys impressions from the heart to the brain, they are, physiologically, really branches. There seem to be also depressor fibres in the vagus itself; but the vagus contains fibres of many kinds, and, among others, some which cause reflex contraction of the vessels and ris6 of blood-pressure — hence called pressor-fibres. The depressor-fibres of the vagus seem to act on the vaso-motor system through the medulla itself, while the pressor-fibres affect it through a centre in the brain, so that, when the brain is perfect, irritation of the central end of the vagus causes increased contraction of the vessels and raised blood-pressure ; but, when the brain is removed or its functions abolished by opium, it causes dilatation of vessels and di- minished pressure. 2. When a sensory nerve is irritated, the action of the vaso-motor centre is suspended in the part supplied by the nerve, and in those 256 PHARMACOLOGY AND THERAPEUTICS. which immediately adjoin it, so that their vessels become dilated, while at the same time contraction of the vessels in other parts of the body is produced. The blood-pressure is thus increased generally, and produces in the locally dilated vessels a very rapid stream of blood. This fact was first discovered, and its therapeutics indicated, by Ludwig and Loven. The causes of alteration in blood-pressure as well as in the pulse- rate, will perhaps be more easily seen from the following table : — ACTION OF DRUGS ON CIRCULATION. 257 •paqsiuiimp oq Aum oinssaid-pooftj 17' pas^aioui aq ^m amssaid-pooia 258 PHARMACOLOGY AND THERAPEUTICS. Action of the Heart on Blood-Pressure. — I have already mentioned that we can to a certain extent ascertain whether a rise or fall in blood-pressure is due to the heart or arterioles, by comparing the pressure curve with the pulse curve. If they run parallel the effect may be attributed in great measure to the heart. But the effect of the heart on the blood-pressure is not so simple as that of the arterioles. In the case of the arterioles we have to consider only the rate at which the blood will flow through them when they are more or less contracted ; but in the case of the heart we have to consider not only the rapidity of its pulsations, but the amount of blood which is sent into the arterial system at each beat. We judge of the amount of blood chiefly by the extent to which the blood-pressure oscillates with each pulsation. A large quantity of blood will as a rule cause an extensive, and a small quantity only a slight oscillation. When the heart is beating slowly, so that it has time to fill completely during each diastole, the os- cillations are large, and when it is beating quickly the oscillations are small. It is evident that although quick pulsations tend to raise the blood-pressure, they only do so up to a certain point, as beyond that the heart does not get properly filled, and so sends but little blood into the aorta at each beat. But the heart may sometimes be imperfectly filled, even when it is beating slowly ; this has been shown to occur in the case of the frog, by Goltz. When a blow or two is struck on the intestines the veins dilate and the blood accumulates in them, BO that the heart, which is also stopped at first, receives no blood when it does begin to beat again. It can therefore send none into the aorta, and the circula- tion remains completely arrested, although the heart is beating. Fig. 68.— For description vide p. 230. If the pulmonary capillaries also are contracted the left ventricle will receive little blood, and bo will send little blood into the arteries, although the right ven- tricle may be much distended. This appears to occur during poisoning with muscarine, which causes the lungs to become blanched, 1 the right ventricle dis- tended, and the left ventricle and the arterial system empty: so that little blood flows from a wound. 2 It is difficult, however, to estimate precisely the quantity of blood sent into rteries at each beat, and its relation to the rapidity of the pulse, so as to rtain directly how much the rise or fall of blood-pressure is due to the heart; ami therefore tin- is sometimes estimated indirectly by ascertaining first how much of tie- effect of the drug on the blood-pressure is due to the arterioles, and then attributing to tie- heart what is not accounted for by their action. Sometimes also we may gel DsefbJ information by compressing the abdominal ':'-.-ir th<- diaphragm as possible before and after injection. We thus 1 Lander Bnmton, Brit. Med. Journ., Nov. 14th, 1874. 1 Schmiedeberg and Koppe. Das 3fuscarin, p. 57. ACTION OF DKUGS ON CIRCULATION. 259 diminish so greatly the number of capillary outlets by which the blood may flow from the arteries into the veins that we greatly lessen though we do not quite destroy the effect of the arterioles on the blood-pressure. We can thus estimate more precisely the action of the heart upon it. Section of the spinal cord below the medulla oblongata by destroying the effect of the vaso-motor centre upon the vessels, also aids us in estimating the action of the heart. Another method of ascertaining what share in alterations of the circulation locally is due to the heart and arterioles respectively, consists in the combined use of the manometer and Ludwig's stromuhr or Marey's haemodromometer,, The manometer shows the general blood-pressure, while the haBmodromometer shows the rate of circulation in the particular artery experimented upon. If the rate of flow increases while the blood-pressure remains constant or sinks, it is evident that the arterioles of the particular vascular district to which the artery is dis- tributed have become dilated. If, on the other hand, the rate of circulation diminishes while the pressure remains constant or rises, it is clear that the arterioles have become contracted. This method is only capable of being applied to large arteries, such as the carotid or femoral. By placing the stromuhr in the femoral artery, Dogiel and Kowalewsky found that during suffocation the rapidity of the blood-flow dimin- ished while the pressure rose, showing that the peripheral vessels were contracted. 1 By the use of the stromuhr, Dogiel 2 has found that the rapidity of the flow of blood in the carotid is first increased and then diminished by alcohol, the greatest diminution occurring during complete narcosis. Effect of Drugs on the Pulse-Rate. — The pulse-rate, i.e., the rapidity of the heart's beats, is chiefly regulated by the inhibitory fibres of the vagus, although it is affected also by accelerating fibres. In the frog the latter, excepting those which pass to the motor ganglia of the heart from the endocardium, also run mainly in the vagus, which is really the vago-sympathetic (Gaskell). In the higher animals they run chiefly through sympathetic channels, though to a slight extent also in the vagus. If we find that the administration of a drug quickens the pulse, we next try to discover the mode in which it has done so. A glance at the table will show that there are several ways in which acceleration may occur, though the most important is either paralysis of the vagus or, at least, cessation of its action. The usual stimulus to the vagus roots in the medulla which calls the nerve into action is the pressure of blood within the medulla ; when this is high the vagus roots are stimulated, and the pulse becomes slow ; when the pressure is low, the stimulus is removed, and the pulse again becomes quick. Alterations in the blood- pressure will therefore alter the pulse, and drugs which affect the arte- rioles may quicken or slow the pulse-rate without any marked action of their own on the heart or vagus. This has already been mentioned when speaking of nitrite of amyl, which, by lowering the blood-pressure, and thus lessening the normal stimulus to the vagus roots, greatly quickens the heart in the dog. 1 Pfluger's Archiv, 1870, p. 489. 2 Ibid., 1874, vol. viii., parts 11 and 12. 260 PHARMACOLOGY AND THERAPEUTICS. In order to ascertain whether irritation of the vagus has been caused reflexly or not, we may divide the nerves through which we may expect the reflex to have occurred, or we may abolish their action on the medulla to a great extent by the use of large doses of chloral. Action of Drugs on the Car dio -inhibitory Functions of the Vagus. When speaking in the following pages of the inhibitory action of the vagus on the heart, I mean its power to affect the rhythm of the heart so as to render its pulsations slow or stop them entirely, and I do not include under the term inhibition the power which the vagus also possesses of enfeebling the cardiac contractions unless when this is expressly stated. We distinguish between (a) stimulation of the vagus roots by any cause whatever, and (6) stimulation of its ends in the heart 1 by dividing both vagi. Sometimes we inject the drug first, and see whether any slowing of the heart which it has produced disappears on section, or we may divide them before injecting the drug, and see whether any change either in the way of slowing or acceleration, occurs after the injection. If the effect of a drug in slowing the heart is removed by dividing the vagi, we conclude that its action has been exerted on the vagus roots ; if it should still persist, after their division, we conclude that it lias acted on the vagus ends in the heart, or on the heart itself. Thus aconitine, 2 veratrine, 3 erythrophloeum, 4 and probably all members of the digitalis 5 group, stimulate the vagus roots, so that the slowing of the pulse they produce is much lessened or completely abol- ished by section of the vagi, and takes place to a much less extent when the vagi are divided before the injection. That the slowing does not always completely disappear after the section of the vagi, or is not always completely prevented by their previous section, is due to the fact that most of these drugs have also an action either on the ends of the tragus in the heart, or on the nervous mechanism or muscular fibre of the heart itself. Nicotine resembles the substances already mentioned, in so far that the slowing which it would otherwise produce is somewhat lessened by section of the vagi, but only to a slight extent, its action being chiefly exerted on the peripheral cardio-inhibitory system. 6 Phy- gmine chiefly affects the heart itself, and so the slowing of the pulse it causes is not abolished by section of the vagi. 7 1 We use the term ragns ends here for the sake of convenient distinction between the central cardio-inhibitory systems in the medulla oblongata and the peripheral one in the heart A fuller explanation of the peripheral cardio-inhibitory apparatus will be gh en further on. ? Vide Dim rtation on Aconitine under B'ohm's direction, by C. Ewers, Dorpat, 1873. ; Von Bezoldand Hirt, \Y urzhurycr Physiol. Untersuch., i., p. 103. '■ Brnnton and Pye, /'hi/. Trans., 1877, p. 627. Tranbe and other-. ' Traiii..-. Med. OnUrabstg.! 1862 and 1803, No. 9: Centralblatt d. med, Wiss., 1863, ].].. Ill .-md 169; Rosenthal, Centralblatt d.m. Wiss., 1863, p. 737. • i. Trans, of Roy 8oe. of Edinburgh, 1867, Reprint, p. 39; for other literature llarnack, Anh.f. exp. Path. /'. P/uinn., Bd. v., p. 446. ACTION OF DRUGS ON CIRCULATION. 261 Keflex Stimulation of the Vagus. — The vagus centre may be also stimulated reflexly, and slowing or stoppage of the heart produced by irritation of sensory nerves. This stimulation occurs most readily through the nasal, dental, or other branches of the fifth nerve, the nucleus of which is closely connected with that of the vagus or through the sensory branches of the vagus itself, but it may also be induced through almost any sensory, and some sympathetic nerves, if the stimulus be strong. The vagus centre in rabbits appears to be very readily stimulated through the nasal nerves, for the application of any strong vapor such as ammonia or chloroform to the nose not only induces closure of the nostrils and stoppage of respiration, but also complete arrest of the heart's pulsa- tions. It appears also to be very sensitive to venous blood. Stoppage of the heart may occur in man from irritation of a sensory nerve, even under chloroform anaesthesia, and indeed I believe that in excision of the eyeball the heart usually misses one beat at the moment the nerves are divided. In dogs, stoppage of the heart and death may occur from irritation of the stomach, even when complete anaesthesia has been produced by chloroform. Some years ago, when making a gastric fistula in a dog, the animal, which was in a state of profound anaesthesia from chloroform, suddenly died when the stomach was laid hold of with the forceps. This occurred in a second case just as the cannula was being introduced. On mentioning the subject to Professor Schiff, he informed me that he had had several cases of a similar sort when using chloroform as an anaesthetic, but had none after he began to use ether instead. I found also on using ether that no further death occurred. Causes of Quickened Pulse. — If, instead of causing a slowness of the pulse, the drug produces quickening-, it may be due to paralysis of the vagi, to stimulation of the accelerating nerves, or to direct action on the heart itself. We ascertain whether the drug has paralyzed the ends of the vagus in the heart by injecting it, and then irritating the vagi in the neck by a faradaic current. If we find that we are no longer able to slow or stop the heart by stimulation of the vagi, we conclude that the drug has paralyzed these nerves. This action is well marked in the case of atropine. Action of Drugs on Vagus Roots. — We may wish to know, however, what the action of the drug has been on the vagus roots, and it is evident that if the ends in the heart are paralyzed, no action on the vagus centre could alter the pulsations of the heart any more than nervous stimuli proceeding from the cord could move the legs of an animal poisoned by curare. Nor can we separate the vagus centre from the heart by ligature of the vessels so readily as one isolates the frog's leg. It can be done no doubt by tying the carotid and vertebral arteries and keeping up an artificial stream of blood through the head. Instead of this, however, the simpler method is generally adopted of injecting the drug to be tested into the carotid artery, so that it will reach the vagus centre before it gets to the heart instead of injecting it as usual into the subcutaneous tissue or veins, whence it will be carried to the heart before it can reach the vagus centre. By experimenting in this way it is shown that atropine stimulates the vagus roots so that when injected into the carotid it causes slowing of the heart's action. 262 PHARMACOLOGY AND THERAPEUTICS. When it has passed through the cerebral vessels, and returns with the blood to the heart it paralyzes the ends of the vagus in the heart, and therefore the pulse again becomes very rapid, notwithstanding the continued stimulation of the vagus roots. We cannot always conclude with certainty that a drug has excited the vagus roots merely because it has caused the pulse to become slower and has had no action after the vagi have been divided, for it is possible that the terminations of the vagus in the heart may be rendered more sensitive than usual by a drug, so that they may respond to a slighter stimulus than usual or with greater energy to a normal stimulus. Such an action appears to be exerted by physostigmine, which in a certain stage of poisoning renders the vagus more excitable, so that when irritated in the neck by a faradaic current a slighter stimulus suffices to stop the heart after the administration of the drug than before. Action on Accelerating- Nerves. — We ascertain whether a drug has a stimulating action on the accelerating nerves of the heart by cutting both vagi and then injecting the drug. If it quickens the heart still further, we assume that it does so by stimulation of the accelerating nerves. This experiment, however, does not enable us to decide whether the stimulation has affected the accelerating nerves passing to the cardiac ganglia from the central nervous system or those passing from the endocardium. Stimulating- Effect of Asphyxial Blood on the Medulla. — In order to prevent fallacies arising from stimulation of the vagus roots by an asphyxial condition of the blood due to the action of the drug upon respiration, it is usual to maintain artificial respiration through a cannula placed in the trachea. This acts perfectly well in some cases, but if the drug should cause violent convulsive actions it may prevent the movements of the thorax occurring regularly, and there- fore it is sometimes necessary to paralyze them by means of curare. Moreover, it must be remembered that prolonged stoppage of the heart itself will allow the blood in the medulla to become venous and will thus irritate the vagus roots. Prolonged arrest of the heart, therefore, tends by this action to prolong it still further, and functional inactivity tends to pass into death. This mechanism would render every intermission of the pulse very dangerous were it not that the same venous condition of the blood which stimulates the vagus roots stimulates also the vaso-motor centre and the respiratory centre. The vaso-motor centre by contracting the arterioles maintains the blood-pressure during the pro- longed diastole, and excitation of the respiratory centre tends to restore the arterial character of the blood. The venous condition of the blood also stimulates accel- erating centres in the medulla (Dastre and Morat). Stimulation of the Heart by increased Blood-Pressure. — It has already been mentioned that increased blood-pressure usually renders the beats of the heart slower by the stimulating action it exerts on the vagus loots. When the vagi are divided, however, its effect is usually quite different, and a rise in blood-pressure after division of the vagi renders the pulse quicker instead of slower, at least generally. An opposite result has been found by Marey in the heart of the tortoise, where increased pressure rendered the beats slower. The reason of the difference observed between the mammalian heart and that of the tortoise i< probably due to the different development of the nervous and muscular Structures. The tortoise heart acts more like a single simple muscle, and the more resistance it has t«» overcome the more slowly does it work. In the mammalian hearl the increased pressure appears to stimulate the nerves, 80 thai the more resistance it has to overcome the more ACTION OF DEUGS ON CIKCULATION. 263 quickly does it work — that is, if the vagi have been cut. The sensibility of the nervous system in the heart to increased pressure appears to be diminished by atropine, for Schiff 1 has found that a quantity of this poison slightly larger than will dilate the pupil lessens the sensibility of the heart to changes in blood-pressure so much that the pressure may be first increased to three times the normal and then diminished to one-half, or even one-third, without any change in the pulse-rate being produced. Such an observation suggests that atropine would be useful in lessening pain or palpitation of the heart in persons with high blood-pressure or suffering from the effects of cardiac strain consequent on violent muscular exertion. I have tried it in such cases sometimes with apparently great benefit, at other times with little result. The cases of failure may, how- ever, have been due to the remedy not being pushed far enough, as in them the pupil was not markedly dilated. Palpitation. — In what I have just said regarding the effect of blood-pressure on the heart I have spoken of the total work, including in it both the rapidity of pulsation and the amount of work done by each beat. This is, perhaps, fair enough ; but at the same time we must not forget that there is a distinction between the total amount of work done and the nature of the individual contraction, either in the heart of tor- toises or mammals, or in voluntary muscles. Both voluntary muscles and the heart tend to contract rapidly if they have little resistance to overcome. In patients suffering from anaemia and debility where the blood-pressure is low and the resistance to the ventricular contractions is consequently small, they are apt to take place with great quickness, giv- ing rise to a short flapping first sound and a sharp but unsustained apex beat, while the patient complains of much palpitation. In such cases increased blood-pressure will tend to lessen the palpitation, and digitalis, which contracts the vessels, will be useful; iron also is serviceable by increasing the nutrition of the circulatory apparatus of the body gener- ally. The low blood-pressure, however, while it increases the tendency to palpitation, is not the only factor, and is usually accompanied by a tendency to disturbance of the cardiac innervation which is to be met by sedatives such as the bromides, or by remedies directed to the stomach or other organs from which the disturbing stimulus may proceed. The Heart of the Frog. This is a very convenient object on which to study the action of drugs. Their effects upon it are somewhat, though not absolutely, the same as their effects on the mammalian heart; and the frog's heart being simpler in its construction it is easier to analyze the exact mode in which drugs act upon it. The frog's heart consists of three chambers, one ventricle and two auricles. But in addi- tion to these, there is what might almost be called a fourth chamber, the venous sinus or sac into which the venae cavae open. There are three venae cavae, two superior and one inferior, which open into the venous sinus. The venous sinus itself opens into the right auricle, the opening being covered during the auricular systole by a small fold which acts as a valve. 1 La Nazione, 1872, No. 235. 264 PHARMACOLOGY AXD THEEAPEUTICS. The left auricle receives the pulmonary veins and discharges into the single ventricle the arterial blood which enters it from them, while the right auricle does the same with the venous blood it receives from the sinus. Left auricle and pulmonary veins. Aortic bulb. 5* Bidder's ganglia. Y *i] \ Fig. 69.— Diagram of the frog's heart Superior venae cavae and vagi nerves. Venous sinus and Remak's ganglion. Inferior vena cava. Ventricle. The septum between the auricles ends inferiorly in two triangular flaps which act as valves between the auricles and ventricle. From the ventricle issues the common aorta, or aortic bulb, which has at its origin from the ventricle a spiral valve to prevent the return of the blood. The E.t£BMQBC*M.sc FlG. 70.— View of the auricular septum in the frog (seen from the left side). The nerves are stained with osmic acid, n is the posterior, and n' the anterior cardiac nerve; t is a horizontal portion of the latter nerve ; 6 is the posterior, and b' the anterior auriculo-ventricular ganglion ; m is a pro- jecting muscular fold. [This figure is taken by the kind permission of my friend, M. Ranvier, from lis Lemons d'Anatomie Genbrale, Ann6e 1877-8, " Appareils nerveux terminaux," t. 6., p. 79.] tii two auricles beat together, and the aortic bulb and ventricle usually beat together, though the bulb is capable of independent pulsation. The usual rhythm is the following: first the venous sinus, next the auricles, then the ventricle and bulb. The pulsations of the venous sinus and ventricle alternate with those of the auricle. The heart continues to pulsate rhythmically after it has been com- pletely removed from the body, so that the motor power of rhythmical contrac- tion i- evidently contained within itself. Its rhythm is, however, regulated by the vagi nerve-. These pass along behind the two superior cavae to the junction of the venous sinus with the auricle. At this spot, or just over the auricles, between the superior cavae and the pulmonary veins, they anastomose to form a single •* o Cumarine. [Depression is shown by diminished energy of contraction with final stoppage in diastole. The cardiac muscle is shown to be paralyzed by no longer contracting on stimulation, either mechanical or electrical.] Salicylic acid. Potassium salts. Copper double salts. Zinc double salts. Quinine (?). Saponin (removes the systolic still- stand produced by digitalin). Apomorphine. Emetine. Muscarine. Pilocarpine. Veratrum viride (veratroidine and jervine). ,3.3 g-a g£ . -: fe» U & -5 a §2 CQ c3 2 -P C3 03 2 CO rt « *3 h i * ^^2 ftcj This stoppage of the heart in systole occurs in frogs, but in higher animals the heart may stop in diastole. Vaso-motor Nerves. [It is very doubtful whether they are stimulated by drugs, and at any rate it is very difficult to ascertain whether any stimulation which may occur in the arterioles or capillaries is in the termi- nations of the vaso-motor nerves or in the muscular walls.] [Paralysis is shown by the vessels not contracting on stimulation of the vaso- motor nerves, while they still contract on direct stimulation. This has been chiefly observed in the vessels of the intestines after irritation of the splanch- nic nerves. The effect of irritation is ascertained by the alterations in color of the intestine, and also by the alterations in the general blood-pressure which occur after irritation.] Potassium salts. Arsenic. Antimony. Mercury. Iron. 282 PHARMACOLOGY AXD THERAPEUTICS. Capillaries. STIMULATED BY. DEPRESSED OR PARALYZED BY. [Stimulation is shown by a rise in [Depression is shown by fall of blood- blood-pressure which remains after sec- pressure to a slight extent, even after the tion of the spinal cord at the occiput, spinal cord has been divided, and by in- and is produced by the injection of the creased rapidity of flow when artificial drug after previous division of the cord. circulation is kept up.] It is also ascertained by the rate of flow Acids, through the vessels being diminished by Nitrites. the drug when circulation is kept up Quinine (?). artificially in a frog whose nerve-centres have been destroyed, or in a single limb of a warm-blooded animal.] Alkalis. Digitalis and its allies. Barium salts. Potassium salts. Copper. Zinc, &c. Stannius's Experiments. Some of the most important experiments relating to the action of the various cavities of the frog's heart were first performed by Stannius, and bear his name. When the venous sinus is separated from the rest of the heart by cutting it off with a sharp razor, or by a ligature tightly drawn round it at its junction with the auricle, it continues to pulsate, but the auricle and ventricle stand perfectly still (a, Fig. 82). If now the auricle is separated from the ventricle by another cut fb, Fig. 82), or another ligature be applied (c, Fig. 82), at the auriculo- ventricular groove, the auricles remain motionless, but the ventricle begins to i he 3 .-,-: bwi a b c 1 1 ( '- v --— ", diagram of frog's heart ligatured at the junction of the venous sinus with the auricles. The rense cav;e and sinus are represented with a crenated outline resembling the tracing which their beats might give if recorded on a revolving cylinder. The auricle and ventricle being mo- tionless would only trace a straight line if connected with a recording apparatus. Their outline •efore represented by a straight line, b, diagram of a frog's heart in which sections have been made at the junction of the sinus with the auricles, and at the auriculo-ventricular groove. The sin us and ventricles pulsate, whilst the auricles remain motionless. The beats of the ventricle should have been represented as slower than those of -the auricle as in/, Fig. 83. c, the same as 6, but with the parts of the heart separated by ligature instead of section. beat, bo that the venous sinus and ventricle are both pulsating, while the auricles are at rest. The venous sinus and the ventricle, however, no longer beat with the same rhythm, and the rate of the ventricular beats is usually much slower (j. Fig. 83). In this remarkable experiment the complete stoppage of the auricle- and ventricle which follows the removal of the venous sinus has been Supposed to show that the motor centres for the entire heart reside in the sinus, and that from them the motor impulses originate which keep up the rhythmical pulsations of the organ. But the fact that the ventricles begin to pulsate on theb own account when separated by another cut from the auricle seems to show that they also contain motor centres. The hypothesis has therefore been advanced that both venous sinus and ventricles contain motor centres, while the auricles contain inhibitory c-ntr ACTIOX OF DRUGS OX CIRCULATION. 283 So long as the auricles are in connection both with the venous sinus and the ventricle, the motor centres in the latter two cavities are supposed to be suffi- ciently powerful to overcome the resistance offered by the inhibitory centres, and thus the cardiac rhythm is maintained. When the motor centres of the sinus are removed the inhibitory centres of the auricle are supposed to be so powerful as to keep both it and the ventricle in a state of rest. When the ventricle is separated from the auricles and their inhibitory in- fluence removed, it again begins to pulsate rhythmically. In order to obtain a clearer idea of the mechanism of the heart, many variations of the above funda- mental experiments have been made. The chief results of these are the following : — First, section or ligature of the venae cavae or of the venous sinus at any point before its junction with the ventricle does not affect the action of the heart (<*, Fig. 83). Second, section or ligature of the auricles at any point above the auriculo- ventricular groove arrests the movements of the part below them, while that connected with the venous sinus still continues to pulsate (e, Fig. 83). 3$* 6P? V d e f Fig. S3. — d, diagram of a heart with ligature round the venous sinus, e, diagram of heart with ligature round middle of auricles. /, diagram of heart with ligature in the auriculo-ventricular groove. The pulsations of the ventricle are much slower than those of the auricle and venous sinus. This is indicated by the larger dentation of the outline of the ventricle. Third, irritation of the vagus nerves usually produces stoppage of the heart-beats. Fourth, ligature or section of the vagi before their entrance into the heart prevents their having any action upon it when they are stimulated. Fifth, ligature or section of the venous sinus or auricles prevents any action of the vagi upon the part of the heart below the ligature or section. It is evident that section or ligature of the heart at any point between the junction of the sinus and auricles and the auriculo-ventricular groove has the same action on the movements of the part below it as irritation of the vagus. But more than this, although, as we have seen, the motor ganglia of the heart appear to be situated chiefly in the venous sinus, yet irritation of the sinus produces complete still-stand of the heart, even more perfect and prolonged p, £p Fig. S4.—g, diagram of heart stopped by a ligature at the junction of the sinus and auricles. The out- side of the ventricle is irritated by a needle, and the even outline indicates that no contraction occurs. A, diagram similar to g, but with the inside of the ventricle irritated by a needle. The projections on the outline of the heart indicate that one contraction of the ventricle and three or four of the auricles occur, k, diagram similar to g and A, but with the outside of the auricle stim- ulated by a needle. The projections indicate that one contraction of the auricle and one of the ventricle occur. than irritation of the vagus. Strong stimulation of the venous sinus has there- fore the same effect as its removal. The parts whose motions have been arrested 284 PHARMACOLOGY AND THERAPEUTICS. by section or by irritation, in the experiment just described, are not paralyzed : this is shown by the effect of stimulation upon them. When the auricles and ventricle are standing still after section or ligature of the venous sinus, irritation of the outside of the ventricle with a needle has no action (y, Fig. 84); but if its interior be irritated by a needle (h, Fig. 84), the auricle contracts first, then the ventricle, then the auricle again two or three times, but the ventricle does not respond. When the auricle is irritated by a needle applied to its outside, contraction both of the auricle and ventricle ensues (&, Fig. 84). When the auriculo-ventricular groove is irritated by a needle there are usually eight or ten contractions in response. When the outside of the auricle is irritated by an interrupted current, numerous and rhythmical con- tractions both of auricle and ventricle ensue. To sum up these results shortly, we find that either removal of the normal stimuli which pass in the direction of the circulation from the venous sinus to the auricle and then to the ventricle, or abnormally strong stimulation, produces arrest of the rhythmical movements of the heart, or, as it is usually termed, inhibition. Some exceedingly instructive experiments have been made by Gas- kell, who, instead of separating the cavities of the frog's heart from each other by sections or by a ligature, compresses more or less completely the point of junction, so as to impede to a certain extent the transmis- sion of stimuli from one cavity to another. ATI; " Fig. 85.— Diagram to illustrate Gaskell's experiment. At a the jaws of the clamp hold the heart with- out compressing it, and each beat of the auricle is succeeded by one of the ventricle as shown by the figure ^ At 6 the heart is compressed, and its rhythm disturbed, so that one beat of the ven- tricle only occurs for several of the auricles. He does this by a clamp the two limbs of which are placed one on each side of the heart. By means of a micrometer screw their edges can be approxi- mated so as either simply to hold the heart without pressure or to compress it to any desired extent. When the clamp is placed in the auriculo-ventricular groove, the beats of the auricles and ventricle are registered separately by levers above and below the clamp with which the auricles and ventricle are connected by threads. When the heart is simply held by the clamp without compression, each beat of the auricle is followed by one of the ventricle; but when the auriculo-ven- tricular groove is compressed the transmission of stimuli from the auricle to the ventricle appears to be blocked in somewhat the same way as it is by compres- Bion in the contractile tissue of medusa), and one beat of the ventricle then occurs with every second, third, fourth, or more auricular beats, according to the degree of pressure, and if this be very great the ventricle will cease beating altogether. The beatfl of the ventricle are shown in this experiment to be diminished or arrested bj hindering or blocking the transmission of stimuli to it from the venous sinus and auricle. I>ut, as one might expect, a diminution of the stimuli themselves has a similar effect as a block to their passage. Thus, if the auricle and sinus are heated, but not the ventricle, their rhythm is markedly quickened, ACTION OF DRUGS ON CIRCULATION. 285 but the ventricle now beats only once for every two or even more pulsations of the auricle, the heat appearing to render the impulses proceeding from the auri- cle and sinus more rapid but more weak. If the ventricle be heated as well, it will respond to each beat of the auricle, so that the whole heart beats more quickly, but if the ventricle alone be heated its rhythm remains unchanged. Experiments which are likely to give useful information in regard to the action ot various drugs on the cardiac muscle and nerves have been made by Graskell by the aid of the clamp already described. General Considerations regarding the Heart. In ascidians the heart is a mere contractile sac open at both ends, and drives the fluid alternately in opposite directions. In snails it is a simple sac of proto- plasm without differentiated nerves, but drives the nutritive fluid in one direc- tion. In the amphioxus there is no special heart, but only numerous contractile dilatations in the chief blood-vessels. In fishes the heart may be said to consist of three parts — the auricle, ventricle, and arterial bulb. The heart of the frog has already been described, and that of mammals requires no description. Even the complicated mammalian heart may be regarded as a special develop- ment of the simple contractile tube endued with the power of peristaltic contrac- tion. The direction in which the contraction occurs is probably determined at first by slight differences in the stimuli to which the two ends of the tube are subjected, and the direction may be altered by altering the stimulus. Thus in the heart of a fish the contraction usually proceeds from the auricle to the ven- tricle and bulb, but by irritating the bulb the direction may be reversed so that the bulb contracts first and the auricle last, and this reversal of rhythm may persist for some time. 1 In the mammalian heart it is not perhaps so easy to re- verse the rhythm by simple irritation, and probably some interference with the cardiac nervous system is also requisite, but by introducing tincture of opium into the mammalian ventricle the rhythm may be reversed so that the beats of the auricle follow instead of preceding those of the ventricle. 2 The cause of rhythmical pulsation in the heart is usually supposed to be the motor ganglia which it contains. Of late years numerous researches have shown that, although these are very important indeed, yet they are not to be looked upon as the exclusive originators of the rhythm. The heart of the snail, although it consists of simple protoplasm without nerves, beats rhythmically, and when a ligature is tied across the venous sinus in the frog the vense cavas and upper part of the sinus continue to beat although they possess no special ganglia, while the rest of the heart remains motionless, although it contains both Bidder's and Remak's ganglia. From this experiment one would be inclined at first to say that the initiation of rhythm in the heart is due to the mus- cular tissue of the venas cavas and sinus, and might be inclined to regard the nervous system of the heart as an apparatus for merely conducting stimuli from the sinus to the auricles and ventricle. Other experiments would seem to deprive the nerves even of this function, for Engelmann 3 and Graskell have shown that when Bidder's ganglia are excised, or the nerves cut through as they traverse the auricles, contractions still pass from the venous sinus to the ventricle, and continue to do so when the nerves have not only been divided but most of the muscular tissue of the auricle has been cut through and only a narrow bridge remains behind. This may seem 1 Gaskell, Journ. of Physiol., vol. iv., p. 78. 2 Ludwig, Physiologie, 1861, vol. ii., p. 88. 3 Pfluger's Archiv, xi., p. 465. 286 PHARMACOLOGY AND THERAPEUTICS. to prove that the muscular tissue of the heart conducts the motor stimuli from the venous sinus to the auricle and ventricle, which cause them to contract, and may appear to show that the cardiac nerves are entirely superfluous. A similar mode of reasoning, however, would lead us to say that the ganglia in medusae are also superfluous because the contractile tissue will pulsate rhythmically after they have been cut off", if it be placed in acidulated water. In regard to the conduction of stimuli, the fact probably is that under favorable conditions they may be conveyed by the muscular tissue alone from the sinus to the ventricle, but, under ordinary circumstances, they are conveyed in part, at least, by the nerves. Granglionic tissue is more sensitive than contractile tissue, and the stimuli which act on the ganglia of the medusa, under the conditions in which it lives, are insuflicient to excite contractile tissue. When the ganglia are paralyzed by a poison, the effect is the same as if they were cut off, and pulsation is arrested. A similar condition appears to occur in the ventricle. The muscular tissue forming the apex of the frog's heart under ordinary circumstances will not beat when separated from the rest unless an extra stimulus be applied to it. The ventricle containing Bidder's ganglia will usually pulsate rhythmically, and if its apex be dipped in a solution of chloral no effect is produced, but if its base be dipped in the solution so that the drug acts upon the ganglia, the pulsations are arrested apparently by paralysis of the ganglia (Harnack). We may consider then that ganglia are more susceptible to stimuli than muscular fibre, and have the function of making it pulsate rhythmically when it otherwise would not. It is probable also that they serve to prevent the occurrence of blocks at the junction between the different cavities of the heart which might occur if the stimuli were transmitted from each cavity by muscular tissue alone. When the heart is dying, and when we may fairly assume that its nerves are losing their functional activity, such blocks actually take place, and the ventricle may beat only once for every two or three or more beats of the auricle. The cardiac muscle is also without doubt losing its functional activity, yet it still retains it to such an extent that each cavity can contract powerfully. The same thing occurs when the heart is poisoned with chloral, iodal, or other members of the same group, which, as already mentioned, paralyze the cardiac ganglia. 1 In the present state of our knowledge it is difficult to make any absolute statement regarding the function of the cardiac g-anglia, but I think we may fairly assume them to have two functions, (1) to originate rhythmical pul- sations in the heart when the muscular fibre alone, although capable of inde- pendent rhythmical pulsation, would not pulsate under the conditions which may be present ; (2) to transmit and receive stimuli from one cavity of the heart to ill' other, and thus prevent the occurrence of blocks at the junction of the cavities and consequent irregular action which might occur if the stimuli were transmitted only by the muscular fibre. Regulating Action of the Nervous System. 'I'll, necessity of some means for regulating the action of the heart in ac- cordance with the wants of the body is obvious, and in the heart we find that suet an arrangement exists in relation both to the strength and rate of pulsation. 1 Harnack and Witkowski, Arch.f. exp. Path, und Pharm., vol. xi., p. 15. ACTION OF DEUOS ON CIRCULATION. 287 The action of the vagus upon the heart has long been a matter of great dispute, some physiologists holding it to be the motor nerve of the heart, while the majority regard it as inhibitory. The reason of this disagreement probably is that the right and left vagi have frequently different effects upon the heart, and that the effects even of the same vagus may vary according to the state of nutrition of the heart and other circumstances. We find for example in rabbits that both the right and left vagi can usually slow or stop the heart ; but some- times the right has much greater power in this respect than the left, and in some species of tortoise the left vagus has no inhibitory action upon the heart at all. A number of experiments made by Graskell on the heart in situ and with the clamping apparatus already mentioned, by which the beats of the auricle and ventricle may be simultaneously recorded, have led him to divide the effects produced on the heart by irritation of the vagi into two types : (a) affec- tions of the rate of rhythm ; and (6) affections of the strength, of the contractions. The effects of vagus stimulation on the heart of the frog may thus be divided into five classes. The 1st class is that which occurs with the heart of the tortoise or frog in situ or just after their removal from the body. The vagus here causes arrest by slowing the rate of rhythm ; and, in consequence, the first beats which occur after the heart again begins to beat are slower than those preceding the stimulation. In the next classes the vagus produces its effect by weakening the strength of the contractions so that they may become invisible and the heart remains still, but after it begins to beat their rate is as quick or quicker than before. The 2d class is an example of this. In it irritation of the nerve produces complete stoppage of both auricles and ventricles. This is followed by con- tractions, which are at first so small as to be hardly visible, but quickly grow larger until they are much greater than the normal ; from this they gradually decrease to the normal size (Fig. 86). Fig. 86. — After Gaskell. Tracing showing the action of the vagus on the heart. Aur. indicates the auricular, and Vent, the ventricular tracing. The part included between the upright lines indi- cates the time during which the vagus was stimulated. C. 8 indicates that the secondary coil used for stimulation was eight centimetres distant from the primary. The part of the tracing to the left hand shows the regular contractions of moderate height before stimulation. During stimula- tion, and for some time after, the movements of both auricle and ventricle are entirely arrested. After they again commence they are small at first, but soon acquire a much greater amplitude than before the application of the stimulus. The two types of action may occur together, the rhythm becoming slower and the contractions smaller. This is seen in Fig. 87. The 3d class is where irritation produces no still-stand of either auricles or ventricles, but only great diminution in the size of the beats, followed by a gradual increase and subsequent fall similar to that just described. This curve is like the first, but differs from it in the absence of the complete arrest (Fig. 88). 288 PHARMACOLOGY AND THERAPEUTICS. The 4th is that where there is no primary diminution, but gradual increase in the size of the beats, which again sink to the normal (Fig. 89). Vend Co. Tnnmnnfl/i/iiififinflfKKififii mmmimmi jUUUUUUiiJiJU^^ Fig. 87. — After Gaskell. Tracing showing diminished amplitude and slowing of the pulsations, with- out complete stoppage, during irritation of the vagus. The 5th is where irritation of the vagus does not stop the beats of the venous sinus but causes both auricles and ventricle to stop. Fio. B8.— After Gaskell. Tracing showing diminished amplitude of contraction without slowing or stoppage during irritation of vagus. The ordinary inhibitory effect of the vagus is the one which is noticed best in well nourished hearts, and as the heart becomes more exhausted and is dying, icing showing Increased cardiac contractions from irritation of the In thii figure the upper tracing shows the ventricular and the lower the auricular ■ ACTION OF DEUGS ON CIRCULATION. 289 the motor power of the vagus becomes more and more pronounced. We find a similar occurrence in the case of the splanchnics, which lose their inhibitory -3-BM I . /UOWMAWAI Fig. 90. — Part of the posterior cardiac nerve, more highly magnified, showing the ganglia. (Ranvier, op. cil., p. 106.) Fig. 91. — Spiral ganglion cell from the pneumogastric of the frog. This figure is not taken from the cells in the cardiac nerves, as in them the connection between the spiral and straight fibres has not been clearly made out, but it is probable that these cells have a structure similar to the one figured (Ranvier, op. cit., pp. 114-20). a is the cell-body, n the nucleus, r the nucleolus, d nucleus of the capsule. / the straight fibre, g Henle's sheath, sf spiral fibre, g' its gaine, n nucleus of Henle's sheath (Ranvier, op. cit., p. 114). 19 290 PHARMACOLOGY AND THERAPEUTICS. power as the intestine dies. Nervous structures as a rule die sooner than muscle, and the conclusion is not unwarranted that the disappearance of the inhibitory action of the vagus is due to a gradual death of the nervous structures upon which it acts in the healthy heart, while its action on the muscular tissue, which has a more prolonged vitality, still remains. The actual increase, indeed, in its motor action we may attribute to the removal of nervous interference. Hypothesis regarding- the Action of the Vagus. — Nervous inter- ference as a cause of inhibition was clearly pointed out by Bernard, and in the case of the heart has been discussed by Ranvier with his usual clearness. In the gray matter of the spinal cord there is ample room for the slowing of nervous stimuli by transmission along paths of different lengths (p. 156), more especially as a small length of gray matter is equivalent to a great length of ordinary nerve fibre (p. 149). In the heart we might suppose there was no such provision, but, as Ranvier points out, the ganglion cells in the auricle have one of their fibres wound spirally, so as to give a great length in small space, and thus provide for retardation and interference of stimuli. If we suppose that some of the fibres of the vagus pass through these spiral ganglia while others pass on directly to these ganglia, we can understand that the different rates of transmission may lead to interference and stoppage of pulsation. Alterations in the rate of transmission along the spiral fibre may again convert interference into coincidence of waves and cause acceleration and increased action as in GaskelTs experiments just described. If these spiral fibres are affected by drugs so that the rate of transmission of stimuli along them is altered, we can understand that the interference may in some cases be increased, in others diminished, and that an increase of interference may readily pass into the opposite condition, so that irritation of the vagus no longer produces stoppage but acceleration of the heart, such as actually occurs on irrita- tion of the vagus after its inhibitory power has been paralyzed by atropine. We can understand also how curare and the large class of drugs which par- alyze the motor nerves may destroy the inhibitory power of the vagus. Inhibition in the Heart. — But it is probable that interference between the nervous structures is not the sole cause of inhibition in the heart, we must look also to the relationship between nervous and muscular rhythms. Thus distension of the ventricle frequently diminishes or abolishes the action of the vagus, the stimulus which the pressure within the heart exerts on the muscular fibre appearing to more than counteract the inhibitory action of the nerve. The condition of the muscular fibre too is probably very important. Thus, feeding the frog B heart with a solution containing soda appears to paralyze the power of the vagus, which is again restored by potash. It is indeed to an action on the muscle rather than on the nerve that we must probably look for the explanation of the action of atropine. For the heart in snails, though apparently destitute of both ganglia and nerves, is arrested by an interrupted current. This effect is prevented by atropine. It [fl exceedingly difficult, or perhaps impossible, with the physiological data which we at present possess, to give a complete and satisfactory ex- planation of the action of drugs on the heart, but it is evident that while all now discoveries tended for a while to render our ideas regarding the cardiac mechanism more and more complicated, our increasing knowledge now tend- to render our ideas more simple. Before long we may hope that systematic investigations into the action of drugs on the excitability, rhythm, and power to conduct stimuli of the cardiac muscle itself; on the action of drags upon the rhythm of the ganglia, and on the rate of ACTION OF DRUGS ON CIRCULATION. 291 transmission by the nerves, as well as on the mutual relations of these various factors, will at last give us a clear understanding of this very difficult and complicated subject. Therapeutic Uses of Drug's acting* on the Circulation. The drugs which act on the circulation have been divided according to their action into stimulants, tonics, and sedatives. Each of these classes has been further subdivided into cardiac and vascular, according as its members act on the heart and vessels. There are thus six subdi- visions in all: cardiac stimulants, vascular stimulants, cardiac tonics, vascular tonics, cardiac sedatives, and vascular sedatives. Cardiac Stimulants. These are substances which rapidly increase the force and frequency of the pulse in conditions of depression. The most important are ammonia, and alcohol in its various forms, but there are also other substances which are sometimes useful : — Heat. Liquor ammoniae. B. P. Aqua Ether. ammoniae. U.S. P. Chloroform. Ammonium carbonate. Spirit of chloroform. Sal volatile (spiritus ammoniae Spirit of ether. aromaticus). Camphor. Alcohol. Aromatic volatile oils. Brandy. Oil of turpentine. Whisky. Heat and counter-irritants to the Eau de Cologne. praecordium. Gin. Liqueurs. Strong wines. Atropine. Cardiac stimulants are used to prevent or counteract sudden failure of the heart's action in syncope or shock due to mental emotion, physical injury, or poisoning by cardiac depressants, or by the bite of snakes, or when the action of the heart becomes much depressed in the course of fevers or other diseases. B Although alcohol after its absorption stimulates the heart, yet its effect on the heart is probably, to a considerable extent, due to a reflex action on it through the nerves of the mouth, gullet, and stomach. Its action is consequently very rapid, and begins before there has been time for much of it to be absorbed. On this account, however, it must be given in a somewhat concentrated form, and if much diluted, as in the form of weak wine or beer, which has little or no local action and can exert no reflex action, it has little or no power as an immediate stimulant. When given in disease it is best to administer it in small quantities frequently, and the rule by which to ascertain whether it is doing good or not is : Does it bring the circulation more nearly to the normal or not? If it 292 PHARMACOLOGY AND THERAPEUTICS. does so it is beneficial ; if it does not it is harmful. Thus, if the pulse be too quick, alcohol should render it slower; if already abnormally slow, alcohol should make it quicker. If too small, soft, and compressible, alcohol should render it larger, fuller, and more resistant. There are other rules connected with the effect of alcohol on other organs which also regulate its use in disease, but these will be given further on. Ether alone or mixed with alcohol has a stimulant action almost more rapid than alcohol itself; and chloroform in small doses, and especially when mixed with alcohol, is also a powerful stimulant. Ammonia has not only a reflex action on the heart like that of alcohol, but has powerful stimulating action on the vaso-motor centre. Its action when applied to the nose in syncope has already been discussed. In cases of snake-bite thirty minims of liquor ammoniae have been injected directly into the veins. The immediate stimulating effect appears to be beneficial, although it is doubtful whether life can really be saved by this means. Camphor is useful as a cardiac stimulant in febrile conditions with tendency to failure of the circulation, as in typhus and typhoid fevers ; in exanthemata, when the rash does not appear ; in asthenic pneumonia, and in the typhoid condition depending on other diseases. Aromatic volatile oils and substances containing them have also been used in similar but less severe conditions. One of the most powerful of all cardiac stimulants is heat, and when the heart's action threatens to fail it may be frequently restored by warm fluid taken into the stomach, or by the application of an India-rubber bag 1 or bottle filled with hot water, or of a bag filled with hot sand or salt, or of a hot poultice to the cardiac region. Vascular Stimulants. These are substances which cause dilatation of the peripheral vessels, 2 and thus render the flow of blood through them more rapid. The most important are : Heat. Alcohol in its various forms. Dover's powder. Ether. Acetate of ammonia. Nitrous ether. Alcohol and ether, by stimulating the heart at the same time that they 1 An India-rubber bag for holding hot water is one of the most useful things an invalid can carry about with him. It should have a flannel case fastened by bat- tons bo that it can easily be removed. This allows the heat to come gradually through without burning the skin. For a small gratuity the engine driver or stoker is usually willing to fill the bag with hot water, and the bag can be refilled if neces- sary at each station where there is a sufficiently long stoppage. This is sometimes a very great boon to invalids on long railway journeys such as they are often com- pelled to make oo kheif way to winter health resorts. Fiom this definition it will be observed that while cardiac stimulants increase the functional activity of the heart, vascular stimulants do not increase the contrac- tile power of the vessels, nor the activity of the vaso-motor centre, but on the con- trary diminish the contraction of the vessels. ACTION OF DRUGS ON CIRCULATION. 293 dilate the vessels, render the peripheral circulation very vigorous. From its stimulant action on the vaso-motor centre, ammonia is less useful than alcohol. Vascular stimulants are useful in equalizing the circulation and pre- venting congestion of internal organs. Thus, from exposure to cold generally so that the whole surface of the body is chilled, or from a local chill due to a draught, or to the combined action of cold and mois- ture, as in wet feet, congestion of the respiratory tract, or of the stomach, intestines, or pelvic organs may occur. This frequently evidences itself immediately either by rigors or by localized pain. If the congestion be not relieved inflammation may occur, but if alcohol be taken either in a concentrated form or diluted with boiling water, the vessels of the sur- face dilate, a warm glow is felt throughout the body, the shivering and pains disappear, and frequently all injurious results of the chill are averted. If the external cold, however, is very excessive, and the expo- sure is to be prolonged, alcohol must be used with great care, as the blood becomes much more rapidly cooled when the cutaneous vessels are dilated than when they are contracted, and in arctic temperatures a per- son is much more readily frozen to death after the free use of alcohol. Dover's powder is also a useful vascular stimulant, though less powerful and rapid than alcohol. It is of use in similar cases to those just de- scribed, and may be given after the alcohol to supplement and continue its action. Slighter cases of chill may be treated by Dover's powder alone, and ten grains of it taken at night will often cut short commencing coryza, and will frequently prevent slight increase of consolidation occurring round a cavity after a chill in persons suffering from phthisis. Patients suffering from this disease should not omit to take a Dover's powder or some other vascular stimulant at night whenever they feel as if they had caught cold, and before any local mischief can be detected. All nitrites dilate the blood-vessels and thus act as vascular stimu- lants. The one most commonly employed is nitrite of ethyl in the form of spirits of nitrous ether. This remedy, taken in hot water or along with acetate of ammonia, is a useful vascular stimulant, and is often used for the same purposes as Dover's powder. Camphor is frequently used as a popular remedy instead of alcohol or Dover's powder in order to cut short coryza or catarrh, about ten drops of the tincture being taken on a piece of sugar. Local vascular stimulation is useful in removing chronic inflammation or consolidation. For a more detailed account of its action and uses, vide Irritants and Counter-irritants, p. 301. Cardiac Tonics. These are drugs which have no perceptible immediate action on the heart, but when given for a little while render its beats much more pow- erful, although usually much slower. The most important of them are: — Digitalis. Convallaria majalis. Digitalin. Convallamarin. 294 PHARMACOLOGY AND THERAPEUTICS. Digitalein. Adonis vernalis. Digitoxin. Adonidin. Erythrophloeum (Casca). Squills. Erythrophlcein. Scilla'in. Strophanthus hispidus. Helleborein. Strophanthine. Antiarin. Caffeine. Nux vomica. Strychnine. All these drugs, as already mentioned, stimulate the cardiac muscle and render its contractions slower and stronger. Although in large doses they tend themselves to produce irregular and peristaltic contraction of the heart, yet in moderate doses they tend to remove irregularity already present. The cases in which they are most useful are those in which the left ventricle is unable to drive the blood with sufficient force into the aorta. It is evident that this inability may depend on simple weakness of the ventricle without any valvular lesion, or upon irregular action of the various cavities, or upon valvular lesions, or on a combination of two or more of these conditions. Weakness of the heart may occur in cases of general malnutrition, as anaemia and chlorosis, or in consequence of acute disease, such as fevers. It is not necessarily accompanied by dilatation, but if it continues for some time the cavities are apt to dilate. A considerable amount of dila- tation may sometimes occur without leading to valvular incompetence, but if it proceeds beyond a certain point the cusps of the tricuspid and mitral valves become insufficient to close the dilated orifices, and mitral or tri- cuspid regurgitation is the result. For it must be remembered that in the healthy heart the tricuspid and mitral orifices are much diminished in size by the contraction of the muscular tissue of the heart at the mo- ment of systole. In cases where the mitral valve is thus affected, a systolic murmur may be heard at the apex during life, but should death occur, the valves may be found perfectly competent to close the mitral orifice in the heart, which is then in a state of more or less complete rigor. In all such cases of weakness of the heart, either with or without dilatation and functional incompetence of the valves, digitalis is of the greatest possible service. I have also found erythrophloeum give most satisfactory results in simple dilatation without incompetence. The form of valvular disease in which cardiac tonics are especially useful is mitral regurgitation. In all forms of valvular disease there is a tendency to the occurrence of compensatory hypertrophy, which will enable the heart to do its work in spite of the hindrance caused by the disease. Wherever this is sufficient so that the circulation is well carried on, QOtwithstanding the valvular defect, cardiac tonics are useless and likely to be injurious. Nor should they be given when the compensatory hypertrophy is just beginning to take place. But when compensation is insufficient, cardiac tonics are of the very highest value. In mitral regur- gitation the Mood, instead of being driven entirely onwards by the left ventricle into the aorta, is partially driven backwards into the left auricle ACTION OF DRUGS ON CIRCULATION. 295 at the very moment that the right ventricle is driving the blood into the pulmonary artery and lungs. Hence there is a tendency to pulmonary congestion, which may lead to haemoptysis. The right ventricle having to work against greatly increased pressure tends to dilate, the blood ac- cumulates in the venous system generally, and venous congestion of the stomach leads to loss of appetite, of the kidneys to albuminuria, and of the limbs to anasarca. While the venous system is gorged, the arterial is correspondingly empty, and it is not only the stomach, kidneys and limbs which suffer by the stagnation of the circulation, for a similar con- dition exists in the heart itself. In consequence of this its action may become not only weak, but irregular, and matters go on from bad to worse. In such a condition cardiac tonics are of the greatest possible service. By increasing the strength of the cardiac muscle they not only enable the left ventricle to drive a larger proportion of blood into the aorta, but they actually tend to lessen the opening of the mitral orifice in the same way as in functional incompetence. By rendering the pulse less fre- quent they allow the ventricle to become more completely filled during each diastole. The pressure on the lungs, right side of the heart, and venous system, is diminished, the arterial system becomes correspond- ingly filled, the congestion of the various organs is diminished and their function correspondingly improved. The consequence of this is that in the stomach we have increased appetite, in the kidneys diminished albumen, and in the limbs removal of anasarca. The heart also benefits by the improved circulation in it, its pulsations are more regular and powerful, and it will often continue to act well and carry on the circulation satisfactorily even after the tonics which first enabled it to do so have been discontinued. In mitral stenosis cardiac tonics probably are beneficial both by lengthening the diastole and thus allowing more time for the blood to run out of the auricle into the ventricle, and by strengthening the auricle itself. Besides this, mitral stenosis is usually accompanied by mitral re- gurgitation which will be benefited by cardiac tonics in the way just described. In aortic stenosis digitalis is of little or no use when there is sufficient compensatory hypertrophy, but may be useful if the heart is becoming feeble. There has been considerable difference of opinion regarding the use of digitalis in aortic regurgitation, some holding it to be useful and unat- tended with any risk, while others regard its administration as attended with considerable danger. In considering this question we must bear in mind that the risks which a patient runs from aortic regurgitation are not the same in all stages of the disease. While the aortic regurgitation is uncomplicated, and the ventricle strong enough to carry on the circu- lation, the risk to the patient is that of sudden death by syncope. It is easy to understand how this should be the case. When the aortic valves are healthy the arterial system may be regarded as a large- branched tube open only at one end — the capillaries — and through these the blood flows so slowly that there is no risk of syncope from the blood- pressure falling too low (Fig. 92, a). 296 PHARMACOLOGY AND THERAPEUTICS. In a case of aortic regurgitation, on the contrary, the arterial system is open at both ends, and during the cardiac diastole the blood is not only running through the capillaries, but is running backwards into the left ventricle, so that the conditions are favorable for the blood-pressure falling so low as to induce syncope (Fig. b). It is evident that anything which prolongs the diastole, and thus allows more time for the arterial system to empty itself through the capillaries at one end and into the Fig. 92.— Diagram to illustrate the tendency to syncope in aortic regurgitation. In a the aortic valves are healthy and prevent regurgitation. The carotid and its branches are shown as full. In 6 there is aoftic regurgitation, the blood flows out of the arterial system through the capillaries and into the heart. The carotid and its branches as shown are empty. In c the condition is the same as in b, but the patient is supposed to be in the recumbent posture, and the carotid and its branches remain full. ventricle at the other, will increase the risk of syncope, and for this reason digitalis cannot be regarded as free from danger in aortic regur- gitation. The danger may, however, be very considerably diminished by keeping the patient in a recumbent posture with the head low. The column of blood above the aortic valves being lower, there will be some- what less tendency to regurgitation ; and even should the arterial pres- sure fall much, the brain may still receive sufficient blood supply to prevent syncope. In cases of aortic disease, where compensatory hypertrophy is insuf- ficient, or where the hypertrophied heart is becoming enfeebled and dilated so that the mitral valves no longer close the orifice, the most urgent risk to the patient is no longer that of sudden syncope, but of pulmonary embarrassment, dropsy, and all the other consequences of mitral regurgitation. In such cases, as well as in those where organic disease of both mitral and aortic valves exist simultaneously, we must treat the urgent Bymptoms and give digitalis or other cardiac tonics. In dilatation of the right heart due to bronchitis or emphysema, digi- talis is frequently useful, though its benefit is less marked than in mitral diseai Bisks attending the Administration of Digitalis and other Cardiac Tonics. — The great risk attending the use of these drugs is sudden death from syncope. Whenever it is necessary to push them to any extent, the patient should be kept strictly in the recumbent posture, and not allowed to raise himself' quickly even into a sitting position on ACTION OF DRUGS ON CIRCULATION. 297 any pretence whatever, even when there is no aortic complication. The effects of sudden change from the lying to the standing position in pro- ducing syncope have already been mentioned (p. 187), and when the patient is allowed to sit up he should be helped up slowly and with care. A change from the lying to the standing position by the patient getting out of bed is, of course, still more dangerous than simply sitting up in bed, and the most dangerous thing of all is for him to get up for the pur- pose of micturition. The reason of this has been already explained (p. 231). Such strict precautions are, of course, not required excepting when the cardiac tonics have to be given in full doses. But when it is neces- sary to do this they should on no account be neglected. As digitalis is cumulative in its action, it is often advisable after con- tinuing it for several days to leave it off for a day or two, and then recommence, and this is a useful precaution when giving digitalis to out-patients who are seen at an interval of a week or more, even when the dose is comparatively small. Another difficulty in the administra- tion of cardiac tonics is the gastric disturbance, loss of appetite, and vomiting, which they are apt to produce. In cases where the arterial tension is already abnormally high, e.g., in cases of contracting kidney, and the heart seems unable to drive the blood into the aorta, the proper treatment of course is to reduce the abnormally high blood-pressure by purgatives, diuretics, and diaphoretics, and not to attempt to strengthen the heart by the use of cardiac tonics. If this be done the pressure may be raised still further and burst the vessels, giving rise to apoplexy. Vascular Tonics. Vascular tonics are substances which cause increased contraction of the arterioles or capillaries. They not only raise the blood-pressure, but influence to a considerable extent the quantity of lymph poured out into the tissues or absorbed from them, and thus modify tissue change. They are of special importance in the treatment of dropsy. The most important vuscular tonics are : — Digitalis. Iron. Strychnine. Pathology of Dropsy. — Dropsy consists in the accumulation of lymph, either in small lymph spaces in the tissues (oedema, anasarca), or large serous cavities (ascites, pleural or pericardial effusions). The accumulation is caused by more lymph being poured out from the capil- laries than can be removed by the lymphatics and veins. The chief causes of dropsy are — (1) Diminished removal of lymph from the spaces or serous cavities. This may be due to (a) obstruction of the veins, or (h) of the lymphatics. (2) Increased exudation of lymph from the capillaries. This increased exudation may be due to (a) changes in the walls of the capillaries themselves rendering them more permeable. 298 PHARMACOLOGY AND THERAPEUTICS. This appears to be the only condition which by itself can produce oedema. There are two others, however, which, although by themselves incapable of producing oedema, yet, along with others, are of the utmost impor- tance ; these are (b) a watery condition of the blood, and (c) vaso-motor paralysis. In many, indeed in most cases of dropsy, two or three of these factors are combined. Obstruction to the veins, or lymphatics alone, will rarely cause dropsy unless at the same time there is increased transudation from the capil- laries. Thus Ranvier found that ligaturing the vena cava of a dog did not produce dropsy in the legs, the lymph being removed either by the Vaso-motor— nerves i/ \ ucature\— i-ARTERIES Eight leg. Left leg. Fig. 'J.5.— Diagram of Ranvier's experiment on dropsy. The vena cava is ligatured, and in the left leg the trunk of the sciatic has been divided so that both the motor and vaso-motor nerves contained in it are paralyzed. On the right side the motor roots of the sciatic alone are divided and the vaso- motor left uninjured. There is thus motor paralysis on both sides, but vaso-motor paralysis and dropsy only on the left side. collateral venous circulation or by the lymphatics. On dividing the sciatic nerve on one side, however, after ligature of the vena cava, dropsy ap- peared in the corresponding leg, while it remained absent from the other. He showed that the dropsy was caused by paralysis of the vaso-motor, and not of the motor fibres contained in the sciatic, by dividing the motor roots of the sciatic on the other side, leaving the vaso-motor roots unin- jured. When this was done motor paralysis occurred equally in both legs, but dropsy only appeared in the one where the vaso-motor nerves had been divided. This experiment shows what an important factor the lose of Fascular tone is in the production of oedema, and we may legi- timately infer from it that vascular tonics, by increasing the contractility of the veeselfl, will tend to prevent oedema, or remove it when it is already present. ACTION OF DRUGS OX CIRCULATION. 299 A watery condition of the blood does not of itself increase the exu- dation of lymph, nor does it produce oedema, yet in cases of anaemia or chlorosis we very frequently find a tendency to oedema of the ankles, and experiments in Cohnheim's laboratory have shown that, although a watery condition of the blood alone causes no increased exudation of lymph so long as the vaso-motor nerves are intact, yet it does so to a very great ex- tent when the vaso-motor nerves are paralyzed. 1 Alteration of the capillaries by inflammation causes increased exuda- tion of lymph, and tends to produce a local oedema. This oedema is greatly increased if the vaso-motor nerves are paralyzed, not only attain- ing a much greater extent, but appearing more quickly and lasting longer. I have already mentioned that, in experiments on artificial circulation, acids added to the circulating fluid not only caused dilatation of the vessels, but increased transudation through them, and tended to render the tissues cedematous. It is not improbable that some alterations of the blood-vessels of the living body which tend to render them more per- meable maybe connected with imperfect oxidation, and the formation of sarco-lactic instead of carbonic acid. Arsenic has this power of lessening oxidation, 2 and it seems not improbable that the tendency to produce oedema of the eyelids which it possesses may be due to this peculiar action. It is evident that whatever tends to increase oxidation will have an opposite effect, and will tend to prevent any excessive exudation from the capillaries. In cases of anaemia iron is therefore serviceable, and as the condition of the blood improves the tendency to oedema disappears. What has just been said regarding the action of acids may seem to be in contradiction to the usually received opinion that the mineral acids act as vascular tonics. It is quite true that small doses of dilute acids, especially when given, as they usually are, along with bitters, frequently impart a feeling of strength and tone, whereas alkalies are frequently felt to be depressing, but in the case of both these classes of remedies this effect is probably not due to any direct action on the vessels themselves (vide Acids). Cardiac Sedatives. Cardiac sedatives are substances which lessen the force and frequency of the heart's action. They are chiefly used, either for the purpose of lessening violent action or palpitation of the heart, or of rendering the pulse slower in febrile conditions, especially those consequent on local inflammation. It has already been mentioned that belladonna diminishes the sensibility of the heart to changes of pressure, and that sometimes it is useful in palpitation consequent on cardiac strain. Simple pressure over the cardiac region appears to have the power of lessening palpitation, so that when this occurs in consequence of any sudden emotion, there is a natural tendency to press the hand over the region of the heart. It is impossible to say whether the relief which such pressure centainly affords is simply 1 Jankowski, Virchow's Archiv, xciii., p. 259. 2 Feitelberg, Inaug. Diss., Dorpat, 1883. 300 PHARMACOLOGY AXD THERAPEUTICS. mechanical, or is due to reflex action on the heart through the cutaneous nerves. Plasters applied to the cardiac region have a beneficial action upon palpitation similar to that of the hand, and one of the most com- monly used and beneficial is belladonna plaster. In irritable heart of soldiers Dr. Da Costa found digitalis better than any other remedy. 1 In palpitation depending on indigestion, hydrocyanic acid is useful. In palpitation due to aortic disease, senega has been recommended. It is probable that its efficacy depends upon the diminished action of the cardiac ganglia and muscle which its active principle, saponin, produces. An active circulation of blood is usually advantageous both for func- tional activity and for the repair of damage to an organ, but sometimes it may become excessive, and relief may be afforded by diminishing it (vide p. 303). The chief cardiac sedatives employed for this purpose are : — Aconite. Veratrum viride. Antimonial preparations. It is questionable whether in extensive inflammation of internal organs cardiac sedatives are of much service or not. They seem, however, to give relief in the feverish condition which accompanies more limited inflammation, such as tonsilitis, otitis, &c. In such cases the tincture of aconite is best employed in very small doses (one drop) frequently repeated. The introduction of this method of using the drug in divided doses is due in great measure to Ringer, and it has the very great advantage that the desired effect can be produced with greater certainty and with less risk of an overdose being given. Vascular Sedatives. Vascular sedatives are substances which, by increasing the contrac- tion of the vessels, lessen the flow of blood through them. They are chiefly used to lessen local inflammation or prevent haemorrhage. One of the most powerful of all vascular sedatives is cold. For its use in local inflammation vide p. 302. It is not only a vascular but a cardiac sedative, and ice swallowed in considerable quantity will tend to lessen the action of the heart. It is therefore one of the means to which we chiefly trust in cases of haemoptysis. In haematemesis it has the double action of lessening the activity of the heart, and of contracting the vessels in the stomach. The remedies which are chiefly employed in addition to cold are: — Digitalis. Ergot. Hamamelis. Lead acetate. Opium. Amer. Journ, Med. &e»., Jan., 1871. REMEDIES ACTING ON THE BODY. 301 CHAPTER XII. REMEDIES ACTING ON THE SURFACE OF THE BODY. Irritants and Counter-irritants. Irritants are substances which, when applied to the skin, cause a greater or less degree of vascular excitement or inflammation. They are employed for the sake of their local action, to produce increased circulation in the part to which they are applied, and thus to remove ab- normal conditions already present in it. When irritants are employed for the purpose of affecting reflexly a part remote from the seat of application they are named Counter- irritants. Irritants are subdivided, according to the amount of effect produced, into rubefacients, vesicants, pustulants, and escharotics. Rubefacients produce simply congestion and redness, which may be merely temporary, passing off in a few minutes, or may be more per- manent, remaining for several days. When more powerful, so as to cause exudation between the true skin and epidermis, giving rise to vesicles, they are called vesicants, or epispastics. When they do not affect the whole skin alike, but do so unequally, and irritate isolated parts in it, such as the orifices of the sudoriferous glands, so powerfully as to give rise to pustules, they are called pus- tulants. When they destroy the tissues altogether,, forming a slough, they are called caustics or escharotics. The difference between these sub-classes is chiefly one of degree, and not of kind. The weaker ones produce the higher degrees of action when applied for a long time, and the stronger ones produce the slighter kinds of action when applied for a short time. It must be remembered that although inflammation is usually asso- ciated with increased circulation, the two things are essentially different. Inflammation is the injury to the tissue, the increased circulation is the attempt to repair it. Increased circulation occurs wherever we have increased functional activity, whether this be for the purpose of performing a normal function, as in glands during the process of secreting, and in muscles during con- traction, or for the purpose of repair. When repair is going on slowly, the process may be frequently quickened by increasing the supply of blood to the part, and this is the reason for using friction, and liniments and blisters of various kinds, in cases of chronic inflammation in joints or in ulcers. Sometimes irritation fails to cause absorption from being too weak. In a case of rheumatic gout which I saw some years ago, irritating lini- ments had been applied for some time in vain, until, by mistake on the patient's part, so much iodine liniment was put on at once as to cause vesi- cation over the whole back of the hand, when recovery began immediately. In acute inflammation, however, the greatly increased circulation, along with the heightened sensibility of the sensory nerves in the inflamed 302 PHARMACOLOGY AND THERAPEUTICS. part, causes much pain, and this is relieved when the tension of the blood in the inflamed part is lessened. We notice this very clearly when the finger is inflamed in consequence of a thorn, bruise, or other injury. When it is allowed to hang by the side, the throbs of pain, coincident with every pulse-beat, become excruciating, while, if raised above the head, so that the pressure of blood in the vessels is less, the pain becomes greatly diminished. The tension in the vessels may be relieved likewise by causing contraction of the arteries leading to the part by a cold com- press around the arm, or by dipping the finger in cold water ; but relief Fig. 94.— Tracings from the radial artery at the wrist : A before and B after the application of a cloth dipped in cold water round the arm. After Winternitz. is also afforded by a warm poultice applied to the finger. At first sight it seems strange that heat and cold should both relieve the pain, but a little consideration will show that they both relieve the tension in the vessels of the inflamed part. Cold does so by causing a reflex contrac- tion of the afferent arteries, and thus diminishing the quantity of blood going to the inflamed part. Warmth, on the other hand, dilates the capillaries of the collateral circulation, and thus diverts the current away from the inflamed vessels. The use of counter-irritation as a remedial measure depends on the fact that similar alterations to those produced by heat and cold on the finger may be produced on the circulation in internal organs reflexly through the nervous system. Fig. 95.— Diagram to show the effects of heat and cold in lessening ihe pain of inflammation. The dia- gram is supposed to represent the end of the finger. The small star indicates the point of irrita- tion, e.g., a prick by a thorn. The line in the centre of each figure is intended to represent the nerve going to the injured part ; and at the side of each figure is an artery and vein connected by a capillary network. In a the capillary network around the seat of irritation is seen to be much congested: the nerve filaments are thus pressed upon and pain is occasioned, b represents the condition of the finger after the application of cold to the arm or hand. In consequence of the conti act Ion of t be afferent arteries the finger becomes ansemio ; no pressure is exerted on the ner- vous filaments, and pain is alleviated, 6 represents the finger after it has been incased in a warm poultice : the capillary network at the surface of the finger is dilated, and the blood is thus drawn away from the seat orirrltation and the pain therefore relieved. When ;m Irritant is applied to any part of the skin, it causes a local dilatation of the vessels and redness of that part, but contraction of the vessels in other parts of the body. Probably this contraction takes place with the greatest force in certain organs having a definite nervous REMEDIES ACTING ON THE BODY. 303 relation to that part of the surface which is irritated. ZUlzer found that when cantharides-collodion was painted repeatedly over the back of a rabbit for fourteen days, the vessels underneath the skin, and the super- ficial layers of muscles were congested. The deeper layers of the mus- cles, the thoracic wall, and even the lung itself, were much paler and more anaemic than those of the other side. Vaso-dilating nerves to the cuta- neous vessels. Vessels of the skin and surface. Blister applied to the chest-wall. Thoracic wall. Vaso-motor centre. Afferent nerves. Vaso-contracting nerves for the vessels of the lung. Vessels of the lung. Fig. 96.— Diagram to represent the mode of action of counter-irritants applied to the chest. It is probable that a similar condition occurs in man, and that when we apply a blister to the side we, sometimes at least, cause contraction of the vessels in the pleura and lung below, and thus relieve pain in the chest in much the same way as when we apply cold to an inflamed finger. It has been supposed that the action of a poultice or blister was simply to draw away blood from the inflamed part. We have seen that the poultice does this in the case of an inflamed finger, but in an inflamed lung the quantity which comes to the skin is insufficient to explain the relief. It is quite possible, however, that the vessels in the lung and pleura adjoining the inflamed district may be dilated by the application of a poultice or blister to the side, and thus relief is afforded in the same way as by the application of a poultice to the finger. It is not easy to say in which of these ways a poultice or blister acts in any particular case. Clinical experience seems to show that sometimes the blisters re- lieve acute inflammation by causing contraction of the afferent vessels (as represented in the accompanying diagram) and thus lessening the tension in the vessels of the inflamed part. If the blister is too near to the inflamed part, it may increase instead of diminishing the conges- tion, and thus do harm instead of good. As a matter of practice, the rule is usually insisted upon that in a case of pericarditis, for instance, the blister should not be put immedi- ately over the pericardium, but at some little distance from it. Counter-irritation is not only used however as a means of lessening congestion and pain in acute inflammation, it is also employed with much advantage to cause the re-absorption of inflammatory products. The use of the increased circulation which a blister causes in a chronic ulcer is unquestionable, and the rapid absorption of the thickened margins of the ulcer is perceptible to the eye. A similar absorption appears to oc- cur in deeper seated organs, such as the lung, on the application of coun- ter-irritation to the chest, and painting with iodine liniment is useful in promoting absorption of liquid effused into the pleural cavity or of the product of chronic inflammation of the lung. The mode in which the irritation acts is probably the same both in the chronic ulcer and in the lung, i. e., by increasing the circulation through the part affected. Where 304 PHARMACOLOGY AND THERAPEUTICS. the blister is applied, as in acute pericarditis, to lessen congestion, it is usually placed at a little distance from the inflamed part, but where we wish to increase absorption, as in consolidation of a part of the lung, we apply the counter-irritant directly over the consolidated part. Rubefacients. Mechanical as friction. Ammonia. — Solution of ammonia, compound camphor liniment. Alcohol (prevented from evaporat- ing by oil-silk or watch-glass). Arnica. Cajeput oil. Camphor. Capsicum. Chloroform (prevented from evapo- rating, like alcohol) ; chloroform liniment. Ether (like chloroform). Iodine and its preparations. — Io- dide of cadmium, iodide of lead. Menthol. Mustard. Oil of turpentine, of nutmeg, and many other volatile oils. Vesicants. Acetic acid (glacial). Heat of: Boiling water. Corrigan's hammer. Cantharides. — Solutions, plaster, cantharidine. Euphorbium. Mezereon. Volatile oil of mustard. Rhus toxicodendron. Pustulants. Croton oil. Tartarated antimony. Caustics. Acids: — Acetic (glacial). Carbolic. Chromic. Hydrochloric. Nitric. Osmic. Sulphuric. Alkalies : — Lime. Potash. Soda. Alum (burnt). Antimony (chloride). Arsenious oxide. Bromine. Soluble compounds of the heavier metals; as: Copper sulphate. Mercuric chloride. " nitrate. " oxide. Silver nitrate. Zinc chloride. Zinc sulphate. Rubefacients. — One of the simplest rubefacients is mere friction. This may be made either with the hand, or more effectually still, with a rough cloth or flesh-brush. Friction also greatly aids the action of many of the slighter rubefacients. Rubefacients may be used for their action upon the skin itself to relieve itching. They may also be used for their effect on deeper-seated structures. Friction, with firm pressure, is used in shampooing. Upward friction in the limbs will diminish their tension in dropsy, by removing part of the fluid from them. It also aids the circulation of the lymph, and by accelerating the passage of the products of muscular waste from the muscles themselves into the general circulation, it removes to a great REMEDIES ACTIXG ON THE BODY. 305 extent the sense of fatigue after over-exertion. When applied along the back it soothes conditions of nervous excitement, and tends to produce sleep. Friction, along with stimulating liniments, applied to the joints after active inflammation has subsided in them, tends to remove the swelling and to restore their function. Neuralgic pains are frequently relieved by the application of rube- facients such as ammonia, chloroform applied by a watch-glass, or a mustard plaster to the painful spot. Conditions of nervous debility are sometimes benefited by the mustard liniment applied over the spine, and a mustard plaster to the nape of the neck is sometimes useful in nervous irritability with sleeplessness. In addition to the action which the mustard has on the vessels, it pro- duces a sharp pain, so that it is employed also to rouse persons suffering from narcotic poisoning, or from coma. Mustard leaves or iodine liniment applied over consolidated parts of the lung tend to cause absorption of inflammatory products and are used for this purpose in cases of effusion into the pleura or pericardium of chronic consolidation remaining after an attack of pleurisy or pneumonia, or in commencing phthisis. Vesicants. — Vesicants are employed locally in chronic ulcers and to cause absorption of effusions into joints, or chronic thickening about them. When applied around the inflamed joints in acute rheuma- tism, they not only relieve the local affection, but appear to have a curative action on the general febrile condition. In neuralgia, blisters over the painful point are useful, and sometimes, when neuralgia is in the side, or in the breast, it may be relieved by applying the blister over the corresponding part of the spine where there is usually a spot which is tender on pressure. In sciatica, the relief is often greater when the blister is applied to the heel, than over the nerve itself. In neuralgia also it not unfrequently happens that a slight application of the actual cautery is more efficacious than a blister. The most con- venient form of this is Paquelin's thermo-cautery. In inflammation of the pericardium or pleura, a blister frequently relieves the pain, and it sometimes lessens or cuts short the inflammation. Applied over the epigastrium, blisters relieve vomiting arising from various causes. In cerebral affections, such as obstinate headache, in meningitis and hydrocephalus, blisters to the nape of the neck or under the mastoid process are useful. Hysterical paralysis of the limbs sometimes yields to blisters locally applied ; and hysterical aphonia is sometimes removed by a blister over the larynx. Pustulants. — Pustulants are employed for the purpose of keeping up a continuous moderate irritation in chronic inflammations: tartar emetic ointment, and croton-oil liniment seem sometimes to be of consid- erable advantage in chronic inflammation of joints or synovial membranes, in chronic bronchitis and in pleurisy; perhaps sometimes in phthisis. They have been used also as an application to the spine in paralysis and hysteria, and to the head in tubercular meningitis, and to the nape of the 20 306 PHARMACOLOGY AND THERAPEUTICS. neck in chronic headache or giddiness. Though formerly these were much employed, iodine liniment of late years has to a great extent taken their place. Caustics. — Caustics are used to destroy excrescences on the surface of the skin and mucous membranes : warts, condylomata, or polyp ; to destroy exuberant and unhealthy granulations in ulcers and fungating sores : thus, a slight touch with nitrate of silver, sulphate of copper, or with nitric acid, will sometimes cause the tissues in an unhealthy wound after an operation to become less exuberant, and take on a healthy heal- ing action. Caustics are only used to destroy malignant growths, more generally in the surgical operation performed for this purpose. Sometimes patients have such a horror of the knife that they will not submit to an operation, and in such cases caustics are sometimes employed. For this purpose Vienna paste may be employed, consisting of caustic lime and caustic potash. Sulphuric acid mixed with sawdust has sometimes also been used, but is exceedingly painful. Arsenious acid made with various inert substances into a paste is not unfrequently employed with consider- able success by charlatans, who sometimes succeed in removing cancerous growths by its use in apparently hopeless cases, but the risk attending its use is considerable. Caustics are sometimes employed also to open abscesses, especially abscesses of the liver, where it is advisable to cause adhesions between the viscus and the abdominal wall before the abscess is opened, so as to avoid any risk of pus finding its way into the abdominal cavity. The substance usually employed for this purpose is caustic potash. Caustics are also used to keep up chronic irritation, as in chronic headache or epilepsy, a wound being first made by the use of the caustic, and prevented from healing by the introduction of a foreign body into it, or by the continued application of some irritating ointment, such as savine ointment. Caustics are also used as an application to the bites of venomous ser- pents, or of rabid dogs, in order to destroy the virus and prevent its general action on the organism. The weaker caustics are of no use for this purpose. I have seen a boy die of hydrophobia six weeks after he was bitten by a mad dog, although the wound had been thoroughly cauterized by nitrate of silver five minutes after the bite. In all cases the parts around the bite should be, if possible, excised, and then cauterized with a red-hot iron, a ligature being, if possible, placed between the bitten part and the heart until the operation has been effected, so as to prevent any absorption of the virus. Emollients and Demulcents. Emollients are substances which soften and relax, while Demul- cents are substances which protect and soothe the parts to which they are applied. Many substances exercise both of these actions, and so no very sharp line of distinction is drawn between them. Emollients, however, are BEMEDIES ACTING ON THE BODY 307 more generally spoken of in relation to their application to the skin, and demulcents to the mucous membranes. Emollients. Moist warmth — bathing with warm water, hot sponge, hot fomenta- tions, steam. Poultices made of substances which retain heat and moisture — bran, bread, figs, flour, linseed-meal, oat- meal, &c. Gelatinous substances. Fats — almond-oil, glycerin, lard, lin- seed-oil, neat's-foot oil, olive-oil, spermaceti, suet. Paraffin — petrolatum, vaseline, and unguentum petrolei. Soap, and other liniments. Demulcents. Bread. Collodion. Cotton-wool (for external use only). Figs. Fuller's earth. Gelatine. Iceland moss. Isinglass. Glycerine. Gum. Honey. Linseed. Linseed-tea. Marsh-mallows. Almond-oil. Olive-oil. Starch. White of egg. The action of Demulcents is chiefly mechanical. They form a smooth, soft coating to an inflamed mucous membrane, or to a skin deprived of its epidermis, and they thus protect the surface from external irritation, and allow the process of repair to go on. They are used ex- ternally in cases of irritating skin diseases, where the epidermis, from one cause or another, has been broken or removed, as by friction, ex- posure to cold, &c. Internally they are employed when the mucous membranes have been irritated, as, for example, in the after-treatment of cases of irritant poisoning. Mucilaginous substances are also used to relieve pain and irritation of the throat, and to lessen the irritable cough which frequently depends on congestion of the pharynx and upper parts of the respiratory passages. Such substances as figs, prunes, and even cabbage, are employed to protect the intestines from injury by hard and pointed substances which have been accidentally swallowed. They do this by leaving a bulky indi- gestible residue in which the pointed article becomes imbedded, and thus passes along the intestine without lacerating it. The action of Emollients is to relieve the tension and pain in inflamed parts ; warmth and moisture do this by dilating the collat- eral blood-vessels in the manner already described (p. 302). They also relax the tissues themselves and lessen the pressure upon the nerves of the part. Fatty emollients soften the skin and thus render it softer and more flexible. These emollients also aid the immediate effect of friction upon the skin, enabling it to be applied with greater advantage, and to act on the more deeply-seated tissues, as, for example, in cases of stiffness in joints. 308 PHARMACOLOGY AND THERAPEUTICS. Therapeutic Uses. — Warmth and moisture are almost invariably used to relieve spasm and the pain attending it, as well as to relieve pain in all cases of inflammation, whether superficial or deep-seated, and to re- lieve so much, that with many people the connection between pain and poultice has come to be a household word. When poultices are intended to act directly on the part to which they are applied, the linseed, bran, or bread should be applied to the skin with nothing between, or at most with only a thin piece of muslin, but when intended to act on deep-seated or- gans, a considerable thickness of flannel should be interposed, so that the heat may come gradually through, and allow an excessively hot poultice to be applied without burning the skin. In cases of disease of the respiratory passages the warmth is usually ap- plied by means of inhalation. Fatty emollients, by softening the skin or mucous membranes, such as those of the lips, prevent them from cracking, and are used by persons with a delicate skin to prevent cracks forming on exposure to cold. They are also used to prevent friction between surfaces of skin con- stantly in contact, as between the nates and inner joints in children, and to prevent bed sores. These are substances which cause contraction of the tissues to which they are applied and lessen secretion from mucous membranes. Acids. Gallic acid. Alcohol. Tannic Acid. Alum. Vegetable substances containing these Chalk and Lime. acids, e.g. — Salts of the heavier metals, e.g. — Catechu. Bismuth subnitrate, &c. Galls. Cadmium sulphate. Kino. Copper sulphate. ( )ak-bark. Ferric chloride. Uva-Ursi. Lead acetate. Arbutine. Silver nitrate. Zinc sulphate. Astringents are usually divided into local and remote. Local astringents arc those which affect the part to which they are applied. Remote arc those which act on internal organs after their absorption into the blood. With the exception of gallic acid and ergot they all coagulate or pre- cipitate albumen. Dilute mineral acids do not coagulate albumen, but precipitate albuminous substances from the alkaline lluids in which they are naturally dissolved in the body. When applied to a surface from which the epidermis has been removed, the other astringents combine with the albuminous juices which moisten this Surface, ;i- \w|] as with the tissues themselves, and form a pellicle more or Less thick and dense, which in some measure protects the struct- ures beneath it from externa] irritation at the same time that they cause REMEDIES ACTING ON THE BODY. 309 the structures themselves to become smaller and more dense. On a mu- cous membrane they have a similar action, and they lessen its secretion. It was formerly supposed that their action was partly due to their causing the blood-vessels going to a part of the body to contract, thus lessening the supply of fluid to it, as well as to their effect on the tissues themselves. But experiment has shown that, while nitrate of silver and acetate of lead possess this power, perchloride of iron and alum do not, and that tannic and gallic acids actually dilate the vessels. The astringent action of these latter drugs must therefore be exerted upon the tissues. (Ross- bach.) Uses. — Astringents may be employed locally in various forms. In the solid form, as a powder, or in various preparations, such as lotions, ointments, plasters, glycerines, &c, they are applied, especially the me- tallic astringents, to wounds and ulcers for the purpose of reducing the size and increasing the firmness of exuberant granulations, as well as of protecting the surface by forming a pellicle over it. They are used to lessen congestion and diminish the secretion of the various mucous mem- branes — as a lotion to the eye and mouth ; as a gargle or a spray to the throat ; in the form of an injection to the nose, urethra and vagina ; and of suppositories to the rectum. Administered internally, several astrin- gents have a powerful effect in checking diarrhoea, and certain of them may have a local action upon the stomach and intestines. The remote action of such astringents as acetate of lead and gallic acid, when absorbed into the blood, in lessening haemorrhage, is made available in the treatment of haemoptysis, heematemesis, hematuria, and loss of blood from other parts of the body. Styptics. Styptics are substances which arrest the flow of blood from broken or wounded surfaces or vessels. They may do this either by aiding the rapid formation of a coagulum which will plug up the wounded vessels, or by causing the vessels themselves to contract so much as to check the flow of blood out of them. They are closely connected with astringents, which, as we have already mentioned, nearly all coagulate albuminous sub- tances. Acids. Matico. Actual cautery. Spider's-web. Alum. Tannin. Collodion. Lead acetate. Ferric chloride. Substances acting on the blood-vessels : — Digitalis. Ergot. Action. — Matico and cobwebs act mechanically in aiding the formation of a clot around the fibres. Collodion also acts mechanically by exerting pressure over the surface, and thus preventing the blood from issuing. 310 PHARMACOLOGY AND THERAPEUTICS. Aluru, lead acetate, and ferric chloride cause coagulation of the blood. Pressure to the surface, cold sponges or ice, cause the vessels to con- tract, and thus prevent the blood from running out of them. Lead acetate and gallic acid, when absorbed into the blood, not only tend to lessen secretion from the mucous membranes, but arrest haemor- rhage from internal organs. This is probably partly due to their effect in increasing the coagulability of the blood, and possibly partly also to their power of causing contraction of the anterioles. Ergot and digitalis also lessen or arrest haemorrhage, although they have little or no action on coagulation, and their action probably depends on their power to cause contraction of the blood-vessels. A dependent position increases the pressure of blood locally in the part, and thus tends to increase haemorrhage. It is therefore advisable to keep the bleeding part as much raised as possible. Powerful action of the heart tends to increase the blood-pressure generally. In cases of severe haemorrhage it is therefore of the greatest importance that the patient should keep absolutely quiet, and that all the food should be taken cold. CHAPTER XIII. ACTION OF DRUGS ON THE DIGESTIVE SYSTEM. Action of Drugs on the Teeth. Although the hurry and bustle of modern life is apt to make people forget it, mastication is a most important part of the digestive process. During early life the stomach and intestines may be able to digest im- perfectly-masticated food, but as years advance they cease to do so, and imperfect mastication becomes a fruitful source of dyspepsia. If the teeth are entirely or almost entirely gone, the person may chew with his gums, but if they are only partially gone it frequently happens that those which remain oppose one another only sufficiently to prevent the gums from closing, while they do not help mastication. The decay of teeth is chiefly due to the dentine being attacked by the acid products of the decomposition of food in the mouth. This decom- position is to a great extent due to bacteria, and antiseptics are therefore useful in preventing decay. By cleaning the teeth with a soft brush at night before going to bed, particles of food sticking between the teeth maybe removed, and thus its decomposition and consequent injurious action on the teeth may be avoided. Chalk is employed as a basis of most dentifrices, as its me- chanical action is sufficient to clean the teeth without injuring their polish, ACTION OF DRUGS ON DIGESTIVE SYSTEM. 311 and at the same time it neutralizes any acid which may be present. Charcoal has also a useful mechanical action greater than that of chalk, but it is more liable to scratch the enamel. The antiseptics which are usually employed to cleanse the teeth are borax, quinine, and carbolic acid. Dilute solutions of permanganate of potash are also very useful, but have a very disagreeable taste. Where the gums are soft and spongy and are apt to leave the fang of the tooth more or less exposed, vegetable astringents, such as areca nut, catechu, kino and rhatany, are useful. Mineral acids, when given medicinally, cause an unpleasant feeling of the teeth being on edge, and are also injurious to the teeth ; they are therefore usually sucked up by means of a glass tube or quill instead of being simply swallowed. When used as gargles for the throat, their injurious action on the teeth may be to a considerable extent prevented by previously rubbing the teeth with oil, butter, or lard, and washing out the mouth or brushing the teeth with a weak solution of an alkaline bicarbonate or soap. Soluble preparations of iron, especially persalts, are apt to stain the teeth, and they are therefore also given by means of a tube ; alum appears also to have a very injurious action on the teeth ; alum gargles should therefore not be employed for a length of time together, and the same precautions should be used as with acid gargles. When the gums have receded somewhat from the crown of the teeth, a pain or soreness is not unfrequently felt in the teeth although no definite caries is present. This soreness appears to be due to the irritant action of acid secretions in the mouth upon the exposed fang, and it may be often to a great extent removed by washing the mouth out with a weak solution of bicarbonate of soda, or rubbing finely-powdered chalk or magnesia along the gums. When toothache occurs in consequence of caries, it may sometimes also be relieved by a small pledget of cotton- wool dipped in tincture or liquid extract of opium with a little bicarbonate of soda and placed in the cavity of the tooth. A pledget of cotton-wool dipped in creasote is often used for a similar purpose, and one of the most effectual remedies is to dip a small pledget of cotton-wool in pure carbolic acid liquefied by heat, and place it in the cavity of the toothy taking care to cover it well with clean cotton-wool so as to prevent the carbolic acid coming in contact with the tongue or cheeks. Chlorate of potash often lessens toothache if due to inflammation of a large open carious cavity. Sialagogues. These are remedies which increase the secretion of saliva. Anything which is chewed, or even turned about in the mouth, such as a pebble, will increase the secretion of saliva ; but the chief sialagogues have a stimulating action of their own. Action. — In the secretion of saliva there are two factors, first the activity of the secreting- cells ; secondly, the supply of new material to them, from which they may manufacture the secretion. This depends on the circulation. The secreting cells do not derive the new material from which they form the secretion directly from the blood. They obtain it from the 312 PHARMACOLOGY AXD THERAPEUTICS. lymph which fills the adjacent lymph spaces. Hence they may continue to secrete for a short while after the circulation has ceased, as in the sweat glands of an amputated limb, or in the salivary glands after the head of the animal has been separated from the body. But the supply of lymph soon becomes exhausted unless a supply of fresh lymph in the spaces is kept up by exudation from the blood-vessels. We therefore find that abundant secretion is usually, though not invariably, associated with an abundant blood supply. If the flow of blood is not rapid the secretion must soon diminish or come to a stop, for, although it may occur rapidly at first, the lymph which has accumulated in the lymph spaces, supplying the cells, soon becomes exhausted. I/sssel s orGuArn f *#£ Fig. 97. — Diagram representing the general relation of nerves to the secreting cells and vessels of a gland. For the sake of simplicity only one afferent nerve and one nerve centre and one set of secreting and vascular nerves are here represented. In the salivary gland, when the secretion is going on, the arteries usually dilate, and the blood flows rapidly through them. The submax- illary gland, in which secretion has been best studied, appears to receive four kinds of nerves — two sets being contained in the chorda tympani and two in the sympathetic. The chorda contains some fibres which act on the blood-vessels, caus- ing them to dilate and allow the blood to flow freely through the gland, and others which stimulate the cells of the gland, to secrete a thin, watery saliva. These two kinds are spoken of as vaso-dilating and secreting, or secretory, fibres. At present the usually accepted theory is that the secretory nerves have a direct influence upon the tissue change in the cells of the gland. During secretion the granules in the cell decrease in number and gener- ally in size, the hyaline substance increases, and the network within the cell grows. 1 It is not at all improbable, however, that in addition to their action upon secreting nerves some drugs influence the amount of fluid poured out from the vessels. For if we inject a solution of quinine into the d«ct of the gland and thus destroy its secreting power, and after- wards irritate the chorda tympani, the lymph poured out from the blood- vessel- will accumulate in the gland and render it cedematous; but if 1 Langley, Proceed '. Oamb. Phil. Soc, Nov. 12, 1883. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 313 an animal be poisoned with atropine the gland does not become oedema- tous when chorda tynipani is stimulated — although the blood-vessels going to it are dilated and its power of secretion is completely destroyed. We might suppose that the gland did not become oedematous because the lymph, although not used up by the gland, had been carried away by the cervical lymphatics. But this is not the case, for Heidenhain has found that the flow of cervical lymph is not increased under these circumstances. It appears to me that this circumstance can hardly be explained otherwise than by supposing that atropine not only paralyzes the secreting fibres of the chorda, but acts upon the vessels in such a manner as to greatly diminish or prevent the exudation which would usually take place from them into the lymph spaces on irritation of the chorda. The sympathetic contains some fibres which cause the vessels of the gland to contract and the blood to flow slowly through it, and others which stimulate the cells to secrete a thick and viscid saliva. Besides the ordinary secretion of saliva regulated by the action of the nerves, there is a secretion which is usually termed paralytic, because it occurs, not after irritation, but after paralysis of the nerves going to the salivary gland. It occurs in the submaxillary gland, when its nerves have either been paralyzed by the injection of small doses of curare into the artery going to the heart, or by a section of the combined lingual nerve and chorda tympani, or extirpation of the submaxillary ganglion. It is not improbable that morphia also, like curare, produces it, because in moder- ate doses it causes dryness of the mouth, but in enormous doses causes excessive salivation. -TO/VGL/a SALIVARY CLAWO " !/CSS£-LS OrCLANO Fig. 98. — Diagram to show the afferent nerves by -which the secretion of saliva may be reflexly excited. The nerve -centre which regulates the secretion of the thin chorda saliva is probably the nucleus of the seventh nerve situated in the medulla oblongata. Efferent fibres pass out along the chorda tympani and reach the gland, some directly, and some after passing through the submaxillary ganglion. 314 PHARMACOLOGY AXD THERAPEUTICS. The afferent fibres, which convey stimuli from the mouth to the medulla are contained in the lingual branch of the fifth, and the glosso- pharyngeal nerves. Those which convey stimuli from the stomach, and excite the salivation which accompanies nausea, are contained in the vagus. The salivary centre may also be stimulated by impulses sent down from the brain, and the nerves of sight and smell may act as afferent nerves to the salivary centre indirectly through the brain. 1 Besides the nerve-centre in the medulla oblongata there are subsidi- ary nerve-centres. These are the submaxillary ganglion and small gan- glionic masses in the submaxillary gland itself. The secretion of saliva may be stimulated by the direct action of drugs upon secreting nerves in the gland itself, or reflexly through the sensory nerves of the mouth, stomach, eye, or nose. The mere smell, or sight, of appetizing food causes secretion of saliva, which is probably due to the nerves of smell and taste acting through the brain upon the me- dulla. The brain, when excited by mere recollection, may also stimu- ulate the secretion of saliva. Increased salivation is a common accompaniment of sickness or nausea. The afferent nerve here appears to be the gastric branches of the vagus. Sialagogues have been divided into two classes : 1st, topical, or direct ; and 2d, specific, remote, or indirect. The names direct and in- direct are complete misnomers, and ought not to be used ; inasmuch as the so-called direct sialagogues are those which act directly on the mouth, but do not act directly on the substance of the gland, or on the nervous structures contained within it or immediately connected with it. Topical Sialagogues. General Sialagogues. Acids, mineral and vegetable. Jaborandi. (Pilocarpine.) Acid salts. Muscarine. Alkalies. Physostigma. Ethereal bodies — Compounds of Iodine. Ether. Mercury and its compounds. Chloroform, &c. Pungent substances — Mustard. Horseradish. Ginger. Pyrethrum. Mezereon. Tobacco, ^v«-. Rhubarb. Cubebs. 1 The nasal branches of the fifth nerve probably also act as afferent nerves for the stlivary secretion, for I have noticed that on dipping the tip of the nose into hot water containing a little compound tincture of benzoin, salivation occurred, ceased when the nose was withdrawn, and again occurred regularly whenever the nose Again introduced into the mixture. The mere inhalation of the vapor had no effect. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 315 The topical sialagogues, acids, ether, ginger, horseradish, niezereon, mustard, pyrethrum and rhubarb, all produce salivation by stimulating the salivary glands reflexly through the nerves of the mouth. The effect produced by topical or reflex sialagogues is not the same for each. Ether and dilute acids produce a thin, watery saliva, but alkalies cause the secretion of a thicker and more viscid saliva ; the former ap- pearing to affect chiefly the chorda tympani, and the latter the sympa- thetic. Mercury probably acts partly upon the glands tructures and partly reflexly through the nerves of the mouth. Jaborandi, physostigma, and tobacco, probably stimulate the terminal branches of the secretory nerves in the glands. Nauseants, such as tartar emetic, stimulate the gland reflexly through the vagus. The peripheral ends of the secreting nerves in the gland itself are stimulated by pilocarpine, muscarine, nicotine and physostigmine, so that secretion is induced by the injection of these substances into the blood even after all the nerves going to the gland have been cut. In large doses these substances paralyze the ends of the secreting nerves, so that irritation of the chorda tympani will no longer cause secretion. Physostigmine and nicotine, besides acting on the peripheral ter- minations of the secretory nerves, stimulate the central ends of those nerves so that section of the chorda tympani greatly lessens the secretion which these substances cause, although it may still persist from the effect of the drug upon the peripheral terminations. The peripheral action of physostigmine and nicotine is however much less marked than that of muscarine and pilocarpine, so that the secretion caused by the two former after the nerves have been divided is very much less than that produced by the latter. Physostigmine acts also on the sympathetic nerves, producing contraction of the vessels at the same time that it is stimulating the secreting centre in the medulla. In consequence of this double action, secretion is rapid at first, but, however, diminishes very quickly or ceases entirely, the circulation being so much lessened by the contraction of the vessels that the glands do not get sufficient supply of new material to go on secreting. Iodide of potassium may act partially as a reflex sialagogue, for it is secreted in the saliva, and it therefore comes to be present in the mouth more or less persistently. It is probable, however, that it acts also upon the gland structures, though it has not been determined whether the secreting cells or the nerves are chiefly affected. Excretion by the Saliva. Iodide of potassium is very quickly excreted by the kidneys, so that the great bulk of it passes out of the body in a short time after it has been taken. But a little of it is retained very persistently for a length of time. There may be more than one reason for this. It is possible that it be- comes combined with albuminous matters of the blood and tissues, and this combination being .only slowly broken up, the elimination of the drug continues for a length of time. Another reason appears to be that it is 316 PHARMACOLOGY AND THERAPEUTICS. excreted even more readily by the salivary glands than by the urine. The saliva in which it is contained is swallowed, the iodide is again absorbed from the stomach and carried by the circulation to the salivary glands. It thus goes on in a continual round from mouth to stomach and from stom- ach to mouth. Iodide of iron, and probably other iodides, are eliminated by the saliva in the same way. Iodide of iron occurs in the saliva either when injected into the artery of the gland or when absorbed from the stomach. When lactate of iron and iodide of potassium are introduced Fig. 99. — Diagram of the gastro-salivary circulation. simultaneously, or at a short interval after each other, into the stomach, so that iodide of iron is formed there by their combination, iodide of iron is found in the saliva. 1 But if they are injected separately into the blood, iodide of potassium alone without any iron appears in the saliva. Iodine probably causes other substances besides potassium and iron to appear in the saliva when they arc combined with it. It probably does so to quinine, for when iodide of potassium and quinine are given together in a mixture, patients frequently complain of a very persistent bitter taste in the mouth much more marked than when the quinine is given in simple solution with acid. Uses. — Saliva is useful in keeping the mouth moist, and thus facili- tating mastication, solution, deglutition, and the movement of the tongue in speaking. By moistening the fauces, it also prevents or lessens thirst. ' Bernard, Physiologie Expfrimentale, torn, ii., p. 99. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 317 A pebble placed under the tongue or masticated, will keep up a slight flow of saliva, and may be useful for these purposes. Where this is insufficient, dilute acids are employed. As the flow of blood to the glands is greatly increased through secretion, sialagogues have been used as derivatives to lessen inflammation, congestion, and pain, in other part of the head, as in tooth-ache, ear-ache, and inflammation of the ear, nose, or scalp. Saliva has also a digestive action on starch, and increase of the flow may be advantageous in imperfect digestion of this substance. When swallowed the saliva stimulates the secretion of gastric juice, and increased salivary secretion therefore tends to aid the gastric digestion of proteids also. To obtain this object it is best to chew a piece of ginger, pellitory, or rhubarb. Refrigerants. Refrigerants are remedies which allay thirst, and give a feeling of coolness. There appear to be two kinds of thirst : one of which is general, the other of which is local. Local thirst is occasioned by dryness of the mouth and fauces. It may be quenched by washing the mouth and gargling the throat with water, although none of it be swallowed, or by anything which will increase the flow of saliva, and thus keep the mouth and fauces moist. Thus, a pebble under the tongue, or chewed, will lessen thirst by increasing the secretion of saliva ; and acids, both min- eral and vegetable, as well as effervescing drinks containing carbonic acid and the juices of fruits, which contain either free vegetable acid or acid salts, acetates and tartrates, have a similar effect. When the secretion from the mouth and throat is very scanty, it is dried up by the passage of air to and fro in the process of respiration. The evaporation thus occa- sioned may be lessened, and the feeling of thirst diminished by the use of mucilaginous substances, which will form a thin coating over the mu- cous membrane of the mouth and pharynx. Thus, the addition of oat- meal to water will increase its power to quench thirst, and a very little milk added to water has a similar effect. General thirst depends upon the condition of the organism gen- erally, which appears to be due either to deficiency of water or excess of soluble and especially saline substances in the circulation. General thirst is very often accompanied by local thirst, and may be partially alleviated by the means already described, but cannot be removed excepting by the introduction of water into the organism, or removal from it of the saline or other substances which are present in excess, or by lessening the excitability of that part of the nervous system by which the sensation of thirst is perceived. This part of the nervous system, or thirst centre, as Nothnagel calls it, is probably situated according to him in the occipital lobes of the brain, and it is possible that it maybe irritated directly by mechanical injury, or by the condition of the blood circulating in it, as well as reflexly from mucous membranes, such as that of the mouth and throat, and possibly also from the kidneys. Its excitability is lessened by opium, and this may be used to diminish thirst in cases where other remedies fail to relieve. 318 PHARMACOLOGY AXD THERAPEUTICS. Anti-sialics. Anti-sialics are substances which lessen the salivary secretion. They may do this : First, by removing the stimulus to secretion. Second, by lessening the excitability of the efferent nerves or reflex centres. Third, by paralyzing the efferent nerves, such as the chorda tympani. Fourth, by acting on the circulation through the gland. Fifth, by acting on the gland structures themselves. Borax and chlorate of potash are useful in the first of these ways by inducing a healthy condition of the mucous membrane of the mouth, and thus lessening the irritation which gives rise to salivation ; opium and morphia diminish the reflex excitability of the nerve-centre, and are thus powerful anti-sialics. Physostigma in large doses greatly lessens the supply of blood to the gland, and thus diminishes its secretion, and quinine, hydrochloric acid, and alkalies injected directly into the duct of the gland arrest secretion by affecting the secretory cells themselves. These latter drugs however cannot be used as anti-sialics. The most powerful of all anti-sialics is however atropine, which par- alyzes the peripheral terminations of secreting nerves. It does not affect the vaso-dilating nerves, so that in an animal poisoned by atropine electrical stimulation of the chorda tympani will cause dilatation of the vessels and a free flow of blood through the gland as usual, but not a drop of saliva will be secreted. That this absence of secretion is due to paralysis of secretory nerves and not of the secreting cells appears to be shown by the fact that at the time when the power of the chorda to induce secretion is completely paraylzed stimulation of the sympathetic will still induce secretion. Very large doses of atropine, however, paralyze the secreting power of the sympathetic in the cat, although this has not been noticed in the dog. The paralyzing action of atropine can be counteracted by physostig- mine. This is shown by poisoning an animal with atropine, and then injecting physostigmine into the gland of one side through the submental artery. It is then found that irritation of the chorda causes salivation in the gland which has received physostigmine, while it causes no secre- tion in the other. Iodide of ethyl-strychnia and cicutine have an action on the secret- ing and not on the vaso-dilating 1 fibres of the chorda tympani like that of atropine. Gastric Tonics. These are substances which increase the appetite and aid gastric digestion. From observations made on the stomach in persons or animals where tstric fistula has been present, it has been found that in the normal 1 Jolyet, Gaz. Med. tie Paris, 1877. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 319 condition, when the stomach is empty and quiet, the mucous membrane is of a pale rose color. When stimulated mechanically, by rubbing it gently with a feather or glass rod, the mucous membrane becomes redder, and such abundant secretion of gastric juice occurs that it runs down in drops along the walls of the stomach. When the irritation is greater, as, for example, when the mucous membrane is rubbed roughly instead of gently, an opposite effect is pro- duced. The vessels then contract, the mucous membrane becomes pale, and the secretion of gastric juice stops, secretion of mucus commences, and if the irritation be carried still further, vomiting occurs. Almost all substances which, when applied to the skin, act as irri- tants, as arsenic and salts of copper, silver, or zinc, and those also which, without irritating the skin, irritate the nerves of taste, as bitters, produce a feeling of appetite in the stomach, but they only do this in certain con- ditions of the stomach, and in certain quantities. The appetite appears to be associated with gentle stimulation of the gastric walls; stronger stimulation removes the appetite, still greater irritation causes nausea, and lastly vomiting. In cases of atonic dyspepsia, where the stomach is below par, as, for instance, in anaemia and debility, slight stimulants or irritants produce appetite. ^tXQFSTOli* 6 * Fig. 100.— Diagram to illustrate the supposed nervous connections of the stomach. A gentle stimulus applied to the walls of the stomach is transmitted by the afferent nerves, a, to a nerve-centre, b, and thence along the vaso-dilating nerves, c, and the secreting nerves, d, to the vessels of the mucous membrane and the cells of the gastric follicles. A stronger stimulus is transmitted up to the nerve-centre, e, and thence along the vaso-constricting fibres, r, and the secreting fibres, D, of the mucous follicles. A still stronger stimulus is transmitted to h, and thence along the motor nerves to the abdominal walls, k, k, causing them to contract and produce retching or vomiting. In such cases, where the tongue is usually smooth and flabby, bitters and metallic salts are useful. But when the stomach is already too irri- table, and the tongue is red with enlarged papillae, such substances are 320 PHARMACOLOGY AND THERAPEUTICS. likely to irritate still more, and thus, instead of increasing the appetite, to diminish it, and produce nausea. The increased irritability of the stomach which precedes a bilious attack is often signalized by an unu- sually good appetite, which continues during the meal, so that food is eaten with relish. A still greater irritability is characterized by a great appetite before meals, which disappears, giving place to anorexia as soon as a few mouthfuls have been swallowed, and the gastric irritation increased by the increased circulation consequent on the introduction of the food. In such cases, bitters are likely to do harm, and gastric seda- tives, such as bismuth, are required. Bismuth is probably only a milder irritant than the others, because so slowly dissolved, and mild irritation allays inflammatory conditions. But the stomach has not merely to receive food, it has to digest it, and in the process of digestion there are three factors : 1st, secre- tion of the gastric juice which is to render the food capable of absorption and of assimilation ; 2dly, movements of the stomach to break up the food and mix it thoroughly with the solvent juice; and 3dly, absorp- tion of the products of digestion. Action of Drugs on Secretion in the Stomach. The secretion of the gastric juice is stimulated by gentle mechani- cal and chemical irritation, as by dilute alkalies and alcohol. The name of peptogens is given to substances which increase the gastric secretions. Schiff has examined these, and states the most important of them to be dextrine (toasted bread), soups, peptones, &C. 1 In order to obtain gentle mechanical stimulation, it is often advisable to make patients who are suffering from atonic dyspepsia commence their meals, and especially their breakfast, with solids, instead of commencing with a large draught of liquid. Dilute alkalies given before meals increase secretions of gastric juice; so much so, that the alkali is not only rapidly neutralized, but a large amount of acid gastric juice remains over. The alkaline saliva has a powerful stimulant action on the secretion of gastric juice, and as its quantity is much increased both by savory food and by the movements of mastication, it is important that the food should not only be well cooked, but slowly and perfectly masticated. Alcohol is one of the most powerful stimulants that we know, and is probably surpassed only by ether. In persons suffering from weak digestion, therefore, a little dilute alcohol with meals is sometimes very beneficial. Thorough mastication is also of the greatest importance in ensur- ing perfect digestion, inasmuch as the gastric juice penetrates with difficulty, and only slowly dissolves the masses of albuminous matter, while it would digest them very quickly if they were thoroughly broken up. In children and young people the stomach may be able to do more than its fair share of work, but it cannot do this in persons above middle 1 Roberts, Digestive Ferments. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 321 age, and in them, imperfect mastication, either from deficient or decayed teeth, or from the habit of eating quickly, is one of the most common causes of dyspepsia. When the stomach is too much debilitated to secrete sufficiency of gastric juice, even when stimulated, as in the weakness consequent upon acute disease, general debility, or old age, we may supply artificially the digestive substances in the form of acids and of pepsin. Acids should be given for this purpose immediately after meals, or two hours after meals. Pepsin should be given either with, or immediately after, those meals which contain albuminous substances. As pepsin has no action on farinaceous food or salts, it is no use to give it after meals containing these only. Pancreatin, given two hours after meals, along with a little bicarbo- nate of soda, appears, in some cases, to complete digestion, and to give great relief and comfort. Action of Drug's on the Movements of the Stomach. The digestion is greatly aided by the movements of the stomach, which assist it by breaking up the food and mixing it thoroughly with the gastric juice. When these are deficient, it is probable that they are stimulated by nux vomica, or strychnine, and also by bitters. Absorption from the Stomach. — We know at present very little regarding the effect of drugs in stimulating absorption from the stomach, but it is probable that this is very greatly influenced by the condition of the liver. If there is any obstruction to the free flow of blood through the liver, the circulation in the stomach will necessarily be impeded and absorption probably diminished. All the processes which go on in the stomach — secretion, peristaltic action and absorption — are much influenced by the condition of the circulation. All the blood which circulates in the stomach has to pass through the liver before it gets into the general circulation, and thus the condi- tion of the stomach is necessarily much modified by the condition of the liver. If there is any obstruction to the free flow of blood through the liver, the circulation in the stomach will necessarily be impeded, and absorption probably diminished. Not only the blood from the stomach, but that from the intestines also, passes through the liver, and we may naturally expect that the liver itself will be influenced by the condition of the blood which passes to it from the intestinal canal. In Dr. Beaumont's observations on Alexis St. Martin, in whom a gastric fistula existed, he found that after the stomach had been deranged by various articles of food, including fat pork, there was distress in the stomach, headache, costiveness, and a coated tongue. In the stomach there were numerous white and pustular-looking spots. Half a dozen calomel pills produced catharsis, removed the symptoms, and restored the mucous membrane of the stomach to its normal condition. Whether this effect was due to the action of the pills on the liver, or on the intestines, 21 322 PHARMACOLOGY AND THERAPEUTICS. we cannot perhaps positively say, but at all events the improvement was readily evident to the observer's eye. Purgatives and Cholagogries may thus act as indirect gastric tonics. 1 Absorption from the stomach is probably also much influenced by the condition of the nervous system. Bouley found that when the vagi were divided in a horse, strychnine no longer produced poisoning, the reason being that the absorption took place so slowly after a division of the nerves that the poison was excreted as fast as it was absorbed. The retarded absorption, however, he considers to be due, not to any altera- tion in the absorptive power of the stomach itself, but to diminished movement in its walls, so that its contents are not so quickly poured out into the intestine. Absorption normally goes on more slowly from the stomach than from the intestine, and so, while the poison remains in the stomach it is not absorbed quickly enough to cause poisoning. Antacids. Antacids are remedies employed to lessen or counteract acidity. The excessive acidity for which antacids are given may be present in the stomach, intestines, or urine. Antacids are divided into direct and indirect, or remote. Direct antacids lessen the acidity in the stomach, to which they are directly applied. Remote antacids lessen the acidity of the urine. Some sub- stances have both actions, such as potash and soda, or the carbonates and bi-carbonates. Other substances, such as the citrates, tartrates, and acetates of these bases, have no power to lessen acidity in the stom- ach, but, after absorption into the blood, they appear to undergo com- bustion, and become converted into carbonates — in this form they are excreted in the urine, and lessen its acidity. Ammonia and its carbonates are direct antacids, but not remote antacids. They lessen acidity in the stomach or intestines, but after absorption they undergo change and are eliminated in the form of urea, and, according to some, of nitric acid, so that they do not lessen the acidity of the urine. Direct Antacids. — Liquor potassge, potassium carbonate, potas- sium bi-carbonate, liquor sodse, sodium carbonate, sodium bi-carbonate, liquor lithire, lithium carbonate, lithium bi-carbonate, magnesia, magne- sium carbonate, magnesium bi-carbonate, lime water, saccharine solution of lime, chalk. Direct but not Remote Antacids. — Ammonium carbonate, aromatic spirit of ammonia. Remote Antacids. — Potassium acetate, potassium citrate, potas- sium tartrate, potassium bi-tartrate, sodium acetate, sodium citrate, tar- tarated soda, lithium citrate. Beaumont, Physiology of Digestion, Burlington, 1847, p. 118. ACTION OF DKUGS ON DIGESTIVE SYSTEM. 323 Emetics. These are remedies which produce vomiting*. Action. — The act of vomiting consists in compression of the stom- ach bj the simultaneous spasmodic contraction of the diaphragm and abdominal muscles, while at the same time relaxation of its cardiac ori- fice is produced by contraction of the fibres which radiate out from the lower end of the oesophagus along the gastric walls. By their contrac- tion these fibres draw the stomach up towards the diaphragm and pull the walls of the oesophagus apart at its lower end so as to open the cardia. When the cardiac orifice dilates at the same moment that the stomach is compressed between the diaphragm and the abdominal muscles, its con- tents are expelled and vomiting- occurs ; but when the compression of the stomach and dilatation of the cardiac orifice do not take place simul- taneously, the contents of the stomach are retained and the efforts are then termed retelling. The nerve-centre which regulates the movements of vomiting is situated in the medulla oblongata. The movements of vomiting are modified expiratory actions, and the respiratory centre appears to be closely connected with the vomiting centre. Indeed some groups of ganglion cells probably take part both in respiration and vomiting, or in other words form part of both the respiratory and vomiting centres (Fig. 54, p. 210). The reason for this supposition is not merely that the movements of vomiting consist of modified respiratory movements, but that drugs which cause vomiting also increase the respiratory activity. Emetics usually quicken the respiration considerably before they produce vomit- ing, and if injected into the veins they not only quicken the respiration, but prevent the condition of apnoea being produced by vigorous artificial respiration. On the other hand, the desire to vomit may be lessened to some ex- tent by taking frequent and deep inspirations, and narcotics which dimin- ish the excitability of the respiratory centre also lessen the tendency to vomit. The motor impulses from the vomiting centre are sent to the abdom- inal muscles, diaphragm, stomach and oesophagus by the intercostal, phrenic, and vagus nerves respectively. Section of the vagi generally, though not always, destroys the power to vomit, because it disturbs the co-ordination of the cardia and the abdominal muscles and diaphragm so that they no longer act simultaneously, and vomiting does not occur although retching may continue. The vomiting centre is usually excited by stimulation of afferent nerves passing upwards to it from the body, or by impulses sent down to it from the brain. The "brain may be stimulated so as to act on the vomiting centre in the medulla through impressions on the nerves of special sense, such as a disgusting sight, stench, or taste, or by the recollection of such subjects. Irritation of the brain itself or of its membranes by inflammation, tubercle, hemorrhage, softening, or cancer may also excite vomiting. The afferent 324 PHARMACOLOGY AND THERAPEUTICS. nerves are shown in the accompanying diagram. Those chiefly concerned with the action of emetics are : — 1. Branches of the glossopharyngeal nerve to the soft palate, the root of the tongue, and the pharynx. Tickling these parts with the finger or with a feather is one of the readiest means of inducing vomiting. Vomit- ing also occurs when the soft palate, tonsils, or pharynx are inflamed, especially in children. 2. The nerves of the stomach. These are chiefly branches of the pneumogastric, but they are contained also in the sympathetic system. 3. Mesenteric nerves causing vomiting in hernia. 4. Nerves of the liver and gall-duct. 5. Nerves of the kidney and ureter. 6. Vesical nerves. 7. Uterine nerves. 8. Pulmonary branches of the vagus causing vomiting in phthisis. Central afferent paths through"] which vomiting may be ex- > cited. J Pharyngeal branches of the "I _ glossopharyngeal nerve. J Liver and gall-bladder, with nerves going to them. Stomach and gastric branches ) of the vagus. j Kidney and ureter Intestine Uterus Bladder Vesical nerves Nervous centre of vomiting in the medulla oblongata, Spinal cord. Vagus nerve. Pulmonary branches of vagus. Splanchnics giving fibres to liver and intestines. Gall duct. Eenal nerves. Mesenteric nerves. Uterine nerves. FlO. 101.— Diagram showing the afferent nerves by which the vomiting centre may be excited to action. There are also ;i Dumber of other nerves which produce vomiting, but are more important in connection with pathological vomiting than with the action of cinctics. When Less was known regarding the action of the nervous system in vomiting, Emetics were divided according to their relation to the stom- ach into direct and indirect. Direct emetics were those which acted only when introduced into the stomach. Indirect were those which acted when injected into the blood. ACTION OF DEUGS ON DIGESTIVE SYSTEM. 325 Their relation to the vomiting centre is of course the reverse. Drugs which are applied directly to the stomach act reflexly or indirectly on the vomiting centre, while those injected into the blood may be carried by the circulation to the medulla and act directly upon it. It is to be noted however that drugs injected into the circulation are carried not only to the nerve-centres but to the stomach, and may be excreted by the gastric mucous membrane. They may thus irritate the afferent nerves of the stomach and stimulate the vomiting centre reflexly just as they do when given by the mouth. Thus it has been shown by Brinton that tartar emetic injected into the veins of a dog is excreted in a few minutes into the stomach and may be found on testing its con- tents. It is therefore evident that the action of drugs in causing vomiting may be complex, and that drugs injected into the blood or under the skin may cause vomiting, both by (1) irritating- the vomiting centre in the medulla directly when conveyed to it by the circulation ; and (2) by irritating it reflexly from the stomach, whither they have also been conveyed by the blood. It is frequently very difficult to determine in which of these two ways a drug has acted, and sometimes almost impossible to decide with certainty. The reasons for believing that any drug injected into the circulation has caused vomiting by irritating the medulla reflexly through the stom- ach, and not by acting directly upon it, are : (a) When the vomiting does not take place immediately on injection, but only after sufficient time has elapsed to allow of excretion of the drug into the stomach. (b) When the quantity of a drug required to produce vomiting by injection into the veins is greater than that which is sufficient to produce a similar effect if introduced into the stomach. It is probable that some drugs, as tartar emetic, act in both ways, because, as has already been mentioned, it is excreted into the stomach and will there act as an irritant. But it will also produce vomiting when the stomach has been excised and replaced by a bladder as in Magendie's celebrated experiment. Even this experiment however does not prove that tartar emetic acts directly on the vomiting centre, inasmuch as it is possible that it may be excreted by the oesophagus or intestines and irritate the vomiting centre reflexly through them. As tartar emetic however appears to act as an irritant chiefly in those parts of the body where there is an acid secretion, it seems doubtful whether it would produce irritation in the oesophagus and intes- tines such as it does in the stomach. It therefore seems not improbable that the vomiting which it occasions after excision of the stomach is due to its direct action on the medulla oblongata, but this cannot be regarded as quite proved. In order to avoid the confusion which the terms direct and indirect emetics are likely to produce with regard to their relations to the stomach and vomiting, it is better to describe them as, and to employ the terms, topical or local and general emetics. Topical, or local, are such as produce vomiting by acting locally on the pharynx, oesophagus, or stomach ; and general, such as act through the medium of the circulation. The line between the two is not distinct, 326 PHARMACOLOGY AND THERAPEUTICS. inasmuch as tartar emetic will produce vomiting in either way, and so will sulphate of zinc, or sulphate of copper. The local action of sul- phate of zinc and sulphate of copper, however, on the stomach is so much greater than their general action that they may be classed among the local emetics. Local Emetics. General Emetics. Alum. Tartar emetic. Ammonium carbonate. Ipecacuanha and Emetine. Copper sulphate. Apomorphine. Mustard. Senega. Salt. Squill. Subsulphate of Mercury. Muscarine, ] nQt uged Water (lukewarm and m Urechitme I med icinally copious draughts). Digitalis audits f ag ^^ Zinc sulphate. congeners, J Strong infusions of vege- table bitters, as camomile, quassia, &c. The action of local emetics is confined to that of producing vomit- ing, which is generally not long continued, ceasing after the emetic has been evacuated, and is not accompanied by much general depression. The vomiting occasioned by general emetics on the other hand is much longer continued, and is accompanied by much general depression, nausea, languor, muscular weakness, enfeeblement of the circulation, and increase of the secretions, especially those of saliva, sweat, and mucus in the oesophagus, stomach, and bronchial tubes. Uses. — Emetics may be used for the purpose of simply emptying the stomach, or the violent expulsive efforts which they occasion may be utilized in order to remove foreign bodies or secretions from the oesophagus or from the biliary or respiratory passages. 1. Emetics may be used to cause the expulsion of foreign bodies such as pieces of gristle or meat which have become impacted in the upper part of the oesophagus, and, by pressing on the larynx, are giving rise to suffocation. In such cases apomorphine given subcutaneously, or injected into a vein in the dose of ^th or y^th of a grain, will be found of service. 2. They may be used to remove the contents of the stomach, when these, instead of undergoing digestion and absorption in the normal manner, have undergone fermentative changes and become acid, acrid, and irritating, giving rise to pain, either in the stomach itself, or in some other organ, as in the head. In gastralgia, or in headache either depending upon indigestion, or associated like sick-headache with a ten- dency to vomiting, large draughts of warm water often give relief. Their emetic action may be aided if necessary by tickling the fauces with the finger, or by using strong camomile tea, or mustard and water in place of water alone. Simple draughts of warm water, however, may relieve the gastralgia or headache without causing vomiting. They ACTION OF DRUGS ON DIGESTIVE SYSTEM. 327 appear to do so by simply diluting the acrid contents of the stomach so much that they no longer irritate the mucous membrane. 3. Emetics remove the poison from the stomach in cases where it has been swallowed. Here mustard and water is very useful, as it is the emetic which is most likely to be at hand; but sulphate of copper and sulphate of zinc if readily procured are to be preferred, as they empty the stomach most quickly and effectually. In cases of poisoning by laudanum, the nerve-centres are so much deadened by the narcotic that they may not respond to the stimulus even of large doses of these emetics, and then it may be necessary to employ the stomach-pump or gastric syphon. 4. To expel bile from the gall-bladder, to drive small gall-stones through the gall-duct. The bile is secreted under a very low pressure, and a very slight obstruction in front may prevent its flow through the gall-duct and occasion its accumulation in the gall-bladder and biliary capillaries. The compression of the liver between the diaphragm and abdomen muscles, even in ordinary respiration, tends greatly to dispel the bile from the liver, and this expulsive action is of course greatly increased during the violent efforts of vomiting. During these efforts the bile may be forced through the gall-duct, driving before it the obstruction which has been occasioned by the accumulation of mucus within it due to catarrh, or by the impaction of a small biliary calculus. In this manner emetics may remove jaundice due to obstruction. 5. To remove bile from the body in cases of biliousness, fevers, and ague. In biliousness the emetics have got the double action of expelling the bile from the liver in the way just mentioned, and of removing it from the body through the stomach. When bile passes along the intestines, not only is it reabsorbed, but poisonous mat- ters from the intestine are absorbed with it. When it is ejected from the stomach by the efforts of vomiting, no time is allowed for its reab- sorption, and so both the bile itself, and any poisonous matter which it contains, are more rapidly and certainly removed from the body. It is probable that the malarious poison circulates in the bile, and possibly also other poisons which give rise to fevers. There can be no doubt of the advantages to be derived from the use of emetics in ague before the administration of quinine; and indeed cases of ague may be sometimes cured by the use of emetics alone without quinine, while quinine without emetics is not unfrequently of very little use in bad cases. Emetics have also been recommended in the early stages of continued fevers in order to remove the poison on which they are supposed to depend. For such purposes ipecacuanha or tartar emetic is best. 6. To remove obstructions from the air-passages, such as false membranes from the trachea and bronchia in croup or diphtheria, or the over-abundant secretion which is clogging the bronchia and interfering with respiration in bronchitis, and more rarely in phthisis. Ipecacu- anha is the emetic most readily chosen in such cases, as it tends to increase the secretion from the air-passages, as well as to produce vom- iting. When it does not act rapidly, sulphate of zinc or sulphate of copper may be used, and a teaspoonful of alum is a very efficient remedy in croup. When there is much depression of the circulation, carbonate 328 PHARMACOLOGY AND THERAPEUTICS. of ammonia is to be preferred as an emetic, inasmuch as it stimulates the circulation, as well as causes vomiting. Contra-in dications. — Emetics must be avoided in persons suffer- ing from aneurism, and used with care in persons suffering from atheroma or a tendency to haemorrhage from the lungs or uterus, lest the high blood-pressure which occurs during the efforts of vomiting should lead to the rupture of a blood-vessel. They should be used with caution also in persons suffering from hernia, or who have a tendency to it, or from prolapsus of the uterus. In pregnancy we often find obstinate vomiting lasting for a length of time, and yet producing no abortion ; but where a tendency to abortion exists, emetics should be avoided if possible. Gastric Sedatives and Anti-emetics. Gastric sedatives are substances which lessen the irritability of the stomach and thus diminish pain, nausea, and vomiting. Their action may be either local on the stomach, or general on the nervous system, and especially on the vomiting centre in the medulla oblongata. Local Sedatives. General Sedatives. Alcohol. Ether. Hydrocyanic acid. Alum. Hydrocyanic acid. Morphine. Arsenious acid in Ice. Opium. minute doses. Morphine. Atropine. Opium. Belladonna. Silver nitrate. Bismuth salts. Carbolic acid. Cerium oxalate. Chloroform. Creasote. The most powerful of all local sedatives is ice, and when vomiting is persistent, everything should be iced, and ice swallowed in small lumps. Hydrocyanic acid and morphia probably act by lessening the irritability of both the nerves in the stomach itself and of the vomiting centre as well. The mode of action of creasote and carbolic acid is rather uncertain, because, although they have a local anaesthetic action, yet they are found useful also in cases of reflex vomiting, such as the vomiting of pregnancy. As adjuvants to gastric sedatives, we may mention such substances as diminish or remove the irritation, although not lessening the sensi- bility of the stomach itself. Thus, where the irritant consists of very acrid fluid in the stomach, a large draught of water, by diluting it, may lessen pain, or nausea, and alkalies have a similar action. When the irritation IB due to congestion of the mucous membrane, astrin- gents will also have a sedative action. Probably this is the explanation ACTION OF DKUGS ON DIGESTIVE SYSTEM. 329 of the use of alum in vomiting of phthisis, and possibly, also, of the use of nitrate of silver in the vomiting of chronic alcoholism. Uses. — Gastric sedatives are employed (1) to relieve pain in the stomach, as in gastrodynia. The most useful are small doses of mor- phia, hydrocyanic acid, belladonna, arsenic, and bismuth; (2) to relieve vomiting*. This depends upon the cause of the vomit. When it is due to acrid substances in the stomach, the best sedative is often a large draught of warm water, which either dilutes or renders them less irritating, or causes their removal by vomiting. Where it is due to acute irritation of the walls of the stomach itself, ice, hydrocyanic acid and morphia, and bismuth, are best. When due to the acrid products of fermentation in the stomach sul- phurous acid and creasote are very useful. When due to chronic irritation and congestion, alum, nitrate of silver, creasote, and carbolic acid are serviceable. When the vomiting is due to strangulated hernia, the hernia must be reduced, and in cases of intussusception or obstruction these condi- tions must be removed. In the vomiting of pregnancy, the irrita- bility of the vomiting centre must be reduced by bromide of potassium or morphia. It is only in extreme cases that the source of irritation, viz., the pregnant condition, is to be removed, but certain local means are some- times useful; such are separation of the membranes around the neck of the uterus, which may possibly act by lessening the irritation in the organ, and painting the os-uteri with stimulating applications which probably rather act by a kind of counter-irritation or inhibition. Carminatives. Carminatives are substances which aid the expulsion of gas from the stomach and intestines. They appear to do this by increasing the peris- taltic movements of these organs, and in the case of the stomach by caus- ing the lower end of the oesophagus or cardiac sphincter, and perhaps sometimes the pyloric sphincter, to dilate so as to allow of the exit of gas. The stomach naturally contains a certain amount of gas, chiefly nitrogen and carbonic acid. The nitrogen is derived from air which has been swallowed, the oxygen with which it was mixed being absorbed by the walls of the stomach. For respiration goes on in the stomach, as well as in the lungs, though to a much less extent in mammals, and oxygen is absorbed and carbonic acid excreted. The stomach, therefore, generally contains carbonic acid in addition to nitrogen ; some of the carbonic acid also is derived from the food. In addition to these gases there is frequently hydrogen present: hydrogen and a quantity of carbonic acid being formed by processes of fermentation going on in the food. Sometimes instead of pure hydrogen marsh-gas is formed, which takes fire when expelled from the stomach, and not unfrequently the hydrogen unites with sulphur, forming sulphur- etted hydrogen, causing to the patient an unpleasant taste of rotten eggs in the mouth, or giving their smell to the breath. It is probable that this 330 PHAKMACOLOGY AND THERAPEUTICS. last occurrence is due to the presence and decomposition in the stomach of bile, which contains sulphur as one of its constituents. When digestion is rapid and complete, little or no fermentation occurs, very much less gas is formed, and therefore there is no uncomfortable distension. There are several drugs which tend to prevent fermentation, while they hardly interfere at all with the action of the gastric juice. Among these may be mentioned creasote, sulphurous acid, and bitters. These sub- stances may all be regarded as adjuvants to carminatives, and so indeed may pepsin, dilute alkalies, and all other remedies which stimulate the secretion of gastric juice and thus aid digestion. Where there is any tendency to venous congestion in the stomach, there will be interference with the respiration in the stomach, and thus a greater tendency to the accumulation of gas. Any conditions interfering with the circulation, such as metral disease or hepatic congestion, will thus tend to cause flatulence, and in such cases digitalis and cholagogues will prove useful adjuvants to carminatives. It is possible that much mucus covering the surface of the stomach may interfere both with absorption and with gastric respiration. Charcoal has been given to remove flatulence on the supposition that it absorbs the gases in the stomach. But it only absorbs gas when it is dry, and the beneficial action which it certainly possesses is probably a mechanical one in removing mucus and stimulating circulation. Possibly bismuth and magnesium act similarly, though less powerfully. The chief Carminatives belong to the classes of aromatic oils, alcohols, or ethers. They are : — Allspice and oil. Anise and oil. Assafoetida. Cajeput oil. Capsicum. ( '.n away and oil. Cinnamon and oil. Cloves and oil. Coriander and oil. Dil and oil. Ether and acetic ether. Fennel. Mace. Mustard. Nutmeg and oil. Pepper. Peppermint and oil Spearmint and oil. ( \- in la moms. Chilies. Chloroform. Ginger. Horseradish. Spirits. Valerian and oil. Uses. — Carminatives are employed (1) to remove pain and distension of stomach and intestines caused by flatulence; (2) to render peristaltic action regular, and diminish local spasm and pain depending upon it. They arc useful both in cases where the spasm is due to irritation of the Stomach and intestines, by irritant articles of food, irritant secretions, or Lrritanl medicines. They are therefore commonly used not only in griping and colic pains due to indigestion, worms, or exposure to cold, but are commonly used as adjuvants to purgatives in order to lessen the griping pain, which they often cause when given alone. In addition to this, by rendering the peristaltic action of the bowel more regular, they assist the action of the purgatives. ACTION OF DKUGS ON DIGESTIVE SYSTEM. 331 ACTION OF DRUGS ON THE INTESTINES. Intestinal Movements and Secretion. — The peristaltic move- ments of the intestine occur even when it is separated entirely from the body. Their rhythmical occurrence appears to be due to the action of the ganglia contained in Auerbach's plexus, which lies between the outer longitudinal and internal circular layer of the muscular coat. The secre- tion is probably influenced by Meissner's plexus, which lies in the sub- mucous coat. Both the movements and the secretion of the intestine require to be regulated in accordance with the wants of the body, and this is done by the nerves which connect these plexuses with the cerebro-spinal centres. The chief of these nerves are the splanchnics and the vagi. Irritation of the vagi frequently causes movements of the intestine ; irritation of the splanchnics, on the other hand, arrests them, so that the splanchnics have been regarded as the inhibitory nerves of the intestine, just as the vagi are the inhibitory nerves of the heart. But this arrest is by no means constant, sometimes the movements instead of being arrested are distinctly increased ; so that it is evident that the splanchnics contain a mixture of stimulating and inhibitory fibres, or else that the same fibres are capable of exercising either function under different conditions. Paralytic Secretion. — When all nervous connection between the intestine and the higher nerve-centres is cut off" by completely dividing the intestinal nerves, a copious secretion, exactly resembling the rice- water stools of cholera, occurs in the intestine. This is best shown by isolating three loops of intestine, by means of ligatures, after they have been previously carefully emptied, as shown in Fig. 102. The nerve- fibres going to the middle loop are then divided, and the intestine is Fig. 102.— Diagram showing the effect of section of nerves on secretion from the intestine. The nerves going to the middle loop have been divided, and it is distended with the fluid secreted. returned to the abdominal cavity. After four or five hours the animal is killed, and the intestine examined ; it is then found that the loop, the nerves of which have been divided, is filled with fluid, while the other loops which have been under precisely the same circumstances, but the nerves of which have not been cut, remain empty. It is evident then, that certain nerve-centres possess the power of restraining- the secretion from the intestine. These nerve-centres 332 PHARMACOLOGY AND THERAPEUTICS. have been shown by Pye- Smith and myself to be the smaller or inferior ganglia of the solar plexus, with the superior mesenteric, off-set from them. When these ganglia are destroyed, the same abundant secretion occurs in the intestine as when all the nerves are cut, but if these ganglia be left intact the spinal cord may be removed, the vagi and splanchnics cut, and the semilunar ganglia excised without any excessive secretion occurring in the intestine. The vascular supply of the intestines is regulated to a considerable extent by the splanchnics, irritation of .which causes contraction of the vessels. There appears also however to be an important relation between the intestinal vessels and the lumbar portion of the spinal cord, because when this part of the cord is destroyed with extirpation of the solar plexus, haemorrhage or hyperemia of the intestinal mucous membrane occurs, so that the internal surface of the intestine has a somewhat dysen- teric appearance. This does not occur when the solar plexus and semi- lunar ganglia are destroyed, the splanchnics divided, or the mesenteric nerves cut. 1 The nervous arrangements for regulating intestinal movement and secretion are evidently exceedingly complex, and until our knowledge of their physiological relations is more perfect, we cannot expect to under- stand completely the effect which drugs produce upon them. These are occasionally very complicated, and vary considerably according to the quantity of the drug used. Drugs may affect the intestine by their local action on the intestine itself, by their direct action on the central nervous system, or by their indirect action through the alterations in the quality or supply of the blood. The quality of the blood which cir- culates in the intestine alters its movements very considerably. When the aorta is clamped, so that the blood which circulates in the intestine and in the lower part of the spinal cord becomes venous, the peristaltic movements are usually much increased ; when the compression is removed and arterial blood is allowed to circulate again, the peristalsis instead of diminishing, as one might expect, becomes still more intense. Compression of the vena cava inferior, or of the portal vein, sometimes causes a slight increase in the peristaltic movements, but it is inconsider- able as compared with those produced by clamping the aorta. During suffocation, when the blood becomes venous throughout the whole body and exercises an irritating action, not only on the nerve-centres present in the intestine and in the lumbar portion of the spinal cord, but also on the brain and upper part of the cord, the effect on the movements of the intestine is variable. They are sometimes increased, but some- times an inhibitory effect appears to be produced through the higher centres and their movements are arrested. It is evident therefore that when an animal has been poisoned by any drug, and the intestines are examined after death, two different con- ditions may be found which do not depend upon any peculiar action of the drug on the intestine, but only upon its effects on the higher nerve- 1 T. Lander Brnntofl and Pye-Smith on " Intestinal Secretion and Movement," British Association H< ports, 1874, 1875, 1876. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 333 centres, thus, if the higher centres have been in such a condition as to cause inhibition, the intestines may be found in a state of perfect rest, whereas, if they happen not to be in this condition, brisk peristalsis may be observed. It very often occurs that when the intestines are first exposed after an animal's .death, they are found to be at rest, but as the higher centres die from a stoppage of the circulation, the peristaltic move- ments become much accelerated. In order to simplify the problem presented by the complicated nervous arrangement in the intestine, Ludwig and Salvioli have used the plan of keeping up the circulation artificially in a small piece of intestine, Fig. 103. — Diagrammatic representation of apparatus for testing the action of drugs on the intestine by artificial circulation through it. For the sake of simplicity the means employed to keep up the temperature of the intestine and apparatus have been omitted, a, a board on which the intestine, b, is laid, c, a cannula tied into a branch of the mesenteric artery, n, d, two stopcocks, by means of which pure blood or poisoned blood may be passed at will through the cannula. E and f, two flasks, containing pure and poisoned blood, g, a block on which they stand, and by which they can be raised to a greater or less height, so as to alter the pressure under which the blood flows. When the apparatus is kept warm the pressure is more easily regulated by passing air into the flasks from a pressure bottle, h, the lever for registering the movements of the intestine. One end is weighted and rests on the intestine. I is the axis on which the lever works, k is a revolv- ing cylinder on which the movements are recorded. Fig. 104. — Shows the effect of anaemia. The upper tracing shows the movements of the intestine supplied with normal blood ; the lower shows the movements of an intestine rendered more vigorous by anaemia. Fig. 105.— Shows the effect of peptones. The first half of the tracing shows the movements of an intestine supplied with blood thoroughly oxygenated; the second half shows the effect of blood containing peptones. Fig. 106.— Shows the effect of nicotine. The part of the tracing marked A B shows the intes- tinal movements during the circulation of blood saturated with oxygen (apnoeic blood) ; the part N B of blood containing nicotine. Fig. 107.— Shows the effect of opium. In the first part of the tracing the intestine was supplied with apnoeic blood ; in the latter with blood containing opium. and then investigating its movements under various conditions. The intestine was laid on a piece of cork, in a warm chamber. It was supplied with blood by means of a cannula placed in the artery, and allowed to flow out through a cannula in the veins. Its movements were registered by a small lever placed upon it. When blood fully oxygenated passed 334 PHARMACOLOGY AND THERAPEUTICS. through it, the lever traced only a straight line or gently oscillating curve, but when the flow of blood was stopped, so that the blood stagnated and became venous, contractions began which were indicated as a series of curves. A trace of peptone caused first strong contraction and then a number of irregular contractions, at the same time that the vessels become fuller of blood. Nicotine causes brisker movements of the intestine, and lessens the rapidity of the flow of blood. In large doses it causes tetanic contraction of the circular fibres. Atropine causes irritation of the vessels, while the muscular fibres remain at rest. The action of opium is very remarkable when a tinct- ure is added in the proportion of *04 to *01 per cent, to the blood which is circulating through the intestine, the circulation becomes at once lessened, but almost immediately afterwards the diminution passes abruptly into great increase, so that five or seven times as much blood flows through in a given time as formerly ; at the same time all the move- ments of the intestine are abolished, but the intestinal wall instead of being relaxed, as one would expect, is in a condition of considerable con- traction. When the opium is washed out of the vessels by pure blood, the after-effects vary according to the quantity which is used. If it is small, the movements and circulation in the intestine soon become normal, but if a large dose has been used, the circulation returns to the normal condition but the movements remain abolished for a length of time. The peristaltic action induced by nicotin is arrested by opium. The local action of this drug therefore seems to be that it converts the peristaltic movement into a steady contraction. A remarkable difference between the action of soda and potash on the intestine has been detected by Nothnagel. When the intestine is exposed, and a potash salt is applied to its external or peritoneal surfaces, it produces a contraction of the muscular walls, which remains localized to the point of contact, or simply causes a ring of contraction opposite the point. When a sodium salt is used instead, it produces a contraction which is not limited to the point of contact, but always spreads some little distance from it, and invariably does so in the direction towards the pylorus, and not towards the anus. This peculiar action appears to be due to the potassium salts acting as stronger muscular irritants than the sodium salts, while the progressive contractions caused by the sodium is due to the intestinal nerves, in their case more being involved. The effect of morphine is very remarkable. When the animal, in addition to being anaesthetized by ether only, as in the previous experiment, has a small dose of morphia injected also into the veins, it has a sedative effect, so that sodium salts applied to the intestine produce only a local contraction like potash-salts. But this is only when a certain dose of morphia is employed, about 0*01 to 0*03 of morphia for a rabbit. When the dose was increased from 0-05 to 0-1 gramme of morphia, an exactly contrary effect was produced, and the application of sodium salts, instead of being followed only by local contraction, caused a peristaltic contraction, which was usually very much more energetic than in the normal condition and not only spread upwards from the point of contact, hut downwards towards the large intestine, which it never did under other circumstances. The quieting or inhibitory effect of moderate doses of ACTION OF DKUGS ON DIGESTIVE SYSTEM. 335 morphia upon the intestine, irritated by soda salts, appears to be exer- cised through the splanchnic nerves, inasmuch as when the mesentery, going to one part of the intestine, is divided in an animal that has received a moderate dose of morphia, the application of soda salts to this part is followed by a peristaltic wave ; while, in the other parts of the intestine where the nerves are uninjured, the soda still produces only local con- tractions. From these experiments it is evident that moderate doses' of morphia produce a very different effect upon the intestine from large ones : and this effect has indeed been long recognized in practice. Moderate doses of opium have a constipating action and are constantly used to check diarrhoea, but large doses, such as those taken by opium- eaters, really have no constipating effect. Indeed, large doses of opium injected directly into the jugular vein of a dog, act as most energetic purgatives, being much more prompt in their action than almost any other drug that we know. Immediately after their injection the whole intestinal tract is thrown into violent action and its contents expelled, after which it again becomes quiet. Very minute doses also seem to have a purgative action, as well as very large ones, and I have used them with considerable success in many cases of constipation. Constipation may be due to diminished peristaltic action, or dimin- ished secretion, or to both, and in some cases is associated with acceler- ated absorption. In all probability it is generally due to a diminution in the peristaltic action. In the normal condition this ought to go on regularly, so that the bowels should be evacuated, on an average, once a day, though in some persons evacuations normally occur two or three times a day, and in others only once in three or four days. In some apparently healthy persons I have observed an interval of as much as two or three weeks. In some persons the normal stimulus of ordinary easily digestible food does not seem to be sufficient to keep the bowels acting, but food which leaves much indigestible residue, such as brown or bran bread, salad, figs, prunes, or tamarinds, will do so. These latter fruits owe their laxative properties partly to the insoluble residue they leave and which acts as a mechanical irritant to the intestine, and partly to the salts and sugar and mild laxative principles they contain. Treacle and gingerbread also have a useful aperient action, and their pleasant taste makes them specially suitable for children. The effect of a some- what stimulant article of food is greater when taken on an empty stomach, and thus a fig before breakfast will have a much greater laxative effect than one taken after dinner. A glass of cold water also, by stimu- lating peristalsis, will have a laxative action when taken on an empty stomach at bed-time or on rising in the morning. "When these means are insufficient a slightly irritating substance, such as an aloetic pill taken on an empty stomach just before dinner, will aid the stimulating effect of the food which is taken afterwards, and will be sufficient to ensure per- fectly regular and normal evacuations which do not in any way incommode the person. In consequence of this many people continue to take such dinner pills regularly for many years together. Others, again, suffer from constipation, but with them small doses of purgative medicine 336 PHARMACOLOGY AND THERAPEUTICS. if they act at all, act violently, and leave the person weak and uncom- fortable, while the bowels again become constipated. This condition is found not unfrequently among women, and is accompanied, sometimes at least, with pain or tenderness in one or both ovaries. In such persons also, contrary to the general rule, walking exercise increases instead of diminishing constipation. My friend Dr. Litteljohn noticed that in a case of ovarian tenderness half a grain of opium given to relieve the pain acted as a purgative. On thinking over this, it occurred to me that the constipation in such cases might be due to reflex irritation of the inhibitory intestinal nerves by the NERVE CENTRE OVARIAN NERVES 'OVARY Fig. 108.— Diagram to show the way in which ovarian irritation probably causes constipation. tender ovary. It seemed therefore probable that by using graduated doses of opium, one might be able to lessen the action of the inhibitory nerves, or even to divert the stimulus from them on to the stimulating fibres, and thus produce purgation instead of constipation. Not knowing what dose would be sufficient to produce this effect, I began with one drop of tincture of opium given in a teaspoonful of water every night. To my astonishment this dose was, not only in most cases sufficient, but in one case it proved excessive, doing no good, while half a drop acted as a brisk purgative. It is evident that opium used in this way will not act as a purgative in cases of constipation depending upon general insensi- bility of the intestinal nerves. The cases in which it is most useful are those of delicate women of a nervous temperament, suffering from ovarian pain, and in whom, ordinarily, purgatives produce excessive action, fol- lowed by constipation. Small doses of belladonna have also been recom- mended in constipation, and it is probable that they act in a similar manner when given alone, and that belladonna, hyoscyamus, and essential oils assist the action of purgatives by tending to divert the stimulus, which the irritating constituent of a purgative produces, from the inhib- itory to the accelerating intestinal nerves. We know at present but little regarding diminished secretion as a cause of constipation. Action of Drugs on Absorption from the Intestines. — Ether introduced into the intestine greatly increases its vascularity. It also quickens absorption very much, as is shown by the fact that poisons act more quickly, and such substances as ferro-cyanide of potassium appear sooner in the urine, when they are administered along with ACTION OF DRUGS ON DIGESTIVE SYSTEM. 337 ether than when given alone. Carbonic acid has a somewhat similar though weaker action. Coto bark has been used in diarrhoea, and as it has no proper astringent action, its utility has been ascribed to an antiseptic action by which it diminished the formation of irritant products in the intestines. Albertorii has investigated the action of the coto alkaloids, and finds that although cotoine somewhat lessens putrefaction and the development of bacteria, it does not stop them either in the organism or outside it. It has, however, a very peculiar action on the vessels of the intestine. By keeping up artificial circulation in a loop of intestine (vide p. 333), he finds that cotoine dilates the arteries, causes the blood to flow more readily into the veins, and preserves the vitality of the intestine. It also dilates the vessels of the kidney, and causes the blood to flow more rapidly through them, but does not alter the circulation in the sub- maxillary gland. Opium and chloral also dilate the vessels of the intestine, but their action is a paralyzing one, while that of cotoine is not. The action of paracotoine is similar to that of cotoine, but less marked. Albertoni thinks that the benefit which cotoine produces in diarrhoea is due to dilatation of the intestinal vessels, and the increased power of absorption which it causes. He considers that in many cases of diarrhoea diminished absorption is a most important factor. 1 It is possible that the beneficial action of bael fruit in dysentery may depend on some similar property, as this substance has the pecu- liarity of acting as a laxative in health, while it lessens the evacuations in dysentery. Intestinal Astringents. — Diarrhoea may depend (1) upon exces- sive peristaltic action, whereby the contents of the intestine are hurried along before time has been allowed for their absorption, (2) upon diminished absorption, (3) upon excessive secretion. In one form of diarrhoea, where the introduction of food into the stomach seems to excite peristaltic action throughout the intestine so that the person is frequently forced to rise from the table in order to evacuate the bowels, small doses of one-half to two minims of liquor arsenicalis given imme- diately before meals, as recommended by Ringer, frequently act like a charm. In ordinary cases of diarrhoea, opium, by lessening the irrita- bility of the intestine, is most serviceable. Some medicines lessen peristaltic action, not by affecting the bowel, but simply by removing the stimuli which were exciting it. Thus small doses of soda are useful in the diarrhoea of children by neutralizing the acid which was acting as an irritant. Creasote has a similar action by lessening putrefaction or fermentation, and thus preventing the formation of irritant products. It is probable that lime acts also to a certain extent by its antacid pro- perties, but there is little doubt that there are other factors in its astrin- gent action which we do not yet understand. The effect of cotoine on intestinal absorption has just been mentioned. With the view of ascer- taining whether we could find any drug which would arrest the copious secretion from the intestine which takes place in cholera, Pye-Smith and 1 Archiv fur exper. Path, und Pharm., p. 291, vol. xvii. 22 338 PHARMACOLOGY AND THERAPEUTICS. lated I made a large number of experiments. For this purpose we isolate loops of intestine, and into one injected sulphate of magnesia mixed with the drug to be tested. In some experiments we injected the sul- phate of magnesia into the intestine, and the drug which we wished to test into the veins. Sulphate of atropine, iodide of Diethyl-atropine, chloral-hydrate, emetine, morphine, sulphate of quinine, tannin, and sulphate of zinc, were all tried locally with negative results. Chloral and morphine injected subcutaneously also gave negative results. 1 In many cases the best way of checking diarrhoea at its commence- ment is to give a purgative such as castor-oil, either alone or with a few Fig. 109.— Diagram illustrating diarrhoea depending on the presence of scybala in the intestine, a is a scybalous mass ; b is the fluid which it causes the intestine to secrete. drops of tincture of opium in it. The irritant substances which cause the diarrhoea are swept out of the intestine by the action of the purga- tive, and any irritation which remains is soothed by the opium. Chronic watery diarrhoea, alternating with constipation, is often best treated in the same way. We may suppose that here the presence of scybalous masses in the intestine gives rise to a watery discharge, which does not, however, wash away the scybala themselves. When a purgative is given which causes secretion from the intestine above the scybala, the fluid in its downward flow, assisted also by the increased peristalsis, washes away the scybala, and thus removes the source of irritation. Purgatives. Purgatives are substances which cause intestinal evacuations. They are divided according to their nature into laxatives, simple, drastic, and saline purgatives, hydragogues, and cliola- gogins. Laxatives are those which increase only slightly the action of the bowels and render the motions slightly more frequent and softer, without causing any irritation. Most articles of food which leave a large indi- gestible residue in the stomach act as laxatives : such are oatmeal, brown Report to Brit. Assoc, 1874. ACTIOX OF DRUGS OX DIGESTIVE SYSTEM. 339 bread, and bran biscuits. Articles of food also which contain salts of vegetable acids and sugar in considerable quantity also act as laxatives. The chief laxatives are: — Honey. Cassia. Stewed apples. Treacle. Tamarinds. Sulphur. Gingerbread. Figs. Magnesia. Manna. Prunes. Castor-oil (in small doses). Figs, raspberries, and strawberries, in addition to containing sugar and vegetable acids, have a number of small seeds which are absolutely indigestible, and these have probably a mechanical action in stimulating the bowel. Simple purgatives, also, when given in small doses, act as laxa- tives : such are carbonate of magnesia, magnesia, olive-oil, and sulphur. Simple purgatives are more active than laxatives, and their adminis- tration is usually followed by one or more copious and somewhat liquid stools. Their action is sometimes accompanied by some irritation and griping. These are: — Aloes. Rhamnus (various species). Rhubarb. Castor-oil. Senna. Drastic purgatives are those which cause violent action of the bowels, usually accompanied by evidences of greatly increased peristaltic action, such as borborygmi. They cause irritation of the intestine, and when taken in large doses produce inflammation and symptoms of poison- ing. These are : — Elaterium. Gamboge. Colocynth. Podophyllin. Jalap. Croton oil. Scammony. Saline purgatives consist of neutral salts of metals of the alkalies or alkaline earths. The more commonly employed are : — Sulphate of potassium. Bi-tartrate of potassium. " sodium. Tartrate of potassium and sodium. " magnesium. Citrate of magnesium. Phosphate of sodium. Sulpho-vinate of sodium. Tartrate of potassium. Hydragogues are purgatives which excite a copious secretion from the intestinal mucous membrane and thus remove much water from the body ; some of them belong also to the drastic group and others to the saline. 340 PHARMACOLOGY AND THERAPEUTICS. Bi-tartrate of potassium. Elaterium. Gamboge. Cholagogues are purgatives which remove bile from the body. Some of them probably do this by stimulating the secretion of the liver, others by quickening peristaltic action of the duodenum and small intes- tine and thus preventing the absorption of the secreted bile. Aloes. Euonymin. Rhubarb. Iridin. Mercurial preparations (blue Podophyllin. pill, calomel, gray-powder). Action, of Purgatives. — Purgatives may act in three ways: 1st, by quickening the peristaltic action of the bowels ; 2d, by increasing secretion of the intestinal membrane, and thus to some extent washing out its interior; 3d, by hindering absorption of the fluids of the intes- tines. Simple purgatives act chiefly by stimulating peristaltic movements and have little effect on the secretion. Hydragogue and cholagogue purgatives increase the secretion more than the peristaltic action, and drastics increase both. It has been held by several eminent German pharmacologists that the more watery stools produced by many purgatives are due only to more rapid peristaltic action, which hurries along the intestinal contents before there has been time for the absorption of their fluid constituents. This opinion is chiefly based on the observations of Thiry and Radzie- jewski. Thiry isolated a small piece of intestine, one end of which he attached to the abdomen and the other he sewed up. The part of the intestine from which this piece had been removed was again united by sutures, so that the intestine was perfect as before, though rather shorter. The small bag of intestine retains its vascular nerves supply uninjured and secreted readily when tickled with a feather, but purgative medicines, such as croton oil, senna, sulphate of magnesia, aloes, jalap, and sulphate of soda, when applied to it, produced no increased secretion. These experiments, led pharmacologists to believe that the ordinary idea that purgatives pro- duced increased secretion from the intestine was erroneous; and the neces- sity for any such supposition seemed to be removed by an experiment of Radziejewski, who made an intestinal fistula in the ascending colon of a dog, and found that the intestinal contents as poured into the large from the small intestine exactly resembled the stools which ordinarily follow the administration of a purgative. The ordinary phenomena produced by purgative medicines would therefore Beem to be readily explained by increased peristalsis alone, but -Mine oilier experiments by Colin and by Morcau have shown that the method employed by Thiry did not afford trustworthy results as to the action of purgatives on the intestines. Moreau isolated three loops of intestine by means of ligatures, carefully emptying the loops beforehand. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 341 He then injected a purgative medicine into the middle loop and returned the intestine to the abdomen. On examination some hours afterwards, it was found that although all three loops had been under similar condi- tions, the one into which the purgative had been injected was distended with fluid while the others remained perfectly empty. These experi- ments were repeated by Vulpian, and afterwards by myself, with similar results. There can be no doubt whatever, then, that purgatives act both by increasing peristaltic action and intestinal secretion. Some purga- tives act chiefly by the one, and some chiefly by the other. In the case of some of the salines, the secretion is greatly increased, while the peristaltic movement is so little affected that the secretion may lie so long in the intestine as to be again re-absorbed, and the drug therefore fails to produce purgation at all. For this reason it is usual to combine such salines with simple purgatives, which will accelerate the peristalsis. Laxatives have little action on the system beyond that which is due to the removal of waste and irritating substances from the bowels, but simple purgatives, and still more drastic purgatives, in addition to the direct action upon the bowels, exert an indirect effect upon the blood, removing from it a not inconsiderable portion of its fluid, and therefore causing a form of partial depletion. The action of cholagogues will be more particularly considered in another paragraph (p. 351). The action of purgatives generally and especially of saline cathartics has been a subject of very great dispute, and it is a matter of extreme difficulty to determine exactly. The question seems to be, however, set- tled by the masterly researches of Dr. Matthew Hay, and I cannot, I think, do better than give his conclusions in his own words : 1. A saline purgative always excites more or less secretion from the alimentary canal, depending on the amount of the salt and the strength of its solution, and varying with the nature of the salt. 2. The excito-secretory action of the salt is probably due to the bit- terness as well as to the irritant and specific properties of the salt, and not to osmosis. 3. The low diffusibility of the salt impedes the absorption of the secreted fluid. 4. Between stimulated secretion on the one hand, and impeded absorption on the other, there is an accumulation of fluid in the canal. 5. The accumulated fluid, partly from ordinary dynamical laws, partly from a gentle stimulation of the peristaltic movements excited by distension, reaches the rectum and produces purgation. 6. Purgation will not ensue if water be withheld from the diet for one or two days previous to the administration of the salt in a concen- trated form. 7. The absence of purgation is not due to the want of water in the alimentary canal, but to its deficiency in the blood. 8. Under ordinary conditions, with an unrestricted supply of water, the maximal amount of fluid accumulated within the canal corresponds very nearly to the quantity of water required to form a 5 or 6 per cent, solution of the amount of salt administered. 342 PHARMACOLOGY AND THERAPEUTICS. 9. If, therefore, a solution of this strength be given, it does not increase in bulk. 10. If a solution of greater strength be administered, it rapidly increases in volume until the maximum is attained. This it accom- plishes in the case of a 20 per cent, solution in from one to one and half hours. 11. After the maximum has been reached, the fluid begins gradually and slowly to diminish in quantity. 12. Cceteris paribus, the weaker, or in other words, the more volu- minous the solution of the salt administered is, the more quickly is the maximum within the canal reached ; and accordingly purgation follows with greater rapidity. 13. Unless the solution of the salt is more concentrated than 10 per cent, it excites little or no secretion in the stomach. 14. The salt is absorbed with extreme slowness by the stomach of the cat. 15. The salt excites an active secretion in the intestines, and probably for the most part in the small intestine, all portions of this viscus being capable of yielding the secretion in almost equal quantities. 16. The bile and pancreatic juice participate but very little in the secretion. 17. The scretion is probably a true suceus entericus, resembling the secretion obtained by Moreau after division of the mesenteric nerves. 18. The secretion is promoted by local irritation of the intestine, as by ligatures, but only in the immediate vicinity of the irritation. 19. Absorption by the intestine generally is reflexly stimulated by such irritation (the effect of numerous ligatures applied at points remote from the seat of the injected salt being to diminish the amount of purgative fluid by accelerated absorption). 20. If the salt solution be injected directly into the small intestine, the stronger within certain limits the solution is, the greater will be the accumulation of fluid within the intestine. 21. This difference is not observed when the salt is administered per os, as the strong solution becomes diluted in the stomach and duodenum before passing into the intestine generally. 22. The difference is due to the local action of the salt on the mucous membrane, and probably more to an impeded absorption than to a stimu- lated secretion. 23. When the salt is administered in the usual manner, it appears, in the case of the sulphate of magnesia and sulphate of soda, to become split up in the small intestine, the acid being more rapidly absorbed than the base. 24. A portion of the absorbed acid shortly afterwards returns to the intestines. ■>■-, '). After the maximum of excretion of the acid has been reached, the -alt begins very slowly and gradually to disappear by absorption, which is checked only by the occurrence of purgation. 26. Daring the alternations of absorption and secretion of the acid, it is the salt left within the intestine which excites secretion, the absorbed and excreted acid exerting no such action whilst in the blood, or during the process of its excretion, as Headland believed. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 343 27. The salt does not purge when injected into the blood, and excites no intestinal secretion. 28. Nor does it purge when injected subcutaneously, unless in virtue of its causing local irritation of the abdominal subcutaneous tissue, which acts reflexly on the intestines, dilating their blood-vessels, and perhaps stimulating their muscular movements. 29. The sulphate of soda exhibits no poisonous action when injected into the circulation. 30. The sulphate of magnesia is, on the other hand, powerfully toxic when so injected, paralyzing first the respiration and afterwards the heart, and abolishing sensation or paralyzing the sensory-motor reflex centres. 31. Both salts, when administered in the usual manner, produce a gradual but well-marked increase in the tension of the pulse. 32. According as the salt-solution within the intestine increases in amount, there occurs a corresponding diminution of the fluids of the blood. 33. The blood recoups itself in a short time by absorbing from the tissues a nearly equal quantity of their fluids. 34. The salt, after some hours, causes diuresis, and with it a second concentration of the blood, which continues so long as the diuresis is active. 35. As the intestinal secretion excited by the salt contains a very small proportion of organic matter as compared with the inorganic matter, the purgative removes more of the latter than the former from the blood. In certain cases a large quantity of the salts of the blood is thus evacuated. 36. The amount of the normal constituents of the urine is not affected by the salt. 37. After the administration of sulphate of magnesia much more of the acid than of the base is excreted in the urine. 38. The salt has no specific action in lowering the internal tempera- ture of the body, or has it only to a very small extent. 39. It reduces, however, the absolute amount of heat in the body. Uses. — Purgatives are used, firstly, to remove from the intestinal tube faecal matters. They thus not only prevent the accumulation of such matters, but remove the irritation which their presence produces, and which may evidence itself in disturbances of other organs, producing, for example, headache and malaise. These disagreeable symptoms pro- duced by constipation are perhaps partly due to the irritation of the intestinal nerves producing reflex disturbance of the circulation, but it is probable also that they may be due in part to the toxic action of poisonous gases, liquids, or solids, generated in the intestine by imperfect digestion or decomposition of the food. For such purposes as this we may employ, as we find them necessary, laxatives or simple purgatives. The second use of purgatives is to remove liquid from the body in cases of dropsy, due either to heart or kidney disease. For such pur- poses we use saline hydragogue cathartics. From his researches on the action of saline cathartics Dr. Hay had found that if a salt be given in a concentrated solution when the ali- mentary canal contains little or no fluid, it produces an almost immediate 344 PHARMACOLOGY AND THERAPEUTICS. and very decided concentration of the blood by the removal of a large quantity of its water in the form of intestinal secretion. But if the salt be given in sufficient water, or if the alimentary canal contain suffi- cient fluid at the time of administration, no such concentration occurs. The concentration reaches its maximum in half an hour, but does not last more than half an hour or an hour, when it begins to decline, and continues to do so until it reaches the normal at the end of about four hours. This return of the blood to its normal concentration is not due to re-absorption from the intestine, but to the absorption of lymph and fluids from the tissues. Some hours after the administration, either of a concentrated or dilute saline solution, the blood undergoes another con- centration, less than the first, but continuing longer. Saline cathartics as often used in dilute saline solution owe their use in dropsy to a great extent to their diuretic action. When given in concentrated solution under proper conditions, the benefit they produce by purgation is exceedingly great. These conditions are that the alimentary canal should be freed from food, and especially from liquids, by previous abstinence for some hours, and that the salt should be given along with the smallest possible quantity of water. Sulphate of magnesia being soluble in less than its own weight of water is most suitable. Alkaline tartrates and Rochelle salt may also be useful ; sulphate of soda is more insoluble, and therefore less suitable; phosphate of soda and sulphate of potash are too insoluble to be of any service. 1 The third use is to lower the temperature in fever, and for this we chiefly use salines. The modus operandi here is not yet well understood, as they have no such action in health (p. 343). The fourth use is to lower the blood-pressure, and thus to prevent the rupture of a blood-vessel, and consequent apoplexy, or to prevent further extravasation in a case where the vessel has already burst. The regular use of aperients is especially necessary in gouty persons with contracting kidney and high blood-pressure. How far their utility is to be ascribed to their direct effect in lowering the blood-pressure and how far to the removal of waste products which might raise the pressure it is impossible at present to say. The utility of purgatives after apo- plexy has occurred may be doubtful, but they are usually administered, and probably, they do no good. Even if they do no good, they do no harm. A drop of croton-oil or a few grains of calomel on the tongue is the usual form of administration. A fifth use is to prevent straining at stool where violent efforts are dangerous, as in aneurism, hernia, &c. Action of Irritant Poisons. A great number of drugs which are employed in medicine, and are most useful when given in small doses, act as irritant poisons in large ones. Their action is then not restricted to the stomach, nor even to 1 Land, April 21, 1883. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 345 the whole of the intestinal canal, but they exercise, in addition, a marked effect upon other functions of the body, such as respiration and circula- tion. In considering the physiological action of many drugs it is necessary to describe the effect they will produce when given in large quantities, as, for example, in an overdose, as well as in moderate or small ones. It will save both time and space to consider here the action of irri- tant poisons generally, and to refer to this description when discussing the effect of individual drugs. The symptoms of irritant poisoning are to a great extent the same, whatever be the irritants swallowed; it is therefore convenient to give an account of these symptoms, and then to mention the special peculiar- ities which occur in the case of different poisons. A poison is most usually swallowed, and it then comes successively in contact with the lips, moutli and tongue, gullet and stomach. It may sometimes reach no further, being either evacuated by vomiting or absorbed. It frequently, however, also passes into the intestine. On all those parts which it reaches it exerts a local action ; besides this, however, it exerts a reflex action on the respiration and circulation. Corrosive poisons produce a feeling of burning in the lips, mouth, gul- let and stomach; the pain in the stomach, extending more or less over the abdomen, is accompanied by tenderness, and is increased by pressure. It is thus distinguished from the pain of colic, which is usually relieved by pressure. Fig. 110.— Diagram to show the nervous mechanism by which the action of the heart may be depressed by irritation of the stomach. The reflex irritation of the vagus may render the heart's action simply weak, or slow and weak {vide p. 287). The irritation of the stomach gives rise to vomiting- ; the vomited matters usually consisting, first of the contents of the stomach, next of bile or mucus, and lastly of mucus stained with blood. These matters may sometimes be more or less acted upon by the poison where this is a strong acid or alkali. The intense irritation in the stomach produces effects on the respiration and circulation very much like those caused by a severe blow in the epigastrium. The heart's action is greatly weakened 346 PHARMACOLOGY AND THERAPEUTICS. at first, and it may be rendered slow from reflex irritation of the vagus, but in the later stages it is generally rapid, very small, weak, or almost imperceptible; sometimes it may be intermittent. On account of the weakness of the circulation the face and the general surface of the body are pale, the cheeks sunken, and the extremities cold. The frequency of the respiration may vary — may be either slower or quicker than normal, but it is almost always labored and shallow, as the intense irritation in the stomach renders the descent of the diaphragm in deep inspiration painful, and the sufferer therefore tries to avoid it. Although the pulse at the beginning of the poisoning may be slow, when advanced it is usually, as already mentioned, very rapid. Excep- tions to this rule may occur chiefly in the case of poisons which, after their absorption, have an action on the heart itself; these are potassium nitrate and salts of barium. In consequence of the weakness of the cir- culation the face is usually very pale, but an exception to this may occur in poisoning by corrosive sublimate, where the face may be flushed. In arsenical poisoning the face is not only pale, but assumes a bluish hue, and the pinching may be extreme, so that the condition resembles that of a person suffering from Asiatic cholera. Where the poison is exceedingly corrosive, as in the case of acids and alkalies, its local action on the stomach in causing swelling of the mucous membrane may tend partially to occlude the pylorus, and the greater part of the poison may either remain in the stomach itself or be ejected by vomiting without passing into the intestine. In such cases vomiting will occur alone without being accompanied by purging, and the pain in the abdomen may be less diffused. Most irritant poisons, however, pass from the stomach into the intestines, and thus violent purging is induced in addition to the vomiting. The inflammation of the intestines also causes the pain to be diffused over the whole abdomen. Peculiarities in the Action of different Irritant Poisons. — Acids throw down albumen as a white precipitate, and in consequence, when brought in contact with the lips or tongue in a concentrated condi- tion, they cause white stains. The white stain is most marked in the case of hydrochloric acid ; it may occur also from sulphuric ; but as the further action of the sulphuric is to char albumen or other organic sub- stances, the stain may acquire a brown or black color. Nitric acid pro- duces a yellow stain, rendered brighter by the application of ammonia. Perchloride of iron produces a yellowish-brown stain ; the caustic alka- lies remove the epidermis and give a soapy feeling to the surface, but do not leave any stain. After a short time the mucous membrane becomes injected and swollen from the irritation. In the mouth the taste peculiar to the poison often leads to its detec- tion, so that very little of it may be swallowed in cases where a person was about to take it unwittingly and not intentionally. Arsenic, although a powerful irritant in the stomach, is almost tasteless. As the poison passes down the gullet, it may have an important influence on the respir- atory tract ; this is especially the ease where it gives off* fumes like nitric acid, hydrochloric acid, and ammonia ; the fumes, passing into the larynx and trachea, excite irritation, spasm, and inflammation, and may cause death by suffocation. Death by suffocation may, however, sometimes ACTION OF DRUGS ON DIGESTIVE SYSTEM. 347 occur from the action of poisons which do not fume, e.g., sulphuric acid ; the local irritation about the epiglottis being so great as to cause obstruc- tion to the respiratory passages. Sometimes, also, such poisons as sul- phuric acid may pass directly into the trachea instead of the oesophagus, and thus cause very rapid death from suffocation. Purging is usually absent and the bowels constipated in poisoning by strong alkalies or acids, and by salts of lead ; the former probably act by corroding the stomach, and partially occluding the pylorus ; the latter by lessening the peristaltic movements of the intestine. In the case of lead salts, the abdominal pain differs from that of ordinary irritant poi- sons, being of a colicky nature, and to a certain extent relieved by pressure. Secondary Effects of Irritant Poisoning-. — After the imme- diate condition of collapse caused by the powerful action of the irritant has passed off, the local inflammation which it has produced may give rise to a general febrile condition, with hot skin, flushed face, and quick bounding pulse. This condition may be accompanied by other symptoms due to the physiological action of the poison after its absorption ; thus, in the case of corrosive sublimate, there may be the metallic taste, sore gums, and profuse salivation. One of the most important instances of the secondary effects of irritant poisons is phosphorus ; after the primary symptoms of gastric irritation have passed off the patient may appear perfectly well, and then vomiting and purging may set in a second time. These are due, not to the local action of the phosphorus which has been swallowed on the stomach and intestines, but to changes in the liver, blood, and other organs, which the phosphorus has produced after its absorption. A sim- ilar condition has been observed in poisoning by arsenic, but usually the symptoms of arsenical poisoning are continuous, and do not exhibit a distinct intermission of this kind. Death may occur from the secondary action of some poisons a good while after the primary symptoms have disappeared ; thus strong acids and alkalies may produce death, weeks or even months after they have been swallowed, from the effects of their local action on the oesophagus or the stomach. During the passage down the oesophagus they may destroy the mucous membrane to such an extent that when it heals and the cicatrix begins to contract, the lumen of the tube may be completely obstructed, so that no food can reach the stomach, and the patient dies of starvation, or the mucous membrane of the stomach may be destroyed to such an extent that what remains is insufficient to digest the food, and the patient dies from non-assimilation. Action of Drugs on the Liver. The liver is by far the largest organ in the body, and it is placed in a very peculiar situation. It acts as a porter or doorkeeper to the circu- lation, all the substances which are absorbed from the intestinal canal having to pass through the portal vein and the capillaries of the liver before they can enter the general circulation. Since the discovery by Ludwig and Schmidt-Mulheim that peptones are poisonous when injected directly into the circulation, the liver has 348 PHARMACOLOGY AND THERAPEUTICS. acquired a new importance. Schiff and Lautenbach indeed had previously made some experiments which they thought showed that a subtle poison existed in the blood even of healthy animals, but was destroyed by the liver. They based this idea on the observation that ligature of the portal vein causes death in animals with very much the same symp- toms as when they are bled to death. Ludwig had formerly explained this phenomenon by supposing that the ligature caused the blood to accu- mulate in the large and dilatable portal radicals and prevented it from getting into the general circulation again. The animal was thus, as Ludwig expressed it, bled to death into its own veins. Schiff and Lau- tenbach, however, thought the symptoms were due rather to poison than to this mechanical alteration in the circulation, because they found that when the blood of an animal whose portal vein had been ligatured was injected into a frog, it produced death within three hours, whereas blood from a similar animal whose portal vein had not been ligatured produced no effect. The liver therefore seems to have a most important function in destroying- the poisonous properties of peptones, and perhaps other substances produced during digestion, and possibly also of poisonous products of tissue waste. The peptones are converted by it into sugar and glycogenic substance. 1 Drugs which act on the liver are usually divided into hepatic stimu- lants and cholagogues and into hepatic depressants. It has been for a very long time a matter of clinical experience that the administration of mercurial purgatives was frequently followed by the discharge of greenish bilious-looking evacuations and a great improve- ment in the general condition of the patient. These two results were classed together as cause and effect, and the improvement was considered to be due to the removal of bile. It was then supposed that the bile was formed in the blood and simply excreted by the liver, and, therefore, the bilious-looking stools were ascribed to stimulation of the secreting func- tion of the liver by the mercurials. Hepatic stimulants and cholagogues were therefore considered to be identical. We now know that the bile is formed in the liver and not simply excreted by it from the blood, and that bile formed in the liver may again be absorbed into the blood. Increased functional activity of the liver might thus lead to the presence of a greater instead of a less quantity of bile in the blood. Recent experiments have also shown that one of the most marked cholagogues which we know, viz.. calomel, appears rather to diminish than to increase the actual secre- tion of bile, so that we are now obliged to distinguish between hepatic stimulants and cholagogues. Hepatic stimulants are drugs which increase the functional activity of the liver, and the amount of bile which it forms. Cholagogues are substances which remove bile from the body, possibly by acting rather on the intestines; they do not necessarily increase the secretion of bile, they may only prevent its re-absorption and thus diminish the quantity in the circulation. Hepatic depressants are drugs which Lessen the quantity of bile secreted by the liver. In relation to tissue waste it is not to be forgotten that the products of the functional activity of one organ are not only poisonous to itself, but Seegen, rjlHyirs Arehiv, xxviii., p. 990. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 349 may be poisonous to other organs. Thus the waste products of muscular activity gradually poison the muscle and prevent its contraction, although as soon as they are washed out with salt solution the muscle recovers its power. Lactic acid also, which is a product of muscular waste, is poisonous not only to muscle but to some extent to nerves, and lessens the functional activity of the brain and produces sleep. At the same time it is possible that these waste products, poisonous in themselves, may through slight changes be rendered available for nutrition, just as peptones, which are themselves poisonous, are most important foods. Besides acting on peptones, the liver seems to have the power of destroying the poisonous properties of some vegetable alkaloids. For example, ■£$ th of a drop of nicotin given to a frog does not produce death, but 4^-th is sufficient, when the liver has been previously removed. Conia, cobra poison, and hyoscyamin, all exert much less poisonous action after they pass through the liver, before they reach the general circulation, than they do when injected directly into the blood. Curare, prussic acid and atropia, on the other hand, do not have their action modified. 1 The result of these experiments may be partly explained on the sup- position that a good deal of the poison has been excreted along with the bile, and has thus been prevented from reaching the general circula- tion. But it is probable that in addition to the function of excreting poisons, the liver has also got the power of destroying poisons, and, it may be, the power of removing poisons from the circulation by merely' storing them for a time. In relation to this subject it is interesting to bear in mind that alka- loids, to which the name of ptomaines has been given, are formed in dead bodies during the process of decomposition, and that when a solution of peptone is treated with potash and ether it yields a body which appears to be a volatile alkaloid. If putrid peptone is treated in the same way, a solid non-volatile alkaloid is obtained. 2 Ptomaines are not only formed in dead bodies, they are also formed in the intestine by the decomposition of parts of its contents. They have been found in large quantities by Bouchard both in the stools of persons suffering from diarrhoea or typhoid fever, and in normal faeces. They appear to be absorbed from the intestine into the blood and excreted by the urine. They have been found by Bouchard in the urine both in health and disease, and Bocci has shown that the human urine has a paralyzing action on frogs like that of curare, or of the ptomaines which Mosso and Guareschi have obtained from putrefied fibrin or brain. Some time ago I pointed out 3 the resemblance between the languor and weakness which occur in many cases of indigestion and the symp- toms of poisoning by curare, and drew attention to the probability that the languor was due to the effect of poisonous substances absorbed from the intestine. These I considered to be probably peptones, but it is possible 1 Lautenbach, Philadelphia Medical Times, May 26, 1877. 2 Tanret, Convptes Bendus, xcii., 1163. 3 Lauder Brunton, " Indigestion as a Cause of Nervous Depression," Practitioner, vol. xxv., October and November, 1880. 350 PHARMACOLOGY AND THERAPEUTICS. that they may be ptomaines. But whether the poisonous substances be peptones or ptomaines, the function of the liver is equally important in preventing them from reaching the general circulation. Bearing in mind, then, the office of the liver as a porter to prevent the passage of injurious substances from the intestinal canal into the blood, and the great effect that any alteration in the circulation through it may produce upon the circulation, and consequently on the functions of all the intestinal organs, we will much more readily understand the importance of this gland, the largest in the body, than if we look upon it simply as an instrument for secreting the bile which plays a useful but still subordinate part in the process of digestion. "We are still but imperfectly acquainted with its functions, but we may say that they are at least five: — 1st, to form and store up glycogen, a material which will after- wards be used in evolving heat and muscular energy : it will thus, as it were, perform the office of a kind of coal-bunker to the body : 2dly, to secrete bile for use in digestion ; 3dly, to excrete bile; 4thly, to destroy peptones which are poisonous when they are directly introduced into the general circulation, and to convert them into glycogen, &c. ; 5thly, to destroy or store up and excrete other organic poisons which may have been formed in the alimentary canal during the process of digestion, or may have been introduced into it from without. The glycogenic function of the liver is influenced by a number of drugs, especially phosphorus, and substances belonging to the same chemical group. Phosphorus, arsenic, and antimony, all destroy the glycogenic function, and at the same time tend to cause fatty degenera- tion of the organ. It is possible that these effects of the poisons are closely connected, but the exact connection between them has not yet been ascertained. In consequence of the disappearance of glycogen from the liver which is caused by these drugs, puncture of the fourth ventricle will no longer cause glycosuria in animals which have been poisoned by them. Attempts have been made to utilize this fact in the treatment of diabetes, but as yet the results have not been very satisfactory. Hepatic Stimulants. — The action of drugs on the secretion of the liver has been very carefully studied by some observers, especially by Rohrig, Rutherford, and Vignal. The mode of experimenting was to cura- rize a dog, ligature the common bile duct and insert a cannula into it. The bile was thus entirely prevented from reaching the intestine, and the whole of it flowed through the cannula into a vessel in which it was col- lected, so that the amount secreted in a given time was readily estimated. The drug was then administered, usually by injection into the duodenum, and the increase or diminution which this caused in the bile was noticed. The ingestion of food greatly increases the secretion of bile, and in order to get rid of this disturbing factor, the experiments were all made on fasting animals. A great number of drugs were experimented upon, some of which were found to stimulate the liver, and increase the quantity of bile ACTION OF DRUGS ON DIGESTIVE SYSTEM. 351 without altering its quality, so that their action upon the liver would be nearly analogous to that of laxatives upon the intestine ; others increase the quantity of bile, and render it more watery ; others again had little effect upon the liver, but stimulated the intestinal secretion and move- ments. The following are hepatic stimulants : — Acid, dilute nitro- hydro-chloric. 1 Aloes. 1 Rochelle salt. 3 Sodium sulphate. 2 Sodium phosphate. 1 Potassium sulphate. 2 Mercuric chloride. 1 Sodium salicylate. 1 Sodium benzoate. 1 Ammonium benzoate. 2 Baptism. 2 Euonymin. 1 Hydrastin. 2 Juglandin. 2 Iridin. 1 Leptandrin. 2 Phylolaccin. 1 Podophyllin. 1 Sanguinarin. 1 Colchicin. 1 Colocynth. 1 Jalap. 2 Rhubarb. 2 Ipecacuanha. 1 Physostigma 3 (extract). The most powerful stimulants in the preceding list are indicated by ( 1 ), the less powerful by ( 2 ) and ( 3 ). Those drugs which stimulate the intestine much, as a rule increase only slightly the secretion of bile by the liver, and podophyllin, which in certain doses acts as a powerful hepatic stimulant, ceases to have this effect when it produces marked purgation. These effects occur indepen- dently of the action of the drugs on the re-absorption and re-secretion of bile, inasmuch as in the experiments quoted the whole of the bile was collected directly from the liver and not allowed to pass at all into the intestine. Cliolagog-ues. — In making similar experiments, however, Schiff observed that the secretion of bile was very much greater for a short time Liver with bile duct lead- ) ing into the duodenum. J ' Portal vein with entero-] hepatic circulation show- i ( ing absorption and re- j excretion of bile Mesenteric veins. Stomach. Small intes- tine. — Colon. Fig. 111. immediately after the bile duct was tied, than it was later on ; and on fur- ther investigation he found that this was due to the fact that the liver has a double function : it not only forms new bile, but re-excretes 352 PHARMACOLOGY AND THERAPEUTICS. the old bile which has been re-absorbed from the intestine. A certain quantity of bile is lost in the faeces, but a considerable portion of it seems to be utilized again and again ; being formed by the liver, poured out into the intestine, re-absorbed and again excreted. This circulation of bile between the intestine and the liver has been called by Lussana the entero-hepatic circulation. It has been shown that the bile which is absorbed from the duodenum does not merely act as a stimulus to the liver to cause a greater formation of new bile, but is actually re-excreted by injecting ox-bile, which gives Pettenkofer's reaction, into the duodenum of a guinea-pig, and finding that shortly afterwards the bile which issued from the gall duct gave this reaction while the bile normally secreted by the guinea-pig does not. Not only is bile re-excreted in this manner by the liver, but other sub- stances also, such as medicines and poisons, are likewise excreted. The absorption and re- excretion takes place with great rapidity, for Laffter, in some experiments made under Heidenhain's direction, found that rhubarb injected into the duodenum appeared in the bile in less than five minutes. Substances injected into the blood were also excreted by the bile with great rapidity, so that sulphindigotate of soda introduced directly into the circulation in some experiments, began to color the bile blue one minute after its injection. Other substances are also absorbed from the intestine and excreted by the liver and passed round in the entero-hepatic circulation, just like the bile. Curare is one of those, and to this probably is due in a great measure the absence of fatal effect from its introduction into the stomach. Iron also circulates with the bile, and it is probable that the beneficial effect of large doses may be due in part to the action of the iron upon the liver. The objection has been raised to the use of large doses that they are useless, inasmuch as the whole of the iron which is taken into the mouth is again expelled in the faeces, but there can be no doubt that clinically large doses of iron are sometimes beneficial. Copper and manganese also appear in the bile, arid it is probable that lead and all the heavy metals pass chiefly out of the body by this channel. It has been suggested by Lussana that the malarial poison also cir- culates in the entero-hepatic circulation. From the fact that bile is re-absorbed from the intestine, it is obvious that a hepatic stimulant which simply increases the secretion of the bile by the liver, will not of itself act as a cholagog'ue and remove the bile from the body. In order to do this, this action must be combined with increased peristaltic action of the bowels, which will hurry the bile out and prevent its re-absorption. If, in addition to increased peristalsis, we have increased secretion from the intestinal mucous membrane, so as to was] i out the intestine, we shall get the bile still more effectually removed from the body. The necessity for such a combination has indeed been long air" shown by clinical experience, and the advantages of following a mercurial pill by a saline purgative in order to clear it away have long beeE recognized. Some hepatic stimulants increase also the peristaltic movements and secretions from the intestine; for example, those substances which have been already enumerated as cholagogue purgatives. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 353 Aloes. Colocynth. Sulphate of potash. Baptism. Jalap. Sulphate of soda. Colchicum in large Podophyllin. Phosphate of soda, doses. Rhubarb. Mercury salts. In most cases, however, it is advisable to combine hepatic and intestinal stimulants in order to insure a more complete chola- gogue effect. Thus calomel as employed in Rutherford's experiments has no stimulant action on the liver, but stimulates the intestinal glands ; corrosive sublimate, on the contrary, stimulates the liver powerfully, but has a very feeble stimulant action on the intestine ; a combination of the two stimulates both the liver and the intestinal glands. When used in medicine, calomel is recognized to be a powerful cholagogue, one of the most powerful indeed that we possess, and it is by no means impossible that a small portion of it may be converted into a corrosive sublimate in the intestine, so that we thus get from the calomel, when given alone, the combined effects of both the mercurial preparations just mentioned. It is perhaps more probable, however, that the cholagogue action of cal- omel may be due to its having a peculiar stimulant action on the duo- denum and ileum, so as to hurry the bile along the intestine and prevent its re-absorption. The reason for supposing that this is the case rather than that part of it is converted into corrosive sublimate and stimulates the liver, is that when given to dogs with a permanent fistula it does not increase the flow of bile, which it would probably do if any corrosive sublimate were formed. Another is that after the administration of calomel, leucine and tyrosine, which are products of pancreatic diges- tion, are found in the stools, and it seems not improbable that their appearance under such circumstances is due to their having been hur- ried along the intestine from the duodenum to the anus, and evacuated without time being allowed for their absorption or decomposition in the intestine. Adjuncts to Cholagog-ues. — The pressure under which bile is secreted is very low, so that a very slight obstruction to its flow through the common bile duct is sufficient to cause its accumulation in the gall bladder and gall ducts, and thus to lead to its re-absorption. This is readily observed in cases of catarrh, either of the duodenum or of the gall ducts. In such cases the use of ipecacuanha is indicated. It has been found clinically to be of great service, and it probably acts by les- sening the tenacity of the mucus in the gall duct, and thus tends to remove the obstruction in front, while at the same time it increases the pressure behind, by stimulating the hepatic secretion. The movements of the diaphrag-m have a powerful action in aiding the expulsion of bile from the liver ; they do this to a certain extent in ordinary respi- ration, but their effect is much greater in forced inspiration. Exercise therefore tends to expel bile from the liver, and prevent its accumulation in the biliary capillaries, but a little brisk exercise, as in riding, rowing, climbing, tennis, &c, will have in a few minutes a more benefi- cial action than a lazy constitutional walk of a couple of hours. The secretion of bile is not only increased, but the pressure under which it is secreted is raised by sipping* fluids. This is in all 23 354 PHARMACOLOGY AND THERAPEUTICS. probability due to nervous influence, for it has been shown by Kronecker that taking a liquid in numerous small sips will for the time completely abolish the inhibitory action of the vagus on the heart. It is probable in consequence of this fact, that Carlsbad water when taken in numerous sips for an hour or more, as at Carlsbad itself, is so exceedingly effica- cious in hepatic diseases, while sodium sulphate, which is the main con- stituent of the water, was found by Rutherford to have only a very slight action as a stimulant to the liver. Uses of Hepatic Stimulants and Cholagogues. — The pres- sure under which the bile is secreted is very small, but the blood-pressure also in the portal vein is very low. In consequence of this a very slight increase in the tension of the bile within the gall ducts, or diminution of the pressure of blood in the vein, causes the bile to be absorbed. It is then carried by the circulation to various parts of the body and disturbs their functions. It lessens the power of the heart and appears to dimin- ish the activity of the brain, so that persons suffering from biliousness and presenting a slight icteric tinge of the conjunctiva, are apt to feel irritable, stupid, and out of sorts generally. Cholagogues are useful by removing bile from the body, and thus relieving the symptoms above mentioned. It is probable, however, that they also in some way improve the portal circulation, and thus lessen congestion of the stomach and intestines, as in Beaumont's experiments on Alexis St. Martin (p. 321). Hepatic Depressants. Purgatives will act as hepatic depressants and lessen the secretion of the liver by removing from the intestine the bile which would other- wise be re-absorbed, and by hurrying out also the food which might yield materials for the secretion of new bile, but some substances, such as calomel, castor-oil, gamboge, and magnesium sulphate, were found by Rutherford to depress the secretion in cases where the bile duct was ligatured and the animals fasting, so that in all probability the effect of the drugs in diminishing the secretion was due to their lowering the blood-pressure in the liver. Action of Drugs on the Pancreas. The pancreatic juice is important in the process of digestion, as it has the threefold power of converting starch into sugar, of digesting proteids with the formation of peptones, and of splitting up fats. The process of secretion in the pancreas is associated with increased blood supply as in other glands. Its nerves arise from the hepatic, -picnic and superior mesentery plexures, with branches from the vagi and splanchnics. Electrical stimulation of the gland itself will cause etion, and bo will stimulation of the medulla oblongata. It isarrested by powerful irritation of sensory nerves, such as the central end of the 08, the crural or sciatic, and by the production of nausea or vomiting. The secretion is stimulated by the injection of ether into the stomach, and appear- to be paralyzed by atropine in the same way as the secretion of the Balivary gland. ACTION OF DRUGS ON DIGESTIVE SYSTEM. 355 When fibrin is digested with pancreatic juice the solution soon begins to swarm with bacteria and products of decomposition occur, among which is indol with a peculiarly disagreeable odor. When calomel is added to pancreatic juice it does not impair its digestive action upon starch, proteids, or fats, but it arrests decomposition and thus prevents the formation of indol and scatol, although leucin and tyrosin, which are the normal products of pancreatic digestion, are still formed. Salicylic acid has a similar action. 1 After the administration of calomel the stools are often of a green color, and this is due to unaltered bile. From the experiments on biliary fistulse already mentioned it is probable that this bile in the motions is not due to increased secretion by the liver but to occurrence of diminished absorption, caused by its more rapid passage through the intestine, and possibly also to lessened transformation from the effect of the calomel in preventing its decomposition. Anthelmintics. These are remedies which kill or expel intestinal worms. They have been divided into vermicides, which kill the worm, and vermifuges, which expel the worm without necessarily killing it, e.g. y purgatives. The chief worms which infest the intestine are tape worms, round worms, and thread worms. The chief Vermicides are : — For Thread Worms. — Local injections of alum, iron, lime-water, quassia, eucalyptol, sodium chloride, and tannin or substances containing it, as catechu, hamatoxylon, kino, rhatany. For Round Worms. — Santonin, santonica. For Tape Worms. — Areca nut, filix mas, kamala, kousso, pome- granate, turpentine. As Vermifuges. — Castor oil, scammony. Adjuncts. — Ammonium chloride, common salt and iron, and bitter tonics, are useful internally in preventing excessive secretion of intestinal mucus which affords a nidus for intestinal worms. Uses. — They are used to destroy and remove worms present in the intestine. In order that the remedies can come into more intimate con- tact with the worms, and thus destroy them more easily, it is usual to clear out the intestine by a purgative some hours before the administration of the remedy, which is usually given on an empty stomach, or with a small quantity of milk. After some hours another purgative is given in order to bring the worms away. As much mucus in the intestine forms a nidus for the worms, remedies which diminish it tend to prevent their occurrence. For this purpose preparations of iron and bitter tonics are useful. Zeitschr. f. physiol. Chem., vi. 2. 356 PHARMACOLOGY AND THERAPEUTICS. CHAPTER XIV. DRUGS ACTING ON TISSUE CHANGE. Tonics. These are remedies which impart permanent strength to the body, or its parts. When an individual is loose and limp, and feels unfit for work, like a relaxed bowstring, tonics restore his energy and strength, and again fit him for work. As their action in this respect resembles the effect of tightening a bowstring, they have received their name, which is derived from rovoc, tension. The feeling of debility may depend on many different causes. It may be due to weakness of the muscles, or weakness of the nervous system. Again, the nerves and muscles may suffer because the circulation is languid and feeble, or because the blood which supplies them is deficient in oxygen, or in nutritive matter. These deficiencies again may depend on deficient nutrition, due to want of appetite, so that too little food is consumed, or to an improper or insufficient diet, or to imperfect digestion, so that it is not assimilated. But weakness may be also induced by the accumulation of waste pro- ducts in the body, which interfere with the functional activity of the muscular and nervous systems; and these products may accumulate, because they are formed in excess in the tissues themselves by overwork, or in the intestinal canal from imperfect digestion ; or because they may be allowed to pass too readily from the intestinal canal into the blood by deficient action of the liver. Or their excretion may be defective from the kidneys being insuffi- ciently active, or the bowels constipated. The mode of action of tonics is so manifold that they have been divided into blood tonics or hsematinics, vascular tonics, gastric tonics, intestinal tonics, and nervine tonics. Uses. — In order to ascertain what form of tonic is required, it is necessary to determine carefully what part of the organism is in fault. In very many cases the imperfect functional activity in the body gener- ally, which exhibits itself in languor and weakness, is due to accumula- tion of waste products, and not to deficient nutriment. In such cases the plan of loading the stomach with food, and giving iron, wine, and beef- tea, simply increases the mischief. If it is found on examination of the urine that the kidneys are not excreting a sufficient quantity of solids, and especially of urea, it is necessary to diminish the quantity of food, and especially of animal food, as all, or nearly all, the nitrogen taken into the body must be excreted by the kidneys. In order that no unnecessary work be thrown on the kidneys, we must as for as possible prevent products of imperfect digestion from being absorbed from the intestinal canal, and therefore the state of the liver must be carefully attended to, and the bowels themselves carefully regulated. In cases where the debility does not depend upon excessive waste products in the Mood and tissues, but upon defective oxidation due to deficiency of haemoglobin, the patient must be treated by hsematinics, DRUGS ACTING ON TISSUE CHANGE. 357 such as iron, cod-liver oil, and phosphate of lime. When the digestion is imperfect, gastric or intestinal tonics must be used as the case requires. Where enfeeblement of the stomach appears to be present, as shown by loss of appetite, and such signs of imperfect digestion as flatulence or weight and pain after eating, gastric tonics are used. Should its mus- cular coat be feeble or inactive, as shown by tendency to dilatation and splashing of the contents on movement, strychnine is especially indicated, and galvanism or systematic kneading may be also employed. Where the stomach is too debilitated to respond sufficiently to this form of treat- ment, as after long-continued gastric catarrh, or in old age, its work must be partly done for it, and then such digestives as hydrochloric acid and pepsin are useful. When the muscular movements of the intes- tine are sluggish, as indicated by constipation and by a tendency to the distension of the bowel with gas, nux vomica and belladonna may be given ; and when its mucous membrane appears to be relaxed and flabby, and secreting too profusely, the mineral acids, astringents and metallic salts may be of much service. When the pulse is soft and feeble, and there is a tendency to vascular dilatation, either general or local, as shown by local congestion and oedema of the dependent parts, or by drow- siness in the upright position and sleeplessness in the recumbent posture, vascular tonics are serviceable. Xerve tonics are used where the nervous functions are imperfectly performed, as shown by dulness, loss of memory, incapacity for work, languor, paralysis, or tendency to spasm, as in chorea. As the functions of this system depend very greatly upon the quality of the blood with which the nervous system is supplied, and on the rapidity of the circulation, the other tonics frequently require to be given in addition to nervine tonics. Haematinics. Blood tonics, blood restoratives, analeptic tonics. — These are generally remedies which improve the quality of the blood ; but the name blood tonics or haematinics is generally applied specially to such remedies as increase the quantity of red blood-corpuscles and haemo- globin in the blood. The quality of the blood depends upon a number of conditions : upon the amount and nature of the food ingested, on the digestion, on the formation and excretion of the various products of tissue change, and more especially on the formation and destruction of the red blood-corpuscles themselves. The red "blood-corpuscles are probably formed in the spleen, the medulla of bones, the liver, and possibly other parts of the body, from leucocytes which lose their nucleus, take up haemoglobin, and alter their forms to that of the red corpuscles. The red corpuscles are probably destroyed, at least to a great extent, in the liver, and probably also in the spleen. The coloring matter of bile contains a quantity of iron, and appears to be formed from haemoglobin. An abnormal condition of the liver, by leading to excessive destruc- tion of blood-corpuscles, may therefore be an important cause of anaemia. 358 PHARMACOLOGY A1SD THERAPEUTICS. The corpuscles contain albuminous matters as well as haemoglobin, and deficiency of albumen in the blood will lead to anaemia. Thus, in cases of Bright' s disease, the loss of albumen through the kidneys tends to pro- duce anaemia, and this must be combated by lessening the loss, if pos- sible, as well as by supplying albumen. The blood-corpuscles also contain fat, and deficiency of fatty food will tend to produce anaemia. Cod-liver oil, on the other hand, which is an easily assimilated form of fat, is a powerful haematinic. In anaemia there is a deficiency of iron in the blood, and chalybeate preparations are among the most powerful of all haematinics. One well-marked disease due to imperfect nutrition is scurvy. In it there is not only a deficiency of red blood-corpuscles, but a tendency to extravasation. Its pathology is not definitely made out, and it has been supposed to be due to a deficiency of potash in the blood, but it is much more likely that it is due to increase in the chlorides, and especially chloride of sodium, either absolutely or relatively to the carbonates. Excess of chloride of sodium causes the blood-corpuscles to pass out of the vessels (page 73), and potash salts alone, or beef-tea, which con- tains them, do not cure scurvy ; but it is removed by fresh vegetables or by lime juice. Alteratives. These are remedies which improve the nutrition of the body without exerting any very perceptible action on individual organs. The chief alteratives are: — Arsenic. Colchicum. Mercury. Guaiacum. Iodine. Iodides. Stillingia. Cod-liver oil. Sanguinaria. Sarsaparilla. Xanthoxylum. Gold. Mezereum. Action. — Healthy nutrition depends (1) upon a proper supply of oxygen and nutriment to each tissue and organ in the body, (2) on the proper amount and kind of tissue change in the various cells, (3) on the proper removal of waste. The proper supply of oxygen and of nutriment to the body generally will depend upon the state of the respiratory and digestive organs ; their proper supplies to the tissues, as well as the removal of waste from them, will depend upon the circulation ; and the removal of waste from the body generally will depend upon the bowels, skin, and kidneys. The drugs which act upon the different organs just mentioned are considered under other headings, but the changes which take place in the tissues themselves appear to be effected by drugs which produce no marked corresponding changes in assimilation, circulation, or excretion. It ie uncertain how they act; it is possible that they may alter in some way the action of enzymes in the body, but it is also possible that they act by replacing the normal constituents of the tissues and forming compounds which tend to break up in a different way from those which are ordinarily present. DRUGS ACTING ON TISSUE CHANGE. 359 Thus chloride of sodium and nitrogenous bodies such as albumen are amongst the most important constituents of the body ; and we find that among the chief alteratives are substances which will replace chlo- rine, soda, or nitrogen in many compounds. Thus we have iodine and iodides, and nitric or nitrohydrochloric acids, which will displace or replace chlorine. We have chlorine itself, and chlorides which may alter the proportion of chlorides to other salts in the blood and tissues, and thus modify the solubility of various constituents of the tissues. We have salts of potash and lime, which may replace those of soda ; sulphur and sulphides, which may replace oxygen ; phosphorus, hypophosphites, antimony and arsenic, which may replace nitrogen ; mercury and its salts, which may replace calcium. Besides these we have organic alteratives, regarding the action of which we can at present form no hypothesis unless they influence the processes of digestion. Nitrohydrochloric acids, taraxacum, and small doses of mercurials, probably act either by modifying the digestion of food in the duodenum and jejunum, or by modifying the changes which it undergoes in the liver after absorption. The action of drugs upon tissue change has usually been investigated by ascertaining the amount of urea excreted before, during, and after the adminis- tration of a drug. Most of the older experiments on this subject are of little or no value, as sufficient care was not taken to ensure that the amount of nitro- genous food consumed each day during the experiment was exactly the same. As all the nitrogen taken in the food reappears in the urine, any irregularity in the quantity introduced into the body will cause a corresponding irregularity in the quantity excreted. After this fact was ascertained the plan adopted by some experimenters was to deprive an animal of food for several days until the excre- tion of urea due to the gradual destruction of its nitrogenous tissues became nearly constant. The plan now adopted is to give to a dog or a man a quantity of food of an uniform quality and the amount of nitrogen in which is exactly known. The quantity given each day is exactly weighed. The same amount of nitrogen is thus introduced into the organism every day, and therefore any variations in the amount of nitrogen excreted must he due to changes in the organism itself. Observations on the excretions of urea only give us a very partial and imper- fect knowledge of the process of tissue change, and they ought to be combined as in the experiments of Pettenkofer and Yoit, with observations on the amount of oxygen absorbed and of carbonic acid given off. Such experiments as these, although very valuable, are very laborious, and comparatively few have hitherto been made. 1 From experiments made with those necessary precautions just described it has been found that free consumption of water increases tis- sue change very considerably, as is shown by the increased excretion of urea. Common salt, sulphate of soda, phosphate of soda, acetate of soda, borax, nitrate of potash, chloride of ammonium, carbonate of ammonium 1 A complete account of the whole subject is given by Voit in Hermann's Handb. d. physiol, Band. VI., Theil. i. This contains also complete references to the litera- ture. 360 PHARMACOLOGY AND THERAPEUTICS. and probably all salts which pass out in the urine carrying water with them, somewhat increase tissue change and the amount of urea excreted. Fats and fatty acids apparently lessen the decomposition of albumi- nous tissues and the excretion of urea, but glycerine has no action of this sort. Alcohol in small or moderate doses lessens, in large doses increases, tissue change. Benzoic acid, salicylic acid and benzamide, all increase tissue change and the excretion of urea. Contrary to what perhaps might have been expected, tea, coffee and cocoa, have no action whatever on the excretion of urea. 1 The experiments which seemed to show that they diminished it, appear to have been made without the necessary pre- cautions. Morphine slightly diminishes the excretion of urea but its action is much more marked on the consumption of oxygen and excre- tion of carbonic acid. These are greatly increased in the stage of excite- ment and greatly diminished in the stage of quiescence. It would appear that these changes are not due to the direct action of the morphine but only to the alterations of muscular activity which follow its adminis- tration. Quinine lessens tissue change, iron appears to increase it, mercury also slightly increases it, 2 while iodine appears to have little influence upon the quantity of urea excreted. This fact is of itself I think sufficient to show that the mere estimation of the quantity of urea excreted before and after the administration of a drug is quite insufficient to give us any precise information regarding their action on tissue meta- morphosis. Antimony, arsenic, and phosphorus have a special action on tissue change, and powerfully affect the glandular, nervous, respiratory and cutaneous systems. In large quantities they affect the liver very markedly, producing fatty degeneration ; and this also occurs in other tissues. This fatty degeneration is due to a twofold action : — 1st, increased tissue metamorphosis ; and 2d, diminished oxidation. In the normal condition albuminous tissues split up as indicated below : — Albuminous e< Tissues. s Non-nitrogenous l.S f Carbonic acid, substances e.g., Fat, &c. | r& "p \ excreted by lungs. Nitrogenous e.g., Leucine, c o> f Urea, substances, Tyrosine, &c. J Q A \ excreted by kidneys. In poisoning by antimony, arsenic, and phosphorus, the nitrogenous products of tissue waste appear in much larger quantity in the urine than normally, owing to the increased decomposition which is going on. They may appear in the urine in the form of an excessive quantity of urea, as in cases of phosphorus poisoning in the dog, but in man they may appear in the form of leucine and tyrosine. Owing to the diminished oxidation the non-nitrogenous substances remain in the body as fat instead of being oxidized and passing out of the body as carbonic acid. Voit, op. cit 1 Voit, op. cit. Boeck, quoted by Voit, op. cit. DRUGS ACTING ON TISSUE CHANGE. 361 The exact nature of their effect on the nervous system has not been made out. Their action on the skin and epithelial cells of the lungs seems to be that of causing fatty degeneration. Fatty degeneration of the liver occurs also in poisoning by salts of silver. Mercury has a peculiar power of breaking up newly deposited fibrin and of causing disorganization of syphilitic deposits. Iodine, iodides, and probably also chlorides, appear to act on the lymphatic system and promote absorption : their action is specially well marked in cases of glandular enlargement. Uses. — In general mal-nutrition without definite symptoms, mercu- rials, taraxacum, and nitrohydrochloric acid are used and are especially indicated where the liver is suspected to be in fault, as where there are symptoms of biliousness, and also where oxalates and urates are found abundantly in the urine. In gout, potash and colchicum are used. Phosphorus and arsenic are employed in nervous debility : and they as well as antimony are ser- viceable in neuralgia, chorea, and other nervous diseases. In diseases of the skin, arsenic is chiefly employed. In diseases of the respiratory organs, antimony is very serviceable when the attack is acute ; and arsenic is most valuable in some chronic conditions, especially in chronic consolidation, where it probably acts by producing fatty degeneration and softening of the effusion, so that it is either absorbed or expectorated. Mercury is employed specially to break up deposits of lymph and to prevent adhesions, as in iritis and pericarditis ; and is also used and is most serviceable in the treatment of syphilis. It is most generally em- ployed in the secondary stage of this disease : in the third stage it is either given along with, or entirely replaced by the use of, iodides. Antipyretics, Febrifuges. These are remedies which reduce the temperature of the body in fever. They act much more powerfully when the temperature is abnormally high than when it is normal. The constant temperature of warm-blooded animals depends upon the maintenance of a proper balance between the amount of heat generated in the body, chiefly by oxidation, and on the amount given off to the surrounding medium — air or water. The heat is chiefly generated in the muscles and glands. It is chiefly given off by the skin, although some is also lost by the lungs, etc. A little heat, but not much, may be given off by radiation alone. The power of dry air to take up heat is very slight, and so the skin is not much cooled, and very little sensation of cold is felt at temperatures much below 0° if the air is both still and dry. If the air be moist its capacity for heat is much greater, and the loss of heat from the skin being much more rapid, a person may actually feel the weather colder at 4° F. than at -40° F., the air being still in both cases. If air, either dry or moist, is in motion, so that fresh portions of it come successively into contact with the skin, the loss of heat is much more rapid, and a little 362 PHARMACOLOGY AND THERAPEUTICS. wind will render even dry air unbearably cold at a temperature which would be quite supportable if the air were still. It is to be observed that during sleep the action of the vaso-motor centre is less, the vessels of the surface dilate, and loss of heat, with dan- ger of consequent chill, takes place more rapidly. For the effects of local chill to the surface, vide Rossbach's experiments (p. 225). Antipyretics may be divided into two great classes : those which lessen the production of heat, and those which increase the loss of heat ; and these again may be subdivided as shown in the following table: — Anti- pyretics. 1 Lessen production of heat Acting on tissue change. Quinine. Cinchonine. Quinidine. Cinchonidine. Berberin. Benzoic acid. Carbolic acid. Picric acid. Salicylic acid. Salicylate of soda. " quinine. " methyl, (oil of winter green). Salicin. Kairin. Camphor. Eucalvptol. Thymol. Other essential oils. Alcohol. f Generally... Acting on the circula- tion Antimony salts. Aconite. Digitalis. i Veratrine. I C dchicum. f Wet cupping. I Leeches. -\ Dry cupping. I Blisters. I Poultices. r By dilating the cutaneous vessels f Alcohol. and increasing radiation \ Nitrous ether. Locally. Increase loss of heat Mode of action un- certain By increasing the lossl of heat due to evapo- >Sudorifics... ration of perspiration J _ By abstracting heat from the body- Purgatives. Venesection. f Antimouial prepara- J tions. ] Opium and ipecacuanha. I Nitrous ether. r Cold bath. Cold affusion. Cold sponging. Wet pack. Ice to the surface. Cold drinks. Cold enemata. The mode of action of those which affect the blood and tissues them- selves has already been considered tolerably fully under the head of " Oxidation of Protoplasm " (p. 77). They appear simply to diminish the temperature by lessening oxidation. The mode of action of anti- pyretics which produce their effect through the circulation, has not been investigated in detail with satisfactory exactitude, but it is supposed that by lessening the rapidity of the circulation through those parts of the body in which the increased tissue change is taking place, the temperature is reduced. DRUGS ACTING ON TISSUE CHANGE. 363 Blisters will have this effect locally by causing contraction of the vessels in the inflamed part, as already described under the head of Counter-irritants (p. 303). Antipyretics, which increase the loss of lieat, may do so (1) by causing greater dilatation of the vessels of the skin, and thus allow- ing a quicker radiation of heat from the body; (2) by augmenting the secretion of sweat : and thus carrying off heat by means of evapora- tion ; or (3) they may actually remove warmth from the body, as cold baths, cold affusion, cold sponging, wet packing, cold enemata, or ice to the surface. Uses. — Antipyretics are used to lower the temperature when it has risen above the normal, whatever be the cause. A high tempera- ture may be produced simply by prolonged exposure to heat. This exposure, and the rise in temperature it occasions, seems to induce increased tissue change, and this increase of the tissue change will keep up a febrile temperature, even after the external temperature has fallen. Such thermal fever is found in warm climates, and in it quinine injected subcutaneously seems to be very efficient. A high temperature may also occur from specific fevers, as typhus, typhoid, scarlet fever, measles, and acute rheumatism. The most rapid and powerful antipyretic in such cases is the application of cold by bathing, or sponging ; and probably next come large doses of quinine or salicylate of soda. In typhoid fever, salicylate of soda does not seem to act so rapidly as it does in acute rheumatism. Venesection, though formerly the antipyretic which was chiefly relied upon, has now fallen to a great extent out of use — this is probably from its having been very much abused. In persons suffering from acute inflammation of the lungs or bronchi, where the amount of lung tissue which remains sound is insufficient to aerate the whole mass of blood, and the patient is becoming livid, small bleedings are serviceable, not only relieving the breathing, but lessening delirium which may be present. Venesection lowers the temperature for a short time, but it soon rises again in many cases, so that bleeding alone is by no means a powerful antipyretic, 1 unless the quantity of blood abstracted be so great as proba- bly to injure the patient seriously ; yet in combination with other anti- pyretics it may sometimes be of very great service. Local bleeding- by leeches or by wet cupping- sometimes gives very great relief, lessening both local inflammation and the general symptomatic fever consequent upon it, in pneumonia, pleurisy, pericar- ditis, peritonitis, etc. In such cases blisters may be used to diminish the local inflammation, and thus aid the action of other antipyretics. Vascular antipyretics, such as aconite and digitalis, also seem to be of more service in symptomatic fever than they are in specific fevers. Purgatives take an intermediate place between antipyretics which lessen the production of heat by acting on the tissues, and those which act on the circulation. They diminish the force of the circulation, and 1 Wunderlich's Medical Thermometry, pp. 118, 134, 378, New Sydenham Society's edition. 364 PHARMACOLOGY AND THERAPEUTICS. may in this way lessen the production of heat. It is not impossible also, however, although this is a point on which we have not sufficient infor- mation, that they may do so by removing from the body substances whose effect when present in the circulation or tissues would be to maintain the high temperature. Amongst antipyretics which increase the loss of heat we have : first, alcohol, which is included also in the former list of those which lessen the production of heat, for it appears to act in both ways, both diminishing oxidation and also increasing the loss of heat. It does this by dilating the vessels of the skin and allowing free radiation from the surface, and also by the cooling effect of evaporation of the sweat, although its action as a sudorific is not very marked. We have also the whole class of sudorific s. One of the most useful of these in checking a febrile condition just at its onset is a dose of compound ipecacuanha powder, or Dover's powder, which has now, to a great extent, taken the place of the older remedy, having a somewhat similar action, viz., antimonial powder, or James's powder. Another mixture in great favor is acetate of ammonia and spirits of nitrous ether. The most powerful, however, of all remedies which increase the loss of heat are the application of cold water or ice. CHAPTER XV. ACTION OF DRUGS ON EXCRETION. Action of Drug's on the Kidneys. The kidney has a twofold office. It has (1) to regulate the amount of water in the body under various conditions ; (2) to remove the products of tissue waste. These products must be removed in a state of solution from the part of the kidney where they are excreted, and yet sometimes provision must be made for the water, by which they are washed out, being retained in the body. The urine in mammals and amphibia is liquid ; in birds and reptiles it is semi-fluid or solid, yet the solid con- stituents are removed in solution from the urinary tubules, and the water in which they are dissolved is afterwards absorbed. We may say then that the kidney has not only a twofold, but a threefold action: — 1st, the excretion of waste products; 2dly, a provision for the removal of excessive water; and -idly, an arrangement for the retention of w ftter in the body by its re-absorption, after it has washed out the waste products. On looking at the kidney we find three structures which seem to be connected with these three functions, viz.: (1) convoluted tubules with epithelial cells, which in all probability are the chief ACTION OF DRUGS ON EXCRETION. 365 structures for excreting waste products ; (2) the Malpig-hian corpuscles for excreting water along with some solids, and (3) usually one or more constrictions in the tubule which may serve the purpose of preventing too rapid exit of the water, and thus allow time for its re-absorption in cases where its retention is desirable, as for example on a hot day and when the supply of drinking-water is very limited. The process of secretion in the kidney was regarded by Bowman as consisting of the filtration of water from the vessels of the glomeruli into the tubules, and the excretion of waste products by the epithelium lining the tubules. Ludwig, however, came to look upon it rather as a process of filtration and re-absorption ; a dilute solution of urea and salt being according to him poured out from the Malpighian corpuscles and gradually concentrated by the absorption of water in its passage along the tubules. This theory had so many facts in its favor that it was for a good while exclusively adopted, but latterly Heidenhain in an admirable series of experiments has shown that such substances as indigo are Fig. 112. — Diagram showing the form of the urinary tubules in different classes of animals, after Hiifner. 1. Fish. 2. Frog. 3. Tortoise. 4. Bird. 5. Mammal. The letters have the same signi- fication in each. a. Capsule of the glomerulus, b. Convoluted tubule, c. Loop. d. Collecting tubule, u in 2 indicates the transverse section of the ureter. certainly excreted by the epithelium of the tubules. At the same time Hiifner has shown by a comparison of the structure of the kidney in fishes, frogs, tortoises, birds and mammals, that the form of the tubules closely agrees with that required for the re-absorption of water in each case. Fishes have a low blood-pressure, and so the resistance in the kidney requires to be small in order to allow of the secretion of urine. Living as they do in water, they do not require any apparatus for its retention in the body. In them therefore the tubule is short and wi'de, and destitute of any constriction which would retard the outflow of fluid. In frogs there must be ample provision for the retention of water in the 66 PHARMACOLOGY AND THERAPEUTICS. body, as evaporation takes place freely from their skin. In them we find, as we might expect, that the tubule, and especially the contracted part of it, is very long. In tortoises no evaporation from the skin can take place, and in them the contracted part of the tubule is short. This renders it probable that, while the ideas advanced by Bowman and supported by Heidenhain are in the main true, the re -absorption of water on which Ludwig lays so much stress is also an important factor in the secretion of urine under different circumstances. But it is not only rendered probable by the facts of comparative anatomy ; it appears to be proved by direct experiment. Bibbert 1 has extirpated the medullary substance of the kidney in the rabbit while leaving the cortical substance. He has thus succeeded in collecting the urine as it is excreted by the Malpighian corpuscles before it has passed through Henle's loops, and has found that the urine secreted by the cortical substance alone is much more watery than that which is secreted by the entire kidney, a fact which appears conclusively to prove that water is actually re-absorbed, and the urine rendered more concentrated, during its passage through the tubules of the medullary substance. In the frog and triton the arrangement of the kidney is such as to allow of a much more complete investigation of the different factors in secretion, than in mammals, because in amphibia, the glomeruli which separate the water and the tubules which excrete the solids, receive their blood supply to a great extent independently. The glomeruli are sup- plied by branches of the renal artery. The tubules are supplied by a vein which proceeds from the posterior extremities and, entering the kid- ney, breaks up into a capillary plexus bearing a somewhat similar rela- tion to the renal tubules as that which the portal vein does to the lobules of the liver. It is therefore called the portal vein of the kidney. The arterial circulation in the glomeruli and the venous portal cir- culation round the tubules are not entirely distinct, for the efferent arteries of the glomeruli unite with the portal capillaries, and, moreover, arterial twigs also pass directly from the renal artery into the capillary venous plexus. The two systems are, however, so far distinct that Nuss- baum has been able to ascertain with considerable exactitude the part played by each in secretion. By ligaturing the renal artery he destroyed the functional activity of the glomeruli, and by ligaturing the portal vein of the kidney he destroyed that of the tubules. By injecting a substance into the circulation after ligature either of the artery or the vein, and observing whether it is excreted or not, he determines whether it is excreted by the glomeruli or by the tubules. In this way he finds that sugar, peptones, and albumen pass out through the glomeruli exclu- sively, for they are not excreted when the renal arties are tied. Albu- men, however, only passes out through the glomeruli when an abnormal change has already occurred in the vascular wall ; as, for example, after the circulation has been arrested for a while by ligature of the renal artery. Indigo-carmine, when injected after ligature of the renal arteries, passes into the epithelium of the tubules, but it does not give rise to any etionofwater,so that thebladderis found empty. Urea, on the contrary, 'Ribbert, Virchow'a Archiv, July, 1883, p. 189. ACTION OF DRUGS ON EXCRETION. 367 is not only excreted by the tubules after ligature of the renal artery, but carries with it, in the process of secretion, from the venous plexus, a considerable quantity of water, so that the bladder becomes partially filled. Branch of renal artery Afferent artery to the glomerulus .... .^^ / Connecting branch Artery passing directly to thel plexus (corresponding to one of the arterise rectfe). j Glomerulus with efferent artery - - -J?- - - - -^. f|||§? ) J? Union of arterial and venous branches to form the plexus. Portal vein of the kidney Urinary tubule — -Abdominal vein. -Small branch connecting the efferent artery from the glomerulus direct- ly with the abdominal vein. Fig. 113.— Diagram of the circulation in the kidney of the newt. Modified from Nussbaum. . The excretion of water, therefore, takes place in a double man- ner : it passes out through the glomeruli when the renal arteries are free, and it passes out from the venous plexus along with urea, even although the renal arteries are tied. Fig. 114. — Diagrammatic sketch of the blood-vessels in a mammalian kidney; from Schweigger-Seidel, Die, Nieren, Halle, 1865. is an artery ascending into the cortical substance of the kidney; p is a branch from it which divides into two branches, q and P. q breaks up at once into a number of twigs. Pis the afferent artery to a glomerulus, S, of the lowest row. t is the efferent vessel of the glomerulus. It divides into two branches, one of which, u, ascends towards the cortex, whilst the other, v, descends towards the medulla. In the kidneys of the higher animals and of man the glomeruli and the tubules do not receive blood from two entirely different sources ; but there is an arrangement somewhat similar, for the plexus surrounding the tubules does not receive blood only from the efferent vessels of the Mal- pighian corpuscles, but gets it also directly from the renal arteries. There are three channels by which the blood may pass from the renal arteries into the venous plexus without going through the glomeruli. The first is the inosculation which takes place between the terminal twigs of the renal artery and the venous plexus on the surface of the kidney directly under 368 PHARMACOLOGY AND THERAPEUTICS. the capsule. 1 The second channel is formed by small branches given off directly by the interlobular arteries or by the afferent arteries before they reach the glomeruli. The former of these may be regarded as cor- responding to the artery which passes directly to the plexus in the newt, and the latter to the branch connecting it with the afferent artery (Fig. 113). These arterial twigs are found not only near the surface of the kidney, Arteriae rectse. Fig. 115.— Diagram of the tubules and vascular supply of the kidney. On the left is a tubule alone ; in the middle is a tubule along with the blood-vessels ; on the right are blood-vessels only. but, also in the deeper layers of the cortical substance. 2 The third and most important channel is afforded by the arteriae rectae, which spring from the branches of the renal artery at the boundary between the cortical and medullary substance and pass into the medulla, where they form a plexus with elongated meshes surrounding Henle's loops and the collect- ing tubules. Near their origiD the arteriae rectae inosculate with the venous plexus surrounding the convoluted tubules. 1 Ludwig, Handworterbuch d. Physiol., v., R. Wagner, Brt. 2. 2 Bchweigger-Seidel, Die Nieren, p. 67; Heidenhain, Hermann's Handbuch d. Physiologic, vol. v., Tli. 1, p. 293. ACTION OF DRUGS ON EXCRETION. 369 Through these three channels it is possible for blood to reach the secreting structures of the kidney and there get rid of urea, salts, &c, without losing water by its passage through the glomeruli. On the other hand, if these vessels contract, while the size of the renal artery and the pressure of the blood within it remain unaltered, more blood will be forced into the Malpighian corpuscles, and thus the quantity of water excreted will be increased. At the same time the contraction of the arterise rectae will probably diminish absorption from the tubules, and thus the quantity of water excreted will be increased in a twofold manner. Circumstances Modifying- the Secretion of Urine. — The experiments of Ludwig and his pupils have shown that the amount of urine secreted depends very closely upon the pressure of blood in the Mal- pighian corpuscles, or, to put it more exactly, on the difference of pres- sure between the blood in these corpuscles and the pressure within the tubules. For if the ureter be tied so that the pressure of urine in the tubules is increased, the secretion is greatly diminished, and even arrested, even though the pressure of blood in the renal artery be high. A somewhat similar effect to that of ligature of the ureter is produced by ligature of the renal vein, for the blood accumulating in the venous plexus surrounding the tubules compresses them so as to prevent the flow of urine through them. A similar condition may occur from cardiac or pulmonary disease obstructing the venous circulation. But unless under exceptional circumstances which alter the pressure within the tubules, such as compression of the tubules by congestion of the venous plexus, as in cardiac disease, impaction of a calculus in the ureter, or pressure on the ureters by dropsical accumulations or tumors, the rapidity of the secretion of urine depends on two factors : — (1) arterial pressure in the glomeruli ; and (2) the composition of the olood. The pressure of blood in the glomeruli may be raised : (1) By increase of the arterial tension generally. (2) By increased tension locally. Such a general increase may be brought about by greater action of the heart, or by contraction of the blood-vessels in other vascular areas, such as the intestines, muscles or skin, by nervous stimulation, exposure to cold, or the action of drugs. The pressure may be increased locally by dilatation of the renal arteries, e.g., from section of the vaso-motor nerves, or possibly stimulation of vaso-dilating nerves. In addition to such increase of pressure in the glomeruli by increase of blood supply to them, we must not, however, forget the possibility of increased pressure in them by contraction of the efferent vessels leading from them, as well as of those arterial twigs (arteriae rectae) which pass directly to the venous plexus surrounding the tubules, and which form no inconsiderable part of the vascular supply of the kidney. Alterations in the size of the renal vessels were formerly ascertained simply by exposing the kidney and observing its color, contraction of the arteries being associated with paleness, and dilatation with redness of the organ. A much more exact method has been introduced by Roy, who incloses the kidney in a capsule filled with oil and connected with a 24 370 PHARMACOLOGY AND THERAPEUTICS. registering apparatus. When the vessels dilate, the kidney increases in size, and diminishes when it contracts, so that the alterations can be readily recorded on the same revolving cylinder on which the general blood-pressure is registered by the manometer. The pressure of blood in the glomeruli may be diminished gen- erally : (1) By failure of the heart's action, or (2) By dilatation of the vessels of large areas, as the intestines, mus- cles, or skin. The pressure of blood in the glomeruli may be diminished locally by contraction of the renal arteries, or of the afferent branches to the glomeruli. The heart's action may fail from many causes, which have already been discussed more particularly. Dilatation of the vessels in the skin, intestines, &c, may be caused by exposure to warmth, by the action of drugs, or by paralysis due to nervous injury. Section of the splanchnics or of the spinal cord causes paralysis of the renal arteries, and ought, therefore, to increase the secretion of urine. This does occur, though not invariably, when the splanchnics are divided ; but section of the spinal cord, by paralyzing the intestinal and other vessels, lowers the blood-pressure so much that the supply of blood to the kidney is not only much below the normal, but is so small that the secretion of urine is generally almost completely arrested. The nerves of the kidney consist of a number of small branches running along the renal artery and containing a number of ganglia. When these nerves are cut the vessels of the kidney dilate; when they are stimulated the vessels contract. A number of those fibres pass to the kidney from the spinal cord through the splanchnics, so that when the splanchnics are cut the vessels of the kidney usually dilate, and when they are irritated they contract. The whole of the nerves, however, do not pass through the splanch- nics, for stimulation of a sensory nerve, of the medulla oblongata, or of the spinal cord in the neck, will cause contraction of the renal vessels after both splanchnics have been cut, and section of the splanchnics does not always cause the renal vessels to dilate. The nervous centre for the renal arteries is probably, like the chief vaso-motor centre for the body generally, in the medulla oblongata ; but in all probability there are also subsidiary centres in the spinal cord and in the solar and mesenteric plexuses. The reason for supposing these latter centres to exist is, that stimula- tion of the peripheral end of the splanchnic, divided at its passage through the diaphragm, causes contraction of both kidneys, and the vessels of the kidney of the side opposite to the stimulated nerve com- mence to contract later than that on the same side. A delay like this in the action of the stimulus indicates that it has not acted directly, but through the medium of ganglia. When the splanchnics are divided the vessels of the kidney some- times dilate and the kidney increases in size; a profuse secretion of urine may take place, which quickly increases to a maximum and remains for ACTION OF DRUGS OX EXCEETIOX 371 a considerable time. This, however, is not a constant effect, and not unfrequently the vessels do not dilate, and the kidney instead of increas- ing, diminishes in size. This is what to a certain extent might be expected, inasmuch as a section of the splanchnics causes dilatation of the intestinal vessels and lowers the blood-pressure, an thus diminishes the supply of blood to the kidney. When a puncture is made in the medulla oblongata in the fourth floor of the ventricle, profuse secretion also occurs, but this differs from that caused by section of the splanchnics, in being preceded by a slight diminution, by rising rapidly to a maximum and then rapidly falling. These characters seem to show that it is due to irritation of some vaso- dilating mechanism, 1 rather than to any paralysis. Stimulation of the vaso-motor centre in the medulla oblongata by venous blood, or by drugs such as strychnine or digitalis, has a two- fold action on the kidney, for it tends to cause contraction not only in the vessels of the kidney, but in those of other parts of the body. The effect upon the kidney is thus a complicated one, for the contraction of the intestinal and other vessels by raising the blood-pressure tends to drive blood into the kidneys, at the same time that the contraction of the renal arteries tends to keep it out. When the renal nerves are cut, £2 £•§ Fig. 116. — Curres showing the effect of erythrophloeum upon the blood-pressure and secretion of urine. Froni Phil. Trans., vol. clsviL the renal vessels no longer oppose the entrance of blood, and therefore the renal vessels dilate very greatly when the vaso-motor centre is stimu- lated ; but when the renal nerves are intact the result is a varying one, for sometimes contraction of the renal vessels may be so great as to prevent the entrance of blood into the kidney, however high the general blood- pressure may rise ; at other times the general high blood-pressure may be able to dilate the renal arteries in spite of any resistance they may 1 Heidenhain, Hermann's Handbuch der Physiologie, vol. v., Th. 1, p, 366. 372 PHARMACOLOGY AND THERAPEUTICS. offer. These different conditions may occur subsequently to one another ; and this stimulation of the vaso-motor centre may cause contraction of the renal vessels succeeded by dilatation, or vice versa. Thus Mr. Power and I found that on injecting digitalis into the circulation of a dog, the blood-pressure rose, but the secretion of urine was either greatly diminished or ceased altogether. Here it is evident that the renal ves- sels had contracted so much as to prevent the circulation through the kidney, notwithstanding the rise which had taken place in the blood- pressure. After a while the blood-pressure began to fall, and then the secretion of urine rose much above its normal, showing that the general blood-pressure was then able again to drive the blood into the kidneys. 1 Similar observations were made by Mr. Pye and myself with regard to erythrophloeum ; and the accompanying curves show well the result upon the urine of the mutual action of the rise in blood-pressure and the contraction of the renal arteries upon the secretion of urine. It will be noticed that at first the blood-pressure rises more quickly than the secre- tion of urine, the circulation through the kidney appearing to be opposed by the renal arteries. This opposition is then overcome, and the secre- tion of the urine rises more quickly than the general blood-pressure. The renal vessels again appear to contract, so that the urine diminishes while the blood-pressure rises still further. We have then oscillations, due first to one factor and then to the other being predominant; and then, when the blood-pressure rises to its maximum, we find that the urine is at its minimum, the secretion of urine again rising as the blood- pressure falls. A good deal of discussion has arisen regarding the mode of action of digitalis, and it has been stated by many to act as a diuretic only in cases of heart disease, and to have no diuretic action in health. In my own experiments, however, I found that it acted as a very marked diu- retic even in health, and the explanation of this discrepancy may possibly be that, in my own case, the blood-pressure was low, whereas in the others it was probably much higher; but I am uncertain regarding the true explanation, though I am certain of the fact. By causing increased secretion of water through the kidneys diuret- ics may increase the concentration of the blood, and thus produce thirst, or cause absorption of water from the intercellular tissue or serous cavi- ties in dropsies. In my own experiments on digitalis I weighed all my food and measured all my drink for nearly six months, taking exactly the same quantity every day. After producing profuse diuresis by a large dose of digitaline (sixty milligrammes in two days), such thirst ensued that I was forced to take a quantity of water to allay it. 2 Mode of Action of Diuretics. — From what has already been said, it is evident that diuretics may act in several ways. They may act: A, on the circulation in the kidney, raising the pressure in the glomeruli, (1) locally, (a) by contracting the efferent vessels, or the arterial twigs which pass directly to the capillary plexus ; (b) by causing 1 Royal Society's Proceedings, No. 153, 1874. 2 The experiments were made in 1855, and published in part in my thesis on Digitalis, with some Observations on Urine. London: Churchill & Co., 1868. ACTION OF DRUGS ON EXCRETION. 373 dilatation of the renal arteries, and thus increasing the supply of blood to the kidney. This they may do also, in more ways than one, for they may either paralyze the vaso-motor nerves of the kidney, or act on vaso- dilating mechanisms. (2) they may raise the blood-pressure generally by causing the contraction of vessels in other parts of the body. Afferent vessels. (?) Dilated by nitrous ether, potassium nitrite. Efferent vessels. (?) Contracted by digi- talis, strychnine, erythrophloeum, squill. Tubules. (?) Stimulated by urea and po- tassium nitrite, acetate, &c. Caffeine, turpentine, cantharidine (?) Paralyzed by curare (?) Fig. 117. — Diagram to show the parts of the secreting apparatus of the kidney which are probably affected by different diuretics. B. Other diuretics may act on the secreting- cells of the tubules, and may increase both the amount of water and the amount of solids excreted by them. Diuretics have already been classified as stimulating and sedative; and the sedative class agrees very closely with the one which we have just indicated as acting on the kidney through the circulation. From what has been said of the action of diuretics it is evident that we may hope to do much more by combining them than by using them singly. Thus we see that digitalis instead of acting as a diuretic may completely arrest the renal circulation and stop the secretion altogether. If, however, we can combine it with something which will produce dila- tation of the renal vessels, while the general blood-pressure remains high, we shall greatly increase the circulation through the kidney, and obtain the desired result. Experiments in regard to this were made by Grutzner with nitrite of soda. He found that this substance increased the secretion of urine when the blood-pressure was reduced to a minimum by curare ; and he found that it also had this effect when the blood-pressure was raised by imperfect respiration. When the vaso-motor centre was greatly stimulated however, by allowing the blood to become very venous, the nitrite of soda no longer produced any increase of secretion. Diuretics. Refrigerant Diuretics. Water in large quantities. Carbonic acid (aerated waters). Potassium salts, especially the Acetate. Citrate. Stimulant Diuretics. Alcohol. Gin. Hock. Cantharides. Blatta Orientalis. 374 PHARMACOLOGY AXD THERAPEUTICS. Refrigerant Diuretics— continued. Potassium salts, especially the Bitartrate. Chlorate. Nitrate. Sodium salts, e.g., common salt. Hydragogue diuretics — Adonis Yernalis. Broom. Caffeine. Colchicum. Digitalis. Erythrophlceum. Nitrous ether. Squill. Strophanthus. Stimulant Diuretics— continued. Oleo-resins, resins and volatile oils — Turpentine. Juniper. Savine. Copaiba. Cubebs. Black pepper. Matico. Kava. Guaiac. Umbelliferous plants chiefly con- taining volatile oils — Parsley. Carrot. Dill. Fennel. Cruciferous plants — Mustard. Horseradish. Asparagus. Uva ursi. Sarsaparilla. Buchu. Pareira. Chimaphila. Taraxacum. Ononis spinosum. Santonica. The following tabular view of the probable mode of action of the various diuretics may help to show it more distinctly :- Raise arterial pressure Generally. (Increased action of the f digitalis, heart ( alcohol. Contraction of vessels in intestine and through- out the body. Locally in kidney ' Contract efferent vessels or arterite rectse so as to raise pressure in • glomerulus and lessen absorption in tubules, or both. Dilate afferent vessels. By action on vaso- motor centres. f Digitalis. Erythrophlceum. I Strophanthus. ■ Squill. Convallaria. Strychnia. Cold to surface. ? The same as in preceding list. Act on the se- f crtting nerves or secreting-^ cells of the I kidney itself. ! Increase water excreted. Increase solids excreted. Urea. Caffeine. By local action on vessels or nervous structures in the' kidney itself. Paralyze vaso-motor nerves or involun- tary muscular fibre, ■ or stimulate vaso- dilating nerves. ? Broom. ? Turpentine. ? Juniper. ? Copaiba. ? Cantharides. Nitrites. Alcohol. ? Urea.* { Liquor potassse. 1 Potassium acetate, 4c. ♦When a current of blood is pasted artificially through an excised kidney, the stream is much accelerated by the addition of urea. Abeles, Sitz-Ber. d. k. k. Wiener Akad. Bd. 87, Abt. 3, April, 1883. ACTION OF DRUGS ON EXCRETION. 375 Uses. — Diuretics may be employed for the purpose of removing* either water or solids from the body. They are used : 1st, to remove the excess of fluid met with in the tissues and serous cavities in cases of dropsy. 2d, to hasten the removal of injurious waste products and poisonous substances from the blood. 3d, to dilute the urine. In cases where the accumulation of fluid depends on venous conges- tion, as for example in cardiac dropsy, those diuretics which act on the general vascular system, like digitalis, strophanthus, squill or erythro- phloeum, are most efficient because they tend to remove the cause of the dropsy (p. 295), as well as to assist the absorption and excretion of the fluid already effused. When the dropsy depends on the disease of the kidneys or liver, other diuretics should either be given instead of, or along with, digitalis or squill. Even in cases of cardiac disease where digitalis or squill are not proving efficacious, the addition of a little blue pill greatly assists their action, though it would be hard to say in what way it does so. In dropsy depending on kidney disease, decoction of broom, oil of juniper, and nitrous ether, are amongst the most reliable diuretics, and copaiba in hepatic dropsy. Diuretics are used to increase the secretion of solids in febrile con- ditions, and in cases of kidney disease where the excretion of waste products is deficient, and their retention threatens to prove injurious. In such cases, nitrate and bi- tartrate of potash, turpentine, juniper, and caffeine are useful. Diuretics are also used to increase the proportion of water in the urine, and thus to prevent the solids being deposited from it and forming calculi in the kidney or bladder ; or even to dissolve again such concre- tions as have been already formed. Adjuvants to Diuretics. — As the amount of urine secreted depends upon the difference in pressure between the blood in the glo- meruli and the urine in the tubules, it is evident that any pressure on the tubules, whether caused by obstruction of the ureter by a calculus, by the mechanical pressure of dropsical accumulations in the abdomen, or by distension of the venous plexus in the kidney itself, will tend to lessen the secretion of urine. Consequently we sometimes find that in such cases diuretics fail to act until the pressure has been relieved by para- centesis in cases of dropsy, or the venous congestion lessened by the use of a brisk purgative, or by cupping- over the loins. If the venous congestion is very great, as in cases of mitral disease or of chronic bronchitis with emphysema and dilated heart, bleeding from the arm may be advantageous or even imperatively necessary. In dilated heart and in mitral incompetence, the action of digitalis on the heart itself, strengthening its action and enabling it more effectually to pump the blood out of the venous into the arterial system, and thus reduce venous congestion, will aid its action upon the kidneys. Action of Drugs on Albuminuria. — In the normal kidney no albumen passes from the vessels or lymphatics into the urinary tubules, but under abnormal conditions it may do so and the urine become albuminous. 376 PHARMACOLOGY AXD THERAPEUTICS. Albuminuria may be produced by ligature or compression of the renal artery ; by ligature of the renal vein ; and, though to a less extent, by ligature of the ureter. A similar effect to that of ligature of the renal artery may be produced by causing it to contract temporarily by means of drugs such as digitalis. In the experiments made by Mr. Power and myself we noticed that the urine which was secreted after the secretion had been completely stopped by digitalis was albuminous. Albuminuria is also noticed after poisoning by strychnine, which, as Griitzner has shown, has a similar action to digitalis, and in cases of suf- focation or of epilepsy, where the vaso-motor center is stimulated by venous blood. Other drugs appear to cause albuminuria by a direct action on the kidney itself. A marked example of this is cantharides, which produces both albuminuria and hematuria. Shortly after its injection the kidney appears congested and swollen, and on microscopic examination it is found that the alterations begin first in the glomeruli and convoluted tubules, and gradually extend to the straight- tubules. These changes consist in intense congestion, especially of the glomeruli, with increased tension of blood in the vessels. Then the liquid constituents of the blood pass through the vascular walls, carrying along with them granules, red cor- puscles, and white corpuscles. This exudation then passes from the glomerulus along the whole length of the tubules, the epithelium of which next becomes changed, the cells which line them swelling up, multiplying, and becoming modified in form, migration of leucocytes also occurring. In short, we have the signs of inflammation beginning in the glomeruli and passing along the tubules. Lead produces also disease of the kidney, but of a different kind. The kidney in animals poisoned by it is pale and granular, with an adhe- rent capsule and with atrophy of the cortical substance, in which crystals are often present. These appearances are due to chronic interstitial nephritis caused by calcareous deposits in Henle's loops. These block up the tubuli, produce subacute inflammation of the glomeruli and tubules, with atrophy and cirrhosis. A similar result is produced also by mercury. Chlorate of potash has a very peculiar action on the kidney. In large doses it produces a peculiar kind of hematuria, the urine being dark brown and containing large quantities of broken-up blood corpuscles. The drug arrests the secretion of the urine by blocking up the tubules with plugs of broken-up blood corpuscles. Tannin and tannate of soda appear to have a certain power to lessen the exudation of albumen through the Malpighian tufts, as Ribbert found that when albuminuria was produced artificially in rabbits by temporary ligature of the renal artery, both tannin and tannate of soda either les- sened or prevented the exudation of albumen. Arbutine, the active principle of uva ursi, appears to be still more efficacious, but requires to be given in somewhat large doses. Lithontriptics. These are remedies employed for the purpose of preventing the solids of the urine from being deposited, or of causing re-solution. ACTION OF DRUGS ON EXCRETION. 377 One of the most important is the abundant use of water, and some- times it is advisable to use distilled water in place of ordinary water, as distilled water is free from salts of all kinds. Distilled water has a dis- agreeable, flat taste, but it may be made quite agreeable by charging it with carbonic acid in a gasogene. The substances which most generally are deposited from the urine are uric acid, acid urates, oxalate of lime and phosphates ; the two former are liable to be deposited when the urine is too acid, and the two latter when it is alkaline or neutral. Oxalate of lime also may be deposited from faintly acid urine. These substances may be deposited either in the kidney or bladder, and thus give rise to renal or vesical calculi. The lithontriptics generally employed when uric acid, or acid urates, are present, are salts of lithia and potash, as the urate of potash is more soluble than the urate of soda, and the urate of lithia more soluble than even that of potash. On account of the low atomic weight of lithium its salts have the further advantage of combining with a much larger relative proportion of uric acid than the salts of potash or soda. When phosphates are present, mineral acids, such as phosphoric, are sometimes employed, but it is difficult to render the urine acid by the internal admin- istration of mineral acids, although it is easy to render it alkaline by the administration of alkalies. Benzoic and cinnamic acids, however, in passing through the body, are converted into hippuric acid, and they ren- der the urine acid. They may either be given alone, or in combination with ammonia as benzoate of ammonia, because although ammonia is alkaline, yet it appears to undergo conversion into urea in the body, and does not render the urine alkaline. The deposition of oxalate of lime is usually connected with disturb- ances in the digestive system, and I have observed in a hospital ward, that a deposit of it is very commonly found in the urine after the patients have had cabbage for dinner. The administration of nitro-muriatic acid frequently tends to prevent the deposition of oxalates, and this is perhaps, on the whole, the best remedy for the form of dyspepsia to which the name of oxalic diathesis is sometimes given. Sometimes, however, car- bonate of soda, by aiding the digestion, seems to be more beneficial. Action of Drugs on the Skin. Diaphoretics and Sudorifics. The difference between these classes of remedies is simply one of degree. When the drugs increase the secretion of sweat only slightly, so that it can still evaporate from the skin without running down in drops, they are called diaphoretics ; but when they increase it so greatly that it can no longer evaporate, and streams down the skin, they are called sudorifics. The secretion of sweat, like that of saliva, consists in the formation of the secretion by the cells of the gland from the material which is yielded by the fluid in the lymph spaces around the gland. New material is constantly supplied to this fluid by the blood which circulates in the vessels. We therefore find that increased circulation of blood through the cutaneous vessels and increased secretion of sweat Q 78 PHARMACOLOGY AXD THERAPEUTICS. usually accompany one another, but this is not always the case. In the sweat glands, as in the salivary glands, the secreting- nerves which regulate the activity of the cells are independent of the vascular nerves which regulate the capacity of the vessels. In fever or in poisoning by atropine the vessels may be widely dilated and the current of blood through them rapid, while the secretion of sweat is arrested. On the other hand, in dying persons we see a copious secretion of sweat occur, while the circulation through the skin has become very feeble or almost stagnant. A certain amount of sweat, indeed, may even be secreted by amputated limbs, the material for it being afforded by the lymph around the glands. But profuse secretion of sweat cannot go on long unless the gland is freely supplied with blood, for otherwise the supply of new material would cease. Dilatation of the vessels therefore aids the secre- tion of sweat. Dilatation may be induced by section of vaso-motor nerves or stimulation of vaso-dilating nerves. Thus, when the sympa- thetic is cut in the neck of a horse, dilatation of the vessels is produced by the section, and sweating occurs on that side. The vaso-dilating and secreting nerves of the sweat glands usually run together, and by irritation of a nerve trunk, such as that of the sciatic, the vessels of the foot may be dilated, and sweating excited. Warmth usually increases both the circulation of blood in the skin and the secretion of sweat ; while cold has the the contrary effect. The nerve centres which excite the secretion of sweat appear to be situated in the spinal cord ; the centre for the posterior extremities being situated in the upper lumbar and lower thoracic part of the cord in the cat ; while that for the upper extremities in the same animal is situated in the under part of the cervical part of the cord. The sweat glands may be excited to secrete : (1) By the action of drugs upon the terminations of nerves in the glands. (2) By the action of drugs on the sweat centres themselves. (3) Reflexly by stimulation of sensory nerves. (4) By mental stimuli. An example of the stimulation of sweating by the action of drugs on the nervous terminations in the glands themselves is afforded by pilocarpin, which will cause secretion even when the nerves which connect the centres with the glands have been cutt. Secretion may be also arrested by the paralyzing action of drugs upon the terminal fibres; thus, atropine locally injected, prevents the secretion of sweat, however much the nerves going to the gland or the nerve centres be stimulated ; and atropine also antagonizes the effect of pilocarpine on the nervous terminations, and arrests the secretion which the latter causes. The nerve centres may be stimulated directly by the condition of the blood which is passing through them, or reflexly by irritation of sensory nerves. Stimulants of these nerve-centres are: (1) a venous condition of the blood ; (2) high temperature of the blood ; and (3) poi- sons, especially nicotine. A venous condition of the blood is one of the most powerful stimu- lants, and it is to this that the sweats which precede death are in all ACTION OF DRUGS ON EXCRETION. 379 probability due, for I have watched a patient dying, and observed that drops of sweat appeared on the brow just at the time that the blood became venous, as was evidenced by the commencing lividity of the finger-nails and lobes of the ears. Under such conditions, while the secreting cells are strongly stimulated, the circulation is very feeble. A high temperature is also a powerful stimulant. In considering its action we must take into account the effect of the warm blood upon the sweat centres in the cord, as it circulates through them, and its local action also on the sweat glands themselves. Up to a certain point it appears to have the effect of dilating vessels and of increasing the activity of the glands by acting both on the sweat centres and on the periphery. Local warmth to one foot increases the secretion of sweat, and local cold diminishes it in that foot, when the glands in all four feet of an animal are stimulated equally either by excitement of the sweat centres or by the action of pilocarpine on the peripheral ends of the sweat nerves. 1 The sweat centres appear to be directly stimulated by nicotine, but the action of this drug may be partly due also to a reflex effect on those centres through the nerves of the stomach. The sweat centres appear to be reflexly excited by severe irritation of any sensory nerve passing from the surface of the body, and the point at which the irritation is applied does not seem to be of much impor- tance. They are probably stimulated reflexly from the stomach, as in the sweating which accompanies nausea. The power of the brain to stimulate the sweat centres is shown in the effect of mental emotion, and direct irritation of the medulla oblon- gata will cause sweating in cats even some time after death. Excretion by the Sweat Glands. — A number of substances taken into the body pass out in small quantities through the skin. Aromatic and volatile substances appear to pass readily, so also benzoic acid, hippuric and cinnamic acid, tartaric acid, succinic acid, iodide of potassium, quinine, corrosive sublimate, arseniates of soda and potash. When arseniate of iron has been taken, curiously enough, arsenious acid has been found in the sweat and iron in the urine. Some coloring matters are excreted especially by the skin of the arm- pits, and the underclothing may sometimes be found stained of a brick-red color at these parts. I have observed this in some cases after drinking claret or port, but it only occurs exceptionally after the employment of these wines, and it is possible that it is due to adultera- tion with foreign coloring matters, for I have also noticed it in cases where no wine has been drunk, but where pickled red cabbage or beet- root has been eaten. Relation between Sweat Glands and Kidneys. — The sweat glands and the kidneys both remove water and small quantities of salts from the blood, and thus tend to keep it at its normal concentration. Their functions are complementary, so that when much water is excreted by the skin less is excreted by the kidneys, and vice versa. 1 Luchsinger, Pfliiger's Archiv, 1876, vol. xviii., p. 480. 380 PHARMACOLOGY AND THERAPEUTICS. The amount of sweat and of urine is in inverse ratio — when the skin acts more, the kidneys act less. This is to a great extent due to the different distribution of blood under varying conditions, because when both are stimulated, as, for example, by salts of ammonia, diuresis will occur, if the blood be driven towards the kidneys by external cold ; and diaphoresis if it be attracted to the skin by external warmth. The quantity of solids contained in the sweat is very small, only a little over one per cent. — three-fourths of these being organic, and one- fourth inorganic. The organic are chiefly fats, fatty acids, and small quantities of urea — about one-tenth per cent. When the kidneys are insufficient, however, to excrete urea, the quantity in the sweat becomes greatly increased, and it has even been found crystallized upon the skin. Action of the Skin in Regulating- Temperature. — As I have already mentioned, the skin has an excreting function complementary to that of the kidneys, and it may to some extent relieve them when they are doing their work imperfectly. But its chief function is that of regu- lating the bodily temperature. The quantity of heat which is changed into potential energy, in converting liquid water into gaseous steam, is very great. Five and a half times as much heat is required to convert boiling water into steam, as to raise the same amount of water from the freezing to the boiling point. The immense loss of heat thus occasioned, converts the healthy skin under the influence of great heat into an actual cooling apparatus. In negroes on the west coast of Africa it has been noticed that while the skin is perspiring profusely, it is as cold as marble, and Sir Charles Blagdon observed that in a room with a temperature of 198° Fahr. his side felt quite cold to the touch. Uses. — Diaphoretics are used in cases of threatened catarrh or inflammation of mucous or serous surfaces, or internal organs after expo- sure to cold. Their beneficial action in such cases may be partly due to the withdrawal of blood from internal organs to the surface of the body by the use of diaphoretics, but it is not improbable that in addition to this the condition of the skin which they induce exercises a favorable action reflexly on internal parts. There seems to be a sort of complementary action between the skin and the internal mucous membranes, as well as between the skin and kidneys. This is sometimes well marked in gouty patients where the disappearance of an eruption from the skin is followed by asthma, and vice versa. It is also shown by the experiments of Rossbach (p. 225) ; and the effect of irritation of the stomach and nausea on the secretion of the skin has already been noticed. One of the best diaphoretics to cut short commencing catarrh is com- pound ipecacuanha powder. In fevers, with the exception of rheumatic fever, the skin is generally dry although the temperature is high, and diaphoretics are employed to increase the cutaneous secretion, and thus to lower the temperature. In exanthemata, after the eruption disappears from the skin, there is a tendency to inflammation of internal organs, and in order to prevent this diaphoretics arc used, those which act markedly on the vessels, or stimulating diaphoretics, being especially indicated. The advantage of a free supply of blood in chronic morbid conditions, sucl i as chronic ulcers has already been mentioned when speaking of ACTION OF DRUGS ON EXCEETION. 381 irritants (p. 301) ; and in chronic morbid conditions of the skin diapho- retics are sometimes employed to promote the cutaneous circulation. In diseases of the kidneys, when it is advantageous to lessen their functional activity, diaphoretics are employed in order to make the skin act vigor- ously ; and they are used also to assist the kidneys in removing the fluid which has already accumulated in the body in cases of dropsy. When the kidneys, though not diseased, are called upon to do excessive work — as in diabetes mellitus, or polyuria — diaphoretics are employed to aid them. Where an unnatural secretion of fluid is taking place from the intestine, as in cases of chronic diarrhoea, diaphoretics are also employed to divert secretion from the intestine to the skin and thus lessen the diar- rhoea. Antihydrotics or Annydrotics. These are substances which lessen the secretion of sweat : — Acids. Belladonna and Atropine. Hyoscyamus. Amarita muscaria and muscarine. Agaricus albus. Jaborandi and Pilocarpine. Nux vomica and Strychnine. Quinine. Picrotoxine. Ipecacuanha (compound powder). Zinc salts. These remedies may act (1) on the sweat glands themselves by les- sening the excitability either of the secreting cells or of the secreting nerves ; (2) on the sweat centres, by lessening their excitability or Motor nerves of thorax Motor nerves of diaphragm. Diaphragm Nerves to sweat glands. Respiratory centre — more readily stimulated by venous blood than the sweat centres in the spinal cord. Carotid artery and verte- bral arteries supply- ing the respiratory centre with blood. Sweat centres in spinal cord with arteries car- rying blood to them, and with nerves pass- ing to sweat glands. Fig. 118.— Diagram to illustrate the action of antihydrotics. The secretory nerves passing to the sweat glands from the sweat centres in the spinal cord have been represented as a single nerve for the sake of simplicity. removing the excitant; and (3) on the circulation. Belladonna in large doses paralyzes the ends of the secreting nerves, just as it does in the salivary glands, so that the sweat glands will not secrete even when a 382 PHARMACOLOGY AND THERAPEUTICS. strong stimulation is applied to their nerves. As belladonna acts thus when locally applied, it may be used for local sweating in the form of extract or of solution of atropine painted on. or rubbed over, the surface. It is thus useful in cases of local sweating of the palms of the hands and soles of the feet. It may also be given internally to paralyze the ends of the secreting nerves, and thus to arrest the night sweats in phthisis. But in all probability its beneficial effect in the night sweats of phthisis it not dependent on its paralyzing action on the secreting nerves, for it is useful in doses which appear to be too small to produce this effect, and which also do not act immediately, but rather after some time. Its utility in such cases, therefore, is probably due to an effect on the nerve-centres, and especially to a stimulating action on the respiratory centre. The night sweats of phthisis are usually followed by great weak- ness and prostration, which has sometimes been attributed to the loss of salts and organic matter contained in the sweat. But the quantity of these is very small, and the same depression is not noticed when there is an increase of two or three ounces in the daily secretion of urine, although it will carry off quite as large a quantity of both salts and organic mat- ter. Xor is the same depression produced by the profuse sweating due to active exertion, nor even by the sweating in ague. The depression is not the consequence of the profuse sweat ; both are probably the con- sequence of one common cause. This cause I believe to be partial fail- ure of the respiration and consequent accumulation of carbonic acid in the system, which leads at the same time to stimulation of the sweat cen- tres and impairment of tissue change throughout the body generally. In healthy persons the respiratory centre is more sensitive to the stimulus of carbonic acid than other parts of the nervous system. Thus any increase in the venosity of the blood at once stimulates this centre, and through it the diaphragm and respiratory muscles of the thoracic wall, rendering the respiration more active, and increasing arterialization. Consequently, the blood does not become venous enough to stimulate the sweat centres. But when the respiratory centre is depressed by excessive reflex stimulation during the day in the process of coughing, and by the natural depression which occurs during sleep, it may respond less readily to the stimulus of venous blood. The amount of carbonic acid in the blood may thus accumulate to such an extent that the sweat centres are stimulated before the respiratory centre responds, and thus the profuse sweats which are so depressing to the patient may occur. It is probable that this is only part of the truth, and that there are other factors in the production of abnormally profuse sweats ; for in chil- dren suffering from rickets, the head perspires profusely during sleep, yet the mucous membranes are of a bright rosy color. Nevertheless, acting on this idea, I have given at night such substances as are powerful stimu- lants to the respiratory centre, like nux vomica and strychnine, and I have found that the sweating is usually arrested by them. A small dose is sometimes sufficient, but occasionally it must be steadily increased until as much as half a drachm of the tincture of nux vomica is given at once. The only disadvantage that I have noticed from this treatment is that the excitability of the respiratory centre sometimes persists during the day, and renders the cough more troublesome. I have tried to remedy this ACTION OF DRUGS ON EXCRETION. 383 by combining strychnia with opium, and partially succeeded. If we now review the remedies used in the night sweating- of phthisis, we shall see that almost every one of them has a stimulant action on the respiratory centre. It is possessed in a marked degree by atropine and hyoscyamus. Ipecacuanha has this action also, and its combination with opium, in the form of Dover's powder, although it causes sweating in healthy persons, tends to restrain it in phthisical patients. Picrotoxine, salts of zinc, and pilocarpine, all stimulate the respiratory centre also, and we find that the last is useful in the night sweats of phthisis, although we would expect from its physiological action that it would be injurious, stimulating, as it does, the terminations of the secreting nerves in the sweat glands themselves. It is possible, however, that in addition to the stimulation of the sweat centres by venous blood, the night sweats of phthisis may be sometimes increased by the liig'li temperature of the patient, and in such cases quinine, as Murrell has pointed out, is likely to be most serviceable. Action of Drugs on the Bladder. The walls of the bladder consist of involuntary muscular fibre which expels the urine by its contraction. Around the neck of the bladder is a band of involuntary muscular fibre, the sphincter vesicae, which by its contraction closes the orifice and prevents the escape of urine. The sphincter vesicae receives its motor supply through the third, fourth and fifth sacra nerves. The nerve-centre for the movements of the bladder is situated in the spinal cord opposite the fifth lumbar vertebra in dogs, and the seventh in rabbits. This centre is able to regulate the retention and discharge of the urine by the bladder even when the spinal cord is divided between it and the brain, but the activity of the centre under normal conditions is modified by the brain, so that we may consider that there is a cerebral as well as a spinal centre for the bladder. The spinal centre may be set in action either reflexly, or by stimuli passing down from it to the brain. The cerebral centre may be set in action either reflexly or voluntarily. Usually when the pressure of the urine within the bladder is increased beyond a certain limit depending not only on the quantity of the water, but on the state of the contraction of the bladder itself, the neck of the bladder becomes slightly dilated, and a drop of urine exuding acts as a stimulus to the sensory nerves of the urethra, and thus calls reflexly into action the centre in the spinal cord by which at the same time the sphincter vesicae is inhibited, and the detrusor urinae stimulated. Reflex action may also be induced by stimulation of other nerves, as for example by the application of a wet sponge to the anus or perinaeum. The cerebral centre is usually called into action by the sensation of the bladder being full. It may be called into action voluntarily, although there is little urine in the bladder ; and also may be excited by emotion, such as fear. It maybe also excited reflexly through the sense of hearing. Boer- haave was accustomed when patients found difficulty in passing water, to make an attendant pour water from a height into a basin in the patient's 384 PHARMACOLOGY AXD THERAPEUTICS. hearing. The splashing thus occasioned induced the patient to pass water, and a similar effect, as is well known, is produced on horses by whistling. Nervous agitation has often the contrary effect of producing retention of water. When it is desirable for a person to pass water — e.g., when a specimen of urine is wanted for examination — it is advisable to put him in a room by himself and turn on a tap within his hearing. The removal of the restraint exercised by the presence of another per- son, along with the stimulant action of the sound of falling water, rarely fails to produce the desired effect. Even the recollection of the sound of falling water will tend to cause evacuation of the bladder, and when there is difficulty in passing water the patient may sometimes obtain relief by thinking of a waterfall. Washing the hands in cold water also tends reflexly to cause evacuation of urine, and the effect of a wet sponge to the perineum has already been mentioned. Vesical sedatives are substances which lessen the irritability of the bladder, and thus remove pain, and lessen the desire to urinate. This desire may be excited not only by the presence of urine in the bladder, but by the irritation of calculi or inflammation of the mucous membrane of the bladder itself. When calculi are a source of irritation, carbonate of lime taken internally seems to lessen the irritability. In cystitis the irritation is diminished by the use of very hot water exter- nally, in a bidet or hip-bath. The irritability of the nerves may be diminished by opium, belladonna, and hyoscyamus, and by drinking freely of warm water, either alone, or in the form of an infusion or decoc- tion of some mucilaginous substance, e.g., linseed-tea or barley-water. In chronic inflammation the irritation may be diminished by astrin- gents, such as buchu, uva ursi, pareira brava, and alchemilla. Vesical tonics are substances which increase the contractile power of the mus- cular fibres in the bladder. They are therefore useful in two different conditions, for by strengthening the detrusor urinre they prevent reten- tion, and by strengthening the sphincter vesicae they prevent incon- tinence. Some of these remedies appear to act by increasing the stimulating power of the urine, so that the sphincter vesicae is consequently more firmly contracted — of this class is cantharicles. Others appear to alter the direction of reflex action — such are the passing of a bougie through the urethra once or twice a day, or the application of an injection of nitrate of silver, ten to thirty grains to the ounce, to the neck of the bladder. Others act on the nerve-centres, and apparently are useful sometimes by lessening the reflex susceptibility from the bladder, so that the detrusor urime is less called into action ; at other times by increasing the susceptibility of the nerve-centre, so that the sphincter vesicae is more firmly contracted — of the latter class is strychnia; to the former belong bromide of potassium, given at night. Belladonna, which is one of the most useful remedies in incontinence of urine, acts upon the nerve-centres, but whether it acts in the same way as strych- nine or as bromide of potassium, it is difficult to say. It is quite pos- sible that it lessens the sensibility of the bladder to changes in pressure -within it in somewhat the same way as it lessens the sensibility of the heart to changes in blood-pressure (p. 203). ACTION" OF DRUGS ON EXCRETION. 385 Urinary Sedatrves and Astringents. When the urinary passages are healthy, the secretion of mucus from them is very slight, and the presence of urine in the bladder, or its passage along the urethra usually gives rise to no pain. Pain and scalding are sometimes caused by an abnormally acid urine, or by the presence of crystals of uric acid in it, even though the mucous mem- brane itself be healthy. In such cases the use of potash or lithia is indicated to restore the healthy character of the urine. When the bladder itself is irritable or inflamed, the secretion of mucus is increased and there is constant desire to micturate. There are here two indications to be fulfilled ; one is to lessen the irritability, and the other is to remove the inflammation. In lessening the irritability, belladonna seems to be especially useful, and to diminish the inflamma- tion astringents are employed. In inflammation of the urethra the same indications exist, and here also cubebs, copaiba, and sandal-wood oil are employed. It is, however, easier to apply astringents locally to the urethra than to the bladder, and consequently astringent injections are more frequently used : these are usually solutions of alum, sulphate or acetate of zinc, and acetate of lead. Finely-divided powders act also beneficially by keeping the inflamed walls of the urethra apart, and on this account a mixture of sulphate of zinc and acetate of lead, which gives a fine, white, insoluble precipitate of sulphate of lead, is more efficacious than either of the solutions employed alone. Kaolin or china clay, which is a completely inert powder, as well as bismuth and calomel, have also been used for a similar purpose. As it is found that the secretion in gonorrhoea frequently, if not always, contains microscopic organisms, the injection of antiseptics has been used; among these may be mentioned permanganate of potash, boracic acid, carbolic acid, sulpho-carbolates, sulphurous acid, as well as drugs having both an astringent and antiseptic action, like chloralum, perchloride and pernitrate of mercury, and chloride of zinc. The beneficial effects of copaiba in inflammation of the bladder and urethra are probably due to its antiseptic action. It is excreted in con- siderable quantities by the kidneys and renders the urine antiseptic, so that its decomposition and the appearance of bacteria in it are greatly retarded or completely prevented. The whole urinary passages from the glomeruli of the kidneys to the orifice of the urethra are thus washed out by antiseptic urine, which does not decompose, and which tends to destroy or remove any germs that may be present. Cubebs and terpenes have probably a similar action. 1 1 Schmiedeberg, Arzneimittellehre, p. 121. 25 386 PHARMACOLOGY AND THERAPEUTICS. CHAPTER XVI. ACTION OF DRUGS ON THE GENERATIVE SYSTEM. Aphrodisiacs and Anaphrodisiacs. The sexual function is regulated by two nerve-centres, one of which is cerebral and the other spinal. The cerebral centre is the seat of the feelings and appetite which prompt the individual to seek sexual congress. The spinal centre regulates the condition of erection in the sexual organs which is necessary for coitus. These two centres may act inde- pendently of each other, e.g., when the spinal cord is cut, but in the normal condition they naturally influence each other, excitement of the spinal centre reacting on the cerebral centre so as to awaken sexual feel- ings, and excitement of the cerebral centre reacting on the spinal so as to produce erection of the genital organs. Erection is due partly to dilatation of the arteries in the erectile tis- sues of the genital organs, and partly to compression of the efferent veins. The blood being thus allowed to flow freely into the organs, and pre- vented from flowing out, distends them so as to render them turgid and more or less rigid. During the orgasm the turgidity is increased by par- tial stoppage of respiration, which, by rendering the blood venous and thus stimulating the vaso-motor centre, tends to raise the blood-pressure in the body generally, and in the erectile tissues particularly. Dilatation of the arteries in the genital organs and consequent erec- tion occurs on stimulation, either of the genital centre in the lumbar spinal cord or of the vaso- dilating nerves (nervi erigentes) which pass from it to the genital organs and end in a ganglionic plexus surrounding the arteries. The lumbar genital centre may be excited either reflexly by stimu- lation of the sensory nerves of the genital organs and adjoining parts, or by psychical stimuli transmitted to it from the brain. The exact seat of the cerebral genital centre has not been determined, but Eckhard has found that irritation of the crura cerebri can produce similar effects to stimulation of the nervi erigentes. The cerebral genital centre may be stimulated and sexual feelings aroused by impressions made on the nerves of special or general sense, e.g., on the eye, ear, nose, on the mammae, and general surface of the body, the genital organs and parts adjoining, as the bladder, prostate, and nates. Thus, sexual excitement may occur in consequence of the sight of persons or pictures, the reading or hearing licentious stories, or of irritation of the surface of the body either by gentle friction or by prurigenous irritation due to irritating articles of clothing, parasites, or skin diseases. Distention of the bladder has a somewhat similar effect, and the irritation consequent on an enlarged prostate is probably, in part at least, the cause of the great sexual excitement which sometimes occurs in elderly men. A very acid condition of the urine, such as is found in some gouty patients, may possibly have a similar action. Chlorate and ACTION OF DRUGS ON GENERATIVE SYSTEM. 387 nitrate of potash administered internally are said by Jacobi 1 to render the urine so irritating and to produce such sexual excitement as to lead to onanism. Ascarides in the rectum may cause excitement of the cere- bral genital centre and give rise to nocturnal emissions as well as pos- sibly to diurnal excitement, and in females they may cause even greater Optic nerves Auditory nerves Olfactory nerves Nerves of mammae and general surface, Nervi erigentes passing to the genital arteries Sensory nerves of the genital organs... prostate and bladder perineum and rectum — Sensory nerves of nates, and rectum. Fig. 119. — Diagram to illustrate the action of aphrodisiacs and anaphrolisiacs. The darkly-shaded spot indicates the genital centre in the brain, and the lighter spot the spinal centre in the lumbar portion of the cord. The direction in which impulses are conveyed along tbe nerves are indicated by the arrows. The nerves from the general surface have been represented as going to the cerebral centre, and acting through it on the spinal centre. It is probable, however, that several of them pass directly to the spinal centre, as represented in the case of the nerves of the nates. irritation by passing into the vagina. Irritation of the rectum from the presence of piles or fissure may also give rise to such great sexual excite- ment as to induce onanism or nymphomania. Faeces in the rectum, and perhaps in the colon, may also cause sexual excitement in some persons or increase it when present. Such sources of local irritation may sometimes be insufficient to affect the cerebral centre during waking hours, when the attention is otherwise engaged, but may do so powerfully during sleep, or when the cerebral functions are disturbed by cannabis indica, and they may then produce erotic dreams or seminal emissions. The lumbar centre is most readily excited by mechanical stimulation of the genital organs, but it may be also powerfully stimulated from the mucous membranes of the urinary passages, as is seen in the painful priapism which occurs in poisoning by cantharides. Stimulation of the lumbar centre without stimulation of the cerebral centre may occur from the presence of faeces in the rectum and perhaps in the colon, so as to give rise to seminal emissions during sleep unac- companied by any dreams of a sexual character. Aphrodisiacs. These are medicines which increase the sexual appetite. Irritation of the nates either mechanically alone by flogging or 1 Medical Times and Gazette, 1876, vol. i., p. 177. 388 PHARMACOLOGY AND THERAPEUTICS. mechanically and chemically combined by urtication or flogging with nettles has been used as an aphrodisiac. 1 The sexual function requires, however, for its proper performance a healthy state of the body, and good, or at least fair, nutrition ; without these, mere reflex excitement of the genital centres is likely to prove inefficient for the propagation of the race. Tonics generally, such as iron, are therefore to be regarded as indirect aphrodisiacs. Strychnia has probably a double action, both increasing the general nutrition and rendering the genital nervous centres, both lumbar and cerebral, more susceptible to the action of stimuli. Its aphrodisiac action is sometimes an objection to its use as a tonic, for both it and nux vomica may cause seminal emissions which more than counter-balance its tonic action and weaken the patient. Cannabis indica has been regarded as an aphrodisiac, but the trials of it made in this country seem to show that it does not itself at least have any such action, and merely induces a condition of partial delirium in which Easterns may possibly have visions of a sexual nature, and, indeed, they try to give a sexual direction to the mental disturbance which the cannabis produces, by mixing with it musk, ambergris or cantharides. Cantharides act as an aphrodisiac, but their action is probably due to their irritating effect on the mucous membrane of the urethra, and its use in such doses as to have any aphrodisiac action is attended with danger. Blatta orientalis when used as a diuretic may have an aphro- disiac action like cantharides. 2 Alcohol appears to excite the cerebral centre and increase the sexual appetite, while it partially paralyzes either the lumbar centre or the nervi erigentes, through which the centre acts on the genital organs and thus interferes with the proper performance of the generative act. 3 Anaphrodisiacs. These are medicines which diminish the sexual passion. The agents employed as anaphrodisiacs are: — Ice. Conium. Cold baths, local and Camphor. general. Digitalis. Bromides of potassium and Purgatives. ammonium. Nauseants, and Iodide of potassium. Bleeding. Anaphrodisiacs may act locally on the genital organs, or may act upon the genital nerve-centres. The effect on the nervous system may be directly exerted on the nervous structures themselves, on the circulation, nutrition, and general 1 Trousseau et Pidoux, Traite de Thcrapeutique. 2 Buttenwieser, Der practische Arzt, Feb., 1882. :i Shakespeare, Macbeth, act ii., scene iii. ACTION OF DRUGS ON GENERATIVE SYSTEM. 389 surroundings. Amongst the most powerful local anaphrodisiacs is the continuous application of cold by means of ice. Bromide of potassium possibly has also a local as well as a general action. When the lumbar portion of the cord is abnormally stimulated reflexly, the stimulus ought to be removed: thus, in warm countries, where smegma may accumulate around and irritate the glans penis, very careful washing is requisite and circumcision is an advantage. Both in warm and cold countries, circumcision, either general or partial, is useful if the prepuce be very long and its orifice much contracted. When the irritation appears to arise from the presence of very acid urine, or of crystals of uric acid irritating the bladder or urethra, as in gouty persons, potash or lithia should be employed to lessen the acidity of the urine, or to render it neutral. Where abnormal irritation of the genitals is present the urine should be examined for sugar as well as for uric acid, as the sugar may cause local irritation of the prepuce or vulva. Distention of the bladder ought also to be avoided, and in persons who suffer from seminal emissions, occurring in the morning, it is occa- sionally advisable that they should be awakened and empty the bladder an hour or more before their usual time of rising. If stone in the bladder is acting as an irritant, surgical treatment should be employed, but in cases where this is inadvisable, or where the irritation is dependent on enlarged prostate, general anaphrodisiacs must be used, such as bromide of potassium in large doses, care also being taken that the condition of the urine is not abnormally acid or alkaline. Ascarides in the rectum must be treated with anthelmintics. When irritation arises from piles the use of sulphur internally is often bene- ficial, though surgical interference may be necessary both for them and for fissure. When irritation arises from faecal accumulations in the rectum or colon, they should be removed and their return prevented by the careful use of aperients. As anything which tends to increase the flow of blood to the genital orgajis or the lumbar portion of the spinal cord heightens their excita- bility, care should be taken not only to avoid this, but also to direct as much as possible the current of blood to other parts of the body. Thus, warm and heavy clothing or pads about the hips or loins should be avoided, and a hard mattress should be used in the place of a feather bed. Sometimes patients suffer from emissions in consequence of lying on their back. This is probably due to the effect of warmth on the spinal cord, and in order to avoid it, a towel or girdle should be put around the loins with a knot tied in it, or some hard substance fastened on it opposite the spine, so that the person would, even during sleep, be prevented from lying on his back. Walking exercise is not so useful as exercise of the arms, as in rowing, gymnastics, or mechanical occupations, such as those of a carpenter or blacksmith, because, in walking, the current of blood passes towards the lower extremities and part of it may become directed to the pelvis. In the other occupations just mentioned, the current of blood is, on the contrary, directed to the upper extremities. Working a treadle, as in turning a lathe or sewing machine, is objectionable, both because the blood is directed towards the lower extremities generally and 390 PHARMACOLOGY AND THERAPEUTICS. because it may become specially directed to the genitals by occasional friction of the clothes. Hard mental work has also a similar effect to that of bodily exer- cise. In addition to these measures, a meagre diet, and especially a vegetable diet, with the avoidance of stimulants, is of considerable service. Emmenagogues and Ecbolics. Emmenagogues are remedies which restore and regulate the normal menstrual flow when it is absent or deficient or irregular. Ecbolics are remedies which cause the expulsion of the contents of the uterus. In menstruation both ovaries and uterus become congested. An ovum is discharged, and a flow of blood occurs from the uterus. Dimi- nution or absence of the menstrual flow may be occasioned either by general or local conditions : thus great debility or anaemia may cause it, and it is very frequent indeed in the anaemia and debility which are con- sequent on the occurrence of slight consolidation in the lungs. A local cause may be deficient determination of blood to the ovaries and uterus, although no general anaemia exists. The remedies employed for these two conditions are termed indirect emmenagogues. To correct anaemia, iron, manganese, and cod-liver oil may be employed. In order to determine more blood to the uterus, warm foot-baths, warm hip-baths, mustard hip-baths, mustard stupes or poultices to the thighs and lower part of the abdomen, and leeches to the inside of the thighs or to the genitals, and aloetic purgatives, may be employed. It might at first seem from theoretical considerations that foot-baths could hardly have any action on the uterus, but warm foot-baths cause great dilatation of the arteries in the legs, and it is probable that this dilatation extends up the iliacs, so that more blood may be sent to the genitals as well. But in addition to this, it is not at all improbable that a close nervous connection exists between the vascular supply of the uterus and of the feet, for not only does the warm foot-bath tend greatly to restore, but cold and wet feet are amongst the most powerful agents in checking menstruation. Other substances, which seem to have a direct stimulating action on the womb itself, are called direct emmenagogues. It is not easy to see at present how they act ; we know, however, that when given in large doses they cause contraction of the womb, and then act as ecbolics. The chief emmenagogues are : — Indirect Emmenagogues. Direct Emmenagogues. ( Hot foot. Ergot. Baths < Hot hip. Digitalis. ( Mustard. Savine. TV,/ ^° genitals. Quinine. iieecnes ^ Tq thighg Assafoetida. f l>aths. Myrrh. Mustard^ Poultices. Guaiacum. ( Stupes. Cantharides. ACTION OF DRUGS ON GENERATIVE SYSTEM. 391 Indirect Emmenagogues. IMrect Emmenagogues. {Continued.) {Continued. Purgatives, as aloes. Iron. Manganese. Cod-liver oil. Strychnine. Echolics. Borax. Rue. The involuntary muscular fibres of the uterus appear, like those of the ureter or of the frog's heart, to possess the power of rhythmical contraction, and may contract when entirely separated from the general nervous system. They are, however, controlled by the higher nerve- centres. There appears to be one centre, situated in the lumbar por- tion of the spinal cord, which is of itself sufficient to regulate all the movements, for they go on normally, even when the spinal cord has been completely divided above it. This centre may be reflexly stimulated and contractions of the uterus induced by irritation of the ovarian, crural or sciatic nerves. It may be also stimulated by the action upon it of drugs circulating in the blood, as ergotine, picrotoxine, or strych- nine, or by great venosity of the blood, due to asphyxia. There appears, however, also to be a second centre for the uterus, as for the male genital organs, in the "brain (vide p. 387), by which the lumbar centre may be excited, and in consequence of this, stimulation of the cerebellum, crura cerebri, corpora striata, and optic thalami, also give rise to uterine contractions. Y. Basch and Hofmann consider that the impulses pass to the uterus from the central nervous system, along two sets of nerves. One is com- posed of nerves passing from the inferior mesenteric ganglion to the hypogastric plexus. Stimulation of these causes circular contraction of the uterus, descent of the cervix and dilatation of the os. The other consists of branches passing from the sacral nerves across the pelvis to the hypogastric plexus, and representing the nervi erigentes. On stim- ulation of these the uterus contracts longitudinally ; the cervix ascends and the os closes. The mode of action of ecbolics has not been satisfactorily ascer- tained. Ammonia injected into the circulation appears to cause con- traction of the muscular fibres, for it causes contraction of the uterus even when all nervous connections have been divided. Ergot possibly acts in the same way, but it is possible also that it acts on the spinal centre. The chief ecbolics are : — Ergot. Savine. Quinine. Uses. — Ecbolics are used to accelerate the expulsion of the child when the passages are free but expulsive power is deficient, and to cause firm contraction of the uterus and so prevent haemorrhage after delivery. 392 PHAKMACOLOGY AND THERAPEUTICS. Adjuncts. — Compression of the uterus by kneading, pressure over it by a pad, the hand dipped in cold water laid over the uterus, or a cold pad. Sternutatories have been used to supplement the expulsive power of the uterus, and, when necessary, operative interference must be had recourse to. Action of Drugs upon Milk. The milk glands somewhat resemble the salivary glands in the way in which they are affected by the central nervous system, and by the action of drugs upon them. The action of the central nervous system on the milk glands, however, has not been made out with anything like the same clearness as in the case of the salivary glands, experiments on animals having given not very definite results. It is chiefly inferred from the effect of mental emotions in checking or altering the secretion of the milk ; and from the effect of belladonna locally applied in check- ing the secretion. The amount of secretion appears to depend on the amount of blood-pressure in the gland, and gentle stimulation of the nipple increases both the flow of blood to the gland and the secretion of milk. It is uncertain whether there are definite secreting nerves affecting the gland cells apart from the vaso-motor nerves. The character of the milk depends to a great extent upon the feed- ing and exercise of the mother, and diet is the most important agent in regulating both the quality and the quantity of the milk. As Dolan points out, it not unfrequently happens that a wet nurse, when first she arrives, yields such milk that the child she is nursing thrives well, but the quality soon falls off. In place of much out- door exercise and plain, nutritious diet, she is fed luxuriously and gets little exercise. In order to restore the quality of the milk in such a case, the woman must be restored as far as possible to her previous conditions of diet and exercise. Many substances are excreted in the milk, such as ammonia and the aromatic oils to which vegetable substances belonging to umbellifera and crucifera owe their flavor, probably also all volatile oils are thus excre- ted. Amongst those which have actually been found to pass into the milk are the oils of anise, cummin, dill, wormwood and garlic, as well as turpentine and copaiba. The purgative principles of rhubarb, senna, scammony and castor-oil, pass into the milk. Opium, iodine and indigo do so also, and metals, such as antimony, arsenic, bismuth, iron, lead, mercury and zinc. Volatile oils, having an agreeable taste, do not appear to affect the secretion of milk directly, but appear to render it pleasant to children, so that they take the breast eagerly. When lactation is defective they may increase the reflex stimulus to the nipple by making the child suck more vigorously, and thus increase the quantity of milk. For this reason such volatile oils as anise and dill may be useful as galactagogues. Garlic, on the contrary, renders the milk disagreeable to children, so that they will not take it. Copaiba also renders the milk disagreeable. The nearest approach to a true galactagogue is jab- orandi, but it affects the gland only temporarily. Beer and porter stim- ulate the secretion for a short time, but they produce no proportionate benefit in the child, and nursing mothers are, as a rule, much better without alcohol, and should rather take milk instead. When the milk METHODS OF ADMINISTERING DRUGS. 393 of the mother is deficient in saline constituents they may be supplied by giving the appropriate salts to the mother. Various physiological actions may be produced in the child by admin- istering drugs to the mother. The administration of acids to nursing mothers is generally to be avoided, as they are apt to cause griping in the child. Neutral salts as a rule pass into the milk and cause looseness of the bowels in the child. Senna, castor-oil, rhubarb, scammony, sul- phur, and probably jalap, act as purgatives to the child. Salts of potash administered to the mother will act as diuretics to the child. Turpentine administered to the mother also can be detected in the urine of the child ; and this is also the case with copaiba and iodide of potassium. Opium administered to the mother may act as a narcotic to the child, and mer- cury, arsenic and iodide of potassium, may all be given to nursing chil- dren by administration to the mother. CHAPTER XVII. METHODS OF ADMINISTERING DRUGS. Drugs may be used either for their local or general action, and sometimes for a combination of the two. Thus a solution of opium may be applied to the eye for its local effect in relieving irritation of the con- junctiva. It may be given by the mouth or injected under the skin to relieve pain and induce sleep, though the seat of the pain may be far removed, both from the point of injection and from the alimentary canal; or the opium may be applied in the form of a pessary in uterine disease to relieve pain, both by its local action on the part, and its general action on the system after absorption. In order to produce their general action drugs may be introduced into the system through the skin, subcutaneous cellular tissue, lungs, mucous membranes, especially that of the alimentary canal, serous mem- branes and veins. The same drug applied in the same quantity through different channels may have different effects; for not only may slower absorption give rise to difference in the amount present at any time in the blood, as already explained (p. 55), but a reflex effect upon the organism may be produced by the local action of the drug at the place of introduction. Application of Drug's by the Skin. There are three different methods of applying drugs to the skin which are well recognized, these are : — 1. Epidermic, to the skin covered by epidermis. 2. Endermic, to the skin denuded of epidermis. 3. Hypodermic, to the subcutaneous cellular tissue. 394 PHARMACOLOGY AND THERAPEUTICS. Epidermic Application. — Remedies are applied to the unbroken skin chiefly for their local action on the part to which they are applied, or their reflex action through the nervous system on more distant parts. The epidermic applications are comparatively rarely used as a means of introducing drugs into the system, for the epidermis opposes such an obstacle to absorption, that it takes place slowly and with great difficulty. In some of the lower animals, such as frogs, respiration takes place to such an extent through the skin that the animal will live for a long time after respiratory movements have ceased. Respiration also takes place through the skin in man, but to a very slight extent, the absorption of oxygen and the excretion of carbonic acid being only about 2iro~th part of that in the lungs. The skin is able to absorb other gases as well as oxygen, such as sul- phuretted hydrogen, carbonic acid, carbonic oxide, and the vapors of hydrocyanic acid, ether and chloroform. From the relief which persons who have been shipwrecked and have suffered from extreme thirst have received by bathing in sea-water, or putting on shirts wet with sea-water, it seems probable that the skin is able to absorb water, but this fact also shows that solids dissolved in the water are not absorbed by the skin. A good deal of discussion has taken place regarding the absorption by the skin of substances applied to it in a state of solution. Experiments on this point have usually been made with iodide of potassium, on account of the ease with which this salt can be detected in the urine. The results have generally been negative, but sometimes they have been positive. The general result is that the salt is never absorbed by the skin from the solution, and that in the cases where absorption has taken place, it has been due to the skin not having been washed after the bath, so that the iodide has crystallized on the surface, and has afterwards by friction of the clothes been rubbed into the sebaceous glands. It would appear that the fat in the skin as well as the epidermis presents an obstacle to the absorption of substances in solution, but when they are applied in such a form that they can readily mix with the sebaceous matter of the skin, they are tolerably readily absorbed, as for example when they are used in the form of ointment and well rubbed into the skin, so as to penetrate into the sebaceous follicles and also the sweat glands. They are also absorbed when dissolved in ether, and especially in chloroform, even when simply painted over the surface. Alcoholic solutions are not absorbed when painted on in this way, although they may be absorbed if rubbed well in. It has been sup- posed that the absorption of chloroform solutions is due to the chloroform mixing with the sebaceous matter. But if true at all, this is certainly not the complete explanation of the fact, for, as has just been mentioned, alcoholic solutions are not absorbed, although alcohol as well as chloro- form will dissolve sebaceous matter. Waller has also shown that chloro- form passes rapidly through the dead skin, carrying with it alkaloids dissolved in it. Its action is therefore to a great extent due to its pecu- liar endosmotic power. The vascularity of the skin greatly alters its absorptive power. In the frog, absorption usually occurs rapidly through the skin, so that if the hind legs be immersed for a few minutes in a solution of cyanide of METHODS OF ADMINISTERING DRUGS. 395 potassium, the salt is rapidly absorbed and can be detected in the mouth of the animal in a few minutes. But if the circulation be depressed by the previous administration of ether, curare, or any cardiac depressant, this absorption into the system does not take place ; for although the cyanide of potassium passes through the skin, yet, the subcutaneous cir- culation being feeble, it is not conveyed away from the point of local application into the system generally. The absorption of drugs may therefore be diminished by depression of the circulation either locally at the point of application or in the sys- tem generally. It may be rendered more rapid by increased circulation at the point of application. A general increase in the circulation usually accelerates the circulation in the different parts of the body, but does not necessarily do so, for the vessels of a part may remain contracted while the general circulation is more rapid than usual. A local increase in the circulation occurs from inflammation of a part, or from temporary irritation such as that produced by rubbing, or by the application of irritant substances. The use of friction, therefore, increases absorption not only by pressing the substances employed into the sweat glands and hair follicles but also by increasing the circulation, and this effect will take place to a still greater extent if the substances used have a tendency to cause dilatation of the vessels. The most common methods of applying drugs epidermically are baths, poultices, inunction, and friction. Baths. These may be either local or general. In general baths the whole of the body excepting the head is exposed to the action of various agents. According to the nature of the agent, baths may be divided as follows : — ' (1) Ordinary full bath. (2) Affusions. (3) Spray. r's . (4) Sitz-bath o (5) Foot-bath. (6) Cold pack. (7) Compresses. A. Simple. - ^ ^ (8) Douches. ' (1) Tepid bath. (2) Warm bath. . w H (3) Hot bath. I. Watee. - (4) Hot foot-bath. _ (5) Hot sitz-bath. (1) Sea-bathing. s (2) Common saline bath. Artificial sea- water made by dissolving bay-salt in water (1 lb. of salt in 30 gal. of B. Medicated. - water). (3) Acid bath. (4) Akalinebath. (5) Sulphurous bath. (6) Mustard bath. . (7) Pine bath (Fichtennadelbad). . 396 PHARMACOLOGY AXD THERAPEUTICS. f A. Aqueous. (1) g . x f Russian. v y ^ ( Simple vapor. II. Vapoe. -{ (2) Medicated. Vinegar. _B. Volatilized drugs, e.g., Calomel. III. Air. Turkish bath. Cold Bath. — The effect of a bath depends very much upon its temperature. In a cold bath, the temperature of the water is at or below 70° F. The first effect of immersion in a cold bath is contraction of the ves- sels of the skin, accompanied by a feeling of chilliness and perhaps even of shivering. When the water reaches the level of the chest, the respira- tory centre becomes reflexly affected, and the respiration becomes gasping. After a few minutes the cutaneous vessels begin to relax, and the blood returning to the surface warms it. If the person now comes out of the bath, dries quickly and rubs vigorously, the brisk circulation in the skin gives rise to a pleasant feeling of warmth. The feeling of warmth, or at least of lessened coldness, will occur even if the bath be continued, but the increased circulation in the skin allows the blood to be much more rapidly cooled, and thus the tempera- ture of the body is much more quickly reduced. When the blood which has been thus cooled in the skin returns to the nerve-centres, it appears to stimulate the vaso-motor centre and produce a second contraction of the cutaneous vessels, accompanied by a greater and more persistent chilliness than before. The object of cold baths is usually: — 1st, either to have a tonic and bracing influence on the body; or 2dly, to abstract heat from the body in cases of fever. As a tonic the cold bath is often very efficacious, and not only gives a feeling of strength and comfort, but tends to prevent those who take it from catching cold so readily as they might otherwise do. The vessels of the skin are, as has already been mentioned, the regulators of tempera- ture, and contract when they are exposed to cold : thus protecting the internal organs from its chilling influence. But Rosenthal has found that when animals are kept for a long time in a warm chamber, their vessels lose to a great extent their contractile power, and thus the animal becomes much more readily chilled when exposed to cold. Cold baths, by training as it were the cutaneous vessels to contract, tend to • protect the organism from the injurious effects of accidental exposure. Besides this, however, the stimulation to the circulation which comes as an after- effect, tends to increase both the tissue change in the body, and the excretion of waste substances from it. In consequence of this cold bath- ing is usually followed by an increased appetite, so that the most favor- able conditions for the nutrition of the body are supplied by cold baths, viz., increased supply of food, increased tissue change, increased excre- tion of waste. Cold baths may therefore be looked upon as a most powerful tonic. But while cold baths are of great use to those with whom they agree, they may be productive of great harm when they are indiscreetly METHODS OF ADMINISTERING DRUGS. 397 used. As a general rule it may be said that when they cause much dis- comfort during the bath, and especially if they cause chilliness afterwards, they do harm rather than good. This is more especially the case with children and with persons of feeble circulation. Rosenthal's experiments, already quoted, show us that there is a scientific basis for the popular notion of "hardening"" by exposure. But this process may be carried much too far, and instead of getting excitement of the circulation with all its attendant advantages, the effect of the bath may be to lower the temperature, depress the circulation, and greatly injure the nutrition. The risk of such injury may be much diminished by proper attention to the mode of giving the bath. In children or delicate persons it is better as a rule to avoid immersing the whole body, and especially to avoid putting the feet in cold water at the same time as the body. The best way is to let the person sit down in a sitz-bath with the feet out and quickly to dash the water over the face, chest, back, and arms. Then a large bath sheet is to be thrown around the body so as completely to envelop it, and to prevent its being chilled during the process of drying. For during the exposure of the body while the surface is still wet, the chilling process is going on by evapora- tion during summer, and by conduction by the cold air in winter. This may be seen markedly in persons of a feeble circulation who rise from the bath with a feeling of slight glow, but lose it completely and begin to feel chilly, if the process of drying is delayed. Instead of a bath sheet, a dressing-gown made of towelling may be used. For very deli- cate persons the water of the bath should be rendered tepid by the addi- tion of a little hot water, and the face may not be sponged until after the rest of the body has been dried and the clothes put on. Sometimes the vigorous use of a flesh-brush over the chest tends to assist the reaction, and if practicable a short though brisk walk is advisable just after the bath. It must not, however, be long, as other- wise exhaustion might set in, and the appetite instead of being increased would be diminished. Besides the tonic action which cold baths exert on the circulation and on the body generally, they appear to have a beneficial action in cer- tain disturbances of the respiration. The respiratory centre (p. -11), may be strongly affected reflexly by cold applied to the surface of the chest, as is shown by the gasping breathing, or inspiratory tetanus, observed when the cold water reaches the chest on walking slowly into it. Cold sponging as recommended by Binger in his excellent work on Therapeutics is exceedingly useful in laryngismus stridulus. It should be used two or three times a day whatever be the weather. If the child be hoarse, it should not be allowed to go out, but if there is no hoarseness, the fresh air, even if cold, will be advantageous. To arrest a paroxysm cold water should be dashed over the child. Binger also recommends it for a catch in the breath occurring in young children during the night, awaking them from sleep. By abstracting heat, cold baths are useful in fever in several ways. By reducing the temperature they tend to lessen the amount of tissue change which is already excessive, and they thus tend to husband 398 PHARMACOLOGY AND THERAPEUTICS. the patient's strength, as well as to reduce the alterations of the tissues, such as fatty degeneration of the heart, which occur in consequence of a high temperature. By lessening the temperature also, they diminish the rapidity of the pulse, and by thus prolonging the cardiac diastole give more opportunity for the nutrition of the muscular wall of the heart. A high temperature, if it is remittent is better supported than a lower temperature which is continuous, and therefore Liebermeister, to whom we in a great measure owe the recent introduction of cold baths as a therapeutic measure, uses them with the object of increasing and prolong- ing the remissions in temperature which usually occur spontaneously in febrile diseases. There are several ways of employing cold baths to reduce temperature. One is that of cold affusion, in which the patient is put into a tub and four or five gallons of cold water thrown over him. Another is to place the patient in a bath at about 90° F. and gradually reduce the temperature, by the addition of cold water, to 80°, 70°, or even 60° F. The patient is kept in this from ten to twenty minutes, according to his strength and the height of the temperature. As the temperature continues to fall for some time after the removal of the patient from the water, the bath should not be continued so long as to lower it to the full extent required while he is in the bath, lest collapse occur afterwards. Instead of the bath being gradually cooled down, it may be used at once at a temperature between 60° and 90° according to the condition of the patient, and if the temperature be very high, the water must be cooled still more by means of ice, and its action aided by ice given by the mouth and rubbed or laid upon the surface of the body. This treat- ment may be adopted even although pneumonia be present, if the patient's life is threatened by an excessive rise in temperature. When the tem- perature rises again the bath should be repeated. Cold Pack. — The pack is a less efficient means of abstracting heat from the body, but it is useful in causing a different distribution of blood in the body. It is therefore sometimes very useful in lessening delirium and producing quietness and sleep. In employing it a wet sheet is wrung well out of cold water and wrapped tightly around the patient ; over this are wrapped one to three blankets. A little heat is abstracted at first by the cold of the sheet, but this is very little, and indeed it is asserted by some that cold packs instead of abstracting heat, prevent its escape. The skin soon becomes warm and frequently profuse perspiration is produced. A certain amount of heat is lost, though perhaps not very great, by the evaporation through the blankets. It is probable however that the pro- duction of heat is to a certain extent lessened, at least in restless patients, by their movements being mechanically restrained by the sheet, and also by the blood being withdrawn from the internal organs and muscles to the skin. As the pack restrains the movements in a most complete way and with a force against which it is in vain to struggle, while at the same time it is comfortable and soothing, it frequently induces sleep when narcotics have been useless. Cold sponging is sometimes a very useful means of abstracting heat in cases of fever, where the patient is weak and the temperature, thougli perhaps not going above 104° or 105° F., tends rapidly to regain METHODS OF ADMINISTERING DRUGS. 399 its former height after cooling, and where it seems inadvisable to subject the patient to the frequent movement in and out of bed required in cold baths. The loss of heat consequent on cold sponging is due partly to the application of the cold water, but it is due chiefly to the evaporation which takes place from the surface of the body. Consequently sponging with tepid or even with hot water will also reduce temperature. Cold Douches. 1 — In this form of bath a stream of water having considerable force is directed against a part of the body. The stream may either be unbroken, and to this the name douche is usually restricted, or it may be broken up by delivery through a rose into a number of minute streams so as to form a shower or rain bath. If the douche is large (one to two inches in diameter) it causes a great amount of shock and sometimes does much harm. Usually a stream of a quarter of an inch in diameter is quite sufficient for all purposes. Douches are chiefly applied to the spine, spleen, liver, joints, anus, and vagina. The spinal douche usually consists of a single stream, and may either be allowed to fall vertically upon the spine, the body being more or less inclined, or it may be delivered from a horizontal pipe with the body in an upright position. It is useful as a stimulant in melancholia, cerebral anaemia, and general debility. To avoid too great depression it is better to apply hot and cold water alternately, unless it is used immediately after a hot application such as a spinal pack. Douches to the liver and spleen have been found useful in chronic congestion and enlargement of these organs. The douche applied to stiffened joints appears sometimes to be of considerable service. The ascending douche is usually delivered through a rose, so as to form a shower, and it is directed against the perinreum while the patient is in a sitting position. It is useful in haemorrhoids and pruritus ani, and when used at a regular hour daily, first tepid and then cold, it is useful in constipation. The vaginal douche is used by the patient lying on her back with her knees drawn up and with the pipe in the vagina. It is useful in vaginal leucorrhoea and cervical catarrh, and in chronic subinvolution and hyper- plasia the hot douche at 105° F. to 110° F. twice a day for several minutes is of much service. 2 Local Application of Cold. Sitz-Bath. — When a person sits down in a cold sitz-bath, or when he sits down in an empty bath and cold water is poured into it, until it covers the hips, the vessels of the parts exposed to the cold contract, and the blood is consequently driven into other parts of the body. It would appear however that not only do the vessels of the skin contract, but that also contraction of the intestinal vessels occurs reflexly through the splanchnic nerves : so that in consequence there is a feeling of warmth 1 For a short and concise account of the various appliances used in hydro-thera- peutics, vide Paper on "Rational Hydro-therapeutics" by G. L. Pardington, M.D., Practitioner, Jan., 1884. 2 Pardington, op. cit. 400 PHARMACOLOGY AXD THERAPEUTICS. and fulness in the head, an increase in the volume of the arm as measured by the plethysmograph, and a rise of temperature in the axilla. A cold sitz-bath, when applied only from one to five minutes and followed by a brisk rubbing afterwards, tends to increase the amount of blood in the abdominal organs, to quicken the circulation in the liver and spleen, and to augment the activity of the movements of the intestine and bladder. It may therefore be used with advantage in constipation and in disorders of the bladder depending upon weakness, such as either difficulty in expelling the urine or difficulty in retaining it. In pregnancy, cold sitz-baths are sometimes useful, giving a feeling of comfort and strength, and lessening the sensations of dragging in the abdomen. Where any tendency to premature expulsion of the foetus exists they should be avoided, as the increased circulation which they cause in the pelvic organs might lead to abortion. When cold sitz-baths are continued for a long time, as from ten to thirty minutes, at a temperature from 8° to 15° C, the contraction of the abdominal vessels appears to be more permanent, and thus they may be employed for the purpose of lessening congestion in the intestine ; and may be used with advantage in cases of obstinate diarrhoea and congestive enlargement of the liver and spleen. The effect of a prolonged sitz-bath in lessening congestion of the abdominal organs is greatly increased if it be preceded by a wash-down with brisk friction, so that the blood may be attracted to the other parts of the surface as well as driven out of the abdomen by contraction of the intestinal vessels. Cold Foot-Batli. — Coldness of the feet not only causes discomfort to the person, but if it occurs at night, it may prevent sleep. Putting them in hot water may warm them temporarily, but will not do so per- manently, and a much better way is to put them in cold water, rub them briskly while in it, and then dry them thoroughly with a soft towel, giving them a rub afterwards with a rough bath-towel. Cold foot-baths are to be avoided during the menstrual period, as they have a very great power indeed to check menstruation and frequently bring on amenorrhcea. Their power to check the menstrual flow is popu- larly known, and sometimes great harm is occasioned by young women using them to check menstruation in order that they may be able to attend some party of pleasure. FlG. 120.— Tracings from the radial artery at the wrist: A before and B after the application of a cloth dipped in cold water round the arm. After Winternitz. Cold Compresses. — By the application of cold over the course of an artery, it can be made to contract, and the amount of blood to the district which it supplies may consequently be diminished. This is shown by the accompanying curve taken by Winternitz from the radial artery. METHODS OF ADMINISTERING DRUGS. 401 The first half of the curve (A) was taken before anything had been applied to the arm, the instrument being allowed to remain. Ice was next applied to the arm, and the second half of the curve (B) shows the contraction which it had produced in the artery. When the cold application is allowed to remain for a while, it gradu- ally acquires the temperature of the body, and if evaporation be prevented, it comes to have the same effect as warmth, but if constantly renewed, the contraction of the artery may be kept up. A similar contraction to that just noticed in the vessels of the arm may be produced in the vessels of the head by cold applications around the neck. This is shown by the fall of temperature in the auditory meatus. Cold may be applied to the neck either by a bag containing ice, or by an India-rubber bag, or coils of tubing, through which cold water may be kept constantly flowing. It may be applied to the neck in cases of tonsillitis. Cold to the head is frequently applied in delirium, meningitis, and severe cephalalgia. It may be applied either by a bag containing cold water or ice, or still more conveniently by a cap consisting of India-rubber tubing through which water constantly flows. Warm Baths. Tepid Baths.— These baths range from 85° F. to 65° F., or 29° -4 C. to 18° • 3 C. They are chiefly used for cleansing purposes, and at the lower margin of about 65° F. they may be used for a somewhat tonic action in persons of feeble circulation. Warm Baths.— These range from 97° F. to 85° F., or 36°-l C. to 29° -4 C. When the water is above these temperatures it forms a hot bath. The warm water softens the epidermis, and is thus of much use in chronic skin diseases. It dilates the vessels of the surface of the body, and thus tends to lessen any internal congestion. At the same time it tends to induce perspiration. On this account the warm bath is useful in lessening pain depending on congestion of internal organs, and in preventing congestion from going on to inflammation. It is therefore very serviceable when there is a threatening of bronchitis, or gastro-intestinal catarrh, colic, etc. It tends to reduce the tempe- rature both by dilating the peripheral vessels and inducing perspira- tion, and is therefore useful in febrile conditions. By withdrawing blood from the brain it tends to induce sleep. Hot Baths.— These range from 97° F., or 36°-l C, upwards. A much higher temperature than can be endured at first can be borne if the temperature be gradually raised by the gradual addition of hot water to the bath while the body is immersed, and the bath may thus be raised as high as 110° F. Hot baths not only prevent loss of heat from the surface, but if above the temperature of the blood, actually impart heat to the body. The consequence of this is that the temperature of the body rises very rapidly, and therefore the respiration and pulse both become very quick. The peripheral vessels become still more dilated than in the warm bath, and the blood pours so rapidly through them that, in spite of the quick and powerful action of the heart, there may be a tendency to syncope when the head is raised. After remaining 26 402 PHARMACOLOGY AXD THERAPEUTICS. in such a bath from ten to twenty minutes, the patient must be carefully lifted out so as to avoid any risk of syncope, and should be wrapped in warm, dry blankets. The hot bath is a still more powerful agent than the warm bath in producing sweating, and is employed in cases of dropsy. Hot Foot-Batli. — A hot foot-bath has a general effect that can hardly be explained by the simple dilatation of the vessels in the feet, and consequent derivation of blood to them. It seems, indeed, to exert some reflex action on other parts of the body and causes a general feeling of warmth. It is very useful as an adjunct to vascular stimulants in relieving congestion and preventing inflammation, as in threatened catarrh, bron- chitis, etc. When the feet are put into a hot bath, we find that the femoral arteries become much dilated and pulsate much more vigorously than they did before. It is not improbable that this dilatation extends beyond the femoral to the iliac arteries, and that the supply of blood is increased in the pelvic organs as well as in the feet. In cases of amenorrhoea, espe- cially where it has been brought on by exposure to cold, hot foot-baths tend to restore the menstrual flow. They should be begun four or five nights before the period is expected, and continued during the time it ought to last. Their efficacy may be increased by the addition of a little mustard. Hot Sitz-Batlis. — These have a still greater tendency than hot foot-baths to increase the circulation in the pelvic organs, and they may be used either alone or with mustard in the manner just described in cases of amenorrhoea. Poultices. — Poultices are simply a means of applying heat and moisture to a limited portion of the surface of the body, and they con- sist essentially of some farinaceous substance made into a paste with hot water. The most common substances used are linseed meal, crushed linseed, bread, bran, oatmeal and starch. The most common basis of a poultice is either linseed meal or crushed linseed. The difference between the two is that the crushed linseed still retains the oil naturally present in the seed, whereas it has been expressed from the linseed meal. Crushed linseed, if fresh, forms an excellent basis for a poultice, but if kept long is apt to become rancid. In order to avoid this disadvantage, the British Pha ■macopoeia directs that linseed meal should be used, and that olive oil sh juld be added to the poultice. Oil is only wanted when the poultice is to be applied directly to a wound or sore. It is unneces- sary when the poultice is to be used for the relief of internal pain. In all cases, not only should the water with which the poultice is made be perfectly boiling, but the bowl in which it is to be mixed, the spoon with which it is to be stirred, and the tow or flannel in which it is to be laid, should all be as hot as possible. By adding the linseed meal to the water and constantly stirring, there is less chance of the poultice being knotty than if the water were added to the meal. If the poultice is intended to be applied to a wound, sore, boil, or carbuncle, it should be spread upon a piece of flannel or tow and applied directly to the skin, because the softening action of the water and oil it contains on the dermal tissues is required as well as the warmth. But where the poul- tice is used to relieve pain or congestion of the internal organs it ought not to be applied directly to the skin, but should be separated from it by something which conducts heat badly, such as flannel. The reason METHODS OF ADMINISTERING DRUGS. 403 for this is that it is impossible to apply a very hot poultice directly to the skin on account of the pain it causes, whereas if a substance which conducts heat badly be interposed, the poultice can be applied boiling hot, the heat gradually passes through without becoming inconveniently great, and is retained for a much longer time. Medicated Baths. The addition of stimulating substances, such as salt, to the water increases the stimulation to the skin, and the amount of after-reaction. In sea-bathing the stimulating effect of the salt is further increased by the mechanical shock of the waves, and sometimes also by the friction of the fine sand of the beach. Sea-bathing also differs from baths in the fact that muscular exertion is combined with it either in simply moving about and retaining one's footing, or still more in swimming. Acid Batli. — This bath is made by mixing eight ounces of nitro- hydrochloric acid with a gallon of water at blood heat (98° F.). This is sometimes used as a foot-bath, but it is better applied as a compress. A flannel roller about a foot wide, and long enough to go twice round the body, should be soaked in the acidulated water, wrung thoroughly out, and rolled round the region of the liver ; a piece of oil-silk, large enough to cover it completely and leave a little margin over, should then be put over it. It may be worn for several days, being renewed every night, and it is chiefly useful in chronic disease of the liver. 1 Alkaline Bath. — This is made by adding crystallized carbonate of soda to water in the proportion of about one drachm to each gallon. It is chiefly used in chronic skin diseases. Sulphurous Bath. — This may be made by dissolving sulphurated potash in water, about half a drachm to the gallon, or an imitation of Barege waters may be made by mixing sodium sulphide, sodium carbon- ate, and sodium chloride in the proportion of twenty grains of each to the gallon. These are chiefly useful in chronic scaly skin diseases, and in rheumatism. Much more benefit is usually obtained by a visit to sul- phur springs, such as those of Aix-les-Bains, Aix-la-Chapelle, Barege, Harrogate, or Strathpeffer, than from the use of sulphur baths at home. Mustard Bath. — This is made by adding mustard to water in the proportion of about half a drachm to a drachm and a quarter per gallon. It is a powerful stimulant, but must not be applied too long. It must be remembered that, while slight stimuli to the skin increase the fre- quency and energy of the cardiac contractions and the rapidity of the circulation, and raise the temperature, severe irritation of the skin les- sens the frequency of the pulse and the rapidity of the circulation, dilates the vessels and lowers the temperature. 2 The patient should never be allowed to remain more than ten minutes in the bath, and should be at once removed as soon as he feels either burning of the skin or icy coldness. 1 Squire's Companion to the British Pharmacopoeia, 13th Ed. 2 Naumann, Prager, Med. Jahrsch., 1863, i., p. 1, and 1867, i., p. 133 ; Heidenhain, Pfliiger's Archiv, Bd. iii., p. 504, and Bd. v., p. 77 ; Riegel, Pfliiger's Archiv, Bd. iv., p. 350. 404 PHARMACOLOGY AND THERAPEUTICS. Mustard baths are generally used in order to quicken the appearance of the eruption in exanthemata. Pine Bath. — This is made by adding a decoction of the shoots of pines to water, but it is more convenient to use the oleum pini sylvestris in the proportion of one minim to the gallon. These baths are used in rheumatism, gout, paralysis, scrofula, and skin diseases. Vapor Baths. In these the body is exposed to steam instead of being immersed in hot water. The effect is much the same as that of the hot bath. The so-called Russian bath consists of a room filled with steam and provided with benches at various levels. The higher the level the greater is the heat, and usually, excepting on the lower benches, it is only possible to breathe with any comfort by holding a sponge dipped in cold water before the nose. From this room the bather goes to another where he is drenched with cold water by a douche, and is then quickly dried, and allowed to rest for some time before dressing. These baths are chiefly used in chronic rheumatism. They are liable to the same objections as the hot bath, and to a still greater extent, for the inhalation of the hot steam produces greater difficulty of breathing, greater acceleration of the pulse, and greater tendency to syncope. Vapor baths, in which the body only is exposed to the action of the steam, and the head is left out, are much better. They are usually applied either by means of a kind of box in which the body of the bather is inclosed while the head remains outside, or else by introducing steam under the bedclothes, which are supported by a kind of cradle, while the bedclothes are tucked tightly round the patient's neck to prevent the escape of the vapor. The latter plan is very useful in cases of dropsy and uraemia, as it induces a copious perspiration and does not exhaust the patient nearly so much as a hot bath. In cases of acute rheumatism a vapor bath of vinegar has been recommended. Calomel Fumigation. — This is used as a means of inducing the general action of mercury. The patient is seated naked on a wicker- work chair, underneath which is put a stand holding a shallow cup con- taining calomel. The calomel is volatilized by means of a spirit-lamp, and a blanket or water-proof sheet being thrown round the patient so as completely to envelop himself, his chair, and the fumigating apparatus, the calomel fumes become condensed upon his skin in a fine state of divi- sion. It is absorbed with considerable rapidity, probably from becoming mixed with the sebaceous secretion from the skin, and the general action of mercury is quickly induced. Air Baths. Turkish Bath. — The Turkish bath usually consists of three rooms, although frequently there are more. The temperature of the first, or dressing-room, is moderate, that of the second is higher, and that of the third is higher still. In the first room, the bather, after undressing, winds one towel round his loins, and a second round his head in the form of a turban. If he has any tendency to cerebral congestion, the second METHODS OF ADMINISTERING DRUGS. 405 one may be wet. He then passes into the second room, where he usu- ally waits a short time before passing into the third room. Some people,' however, go directly into the third room. In both the second and third rooms the bathers partake freely of cold water. A few minutes' stay in the warmest room is usually sufficient to make the bather perspire freely, and he then returns to the second or cooler room, where he may remain half an hour or more, according to circumstances. He may then be shampooed, the surface of the body being rubbed, the muscles kneaded, and the smaller joints extended. He is next washed with a lather of soap, and sluiced with basins of tepid or warm water. For some people it is most agreeable after this to be simply wrapped in warm towels and allowed to repose in the dressing-room. Others prefer to finish up with a cold douche before proceeding to the dressing-room. Here they remain resting for a considerable time before they again dress. Turkish baths are exceedingly useful in chronic rheumatism and gout, and in persons suffering from the effects of malaria. The chief objection to the Turkish bath is the length of time that it takes. In some persons it has a weak- ening effect, but in many others it has none. The chief precautions are not to stay too long in the hot room, and to leave it at once if giddiness or a feeling of tightness in the head comes on. If the skin perspires with difficulty, the necessity for caution in entering the hot room becomes still greater, and it is advisable rather to spend a longer time in the second room, and drink freely of water before entering the hotter room, if, indeed, this be entered at all on the first few times of taking the bath. Persons who suffer from a feeling of exhaustion after a Turkish bath should not take a cold douche nor a plunge into water after perspiring, but should simply allow themselves to cool very gradually, and should take some stimulant such as coffee or beef-tea while doing so. Persons who suffer from malaria also should spend a good while in the second room before attempting to enter the third, as the sudden application of heat to the skin and lungs seems to irritate the vaso-motor centres and cause chilliness or even shivering. Friction and Inunction. Friction of the skin causes first a temporary contraction of the ves- sels, followed by a more or less permanent dilatation, so that the skin continues red for a length of time after the irritation has ceased. This redness is accompanied by a warm glow from the increased circula- tion in the skin, and friction is therefore useful as an adjunct to cold baths. Besides this, friction along the extremities in an upward direc- tion tends to aid the flow of lymph, and thus to remove the products of waste from the muscles. The fascia covering a muscle forms a pumping apparatus for remov- ing waste products from the muscles. It consists of two layers, a b and e /, and between these are lymph spaces, some of which, x, are seen in transverse, and others, which appear black from the injection with which they are filled, are seen in longitudinal section. Each time the muscle contracts it becomes thicker, presses the two layers of fascia together, and drives the lymph from the spaces onwards into the lymphatics. 406 PHARMACOLOGY AND THERAPEUTICS. Each time the muscle relaxes the layers of fascia tend to separate, and lymph from the muscle, carrying with it the waste products, fills the spaces between the layers. The action of the muscle itself thus tends to remove the waste products which give rise to fatigue (vide Massage, p. Fig. 121. — Injected lymph spaces from the fascia lata of a dog, after Ludwig and Schweigger-Seidel. The injected lymph spaces are black in the figure. 128), but after over-exertion their removal may be greatly aided by gentle but firm upward friction which will have a similar action on the fascia to the alternate compression and separation of its two layers, caused by the action of the muscle itself. Gentle firm friction thus lessens or may even remove entirely the feeling of fatigue and weight in the extremities after exertion. When applied to the nape of the neck, or along the spine — it is some- times useful in headache, in nervous irritability and in sleeplessness. When applied between the shoulders in persons suffering from flatu- lence, it appears to aid the expulsion of gas from the stomach. The effect of friction as a counter-irritant is greatly increased by the use of stimulating liniments. These are applied by pouring a little into the hollow of the hand and then rubbing it over the sur- face of the body, or else by soaking a piece of flannel in the lini- ment and rubbing the skin with it. Linimentum ammonise applied thus to the chest is useful in the bronchitis of children ; and linimen- tum camphorae compositum, B.P., or linimentum terebinthinge may be used in a similar way for adults. In chronic inflammation of joints, liniments may be applied in a similar way. Sometimes it may be advisable also in such cases to swathe the joint in a piece of flannel or lint, soaked in the liniment so as to procure more continuous application. Inunction. — Metallic salts are very slightly, if at all, absorbed from the skin when applied to it in watery solution, and wiped off with- out being allowed to dry. But when applied in the form of ointments a considerable absorption takes place. Advantage is taken of this in order to obtain the general action of mercury without its local effect on the intestinal canal. For this purpose mercurial ointment is rubbed on the skin, and especially on those parts where the epidermis is thin, as under the axilhe and on the inside of the thighs. Absorption also takes place, however, through the skin of the hands, and if the ointment is not rubbed on by the patient himself, but by another person, in whom the action of mercury is undesirable, it has METHODS OF ADMINISTERING DRUGS. 407 been recommended that the latter should cover his hands with a piece of bladder thoroughly well oiled in order to prevent absorption. In children, instead of applying the mercurial ointment by inunc- tion, it is customary to smear the ointment on a piece of flannel, and to keep it applied to the abdomen of the child by means of a bandage. Endermic Application of Drugs. This method consists in applying the drug to the skin previously denuded of its epidermis or epithelial layer by blistering. The drug may be applied in the form of powder, solution, ointment, liniment, or plaster, but most frequently in the form of powder. The drug is more readily absorbed when applied in this manner than when applied over the epidermis. Cantharides may be used for the purpose of raising a blister, but a more convenient method is to fill a thimble with cotton- wool or lint soaked in the strongest liquor ammoniae, apply it to the spot and keep it on for five minutes. If the cuticle has not then risen in a blister, apply a poultice until it rises. Cut off the cuticle, place the powder on the denuded surface, and cover it with a piece of oil-silk fixed in position by two pieces of strapping crossed over it. This method was chiefly employed for the local application of morphine. It has now been almost entirely superseded by the hypodermic method, but may still be occasionally employed in cases where it is advisable to combine the counter-irritant action of the blister with the local sedative effect of the morphine. Hypodermic Administration of Drug's. This method, the introduction of which we owe to Dr. Alexander Wood, of Edinburgh, possesses great advantages. It consists in the injection of a solution of a remedy under the skin. Absorption takes place from the subcutaneous cellular tissue rapidly, and it is much less likely to be modified by altered conditions of the organism than absorption from the stomach and intestine. For in the intestinal canal there is not only the condition of the circulation to be taken into consideration, but the fulness or emptiness of the stomach and intestine, the condition of their epithelial covering and of their ner- vous supply, and the state of the liver. These conditions may not only delay but entirely prevent absorption. The advantages of the hypodermic method, therefore, are 1st, cer- tainty of effect, and 2d, rapidity of action. As absorption of a drug takes place so much more rapidly from the subcutaneous cellular tissue than from the stomach, a less quantity is excreted during the process of absorption, and consequently a smaller quantity of the drug is required (p. 56). But absorption does not take place with equal rapidity from all parts of the intercellular tissue. The vascularity of this tissue, and the rate of absorption from it, are greater on the temples and breast than on the back, and greater on the inner than on the outer surfaces of the arms and legs. 408 PHARMACOLOGY AND THERAPEUTICS. As the liquids used for hypodermic injection are usually concen- trated solutions of powerful poisons, it is important that neither more nor less than the quantity previously determined upon should be admin- istered. The syringe consists of two parts : a glass barrel in which a 1 15 \4 13 la U Fig. 122. — Syringe for hypodermic injection. piston plays air-tight, and a hollow needle which fits tightly on to the end of the syringe either with or without a screw. The bore of the needle being very fine it is apt to get choked by rust, or by crystals of the substance last employed for injection forming within it, and render- ing it impermeable and useless. In order to avoid this it should be care- fully washed with water each time it is used, and a small piece of thin wire kept constantly in it during the intervals of use. When the syringe has not been used for some time, the packing of the piston is apt to shrink, so that it will no longer either suck in or drive fluid out of the barrel efficiently. This may often be remedied to a great extent by soak- ing the syringe for a short time in warm water and driving the piston up and down in it. If this is insufficient the piston may be taken out, and sufficient thread wound round it to make it work. Care must be taken also that the needle fits tightly on the syringe, and that no leakage takes place at the junction. The liquid to be injected should contain no solid particles which may obstruct the needle, and if any such should be present, the fluid may be filtered through clean blotting paper. The exact quantity required, and no more, should then be drawn up into the syringe and injected. Some syringes have a small screw upon the piston, so as to stop its movement at any required point. With such a syringe the barrel may be filled quite full of the solution, and the required quantity injected by forcing the piston down until it is stopped by the screw. The advantage of this arrangement is that if any leakage should occur, the screw may be moved further up, and an additional quantity of solution injected without the necessity of withdrawing and reintroducing the needle under the skin. If all proper precautions be taken, however, the necessity for such a procedure will rarely arise. Convenient places for injection are the outside of the arm near the deltoid, the fore-arms, or the thighs. In order to avoid the risk of introducing the needle into a vein, the injection should not be made over a vein visible through the skin. The skin should be pinched up between the finger and thumb, the needle pushed directly through it, and then passed onwards a little way obliquely in the subcutaneous cellular tissue. Objections to Hypodermic Injections. — The chief objections are, (1) the pain caused at the time by the introduction of the needle, or by the drug itself after its injection, (2) the inflammation which either the needle or the drug may give rise to subsequently, (3) the scars which may be left by the frequent repetition of the injection, (4) the danger of communicating a specific or contagious disease, (/>) the danger of inject- ing the drug directly into a vein, and thus producing a dangerous or METHODS OF ADMINISTERING DRUGS. 409 fatal effect from the too rapid entrance of the drug into the circulation. With a little care these untoward results may be almost entirely avoided. If the needle is well sharpened the pain of introducing it is very slight, and may be still further lessened by making the patient take several deep breaths in rapid succession before the injection is made. If the patient is excessively sensitive, partial or complete anaesthesia of the part may be produced by cold or by carbolic acid (p. 186). The solutions should always be perfectly free from solid particles and should be as neutral and bland as possible. Metallic salts have their irritating properties diminished or removed when combined with albumen or with an alkaline citrate or tartrate so as to form double salts. By washing the syringe and needle thoroughly out with carbolic acid, the danger of conveying any specific or contagious disease is ren- dered very slight, and it may be completely avoided by heating all parts of the syringe in a spirit-lamp before using them. The syringe employed by Koch in his experiments on the effects of micro-organisms in pro- ducing disease (Fig. 122) is admirably adapted for this purpose, as all parts of it can be readily heated, and the padding upon the piston which is more likely to retain infective matter than any other part of the syringe can be renewed each time that the instrument is employed. In order to prevent pain or inflammation being caused by the solution injected, care should be taken that its reaction is as nearly as possible neutral, and that the quantity should not be great. The smart which follows the injection is lessened by rubbing the finger gently over the part, so as to distribute the fluid in the subcutaneous tissue. If it is necessary to employ such large quantities as half a drachm or a drachm, as may be the case with ergot, it is better not to inject the solution under the skin, but into the substance of a muscle, such as the gluteus maximus. Cicatrices are not apt to follow injection if the precautions already mentioned have been taken, and if the injections are not made too fre- quently at the same point. Application of Drugs to the Eye. For inflammation of the lids, ointment is smeared between the edges. Cold water is applied to the conjunctiva for its tonic action, by keeping the eyes open and then dipping the face into a basin of water. Strong solutions like that of atropine are applied to the conjunctiva by dropping them into the outer canthus of the eye and allowing them to flow over the surface. If such a solution is to be applied frequently, it may be dropped into the inner canthus, and the head held so as to allow it to drop out of the outer canthus ; for when the reverse proce- dure is employed the atropine may pass down the lachrymal duct, and being absorbed may produce its general effect upon the system and cause symptoms of poisoning. Application of Drug's to the Ear. Astringent solutions are usually applied to the auditory meatus by injecting them in a gentle stream by means of a small syringe (Fig. 123). 410 PHARMACOLOGY AND THERAPEUTICS. Fig. 123. — Vulcanite syringe for injecting solutions into the ear. For the mode of injecting into the middle ear, special treatises on aural surgery must be consulted. Application of Drugs to the Nose. Drugs are applied to the nose in the form of powder, which may be taken in the same way as snuff by putting a little on the top of the thumb, holding it in front of the nose and strongly inspiring ; or the powder may be put on a small piece of card-board in which a pin-hole has been made just under the powder, or with a small perforated spoon like that used in Scotland for snuff. Sternutatories may be used in this way, and so may Ferrier's powder for soothing the mucous membrane in cases of commencing catarrh. Fluids may be applied by insufflation, the nose being simply immersed in them and strong inspiration being made. They may also be applied by the nasal douche. This consists simply of a long India-rubber tube to act as a syphon (Fig. 124). The Weight. Clip to stop the now " Conical nozzle ( Fig. 124.— Nasal douche. upper end of it is placed in a vessel filled with the solution to be applied, and it is prevented from falling out by a hollow lead weight attached to its upper end. At the lower end is a conical nozzle, which completely plugs the nostril. The tube being filled with the fluid by suction so that it commences to act as a syphon, the nozzle is placed in one nostril, and the head is held with the mouth open over a basin. In this position the METHODS OF ADMINISTERING DRUGS. 411 posterior nares are cut off by the soft palate from the pharynx, and the solution passes up one nostril and out through the other, so that the nasal cavity is washed out and its mucous membrane acted upon by the solution which is employed. By altering the position of the head, both in insufflation and in washing with the douche, the part of the nose reached by the fluid will be changed. Thus when the head is held much forward, the anterior and upper part of the nose will be chiefly cleansed, when the head is held upright, the posterior and lower, and when the position is intermediate, the middle part of the nose will be most affected. Pure water is irritating to sensitive mucous membranes like that of the nose, and so instead of employing pure water it is much better to use a *5 to 1 per cent, solution of common salt, which is a bland non-irritating fluid. Such a solution may be made by adding a drachm of common salt to a pint of water. Fluids may also be applied to the nose in the form of spray, either directed simply into the nostrils, or by means of a catheter perforated with a number of minute holes, and introduced along the floor of the nasal fossae. The former may be used for applying astringent and deo- dorizing solutions, and the latter for the purpose of washing out the nose and removing hardened secretions. Application of Drug's to the Larynx. Solid powders may be applied to the larynx by insufflation. The insufflator used for this purpose consists of a tube curved at one end, and having at the other a piece of India-rubber tubing or an India-rubber ball, by which a powder may be blown through the tube near this end of the _^ T— C Fig. 125. — Insufflator for applying powders to the larynx. A, piece of India-rubber covering the open- ing in the insufflator, by which the powder is placed in it. B, India-rubber tube by which the pow- der is blown out of the insufflator into the larynx. C, curved end of insufflator for introduction into the pharynx. tube. There is a small opening in its side through which the powder may be introduced, and this is afterwards covered by a sliding ring or a piece of India-rubber tubing so as to prevent the powder from escaping. The bent part of the tube is carefully introduced into the mouth so as not to cause retching by touching the tongue or soft palate, and, when the end of it points down over the larynx, the patient is told to take a deep breath. At the moment of inspiration the operator forces the powder out of the tube into the larynx, either by blowing through the 412 PHARMACOLOGY AIVD THERAPEUTICS. India-rubber mouth-piece or by compressing tbe India-rubber ball. Mor- phine applied by this method gives more relief than almost anything else in laryngeal phthisis. About one-sixth of a grain is sufficient, and in order to give it sufficient bulk it may be mixed with either starch or bismuth. Solutions may be simply applied by means of a sponge firmly tied to a piece of whalebone having the proper curve ; as the patient inspires this is pushed down the larynx. Doubts have been expressed as to whether the sponge does get through the larynx, but I have seen the cricothyroid membrane projected forwards by the sponge applied in this manner. Nitrate of silver applied in this way gives relief in cases of phthisis, but it is a very rough method, and the application of the solution by means of a brush with the aid of the laryngoscope is much to be preferred. When the sponge has not been firmly fixed it has been known to come off and fall into the trachea. Fluids may be applied by a brush to the larynx, the operator using the brush with one hand and holding the laryngoscopic mirror with the other, while the patient holds his tongue out himself. If the patient is made to take several deep breaths in succession a slight anaesthetic con- dition is produced which renders the operation much more easy. Caustics are best applied to the larynx by means of a caustic holder in which the caustic is concealed until it reaches the point of application when it can be projected by a touch of the finger, and again withdrawn at the wish of the operator. Liquid may be applied to the larynx in the form of spray, produced either by means of Richardson's apparatus or by a current of steam. The nozzle of the spray producer may be simply directed towards the pharynx, or the tongue and the cheeks may be protected from the spray by a cylindrical glass speculum. Application of Drugs to the Lungs. % Inhalations. — Vapors employed as inhalations act not only on the bronchial tubes but upon the larynx, pharynx, and nostrils. One of the commonest is that of simple hot water. A jug is filled about half full of boiling water and the head held over it, the steam being kept in by means of a napkin or towel thrown over the head and around the mouth of the jug. This application often gives great, though temporary, relief in nasal, laryngeal, and bronchial catarrh. Vapor may be medicated by the addition of various substances to it such as carbolic acid, tincture of benzoin, creasote, or pine oil. But in order to gain the full advantage of the admixture of these substances it is better that the inspired air should not merely play over the surface of the hot water, but be drawn through it, and for this purpose inhalers are employed. In these the air is inspired by means of a mouth-piece fitted with a valve. This valve prevents the air from passing into the mouth-piece, so that during inhalation it is sucked through a tube which dips under the water and passes into the mouth laden with the vapor. During expiration it passes readily through the valve just mentioned. METHODS OF ADMINISTERING DRUGS. 413 In cases of bronchitis, the patient breathes much more easily when the air of the room is kept warm and moist, and this is effected by means of a bronchitis kettle. This is simply a tin kettle with a spout about three feet long which projects into the room, so that when the kettle is kept boiling briskly a constant current of steam is driven well out into the room. When this cannot be obtained a substitute may be extempo- rized by rolling a piece of brown paper into a tube, tying a piece of string around it at intervals so as to keep it in shape, and putting it over the spout of an ordinary kettle. In cases of tracheotomy it is usual to keep the air still warmer and moister by hanging sheets around the bed so as to convert it into a kind of tent, and then conveying the steam from a bronchitis kettle into it by means of an India-rubber tube, or keeping up a constant spray by one of Lister's steam spray producers. Smoke. — The attacks of difficulty of breathing which come on in cases of pure spasmodic asthma, in advanced kidney disease, or in emphy- sema, are frequently much relieved by inhaling the smoke which issues from burning touch-paper or from powdered stramonium. The touch-paper or stramonium may be simply laid on a plate, or may be placed at the bottom of a cup or jug, and the fumes inhaled. Datura is often used in the form of cigarettes made either from the leaves of the datura stra- monium or datura tatula. Application of Drugs to the Digestive Tract. Mouth and Pharynx. — Weak solutions are applied to the mouth in the form of washes with which the mouth is rinsed out. Stronger ones may be painted with a camel's hair brush inside the cheek, lips, gums, tongue or pharynx. Solutions may be applied to the pharynx by painting with a brush ; solid substances, as caustics, by rubbing. In using caustic, care must be taken that it is firmly attached to the caustic holder, and, in the case of nitrate of silver, that only a short point is used, as otherwise the caustic may fall off, or the stick of nitrate of silver may break and be swallowed. This is especially necessary in touching the throat in children. In cases of post-nasal or pharyngeal catarrh, solutions such as glycerin or tannin, &c, may be applied to the back of the soft palate and the posterior part of the nares by means of a camel's hair brush fixed on a wire which may be bent to any desired angle. Masticatories. — We sometimes give the patients solid pieces of a drug to chew. These are called masticatories. We use them for their action upon the mouth itself, e.g., pellitory, where we wish to increase the secretion of saliva; or where we not only wish to produce the effect upon the mouth, but the effect of the drug mixed with the saliva upon the stomach and intestines, as in the case of rhubarb. Gargles. — In gargling, a full breath is taken, the mouth is filled with the liquid which is to be applied to the pharynx, and the head being thrown back the fluid runs against the pharynx and is partly thrown up against the soft palate by the air which gradually escapes from the lungs. In cases where it is advisable for the fluid to reach the posterior nares, the patient should lie down flat, take a mouthful of the liquid, draw out the tongue as far as possible with a handkerchief, and gargle while in that position. By throwing the head suddenly forward 414 PHARMACOLOGY AND THERAPEUTICS. the liquid may be brought through the nose. This method is useful both as a method of applying the liquid more thoroughly to the pharynx and as a training preparatory to rhinoscopic examination. Stomach. — Drugs are applied to the stomach in the form of solu- tions or draughts, pills, powders, or boluses, &c., which are swallowed. Powders may be very conveniently given in wafers. A thin wafer is moistened with water, and the powder being introduced, is folded up in it and swallowed. Another most convenient vehicle is oatmeal por- ridge, a little of which is put upon a spoon, and, a depression being made in it with the finger, the powder is put into it and covered over with por- ridge. The porridge should fill the front half of the spoon, and the back part should be filled with milk, which helps the child to swallow more easily. Powders are sometimes given to children in jelly, but this is too soft, and so also is the paste made of bread and milk, although this may be used when porridge cannot be readily obtained. Pills may be simply swallowed with water, or taken in jelly, but some people are unable to take them without choking, and children especially have much difficulty in swallowing them. This difficulty is readily got over by dividing the pill into four or more parts, and taking each part in a little oatmeal por- ridge. Custard puddings, or puddings made of corn flour or arrowroot, may be used instead of porridge, but are hardly so good. Stomach-pump. — In cases where the patient is unable to swallow from paralysis of the pharynx, constriction of the oesophagus, or narcotic poisoning, the stomach-pump may be used. . This consists of a large, double-acting syringe with a flexible tube attached. In using it care must be taken 1 (1) to have the tube well softened in hot water; (2) to keep its end directed towards the pharynx, and not bent too much for- ward, lest it enter the larynx; (3) not to use violence in introducing the tube, lest it should be driven into the mediastinum, or even through the walls of the stomach itself, into the peritoneal cavity ; (4) not to use vio- lence in working the syringe, lest the mucous membrane of the stomach should be drawn into the lower orifice of the tube and injured. In place of the stomach-pump the gastric syphon may sometimes be advantageously employed, especially for feeding. It consists of a piece of thick-walled, soft, and flexible India-rubber tubing. It is so soft and flexible that it can hardly by any possibility injure the oesophagus or stomach, and yet it is sufficiently firm to pass down without much difficulty. After it is in, an ordinary funnel is attached to the project- ing end, and water, beef-tea, or whatever substance one wishes to intro- duce into the stomach, is simply poured in, the funnel being kept at or above the level of the patient's mouth. When it is desired to empty the stomach, water is poured in, in the manner just described, and then the outer end of the funnel is held down as low as possible — the syphon action is thus reversed, and the fluid which has just been poured into the stomach again flows out of it. 1 In cases of poisoning it may be absolutely necessary to use the stomach-pump, but in ordinary cases a tube should never be passed down the oesophagus until the absence of aortic aneurism has been ascertained by a careful examination of the patient's chest. METHODS OF ADMINISTERING DRUGS. 415 Intestine. — Drugs are applied to the intestine by means of enemata or suppositories. Enemata are liquid injections into the rectum for the purpose of emptying the lower parts of the bowels when we do not wish to excite the whole bowel, or when we wish to cause as little movement as possible to the patient. They are also used for the purpose of adminis- tering nutriment when the patient is unable to swallow or to retain food given by the mouth. In using enemata for the purpose of inducing action of the bowels the quantity should be considerable — sixteen fluid ounces, or even more. When they are intended to be retained, the quan- tity is usually small — not more than two to four fluid ounces at most. In using the enema syringe care should be taken that it is first emptied of air and that it is not pushed forcibly into the bowel. The nozzle should not be directed too much backward, as if this be done, and espe- cially if force be employed, ulceration of the posterior wall of the rectum may be induced. Where enemata are given for the purpose of nutrition, a much larger quantity than four ounces may be retained by using the proper- method. A flexible, soft rubber tube should be passed for eight or ten inches up the intestine and the nutrient enema may then be slowly and gently introduced either by using a syringe or by simply pouring it into the tube by a funnel. By this method the fluid is intro- duced into the sigmoid flexure or descending colon, and if the patient can be propped somewhat so as to lie on his left side, none of it may descend into the rectum. In this case there will be little or no tendency to evacuate it and the whole may be readily absorbed. Suppositories are drugs made up into a conical shape by means of cacao-butter. When introduced into the rectum the cacao-butter melts, the drugs become spread over the surface of the mucous mem- brane of the rectum, and gradually absorbed. They are employed when we wish to get the local action of a drug upon the rectum, or the parts surrounding it, or when we wish to get the general action of a drug after its absorption without producing any local effect upon the stomach. Application of Drug's to the Urethra. — They are usually employed as lotions. The syringe used to inject them should not have a small thin nozzle, but should have a conical point such as that shown in Fig. 126, which fills up the opening of the urethra and allows the injection to be forced up to the neck of the bladder without any escaping. Fig. 126. — Vulcanite syringe for injecting solutions into the urethra. Application of Drug's to the Vag-ina and Uterus. — Lotions are usually either injected into the vagina with a syringe, or allowed to flow into it from a reservoir at some height above the patient. In either case, if it is desirable that the lotion should remain in contact with the vaginal walls or cervix uteri, the patient should lie on her back with the hips raised by a pillow. The syringe employed for the vagina is usually furnished with a shield to prevent it from being introduced too far, and it ought to have no central opening, but only openings at the side, as occasionally, when astringent and irritating fluids have been used with 416 PHARMACOLOGY AND THERAPEUTICS. syringes having a central aperture, they have been forced into the cavity of the uterus, and have there produced uterine contraction and conse- quent pain. Sedative and astringent substances are often introduced in the form of pessaries or vaginal suppositories, in which the active substance is mixed with either cacao-butter or with gelatine and glyce- rine. Solids such as caustics are applied either to the vaginal walls or cervix directly through a speculum, and powders are applied on pledgets of cotton-wool. Tents, consisting of thin sticks of a porous substance, are introduced into the cervix itself for the purpose of dilat- ing it, and solutions may be injected into the uterine cavity itself by means of a syringe provided with a long nozzle. CHAPTER XVIII. ANTIDOTES. Antidotes are remedies which counteract the effect of poisons. Action. — Antidotes may act in two ways : they may either pre- vent the action of the poison on the body, or they may counteract its effects. Many of them, especially those which are employed in the case of mineral poisons, form chemical compounds with the poisons which are almost insoluble and therefore inert. Some of these compounds, though nearly insoluble, will nevertheless be gradually dissolved and absorbed if left too long in the stomach, and therefore it is advisable to remove them by means of emetics or by the stomach-pump or stomach-syphon as soon as possible. Indeed, it is advisable in all cases of poisoning-, when the substance has been taken into the stomach, to empty the stomach at once before pro- ceeding to administer the antidote. The only possible exception is when a highly corrosive substance has been taken which may have par- tially dissolved the wall of the stomach and rendered it extremely liable to rupture during emesis, or on the introduction of a stomach-tube. If the poison has been absorbed, we must try to counteract its poisonous action on the respiration, circulation, or temperature, by giving sub- stances which will tend to produce an opposite effect. The more common poisons with their antidotes are given in the following table: — Poisonous Gases. Sulphuretted hydrogen . Chlorine cautiously inhaled. Chlorine ] I ir* imine L Steam inhalations. Iodine vapor .... J Vapor of ammonia . . Vapor of vinegar. ANTIDOTES. 417 Poisonous Gases— continued. Carbon monoxide Nitrous oxide Coal gas . . . . . Charcoal fumes . . Carbonic acid (choke damp) Marsh gas Fire damp {Fresh air and artificial respiration. Transfusion. Artificial respiration, with the tongue drawn forward, and with intermittent pressure over the cardiac region if the heart is failing. Artificial respiration. Alternate warm and cold douche to the head and chest. Friction. Mustard plasters over surface. Acids — Sulphuric . . Hydrochloric . Nitric . . . Phosphoric . . Oxalic acid .... Bin-Oxalate of potash (salts of lemon or salts of sorrel) . . . . Tartaric acid .... Acetic acid .... Acids. Alkalies — Bicarbonate of soda or potash. Magnesia. Chalk or whiting. Plaster from the wall. Soap. Milk. Eggs beaten up. Olive or almond oil. Chalk or whiting, or plaster from the wall, with water. Hydrocyanic acid . . «j Alternate cold and warm affusions. Artificial respiration. Injection of atropine (2 to 4 min. liquor atropise), repeated every half hour. Per- and proto- salts of iron, with magnesia, are recommended to render the acid insol- uble, but it acts so quickly that there is usually no time for their application. Caustic potash or soda Caustic lime . . . Caustic ammonia Carbonate of soda or pot ash 27 Alkalies. Vinegar. Lemon juice. Other dilute acids. Milk. Oil. 418 PHARMACOLOGY AND THERAPEUTICS. Aconite Alcohol Alkalies — continued. f Spirits. Ammonia. . Warmth. Digitalis. Atropine. Coffee. Cold douche to head. ^.ntesthetics • ! Chloroform, ether, etc. '. f Artificial respiration, inversion, etc. Antimony Arsenic Atropine Baryta salts If vomiting does not occur, wash out the stomach with water first; then with tannic or gallic acid; then give milk and white of egg as demulcent to stomach. Wash out the stomach with large draughts of warm water, either by stomach-pump, or, if the arsenic itself does not cause vomit- ing, by using sulphate of zinc. Give magnesia, or still better, freshly precipi- tated oxide of iron made by precipitating a solution of perchloride of iron with car- bonate of soda. Dialyzed iron is also very useful. Give stimulants and coffee; inject caffeine subcutaneously ; arouse from stupor, as in opium poisoning, and, if necessary, arti- ficial respiration. Give cautiously physo- stigma. J Give Epsom or Glauber salts or dilute sul- [ phuric acid. Belladonna, vide Atropine. Burnett's Disinfecting Fluid, vide Metallic Salts. Calabar bean . Cannabis Indica Cantharides f Stimulants. \ Atropine. I Artificial respiration, if necessary. Vide Morphine. Large quantity of demulcent drinks. Barley water. Gruel. Linseed tea. Avoid oils and fats. ANTIDOTES. 419 Carbolic acid . . Cherry laurel water Alkalies — continued. Saccharated lime. Stimulants. Chloral Bichromate of potash Colchicum . . . . Conium Quinia Copper .... Corrosive sublimate Creasote . . . Croton oil . . . Curare Cyanide of potassium Digitalis . . . Ergot Vide Hydrocyanic acid. Keep patient warm. Arouse him. Give him coffee per rectum. Liquor strychnine, 4 minims, subcutaneously, repeated every 10 to 20 minutes, if neces- sary. Same as Acids. f Tannic or -i Gallic acids. [ Stimulants. f Tannic acid, j Stimulants. I Coffee. Tannic or Gallic acids. Strong tea or coffee. Stimulants warmed. Artificial respiration. Vide Metallic Salts. Vide Metallic Salts. Vide Carbolic Acid. Demulcents. Stimulants. Artificial respiration. If there is a wound, ligature above it if pos- sible, and incise and suck strongly. The ligature should be loosened from time to time, and again tightened, so as not to let too much poison into the blood at once. Vide Hydrocyanic acid. f Strong tea. I Tannin, i Stimulants. Aconite, 5 mins. of the tincture subcuta- neously. I Keep perfectly quiet, lying in bed. Tannin. Stimulants. 420 PHARMACOLOGY AKD THERAPEUTICS. Alkalies — continued. Vide Arsenic. Insect powder .... {Atropine. Stimulants. Artificial respiration. Hyoscyamus .... Vide Atropine. f Stimulants. Laburnum \ Coffee. [ Alternate hot and cold douches to chest. Lead Vide Metallic Salts. Lobelia Metallic salts . Morphia Mushrooms Nitro-benzol . Nitrite of Amyl Nitro-glycerin Tannin. Stimulants. Strychnia hypodermically (5 mins. liq. strychniae). White of egg freely to form insoluble com- pound : then wash out stomach to remove it : afterwards demulcents. Poultices to surface, and morphia if neces- L sai 7- Warm coffee after the stomach is emptied. Ammonia. Arouse by flicking with a towel, or by gal- vanic battery, and keep awake by walking about and renewal of stimulation if neces- sary. 2 to 4 mins. liq. atropine, subcutaneously. Artificial respiration, if necessary. 2 to 4 mins. liq. atropine, subcutaneously : repeat if necessary. Castor oil. Stimulants. f Stimulants. \ Alternate douche. [ Artificial respiration. f Cold to head. \ Ergotin. I Atropine, subcutaneously. Oil of Bitter Almonds . Vide Hydrocyanic acid. Opium Vide Morphine. Phosphorus f Sulphate of copper. \ Oil of turpentine, old and oxidized. [ Avoid oils and fats. ANTIDOTES. 421 Physostigma . . . Picrotoxine . . . Pilocarpine . . . Eat paste .... Savin . . . . . •I Snake-bite Stramonium . . . Strychnia . . . Tobacco . . . . Turpentine (oil of) . Veratrine . Alkalies — continued. ' Stimulants. Atropine. Chloral. Strychnine. Artificial respiration. Chloral. Bromide of potassium. Atropine. Vide Phosphorus. f Epsom Salts. { Demulcents. Ligature limb, cut out part with penknife and sear with hot iron. Alcoholic stimulants. Ammonia. Artificial respiration. Vide Atropine. ' Chloroform. Tannin. Bromide of potassium. Chloral. Tannin. Stimulants, warm. [ Strychnine. Demulcents. Sulphate of magnesia. f Stimulants. \ Coffee, warm. [ Recumbent posture. 422 PHARMACOLOGY AND THERAPEUTICS CHAPTER XIX. ANTAGONISTIC ACTION OF DRUGS. The idea that one drug might be made to counteract the deadly effects of another is a very old one, and in the middle ages alexiphar- mics and mithridates were used as antidotes. Of late years, however, the subject has been investigated experimentally, and a more accurate knowledge of it obtained. Amongst the first of these experimental researches were those of Preyer, on the antagonism of atropine and hydrocyanic acid; of Schmiedeberg and Koppe on the antagonism of muscarine and atropine; and of Fraser on the antagonism between physostigma and atropine. Although the fact is undisputed that we are occasionally able by the administration of one drug, to prevent the appearance of certain symp- toms which would otherwise have certainly been produced by another previously administered, it is by no means certain that the one simply counteracts the effect of the other. Some regard the effect of one drug in counteracting another as a case of chemical combination or substitution, the second drug either becoming added on to a compound of the first with some of the tissues, or else displacing it from such a compound with the tissues. Others, again, think that no chemical action of this sort takes place, but that each drug acts upon the tissue or tissues by itself, one, for example, exciting and the other paralyzing. In favor of the first view may be mentioned the analogy between the action of poisons and the formation of acid-albumen and alkali- albumen, either of which can be changed into the other by excess of alkali or of acid respectively. The objection is a very natural one that the doses of alkaloids required to produce marked physiological action are so extremely small that one can hardly fancy any chemical action being the cause of their physiological action. I have, however, on one occasion, by the addition of a single drop of liquor potassse, converted a milky-looking fluid, con- sisting of the nuclei of fowl's blood corpuscles suspended in water and measuring 90 cc, into a solid jelly-like mass, a result more ' striking than if a similar quantity injected into a frog had induced rigor in every muscle. Even such a result is infinitely less delicate than the color reactions by which alkaloids are detected. Some of the best-marked examples of antagonism in regard to invol- untary muscular fibre are those observed by Ringer in the frog's heart, and they strongly support the view which he advocates of chemical substitution. As already mentioned, calcium salts and veratrine greatly prolong the cardiac systole; but this prolongation is at once removed, and the systole rendered normal by a small quantity of a potash salt. The salts of potash alone render the systole short and weaker, and then normal, but this action again is neutralized by calcium. A similar condition has been observed by Cash and myself in the voluntary muscles of the frog. The contraction of the gastrocnemius is prolonged to a slight extent by calcium, and to a great extent by veratrine, ANTAGONISTIC ACTION OF DRUGS. 423 and also by barium salts. This contraction is quickly reduced to the normal by the addition of a small quantity of potash. There is no very well-marked case of antagonism in which one drug is able to restore power to motor nerves which have been paralyzed by another drug : such antagonism, however, has been observed in regard to the vagus. By small doses of atropine this may be paralyzed ; by a dose of physostigma administered afterwards the inhibitory power may again be restored ; and by a further dose of atropine it may be again paralyzed. This action has been denied by Rossbach, but in experiments on the subject by myself, I have obtained this effect in such a marked degree that I have no doubt regarding it. It is possible that the different results obtained may be due partly to the animal employed, partly to the dose, partly to the preparations of the drug, and partly to the tem- perature at which the experiments are made. 1 In my experiments the vagus was irritated, and I ascertained that the stimulation was strong enough to stop the heart. A very small quantity of atropine was then injected, and the same stimulus was repeated. After enough atropine had been gradually injected to abolish the inhibitory action of the vagus completely, some physostigma was then injected into the jugular vein, and the irritation again repeated with the effect of stopping the heart as at first. The antagonism of certain drugs upon the frog's heart has received much attention. In considering this subject care must be taken to dis- tinguish between experiments made with the ventricle alone, containing involuntary muscular fibres but no ganglia, and the whole heart, in which both muscle and ganglia are contained. The experiments on veratrine, calcium, and potassium, already alluded to, were made with the ventricle alone ; those which are now to be considered have reference to the whole heart. Atropine appears to have the power not only of destroying the inhibitory action of the vagus upon the heart, but of antagonizing those drugs which inhibit the heart and render its beats slower, or stop them altogether, such as muscarine, physostigma, pilocarpine and phytolacca. Digitalin and saponin have a mutually antagonistic power, so that when the frog's heart has been stopped by either of them, the other will restore its pulsations. A limited antagonism also exists between muscarine, aconitine, and digitalin ; when the heart has been stopped by digitalis, muscarine and aconite will restore its movements. Digitalin will also restore the pulsations in a heart which has been arrested by aconite. Physostigmine, camphor, and other drugs which stimulate the muscular fibre of the heart will remove the still-stand caused by muscarine. Another very important antagonism is that between drugs acting on the respiratory centre and spinal cord. The mode of action of these drugs is difficult to explain on account of our imperfect knowledge of the physiology of the structures on which they act. Chloral lessens the excitability of these structures, strychnine increases it. These drugs have to a certain extent an antagonistic action, so that a fatal dose of 1 My experiments were made on rabbits during the summer. The preparation of physostigma employed was a glycerin extract of the bean, and the preparation of atropine used was the Liquor Atropine, B.P. 424 PHAKMACOLOGY AND THERAPEUTICS. strychnine may be so antagonized by chloral as to prevent death ; and a small quantity of strychnine may prevent death from chloral. Atropine has an exciting action on the respiratory centre somewhat like strych- nine, though very much less marked ; and atropine also will antagonize chloral. It has also an antagonistic action to aconite, which has a peculiar depressing influence on the respiratory centre. The sedative action of chloral enables it to antagonize picrotoxine, which has a stimulant action on the brain, causing convulsions. Opium and belladonna have to a certain extent an antagonistic action to one another. The first point which appeared to indicate an antagonistic action was their different effect on the pupil; but probably the point in which they chiefly antagonize one another is their action on respiration, atropine acting as a stimulant and morphine as a depressant to the respiratory centre. The alkaloids of tea, coffee, and allied substances, viz., theine, or caffeine, cocaine and guaranine, are antagonistic to morphine. These alkaloids in small and moderate doses increase the irritability of the brain, spinal cord, heart, and vaso-motor system, and in large doses paralyze them. Morphine and these alkaloids to a certain extent counteract one another, so that a lethal dose of one may be prevented from causing death by administering the other. The antagonism of drugs is also marked in regard to their action on the glandular system ; thus the excessive salivation produced by physo- stigma, pilocarpine, and bromal may be arrested by atropine, which also arrests the excessive secretion from the skin caused by pilocarpine, and the secretion from the mucous membrane of the lungs produced by bromal. The following table shows the most important examples of antagonism. The lethal and antagonistic doses have only been ascertained for a few. When the remark a not antagonistic" occurs in the table, it means that the second drug mentioned will not prevent death from a lethal dose of the first, although the first will prevent death from a lethal dose of the second. Aconitine Alcohol . . Ammonium chloride . Atropine . . .} Barium . ; . u Bromal-hydrate Brucine . . . Calabarine . . Carbolic acid . Chloral . . . Chloroform Cocaine . Codeine . Digitalin Gelsemium u Morphine Muscarine Opium . Physostigma Saponin . Strychnin Thebaine Atropine .... Digitalin .... Strychnine . . . Strychnine . . . Chloral .... Aconitine .... Bromal hydrate Chloral-hydrate Hydrocyanic acid . Jaborandi .... Muscarine . . . Morphine .... Physostigmine . . Phytolacca. . . . Pilocarpine . . . Quinine .... Sodium sulphate . Potash salts . . . Atropine .... Chloral Chloral Chloral Ammonium chloride Atropine ... . Brucine .... Calabarine . . . Carbolic acid . . Codeine .... Physostigma . . . Picrotoxine . . . Strychnine . . . Thebaine .... Amyl nitrite . . . Morphine .... Chloral Aconitine .... Muscarine . . . Saponin .... Opium Atropine .... Atropine .... Caffeine .... Chloroform . . . Cocaine .... Daturine .... Hyoscyamine . . Nicotine .... Physostigma . . . Atropine .... Atropine .... Gelsemium . . . Veratrum viride . Atropine .... Chloral .... Morphine .... Digitalin .... Alcohol .... Chloral. .... Hydrocyanic acid . Nicotine .... Nitrite of amyl . . Chloral Lethal dose.— I. Lethal dose.— II. 7 Antidotal Tio th - 60V h ' not antagonistic not antagonistic not antagonistic 426 PHARMACOLOGY AND THERAPEUTICS. CHAPTER XX. DOSAGE. The circumstances which affect dosage have already been discussed (p. 54). In practice we reckon the dose according to age, making allowances, however, for the size and sex of the patient. Various tables have been drawn up for this purpose. One in common use is Dr. Young's. It is to convert the age into a fraction by adding twelve to it and using the number thus obtained as the denominator, the age itself being the numerator. Thus, if a child's age be three years, the denominator will be 3 + 12=15, and the numerator will be 3. The dose for the child will therefore be 3 + 3 1 2 = -^ = i- of that for an adult. For a child five years old it will be 5 _f ± 2 = -f=-, which is between one-third and one-fourth of that for an adult. If the child is large for its years, we would give one-third ; if small, we would rather give one-fourth. Another rule, proposed by Dr. Cowling, is to divide the number of the patient's next birthday by twenty-four. Thus, for a child three years old, the fraction representing the dose would be -£$ = \\ for a child five years old, ^ = \. The rule which I should propose as being more convenient for the metric system is a modification of Dr. Cowling's. If we assume that the body has attained its full growth at twenty-five years of age instead of twenty-four, we get the proportion by dividing the number of the next birthday by twenty-five. Thus, for a child three years of age, the pro- portion would be -gt- = nearly \ ; for a child five years of age, -^ = between 4- and \. This number does not lend itself readily to fractions such as the preceding, but it is very easy to divide by twenty-five by simply multiplying by four and dividing by 100. When the metrical system is used, all that is necessary is to multiply the full dose by the number of the child's next birthday, then by four, and remove the decimal point two places to the left. Thus, if the full dose for an adult be 1 gramme, the dose for a child of three will be 1 *q* 4: = '160 gramme or 16 centi- grammes. If the full dose for an adult be "3 gramme, the dose for a child of three will be ' 8 ^ X4 = '048, or 48 milligrammes. If the full dose be 1 gramme, the dose for a child of five will be ^{j* 4 = *240 gramme or 24 centigrammes. If the full dose be -3 gramme, the dose for a child of five will be '3Xgim.X6 _X4 = .079 gramme or 72 milligrammes. To put it more shortly, the number of grammes in the full dose multiplied by the child's next birthday and by four, gives the result in centigrammes. The number of decigrammes multiplied in the same way gives the result in milligrammes. SECTION II. GENERAL PHARMACY. CHAPTER XXI. PHARMACEUTICAL PREPARATIONS. Pharmacy includes both the general preparation of drugs from crude natural products and their combinations with other substances, so as to render them either more effectual or more easily administered. The great rule for the administration of medicines is (1) curare, (2) cito, (3) tute, et (4) jucunde — that they shall not only (1) cure, but that they shall do so (2) quickly, (3) safely, and (4) pleasantly. According to this rule many prescriptions contain four ingredients, viz.: (1) the substance which is to cure, or the basis; (2) the adjuvant to help it; (3) the corrective to prevent any bad effects ; and (4) the vehicle to make it pleasant to take. This rule, however, is carried out not only in written prescriptions, but in those also which have been adopted by the profession at large, as a means of saving labor and time in the routine of practice, and embodied in the Pharmacopoeia as useful preparations. Formerly we were dependent for our medicines chiefly on the crude products of the animal, vegetable, and mineral kingdoms. As chemistry advanced various inorganic compounds were discovered and added to the Materia Medica, and as our knowledge of this science becomes greater and our power of preparing various organic bodies increases, we find that such bodies are becoming more and more introduced into medicine. As examples of these, we may take carbolic acid, chloral, chloroform, ether, hydrocyanic acid, iodoform, nitrite of amyl, salicylic acid, and kairin. We seem now on the verge of discovering the mode of preparation of many organic alkaloids, and when this has been done, the vegetable Materia Medica will be less important than it is now, inasmuch as it is probable that, by using artificial alkaloids, prepared always under similar conditions, we may obtain purer products and greater constancy of action than we can at present from the natural active principles. 428 GENERAL PHARMACY. Recent discoveries have shown that plants generally contain active principles so closely associated that the mixture was regarded as a pure alkaloid, and yet these drugs have very different and sometimes opposite physiological actions. Thus ordinary conine usually contains pure conine and methyl-conine, the former of which paralyzes the motor nerves, while the latter paralyzes the spinal cord. Extract of physostigma, and sup- posed pure physostigmine, or eserine, have been found to contain two active principles, viz., physostigmine having a paralyzing action, and calabarine having a tetanizing action on the spinal cord. The power which chemistry now gives us also of modifying the chem- ical constitution of organic bodies and therewith their physiological action, will almost certainly enable us to treat disease much more perfectly than we can at present. For such modified drugs, however, we must be indebted to the chemist. He will prefer to operate on substances which have been already prepared by himself rather than on crude drugs obtained from plants. But at present we are still dependent on the vege- table kingdom for a large number of our most useful remedies. In plants they are associated as a rule with quantities of woody tissue which is quite inert and indigestible, and which would interfere very much both with their easy administration and with their action. Sometimes the crude drug is given in the form of a simple powder, without any admixture, as in the case of guaiac given in tonsillitis, where it is advisable to have the local action of the drug on the throat, as well as its general action on the system. Sometimes the powder may be readily given by enveloping it in a wafer, and swallowing it with a little water, and at other times it is made up with saccharine, and more or less adhesive substances, into the form of a confection or bolus ; or suspended in water by means of mucilage in the form of a mixture. Usually however the active parts of the drug are extracted by means of solvents, and either given in solution, or in the solid form, after the solvents have been evaporated. There are a number of preparations according to the solvents used, and the mode in which they are applied. Probably the most convenient arrangement is not to take the groups of preparations according to the solvents or mode of preparation, but alpha- betically for the sake of reference. The letters U.S.P. stand for the United States Pharmacopoeia of 1883, and B.P. for the British Pharmacopoeia of 1874. When the letters U.S.P. or B.P. precede the name of a class or of a substance, they indi- cate that it is contained in the corresponding pharmacopoeia only, but not in the other. They succeed the name or are omitted when the class or substance occurs in both pharmacopoeias. When there are differences between things bearing the same name in the United States and British Pharmacopoeias, the letters U.S.P. are placed after the descriptions of that contained in the United States, and B.P. after that of the British Pharmacopoeia. U.S.P. Abstracta. Abstracts. — These are dry powdered ex- tracts. They are twice the strength of the crude drug, and about twice the strength of the corresponding fluid extracts. They are prepared by extracting the active principles from 200 parts of the crude drug by per- colation with the strong or diluted alcohol, mixing the percolate with PHARMACEUTICAL PREPARATIONS. 429 some sugar of milk, letting it dry, and then adding sufficient sugar of milk to make up the product to 100 parts. They are eleven in number. DOSE. Abstractum Aconiti *j-l gr. " Belladonnse 5-I gr. " Conii 1-3 grs. " Digitalis J-l gr. " Hyoscyami 2-3 grs. " Ignatise J-lJgr. DOSE. Abstractum Jalapee 5-15 grs. Nucis Vomicse %-2 grs. Podophylli 5-10 grs. " Senegse 1-3 grs. " Valerianae 10-20 grs. Aceta. Vinegars. — These are solutions of medicines in vinegar or acetic acid. In the U.S. P. there are four; in the B.P. there are three. u.s.p. DOSE. Acetum Lobelise 30-60 min. " Opii 10-15 min. " Sanguinarise 3-4 fluid dr. Scilla3 15-60 min. B.P. DOSE. Acetum Cantharidis Scillse 15-60 min. Alkaloidea. Alkaloids. — These are organic bases which may be regarded as compound ammonias. Like ammonia they all contain nitrogen, and form salts with acids. Most of them contain oxygen in addition to nitrogen, carbon, and hydro- gen, and occur as crystalline solids. Some, e.g., conine, nicotine, spar- teine, contain no oxygen, and occur as oily liquids. They generally have a powerful physiological action. They occur in many exogenous plants, but only veratrine and substances nearly allied to it have been obtained from the class of endogens and muscarine from thallogens. They occur in the plants in combination with acids. The alkaloids themselves are generally soluble in alcohol, but sparingly soluble in water. Their salts are more soluble in water. The general plan of pre- paring them is to precipitate them by ammonia from an aqueous solution either of the salt originally present in the plant, or of one formed by treatment with an acid. In the B.P. the names of alkaloid all terminate in "ia," like ammonia, e.g., quinia, strychnia. Neutral principles have the termination "in," e.g., santonin, digitalin. Chemists have now gen- erally returned to the older nomenclature, and assign the termination " ine" to alkaloids, e.g., strychnine, quinine. To neutral principles they give the termination " in," e.g., santonin, digitalin. This terminology has been followed in the U.S.P. U.S.P. Apomorphina (Apomorphine). Atropina (Atropine). Caffeina (Caffeine). Ciuchonidinse Sulphas (Sulphate of Cin- chonidine). Cinchonina (Cinchonine). Codeina (Codeine). Hyoscyaminae Sulphas (Sulphate of Hyos- cyamine). Morphina (Morphine). B.P. Aconitia (Aconitia). Atropia (Atropia). Beberiae Sulphas (Sulphate of Be- beria.) Morphiae Hydrochloras (Hydrochlo- rate of Morphia). Quinise Sulphas (Sulphate of Quinia). Strychnia (Strychnia). Veratria (Veratria). 430 GENEEAL PHARMACY. U.S.P. Physostigminas Salicylas (Salicylate of Physostigmine). Pilocarpine Hydrochloras (Hydrochlorate of Pilocarpine). Peperina (Peperine). Quinidinae Sulphas (Sulphate of Quini- dine). Quinina (Quinine). Strychnina (Strychnine). Veratrina (Veratrine). Chinoidinum (Chinoidin or Quinoidin), U.S.P., is a mixture of bases. Along with the alkaloids may be mentioned several neutral prin- ciples which resemble alkaloids in having a powerful physiological action. U.S.P. B.P. Chrysarobinum (Chrysarobin). Digitalinum (Digitalin). Picrotoxinum (Picrotoxin). Santoninum (Santonin). Salicinum (Salicin). Santoninum (Santonin). Aquae. Waters. (15 in U.S.P. and B.P.) — One is simply water, another distilled water. The others in the B.P. are water containing small quantities of volatile oils in solution, with the exception of two, aquae chloroformi and aquae laurocerasi, which contain chloroform and prussic acid respectively instead of a volatile oil. Two waters are pre- pared by simply dissolving the substances in them in the cold ; these are aqua camphorae and aqua chloroformi. All the rest are prepared by dis- tillation. Two are prepared by distilling the volatile oils with water ; these are peppermint and spearmint waters. All the rest are prepared by distilling the plant in a retort with water and continuing the process until a certain quantity is distilled over. In the U.S.P. aqua ammonias, aqua ammoniae fortior, and aqua chlori consist of solutions of ammoniacal and chlorine gases in water. One, the aqua creasoti, consists of a solution of one part of creasote in 100 of water. The others consist of volatile oils in water. Only two, aqua aurantii florum and aqua rosae, are prepared by distilling the flowers with water. The others are prepared by thoroughly distributing the requi- site quantity of volatile oil through a quantity of cotton, and dissolving it in water, by allowing the latter to percolate through. Camphor is dissolved in alcohol before adding it to the cotton. Waters are chiefly used as vehicles. The dose of all those in the B.P. with one exception is from half an ounce to two ounces. This exception is aquae laurocerasi, which is not used as a vehicle, but is on the contrary a powerful drug containing hydrocyanic acid, and the dose of it is very small, 5-30 minims. Aqua anethi is a favorite remedy for flatulence in children, and in them it is given in a dose of a teaspoonful or more. PHAEMACEUTICAL PREPARATIONS. 431 Aqua u.s.p. (15). DOSE. Destillata Ammoniae 10-30 minims. Ammoniae Fortior.. Amygdalae Amarae .2 drachms. Anisi J-2 oz. Aurantii Flor uni ... " Camphorae " Chlori u Cinnamonii |-2 fluid oz. Creasoti 1-4 drachms. Foeniculi 1-2 fluid oz. Menthae Piperitae.. " Menthae Viridis.... Rosae " Aqua B.P. (15). DOSE. Destillata Anethi ^-2 oz. Aurantii Floris '' Camphorae " Carui " Chloroformi " Cinnamoni " Fceniculi " Laurocerasi 5-30 minims. Menthae Piperitae ...£-2 oz. Menthae Viridis " Pimentae " Rosae " Sambuci '' B.P. Cataplasmata. Cataplasms or Poultices. (6.) — These are used as a means of applying externally moisture and warmth, and in certain cases medicaments, to parts of the body. They consist of linseed meal or of bread crumb, made into a paste with hot water. In one, cata- plasma conii, hemlock leaf is added to relieve pain; in another, cataplasma sinapis, mustard is used to stimulate the skin ; and in the cataplasma carbonis, cataplasma fermenti, and cataplasma sodse chloratae, wood char- coal, yeast, and chlorinated soda respectively, are added for the purpose of removing foetor or acting as disinfectants. Cataplasma Carbonis. " Conii. " Fermenti. Lini. " Sinapis. " Sodae Chloratae. U.S.P. Cerata. Cerates. — These are ointments containing wax. The admixture of wax with oil or lard in cerates renders them harder than ointments, though they are softer than plasters. They can be spread on linen or leather, at ordinary temperatures without requiring heat like plasters, and they can be applied to the skin without melting and running like ointments. Ceratum. TJ.S.P. Camphorae. Cantharidis. Cetacei. Extracti Cantharidis. Plumbi Subacetatis. Eesinae. Sabinae. Chartse. Papers. — Charta epispastica or cantharidis, and charta sinapis consist of irritating substances spread upon paper, and used for the purpose of producing rubefaction or vesication. Charta potasii nitratis consists of bibulous paper soaked in a solution of nitrate of potash and dried, and is used for burning to give relief in asthma by inhalation of the fumes. 432 GENERAL PHARMACY. U.S.P. (3). B.P. (2). Charta Cantharidis. Charta Epispastica. " Potassii Nitratis. " Sinapis. " Sinapis. Collodia. Collodions. — In these collodion is used as a solvent and means of application. U.S.P. B.P. Collodium. Collodium. " cum Cantharide. " Flexile. " Flexile. " Stypticum. Confectiones. Confections, Electuaries or Conserves. — These are soft pastes which contain the drug mixed with sugar or honey, and are convenient forms of administering drugs, which would be unpleasant to take alone, and would be too bulky for pills. In two of them, the confection of dog roses, and of red roses, the drug is of itself inert, and the confection is used only as a vehicle ; in the others, the drug is active, and the confection is used as a mode of administering it. The dose of all is 1 to 2 drachms, with the exception of the confection of opium (B.P.) and of scammony (B.P.). U.S.P. (2). DOSE. B.P. (8). DOSE. Confectio Rosse Confectio Opii 5-20 grs. " Sennse 1-2 dr. " Piperis " Rosse Caninae .. " Rosse Gallicse.. " Scaninionii 10-30 grs. li Sennse " Sulphuris " Terebenthinse. Decocta. Decoctions. — These are made by boiling the drug with water, and then straining while hot. Usually the boiling is continued from ten to twenty minutes, in order to dissolve out the active part of the drug ; prolonged boiling frequently alters it, and may render it inert. U.S.P. (2). DOSE. B.P. (14). DOSE. Decoctum Cetrariae ad lib. Decoctum Aloes Conipositum.^-1 fl. oz. Sarsaparilke Com- positum 4-6 fl. oz. Cetrariae ad lib. Cinchona? Flavie....l-2 fl. oz. Granati Radicis " Hoematoxyli " Hordei ad lib. for external Papaveris 1 t use Pareiroe 1-2 fl. oz. Quercus " Sarsse 2-10 fl. oz. Sarsic Compositum. " Scoparii 2-4 fl. oz. Taraxaci " Ulmi " PHARMACEUTICAL PREPARATIONS. 433 U.S. P. Elixiria. Elixirs. — These are diluted tinctures rendered agreeable by aromatics and sugar. The only one in the U.S. P. is used as a vehicle. ; TJ.S.P. (1). Elixir Aurantii (Simple Elixir). Emplastra. Plasters. — These consist of adhesive substances spread upon leather or cloth, so as to stick to the part of the body to which they are applied. Lead plaster is one of the most important, as it forms a basis for other plasters. It is also used for covering slight wounds and excoria- tions. Resin plaster is more adhesive, and is used to hold the edges of wounds together and to apply pressure. Two others, emplastrum bella- donna and emplastrum opii, contain narcotic substances with the inten- tion of lessening pain locally. The others are used for the purpose of affording mechanical support or gentle stimulation, and emplastrum can- tharidis (B.P.) is used as a vesicant. b.p. (14). Ammoniaci cum Hydrargyro. Belladonna?. Calefaciens (warming). Cantharidis. Cerati Saponis. Ferri. Galbani. Hydrargyri. Opii. Picis. Plumbi. Iodidi. Resinee. Saponis. u.s.p. (17). Emplastrum Ammoniaci ( Ammoniac ) . Emplastrum " " c. Hydrargyro " (ammoniac with mercury). " " Arnicas (Arnica). " " Asafoetidse (Asafoetida). " " Belladonnas (Belladonna). " " Capsici (Capsicum). " " Ferri (Iron). " " Galbani (Galbanum). " " Hydrargyri (Mercurial). " " Icthyocollae (Court). " " Opii (Opium). " " Picis Burgundicse (Burgundy " pitch). " " Picis Canadensis (Hemlock pitch). " Picis cum Cantharide (warm- ing). " Plumbi (Diachylon). " Resinse (adhesive). " Saponis (soap). B.P. Enemata. Injections, Enemas, or Clysters. — These are preparations for injection into the rectum. When the quantity injected is large, and especially if cold, it is usually returned almost immediately ; therefore, when we wish to get it retained, a small quan- tity only, and warm, must be employed. The vehicle in most injections is starch mucilage. In the enema of aloes 10 ounces, and in those of Epsom salts and of turpentine, 15 ounces of the vehicle are used, and these enemata are employed for the purpose of evacuating the bowel. In the case of the enema opii which we wish to be retained the quantity is only 2 ounces. This is used both as a local and general sedative, in order to relieve pain in or about the pelvis, or to produce the general action of opium after its absorption, in eases where medicines cannot be retained by the stomach, or when it is inadvisable to administer them by the mouth. The enema asafcetidae is perhaps the most powerful remedy 28 434 GENERAL PHARMACY. we possess in cases of tympanitic distention of the bowels. As it is used for the purpose of exciting the contraction of the bowels and the expul- sion of flatulence, but not of simply evacuating the rectum, an interme- diate quantity is used, viz., 4 ounces. Asafoetidsfcontains a gum as well as a resin, and therefore no mucilage is required to suspend it, and water only is required in preparing it. The enema of tobacco is now rarely used on account of the danger from collapse ; but formerly, before the introduction of chloroform, it was frequently employed in order to cause muscular relaxation and aid in the reduction of hernia. b.p. (6). NONE IN U.S.P. Enema Aloes (aloes 40 grains, carbonate of potash 15 grains). " Magnesias Sulphatis (sulphate of magnesia 1 oz., olive oil 1 fi. oz.). " Opii (tincture of opium \ fl. dr.). " Terebinthinse (oil of turpentine 1 fi. oz.). " Asafoetidae (asafcetida, 30 gr., water 4 A. oz.). " Tabaci (leaf tobacco 20 gr., water 8 fi. oz.). B.P. Essentise. Essences. — These are strong solutions of 1 part volatile oil in 4 of rectified spirit. They are used as carminatives, and are usually given in the form of a few drops on a piece of lump sugar or with a little hot sugar and water, in order to remove flatulence. B.P. (2). DOSE. Essentia Anisi 10-20 m. " Menthae Piperita 10-20 m. Extracta. Extracts. — Extracts consist of the soluble parts of plants reduced to the consistence of a thick paste by extraction and evaporation. The plan of treatment adopted in order to extract the soluble parts, and leave behind the woody fibre and other inert constitu- ents varies, according as the plant is fresh or dry. From fresh plants, green extracts (B.P.) are obtained by evaporation of the fresh juice after removal of the coagulable albumen. From dried plants the active principles are removed by treatment with cold or boil- ing water, with spirit, ether, or acetic acid, and the solutions thus obtained are evaporated to a consistence suitable for making pills, or else to dryness. Where the active principles are of a resinous or alkaloidal nature, and are more soluble in pure than in dilute spirit, alcohol or rectified spirit is used; in other cases dilute alcohol or proof spirit is employed. Where the drug contains more than one active substance and one is more soluble in spirit, and the other in water, both spirit and water are used. In order to prevent extracts which, when freshly prepared, are of a proper consistence for making pills, from becoming too dry and hard by keeping, the U.S.P. in several instances directs them to be mixed with 5 per cent, of glycerine. U.S.P. (31). DOSE. B.P. (29). DOSE. Extractum Aconiti \-\ gr. Extractum Aconiti 1-2 gr. " Aloes Aquosum 2-10 gr. " Aloes Barbadensis 2-6 gr. " Arnica; Radicis 3-5 gr. " " Socotrinae " " Belladonna; Alco- ) , " Anthemidis 2-10 gr. holicum /* gn " Belladonnas \-\ gr. PHARMACEUTICAL PREPARATIONS. 435 U.S.P. (31). DOSE. Extractum Cannabis Indicse i gr. Cinchonae 10-30 gr. Colchici Radicis 1-2 gr. Colocynthidis J-l gr. " Com- 1 positum j & Conii Alcoholicum ^-1 gr. Digitalis £ gr. Ergotae 5-15 gr. Euonymi 1-3 gr. Gentianae 10-30 gr. Glycyrrhizae Purum... Haematoxyli 10-30 gr . Hyoscyami Alco- \ 12 holicum j s Iridis 1-2 gr. Juglandis 5-10 gr. Krameriae 10-20 gr. Leptandrae 20-30 gr. Malti 1-4 dr. Mezerei Nucis Vomicae ^-2 gr. Opii j-1 gr. Podophylli 1-3 gr. Physostigmatis T V -i gr. Quassiae 1-2 gr. Rhei 5-10 gr. Stramonii J-4 gr. Taraxaci 20-60 gr. B.P. (29). DOSE. Extractum Calunibae 2-10 gr. " Cannabis Indicse J-l gr. " Colchici J-2 gr. " " Aceticum " " Colocynthidis Com- 1 o -1 n positum J " ^ r * " Conii 2-6 gr. " Gentianas 2-10 gr. Glycyrrhizae 10-30 gr. " Haematoxyli " " Hyoscyami 5-10 gr. " Jalapa3 5-15 gr. " Krarueriae 5-20 gr. " Lactucae 5-15 gr. Lupuli ' Mezerei iEthereum.... " Nucis Vomicae 2-2 gr. Opii " Papaveris 2-5 gr. " Pareirae 10-20 gr. " Physostigmatis T V? gr. " Quassiae 3-5 gr. " Rhei 5-15 gr. " Stramonii £-§ gr. " Taraxaci 5-30 gr. Fluid u.s.p. oe Liquid b.p. Extracts. — These are made like watery extracts, excepting that instead of evaporating the infusion, decoction or alcoholic solution (U.S.P.) to a solid paste, it is only reduced to a small bulk, and in the B.P. some spirit is added to it in order to prevent decomposition. U..S.P. (79). DOSE. Extractum Aconiti Fluidum §-1 m. (0*03-0'06 c.c.) " Arnicae Radicis Fluidum 5-10 m. (0'3-0'6 c.c.) " Aromaticum " 10-20 m. (0'6-l'25 c.c.) " Aurantii Amari " 15-30 m. (0'9-l'9 c.c.) Belladonnae " 1-2 m. (0'06-0\L2 c.c.) Brayerae " |-1 fl. oz. (15-30 c.c.) Buchu " 30-60 m. (1-9-38 c.c.) Calami " 5-15 m. (0-3-0'9 c.c.) Calumbae " 15-30 m. (09-19 c.c.) " Cannabis Indicae " £-1 m. (0-03-0-06 c.c.) Capsici " ^-1 m. (0-03-0-06 c.c.) Castanet " 1-2 fl. dr. (3'75-7'5 c.c.) Chimaphilae " 1 fl. dr. (3'75 c.c.) Chiratae " J fl. dr. (P9 c.c.) Cimicifugae " |-1 fl. dr. (l'9-3'75 c.c.) Cinchonae " J-2 fl. oz. (7*5-60 c.c.) " Colchici Radicis " 2-8 m. (0-12-0*5 c.c. " Colchici Seminis " 2-8 m. (0'1 2-0*5 c.c. Conii " 5 m. (03 c.c.) Cornus " 30 m. (1*9 c.c.) " Cubebae " 10-40 m. (0.6-25 c.c.) " Cypripedii " 15 m. (0-9 c.c.) " Digitalis " 1-2 m. (0'06-0'12 c.c.) " Dulcamarae " 30-60 m (19-3-75 c.c.) 436 GENERAL PHARMACY. u.s.p. (79). Extractum Ergotae Erythroxyli Eucalypti Eupatorii Frangulae Gelsemii Gentianae Geranii Glycyrrhizae Gossypii Radicis Grindeliae Guaranae Hamamelidis Hydrastis Hyoscyami Ipecacuanha? Iridis Krameriae Lactucarii Leptandrae Lobeliae Lupulini Maticae Mezerei Nucis Vomicae Pareirae Pilocarpi Podophylli Pruni Virginianae Quassiae Rhei Rhois Glabrae Rosae Rubi Rumicis Sabinae Sanguinariae Sarsaparillae DOSE. ,f-t jul. ur. (19-15 c.c.) .20-60 m. (1-25-3-75 c.c.) .5-10 m. (0-3-06 c.c.) .20-60 in. (1-25-3-75 c.c.) 10-20 m. (0-6-1-25 c.c) .2-3 m. (012-0-18 c.c.) .10-30 m. (0-6-1-9 c.c.) .30-60 m. (1-9-3-75 c.c. .30-120 m. (1-9-7-5 c.c. .30-60 m. (1-9-3-75 c.c.) .30-60 m. (1-9-3-75 c.c.) .1-2 fl. dr. (375-7-5 c.c.) .30 m. (1-9 c.c.) .1-2 fl. dr. (3-75-7-5 c.c.) .5 m. (03 c. c.) .15-30 (0-9-1-9 c.c.) .5-10 m. (0-3-06 c.c ) .10-60 m. (0-6-3-75 c.c.) .5-30 m. (0-3-1-9 c.c.) .20-60 m. (1-25-3-75 c.c.) .10-20 m. (0-6-1-25 c.c.) .10-15 m. (0-6-0-9 c.c.) .30-60 m. (1-9-375 c.c.) .for external use. .3-5 m. (0-18-0-3 c.c.) .1-2 fl. dr. (375-7-5 c.c.) .15-30 m. (0-9-1-9 c.c.) .5-15 m. (0-3-0-9 c.c.) .30-60 m. (1-9-3-75 c.c.) .5-10 m. (03-0-6 c.c.) .5-30 m. (03-19 c.c.) .for external use. .1-2 fl. dr. (375-7-5 c.c.) .H fl. dr. (1-9-3-75 c.c.) .1 fl. dr (3-75 c.c.) .3-8 m. (0.18-0-5 c.c.) .3-5 m. (0-18-0-3 c.c.) .2-4 fl. dr. (7.5-15 c.c.) Sarsaparillae Compositum Fluidum 30-60 (19-3-75 c.c.) Scillse Scutellariae Senegae Sennae Serpentariae Spigelian Stillingiae Stramonii Taraxaci Tritici Uvx- Ursi Valerianae Veratri Viridis Viburni Xanthoxyli Zingiberis .1-3 m. (0-12-0-18 c.c.) ..30-60 in. (1-9-3-75 c.c.) ..1-5 m. (006-03 c.c.) ..1-4 fl. dr. (3-75-15 c.c.) ..20-30 m. (1-25-1-9 c.c.) ..1-2 fl. dr. (3-75-7'5 c.c.) ..15-45 in. (0-9-2-8 c.c.) ..1-2 m. (006-0-12 c.c.) .1-3 fl. dr. (3-75-11-25 c.c.) .3-6 fl. dr. (1125-22-5 c.c.) ..30-60 m. (19-3-75 c.c. .lfl. dr. (3-75 cc.) .1-2 m. (006-0-12 c.c.) ..30-60 m. (1-9-3-75 c.c.) ..30-60 m. 1-9-3-75 c.c.) ..10-20 m. (06-1-25 c.c.) B.l\ (8). DOSE. Extractum P>elae Liquidum 1-2 fluid drachms. Cinchona; Flavae Liquidum 10-XU minims. Ergotae Filicis Glycyrrhizae Opii Pareirae Sarsa? K»-3ii minims. .15-60 minims. .60- 120 minims. .10-40 minims. .o-2 fluid drachms. .2-4 fluid drachms. PHAEMACEUTICAL PREPARATIONS. 437 b.p. Fresh or Green Extracts — These extracts have already been enu- merated among the others. In preparing them, the juice obtained from the fresh leaves, flowering tops or fruits, of the plant, by pres- sure, is heated to 130° F. to coagulate the green coloring matter. This is then filtered off and laid aside. The filtrate is next heated to 200° so as to coagulate the albumen ; this is filtered out and thrown away. The filtrate is then evaporated at a temperature not exceeding 140° to a thin syrup. The coloring matter is then added to it, and the whole evaporated to a proper consistence. In the case of extracts of col- chicum and taraxacum there is no chlorophyll to separate, as the juices are obtained by expression from the colchicum corm and the taraxacum root, and not from flowering tops. Consequently the juice is at once heated to the boiling point to coagulate the albumen, and after this has been filtered out the filtrate is evaporated at a temperature of 160°. In the case of green extracts, the preservation of the green color is usually regarded as a sign that they are good. It certainly indicates that the first and the last parts of the process have been conducted with care, as too high a temperature destroys the green color. It is therefore probable that the whole process may have been carefully done ; but this is not cer- tain, for the juice may have been exposed to a high temperature, and thus injured during its evaporation after the chlorophyll has been removed and before it has been again added. The green extracts of the B.P. are (8): — Extractum Aconiti. Extractum Colchici Aceticum. Extractum Lactucse. Belladonnas " Conii. " Taraxaci. " Colchici. " Hyoscyami. Glycerita, U.S. P. ; Glycerina, B.P. Glycerines. — These are solutions of soothing, astringent, or antiseptic substances in glycerine. Glycerine being thick and adhesive, they form most useful local applica- tions, either to the skin or mucous membranes. Those in the B.P. contain one part of the drug by weight to four of glycerine by measure, excepting in the case of starch, which being very light and bulky, is used in only half this proportion, i.e., one ounce of starch to eight ounces of glycerine. In the U.S. P. the starch is in the proportion of 1 to 9, i.e., 10 per cent. The glyceritum vitelli contains 45 parts fresh yolk of egg to 55 of glycerine. TJ.S.P. (3). B.P. (6). Glycerinum. Glycerinum. Glyceritum Amyli. " Acidi Carbolici. " Vitelli. " " Gallici. " " Tannici. " Amyli. " Boracis. Infusa. Infusions. — These are prepared by simply pouring boil- ing water on the drug and allowing it to stand for a short time and then straining. There are two exceptions to this rule, calumba and quassia, which are prepared with cold water. The reason for using cold water in the case -138 GENERAL PHARMACY. of calumba is that the root contains a quantity of starch, and if hot water be used, this is extracted and renders the infusion liable to decompose, especially in hot weather. I have been unable to find any definite reason assigned for using cold water in the preparation of infusion of quassia, excepting that cold water is sufficient to dissolve the active principle. In the only instance in which I have seen an infusion made with hot water used, it caused vomiting, so that perhaps an infusion made with hot water has a more irritating action than that made with cold. Infusions of chiretta and cusparia are made with water at 120° instead of boiling water, as they are more agreeable when prepared in this way. The infusions of substances not specified in the U.S. P. are directed by it to be prepared by taking ten parts of the substance in coarse pow- der and 100 of boiling water. These are to be put into a vessel with a tight cover, and allowed to stand for two hours. The infusion is then strained, and enough water passed through the strainer to make the pro- duct weigh 100 parts. All the infusions both of the U.S. P. and B.P. are strained, with the exception of the infusion of cusso or brayera. TJ.S.P. (5). DOSE. B.P. (28). Of all not specified 1-2 fl. oz. Infusum Brayerae (Cusso) 10 oz. Infusum Anthemidis 1-4 fl. oz. " Cinchonae 2 oz. " Aurantii " Digitalis % oz.* " " Compositum " Pruni Virginianae...2-3 oz. " Buchu 1-4 fl. oz. " Sennas Compositum, 4 fl. oz. " Calumbae " Caryophylli " Cascarillae " Catechu " Chiratse " Cinchonae Fluidum.. " Cuspariae " Cusso (Brayera an-) . Q a ^„ thelmiutica) }4-8fl.oz. " Digitalis 1-4 fl. dr. " Dulcamarae " Ergotae " Gentian* Compos- 1 itum I " Kramerine " Lini " Lupuli " Maticrc " Quassia; Rhei " Rosa* Acidum " Senega* " Senna? " Serpentaria* Uvae Ursi Valeriana- * This infusion is about twice the strength of the B.P. The dose is usually stated at \ oz. twice a day, but in many cases this dose would probably prove too large, and it is safer to begin with a smaller dose, and gradually push it as the patient will stand it. PHARMACEUTICAL PREPARATIONS. 439 B.P. Injectio Hypodermica. Hypodermic Injection. — There is only one, that of acetate of morphia, used simply for injecting under the skin. It is 10 times stronger than the liquor morphiae ace- tatis, and contains 40 grains to the fluid ounce or 1 grain in 12 minims. B.P. DOSE. Injectio Morphise Hypodermica 2-3 minims. Linimenta. Liniments or Embrocations. — These are prepara- tions for rubbing or painting on a part of the body in order to produce local stimulation or relieve pain. The basis of most of those in the United States Pharmacopoeia is cotton-seed oil, and of those in the British Phar- macopoeia olive oil. 1 Camphor is added to most of the liniments in the B.P. for its local stimulant action, and also that its strong smell may les- sen the risk of the liniment being used internally. There are four excep- tions in the B.P., the liniments of ammonia, lime, croton oil, and iodide of potassium with soap. With the exception of the liniment of lime all these contain very strong smelling substances, namely, ammonia in the corresponding liniment, cajuput oil in the croton oil liniment, and oil of lemon in the iodide of potassium and soap liniment. Camphor is not contained in the liniments of the U.S. P., with the exceptions of the liniments of belladonna, camphor, chloroform and soap. Soap is used to give a lubricating quality to two liniments in the U.S. P., viz., chloroform and soap, and to four in the B.P., viz., opium, iodide of potassium with soap, soap and turpentine. In the compound mustard liniment, whose composition is nearly the same in the U.S. P. and the B.P., castor oil is used as a lubricant along with alcohol. In one, the turpentine liniment of the U.S. P., the lubricating substances are lard and yellow wax. One liniment in the U.S. P., belladonna, and three in the B.P., aconite, belladonna, and iodine, are really exceedingly strong solutions of active principles in spirit with camphor added for the purposes already mentioned. The liniments last mentioned contain no fatty substances as lubricants, nor does the linimentum cantharidis (U.S. P.), nor the croton oil liniment of the B.P., compound camphor liniment (B.P.). Croton oil liniment (B.P.) is a solution of croton oil with cajuput oil in spirit. The compound camphor liniment is a mixture of strong solution of ammonia with rectified spirit, camphor and oil of lavender. The linimentum cantharidis (U.S. P.) is a solution of the active princi- ples of cantharides in turpentine. The difference in composition between the ordinary camphor liniment (B.P.), which is simply a mixture of camphor and olive oil, and the compound camphor liniment, should be carefully borne in mind. The linimentum terebinthinse aceticum (B.P.) consists of oil of turpentine and acetic acid mixed with ordinary camphor liniment. But if any one thinking to increase its efficacy should add to it compound camphor liniment, the acetic acid and ammonia would neutralize one another more or less completely, and the activity of both liniments would be to a great extent destroyed. 1 1 have been told that a great deal of what is sold as olive oil in Great Britain is really cotton-seed oil. uo GENERAL PHARMACY. U.S. P. Linimentum Ammonia?. B.P. Linimentum Aconiti. Belladonna?. Caleis. Camphora?. Cantharidis. Chloroformi. Plumbi Subacetatis. Saponis. Sinapis Compositum. Terebinthina?. Ammonia?. Belladonna?. Caleis. Camphora?. Camphora? Compositum. Chloroformi. Crotonis. Hydrargyri. Iodi. Opii. Potassii Iodidi cum Sapone. Saponis. Sinapis Compositum. Terebinthina?. Terebinthina? Aceticum. Liquores. Solutions. — These are solutions of active substances in water, either alone or with the aid of other solvents. U.S. P. DOSE. Liquor Acidi Arseniosi 2-8 m. " Ammonii Acetatis j-l^ oz. " Arsenici et Hydrar- \ - 1n gyri Iodidi |5-lUm. " Caleis 2-4 fl. oz. " Ferri Acetatis 2-10 m. " Chloridi " " " Citratis 10 m. " rt 2£r. *}««•■»• " Nitratis 5-20 m. " Subsulphatis 3-6 m. " Tersulphatis ... " Gutta-Percha? " Hydrargyri Nitratis " Iodi Compositus 5 m. " Magnesii Citratis 6-12 fl. oz. " Pepsini £-2 fl. oz. " Plumbi Subacetatis " Subacetatis Dilutus... " Potassii 10-60 m. " Arsenitis 5 m. " Citratis £-2 fl. oz. " Soda? 10-60 m. " Soda? Chlorata? 30-60 m. " Sodii Arseniatis 3-8 m. " " Silicatis " Zinci Chloridi b.p. (39). DOSE. Liquor Ammonia? 10-30 m. " " Acetatis 2-6fl.dr. Citratis " " " Fortior 3-10 m. " Antimonii Chloridi " Arsenicalis 2-8 m. " Arsenici Hydrochlo- \ « ricus j " Atropia? 1-2 m. " Atropia? Sulphatis " " Bismuthi et Ammo- | iifl a t nia? Citratis J 2 " " Caleis 1-4 fl. oz. " Caleis Chlorata? " " Saccharatus 15-60 m. " Chlori 10-20 m. " Epispasticus " Ferri Perchloridi 10-30 m. " " " Fortior <; " Pernitratis " '* Persulphatis " Gutta-Percha " Hydrargyri Nitratis Acidus " Hydrargyri Perchloridi £-2 fl. dr. " Iodi " Lithia? Effervescens 5-10 fl. oz. " Magnesia? Carbonatis....l-2 fl. oz. 11 Citratis 5-10 fl. oz. " Morphia? Acetatis 10-60 m. Hydrochlo- \ ratis j " Plumbi Subacetatis " " Dilutus.. " Potassa? " 11 " Effervescens 5-10 fl. oz. " " Permanganatis..l-4 fl. dr. " Soda? 10-60 m. " " Arseniatis 5-10 m. " " Chlorate 10-20 m. " Effervescens 5-10 fl. oz. " Strychnia' 5-10 m. " Zinci Chloridi PHARMACEUTICAL PREPARATIONS. 441 U.S. P. Massae. Masses. — These simply consist of substances mixed together to a consistence suitable for making pills. Massa Copaibse. " Ferri Carbonatis. " Hydrargyri. Mellita. Honeys. — In these preparations honey is used as a vehicle. Oxymel and oxymel scillse of the B.P., which contain acetic acid, may be regarded as belonging to this class. U.S.P. B.P. Mel Despumatum. Mel Boracis. " Kosae. " Depuratum. Oxymel. Scillse. Misturse. Mixtukes. — These usually consist of insoluble sub- stances simply mixed with water or suspended in it by the aid of gum or other viscid substances. In almond (U.S.P and B.P.), chalk (U.S.P. and B.P.), guaiac (B.P.), and compound glycyrrhiza (U.S.P.) mix- tures, gum is added. In the ammoniacum (U.S.P. and B.P.), asafoetida (U.S.P.), and compound iron (U.S.P. and B.P.) mixtures, gum is con- tained in the ammoniacum, asafoetida, and myrrh used in their preparation respectively. In scammony mixture (B.P.) the scammony resin is simply suspended in milk. In egg flip or brandy mixture (mistura spiritus vini gallici) (B.P.) and chloroform mixture (U.S.P.), yolk of egg forms the basis of the mixture. The magnesia and asafoetida, 1 and rhubarb and soda mixtures of the U.S.P. contain insoluble substances mixed with water without the addi- tion of any viscid substance; in the creasote mixture (B.P.) the syrup may be looked upon as viscid and tending to keep the ingredients mixed, but the aromatic iron, compound gentian, and compound senna mixtures of the B.P., and the acetate of iron and ammonia (U.S.P.) mixture, are simply solutions and not mixtures in the usual sense. U.S.P. (11). DOSE. B.P. (11). DOSE. Mistura Ammoniaci £-1 fl. oz. Mistura Ammoniaci \-\ A- oz. " Amygdalae 1-2 fl. oz. " Amygdalae 1-2 fl. oz. " Asafoetidse ^-1 fl. oz. " Creasoti " " Chloroformi " " Cretan " " Creta3 1-2 fl. oz. " Ferri Aromatica " " Ferri Composite " " Composita " " " etAmmonii ) l1fl " Gentianae |-1 fl. oz. Acetatis f 2_1 n ' oz " " Guaiaci £-2 fl. oz. Glycyrrhizae Com- \ L " Scammonii. posita J 2 ' Sennae Composita 1-2 fl. oz. Magnesise et Asafce- \ oft " Spiritus Vini Gallici.... tidas r um> Potassii Citratis J fl. oz. Rhei et Sodae ^-1 dr. 1 In this mixture there is no gum, for although it is contained in crude asafoetida it is not contained in the tincture of asafoetida used in this preparation. 442 GENERAL PHARMACY. 3Iueilagines. Mucilages. — These are thick solutions, partial or complete, of gurn or starch, which are convenient for suspending heavy powders in mixtures. u.s.p. (5). b.p. (3). Mucilago Acaciae. Mucilago Acaciae. " Cydonii. " Amyli. " Sassafras Medullar " Tragacanthse. " Tragacanthse. Ulmi. Olea. Oils. — These are divided into fixed and volatile. The fixed are obtained by simple expression ; the volatile by distillation excepting in the case of oil of lemons, which, being contained in distinct vittse in the rind, may be expressed instead of being distilled. Fixed Oils. U.S.P. (11). DOSE. B.P. (9). DOSE. Oleum Adi pis Oleum Amygdalae 1-4 fl. dr. " Amygdalae Expressum.... 1-8 fl. dr. " Crotonis (croton oil) fl min. " Gossypii Se minis " Lini " Lini " Morrhuae 1-8 fl. dr. " Morrhuae 2-4fl. oz. " My risticae Expressum.... " Olivae " Olivae " " Phosphoratum 1-5 min. " Phosphoratum 5-10 min. " Eicini 1-8 fl. dr. " Ricini 1-8 fl. dr. " Sesami " Theobromae " Theobromae " Tiglii (croton oil) |-1. min. Volatile Oils. U.S.P. DOSE OF EACH. Oleum ^thereum 1-5 m. unless otherwise mentioned. " Amygdalae Amarae |-1 min. (0-016-0-06 c.c.) " Anisi 5-15 min. (0'3-0'9 c.c.) " Aurantii Corticis " Florum " Bergamii Cajuputi 5-20 min. (03-1 25 c.c.) Cari 1-10 min. (006-06 c.c.) Caryophvlli 2-6 min. (012-036 c.c.) Chenopodii 4-8 min. for a child (025-05 c.c.) " Cinnamomi 1-3 min. (006-018 c.c.) " Copaibie 10-15 min. (06-09 c.c.) " Coriandri Cubebie 10-12 min. at first (0*6 or 072 c.c.) gradually increased. " Erigerontis 10 min. 4 fluid drachm (06-018 c.c.) Eucalypti 10-15 min. (06-09 c.c.) " Fo3niculi 5-15 min. (03-09 c.c.) " Gaultherine Hedeoma: (penny royal) 2-10 min. (012-06 c.c.) Juniperi 5-15 min. (03-0-9c.c.) " Lavandulae 1-5 min. (006-03 c.c.) Florum " Limonis Menthoe Pi]»crit;r 2-6 min. (012-036 c.c.) " Viridis 2-6 min. (006-036 c.c.) PHARMACEUTICAL PREPARATIONS. 443 U.S.P. DOSE OF EACH. Oleum Myrcise 1-5 m. unless otherwise mentioned. " Myristicse 2-3 min. (012-0-18 c.c.) " Picis Liquidse " Pimentse 3-6 min. (0*18-0-35 c.c.) " Rosse " Rosmarini 3-6 min. (0-18-0'36 c.c.) " Rutae 2-5 min. (012-0-3 c.c.) " Sabinse 2-5 min. (012-0 "3 c.c.) " Santali 20-30 min. (1'25-1'9 c.c.) u Sassafras 3-5 min. (018-0'3 c.c.) " Sinapis Volatile " Succini 5-15 min. (03-0'9 c.c.) " Terebinthinse 5-30 min. (03-l'9 c.c.) " Thymi " Valeriana3 4-5 min. (0'24-0'3 c.c.) § Volatile Oils. B.P. (22). DOSE OF EACH. Oleum Anethi 1-5 m. unless otherwise mentio " Anisi " Anthemidis " Cajuputi 11 Carui " Caryophylli " Cinnamomi " Copaibse 5-20 min. " Coriandri " Cubeba3 5-20 min. " Juniperi 1-10 min. " Lavandulae " Limonis " Mentha3 Piperita? " Viridis " Myristica3 " Pimenti " Rosmarini " Rut83 " Sabinas " Sinapis For external use only. " Terebinthinas 10-20 m. as diuretic, 2-6 n. dr. as anthelmintic. U.S.P. Oleata. Oleates. — Solutions of bases in oleic acid. They are more readily absorbed by the skin than ointments. U.S.P. Oleatum Hydrargyri. " Veratrinse. U.S.P. Oleoresinse. Oleoresins. — These are, as their name im- plies, mixtures of volatile oil and resin. They are extracted by treating the crude substance with stronger ether, and removing the ether partly by distillation and partly by evaporation. Their advantage is that they remain in a liquid or semi-liquid state, and are stable, not requiring alco- hol to prevent decomposition. U.S.P. DOSE. Oleoresina Aspidii ?-l fl. dr.(r9-3*75 c.c.) " Capsici i-1 min. (0"015-006 c.c.) Cubebse 5-30 min. (0*3-l*9 c.c.) Lupulini 2-5 gr. (013-033 gm.) " Piperis H min. (0'015-0-06 c.c.) " Zingiberis T V1 min. (0'006-0'06 c.c.) 444 GENERAL PHARMACY. Oxymel, vide Mellita. Pilulae. Pills. — Pills are small round masses which can be con- veniently swallowed. They are rarely made of a greater weight than five grains, as they then become too bulky to be swallowed easily. Those of the U.S. P. are four grains each. In their composition the old rule of curare, cito, tute et jucunde, has been pretty strictly followed, and most of them in addition to the basis contain an adjuvant, corrective, and vehicle. To prevent them sticking together they are generally shaken with some dry powder, such as lycopodium, carbonate of magnesia, flour, starch, or liquorice powder. Sometimes they are gilt or silvered by shaking them while freshly prepared, and without the addition of any dusting powder, along with gold or silver leaf in a hollow spherical wooden box. Recently a coating of firm gelatine has been used, and sometimes pills are coated with sugar. « U.S.P. DOSE. Pilulae Aloes 1-5 pills. " Aloes et Asafoetidae 2-5 pills. 11 " et Ferri 1-3 pills. " " etMastiches 1 pill. " et Myrrhae 3-6 pills. " Antimonii Compositae 1-2 pills. " Asafcetidae 1 pill. " Catharticae Compositae 1-3 pills. " Ferri Compositae 2-6 pills. " Iodidi 1 pill. " Galbani Compositae 2-4 pills. " Opii.' 1 pill. " Phosphori 1-2 pills. " Rhei 1-6 pills. " " Compositae 2-4 pills. B.P. DOSE. Dose 5-10 grs. with the exception of those mentioned. Pilula Aloes Barbadensis " Aloes et Asafcetidae " et Ferri " " et Myrrhae " " Socotrinae " Asafoetidae Composita " Cambogiae Composita " Colocynthidis Composita " " et Hyoscyami " Conii Composita " Ferri Carbonatis " Iodidi 3-8 grs. " Hydrargyri 3-8 grs. " Hydrargyri Subchloridi Composita " Ipecacuanhas cum Scilla " Phosphori 2-5 grs. " Plumbi cum Opio 2-5 grs. " Quiniai 2-10 grs. " Rhei Composita " Saponis Composita 2-5 grs. " Scammonii Composita 5-15 grs. " Scilla- Composita Pulvercs. Powders. — The officinal powders contain two or more substances triturated and mixed together. The fineness of powders is PHARMACEUTICAL PREPARATIONS. 445 ascertained by the size of the meshes of the sieve through which they pass. TJ.S.P. (9). DOSE. Pulvis Antimonialis 3-8 grs. (0-2-0 '52 gm.) " Aromaticus 10-30 grs. (0-65-195 gm.) " Cretse Compositus 10-30 grs. (065-1-95 gm.) " Effer vescens Compositus One powder. " Glycyrrhizse Compositus 30-60 grs. (l'95-3*9 gm.) " Ipecacuanha? et Opii 5-15 grs. (0 33-1 gm.) " Jalapse Compositus 30-60 grs. (l'95-3'9 gm.) " Morphinse Compositus 10 grs. (0"65 gm.) " Rhei Compositus 30-60 grs. (1-95-3-9 gm.) b.p. (15). DOSE. Pulvis Amygdalae Compositus 60-120 grs. " Antimonialis 3-10 grs. " Catechu Compositus 20-40 grs. " Cinnamomi Compositus 3-10 grs. " Cretse Aromaticus 10-60 grs. " " Aromaticus cum Opio 10-40 grs. " Elaterii Compositus h-5 grs. '' Glycyrrhizse Compositus 30-60 grs. k ' Ipecacuanha? Compositus 5-15 grs. " Jalapse Compositus 20-60 grs. " Kino Compositus 5-20 grs. " Opii Compositus 2-5 grs. " Rhei Compositus 20-60 grs. " Scammonii Compositus 10-20 grs. " Tragacanthse Compositus 20-60 grs. Resina. Resins. — These are brittle, amorphous solids, consisting of an acid or mixtures of acids formed by the oxidation of terpenes which are volatile hydrocarbons having the formula C 10 H 16 . Resins are insoluble in water but soluble in spirit. They melt when heated and solidify again on cooling. They dissolve in alkalies, forming a kind of soap. They frequently occur in plants along with unoxidized volatile oils as oleo- resins. Resins may be obtained from oleo-resins, e.g., turpentine, by simple distillation, when the volatile oil distils over and resin remains. They may be got by heating the part of the plant in which they are contained, e.g., guaiac resin. They may be prepared by dissolving them out of the plants by means of alcohol and removing the alcohol by distillation, or precipitating them by throwing the strong tincture into water. Resins are of an acid nature, and the addition of a little mineral acid to water causes them to be precipitated more readily. U.S.P. B.P. Resina Copaibae. Resina. " Jalapse. " Guiaci. " Podophylli. " Jalapse. " Scammonii. " Podophylli. Guaiaci Resina. " Scammonise. Spiritus. Spirits. — With the exception of rectified and proof spirit, these are alcoholic solutions of volatile oils or ethers. The dose is \ to 1 fluid drachm, except where otherwise mentioned, and except in the case of brandy, rum, and whisky, the doses of which vary very much, according to the purpose for which they are used. 446 GENERAL PHARMACY. U.S.P. (22). DOSE. Spiritus iEtheris 1-3 fluid drachms (3*75-11*25 c.c.) " " Compositus $-2 fluid drachms (TO-7'5 c.c.) " Nitrosi 30-60 min. (1*9-3*75 c.c.) " Ammonia? 10-30 min. (0*6-1*9 c.c.) 11 " Aromaticus 30-60 min. (1*9-3*75 cc.) " Anisi 1-2 fluid drachms (3-75-75 c.c.) Aurantii 1-2 fl. dr. (3*75-7*5 c.c.) " Camphora? 5-60 min. (0*3-3*75 c.c.) Chloroformi 10-60 min. (0 6-3*75 c.c.) " Cinnamonii 10-20 min. (0*6-1*26 c.c.) " Frumenti (Whisky) Gaultheria? 10-20 min. (0*6-1*25 c.c.) " Juniperi 30-60 min. (1*9-3*75 c.c.) " Compositus 2-4 fluid drachms (7*5-15 c.c.) " Lavandulae 30-60 min. (1*9-3*75 c.c.) " Limonis " Mentha? Piperita? 10-20 min. (0*6-1*25 c.c) Viridis 30-40 min. (1*9-2*5 c.c.) " Myrcia? (Bay Rum) " Myristica? 1 fluid drachm (3*75 c.c.) ■* Odoratus (Cologne- Water)... " Vini Gallici B.P. (16). DOSE. Spiritus iEtheris " Nitrosi £-2 fluid drachms. " Ammonia? Aromaticus " '* Foetidus " Armoracia? Compositus 1-2 fluid drachms. " Cajuputi " Camphora? 10-30 min. " Chloroformi 10-60 min. " Juniperi \-l\ fluid drachms. ■' Lavandula? " Mentha? Piperita? " Myristica? " Rectificatus " Rosmarini 10-60 min. " Tenuior " Vini Gallici Suppositoria. Suppositories. — These are small conical masses for introducing drugs into the rectum. They are used either to produce a local action on the rectum itself, or on the adjoining pelvic organs, such as the uterus or the bladder ; or to introduce certain drugs into the body when we wish to avoid any local action on the stomach. Thus the morphia suppositories may be used for their general action in inducing sleep, or for their local action in soothing pain or irritation in the rectum or pelvic organs, or to check diarrhoea. The compound lead suppository may be used in diarrhoea for its local action on the rectum, and likewise for its general action in checking bleeding from the lungs, etc. The same may be said of the mercurial suppository. The others are more intended for local action. B.P. (7). Suppositoria Acidi Carbolici cum Sapone. " " Tannici. " cum Sapone. Hydrargyri. " Morphia?. " cum Sapone. " Plumbi Composita. PHARMACEUTICAL PREPARATIONS. 447 In the U.S. P. no special suppositories are named, but a formula is given for their preparation. The quantity of the medicine required, brought to a proper consistency if necessary, is to be mixed with a small quantity of oil of theobroma by rubbing together, and then sufficient oil of theobroma previously melted and cooled to the temperature of 35° C. (95° F.) is to be mixed thoroughly with it, and immediately poured into suitable moulds cooled by ice. In the absence of moulds the mass is to be divided into parts of a definite weight, which are to be made into a convenient form for a suppository. Unless otherwise specified, they should weigh fifteen grains or one gramme. B.P. Succi. Juices (8). — These consist of the fresh juices of the plant which are mixed with a sufficient quantity of spirit to prevent them from decomposing, except in the case of lemon, mulberry, and buckthorn juice, to which no alcohol is added. B.P. (8). Succus Belladonnse. Limonis Succus. " Conii. Mori " " Hyoscyami. Rhamni " " Scoparii. " Taraxaci. Syrupi. Syrups. — These are strong solutions of sugar ; many of them contain flavoring or coloring matters, and are used to make medi- cines more agreeable to the eye or palate. In the case of iodide of iron and phosphate of iron the sugar prevents oxidation, and thus preserves the preparation from decomposition. U.S.P. DOSE. All 1 fluid drachm except those specially marked. Syrupus Acacise " Acidi Citrici " Hydriodici 1-4 fl. dr. (3 75-15 c.c.) Allii 1 fl. dr. (375 c.c.) Althsese 1-4 fl. dr. (375-15 c.c.) " Amygdala? " Aurantii " Florum 1 fl. dr. (3'75 c.c.) " Calcii Lactophosphatis 2-4 fl. dr. (7 "5-15 c.c.) Calcis , 1 fl. dr. (375 c.c.) Ferri Bromidi H fl. dr. (19-315 c.c.) " " Iodidi 15-30 m. (09-19 c.c.) " Quininae et Strych- \ . fl , ,».„- ) ninse Phosphatum [ 1 fl " dr - ^ 7& c ' c ^ Hypophosphitum 1-2 fl. dr. (3-75-7"5 c.c.) cum Ferro...l-2 fl. dr. (3 '75-7 "5 c.c.) " Iuecacuanhse I (Emetic) \-\ oz. (15-30 c.c.) Ipecacuannae j ( Expectorailt ) 30 . 6 o m . (19-375 c.c.) " Kramerise \ fl. oz. (15 c.c.) Lactucarii 2-3 fl. dr. (7 -5-11 '25 c.c.) " Limonis ,.. Picis Liquidse ....1-2 fl. dr. (3 "75-7 '5 c.c.) " Pruni Virginianse \ fl. oz. (15 c.c.) Ehei 1 fl. dr. (3'75 c.c.) " " Aromaticus 1 fl. dr. (3*75 c.c.) Kosae 1 fl. dr. (375 c.c.) Eubi 1-2 fl. dr. (3*75- 7*5 c.c.) " Ida^i 448 GENERAL PHARMACY. U.S.P. DOSE. Syrupus Sarsaparillse Compositus. ...\ fl. oz. (15 c.c.) Scillse lfl. dr. (3 "75.) 11 " Compositus (Expectorant) 20-30 m. (1-25-1-9 c.c.) " Senegas 1-2 fl. dr. (375-7.5 c.c.) Senna? 1-4 fl. dr. (375-15 c.c.) " Tolutanus " Zingiberis lfl. dr. (3'75c.c.) b.p. (18). DOSE. Syrupus. All 1 fluid drachm except those specially marked. Aurantii Aurantii Floris Chloral £-2 fluid drachms. Ferri Iodidi \-l fluid drachm. " Phosphatis Hemidesmi Limonis Mori Papaveris Rhamni Rhei 1-4 fluid drachms. Rhoeados Rosse Gallicae Scillse \-\ fluid drachm. Sennse 1-4 fluid drachms. Tolutanus Zingiberis \-\ fluid drachm. Tincturse. Tinctures. — These are solutions of active principles in spirit. Rectified spirit, or alcohol, is used whenever the active prin- ciple is more soluble in strong than in dilute alcohol, as in the case of alkaloids, such as veratrum viride; resins, such as asafoetida, benzoin, and Indian hemp ; oils, such as cubebs, lavender, tolu, orange peel, larch bark, and ginger; and other substances, such as chloroform, acetate of iron, perchloride of iron, iodine, kino. Aromatic spirit of ammonia is used in the ammoniated tincture of guaiac, of valerian, and of opium (U.S.P. and B.P.). In the case of guaiac and valerian the active principles have an acid character, and so ammonia tends to dissolve them more completely. In both of them, however, as well as in ammoniated tincture of opium, the ammonia has got a stimulating action of its own, which tends to aid the effect of the other substances. Tinctures of fresh herbs (Tincturae Herbarum recentium) when not otherwise directed, are, according to the U.S.P., to be prepared by macerating fifty parts of the fresh herb bruised or crushed in a hundred parts of alcohol for fourteen days, then expressing the liquid, and filtering. U.S.P. DOSE. The usual dose is £-2 fl. dr. unless otherwise mentioned. Tinctura Aconiti 1-3 m. (006-018 c.c.) " Aloes (As laxative) \-\ fl. dr. " (As purgative) 2-4 fl. d " et Myrrhu; 1-2 fl. dr. (375-7-5 c.c.) " Arnicie Florum 10-30 m. (0*6-1 *9 c.c.) " Radicis 20-30 m. fl'25-1'9 c.c. " Asafoetida; 30-60 m. (19-3-75 c.c. PHAEMACEUTICAL PREPARATIONS. 449 U.S.P. DOSE. Tinctura Aurantii Amari 1-2 fl. dr. (3'75-7'5 c.c.) 29 Dulcis. Belladonnse 15-30 m. (0*9-1*9 c.c.) Benzoini 20-30 m. (1*25-1 9 c.c.) " Coinposita £-2 fl. dr. (1*9-7 5 c.c.) Bryonia? 1-2 fl. dr. (375-7'5 c.c.) Calendula? Calumba? 1-4 fl. dr. (3*75-15 c.c.) Cannabis Indica? 30 m. (1*9 c.c.) Cantharidis 3-10 m. (0*07-0*30 c.c.) Capsici 30-60 m. (l"9-3*7 c.c.) Cardamomi 1 fl. dr. (3*75 c.c.) " Composita 1-2 fl. dr. (3*75-7-5 c.c.) Catechu Composita £-3 fl. dr. (P9-1125 c.c.) Chirata? 1-2 fl. dr. (3-75-7-5 c.c.) Cimicifuga? 1-4 fl. dr. (375-15 c.c.) Cinchona? 1-4 fl. dr. (375-15 c.c.) " Composita 1-4 fl. dr. (375-15 c.c.) Cinnamomi 1-4 fl. dr. (3*75-15 c.c.) Colchici £-2fl. dr. (1*9-7*5 c.c.) Conii 30 m. (1*9 c.c.) to be increased. Croci 1-3 fl. dr. (3-75-11-25 c.c.) Cubeba? 1-2 fl. dr. (3*75-7 "5 c.c.) Digitalis 10-20 m. (0'6-l'25 c.c.) Ferri Acetatis 20-60 m. (1*25-3*75 c.c.) u Chloridi 10-30 m. (0*6-1*9 c.c.) Galla? 1-3 fl. dr. (3 '75-11 '25 c.c.) Gelsemii 10-20 m. (0*6-1 '25 c.c.) Gentiana? Composita 1-2 fl. dr. (3*75-7*5 c.c.) Guaiaci 1 fl. dr. (3*75 c.c.) " Ammoniata 1-2 fl. dr. (3 *75-7 *5 c. c. ) Herbarum recentium Humuli 1-3 fl. dr. (3-75-11*25 c.c.) Hydrastis 30-60 m. (1*9-3*75 c.c.) Hyoscyami 60 m. (3*75 c.c.) Ignatia? 15-20 m. (0*9-1*25 c.c.) Iodi 5-15 m. (0*3-0*9 c.c.) Ipecacuanha? et Opii 10 m. (0*6 c.c.) Kino 1-2 fl. dr. (3*75-7*5 c.c. Krameria? 1-2 fl. dr. (3*75-7*5 c.c/ Lavandula? Composita 30-60 m. (1 9-3 75 c.c. Lobelia? 30-60 m. (1*9-3*75 c.c. Matica? 1 fl. dr. (3*75 c.c.) Moschi £-2fl. dr. (1*9-7*5 c.c. Myrrha? 15-30 m. (0*9-19 c.c. Nucis Vomica? 20 m. (1*25 c.c.) Opii 11m. (0*65 c.c.) or 22 drops. " Camphorata 1-4 fl. dr. (3*75-15 c.c.) " Deodorata 11m. (0*65 c.c.) Physostigmatis 20-40 m. (l*25-2'5 c.c.) Pyrethri Quassia? 1 fl. dr. (3*75 c.c.) Rhei 1-2 fl. dr. (3*75-7*5 c.c.) " Aromatica KL fl dr. (P9-3-75 c.c.) " Dulcis 2-3 fl. dr. (7*5-11*25 c.c.) Sanguinaria? 30-60 m. (1*9-3*75 c.c.) Saponis Viridis Scilla? 10-20 m. (0*6-1*25 c c. Serpentaria? 1-4 fl. dr. (3*75-15 c.c. Stramonii 20-30 m. (1*25-1*9 c.c. Sumbul 20-60 m. (1*2-3*7 c.c.) Tolutana 1-2 fl. dr. (3*75-7*5 c.c.) Valeriana? 1-4 fl. dr. (3*75-15 c.c.) " Ammoniata 30-60 m. (1-9-3*75 c.c.) 450 GENERAL PHARMACY. U.S.P. DOSE. Tinctura Vanilla? " Veratri Viridis 3-8>iin. (0-18-0-5 c.c.) " Zingiberis 8-40 m. (0'5-2'5 c.c.) b.p. (68). DOSE. The usual dose is ^-2 fl. dr. unless otherwise mentioned. Tinctura Acouiti 1-10 min. " Aloes " Arnica? " Asafoetida? \-l fluid drachm. " Aurantii " " Recentis " Belladonna? 5-20 min. " Benzoini Composita ^-1 fluid drachm. " Buchu " Calumbse " Camphorse Composita 15 min.-l fluid drachm. " Cannabis Indica? 5-20 min. " Cantharidis 5-20 min. " Capsici 5-20 min. " Cardamomi Composita " Cascarilla? " Castorei ...^-1 fluid drachm. " Catechu " Chirata? " Chloroformi Composita 10-60 min. " Cinchonse Composita 11 Cinchona? Flava? " Cinnamomi " Cocci " Colchici Seminum 10-30 min. " Conii 10-60 min. " Croci Cubeba> " Digitalis 5-30 min. " Ergota? 10-60 min. " Ferri Acetatis 5-30 min. " " Perchloridi 5-30 min. Galla? " Gentiana? Composita " Guaiaci Ammoniata |-1 fluid drachm. " Hyoscyami f-1 fluid drachm. " Iodi 5-20 min. " Jalapa? " Kino 11 Krameria? " Laricis 15-30 min. " Lavandula? Composita " Limonis Lobelia? 10-30 min. " " ^Etherea 10-30 min. " Lupuli " Myrrha- 30-60 min. " Nucis Vomica' 10-30 min. " Opii 5-40 min. " " Ammoniata 30-60 min. " Pyrethri " Quassia- Qninia' , " " Ammoniata " Rhei (Stomachic) ]-2 fluid drachms. " (Purgative) 4-8 fluid drachms. " Sabina- 10-60 min. PHARMACEUTICAL PREPARATIONS. 451 B.P. (68). DOSE. Tinctura Scilla? 10-30 min. " Senega? " Senna? 1 fluid drachm to 4 fluid oz. " Serpentaria? " Stramonii 10-30 min. " Sumbul 10-30 min.- " Tolutana 10-30 min. or more. " Valerianae " '' Ammoniata %-l drachm. " Veratri Viridis 5-20 min. " Zingiberis 10-60 min. " " Fortior 5-20 min. U.S. P. Triturationes. Tkiturations. — These are intimate mixtures of substances with sugar of milk. Each contains 10 per cent, of the active substances. A general formula for their preparation is given in the U.S. P., although only one is named. According to this formula 10 parts of the substance and 90 parts of sugar of milk are to be weighed out separately. The substance, reduced to a moderately fine powder if necessary, is mixed in a mortar with about its own bulk of sugar of milk and they are triturated together. Fresh portions of the sugar of milk are added from time to time until the whole has been added, and the tritura- tion is continued until the substance is intimately mixed with the sugar of milk and finely comminuted. U.S.P. Trituratio Elaterini. Trochisci. Lozenges. — These are small, flat, and hard, so that they can be readily carried about and melt slowly in the mouth. They are thus convenient for giving drugs which are intended to act upon the mouth or throat locally, or to be readily carried about and taken at times and in places where more bulky preparations would be inconvenient. Thus we have lozenges of chlorate of potash which are useful for soreness of the mouth and tongue ; tannic acid and catechu which are useful in relaxed sore throat and hoarseness ; ipecacuanha with morphia, and with opium, which are useful in coughs ; bicarbonate of soda, useful before meals in dyspepsia or after meals in acidity ; bismuth for irritability of the stomach; and reduced iron for debility. Bismuth, morphia and opium, are also useful in diarrhoea. In many cases it happens that although patients can take potions before, after, or with their morning and evening meals, they are unable to do so in the middle of the day when they are absent from home and engaged in various avocations. For such cases lozenges form a useful means of administering medicine. U.S.P. (16). B.P. (10). Trochisci Acidi Tannici. Trochisci Acidi Tannici. " Ammonii Chloridi. " Bismuthi. " Catechu. " Catechu. " Creta?. " Ferri Redacti. " Cubeba?. " Ipecacuanha?. " Ferri. " Morphia?. " G-lycyrrhiza? et Opii. " Morphiae et Ipecacuanha?. " Ipecacuanha?. " Opii. " Krameria?. " Potassa? Chloratis. " Magnesia?. " Soda? Bicarbonatis. 452 GENERAL PHARMACY. U.S.P. (16). Trochisci Menthae Piperita. " Morphinae et Ipecacuanha?. " Potassii Chloratis. " Sodii Bicarbonatis. " Santoninatis. 11 Zingiberis. Ungueiita. Ointments. — These are soft admixtures of medicines with fatty substances for external application. The basis of many of them is lard, either alone or mixed with benzoin in order to preserve it from rancidity, or mixed with white wax in the form of ointment (ungu- entum U.S. P.). In the B.P. simple ointment, which consists of white wax and almond oil, forms the basis of several ointments. The semi-solid substances, obtained from American petroleum, form a useful basis for ointments, as they do not become rancid. They consist of hydrocarbons chiefly of the marsh-gas series. There are two chief varieties, one softer, having a melting point about 40° C. (104° F.), the other 51° C. (or 121° F.). They are obtained by distilling off the lighter and more volatile portions from American petroleum. They are known under different names. Petrolatum (U.S. P.) cosmoline, unguen- tum petrolei, and vaseline. U.S. P. (25). B.P. (34). Acidi Carbolici. Unguentum Aconitiae. Acidi Gallici. ' Antimonii Tartarati. " Tannici. Atropiae. Aquae Rosae (cold cream) . ' ' Belladonnae. Belladonna?. ' Cadmii Iodidi. Chrysarobini. ' Cantharidis. Diachylon. Cetacei. Gallae. ' Creasoti. Hydrargyri. Elemi. " Ammoniati. ' Gallae. " Nitratis. ' ' " cum Opio. " Oxidi Flavi. c ' Hydrargyri (blue ointment) " Rubri. ' Ammoniati. Iodi. ' " Compositum. Iodoformi. ' ' " Iodidi Rubri. Mezerei. 1 u Nitratis. Picis Liquidae. 1 " Oxidi Rubri. Plumbi Carbonatis. ' ' " Subchloridi. " Iodidi. ' Iodi. Potassii Iodidi. 1 Picis Liquidae. Straruonii. ' Plumbi Acetatis. Sulphuris. { " Carbonatis. " Alkalinum. ' Iodidi. Veratrinae. ' ' " Subacetatis Compos- Zinci Oxidi. itum. Potassae Sulphuratae. Potassii Iodidi. Resins. ' Sabina?. ' Simplex. ' Sulphuris. Iodidi. ' Terebinthinae. 1 Veratriae. Zinci. PHAKMACEUTICAL PREPARATIONS. 453 B.P. Vapores. Vapors, Inhalations. — These are prepara- tions for applying volatile drugs to the air-passages for the purpose of deodorizing, disinfecting, stimulating or soothing. The drug is mixed with water and the vapor inhaled. If the drug is not readily volatile, warm water is used, as in the vapor creasoti, or the water is warmed during inhalation, as in the vapor iodi. B.P. (5). Vapor Acidi Hydrocyanici. " CMori. " Coniae. " Creasoti. " Iodi. The vapors of chlorine, creasote, and iodine may be used for deodorizing in cases of ozoena or in cases of chronic bronchitis with offensive sputa. Antiseptic inhalations, such as those of creasote and iodine, as well as non-officinal inhalations of iodoform and oil of pine, have been recently used in the treatment of phthisis with the object of destroying the tubercle bacillus. For this purpose a special form of inhaler is used, which fits over the mouth and nose. It contains a sponge which is soaked with the drug to be inhaled either pure or dissolved in spirit or water. They are probably also useful even in simple catarrh by destroying organisms which may have found their way into the air-passages and occasion or keep up inflammation. The vapors of hydrocyanic acid and conium are useful for the purpose of allaying irritability, as in spasm of the glottis, violent coughing or spasmodic asthma. Vina. Wines. — These are made in the same way as tinctures, strong white wine (U.S. P.) or sherry or orange wine (B.P.) being employed instead of spirit. U.S.P (14). DOSE. Vinum Album " Album Fortius u A1n . a f Stomachic, 1-2 drachms. Aioes I Purgative, H fluid oz. " Antimonii Expectorant, 10-30 min. " Aromaticum " Colchici Radicis 10 min.-l fluid drachm. " Seminis 30 min. -2 fluid drachms. " Ergotse 1-4 fluid drachms. " Ferri Amarum 2-4 fluid drachms. " Citratis 1-4 fluid drachms. " *p— {iSi-sV^r " Opii 15-20 min. " Rhei 1-4 fluid drachms. " Rubrum B.P (10). DOSE. Vinum Aloes 1-2 fluid drachms. " Antimoniale 5-30 min. as expectorant. 5-1 fluid oz. as emetic. " Colchici 10-30 min. 454 GENERAL PHARMACY. B.P. (10). DOSE. Vinum Ferri 1-4 fluid drachms. " Citratis 1-4 fluid drachms. Ipecacuanhse 5-40 min. as expectorant, 1-8 drachms as emetic. Opii 10-40 min. Quiniae £-1 fluid oz. Rhei 1-2 drachms. Xericam SECTION III. INORGANIC MATERIA MEDICA. CHAPTER XXII. HYDROGEN, OXYGEN, OZONE, CARBON, SULPHUR, AND THE HALOGENS. Although the officinal substances included in this chapter differ widely from each other in many respects, yet their relations to oxygen form a connecting link between them. Sulphur belongs to the same chemical group as oxygen. The chief action of charcoal is its power of oxidizing organic substances by means of oxygen which it has condensed in its pores. The halogens probably owe their disinfecting properties in great measure to their power of liberating oxygen from water in the pres- ence of organic matter which they thus oxidize and destroy. HYDROGEN (H ; 1). Not officinal. Preparation. — By adding diluted hydrochloric or sulphuric acid to granulated zinc — Zn + 2HC1 = ZnCl 2 + H 2 . Uses. — It is of little or no use as a remedy, and is only used as a test. It is very frequently employed in testing for arsenic, antimony, or sulphur. When in its nascent condition it has active chemical affinities, and readily unites with these substances, forming sulphuretted, arseniu- retted, or antimoniuretted hydrogen. OXYGEN (0 ; 16). Not officinal. Preparation. — By heating chlorate of potash with peroxide of manganese — 2KC10 S = 2KC1 -f 30 2 . (455) 456 INORGANIC MATERIA MEDICA. Peroxide of manganese merely aids the decomposition of the chlorate of potash, and takes no part in the reaction. Properties. — Oxygen is a colorless gas without smell, slightly heavier than common air. It forms rather more than a fifth by volume of the atmosphere. Physiological Action. — Oxygen applied to the unbroken skin has but little action, but when applied to a wound it increases the circulation in it, and acts as a stimulant. When inhaled by healthy persons it causes a slight feeling of warmth in the mouth, extending downwards over the front of the body. In some people it appears to cause nervous symptoms somewhat like those produced by nitrous oxide. In animals, excess of oxygen produces tetanic symptoms almost like those of strychnine, and death. This effect is produced by a pressure of three atmospheres, and it is evident that it is due to the oxygen and not to the simple increase in atmospheric pressure only, because when ordi- nary air is used a pressure of three atmospheres has no such action, and a pressure of twenty -five atmospheres is requisite to produce this effect (Bert). It has been thought by some that when oxygen has been once breathed it loses something which enables it to support life. The reason of this belief is that animals soon die which are kept in a confined space, from which the carbonic acid formed during respiration is absorbed by lime or baryta, and its place supplied by fresh oxygen. Professor Seegen, however, has found that the death in such cases is not due to the removal of anything from the oxygen, but to actual poisoning by products of tissue waste. In some experiments he noticed that the air in which the animal had been confined for a while, although its chemical composition was correct, had a disagreeable smell, and the animal after its removal soon died of pneu- monia. When the air which the animal was breathing was extracted from one end of the compartment, made to pass through a red-hot tube, and introduced at the other end so that any organic matter formed dur- ing respiration was consumed, the animal could be kept for almost any length of time without injury to its health. Uses. — Oxygen has been applied to the surface in atonic, scrofulous, and syphilitic ulcers, and in cases of senile or other gangrene. It has more especially been employed in cases of respiratory disease such as emphysema, bronchial dilatation, phthisis, and gangrene of the lung, in asphyxia from noxious vapors or anaesthetics, and in spasmodic asthma. It seems to be chiefly of use in the latter disease. It has been employed also in cases of difficulty of breathing, of cardiac disease, and of anaemia from loss of blood or suppuration. It has been employed also in condi- tions where oxidation seems to be deficient, as in gout and diabetes, where sometimes the sugar disappears from the urine during its inhalation. Oxygen has also been used in the treatment of epilepsy and spasm. It has been strongly recommended by Bert in paralysis occurring in divers, due to their sudden ascension from a great depth to the surface. When submerged at a considerable depth the pressure of the air causes both nitrogen and oxygen to be absorbed by the blood ; when they return to the surface the oxygen enters into combination, but the nitrogen is set free in the blood-vessels, forming minute bubbles, which act as emboli, HYDROGEN, OXYGEN, OZONE, CARBON, ETC. 457 obstructing the circulation in the nerve-centres and in the lungs, thus pro- ducing paralysis and dyspnoea. The nitrogen diffuses as readily into an atmosphere of oxygen as into an absolute vacuum ; and therefore when animals, in which such a state has been artificially induced, have been made to breathe pure oxygen, bubbles of nitrogen disappear from the blood, the circulation is speedily restored to its normal condition, and the paraly- sis and dyspnoea disappear. Its inhalation has been recommended in cases of cholera. OZONE. Not officinal. When an electric spark is passed through air a peculiar smell is noticed ; this is due to the formation of ozone. The electricity in pass- ing through the air appears to break up the molecules of ordinary oxygen (Fig. 127), and the atoms which are thus dissociated join together so as Fig. 127.— Diagram to illustrate the formation of ozone by electricity, a represents oxygen through which a spark is passing ; b, after it has passed. The double rings are intended to represent mole- cules of oxygen, each containing two atoms. As the electric spark passes through the oxygen it breaks up the first molecule, carrying one atom on to join the second molecule of oxygen, and form one of ozone. The atom which is left joins another molecule of oxygen, and also forms ozone. (After Lockyer.) to form ozone. It is also formed by the slow oxidation of phosphorus (Fig. 128), and is formed also by protoplasm (p. 78). Two atoms are present in a molecule of oxygen and three in that of ozone. When elec- tricity is passed through a quantity of oxygen, contained in a tube over 4 ^ ■H A 8-rr $, K^ / \rz\ V" \ 1 H5 - A dPf t pp& V rv n> r^Q>0^ ^ QQd ^2>pC ) °-TpV-0 Zj uo * 99-4 %*$; 9 c Nfer°n mwmm % Fig. 128.— Diagram to represent the formation of ozone by the oxidation of phosphorus, a, during oxidation ; b, after oxidation. The phosphorus in uniting with oxygen splits up the molecules. Some of the atoms combine with the phosphorus to form phosphoric acid. Others reunite to form oxygen, and others form ozone (3P -J- 150 2 = 3P0 5 + 60» + U 3 ). 458 INOEGANIC MATERIA MEDICA. mercury, so as to convert a portion of it into ozone, it becomes condensed in bulk and acquires much greater chemical activity. On warming it again to about 300° C. the molecules of ozone become again dissociated, ordinary oxygen is formed, the gas then returns to its original bulk, and it loses its active properties. Ozone has a most powerful oxidizing prop- erty, attacking metals and forming oxides, and destroying organic sub- stances, such as paper and caoutchouc. It has a curious action upon albumen, already described (p. 69), and decomposes blood. As might be expected, it is exceedingly poisonous to low organisms, and is fatal also to the higher animals. Its effect appears to be due in a great measure to its having such a powerful irritant and even destructive effect on the albuminous tissues of the respiratory passages, that it causes reflex depression of the heart and interferes with the ordinary respiration in the lungs. It thus diminishes instead of increasing oxidation. In animals it causes sometimes quick- ness and sometimes slowness of the respiration (vide p. 215), and pro- duces excitement followed by exhaustion and sometimes convulsions. When it is present only in small quantity in air, it may be inhaled without any disagreeable effects, and is, according to Binz, a decided soporific. Uses. — It has been recommended in cases similar to those already mentioned under oxygen ; and also in infectious diseases, and in diph- theria, where it is likely to be useful by destroying low organisms, which produce the disease. PEROXIDE OF HYDROGEN (H 2 2 ; 34). Not officinal. Preparation. — It is generally prepared by treating barium di-oxide with dilute sulphuric acid (Ba0 2 + H 2 S0 4 = H 2 2 + BaS0 4 ) and filtering off the aqueous solution from the sulphate of barium which is precipitated. Properties. — When the watery solution thus obtained is evaporated it forms a transparent oily liquid, but it is generally employed in the form of a 10 to 15 per cent, solution in water or in ether. The ethereal solu- tion is commonly known by the name of ozonic ether. The ethereal solu- tion is generally more stable than the aqueous solution, which, especially if kept in a badly-stoppered bottle, soon decomposes into water and oxygen. Action and Uses. — Peroxide of hydrogen has a powerful oxidizing effect upon organic substances, readily giving off an atom of oxygen in much the same way as ozone. It has therefore been used for the same purposes as ozone. It destroys bacteria, and is a powerful antiseptic. 1 When mixed with the secretion from chancre it destroys its infective power ; and it has been employed as a local dressing for chancres, and also as an application for diphtheritic sore throat. Curiously enough, although when mixed with blood or with albumen it becomes decomposed almost immediately, it appears to be tolerably stable in the body, and is Baid to have been found in the urine after it has been taken by the mouth. 1 Professor Dewar. Cambridge, unpublished experiments. HYDROGEN, OXYGEN, OZONE, CARBON, ETC. 459 Its internal administration has been recommended in rheumatism, scrofula, diabetes, and cardiac disease. CARBON (C; 12). This element is employed in medicine in the form of animal and vegetable charcoal. Carbo Lig-ni, U.S. P. and B.P. Wood Charcoal. — Charcoal prepared from soft wood, U.S. P. Wood charred by exposure to a red heat without access of air, B.P. Preparation. — It is prepared either by burning the wood under turf, or in retorts, so that the hydrogen and oxygen are driven off and charcoal alone remains. If too much air be allowed to have access, the charcoal itself becomes burnt, and too large a proportion of ash comes to be present. Characters. — In black, brittle, porous masses, without taste or smell, very light, and retaining the shape and texture of the wood from which it was obtained. When pulverized it forms a fine black powder. Impurities. — Too much ash. Tests. — When burned at a high temperature with free access of air it leaves not more than two per cent, of ash. Dose. — 20-60 grains. Officinal Peepaeatiox. U.S.P. B.P. None. Cataplasma Carbonis B.P. Cataplasma Carbonis. Chaecoal Poultice. — Powdered charcoal 1 ; bread 4 ; linseed-meal 3 ; boiling water 20. Mix the water, bread, and linseed-meal, then add half the charcoal and sprinkle the remainder on the surface. By simply sprinkling a part of the charcoal on the surface of the poultice it is not wetted, and its disinfectant power not destroyed. Action. — Charcoal has the power of absorbing gases and of con- densing them within its pores. Amongst others it absorbs oxygen readily. The oxygen thus condensed has an oxidizing action akin to that of ozone, and the charcoal parts with it readily when brought into contact with oxidizable substances, whether these substances be in solu- tion or in the form of gas, but especially the latter. Thus it oxidizes and decomposes sulphuretted hydrogen very readily, and also quickly oxidizes and destroys decomposing organic substances. It thus acts as a deodorizer and disinfectant. It only possesses this power, however, when it is dry, and loses it when it is wet. For this reason the whole of it is not mixed with the poultice in the cataplasma carbonis, a part of it being merely sprinkled on the surface. Its oxidizing power is destroyed completely only when the charcoal is thoroughly saturated with water, and this occurs with difficulty even when it is thrown into water. Consequently its oxidizing power may still be exerted in fluids to which it has been freshly added. Uses. — It is employed as a deodorizer and disinfectant in traps •through which sewer gases may pass, and in a respirator for persons exposed to sewer gas or other noxious emanations. As a poultice it is 460 INORGANIC MATERIA MEDICA. employed for foetid and phagedenic ulcers and gangrene. It forms a useful tooth-powder, cleaning the teeth rapidly, but it is much more apt to scratch the enamel than a tooth-powder of chalk. When taken into the stomach it relieves flatulent distention and acidity in the stomach and intestines. It has thus been used in acute and chronic dyspepsia, gastrodynia, and even cancer of the stomach ; in constipation, flatulent distention of the colon, diarrhoea, dysentery, cancer of the rectum. It has been supposed to relieve flatulence by absorbing the gases in the stomach and intestines, but as it will become wet by the juices of the 'intestinal canal after it is swallowed, it is much more probable that it acts mechanically, by removing mucus, or by stimulating the circulation and peristaltic movements in the walls of the stomach and intestine. This is rendered all the more probable by the fact that in some cases where it is useful the patient is likewise benefited by beginning each meal with solid food, and abstaining from liquids until the meal is well over, so that the stomach may receive a mechanical stimulus from the food, which would be prevented by the ingestion of much liquid at the beginning of the meal. In large doses it acts as a mild purgative. It has also been used in diabetes and in intermittent fevers. Administration. — It is either used in the form of powder, or made up into biscuits or lozenges. Carbo Animalis, U.S. P. and B.P. Animal Charcoal. — Bone black. Animal charcoal prepared from bone, U.S. P. The residue of bones, which have been exposed to a red heat without the access of air. Consists principally of charcoal and phosphate and carbonate of lime, B.P. Carbo Animalis Pnrificatus, U.S. P. and B.P. PURIFIED Animal Charcoal. Preparation. — By dissolving out the earthy matter by hydrochloric acid, washing and drying. Characters. — It is a black powder without taste or smell. It absorbs coloring matters, and tincture of litmus diluted with 20 times its bulk of water agitated with it and thrown upon a filter passes through colorless. It is insoluble in all reagents. Impurities. — Too much ash. Test. — When burnt at a high temperature with a little red oxide of mercury and free access of air, it leaves only a slight residue. Dose. — 20-60 grains. Uses. — From its power of absorbing coloring matters, animal char- coal is used in the preparation of organic alkaloids, for the purpose of decolorizing them. It not only carries down coloring matters with it, but alkaloids as well, and therefore a considerable loss is occasioned in the process of bleaching. Advantage has been taken of this power to use animal charcoal as an antidote in poisoning by opium, aconite, nux vomica, etc. The alkaloid is removed from solution by the animal char- coal and retained by it with considerable pertinacity. It would, however, be gradually dissolved out if allowed to remain too long in the stomach, and therefore the stomach-pump, or emetics, must be used in addition. As an antidote it is used in doses of a tablespoonful frequently repeated. HYDROGEN, OXYGEN, OZONE, CARBON, ETC. 461 SULPHUR (S : 32). Sulphur is found native in volcanic districts, and occurs in combina- tion with metals as sulphides in various ores, especially in iron and copper pyrites. Sulphur Suhlimatum, U.S. P. and B.P. Sublimed Sulphur, Flowers of Sulphur. Preparation. — Native sulphur is usually mixed with earthy impuri- ties. When heated the sulphur volatilizes. If the vapor is condensed in a large room it falls in a fine powder. If condensed in water it forms- masses, which, when melted and run into moulds, form roll sulphur, but this is not officinal. Ores containing sulphur are decomposed by heat, and part of the sulphur they contain sublimes, and may be condensed in the same way as native sulphur. Characters. — A fine, citron-yellow powder, of a slight characteris- tic odor and generally of a faintly-acid taste and an acid reaction from slight oxidation occurring with the formation of small quantities of sul- phurous acid. It is insoluble in water or alcohol, slightly soluble in oils and fats, and completely soluble in carbon disulphide. When ignited it burns with a blue flame, forming sulphurous acid gas and leaving no residue, or only a trace. Impurities. — Ores are apt to contain arsenic, and when this is the case, sulphide of arsenic, being volatile, sublimes along with the sulphur and renders it impure. During sublimation the sulphur may undergo oxidation, and thus sulphurous or sulphuric acids may be present in it as impurities. Tests. — Vide Sulphur Lotum. Officinal Preparations. u.s.p. B.P. DOSE. Sulphur Lotum. Confectio Sulphuris, as laxative 60-120 grs. " Prsecipitatum. " as alterative 5-20 grs. Unguentum Sulphuris. Ungueutum Sulphuris. B.P. Confectio Sulphuris. CONFECTION OF SULPHUR. — Sulphur 4; acid tartrate of potash 1 ; syrup or orange peel 4. The acid tartrate of potash is added for the purpose of increasing the secretion from the intestine, while the sulphur stimulates peristaltic action. Unguentum Sulphuris. Sulphur Ointment. — Sulphur mixed with benzoated lard 30 parts to 70, U.S.P. ; 1 to 4, B.P. The U.S.P. ointment is nearly twice as strong as the B.P. U.S.P. Sulphur Liotum. Washed Sulphur. Preparation. — By digesting sulphur with dilute ammonia, thor- oughly washing, drying at a gentle heat and passing through a No. 30 sieve. In this process the ammonia not only neutralizes the sulphurous or sulphuric acid, but dissolves out and removes sulphide of arsenic, which is soluble in it. Characters and Impurities. — Those of sulphur sublimatum. Tests. — Water agitated with it should not redden blue litmus paper (absence of free acid). If washed sulphur be digested with two parts of 462 INORGANIC MATERIA MEDICA. water of ammonia, and the mixture filtered, the filtrate, on being super- saturated with hydrochloric acid, should remain unaltered (absence of arsenious sulphide), nor should a precipitate make its appearance on passing hydrosulphuric acid through the filtrate (absence of arsenious acid). Officinal Peepaeations. u.s.p. Purvis Glycyrrhizae Compositus. Sulphuris Iodidum. Unguentum Sulphuris Alkalinum. U.S.P. Unguentum Sulphuris AlkaUnum. ALKALINE SULPHUE OINTMENT. Sulphur 20; carbonate of potassium 10; water 5; benzoated lard 65. Sulpliur Precipitatum, U.S.P. and B.P. PRECIPITATED SUL- PHUR, Lac Sulphuris, Milk of Sulphur. Preparation. — By boiling sulphur with slaked lime and water. Calcium sulphide and calcium hyposulphite are thus formed. Hydro- chloric acid is then added, which decomposes these substances and throws down sulphur in the form of an exceedingly fine powder which is washed until the washings are tasteless (U.S.P.), and have no acid reaction and cease to give a precipitate with oxalic acid (B.P.), showing that both acid and lime have been removed. Characters. — Being in a finer state of division than sublimed sul- phur, it looks almost white, with only a slight tinge of yellow. Otherwise its characters are the same. Impurities. — There is a great temptation to fraudulent manufac- turers to use sulphuric acid instead of hydrochloric acid. It is not only cheaper, but it yields a large product consisting to a great extent of sul- phate of lime which is precipitated along with the sulphur instead of remaining in solution like the calcium chloride which is formed when hydrochloric acid is employed. With Hydrochloric Acid, 2CaS 5 — CaS 2 3 — 6HC1 = (S 2 ) 6 + 3H 2 + 3CaCl 2 " Sulphuric " 2CaS 5 + CaS 2 3 — 3H 2 S0 4 = (S 2 ) 6 + 3H 2 + 3CaS0 4 Besides this there are the other impurities which may be present in the sublimed sulphur employed in the process. Tests. — It should be completely volatilized by heat and leave no resi- due of sulphate behind. Under the microscope it should exhibit only minute globules of sulphur and no crystals of sulphate. The absence of the impurities contained in sublimed sulphur is ascertained by the tests already given. Dose. — Of precipitated sulphur, as alterative 10 grs., as laxative 30-60 grs. Sulphuretted Hydrogen or HYDROGEN SULPHIDE (H 2 S ; 34). A colorless gas, with a smell of rotten eggs. Used only as a test. Preparation. — By pouring diluted sulphuric acid on sulphide of iron. By passing the gas into cold water a solution is obtained. HYDROGEN, OXYGEN, OZONE, CARBON, ETC. 463 Properties. — It precipitates most metals as sulphides from acid solu- tions, the precipitate with arsenic being yellow ; antimony, orange ; cad- mium, yellow ; copper, lead, mercury, and silver, black ; bismuth, brown ; gold and platinum, brownish black. General Action of Sulphuretted Hydrogen. — As sulphuretted hydrogen is formed in small quantities from sulphur when the latter is used in various ways, it may be more convenient to take its action before that of sulphur. It is very destructive to plant life even in very minute quantities. There is a curious difference between the action of sulphu- retted hydrogen and that of sulphurous acid on plants. The latter seems to act as an irritant, causing the leaves to crumble up and fall off, but even when the leaves are destroyed by sulphurous acid the plant may again recover. Sulphuretted hydrogen causes the leaves simply to become flaccid and droop, but when this has once taken place the plant does not recover. In animals it destroys the functions of all tissues, and in consequence has two actions which are well marked, (1) decomposing the blood and thus producing symptoms of asphyxia, and (2) paralyzing the nervous system and muscles. It is absorbed by the skin, by the lungs, mucous membrane of the alimentary canal, and subcutaneous cellular tis- sue, and may produce symptoms of poisoning through any of these chan- nels. In frogs, which are less affected than mammals by interference with the respiration, the symptoms produced by sulphuretted hydrogen are those of paralysis of voluntary motion and reflex action, preceded by a stage of restlessness. In mammals the symptoms are those of asphyxia ; muscular tremors occur and are succeeded by asphyxial con- vulsions and death. Most cases of poisoning by sulphuretted hydrogen in man occur from inhalation of the gas which is often found in large quan- tities in cesspools. One case has been recorded where symptoms of poisoning occurred irom excessive formation of the gas in the intestinal canal and subsequent absorption into the blood. Cases of poisoning are best treated by artificial respiration. Special Action. — Even in minute quantities it destroys the catalytic action of many substances on peroxide of hydrogen. In this respect as well as in many of the symptoms it produces, it resembles hydrocyanic acid. On the blood. It first reduces and then decomposes haemoglobin. Both the blood and the muscles of frogs poisoned by it exhibit a greenish color. As death occurs in mammals before the blood has become so exten- sively changed, it simply exhibits the characters of asphyxial blood. It induces rigor mortis rapidly in the muscular substance both of the voluntary muscles and of the frog's heart. Action of Sulphur. — Sulphur, when brought into contact with living protoplasm, enters into combination and forms sulphuretted hydrogen or sulphurous acid. When sulphur is sprinkled over actively- growing fungi, like those which cause the vine disease, these gases are formed and the fungi destroyed. Sulphur has little or no action on the skin, excepting a mechanical one. When taken into the intestinal canal, a considerable part of it 464 INORGANIC MATERIA MEDICA. again passes out unchanged ; a little of it, however, appears to be con- verted into sulphides and into sulphuretted hydrogen. The latter is excreted by the breath, and may give to it the peculiar disagreeable smell of rotten eggs. It is also excreted by the skin, so as to blacken any silver articles which may be worn about the person. The sulphides give rise to increased peristaltic action of the bowels so that the motions become more frequent and softer ; colicky pains are sometimes produced. The sulphides, after absorption into the blood, are excreted in the urine, chiefly as sulphates. Uses. — It has been applied by insufflation to the throat in diphtheria, in order to destroy the organisms present in the pharynx, in the same way as in the vine disease. I have seen one case do very well under this treatment ; but its general efficacy is by no means certain. In the form of ointment it is used in scabies to kill the acarus which is the cause of the disease. Internally it is employed as a mild laxative in cases of con- stipation where active purgatives are inadmissible, as in pregnancy, in haemorrhoids, fissure of the anus, and stricture or prolapsus of the rectum. It has been used also in cases of lead-poisoning, to prevent the reabsorp- tion of the lead from the intestine. It has been found useful in cases of sexual irritation arising from hemorrhoidal congestion (pp. 387 and 389), and also in the nervous excitement and other disturbances accompanying the menopause. It exerts a beneficial action on the tissues in chronic rheumatism and gout, and is especially useful in the form of sulphurous waters. During its elimination by the lungs it is supposed to have a beneficial action on them, and it is consequently used in chronic bronchitis. HALOGEN ELEMENTS. Fluorine, Fl. ; 19 or 194. Chlorine, CI. ; 355 or 354. Bromine, Br.; 80 or 79-75. Iodine, I. ; 127 or 126-53. These substances form a series in which the atomic weights are nearly in the relation of 1, 2, 4, and 7, (vide also p. 42). They are distin- guished by the activity of their chemical affinities and the number of compounds they form. General Source. — The name halogen (from d?^ the sea) has been given to the group, because its most important members, chlorine, bro- mine, and iodine, are derived from the sea; chlorine being obtained from sea-salt, bromine from sea-water, iodine from sea-weed. General Characters. — They are all very volatile. At ordinary temperatures, chlorine is a gas, bromine a liquid, and iodine a solid, but both bromine and iodine give off vapor freely. On account of their active chemical affinities they unite directly with metals, as is seen in the officinal processes for the preparation of iodide of iron and green iodide of mercury. They have all a great affinity for hydrogen, and are therefore powerful decomposers of organic matter, destroying organic colors and dis- agreeable emanations of organic origin, as well as decomposing sulphuretted hydrogen (H 2 S -j- Cl 2 = 2IIC1 + S 2 ) and ammonia, which occur amongst the products of decomposition of organic matter. They are therefore HYDKOGEN, OXYGEN, OZONE, CARBON, ETC. 465 used as deodorizers and disinfectants. Chlorine is used for bleaching, but bromine and iodine form colored compounds with many organic sub- stances, and so are not used for this purpose. Probably the bleaching power of chlorine is not due to its decompos- ing organic colors by removing hydrogen from them, but rather to its decomposing water by removing the hydrogen from it, and thus setting free nascent oxygen, which is the direct destroyer of organic matters. The reason for this supposition is that chlorine does not act upon coloring matters when they are dry, but only when moist. Mode of Preparation. — Chlorine, bromine, and iodine are all pre- pared by expelling them from their compounds with the alkaline metals by means of sulphuric acid and manganese dioxide. Chlorine is prepared by putting sodium chloride, sulphuric acid and manganese dioxide into a retort, applying heat and collecting the chlorine gas in a receiver, by displacement or over warm water, or passing it into cold water which dissolves it freely, forming aqua chlori U.S. P. or liquor chlori B.P. Bromine is prepared in a similar manner from the bromides of sodium and magnesium contained in the bittern or mother-liquor left after the salt has crystallized out of sea-water, or out of the brine obtained in salt mines. In order to obtain the bromine pure, the bittern is often not treated directly with sulphuric acid and manganese dioxide. Instead of this the bromine is first separated by passing chlorine through the liquid which is then shaken up with ether. The chlorine decom- poses the magnesium bromide and the ether dissolves the bromine thus set free. The bromine is then converted again by potash into bromide, from which bromine is obtained by means of manganese dioxide and acid. Iodine is prepared in a similar manner to chlorine from the iodides of sodium and magnesium contained in sea-weed. The iodides are obtained from the weed by calcining it in a retort, or by burning it, when the ashes in which they are contained form a hard mass called kelp. This is treated with successive portions of water until the soluble salts are all dissolved out (lixiviation). The solution is filtered, and evapo- rated to a small bulk, when the less soluble salts, as the sulphates, &c, crystallize out. The mother-liquor containing the iodides of sodium and magnesium is then treated with manganese dioxide and sulphuric acid, and the iodine distils over. The reactions which occur in the preparations just described are — Chlorine 2NaCl + 2H 2 S0 4 + Mn0 2 = Cl 2 + Na 2 S0 4 + MnS0 4 + 2H 2 0. bromine ^ MgBr2 + 2 H 2 So 4 + Mn0 2 = Br 2 + MgS0 4 + MnS0 4 + 2H 2 0. Torn™ / 2NaI + 2H 2 S0 4 + Mn0 2 = X 2 + Na 2 S0 4 + MnS0 4 + 2H 2 0. loume ^ Mg] - 2 + 2H2 gQ 4 +Mn Q 2 = t 2 _|_ MgSO, + MnS0 4 + 2H 2 0. General Action. — As chlorine, bromine, and iodine decompose organic compounds having a disagreeable odor, they have been sup- posed to have a similar action upon the germs of infectious diseases. Chlorine, and sometimes iodine, are therefore used as deodorizers and disinfectants in sick rooms. Bromine cannot well be used on account of its abominable smell. 30 466 INORGANIC MATERIA MEDICA. The objections to chlorine or the vapor of iodine as disinfectants are that we do not at all know that they have any disinfecting power in the dilute state, in which only they can be used in a sick room. When applied to the skin or mucous membranes they cause a greater or less amount of irritation or inflammation, according to the length of time during which they act, and the greater or less degree of concentration in which they are applied. They probably do not enter the blood in the free state, but combine with bases or with albuminous substances at the place of application, and are absorbed as chlorides, bromides, or iodides, or else as albuminous compounds. According to Binz, free chlorine, bromine, and iodine, and all their readily decomposable compounds, have a narcotic action, and paralyze nervous centres in the brain by a direct action on the nervous structures themselves. He considers that they cause death by paralysis of the respiratory centre, and not by paralysis of the heart. CHLORIXE. CI. 355. A greenish-yellow gas with a suffocating odor. Its preparation and general action have already been described (p. 465). Actiox. — When applied for a long time to the skin, as in persons who have to work in an atmosphere containing it, it causes itching, reddening and inflammation. When applied to the more sensitive mucous membranes of the respiratory passages, it acts as a stimu- lant or irritant. In a concentrated form it may cause death from spasm of the glottis, or intense bronchitis. In a more dilute form it is used as a stimulant, deodorizer, and disinfectant. The manner of employing it, is to put a saucer containing salt, binoxide of manganese, and sul- phuric acid on a shelf or high piece of furniture in the sick room, and thus allow the chlorine vapor, which is heavier than air, to diffuse itself through the apartment. When placed on the floor it is of little use. Aqua Clilori, U.S. P. ; Liquor Cnlori, B.P. CHLORINE Water. — An aqueous solution of chlorine containing at least 0-4 per cent, of the gas U.S. P., or 2*66 grains in 1 fluid ounce = about 0*6 per cent. B.P. Preparation. — By passing washed chlorine into water, p. 465. The chlorine is directed by the U.S. P. and B.P. to be prepared from hydrochloric acid and manganese dioxide, instead of from sodium chloride. 4HC1 + Mn0 2 = Cl 2 + MnCl 2 + 2H 2 0. Characters. — A greenish-yellow clear liquid with a strong smell and taste of chlorine. It instantly decolorizes dilute solutions of litmus and indigo. Impurities. — The chief is too little chlorine. When exposed to light it is apt to be decomposed, the chlorine combining with the hydro- gen of the water and forming hydrochloric acid. The chlorine water thus loses strength, and it also becomes weaker by the chlorine escaping when the bottle is imperfectly stopped or frequently opened. A solution of chlorinated soda or lime may be .sometimes substituted for chlorine water. Tests. — The amount of chlorine is not tested directly, but indirectly, by estimating the amount of iodine which a definite quantity of chlorine HYDROGEN, OXYGEN, OZONE, CARBON, ETC. 467 water liberates from iodide of potassium. In this process chlorine water (35-4 gm. U.S. P., or 439 grains or 1 fluid ounce B.P.,) is mixed with iodide of potassium (0*9 gm. U.S.P., 20 grains B.P.) and water (20 gm. U.S. P., 1 fluid ounce B.P.). The amount of iodine which is set free by the chlorine (2KI + Cl 2 — 2KC1 + I 2 ) gives a red color to the solution, and corresponds in quantity to the chlorine contained in the water. The red solution requires for its decolorization 40 cc. U.S. P., or 750 grain- measures B.P., of the volumetric solution of hyposulphite of soda. The reaction which occurs is : — Iodine. Sodium Hyposulphite. Sodium Iodide. Sodium Tetrathionate. Water. I 2 + 2NaH 2 S 2 4 = 2NaI + Na 2 S 2 4 + H 2 0. Uses. — Chlorine is used in solution as a lotion to foul-smelling ulcers or cancer ; as an application to relieve itching in chronic skin dis- eases ; and as a gargle or wash to the mouth in affections of the mouth, throat and tonsils, especially where they are accompanied by foetor, as in mercurial ptyalism and ulceration of the tonsils. It is sometimes given internally in cases of blood-poisoning. As an inhalation it has been used in cases of phthisis, it is said with good effect. It is also employed as a stimulant and deodorizer in cases of chronic bronchitis with foetid sputa. ( Vide Vapor Chlori, p. 468.) The aqueous solution is so unstable and liable to lose its strength, that compounds of chlorine from which it can be easily evolved are more convenient for general use. The chief of these are the following compounds with lime and with soda. Calx Clilorata, U.S. P. and B.P. Chlorinated Lime. — A compound resulting from the action of chlorine upon hydrate of calcium, and containing at least 25 per cent, of available chlorine, U.S. P. A product obtained by exposing slaked lime to the action of chlorine gas so long as the latter is absorbed, B.P. Characters. — A grayish-white powder having the odor of chlorine and an acrid taste ; absorbs carbonic acid and water when exposed to the air, and at the same time gives off chlorine ; it is only partly soluble in water. The solution is alkaline, and possesses bleaching properties (e.g., it bleaches sulphate of indigo). It is readily decomposed by acids, even by carbonic acid, and thus when exposed to the air chlorine is given off slowly. The addition of a stronger acid causes it to be evolved rapidly. Its probable constitution f CI is Ca< Qpi This is decomposed by water into a mixture of calcium chloride and hypochlorite, and as it is usually moist it may be regarded as usually consisting of a mixture of these substances. On the addition of sulphuric acid, hypochlorous and hydrochloric acids are set free, which, reacting on one another, yield free chlorine. HCIO + HC1 = Cl 2 + H 2 0. Reaction — The addition of oxalic acid causes the rapid and copious evolution of chlorine and the deposition of oxalate of lime. Impurities. — Imperfect saturation with chlorine. It is tested volu- metrically in a similar way to liquor chlori, the chlorine being set free 468 INORGANIC MATERIA MEDICA. from it by the addition of hydrochloric acid. The chlorine thus liberated should amount to 25 per cent. U.S. P., 30 per cent, B.P. Officinal Peepaeations. U.S. p. B.P. Liquor Calcis Chloratae. Liquor Calcis Chloratse. Vapor Chlori. Liquor Calcis Cliloratae. SOLUTION OF CHLOEINATED LlME. — It is a solu- tion of 1 lb. to the gallon of water, and when tested volurnetrically it should contain 13 grains of available chlorine in 1 fl. oz. B.P. Tapor chlori. IxHALATiox of Chloelne— Put 2 ounces of chlori- nated lime into an inhaler or jug, moisten it with water and let the vapor be inhaled. Liquor Sodse Cliloratae, U.S. P. and B.P. Solution of Chlo- rinated Soda. (Labarraque's disinfecting fluid.) Preparation. — By decomposing chlorinated lime by sodium carbon- ate U.S. P., or by passing chlorine into a solution of sodium carbonate B.P. Characters and Tests. — A colorless alkaline liquid, with astringent taste and feeble odor of chlorine. It behaves like a solution of chlo- rinated lime, but is not precipitated by oxalic acid nor oxalate of ammonia. (Distinction from and absence of solution of chlorinated lime.) Dose. — 10 to 20 minims. Officinal Peepaeation, B.P. Cataplasma Soda? Chloratae. Cataplasma Sodae Cliloratae. Linseed meal 4 ; solution of chlorinated soda 2 ; boiling water 8. Uses. — Chlorinated lime is chiefly employed as a disinfectant and a deodorizer. In sick rooms some of it is put in saucers, and either simply moistened and exposed to the air, when it is gradually decomposed by the carbonic acid, or acid is added to it according to the amount of chlo- rine which it is wished to evolve. It is employed also for disinfecting typhoid stools, water-closets and sewers. For this purpose it is used either in powder or solution. A solution is used to disinfect the sheets and bedding of patients suffering from infectious diseases. Solutions of chlorinated lime or of chlorinated soda may be employed instead of chlorine water or permanganate of potash for washing the hands after dissecting or performing post-mortem examinations. They are applied externally to wounds and ulcers of all sorts which have a foetid discharge and a tendency to slough. Not only do they remove the fcetor, but they often induce a healthy action in the tissues themselves ; and instead of the ulceration or sloughing extending farther and farther, the slough is thrown off and leaves behind it a healthy healing surface. As the removal of sloughs is aided by heat, we have in the B.P. the poultice of chlorinated soda. Like chlorine they are destructive to plant life, and they are there- fore useful in skin diseases depending on the presence of parasitic fungi, such as ringworm of the scalp, and in scabies which is due to the pres- ence of a parasitic acarus. As they have a stimulant action on the skin, they are sometimes useful in eczema and prurigo. They are employed as gargles, or washes to the mouth when foetid ulcers occur in these parts, as in ptyalism or in scarlatina; as an injection into the nose they have been used to lessen the discharge and to remove HYDKOGEN, OXYGEN, OZONE, CARBON, ETC. 469 the foetor in ozgena, a disease in which the discharge from the nostrils is sometimes so disgusting as to be almost unendurable to the patient himself as well as to those around him. They are likewise useful in foetid discharges from the vagina, such as occur when the uterus is the seat of malignant disease. Internally they have been employed in so-called putrid fevers, when it was imagined there was a special tendency to decomposition in the blood, such as typhus and malignant scarlatina. They have been given more especially in these diseases when there was great prostration of strength, with foetid evacuations and a dry and furred tongue. BROMUM. Br. 80. Bromine, U.S. P. and B.P. A liquid non-metallic element obtained from sea-water and from some saline springs. Preparation. — Vide p. 465. Characters. — A dark brownish-red, very volatile liquid, with a strong, disagreeable odor. The solution renders cold starch-water yellow. Impurities. — Iodine. Test. — When agitated with sufficient soda to render the fluid very slightly alkaline, it forms a colorless liquid, which, if colored by a fur- ther addition of a little bromine, does not become blue on the subsequent addition of a cold solution of starch. B.P. (absence of iodine). If an aqueous solution of bromine be poured upon reduced iron and shaken with the latter until it has become nearly colorless, then filtered, mixed with gelatinized starch, and a few drops of bromine solution be now carefully poured on the top, not more than a very faint blue zone should appear at the line of contact of the two liquids (limit of iodine), U.S. P. Uses. — Bromine, although a powerful disinfectant, is not much used on account of its exceedingly foetid and disagreeable smell. It is a pow- erful irritant, and when inhaled without sufficient dilution with air will produce pneumonia. Taken in small doses, for a length of time, it has produced mental depression, drowsiness and stupidity. It is only used in the form of its potassium, sodium, ammonium, calcium, and zinc salts, and of hydrobromic acid, which have not its powerfully irritant local action. It is introduced into the pharmacopoeias for their preparation. IODUM. I. 127 or 126-6, U.S.P. Iodine. — A non-metallic element obtained principally from the ashes of sea-weed. Preparation. — Vide p. 465. Characters. — Heavy bluish-black rhombic plates of a peculiar odor and metallic lustre, which, when heated, yield a beautiful violet-colored vapor ; very sparingly soluble in water, but freely dissolved by alcohol, by ether, and by a solution of iodide of potassium. The aqueous solution strikes a deep blue color with starch. Impurities. — Moisture, metallic impurities fraudulently added, cya- nide of iodine (the nitrogen in this is yielded by marine animals amongst the sea-weed), chloride of iodine, chlorine and bromine. Tests. — It should not adhere to the sides of the bottle and its solution in chloroform should be clear and limpid (absence of moisture). It 470 INORGANIC MATERIA MEDICA. sublimes as a purple vapor without leaving any residue (absence of fixed impurities), and the portion that first comes over does not include any slender colorless prisms emitting a pungent odor (absence of cyanide of iodine) ; 12*7 grains dissolved in an ounce of water containing fifteen grains of iodide of potassium require for complete discoloration 1000 grain-measures of the volumetric solution of hyposulphite of soda. PREPARATIONS . TJ. S. P. Ammorrii Iodidum. Sulphuris Iodiduni. Argenti Iodidum. *Tinctura Iodi (8 in 100). Arsenici Iodidum. "^TJnguentuni Iodi (4 in 100). *Xiquor Iodi Corapositus (5 in 100) T Plumbi Iodidi. Plumbi Iodidum. Potassii Iodi. Potassii Iodidum. Zinci Iodidum. Sodii Iodidum. B.P. Cadmii Iodidum. Ferri Iodidum. Hydrargyri Iodidum Rubrum. " * " Viride. *L.inimentuni Iodi, alcoholic solution (1 in 9). Linimentum Potassii Iodidi cum Sapone, aqueous solution. liquor Iodi (1 in 24). Pilula Ferri Iodidi. Potassii Iodidum. Sulphuris Iodidum. Syrupus Ferri Iodidi. *Tmctura Iodi, alcoholic solution (1 in 40). Unguentum Cadmii Iodidi. * " " Iodi (1 in 31). Plumbi Iodidi. " " Sulphuris Iodidi. *Vapor Iodi (Tincture of Iodine, 1 n. dr. mixed with 1 fl. oz. of water, gently warmed, and the vapor inhaled). The preparations marked with * in the preceding list contain iodine in a free state. The others contain it in a state of combination. Sulphuris Iodidum. Iodide OF Sulphur, U.S. P. and B.P. Preparation. — By fusing iodine and sublimed sulphur together. Characters. — Grayish-black crystalline lumps. It smells like iodine and stains the skin. When boiled with water it is decomposed, iodine passing off and sulphur remaining. Officinal Preparation, b.p. Unguentum Sulphuris Iodidi. — Ointment of iodide of sulphur (30 grains to an ounce of prepared lead). U.S.P. \ None. Uses. — It has been given internally in scrofula, skin diseases, and glanders. It is used externally as ointment in lupus and parasitic skin diseases. Iodine is rendered much more soluble either in water or spirit by the addition of iodide of potassium, hence this substance is used in the com- pound solution and ointment of the U.S. P., and in the liniment, liquor, tincture, and ointment of the B.P. It is not contained in the tincture of the U.S. P., which is a simple solution of iodine in alcohol. Dose. — The only preparations of iodine used for internal adminis- tration are the tincture U.S.P. and B.P., the compound solution U.S.P. and the liquor B.P., of all of which the dose is 5 to 20 minims. PHYSIOLOGICAL Action. — Like chlorine and bromine, iodine is a powerful antiseptic and oxidizing agent. When applied to the unbroken skin, iodine stains it of a dark yellowish-brown color, causes slight HYDROGEN, OXYGEN, OZONE, CARBON, ETC. 471 warmth, and afterwards a little itching. In stronger solutions it will cause a painful burning sensation, and desquamation of the epidermis. In still stronger solution it may produce vesication. When taken internally, in small doses, it acts as an irritant to the intestinal canal, causing catarrh of the mucous membrane. When absorbed into the blood it some- what increases the rapidity of the pulse. It has little action upon blood-pressure. Its influence upon the temperature is very slight, but seems rather to raise it. Iodine appears to have a tendency to cause absorption of enlarged glands and thickenings caused by chronic inflammation. It seems to combine with such metals as lead and mer- cury, which have become deposited in the tissues in cases of chronic poisoning, forming with these soluble iodides, which are eliminated in the same way as iodine itself. It is eliminated by the urine, nasal mucous membrane, saliva, intestinal mucus and milk, in all of which it may be readily detected. It appears to be eliminated even more readily by the saliva than by the urine (p. 315), and on this account it may remain a considerable time in the body. During the process of elimina- tion it may irritate those parts where it is set free from its compounds, as the nose or skin. Even in small doses it may cause symptoms of iodism. These consist in irritation, either of the nose or intestinal tract ; the most prominent are great running at the nose, lacrymation, and sometimes frontal headache. Similar symptoms are produced by exposure to the fumes of iodine for a length of time. The nasal symp- toms may be accompanied or replaced by symptoms of gastric irritation, loss of appetite, slight nausea, and tendency to looseness of the bowels. The symptoms of poisoning', such as have occurred from the injec- tion of large quantities of iodine solution into the ovarian cyst, were first, collapse, followed after a little while by an appearance of fever, with rapid pulse and flushed face, but without any rise of temperature. This condition passed off in several days, but during apparent convales- cence the patient suddenly died. Small doses of iodine, by improving the health of patients, may increase the menstrual flow, and may act as aphrodisiacs. Larger doses generally have a very marked anaphro- disiac action, and it has been stated that long continued use has pro- duced atrophy of the mammae, ovaries, and testes. It has been stated that very large doses affect the nervous system, causing delirium,and twitching or paralysis of the muscles (p. 466). Uses. — Iodine applied to the epidermis acts as a parasiticide, and may be used, in cases of tinea, either alone or combined with tar to destroy parasitic fungi. Its solution, painted on the surface, is useful in removing muscular pains, and in causing absorption of thickening around joints, or of enlarged strumous glands. When painted on the surface it sometimes causes absorption of the enlarged thyroid gland in goitre, and, when outward application is insufficient, success is some- times obtained by injecting from ten to thirty minims of tincture of iodine into the substance of the tumor by means of a hypodermic syringe, care being taken to avoid injection into a vein. Its solution, painted on the surface, is also useful in causing absorption of fluid from serous cavi- ties, as pleurisy. Sometimes, after the fluid has been evacuated from a serous sac, such as the pleura, or the tunica vaginalis in hydrocele, or 472 IXORGANIC MATERIA MEDICA. from ovarian cysts, a dilute tincture of iodine is injected into the sac to prevent the fluid from again accumulating. In removing slight consolidation of the lung, remaining after pneu- monia or pleurisy, or in cases of commencing phthisis, the external application of liniment of iodine is very useful. It should be painted on the surface, every second or third day, so as always to keep one part a little tender. By mixing the liniment with the tincture in varying pro- portions any degree of strength can be obtained. Cases of ozoena are sometimes much benefited by washing out the nose with a solution of common salt to which a few drops of tincture of iodine have been added. The vapor of iodine is employed in chronic bronchitis and phthisis. On account of its irritating action on the intestinal mucous mem- brane, iodine is rarely given internally, its place being supplied by iodide of potassium, but some consider that iodine is sometimes more effectual. The compound solution of iodine U.S. P., or liquor iodi B.P., is useful in arresting vomiting when administered internally in doses of 3 to 5 minims. CHAPTER XXIII. ACIDS. General Characters. — It is somewhat difficult to get a correct definition of an acid. Most of them have a sour taste and redden blue litmus: they combine with alkalies and destroy the power which these have of turning red litmus-paper blue. They may be regarded as compounds of hydrogen with certain radi- cals, hydrogen being readily displaced by other bases. Some acids, as boric and carbolic, have no sour taste. Carbolic acid does not redden litmus-paper, but it is in reality an alcohol, although in chemical com- binations it behaves like an acid. General Preparation of Acids. — Most acids are prepared by liberating them from their alkaline salts by means of sulphuric acid. When they are volatile they are separated by distillation, and when non- volatile by crystallization. Sulphuric acid, which is of such importance in the preparation of other acids, is itself prepared by oxidizing the fumes of sulphur by means of nitric acid. Sulphur is burnt, and the sulphurous oxide thus produced is conducted along with the vapor of nitric acid into a large leaden chamber where it is mixed with steam. Sulphurous oxide is oxidized by the nitric acid and sulphuric oxide is formed, which, uniting with the watery vapor, forms sulphuric acid. The nitric acid is deoxidized in this process into nitric oxide, this unites with the oxygen of the air to form nitric peroxide, and this again supplies fresh oxygen to the sulphurous ACIDS. 473 acid, N0 2 + S0 2 + H 2 = NO + H 2 S0 4 . In this way a small quantity of nitric acid is sufficient to oxidize a large quantity of sulphuric acid ; reduction and reoxidation going on alternately in the nitrous fumes. The sulphuric acid formed in the leaden chamber is drawn off and evapo- rated to the proper strength. The acids which are prepared by liberation from their salts by sul- phuric acid are given in the following tables : — Volatile Acid. Prepared from By addition of Sulphuric Acid and Carbonic Acid. Any carbonate, gener- ally carbonate of lime. Conducting into water or alkaline solution, according to the purpose required. Hydrochloric Acid, U.S.P. and B.P. Sodium chloride. Distilling into water, which dis- solves the acid. Nitric Acid, U.S.P. and B.P. Sodium Nitrate, or Potassium Nitrate. Distilling. Acetic Acid, U.S.P. and B.P. Crystallized Sodium Acetate. Do. Glacial Acetic Acid, U.S.P. and B.P. Dried Sodium Ace- tate. Do. Dilute Hydrocyanic Acid,U.S.P.andB.P. Potassium Ferrocy- anide. Distilling into water. Dilute Hydrobromic Acid, U.S.P. Potassium Bromide. Crystallizing out potassium sul- phate, distilling the mother- liquor, and diluting the distillate. Sodium chloride and sodium nitrate are found native: the sodium acetate is prepared from gas liquor by saturating with sodium carbonate. In preparing hydrocyanic acid the cyanide is not employed, but the ferrocyanide which is prepared by heating together animal refuse and iron filings and potassium carbonate. Non-Volatile Acid. Tartaric Acid,U.S.P. and B.P. Citric Acid, U.S.P. and B.P. Boric Acid U.S.P., or Boracic Acid B.P. Prepared from Tartrate of lime made from acid tartrate of potash. Citrate of lime pre- pared from lemon juice. Sodium borate. By addition of Sulphuric Acid and Subsequent decantation from cal- cium sulphate, evaporation and crystallization. Subsequent decantation from cal- cium sulphate, evaporation and crystallization. Precipitation ; the boracic acid, sparingly soluble in water, falls as a precipitate, and the sodium sulphate is removed by decanta- tion or nitration. 474 INOBGAmC MATERIA MEDICA. If sulphuric acid were added to citrate or tartrate of potassium or sodium, it would be difficult to separate the acid from the sulphate. To avoid this, the citrates and tartrates of lime are first prepared, and to these sulphuric acid is added. There results an insoluble calcium sul- phate which falls as a precipitate, and the solution of citric or tartaric acid is readily separated by decantation or filtration, and evaporated to crystallization. Citrate of lime is prepared by adding chalk to boiling lemon-juice, and washing the coloring matter from the precipitate by hot water. Hot is employed in preference to cold water because citrate of lime is less soluble in it. Tartrate of lime is prepared from the crude acid tartrate of potash or argol, which is deposited from wine during the process of fermentation. Chalk is first added to a solution of it, whereby a neutral tartrate is formed, 2(KHC 4 H 4 6 ) + CaC0 3 = CaC 4 H 4 6 + K 2 C 4 H 4 6 -f- C0 2 + H 2 0. This is then decomposed by the addition of calcium chloride or sulphate, K 2 C 4 H 4 6 + CaCl 2 = CaC 4 H 4 6 + 2KC1. Hydrobromic acid, although volatile, is not unfrequently prepared without distillation. Hamilton's plan is to dissolve 84J grs. potassium bromide in a fluid ounce of water, and add 99 grs. of tartaric acid to it. After standing at a low temperature for twelve hours, acid tartrate of potassium crystallizes out, and leaves a solution containing about 10 per cent, of real hydrobromic acid. Exceptions to the rule that acids are prepared from salts by the addition of sulphuric acid : — Acid. Prepared by- Sulphuric Acid. Oxidizing sulphur by means of nitrous fumes. Phosphoric Acid Dilute. Oxidizing phosphorus by heating it with diluted nitric acid until nitrous fumes have ceased to form, and then diluting it to the proper strength. Oxalic Acid. Oxidizing sugar by heating with nitric acid. Sulphurous Acid. Deoxidizing sulphuric acid by means of charcoal and passing the fumes into water. Arsenious Acid. Roasting arsenical ores, collecting the acid which sub- limes, and purifying it by resublimation. Benzoic Acid. Heating gum benzoin when the acid sublimes. Carbolic Acid. Fractional distillation of tar. Oleic Acid. Decomposing lead oleate by hj'drochloric acid. Salicylic Acid. By passing carbonic acid gas over sodium carbolate which is made by evaporating caustic soda and car- bolic acid together to dryness. Tannic Acid. Dissolving out from the fresh nut-galls in which it is contained by ether and water. Gallic Acid. Dissolving it out from fermented nut-galls by hot water. acids. 475 General Action of Acids. — They have an affinity for electro-positive or basic substances, and combine with them when they come in con- tact. Stronger acids drive out weaker ones from their combination with bases, setting them free ; but are themselves sometimes driven out by weaker ones if these form an insoluble combination. When they come in contact with the tissues they produce changes in a twofold manner ; (1) by forming new compounds, (2) by destroying others previously existing. The different acids possess different affinities, and the actions they exert vary with the acid and with the degree of its concentration, weak acids having their affinities easily satisfied. All the tissues of the body are alkaline, and the first effect of acids will be to neutralize the alkali, and if albumen be dissolved in it to precipitate it. If sufficient acid be present, they all, with the exception of nitric acid, again redissolve it. Acids unite with albumen in different proportions, forming acid albumins. When mixed with blood they not only precipi- tate albuminous substances, but decompose haemoglobin, forming a sub- stance which holds oxygen with more tenacity than haemoglobin. They coagulate myosin and produce instantaneous rigidity in muscles. Sul- phuric and phosphoric acids have, besides their chemical affinities, a strong attraction for water, and completely decompose the tissues to which they are applied, so that they are most powerful eseliarotics. Nitric acid does not readily redissolve the albumen precipitated by it, and thus forms a barrier to its own action, so that it does not penetrate so deeply as sulphuric acid. Round the tissue killed by the acids inflammation ensues, and an eschar is separated. When their action is less intense they cause inflam- mation of the surface of the dermis, and produce vesication. Still less concentrated, they precipitate albumen from its solutions in the tissues, act as irritants, and cause contraction of the blood-vessels. This effect is removed by the alkalinity of the blood, and the irritation may be only sufficient to cause a temporary congestion subsequent to the contraction. Then the acids act only as rubefacients. As such they are used in the form of baths. In the mouth they cause a peculiar taste, and a feeling of roughness in the teeth. They cause an increased flow of saliva from the parotid, and of the thin saliva which the submaxillary secretes when the chorda tympani is irritated, but have no effect on the sympathetic saliva. They are therefore given to allay thirst in fever, the increased secretion of saliva which they provoke keeping the fauces moist (p. 316). Acids stimulate the secretion of the alkaline saliva and intestinal juice, and excite the expulsion of bile from the gall-bladder. They are supposed generally to stimulate those glands whose secretions are alka- line. On the other hand alkalies stimulate the secretion of gas trie juice, which is acid ; and they are supposed to stimulate in general those glands whose secretion is acid. Professor Ringer supposes that the converse is also the case, and that acids and alkalies severally hinder the secretions of a like character. This supposition may be correct, and no doubt when an acid is present, e.g., in the stomach, it will neutralize any alkali which may be taken and either retard its stimulant action on the gland or pre- vent it altogether, according to the relative quantities of acid present 476 INORGANIC MATERIA MEDICA. and of alkali employed. The presence of much alkali will also hinder the action of an acid stimulus in the same manner, but whether acids and alkalis have any farther effect in hindering secretion than that just mentioned is uncertain. Acids are partly neutralized by the saliva, and partly act as astrin- gents on the mouth and fauces. They are thus used in congestion of the throat. As they corrode the teeth, they are generally given through a glass tube or quill, and the teeth should be rubbed with chalk afterwards. Digestion in the stomach is accomplished by the action of pepsin along with dilute hydrochloric acid. This ferment only acts in presence of free acid ; but the amount of acid necessary is different in different animals, being greatest in the carnivora and least in the herbivora. Pepsin seems able to go on dissolving fibrin almost without a limit, but fresh acid must always be added. If the secretion is deficient, digestion goes on slowly and fermentation of the food takes place, causing the formation of other acids and liberation of gases. The secretion of gastric juice may be stimulated by alkalis given just before meals, but if the stomach is so much out of order as not to respond to the stimulus, hydrochloric or phosphoric acid may be given after meals, alone or with pepsin. In febrile conditions there is a defi- ciency of acid in the stomach, although pepsin is present in plenty. In chronic gastric catarrh, especially when accompanied by dilatation, the acid is greatly diminished, and in carcinoma of the stomach it would seem to be wanting in the great majority of cases. In such conditions, therefore, the administration of diluted hydrochloric acid is indicated. For acid eructations and heartburn depending on excessive acidity of the gastric juice, acids should be given before meals (Ringer). Some persons are troubled by eructations of sulphuretted hydrogen with a taste of rotten eggs. These persons have generally oxalic acid in the urine, and frequently suffer from depression of spirits. Such patients are benefited by acids, especially nitro-hydrochloric acid. Per- sons who suffer from dyspepsia and depression of spirits with oxaluria are also benefited by mineral acids, even when no sulphuretted hydrogen is present in the intestines. When the use of acids is long continued they lessen the secretion of gastric juice, and produce a catarrhal condition of the mucous membrane of the stomach. They should therefore not be given for more than a week or two at a time. They should then be left off for a short time, or alternated with alkalis. Constant use of acid wines has a similar tendency to produce catarrh. Vinegar is sometimes drunk in order to lessen obesity or even plumpness. It has this effect by inducing gastro- intestinal catarrh, but sometimes the derangement of the digestion occa- sioned by it has been so great as to cause death. Acids stimulate the expulsion of bile from the gall-bladder, and the secretion of intestinal juice. As they will be rapidly neutralized by the bile and pancreatic juice, and absorbed in the duodenum, they can hardly reach the lower and middle parts of the alimentary canal as acids. Their action in relieving diarrhoea is difficult to explain. When absorbed from the intestine they must pass through the liver before they can reach the general circulation. It is probable that during acids. 477 their passage through the portal system they alter the processes of tissue change which go on in the liver, and check the formation of urea. The reason for this supposition is that acids are excreted in the urine, chiefly in the form of ammoniacal salts. In the normal condition ammonia is readily converted into urea in the organism, and when given internally it appears in the urine in the form of urea and not of ammoniacal salts. The appearance of these salts in the urine after the administration of acids shows that the normal process of conversion into urea has been diminished. Possibly it is to such alterations in the tissue change in the liver that the so-called tonic action of acids is due (p. 356), as well as the marked benefit obtained in hepatic disorders from the admin- istration of nitric and nitro-hydrochloric acids. Although acids appear in the urine in combination with ammonia and other bases, yet their free administration increases the acidity of the urine. They are there- fore used to prevent the deposits of phosphatic calculi which are apt to occur in alkaline urine. Poisoning by Acids. — The symptoms of poisoning by acids, and the antidotes to be employed, have already been described (pp. 345, 347, and 417). In cases of acute poisoning where death has not occurred too quickly, much albumen, hsematin and indican have appeared in the urine, and fatty degeneration of the liver, muscles and kidneys has been found. In the kidneys the cloudy swelling and fatty degeneration of the cells was accompanied by evidences of inflammation in the connec- tive tissue also, as it exhibited proliferation of nuclei, especially along the course of the vessels. Acidum Sulpliuricum, U.S. P. and B.P. Sulphuric Acid. — It contains 96*8 per cent, of H 2 S0 4 (98) and corresponds to 79 per cent, of anhydrous sulphuric acid, S0 3 (80). Preparation. — Vide p. 474. Properties. — A colorless, oily-looking heavy liquid. Sp. gr. 1*843 ; no smell ; but intensely acid taste. It blackens and corrodes most organic substances. It has a great affinity for water, and when mixed with it evolves much heat. When diluted it gives a copious white pre- cipitate of barium sulphate (BaS0 4 ) with chloride of barium, insoluble in nitric or in hydrochloric acid. Impurities. — Lead derived from the leaden chambers in which it is prepared ; nitric acid from the nitrous fumes ; arsenic from impure sulphur being used and the arsenious fumes passing over with the sulphurous acid ; and water from imperfect concentration or fraudulent addition. Tests. — Not unfrequently it contains so much lead in the form of sulphate, that when diluted with water it deposits a white precipitate, the sulphate being soluble in the strong but not in the weak acid. It should not do this, and when evaporated in a platinum dish it should leave little or no residue (no lead, arsenic, or saline impurities). When a solution of sulphate of iron is carefully poured over its surface, there is no purple color developed where the two liquids unite (no nitric acid). Diluted with six times its volume of distilled water, it gives no precipi- tate with sulphuretted hydrogen (no arsenic or lead). The absence of 478 INORGANIC MATERIA MEDICA. water is ascertained by the sp. gr. not being below 1*840, and by the volumetric estimation of its neutralizing power with solution of soda. Officixal Peepakations. AcidmnSulplmricitru Aroinaticuin, U.S.P. antlB.P. AEOMATIC SULPHUEIC ACID. — Is sulphuric acid diluted with alcohol and flavored with cinnamon and ginger. 1 in 10 U.S.P. and about 1 in 13 B.P. by measure. Aciduui Siilpburicum Dilutum, U.S.P. and B.P. DILUTE SULPHUEIC ACID. — Is the strong acid diluted with 164- parts U.S.P., 11 parts B.P., of water by measure; 1 in 10 by weight U.S.P. Doses. — Of either aromatic or dilute sulphuric acid 5-30 min. freely diluted. Incompatibles. — Preparations of lead. Action. — It is a most powerful caustic and quickly chars and destroys the parts it touches. When mixed with charcoal paste it is used as a caustic in cancer, and with lard in obstinate skin diseases. When swallowed, as it not unfrequently is in manufacturing districts, it pro- duces symptoms of irritant poisoning (p. 344). The antidotes are alkalis, soap, oil, whiting, milk, plaster from the wall, or magnesia. Uses. — Internally it is used after free dilution to quench thirst in fever, to prevent absorption of lead from the stomach in painters and color-grinders, to check diarrhoea, especially in phthisis, to arrest haemop- tysis and other haemorrhages, and to lessen night sweats and mucous discharges. - - Acidum Sulplmrosuiii, U.S.P. and B.P. SULPHUROUS Acid. — Sulphurous acid gas (S0 2 ; 64) dissolved in water and constituting 9-2 per cent, of the solution. Preparation.— Vide p. 474, 2H 2 SO, + C = C0 2 + 2S0 2 + 2H 2 0. Properties. — A colorless liquid with a strong sulphurous odor. Unlike sulphuric acid, it gives no precipitate with chloride of barium, but if chlorine be added to it, it becomes converted into sulphuric acid, and then gives a precipitate, S0 2 + 2H 2 + Cl 2 = H 2 SO, + 2HC1. Impurities. — Sulphuric acid, solid impurities, too little sulphurous acid. Test. — It should give no precipitate, or only a slight one, with chlo- ride of barium (little or no sulphuric acid) ; but very few specimens answer either to this test or to the officinal volumetric test on account of the liability of the acid to decompose. It should leave no residue on evapo- ration. Its strength is determined by its sp. gr. 1-04 and the volumetric test. Dose. — J— 1 fluid drachm diluted with water. Action. — It is a powerful deoxidizing agent. It is extremely de- structive to plant life, and so may destroy disease germs. Uses. — Gaseous sulphurous acid is used to disinfect rooms. The room should be closely shut up, and a brazier with charcoal placed in it. On this sulphur is thrown, and the fumes are allowed to permeate the room for several hours. Care must be taken that the brazier is so placed that there is no danger of anything in the room catching fire. A solu- tion mixed with glycerine may be applied in skin diseases depending on acids. 479 parasitic fungi. It is very useful in cases of vomiting, especially when the vomited matters have a frothy or yeasty appearance, due to the pres- ence of sarcinie and to the occurrence . of fermentation in the stomach. Applied as spray it sometimes gives relief in laryngeal phthisis. Acidum Hydrocliloricum, U.S. P. and B.P. HYDROCHLORIC or Muriatic Acid. — Hydrochloric acid gas (HC1; 36*4) dissolved in water, and forming 31*9 U.S. P., 31-8 B.P., per cent, by weight of the solution. Preparation. — By warming chloride of sodium with sulphuric acid, washing the evolved HC1, and conducting it into cold water by which it is absorbed. Excess of sulphuric acid is employed if glass vessels are used in the preparation either of this or of nitric acid, as the bisulphate of potash left behind is more soluble than the neutral sulphate, and thus the vessels are more easily cleaned. NaCl -f- H 2 S0 4 = NaHS0 4 + HC1. Properties. — A nearly colorless liquid, sp. gr. 1-16. It emits white vapors having a pungent odor, and has a strongly acid taste. Reaction. — It gives with nitrate of silver a curdy white precipitate soluble in excess of ammonia, insoluble in nitric acid. Impurities. — Salts ; sulphuric acid, with its impurities, lead and arsenic ; chloride of sodium or chlorine ; sulphurous acid formed from sulphuric by organic substances ; iron from the apparatus in which it is made commercially.'] Arsenic is of importance as an impurity because hydrochloric acid is sometimes used in testing for arsenic by the formation of arsenuretted hydrogen. When testing for arsenic in cases of suspected poisoning both the acid and the zinc must be tested first, in order to ascertain their purity before the suspected substance is added. Tests. — When diluted with four times its volume of distilled water it gives no precipitate with solution of chloride of barium (absence of sulphuric acid), or with sulphuretted hydrogen (absence of lead or arsenic), and does not tarnish or alter the color of bright copper foil when boiled with it (absence of arsenic). When diluted with five volumes of water it should not liberate iodine from iodide of potas- sium (absence of chlorine) ; and when 1 c.c. is diluted to 10 c.c. with water, and supersaturated with ammonia, the addition of two drops of ammonium sulphide causes no black color (absence of iron). If a fluid drachm of it mixed with half an ounce of distilled water be put into a small flask with a few pieces of granulated zinc, and while the effer- vescence continues a slip of bibulous paper wetted with solution of nitrate of silver, U.S. P., or subacetate of lead, B.P., be suspended in the upper part of the flask above the liquid for about five minutes, the paper will not become discolored (absence of sulphurous or arsenious acid, S0 2 + 6H = H 2 S -f- 2H 2 0). When evaporated it leaves no residue (no sodium chloride or other fixed impurity). Peepaeatioxs coxtaining feee Hydeochloeic Acid. U.S.P. DOSE. Acidum Hydrocliloricum Dilutum (acid 6, water 13 by weight ; 5 j and 14 by measure) 10-30 m. Acidum Nitro-hydrochloricum " " Dilutum 10-30 m. 480 INOKGANIC MATERIA MEDICA. Peepaeations containing feee Hydeochloeic Acid. B.P. DOSE. Aoidimi Hydrochloricum Dilutura (acid 8, diluted with water up to 26 J by measure) 10-30 m. Acidum Nitro-hydrochloricuin Dilutum 10-30 m. Liquor Antimonii Chloridi " Arsenici Hydrochloricus " Morphise Hydrochloratis Action and Uses. — It produces symptoms of poisoning like those of sulphuric acid. The stains which it leaves upon the mucous mem- brane are white. It is rarely used externally. It may be employed to quench thirst in fevers, and to lessen phosphatic deposits in the urine. As it is the acid of the gastric juice, it may be given after meals in cases of indigestion, where we suspect deficiency of acid (p. 475) and to aid the digestion of food, as well as to relieve thirst in febrile conditions (pp. 475 and 316). Acidum Nitricum, U.S. P. and B.P. Nitric Acid, (HN0 3 ; 63.) — An acid prepared from nitrate of potash or nitrate of soda by distilla- tion with sulphuric acid and water, and containing 69*4 per cent. U.S. P. or 70 B.P. by weight of nitric acid, HN0 3 , corresponding to 60 per cent, of anhydrous nitric acid, N 2 5 . Characters. — A colorless liquid, having a specific gravity of 1*42. When exposed to the air it emits an acrid, corrosive vapor. If it be poured over copper filings, dense red vapors are immediately formed, but if the acid be mixed with an equal volume of water, and then added to the copper, it gives off a colorless gas, which acquires an orange-red color as it mixes with the air, and which, if it be introduced into a solu- tion of sulphate of iron, communicates to it a dark purple or brown color, due either to solution of N 2 2 in the sulphate or combination with it. The boiling point of the acid is 250°. If submitted to distillation the product continues uniform throughout the process. Impurities. — Weaker or stronger acid, sulphuric or hydrochloric acids, fixed impurities. Tests. — It leaves no residue when evaporated to dryness (no fixed impurities, as iron, lead, &c). Diluted with six times its volume of distilled water it gives no precipitate with chloride of barium or nitrate of silver (absence of sulphuric or hydrochloric acids). Peepaeations containing feee Niteic Acid. u.s.p. B.P. dose. Acidum Nitricum Dilutum (acid 1, water Acidum Nitricum IMlutuin (1 *) 6 by weight; 1£ and 12J by measure). with about 4 of water by > 10-30 m. Acidum Nitro-hydrochloricum measure) J " Dilutum. Acidum Nitro-hydrochloricum Dilutum Liquor Ferri Pernitratis " Hydrargyri Nitratis Acidus Ungucntum Hydrargyri Ni- tratis Action. — It is an exceedingly powerful caustic, and destroys the tissues, but, unlike sulphuric acid, it forms, to some extent, a barrier to ACIDS. 481 its own action by coagulating the albumen with which it meets. When swallowed, it may not only produce the symptoms of irritant poisoning already described, but the vapor, getting into the larynx, may cause spasm of the glottis, and death from suffocation, or may produce intense bronchitis. Uses. — Nitric acid is applied externally to destroy chancres, warty growths, and haemorrhoids ; to the surface of phagedenic ulcers ; and to bites of snakes or rabid dogs in order to destroy the virus and prevent its absorption. Internally the dilute acid is used to quench thirst in febrile conditions, like other dilute acids, and it is useful in cases of dyspepsia. It is supposed to have an action upon the liver, and certainly appears to be of use in cases of so-called biliousness. When absorbed it has an astringent action, and is exceedingly serviceable in diminishing the secretion from the lungs in bronchitis and in the sub-acute exacerba- tions of phthisis. It is also employed in cases of syphilis occurring in debilitated subjects, where mercurials are not well borne. It diminishes phosphatic deposits in the urine, and, in a dilute condition, has been injected into the bladder in order to dissolve calculi already formed. U.S. P. Acidum Xitrohydrocliloricum. NITROHYDROCHLORIC Acid. Preparation. — By mixing nitric acid (4) with hydrochloric acid (15 parts) and when effervescence has ceased, preserving it in glass- stoppered bottles, which should not be more than half filled and kept in a cool place. Characters. — A golden yellow, fuming and very corrosive liquid, having a strong odor of chlorine and a strongly acid reaction. By heat it is wholly volatilized. It readily dissolves gold leaf, and a drop added to test solution of iodide of potassium liberates iodine abundantly. Acidum Nitrohydrochloricum Dilutum, U.S. P. and B.P. Dilute Nitrohydrochloric Acid. Preparation. — By diluting nitrohydrochloric acid (1) with water (26 parts by weight U.S. P.). The proportions in the U.S. P. by measure, are nitric 3, hydrochloric acid 13J, water 80. In the B.P., nitric 3, hydrochloric 4, water 25, by measure. Dose. — 5-20 min. Use. — This, like nitric acid, is supposed to have a special action upon the liver. It is sometimes used in the form of baths or compresses in hepatic disorders, and is frequently given in cases of dyspepsia, bil- iousness and jaundice. When given before meals it seems to check acidity in the stomach, and it is very useful in removing headache situated in the forehead, just above the eyebrows, and unaccompanied by constipation. Acidum Aceticum, U.S. P. and B.P. Acetic Acid — HC 2 H 3 2 ; 60. An acid liquid prepared from wood by destructive distillation and subsequent purification. 100 parts by weight contain 36 U.S. P., 33 B.P. parts of acetic acid HC 2 H 3 2 ; 60 corresponding to 28 parts of anhydrous acetic acid, C 4 H 6 3 . Characters and Tests. — A colorless liquid having a strong acid reaction and a pungent odor. Specific gravity 1*048 U.S. P., 1*044 B.P., at 15° C. 31 482 INORGANIC MATERIA MEDICA. Impurities. — Lime, lead, copper, tin, sulphuric and hydrochloric acids, and sulphurous acid due to the action of organic matter on the sulphuric acid. Tests. — It leaves no residue when evaporated (no lime, &c), and gives no precipitate with sulphuretted hydrogen (no metals), chloride of barium (absence of sulphuric acid), or nitrate of silver (absence of hydro- chloric acid). If a fluid drachm of it mixed with half an ounce of dis- tilled water and half a drachm of pure hydrochloric acid be put into a small flask with a few pieces of granulated zinc, and while the efferves- cence continues a slip of bibulous paper wetted with solution of sub- acetate of lead be suspended in the upper part of the flask above the liquid for about five minutes, the paper will not become discolored (absence of sulphurous acid S0 2 + 6H = H 2 S -f 2H 2 0). Preparations containing feee Acetic Acid. Acetuiu ....4*6 per cent, anhydrous acetic acid. " Cantharidis " Scillae Acidum Aceticuiu Giaciale 84 per cent, anhydrous acid. " Aceticuiu 28 per cent. " " DUutuni 3'6 per cent. " fExtractum Colchici Aceticum Linimentuni Terebinthinse Aceticum 1 volume acetic acid in 3. Liquor Epispasticus 1 volume acetic acid in 5. Mistura Creasoti Oxvmel " Scillse Sy rupus Scillse Acidum Aceticum Dilutum, TJ.S.P. aud B.P. DILUTED ACETIC ACID.— Acetic acid 17 parts, water 83 parts, U.S.P., or acetic acid 1 part diluted with water 7 parts, B.P. Properties, Impurities. — The same as of acetic acid, except so far as they are affected by its dilution. Dose. — 1 to 2 fluid drachms. Preparations in which Diluted Acetic Acid is used. b.p. Acetuin Scillae. Liquor Morphia? Acetatis. Acidum Aceticum Giaciale, U.S. P. aud B.P. — Glacial Acetic Acid, HC 2 H 3 2 ; 60. Nearly or quite absolute acetic acid, U.S. P. Concentrated acetic acid, corresponding to at least 84 per cent, of anhy- drous acid, C 4 H O 3 , B.P. Characters axd Tests. — At or below 15° C. (59° F.) a crystalline solid; at higher temperature, a colorless liquid. "When liquefied and as near as possible to 15° C. (59° F.) it has the sp. gr. 1-056-1-058. Its properties are similar to those of acetic acid, and it is similarly affected by reagents. U.S. P. It crystallizes when cooled to 34°, and remains crystalline until the temperature rises to above 48°. Specific gravity 1-065 to 1*066, and this is increased by adding ten per cent, of water. At the mean tem- perature of the air it is a colorless liquid, with a pungent acetous odor. B.P. Preparations in which Glacial Acetic Acid is Used. b.p. \< itum Cantharidis. Mistura Creasoti. acids. 483 B.P. Acetum. Vinegar. — An acid liquid, prepared from malt and unmalted grain by the acetous fermentation. Characters. — A liquid of a brown color and peculiar odor. Impurities. — A little sulphuric acid added to it is said to make it keep better. Too much may be fraudulently added in order to increase its acidity. Lead from the vessels in which it is kept. Tests. — If ten minims of solution of chloride of barium be added to a fluid ounce of the vinegar, and the precipitate, if any, be separated by filtration, a further addition of the test will give no precipitate (limit of sulphuric acid). Sulphuretted hydrogen causes no change of color (absence of lead). Dose. — 1 to 2 fluid drachms. Peepaeation in which Vinegae is Used. Emplastrum Cerati Saponis. Action and Uses. — When applied externally to the skin, glacial acetic acid causes the formation of a large bleb. It is used to destroy warts, and is sometimes employed as a vesicant in cases of kidney dis- ease, where danger is apprehended from the use of cantharides. When the vapor of it is sniffed up the nose, it causes reflex contraction of the blood-vessels, and raises the blood-pressure. It is therefore useful in lessening drowsiness and preventing syncope, or arousing patients from it (pp. 177 and 231). Dilute acetic acid is applied to the skin in cases of headache, and is used to sponge the surface and check perspiration when too profuse. It checks bleeding, and may be used to stop oozing from leech bites, or to wash out the mouth after the extraction of a tooth ; and, when sniffed up the nose, sometimes arrests epistaxis. It is occasionally employed in the form of an enema to destroy ascarides. U.S. P. Aciduiu Pliosplioricum. Phosphoric Acid. — A liquid composed of 50 per cent, of orthophosphoric acid (H 3 P0 4 ; 98) and 50 per cent, of water. Preparation. — Oxidizing phosphorus by nitric acid. Vide p. 474. Characters. — A strongly acid liquid, without odor, and of a strongly acid taste and reaction, sp. gr. 1*347. When heated it loses water, and when a temperature of about 200° C. (392° F.) has been reached, the acid is gradually converted into pyrophosphoric and meta- phosphoric aeids, which may be volatilized at a red heat. When diluted, and supersaturated with ammonia, the test solution of magnesium gives a white precipitate. Vide also the reactions and tests of acidum phos- phoricum dilutum. Officinal Peepaeation. u.s.p. Acidum Phosphoricum Dilutum. Acidum Phosphoricum Dilutum, U.S.P and B.P. Diluted Phosphoric Acid. — Phosphoric acid, H 3 P0 4 , 20 parts dissolved in 80 parts of water, U.S.P. Phosphoric acid, dissolved in water and corres- ponding to 10 per cent, by weight of anhydrous phosphoric acid, P 2 5 , B.P. 484 INORGANIC MATERIA MEDICA. Characters and Tests. — A colorless liquid, with a sour taste and strongly acid reaction. Specific gravity, 1*08. With ammonionitrate of silver it gives a canary-yellow precipitate, soluble in ammonia and in diluted nitric acid. Evaporated, it leaves a residue which melts at a low red heat, and upon cooling exhibits a glassy appearance. Impurities. — Phosphorous acid, meta-, and pyro-phosphoric acids, nitric, sulphuric and hydrochloric acids, arsenic. Tests. — It is not precipitated by sulphuretted hydrogen (no metals), chloride of barium (no sulphuric acid), nitrate of silver acidulated with nitric acid (no hydrochloric acid), nor by the solution of albumen (absence of metaphosphoric acid which coagulates albumen). When mixed with an equal volume of pure sulphuric acid, and then introduced into solution of sulphate of iron, it does not communicate to it a dark color (absence of nitric acid). Mixed with an equal volume of solution of perchloride of mercury and heated, no precipitate is formed (no pyrophosphates). Its strength is estimated gravimetrically by ascer- taining the increase in weight which occurs in oxide of lead when phos- phoric acid is poured on it, evaporated and ignited. Dose. — 10 to 30 minims. B.P. Prepakatton containing feee Phosphoeic Acid. Syrupus Ferri Phosphatis. Uses. — Phosphoric acid may be used to allay thirst, like other dilute acids, in febrile states, and in diabetes. It may be given in larger doses than other mineral acids without deranging digestion, and is therefore to be preferred to them in cases where it requires to be given for a length of time, as in diabetes and alkalinity of the urine. It is said to be useful in scrofula, and to diminish the growth of bony tumors. Acidum Tartaricum, U.S. P. and B.P. TARTARIC AciD. H 2 C 4 H 4 6 ; 150. — A crystalline acid prepared from the acid tartrate of potash. Preparation. — Vide p. 473. Characters. — In colorless crystals, the primary form of which is the oblique rhombic prism. It has a strongly acid taste, and is readily soluble in water and in rectified spirit. When to either solution, not too much diluted, a little acetate of potash is added, a white crystalline precipitate is formed. {27 grains bicarbonate of potash. 22 " soda. 15} " carbonate of ammonia. Dose. — 10 to 30 grains. Impurities. — Lead, copper, and iron from the vessels in which it is prepared ; lime, or acid tartrate of potash, from the substances used in its preparation ; racemic and oxalic acids. TESTS. — An aqueous solution of the acid is not affected by sulphu- retted hydrogen (absence of metals), and gives no precipitate with the solution of sulphate of lime (no racemic or oxalic acids) or of oxalate of ammonia (no lime). It leaves no residue, or only a mere trace, when burned with free access of air (no acid tartrate of potash). Action and Uses. — Used for cooling drinks. acids. 485 Aciclum Citricum, U.S. P. and B.P. Citric Actd. H 3 C 6 H 5 7 .H 2 ; 210. A crystalline acid prepared from lemon juice, or from the juice of the fruit of the Lime, Citrus Limetta. Preparation. — Vide p. 473. Characters. — In colorless crystals, of which the right rhombic prism is the primary form : very soluble in water, less soluble in rectified spirit, and insoluble in pure ether. The crystals dissolve in three-fourths of their weight of cold, and in half their weight of boiling water. The diluted aqueous solution has an agreeable acid taste. When the solu- tion is made by dissolving thirty -four grains of the acid in one ounce of water, it resembles lemon juice in strength and in the nature of its acid properties, and, like lemon juice, it undergoes decomposition and becomes mouldy by keeping. The quantity contained in j- fl. oz. of this solution ; viz : — f 25 grains bicarbonate of potash. 17 grains neutralize -j 20 " " soda. (. 15 " carbonate of ammonia. Impurities. — Lead and copper from the vessels in which it is pre- pared, lime used in its preparation, tartaric acid, which is cheaper, and is apt to be mixed with or substituted for it, sulphuric acid or sulphates, oxalic acid. Tests. — The aqueous solution is not darkened by sulphuretted hydro- gen (absence of metals), gives no precipitate when added in excess to solution of acetate of potash (no tartaric acid), or of chloride of barium (no sulphates), and if sparingly added to cold lime-water it does not render it turbid (no oxalic acid). The crystals leave no ash when burned with free access of air (no lime). Dose. — 10 to 30 grains. Peepaeations containing free Citeic Acid. U.S.P. B.P. Syrupus Acidi Citrici. Succns Limonis. Syrupus Limonis. Vinnm Quinise. u.s.p. syrupus Acidi citrici. Syrup oe Citric Acid. — Citric acid 8, water 8, spirit of lemon 4, syrup 980. Action and Uses. — Citric acid, from the agreeable taste of its solu- tion in water, is used for drinking in fever to allay thirst, either alone or with alkaline bicarbonates as effervescing drinks. It is also used in scurvy, as it is supposed by some to be the ingredient to which lemon juice owes its properties. B.P. Oxalic Acid, Purified. H 2 C 2 4 . 2H 2 0. ; 126. Dissolve 1 pound of commercial oxalic acid in 30 fluid ounces of boil- ing distilled water, filter the solution, and set it aside to crystallize. Pour off the liquor, and dry the crystals by exposure to the air on filter- ing paper placed on porous bricks. 486 INORGANIC MATERIA MEDICA. Test. — It is entirely dissipated by a heat below 350°. Uses. — As a test. Standard Solution of Oxalic Acid, U.S.P. and B.P. 63 grammes dissolve ill water to 1000 cc. Aeiclum Gallicuin. — Vide Cupuliferse, Sect, v., Chap, xxxiv. Acidum Tannicum. — Vide Cupulifene, Sect, v., Chap, xxxiv. U.S.P. Aciduni Boricum. Boric OR Boracic Acid, H 3 B0 3 ; 62. Preparation. — Vide p. 473. Characters. — Transparent, colorless, six-sided plates, slightly unctuous to the touch, permanent in the air, odorless, having a cooling bitterish taste and a feebly acid reaction ; in solution turning blue litmus paper red and turmeric paper brown, the tint in the latter case remain- ing unaltered in presence of free hydrochloric acid. The alcoholic solu- tion burns with a flame tinged with green. Impurities. — Sulphates, chlorides, lead, copper, iron, &c, calcium and sodium salts. Tests. — An aqueous solution of boric acid should not be precipitated by test solutions of chloride of barium, nitrate of silver with nitric acid, sulphide of ammonium, or oxalate of ammonium. A fragment heated on a clean platinum wire in a non-luminous flame should not impart to the latter a persistent yellow color. Action. — It has the power of destroying low organisms, and has therefore been used as an antiseptic application to wounds either in the form of a solution (1 part in 20 of hot water) or of an ointment. The antiseptic ointment originally recommended by Lister consisted of a mix- ture of the acid (1) with white wax (1), paraffin (2), almond oil (2). This is rather hard, and a better ointment consists of the powdered acid (3), paraffin (5) and vaseline (10). The relative proportions of these may be varied according to the temperature, more or less paraffin being added according as the temperature is high or low. The powdered acid, mixed with starch, forms a useful dusting powder for infants, and lessens the foetor of perspiration. When given internally it is said to be occasionally useful in cases of vomiting in somewhat the same way as sulphurous acid, and it has also been given along with ether in septic diseases. Boro- glyceride, discovered and patented by Barff, is made by heating 92 parts of glycerine with 62 of boric acid. A solution of 1 in 40 of water is recommended as a powerful antiseptic. It is used to preserve food, and as a lotion for the treatment of wounds and in purulent ophthalmia. 1 U.S.P. Acidum Chromicum. Chromic Acid, Cr0 3 ; 100-4. Characters. — Small, crimson, needle-shaped or columnar crystals, deliquescent, odorless, having a caustic effect upon the skin and other animal tissues, and an acid reaction. Very soluble in water, forming an orange-red solution. Brought in contact with alcohol, mutual decompo- sition takes place. When heated to about 190° C. (374° F.) chromic ' Extra Pharmacopoeia, Martindale and Wcstcott. acids. 487 acid melts, and at 250° C. (482° F.) it is mostly decomposed with the formation of dark green chromic oxide and the evolution of oxygen. On contact, trituration, or warming with strong alcohol, glycerine, spirit of nitrous ether, or other easily oxidizable substances, it is liable to cause sudden combustion or explosion. Tests. — If 1 grain of chromic acid be dissolved in 100 cc. of cold water and mixed with 10 cc. of hydrochloric acid, the further addition of 1 cc. of test solution of chloride of barium should cause not more than a white turbidity (limit of sulphuric acid). Actions. — It has a great power of coagulating albumen, and destroying low organisms, and as it parts very readily with oxygen it oxidizes organic matter and decomposes ammonia and sulphuretted hydrogen. It is thus a powerful deodorizer and disinfectant. It is chiefly used as a caustic to destroy condylomata, and morbid growths in the mouth, larynx, or uterus, and to phagedenic ulcers, poisoned wounds, &c. As a solution of 1 in 40 it has been especially recom- mended in syphilitic affections of the tongue, mouth and throat. As a lotion it has been employed to lessen foetid discharges, and as an injection in ozoena, leucorrhoea and gonorrhoea. Care must be taken not to pre- scribe it with any substance to which it readily yields oxygen, such as glycerine, as the mixture may explode spontaneously. Acidum Carbonicum. Carbonic Acid, C0 2 ; 44. Not officinal. It is very extensively used dissolved in water, as aerated water, effer- vescing soda, potash or lithia waters, or in wine as champagne. Properties. — Colorless gas, heavier than air, causes a pungent feeling in the nostrils. Soluble in its own volume of water. Its solu- bility is increased by the presence of carbonates, or by pressure, and when this is removed the gas escapes and causes the fluid to effervesce. The solution has an acid reaction. Carbonates of magnesia, lime, iron, &c, which are only sparingly soluble in water, are dissolved with com- parative ease by water holding the gas in solution. Action and Uses. — Like other acids, when applied to the skin it acts as an irritant, but only slightly. After a prolonged application it causes a slight reddening of the skin and a feeling of warmth, which changes on the continuance of the application into burning or prickling, most felt where the skin is thin and richly supplied with nerves, as the external genitals, and this is not unfrequently accompanied by sweat. Carbonic acid baths are therefore sometimes used in catarrh and rheu- matism as a slight rubefacient to the whole skin, and to cause sweat, especially where it can be obtained with ease, as in places where there are springs containing much C0 2 . It has been used as a stimulant to ulcers, either by directing a stream of gas directly upon them or by applying a poultice of yeast (Cataplasma Fermenti, B.P.), which, in the process of fermentation, causes a constant production of this gas. Streams of C0 2 have been applied to the eyes, ears, nose, vagina, and rectum in catarrhal inflammation or ulceration of these parts, in order to cause a slight hyperemia of the parts and healing of the inflammation and to diminish pain, as C0 2 is supposed to act locally by diminishing the sensibility of the nerves of the part. 488 INORGANIC MATERIA MEDICA. In the moutli C0 2 , like other acids, acts as a stimulant to the secre- tion of saliva, and so water containing C0 2 quenches thirst better than pure water, and it is therefore often used in feverish states (p. 317). In the stomach it causes that slight pain which we confound with hunger, and a pleasant feeling of warmth just as on the skin. Here too it most probably causes a slight hyperemia, and increased secretion. The greatest part leaves the stomach as gaseous eructations, but a portion is absorbed and enters the blood. Its action is thus transient, and it pro- duces no material change in the chemical composition either of the con- tents or walls of the stomach. It increases the rapidity of the absorption of water in the intestinal canal, as is shown by the fact that water containing carbonic acid is excreted by the kidneys much sooner after it has been drunk, than water without it. It relieves irritation in the stomach, and allays or stops vomiting or nausea and slight derangements of digestion. Carbonic acid is naturally present in the intestines in greater quantities in the large than the small. The C0 2 is partly that which passes from the blood into the intestine in interchange for the contained in the air we swallow, and is partly formed by processes of fermentation which take place in the chymus. That part of the C0 2 which, after introduction into the stomach passes into the blood, is excreted by the lungs. C0 2 injected into the blood through a vein is likewise excreted in the same way without causing any injury, unless it is injected in such a quantity that some remains as gas undissolved in the blood, and then it causes death mechanically, just like air, by hindering the passage of blood through the lungs. Poisoning by Carbonic Acid. — When C0 2 is inhaled, the ordi- nary interchange between the C0 2 in the blood and the of the air is prevented, the C0 2 in the blood accumulates, and the processes of oxi- dation in tissues being interfered with, their functions are lessened or destroyed (p. 229). The nervous system is first affected, and there is headache, beating or singing in the ears, giddiness, flushing of the .face. Then there is a feeling of want of breath, tightness of the breast, palpitation of the heart and great anxiety. If the C0 2 be still inhaled, the pulse becomes slower, consciousness is lost, delirium or coma ensues, and death occurs with convulsions. In poisoning by carbonic acid three stages may be distinguished, (1) dyspnoea ; (2) convulsions ; (3) paralysis. During the first stage the carbonic acid appears to act as a stimulus to the nerve-centres in the medulla, and especially. to the respiratory and vaso-motor centres. In the second stage it stimulates other motor centres (p. 212). In the third it paralyzes them. In the first stage, that of dyspnoea, the respirations are both rapid and deep, the inspiratory as well as the expiratory movements being increased. Both the inhibitory and the accelerating centres for the heart are stimulated, but the irrita- tion of the vagus roots preponderates, and the heart is generally slow. The vaso-motor centre in the medulla is also stimulated, and the blood- pressure rises. Besides this the carbonic acid also stimulates either sub- sidiary centres in the spinal cord (pp. 251 and 252), or acts directly on the walls of the vessels themselves, causing them to contract (p. 247), for acids. 489 the blood-pressure rises during inhalation of carbonic acid even when the spinal cord has been divided below the medulla. The vessels of the sur- face become dilated. This is ascribed by Frankel to stimulation of a dilating centre. During the second stage, that of convulsions, the respiration becomes more and more labored, and the expiratory move- ments greater, until general convulsions occur. The blood-pressure rises still more, the heart becomes still slower, and the right ventricle more distended. In the third stage, that of paralysis, the inspiratory move- ments become more and more feeble, the intervals between them longer and longer, and finally they cease. The vaso-motor centre becoming exhausted the blood-pressure falls, and this fall is probably aided by the action of the carbonic acid on the muscular walls of the blood-vessels themselves (p. 247), as well as by weakness of the heart. The heart generally continues to beat for some minutes after respiration has com- pletely ceased, and if artificial respiration be commenced before pulsation is entirely arrested, life may generally be saved. Indeed, this is the case even when the cardiac pulsations are quite imperceptible, and therefore in cases of death from asphyxia it is well to keep up artificial respiration if possible for an hour or even longer, notwithstanding the apparent hope- lessness of the case. It should only be discontinued when a ligature tied moderately tightly, causes no trace of congestion in the finger-tip after being on for ten minutes, and it ought to be supplemented by intermittent pressure on the cardiac region in order to stimulate the heart. These observations apply not only to poisoning by carbonic acid, but to poison- ing by all drugs which produce death by asphyxia. Post-mortem examination shows great venous congestion everywhere, the right side of the heart being distended with blood, the brain much congested, with exudation and even extravasation, and the blood extra- ordinarily dark. Treatment. — In the case of poisoning by C0 2 , as in miners or men who have been suffocated in wells or brewers' vats, the great object is to get the blood oxygenated as quickly as possible. Get the person into the fresh air, and if the respiratory movements have ceased, dash cold water on the face and chest to awaken them reflexly. If this does not do, have recourse to artificial respiration. The next thing is to see that the heart is beating. When the right ventricle is distended with blood it becomes paralyzed, and if it does not begin to beat shortly after artificial respira- tion has been begun, the jugular vein should be opened in order to relieve the dilatation. There are no valves between the heart and the jugular vein (at least of any importance), so the blood flows directly out and the distended ventricle is relieved. One must of course be careful to prevent the access of air into the vein. Acicluni Hydrocyanicnm Dilntum, U.S. P. and B.P. — Diluted Hydrocyanic Acid. Prussic Acid. — A liquid consisting of 2 per cent, of absolute hydrocyanic acid (HON; 27) and 98 per cent, of water, U.S. P. Hydrocyanic acid, HON, dissolved in water, and con- stituting 2 per cent, by weight of the solution, B.P. Preparation. — By distilling yellow prussiate of potash with H 2 S0 4 . Potassium Ferrocyanide. Everett's yellow salt. 2K 4 FeCy 6 + 6H 2 S0 4 = 6HCy + K 2 Fe 2 Cy 6 + 6KHS0 4 . 490 INORGANIC MATERIA MEDICA. Half the cyanogen of the ferrocyanide passes over as hydrocyanic acid, while a ferrocyanide of potassium and iron, often called Everett's yellow salt, remains behind along with potassium sulphate. Characters and Tests. — A colorless liquid, with a peculiar odor. Specific gravity, 0-997. It only slightly and transiently reddens litmus paper. Treated with a minute quantity of a mixed solution of sulphate and persulphate of iron, afterwards with potash, and finally acidulated with hydrochloric acid, it forms Prussian blue. Impurities. — The most important is want of strength, so that when prescribed it has not the desired effect. It loses strength when kept, and therefore the volumetric test is more important than in the case of other acids. Tests. — A fluid drachm of it evaporated in a platinum dish leaves no fixed residue (no fixed impurities). It gives no precipitate with chlo- ride of barium (no sulphuric acid), but with nitrate of silver it gives a white precipitate entirely soluble in boiling concentrated nitric acid (no hydrochloric acid). 270 grains of it rendered alkaline by the addition of solution of soda, require 1000 grain-measures of the volumetric solution of nitrate of silver to be added before a permanent precipitate begins to form, which corresponds to 2 per cent, of the real acid. Silver nitrate forms a soluble double cyanide of silver and sodium, and till all the hydro- cyanic acid is used up no silver oxide is precipitated. AgN0 3 +2NaCy = NaNO s + NaAgCy 2 . Standard silver test solution contains fa of an equivalent of AgN0 3 and 1000 grains therefore combine with fa of 2 Na Cy. Dose. — 2 to 8 minims. As a lotion, 5-10 min. to 1 fl. oz. of water, rose water, elderflower water, or almond mixture. The addition of 1 fl. dr. of glycerine tends to prevent evaporation. Preparations, b.p. Vapor Acidi Hydrocyanici. B.P. Vapor Acidi Hydrocyanici. VAPOR OF HYDROCYANIC ACID. — Mix 10 to 15 minims of diluted hydrocyanic acid with 1 fluid drachm of cold water in a suitable apparatus, and let the vapor that arises be inhaled. Actiox. — Hydrocyanic acid differs from all the other acids in having upon the organism an action peculiarly its own. It is one of the most powerful and most rapid poisons known. It destroys protoplasmic movement, kills infusoria, checks oxidation and arrests fermentation. When applied to the skin it passes through the epidermis and paralyzes the ends of the sensory nerves below, so that the part becomes numb, and tactile sensation is diminished or destroyed. It is rapidly absorbed from the mucous membranes, and its action is the same when applied to any of them. A single drop of pure hydrocyanic acid injected into the eye, nose, or mouth of a small animal, causes it to fall down dead as if struck by lightning, and the same dose is sufficient to cause the death oven of a large animal. In these cases the pupils are usually widely dilated, and the animal generally utters a characteristic cry. When a smaller but still fatal dose is given, the poisoning may be divided into three stages. In the first stage the brain is chiefly affected. There is ACIDS. 491 giddiness, uncertain gait, a few slow breaths, and then rapid respiration, and irregular action of the heart. These are succeeded in the second stage by violent convulsions, tonic and clonic. The head is bent back- wards, the limbs are stiffly extended, and sensibility is generally lost, although reflex action may still persist. In the third stage there is coma, complete loss of sensibility, paralysis of the voluntary muscles, almost imperceptible pulse, slow and weak respiration — the expiratory movements predominating, and death. It is evident that these are the symptoms of rapid asphyxia. They are very like those produced by carbonic acid, but much more rapid, and resemble those of poisoning by sulphuretted hydrogen. The convulsions occur only in warm-blooded animals, and not in frogs. In this point they resemble those of simple asphyxia (p. 212). They differ from those of ordinary asphyxia, however, in the fact that whereas the blood is venous when asphyxial convulsions occur, the blood is arterial in color when the hydrocyanic acid convulsions occur. They differ also in not being arrested by artificial respiration. Death, in animals poisoned by hydrocyanic acid, is due to sudden arrest of the heart in the more rapid cases, and to paralysis of the res- piration in those which occur more slowly. In consequence of this, the blood in the left side of the heart is found to be arterial in cases of instantaneous death, but venous in those instances where some minutes have been required. It is stated that in the first stage of poisoning the blood is more arterial than usual, though it afterwards becomes more venous. This has been said to depend upon diminution of the oxidizing power of the "blood by the action of the acid. Hydrocyanic acid is said to form a compound with haemoglobin (cyan-haemoglobin) which does not readily give up its oxygen (p. 80). But this compound is often not to be found in the blood of animals poisoned by the acid, and the arterial appearance is more probably due to dilatation of the peripheral vessels allowing the blood to pass through them rapidly, without undergoing the usual changes, just as it does in the sub-maxillary gland on irritation of the chorda tympani nerve. This is rendered all the more probable by the fact, that at the exact moment in which the blood becomes of an arterial color in the veins, the blood-pressure suddenly falls in the arte- ries (Rossbach). The respiratory cliang-es, however, do seem to be also interfered with, for in the first stage of poisoning the exhalation of carbonic acid is diminished. As the diminution in the power of the blood to give oxygen off is hardly sufficient to explain this, and as the convulsions, apparently asphyxial in character, come on while the blood is still arte- rial, we may, with some probability, suppose that the respiratory changes are due to the effect of the hydrocyanic acid in lessening internal respira- tion in the nervous tissues themselves (p. 214). The stoppage of the heart in mammals is partly due to irritation of the vagus roots in the medulla, and partly to paralysis of the motor gan- glia in the heart. When placed upon the heart of a frog, it arrests its beats, but the heart, at first, still contracts when irritated, although after a short time its muscular irritability is also lost. 492 INORGANIC MATERIA MEDICA. That its action in stopping the mammalian heart is partly due to irritation of the vagus roots is shown by the fact that, in some animals, section of the vagi prevents the stoppage. The effect of hydrocyanic acid is, first to raise, and afterwards greatly to depress the arterial pressure, and at the same time to slow the pulse. The slowing and paralysis of respiratory movements which this acid produces are chiefly due to its action on the respiratory centre in the medulla oblongata. When directly applied to the medulla in the alligator it causes continu- ous powerful expiration and death, whereas when given in other ways considerable time is required for its action to be produced. It appears to paralyze the brain, peripheral afferent nerves, then spinal cord, motor nerves and muscles. That the afferent nerves are paralyzed before the cord is proved by the fact that when frogs are poisoned with prussic acid, and afterwards with strychnine, slight irritation of the sen- sory nerve roots will cause tetanus, after irritation of the periphery has ceased to produce any effect. This fact was observed by von Kiedrowski, working under Reichert's direction. The same author observed the effect of the local application of hydrocyanic acid in paralyzing muscle and nerve, by removing the soft parts and bone from the lower part of the thigh of a frog, leaving the leg attached to the body only by nerves. The gastrocnemius and crural muscles were then separated, and the gastrocnemius with its nerve was immersed in aqueous humor diluted with water, and the crural muscles with their nerves in a similar liquid to which hydrocyanic acid had been added. After four hours the crural muscles did not contract Fig. 129. — After Kiedrowski. Diagram to show the effect of hydrocyanic acid when applied locally, a, the sciatic nerve; 6, thigh of a frog; d and e, branches of sciatic going to the crural muscles; / g, branch going to the gastrocnemius. on direct irritation, but the gastrocnemius did so readily. This showed that the acid had paralyzed the muscles. Irritation of the gastrocne- mius, of its nerve f g y or of the sciatic nerve a b, caused reflex move- ments in the body of the frog, but irritation of the crural muscles caused no such reflex movements, showing that the ends of the sensory nerves within them had been paralyzed. When the sciatic a b was irritated the crural muscles did not contract, but the gastrocnemius did. This poison probably paralyzes motor nerves as well as muscles, for it is found that the muscles contract, though feebly, on direct irritation, acids. 493 after they have ceased to respond to the strongest irritation of the motor nerves. Uses. — Hydrocyanic acid is used externally in order to lessen itch- ing in skin diseases, and is best applied in combination with glycerine. It is chiefly employed internally to diminish irritability of the stomach, and to relieve vomiting, also pain in the stomach or intestines, and functional palpitation of the heart dependent on dyspepsia. It is also used to relieve cough in cases of bronchitis, phthisis, asthma and whoop- ing cough. It has sometimes been employed, though with doubtful effect, in chorea, epilepsy and hysteria. Its vapor is sometimes used to lessen irritability of the respiratory passages and cough. Aciduni Arseniosum. — Vide Sect, iii., Chap, xxvii. Aciclum Benzoicum. — Vide Styracacse, Sect, v., Chap, xxxiii. Aciduni Chrysophaiiicum. — Vide Leguminosae; Papilionacese, Sect, v., Chap, xxxii. U.S. P. Acidum Lacticum. Lactic Acid. HC 3 H 5 3 ; 90. A liquor composed of 75 per cent, of absolute lactic acid and 25 per cent, of water. Preparation. — By adding chalk to sour milk and decomposing the lactate of lime with sulphuric acid. Characters. — A nearly colorless syrupy liquid, odorless, having a very acid taste, and an acid reaction. Sp. gr., 1*212. It is freely miscible with water, alcohol and ether, but nearly insoluble in chloro- form. It is not vaporized by a heat below 160° C. (320° F.) ; at higher temperatures it emits inflammable vapors, then chars, and is finally entirely volatilized, or leaves but a trace of residue. Impurities. — Hydrochloric acid, sulphuric acid, sarcolactic acid, lead, iron, sugars, glycerin, organic impurities. Tests. — When diluted with water, lactic acid should afford no pre- cipitate with test solutions of nitrate of silver, chloride of barium, sul- phate of copper, nor with sulphide of ammonium after addition of excess of water of ammonia. It should not reduce warm test solution of potassio-cupric tartrate. When mixed and heated with excess of hydrated zinc oxide and extracted with absolute alcohol, the latter should not leave a sweet residue on evaporation. Cold concentrated sulphuric acid shaken with an equal volume of lactic acid should assume at most only a pale yellow color. Dose. — 1 to 3 fl. dr. per diem, diluted or sweetened, like lemonade. Action. — It has been employed in solution of 1 part to 5, to dissolve the false membrane in croup and diphtheria. In cases of dyspepsia it is used to aid digestion in somewhat the same way as hydrochloric acid, and it has been given also to lessen the alkalinity of the urine and pre- vent phosphatic deposits. In diabetes it has been employed with con- siderable success along with an exclusively meat diet in doses of J oz. in 1 pint of water daily. Buttermilk has been recommended in place of it, but the difficulty of obtaining this in towns is very great. U.S. P. Aciduni Hydrobroinicum Dilutum. Diluted Hydro- bromic Acid. — A liquid composed of 10 per cent, of absolute hydro- bromic acid (HBr; 80*8) and 90 per cent, of water. 494 INORGANIC MATERIA MEDICA. Characters. — A clear, colorless liquid, odorless, having a strongly acid taste and an acid reaction. Sp. gr., 1*077. By heat it is completely volatilized. On adding chlorine or nitric acid to diluted hydrobroniic acid, bromine is liberated, which is soluble in chloroform or in disulphide of carbon, imparting to these liquids a yellow color. Test solution of nitrate of silver causes a white precipitate, insoluble in nitric acid and in water of ammonia, and sparingly soluble in stronger water of ammonia. On being kept for some time, the acid should not become colored ; test solution of chloride of barium should not produce a turbidity or pre- cipitate (sulphuric acid). Dose. — Two fluid drachms, which are equal to about 18 grains of bromide of potassium. It may be given in syrup. Action and Uses. — It appears to act as a sedative to the nervous system, diminishing reflex action and lessening tendency to spasm, in the same way as bromide of potassium, but differing from it in not producing the feeling of depression frequently caused by potassium bromide. It has been employed in epilepsy, and to relieve nervousness. It is useful in headache and singing in the ears, either idiopathic or due to the administration of quinine or of iron. It is used also to remove the bad effects of excess in tea or alcohol, and to quiet palpitation. U.S. P. Acidum Oleicum. Oleic Acid.— HC 1S H 33 2 ; 282. Preparation. — It is obtained from almond oil by adding lead oxide, which forms an oleate of lead, and decomposing this by hydrochloric acid. Or by decomposing palm oil by superheated steam. Characters. — A yellowish, oily liquid, gradually becoming brown, rancid and acid, when exposed to the air ; odorless, or nearly so ; taste- less, and, when pure, of a neutral reaction. Sp. gr., 0-800 to 0*810. Oleic acid is insoluble in water, but completely soluble in alcohol, chlo- roform, benzol, benzin, oil of turpentine, and the fixed oils. At 14° C. (57 -2° F.) it becomes semi-solid, and remains so until cooled to 4° C. (39-2° F.), at which temperature it becomes a whitish mass of crystals. At a gentle heat the acid is completely saponified by carbonate of potassium. If the resulting soap be dissolved in water and exactly neu- tralized with acetic acid, the liquid will form a white precipitate with test solution of acetate of lead. This precipitate, after being twice washed with boiling water, should be almost entirely soluble in ether (abs. of more than traces of palmitic and stearic acids). Equal volumes of the acid and of alcohol, heated to 25° C. (77° F.), should give a clear solution, without separating oily drops upon the surface (fixed oils). Uses. — Oleic acid is employed only for the preparation of oleates, which are not only elegant preparations, but appear to be more readily absorbed than other ointments. Q.8.P. Preparations. dose. Oleatum Hydrargyri. OLEATE OF MERCURY (Hy- 1 drargyri Oxiduui Flavum, 1 part ; Acidum Olei- > 10 min., externally. cum, 9 parts) J Oleatum Veratrinee. (Veratrinum, 2 parts; Acidum \ „ or - «-**im«liir Oleicum, 98 parts). >b-~{>gi., exteinauj. Acidum Carbolicum. — Vide Sect, iv., Chap. xxx. Acidum Salicylicum. — Vide Sect, iv., Chap. xxx. METALS. 495 CHAPTER XXIV. METALS. GENERAL CLASSIFICATION OF THE METALS. It has already been mentioned (p. 47) that Mendelejeff's classification of the elements, although it gives us the outlines of a true natural classi- fication, is not at present perfect, inasmuch as it separates members of natural groups, such as those of the earthy metals. In regard to this classification it must be borne in mind that by it the elements are arranged in groups according to their atomicity, and this is not in all cases deter- mined. A glance at the table (p. 45) will show this, for copper, silver, and gold are there included both in Group I., containing monad metals, and in Group VIII. But the commonest and most stable compounds of copper, such as cupric oxide or cupric sulphide, appear to show that it is a dyad rather than a monad. Silver, also, though it appears like copper in Groups I. and VIII., may also be a dyad, 1 while gold forms two series of compounds, in one of which it is monad and in the other triad. In the classification which I have adopted I have followed Mendelejeff's tables, as modified by Watts, but I have modified them somewhat in order not to separate metals having a similar physiological action. Class I.— MONAD METALS. 2 Group I. — Alkalis — Potassium, Sodium, Lithium, Catsium, Rubidium. II. — Ammonium. Class II.— DYAD METALS. Group I. — Metals of the alkaline earths — Calcium, Strontium, Barium. (Appendix.) Metals of the earths — Aluminium, Cerium, Beryllium, Zirconium, Thorium, Lanthanum, Didy- mium, Yttrum, Erbium. II. — Magnesium. III. — Copper, Zinc, Silver, Cadmium. IV. — Mercury. Class III.— TRIAD METALS. Thallium,, Iridium, G allium. Class IV.— TETRAD METALS. Tin, Lead, Titanium. 1 The formula of argentons oxide is Ag^O, and if this formula be correct, and silver be a monad, oxygen must be a tetrad; but if silver be a dyad, argentous oxide maybe represented as \ fr ?Q_f„ (Fownes' Chemistry, by Watts, 12th ed., p. 324.) 2 The metals whose names are printed in italics are not officinal. 496 INORGANIC MATERIA MEDICA. Class V.— PENTAD ELEMENTS. Nitrogen, Phosphorus, Arsenic, Antimony, Bismuth, Vanadium, Tantalum, Niobium or Columbium. Class VL— HEXAD METALS. Chromium, Uranium, Tungsten, Molybdenum. Class VIL— HEPTAD METALS. Manganese, vide next group. Class YIII. Group I. — Iron metals — Iron, Nickel, Cobalt, Manganese. II. — Platinum, Gold. General Tests for the Acid Radicals in Metallic Salts. — As the same acids occur in the salts of different metals, the tests for their presence are described again and again in the Pharmacopoeias. In order to save repetition, it may be advisable to give here in a tabular form the tests for the different acids. It is to be remembered that the same tests apply to the simple recognition of a metallic salt and to its detection as an impurity in other substances. The tests are generally applied to solutions of the salt in water. Salt. Reagent. Reaction. Acetate* Sulphuric acid. Vapor of acetic acid given off and recog- nized by its smell. a Ferric chloride. Deep red color. Borate. Sulphuric acid. The saturated solution causes deposit of shining scales, which give a green color to the flame of alcohol. Benzoate* Bromide. Dilute solution of ferrous sulphate. Disulphide of car- bon and chlorine water. Flesh-colored precipitate. If disulphide of carbon be poured into a solution of the salt, the chlorine water added drop by drop, and the whole agitated, the disulphide will acquire a yellow or yellowish-brown color. (If iodine be present there will be a violet tint, ) Carbonate. Acid. Causes effervescence. Bicarbonate. Causes effervescence more abundant than in the case of the carbonate. With solu- tion of mercuric chloride bicarbonates give a white, and carbonates a yellow, precipitate. METALS. 497 Salt. Citrate.* Chloride. Hypophosphite. Hyposulphite. Iodide. Nitrate. Oxalate* Phosphate. Phosphide. Salicylate* 32 Eeagent. Calcium chloride. Sulphuric acid and heat. Nitrate of silver. Heat. Nitrate of silver. Hydrochloric acid and mercuric chlo- ride. Sulphuric acid. Disulphide of car- bon and chlorine water. Starch water, starch paste, or gelati- nized starch, with chlorine water. Sulphuric acid and copper. Sulphuric acid and solution of ferrous sulphate. Calcium chloride. Chloride of ammon- ium, ammonia and sulphate of mag- nesia. Sulphuric or hydro- chloric acid. Ferric salts. Reaction. The solution remains clear, but deposits white precipitate on boiling (calcium citrate being less soluble in hot than in cold water). Is charred and evolves the odor of acetic acid. White precipitate, soluble in ammonia, insoluble in hydrochloric or nitric acid. Heated in a dry test-tube it evolves phos- phoretted hydrogen, which takes fire spontaneously, and burns with a bright flame. White precipitate, brown and black. which rapidly turns White precipitate of calomel, and on fur- ther addition separation of metallic mer- Gives rise to the smell of burning sulphur, and causes white precipitate of sulphur (bisulphite and sulphite give no precipi- tate). If disulphide of carbon be poured into a solution of the salt, then chlorine water added drop by drop, and the whole agitated, the disulphide of carbon will acquire a violet color. Blue color in the cold, discharged by boiling. Nitrous fumes. When sulphuric acid is added to a solu- tion containing a nitrate, and a solution of ferrous sulphate is carefully poured over it, a dark color appears at the junc- tion of the two liquids. White precipitate. In applying the test to cerium and iron, their salts must be decomposed by boiling with potash or soda. The oxide of cerium or iron is removed by filtration, and the reagent applied to the filtrate, which contains oxalate of potash or soda. White precipitate. Evolves phosphoretted hydrogen. Intense violet color. 498 INORGANIC MATERIA MEDICA. Salt. Reagent. Reaction. Sulpho-carbolate. Ferric chloride. Violet color. This salt can be distin- guished from the salicylate by heat, when it gives off inflammable vapors having the odor of carbolic acid. Sulphate. Barium chloride. White precipitate, almost insoluble in nitric acid. Sulphide. Mineral acids, e. g., sulphuric or hydro- chloric. Gives off sulphuretted hydrogen. Sulphite. Ditto. Gives off sulphurous acid (has neutral or feebly alkaline reaction). Bisulphite. Ditto. Ditto (has acid reaction). Tartrate* Acetic acid in pres- ence of potash. White crystalline precipitate of bitartrate. « Sulphuric acid and heat. Is charred and evolves the odor of burnt sugar. u Xitrate of silver. White precipitate, becoming black on boil- ing. Bitartrate.* Nitrate of silver. Solution rendered neutral by potash, gives with the reagent a white precipitate, becoming black on boiling (very spar- ingly soluble in water : is thus distin- guished from neutral tartrate, which is readily soluble). u Sulphuric acid and heat. Same reaction as tartrate. * In the preceding table the salts of organic acids marked * when ignited in a crucible, or on a piece of platinum foil, become charred and oxidized, leaving a residue which consists of carbonate. This is black from the presence of carbon, if ignition has not been carried sufficiently far to convert all the carbon into carbonic acid. This residue gives the reaction of a carbonate, effervescing with acids, and it is frequently convenient to convert the carbonate into chloride, before applying tests for the base. Class I. — MONAD METALS. Group I.— METALS OF THE ALKALIS. Lithium, Sodium, Potassium, Rubidium, Ccesium. Group II.— AMMONIUM. I have omitted silver and gold from this class, because both their physiological actions and physical properties appear to show that they do not belong to it. I have put ammonia into a group by itself and separated it from the other members of this class, because it differs from them in being a compound and not an element ; in being volatile ; and in having an entirely different physiological action. General Characters. — They are all powerful bases and have a great affinity for oxygen. The oxides of the first group are non-volatile METALS. 499 and are sometimes termed fixed alkalis, while ammonia is volatile. They all have a strong alkaline reaction, neutralizing acids readily, turning red litmus paper blue and turmeric paper brown. General Reactions. — They are not precipitated from solutions by the successive addition of (1) hydrochloric acid, (2) hydrogen sulphide, (3) ammonium sulphide, (4) ammonium carbonate, and (5) sodium phosphate. General Physiological Action. — The alkalis are of great physio- logical importance, and salts of potash and soda form a large proportion of the saline constituents of the body. These two bases are differently distributed, potash being chiefly found in solid tissues, while soda is more abundant in the fluids. They are found as carbonates, bicarbonates, chlorides, phosphates, and sulphates. The proportion of these salts in the body is, however, very different, as are also their uses in the economy. The chlorides are by far the most abundant, and sodium chloride may be looked upon as the most important constituent of the nutritive fluids in which all the tissues of the body are bathed. But while sodium chloride forms the saline basis of these fluids, the other constituents are indispen- sable for the continued life of the tissues. All the fluids of the body are alkaline, and death occurs whenever the alkalinity is diminished below a certain point, even though the fluids and tissues are far from having an acid reaction. Such a reaction is only observed in the tissues after death. The importance of the different saline constituents in nutrition has been most fully worked out in the case of the frog's heart (p. 270). In the case of the heavy metals, which are not normal constituents of the body, the action of their salts depends almost entirely on the "base and only slightly on the acid with which it is combined. In the case of the alkalis, however, this is not so, the action of their salts depending much on the acid. In consequence of this it is necessary in considering the physiologi- cal action of salts of the alkaline metals to divide them into at least three groups : — 1. Alkaline salts, hydrates, carbonates and bicarbonates. (Sub-groups — Salts of organic acids, acetates, citrates, tartrates.) 2. Chlorides. 3. Sulphates and other salts which are slowly absorbed. General Action of the Alkaline Group.— Alkaline salts have their activity diminished by combination with carbonic or organic acids. The hydrates have an intense local action on the tissues; and the carbonates have an action, the same in kind, but much less in degree. In the case of the bicarbonates it is still further diminished, and in the acetates, citrates, and tartrates it is absent. The hydrates of potash and soda dissolve horny tissues such as the epidermis. They combine with albumin and form a soluble alkali-albuminate. When applied to the skin the hydrated alkalis, which have a great affinity for water, withdraw it from the tissues and form a solution which softens and partly dissolves the epidermis and then acts on the softer 500 IXOKGA1STC materia medica. textures below, combining with and dissolving them. Round the part thus killed, inflammation sets in, and a slough separates. The rapidity with w T hich they absorb water and form a solution which flows readily over adjacent parts, where its action is injurious, is an objection to their application, and the part actually cauterized by them should always be less than the part we wish to destroy. From this very property of widely destroying the tissues over which they flow, or through which they soak, they are admirably adapted for application in cases where we desire this effect, as in cauterizing poisoned wounds. When applied as caustics to unhealthy sores, cancer, &c, their action is sometimes limited by adding lime and forming the so-called Vienna paste. The water which they withdraw from the tissues is sucked up by the lime, forming a solid hydrate and preventing the caustic from becoming too fluid and running over other parts. When less con- centrated they may only irritate the surface sufficiently to produce exudation, but they generally soften or dissolve the epidermis so much that vesicles do not form well. When still more diluted they may cause only congestion or redness of the skin. They are then said to act as rubefacients. This rubefacient action may be used for the purpose of relieving troublesome itching in skin diseases, or to produce deriva- tion from other parts. Ammonia does not dissolve the epidermis, and so, unlike potash or soda, it does not act as an immediate caustic, but only passes through the epidermis and irritates the skin below, causing lymph to be effused between it and the epidermis, and thus acting as a vesicant. It may, however, act as a caustic if its evaporation is prevented and it is applied too long, the irritation then becoming so great as to lead to suppuration or even to sloughing of the part. From their great solvent power, and especially their power of dis- solving greasy substances, alkalis are used for cleansing* the skin, but when used alone they very frequently produce irritation, and we there- fore generally employ them in the form of soap, or in the form of those salts which have only a very slight alkaline character, such as borax. In the mouth they neutralize any acid present. They may thus relieve toothache due to irritation of the exposed nerve in a carious tooth or of the roots of the teeth close to the gums by acid secretions. A dilute solution of sodium bi-carbonate as a wash to the mouth frequently relieves soreness of the teeth, or headache depending on dental irritation and prevents injury from acid tonics. Alkalis are used in the shape of borax to heal aphthae in the mouth and as soap for cleaning the teeth. In the stomach they increase the amount of gastric juice secreted; and where this is deficient and the food lies heavy and is digested slowly and with difficulty, they should be given before a meal or just at its commencement, either in the form of a medicinal mixture or as aerated potash or soda water. The amount of acid secreted by the stomach after their introduction is sufficient to neutralize them pretty rapidly, and probably only the caustic alkalies which act very rapidly have time to produce any local action before they are neutralized, unless large quan- tities have been ingested. Where there is a large amount of mucus on the surface of the stomach it will both hinder the exit of the gastric METALS. 501 juice from the follicles and the entrance of the peptones from the stomach into the blood. Caustic alkalies have a great power of dissolving mucus. They probably do this to some extent before they are neutralized, and this may be the reason why we occasionally find that they are of great service when a corresponding amount of their carbonates does little or no good. From the effect they produce on the secretion of gastric juice, alkalis in small doses are said to act as gastric stimulants (p. 320). When the amount of acid in the stomach is too great, either because too great a proportion of it has been present in the gastric juice, or because it has been generated by the decomposition of food, digestion goes on slowly, and acid, burning eructations take place after meals. In such cases we give alkalies to neutralize the excess and to restore the proportion of acid in the stomach to its normal. They are then said to act as antacids (p. 322). Alkalies are serviceable as antidotes in poisoning by acids, metals and alkaloids. They neutralize the acids, they precipitate the metals as insoluble oxides, and they render alkaloids less soluble by taking away the acid with which they are generally combined. They thus retard their absorption and afford time for the use of other means. The chyme from the stomach is normally acid, and will therefore act as a stimulus to the expulsion of bile from the gall bladder. It is partly neutralized by the bile and pancreatic juice, but generally remains acid throughout the small intestines and will act as a stimulus to the secretion of intestinal juice. If it be neutralized by alkalies in the stomach, this stimulus will be removed and digestion consequently impaired. Many substances will thus pass through the intestinal canal undigested, which amounts to the same thing as if less food had been taken. Through this derangement of the digestion the blood will become poorer in solids, the person will become emaciated, the fat will naturally be first absorbed, and, along with this, perhaps pathological formations may also disappear. The excessive use of alkalis or their carbonates is thus injurious and their employment to reduce obesity may, unless carefully watched, be followed by serious consequences like the use of acids for a similar pur- pose (p. 476). Caustic alkalies injected directly into the blood cause death in a few minutes, probably from formation of alkaline albuminate in the blood and its consequent coagulation. Shortly after death the blood is found coagulated. Smaller amounts taken in from the stomach will to some extent increase the alkalinity of the blood, but are rapidly separated by the kidneys. They cause thirst, and probably the larger amount of water drunk in consequence is one cause of the diuresis they produce. From their power of dissolving fibrin outside the body, they have been given in acute rheumatism to prevent fibrinous deposits on the heart. It is not certain that the amount we can introduce into the blood without injury to the patient has this effect. After small doses of liquor potassii the urea and sulphuric acid in the urine are increased, and Parkes therefore thinks that the tissue change of the albuminous substances is increased. Alkalis are therefore classed as alteratives (p. 358). 502 INORGANIC MATERIA MEDICA. They are used both to increase the amount of water passed and to to diminish its acidity if this be excessive. They are therefore classed amongst diuretics (p. 373), and remote antacids (p. 322). General Action of the Group of Chlorides. — Chloride of sodium is not only one of the most abundant saline constituents of the animal body, but it is one of the most important solvents of albuminous substances. Water will dissolve albumins proper, but globulins are in- soluble in it, and are precipitated by it from solutions. Dilute solutions of chloride of sodium on the contrary dissolve both albumins and globu- lins. From this action of water on albuminous substances it is very irritating when applied to a cut surface, or to the delicate mucous mem- brane of the nose, while muscles dipped in it swell up, and pass into a state of rigor. Weak solutions of chloride of sodium, on the other hand, have no irritating action, and may be applied to cut surfaces or mucous membranes without causing pain, and to muscle and nerve without pro- ducing any injurious effect. A solution of the strength of 0*65 per cent, is the one usually employed in physiological experiments as a basis for the nutritive fluid in artificial circulation through the frog's heart or vessels, and as a solvent for alkaloids which are to be injected into the lymph sac of the frog, in order to avoid the local irritation which the injection of a watery solution would produce. A solution of this strength is often called "normal salt solution " in physiological treatises. While dilute solutions of chloride of sodium are ready solvents of albuminous substances and are non-irritating, sodium chloride, in sub- stance or in concentrated solutions, precipitates globulins, withdraws water from the tissues, and acts as an exceedingly powerful irritant to cut sur- faces, mucous membranes, muscle, and nerve. Common salt taken in a large quantity at once will irritate the stomach and cause vomiting. It is absorbed with great rapidity, but is also excreted so rapidly that it produces no definite symptoms of irritation in any part of the body, ex- cepting that part of the nervous system by which the sensation of thirst is perceived. This sensation becomes so urgent when much salt has been taken that any risk will be encountered in order to gratify it. Should it be impossible to obtain fresh water, other parts of the nervous system become involved, and travellers whose supply of water has failed in the desert, or shipwrecked sailors who have drunk sea-water, have become delirious. It is difficult to say, however, how far the delirium is due to the direct irritant action of sodium chloride on the brain, as many other factors may concur in its production. Under ordinary circum- stances, the thirst occasioned by sodium chloride, after its absorption, causes as much water to be drunk as will allow the salt to be excreted by the kidneys, leaving the proportion both of salt and water in the body nearly the same as before. During its stay in the body the salt does not appear to alter the composition of the tissues, and the chief alterations produced by it are probably due to its action on the solubility of albumi- nous substances and on the processes of osmosis between the intercellular fluid and blood, and the circulation of lymph in the tissues. In conse- quence of this, sodium chloride increases tissue change as is shown by an increase in the amount of urea excreted. A similar increase, however, occurs when the quantity usually taken is diminished, the amount of METALS. 503 water daily consumed remaining the same. The alteration here is probably also due to increased rapidity of the circulation of fluid through the tissues (Voit), but it may also be due in part to the different solubilities of albu- minous substances in solutions of sodium chloride of different strengths. Certain albuminous tissues may thus be affected by one proportion of salt in the blood, others by another, so that increase and diminution of the normal proportion of sodium chloride may increase tissue change in the body as a whole, though not in the same tissues. The proportion of chloride of sodium in the body is not always the same. It depends on the quantity taken daily, and may be increased or diminished within certain limits. If a definite quantity be taken daily for some time, the same quan- tity will be found in the urine, so that the amount present in the body is constant. If the quantity consumed be now increased, no increase takes place in the excretion for about three days, a storage of salt taking place in the body. After about three days the quantity excreted daily in the urine will again be found equal to the quantity daily taken, the amount present in the body remaining constantly at the higher level. If the quan- tity daily taken be now diminished, no diminution takes place in the quantity excreted for about three days, and then the quantities daily taken and excreted again correspond. The amount stored up at first is now gone, and the proportion of salt in the body is now again reduced to its lower level. 1 Increased consumption of sodium chloride not only increases the quan- tity of it and of urea in the urine but increases also the excretion of potash salts. On the other hand, potash salts also increase the excretion of sodium. Between salts containing no chlorine, such as carbonate or phosphate, and the sodium chloride in the blood, a double decomposition takes place, potassium chloride, and sodium carbonate or phosphate, being formed. These newly-formed salts are unnecessary for the organism, and are excreted in the urine along with the unaltered remainder of the phosphate or carbonate administered. Considerable quantities both of chlorine and sodium may thus be removed from the organism. In consequence of this, herbivorous animals and people living chiefly on a vegetable diet, and who thus consume considerable quantities of potash salts, feel the need of sodium chloride greatly, and on the American prairies the herds of buffa- loes travel hundreds of miles to visit the salt licks. Beyond a certain point, however, the excretion of sodium chloride is not increased by potash salts, and when the quantity of sodium salts in the body is low, excretion is not increased at all. When an abnormal quantity of fluid is present in the tissues, as in dropsies, an increase in the saline constituents of the blood may cause its absorption, especially if the quantity of water drunk by the patient be limited. It is probable that in addition to their diuretic action the alka- line salts affect the nutrition of the tissues themselves, and that salts of potash are better than those of soda in cases of dropsy, because of their action on the tissues. 1 Lmebvig, Manuscript Notes of Lectures, 1S69-1S70. 504 IXOEGAXIC MATERIA MEDICA. GrENERAL ACTION OF THE S-UB-GeOUP OF SULPHATES, &C. — This group contains salts which are sparingly absorbed, such as sulphates, phos- phates, and bitartrates. That they are sparingly absorbed is shown by the fact that when administered internally they only appear to a small extent in the urine. They usually act as purgatives, but if from any cause their purgative action should be prevented, and they remain long in the intestine, absorption will occur, though slowly. In herbivorous ani- mals, which have a much longer intestinal canal than carnivora, larger doses of these salts are required to produce a purgative action. The mode of action has already been discussed (p. 341). Comparative Action of the Alkalixe Metals. — As the action of the base appears to be less modified by the acid radical in the case of the chlorides than of other salts of the alkaline metals, they are better adapted for experiments on the comparative action of the members of this class. Group I. — The chlorides of lithium, sodium, potassium, rubidium, and caesium produce in frogs gradually increasing torpor, paralysis and death. The chief action appears to be on the spinal cord, which is paralyzed, a slight primary excitement occurring in the case of potas- sium and rubidium. Lithium and potassium paralyze also the ends of the motor nerves. Sodium does so also, though to a much less extent. Caesium and rubidium do not do so, excepting when given in very large doses. The contractile power of muscle is almost always diminished by lithium, unaffected by sodium, and increased by the other members of this group in small or moderate doses. Large quantities of potassium diminish both the irritability and contractile power of muscle voluntary and invol- untary. In frogs the heart becomes weaker and finally stops in diastole. Group II. — Ammonium differs entirely from the members of the first group in the symptoms it produces. While they paralyze the spinal cord with little or no previous excitement, causing torpor and death, ammonia at first stimulates the cord, producing tetanic convulsions. The action of ammonium is considerably modified by the acid radical with which it is combined. All the ammonium salts have an action on the spinal cord, motor nerves, and muscles, and, in advanced poisoning, paralyze these structures. They do not, however, affect all these structures with equal readiness. The organ first affected, and consequently (p. 48) the symptoms of poison- ing, vary with the salt employed. Some salts affect the spinal cord first, others the motor nerves. Ammonia and ammonium chloride produce tetanus. The bromide produces hyperesthesia witli some clonic spasm, passing into tetanus, which, however, comes on very late. The sulphate also produces hyperesthesia and clonic spasms, but rarely tetanus. The phosphate produces paralysis without convulsions, either clonic or tonic, the only indication of any convulsant action being slight twitches accompanying movements in the hind limbs before reflex action has ceased. The iodide produces progressive paralysis and no tetanus. The brain appears to be affected before the spinal cord. This is shown by the frog croaking when stroked, as it does after removal of the cere- bral hemispheres, and by the reflex from the conjunctiva failing before that from the limb-. METALS. 505 Ammonium salts appear to form a series, at one end of which the members stimulate the spinal cord and have no marked paralyzing action on the motor nerves, while those at the other end have no marked stimulating action on the cord, but, on the contrary, have a marked paralyzing' action both on the cord and on motor nerves. At the stimulating; end of this series are ammonia and ammonium chloride, and at the paralyzing end ammonium iodide ; whilst the bromide, phosphate, and sulphate lie between. Group I.— METALS OF THE ALKALIES. POTASSIUM. K; 39. General Sources of Potash Salts. — The chief source of potash salts is the ash left by the combustion of plants or trees ; but there are two subsidiary sources, viz., nitrate of potash, which is found native, and bitartrate of potash, which is deposited from wine in the process of fer- mentation. General Reactions of Potash Salts. — In analysis, potassium is distinguished from all other bases, excepting magnesium, sodium, and ammonium, by not being precipitated by ammonium sulphide nor carbo- nate of ammonia. The positive reactions by which its presence is ascertained are — (1) its precipitation when converted into an acid tar- trate : (2) its precipitation by perchloride of platinum ; (3) the violet color it imparts to flame. The sparing solubility of the acid tartrate is the test which is used in the U.S. P. to distinguish all salts of potash. The reagent employed is tartaric acid in the case of potassium hydrate, carbonate and bicarbo- nate; in the case of the tartrate of potassium and sodium, acetic acid is used. In the case of most other salts a saturated solution of bitar- trate of sodium is added to their aqueous solution. Potassium chlorate is calcined and the reagent added to a solution of the residue. Potassa sulphurata is decomposed by boiling with hydrochloric acid, the sulphur removed by filtration, and the filtrate neutralized by soda before the reagent is applied. No test for potassium is given in the case of potas- sium bitartrate or permanganate. This test is only employed in the British Pharmacopoeia in four instances, viz., neutral tartrate, acetate, bromide, and iodide. In the case of the neutral tartrate the test is applied by adding a small quantity of acetic acid, and thus producing acid tartrate. In the case of the acetate, bromide, and iodide, it is applied by adding tartaric acid. On the addition of perchloride of platinum to chloride of potassium a double chloride of potassium and platinum is formed, and falls as a sparingly soluble pale-yellow precipitate. If the potassium salt be other than a chloride, part of the chlorine in the platinum salt is used up to con- vert the potassium into a chloride, and thus loss of the expensive reagent takes place. To avoid this loss hydrochloric acid is always to be added before the addition of the platinum salt. This reaction is not used for the bromides and iodides, because bromide and iodide of platinum would be formed and a loss of the reagent would occur. In testing some 506 INORGANIC MATERIA MEDICA. potassium salts, modifications are observed in the mode of applying the test. Before applying it to the chlorate the salt is calcined, oxygen is thus driven off, and the residue, consisting of chloride of potassium, does not require the addition of hydrochloric acid. The permanganate is also calcined, but the potash contained in the residue, after being dissolved out by water from its admixture with manganese dioxide, requires to be treated with acid as usual. In the case of the sulphide the hydrochloric acid causes the evolution of hydrogen sulphide, which must be removed by boiling, and causes also the precipitation of sulphur, which must be removed by filtration before the addition of platinum chloride. Preparation of Potash Salts. Prepared from By Potassium carbonate, U.S. P. and B.P. Wood ashes. Lixiviating, evaporating, and crys- tallizing. Liquor potassii, U.S. P. " potassae, B.P. Carbonate of potash. Treating solution with slaked lime and partially evaporating. Caustic potash, U.S. P. and B.P. Do. Ditto, and evaporating to dryness. Potassium bicarbon- ate, U.S. P. and B.P. Do. Passing carbonic acid gas into solu- tion. Potassium sulphite, U.S.P. Do. Passing sulphurous acid gas into strong solution until acid, adding equal weight of potassium carbo- nate, and crystallizing. Potassium acetate, U.S.P. and B.P. Do. Dissolving in acetic acid. Potassium citrate, U.S.P. and B.P. Do. Neutralizing with citric acid. Potassium hypophos- phite, U.S.P. Do. Decomposing by hypophosphite of lime. Potassium chlorate, U.S.P. and B.P. Do. Treating with lime and chlorine. Potassium ferrocyan- ide, U.S.P. Carbonate of potash. Heating animal matter and iron together. Potassium cyanide, U.S.P. Potassium ferroc3 T an- ide. Igniting either alone, or with car- bonate of potash. The former process gives a purer, the latter a more abundant, product. Potassa sulphurata, I'.S.P. and B.P. Carbonate of potash and sulphur. Heating together. Potassium acid tar- trate, U.S.P. and B.P. Crude tartar or argol. Treating with charcoal or clay. Pol assi urn tartrate, U.S.P. and B.P. Acid tartrate of pot- ash. Neutralizing with carbonate of pot- ash. METALS. 507 Preparation of Potash Salts — {continued). Potassium nitrate, U.S.P. and B.P. Potassium sulphate, U.S.P. and B.P. Potassium permanga- nate, U. S. P. and B.P. Potassium iodide, U.S.P. and B.P. Potassium bromide, U.S.P. and B.P. Prepared from Native. Acid sulphate left from admixture of sulphuric acid and potassium nitrate in the preparation of nitric acid. Chlorate of potash, caustic potash, and oxide of manganese. Potash and iodine. Potash and bromine. By Neutralizing with carbonate of pot- ash or lime. Ignition together, boiling and neu- tralizing. Mixing and heating with charcoal. As in the iodide. General Action of Potash Salts. — According to Ringer, potash is a protoplasmic poison destroying muscle, nerves and nerve-centres when applied to them sufficiently long and in a sufficiently concentrated form. But this action is not peculiar to potassium, for sodium, ammonium, hydrocyanic acid, and probably many other substances possess it. Potash salts differ from soda salts in diffusing- more readily through membranes. They are more easily absorbed and more easily excreted than soda salts. In the living organism they occur chiefly in the solid structures, such as blood-corpuscles and muscles, while soda salts occur chiefly in the fluids of the body. When applied to muscle, potash salts in minute doses may increase its contractile power (p. 126) ; but in larger doses, or when continued for a longer time, they diminish its power and finally paralyze it altogether. They remove the excessive prolongation of muscular contraction produced by veratrine, barium, calcium, strontium, and by large doses of sodium or lithium (p. 127). They have a somewhat paralyzing action on motor nerves. They paralyze also the nerve-centres, generally after a primary, transitory, excitement. A peculiar difference in the action of sodium and potassium salts locally applied to the intestine has been already noticed (p. 334). Large doses paralyze the muscular fibre of the intestines, and it is possible that this paralyzing action is the cause of the digestive disturbances which the prolonged use of potash salts causes (Rossbach). When administered by the mouth they may produce, like other salts in large doses, irritation of the gastro-intestinal canal. They are, however, so quickly excreted that they can hardly produce poisoning by their action on the heart while circulating in the blood ; they probably modify the nutrition of the tissues and act as alteratives. It is probable 508 INOEGANIC MATERIA MEDICA. that potash salts may accumulate to a certain extent in the body in the same way as sodium chloride (p. 503). By feeding animals with potash salts the poisonous action of barium may be lessened. Cash and I have now found that when injected simultaneously with salts of barium (cf., p. 132), they will antagonize the action of the latter, and prevent death from an otherwise lethal dose of barium. Similar experiments with veratrine have given negative results. The prolonged use of potash salts is apt to cause some depression, and larger doses continued for some time may diminish the force of the circulation. They do not paralyze the heart when given by the mouth, but when injected directly into the veins they produce transitory excitement, clonic spasms, paralysis, and death. Deatli is preceded by convulsions, and is caused by stoppage of the heart while respiration still continues. Even after both heart and respi- ration have ceased and the animal is apparently dead, life may be restored by the patient use of artificial respiration, and mechanical irritation of the heart by compressing the cardiac region. After the heart has thus been induced to beat spontaneously, respiration still remains in abeyance for some time. The nerve-centres are also paralyzed, and neither volun- tary movement nor reflex action occur for some time. When reflex excitability returns it is often much exaggerated, so that a slight shake or gentle touch on the surface may cause spasms. In this respect potas- sium somewhat resembles atropine, and the possible explanation of this action has already been discussed (p. 158). The effect of potash salts on the circulation somewhat resembles that of digitalis. In large doses they cause a rapid fall of the blood- pressure and pulse-rate. Smaller doses cause a slight fall of both pulse-rate and pressure, followed by a rise of both. During the rise of pressure, however, the pulse becomes again slow, and continues so even when the pressure again begins to fall to the normal. The rise of pressure occurs even when the spinal cord is divided, and probably depends on contraction of the arterioles (p. 246). Potassii Carbonas, (K 2 C0 3 )3H 2 0, 330, TJ.S.P. ; Potassse Carbonas, B.P. Carbonate of Potash. K 2 C0 3 , with about 16 per cent, of water of crystallization, B.P. Characters axd Tests. — A white crystalline powder, alkaline, and caustic to the taste, very deliquescent, readily soluble in water but insoluble in spirit, and giving the reactions of a carbonate and of potassium. 20 grains Carbonate' \ , v J 11 grains Citric Acid, or of Potash ? / neutralize j lg graing Tartaric Acid> Dose. — 10 to 30 grains. A' TION. — When taken internally it acts as an irritant poison. It is rarely used' internally, but may be given instead of liquor potassa?, or of bicarbonate, or in an effervescent form with citric or tartaric acid. It is chiefly employed in the preparation of other potash salts. A dilute solution of it may be used as an application to the skin to relieve itch- in-, and for this purpose may be alternated with dilute acid. METALS. 509 Liquor Potassae, U.S. P. and B.P. Solution of Potassa, U.S. P.; of Potash, B.P. — An aqueous solution of hydrate of potas- sium (KHO; 56) containing about 5 per cent, of the hydrate, U.S. P. Uses. — Dilute liquor potassas is used externally as a lotion in freckles, and, when diluted with water in the proportion of 1 to 6, is employed in order to soften in-growing toe-nails. It is also administered internally in scaly skin diseases, in eczema and acne, especially when these occur in gouty subjects, or are accompanied by acidity of the stomach. In cases of dyspepsia, with irritability, liquor potassse is said to have a sedative action upon the stomach, and thus to be preferable to the bicarbonate. It is believed to be useful in jaundice, and enlarge- ment or cancer of the liver. For its action upon the system it has been administered in rheumatism, both acute and chronic. It is given to cause the absorption of fat in obese persons, but may destroy the general health (cf., p. 501). It has been used to cause the absorption of scrofulous glands and of bronchocele. It increases the bronchial secretion, and renders it more liquid and easier to cough up. It is there- fore useful in bronchitis where the secretion is scanty and difficult to expectorate, and is equally serviceable in the intercurrent bronchitic attacks to which phthisical patients are liable (p. 225). Potassa, U.S. P.; Potassa Caustica, B.P. KHO; 56. Caus- tic Potash. — Hydrate of potash, KHO, containing some impurities. Characters and Tests. — In hard white pencils, very deliquescent, powerfully alkaline and corrosive. A watery solution gives the reactions of potassium and those showing the absence of impurities. Peepaeation containing Caustic Potash. Liquor Potassse « 27 grains in 1 fluid ounce. Peepaeation in which Caustic Potash is used. Potassse Permanganas. . Uses. — It is used as a caustic where we wish to burn deeply and widely, as in snake-bites, the bites of rabid animals, or in poisoned wounds. It is sometimes employed to open abscesses, more especially abscess of the liver, in which it is preferred to the knife, as by its use we secure adhesion of the liver to the abdominal wall before the abscess is opened, and thus prevent any pus from finding its way into the peri- toneal cavity. Ringer says that the best way to apply it is to cut a hole in a thick piece of plaster, smaller than the size of the slough which we wish to make, and rub on the caustic potash, slightly wetted until the tissues assume a grayish color, then to wash the part with vinegar, and apply a poultice. U.S.P. Potassa cum Calce. Potassa with Lime; Vienna Paste. Preparation. — Equal parts of caustic potash and lime made into a paste with alcohol. Characters. — It is a grayish white, deliquescent powder with a strongly alkaline reaction. It gives the tests of potassium and calcium. Uses. — It is used for the same purposes and in the same manner as caustic potash, but being less deliquescent its action is slower and more 510 INORGANIC MATERIA MEDICA. limited ; it is thus more easily restricted to the part which it is wished to destroy, and is less liable to spread. Potassae Bicarbonas, U.S. P. and B.P. Bicarbonate of Potash. KHC0 3 ; 100. Characters and Tests. — Colorless right rhombic prisms, not deliquescent, of a saline feebly alkaline taste, not corrosive. Diluted hydrochloric acid causes strong effervescence, forming a solution which gives the reactions of potassium and those showing the absence of impurities. 20 grains Bicarbonate 1 Y f 14 grains Citric Acid, or of Potash J \ 15 grains Tartaric Acid. Dose. — 10 to 40 grains. Peeparatiox. b.p. Liquor Potassae Effervescens (Potash water) 30 grs. in 1 pint. Uses. — Solutions of bicarbonate of potash may be used externally to relieve itching. Internally it is given in dyspepsia, rheumatism, gout, and scalding depending upon excessive acidity of the urine with presence of uric acid, or in cases of deposit of this acid in the urinary passages. Potassae Acetas, U.S. P. and B.P. Acetate of Potash. KC 2 H 3 2 ; 98. Characters and Tests. — White foliaceous satiny masses, very deliquescent, with a watery solution of which tartaric acid causes a crys- talline precipitate (potash), sulphuric acid the disengagement of acetic acid, and a dilute solution of perchloride of iron strikes a deep red color (acetate). Impurities. — Acid, carbonate, lead. Tests. — Xeutral to test paper (no acid) ; entirely soluble in rectified spirit (no carbonate). Its solution is unaffected by sulphide of ammonium (no metals). Dose. — 10 to 60 grains. Preparation ix which Acetate of Potash is used. Tinctura Ferri Acetatis. Uses. — From its slight local action and its great solubility it produces little effect directly on the stomach and is easily absorbed into the blood. Here it is converted into carbonate and renders the blood and the secre- tions which come from it more alkaline. This salt of potash is one which is very frequently used for the purpose of rendering the urine alkaline. It is -.ne of the most powerful saline diuretics we possess, and is much used in dropsies, alone or combined with other diuretics, or witli tonics and stimulants, '-.//.. acetate of iron and acetic ether. When given in large doses (120 grains and upwards) and in a con- centrated form it act- a- a purgative. It is employed like other potash salts as an alterative in acute rheu- matism, -kin 3*5., B.P. Copper. — Fine copper wire, about No. 25. CFsb. — To detect the presence of metals, as silver, mercury, and arsenic, by their being precipitated on its surface and forming a stain. METALS. 573 It is employed in the preparation of sulphate of copper and of spirit of nitrous ether. Cupri Sulphas, U.S. P. and B.P. Sulphate of Copper. Cu S0 4 .5H 2 0; 249-2. May be obtained by heating sulphuric acid and copper together, dis- solving the soluble product in hot water, and evaporating the solution until crystallization takes place on cooling. Characters and Tests. — A blue crystalline salt, in oblique prisms, soluble in water, forming a pale blue solution which strongly reddens litmus. The aqueous solution gives the reactions of copper and a sulphate. Dose. — As an astringent, J grain to 2 grains ; as an emetic, 5 to 10 grains. B.P. Sulphate of Copper, Anhydrous. CuS0 4 . Sulphate of copper deprived of its water by a heat of 400°. Characters. — A yellowish-white powder, which becomes blue when moistened with water. Action. — Sulphate of copper has little or no action on the skin cov- ered by epidermis, but when applied to the denuded skin it combines with the albuminous constituents of the tissues, forming an albuminate of copper. It thus acts as a mild caustic, and is an astringent. It has a similar astringent action on mucous membranes, and when swallowed in large doses it acts as a powerful emetic, like the sulphate of zinc, and in smaller doses as an astringent. Like sulphate of zinc, it proba- bly exerts its action partly on the stomach itself and partly on the vomit- ing centre. Small doses absorbed into the blood appear to have a tonic action on some parts of the nervous system, and to exert an astringent action on mucous membranes. The copper is excreted by the mucous membrane of the intestine, by the bile, sweat, and kidneys. It is probable that its effect as an emetic when injected into the blood is par- tially due to the action it produces upon the stomach or intestines in the process of elimination (p. 56). Its action as an astringent upon other mucous membranes is probably due to a similar cause. Uses. — Sulphate of copper in substance is used as a mild caustic to the edges of sores, to repress exuberant granulations, and as a styptic to arrest the blood from leech bites. When mixed with honey it may be ap- plied to the mouth in cancrum oris. In solution it may be applied to indolent ulcers, and to remove warts and parasitic skin diseases, and as an injection into the nose to stop epistaxis. It is used as a wash to the eyes in ophthalmia, as an injection in gonorrhoea and leucorrhoea, and as a gargle in sore throat. It is an efficient and rapid emetic in cases of narcotic poisoning, in phosphorous poisoning, and in croup. It is a pow- erful astringent in chronic diarrhoea, dysentery, and colliquative diarrhoea of phthisical patients. It is employed, like zinc, in chorea, epilepsy, and hysteria, but seems less useful than zinc. B.P. Test Solution of Amnio nio -Sulphate of Copper. Used as a test for arsenious acid, forming with it Scheele's green. B.P. Subacetate of Copper of Commerce. Cu.CuO {C 2 H 3 2 ) 2 . Verdigris, Aerugo. — Used in solution as a test. 574 INORGANIC MATERIA MEDICA. B.P. Test Solution of Acetate of Copper. Use. — In testing for butyric acid in valerianates. U.S.P. Cupri Acetas. Acetate of Copper. Cu (C 2 H 3 2 ) 2 H 2 ; 199-2. Characters. — Deep green, prismatic crystals, yielding a bright green powder, efflorescent on exposure to air, odorless, having a nauseat- ing metallic taste and an acid reaction. Tests. — If the aqueous solution of the salt be treated with hydrosul- phuric acid until all the copper is precipitated, the nitrate should leave no residue on evaporation (alkalies, alkaline earths, or iron). If the aqueous solution be heated to boiling with solution of soda in excess, it will yield a filtrate which should not be clouded by hydrosulphuric acid (absence of lead and zinc). Uses. — Same as those of sulphate of copper. Not used internally. CADMIUM. Cd; 112. It is a somewhat rare metal occurring in certain zinc ores. It is more volatile than zinc, and when the native zinc carbonate or calamine is heated with charcoal the cadmium volatilizes first. It is like tin, but is rather harder. B.P. Cadinii Iodidum. Iodide oe Cadmium, Cdl 2 . Preparation. — It is prepared by acting on cadmium with iodine in the presence of water. ' Characters. — It forms white micaceous crystals, which have a pearly lustre. When heated to 600° they melt and form an amber-colored fluid. When the heat becomes dull red they give off violet fumes, showing that iodine is present in them. The presence of cadmium is shown by adding H 2 S or 2s H 4 S to the solution in water when the yellow sulphide, so much used in painting under the name of cadmium yellow, is precipitated. This precipitate is insoluble in excess of sulphide of ammonium, and is thus distinguished from antimony and arsenic, whose sulphides are soluble. The solution also gives a white gelatinous precipitate with potash, insol- uble in excess. Impurities. — It might be contaminated with tin and zinc. Tests. — These are detected by adding ammonium sulphide to the filtrate after the cadmium has been precipitated by potash from the aqueous solution. Officinal Peepaeation. B.P. Vngnentum Cadmii Iodidi. OINTMENT OF IODIDE OF CADMIUM (62 grs. to 1 oz. of simple ointment). Use. — "When applied to the skin, iodide of cadmium acts as a rubefa- cient, and has been used to promote the absorption of glandular enlarge- ments. Its advantages over iodine and iodide of lead are that it does not cause poisoning like lead, and it does not stain the skin, and may therefore be applied to cause absorption of glands in the neck, where stains would be unsightly. ARGEXTUM. Silver. Argentum Purificutum, B.P. PtEFIXED SILVER. Pure metallic silver. METALS. 575 Impurities. — Gold, copper, and lead. Test. — If ammonia be added in excess to a solution of the metal in nitric acid, the resulting fluid exhibits neither color nor turbidity. Preparation. — Argenti Nitras. Argenti Xitras, U.S.P. and B.P. NlTRATE OF SILVER. — AgNo 3 ; 169-7. Preparation. — By dissolving silver in nitric acid, evaporating and crystallizing. Characters. — In colorless tabular crystals, the primary form of which is the right rhombic prism ; or in white cylindrical rods ; soluble in distilled water, and in rectified spirit. The solution gives with hydro- chloric acid a curdy white precipitate, which darkens by exposure to light, and is soluble in solution of ammonia. A small fragment heated on charcoal with the blow-pipe, first melts, and then deflagrates, leaving behind a dull white metallic coating. Impurities. — Nitrate of potash, metallic impurities. Tests. — Ten grains dissolved in two fluid drachms of distilled water give with hydrochloric acid a precipitate, which, when washed and thoroughly dried, weighs 8*44 grains. The filtrate when evaporated by a water-bath leaves no residue. Dose. — ^ to J grain. Administration. — As an application to the eyes or injection it is used of various strengths, but an ordinary safe one is 2 grains to the ounce. When made into pill it must not be mixed with tannin, which reduces the silver to the metallic condition and becomes converted into gallic acid with evolution of carbonic acid gas. It is best made up into pill with kaolin and a very little tragacanth. As a draught it may be made up with dilute nitric acid, syrup, and mucilage. U.S.P. Arg-enti Nitras Fusus. Moulded Nitrate oe Silver. Prepared by fusing together nitrate of silver 100 parts, hydrochloric acid 4 parts, and pouring into suitable moulds. Characters. — A white, hard solid, generally in form of pencils or cones, of a fibrous fracture, becoming gray or grayish-black, on exposure to light in presence of organic matter. U.S.P. Argenti Nitras Dilutus. Diluted Nitrate of Silver. Preparation. — Prepared by fusing together equal parts of nitrate of silver and nitrate of potassium. Characters. — A white, hard solid, generally in the form of pencils or cones, of a finely granular fracture, becoming gray or grayish-black on exposure to light in presence of organic matter. Tests. — An aqueous solution of 1 Grm., acidulated with nitric acid, when completely precipitated by hydrochloric acid should yield not less than 0-84 Grm. of dry chloride of silver. The filtrate separated from the precipitate, when evaporated to dryness, leaves a residue which is completely soluble in water, and which yields a white crystalline precip- itate with a concentrated solution of bitartrate of sodium (potassium). General Action of Silver Salts. — Soluble silver salts, such as the nitrate of silver, have a strong affinity for the cement by which 576 INORGANIC MATERIA MEDICA. epithelial or endothelial cells are united, and are therefore much used in staining microscopic preparations. They also unite with albumen, form- ing albuminates of silver. When applied to the skin, nitrate of silver produces a white mark which rapidly becomes blackened by exposure to light, and the epidermis, either alone or with a slough varying in depth according to the strength of the application, is thrown off. Locally, it causes greater contraction of the vessels than other metals. In the mouth it has an unpleasant astringent taste, corrugates the mucous membrane, and acts as an irritant or caustic. In the stomach, in small doses, it acts as an astringent, and occasionally lessens vomiting, but in larger doses it acts as an irritant, and causes vomiting and symptoms of irritant poisoning (p. 346). In the intestine small doses are astringent, and, when absorbed from the blood, appear, like zinc or copper, to have a tonic action on some parts of the nervous system. When taken for a length of time it is apt to cause a livid discoloration of the skin. This discoloration appears to depend upon the amount of silver taken inde- pendently of the time during which its administration has been continued, so that it is advisable, when administering nitrate of silver to a patient, to inquire whether he has previously taken it or not, as the silver remain- ing in the system, together with that administered in the second instance, might cause a darkening of the skin which the quantity employed in the second course alone would not have produced. When taken for a long time, silver salts appear to produce fatty degeneration of the tissues. They are probably very slowly eliminated by means of albuminous secretions, such as bile. Uses. — Nitrate of silver may be applied to destroy parasitic fungi and remove tinea ; to destroy the epidermis itself or epidermic structures, such as warts, and to check the bleeding from leech bites. In solution it relieves the itching of pruritus and of lichen. When sponged over the skin it hardens the epidermis and may prevent the formation of bed-sores. It is said to arrest vesication in herpes if painted over the surface as soon as the vesicles begin to form. It is also said that the pitting of small- pox is prevented by opening the vesicle and touching the surface beneath with a solution of the salt, or even by painting the solution over the skin. It has been recommended as a remedy in erysipelas, and is applied either by painting the strong solution over and beyond the inflamed surface, or by drawing a line with solid nitrate of silver upon the skin a little way beyond the margin of the inflammation. The alteration produced in the tissues underneath this line is said to prevent the extension of the inflam- mation beyond the limit thus formed. It is of little use in poisoned wounds, such as the bite of a mad dog (p. BOG). Dilute solutions may be applied to the eye in tinea tarsi and conjunctivitis. In the mouth it may be used as an application to ulceration of the tongue, soft palate or tonsils, and is often employed for this purpose on account of the readiness with which it can be applied. In thus applying it care should be taken that it is well fixed in the holder, as otherwise a quick motion of the patient may break oft" the portable stick of nitrate of silver which will probably fall into the pharynx, be swallowed, and may produce symptoms of irritant poisoning. The treatment of poisoning is to give common salt in order to form insoluble, and therefore inert, chloride of silver. METALS. 577 Where the stick of nitrate of silver has been swallowed in substance this treatment has not always proved efficacious, and salt should therefore then be administered in combination with mucilaginous substances, such as porridge and gruel, along with an emetic, so that the stick of silver may be at once evacuated from the stomach, while the mucilaginous envelope prevents it from doing any harm to the oesophagus on its way. It has been used to destroy the false membrane in croup, and as a useful application to the larynx in laryngeal phthisis. It may be applied either in solution, by means of a brush, or in the form of lycopodium, which, after being dipped in the solution and then dried, may be blown by a curved tube into the larynx. It is sometimes used as an injection in gonorrhoea. Internally, it may be employed in irritable stomach, and also as an astringent in chronic diarrhoea and dysentery, and as a nervine tonic in chorea and epilepsy. Argenti Oxidum, U.S.P. and B.P. OxiDE OF SILVER. Ag 2 0; 213-4. Characters and Tests. — An olive-brown powder, which at a low red heat gives off oxygen, and is reduced to the metallic state. It dis- solves completely in nitric acid without the evolution of any gas, forming a solution which has the characters of nitrate of silver. 29 grains heated to redness leave 27 grains of metallic silver. Dose. — J grain to 2 grains. Uses. — It has been used internally in neuralgic pain in the stomach, irritable dyspepsia, and pyrosis. Another drug not unfrequently given in similar affections is creasote, but creasote and oxide of silver are incompatible, as the former becomes oxidized at the expense of the silver oxide, and the mixture may undergo spontaneous combustion. It has been used in haemorrhage from the stomach and lungs, and has been highly recommended in monorrhagia. U.S.P. Argenti Cyanidum. Cyanide of Silver. AgCN; 133-7. Characters. — A white powder, permanent in dry air, but gradually turning brown by exposure to light, odorless and tasteless and insoluble in water or alcohol. Insoluble in cold, but soluble in boiling nitric acid with evolution of hydrocyanic acid ; also soluble in water of ammonia and in solution of hyposulphite of sodium. When heated the salt fuses, gives off cyanogen gas, and on ignition metallic silver is left. Officinal Preparation. U.S.P. Acidum Hydrocyanicum Dilutum. U.S.P. Arg-enti Iodidum. Iodide of Silver. Agl; 234-3. Characters. — A heavy, amorphous, light-yellowish powder, unal- tered by light if pure, but generally becoming somewhat greenish-yellow, without odor and taste, and insoluble in water, alcohol, diluted acids or in solution of carbonate of ammonium. Soluble in about 2500 parts of stronger water of ammonia. It is dissolved by an aqueous solution of cyanide of potassium and the resulting solution yields a black precipitate with hydrosulphuric acid or sulphide of ammonium (silver). If a small 37 578 INORGANIC MATERIA MEDICA. quantity of chlorine water be agitated with an excess of the salt, the filtrate acquires a dark blue color on the addition of gelatinized starch (iodide). Dose. — 1 to 2 grains. Use. — It has been used instead of nitrate of silver in irritability of the stomach, dysmenorrhea, and epilepsy. Class II. — Group IV. MERCURY, Hg; 200. Mercury is a liquid metal. It forms two series of compounds, viz., mercurous, in which it is univalent, e.g., Hg 2 Cl 2 ; and mercuric, in which it is bivalent, e.g., HgCl 2 . In constitution these salts are analogous to the cuprous and cupric salts. General Sources. — The chief source is native sulphide or cinnabar. Metallic mercury is prepared from this by roasting it either alone or with lime or iron. General Reactions of Salts of Mercury. — They are all either volatile or decomposed by heat with the liberation of free mercury. The soluble salts are decomposed by stannous chloride; the mercuric salts giving first a white precipitate, changing into black, and the mercurous salts a black one of finely divided mercury at once. Mercurous salts are most readily distinguished from mercuric salts by their reactions with alkaline carbonates with ammonia, or with potassium iodide. The differ- ences will be readily seen from the following table. The difference between the reactions of potash and ammonia with mercuric salts is noteworthy. General Reactions of Salts of Mercury. Reagent. Mercurous Salts. Mercuric Salts. Stannous chloride. Black ppt. (finely- divided mercury). White ppt. , turning black (calomel changing into mercury). Caustic soda or potash. Black ppt. Yellow ppt. (oxide). Carbonates of ditto. White ppt., turning black. Red-brown ppt. Ammonia. Black ppt. White ppt. (double salt of mercury and ammonia). Ammonium carbonate. White ppt., turning black. White ppt. Potassium iodide. Greenish-yellow ppt. Bright scarlet ppt., soluble in ex- cess either of mercuric chloride or of potassium iodide. General IMPURITIES. — Other metals, especially lead, arsenic, and antimony, may be present. But there is such an enormous difference METALS. 579 between the activity of the mercurous and the mercuric salts, that the latter form the most important impurities of the former. Corrosive sub- limate, for example, is so active that a slight trace of it as an impurity in calomel might cause a medicinal dose of the latter to produce poison- ous effects. General Test. — Mercuric salts are readily soluble in alcohol, and especially in ether, and also in a solution of sodium chloride, while mer- curous salts are not. The presence of mercuric compounds as an impurity in mercurous preparations can be ascertained by shaking them with a solu- tion of common salt (U.S. P.), or with ether (B.P.), filtering, and testing the filtrate for mercury. If no mercuric salt has been present, neither the ether nor salt solution will dissolve anything, and so the test will show the absence -of mercury. When ether or alcohol is used, the absence of mercury may be ascertained by evaporating it and finding that no residue remains. General Action. — Metallic mercury, mercurous salts and mercuric salts all have actions differing from each other as far as their local effect is concerned, but agreeing together in their general result after absorp- tion into the system. When applied locally to the skin, mercury, either in a state of vapor or when finely subdivided in the form of ointment, will pass through the epidermis without exciting any local irritation, and be absorbed into the circulation, where it will produce the general effects of the drug. Taken in the form of vapor into the lungs, it will have a similar action. The mercurous salts are also absorbed in the same way as metallic mercury. They have a slightly more stimulating effect than it, but do not produce the same intense irritation that the mercuric salts cause. The mercuric salts unite with albumen, forming albu- minates. They have little action on the epidermis, but when applied to the denuded skin, or to a mucous membrane, they precipitate the albumen, and, when used in a concentrated form, produce a slough. When swal- lowed, they cause the symptoms of gastro- enteritis produced by other irritant poisons, but these may be quickly succeeded by the symptoms of special mercuric poisoning from the absorption of the substance into the circulation. The general effects on the body which are produced alike by mercury and its salts are termed mercurialism. The first symptoms produced by mercury, however it is applied, are almost always connected with the alimentary canal, and more especially the mouth. A metallic, unpleasant taste is observed in the mouth, along with a feeling of heat ; the saliva is somewhat increased and the breath has a most unpleasant smell. The teeth feel sticky, as if their edges were glued together with some adhesive substance, when the patient tries to separate them ; they feel as if they were longer than usual. The gums are red and swollen and tender, and chewing is painful. The tongue is covered with a thick coating, and the appetite is small. The medicinal administration of mercury is generally stopped when the gums become sore and salivation begins. In children salivation occurs with difficulty, and mercury may be discontinued when the breath becomes fcetid. When the administration of mercury is continued the symptoms increase : the gums become still more inflamed, their edges are 580 INORGANIC MATERIA MEDICA. covered with a white, sticky substance, and they bleed on the slightest touch; the teeth become loosened in their sockets, and the salivation becomes still greater. In still worse cases ulcers form on the gums and inside of the cheeks, the tongue itself becomes swollen so that articulation becomes difficult, mastication is so painful as to be nearly impossible, the foetor of the breath is insupportable, and the saliva pours from the mouth in great quantities. Along with these symptoms there is a certain amount of fever, which, indeed, sometimes is present before any local symptoms have appeared. There is general depression, chilliness, and even rigors, followed by a rise of temperature, a feeling of heat, thirst, loss of appe- tite, quick pulse, weight or pain in the epigastrium, nausea, belching, vomiting, and purging, sometimes bloody, or more rarely, constipation. These last several days and then decrease, sweating occurring at this time, or salivation if the fever has preceded it. Mercurial fever occurs most readily after a lengthened application of blue ointment. When the administration of mercury is stopped the symptoms decrease, though in the case of broken-down individuals necrosis of the jaw and even death has occurred. Occasionally it has happened that even healthy individuals, instead of recovering after profuse salivation, have become permanently dyspeptic. These symptoms appear in adults, generally with great regularity, when a similar quantity of mercury has been taken in a similar time, though the effect is modified by various conditions, as age, sex, &c. When persons are exposed for a long time to the fumes of mercury, and the metal is thus taken in in very small quantities for a lengthened period, a different effect is sometimes produced. This is called mercu- rial cachexia. In this condition the appetite is lost, the gums become livid and bleed easily, the breath is fcetid, and a tendency to diarrhoea is often present. In bad cases vomiting and purging generally occur. The lips become pale, the complexion earthy, the person becomes emaciated, the hair sometimes falls out, the muscles become weak and small. The person is easily affected by changes of weather; there is a tendency to fainting, uneasiness, and anxiety ; the pulse and respiration become quick ; the pulse is also small and intermittent ; and palpitation becomes very troublesome. The intellect is dull, and rheumatic pains are felt in the muscles of the extremities, more rarely in those of the trunk. These symptoms go on increasing, and new ones also appear. Mer- cnrial tremors occur in the muscles, beginning generally in the upper extremities, and gradually extending till the patient cannot execute any movement, and the speech itself becomes stammering. Mercurial paralysis of muscles or groups of muscles occasion- ally occurs. Generally this is confined to the muscles of the upper extremities, but sometimes affects other muscles, such as those of the larynx, causing mercurial aphonia. These paralyses generally occur in the later stages of mercurial erethism, and rarely occur before the other symptoms. The mental qualities become also affected. Ill-humor, irritability, melancholy, and fear of death occur in some persons, and in others, METALS. 581 though very rarely, idiocy, and still more rarely, furious mania. In some instances epilepsy has been observed. Mercury in the form of organic compounds appears to have a special action on the brain. The symptoms are those of impairment of the special senses, sight, taste, hearing, of motor power, and of the cerebral functions. Two chemists who were engaged in the preparation of mer- curic methide during three months suffered from weakness and dimness of vision, and one of them from some soreness of the gums, nausea, and vomiting. At the end of this time the symptoms became much worse, deafness and numbness came on, and were succeeded by a semi-comatose condition with great restlessness. In the one who had not previously suffered from soreness of the gums, this now appeared, along with foe tor of the breath; the urine was albuminous,* Cheyne-Stoke's breathing was observed, the evacuations were passed involuntarily, and he died coma- tose a fortnight after the symptoms became severe. Sensibility was retained nearly to the last. In the other patient, impaired sensation, loss of power to direct movement, and muscular feebleness were succeeded by involuntary passage of evacuations, an idiotic condition with restless- ness, and violent muscular movements, especially when he was touched. After remaining in an idiotic state for a year he died of pneumonia. The action of mercury may be modified by sex, age or idiosyncrasy. Women, as a rule, are more easily affected than men, whilst children may take mercury in considerable quantities without showing any symptom of salivation. In certain persons large quantities of mercury may be admin- istered for a length of time without producing much more effect than in children, but in others exceedingly injurious results may follow very minute doses. A case of salivation from as little as a grain and a half of calomel has been recorded, and from one-eightieth of a grain of corrosive sublimate. In typhus it is very hard to produce salivation, but in per- sons suffering from Bright's disease, although mercury may be useful as a purgative, it requires to be given with caution, on account of the violent effects which may follow even small doses. Mercury combines with albumen, and forms albuminate of mercury, which is insoluble in water, but is easily soluble in excess of albumen or in chloride of sodium. This compound may be formed in the stomach or intestines, and a compound of mercuric oxide with albumen is probably the form under which mercury, however administered, circulates in the blood. When taken into the stomach, mercuric salts are powerful irri- tants, and, when given in large quantities, cause gastro-enteritis, vomit- ing, and purging. Finely divided metallic mercury and mercurous salts are less irritating, and act simply as purgatives. A good deal of discussion has arisen regarding the action of mercury on the liver. It has long been ranked as a cholagogue, and there can be no question whatever, that mercury and its compounds are very bene- ficial in cases of so-called bilious disorder characterized by feelings of laziness and apathy, inability to think, dislike of exertion, not unfre- quently combined with irritability of temper, deranged digestion, and slight yellowish tinge of the eyes. When bile was supposed to be formed in the blood, and to be only excreted by the liver, the beneficial effect of mercury was attributed to a stimulating action on the liver, whereby it 582 INORGANIC MATERIA MEDICA. increased the rapidity of the secretion, and thus removed the bile more quickly from the blood. But it was found on experiment by Dr. Scott that mercury does not increase the rapidity of the biliary secretion, and this result was confirmed by a committee of the British Medical Associa- tion, the chief members of which were Hughes, Bennett, Rutherford, and (xamgee, and also by later experiments made by Rutherford alone. As we now know that bile is formed from the liver, and not merely separated by it from the blood, we can understand that the real action of mercury as a cholagogue consists, not in its stimulating the liver to form more bile, but in removing more readily from the body the bile which is already present in excess. It appears to perform this function by stimulating the upper part of the small intestine, and thus causing the evacuation of the bile before time has been allowed for its reabsorption. For the liver does not merely form bile, it also excretes bile which has been previously formed and reabsorbed from the intestine. The bile may thus serve several times over. It is formed, passes from the liver into the duodenum, is reabsorbed and carried by the portal blood to the liver, where it is again excreted and poured out through the bile-duct a second time (p. 351). Part of it, however, is carried down the intestine, decomposed, and evacuated, and to supply the place of this a certain amount of new bile is constantly being formed, which is poured into the intestine along with the old. It is evident that any drug which acts upon the lower part of the intestine will have little power to remove the bile, as this will have undergone absorption already in the upper part of the digestive tract. But any drug acting upon the duodenum will cause the bile to be rapidly moved on, and its absorption to be prevented. More especially will this be the case if the cholagogue be combined with a saline purgative, which, by causing a profuse secretion of watery fluid, will wash the bile out. This action on the upper part of the small intestine is probably possessed by mercury, and the reasons for this supposition are : (1) that it is so beneficial in bilious disorders ; (2) that it does cause the appearance of bile in the stools, for Buchheim has found by analysis that the green stools which occur after purgation by calomel actually owe their color to bile ; and (3) that in the stools passed after mercurial purgatives, leucin and tyrosin, the products of pancreatic digestion, have been found. Mer- cury acts as a disinfectant of the intestinal contents. After the absorption of mercury into the blood, it is said, in small doses, to increase the number of blood corpuscles; in larger doses, how- ever, it produces anaemia, but how far these results are dependent upon the improvement or disturbance of the digestion, and how far upon the action of the mercury itself upon the blood, has not been ascertained. Albuminate of mercury, when added to blood out of the body, gradually destroys the corpuscles. Mercury appears to have the power of causing absorption of fibri- nous exudations, for the fibrinous adhesions observed in syphilitic iritis have been Been to disappear as the patient was brought under the influence of mercury. When mercury is used for a long time, it appears to lessen greatly the force of tlie pulse, and large doses of mercuric prepa- rations, when brought into contacl with a frog's heart, will arrest its pulsations immediately. The respiration is affected in persons who METALS. 583 have been taking too much mercury, and becomes labored and accompa- nied by a feeling of constriction. The temperature is rarely affected, excepting secondarily, in consequence of local inflammations which the mercury may excite, although sometimes mercurial fever (p. 580) pre- cedes any marked local change. Mercury is excreted by the saliva, bile, urine, sweat, and milk. The salivation which it produces is probably due in part to reflex ex- citement of the salivary glands by the irritation of the tongue, but it is no doubt also in part due to irritation of the nerves of the gland, or of the gland structure itself, by the mercury. The urine is said to be some- what increased, and it is stated that the addition of a little mercury to digitalis and squill greatly increases the diuretic action of these drugs. Hydrargyrum, Hg\; TJ.S.P. and B.P. Mercury; 192-t. Characters and Tests. — A metal, fluid at common temperatures, brilliantly lustrous, and easily divisible into spherical globules. Volatilizes at a heat below that of visible redness, leaving no residue. Peepaeations containing Meecuey. 1 I. — In the metallic state. Hydrargyrum, Mercury, U.S.P. and B.P. Emplastrum Ammoniaci cum Hydrargyro, U.S.P. and B.P. Plaster of ammo- niac with mercury. Emplastrum Hydrargyri, U.S.P. and B.P. Plaster of mercury. Hydrargyrum cum Creta, U.S.P. and B.P. Mercury -with chalk. Massa Hydrargyri, U.S.P.; Pilula Hydrargyri, B.P. Mass of mercury; mer- curial pill ; blue pill. Unguentum Hydrargyri, U.S.P. and B.P. Mercurial ointment. B.P. Linimentum Hydrargyri. Liniment of mercury. B.P. Suppositoria Hydrargyri. Mercurial suppositories. B.P. Unguentum Hydrargyri Compositum. Compound ointment of mercury. II. — Oxidized. B.P. Lotio Hydrargyri Nigra. Black mercurial lotion (mercurous oxide). Hydrargyri Oxidum Rubruru, U.S.P. and B.P. Eed oxide of mercury ; red precipitate. Unguentum Hydrargyri Oxidi Eubri, U.S.P. and B.P. Ointment of red oxide of mercury ; red precipitate ointment. Hydrargyri Oxidum Flavum, U.S.P. and B.P. Yellow oxide of mercury. B.P. Lotio Hydrargyri Flava. Yellow mercurial lotion. U.S.P. Unguentum Hydrargyri Oxidi Flavi. Ointment of yellow oxide of mercury. U.S.P. Oleatum Hydrargyri. Oleate of mercury. III. — Sulphuretted. U.S. P. Hydrargyri Sulphidum Rubrum. Red sulphide of mercury ; cinnabar. IV. — As Mercurous Chloride. Hydrargyri Chloridum Mite, U.S.P. ; Hydrargyri Subchloridum, B.P. Mild chloride of mercury ; mercurous chloride ; calomel. Pilulse Antimonii Compositse, U.S.P. ; Pilula Hydrargyri Subchloridi Compo- site, B.P. Compound pills of antimony ; compound pills of calomel ; Plum- mers' pills. U.S.P. Pilulse Catharticse Compositse. Compound cathartic pills. V. — As Mercuric Chloride. Hydrargyri Chloridum Corrosivum, U.S.P.; Hydrargyri Perchloridum, B.P. Corrosive chloride of mercury; corrosive sublimate. 1 Altered from the United States Dispensatory, p. 773. 584 IXORGAXIC MATERIA MEDICA. Preparations containing Mercury — (continued). V. — As Mercuric Cliloride — (continued). Hydrargyrum Ammorriatum, U.S.P. and B.P. Ammoniated mercury; white precipitate. Unguentum Hydrargyri Ammoniati, U.S.P. and B.P. Ointment of ammoni- ated mercury ; white precipitate ointment. B.P. Liquor Hydrargyri Perchloridi. Solution of perchloride of mercury. VI. — Combined with Iodine. Hydrargyri Iodidum Rubrum, U.S.P. and B.P. Red iodide of mercury; mercuric iodide. U.S.P. Liquor Arsenii et Hydrargyri Iodidi. Solution of iodide of arsenic and mercury; Donovan's solution. B.P. Unguentum Hydrargyri Iodidi Rubri. Ointment of red iodide of mercury. Hydrargyri Iodidum Viride, U.S.P and B.P. Green iodide of mercury ; mer- curous iodide. VII. — Combined -with Cyanogen. U.S.P. Hydrargyri Cyanidum. Cyanide of mercury. VIII — Oxidized and combined with Acids. Liquor Hydrargyri Nitratis, U.S.P. ; Liquor Hydrargyri Nitratis Acidus,- B.P. Solution of nitrate of mercury ; mercuric nitrate. Unguentum Hydrargyri Nitratis, U.S.P. and B.P. Ointment of nitrate of mercury ; citrine ointment. B.P. Hydrargyri Sulphas. Sulphate of mercury ; mercuric sulphate. U.S.P. Hydrargyri Sulphas Flava. Yellow sulphate of mercury ; Turpeth mineral ; mercuric oxysulphate. Impurities. — Other metals. Tests. — The presence of other metals is ascertained by their being left behind as a residue when the mercury is volatilized. It is indicated by the formation of a gray scum or dust on the surface of the metal after exposure to air, and by the mercury forming globules which are not spherical but elongate to a tail when allowed to run over a piece of paper. They are also recognized by shaking the mercury in a perfectly dry bottle, when a gray powder will be formed if they are present. On boiling 5 grms. of distilled water with 5 grms. of mercury and 4*5 grms. of hyposulphite of sodium in a test-tube for a minute, the mercury should not lose its lustre nor acquire more than a slightly yel- lowish shade (absence of more than a trace of other metals, U.S.P.). Purification. — Other metals may be separated by distillation, or by mixing the mercury with strong sulphuric acid and letting it stand in the cold for twenty-four hours. The other metals will be converted into sulphates, but mercury is only attacked by sulphuric acid when it is aided by heat. The mercury is then washed with water to remove the sul- phates, and dried with blotting-paper. Mercury is freed from dust and mechanical impurities by pressing it through chamois leather or filtering it through a paper filter in the apex of which several small holes have been made with a needle or pin. CTe ES. — Metallic mercury in mass has no action whatever on the body. As much as a pound has been taken without producing any physiological effect. Such a dose as this is sometimes given in cases of intestinal obstruction in the hope that the weight of the mercury may carry the obstruction before it. The theory of its action formerly held was purely mechanical: that the mercury passed from the stomach to the intestines and meeting with the obstruction drove it on, but latterly Traube has METALS. 585 supposed that the mercury remains chiefly in the stomach, and by pulling on it excites the intestines reflexly to peristaltic action. Whatever the correct theory may be, however, it is certain that the mercury does not always stay in the stomach but does get down into the intestine, and consequently some precautions must be observed in its administration, and it is never given except when all other measures fail. The precau- tions are not to give it in cases of intussusception, as it may very prob- ably render this worse ; nor in cases where the intestine is considerably inflamed, as the tissues being weak are then easily torn ; nor in hernia, as better means, viz., external means, can be employed. Hydrargyrum cum Creta, U.S.P. and B.P. MeECTJEY WITH CHALK. Peepaeations. — By rubbing up mercury (38), chalk (50), and sugar of milk (12) together, moistening them with a mixture of equal parts of ether and alcohol, U.S.P. By rubbing up chalk (2) and mercury (1) together, B.P. Chaeactees and Tests. — A powder of light-gray color; free from grittiness; insoluble in water ; partly dissolved by diluted hydrochloric acid, leaving the mer- cury in a finely divided state. Impueity .— Mercuric oxide. Test. — The solution formed with hydrochloric acid is not precipitated by the addition of chloride of tin. Dose. — 3 to 8 grains. Uses. — It has been much recommended by Ringer as a remedy in many diseases both of adults and of children. In simple tonsillitis, or the inflamed throat of scarlatina, or in mumps, he recommends a third of a grain every hour, and the same dose three or four times a day will, he says, clean the tongue, remove the disagreeable taste from the mouth, and improve appetite and digestion in the dyspepsia occurring in chronic disease or of commencing convalescence. A similar dose will cut short an attack of jaundice, with vomiting and pale stools, occurring in nervous persons after exposure to cold, fatigue, or excitement ; and half a grain thrice a day will restore the color to the stools and remove the dyspepsia in patients suffering from acidity, flatulence, and vomiting in the morn- ing. Diarrhoea in children, accompanied by pale, offensive motions, or by muddy, or green-colored, or curdy stools, whether accompanied by sickness or not, is successfully treated by similar doses of this remedy. It may also be used to produce the general action of mercury combined with opium or Dover's powder. Piluia Hydrargyri, B.P. Meecueial Pill ; Blue Pill. — Contains mercury (2), confection of roses (3), powdered liquorice root (1). 3 grs. contain 1 of mercury. Dose. — 3 to 8 grains. Uses. — Blue pill may be given either for its local action upon the intestines or to produce the action of mercury upon the system. This pill is one of the most effectual remedies for the condition usually termed biliousness. The patient complains of being dull, heavy, and often sleepy, suffers from occasional headache, has little appetite, and occa- sionally feels sick. The complexion is often of a dirty yellow, muddy color, and the white of the eyes likewise. The use of blue pill in such conditions was recommended by Mr. Abernethy. Five grains of blue pill are given overnight and a draught of salts and senna in the morn- ing. This is very effective, but the disadvantage of it is said to be that 586 IXORGA-STC MATERIA MEDICA. the bilious state is more apt to return, and that when a patient has once become habituated to the use of mercurials no other medicine will do instead. It is one of the best preparations for producing mercurialisni : 5 grains with J a grain of opium are given in the morning, and 5 or 10 also with J a grain of opium in the evening. The addition of a small quantity of blue pill to digitalis and squill sometimes increases their efficacy in cases of cardiac disease. B.P. Suppositoria Hydrargyri. MERCURIAL SUPPOSITORIES. — Each contains 60 grs. of ointment of mercury, benzoated lard and white wax each 20 grs., oil of theo- broma 80 grs. Uses. — They are employed where we wish to produce mercurial action without the risk of interfering with the digestion. Ungnentum Hydrargyri, U.S.P. and B.P. MERCURIAL OINTMENT, U.S.P. ; OINT- MENT of Mercury, B.P. — Contains 1 lb. each of mercury and prepared lard. As this would be too soft, 1 oz. of prepared suet is added. Preparations. — Linimentum Hydrargyri ; Suppositoria Hydrargyri ; Unguen- tum Hydrargyri Compositum. Uses. — It may be used either for its general or its local action. When employed to produce the general action of mercury in the system, it is rubbed into some part of the body where the skin is thin, as the armpits or the sides of the thighs. If it is rubbed in by another person, and not by the patient himself, it is advisable to protect the operator's hand by a piece of bladder soaked in oil, in order to prevent absorption through the palm. In cases of congenital syphilis, the mer- curial ointment may be put upon a flannel roller, and bound round the child's belly. It has been applied locally in inflammation of the skin, as ery- sipelas ; of the veins in phlegmasia dolens ; or of the genital organs, as in ovaritis, orchitis, and indurated testicles. B.P. Unguentum Hydrargyri Compositum. COMPOUND OINTMENT OF MER- CURY. — Contains mercurial ointment (6), yellow wax (3), olive oil (3), and camphor The compound ointment is used to cause absorption of effusion or thickening around joints in cases of disease or injury after the inflam- mation has subsided. It ought to be combined with pressure and rest. Emplastrum Hydrargyri, U.S.P. and B.P. MERCURIAL PLASTER. Preparation. — Rub mercury with olive oil and resin, U.S.P., or sulphur, B.P., and add lead plaster to give it consistency. Sulphur and resin are used to extin- guish the globules of mercury, i.e., make them so small as to be invisible. Emplastrum Ammoniaci cum Hydrargyro, U.S.P. and B.P. AMMONIAC PLAS- Ti:i: wmi RlERCUBY, U.S.P.; AMMONIACUM AND MERCURY PLASTER, B.P. PBEP \ RATION.— U.S.P. Mercury 180 is extinguished with sulphur 1 and olive oil 8 as in the B.P. process. Animoniacum 720 is digested with diluted acetic acid 1000, strained, evaporated until it hardens on cooling. It is then added while hot to the mercury and mixed. Then enough red plaster previously melted is added to make up to 1000 parts. B.P. By rubbing mercury 3 oz. with warm olive oil 1 fl.dr., and sulphur 8 grs. until the globules of mercury are no longer visible, then adding melted ammoniacmn 12 oz. and mixing. Both plasters are used to promote the absorption of glandular enlargements, buboes, nodes, and arc applied over the liver in chronic enlargement and induration. METALS. 587 B.P. Iiinimentum Hydrargyri. LlNlMENT OF MEECUEY. — Contains equal parts of mercurial ointment, solution of ammonia, and camphor liniment. Used for similar purposes as the plaster or ointment. It is more irritating than either on account of the ammonia it contains. It is said to cause salivation more readily than mercurial ointment, as the camphor and ammonia with which it is mixed assist its absorption. B.P. Hydrargyri Sulphas. SULPHATE OF Mercury. HgS0 4 . Preparation. — Heat mercury 20 oz. with sulphuric acid 12 fl. oz. in a porcelain vessel, stirring constantly until the metal disappears, then continue the heat until a dry, white salt remains. Characters. — A white crystalline heavy powder, rendered yellow by affusion of water. Entirely volatilized by heat ; subsulphate formed by water. Preparations in which Sulphate of Meecuey is used. Hydrargyri Perchloridum. Hydrargyri Subchloridum. U.S.P. Hydrargyri Subsulphas Flavus. Yellow SuBSUL- phate of Mercury. Hg(HgO) 2 S0 4 ; 727-1. Characters. — A heavy lemon-yellow powder, permanent in the air, odorless and almost tasteless, insoluble in water or in alcohol, but soluble in nitric or hydrochloric acid. When heated the salt turns red, becom- ing yellow again on cooling. At a red heat it is volatilized without residue, evolving vapors of mercury and of sulphurous acid. Tests. — As it is a mercuric oxysulphate, it should be soluble in 20 parts of hydrochloric acid without residue (no mercurous salt). Uses. — The yellow oxysulphate has been used under the name of Turpeth mineral as an errhine in chronic ophthalmia. It is a prompt emetic, and is sometimes preferred to other emetics in croup, as it is quick and certain, and does not produce depression nor purging. The dose for a child two years old is 2-5 grains (0-13-O33 Gm.), repeated in fifteen minutes if necessary. It may also be used as an alterative. Hydrargyri Chloridum Mite, U.S.P. ; Hydrarg-yri Subchlo- ridum, B.P. Mild Chloride of Mercury, U.S.P. ; Subchloride of Mercury, B.P. Calomel. Hg 2 Cl 2 ; 470-2. Preparation. — Calomel is prepared by rubbing up mercury with sulphate of mercury moistened with water till globules are no longer visible, adding sodium chloride, mixing the whole by trituration, and subliming the mixture into a large chamber. The mercury and mercuric sulphate form mercurous sulphate, and this, with sodium chloride, forms calomel and sulphate of soda, HgS0 4 -f Hg + 2NaCl = 2HgCl + Na 2 S0 4 . When the calomel is sublimed into a small receiver it forms a thin crystalline crust which adheres to the sides, but when sublimed into a large chamber, as directed in the B.P., it falls as a powder on the floor. As some corrosive sublimate is often formed, the powdered calomel is washed with water till all the sublimate is removed, as shown by the water no longer giving a precipitate with ammonium sulphide. It is then dried under 212°, and kept in a well stoppered and dark bottle. 588 INORGANIC MATERIA MEDICA. Characters. — A dull-white, heavy and nearly tasteless powder, ren- dered yellowish by trituration in a mortar ; insoluble in water, spirit, or ether. It is very heavy, and can be distinguished by its weight from almost every other white powder. Its weight is noticed more distinctly by giving the bottle an up-and-down shake. Digested with solution of potash it becomes black (mercurous oxide) ; and the clear solution, acidu- lated with nitric acid, gives a copious white precipitate with nitrate of silver (chloride). Contact with hydrocyanic acid also darkens its color. Adulterations. — Chalk, sulphate of lime, sulphate of baryta, car- bonate of lead, corrosive sublimate. Tests. — It is entirely volatilized by a sufficient heat (no earthy impurities). Warm ether which has been shaken with it in a bottle leaves, on evaporation, no residue (no corrosive sublimate). Dose. — J grain to 5 grains. Peepaeations in which Subchloeide of Meecuey is used. u.s.p. Pilulre Antimonii composite. Pilulse Catharticse composite. B.P. Lotio Hydrargyri Nigra 3 grains to 1 fluid ounce. Pilula Hydrargyri Subchloridi Composita 1 part in 5. Unguentuin Hydrargyri Subchloridi, Calomel 1 ^ , . rt1 , Ointment^yith prepared lard) } * P art ln 6 * nearl y- Pilulse Antiinonii Compositse, U.S.P. ; Pilula Hydrargyri Subchloridi Composita, b.p. Compound Pills of Antimony, U.S.P. ; Compound Pill of Subchloeide of Meecuey, B.P. Compound Calomel Pill. Plummee's Pill. — Contains sul- phurated antimony (50), mild chloride of mercury (5), guaiac (100), mucilage of tragacanth (q.s.), U.S.P. Subchloride of mercury (1), sulphurated antimony (1), guaiacum resin, in powder (2), made up with castor oil, B.P. Dose. — 5 to 10 grains. Uses. — Calomel may be employed as a dusting powder to remove condylomata from the skin, and condylomatous patches from the tongue, throat, and larynx. As an ointment it may be applied to relieve the itching in pruritus ani, and pityriasis of the scalp, and to heal strumous sores and lupus in children. Internally it may be given in cases of biliousness, and followed by a saline purgative in the same manner as is recommended under "Blue Pill." In some cases of diarrhoea it is very useful in combination with opium (p. 107). It may also be used to produce the general action of mercury in syphilitic patients, and for this purpose may either be given internally, in combination with opium, or applied to the skin in the form of calomel fumigations (p. 404). Calomel ointment is useful in allaying the itching of many skin affections. In pruritus ani and pruritus scroti it often removes the itching at once. In pruritus pudendi it is also of service, though not quite so much as in the other cases (Ringer). It should not be applied in large quantities, lest so much of it be absorbed as to cause its physio- logical action. Lotio Hydrargyri Nigra, B.P. Black Mercurial Lotion. Blace W ish. — Consists of half a drachm of calomel mixed with half a pint of lime-water. METALS. 589 Uses. — It contains suboxide of mercury. It is a good application to varicose ulcers, and is used as an application to syphilitic ulcerations, as a wash to the mouth in syphilitic sore throat, and in cancrum oris. The compound pill of subchloride of mercury may be used in cases of bilious- ness, gout, or rheumatism. Hydrargyri Cliloridum Corrosivum, U.S. P.; Hydrargyri Perchloriduin, B.P. Corrosive Chloride of Mercury, U.S. P. ; Perchloride of Mercury, B.P. HgCl 2 ; 270-5. Preparation. — By mixing mercuric sulphate with sodium chloride and subliming into a small chamber. To prevent the formation of any calomel some peroxide of manganese is added. Characters and Tests. — In heavy colorless masses of prismatic crystals, possessing a highly acrid metallic taste ; more soluble in alcohol, and still more so in ether, than in water. Its aqueous solution gives the reactions of mercuric salts and of a chloride. Dose. — ^ to -J- grain. In cholera this dose may be given every quarter of an hour, half-hour, or hour. Officinal Peepaeation. u.s.p. B.P. None. Liquor Hydrargyri Perchloridi. B.P. Liquor Hydrargyri Perchloridi. SOLUTION OF PEECHLOEIDE OF MEE- cuey. — Contains J grain of perchloride of mercury in 1 oz. of water, with 1 grain of ammonium chloride to keep it in solution and prevent precipitation. Dose. — ^ fluid drachm to 2 fluid drachms. Uses. — When mixed with albumen, corrosive sublimate precipi- tates it, forming a mercuric albuminate. It is one of the most powerful antiseptics known (p. 96). It may be applied to the skin to destroy vegetable and animal parasites present upon it, such as the fungus in pityriasis versicolor, sycosis and favus, the acarus in scabies and the pediculus pubis. It is useful in allaying the itching of pruritus scroti and pudendi, prurigo and urticaria. It may be employed as a wash in ophthalmia, as a gargle in syphilitic sore throat, and as an injection in gonorrhoea, gleet and leucorrhoea. When swallowed in strong solution it sometimes causes an irritant poisoning- ; and if this should pass off, it may be succeeded by intense salivation due to the absorption of the drug. The treatment in such cases is to give albuminous substances, such as white of egg or milk, in order to form mercuric albuminate in the stomach, and thus prevent its irritant action on the mucous mem- brane. If the irritation which the drug itself produces is not sufficient to cause vomiting, the stomach should be emptied by an emetic or a stomach-pump, in order to prevent digestion and absorption of the mer- curic albuminate and the poisoning which might occur from its absorp- tion. In small doses it is useful in dysenteric diarrhoea of adults or children, and in cholera, its utility probably depending, to a great extent at least, on its antiseptic power, which is not destroyed, like that of other antiseptics, by considerable admixture with organic matter, such as the faecal contents of the intestine (p. 107). After its absorption it has the same effect as the other salts of mercury, and may be used for this pur- pose in syphilitic cases. 590 INORGANIC MATERIA MEDICA. B.P. Lotto Hydrargyri Flava. YeLLOTT TV ASH. Peepaeatiox. — By mixing 18 grs. of corrosive sublimate with half a pint of lime-water. Uses. — It is used as a stimulating application to syphilitic sores in cases where the black wash is not sufficiently powerful. Hydrarg-yri Oxidum Flavum, U.S.P. and B.P. Yellow Oxide of Mercury. HgO; 215*7. Characters. — A light orange-yellow, heavy, impalpable powder, permanent in the air, and turning darker on exposure to light ; odorless and tasteless, insoluble in water or alcohol, but wholly soluble in nitric or hydrochloric acid. When strongly heated it assumes a red color ; at a higher temperature it is decomposed, giving off oxygen and separating metallic mercury, and is finally volatilized without residue. When digested on a warm bath for fifteen minutes with a strong solution of oxalic acid, it forms mercuric oxalate of a white color (difference from red mercuric oxide). Peepaeations. r.s. p. Oieatum Hydrargyri (yellow oxide 10, oleic acid 90, parts). Ungnentiun Bydrargyri Oxidi Flavi (1 in 10 of Unguentum). Hydrargyri Oxidum Rubrnm, U.S.P. and B.P. Red Oxide of Mercery. HgO ; 215*7. Preparation. — Triturate nitrate of mercury and metallic mercury together and heat. Hg2N0 3 + Hg = 2HgO + N 2 4 . Characters. — An orange-red powder readily dissolved by hydro- chloric acid, yielding a solution which, with caustic potash added in excess, gives a yellow precipitate, and with solution of ammonia a white precipitate. Impurity. — Undecomposed nitrate. Test. — Entirely volatilized by a heat under redness, being at the same time decomposed into mercury and oxygen. If this be done in a test-tube, no orange vapors are perceived. Peepaeations. u.s.p. and b.p. ^(STntm™ »& of Merfu"')' } J ^ fa 10 > U ' S - P - i » * 8 ' PB ' With ointment, U.S.P.; with yellow wax and olive oil, B.P. Uses. — The red oxide is rarely given internally. The ointment may be used in ophthalmia and conjunctivitis in the same way as the nitrate of mercurial ointment, and as an application to the auditory meatus in otorrhcea occurring after scarlet fever. It is also useful in scaly skin diseases, syphilitic sores on the skin, and in ulcers within the margin of the anus. Hydrargyrum Ammoiiiatum, U.S.P. and B.P. Ammoniated Mercury. White Precipitate. ]S T H 2 HgCl; 251*1. Preparation. — By dissolving corrosive sublimate in water, and precipitating by ammonia. Cii.aracters. — An opaque white powder on which cold water, alcohol and ether have no action. Digested with caustic potash, it evolves METALS. 591 ammonia, acquiring a pale yellow color, and the fluid, filtered and acid- ulated with nitric acid, gives a white precipitate with nitrate of silver. Boiled with a solution of chloride of tin it becomes gray, and affords globules of metallic mercury. Impurities. — Chalk, sulphate of lime, baryta, lead, carbonates, mercurous salts. Tests. — Entirely volatilized at a heat under redness (no chalk, etc.). It should dissolve in hydrochloric acid without residue (no mercurous salt) and without effervescence (no carbonate). Prepaeation. u.s. p. and b.p. Uuguentum Hydrargyri Aminoniati 1 part in 10, U.S. P. ; 1 in 8, B.P. With benzoated lard, U.S. P. ; with simple ointment, B.P. Uses. — Not used internally. The ointment is used in order to destroy parasitic fungi, but more especially to kill pediculi in the hair or on the body. It is also useful in lichen, pityriasis, herpes and other skin diseases. Liquor Hydrargyri Nitratis Acidus, U.S. P. and B.P. Acid Solution oe Nitrate of Mercury. (HgN0 3 ) 2 ; 327*7. Characters and Tests. — A colorless and strongly acid solution, which gives a yellow precipitate with solution of potash added in excess (mercuric oxide). If a crystal of sulphate of iron be dropped into it, in a little time the salt of iron, and the liquid in its vicinity, acquire a dark color (nitrate). Uses. — It is a powerful caustic, and is used as such in lupus. It is to be applied with a camel's-hair brush to the extent of a crown piece over the ulcers, tubercles, and scars which are soft and ready to break. The part is then covered with lint moistened in the solution. It soon becomes white, a kind of erysipelatous inflammation sets in around it, and it falls off as a yellow scab. The solution is also applied to the os uteri when there are large ulcers with flabby, unhealthy granulations upon it. It has been used in cancer and in chancres, condylomata, syph- ilitic and scrofulous ulcers, favus, and obstinate psoriasis. If applied often it may cause mercurialism, and indeed salivation has occurred after one application to the os uteri. To prevent this it should be washed off immediately after being applied. Unguentum Hydrargyri Nitratis, U.S. P. and B.P. OINT- MENT of Nitrate of Mercury. Citrine Ointment. Preparation. — By mixing a hot solution of mercury in nitric acid with lard oil, U.S. P. ; or with lard and olive oil, B.P. Characters. — It has a fine lemon-yellow color and a consistence like butter. It is apt to become decolorized when mixed with metals or deoxidizing powders, and hence an excess of acid is used in order that it may reoxidize them as necessary. It should be spread with a wooden or ivory spatula. Uses. — This ointment was made in imitation of Singleton's golden eye ointment, and it is of remarkable service in ophthalmia tarsi. It should be mixed with its own weight of almond oil and applied to the lids. 592 INORGANIC MATERIA MEDICA. It is also applied to phagedenic ulcers and syphilitic sores, and soon destroys the parasitic fungi on which ringworm, &c 3 depend. Hydrargyri Iodiduiu Tiride, U.S. P. and B.P. Green Iodide of Mercury. Hg 2 I 2 ; 652-6. Preparation. — By rubbing iodine and mercury together in a porce- lain mortar, occasionally moistening with a few drops of spirit. Characters and Tests. — A dull green powder, insoluble in water, which darkens in color upon exposure to light. When it is shaken in a tube with ether nothing is dissolved. Gradually heated in a test-tube, it yields a yellow sublimate, which, upon friction, or after cooling, "becomes red, while globules of metallic mercury are left in the bottom of the tube. Dose. — 1 to 3 grains. Uses. — It is employed for the purpose of combining the action of iodine with that of mercury, as in cases of secondary and tertiary syphilis occurring in persons of a scrofulous constitution, and especially in the syphilis of children. Hydrargyri Iodidum Bubrum, U.S. P. and B.P. Red Iodide of Mercery. Preparation. — By mixing solutions of corrosive sublimate with potassium iodide in the proper proportions. Characters and Tests. — A crystalline powder of a vermilion color, "becoming yellow from an alteration in its crystalline form when gently heated over a lamp on a sheet of paper, and again becoming red when placed on a sheet of paper and rubbed with a smooth substance. It is almost insoluble in water, dissolves sparingly in alcohol, but freely in ether, or in an aqueous solution of iodide of potassium. When digested with solution of soda it assumes a reddish-brown color (mercuric oxide) ; and the fluid cleared by filtration and mixed with solution of starch, gives a blue precipitate on being acidulated with nitric acid (iodide). Entirely volatilized by a heat under redness. Dose. — ^ to J grain. Preparation, b.p., not in u.s.p. TJnguentum Hvtlrarg3'ri Ioclidi Rubri... 1 1 + • OP (Ointment of Red Iodide of Mercury) J X part ln M ' With yellow wax and almond oil. Uses. — It may be used for the same purposes as the green iodide, but, like all the mercuric salts, it is much more powerful than the corres- ponding mercurous one. It is a powerful local irritant, and is used in the form of ointment in cases of goitre. The mode of employing it is to rub the ointment upon the tumor, and afterwards to expose the patient either to the heat of the sun or of a fire as long as he can bear it. This iodide was first used in India. In this country, where the sun's rays are not so powerful, the heat of a fire has been employed, but has not been found so efficacious It is useful in obstinate skin diseases, especially in lupus. It is fre- quently given in syphilis, one of the most common ways of prescribing it being to give \- 1 drachm of the solution of the perchloride with several METALS. 593 grains of potassium iodide. The periodide is thus formed, and is dis- solved in excess of the potassium iodide. U.S.P. Hydrargyri Cyanidum. Cyanide of Mercury. Hg(CN) 2 ; 251-7. Characters. — Colorless or white prismatic crystals, becoming dark- colored on exposure to light ; odorless, having a bitter metallic taste, and a neutral reaction. When slowly heated the salt decomposes into metallic mercury and cyanogen gas, which is inflammable, burning with a purplish flame. On further heating, the blackish residue containing globules of metallic mercury is wholly dissipated. On adding hydrochloric acid to the aqueous solution, hydrocyanic acid vapor is evolved. Tests. — A 5 per cent, aqueous solution of the salt, when mixed with a dilute aqueous solution of iodide of potassium, should not yield a red or reddish precipitate soluble in excess of either liquid (absence of mercuric chloride). Dose.: — ^ to -J- grain. Uses. — It may be given in syphilis. A solution of 5-10 grains in an ounce of water, painted on with a camel's-hair brush, is a useful application to syphilitic sores of the tongue or mouth. U.S.P. Hydrargyri Sulpliidum Rubrum. Red Sulphide of Mercury. HgS; 231-7. Characters. — Brilliant dark-red crystalline masses, or a fine bright scarlet powder, permanent in the air, odorless and tasteless, insoluble in water, alcohol, nitric or hydrochloric acid, or in dilute solutions of alka- lies. It is dissolved by nitrohydrochloric acid, and on adding an excess of stannous chloride, metallic mercury is precipitated. Uses. — It is used for mercurial fumigation. Thirty grains may be used instead of calomel in the way already described (p. 404). Class IV. Tetrad Metals. LEAD. Titanium. TIX. General Actions. — Lead and tin resemble one another to a con- siderable extent in their physiological action. After absorption into the circulation lead affects the muscles, involuntary and voluntary, and the central nervous system. Its action on muscle appears to be first irritant then paralyzing. The irritant action on the muscle of the intestine leads to colic, and on the voluntary muscle to cramps in man. In animals, when the quantity administered in experiments at one time is much larger, paralyzing action is more marked, and in frogs and rabbits, mus- cular weakness and rapid loss of irritability both in the voluntary muscles and heart are marked symptoms. In cats the paralysis of voluntary muscle is less marked, and in dogs it is absent. The motor areas of the central nervous system appears to be much more affected by lead than the sensory ; and in dogs, cats, and pigeons choreic movements, and even convulsions occur without impairment of 38 594 INORGANIC MATERIA MEDICA. sensation or consciousness. The irritation of the motor centres is suc- ceeded by paralysis and death. Tin has an action resembling lead in increasing the contractions of the intestinal canal and causing paralysis of the spinal cord. In rabbits it produces weakness and apparent recovery, and then paresis and death. 1 LEAD. Pb.; 207. General Source of Lead Salts. — Lead is obtained entirely from the native sulphide called galena by roasting. General Reactions. — The chief reactions of lead salts are shown in the following table: — Reagent. Reaction. Hydrogen sulphide Ammonium sulphide Caustic potash or soda } Black precipitate White (( u Yellow " soluble in excess. Ammouia ,--. insoluble " Carbonates of potash, soda, ammonia or u a Sulphuric acid or sulphates Potassium iodide " in nitric acid. u General Impurities. — Alkaline earths, zinc or copper. General Tests. — As alkaline earths and zinc are not precipitated by sulphuretted hydrogen, they can be detected by passing this gas through the solution of a lead salt until all the lead has been precipitated as sulphide. On removing the sulphide by filtration, and evaporating the filtrate to dryness, no residue should remain if the lead be pure, U.S. P. Copper may be detected by precipitating the lead from a solution by sulphuric acid, filtering, and super-saturating with ammonia. If copper be present, the solution will exhibit a blue color, U.S. P. Insoluble salts, as the oxide, may be dissolved in dilute nitric acid super-saturated with ammonia. The filtrate should show no blue color. Action. — Soluble lead salts unite with albumen, and form albumi- nate of lead. They have little or no irritating action when applied directly to the denuded skin or to a mucous membrane. In the mouth they have an astringent action, but a sweet instead of corrosive taste. In large doses in the stomach they may excite vomiting and may produce symptoms of irritant poisoning. In the intestine they act as powerful astringents. After absorption into the blood lead is carried by the blood to all parts of the body, and there becomes deposited. It appears to be eliminated very slowly, so that even when very minute quantities are taken continuously chronic lead poisoning may be produced. One of the most important sources of lead poisoning- of this sort is drinking water. Soft water attacks the leaden pipes in which it may be conveyed, or the cisterns in which it may be stored, and dissolves enough lead to cause lead poisoning, the small quantity of one grain per 1 T. P. White, Archivf. exp. Path u. PJiarm., 1880, viii., p. 33. METALS. 595 gallon appearing to be sufficient. Hard waters are not injurious, as they cause a coating of phosphate or sulphide of lead to form on the surface of the pipe or cistern, and thus protect it from further attacks. Other sources of lead poisoning are, beer which has stood in the pipes leading to the tap, and snuff, from the decomposition of the lead foil which sur- rounds it. There are certain trades, the workers in which are very liable to lead poisoning, such as color grinding, painting, plumbing, type found- ing, and printing (compositors). The chief source of poisoning in these trades is the lead which adheres to the hands and is swallowed along with the food, and the precautions to be adopted are cleanliness, washing the hands carefully before taking meals, taking the food in a different room from that in which the work is carried on, changing the clothes when the work is over, and, if necessary, drinking water acidulated with sul- phuric acid. Treatment of chronic lead poisoning consists in eliminating the poison, first from the tissues and then from the body. Various means have been employed, such as sulphur baths, the internal administration of sulphur, frequent doses of castor oil. As the lead is eliminated by the skin and mucous membrane, sulphur, applied either to the skin or taken internally, will convert it into an insoluble sulphide and prevent its reabsorption. Castor oil will remove from the intestinal canal the lead excreted into it. But the treatment which I employ, and which I find very satisfactory, is to combine the use of iodide of potassium with that of sulphate of magnesia, giving from five to ten grains of the iodide three times a day, and a drachm of the sulphate also three times a day, with an interval of about two hours between the medicines. The object of this treatment is (1) to dissolve the lead deposited in the tissues, and to cause its elimination by the mucus of the alimentary canal, and (2) to render the lead insoluble after it has passed into the intestine, and to remove it thence as quickly as possible. The symptoms of chronic lead poisoning" are a blue line on the gums, lead colic, lead cramps and lead paralysis. The blue line on the gums may appear when neither the colic, cramps nor paralysis are present. It appears to be produced by sulphuretted hydrogen in the mouth precipitating the lead as black sulphide in the gums just at the margin of the teeth, and this, shining through the tissue above it, appears of a bluish color. It is absent when the teeth have been lost, and slight if they are kept clean. The lead colic may either be preceded by symptoms of digestive derangement, such as loss of appetite, or may appear at once. It is characterized by a tearing pain referred chiefly to the region of the umbilicus, and generally accompanied by obstinate constipation. It is usually, though not always, relieved by pressure, but may sometimes be somewhat increased by it. Lead cramps are almost entirely confined to the flexor surfaces specially marked in the calves of the legs, and are usually worse at a change of weather. They may either accompany or succeed the colic. Lead paralyses are usually confined to the extensor surfaces, and more particularly affect the extensors of the wrist, so that this form of paralysis is sometimes known as wrist-drop. The affected muscles 596 INORGANIC MATERIA MEDICA. become atrophied, and as the extensor tendons also act as ligaments of the wrist, the bones of the carpus may become displaced. The paralysis probably depends on an affection of the spinal cord rather than of the muscles themselves; for the muscles are affected in physiological groups which act together, although supplied by different nerves, and the degeneration of the muscle does not occur until after the paralysis has set in for some time. Lead appears to cause contraction of the muscular walls of the arteries, and to raise the arterial tension and to slow the heart. It has been supposed that this action depended on a local astringent effect upon muscular fibre itself, but as in cases of chronic poison the propor- tion of lead in the nervous system is much greater than in muscular fibre, it is more probable that these effects are of nervous origin. The contraction of the intestine which gives rise to the colic is probably due more to the action of the lead upon the nerves of the intestine than upon its muscular coats. Lead is eliminated, to a slight extent, in the urine, and probably largely by the mucus of the intestinal canal. It appears to check the elimination of the uric acid, and in London gout occurs very frequently among patients who work in lead. Lead salts may be administered in medicinal doses for a considerable time without bringing on any sign of lead poisoning ; but Garrod has observed, and I can confirm the statement, that the administration of medicinal doses of lead salts will bring on a fit of gout in persons predis- posed to it. Lead poisoning appears to occur readily in gouty subjects. Chronic lead poisoning has a tendency to induce cirrhotic changes in the kidneys, the tubules becoming blocked by plugs of lead carbonate and atrophy ensuing. Uses. — Lead lotions are sometimes applied externally to sprains and bruises. They are useful in relieving the itching of pruritus, and the discomfort and in lessening the discharge of eczema. As injections they may be applied in otorrhcea, vulvitis in children, gonorrhoea and leucorrhoea. They are not used in ulceration of the cornea, lest lead should be deposited in the ulcer and leave a permanent opacity. Inter- nally, lead is used for its local action on the stomach in pyrosis, and on the intestine in diarrhoea and dysentery, and for its astringent action on the vessels in hsematemesis, haemoptysis and bleeding from the kidneys and uterus. It has also been employed in palpitation from hypertro- phied heart, and in aortic aneurism. Plumbi Oxidum, U.S.P. and B.P. Oxide OF Lead. PbO; 222-5. Preparation. — By roasting lead in a current of air. Characters and Tests. — In heavy scales of a pale brick-red color, completely soluble without effervescence in diluted nitric and acetic acids, either solution, when neutral, giving the reactions of lead. It should con- tain no copper. Pnrciw katioxs i.\ which Oxide of Lead is used. Emplastrum Ccrati Saponis. Liquor Plumbi Subacetatis. " Plumbi Plumbi Acetas. METALS. 597 Emplastrum Plumbi, U.S. P. and B.P. Lead Plaster. Preparation. — By heating oxide of lead with olive oil and water. The oleic acid of the oil combines with the lead, forming oleate of lead and leaving glycerine. This plaster is a lead soap. Pkepakations. u.s.p. B.P. Emplastrum Ammoniaci cum Hydrargyro. Emplastrum Ferri. " Asafbetidse. " Galbani. " Ferri. " Hydrargyri. " • Galbani. " Resinse. " Hydrargyri. " Saponis. Opii. Resinae. " Saponis. Unguentum Diachylon. And several other plasters into which it enters as resin plaster. Uses. — Lead plaster is used to hold together the edges of wounds, to protect irritable surfaces, either alone or by keeping other dressings in contact with them by means of its adhesive power. It is also used as a means of applying pressure. Plumbi Carbonas, U.S.P. and B.P. Carbonate of Lead. (PbC0 3 ) 2 Pb(HO) 2 ; 773-5. Preparation. — By exposing lead to the fumes of vinegar and to C0 2 . Characters and Tests. — A soft, heavy, white powder, blackened by sulphuretted hydrogen, insoluble in water, soluble with effervescence in diluted acetic acid without leaving any residue, and forming a solution, which gives the reaction of lead. Impurity. — Lime. Test. — The acetic solution when treated with excess of sulphuretted hydrogen, boiled and filtered, gives no precipitate with oxalate of ammonia. Preparation, u.s.p. and b.p. Unguentum Plumbi Carbonatis 1 part in 10, U.S.P. ; 1 in 8, B.P. With benzoated lard, U.S.P. ; with simple ointment, B.P. Uses. — Carbonate of lead is used as an application to excoriated sur- faces, piles, boils, and ulcers. The ointment is used in the same way. Plumbi Acetas, U.S.P. and B.P. Acetate of Lead. Pb(C 2 H 3 2 ) 2 3H 2 ; 378-5. (Sugar of Lead.) Preparation. — By dissolving oxide of lead in acetic acid. Characters and Tests. — In white crystalline masses, slightly efflorescent, having an acetous odor, and a sweet astringent taste. Its solution in water slightly reddens litmus, and gives the reactions of lead and of an acetate. Impurity. — Slight amount of carbonate. Test. — Its solution in distilled water is clear, or has only a slight milkiness, which disappears on the addition of acetic acid. Dose. — 1 to 4 grains. 598 INORGANIC MATERIA MEDICA. Preparations in which Acetate of Lead is used, u.s.p. B.P. Liquor Plumbi Subacetatis. Liquor Plumbi Subacetatis 5 ounces to 1 pint. Pilula Plumbi cum Opio 36 parts in 48. Suppositoria Plumbi Composita...6 parts in 30. Unguentum Plumbi Acetatis 1 part in 38. Uses. — The acetate is the preparation of lead most frequently used as a local application in inflammations, ulcers, ophthalmia and gonorrhoea, or for its general actions on the system. b.p. Pilula Plumbi cum Opio. Pill of Lead and Opium. — Contains 6 grains of lead acetate, 1 of opium, and 1 of confection of roses in every 8 grains of the pill. Dose. — 3 to 5 grains. Uses. — It is a powerful astringent, used either for the purpose of obtaining the local astringent action of lead upon the bowels in diarrhoea, or for its general effect upon the system after absorption, as in haemoptysis. B.P. Suppositoria Plumbi Composita. COMPOUND LEAD SUPPOSITORIES. — Each suppository contains 1 grain of opium and 3 grains of acetate of lead. Uses. — Used in piles and dysentery accompanied by much tenesmus, or in phthisis, where we wish to stop haemoptysis without putting lead or opium into the stomach and thus running the risk of interfering with digestion. B.P. Unguentum Plumbi Acetatis. OINTMENT OF ACETATE OF LEAD. — Acetate of lead (12 grains), benzoated lard (1 ounce). Uses. — It is used as a sedative and astringent application to ulcers, excoriations, painful piles, irritable and itching skin diseases, erysipelas, burns, bruises, &c. Liquor Plumbi Subacetatis, U.S.P. aud B.P. Solution of SUBACETATE OF LEAD. An aqueous liquid containing in solution about 25 per cent, of sub- acetate of lead, U.S.P. Subacetate of lead, Pb(C 2 H 3 2 ) 2 .PbO., dissolved in water, B.P. Preparation. — By boiling acetate of lead, oxide of lead, in powder, and distilled water together. Characters and Tests. — A dense, clear, colorless liquid, with alka- line reaction and sweet, astringent taste, becoming turbid by exposure to the air, and forming with mucilage of gum-arabic an opaque white jelly. It gives the reactions of lead and of an acetate. Peepakations. u.s.p. B.P. Ceratum Plumbi Subacetatis. Liquor Plumbi Subacetatis Dilutus. Linimentum " " Unguentum " " Compositum. Liquor " " Dilutus. USES. — It is recommended by Ringer as an application to pityriasis and eczema, and in combination with one or two parts of glycerine to the milder forms of lupus after the crusts have been removed. Diluted and mixed with liquor morphise acetatis, it is a useful application to haemorrhoids. METALS. 599 laquor Plumbi Subacetatis Dilutus, U.S.P. and B.P. DILUTED SOLUTION OF Subacetate OF Lead. — Solution of acetate of lead 3, distilled water 97 parts, U.S.P. Consists of 2 fl. dr. of solution of lead and 2 fl. dr. of rectified spirit diluted with water up to a pint, B. P. Uses. — Used as a mild astringent and sedative to irritable and itching skin diseases and superficial inflammation ; as an eye wash, unless ulcera- tion of the cornea be present; as an injection in leucorrhoea and pruritus pudendi. Ceratum Plumbi Subacetatis, U.S.P. ; Unguentum Plumbi Subacetatis Composi- tum, b.p. Cerate of Subacetate of Lead, U.S.P. ; Compound Ointment of Subacetate of Lead, B.P. Solution of subacetate of lead (20 parts), camphor cerate (80 parts), U.S.P. Solution of subacetate of lead (6 fluid ounces), camphor (60 grains), white wax (8 ounces), oil of almonds (1 pint), B.P. Uses. — Chiefly as an application to chapped hands and ulcers. U.S.P. Linimentum Plumbi Subacetatis. LlNIMENT OF SUBACETATE OF LEAD. — Solution of subacetate of lead (40 parts), cotton seed oil (60 parts). Uses. — To allay itching in chilblains and skin diseases. Plumbi Nitras, U.S.P. and B.P. Nitrate of Lead. Pb(N0 3 ) 2 ; 330-5. Preparation. — By dissolving lead in nitric acid with the aid of heat and crystallizing. Characters and Tests. — In colorless octahedral crystals which are nearly opaque, permanent in the air, of a sweetish astringent taste, soluble in water and alcohol. The aqueous solution gives the reactions of lead. Added to sulphate of indigo it discharges the color. PEEPAEATION IN WHICH NlTEATE OF LEAD IS USED. Plumbi Iodidum. Uses. — It is sometimes applied as a disinfectant, and occasionally to cracked hands or lips and fissured nipples. It has been given in order to check haemorrhage from the lungs. Plumbi Iodidum, U.S.P. and B.P. Iodide of Lead. Pbl or Pbl 2 ; 459-7. Preparation. — By mixing solutions of nitrate of lead and potas- sium iodide. Characters. — A heavy, bright, citron-yellow powder, neutral, no taste nor smell. Sparingly soluble in water, readily soluble in chloride of ammonium. When strongly heated it first fuses and then is decomposed, emitting violet vapors of iodine, and leaving a citron-yellow residue. Impurities. — Chromate, zinc, alkalies, and alkaline earths. Tests. — On triturating 1 part of the salt with 2 parts of chloride of ammonium in a porcelain mortar, and adding 2 parts of water, a colorless liquid should result (with absence of, and different from, chromate). This liquid, diluted with water, affords a white precipitate with diluted sulphuric acid, and a black one with hydrosulphuric acid. If all the lead has been precipitated from a portion of the solution by the last-named reagent, the filtrate should leave no residue on evaporation and gentle ignition (absence of zinc, alkalies, or alkaline earths). 600 INORGANIC MATERIA MEDICA. Pbepaeations. B.P. Einpl a strain Plurubi Iodidi. IODIDE OF LEAD PLASTEE. 1 part in 9 (with soap and resin plaster). Ungaientum Plunibi Iodidi, TJ.S.P. and B.P. OlXTMENT OF IODIDE OF LEAD. "With benzoated lard, 1 part in 10, U.S.P. ; with simple ointment, 1 part in 8, B.P. Uses. — It lias been used externally as an application to ringworm, and as a counter-irritant in scrofulous enlargement of the glands. It has been given internally in enlarged glands, and in chronic enlargement of the spleen. In the latter case the iodine may be supposed to have a beneficial effect upon the corpuscles of the spleen, and the lead to cause contraction by acting upon the involuntary muscular fibre of the organ. The ointment is used for enlarged glands. TIN. Sn. ; 118. B.P. Tin, granulated. Grain tin, reduced to small fragments by fusing and pouring into cold water. Use. — Used formerly in powder as an anthelmintic in J ounce doses. Solution of Chloride of Tin. SnCl 2 . Preparation. — By dissolving granulated tin in diluted hydro- chloric acid. Uses. — It has a powerful affinity for oxygen and for chlorine. When added to trichloride of gold it gives a precipitate called purple of Cassius, whose composition is not known. It is used as a test for mercury. When added to calomel it abstracts chlorine and precipitates metallic mercury. When added to corrosive sublimate it precipitates calomel, which it after- wards reduces to mercury. Salts of tin are not used in practice, but have been given in nervous diseases in somewhat the same way as zinc. Chloride of tin is a caustic of considerable power. In poisoning by it the treatment would be to give milk and alkaline carbonates. CHAPTER XXVII. Class V. PENTAD ELEMENTS. Nitrogen, Phosphorus, Vanadium, Arsenic, Niobium, Antimony , Tantalum, Bismuth. In the heading to this class I have substituted the word elements for metals, for nitrogen and phosphorus belong to it, although they are non- metallic elements. METALS. 601 They form analogous compounds with oxygen and hydrogen. 12 3 4 5 Nitrogen N ... N 2 ... N 9 2 ...N 9 3 ... NA ... N,0 5 ... NH 3 Phosphorus P ... ... P 2 3 P 9 5 ... PH 3 Vanadium V ... V 2 ... V 2 2 ... V 2 3 ... V 2 4 ... V 2 5 ... Arsenic As... ...As 9 3 ... ...As 9 5 ... AsH 3 Antimony Sb... ...Sb 2 3 Sb,0 5 ... SbH 3 Bismuth Bi... ...Bi 2 3 ... ...Bi 2 5 ... Xitrogen. X; 14. Non-officinal. Nitrogen when free is chemically inactive, and does not readily unite with other elements. It is also physiologically inactive, but has been used as an anaesthetic. The anesthesia is due to asphyxia from absence of oxygen ; but as the carbonic acid is constantly removed by the inhalation of nitrogen, the symptoms of irritation produced by it in ordinary asphyxia are absent. The 1st, 3d and 5th of its compounds in the above table can take up the elements of water and of metallic oxides to form salts. Hydeogen Salt. Metallic Salt, e.g., of Potassium. Hyponitrous acid H 2 ON 9 or HNO. Potassium hyponitrite K 2 ON 2 or KNO. Nitrous acid H 9 ON 9 3 or HN0 2 . " nitrite K 2 ON 2 3 or KN0 2 . Nitric acid H 2 ON 2 5 or HN0 3 . " nitrate K 2 ON 2 5 or KN0 3 . The acid compounds of nitrogen with oxygen resemble those of phos- phorus and arsenic in this, that the nitrites are considerably more active than the nitrates, just as the phosphites and arsenites are more active than the phosphates and arseniates. The action of nitrites on the organ- ism was first investigated in the case of nitrite of amyl, but by some unpublished experiments made in Professor Ludwig's laboratory in 1869-70, I satisfied myself of the correctness of Dr. B. W. Richard- son's observation, 1 that other nitrites such as those of ethyl and sodium had an action on the blood-pressure similar in kind though less in degree. In other experiments, Dr. Gresswell and I found that the nitrites of propyl and butyl had also this action, and that all nitrites were muscu- lar poisons. 2 Mr. Tait and I found that nitroglycerine had an action resembling the nitrites both in its effect on blood-pressure and the change it caused in the color of the blood, but the headache it produced deterred us from employing it in the treatment of patients. 3 Nitrous Oxide. Nitrogen Monoxide. Laughing gas. N 2 0. Not officinal. Preparation. — By heating nitrate of ammonia. Action. — When a mixture of nitrous oxide and air is inhaled it causes excitement, generally characterized by fits of involuntary laughter, dancing, singing and shouting, although it sometimes appears to arouse pugnacity. When inhaled pure, it produces, first of all, a feeling of increased circulation through the body generally, accompanied by warmth 1 B. W. Richardson, Brit, and For. Med. Chir. Rev., July, 1867. 2 St. Bartholomew's Hospital Reports, 1876, p. 143. 3 Ibid., p. 140. 602 INORGANIC MATERIA MEDICA. and a little singing in the ears. If the inhalation be now stopped, the effect may pass off, but occasionally, after a few breaths of pure air have been taken, the same excitement may ensue which is usually produced by the inhalation of mixed air and gas. On one occasion, having inhaled pure gas for a short time, I felt a little warmth of the skin, and a hum- ming in the head, and, thinking it was time to desist, laid down the mask of the inhaler. After a few breaths of fresh air, I noticed that on attempting to speak, the speech was slow and hesitating. An electric shock then seemed to shoot through the spine, and I was seized with an uncontrollable desire to laugh, jump and throw the arms about, while the perceptive faculties appeared quite unaffected. Although unable to con- trol my movements, I was perfectly conscious of their ludicrous nature, and was astonished that two men who were sitting by, and who after- wards informed me that they thought the whole thing a bad joke, were able to preserve their gravity. After lasting for one or two minutes, the effect of the gas suddenly and completely passed off. When inhalation is continued for a longer time, the feelings of warmth and buzzing in the ears are succeeded by gradually increasing dimness of perception ; sight, sounds and tactile impressions become much dim- mer than usual; and then the person becomes unconscious. At this time the face usually assumes a livid aspect, and during the period of insensi- bility small operations may be performed without the patient being the least aware of them. When the administration of the gas is stopped, recovery quickly and completely occurs, often passing off without leaving any after effects, though occasionally more or less headache is experienced for some hours. No stage of exhilaration such as that which has already been described as occurring after the administration of a small quantity of nitrous oxide is noticed during recovery from complete narcosis. Nitrous oxide appears to act as an anaesthetic, chiefly by depriving the nerve-centres of oxygen. As the inhalation of pure nitrogen has a similar anaesthetic power, the exhilarating effect of small doses of nitrous oxide seems to show besides that it has a special relation to the nerve- centres. Uses. — It is useful as an anaesthetic for extraction of teeth, evulsion of the toe-nail, and other minor operations. The intense venosity of the blood which occurs during its use renders it unsuitable for continued administration, and therefore inadmissible in the case of a lengthy operation. Mode of Administration. — The most convenient mode of adminis- tering it is to have it condensed in a large iron bottle, from which the gas may be readily conveyed to the patient by means of a flexible tube attached to a mask. The mask ought to be provided with a margin of inflated India-rubber, so that it will fit perfectly tightly to the face and thus prevent the escape of gas. PHOSPHORUS. P; 31. U.S.P. and B.P. A non-metallic element obtained from bones. PREPARATION. — By treating bones with sulphuric acid, when sul- phate of calcium is precipitated and acid phosphate of calcium remains METALS. 603 in solution. This is evaporated and distilled with charcoal, which removes the oxygen. The phosphorus distils over and is condensed under water. Characters. — A semi-transparent, yellowish, waxy-looking solid. When exposed to air it emits white fumes which are luminous in the dark and have a garlicky odor. Officinal Prepakations. U.S. p. DOSE. Pilulae Phosphori ( T ^ gr. in each) 1-5 pills. Oleum Phosphoratum (with stronger ether and almond oil, 1 per cent.) 1-5 min. B.P. DOSE. Pilula Phosphori (with balsam of tolu and yellow wax, T ^- gr. in 5 grs.) 1-5 grs. Oleum Phosphoratum (phosphorus in almond oil, ■£% gr. in 5 m.) 1-10 m. Action of Phosphorus. — Living protoplasm has the power of oxidizing all the members of this group, and also of reducing the pro- ' ducts of their oxidation (Binz). It is probable that this action goes on more easily with phosphorus than with nitrogen. Hence if phosphorus replaces nitrogen in a living cell it will quicken metabolism. It is absorbed unchanged into the blood, and is excreted by the kidneys either as phosphorus or phosphoric acid. In small doses it appears to cause development of the fibrous tissue in the liver, and in doses too small to affect the liver or stomach it acts upon the osseous tissues. Its action upon the bones is somewhat peculiar, and has been fully investigated by Wegner. When phosphorus is given to growing animals, the bone, as it develops, is denser than usual, the cancellous tissue being like the denser tissue in the long bones. Cancellous tissue formed before the administra- tion of phosphorus remains unchanged. If the administration be still continued, the cancellous tissue formed previously to the use of the drug is absorbed, and serves to form the cavity of the bone, and after awhile the normal cancellated tissue at the end of the epiphysis is also replaced by solid bone. Afterwards even the dense bone thus formed becomes absorbed, and forms the cavity of the long bone. In adult animals phosphorus also causes the bones to become denser, and this is especially noticeable in chickens, in which the cavity of the bone may be completely filled up, so that long bones form a solid rod instead of a tube. The influence of phosphorus upon osseous tissues is not due to excess of phos- phates produced by it in the blood, but to stimulation of tissue growth itself by the phosphorus, for Wegner found that in animals fed with phos- phorus, but almost entirely deprived of phosphates, the same dense, bony substance was formed, except that instead of the bone being hard, it was like that which occurs in rickets. In men exposed to the fumes of phos- phorus, e.g., those employed in the manufacture of lucifer-matches, caries of the lower jaw is a frequent occurrence. This is not due to the action of the phosphorus after absorption into the circulation, but to the direct effect of the fumes upon the bone itself. For it has been found that when a bone of an animal fed by phosphorus was exposed, no carious change took place ; but if one were exposed to the fumes, caries was produced, and amongst lucifer-match makers it has been noticed that only those who have carious teeth suffer from necrosis of the jaw. 604 INORGANIC MATERIA MEDICA. When doses larger than those which induce induration of the bones are given, the phosphorus appears to act upon the connective tissue of the stomach and liver, causing chronic inflammation of these organs, and atrophy of the secreting cells, so that cirrhosis of the liver appears. In poisonous doses the phosphorus first produces the symptoms of gastro-enteritis, with a garlicky taste in the mouth, the vomited matters having a similar odor, containing bile, and but rarely blood. They sometimes shine in the dark. At the end of twenty-four to thirty-six hours, the symptoms of gastro-intestinal irritation cease, and the patient is apparently well, with the exception of vague pains in the limbs and loins. During this period, however, fatty degeneration of the liver, stomach, and kidneys is going on, and the effect of the changes in these organs soon manifests itself. Sometimes, after two or three days, the patient may die suddenly, without exhibiting any fresh symptoms, but usually on the second or third day jaundice appears, while the urine contains bile, and often albumen. There is occasionally vomiting and purging, headache, sleeplessness, delirium, and coma, and death with or without convulsions. In some cases, when the poisoning runs a less acute course, the effect of fatty degeneration of the vessels is most prominent, discharges of blood occurring from the stomach, intestines, nose, lungs, bladder, uterus, and ears, and ecchymosis appearing on the surface. Increasing anaema and debility finally kill the patient. The treatment in cases of poisoning by phosphorus is to wash out the stomach freely by means of the stomach-pump, or by an emetic of sulphate of copper, and to give oxidized oil of turpentine in 40-minim doses in mucilage every fifteen minutes for an hour. Fats and oils should be withheld, as they dissolve any phosphorus which may be present in the stomach, and assist its absorption. The fatty degeneration produced by phosphorus appears to depend on a more rapid splitting up of albuminous tissues, along with deficient oxidation. This was shown by Voit and Bauer, who produced fatty degeneration of the organs by the administration of phosphorus in dogs absolutely deprived of food, where the fat found after death could neither have come from food nor from fat deposited in other parts of the body, as that had all been absorbed before the administration of the drug had been commenced. It must therefore have been formed in situ from the decomposition of albuminous substances, and these were shown to have split up more quickly than usual by the amount of urea in the urine being increased by the phosphorus, while oxidation in the body was shown to have diminished by the amount. of oxygen absorbed and carbonic acid given off being lessened. In man, the products of albuminous waste are often not converted into urea, but appear in the urine as leucin and tyrosin. The action of compounds containing phosphorus appears to depend considerably on the more or less complete saturation of its affinities, and the readiness with which the phosphorus may attach itself to the organic constituents of the tissues. Thus, phosphoric acid, in which the affinities of the phosphorus are fully saturated by oxygen, appears simply to act &B ;m acid without exerting any specific action, and when combined with soda, its effects are simply those of a neutral alkaline salt. METALS. 605 Metaphosphoric and pyrophosphoric acids appear to have a specific poisonous action more nearly resembling that of phosphorus. Pyrophos- phate of soda paralyzes the nerve-centres in the spinal cord and medulla oblongata, producing drowsiness, loss of reflex action, paralysis, and death, which is sometimes preceded by convulsions. It lowers the blood- pressure in mammals, slows the beats of the frog's heart, renders them powerful and finally arrests them in systole. When death does not occur rapidly, marked fatty degeneration of the heart and kidneys are found, and a similar change, though to a less extent, in the liver. Although it acts as a poison when injected subcutaneously or into the circulation, pyrophosphate of sodium has no poisonous action when taken into the intestinal canal. Metaphosphate of soda has a similar but less powerful action. Uses. — Phosphorus forms an important constituent of nervous tissue, and has been employed in cases of nervous debility, neuralgia, wakeful- ness, paralysis, locomotor ataxia, and impotence. In some cases of leucocythamia it is useful. It has been used in osteomalacia, and instead of arsenic in skin diseases (vide also p. 610). Even in small doses it may •cause nausea, with unpleasant eructations. It is well, therefore, to com- mence with a very small dose, such as y^-g- of a grain. General Reactions of Aesenic, Antimony, and Bismuth. Arsenic. Antimony. Hydrosulphuric Acid Yellow precipitate (solu- ble in ammonium sulphide and re- pre- cipitated by acids). Orange or brick-red precipitate (soluble in aninionium sulphide, and precipitated by acids). StroDg solution thrown into much water gives a white precipitate, which becomes orange on the addi- tion of hydrosulphu- ric acid. Bismuth. Black precipitate (insol- uble in ammonium sulphide). Strong solution thrown into water gives a white precipitate, which becomes black on the addition of hydrogen sulphide. ARSENIC. As; 75. Metallic arsenic is not used in medicine. It is steel-colored, crystal- line, and brittle, and when heated gives off garlic fumes. Very light (sp. gr. 5*8), very volatile. It forms two classes of salts. In one, the arsenious salts, it is tri-, in the other, arsenic salts, pent-atomic. Arse- nious oxide, As 2 3 , usually called arsenious acid, forms arsenites. Arsenic oxide, As 2 5 , or arsenic acid, forms arsenates, or, as they are termed in the U.S. P. and B.P., arseniates. General Sources of Arsenic. — It occurs in many ores combined with metals, oxygen and sulphur. Its presence as a frequent impurity in sulphur has already been mentioned. It is chiefly obtained by roast- ing the arsenides of iron, nickel and cobalt, and condensing the arsenious oxide in a long nearly horizontal chimney. General Tests for Arsenious Acid. — With hydrosulphuric acid it gives a yellow precipitate, which is brightest in acid solutions. Silver 606 IXORGAXIC MATERIA MEDICA. nitrate gives a canary-yellow, and copper sulphate a brilliant green pre- cipitate (Scheele's green). These are very soluble in acid and neither of them is thrown down from simple aqueous solutions of arsenious acid (a little acid being freed in the reaction) ; a little alkali must be present. Both are very soluble in excess of ammonia, so that to avoid adding excess ammonio-nitrate of silver and ammonio-sulphate of copper are used as reagents, in preference to adding ammonia along with simple solutions of nitrate of silver or of sulphate of copper. Arseniates throw down a brick- red precipitate with ammonio-nitrate of silver, and are thus distinguished from arsenites. G-exeral Action of Arsexic. — Although arsenic, like antimony, has no great affinity for albumen, and does not produce with it a coagulum, yet, when applied to the skin denuded of its epidermis, it acts as a caustic and produces a slough. If used in a dilute form, and over a large surface, it may be absorbed, and may produce the general effects of the drug upon the system. When applied in a concentrated form it appears to produce a slough more rapidly, and the dead tissue forms a barrier to its farther absorp- tion. In the mouth it has a somewhat sweetish taste, and in small doses excites in the stomach a feeling of appetite. In larger doses it produces irritation, colicky pains, diarrhoea, and mucous evacuations, sometimes tinged with blood. In still larger doses it causes symptoms of gastro- enteritis, vomiting, and' purging, the stools being finally of a rice-watery appearance, closely resembling those of Asiatic cholera. These are also occasionally accompanied by collapse, with pale, pinched, and somewhat livid surface, and violent cramps of the extremities, so that cases of arsenical poi- soning may be readily mistaken for cholera, and vice versa. There is sometimes strangury, priapism, suppression of urine or bloody urine; the consciousness is retained to the last. In some cases there are no symptoms at all of gastro-intestinal irritation, the nervous system being affected, and the patient presents the symptoms of coma, very much resembling those of opium poisoning. The treatment in cases of arsenical poisoning is to wash out the stomach freely by means of the stomach-pump, and the copious adminis- tration of diluents, taking care to insure their evacuation by the subsequent speedy administration of such emetics as mustard or sulphate of zinc if they are not at once rejected by the vomiting caused by the arsenic itself. Peroxide of iron may be administered in doses of a tablespoonful every ten minutes, and alcohol has been given when the moist peroxide could not be obtained. Demulcents should afterwards be given to allay the irritation. Chronic poisoning- by arsenic may occur from the inhalation of arsenical vapor or dust, arising from wall-papers, dresses, or other sub- stances containing arsenic. The proportion of arsenic necessary to pro- duce poisoning when taken into the lungs in this way appears to be very small. The symptoms are at first increased appetite, then colicky pains and mucous or dysenteric stools, with great prostration, irritation of the 3, running at the nose, a short cough, which is dry or accompanied by slight expectoration, and a white, silvery appearance of the tongue. These symptoms may sometimes continue for months, or even years, without the cause being suspected, until the recovery which ensues upon the removal of the offending wall-paper gives the clue to their cause. METALS. 607 When taken internally for a length of time a condition of tolerance may be induced in the case of arsenic, as well as in antimony. This is seen in the arsenic-eaters of Styria, who, beginning with small quantities, are gradually capable of taking larger and larger doses, until they can swallow at once, with safety, as much as five grains. In taking such doses as these they are careful not to take water with the arsenic, so that it is probably slowly absorbed from the stomach, and is, very possibly, rapidly evacuated. Dr. Craig Maclagan watched a noted arsenic-eater swallow his dose, and obtained from the urine which he afterwards passed a considerable quantity of the poison. By using the arsenic in this way, these people are said to undergo much greater exertion than usual without exhaustion, and to be able to ascend the steep Styrian hills without being affected with breath- lessness. Some, no doubt, die in the attempt to acquire the habit, but those who have once become accustomed to the drug appear to continue its use without deriving any harm from it, and, moreover, seem sturdy and vigorous, and live to an old age. After absorption into the blood, arsenic appears to some extent to modify tissue change. When a solution of arsenious acid is added to blood outside the body, it retards coagulation, prevents putrefaction, and con- serves the form of the red blood corpuscles. A very dilute arsenical solution also conserves the irritability of the excised nerve and muscle of the frog. Considerable doses of arsenic given for a length of time produce fatty degeneration of the liver and other organs, and cause the glycogen to disappear from the liver, so that puncture of the fourth ventricle no longer produces glycosuria. Minute doses of arsenic appear to increase the rapidity of the pulse. Larger doses diminish the pulse and blood-pressure. In frogs the heart is slowed, and finally stands still in diastole. This stoppage of the heart appears to be due to paralysis of the motor ganglia, as the muscular substance will still continue to contract upon direct irritation. In warm-blooded animals it appears to prolong the irritability of the heart, so that it will still continue to beat for many hours after the death of the animal. According to Kuntzer, this is due to retardation of the vital processes in the mammalian heart, so that it comes to resemble that of a cold- blooded animal. In animals arsenic has been found to diminish the blood- pressure from the beginning. This appears to be due partly to diminished activity of the heart, but chiefly to paralysis of the splanchnics allowing the abdominal vessels to dilate (p. 249). In frogs it produces apparent paralysis, but this appears rather due to diminished sensibility of the gray matter in the posterior cornua of the spinal cord than to real paralysis, for the nerves and muscles in this state are found to be still quite irritable, and although the animal is insensible to pinching, it can and does move when laid on its back. As, according to Schiff, the muscular sensations are conveyed in the white substance of the pos- terior columns, this would appear to be unaffected, while the gray substance which conveys sensations of pain is completely paralyzed (p. 151). In some cases of poisoning by arsenic, paralysis of one or more limbs occurs after the acute symptoms have passed off. It usually affects the extensors more than the flexors, and generally is temporary, though it may be permanent. 608 INORGANIC MATERIA MEDICA. The action of arsenic on the skin is peculiar. Ringer and Murrell noticed that in frogs poisoned by it the cuticle could be stripped off the whole body with the greatest readiness within a few hours after its administration. This condition was found by Nunn to depend upon softening of the protoplasm of the columnar layer of cells in the epider- mis, so that the cuticle remained attached to the dermis only by a few protoplasmic threads (Figs. 131 and 132). £T> Fig. 131.— Vertical section of the healthy epi- dermis of a frog, a, Columnar layer of cells. b, Malpighian layer, c, Intermediate layer. e, Corneous layer. /, Sheet of connective tissue forming boundary between dermis and epidermis. After Nunn. Fig. 132.— Vertical section of epidermis from a frog poisoned by arsenic, b, vacuole in the softened protoplasm of the columnar layer of cells. At a the protoplasm is more softened and the vacuoles enlarged so that the cells are attached to the dermis only by threads of protoplasm. After Nunn. Other epithelial structures are also affected, and Cornil has found fatty degeneration of the epithelium lining the alveoli of the lungs in animals poisoned by arsenic (Fig. 133). Arsenic is eliminated chiefly by the urine, and to a less extent by the bile, and slightly by the skin. Its elimination by the urine is very rapid. Fig. 188. — Section of lung, hardened in osmic acid, from guinea-pig poisoned by arsenious acid. The capillaries, v, project into the cavities of the alveoli, and are lull of red blood corpuscles. The protoplasm, a, of the cells is filled with fatty granules. The nuclei are well preserved. After Cornil. Uses. — Arsenic has been used externally as an application to can- cers, and forms the basis of most of the secret "cures" for this disease. The old recipe for this purpose consists of the following ingredients : — Arsenious acid, 2 drachms; cinnabar, 2 drachms; ashes of old leather, 8 grains; dragon's blood, 12 grains, made into a paste with water or saliva. METALS. 609 In applying a paste of this sort it is advisable that it should consist of at least one-fifth of arsenic, and that it should not be applied to too large an extent of surface at a time. Internally, arsenic is used for its local action on the intestinal canal as a tonic and astringent, for its action on tissue change, and as a tonic and anti-spasmodic in cases of nervous disease. In the stomach, small doses stimulate the appetite, and are useful in allaying pain and checking vomiting. It may be given in irritative dyspepsia, in gastralgia, heart- burn, in the vomiting of drunkards, and in gastric ulcer or cancer. It is also recommended by Ringer in cases of regurgitation of food unac- companied by nausea. It is very useful in cases of diarrhoea where the tendency comes on during or immediately after the ingestion of food, whether in adults or children. Arsenic is a powerful antiperiodic, nearly rivalling quinine ; it seems less serviceable than quinine in well-marked cases of ague, but is sometimes as good, or even better than it in the irregular malarious manifes- tations, such as headache, neuralgia, &c, which are known under the head of masked malaria. It is sometimes useful in chronic rheumatism and rheumatic gout, and in neuralgia of various sorts its effects are occasionally almost magical. It has been used, not only in tic and hemicrania, but in spasmodic nervous diseases, such as angina pectoris, chorea and epilepsy, whooping- cough and asthma. It is often very serviceable in hay fever, and in cases of spasmodic sneezing coming on after exposure to dust, or even without any apparent cause. It has been employed in chronic bronchitis with copious expectoration, and in ordinary catarrh without febrile dis- turbance. It appears to be very useful in the commencement of phthisis. Under its influence the author has seen consolidation of the lung, conse- quent on catarrhal pneumonia, clear up completely even in a subject having a very bad family history. Probable mode of action of Arsenic in Phthisis. The treatment of phthisis is so important that it may be advisable to discuss in a few words the probable mode of action of arsenic and hypo- phosphites in its early stages. It is now probable that this disease depends on the presence of a bacillus (B. tuberculosis, p. 90). In order that it should grow within the body, however, it is necessary that a suitable nidus should be present, and the different susceptibility to the disease of different individuals, or of the same individual at different times, probably depends on their liability to present a suitable nidus. The Bacillus tuberculosis differs from such bacilli as the B. anthracis in being of very slow growth, so that when it is cultivated artificially on a solid medium it takes about ten days before it succeeds in establishing itself and begins to grow. Consequently, when applied to an open wound, or when inhaled into the lungs of a healthy person, it does not, like the Bacillus anthracis, at once begin to multiply and produce disease in the organism, but it is usually removed by washing in the case of a wound, or by expectoration in healthy persons. But if its removal be interfered with it will produce disease. Thus, if instead of being 39 610 INORGANIC MATERIA MEDICA. applied to an open wound it be injected under the skin so that it cannot be removed by washing, it will, after a time, begin to grow, and produce tuberculosis, first local and then general. It is probable that the case is similar in the lungs. In the healthy lung it finds no nidus, and is removed by expectoration, but if a portion of the lung be consolidated by catarrhal pneumonia, the consolidated part probably affords a nidus to the bacillus, and the longer the consolidation lasts the greater the risk of bacilli finding entrance. In croupous pneumonia the exudation into the alveoli, consisting chiefly of fibrin with a few leucocytes, quickly breaks up and is absorbed, so that it is comparatively rarely followed by phthisis. But the proliferated epithelial cells which fill the alveoli of the lung in catarrhal pneumonia are much more resistant; they break down and are absorbed much more slowly, and hence a much longer time is given during which bacilli may find a nidus. The marked hereditary nature of phthisis is a curious point in a disease which we suppose to depend on the presence of a bacillus, and is a character in which it differs from such diseases as anthrax, ague, or relapsing fever, which are also due to foreign organisms. But the difference probably depends on the slow growth of the tubercle bacillus, which renders a prolonged undisturbed rest at the point where it enters the body neces- sary for its farther growth. Tlie disease is not hereditary, "but the predisposition to such morbid changes in the lungs as afford a nidus to the bacilli is hereditary. The more rapidly the effused products in pneumonia can be removed from the lung, the less chance have the bacilli of finding a nidus. It is probable that arsenic, which causes fatty degeneration of the normal epithelial cells lining the alveoli, also causes a similar degeneration of such cells when filling the alveolar cavities. By thus breaking them up and quickening their absorption, arsenic will lessen the risk of bacilli finding a nidus in them and converting catarrhal consolidation into phthisis. Probably the hypophosphites act in a similar way. If the patient should be in places where there are no tubercular bacilli, the con- solidation may persist for a long time without phthisis occurring, and hence one advantage of sea voyages in cases of recent consolidation. Mode of Administration. — In those cases where the local action of arsenic on the stomach and intestine is desired, it is best to give it in small doses before meals, but where the action of the drug on other organs of the body is desired, it should be administered immediately after meals. The symptoms which show that arsenic is beginning to produce its physiological effect, and that it is time to diminish the dose or cease its administration, are irritation of the eyes, the conjunctivae being some- what injected, and the patient showing a tendency to rub the eyes; or the digestive canal may be the first to show the effect of the drug, the appetite may fail, and colicky pains with a tendency to diarrhoea may appear before the eyes are affected. Either of these symptoms indicates that the drug should be discontinued, or the dose diminished. In skin diseases arsenic is used more frequently than any other internal remedy. As it increases metabolism in the cells of the epidermis (p. 608) it is contraindicated in acute cases. Its administration should METALS. 611 not be commenced while there is any active cutaneous inflammation, and it should be given until either the amendment begins, or the signs of conjunctivitis or gastric irritation appear. When these are noticed, the dose should be diminished until they become just perceptible, and the administration of the drug should be continued for some time after the eruption has disappeared, in order to prevent its recurrence. Acidum Arseniosum, U.S.P. and B.P. Arsenious Acid. As 2 3 ; 1 9 7'8. An anhydrous acid, obtained by roasting arsenical ores, and purified by sublimation. Characters and Tests. — Occurs in sublimed masses which usually present a stratified appearance caused by the existence of separate layers differing from each other in degrees of opacity, or as a heavy white powder. When slowly sublimed in a glass tube it forms minute brilliant and transparent octahedral crystals. It is sparingly soluble in water, and its solution gives with ammonio-nitrate of silver a canary-yellow precipitate insoluble in water, but readily dissolved by ammonia and by nitric acid. Sprinkled on a red-hot coal, it emits an alliaceous odor. Impurities. — Gypsum and chalk. Test. — It is entirely volatilized at a temperature not exceeding 400°. Four grains of it dissolved in boiling water with eight grains of bicarbo- nate of soda, discharge the color of 808 grain-measures of the volumetric solution of iodine. As 2 3 + 2H 2 + 41 = As 2 5 + 4HI. Dose. — ^ to -^ of a grain, in solution. Peepaeations of Aesenious Acid, u.s.p. Liquor Acidi Arseuiosi. Liquor Potassii Arsenitis. B.P. Liquor Arsenicalis 4 grains in 1 fluid ounce. " Arsenici Hydrochloricus 4 grains in 1 fluid ounce. Peepaeations of Arsenic Acid. Ferri Arsenias. Sodse Arsenias. " Arseniatis, Liquor. Liquor Potassii Arsenitis, U.S.P. ; Iiiquor Arsenicalis, B.P. SOLUTION OF AESE- nite of Potassium, U.S.P. ; Aesenical Solution, B.P. Fowlee's Solution. — Is a mixed solution of arsenite and carbonate of potash flavored with compound tincture of lavender. Contains 4 grs. arsenious acid in 1 fl. oz., B.P.; 1 in 100, U.S.P. Chaeactees. — A reddish liquid, alkaline to test-paper, and having the odor of lavender. Test. — After being acidulated with hydrochloric acid, it gives, with sulphu- retted hydrogen, a yellow precipitate, which is brightest when the arsenical solution has been previously diluted. Dose. — 2 to 8 minims. Use. — This is the preparation of arsenic most commonly employed. It may be given along with alkalies. Liquor Acidi Arseniosij U.S.P. ; Liquor Arsenici Hydrochloricus, B.P. SOLUTION of Aesenious Acid, U.S.P. ; HyDEOCHLOEic Solution of Aesenic, B.P. — A solu- tion of 1 part arsenious acid and 2 of hydrochloric in 100 of water, U.S.P.; 4 grs. with 6 min. of hydrochloric acid in 1 fl. oz. of water, B.P. 612 INORGANIC MATERIA MEDICA. Chaeactees and Tests. — A colorless liquid, having an acid reaction. Sulphu- retted hydrogen gives at once a bright yellow precipitate. Dose. — 2 to 8 minims. Use. — Some think it milder than the ordinary liquor. Garrod thinks not. It can he given along with perchloride of iron in solution, or with acids. Sodii Arsenias, U.S.P.; Sodse Arsenias, B.P. Arseniate OF Sodium, U.S.P.; or Soda, B.P. Na 2 HAs0 4 .7H 2 0; 311-9. Preparation. — By fusing arsenious acid with nitrate and carbonate of soda. The As 2 3 is oxidized by the nitrate to As 2 5 , which combines with the soda to form arseniate. Characters and Tests. — In colorless transparent prisms, soluble in water; the solution is alkaline, giving white precipitates with chloride of barium, chloride of calcium, and sulphate of zinc, and a brick-red pre- cipitate with nitrate of silver (arseniate), all of which are soluble in nitric acid. Dose. — ^ to ■§■ grain; of the dried salt -^ to -^ grain. Peepaeations. b.p. Liquor Sodae Arseniatis j 4 ^^^^ } 1 in 100, U.S.P. ; in 1 fl. oz. of water, B.P. Dose. — 5 to 10 minims. Action. — It acts like other preparations of arsenic, but does not irritate the stomach so much, and may be given in larger doses. In frogs it produces, like arsenious acid, paralysis of the brain and spinal cord, but is much less powerful (Ringer and Murrell). Uses. — It may be used in the same diseases as arsenious acid. It is perhaps one of the best remedies for neuralgia which we have. U.S.P. Arsenii Iodidum. Iodide OF Arsenic. Asl 3 ; 454*7. Preparation. — By gently warming arsenious acid and iodine together. Characters. — Glossy, orange-red, crystalline masses, or shining, orange-red, crystalline scales, gradually losing iodine when exposed to the air, having an iodine-like odor and taste and a neutral reaction. The aqueous solution has a yellow color, and on standing gradually decom- poses into arsenious and hydriodic acids. On passing hydrosulphuric acid through the solution a lemon-yellow precipitate is thrown down. If the salt be heated with diluted nitric acid, vapor of iodine will be given off. Use. — In skin diseases. Dose.— J- grain (0-008 Gm.). U.S.P. Liquor Arsenii et Hydrargyri Iodidi. SOLUTION OF Iodide of Arsenic and Mercury. Donovan's Solution. — Iodide of arsenic, 1 ; red iodide of mercury, 1 ; water up to 100. Characters. — A pale or orange-yellow solution, with a somewhat styptic taste. INCOMPATIBLES. — Solutions of opium or morphine. Uses. — In skin diseases, syphilis, rheumatism, and nocturnal pains. Dose. — 5 to 10 minims (0-3-0-6 cc). METALS. 613 ANTIMONY. Sb; 122. Antimony forms two classes of salts, antimonious and antimonic. In the former it is tri- and in the latter pent-atomic. General Sources. — It is chiefly found native in the form of the black antimonious sulphide, Sb 2 S 3 . General Reactions. — It is recognized by the orange-colored pre- cipitate which it gives with sulphuretted hydrogen in acid solutions. A characteristic reaction is the white precipitate which falls on throwing a strong solution of a salt of antimony, such as the chloride, into water and the change of the white into an orange color on the addition of sulphuret- ted hydrogen. A similar reaction occurs with salts of bismuth, but the white precipitate becomes black on the addition of sulphuretted hydrogen. A solution of chloride of antimony gives with potash or soda a white precipitate which only dissolves in large excess, and with ammonia a white precipitate insoluble in excess. But if tartaric acid be present the precipitate dissolves in a slight excess of potash or soda, and with ammo- nia only a slight precipitate is formed. General Actions of Antimony. — Salts of antimony probably com- bine with albumen, but in alkaline solutions they form no precipitate. They only form precipitates in acid solutions, and they consequently appear to exert an irritant action only on those parts of the animal body where they meet with a,n acid secretion, such as the orifices of the sweat- glands and the stomach. When applied to the skin the chloride of antimony destroys the cuticle, and acts as a powerful escharotic, produc- ing a deep slough and a slowly healing sore. The other preparations, however, instead of affecting the whole surface to which they are applied, produce inflammation in isolated spots, which, beginning with papules, proceeds to pustules resembling those of small- pox. A similar pustular irritation is sometimes noticed upon the fauces of persons who have been taking antimony for some time or have been poisoned by it. When taken internally, sniall doses produce little more than a feeling of warmth in the stomach and slightly increased dia- phoresis, but larger doses cause loss of appetite, nausea accompanied by enfeeblement of the circulation, and a feeling of great depression and weakness. Not only the secretion of sweat, but those of the mucous membranes, stomach, intestine, and respiratory passages, seem at the same time to be considerably increased. In still larger doses antimony produces vomiting, with great depression of the circulation, and relaxa- tion both of the voluntary and involuntary muscles. In large and poi- sonous doses it causes gastro-enteritis, with profuse diarrhoea and extreme collapse. The pulse is small and quick, the surface cold, and covered with clammy perspiration. There is great weakness and severe cramps of the extremities, and the symptoms somewhat resemble those of Asiatic cholera. Death may occur in this condition. It is some- times preceded by delirium and convulsions, and tonic or clonic convul- sive spasms. The treatment of antimonial poisoning consists in the administra- tion of tannin, and in some readily accessible form. The most easily obtained is a strong infusion of tea, and the tannin is more readily 614 INORGANIC MATERIA MEDICA. extracted from this by the addition of a small quantity of bicarbonate of soda. Infusions of oak bark or of cinchona may also be used if obtain- able. Milk and mucilaginous drinks may also be used. A diffusible stimulant should be given to counteract the collapse. The mode in which tartar emetic causes vomiting- has given rise to considerable dispute. It acts as an emetic even when injected into the veins, as well as when given by the stomach, and it was found by Magendie that when the stomach of an animal was excised, and a pig's bladder filled with liquid attached to the lower end of the oesophagus, an injection of tartar emetic into the circulation caused movements of vomit- ing, and the contents of the bladder were expelled just as if the stomach had been in situ. This experiment seemed to prove not only that the act of vomiting was independent of the movements of the stomach itself, but also that tartar emetic caused vomiting by acting upon the vomiting centre, and not upon the stomach. The objection, however, has been raised that the action of the drug upon the vomiting centre is not direct, but reflex ; and it has been urged that, although the stomach was removed, the antimony might still be carried by the circulation to the oesophagus and intestines, and by there causing irritation might produce reflex vom- iting. This seems improbable, especially as the antimonial salts have a comparatively slight action on organs having, like the oesophagus and intestines, an alkaline reaction, instead of an acid one, as the stomach has. It is probable, then, that tartar emetic does produce vomiting by its direct action on the vomiting centre in the medulla oblongata, but prob- ably this direct action is not the only way in which it stimulates the vomiting centre — it also produces a reflex action upon it through the stomach. For it has been found that even when tartar emetic is injected into the veins, it is eliminated by the mucous membrane of the stomach (p. 5o), and may thus act upon that organ in the same way as when introduced directly into it. If its emetic action be due in any great measure to irritation of the stomach, one would expect that a smaller dose would be found sufficient to produce vomiting, when introduced directly into the stomach, than when injected into the veins, for in the former case the whole of it will come in contact with the stomach and will do so at once ; in the latter case only a fraction of the quantity injected into the veins will reach the stomach, and some time will be required before it accumulates in the gastric mucous membrane sufficiently to cause irritation. This is exactly what is found by experiment, and vomiting is produced more quickly, and by a smaller dose, when the drug is introduced into the stomach, than when injected into the veins, just as we should expect to be the case if its emetic action were due in con- siderable measure to its action upon the stomach itself. This view is also supported by another experiment, for after the nervous channel by which impressions are conducted from the stomach to the vomiting centre is destroyed by section of the vagi, double the dose of the drug is required in order to produce vomiting. It may then be concluded that antimony acts chiefly as an emetic by irritating the stomach, and thus exciting the vomiting centre reflexly, but that it also acts directly on this centre when conveyed to it by the blood (p. 326). METALS. 615 After its absorption into the blood, antimony diminishes the blood- pressure, and slows the pulse. When applied directly to the heart of a frog, it first increases, then slows, and finally arrests its pulsations in diastole. This action appears to be chiefly due to paralysis of the car- diac muscle itself, and possibly also to the effect upon motor ganglia. The effect of antimony upon the circulation appears to depend partly upon the direct action of the drug upon the heart and vessels, and partly on its reflex action upon them through the nerves of the stomach. In warm-blooded animals the pulse becomes quicker as the feeling of nausea increases, and, after the vomiting, again falls nearly to the normal. Its volume is, at the same time, diminished. After the nausea has ceased, the pulse again becomes quicker, and after this secondary acceleration has reached a greater or less height, according to the dose, it again sinks to the normal. As the primary acceleration during the stage of nausea ceases with vomiting, it is probably to be attributed to reflex irritation of the accel- erating centres, or reflex depression of the vagus through the gastric nerves, whereas the cause of the secondary acceleration is more probably to be sought in diminished power of the vagus nerve itself. The blood- pressure sinks constantly, from the very beginning, and this sinking is probably due to diminished power of the cardiac pulsations. The temperature in the extremities appears to be diminished during the stage of nausea, owing to the smaller amount of blood going to them. As less blood reaches the surface in this condition, there is less opportunity afforded for its being cooled by contact with the atmosphere, and the temperature in the body gradually rises, even above the normal. When the spasm of the vessels in the extremities relaxes, they also become warmer than normal. As the effects pass off, the temperature sinks to the normal, or below it. The respiration is first increased, and then diminished. Large doses of antimony affect the spinal cord both in cold and warm-blooded animals. It appears to paralyze, after, perhaps, slightly exciting both the sensory and motor tracts of the spinal cord, and as this paralysis appears in frogs while the heart still continues to beat, it must be due to the direct action of the drug upon the nervous system itself, and not to its indirect action through the circulation. The motor and sensory nerves appear also to be paralyzed. The muscles are weakened (p. 124). When given for a length of time, antimony seems to produce fatty degeneration of various organs. The action of antimony upon the skin in frogs is even more rapid than that of arsenic, and differs from it in this respect, that the softening does not affect the cells of the columnar layer only, but extends to those of the intermediate layer (Fig. 134). In consequence of this, the cuticle does not merely become detached from the dermis and peel off in strips as in poisoning by arsenic, but, the cells of the epidermis becoming detached from each other, the cuticle becomes converted into a soft jelly- like mass which can be scraped or brushed off. Tartar emetic appears to be eliminated by the mucus of the stom- ach and alimentary canal, by the bile, and by the kidneys. Its action 616 INORGANIC MATERIA MEDICA. upon the renal secretion is somewhat uncertain. It appears to increase urea, uric acid, and pigment, and to diminish the water and the chloride of sodium, probably by increasing the perspiration. Uses. — The local uses of antimony will be considered under the special preparations. Fig. 134.— Vertical section of epidermis from a frog poisoned by antimony, a, Columnar layer in which large cavities are formed. &, Columnar ceils in which the reduced protoplasm is drawn into processes, c, Spaces in the intermediate layer, d, Light lines between cells indicating a soften- ing and separation of cells. After Xunn. When antimony is given internally for its action on the system generally, tartar emetic is the preparation usually employed, but the other preparations of antimony have a similar action when given in appro- priate doses. It can be used for its emetic action, nauseant and depressant action, or diaphoretic action. As an emetic it has been employed in cases of croup, in order to cause expulsion of the false membrane ; but for this purpose other emetics, such as ipecacuanha, alum, or sulphate of zinc, are now more generally employed, as they do not cause so much depression. It has also been used with considerable success to cut short an attack of intermittent fever, either alone or combined with a purga- tive. Indeed in cases where malarial poisoning has been intense, quinine sometimes proves ineffectual unless preceded by the administration of an emetic and purgative. It has sometimes been injected into the veins to produce vomiting, in cases of obstruction of the oesophagus, as, for exam- ple, by a piece of meat firmly lodged in it, and to cause expulsion of a biliary calculus lodged in the gall-duct, by the pressure from behind which the movements of vomiting produce, along with the relaxation of the muscular fibres of the gall- duct itself. When large doses are administered several times, what is termed tolerance of the drug sets in, and it no longer produces vomiting. It has been used in this way in pneumonia, but the plan is now rarely fol- lowed. How this tolerance is produced is not at present understood. It is not improbable that it may be caused by the irritant action of the first few doses upon the stomach arresting the secretion of the acid juice and producing a condition similar to that which occurs in fever. In this condition, subsequent doses of the tartar emetic, meeting with no acid, will have but a feeble action upon the stomach. In cases of obstinate constipation it has been used along with sulphate of magnesia. As a nauseant it has been given to relax the cervix uteri in labor ; in acute inflammations, e.g., in acute orchitis, where the emetic is first given, and nausea is kept up by a continued administration of smaller doses, and also in pericarditis, pneumonia, pleurisy, peritonitis, METALS. 617 meningitis, bronchitis, and hepatitis, as well as in acute rheumatism. As an expectorant it is used in bronchitis. The cases in which it is especially serviceable are those in which there is great congestion and much dyspnoea, with little or no secretion, as shown by loud, sibilant rales over the chest, the pulse being full, and the face flushed, with a tendency to lividity. It has also been given to check haemoptysis when there was much excitement of the circulation. In nervous diseases, attended with much excitement, such as certain cases of insanity, delirium tremens, and puerperal convulsions, it is of use. In the delirium of fever, it has been highly recommended by Dr. Graves, in combination with opium, as a means of producing sleep. Where the delirium is furious the tartar emetic must be given in full, and the opium in small doses ; while if the delirium is milder and the sleeplessness great, the opium dose must be increased and that of the tartar emetic diminished. The same treatment may be adopted in the delirium and sleeplessness of delirium tremens. For its diaphoretic action, antimony has been used to arrest com- mencing inflammations, such as catarrh, and to check febrile conditions. For this purpose it is not unfrequently given as tartar emetic in doses of 3^ grain frequently repeated, or as James's powder. In acute dropsy it appears to be occasionally useful, especially as a diaphoretic, in combina- tion with bitartrate of potash and squills. Peepaeations containing Antimony, u.s.p. B.P. Antimonii et Potassii Tartras. Antimonii Oxidum. Oxidum. Antimonmni Nigrum. " Sulphidum. " Sulphuratum. " " Puriflcatum. " Tartaratum. Sulphuratum. Liquor Antimonii Chloridi. Pilulae Antimonii Compositse. Pilula Hydrargyri Subchloridi Composita. Pulvis Antimonialis. Pulvis Antimonialis. Syrupus Scillse Compositus. Unguentum Antimonii Tartarati. Vinum Antimonii. Vinum Antimoniale. Antinionii Sulphidum, U.S.P. ; Antimouium Nigrum, B.P. Sulphide of Antimony, U.S.P. ; Black Antimony, B.P. — Native sulphide of antimony, Sb 2 S 3 ; 336 ; purified from siliceous matter by fusion, and afterwards reduced to fine powder. Characters and Tests. — A grayish-black crystalline powder. It dissolves almost entirely in boiling hydrochloric acid, evolving sul- phuretted hydrogen. H 2 added to the solution precipitates a white oxychloride. Peepaeations in which Black Antimony is used. u.s.p. • B.P. Antimonii Sulphidum Puriflcatum. Antimonium Sulphuratum. Liquor Antimonii Chloridi. This is the ore from which the other compounds are prepared. It seems to be inert, and is not used internally. U.S.P. Antimonii Sulphiduni Puriflcatum. Purified Sul- phide of Antimony. Sb 2 S 3 ; 336. 618 INORGANIC MATERIA MEDICA. Preparation. — The crude sulphide is obtained in very fine powder by elutriation, then digested with ammonia to remove arsenic, washed and dried. Characters. — A dark gray powder, odorless and tasteless, and insoluble in water or alcohol. It fuses at a temperature below red-heat. When boiled with ten parts of hydrochloric acid it is nearly all dis- solved, hydrosulphuric acid being evolved. The solution when added to water yields a white precipitate which is soluble in a solution of tartaric acid. After separation of the precipitate by filtration, the filtrate gives an orange-red precipitate with hydrosulphuric acid. Impurities. — Other sulphides and arsenic. Tests. — If 2 Gm. of the salt be mixed and cautiously ignited in a porcelain crucible with 8 Gm. of pure nitrate of sodium, and the fused mass boiled with 25 Gm. of water, there will remain a residue which should be white or nearly so, and not yellowish or brownish (absence of other metallic sulphides). On boiling the filtrate with an excess of nitric acid until no more nitrous vapors are evolved, then dissolving in it 0*1 Gm. of nitrate of silver, filtering again if necessary, and cautiously pouring a few drops of water of ammonia on top, not more than a white cloud, but no red nor reddish precipitate should appear at the line of contact of the two liquids (absence of more than traces of arsenic). Preparation. Antimonium Sulphuratum. Antimonium Sulphuratum, U.S. P. and B.P. SULPHURATED Antimony. U.S. P. Chiefly antimonious sulphide, Sb 2 S 3 ; 336; with a very small amount of antimonious oxide. B.P. Sulphide of antimony, Sb 2 S 3 ; 336 ; with a small and variable amount of oxide of antimony, Sb 2 3 . Preparation. — By boiling black sulphide with caustic soda the sul- phide is partly converted into oxide and partly unites with sodium, forming sulphantimonite and antimonite of sodium. Sulphide of Sulphantimonite Oxide of Antimony. Soda. of Sodium. Antimony. 2Sb 2 S 3 + 6NaHO = 2Na 3 SbS 3 + Sb 2 3 + 3H 2 0, and Oxide of Antimonite Antimony. Soda. of Sodium. Sb 2 3 + 6NaIIO = 2Na 3 Sb0 3 + 3H 2 0. These antimony compounds are soluble in caustic soda, but when this is neutralized they are precipitated, the greater part of them being decomposed and the Sb 2 3 reconverted into Sb 2 S 3 . Sulphantimonite Sulphuric Sodium Sulphate of of Sodium. Acid. Sulphate. Antimony. 2Na*SbS 8 + 3II 2 S( ) 4 = 3Na 2 S0 4 + Sb 2 S 3 + 3II 2 S. Antimonite Of Sodium. 2Na 3 Sb0 3 + 3H 2 S0 4 = 3Na,S0 4 + Sb 2 3 + 3H 2 0. METALS. 619 Characters and Tests. — U.S. P. A reddish-brown, amorphous powder, odorless and tasteless, and insoluble in water and in alcohol. When heated with 12 parts of hydrochloric acid, it is nearly all dissolved with evolution of hydrosulphuric acid. The residue, after having been washed and dried, burns, on the application of a flame, with the charac- teristic odor of sulphur, and should leave not more than a scanty ash. On dropping a solution of sulphurated antimony in hydrochloric acid into water, a white precipitate is produced, which, after washing and drying, should weigh not less than 85 per cent, of the sulphide. The liquid filtered from this precipitate yields an orange-red precipitate with hydrosulphuric acid. B.P. An orange-red powder, readily dissolved by caustic soda, also by hydrochloric acid with the evolution of sulphuretted hydrogen and the separation of a little sulphur. Boiled in water with acid tartrate of potash it dissolves, and the resulting solution is precipitated orange-red with sulphuretted hydrogen. Distilled water boiled with sulphurated antimony, filtered and acidu- lated with hydrochloric acid, should be rendered not more than slightly opalescent by test solution of chloride of barium (limit of sulphate). Dose. — 1 to 5 grains. Peepaeations. u.s.p. Pilulae Antimonii Composita (Plummer's pill) (p. 588) 1 part in 4. B.P. Pilula Hydrargyri Subchloridi Composita (Plummer's pill) (p. 588) 1 part in 5. The oxide it contains is probably the active part, and as this is variable the action is rather uncertain. Liquor Antimonii Chloridi, B.P. SOLUTION OF CHLORIDE OF Antimony. Preparation. — By boiling black antimony with hydrochloric acid, Sb 2 S 3 + 6 HC1 = 2 Sb01 3 + 3 H 2 S. Characters and Tests. — A heavy liquid usually of a yellowish- red color. A little of it dropped into water gives a white precipitate, and the filtered solution lets fall a copious deposit on the addition of nitrate of silver. If the white precipitate formed by water be treated with sulphuretted hydrogen it becomes orange-colored. The specific gravity of the solution is 1*47. One fluid drachm of it mixed with a solution of a quarter of an ounce of tartaric acid in four fluid ounces of water, forms a clear solution, which, if treated with sulphuretted hydro- gen, gives an orange precipitate, weighing, when washed and dried at 212°, at least 22 grains. Peepaeation in which Solution of Chloeide op Antimony is used. Antimonii Oxidum. Uses. — Is a powerful caustic — sometimes applied to cancers and to poisoned wounds. Antimonii Oxidum, U.S.P. and B.P. Oxide of Antimony. Sb 2 3 ; 288. 620 INORGANIC MATERIA MEDICA. Preparation. — By pouring solution of chloride of antimony into water and treating the precipitate of oxychloride with sodium carbonate. Chloride of Oxychloride of Hydrochloric Antimony. Antimony. Acid. 12SbCl 3 + 15H 2 =2SbCl 3 5Sb 2 3 + 30HC1. Oxychloride of Carbonate Oxide of Sodium Antimony. of Sodium. Antimony. Chloride. 2SbCl 3 ,5Sb 2 3 + 3Na 2 C0 3 = 6Sb 2 3 + 6NaCl + 3C0 2 . Characters and Tests. — A grayish-white powder, fusible at a low red-heat, insoluble in water, but readily dissolved by hydrochloric acid. The solution, dropped into distilled water, gives a white deposit, at once changed to orange by sulphuretted hydrogen. It dissolves entirely when boiled with an excess of the acid tartrate of potash. Dose. — 1 to 4 grains. Preparations, u.s.p. and b.p. dose. Puivis AntimoniaUs. Antimonial powder or James's powder (one part of oxide of antimony with two of phosphate of lime)... 3-10 grs. Uses. — Oxide of antimony may be used for the same purposes as tartar emetic, but it is not soluble in water, and it depends very much on the state of the stomach how much of it will be dissolved. It is there- fore less certain in its action than tartar emetic, and the latter is conse- quently to be preferred. In consequence of its insolubility it is said to be slower and milder than tartar emetic, but this advantage is more than counterbalanced by its uncertainty. James's powder is given as an antipyretic in fever and rheumatism. It is also given in chronic skin diseases along with mercury. Antimonii et Potassii Tartras, U.S. P.; Antimoiiium Tar- taratum, B.P. Tartrate of Antimony and Potassium, U.S.P.; Tartarated Antimony, B.P. 2KSbOC 4 H 4 6 .H 2 0; 664, U.S.P.; KSbC 4 H 4 7 .H 2 0, B. P.— A tar- trate of potash and antimony. Preparation. — By boiling acid tartrate of potash and oxide of anti- mony together, 2KHC 4 H 4 6 + Sb 2 3 = 2K(SbO)C 4 H 4 6 + HO. Characters and Tests. — In colorless transparent crystals exhibit- ing triangular facets, soluble in water, and less so in proof spirit. It decrepitates and blackens upon the application of heat (tartrate). Its solution in water gives with hydrochloric acid a white precipitate, soluble in excess, and which is not formed if tartaric acid be previously added. Dose. — As a diaphoretic, -^ to -jt of a grain; as an emetic, 1 to 2 grains. Of the wine, as a diaphoretic, 10 to 40 min.; as an emetic for children, \ to 1 fl. dr., repeated frequently. Preparations, u.s.p. DOSE. Syrupus Scilhe Compositus 5 min.-l fl. dr. vimim Antimonii. Wine of Antimony 4 parts in 60 of water and stronger white wine up to 1000. B. P. STRENGTH. Unguentam Antimonii Tartarati 1 part in 5. | With simple ointment.) \ inum Antimoniaie. Antimonial Wine 2 gr. in 1 fl. oz. of sherry. METALS. 621 Use. — This preparation of antimony is readily soluble, and as the proportion of the dose administered which actually takes effect is more constant than that of the other preparations of antimony, it has gradually displaced them. For its uses vide p. 616. Tartar emetic ointment has been used as a counter-irritant in cases of neuralgia, paralysis of children, enlarged joints, acute meningitis, laryngitis, acute bronchitis, whooping-cough, phthisis, asthma, angina pectoris, and subacute ovaritis. For many of these purposes the appli- cation of iodine preparations is now preferred. BISMUTH. Bi; 210. Bismuth forms three classes of compounds in which it is bitri- and quinqui-valent respectively. General Action. — The soluble salts of bismuth, such as the citrate of bismuth and ammonia, when given in large doses have an action like that of antimony or arsenic and cause gastro-enteritis with fatty degen- eration of the liver. Small doses of soluble preparations, or larger doses of sparingly soluble preparations, have a sedative effect on the stomach like that of minute doses of arsenic. The subnitrate is so sparingly solu- ble that its utility in gastric catarrh is probably due to its mechanical action, like charcoal (p. 459) or binoxide of manganese. General Sources. — It is found native in the metallic state. General Reactions. — It is distinguished by the white precipitate which falls on throwing a solution of the nitrate or chloride into water, and the blackening of this by sulphuretted hydrogen. Geneeal Peepaeation of Salts of Bismuth. Salt. Prepared from By Subnitrate, U.S.P. and B.P. Bismuth. Dissolving in nitric acid, throwing the solution into a large quantity of water, collecting and drying the precipitate. Subcarbonate, U.S.P. \ Carbonate, B.P. / Do. Dissolving in nitric acid, evaporat- ing to a small bulk and adding to solution of ammonium carbonate. Oxide, B.P. Subnitrate. Boiling with solution of soda. Citrate, U.S.P. Do. Boiling with citric acid and washing with a large quantity of water, when insoluble citrate is formed. Solution of citrate of bismuth and ammo- nia, B.P. Bismuth. Dissolving in nitric acid as for sub- nitrate, evaporating to a small bulk, adding citric acid, and add- ing ammonia until the precipitate of citrate is redissolved and the liquid is neutral or slightly alka- line. Citrate of bismuth and ammonia, U.S.P. Citrate of bismuth. Mixing the citrate to a smooth paste with water and adding ammonia until it is dissolved and the liquid is neutral or faintly alkaline. 622 IXOKGANIC MATERIA MEDICA. Uses. — Subnitrate of bismuth is used under the name of Spanish or pearl white to whiten the complexion, and as a dusting powder, lotion, or ointment to chapped nipples and hands, abraded ' surfaces and chronic oozing from the skin, as eczema, in order to take up moisture and allay smarting and itching. It has also been employed externally as an application in scaly dis- eases, and in intertrigo. From its power of diminishing the irritability of mucous membranes it was applied by Ferrier, along with morphia in the form of a snuff, to arrest nasal catarrh, and has been used as an injec- tion in ozoena, leucorrhcea, and gonorrhoea to diminish the irritability. It is applied as a local sedative to diminish the pain, nausea or vomiting in irritable dyspepsia, and to lessen the irritability of the intestine in diarrhoea and dysentery. It is very serviceable, either alone or com- bined with lime or alkalis in the gastro-intestinal catarrh caused by cold, which is commonly known as cold in the stomach, as well as in the same affection occurring in children at the period of dentition. It is useful in pyrosis, gastralgia and vomiting, whether the vomiting be from ulcer of the stomach or other causes. It acts remarkably well in the indigestion and pain in the stomach caused by the use of alcohol. In such cases it is best given with a little magnesia, about ten grains of the subnitrate with an equal quantity of magnesia or its carbonate. The carbonate of bismuth is more soluble in the gastric juice than the subnitrate, and is supposed to be more powerful, and the same advan- tage, if advantage it be, is possessed by the citrate of ammonia and bis- muth. My own experience leads me to prefer the less soluble subnitrate to either of the other preparations. B.P. Bismutlmm. Bismuth. — A crystalline metal. As met with in commerce it is generally impure. Preparation. — Bismuthum Purificatum. B.B. Bismuthum Purificatum. Purified Bismuth. Preparation. — By fusing with nitrate of potash. Characters. — A crystalline metal of a grayish-white color, with a distinct roseate tinge. Specific gravity 9-83. Dissolved in a mixture of equal volumes of nitric acid and distilled water, it forms a solution which by evaporation yields colorless crystals, that are decomposed on the addi- tion of water, giving a white precipitate. Impurities. — Iron and copper. Test. — If the mother liquor from which the crystals have been sepa- rated be added to solution of carbonate of ammonia, the precipitate formed and the solution are free or nearly free from color. Preparations containing Bismuth. r.s.p. b.p. Bismuthi Carbonas. Bismuthi Carbonas. Citras. " Subnitras. et Ammonii Citras. Liquor Bismuthi et Amnionic Citratis. " Citratis Liquor. Trochisci Bismuthi. " Subnitras. Bismuth! Subnitras, U.S. P. and B.P. Subnitrate of Bis- muth. BiON0 3 .II 2 0; 306, U.S.P.; BiN0 4 .H 2 0, B.P. METALS. 623 Characters and Tests. — A heavy white powder in minute crys- talline scales, blackened by sulphuretted hydrogen ; insoluble in water, but soluble in nitric acid mixed with half its volume of distilled water, forming a solution which poured into water gives a white precipitate. It forms with sulphuric acid diluted with an equal bulk of water a solution which is blackened by sulphate of iron (nitrate). The nitric acid solution gives no precipitate with diluted sulphuric acid (no lead) nor with solu- tion of nitrate of silver (no chloride). Impurities. — Lead, nitrates, chlorides. Dose. — 5 to 20 grains. Peepaeation. b.p. dose. Trochisci Bismuthi, 2 grains in each lozenge 1 to 6 lozenges. Bismuthi Subcarbonas, U.S. P.; Bismuthi Carbonas, B.P. SUBCARBONATE OF BlSMUTH, U.S. P. ; CARBONATE OF BlSMUTH, B.P. (BiO) 2 C0 3 .H 2 ; 530, U.S.P.; 2(Bi 2 C0 5 ).H 2 0, B.P. Characters and Tests. — A white powder, blackened by sulphu- retted hydrogen ; insoluble in water, but soluble with effervescence in nitric acid. The solution gives the reactions of bismuth. Impurities. — Nitrate. Test. — When added to sulphuric acid colored with sulphate of indigo the color of the latter is not discharged. Dose. — 5 to 20 grains. B.P. Liquor Bismuthi et Animonige Citratis. SOLUTION OF Citrate of Bismuth and Ammonia. Characters. — A colorless solution with a saline and slightly metallic taste. Neutral or slightly alkaline to test paper ; mixes with water without change. It gives the reactions of ammonia and bismuth. One fluid drachm contains 3 grains of oxide of bismuth. Dose. — J to 1 fluid drachm. U.S.P. Bismuthi Citras. Citrate of Bismuth. BiC 6 H 5 7 ; 399. Characters. — A white amorphous powder, permanent in the air, odorless and tasteless, insoluble in water or alcohol, but soluble in water of ammonia. Uses. — Not given internally, but used to prepare the solution with ammonia. Preparation. — Bismuthi et Ammonii Citras. U.S.P. Bismuthi et Ammonii Citras. ClTRATE OF BlSMUTH and Ammonium. Characters. — Small, shining, pearly or translucent scales, becoming opaque on exposure to air, odorless, having a slightly acidulous and metallic taste, and a neutral or faintly alkaline reaction. The aqueous solu- tion of the salt gives the reaction of bismuth, of ammonia and of a citrate. Dose. — 2 to 4 grains. Uses. — The solution of bismuth and ammonia, B.P., and the soluble salt, U.S.P., are more astringent and irritant in their action than the insoluble subnitrate, oxide or carbonate. They may be used as astrin- gents, but are inferior to the insoluble preparations as a means of allay- ing irritation. 624 INORGANIC MATEEIA MEDICA. CHAPTER XXVIII. Class VIII. Group I. Iron, Nickel, Cobalt, Manganese. FESBTJM; IKOX ; Fe ; 55-9. Metallic iron in the form of fine, bright, and non-elastic wire. Iron forms ferrous salts in which it is bivalent, e.g., FeCl 2 or FeS0 4 , and ferric, in which it is either trivalent or quadrivalent. Ferric chlo- ride may be regarded as FeCl 3 or as Fe 2 Cl 6 , in which each of two atoms of quadrivalent iron have one affinity saturated by union with each other, and the other three by chlorine, Cl 3 — Fe — Fe — Cl 3 . General Sources. — It is found native in the metallic state, and also as oxide, sulphide, chloride, carbonate, phosphate, sulphate, and arseniate. It is obtained from its ores by smelting with coke and clay or limestone. General Reactions. — These are shown in the accompanying table. The reactions most generally mentioned in the pharmacopoeias are those with ferrocyanide and ferricyanide of potassium. It is to be remembered that a preparation of iron containing it in both the ferrous and ferric condition, or which, by its decomposition, yields iron in these two states, gives a precipitate with both of these reagents. The arseniate of iron, B.P., magnetic oxide, and the citrate of iron and quinine are exam- ples of this. Gexeeal Reactions of Ieon Salts. Reagent. Ferrous Salts. Ferric Salts. Hydrogen sulphide. No precipitate. White precipitate of sulphur (the ferric are reduced to ferrous). Ammonium sulphide. Black precipitate. Black precipitate Caustic alkalis and ammonia. Nearly white precipitates of ferrous hydrate, rapidly becoming green, and then brown. Foxy-red precipitates of ferric hydrate. Carbonates of ditto. Whitish precipitate of fer- rous carbonate which changes like the hydrate. Fox3 T -red precipitates. Car- bonic acid escapes. Potassium ferrocy- anide Nearly white precipitate, be- coming blue on exposure. Deep blue precipitate (Prus- sian blue) * Potassium ferricy- anide. Deep blue precipitate. No precipitate. Dark colora- tion. Tincture of galls. Intense black. * With the tartrate of iron and ammonia (U.S.P.) no color nor precipitate is pro- duced unless the solution is acidulated with hydrochloric acid. METALS. 625 General Impurities. — Zinc, copper, and fixed alkalis may be present in its salts. Ferrous salts may be present as impurities in ferric and vice versa. Tests. — The test used for the chloride in the U.S. P. is as follows: — If the iron be completely precipitated from a solution of the salt by an excess of water of ammonia the filtrate should not yield either a white precipitate (absence of zinc) or a dark-colored precipitate with hydro- sulphuric acid (absence of copper), nor should it leave a fixed residue on evaporation and gentle ignition. The absence of ferrous salts as impu- rities in ferric is ascertained by their giving no precipitate with ferricya- nide of potassium. The absence of ferric salts as an impurity in ferrous is ascertained by the precipitate not being blue at first, but nearly white, and only becoming blue on exposure. General Preparation of Salts of Iron. Ferrous Sulphate (p. 629). Dried Sulphate (p. 630) Precipitated, U.S.P., or Granulated, B.P., (p. 630). Carbonate (Saccha- rated) (p. 630). Do. (Mistura Ferri Composita) (p. 630). Ferric Tersulphate, U.S.P. (p. 631). " Sulphate, B.P. (p. 631). " Subsulphate (p. 631). " Oxide (p. 631). Do. (Hydrated, U.S.P., Humid, B.P.) (p. 631). Do. Hydrated, B.P. (p. 632). " Do. Magnetic (p. 632). Reduced iron (p. 632). 40 Prepared from Iron. Ferrous sulphate. Ferrous sulphate. Do. Do. Do. Ferric sulphate. Do. Do. Do. and ferrous sul- phate. Ferric oxide. By Dissolving in sulphuric acid. Heating to drive off water of crys- tallization. Pouring an aqueous solution into spirit. Decomposing (by sodium bi-carbonate, U.S.P.) , (by ammonium carbonate, B.P.), and mixing with sugar. Decomposing by potassium carbonate and mixing with myrrh, &c. Adding sulphuric acid and oxidizing by heating with nitric acid. (6Fe S0 4 + 3H 2 S0 4 + 2HN0 3 = 3Fe 2 (So 4 ) 3 + 4H 2 + N 2 2 ). Do. using too little sulphuric acid to form tersulphate. Mixing with magnesia and water, U.S.P. Pouring the diluted solution into solu- tion of soda, B.P. Pouring the diluted solution into solu- tion of soda, B.P. ; and drying below 212°. Pouring the diluted solution into solu- tion of soda, B.P. Passing hydrogen over it while heated (Fe 2 3 + 6H = F 2 + 3H 2 0). 626 INORGANIC MATERIA MEDICA. General Preparation of Salts of Iron — {continued). Ferric chloride (p. 633). " Nitrate (p. 634). " Acetate (Tinc- ture of, B.P.) (p. 633). " Do. (Solution of, U.S.P.) (p. 633). " Citrate (p. 636). Tartrate of iron and potassium, U.S. P. (Ferrum Tartratum, B.P.) (p. 635). Tartrate of iron and ammonia (p. 635). Citrate of iron and ammonia (p. 635). Citrate of iron and quinine (p. 636). Citrate of iron and strychnine (p. 636). Sulphate of iron and ammonia (p. 637). Ferrous Lactate (p. 637). Ferrous Oxalate (p. 637). Prepared from Iron. Iron. Ferric sulphate. Do. Tersulphate. Do. (Tersulphate). Persulphate. Do. Do. Do. and sulphate of quinine. Ferric sulphate and strychnine. Ferric sulphate and ammonium sulphate. Iron. Ferrous sulphate. Ferrous Iodide (p. Iron. 637). By Dissolving in hydrochloric acid and oxidizing by nitric acid. (3Fe 2 + 12HC1 = 6FeCl 2 + 12H — 6FeCl 2 + 6HC1- N 2 2 ). Dissolving in nitric acid (Fe 2 -f 8HN0 3 Fe 2 (N0 3 )6 N 2 2 ). Decomposing an alcoholic solution of acetate of potash, by a solution of ferric sulphate and separating the potassium sulphate by filtration. Precipitating ferric oxide by ammonia, washing and dissolving in glacial acetic acid, and diluting to the neces- sary strength. Precipitating oxide by ammonia, wash- ing and dissolving in citric acid. This forms the Liquor Ferri Citratis, U.S.P. Ferri Citras is prepared by evaporation of the Liquor under 60° C. Precipitating ferric oxide by ammonia, washing and mining with acid tar- trate of potash. Do. using tartaric acid and tartrate of ammonium in place of acid tartrate of potash. Do. using citric acid and ammonia. Precipitating ferric oxide and quinine by ammonia and dissolving it in citric acid. Precipitating ferric oxide by ammonia and dissolving it along with strych- nine in citric acid. Heating them together. Dissolving in lactic acid. Precipitating a solution with oxalic acid (ferrous oxalate is very slightly soluble). Heating with iodine and water. (The completion of the process is recog- nized by the brown color of the iodine disappearing and the froth becoming white). METALS. 627 General Preparation op Salts of Iron — (continued). Prepared from By Ferrous Iodide, Syrup Iron. Same as ferrous iodide, and then adding of (p. 638). sugar. " Bromide (Syrup Do. Same as syrup of iodide, using bromine of) (p. 638). instead of iodine. Arseniate of iron (p. Ferrous sulphate, ar- Mixing a solution of arseniate and ace- 638). seniate of soda, and tate of soda with one of ferrous sul- acetate of soda. phate. If arseniate of soda alone were used, free sulphuric acid would be formed, which would react on the arseniate 3FeSo 4 + 2Na 2 HAs0 4 ■= Fe 3 As 2 8 + 2Na 2 S0 4 + H 2 S0 4 . To avoid this acetate of soda is added. The sulphuric acid combines with the soda and sets free acetic acid which has no action on the arseniate of iron. 3FeS0 4 + 2Na 2 HAs0 4 + 2NaC 2 H 3 2 = Fe 3 As0 8 + 3Na 2 S0 4 + 2HC 2 H 3 2 . Phosphate of iron Ferrous sulphate, The same process as in the prepara- (p. 638). phosphate of soda, tion of arseniate. The reactions are and acetate of soda. similar. 3FeS0 4 + 2Na 2 HP0 4 + 2Na C 2 H 3 2 = Fe 3 P 2 8 + 3NaS0 4 + 2H C 2 H 3 2 . Pyrophosphate of Citrate of iron. Decomposing solution by solution of iron (p. 639). sodium pyrophosphate. Hypophosphite of Ferrous sulphate. Decomposing by hypophosphite of cal- iron (p. 639). cium when ferrous hypophosphite is precipitated, but on evaporation becomes ferric. Valerianate of iron Ferric sulphate. Decomposing by valerianate of soda. (p. 639). General Action op Iron Salts. — Iron differs from most of the other heavy metals in forming a normal constituent of the animal body, so that it may be regarded as a food as well as a medicine. It forms an important constituent of the haemoglobin in the blood. This acts as the oxygen carrier to the tissues, and therefore, the tissue-oxidation and the functional activity of the organs depend more or less upon the amount of iron present in the body. Both per- and proto-salts of iron form compounds with albumen, but they differ in their properties. The fer- rous salts give a yellow color with albuminous solutions, but do not pre- cipitate them, the albuminous compound being, apparently, usually soluble. Diluted ferric salts, on the contrary, precipitate albumen slowly, and concentrated solutions precipitate it rapidly. The precipitate is soluble in dilute acids and in gastric juice. When applied to the skin neither ferrous nor ferric salts have any action, as they do not dissolve the epidermis nor pass through it in 628 INORGANIC MATERIA MEDICA. any appreciable quantity. When applied to a denuded surface, or to a mucous membrane they combine with albumen. The ferrous salts have but a slight astringent action, whereas the ferric salts coagulate the albumen on the surface and also blood. They are thus powerful astrin- gents and styptics. In the niouth they all have an inky taste, and as they are liable to form black sulphides with sulphurated hydrogen, which is not unfrequently present in the breath, they are apt to discolor the teeth or tongue. In the stoniacli they have an astringent and irritant action, that of the ferric being more powerful than that of the ferrous salts. In the intestine they have a somewhat similar action ; meeting here, as they often do, with sulphurated hydrogen, they become converted, in great part, into sulphides, and, passing out into the stools, give to them an inky, black color which sometimes alarms patients. In small doses they usually have an astringent action, and tend to cause constipa- tion. Larger doses, on the other hand, seem to stimulate peristalsis, and increase the number of stools, and sometimes even small doses will cause diarrhoea in some individuals. After absorption into the blood they are found to increase, not only the number, but the percentage of haemoglo- bin contained in the blood corpuscles, and they may also cause a little free iron to be present in the serum. By thus increasing oxidation in the tissues they increase the functional activity of the various organs. The effect of ferrous and ferric salts added to the blood is very different, ferric salts producing a firm coagulum, whereas the ferrous salts tend rather to diminish the coagulability of the blood. Iron has an action on the nervous system which varies according to the dose and mode of administration. When injected subcutaneously in frogs, iron salts cause slight excitement and then paralysis of the central nervous system. In the later stages of poisoning the irritability of the voluntary muscles is diminished, but the heart is not affected. In mammals they cause congestion of the stomach and intestine, and diar- rhoea. They produce paralysis both of sensation and motion. The blood-pressure falls. This is due to paralysis of the vaso -motor nerves, especially of the intestine, resembling that produced by arsenic, antimony, emetine, and colchicine. Iron is eliminated to a considerable extent by the bile, by the mucous membrane of the intestine, and by the kidneys. Uses of Iron. — The ferrous salts are rarely employed for their local action. The ferric salts are used as styptics. The strong solution of perchloride may be employed to arrest bleeding from the cavity of a tootli after extraction, or to stop the oozing from a wound where it is impossible to ligature all the bleeding points. When diluted it may be used as an injection to arrest haemorrhage from the nose, or may be injected into the cavity of the uterus to arrest bleeding from that organ. Mixed witli laudanum it has been used as an injection in gonorrhoea and gleet. Both ferrous and ferric salts are administered internally in order to produce the general action of iron in increasing the blood corpuscles. They differ to some extent, however, the ferrous salts having a less astringent action on the intestines than the ferric. In cases where the mucous membrane of t lie alimentary canal is irritable this is advantageous, as in such instances the ferric salts might cause digestive disturbances METALS. 629 and headache. In other instances, however, especially those where the tongue is pale and flabby, the more astringent preparations are to be preferred. The chief condition in which iron is useful is where we have anaemia and chlorosis, whether these be due to loss of blood, imper- fect nutrition, chronic discharges, scrofula, syphilis, malarial poisoning, amenorrhea or albuminuria, or be consequent upon acute febrile disease, but it is also serviceable in a number of disturbances of the nutritive and nervous systems. It has been recommended in large doses in cases of blood- poisoning, such as diphtheria and erysipelas, and in nervous diseases like chorea, epilepsy, giddiness, formication, twitching of the fingers and sub- jective sensations of light and heat or cold to which some patients are liable, especially about the climacteric period. It is also used internally in order to diminish discharges from the mucous membranes of the intestines, as in chronic diarrhoea and dysentery, and from the vagina in leucorrhcea. It acts as an astringent on the kidney, lessening the amount of blood in hgematuria, and sometimes the amount of albumen in albuminuria. It is also a useful adjunct to diuretics in cardiac and renal dropsy (p. 299). B.P. Vinum Ferri. — This is prepared by macerating iron wire in sherry for a month. Some of it is converted into tartrate and dis- solved by the bitartrate of potash in the wine. Use. — It is useful in anaemia both in children and adults. Dose. — 1 to 2 fl. dr. or more. B.P. Mistura Ferri Aromatica. — This is a curious preparation containing tannate of iron in very small quantities. It is sometimes called Heberden's ink. It is usually said that iron and tannin are incom- patible, and so they are in so far that they produce ink, but this prepa- ration is said to be a very useful one. Iron cannot be taken up in very large quantities, and its absorption is often prevented by the condition of the patient's stomach. This prepa- ration has been put together evidently with the view of combining all the drugs, which were likely to do good by themselves, and in total disregard of the chemical action which would take place among themselves. Preparation. — By macerating pale cinchona bark (1 oz.), calumba root (J oz.), cloves (J oz.), and fine iron wire (J oz.), in peppermint water (12 oz.) for three days, agitating occasionally ; then filtering and adding as much peppermint water to the filter as will make the product measure 121 fl. 0Zt • to this add compound tincture of cardamoms (3 fl. oz.) and tincture of orange peel (J fl. oz.), and preserve the mixture in a well- stopped bottle. The pale cinchona bark contains tannin, which combines with the iron. Both it and calumba are gastric tonics, and the carmina- tives relieve flatulence. Dose. — 1 to 2 fl. oz. Ferri Sulphas, U.S.P. and B.P. Sulphate of Iron. FeS0 4 . 7H 2 0; 277-9. Characters and Tests. — In oblique rhombic prisms, of a pale greenish-blue color and styptic taste ; insoluble in rectified spirit, soluble in water. The aqueous solution gives the reaction of a sulphate and of a ferrous salt. Dose. — 1 to 5 grains. 630 INORGANIC MATERIA MEDICA. Peepabations. U.S.P. B.P. Ferri Sulphas Exsiccata. Ferri Sulphas Exsiccata Pilula Aloes et Ferri 1 part in 7. Ferri Sulphas Exsiccatus, U.S.P. ; Ferri Sulphas Exsiccata, B.P. Dried Sulphate of Iron. FeS0 4 .H 2 ; 169-9. Prepared by heating sulphate. It is less apt to oxidize, and is well fitted for pills. Dose. — J grain to 3 grains. Peepaeation. U.S.P. Pilulse Aloes et Ferri. Ferri Sulphas Precipitatus, U.S.P. ; Ferri Sulphas Grauu- lata, B.P. Precipitated Sulphate of Iron, U.S.P.; Granulated Sulphate of Iron, B.P. FeS0 4 .7H 2 ; 277-9. Characters and Tests. — In small granular crystals of a pale greenish-blue color. In other respects corresponds to the characters and tests for sulphate of iron. Dose. — 1 to 5 grains. Uses. — It is very astringent. It has been used externally as oint- ment or lotion to the skin in erysipelas, as a lotion in ophthalmia, and as a lotion or injection in prolapsus ani, and bleeding piles. It has also been used as an injection in gonorrhoea and leucorrhoea. Internally it is used in cases of anaemia, especially where this is accompanied by a tendency to profuse sweating, passive haemorrhages, or mucous discharges, such as chronic catarrh or leucorrhoea. Its astringent action on the stomach has been said to render it serviceable in gastrodynia and gastric ulcer. Ferri Carbonas Saccharatus, U.S.P. ; Saccharata, B.P. Saccharated Ferrous Carbonate, U.S.P. ; Saccharated Car- bonate of Iron, B.P. Carbonate of iron, FeO,C0 2 or FeC0 3 , mixed with peroxide of iron and sugar, the carbonate forming at least 15 per cent, of the mixture, U.S.P., 37 per cent., B.P. Characters and Tests. — Small coherent lumps, or powder, of a gray color, with a sweet, very feeble chalybeate taste. It dissolves with effervescence (carbonate) in warm hydrochloric acid diluted with half its volume of water, and the solution gives only traces of sulphate (p. 498) and exhibits the reactions of a ferrous salt. Dose. — 5 to 20 grains. Peepaeation. B.P. (With confection of roses.) DOSE. Pilula Ferri Carbonatis 1 part in 1J 5-20 grs. Mistura Ferri Composita, U.S.P. and B.P. COMPOUND Mixture of Iron. Griffith's Mixture. COMPOSITION. — Sulphate of iron, 6; myrrh, 18; sugar, 18; car- bonate of potassium. 8; spirit of lavender, 50; rose water, 900, (J.S.P. Sulphate of iron, 25 grs. ; carbonate of potash, 30 grs. ; myrrh METALS. 631 and refined sugar, of each 60 grs. ; spirit of nutmeg, 4 fl. drs. ; rose water, 9J fl. oz., B.P. Dose. — 1 to 2 fluid ounces. Uses. — Carbonate of iron in its various preparations is one of the most useful forms of iron for administration as a hematinic and emmen- agogue. Liquor Ferri Tersulphatis, U.S. P. ; Persulphatis, B.P. Solution of Tersulphate of Iron, U.S.P.; of Persulphate of Iron, B.P. Fe 2 (S0 4 ) 3 ; 399-8. Characters and Tests. — A dense solution of a dark-red color, inodorous and very astringent, miscible in all proportions with alcohol and water. Diluted with ten volumes of water, it gives the reactions of a sulphate and of a ferric salt only. Pbepaeations in which Solution of Peesulphate of Ieon is used. Ferri et Ammonise Citras. Ferri Peroxidum humidum. " et Quinise Citras. Ferrum Tartaratum. " Oxidum magneticum. Tinctura Ferri Acetatis. Uses. — Not used as a remedy, but to prepare peroxide, &c. U.S.P. Liquor Ferri Subsulphatis. SOLUTION OF SuBSUL- phate of Iron. Solution of Basic Ferric Sulphate. (Monsel's Solution.) Characters. — Like the tersulphate; but on mixing two volumes of the solution with one of concentrated sulphuric acid a solid white mass separates on standing. Dose. — 3 to 10 minims (-18-64 c.c). Actions. — Astringent, styptic, haematinic. Less irritating than the tersulphate. Uses. — Like the chloride. It is a useful astringent in relaxed sore throat and tonsillitis. Ferri Peroxidum Humidum, B.P. Moist Peroxide of Iron. Hydrated peroxide of iron with about 86 per cent, of uncombined water. It should be recently made, B.P. Ferri Oxidum Hydratum, U.S.P. Hydrated Oxide of Iron. Fe 2 (HO) 6 ; 213-8. Characters and Tests. — A soft, moist, pasty mass, of a reddish- brown color. Dissolves readily in diluted hydrochloric acid, and gives the reaction of a ferric salt only. Dose. — J to J ounce. Use. — As an antidote for arsenic, it should be given in doses of a tablespoonful every five or ten minutes. It may be used in anaemia and amenorrhoea. Peepaeations. U.S.P. Empiastrum Ferri (Hydrated oxide dried, with Canada turpentine, Bur- gundy pitch and lead plaster). U.S.P. Trochisci Ferri (Troches of iron). Iron lozenges, 5 grs. in each lozenge. U.S.P. Ferri Oxidum Hydratum cum Magnesia. Hyd RATED Oxide of Iron with Magnesia. — Antidote to arsenious acid. 632 ItfOKGANIC MATERIA MEDICA. Preparation. — Mix solution of tersulphate of iron, 1000 grs. (65-00 gm.) with twice its weight of water. Rub the magnesia, 150 grains (10-00 gm.) with water to a smooth and thin mixture; transfer this to a bottle capable of holding 32 fl. oz., or about 1 litre, and fill it up with water. When the preparation is wanted for use, mix the two liquids by adding the magnesia mixture gradually to the iron solution, and shake them together until a homogeneous mass results. Note. — The diluted solution of tersulphate of iron and the mixture of magnesia with water should always be kept on hand, ready for imme- diate use. Use. — As an antidote in poisoning by arsenic. B.P. Ferri Peroxidum Hydratum. Hydratbd Peroxide of Iron. Characters. — A reddish-brown powder, destitute of taste and not magnetic. It dissolves completely, though slowly, with the aid of heat, in hydrochloric acid, diluted with half its volume of water, and the solu- tion gives the reactions of a ferric salt only. Dose. — 5 to 30 grains. B.P. Peepaeation. Ernpiastrum Ferri. Iron Plastee. — Hydrated peroxide of iron in fine powder, Burgundy pitch and lead plaster. Uses. — Not astringent. Given in powder or electuary chiefly in cases of tic and neuralgia. Iron plaster is often called "strengthening plaster." It forms a mechanical support to weak parts and keeps them warm. Used in pains or weakness across the loins in females, in rheumatic pains, as lumbago, weak joints, &c. B.P. Ferri Oxidum Magiieticum. Magnetic Oxide of Iron. Magnetic oxide of iron, Fe 3 4 , combined with about 20 per cent, of water of hydration, and containing some peroxide of iron. Characters and Tests. — Brownish-black, destitute of taste, strongly attracted by the magnet. It dissolves without effervescence in hydrochloric acid diluted with half its volume of water, and the solution thus obtained gives the reactions both of ferrous and ferric salts. Dose. — 5 to 10 grains. Uses. — It is but sparingly soluble, and so not so good as reduced iron. Ferrum Reclactum, U.S. P. and B.P. Reduced Iron. — Metallic iron, with a variable amount of magnetic oxide of iron. Characters and Tests. — A fine grayish-black powder, strongly attracted by the magnet, and exhibiting metallic streaks when rubbed with firm pressure in a mortar. It dissolves in hydrochloric acid with the evolution of hydrogen, and the solution gives a light blue precipitate with the yellow prussiate of potash. Fe -f- 2ITC1 = Fe Cl 2 + H 2 . IMPURITY. — Magnetic oxide. Test. — When ten grains are added to an aqueous solution of fifty grains of iodine and fifty grains of iodide of potassium (Fe -|- I 2 = Fe \., which dissolves in Klj, and digested in a small flask at a gentle heat, METALS. 633 the reduced iron is converted into iodide and dissolved, and not more than five grains should be left undissolved, which should be entirely sol- uble in hydrochloric acid (oxide). Dose. — 1 to 5 grains. Trochisci Ferri Kedacti, B.P. REDUCED lEON LOZENGES, B.P. — Each lozenge contains one grain of reduced iron. Dose. — 1 to 6 lozenges. Uses. — This preparation is generally well borne even if the stomach be somewhat irritable. It has no astringent action. When dissolved by the gastric juice it evolves hydrogen, and if sulphur be present as an impurity eructations of sulphuretted hydrogen are produced. Tinctura Ferri Acetatis, U.S. P. and B.P. Tincture op Acetate of Iron. Dose. — 5 to 30 minims. Use. — May be given along with acetate of potash in dropsy. U.S. P. Mistura Ferri et Ammonii Acetatis. Mixture op Acetate op Iron and Ammonium (Basham's Mixture) comprises tincture of chloride of iron (2 parts), diluted acetic acid (3), solution of acetate of ammonium (20), elixir of orange (10), syrup (15), water (50). Dose. — J-l fluid ounce. Use. — As hgematinic generally, and in cases of renal disease especially. U.S.P. Ferri Chloridum. Chloride of Iron. — Fe 2 Cl 6 12H 2 ; 540-2. Characters. — Orange-yellow crystalline pieces, very deliquescent, odorless or having a faint odor of hydrochloric acid, a styptic taste, and an acid reaction. Freely and wholly soluble in water, alcohol, or ether. The dilute aqueous solution gives a brown-red precipitate with water of ammonia, a blue one with test solution of ferrocyanide of potassium, and a white one, insoluble in nitric acid, with test solution of nitrate of silver. Use. — In the solid state it keeps indefinitely, whereas in solution it is apt to deposit ferric oxide leaving excess of acid in the solution which renders it irritating. When required it may be dissolved in water in the proportion of 1J-6 drachms to the ounce of water. When semi- deli- quesced it is an efficient styptic. Liquor Ferri Cliloridi, U.S.P. ; Liquor Ferri Perchloridi Fortior, B.P. Solution of Chloride of Iron, U.S.P. ; Strong Solution op Perchloride of Iron, B.P. Characters and Tests. — An orange-brown solution with a strong styptic taste, miscible with water and rectified spirit in all propor- tions. Diluted with water it gives the reactions of a chloride and of a ferric salt only. Applied externally as a styptic and caustic. Peepaeation. U.S.P. Tinctura Ferri Cliloridi. TlNCTUEE OF CHLOEIDE OF lEON. DOSE. — 10 to 30 minims. 634 IXORGAXIC MATERIA MEDICA. Peepaeations. Mistura Ferri et Ammonii Acetatis, U.S. P. B.P. DOSE. Liquor Ferri Percliloridi (with water) 1 volume in 4. 10-30 niin. Tinctura Ferri Percliloridi (with spirit) 1 volume in 4. 10-30 min. Uses. — The strong solution is one of the most powerful styptics we possess. It forms, almost immediately, a hard black coagulum with blood, and by blocking up the mouths of the vessels arrests further haemorrhage. Cotton wool steeped in this may be used to arrest the haemorrhage from the cavity of a tooth after its extraction, and to stop the bleeding from leech bites. It has been applied as a caustic in hospital gangrene, in bleeding from the uterus, and, diluted with three volumes of water, it may be injected into the uterine cavity, but is better applied hy swabbing it over the interior of the uterus with a sponge. It has been injected into aneurisms, in order to produce coagulation within them. There is, however, great danger that part of the clot may become detached and carried onwards, producing embolism, or that inflammation and ulceration may take place within the aneurismal sac itself. It has also been injected into varicose veins and nsevi for a simi- lar purpose, but in naevi on the face it may cause sloughing, and leave scars. It has been used as a spray for the purpose of arresting haemorrhage from the lungs. The liquor and tincture are perhaps more often employed than any other preparation of iron. They are astringent, generally causing constipation, but sometimes they irritate the intestine, increasing the number of stools. They are amongst the most efficient preparations of iron as haematinics. They are contraindicated by a red irritable tongue, and succeed best when the tongue is pale, flabby and marked with the teeth at the edges. I have found that when patients bear iron badly and complain of headache even after small doses, they can take with benefit a single drop of the tincture or solution of the perchloride in a full tumbler of water. In its great dilution the mixture somewhat resembles chalybeate waters, which often succeed much better than pharmaceutical prepara- tions. The tincture has been given in erysipelas in very large doses, 20-30 min., repeated every hour or two. Liquor Ferri Nitratis, U.S. P.; Liquor Ferri Pernitratis, B.P. Nitrate of Iron, U.S. P. ; Solution of Pernitrate of Iron, B.P. Fe 2 (N0 3 )6; 483-8. Characters and Tests. — A clear solution of a reddish-brown color, slightly acid and astringent to the taste. When to a little of it placed in a test-tube half its volume of pure sulphuric acid is added, and then a solution of sulphate of iron is poured on, the whole assumes a dark brown color (nitrate). It gives the reactions of a ferrous salt only. DOSE. — 10 to 40 minims. USES. — It has been used as an astringent in the diarrhoea of chil- dren, and, also as an astringent, to diminish discharges from mucous surfaces, also to arrest haemorrhage from internal organs. It can be METALS. 635 given along with spirit of nitrous ether or nitrate of potash in cases of anaemia with albuminuria and dropsy. Ferri et Potassii Tartras, U.S. P. ; Ferrum Tartaratuin, B.P. Tartrate of Iron and Potassium, U.S. P.; Tartarated Iron, B.P. Characters and Tests. — Thin, transparent scales of a deep garnet color, slightly sweetish and astringent in taste, soluble in water and sparingly soluble in spirit. The aqueous solution, when acidulated with hydrochloric acid, gives the reactions of a ferric salt only. When the salt is boiled with solution of soda, peroxide of iron separates, but no ammonia is evolved (not the ammonio-citrate), and the filtered solution when slightly acidulated by acetic acid gives, as it cools, a crystalline deposit (potassium). Dose. — 5 to 10 grains. The double salts of iron with potassium, ammonium, quinine, &c, are usually called the scale preparations of iron from their appear- ance. These are less astringent than, and do not confine the bowels so much as, either the proto-sulphate or the per-salts. Another advantage is that they may be given along with alkaline carbonates without being precipitated. They are employed in cases where the other preparations cause headache, or where other preparations derange the digestion, on account of the stomach being irritable. U.S. P. Ferri et Ammonii Tartras. TARTRATE OF Iron AND Ammonium. Characters. — Transparent scales, varying in color from garnet-red to yellowish-brown, only slightly deliquescent, without odor, having a sweetish and slightly ferruginous taste and a neutral reaction. It is not precipitated by ammonia but gives a brown precipitate of ferric oxide with potash and evolves the vapor of ammonia. On adding test solution of ferrocyanide of potassium to the salt, no blue color or precipitate is produced unless the solution is acidulated with hydrochloric acid. Ferri et Ammonii Citras, U.S. P. ; Ferri et Ammoniae Citras, B.P. Citrate of Iron and Ammonium, U.S. P. ; Citrate of Iron and Ammonia, B.P. Characters. — In thin, transparent scales of a deep red color, slightly sweetish and astringent in taste. It feebly reddens litmus paper, is sol- uble in water, but almost insoluble in rectified spirit. Heated with solution of potash it evolves ammonia and deposits peroxide of iron. The alkaline solution from which the iron has separated does not, when slightly supersaturated with acetic acid, give any crystalline deposit (distinction from and absence of tartrate). Dose. — 5 to 10 grains. Preparations. U.S. p. DOSE. Ferri et Strychnine Citras Liquor Ferri et Quinine Citratis Vinum Ferri Citratis 1-2 fl. drs. B.P. Vinum Ferri Citratis. 8 grains in 1 fl. oz. of orange wine 1-4 fl. drs. U.S.P. Vinum Ferri Citratis. (Citrate of iron and ammonia, 4 ; tincture of sweet orange peel, 12 ; syrup, 36 ; stronger white wine, 44.) 636 INORGANIC MATERIA MEDICA. U.S.P. Liquor Ferri Citratis. An Aqueous Solution of Ferric Citrate, Fe 2 (C 6 H 5 7 ) 2 ; 489*8, containing about 35 per cent. of the anhydrous salt. Characters. — A dark brown liquid, odorless, having a slightly fer- ruginous taste and acid reaction. It gives the reactions of a citrate and a bluish-green precipitate with ferrocyanide of potassium, which is increased and rendered dark blue by the subsequent addition of hydro- chloric acid. Dose. — Ten minims (0*6 c.c), equal to 5 grains of the salt. U.S.P. Ferri Citras. Citrate of Iron. Fe 9 (C 6 H 5 7 ) 2 .6H 9 ; 597-8. Characters. — Transparent garnet-red scales, permanent in the air, odorless, having a very faint, ferruginous taste and an acid reaction. Slowly but completely soluble in cold water and readily so in boiling water ; insoluble in alcohol. Peepaeatiox. Ferri et Quininse Citras. Use. — Is pleasant. A solution of 240 grains in 1 fl. oz. of water keeps perfectly, and may be given in doses of 10 minims, equal to 5 grains, as a tonic. Ferri et Quininae Citras, U.S.P. ; Ferri et Quinise Citras, B.P. Citrate of Iron and Quinine, U.S.P. ; Citrate of Iron and Quinia, B.P. Characters and Tests. — Thin scales of a greenish, golden-yellow color, somewhat deliquescent, and entirely soluble in cold water. The solution is very slightly acid, and is precipitated reddish-brown (iron) by solution of soda, white (quinine) by solution of ammonia, blue by the yellow ferric and red prussiates (ferrous) of potash, and grayish-black by tannic acid. The taste is bitter (quinine) as well as chalybeate. Dose. — 5 to 10 grains. U.S.P. Liquor Ferri et Quininse Citratis. SOLUTION OF Citrate of Iron and Quinine. (Citrate of iron and ammonium, 65 ; quinine, 12 ; citric acid, 28 ; alcohol, 30 ; distilled water up to 200.) Dose. — 8 to 15 minims (J— 1 c.c). Peepabation. U.S.P. vinum Ferri Amamm. Bittee WlNE of Ieon. (Solution of citrate of iron and quinine, 8; tincture of sweet orange peel, 12 ; syrup, 36; stronger white wine, 34.) Dose.— 1-2 fl. drs. (4-16 c.c). U.S.P. Ferri et Strychnine Citras. ClTRATE OF Iron AND Strychnine. Characters. — Transparent garnet-red scales, deliquescent on exposure to air ; odorless, having a bitter and slightly ferruginous taste and a slightly acid reaction. If one Gm. of the salt be dissolved in 4 c.c. of water in a small test-tube, then 1 c.c. of solution of potassa added and the mixture shaken with 2 c.c. of chloroform, the residue left on METALS. 637 evaporating the chloroform will answer to the reaction of strychnine. (See " Strychnina.") Dose.— 3 to 5 grains (0-20-0-33 Gm.). Uses. — As tonic and chalybeate to combine the uses of strychnine and iron. U.S. P. Ferri et Ammonii Sulphas. Sulphate of Iron and Ammonium. Ammonio-Ferric Sulphate or Ammonic-Ferric Alum. Fe 2 (NH 4 ) 2 (S0 4 ) 4 .24H 2 0; 963-8. This is an ammonia iron-alum in which the place of the aluminium oxide is occupied by the ferric oxide. Characters. — Pale violet octahedral crystals, efflorescent on exposure to air, odorless, having an acid styptic taste and a slightly acid reaction. Dose. — 5 to 10 grains. Uses. — It is more astringent than common alum, and has not the stimulating properties of other iron salts. It is useful in leucorrhoea. Internally it is sometimes very useful in lessening albumen in cases of intermittent albuminuria. TJ.S.P. Ferri Lactas. Lactate of Iron. Fe(C 3 H 5 0) 2 .3H 2 0; 287-9. Characters. — Pale greenish-white, crystalline crusts or grains, per- manent in the air ; odorless, having a mild sweetish ferruginous taste and a slightly acid reaction. When heated on platinum foil the salt froths up, gives out thick white acrid fumes and chars, a brown-red residue being finally left. If the salt be boiled for fifteen minutes with nitric acid of the sp. gr. 1*200, white granular mucic acid will be deposited on cooling the liquid. Peepaeation. U.S.P. Syrupus Hypophospiiituin cum Ferro. (Lactate of iron, 1 ; syrup of hypo- phosphites, 99.) Dose. — 12-20 grains per diem ; of syrup, J to 1 fl. dr. Use. — In chlorosis and anaemia. U.S.P. Ferri Oxalas. Oxalate of Iron. FeC 2 4 .H 2 0; 161-9. Characters. — A pale yellow, or lemon-yellow crystalline powder, permanent in the air, odorless and nearly tasteless, very slightly soluble in cold or hot water, but soluble in cold concentrated hydrochloric acid and in hot diluted sulphuric acid. Dose.— 2 to 3 grains (0-13 to 0-20 Gm.). Ferri Iodidum, B.P. Iodide of Iron. Fel 2 ; 309-1 — Iodide of iron, Fel or Fel 2 , with about 18 per cent, of water of crystallization and a little oxide of iron. Characters and Tests. — Crystalline, green, with a tinge of brown, inodorous, deliquescent, almost entirely soluble in water, forming a slightly green solution which gradually deposits a rust-colored sediment, and acquires a red color. Its solution gives the reaction of an iodide and of a ferrous salt. Dose. — 1 to 5 grains. 638 LXORGAXIC MATERIA MEDICA. Peepaeations. u.s.p. axd b.p. dose. Piliila Ferri Iodidi. 1 part in 3 3-8 grs. (With sugar and liquorice ) Syrupus Ferri Iodidi. 43 grains in 1 fluid drachm |-1 fl. dr. U.S.P. Ferri Iodidum Saccharatum. Saccharated Iodide of Iron. Characters. — A yellowish-white or grayish, powder, very hygro- scopic, odorless, having a sweetish ferruginous taste, and a slightly acid reaction. Dose.— 2 to 5 grains (0*13 to 0-33 Gm.). Uses. — Iodide of iron is given when a combination of the effect of iodine on the lymphatic system is desired along with the haematic action of iron. It is thus very useful in the form of the syrup in dispensary practice in large towns, where pale, anaemic, flabby, and scrofulous children abound, and come in large numbers to be treated. It is generally advan- tageous to combine it with cod-liver oil, a few drops of the syrup being dropped into the oil and taken along with it. It has been given in phthisis in the same way, and has been useful in rheumatic arthritis and syphilis. U.S.P. Syrupus Ferri Bromidi. Syrup of Bromide of Iron. — A syrupy liquid containing 10 per cent, of ferrous bromide. FeBr 2 ; 215-5. Dose. — J to 1 fluid drachm (1-9 to 3*75 c.c). Use. — In nervous diseases accompanied by anaemia. It is doubtful, however, whether it is not better to give the iron and bromine separately, as sufficient bromine cannot be given in this form. It may, however, be advantageously combined with other bromides. B.P. Ferri Arsenias. Arseniate of Iron. — Arseniate of iron, Fe 3 As 2 8 , partially oxidized. Characters and Tests. — A tasteless amorphous powder of a green color, insoluble in water, but readily dissolved by hydrochloric acid. This solution gives a copious light-blue precipitate with the yellow prus- siate of potash (ferric), and a still more abundant one of a deeper color with the red prussiate of potash (ferrous). A small quantity boiled with an excess of caustic soda and filtered, gives, when exactly neutralized by nitric acid, a brick-red precipitate on the addition of solution of nitrate of silver (arseniate). Dose. — ^ to J grain. Uses. — Used when we wish to employ arsenic and iron together, as in skin diseases in anaemic subjects. Ferri Phosphas, U.S.P. and B.P. PHOSPHATE OF Iron. — Phosphate of iron, Fe 3 P 2 8 , partially oxidated. Characters and Tests. — A slate-blue amorphous powder, insolu- ble in water, soluble in hydrochloric acid. The solution yields a precipi- tate with both the yellow (ferric) and red prussiate of potash, that afforded by the latter being the more abundant (ferrous) ; and when treated with tartaric acid and an excess of ammonia, and subsequently with the solution of ammonio-sulphate of magnesia, lets fall a crystalline METALS. 639 precipitate (phosphate). When the salt is digested in hydrochloric acid with a lamina of pure copper, a dark deposit does not form on the metal (distinction from and absence of arseniate). Dose. — 5 to 10 grains. Peeparations containing Phosphate of Iron. U.S.P. Syrupus Ferri Quininse et Strychninae Phosphatum. (Phosphate of iron, 133; quinine, 133 ; strychnine, 4 ; phosphoric acid, 800 ; sugar, 6000 ; distilled water up to 10,000). This preparation resembles Easton's Syrup. b.p. dose. Syrupus Ferri Phosphatis (freshly precipitated phosphate (p. 627) is dissolved in dilute phosphoric acid and sugar added) 1 gr. in 1 rl. dr.... 1 fl. dr. Uses. — It is used in diabetes, in rickets, and in nervous depression. It is frequently given along with the phosphates of lime, potash, and soda, as the preparation usually called Parrish's Chemical Food, or with the phosphates of quinine and strychnine as in Easton's Syrup. U.S.P. Ferri Pyropliosplias. Pyrophosphate of Iron. Characters. — Thin, apple-green, transparent scales, permanent in dry air when excluded from light, but turning dark on exposure to light. Odorless, having an acidulous slightly saline taste, aud a slightly acid reaction. When heated with solution of potassa in excess a brown-red precipitate is thrown down, and the filtrate, after being supersaturated with acetic acid, yields a white precipitate with test solution of nitrate of silver (difference from phosphates). Dose.— 2 to 5 gr. (0-13 to 0-33 Gm.). Uses. — Has no disagreeable taste, and is very soluble, so that it can be given in any form. U.S.P. Ferri Hypophospliis. Hypophosphite of Iron. Fe 2 (H 2 P0 2 ) 6 ; 501-8. Characters. — A white or grayish-white powder, permanent in the air, odorless and nearly tasteless, only slightly soluble in water, more readily so in presence of hypophosphorous acid, freely soluble in hydro- chloric acid, or in solution of citrate of sodium, forming with the latter a green solution. When strongly heated in a dry test-tube, the salt evolves a spontaneously inflammable gas (phosphorated hydrogen), and on ignition leaves behind ferric pyrophosphate. The salt is readily oxidized by nitric acid or other oxidizing agents. It should be com- pletely soluble in acetic acid (absence of. ferric phosphate). This solu- tion, when mixed with test solution of oxalate of ammonium, should not afford a white precipitate soluble in hydrochloric acid (absence of calcium). Dose. — 5 to 10 grains in pill, more generally given in syrup. Uses. — In nervous debility with anaemia, and also in phthisis. U.S.P. Ferri Valerianas. Valerianate of Iron. Fe 2 (C 5 H 9 2 ) 6 ; 717-8. Characters. — A dark tile-red amorphous powder, permanent in dry air, having a faint odor of valerianic acid, and a mildly styptic taste. Insoluble in cold water, but readily soluble in alcohol. Boiling water 640 INORGANIC MATERIA MEDICA. decomposes it, setting free the valerianic acid and leaving ferric hydrate. When slowly heated the salt parts with its acid without fusing, but when rapidly heated it fuses and gives off inflammable vapors having the odor of butyric acid. Dose. — 1 grain or more. Uses. — In hysteria with anaemia. MAXGAXESE. Mn ; 55-54. Mangani Oxidum Nigrum, U.S. P. ; Manganesii Oxidum Nigrum, B.P. Black Oxide of Manganese. — Native crude per- oxide of Manganese containing at least 66 of the pure oxide. Mn0 2 : 86. U.S.P. Characters and Tests. — A heavy black powder, which dissolves almost entirely in hydrochloric acid with evolution of chlorine, and gives off oxygen when heated to redness. Uses. — Used for producing chlorine, and for making oxygen. It has been used instead of bismuth in pyrosis and irritable conditions of the stomach, with pain after eating; and instead of iron in debilitating diseases, anasmia, syphilis, scurvy, and in skin diseases. U.S.P. Mangani Sulphas. Sulphate of Manganese. — MnS0 4 ,4H 2 0; 222. Characters. — Colorless or pale rose-colored, transparent right rhombic prisms, odorless, having a slightly bitter and astringent taste, and a faintly acid reaction. The aqueous solution of the salt yields with sulphide of ammonium a flesh-colored precipitate completely soluble in moderately-diluted acetic acid (absence of zinc) ; with test solution of ferrocyanide of potassium it affords a reddish-white precipitate, and a brown one with test solution of ferri cyanide of potassium. Action of Manganese Salts. — When injected into the blood, or subcutaneously, manganese salts paralyze voluntary movement and reflex action, and stop the heart in diastole. The paralysis of reflex action is due to destruction of the transverse conduction of the spinal cord (p. 149), longitudinal conduction remaining intact until death (Robert). Proto-sulphate produces purging in doses of 1 to 2 drms., and in consequence of Gmelin's experiments has been thought to increase the secretion of bile. Uses. — Has been used in place of iron in anosmia, but without good results. Possibly it may be serviceable in amenorrhcea. Class VIII. Group II. — Gold, Platinum. AUKUM; GOLD, An. B.P. Gold, Fine. GOLD, FREE FROM METALLIC IMPURITIES. Gold foil is used for stopping teeth and to make the test solution. B.P. Solution of Chloride of Gold. PREPARATION. — By dissolving gold foil in a mixture of nitric and hydrochloric acids and diluting. METALS. 641 U.S. P. Auri et Sodii Cliloridum. CHLORIDE OF Gold AND Sodium. A mixture composed of equal parts of dry chloride of gold, AuCl 3 ; 302-4 ; and chloride of sodium, NaCl ; 58*4. Preparation. — By dissolving gold in nitro-hydrochloric acid and evaporating to dryness chloride of gold is obtained. This is dissolved in water, and mixed with its own weight of pure decrepitated common salt, also dissolved in water. The mixed solution is then evaporated to dryness. Characters. — An orange-yellow powder, slightly deliquescent, in damp air odorless, having a saline and metallic taste and a slightly acid reaction. The compound is very soluble in water ; at least one-half of it should be soluble in cold alcohol. When exposed to a red heat it is decomposed and metallic gold is separated. A fragment of the com- pound imparts an intense persistent color to a non-luminous flame. Dose. — ^ to ^ grain (-006--012 Gm.) once or twice a day. Action. — Salts of gold cause rapid paralysis of the central nervous system in frogs, which appears to affect first the optic lobes and cere- bellum, then the cord, and lastly the cerebral lobes (vide p. 168). In mammals small doses appear to increase the appetite ; larger ones cause symptoms of irritation in the stomach and intestines, viz., loss of appetite, diarrhoea and emaciation, followed by paralysis of the limbs, a catarrhal condition of the respiratory passages, and death by asphyxia. Large doses injected into the veins cause oedema of the lung's, and rapid death, with convulsions from asphyxia. In man they are said to increase the secretions, and to produce salivation like mercury, but without stomatitis. They are eliminated in the urine. Uses. — Salts of gold have been supposed to act like those of mer- cury and silver. They have been given like mercurial salts in syphilis, scrofula and cancer ; and, like silver salts, have been used in myelitis. Gold has been supposed to act specifically on the genital organs, and has been used in chronic uterine inflammation and irritation, and inflamma- tion and neuralgia of the ovaries. PLATINUM. Pt. 197. B.P. Platinum Foil. A heavy whitish metal, 8*921. Withstands considerable heat. The foil is convenient for holding .salts of organic acids which it is wished to char. B.P. Solution of Perchloride of Platinum. PtCl 4 ; 339. Preparation. — By dissolving thin platinum foil in a mixture of nitric acid and hydrochloric acid and diluting. Uses. — Used to distinguish potassium from sodium and to precipitate salts of ammonium, and of compound ammoniums, e.g., organic alkaloids. Action. — Soluble salts of platinum are as poisonous as arsenic. In frogs they appear to paralyze the centres for voluntary motion in the cerebral lobes, and irritate the motor centres between them and the cord, so that voluntary motion is diminished, but reflex convulsions occur. The excitability of voluntary muscle is much lessened, that of 642 INORGANIC MATERIA MEDICA. the heart is not apparently altered. In mammals the most prominent symptom is paralysis of the peripheral ends of the vaso-inotor nerves. In consequence of this, diarrhoea, blood in the motions, hyperemia of the abdominal viscera, and ecchymoses of the mucous membrane of the stomach and intestine and bladder occur. B.P. Platinum Black. Platinum in a state of minute division, obtained by adding excess of carbonate of soda and some sugar to solution of perchloride of platinum, and boiling until a black precipitate is formed, which is washed and dried. Action. — Platinum black appears to have a greater power than even charcoal to condense gases, and especially oxygen in its pores. By giv- ing the oxygen off again it acts as an oxidizing agent. Use. — To test amylic alcohol by oxidizing it into valerianic acid. SECTION IV. ORGANIC MATERIA MEDICA. This Section contains Organic Compounds artificially prepared, and not merely extracted from Vegetable Substances containing them. Although it is small, it contains some of the most important remedies we possess, and by and by will probably replace to a great extent, and perhaps entirely, the vegetable materia medica. CHAPTER XXIX. CARBON COMPOUNDS— FATTY SERIES. Carbon is a tetrad element. It is sometimes represented graphically thus : I -C- I It combines with four atoms of a monad, or two of a dyad ele- ment, e.g. : H-C-H or )C\ i ^ It combines with itself, and thus the number of its compounds is almost endless. These compounds are divided into two great classes, according to the mode in which the atoms are linked. (643) 644 ORGANIC MATERIA MEDICA. In the first class, or fatty series, the carbon atoms are supposed to be linked so as to form an open chain, e.g. : III II /0= -C-C-C- or -C-C-C &c. Ill II \c= I In the second class, or aromatic series, the carbon atoms are supposed to be linked so as to form a closed chain. ■c c- ii i c c- Some of the simpler compounds of carbon have already been con- sidered — carbonic acid, C0 2 (p. 487), hydrocyanic acid, HCN (p. 489), acetic acid, C 2 H 4 2 (p. 481). General Action. — It will be noticed that compounds of carbon with hydrogen alone, as in the hydrocarbons of the marsh-gas series; with oxygen alone, as in carbonic acid, C0 2 ; with sulphur alone, as in bisulphide of carbon, CS 2 ; or with chlorine alone, as in tetrachloride of carbon, CC1 4 , all tend to paralyze the nervous system, and to destroy the functional activity of its various parts in a definite order. Thought fails first, next sensation, and next reflex action (p. 188). The compounds with hydrogen have a comparatively slight action on muscle, but those containing chlorine are more powerful muscular poi- sons, and destroy the contractility of muscular fibre, both voluntary and involuntary. Many compounds containing oxygen in addition to carbon and hydro- gen have an anaesthetic action, e.g., alcohol and ether; others, like acetic acid, have a strongly irritant action. Compounds of carbon with nitrogen, hydrogen, and oxygen may have a very complicated chemical constitution, and, as in the organic alkaloids, have physiological actions which are too varied and specialized to allow of their being classed at present under a general law. U.S.P. Carbonei Bisulphidum. Bisulphide of Carbon. CS 2 ; 76. — Bisulphide of carbon should be kept in well-stopped bottles, in a cool place, remote from lights or fire. Characters. — A clear, colorless, highly refractive liquid, very diffusive, having a strong, characteristic odor, a sharp, aromatic taste, and a neutral reaction. It is insoluble in water; soluble in alcohol, ether, chloroform, and fixed or volatile oils. Specific gravity 1*272. It vaporizes abundantly at ordinary temperatures, is highly inflammable, boils at 46° C. (114°. 8 F.), and, when ignited, burns with a blue flame, producing carbonic and sulphurous acids. CARBON COMPOUNDS FATTY SERIES. 645 It should not affect the color of blue litmus paper moistened with water (absence of sulphurous acid). A portion evaporated spontaneously in a glass vessel should leave no residue (sulphur). Test solution of acetate of lead agitated with it should not be blackened (absence of hydrosulphuric acid). Action. — When inhaled it is a rapid, powerful, but transient anaes- thetic. Uses. — It is not used as an internal remedy. It can be used to pro- duce local anaesthesia by atomization. It has been employed as a local irritant in enlarged lymphatic glands, neuralgia, and deafness accom- panied by insufficiency of wax. FATTY SERIES. HYDROCARBONS. The chemical nature of a carbon compound depends on the arrange- ment of its constituent atoms, but its physical characters on the number of the atoms. The physical character of a compound greatly influences its physiological action, a gaseous body being more easily absorbed and excreted than a liquid, and a liquid more easily than a solid. There will also be differences amongst the gaseous, liquid, and solid bodies themselves ; for if a liquid, for example, has a low boiling-point so as to volatilize readily at ordinary temperatures, it will more resemble a gas in its action, while a liquid which has a high boiling-point will act more like a solid. Thus in the group of hydrocarbons belonging to the paraffin series the lowest members are gaseous at ordinary temperatures, the highest members form solid wax-like bodies, while those which are intermediate are liquid. Obviously we cannot expect a gas which can be inhaled in large quantities, and which will be quickly excreted when pure air is inhaled instead, to have the same action as a solid wax-like substance which can only be slowly absorbed, and slowly excreted or broken up in the organism. The boiling- -point of substances belonging to a series differs some- what according to the chemical nature of the substance, but amongst the members of the series having the same chemical nature it rises with the number of atoms. It will be seen from the accompanying table that the boiling-point differs according to the series, e.g., that of chlorides is lower than that of bromides ; this, again, is lower than that of iodides. In each series also of chlorides, bromides, or iodides, the boiling-point rises with the number of carbon atoms which the member of the series contains. As the action of substances depends so much on their volatility, it may be convenient to give here the boiling-points of the various members of the paraffin series : — 646 ORGANIC MATERIA MEDICA. Radical. •It c it r$ + § + ^ hi ""do 1 Methyl, CH 3 Ethyl, C,H* 12 V 5° ' 39° 46-4° 1 71° 77-6° 100-4° 105-6° 128*7° 40° 72° 102° 129-6° 153-4° 179-4° 221° Gas. Gas. Gas. 1° 38° 70° 99° 124° 202° 278° 66-0° 78-4° 97.40 116-9° 138° 158° 176° 192° 20-8° 48-8° 58° 92-5° 127-9° 150° Gas. 35° Propyl, C 3 H 7 Butyl, aH q 85° 140° Amyl, CvHn 163° Hexyl, C 6 H 13 Heptyl, C 7 H U Octyl, C S H 17 Dodecyl, C 12 H 23 .... Hexdecyl, or Cetyl,C 16 H 33 180° 199° 205° 281° 300° Melting Point. 55° Physiological Action of Hydrocarbons Belonging to the Marsh-Gas Series. — These hydrocarbons may be regarded as hydrides of the radicals, methyl, &c. Those low in the series — methane, ethane, propane, and butane — are permanent gases at ordinary temperatures, and when inhaled pure produce anaesthesia much like that of nitrous oxide. The intermediate fluid members of the series, e.g., pentane, and substances containing them, as benzin, petroleum oil, &c, give off vapor having an anaesthetic action somewhat like that of chloroform. The higher members of the series are solid at ordinary temperatures, and are used as a basis for ointments under the names of petrolatum, vaseline, cosmoline, &c. U.S. P. Benzinum. Benzin. Petroleum Benzin. Petro- leum Ether. — A purified distillate from American petroleum, consist- ing of hydrocarbons, chiefly of the marsh-gas series [C 5 H 12 ; C 6 H 14 , and homologous compounds], having a specific gravity from 0-670 to 0-675, and boiling at 50° to 60° C. (122° to 140° F.). Benzin should be carefully kept in well-stopped bottles or cans, in a cool place, remote from lights or fire. Characters. — A transparent, colorless, diffusive liquid, of a strong, characteristic odor, slightly resembling that of petroleum, but much less disagreeable ; neutral in reaction ; insoluble in water, soluble in about 6 parts of alcohol, and readily so in ether, chloroform, benzol, and fixed and volatile oils. It is highly inflammable, and its vapor, when mixed with air and ignited, explodes violently. Benzin, when evaporated upon the hand, should leave no odor, and, when evaporated in a warmed dish, should leave no residue (absence of heavy hydrocarbons). When boiled a few minutes with one-fourth its volume of spirit of ammonia and a few drops of test solution of nitrate of silver, the ammoniacal liquid should not turn brown (absence of pyrogenous products, and sulphur compounds); and it should require six parts of officinal alcohol to dissolve it (difference from benzol). If 5 drops are CARBON COMPOUNDS FATTY SERIES. 647 added to a mixture of 40 drops of sulphuric acid with 10 drops of nitric acid, in a test-tube, the liquid warmed and set aside for half an hour, and then diluted, in a shallow dish, with twice its volume of water, it should not have the bitter-almond-like odor of nitro-benzol (absence of benzol). Dose. — As a vermifuge, 30 min. Uses. — It is a good solvent for fats, resins, caoutchouc, and some of the alkaloids. It has been used externally as a sedative in prurigo and other cutaneous diseases, and internally as a vermifuge for tape-worm. XJ.S.P. Petrolatum. Petrolatum. [Petroleum Ointment. Vaseline.] — A semi-solid substance, consisting of hydrocarbons, chiefly of the marsh-gas series, C 16 H 34 , &c, obtained by distilling off the lighter and more volatile portions from American petroleum, and purifying the residue. Melting-point about 40° C. to 51° C. (104° F. to 125° F.), the first constituting the softer, and the second the firmer variety. When petrolatum is prescribed or ordered, without specifying its melting point, the low-melting variety, which liquefies at about 40° C. (104° F.), is to be dispensed. Characters. — A yellowish or yellow, fat-like mass, transparent in thin layers, more or less fluorescent, especially when melted, completely amorphous, tasteless and odorless, or giving off, at most, only a faint petroleum odor when heated, and having a neutral reaction. When gently heated, until the mass is almost entirely melted, the liquid portion has a specific gravity varying from 0*835 to 0*860. It is insoluble in water, scarcely soluble in alcohol, or in cold absolute alcohol, but soluble in 64 parts of boiling absolute alcohol, and readily soluble in ether, chloroform, bisulphide of carbon, oil of turpentine, benzin, benzol, and in fixed or volatile oils. When heated on platinum foil, it is completely volatilized without emitting the acrid vapors of burning fat or resin. If 5 Gm. of petroleum ointment be digested, for half an hour, with 5 Grm. of soda and 25 Grm. of water, the aqueous layer separated, and super- saturated with dilute sulphuric acid, no oily substance should separate (absence of fixed oils or fats of vegetable or animal origin, or of resin). Liquefied petroleum ointment agitated with sulphuric acid of specific gravity 1*540 should not acquire a dark color within two hours (absence of readily carbonized organic impurities). Uses. — These hydrocarbons, which are not liable to become rancid, have been found very useful as a bland protection, and as a substitute for animal and vegetable fats in the preparation of ointments. ALCOHOLS. Alcohols of the Series C 2 H 2n + 1#OH# — These may be regarded as hydrates of the radicals. They differ from the hydrides by the radical being united in them to hydroxyl, HO, instead of to hydrogen. The most important of them are : — Methyl alcohol, CH 4 0. Wood spirit. Ethyl alcohol, C 2 H 6 0. Spirit of wine. Propyl alcohol. C 3 H 8 0. Amyl alcohol, C 5 H 12 0. Fusel oil or potato spirit. 648 ORGANIC MATERIA MEDICA. These alcohols have all a toxic action when given in sufficiently large doses. The general effect they produce on the organism appears to be much the same in all, viz., paralysis affecting the nerve-centres in the inverse order of their development, Their lethal power and the symptoms they produce are modified by their physical characters, such as their solubility in water, and their volatility ; for if they are not readily soluble in water they cannot be readily absorbed, and probably will not be readily excreted. Their toxic power increases with their atomic weight, so that a less quantity of the higher alcohols will produce death. This is shown in the following table by Dujardin-Beaumetz. It will be noticed, however, that the lowest term and also the higher terms of the series form exceptions. This may possibly be due to rapid absorption as compared with excretion (p. 56) in the case of methylic alcohol, and to slow absorption in the case of cenanthic and caprylic alcohols : — Kind of Alcohol. Xon-fermented Fermented. Methylic Alcohol, CH 4 Non-fermented. Ethylic Propylic (Isopropylic) Butylic Amylic CEnanthylic Caprylic C 2 H 6 C 3 H 5 (C 3 H s O) C 4 H 10 O C;H 16 C S H 1S Mean toxic dose in grammes per kilogramme weight of the animal. Diluted. 7-0 7-75 375 (3'7 to 3-8) 1-85 1-50 All the alcohols produce symptoms which are divided by Dujardin- Beaumetz into three stages, the first of which corresponds to the first and second stages of action I have given at p. 188, and his second and third corresponding to the third and fourth of mine respectively. These stages are modified "by (a) the kind of alcohol used, (b) its quantity, and ( or K 2 0, corresponds to C H ) Q 2 TT fi [Oor (C 2 H 5 ) 2 0, ethylic ether. 2 ■> J iEther, U.S.P. and B.P. (C 2 H 5 ) 2 ; 74. Ether. A liquid composed of about 74 per cent, of ethyl oxide, C 2 H 5 ; and about 2G per cent, of alcohol containing a little water. Specific gravity about 0-750 at 15° C. (59° F.), U.S.P. A volatile liquid prepared from alcohol, and containing not less than 92 per cent, by volume of pure ether, C 4 II 10 O, B.P. Preparation. — By distilling rectified spirit with sulphuric acid, and freeing the ether thus obtained from water by redistillation with calcium chloride and lime. CARBON COMPOUNDS FATTY SERIES. 661 In this process ethylsulphuric or sulphovinic acid and water are first formed, ethyl replacing one atom of hydrogen in the sulphuric acid. Sulphuric Acid. Alcohol. Ethylsulphuric Acid. Water. 2}so 4 + °A|o = °A}so 4 + g}o. By the action of fresh alcohol on the ethylsulphuric acid it is decom- posed, ether being formed and sulphuric acid being reproduced. Ethylsulphuric Sulphuric Acid. Alcohol. Acid. Ether. C 2 H 5 H } so * + ajt} = 5} SOj + ck}°- Theoretically this process might go on ad infinitum if fresh alcohol were continually supplied, but practically the acid volatilizes partly in the form of oil of wine, so that the process cannot go on indefinitely. Characters and Tests. — A colorless, very volatile and inflamma- ble liquid, emitting a strong and characteristic odor, and boiling below 105°. Specific gravity 0-735. Fifty measures agitated with an equal volume of water are reduced to 45, by an absorption of 10 per cent. It evaporates without residue. Impurities. — Water, alcohol, and fixed impurities. Tests. — Water is detected by the greater sp. gr., and so is alcohol ; the fixed impurities by their remaining on evaporation. Dose.— 20 to 60 min. B.P. Peepaeattons. iEther Purus Collodium 6 volumes in 8 nearly. " Flexile 6 volumes in 8 " Liquor Epispasticus 4 volumes in 5 " Spiritus ^theris 1 volume in 3 " U.S. P. ^Etlier Fortior. Stronger Ether, (C 2 H 5 ) 2 ; 75. Peepabations. Spiritus JEtheris. Spiritus iEtheris Compositus. Characters. — A liquid composed of about 94 per cent, of ethyl oxide and about 6 per cent, of alcohol, containing a little water. Specific gravity not higher than 0-725 at 15° C. (59° F.) or 0-716 at 25° C. (77° F.). Ether is highly inflammable, and its vapor when mixed with air and ignited explodes violently. It should boil actively in a test-tube half filled with it and held a short time in the hand on the addition of small pieces of broken glass. Uses. — Used for inhalation as an anaesthetic. B.P. JEther Purus. Pure Ether. — Ether, C 4 H 10 O, free from alcohol and water. Preparation. — By washing ether with distilled water, and then dis- tilling from calcium chloride and recently calcined lime. 062 ORGANIC MATERIA MEDICA. Uses. — Used as an anaesthetic ; to prepare some alkaloids, as aconitine ; to test the amount of quinine in bark. Test. — Specific gravity not exceeding 0*720. Spiritus iEtheris, TJ.S.P. and B.P. Spirit OF Ether. — It is a mixture of ether (1), rectified spirit (2). Test. — Specific gravity, 0*809. Dose. — 30 to 90 min. Peepaeation. B.P. Tinctura Lobeliae iEtherea. Uses. — Spirit of ether is used as carminative and stimulant. It is useful in lessening the pain in passage of biliary or urinary calculi. Action of Ether. — When applied to the skin ether evaporates very readily, and causes intense cold. The application of ether to the surface will freeze it completely, and render it perfectly insensitive to pain. If the freezing be continued for too long a time, the frozen part may be killed, and separate as a slough. In the niouth, ether acts as a powerful stimulant to the salivary secretion. In the stomach it increases the secretion of gastric juice, stimulates the movements of the organ, expels flatulence, and probably tends to increase the co-ordination of the move- ments of the stomach and intestine, so that it diminishes spasm and relieves pain. When absorbed into the circulation from the intestine, or, still more markedly, when absorbed from the lungs after an inhalation, it first stimulates the circulation, and, after a very brief, and perhaps hardly perceptible period of stimulation of the nerve-centres, it depresses their powers in succession. First of all it affects the cerebral hemis- pheres, causing delirium and unconsciousness ; next, the gray matter of the spinal cord ; next the white matter of the spinal cord, and lastly the cardiac and vaso-motor centres in the medulla oblongata. It does not appear to destroy the irritability of the muscles in animals poisoned by it, but muscles exposed to its vapor soon lose their contrac- tility, and fall into a condition of rigor mortis. Nerves, also, which are exposed to its vapor, lose their irritability, so that when attempted to be irritated, they no longer respond, the irritability of the sensory fibres apparently disappearing before that of the motor fibres. When the vapor is applied only for a short time, they may regain their irritability, but if its application be continued too long, the irritability is permanently destroyed. There is no marked alteration in the blood of animals poisoned by ether, but when mixed in small quantity with blood outside the body, it appears to form a compound with the lncmoglobin, and to lessen its oxidizing power. If mixed with the blood in large quantity, it destroys the blood corpuscles, probably by dissolving the protogon which forms an essential constituent of them. The heart is very much less easily paralyzed by ether than by chloro- form. If two rabbits are thoroughly narcotized by ether and chloroform vapor respectively, and the thorax opened, and artificial respiration kept up with air containing these vapors, the heart of one can be readily stepped by increasing the proportion of chloroform vapor in the air blown in, whereas the heart of the other is only arrested when the proportion CARBON COMPOUNDS FATTY SERIES. 663 of ether vapor becomes exceedingly large. It is this peculiarity of ether which gives it the advantage over chloroform, and renders death from syncope during operations less probable when ether is employed as an anaesthetic. Another difference between ether and chloroform, which renders the former much safer as an anaesthetic, is that the vaso-motor centre appears, like the heart, to be very much less readily affected by ether than by chloroform, so that irritation of a sensory nerve continues for a longer time to raise the blood-pressure when ether is employed as an anaesthetic. The disadvantages of ether are that it is less agreeable to take, and that its odor hangs unpleasantly about the patient for a much longer time than is the case with chloroform. It causes greater irritation of the air passages, and may produce a catarrhal condition. It has to be administered in a more concentrated form than chloroform, and thus is not so convenient as the latter when operations on the face and mouth are necessary. It is frequently administered along with nitrous oxide, the nitrous oxide being first given alone until the patient is sufficiently under its influence not to notice the taste or smell of the ether. Nitrous oxide loaded with ether vapor is then given, and as soon as complete insensibility is induced air is mixed with ether vapor, the anaesthesia being maintained by regulating the proportion of vapor according to the condition of the patient. SALINE ETHERS. These correspond to metallic salts, in which the metal is replaced by an organic radical, e.g. : Potassium Sulphate. Ethyl Sulphate. 1 1 S0 4 or K 2 S0 4 . £g | S0 4 or (C 2 H 5 ) 2 S0 4 . U.S. P. Oleum ^thereuin. Ethereal Oil. — A volatile liquid, consisting of equal volumes of heavy oil of wine and of stronger ether. The heavy oil of wine is either a mixture of ethyl sulphate (C 2 H 5 ) 2 S0 4 , ethyl sulphite (C 2 H 5 ) 2 S0 3 , and a polymeric form of ethylene (C 2 H 4 ), or else a sulphovinate of a hydrocarbon radical. Preparation. — By mixing alcohol with sulphuric acid, allowing it to stand for twelve hours, and then distilling. The distillate consists of three layers — ether, water and yellow ethereal oil of wine. The yellow oil of wine is separated and exposed to the air for twenty-four hours in a shallow capsule, so that any ether evaporates. It is then put in a wet filter, washed with distilled water, and mixed with an equal volume of stronger ether. Characters. — A transparent, nearly colorless, volatile liquid, of a peculiar aromatic ethereal odor, a pungent, refreshing, bitterish taste, and a neutral reaction to dry litmus paper. Specific gravity, 0*910. Peepaeation. Spiritus iEtheris Compositus. 664 ORGANIC MATERIA MEDICA. Spiritus ^Etheris Coinpositus, U.S. P. and B.P. COMPOUND Spirit of Ether. — Hoffmann's anodyne. Composition. — Stronger ether 30, alcohol 67, ethereal oil 3 parts. Use. — Like that of spirit of ether, but more powerful. It is given in similar doses. iEther Aceticus, U.S.P. and B.P. Acetic ^Ether. C 2 H 5 C 2 H 3 2 ; 88. Acetate of Ethyl. Preparation. — By distilling rectified spirit with acetate of soda and sulphuric acid, NaC 2 H 3 2 + H 2 S0 4 + C 2 H ? = C 2 H 5 ,C 2 H 3 2 + NaH S0 4 -j- H 2 0. The acetic ether and water distil over together, and they are separated by means of calcium chloride. Characters. — A transparent and colorless liquid, of a strong fra- grant ethereal and somewhat acetous odor, a refreshing taste and a neutral reaction. Dose.— 20 to 60 min. Uses. — It has an action much like ether, but is inconvenient as an anaesthetic. It has a pleasanter taste than ether, and is used as a stimu- lant, carminative, and antispasmodic. It may be given along with the acetates of iron and potash in albuminuria. Spiritus JEtheris Xitrosi, U.S.P. and B.P. SPIRIT OF NlTROUS Ether. An alcoholic solution of ethyl nitrite (C 2 H 5 N0 2 ; 75), containing 5 per cent, of the crude ether, U.S.P. A spirituous solution containing nitrous ether (C 2 H 5 N0 2 ; 75), B.P. Preparation. — By distilling rectified spirit with nitric and sulphuric acids and copper wire, and diluting the distillate with spirit. In this process the copper reduces the nitric to the nitrous radical. C 2 H 5 HO + HN0 3 + H 2 S0 4 + Cu = C 2 H 5 N0 2 + 2H 2 + CuS0 4 . Impurities. — Water, free acid. Characters and Tests. : — Transparent and nearly colorless, with a very slight tinge of yellow, mobile, inflammable, of a peculiar penetrat- ing apple-like odor, and sweetish cooling sharp taste. Specific gravity, 0-845. It effervesces feebly or not at all when shaken with a little bicarbonate of soda (no acid). When agitated with solution of sulphate of iron and a few drops of sulphuric acid it becomes deep olive-brown or black. If it be agitated with twice its volume of saturated solution of chloride of calcium in a closed tube, 2 per cent, of its original volume will separate in the form of nitrous ether and rise to the surface of the mixture (proper strength). Dose. — 3 to 2 fluid drachms. Use. — Is used as a diaphoretic and diuretic. Preparation. U.S.P. Mistura Glycyrrhizie Composita. Amy] Nitris, U.S.P. and B.P. Nitrite of Amyl. C 5 H n N 2 2 ; 117. Preparation. — By distilling dilute amyl alcohol with nitric acid, sulphuric acid and copper wire. The distillate is washed with caustic CAKBON COMPOUNDS FATTY SERIES. 665 soda to remove hydrocyanic and other acids ; the moisture removed by potassium carbonate, and the nitrite purified by fractional distillation. Characters. — A yellowish liquid with a strong ethereal, fruity smell. When freely exposed to air it decomposes, leaving a large residue of amyl alcohol. Insoluble in water, but soluble in all proportions in alcohol, ether and chloroform. Impurities. — It is apt to contain free acid, nitrate of amyl, nitro- pentone. Tests. — The physiological test is the most certain. One or two sniffs from a bottle containing the nitrite are usually sufficient to produce flushing of the face and fulness in the head. If the preparation is impure or has lost its strength, this effect does not occur. Some specimens are entirely inert. Physiological Action. — When mixed with blood it forms methte- moglobin ; which is not so readily deoxidized as haemoglobin itself. The blood, under the influence of the nitrite, becomes of a dark chocolate color, both in the arteries and veins, and oxidation in the body is inter- fered with; so much so, that in rabbits convulsions almost exactly resembling those of ordinary asphyxia are very rapidly produced by the inhalation of the drug. The methaemoglobin may be broken up by reducing agents, and the blood will then take up oxygen again. It is therefore probable that when the venosity of the blood becomes great, the unoxidized products of tissue-waste will act as reducing agents, and again restore the internal respiration. When inhaled, nitrite of amyl causes at first a short, dry, tickling cough, followed in about half a minute by flushing of the face, throbbing of the carotids and their branches, a quicker and fuller pulse, a feeling of tension in the head, sometimes lachrymation, quickened respiration and giddiness. The giddiness is more especially felt if the patient is sitting up. If the dose of nitrite be large the respiration becomes very quick, labored and dyspnceic. The blood-pressure is very greatly lessened by nitrite of amyl, the dimi- nution being chiefly due to dilatation of the arterioles. The pulse in man and in dogs is very much quickened by it. In rabbits the accelera- tion is not so great. This appears to show that the quickening is in a great measure due to diminution in the tone of the vagus roots in the medulla, caused by the fall of blood-pressure. The dilatation of the arterioles appears to be due to weakening or paralysis, either of the mus- cular walls of the arterioles themselves, or of the vaso-motor ganglia in or near them. This is shown by the fact that the nitrite of amyl lowers the blood-pressure in animals, even after the cord has been divided just below the medulla. It has been objected to this that Bernheim has found that when the capillaries are dilated by nitrite of amyl they may still be made to contract, by irritation of the vaso-motor nerves ; and he concludes from this that the dilatation is due rather to paralysis of vaso-motor centres than to vaso-motor nerves, or to the arterioles. It is possible that the dilatation may be partly due to weakening of the vaso-motor centres also ; but Bernheim' s objection is altogether without force, because in animals killed by curare, the muscles will still contract on the application of an electric current to the motor nerves. In this case the nerves are so far paralyzed that they will no longer respond to the stimuli sent down from 666 ORGANIC MATERIA MEDICA. the nerve-centres, although they will do so to strong currents, and proba- bly the same thing occurs with the muscular walls of the arterioles when paralyzed by nitrite of amyl. Action on Muscles. — The voluntary muscles are not paralyzed in animals poisoned by nitrite of amyl, but when the muscles of a frog are exposed to the vapor they soon lose their contractility. It was stated by Dr. Richardson that nitrite of amyl, like curare, paralyzed the ends of the motor nerves, and that it acted in consequence as an antidote to strychnia. On repeating his experiments other obseiwers have failed to detect any paralysis of motor nerves ; I have found that nitrite of amyl alone does not paralyze them, nor does strychnine alone, but if a frog be poisoned with strychnia after one leg has been protected by a ligature from the influence of poison, and is then exposed to the vapor of nitrite of amyl, the joint action of the strychnine and nitrite paralyzes the ends of the motor nerves, while the nerves of the limb protected from the strychnine retain their irritability, although both were equally exposed to the nitrite of amyl. 1 Action on the Nervous System. — It lessens reflex action, appa- rently by its action on the spinal cord. On the Urine. — When nitrite of amyl is given to animals either by inhalation or hypoclermically, sugar appears in the urine. Uses. — The action of nitrite of amyl in causing flushing was first observed by Guthrie, and Dr. B. W. Richardson recommended it as a remedy in spasmodic conditions, from the power he thought it to possess of paralyzing motor nerves. In the spring of 1867, I had opportunities of constantly observing a patient who suffered from angina pectoris, and of obtaining from him numerous sphygmographic tracings, both during the attack and during the interval. These showed that during the attack the pulse became quick, the blood-pressure rose, and the arterioles contracted ; for the form of the pulse curve was such as could only be caused by con- traction of the arterioles (Fig. 135). The pain, which came on every FlO. 135.— Normal pulse-tracing of a patient suffering from aortic regurgitation and angina pectoris. night, lusted for one and a half or two hours. All other remedies were Dearly useless, though bleeding always removed the pain for one night. It seemed probable that the great rise in tension was the cause of the pain, and it occurred to me that if it was possible to diminish the tension by drugs instead of* by bleeding, the pain would be removed. I knew from unpublished experiments by Dr. A. Gramgee, that nitrite of amy] had this power, and therefore tried it on the patient. My expec- tations \u-rc perfectly answered. The pain usually disappeared in three- 1 These experiments were made with Rana temporaries CARBON COMPOUNDS FATTY SERIES. 667 quarters of a minute after the inhalation began, and at the same time the pulse became slower and much fuller, and the tension diminished. Occa- sionally the pain would disappear, though the pulse regained its normal fulness, and on these occasions the pain always reappeared after the lapse of a few minutes (Fig. 136). Whenever the pulse again regained its Fig. 136. — Tracing of the same pulse during severe anginal pain. normal character completely (Fig. 137), I knew that the pain would not again return. Fig. 137. — Tracing of the same pulse during temporary relief of pain by nitrite of amyl. The pain returned after a few minutes. In some cases of angina pectoris nitrite of amyl has failed. One reason of this may be either that the drug has not been pure, or that it has undergone changes from age. In one case mentioned to me by Dr. Balfour, the patient was only relieved by nitrite of amyl newly made, the drug appearing to lose its power in a few days. From its power of relaxing vascular spasm, I used it in headache and found it occasionally serviceable. As migraine is generally connected with vascular spasm, I employed the nitrite of amyl in headache, and found that frequently, though not invariably, it relieved the pain. It was also useful in neu- ralgia of the scalp. As epilepsy has been supposed to depend upon spasmodic contraction of the cerebral vessels, I employed it in this disease, during the fit, without success, but Dr. Crichton Browne found that when administered immediately after the appearance of the aura it prevented the fit which would otherwise have come on. In sea-sickness, a disease probably of cerebral, rather than gastric origin, nitrite of amyl appears to give relief. It has been employed to aid circulation in cases of syncope, and in chloroform poisoning, its administration in the latter case being combined with the depression of the patient's head below the level of his body, and the use of artificial respiration. In spasmodic asthma it sometimes affords some relief, but this is not very marked. It is useful in the case of persons who are subject to sudden flushes of heat and profuse perspiration. The administration of nitrite of amyl is not attended with much danger. I have pushed it in many cases, and have seen no bad effects from its use. In cases of chronic bronchitis and emphysema, however, it is advisable not to give it even for the relief of asthmatic attacks which come on in this disease, as the difficulty of breathing already present may be seriously increased by the action of the drug upon the blood. It has been thought that its administration would be especially 668 ORGANIC MATERIA MEDICA. dangerous in aortic disease ; and no doubt it is well both in this disease and in other cases to give the drug in the recumbent posture and thus avoid the faintness which might otherwise occur. Although it causes a feeling of fulness in the head, little danger of apoplexy is to be apprehended from it, because the blood-pressure, instead of being higher, is much lower than usual, and therefore the tendency of the vessel to burst must be reduced to its minimum. Xitro-glycerinuin. NiTRO-GLYCERlNE, Glonoine. C 3 H 5 (N0 3 ) 3 . Not officinal. Preparation. — By dropping pure glycerine into a mixture of sul- phuric and nitric acid kept cool by ice, pouring the mixture into water ; washing it well ; and carefully drying in a warm room. Properties. — A colorless transparent liquid ; aromatic taste ; slightly soluble in water, readily soluble in absolute alcohol and ether, soluble also in oils and fats. Dose. — ^iTo t0 oV increased to -^ grain. Peepaeations (Non-officinal). 1 DOSE. Liquor Nitro-glycerini (1 gr. in 100 min. rectified spirit)... J-10 min. Pilula Nitro-glycerini ( 3 V or -jfa gr. with cacao butter) 1-2, or more. Trochisci Nitro-glycerini. (Nitro-glycerine tablets). ( T ^gr. in chocolate) 1-2, or more. Action. — Its action is much like that of nitrite of amyl and other nitrites, but is more persistent. In frogs it causes at first great rest- lessness, then lethargy, to which convulsions and paralysis succeed. In mammals it causes depression, with very rapid pulse and respiration, paralysis of reflex action and voluntary motion, loss of sensation, and death by stoppage of the respiration. It agrees with nitrites in acting as a poison to muscle. The spinal cord appears to be paralyzed before the cerebral ganglia, and the convulsions in frogs are of cerebral rather than spinal origin. It paralyzes the heart of the frog when directly applied. It diminishes the oxidizing power of the blood and communicates to it a chocolate color, like nitrites, and like them also it lessens the blood-pressure. In some persons it produces intense headache even in exceedingly minute doses. It is curious that its action upon the blood and organs should so exactly resemble that of nitrites, because nitro-glycerine is a nitrate and not a nitrite of glyceryl. Hay has shown, however, that nitro-glycerine is decomposed by alkalies, two-thirds of its nitric acid being reduced to nitrous acid and uniting with the alkali to form a nitrite, whilst the remaining third is set free without reduction and forms a nitrate. The reasons why nitro-glycerine acts more powerfully than nitrites probably are that the whole of it is absorbed without decomposition, and that nitrous acid being set free in the blood in a nascent condition is more active than it would otherwise be. USES. — Like nitrite of amyl, it is useful in angina pectoris, head- ache, neuralgia, epileptic vertigo, and epilepsy. Its action being more 1 Mart judaic and Westcott, The Extra Pharmacopoeia. CARBON COMPOUNDS — FATTY SERIES. 669 persistent than that of nitrite of amyl, it is sometimes more efficacious. It sometimes is of service in spasmodic asthma, uraemic asthma, and in puerperal convulsions. It frequently relieves sea-sickness, and may lessen pain in gastralgia and hepatic colic. By dilating the vessels it may cut short or prevent the cold stage of ague. By lessening the arterial tension and diminishing the resistance the heart has to overcome, it is useful when the heart is weak in old persons, or from fatty degenera- tion, or where the tension is abnormally high, as in Bright's disease. In conjunction with elaterium it is said to have proved useful in myxoedema. HALOID COMPOUNDS. These correspond to haloid salts of metals, e.g. : Potassium Bromide. Ethyl Bromide. KBr. (C 2 H 5 )Br. ^thyl Bromidum. Bromide of Ethyl. C 2 H 5 Br (Hydro- bromic Ether). — Not officinal. Preparation. — By distilling alcohol with bromine and phosphorus. Characters. — A colorless volatile liquid; of peculiar odor; sweetish taste. Specific gravity, 1-419. Action and Uses. — When applied as spray it produces local anaes- thesia, which seems to depend on the action of the drug on the nerves as well as on the cold produced. It is used as a local anaesthetic in neuralgia. When inhaled it produces anaesthesia, and has been recommended as an anaesthetic either alone or as a mixture of 1 part of it with 3 of chloroform and 4 of alcohol. Its advantages are that it is not inflammable like ether, that it does not irritate the respiratory pas- sages, and that it causes less excitement and struggling than ether or chloroform, and is less depressing than chloroform. Its disadvantages are that it is not absolutely safe, as one death at least has occurred from its use. Its odor remains longer in the breath than either chloroform or ether, and some patients dislike its smell extremely. JEthyl Iodidum. Iodide OF Ethyl, C 2 H 5 I. (Hydriodic Ether). — Not officinal. Preparation. — Like bromide of ethyl, using iodine instead of bromine. Characters. — A colorless liquid, with a penetrating odor. It is apt to become decomposed by keeping, and acquire a brown color from free iodine. Action and Uses. — It has an anaesthetic action when inhaled, which is more slowly produced but is more persistent than that of ethyl bromide. It is decomposed in the body, and the iodine is excreted in the urine as iodide of potassium. It has been given internally as an alterative in doses of 0*2 to 0*5 Gm. in scrofula and rheumatism, and as a diuretic in cases of cardiac dropsy. Its chief use, however, is as an antispasmodic in asthmatic paroxysms, either of the purely spas- modic kind, or occurring in chronic bronchitis and emphysema, or in cardiac or laryngeal disease. In some of these cases it gives very great 670 ORGANIC MATERIA MEDICA. relief, and not only cuts short the paroxysm, but benefits the bronchitic condition, where this is present (cf. p. 520). Administration. — It is best given in small glass capsules, containing 5 minims, and incased in cotton-wool and silk. These can be readily carried about, and when the paroxysm comes on one is crushed between the finger and thumb, and the vapor inhaled from the cotton-wool, which becomes soaked by the iodide. Chloral, U.S. P.; Chloral Hydras, B.P. C 2 HCl 3 O.H 2 0; 1652. Chloral, U.S. P.; Hydrate of Chloral (Chloral Hydrate), B.P. Preparation. — By saturating absolute alcohol with dry chlorine gas much hydrochloric acid gas is formed, and the alcohol is first reduced to aldehyde, which is then attacked by the chlorine, forming XxicMoral- dehyde, a word which has been shortened to chloral. Chloral is an oily liquid, which unites with a small quantity of water to form chloral hydrate. Characters. — Whitish crystals with a peculiar very pungent odor, a bitterish caustic taste, and a neutral reaction. It melts when heated, forming colorless liquid, and volatilizes if the temperature be further raised. It is soluble in less than its own weight of water, alcohol, or ether, and in four parts of chloroform. When mixed with carbolic acid or camphor it liquefies. When mixed with alkalies it is decomposed into chloroform and a formate of the base. Impurities. — Hydrochloric acid and oily impurities. Test. — The aqueous solution should be neutral or only slightly acid. A solution in chloroform when shaken with sulphuric acid should not impart color to the acid (absence of oily impurities). Prepaeatiox. B.P. DOSE. Syrupus Chloral. Syrup of Chloral. Chloral in syrup and water, 10 grs. in each fl. dr 1 fl. dr. Action of Anhydrous Chloral. — Anhydrous chloral applied to the skin is absorbed and converted in the organism into chloral hydrate. When thus applied it sometimes occasions hemoglobinuria and nephritis. Anhydrous chloral being little used, the name "chloral" is applied in ordinary conversation to chloral hydrate, and in the following account of the action of chloral hydrate the name chloral is intended to apply to the hydrate. Action of Chloral Hydrate. — It destroys low organisms, and prevents the decomposition which they occasion. It is therefore some- times used as an antiseptic. In the mouth chloral has a hot, burning taste, and when applied to a raw surface, or to the mucous membrane of the eve it is a powerful irritant. When injected under the skin in a strong solution it is apt to cause inflammation and suppuration. It was intro- duced into medicine by Oscar Liebreich, with the object of attaining by it the same effect- as those of chloroform slowly administered for a length of time. When chloral is mixed with an alkali it is split up, yielding formic acid, which combines with the alkali and chloroform. Liebreich thought that if chloral were administered internally the alkalies of the blood CARBON COMPOUNDS FATTY SERIES. 671 would slowly split it up, and that chloroform would thus be slowly gene- rated from it in the circulating blood for a considerable length of time. His expectations regarding the utility of chloral as a means of producing sleep and relieving pain have been fully answered, but the theory which led him to employ chloral appears to be erroneous, and it probably acts as a hypnotic and analgesic without undergoing any decomposition in the body. The experiments which have led to the conclusion that chloral is not decomposed in the body are chiefly those of Hammersten, who found that when a stream of carbonic acid was passed through the blood taken from chloralized animals, and then passed through a red-hot tube into a mixture of starch paste and iodine or a solution of nitrite of silver, no reaction occurred, and that the slightest addition of chloroform to the blood or the administration of the chloroform to the animal beforehand always caused a reaction to take place. The expired air of chloralized animals is also free from chloroform. The chloral is excreted in the urine as such so long as the urine is acid, and it is only when the urine is alkaline that chloroform is found in it, this being formed by the decomposition of the chloral by the alkali in the urine itself. In frog's, small doses slow the respiration, and abolish reflex action, but the animal recovers perfectly after several hours. When the dose is increased, the stoppage of the heart follows the cessation of reflex movements and the animal dies. In mammals, the respiration also becomes slow, the pupil contracted, and sleep occurs. From this the animal may first be awakened with ease, but it gradually becomes deeper, and the reflex movements disappear. Insensibility occurs first to painful impressions, so that the animal may be cut or burned without showing the slightest symptoms of sensation, whereas it will still withdraw its limb quickly when a slight pressure is made upon the toes. When larger doses are given, the temperature gradually falls until it can no longer be measured by an ordinary clinical thermometer. The respi- ration gets slower and weaker, and finally ceases altogether. When chloral is added to the blood, it causes the red corpuscles to swell up and become paler, but does not dissolve them. Action on the Circulation. — It diminishes the blood-pressure in two ways — first by weakening and finally paralyzing the vaso-motor centre, and thus dilating the vessels; and secondly, by weakening the heart. The pulse may at first be quickened, possibly, in consequence of the lessened blood-pressure, but it afterwards becomes slow. The slow- ing of the pulse is not due to any action of the drug upon the vagus, for it occurs after section of the vagi, or after the previous administration of nicotine, atropine, or curare. The weakening and final stoppage of the heart appears to be due to paralysis of the cardiac ganglia, as the heart still continues to contract when its muscular substance is irritated directly. Action on Muscles and Motor Nerves. — The muscles and motor nerves are not paralyzed by chloral. The paralysis and loss of sensibility is of spinal origin. Action on the Spinal Cord. — Chloral first increases and then diminishes the excitability of the spinal cord, and finally abolishes it altogether. It probably acts first upon the gray matter, as impressions which are usually painful are not felt at a time when tactile impressions still produce reflex. 672 ORGANIC MATERIA MEDICA. Action on the Brain. — At first it may cause a little excitement of the brain, followed by sleep, and then by coma. These actions are probably due partly to the influence of the drug on the circulation, and partly to its direct action on the cerebral tissue itself. In the first stage of excitement the circulation in the brain is somewhat increased, but as sleep comes on the vessels contract and the brain becomes anaemic. The pupil is almost invariably contracted ; the temperature, as has already been mentioned, falls steadily and rapidly, and this fall appears to be due partly, though not entirely, to lessened production of heat, for it still occurs, though to a less extent, when the animal is wrapped up in cotton-wool, or is put in a warm place. The Treatment of Chloral Poisoning. — In conjunction with Professor Strieker, I found that animals which had received a dose of chloral which would certainly kill them if they were left exposed, w T ould recover from the effects of such a dose if they were wrapped up in cotton- wool. If the dose be still further increased, so as to kill the animal even when carefully so wrapped up, it may still be kept alive by being put in a warm place, so that its temperature is kept up artificially. If, how- ever, the dose be still further increased, the animal will die, notwith- standing these precautions. The treatment of cases of poisoning in man is the same as in animals, viz., to keep up the temperature of the patient by putting him in a warm room, covering him with blankets, and apply- ing hot bottles. Uses. — If equal parts of chloral and powdered camphor are rubbed together, they dissolve, and form a syrup. This is useful in neuralgia, when painted over or gently rubbed into the painful part. The chief use of chloral is to produce sleep. It is useful as a hypnotic in the sleeplessness due to overwork or worry, and the wakefulness depending on constitutional peculiarity, old age, or disease, such as fever, delirium tremens, insanity, and puerperal mania. In the later stages of Bright's disease, where there is great sleeplessness accompanied by high blood-tension, chloral is very useful. The sleep which it causes is generally quiet and refreshing, and as a rule it is not followed next day by sickness, headache, and depression, like the sleep caused by opium. Usually, also, the sleep is not too deep to prevent the patient being readily awakened for the purpose of taking food. Chloral may be used to lessen reflex excitability and diminish con- vulsions, as well as to produce sleep. For this purpose it is given in puerperal convulsions, in the convulsions of children, and in chorea and tetanus. In these two latter diseases it must be given in large doses. It alleviates the dyspnoea in spasmodic asthma, and the asthmatic attacks which occur in persons laboring under chronic bronchitis with emphysema. In cases of this sort, however, it is well to give it with care, for Ringer states that in them it often produces increased lividity and muttering delirium, lasting for several days. The action of chloral as an anaesthetic or analgesic is much slighter than that of chloroform, but nevertheless it sometimes relieves pain, and for this purpose it has been used in gastralgia, intestinal and renal colic, neuralgia, and chronic rheumatism. It has been recommended by Dr. Play fair in doses of 15 grains, repeated, if necessary in twenty minutes, CARBON COMPOUNDS FATTY SERIES. 673 and before the os uteri has become completely dilated, to lessen pain in labor. Chloral is an antidote to strychnine, physostigma, and picrotoxin. Liebreich states that strychnia is an antidote to chloral; and while some observers have confirmed his statement, others have denied it, so that strychnine has certainly not the same power of antagonizing the action of chloral as chloral has of antagonizing strychnine. Chloral is a useful remedy in sea-sickness, and in the incontinence of urine in children. Bromal Hydrate. C 2 H 3 OH. — Not officinal. Preparation. — It is prepared in the same way as chloral hydrate, bromine vapor being employed in the place of chlorine. Characters. — An oily, colorless substance, with a strong smell and burning taste. Action. — It irritates the eyes and produces running at the nose. It has a narcotic action like chloral, but causes more excitement and less profound sleep. It has a more powerful paralyzing action on the heart, and is poisonous in smaller doses than chloral. It generally causes salivation, and profuse secretion from the bronchial mucous mem- brane accompanied by congestion. In toxic doses it produces cyanosis, dyspnoea, and death with convulsions, which are probably due, in great measure at least, to clogging of the respiratory passages. Use. — It is said to have been of use in epilepsy. Butyl Chloral Hydrate. Croton Chloral Hydrate. — Not officinal. Preparation. — By acting on aldehyde with chlorine. Characters. — It forms white, pearly, crystalline scales, with a pun- gent smell and acrid, disagreeable taste. It is sparingly soluble in water {1 in 100), but is readily soluble in glycerine (1 in 4). Dose. — To lessen pain, 1 J— 5 gr. (0*1— 0*3 Gm.) ; as hypnotic, 5-15 gr. (0-3-1-0 Gm.). Action. — It acts much like chloral, though less powerfully, and has a less depressing effect on the heart, and is much less poisonous than chloral. It is said by Liebreich to affect the fifth nerve especially, and cause anaesthesia in the parts supplied by it before general anaesthesia is produced. Uses. — It has been used especially in facial neuralgia and migraine, and paroxysmal toothache. It has been used also as a hypnotic instead of chloral in cases of weak heart. Administration. — The disagreeable taste is best covered by syrup of tolu, and it may be suspended in almond mixture or mucilage. Bichloride of Methylene. CH 2 C1 2 . — Not officinal. Preparation. — By acting on chloroform with nascent hydrogen, CHCls + H 2 = CH 2 C1 2 + HC1. Characters. — A colorless, volatile liquid, with a smell like chloro- form. Sp. gr. 1-344. Boiling-point, 40° C. (104° F.). Action. — Like that of chloroform, but more rapid, though a larger quantity is required. It is said to depress the action of the heart more 43 674 ORGANIC MATERIA MEDICA. than chloroform, but it has been found a very satisfactory anaesthetic in ovariotomy, and is more used than other anaesthetics in this operation. It is very doubtful whether the substance sold as bichloride of methyl- ene is anything but a mixture of chloroform and alcohol, as the pure substance is expensive. Cliloroformmn Venale, U.S. P. ; Chloroformum, B.P. CHLO- ROFORM. CHC1 3 ; 119-2. Preparation. — By distilling alcohol with chlorinated lime and slaked lime, washing the distillate with sulphuric acid, and redistilling from slaked lime and calcium chloride. In this process the alcohol probably first becomes reduced to aldehyde. From the aldehyde, chloral is formed, and this is broken up by the caustic lime into formate of calcium and chloroform. Aldehyde. Chloral. C 2 H 4 + 3C1 2 = C 2 HC1 3 + 3HC1. Formate of Calcium. Chloroform. 2C 2 HC1 3 + Ca2HO = Ca2CH0 2 + 2CHC1 3 . Or, disregarding the intermediate steps, the reaction may be represented thus : — Alcohol. Calcium hypochlorite. 4C 2 H 6 + 8CaCl 2 2 = 2CHC1 3 + 3(Ca2CH0 2 + 5CaCl 2 + 8H 2 0). Characters and Tests. — A limpid, colorless liquid, of an agreeable ethereal odor, and sweet taste. Dissolves in alcohol and ether in all pro- portions; and slightly in water, communicating to it a sweetish taste. Burns, though not readily, with a green and smoky flame. Specific gravity 1*49. It is not colored by agitation with sulphuric acid, leaves no residue and no unpleasant odor after evaporation. Impurities. — Hydrochloric acid, chlorine, hydrocarbons, alcohol. Tests. — The same as those of purified chloroform. Dose. — 3 to 10 min. U.S.P. Chloroformum Purificatum. Purified Chloroform. CHC1 3 ; 119-2. Preparation. — By mixing chloroform (200) with sulphuric acid (60) and allowing them to stand, with occasional shaking, for twenty-four hours ; then separating the lighter liquid and adding to it carbonate of sodium (10) previously dissolved in water (20). The mixture is then agitated thoroughly for half an hour and set aside. The chloroform is then separated from the supernatant layer, mixed with alcohol (2), trans- ferred to a dry retort, and lime (1) is added, and the liquid distilled, taking care that the temperature does not rise above 67°-2 C. (153° F.), into a well-cooled receiver, until the residue in the retort is reduced to 2 parts. TESTS. — If 5 c.c. of purified chloroform be thoroughly agitated with 10 cc. of distilled water, the latter when separated should not affect blue litmus paper (absence of acids), nor test solution of nitrate of silver (chloride), nor test solution of iodide of potassium (free chlorine). If a portion be digested warm with a solution of potassa, the latter should not become dark-colored (absence of aldehyde). On shaking 10 c.c. of the CARBON COMPOUNDS FATTY SERIES. 675 chloroform with 5 c.c. of sulphuric acid, in a glass stoppered bottle, and allowing them to remain in contact for twenty-four hours, no color should be imparted to either liquid. If a few c.c. be permitted to evaporate from blotting-paper, no foreign odor should be perceptible after the odor of chloroform ceases to be recognized. Peepaeations. u.s.p. Linimentum Chloroformi 40 per cent. Mistura Chloroformi 8 per cent. Spiritus Chloroformi 10 per cent. B.P. Linimentum Chloroformi 1 volume in 2. Spiritus Chloroformi 1 volume in 20. Tinctura Chloroformi Composita 1 volume in 10. Linimentum Chloroformi, U.S.P. and B.P. LINIMENT OF CHLOEOFOEM. Com- mercial chloroform 40, soap liniment 60, U.S.P. ; Equal parts of chloroform and of camphor liniment, B.P. U.S.P. Mistura Chloroformi. Chloeofoem Mixtuee. Purified chloroform 8, camphor 2, fresh yolk of egg 10, water 80. Dose. — 1 to 2 tablespoonfuls. Spiritus Chloroformi, U.S.P. and B.P. SPIEIT OF CHLOEOFOEM. Purified chlo- roform 10, alcohol 90, U.S.P.; Chloroform 1 fl. oz., rectified spirit 19 fl. oz., B.P. Dose.— 20 to 60 min. B.P. Tinctura Chloroformi Composita. COMPOUND TlNCTUEE OF CHLOEO- foem. Chloroform 2 fl. oz., rectified spirit 8 fl. oz., compound tincture of carda- moms 10 fl. oz. Dose.— 20 to 60 min. Uses. — The liniment is used as a stimulant and local anaesthetic. Spirit of chloroform, chloroform mixture, and compound tincture are used as carminatives and sedatives. Action of Chloroform. — When mixed with albumen, chloroform produces a precipitate, but renders the supernatant albumen more easily filtered than before. It is a powerful solvent of protogon, which forms the essential ingredient both of the nerve centres, of the nerves themselves, and of the red blood corpuscles, and some authors have considered that to this solvent property the action of chloroform as an anaesthetic was, in some measure at least, due. This, however, is at present hypothetical. It appears to lessen the oxidizing power of the blood, although not to a very great extent, for the diminution of this power is hardly perceptible in the blood of animals poisoned by chloroform, although distinct in blood which has been mixed with it. When applied to the skin, it evaporates rapidly, and produces a feeling of cold. When its evaporation is prevented, it passes through the epidermis, and acts as an irritant on the skin, producing rubefaction, and leaving behind a painful burning spot, or even vesication. It greatly assists the absorp- tion of organic alkaloids by the skin, so that a number of them will pass through the epidermis and be absorbed with considerable ease when mixed with chloroform, although they would not pass through at all if applied as an alcoholic solution. In the mouth it has an exceedingly sweet taste, and stimulates the secretion of saliva. When swallowed in large quantities, it acts first as an irritant, producing gastro-enteritis, and afterwards, from its absorption, will cause anaesthesia and coma, so that the vomiting, pain at the epigastrium, and purging, which are first 676 ORGANIC MATERIA MEDICA. observed, gradually pass off, and are succeeded by stupor, coma, and abolition of reflex sensibility, which may either end in death or may pass off, while the irritation of the intestines and stomach may continue for some time afterwards. In small doses it probably stimulates the secre- tion of gastric juice and the movements of the stomach, and both increases and co-ordinates more perfectly the movements of the stomach and intestines, so that it causes expulsion of flatulence and relieves griping. After absorption into the blood, either from the stomach or from the lungs, it acts on the nervous system in somewhat the same way as alcohol, paralyzing the nerve-centres in much the same order. Its action, however, is more rapid than that of alcohol, and it does not appear to pro- duce the stimulation without derangement of the mental faculties which marks the first stage of the action of alcohol. Chloroform appears to derange the mental faculties from the very first. The effect of chloro- form may generally be divided into three stages: (1) of imperfect consciousness, (2) of excitement, and (3) of anaesthesia ; or perhaps one might divide it more exactly into four stages (p. 188), and add a fourth stage, that of paralysis. Its first effect is to produce a feeling of warmth over the surface, with affection of the optic and auditory nerves, noises being heard in the ears, and a sensation of light experienced in the eyes. There is also a feeling of oppression at the chest, and some- times a choking sensation, occasionally accompanied by cough. The choking and cough are more especially felt if the vapor is administered in too concentrated a form, and not unfrequently the patient will put up his hand to try and take away the cloth containing the chloroform. External impressions are now slightly felt, sounds are faintly heard, questions are slowly and imperfectly answered, and any sensation of pain which may be present becomes greatly diminished or entirely disappears. In children and weak persons this stage may pass into that of complete anaesthesia, but in most cases it is succeeded by the stage of excitement. The patient is no longer conscious of what is going on around him, but he may, according to his temperament, sing, shout, or struggle violently. The violent struggles are more especially noticed in men of irritable temperament, who have been accustomed to the use of alcoholic stimulants. In them the excitement is greater, and more chloroform is required in order to produce the stage of complete anaesthesia. During the violent struggles, the efforts of the patient may induce him to hold his breath until suffocation seems impending ; the face becomes livid, the eyes prominent, and the jugulars distended. The struggling is usually less in women than in men, and is less in patients exhausted by previous illness. In women, hysterical sobbing or crying may occur ; occasionally indications of venereal excitement have been observed, and even a com- plete venereal orgasm. When the chloroform is pushed, this stage soon subsides, and the patient passes into the state of complete anaesthesia. The limbs become flaccid; when the hand is taken up it falls like that of a corpse ; painful stimuli produce neither reflex action nor any indication of sensation. The last reflex actions to disappear are those from the con- junctiva, the anus, and the vagina. When touching the conjunctiva no longer causes reflex contraction of the eyelid, anaesthesia may be regarded CARBON COMPOUNDS — FATTY SERIES. 677 as complete, and surgical operations may be commenced. During the administration of chloroform the respiration is generally first rendered somewhat slow, then quicker, and lastly steady, unless the anaesthetic be pushed too far, when it again becomes slower and weaker, and finally ceases altogether. The pulse is usually affected in a similar manner. The reason of this appears to be that the chloroform vapor, as it descends the respiratory passages, successively irritates those parts with which it comes immediately in contact, (1) the nasal mucous membrane, (2) the larynx, and (3) the lungs. It causes, through the nerves of the nose and larynx (p. 216), reflex slowing of the respiration and reflex slowing of the pulse. As these nerves gradually become paralyzed by the action of the drug, its stimulating effect on the branches of the vagus distributed to the lung becomes manifest in accelerated respiration, usually accom- panied by a quickened pulse. Next, as the drug continues to act, it paralyzes those nerves also, and the respiratory centre being now no longer affected by any reflex irritation, continues to keep up the respira- tory movements with a somewhat slow and steady rhythm. If the drug be now pushed still further, the respiratory centre itself becomes para- lyzed, the respirations become still slower aud feebler, and finally cease altogether. These alterations in the respiratory rhythm during the administration of chloroform may sometimes be more or less interfered with by the effect upon the respiratory centre of blood which has become venous in consequence of the altered respiratory movements. The action of the heart is also modified by chloroform, the pulse usually becoming somewhat slower just at first ; then accelerated during the whole period of excitement ; and afterwards steady, at or below its normal rate. The "blood-pressure is usually lowered, and if the chloroform vapor be strong the pressure may fall very considerably, and may even be reduced to zero. The fall of blood-pressure is probably due in great measure to the dilatation of the vessels, but it may also be partly owing to enfeebled action of the heart, even at the beginning of the anaesthesia. When the chloroform has been pushed so far as greatly to lower the blood-pressure, the fall is caused, to a great extent, by the weakening of the heart. The dilatation of the vessels is not due to paralysis of the vaso-motor nerves, for these, when irritated directly, will still cause the artery to contract during chloroform narcosis. It appears to be due to paralysis of the vaso- motor centre. The reflex power of this centre is first diminished, and then abolished, by chloroform, so that irritation of a sensory nerve, during imperfect chloroform narcosis, causes only a slight rise of blood-pressure, and in perfect narcosis no rise at all. The tension of the intercellular fluid and the lymph in the eye appear to be diminished, so that the mammae become flaccid, the intra- ocular tension is diminished, and irregular astigmatism may occur. The nervous system appears to be paralyzed in the following order : first, the cerebral hemispheres ; next, the gray matter of the cord ; next, the white matter ; next, the reflex power of the medulla oblongata; next, the automatic power of the respiratory centre, and lastly, the cardiac ganglia. The order in which the nerve-centres are paralyzed may sometimes be changed, and the heart may be affected before the respiration. 678 ORGANIC MATERIA MEDICA. Dangers of Chloroform. — Cases may arise where it is impossible to obtain assistance, but whenever it is possible to obtain help, anaes- thetics should never be given without the presence of a third person, both for the sake of the administrator and of the patient. In consequence of neglecting this rule a number of medical men have suffered severely from false charges of assault and rape brought against them by female patients. These charges, though perfectly false, have frequently been brought by patients in all good faith, and under the belief that they were true. The action of alcohol on the sexual centres in the brain (pp. 386 and 362) is surpassed by that of chloroform, and sexual excitement caused by the latter (p. 676) may be accompanied by delusions, which are afterwards remembered and believed by the patients to have been real events. By having an assistant in the room false charges arising from such delusions may be disproved. For the patient's sake also no one should attempt, if it can possibly be avoided, both to administer anaesthetics and to operate, for this is more than a single man can do, and the attempt to do both is likely to lead to failure in either one or both. The dangers resulting from the employment of chloroform are : (1) death by stoppage of respiration ; (2) death by stoppage of the heart. Usually the respiration stops before the heart. This order, however, may be somewhat varied, because occasionally the heart will fail before the respiration. This may sometimes be due to the employment of too strong- chloroform vapor, because this very quickly paralyzes the heart ; but sometimes the stoppage of the heart before the respiration may be due to the shock of the operation, and not to the chloroform. The respiration may stop from (1) obstruction to the entrance of air into the glottis by the tongue, by vomited matters, or by blood, (2) by mechanical interference with the respiratory movements, (3) by paralysis of the respiratory centre. Precautions. — (1) If the patient should partially wake from chlo- roform narcosis during an operation, sickness is very likely to occur. In order to prevent this, it is well that the patient should take no solid food for four or five hours before the operation ; but, at the same time, his strength should be kept from sinking by the administration of beef-tea, along with some alcoholic stimulant three hours before. When vomiting does occur, the head of the patient should be turned on one side, so as to allow an easy exit to the vomited matters, which should, if necessary, be removed from the mouth. Mr. Mills tells me that the most common causes of obstruction to the respiration are either falling back of the tongue or depression of the chin. Both of these may be remedied by changing the position of the head by turning it on one side, or forcibly dniwing the chin away from the sternum at each inspiration. Very sel- dom it may be necessary to draw the tongue forwards with dressing for- ceps. (2) Mechanical interference with the respiratory movements may occur from unwary pressure upon the chest, interfering with the thoracic movements. The most common cause of this is the weight of the patient's own body, when any operation upon the back requires him to be laid upon his face. In such cases, special watch should be kept upon the respiratory movements. Mechanical interference with respiration CARBON COMPOUNDS FATTY SERIES. . 679 may occur in old people who have lost their teeth. The flaccid lips and the alae nasi are in them drawn inwards at each inspiration, and, acting as valves, prevent the entrance of air into the trachea. In such cases the mouth should be opened by the fingers (Esmarch). Stoppage of the respiration may occur from the patient spasmodically holding his breath during the stage of excitement, but this usually soon passes off if the anaesthetic be pushed. The struggling is less if the anaesthetic be given gradually. (3) Paralysis of the respiratory centre takes place when the drug is pushed too far. It may sometimes occur suddenly, after a fresh quantity of chloroform has been poured upon the cloth used in administration. If the respiration ceases the administra- tion of chloroform should be discontinued, and the patient roused by flick- ing the cheeks and breast with a wet towel. The tongue should be drawn forward with forceps and artificial respiration begun if necessary. As a rule the patient can be restored with comparative ease by means of arti- ficial respiration, provided the heart continues to beat, but on rare occa- sions even the prolonged use of this means does not induce any further voluntary respiratory movement. The easiest way of performing artifi- cial respiration is to press the sternum forcibly inwards, and allow it to return to its normal position by its own elasticity. The pressure should be exercised synchronously with the operator's own respiration. Each time the sternum is depressed the ends of the fingers may be pressed under the cartilages of the ribs on the left side, so as to stimulate the heart mechanically also. Stoppage of the heart may occur suddenly, and may take place while respiration is still going on. It is usually ascribed to the chloroform, and no doubt concentrated chloroform vapor inhaled into the lungs may arrest the heart. Very commonly, however, it is reflex, and when death occurs in such a case it is to be attributed to the want of chloroform rather than to its excess. It is worthy of note that in the greater number of the cases recorded as deaths from chloroform, the statement is made that the quantity administered was very small, and that anaesthesia was incom- plete. Before anaesthetics were used at all, death from shock during operation was by no means uncommon, and no doubt it still occurs during imperfect anaesthesia, although complete anaesthesia tends to prevent it. The operations in which death during chloroform chiefly occurs are short and comparatively slight, though painful, such as extraction of teeth, and evulsion of the toe-nail — operations in which the introduction of deep chloroform anaesthesia might be regarded as superfluous, and involving a waste of time. These operations appear to be dangerous during imperfect narcosis, and not so when either no anaesthetic at all has been given, or complete anaesthesia has been produced. The reason of this probably is that when no anaesthetic is given, irritation of the sensory nerves during the operation causes two effects — slowing or stop- page of the heart, and reflex contraction of the vessels. This contraction neutralizes the result of cardiac weakness or stoppage, maintains the blood-pressure, and thus prevents syncope. During imperfect anaesthesia the reflex contraction of the vessels is destroyed, whereas the effect on the heart may still persist, so that irritation of a sensory nerve may pro- duce syncope by stopping the supply of arterial blood from the heart, 680 ORGANIC MATERIA MEDICA. while the blood still flows rapidly from the arterial system through the capillaries into the veins. When the anaesthesia is complete, both reflexes are paralyzed, and the circulation remains unaffected by any impression made upon the sensory nerves. Even when chloroform anaesthesia appears perfectly complete, death from shock may still occur, at any rate in the case of animals. I have noticed this on two occasions when engaged in making gastric fistula in a dog. The animal was com- pletely anaesthetized, but in both instances, when drawing upon the stomach in the process of inserting a cannula, the animal died suddenly. On mentioning this to Professor Schiff, he informed me that he had had many similar experiences, so that he had entirely abandoned the use of chloroform in such operations, and substituted ether. When the heart stops, the treatment to be adopted is to lay the patient's head lower than his body (p. 230), to keep up artificial respira- tion, and to administer nitrite of amyl by inhalation. Instead of the plan of artificial respiration already mentioned, Syl- vester's may be used. Howard's plan may be used for very strong patients, but is not suitable for delicate ones. Respiration may be assisted by stimulating the diaphragm by the application of a faradaic current to the phrenic nerve. One pole is applied to the epigastrium and the other to the side of the neck during the time that the inspiratory movement is being made artificially. Uses. — The vapor of chloroform may be applied to the eye in photo- phobia, to the os uteri in pruritus pudendi, neuralgia, ulceration, or cancer of the uterus, in order to relieve pain. A few drops held in the hand of the nurse, and inhaled by a child when a paroxysm of whooping- cough comes on, will lessen its violence. The power of chloroform to aid the absorption of vegetable alkaloids may be employed in order to assist their action when applied externally, but care must be taken not to apply them over too large a surface when using such drugs as aconite or veratrine in combination with chloroform or chloroform liniment. A pledget of cotton-wool dipped in chloroform is frequently employed as a remedy in toothache ; but as the chloroform irritates the pulp, and may increase pain afterwards, Ringer recommends a piece of linen moistened with chloroform to be folded over the tooth, so that the vapor may act upon the pulp without irritating it. It relieves vomiting from gastric catarrh or sea-sickness, lessens flatulent distention of the stomach and intestines, and may be used in dyspepsia and diar- rhoea after the irritant has been removed. Chloroform, in combination with small doses of morphia and with some adhesive vehicle such as glycerine, is a useful remedy in coughs, more especially the coughs of phthisis. When inhaled to an extent quite insufficient to produce even the earlier stages of anaesthesia it may relieve the paroxysms of asthma. The first stage of chloroform action, viz., partial anaesthesia and partial loss of consciousness, is useful in biliary and renal colic, and in very severe pain, such as intestinal colic, severe neuralgia, aneurism, and during labor. A most ingenious plan of administering chloroform in such cases has been devised by Mr. Image, of Bury St. Edmunds. A piece of blotting-paper or lint is put in the bottom of a tumbler, and moistened with chloroform. The patient CAKBON COMPOUNDS — FATTY SEEIES. 681 then takes the tumbler in the hand and inhales the vapor. The shape of the tumbler prevents it from being brought too close to the face, so that the vapor is always inhaled with a free admixture of air. As soon as it begins to take effect, the patient's hand and the tumbler drop, so that the inhalation ceases. When the effect begins to pass off, the patient again raises the tumbler and inhales anew, and so the process may go on for a long time, without any further care on the part of the attendant than to keep the lint or blotting-paper in the tumbler moist with chloro- form. In the administration of chloroform for surgical operations, the towel or napkin may be folded so as to form an imperfect cone, into the cavity of which a little chloroform is poured. The towel is then held over the patient's face, a few inches from his nose, the apex of the cone touching the bridge of the nose, its base being directed downwards, and its margin a couple of inches from the face. Care should be taken that no part of the towel which is wet with chloroform touches the face, on account of the burning sensation which it produces, and that a free admixture of air be allowed and the vapor not administered in a too concentrated state. Another way of giving it is to spread a single fold of the napkin over the patient's face, and allow the chloroform to fall, a drop at a time, upon the napkin a little in front of the nose. The drug may be admin- istered in a similar way upon a wire mask covered with a single layer of flannel. In order to avoid the possibility of the patient inhaling too concentrated a vapor, an apparatus has been devised by Mr. Clover, con- sisting of a bag of 10,000 cubic inches capacity, which is filled with air containing 4 per cent, of chloroform vapor, and from this the patient is allowed to inhale by means of a flexible tube and a mask. The apparatus is filled by pumping successive quantities of air from a bellows holding 1000 cubic inches through a box heated by hot water, into which 32J minims of chloroform have been injected, a quantity just sufficient to charge the air with the proper amount of chloroform. A mixture of 1 part of alcohol with 2 of chloroform and 3 of ether, known under the name of the A, C, E mixture, is sometimes used instead of chloroform. It is supposed to have the advantage of being more stim- ulant and less depressing to the heart than chloroform. One disadvantage of it is that the three constituents evaporate with unequal rapidity, so that at the ead of an operation a patient may get a much larger propor- tion of chloroform than of the other two. U.S. P. Iocloformum. Iodoform, CHI 3 ; 392*8. — Iodoform should be kept in well-stopped bottles, in a cool place. Preparation. — By mixing alcoholic solution of potash with tincture of iodine, and evaporating ; or by acting on dilute alcohol with iodine and carbonate of potash or soda. Characters. — Small, lemon-yellow, lustrous crystals of the hexa- gonal system, having a saffron-like and almost insuppressible odor, and an unpleasant, slightly sweetish, iodine-like taste. Not perceptibly sol- uble in water, to which it imparts a slight odor and taste ; soluble in 80 parts of alcohol at 15° C (59° F.), in 12 parts of boiling alcohol, in 5*2 parts of ether, and in chloroform, benzol, benzine, disulphide of carbon, 682 ORGANIC MATERIA MEDICA. fixed or volatile oils. Its solutions have a neutral reaction. Sp. gr. 2*000. It sublimes slightly at ordinary temperatures, and distils slowly with water; at "about 115° C. (239° F.) it melts to a brown liquid, and at a higher temperature yields vapors containing iodine and carbonaceous matter. If iodoform be digested with an alcoholic solution of potassa, the mixture, when acidulated with diluted nitric acid, will give a blue color with gelatinized starch. Distilled water shaken with iodoform should not change the color of blue litmus paper, and when filtered, should give no precipitate with test solution of nitrate of silver (absence of iodide). Upon full combus- tion, iodoform should leave no residue. Dose. — 1-3 grains. Peepaeation. Unguentum Iodoformi (1 part to 9 of benzoated lard). Administration. — It may be given in the form of pill, made up with sugar of milk, tragacanth and glycerine, or as a suppository made up with cacao butter. As an inhalation in phthisis a solution may be used containing 20 grains of iodoform, 20 minims of oil of eucalyptus, or 10 of creasote, J fl. oz. rectified spirit, and J fl. oz. of ether. This is used with an inhaler of horse-hair matting lined with cotton-wool, on the interior of which the solution is dropped (Dreschfeld). The disagreeable smell of iodoform may be covered by Tonquin bean or Coumarin. As an external application it may simply be dusted over the sore and covered with cotton-wool, or cotton-wool may be soaked in an ethereal solution of it and then dried. The quantity of iodoform in the cotton- wool should be at least 10 per cent. It may be applied to the nose or throat as snuff, or mixed with half its weight of starch as insufflation, or an ethereal solution may be applied as spray. The nozzle of the spray- producer is apt to become choked and must be washed out frequently with pure ether. It may also be applied to the nose in the form of a bougie containing -|— J a grain made up with gelatine and glycerine. Actions. — Iodoform destroys bacilli, and is an antiseptic and deodorizer of very considerable power. It also destroys leucocytes. When applied in substance or strong solution it produces no local irrita- tion, but acts as a local anaesthetic. Its power in this, respect is so great that a suppository containing it when introduced into the rectum may so diminish sensibility that defecation may occur without the knowl- edge of the person or animal (Wood). Its absorption from the intestine is probably aided by fat. It weakens the circulation when taken for some time, and when applied to the frog's heart it has a powerful paralyzing action on the cardiac ganglia in the same way as chloral and iodal (p. 286). It lias a marked -action on the nervous system. In cats and dogs it produces narcosis, but not in rabbits. It may be absorbed from wounds and affect the nervous system in man, but this affection instead of sleep or anaesthesia, usually appears in slight cases as sleeplessness, headache, irritability and loss of memory. In severe cases it appears in the form <»f maniacal attacks, hallucinations, or melancholia. CAEBON COMPOUNDS. 683 These disagreeable effects appear to be diminished by bicarbonate of potash in doses of 10 grains hourly. 1 It appears to have an extraordi- nary power to prevent the development of giant-cells and may thus pre- vent morbid tissue growth. Uses. — Its local anaesthetic and antiseptic actions render it useful as a dressing after operations instead of carbolic acid, and it is especially useful where a regular antiseptic dressing cannot be applied, as in operations on the bladder or rectum, or wounds or ulcers of these parts. It is a most useful application to poisoned wounds, chancres, phagedenic or syphilitic sores, and to fungating growths generally. It induces healthy action in indolent sores. It lessens the discharge and disagreeable smell of ozsena. It has been used as a vapor in cases of phthisis, and also given internally but with doubtful result. CHAPTER XXX. CAEBON COMPOUNDS. Aromatic Series. In this series the carbon atoms are supposed to be linked so as to form a closed chain or chains. The lowest member of the series con- tains six atoms of carbon, which are so linked that the group has six free affinities, thus : I -C C- II I -c c- I For convenience' sake, this carbon ring, or nucleus, is often graphi- cally represented simply thus: /\ I I \/ When five of the free affinities are saturated by hydrogen, the group forms an organic radical with one free affinity, termed phenyl : H H / - \ \_/ H H Behring, Wien. Med. Bltitt., 1884, No. 9. 684 ORGANIC MATERIA MEDICA. When this free affinity is also saturated by hydrogen, the group H H H\ /H forms phenyl hydride, or benzine, or benzol, which must be H~H carefully distinguished from the benzin already mentioned (p. 646). Bodies belonging to the aromatic group differ from those of the fatty series in the fact that they do not readily link on other substances to themselves, and so form compounds by addition. They rather form them by substitution. When one atom of hydrogen in benzine is replaced by hydroxy! (OH), phenyl-alcohol or carbolic acid is formed: <_>0-H, or C 6 H 5 OH. The name of phenol has been given to this body as it is more con- venient than the names phenyl-alcohol or carbolic acid, and its termina- tion, "ol," indicates that it resembles alcohol in its constitution. The relations of some of the other members of the aromatic group to each other may be more easily seen if they are put in a tabular form : Benzine, \ /H, or C 6 H 5 .H. Phenol, \_)OH, or C 6 H 5 .OH, in which 1 atom of hydroxyl (OH) replaces 1 of H in benzine. Nitrobenzine, (_/N\ I or C 6 H 5 .N0 2 , in which 1 atom of nitroxyl (N0 2 ) replaces 1 of H in benzine. Amido^ne,or/-\ N< H orCANH9 in which 1 atom of amidogen (XH 2 ) replaces 1 of H in benzine. Benzoic acid, or y —\ „//§ n -rj nr\ au m, if • -i ;Cf^ TT or C 6 H 5 .C0.0H, rhenylformic acid, N /^\0— H, in which 1 atom of carboxyl (COHO) replaces 1 of H in benzine. As the carbon atoms in the benzine ring or nucleus are supposed to be arranged symmetrically, it does not matter which atom of hydrogen is replaced by another radical if the substitution takes place only in one atom, e.g., in phenol. If we number the carbon atoms so as to distinguish them from one another, thus: CARBON COMPOUNDS. 685 5\/3 it is evident that phenol is always the same, whether the hydroxyl is attached to the carbon atom, 1, 2, or 3, &c, &c. : HO /\ /\HO /\ II II II \/ \/ \/HO But this is not the case when substitution occurs at two or more points in the benzine ring. Thus when substitution in the benzine ring occurs at two points, these may take three different positions : -I -^ The substitution products ^ ■j /\2 1 an d 6 are the same 6/\ a 9 || as 1 and 2, and are usually | | \/ termed ortho compounds. \/ ill and 5 are the same 1 and /\ as 1 and 3, and are usually /\ 3 \/3 termed nieta compounds. 5\/ 1 1 , /\ 1 and 4 are usually termed and I J -, a KJ para compounds. 4 Thus three isomeric forms may occur. When two atoms of hydrogen are replaced by two of hydroxyl, instead of by one, as in phenol, we have three isomeric substances, differing from one another only in the relative position of the substituted ■atoms. These three bodies are pyrocatechin, in which the position is 1 and 2, resorcin, 1 and 3, and hydroquinone, 1 and 4. The relative position of the hydroxyl groups in these three bodies is indicated in their formulae by the figures (1 : 2), (1 : 3), and (1 : 4), or by the terms ortho, meta, or para respectively. H H H rv°- H ■ /\ 1 1 1 1 i i 1 1 \/\ \ H 1 1 \/ 1 H Pyrocatechin. ) 6 H 4 .(OH) 2 (l:2) Resorcin. C 6 H 4 .(OH) 2 (l:3) Hydroquinone. 0^.(0^,(1:4) 686 OKGANIC MATEEIA MEDICA. When two atoms of hydrogen in benzine are replaced, the one by hydroxyl (OH) and the other by carboxyl (CO. OH), we get three isomers, salicylic acid, oxybenzoic acid, and paraoxybenzoic acid. H i H i H ■ 6 \/ U \ H 1 1 . o 1 1 c = o i \ /0% \ / H H Salicylic Acid. Oxybenzoic Acid. Paraoxybenzoic A Pyridine (C 5 H 5 N) is probably formed by one atom of tetrad C in the benzine ring being replaced by triad N: H\ c /N^ c /H II I k Naphthaline (C 10 H 8 ) is formed by the union of two benzine groups, thus: H H H J)\ yQ % H \C C C/ I II I o c c H/%C/ \C^\H k k Chinoline (C 9 H 7 N) is formed by the union of benzine and pyridine groups : H I S0\ /*K H-C C C-H I II I H-C C C-H k k Chinoline is closely connected with quinine, from which it may be produced, and it is probable that many of the organic alkaloids are closely related to the aromatic series. CAKBON COMPOUNDS. 687 That morphine, for example, is related to phenol is shown by the fact that when morphine is treated with nitric acid and heated with water under pressure, it yields trinitrophenol, or picric acid. 1 General Action. — The distinctive action of the lower members of the fatty series is their stimulant and anaesthetic action on the nerve- centres (p. 644). The most marked action of the lower members of the aromatic series is their antiseptic and antipyretic power. The anti- septic action appears to be very easily modified by slight changes in some substances of this group. Thus salicylic acid is antiseptic, but its sodium salt is not; and meta- and para-oxybenzoic acids, which are isomeric with salicylic acid have no antiseptic power. As alterations in the physiological action of the carbon compounds of this group can be aifected by slightly changing their chemical compo- sition, several attempts have been recently made to obtain artificial alka- loids which should possess a strong antipyretic action without depressing the heart or causing sickness. Antipyrin, the most recent introduction, appears to be the best as yet, but further attempts in this direction may be still more successful. U.S. P. Acidum Carbolicum Crudum. Crude Carbolic Acid. Characters. — A nearly colorless or reddish-brown liquid of a strongly empyreumatic and disagreeable odor, having a benumbing, blanching, and caustic effect on the skin or mucous membrane, and a neutral reaction. Bromine water produces in an aqueous solution of carbolic or cresylic acid a white flocculent precipitate. Tests. — Crude carbolic acid should not dissolve in less than 15 parts of water at 15° C. (59° F.), nor should the solution have an alkaline reaction (absence of alkalis). If 50 volumes of crude carbolic acid be diluted with warm water to measure 1000 volumes, the mixture well shaken, cooled, and allowed to separate, the amount of undissolved impurities should not exceed 5 volumes or 10 per cent, by volume of the crude acid. Acidum Carbolicum. XJ.S.P. and B.P. CARBOLIC Acid. Phenol. Phenyl- Alcohol. C 6 H 5 HO ; 94. An acid obtained from coal-tar oil by fractional distillation and sub- sequent purification. Characters and Tests. — In colorless acicular crystals, which at a temperature of 95° become an oily liquid, having a strong odor and taste, resembling those of creasote, which it also resembles in many of its characters and properties. Its specific gravity is 1*065 ; boiling- point, 370°. The crystals readily absorb moisture on exposure to the air, and they are thus liquefied ; the acid, however, is but slightly solu- ble in water, but it is freely soluble in alcohol, ether, and glycerine. It does not redden blue litmus paper. A slip of deal dipped into it, and afterwards into hydrochloric acid, and then allowed to dry in the air, acquires a greenish-blue color. It coagulates albumen. It does not affect the plane of polarization of a ray of polarized light. Dose. — 1 to 3 grains. 1 Chastaing, Cornet. Bend., xciv., 44. 688 ORGANIC MATERIA MEDICA. Peepaeatioxs. U.S. P. Unguentum Acidi CarboUci (with ointment 1 in 10). B.P. Giyceriniiui Acidi Carbolici. Glycerine of Carbolic Acid (Car- bolic acid (1) Glycerine (4) by measure) 1 part in 6 by weight. Suppositoria Acidi Carbolici cuin Sapone. Carbolic Acid Sup- positories. Carbolic acid, 1 gr.; curd soap, 15 gr.; starch, q.s. to give consistence. ACTION. — Carbolic acid is a powerful deodorizer and disinfectant (p. 108). It precipitates albumen, and destroys low organisms. It prevents the decomposition of albuminous fluids by bacteria, and the fermentation of sugar by yeast. Quantities smaller than those which are sufficient to kill these organisms suffice to prevent their development. It does not appear to destroy the action of all organic ferments so readily, although it does so when applied for a long time, or in concen- trated solution ; it prevents the conversion of starch into sugar, the con- version of albumen into peptones, and the decomposition of amygdalin with formation of hydrocyanic acid. When applied to the skin it pro- duces a white stain, and greatly diminishes the sensibility of the part. The stain afterwards becomes brownish, and of a parchment-like con- sistence, and the epidermis by and by peels off. Carbolic acid does not act as a vesicant, but appears to cause anaesthesia of the part to which it is applied, extending to some distance below the surface. If applied over a large surface of skin, it may be absorbed to such a degree as to cause poisoning, and even death. The symptoms are weakness, delirium, and collapse. When applied to mucous membranes it has a similar action. In the mouth it causes a burning pain, and when swallowed produces symptoms of gastro-enteritis, pain in the stomach, and some- times vomiting and purging. Along with this there is great collapse, delirium, and death, sometimes, though not always, preceded by convul- sions. After death the blood is found to be very dark, and its coagula- bility greatly diminished. Carbolic acid appears to be a powerful poison to all the tissues, paralyzing both muscle and nerve when applied directly to them without previously stimulating them. After absorption it acts especially on the medulla oblongata, but acts also on the spinal cord, first stimulating and then paralyzing these centres. From its action on the cord it produces in frogs convulsions resembling those of strychnine, these being followed by paralysis. It first stimulates the respiratory and vaso-motor centres, and afterwards paralyzes them. It thus produces at first quickened respiration with rise of blood-pres- sure, and it also quickens the pulse. As the centres become paralyzed the blood-pressure falls greatly, the respiration becomes slower, and the pulse also becomes slower. When it is injected directly into the blood, so that it can act in large quantity on the nerve-centres, it paralyzes the vaso-motor centre at once, and causes the blood-pressure to fall very greatly without much alteration being observed in the action of the heart itself. That the vaso-motor centre is completely paralyzed by carbolic acid is shown by the fact that after its injection the blood-pressure is not raised either by stimulation of sensory nerves, or by asphyxia. Although CARBON COMPOUNDS. 689 carbolic acid acts first and most markedly on the nerve-centres in the medulla oblongata, it affects the cerebral centres also. This effect is evidenced in man by headache, giddiness, and lassitude, followed by unconsciousness. In animals it also affects the cerebrum, as shown by alterations in sensibility and motor power. It stimulates the sweat centre and salivary centres, producing perspiration and salivation. Medium doses appear to cause death by paralysis of the respiration, so that artificial respiration may be of some use in preventing it, but large doses paralyze the heart also, so that death occurs in spite of artificial respiration. It diminishes the temperature in cases of poisoning, and also when given to animals in a febrile condition, though when the fever is very high it does not seem to have much effect. It is excreted by the kidneys, and can be readily detected in the urine by bromine water. It sometimes gives rise to a very dark coloration of the urine^ due to some oxidation product of the carbolic acid, probably hydroquinone {p. 685). Part of the carbolic acid appears in the urine, in combination with sulphuric acid, as sulpho-carbolates, and if the quantity administered has been large, the ordinary sulphates may completely disappear. The hydroquinone occurs also to a great extent in the urine in combination with sulphuric acid.* The compound is colorless, and thus the urine, when freshly passed, has a normal appearance ; on standing, the hydro- quinone becomes free, undergoes further oxidation, and causes the urine to assume a brown color. Uses. — It has sometimes been applied externally to produce local anaesthesia for slight operations, such as opening abscesses, and, when mixed with oil, in the proportion of ten minims to an ounce of oil, it relieves the pain of burns. One of the best means for removing the pain of toothache is to dip a little cotton-wool into carbolic acid melted by the aid of heat, and insert the pledget into the cavity of the tooth, covering it over with dry cotton-wool, to prevent the tongue being burned by contact with the acid. It is used as a stimulant to indolent ulcers and wounds, and to destroy condylomata, and has been applied to the throat in cases of diphtheria, ulceration, and aphtha . It has been employed as an injection into deep-seated inflammations, such as chronic synovitis, inflamed glands, boils, hydrocele, erysipelas, and poisoned wounds. Its ehief application, however, is to destroy the minute organisms which cause putrefaction in albuminous fluids, and to prevent the untoward results which would arise from the absorption of putrid discharges. According to Sir Joseph Lister, the untoward consequences of opera- tions are frequently due, not to the operation itself, but to the poisoning of the wound by the products of decomposing discharges, and poisoning of the system generally by absorption of these products. The decom- position is due to low organisms, such as bacteria, introduced from with- out, and it may be prevented by the use of such substances as will prevent their development or destroy them when present. In performing opera- tions, therefore, he advises that the skin should first be washed with a watery solution of carbolic acid (1 in 40), that the knife also should be treated with a similar solution, and that the incision should be made under a spray of carbolic acid (1 in 20). After the operation is concluded 44 690 ORGANIC MATERIA MEDICA. under a constant use of the spray, the wound is covered with a protec- tive consisting of varnished linen dipped in a solution of carbolic acid (1 in 40), above which are laid eight layers of gauze, steeped in a mixture of carbolic acid (1), resin (4), and paraffin (4). Between the sixth and seventh layers is put a piece of water-proof tissue, in order to distribute the discharge and prevent it from oozing out at one spot. If the discharge be great the dressings ought to be changed once in twenty- four hours, under the spray, but as it heals, the intervals between the dressings may be lengthened. A solution of carbolic acid in oil is frequently used to lubricate, and at the same time disinfect, catheters (p. 107), but, as Koch's experiments show, such a solution has no antiseptic power, and they ought to be dis- infected, first with an aqueous solution and afterwards oiled. Carbolic acid is very useful in what is sometimes known as an influ- enza cold, beginning with coryza, spreading down the throat to the air- passages, leading to severe bronchitis with much depression, and occa- sionally also to gastro-intestinal catarrh. This form of cold appears, like true influenza, to be extremely infectious, and to be easily commu- nicated, not only by one member of a family to another, but even by casual visitors. It may sometimes be arrested, and may frequently be rendered less severe, by carbolic acid spray applied to the nostrils and by the use of a gargle containing carbolic acid. Other forms of sore throat are also relieved by gargles containing about 1 per cent, of car- bolic acid. Considerable care must be taken in using the gargle not to swallow it, on account of the poisonous properties of the acid. When the cold begins in the nose the solution of carbolic acid for spray may contain 1 per cent., but perhaps a still better method of applying it is by a small ear syringe, as a J or J per cent, solution. A mixture of 1 part of carbolic acid with 3 of creasote has been used for continuous inhalation in phthisis by means of the oro-nasal respirator. Carbolic acid is also used as an injection to wash out serous cavities, after the evacuation of fluids ; for example, the cavity of the pleura after the evacuation of the fluid in pleurisy, and the cavity of an abscess after the removal of the pus. Internally, the acid has been given in cases of flatulent dyspepsia. It is a useful application to the uterus in chronic inflammation, excoriation, catarrh and cancer, and as an injection in leucorrhoea. Creasotum, U.S.P. and B.P. Creasote. A product of the distillation of wood tar. Characters and Tests. — A liquid, colorless or with a yellowish tinge, and a strong empyreumatic odor. It is sparingly dissolved by water, but freely by alcohol, ether and glacial acetic acid. Specific gravity 1-071. It coagulates albumen. A slip of deal dipped into it, and afterwards in hydrochloric acid, acquires on exposure for a short time to the air a greenish-blue color. Dropped on white filtering paper and exposed to a heat of 212°, it leaves no translucent stain. It turns the plane of polarization of a ray of polarized light to the right. It is not solidified by the cold produced by a mixture of hydrochloric acid and sulphate of soda. Dose. — 1 to 3 drops. CAKBON COMPOUNDS. 691 Preparations, u.s. p. dose. b.p. dose. Aqua Creasoti 1-4 fl. dr. Mistura Creasoti (1 min. in 1 fl. oz.) 1-2 fl. oz. Unguentum Creasoti (simple ointment) 1 part in 9 Vapor Creasoti U.S.P. Aqua Creasoti. Creasote Water. Creasote, 1 ; distilled water, 99 ; agitate and filter. B.P. Mistura Creasoti. Creasote Mixture. Take of creasote 16 min., gla- cial acetic acid 16 min., spirit of juniper 1 oz., syrup 1 oz., distilled water 15 ozs. B.P. Vapor Creasoti. INHALATION OF CREASOTE. Mix creasote (12 min.) and water (8 fl. ozs.) in an apparatus so arranged that air may be made to pass through the solution, and may afterwards be inhaled. Action. — Creasote destroys low vegetable organisms, and prevents the fermentation which they cause. When administered to small animals, it causes great dyspnoea, weakening of the heart's action, paralysis, and often sudden death. Its action differs from that of carbolic acid in the absence of convulsions and increased coagulability of the blood. Creasote is a powerful muscular poison. It coagulates albumen and blood. When applied to the skin it destroys the epithelium, and has a similar action upon mucous membranes. In the mouth it produces a burning sensation and much salivation. Large doses taken internally cause nausea, vomiting, colicky pains, and diarrhoea. The pulse is quickened, there is giddiness and headache, the respiration is slow and labored, and the secretion of urine is increased. Uses. — It is often employed as a remedy in toothache, a small pledget of cotton-wool being dipped into it and placed in the cavity of the decayed tooth. Care should be taken to cover this with fresh cotton- wool, to prevent the tongue from being burned. Internally, it is given in cases of vomiting depending upon abnormal processes of fermentation in the stomach, and it is said to relieve vomiting due to other causes, such as ulceration of the stomach, cancer, Bright's disease, sea-sickness, and pregnancy. It is useful in diarrhoea, especially that of children, where the diarrhoea depends upon irritation due to abnormal fermenta- tion processes in the intestinal contents. The vapor is used in phthisis and foetid bronchitis. Resorcin.— Not officinal. CeH 4 (OH) 2 (l : 3) {vide p. 685). Characters. — White, crystalline plates, somewhat like benzoic acid, melting at 99° C. It has a sweetish, harsh taste. It is soluble in less than 2 parts of water and 20 of olive oil. The aqueous solution gives a dark violet color with ferric salts. Dose. — 5-30 grs. (0-3-2 Gm.). It is best given with syrup of oranges and freely diluted. Action. — It is a powerful antiseptic. It coagulates albumen. A saturated solution has a caustic action on the skin, but a weak solution, e.g., 5 per cent., is not irritating to the skin or mucous membranes. In frog-s it produces stupor, collapse, clonic spasms, and dyspnoea like car- bolic acid. In warm-blooded animals it also causes clonic convul- sions, dyspnoea, dilatation of the vessels and increased secretion of saliva 692 ORGAXIC MATERIA MEDICA. and tears. Death occurs through paralysis. Large doses in man, 30 grs. or more, cause giddiness, singing in the ears, symptoms of intoxica- tion, like those of alcohol, convulsive tremors and collapse. In febrile conditions it greatly lowers the temperature. Uses. — It is a powerful antiseptic and has been employed locally in diphtheria. As an antipyretic it has proved useful. A 5 per cent, solu- tion has been used as an application to syphilitic sores and skin diseases, and as an injection into the bladder in cystitis. A 1 per cent, solution has been used as a colly rium. In infantile cholera it has proved very useful in doses of 1J-5 grs. (04-0-3 Gm.) given in infusion of chamomile. As an antipyretic it lessens the temperature in phthisis and in typhoid, less so in pneumonia and erysipelas. It has also been used in ague. Its disadvantages are the profuse perspiration which it produces, the short duration of its antipyretic action, and the rapidity with which the temperature again rises. Hydroquinone, C 6 H 4 (OH) 2 (l : 4), not officinal (p. 685). Characters. — In crystals or plates with a slight sweetish taste. Action. — Like that of resorcin, but about four times stronger. Uses. — Similar to those of resorcin. Pyrocatecliin, C 6 H 4 (OH) 2 (l : 2). Not officinal (p. 685). Characters. — It forms crystals or plates readily soluble in water, alcohol and ether. It reduces cupric sulphate. Action. — Like that of resorcin, but it is about three times stronger. Uses. — Like those of resorcin. U.S.P. Acidum Salicylicum. Salicylic Acid, HC 7 H 5 3 ; 138 (p. 686). Characters. — Fine, white, light, prismatic, needle-shaped crystals, permanent in the air, free from odor of carbolic acid, but sometimes having a slight, aromatic odor, of a sweetish and slightly acrid taste and an acid reaction. Soluble in 450 parts of water, and in 2*5 parts of alcohol at 15° C. (59° F.) ; in 14 parts of boiling water ; very soluble in boiling alcohol ; also soluble in 2 parts of ether, in 2 parts of absolute alcohol, in 3*5 parts of amylic alcohol, and in 80 parts of chloroform. When heated to about 175° C. (347° F.) the crystals melt, and at about 200° C. (392° F.) they begin to sublime ; at a higher temperature they are volatilized and decomposed with odor of carbolic acid. The aqueous solution is colored intensely violet-red by test solution of ferric chloride. Impurities.— Hydrochloric acid,organic matter, iron and carbolic acid. Tests. — A solution of one part of salicylic acid in 10 parts of alco- hol, mixed with a few drops of nitric acid, should not become turbid upon the addition of a few drops of test solution of nitrate of silver (absence of hydrochloric acid). A saturated solution in absolute alcohol, when allowed to evaporate spontaneously in an atmosphere free from dust, should leave a perfectly white crystalline residue, without a trace of color at the points of the crystals (absence of organic impurities ; also of iron). On agitating a portion of salicylic acid with 15 parts of concen- trated sulphuric acid, no color should be imparted to the latter within CARBON COMPOUNDS. 693 fifteen minutes (absence of foreign organic matter). If 5 c.c. of a saturated aqueous solution of salicylic acid be poured into a test-tube, into which had been introduced, shortly before, a crystal of chlorate of potassium and 2 c.c. of hydrochloric acid, and some water of ammonia be now care- fully poured on top, the latter should not assume a reddish or brownish tint (absence of carbolic acid). Dose. — 5 grs.-15 grs. Action. — When mixed in a proportion of 1 to 10 per cent, with fluids containing the germs of "bacteria it will prevent their development, and in the proportion of 1 in 60 will destroy bacteria when swarming in a fluid (p. 96). Salicylic acid likewise destroys the life of the torula, and pre- vents alcoholic fermentation, as well as the fermentation caused by the organic ferments, &c, (p. 86). It has little power to reduce the temperature in health, but is a most powerful agent in lowering the temperature of fever. When injected into the blood, or administered by the stomach in large quantities, it lowers the pulse rate, blood-pressure, and respiration. When taken in medicinal doses for some time, it produces noises in the ears, deafness, giddiness, and headache, in this respect resembling quinine. Occasionally it has caused sudden depression of the circulation and collapse. In large doses salicylic acid causes feeble circulation, lowers the blood-pressure, and produces death through paralysis of the respiration. It is excreted in the perspiration, saliva, and urine. During its excre- tion it frequently irritates the kidneys and produces albuminuria. It appears in the urine partly as salts of salicylic acid, and partly in combi- nation with glycol as salicyluric acid. After its use the urine is not unfre- quently brown by reflected and green by transmitted light, and contains a substance which reduces copper solution. Uses. — Externally it has been employed as an antiseptic instead of carbolic acid, and has been used by insufflation in diphtheria successfully. A mixture of 2 parts with 100 of tallow applied directly to the feet, not to the stockings, has been found most useful in preventing sweating and soreness of the feet in soldiers after a long march. It has been recom- mended for soft sores, which should be kept covered with the pure acid for two days, and then treated with emollient ointment. It is usually employed internally in the form of salicylate of soda (p. 532). As already men- tioned it is useful both in acute and chronic rheumatism, and it has been found also useful in gonorrhoeal rheumatism. It is of much less use in typhoid fever than in rheumatism, and although it has some anti- periodic action, is not such a powerful remedy in malarious affections as quinine. Salicylic acid dissolved in collodion flexile (gr. xxx. to 5 j-) is very use- ful for corns and warts ; also to hasten the peeling of palms and soles after scarlet fever. Salicylate of soda is useful in phegmasia alba. As already mentioned, it relieves headache. It seems to have a peculiar power of increasing the secretion of bile and rendering it more watery. In this it differs from most other cholagogues, which increase the proportion of solids in the bile. It is therefore indicated in cases where there is a tendency to the forma- tion of gall-stones. 694 ORGANIC MATERIA MEDICA. Naphtlialin. C 10 H 8 (vide p. 686). Not officinal. Source. — It is prepared from' tar. Characters. — Colorless micaceous crystals, with a peculiar smell, insoluble in water, dilute acids or alkalis. Sparingly soluble in cold alco- hol, more readily in hot alcohol. As the commercial naphthalin is often impure it should be purified by washing it with alcohol on a filter until the alcohol is colorless, then drying and subliming. Dose. — For adults 1J-8 grains as a single dose. As much as 80 grains may be given during the day. For children 1J-3 grains every three hours. Administration. — In the form of powder mixed with sugar and scented with oil of bergamot it may be taken in wafers or capsules. It may be used as enema, but as it is quite insoluble in water it must be sus- pended in a mucilagenous vehicle, such as decoction of marsh-mallow. The best way of doing this is to mix the quantity of naphthalin required (15-75 grains) with 2 or 3 fluid ounces of boiling distilled water, and stirring until the naphthalin is diffused in very fine drops throughout the liquid. It should then be poured into 15 or 30 fluid ounces of boiling marsh-mallow tea and vigorously stirred. The liquid is then allowed to cool and introduced into the rectum by a soft tube and funnel (p. 414). Action. — It destroys low organisms and prevents the germination of their spores. It is a powerful antiseptic but it must be intimately mixed with the substances on which it is to have this action. It has little or no poisonous action on the higher animals when given either by inhalation or internally, the reason probably being that it is so sparingly soluble that it is not absorbed in sufficient quantity from the intestinal canal to be injurious to the organism. When given internally it disinfects the whole contents of the intestinal canal so that the faeces have either no smell at all or a faint smell of naphthalin. It is so sparingly soluble that most of it remains in the intestine and acts on the contents of the intes- tinal tube along its whole length from the stomach to the rectum. Uses. — It may be used wherever it is desirable to destroy germs and stop processes of putrefaction or fermentation in the intestine. It has proved useful in typhoid fever, diarrhoea, acute and chronic, vomiting and diarrhoea in children, and tubercular diarrhoea. 1 It is possible that it may be useful in cholera. Naphthol. C ](J II 7 OH. There are several kinds of naphthol. The only one hitherto used is the beta- or iso-naphthol. Not officinal. Characters. — In white crystals, with a somewhat agreeable smell. Sparingly soluble even in hot water. Soluble in alcohol, ether and chlo- roform, in olive oil and vaseline. Action. — It has a therapeutic action on the skin like tar. When absorbed it causes vomiting, loss of consciousness, convulsions, and hematuria. Uses. — It is used in scabies, eczema, and local sweating. It may be applied ill \ to 5 per cent, alcoholic solution, or as an ointment (10 per cent.). 1 Rossbach, Berlin, klin. Wochenschr., 1884, No. 42. CAEBON COMPOUNDS. 695 Hydrochlorate of Rosaniline. Synonyms — Fuchsin, Magenta, Roseine, Aniline Red. C 20 H 10 N 3 .HC1. Not officinal. Preparation. — Rosaniline is a colorless substance prepared by acting on aniline with oxidizing agents such as arsenic acid. The com- pounds of rosaniline with monobasic acids have brilliant colors. Characters. — Elongated crystals with a brilliant green lustre, readily soluble in water, and giving a bright red solution. Dose. — J-4 gr. Actions. — Rosaniline hydrochlorate when perfectly pure is said to have no marked physiological action. Fabrics dyed with it have acted as local irritants, producing eczema ; but it is probable that this effect may be due, at least in great part, to the presence of arsenic. When given internally it has produced salivation, vomiting, diarrhoea, and when injected into the veins it has caused trembling, staggering, albumi- nuria, and fatty degeneration of the kidneys. These symptoms may possibly be due to the presence of aniline or of arsenic as impurities. It is excreted by the kidneys, saliva, and bile, and probably also by the intestinal mucous membrane. It gives a magenta color to the urine. Use. — To lessen or remove albumen from the urine in albuminuria. Cliinoline. C 6 H 7 N (p. 686). Not officinal. Characters. — A colorless liquid with an aromatic odor. It forms crystalline salts. Dose.— Of the tartrate 7-15 grs. (0-5-1 Gm.). Action. — It is a powerful antiseptic and antipyretic. In mod- erate doses it lowers temperature and pulse rate. In large doses it produces languor, diminished reflex excitability, dyspnoea, paralysis and collapse. Uses. — It has been used in typhoid fever, rheumatism, and erysip- elas, apparently with benefit. It is little used in pneumonia; and in phthisis it is apt to irritate the stomach and produce collapse. Kairin. Hydrochlorate of oxyethyl-chinoline hydride. Not offi- cinal. Dose. — 3-30 grs. Best given in wafer-paper or a capsule. Action. — It is a powerful antipyretic. Uses. — Used in febrile conditions to lower the temperature. Filehne recommends that doses of 8 grains should be given every hour at first for four times, or until the temperature has fallen to 100° F. If the tem- perature falls after four doses, 4 grains should be given hourly until the temperature again begins to rise, when the dose should be increased. If the temperature has not fallen to 100° after four doses of 8 grains, 12 or 16 grains should be given hourly, until the temperature of 100° is reached, when the dose should be lowered as before. Like resorcin, it produces profuse sweating. Antipyrin. Not officinal. A synthetically prepared alkaloid. There are two substances bearing this name, viz., methyloxychinicine and dimethyloxychinicine. The latter is the commercial drug. Characters. — A white powder, very readily soluble in water; taste sweetish bitter and rather pleasant. Its solutions give with ferric chloride 696 ORGANIC MATERIA MEDICA. a deep red, and with nitrous acid a greenish-blue. Chinicine or quinicine is a hypothetical base. The supposed constitution of chinicine and methyl- oxy chinicine may be thus graphically represented: — XT XT N-H I /N-H C H-C C C-H H-C C C-CH. I II I I II I H-C C C-H H-C C C-H ^ / \ / % / \ S\ C C\ C C H H I H || H HO Chinicine or Quinicine. Methyloxychinicine. Dose. — Thirty grains hourly for three hours. For children a grain and a half for every year of the child's age may be given hourly for three hours. If it causes vomiting it may be dissolved in half its weight of hot water and injected subcutaneously. Action. — It reduces the temperature for several (1-20) hours when given as above in two or three doses, and when its effect has passed off, the rise of temperature which then occurs is less frequently accom- panied by rigor than is the case with Kairin. It causes profuse per- spiration. It slightly increases the blood-pressure. It has no action on the respiration. It is excreted in the urine. It some- times, though rarely, causes vomiting, and very seldom causes collapse. Uses. — In febrile diseases generally. It seems specially useful in typhoid fever and phthisis, but it is also useful in erysipelas, surgical fever, pleurisy, and pneumonia. SECTION V. VEGETABLE MATERIA MEDICA. CHAPTER XXXI. THALAMIFLOK^. Class I.— EXOGEN^E.— Exogens. Sub-Class I.— THALAMIFLOEJE. RANUlSrCIILACEJE. B.P. Aconiti Folia. Aconite Leaves. — The fresh leaves and flowering tops of Aconitum napellus, gathered when about one-third of the flowers are expanded, from plants cultivated in Britain. Characters. — Leaves have deeply-cut wedge-shaped segments, by which even a fragment of the leaf can be recognized; exciting slowly, when chewed, a sensation of tingling. Flowers are deep blue, helmet- shaped. Officinal Peepaeation. b.p. DOSE. Extractum Aconiti (green-extract) 1-2 gr. B.P. Aconiti Radix. Aconite Root. — The dried root of Aconitum napettus, collected in winter or early spring before the leaves have appeared. U.S. P. Aconitum. — The tuberous root of Aconitum napellus. Characters. — Conical and tapering, usually from one to three inches long, not thicker than the finger at the crown, blackish-brown, internally whitish. A minute portion, cautiously chewed, causes prolonged tingling and numbness. (697) 698 VEGETABLE MATEEIA MEDICA. Properties axd Composition. — The chief active princi- ple in both leaves and roots is an alkaloid aconitine or aconitia, which is combined with aconitic acid. It is only present in small quantity in the leaves. In the root resinous and fatty matters and several other active principles are also present. Nepaul aconite, or Bikh, the root of A.ferox, contains an alka- loid pseudaconitine, which is much more active than aconitine. Japanese aconite is said to contain an alkaloid which is much more powerful even than pseudaconitine. It is therefore very important that officinal preparations should be made only from the root of A. napellus. Aconite! Officinal Peepaeations. u.s.p. DOSE. Abstractnm Aconiti £-1 gr. ("OS-'SS Gin.) Extractnni Aconiti H gr. (/01--02 Gm.) Extractum Aconiti FTuidum J-2 niin. (•OS-'liJ c.c.) B.P. DOSE. Tinctura Aconiti 1-5 min. Linimentum Aconiti U.S.P. Abstractum Aconiti. — Exhaust powdered aconite 200 parts, with alcohol containing 2 parts of tartaric acid. Eetain the first 170 parts of the percolate, evap- orate the remainder to 30, at a temperature not exceeding 50° C. (122° F.), and mix with the reserve portion. Place the mixture in an evaporating dish, and, having added 50 parts of sugar of milk, cover it with a piece of thin muslin gauze and set aside in a warm place, where the temperature will not rise above 50° C. (122° F.), until the mixture is dry. Lastly, having added enough sugar of milk to make the mixture weigh 100 parts, reduce it to a fine uniform powder. B.P. Aconitia. — A white, usually amorphous, solid alkaloid. When rubbed on the skin it causes a tingling sensation, followed by prolonged numbness. It is a very active poison. Preparation. — The aconitate of aconitia is dissolved out of the pounded root by macerating in spirit. If ammonia were now added, the aconitia would be set free, but being soluble in spirit would not be pre- cipitated. The spirit is therefore recovered by distillation, and the residual extract dissolved in water, in which the aconitate of aconitia is soluble, although the alkaloid is very sparingly so. By adding ammonia, aconitia is precipitated mixed with coloring matter and other principles. It is then dissolved in ether, which leaves the coloring matter behind. The ether is recovered by distillation, and the aconitia farther purified by dissolving in water acidulated with sulphuric acid and reprecipitating by ammonia. Characters axd Tests. — A white, usually amorphous, solid, soluble in 150 parts of cold and 50 of hot water, and much more soluble in alco- hol and in ether; strongly alkaline to reddened litmus, neutralizing acids, and precipitated from them by the caustic alkalies, but not by carbonate of ammonia or the bicarbonates of soda or potash. It melts with beat, and burns with a smoky flame, leaving no residue when burned with free access of air. Officinal Preparation. B.P. Unguentnm Aconite. — Aconitia 8 gr., dissolved in rectified spirit \ fi. dr., and mixed with prepared lard 1 oz. For external application only. THALAMIFLORJE. 699 Physiological Actiox — General Action. — Its action is exerted most markedly on the peripheral ends of sensory nerves, on the heart, and on the respiration. In frog-s it produces steady loss of motion, both voluntary and reflex, with gradually increasing weakness of respiration, and of the heart, which finally stops in diastole, usually about the same time as the respiration. In man one of the most marked symptoms is the local tingling- and numbness produced in the mouth by aconite or aconitine if they come into actual contact with it. This irritation is not limited to the mouth, but occurs also in the gullet and stomach, where it produces belching, nausea, and vomiting. If aconite preparations, or aconitine, are taken in capsules so that they do not touch the mouth or tongue, this local tingling and numbness are hardly felt at all. After absorption, however, the poison is carried by the circulation throughout the body, and then causes a tingling in all parts of the body in the order of their sensitiveness as determined by Weber. The most sensitive p§rts are affected first, viz., the tongue and lips, the finger-tips, face, perineum, breast, belly, and last the back. The heart is quickly affected even by very small doses, and a single drop of the tincture (B.P.) given in water twice or thrice at intervals of a quarter of an hour will in many cases greatly reduce the rate of the pulse. This slowness of the pulse is due to an action of the aconite upon the vagus roots, and does not occur after the administration of atropine. In some cases of disease also the pulse seems little affected by aconite. In larger doses the vaso-motor centre becomes gradually paralyzed, while the heart remains slow, the blood-pressure falls greatly, and the pulse is not only slow but exceedingly weak and irregular. Great muscular weakness and dyspnoea occur, the respirations being slow, shallow, and feeble. The dyspnoea, and probably the weakness also, depend to a considerable extent upon the feebleness of the circula- tion and consequent imperfect nutrition of the nerve-centres, for the administration of atropine lessens the dyspnoea. In addition to this, however, there must be a direct paralyzing action on the respiratory centre, and death usually occurs from stoppage of the respiration. When the heart is examined immediately after death, it is generally found to be still pulsating, although sometimes it is found to have stopped and even lost its irritability. In the latter stage of aconite poisoning the effects of imperfect respiration may become manifest in the livid color and anxious appearance of the face, the cold sweat on the skin, and sometimes protrusion of the eyes with dilatation of the pupil. Death is sometimes preceded by convulsions which do not appear to be entirely due to asphyxia. Action on Individual Organs. — The muscles are little if at all affected by aconite. The terminations of the motor nerves appear to be first irritated, so that fibrillary twitchings of the muscles occur in a frog; afterwards they are paralyzed. The peripheral ends of sensory nerves in the skin and mucous membranes are first irritated, so that the peculiar tingling and numbness is felt, and sometimes also intense neu- ralgia, affecting branches of the fifth nerve: afterwards they are paralyzed. 700 VEGETABLE MATERIA MEDICA. The motor centres of the spinal cord, and the respiratory and vaso- motor centres in the niedulla, appear first to be slightly stimulated, so that clonic convulsions may occur. The reflex power of the cord is diminished, the sensory ganglia being affected before the motor ganglia. The paralysis of the cord is probably to a great extent, however, due to its imperfect nutrition from failure of circulation. The brain remains unaffected, the mental faculties being usually clear up till death. Some- times drowsiness occurs, which may, however, be due to the circulation ; and headache is also observed, which seems to involve the interior of the head, and is distinct from the facial neuralgia observed in earlier stages of the poisoning. Like the motor centres in the cord, the vaso-motor centre in the medulla oblongata appears to be first stimulated and then paralyzed, so that the blood-pressure in rabbits rises at first, but in dogs and cats it falls, apparently from the slowing of the pulse produced by stimulation of the vagus roots. Later on, the vaso-motor centre becomes paralyzed to a considerable extent, though not entirely, so that the blood- pressure falls greatly. Although not completely paralyzed, ^t becomes insensible to reflex stimulation, so that irritation of a sensory nerve will no longer raise the blood-pressure. The heart in the frog is first quickened and then slowed. In man or mammals there is first slowness of the pulse, but shortly before death it may become more rapid. This effect appears to depend chiefly upon primary stimulation succeeded by paralysis of the motor ganglia in the heart, the effect in mammals being altered by the simultaneous action of the drug upon the vagus roots in the medulla. The respiration is at first slow and deep with marked expiratory effort ; afterwards slow, shallow, and labored. This effect appears to be due to the direct action of the poison on the respiratory centre, together with its indirect action through weakening of the circulation (p. 213). Before death, convulsions occasionally occur, and these are, to a great extent, due to the indirect effect through the circulation, but possibly also, to a direct irritating effect of the drug on a convulsive centre in the medulla. The temperature falls constantly throughout. The stomach is irritated immediately by the poison taken directly into it, so that violent vomiting may occur; but it may also be irritated by the poison being eliminated by the gastric mucous membrane after injection subcutaneously or into the blood, so that the effects are similar to those produced by the direct introduction of the drug into the stomach (p. 55). The secre- tion of the salivary gland is increased, and usually the sweat also, possibly other secretions. The intestines are irritated like the stomach, and diarrhoea occurs in consequence. The pupil at the commencement of poisoning alternately contracts and dilates, the tendency to contraction being best marked ; and a simi- lar result occurs from the local application of aconitine to the eye. Later on there is extreme dilatation. This dilatation may be due to reflex irritation from the gastro-intestinal mucous membrane (p. 198). Aconite quickly passes from the blood into the tissues, for if the greater part of the blood of a poisoned dog is transfused into the veins of a healthy one within a few minutes after poisoning has begun, it produces no effect. THALAMIFLOR^E. 701 Therapeutic Uses of Aconite. — Aconitine is applied locally in the form of ointment in cases of severe neuralgia, a small piece about the size of a pea being rubbed into the painful part. If the neuralgia affects the temple, great care must be taken that the ointment does not get into the eye, as rapid absorption occurs from the conjunctiva, and general poisoning may result. Aconite liniment is frequently employed in muscular rheumatism ; in various forms of neuralgia, such as sciatica ; and over swollen and pain- ful joints. Admixture with chloroform facilitates the absorption of alka- loids through the skin, so that a mixture of aconite liniment with chloroform liniment may be more efficacious than either the one or the other separately ; but the mixture should be employed with care, and not over too large a surface, to prevent any risk of too rapid absorption. As a local sedative to the stomach, it has been employed in full doses to check the vomiting of pregnancy. Its chief use, however, is in the febrile condition depending upon local inflammations, such as tonsillitis, sore throat, pleurisy, pneumonia, phthisis, peritonitis, pericar- ditis, acute rheumatism, gout, erysipelas, otitis, gonorrhoea, and in urethral fever. In many of those conditions small doses of aconite slow the pulse, lower the temperature, and give much relief to the patient. In cardiac disease its action is somewhat uncertain. In nervous palpita- tion it is sometimes useful, and it may give relief in palpitation depending upon hypertrophy, but frequently it is of no use in this condition. In diseases of the nervous system its internal application alone, or combined with its external use, sometimes gives relief in head- ache, toothache, noises in the ear, neuralgia, especially of the face, in intercostal neuralgia, and neuralgia accompanying herpes-zoster. It has been found useful, also, in some cases of amenorrhoea depending on a sudden check to the menstrual flow, and also in severe menorrhagia. Mode of Application. — Externally it may be applied in the form of ointment or liniment, internally in the form of tincture or extract. The extract is uncertain in its strength, and death has occurred from the two grains laid down as a maximum by the British Pharmacopoeia. The tincture should also be administered in very small doses, as it is difficult to counteract its effect when too much has been given. Instead of giving a large dose, therefore, all at once, it is much better to give it in divided doses, such as one drop in a little water, every quarter or half an hour until the pulse has begun to be affected, and then every hour or two hours afterwards, according to the necessities of the case, so as to maintain the action (Ringer). U.S.P. Stapliisag-ria. Staphisagria. Stavesacre. — The seed of Delphinium staphisagria. Characters. — From one-eighth to one-sixth of an inch (3 to 4 millimetres) broad, flattish-tetrahedral, one side convex, brown or brown- ish-gray, with reticulate ridges, containing a whitish, oily albumen and a straight embryo ; nearly inodorous ; taste bitter and acrid. Composition. — It contains several alkaloids, the most important being delphinine and staphisagrine. 702 VEGETABLE MATERIA MEDICA. Action. — Staphisagrine paralyzes the niotor nerves in like curare, and kills mammals without convulsions by paralyzing the respiration. Delpliinine resembles aconitine in many respects, and like it causes slowness of the pulse and respiration, paralysis of the spinal cord, and death by asphyxia. It stimulates the vagus centre in the medulla, and also the accelerating centre for the heart (p. 279). It slows the respiration, apparently by an action on slowing fibres of the vagus, for when the vagi are cut, it quickens respiration, probably by stimulating the respiratory centre in the medulla. In advanced stages of poisoning it paralyzes the ends of the vagus in the heart and also the cardiac muscle. It removes the still-stand caused by muscarine and digi- talin (Boehm). By depressing the action of the spinal cord it arrests the convulsions caused by strychnine. Uses. — Stavesacre is sometimes used externally as a parasiticide in the form of an ointment (3 parts of ground seeds to 5 of lard). U.S.P. Pulsatilla. Pulsatilla. — The herb of Anemone Pulsa- tilla and Anemone pratensis, and of Anemone j^atens, var. Nuttalliana, collected soon after flowering. It should be carefully preserved and not be kept longer than one year. Characters. — Leaves radical, petiolate, silky-villous, twice or thrice deeply three-parted or pinnately cleft, with linear, acute lobes, appearing after the large, purple, (or, in the last-named species, sometimes whitish) flowers ; inodorous ; very acrid. Dose. — 1J-6 grains. Composition. — The fresh plant yields by distillation with water, an acrid, oily principle, with a burning, peppery taste. A similar oil is got from Ranunculus bulb >osus, R. flammula, and R. sceleratus. Its thera- peutic value is not great. When kept for some time, this oily substance becomes decomposed into anemonic acid and anemonin. Action. — The oil acts as a vesicant when applied to the skin. Anemonic acid appears to be inert. Anemonin sometimes causes local inflammation and gangrene when subcutaneously injected; vomiting and purging when given internally. It is uncertain whether these symp- toms are due to anemonin itself or to some impurity in it. The chief action of pure anemonin is a depressant one on the circulation, res- piration and spinal cord, to a certain extent resembling that of aconite. The symptoms are slow and feeble pulse, slow respiration, cold- ness, paralysis affecting first the hind and then the fore-legs, dyspnoea, and death without convulsions. In poisoning by extract of pulsatilla convulsions are always present. Their absence in poisoning by anemo- nin appears to be due to its paralyzing action on motor centres in the brain (p. 1 68) ; it does not paralyze the muscles and motor nerves in frogs. CFSES. — It is supposed to be diaphoretic and emmenagogue. It lias been used in amenorrhcea, dysmenorrhea, catarrh of various mucous membranes, bronchitis and asthma. Adonis Vernalis. Not officinal. — This plant is considered by some to be a apecies of Anemone. I JOMPOSITION. — It contains a glucoside adonidin. THALAMIFLOR.E. 703 Action. — Adonidin has an action almost exactly like that of cligi- talin, but is much stronger, and is said not to be cumulative. It appears to be about ten times as powerful as digitoxin. Use. — It may be used instead of digitalis, and sometimes succeeds when digitalis fails. It is, however, less certainly beneficial in valvular disease than digitalis, and should be used only when digitalis fails (Noth- nagel). It appears to produce vomiting and diarrhoea more readily than digitalis (Bubnoif). Administration. — It may be given in the form of infusion (j-2 dr. of the root to 6 fl. oz. of water) in doses of J fl. oz. every two to four hours. U.S. P. Cimicifuga. Cimicifuga. Black Snakeroot. — The rhizome and rootlets of Cimicifuga racemosa (synonym : Aetearacemosa). Characters. — The rhizome is horizontal, hard, two inches (5 centi- metres) or more long, about one inch (25 millimetres) thick, with numerous stout, upright or curved branches, terminated by a cup- shaped scar, and with numerous wiry, brittle, obtusely quadrangular rootlets, about one-twelfth of an inch (2 millimetres) thick; the whole brownish-black, nearly inodorous, and having a bitter, acrid taste. Rhizome and branches have a smooth fracture, with a large pith, surrounded by numerous sub-linear, whitish wood-rays, and a thin, firm bark. The rootlets break with a short fracture, have a thick bark, and contain a ligneous cord branching into about four rays. Officinal Prepakations. dose. Extractum Cimicifugse Fluidum 30-60 min. Tinctura Cimicifugse %-2 fl. drm. Composition. — It contains, when fresh, a volatile oil, a resin, and a bitter neutral substance, but it is not known to which of these its activity is due. Action. — In large doses this drug produces nausea, vomiting, depres- sion, headache and giddiness. Its action on the heart is said to be like that of digitalis, but is less powerful. Uses. — It is used as a stomachic and cardiac tonic in various conditions of weakened heart. It has been used in chorea, rheumatic affections, headache and neuralgia, and is useful as an expectorant in bronchitis or acute catarrh, and in phthisis. Under the name of Actea racemosa it obtained a great reputation as a cure for acute rheumatism, but this was not confirmed on a more extensive trial. Podophyllum, TJ.S.P. ; Podophylli Radix, B.P. PODOPHYL- LUM Root. — The dried rhizome and rootlets of Podophyllum peltatum. North America. Fig. 139.— Podophyllum. Characters. — In pieces of variable length, about I of an inch thick, dark reddish-brown externally, whitish within, breaking with a 704 VEGETABLE MATERIA MEDICA. short fracture. At intervals of about 2 inches the rhizome is thick- ened, and from each swollen part or joint a number of pale brown root- lets spring. These are brittle, and many of them break short off close to the rhizome, leaving little round white spots which help to distinguish podophyllum easily from other roots. Powder yellowish-gray, sweetish in odor, bitterish, subacrid and nauseous in taste. Properties and Composition. — Its most important constituents are podophyllin, which is a resinous substance, and berberine, which is a yellow alkaloid, having little physiological action. Kesina Podophylli, U.S. P. ; Podophylli Resina, B.P. Resin of Podophyllum. Preparation. — The resin is dissolved out of the powdered root by exhausting with spirit, the greater part of which is recovered by distilla- tion, and the remainder holding the resin in solution is poured into water slightly acidulated with hydrochloric acid, when the resin is pre- cipitated as a fine powder, as it is insoluble in water. The resin itself consists to a great extent of a fatty and resinous acid, and subsides more quickly in acidulated than in pure water. It is afterwards washed and dried. Characters and Composition. — A pale greenish-brown amorphous powder, soluble in rectified spirit and in ammonia ; precipitated from the former solution by water, from the latter by acids. Almost entirely solu- ble in pure ether. It consists chiefly of a fatty and a resinous acid, having little physiological action, and two active substances, podophyl- lotoxin and picropodophyllin, the former being much the more powerful. Officinal Pkeparations of Podophyllum. u.s.p. DOSE. Eesina Podophylli H gr. (0'008-0'03 Gm.) Abstractum " 5-10 gr. (033-0'67 Gm.) Extractum " 1-3 gr. (0'06-0-2 Gm.) Extractum " Fluidum 5-15 min. (0"3-0"9 c.c.) B.P. Podophylli Eesina (Podophyllin) -g-1 gr. Physiological Action. — The resin is the part chiefly employed. It acts as a drastic purgative, increasing the secretions of the intestinal mucous membrane, and of the liver (p. 351). It acts on the bowels, when injected subcutaneously as well as when introduced into the intestinal canal. Like many other hepatic stimulants, it does not increase the secretion of bile so much when it acts as a purgative (p. 354,. Uses. — It is used in cases of biliousness associated with dark stools (Ringer). When the stools are pale, mercurial pill is usually employed. It is often employed in combination with other purgatives, such as colocynth, aloes or rhubarb. It is useful in congestion of the liver and of the portal circulation, in ague with congested liver, and in sick headache with biliousness. Its action is uncertain and it frequentty causes griping. Externally it act^ a- an irritant: if incautiously handled it often produces conjunctivitis. THALAMIFLOR.E. 705 U.S. P. Hydrastis. Hydrastis. Golden Seal. — The rhizome and rootlets of Hydrastis Canadensis. Characters. — Rhizome about an inch and a half (4 centimetres) long and a quarter of an inch (6 millimetres) thick ; oblique, with short branches, somewhat annulate and longitudinally wrinkled ; externally yellowish-gray ; fracture short, waxy, bright reddish-yellow, with a thickish bark, about ten narrow wood-wedges, broad medullary rays and large pith. Rootlets thin, brittle, with a thick, yellow bark, and sub- quadrangular, woody centre. Odor slight ; taste bitter. Officinal Peepaeations. dose. Extractum. Hydrastis Fluidum 1-2 fl. drm. Tinctura Hydrastis 2-5 fl. drm. Composition. — It contains the yellow, bitter alkaloid berberine, and the colorless, also bitter, hydrastia, or hydrastine, besides a third alkaloid and a volatile principle not yet isolated. Uses. — Its uses are similar to those of the simple bitters. Professor Rutherford found the resinous substance obtained from the root to be an hepatic stimulant of moderate power (p. 351). This substance, which is also called hydrastin, must not be confounded with the alkaloid. It consists of a mixture of hydrastine, berberine, and resin in varying pro- portions. The pure alkaloid hydrastine is said to be antiperioclic, and causes ringing in the ears like quinine. MAGNOLIACE^E. U.S. P. Illiciuni. Star- anise. — The fruit of Illicium anisatum. Character. — The fruit consists of 8 brown, boat-shaped carpels, joined at their inner ends so as to form a star. Each contains 1 seed with an oily taste. The taste of the fruit is sweet and aromatic. Composition. — It contains a volatile oil which so closely resembles that of true anise as to be officinal. Oleum Anisi, U.S. P. and B.P. — A volatile oil distilled from Illicium or Anise. For preparations and action vide Anise. MENISPERMACEJE. U.S. P. Menispermum. Menispermum. Canadian Moon- seed. — The rhizome and rootlets of Menispermum Canadense. Characters. — Rhizome several feet long, about a quarter of an inch {6 millimetres) thick, yellowish-brown or brown, finely wrinkled longitu- dinally and beset with numerous thin, rather brittle rootlets ; fracture tough, woody; internally yellowish, with a thickish bark, a circle of porous, short, nearly square wood-wedges, and a large, central pith ; nearly inodorous ; taste bitter. Dose. — 5-20 gr. in infusion. Composition. — It contains a small quantity of berberine and a color- less alkaloid. Uses. — It acts as a bitter tonic, and is sometimes used also as a substitute for sarsaparilla. 45 706 VEGETABLE MATERIA MEDICA. Calumba, U.S.P. ; Calumbse Radix, B.P. Calumba Root. — The root, cut transversely and dried, of Jateorrhiza Calumba (Cocculus palmatus, DC). From the forests of Eastern Africa, between Ibo and the Zambezi. Characters. — Slices, flat, circular, or oval, about two inches in diameter, from ^ to J of an inch thick, softer and thinner towards the centre, so as to present the appearance of biconcave discs, grayish- yellow, bitter. Composition. — It contains a neutral principle, calumbin, a yellow alkaloid, berberine, to which it owes its color, and calumbic acid. All these are bitter. It contains much starch, which is dissolved by hot Fig. 140.— Calumba. water, so that a decoction is blackened by iodine. The infusion is con- sequently made with cold water to leave the starch behind, as it renders the infusion liable to decompose, especially in hot weather. It contains no tannin, and the infusion can therefore be prescribed along with salts of iron. Peepaeatioxs. u.s.p. dose. Extractum Calumbse Fluidum 15-30 min. (0"9-l"9 c.c.) Tinctura Calumbse 1-4 fl. dr. (3-75-15 c.c.) B.P. Extractum Calumbse 2-10 gr. or more. Infusum Calumbse (1 oz. to 1 piut) 1-2 fl. oz. Tinctura Calumbse £-2 fl. drm. Also contained in Mistura Ferri Aromatica. Action. — Calumba is a pure bitter stomachic tonic. Neither the berberine nor calumbin which it contains has any powerful physiological action. Berberine in doses of 1 J grains given subcutane- ously kills rabbits, with symptoms of prostration and fall of temperature; but a dose eight times as great given to them by the mouth has no action, and 15 grains only produce in man slight colicky pains and diarrhoea. It is said to cause contraction of the intestines and of the spleen, and to lessen oxidation in the blood. Calumbin seems to have still less action. In small doses it seems, like other bitters, to raise the blood-pressure slightly, and in large doses to lower it. Uses. — Calumba is used as a bitter tonic in atonic dyspepsia and debility of the digestive organs. It is said to have a soothing effect, and La therefore given in irritable conditions of the stomach. It is frequently employed in combination with iron, chiefly in the form of infusion; the THALAMIFLOK.E. 707 advantage it possesses over other bitter infusions, except quassia, for this purpose, being, that it contains no tannin and consequently does not form an inky-looking mixture. It may be used as a general tonic during convalescence from various acute diseases, and may be prescribed in com- bination with either acids or alkalis. Pareira, U.S.P. ; Pareirce Radix, B.P. Pareira Root. — The dried root of Chondodendron Tomentosum. Brazil. Characters. — Generally seen in more or less cylindrical pieces, about f of an inch in diameter and four inches or more in length. The bark is grayish-brown, and the wood grayish yellow. It is recognized by the well-marked rings and medullary rays on the wood. The rings are irregularly concentric. Composition. — It contains an alkaloid pelosine or buxine, which appears to be identical with beberine. Prepakatioxs. U.S.P. DOSE. Extractum Pareirse Fluidum 1-2 fl. dr. (3'75-7'50). B.P. Decoctum Pareirte 1£ ounce to pint l£-2 fl. oz. Extractum Pareirae 10-20 gr. Extractum Pareirse Liquidum 1 ounce to 1 fluid ounce £-2 fl. drm. Physiological Action and Uses. — Pareira is a bitter tonic, but is chiefly employed as a stimulant to the mucous membrane of the genito-urinary tract, in chronic catarrh of the bladder. It is usually given in the form of decoction or liquid extract, frequently combined with an acid or an alkali, according to the condition of the urine. U.S.P. Picrotoxinum. Picrotoxin. C 9 H 10 O 4 ; 182. — A neu- tral principle prepared from the seeds of Anamirta paniculata. Characters. — Colorless, flexible, shining, prismatic crystals, per- manent in the air, odorless, having a very bitter taste, and a neutral reaction. When heated to about 200° C. (392° F.), the crystals melt, forming a yellow liquid; when heated on platinum foil, they char and are finally completely dissipated. Concentrated sulphuric acid dissolves picrotoxin with a golden-yellow color, which turns violet-red on the addition of a trace of bichromate of potassium. When mixed with three times its weight of nitrate of potassium, moistened with sulphuric acid, and then treated with strong solution of soda in excess, picrotoxin assumes a brick-red color of short duration. The aqueous solution should remain unaffected by solutions of salts of mercury or platinum, tannic acid, iodide of mercury and potassium, or other reagents for alkaloids (absence of, and difference from, alkaloids). Action. — It stimulates all the motor and inhibitory centres in the medulla, especially the respiratory and vagus centres. It also irritates motor centres, either in the cerebrum or in the medulla and cord, producing in all vertebrates alternating epileptiform spasms, with periodic stoppage of the motions of the diaphragm and slowness of the pulse. The spasms often take the form of swimming, running backwards or round in a circle {manege movements), or rolling of the body on its axis (pp. 172 and 196). The temperature is somewhat raised. 708 VEGETABLE MATERIA MEDICA. Use. — It is employed as an ointment (10 gr. to 1 oz. of lard) in tinea capitis, and to destroy pediculi. It should be used with care, as its application to the head has been followed by convulsions and death. BERBERIDACEiE. U.S. P. Caul opliy Hum. Caulophyllum. Blue Cohosh. — The rhizome and rootlets of Caulophyllum thalictroides. Characters. — Rhizome about four inches (10 centimetres) long, and about one-fourth to two-fifths of an inch (6 to 10 millimetres) thick, bent ; on the upper side, with broad, concave stem-scars and short, knotty branches; externally gray-brown, internally whitish, tough and woody. Rootlets numerous, matted, about four inches (10 centimetres) long, and one twenty-fifth of an inch (1 millimetre) thick, rather tough ; nearly inodorous ; taste sweetish, slightly bitter and somewhat acrid. Dose. — 1-5 gr. in infusion. Composition. — It contains the glucoside saponin and resins. Uses. — It has little medicinal virtue, though it has been recom- mended as a diuretic, antispasmodic, and emmenag-og'ue. PAPAVERACE^E. B.P. Papaveris Capsular. Poppy Capsules. — The nearly ripe dried capsules of the white poppy, Papaver somniferum. Cultivated in Britain. Fig. 141.— Poppy capsule. Characters. — Globular, two or three inches in diameter, crowned by a sessile stellate stigma, which distinguishes them from colocynth and bael fruits. Prepaeations. u.s. p. b.p. dose. None. Decoctum Papaveris (2 oz. boiled for ten minutes \ in 1| pints of water, strained, and made up to >- For fomentations. 1 pint) J Extractum Papaveris 2-5 gr. Syrupus Papaveris 1 fl. drrn.-£ fl. oz. Composition. — The capsules contain a small amount of morphine (more being found when unripe than when ripe), together with meconic acid, and very minute quantities of papaverine and papaverosine. The seeds are devoid of these principles, but contain much bland oil. THALAMIFLOK.E. 709 Action and Uses. — Poppy capsules act in a similar manner to opium, but are much weaker, and not so certain in their action. They are employed in the form of syrup of poppies, and given chiefly to chil- dren as an opiate. Considering the uncertainty of its action, and in view of the fact that children are very readily affected by any preparation of opium, the drug should be used with caution. Externally the decoction is used for sedative fomentations to allay pain. Opium, U.S. P. and B.P. Opium. — The inspissated juice obtained from the poppy, Papaver somniferum, grown in Asia Minor. The unripe capsules are incised, or rather deeply scratched. The milky juice which exudes becomes inspissated by spontaneous evaporation, and is scraped off and made into lumps. As these ought to consist only of the tears of thickened juice from the incisions, the lump should tear with an irregular surface, and when drawn across a piece of paper should leave a light-brown interrupted streak. Sometimes vegetable extracts are used to adulterate opium, and then it has a more even fracture, and makes a more or less even streak on a piece of paper. Characters. — Irregular lumps weighing from four ounces to two pounds ; enveloped in the remains of poppy leaves, and generally covered with the chaffy fruits of a species of rumex ; when fresh, plastic, tearing with an irregular, slightly moist chestnut-brown surface, shining when rubbed smooth with the finger, having a peculiar odor and bitter taste. Test. — 100 grains of opium should yield, when assayed, 9 grains of morphia, U.S. P., and at least 6 to 8 according to the B.P. Prepaeations. U.S. P. DOSE. Extractum Opii £-1 gr. (0-031-0*065 Gm.) Emplastrum Opii (6 parts in 100) \ PreTiarpd from Fxt rao- Trochisci Glycyrrhizas et Opii (A \ tlZoxAi gr. in each lozenge) J F B.P. DOSE. Confectio Opii (Pulv. Opii Co. 1 ., . . Ark , _ nrk 192 gr. ; Syrup 1 oz.).„ j 1 P art m 40 > nearl y 5 " 20 « r - B X^C.. . P " ™,-. eS !? } J P art in 10 for ^ternal use. Enema Opii { ? n - drm - tincture to 2 fl. oz. starch \ mucilage. Extractum Opii About 1 part from 2 5-3 gr. or more. Extractum Opii liquidum 22 gr. extract in 1 fl. oz., nearly 4-40 Tt\,or more. Iiinimentum Opii f 1 in 2 (Laudanum, 1 ; Soap Lini- 1 ment, 1). Morphias Acetas About 1 part from 8 or 10 i-lgr. Morphias Acetatis Liquor 4 gr. acetate in 1 fl. oz 10-60 TT\, Morphias Hydrochloras About 1 part from 8 or 10 £-1 gr. Morphias Hydrochloratis Liquor..4 gr. hydrochlorate in 1 fl. oz 10-60 rr\, Pilula Ipecacuanhas cum Scilla...l part in 16J, nearly 5-10 gr. Pilula Pluuibi cum Opio 1 part in 8 - 4-8 gr. 'gMEg£ £Wfc«) I 1 partin 6 - neariy 3 - 5gr - 1 Pilula Saponis Composita is purely a preparation of opium. It is sometimes convenient to give opium to patients "without their knowledge. If the pill were called Pilula Opii the patients would see from the prescription what they were taking, while they learn nothing about the nature of the medicine from the name Pil. Saponis Co. The name of this pill was changed from Pil. Saponis Co. to Pilula Opii in the B.P. of 1864, but the inconveniences which arose from this were so great that the name was altered again. 710 VEGETABLE MATERIA MEDICA. Peepaeatioxs — (continued ). b.p. DOSE. Pulvis Cretae Aromaticus cum Opio, 1 part in 40 10-60 gr. Pulvis Ipecacuanha? Conipositus...l part in 10 5-15 gr. Pulvis Kino Compositus 1 part in 20 5-20 gr. Pulvis Opii Compositus 1 part in 10 2-5 gr. Tinctura Caniphorse Composita 2 grains to 1 fl. oz 15 rr^-l fl. drrn. Tinctura Opii (Laudanum) 33 grains to 1 fl. oz., nearly 4-40 tr^or more. Tinctura Opii Amiuoniata 5 grains to 1 fl. oz |-1 fl. drm. Trocliisci Opii T Vth grain of extract in each 1-4. Unguentum Gallse cum Opio 32 grains to 1 oz. galls ointment... for external use. Tinum Opii 22 gr. extract in 1 fl. oz., nearly. ..4-40 tt\,or more. B.P. Pulvis Kino Compositus. COMPOUND POWDEE OF KlNO. — Kino, 3f ; opium, \ ; cinnamon bark, 1. B.P. Pulvis Opii Compositus. COMPOUND POWDEE OF OPIUM. — Opium, 1J ; black pepper, 2 ; ginger, 5 ; caraway fruit, 6 ; tragacanth, J. B.P. Tinctura Camphoree Composita. COMPOUND TlNCTUEE OF CAMPHOE (English Paeegoeic). — Opium, 40 gr.; benzoic acid, 40 gr.; camphor, 30 gr.; oil of anise, \ fl. drm. ; proof spirit, 1 pint. B.P. Tinctura Opii Ammoniata. AMMONIATED TlNCTUEE OF OPIUM (SCOTCH Paeegoeic). — Opium, in coarse powder, 100 gr. ; saffron, 180 gr. ; benzoic acid, 180 gr. ; oil of anise, 1 fl. drm. ; strong solution of ammonia, 4 fl. oz. ; rectified spirit, 16 fl. oz. B.P. Vinum Opii. Wine of Opium. — Extract of opium, 1 oz. ; cinnamon bark, 75 gr. ; cloves, 75 gr. ; sherry, 1 pint. U.S. P. Opii Pulvis. Powdered Opium. — Opium dried at a temperature not exceeding 85° C. (185° F.), and reduced to a moderately fine powder. It ought not to contain less than 12 nor more than 16 per cent, of morphine. Peepaeations. U.S. p. DOSE. Acetum Opii (Black Drop) 10-15 min. (0'60-l c.c.) Opium Denarcotisatum J-2 gr. (0-016-013 Gm.) Pilulse Opii (Opium, 1 gr.; Soap, \ gr.) One pill. Pulvis Ipecacuanha? et Opii (1 in 10) 5-15 gr. (0'32-l Gm.) Tinctura Ipecacuanha? et Opii 4-15 min. (025-1 c.c.) Tinctura Opii 6 min. Tinctura Opii Camphorata 4-15 min. (\-\ c.c.) Tinctura Opii Deodorata 6 min. Vinum Opii 6 min. (0"37 c.c.) U.S.P. Acetmn Opii. VlNEGAE OF Opium. — Opium, 10 ; nutmeg, 3 ; extracted with diluted acetic acid by maceration and percolation up to 80 parts of liquid ; then sugar, 20, is added. U.S.P. Opium Denarcotisatum. Denaecotized Opium. — Prepared by removing narcotine and odorous principles by extraction with stronger ether, and adding suf- ficient sugar of milk to make up the weight to that of opium containing 14 per cent, of morphine. U.S.P. Tinctura Opii Deodorata. DeODOEIZED TlNCTUEE OF OPIUM. — Macerate opium, 10, with water, 40, evaporate down to 10, shake with ether, 20, pour off the ether, and evaporate until the whole of the ether is gone. Mix with water, 50, filter, adding water up to 80, then add alcohol, 20. u.s.p. Tinctura ipecacuanha et Opii. Tinctuee of Ipecac and Opium. — Deodorized tincture of opium, 100, evaporated to 85, then fluid extract of ipecac, 10, is added, the mixture filtered, and diluted alcohol added up to 100. u.s.p. Tinctura Opii Camphorata. Camphoeated Tinctuee of Opium — Powdered opium, 4 ; benzoic acid, 4; camphor, 4; oil of anise, 4; glycerine, 40; diluted alcohol up to 1000. THALAMIFLOILE. 711 U.S.P. Vinum OpiL Wine of Opium. — Powdered opium, 10 ; cinnamon, 1 ; cloves, 1; stronger white wine up to 100. Composition of Opium. — Besides the usual constituents of vegetable products, such as mucilage, albumen, pectous substances, caoutchouc-like substance, fat, volatile substances, some sugar, salts of ammonia, calcium, and magnesia, it contains seventeen or eighteen alkaloids and two neutral substances, as well as a peculiar acid — meconic acid. The alkaloids are chiefly combined with meconic acid or sulphuric acid, but may be partly free. The three most important alkaloids are morphine, codeine, and thebaine. The others are papaverine, pseudomorphine or oxymor- phine, gnoscopine, codamine, laudanine, laudanosine, meconidine, lantho- pine, protopine, cryptopine, narcotine, oxynarcotine, hydrocotarnine, narceine, rhoeadine. The neutral substances are meconin and meconiasin. Some, at least, of the alkaloids in opium may be regarded as derivatives from morphine. Thus codeine and pseudomorphine or oxymorphine can be produced from morphine artificially. Besides the derivatives of morphine found naturally in opium, various series of alkaloids can be artificially prepared from morphine by (a) the addition of alcohol radicals, or by (b) oxidation, or ( Composition. — Gentio-picrin, from which the root derives its bitter taste ; it is soluble in water. Also gentianin, which is tasteless and only slightly soluble in water. Peepaeations. u.s.p. DOSE. Extractum Gentianse 2-10 gr. Extractum Gentianse Fluidum 8-30 min. Tinctura Gentianse Composita 1-4 fl. dr. B.P. DOSE. Extractum Gentianse 2-10 gr. Tnfusum Gentianse Compositum 1-2 fl. oz. Mistura Gentianse \-l fl. oz. Tinctura Gentianse Composita |-1 fl. dr. B.P. Infusum Gentianae Compositum.— Eoot, 60 gr. ; bitter orange peel, 60 gr. ; fresh lemon peel, \ oz.; and boiling water, 10 fl. oz. B.P. Mistura Gentianse.— Root, \ oz.; bitter orange peel, 30 gr.; coriander, 30 gr. ; proof spirit, 2 fl. oz. ; and water, 8 fl. oz. By maceration, first in spirit, and afterwards in spirit and water. Tinctura Gentianae Composita.— Gentian, 8 ; bitter orange peel, 4 ; cardamom, 2 ; diluted alcohol up to 100, U.S.P. Root, 1£ oz.; bitter orange peel, f oz.; cardamoms, \ oz.; proof spirit, 20 fl. oz., B.P. Use. — Gentian is a simple, bitter stomachic tonic. It is used in atonic dyspepsia to give tone to the stomach and increase the appetite. Also used as a general tonic. Chirata, U.S.P. and B.P. — Chiretta. — The entire plant, Ophelia chirata. Northern India. Characters. — Stems about three feet long, of the thickness of a goose-quill, round, smooth, pale brown, branched ; branches opposite ; flowers small, numerous, panicled; the whole plant intensely bitter. Composition. — Ophelic acid, soluble in water and forming a soluble compound with tannic acid; and chiratin, soluble in warm water and forming an insoluble compound with tannic acid. Both substances are intensely bitter. COKOLLIFLOK^E. Preparations, u.s.p. DOSE. Extractum Chiratas Fluidum 15-30 min. Tinctura Chirata3 $-2 fl. drm. B.P. DOSE. Infusum Chiratse (1 in 40 of water at 120° F.) 1-2 fl. oz. Tinctura Chiratse J-2 fl. drm. 831 Fig. 171.— Chiretta. Uses. — As a bitter tonic like gentian. It has been supposed by some to be specially useful in disorders of the liver. COXVOLVULACE^E. B.P. Scammoniae Radix. Scammony Root. — The dried root of Convolvulus Scammonia. Syria and Asia Minor. Characters. — Tap-shaped roots, often twisted, sometimes three inches in diameter at the top, brown without, white within, slightly odorous but tasteless. Ether agitated with the powder and evaporated leaves a residue having the properties of scammony resin. Composition. — Resina Scammoniae, q.v. Preparations. U.S. p. DOSE. Eesina Scammonii 4-8 gr. B.P. DOSE. Eesina Scammoniae 3-8 gr. Sc ammonium, U.S.P. and B.P. Scammony. — A resinous exu- dation from the root of Convolvulus Scammonia, U.S.P. A gum-resin, 832 VEGETABLE MATERIA MEDICA. obtained by incision from the living root of Convolvulus Scammonia. Chiefly in Asia Minor. Characters. — In irregular, angular pieces or circular cakes, ash- gray and rough externally; fresh fracture resinous, splintery, shining, black when dry ; odor and flavor cheesy ; causes, when chewed, a slight prickly sensation in the back of the throat; easily triturated into a dirty- gray powder, and converted with water into a smooth emulsion. Composition. — Gum and resin. Adulterations. — Chalk, starch, wood-ashes, and gum. Tests. — It does not effervesce with hydrochloric acid (no chalk). Boiling water agitated with the powder, cooled and filtered, does not strike a blue color with tincture of iodine (no starch). Ether removes from 80 to 90 per cent, of resin ; and what remains is chiefly soluble gum, with a little moisture (no wood-ashes). PREPARATIONS. U.S. P. DOSE. Resina Scammonii 4-8 gr. B.P. DOSE. Confectio Scammonii 10-30 gr. or more. Pilula Colocynthidis Composita 5-10 gr. Pilula Colocynthidis et Hyoscyanii 5-10 gr. Pulvis Scammonii Compositus 10-20 gr. Resina Scammonise 3-8 gr. B.P. Confectio Scammonii. COXFECTIOX OF SCAMMOXY. — Scammony, 3 OZ. ; ginger, 1£ oz.; oil of caraway, 1 fl. drm.; oil of cloyes, ? fl. drm.; syrup, 3 fl. oz. ; clarified honey, l£ oz. B.P. Pulvis Scammonii Compositus. COMPOUND POWDEE OF SCAMMOXY. — Scammony, 4; jalap, 3; ginger, 1. Resina Scammonii, U.S. P. ; Scammonise Resina, B.P. Resin of Scammony. Characters. — In brownish translucent pieces, brittle, resinous in fracture, of a sweet, fragrant odor if prepared from the root. It cannot form singly an emulsion with water. Ether dissolves it entirely. Preparation. — Extracted from the root by percolating with alcohol. Composition. — Principally jalapin, soluble in ether; in this respect differing from the convolvulin of jalap. The resin also contains other substances the properties of which are imperfectly known. Contains no gum. Impurity. — Guaiacum fraudulently added. Test. — The tincture does not render the fresh-cut surface of a potato blue. Preparatioxs. U.S. P. DOSE. Extractum Colocynthidis Compositum 5-20 grs. B.P. DOSE. Extractum Colocynthidis Compositum 5-15 gr. Mistura Scammonii 1-2 fl. OZ. Pilula Scammonii Composita 5 gr. u.r. Mistura Scammonii. Scammony Mixture. — Resin of scammony (2gr.) triturated with milk (1 fl. oz.). COROLLIFLOR.E. 833 B.P. Pilula Scammonii Composita. COMPOUND SCAMMOXY PlLL. — Resin of scarnmony, 1; resin of jalap, 1; curd soap, 1; strong tincture of ginger, 1; rectified spirit, 2. Action and Use. — It increases the secretion of the intestines and acts as a drastic purgative. It is used as a derivative in dropsy and cerebral affections. It is also used, in combination with other drugs, as a vermifuge for tapeworm in children. It combines with the soda in the bile and its solution in bile is necessary to its action (Buchheim). Jalapa, U.S. P. and B.P. Jalap. — The tuberous root of Exo- gonium Purga, U.S. P. The dried tubercles of Exogonium Purga (lpomcea Purga), B.P. Mexico. Fig. 172. — Jalap, transverse section, natural size. Characters. — Varying from the size of a nut to that of an orange, ovoid, the larger tubercles frequently incised, covered with a thin, brown, wrinkled cuticle ; presenting, when cut, a yellowish-gray color, with dark brown concentric circles. Jalapae Kesina, U.S. P. and B.P. Resin of Jalap. — Extracted from jalap by rectified spirit. Characters and Tests. — In dark brown, opaque fragments, trans- lucent at the edges, brittle,* breaking with a resinous fracture, readily reduced to a pale brown powder, sweetish in odor, acrid in the throat, easily soluble in rectified spirit, but only partially so in ether, and insol- uble in oil of turpentine. Preparation. — Digesting and gently heating the jalap with recti- fied spirit, precipitating the resin with water, evaporating by a water bath, and drying. Composition. — The resin consists of convolvulin in combination with another resinous substance (gammaresin) which is the part dissolved by ether. The convolvulin of jalap differs from the jalapin of scam- mony in being insoluble in ether. Peepaeations. U.S. p. DOSE. Abstractum Jalapa? 7-10 gr. Pulvis Jalapae Compositus 30-60 gr. Kesina Jalapae 2-5 gr. Pilulae Catharticae Composite ~ 1-3 pills. 53 * 834 VEGETABLE MATERIA MEDICA. P reparations— {continued ) . B.P. DOSE. Extractura Jalapae 5-15 gr. Pulvis Jalapae Compositus 20-60 gr. Pulvis Scammonii Compositus 10-20 gr. Re sina Jalapae 2-5 gr. Tinctura Jalapae 5-2 fl. drm. Resin of Jalap is contained in Pilula Scammonii Composita. Pulvis Jalapae Compositus. COMPOUND JALAP POWDEE. — U.S. P. Jalap, 35; acid tartrate of potash, 65. B.P. Jalap, 5; acid tartrate of potash, 9; ginger, 1 part. Action and Uses. — Jalap is a hydragogue purgative, used for con- stipation, dropsy due to renal disease, and cerebral affections. It is best given with acid tartrate of potash, as in Pulv. Jalapae Co. Like scam- mony, it is dissolved by the bile, and appears to require it in order to act. It has no action when injected subcutaneously, nor when injected into the veins. It has no irritant action when locally applied to the skin or mucous membranes of the eye or nose, nor has it any diuretic action ; or any action on the nervous system. SOLANACE^E. Dulcamara, U.S.P. and B.P. Dulcamara. The dried young branches of Solanum Dulcamara. plants which have shed their leaves. Bittersweet. — From indigenous Fig. 173. — Solanum Dulcamara. Characters. — Light, hollow, cylindrical, about the thickness of a goose-quill, bitter and subsequently sweetish to the taste. Composition. — It contains solanine, and less dulcamarine, both alkaloids, amorphous and of a bitter taste. It yields also sugar. Preparations. D.8.P. DOSE. Extractum Dulcamanc Fluidum 1 fl. drm. COROLLIFLOR^. 835 Preparation — (continued). B.P. DOSE. Infusum Dulcamarse (1 oz. in J pint) 1-2 fl. oz or more. Action. — The action of dulcamarine has not been investigated. Solanine, both in warm and cold-blooded animals, paralyzes the central nervous system without affecting the peripheral nerves or voluntary muscles. It slows the heart and respiration, lessens sen- sibility, and causes death with convulsions. In warm-blooded animals there is constant fall of temperature, and there is entire absence of any action on the pupil. In man it produces weakness, labored breath- ing, nausea, vomiting and drowsiness, but no true sleep. The pupil is unaffected and there is no increased movement of the bowels, diuresis, or diaphoresis. Uses. — Dulcamara is chiefly used as an alterative in scaly skin diseases, in which it is often combined with antimony. It has been recommended by Husemann in chronic bronchial catarrh, asthma and whooping-cough. Capsicum, U.S. P. ; Capsici Fructus, B.P. Capsicum, U.S. P. ; Capsicum Fruit, B.P. — The dried ripe fruit of Capsicum fastigiatum, and of C. annuum. Zanzibar. Characters. — Pod membranous, from five to eight lines long, two lines broad, straight, conical, pointed, smooth, shining, but somewhat corrugated, orange-red, intensely hot in taste. Composition. — An exceedingly acrid, volatile substance, Capsaicin, and an alkaloid resembling con'ine in odor. Adulteration. — The powder is occasionally found adulterated with red lead. Test. — -Digest in nitric acid and add sulphate of soda. There should be no precipitate of sulphate of lead. Should burn away without residue of lead. Preparations, u.s.p. DOSE. Extractum Capsici Fluidum 2-10 min. Oleoresina Capsici ^-1 min. Tinctura Capsici 8 min. to 2 fl. dr. Emplastrum Capsici B.P. DOSE. Tinctura Capsici 5-20 min. (as a gargle, J-2 fl. drm. in 5 oz. of fluid.) Action and Uses. — Externally capsicum is an irritant, producing warmth, redness, and vesication. Internally it is an irritant, and in large doses will produce gastro-enteritis. It has been used for unbroken chilblains, neuralgia, and rheumatic pains. Internally it may be used as a gargle for tonsillitis, pharyngitis, and relaxed sore throat. It is used as a condiment, and to relieve flatu- lence. It is also recommended to relieve the sinking in the epigastrium felt by dipsomaniacs. It promotes appetite and stimulates the stomach. ATKOPACE^E. Belladonnse Folia, U.S.P. and B.P. Belladonna Leaves. — The leaves of Atropa Belladonna, U.S.P. The fresh leaves, with the 836 VEGETABLE MATERIA MEDICA. branches to which they are attached, of deadly nightshade. Atropa Bel- ladonna ; also the leaves separated from the branches and carefully dried ; gathered from wild or cultivated British plants when the fruit has begun to form, B.P. Characters. — Leaves alternate, three to six inches long, ovate, acute, entire, smooth, the uppermost in pairs and unequal. The expressed juice, or an infusion, dropped into the eye, dilates the pupil. Composition. — Less than one per cent, of atropine, and a small proportion of asparagine. More atropine is obtained from the leaves of mature plants than from those gathered before inflorescence. Peepaeations. u.s.p. DOSE. Extractum Belladonnas Alcoholicum \ gr. Tinctura Belladonna? 8-30 min. Unguentum Belladonnse B.P. DOSE. Extractum Belladonna? (green) 1 gr. Tinctura Belladonna? (from dried leaves) 5-30 min. Succus Belladonnse (from fresh leaves) 5-15 min. Unguentum Belladonna? l fromextrart Emplastrum Belladonna? / lrom extract - Belladoniige Radix, U.S.P. and B.P. Belladonna Root. — The dried root of Atropa Belladonna. Characters. — From one to two feet long, and from half an inch to two inches thick, branched and wrinkled, brownish-white. An infusion dropped into the eye dilates the pupil. Roots which are tough and woody, breaking with a splintery fracture, should be rejected. Composition. — Two alkaloids, atropine and belladonnine, the former under one per cent. Also a red coloring matter, atrosin. Peepaeations. u.s.p. DOSE. Atrophia , vhnk gr. Abstractum Belladonna? £ gr. Emplastrum Belladonnse Extractum Belladonna? ..1-2 min. Linimentum Belladonnse Fluidum B.P. DOSE. Atropia shriu &• Linimentum Belladonna? (1 oz. to 1 fl. oz.) Atrophia, U.S.P. ; Atropia, B.P. Atropine, U.S.P. ; Atropia, B.P. C^H^NC^ ; 289. — An alkaloid obtained from belladonna. Preparation. — It cannot be profitably prepared on a small scale. The chief parts of the process are the precipitation of acid coloring matters from a strong tincture by means of lime, removal of the alcohol, addition of water and carbonate of potash, taking up the alkaloid from the alkaline solution by chloroform, and subsequent purification. Characters and Tests. — In colorless, acicular crystals, sparingly soluble in water, more readily in alcohol and in ether. Its solution in water has an alkaline reaction, gives a citron-yellow precipitate with terchloride of gold, has a bitter taste, and powerfully dilates the pupil. It leaves no ash when burned with free access of air. It is an active poison. COROLLIFLOR^. 837 The following test has been proposed for the members of the group of mydriatic alkaloids — atropine, hyoscyamine, daturine, duboisine, and homatropine. To a small portion of atropine in a test-tube add about 2 ccm. of a 5 per cent, solution of mercuric chloride in 50 per cent, of alcohol, and warm gently. A precipitate will at once appear, and become brick-red in color. This test does not answer in dilute solutions, neither does it turn out well if atropine be added to the mercury. Other alka- loids give for the most part a white precipitate (Gerrard). Peepaeations. B.P. DOSE. Atropine Liquor (4 gr. ; spirit, 1 fl. dr. ; water, 7 fl. dr.).... 4 gr. in 1 fl. oz....$-6 min. Atropise Sulphas sVsihr S r - Atropise Sulphatis, Liquor 4 gr. in 1 fl. oz £-6 min. Atropiae Unguentum (with rectified spirit, % fl. dr., and prepared lard, 1 oz.) 8 gr. in 1 oz. Atropinse Sulphas, U.S.P.; Atropise Sulphas, B.P. Sul- phate of Atropine, U.S.P. ; Sulphate of Atropia, B.P. Preparation. — By dissolving atropia in dilute sulphuric acid and evaporating. Characters and Tests. — A colorless powder, soluble in water, forming a solution which is neutral to test-paper, and when applied to the eye, dilates the pupil as the solution of atropia does. It leaves no ash when burned with free access of air. Intended for external application. It is a powerful poison. Peepaeation. U.S.P. B.P. None. Liquor Atropine Sulphatis (4 gr. in 1 fl. oz. of water). General Action of Belladonna or Atropine. — The first symp- toms to appear after a small dose are dryness of the mouth and head- ache. After full doses the pupils become dilated, a red rash appears on the skin like that of scarlatina, and a delirium of a peculiar and often of a pleasant character ensues, in which there is a great desire for move- ment and activity, with a feeling of great lassitude (p. 182). The pulse becomes rapid. This is generally followed by sleep. With large doses the mouth becomes so dry that swallowing is almost impossible, and the attempt to swallow may bring on general convulsions like hydrophobia ; these convulsions are followed by "paralysis, stupor, often alternating with delirium, coma, and death, preceded by marked failure of the heart's action and of respiration. Death is due to asphyxia. Special Action. — Locally applied it diminishes the sensibility of the sensory nerves (whether applied as liniment or injected subcu- taneously). It can be absorbed from the skin and produce its general symptoms. It stimulates the centres in the Drain, but tends to paralyze the ends of the motor nerves, hence causing that peculiar form of delirium in which a constant desire for action is associated with lassitude. The spinal cord is first stimulated, then paralyzed. 838 VEGETABLE MATERIA MEDICA. In a frog the first stimulation quickly passes off, and there follows gradually increasing weakness, both of respiratory and voluntary move- ments, until these become entirely abolished. If the frog be kept in this condition for four or five days, this state of absolute paralysis passes off, and is succeeded by a condition of excitement with violent tetanic con- vulsions, which may be brought on by the slightest afferent stimulus. Various explanations of this action have been given (vide p. 158). The endings of motor nerves in voluntary muscles are paralyzed by large doses, but small doses will paralyze the efferent nerve endings which terminate in peripheral ganglia (e.g., vagus), and in involuntary muscle (p. 134). The converse is the case with curare. Atropine has no action on voluntary muscles. Involuntary muscle is paralyzed by large doses (p. 134). On the Eye. — The pupils are dilated and the eye becomes bright, dry, and injected. The power of accommodation is paralyzed, and by large doses intraocular tension is increased. For the mode of action vide pp. 199-203. On the Circulation. — The action of atropine on the excised heart of the frog affords an illustration of the statement I have made (p. 59), that in all probability contradictory observations frequently depend on differences in the temperature at which the observations were made. Thus Bowditch and Luciani found the contractions, both of the frog's heart containing ganglia and of the apex (p. 272) alone, were rendered more powerful by atropine, while Gnauck, on the contrary, found that the contractions of the ventricle were diminished both by atropine and hyoscyamine. Kronecker and Schapiro have found that these contra- dictory observations are both correct, but at different temperatures. When the temperature is low (7°-8° C.) the ventricular contractions are enlarged by atropine, but diminished by it when the temperature rises over 15° C. Large doses of atropine completely paralyze the intracardiac inhibitory apparatus, while at the same time they stimulate the vagus centres in the medulla. Atropine is supposed to act upon inhibitory ganglia in the heart itself, not upon the vagus endings, in which respect it differs from nicotine (vide p. 277). Sometimes there is a primary slowing of the pulse rate, followed by quickening, but it is uncertain whether this is due to stimulation of the vagus centre or of the inhibitory apparatus in the heart. Small doses raise the blood-pressure by stimulating the vaso-motor centre in the medulla, but large doses diminish it by paralyzing the vaso- motor centre and partly by paralyzing the peripheral vaso-motor ganglia or muscular fibres of the walls of the arteries themselves (p. 247). Atropine also diminishes the sensibility of the heart to changes of pres- sure within it (p. 263). On Respiration. — Atropine first quickens and then slows respira- tion. This is due to stimulation and subsequent paralysis of the respira- tory centre in the medulla. When injected into the jugular vein it appears to paralyze the ends of the sensory fibres of the vagus in the lungs, and thus tends to slow respiration at first (p. 219). It arrests secretion from the bronchial mucous membrane (p. 223). COKOLLIFLOR.E. 839 On Secretion. — Atropine paralyzes the secreting fibres of the chorda tyrupani without affecting the vaso-dilator fibres, so that when the chorda tympani is stimulated, either directly or reflexly, the flow of blood to the gland is increased, but no fluid exudes from the duct (p. 318). It probably has a similar action on many if not all glands, including the sweat glands, milk glands, mucous glands, pancreas, and liver. When locally applied it stops the secretion of milk and sweat. In the case of the sweat it probably paralyzes the efferent sweat-fibres which accompany the vaso-motor fibres and start from centres in the lumbar and lower dorsal parts of the cord (Luchsinger). It does not, however, prevent secretion in the intestine after division of the intestinal nerves (Brunton and Pye-Smith). The secretion of urine is sometimes increased, but large doses may cause retention, from paralysis of the bladder. On the Intestines. — Small doses increase the movements of the intestines. This action is probably due to paralysis of the inhibitory fibres of the splanchnic, since stimulation of the peripheral end of the cut splanchnic will cause arrest of movement in the unpoisoned, but not in the poisoned, animal. Moderate doses completely arrest peristaltic movements, but the muscular fibres of the intestine retain their irrita- bility. Local irritation causes a local contraction, but no peristalsis. This is probably due to paralysis of the intestinal ganglia. Large doses stop the movements and paralyze the involuntary muscular fibres of the intestine, so that they only contract feebly or not at all when directly irritated. The Temperature is increased by small doses, lessened by large ones. Certain animals, especially pigeons and rodents, such as rabbits, guinea-pigs, and rats, are peculiarly unsusceptible to the action of atropine. It is not improbable that the unsusceptibility of rodents to the action of atropine depends on the very slight tonic action which the vagus exerts on the heart in them in their normal condition. When it is paralyzed there is little change in the circulation, while in dogs the case is very different (p. 252). Methyl- and ethyl-atropine paralyze the ends of the motor nerves, but do not tetanize ; they however retain the action of atropine on the eye, heart, &c. Therapeutics. — Locally applied belladonna lessens irritability and pain, and is hence used as a lotion in photophobia. Solution of atropine is employed to dilate the pupil and paralyze accommodation in many conditions which have already been mentioned (p. 203). Migraine frequently depends upon astigmatism or other visual disturbances, and an attack may sometimes be cut short by the local application of atropine to the eye. In the form of a plaster or liniment over the tender spots, it is useful in myalgia, neuralgia, especially supraorbital and intercostal neuralgia, pleurodynia, hypersensitiveness of skin, and irritability of the chest- muscles seen in phthisical patients. The pain arising from old adhesions due to pleurisy is relieved by a belladonna plaster. In the form of ointment it lessens pain and spasm in fissures of the anus. 840 VEGETABLE MATERIA MEDICA. It is used to check local sweating on the head, hands, or feet, m the form of the liniment two or three times a day. Atropine is used internally to check the sweating of phthisis and other exhausting diseases, in doses of yj-g- gr., gradually increased. It may be given in pill, or mixture, or hypodermically. The beneficial effect may here be due to paralysis of nerves of sweat glands, but is probably due also to the stimulating effect on the respiratory centre (p. 383). Belladonna stops the secretion of milk, and is hence used when the mother from any cause is unable to suckle her child, and the breast becomes swollen and inflamed. For its uses in ophthalmic practice vide p. 203. Given internally, atropine is useful in extreme salivation, as in mercurial ptyalism. In chronic constipation relief is often afforded by small doses of \ gr. of the extract of belladonna. Its action here may be due to diversion of a stimulus from the inhibitory to the motor fibres of the splanchnic, or to paralysis of the inhibitory fibres of the splanchnics (p. 336). It lessens griping, hence it is a useful adjunct to purgatives. It is useful in cases of spasm of involuntary muscles, as in lead colic, simple colic, asthma, and in the spasm set up by renal and biliary calculi (cf. p. 134). Internally it is useful in palpitation due to cardiac strain (p. 263), and sometimes gives relief in angina pectoris. One of the most useful applications in all cases of palpitation, whether accompanied by pain or not, is a belladonna plaster to the cardiac region. As atropine, while it appears to lessen the excitability of the ends of the vagus in the lung, excites the respiratory centre, its action in preventing cough is slight and uncertain. As it has the power of completely arresting secretion from the bronchial tubes, it is useful in cases where there is excessive secre- tion, but where the bronchial mucous membrane is already too dry, it is injurious (p. 223). In incontinence of urine in children belladonna is a most useful remedy. It probably acts by lessening the irritability of the bladder. It is also very serviceable in irritability of the bladder with frequent micturition in adults (p. 384). In epilepsy and chorea it is not much use, but in frontal headaches it is useful in doses of 3 m. of tincture every three hours. In leucorrhoea with ulceration of the os uteri, a pessary made up of 2 grs. of ext. belladonna, with 7 grs. of tannin, and cacao butter q.s., is very useful (Trousseau). As an antidote to opium, 4 min. of liquor atropise, B.P., may be injected subcutaneously, and repeated every quarter of an hour until the pupil dilates. It has also been used in poisoning by calabar bean, and in chloroform poisoning, when death is impending from stoppage of the heart. Doses sufficiently large to paralyze the inhibitory apparatus must be used. Hyoscyamns, U.S.P. ; Hyoscyami Folia, B.P. HyoSCYAMUS, U.S. P. ; Hyoscyamus Leaves, B.P. — The fresh leaves, with the branches to which they are attached, of Hyoscyamus niger ; also the leaves separ- ated from the branches and carefully dried ; collected from plants of the second year's growth. Characters. — Leaves sinuated, clammy, and hairy. The fresh herb has a strong, unpleasant odor, and a slightly acrid taste, which COKOLLIFLORJE. 841 nearly disappears on drying. The fresh juice, dropped into the eye, dilates the pupil. Composition. — A volatile alkaloid, hyoscyamine, soluble in water and spirit. It is decomposed, and its physiological action neutralized by caustic alkalies. It is isomeric with, but not identical with, atropine. Nitrate of potassium and other inorganic salts are present in the leaves. Peepaeations. U.S. P. DOSE. Abstractum Hyoscyami 3-5 gr. Extractum Hyoscyami Alcoholicum....2 gr. Extractum Hyoscyami Fluidum 5-10 min. Tinctura Hyoscyami 1 fl. drm. B.P. DOSE. Extractum Hyoscyami 5-10 gr. or more. Tinctura Hyoscyami 30 min. to 1 fl. drm. or more. Succus Hyoscyami 30 min. to 1 fl. drm. XJ.S.P. Hyoscyaminse Sulphas. Sulphate of Hyoscyamine, (C 17 H 23 N0 3 ) 2 .H 2 S0 4 ; 676. — The neutral sulphate of an alkaloid prepared from hyoscyamus. Characters. — Small golden-yellow or yellowish-white scales or crys- tals, or a yellowish-white, amorphous powder, deliquescent on exposure to air, odorless, having a bitter and acrid taste, and a neutral reaction. Very soluble in water and in alcohol. When heated on platinum foil, the salt chars and is finally completely dissipated. An aqueous solution of the salt is not precipitated by test solution of platinic chloride. With chloride of gold it yields a precipitate, which, when recrystallized from boiling water acidulated with hydrochloric acid, is deposited on cooling (without rendering the liquid turbid) in brilliant, lustrous, golden-yellow scales (difference from atropine). The aqueous solution yields, with test solution of chloride of barium, a white precipitate insoluble in hydro- chloric acid. It is found also in the seeds of Belladonna Stramonium, and in Duboisia myoporoides, the alkaloid of which (duboisine) is identical with hyoscyamine. Hyoscyamine is isomeric with atropine. Dose.— fo gr. to 1 gr. Action and Uses. — The physiological action of hyoscyamine is like that of atropine and daturine. Hyoscyamus is used chiefly as an adjunct to purgatives to lessen griping. It is also used to lessen spasm, and to allay pain and irritation of the bladder. It has also been employed as a sedative to the nervous system. Stramonii Folia, XJ.S.P. and B.P. Stramonium Leaves. — The dried leaves of Datura Stramonium. Thorn Apple. Cultivated in Britain. Characters. — Large, ovate, sinuous, deeply cut; of a heavy odor, which is strongest while they are drying, and of a mawkish, faintly bitter, nauseous taste. Composition. — A very small proportion of daturine. The other constituents are chiefly saline and mineral matters. 842 VEGETABLE MATEKIA MEDICA. Strainonii Seinen, U.S. P.; Strainonii Semina, B.P. Stra- monium Seed, U.S. P.; Stramonium Seeds, B.P. — The ripe seeds of Datura Stramonium. Fig. 174.— Stramonium Seed and section, magnified 3 diameters. Characters. — Brownish-black, reniform, flat, rough; inodorous unless bruised, when they emit a peculiar, heavy smell. Composition.— Contains an alkaloid, daturine, identical with atropine, and also some hyoscyamine. Peepaeatioxs. U.S. p. DOSE. Extractum Strainonii J gr. Extractum Stramonii Fluidum 1 min. Tinctnra Stramonii 10-30 min. Unguentum Stramonii B.P. DOSE. Extractum Stramonii \-% gr. Tinctura Stramonii 10-30 min. Action and Use. — The impure alkaloid, daturine, consisting of atro- pine and hyoscyamine, has exactly the same physiological action as atropine, though less powerful. The chief use of stramonium is as an antispasmodic in cases of asthma. It is often employed in the form of cigarettes during the attack, or the fumes of the ignited powder are inhaled. A mixture of potassse nitras, potassse chloras, stramonium, and ipecacuanha has been employed with good effect in asthma by inhaling the fumes of the ignited mixture. The leaves of Datura Tatula have been substituted for Datura Stra- monium. Tabacum, U.S. P.; Tabaci Folia, B.P. Tobacco, U.S. P.; Leaf Tobacco, B.P. — The dried leaves of Virginian Tobacco, Nieotiana Tabacum. Cultivated in America. Characters. — Large, mottled-brown, ovate or lanceolate, acuminate leaves, up to twenty inches (50 centimetres) long, bearing numerous short, glandular hairs ; having a peculiar, heavy odor and nauseous-bitter, acrid taste ; yielding, when distilled with solution of potash, an alkaline fluid, which has the peculiar odor of nicotine, and precipitates with perchloride of platinum and tincture of galls. Not manufactured. Preparatiox. r.s.p. B.P. DOSE. None. Enema Tabaci 20 gr. to 8 fl. oz. Composition. — A volatile liquid alkaloid, nicotine, is contained in tobacco as a malate, and is obtained by distillation with an alkali. The leaves contain also nicotianin, or tobacco camphor, which crystallizes out from an aqueous distillate. Resin, gum and several inorganic com- pounds are also present. corolliflor^:. 843 General Action. — Tobacco stimulates and then paralyzes the motor nerves of involuntary muscles and the secreting- nerves of glands. In consequence of this action of tobacco on the intestine, there is in poisoning by it nausea and vomiting, with intense prostration and wretchedness. In consequence of the action of the drug on the lieart and vaso -motor system, there is paleness of the face, cold sweats, feebleness of circulation, and tendency to faint. The action of tobacco is the same as that of its alkaloid, nicotine, though less power- ful. In frogs, nicotine, after a period of temporary excitement, causes a tetanic condition in a peculiar attitude, the head being drawn down, the fore legs back, and the hind legs forward. This is followed by muscular relaxation. In warm-blooded animals there is excitement, difficulty of breathing, followed by trembling, with expulsion of urine and foeces, stupor, staggering gait, convulsions and death. When the dose is very large, the animal may fall with a loud cry and the convul- sions begin at once, deepening into muscular paralysis ; and death ensues from failure of respiration, the heart continuing to beat after respiration ceases. Convulsions also occur in frogs. Special Action. — Spinal cord is first stimulated (p. 167), giving rise to convulsions, and is afterwards paralyzed. The convulsions are of spinal origin in the frog, as is shown by such experiments as have been already mentioned (p. 166), but those which occur before death in mammals are probably asphyxial. Circulation. — Nicotine causes a great diminution of pulse rate and a fall of blood-pressure, followed by a rise of blood-pressure, the pulse rate still remaining slow ; but if a large dose be given, the pulse rate rises very quickly. The drug first stimulates both the vagus roots and its ends in the heart (causing slow pulse rate), and then paralyzes the latter (causing high pulse rate). It does not, however, paralyze the the inhibitory ganglia of the heart, like atropine, since stimulation of the sinus will slow the heart in frogs after nicotine poisoning. The primary fall of blood-pressure is due to the slowing of the lieart, and the subsequent rise to contraction of the peripheral vessels. Alimentary Canal. -Nicotine stimulates peristalsis markedly (p. 334). Tlie methyl and etliyl derivatives of nicotine have no tetanizing influence on the cord, neither, curiously enough, do they paralyze the ends of the motor nerves. Therapeutics. — Tobacco is used as an enema in supposed intus- susception, but it must be employed with care. Owing to its influence on the cord, nicotine has been used in tetanus and strychnia poisoning, but is not much use. Tobacco-smoking. — The effects produced on the system by tobacco- smoking may be partly due to nicotine, but are probably rather due to products of its decomposition, such as pyridine and collidine. In pipe- smoking pyridine (p. 686) preponderates, but when smoked in cigars, where there is free access of air, the chief product of the dry distillation undergone by the tobacco is collidine, which is far less active than pyri- dine (Vohl and Eulenburg). In those accustomed to smoke tobacco, it has a soothing effect on the nervous system, but it often acts as a nervous stimulant to mental work, 844 VEGETABLE MATERIA MEDICA. as in reading. In these cases the effect is probably not due to the nico- tine itself, but to the stimulus of the smoke on the sensory nerves of the mouth, which reflexly stimulates the vaso-motor centre, and dilates the vessels of the brain ; since some people produce the same effect by sucking sweets, or sipping whisky and water (p. 177). There is no doubt that smoking in excess is injurious. It produces a furred tongue, irritation of the throat, hoarseness, often dyspepsia and irritability of the heart, with a characteristic rhythm and palpitation (smoker's heart). This effect on the heart is like that produced by partial paralysis of the vagus, and disappears when the habit is given up for a time. Sudden faintness is also apt to occur, so that a previously strong and healthy man will suddenly fall down in a state of syncope without apparent cause, or the faint may be brought on by some mental emotion. The sight is impaired by habitual excess in tobacco smoking. Tobacco smoking is often very useful in asthma, and a pipe after breakfast will often relieve constipation. Tobacco snuff is used as an errhine. SCKOPHULARIACE^E. Digitalis, U.S. P. ; Digitalis Folia, B.P. Digitalis, Foxglove, U.S. P.; Digitalis Leaf, B.P. — The dried leaf of Digitalis purpurea, purple foxglove. The leaves of Digitalis, U.S. P. Collected from wild indigenous plants, when about two-thirds of the flowers are expanded, B.P. Characters. — Ovate-lanceolate, shortly petiolate, rugose, downy, paler on the under surface, crenate. Composition. — Contains a number of active principles formerly included under the name of digitaline. Peepaeations. U.S.P. DOSE. Abstractum Digitalis $-1 gr. Extractum Digitalis J--J gr. Extractum Digitalis Fluidum 1-2 min. Infusum Digitalis 1-2 fL dr. Tinctura Digitalis 5-10 min. B.P. DOSE. Digitalinum inrsV g r - Infusum Digitalis (3 gr. to 1 fl. oz.) 2-4 fl. dr. or more. Tinctura Digitalis (54 gr. to 1 fl. oz.) 5-30 min. infusum Digitalis. Infusion of Digitalis. — Digitalis, in No. 20 powder, 3 ; cinnamon, in No. 20 powder, 3; boiling water, 185; alcohol, 15; water, q.s. Pour the boiling water on the mixed powders and macerate for two hours in a covered vessel. Then strain, add the alcohol, and pass enough water through the strainer to make the infusion weigh 200 parts, U.S.P. Digitalis leaves, dried, 30 gr. ; boiling distilled water, 10 fl. oz. Infuse in a covered vessel for one hour, and strain, B.P. B.P. Digitalinum. DlGITALIN. Preparation. — Dissolving out digitalin from alcoholic extract of the leaves by acetic acid and water, decolorizing by animal charcoal. Neu- tralizing by ammonia and precipitating the digitalin by tannic acid. COROLLIFLOE^. 845 Rubbing with oxide of lead and spirit to remove the tannic acid. Dis- solving out the digitalin with spirit, again decolorizing by animal char- coal, evaporating, and purifying by washing with ether. Characters and Tests. — In porous, mammillated masses or small scales, white, inodorous, and intensely bitter ; readily soluble in spirit, but almost insoluble in water and in pure ether ; dissolves in acids, but does not form with them neutral compounds ; its solution in hydrochloric acid is of a faint yellow color, but rapidly becomes green. It leaves no residue when burned with free access of air. It powerfully irritates the nostrils, and is an active poison. Dose. — ^ to -^ of a grain. Chemistry of Digitalis. — Formerly the active principle of digitalis was said to be digitaline, but the substances prepared and sold by different manufacturers under this name varied much in their solubility and in the intensity of their physiological action. The most important varieties were Homolle's amorphous digitaline, Nativelle's crystallized digitaline, and soluble or German digitalin. An examination of the chemistry of digitalis by Schmiedeberg has shown that there are at least five principles present in it, and possibly there are present also some products of their decomposition. They are all non-nitrogenous, and with the exception of one, digitoxin, are gluco- sides. They are: digitoxin, digitalin, digitale'in, digitonin, and digitin. The first three of these are cardiac poisons. Digitonin has an action like that of saponin, and digitin appears to be inert. Digitoxin is quite insoluble in water, and forms the chief constituent in Nativelle's digitaline. By boiling with dilute acids digitoxin yields toxiresin, and digitalin yields digitaliresin. Digitalin is also insoluble in water, and is the active principle of Homolle's digitaline. Digitalein differs from the two former in being readily soluble in water, and forms a large proportion of the soluble digitalin. The digitaline of the B.P. being almost insoluble in water probably consists chiefly of digitoxin or digitaline. General Action. — In large doses digitalis causes sickness, vomit- ing, muscular weakness, diuresis, subjective affections of vision, labored respiration, and death ; the heart usually failing before the respiration. The condition of the heart after death varies. Sometimes I have found it in diastole and sometimes in systole in dogs poisoned by digitalis. Special Action. — On the muscles. In a number of unpublished experiments on this subject made in 1867-68 in the laboratories of Professors Briicke and J. Rosenthal, I found that soluble digitalin did not lessen the excitability of the unweighted muscle, but diminished its power to lift a weight. According to Schmiedeberg and Koppe, digitalis paralyzes all voluntary muscles. Digitalin causes elongation of the muscle, with increased elasticity, in the frog. On the nervous system. It has no marked action on sensory or motor nerves. It has little action on the spinal cord. It has been stated to lessen reflex action in the frog by stimulation of Setchenow's centre, but this may be due to reflex irritation from the point of injection (p. 154). The "brain is unaffected, and in cases of poisoning remains 846 VEGETABLE MATERIA MEDICA. clear to the last. (Two of the products of the decomposition of digitalin, toxiresin and digitaliresin, however, produce convulsions like those of picrotoxin.) Large doses cause subjective affections of vision, consisting in dimness, occasional flashes of light, or in the constant appearance of a rainbow or bright light before the eyes. Locally applied to the eye it produces irritation at first, and afterwards causes a halo to surround bright objects. The respiration is generally somewhat slowed, and occasionally before death may become excessively slow. The effects produced on the circulation by the active principles of digitalis and by substances having a similar action, such as oleandrin, scilliain, adonidin, neriin, convalamarin, antiarin, and helleborein, may be divided according to Schmiedeberg into four stages: — 1. Rise of blood-pressure, usually, though not invariably, accom- panied by slowing of the pulse. 2. Continued rise of blood-pressure, with a quick pulse. 3. Continued high pressure, with irregularity of the heart's action and pulse rate. 4. Rapid fall of the blood-pressure, sudden stoppage of the heart, and death. The rise in blood-pressure is regarded by Schmiedeberg, Boehm, and others as entirely due to increased action of the heart, and not at all to contraction of the vessels. With this view I cannot agree, and I still hold to the opinion which I expressed many years ago, that the rise in pressure is due in great measure to contraction of the arterioles. Not only is it more difficult to raise the pressure in the arterial system by alterations in the heart's action than by contraction of the arterioles, as we find from experiments on a schema (p. 232), but the form of the pulse-curve under the action of digitalis conclusively demonstrates that ■MMMM IKMWA Urn IKIIB* Fig. 175. — Pulse-wave (b) before and (a) after injection of digitalis in a dog. the arterioles are contracted (vide p. 241). This has also been demon- strated by Donaldson and Stevens, 1 who found that the addition of digitalis to blood lessens the flow through vessels in which circulation was artificially maintained. A similar result has been obtained by Ringer. The slow pulse in the first stage of digitalis poisoning is partly due to stimulation of the vagus roots of the medulla, and partly to increased 1 Journal of Physiology, vol. iv., p. 165. COROLLIFLOILE. 847 sensibility or actual stimulation of the ends of the nerves in the heart. This increased sensibility has been shown to exist by Boehm, who found that after the administration of digitalis, a faradaic current which pre- viously had no action on the heart would not only slow the pulse but produce prolonged diastolic arrest. The rapid pulse in the second stage of digitalis poisoning is due to paralysis of the vagus ends. The irregularities in the third stage depend on the action of the drug on the heart itself. The action of digitalis on the frog's heart is very peculiar. At first it causes the pulsations to become slower and more powerful, then the contraction during systole becomes peristaltic, and the dilation during diastole less and less complete, until finally the ventricle stands quite still in such complete systolic contraction that its cavity is entirely oblit- erated. The auricles are sometimes distended with blood, sometimes only moderately dilated. According to Schmiedeberg this contraction is not tetanic, but is rather due to increased elasticity of the cardiac muscle which prevents its normal relaxation during diastole. When it is over- come by driving a nutrient fluid into the ventricle under pressure, or by partially paralyzing the cardiac muscle by saponin, apomorphine, or hydrocyanic acid, the systolic stillstand is removed, and pulsation again recommences. Digestive Organs. — Small doses of digitalin have a pleasant bitter taste, but exercise no marked effect upon the digestive organs. Larger doses produce loss of appetite, nausea, and vomiting, with rumbling and pain in the abdomen, and sometimes diarrhoea. This occurs even when the drug is injected subcutaneously. Urine. — All observers are agreed regarding the diuretic power of digitalis in cardiac disease, but most of them state that it has no such power in health. In my own experiments, however, in which I took the same quantity of food by weight and of fluid by measure during more than a hundred days, I found that, while small doses had little or no action, marked diuresis occurred when the drug was pushed so as to pro- duce symptoms of poisoning. In these experiments also I found that while the diuresis continued the absolute quantity of solids excreted daily in the urine was increased, although their proportion to the urinary water was diminished. In cases of poisoning by digitalis, a marked diminution in the flow of urine frequently precedes a fatal issue; and on injecting digitalis into the veins of a dog, Mr. Power and I found that the secre- tion of urine became entirely arrested when the blood-pressure reached its maximum, and again commenced when the blood-pressure began to fall (p. 372). It is probably to the power of digitalis to arrest the action of the kidneys and thus stop its own excretion that its cumulative action is due (p. 56). Effect of Temperature on the Action of Digitalis. — It has already been mentioned (p. 61) that digitalis has sometimes no action on the pulse in pneumonia. The inhibitory action of the vagi on the heart is lessened by heat, but their peripheral terminations, although weakened, are not completely paralyzed. While this volume was passing through the press Cash and I made some experiments which appear to show that a very high temperature has an action on the vagus centre in the 848 VEGETABLE MATERIA MEDICA. medulla similar to its action on the ends of the nerve in the heart. It does not completely paralyze either the centre or the peripheral ends of the nerve, but it greatly weakens them. This weakening action is so great that it practically amounts to paralysis, for when the temperature rises above a certain point the pulse rate suddenly rises just as it would do if both vagi were cut. This is shown by Fig. 176. When the pulse Ti mi \ 1 D 2 03 4 £ € [0 7 O 8 9 P 1 O'l 0* » Ml »' 1 IOI! II »' 1 '6 1 K)' lk 2 $2 o'2i :o' * 2* 4- r 4 Q* 3 9' •"•*" • -' •.^ '■*•» .»' ('' 2£ 3 8* r , 3 7' „»» _♦" /^ 2. ,0 1 t, 6* „j r" 1 1 12C A N 3! 5* ,4 r* - -" J» 3 4' » — ■*-■* ►""* £ 1 M 9 3" ^s -4 X s iio 3 2' ■*- N s ,/ X" !5,0 \ The unbroken line shows the pulse rate, the dotted line shows the temperature in the axilla in all the figures. Fig. 176.— Shows the effect of rise of temperature alone. At the 195th minute, both vagi were cut; the section was not followed immediately by any apparent effect. After eight minutes more, the pulse rate rose slightly and then fell. rate has been thus quickened by heat, section of the vagi does not render it any quicker (Figs. 176 and 177). Although the vagus centre is so much weakened by the action of the heat that it ceases to exercise any inhibitory action upon the heart, yet Ti Tru /c 1 < ?> 4 5 G ti 7 *a 1 151 !0I 15 1 irfl 15*1 101 kS2 oz \i"a 02 .52 02 53 4 5* 4 A-' •4- J" | »-- 3 JO 4 2' yl t" 3 4 '' ^ ft ^_2 )0 4 0' I i 3P 2 '0 3 9* , y > 2 K 3 S' ^< 4o fe.3 7" ' U o, 5 3 B' > '•'. \ \ ( o* U 5' i r' •^ 1 i ?0 3 4" ,i r li 10 3 1' •** ►•- . J r' ^ J! 10 3 2' '•^ i ^s a * — - Fig. 177. — Shove the effect of rise of temperature after injection of digitalis. At the 45th minute "75 c.c. (12 minims) tincture of digitalis were injected, and another similar injection was made at the 56th minute. At the 65th minute the heating was begun. After section of the vagi the pulse con- tinued to rise, but not more rapidly than before. its functional activity is not completely destroyed even by very high temperatures, and irritation of an afferent nerve will still cause reflex COROLLIFLOR^E. 849 slowing (p. 254) of the pulse, until immediately before the death of the animal from hyperpyrexia. These experiments render it probable that the rapid rise in the pulse rate, which a high temperature occasions, is chiefly of central origin, and is due to partial paralysis of the vagus centre, although diminished action of the peripheral ends of the vagus and increased action of the cardiac ganglia also aid in quickening the pulse. Although neither the vagus centre nor the vagus ends in the heart are completely paralyzed by very high temperatures, they are yet weakened so much that digitalis, and probably all drugs which act like it, such as adonidine (p. 294), no longer slow the pulse as they do at normal tem- peratures. This is shown in Fig. 177, where the pulse remained slow until the temperature rose to nearly 41° C. and then suddenly became very quick. Moderately high temperatures do not prevent digitalis from slowing the heart (Fig. 178). Haul 2; io u to ito IjiO 10 41 3) 3B KUi -!£ 33 2^ M- 3 3 3 m 50 60 70 83 QO IQQ I 120 W iO V -0 V X) l&O I" 1( l: )02$Q2i £ L2 ;:o'2;i 02$Q2K)2» . Fig. 178. — Shows the action of digitalis when given after the temperature has already risen. At the 30th minute the warming was begun ; at the 100th minute '75 c.c. of tincture of digitalis was injected. Action of Different Preparations of Digitalis. — The two most marked effects of digitalis are a reduction in the rate of the pulse, and an increase in the amount of urine. These effects are not coincident, and, according to Christison, the diuretic action is less when the heart is much affected. The preparation generally employed to act on the heart is the tincture, while the infusion is regarded as the best diuretic. 1 The differ- ences between the action of the infusion and tincture of digitalis are probably due, in part at least, to the different proportions in which the active principles of the plant are dissolved by alcohol and water. In digitalis, as in physostigma (p. 762) and many other plants, there is a mixture of principles having antagonistic actions. Digitonin, which has an action very like saponin (pp. 271 and 774), will, to a greater or less extent, antagonize the action of digitoxin, digitalin, and digitalein. Digitonin is readily soluble in water, forming, like saponin, a solution which froths easily. Digitalein is soluble in water, but digitalin is only sparingly so, and digitoxin is hardly soluble in water at all. The solubility of these substances in alcohol is almost the converse of their solubility in water. Digitonin is sparingly soluble in alcohol, while 54 1 The National Dispensatory. 850 VEGETABLE MATERIA MEDICA. digitalin and digitalein are readily soluble. Digitoxin is only sparingly soluble in cold alcohol. From the ready solubility of digitonin in water, infusion of digitalis will contain it in much larger proportion than digitalin or digitalein. This, indeed, is readily seen by putting some infusion of digitalis into one bottle and a corresponding dose of the tincture diluted with water into another, until both solutions have the same bulk. On shaking the bottles, the infusion will be found to froth much more strongly and to retain the froth much longer than the diluted tincture, although the latter also froths strongly. Tincture of digitalis will, on the other hand, contain a larger pro- portion of digitalin and digitalein with probably a small quantity of digitoxin. It is quite possible, however, that in addition to differences in the preparations due to the menstruum, there may be differences in the same preparation due to the plants used. Thus in Edinburgh the usual dose of the infusion is half an ounce, and this is usually readily tolerated, while in London I have frequently seen doses of one or two drachms pro- duce considerable gastric disturbance. The infusion of the U.S. P. is nearly twice as strong as that of the B.P., and yet the recognized dose is considerably larger. Whether these differences are or are not due to the amount and rela- tive proportions of the active ingredients in digitalis plants grown in Scotland, England, and America, is a point which requires investiga- tion, more especially when we have other examples, e.g., cannabis indica, where there is a notable difference between the action of plants of the same species growing in different climates. Therapeutics. — It is chiefly used as a tonic to the heart, especially when its action is irregular and feeble, and in dropsy, cardiac dropsy (pp. 295 and 298). It is used in functional palpitation, and in the irritable heart often seen in young soldiers (p. 300), but its chief use is in mitral disease. In pure aortic disease, with hypertrophy, it is not only injurious but dangerous, since by slowing the pulse rate it lengthens the time during which blood can regurgitate (p. 295). When the aortic disease is accompanied by mitral incompetence and the immediate danger is that from the mitral affection, it may be given with advantage (p. 296). In these cases, whilst taking the drug the patient must be kept perfectly quiet, as there is a great danger of sudden syncope (p. 296). Digitalis is of great use as a soporific in sleeplessness at night accom- panied by drowsiness during the day, for both these symptoms depend on want of tone in the vessels, the blood gravitating to the feet when the patient is erect, and to the head when in a lying posture (p. 177). It is very useful in haemorrhages, especially when occurring in the lungs, and it has been added to cough mixtures to lessen congestion of the mucous membrane. It was formerly used in fever and pneumonia, but is now discarded as being of very little use. In delirium tremens it has been given in very large doses, but its use is dangerous. COROLLIFLOR.E. 851 In dropsy depending on mitral disease, also in renal dropsy and ascites, it has been used with good effect. It is very serviceable in some cases of menorrhagia. Its action in this case is due not to contraction of the vessels of the uterus, but of the walls of the uterus itself, since digitalis did not affect haemorrhage from a fungoid growth in the cervix (Dickinson). It is also useful in spermatorrhoea. Precautions. — (1) Stop the administration of digitalis on the appearance of sickness or a tendency to faint, or change the preparation of digitalis and lower the dose. (2) Do not give digitalis in large doses unless you see the patient frequently, and it is necessary to push the drug. Keep the patient in bed, and do not allow him even to sit up in bed, much less to rise, and above all not to rise up and make water, as otherwise fatal syncope may occur (p. 230). Treatment on Poisoning. — Keep the patient recumbent and give stimulants, e.g., alcohol. Tannin has been recommended in order to precipitate digitalin in the stomach. U.S.P. Leptandra. Leptandra. Culver's Root. — The rhizome and rootlets of Leptandra virginica ( Veronica virginica.) Characters. — Horizontal, from four to six inches (10 to 15 centi- metres) long, and about a quarter of an inch (6 millimetres) thick, some- what flattened, bent and branched, deep blackish-brown, with cup-shaped scars on the upper side, hard, of a woody fracture, with a thin, blackish bark, a hard, yellowish wood, and a large, purplish-brown, about six- rayed pith ; rootlets thin, wrinkled, very fragile, inodorous ; taste bitter and feebly acrid. Peepaeations. DOSE. Extractum Leptandrae (of the root, 2-4 gr.) Extractnm Leptandrae Fluidum 30-60 min. Composition. — It contains a resinous principle, leptandrin. Action. — It is an irritant to the gastro-intestinal mucous membrane, and stimulates the secretion of "bile (p. 351). It may be used as a cathartic in biliousness or constipation. LABIATE. Rosmarinus, U.S.P. Rosemary. — The leaves of Rosmarinus officinalis. Characters. — About one inch (25 millimetres) long, rigid, linear, entire, revolute, dark green above, woolly and glandular beneath ; pun- gently aromatic, somewhat camphoraceous. Peepaeation. Vinum Aromaticum. Oleum Kosmarini, U.S.P. and B.P. Oil of Rosemary. — A volatile oil distilled from rosemary, U.S.P. The oil distilled from the flowering tops of Rosmarinus officinalis. Characters. — Colorless, with the odor of rosemary, and a warm, aromatic taste. 852 VEGETABLE MATERIA MEDICA. Preparations, u.s.p. DOSE. Linimentum Saponis for external use. Spiritus Odoratus do Tinctura Lavandulae Composita $-2 fl. dr. B.P. DOSE. Linimentum Saponis for external use. Spiritus Rosmarini 10-50 min. or more. Tinctura Lavandula? Composita j-2 fl. dr. (of the oil, 1-5 min.) Action axd Use. — It is a stimulant and carminative, and is used to lessen flatulence, and to allay pain and spasm of the intestines. It is a useful adjunct to purgatives, and is used in hysteria. U.S.P. Lavandula. Lavender. — The flowers of Lavandula vera. Characters. — Calyx tubular, blue-gray, hairy, five-toothed, the upper tooth largest and roundish-rhomboid; corolla violet-blue, hairy and glandular on the outside, tubular and two-lipped, the upper lip two- lobed, the lower lip three-lobed ; stamens four, short, on the corolla tube ; odor fragrant; taste bitterish, aromatic, somewhat camphoraceous. Preparation. Vinum Aromaticum. Oleum Lavandulae, U.S.P. and B.P. Oil of Lavender. — A volatile oil distilled from the flowering tops or whole herb of Lavandula vera, U.S.P. The oil distilled in Britain from the flowers of Lavandula vera, B.P. Characters. — Colorless or pale yellow, with the odor of lavender, and a hot, bitter, aromatic taste. Preparations, u.s.p. DOSE. Tinctura Lavandula? Composita £-2 fl. dr. B.P. DOSE. Linimentum Camphone Compositum Spiritus Lavandulae j-l fl. dr. Tinctura Lavandulae Composita £-2 fl. dr. (of the oil, 5 min.) U.S.P. Oleum Lavandulae Flo rum. Oil of Lavender Flowers. — A volatile oil distilled from fresh lavender. Characters. — A colorless or yellowish liquid, having the fragrant odor of lavender flowers, a pungent and bitterish taste, and a neutral reaction while fresh. Sp. gr. about 0*890. It is readily soluble in alcohol, and in acetic acid of 90 or more per cent. When heated to about 80° C. (176° F.) it should not yield a colorless distillate having the characteristics of alcohol. Dose. — 1-5 min. Preparations, u.s.p. DOSE. Spiritus Lavandulae (3 parts of the oil with 97 of alcohol) h-2 fl. dr. Spiritus Odoratus Action and Uses. — Lavender is a stimulant and carminative, and is used to lessen flatulence, to relieve colic, and in hysteria. COROLLIFLORJE. 853 Oleum Menthae Piperita, U.S.P. and B.P. Oil of Pepper- mint. — A volatile oil distilled from peppermint, U.S.P. The oil distilled in Britain from fresh flowering peppermint, Mentha piperita, B.P. Characters. — Colorless or pale yellow, with the odor of pepper- mint ; taste warm, aromatic, succeeded by a sensation of coldness in the mouth. Peepaeations. U.S.P. DOSE. Aqua Menthae Piperitae 1-2 fl. oz. Spiritus Menthae Piperitae 10-15 min. Trochisci Menthae Piperitae (Peppermint Lozenges) ad. lib. B.P. DOSE. Aqua Menthae Piperitae 1J fl. dr. to 1 gallon 1-2 fl. oz. Essentia Menthae Piperitae 1 volume in 5 10-20 min. Pilula Rhei Composita 1 min. in 1 dr. nearly 5-10 gr. Spiritus Menthae Piperitae 1 volume in 50 | fl. dr. (of the oil, 1-5 min.) Action and Uses. — Carminative and stimulant ; used to relieve flatulence and colic ; and as an adjunct to purgatives, to lessen griping. Mosquito bites may be prevented by rubbing the skin of the face and hands, the lips and the margins of the nostrils with soap strongly scented with peppermint or lavender. A sprig of peppermint or pennyroyal, or a small bottle containing their volatile oils, hung near the head during sleep is said to have a similar effect. Peppermint lozenges are useful in relieving flatulence and tendency to faintness due to it. Menthol. C 10 H 20 O. Peppermint Camphor. Not officinal. Preparation. — It separates from peppermint oil after standing, or on cooling to 20° C. Characters. — Colorless crystals, with a taste and smell of pepper- mint oil, sparingly soluble in water, readily soluble in alcohol, ether, and ethereal oils. When rubbed up with an equal quantity of thymol it forms a colorless, oily liquid. The same is the case when it is rubbed with an equal quantity of pure carbolic acid or of chloral hydrate, or with croton chloral hydrate in the proportion of 1 part to 2 of menthol, or with camphor 2 parts to 3 of menthol. Action. — It is a powerful antiseptic. When applied to mucous membrane or skin it causes a feeling of warmth or burning, replaced by a feeling of coldness when the part is blown upon. Uses. — It is chiefly used as an anti -neuralgic. It is either applied in the form of a solid pencil rubbed lightly over the part where the pain is felt, or an alcoholic solution, or the oily liquids prepared by trituration with camphor, carbolic acid, &c, may be painted over the painful spots. These oily liquids are also applied on cotton-wool in order to relieve toothache. Oleum Menthae Viridis, U.S.P. and B.P. Oil oe Spearmint. — The oil distilled in Britain from fresh flowering spearmint, Mentha viridis, B.P. Characters. — Colorless or pale yellow, with the odor and taste of spearmint. 854 VEGETABLE MATERIA MEDICA. Peepaeatioxs. tj.s.p. dose. Aqua Menthse Viridis 1-2 fl. oz. Spiritus Mentha Viridis 5-20 min. B.P. DOSE. Aqua Mentha? Viridis 1£ fl. dr. to 1 gallon 1-2 fl. oz. (of the oil, 1-5 min.) Action and Use. — Like other carminatives and stimulants, to relieve colic, flatulence, and with purgatives to prevent griping. TJ.S.P. Thymol. Thymol. C 10 H 13 HO, or G^.C^.GR.OR. (vide p. 166). Preparation. — It is obtained from the volatile oils of Thymus vulgaris (Labiatse), Thonarda punctata (Labiatae), and Ptyehotis ajowan (Umbelliferse). These oils contain thymol and thymene, C 10 H 16 , which is fluid. The thymol is separated by fractional distillation or prolonged refrigeration. Characters. — Large crystals of the hexagonal system, nearly or quite colorless, having an aromatic, thyme-like odor, a pungent, aromatic taste, with a very slight caustic effect upon the lips, and a neutral reaction. Soluble in about 1200 parts of water, and in 1 part of alcohol at 15° C. (59° F.) ; in 900 parts of boiling water ; freely soluble in burning alcohol, also in ether, chloroform, benzol, benzin, glacial acetic acid, and in fixed or volatile oils. It liquefies with camphor. Its sp. gr. as a solid is 1*028; after fusion it is lighter than water. It melts at about 50° C. (122° F.), remaining liquid at lower temperatures, and boils at about 230° C. (446° F.). A portion mixed with half its volume of glacial acetic acid, then with an equal or somewhat greater volume of sulphuric acid, and gently heated, gives a bright reddish-violet color. Impurity. — Carbolic acid. Test. — Water saturated with thymol, when treated with a few drops of test solution of ferric chloride, should not give a blue color (absence of carbolic acid). Dose. — Internally, J— 1J grains. For spray, 1 in 800 of hot water. As ointment, 5-30 grains to 1 oz. of petrolatum. As inhalation, 6 grains to an ounce of warm water. Action. — In respect of its physiological action, thymol appears to stand between carbolic acid and oil of turpentine. Like carbolic acid, it destroys low organisms, and is a powerful disinfectant. In higher animals it acts as a local irritant and anaesthetic to the skin and mucous membranes. When absorbed it paralyzes the nerve centres in the cord and medulla like carbolic acid, lessening reflex action, slowing respiration, and lowering the blood-pressnre and temperature. In poisonous doses it causes weakness, drowsiness, coma, and death. It differs from carbolic acid in being less volatile and less easily oxidized. Its action as a disinfectant is more permanent, and at the same time more powerful than that of carbolic acid. It is less irritating to the skin or mucous membrane, and does not act as a caustic like carbolic acid, and it i- a less powerful poison to mammals. Its action on the nerve centres is a paralyzing one from the first, and is not preceded by excitement as in COROLLIFLOR.E. 855 the case of carbolic acid. While in the body it appears to affect tissue metabolism, for in animals poisoned by it the liver is found quite fatty, as in phosphorus poisoning. It appears to be eliminated by the respiratory and urinary organs, and to cause irritation of these organs during the process of excretion. In poisoning by it the bronchial mucous membrane is extremely congested, the secretion of mucus increased ; the lungs congested, and sometimes consolidated ; the kidneys inflamed, and the urine albuminous or bloody. Uses. — It has been used as an antiseptic instead of carbolic acid for dressing wounds ; as an application to skin diseases, ringworm, eczema, or psoriasis ; as a gargle, spray, or inhalation in sore throat, or as an injection in ozsena. Internally it has been used in diabetes and vesical catarrh. U.S.P. Hedeoma. Hedeoma. Pennyroyal. — The leaves and tops of Hedeoma pulegioides. Characters. — Leaves opposite, short-petioled, about half an inch (12 millimetres) long, oblong-ovate, obscurely serrate, glandular beneath ; branches roundish-quadrangular ; flowers in small, axillary cymules, with a tubular-ovoid, two-lipped and five-toothed calyx, and a pale blue, spotted, two-lipped corolla, containing two sterile and two fertile exserted stamens ; odor strong, mint-like ; taste warm and pungent. Officinal Peepaeation. U.S.P. DOSE. Oleum Hedeomae 1-5 min. Composition. — It contains a volatile oil. Action and Uses. — It is stimulant, carminative, diaphoretic and emmenagogne. It is used in flatulence and in amenorrhcea. It is frequently given in the form of hot infusion, to promote the menstrual flow when delay or recent suppression has occurred. U.S.P. Marrubium. Marrubium. Horehound. — The leaves and tops of Marrubium vulgare. Characters. — Leaves about one inch (25 millimetres) long, oppo- site, petiolate, roundish-ovate, obtuse, coarsely crenate, strongly rugose, downy above, white-hairy beneath ; branches quadrangular, white, tomen- tose ; flowers in dense, axillary, woolly whorls, with a stiffly ten-toothed calyx, a whitish bi-labiate corolla, and four included stamens ; aromatic and bitter. Composition. — It contains a volatile oil and a bitter principle, mar- rubiin. Dose.— 30-60 gr. (2-4 Gm.). Uses. — It is expectorant, tonic, diaphoretic and diuretic. In large doses it is laxative. It is employed in laryngeal and bronchial catarrh, and in chronic affections of the lungs attended with cough and copious expectoration. U.S.P. Melissa. Melissa. Balm. — The leaves and tops of Melissa officinalis. Characters. — Leaves about two inches (5 centimetres) long, petiolate, ovate, obtuse, crenate, somewhat hairy, glandular ; branches quadrangular ; 856 VEGETABLE MATERIA MEDICA. flowers in about four-flowered cymules, with a tubular, bell-shaped, five- toothed calyx, a whitish or purplish two-lipped corolla, and four stamens ; fragrant, aromatic and bitterish. Composition. — It has a small quantity of a volatile oil. Uses. — It has scarcely any remedial action, but is used in the form of warm infusion or tea as a diaphoretic in slight febrile conditions. XJ.S.P. Origanum. Origanum. Wild Marjoram. — Origanum vulgare. Characters. — Stem branched above, often purplish, leaves opposite, petiolate, about an inch (25 millimetres) long, roundish-ovate, obtuse, nearly entire, pellucid-punctate, hairy beneath; flowers in corymbs, with reddish bracts, a five-toothed calyx, a somewhat two-lipped, pale purple corolla, and four exserted stamens ; aromatic, pungent and bitterish. Peepaeation. Vinum Aromaticum. Used externally. Composition. — It contains a volatile oil, which has been largely superseded by the oil of thyme. Action and Uses. — The infusion is tonic, diaphoretic, and eimiieiiagogne. It is also used externally as a fomentation. XJ.S.P. Salvia. Salvia. Sage. — The leaves of. Salvia officinalis. Characters. — About two inches (5 centimetres) long, petiolate, ovate-oblong, obtuse, finely crenulate, thickish, wrinkled, grayish-green, soft-hairy and glandular beneath; aromatic, bitterish, somewhat astrin- gent. Peepaeation. Vinum Aromaticum. Externally only. Composition. — The leaves contain a volatile oil. Uses. — They are chiefly used as a condiment. The infusion is tonic, carminative, and slightly astringent. It is used in atonic dyspepsia, and to check hectic sweating. U.S.P. Scutellaria. Scutellaria. Skull-cap. — Scutellaria lateriflora (whole plant). Characters.- — About twenty inches (50 centimetres) long, smooth; stem quadrangular, branched ; leaves opposite, petiolate, about two inches (5 centimetres) long, ovate-lanceolate or ovate-oblong, serrate; flowers in axillary, one-sided racemes, with a pale blue corolla and a two-lipped calyx, closed in fruit, the upper lip helmet-shaped ; odor slight ; taste bitterish. Officinal Peepaeation. U.S.P. DOSE. Extractum Scutellaria Fluidum 1-2 fl. drni. Uses. — As a remedy it has little value. It has been used as a nervine tonic in neuralgia, chorea, delirium tremens and nervous exhaustion. PEDALIACEiE. U.S.P. Oleum Sesami. Oil of Sesamum. (Benn the common hemp. (For medicinal use, that which is grown in India,, and from which the resin has not been removed, is alone to be employed, B.P.) Characters. — Tops consisting of one or more alternate branches,, bearing the remains of the flowers and smaller leaves and a few ripe fruits, pressed together in masses of a dusky green color and a character- istic odor. Peepaeations. U.S.P. DOSE. Extractum Cannabis Indicae Fluidum 5-10 min. Tinctura Cannabis Indicae 10-20 min. Extractum Cannabis Indicae £ gr. B.P. DOSE. Extractum Cannabis Indicae ^-1 gr. or more. Tinctura Cannabis Indicae 5-20 min. U.S.P. Cannabis Americana. American Cannabis. — Can- nabis sativa, grown in the Southern United States and collected while, flowering. 880 VEGETABLE MATERIA MEDICA. Characters. — Stem about six feet (2 metres) long, rough; leaves opposite below, alternate above, petiolate, digitate ; the leaflets linear- lanceolate, serrate; dioecious, the staminate flowers in pedunculate clusters forming compound racemes ; the pistillate flowers axillary, sessile, and bracteate ; odor heavy ; taste bitter, slightly acrid. Composition. — The active constituent is a resinoid substance, can- nabin. The tops also contain a small quantity of volatile oil. Physiological Action. — Its chief effect is on the brain, and is of a twofold nature ; it excites a form of delirium and hallucinations, usually followed by deep sleep. . . Sinall doses give rise to delirium with hallucinations, generally of a gay character, causing much merriment ; accompanied by a great incli- nation to muscular movement. The nature of the hallucinations depends greatly on the character of the individual, and people seem to be able to determine their nature, as in the case of opium. Haschish is an Arabian preparation of Indian hemp, and is the origin of the word assassin. An Eastern chief used to dose his fanatic followers with Indian hemp, and they became imbued with the idea that they would be taken to heaven if killed, and hence were not afraid to encounter death. The dreams produced by Indian hemp in inhabitants of Eastern countries are usually of a sexual character (p. 388), but when taken by the more civilized people of Western nations they are not sexual, and are often of a disagreeable nature. During this stage of hallucination, the person may conduct himself rationally and answer clearly any question put to him (Wood). The drug produces in some persons a curious loss of sense of time and of space. This stage is generally followed by deep sleep. The sensory nerves are benumbed, and there is frequently tingling and partial anaes- thesia. The pupil is dilated. Respiration may be either quickened or slowed. Its action on the pulse is very uncertain. Usually it is first quickened, then slowed, sometimes vice versa. The temperature rises or sinks according as the drug produces muscular movement or sleep. The urine is increased. The processes of digestion are less altered by cannabis indica than by opium, and the after effects of opium (nausea, headache, &c.) are not produced. Therapeutics. — As a soporific it is used instead of opium when the latter does not agree, or in old opium-eaters ; also in cases of mental derangement; in acute and chronic mania it is very useful, especially when combined with potassium bromide. It has been used in neuralgia to lessen pain ; also in spasmodic coughs, asthma, &c. In certain cases of menorrhagia it is useful, but its mode of action is unknown. Ringer recommends it in migraine, with or with- out nausea. U.S. P. Humulus. Hops. — The strobiles of Humulu lupulus. Characters. — Ovate, about an inch and a quarter (3 centimetres) long, consisting of a thin, hairy, undulated axis, and many obliquely ovate, membranous, greenish scales, in the upper part reticulately veined, APETALJE. 881 and toward the base parallel-veined, glandular and surrounding a sub- globular achene; odor aromatic; taste bitter, aromatic, and slightly astringent. B.P. Lupulus. Hop. — The dried strobiles of the female plant ot Humulus lupulus. Cultivated in England. Characters. — Strobiles of a greenish-yellow color, with minute yellow grains (lupuline) adherent to the base of the scales. Odor aro- matic, taste bitter. U.S. P. Liupulinum. Lupulin. — The glandular powder, sepa- rated from the strobiles of Humulus lupulus. Characters. — Bright brownish-yellow, becoming yellowish-brown, resinous, consisting of minute granules, which, as seen under the micro- scope, are subglobular, or rather hood-shaped, and reticulate; aromatic and bitter. When agitated with water and allowed to stand, no considerable sed- iment (sand, &c.) should be deposited. When ignited, lupulin should not leave more than 8 per cent, of ash. Composition. — The lupulin of hops consists of a bitter principle, lupulite, volatile oil, to which the odor of hops is due, and resin. Hops, apart from the grains, contain a kind of tannin. Dose. — 5-20 grs. or more (-3-1-3 Gm.). Peepaeations. U.S. P. DOSE. Of Humulus — Tinctura Humuli 1-3 fl. dr. Of Lupulinum — Extractum Lupulini Fluidum 10-30 min. Oleoresina Lupulini 2-20 gr. B.P. DOSE. Extractum Lupuli 5-10 gr. Infusum Lupuli * 1-2 fl. oz. Tinctura Lupuli J-2 fl. dr. Action and Use. — Hops are bitter tonic and stomachic, also slightly soporific. In the form of bitter beer they are used in some cases of atonic dyspepsia ; and a supper of beer and lettuce, with bread and butter, is markedly soporific, from the combined effect of the hops and lettuce. A hop-pillow is sometimes used in sleeplessness of fevers, but its use is probably due, not to the action of the volatile principle of the hops, but to the mechanical elasticity and softness of the pillow. The crack- ling of the leaves in this pillow may be stopped by sprinkling a little alcohol on them. 56 882 VEGETABLE MATERIA MEDICA. CHAPTER XXXV. Class EXOGEXS. Division 2-GYMNOSPERMS. CONIFERJE. Terebinthina Canadensis, U.S. P. and B.P. Canada Tur- pentine (Balsam of Fir), U.S. P. ; Canada Balsam, B.P. — A liquid oleoresin, obtained from Abies balsamea, U.S. P. The turpentine obtained by incision from the stem of Abies balsamea (Pinus balsamea). Balm of Gilead Fir, B.P. Canada. Characters. — A pale yellow, ductile oleoresin, of the consistence of thin honey, with a peculiar, agreeable odor, and a slightly bitter, feebly acrid taste. Composition. — An essential oil resembling oil of turpentine, and a resin. Dose. — 10-30 grains. Peepaeations. u.s.p. B.P. Collodium Flexile. Charta Epispastica. Collodium Flexile. Use. — Used in the preparation of collodion flexile and of charta epispastica; also to mount microscopic objects. It may be given inter- nally as a stimulant to mucous membranes. B.P. Thus Americanuni. Common Frankincense. — The con- crete turpentine of Pinus Taida and Pinus australis. Southern States of North America. Characters. — A softish bright yellow, opaque solid, resinous, but tough, having the odor of American turpentine. Peepaeation. u.s.p. B.P. None. Emplastrum Picis. Use. — Applied externally is a slight stimulant. Contained in pitch plaster. U.S.P. Terebinthina. Turpentine. — A concrete oleoresin, obtained from Pinus australis and from other species of Pinus. Characters. — In tough, yellowish masses, brittle in the cold, crummy-crystalline in the interior, of a terebinthinate odor and taste. Dose. — As a stimulant, antispasmodic, or diuretic, 5-30 min. As an anthelmintic, 2-4 fl. dr. Oleum Terebinthinae, U.S.P. and B.P. Oil of Turpentine. — A volatile oil distilled from turpentine, U.S.P. A volatile oil distilled from the oleoresin (turpentine) obtained from Pinus palustris (P. aus- tralis), Pinus Twda, and sometimes Pinus Pinaster and other species, B.P. Characters. — Limpid, colorless, with a strong, peculiar odor, and pungent and bitter taste. Composition. — A mixture of several hydrocarbons having the com- position C 10 H 1G . GYMNOSPEKMS. 883 Peepaeations. U.S. P. DOSE. Linimentum Cantharidis 1 part in 7. Linimentum Terebinthinae (ol. tereb., 35 ; resin cerate, 65) 1 part in 3. b.p. dose. Confectio Terebinthinae 60-120 gr. Enema Terebinthinae Linimentum Terebinthinae (ol. tereb., 16; camphor, 1; soft soap, 2 Linimentum Terebinthinae Aceticum (ol. tereb., 1 ; acetic acid, 1 ; camphor liniment, 1) Unguentum Terebinthinae Confectio Terebinthinae. CONFECTION OF TURPENTINE. — Oil of turpentine, 1 fl. oz. ; liquorice root, 1 oz. ; honey, 2 oz. Enema Terebinthinae.— Oil of turpentine, 1 fl. oz. ; mucilage of starch, 15 fl. OZ, Physiological Action. — Oil of turpentine when applied to the skin acts as an irritant and rubefacient, causing a sensation of burning, and if applied for any length of time, especially if evaporation be pre- vented, it causes vesication. When inhaled, it produces sneezing, tightness across the eyes, and difficulty of breathing, caused reflexly by the local irritant action of the drug on the nasal mucous membrane. Internally it causes burning in the mouth, and reflexly a profuse flow of saliva, and in the stomach it gives rise to a sensation either of heat or of cold. In large doses it produces gastro-enteritis with vomiting and diarrhoea. Ulceration of the intestine has been found after death from poisoning with turpentine. After absorption it causes a rise and then a fall of blood-pressure, due to its first stimulating and afterwards paralyzing the vaso-motor centres. Its effect on the pulse is uncertain, sometimes it is slowed and sometimes quickened. Respiration becomes quickened and spasmodic. The drug is partly excreted by the lungs, and acts on the mucous membrane, lessening its secretion. The temperature sometimes rises and sometimes falls. It acts on the nerve centres, lessening first the functions of the brain, causing diminution of voluntary movement ; then the functions of the cord, lowering reflex action ; and lastly those of the medulla, causing dilatation of the vessels, lowered blood-pressure, and slowed respiration. It is excreted by the kidneys. In small doses it increases the quantity of urine, to which it gives a sweetish odor resembling that of violets. In large doses it diminishes the quantity of urine and gives rise to pain in the lumbar region, burning in the urethra, painful mictu- rition, and even hematuria. Large doses of turpentine have a purgative action. Therapeutics. — Externally it is used as a rubefacient and counter- irritant to relieve pain or inflammation, as in chronic rheumatism affect- ing either the joints or muscles, also in inflammations of internal organs, as chronic bronchitis (liniment over the chest), pleuritis, and peri- tonitis with tympanites (by means of hot turpentine stupes). It is also very useful as a local application in sciatica and other neuralgias. It is 884 VEGETABLE MATERIA MEDICA. used as an inhalation (as well as internally) in chronic bronchitis (p. 226) with profuse expectoration, and is supposed to be useful in phthisis. Internally in haemorrhage and ulceration of the intestine, as in typhoid fever, it is very serviceable in doses of 5-10 minims frequently repeated ; also in haemorrhage from other organs, as lungs, nose, uterus, kidneys ; but in hematuria it must be given in very small doses (5 minims), as large ones produce harm. As a vermifuge, to destroy tapeworm, it must he given in large closes, which are best combined with castor oil, as it then passes through the alimentary canal rapidly, and consequently is not absorbed, and pro- duces no disagreeable renal symptoms. If moderate doses are given, insufficient to produce purgation, the drug may be absorbed, and hema- turia, nausea, and vomiting may ensue. It is sometimes employed in biliary colic (1 part of oil of turpentine with 3 of ether). The French oil of turpentine (old and containing ozone) is used in phosphorus poisoning. New oil of turpentine, free from ozone, is useless. Turpentine is sometimes used as an antispasmodic in hysterical affections. Non-officinal. Oleum Pini Sylvestris. Oil of Scotch Fir. Fir Wool Oil. — It is a colorless liquid obtained by distilling the leaves of the Scotch fir. Action. — Somewhat similar to that of oil of turpentine. Uses. — It is used as a liniment to rheumatic joints or muscles, and is used as an addition to baths in rheumatism (p. 404). As an inhala- tion it is useful in sore throats and laryngeal catarrh, 5 min., mixed with 2 J gr. of light carbonate of magnesia and a drachm of water, being added to 1 pint water at 140° F., and the steam inhaled. To get the water at this temperature two parts of boiling should be mixed with one part of cold. The use of water which is too hot may cause loss of voice. Not officinal. Sanitas. — A disinfecting solution obtained by acting on oxidized turpentine with water. Its active principle is peroxide of hydrogen (p. 458). Its advantages are that it is not poisonous and does not stain linen. U.S. P. Oleum Succini. Oil of Amber. — A volatile oil obtained by the destructive distillation of amber and purified by subsequent rec- tification. Characters. — A colorless, pale yellow, thin liquid, having an empy- reumatic, balsamic odor, a warm, acrid taste, and a neutral or faintly acid reaction. Readily soluble in alcohol. Action and Uses. — Externally it is stimulant, and may be used like oil of turpentine. Internally it is said to be antispasmodic. Dose. — 5 to 10 minims in capsule. Resina, U.S.P. and B.P. Resin. Colophony. — The residue left after distilling off the volatile oil from turpentine, U.S.P. Characters. — Translucent, yellowish, brittle, pulverizable ; frac- ture shining. Composition. — Resin is the portion of turpentine fixed by oxidation. The greater part of it consists ofabietic anhydride (C 44 H 62 4 ), this being GYMNOSPERMS. 885 formed by the dehydrating of abietic acid (C u H 64: 5 ) during the distillation of the oil. It is again transformed into abietic acid by treating it with alcohol. A small proportion of pimaric acid is obtained from resin. Peepaeations. u.s.p. B.P. Ceratum Resinse. Charta Epispastica. Emplastrum Resinse. Emplastrum Calefaciens. Emplastrum Cantharidis. Emplastrum Opii. Emplastrum Picis. Emplastrum Resinse. Emplastrum Saponis. Unguentum Resinse. Unguentum Terebinthinse. Use. — Resin is only used externally as a stimulant application, in the form of ointment or plaster. B.P. Laricis Cortex. Larch Bark. — The bark, deprived of its outer layer, of Larix europcea (JPinus larix), the common larch. Characters. — In flat pieces or sometimes large quills, with the inner surface yellow and fibrous, and the outer surface reddish-brown under a grayish epidermis. Odor faint, resembling turpentine ; taste astringent. Composition. — A peculiar tannin, striking olive-green with salts of iron, and larixinic acid or larixin. Peepaeation. U.S.P. B.P. DOSE. Not given. Tinctura Laricis 20-30 min. Action and Use. — It has the same action as oil of turpentine. It is seldom used except as a stimulant expectorant in chronic bronchitis with abundant secretion. Pix Burg-undica, U.S.P. and B.P. Burgundy Pitch. — A resin- ous exudation from the stem of the spruce fir, Abies excelsa. Melted and strained. Imported from Switzerland. Characters. — Hard and brittle, yet gradually taking the form of the vessel in which it is kept ; opaque, varying in color, but generally dull reddish-brown ; of a peculiar odor, and aromatic taste, without bit- terness. Composition. — An amorphous resin, mixed with oil of turpentine and other oils isomeric with it, and abietic acid. Peepaeations. u.s.p. B.P. Emplastrum Picis Burgundicse. Emplastrum Ferri. Emplastrum Picis cum Cantharide. Emplastrum Picis. Use. — It is used as a stimulant in chronic rheumatism and bron- chitis in the form of plasters. U.S.P. Pix Canadensis. Canada Pitch. Hemlock Pitch. — The prepared, resinous exudation of Abies canadensis. Characters. — It is somewhat softer than the Burgundy pitch. 886 VEGETABLE MATERIA MEDICA. Peepaeation. Emplastrum Picis Canadensis. Pix Liquida, U.S. P. and B.P. Tar. — An empyreumatic oleo- resin obtained by the destructive distillation of the wood of Pinus palus- tris, and of other species of Pinus, U.S. P. A bituminous liquid, obtained from the wood of Pinus sylvestris and other pines by destructive distilla- tion, B.P. Characters. — Thick, viscid, brownish-black, of a well-known, pecu- liar, aromatic odor. Slightly soluble in water, soluble in alcohol, fixed or volatile oils, and in solution of potassa or of soda. Water agitated with it acquires a pale brown color, sharp empyreumatic taste and acid reaction. Peepaeations. U.S. P. DOSE. Syrupus Picis Liquidae J fl. oz. Unguentum Picis Liquidse (equal parts of tar and suet) B.P. Unguentum Picis Liquidse (tar, 5 oz.; yellow wax, 2 oz.).. t U.S.P. Syrupus Picis Liquidse. Syeup of Tae. — Pour cold water (12) on tar (6), stir frequently for twenty-four hours, and then throw the water away. Pour on boiling distilled water (50), stir for fifteen minutes, and then set aside for thirty- six hours, stirring occasionally. Decant, filter, and add sugar, 40 parts. Composition. — Pyroligenous acid, methyl alcohol, acetic acid, and oily bodies, creasote, with toluene, xylene, and other hydrocarbons. Dose. — Of tar, 20 minims to 1 drachm and upwards, made into pills with flour, or given as tar-water in doses of 1-4 fluid ounces. Action and Use. — Tar acts as a stimulant both to the skin and to mucous membranes. It is used in chronic scaly skin diseases, such as psoriasis and the scaly stages of eczema. In the form of tar-water or of vapor, it is useful in chronic bronchitis and phthisis. U.S.P. Oleum Picis Liquidse. Oil OF Tar. — A volatile oil distilled from tar. An almost colorless liquid when freshly distilled, but soon acquiring a dark, reddish-brown color, having a strong tarry odor and taste, and an acid reaction. Specific gravity about 0*970. It is readily soluble in alcohol. Use. — It is used, dissolved in water or in alcohol, as an external application in skin diseases. U.S.P. Thuja. Thuja. Arbor Vit^e. The fresh tops of Thuja oecidentalis. Characters. — Twigs flattish, two-edged, the scale-like leaves appressed and closely imbricate in four rows, rhombic-ovate, obtusely pointly, with a roundish gland upon the back ; of a balsamic, somewhat terebinthinate odor, and a pungently aromatic, camphoraceous ; and bitter taste. Dose. — Of a saturated tincture or fluid extract, 1 fluid drachm. Action. — The twigs of thuja, like those of savin, may produce abortion. They probably have no direct specific action on the uterus itself, but cause great gastro-intestinal irritation, and thus act on the GYMNOSPERMS. 887 uterus reflexly. The oil of thuja has an action somewhat like camphor, and like it produces epileptiform convulsions in warm-blooded and paralysis in cold-blooded animals. Both camphor and oil of thuja have only a slight action on the heart. They both produce rhythmical con- traction and dilatation of the vessels (as seen in the rabbit's ear). Both lessen the temperature (Kohne) (cf. p. 863). . Use. — It is diuretic, astringent, and aromatic, and its volatile oil has been used as a vermifuge. It has been employed in the form of a decoction in coughs, rheumatism, dropsy, and amenorrhoea. U.S. P. Juniperus. Juniper. — The fruit of Juniperus com- munis. Characters. — Nearly globular, about one-third of an inch (8 milli- metres) in diameter, dark purplish, with a bluish-gray bloom, a three- rayed furrow at the apex, internally pulpy, greenish-brown, containing three ovate, somewhat triangular, bony seeds, with several large oil glands on the surface ; odor aromatic ; taste sweet, terebinthinate, bitterish and slightly acrid. Oleum Juniperi, U.S.P. and B.P. Oil of Juniper. — A volatile oil distilled from the unripe fruit of Juniperus communis. Characters. — Colorless or pale greenish-yellow, of a sweetish odor, and warm, aromatic taste. Peepaeations. u.s.p. DOSE. Spiritus Juniperi (3 per cent, in alcohol) 30-60 min. Spiritus Juniperi Compositus 2-4 fl. dr. B.P. DOSE. Spiritus Juniperi (with spirit, 1 volume in 50) 30 min. to 1 fl. dr. (of the oil, 2-10 min.) U.S.P. Spiritus Juniperi Compositus. COMPOUND SPIEIT OF JUNIPEE.— Oil of juniper, 10 ; oil of caraway, 1 ; oil of fennel, 1 ; alcohol, 1000 ; water up to 5000. Action and Use. — Oil of juniper is a local stimulant. It is con- tained in gin and hollands. It resembles oil of turpentine in its action, but has a more powerful effect on the kidneys. It is used chiefly as a diuretic in dropsy depending on cardiac, liver, or kidney disease. In the last case it must be employed with caution. In a healthy man it does not seem to increase the flow of urine. Gin is flavored with juniper and is frequently employed as a diuretic. The compound spirit of juniper, U.S. P., approximates to gin in strength, and may be used in place of it. Salbina, U.S.P. ; Sabinae Cacumina, B.P. Savinb, U.S.P. ; Savin Tops, B.P. — The (fresh and dried, B.P.) tops of Juniperus Sabina. Characters. — Twigs densely covered with minute, imbricated, appressed leaves in four rows ; odor strong, peculiar, and unpleasant ; taste acrid, bitter, resinous, and disagreeable. Composition. — The active principle is a volatile oil. Peepaeations. u.s.p. DOSE. Extractum Sabinae Fluidum 5-15 min. 888 VEGETABLE MATERIA MEDICA. Preparations — (continued ) . B.P. DOSE. Oleum Sabinae, froni fresh plant 1-5 min. Tinctura Sabinae 20 min. to 1 fl. dr. • Unguentum Sabinae (8 oz. fresh savin tops, bruised, are digested with melted wax, 3 oz., and prepared lard, 16 oz., for 20 minutes, and strained) of dried tops 4-10 gr. or more. Oleum Sabinae, U.S.P. and B.P. — A volatile oil distilled from savine. Characters. — Colorless or yellowish, becoming darker and thicker by age and exposure to air, peculiar odor, pungent, bitterish, and cam- phoraceous taste. Dose. — 1-2 min. Action and Uses. — Savine owes its properties to its oil. Externally it is used as an irritant to keep open issues or blisters. Internally it produces symptoms of violent gastro-intestinal irritation, with either stoppage of the urine or hematuria and difficulty in micturi- tion. In women it causes congestion of the pelvic organs, and has been used criminally to procure abortion ; in these cases gastro-enteritis and death have occurred. Small doses may be used as an emmenagogue when menstruation is deficient and the patient is not pregnant. CHAPTER XXXVI. Class II.— ENDOGENiE. ENDOGENS. SMILACE^. Sarsaparilla, U.S.P. Sarsse Radix, B.P. (Jamaica, B.P.) Sarsaparilla. — The (dried, B.P.) root of Smilax officinalis, Smilax medica, and other undetermined species of Smilax. Native of Central America, imported from Jamaica. Characters. — Roots not thicker than a goose-quill, generally many feet in length, reddish-brown, covered with rootlets, and folded in bundles about eighteen inches long; scentless. Composition. — The active principle is a crystalline body, parillin or smilacin. PREPARATIONS. U.S.P. DOSE. Decoctum Sarsaparillae Compositum 4-6 fl. oz. Extractum Sarsaparillae Compositum Fluidum 30-60 min. Extractum Sarsaparillae Fluidum 30-60 min. Syrupus Sarsaparillae Compositus 1-4 fl. dr. B.P. DOSE. Decoctum Sarsae (2£ oz. ; water, 1£ pint) 2-10 fl. oz. Decoctum Sarsae Compositum 2-10 fl. oz. Extractum Sarsae Liquidum £-4 fl. dr. ENDOGENS. 889 Decoctum Sarsaparillse Compositum, U.S.P. ; Decoctum Sarsae Compositum, B.P. Compound Decoction of Saesapaeilla. — Sarsaparilla, cut and bruised, 10 parts, or 2j oz. ; sassafras, guaiacum wood and liquorice root, of each 2 parts, or \ oz. ; mezereon, 1 part, or 1 dr. ; boiling water up to 100 parts, or up to 1 pint after straining. TJ.S.P. Extractum Sarsaparillae Compositum Fluidum. — Sarsaparilla, 75 ; gly- cyrrhiza, 12 ; sassafras bark, 10 ; mezereum, 3 ; glycerin, 10 ; alcohol and water, of each q.s. to make 100 parts. U.S.P. Syrupus Sarsaparillae Compositus. — Sarsaparilla, 150 ; guaiacum wood, 20 ; pale rose, 12 ; glycyrrhiza, 12 ; senna, 12 ; sassafras, 6 ; anise, 6 ; gualtheria, 6 ; sugar, 600 ; diluted alcohol and water, of each q.s. to make 1000 parts. Action and Use. — The action of sarsaparilla is very much disputed. Some believe it to be diuretic, tonic, and alterative. Others deny its beneficial action. It has been used a good deal in syphilis, scrofula,, chronic rheumatism, gout, and skin diseases, but probably the good effects are due to drugs with which it is used. Syrupus sarsaparillae compositus, U.S.P., is a convenient vehicle for iodide of potassium. OLIACEJE* U.S.P. Allium. Garlic. — The bulb of Allium sativum. Characters. — Bulb subglobular, compound, consisting of about eight compressed, wedge-shaped bulblets, which are arranged in a circle around the base of the stem, and covered by several dry, membranaceous scales. It has a pungent, disagreeable odor, and a warm, acrid taste. It should be preserved in a dry place, and used only in the fresh state. Officinal Peepaeation. u.s.p. dose. Syrupus Allii 1-4 fl. dr. Composition. — The bulblets, or cloves as they are commonly termed,, owe their strong taste and smell to a volatile oil which is sulphide of ally! Action. — Allyl alcohol is a powerful antiseptic (pp. 100 and 105),, and it is probable that oil of garlic will have a similar action. Like oil of mustard, to which it is allied in chemical composition (p. 727), oil of garlic is a powerful irritant, or even vesicant, when applied to the skin. In the intestine it acts in small doses as a gastric tonic and carmina- tive ; in large doses as an emetic and irritant, causing vomiting, purg- ing, headache and fever. After absorption, it quickens the pulse and acts as a nervous stimulant. It is partly eliminated by the lungs, imparting its peculiar odor to the breath and acting as an expectorant* It is diaphoretic or diuretic according as the patient is kept warm or cool. It is said to be an emmenagogue. Uses. — A mixture of garlic juice and oil, or bruised garlic steeped in spirit, is used as a counter-irritant in convulsions or nervous diseases in children, and also in skin eruptions. The syrup may be used as a gastric tonic in atonic dyspepsia, and to check nervous vomiting. It is chiefly employed in nervous coughs of children, and as an expectorant in bronchitis after the acute stage has passed. It is used as an anthelmintic in cases of ascarides, and is given by the mouth and also as an enema. 890 VEGETABLE MATERIA MEDICA. Scilla, U.S.P. and B.P. Squill. — The sliced (and dried, B.P.) bulb of Urginea Scilla ( U. maritima). Mediterranean coasts. Characters. — Bulb pear-shaped, weighing from half a pound to ten pounds ; outer scales membranous, brownish-red or white ; inner scales thick, whitish, fleshy, juicy ; taste mucilaginous, intensely and disagree- ably bitter, somewhat acrid. The dried slices are white or yellowish- white, slightly translucent, scentless, disagreeably bitter, brittle and easily pulverizable if very dry. Fig. 184.— Cut piece of Squill. Composition. — The active principle is a glucoside, scillitoxin or scillain. The scillitin of some authors is probably slightly impure scillitoxin. Peepaeations. U.S.P. DOSE. Acetum Scillse 15-niin. to 1 fl. dr. Extractum Scillae Fhiidum 1-2 min. Syrupus Scillse Compositus 10-30 min. Tinctura Scillae 8-30 min. Syrupus Scillae 2-1 A. dr. B.P. DOSE. Acetum Scillae 15-40 min. Oxymel Scillae J-l fl. dr. Pilula Ipecacuanhas cum Scilla 5-10 gr. Pilula Scillae Composita 5-10 gr Syrupus Scillae \-\ fl. dr. Tinctura Scillae 10-20 min. (of powdered squills, 1-3 gr.) U.S.P. Syrupus Scillse Compositus. Squill, 120; senega, 120; tartrate of anti- mony and potassium, 3 ; sugar, 1200 : precipitated phosphate of calcium, 9 ; diluted alcohol and water, of each, q.s. to make 2000. B.P. Pilula Scillje Composita. Squill, \\ oz. ; ginger, ammoniacum, and hard soap, of each, 1 oz. ; treacle, 2 oz. or q.s. Action axd Uses. — Squill and its active principle, scillitoxin, act like digitalis. Internally, in large doses, it causes vomiting and purging. When absorbed into the blood it slows the pulse and raises the blood-pressure. Like digitalis it acts as a diuretic, and also acts like it on voluntary muscle fibre. It is chiefly used as an adjunct to digitalis to produce diuresis in cases of cardiac dropsy; also as an expectorant, when, although the secretion is profuse, it is difficult to expel. It is of no use when the expectoration is dry and deficient; in such cases ipecacuanha should first be given and then followed by squill. Pilula ipecacuanha cum scilla, 10 grains night and morning, is a most useful remedy in chronic bronchitis. Aloe, U.S.P,; Aloe Socotrina, B.P. Aloes, U.S.P; Soco- trixe Aloes, B.P. — The inspissated juice of the leaf of Aloe socotrina, U.S.P. (one or more undetermined species of Aloe, B.P.). Socotra. ENDOGENS. 891 Characters. — In hard, opaque, reddish-brown or yellowish-brown, not greenish, masses, translucent at the edges ; breaks with an irregular or smooth and resinous fracture ; has a bitter taste, and when breathed on has a saffron-like odor; dissolves entirely in proof spirit, and during solution exhibits under the microscope numerous minute crystals. Peepaeations. U.S.P. DOSE. Aloes Purificata £-6 gr. lExtractum Aloes Aquosum 2~6 gr. B.P. DOSE. Decoctuin Aloes Compositum (Extract) 4 gr. in 1 fl. oz §-2 fl. oz. £nema Aloes 4 gr. in 1 fl. oz 10 fl. oz. Extractum Aloes Socotrinae 1 part from 2, nearly...2-6 gr. Extractum Colocynthidis Compositum (Extract)..! part in 2, nearly 3-10 gr. Pilula Aloes et Assafoetidse 1 part in 4 5-10 gr. Pilula Aloes et Myrrhae 1 part in 3 5-10 gr. Pilula Aloes Socotrinae 1 part in 2, nearly 5-10 gr. Pilula Rhei Composita 1 part in 6 5-10 gr. Tinctura Aloes 11 gr. to 1 fl. oz 1-3 fl. dr. Tinctura Benzoini Composita 8 gr. to 1 fl. oz h-2 fl. dr. Vinum Aloes 16^ gr. to 1 fl. OZ 1-2 fl. dr. U.S.P. Extractum Aloes Aquosum. AQUEOUS EXTEACT OF ALOES. — Aloes, 100 ; boiling distilled water, 1000. Separate the insoluble matter by subsidence and filtration, and evaporate. B.P. Decoctum Aloes Compositum. COMPOUND DECOCTION OF ALOES. — Extract of Socotrine aloes, 120 gr. ; myrrh, 90 gr. ; saffron, 90 gr. ; carbonate of potash, 60 gr. ; extract of liquorice, 1 oz. ; compound tincture of cardamoms, 8 fl. oz. ; distilled water up to 30 fl. oz. B.P. Enema Aloes.— Aloes (Socotrine or Barbadoes), 40 gr. ; carbonate of potash, 15 gr. ; mucilage of starch, 10 fl. oz. B.P. Extractum Aloes Socotrinae. Treating with boiling water, separating insoluble matter by subsidence and filtration, and evaporating the clear solution. B.P. Pilula Aloes et Assafcetidee. PlLL OF ALOES AND ASSAFCETIDA. — Equal parts of Socotrine aloes, assafoetida, hard soap, and confection of roses. B.P. Pilula Aloes et Myrrhee. PlLL OF ALOES AND MYEEH. — Socotrine aloes, 2 oz. ; myrrh, 1 oz. ; saffron, % oz. ; confection of roses, 2 ^ oz. B.P. Pilula Aloes Socotrina. PlLL OF SOCOTEINE ALOES. — Socotrine aloes, 2 oz. ; hard soap, 1 oz. ; volatile oil of nutmeg, 1 fl. dr. ; confection of roses, 1 oz. B.P. Tinctura Aloes. TlNCTUEE OF ALOES.- liquorice, 1^ oz. ; proof spirit, to 20 fl. oz. B.P. Vinum Aloes. "Wine of Aloes. — Socotrine aloes, 1J oz. ; cardamom seeds and ginger, of each, 80 grs. ; sherry, up to 2 pints. Composition. — All kinds of aloes contain a bitter substance, aloin, to which their activity is due. It has in each kind of aloes a slightly -different composition, and has received a name showing its source — socaloin from Socotrine aloes, barbaloin from Barbadoes aloes, and nataloin from Natal aloes. According to some authors these substances are isomeric, according to others they form a homologous series. Besides oloin, aloes contain resinous substances and traces of an ethereal oil. Barbaloin and nataloin are distinguished from socaloin by giving with a drop of nitric acid, on a porcelain slab, a bright crimson color. With barbaloin this gradually fades, but is permanent with nataloin. Socaloin does not give this reaction. Barbaloin is distinguished from nataloin by the latter giving a fine blue color, while the former remains unchanged, on adding a minute quantity of each to one or two drops of 892 VEGETABLE MATERIA MEDICA. strong sulphuric acid and then bringing a glass rod dipped in nitric acid so near that the vapor shall pass over the surface. U.S.P. Aloe Purificata. Purified Aloes. Preparation. — By melting aloes 100, adding alcohol 15, straining and evaporating. Characters. — Purified aloes is in irregular, brittle pieces, of a dull brown or reddish-brown color, and having the peculiar aromatic odor of Socotrine aloes. It is almost entirely soluble in alcohol. Peepaeations. U.S.P. DOSE. Pilulae Aloes 1 part in 2 1 pill. Pilulae Aloes et Asafcetida 1 part in 3 2-5 pills. Pilulae Aloes et Ferri 1 part in 3 1 pill. PUulae Aloes et Masticlies 2 parts in 3 1 pill. PUulae Aloes et Myrrbae 2 parts in 3J 1 pill. Pilulae Rhei Compositae 1 part in 3 1-4 pills. Extractum Colocynthidis Compositum 1 part in 2, nearly 5-10 gr. Pilulae Catharticae Compositae 1 part in 6 1-3 pills. Tinctura Aloes 1 part in 10 1-4 fl. dr. Tinctura Aloes et Myrrhae 1 part in 10 1-2 fl. dr. Tinctura Benzoini Composita 2 fl. dr. to 1 fl. oz. Tinum Aloes 6 parts in 100 1 fl. dr. to 1 fl. oz. U.S.P. Pilulae Aloes. PlLLS OF ALOES. — Aloes and soap, of each, 2 gr. in one pill. U.S.P. Pilulae Aloes et Asafoetida. PlLLS OF ALOES AND ASAFETIDA.— Each pill contains aloes, asafetida, and soap, of each, 1J gr. U.S.P. Pilulae Aloes et Ferri. PlLLS OF ALOES AND lEON. — Each pill contains aloes, dried sulphate of iron, and aromatic powder, of each, 1 gr., made up with con- fection of roses. U.S.P. Pilulae Aloes et Mastiches. PlLLS OF ALOES AND MASTIC— Each pill contains aloes, 2 gr. ; mastic, § gr. ; red rose, £ gr. U.S.P. Pilulae Aloes et Myrrhae. PlLLS OF ALOES AND MYEEH. — Each pill contains aloes, 2 gr. ; myrrh, 1 gr. ; aromatic powder, \ gr. Made up with syrup. u.s.P. Tinctura Aloes. Tinctuee of Aloes. — Aloes, 10 ; extract of glycyr- rhiza, 10 ; diluted alcohol, up to 100. U.S.P. Tinctura Aloes et Myrrliae. TlNCTUEE OF ALOES AND MYEEH. — Aloes, 10 ; myrrh, 10 ; alcohol, to 100. U.S.P. Vinum Aloes. Wine of Aloes. — Aloes, 6 ; cardamom, 1; ginger, 1;. stronger white wine, up to 100. Dose as stomachic, 1-2 fl. dr. As purgative, \-l fl. oz. B.P. Aloe Barbadensis. Barbadoes Aloes. — The inspissated juice of the leaf of Aloe vulgaris. Barbadoes. Characters. — In yellowish-brown or dark -brown opaque masses ; breaks with a dull conchoidal fracture ; has a bitter, nauseous taste, and a strong disagreeable odor. Composition. — Contains barbaloin, resin, and volatile oil. Peepaeations. b.p. DOSE. Enema Aloes {vide supra) 4 gr. in 1 fl. oz Extractum Aloes Barbadensis 8 parts from 10, nearly 2-6 gr. Pilula Aloes Barbadensis 1 part in 2, nearly 5-10 gr. Pilula Aloes et Ferri 1 part in b\ 5-10 gr. Pilula Cambogiie Composita 1 part in 6, nearly 5-10 gr. Pilula Colocynthidis Composita 1 part in 3, nearly 5-10 gr. Pilula Colocynthidis et Hyoscyami 1 part in 41, nearly 5-10 gr. (of aloes in powder, 2-6 gr. ENDOGENS. 893 B.P. Extractum Aloes Barbadensis. — Prepared like extract of Socotrine aloes. B.P. Pilula Aloes Barbadensis. PlLL OF BARBADOES ALOES. — Barbadoes aloes, 2 oz. ; hard soap, 1 oz. ; oil of caraway, 1 fl. dr. ; confection of roses, 1 oz. B.P. Pilula Aloes et Ferri. PlLL OF ALOES AND IEON. — Sulphate of iron, If oz. ; Barbadoes aloes, 2 oz. ; compound powder of cinnamon, 3 oz. ; confection of roses, 4 oz. Action and Uses. — It causes a bitter taste in the moutli, and reflex salivation. In small doses it seems to have a tonic action like simple bitters. It increases peristalsis of the intestines and also intes- tinal secretion. Its action is particularly exerted on the large intestines, and especially in the rectum. This is shown by the great length of time which usually elapses between its administration and its action (ten or twelve, sometimes as much as twenty-four, hours), and by the rectal irritation which it produces, and which is evidenced by tenesmus, hemor- rhoidal swelling, and haemorrhage. It increases the secretion of bile by stimulating the liver (Rohrig and Rutherford). It only acts when mixed with bile, and is consequently useless in jaundice, where the bile does not enter the intestine, as is shown by the whiteness of the stools. It may, however, be rendered active by giving it along with ox gall. Aloes has little or no purgative action when given alone as an enema, but is active if mixed with ox bile. In the enema aloes, B.P., it is mixed with carbonate of potash. Aloes appears to cause hyperemia of the uterus and other pelvic organs as well as of the rectum. It sometimes has an aphrodisiac action, but this is not constant, and probably is due to irri- tation caused by hemorrhoids (p. 387). Aloes differs from other purga- tives in not causing subsequent constipation, but on the contrary render- ing the intestine more sensitive, so that the dose can be gradually reduced. As it does not cause subsequent constipation, it is a favorite purgative, and is contained in most vegetable purgative pills (except pil. scamm. co.). As it acts slowly, it should be given a good while before a motion is desired, and a favorite plan is to give it as a dinner pill just before the last meal of the day, when it usually acts next morning after breakfast. I have known people who have taken dinner pills regularly every day for thirty years without injury and with apparent benefit. As it tends to cause congestion of the rectum, some authorities prohibit its use in piles, but in small doses, and if the piles are not inflamed, it is often beneficial in these cases, although large doses are injurious. From its action in causing congestion of the uterus, it is used in amenorrhoea (at the time when the catamenia are expected), but must be avoided in pregnancy and rectal inflammation. In these cases it is usually combined with iron or myrrh. Veratrum Viride, U.S. P. ; Veratri Viridis Radix, B.P. American Hellebore, U.S.P. ; Green Hellebore Root, B.P. — The rhizome and rootlets of Veratrum viride. United States and Canada. Characters. — Rhizome two or three inches long, one to two inches thick, with numerous shrivelled, light yellowish-brown rootlets. Composition. — It contains several alkaloids — jervine, pseudo-jervine, cevadine, very little rubijervine, and traces of veratrine and veratralbine. 894 VEGETABLE MATERIA MEDICA. Veratroidine, which was formerly regarded as one of its constituents, is probably rubijervine and resin. Fig. 185.— Veratrum viride root. Pbepaeations. U.S. P. DOSE. Extractum Veratri Viridis Fluidum 1-4 min. Tinctura Veratri Viridis 5-10 min. B.P. DOSE. Tinctura Veratri Viridis 5-20 min. or more. (of the powdered rhizome, 1-3 gr. or more.) Action. — In small doses veratrum viride lessens the strength of the- pulse in man without at first affecting its rate, but afterwards it renders it very slow, soft and compressible, although sometimes moderately full. At this stage any exertion at once renders the slow pulse rapid, feeble, small, and even imperceptible. The depression of the circulation is- accompanied by muscular weakness, and frequently, though not always, by nausea and vomiting. When the dose is large these symptoms become increased, and a state of collapse comes on with an exceedingly rapid, almost imperceptible pulse, cold, clammy skin, constant nausea and retching, intense muscular weakness, giddiness, loss of vision, and. partial unconsciousness. The action of veratrum viride is due to the jervine and other alkaloids which it contains. It has been mentioned already that veratroidine is not a pure alkaloid, but as no further investigations have been made on the alkaloids of veratrum since those of Professor H. C. Wood, I give his results. Jervine lessens the functions of the spinal cord, both in frogs and mammals, and of the medulla (especially the vaso-motor centre), and of the cardiac ganglia, and at the same time irritates the motor centres in the l>rain, producing convulsions. Thus the symptoms produced are muscular weakness, loss of reflex action, followed by tremors, lowered blood-pressure, and slow pulse. Respiration ceases before the heart, and death ensues from asphyxia. There is invariably salivation, but no vomiting nor purging. It has no- action on the vagus, and the slow pulse is due to an action on the cardiac muscle or its ganglia. Voluntary muscles and motor nerves are- little, if at all, affected by it. ENDOGENS. 895 Veratroidine differs from jervine in always causing vomiting and purging, and in producing less violent convulsions. It stimulates the vagus centre and paralyzes the vag-us ends. It depresses the spinal cord and paralyzes the respiratory centre, but increases the excita- bility of the vaso -motor centre. At first it slows the pulse and lowers the blood-pressure. Next the pulsations become very powerful, though still slow, and the blood-pressure rises to normal. Then the pulse becomes very rapid, and the pressure rises greatly. This rise is, however, not due to the direct action of the drug, but to stimulation of the vaso-motor centre by asphyxial blood from paralysis of the respira- tion. If artificial respiration be kept up veratroidine steadily lessens both pulse rate and blood-pressure. Therapeutics. — Veratrum viride has been used as a cardiac depres- sant in inflammations, but not generally. B.P. Sabadilla. Cevadilla. — The dried fruit of Asagrcea offi- cinalis. Mexico. Characters. — Fruit about half an inch long, consisting of three light brown papyraceous follicles, each containing from one to three seeds, which are about a quarter of an inch long, blackish-brown, shining, slightly winged, possessing an intensely acrid, bitter taste. Peepaeation. Veratria. Composition. — Three alkaloids, the first, veratria, being the active principle. The remaining alkaloids, sabadillina and sabatrina, occur in very small quantities, and are of little importance in pharmacy. Veratrina, U.S.P.; Veratria, B.P. Veratrlne, U.S.P. ; Vera- tria, B.P. — An alkaloid or mixture of alkaloids prepared from the seeds of Asagrcea officinalis, U.S.P. An alkaloid obtained from cevadilla; not quite pure, B.P. Preparation. — A concentrated tincture of the seeds is poured into, cold water in order to precipitate albumen. From the filtered solution veratria is precipitated by ammonia, and purified by resolution in dilute hydrochloric acid, decolorization by animal charcoal, and reprecipitation by ammonia. Characters. — Pale gray, amorphous, without smell, but, even in the most minute quantity, powerfully irritating the nostrils ; strongly and persistently bitter, and highly acrid ; insoluble in water ; soluble in spirit, in ether, and in diluted acids, leaving traces of an insoluble brown resin- oid matter. An active poison. Impurities. — Mineral matter, and sometimes traces of the other alkaloids of cevadilla. Test. — Heated with access of air it melts into a yellow liquid, and at length burns away, leaving no residue. Dose. — jL— §- S r - Peepaeations. U S.P. Oleatum Veratrinae 1 part in 50 Unguentum Veratrinee 1 part in 25 B.P. Unguentum Veratrise (8 gr. to 1 oz.) for external use. 896 VEGETABLE MATERIA MEDICA. Physiological Actiox. — Large doses of veratrine cause violent sneezing, and great gastro-intestinal irritation, vomiting, purging, and symptoms of collapse, the pulse being rapid, small, and irregular ; and often involuntary muscular tremors come on. A peculiar creeping and prickling sensation in the skin generally accompanies these symptoms. Externally, applied to the unbroken skin, it has no marked action, but if rubbed in with some fat it passes through the epidermis and acts on the true skin, and causes first irritation and then paralysis of the ends of the sensory nerves, producing a prickling and creeping sensation, suc- ceeded by numbness. It is somewhat like aconitine in this respect. This effect is produced whether applied locally or taken internally. Its irritating action on the sensory nerves is also observed if it be inhaled into the nose, when it causes violent sneezing, which also occurs after absorption from the stomach. Internally. — It has no marked action on the brain. It has prob- ably no action on the spinal cord. By some experimenters it is stated that convulsions are produced in frogs, but, from numerous experiments which I performed, I doubt the accuracy of this statement. Muscles. — The contractile power is increased, but the elasticity very much diminished. The period of contraction is very much prolonged, but neither the latent period nor the ascent of the curve are affected in character ; the height of the curve is slightly increased, and the descent of the curve very much prolonged, so that it does not reach the abscissa for several revolutions of the cylinder. This contraction is not a state of partial rigor, since during its continuance the development of heat is increased to a marked degree; neither is it a true tetanus, since the rheo- scopic frog only gives a single contraction when its nerve is laid on the poisoned muscle. It is a prolonged contraction. To this alteration in the muscles is due the peculiar behavior of frogs when poisoned by veratria. The frog jumps readily on stimulation, but after its spring it lies on the table with legs extended for a long time ; then it draws the limbs up slowly, for both the flexors and extensors are contracted, and the contraction has to pass off from the extensors before the flexors can act. When it has drawn its limbs up, it remains still for a time, to allow the contraction to pass off from the flexors, after which it springs again. Thus the frog performs the normal movements with very long intervals between them. These movements have probably been mistaken for con- vulsions. Temperature affects the veratria curve in a remarkable manner. As you cool the muscle down, the curve becomes more and more like the normal, and if the temperature be much raised (keeping below the heat of rigor calo?'is), the effect also disappears; thus extremes of heat and cold remove the veratrine effect on the muscle-curve. The effect of veratrine on the muscle is also removed by potash (p. 127). Muscles previously exhausted by over-exertion have their powers restored by veratrine. Motor nerves have their excitability increased at first; afterwards their peripheral ends are paralyzed. Sensory nerves have their peri- pheral ends first stimulated (causing pricking, &c), and then paralyzed (cf. aconite, p. 69!>). Circulation. — The effect of veratrine on the heart-muscle of the frog is very similar to that on voluntary muscle; hence the contractions ENDOGENS. 897 of the heart become slower, and each systole lasts for a length of time, till finally the heart stops in complete systole. The effect of veratrine on the heart is also removed by heat and by potash (Ringer). In mam- mals, small doses injected into the circulation quicken the pulse and raise the blood-pressure; moderate and large doses slow the heart and lower the blood-pressure. Small doses quicken the respiration; large ones slow it, producing long pauses like those which occur after section of the vagi, and finally paralyze it. These effects are probably due to stimulation at first, and afterwards to paralysis of the ends of the vagus in the lung, and to paralysis of the respiratory centre. The tem- perature is lowered. Therapeutics. — Locally, it is used like aconitine for neuralgia, in the form of the ointment rubbed over the affected part. Internally, it is sometimes used in rheumatic arthritis, and in sthenic febrile affections, as pneumonia, but its action is uncertain, and its use dangerous; hence it is seldom employed. Possibly one cause of the uncertainty of its action is the high temperature accompanying febrile affections, by which its action is altered. A similar reason may hold good for aconite, which varies considerably in its action on febrile dis- orders (cf. digitalis, pp. 848 and 849). Colchici Radix, U.S.P. ; Colcliici Cormus, B.P. Colchicum Root, U.S.P. ; Colchicum Corm, B.P.— The (fresh, B.P.) corm of Colchicum autumnale (collected about the end of June; and the same stripped of its coats, sliced transversely, and dried at a temperature not exceeding 150°, B.P.). Fig. 186. — Colchicum : transverse section. Characters. — Fresh corm about the size of a chestnut ; furnished with an outer brown and an inner yellow coat ; internally white, solid, and fleshy. Dried slices about a line thick, moderately indented on one, rarely on both sides ; firm, flat, whitish, amylaceous. Composition. — Colchicine, and traces of veratrine; also starch, tannin, and fatty oil. They lose their odor by drying. Peepaeations. U.S.P. Colchici Eadix. dose. Extraction Colchici Eadicis ..J-2 gr. Extractum Colchici Eadicis Fluidum 2-5 min. Vinum Colchici Eadicis 8 min. B.P. dose. Extractum Colchici £-2 gr. Extractum Colchici Aceticum £-2 gr. Vinum Colchici 88 gr. to 1 fl. oz 10-30 min. 57 898 VEGETABLE MATERIA MEDICA. Colchici Semen, U.S. P. ; Colchici Semina, B.P. Colchicum Seed, U.S.P.; Colchicum Seeds, B.P. — The seed of Colchicum autumnale, U.S. P. The fully ripe seeds of Colchicum autumnale, B.P. Fig. 187.— Colchicum Seed: a, natural size; 6, section magnified. Characters. — About the size of white mustard seed, very hard, of a reddish-brown color, and pitted. Composition. — Colchicine, generally regarded as an alkaloid, soluble in water and alcohol. Traces of veratrine — in combination with gallic acid — and a fixed oil are found. Peepaeations. U.S.P. DOSE. Extractuni Colchici Seminis Fluidum 2-10 min. Tinctura Colchici Seminis 15-30 min. Vinum Colchici Seminis 15-30 min. B.P. DOSE. Tinctura Colchici Seminum 54£ gr. to 1 fl. oz 10-30 min. General Action. — The action of colchicum does not vary in pro- portion to the dose, since, when a certain (fairly large) dose is given, an increased dose does not seem to produce a more marked effect. It acts as a poison both to cold and warm-blooded animals, but its effect is least marked on cold-blooded animals, and more marked on Carnivora than Herbivora. It has the same effect on the alimentary canal, whether swallowed or subcutaneously injected. When given in continued non-poisonous doses it causes an acrid taste, with reflex flow of saliva, and symptoms of gastro -intestinal disturb- ance, viz., irritation of the fauces, loaded tongue, loss of appetite, flatulence, uneasiness, or pain in the stomach and intestines, and diar- rhoea. The pulse is slowed, and there is a tendency to muscular weak- ness. A single large dose, or moderate doses long- continued, may produce symptoms of acute gastro-intestinal inflammation, viz., violent vomiting (vomited matter being first bilious and then bloody), and purging (the stools being first serous, then mucous, then bloody). Marked symptoms of collapse supervene, the pulse becomes small, rapid, and thready, the skin cold and bedewed with sweat, respiration slow and painful. Death ensues from collapse, the brain remaining clear to the last. Sometimes nervous symptoms occur, such as flying pains over the body, numbness, and occasionally, though rarely, convulsions. Special Action. — When applied to the skin it is an irritant, causing redness, prickling, and smarting, and if taken into the nose causes sneezing and running at the eyes. Internally. — Its action on the brain, if any, is not well marked. ENDOGENS. 899 In frogs the spinal cord is paralyzed, the paralysis being preceded by excitement, sometimes giving rise to convulsions. In the higher animals there is no excitement, the cord being paralyzed from the first. The sensory nerves are more or less paralyzed. The motor nerves and muscles are unaffected. The circulation is affected, but the action is to a great extent reflex, since, if injected directly into the circulation, both the heart and the blood-pressure are only slightly altered. Very large doses are required to paralyze the inhibitory fibres of the vagus, but ultimately they are paralyzed. The Secretion of Urine. — Some authorities affirm that the total solids (both inorganic and organic) are increased, and also the quantity of water. Some say that only the urea is increased, others that the uric acid is increased, while others, again, contradict both these state- ments. The probable explanation of these conflicting statements is that the observers have conducted experiments with different diets. Therapeutics. — Its chief use is in gout, in the form of vinum or tincture, either in large doses during the fit, or in small ones continued for a length of time. It seems to act best when the bowels are previously freely acted on, hence a very old and useful mixture is colchicum, mag- nesia, and sulphate of magnesia. In rheumatic arthritis 10 min. of tincture with 10 gr. of potassium iodide often prove useful. In subacute rheumatism it is of very much less service. In acute rheumatism it is hardly ever used, salicylate of soda being more frequently employed. Treatment in Poisoning'. — Evacuate the stomach by an emetic, if vomiting is not induced by the drug itself; give tannic acid in large quantities (which acts as a chemical antidote) ; white of egg diluted with water may be given freely ; or, if pulse is very depressed, give stimulants and keep the patient warm. ORCHIDACEiE. U.S. P. Vanilla. Vanilla. — The fruit of Vanilla planifolia. Characters. — From six to ten inches (15 to 25 centimetres) long, linear, narrowed and bent or hooked at the base, rather oblique at the apex, wrinkled, somewhat warty, dark brown, glossy-leathery, one-celled, and containing a blackish-brown pulp, with numerous minute seeds, and more or less acicular crystals ; odor and taste peculiar, fragrant. Peepaeation. dose. Tinctura Vanillse A few drops as a flavoring. Uses. — It is used chiefly as a flavoring* and a perfume. It is also an aromatic stimulant in hysteria and low fevers. U.S.P. Cypripedium. Cypripedium. Ladies' Slipper. — The rhizome and rootlets of Cypripedium pubeseens, and of Cypripedium parviflorum. 900 VEGETABLE MATERIA MEDICA. Characters. — Horizontal, bent, four inches (10 centimetres) or less long ; about one-eighth of an inch (3 millimetres) thick ; on the upper side beset with numerous circular, cup-shaped scars ; closely covered below with simple, wiry rootlets varying from four to twenty inches (10 to 50 centimetres) in length ; brittle, dark brown, or orange-brown ; fracture short, white ; odor faint but heavy ; taste sweetish, bitter and somewhat pungent. Preparation. dose. Extractum Cypripedii Fluidum 15 min. Use. — It has an antispasmodic action similar to that of valerian, but it is less powerful. ZINGIBERACEiE. Zingiber, U.S. P. and B.P. Ginger. — The (scraped and dried, B.P.) rhizome of Zingiber officinale. West Indies, India, and other countries. Characters. — Irregular lobed decorticated pieces, three or four inches long, yellowish-white, but not chalky on the surface, with a short, mealy fracture, hot taste, and agreeable aroma. Powder yellowish- white. Preparations, u.s.p. DOSE. Extractum Zingiberis Fluidum 10-30 Ulin. Oleoresina Zingiberis 1-2 min. Pulvis Aromaticus 10-30 gr. Tinctura Zingiberis 15-75 Dlin. Pulvis Khei Compositus 30-60 gr. Syrupus Zingiberis 1 fl. dr. Vinuni Aloes 1-2 fl. dr. B.P. DOSE. Confectio Opii 5-20 gr. Confectio Scammonii 10-30 gr. Infusurn Sennse 1-2 fl. oz. Pilula Scillae Composita 5-10 gr. Pulvis Cinnamomi Compositus 30-60 gr. Pulvis Jalapae Compositus 20-60 gr. Pulvis Opii Compositus 2-5 gr. Pulvis Rhei Compositus 20-60 gr. Pulvis Scammonii Compositus 10-20 gr. Syrupus Rhamni 1 fl. dr. Syrupus Zingiberis £-1 fl. dr. Tinctura Zingiberis 15 min. to 1 fl. dr. Tinctura Zingiberis Fortior 5-20 min. Vinum Aloes 1-2 fl. dr. Composition. — A yellow volatile oil and a resin, the former having the odor, and the latter the taste, of the drug. Action. — Ginger causes a feeling of warmth in the mouth, and reflexly stimulates the secretion of saliva. It has a stimulant action on the stomach, producing warmth at the epigastrium. It promotes the expulsion of flatus. Uses. — It is used in atonic dyspepsia, also to relieve flatulence, and as an adjunct to purgatives to lessen griping. It is also used as a masti- catory to increase secretion of saliva, and in relaxed conditions of the throat. Also used as a carminative in colic. ENDOGENS. 901 B.P. Turmeric. — The rhizome of Curcuma longa. Solution of Turmeric, U.S.P.; Turmeric Tincture, B.P. — A solution prepared by macerating 1 part bruised turmeric in 6 parts diluted alcohol, U.S. P., or rectified spirit, B.P., in a closed vessel for 7 days and filtering. Turmeric Paper, U.S.P. and B.P. — Unsized white paper, col- ored by steeping in tincture of turmeric and drying by exposure to the air without heat. Action and Uses. — Turmeric acts similarly to ginger. Chiefly used as a condiment. Turmeric paper is used as a test for alkalis, which turn it brown. Cardamomum, U.S.P. and B.P. Cardamoms. — The fruit, U.S.P. (dried capsules, B.P.), of Elettaria Cardamomum. Malabar. The seeds are best kept in their pericarps, from which they should be separated when required for use, the pericarpial coats being rejected. Fig. 188.— Cardamoms. Characters. — Seeds obtusely angular, corrugated, reddish-brown, internally white, with a warm, aromatic, agreeable taste, contained in ovate-oblong, triangular, pale brown, coriaceous pericarps. Pkeparations. U.S.P. DOSE. Pulvis Aromaticus 10-30 gr. Tinctura Cardamomi 1-2 fl. dr. Tinctura Cardamomi Composita 1-2 fl. dr. CONTAINED ALSO IN Tinctura Bhei 1-8 fl. dr. Tinctura Gentianse Composita 1-4 fl. dr. Vinum Aloes 1-2 fl. dr. Extractum Colocynthidis Compositum 5-20 gr. B.P. DOSE. Tinctura Cardamomi Composita ...J-2 fl. dr. Tinctura Chloroformi Composita CONTAINED ALSO IN Extractum Colocynthidis Compositum 3-10 gr. Pulvis Cinnamomi Compositus 30-60 gr. Pulvis Cretae Aromaticus 10-60 gr. Tinctura Gentianse Composita %-2 fl. dr. Tinctura Rhei 1-8 fl. dr. Vinum Aloes 1-2 fl. dr. Composition. — Fixed oil and aromatic volatile oil, containing a camphor in solution. Action and Use. — Cardamoms act similarly to ginger. They are stimulant, aromatic, and carminative, and are less pungent than ginger. Used chiefly as a carminative in flatulence, and as an adjunct to other medicines to lessen griping. 902 VEGETABLE MATERIA MEDICA. IRIDACEJE. Crocus, U.S. P. and B.P. Saffron. — The stigmas of Crocus sativus, U.S. P. The dried stigma, and part of the style, of Crocus sativus, B.P. Spain, France, and Italy. Characters. — Thread-like styles, each terminated by three long orange-brown stigmas, broadest at the summit. Has a powerful aromatic odor. Preparations, tj.s.p. DOSE. Tinctura Croci £-2 fl. dr. B.P. DOSE. Decoctum Aloes Compositum £-2 fl. oz. Pilula Aloes et Myrrhse 5-10 gr. Pulvis Cretse Aromaticus 10-60 gr. Tinctura Cinchonae Composita £-2 fl. dr. Tinctura Croci j-2 fl. dr. Tinctura Opii Ammoniata £-1 fl. dr. Tinctura Rhei 1-2 fl. dr. (stomachic). " " 4-8 fl. dr. (purgative). (of dried saffron, 20 gr. upwards.) Composition. — The coloring matter of saffron is a glucoside — crocin — soluble in water and easily decomposed by dilute acids. A volatile oil is obtainable both directly from the drug and by the decomposition of crocin. It possesses the odor of saffron. Impurities. — Saffron is often adulterated with parts of other plants dyed, and with colored chalk. Tests. — By throwing saffron on the surface of warm water, the peculiar form of the stigma is at once seen, and admixture of other plants discovered. The chalk is detected by its immediately rendering the water turbid. Action and Use. — Saffron has but little action. It is used chiefly as a coloring agent, and as a slight carminative. U.S.P. Iris. Iris. Blue Flag. — The rhizome and rootlets of Iris versicolor. Characters. — Rhizome horizontal, consisting of joints, two to four inches (5 to 10 centimetres) long, cylindrical in the lower half, flattish near the upper extremity, and terminated by a circular scar, annulated from the leaf-sheaths, gray-brown; rootlets long, simple, crowded near the broad end ; odor slight ; taste acrid, nauseous. Preparations. dose. Extractum Iridis 2-4 gr. Extraction Iridis Fluidum 5-10 min. Composition. — It owes its medicinal virtues to an oleoresin. Action. — It is emetic and cathartic, and has been proved by Professor Rutherford to act as a stimulant to the liver and the intes- tinal glands (p. 351). Uses. — In constipation and biliousness. EKDOGENS. 903 PALMACE^E. B.P. Areca. Areca Nut. — The seed of Areca Catechu, the betel-nut tree. Composition. — Oil, containing an acid in solution, and red tannic matter resembling rhatany-red. Dose. — As an astringent, 15 to 30 grains. As an anthelmintic, J to | oz. Use. — It is much used in veterinary practice, and occasionally in ordinary practice, as an anthelmintic for tapeworm. It is also astringent, and is used as a masticatory (p. 177). ARACE^E. XJ.S.P. Calamus. Calamus. Sweet Flag. — The rhizome of Acorus Calamus. Characters. — In sections of various lengths, unpeeled, about three- quarters of an inch (2 centimetres) broad, subcylindrical, longitudinally wrinkled; on the lower surface marked with the circular scars of the rootlets in wavy lines; externally reddish-brown, somewhat annulate from remnants of leaf-sheaths; internally whitish, of a spongy texture, breaking with a short, corky fracture, showing numerous oil-cells and scattered wood-bundles, the latter crowded within the subcircular nucleus- sheath. It has an aromatic odor, and a strongly pungent taste. Preparation, u.s.p. DOSE. Extractum Calami Fluidum 15-60 min. Composition. — It contains a volatile oil and a bitter principle. Uses. — It is used as a feeble aromatic, stomachic, and stimulant. GKAMINACE^E. B.P. Farina Tritici. Wheaten Flour. — The grain of wheat, Triticum vulgare, ground and sifted. Preparation. Cataplasma Fermenti. Composition. — Starch and gluten. Use. — Chiefly as an article of food. B.P. Mica Panis. Crumb of Bread. — The soft part of bread made with wheat flour. Preparation. Cataplasma Carbonis (p. 459). Use. — It is used as a cataplasm, both alone and in cataplasma car- bonis. It is also used as a basis for pills, and especially for making up croton oil into pill. Occasionally pills made of it alone are given as a placebo. 904 VEGETABLE MATERIA MEDICA. Amylum, U.S.P. and B.P. Starch. — The fecula of the seed of Triticum vulgar e, U.S.P. The starch procured from the seeds of com- mon wheat, Triticum vulgar 'e, B.P. Characters and Tests. — In white, columnar or irregular angular masses, white, inodorous, and tasteless. Insoluble in alcohol, ether, or cold water. Easily powdered, and when rubbed in a Wedgwood mortar with a little cold distilled water, it is neither acid nor alkaline to test- paper, and the filtered liquid does not become blue on the addition of solution of iodine. Mixed with boiling water and cooled, it gives a deep blue color with iodine. Peepaeations. U.S.P. Amylum Iodatum (starch, 95 parts; iodine, 5 parts) Glyceritum Amyli (starch, 10 parts; glycerine, 90 parts) B.P. DOSE. Glycerinum Amyli 1 part in 11 by weight Mucilago Amyli 12 gr. to 1 fl. oz Pulvis Tragacanthae Compositus 1 part in 6 20-60 gr. Uses. — The glycerine of starch forms a soothing application for chilblains and chapped hands. Amylum iodatum is really a preparation of iodine, q.v. Starch is also used as a vehicle for enemata. Bandages saturated with it are used in surgery. U.S.P. Triticum. Triticum. Couch-Grass. — The rhizome of Triticum repens, gathered in the spring and deprived of the rootlets. Characters. — Very long, but, as met with in the shops, cut into sections about two-fifths of an inch (1 centimetre) long, and about one- twelfth of an inch (2 millimetres) thick ; creeping, smooth, hollow in the centre, straw-yellow, inodorous, and of a sweet taste. Peepaeation. dose. Extractum Tritici Fluidum 1 fl. dr. to 1 oz. Uses. — It is used as a demulcent and diluent, more particularly in cystitis and irritation of the urinary passages. It probably owes its diuretic effect to its sugar, and is best given in the form of an infusion or decoction, which may be freely used. B.P. Hordeum Decorticatum. Pearl Barley. — The husked seeds of Hordeum distichon. Britain. Characters. — White, rounded, retaining a trace of the longitudinal furrow. Composition. — Starch, albuminous matter, cellulose, and a small quantity of fixed oil. Peepaeation. Decoctum Hordei. Baeley Watee. — Pearl barley, 2 oz. ; boiling water, 30 fl. oz. ; the barley is first washed well in cold water, which is thrown away, and then the barley is boiled for twenty minutes and strained. Use. — The decoction is used as a demulcent drink. ENDOGENS. 905 U.S.P. Maltum. Malt. — The seed of Hordeum distichum, caused to enter the incipient stage of germination by artificial means, and dried. Characters. — Malt should be fresh, of a color not darker than pale amber, and should have an agreeable odor and a sweet taste. Peeparation. dose. Extractum Malti 4 fl. dr. U.S.P. Extractum Malti. Extract of Malt. Preparation. — Upon malt in coarse powder, not finer than No. 12, 100 parts, contained in a suitable vessel, pour 100 parts of water, and macerate for six hours. Then add 400 parts of water, heated to about 30° C. (86° F.), and digest for an hour at a temperature not exceecljng 55° C. (131° F.). Strain the mixture with strong expression. Finally, by means of a water-bath, or vacuum apparatus, at a temperature not exceeding 55° C. (131° F.), evaporate the strained liquid rapidly to the consistence of thick honey. Keep the product in well-closed vessels, in a cool place. Dose. — 4 fl. drm. Action. — This officinal extract of malt is similar to various other extracts and foods prepared from malt. It is not only nutritious, but, on account of the diastase contained in it, acts as a digestive ferment. In large doses it relaxes the bowels. Uses. — In cases of imperfect digestion and in phthisis, and in gene- ral imperfect nutrition in children or adults. Saccharum, U.S.P. ; Saccharum Purificatum, B.P. Sugar, U.S.P.; Repined Sugar, B.P. C 12 H 22 O u , or C 24 H 22 12 ; 342.— The refined sugar of Saccharum officinarum, U.S.P. Pure cane sugar pre- pared from the juice of the stem of Saccharum officinarum. West Indies and other tropical countries, B.P. Characters. — Compact, crystalline, conical loaves, known in com- merce as lump sugar. Impurities. — Salts, foreign matters. Tests. — U.S.P. White, dry, hard, distinctly crystalline granules, permanent in the air, odorless, having a purely sweet taste, and a neutral reaction. Soluble in 0*5 part of water, and in 175 parts of alcohol at 15° C. (59° F.); in 0-2 part of boiling water, and in 28 parts of boiling alcohol ; also in 80 parts of boiling, absolute alcohol, but insoluble in ether. The aqueous solution, saturated at 15° C. (59° F.), has the specific gravity 1*345, and is miscible with alcohol in all proportions. Neither an aqueous nor an alcoholic solution of sugar, kept in large, well-closed and completely filled bottles, should deposit a sediment on prolonged standing (absence of insoluble salts, foreign matters, ultra- marine, Prussian blue, &c). If a portion of about 1 gm. of sugar be dissolved in 10 c.c. of boiling water, then mixed with 4 or 5 drops of test solution of nitrate of silver and about 2 c.c. of water of ammonia, and quickly heated nntil the liquid begins to boil, not more than a slight coloration, but no black precipitate, should appear in the liquid after 906 VEGETABLE MATERIA MEDICA. standing at rest for five minutes (absence of grape sugar and of more than a slight amount of inverted sugar). Use. — To mask the taste of disagreeable remedies. It is used as a rehicle, corrigent, preservative, and antiseptic. Syrups have the advantage of protecting the active ingredients against fermentation, and certain ferruginous preparations against oxidation. Peepaeatioxs. U.S. p. Pilulse Ferri Carbonatis. Pulvis Cretae Compositus. Pilulae Ferri Iodidi. Pulvis GUycyrrhizae Compositus. Ferri Carbonas Saccharatus. Troches, Syrups, Compouud Syrups, &c. Mistura Ferri Composita. B.P. Confectio Kosae Caninae. Mistura Guaiaci. Confectio Rosas Gallicae. Pilula Ferri Iodidi. • Confectio Sennae. Pulvis Cretae Aromaticus. Ferri Carbonas Saccharata. Pulvis Amygdalae Compositus. Liquor Calcis Saccharatus. Pulvis Tragacanthae Compositus. Mistura Ferri Composita. All the Syrups and Lozenges. B.P. Theriaca. Treacle. — The uncrystallized residue of the refining of sugar. Characters. — A thick, brown, fermentable syrup, very sweet; not crystallizing by rest or evaporation. Specific gravity about 1 # 40. Test. — Nearly free from empyreumatic odor or flavor. Peepaeatioxs. b.p. Pilula Assafoetidae Composita. Pilula Rhei Composita. Pilula Conii Composita. Pilula Scillae Composita. Pilula Ipecacuanhae et Scillae. Use. — To make up some of the pills of the Pharmacopoeia. "With sulphur it is used as a domestic laxative. Avenae Farina. Oatmeal. Not officinal. — The meal prepared from the seeds of Avena sativa, the common oat. Composition. — The seeds contain starch, gluten and gum. The pericarp contains an amorphous alkaloid. This alkaloid is soluble in alcohol. It is more abundant in dark than in light oats. It probably gives to them their bitterish taste. Action. — The alkaloid appears to act chiefly as a stimulant of the motor ganglia. It increases the excitability of the muscles, and in horses causes excitement. Uses. — Oatmeal is chiefly used for making gruel or porridge, which, in addition to being nutritious, acts as a demulcent in coughs, and as a slight laxative. Warm oatmeal porridge at bed time may have a soporific action (p. 181), though the exciting action of the alkaloid may render panada, Indian corn, or lentils preferable. An infusion, decoc- tion, or tincture, has been recommended as a stimulant to replace opium in persons addicted to opium eating, in order to help them to break off that habit. CEYPTOGAMS. 907 CHAPTER XXXVII. Sub-kingdom II.— CRYPTOGAMS. FILICES. Aspidium, U.S.P. ; Filix Mas, B.P. Male Fern. — The rhizome of Aspidium Filix mas and of Aspidium marginale, U.S.P. The dried rhizome with the bases of the footstalks and portions of the root fibres of Aspidium Filix mas. Collected in summer, B.P. Characters. — Tufted, scaly, greenish-brown ; powder greenish- yellow, with a disagreeable odor, and a nauseous, bitter, somewhat astringent taste. Peeparations. u.s.p. dose. Oleoresina Aspidii 30-60 min. B.P. dose. Extractum Filicis Liquidum 15 min. to 1 fl. dr. (of the powder, 60-180 gr.) Composition. — A dark green oil which deposits crystals of filicic acid, also traces of volatile oil. The filicic acid is regarded as the chief though not the only active principle ; tannin, resin, and sugar have been found in the rhizome. Physiological Action and Therapeutics. — The liquid extract is one of the best anthelmintics against tapeworm, killing the Bothrioee- phalus latus, Taenia solum, and T. medioeanellata. Pomegranate root bark is said to kill the latter with greater certainty. The dose often given is too small, and hence failure is attributed to the drug when it really depends on the smallness of the dose. Single doses of 5i-5iss of the liquid extract will often cure at once. Method of Administration. — Allow the patient to take no food after five or six in the evening except a little bread and milk. Just before bed give 5i of the liquid extract in 5i of mucilage, and let the patient lie down immediately and go to sleep. This often prevents the vomiting which sometimes occurs. Next morning administer a purgative, and repeat the treatment until the worm comes away. Another method is to give a dose of castor oil at night (with the same conditions of feeding) and early next morning give a dose of liquid extract (5ss-5i), and abstain from food till after the bowels have acted. LICHENES. Cetraria, U.S.P. and B.P. Iceland Moss. — The entire lichen, Oetraria islandica. North of Europe. Characters. — Foliaceous, lobed, crisp, cartilaginous, brownish- white, paler beneath ; taste bitter and mucilaginous. A strong decoction gelatinizes on cooling. Preparations, u.s.p. DOSE. Decoctum Cetrariae 2-4 fl. oz. B.P. DOSE. Decoctum Cetrariae 1 oz. to 1 pint 1-2 fl. oz. 908 VEGETABLE MATERIA MEDICA. Composition. — Lichenin and cetrarin or cetraric acid. The former constitutes 70 per cent, of the moss. It swells in cold and dissolves in hot water, gelatinizing on cooling. The latter, which is the bitter prin- ciple, is obtained in white acicular crystals, and forms soluble salts with alkalis. Therapeutics. — It is demulcent, nutritious, and slightly tonic. B.P. Litmus. — A blue pigment prepared from various species of Roccella. Litmus Paper, Blue, U.S. P. and B.P. — Unsized white paper steeped in tincture of litmus and dried by exposure to the air. Litmus Paper, Red, U.S. P. and B.P. — Unsized white paper steeped in tincture of litmus which has been previously reddened by the addition of a very minute quantity of sulphuric acid, and dried by exposure to the air. Solution of Litmus, U.S. P. ; Litmus Tincture, B.P. — A solu- tion prepared by macerating 1 part of litmus, in powder, in 10 parts of diluted alcohol, U.S. P., or proof spirit, B.P., in a closed vessel for two days, and filtering. Use. — Red litmus paper is used as a test for alkalis, and blue litmus as a test for acids. FUNGI. Ergota, U.S.P. and B.P. Ergot. Ergot op Rye. — The sclerotium (compact mycelium or spawn) of Qlaviceps purpurea, replacing the grain of Secale cereale, Nat. Ord. G-raminaceoe, U.S.P. (produced within the palese of the common rye, Secale cereale, B.P.). Characters. — Somewhat fusiform, subtriangular, curved, with a longitudinal furrow on the concave side, obtuse at the ends, about an inch long ; purplish black outside, pinkish within ; solid, breaks with a short fracture ; odor peculiar, but strong if the powder be triturated with solu- tion of potash ; taste oily and disagreeable. Peepaeations. U.S.P. DOSE. Extractum Ergotae Fluidum 100 Gm. in 100 c.c 30-60 min. Vinum Ergotse 2-4 fl. dr. Extractum Ergotse 3-12 gr. B.P. DOSE. Extractum Ergotse Liquidum 1 oz. to 1 fl. oz 10-30 min. Infusum Ergotae 11 gr. to 1 fl. oz 1-2 fl. oz. Tinctura Ergotse 109 gr. to 1 fl. oz 10 min. to 1 fl. dr. Composition. — The chemical composition of ergot is still very imperfectly known, and the active principle (or principles) to which its most important action, that of causing contraction of the uterus, is due, has not been satisfactorily isolated. The active principles were formerly said to be ergotin and ecbolin, but these do not seem to be pure sub- stances. The term ergotin has been applied to several substances. The preparation known commercially as Bonjean's ergotin is an alcoholic CRYPTOGAMS. 909 extract of a watery extract of ergot. According to Schmiedeberg, two pure principles have been isolated — ergotinic acid and an alkaloid, ergo- tinine. According to Dragendorff and Podwyssotzki, the active princi- ples are sclerotinic acid and a colloid substance, scleromucin. Sclerotinic acid is impure ergotinic acid. In addition to ergotinic acid, ergotinin, and probably several other principles, ergot contains about 35 per cent, of oil, a peculiar sugar (mykose), and two coloring matters, scleroxanthin and sclero-erythrin. The most recent researches are those of Robert, who states that ergot contains three active principles — ergotinic acid, sphacelinic acid, and an alkaloid, cornutine. General Action. — There is a great difference of opinion as to the action of ergot, due to its preparations undergoing change so rapidly, and hence not being of the same strength. They become quite inactive if kept for any length of time. In certain parts of Germany, where rye bread is much used, epidemics of ergotism have occurred. These epidemics depend both upon the continued large doses of ergot and upon the deficiency of food, the nutritive part of the rye being replaced by the fungus. The deficiency of food is probably an important factor, since continued therapeutic doses of ergot rarely produce ergotism, though occasionally they do so. There are two varieties of symptoms seen in ergotism: (1) the gangrenous ; (2) the anaesthetic or convulsive. Both begin with gastro-intestinal disturbance, causing loss of appetite, nausea, vomiting, and diarrhoea. The gangrenous symptoms are redness of the skin followed by well- marked gangrene in the part. The cause of this gangrene is probably stasis due to the great contraction of the small blood-vessels. The nervous symptoms are giddiness, with symptoms of irritation and paralysis of sensory nerves, the irritation being indicated by a sensa- tion as of insects crawling over the skin, flying pains, &c, the paralysis by loss of sensation in the hands and feet. Spasms may occur, and even convulsions of an epileptic nature, but their cause is unknown. Special Action. — Ergotinic acid causes paralysis of the spinal cord both in frogs and mammals, with loss of voluntary motion, paralysis of the vaso-motor centre, and fall of blood-pressure, while respiration and reflex irritability continue. It does not appear to have the power of increasing the uterine contractions, and so cannot be regarded as the most important constituent of ergot. Ergotinine is also not the active principle as it is present in very small quantity in ergot, and is to some extent removed by ether without the ergot losing its power. Sphacelinic acid causes contraction of the blood-vessels, with rise of blood-pressure and symptoms of gangrene. The heart is unaffected. The gangrene in fowls appears to be due to occlusion of the smaller arte- ries by a hyaline substance. In rabbits, guinea-pigs, and cats, the sub- stance is not formed, and no gangrene appears, but their walls degenerate, and blood is effused into various organs. Sphacelinic acid causes tetanus of the uterus (Robert). Cornutine causes spastic rigidity in frogs, lasting many days, even when given in very minute doses {-£% of a milli- gramme). In warm-blooded animals half a milligramme causes salivation, 910 VEGETABLE MATERIA MEDICA. vomiting, diarrhoea, and active movements of the uterus, which are clonic and not tonic. The vessels are contracted and the blood-pressure raised. Sphacelinic acid and cornutine are therefore the principles which cause uterine contraction (Kobert). As these active principles have not yet found their way into common use, it will be better at present to take the results of experiments, not with pure principles isolated from ergot, but only of an extract such as Bonjean's ergotin. Action of Extract of Ergot. — A solution of Bonjean's ergotin injected into animals causes an affection of the nervous system, indi- cated by incoordination, anaesthesia, and paralysis ; and death is due to paralysis of respiration. The muscles are unaffected; the motor nerves are not paralyzed, but on the contrary have their power somewhat increased. The sensory nerves are paralyzed, but it is uncertain whether the action is central or peripheral. The spinal cord is paralyzed. Circulation. Heart. — Its action on the frog's heart is not well marked; sometimes the injection of ergot produces slowing of the pulse rate with stoppage in diastole, and in these cases direct mechanical irri- tation immediately after the poisoning does not cause the heart to con- tract. Slowing and diastolic arrest occur after section of the vagi, but not after administration of atropia; hence they are due to the action of the ergot on the inhibitory apparatus in the heart itself. Yaso-motor System. — The blood-pressure is considerably raised. When injected into the jugular vein, the blood-pressure, according to Holmes, is first lowered and then raised considerably, which he explains by supposing that the ergot passing to the right side of the heart causes contraction of the vessels of the lungs (by acting on their muscular walls), and hence lessens the supply to the aortic system and causes a fall of blood-pressure, but when it reaches the medulla it stimulates the vaso- motor centre, and causes contraction of the vessels throughout the body and consequent rise of blood-pressure. This explanation is confirmed by the fact that if ergot is injected into the femoral artery, instead of a fall occurring at first there is a rise due to contraction of vessels in the limb, then a fall as soon as the blood reaches the lungs, and lastly a final rise. This explanation is not accepted by Wood, who considers that the primary fall is due to the sudden introduction of a large quantity of ergot into the heart causing temporary paralysis, which will pass off as the drug is removed by the circulation. The final rise of blood-pressure no doubt is due to the action on the medulla, for if the cord be divided very little rise follows the injection of ergot. One other factor, which usually receives very little attention, must be taken into account (as well in this drug as in many others), viz. : the effect on the blood-pressure of contraction of the internal viscera, as the intestines or uterus, for by contraction their blood will be driven out, and a rise of a blood pressure produced without any action on the vessels. Respiration is usually slowed from the beginning, but in some ani- mals (dogs) it is first quickened and then slowed. Death is due to par- alysis of the respiratory centre. CRYPTOGAMS. 911 Secretion. — The urine is increased in quantity, aud the bladder tends to contract, due to the effect of the drug on its unstriped fibres. Alimentary Canal. — Ergot markedly increases the peristaltic move- ments of the intestine. Uterus. — Ergot causes contraction of the uterus, especially of the pregnant uterus. This contraction is not usually so much rhythmical as tetanic in nature, with occasional increases in violence. There is no complete relaxation between the spasms, as in the ordinary labor pains. This is probably due to an action on the unstriped fibres of the uterus, since ergot causes contraction of involuntary fibres throughout the body, but it may be due wholly or in part to the uterine centre in the spinal cord. Therapeutics. — Ergot is chiefly used in medicine for two purposes : (1) to cause contraction of the uterus ; (2) to check haemorrhage by causing contraction of the vessels. It is sometimes used to hasten delivery when the power of the uter- ine contractions is not sufficient to expel the foetus. But the tetanic nature of the contraction produced by ergot must be borne in mind. It does not increase the power of the labor pains, but only the tonic contrac- tion of the uterus. It should be carefully avoided if there be any mechani- cal obstruction to delivery, such as rigid and undilated os uteri, contracted pelvis, or abnormal presentation, for in such cases it may so far interfere with the circulation in the uterus and placenta as to asphyxiate the foetus, or cause such contraction of the uterus as to produce rupture of its walls. After the child is expelled, the tetanic nature of the contraction produced by ergot is useful, and hence it is used to prevent post-partum haemor- rhage. In these cases, it is administered either in the form of powdered ergot in warm water, or the liquid extract, or by subcutaneous injection of ergotin. The last method gives the most rapid results, bnt if the ergotin is injected just beneath the skin it causes irritation and may lead to an abscess, hence it should be injected deep into a muscle, such as the gluteus maximus. Ergot is also used very largely in the practice of gynaecology, for exam- ple, in chronic metritis, in subinvolution of the uterus, after abortions, to promote the expulsion of retained membranes, and in all atonic condi- tions of the uterus. It is also used in certain cases of leucorrhoea, also in atony of the bladder and enlarged prostate. It is used to check haemorrhage in fibroid tumors of the uterus ; in haemoptysis (either internally, 5ss. of liquid extract every two, three or four hours, or subcutaneously injected). In haematemesis also it is some- times useful. In some cases of chronic constipation it is useful, and appears to give tone to the bowel. U.S.P. Ustilago. Ustilago. Corn Smut. — Ustilago Maydis (Nat. Ord., Fungi), grown upon Zea Mays (Nat. Ord., Graminaeece). Ustilago should be preserved in a dry place, and should not be kept longer than a year. This fungus is a form of smut growing upon maize. 912 VEGETABLE MATERIA MEDICA. Characters. — Irregular, globose masses, sometimes six inches (15 centimetres) thick, consisting of a blackish membrane, inclosing innu- merable brownish-black, globular and nodular spores ; odor and taste unpleasant. Dose.— J-l dr. (1-4 Gm.). Action — It resembles ergot in its action, and probably also con- tains the same alkaloid. B.P. Cerevisise Fermentuni. Beer Yeast. — The ferment obtained in brewing beer. Characters. — Viscid, semi-fluid, frothy, exhibiting under the micro- scope numerous round or oval confervoid cells (p. 90). Dose. — J to 1 ounce. Peepaeation. Cataplasma Fermenti. YEAST Poultice. — Mix beer yeast, 6 fl. oz., with water at 100° F., 6 n. oz., stir in wheaten flour, 14 oz., and place the mass near the fire till it rises. Use. — It has been given internally along with camphor and nitrous ether in typhoid fever and dysentery, and to persons suffering from boils. The poultice is applied to sloughing sores. It is apt to cause much pain. ALGcJE. U.S. P. Chondrus. Chondrus. Irish Moss. — Chondrus erispus and Chondrus mammilosus. Characters. — Yellowish or white, horny, translucent; many-forked ; when softened in water, cartilaginous ; segments flat, wedge-shaped, or linear ; at the apex emarginate or two-lobed ; it has a slight sea-weed odor ; and a mucilaginous, somewhat saline taste. One part of it boiled for ten minutes with thirty parts of water, yields a solution which gelati- nizes on cooling. Dose. — 2-4 dr. Use. — It is a demulcent, which is useful in bronchial and catarrhal affections. SECTION VI. ANIMAL KINGDOM. CHAPTER XXXVIII. Class MAMMALIA. ORDER RODENTIA. B.P. Castoreum. Castor. — The dried preputial follicles and their secretion, obtained from the beaver, Castor fiber, and separated from the somewhat shorter and smaller oil-sacs which are frequently attached to them. Hudson's Bay Territory. Characters. — Follicles in pairs, about three inches long, fig-shaped, firm, and heavy, brown, or grayish-black; containing a dry, resinous reddish-brown or brown, highly odorous secretion, in great part soluble in rectified spirit, and in ether. Composition. — Several fats, salicin, a bitter resin, and bitter volatile oil. Preparation, b.p. DOSE. Tinctura Castorei 22 gr. to 1 fl. oz |-1 fl. dr. (of castor, 5-10 gr.). Therapeutics. — Castor is used chiefly as an antispasmodic and stimulant. It may be given in hysteria and epilepsy. Its action is very like that of musk. Order RUMLNTANTIA. Moschus, U.S. P. and B.P. Musk. — The inspissated and dried secretion from the preputial follicles of Moschus moschiferus. Central Asia. Characters. — In irregular, reddish-black, rather unctuous grains ; having a strong, peculiar, very diffusible odor, and a bitter, aromatic taste; contained in a round or slightly oval membranous sac, about two inches in diameter, covered on the outer side with stiff, grayish hairs arranged in a concentric manner around its central orifice. 58 • (913) 914 ANIMAL KINGDOM. Composition. — An odoriferous substance not yet isolated, fats, resins, and salts. Dose. — 5-10 gr. and upwards. Officinal Peepaeation. U.S. p. DOSE. Tinctura Moschi 20-50 min. Therapeutical Uses. — Musk is often employed in hysteria, although its physiological action has not been investigated. It is more powerful in its action than castor. It is used as an antispasmodic and stimu- lant. It is a powerful stimulant, and excellent results have been obtained in cases of collapse, when due to paralysis of the respiration. It has also been given in asthenic pneumonia, bronchitis, fever, and gangrene of the lungs on account of its power of stimulating' the respiratory centre and covering the disagreeable odor of the sputa. There is a temptation to give it in small doses on account of its high price, and probably many failures are due to this. In cases where it is prescribed at all it should be given freely, and in many instances it seems to be of great service. Sevum, U.S. P. ; Sevum Praeparatum, B.P. Suet, U.S. P. ; Prepared Suet, B.P. — The internal fat of the abdomen of the sheep > Ovis Aries, purified by melting and straining. Characters. — White, smooth, almost scentless ; fusible at 103°. Composition. — Consists principally of stearin. Peepaeations. Emplastrum Cantharidis. Unguentum Hydrargyri. Use. — Used in the preparation of certain unguenta and emplastra. B.P. Sapo Animalis. Curd Soap. — A soap made with soda and a purified animal fat, consisting principally of stearine. Characters and Tests. — White, or with a very light grayish tint; dry ; nearly inodorous ; horny and pulverizable when kept in dry, warm air. Easily moulded when heated. Soluble in rectified spirit ; soluble also in hot water, the solution being neutral or only slightly alkaline to test-paper. It does not impart a greasy stain to paper. Peepaeations in which Cued Soap is used. Pilula Scammonii Composita. Suppositoria Acidi Carbolici cum Sapone. " Morphia? cum Sapone. " Acidi Tannici cum Sapone. This soap may with advantage be substituted for the hard soap made with olive oil in preparing the Linimentum Potassii Iodidi cum Sapone. B.P. Lac. Milk. — The fresh milk of the cow, Bos Taurus. Peepaeatiox in which Milk is used. Mistura Scammonii. Composition. — Fat (butter), casein, milk, sugar, and water. THERAPEUTICS. — Milk is not, strictly speaking, a medicine, but rather an article of diet: it however plays an important part in medi- cine, as we rely on it to a great extent in cases of fever and dyspepsia. ANIMAL KINGDOM. 915 Great attention ought to be paid to the milk given to infants if they are fed from the bottle, for the milk may begin to ferment before it reaches the stomach, and, if it does, it is likely to cause vomiting and diarrhoea, and may even act as a nervous poison, paralyzing the nerve centres. The best way to prevent this is not to have any tubes to the bottles, but to have the teat fixed directly to the bottle, and to scald the bottle well after every meal. The teats should also be soaked in some antiseptic, such as permanganate of potash and water, when not in use. When milk is drunk in any quantity, the rennet-ferment in the stomach produces large curds, which are sometimes hard like felt, and are very indigestible and irritating to the stomach ; hence, in typhoid fever the possibility of these curds should be borne in mind. The milk will not readily curdle if mixed with its own bulk of water or soda water, or (if diarrhoea be present) with lime water. One may often with advantage use koumiss, which is made in the steppes of Tartary by fermenting mares' milk. Consumption is so rare in Tartary, that Russians suffer- ing from phthisis go to the steppes, and numbers have been cured. No doubt other factors aided the cure, such as climate and change of air, but even in the same conditions of life koumiss often helps to keep the disease in check. It can be made artificially from grape sugar and cows' milk, which is allowed to ferment. It is a good stimulant, and is useful in cases of phthisis. It contains lactic acid, alcohol, casein, and fat thrown down in small flakes. Milk may be used with ferments, such as pepsin or pancreatin. The mixture is allowed to stand for a time, and then boiled to stop the fer- mentation. Cows' milk diluted with one or more parts of water and a little milk-sugar added, forms a good substitute for human milk as food for infants. Saccharum Lactis, U.S.P. and B.P. Sugar of Milk. — C 12 H 24 12 or C 2nt H 24 24 ; 360. — A peculiar crystalline sugar, obtained from the whey of cows' milk by evaporation and purified by recrystallization. Characters. — Usually in cylindrical masses, two inches in diame- ter, with a cord or stick in the axis, or in fragments of cakes ; grayish- white, crystalline on the surface and in its texture, translucent, hard, scentless, faintly sweet, gritty when chewed. Soluble in 7 parts of water at 15° C. (59° F.), and in 1 part of boiling water; insoluble in alcohol, ether, or chloroform. On adding to a solution of sugar of milk in an equal weight of boiling water some solution of soda, the liquid turns brownish, and, on farther addition of test solution of sulphate of copper, a brick-red precipitate separates. Impurity. — Cane sugar. Test. — If 1 part of sugar of milk be sprinkled upon 5 parts of sul- phuric acid contained in a flat-bottomed capsule, the acid should acquire not more than a greenish or reddish, but no brownish or brownish-black color within one hour (absence of cane sugar). Uses. — Sugar of milk is used as a diluent in the abstracts, denar- cotized opium, &c, of the U.S.P. It is harder, less sweet, and less soluble than cane sugar, and hence is a better excipient and diluent for pow- ders that require trituration. 916 ANIMAL KINGDOM. B.P. Pepsin. Pepsin. — A preparation of the mucous lining of a fresh and healthy stomach of the pig, sheep or calf. The stomach of one of these animals recently killed having been cut open, and laid on a board with the inner surface upwards, any adhering portions of food, dirt, or other impurity, are to be removed and the exposed surface slightly washed with cold water; the cleansed mucous membrane is then to be scraped with a blunt knife or other suitable instrument ; and the viscid pulp thus obtained is to be immediately spread over the surface of glass or glazed earthenware, and quickly dried at a temperature not exceeding 100° Fahr. Dose. — Of pepsin, 2-10 gr. given with a meal. U.S. P. Pepsiiium Saccharatuin. — Pepsin, the digestive principle of the gastric juice, obtained from the mucous membrane of the stomach of the hog, and mixed with powdered sugar of milk. Saccharated pepsin is a white powder of a slight but not disagreeable odor and taste, and a slightly acid reaction. It is not completely soluble in water, leaving floccules of pepsin floating in the solution, which, how- ever, dissolve on the addition of a small quantity of hydrochloric acid. Strong turbidity of the acidulated solution indicates the presence of mucus, which also imparts to the saccharated pepsin a disagreeable odor and taste, and will eventually impart to it an ammoniacal odor. U.S. P. Prepakation. dose. Liquor Pepsini 2-4 fl. dr. Therapeutics. — Pepsin is given as an aid to digestion, when the ordinary stimuli do not excite sufficient secretion, and the digestive fer- ment is insufficient. Such cases occur during a long illness or during recovery from an acute disease, in old people, and in people with atrophy of the mucous membrane and glands of the stomach, due to alcoholic excesses or long-continued dyspepsia. It may be given either with or just after meals. It has no influence on farinaceous foods or fat, but only acts on gelatinous and albuminous matter; hence it is no use giving it after farinaceous or fatty food. In these cases the secretion of acid is usually defective, and a little dilute hydrochloric acid given along with pepsin, and again about two hours after meals, is very useful. In some cases of asthma, dependent on insufficient digestion, pepsin is very useful. Pepsin wines and essences usually contain little or no pepsin, and have little digestive power, but they contain rennet, and are frequently of use in indigestion in children; they also appear service- able in adults. U.S.P. Fel Bovis. Ox Gall. — The fresh gall of Bos Taurus. Characters. — A brownish-green, or dark green, somewhat viscid liquid, having a peculiar odor, a disagreeable, bitter taste, and a neutral or faintly alkaline reaction. Specific gravity 1-018 to 1*028. A mix- ture of 2 drops of qx gall and 10 c.c. of water, when treated first with a drop of freshly prepared solution of 1 part of sugar in 4 parts of water, and afterwards with sulphuric acid until the precipitate first formed is ANIMAL KINGDOM. 917 redissolved, gradually acquires a cherry-red color, changing successively to carmine purple, and violet. Peepaeations. Fel Bo vis Inspissatum. Fel Bo vis Purificatum. U.S.P. Fel Bovis Inspissatum. Inspissated Ox Gall. Heat the ox gall to a temperature not exceeding 80° C. (176° F.), strain it through muslin, and evaporate the strained liquid, on a water- bath, in a porcelain capsule, from 100 parts to 15 parts. Fel Bovis Purificatum, U.S.P. ; Fel Bovinum Purificatum, B.P. Purified Ox Bile. — The purified gall of the ox, Bos Taurus. Peepaeations. U.S.P. DOSE. Fel Bovis Inspissatum Fel Bovis Purificatum 8-15 gr. Preparation. — Evaporate ox gall, 3 parts, in a water-bath to 1 part. Add alcohol 1 part. After twenty-four hours decant, filter, distil off the alcohol, and evaporate to apilular consistence, U.S.P. Mix fresh ox bile (1 pint) and rectified spirit (2 pints) by agitation in a bottle, and set aside for twelve hours until the sediment subsides. Decant the clear solution and evaporate it in a porcelain dish by the heat of a water-bath until it acquires a suitable consistence for forming pills, B.P. Characters and Tests. — A yellowish-green substance, having a taste partly sweet and partly bitter, soluble in water and in spirit. A solution of one or two grains of it, in about a fluid drachm of water, when treated, first with a drop of freshly made syrup consisting of one part of sugar and four of water, and then with sulphuric acid cautiously added until the precipitate at first formed is redissolved, gradually acquires a cherry-red color, which changes in succession to carmine, purple, and violet. Its watery solution gives no precipitate on the addition of rectified spirit. Composition. — Tauro-cholic and glyco-cholic acids, mucus, choles- terin, fats, and salts. Dose. — Of purified bile, 5-10 gr. or more, formed into pills or given in small gelatin capsules. When the object is to affect the intestines rather than the stomach, the latter mode is preferable. Action and Uses. — Bile precipitates pepsin and interferes with the digestion of albuminous substances in the stomach. It seems also to irritate the mucous membrane and give rise to headache and vomiting. It does not aid the digestion of farinaceous food. It quickens the absorption of fats, it prevents to some extent putrefactive changes in the intestinal contents, and it quickens peristaltic action. Some purgatives, such as aloes and jalap, only act when mixed with bile. It is therefore a useful adjunct to them in cases of jaundice with deficiency of bile in the intestine. It is sometimes used in dyspepsia with constipation, and is given by some along with opium in order to prevent the constipating effect of the latter. Its action in preventing putrefactive changes in the intestine may sometimes be useful in cases of indigestion where these occur (pp. 103 and 463), and where the flatus has consequently a very 918 ANIMAL KINGDOM. disagreeable odor. In order to prevent its local action on the stomach, it may be given as pills coated with keratin. Keratin. Not officinal. Preparation. — Horn turnings are digested with artificial gastric juice until all the matter soluble in them has been removed. The} 7 are then allowed to lie for some weeks in ammonia or glacial acetic acid, which gradually dissolves them. The solvent is then allowed gradually to evaporate until a mucilaginous solution is obtained. Characters. — The solution resembles gum in appearance, and when dry forms yellow or yellowish-brown scales. When dried, keratin is absolutely insoluble in gastric juice, but dissolves readily in the juices of the intestine. Uses. — To coat pills containing any substance which we wish to act upon the intestine without acting on the stomach. These are : 1. Such substances as irritate the gastric mucous membrane when long used, e.g., arsenic, all anthelmintics, salicylic acid, creasote, chrysa- robin, copaiba, cubebs, digitalis, preparations of iron — and especially the iodide and chloride ; preparations of mercury — especially the perchloride and periodide ; opium, phosphorus, quinine, tartarated antimony. 2. Such substances as impair digestion in the stomach by forming insoluble precipitates with pepsin and peptones, e.g., tannic acid, alum, acetate of lead, subnitrate of bismuth, nitrate of silver, corrosive subli- mate. 3. Such substances as are partly rendered inert by the gastric juice, and partly decomposed in an undesired manner, e.g., alkalies, soap, bile, calcium sulphide, ferric sulphide, charcoal, nitrate of silver, iodide of iron, green and red iodides of mercury, &c. 4. Medicines which we wish to introduce into the duodenum in as concentrated a form as possible, e.g., kousso, extract of male fern, san- tonin, nitrate of silver, acetate of lead or tannin, in ulceration of the bowels ; bile, charcoal, soaps, and alkalies, &c. 5. Medicines of which we desire the remote without the local action, e.g., iron, quinine, arsenic in gastric catarrh, in anaemia, in cardialgia and gastric ulcer. Mode of Application. — The medicine is thoroughly mixed with marsh-mallow powder, liquorice powder, or charcoal, and a few drops of almond oil. It is then made into a pill mass with cacao butter. After the pills have been made of the proper size they are covered with a thin coating of cacao butter, and then with one, or better still, with two or three coats of keratin. Usually the solution of keratin in ammonia is employed, but the solvent least likely to decompose the medicine may be employed, and thus the acetic acid solution may be used for the chloride of iron or mercury, or salicylic acid. Order PACHYDERMATA. Adeps, U.S.P. ; Adeps Praeparatus, B.P. Lard, U.S. P.; Prepared Lard, B.P. — The prepared internal fat of the abdomen of Sm scrofa purified by washing with water, melting, and straining, U.S.P. The purified fat of the hog, Sus scrofa, B.P. ANIMAL KINGDOM. 919 Impurities. — Rancidity due to acrid, fatty acids, alkalies, common salt, starch, water. Characters and Tests. — A soft, white, fatty substance, melting at about 100°. Has no rancid odor ; dissolves entirely in ether. Distilled water in which it has been boiled should not acquire an alkaline reaction (absence of alkalies). A portion of the water when cooled and filtered, and another portion acidulated with nitric acid, should give no precipi- tate with nitrate of silver (absence of salt), and is not rendered blue by the addition of solution of iodine (no starch.) When heated for several hours on the water-bath, under frequent stirring, lard should not diminish sensibly in weight (absence of water). Peepaeations. U.S. p. Adeps Benzoinatus Unguentum Acidi Tannici. Ceratum Kesinae. ' ' Belladonnas. Unguentum. ' ' Chrysarobini. Ceratum. ' 1 Gallae. " Camphorae. * { Hydrargyri Ammoniatae " Cantharidis. ' Iodi. " Extracti Cantharidis. * ' Iodoformi. " Plumbi Subacetatis. ' ' Plumbi Carbonatis. Sabinas. Iodidi. Unguentum Acidi Carbolici. ' ' Potassii " " Hydrargyri. ' ' Stramonii. OxidiFlavi. ' Sulphuris. 44 Rubri. Alkalinum. " Mezerei. ' ' Veratrinae. " Acidi Gallici. « ' Zinci Oxidi. B.P. Adeps Benzoatus. Unguei ltum Iodi. Emplastrum Cantharidis. ' ' Potassae Sulphuratae. Unguentum Aconitiae. 4 ' Potassii Iodidi. " Atropiae. ' ' Sabinae. " Belladonnas. ' ' Simplex. " Hydrargyri. ' ' Sulphuris Iodidi. Nitratis. ' Terebinthinae. Subchloridi. ' Veratriae. Adeps Benzoinatus, U.S.P. ; Adeps Benzoatus, B.P. Ben- zoated Lard. Preparation. — By mixing powdered benzoin (2 parts, U.S.P. ; 2 drachms, B.P.) with melted lard (100 parts, U.S.P. ; 1 lb. B.P.), and straining. The benzoin prevents the lard from becoming rancid. Uses. — Lard is emollient. It is used in the preparation of oint- ments, and spread upon poultices to prevent them from getting dry or sticking to the surface of the body. Order CETACEJE. Cetaceum, U.S.P. and B.P. Spermaceti. — A peculiar, concrete, fatty substance obtained from Physeter maerocephalus, U.S.P. Nearly pure cetine, obtained, mixed with oil, from the head of the sperm whale, Physeter macrocephalus, inhabiting the Pacific and Indian Oceans. It is separated from the oil by filtration and pressure, and afterwards puri- fied, B.P. Characters and Tests. — Crystalline, pearly white, glistening, translucent, with little taste or odor, reducible to powder by the addition 920 ANIMAL KINGDOM. of a little rectified spirit. Scarcely -unctuous to the touch ; does not melt under 100°. Peepaeatioxs. TJ.S.P. B.P. Ceratum Cetacei. Charta Epispastica. Unguentum Aquse Rosa?. Unguentum Cetacei. Use. — It is used as an emollient external application. Class AVES. Order GALLING. B.P. Albumen Ovi. Egg Albumen. — The liquid white of the egg of G-allus banckiva, var. domesticus. Characters. — Transparent, viscid, soluble in water, coagulable on heating to 160° F. When coagulated it is opaque and insoluble in water. It is coagulated by ether. U.S. P. Test Solution or Albumen. — A solution recently pre- pared by triturating the white of one egg with 100 cubic centimetres of distilled water and filtering through cotton moistened with distilled water. ViteUus, U.S.P. ; Ovi Vitellus, B.P. Yolk of Egg.— The yolk of the egg of G-allus banckiva, var. domesticus. Peepaeatioxs. U.S.P. B.P. Glyceritum Vitelli. Mistura Spiritus Vini Gallici. Properties. — Yellow, coagulated on heating, contains vitellin, also cholesterin, and fats, together with salts of lime, &c. B.P. Mistura Spiritus Vini Gallici. — Is prepared by rubbing up the yolk of an egg with \ oz. of fine sugar, then adding one wineglassful (2 fl. oz.) of brandy and another of cinnamon water, and beating them all up together. Therapeutics. — White of egg forms insoluble albuminates with a number of metals, and hence is employed as an antidote in cases of poisoning (especially in the cases of corrosive sublimate and sulphate of copper) ; in these cases the albuminates generally dissolve readily enough in the gastric juice, and therefore you must give an emetic at once. The white and yolk of egg are useful as nutritious articles of diet, and in the form of egg flip (mistura spiritus vini gallici) is much used in exhausted conditions of the system. One case in which eggs are very useful is cancer of the rectum, since being entirely absorbed in the ali- mentary canal, disturbance in the rectum is avoided. A good mixture is the white of three eggs, the yoke of two, and a quarter of a pint of beef tea ; beat up separately and then together, put in hot water until set and given in two or three portions. Eggs are often mixed with a little pancreatin, and administered as enemata. Class PISCES. ORDER STURIONES. Iclithyocolla, U.S.P.; Isinglass, B.P. — The swimming-bladder or sound of Acipemer huso, and other species of Acipenser. PROPERTIES. — In separate sheets, &c, U.S.P. ; in fine shreds, B.P. ANIMAL KINGDOM. 921 Composition. — It consists of gelatine, which is precipitated by tan- nic acid. Peepaeations. u.s.p. B.P. Emplastrum Ichthyocollse (Court Plaster). Solution of gelatine. Order teleoste^e. Fam. GADID^e. Oleum Morrhuse, U.S.P. and B.P. Cod-Liver Oil. — A fixed oil extracted from the fresh livers of the cod, G-adiis morrhua, B.P. (or of other species of Gadus, U.S. P.), by the application of a heat not exceeding 180°. Characters and Test. — Pale yellow, with a slight fishy odor, and bland, fishy taste. A drop of sulphuric acid added to a few drops of the oil on a porcelain slab develops a violet color, which soon passes to a yel- lowish or brownish-red. Composition. — Contains olein (7 per cent.), palmitin (25 per cent.), and some stearin, also minute traces of iodides, and a peculiar substance probably allied to biliary acids. Dose. — From 1 to 8 fl. dr. Physiological Action. — Cod-liver oil is rather a food than a medi- cine, and its therapeutical use depends on two properties, viz., its ready absorption and its ready assimilation. Its ready absorption is probably partly due to the presence of bil- iary matters in the oil, since oil passes more readily through a membrane when it is moistened with bile. If you take two loops of intestine and fill one with ordinary oil and the other with cod-liver oil, and replace them, the one with cod-liver oil will lose more in the same time than that containing ordinary oil. It is readily assimilated, and hence it is used in all diseases where nutrition is slow, as in enlarged glands, catarrhal pneumonia, bronchitis, &c. By means of its property of stimulating nutrition, cod-liver oil improves all the functions of the body, but has no specific action on any of the organs themselves. When large quantities of the oil are taken into the stomach, they cause vomiting, but if the oil be finely divided previously, it can be taken without discomfort. Hence it is advisable, when giving it in any quantity, to make it into an emulsion. Potash is some- times used, but in the stomach the potash is probably neutralized, the emulsion decomposed, and the oil liberated. A better method is to mix it with an equal volume of mucilage of acacia and a few drops of oil of lemon ; this emulsion is not decomposed by the acid of the stomach. The oil can also be mixed with isinglass and taken as jelly. Some peo- ple take it best by putting a little salt on the tongue before, and eating a piece of bread after the oil. It is often digested if taken with a little ether, for the ether stimulates the pancreatic secretion. The oil must not be pressed if it causes nausea or diarrhoea, — for it is a food and not a medicine, and must not be given if detrimental to the appetite. It can sometimes be taken in a single dose at bed-time, when it cannot be retained during the day. It is rarely well borne when taken on an empty stomach, but is best retained when given not immediately after, 922 ANIMAL KINGDOM. but from half an hour to two hours after a meal. Probably the partially digested food then forms it into an emulsion. Therapeutics. — Cod-liver oil is used in all diseases arising from defective nutrition and in all scrofulous conditions, and as a food during chronic illnesses and in convalescence from acute diseases. In children emaciated with diarrhoea, a useful mixture is vinum ferri and cod-liver oil ; it must not be given in such quantities as to increase the diarrhoea. Often it will also relieve constipation in children. Its nutritive properties are especially directed to glandular tissues ; hence it is used in all cases of enlarged glands, as in tabes mesenterica. In malnutrition of the heart, and defective circulation, it improves the condition of the heart, increases the red corpuscles, and to some extent also the white corpuscles ; hence it is useful in old people with giddiness and a tendency to syncope. It is also used in chronic rheumatism and tertiary syphilis. It is also a tonic to the nervous system, and is of great service in cases of nervous debility consequent on hard work, worry, or acute dis- ease. It is used in neuralgia with iron and port wine. In hysteria in middle-aged persons, it is often serviceable. In rickets it may be given alone or in combination with phosphate of lime. In inflammations, as bronchitis, newly developed cells are present in great abundance, but nutrition is so defective that they cannot take on the character and functions of mucous cells, and hence, in order to allow them to form a new mucous membrane, they must be supplied with a readily assimilable nutritive material; this is probably the explanation of the benefit obtained by the use of cod-liver oil in bronchitis and other diseases dependent on malnutrition. In chronic bronchitis, with violent cough and abundant sweetish expectoration, it gives great relief. In phthisis it is of great service, and is used in all stages of the dis- ease except when the temperature is very high ; especially is it useful in the first stage where there is little consolidation. Under its use the patient gains flesh, keeps the disease in check, and even sometimes becomes cured. In catarrhal conditions of other mucous membranes besides those of respiration it is very useful, as in ozeena in children recovering from measles, and in otitis after scarlet fever. Class INSECTA. Order HYMENOPTERA. Mel, U.S. P. and B.P. Honey. — A saccharine secretion deposited in the honeycomb by Apis mellifica, the hive bee. Characters. — When recently separated from the honeycomb, it is a viscid translucent liquid, of a brownish-yellow color, which gradually becomes partially crystalline and opaque. It has a peculiar heavy odor, and a very sweet taste. Composition. — Chiefly glucose and levulose. Impurities. — Starch, common salt, sulphates, grape sugar, and other foreign substances. ANIMAL KINGDOM. 923 Test. — Water boiled with it for five minutes and allowed to cool does not become blue or green with the solution of iodine (absence of starch). If 1 part of honey be dissolved in 4 parts of water, a clear solution should result, which should not be rendered more than faintly opalescent by a few drops of test solution of nitrate of silver (chloride), or of nitrate of barium (sulphate). If a small portion of honey be diluted with 1 volume of water and then gradually mixed with 5 volumes of absolute alcohol, it should not become more than faintly opalescent, and should neither become opaque nor deposit a slimy substance at the bottom and along the sides of the test-tube. When incinerated in small portions at a time, in a platinum crucible, it should not leave more than 0*2 per cent, of ash (any larger percentage of ash and failure to respond to the preceding tests indicating the presence of glucose or other foreign admix- tures). Officinal Peepaeations. u.s.p. Mel Despumatum (warmed and strained) Confectio Rosae Mel Rosae B.P. DOSE. Mel Depuratum (melted and strained) Ad lib. Of Mel Depuratum — Oxymel (honey, 40; acetic acid, 5; water, 5) 1 fl. dr. to 1 fl. oz. Mel Boracis Oxymel Scillse Confectio Piperis " Scammonii Terebinthinae Use. — It is slightly laxative — chiefly used as a vehicle. Oxymel is the old-fashioned household remedy of honey and vinegar, and is used for colds and sore throats. Cera Flava, U.S.P. and B.P. Yellow Wax. — A peculiar con- crete substance prepared by Apis mellifica, U.S.P. The prepared honeycomb of the hive bee, Apis mellifica, B.P. Characters. — Yellowish, or yellowish-brown, solid, firm, breaking with a granular fracture, having an agreeable honey-like odor. Composition. — Cerin and myricin. Impurities. — Fats, fatty acids, Japan wax, resin, soap, and paraffin. Tests. — U.S.P. If 1 Gm. of wax be boiled for half an hour with 40 Gm. of solution of soda (specific gravity 1*180), the volume being preserved by the occasional addition of water, the wax should separate, on cooling, without rendering the liquid opaque, and no precipitate should be pro- duced in the filtered liquid by hydrochloric acid (absence of fats or fatty acids, Japan wax, resin) ; nor should the same reagent produce a pre- cipitate in water which has been boiled with a portion of the wax (absence of soap). If 5 Gm. of wax be heated in a flask for fifteen minutes, with 25 Gm. of sulphuric acid to 160° C. (320° F.), and the mixture diluted with water, no solid wax-like body should separate (absence of paraffin). B.P. Not unctuous to the touch ; does not melt under 140° (absence of fats) ; yields nothing to cold rectified spirit (absence of resin), but is entirely soluble in oil of turpentine. Boiling water in which it has 924 ANIMAL KINGDOM. been agitated, when cooled, is not rendered blue by iodine (absence of starch). Officinal Preparations. U.S. p. b.p. Ceratuni Resinse. Eniplastrurn Calefaciens. Cantharidis. " Cantharidis. Extracti Cantharidis. " Cerati Saponis. " Sabinae. " Galbani. Unguentum— u pi c i s . Acidi Carbolici. Unguentum Cantharidis. Mezerei. " Hydrargyri Compositum. Oxidi Rubri. Picis Liquidse. Besinse. Sabinse. Terebinthinse. Use. — To give proper consistence to ointments. Cera Alba, TJ.S.P. and B.P. White Wax. — Yellow wax bleached by exposure to moisture, air, and light. Characters. — Hard, nearly white, translucent. Not unctuous to the touch; does not melt under 150°. Officinal Preparations, u.s.p. b.p. Ceratum. Charta Epispastica. Compound Cerates— Suppositoria Acidi Tannici. Ceratum Camphorge. " Hydrargyri. Cetacei. " Morphia?. Plumbi Subacetatis. " Plumbi Composita. Unguentum Aquae Rosae. Unguentum Cetacei. Plumbi Subacetatis Com- positum. Simplex. Use. — In the preparation of the above ointments and supposi- tories. Order HEMIPTERA. Coccus, Cochineal, TJ.S.P. and B.P. — The dried female of Coccus cacti. Mexico and TenerifFe. Characters. — Ovate, plano-convex, about one-fifth of an inch (5 millimetres) long ; wrinkled, of a purplish-gray or purplish-black color ; easily pulverizable, yielding a dark-red powder. Odor faint ; taste slightly bitter. It contains a red coloring matter soluble in water, alcohol, or water of ammonia, slightly soluble in ether, insoluble in fixed and volatile oils. On macerating cochineal in water, the insect swells up, but no insoluble powder should be separated. The grayish-white insect quickly becomes black when warmed before the fire. USES. — It has little medicinal value; it is used to give an attractive color to various liquid preparations. Preparations, b.p. DOSE. Tlnctnra Cocci (2J oz. in 1 pint) Ad lib. Cardamom i Composita Cinch onae Composi ta ANIMAL KINGDOM. 925 Order COLEOPTERA. Cantliaris, TJ.S.P. and B.P. Cantharides. Spanish Flies. — Cantliaris vesicatoria. The beetle, dried. Hungary. Characters. — From eight to ten lines long, furnished with two wing-covers of a shining metallic-green color, under which are two membranous transparent wings ; odor strong and disagreeable ; powder grayish-brown, containing shining green particles. Free from mites. Composition. — Cantharidin, a tasteless, inodorous substance, which may be crystallized from an alcoholic extract. It is insoluble in water and cold alcohol, although it may be extracted from the cantharides by both when in conjunction with the yellow coloring-matter. The other ingredients are unimportant. Peepaeations. u.s.p. Ceratum Cantharidis Ceratum Extracti Cantharidis Charta Cantharidis Collodion cum Cantharide Lininientum Cantharidis Tinctura Cantharidis B.P. • DOSE. Acetum Cantharidis 2 oz. to 1 pint Charta Epispastica Emplastruni Calefaciens 1 part in 24, nearly Eniplastrum Cantharidis 1 part in 3 Liquor Epispasticus 1 oz. to 2£ fl. oz — Tinctura Cantharidis 5£ gr. to 1 fl. oz 5-20 min. Unguentum Cantharidis 1 part to 7, nearly Action. — Externally the preparations of cantharides produce, when applied to the skin, tingling, redness, and vesication ; if the action is prolonged, the vesicles coalesce into a large bleb filled with serum, and if left on too long the true skin becomes irritated, and suppuration, ulceration, and even sloughing occur. Internally the drug causes irritation of the alimentary canal, with a feeling of warmth in the mouth, oesophagus, and stomach, loss of appetite, and (if its use be prolonged, or if a single large dose be given) burning and pain in the stomach (increased by pressure), nausea, vomiting, and diarrhoea (the vomited and ejected matters often being mixed with blood). It affects the kidneys and urinary passages, causing pain in the loins, burning in the bladder and along the urethra, irritation of the glans penis, and sometimes increased sexual appetite. If continued for a long time, it causes great pain in the kidneys, painful erections of the penis, difficulty of micturition or suppression of urine, the latter often contain- ing albumen or blood. The nervous system is usually not affected by small doses, but large doses cause headache and quickened pulse and respiration. Very large doses produce insensibility, paralysis of respiration, and death with asphyxial convulsions. The salivary glands and the back of the throat become so much swollen that swallowing is difficult, and the attempt to swallow may give rise to convulsions, like hydrophobia. 926 ANIMAL KINGDOM. Urinary Organs. — The inflammation caused by cantharides begins in the glomeruli, and not in the straight tubes as is often stated. The first condition of the kidneys noticed after the administration of cantharides is extravasation of leucocytes into the glomeruli and an exudation of a fibrinous matrix ; next, following in order, we notice : — (1) The glomeruli and the proximate tubules are filled with a granular fluid. (2) The cells of the capsule become swollen. (3) Cells of collecting tubes are affected, and become swollen. (4) The cells of the whole urinary tubule become swollen. (5) In the straight collecting tubes the cells become multiplied, and are thrown off, so that the lumen becomes full of exuded cells. Therapeutics. — It is used externally as an irritant and counter- irritant, and internally for its effect on the genito-urinary tract. Externally as irritant — (1) To increase the supply of blood to a part, and hence improve its nutrition, as in chronic ulcers in the leg. (2) To cause disappearance of inflammatory products in chronic inflamed joints and swellings; also in acutely inflamed joints, as in acute rheumatism, in the form of a blister above and below the joint. In chronic rheumatism a large and strong blister should be used. As counter-irritant it is used in pleurisy and pneumonia, and often relieves the pain almost immediately. It is also used in acute inflammation of the heart and pericardium. It is better not to apply the blister directly over the affected part, but a little to one side, since there is a risk of getting the vessels just underneath it congested instead of anaemic. In affections of other serous membranes, as in meningitis, and often in inflammation of the brain itself, the application of a blister is very useful. When applied to the nape of the neck it often relieves giddiness and disturbed cerebral functions dependent on tertiary syphilis, diseases of the ear, or of the semicircular canals. It is occasionally useful to keep up the irritation by means of savine ointment applied to the blistered surface. It is also locally applied to the perineum in inflammation of the prostate, and over the tender region in inflammation of the ovary. Internally, in small doses of 1 or 2 min. of tincture, it checks hematuria ; in larger doses it increases the disease. In Bright's disease, after the acute stage has passed, but a little albumen and blood still remain in the urine, it is very useful in doses of 1-3 min. every three hours. In cystitis, especially where there is inability to retain the urine, and also in ordinary incontinence of urine, it is useful ; though in both cases atropin generally acts better. A drop of tincture three times a day will often relieve chordee. Precautions. — (1) Do not use the blisters on debilitated persons and children; or do not keep them on long, but just sufficient to start the blister, and then, after two or three hours, put on a poultice to make the blister rise. ANIMAL KINGDOM. 927 (2) Be careful of its use both externally and internally in Bright's disease. Treatment in Poisoning". — Evacuate the stomach, give mucilagi- nous drinks to lessen gastro-intestinal irritation, but avoid oils or fats, which increase the solubility of cantharidin and the dangers arising from its absorption. Use opium and sitz baths to relieve the strangury. Class ANNELIDA. B.P. Hiruclo. The Leech. — (1) Sanguisuga medicinalis, the speckled leech ; (2) S. officinalis, the green leech. Collected in Spain, France, Italy, and Hungary. Characters. — Body elongated, two or three inches long, tapering at each end, plano-convex, wrinkled transversely ; back olive green with six rusty-red, longitudinal stripes. (1) Belly greenish-yellow, spotted with black ; (2) belly olive green, not spotted. Action. — At the anterior extremity the leech has a sucking disc, in the middle of which is a triradiate mouth furnished with sharp teeth. Fixing itself to the surface by its disc, it saws through the skin and sucks the blood. This process is facilitated by the power of destroying the coagulability of the blood which the secretion from the pharynx of the leech possesses (Hay craft). This secretion is probably the cause of the ecchymoses which frequently occur at the bites as well as of the persistent haemorrhage they sometimes occasion. Uses. — Leeches may be employed as a substitute for general blood- letting in women and children. They are more generally employed for the purpose of local depletion in inflammation. The irritation occasioned by the bites has probably a certain counter-irritant action (p. 301), but the relief they afford is chiefly due to the depletion. They are useful in bruises, fractures, inflamed joints, meningitis, otitis, ophthalmia, persist- ent headache, laryngitis, pleurisy, pneumonia, pericarditis, hepatitis, orchitis, and haemorrhoids. Application. — Each leech draws on an average about 1J fl. dr. of blood. By applying fomentations afterwards, as much again, or even more, may be withdrawn. Care should be taken that leeches which have been applied to any one suffering from an infective disease should not be used again, lest they convey the virus. When they are to be applied to a mucous membrane, such as the tonsil, they should be put in a leech- glass. This is a small syringe large enough to hold a leech. The head of the animal is introduced first, and the body gently pushed down with a piston. The nozzle of the leech-glass is large enough to allow the head of the animal to protrude, but not to allow the body to follow. Leeches may be applied to the skin by simply confining them to the spot with a pill-box ; or a piece of blotting-paper, with holes in it at the points where we wish the leeches to fix, may be laid on the skin, and the leeches kept over this by a wine-glass or tumbler. It is sometimes difficult to make leeches bite. The skin should be carefully washed, and thoroughly dried and warmed, and, if necessary, shaved. The room should be well ventilated and free from tobacco smoke, and from the fumes of vinegar or disinfectants. Leeches should be dried in a soft, warm cloth and then 928 ANIMAL KINGDOM. applied. If a single one is to be used, the body may simply be held in the cloth, and the head allowed to reach the skin. A slight movement of withdrawal being now made, the leech will probaly fix. Care should be taken not to withdraw it so strongly as to tear it from its hold. When difficulty is still experienced in making the leeches bite, a little warm milk sweetened with sugar may be rubbed over the skin, or a drop of blood extracted from the finger by a needle may be used for the same purpose. Usually leeches fall off when they are full, but if they do not they can be detached by sprinkling salt over them. If it is desirable to encourage the bleeding, warm fomentations, poultices, or cupping-glasses may be employed. The bleeding may be stopped by applying a small piece of absorbent cotton-wool, or of lint rolled into a hard cone and fixed over the bite with a compress and bandage. Cobwebs used in the same manner are very efficacious. If these are insufficient, a piece of absorbent cotton-wool dipped in strong solution of perchloride of iron and dried, or the styptic collodion of the U.S. P. may be applied. When other means fail a pointed stick of nitrate of silver may be pushed into the bite, or the bite may be transfixed with a needle and a silk thread passed in a figure of 8 around it. If possible leeches should not be applied at night, especially to feeble individuals or children, unless the patients are carefully watched, as, if haemorrhage from the bites should occur, it might not be noticed until much blood had been lost. Leeches should not be applied over loose cellular tissue, where pressure cannot be applied. In inflammation of the eyes they should be applied to the temples, and not to the eyelids ; and in inflammation of the testicles to the perineum, and not to the scrotum. As the marks of the bites are permanent, care should be taken to apply leeches, if possible, where the marks will not appear. Thus, in applying them to the temples the hair may be shaved off a spot and the leeches applied. When the hair grows the marks will be hidden. In applying them to the chest in girls they should, if possi- ble, be placed so low down that the marks will not be seen when evening dress is worn. If leeches should get into any mucous cavity, nose, stomach, or rectum, they may be dislodged by the injection of strong brine. INDEXES. 59 GENERAL INDEX. Abdomen, mustard stupes or poultices applied to the lower part of the, act as indirect ern- menagogues, 390 Abernethy, Mr., reference to, 585 Abney and. Festing, reference to, 50 Abortion, emetics to be avoided where a ten- dency to, exists, 328; the twigs of thuja may produce, 886 Abscesses, especially of the liver, caustics em- ployed to open, 306 Absinthe, as a spinal stimulant, 167 ; action of, on the brain of dogs, 172 Absorption and excretion of drugs, diagram illustrative of, 56; effects of rapid or de- layed, 56 Abstracts, 428 Abstractum aconiti, 429, 698 Belladonna, 429 Conii, 429, 786 Digitalis, 429, 844 Hyoscvami, 429, 840 Ignatise, 429, 821 Jalapre, 429, 833 Nucis Vomicae, 429, 821 Podophylli, 429, 704 Senegse, 429, 730 Valerianae, 429, 805 Acetate, test for, 496 Acetate Of aluminium, action of, on enzymes, 86; on bacteria, 96 Ammonia, as a vascular stimulant, 292, 293 Ethyl, 663 Lead, 597 Morphia, 712 Morphine, 712 Potash, 510 Soda, 528 Zinc, 570 Acetic acid, action of, on bacteria, 99, 100 ; of the vapor of, on the general circulation, 177 ; action of, on the mucous membrane, 225; as a vesi- cant, 304; as a caustic, 304; as a poison, with its antidote, 417; properties and uses of, &c, 481; preparations containing, 4S2; glacial dit- to, 482 Acetone, action of, on bacteria, 98, 100 Acetum, 429, 483 Cantharidis, 429, 482, 925 Lobeliee, 429, 814 Opii, 429, 710 Sauguinarise, 429, 726 ScillEe, 429, 482, 890 Acid bath, the, 403 Dilute nitro-hydrochloric, as a hepatic stimu- lant, 351 Ergotinic, 909 Hseinatin, 81 Radicals in metallic salts, general tests for, 496; list of tests for the different acids, 496, 497, 498 Solution of nitrate of mercury, 591 Sphacelinic, 909 Tartrate of potash, 512 Acidity, corrected by antacids, 322 Acids, action of, on the secretion of the mucous membranes, 225, 226; as stimulating expecto- rants, 227 ; action of dilute on the frog's heart, 270; on the capillaries, 282 ; as caustics, 304 ; as astringents, 308: as styptics, 309; as siala- gogues, 314 ; as artificial digestive substances, 321 ; action of, as irritant poisons, 346 ; strong, may produce death weeks after they have been swallowed, 347; as antihydrotics, 381; as poisons, with their antidotes, 417 ; general characters and properties of, 472-474 ; general action of, on the tissues, 475 ; on the skin, 475; in the mouth, 475; in the stomach, 476; on the bile and liver, 476 ; treatment of poisoning by, 478 Acids, mineral, action of, on albumen, 68 ; on protoplasm, 71; on infusoria, 75; as siala- gogues, 314 Acids, physiological action of — Arsenic, 51 Bromic, 51 Hydriodic, 51 Hydrochloric, 51 Iodic, 51 Phosphoric, 51 Selenic, 51 Sulphuric, 51 Acids, preparation, properties, action, and uses of— Acetic, 473, 481 Glacial, 473, 482 Arsenious, 474 Benzoic, 474 Boracic or boric, 473, 486 Carbolic, 474 Carbonic, 473, 487 Chromic, 486 Citric, 473, 485 Dilute hyd robromic, 473, 474, 493 Hvdrocvanic, 473, 489 Phosphoric, 474, 483 Gallic, 474, 877 Hydrochloric, or muriatic, 473, 479 Lactic, 493 Nitric, 473, 480 Nitro-hydrochloric, 481 Dilute, 481 Oleic. 474, 494 Oxalic, 474, 485 Phosphoric, 483 Salicylic, 474 Sulphuric, 474, 477 Aromatic, 478 Dilute, 478 Sulphurous, 474, 478 Tannic, 474, 875 Tartaric, 473, 484 Vinegar, 483 Acidum Aceticum, 482 Dilutum, 482 Glaciale, 482 Benzoicum, 817 Gallicum, 875 Hydrochloricum Dilutum, 479 Hydrocyanicum Dilutum, 577 Nitricum Dilutum, 480 Nitro-hydrochloricum, 479 Dilutum, 479, 480 Phosphoricum, 483 Sulphuricuin aromaticum, 478, 861 Dilutum, 478 Tannicum, 875 Tartaricum, 511 Aconite leaves, 697 ; and root, 697 (931) 932 GENERAL INDEX. Aconitia or Aconitine, action of, on oxidation ; 79; effects of, on muscle, 146; as a sedative, 146; as an anodyne, 183, 184; action of, on the respiratory centre, 209,215; on the vagus roots, 260;" on the vagus centre, 279; on the heart, 300; Einger's mode of using, 300; as a poison, with its antidote, 418; antagonism of, to other drugs, 422-425; preparation, char- acters and tests of, 698; general action of, in frogs, 699; in man, 699; on the heart, 699; action of, on individual organs, 699; on the muscles, motor and sensory nerves, 699; on the spinal cord, brain, and vaso-motor centre, 700; on the heart and respiration, 700; on the temperature, the stomach, and the secretion of the salivary gland, 700; on the pupil of the eye and the tissue-, 700; thera- peutic use of, locally, 701 ; for the stomach, in lebnle conditions, "in cardiac dis-ease, and on the nervous system, 701; mode of application, 701 Aconitum, properties, composition, and prepara- tions of, 697 Actual cautery, as a styptic, 309 Adeps benzoatus, 817, 919 Benzoiuatus, 817, 919 Adonidin, as a cardiac tonic, 294 Adonis vernalis, as a cardiac tonic, 294; as a re- frigerant diuretic, 374; composition, action, and use of, 703 Aeby, reference to, 128 iEther purus, 661 Agaricus albus, as an antihydrotic, 381 Ague, utility of quinine in, 33; produced by the bacillus malaria?, 103 ; importance of emetics and purgatives in aiding the action of anti- periodics in the cure of, 108, 109; value of emetics in, before the administration of qui- nine, 327; sometimes cured by emetics alone, without quinine, 327 ; action of opium in, 725 ; brought on by strychnine, 824 Air baths, 404 Air passages, value of emetics in removing ob- structions from the, 327 Albertoni, reference to, 171 Albumen, nature of, and action of drugs on, 68; effects of acids and organic alkaloids on, 69 ; action of quinine on, 799 ; test solution of, 920 ; albumen of eggs, 920 Albuminous solutions, action of alcohol on, 6. Albuminuria, action of drugs on, 375 ; how far caused in apparently healthy persons by mer- curials, 565 Alehemilla. action of, on the bladder, 384 Alcohol, effects of, on the blood, 82; change un- dergone by, when boiled with sulphuric acid, 82; action'of, on enzymes, 86 ; on bacteria, 96, 98, 100 ; appears to arrest the action of zymotic diseases, 105 ; and preserves animal matter, 105 ; action of, on medusae, 112 ; on annulosa, 115; on muscles, 124-144 ; on the brain of the lower animals, 172; on psychical processes, 175; a typical stimulant on" the action of the brain, 178; different action of, in different doses, on the brain, 178 : has both stimulant and narcotic action on the brain, 182; as an antispasmodic, 191: action of, on frogs, 196; on the respiratory centre, 215; on the vaso-motor centre, 251 ; on the motor ganglia, 280 ; as a cardiac stimulant, 291 : as a vascular stimulant, 292 ; as a rubefa- cient, 304 : as an astringent, 308; as a local seda- tive, 328; as an antipyretic, 364; as a stimulant diuretic, 373 ; as an aphrodisiac, 388 ; as a poison, with its antidote, 418; antagonism of, to strych- nine, 122- 125 Alcohol, 657 Absolute, 657 Amylic, 659 Diluted, 658 Proof spirit. 658 tified spirit, 658 Red wine. 659 Sherry, 658 Spirit of French wine, White wine, 658; stronger, 659 Alcohol, ethyl, 'general source and preparation of, 649; Impurities and teste of, 649,650; general action of, 650 ; on albuminous solutions, 650; on the skin, mouth, stomach, intestine, and blood, 650 ; and tissues, 650 ; dispute as to whether it can be regarded as a food, 650; its action on the circulation and temperature, 651 ; on the nervous system, 652; and cranial circulation, 652; on the nervous tissues, on the judgment and emotions, 652 ; on the motor centres, the the speech, and the cerebellum, 652; on the spinal cord, the respiratory centre, the vaso- motor centre, and the heart, 652, 653; impor- tance of a proper diagnosis of drunkenness from effects of opium and apoplexy, 653 ; effect of impurities on the action of, 653; effect3 of chronic poisoning by, 653; on the bowels, skin, liver, kidneys, and nervous system, 653, 654; nature and effects of delirium tremens, 654; and treatment of, 654; causes of chronic alco- holism, 654; uses of, 655; its weakness as a stimulant compared with beef tea, 656 ; action of, as a stimulant, 656 ; and on the urine, 657 Alcohol, methyl, preparation, characters, and uses of, 649 Alcoholism, causes of chronic, 654 Alcohols, list of the principal, with their respec- tive toxic powers, 647-649; action of, on the general system, 648, 649 Aldehydes/properties, action, and uses of— ethyl aldehyde, 660; and paraldehyde, 660 Alder, black, 754 Ale, intoxicating effects of a single glass of, when sucked through a stiaw, 178 Algae, 912 Alimentary canal, action of drugs on the, 310 ; of quinine on the, 801 ; of sulphate of strychnine on the, 823 ; of tobacco, 843 ; of extract of ergot, 911 Alkalies, action of, on protoplasm, 71 ; on infuso- ria, 75 ; on muscles, 130 et seq.; on the secre- tions of mucus from the trachea, 224; on the amount and nature of moist rales in the lungs, 225; as stimulating expectorants, 227; dilute, on the frog's heart, 270 ; on the capillaries, 282 ; as caustics, 304; as sialagogues, 314; arrest secretion of saliva, 318; dilute, increase the action of the gastric juice, 320; strong, may produce death weeks after it has been swal- lowed, 347; as poisons, with their antidotes, 417-421 Alkalies, metals cf the, 498; (1) alkaline salts, general characters and reactions of the, 499 ; physiological action, 499; and general action, 499 ; on the skin, as caustics, rubefacients, and vesicants, 499,500; in the mouth, 500; in the stomach, 500; on the gastric juice, 501 : as anti- dotes in poisoning by acids, metals, and alka- loids, 501; their action on the blood, 501; as alteratives, diuretics, and antacids, 501, 502; (2) general action of the group of chlorides, 502; on the stomach and other parts oi the body, 502, 503 ; (3) general action of the sub-group of sulphates, 504 ; comparative action oi the alka- line metals, 504 Alkaline hath, 403 Bromides, as antispasmodics, 195 Hsematin, 81 Sulphur ointment, constituents of, 462 Alkaloids, action of, on the general system, 50, I | on albumen, 69 ; onprotoplasni, 71 ; on bacte- ria, 93; formed by putrefaction ,103; Albertoni 'a investigations as to the action of the coto, 337 ; objection to the extremely small doses of, required to produce marked physiological action, 122; antagonistic action of certain, to morphine, 421, 425; nature and action of, 429; and of opium, 721 Alkaloids, cinchona, and their salts, 799; of opium, action of the, 721 Allspice and oil, as carminatives, 330 Oil of, 779 All yl alcohol, action of, on bacteria, 100 ; extra- ordinary enecj of, 105 ; vide also 889 Almond, bitter, 775 Oil of, 776 Oil, as a demulcent, :;07 ; nature of, 776 Oil of, expressed, 776 Aloes, as a purgative, 839; as a cholagogue, 340 GENERAL INDEX. 933 Aloes, as a hepatic stimulant, 531 ; characters, pre- parations containing, and composition of, 890-892 Barhadoes, 892 ; action of, in the mouth, the intestines, and the rectum, 893 ; on the bile and the uterus, 893; as an aphrodisiac and a purgative, 893 Aloes, Purificata, 891 Purified, 892 Socotrine, 890 Aloin, nature and action of, 891 Alteratives, nature of, 35S ; list of the principal, 358 ; action of, 35S-361 ; uses of, 361 ; alkalies as, 501 ; lappa as, 813 ; solanine as, 835 ; rumex as, 859 ; Phytolacca root as, 859 ; stillingia as, 867 ; sarsaparilla as, 889 Althaea (rnarshmallow), characters, composition, and uses of, 736 ; a useful demulcent, 736 Alum, action of, on bacteria, 98 ; on the mucous membranes, 308 ; as a caustic, 304; as an astrin- gent, 308; as a styptic, 809; as a local emetic, 326 ; as a local sedative, 328 ; as a vermicide, 355 ; action of, on the skin, 556 ; as an astrin- gent, 556 ; as a styptic, 556 ; a caustic, and an emetic, 556 ; properties, action, and uses of, 555- 557 ; of dried, ditto, 557 Aluminium, symbol and atomic weight of, 35; physiological action of, 51; action of, on the mouth and stomach, 475, 476 ; general sources, reactions, &c., of the salts of, 555 ; hydrate of, 557 ; sulphate of, 558 Amanita muscaria, as an antihydrotic, 381 Amber, oil of, action and uses of, S84 American cannabis, 879, 880 Wormseed. See Chenopodium Ammonia, nature of, and changes it undergoes, 41 ; physiological action of, 51 ; action of, on bacteria, 98 ; on the muscles, 124 et seq. ; as a spinal stimulant, 167 ; stimulating effects of the vapor of strong, and of carbonate of, on the gene- ral circulation, 177 ; action of, on the ear, 205 ; on the respiratory centre, 214 ; and movements, 218 ; of strong liquor of, on the secretion of the mucous membranes, 225 ; as a stimulating ex- pectorant, 227 ; carbonate of, as an emetic in chronic bronchitis, 22S ; action of, on the vagus centre, 279 ; on the accelerating centre, 279 ; action of salts of, on the vaso-motor centre, 279 ; as a cardiac stimulant, 291, 292 ; as a rubefacient, 304 ; aromatic spirit of, as a direct antacid, 322 ; action of, on the uterus, 391 ; va- por of, as a poison, with its antidote, 416 Ammonia, character, action, and uses of— Acetate of, 544 Aromatic spirit of, 543 Bromide of, 544 Benzoate of, 545 Carbonate of, 542 Chloride of, 540 Citrate of, 544 Iodide of, 545 Kitrate of, 545 Phosphate of, 544 Solution of, 545 Solution of acetate of, 544 Solution of citrate of, 544 Spirit of, 542 Strong solution of, 541 Sulphate of, 545 Sulphide of, 546 Valerianate of, 545 Water of, 542 ; stronger, 541 Ammoniac, 7S8 Ammoniacum, as an antispasmodic, 195 ; charac- ters and uses of, 788 Ammoniae benzoas, 817 Phosphas, 541 Ammoniated mercury, 590 Amnion ii benzoas, 817 lodidum, 470 Ammonio-ferric sulphate, or amnionio-ferric alum, 637 Ammonium, sulphate of iron and, 637 Benzoate, as a hepatic stimulant, 351 Bromide, action of, on the spinal cord, 159 Carbonate, as a cardiac stimulant, 291; as a direct antacid, 322 ; as a local emetic, 326 Ammonium — Chloride, action of, on bacteria, 9S ; on mus- cle, 125 et seq. ; on the ear, 205 ; as a stimu- lating expectorant, 227 ; antagonism of, to chloral, 334-337 ; character, action, and uses of, 540 ; on the liver, 540 Salts, characteristics of, 536 ; sources, reac- tions, and preparations of, 537 ; impurities , tests, and actions of, 539 ; figure showing the paralyzing action of ammonium sul- phate on muscle, 539 Sulphide, action of, on bacteria, 99 Amoeba?, nature of, action of drugs on, and method of experimenting on, 70 et seq. ; an, figured at two different periods during move- ment, 83 ; struggle for life between the, and ba- cilli, 92 ; the protoplasm of, contracts in any di- rection, 116; anaesthetics act as poisons to, 187 Amphioxus, mechanism of respiration in the, 207 ; diagram of an, 208 Amyl nitris, 660 Amyl, nitrite of, use of, in diminishing tension and removing pain in angina pectoris, 34; dif- ference of action of, in different animals, 66 ; blood treated with, and alcohol, SI ; action of, on medusse, 90 ; on psychical processes, 175 ; on the dog and rabbit, 252 ; as a poison, with its antidote, 420; antagonism of, to strychnine, 422-125; preparation, characters, and tests of, 664, 665; physiological action of, 665; on the blood, blood-pressure, respiration, and pulse, 665 ; on the muscles and motor nerves, 666 ; on the ner- vous system and urine, 666 ; uses of, 666 ; as a remedy in spasmodic conditions, 667 ; in angina pectoris, headache, &c, 666, 667 ; pulse-tracings illustrative of the action of, in angina pectoris, 666, 667 ; considerations regarding the admin- istration of, 667 Amylum iodatum, 904 Ainyridaceae, 756 Anacardiae, 754 Anaemia, causes functional inactivity of the cerebro-spinal system, 179; loss of albumen through the kidneys, and deficiency of fatty food cause, 358; a deficiency of iron in the blood in, 358 Anaesthesia, various modes of inducing, 1S6, 187 ; may be caused by the direct action of drugs on the nerve cells, 187 ; dangers arising from the efforts to induce, 189; action of, and mode of using in animals, 190, 191 ; history of the dis- covery of, 192 Anaesthetics, nature and uses of, 146, 185 ; action of, on the motor centres of the brain, 172 ; dif- ference between anodynes and, 185; divided into local and general, 186; chief local and general, 186; usual action of general anaesthet- ics, 186-188; the action of, divided into four stages— the stimulant, 188; the narcotic, 188; the anaesthetic, 188 ; and the paralytic stage, 188; uses of, 189 ; dangers of, 189, 190 ; mode of administering, 190 ; action of on, and mode of using in, animals, 191 ; history of the discovery of the uses of, 192 ; action of, on the eye, 198 ; may obstruct respiration, 212 ; fallacies from, in ascertaining the action of drugs on the circu- lation, 235 ; action of, on the motor ganglia, 280 ; as poisons, with their antidotes, 417 ; iodide of ethyl as an anaesthetic, 669 ; iodoform as, 682, 683; erythroxylon and cocaine as, 732 Analgesics. 'See Anodynes Anaphrodisiacs, nature and action of, 3S6-390; diagram illustrating the action of, 387 ; general considerations regarding, 388, 3S9; camphor as an, 863 Anemonin, 702 Aneurism, emetics to be avoided in persons suf- fering from, 328 Angina pectoris, 34; nitrite of ainyl diminishes tension and removes pain in, 34 Aniline red, 695 Sulphate, action of, on the cardiac muscle, 2S1 Animal charcoal, 460 ; purified. 460 Animal Kingdom, 913-92S ; class mammalia, order rodentia, 913; order ruminantia, 913; order pachydermata, 91S; order cetaceae, 919; class 934 GENERAL IXDEX. aves, order gallinje, 920 ; class pisces, order sturiones, 920 ; order teleostese, family gadida?, 921 ; class insecta, order hynienoptera, 922 ; order heiniptera, 924; order coleoptera, 925; class annelida, 927 Animals, utility of, for experiments in medicine, 65, 67 Anise, character of, 7S9 ; oil of, 705, 7S9 ; as a car- minative, 7S9 Anise and oil, as carminatives, 330 Annelida. 927 Annulosa, action of drugs on, 115, 116 Anodynes, two classes ot local and general, 183; nature, action, and uses of, 183, 184 ; adjuncts to, 184, 185 Antacids, nature and action of, 322; divided into direct and indirect, or remote, 322; action of alkalies as, 501 ; slaked lime as an antacid, 551 Antagonistic action of drugs, 422-425 Anthelmintics, nature of, 355; divided into two kinds, 355; list of the chief, 355; adjuncts to, 355: uses of, 355; benzine as an, 646; azeda- raeh as, 747 ; pomegranate root hark as, 782 ; pumpkin seed as, 785 ; bryonia as, 785 ; worm- wood as, 807 ; tansy as, 807 ; santonin as, SOS ; spigelia as an, 828; oleum chenopodii as, 859; kamala as, 870; oil of turpentine as, S84; thuja as, 8S6 ; areca nut as, 903 : male fern as, 907 Anthrax, produced by the bacillus anthracis, 103 Anthrax bacilli. See Bacilli Antiarine, action of, on mollusca, 114 ; on the frog's heart, 271 ; on the cardiac muscle, 281 ; as a cardiac tonic, 294 Antidotes, alkalies serviceable as, in poisoning by acids, metals, and alkaloids, 501 Antidotes, nature and action of, 416 ; list of the more common poisons, with their antidotes, 416-421 Antidysenteric, ipecacuanha as an, 804 Antihydrotics, or anhydrotics, nature, action, and uses of, 381-383; on the sweat glands, 3S1 ; on the secreting cells and nerves, 381 ; on the sweat centres and on the circulation, 381 ; dia- gram illustrating the action of, 381 Antimonial preparations are depressant expec- torants. 227 Antimonii et pota?sii tartras, 617 Oxidum, 617. 619 Sulphidum, 617 Purificatum, 617 Sulphuratum, 617 Antimonium nigrum, 617 Sulphuratum, 617, 618 Tartaratum, 511, 617 Antimony, symbol and atomic weight of, 35; its relations to other members of a group, 42; causes sickness, 50; action of, on muscle, 125 el seq.; of large doses of, on the lungs, 213; on the motor ganglia, 280; on the vaso-motor nerve-, 281 ; tartarated, as a pustulant, 304; as a caustic, 304 ; destroys the glycogenic function of t lie liver, 350; has a special action on tissue change, 360; in poisoning by, action of, on the urine, 360; employed in diseases of the respira- tory organs, 361 ; as a poison, with its antidote. U8 ; general sources and reactions of , 613 ; ac- tion of, on the skin and stomach, 613; effects of poisoning from, 613 ; and mode of treatment, 613 : account of the dispute that has arisen re- garding the mode in which tartar emetic causes vomiting, 61 1 ■. action of, on the heart of a frog, 615; on the circulation, blood-pressure, and temperature, 615; on the respiration, spinal cord, motor ami sensory nerves and muscles, 615; produces Gattj degeneration of various us, 615; rapidity of its action on the skin of frogs, 615: diagram of vertical section i epidermis ol a frog poisoned by, 616: how eliminated, 616; usee of, 616 ; as an emetic, 616; how tolerance of t he drug is produced, 59, 616 ; oauseant, 616; a- an expectorant, 617: as a diaphoretic, 617; preparations containing, 617 Antimony, properties, action, and uses of— Black, 617 de oi, 619 Purified sulphide of, 617 Antimony — Solution of chloride of, 619 Sulphurated, 618 Tartarated, 620 Tartrate of, and potassium, 620 • Antineuralgic, peppermint camphor as an, 853 Antiperiodics, list of the chief, 108; their action, uses, and adjuncts, 109; emetics and purgatives aid the action of, 109; they rarely succeed without them if the functions of the liver are disturbed, 109 ; lemon juice as a powerful, 740; quinine as, 801 ; sulphate of beberia as, S65 Antipyretics, or febriluges, divided into two great classes, 362 ; their nature, 361 ; action, 362 ; and uses, 363; aromatic series as antipyretics, 687 ; resorcin as, 692; chinoline as, 695": kairin as, 695 ; quinine as, 801, 802 ; oil of gaultheria as, 816 ; salicin as, 873 Antipyrin, characters, 695; action of, in reducing temperature, causing profuse perspiration, and slightly increasing the blood-pressure, 696; uses of, in febrile diseases generally, 696 Antiscorbutic, lemon juice as an, 740 Antiseptic, what is required in an, 94 Antiseptics, nature and action of, 105 ; uses of, 106-108 ; externally, 106 ; internally, 107 ; chlo- ral hydrate as an antiseptic, 670 ; iodoform as, 682; the aromatic series of the carbon com- pounds as, 687 ; naphthalin as, 694 ; chinoline as, 695; cheken as, 779: oil of myrtle as, 780; oil of eucalyptus as, 781 ; quinine'as, 799 ; ben- zoic acid as, 817 ; peppermint camphor as, 853; thymol as, ^55; garlic as, 889 Antisialics, nature and action of, 318, 319 Antispasmodics, nature, action, and uses of, 193- 195 ; action of, and list of, general, 194, 195 ; ad- juvants to, 194; acetic ether as an antispas- modic, 664 ; iodide of ethyl as, 669 ; caulophyllum as. 708; oil of rue as, 747 ; oil of cajuput as, 780 ; valerian as, 806; oil of stramonium leaves as, 842 ; asafcetida as, 788 ; cypripedium as, 900 Antizymotics, nature and action of, 105 Aortic regurgitation. See Regurgitation, aortic Aortic stenosis. See Stenosis, aortic Apetake, 857 Aphrodisiacs, nature and action of,386-3S9; dia- gram illustrating the action of, 387 Apncea, nature and cause of, 211-215 Apocynaceas, 828 Apocynum, characters and action of, 828: as a laxative, a cardiac tonic, and a diuretic, 828 Apomorphia, action of, on the cerebellum, 196; may lead to obstruction of the bronchi, 213; action of, on the respiratory centre, 215: on the mu- cous membraues, 226 ; caution required in the administration of, in catarrhal conditions, 22G ; as a depressant expectorant, 227; effect of, on the frog's heart, 271; on the cardiac muscle, 281 : as a general emetic, 326 Apomorphina, 429 Apomorphine, hydrochlorate of. See Hydro- chlorate of apomorphine Apoplexy, diagnosis between opium poisoning, intoxication, and, 717 Apples, stewed, as a laxative, 339 Aqua Ammonia, 291 Ammonia;, 4:'>l Fortior, 431 Amygdalae amarse, 431, 776 Anethi, 431, 790 Anisi, 431, 790 Aurant ii Boris, 431 Au rantii florum, 431, 737 Camphorse, 131, 862, 863 Carui, 431, 791 Chlori, 131 Chloroformi, 431 Cinnamonii, i:;i, 862 Cinnamonii, 131 Creasnti, 131, 691 Destillata, 131 lo nindi, 131, 789 Laurocerasi, 131, 777 Mentha piperita'. 131, 853 Mentha? viridis, 431, 854 Pimentse, 131, 779 Rose, 131,772 GENERAL INDEX. 935 Aqua— Sambuci, 431, 793 Aqueous solution of ferric nitrate of iron, 636 Aquifoliacese, 754 Arbutin, as an astringent, 308 ; action of, on the kidneys, 376 Areca nut, as a vermicide, 355 ; nature of, 903 Argenti oxidum, 577 Argenturu. See Silver Iodidum, 577 AristolochiaceaB, 865 Arnica, as a rubefacient, 304 Camphor, action of, on the cardiac muscle, 281 Flowers, characters, action, and uses of, 881; root, 8S1 Arnstein, reference to, 277rc. Arseniate of iron, 638 Arseniate of soda, and of sodium— properties, ac- tion, and uses of, 612 Arsenic, symbol and atomic weight of, 35 ; effect of habit in eating, 58 ; use of a small dose of, for gastric neuralgia, 58 ; action of, on bacteria, 9S ; as an antiperiodic is sometimes more powerful than quinine, 109 ; action of, on muscle, 124 et seq. ; on the ends of the vaso-motor nerves, 249 ; on the motor ganglia, 280 ; on the vaso-motor nerves, 281 ; almost tasteless as a poison, 346 ; secondary effects of, as a poison, 347 ; destroys the glycogenic function of the liver, 350 ; as an alterative, 358 ; has a special action on tissue changes, 360 ; in poisoning by, action of, on the urine, 360 ; used in nervous debility, 361 ; in diseases of the skin, 361 ; in some chronic con- ditions of the respiratory organs, 361 ; as a poison, with its antidote, 418 ; character and general sources, 605; action of, on the skin, mouth, stomach, and nervous system, 606; treatment in cases of poisoning by, 606 ; how chronic poisoning by, may occur, 606 ; how the system may become habituated to it, as seen in the arsenic eaters of Styria, 607 ; action of, on the blood, pulse, and heart, 607; on the blood- pressure in animals, 607 ; causes paralysis, 607 ; peculiarity of its action on the skin, 608 ; dia- grams illustrating the epidermis of a frog be- fore and after poisoning by, 608 ; uses of, in various diseases, 608, 609 ; diagram of section of lung of a guinea-pig poisoned by arsenious acid, 60S ; probable mode of action of, in phthisis, 609, 610 ; mode of administration of, 610 Arsenic acid, physiological action of, 51 ; effects of, on the blood, 82 ; iodide of, nature and use of, 612 ; solution of, and mercury, 612 Arsenici iodidum, 470 Arsenious acid, effects of, on the blood, 82 ; as a local sedative (in minute doses), 382; properties, preparations, and uses of, 611 Arsenious oxide, as a caustic, 304 Arteries, nature and functions of, 229; blood only available for the nutrition of cells while in the, 229 ; action of the pressure of the, on the circulation of the blood, 229 ; action of the heart on the, 230 ; effect of an upright and of a horizontal position on the circulation of the blood in the, 230 ; arrest of circulation in the, cause of fainting and shock, 230, 231 ; schema of the circulation from the heart to the veins and the, 232, 233 ; action of blood-pressure on the, 234; method of ascertaining the blood- pressure in the, 234-237 ; causes of alterations in blood-pressure of the, 237; how it may be raised and lowered, 237 ; relation of blood- pressure to pulse rate and the, 237-241 ; effect of the, on pulse curves, 240-242 ; investigation of the action of drugs on the, 243-246 ; another method of ascertaining this, 246-248 Arterioles, action of the, on the blood-pressure, 229; effects of rapid dilatation of the, 230; schema of the circulation in the, 232, 233 ; circu- lation in the, in the living body, 233; bLod- pressure in the, and method of ascertaining it, 234-237 ; diagram of the apparatus employed in this, 235 ; alterations in blood-pressure in the, 236 ; relation of pulse rate and the, to blood- pressure, 237-240 ; diagrams illustrative of this, 238-242 ; effect of the, on pulse curves, 240-242 ; investigation of the action of drugs on the, 243- 248 ; two modes of estimating the contraction of the, 243 ; the method of direct observation, 243; the method of measurement by rate of flow, 246 ; mode of ascertaining whether a rise or fall in blood-pressure is due to the heart or to the, 258 ; action of digitalm on the, 846 Artocarpese, 879 Asafcetida, as an antispasmodic, 194, 195 ; as a carminative, 330 ; characters and uses of, 7S7 ; as an antispasmodic, carminative and expecto- rant, 788 Asarum Europseurn or asarabacca, action of, in- ternally, 866 Ascidians, action of drugs on, 114; diagram of an ascidian, 208 Asclepiadacese, 828 Asclepias, characters and use of, 828 ; as a dia- phoretic, or expectorant, 829 Asparagus, as a stimulant diuretic, 374 Asphyxial blood, stimulating effects of, on the medulla, 262 Aspidospermine, as a depressant expectorant, 227 Astringents, action of. on the mucous mem- branes, 226 ; sulphate' of copper as an astrin- gent, 304, 573; nature, action, audusesof, 308, 309, slaked lime as an astringent, 550 ; alum as, 556 ; salts of zinc as, 568 ; geranium as, 730; rhatany root as, 731 ; prinosas, 754; rhus glabra (sumach) as, 755 ; myrrh as, 756 ; kino as, 759 ; logwood as, 765 ; catechu as, 770 ; rubus or blackberry as, 771 ; pale catechu as, 804 ; bearberry as, 815 ; chimaphila as, 815 ; saliva as, S56 ; rhubarb as, 858 ; rumex as, 859 ; oil of cinnamon as, 862 ; the bark of quercus alba as, 875 ; galls or nut- galls as, 875 ; elm bark as, 878 Atheroma, emetics to be avoided in persons suf- fering from, 328 Atomic weight of the elements, 35, 36, 37 ; ar- rangement according to, 42 Atonic dyspepsia, slight stimulants produce ap- petite in, 319 Atropacea?, 835 Atropia, 429-837 Atropia, preparation and characters of— Liquor, 836 Sulphas, 837 Sulphate of, 837 Sulphatis, liquor, 837 Unguentum, 837 Atropina, 429 Atropine, physiological action of, on the motor or efferent nerves, 4S , effect of large and small quantities of, on the pulse, 54; action of, on oxidation, 79; on rnecb-sse, 112; on annulosa, 116 ; on muscles, 134, 135, 144, 146 ; as a sedative, 146 ; action of, on the spinal cord, 150, 158, 160; on the brain of the lower animals, 172 ; as a local and general anodyne, 183, 184, as a mydriatic, 196-198 ; action of, on the respira- tory centre, 215 ; on the vagus, 218 ; when injected into the jugular vein, 219 ; has a slight and uncertain action on the respiratory centre, 223 ; but a powerful effect in completely arrest- ing the secretion from the bronchial tubes, 223 ; cases in which it is useful as a pulmonary seda- tive when combined with apomorphine, 223; diagram of pulse and blood-pressure curve caused by the actions of, on the heart, 23S ; on the vessels of circulation, 247 ; destroys the in- hibitory action of the vagus on the heart in dogs and rabbits, 252 ; acts on the heart through the vagus roots, 261 ; might be useful in lessen- ing pain or palpitation of the heart in persons with high blood-pressure, 263 ; with muscarine, restores the pulsations in the heart-apex of the frog, 270 ; rapid action of, on the heart of the frog, 273 ; on the inhibitory power of the vagi, 274, 275 ; neutralizes the action of muscarine on the heart, 277 ; action of, on the vagus-cen- tre, 279 ; on the vaso-motor centre, 279 ; as a cardiac stimulant, 291 ; effect of, on the secre- ting cells of a gland, 313 ; the most powerful of all antisialics, 318 ; paralyzing action of, coun- teracted by physostigmine, 318 ; as alocal seda- tive, 32S ; action of, on the intestines, 333 ; as 936 GENERAL IXDEX. an antihydrotic, 3S1; strong solutions of, ap- plied to the conjunctiva, 409 ; as a poison, with its antidote, 418 ; antagonistic action of, to other drugs, 422-425; general action of bella- donna or, in large and small doses, S37 ; special action of, locally applied, S37; on the brain, the spinal cord," and the motor nerves, 837 ; on the muscles, the eye, and the circula- tion, 838; on the urine, 839 ; on the intestines in large and small doses, 839 ; and on the tem- perature, 839 ; certain animals unsusceptible to the action of, S39 ; uses of, 839 ; as an anti- dote to opium, 840 Aurantiacese, 737 Auricular septum, view of the, in the frog, 264 Aves, 920 Azedarach, nature and use of, 746; chiefly as an anthelmintic, 747 B. Bacilli, action of drugs on particular species of, 97 , mode of experimenting on the action of drugs on reproduction of, 97 ; power of the spores of Anthrax bacilli to resist certain sub- stances usually fatal to life, 99 ; action of drugs on the development and growth of, 99. See also Bacteria Bacillus anthracis, nature and action of, 609 The lactic ferment a, 86 ; treatment for de- stroying the tubercle bacillus, 453 Bacillus tuberculosis, difference between the action of, and that of Bacillus anthracis, 609 Bacteria killed by creasote, 87 ; origin and nature of, 88; diagram of the different kinds of, 89, 90; diseases caused by, 91 ; importance of a knowl- edge of, in relation to disease, 91 ; divided by Pasteur into two classes, 91 ; lite history of, 91, 92 ; struggle for existence between the different species of, 91, 92 ; action of drugs on the move- ments of, 93 ; and on the reproduction of, in general, 93; the most destructive substances to, 93; mode of experimenting to test the effects of drugs in destroying the germs of, 94; compara- tive action of different drugs on, 95, 96 ; action of drugs on particular species of, 97 ; mode of experimenting on the action of drugs on the reproduction of, 97 ; results of Koch's experi- ments on, with three groups of disinfectants, 98, 99 ; action of drugs on the development and growth of, 99 ; table showing the strength of various disinfectants required to prevent the development of, 100: influence of temperature on the action of antiseptics on, 101 ; alterations in, by heat and soil. 101; possible identity of different forms of, 102 ; may be modified by cultivation, 102 ; action of, and their products on the animal body, 103; list of diseases caused by, 103; effect of drugs on the action of, in the animal body, 104; decomposition of food in the mouth due to, 310; action of salicylic acid on, 693 Bael fruit, beneficial action of, in dysentery, 337 ; characters, composition, and uses of, 741 " Baker, Morrant, reference to, 720». Balm. See Melissa Balsam, Canada. 882 Of Copaiva, 768 Fir 882 . as a stimulant expectorant, 227 ; na- ture, action, and uses of, 759, 760 Tolu, as an expectorant, 227, 760 Baptisin, as a hepatic stimulant 351, 353 Barbaloin, nature and action of, 89] Barium, symbol and atomic weight of, 35; its relal ion to other members of a group. 12 ; physi- ological action of, ">1 : salts of, action of, on muscles, 126, 131, 132.137; cause- contraction of the vessels, 246; action of, on the heart of the frog, 271; salt- of, action of, on the cardiac muscle, 281; and on the capillaries, 282; an- tagonism of. to other drugs, 422 125 Barium chloride, action of, on bacteria, 98 J'.ark. Angostura, 7J7 Bebeeru, 866 Bark— Calisaya, 794 Canella alba, 744 Casca, 771 Cascarilla, 866 Cinchona, Pale, 794 Bed, 795 Yellow, 794 Cinnamon, 861 Coto, 862 Cotton root, 734 Elm, 87S Larch, 885 Oak, S74 Pale cinchona, 794 Paracoto, 862 Pomegranate root, 782 Quebracho, White, 828 Bed cinchona, 795 Sassy, 771 Soap, 774 "White quebracho, 828 Yellow cinchona, 794 Barley, pearl, 904 Baryta salts, as a poison, with its antidote, 418 Basham's mixture, 633 Baths, cold, as anaphrodisiacs, 389 ; hot foot, hip, and mustard, as indirect emmenagogues, 390 ; may be either local or general, 395 ; three chief kinds, 395, 396; the cold bath, 396, 398; the cold pack, 398 ; cold sponging, 398 ; cold douche, 399; the spinal douche, 399; the ascending douche, 399 ; sitz bath, 399, 400 ; cold foot bath, 400 ; cold compresses, 400 ; tepid baths, 401 ; warm baths, 401 ; hot baths, 401 ; hot foot bath, 402 ; hot sitz baths, 402 ; poultices, 402 ; medicated baths, 403 ; sea bathing, 403 ; acid bath, 403; alkaline bath, 403 ; sulphurous bath, 403; mustard bath, 403 ; pine bath, 404; vapor baths, 404; calomel fumigation, 404; air baths, 404; the Turkish bath, 404; friction and in- unction, 405-407 ; carbonic acid baths, 4S7 Bat's wing, Luchsinger's experiment with a, 133 Baxt, reference to, 718 Baxter, B., references to, 72n. Beads, jumble, 716 Praver, 760 Bean of" St. Ignatius, 821 Bearberry, and bearberry leaves, 814 Beaumont, Dr., references to his observations on the case of Alexis St. Martin, 321, 354 Bebeerin, action of, on bacteria, 93; as an anti- periodic, 108 Bebeeru bark, as an antiperiodic, 10S ; characters and composition of, 865 Beberia, sulphate of, properties, action, and uses of, 865 Beef tea versus alcohol, as a stimulant, 656 Beer yeast, 912 Belladonna, difference of action of, in men, rab- bits, and dogs, 06; as a sedative, 146; action of, on frogs, 159; as a spinal stimulant, 167; as a narcotic, 182; as a local and general anodyne, 183j 184; as a mydriatic, 199, action of, on the respiratory centre, 223 ; on palpitation of the heart, 299; as a local sedative, 32S; as a purga- tive, 336 ; as an antihydrotic, 381 ; its action in incontinence of urine, 384; as a poison, with its antidote, 418; antagonism of, to opium, 424 Belladonna leaves, 835 Root, 836. For general action of belladonna, see Atropine Belladonninc, as a mydriatic, 198 Bennett, Hughes, reference to, 148 Benzin, properties and uses of, 646 Benzoates, test for, 496 Benzoate of ammonia, 817 of ammonium, 545 of Lithium, 535 of soda, action of, on enzymes, 86 ; on bac- teria, Hi), luii; nature of, 531 Benzoated lard, 919 Benzoic acid, action of, on enzymes, 86; on bac- teria, 96, 99, inn; as a stimulating expectorant, 227: action of, on the kidneys, 377 ; prepara- tion and properties of, 817; action of, a- an antiseptic, and a diaphoretic, 817 ; uses of, 818 GENERAL INDEX. 937 Benzoin, as a stimulating expectorant, 227 ; char- acters and preparations of, 816; compound tincture of, 817 Benzol, action of, on bacteria, 98 Benzovltropine, as a mydriatic, 198 Berberiae sulphas, 429, 865 Berberidaceae, 708 Berberine, character and action of, 706 Bergamot, oil of, characters and uses of, 739 Bergmann, references to, 10-1 Bernard, M., references to, 55, and n., 67, 139, 143, 316, 715 -Bernstein, references to, 161, 210, 212 Bert, Paul, reference to, 99 Beryllium, symbol and atomic weight of, 36; physiological action of, 51 Bezold, Von, references to, 250, 252, 260«. Bicarbonates, test for, 496 Bicarbonate of potash, 510 of soda, action of, on the gastric juice, 321 ; nature of, 526 Bichloride of ethidene, as a general anaesthetic, 186 ; of methylene, as a general anaesthetic, 186 ; nature of, 673 Bichromate of potash, as a poison, with its anti- dotes, 419 ; nature and uses of, 516 Biedermann, references to, 129, 130 Bigelow, Dr., reference to his use of ether, 193 Bile, utility of emetics to expel, from the gall bladder, 327 ; and to remove it from the body in cases of biliousness, fevers, and agues, 327 ; nature and functions of the, 348-354 ; use of cholagogues in removing the, from the body, 354 ; action of acids on the, 476 ; of pilocarpine, 750 ; of leptandra, 851 ; of aloes, 893 ; purified ox bile, 917 ; its composition, action, and uses, 917 Bin-oxalate of potash (salts of lemon or sorrel), as a poison, with its antidote, 417 Binz, Prof, references to the experiments of, 72, 81, 154, 466, 735 Birds, action of opium on, 716 Bismuth, properties, preparation, action, and uses of — Carbonate of, 621, 623 Citrate of, 623 and ammonium, 623 Common, 621, 622 Oxide of, 621 Puriried, 622 Solution of citrate of, and ammonia, 623 Subcarbonate of, 623 Subnitrate of, 621, 622 Bismuth, symbol and atomic weight of, 35; a mild irritant to the stomach, 320 ; salts of, as a local sedative, 328 Bismuth subnitrate, as an astringent, 308 Bismuthi et ammonii eitras, 622 Citratis liquor, 622 Carbonas, 622 Citras, 622 Subnitras, 622 Bisulphide, test for, 498 of carbon, action of, on bacteria, 98 Bisulphite of soda, 533 Bitartrate, test for, 498 Bites of venomous serpents or of rabid dogs, utility of caustics in, 306 ; necessity for care in cauterizing for dog bites, 306 Bittersweet. See Dulcamara Blackberrv, 771 Haw, 806 Pepper, 870 Wash, 588 Bladder, diagram to show the effects on the cere- bral circulation of rapidly emptying the, 231 ; action of drugs on the, 383,384; situation of the nerve centre of the, 3S3 ; and of the cere- bral, 383; action of vesical sedatives on, 384; and vesical tonics, 384 ; urinary sedatives and astringents, 385 ; treatment of inflammation of the, 385 ; result of distention of the, and of stone in the, 389 ; utility of pareira root in chronic catarrh of the, 707 ; action of buchu leaves on the mucous membrane of the, 748 ; of pilocarpine, 749, 750 ; of physostigmine, 764 Blagdon, Sir Charles, reference to, 3S0 Blake, reference to, 51 Blastomycetes, 89 Blatta orientalis, as a stimulant diuretic, 373; as an aphrodisiac, 388 Bleeding, local, by leeches or by wet cupping, usefulness of, in inflammation and fever, 363 ; as an anaphrodisiac, 388 Blisters, probable action of, in inflammation, 303, 304; various diseases in which they are useful, 305; as antipyretics, 363 Blood, red corpuscles of the, effect of heat and cold on, 73 ; action of drugs on the, 79 ; effects of oxygen and other gases on the, 80, 81 ; vari- ous constituents of the— haemoglobin, 80, 81 ; oxy haemoglobin, 80, 81 ; haeniatin, 80, 81 ; met- haemoglobin, 80, 81; effects of carbonic acid on the, 80 ; of hydrocyanic acid, 89 ; of nitrites, 80 ; alterations effected in the interchange be- tween the air and the, 81 ; poisoning of the, produced by the bacillus septicaemia?, 103 ; ac- tion of, on the brain, 176-182 ; state of the, in respiratory complications, 212-215 ; effect of excessive venosity of the, on the respiratory centres, 211-213 ; condition of the, in suffoca- tion, and in nitrite and carbonic oxide poison- ing, 214; difference in the quality of, in the arteries and in the veins, 229 ; importance of the pressure of the arteries and veins on the circulation of the, 229 ; action of the heart in reference to the, 230; fainting and shock caused by the sudden arrest of the supply of, to the brain, 230; schema of the circulation of the, 232, 233 ; diagram illustrating this, 232 ; circulation of the, in the living body, 233 ; na- ture of arterial tension, or blood-pressure, 234; method of ascertaining the blood-pressure, 235; alterations in blood-pressure and their causes, 236 ; how this pressure may be raised and low- ered, 237; relation of pulse rate and arterioles to blood-pressure, 237-240 ; diagrams illustra- tive of blood-pressure, 238 et seg.; effect of the arterioles on blood-pressure and pulse rate, 240-243; investigation of the action of drugs on the blood vessels, 243-246 ; another method of ascertaining this, 246-248; venous, causes contraction, and oxygenated, dilatation of the vessels, 247; action of other parts on blood- pressure, 249 ; reflex contraction of blood ves- sels, 250 ; action of drugs on this reflex con- traction, 251 ; comparative effect of heart and vessels on blood-pressure in different animals, 252 ; influence of nerves on blood-pressure, 253-256 ; causes of alteration in blood-pressure and pulse rate, 257 ; action of the heart on blood-pressure, 258 ; action of styptics on the, 309 ; coagulation of the, caused by alum, lead, acetate and ferric chloride, 310 ; action of hae- matinics in improving the quality of the, 357 ; nature and action of the red corpuscles of the, 357 ; the various constituents of, 359 ; pressure of the, in the -glomeruli, and the composition of the, two factors in the rapidity of the secre- tion of urine, 369, 372 ; experiment with digi- talis on blood-pressure, 372, 373 ; - action of hydrocyanic acid on the, 490, 491 ; of caustic alkalies injected into the, 501 ; action of the metals on the, 564 ; of mercury, 582 ; of salts of iron, 628 ; of alcohol, 650 ; of spirit of ether, 661; of nitrite of amyl, 664; of nitro-glycerine, 668 ; of chloral hydrate, 671 ; of purified chloroform, 675-677 ; of carbolic acid, 688 ; of creasote, 690; of antipyrin, 695 ; of caffeine, 740 ; of Jamaica dogwood, 769 ; of oil of euca- lyptus, 781 ; of quinine, 805 ; of oil of valerian, 806 ; of sulphate of strvchnine, 826 ; of curare, 826 ; of gelsemium, 827"; of tobacco, 842; of digi- talin, 844 ; of thymol, 854 ; of tannic acid, 876 Blood-letting, as a local anodyne, 183 Bloodroot. See Sanguinaria Blue cohosh, 708 Bocci, reference to, 349 Body, remedies acting on the surface of the, 301-310. See Remedies, &c. Boehm, references to, 122, 219, 249, 278n., 702, 847 Boerhaave, reference to, 383 Boisbaudran, L. de, on molecules, 49 Bon, M. Gustav le, reference to, 106 938 GENERAL IXDEX. Bones, action of phosphorus on the, 603 Boracie acid, action of, on bacteria, 99; nature and properties of. 486 Borates, test for, 496 Borax, action of, on enzymes, So ; on bacteria, 97, 99 ; as an antiseptic for cleansing the teeth, 311 ; as an antisialic. 318 : as a direct emmena- gogue, 390 ; nature and uses of, 528 ; its deriva- tives, glyceriuum, boracis and rnel boracis, 529 Boric or boracie acid, properties of, &c., 486 Borneol, action of, on the brain and spinal cord, 194; on the cardiac muscle, 281 Boron, symbol and atomic weight of, 35 Borosalicylate of soda. 96 Bouchard, reference to, 349 Bouley. reference to, 322 Bowditeh, reference to, 268 Bowels. See Intestines Bowman, references to. 365 Brain, action of drugs on the, 167-196 ; of the lower animals, 167 ; of the higher, 168 ; of frogs, rabbits, guinea-pies, monkeys, dogs, and cats, 168-171; diagram of the brain of a monkey, 170; arrangement of the motor and sensory centres of the, in the lower animals, 171; de- pressant action of drugs on the motor centres of the, 171 ; method of investigating the action of drugs on the excitability of the, 171 ; irritant action of drugs on the motor centres of the, 171-174; action of drugs on the sensory and psychical centres of the, 175-195 ; effect of drugs upon the time required for mental processes, 175 : drugs which increase the functional ac- tivity of the, 176: nerve stimulants, 176; cere- bral" stimulants, 176; effects of posture and mastication on the action of the, 176 ; stimu- lating effects of smoking, sips of alcohol, and tea and coffee on the, 177: suction causes an increased supply of blood to the, 178; exercise causes inci eased' activity in the, 177: sipping a powerful stimulant to the, 177: alcohol one of the typical stimulants of the, 178; direct action of strychnine and caffeine on the, 17 s -: drugs which* lessen the functional activity of the, 178-193; hypnotics or soporifics induce sleep, 179 : effects of different degrees of sleep on the, 180; action of hypnotics on the, 17 of narcotic-, 182; peculiar action of alco- hol on the, 182; peculiar physiological condi- tion- of the, 182 : action of anaesthetics on the, 185-191 ; of antispasmodics, 194; of drugs on the different kinds of spirits ap- pear to affect different parts of the, 195: fainting and shock caused by the arrest of the supply of Mood I ,230, 231 : action of the, on vomiting, 324 ; action of bromide of potassium on the, 521 ; of strong solution of ammonia, 542: of alcohol, 651 ; of spirit of ether, 663; of chloral hydrate, 672; of nydrochlorate of apo- morphine, 713; of codeine, 714: of opium, 71S: of sanguinaria, 725; of caffeine, 743;of oil of eucalyptus, 781 ; of confine, 7^7 ; of oil of vale- rian, 806 ; of strychnine, v -'4; of belladonna or atropine, 837 Brandy, as a cardiac stimulant, 291 ; nature. &c, mill of, 903 cation of organized ferments, 89 d-hydrate, antagonism of, to atropine, 123, i m, and use of. .;::; Bromicai id, physiological action of. 51 Brom i or, 196 Bromide of ammonium as a hypnotic, 181, 182; o anaphrodisiac, 389 :* nature of, 51 1 Calci Lithium, Potash, 521 Soda /.in.-, 1-1, -".71 Bromide of potassium, action of, on the motor treaof the brain, 172; lessens the functional activity of the brain, 178 ; as a hypnotic, 181 ; a- an anodyne, 184; a- an antispasmodic, 194; action of, aa an antispasmodic, !'.'■"•: on the : circulation, 250 ; as an anaphrodisiac, 3S8 ; uses of, 520-522 ; action of, on the spinal cord and the brain, 521; in nervous diseases and as a hypnotic, 521 ; allays excitability and irritability, 521 ; in epilepsy and sickness, es- pecially in pregnancy and. sea-sickness, 522 ; as an anaphrodisiac, 522 Bromide of sodium, as a hypnotic, 1S1 Bromiue, symbol and atomic weight of, 35 : ac- tion of, on infusoria, 75; on enzymes, 87 : on bacteria, 93,97,98,99; as a caustic, 304; as a poison, with its antidote, 417 : characters, test, and uses of, 469 Bromo-camphor, antispasmodic powers of, 194 Bromoform, as a general anaesthetic, 186 Broncnial tubes, atropine completely arrests the secretion from the, 223 Bronchitis, chronic, cod-liver oil affords more relief in, than any of the ordinary expecto- rants, 217 : importance of an emetic in, 195; ipecacuanha, either alone or combined with squills, as expectorant in, 208: with great de- pression and feeble circulation, carbonate of ammonia to be preferred, 228 : importance of warmth and moisture in, 22.8; of respirators, warm clothing, &c, in, 228; value of certain plasters in, 228; tartar emetic ointment and croton-oil liniment sometimes of use in, 305 Bronchitis kettle, nature and use of, 413 ; Broom, as a refjigerant diuretic, 374 ; broom and broom tops, characters and composition of, 758 ; physiological action and therapeutical uses of, 758" Brown-Sequard, reference to, 218n. Brucia, effects of, on the blood, 82 Brucine, as a spinal stimulant, 167 : action of, on the respiratory centre, 215: antagonism of, to chloral, 420-424 : acts like strychnine, 825 Brucke, Professor, reference to, 845 Brunton, Dr. L., references to, 58, 61, 67, 122,126, 143, 162. 171/?., 205/2., 239. 241//.. 252n., 258n., 260/2.. 275/2., 332/2., 349/2., 372//., 423, 426, 508, 758 Bryonia, or bryony, characters and use of, as a hydragogue cathartic. 785 Bubnoff, reference to, 703 Buchheim, references to, 55, 143 Buchner, reference to, 102 Buchu, as a stimulant diuretic, 374: action of, on the bladder, 384: buchu leaves, nature, action, and use of. 747 Buckthorn, nature, action, and use of, 753; and of buckthorn juice, 753 Burdock, 813 Burgundy pitch, 885 Burnett, Sir W., reference to, 570: his disinfect- ing fluid, as a poison, with its antidote, 418 Burseracese, 756 Butternut. See Juglans Butyl-chloral, as a general anodyne, 183, 184; characters, action, and u.-es of, 670 Butyric acid, action of, on bactei Buxine, as a spinal stimulant, 167 Byttneriacese, 741 c. Cabbage-rose petals, 772 Cacao butter, 7 (I Cadmii iodidum, 470 Cadmium, iodide ol Cadmium, symbol and atomic weight of, 35; its relation to other members of a group, 42; phy- siological action of, 51 ; effect of, on muscle. 121 ,.■ causes slighl contraction of the \< 246 ; cadmium sulphate, a- an ast i ingent, Csesalpinia . Cesium, symbol and atomic weight of, 35; its rela- tion to other members of a group, 12; physio- logical action of, 51 Caffeina, 429 Caffeine, action of, on oxidation, 7:': on m 112; on annulosa, 115; on muscles, 127; 131 et ,; on the spinal cord, 148; on the brain on the accelerating centre. 279; on the vaso- motor centre, 279 ; on tin; cardiac inuscli as a cardiac tonic, 293; as a refrigerant diuretic, GENERAL INDEX. 939 373; antagonism of, to morphine, 420-425; (theine) characters of, 742 ; action of, on the nerve centres, and on muscular fibre, 743 ; on frogs and warni-blooded animals, 743; on the brain, medulla, respiration, blood-pressure and pulse, 743; on the salivary secretion and the intestines, 743; on the temperature, 743; as a diuretic, 743 Cahours, reference to, 143 Cajuput oil, as a rubefacient, 304; and carmina- tives, 330 ; oil of, characters aud uses of, 780 ; as a powerful stimulant, antispasmodic and rube- facient, 780 Calabar bean as a myotic, 198 ; as a poison, with its antidote, 418; character, composition, and preparations of, 761 Calabarine, as a spinal stimulant, 167 ; antagonism of, to chloral, 425 Calamus, 973 Calcis hydras, 550 Calcium, symbol and atomic weight of, 36; its relation to other members of a group, 42 ; and specially to lithium, 42 ; physiological action of, 51 ; action of, on the muscles, 130, 137 ; causes great contraction of the vessels, 246; salts of, and distilled water prolong the beating of the frog's heart, 270 Calcium, characters and uses of— Chloride of, 98, 553 Bromide of, 553 Precipitated carbonate of, 553 Phosphate of, 553 Hypophosphite of, 554 Sea alsu under Lime Calendula (marigold), 812 Calomel, antiseptic power of, 107; action of, on the stomach. 321 ; on the pancreatic juice, 355; its action and uses, 587 Calomel fumigation, 404 Calumba and Calumba root, characters, compo- sition, and preparations of, 706 ; actions and uses of, 707 Calyciflorse (sub-class II.), 753 Camphor, action of, on bacteria, 100; on ascidians, 114; and on annulosa, 115; curious exciting action of, on the brain and the medulla, 174; action of, as an antispasmodic, 194 ; on the ear, 205; on the vaso-motor centre, 279; on the car- diac muscle, 281; as a cardiac stimulant, 291; as a popular remedy to cut short coryza or ca- tarrh, 293 ; as an anaphrodisiac, 38S r ; charac- ters, composition, and preparations of, 862; action of, as a stimulant and rubefacient, 864; as a diaphoretic and anaphrodisiac, 864; action of, on the heart, nerve centres, and the tempe- rature, 864; uses of, externally and internally, S64 Camphor, monobromated, characters of, 864; action and uses of, S64; as a sedative, 864 Campylospermas, 785 Canada balsam, 882 Pitch, 885 Turpentine, ditto, 882 Canadian hemp. See Apocynum Canellaceaa, 744 Canella alba bark, an aromatic bitter and tonic, 744 Cannabin, action of, on brain of dogs, 172 Cannabinea', 879 Cannabis, American, 879, S80 Cannabis indica, as a hypnotic, 181 ; as an ano- dyne, 184; action of, in producing visions, 204; doubtful value of, as an aphrodisiac, 388 ; as a poison, wiih its antidote, 418 ; character, action, and uses of, 879, 8S0 Cantharides, as a vesicant, 305; as a stimulant diuretic, 373 ; action of, on the kidneys, 376 ; produces both albuminuria and hematuria, 376; its action on the urine, 383; as an aphro- disiac, 388; as a direct emmenagogue, 391; as a poison, with their antidotes, 418 ; character and composition of, 925 ; action of, externally and internally, 925 ; on the salivary glands and on the urinary organs, 925, 926; uses of, externally as an irritant and a counter-irritant, 926; and internally, 926 ; precautions, 926 ; treatment in poisoning by, 927 Capillaries, list of drugs by which they are stim- ulated, depressed, or paralyzed, 282 ; a certain abnormal condition of the, one of the chief causes of dropsy, 297 Caprifoliacese, 793 Capsicum, 835 ; as a rubefacient, 304 Fruit, characters and composition of, 835; action and uses of, 835 Caraway, as a carminative, 790 Fruit, 790 Oil of, 791 Caraway and oil, as a carminative, 330 Carbolic acid, action of, on enzymes, 86 ; on bac- teria, 96, 97; as a deodorizer, 105-108; its super- iority for removing smell from the hands, 108 ; as a sedative and au anaesthetic, 146; oue of the chief local anaesthetics, 186 ; action of, on the vaso-motor centre, 279 ; as a caustic, 306 ; as an astringent for the teeth, 310; liquefied as a remedy for toothache, 311 ; as a local sedative, 328 ; as a poison, with its antidote, 419 ; antag- onism of, to chloral, 425 ; characters, tests, and preparations of, 687; action of, as a deodorizer and disinfectant, 688; on the skin and mucous membranes, 688; on the blood, muscle, nerve, and medulla oblongata, 688 ; on the spinal cord, respiratory and vaso-motor centres, 688; on the cerebral, sweat and salivary centres, 689 ; on the temperature, 6^9; how excreted, 689; uses of, 689-691 Carbon, symbol and atomic weight of, 36; found in three foims, and in various compounds, 40; its relation to other members of a group, 42 ; its forms, 459-461 Carbon, bisulphide of, character, action, and uses of, 644 Carbon compounds, fatty series, 643 et seq. ; prop- erties and general action of, 644; aromatic series, 683-696 ; general characters of, 683 et seq. ; action of, 687; the antiseptic and antipyretic power, 687. See Hydro-carbons Carbon monoxide, as a poison, with its antidote, 417 Carbonates, test for, 496 Carbonate of ammonia, 542 Bismuth, 623 Lead, 596 Lithia, 534 Magnesia, 560 Potash, 508 Soda, 526 Zinc, 569 Carbonate of soda, action of, on the ear, 205; on the mucus from the trachea, 224 ; as a poison, with its antidote, 417 Carbonic acid, action of, on protoplasm, 71 ; as a local anodyne, 183 ; action of, on the blood, 248 ; as a refrigerant diuretic, 373 ; as a poison, with its antidote, 417 ; as choke damp, with its anti- dotes, 417; properties of carbonic acid, 487; action aud uses of, 487 ; effects of, in the mouth, the stomach, and the intestinal canal, 488 ; poi- soning by, 4SS ; has three stages— dyspnoea, con- vulsions,'and paralysis, 488; its treatment, 489 Carbonic oxide, action of, on muscles, 125 et seq.; on the vagus centre, 279 ; effects of poisoning by, on the color of the blood, 214 Cardamoms, as carminatives, 330: as stimulants and carminatives, 901 Cardiac muscle, drugs which stimulate or depress, 281 Cardiac poisons, action of different kinds of, 271, 281 Cardiac sedatives, nature and action of, 299, 300 Cardiac stimulants, nature and action of, and list of the principal, 291 Cardiac tonics, 223; nature of, and list of the principal, 293; conditions and diseases of the heart in which they are most useful, 294-297; the question as to the use of digitalis in aortic regurgitation considered, 296; risks attending the administration of digitalis and other car- diac tonics, 296; cimicifuga (black snakeroot), as a cardiac tonic, 703; apocynin and apocynein as, 828 Carlsbad water, probable cause of its efficacy in hepatic diseases, 354 ; nature and uses of, 530 940 GEXERAL INDEX Carminatives, nature of the action tliev exert on the stomach, 329, 330; list of the "chief, 330; their principal uses, 330 ; cloves as", 77S ; asafoet- ida as, 787; fennel fruit as a, 789 ; oil of anise as, 789 ; oil of dill as, 790 ; oil of caraway as, 790; oil of coriander as, 792; oil of chamomile as, 809; oil of rosemary as, 851; oil of lavender flowers as, 852 ; oil of peppermint as, S53 ; oil of spearmint as, S53 ; hedeoma or pennyroyal, 855 ; expressed oil of nutmeg as, 860; oil of cinnamon as, 861 ; garlic as, 889 ; cardamoms as, 901 ; saff- ron as, 902 Carolina pink. See Spigelia Carron oil, origin, composition, and uses of, 551 Carrot as a stimulant diuretic, 374 Casca bark (sassy bark), composition, action, and uses of, 771 Cascara Sagrada as a purgative, 753 Cascarilla, 866; cascarilla bark as a stimulant, tonic, and expectorant, 867 Cash, Dr., references to, 59, 122, 126, 130, 132, 137, 14-4, 245, 246, 422, 508, 824 Cassia, as a laxative, 339; cassia pulp, characters, and use, 767 ; purging cassia, 767 Castanea, characters and uses of, 878 Castor, antispasmodic action of, 194 ; its charac- ters and therapeutics, 913 Castor oil, nauseous taste of, owing almost en- tirely to its odor, 206 ; as a purgative, 339 ; as a vermifuge, 355 ; characters and preparations of, 869 ; composition, action, and uses of, 869 ; as a purgative, S69 ; mode of administration, 869 Cat. easiest mode of anaesthetizing, 191; diagram of curve of the pulse and blood-pressure in a, after division in the spinal cord and injection of erythrophlceum, 239 Catalysis, effects of, on different substances, 82 Catap'lasma carbonis, 431, 459,900 Conii, 431, 786 Fermenti, 431,903, 912 Li ni, 431,729, 819 Sin apis, 431, 726 Soda? chloratie, 431, 468 Cataplasms, or poultices, 431 Catarrh, with copious secretion of mucus, a com- bination of morphine and atropine useful in, 224; camphor a popular remedy in common, 293 Catechu, as an astringent, 308 ; for the teeth and gums. 311 ; characters, composition, and uses of, 770, 771 ; pale, 804 Cathartics. See Purgatives Catheter, importance of cleansing and disinfect- ing, 107 Caulophyllum (blue cohosh), character, composi- tion, and uses of, 708 Caustic ammonia, as a poison, with its antidote, 417; caustic lime, as ditto, 417; caustic potash, or soda, as ditto, 417 Potash, -in!) Soda, 526 Caustics, nature and uses of, 306; general action of the alkaline group of metals as, 499; alum as a cau-tic, 556 Celandine. See Chelidonium Celastracese, 7.",:; Cells, how kept alive, and cause of death of, 229 Cerates, or ointments, 431 Ceratum. 431, 920,924 Cam phone, 431, 862, 863, 920, 924 Cantharidis, 131, 920, 925 Cetacei, 431, 920, 924 Extract! eantharidis, 431, 920, 924, 925 Plumb] Bubacetatis, 431, 598, 920, 924 Ceratum Resinse, 131, 885, 920. 924 Sabinse, 131, 920, 921 Cerebellum, action of drugs on the, 195 ; different kinds of spirits appear to affect different parts • .("the 19.".: action of alcohol on the, 652 Cerebral affections, blisters useful in, 805; cir- culation, diagram to show the effects on, of rapidly emptying the bladder, 281 ; stimulants, nature, and action of, 1 70- 17s ; action of cat- holic acid on the cerebral centres, 689 ; tea as a powerful stimulant, 7 12 Cerium oxalate, as a local sedative, 828 j charac- ter, use*, Ac, of, 558 Cerium oxalate — Symbol and atomic weight of, 36 ; physio- logical anion of, 51 Cetacean, 919 Cevadilla, 895 Chalk, as an astringent, 308 ; as a dentifrice, 310; as a direct antacid, 322 Chalk, prepared, 551 ; officinal preparations of, 552 ; mixture of, 552 ; aromatic powder of, 552; com- pound powder of, 552 ; lozenges of, 552 ; hydrar- gyrum cum creta contains, 552 Chamomile, characters and uses of, 809 German, 809 ; a bitter carminative, anthel- mintic, 809 ; infusion of, 809 Oil of, 809 ; a tonic, stomachic, and carmina- tive, 809 Chaperon's experiments on inhibitory paralysis, 154 Charcoal, reputed power of, for attracting oxy- gen, 82 ; as a deodorizer, or antiseptic, 108 ; as a dentifrice, 311 ; action of, on the stomach, 330 ; chief action of, 455 Charcoal, animal, preparation and constituents of, 460 Fumes, as a poison, with its antidote, 417 Purified, animal, preparation, characters, and uses of, 460 Wood, its prepiration, characters, action, and uses, 459 ; poultice of, how to make, 459 Charta Cantharidis, 432, 925 Epispastica, 432, 819, 882, 885, 920, 924, 925 Potassii nitratis, 432 Sinapis, 432, 727 Cheken, composition, action and uses of, 779 Chelidonium (celandine), characters, composi- tion and uses of, 726 Chemical constitution and physiological action, connection between, 50; the most important subject in pharmacology, 51 Chemical reactions, numher and nature of, 47; of the metallic elements divided into two groups, 47, 48 ; which only occur between two bodies when a third is present, 82 Chenopodiaceie, 859 Chenopodii, oleum, as a vermifuge, S59 Chenopodium, characters of, 859 Cherry-laurel water, as a poison, with its anti- dote"; 419 ; cherry-laurel leaves, nature, action, and use of, 777 Cherry, wild, as a nervous sedative and tonic, 777 Chestnut, See Castanea Chilies, as carminatives, 330 Chill, or cold, utility of vascular stimulants in, 293; action of, on bronchi, 225 Chimaphila, (pipsissewa), as a stimulant diuretic, 374; as an astringent and diuretic, 815 Chinicine, constitution of, 696 Chinoidin (quinoidin), 799 Chinoidinum, 430,799 Chinoline, 695 Chinoidinse sulphas, 799 Chiretta, as a bitter tonic, 831 Chloral, action of, on muscle, 124 et seq.; as a sedative, 146; diagram to show the action of, on the spinal cord, 151; a useful hypnotic, 181 ; as a general anodyne, 183,184; action of, on the respiratory centre, 215; on the brain, 218; on the vessels and circulation, 247 ; on the vaso- motor centre, 251,279; on the motor ganglia, 280; on the intestines, 337 ; as a poison, with its antidotes, 419; antagonistic action of, and strychnine and picrotoxine, 423; antagonism of, to other drugs, 421-424 Chloral hydrate, action of, on the nervous sys- tem, 186; on the vagus centre, 279; antagonism of, to atropine, 421-424; preparation and char- acters of, 670; action of, 670-673; as an anti- septic, in the mouth, and when injected under the skin, 07(1; first introduced into medicine by Oscar Liebreich, 670; his speculations regard- ing its action, 670 ; its action in the hody, 670 ; in frogs and mammals, 671 ; on the tempera- ture, respiration, and hlood, 671 ; on the circu- lation, 671 : on muscles and motor nerves, 671 ; on the spinal cord, 671 ; on the brain, 671; treatment o!' poisoning by, 672 ; uses of, 672 GENERAL INDEX. 941 Chlorate of potash, action of, on bacteria, 96, 100 ; as a remedy for toothache, 311 ; as an antisialic, 318 ; action of, on the kidneys, 376 ; characters, action, and uses of, 513-515 Chlorate of soda, 530 Chlorides, test for, 497 Chloride of ammonium, 540 Calcium, 552 Gold, 640 Iron, 633 Soda, 524 Sodium, 502, 503 Tin, 600 Zinc, 569 Chloride of lime, action of, on enzymes, 86, 87 ; on bacteria, 98 Chloride of sodium, action of, on bacteria, 101 ; action of, as compared with bromide of potas- sium, 195 ; on the pulsations of the frog's heart, 269 ; effects of excess of, in t he blood, 358 ; one of the mostimportantconstituentsof the body, 359 Chlorides, general action of the group of, 501-503 Chlorinated lime, 96 ; characters of, &c, 467 ; so- lution of, 468 ; inhalation of, 468 Chlorinated soda, solution of, 468 ; as a cataplasm of, 468 Chlorine, symbol and atomic weight of, 36 ; its relation to other members of a group, 42 ; action of, on infusoria, 75 ; on enzymes, 85-87 ; on bacteria, 96, 100 ; as a poison, with its antidote, 416 ; general source, characters, and mode of preparation of, 464-466 ; action of, 466 ; chlorine water, tests, and uses of, 466 ; chlorinated lime, its characters and uses, 467 ; solution of chlori- nated lime, 468 ; inhalation of chlorine, 468 ; solution of chlorinated soda, 468 ; poultice of ditto, 468 ; uses of ditto, 468 Chlorine water, action of, on bacteria, 98 ; nature, action, and uses of, 466, 467 Chloroform, effects of, on the blood, 82 ; on enzy- mes, 86 ; on bacteria, 96, 98 ; on medusse, 112 ; on mammals and leeches, 115; on muscle, 124 et seq. ; as a sedative, 146 ; diagram to show the action of, on the spinal cord, 151; action of, on psychical processes, 175; action of, as an anaesthetic. 185 elseq.; acts directly on the nerve cells, 187; dangers arising from the use of, 189 ; mode of administering, 190; action of, on the respiratory centre, 214 ; on the brain, 218 ; on the vagus centre, 279 ; on the vaso-motor cen- tre, 279; on the motor ganglia, 280 ; as a cardiac stimulant, 291 ; as a rubefacient, 304 ; as a siala- gogue, 314; as a local sedative, 328; as a car- minative, 330; as a poison, with its antidotes, 418; antagonism of, to amyl nitrite, 425; puri- fied, preparation, 674 ; tests, 674 ; preparations of, 675; action of, 675; when mixed with albu- men, 675 ; a powerful solvent of protogon, 675 ; on the blood and skin, 675 ; on themouth, stom- ach, and intestines, 676 ; the nervous system, 676 ; its action divided into three stages, 676 ; its action on the respiration, pulse, heart, and blood-pressure, 677 ; on the nervous system, 677 ; dangers in the administration of, 678 ; precautions to be taken, 678-681 ; uses of, and various plans for administering, 680, 681. See also Anaesthetics. Chloropicrin, action of, on bacteria, 99 Cholagogues, may act as indirect gastric tonics, 322 ; nature and action of, 340, 349 ; experiments with, 351-353 ; adjuncts to, 353; uses of, 354; re- move bile from the body, 354 Cholera, corrosive sublimate in, 589 ; possible use of naphthalin in, 694 Chondrus, 912 Christison, Sir Eobert, references to, 58, 716, 719, 849 Chrome alum, action of, on bacteria, 98 Chromic acid, action of, on bacteria, 98, 100 ; as a caustic, 304; characters and action of, as a dis- infectant and caustic, 486 Chromium, symbols and atomic weight of, 36 Chrysarobin, characters and uses of, 765 Chrysarobinum, 430 Cicutine, as an antisialic, 318 Cicutoxine, action of, on the accelerating centre, 279; on the vaso-motor centre, 279 Cimicifuga (black snakeroot), characters and composition of, 703 ; action and uses of, 703 ; as a stomachic, a cardiac tonic, and an expecto- rant, 704 Cinchona bark and its alkaloids the chief anti- periodics, 108; the former almost a specific in intermittent fevers, periodic headaches, neu- ralgias, &c, 109 ; cinchona alkaloids and their salts, 799 ; action and uses of, 801 Cinchona, characters, &c, of, 794 Bark, pale, 794 Red, 795 Yellow, 794 Calisaya bark, yellow, 794 Properties and composition of the cinchona barks, 795 ; physiological action of, 799-801 ; uses of, 801 Cinchonacea, 793, 799 Cinchonea?, 793 Cinchonidina, 430, 799 Cinchonidine, an antiperiodic, 108 ; sulphate of, 799 Cinchonina, 430, 799 Sulphas, 799 Cinchonine, 798 Action of, on oxidation, 79 ; on the blood, 81 ; as an antiperiodic, 108 ; action of, on mus- cle, 125 Sulphate of, 798 Cinnamic acid, action of, on bacteria, 99 ; on the kidneys, 377 Cinnamon and oil, as a carminative, 330 Cinnamon, characters and composition of, 861 Aromatic powder of, 861 Bark, 861 Powder, compound, 861 Oil of, 861 ; as a carminative and an astrin- gent, 862 Circulation, action of drugs on the, 229-300 ; nature of the, in the arteries and veins, 229 ; effect of blood-pressure on the, 229; arrest of the, causes fainting and shock, 230 ; schema of the, 232, 233 ; diagram illustrative of this, 232 ; nature of the, in the living body, 233 ; effects of variation in blood-pressure on the, 234 ; method of ascertaining this, 234; alterations in blood- pressure in the, 236 ; relation of pulse rate and arterioles to blood-pressure in the, 237-242 ; dia- gram of the, 241 ; method for maintaining arti- ficial, in the rabbit's ear, 245 ; in the frog, 244 ; method of measurement of the, by the rate of flow, 246-248 ; action of potash salts on the, 508 ; of strong solution of ammonia, 512 ; of the heavy metals, 563; of the salts of iron, 564; of anti- mony, 615 ; of alcohol, 651 ; and on the cranial, 652 ; of the spirit of ether, 663 ; of chloral hy- drate, 672; of" salicylic acid, 693; of anemonin, 702; of opium, 719-724; of pilocarpine, 751; of strychnine, S22 ; of belladonna or atropine, 837 ; of tobacco, 842 ; of veratrine, 897 ; ofcolchicum, 897 ; of extract of ergot, 910 Citrate of bismuth, 623; and ammonia, 623 Iron, 637 and ammonia, 635 Ammonium, 635 Magnesium, 339 Quinia, 636 Quinine, 636 Strychnine, 636 Lithia, 535 Potash, 510 Citrates, test for, 496 Citric acid, properties of, &c, 4S5 ; syrup of ditto, 485 Citrine ointment, 592 Citro-tartrate of soda (effervescent), 528 Clover, Mr., his plan of administering chloro- form, 681 Cloves, characters, action, and use of, 778 ; as a carminative, 778 ; oil of, 778 Cloves and oil, as a carminative, 330 Clysters, injections, or enemas, 433 Coal gas, as a poison, with its antidotes, 417 Coats, reference to, 245 Cobalt, symbol and atomic weight of, 36 ; physio- logical action of, 50 ; causes slight contraction of the vessels, 246 942 GEXEEAL IXDEX. Cobra poison, action of, on the infusoria, 75 ; con- vulsions caused by, 174 Coca. See Erythroxylon Cocaine, action of, on muscle, 125 ; antagonism of, to morphine, 422-424; characters, action, and uses of. 732-734: as a local anaesthetic, 732, 733; action of. on the nerve centres in man, 733 : is said to lessen fatigue, 733 ; on animals, on the spinal cord, the respiration, the pulse, blood- pressure, and temperature, 733 ; use of, 733 Coccus, 924 Cochineal. 024; its characters and uses, 924 Codeina. 429 Codeine, action of, on oxidation, 79 ; antagonism of. to chloral. 420-425 : characters of, 714 ; action of. on the nerves and abdominal viscera, 714; on the spinal cord and motor centre in the brain. 714: uses of, 715; action and use of, in diabetes. 715 Codeines, artificial. 772 Cod-liver oil, one of the most efficient expecto- rants. 226: great virtue of, in chronic-bronchitis, 226; a powerful hreniatinic, 358; as an altera- tive, 358 ; as an indirect emmenagogue, 391 ; character, composition, physiological, and ther- apeutic action of, 921-923 Correct. 802 Coffee, composition, action and use of, 803 Colchici radix. 897 Collodion cum cantharide, 925 Colchicine, action of, on the respiratory centre, 215: as a hepatic stimulant, 351, 353; as an alterative, 358 ; used in gout, 361 : as a refriger- ant diuretic. 374: as a poison, with its antidote, 419 Colchicum corm, 897 Root. 897 Seeks attending, 396-398 Compresses. 400 Douche, use-ending, 399 Spinal 399 Douches, 399 I OOt hath, 400 Pack. 398 Coleoptera, 925 Collodion, as a demulcent, 307 : and a styptic, 309 (olio. hon. characters, action, and uses of, 730 < antharidal, 736 Flexible 5 Btyptic, 736 Collodion. . B2 Collodion, . 132, 661 Cum cantharide, 182, 736 Flexile, 432, 661, 736, B68, 882 Stypticum, 132, 786, s;,; Colocynth, 782 ■itii a- a drastic purgative. 389; as a hepatic stimulant, 851, 853: cofocyntb pulp, composi- tion, action, and therapeutics of, 782, 783; a powerful cathartic and diuretic. 782, 788 ( oiogne water, tor perfuming, 789 Colophony, 884 Coma, condition of the veins and brain during. 179 B Compound radicals, nature of, 47 ; most of them possess a paralyzing action on the motor nerves, 50 Condurango, characters, action, and uses of, 829 Confectio opii. 432, 709, 758, 791, 870, 900 Piperis. 432, 791, 870, 923 Rosa?, 432, 773, 923 Caninae, 432, 773, 906 Gallica?, 402, 773, 906 Scammonii, 432, 779, 791, 832, 990, 923 Senna?, 432, 757, 766, 776, 792, 879, 906 Sulphuris, 432, 461, 511 Terebinthina?, 432, 751, S83, 923 Confection of sulphur, mode of preparing, 461 Confections, electuaries, or conserves, 432 Congestion of the internal organs arising from cold, 224 ; utility of vascular stimulants in, 293 Conifene. 882 Confine, effects of, on oxidation, 79 ; action of. on the spinal cord, 150 ; as a general anodyne, 183 ; on the inhibitory powers of the vagi, 274. See Hemlock Conium, as a local and general anodyne, 183; the vapor of, has a local sedative action on the lung, 223 ; as an anaphrodisiac, 388 ; as a poi- son, with its antidotes, 419 ; nature, actions, and uses of, 786, 787 Conjunctiva of the eve, action of drugs on the, 196 Constipation, the cause of, and remedies for, 335 ; diagram to show how ovarian irritation proba- bly causes, 336 : action of opium in, 336 ; and of small doses of belladonna, 336 Contraction of the pupil of the eye, origin and nature of, 200 Convallamarin, as a cardiac tonic, 293 Convallaria majalis, as a cardiae tonic, 293 Convolvulacete, 831 Convulsions produced by poisoning, 53: and by strychnine and other drugs acting on the spinal cord, 158-167 ; by the absence or excess of oxygen, 162 ; whether convulsions are caused by the action of poison on the brain or the spinal cord, 105 ; certain drugs, when taken, are the cause of, 172 ; they are usually of spinal or cerebral origin, 172 ; asphyxial convulsions, 173; experiments to ascertain whether they are asphyxia! or not, 173: excitement of the respiratory centre causes. 212 : asphyxial, only occur in warm-blooded animals, 212; carbolic acid produces convulsions in frogs, 688 Copaiba, as a stimulant diuretic, 374 ; value of, in inflammation of the bladder, 385 Copaiva, characters, &c, of, 70S ; balsam of, 768 ; oil of, characters, action, and uses of, 769 Copper, sources, reactions, uses, &c, of, 572 Acetate of, 574 Test solution of, 574 Subacetate of, 573 Sulphate of, 573 Anhydrous, 573 Test 'solution of ammonio-, 573 Copper sulphate, action of, on enzymes, SO; on bacteria, 98 ; on annulosa, 116; as a caustic, 304, 573: as an astringent, 308; as a local emetic, 326; character, action, and uses of, 573, 574 Copper, symbol and atomic weight of, 36 ; phys- iological action of, 51; action of, on muscle, 121 etseg.; causes powerful contraction of the vessels, 246 ; double salts of, action of, on the cardiae muscle, 281; on tin" capillaries. 282; as a poison, with its antidote, 419, nature, ac- tion and uses of, 572-574 Coriander and oil, as a carminative, 330 Coriander, characters of, 792 Fruit, 792 on of, a carminative and stimulant, 792 Cornacea-, 79:; Cornea, chief drugs employed in disease of the, 196 : action of alum on, 190, 557 Corn smut, 9] ] ComUS. characters and action of, 793 Coroutine, 909 GENERAL INDEX. 943 Corolliflone, 793 Corrosive chloride of mercury, 589 Corrosive sublimate, action of, on infusoria, 75; on enzymes, 85-87 ; on bacteria, 93, 96, 98, 100 ; extraordinary destructive power of, might be useful in destroying bacilli, 104 ; owes its cura- tive power in cases of infantile dysentery to its antiseptic action, 107 ; the only trustworthy disinfectant for destroying septic organisms, 108 ; as a poison, with its antidotes, 419 ; nature and uses of, 589 : one of the most powerful antiseptics known, 5S9 ; use of, in cholera, 589 ; poisoning by, and treatment for, 589 Coto alkaloids, action of, on the intestines, 337 ; Albertoni's investigations regarding the action of the, 337 Coto bark, composition, action, and uses of, 862 ; paracoto bark, 862 Cotoine, action of, on the intestines, 337 Cotton, gun, preparation and uses of, 735 Hoot bark, characters, action, and uses of, 734 Peed oil, characters and uses of, 734 Wool, what derived from, 735 Couch-grass, as a demulcent, 904 Cough, chest and stomach, cause of, remedies for and general treatment of, 220-228 ; diagram of the afferent nerves by which it may be ex- cited, 221 ; action and use of expectorants in, 223-227 ; of emetics, 228 ; of warmth and mois- ture, 228 ; of respirators, 228 ; of warm clothing, friction, liniments, poultices, and plasters, 228; action of lactucarium in allaying, 811 Cowling, Dr., his rule for dosage, 426 Cramps of the muscles, cause and general treat- ment of, 193, 194 Cranesbill, 730 Cranial circulation, 176 ; action of| alcohol on the, 632 Cream of tartar, nature and uses of, 511 Creasote, action of, on infusoria, 75; no effect on ptyalin, 85 ; on enzymes, S6, 87 ; on yeast and bacteria, 87 ; as a loc;il anodyne, 183 ; as a rem- edy for toothache, 311 ; as a local sedative, 328; as "a poison, with its antidote, 419 ; characters, tests, and preparations of, 690 ; action of, as a muscular poison, 691 ; on the blood, skin, and mouth, 691; oh the pulse, respiration, and urine, 691 ; uses of, 691 Croix, N. de la, results of his experiments with different drugs on bacteria, 95, 96 Croton chloral, action of, on the vagus centre, 279; character, action, and uses of, 673 Croton oil, as a pustulant, 304; as a drastic pur- gative, 339 ; as a poison, with its antidote, 419 ; action of, externally and internally, 868 ; use of, ditto, 868 ; treatment of poisoning by, 868 Cruciferse, 726 Crum-Brown, reference to, 143/i., 722«. Crumb of bread, 903 Crvptogams (sub-kingdom II.), 907-912; filices, 907 ; lichens, 907 ; fungi, 908 ; alga?, 912 Cubeb. oleoresin of, preparation, action and uses of, 872 ; as a stimulant and diuretic, 872 Cubeha, 871 Cubebs, as a sialagogue, 314; as a stimulant diu- retic, 374 ; characters and composition of, 871 Oil of, 871 Cucumher fruit, squirting, 784 Cucurbitacete, 782 Culver's root. See Leptandra Cumarin, action of, on the cardiac muscle, as an antipyretic. 281 Cupping, wet, 363 Cupulifene, 874 Curare, physiological action of, on the motor of efferent nerves, 48 ; when applied externally and internally, 52, 53 ; opposite effect of, when differently administered, 55 ; effects of, on the blood, 82 ; on mollusca, 93 ; on muscle, 114, 125, 140, 141 ; list of drugs which have a similar action to, on the motor nerves, 142, 143; on the muscles of respiration, 213 ; on the vaso- motor nerves, 249 ; on the inhibitory power of the vagi, 274, 275 ; on the vagus ends in the heart, 2S0 ; on the nerves of the salivary gland, 313 ; action of the liver on, 352 ; as a poison, with its antidote, 419 ; characters, composition, and action of, 826: on the motor nerves, vagus, and sensory nerves, 826 ; on the spinal cord, muscles, and vessels, 826 ; on the blood-pres- sure and on salivation, 826; effects of, on the general system, 826 ; uses of, 826 Curd soap, 914 * Cyanide of potassium, action of, on medusae, 112 ; as a poison, with its antidote, 419 Cyanide of silver, 577 ; of mercury, 593 Cyanogen, action of, on the motor ganglia, 280 Cydonium, characters and use of, 771 Cypripedium, characters and use of, as an anti- spasmodic, 899 D. Da Costa, Dr., reference to, 300 Dandelion protoplasm, experiment with, on oxy- gen, 78, 79 Dandelion root, characters and action of, 810 ; on the liver, and as a diuretic, 810 Dastre, reference to, 243, 262 Daturine, as a mydriatic, 198 ; action of, on the vagus centre, 279; on the vaso-motor centre, 279; on the inhibitory ganglia, 280; antagonism of, to morphine, 422-425; nature, action, and use of, 842 Davy, Sir H., split up some supposed elements into oxygen and a metal, 37 ; his observation on the properties of nitrous oxide, 192 Decoction of lemon, as an antiperiodic, 740 Decoctions, 432 Decoctum, aloes compositum, 432,756, 757, 891,902 Cetrarise, 432, 907 Cinchonse flava?, 432, 795 Granati radicis, 432, 782 Hsematoxyli, 432, 765, 861 Hordei, 432, 904 Papaveris, 432, 708 Pareira?, 432, 707 Quercus, 432, 875 Sarsse, 432, 888 Sarsse compositum, 432, 745, 757, 864, 88S Sarsaparilhe compositum, 432, 745, 864, 889 Scoparii, 432, 758 Taraxaci, 432, 810 Ulmi, 432, 87S Delirium tremens, cause, symptoms, and treat- ment of, 654, 655 Delphinine, action of, on the frog's heart, 270; on the accelerating centre, 279; on the vaso-motor centre, 279 ; nature, action, and use of, 702 Demulcents, nature, action, and therapeutic uses of, 306-308 ; linseed as a demulcent, 729 ; liquor- ice root as a demulcent, 757 ; gum, acacia or arabica, as a, 770 ; quince seed as a, 771 ; sassa- fras pith as a, 865 ; elm as, 878 ; triticum as, 904 ; Iceland moss as, 908; chondrus as, 912 Deodorizers, or deodorants, nature and action of, 105, 108 ; iodoform as a, 682 ; carbolic acid as a, 688 De?mobacteria, 90 Dew- Smith, 7-eference to, 115ra. Diabetes, action of codeine in, 714 Diaphoretics, action of, on the secretion of sweat, 370 ; antimony as a diaphoretic, 617 ; eupato- riurn as a, 810 ; ipecacuanha as, 803 ; asclepias as a, 829; melissa or balm as, 856; origanum as, 856 ; camphor as, 863 ; oil of sassafras as, 865 ; serpentary root as, 866 Diarrhoea, astringents have a powerful effect in checking, 309 Diastase, 84 Dickinson, reference to, 851 Didymum, symbol and atomic weight of, 36 Diedrich, references to, 720n., T21n. Diediilin, reference to, 143 Digestive system, action of drugs on the, 310-355 ; on the teeth, 310 ; on the saliva, as sialagogues, 311-317 ; on thirst, as refrigerants, 317 ; on the salivary secretion, as antisialics, 318 ; on the appetite, as gastric tonics, 318-322 ; on acidity, as antacids. 322 ; on vomiting, as emet- 944 GENERAL IXDEX. ics, 323-328 : on the stomach, as gastric seda- tives, 32S ; on the gases of the stomach, as car- niinatives, 329, 330 ; on the intestines, 330-33S ; as purgatives, 338-344; as irritant poisons, 344- j 347 : on the liver, 347-355 ; on the pancreas, ; 354; on the intestines, as anthelmintics, 355 Digestive tract, application of drugs to the, 413- ! 416 : by the mouth and pharynx, 413 ; as nias- ticatories, 413 ; as gargles, 413 ; by the stomach, 414 : by the stomach-pump, 414 ; by the gastric syphon, 414 ; to the intestine, 415 ; as enemata, 415; as suppositories,. 415 ; action of opium on i the, 723; action of digitalin on the, 847 Digestives, when necessary, 357 Digitaliu, effects of, on medusa?, 112 ; action of, j on the vision, 205 ; on the frog's heart, 271 ; on the vagus centre, 279 ; on the cardiac muscle, i 281 ; as a cardiac tonic, 293 ; antagonistic action of, 423, 424 : preparation and characters, 844 ; I chemistry of, 845 ; general action of, 845 ; spe- cial action of, on the muscles, nervous system i and spinal cord, S45 ; on the brain, respiration, and blood-pressure, 845, S46 ; on the heart and arterioles, S46 ; diagram of a pulse-wave before and after injection of, in a dog, 846; on the vagus roots and ends, 846 ; peculiar action of, | on the frog's heart. 84/ ; on the digestive organs and the urine, 847 ; effect of temperature on the action of, 847 ; diagram showing effects of rise of temperature alone, S48 ; ditto, showing effects of rise, after injection of, 848 ; ditto, showing action of, after temperature, 849 ; ac- tion of different preparations of, 849 ; uses of, 850 ; precautions, 851 : treatment of poisoniDg by, 851 Digitalinum, 430, 844 Digitalis, effect of varied quantities of, on the pulse, 54; cumulative action of, 58; has some- times no action on the pulse in pneumonia, 61 ; acts differently on the heart of a frog from that of mammals, 66; action of, on oxidation, 79; on mollusca, 114 : action of, on the brain, 180 ; as a cardiac tonic, 223; as a vascular tonic, 226; diagram showing the blood-pressure and form of the pulse-wave before and after the injection of, in the dog, 242 : on the vagus centre, 279 : on the cardiac 'muscle, 281; on the capillaries, 2^2 : on the heart, as a cardiac tonic, 293-295 ; the question of the use of, in aortic regurgita- tion considered, 295 : caution to be observed in the use of, as a cardiac tonic, 297 ; as a vascular tonic, 297 ; as a sedative, 300 ; as a styptic acting on the blood vessels, 309'; has the power of lessening or arresting haemorrhage, 310 ; as a general emetic, 326 ; experiment with, on blood pressure, 372 ; as a refrigerant diuretic, 374 ; as an anaphrodisiac, 388 ; as a direct emmena- gogue, 390 ; as a poison, with its antidotes, 419 ; antagonism of, to other drugs, 422-425 Digitalis (foxglove), characters, &c, of, 844 Leaf, 844 Digitin, composition of, 8 15 Digitonin, composition of, 845,849 Digitoxin, composition or, 845; action of, on the cardiac muscle, 2S1 ; as a cardiac tonic, 294. See Digitalis Dilatation of the pupil of the eye, origin and nature of, 199, 200 Dilator muscle of the iris, nature and functions of, 197 Dill, as a stimulant diuretic, 374 I 'ill and oil, a> a carminative, 330 Dill, fruit, characters and use of, as a carmin- ative, 790 Oil of, 790 Dimethyl-confine, 787 Diosmese, 747 Diseases caused by mould fungi, 90; by bacteria, 91 i Disinfectants, ELoch's experiments on bacteria with, 97-lul: nature and action of, 105, 108; super-heated steam the best disinfectant under ordinary circumstances. 108; borax as a disin- fectant, 529; carbolic acid as a, 688; thymol as, 354 Distilled water, action of, on bacteria, 98; and calcium salt, on tin; frog's heart, 270; as a Uthontriptic, :;77 Diuretics, nature and mode of action cf, 372 ; list of refrigerant and stimulant, 373 ; uses of, 375 ; adjuvants to, 375 ; alkalis as, 502 ; iodide of ethyl as a diuretic, 669 ; caulophyllum as, 708 ; caffeine as a, 743 ; tansy as, 808 ; dandelion root as, 810 ; uva ursa as, 815 ; chimaphila as, 815 ; benzoic acid as, SIS ; serpentary root as, 866 ; thuja as, 8S7 ; oil of juniper as, 887; sarsapa- rilla as, 889 ; garlic as, 889 ; squill as, 890 Dogiel, reference to, 251ra., 259 Dog-rose, fruit of the, 773 Dogs, experiments with drugs on, 66, 67; Magen- die's series of experiments on the action of strychnine on the reflex powers of the spinal cord of, 163 et seg. ; easiest way of anesthetizing, 191 ; diagram of a stopcock by which air or va- por, or two kinds of gas may be given to, 191; diagram showing the blood-pressure and form of the pulse-wave before and after the injection of digitalis in, 242; action of the heart in, 252;, difference between rabbits and, in this respect, 253 ; cause of the stoppage of the heart in, 261 ; effects of large doses of opium injected into, 335 ; diagram of a pulse-wave before and after injection of digitalis in, 846; action of, on, 847 Dogwood, 793; dogwood quinine, 793 Jamaica, action and use of, 769 Donaldson, reference to, 846 Donovan's solution, 612 Dosage, the rules which affect correct, 426 Dose, nature, size, and effects of a, on the sys- tem, 54, 55 ; rules which regulate the amount of a, for children and adults, 426 ; Dr. Young's rule, 426; Dr. Cowling's, 426; the author's pro- posed modification of Dr. Cowling's, 426 Douche, nasal, diagram of a, 410 Douches, cold, nature and uses of, 399 ; the spinal, 399 ; the ascending, 399 Dover's powder, as a vascular stimulant, 292, 293 ; as a sudorific, 364 ; in combination with mer- cury, 5S5 ; ten grains of, useful when a cold is coming on, 723; will cause diaphoresis, 724 Dropsy, the pathology of, 297-299; diagram of RanVier's experiment on, 298; the principal causes of, 297 ; and drugs that are useful in, 298, 299 ; usefulness of upward friction in, 304 Drugs, reaction between, and the various parts of the body, 34; changes undergone by, in the body, 34; physiological action cf, depends chiefly upon their power of acting on one tissue or organ first, 48; the effects produced by large and moderate doses of veratrine on the frog an example of this, 48; effect of artifi- cially modifying the chemical constitution of, 50, 51 ; CIRCUMSTANCES WHICH AFFECT THE AC- TION of, on the organism, 52-67 ; direct and indirect action of, 53 ; local and remote action of, 53 ; relation of effect to quantity employed, 53; the doctrine of homoeopathy in, 54; the dose, 55; size, 55 ; and mode of administration of, 55 ; difference betwixt venous and subcuta- neous injection and absorption by the stomach, 55-57 ; action of the liver on, 56 ; absorption and excretion of, 56, 57 : cumulative action of, 57; effect of different preparations of, 58; of fasting on the action of, 58; of habit, 58; of temperature, 59 ; effect oi temperature on the action of, on the spinal cord, 61 ; the proper definition of the action of, is the reaction be- tween them and the various parts of the body at a certain temperature, 61 ; effects of climate on, 62 ; time of day, 62 ; season, 62 ; and disease, 63 : use of experiments in the administration of, 63 ; effects of idiosyncrasies on the power of, 64 ; objections to experiments, 05 ; difference in the effect of, on men and animals, and on dif- ferent animals, 65-67; erroneous deductions from, 67 ; ACTION OF, ON PROTOPLASM, BLOOD, and low organisms, 68-109 ; on albumen, OS ; on protoplasmic movements, 70-73; on infuso- ria, 73-75 ; relations of motion and oxidation to, 75-7H; action of, on oxidation, 7:> : on the blood, 79-82; on enzymes, 85-87 ; on the move- ments of bacteria, 93; on the reproduction of bacteria in general, 93; and on the destruction of the germs, 94; table of the comparative aC- Uon of different, on bacteria, 95,96; action of, GENEKAL INDEX. 945 on particular species of, 97; mode of experi- menting on the action of, on the reproduction of bacteria, 97 ; Koch's experiments with three groups of disinfectants on bacteria, 98, 99; action of, on the development and growth of bacilli, 99; strength of various disinfectants re- quired to prevent the development of anthrax bacilli, 100; effect of, on the action of bacteria in the animal body, 104; action of, on inver- tebrata, 109-116; on the medusae, 109-114; on mollusca, 114; on ascidians, 114; on annulosa, 115 ; on muscle, 116-138 ; on voluntary muscle, 116 ; as poisons to the muscles, 124-128 ; the ac- tion of, on muscle is voluntary, not absolute, 131; on in voluntary muscular fibre, 132; hypo- thetical considerations regarding the action of, on . muscles, 136 ; on nerves, 138-147 ; on mo- tor nerves, 138 ; on motor nerve-endings, 140 ; on the trunks of motor nerves, 144 ; on sen- sory nerves, 144 ; on the peripheral ends of sen- sory nerves, 147; on the spinal cord, 147- 167 ; on the conducting power of the cord, 147 ; on the reflex action of the cord, 148-151 ; di- rect, indirect, and inhibitory paralysis of the cord by, 151-158 ; explanation of the action of certain drugs on a given hypothesis, 158- 163 ; stimulating action of, on the reflex pow- ers of the cord, 163-167 ; on the brain, 167- 196 ; depressant action of, on the motor cen- tres, 171 ; irritant action of, on motor centres in the brain, 172 ; action of, on the sensory and psychical centres in the brain, 175-196 ; drugs which increase the functional activity of the brain, 176 ; nerve stimulants, 176 ; cerebral stim- ulants, 176 ; which lessen the functional activity of the brain, 178; hypnotics, or soporifics, 179; narcotics, 182; anodynes, or analgesics, 183; anaesthetics, 185-193; antispasmodics, 193; ac- tion of drugs on the cerebellum, 195 ; ON the organs of special sense, 196-207 ; on the eye, 196 ; on the conjunctiva, 196 ; on the lachrymal secretion, 196; on the pupil, 197-201; on ac- commodation, 201 ; on intra-ocular pressure, 202 ; on the sensibility of the eye, 204 ; in pro- ducing visions, 204 ; on hearing, 205 ; on smell, 206; on taste, 206; on respiration, 207-228; action of, when injected into the jugular veins, 213 ; on the respiratory centre, 214-218 ; on the respiratory nerves, 218-228 ; on the circula- tion, .229-300; method of ascertaining the action of, on the circulation, 234-236 ; diagrams illustrative of this, 238-242; investigation of the action of, on the arterioles, 243-246 ; another method of ascertaining the action of, on the blood vessels, 246-248 ; action of, on the vaso- motor and vaso-dilating nerves, 248 ; on reflex contraction of vessels, 251 ; as the cause of al- teration in blood-pressure and pulse rate, 257 ; on the pulse rate, 259 ; on the cardio-inhibitory functions of the vagus, 260 ; on the reflex stim- ulation of the vagus, 261 ; on vagus roots, 261 ; on the heart of the frog, 263-269 ; on the mus- cular substance of the heart, 269-273 ; on the vagus in the frog, 273 ; on inhibition of the heart, 274, 275 ; theories regarding the mode of action of, upon the heart, 275-278 ; diagram to illustrate the action of, on the various parts of the circulatory apparatus, 278 ; on the vagus centre, 279; on the accelerating and vaso- motor centres, 279 ; on the vagus ends in the heart, 280 ; on the inhibitory and. motor ganglia, 280; on the cardiac muscle, 281; on the vaso- motor nerves, 281 ; on the capillaries, 282 ; various experiments with, on the heart of a frog, 282-291 ; therapeutic use of, acting on the circulation, 291-300 ; as cardiac stimulants, 291 ; as vascular stimulants, 292; as cardiac tonics, 293-297; as vascular tonics, 297; as cardiac sedatives, 299 ; as vascular sedatives, 300 ; ACTION OF, ACTING ON THE SURFACE OF THE body, 301-310; as irritants and counter-irri- tants, 301-306; as rubefacients, 304,305; as vesicants, 305 ; as pustulants and caustics, 305, 306 ; as emollients and demulcents, 306-308 ; as astringents, 308, 309; as styptics, 309, 310; ACTION OF, ON THE DIGESTIVE SYSTEM, 310-355 ; on the teeth, 310 ; as sialagogues, 311-317 ; as 60 refrigerants, 317 ; as antisialics, 318 ; as gastric tonics, 318 ; on the secretion of the stomach, 320 ; on the movements of the stomach, 321 ; as antacids, 322 ; as emetics, 323-328 ; as gastric sedatives and anti-emetics, 328 ; as carmin- atives, 329, 330 ; action of, on the intestines, 331-355; on absorption from the intestines, 336 ; as intestinal astringents, 337 ; as purga- tives, 338-344; as irritant poisons, 344-847; action of, on the liver, 347 ; as hepatic stim- ulants, 350 ; as cholagogues, 351-355 ; as hepatic depressants, 354; action of, on the pancreas, 354 ; as anthelmintics, 355 ; ON tissue change, 356-364 ; as tonics, 356 ; ON excretion, 364- 385 ; on the kidneys, 364 et seq. ; as diuretics, 372-375; as albuminuria, 375 ; as lithontripties, 376 ; on the skin, as diaphoretics and sudorifics, 377-381 ; as antihydrotics or anhydrotics, 381- 383; on the bladder, 383-385; on the genera- tive syst M, 386-393; as aphrodisiacs and anaphrodisiacs, 386-890 ; as emmenagogues and ecbolics, 390-392; upon milk, 392, 393; methods of administering, 393-416 ; by the skin, 393 et seq. ; as baths, 395 ; cold baths, 396- 401 ; warm baths, 401 ; medicated baths, 403 ; vapor baths, 404 ; air baths, 404 ; friction and inunction, 405 ; endermic application of, 407 ; hypodermic administration of, 407 ; application of, to the eye, 409 ; to the ear, 409 ; to the nose, 410 ; to the larynx, 411 ; to the lungs, 412 ; to the digestive tract, 413 ; to the urethra, 415 ; to the vagina and uterus, 415 ; as antidotes, 416- 421 ; antagonistic action of, 422-425 ; table showing the antagonism of, 425 Drunkenness, general effects of, 651 et seq,; causes and treatment of, 654 Dryadese, 771 Duboisine, action of, as a mydriatic, 198 ; on the respiratory centre, 215 ; on the inhibitory gan- glia, 280 Dujardin-Beaumetz, reference to, 874 Dulcamara, characters, action, and uses of, 834 ; action of, on the nervous system, heart, respi- ration, and temparature, 835 ; as an alterative, 835 Dumas, M., points out a curious relationship between the potassium and the lithium group of elements, 43 Dyad metals, 546 et seq. Dyspepsia, atonic, slight stimulants produce ap- petite in, 319 Dyspnoea, nature and cause of, 212-214 ; action of aconitia on, 699 E. Ear, various diseases of the, and their treatment, 205 ; action of salicylic acid on the, 693 ; ap- plication of drugs to the, 409 ; diagram of a vulcanite syringe for injecting solutions into the, 410 ; action of pilocarpine on the, 749, 750 Eau de Cologne, as a cardiac stimulant, 291 ; as a general stimulant, 739 ; uses of, in headache, fainting, &c, 655 Ecbolics, nature and action of, 391 ; list of the chief, 391 ; uses of, 391 ; adjuncts to 392 Eckhard, references to, 160ra., 161n., 249rc. Egg albumen, 920 Yolk of, 920 Elaterin, characters and action of, 784 ; a power- ful hydragogue cathartic, 7 5 ; action of, on the nervous system, 785 Elaterium, as a drastic purgative, 340 ; and a hydragogue, 340 ; characters and composition of, 784 Elder, characters and uses of, 793 Flowers, 793 Elecampane, 813 Electricity, effects of, on the protoplasmic move- ments, 71 ; on the action of infusoria, 74 Elements composing the earth, list of the, with their symbols and atomic weights, 35, 36, 37 ; nature of the, 37 ; recent spectroscopic re- searches prove them to be compounds, 37 ; dissociation of the, 38 ; spectrum analysis of 946 GENERAL INDEX. the, 38-41 ; evolution of the, 41 ; classification of the, 41; according to their atomic weight, 41, 42 ; in groups, 42 ; iu series, 43 ; Mendel- ejeff 's classification, 45 ; differences between the even and the uneven series, 46 ; the class- ification in series not yet perfect, 46 ; general relations of the, 47-52 ; organic radicals, 47 ; chemical reactions of the, 47 ; physiological re- actions of the, 48 ; the latter divided into groups, 4S; relation between atomic weight and physi- ological action, 49 ; between spectroscopic char- acters and physiological action, 49 ; connection between chemical constitution and. physiologi- cal action, 50 ; relation between isomorphism and physiological action, 51 ; Blake's division of the, into nine groups, according to their physi- ological action, 51 ; his classifications and con- clusions cannot be accepted as final, 52 Elemi, nature and use of, 756 Elixir aurantii, 433, 738 Elixirs, 433 Elm, characters and uses of, 878 ; as a demulcent, astringent, and tonic, 878 Bark, 878 ; characters of, 878 Embrocations, or liniments, 439 Emetics, aid the action of antiperiodics, and sometimes cure ague without their aid, 109 ; powerful adjuncts to expectorants, 228 ; nature and action of, 323 ; divided into two classes, local and general, 326 ; the various uses of, 326- 328; in simply emptying the stomach, 326; in expelling foreign bodies from it, 326; in re- moving the contents of it, 326 ; in removing poison from it, 327 ; and bile, 327 ; and obstruc- tions from the air passages, 327 ; contra-in- dications of, 328 ; anti, 328 ; salt as an emetic, 525 ; alum as, 557 ; sulphate and acetate of zinc as, 568 ; sulphate of copper as, 304, 573 ; sub- sulphate of mercury as, 587 ; antimony as, 616; hydrochlorate of apomorphine as, 713 ; mustard as a prompt and direct, 728 ; ipecacuanha as an, 804 ; Phytolacca root as, 859 ; iris as, 902 Emetine, action of, on muscle, 125; as a depress- ant expectorant, 227; action of, on the cardiac muscle, 281 ; as a general emetic, 326 Emmenagogues, nature and action of, 390; list of indirect and direct, 390, 391; caulophyllum as an emmenagogue, 708; oil of rue as an, 747; tansy as, 808; hedeoma or pennyroyal as, 855; origanum as, 856 Emollients, nature, action, and therapeutic uses of, 306-308 Emphysema, with copious secretion of mucus, a combination of morphine and atropine useful in, 223 Empirical therapeutics, explanation and ex- ample of, 35 Emplastrum Ammoniaci, 433, 789, 819 cum Hydrargyro, 433, 583, 597, 789, 819 Arnica-, 443, 811, 819 Asaf(X-Lid;e, 433, 597, 787, 788, S19 Belladonna', 433, 819,836 Calefaciens, 433, 860, 885, 924, 925 Cantharidis, 433, S85, 914, 919, 924, 925 Capsici, 433, 819, 835 ('(•rati saponis, 433, 483, 596, 819, 924 Ferri, 433, 597, 631, 819, 885 Galbani, 433, 597, 788, 819, 924 Ilydrargyri, 433,583, 597, 819 Icthyocolke, 433 Opii, 433, 597, 709, 819, 885 Picis, 133, 819, 860, 882, 885, 924 Burgundicse, 133, 885 Canadensis, 433, 886 (•mn Cantharide. 433, 885 Plumbi, 433, 597, 819 Iodidi, 433, 600 Resinse, 4:;:;, 597, 819, 885 Saponis, 133, 597, 819, 885 Endermic application of drugs, 107 Endocarditis, ulcerative, micrococci present in, 103 Endogense, 888 Enema Aloes, 134, B91, 892 Magnesia Bulphal is, 134, 819 Opii, 134, 709 Enema — Terebinthinae, 434, 883 Asafcetidie, 434, 787 Tabaci, 434, 842 Enema of sulphate of magnesia, 560 Enemas, injections, or clysters, 433 Enemata, nature and uses of, 415 Engelmann, reference to, 133 Enzymes, nature of, 84 ; action of drugs on, 85 : functions of, 85 ; list of the chief, in the animal body, 85 ; method of ascertaining the action of drugs on, 85 ; table and diagram showing the different action of drugs on different, 86 ; meth- ods of liberating from zymogens, 87 ; alteratives supposed to alter in some way the action of, 358 Epidermic application of drugs, 349 Epsom salts, 560 Erbium, symbol and atomic weight of, 36 Ergot, action of, on the vaso-motor centre, 279; on the motor ganglia, 280 ; as a vascular seda- tive, 300 ; as a styptic acting on the blood-vessels, 309; has the power of lessening or arresting haemorrhage, 310 ; as a direct emmenagogue, 390 ; one of the chief ecbolics, 391 ; as a poison, with its antidotes, 419 ; its characters, compo- sition, and general action, 908 ; special action, 909 Ergot, extract of, its action on the nervous system, muscles, and sensory nerves, 910 ; on the circu- lation and heart, 910 ; on the vaso-motor system, respiration, and secretion, 910 ; on the alimen- tary canal and uterus, 911 ; therapeutics, 911 Ergot of rye, 908 Ergotinic acid, 909 Ergotinin, 909 Ergotism, symptoms of, 909 Ericaceae, 814 Erysipelas, caused by micrococci, 103 Erythrophloein, as a cardiac tonic, 294 Erythrophloeuui, state of the pulse and blood- pressure in a cat after division of ihe spinal cord and injection of, 239 ; action of, on the vagus roots, 260; on the caidiac muscle, 281; as a cardiac tonic, 294; diagram showing the effect of, upon the blood-pressure; and secre- tion of urine, 371 ; as a refrigerant diuretic, 374 Erythroxylaceae, 732 Erythroxylon (coca), characters and composition of, 732 ; action of, as a powerful local anaesthetic, 732; on the nerve centres, respiration, pulse, and blood-pressure, 733 ; on mammals, 733 ; on the secretion of saline and sweat, 733; on the urine and temperature, 733 ; uses of, 733 Escharotics, acids as, 475 Esmarch, reference to, 679 Essences, 434 Essentia Anisi, 434, 790 Mentha' piperita', 434, 853 Ether, action of, on bacteria, 98; on annulosa, 115; on muscle, 124 et seq.; on psychical pro- cesses, 175; nature of narcosis by, 185; first used as an amesthetic in dentistry, 192; as an antispasmodic, 194 ; action of, on the respiratory centre, 215; on the brain, 218; on the vaso- motor centre, 279; on the motor ganglia, 280; as a cardiac stimulant, 291 ; as a vascular stim- ulant, 292 ; as a rubefacient, 304 ; as a sialagogue, 314; as a local sedative, 328; and acetic acid, as a carminative, 330 ; action of, on the vascularity of and absorption in the intestines, 336 ; its preparation, character and uses, 660; action of, on the skin, 662; mouth, stomach, and intes- tine, 662 ; cerebral hemispheres, spinal cord, and medulla oblongata, 662; muscles, nerves, and blood, 662; and heart, 662; dill'crence be- tween chloroform and, 663, 664 Ether, simple and saline — Acetic, 661 Amyl, nitrite of, 66 I Compound spirit of, 664 Nitro-glycenne, glonoine, 668 Oil of, 668 Pure, 661 Spirit of, 662 Nitrous, 664 Stronger, 661 Ether spray as an anaesthetic, 146 GENERAL INDEX. 947 Ethereal oils, action of, on bacteria, 104 Ethyl, iodide of, preparation and characters of, 669 ; action and uses of, as an anaesthetic, alter- ative, diuretic, antispasmodic, 669 ; mode of administration, 670 Ethyl-atropine, action of, on the motor nerves, &c, 839 Eucalyptol, action of, on bacteria, 100; as a disin- fectant, 108 ; and antiperiodic, 108 ; as a vermi- cide, 355 Eucalyptus, character, action, and uses of, 781 ; oil of, 781 ; action of, as an antiseptic, 781 ; on the blood, spleen, and skin, 781 ; effects of, when swallowed, 781 ; action of, on the nerve centres, spinal cord, brain, medulla, and heart, 781 ; on the temperature, 781 ; how excreted, and uses of, 781 Eucalyptus oil, action of, on enzymes, 86 ; on bac- teria, 96 ; use in blood-poisoning, 108, 781 Eulenberg, references to, 57, 185 Euonymin, as a cholagogue, 340; as a hepatic stimulant, 351 Euonymus, wahoo, nature and action of, 753 ; acts as a hepatic stimulant, &c, 754 Eupatorium, characters and use of, 810 ; as atonic, diaphoretic, emetic, and cathartic, 810 Euphorbia, action of, on the nose, 219 Euphorbiacese, 866 Euphorbium, as a vesicant, 304 Eustachian tube, the, some diseases of, and their treatment, 205 Evolution of species and of elements, 41 Ewald, A., reference to, 163 Ewers, references to, 219, 260ra. Excretion, action of drugs on, 364-385 Exogense, exogens, 697 et seq., 753 etseg., 882 etseq. Expectorants, nature and action of, 223-228 ; action of, on the secretions of the air passages and the mucous membranes, 224 ; on the expul- sive mechanism, 227; list of depressant, 227; of stimulating, 227; adjuncts to, 228; antimony as an expectorant, 617 ; cimicifuga (black snake- root) as an, 703; senega root as a stimulating, 730; myrrh as, 756; balsam of Peru as, 760; balsam of Tolu as, 760 ; cheken as, 779 ; galba- num and ammoniacum as, 788 ; ipecacuanha as, 802; benzoic acid as, 817; marrubium as, 855; cascarilla bark as, 866 ; garlic as, 889 ; squill as, 890 Experiments, use of, 63 ; objections to, answered, 65-67 ; erroneous deductions from, 67 ; mode of conducting, for examining the action of drugs on infusoria, 73; for testing the power of pro- toplasm over oxygen, 78 ; the action of drugs on oxidation, 79; the action of drugs on alco- holic fermentation, 88; on the movements of bacteria, 93 ; on the destruction of germs, 93 ; on the action of drugs on the reproduction of bacilli, 97 ; and on the development and growth of bacilli, 99 ; for testing the action of drugs on the motor nerves, 141 ; on the reflex action of the spinal cord, 151 ; on the respiratory centre, 215 ; on the action of drugs on the circulation, 231-234; on blood-pressure, 234-237; on the action of heat and cold on the frog's lung, 244 ; on the action of the heart on blood-pressure, 258 ; on the heart of the frog, 263-268 ; Stannius's, on the action of the various cavities on the frog's heart, 282 ; Ranvier's, on dropsy, 298 Expressed oil of nutmeg, 860 Extract of ergot, 910 Extract of malt, 905 Extracts, 434 ; fluid or liquid extracts, 434; fresh or green extract, 437 Extractum, Aconiti, 434, 437, 697, 698 Fluidum, 434, 698 Aloes aquosum, 434, 891 Barbadensis, 434, 892 Socotrinse, 434, 891 Anthemidis, 434, 809 Arnicse Radicis, 434, 811 Fluidum, 435, 811 Aromaticum fluidum, 435 Aurantii amari, 435, 737 Belse liquidum, 435, 741 Belladonna, 835 Fluidum, 434, 435, 436 Alcoholicum, 434, 836 Extractum — Brayerae fluidum, 435, 773 Buchu fluidum, 435, 748 Calami fluidum, 435, 903 Calumbse, 706 Fluidum, 435, 436, 706 Cannabis Indices, 879 Fluidum, 435, 436, 879 Capsici fluidum, 435, 835 Castanese fluidum, 435, 878 Cheken fluidum, 780 Chimaphilse fluidum, 435, 815 Chiratse fluidum, 435, 831 Cimicifugse fluidum, 435, 703 Cinchonse, 795 Flavse liquidum, 435, 795 Fluidum, 435, 436, 795 Colchici, 435, 436, 897 Aceticum, 435, 436, 482, 897 Radicis, 897 Fluidum, 435, 436, 897 Seminis fluidum, 435, 898 Colocynthidis, 435, 782 Compositum, 435, 783, 819, 834, 891, 892, 901 Conii, 786 Alcoholicum, 435, 786 Fluidum, 435, 436, 438, 786 Cornus fluidum, 435, 793 Cubebse fluidum, 435, 871 Cypripedii fluidum, 435, 900 Digitalis, 844 Fluidum, 435, 436, 844 Dulcamara? fluidum, 435, 834 Ergot*, 908 Fluidum, 436, 908 Liquidum, 436, 908 Erythroxyli fluidum, 436, 732 Eucalypti fluidum, 436, 781 Euonymi, 435, 754 Eupatorii fluidum, 436, 810 Filicis liquidum, 436, 907 Frangulse fluidum, 436, 753 G-elseniii fluidum, 436, 827 Gentianse, 830 Fluidum, 436, 830 Geranii fluidum, 436, 730 Glycyrrhizse, 757 Fluidum, 436, 757 Liquidum, 436,757 Purum, 435, 757 Gossypii radicis fluidum, 436, 734 Grindelise fluidum, 436, 813 Guaranse fluidum, 437, 732 Hsematoxyli, 435, 765 Hamamelidis fluidum, 436, 874 Hydrastis fluidum, 436, 705 Hyoscyami, 841 Alcoholicum, 405, 841 Fluidum, 435, 436, 438, 841 Ipecacuanha? fluidum, 436, 803 Iridis, 902 Iridis fluidum, 436, 902 Jalapse. 435, 834 Juglandis, 435, 873 Krameriae, 731 Fluidum, 435, 731 Lactucse, 435. 437,811 Lactucarii fluidum, 436, 811 Leptandrse, 851 Fluidum, 435, 436, 851 Lobelias fluidum, 436, 814 Lupuli, 435, 881 Lupulini fluidum, 436, 881 Malti, 435, 905 Maticse fluidum, 436, 872 Mezerei iEthereuin, 436 Fluidum, 436 Nucis Vomicae, 822 Fluidum, 436, 822 Opii, 435, 709, 710 Liquidum, 436, 709 Papaveris, 435, 709 Pareirse, 707 Fluidum, 436, 707 Liquidum, 436, 707 Physostigmatis, 435, 761 948 GENERAL INDEX. Extractum — Pilocarpi fluidum, 436, 749 Piscidise erythrinse fluidum, 769 Podophvlli, 704 Fluidum, 435, 436, 704 Pruui virginiana? fluidum, 436, 777 Quassiae, 752 Fluidum, 435, 436,752 Rhei, S57, 858 Fluidum, 435, 436,857 Rhois glabrse fluidum, 436, 755 Rosa? fluidum, 436,773 Rubi fluidum, 436,772 Rumicis fluidum, 436,859 Sabinae fluidum, 436, 887 Sanguinarire fluidum, 436, 726 Sarsae liquid urn, 439, 888 Sarsaparillae fluidum, 436, 888 Compositum fluidum, 436, 864, 888 Scillse fluidum, 436, 890 Scutellariae fluidum, 436, 856 Senegte fluidum, 434,731, 766 Senme fluidum, 436 Serpentarise fluidum, 436, 866 Spigelian fluidum, 436,828 Stillingiae fluidum, 436, 867 Stramonii, 842 Fluidum, 435, 436, 842 Taraxaci, 810 Fluidum, 435, 436, 810 Tritici fluidum, 436, 904 Uvse ursi fluidum, 436, 815 Valerianae fluidum, 436,805 Veratri viridis fluidum, 436, 894 Viburui fluidum, 436, 806 Xanthoxyli fluidum, 436, 749 Zingiberis fluidum, 436, 900 Eye, action of drugs on the, 196-205; chief drugs "employed in the treatment of disease of the cornea, 196; on the conjunctiva, 196; on the lach- rymal secretion, 196; projection of the eyeball, 197; on the pupil, 197; diagram to show the ner- vous supply of the, 197; the iris of the, and the two muscles of which it consists— the sphincter and the dilator, 197; drugs which act on the iris — mydriatics and myotics, 198; causes and consequences of the dilatation of the pupil of the, 199, 200 ; and of the contraction of the, 200 ; action of drugs on accommodation, 201; on iutra-ocular pressure, 202; uses of mydriatics and myotics, 203; action of drugs on the sensi- bility of the, 204; in producing visions, 204 application of drugs to the, 409 ; action of puri fied chloroform on the eye, 679; of aconitine, 701 of opium on the pupil of the, 717; of cocaine. 732; of pilocarpine, 749-752; of Jamaica dog- wood on the pupil of the, 769; of gelsemium, 827; of belladonna or atropine, 838; of Indian hemp or American cannabis, on the pupil of the, 800 Fainting, cause of, 230; effect of emptying the bladder on, 231 : treatment of, 231 Farina lini, 729 Fasting, rapid effects of drugs when taken, 58 Fat*, as emollients, 307 Fatty degeneration, due to a twofold action, 360; of the In er, stomach, and kidneys produced by phosphorus, 604; what this chiefly depends on, 604; of the vessels, and its result, 604; of the liver and other organs produced by arsenic, 607 Febrifuges. See Antipyretics Feet, cold, remedy for, 181 Feitelberg, reference to, 299ft. Fel boris insplssatum, 917 Purificatura, 917 Fennel, as a carminative, 330; as a stimulanl diu- retic. 37 1 : characters, composition, and uses of. 789 Fruit, characters, and usee of, as a stimulanl and carminative, 789 Ferments, inorganic, 82; organic and organized, 83 ; nature of, 83 ; the process of fermentation divided into two kinds, 84; diastatic amylolytic, 85; inversive, 85; proteolytic, 85; action of drugs on, 85-87; yeast and bacteria, 88 etseq.; description of the chief oiganized, 88 etseq.; Brefeld's classification of, 89; diagram illustrat- ing the principal organized, 90. See also Yeasts, Mould fungi, Bacteria, Bacillus, &c. Fern, male, its characters, physiological action, and therapeutics, 907; method of administra- tion, 907 Ferri Arsenias, 528, 611 Carbonas Saccharata, 906 et ammonise citras, 631 et Quiniae citras, 631, 635, 796 et Quininse citras, 796 et Strychnime citras, 635, 822 Iodidum, 469 Oxidurn magneticum 631 Peroxidum humidum, 631 Phosphas, 528 Sulphas exsiccata, 630 Ferric chloride, action of, on bacteria, 98; as an astringent, 308 ; as a styptic, 309 Ferrier, Dr., reference to, 160,171,183,195,204,206; composition and use of his snuff, 622 Ferrous salts, physiological action of, 51 Ferrous sulphate, action of, on bacteria, 98 Ferrum tartaratum, 511, 631 Fever, remittent, depends on the presence of a spirillum in the blood, 109 Fibres, efferent and afferent, position and func- tions of the, 313, 314 Fibrin, condition of, when digested with pan- creatic juice, 354 Fibrine, effects of heating, 84; and of pepsin on, 84 Fick, A., his kymograph, 235, 75S Fick, J., references to, 122 Figs, as demulcents, 307 ; as laxatives, 339 ; char- acters and composition of, 879; uses of, 879 Filices, 907 Filix mas, as a vermicide, 355 Fir wool oil, action and use of, 884 Fire damp, as a poison, with its antidote, 417 Fish, mechanism of, respiration in the, 208; dia- gram of a, 208 Flag, blue, 902; as an emetic or cathartic, and a stimulant, 902 Flag, sweet, as a stomachic stimulant, 903 Flaxseed, 729 ; oil of, 729 Flies, Spanish, 925; external and internal ac- tion of, 925; in very large doses, 925; on the sali- vary glands, 925; on the urinary organs, 926; external and internal use of, 926; as anirritant and counter-irritant, 926; precautious, 926; treatment in poisoning by, 927 Flour, wheaten, 903 Flourens, reference to, 211 Flowers of sulphur, its preparation, characters, &C., 417 Fluorine, symbol and atomic weight of, 36; its relation to other members of a group, 42 Fokker, reference to, 104 Food, discussion as to whether alcohol can be deemed a, 650 Foot baths, warm, utility of, as direct emmena- gogues, 390 Formad, reference to, 103 Formic acid, action of, on bacteria, 98 Foster, M., reference to. 114»., 163 Franck, F., reference to, 171ra., 172». Frankincense, common, characters and use of,882 Fraser, reference to, 143, 158-160, 260»., 422 Freusberg, references to, 167 Friars' balsam, 817 Friction, one of the simplest rubefacients, 304; value of friction of the skin, as an adjunct to cold baths, 405 Fritsch, reference to, 171 Frogs, effects of large and small doses of vera- trine on, 19; and of various poisons, when modified by heat or cold, 59,60; various experi- ments on, 65-67; action of quinine on the mesentery of, 72; act ion ofveratrine on, 126; ex- periment* on the Bartorius of, 129; rhythmical GENERAL INDEX. 949 action of the ventricle of the heart of, 133; experiment on the leg of, 140 ; explanation and diagram of the mode of experimenting on the sensory nerves in, 141 ; experiment on the gas- trocnemius of, 148-151 ; mode of experiment- ing on the action of drugs on the reflex action of the spinal cord of, 151 ; on the heart of, 152 ; diagram showing the nervous system of, 153; experiments with quinine on the spinal cord of, 153; experiments with, 154-161; on the sarto- rius of, 163 ; experiments on the nervous sys- tem of the, 168; diagram of the higher nerve centres of, 169 ; Pi evost's experiment with chlo- roform on the brain of, 187 ; the easiest way of anaesthetizing, 190, 191 ; action of alcohol on 196 ; on convulsions in, 212 ; diagram to illus- trate the effects of the horizontal and vertical position of the, in shock, 230; experiments on the arterioles of, 243 ; as to the effects of drugs on the vessels of, 243; and as to the effect of heat and cold on the lung of, 244; diagram illustrative of this, 244; method of maintain- ing artificial circulation in 245; method of measurement by the rate of flow, 246; ex- periments on the out-flow of blood from divided vessels in, while the nervous system is intact, 250; heart beats in the, when im- perfectly filled, 258; the heart of, 264; diagram of the heart of, 264; diagram of the auricular septum in, 264 ; action of drugs on the heart of, 265; instrument for showing the action of heat and cold, and of poisons on the heart of, 265; effect of heat and cold on the action of the heart of, 265; Ludwig and Coats's apparatus for observing alterations in the pulsations and rhythm of the heart of, 266 ; Williams's, 266, 267; tracings showing changes in the pulsa- tions of the apex of the heart of, 269 ; irritation of the vagus of, causes still-stand of the heart of, 273; actions of two classes of poisons on the vagus of, 274; difference between the action of the accelerating nerves and the inhibitory fibres of the vagus of, 275; Stannius's experi- ments on the heart of, 282-285; diagrams illus- trative of these, 282-285; Gaskell's experiments on, 284; with illustrative diagram, 284; general considerations regarding the heart of, 285; vagus stimulation on the heart of, divided into five classes, 287-289; diagrams illustrative of this, 288; hypothesis regarding the action of the vagus on the heart of, 288; with illustra- tive diagrams, 289 ; inhibition in the heart of, 290 ; experiments with, as to the antagonism of drugs, 422 ; action of chlorides on the nervous system of, 504, 547 ; of soda on, 525 ; action of barium on, 548 ; of mercury, 582 ; of phosphorus, 603; of arsenic on the skin of, 608; diagrams of the epidermis of, before and after poisoning by arsenic, 608 ; action of antimony on the heart and skin of, 615, diagram of the vertical sec- tion of the epidermis of a, poisoned by anti- mony, 616; of solution of perchloride of plati- num on, 641; of salts of iron on, when injected subcutaneously, 628 ; of the nitrite of amy!, 667 ; of chloral hydrate, 670; of iodoform, on the heart of, 682 ; carbolic acid produces convul- sions in, 6S9; action of resorcin on, 691; of ac- onitia, 698; of staphisagrine, 702; of opium, 715; of caffeine, 740; of quinine, 803; of bella- donna or atropine, 837; of nicotine, 843; of digitalis on the heart of, 847; of veratrine on the heart muscle of the, 897 ; of colchicum on the spinal cord of the, 898 ; and of ergotinic acid, 909 ; of cornutine, 909 Fruit, Bael, 741 Capsicum, 835 Caraway, 790 Coriander, 792 Dill, 790 Fennel, 789 Hemlock, 786 Squirting cucumber, 784 of the dog-rose, 773 Fuchsin, 695 Fuller's earth, as a demulcent, 307 ; nature and uses of, 555 0. Gadhxe, 921 Galbanum, as an antispasmodic, 195 ; characters and use of, as a stimulant expectorant, 788 Gall, ox, inspissated, 917 Gallic acid, 877 ; properties and uses of, 877 Gallici, mis tur a spirit us vini, 920 ; its therapeutics, 920 Gallinse, 920 Gallium, symbol and atomic weight of, 36 ; prop- erties of, 46 Galls, as an astringent, 308 ; characters, action, and uses of, 875 Gamboge, as a drastic purgative, 339 ; and a hy- dragogue, 340; characters, action, and uses of, 744 Gamgee, A., reference to his Physiological Chem- istry, Tin. Ganglia, motor cardiac, 253; inhibitory, 253; diagram to show the supposed relation of mo- tor, in the heart to accelerating fibres, 254; Kemak's and Bidder's, 264, 268, 272; motor, in- hibitory, and quickening, supposed to be pre- sent in the nervous system of the frog, 275- 277 ; inhibitory and motor, of the heart, 280 ; functions of the cardiac, 286 Gargles, method of using, 413 Garlic, as a stimulating expectorant, 227; action of, 889 ; as an antiseptic, irritant, and carmin- ative, 889; as a stimulant, expectorant, and diuretic, 889 Gartner, references to, 59 Gases, action of different, on the frog's heart, 271; poisonous gases, with their antidotes, 416 Gasket], references to, 111, 242, 245, 249w., 259, 271n., 275, 276«., 285, 289 Gastric juice, action of acids on the, 475 Sedatives, and anti-emetics, nature, number, and uses of, 328; divided into local and general, 328 ; adjuvants to, 328 Stimulants, alkalies as, 501 Syphon, nature and us?es of, 414 Tonics, nature and action of, 318 et seq.; purgatives and cholagogues may act as in- direct, 322 ; states in which they are indi- cated, 356 Gastro-salivary circulation, diagram of, 316 Gaultheria, oil of, characters, action, and use of, 816 ; as an antipyretic, 816 Gelatine, as a demulcent, 307 ; solution of, 921 Gelsemine, as a spinal stimulant, 167 ; as a local and general anodyne, 183 ; as a mydriatic and myotic, 198 ; action of, on the respiratory cen- tre, 209, 215. See Gelsemium Gelsemium, as a poison, with its antidote, 420; antagonism of, to opium and atropine, 420-425 ; characters and action of, 827; on the eye, the spinal cord, the motor centres, 827; on the head, the vagus, the blood, pulse, and heart, 827; uses of, 827 Geltowsky, references to, 71n. Generative system, action of drugs on the, 386-393; action of the ceiebral and spinal cen- tres on the, 386; action of drugs on the, as aphrodisiacs, 387 ; as anaphrodisiacs, 388 ; as emmenagogues, 390; andasecbolics, 390; action of drugs upon milk, 392 Genito-urinary tract, action of opium on, 724 Gentian, 830 Boot, characters, and composition of, 830; preparation and use of, 831 Gentianacese, 830 Geraniacese, 730 Geranium, (cranesbill), characters, composition, and action of, as an astringent, 730 Gianuzzi, references to, 213, 829 Giant cells, action of iodoform on, 683 Gilbert, reference to, 132 Gin, as a cardiac stimulant, 291 ; and as a stim- ulant diuretic, 373 Ginger, as a carminative, 330 ; as a sialagogue, 314, 315 ; characters, action, and uses of, 900 ; as a carminative, 900 Gingerbread, as a laxative, 639 950 GENERAL IXDEX. Glanders, caused by a species of bacillus, 103 Glands, poisonous action of tbe heavy metals on the, 564 Glandular system, antagonistic action of drugs on the, 423 Glauber's salt, 529 Glaucoma, nature of, and mode of treatment, 204 Glomeruli, the result of arterial presure on the, 369 ; poisonous action of the heavy metals on the, 564 Glycerine, action of, on enzymes, 86; on bacteria, 9S : as a demulcent, 307 : characters and uses of, '819, 820 Glycerines, 437 Glvcerinurn, 437 " Acidi Carbolici, 437, 6SS, 820 Gallici, 437, 820, 877 Tannici, 437, 820, 876 Amyli, 437. 820, 904 Boracis, 437, 820 Glyceritum vitelli, 437, 820, 920 Glycogen, formed and stored up by the liver, 350; glycogenic function of the liver destroyed by phosphorus, aisenic, and antimony, 350 Glycyrrhizinum ammoniatum, 757 Gold, symbol and atomic weight of, 36; as an al- terative, 35S ; properties, action, and uses of, free from metallic impurities, 640; solution of chloride of, 641 ; cbloride of, and sodium, 641 Goltz, reference to, 167, 250 Gonorrhoea, caused by micrococci, 103 Gout, rheumatic. See Rheumatic gout Granville, Mortimer, his proposed mode of re- lieving pain, 1S5 Grass, couch, 904 Graves, Dr., reference to, 617 Grawitz, references to, 89 Griffith's mixture, 630 Grindelia, characters and uses of, 812 ; in asthma, dyspnoea, and as a local application, 812 Groups, arrangement of the elements in, 42 Grutzner, reference to, 58 Guaiac resin and tincture of guaiac, experiments with, on oxygen, 7S; as a stimulant diuretic, 374 Guaiaci, resin a, 445 Guaiacum, as an alterative, 358; as a direct eni- menagogue, 391; guaiacum resin, characters, composition, action, and uses of, chiefly in the treatment of tonsillitis, 745; guaiacum wood, nature and composition of, 745 Guanidine, action of, destroyed by extremes of heat or cold, 60; effect of "temperature on, ex- traordinary, 162 ; action of, on the motor gan- glia, 280; on the cardiac muscle, 281 Guarana, characters, composition, and uses of, 732 Guareschi, references to, 104, 349 Gum, as a demulcent, 307 Gum acacia, characters, &c, and uses of, 770; gum arabic, 770 Gumchi, 760 Gun cotton, preparation and use of, 735 Gutta-percha, characters and use of, S16 Guttifene, 744 Gymnosperms, 8S2. II Habit, effect of, on the action of drugs, 58 Hsematemesis, value of astringents and styptics in, 809 Hainatin, nature and spectrum of, SO Hsematinics, or blood tonics, nature, actions and 084 - "f. 357 Ha materia, value of astringents and styptics in, 809 Hsmodromometer, Marey's, 269 Hemoglobin, solution of, 78 ; power of, 70; spec- troscopic examination of, 81; action of, on the frog's ueart,272; treatment to be adopted when tlnre is a deficiency of, in tli*- blood, 856; the quantity of. Increased by hsematinics, 356 Ha moptysis, value of astringents and styptics In, 809 Haemorrhage, action of astringents and styptics in lessening or arresting, 309, 310 ; importance of absolute quiet in severe, 310; emetics to be avoided in persons suffering from, 328 Hall, Marshall, reference to, 220 Halogen elements, the general source, characters and mode of preparation of, 464-472 Haloid Compounds — Bichloride of methylene, 673 Bromal hydrate, 673 Bromide of ethyl, 669 Chloral, 670 Hydrate, 670 Chloroform, 674 Purified, 674 Croton chloral hvdrate, 673 Hydrate of chloral, 670 Iodide of ethyl, 670 Hanramelacea?, 873 Hamamelis, as a vascular sedative, 300; charac- ters and use of, 874 Harlev, reference to, 82 Harnack, references to, 117, 125, 143, 260//., 268n. t 271 Haywood, Dr., reference to his use of ether, 193 Head, action of gelsemium on the, 827 Hearing, action of drugs on, 205 Heart and vessels, comparative effect of, on blood- pi essure in different animals, 252; in dogs and rabbits, 252 ; action of the, on blood-pressure, 258; various modes of estimating the action of the, on the circulation, 258; cause of the stop- page of the, in rabbits, dogs, and men, 261; stimulation of the, by increased blood-pressure, 262; difference betwixt the tortoise and the mammalian heart, 262; palpitation of the, 263; the, of the frog, 263 ; diagram of the heart of the frog, 264; action of drugs on the, of the frog, 265 ; instrument for showing the action of heat and cold, and of poisons on the frog's heart, 265; diagram of Ludwig and Coats's frog-heart apparatus, 266; diagram of Williams's apparatus for investigating the action of drugs on the heart of the frog, 267 ; action of drugs on the muscular substance of the, 269; appara- tus for ascertaining the action of drugs on the muscular substance of the, 269; tracings show- ing changes in the action of the frog's heart, 269; difference between the heart-apex and the, 272; diagram to show the difference in the mode of experimenting with the heart and with the apex alone, 272; diagram showing the periodic rhythm of the, 272; tracings of the pulsations of a ventricle of the, 273; action of drugs on inhibition of the, 274; theories regarding the mode of action of drugs upon the, 275 ; hypo- thetical view of the nervous system of the, 276, 278; diagram of the hypothetical nervous appa- ratus in the, 276; detailed description of the physiology of the, 277-291 ; diagram of the heart and vessels to illustrate the action of drugs on the circulatory apparatus of the, 278; drugs which stimulate, or depress, or paralyze the vagus centre of the, 279 ; the accelerating centre, 279; the vaso-motor centre, 279 ; the vagus ends in the, 280; the inhibitory and motor ganglia, 280; the cardiac muscle, 281 ; the vaso-motor nerves, 281 ; the capillaries, 2S2; Stannius'sexperiments regarding the action of the various cavities of the frog's, 282-286 : diagrams illustrative of this, 282,283,284; Gaskell's experiments on the same subject, 284; diagram to illustrate this, 284; general considerations regarding the, 285; reg- ulating action of the nervous system of the, 2S5-2M); diagrams illustrating this, 2SS; hypo- tin >is regarding the action of the vagus of the, 288; illustrative diagrams, 289; inhibiti f the, 290; no satisfactory explanation can as yet be -liven of the action of drugs on the, 290; knowledge in this respect at present in a pro- ve state, 290; drugs which act on the circulation of the, their divisions and subdi- visions, 291 ; cardiac stimulants, 291 : vascular. 292: cardiac tonics, 293; various conditions and diseases of the, in which tonics are most use- ful, 293-297 ; the question of the use of digitalis, in aortic reguigitation considered, 295; pre- GENERAL INDEX. 951 cautions as to position of the, during the ad- ministration of cardiac tonics, 296; action of sedatives on the, 299 ; diagram to show the nervous mechanism by which the action of the, may be depressed by irritation of the stomach, 345 ; action of manganese salts on the, 640 ; of alcohol, 653 ; of spirit of ether, 662 ; of bromal hydrate, 673; of purified chloroform, 676-681: of iodoform, 682; of aconitia, 699,700; of sta- phisagria, 701; of quillaia (saponin), 774; of quinine, 800; of ipecacuanha, 803; ot strych- nine, 823; of gelsemium, 827; of solanine, 835; of tobacco, 907; of digitalin, 911; of camphor, 929 ; of extract of ergot, 981 Heat, effect of, on the power of poisons, 59-63 ; power of, to preserve life in narcotic poisoning, 61 ; effects of, in accelerating death from mus- cular and metallic poisoning, 61 ; effect of, on protoplasmic movement, 71 ; on the action of infusoria, 73; on mould mngi, 90; on bacteria, 93 ; as a disinfectant, 108 ; effects of, on muscle, 117, 121, 128, 133; on the action of strychnine, 162; in inducing sle°p, 180 ; as a local anodyne, 183; dry, in the form of a poultice, relieves pain, 185; action of, on the respiratory centre, 215; apparatus for ascertaining the effect of, on the vessels of the frog's lung, 244 ; instru- ment for showing the action of, on the frog's heart, 265; the most powerful of all cardiac stimulants, 291 ; as a vascular stimulant, 292 ; action o r , on inflammation, 301; diagram to show the effect of, in lessening the pain of in- flammation, 302, as a vesicant, 304; as an emol- lient, 307 Hedeoma, or pennyroyal, characters of, 855; ac- tion and uses of, 855; as a carminative, dia- phoretic, and eramenagogue, 855, 856 Heidenhain, originates the name of zymogens, 88; references to, 352, 366, 368?i. Hellebore, American, 893 ; hellebore root, green, 893 ; action of, on the pulse, S94 Helleborin, action of, on ascidians, 115; on the frog's heart, 271 ; on the cardiac muscle, 281 ; as a cardiac tonic, 294 Hemiptera, 924 Hemidesmus root, characters, composition, and use of, 829 Hemlock (conium), composition, action, and therapeutics of, 786 ; paralyzingpowerof,786 Fruit, 786 Leaves, 786 Pitch, 953 Hemp, Indian, as a hypnotic, 182; as a narcotic, 182; character, action, and uses of, 879; on the sensory nerves, the pupil, and respiration, 880 ; on the pulse, temperature, urine, and digestion, 880 ; uses of, as a soporific, 880 Henle's loop, 366, 368, 376 Hepatic stimulants, nature of, 348 ; action of, 350 ; importance of combining intestinal and, 352; cholagogues, 353; depressants, 354; resin of podophyllum as a, 704; euonymus (wahoo), as a, 754; juglans as a, 873 Hermann, references to, 52, 56, 83, 271n. Hernia, emetics to be used with caution in per- sons suffering from, 328 Hipbaths and mustard hip baths, utility of, as in- direct emmenagogups, 390 Hips (fruit of the dog-rose), 773 Hirt, reference to, 260 Hitzig, reference to, 171 Hock, as a stimulant diuretic, 373 Hoffmann, reference to, 268 Hoffman's anodyne, 664 Holmgren, reference to, 244 Holmium, symbol and atomic weight of, 36 Homatropine, as a mydriatic, 198 Homoeopathy, the principle of, 54 Homolle's digitalin e, 845 Honey, as a demulcent, 307 ; its characters, com- position, &c, 922 Honeys, 441 Hoppe-Seyler, references to, 83«. Hops, as a hypnotic, 181 ; characters of, 881 Horehound. See JMarrubium Horseradish, as a sialagogue, 314; as a carmina- tive, 330 ; as a stimulant diuretic, 374 ; horse- radish root, characters, composition, and uses of, 728 Hot baths, 401 ; hot foot baths, 402 ; hot sitz baths, 402 Howard's plan of artificial respiration, 680 Hiifner, reference to, 365 Humboldt, Alexander von, references to, 59 Humulus, or hop, 880 Hunter, John, reference to, 242 Husemann on lithium, 49 Hydragogues. See Purgatives Hydrargyri Chloridum mite, 583 Corrosivum, 583 Cyanidum, 584 Iodidum rubrum, 469, 584 ^Viride, 470, 584 Oxidum fiavum, 583 Rubrum, 583 Perchloridum, 583, 587 Subchloridum, 583, 587 Sulphas, 584 Flava, 584 Sulphidum rubrum, 583 Hydrargyrum, 583 cum Creta, 552, 583 Ammoniatum, 584 Hydrastin, as a hepatic stimulant, 351 Hydrastis (golden seal), characters, composition, and uses of, 705 ; as a hepatic stimulant and as an antiperiodic, 705 Hydrate, bromal, preparation and characters, 673; action of, 673; irritates the eyes and causes running at the nose, 673; has a narcotic action like chloral, and a powerful paralyzing action on the heart, 673 ; causes salivation and profuse secretion from bronchial mucous mem- brane, 673 ; uses of, 673 Hydrate, croton chloral, action, uses, and admin- istration of, 673 of aluminium, 557 of chloral, action of, on bacteria, 100 Hydriodic acid, physiological action of, 51 Hydrobromic acid, action of, on the ear, 205; di- lute ditto, properties of, &c, 493, 494 Hydrocarbons, fatty series, 645 ; chemical nature and physical character of the, 645 ; boiling point of the, 645 ; physiological action of those belong- ing to the marsh gas series, 646. See under the different names of the series. Hydrochlorate of apomorphine, characters of, 713 ; action of, as an emetic, on the motor centres in the brain and the respiratory and vomiting centres in the medulla, 713, 714; on muscular fibre, the pulse, and the secretion of bronchial mucus, 714; opium versus, 723 Hydrochlorate of morphia, 712; of morphine, 712 Hydrochlorate of pilocarpine, characters and composition of, 749 ; action of, on the nerves, nerve centres, and muscular fibre, 749, 750 ; and on all the secretions of the body, 750 ; on the bladder, uterus, and spleen, 750; on the circula- tion and vessels, 750; on the respiration and temperature, 751 ; on the eye, skin, and throat, 751 ; its chief use in dropsy, 751 ; contra-indica- tions, 752 Hydrochlorate of rosaniline, preparation, char- acters, actions, and uses of, 695 Hydrochloric acid, physiological action of, 51; action of, on the protoplasmic movements, 71 ; on enzymes, 86; on bacteria, 98; as a caustic, 304; arrests secretion of saliva, 318; as a poison, with its antidote, 417; properties and uses of, 479 ; preparations containing free, 479 Hydrocyanic acid, forms acompound with haemo- globin, 80 ; nature and spectrum of this com- pound, 80; effects of, on the blood, 82; on bacteria, 98; as a local anodyne, 183; action of, on the respiratory centre, 209 ; on the muscles of respiration, 213 ; effects of poisoning by, on the color of the blood, 214; the vapor of, has a local sedative action on the lung. 223 ; action of, on the vagus centre, 279 ; on the motor ganglia, 280 ; on palpitation of the heart, 300 ; as a local and general sedative, 328 ; as a poison, with its antidote, 417; antagonism of, to atropine, 422- 425 ; preparation, properties, action, and uses of, 473, 490 et seq.; action of, on the skin, 490; on 952 GENERAL IXDEX. the blood, 491 ; ou respiration, 491 ; ou the heart, I 491 ; on the arteries and nerves, 492 ; diagram J to show the effect of, when applied locallv, 492; uses of, 493 Hydrogen, symbol and atomic weight of, 36; its i preparation and uses, 455 Hydrogen, peroxide of, rapidly decomposed by : finely divided platinum, 82; power of certain metals to absorb, S3 ; it? preparation, properties, | action, and uses, 458 Hvdmquinone, characters, action, and uses of, 692 Hymenoptera, 922 Hyoscyainina? sulphas, 429 Hyoscyaniine, as a general anodyne, 183 ; action of, on the vagus centre. 279; on the vaso-motor centre, 279 ; and inhibitory ganglia, 280 ; as an antihydrotic, 381; as a vesical sedative, 384; as a poison, with its antidotes, 420; antagonism of, to morphine, 422-425 Hyoscyamine, sulphate of, characters, action, and uses of, 841 Hyoscyamus, a hypnotic, 181 ; as a narcotic, 182 ; as a general anodyne, 183; action of, on the vagus centre, 279 ; on the vaso-motor centre, 279; on the inhibitory ganglia, 280; characters, composition, and preparation of, 840 Hyoscyamus leaves, 840 Hyphonrycetes, 89, 90 Hypnotics, or soporifics, nature and action of, on the brain, 179-182; list of the chief, 181; bro- mide of potassium as a hypnotic, 521 Hypodermic administration of drugs, 407; advan- tages of this method, 407; nature and method of the injections, 407; diagram of a syringe for hypodermic injection, 408 ; objections to hypo- dermic injections, 408; method of obviating these, 409 ; account of the syringe employed by Koch, 409; injections of acetate of morphia, 439 Hypophosphite of soda, 530 ; of lime, 554; of iron, 639 Hyposulphite, test for, 497 Hysterical paralysis of the limbs and hysterical aphonia, usefulness of blisters in, 305 Hystozyme, a recently discovered ferment, 85 I. Ice, as an anesthetic, 146; action of, externally, on the mucous membrane, 225 ; the most pow- erful of local sedatives, 328; as a cardiac seda- tive, 300; as an aphrodisiac, 388 Iceland moss, as a demulcent, 307; composition of, 907 IcMhyocolla, 920 Idiosyncrasy, effects of, on the action of drugs, 64 Ignatia, characters and composition of, 821 Image, Mr., of Bury St. Edmunds, his plan of administering chloroform, 680 Indian hemp, 879, 880 White, 829; acts like digitalis, 829 Liquorice, 760 Indiarubber bag for holding hot water, utility of, to invalid travellers, 292 and n._ Indigo, preparation and use of, 771 Indol, action of, on bacteria, 99 Inflammation, chronic and acute, action of irri- tants and counter-irritants in, 301-306; diagrams illustrative of the action of irritants in, 302,303; of the joints, utility of friction in, 305 Infusions, 137 Infusoria, nature of, and action of drugs on, 73 el teg.; mode of experimenting on, 74; effects of hem, cold, and saline solutions on, 74, 75: of acids, alkalies, and other drugs on, 75; oxi- dation of, 75-78 Infusum Anthemidis, 138,809 Aurantii, 438, ::;s Composltum, 438, 788, 789, 778 Bravene (Cusso), (38, 77:; Buchu. 138, 74* Calumbe, 438, 706 Caryophylli, 138, 77s Caecarillae, 138, 867 Catechu, 138, 805, B61 Infusum — Cheken, 7S0 Chiratae, 43S, 831 Cinchona?, 43S, 893 Flava?, 795 Fluid urn, 438 Cuspariie, 438, 747 Cusso, 438, 773 Didtalis, 438, 844 Dulcamara, 438, 835 Ergota?, 438, 908 Gentian* compositum, 438, 738, 739, 830 Kranieria?, 438, 731 Lini, 438, 729, 756 Lupuli, 438, 881 Maticae, 438, 872 Pruni Virginians, 438 Fluidum, 777 Quassia?, 438, 752 Ehei, 438, 858 Rosa? Acidum, 438, 773 Senega?, 438, 731 Senna?, 438, 766, 900 Compositum, 438, 560, 766, 821 Serpentaria?. 438, 866 Uva? ursi, 438, 815 Valeriana?, 438, 806 Inhalations, of chlorine, 468 of vapors for the lungs, 412, 453 Inhalers for the lungs, 412 Inhibition, and the action of drugs on inhibitory centres, nature of, 154-158 Injectio morphia? hypodermica, 439, 712 Injections, enemas, or clysters, 4s3 Inorganic materia medica, 455 et seq. Insect powder, as a poison, with its antidotes, 420 Insufflator, for applying powders to the larynx, diagram of an, 411 Intestines, difference between the vessels of the, and those of the muscles, 242 ; action of drugs on the, 331 ; movements and secretion of the, 331 ; cause of these, 331 ; paralytic secretion of the, 331; diagram illustrative of the effect of section of the nerves on secretion from the, 331 ; certain nerve-centres possess the power of re- straining the secretion from the, 331 ; nervous arrangements and nerve-centres of the, 332; natural and artificial circulation in the, 332; diagrams illustrating the effects of artificial cir- culation in the, 334; action of peptones, nicotine, and atropine, 334; of opium, 334, 335 ; difference between the action of soda and potash on the, 334; effects of morphine on the, 334; and of so- dium salts, 334 ; cause of constipation of the, and remedies for, 335; diagram to show how ovarian irritation probably causes constipation, 336; action of opium as a purgative on the, 336; small doses of belladonna also act as purgatives on the, 336; action of drugs on absorption from the, 336; action of astringents on the, in diar- rhoea, 337; diagram illustrating diarrho?a de- pending on the presence of scybala in the, 338; nature and action of various kinds ofpurgatives on the, 33S-344; of irritant poisons, 346; dia- gram of the liver, stomach, and, 351 ; application of drugs to the, 415; as enemata, 415 ; as suppo- sitories, 415; action of strong solution of am- monia on the, 542 : action of iron on the, 563; of copper, 566; of alcohols, 649, 650, 653; of salts of iron, 627; of gold, 641; of spirit of ether, 662; of purified chloroform, 676; of opium, 719; of sanguinaria,725j of caffeine, 743; of pilocarpine on the glands ofthe, 749,750; of physostigmine, 764; ofquillaia (saponin), 774; of ipecacuanha, 803; of sulphate of strychnine, 822; of bella- donna or atropine, 839; of aloes, 893 Intoxication, diagnosis between opium poisoning, apoplexy, and, 717 Inula (elecampane), characters and uses of, 813 Inunction ofdrugS, method of employing, 406 Inunction of the skin, advantage to be derived from, 406 Invertebrata, action of drugs on, 109-116 1 odlc acid, physiological action of, 51 Iodide, test for, 497 Iodide of ammonium, action of, on the ear, 205; preparation, character, and uses of, 545 GENERAL INDEX. 953 Iodide of— Ethvl-stryclmine, 318 Lead, 599 Mercury, green, 592 Red, 592 Potassium, 517 Silver, 577 Soda, 531 Sulphur, 470 Zinc, 571 Iodide of potassium, action of, on the ear, 205; on the sense of smell, 206; on taste, 207; difference between large and small doses of, on the secre- tion of mucus, 225 ; as an anaphrodisiac, 388 ; nature, action, and uses of, 517-520 Iodides, the, as alteratives, 358 Iodine, symbol and atomic weight of, 36 ; its rela- tion to other members of a group, 42 ; action of, on infusoria, 75; on enzymes, 86, 87; on bacteria, 93, 96, 98, 100 ; on taste, 207 ; on qui- nine, 207 ; and its preparations, as rubefacients, 304; and its compounds, as a sialagogue, 314; as an alterative, 358 ; has little influence on the excretion of urea, 360; vapor of, as a poison, with its antidote, 416; characters, tests, and preparations of, 469; iodide of sulphur, charac- ters and uses of, 470 ; ointment of, 470 ; physio- logical action of iodine, 470 ; uses of, 471 ; as an aphrodisiac, 471 ; as an anaphrodisiac, 471 Iodine water, action of, on bacteria, 98 Iodism, symptoms of, 471, 519 Iodoform, a local anaesthetic, 186; preparation and characters of, 681 ; mode of administration, 682; action of, as an antiseptic, a deodorizer, and a local anaesthetic, 682; action of, on the heart and nervous system, 682; on giant cells, 683 ; uses of, 683 Ipecac, 802 Ipecacuanha, causes vomiting in man, but not in rabbits, 66; action of, on the nose ; 219; one of the most useful expectorants in sufficient doses, 226; as a depressant expectorant, 227; as a local emetic, 326, 327; as a hepatic stimulant, 351; as an antihydrotic, 381 ; characters, composition, and preparations of, 802, 803; physiological action of, on frogs, 803 ; locally, 803 ; on the stomach and intestine, 803;. on the vessels, heart, and lungs, 803; uses of, as an emetic and diaphoretic, 804; as an expectorant and antidysenteric, S04; precautions, 804 Ipecacuanha powder, as a sudorific, 361 Iridin, as a cholagogue, 340; as a hepatic stimu- lant, 351 Iridium, symbol and atomic weight of, 36 ; phy- siological action of, 51 Iris of the eye, structure and action of the, 197 Iris, the, or blue flag, 902 Irish moss, 912 Iron, symbol and atomic weight of, 36 ; effects of large and small doses of, on the muscles, 124; causes slow contraction of the vessels, 246; action of, on the vaso-motor nerves, 281 ; as a vascular tonic, 297 ; action of, on the liver, 352 ; as a vermicide, 355 ; action of, on the general system, 563 ; properties, sources, and reactions of 624, 625 ; general preparations of, 625-627 ; action of, 627; on the skin, mouth, stomach, and intestine, 627, 628; on the blood and tissues, 62S ; on the nervous system, 628 ; on frogs and mammals, 628 ; how eliminated, 628 ; the strong solution of the perchloride of, one of the most powerful styptics, 634 ; the liquor and tincture of, more often employed than any other preparation of, 634 Iron, properties, preparations, action, and uses of— Ammonio-ferrie, sulphate of, or alum, 637 Aqueous solution of ferric citrate of, 636 Arseniate of, 638 Citrate of, 636 and ammonia, 635 Ammonium, 635 Quinia, 636 Quinine. 636 Strychnine, 636 Chloride of, 633 Compound mixture of, 630 Iron — Hydrated oxide of, 631 with magnesia, 631 Peroxide of, 632 Hypophosphite of, 639 Lactate of, 637 Magnetic oxide of, 632 Mixture of acetate of, and ammonium, 633 Moist peroxide of, 631 Nitrate of, 634 Oxalate of, 637 Phosphate of, 638 Pyrophosphate of, 639 Reduced, 632 Iron, saccharated carbonate of, 630 Iodide of, 638 Solution of basic ferric sulphate of, 631 Chloride of, 633 Citrate of, and quinine, 636 Pernitrate of, 634 Persulphate of, 631 Subsulphate of, 631 Tersulphate of, 631 Strong solution of perchloride of, 633 Sulphate of, 629 and ammonium, 637 Dried, 630 Granulated, 630 Precipitated, 630 Syrup of bromide of, 638 Tartrate of, and ammonium, 635 Potassium, 635 Tartarated, 635 Tincture of acetate of, 633 Valerianate of, 639 Irritants and counter-irritants, 301-306 ; divided into four classes, 301 ; diagrams illustrating the action of, 302, 303; rubefacients, and their action on chronic and acute inflammation, 301- 305; list of the principal, 304; vesicants and their action, 305; pustulants, 305; and caustics, 306 ; oil of copaiva as an irritant, 769 ; quillaia (saponin) as an, 774; oil of myrtle as, 780; camphor as, 863 ; garlic as, 889 Isinglass, as a demulcent, 307 ; nature and prop- erties of, 920, 921 Isomorphism and physiological action, relation between, 51 Ivy, poison, 755 Jaborandi, as a myotic, 198; as a depressant expectorant, 227 ; as a sialagogue, 314, 315 ; as an antihydrotic, 381; antagonism of, to atro- pine, 422-425 ; characters, action, and uses of, 749-752 Jackson, Dr., advises the use of sulphuric ether as an anaesthetic, 192 Jalap, as a drastic purgative, 339 ; as a hepatic stimulant, 351 ; as a cholagogue, 353 ; char- acter of, 833 Resin of, characters, action, and uses of, 833 Jamaica dogwood, action and use of, 769 Sarsaparilla, 888 James's powder, 617, 620 Jankowski, reference to, 299w. Jaw, lower, action of phosphorus on the, 603 Jequirity seeds, character, action, and uses of, 760 Jervine, action of, on the spinal cord aud the medulla, 894 ; the cardiac ganglia and the brain, 894 Joints, inflammation of the, utility of friction in, 305 ; and of vesicants, 305 ; tartar emetic oint- ment and croton-oil liniment sometimes useful in, 305 Jolyet, references to, 143, 318n. Juglandacea?, 873 Juglandin, as a hepatic stimulant, 851 Juglans, characters and uses of, 873; as a cathartic and hepatic stimulant, 873 Jugular veins, action of poisons when injected into the, 164, 213, 218 Juices, 447 954 GENERAL INDEX. Jumble beads, 760 Juniper, as a stimulant diuretic, 374 ; composition of, 8S7 ; oil of, 887 ; as a stimulant and diuretic, 887 K. Kairix, action of, as an antipyretic, and uses of, 695 Karnala, as a vermicide, 355 ; characters, action, and uses of, 869 ; as an anthelmintic, 870 Kaolin, or China clay, action of, in inflammation of the urethra, 385; nature and uses of, 555 Kava, as a stimulant diuretic, 374 Keratin, its preparation, characters, and uses, 992 ; its mode of application, 993 Kidneys, precautions to be taken regarding the state of the, 356 ; action of drugs on the, 364- 377 ; the threefold functions of the, 364 ; three structures connected with these functions, 364; nature and process of secretion in the, 364-377 ; diagram' of the urinary tubules in different classes of animals, 365 ; diagram of the circula- tion in the kidney of the newt, 367; diagram- matic sketch of the blood vessels in a mamma- lian kidney, 367 ; diagram of the tubules and vascular supply of the, 368; circumstances modifying the secretion of urine by the, 369 ; relation between sweat glands and the, 379 ; action of the heavy metals on the, 564 ; the possible effect of mercury on the, 565 ; action of phosphorus on the, 604; of alcohol, 649, 654; of pilocarpine, 750, 751 ; of tannic acid, 876 ; of oil of turpentine, 883 Kiedrowski, reference to, 492 Kino, as an astringent, 308 ; nature, action, and uses of, 759 Klein, on bacteria, 88 ; reference to, 102 Knoll, reference to, 218 Kobert, references to, 124 Koch, on bacteria, 88; reference to, 94; his experiments on bacteria with disinfectants, 97- 101; references to, 105, 107; account of a syringe employed by, 409 Kohler, F., reference to, 102 Kolliker, references to, 139, 143 Koppe, references to, 258n., 422 Koumiss, nature and use of, 914, 915 Kousso, as a vermicide, 355 ; nature, action, and use of, 773 Kowalewsky, reference to, 259 Kraepelin, references to, 175 Krameria, 731 Kramerise, 731 Kratschmer, reference to, 218 Kronecker, references to, 60, 122, 123, 354 Krukenberg, reference to his researches on the medusa, 112, 115, 116 Kuhne, Professor, references to, 59, 71n. ; his dis- covery of ferment-yielding bodies, 88; refer- ences to, 129, 163 Kunde, references to, 161 Kiintzer, reference to, 607 Kymograph, the, for ascertaining blood-pressure, description and diagram of, 235, 240 Laijiat.i:, 851 Laburnum, as a poison, with its antidote, 420 Lachrymal secretion, action of drugs on the, 196 Lac sulphuris, 462 Lactate of iron, 637 Lactic acid, action of, on bacteria, 99; a hyp- notic, 181 ; properties of, \2n. Lanthanum, symbol and atomic weight of, 36 Lappa, characters and uses of, 813; as an altera- tive, and in skin diseases, 818 Larch hark, 886 Lard, prepared, 918 Benzoated, 919; as an emollient, 919 Larynx, irritation of the, a cause of cough, 220- 222; application of drugs to the, 411; diagram of insufflator for applying powders to the, 411; various modes for applying different drugs to, 411, 412 Laudanum, use of, in maintaining anaesthesia, 192 Lauracete, 861 Lautenbach, references to, 348, 349n. Lavender, characters of, 852 Oil of, characters of, 852 Flowers, 852; characters, action, and uses of, 852 ; as a stimulant and car- minative, 852 Laxatives. See Purgatives Lead, symbol and atomic weight of, 36; action of, on the kidneys, 376 ; sources and reactions, of, 593, 594; action of, 593; in the mouth, stom- ach, and intestine, 594; general sources of lead poisoning, 594; treatment for, 595; symptoms of chronic poisoning by, 595 ; lead colic and cramps, 595 ; paralysis, 595 ; known as wrist- drop, 595; action of, on the general system, 596; how eliminated, 596; uses, 596 Lead, acetate of, action of, on bacteria, 99 ; as a vascular sedative, 300; as an astringent, 308; as a styptic, 309 ; as a poison, with its antidote, 420 Lead, acetate of, 597 Carbonate of, 597 Iodide of, 599 Nitrate of, 599 Oxide of, 596 Plaster of, 597 Solution of subacetate of, 598 Leaf, digitalis, 844 Tobacco, 842 Leaves, aconite, 697 Bearberry, 814 Belladonna, 835 Buchu, 747 Cherry-laurel, 777 Hemlock, 785 Hyoscyamus, 840 Matico, 872 Stramonium, 841 Leech, the, 927 ; its action and uses, 927 Leeches, action of chloroform on, 115; and of anaesthetics, 187 ; to genitals and thighs, as in- direct emmenagogues, 390 Lemon, decoction of, 740 Juice, characters, preparations, and uses of, 740; it is refrigerant, antiscorbutic, and a powerful antiperiodic, 740 Peel, characters, composition, and prepara- tions of, 739 Lemons, oil of, characters, preparation, and ac- tion of, 739 Leguminosie, 757, 766 Leprosy, produced by the bacillus lepra?, 103 Leptandra, characters, and action of, 851; on the bile and as a cathartic, 851 Leptandrin, as a hepatic stimulant, 351 Lettuce, experiments with the protoplasm of, and water on oxygen, 79; as a hypnotic, 182; composition of, 810 Leucin, action of, on bacteria, 99 Leucocytes, nature of, action of drugs on, and methodof experimenting on, lOelseg.; diagram to illustrate the action of quinine on, 73; the protoplasm of, contracts in any direction, 116; anesthetics act as poisons to, 187 Lewin, reference to, 824 Lichens, 907 Liliacese, 889 Lime, as a caustic, 304; as an astringent, 308; composition of, 549 Lime, character, tests, and preparations of, 549, 550 Lime, as an astringent and as an antacid, 551 Chlorinated, HIT, 168,654 I [ypophosphate of, 554 Liniment of, 550 Phosphate of, 558 Precipitated carbonate of, 558 GENERAL INDEX. 955 Lime — Saceharated solution of, 550 Slaked, 550 Sulphurated, 554 Syrup of, 550 Lime salts, sources and test of, 548 ; general pre- paration of, 549 ; impurities and tests of, 549 Lime water, action of, on bacteria, 98 ; as a direct antacid, 322; as a vermicide, 355 ; composition of, 549 Limonis succus, 447 Linaceae, 729 Liniments, or embrocations, 439 Linimentum aconiti, 440, 698, 863 Ammonite, 440, 734, 819 Belladonna, 440, 836, 862 Fluidum, 836 Calcis, 440, 734, 819 Camphorie, 440, 734, 819, 862, 863 Compositum, 440, 852, 863 Cantbaridis, 440, 883, 925 Cbloroformi, 440, 675, 819, 863 Crotonis, 440, 780, 868 Hydrargyri, 440, 583, 863 Iodi, 440, 470, 518, 663 Opii, 440, 709, 863 Plumbi subacetatis, 440, 598, 734 Potassii iodidi cum sapone, 440, 470, 518, 740, 819, 820 Saponis, 440, 819, 852, 862 Sinapis compositum, 440, 727, 863, 868, 869 Terebinthime,440, 819, 863, 883 Aceticum, 440, 482, 863, 883 Linseed, arid linseed tea, as demulcents, 307; com- position, action, and use of, 729 ; cbief use is as a demulcent, 729 Meal, 729 Oil, 730 Lippia Mexieana, composition, action and uses of, 818 Liqueurs, as cardiac stimulants, 291 Liquor acidi arseniosi, 440, 611 Ammonias, 291, 541 Ammonii acetatis, 440 Citratis, 440, 541 Fortior, ^40 Antimonii chloridi, 440, 480, 617 Arsenicalis, 440, 611 Arsenici hydrochloricus, 440, 611 et Hydrargyri iodidi, 440, 584 Atropiae, 440 Sulphatis, 440, 837 Bismutbi et ammonias citratis, 440 Calcis, 440, 550 Chloratae, 440, 468 Saccharatus, 440, 550, 906 Cblori, 440 Epispasticus, 440, 482, 661, 925 Ferri acetatis, 440 Chloridi, 440 Citratis, 440 et Quinmas citratis, 440, 636, 796 Mtratis, 440 Perchloridi, 440, 634 Fortior, 440 P^rnitratis, 440, 480 Persulphatis, 440 Subsulphatis, 440 Tersulphatis, 440 Gutta-percha, 440, 816 Hydrargyri nitratis acidus, 440, 480, 584 Perchloridi, 440, 584, 589 Iodi, 440, 470, 518 Compositus, 440, 470, 518 Lithias, 322 Effervescens, 440, 535 Magnesias carbonatis, 440, 562 Citratis, 440, 562 Magnesii citratis, 440 Morphias acetatis, 440, 482, 712 Hydrochloratis, 440, 480, 712 Nitro-glycerini, 668 Pepsini, 440, 916 Plumbi subacetatis, 440, 596, 598 Dilutus, 440, 598 Potassas, 322, 440, 509 Effervescens, 440, 510 Liquor potassas permanganatis, 440 Potassii, 440 Arsenitis, 440, 611 Citratis, 440 Sodas, 322, 440 Arseniatis, 440, 612 Chloratas, 440 Effervescens, 440, 527 Sodii arseniatis, 440 Silicatis, 440 Strychnias, 440, 822 Zinci chloridi, 440, 568, 570 Liquorice, as a stimulating expectorant, 227 Liquorice root, characters and composition of, 757 ; preparation, action, and uses of, 757 Lister, Sir Joseph, originates the antiseptic mode of treatment, 106; on the untoward conse- quences of operations, 689 Lithia, benzoate of, 535 Bromide of, 536 Carbonate of, 535 Citrate of, 535 Salicylate of, 536 Lithium, symbol and atomic weight of, 36 ; more poisonous than sodium or potassium, 49; its relation to other members of a group, 42 ; phy- siological action of, 51 ; causes contraction of the vessels, 246 ; sources, reaction, impurities, and tests of, 534 ; general action of, 535 Lithium, bicarbonate, as a direct antacid, 322 Carbonate, as a direct antacid, 322 Citrate, as a remote antacid, 322 Lithontriptics, nature and uses of, 376 Litmus, 908 Paper, blue, 908 Ked, 908 Tincture, 908 Solution of, 908 Litteljohn, Dr., reference to, 336 Liver, effect of the, on the action of drugs, 56, 59; caustics employed to open abscesses of the, 306; action of drugs on the, 347 ; important function of the, in the general system, 348; action of hepatic stimulants and cholagogues on, 348; power of the, in destroying the poisonous properties of some vegetable alkaloids, 349; five principal functions of the, 350; experiments on the action of hepatic stimulants, 350; list of these stimulants, 351 ; diagram of the stom- ach, intestines, and, 351 ; experiments on the action of cholagogues, 351, 352 ; importance of combining hepatic and intestinal stimulants to ensure complete cholagogue effect, 353; ad- juncts to cholagogues, 353; uses of hepatic stimu- lants and cholagogues on the, 354; action of hepatic depressants on the, 354 ; action of acids on the, 476 ; of chloride of ammonium, 540 ; of mercury, 581; of phosphorus, 604; of alcohol, 649, 654 ; of dandelion, 810 Liversedge, references to, 88 Lobelia, as a depressant expectorant, 227 ; as a poison, with its antidote, 420 ; characters and composition of, 814 ; action of, on the respira- tory centre, the blood-pressure, the vaso-motor centre and the vagi, 814; uses of, 814 Lobeliaceas, 814 Lobeline, as a myotic, 198 ; as a depressant expec- torant, 227 ; action of, on the vagus ends of the heart, 280 Lockyer, J. N., propounds the hypothesis that all the elements are compounds, 37; reference to, 50 Loganiaceas, 821 Logwood, characters, composition, and uses of, 765 Long, Dr. C. W., first uses ether as an anaesthetic, 192 Loos, reference to, 143 Lotio hydrargyri flava, 550, 590 Nigra, 550, 583, 588 Loven, reference to, 256 Lozenges, 451 Luchsinger, Dr., references to, 59-61,133, 134, 379, 839 Luciani, reference to, 272ra. Ludwig, -references to, 163, 166n., 234, 244ra., 245, 247, 256, 259, 285, 347 956 GENERAL INDEX. Ludwig and Coats's apparatus for experimenting on the frog's heart, 265, 266, 267, 273, 365, 368 Lumbar genital centre, connection of the, with the generative organs, 386 Lungs, application of drugs to the, 412; by inha- lation of vapors, 412 ; by the bronchitis kettle, 413; and by smoke, 413; action of gold on the, 641; of ipecacuanha, 803 Lupuline, as a general anodyne, 183, 184; char- acters, composition, action, and uses of, 881 ; as a tonic, stomachic, and soporific, 881 Lupulinum, 881 Lupulus, as a general anodyne, 183 Lussana, reference to, 352 Lymph, an abnormal condition of, one of the chief causes of dropsy, 297, 298 M. Mace, as a carminative, 330 ; characters and uses of, 861 McKendrick, reference to, 245 Mackenzie, J. N., reference to, 221n. Maclagan, Dr. Craig, reference to, 607 Magendie's experiments on the spinal cord, 160 ; references to, 325, 825 Magenta, 695 Magnesia, as a direct antacid, 322 ; as a laxative and purgative, 339; carbonate of, as a purga- tive, 339; characters and action of, 560, 561; sulphate of, 560; enema of sulphate of, 560; carbonate of, 561; light ditto, 561; solution of carbonate of, 562; solution of citrate of, 562 Magnesium, symbol and atomic weight of, 36 ; its relation to other members of a group, 42 ; phy- siological action of, 51 ; causes contraction of the vessels, 246; sources, reactions, and prepa- rations of, 559; impurities, tests, and action of, 560; sulphate of, 560; carbonate of, 561 Magnesium, carbonate and bicarbonate, as a direct antacid, 322 Magnetic oxide of iron, 632 Magnoliacerc, 705 Malaria, and all diseases of malarious origin, quinine and cinchona bark are almost specifics in, 109 ; condition of vaso-motor centre in, 725 Malpighian corpuscles, the, 365, 366, 367, 369 Malt, extract of, 905; as a digestive ferment, 905 Malvaceae, 734 Mammalia, 913 Mammals, action of nitro-glycerine on, 668; of chloral hydrate, 671; of opium, 716; of ery- throxylon, 733 Manganese, symbol and atomic weight of, 36 ; as an indirect emmenagogue, 391; properties, action, and uses of black oxide of, 640; of sul- phate Of, 640 Manna, as a laxative, 339; characters, compo- sition, and use of, 820; as a laxative, 821 Manometers, fallacies of mercurial, 235 Monsel's solution of iron, 631 Marble, white, 549 Marey, references to, 125 Marey's levers, 217; pneumograph, 217; and Incinodromometer, 259; reference to, 262 Marigold, 812 Marjoram, wild. See Origanum Marruhiuni, characters and use of, 855; as an expectorant, 855; and in large doses a laxative, 855 Marsh gas as a poison, with its antidote, 417 Marshinallow. See Althsca Marshmallows, as demulcents, 307 Marx, reference to, 57 Maryland pink. 8ee Kpigelia Massa copaibae, 441, 768 Fen i earbonat is, 441 Ilydrargyri, 441, 583 Massage, action Of, on muscles, 107 Masses, 1 1 1 Mastication, arteries of the brain dilated in ani- mals by the movements of, 176 Mas! Icatoi les, nature and use of, 418 Mastich, characters, composition, and uses of, 754 Materia medica, definition of, 33 Inorganic, 455 et seq. Organic, 643 et seq. Proper, 33 Vegetable, 697 et seq. Matico, as a styptic, 309 ; and stimulant diuretic, 374; characters, action, and uses of, 872; as a styptic, 872 ; leaves, 872 Maynard, reference to, 196 Mays, reference to, 268 Meconic acid, 711 Medicated baths, 403 Medicine, materia medica gives an account of the various remedies used in, 33 ; preventive medi- cine, or prophylaxis, growing importance of, 34 ; cause of the rapid advance of, 34 Medulla oblongata, nature and functions of, 207 et seq.; diagram representative of various groups of ganglion cells or "centres," in the, 210; experiments on the, 218; blood vessels relax after section of the, 229; stimulating effect of asphyxial blood on the, 262; the nerve- centre which regulates the secretion of the saliva situated in the, 313; the nerve-centre which regulates the movements of vomiting is situated in the, 323; the nervous centre for the renal arteries in the, 370 ; action of spirit of ether on the, 662; of carbolic acid, 688; of aconitine, 700 ; of delphinine, 702 ; of hydro- chlorate of apomorphine, 714; of caffeine, 743; of physostigmine, 762; of oil of eucalyptus, 781; of thymol, 854 Medusae, action of drugs on, 109-113; effect of stimuli on the rhythmical movements of, 109- 112; and of various poisons on, 111,112; general results of various experiments on, 113, 114 Mel boracis, 441, 923 Depuratum, 441, 923 Despumatum, 441, 923 Eoste, 441, 773, 923 Meliacese, 746 Mendelejeff, perfects the classification of the elements in series, 43-47 ; table of his arrange- ment, 45; his predictions regarding gallium, 46; reference to his classification, 495 Menispermaceaj, 705 * Menispermum (Canadian moonseed), characters, composition, and uses of, 705 Menstruation, action of emmenagogues on, 390 Menthol, action of, on the brain and spinal cord, 194; as a rubefacient, 304 Mercurial cachexia, 580; tremors, 580; and paralysis, 580 Mercurial preparations, as cholagogues, 340 Mercurialism, nature and cause of, 612; one of the best preparations for producing, 586 Mercuric chloride, effects of, on the blood 82; on annulosa, 116; as a caustic, 304; as a hepatic stimulant, 351 Mercuric nitrate, as a caustic, 304 Mercuric oxide, as a caustic, 304 Mercury, symbol and atomic weight of, 36; physiological connection between calcium and, 47; causes salivation, 50; action of, on muscle, 124; on the vaso-motor nerves, 281; and its compounds as a sialagogue, 314; as an altera- tive, 358; its power in fibrin and syphilitic deposits, 361 ; used to break up deposits of lymph, and to prevent adhesions in iritis and pericarditis, 361; and in the treatment of the secondary stage of syphilis, 361 ; action of, on the kidneys, 376; sources and reactions of, 578; general impurities and tests, 579; general action of, 579-583 ; on the skin, 579; effects of, on the body, termed "mercurialism," 579; action of, on the mouth, 579; salivation, 580; causes fever, 580; the fumes of, produce a state called mercurial cachexia, 580; which results in mer- curial tremors in the muscles, 580; and paraly- sis, 580; mental powers also affected, 580; special action of, on the brain, 581; action of, modified by sex, age, and idiosyncrasy, 581; action of, on the stomach, 581; the liver, 581, 582; and blood, 582; has the power of causing the absorption of fibrinous exudations, 582; action of, on the pulse, 582; on respiration, 582; and the temperature, 583; cause of the GENERAL INDEX. 957 salivation produced by, 583 ; action of, on the urine, 583 Mercury, nature, preparations, action, and uses of, 583-587 Acid solution of nitrate of, 591 Aninioniated, 590 Black lotion of, 588 Corrosive chloride of, 589 Cyanide of, 593 Green iodide of, 592 Mild chloride of, 587 Ointment of nitrate of, 591 Perchloride of, 589 Red iodide of, 592 Red oxide of, 590 Red sulphide of, 593 Subehloride of, 587 Sulphate of, 587 Yellow oxide of, 590 * Yellow subsulphate of, 587 Mercury salts, as a cholagogue, 353 Metallic salts, as poisons, with their antidotes, 420; general tests for the acid radicals in, 496; list of tests for the different acids, 496^98 Metals, general classification of the, 495; I., monad metals, 495; 1, metals of the alkalis, 498; 2, ammonia, 498; general characters and reactions, 498, 499; physiological action, 499; general action of the alkaline group, 499-501 ; and of the group of chlorides, 502, 503 ; general action of the sub-group of sulphates, 504; com- parative action of the alkaline metals, 504; 1, metals of the alkalis — potassium, 505-522; sodium, 522-534; lithium, 534-536; monad metals, group 2, ammonium salts, 536-546; II., dyad metals, 546 ; reactions of the metals in class IL, 547; group 1, metals of the alkaline earths, 546; general action, 547; calcium, 548- 554; appendix to group 2, aluminium, 555-558; and cerium, 558 ; group 2, magnesium, 559-562; general action of heavy metals on the circula- tion, intestinal canal, blood, tissue, muscles, nerves, nerve-centres, and glands, 562-565; group 3, 565; general action of, on the system, 565; zinc, 566-572; copper, 572-574; cadmium, 574; argentum, 574-578; mercurv, 578-593; lead and tin, 593-600 MethaBinoglobin, origin, nature, and changes of, 80, 81 Methyl, effect of the introduction of, into the molecule of the strychnine, brucine, and the- baine, 50 Methyl-atropine, -codine, -morphine, -nicotine, -quinine, and -veratrine, paralyzing action of, 51 Methyl-atropine, action of, on the motor nerves, &c, 839 Methyl-conine, action of, on the spinal cord, 787 Methylene, bichloride of, preparation, character, and action of, 673 Methyloxyehinicine, constitution of, 696 Methyl-strychnine, action of, on muscle, 139; on the vagus ends in the heart, 280; methyl- strychnine, characters of, 825 Meyer, reference to, 241 Meyer, Hermann, reference to, 85 Meyer, Lothar, his labor in completing the classi- fication of the elements in series, 43 Meyer, R., reference to, 222 Meyer, Sigmund, reference to, lMn. Mezereon, as a vesicant, 304; as a sialagogue, 314 Mezereum, as an alterative, 358 Microbacteria, 90 Microbes, recent increase in knowledge of, 34; destruction or prevention of, diminishes disease, 34 ; references to, 103, 106 Micrococci, referenc s to, 90, 92, 94, 103 ; list of diseases caused by, 103 Microzymes, references to, 97, 98, 108 Milk, action of drugs upon, 392; what the char- acter of the, depends upon, 392; substances excreted by the, 392 ; various drugs adminis- tered to the mother react upon the child through the, 393; action of pilocarpine on the secretion of, 750; its composition, therapeutics, and use, 914 Milk, sugar of, its characters, and uses, 915 Milk of sulphur, 462 Mills, Mr., reference to, 678 Mimosese, 770 Mistura ammoniaci, 441, 789 Amygdalae, 441, 775 Asafcetidfe, 441, 787 Chloroformi, 441, 675 Creasoti, 441, 482, 691 Creta?, 441, 770 Ferri aromatica, 441, 778, 794 Composita, 441, 7.56, 860, 906 et ammonii, 441 Acetatis, 441, 634 Gentians:, 441, 738, 792, 830 Glycyrrhizse composita, 441, 664 Guaiaci,441, 746, 770, 906 Magnesife et asafcetidse, 441, 787 Potassii citratis, 441, 739, 740 Rhei et soda?, 441, 857 Scammonii, 441, 832, 914 Sennte composita, 441, 757, 766 Spiritus vini gallici, 441, 658, 920 Mixtures, 441 Molecules, origin and nature of, 37 ; simple and complex, 38; condition of, in a solid and gaseous state, 38; the vibrations of, determined by their weight, 49 Mollusca, action of drugs on, 114; effects of various poisons on, 114 Molybdenum, symbol and atomic weight of, 36; its relation to other members of a group, 42 Mommsen, reference to, 144 Monobromo-camphor, as a hypnotic, 181 ; action of, on the cardiac muscle, 281 Morat, reference to, 243, 262 Morete, 878 Mori succus, 447 Morphia, acetate of, characters and preparations of, 712 Hydrochlorate of, ditto, ditto, 712 Morphia; acetas, 709 Acetatis liquor, 709 Hydrochloras, 429, 709 Hydrochloratis liquor, 709 Morphina, 429 Morphine, effect of habit on the quantity that can be taken; 59; action of, on oxidation, 79; on the blood, 82; as a sedative, 146; action of, on the spinal cord, 150, 159; as a spinal stimu- lant, 167; as a powerful hypnotic, 181, 182; induces sleep and lessens pain, 181; as a local and general anodyne, 183; as a myotic, 198, 199; action of, in diminishing the excitability of the respiratory centre, 223; and when com- bined with atropine, 223; as an antisialic, 318; as a local and general sedative, 328 ; action of, on the intestines, 334 ; action of, on urea, 360 ; value of, in laryngeal phthisis, 412 ; as a poison, with its antidote. 420 ; antagonistic action of, to certain alkaloids, 424, 425 Morphine, characters, reactions of, &c, 711; opium versus, 722 Acetate of, character and preparations of, 712 Hydrochlorate of, characters of, &c, 712 Apo-, characters, action, and uses of, 713, 714 Sulphate of, preparations of, 713 Morshead, reference to, 199 Morton, Mr., his use of ether in dentistry, 192 Moseley, reference to, 115, 115n. Moss, Iceland, its characteis, composition, and therapeutics, 907 Moss, Irish, characters and use of, 912 Mosso, references to 104, 125, 143, 247, 349 Motion and oxidation, relations of, in the animal economy, 75 Motor ganglia, action of oatmeal on the, 906 Motor nerves. See Nerves Mould fungi, origin, nature, and effects of, 89-91; diseases caused by, 91 Mouth, application of drugs to the, 414 ; as washes, 413 ; as caustics, by rubbing, 413 ; as mastica- tories, 413; as gargles, 413; action of acids in the, 476; action of alkalis in the, 500; of the metals, zinc, copper, cadmium, and silver, 565; of silver, 576 ; of alcohol, 649, 650 ; of spirit of 958 GENERAL IKDEX. ether, 662 ; of chloral hydrate, 670 ; of purified chloroform, 675: of creasote, 691; of tannic acid, S76 ; of aloes, 893 Mucilages, 442 Mucilaginous remedies, useful in cases of irri- tating cough, 222 Mucilago acacias, 442, 770 Ainyli, 442, 904 Cydonii, 442, 771 Sassafras medulla 3 , 442, 865 Tragacantha?, 442, 758, 820 Ulmi, 442, 878 Mucous membranes, action of morphine and atropine on the secretions of the, 223; character and action of the secretion of the, 223 ; of heat and cold on the circulation and secretion of the, 224 : of drugs on the secretion of the, 225- 227; drugs which increase the ciliary motion in the tracheal, 227 ; action of chloride of ammo- nium on the gastric, 540 ; of tannic acid, 876 Mulberrv juice, characters and use of, 878 Murrell,"references to, 608, 612 Muscarine, action of, on mollusca, 114; as a myotic, 198, 199 ; action of, on the respiratory centre, 214, 219 ; on the frog's heart, 271 ; on the inhibitory power of the vagi, 274; on the gan- glia, 276; action of, neutralized by atropine, 277; action of, on inhibitory ganglia, 280; on the cardiac muscle, 281 ; as a sialagogue, 314, 315; as a general emetic, 326; as an antihy- drotic, 381; antagonism of, to atropine, 422- 425 Muscle, action of drugs on, 116-138; on voluntary, 116; elasticity, extensibility, and retractility of, 117; irritability of, 117; contraction of, 117; latent period of, 118; muscle-dynamite, nature and action of, 118n.; summation of stimuli, 120; contraction, 120; fatigue, 121; contracture of, 122; tetanus, 123; poisons, 124-128; massage of, 128; propagation of the contraction wave in 128; rhythmical contraction of, 128; connection between chemical constitution and physiologi- i cal action on, 130; action of drugs on, relative, I not absolute, 131; action of drugs on involun- tary muscular fibre, 132; contraction, 132, effect of stimuli on the, 133; of cold and heat, ! 133; relation of the contractile tissue to the ; nerves, 134 ; propagation of contraction waves, j 134: effects of stimulation of the vagus and a ! weak interrupted current, 135 * artificial rhythm, 135; hypothetical considerations re- I garding the action of drugs on muscle, 136 Muscles, spasms and cramps of the, nature, cause, and general treatment of, 193-195; of the eye, j 196 et seq.; of respiration, 210; difference be- I tween the vessels of the intestines and those of ! the, 242; the vaso-motor centre has no power over the vessels of the, 242; action of chlorides ! on the, 504; of ammonium salts, 504; of potash .-alts. 5o7; of ammonium chloride, 539 ; poison- ! ous action of the heavy metals on the, 464 ; of platinum, 641; of spirit of other, 662; of nitrite of amyl, 666 : of nitro-glycerine, 668 ; of chloral hydrate, 671 ; hydrochlorate of apomorphine on the fibres of the, 714; of caffeine on ditto, 743: of pilocarpine on muscles and muscular fibre, 749, 750; of physostigmine on ditto, 762; | of quinine, 801 ; of strychnine, 824; of curare, 826; of belladonna or atropine, 838; of digita- lin, 845; of reratrine, 896; of oatmeal, 906 Muscular contraction, apparatus for registering, 118; muscular poisons, Dumber and action of, 124-128; muscular fibre, importance of the ac- tion of chloroform and other on, 188, 189; nerves die sooner than the, 217 Mushrooms as poisons, with their antidotes, 420 Musk, antispasmodic action of, 194, 195,913; as an antispasmodic and stimulant, 914; its action on the respiratory centre, 914 Mustard leaves and liniment of, as rubefacients, 804, 305; as a sialagogue, 314 ; as a local emetic, 326; as a carminative, 830; as a stimulant diu- retic, 874; baths, poultices, and stupes, as Indi- rect emmenagogues, 390; hath, 403; powdered, 726; white, 72''.; black, 726; characters and Compositions Of the powdered, 726; prepara- tion* of, 727 Mustard, oil of, action of, on enzvmes, 86; on bacteria, 96, 99, 100; as a vesicant, 304, 727; characters and preparations of, 727 ; action of, on the skin, and internally as a prompt emetic, 727, 72S; it is also used externally as a counter- irritant, in the form of a poultice, &c, 728 Mycoderma, vini, nature and action of, 89 Mydriatics, and their action in dilating the pupil of the eye, 198-200 Myositis, infective, micrococci present in, 103 Myotics, and their action in contracting the pupil of the eye, 198-201 Myristicacese, 860 Myrrh, as a direct emmenagogue, 390 ; characters and composition of, 756 ; action and uses of, as an astringent and expectorant, 756 Myrtacese, 778 Myrtle, oil of, action and uses of, 780 ; is an anti- septic, rubefacient, internal irritant, and expec- torant, 780 N. Njegeli, references to, 89, 102 Naphthalin, source and characters of, 694 ; mode of administration, 694; action of, in destroying low organisms and preventing the germina- tion of their spores, 694; as an antiseptic, and when used internally, 694; uses of, 694 Naphthol, characters, action, and uses of, 694 Narcotics, nature and action of, 182 Nasal douche, diagram of a, 410 Natalo'in, nature and action of, 891 Nativelle's digitaline, 845 Nauseant, antimony as a, 616 Nerein, action of, on the cardiac muscle, 281 Neroli, oil of, 737 Nerve centre, the, which regulates the move- ments of vomiting, 323 Nerve centres, in respiration, nature and func- tions of the, 209-219; for the secretion of sweat situated in the spinal cord, 378; hbw they may be stimulated, 378; situation of the, for the movements of the bladder, 383; action of pot- ash salts on the, 507 ; poisonous action of the heavy metals on the, 564 ; action of gold on the, 641 ; of alcohol, 648, 652 ; of erythroxylon, 733; of caffeine, 743; of hydrochlorate of pilo- carpine, 750; of physostigmine, 762 ; of quillaia (saponin), 775; of oil of eucalyptus, 781; of thymol on the, of the cord and medulla, 854; of camphor, 863; of oil of turpentine, 883 Nerve stimulants divided into two kinds, 176; tonics, when necessary, 357 Nerves, relation of the contractile tissue to the, 134; action of drugs on, 138-147; on motor, 138- 144; paralysis of the motor ending? of the, 139, 140; paralysis may be due to disturbance of rhythm between muscle and, 138; experiments illustrative of paralysis, 140-142; list of drugs which have the same paralyzing action on the, as curare, 142; irritation of the motor endings of the, by drugs, 143; action of drugs on the trunks of the motor, 144; on sensory, 144; the general action, 144; the local action, 146; action and uses of local sedatives and anaesthetics on, 146; and of drugs on the peripheral ends of the sensory, 117; pain ascribed to vibrations of, or of the sheaths, 185: action of anaesthetics on the, 185 et seq. ; the chief afferent, expiratory, and inspiratory, 215-218; of drugs on the respi- ratory, 218; the, die sooner than the muscular fibres, 217; action of drugs on the vaso-motor and vaso-d dating, 248; action of the, on the vessels of circulation, 251; influence of, on blood-pressure, 253-256; inhibitory nerves, 253; quickening nerves, 254; vaso-motor nerves, 254; depressor nerves, 255; action of dm the accelerating, 262; action of the, on the secretion of saliva, 311 317; diagrams illus- trating this action, :;i2, 313, 316; action of the afferent, on vomiting, 323, 324; dlagramshow- tng the afferent, by which the vomiting centre may be excited, 324; of the kidney, 370, 371; action of ammonium Baits on motor, 504; of GENERAL INDEX. 959 potash salts on ditto, 507 ; of strong solution of ammonia, 542 ; poisonous action of the heavy metals on the, 564; action of silver on the, 576; of salts of iron, 628; of manganese salts, 640; of alcohol, 652-654 ; of spirit of ether, 662 ; of ni- trite of amyl, 666; of chloral hydrate, 671; of purified chloroform, 676 ; of carbolic acid, 688 ; of codeine, 714; of opium on the sensory, 718; of pilocarpine on the efferent and other, 749, 750; of physostigmine on the motor and sen- sory, 762; of sulphate of strychnine on the sensory, 822; of belladonna or atropine on the motor, 838; of tobacco on the motor and secret- ing, 843; of Indian hemp on the sensory, 880; of veratrine, 896 ; of colchicum, 899 ; of extract of ergot, 910 Nervine tonics, zinc salts as, 568; sulphate of copper as, 573 Nervous debility and irritability, relieved by mustard applications, 305 Nervous ganglion in some lower organisms, na- ture and functions of the, 207 et seq. Nervous system, general irritability of the, gen- erally precedes an attack of gout, 194; regulating action of the, 286-290 ; action of silver on the, 576 ; of purified chloroform on the, 676, 677 ; of iodoform, 682 ; of aconitine, 701 ; of opium on the central, 715, 718, 724 ; of pilocarpine, 749, 750; of elaterin, 785 ; of quinine, 800; of strych- nine, 824; of solanine, 835; of tobacco, 843; of digitalin, 845; of extract of ergot, 910 Neuralgia, blisters and cautery of great use in, 305 Neuralgic pains, relieved by rubefacients, 305 Newlands, Mr., makes the first natural classifica- tion of the elements, 42, 43; points out a curi- ous relationship between the lithium and cal- cium group of elements, 43; and notes that the eighth element is a kind of repetition of the first, 43 Newman, reference to, 245 Newt, diagram of the circulation in the kidney of the, 367 Nickel, symbol and atomic weight of, 36 ; ph ysio- logical action of, 51; causes slight contraction of the vessels, 246 Nicotia, action of, on oxidation, 79, 82 Nicotine, action of, on medusae, 112; onmollusca, 114; on ascidians, 115; on the spinal cord, 150; as a spinal stimulant, 167 ; as a myotic, 198 ; on the respiratory centre, 215; on the vessels of circulation, 247; on the vagus roots, 261; on the heart of the frog, 273 ; on the inhibitory power of the vagi, 274; on the vagus centre, 279 ; on the vagus-ends in the heart, 280 ; action of, on the intestines, 334; on the sweat centres, 379 ; antagonism of, to morphine, 422-425. See also Tobacco. Niobium, symbol and atomic weight of, 36 Nitrates, test for, 497 Nitrate of ammonia, 545 Iron, 634 Lead, 599 Potash, 512 Potassium paper, 513 Silver, 575 Diluted, 575 Moulded, 575 Nitrate of silver, action of, on the mucous mem- brane, 226; difference of the action of, on the mucous membrane and on the trachea, 226; value of, in laryngeal phthisis, 412 Nitric acid, as a caustic, 304; as a poison, with its antidote, 417 ; properties and uses of, 480 Nitrite of amyl, ethyl, &c. See Amyl, Ethyl, &c, nitrite of Nitrites, effects of mixing, with freshly-drawn blood, 80; of poisoning by, on the color of the blood, 214; on the capillaries, 282 ; all nitrites act as vascular stimulants, 293 Nitro-benzol, as a poison, with its antidote, 420 Nitrogen, 601 ; symbol and atomic weight of, 36 ; its relation to other members of a group, 42 ; experiments as to the excretion of, in the body, 359 Nitrogen monoxide, nature, action, uses, and mode of administration of, 601, 602 Nitro-glycerin, as a poison, with its antidote, 420 Nitro-glycerine, glonoine, preparation and prop- erties of, 668; action of, similar to that of nitrite of amyl and other nitrites, 668 ; in frogs and mammals, 668; on the blood and blood- pressure, 668; why it acts more powerfully than other nitrites, 668 ; uses of, 668 Nitrohydrochloric acid, properties and uses of, &c, 481 ; dilute ditto, 481 Nitro-muriatic acid, action of, on the urine, 377 Nitrous ether, as a vascular stimulant, 292; as a refrigerant diuretic, 374 Nitrous oxide, as an ansesthetic, 186 et seq.; nature and action of, 601, 602 Nose, application of drugs to the, 410 ; as snuff, 410 ; by insufflation, 410 ; by the nasal douche, 410; diagram of nasal douche, 410; action of pilocarpine on the, 750 Nothnagel, reference to, 317, 334, 703 Nowak, reference to, 132 Nussbaum, reference to, 366 Nut, areca, 903; as an anthelmintic, 903 Nutgalls, action and uses of, 875 Nutmeg, characters and composition of, 860 ; vol- atile oil of, 860 ; expressed oil of, as a stimulant and carminative, 860 Nutmeg and oil, as carminatives, 330 Nutrition, remedies which improve, 358 ; what healthy nutrition depends on, 358 Nux vomica, as a stimulating expectorant, 227 ; as a cardiac tonic, 294 ; as an antihydrotic, 381 ; characters, composition, and preparations of, 821 0. Oak-bark as an astringent, 308 ; action and uses of, 874 Oatmeal, 906 ; action and uses of, 906 CEsophagus, the, of various animals, muscular structure of, 134 Officinal preparations. See the different drugs Oil, castor. See Castor oil Oil, cod-liver, 921 ; its characters and composition, 921; its physiological action, 921; powers of absorption and assimilation, 921 ; therapeutics, 922 Oil, ethereal, 663 Oil of allspice, 779 Almonds, 776 Bitter, 776 Amber, 884 Anise, 789 Bergamot, characters and use of, 739 Cajuput, 780 Caraway, 791 Castor, 868 Chamomile, 809 Cinnamon, 861 Cloves, 100, 778 Copaiva, 769 Coriander, 792 Croton, 867 Cubebs, 871 Dill, 790 Eucalyptus, 781 Fir wool, 884 Gaultheria, 816 Juniper, 887 Lavender, 852 Flowers, 852 Lemons, 739 Mace, 125 Mustard. See Mustard oil Myrtle, 780 •Neroli, 737 Nutmeg, expressed, 860 Volatile, 860 Orange flowers, 737 Peel, 738 Peppermint, 853 Pimenta, 779 Pimento, 779 Kue, 747 Eosemary, 279, 851 960 GENERAL INDEX. Oil of— Santal, 866 Scotch fir, 884 Spearmint, 853 Sesamurn, 856 Tar, 886 Theobroraa, 741 Turpentine, 100, 226, 291, 304 Valerian, 806 Oil of turpentine, action of, on bacteria, 100 ; of the vapor of, on the mucous membrane, 226 ; great therapeutical value of the vapor of, in bronchitis, 226; as a cardiac stimulant, 291 ; as a rubefacient, 304; as an antidote to phos- phorus, 421 Oils, ethereal, action of, on bacteria, 105 ; on the vaso-motor centre, 279; aromatic volatile, as cardiac stimulants, 291 ; volatile as rubefacients, 304 ; as an antidote to phosphorus, 421 Oils, fixed and volatile, 442, 443 Ointment, sulphur, 461; alkaline sulphur, 462; various kinds of iodine, 470; iodide of sulphur, 470. See Unguentum Ointments, their nature', number, and uses, 452 Oleaceoe, 818 Oleate of mercury, 494 of veratrinum, 494 Oleates, 443 Oleatum hydrargyri, 443, 494, 583, 590 Veratrinse, 443, 494, 895 Oleic acid, action of, on bacteria, 99 ; properties and uses of, 494 Oleoresina Aspidii, 443, 907 Capsici, 443, 835 Cubebie, 443, 871 Lupulini, 443, 881 Piperis, 443, 870 Zingiberis, 443, 900 Oleoresins, 443 Oleum adipis, 442 JEthereurn, 442 Ainygdake, 442, 776 Amar^e, 442 Expressum, 442 Anethi, 443, 790 Anisi, 442. 443, 705 Anthemidis, 443, 809 Aurantii, corticis, 442 Florum, 442 Bergamii, 442 Cajuputi, 442, 443 Cari, 442, 791 Carui, 443, 791 Caryophylli, 442, 443, 778 Chenopodii, 442 Cinnaniomi, 442, 443, 861 Copaiba', 442, 443, 768 Coriandri, 442, 443, 792 Crotonis, 442 Cubebae, 442, 443, 871 Erigerontis, -1 12 Eucalypti, 442, 781 Fceniculi, 442 Gaultheri*, 1 12 Gossypii seminis, 442 Hedeomse, 112, 855 Junipcii. 112, It:; Lavandula', 112,443 Florum, 442 Limonis, 1 12, 113,739 Lini, 442, 729 Mentha piperitse, 1 12, 443 Yiridis, 112, 113 Morrhuse, 142 Myrciae, 143 Myristinic, 113, 860 Expressum, 112,860 Olivse, 142 Phosphoratum, 1 12, 603 Picia Uquidse, us Pimento, 143, 779 I5i.ii, i, 112 Rosse, 148 Rosmarinl, 1 18 Bute, 148 Sablnee, 148, 888 Bantall, W3 Oleum- Sassafras, 443, 864 Sesami, 442 Sinapis, 443, 727 Volatile, 443, 727 Succini, 443 Terebinthinse, 443 Theobromse, 442 Thymi, 443 Tiglii, 442 Valeriana?, 443, 805 Oleum animale, action of, on bacteria, 99 Oleum pini pumilionis, as a stimulating expec- torant, 227 Oleum pini sylvestris, as a stimulating expec- torant, 227 Olive oil, as a demulcent, 307 ; characters, com- position, and preparations of, 818 ; action and uses of, 818, 819 Oleum menthte piperitse action of, on bacteria, 99 Onion, as a stimulating expectorant, 227 Ononis spinosum, as a stimulant diuretic, 374 Operations, surgical, Sir Joseph Lister on the best mode of performing, 689 Ophthalmia, gonorrhceal, contagious, and nean- otorum, caused by micrococci, 103 Opium, effect of habit on the quantity that can be taken, 59 ; abnormal effects of, in some cases of fever, 62 ; some persons very slightly affected by, 65 ; as a sedative, 146 ; as a spinal stimulant, 146; different actions of, in different doses, on the brain, 178; one of the most powerful hypnotics, 181 ; induces sleep and lessens pain, 181; as a local and general anodyne, 183; as a myotic, 198; action of, on the respiratory cen- tre, 215; on the brain, 218; in diminishing the excitability of the respiratory centre, 223; action of, on the vessels of circulation, 249; as a vascular sedative, 300; as an, antisialic, 318; as a local and general sedative, 328 ; action of, on the intestines, 333-335, 337; as a purgative, 336 ; as a vesical sedative, 384 ; as a poison, with its antidotes, 420; antagonistic action of, and belladonna, 424, 425; antagonism of, to other drugs, 422-425; characters and preparations of, 709, 710; alkaloids of, 711 ; physiological action of, 715; general action of, exclusively on the central nervous system, 715; and in mammals especially on the brain, 715; in the frog it acts on the motor ganglia of the heart, 715 ; action of, on fiogs, 715; on birds, 716; on mammals, 716; on man, it acts chiefly on the brain, 716 ; in producing sleep and, in large doses, death, 716; diagnosis between poisoning by, and in- toxication and apoplexy, 717 ; treatment in poisoning by, 717; precautions, 717; treatment of the symptoms after an ordinary dose, 717; action of, on special organs, 717 ; on the sensory nerves, the spinal cord, and the brain, 718; on the pupil, the circulation, and the vaso-motor centre in the medulla, 718; has a peculiar ac- tion on the peripheral vaso-motor apparatus, 718; on secretion, 719; on sweat and the urine, 719; on the intestines, 719; elimination, 719; circumstances modifying the action of, 720; sex and idiosyncrasy, 720 ; habit, 720 ; opium eating, 721 ; action of, in disease, 721; and in combina- tion with other drugs, 721 ; action of the al- kaloids of, 721 ; the morphine group and the codeine group, 722 ; how codeines are produced, 722; action of apomorphine and morphine, 722; therapeutics — general uses and local uses, 722; on the digestive system, 723; the respi- ratory tract, 723; the circulatory system, 724; the genito-urinary tract, 72 1; the skin, 721; two most important uses of opium and morphia to relieve pain and produce sleep, 724; action of, on the nervous system, 724; contni-indica- tions, 725 Opium denarcotisatum, 710 Opium, powdered, preparations and composition Of 710 Orcnidacese, 899 Organism, the animal, general relations between, and substances affecting it, 35-52; circum- stances which affect the action of drugs on the, 52-67; effects Of oxidation on, 75 etseq.; rela- GENERAL INDEX. 961 tions of motion and oxidation in, 75 ; excess of temperature injurious to, 104 Orange, bitter, 737 Flower water, 737 Flowers, character, composition, and uses of, 737 Oil of, 737 Peel, bitter, 737 Oil of, 738 Sweet of, 738 Origanum, characters, action, and uses of, 856 ; as a diaphoretic and emmenagogue, 856 Orthospermae, 787 Osmic acid, action of, on bacteria, 99 ; as a caus- tic, 304 Osmium, symbol and atomic weight of, 35 ; physi- ological action of, 51 Ovarian irritation, diagram showing how, proba- bly causes constipation, 336 Oxalates, test for, 497 Oxalate of cerium, 558; of iron, 637 Oxalic acid, as a poison, with its antidote, 417 ; nature and use of, 485 Oxidation, relations of motion and, 75; of proto- plasm, 77 ; action of drugs on, 79 ; methods of ascertaining the effects of drugs on, 81 Oxide of lead, 596 Manganese, black, 640 Red, 590 Mercury, yellow, 590 Silver, 577 Zinc, 569 Ox bile, purified, 917 Oxgall, 916; inspissated, 917 Oxygen, symbol and atomic weight of, 36 ; broken up by electricity, and forms a new element, ozone, 40; its relation to other members of a group, 42 ; necessary for protoplasmic life, 71 ; power of protoplasm over, 78 ; action of haemo- globin on, 79; effects of other gases on, 80; of carbonic oxide on, 80; of charcoal, 82; effects of, on mould fungi, 89 ; on bacteria, 91 ; ex- cess or absence of, causes tetanus, 162 ; effects of the presence or absence of, on the blood, 211- 214; its preparation, 456; properties, physio- logical action, and uses, 456, 457 Oxyhsemoglobin, 78-81 Oxymel, 441, 482, 923 Scillae, 441, 482, 890, 923 Ozone, origin and nature of, 40; action of, on albumen, 69 ; power of protoplasm in forming, 78; action of phosphorus in forming, 78; na- ture and uses of, 457, 458 ; diagram illustrating the formation of, by electricity, 457 ; diagram representing the formation of, by the oxidation of phosphorus, 457 Pachydermata, 918 Paget, Sir James, reference to his lecture on ''Elementary Pathology," 64 Pain, origin and nature of, 184 ; where seated, 184 ; how caused, and how relieved, 184; action and uses of anodynes in, 184, 185; relieved by an effort of the attention, 185 ; action of anaesthe- tics in relieving, 185 et seq.; and of electricity and cold, 185 ; Mortimer Granville's treatment of, 185 ; action of anaesthetics in alleviating or destroying, 185 et seq. Pale catechu, 804 Pale cinchona bark, 794 Pale rose, composition and uses of, 772 Palladium, symbol and atomic weight of, 35 ; physiological action of, 51 Palmitic acid, action of, on bacteria, 99 Palpitation, of the heart, effect of blood-pressure on, 262, 263 ; the principal drugs which dimin- ish it, 300 Pancreas, action of drugs on the, 354 Pancreatic juice, importance of the, in the pro- cess of digestion, 355; effects of the secretion of the, 355 ; and of different drugs on the, 355 Pancreatin, utility of, in aiding digestion, 321 Papain, 777 Papaveraceae, 708 61 777 Papayotin, preparation, action, and uses of, 777 ; digestive power of, on muscular fibre and con- nective tissue, 777 Paper, litmus, blue, 908 Red, 908 Paper, turmeric, 901 ; as a test for alkalis, 901 Papers, 446 Papilionacese, 757 Papillon, M., reference to, 50 Paracotobark, 862 Paraffin, as an emollient, 307 Paraldehyde, a hypnotic, 181; a general anaes- thetic, 186 Paralysis, of the respiration and heart, danger from anaesthetics, 189; treatment necessary when this occurs, 189 ; of the sphincter muscle of the iris of the eye, 199 ; and of the dilator muscle of the same, 200 Parasiticide, balsam of Peru as a, 759 Pardington, Dr., reference to, 154 Pare, Ambrose, reference to, 106 Pareira, as a stimulant diuretic, 374; brava, action of, on the bladder, 383 Pareira root, characters and composition of, 707 ; action and uses of, 707 Parsley, as a stimulant diuretic, 374 Passiflorae, 777 Pasteur, divides bacteria into two classes, 91 Paton, reference to, 758 Pavy, reference to, 115n. Pearl barley, 904 Pedaliaceae, 856 Pellitory root, characters, action, and uses of, 806 Pennyroyal, 855 Pentad elements, 600-642 Pepper, as a carminative, 330 Pepper, black, as a stimulant diuretic, 374; char- acters, composition, and preparations of, 870; action and uses of, 871 ; as a stomachic, &c, 871 Peppermint camphor, characters, action, and uses of, 853; as an antiseptic and antineural- gic, 854 Peppermint and oil, as a carminative, 330 Peppermint oil, action of, on bacteria, 100; char- acters, action, and use of, 853; as a carminative and stimulant, 853 Pepsin, action of, on fibrine, 84, 85; action of, as an artificially digestive substance, 321 ; nature of, 916 Pepsinum saccharatum, 916; its therapeutics, 916 Peptogens, their action in increasing the gastric juice, 320 Peptones, action of, on the intestines, 334; action of the liver on, 348 Perchloride of mercury, 589 Perinaeum, a wet sponge applied to the; causes the evacuation of urine, 384 Peristalsis, and mode of increasing, 193 ; some hepatic stimulants which increase, 352 Permanganate of potash, action of, on bacteria, 100 ; as a powerful antiseptic, may be used to wash out abscesses, and as a lotion for ulcers or wounds, 107; action of, on muscle, 120, 122; characters, action, and uses of, 515 Peroxide of hydrogen, preparation, properties, action, and uses of, 458 Perspiration, antipyrin causes profuse, 696 Peru, balsam of, as a parasiticide, 759 Pessaries, nature and uses of, 416 Petals, cabbage-rose, 772 Red poppy, 725 Red rose, 773 Petrolatum, properties and uses of, 647 Petroleum benzin, or ether, properties and uses of, 647 ; petroleum ointment, 647 Petroleum ether, action of, on bacteria, 98 Pettehkofer, reference to, 352, 359 Pharmaceutical preparations, 427-454; general principles which govern, 427, 428 ; the following are the principal abstracts, 429 ; vinegars, 429 ; alkaloids, 429 ; waters, 430 ; cataplasms or poul- tices, 431 ; cerates, 431 ; papers, 431 ; collo- dions, 432 ; confections, electuaries, or conserves, 432 ; decoctions, 432 ; elixirs, 433 ; plasters, 433 ; injections, enemas, or clysters, 433; essences, 962 GEXERAL INDEX. 434; extracts, 434-437 ; fluid or liquid extracts, 435; fresh or green extracts, 437; glycerines, 437: inlusions, 437; hypodermic injection, 439; liniments or embrocations, 439; solutions, 440; masses, 441 ; honeys, 441 ; mixtures, 441 ; muci- lages, 442; oils, fixed and volatile, 442 ; oleates, 443: oleoresins, 443; pills, 444; powders, 444; resins, 445; spirits, 445; suppositories, 446; juices, 447; syrups, 447; tinctures, 448-451; tri- turations, 451; ointments, 452; vapors, inhala- tions, 453; wines, 453 Pharmacology, definition of, 33; one of the most important subdivisions of materia medica, 33; rapid advances of, of late years, 34; difficulty students find in dealing with, 34; the great object of, 47; the connection between chemical constitution and physiological action the most important one in, 50; importance of compara- | tive, 63, 64; inhibition, and the action of drugs on inhibitory centres play a very important part in, 154-158 Pharmacy, definition of, 33, 427 Pharyngeal irritation the probable origin of the so-called stomach cough, 222 Pharynx, structure and functions of, 222 ; cough caused by irritation of the, 222 ; application of drugs to the, 413 ; as washes, 413 ; as caustics, 413 Phenol. See Carbolic acid Phenvl-alcohol. See Carbolic acid Phosphates, test for, 497 Phosphate of soda, as a cholagogue purgative, 353 ; nature of, 538; of sodium, as a saline pur- gative, 339 ; of lime, 553, of iron, 638 Phosphides, test for, 497 Phosphide of zinc, 572 Phosphoric acid, physiological action of, 51 ; as a poison, with its antidotes, 417 ; properties, &c, 483; dilute ditto, 483 Phosphorus, symbol and atomic weight of, 36; occurs in two forms, red and yellow, 40 ; in combination sometimes pentad and sometimes triad, 40 ; its relation to other members of a group, 42; secondary effects of, as an irritant poison, on the system, 347 ; destroys the glyco- genic function of the liver, 350; has a special action on tissue change, 360; in poisoning by, action of, on the urine, 360 ; used in nervous debility, 361 ; as a poison, with its antidotes, 421 : preparation and characters of, 602 ; action of, 603: on the liver and bones, 764; on the lower jaw, 603 ; in poisonous doses, 604 ; pro- duces fatty defeneration of the liver, stomach, and kidneys, 604; treatment in cases of poison- ing by, 604; cause of the fatty degeneration, 604 : action of compounds containing, 604 ; uses of, 605 Phthisis, caused by the bacillus tuberculosis, 103 ; when accompanied by a copious secretion of mucus, a combination of morphine and atro- pine useful in, 223 ; the atropine beneficial also in lessening sweating in, 223; alkalies useful in diminishing the moist nVes heard in the lungs in, 225 ; tartar emetic ointment and croton-oil liniment sometimes useful in, 305; on the ni,L r ht sweats of, 382; diagram illustrating the action of antihydrotics in diminishing sweating in, 381; probable mode of action of arsenic in, 609 ; how the disease originates and increases, 609 Phylolaccin, as a hepatic stimulant, 351 Physiological action, relation between atomic weight and, 49; between spectroscopic char- acters and, 49; between isomorphism and, 51; Blake's division of the elements into nine groups, according to their, 51 Physiological reactions, 4S ; divided into groups, 1- PhyBOStigma, lethal dose of, o'^; action of, on muscle, 128 el seq.; effects of a solution of, applied locally to t lie nerve trunk, 144; action of, on the motor centres of the brain, 172 ; as a myotic, 198; <*i the respiratory centre, 215, 219; on the blood-pressure, 250 ; chiefly affects t he heart, 260 : action of, on the vagus, 261 ; on the frog's heart, 271 ; on the ganglia, 276, 277 ; on the vagus ends in the heart, 280 ; on the cardiac muscle, 281 : action of, on the secretory and sympathetic nerves, 315; as a sialagogue, 314,315; as an antisialic, 318; the paralyzing action of atropine counteracted by, 318 ; as a hepatic stimulant, 351; as a poisbn with its antidotes, 421 ; antagonism of, to atropine, 420-425; antagonistic action of, 422-425; nature, physiological action, and therapeutics of, 761-765. See also Physostigmine Physostigmina? salicylas, 430 Physostigmine, salicylate of, characters of, 761; action of, on the muscular fibres and nerve centres, 762 ; general action on the muscles, spinal cord, medulla, and motor and sensory nerves, 762; on the brain, eye, respiration, and. circulation, 763; on muscle, stomach, and intestines, 763; on the spleen, bladder, and uterus, 764; on the secretions and secreting cells, 764; uses of, 764; treatment of poisoning by, 765 Phytolacca berry, 859 Eoot, characters, and action of, 859 ; as an emetic, narcotic, and alterative, 859 Picric acid, action of, on bacteria, 96, 100 Picrotoxin, effect of temperature on the action of, 61; action of, on oxidation, 79; powerful convulsant action of, 174; action of, on the accelerating centre, 279; as an antihydrotic, 381 ; as a poison, with its antidotes, 421 ; antago- nism of, to chloral, 420-425 ; characters of, 707 ; action of, on the medulla, motor centres, spinal cord, and temperature, 707 ; uses of, 708 Picrotoxinum, 430 Pills, 444 Pilocarpine hydrochloras, 430 Pilocarpine, effects of cold on the action of, 60 ; as a myotic, 198 ; action of, on the mucous mem- brane, 226; as a depressant expectorant, 227: effect of, on the frog's heart, 271 ; on the cardiac muscle, 281 ; as a sialagogue, 314 ; action of, on the peripheral ends of the sweat nerves, 379; as an antihydrotic, 3S1 ; as a poison, with its antidote, 421 ; antagonism of, to atropine, 421- 425 Pilocarpus (jaborandi), characters of, 749 Pilula aloes, 444, 819, 892 Barbadensis,444, 791, 819, 893 et asafcetidav, 444, 788, 819, 891, 892 et ferri, 444, 630, 892 et mastiches, 444, 754, 773, 892 et myrrha?, 444, 756, 891, 892, 902 Socotrime, 444, 819, 860, 891 Antimonii composite, 444, 583, 588, 617, 619, 746 Asafoetidie, 444, 787, S19 Composita, 144, 756, 787, 788, 906 Cambogia? composita, 444, 744, 819, 892 Catharticae composite, 444, 5S3, 588, 744, 783, S33, 892 Colocvnthidis composita, 444, 512, 779, 783, 832, 892 et hvoscyami, 444, 512, 779, 783, 832, 892 Conii composita, 444, 786, 803, 906 Ferri carbonatis, 444, 630, 906 Iodidi, 444, 470, 637, 757, 906 Composita', 444, 756 Galbani compositae, 444, 756, 787, 788 Hydrargyri, 444, 583, 7.17 Subchloridi composita, III, 756j 587, 617, 619, 746, 869 Ipecacuanha- cum scilla, 444, 512, 710, 890, 906 Kitro-glyc-erini, 668 Opii, 444, 710, 819 Phosphori, 444, 603 Plumbi cum opio, 444, 598, 709 Quinia', 111, 796 Composita, 891.892, 906 IMiei, 111, si*), 857 Saponis composita, 1 1 1, 709, 719 Scamnionii composita, II I, 832, '.'1 I Scilhc composita, 111, 719, 890, 900,906 Pimeuta, 779 Oil of, 779 Pimento, characters and composition of, 779 Oil of, 779 Pine bath, 101 Pinkroot. See Spigelia GENERAL INDEX. 963 Piperaceae, 870 Piperine, 430 ; character, action, and uses of, 870, 871 Pisces 920 »• Pitch, Burgundy, 885 Canada, 885 Hemlock, 885 Pitres, reference to, 171ra., 172/!. Piturine, as a mydriatic, 198 Plasters, 433 Plasters, utility of, in chest complaints and in bronchitis, 228 Platinum, symbol and atomic weight of, 36 ; physiological action of, 51; action of, on muscle, 124 ; causes powerful contraction of the vessels, 246; properties, action and uses of foil, 641; of solution of perchloride of, 641; of platinum black, 642 Pleurisy, tartar emetic ointment and croton-oil liniment sometimes useful in, 305 Pleurisy root. See Asclepias Plumbi acetas, 642 Iodidum, 470, 599 Pneumonia, contagious, micrococci present in, 103 Podophylli resina, 704 Podophyllin, as a drastic purgative, 339 ; and as a cholagogue, 340. See also Podophyllum root, and Resin of podophyllum Podophyllum root, characters, properties, and composition of, 703, 704; resin of, nature, properties, and uses of, 704 Poisoning, what is necessary to be done in all cases of, before administering the antidote, 416; by acids, 477; chronic, by copper, 566; by phosphorus, and its treatment, 603, 604; by arsenic, and its treatment, 606; chronic, by arse uic, 606 ; by antimony, 613; chronic alco- holic, 653; treatment of, by chloral, 672; by opium, 716; by physostigmine, 764 ; by strych- nine, and its treatment, 823 ; by belladonna or atropine, 840; by digitalis, and its treatment, 850; by croton oil, and its treatment, 867 ; by colchium, 899; treatment of, by cantharides, 927 Poisonous gases, with their antidotes, 416 Poisons, effect of heat on the power of, 59-62; different effects of, ou different animals, 58-62; effects of various, on medusge, 111, 112 ; list of muscular, 124-128; effects of certain, on the color of the blood, 214; on the muscular fibre of the ventricle of the heart, 271 ; on the heart itself, 273; of two classes of, on the vagus, 274- 277; list of cardiac, 281; most suitable emetics for removing, from the stomach, 32S ; action of various irritant, on the general system. 344- 346 ; peculiarities in the action of different irritant, 346; secondary effects of irritant poisoning, 347 ; list of the more common, with their antidotes, 416-421 ; carbonic acid as a, 488 ; has three stages— dyspnoea, convulsions, paralysis, 488 ; copper as a, 566 Poke berry. See Phytolacca berry Root. See Phytolacca root Polygalacepe, 730 Polygonacere, 857 Poniea?, 771 Pomegranate, as a vermicide, 355 ; characters, composition, and use as an anthelmintic, 782 Root bark, 782 Poppy capsules, character of, 708 ; composition, action, and uses of, 708 Poppy petals, red, characters, composition, and use of, 725 Potash, physiological action of, 51 ; action of, on protoplasm, 71 ; permanganate of, effect of, on infusoria, 75; on bacteria, 96; on muscle, 120; salts of, effects of, on muscular contrac- tion, 126; action of, on the ends of the vaso- motor nerves, 249; action of, combined with other ingredients, on the frog's heart, 270; as a caustic, 304 ; difference between the action of, and soda, on the intestines, 334; used in gout, 361 Potash salts, preparation, nature, and uses of the following — Potassium acetate, 506, 510 Acid tartrate, 506, 511 Bicarbonate, 506, 510 Bichromate of, 516 Bitartrate of, 511 Bromide, 507, 520, 523 Carbonate, 506, 508 Caustic potash, 506, 508 Chlorate, 506, 513 Citrate, 506, 513 Cyanide, 511 Ferrocyanide, 511, 517 Hypophosphite, 506 Iodide, 511, 518 Liquor potassse, 506, 508 Potassii, 506 Nitrate, 507, 512 Nitrate of potash, 512 Permanganate, 507, 515 Potassa with lime, 509 Solution of potash, 508 Sulphate, 507, 512 Sulphite, 506 Sulphurata, 507, 516 Tartrate, 509, 512 Tartrate of potash, 512 Potash salts, general sources and reactions of, 505, 506 ; action of, on the general system, 506-509 Potassse cum calce, 550 Permanganas, 509 Tartras, 511 Potassa?, liquor, singular effect of a single drop of, 422 Potassic picrate, effects of, in destroying bacte- ria, 93 Potassii iodidum, 470 Potassium, symbol and atomic weight of, 36 ; its relation to other members of a group, 42; and especially to lithium, 43; action of, on muscles, 125, 126, 130. 137, 138 ; on the vaso-motor cen- tre, 279 Potassium acetate, action of, on bacteria, 99; as a remote antacid, 322; as a refrigerant diure- tic, 374 Potassium bicarbonate, as a direct antacid, 322 Potassium bichromate, action of, on baeteria, 98 Potassium bitartrate, as a remote antacid, 322 : as a saline purgative, 339 ; a hydragogue, 340 ; and a refrigerant diuretic, 374 Potassium bromide, action of, on bacteria, 98; on the nervous system, 186 Potassium carbonate, as a direct antacid, 322 Chlorate, action of, on bacteria, 99 ; as a re- frigerant diuretic, 374 Potassium chloride, causes great contraction of the vessels, 246 ; neutralizes the action of vera- trine in certain cases, 271 Potassium chromate, action of, on bacteria, 98 Potassium citrate, as a remote antacid, 322 ; and refrigerant diuretic, 374 Potassium iodide, action of, on bacteria, 98; as a depressant expectorant, 227 Potassium nitrate, as a refrigerant. diuretic, 374 Potassium permanganate, action of, on bacte- ria, 98 Potassium salts, action of, on the cardiac mus- cle, 281 ; on the vaso-motor nerves, 281 ; on the capillaries, 282 ; as refrigerant diuretics, 374 ; antagonism of, to barium, 420-425 Potassium sulphate, as a hepatic stimulant, 351 Potassium tartrate, as a remote antacid, 322 ; as a saline purgative, 339 ; and sodium, as ditto, 339 Potato and potato water, experiments with, on oxygen, 79 Poultice, action of a warm, on the mucous mem- brane, 224 ; and on the chest, 228 ; use of a warm, in inflammation, 302, 303 ; as an emol- lient, 307 ; uses of, and how to apply different kinds of, 402 ; a linseed, 729 Poultices, or cataplasms, 431 * Powders, 444 Power, Mr., reference to, 372, 847 Prayer beads, 760 Precipitated sulphur, its preparation, &c, 462 Pregnancy, best mode of treating the vomiting of, 328 964 GENERAL INDEX. Preventive medicine, growing importance of, 34; ehiefly owing to recent increase in knowledge of microbes and their action in causing dis- ease, 34 Prevost on poisoning by mercury, 47 Prever, reference to, 143, 422 Prickly ash, 748 Prinos (black alder), characters and action of, as an astringent, 754 Prolapsus of the uterus, emetics to be used with caution in persons suffering from, 328 Prophylactic, quinine as a, 802 Prophylaxis. See Preventive medicine Protoplasm, action of drugs on, 70-74; method of experimenting on amcebte and leucocytes, 70-72 ; relations of motion and oxidation to, 75 ; oxi- dation of, 77 ; oxygen-carrying power of, 78 ; potash salts poisons or destroys, 507 Protoplasmic poison, anaesthetics act as a, 187 ; and potash salts, 5u7 Prune, composition and use of, 776 ; Virginian prune, or wild cherry, 776 Prunes, as a laxative, 339 Prussic acid, 489 Ptomaines, alkaloids formed by putrefaction, 103 ; action of, on muscle, 125 ; how formed, 349 Ptyalin, 84 Puerperal fever, micrococci present in, 103; sin- gular cause of an epidemic, 106 Pulmonary sedatives, nature, number, and uses of, 220-224 ; divided into three classes, 220 Pulsatilla, characters and composition of, 702; action of the oil of, as a vesicant, 702 ; pure anemonin has a depressant action on the cir- culation, respiration, and spinal cord, 702; causing feeble pulse, slow respiration, paralysis, dyspnoea, and death, 702 ; uses of, as a diapho- retic and emmenagogue, 702 Pulse rate, relation of, and arterioles to blood-pres- sure, 237; diagrams of a pulse curve, 238 ; effect of the arterioles on pulse curves, 240 ; effect of drugs on the, 259; of irritant poisons on, 346; of arsenic, 607; of nitrite of amyl, 665-667 ; of chloral hydrate, 671 ; of purified chloroform, 677; of carbolic acid, 689; of creasote, 691; of staphisagria, 701; of anemonin, 702; of hydro- chlorate of apomorphine, 712 ; of erythroxylon, 732 ; of caffeine, 743 ; of Jamaica dogwood, 769 ; of oil of valerian, 805; of gelsemium, 827; of tobacco, 845 ; of camphor, 864; of Indian hemp or American cannabis, 880; of squill, 890; of hellebore, 594 ; of veratrine, 897 Pulvis amvgfiake compositus, 445, 770, 775, 906 Antimonialis, 445, 553, 617, 620 Aromaticus, 445, 860, 900, 901 Catechu compositus, 445, 731, 759, 805, 860, 861 Cinnamotui compositus, 445, 759, 901, 902 Cretie aromaticus, 445, 552, 860, 861, 901, 902, 906 Aromaticus cum opio, 445, 552, 710 Compositus, 445, 552, 906 EfFervescens compositus, 445 Elaterii compositus, 445, 784 Glycyrrhiza; compositus, 445, 462, 757, 766, 906 Ipecacuanha compositus, 445, 512, 710, 803 et Opii, 445, 710, 803 .Talap;c compositus, 445, 511, 833, 900 Kino compositus, 445, 710, 759, 861 Morphina- compositus, 445, 713 Opii compositus, 445, 710, 758, 791, 870, 900 Rhei, 858 Rhei compositus, 445, 858, 900 Seammonii compositus, 115, 834, 900 Tragacantha: compositus, 1 45, 758, 904. 906 Pumpkin seed, composition and uses of, as an anthelmintic, 785 Pupil of the eve, structure of, and action of drugs on the, 196-204 Purgatives, aid the action of antiperiodics, and sometimes cure ague without them, 109; nature Of, 388: divided into laxatives (list of the chief), :;:;-: simple. 838; drastic, 388; saline, 388; hy- dragogues. 338, and oholagogues, 888; action of, 340; Dr. lias's researches into the action of, 341-844; the various uses of, 848, 844; to re- move I'm eal matters from the intestinal tube, 348; to remove liquid from the body, 848; to lower the temperature in fever, 344 ; to lower the blood-pressure, 344; they act as hepatic depressants, 384; as antipyretics, 360; as an- aphrodisiacs, 388; as indirect emmenagogues, 391; resin of podophyllum as a, 704; gamboge as a, 744; buckthorn as a, 753; senna as a, 766; tamarind as a, 767; olive oil as, 820; manna as, 820; castor oil as, 869 ; oil of turpen- tine as, 883 ; aloes as, 893 ; treacle as, 906 ; oat- meal as, 906 Putrefaction, alkaloids formed by, 103; antisep- tics arrest the, 106, 107 Pyaemia, micrococci present in, 103 Pye, Mr., references to, 260, 372 Pye-Smith, Dr., reference to, 332«., 839 Pyrethrum, 806 Pyrethrum, as a sialagogue, 314 Pyrocatechin, characters, action and uses of, 692 Pyrophosphate of iron, 639 Pyrophosphate of soda, 533; action of, on the nerve centres of the spinal cord, &c, 605 Pyroxylin, 735 Pyroxylinum, 735 Q. Quassia, as a vermicide, 355 Quassia and quassia wood, properties and compo- sition of, 752 ; action and uses of, 752 ; is simply a pure bitter stomachic, 752 Quebracho, as a depressant expectorant, 227 Quebracho bark, white, characters, action, and uses of, 828 Queen's root. See Stillingia Quercus alba, the bark of, 875; characters, action, and use of, as a local astringent, 875 Quillaia (saponin), characters, composition, ac- tion, and uses of, 774; action of, as a local irritant, 774; produces local paralysis and anaesthesia, 774; action of, on the voluntary - muscles, the intestine and the heart, 774; on digitalis, and on the nerve centres, 774 Quince seed, characters and use of, 771 Quinia, sulphate of, 796 Quinise sulphas, 430, 796 Quinicine, constitution of, 696 Quinidinse sulphas, 430, 799 Quinidine, sulphate of, 798 Quinina, 430, 799 Quininse sulphas, 799 Bisulphas, 799 Hydrobromas, 799 Valerian as, 799, 805 Quinine, example of the empirical use of, 33; utility of, in ague. 33; action of, on protoplas- mic movements, 72, 73; on the mesentery of a frog, 72; on infusoria, 75; effects of, on oxida- tion, 79, 82; on bacteria, 93, 99, 100; as a dis- infectant, 108; as an antiperiodic almost a specific in intermittent fevers, periodic head- aches, neuralgias, f, 532 Salicylate of, 532 Santoninate of, 532 S> pint ion of, 526 Sulphate of, 529 Sulphite of, 533 Sulphocarbolate of, 533 Tartarated, 528 Valerianate of, 538 Soda .'-alts, sources of, 522; reactions of, 522; pre- paration- of, 528; impurities of, 524; tests for impurities in, 524 ; genera] action of, 521; their action, in Large doses, on muscle and nerve, 524 Soda tartarata, 511 Bods, arsenias, on ,\ reeniatis, liquor, on Citro-tartras effervescens, 527 Valerian as, 660 Sodlc hyposulphite, 93 SodiC sul]. hate, action of, on bacteria, 9.". Sodii iodidum, 470 Santoninas, 808 Sodium, symbol and atomic weight of, 37; its relation to other members of a group, 42, phy- siological action of, 51 Sodium Acetate, as a remote antacid, 322 Benzoate, as a hepatic stimulant, 351 Bicarbonate, action of, on the ear, 205; as a direct antacid, 322 Carbonate, as a direct antacid, 322 Chloride, as a vermicide, 355 Citrate, as a remote antacid, 322 Phosphate, as a hepatic stimulant, 351 Salicylate, as a hepatic stimulant, 351 Salts, action of, on the intestines, 334; as a refrigerant diuretic, 374 Sulphate, as a hepatic stimulant, 351; an- tagonism of, to barium, 422-425 Sokoloff, reference to, 133?*. Solanacese, 834 Solution of— Acetate of ammonia, 544 Ammonia, 542 Basic ferric sulphate of iron, 631 Bichromate of potassium, 517 Carbonate of magnesia. 561 Chloride of calcium, 552 Chloride of iron, 633 Chloride of tin, 600 Chloride of zinc, 569 Chlorinated lime, 467 Citrate of ammonia, 544 Citrate of bismuth, 623 Citrate of iron and quinine, 636 Citrate of magnesia, 562 Iodide of arsenic and mercury, 612 Liquor potassse permanganatis, 515 Litmus, 908 Perchloride of (strong), 633 Pernitrate of iron, 637 Persulphate of iron, 637 Potash, 509 Red prussiate of potash, 517 Soda, 525 Sr.bacetate of lead, 598 Subsulphate of iron, 631 Tersulphate of, 631 Turmeric, 901 Yellow prussiate of potash, 517 Solution, test, of albumen, 920 Solutions, 440 Sonnenschein, references to, 104 Soporific, Indian hemp or American cannabis as a, 880 ; lupulin as, 881 Soporifics, 179. See Hypnotics Spanish flies, 925 Sparteine, action of, on inhibitory ganglia, 280 Spasm, nature and cause of, 193 ; general mode of treatment, 193-195 ; list of antispasmodics and adjuvants, 195 Spearmint and oil, as a carminative, 330 Spearmint, oil of, characters, action, and use of, 853; as a carminative and stimulant, 853 Spectrum of simple and compound bodies, 38; of calcium chloride, 39 ; of lithium, 39; of calcium, 40; hemoglobin and its derivatives, 81 Spence, Dr. A. J., references to, 166 Spermaceti, 919; as an emollient, 920 Sphacelinic acid, 910 Splnerobacteria, 90 Sphincter muscle of the iris, nature and func- tions of, 197 Spider's web as a styptic, 309 Spigelia, characters "and use of, 821 ; as an anthel- mintic, 827 Spinal centre for respiration, 211; vaso-motor, 251, 262, 824; for secretion of sweat, 377 ; for the generative organs, 886 Spinal cord, action of drugs on the, 117-167; the three functions of the, 1 17; action of drugs on the conducting power of the, 117; mode of testing this, 117; mode of ascertaining the power of the, to conduct sensory impressions, 148; and reflex stimuli, 148: and of the time required for transverse and longitudinal con- duction, 1 1^; diagrams illustrative of this, 149, I 151; mode of experimenting on the action of GENERAL INDEX. 969 drugs on the reflex action of the, 151 ; direct, indirect, and inhibitory paralysis of the, by drugs, 151, 152 ; list of, and uses of, depressants for the, 152; inhibitory paralysis of the, 153; experiments illustrative of this, 153 ; diagram to illustrate inhibition in the, 156; explana- tion of the actions of certain drugs on the, on the author's hypothesis, 158-163; stimulating action of drugs on the reflex powers of the, 163; Magendie's series of experiments on the action of poison on, 163-167 ; diagram illustra- ting Magendie's method of investigating the mode of action of strychnine on, 165; stimu- lants for the, and their uses, 167 ; antagonism between drugs acting on the respiratory centre and the, 425; action of ammonium salts on the, 504 ; of bromide of potassium, 521 ; of am- monium chloride, 540 ; of manganese salts, 640 ; of spirits of ether, 662; of nitro-glycerine, 668; of chloral hydrate, 671; of carbolic acid, 688; of aconitia, 689; of delphinine, 702; of codeine, 714; of opium, 718; of sanguinaria, 725; of physostigmine, 762; of Jamaica dogwood, 769; of oil of eucalyptus, 781 ; of con'ine, 786 ; of quinine, 801; of oil of valerian, 806 ; of strych- nine, 825; of curare, 826; of gelsemium, 827; of tobacco, 843 ; of digitalin, 844 ; of thymol, 854 ; of colchicum, 898 Spinal depressants, number, nature and uses of, 152; stimulants, 167 Spirit, proof, 658; rectified, 658; of French wine, 658 Spirit of chloroform, as a cardiac stimulant, 291 Spirit of ether, as a cardiac stimulant,* 291 Spirits, 445 Spirits, as a carminative, 330 Spiritus retheris, 446, 662 Compositus, 446, 661, 663 Nitrosi, 446 Ammonia?, 446 Aromaticus, 446, 540, 541,543,661, 860 Fcetidus, 446 Anisi, 446, 790 Armoracise compositus, 446, 728, 738, 860 Aurantii, 446, 738 Cajuputi, 446, 780 Camphorse, 446, 862 Chloroformi, 446, 675 Oinnamomi, 862 Cinnamonii, 446 Frumenti, 446 Gaultheria?, 446, 816 Juniperi, 446, 887 Compositus, 446, 791, 887 Lavandulae, 446, 852 Limonis, 446, 739 Menthse piperita?, 446, 853 Viridis, 446, 853 Myrcise, 446, 738, 779 Myristicae, 446, 860 Odoratus, 446, 737, 739, 740, 852 Rectifieatus, 446 Rosmarini, 446, 852 Tenuior, 446 Vini gallici, 446 Spiritus vini gallici, mistura, 920 Spirobacteria, 90 Splanchnics, the, and the kidneys, 370 Spleen, action of alcohol on the, 649 ; action of physostigmine, 764 ; of oil of eucalyptus, 781 Squill, action and. use of, 890 ; in large doses, 890 ; on the pulse, and as a diuretic and expecto- rant, 890 Squills, action of, on the blood vessels, 223; as a stimulating expectorant, 227; as a cardiac tonic, 294; as a general emetic, 326; as a re- frigerant diuretic, 374 Squirting cucumber fruit, 784 Stannius, reference to, 824 Stannius's experiments as to the actions of the various cavities of the frog's heart, 282-285 Staphisagria, or stavesacre, cbaracters and com- position of, 701 ; action of, in frogs, 702 ; del- phinine acts like aconitine on the pulse and respiration, 702 ; on the spinal cord and medulla, 702; on the vagus and the heart, 702; uses of, 702 Star-anise, character and composition of, 705 Starch, 904 ; characters and uses, 904 Starch, is converted into dextrin and sugar by boiling with acids, 82 ; as a demulcent, 307 Stavesacre, 701 Stearic acid, action of, on bacteria, 99 Stenhouse, Dr., reference to, 758 Stenosis, mitral, cardiac tonics useful in, 295 ; aortic, digitalis of doubtful use in, 295 Stenson's experiment on the abdominal aorta of a rabbit, 152 Sterculiacese, 741 Sternutatories, or errhines, number, nature, and uses of, 219, 220; contra-indications of, 220; must be used with caution in certain cases, 220 Stevens, reference to, 846 Stewed apples, as a laxative, 339 Stillingia, as an alterative, 358; characters and uses of, 867 ; as an alterative, 867 Stimulant, beef-tea versus alcohol as a, 656 Stimulants, spinal, 167; nerve, 176; cerebral, 176; cardiac, 291; vascular, 292; hepatic, 361; diu- retic, 373, 374 Stirling, references to, 123 Stolnikow, reference to, 722ra. Stomach, impaired power of the, in the aged, 310; normal and abnormal condition of, 319; irritability of the, 319; diagram to illustrate the supposed nervous connections of the, 319 ; three factors in the process of digestion in the, 320 ; action of drugs on secretion in the, 320 ; drugs which stimulate the secretion of the gastric juice, 320; importance of thorough mastication, 320; supply of artificially diges- tive substances to the, 321 ; action of drugs on the movements of the, 321 ; absorption from the, 321 ; action of calomel on the, 322 ; use of gastric sedatives in relieving pain in the, 328 ; and vomiting from the, 328 ; list of sedatives which have the most powerful action on the, in certain circumstances, 328 ; action of, in expelling gases from the, 329, 330 ; drugs which tend to prevent fermentation in the, 329 ; they remove pain and distention of, and diminish local spasm, 330 ; action of irritant poisons on the, 344, 345; diagram to show the nervous mechanism by which the action of the heart may be depressed by irritation of the, 345; diagram of the liver, intestines, and, 351 ; ap- plication of drugs to the, 414 ; the stomach- pump, 414; the gastric syphon, and its use, 414 ; action of acids in the, 476 ; of alkalis, 501 ; of the metals— zinc, copper, cadmium, and silver, 565, 566 ; of nitrate of silver, 576 ; of mercury, 581 ; of phosphorus, 604 ; of arsenic, 606 ; of antimony, 613; of iron salts, 628; of gold, 641 ; of alcohol, 650 ; of spirit of ether, 662 ; of chlo- ral hydrate, 671; of aconitia, 700; of pilocar- pine, 749 ; of physostigmine, 764 ; of quinine, 799 ; of tannic acid, 876 ; of oil of turpentine, 883 Stomach cough, probable origin of the so-called, 222; rationale of the, 222 Stomachic, black pepper as a, 871 ; lupulin as, 881 Storax, characters, composition, and use of, 874 ; prepared, 874 Stramonium, as a narcotic, 182; as a general ano- dyne, 183; action of, on the lung, on the respi- ratory centre, and on the ends of the vagi, 223; on the vagus centre, 279 ; on the vaso-motor centre, 279 ; as a poison, with its antidote, 421 Stramonium leaves, characters of, 841 Seed, 842 Seeds, characters, action, and use of, 842; as an antispasmodic, 842 Strieker's stage, uses of a, 70 Stromuhr, Ludwig's, 259 Strontium, symbol and atomic weight of, 37; physiological action of, 51; action of, on the muscles, 131, 137; causes contraction of the vessels, 246 Strophanthine, as a cardiac tonic, 294 ; as a refrig- erant diuretic, 374 Strophanthus hispidus, action of, on the cardiac muscle, 281 ; as a cardiac tonic, 294 Strychnina, 429, 822 Strychnine, cumulative action of, 58; effect of, on protoplasm, 72; has little power on infusoria, 970 GEXEEAL IXDEX. 75: effects of, on oxidation, 79, 82; action of, on medusa?, 112; onmollusca,114; onascidians,115; and on annulosa, 116; on muscle, 120, 139; effect of, on the spinal cord, 150, 15s ; effect of, in causing tetanus, 160, 161-163; Magendie's series of experiments on the action of, 163-167 ; as a spinal stimulant, 167; action of, on the brain of dogs, 172; and of men, 178; on the ear, 205; on taste and the sense of smell, 206; on the respiratory centre, 215; as a stimulating expectorant, 227 ; action of, on the vaso-motor centre, 251, 279 ; as a cardiac tonic, 294 ; as a vascular tonic, 297; fails to poison -when the vagi are divided, 322 ; as an antihydrotic, 381 ; action of, in lessening the night sweats in phthisis, 381-383 ; as an aphrodisiac, 388 ; as an indirect emmenagogue, 391; as a poison, with its antidote, 421; antagonism of, to other drugs, 422-425 : antagonistic action of, to chloral, 424, 425 Strychnine, 822 Sulphate of, preparation and characters of, s22 : action of, on low organisms, on oxidation, and fermentation, 822; on the reflex nerve centres, on the intestines and sensory nerves, 822; poisoning by, and treatment for, 823; action of, on the alimentary canal, on the blood and circu- lation, 823: on the heart, respiration, and muscles, 824; on the nervous system and brain, 624; on the spinal cord, 824; uses of, 825 Stuart, Anderson, references to, 124, 137 Sturiones, 920 Styptic, action of dried alum as a, 556; strong solution of perchloride of iron one of the most powerful styptics, 634; matico as a, 872 Styria, arsenic-eaters of, account of the, 607 Subchloride of mercury, 587 Sublimed sulphur, its preparation, characters, &C., 461 Subnitrate of bismuth, 622 Subsulphate of mercury, as a local emetic, 326 Succus belladonna?, 447*, 836 Conii, 447, 786 Hyoscyami, 447, S41 Limonis, 485 Scoparii, 447, 758 Taraxaci, 447, 810 Sudorifics, action of, on the secretion of sweat, 377 Suet, 914; prepared, 914 Suffocation, cause of, 214; produced by the action of certain poisons on the respiratory tract, 346 Sugar, 905 : as a vehicle and corrigent, 906 ; pre- servative and antiseptic, 906; sugar, refined, 905 Sugar of milk, 915 Sulpha-moglobin, 81 Sulphate of aluminium, action of, on bacteria, 98 Sulphate of aluminium, 558 Ammonium, 545 Atropine. s :;7 Boberia. ><;•" Hyoscyamine, 841 Iron, 629 and Ammonium, 637 Dried, 630 Granulated, 630 Precipitated, 630 Magnesia, 560 Mercury, 587 Morphine, 713 Potash, 512 Soda, 529 Zinc. 570 Sulphate of bebei inc. action of, on protoplasm, 72 Sulphate "f potash, as a cbolagogue purgative, Sulphate of potassium, sodium, and magnesium, as saline purgatives, '■'>'■'•'.* Sulphate o/ Boaa, as a cholagogue purgative, 853 Sulphates, genera] action of, 504 Sulphide of mercury, red, Sulphite of Boda, •">:;:; Sulphites, teal for, 198 Salpbocarbolateofsoda, 533 Sulphocyanide of potassium, action of. on mol- luscs, 1 1 1 Sulpho-vinate of sodium, as a saline purgative, 339 Sulphur, symbol and atomic weight of, 37; its relation to other members of a group, 42 ; as a stimulating expectorant, 227; as a laxative and purgative, 339 Sulphur and its elements, 461-464; sublimed sul- phur, flowers of sulphur, 461 ; confection of sulphur, 461 ; sulphur ointment, 461 ; washed sulphur, 461 ; alkaline sulphur ointment, 462 ; precipitated sulphur, lac sulphuris, or milk of sulphur, 462 ; sulphuretted hydrogen, or hydro- gen sulphide, 462 ; general action of sulphuret- ted hydrogen, 463; special action, 463; action and uses of sulphur, 463, 464; iodide of, 470 Sulphur lotum, 461 Precipitatum, 461 Sulphurated potash, 516 Sulphuretted hydrogen, action of water of, on bacteria, 99; as a poison, with its antidote, 416 ; its preparation and properties, 462, 463 Sulphuric acid, physiological action of, 51; direct and local action of, 53; effects of, on alcohol, 82 ; on bacteria, 96, 9S ; as a caustic, 304 ; as a poison, with its antidote, 417; properties and uses of, 477 Sulphuris iodidum, 462, 470 Sulphurous acid, action of, on enzymes, 86; on bacteria, 96 ; properties and uses of, 478 Sulphurous bath, uses of a, 403 Sumach, as an astringent, 755 Sumbul, as an antispasmodic, 195; characters and uses of, chiefly in hysteria, 791 Root, 791 Suppositoria acidi carbolici cum sapone, 446, 688, 914 Acidi tannici, 446, 742, 876, 924 cum Sapone, 446, 914 Hvdrargyri, 446, 583, 742, 924 Morphite, 446, 712, 742, 924 cum Sapone, 446, 712, 914 Plumbi composita, 446, 598, 742, 924 Suppositories, nature and uses of, 415 Suppositories, 446 Surgical operations, use of antiseptics in, 106; Sir Joseph Lister on the best mode of performing, 689 Sustschinsky, reference to, 277 Sweat, mode" of secretion of, 377; various causes which arrest or increase the secretion of, 378; excretion by the sweat glands, 379; relation between the sweat glands and the kidneys, 379; uses of diaphoretics and sudorifics in increas- ing the secretion of, 377 ; action of antihy- drotics on the secretion of the, 381; the night sweats of phthisis, 382; diagram to illustrate the action of antihydrotics, 381; connection of the respiratory centre with the sweat glands, 383; various drugs which act on the secretion of, 382 ; action of carbolic acid on the sweat centres, 689 ; action of opium on the secretion of, 719; and of erythroxyl.m, T;!-'! Sylvester's plan of artificial respiration, 680 Syncope, caused by sudden change of posture, 186, 187 ; by the use of anesthetics, 189-191 ; by fainting and shock, 230-232; by the incautious use of cardiac tonics, 296; by the lownessofthe blood-pressure, 295; by the administration of digitalis, 296 Syphon, gastric, nature and uses of, ill Syringe, diagram of a, for hypodermic injection, ' in-- : of a vulcanite, for injecting solutions into the ear, 410; of a vulcanite, for injecting solu- tions into the urethra, 415 Syrupus acaciae, i it, 77o Acidi citrici, I 17, 185 Hydriodici, 1 17 Allii, 117, 889 Althsese, 447, 786 Amygdala?, n:. 77'; Aurantii, 147, 148, 788 Floris, 148,787 Calcii lactophosphatis, 117, 558 Calcis, H7, 550 Cheken, 770 Chloral, us, 670 FerrJ Bromidi, 1 17 GENERAL INDEX. 971 Syrupus Ferri— Iodidi, 447, 448, 470, 638 Phosphatis, 448, 484, 528, 639 Quinina? et strychnina? phosphatum, 447, 639, 796, 822 Heinidesmi, 448, 829 Hypophosphiturn, 447, 531, 554 cum Ferro, 447, 637 Ipecacuanha?, 447, 803 Kranieria?, 447, 731 Lactucarii, 447, 811 Limonis, 447, 448, 485, 739, 740 Mori, 448, 879 Papaveris, 448, 708 Picis liquid a?, 447, 886 Pruni Virginian a?, 447 Fluidum, 777 Rhanini, 448, 753, 779, 900 Rhei, 447, 792, 857, 858 Aroniaticus, 447, 778, 857, 858 Rhceados, 448, 725 Rosa?, 447, 773 Galliea?, 448, 773 Rubi, 447 Ida?i, 447, 772 Sarsaparilla? compositus, 448, 766, 772, 816, 8( 888 Scillae, 448, 890 Compositus, 448, 617, 620, 731, 890 Senega?, 448, 731 Semite, 448, 766, 792 Tolutanus, 448, 760 Zingiberis, 448, 900 Syrup of bromide of iron, 638 Syrups, 447 Szpilman, reference to, 134 T. Tamarind, character, composition, and use of> 766, 767 Tannate of soda, action of, on the kidneys, 376 Tannic acid, 875 Tannic acid, as an astringent, 308 ; preparation and properties of, 875 ; action of, on the skin, mucous membranes, mouth, and stomach, 876; on the blood and kidneys, 876; uses of, exter- nally and internally, 876, 877 Tannin, action of, on bacteria, 99; on the mucous membranes. 226; as a styptic, 309; as a vermi- cide, 355 ; action of, on the kidneys, 376; indi- gestibleness of tea partly due to the tannin it contains, 742 Tansy, characters and uses of, 807; as a diuretic, stimulant, emmenagogue, and anthelmintic, 808 Tantalum, symbol and atomic weight of, 37 Tar as a stimulating expectorant, 227 ; action and use of, 886 ; as a stimulant, 886 Tar, oil of, 886 Taraxacum, 810 Taraxacum, as a stimulant diuretic, 374 Tartar emetic, effects of, on the blood, 82; as a depressant expectorant, 227 ; action of, on the system, in causing vomiting, 325 ; as a general emetic, 326 ; nature aud use of, 614-616 ; oint- ment, 621 Tartarated soda, as a remote antacid, 322 Tartaric acid, as a poison, with its antidote, 417; properties of, &c, 484 Tartrate, test for, 498 Tartrate of iron and ammonium, 635 Potassium, 635 Potash, 512 Soda, 528 Taste, action of drugs on the sense of, 206 Tea, characters, action, and uses of, 742; a powerful cerebral stimulant, 742 ; indigestible- ness of, partly due to the tannin it contains, 742 Teeth, danger of extracting the, with chloroform, in certain cases, 189; action of drugs on the, 310; importance of the, for mastication, 310; what the decay of the, is chiefly due to, 310, 554; the best substances for cleansing the, 310; and for protecting and preserving the gums, 311,500; remedies for toothache, 311, 554,689, 691, 723 Tellurium, symbol and atomic weight of, 37 ; its relation to other members of a group, 42 Teleostese, 921 Temperature, effect of, on the action of drugs, 59, 62; on the secreting nerves, 60 ; of the body half a degree higher in India, 62 ; effects of, on ferments, 84; on mould fungi, 91; on bacteria, 93 ; excess of, injurious to the human organism, but destructive of bacteria, 104 ; effects of, on the rhythmical action of medusa?, 110; on mollusca, 114; on muscles, 126 et seq.; effects of, on the poisonous action of guanidine, 162 ; the, of warm-blooded animals, 361 ; action of antipyretics on, 362; action of the skin in regulating the, 380; action of salicylate of soda on the 532; of mercury on the, 583; of alcohol, 651 ; of chloral hydrate, 671 ; of carbolic acid, 689 ; of salicylic acid, 693; of aconitine, 700; of erythroxylon, 733; of caffeine, 743; of pilocar- pine, 751 ; of oil of eucalyptus, 781 ; of solanine, 835; of belladonna or atropine, 839; effects of, on the action of digitalin, 847 ; of thymol, 854; of camphor, 863, 864; of Indian hemp or American cannabis, 880; of oil of turpentine, 883; of thuja, 887; of veratrine, 897 Tents, nature and uses of, 416 Tepid baths, 401 Terbium, symbol and atomic weight of, 37 Terebinthacea?, 754 Tetrachloride of carbon, as an anaesthetic, 186 Thalamiflora?, 697 et seq. Thallium, symbol and atomic weight of, 37; physiological action of, 51 Thebaine, a» a spinal stimulant, 167; action of, on the respiratory centre, 215; on the vaso- motor centie, 279; antagonism of, to chloral, 422-425 ; acts like strychnine, 825 Theobroma, oil of (cacao butter), characters uses, &c, of, 741 Theobromine, action of, on muscles, 128 Therapeutics, definition of, (1) may be either empirical or rational, 33; explanation and example of empirical therapeutics, 33; and also of rational, 33, 34; first stage of rational, 34; what should follow this, 34 Thermometer, importance of cleansing and dis- infecting, 106, 107 Theveresine, action of, on the cardiac muscle, 281 Thevetin, action of, on the cardiac muscle, 281 Thighs, utility of mustard stupes, poultices, and leeches to the, as indirect emmenagogues, 390 Thirst, two kinds of, local and general, 317; nature of local, and how it is lessened or quenched, 317; general, and the means of alleviating, 317 Thomas, reference to, 61 Thorium, symbol and atomic weight of, 37 Thoroughwort, 810 Throat, action of pilocarpine on the, 751 Thuja, characters and action of, S86; in pro- ducing abortion, convulsions, and paralysis,. 886, 887; on the vessels and temperature, 887; uses of, as a diuretic, astringent, aromatic, and vermifuge, 887 Thulium, symbol and atomic weight of, 37 Thymol, action of, on enzymes, 86 ; on bacteria, 96, 99, 100; preparation and characters of, 854; action of, as a disinfectant, and on the nerve centres of the medulla and cord. 854 ; on the respiration, blood-pressure, and temperature, 854; how eliminated, 855; utes of, as an anti- septic, 855 Ticunas. See Curare Tinctura aconiti, 448, 450, 698 Aloes, 448, 450, 757, 891, 892 et Myrrh a?, 448, 756, 892 Arnica?, 450, 811 Florum, 448, 812 Radicis, 448, 811 Asafcetida?, 448, 450 Aurantii, 450, 738 Recentis, 450, 738 Amari, 449, 737 Dulcis, 449, 738 972 GENERAL INDEX. Tinctura — Belladonna;, 449, 450, 836 Benzoini, 449, 817 Composita, 449, 450, 7G0, 817, 874, 891, 892 Brvoniae, 449, 785 Buchu, 450, 74S Calendula;, 449, S12 Calumbae, 449, 550, 706 Camphorse composita, 450, 710, 790, 817, 863 Cannabis indicae, 449, 450, S79 Cantharidis, 449, 450, 925 Capsici, 449, 450, 835 Cardamomi, 449, 901 Composita, 449, 450, 745, 791, 861, 901, 924, Cascarillae, 450, 867 Castorei, 450, 913 Catechu, 450, 861 Composita, 449, 770 Chiratae, 449, 450, 831 Chloroformi composita, 450, 675, 901 Ciniicifugae, 449, 703 Cinchona?, 449, 795 Composita, 449, 450, 738, 794, 795, 866, 902, 924 Flavae, 450, 795 Ciunamomi, 449, 450, 861 Cocci, 450, 924 Colchici, 449 Seminum, 450, 898 Seminis, 898 Conii, 449, 450, 786 Croci, 449, 450, 902 Cubebae, 449, 450, 871 Digitalis, 449, 450, 844 Ergotae, 450, 908 Ervthrophlcei, 771 Ferri acetatis, 449, 450, 510, 631 Chloridi. 449, 633 Perchloridi, 450, 634 Gallae, 449, 450, 875 Gelsemii. 449, 827 Gentianae composita, 449, 450, 738, 830, 901 Guaiaci, 449, 746 Ammoniata, 449, 450, 543, 746 Herbarum receutium, 449 Humuli, 449, 881 Hydrastis, 449, 705 Hyoscyanii, 449, 450, 841 Ignatiae, 449, 821 Iodi, 449, 450, 470, 518 Ipecacuanha; et opii, 449, 710, 803 Jalapae, 450, 834 Kino, 449, 450, 759 Krameria', 449, 450, 731 Laricis. 450, 885 Lavandula: composita, 449, 450, 759, 778, 852, 860, 861 Limonis, 450, 739 Lobelia', 440. 450, 814 .Etherea, 450, 662, 814 Lupuli, 450, 881 Maticae, 440, 872 Moschi, 449,911 Myrrhae, 449, 450, 756 Nucis vomicae, 449, 450, 821 Opii, 449, 450, 710 Ammoniata, 450, 541, 710, 790, 817, 902 Camphorata, M9, 710, 790, 817, 862 Deodorata, 1 19, 710 Phy80Stigmatis, 149, 761 Pyrethri, 1 19, 450, 807 Quassiae, 1 19, 150, 752 Quebracho, 828 Quiniae, 150, 797 Ammoniata, 450, 797 Rhei, 449, 150, 792, 857, 858,901, 902 Aromatica, 149, 77s, 857, 858 Dulcis, 1 19, 857, 858 Sabinae, 150 linai i:i . 1 I'.), 726 Saponifl \ Lridifl, 1 19, 819 Sdllae, ir.t, 151, Sen< ra . L0L 781 Sennae, 151, 745, 766, 791, 792 Serpentarise, 149, 151, 366 Tinctura — Stramonii, 449, 451, 842 Sumbul, 449, 451, 791 Tolutana, 449, 451, 760 Valerianae, 449, 451, 805 Ammoniata, 449, 451, 543, 805 Vanilla;, 450, 899 Veratri viridis, 450, 451, 894 Zingiberis, 450, 451, 900 Fortior, 451, 910 Tin, symbol and atomic weight of, 37 ; causes powerful contraction of the vessels, 246 ; gen- eral action of, 593 ; nature and uses of granu- lated, 600; of solution of chloride of, 600 Tincture, litmus, 908 Tincture, turmeric, 901 Tincture of acetate of iron, 633 Tinctures, 448-451 Tissue change, action of drugs on, 356-364; of tonics, 356; of haeinatinics, or blood tonics, 357 ; of alteratives, and their action on the tis- sues, 35S-361 ; of antipyretics, or febrifuges, 361 ; list of the chief, their action, 362 ; and their uses, 363; experiments as to the action of drugs on, 359; action of the heavy metals on, 564; of silver, 576 ; of salts of iron, 628; of alcohol, 650; of quinine, 800 Titanium, symbol and atomic weight of, 37 Tobacco, effect of the inhalation of the smoke of, on a rabbit, 218 ; snuff, action of, on the nose, 219 ; the vapor of tobacco has a local sedative action on the lung, 223 ; tobacco as a sialagogue, 314, 315 ; as a poison, with its antidote, 421 Tobacco, 842 ; tobacco leaf, character of, 842; gen- eral action of, 843 ; on the motor and secreting nerves, the intestine, the heart, and vaso-motor system, 843 ; in frogs and warm-blooded ani- mals, 843; special action of, on the spinal cord, circulation, and vagus, 843 ; on the blood-pres- sure, heart, and alimentary canal, 843 ; uses of, 843; on the effects of tobacco-smoking, 843 Toldt, reference to, 132 Tolu, balsam of, characters and uses of, as an ex- pectorant, 760 Tonics, as adjuvants to antispasmodics, 194; list of cardiac, 293-297; of vascular, 297; of gastric, 318 ; nature and action of, 356 ; subdivisions of, 356 : states in which gastric, digestive, vascular, and nerve tonics are indicated, 357 ; haema- tinics, or blood tonics, 357 ; their mode of ac- tion on the blood, 357 ; alteratives and their action, 358-361; nature, action, and uses of antipyretics or febrifuges, 361-364; quassia as a tonic, 752 ; cheken as, 779; quinine as a, 801 ; wormwood as, 807 ; oil of chamomile as, 809; eupatorium as, 810; rhubarb as, 858 ; sulphate of beberia as, 865 ; serpentary root as, 866 ; cas- carilla bark as, 867; elm as, 878; lupulin as, 881 ; sarsaparilla as, 889 ; Iceland moss as, 908 Tonometer, Boy's, 235 Toothache, may frequently be removed by means of a brisk purgative, 184; various remedies for alleviating, 311, 689, 691, 723 Tortoise, experiments on the muscular structure of the, 123, 135; difference betwixt the mam- malian heart and that of the, 262 Tragacanth, characters, composition, and uses of, 758 Traube, references to, 54, 260?i. Traubes curves, nature of, 234 Treacle, as a laxative, 906 Trephining, utility of, in investigating the func- tions of the brain, 171, 180 Trichlorhydrin, as an anaesthetic, 186 Trimethylamine, action of, on bacteria, 99 Triticum, 904 Trituratio elaterini, 451, 785 Triturations, 151 Trochisci, 770 Acidi tannici, 151, 876 Ammonii chloridi, LSI, 540 Bismuthi, 451, 622, 623 Catechu, 151, 770, 805 Crete, 151, Cubebae, 451, 871 Ferri, 151,631 Redact!, 151,633 GENERAL INDEX. 973 Trochisci — Glycyrrhiza? et opii, 451, 709, 790 Ipecacuanha?, 451, 803 Krameria?, 451, 731 Magnesise, 451 Mentha? piperita?, 452, 853 Morphia?, 451, 712 et Ipecacuanhas, 451, 712, 803, 816 Morphina? et Ipecacuanha?, 452, 713 Nitro-glycerini, 668 Opii, 451, 710, 757 Potassa? chloratis, 451, 514 Potassii chloratis, 452 Sodii bicarbonatis, 452, 527 Santoninatis, 452, 532, 808 Zingiberis, 452 Trypsin, action of, on fibrine, 84, 85 Tungsten, symbol and atomic weight of, 37; its relation to other members of a group, 42 Tiirck's method of experimenting on reflex ac- tion, 151 Turmeric, 901 ; as a condiment, 901 Paper, 901 Solution of, 901 Tincture, 901 Turpentine, as a stimulating expectorant, 227 ; action of, on the vaso-motor centre, 279 ; as a vermicide, 355 ; as a stimulant diuretic, 374 Turpentine, oil of, action of, on the mucous mem- branes, 226 ; importance of, in bronchitis, 226; as a poison, with its antidote, 421 Turpentine, characters of, 882 Canada, 882 Oil of, characters and action of, 882 ; when inhaled and internally, 883; on the stom- ach, respiration, and temperature, 883; on the nerve centres and the kidneys, 883 ; use of, externally and internally, and as a ver- mifuge, 883, 884 Turpentine water, action of, on enzymes, 86 Tweedy, Mr. J., reference to, 196, 202 u. Ulcers, chronic, use of vesicants in, 305 ; of as- tringents, 309 UlmaceaB, 878 Umbellifera?, 785 Unguentum, 919, 924 Acidi carbohci, 452, 688, 919, 924 Gallici, 452, 877, 919 Tannici, 452, 876, 919 Aconitia?, 452, 698, 919 Antimonii tartarati, 452, 617, 620 Aqute rosa?, 452, 772, 776, 920, 924 Atropia?,452, 919 Belladonna?, 452, 836, 919 Cadmii iodidi, 452, 470, 574 Cantharidis, 452, 819, 924, 925 Chrysarobini, 452, 765, 919 Cetacei, 452, 776, 920, 924 Creasoti, 452, 691 Diachvlon, 452, 557, 819 Elemi; 452, 756 Galla?, 452, 875, 919 cum Opio, 452, 710, 875 Hydrargyri, 452, 583, 914, 919 Ammoniati, 452, 584, 591, 919 Compositum, 452, 583, 819, 863, 924 Iodidi rubri, 452, 584, 592 Nitratis, 452, 480, 584, 819, 919 Oxidi flavi, 452, 583, 590, 919 Eubri, 452, 583, 590, 776, 919, 924 Subchloridi, 452, 588, 919 Iodi, 452, 518, 919 Iodoformi, 452, 682, 919 Mezerei, 452, 919, 924 Picis liquidge, 452, 886, 924 Plumbi acetatis, 442, 598 Carbonatis, 452, 597, 919 Iodidi, 452, 600, 919 Subacetatis compositum, 452, 776, 863, 924 Unguentum — Potassa? sulphuratse, 452, 516, 919 Potassii iodi, 470 Iodidi, 452, 919 Resinse, 452, 885, 924 Sabina?, 452, 888, 919, 924 Simplex, 452, 776, 919, 924 Stramonii, 452, 842, 919 Sulphuris, 452, 461, 919 Alkalinum, 452, 462, 919 Iodidi, 452, 470, 919 Terebinthina?, 452, 883, 885, 919, 924 Veratria?, 452, 819, 895, 919 Veratrina?, 452, 895, 919 Zinci, 452, 568, 569 Oxidi, 452, 568, 569, 919 Uranium, symbol and atomic weight of, 37 Urari. See Curare Urea, drugs which act on the excretion of, 359 ; excreted by the tubules, 366, 367 Urechitine, as a general emetic, 326 Ureter, rhythmical contraction of the, 133 Urethra, drugs employed in inflammation of the, 385 ; application of drugs to the, 415 ; diagram of a vulcanite syringe for injecting solutions into the, 415 Uric acid, effects of, on the blood, 82; action of lithontriptics on, 377 Urinary sedatives and astringents, 385; urinary organs, action of cantharides on the, 926 Urine, circumstances modifying the secretion of, 369-377 ; the rapidity of the secretion of, de- pends on two factors, 369 ; arterial pressure in the glomeruli and the composition of the bloody 369-371 ; curves showing the effect of erythro- phloeum on blood-pressure and secretion of the, 371 ; action of lithontriptics on the, 377 ; how evacuation of the, is promoted, 384; action of the bladder on the, 383-385 ; action of mercury on the, 583 ; of nitrite of amyl, 666 ; of bella- donna or atropine, 839 ; of Indian hemp or American cannabis, 880; of colchicum, 899 ; of extract of ergot, 911 Urticacea?, ulmea? (ulmaceae), 878 Ustilago, 91 Uterus, action of ecbolics on, 391 ; the involun- tary muscular fibres of the, controlled by two nerve centres, 391 ; nature of the nerves which stimulate the, 391 ; mode of aiding the expul- sive power of the, 392 ; application of drugs to the, 415; as pessaries, 416; as caustics, 416; utility of tents inserted in, 416 ; action of bo- rax on the, 529 ; of pilocarpine, 750, 751 ; of physostigmine, 764; of quinine, 801; of aloes, 893 ; of extract of ergot, 911 Uva ursi (bearberry), action of, on the bladder, 384 ; as an astringent, 308 ; as a stimulant diure- tic, 374; characters and uses of, 814, 815; as an astringent and diuretic, 815 y. Vagina, application of drugs to the, 415 ; as pes- saries, 416 ; as caustics, 416 Yagus, effects of stimulation of the, 135 ; contains both expiratory and inspiratory fibres, 215; diagram illustrating this, 216 ; reference to the, 218; experiments on the, 218; cough chiefly excited by branches of the, 220; heart's beats chiefly regulated by the inhibitory fibres of the, 259 ; action of drugs on the cardio-inhibi- tory functions of the, 260 ; reflex stimulation of the, 261 ; quickened pulse may be caused by paralysis of the, 261 ; action of drugs on roots of the, 261; irritation of the, causes still-stand of the heart, 274 ; action of two classes of poi- sons on the, 274; position of the accelerating nerves of the, in frogs and warm-blooded ani- mals, 274 and %. ; vagus centre in the heart, 279 ; and ends, 280 ; nature of the action of the, upon the heart, 287 ; antagonistic action of cer- tain drugs on the, 423; of delphinine, 702; of pilocarpine, 750 ; of tobacco, 843 ; of digitalin on the roots and ends of the, 847 Valerianic acid, action of, on bacteria, 99 974 GENERAL INDEX. Valerian, antispasmodic action of, 194, 195 Valerian, characters, &c, 805 Oil of, 806; action o', on the hrain and spinal cord, 806; on the blood-pressure and the pulse, 806 ; as an antispasmodic, 806 Eoot, 805 Valerian and oil, as a carminative, 330 Valerianaceas, 805 Valerianate of soda, 533; of zinc, 571; of iron, 639 Vanadium, symbol and atomic weight of, 37 Vanilla, characters and action of, 899; as an aro- matic stimulant, 899 Vapor acidi hydrocyanici, 453, 490 Chlori, 453, 468 Conue, 453, 786 Creasoti, 453, 691 Iodi, 453, 470 Vapor baths, 404 Vapor of hydrocyanic acid, 490 Vapors, inhalations, 453 Vascular stimulants, nature and uses of, 292; tonics, 297; and sedatives, 300; when vascular tonics are serviceable, 357 ; antipyretics, more useful in symptomatic fevers than in specific ones, 363 Vaseline, properties and uses of, 647 Vaso-motor and vaso-dilating nerves, action of drugs on, 248 ; the vaso-motor centre paralyzed by various drugs, 251 ; action of, on the smaller arteries and capillaries, 254; how the activity of the vaso-motor centre may be increased, 255 ; vaso-motor centre of the heart, 279; and nerves, 281; action of the salts of iron on the, 628; of platinum on the, of mammals, 642; of alcohol, 653; of carbolic acid, 688; of aconitine, 700; of opium on the peripheral, 718; of quillaia (sa- ponin), 775; of tobacco, 843; of extract of ergot, 910 Vegetable alkaloids, poisonous properties of some, destroyed by the liver, 349 Vegetable bitters, strong infusions of, as local emetics, 326 Veins, nature and functions of, 229; blood in the, useless for nutrition, 229 ; action of the nervous system on the, 229 ; of the heart, 230 ; effect of an upright and of a horizontal position on the circulation of the blood in the, 230; arrest of circulation in the, the cause of fainting and shock, 230, 231; schema of the circulation from the heart to the arterial system and the, 232, 233; action of blood-pressure on the, 234; method of ascertaining the blood-pressure on the, 234-236; causes of alterations in blood- pressure in the, 236; how blood-pressure may be raised and lowered in the, 237 Venesection, as an antipyretic, 363 Veratria, 429, 895 Verarxina, 430 Verat tine, effects produced by different doses of, on froga, 48; effects of heat or cold on the ac- tion of, 59; action of, on oxidation, 79; on me- dusa-, 112; on mollusca, 114; on ascidians,U5 ; on annulosa, 116; power of, for restoring mus- cle after fatigue, 120; as a muscular poison, 126- 147: as a sedative, 146: action of, on the spinal cord, 150; as an anodyne, 184; on the respira- tory centre, 215, 219; action ofon the vagus roots, 260; on the heart of the frog, 271 : on the vaso-motor centre, 279; on the cardiac muscle, 281 : as a poison, with its antidote, 121 ; antago- nism of, to opium, 422-425 ; physiological ac- tion of, in large doses and externally, 896; internally, action of, on the brain, spinal cord, and muscles, S!)6; on the motor and sensory nerves, the circulation, and the pulse, 896; on blood-pressure, respiration, and temperature, " . u>es of, locally and internally, 896, 897 Veratroidine,' 895 ; action of, on the vagus centre and ends, 895; on the spinal cord and respira- tory centre, 895; on the vaso-motor centre, blood-pressure, and the pulse, 895 Veratruin album, action of, on the DOSe, 219 Veratrum viride, action of, on the vagus centre, 279; on the cardiac muscle, 281 ; on the palpi- tation of the heart, 800; nature and action of, Verbenancese, 818 Vermicides. See Anthelmintics Vermifuges. See Anthelmintics Vesical sedatives and tonics, action of, on the bladder, 384 Vesicants, 305; strong solution of ammonia as a, 541 Vesication, produced by acids, 475 Vessels, blood, 229; reflex contraction of the, 231; experiments with bromide of potassium on the, 250, 251 ; action of drugs on this reflex contrac- tion, 251 ; comparative effect of heart and, on blood-pressure on different animals, 252 ; influ- ence of nerves on blood-pressure in the, 253- 256 ; action of pilocarpine on, 750; of thuja on, 887. See Arteries and Arterioles Viburnum (black haw), characters and uses of, 806 Vienna paste, as a caustic to extirpate malig- nant growths, 306 Visnal, reference to, 350 Vinegar, properties and uses of, &o, 483 Vinegar, aromatic, stimulating action of, on the brain, 177 ; action of the, on the heart in man, 252 ; in dogs and rabbits, 252, 253 Vinegar *, 429 Vini gallici, mistura spiritus, 920 Vinum aloes, 453, 891, 892, 900, 901 Album, 453 Fortius, 453, 745 Antimoniale, 453, 617, 620 Antimonii, 453, 617, 620 Aromaticum, 453, 851, 856 Aurantii, 738 Colchici, 453, 897 Radicis, 453, 897 Seminis, 453, 898 Ergot a?, 453, 908 Ferri, 454, 629 Amarum, 453, 636 Citratis, 453, 635 Ipecacuanha?, 453, 803 Opii, 453, 710, 711,778, 861 Quinise, 454, 485, 797 Rhei, 454, 744, 857, 858 Rubrum, 453 Xericum, 454 Viola tricolor (pansy), characters, composition, and uses of, 729 Violacese, 729 Virchow, references to, 161 Visions, action of drugs in producing, 204 Vitaceoe, 745 Voit, reference to, 360 Volatile oils, 442, 443 Vomiting, relieved by blisters, 305; description of the act of, 323; and of the nerve centre which regulates the, act of, 323; action of the brain and afferent nerves on, 323: diagram showing the afferent nerves by which the vom- iting centre may be excited, 324 ; the action of drugs in causing. 324-326; the various uses of emetics in causing, 326-328; action of the most powerful sedative in persistent, is ice, 328; gastric sedatives in relieving, 329; list of seda- tives useful in vomiting arising from different causes, 329; the action of irritant poisons on the stomach gives rise to, :;4."> ; action of pilo- carpine on, 75D w. Warburg's tincture, 802 Warm, foot, and hip baths, utility of, as indirect emmenagogucs, 890 ; warm baths, 401 Warm-blooded animals, action of tobacco on, 843; of thuja on, 887 Warm clothing, importance of, to delicate people, 228 Warmth. See Heat Warmth and moisture, importance of ; in rooms occupied by patients bavins bronchial or chesl complaints', 228 ; as an emollient, 307 : poultices made of substances which retain, 307 ; action of, on the circulation of the blood and the secretion of sweat, 878 GENERAL INDEX. 975 Warren, Dr., reference to his use of ether, 193 Washed sulphur, its preparation, &c., 461 Wassilieff, reference to, 107 Water, lukewarm, as a local emetic, 326 ; in large quantities, as refrigerant diuretics, 373 Water of ammonia, 542 Waters, nature of, uses, and doses, 430 Watts's modification of Mendelejeff's tables, ref- erence to, 495 Wax, white, 924 Wax, yellow, 923; its characters, composition, tests, and uses, 923 Weber, E. H., reference to, 199 Wedenskii, reference to, 129 Wells, Mr. H., his use of nitrous oxide as an anaesthetic, 192 Wernitz, reference to, 85 Wheaten flour, 903 White, reference to, 137 Indian hemp, 829 Precipitate, 590 Quebracho bark, 828 Wax, 924 Wild marjoram. See Origanum Williams's apparatus used in researches in digita- ls, 267, 268 Willow. See Salix Wilwhite, Dr., reference to his use of ether, 192 Wine, spirit of French, 658; red wine, 659, 745; white wine, 658, 745 ; stronger ditto, 659 ; sherry, 658, 745 Wines, 453 Wines, strong, as cardiac stimulants, 291 Witchhazel. See Hamamelis Witkowski, reference to, 117 Wood, Dog, 769, 793 Guaiacum, 745 Log, 765 Quassia, 752 Red sandal, 759 Worm, 807 Wood, H. C, references to, 103 Wood charcoal, its preparation and characters, 459; its action, uses, and administration, 459, 460 Wood tar, as a stimulatingexpectorant, 227 Woorari. See. Curare Worms, the three chief kinds which infest the intestines, 355; list of the principal vermicides, 355; and vermifuges, 355; and their adjuncts, 355 Wormseed, American. See Chenopodium Wormwood, nature, action, and use of, 807; as a stomachic tonic and anthelmintic, 807 Wounds, value of astringents in, 309; of styptics, 309 Wourali. See Curare Wundt, references to, 149, 161, 162 Wurrus. See Kamala X. Xanthine, action of, on muscles, 128 Xanthoxyleae, 748 Xanthoxylum (prickly ash), as an alterative, 358; characters and use of, 748 Xylol, action of, on bacteria, 99 Y. Yeast, beer, character and uses of, 912 Yeasts, origin and nature of, 89 Yellow cinchona bark, 794 Calisaya bark, 794 Prussiate of potash, 517 Yellow wax, 923 Yolk of egg, 920 Young, Dr., his table for dosage, 426 Ytterbium, symbol and atomic weight of, 37 Yttrium, symbol and atomic weight of, 37 ; physi- ological action of, 51 Zabludowski, reference to, 128». Ziegler's Pathological Anatomy, reference to, as translated and edited by MacAlister, 92n. Zinc, symbol and atomic weight of, 37 ; physio- logical action of, 51 ; double salts of, action of, on the cardiac muscle, 281 ; on the capillaries, 282 Zinc, nature, characters, and uses of— Acetate of, 570 Bromide of, 571 Carbonate of, 569 Precipitated, 569 Chloride of, 569 Iodide of, 571 Oxide of, 569 Of commerce, 568 Phosphide of, 572 Sulphate of, 570 Valerianate of, 571 Zinc chloride, as a caustic, 304 Zinc salts, as anantihydrotic, 381 ; sources of, 566 ; general reactions and preparation of, 567 ; impurities, tests, and general action of, 568 Zinc sulphate, as a caustic, 304; as an astringent, 308 ; as a local emetic, 326 Zinci acetas, 568 Bromidum, 568 Carbonas, 568 Preeipitatus, 568 Chloridum, 568 Iodidum, 470, 568 Oxidum, 568 Phosphidum, 568 Sulphas, 568 Valerian as, 568 Zincum granulatum, 568 Zingiberacese, 900 Zirconium, symbol and atomic weight of, 37 Zuelzer, references to, 104, 303 Zuntz, reference to, 81 Zygophyllacese, 745 Zymogens, ferment-forming substances, 87 INDEX OF DISEASES AND REMEDIES. Abscess. Belladonna, 839. Internally and locally as plaster or liniment. Calcic Phosphate, 553. Where abscess is large. Calcic Sulphide, 555. Small doses frequently repeated, to hasten maturation or healing. Carbolic Acid, 689, 690. As dressing, and as injection after evacuation. Caustic Potash, 509. For opening abscess in liver. Cod-liver Oil, 358, 922. In scrofulous cases. Counter-irritation, 301. To surrounding parts, to check formation or hasten irrita- tion. Creasote, 577. Same as carbolic acid. Iodine, 471, 472. As injection into the sac. Permanganate of Potash, 107. As antiseptic. Poultices, 402, 729 Salicylic Acid. Sulphides, 515, 555. To hasten suppuration. Acidity. Acids, 476. Before meals. Alkalis, 501. After meals. Bismuth, 621. Carbolic Acid, 691. To stop fermentation. Creasote, 690. Ipecacuanha, 804. In pregnancy. Kino, 759. Useful along with opium. Manganese Oxide, 640. Sometimes relieves, probably acting like charcoal. Mercury, 585. When liver deranged and stools pale. Nux Vomica, 821. In small doses before meals, especially in pregnancy. Pulsatilla, 702. 5 m. every four hours in water. Silver Nitrate, 328, 575. Same as silver oxide. Silver Oxide, 577. Especially useful when acidity is accompanied by neuralgic pains in stomach. Tannic Acid, 875. Acne. Alkaline Lotions, 509. When skin is greasy. Arsenic, 609. In chronic acne; generally, though not always, prevents the acne from bromides or iodide of potassium. Belladonna, 183, 184. As local application. Bismuth, 622. As ointment or powder. Borax, 529. Solution very useful. Glycerine, 820. Both locally and internally. Iodide of Sulphur, 470. In chronic cases. Mercury, 586. Weak lotions. Phosphorus, 605. In chronic cases in place of arsenic. Potassic Bromide, 186. Sometimes useful in moderate doses. Sulphur, 463. Internally and externally. Water. Hot sponging several times a day. Addison's Disease. Iron, 194 el seq. Antemetics and tonics. After-pains. Belladonna, 838. As ointment. Camphor, 864. Useful when combined withi morphia, 10 grs. with Y s gr. of morphia. Chloroform, 680. Liniment to abdomen along with soap liniment. Chloral, 673. In large doses arrests the pains. Cimicifuga, 703. Diminishes excitement. Ergot, 911. To keep the uterus constantly contracted and prevent accumulation of clots in its cavity, and consequently the pains which they would occasion. Gelsemium, 827. In 20 m. doses stops pains. Morphia and Atropia. Hypodermically very useful, y^/i gr. morphia with x a_ gr o of atropia. Opium, 722. The same as morphia. Poultices, 402. Warm, to the hypogastrium, relieve. Quinia, 802. 5-10 grs. night and morning, with neuralgic after-pains which do not yield to opiates. Albuminuria. Aconite, 701. In high temperature. Alkalies, 501. Diuretics. Arbutin, 815. Cannabis Indica, 880. In hematuria. Cantharis, 926. In hsematuria, after acute symptoms have gone, 1 m. every three hours. Chalybeate Waters, 564, 634. Not very useful in chronic cases. Chimaphila, 374, 815. Decoction of extract when urine scanty, or in hematuria. Gallic Acid, 878. In acute cases 5-10 grs. Iron, 634. Useful often— best as chalybeate waters. Lead, 596. Lessens albumen. Milk Cure, 914. Turkish Baths, 404. Useful in chronic cases. Turpentine, 374, 883. Sometimes very useful, diminishes albumen, and acts as diuretic. Alcoholism. Ammonia, 322. Aromatic spirits of, as sub- stitute for alcohol, to be taken when the craving comes on. Arsenic, 609. To lessen vomiting in drunk- ards. Bromides, 521. Useful during delirium tremens, or to lessen irritability. Capsicum, 816. As substitute for alcohol. Chloral, 672. To quiet nervous system and induce sleep. Lupuline, 881. Along with capsicum as sub- stitute for alcohol, also to quiet nervous system in delirium tremens. Nux Vomica, 821. As tonic and stimulant, both to nervous system and generally, to aid digestion. Opium, 722. May be necessary to produce sleep. Orange, 177. Slowly sucked, a substitute for alcohol. 62 (977) 978 INDEX OF DISEASES AND REMEDIES. Alcoholism. Phosphorus, 360, 605. In chronic cases as Dervine tonic. Picrotoxine, 279, 707. For tremors. Quinia, 801. As tonic and in gastric catarrh. Water, Cold, 177. A glass taken in small sips at a time as substitute for alcohol. Zinc Oxide, 568, 569. In chronic alcoholic dyspepsia, and nervous debility. Alopecia. Ammonia, 540. Very useful — IJfc ol. amygd. dul. Liq. ammonite aa f. Sj spt. Rosmarini, aqua?, mellis aa f. 5iij mm. fl. lotio (E. "Wilson). Arsenic, 609. Internally. Cantharides Tine, 926. One part to eight of castor oil rubbed in roots of hair morning and night. Glycerine, 820. Very useful ; either alone or in combination, appears greatly to assist. Nitric Acid, 480. With olive oil in sufficient quantity just to make it pungent. Shaving. Sometimes useful after illness. Sulphur Iodide, 471. Useful both internally and externally. Amaurosis and Amblyopia. Arnica, 811. Sometimes useful. Rue, 747. In minute doses in functional dim- ness of vision. Santonin, 809. Sometimes useful in later stages of iritis and choroiditis. Seton,301. In temple for along time some- times useful. Strychnine, 252, 825. Sometimes very useful. Yeratrine, 895. To eyelids and temples. Care must be taken to keep out of the eye. Amenorrhea. Aconite, 700. When menses suddenly checked, as by cold, &c. Aloes, S95. Alone or with iron. Ammonium Cbloride, 540. In headache, ma- larial. Arsenic, 607, 609. Along with iron in anieinia. Cimicifuga, 703. Sometimes gives good re- sults. Colocynth, 783. In anaemia with constipa- tion. Electricity. Locally applied, sometimes use- ful. Ergot, 911. Gold, Salts, 641. Ignatia, 821. In hysteria. Iron, 628, 634. In amemia. Manganese, 391, 640. Sometimes very useful. Nux Vomica, 381, 821. Pulsatilla, 702. Like Aconite. Rue, 391. In atonic condition of ovaiies of uterus. Sanguinaria, 358, 726. Like Rue. Savin, 390. Like Rue. Senega, 730. A saturated decoction in large dobes of a pint daily about two weeks before period. Serpentaria, 866. In anaemia. Silver Nitrate, 308, 575. Locally, to os uteri at period. Sit/. Bath*, 899. Hot, alone, or with mustard, for Borae days before the period. Spinal Ice Bag. To lumbar vertebra?. ANyL.MI a. Adds, 175, I7i;. A reenlc, 607. 609. Very useful along with or in place of iron, fold -ponging, :;<;:;, 899. Galvanization. Anemia. Hypophosphites of Lime, 553, or Soda, 530. In cases of nervous debility care must be taken that they do not derange the diges- tion. Iron, 628, 634. Yery useful where stomach is at all irritable. The carbonate is often best. Where mucous membrane very flabby large doses of theperchloride. Chalybeate waters more often succeed than pharmaceutical preparations. They may be mutated by one drop of the solution in a tumbler of water. Lactophosphate of Lime, 553. During nurs- ing, or where drain has taken place from body in shape of pus. Manganese, 640. May be given along with iron— not much use alone. Nux Vomica, 294, 821. Useful sometimes along with iron. Pancreatin, 321. In feeble digestion. Pepsin, 321. In feeble digestion. Phosphate of Lime, 553. During growth, or where system enfeebled by drain of any kind. Quinia, 109, 801. Wines, 291. Along with food to aid diges- tion. Aneurism. Aliment. Low diet ; absolute rest. Chloroform, 680, 681. Inhaled to relieve dyspnoea. Electrolysis. Sometimes useful in causing coagulation within the sac. Ergot, 909, 910. As adjunct to rest. Lefcd Acetate, 597. Useful, combined with rest. Potassic Iodide, 227, 519. Yery useful in doses of 30 grs. Yeratrum Viride,281, 300. Along with opium in quieting circulation. Angina Pectoris. Aconite, 300, 699, 700. Arsenic, 607, 609. To prevent paroxysms. Chamomile, 809. In hysterical symptoms. Ether, 662 To diminish pain. Laurocerasus, 777 Morphia, 181, 183, 714. Hypodermically. Nitrite of Amyl, 666, 667. Gives g eat relief during paroxysms. Nitrite of Soda, 524. Less rapid than nitrite of amyl, but has more power to prevent return of symptoms. Nitro-glycerine, 668. Like nitrite of soda. Phosphorus, 361, 605. During intervals to lessen tendency. Quinia, sol. When any malarious taint is present. Strycbnia, 274, 279, 825. Sometimes useful in mild cases, in very small doses. Turpentine, 226, 884. Locally to the chest during paroxysms. Anus, Fissure of. Belladonna, 1S3, 1S4, 839. Locally, relieves spasms. Castor Oil, 3:'»9, 869. To keep motions soft. Collodion, 736. Locally, to protect. Hydrastis, 705. Local application. Iodoform, 682, 683. Locally, to heal and relieve pain. [odo-tanniD (solution of iodine in tannin). Useful locally. Opium and Gall Ointment, 709. Relieves pain. Potassic Bromide, 521. With five parts of glycerine locally. Ethatany, 782. injected after the bowels have been opened by enema. INDEX OF DISEASES AND KEMEDIES. 979 Anus, Fissure of. Sulphur, 339. To keep motions soft. Tannin, 876. Useful as local application. Aphonia. Alum, 555-557. As spray in chronic conges- tion of throat and larynx, with hoarseness. Ammonium Chloride, 539. As vapor in laryn- geal catarrh. Atropia, 839. In hysterical aphonia. Benzoin, Tincture of, 228, 817. Inhaled in laryngeal catarrh. Borax, 529. A piece the size of a pea slowly sucked. Glycerine of Tannin, 820, 876. Locally, to pharynx. Ignatia, 821. Like Atropia. Ipecacuanha, 803, 804. Wine as spray in laryngeal catarrh. Nitrate of Potash, 513. Like Borax. Nitric Acid, 4S1. In hoarseness from fatigue or indigestion. Rue, Oil of, 747. As inhalation in chronic catarrh. Sulphurous Acid, 477. As spray or inhala- tion in clergyman's sore throat. Turkish Bath, 405. In acute laryngeal catarrh. Uranium, Nitrate of, 37. As spray in very chronic catarrh. Aphtha. Bismuth, 622. As local application. Borax, 529. As honey or as glycerine, either alone or with chlorate ot potash. Copper Sulphate, 573. Weak solution painted over the aphthae. Coptis. Infusion is employed in New Eng- land. Glycerine, 820. Mercury, 583. In the form of hydr. cum creta in children, to remove the indiges- tion on which aphthae frequently depends. Mineral' Acids, 474. Dilute solution as paint. Potassic Chlorate, 374. Exceedingly useful as wash, 10 grs. to the oz., alone or with borax, also given internally. Potassic Iodide, 518. As local application, solution of 1-5 grs. to the oz. Quinia, 801. 1 gr. every two or three hours m aphthse in infants, consequent on diar- rhoea. Rhubarb, 858. To remove indigestion, as compound rhubarb powder. Salicylic Acid, 693. As local application. Sulphurous Acid, 477. As solution or spray. Apoplexy. Aconite, 700. To lower blood-pressure and prevent further haemorrhage, where pulse strong and arterial tension high. Cold Water, 363. To the head when face congested. Colocynth, 339, 784. As purgative. Croton Oil, 339, 868. As purgative, one drop on back of tongue, or part of a drop every hour. Diet and Hygiene, Prophylactic. Butcher's meat and stimulants to be taken very sparingly, exposure to heat, over- exertion, and especially anger, to be avoided. Elaterium, 340, 785. In suppository, or as enema, during attack. Electricity. To promote absorption, after partial recovery has taken place. Appetite, Impaired. Food. Savory, well cooked. Ignatia, 821. Corrects diseased appetite and hysteria. Atheroma. Ammonium Bromide, 544. To promote ab- sorption. Arsenic, 607. Often useful, especially when symptoms of imperfect action of kidneys. Cod-liver Oil, 921 Digitalis, 850. Requires caution. Phosphorus, 361, 605. In minute doses, along with cod-liver oil. Quinia, 801. Ascites. Arsenic, 607, 609. In old persons with feeble heart. Copaiba, 374, 768. Especially useful in hepa- tic dropsy. Digitalis, 850. Best in cardiac dropsy; its action is increased by combination with squill and blue pill. Elaterium, 340, 785. As hydragogue cathar- tic. Jalap, 834. In compound powder as hydra- gogue cathartic. Milk Diet, 915. Sometimes very useful when kidneys are inadequate. Stillingia, 358, 867. In hepatic dropsy. Asthenopia. Atropia, 840. To prevent spasms. Asthma. Aconite, 701. In spasmodic cases, also in asthma consequent on nasal catarrh in children. Amyl Nitrite, 666. Sometimes cheeks parox- ysm. Antimony, 621. In asthmatic conditions in children, ^ gr. of tartar emetic every quar- ter of an hour. Arsenic, 609. In small doses in cases asso- ciated with bronchitis or hay fever. Inhaled as cigarettes. Asafcetida, 787. Belladonna, 840. Internally, in large doses or as cigarettes. Bromides. Cannabis Indica, 880 Chloral, 672. During paroxysm. Chloroform, 676. Relieves when inhaled from tumbler or with warm water. Coffee, 804. Very strong during paroxysm. Colchicum, 899. "in gouty cases. Datura. See Stramonium. Ether, 662. In full doses at commencement of attack. Eucalyptus, 781. Sometimes along with stra- monium, belladonna, and tobacco. Galvanism of Pneumogastric Region. Posi- tive pole beneath mastoid process, negative pole to epigastrium. Grindelia, 813. To prevent or cut short attack. Ipecacuanha, 804. As spray in bronchial asthma, especially in children. Lobelia, 814. To prevent and cut short paroxysm. Nux Vomica, 227. Opium, 223. Hypodermically, during par- oxysm. Oxygen, 456, 457. As inhalation during par- oxysm. Pepsin, 321, 916. Exceedingly useful in pre- venting attacks. Potassic Iodide, 519. In large doses, when asthma due to acute bronchial catarrh. Potassic Nitrate, 513. Inhalation of fumes of touch paper relieves paroxysm. Some- times advisable to mix a little chlorate with it. Quinia, 215, 801. During intervals when attacks are periodical. Silver Nitrate, 575. Has been injected into • trachea. 980 INDEX OF DISEASES AND REMEDIES. Asthma. Stramonium, 842. Sometimes very useful. May be made into cigarettes, or 20 grs. of dried leaves may be mixed with nitrate of potash, and the fumes inhaled. A little powdered ipecacuanha may often be added. Sulphurous Acid, 477. Tobacco, 843. Smoking is sometimes benefi- cial. Astigmatism. Suitable Glasses. Atrophy. In muscular atrophy. Arsenic, 60! Electricity. Massage, 128, 406. Olive Oil, 820. Inunction to atrophied parts. Balanitis. Astringent Lotions. Alum, 557. Sulphate of zinc, 570. Lime Water, 550. As lotion. Mercury, 588. % gr. chlor. con. to an oz. lime water, as lotion. Oil, 819. Bed Sores. Alcohol, 304, 650. As wash, to prevent. Alum, 556. With white of egg as local appli- cation. Charcoal, 459. As poultices, to stop bed sores. Galvanic Couplet. Of zinc and silver; one element on sore, the other on adjacent part. Glycerine, 820. Prophylactic local applica- tion. Iodoform, 682. Silver Nitrate, 575. Dusted over open bed sores. Biliousness. Aconite, 701. As adjunct to podophyllum. Alkalies, 499,500. Aloes, 339. In constipation. Ammonium Iodide, 545. In catarrh of duo- denum and biliary ducts. Angostura, 747. In bilious fevers. Calumba, 706. As stomachic tonic. Carlsbad Water, 529. A tumbler sipped warm during dressing very useful. Horse Exercise. Hydrastis, 705. When chronic gastric catarrh "is present. Manganese, 640. In gouty cases. Mercurial Cathartics, 585." In moderate doses night and morning, or in small doses more frequently repeated. Especially useful when stools are pale. Milk Cure, 914. In obstinate cases. Mineral Acids, 481. Nitro-hydrochloric acid especially useful. Podophyllum, 340, 704. In place of mercury wh D stools dark. Rhubarb, 839,351, 353,858. Sal-ammoniac, 540. In hepatic abscess. Stillingia, 358, 867. in place of mercury. Bladder, Irritable. Aquapuncture. Belladonna, 384, 839. Benzoic Acid, 377. In large, prostate, and alkaline Conditions of urine. Benzoate of Ammonia, 817. Like Benzoic Acid. Cantharides, 925, in women without acute inflammation. Cubebs, 874, s 7i. Like Cantharides. Bladder, Paralysis of. Arnica, 811. Cannabis Indiea, 880. In retention, from spi- nal disease. Cantharides, 384, 925. In atonic bladder. Ergot, 911. In paralysis, either in bladder or sphincter, when bladder so that urine is retained, and incontinence in sphincter. Galvanism. Strychnia, 825. Blepharitis. Alum, 555-557. After acute symptoms sub- side. Bismuth, 328, 621. Equal parts of the sub- nitrate and glycerine as local application. Hydrastis, 705. As lotion. Mercury (Unguentum Hydrargyri Nitratis), 591. Most useful application. If too strong, dilute with vaseline or simple ointment. Pulsatilla, 702. Internally and locally. Tannin, 376. Boils. Arsenic, 361, 608. To lessen tendency to re- currence. Belladonna, 837. Internally, or as local appli- cation. Camphorated Alcohol, 655. As local applica- tion in earlv stage. Carbolic Acid", 688-690. Injection. Collodion, 735. Painted over whole surface to abort in papular stage and over base, leaving centre free, in pustular stage. Counter-irritation, 433. By plasters sur- rounding the boil. Opium, 723. Locally to remove pain. Poultices, 402. To relieve pain and hasten maturation. Silver Nitrate, 575. Strong solution painted over the skin round boil. Strapping, 595. Properly applied gives great relief. Sulphides, 516, 554. In small doses to abort or hasten maturation. Bone, Diseases of. Cod-liver Oil, 226, 922. In scrofulous condi- tions. Iodine, 471, 922. Alone, or with cod-liver oil. Breath, Fcetid. Camphor, 863. Carbolic Acid, 688-690. Dilute solution as wash to mouth. Chlorine, 467, 557. Liq. chlor /and chlor. of lime as lotion. Permanganate of Potash, 107, 515. As wash to mouth. Brigiit's Disease. Baths, 395 el seq. Warm water and hot air and Turkish, to increase action of skin. Broom, 37 1, 758. As diuretic. Caffeine, 743. To increase secretion of solids. Cannabis Indiea, 880. As diuretic when he- maturia. Chimaphila, 815. Cod-liver Oil, 226, 922. Counter-irritation, 301, 302. Dry cupping most useful when tendency to uncinia. Elaterium, 785. As hydragogue cathartic for dropsy. Eucalyptus, 781. Gallic Acid, 877. Lessens albumen. Gold, Chloride of, 641. In contracted kidney. Hydrastis, 705. Lessens albumen. Iron, 634. To diminish aiucmia. Jaborandi, 751. In uraemia and dropsy. Juniper, Oil of, 887. Diuretic. INDEX OF DISEASES AND REMEDIES. 981 Bright's Disease. Lead, 594. Lessens albumen. Milk Care, 915. Pure skim milk diet some- times very useful when tendency to ursemia. Nitrous Ether, 374. As diuretic. Potassic Bitartrate, 339, 374. As hydragogue cathartic and diuretic. Potassic Bromide, 186. In ursemic convul- sions. Potassic Iodide, 519. Tartrates, 511, 528, 635. As diuretics. Turpentine, 374. As diuretic. Water. In large draughts as diuretic when excretion of solids is deficient, and in dropsy. Bronchiectasis. Chlorine, 467. As inhalation to lessen fcetor. Creasote, 691. As inhalation. Iodine, 471. As inhalation. Phosphates and Hypophosphites, 530, 553, 638, 639. Quinia, 215, 801. Bronchitis, Acute. Aconite, 209, 701. }4-l m. every hour at com- mencement. Ammoniacum, 788. Very uselul in old people. Ammonium Carbonate, 542. Where much expectoration and much depression. Aeafootida, 787. Like Ammoniacum. Cimicifuga, 703. In acute catarrh and acute bronchitis when active symptoms have sub- sided. Colchicum, 361. In gouty cases. •Counter-irritants, 305, 390, 728. Dry cup- ping most efficient in acute cases; mustard leaves; mustard poultices. Cubebs, 872. When secretion copious. Ipecacuanha, 227, 228. When expectoration scanty, dryness in chest, ipecacuanha in large doses; also when expectoration has become 'more abundant, but difficult to expel. Lobelia, 227. When cough paroxysmal and expectoration slight. Nitric Acid, 480, 481. When expectoration free and too copious. Opium, 223, 292, 293. As Dover's powder to cut short attack, and along with expecto- rants to lessen cough. Quinia, 797. To reduce temperature. Sanguinaria, 725. After acute symptoms have subsided. Tartar Emetic, 227, 325, 326. In dry stage to promote secretion. Turpentine, 226. When expectoration very ■ profuse ; also as inhalation. Bronchitis, Capillary. Ammonium Carbonate, 542. Much expecto- ration andlividity commencing, and emetic. Ammonium Chloride, 227. Ammonium Iodide, 545. In small rapid doses relieves much. Camphor, 864. As expectorant. Cupping, 363. Four to six dry cups over the back often give very great relief, and if the pulmonary congestion appears very great wet cups should be placed instead, and 8-10 ozs. of blood withdrawn from adult. Ipecacuanha, 227, 228. As expectorant and emetic. Mustard, 228. As poultices. Poultices, 228. Over whole chest. Serpentaria, 865. In children. Bronchitis, Chronic. Ammonia, 227. When there is difficulty in bringing up expectoration. Bronchitis, Chronic. Ammoniacum, 788. Very useful, especially in elderly people. Ammonium Chloride, 227. Antimony, 227. When secretion scanty. Arsenic, 607, 608. In emphysema and asth- matic attack as cigarettes. Asafoetida, 787. Balsam of Peru, 227. When expectoration copious. Balsam of Tolu, 227. The same. Benzoin, 227. As inhalation or as spray. Camphor, 864. Carbolic Acid, 689. As inhalation or as spray. Codeia, 715. In place of opium when the lat- t©r cliscifirrGCs Cod-liver Oil. 226, 921, 922. One of the most useful of all remedies. Colchicum, 897. In acute cases. Copaiba, 769. Like Balsam of Peru. Digitalis, 223. Where heart feeble. Emetic, 227. Eucalyptus, 781. Galbanum, 788. Gallic Acid, 877. Hydrastis, 705. In chronic coryza. Iodine, 471. As inhalation. Iron, 627. When expectoration is profuse. Koumiss Cure, 915. Sometimes very useful. Lobelia, 814. When there is spasmodic dyspnoea. Opium, 223. To lessen secretion and cough. Phosphates, 530, 554, 639 Senega, 227, 326, 731. When eupulsive efforts are feeble. Serpentaria. 866. Like Senega. Squill, 227, 326, 890. Where expectoration is thick. Sulphur, 227, 463. Where expectoration co- pious. Sulphurous Acid Gas, 478. As inhalation or spray. Sumbul, 195, 791. Tar, 227, 886. To lessen secretion and allay cough. Turpentine, 226. Bronchorrhcea. Ammoniacum, 788. Ammonium Iodide, 545. Small doses fre- quently repeated. Asafoetida, 787. Eucalyptus, 781. Sometimes very useful. Grindeha, 812, 813. Iodine, 471. As counter-irritant to chest, and as inhalation. Lead Acetate, 597. To lessen secretion. Spinal Ice Bag. To lessen secretion. Sulphurous Acid Gas, 478. As inhalation or spray. Bruises. Aconite, 697. Liniment locally, to relieve pain. Arnica, 811. As local application, no more use than alcohol, and sometimes gives rise to much inflammation. Capsicum, 835. To remove discoloration of bruise. Oil of Bay. Same as Capsicum. Opium, 183. Local application to relieve pain. Sulphurous Acid, 477. As local application constantly applied. Bubo. Ice, 224. To relieve pain and lessen inflam- mation. Iodine, 472. As counter-irritant applied round the bubo. Iodoform, 681. As local application. 982 INDEX OF DISEASES AXD KEMEDIES. Bubo. Mercury, 591. As local application after opening bubo, when syphilitic infection is great. Nitric Acid, 480. As local application to in- dolent bubo. Silver Nitrate, 575. Lightly applied to sur- face in indolent bubo. Sulphides, 498, 554. To check suppuration. Tartar Emetic, 325, 326. When inflammation acute and fever considerable. Bunion. Iodine, 472. Painted on in indolent forms. Best. When thickened and painful. Pres- sure is removed by thick plasters with a hole in the centre. Burns and Scalds. Boracic Acid, 486. Saturated watery solu- tion. Carbolic Acid, 687-690. One to six of olive oil, locally. Collodion, 736. Flexible ; to protect from air. Cotton Wool. To protect from irritation and lessen pain. Lead Carbonate, 597. As white paint for small burns. Lime, 550. As lin. calc, or lime water with linseed oil. Phytolacca, 859. To relieve pain. Salicylic Acid, 692, 693. 1 to 60, olive oil. Turpentine, 882. Local, to severe burns. Warm Bath, 401. Keep whole body, with exception of head, totally immersed for some days in very extensive burns or scalds. It relieves pain, although it may not save life. Bursitis. Blisters, 305. Most useful. Fomentations. To relieve pain. Iodine, 471. When chronic, lin. iodi. may be used as a blister, or the liquor, alter blister- ing or aspiration. Cachexle. Air. Fresh. Aliment. Nutritious. Arnica, 811. Internally, in bad cases. Arsenic, 607, 608. In malarial, also in can- cerous, cachexise. Bath, 404. Turkish hath useful. Cholagogues, 340, 353. Most useful before, or along with other remedies. Eucalyptus, 781. EuiiMin min, 340. As cholagogue. ( rrape Cure. Hydrastis, 705. In malaria. Iron, 628. In all anaemic conditions. Lime Phosphates, 553. In scrofulous phthisis and mal-nutrition. Mangauese, <;i f) . Along with iron and iodine. Massage, 128, K)6. Exceedingly useful. Mercury, 340. In syphilitic cases. See Cho- lagogues. Nitric Acid, iso. In debility after acute dis- ease. Oil and Fats, 226, 227, 922. Cod liver oil very useful. Cream us an addition to food. Phosphates, 353, 530, 558, 638. in cachexia? attended with much discharge. Podophyllin, 339, 703. As cholagogue. Potasslc Iodide. 519. in syphilitic and re- sulting conditions. Purgatives, Saline, 339. A.s adjuncts to cho- lagogues. Barsaparilla, 888. in syphilis. Calculi, Biliary. Aliment. Absence of starch and fat recom- mended. Alkalies. Yichy water useful. Carlsbad Water, 530. Useful as prophylactic. Chloral, 672. To relieve pain during par- oxysm. Chloroform, 680, 681. Inhalation from tum- bler, most useful to relieve paroxysm. Counter-irritants, 403. Mustard poultices to relieve pain during paroxysm. Morphia, 715. y± gr. with T ^ gr. atropia, subcutaneously to relieve pain and vom- iting in paroxysm. Nitro-muriatic Bath, 377, 403. To cause ex- pulsion of calculus, and to relieve pain. Salicylate of Soda, 693. As prophylactic. Sodium Phosphate, 351. In 20 or 30 gr. doses before each meal as prophylactic. Should be given in plenty of water. Turpentine and ether, 374, 882. Equal parts to relieve pain during paroxysm ; also oc- casionally as prophylactic along with a course of Carlsbad or Vichy water. Calculi, Renal and Vesical. Alkalies, 501. To resolve calculi, potash and soda to be used. Alkaline Mineral Waters. Especially Vichy. Ammonium Benzoate, 545. To resolve phos- phatic calculi. Anaesthetics 189, 190. To relieve pain during passage of calculus. Calumba, 706. To relieve vomiting. Castor Oil, 339, 868. As purgative. Chloroform, 680, 681. As in biliary calculi. Cotton Root, 734. As decoction to relieve gravel and strangury. Counter-irritants. To lessen pain during passage of calculus. Mineral Waters. Especially Wildungen. Morphia, 711. Hypoderrnatically, as in bil- iary calculi. Nitric Acid, 480. Dilute, as injection into the bladder to dissolve calculi. Potassium Citrate, 373. In hematuria with uric acid crystals. Water, Distilled. As drink. Cancer. Acetic Acid, 481. As injection into tumors. Arsenic, 605. As local application, causes cancer to slough out. .Sometimes success- ful when the knife fails, but is dangerous. Internally, in cancer in stomach, lessens vomiting.' Supposed to retard growth of cancer in stomach and other parts. Belladonna, 840. Locally relieves pain. Used internally also. Bismuth, 622. To relieve pain and vomiting in cancer of stomach. Bromine, 469. As caustic to use round can- cer. Carbolic Acid, 688-691. As application or in- jection into tumor to lessen pain, retard growth, and diminish foetor. Carbonic Acid, 487. To relieve pain in ute- rine cancer. Charcoal Poultices, 459. To relieve pain and foetor. Chloral, 673. To lessen pain. Chloroform, 680, 681. Vapor as local applica- tion to ulcerated cancer. Chromic Aciii, 804. As caustic. Citric Acid, 185. As lotion to allay pain, jfo. Condurango, 828. Conium, 786. As poultices to relievo pain. I'sed internally also. Glycerine of Tannin, 820. Mixed with iodine, tn check discharge and remove smell in uterine cancer. INDEX OF DISEASES AND REMEDIES. 983 Cancer. Hydrastis, 705 Hyoscyamus, 841. Bruised leaves locally applied. Iodoform, 186, 877. Locally, to lessen pain and fcetor. Iron and Manganese, 633, 640. Internally, as tonics. Opium, 183, 184. Locally and generally, to relieve pain. Papain, 777. As local application or injection. Pepsin, 916. As injection into tumor. Potassa Fusa, 509. As escharotic. Poultices, 402. To relieve pain. Salicylic Acid, 692. Locally applied as powder or saturated solution. Vienna Paste, 509 Warm Enemata. To lessen pain in cancer of rectum. Zinc Chloride, 304 , 569. As caustic. Zinc Sulphate, 304, 567. As caustic. Cancrum Oris. Arsenic, 608, 609. Internally. Nitric Acid, 480. Undiluted as local caustic. Quinia, 801. As syrup or enema. Carbuncle. Belladonna Extract, 836. With glycerine, as local anodyne. Calcic Sulphate, 554. ^ gr. hourly useful. Carbolic Acid, 690. As wash and injection after spontaneous discharge, or on lint after opening. Collodion, 735. Round base, leaving opening in centre. Iodine, 471. Locally, to lessen pain and in- flammation. Opium, 183. Locally, mixed with glycerine. Poultices, 402. To relieve pain. Strapping. Concentrically, leaving centre free, lessens pain. Caries. Cod-liver Oil, 226, 922 Gold, 640. In syphiloma of bone. Iodine, 471. Locally and internally. Phosphates of Lime and Iron, 553. Useful. Phosphoric Acid, 483. Diluted, 1 in 8 of water, locally. Potassic Iodide, 518. In syphilitic cases. Sarsaparilla, 888. Villate's Solution — Cupri. sulph. zinc, sulph. aa partes xv, liq. plumb, subacetat part xxx, acid acet. part c.c. as injection. Catalepsy. Turpentine, 882. As enemata and embroca- tions to spine during paroxysms. Cataract. Codeia, 714. In diabetic cases. Diet and Regimen. Nutritious in senile cases. Sugar and starch to be avoided in diabetic cases. Galvanism. In early stage. Mydriatics, 198-201. To dilute pupil as a means of diagnosis. Catarrh, Acute Nasal. Aconite, 215, 698. Internally at commence- ment. Aconite and Belladonna, 835. In sore throat and cold, one drop of tinct. aconite to two of belladonna every hour. Aconite Liniment, 701. To outside of nose in paroxysmal sneezing and coryza. Ammonia, 177. As inhalation in early stage. Catarrh, Acute Nasal. Ammonium Iodide, 545. 1 gr. every two hours. Arsenic, 608, 609. Internally or as cigarettes in paroxysm and chronic cases. Baths. Hot foot bath, 401. Turkish at com- mencement, 404; cold bath is prophylactic, 400. Belladonna, 835. 5 m. of tinct., and after- wards one or two every hour, to throat, dry in acute nasal catarrh, with profuse watery secretion, and in ordinary sore throat. Bismuth, as Ferrier's Snuff— Bismuth subnit. 5ii, acacia pulv. 5ii, morph. hydrochlor. gr. ii. Camphor, 862. As inhalation. Carbolic Acid, 688-691. As inhalation, or much diluted as spray. As gargle, 1 in 100, when catarrh tends to spread from nose into throat and chest, or to ascend from throat into nose. Cimicifuga, 703. In coryza accompanied by rheumatic or neuralgic pains in head and face. Cold Powder— Camph. partes v, dissolved in ether to consistence of cream, add amnion, carbonat. partes iv, and pulv. opii pars j. Do^e, grs. iij.-x. To break up or modify cold. Cubebs, 871. Powder as insufflation; also smoked. Eucalyptus, 781. Ferrier's Snuff, vide Bismuth. Hydrastis, 705. Externally and internally. Iodine, 471. As inhalation. Iodoform, 681, and Tannin, 877. As insuffla- tion. Ipecacuanha, 802. Nux Vomica, 227. In dry cold in the head. Oil, 820. Inunction to whole body to lessen susceptibility. Locally to nose. Sometimes ointment may be used instead. Potassic Bichromate, 516. Solution locally, 1 to 10 gr. in 4 oz. Potassic Chlorate, 513. Eight or ten lozenges a day to check. Potassic Iodide, 518. 10 gr. at bedtime to avert acute coryza. Pulsatilla, 702. Warm lotion applied to interior of nares. Quinia, 215, 799. 10 gr. of quinia to % gr. morphia at commencement. Salicylic Soda, 532. 2J4 gr. every half hour to relieve headache and neuralgia associated with coryza. Sanguinaria, 725. Internally, and powder locally. Sea-water Gargle. Senega, 730. Spray. Useful means of applying solutions already mentioned. Sulphurous Acid, 477. As inhalation, spray, or fumigation. Tartar Emetic, 325, 326. J'>. Glycerine, 820. Saturated with half the quantity of eau do cologne. Bydrasi 18, 705. As lotion. Sulphurous Ae- ful for children and pregnant women. COXSTIPATIOX. Mercury, 585. In bilious disorders, stools light. Kux Vomica, 821. 5-10 m. in a glass of cold water before breakfast or before dinner. Physostigma, 351. 10 m. of tincture along with belladonna and nux vomica. Podophyllum, 339. Very useful, especially in biliousness; ten drops of the tincture at night alone, or the resin along with other purgative pills, specially when stools are dark. Prunes, 339. Stewed, often efficient. If stewed in infusion of senna they are still more active. Rhubarb Compound Pill, 351. At night. Saline "Waters. In morning, before breakfast ; Friedrichshall, Hunyadi Janos, or Pullna. Senna, 766, 767. As confection, &c. Stillingia, 358, 867. 10 m. fluid extract. Sulphur, 339, 463. Sometimes very useful as a good addition to compound liquorice powder, as in that of the Prussian Phar- macopoeia. Treacle, 906. "With porridge, useful for chil- dren. Turpentine, 883, S84. In atonic constipation with much gaseous distention of colon. Water. Draught in the morning before breakfast. COXVALESCEXCE. Alcohol, 656. With meals. Bitters. Coca, 733. Either extract, or as coca wine. Cod-liver Oil, 922. Cream. Eucalyptus, 782. A tonic. Guarana, 732. Koumiss, 915. Lime, 550. As lime water or carbonate. Opium, 181, 1S3. As enema for insomnia. Surubul, 195, 791. Where great nervous ex- citability. COXVULSIOXS, IXFAXTILE. Aconite, 701. Alcohol. A small dose of wine or brandy arrests convulsions from teething. Asafcetida, 788. A small dose in an enema arrests convulsions from teething. Baths, 401. Warm, with cold effusions to the head. Belladonna, S39. Very useful. Bromide of Potassium, 194. Exceedingly use- ful; children bear it in large doses; 5 gr. three times a day or oftener, for a child a year old in convulsions from teething. Chloral, 672. In large doses, 5 gr., per mouth or rectum. Chloroform, 680, 681. To arrest fit. Ignatia, S21. When intestinal irritation. Morphia, 724. Hypodermically. Potassium Bitartrate, 339, 511. Spinal Ice Bag. Valerian, 194, 195, 806. When due to worms. Veratrum, 279, 281. Corneal Opacities. Cadmium, 308. Iodine, 471. Internally and locally. Mercury, 585. Internally and locally. Silver Nitrate, 575. Locally. Sodic Chloride, 525. Injected under con- junctiva. Corns. Acetic Acid. 304. Chromic Acid,4S7. Iodine, 471. INDEX OF DISEASES AND KEMEDIES. 987 Corns. Poultices, 402. And plaster with hole in centre to relieve pressure. Silver Nitrate, 575. Cough. Aconite, 209, 215, 700. In throat cough and emph sema. Alum, 556, 557. As spray or gargle. Apomorphia, 215, 226. In bronchitis, with deficient secretion. Asafcetida, 788. In the after-cough from habit, and in the sympathetic whooping- cough of mothers. Belladonna, 839. Blue Pill, 585. In gouty or bilious pharyn- geal irritation. Camphor, 863. Internally or locally, painted over the larynx with equal parts of alcohol. Chloral, 672. Chloroform, 680, 681. Cod-liver Oil, 226, 922. One of the most useful of all remedies in cough. Conium, 787. Gelsemium, 827. In convulsive and spas- modic cough. Griudelia, 813. In habitual or spasmodic cough. Hydrocyanic Acid, 493. For irritable cough, and in phthisis. Hyoscyamus, 183. In tickling night coughs. Iodine, 472. As inhalation. Ipecacuanha, 804. Internally and as spray, locally. Ipecacuanha and Squill Pill, 803. In chronic bronchitis at night, Lactucarium, 811. Laurocerasus, 777. Substitute for hydrocy- anic acid. Linseed, 729. In throat cough. Liquorice, 227, 757. In throat cough. Lobelia, 814. Nasal Douche, 410. In nasal cough, 221. Opium, 181, 183. Morphia locally to the throat, and generally. Plasters, 228, 433. Calefaciens and picis to the chest. Potassic Bromide, 521. In reflex coughs. Primus Virginiana, 339. Pulsatilla, 702. Anemonine, 3^-1 gr. dose in asthma and whooping-cough. Sanguinaria, 725, 726. In nervous cough. Tannin, 876. As glycerine to the fauces. Tar Water, 227, 886. In winter cough, bron- chitis, and phthisis. Valerian, 194, 195. In hysterical cough. Croup. Alum, 326, 556. Teaspoonful, with honey or syrup, every % or % hour until vomiting is induced ; most useful emetic. Copper Sulphate, 573. 1-5 grs., according to age of child, until vomiting is induced. Ipecacuanha, 804. Must be fresh ; if it does not succeed, other emetics must be taken. Lactic Acid, 493. To dissolve membrane (1 in 20). Mercury Subsulphate, 587. One of the best emetics ; 3-5 gr. given early. Sanguinaria, 725. A good emetic. ~fy syr. ipecac, Sij ; pulv. sanguin. gr. xx ; pulv. ipecac, gr. v; mix a teaspoonful every quarter hour till emesis, then half a tea- spoonful every hour. Senega, 731. As an auxiliary. Sulphurous Acid, 479. As spray. Tannin, 876. As spray. Tartar Emetic, 227. Too depressant. Zinc Sulphate, 326, 570. Cystitis. Aconite, 701. When fever present. Alkalies, 501. When urine is acid. Cystitis. Belladonna, 839. Most useful to allay irrita- bility. Buchu, 384, 748. Especially useful in chronic cases. Cantharides, 926. In small doses long con- tinued. Chimaphila, 815. In chronic cases. Copaiba, 385. Useful. Cubebs, 374, 872. Eucalyptus, 781. Extremely useful in chronic cases. Iodoform, 683. As suppository. * Opium, 181, 183. As enema, or suppository,. to relieve pain. Pareira, 707. In chronic cases. Quinine, 801. In acute cases. Sulphites, 533. To prevent putrefaction of urine. Turpentine, 374, 882, 883. Uva Ursi, 815. In chronic cases. Cysts. Chloride of Gold, 641. In ovarian dropsy. Galvano Puncture. Iodine, 471. As an injection after tapping. Silver Nitrate, 575. As an injection. Deafness. Cantharides, 819. As ointment behind the ear. Colchicum, 899. In gouty persons. Gargles, 413. In throat deafness. Glycerin, 820. Locally. Quinine, 801. In Meniere's disease. Tannin, 876, 877. In throat deafness. Debility. Alcohol, 656. Along with food often very useful. Liable to abuse— not to be con- tinued too long. Arsenic, 109,361. In young ansetnic persons,, alone or with iron, and in elderly, with feeble circulation. Bitters. Useful as tonic. Cholagogue Purgatives, 353. When debility is due to defective elimination of waste. Cinchona, 801, 802. Digitalis, 850. When circulation is feeble. Eucalyptus, 782. In place of quinine. Hydrastia, 705. The same. Iron, 634. Anaemia. Lime Salts, 553. Phosphates, if from over- work and town life; hypophosphites in nervous debility. Manganese, 640. In place of iron. Nux Vomica, 821. Most powerful general tonic. Sanguinaria, 358, 725. When gastric digestion is feeble. • Sarsaparilla, 889. When syphilitic taint is present. Sea Bathing, 395. Delirium. Alcohol, 656. When delirium is due to ex- haustion. Antimony, 616. Along with opium in fever. Bath, Cold, 396. In fever. Belladonna, 839. Bromide of Potassium, 521, 522. In fevers. Camphor, 863. In 20-gr. doses every two or three hours in low-mutteringdelirium. Cannabis Indica, 879, 880. In nocturnal delirium occurring in softening of the brain. Morphia, 716. Hypodermically. Opium, 181, 183. With tartar emetic. 988 INDEX OF DISEASES AND REMEDIES. Delirium Tremens. Alcohol, 654. Sometimes necessary. Ammonium Carbonate, 543. In debility. Beef Tea, 656. Most useful. Belladonna, 837,839. In insomnia when coma Tigil. Bromides, 521, 536. 544, 553. In large doses. Cannabis Indica, 879, 8S0. Useful, and not dangerous. Capsicum, 835. 20-30 gr. doses, repeated after three hours, to induce sleep. Chloral, 672. At commencement requires caution. Cimicifuga, 703. As a tonic. Coffee, 304 Conium, 787. As an adjunct to opium. Digitalis, 850. In large doses has had some success Enemata, 415. Xutritive, when stomach does not retain food. Food, nutritious, more to be depended upon than anything else. Hyoscyamus, 181-183. Useful, like belladonna. Ice, 328. To check vomiting. Lupulin, 881. Opium, 722. To be given with caution. Potassium Bromide, 521. Quinine, 801. Stramonium, 842. More powerful than bella- donna. Sumbul, 195, 791. In insomnia. Tartar Emetic, 227. Along with opium. Dentition. Belladonna, 839. In convulsions. Bromide of Potassium, 521. To lessen irrita- bility and to stop convulsions. Calumba, 706. In vomiting and diarrhoea. Hypophosphites, 531, 554, 639. A tonic. Phosphates of Lime, 553, 554. When delayed or defective. Diabetes Insipidus. Alum. 556. 557. Atropia, 839. Creasote, 691. Ergot, 911. Gallic Acid, 877. Combined with opium. Jaborandi, 749. Krameria, 731. To lessen the quantity of urine. Nitric Acid, 481. Opium, 719. Most useful; large doses, if necessary. Valerian, 806. In large doses. Diabetes Mellitus. Alkalies. Alkaline waters are useful. Ammonium Carbonate, 543. Ammonium Citrate, 623. Ammonium Phosphate, 544. Arsenic, 608. Belladonna. 903. Full doses. t Calcium Sulphide. 555. Codeia,715. A most efficient remedy. Some- times requires to be pushed to the extent of 1*- gr-. or inure per diem. Creasote, 691. Glycerin, B20. As remedy, and as food in place of sugar. Hydrogen Peroxide. 458. Iron, 634. Most useful along with morphia. .lab'U audi, 749. Krameria. 731* Lactic Acid, -i'x>. Opium, 719. Most useful. Phosphoric Add. 183. To lessen thirst. Potassium Bromide, 521. Quinine, 800, 801. Quinine Bromide. With morphia. Quinine Sulphate, 796. Rhubarb, Diabetes Mellitus. SalicvlicofSoda, 532. Skim Milk Diet. Sodium Citrate, 322. Sodium Phosphate, 530. As purgative. DlABBHCEA. Aconite, 701. In high fever and cutting abdominal pains. Alkalies, 499, 500. In small doses in diarrhoea of children. Alum, 556, 557. Ammonium Carbonate, 543. Arsenic, 608, 609. Bael, 741. Bismuth, 621, 622. Calcium Carbolate, vide 691. Calcium Carbonate, 553. Calcium Phosphate, 553. Camphor, 863. In summer diarrhoea at com- mencement. Capsicum, 835. From eating fish. Carbolic Acid, 689, 690. Cascarilla, 867. Castor Oil and Opium, 869. Most useful at commencement. Catechu, 770. Copper Sulphate, 573. In chronic cases. Corrosive Sublimate, 107, 589. In small doses for children. Creasote, 691 Dulcamara, 835. In diarrhoea of children from teething or exposure. Ergot, 911. Erigeron Canadense. Galls, 875. Haematoxylon, 765. Iron Pernitrate, 634. Iron and Potash Tartrate, 635. Kino, 759. Krameria, 732. Lead Acetate, 597. By mouth or suppository. Matico, 872. Naphthalin, 694. Kitrous uxide, 186. Nux Vomica, 821. In chronic cases. Oak Bark, 308, 874. Opium, 722. Most useful. Potassium Chlorate, 514. In chronic cases with mucilage-like stools. Pulsatilla, 702. Rhubarb, 858. In early stages. Bumex Crispus, 436, 859. In morning diar- rhoea. Salicin, 873. In chronic cases along with ipecacuanha. Salicylic Acid, 693. In summer diarrhoea and in diarrhoea of phthisis. Tannin with Opium, 877. Zinc Oxide, 569. Zinc Sulphate, 30S, 570. Diphtheria. Alcohol, 655, 656. Freely given, very useful. Ammonium Chloride, 540. Apomorphia, 714. As an emetic. Arsenic, 60S, 609. Internally. Belladonna, 839. At commencement, espe- cially useful when tonsils much swollen. Bromine, 469. As inhalation. Carbolic Acid, 6S8-C90. As spray or painted on throat, internally with iron. Chloral, 672. Chlorinated Lime, 467, 468. Locally as gargle or wash. Chlorine Water, 467. Internally. Copper Sulphate, 573. As emetic. Gualacum, 7 16. Internally. Hydrochloric Acid, 479. Dilute as gargle, or Btrong as caustic. Iodine, 471. As inhalation. [ron Perchloride, 633. Iron Persulphate, 631. IXDEX OF DISEASES AXD REMEDIES. 989 Diphtheria. Lactic Acid, 493. As solvent of false mem- brane. Lemon Juice, 740. As gargle. Mercury, 585. Internally as calomel or cyanides, oV~ ^ of a grain. Papain, 778." As solvent of false membrane. Potassium Bichromate, 517. As emetic. Potassium Chlorate, 514. Internally in large doses frequently repeated, and locally as a gargle. Potassium Liquor, 509. Internally. Potassium Permanganate, 515. As gargle. Salicylic Acid, 693. Locally as gargle, or internally. Sanguinaria, 725. As emetic. Vide Croup. Sassafras, Oil of, S64. As local application. Soda Chlorate, 530. Soda, Chlorinated, 530. In a solution as gargle. Soda Sulphites, o33. Internally and locally. Strychnia, 824. Subcutaueously for paralysis. Sulphurous Acid, 478. Dropsy. Ammonium Benzoate, 546. In hepatic dropsy. Ammonium Chloride. 540. In hepatic dropsy. Arsenic, 608, 609. From fatty heart, debility, and old age. Asclepias Syriaca, 829. Asclepias Syriaca and Apocynum, 828. Blatta, 373." Broom, 375, 758. One of the most useful diuretics, especially in scarlatinal, renal, and hepatic dropsy. Byronia, 7S5. As "drastic, purgative, and diuretic. Cannabis Indica, SS0. As diuretic. Chenopodium Anthelminticum, S59. In scar- latinal dropsy. Chiniaphila, 815. In renal dropsy. Colchicum, 899. In hepatic, cardiac, and scarlatinal dropsy. Copaiba, 375. Especially in hepatic dropsy. Digitalis, 375, 850. In all dropsies, but espe- cially in cardiac dropsy; infusion is the best "form. Elateriuin, 340, 784. Useful hydragogue cathartic. Erythrophlceum, 375. In cardiac dropsy. Hellebore, 894. In post-scarlatinal dropsy. Iron, 634. Along with saline purgatives." Juniper, 375, 887. Exceedingly useful. Nitrous Ether, 374, 375. Useful alone, or with other diuretics. Potassium Bitaitrate, 374. With compound jalap powder, most useful of the hydragogue cathartics. Potassium Nitrate, 374. As diuretic. Senega, 731. In renal dropsy. Squill, 375. In cardiac dropsy. Strophanthus, 374. In cardiac dropsy. * Taraxacum, 374. Turpentine, 374. In albuminuria. Duodexal Catarrh. Arsenic, 608, 609. Bismuth, 622. Ipecacuanha, 804. Nitro-rnuriatic Acid, 377. Podophyllum, 704. Rhubarb, 858. Dysentery. Aconite, 701. With much fever. Arnica, 811. With much depression. Arsenic, 60S, 609. Belladonna, S39. Benzoin, 817. In chronic cases. Carbolic Acid, 689, 690. Castor Oil, S69. In small doses, with opium. Corrosive Sublimate, 107. In small doses in chronic cases. Dysextery. Creasote, 691. Ergotine, 911. Glycerin, 820. With linseed tea to lessen tenesmus. Hamamelis, 874. Where much blood in motions. Iodine, 472. Ipecacuanha, 804. In 30-gr. doses on empty stomach, with complete rest. Iron, 634. Internally, or as enemata. Lead Acetate, 597. By mouth, or as enemata or suppusitory. Lemon Juice, 740. Magnesium Sulphate, 560. In acute cases. Xux Vomica, 821. In epidemic cases, and where prune-juice stools and much depres- sion. Opium. 723. Potassium Bitartrate, 340, 511. In advanced stages where much mucus. Potassium Chlorate, 514. As enema. Quinine Sulphate, 797. In large doses in malarious cases, followed by ipecacuanha. Soda, Chlorinated, 530. As enema. Sulphur, 463. In chronic cases. Tannin, 876. Zinc Oxide, 569. Zinc Sulphate, 30S, 570. By mouth or enema. Dysmenorrhea. Aconite, 701. Ammonium Acetate, 544. Aniyl Nitrite, 666. In neuralgic form. Apiol .Oil of Parsley). As emmenagogue in neuralgic form. Arsenic, 608, 609. When membranous dis- charge from uterus. Belladonna, S39. In neuralgic form. Borax, 391, 529. In membranous form. Cajuput Oil, 780. Camphor, 863. Frequently repeated. Cannabis Indica, 879, 880. Very useful. Cimicifuga, 703. In congestive "cases at com- mencement. Croton Chloral, 673. In neuralgic form. Ergot, 911. In congestive cases at commence- ment. Gelsemium, 827. Guaiacum, 390. In rheumatic cases. Ipecacuanha, 804. As an emetic. Iron, 634. Xux Vomica, 821. In neuralgic form. Opium, 723, 724. Exceedingly useiul in small doses, of 3 to 5 m. of tincture alone or along with 3 or 4 gr. of chloral. Pulsatilla, 702. Rue, 391, 747. Sumbul, 791. Dyspepsia. Acids, 480. Before or after meals, especially nitro-muriatic acid. Alcohol, 656. Along with food. Alkalies, 500. Very useful before meals, or two hours after. " Alkaline Mineral Waters. Aloes, 892. As dinner pill. Arsenic, 608, 609. 1 m. of liquor before meals in neuralgia of the stomach, or diarrhoea excited by food. Asafcetida, 788. Belladonna, 839. To lessen pain and consti- pation. Berberine, 865. Bismuth, 622. When stomach irritable. Bryonia, 785. In bilious headache. Calumba, 706. Very useful. Capsicum, S35. In atonic dyspepsia. Cardamom, 901. Castor Oil, 869. Cerium Oxalate, 558. Chamomile, 809. 990 INDEX OF DISEASES AND REMEDIES. Dyspepsia. Charcoal, 460. For flatulence. Cholagogues, 340. Often verv useful. Cinchona, SOI, 802. Gallic Acid, 877. In pyrosis. Hydrastis, 705. In chronic dyspepsia. Hydrocyanic Acid, 493. In irritable cases. Ipecacuanha, 804. Useful adjunct to dinner pill. Kino, 759. In pyrosis. Lactic Acid, 493. In imperfect digestion, Lime Water, 550. Magnesium Sulphate, 560. Manganese, 640. In gastrodyrjia and pyro. Mercury, 585. As cholagogue. Nux Vomica, S21. Exceedingly useful. Pancreatin, 321. 1% or 2 hours after meals, very useful. Pepsin, 321. Sometimes very useful with meals. Potassium Iodide, 518. Potassium Sulphide, 506. Quassia, 752. Rhubarb, 351, 858. Sanguinaria, 725. In atonic dyspepsia. Silver Nitrate, 575. In nervous aud neuralgic cases. Silver Oxide, 577. Sulphurous Acid, 47S. In acid pyrosis and vomiting. Tannic Acid, 308. Taraxacum, 810. Xanthoxylin, 749. As stomachic tonic. Dysphagia. Bromide of Potassium, 521, 522. In hyster- ical dysphagia, or dysphagia of liquids in children. Cajuput Oil, 780. In nervous dysphagia. Iced Fluids. Slowly swallowed in spasmodic dysphagia. Dyspncea. Vide Asthma, Bronchitis, Cioup, Emphysema, Phthisis. Dystjria. Alkalies, 501-503. When urine very acid. Belladonna, 839. Camphor, 863. In strangury. Cannabis Indica, S79, S80. In hematuria. Cantharides Tincture, 926. Chimaphila, 374, 815. Ergot, 911. In paralysis, when bladder feels imperfectly emptied. Gelsemium, 827. Nitrous Ether, 374. Opium, 723, 724. Earache. Almond Oil, 776. Blisters, 305. I'.chind the ear. Glycerin, 820. Lead Acetate and Opium, 598. As wash. Opium. 722. Pulsatilla, 702. El CHYMOSBS. Alcohol, 655. Externally. Arnica, 811. Internally and externally. ECTIIYM \. Cod-liver Oil, 921. Internally and locally. Grape Cure. I Useful. Lead, 596. Locally. Quinine, 799 301, " Zinc Oxide, 588. Locallv. ECTROPIUM AND EnTROPIUM. Collodion, 736. Silver Nitrate, Eczema. Alkalies. Weak solutions of, as constant dressing. Anacardium Orientale, vide Cashew Nut Oil. Arsenic, 608, 609. Most generally useful. Benzoin, 817. Compound tincture locally, to allav itching. Bismuth, 622. Locally. Carbolic Acid, 689, 690. Internally and ex- ternally. Carron Oil, 551. To allay irritation. Cashew Nut Oil. As ointment in chronic cases. Citrine Ointment, 591. Locally, alone or mixed with tar ointment. Croton Seeds, 867. Tincture of, as ointment. Electricity. In obstinate cases. Glycerin, 820. Hamamelis, 874. Locally to allay itching. Iris Versicolor, 902. In chronic gouty cases. Lead Salts, 597. Locally. Lime Water, 550. Alone, or with glycerin or oil. Mercury, 585. Milk Cure, 915. Sometimes useful. Phytolacca, 859. In obstinate cases. Ehus Toxicodendron, 755. Internally and externally. With much burning and itch- ing, and in chronic eczema of rheumatism, worse at night-time. Sulphides, [ 403, 463, 516, 555. Internally, Sulphur, j and as baths. Tannin, 876. Glycerin of, most useful appli- cation. Viola Tricolor, 729. Iufusion along with senna. Elephantiasis. Anacardium Orientale. Arsenic, 60S, 609. Along with five or six times as much black pepper. Cashew Nut Oil. Gurjun Oil. Sarsaparilla, SS9. Emaciation. Arsenic, 608, 609. Cinchona, 801, 802. Cod-liver Oil, 358, 921. Iodine, 471. Iron, 634. Pancreatin, 321. Pepsin, 321. Phosphate of Lime, 554. Emphysema. Apomorphia, 713, 714. When secretion is scanty. Arsenic, 608, 609. Bleeding, 363. When right side of heart engorged. Chloral, 672. In acute. Cod-liver Oil, 358, 921. One of the best rem- edies. Ether, 662. Internally as inhalation. Grindelia, 812. Bypophosphites, 531, 554,639. Iodide of Ethyl, 669, 670. As inhalation. Iron, 634. Oxygen, 456. Senega, 731. Stramonium, 842. Turpentine, Oil of, 883, 8S4. INDEX OF DISEASES AND REMEDIES. 991 Empyema. Aspiration, or free incision Carbolate of Iodine, 471. Carbolic Acid, 689, 690. Chlorine Water, 467. Iodine, 471. Quinine, 799-802. Salicylic Acid, 693. J All used as in- jections to wash out cavity. Endocarditis. Aconite, 300, 699, 701. In small doses fre- quently at commencement. Blisters, 305. Bryonia, 785. Mercury, 582. To prevent fibrinous deposits. Opium, 722. Quiuia, 801. Salicylic Acid, 693. Endometritis. Carbolic Acid, 689, 690. Locally. Chromic Acid, 304. Ergot, 911. Subcutaneously. Glycerin, 820. Locally. Hot Water Injections. Iodine, 471. Iodoform, 683. Iodo-tannin. Solution of iodine in tannic acid. Nitric Acid, 481. Ustilago Maydis, 911. Enteritis. Aconite, 701. In acute cases. Arsenic, 608, 609. Castor Oil, 869. Very useful along with opium. Iron, 634. Opium, 723. Podophyllum, 704. Poultice, Hot, 402. Skim Milk. As diet, alone or with lime water. Enuresis. Atropia, 837. Belladonna, 839. Very useful for children, but the dose must be large. Buchu, 748. In chronic cases. Cantharides, 925, 926. Internally very useful. Chloral Hydrate, 672. Jn children. Collodion, 736. To form a cap over prepuce. Ergot, 911. In paralytic cases. Iodine of Iron, 637. Lupuline, 881. Rhus Aromatica, 756. Rhus Toxicodendron, 755. Santonin, 808. When worms present. Strychnia, 825. Very useful. Turpentine, 883. Epididymitis. Aconite, 701. In small doses frequently re- peated. Mercury and Morphia, 585. Locally as oleate. Pulsatilla, 702. In very small doses along with aconite. Silver Nitrate, 575. Strong solution locally applied to abort. Epilepsy. Arsenic, 608, 609. In epileptiform vertigo. Asafcatida, 788 Belladonna, 839. Jn petit mal. Blisters, 303, 304, 305. Over seat of aura. Bromides of Potassium, Sodium, Lithium, and Iron, 521, 531, 536. Most generally use- ful ; dose should be large. Epilepsy. Bryonia, 785. Camphor, 863. Cautery. Frequently and lightly repeated. Chloroform, 680, 681. As inhalation in hystero-epilepsy. Cod-liver Oil, 922. Conium, 787. Copper Salts, 573. Hvdrobromic Acid, 494. Ignatia, 821. Nitrite of Amy], 666. As inhalation at com- mencement of aura. Nitrite of Soda, 524. Nitro-glycerin, 668, 669. Phosphorus, 361, 605. Picrotoxin, 707, 708. Quinia, 801. Rue, 747. When seminal emissions present. Seton at back of neck. Strychnia, 825. Turpentine, 355, 884. When worms present. Valerian, 806. Zinc Oxide, 569. Epistaxis. Aconite, 701. Alum Powder, 556, 557. Snuffed or blown up the nostrils. Arnica, 811. In traumatic cases. Belladonna, 839. Digitalis, 850. Ergot, 911. Gallic Acid, 877. Alone with ergot and dig- italis. Hamamelis, 874. Ice over nose and head. Ipecacuanha, 803. Iron, 634. As spray. Plugging anterior and posterior nares neces- sary, if epistaxis obstinate. Turpentine, 884. Internally. Warm Bath, 401. To feet and hands. Warm Water Bag. To spine. Erysipelas. Aconite, 701. At commencement. Ammonium Carbonate, 543. When tendency to collapse. Belladonna, 839. Collodion, 736. Locally. Digitalis, 850. Locally. Iodine, 471. Iron, 634. Large doses frequently. Quinine, 801. In large doses. Khus Toxicodendron, 304, 756. Silver Nitrate, 575. Strong solution locally applied. Sulphurous Acid, 478. Equal parts with gly- cerin locally. Tartar Emetic, 616, 617. Small doses fre- quently. Erythema. Acids. In cases of indigestion. Belladonna, 839. Bismuth, 622. Locally. Quinia, 801. In erythema nodosum. Rhus Toxicodendron, 304, 756. Zinc, 304. Locally. Exophthalmos. Belladonna, 839. Digitalin, 850. Galvanism of the cervical sympathetic and pneumogastric. Iron, 634. 992 IXDEX OF DISEASES AND KEMEDIES. Exostosis. Aconite, 701. Iodide of Potassium, 519. Mercury, 585. Fever. Acids, 475-477. To allay thirst. Aconite, 701. Small doses frequently, in all sympathetic fevers. Alcohol, 655. Often useful. Ammonium Acetate, 544. Very useful as diaphoretic. Ammonium Carbonate, 543. In scarlet fever and measles. Antipyrin, 696. Arnica, 811. Arsenic, 608, 609. In malarious fevers. Belladonna, 839. In eruptive fevers and deli- rium. Camphor, 863. In adynamic fevers. Cimicifuga, 703. Cinchona, 801, 802. Cocculus, 706. In typhoid, to lessen tym- panitis. Coffee, 804. In place of alcohol. Digitalis, 850. Gelsemium, 827. Hydrastia, 705. Mercury, 58o. Small dnses at commence- ment of typhoid or scarlet fever. Opium, 181," 183. In sleeplessness, alone or with tartar emetic. Quinine, 109, 802. In hyperpyrexia. Rhus Toxicodendron, 304, 812. In rheumatic fever and scarlet fever with typhoid symp- toms. Salicin, 873. "] In rheumatic fevers, Salicylate of Soda, 532. v or in hyperpy- Salicylic Acid, 693, J rexia. Tartar Emetic, 616, 617. In small doses, with opium. Turpentine, 374. As stimulant in typhoid, puerperal, and yellow, and to stop haemor- rhage in typhoid. Yeratrum Viride, 894. In delirium ferox. Fistula. Capsicum, S35. As weak infusion locally. Pepper, 870. The confection as laxative. Sanguinaria, 358, 725. As injection. Flatulence. Alkalies, 320, 501. Before meals. Asafcetida, 787. Calumba, 706. Carbolic Acid, 689, 690. Carminatives, 329. Charcoal, 330. Creasote, 691. Mercury, 585. When liver sluggish. Nux Vomica, 821. Physostigma, 351. in women at change of life. Potassium Permanganate, 515. In fat people. Turpentine, 882. lew drops internally, or as enema. Flushing and Heat. Iron, 634. .Most useful. Nit rile of Amy], 666. Nux Vomica, 821. Potassium Bromide, 521, 531. Valerian, 806. Valerianate of Zinc, 572. Fb lctures and Dislocations. Aconite, 701. if febrile symptoms are pres- ent. Arnica, 811. Internally and locally. Fractures and Dislocations, Iodine, 471. Opium, 723. Phosphate of Lime, 553. Freckles. Quickens union. Benzoin, 817. Borax, 529. Iodine, 471. Lime Water, 550. Mercuric Chloride, 82, 588. Locally with gly- cerine, alcohol, and rose water, % of gr. to the oz. Olive Oil, 819, 820. Potassium Carbonate, 322, 508. Gangrene. Balsam of Peru, 760. Bromine,*469. Charcoal, 459. As poultice. Cinchona, 801, 802. Creasote, 691. Lime Juice and Chlorine Water in hospital gangrene. Nitric Acid, 481. Opium, 723. Oxygen, 456. As a bath. Potassium Chlorate, 374, 514. Salicylic Acid, 693. Locally. Sanguinaria, 725. Gastralgia. Acupuncture. Sometimes gives great relief. Alum, 556, 557. Arsenic, 608, 609. In small doses. Atropia, 839, 840. Bismuth, 329. Chloroiorm, 680, 681. Two or three drops on sugar. Creasote, 691. Ergot, 911. Galvanism. Hydrocyanic Acid, 329. Milk Cure, 915. Morphia, 715. Subcutaneously, in epigas- trium. Very useful, or with bismuth and milk before each meal. Nux A'omica, 821. Pancreatine, 321. Pepsine, 321. Silver Nitrate, 575. Silver Oxide, 577. Zinc Oxide, 568. Gastric Ulcer. Arsenic, 60*, 609. Atropia, 839. Bismuth, 622. Cannabis Indica, 879, 880. Carlsbad Salts, 529. Before meals. Castor Oil, 869. Charcoal, 460. Ice Bag. To epigastrium. Lead Acetate, 597. To check lnematemesis. Lime Water, with Milk, 550. Mercuric Chloride, 82, 588. Small dose before meals. Milk, 915. Morphia, 713,715. Nutritive Knemata. Opium, 72:;. Pepsine, 821. Potassium Iodide, 518. With bicarbonate, to lessee flatulent dyspepsia. Silver Nitrate, 575. Silver Oxide, 577. Turpentine, 882, 883. Frequently repeated to check haemorrhage. INDEX OF DISEASES AND KEMEDIES. 993 Gastritis. Along with opium. Alum, 556, 557. When vomiting of glairy- mucus. Ammonium Chloride, 540. Arsenic, 608, 609. Atropia, 839. In chronic cases. Bismuth, 622. Caffeine, 742, 743. Especially when associated with migraine. Calumba, 706. Cinchona, 801, 802. Eucalyptus, 781. Hydrastis, 705. Ipecacuanha, 803. Lead Acetate, 597. Nux Vomica, 821. Opium, 723. Pulsatilla, 702. Silver Nitrate, 575. Silver Oxide, 577. Tannic Acid, 876. Glanders. Ammonium Carbonate, 543. Every hour in concentrated solution, followed by opiate. Arseniate of Strychnia, 825. Carbolic Acid, 688-690. Locally. Chlorinated Soda, 468. Locally. Creasote, 691. Iodine, 471. Iodide of Sulphur, 470. Potassium Bichromate, 98. Sulphites, 533. Glandular Enlargements. Ammonium Chloride, 540. Arsenic, 608, 609. Barium Chloride, 246. Belladonna, 839. Cadmium Chloride, 246. Calcium Sulphide, 555. For glands behind jaw, with deep-seated suppuration. Carbolic Acid, 688-690. Injections, a 2 per cent, solution. Gold Chloride, 641. Guaiacum, 746. Hydrastis, 705. Iodine, 471. Iodoform, 682. Mercury, 585. Internally and locally. Sulphides, 516, 555. Valerian, 806. Has caused this disease. Like Atropia. Lowers intra-ocular tension. The only cure. Glaucoma. Atropia, 839. Dubosia, 198. Eserine, 761. Iridectomy. Gleet. Aloes, 892. Blisters, 305. To perinaeum useful. Cantharides, 376, 926. Minim doses of tinc- ture. Copaiba, 385, 768. Internally and locally smeared on a bougie and introduced. Copper Sulphate, 573. As injection. Iron, 634. Juniper Oil, 887. Like Copaiba. Kino, 759. Peru, Balsam of, 760. Piper Methysticum, 871. Sandal Wood Oil, 759. Useful both locally and generally. Tannin, Glycerine of, 876. As injection. Tolu, Balsam of, 760. Turpentine, 374, 883. Glossitis. Bismuth, 622. As lotion. Purgatives, 339. 63 Glottis, (Edema of. Ammonium Carbonate, 543. As emetic. Inhalations, 412, 453, 468. Scarification especially useful. Tracheotomy. Goitre. Iodine, 471. Internally and locally, as oint- ment or tincture, and as injection. Mercuric Biniodide, 592. As ointment. Potassic Iodide, 518. Aconite, 839. In acute stage. Gonorrhoea. Alkaline salts or waters. Alum, 555-557. As an injection. Cannabis Indica, 879, 880. To relieve pain and lessen discharge. Cantharides, 926. In small doses. Colchicura, 374, 890. Copaiba, 385, 768. Cubebs, 871. Either alone or mixed with copaiba. Hydrastis, 705. As injection. Kaolin, 385, 554. Lead Salts, 595. As injection. Mercuric Chloride, 588. Weak solution, lo- cally. Pulsatilla, 702. Sandal Wood Oil, 759. Internally and locally. Silver Nitrate, 575. As injection. Turpentine, 379, 884. Zinc talts, 568. As injection. Gout. Aconite, 701. Alkalies, 499-502. Arsenic, 608, 609. Belladonna, 839. Colchicum, 362. Iodine, 471. Lithium, 535, 536. Manganese, 640. Strychnia, 826. Sulphides, 516, 554. In chronic cases. Sulphur Baths, 403. Veratria, 895. As ointment. Gums, Spongy. Alum, 556. Areca, 903. Iodine Tincture, 518. Locally. Krameria, 732. Myrrh, 757. Pomegranate Bark, 782. Potassium Chlorate, 513. H^MATEMESIS. Alum, 555, 558. Ammonium Chloride, 540. Ergot, 911. Hypodermically. Gallic Acid, 308. Hamamelis, 873. Ice. Exceedingly useful. Ipecacuanha, 804. Iron Perchloride, or Pernitrate, 718, 720. Lead Acetate, 597. Magnesium Sulphate, 339. Sulphuric Acid, 477. Tannic Acid, 876. Turpentine, 279, 883, 884. HEMATURIA. Alum, 555-557. Internally, or as injection into the bladder. Bitartrate of Potash, 511. Chimaphila, 815. Copaiba, 768. Creasote, 691. 994 IXDEX OF DISEASES AXD REMEDIES. HEMATURIA. Digitalis, 850. Gallic Acid, 877. Hamamelis, 874. Ipecacuanha, S04. Iron Perchloride, or Pernitrate, 634. Krameria, 732. Extract in large doses. Lead Acetate, 597. Matico, ^72. Tannic Acid, 876, 877. Turpentine Oil, 883, 884. HEMOPTYSIS. Acetic Acid, 473, 481. Aconite, 209, 215, 701. Alum, 555-558. Ammonium Chloride, 540. Arnica, 811. Chloroform, 6S0, 681. Outside of chest. Copaiba, 768. Copper Sulphate, 573. Digitalis, S50. Drv Cups to chest. Ergot, 908. Ferric Acetate, 632. Added to water, so as to take away the taste ; a little constantly sipped. Gallic Acid, 877. Very useful. Hamamelis, 374. Very useful. Ipecacuanha, S03. Iron, 633. And absolute rest. Lead Acetate, 597. Very useful. Matico, 309. Phosphoric Acid, 483. Potassium Nitrate, 512. "When fever present, along with digitalis or antimony. Silver Oxide, 577. Sodium Chloride, 524. In drachm doses. Tannin, 309. Hemorrhage, Intestinal. Belladonna, S39. For rectal ulcers. Castor Oil, 868. Ferric Chloride, 309. Iodine, 471. Sulphuric Acid, 477. Turpentine, 374, SS2. Very useful. Hemorrhage, Postpartum. Acetate Acid, 473, 481. Achillea. Capsicum, 835. Cimicifuga, 703. Digitalis, 850. Enemata, Hot. Ergot, 911. Most efficient. Ether Spray, 146, 661-663. Gallic Acid* 877. Hamamelis, 874. For persistent oozing. Hot Water, 180-133. Injection into uterus. Hydrastis, 705. Ice, 398. To abdomen, uterus, or rectum. Iodine, 471. Ipecacuanha, 802. An emetic dose ; good. Iron Perchloride, Diluted, 633. 1-4 injected into uterus. Xux Vomica, 821. Along with ergot. Opium. 722. 1 dr. dose of tincture, with brandy, in profuse bleeding. Pressure over Uterus. Hemorrhoids. Alkaline Mineral Waters. Useful. Aloe-. :;:::». B90. A- purgative. Alum, 566-558. in bleeding piles, powder, ci ystal, oi- ointment. Carbolic Add, 688-691. Injection into piles. Ergot, 911. '.alls Ointment, S77. With opium very useful. Grape Cure. HEMORRHOIDS. Hamamelis, 874. Internally and locally, as lotion, injection, enema, or suppository. Hydrastis, 705. As lotion and internally. Hyoscyamus, 840. Bruised leaves or ointment locally. Iodoform, 682. As ointment or suppository. Iron Protosulphate, 639. As lotion. Leeches, 927. Nitric Acid, 480. As caustic ; dilute as lotion. Nux Vomica, 821. Yery useful. Senna, 766. As confection, or better, com- pound liquorice powder of Prussian Phar- macopoeia. Stillingia, 867. In constipation and hepatic disease. Sulphur, 463. As confection. Hay Fever. Aconite, 701. Arsenic, 60S, 609. As cigarette. Coffee, Strong, 804. Iodide of Potassium, 518, 519. Internally and locally. Ipecacuanha, 802. Quinia, 801. Locally, as injection or douche. Headache. Aconite, 701. When circulation excited. Ammonia, 542. Aromatic spirits in ]A-2 dr. doses. Ptaspail' s lotion very useful ;" often relieves nervous headache. Ammonium Chloride, 540. 10-15 gr. doses in hemicrania. Arsenic, 608, 609. In brow ague. Atropia, 836. Locally to eye in migraine. Belladonna, 836. Frequently given in fron- tal headache, especially at menstrual pe- riod, or from fatigue. Bicarbonate of Soda, 527. "With bitters be- fore meals in frontal headache at the junc- tion, for pain in upper part of forehead without constipation. As wash to the mouth when headache depends on decayed teeth. Bromide of Potassium, 179, 521. In large doses. Bryonia, 785. In bilious headache. Caffeine, 178, 742. Cajuput Oil, 730. Locally. Camphor, 862. Internally, and saturated so- lution externally. Cannabis Indica, 879, 880. In neuralgic head- ache. Chamomile, s09. Chloroform, Spirits of, 6S0. In nervous head- ache. Cimicifuga, 703. In nervous and rheumatic headache, especially at menstrual period. Croton Oil, 867. Digitalin, 850. B \j of a grain twice a day for congestive hemicrania. Ether Spray, 146, 219. Locally, for frontal headache after illness or fatigue. (in a ran a, 732. Heat, 305, 402. As hot water bag or poultice to nape of neck. Hydrastis, 705. In congestive headache with constipation, Ignatia, 821. In hysterical headaches. Iodide of Potassium, 518-520. In rheumatic headache, with tenderness of Bcalp. Iris, 902. In supra-orbital headache, with nausea. Magnesia Sulphate, 560. For frontal head- ache with constipation. Menthol, 194. As local application. M. rcury, 585. [n bilious headache. Mustard, 805,890. As foot bath, or poultice to nape of Deck. Nitrite of Amyl, 666, 667. As inhalation when face pale. INDEX OF DISEASES AND REMEDIES. 995 Headache. Nitro-hydrochloric Acid, 481. For pain just above eyeballs without constipation, also for pain at back of neck. Nux Vomica, 821. Frequently repeated in nervous or bilious headache. Picrotoxine, 707. In periodical headache. Podophyllum, 704. When constipation. Potassium Cyanide, 506. As local applica- tion. Salicylate of Soda, 532. 3-gr. dose every half hour, exceedingly useful. Sanguinaria, 725. In gastric derangement. Skull-cap as prophylactic. Sodium Phosphate, 351, 529. As laxative in bilious headache. Spectacles. Where the headache depends on inequality of focal length or astigmatism. Tea, 742. Strong black or green, often re- lieves nervous headache quickly. Valerian, 805. In nervous and hysterical cases. Zinc Oxide, 569. Heartburn. Capsicum, 835. Nux Vomica, 294, 821. Very useful. Podophyllum, 703. Pulsatilla, 702. Heart, Dilated. Digitalis, 293, 295, 850. Iron, 633. Morphia, 713. Nitrite of Aniyl, 666, 667. Nitrite of Soda, 524. Nitro-glycerin, 668. Heart, Fatty. Arsenic, 608, 609. Belladonna, 839. Cimicifuga, 703. Cod-liver Oil, 226. Ergot, 300. Iron, 633. Strychnia, 822. Heart, Hypertrophied. Aconite, 701. To be used with care when valvular disease is present. Camphor, 292. In palpitation and dyspnoea. Digitalis, 293. In small doses. Ergot, 300. Lead Acetate, 597. In palpitation. Nitrite of Amy], 666. Veratrum Viride, 279, 281, 300. Heart, Palpitation of. Aconite, 300, 701. Internally. Belladonna, 839. Internally, useful in car- diac strain. Bromide of Potassium, 520-523. In fluttering heart. Camphor, 291, 292. Cimicifuga, 703. Digitalis, 294. Eucalyptus, 781. Hot Bath, 292. Hyoscyamus, 279, 840. In nervous palpita- tion. Milk Cure, 915. In gouty persons. Posture. Head hung forward, body bent, arms by the sides, and breath held for a few seconds. Senega, 326, 731. Valerian, 805. In nervous cases with dyspnoea. Veratria, 430, 895. As ointment to chest. Heart, Valvular Disease of. Aconite, 300, 699, 701. To quiet action ; to be used with caution. Digitalis, 293-297. In mitral disease, to be avoided in purely aortic disease, but useful when this is complicated with mitral. Morphia, 713, 714. To relieve pain and dyspnoea. Nitrites, 293. To lessen vascular tension. Purgatives, 338. To lessen tension and re- move fluid. Strychnia, 294, 822. As cardiac tonic. Hectic. Anti pyrin, 695. Calumba, 706. Digitalis, 850. Gelsemium, 827. Ipecacuanha, 802. Iron, 634. Especially mistura ferri com- posita. Lime Phosphate, 553. Prunus Virginiana, 777. To lessen cough. Salicin, 873. To lessen perspiration. Salicylate of Soda, 532. Strychnia, 294, 822. To lessen night sweats. Hemeralopia. Blisters, 303, 305. Small, to external canthus of the eye. Electricity. Mercury, 585. Locally. Quinine, 799-801. In large doses internally. Hepatitis. Ammonium Chloride, 540. Bryonia, 785. Chelidonium, 726. Iodine, 472. As enemata. Leeches, 927. Nitro-hydrochloric Acid, 481. Tartar Emetic, 615, 616. With opium. Hernia. Chloral, 672. As enema. Chloroform, 680, 681. Coffee, 804. Ether Spray, 146. Opium, 722. Herpes Zoster. Aconite and Opium, 183, 701, 722. Locally. Alcohol, 655. Locally. Celandine, 726. Dulcamara, 834. Galvanism. Morphia, 712, 713. Bhus Toxicodendron, 304, 755. Silver Nitrate, 575. Strong solution locally. Veratria, 895. As ointment. Hiccough. Amber, Oil of, 884. Belladonna, 839. Bismuth, 621. Camphor, 864. Cannabis Indica, 879, 880. Chloral, 672. Chloroform, 680, 681. Ether, 215, 660-663. Iodoform, 681. Jaborandi, 749. Laurel Water. Morphia, 713, 714. Hypodermicallv. Musk, 914. Mustard and Hot Water. Nux Vomica, 821. 996 INDEX OF DISEASES AND REMEDIES. Hiccough. Pepper, 330, 871. Pressure over Phrenic, Hyoid, or Epigas- trium. Quinine, 799-801. In full doses. Hydrocephalus, Acute. Blisters, 305. To the nape of the neck, useful. Bromide of Potassium, 178, 520. 523. Croton Oil, 867. Liniment. Elaterium, 784. Ergot, 911. Iodide of Potassium, 517, 518. Iodoform, 681. Dissolved in collodion, or as ointment to neck and head; along with small doses of calomel as enemata. Leeches, 927. Mercuric Chloride, 587. Small doses inter- nally. Tartar Emetic, 615. Ointment. Turpentine, 884. By mouth or as enema, at commencement. Hydrocephalus, Chronic. Blisters, 305. Cod-liver Oil, 921, 922. Iodide of Iron, 637. Iodide of Potassium, 517, 518. Iodine, 471. Mercury, 585. Hydrophobia. Actual Cautery, comhined with excision, is best. Acupuncture. To wound immediately. Belladonna, 839. Bromide of Potassium, 520-523. Chloroform, 680, 681. To control spasms. Excision of bitten part. Morphia, 713, 714. Permanganate of Potash, 515. As lotion to wound. Quinine, 801. Silver Nitrate, 575. To wound, no use, even though applied immediately. Hydrothorax. Blisters, 303, 304, 305. Broom, 758. Digitalis, 850. As diuretic. Elaterium, 784. Iodine, 471. Injections after tapping. Jaborandi, 749. Sanguinaria, 725, 726. Hypochondriasis. Alcohol, 698. As temporary stimulant. Arsenic, 60S, 009. In the aged. Asafoetida, 787. Bromide of Potassium, 520-523. Caffeine, 741-743. Cimicifuga, 703. In puerperal, and sperma- torrhoea, Creasote, 690, 091. Gold Chloride, 641. When giddiness and cerebral anaemia, 6 11. Byoscyamus, 840. In syphiliphobia. Ignatia, 821. Musk, 913, 914. Opium, 722 725. Small doses. Ox Gall, 916. Sumbul, 791. Hysteria. Aloes, 889, 892. In constipation. Ammonia, Aromatic Spirits of, 543. Amy] Nitrite, 666. Apomorphia, 713, 714. Arsenic, COM, 609. Hysteria. Asafoetida, 787. Atropia, 839. In hysterical aphonia. Belladonna, 839. Bromide of Camphor, 191. Bromide of Potassium, 520-523. Camphor, 864, In hysterical excitement. Cimicifuga, 703. In hysterical chorea. Cold Water. Poured over mouth to cut short attack. Electricity. To cut short attack. Ether, 660-663. Galbanum, 788. Internally, and as plaster to sacrum. Garlic, 889. To smell during the paroxysm. Ignatia, 821. Ipecacuanha, 802. As emetic. Iron, 633. Lupulin, 881. When sleepless. Musk, 913, 914. Opium, 722-724. In small doses. Pellitory, 807. For globus. Phosphorus, 361, 605. In hysterical paralysis. Santonin, 355. If worms present. Spiritus Etheris Nitrosi, 662. To relieve spasm. Tartar Emetic, 615, 617. Valerian, 805. Zinc, Valerianated, 571. Ichthyosis. Baths, 395 et seq. Cod-liver Oil, 922. Elm Bark Decoction, 878. Useful. Glycerin, 820, 821. Zinc Oxide, 569. Impetigo. Arsenic, 608, 609. Boracie Acid, 486 Calcium Chloride, 552. Cod-liver Oil, 921-923. Grape Cure. Gutta Percha, 816. Hydrocyanic Acid, 473, 490. To relieve itch- ing. Laurel Water. To relieve itching. Mercury, 585. Locally. Nitric Acid, 480. Internally. Oil of Cade. Potassium Chloride, 246. Quinine, 799-801. Sulphur, 464. Internally. Tannin, 877. Locally. Tar, 886. Zinc Ointment, 452. Impotence. Arseniate of Iron, 638. Cannabis Indica, 879. Cantharid.es, 925, 926. Cubebs, 871. Ergotine, 911. Hypodermically about dorsal vein of penis, when it empties too rapidly. Gold Chloride, 641. To prevent decline of sexual power. Nux Vomica, 821. Very useful. Phosphoric Acid, 483. Phosphorus, 361, 605. Sanguinaria, 725. Serpentaria, 865, 866. Zinc Phosphate, 572. Very useful. Inflammation. Aconite, 701. At the commencement of all inflammations, superficial or deep-seated; best given in small doses frequently re- peated until pulse and temperature are reduced. Alcohol, <;.">('>. As antipyretic and stimulant, especially useful in blood-poisoning. INDEX OF DISEASES AND EEMEDIES. 997 Inflammation. Antimony, 616. 10-15 m. of vini antimonii frequently repeated at commencement. Arnica, 811. Belladonna, 836. In gouty and rheumatic inflammation and cystitis. Bryonia, 785. In serous inflammations after heart or pulse lowered by aconite. Chloral, 672, 673. When temperature is high and much delirium. Cod-liver Oil, 922. In chronic inflamma- tions. Digitalis, 850. . Fomentations, 302. Ice, 302. Locally applied. Iodine, 470. Locally. Mercury, 585. In deep-seated inflammations, especially those of serous membranes and iritis, and in syphilitic cases. Opium, 723, 724. Exceedingly useful to check it at commencement, and relieve pain afterwards. Pack, 181. Poultices, 402. Pulsatilla, 702. In inflammation, when pur- ulent discharge from eyes, ears, and nose, and in epididymitis. Purgatives, 339 et seq. Quinine, 108, 799-802. In peritonitis and in acute inflammations along with morphia. Salicine, 873. Salicylate of Soda, 532. Most useful, espe- cially in rheumatic affections. Salicylic Acid, 693. Most valuable. Sulphides, 516, 555. To abort or to hasten maturation. Veratrum Viride, 893. Influenza. Ammonium Acetate, 554; with Nitrous or Chloric Ether, 373. Carbolic Acid, 688-691. As spray and gargle. Cimicifuga, 703. Opium, 183, 723, 724. With ipecacuanha, useful for cough. Potassium Nitrate, 513. Freely diluted, as lemonade. Quinine, 799-801. Useful, especially in later stages. Sanguinaria, 725. Sometimes very useful. Spiritus Etheris Nitrosi, 446. Sulphurous Acid, 477. By fumigation or in- halation. Turkish Baths, 404. Useful. Insomnia. Aconite, 701. 1 m. every quarter of an hour, when skin dry and harsh. Alcohol, 656. Sometimes very useful. Atropia, 836. With opium, tJo-too g r - atro- pia, to y± or % gr. morphia. Camphor, 863. Cannabis Indica, 181, 879. Alone, or with hyoscyamus. Chloral, 181, 673. Most useful alone, or with bromide of potassium ; the addition of a small quantity of opium to the chloral and bromide assists their action. Chloroform, 680, 681. Coffee, 804. Causes insomnia, but has been recommended in insomnia from deficient nervous power, or chronic alcoholism. Croton Chloral, 672. If heart weak. Digitalis, 850. When deficient tone of vaso- motor system. Ether, 660-663. In full dose. Gelseinium, 827. In simple wakefulness. Humulus, 880. A hop-pillow sometimes useful. Hyoscyamus, 181, 840. Alone, or with can- nabis indica, useful to combine with quinine. Ignatia, 821. In nervous irritability. Lupuline, 881. In aged people. Insomnia. Musk, 913, 914. In irritable and nervous cases. Opium, 181, 724. Most powerful hypnotic, given alone or in combination. Phosphorus, 605. In the aged. Potassium Bromide, 186. In full doses, alone or with other hypnotics. Sumbul, 195, 791. In nervous irritability and chronic alcoholism. Tartar Emetic, 615, 616. Along with opium, when there is a tendency to congestion of brain, which opium alone would increase. Warmth, 180. Internally and externally. Wet Compress, 180. Wet Pack, 180. Intercostal Neuralgia. Is very commonly connected with Leucorrhoea, q.v. {Vide also neuralgia.) Intermittent Fever. Ammonium Carbazotate, %-l gr. in pill. Ammonium Chloride, 540. Apiol. In mild cases, 15 grs. during an hour, in divided doses, four hours before the paroxysm. Arsenic, 608, 609. Exceedingly useful, espe- cially in irregular malaria. Atropia, 836. Subcutaneously, to arrest or cut short cold stage. Berberin, 706. In chronic cases. Brucine, 825. Camphor, 864. Taken before the fit to pre- vent it. Capsicum, 835. Along with quinine as adju- vant. Carbolic Acid, 689-691. Chloral Hydrate, 672. As antipyretic when fever high ; and. to check vomiting or con- vulsions in adults and children during malarious fevers. Chloroform, 681. To prevent or cut short cold stage. Cimicifuga, 703. In brow ague. Cinchonidine, 798, 799. Like cinchonine. Cinehonine, 108, 125. Useful and cheap. Cornus Florida, 793. A substitute for qui- nine. Eucalyptus Globulus, 781. During conva- lescence. Ferric Sulphate, 630. Ferrous Iodide, 470. Gelsemium, 827. Pushed until it produces dilated pupils or double vision. Grindelia Squarrosa, 813. In hypertrophied spleen. Hydrastis, 705. In obstinate cases. Iodine Tincture, 469, 518. To prevent recur- rence of ague. Ipecacuanha, 803. Most useful as emetic. Leptandra Virginica, 851. After disease is lessened, by quinine. Morphia, 713, 714. Along with quinine an adjuvant. Narcotin, 711. 2-5 gr. three times a day sometimes very useful. Nitric Acid, 480. In obstinate cases. Nitrite of Amy], 666. By inhalation to re- lieve or shorten cold stage.' Opium, 723. In full doses, to prevent chill. Pepper, 871. Along with quinine. Potassium Nitrate, 513. 10 gr. in brandy and water, or dry on the tongue to prevent fit. Quinine, 109, 800-802. As prophylactic to abort fit and to prevent recurrence; its action is aided by purgatives, emetics, and aromatics. Quinine B omohydrate, 797. Like quinine, and less liable to produce cinchonism. Salicin, 873. Sodium Chloride, 525. Tablespoonful in glass of hot water at a draught on empty stomach. 998 INDEX OF DISEASES AXD REMEDIES. Intermittent Fever. Sodium Hyposulphate, 531. In mild cases. Spider Web. As pill. Strychnine. Intertrigo. Bismuth, 622. Locally. Camphor, S63. Added to dusting powders to allav heat and itching. Carbolic Acid, 6SS-691. Fuller's Earth, 555. Lead Lotion, 595-597. Lime Water, 550. Soap, 307. Tannin, S75. Iritis. Atropia, 839. Belladonna, 839. Internally and locally. Duboisia, 198. Substitute for atropia. Mercury, 584. Most serviceable. Opium, 716. To lessen pain. Turpentine, 884. In rheumatic iritis. Irritability. Alkaline Waters. Bromide of Potassium, 521. Chloral, 183, 672. Colchicum, 899. With potash in large quan- tity of water when gouty. Ignatia, 821. In small doses. Laxatives, 339. In constipation. Strychnia, S25. In small doses. Jaundice. Alkaline Mineral Waters. In catarrh of duo- denum or bile ducts. Ammonium Chloride, 540. In scruple doses in jaundice from mental emotion. Ammonium Iodide, 545. When catarrh of bile ducts. Arsenic, 607, 608. In malarious cases. Benzoic Acid, 817. Calomel Purgative, 5S7. Followed by saline, often verv useful. Carlsbad Salts, 530. Very useful. Carlsbad Water, 530. Celandine, 726. Colchicum, S99. Dulcamara, 834. Enemata. Cold water, one or two litres once a day. Enonymine, 340, 351. Ether, 660-663. When due to gallstones. Hydrastis, 705. In cases of catarrhal ducts. Iridin, 340, 351. Magnesium Sulphate, 560. Manganese, 640. In malarious or catarrhal cases. Nitro-muriatic Acid, 377. Internally, and as local application over liver, or as "bath in catarrhal cases. Podophyllum, 704. In catarrhal conditions, verv useful. Potassium Chloride, 346. Potassium Sulphate, 618. As laxative. Quinine, 801. In malarious cases. Rhubarb, 851. Jaundice in children. Sanguinaria, 358. Sodium Phosphate, 851. Very useful in ca- tarrhal bile ducts. Btillingia, 858, 867. After ague. Lactation, Defective. Castor-oil Leaves, Jaborandl 749. Mustard Poultice, 390. Vanilli Lactation, Excessive. Belladonna, 839. Internallv andlocallv. Camphor and Glycerin, 820* 863. Chloral, 673. Coffee, 804. Hemp-seed Oil, 879. Iodide of Potassium, 519. Laryngismus Stridulus. Aconite, 701. Belladonna, 839. Bromides. Very useful in large doses. Chloral, 673. Chloroform, 680, 6S1. As inhalation to stop spasm. Cold Sponging, 363. Conia, 786. Pushed until physiological action observed. Emetics, 323. Ipecacuanha, 804. As emetic. Morphia, 713, 715. Hypodermicallv. Quinine, 801. Laryngitis, Acute. Acetic Acid, 481. As inhalation. Aconite, 701. Benzoin, S17. As inhalation. Iodine, 471. As inhalation and counter-irri- tant over neck. Leeches, 363, 927. To larynx, or nape of neck. Morphia, 713, 715. Quinine, 801. Scarification of Larynx. Silver Xitrate, 575. As spray. Sulphurous Acid, 477. As inhalation or spray. Zinc Sulphate, 570. As emetic. Laryngitis, Chronic. Alum, 555-557. As gargle. Ammonium Chloride, 540. As spray. Bismuth, 622. Locally by insufflation. Carbolic Acid, 789-791. As spray. Ferric Chloride, 308, 309. As spray, or brushed on interior of larynx. Guaiacum, 745. As lozenges or mixture. Iodine, 471. As counter-irritant. Morphia, 713, 715. Mixed with bismuth or starch as insufflation, most useful when much irritation, as in laryngeal phthisis. Silver Nitrate, 575. As solution to interior of larynx. Sulphurous Acid, 477. As fumigation, inha- lation, or spray. Tannin, 309. As gargle or spray. Uranium Nitrate. As spray. Leucorrhcea. Alum, 555, 557. As injection. Balsam of Peru, 759. Internally. Balsam of Tolu, 760. Internally. Belladonna, 839. As pessary, for over-secre- tion, and pain. Bismuth, 621. As injection or pessary. Borax, 529. As injection. Carbolic Acid, 789-791. As injection. Cimicifuga, 703. Copaiba, 769. ( '■ >pper Sulphate, 573. As injection. Ergot, 911. Glycerin, 820. Hydrastis, 705. Locally. Iodoform, 682. As local application, alone, or mixed with tannic acid. Iron, 634. Internally. Myrrh, 756. Internally. Phosphate of Lime, 654. Internally. Potassium Bicarbonate, 510. Dilute solution as injection. Potassium, Permanganate of, 515. Sumbul, 791. Tannin, 809. As injection or suppository. INDEX OF DISEASES AND REMEDIES. 999 Lichen. Arsenic, 608, 609. Mercury, 585. Locally. Silver Nitrate Solution, 575. Locally. Sulphides. Sulphur, 461. Tar Ointment, 886. Thymol, 854. Locomotor Ataxia. Belladonna, 760. Cannabis Indica, 879. Electricity. Ergot, 911. Hyoscyamus, 840. Nitro-muriatic Acid, 377. Phosphorus, 605. Physostigma, 761-765. Potassium Iodide, 517. For syphilitic taint. Silver Nitrate, 575. Strychnia, 825. Lumbago. Aconite, 700, 701. Small doses internally, and liniment locally. Acupuncture. Aquapuncture. Sometimes very useful. Capsicum, 835. Locally. Chloroform, 675, 819. Liniment. Cimicifuga, 703. Sometimes very useful internally. Carbolic Acid, 789-791. Hypodermically. Cautery. Ether Spray, 146, 660. Eucalyptus Oil, 781. As liniment. Guarana, 732. In large doses. Hot Douche, 401, 402. Or hot poultice. Ice, rubbed over back. Iodide, Potassium, 517. Morphia, 713, 715. Hypodermically. Quinine, 801. Rhus Toxicodendron, 755. Turpentine, S83. Internally and locally. Lupus. Arsenic, 608, 609. Carbolic Acid, 789-791. Cautery. Chalmugra Oil. Chromic Acid, 486. Creasote, 691. Iodide of Potassium, 470. Iodide of Starch. Iodide of Sulphur, 470. Externally. Iodine, 471, 820. In glycerine. Iodoform, 682. Lead Lotion, 595, 597. Mercury, 584. Internally and locally. Phosphorus, 605. Pyrogallic Acid. Salicylate of Soda, 532. Silver Nitrate, 575. Sodium Acetate, 322, 502. Sodium Ethylate. Zinc Chloride, 570. Mania. Belladonna, 839. Useful. Bromide of Potassium, 520, 522. Camphor, 864. Cannabis Indica, 879. Chloral, 673. As narcotic and carminative. Conia, 787. Alone, or with morphia. Croton Oil, 339, 868. As purgative. Daturin, 280. Digitalis, 850. In acute and chronic mania, especially when complicated with general paralysis and epilepsy. Duboisia, 198. As calmative. Mania. Ergot, 911. In recurrent mania. Ether, 660. In maniacal paroxysms. Galvanism, to head and cervical sympathetic. Gelsemium, 827. With much motor excite- ment and wakefulness. Hyoscyamus, 841. In hallucinations and hypochondriasis. Iron, 634. Opium, 723. Alone or with tartar emetic. Physostigma, 761-765. Stramonium, 183, 842. Veratrum Viride, 894. Wet Pack, 181, 401. Mastitis. Ammonium Chloride, 539. As lotion, locally. Belladonna, 839. Locally as liniment or oint- ment. Calcium Sulphide, 554. Internally, if abscess is forming. Digitalis, Infusion, 850. Locally as fomenta- tion. Friction, with oil. Hyoscyamus, 841. As plaster to relieve pain- ful distention from milk. Iodine, 471. Mercury and Morphia Oleate, 585. Locally, in mammary abscess. Phytolacca, 859. To arrest inflammation, local application. Plaster, 443. To support and compress mammee. Stramonium, 842. Fresh leaves as poultice. Tartar Emetic, 325. In small doses fre- quently repeated at commencement. Tobacco Leaves, 843. As poultice. Measles. Aconite, 701. Ammonium Acetate, 544. Ammonium Carbonate, 542. Antimony, 615, 616. Camphor, 864. Carbolic Acid, 6S8-691. Internally at com- mencement. Digitalis, 850. Ipecacuanha, 804. Mustard Bath, 403. When retrocession of rash. Potassium Bromide, 521, lessness. Potassium Chlorate, 513. Pulsatilla, 702. Quinine, 801. Veratrum Viride, 893. 522. When sleep- In adynamic cases. Melancholia. Arsenic, 608, 609. In aged persons, along with opium. Bromide of Potassium, 520-522. Often very useful. Caffeine, 742. Cannabis Indica, 879. Chloral, 672. As hypnotic. Cimicifuga, 703, In puerperal or uterine despondency. Galvanism. Gold, 641. Ignatia, 821. Iron, 634. Opium, 722. In small doses especially useful. Valerian, 806. In hysterical and suicidal cases. Meniere's Disease. Quinine, 801. 1000 INDEX OF DISEASES AND REMEDIES. Meningitis, Cerebral. Aconite, 701. Belladonna, 839. Blisters, 305. To nape of neck. Bromide of Potassium, 520-522. In convul- sions consequent on meningitis. Bryonia, 785. When effusion. Cold. To head. Gelsemium, 827. Hyoscyamus, 841. Iodide of Potassium, 520. Mercury, 585. As ointment, or internally. Opium, 722. In small doses, alone or with tartar emetic. Pulsatilla, 702. In acute cases. Purgatives, 338, 587. At commencement; calomel and jalap most useful. Venesection, 363. When much excitement. Meningitis, Cerebro-Spinal. Aconite, 701. Along with opium. Antimony, 615, 616. Alone, or with opium. Belladonna, 839. Cautery, 309. Freely to back. Cold. To spine. Digitalis, 850. In early stage. Ergot, 911. Useful. Gelsemium, 827. Useful. Opium, 723. Very useful in large doses. Quinine, 801. At commencement, large doses. Turpentine, 883. As enema. Venesection, 363. Menorrhagia. Aloes, 892. As adjuvant to iron. Ammonium Chloride, 539. For headaches. Arsenic, 608, 609. With iron. Bromide of Potassium, 520, 522. Calcium Phosphate, 553. In angemia. Cannabis Indica, 879. Sometimes very use- ful. Cimicifuga, 703. Cinnamon, Oil of, 861. Digitalis, 850. Sometimes useful. Ergot, 911. Most useful. Gallic Acid, 877. Very useful. Hamamelis, 873. Useful. Hot Water Bag. To dorsal and lumbar vertebrae. Ipecacuanha, 804. In emetic doses in even- ing, followed by acidulated draught in morning. Iron, 634. Magnesium Sulphate, 560. Sometimes useful. Quinine, 801. Rue, 747. Savine, 887. Senega, 730. Sulphuric Acid, 477. When due to fibroid or polypus. Mentac-ra. Arsenic, 608, 609. Canada Balsam, 882. Carbolic Acid, 688-691. Cod-liver Oil, 922. Copper, 572. Locally as lotion. Iodide of Sulphur, 470. Mercurv, 584. Oil of Turpentine, 888. Oleate, Bichloride, or Nitrate of Mercury, 589. As ointment or lotion. Petroleum, 647. Sulphurous Acid, '177. With glycerin. Metritis, Acute. Metritis, Acute. Aconite, 701. Hot Water. Vagina] for a length of time. Leeches, 925. injection frequently Opium, 723. As suppository or enema. Poultices, 402. Turpentine Stupes, 883. Milk Deficiency. Gossypium. Decoction of seeds, two or three times every hour. Ricinus, 868. Poultices or infusion of leaves to the mammae. Muscle Yolitantes. Blue Pill, 585. In biliousness. Iodide of Potassium, 518. Iron, 633. Perchloride in antenna and cli- macteric. Valerian, 805, 806. Myalgia. Ammonium Chloride, 540. Arnica, 811. Internally and locally. Belladonna Liniment, 839. Locally. Belladonna Plaster, 819. Chloroform Liniment, 680. With friction. Cimicifuga, 703. Friction, 305, 405. _ Gelsemium, 827. .Large Doses. Iodine, 471. Iodide of Potassium, 520. In rhuematic Opium, 722. Packing, 181, 398. Salicylate of Soda, 693. Veratria, 897. Externally. Xanthoxylum, 748. Internally and exter- nally. Myelitis. Belladonna, 839. Electricity. In chronic cases. Ergot, 911. Phosphorus, 605. In paraplegia from ex- cessive venery. Silver Nitrate, 575. Useful. N^ivus. Chromic Acid, 486. Creasote, 691. Electrolysis. Ferric Chloride, 305, 310. Galvano Cautery. Nitric Acid, 4S1. Zinc Chloride, 570. Nails, Ingrowing. Glycerin, 820. Lead Carbonate, 597. Locally. Liquor Potass;e, 509. Silver Nitrate, 575. Nausea. Bismuth, 621. Calumba, 706. Cinnamon, 861. Cloves, 778. Hydrocyanic Acid, 493. ice, 225. Ipecacuanha, 804. In sickness of pregnancy and chronic alcoholism; very small dose, 1 m. of wine. Morphia, 712. Nutmeg, 860. Pepper, 871. Peppermint, 853, Pimento, 779. Pulsatilla, 702. In gastric catarrh. INDEX OF DISEASES AND KEMEDIES. 1001 Nephritis, Acute. Aconite, 698, 701. At commencement. Belladonna, 839. Cannabis Indica, 879, As diuretic, especially in hseinaturia. Cantharides, 925. 1 m. of tincture every three hours to stop h hematuria after acute symptoms have subsided. Digitalis, 850. As diuretic. Eucalyptus, 781. Given cautiously. Gallic Acid, 877. Hyoscyamus, 841. Jaborandi, 749. Juniper, 887. Poultices, 402. Over loins, very useful. Turpentine, 883. 34-1 m. doses, every two to four hours. Nervousness. Aconite, 698, 701. 1 m. of tincture at bed- time for restlessness and fidgets. Bromide of Potassium, 520-523. Over-work and worry. Caffeine, 743. Where much debility. Camphor, 863. Chamomile, 809. Chloral, 673. Chloroform, 680, 681. Hops, 880. Internally and as pillow. Ignatia, 821. Musk, 914. In uterine derangement. Strychnine, 825. Where wandering. Sumbul, 791. In pregnancy, and alter acute illness. Neuralgia. Aconitia, 698. As ointment. Acupuncture. Alcohol, 655. Ammonium Chloride, 540. 3^-dr. doses. Ammonium Valerianate, 545. Amyl Nitrite, 666. Aquapuneture. Atropine, 839. As liniment, or hypodermi- cally near the nerve. Belladonna, 839. Bebeeru Bark, 865. Blisters, 305. Bromide of Potassium, 521 , 522. Caffeine, 743. Cannabis Indica, 879. Capsicum, 835. Locally. Carbonic Acid, 487. Locally, for uterine neuralgia. Chalmugra Oil. Chamomile, 809. Chelidonium, 726. Chloral and Camphor, 672, 863. Equal parts locally applied. Chlorate of Potash, 504. In facial neuralgia. Chloroform, 680, 681. Locally and by inha- lation, when pain very severe. Cimieifuga, 703. In neuralgia of fifth nerve, and ovarian neuralgia. Cod-liver Oil, 921. Croton Chloral, 279, 673. For neuralgia of the fifth nerve. Digitalis, 850. Electricity. Ergot, 911. In visceral neuralgia. Gelsemium, 827. Ignatia, 821. In hysterical cases and in in- tercostal neuralgia. Iodides, 520. Especially when nocturnal. Iodoform, 681. Iron, 633. Morphia, 712. Hypodermically. Mustard Poultice, 390, 402. Narcein, 711. Nitro-glycerin, 668. Nux Vomica, 821. In visceral neuralgia. Peppermint, 853. Locally. Pulsatilla, 702. Pyrethrum, 807. As masticatory. Neuralgia. Quinine, 801. In periodical cases. Salicylic Acid, 692. Stavesacre, 701. Sumbul, 791. Sometimes very useful. Thermo-cautery. Valerian, 806. Valerianated Zinc, 571. Vibration, 185. Neuralgic Pains. Cold Sponging, 363. Friction, 305, 405. Along back or on limbs. Kubefacients, 304. Useful. Valerian, 805. Warm Sponging. Nightmare. Bromide of Potassium, 520-522. Camphor Water, 863. Nipples, Sore. Alcohol, 655. Locally. Arnica, 811. Balsam of Peru, 759. Balsam of Tolu, 760. Benzoin, 816. Borax, 528. Saturated solution locally. Carbolic Acid, 688-691. Collodion, 735. Ferrous Subsulphate, 630. Locally. Lead Salts, 595. Bhatany, 731. 1 part extract to 15 of cacao butter. Shield. Silver Nitrate, 575. Sulphurous Acid, 477. Tannin, Glycerin of, 877. Nodes. Mercury Oleate, 584. With morphia, locally. Potassium Iodide, 520. Internally and exter- nally. Stramonium Leaves, 842. As poultice. Nyctalopia. Blisters, 302, 308, 305. Small, to external canthus. Quinine, 801. Strychnine, 825. Nymphomania. Bromide of Potassium, 384, 520-522. In large doses. Camphor, 862. In large doses. Lupuline, 881. Sulphur, 463. When due to haemorrhoids. Sulphuric Acid. Internally. Tobacco, 336. So as to cause nausea, effectual, ' _ but depressing. Obesity. Alkaline Waters. Especially those of Ma- rienbad. Ammonium Bromide, 544. Banting's System— living on meat and green vegetables, and avoiding starch, sugars, and fats. Potassium Permanganate, 515. Sulphurous Waters, 477. Vinegar, 483. Very injurious. Onychia. Carbolic Acid, 186, 688-691. As local anses- thetic. Chloral, 183, 184, 672. Locally. Iodoform, 681. Locally. Lead Nitrate, 599. 1002 INDEX OF DISEASES AND REMEDIES. Onychia. Mercury, 584. As ointment, alternately with poultices. Silver Nitrate, 575 At commencement. Tartar Emetic, 616, 617. Otitis, vide Earache. Ophthalmia, vide Conjuncti- vitis. Orchitis, vide Epididymitis. Otorrhcea. Alcohol, 655. Alum, 555-557. Insufflation. Boracic Acid, 486. Cadmium, 308. Locally. Carbolic Acid, 688-691. Chloral, 672. Iodide, 545. 2 grs. to an ounce, locally. Iodoform, 681. Lead Acetate, 597. Liquor Sodse, 440. Locally, when discharge is foetid. Mercury Ointment ,and Nitrate, 584. Permanganate of Potassium, 515. As injec- tion or spray. Quinine, 801. Silver Nitrate, 575. Locally. TanDin, Glycerin of, 875. Very useful. Zinc Sulphate, 570. OXALURIA. Nitro-muriatic Acid, 377. Oz,ENA. Alum, 556. As powder or wash. Bromine, 469. As inhalation. Carbolic Acid, 688-691. Chlorinated Lime, 468. Injections of the solutions of. Gold Salts, 640. Hydrastis, 705. Internally and locally. Iodine, 471. As inhalation. Much benefit derived from washing out the nose with a solution of common salt, to which a few drops of the tincture of iodine have been added. Iodoform, 681. Mercuric Oxide, or Ammoniated Mercury, 590. Potassium Permanganate, 515. Tannin, Glycerin of, 875. Parotitis. Aconite, 701. Emetics, 323. Jaborandi, 749. Mercury, 584. % gr. of gray powder three or four times a day. Poultice, 402. Pediculi. Anise, 789. Bake Clothes. To destroy ova. Cocculua [ndicus, 70o. Mercury, 58 I As ointment or wash. Pyrethrum, 807. Staresacre, 701. Pemphigus. Arsenic, 60*. 609. Chlorate of Potash, 513. Cod-liver Oil, 922. Iodide of Potassium, 520. Pemphigus. Mercury, 584. Phosphorus, 605. Silver Nitrate, 575, Sulphides, 515, 556. Tar, 886. Pericarditis. Aconite, 300, 701. Alcohol, 304, 655. Sometimes verv useful. Blisters, 303, 305. Near heart very useful. Bryonia, 785. Useful in exudation. Calomel and Opium. Formerly much used. Digitalis, 850. When heart is rapid and feeble with cyanosis and dropsy. Opium, 723. In grain doses every three to six hours, very useful. Quinine, 801. Veratrum Viride, 300, 893. Periostitis. Iodide of Potassium, or Ammonium, 520, 544. Iodine, 471. Locally. Mercury, 584. Internally. Mercury and Morphia Oleate, 589. Exter- nally. Mezereum, 304. In rheumatic and scrofulous cases. Poultices, 402. Stavesacre, 701. "When long bones affected. Peritonitis. Aconite, 701. At commencement. Bryonia, 785. When exudation. Cocculus Indicus, 706. For tympanites. Iron, 634. To abdomen. Leeches, 927. Mercury, 584. When there is a tendency to fibrous exudation. Opium, 724. Freely, most useful. Poultices, 402. Quinine, 801. Steam. Applied to the abdomen under a cloth when poultices cannot be borne. Turpentine, 226, 8S4. For tympanites. Perspiration. Agaric. In phthisis. Aromatic Sulphuric Acid, 47S. In phthisis. Atropia, 839. In sweating of phthisis, inter- nally. Belladonna, 836. As liniment for local sweats. Carbolic Acid, 688-691. With glycerin, locally, for foetid sweat. Ergot, 911. Gallic Acid, 877. In phthisis. Jaborandi, 749. Neat's Foot Oil. Rubbed over the surface. Opium, 286, 293, 364. As Dover's powder in phthisis. Permanganate of Potash, 515. Locally for foetid perspiration. Quinine, 801. Salicin, 873. In phthisis. Salicylic Acid, 693. With borax in foetid perspiration. Sponging. Very hot. Strychnine, 825. In phthisis. Vinegar, 483. Locally. Zinc Oxide, 596. In phthisis. Pertussis. Aconite, 701. Alum, 555-557. Belladonna, 836. Bromide of Ammonium, 5 1 1. Bromide of Potassium, 520-522. Carbolic Acid, 688. As spray. ( lastanea Vesca, 878. Cerium Oxalate, 558. INDEX OF DISEASES AND REMEDIES. 1003 Pertussis. Cheken,779. Chloral 672. In spasmodic stage. Chloroform, 680. As inhalation during paroxysm. Cod-liver Oil, 226, 922. Coffee, 804. Croton Chloral, 279. Decoction of Chestnut Leaves, ad. lib., 878. Sometimes useful. Ergot, 911. Gelsemium, 827. In spasmodic stage. Hydrocyanic Acid, 493. In habitual cough when the true whooping-cough has ceased. Ipecacuanha, 804. Sometimes very useful alone, or combined with bromide of ammo- nium. Lobelia, 814. In spasmodic stage. Monobromide of Camphor, 281. Opium, 723. In convulsive conditions. Salicylic Acid, 693. As spray. Silver Nitrate, 575. Tannin, 877. Tar, 886. For inhalation. Tartar Emetic, 616. Valerian, 805. Zinc Sulphate, 570. Pharyngitis. Aconite, 701. Alcohol, 655. Dilute as gargle. Alum, 556. As gargle. Belladonna, 836. Capsicum, 835. As gargle. Cimicifuga, 703. Internally when pharynx dry. Copper Sulphate, 326, 573. Locally. Cubebs Powder, 872. Locally applied. Ferric Chloride, 308, 309. Locally as astrin- gent, internally as tonic. Glycerin, 820. Locally, alone, or as glycerin and tanin. Hydrastis, 705. Internally and locally. Ipecacuanha, 803. As spray. Pomegranate Bark, 782. As gargle. Potassium Chlorate, 514. Locally. Quinine, 801. As tonic. Silver Nitrate, 575. In solution locally. Strychnine, 825. As tonic. Tannin, 877. As powder or glycerine, locally. Zinc Sulphate, 570. As gargle. Phimosis. Belladonna, 836. Locally. Lupulin, 881. After operation. Phlebitis. Hamamelis, 873. Hot Fomentations. Opium, 723. To allay pain. Rest. Absolute. Phlegmasia Alba. Ammonium Carbonate, 543. In full doses, when much prostration. Belladonna Extract, 836. With mercurial ointment locally. Blisters, 303, 305. In early stage. Creasote, 691. As enemata. Hamamelis, 873. Hydrochloric Acid, 479, 513. With potassic chlorate, in barley water. Leeches. 927. During active inflammation. Opium, 723. Internally and locally to allay pain. Photophobia. Belladonna, 839, 840. To eye. Bromide of Potassium, 521. Photophobia. Calabar Bean, 198. Chloroform Vapor, 185, 680, 681. Cold. Conia, 787. In scrofulous photophobia, locally. Croton Chloral, 672. Mercuric Chloride, 395. By insufflation. Potassium Chloride, 588. In large doses. Tonga. Phthisis. Alcohol, 655. Along with food or cod-liver oil, 226, 922. Antipyrin, 695. To reduce temperature. Arsenic, 609. To remove commencing con- solidation, and also when tongue is red and irritable. Atropia, 223, 839. To check perspiration. Belladonna, 839. Locally for pain in muscles. Benzoin, 816. As inhalation to lessen cough and expectoration. Blisters, 305. Chloral, 181. As hypnotic. Chloroform as Linctus, 680, 681. To check cough. Coca'ine, 733. Solution 4-20 per cent, locally to tbroat and mouth to relieve irritation, soreness and aphthae, especially in the latter stages. Cod-liver Oil, 921, 922. Most useful as nu- trient. Creasote, 691. As inhalation. Croton Chloral, 279. To check cough. Croton Oil, 868. To chest as counter-irritant. Gelsemium, 827. Glycerin, 820. As nutrient in place of cod- liver oil, locally to mouth in the last stages to relieve dryness and pain. Hypophosphites, 355, 377, 640. Very useful in early stage. Inulin, 813. Possibly useful. Iodine Liniment, 472. As a counter-irritant to remove consolidation in early stage, and to remove pain and cough later ; as inhala- tion to lessen cough and expectoration. Iodoform, 683. As inhalation. Ipecacuanha, 804. As spray to the throat to relieve bronchial asthma and emphysema, combined with fibroid phthisis. Mercuric Chloride, 82. In minute doses for diarrhoea Morphia, with Starch or Bismuth, 713, 714. Locally to larynx, and in laryngeal phthisis most useful. Mustard Leaves, 305. Most useful to lessen pain and prevent spread of subacute inter- current inflammation. Opium, 722. To relieve cough, and, with ipecacuanha and Dover's powder, to check sweat, Oxygen, 457. Phosphate of Lime, 553. As nutrient, and to check diarrhoea. Picrotoxin, 708. To check perspiration. Pilocarpin, 379, 380, 397. To check sweats. Quinine, 801. As tonic to lessen temperature, to check swBUt Salicylic Acid, 693. When breath foul and expectoration offensive. Silver Nitrate, 575. Sulphurous Acid, 478. As fumigation. Pityriasis. Arsenic and Mercury, 585, 607. Internally. Borax, 353. Saturated solution or glycerin, locally. Carbolic Acid, 689, 690. With glycerin and water, locally. Chrysarobinum, 766. Lead, 595. Locally. Mercuric Ointment, 914. Locally. Sulphides, 516, 554. Locally. Sulphurous Acid, 477. 1004 IXDEX OF DISEASES AND REMEDIES. Pleurisy. Aconite, 701. In early stage. Antimony, 616. Belladonna Plaster, 839. Most useful to re- lieve pain in old adhesions. Blisters, 305. Bryonia, 785. After aconite. Cod-liver Oil, 226, 921, 922. Digitalis, 850. When much effusion. Iodide of Potassium, 519. To aid absorption. Iodine, 471. As a liniment externally, to assist absorption, or as a wash, or injection, to cavity after tapping. Leeches, 927. Local Wet Pack, 396. To chest. Pleurodynia. Belladonna, 839. Plaster or liniment very useful. Chloral, 672, 863. With camphor, locally. Croton Oil, 868. Locally in obstinate cases. Ether, 660. As spray, locally. Iodine, 470. Locally. Iron, 634. When pleurodynia associated with leucorrhcea. Mustard Leaves, 305. Opium, 709. Liniment rubbed in after warm fomentations or hypodermic injections. Opium, 722. Most useful to cut short attack and relieve pain. Plasters, 228. To relieve pain and give sup- port. Poultices, 402. Quinine, 801. Strapping, 597. Veratrum Viride, 894. • Wet Cupping, 366. When pain severe and fever high. Pleuro-Pneumonia. Byronia, 785. Carbolic Acid, 689, 690. 2 per cent, solution injected locally. Sanguinaria, 725. Turpentine, 883. Locally. Pneumonia. Aconite, 701. Very useful, especially at com- mencement. Ammonium Carbonate, 542. As stimulant. Belladonna, 839. At commencement. Blisters, 305. At beginning to lessen pain. Bryonia, 785. When pleurisy present. Copper Acetate, 574. Digitalis, 850. To reduce temperature. Iodide of Ammonium, 545. Phosphorus, 605. Poultices, 402, 404. To lessen pain. Quinine, 802. To lower temperature. Salicylate of Soda, 532. As antipyretic. Senega, 731. As expectorant. Serpentaria, 865. With carbonate of ammo- nia as stimulant. Turpentine, 883. As stimulant at crisis. Polypus. Alum. 566-558. As Insufflation. Tannin, 876. As insufflation. Prolapsus A.m. Alum, 557, 568. In solution locally. Bydrastis, Tor,. As enema or lotion. 38. When prolapsed parts inflamed. Pepper, 871. Confections. Podophyllum, 704 [n small d Strychnia. 826. As adjunct to laxatives, j annin, 801. As enemata. Prolapsus Uteri. Alum, 557, 558. As hip bath and vaginal douche. Cimicifuga, 703. To prevent miscarriage and prolapsus. Galls, 875. Decoction of, as injection. Ice, 328. Locally when part inflamed, and to spine. Oak Bark, 875. As injection. Tannin, 877. Prostate, Enlarged. Alkalies, 501. When irritation of the bladder with acid urine. Ammonium Benzoate, 545. For cystitis with alkaline urine. Ammonium Chloride, 540. Conium, 786. Ergot, 911. Iodine, 471. Apply to rectum. Iodoform, 682. As suppository very useful. Prostatitis. Blisters, 303-305. To perinseum in chronic cases. Buchu, 748. Cantharides, 926. Small doses of tincture. Cubebs, 871. Hot Injections. Hydrastis, 705. Internally and locally. Iron, 634. Silver Xitrate, 575. Locally. Turpentine, 883. Prurigo and Pruritus. Aconite, 701. Externally. Alum, 557, 558. A strong solution for pruri- tus vulvae. Arsenic, 608, 609. Internally. Atropine, 839. Balsam of Peru, 760. Boracic Acid, 486. Borax, 528. Saturated solution. Calomel, 5S8. Ointment very useful in pruri- tus ani. Carbolic Acid, 688-690. Internally and lo- cally, especially in prurigo senilis. Chloral, 672, and Camphor, 863. Chloroform Ointment, 680, 681. Cod-liver Oil, 922. As inunction. Corrosive Sublimate, 108. For pruritus vulva?. Cyanide Potassic, 506. As lotion or ointment to be used with care. Galvanism. Gelsemium, 827. Glycerin, 820. Glyeerole of Tar, 886. Hydrocyanic Acid, 493. Locally. Iodoform, 683. As ointment. Liquor Carbonis Detergens. Mercury, 585. Locally. Opium, 722. Oil of Cade. Petroleum Oil, 647. Pilocarpi n, 749. Potassium Carbonate, 508. Silver Nitrate, 575. Sodium ( larbonate, 526. Stavesacre, 702. Sulphate of Zinc, 570. Sulphides, 516, 554. Sulphites,."):;:}. Tar Ointment. Tobacco, 843. Useful but dangerous. Psoriasis. Aconite, 701. Akaline Bath, 103. Ammonium Carbonate, 542. Ammonium Chloride. INDEX OF DISEASES AND REMEDIES. 1005 Psoriasis. Arsenic, 607-609. Baths, 388 etseq. Berberine, 865. Bleeding, 363. Calomel, 588. Locally as ointment. Carbonic Acid, 487. Chromic Acid, 486. 10 grs. to the ounce in psoriasis of tongue. Chrvsophanic Acid, 765. Cod-liver Oil, 922. Copaiba, 769. Copper Sulphate, 573. Creasote Baths, 691. Cupric Sulphate, 573. Electricity. Constant current rapidly applied. Glycerin, 820. Hepar Sulphuris. India-rubber Solution. Iodine, 471. Iris, 902. Lead Iodide, 599. Locally. Mercury, 585. Locally as ointment. Mezereon, 304. Nitric, 480, and Nitro-hydrochloric, 481, Acids. When eruption is symptomatic of indigestion. Phosphorus, 605. As substitute for arsenic. Potassium Acetate, 510. Potassium Iodide, 518. Silver Nitrate, 575, In psoriasis of tongue. Sulphur Iodide, 470. Internally and exter- nally. Sulphur, 464. Internally. Tar, 886. As ointment. Thymol, 854. Ulnius, 878. Vaseline, 647. Ptosis. Arseniate of Soda, 612. Ergot, 911. Paregoric Acid, 710. Salicylic Acid, 693. Veratria, 897. Locally to the eyelids and temples. Zinc Chloride, 570. Ptyalism. Acids. In small doses internally and as gar- gles. Alcohol, 657. Dilute as gargle. Atropia, 839. Hypodermically. Belladonna, 183, 184, 839. Very useful. Calabar Bean, 198. Chlorate of Potash, 514. As gargle. Iodide of Potassium, 519. Iodine, 471. As gargle, 1 of tincture to 30 of water. Tannin, 876. Puerperal Convulsions. Aconite, 701. In small doses frequently. Belladonna, 839. Useful. Chloral, 672. In full doses. Chloroform, 680, 681. Dry Cupping over Loins. Ice, 328. To head. Morphia, 711, 712, Hypodermically very useful. Mustard, 304. To feet. Nitrite of Amyl, 666. Of doubtful utility. Veratrum Viride, 894. Pushed to nausea, very useful. Puerperal Fever. Aconite, 701. Useful at commencement. Alkaline Sulphate, 504. In early stages. Calumba, 449. As tincture. Opium, 723. For wakefulness and delirium, very useful. Puerperal Fever. Permanganate of Potash, 515. Quinine, 801. In large doses. Stramonium, 842. When cerebral excite- ment. Turpentine, 882. When much vascular de- pression and tympanites. Puerperal Mania. Aconite, 701. With much fever. Anaesthetics, 146. During paroxysm. Bromide of Potassium, 521, 522. Chloral, 672. Cimicifuga, 703. Useful in hypochondriasis. Hyoscyamus, 841. In mild cases. Iron, 634. In anaemia. Opium, 723. Poultices, 402. Quinine, 801. When much sickness. Stramonium, 842. When delirium furious but intermittent, or suicidal, or when im- pulse to destroy child. Tartar Emetic, 616, 617. Frequently re- peated. Puerperal Peritonitis. Aconite, 701. At commencement. Antimony, 616. Cimicifuga, 703. In rheumatic cases. Laxatives, 338. Useful combined with Do- ver's powder and hyoscyamus. Opium, 723. Very useful. Quinine, 801. In large doses. Turpentine, 882. As stimulant, 10 m. fre- quently repeated. Purpura. Alum, 557, 558. Locally with brandy. Ergot, 911. Very useful. Gallic Acid, 877. Iron, 634. Internally. Nitrate of Potash, 513. Nux Vomica, 821. Quinine, 801. Tannic Acid, 877. Turpentine, 882. Pyemia. Boracic Acid, 486. Oil of Cloves, 779. Locally. Permanganate of Potash, 515. Internally. Quinine, 801. In large doses. Salicin, 873. Salicylic Acid, 693. Turpentine, 882. As stimulant. Pyelonephritis. Eucalyptus, 781. Hydrastis, 705. Pyrosis. Bismuth, 622. Camphor, 863. Carbolic Acid, 689, 690. Creasote, 691. Gallic Acid, 877. Glycerin, 820. Manganese Oxide, 640. Mineral Acids. Nux Vomica, 821. Pulvis Kino Compositus, 710. Sulphur Oxide and Nitrate, 463. Sulphuric Acid, 477. Relapsing Fever. Laxatives, 338. Leeches, 927. As cupping for headache. Quinine, 801. 1006 INDEX OF DISEASES AND EEMEDIES. Remittent Fever. Aconite, 701. Emetics, 327. Gelsemium, 827. In bilious remittents. Morphia, 711. Hypodermically. Packing, 181. Useful. Quinine, 801. 20-30 grs. for a dose, once or twice daily. Renal Calculi, vide Calculi. Alkaline Waters. Ammonium Benzoate, 515. Chalybeates. Wild un gen Water. Rheumatic Arthritis. Aconite, 701. Locally. Arnica, 812. Internally and externally. Arsenic, 608, 609. Cimicifuga, 703. When pains and nocturnal. Cod-liver Oil, 358, 922. Colchicum, 899. Guaiacum, 745. Iodine, 465. Internally as tonic. Lithium, 535. Internally and locally. Potassium Bromide, 521, 522. Sometimes re- lieves pain. Sulphur, 464. Turkish Bath, 405. Rheumatism, Acute. Aconite, 701. Alkalies, 501. Ammonium Bromide, 544. Arnica, 812. Blisters, 305, 363. Very efficient around joints near to the cardiac region. Bryonia, 785. Cimicifuga, 703. Colchicum, 899. Cold Baths, 396. Digitalis, 850. Dulcamara, 834. In persons liable to catarrh. Iron, 634. Lime Juice, 740. Lithium Bromide, 536. Especially when in- somnia and delirium present. Opium, 723. One gr. every 2 or 3 hours, es- pecially when cardiac inflammation. Permanganate of Potash, 515. Quinine, 109, 801. As antipyretic. Rhus Toxicodendron, 755. Exceedingly use- ful in after stage and subacute forms. Salicin, 873. Salicylate of Soda, 532. Relieves pain most quickly. Sulphurous Acid, 478. Fumigation. Trimethylaniine. Veratrum Viride, 894. Rheumatism, Chronic. Aconite, 701. Arnica, 812. Belladonna, 839. Bryonia, 786. Burgundy Pitch, 886. As plaster locally. Cajupul Oil, 780. internally and externally. Chimaphila, 815. < imicifuga, 708. Cod-liver Oil, 358, 921. Internally and exter- nally. Colchicum, 899. Dulcamara, 885. i .uaiiic, 710. [odide of Potassium, 519. Especially when pain worse at night. Iodine, 171, ~>V->. Locally. Lithium Bromide, 586. When smaller joints affected. Lupulin, 881. Rheumatism, Chronic. Mercury and Morphia, 584, 713. Oleate lo- cally. Mezereon, 305. Phytolacca, 850. Quinine, 801. When much debility and night sweats. Rhus Toxicodendron, 755. Internally and locally. Sulphur, 463. Locally and as sulphides or sulphur waters internally. Thuja Occidentalis, 886. Turkish Baths, 404. Xanthoxylum, 748. Rickets. Calcium Phosphate, 453. If child is sucking it may be given to nurse. Cod-liver Oil, 358, 921. Cold Sponging, 364. Ferric Iodide, 470. Nitro-hydrochloric Baths, 403. Quinine, 801. Sarcin^e. Carbolic Acid, 689. Creasote, 691. Gastric Syphon. To wash out stomach. Sulphitis. Sulphuric Acid, 477, Scabies. Anise, 789. As ointment. Arsenic, 608, 609. Baking of clothes. To destroy ova. Balsam of Peru, 769, 770. Locally, agreeable and effective. Benzoic Acid, 817. As ointment or lotion. Carbolic Acid, 689. Dangerous. Coal Tar Naphtha, 699. Cocculus Indicus, 706. As ointment. Copaiba, 768. Copper Sulphate, 573. Hog's Lard, 918. Kaniala, 869. As ointment. Mercury, 585. White precipitate ointment. Oil, 818. Inunction. Petroleum, 647. Soft Soap, 819. Stavesacre, 702. As ointment. Storax, 874. With almond oil, when skin cannot bear sulphur. Sulphide of Calcium, 554. Sulphur, 461. As ointment. Sulphuric Acid, 477. Internally as adjuvant. Sulphurous Acid, 477. Tar, 886. Ointment. Vaseline, 647. Scarlet Fever. Aconite, 701. Arsenic, 608, 609. If tongue remains red and irritable during convalescence. Belladonna, 839. Carbolic Acid, 690. As gargle. Carbonate of Ammonium, 542. Greatly recom- mended in frequent doses given in milk or cinnamon water. Chlorine Water, 468. As gargle. Cold Compress to throat, 405. Cold Affusion, 396. Digitalis, 850. Fat. As inunction to hands and feet during the rash, and over the whole body during desquamation. Ferric Perchloride, 633. In advanced stage with albuminuria and hematuria, very useful. Ice, 328. To suck, especially at commence- ment. Juniper Oil, 887. As diuretic when dropsy occurs. INDEX OF DISEASES AND KEMEDIES. 1007 Scarlet Fever. Mercury, 585. ^ of a gr. of gray powder every hour to lessen inflammation of tonsils. Mineral Acids, 476. Internally and as gargle. Mustard Bath, 403. When rash recedes. Packing, 396. Useful and comforting. Potassium Permanganate, 515. As gargle to throat. Purgatives, 338. More useful to prevent al- buminuria. Ehus Toxicodendron, 755. Salicylate of Soda, 532. As antipyretic. Salicylic Acid, 693. Strychnine, 825, Hypodermically in para- lysis. Sulphurous Acid, 477. Inhalation when throat much affected. Veratrum 7iride, 893. Sciatica. Aconite, 698. As ointment or liniment. Acupuncture. Aquapuncture. Atropia, 839. Belladonna, 839. Blisters, 302-305. Cautery. Exceedingly useful, slight applica- tion of Paquelin's therm o-cautery. Chloride of Ammonium, 451. Chloroform, 328, 680. Locally as liniment, in- halation when pain excessive. Croton Oil, 868. Internally as purgative. Electricity. Ether, 146, 661. As spray. Iodide of Potassium, 519. Morphia, 714. Hypodermically most useful. Poultices, 402. Stramonium, 842. Internally pushed until physiological action appears. Sulphur, 463. Tied on with flannel over painful spot. Turkish Bath, 404. Turpentine, 882. In }4-oz. doses internally for 3 or 4 nights successively. Veratria, 895, 896. As ointment ' Scrofula. Blisters, 305. To enlarged glands. Calcium Phosphate, 552. Chloride of Calcium, 552. Cod-liver Oil, 358, 922. Exceedingly ser- viceable. Iodides, 519. Iodide of Iron, 637. Iodine, 476, 471. Locally to glands and in- ternally. Sulphides, 516, 554. Scurvy. Acids, 485. As preventive in the absence of lime juice. Aconite, 701. In acute stomacace with saliva- tion in scorbutic conditions. Alcohol, 653. Diluted as gargle. Alum, 556. Locally with myrrh for ulcerated gums. Ammonium Carbonate, 542. In scorfcmtic diathesis. Arsenic, 607, 608. In some scorbutic symp- toms. Atropia, 839. Hypodermically when saliva- tion. Cinchona, 801, 8C2. As decoction, or diluted with myrrh as gargle. Citric Acid, 485. As substitute for lime juice. Lemon Juice, exceedingly useful as preven- tive and curative. Liberal Diet. -Often sufficient. Liquor Sodse Chlorinatse, 440. Locally to gums. Scurvy. Oranges. Useful. Quinia, 801. With mineral acids internally. Silver Nitrate, 606. Tartar Emetic, 616, 617. Vegetable Charcoal, 459. As tooth-powder to remove foetid odor. Vinegar, 483. Substitute for lime juice. Sea- Sickness. Apomorphia, 713, 714. Arsenic, 608, 609. Atropia, 839. Hypodermically in epigastrium. Bromide of Potassium, 521. Very useful in large doses. Bromide of Sodium, 531. Calumba, 706. Cannabis Indica, 879. Capsicum, 835. Champagne, Iced. Chloral, 672. 15 to 30 grs. every four hour* most useful. Chloral Hydrate, 673. Chloric Ether, 662. Chloroform, 680. Pure, 2-5 ms. on sugar. Creasote, 691. Ice, 328. To spine. Magnetic Belt. Morphia, 714. Hypodermically. Nitrite of Amyl, 666. Inhalation. Nitro-glycerine, 668. Nux Vomica, 821. When indigestion, with constipation. Petroleum, 647. Quinine, 801. Seborrhea. Borax, 528, with Glycerin, 820, and Lead Ace- tate, 597. Glycerin, 820. Iodine, 471. Lead Acetate. With borax and glycerine, as above. Phosphorus, 605. Sodic Chloride, 524. Zinc Oxide, 596. Sneezing. Arsenic, 608. In paroxysmal sneeziDg. Belladonna, 839. Chamomile Flower, 809. In nares. Camphor, 863. As powder, Cotton Plug. In nares. Gelsemium, 827. In excessive morning sneez- ings with discharge. Iodine, 471. Inhalation. Mercury, 585. Heaviness of head and pain in limbs. Potassic Iodide, 519. 10-gr. doses frequently repeated. Pressure beneath nose, 220. Somnambulism. Opium, 722. Potassic Bromide, 521. Spasmodic Affections. Aconite, 839. Externally and internally. Ammonia, 543. Amyl Nitrite, 666. Arnica, 811. Belladonna, 839. Camphor, 863. Cardamoms, 901. Chamomile Oil, 809. Chimaphila, 815. Chloroform, 680. Cimicifuga, 703. Colocynth, 784. Conium, 787. 1008 INfDEX OF DISEASES ANTD REMEDIES. Spasmodic Affection; Copper Sulphate, 573. In chorea. Electricity. Gelsernium, 827. Hyoscyamus, 840. Ice, 32S. Ice to spine. Ipecacuanha, S04. Leeches, 927. Lohelia, 815. Local Pressure, 155, vide Sneezing. Over the ovary in hysteria. Lupuline, 881. Nux Vomica, 821. Opium, 722. Oxygen, 457. Physostigma, 764. Plumbum, 642. Potassium Bromide, 521. Poultices, Mustard, 402. Secale, 911. Silver Nitrate, 575. Strychnia, 825. Sulpho Carbolate, 463. Sulphur, 464. •Sumbul, 791. Tobacco, 843. Veratria, 896. Yeratrum Viride, 894. Spermatorrhea. Arsenic, 608. Atropia, 839. Belladonna, 839. Bromides, 521. Camphor Bromide, 864. Cannabis Indica, 879. Cantharides, 926. Cimicifuga, 703. Digitalis, 850. Electricity. Ergot, 911. Ferric Bromide. Ferric Iodide, 470. Gold Chloride, 641. Hvdrastis. 705. Iron, 634. Nitrate of Silver, 575. Nux Vomica, 821. Phosphorus, 605. Physostigma, 764. Potassic Bromide, 521. Quinia, 801. Silver Xitrate, 575. Strychnia, 825. Sulphur, 463. Turpentine, 883. Spina Bifida. Collodion, 735. As means of compression. Cotton Wool. Over tumor. Glycerin, 820. Injection after tapping. Iodine, 171. Injections. Lime Phosphate, 554. Potassic Iodide, 519. Spinal Concussion. Arnica, 811. Bleeding, 363. To relieve heart. Lead Water and Opium. As lotion. Leeches, 927. Vinegar, 483. To restore consciousness. Spinal Congestion. Aconite, 889. Antiphlogistic Treatment. ( old Lffusions, 894. To spine. Ergot, 911. Gewemium Niix Vomica, B21. Turpentine, 883. Wei Cuppin Spinal Irritation. Aconite Ointment, 698. Locallv. Arsenic, 608. Atropia, 839. Belladonna, 839. Blisters, 305. Cimicifuga, 703. Cocculus Indicus, 706. Conium, 786. Counter-irritation, 301-306. Digitalis, 850. Electricity. Ergot, 911. Ignatia, 821. Leeches, 927. Nux Vomica, 821. Opium, 722. Small doses. Oxalic Acid, 485. Phosphoric Acid, 604. Phosphorus, 605. Picrotoxin, 707. Siuapis, 305. Sodium Hypophosphite, 506. Strychnia, 825. Yeratrum Viride, 893. Spinal Paralysis and Softening. Belladonna, 839. Electricity. Ergot, 911. Oxalic Acid, 485. Phosphorus, 605. Plumbic Iodide, 599. Splenic Affections. Aconite, 701. Ammonium Iodide, 545. Bryonia, 786. Ferrum, 634. Grape Cure. Iodine, 471. Iodide of Ammonium, 545 Mercuric Biniodidi, 592. Quinia, 801. Sprains. Aconite, 701. Ammonium Chloride, 540. Arnica, 811. Bandaging. Cold Douche, 399. Collodion, 735. Hot Fomentations, 401. Inunction, 406. Iodine, 471. Massage, 12S. Oil of Bay. Rest. Rhus Toxicodendron, 755. Shampooing. Strapping. Turpentine, S83. Stammering. Hyoscyamus, 841. Stramonium, 842. Vocal Training. Sterility. Alkaline Injections, 488. Aurora, 640. When the result of chronic metritis or amenorrhcea. Borax, r,2'.). Cantharides, 926. Cimicifuga, 703. Conium, 786. Dilatation, of os and cervix when obstruc- tion, with dysmenorrhea. INDEX OF DISEASES AND KEMEDIES. 1009 Sterility. Gossypiurn, 734. Guaiacum, 746. Intra-uterine Stems. Iodine, 471. Metallic Bougies. Potassic Iodide, 519. Stings and Bites. Aconite, 701. Allium, 889. Ammonia, or Alkalies, 543. Aqua Calcis, 550. Aqua Potassae, 509. Arsenic, 608, 609. Camphor, 863. Carbolic Acid, 688-690. Chloroform, 680. On lint. Fennel, 789. Keep away fleas. Ipecacuanha, 802. Liquor Ammonise, 541. Peppermint, 853. Soap scented with it and rubbed over face keeps off mosquitoes. Rosemary, 851. Sage, 856. Silver Nitrate, 575. Stimulants, 905. Sugar, 906. Tobacco, 842. Moistened and squeezed on spot. Stomatitis. Acids, Mineral. Alcohol, 655. Alum, 556. Carbolic Acid, 6S9-691. Chlorate of Potassium, 513. Copper Sulphate, 573. Cornus, 793. Eucalyptus, 781. Glycerin of Tannin, 877. Hydrastis, 705. Iris, 866. Mercury, 585. Nitric Acid, 480. Phytolacca, 859. Potassium Chlorate, 513. Salicylic Acid, 693. Strabismus. Atropia, 836. Belladonna, 836. Bryonia, 785. Electricity. Hyoscyamus, 840. Operation. Spigelia, 827. Strophulus. Antimonium Crudum, 616. Carbonate of Lime, 553. Chamomile, 809. Glycerin, 820. Lancing the Gums. Pulsatilla, 702. Sunstroke. Apomorphia, 713. Artificial Respiration. Belladonna, 836. Bleeding, 363. Brandy, 655, 658. In small doses. Camphor, 862. Chloroform, 680, 681. Ergot, 911. Gelsemium, 827. Hot Bath, 401. i Leeches, 363, 927. Nitrite of Amyl, 666. Nitro-glycerin, 668. Sunstroke. Potassic Bromide, 521. Quinine, 801. Scutellaria, 856. ■ Tea, 742. Veratrum Yiride, 893. Water, Cold, 363. Affusion. Wet Sheet, 181. Suppuration. Alcohol, 655. Arnica, 811. Bark, 776, 777. Calendula, 812. Chamomile, 809. Hypophosphites, 530, 553, 6; Iodide of Iron, 637. Iodide of Manganese, 640. Mercury, 584. Phosphates, 538, 553, 63S. Quinia, 801. Sarsaparilla, 888. Sulphides, 339, 353, 516, 555. Surgical Fever. Aconite, 701. Chloral, 672. Cinchona, 794, 795. Salicylic Acid, 693. Sycosis. Arsenic and Mercury, 585, Carbolic Acid, 688-691. Chloride of Zinc, 569. Cod-liver Oil, 921. Nitric Acid, 480. Sodic Sulphite, 533. Sulphurous Acid, 477. Thuja, 8S6. Turpentine, 882. Syncope. Aconite, 701. Alcohol, 655. Ammonia, 541. Arsenic, 608. Belladonna, 836. Camphor, 862. Chamomile, 809. Chloroform, 680. Cinnamon, 862. Cocculus Indicus, 706; Cold Water over face and volatile substances to the nose. Counter-irritation to Epigastrium. Digitalin, 850. Galvanism. Heat, 185. Iodine, 471. Lavandula, 852. Musk, 914. Nitrite of Amyl, 666. Position. Head between knees. Veratrum Album, 219. Synovitis. Aconite, 701. Alcohol and Water, 655. Equal parts. Arnica, 811. Bandage or Strapping. Blisters, 305. Bryonia, 785. Calcic Sulphide, 554. Carbolic Acid, 688-691. Injections. Carbonate of Lime, 553. Cod-liver Oil, 358, 922. Colocynth, 783. Heat. Iodine, 471. Injection. Mercury, 584. 64 1010 IXDEX OF DISEASES AND REMEDIES. Synovitis. Oleate of Mercury, 494. Potassic Iodide, 5*18. Pressure. Pulsatilla, 702. Shampooing and Aspiration, 304. Silver Nitrate, 575. Splints. Sulphur, 463. Syphilis. Arsenic, 608. Aurum, 640. Calcic Sulphide, 554. Calendula, 812. Calomel, 5S8. Camphor, 862. Carbolic Acid, 6S8-691. Cod-liver Oil, 358, 922. Creasote, 690. Cauterization. Of primary sore. Gold, 640. Guaiacum, 745. Hvdrastis, 705. Iodides, 358. Iodine, 471. Iodoform, 681, Iron, 633. Manganese, 640. Mercury, 584. Monsel's Solution, 631. Nitrate of Silver, 575. Nitric Acid, 480. Nitro-muriatic Acid, 377. Opium. 723. Potassic Bichromate, 516. Potassic Chloride, 513. Potassic Iodide, 517. Salicylic Acid, 693. Sanguinaria, 725. Sarsaparilla, 888. Stillingia, S67. Suppositories, 415. Turkish Baths, 404. Zinc Chloride, 569. Tabes Mesexterica. Alcohol, 655. Arsenic, 60S. Barium Chloride, 548. Chloride of Lime, 554. Cod-liver Oil, 922. Diet. Simple and nourishing. Fatty Inunction, 405. Ferri Pernitrate, 634. Gallic Acid, S77. Gelsemium, 827. Iodine, 471. Olive Oil, 819. Phosphates, 538, 553, 638. Phosphoric Acid, 483. Sarsaparilla, 888. Teeth, Alum, 556, 557. Arnica, 811. Arsenic, 608. Calcium Phosphate, 553. Carbonate of Lime, 553. Charcoal, 81 1. Cinchona, 802. Collodion.::;.-,. Creasote, 691. Iodine, 471. Liquor Soda Chlorinate, 440. Mercury, 58 1. Phosphorus, 605. PotaSBiC Iodide, 517. Sodium Bicarbonate, 527. acre, 70L Washing and Unfiling, 310, Testicles. Belladonna, 836. Collodion, 735. Compression. Conium, 7S6. Copaiba, 769. Digitalis, 850. Gold, 640. Hamamelis, 874. Heat and Cold. Iodine, -171. Iodoform, 681. Magnesium Sulphate, 560. Mercury and Morphia Oleate, 494. Nux Vomica, 821. Phosphoric Acid, 483. Plumbago, 595. Potassic Bromide, 521. Rest. Silver Nitrate, 575. Tetanus. Aconite, 701. Acupuncture. Apomorphia, 713, 714. Arnica, 811. Arsenic, 608. Atropine, 836. Belladonna, 836. Bromides, 489, 520, 531, 536, 553. Bryonia, 785. Cannabis Indica, 879. Chloral, 672. Chloroform and Ether, 663, 680. Conium, 786. Curare, 826. Freezing Nerve. Gelsemium, 827. Hyoscyamus, 840. Ice Bag to Spine. Nerve Stretching. Neurotomv. Nicotia, 843. Nitrite of Amvl, 666. Opium, 722. Physostigma, 761. Potassic Bromide, 521, 523. Quinine, 801. Strvchnia, 825. Tobacco, 843. Vapor Bath, 404. Warm Bath, 401. Throat, Sore. Externally, Externally. Aconite, 701. Alum, 556, 557, Apis, 923. Arsenic, 608. Balsam of Peru, 759. Balsam of Tolu, 760. Belladonna, 836. Capsicum, 835. Carbolic Acid, 6S8-691. Catechu, 770. Cimicifuga, 703. Cold Compress, 400. Ferri Perchloride, 633. Glycerin of Tannin, 876. Guaiacum, 7-15. Hydrastis. 705. [ce,225. Sucked. Inhalations, 412. Steam of boiliug'water and vapor of hot vinegar. Iodine, 471. [pecacuanha, 804. Mercury, 584. Myrrh, 756. N i'uht shade. s.*56. Nitre, 513. Nitric \.-id, 480. Phytolacca, 859. Internally and as gargle, Podophyllum, 708. Pulsatilla, 702. INDEX OF DISEASES AND REMEDIES. 1011 Throat, Sore. Sanguinaria, 725. Silver Nitrate, 575. Sulphurous Acid, 477. Veratrum Viride, 893. Zinc Chlorate, 569. Zinc Sulphate, 570. Tic Douloureux. Aconite, 701. Anmionii Chloridum, 539, 540. Aqua Aninioniee, 431. Arsenic, 608. Atropia, 836. Hypodermically. Beberice Sulphas, 865. Caffein, 742. Cannabis Indica, 879. Croton Chloral, 673. Counter-irritation, 301-306. Delphinia. Externally. Electricity. Ergot, 911. Ferruni, 631. Heat. Hyoscyamus, S40. Hypodermic Injection, 713. Iodides. Laurocerasus. Morphia, 713, 714. Morphia, 713. Hypodermically. Neurotomy. Nitrate of Silver, 575. Oleum Tiglii, 442. Phosphorus, 605. Physostigma, 761-765. Stramonium, 842. Sulphur, 463. Thuja, 886. Yeratria, 894. Tinea Circinata. Boracic Acid, 486. Carbolic Acid, 688-691. Carbonate of Lime, 553. Chromic Acid, 486. Cocculus Indicus, 706. Cod-liver Oil, 922. Goa Powder, 765. Mercury, 584. Oil of Cade. Sulphur, 463, Sulphurous Acid, 477. Tinea Decalvans. Cantharides, 925. Carbolic Acid, 688-691. Iodoform, 681. Parasiticide Lotions, 760. Pilocarpin, 749. Raw Onion. Rubbed on. Sapo Viridis, 819. Tannin, 877. Tinea Favosa. Arsenic, 608. Calcic Sulphide, 554. Carbolic Acid, 688-691. Cleanliness. Dulcamara, 834. Epilation. Hyposulphites, 533. Mercury, 584. Nitric Acid, 480. Oils, 304. Oleander. Petroleum, 647. Sulphides, 516, 554. Sulphurous Acid, 477. Turkish Bath, 404. Viola Tricolor, 729. Zinc Chloride, 569. Tinea Tonsurans. Arsenic Iodide, 608. Carbolic Acid, 688-691. Cocculus Indicus, 706. Cod-liver Oil, 922. Creasote, 690. Croton Oil, 867. Epilation. Goa Powders, 765. Iodine, 471. Lead, 595. Manganese, 640. In porrigo capitis. Mercury Oleate, 494. Menthol, 194. Sulpho-cyanide of Potassium, 512. Thymol, 854. Turpentine, 882. Vaseline, 647. Viola Tricolor, 729. Tongue. Aconite, 701. Borax, 529. Cinnamon, 862. Cloves, 778. As gargle. Conium, 786. Ginger, 900. Hydrastis, 705. Iodine, 471. Mercury, 584. Mezereon. Nitric Acid, 480. Nux Vomica, 821. Pepper, 870. Phytolacca, 859. Potassic Bromide, 521, 522. Potassic Chlorate, 513. Potassic Iodide, 517. Pyrethrum, 806. Rhus Toxicodendron, 755. Silver Nitrate, 575. Tonsillitis. Aconite, 701. Alum, 556, 557. Apis, 923. Arsenic, 608. Belladonna, 836. Capsicum, 835. Carbolic Acid, 688-691. Cold Wet Compress, 400. Eucalyptus, 782. Gallic Acid, 877. Guaiac, 745. Ice and Wet Pack, 181, 328, 396. Iodine, 471. Iodides, 519, 531, 545. Mercury, 584. Milk and Water Gargle. Nitrate of Silver, 575. Opium, 722. Phytolacca, 859. Potassic Iodide, 342. Quinine, 801. Silver Nitrate, 575. Steam of Hot Water. Tannic Acid, 877. Tonsils, Enlarged. Ammonia Iodide, 545. Belladonna, 836. Bryonia, 785. Calcic Phosphate, 553. Catechu, 770. Excision. Ferri Tincture, 510. Iodine Tincture, 470. Massage, 128. Ox Gall, 917. Locally. Silver Nitrate, 575. Tannin, 877. 1012 INDEX OF DISEASES AND REMEDIES. Tonsils, Ulcerated. Ailantlius Glandulosa. Cantharides, 925. Mercuric Iodide, 592. Potassium Iodide, 521. Sulphurous Acid, 477. Toothache. Aconite, 701. Alum, 556, 557. Arsenic, 608. Belladonna, 836. Bryonia, 785. Camphor, 862. Capsicum. 835. Carbolic Acid, 688-691. Very useful. Caustic Potash, 509. Chamomile, 809. Chloral, 672. Chloroform, 680. Coffee, 804. Colchicum, 899. Collodion, 735. Conia, 786. Creasote, 690. Very useful. Croton Oil, 673. Electricity. Gelsemium, 827. Ginger, 900. Mercury, 584. Morphia, 713, 714. Nitrate of Silver, 575. Nitric Acid, 480. Nitro-glycerin, 668. Nux Vomica, 821. Oil of Cloves, 337. Opium, 722. Pulsatilla, 702. Sodium Bicarbonate, 526. Staphisagria, 702. Tannin, 875. Xanthosylum, 748. Zinc Chloride, 569. Torticollis. Aconite, 701. Arsenic, 608. Belladonna, S36. Capsicum, 835. Cimicifuga, 703. Conium, 786. Dulcamara, 835. Electricitv. Ether Spray, 146. Galvanization. Local Pressure. Mercury,'854. Nerve Stretching. Nux Vomica, 821. Trismus. Aconite, 701. Amesthetics, 146, 185. Belladonna, 836. Calabar Bean, 701. Cannabis Indica, 879. Chloral, 672. Conium, 786. Ether, 060. Gelsemium, 827. Opium, 722. Pnysostigma, 761-765. Tumors. Acupuncture. a rnlca, 811. Barium Carbonate. Belladonna, 836. Bryonia, 785. Carbonate of Lime, 553. Chloroform. 680, 861. Conium, 788. Tumors. Electrolysis. Galbanum, 789. Hyoscyamus, 841. Iron, 633., Pepsine, 916. Plumbago, 595. Potassic Carbonate, 508. Tympanitis. Acids and Alkalies. Arsenic, 608. Asafcetida, 787. Most useful. Aspiration. Bismuth, 621. Chamomile, 809. Capsicum, 835. Carbolic Acid, 688-691. Chloral, 672. Cocculus, 706. Colchicum, 899. Cubebs, 871. Ginger, 900. Glycerin, 820. Hyoscyamus, 840. Iris, 902. Nux Vomica, 821. Rue, 747. Sumbul, 791. Turpentine, 882. Vegetable Charcoal, 459. Typhilitis. Arsenic, 608. Belladonna, 836. Ice Bag. Leeches, 927. Mercury. Opium, "722. Most useful. Veratrum Viride, 893. Typhoid Fever. Aconite, 701. Alcohol Aliment, 650, 655, 656. Arnica, 811. Arsenic, 608. Baths, 388 et seq. Bismuth, 621. Bryonia, 785. Calomel, 588. Carbonate of Ammonia, 542. Cold Compress, 400. Digitalis, 850. Ergot, 911. Hydrastis, 705. Hydrochloric Acid, 479. Hyoscyamus, 840. Lead Acetate, 597. Mercury, 584. Muriatic Acid, 479. Opium, 722. Phosphoric Acid, 483. Phosphorus, 605. Purgatives, 338. Quinine, 801. llhus Toxicodendron, 755. Serpentaria, 865. Sodic Chloride, 524. Sulphur 463. Tartar Emetic, 617. Turpentine, 882. Veratrum Viride, 893. Typhus Fever. Aconite, 701. Arnica, 811. Arsenic, 60S. Baths, 888 et seq. Belladonna, 836. INDEX OF DISEASES AND REMEDIES. 1013 Typhus Fever. Camphor, 862. Chloral, 672. Coffee, 804. Counter-irritation. Diet, Nutritious. Digitalis, 850. Erythroxylon,732. Expectant Treatment. Hydrochloric Acid, 479. Hyoscyamus, 840. Iodine, 471. Mercury, 584. Mineral Acids. Muriatic Acid, 479. Musk, 914. Opium, 722. Phosphoric Acid, 483. Phosphorus, 605. Podophyllin, 703. Potassic Chlorate, 513. Potassic Nitrate, 512. Quinine, 801. Rhatany, 731. Rhus Toxicodendron, 755. Serpentaria, 865. Stimulants, 657. Stramonium, 841. Strychnia, 825. Sulphuric Acid, 477. Tar, 886. Tartar Emetic, 617. Turpentine Oleate, 882. Yeast, 912. Vomiting. Alcohol, 655. Ammonia Salts, 538. Ammonium Carbonate, 542. Apomorphia, 713, 714. ■ Arsenic, 608. Belladonna, 836. Blisters, 305. Bromides, 521, 531. Bryonia, 785. Calumba, 706. Carbolic Acid, 688-691. Carbonate of Ammonia, 542. Cerium Oxalate, 558 Champagne. Chloroform, 680. Cinnamon, 861. Cloves, 778. Cocculus Indicus, 706. Conium, 786. Creasote, 691. Counter-irritation, 301-306. Emetics, 326. Horseradish, 728. Ice,_328. Sucked. Iodi, 472. The liquor, administered inter- nally, in 3-5 m. doses. Ipecacuanha, 804. Iris, 902. Koumiss, 915. Leeches, 927. Lobelia, 814. Magnesia, 561. Mercury, 584. Milk and Lime Water, 566. Morphia, 713, 714. Nutrient Enemata. Nux Vomica, 821. Opium, 722. Pepsin e, 916. Pulsatilla, 702. Sanguinaria, 725. Secale, 911. Serpentaria, 865. Silver Nitrate, 575. Strychnia, 825. Sulphites, 533. Sulphurous Acid, 477. Tartar Emetic, 617. Vomiting. Veratrum Yiride, 893. Zinc, 570. Vomiting of Pregnancy. Aconite, 701. Apomorphia, 713, 714. Arsenic, 608. Atropia, 838. Bismuth, 621. Bromide of Potassium, 329. Calumba, 706. Carbolic Acid, 688-691. Cerium Oxalate, 558. Champagne. Coffee, 804. Copper Sulphate, 573. Creasote, 691. Emetics, 323. Hydrocyanic Acid, 493. Iodine, 471. Tincture of Iodine, 469. Ipecacuanha, 804. Koumiss, 915. Morphia, 713, 714. Nux Vomica, 821. Pepsine, 916. Potassic Bromide, 521, 522. Pulsatilla, 702. Spinal Ice Bag. Staphisagria, 701. Strychnia, 825. Sulphate of Copper, 573. Warts. Antimonic Chloride, 619. Arsenious Acid, 611. Caustic Alkalies. Carbolic Acid, 688-691. Carbonate of Lime, 553. Chloral, 672. Chromic Acid, 486. Corrosive Sublimate. Creasote, 691. Dulcamara, 834. Magnesic Carbonate, 561. Mercuric Nitrate, 591. Nitric Acid, 480. Permanganate of Potash, 515. Phosphoric Acid, 483. Poultice, 402. Rhus Toxicodendron, 755. Rue, 747. Savine, 887. Silver Nitrate, 575. Sodic Carbonate, 526. Stavesacre, 701. Sulphur, 463. Wen. Baric Carbonate. Calcic Sulphide, 554. Carbonate of Lime, 553. Conium, 786. Extirpation. Plumbago, 595. Worms. Aconite, 701. Aloes, 890. Alum, 355. As an injection for thread-worms. Ammonium Chloride, 355. As an adjunct. Areca Nut, 355. For tape-worms. Azedarach, 746. Castor Oil, 355. Eucalyptol, 355. As an injection for thread- worms. Ferric Perchloride, 633. Filix Mas, 355. For tape-worms, Ignatia, 821. Iron, 355. As an injection for thread-worms, and as a tonic. 1014 INDEX OF DISEASES AND REMEDIES. Worms. Karaala, 355. For tape-worms. Kousso, 355. For tape-worms. Lard or Oil. Lime Water, 355. As an injection for thread- worms. Male Fern, 907. Pepo, 7S5. Quinia, 801. Quassia, 355. worms. Santonica, 355. Santonine, 355. Scarnmony, 355, Silver Nitrate, 575: Sodium Chloride, 355. As an injection for thread-worms, 355. Tannin, 355. As an injection for thread- worms. Tonics, 355. To prevent secretion of intesti- nal mucus. Turpentine, 355. For tape-wornis. Valerian, 805. As an injection for thread- For round-worms. For round-worms. Wouxds. Aconite, 701. Alcohol, 655. Aloes, 890. Arnica, 811. Asafcetida, 787. Balsam of Peru, 759. JBenzoin, 816. Blotting-paper. Boracic Acid, 311. Calendula, 812. Carbolic Acid, 688-691. Carbonic Acid, 487. Chloral, 672. Collodion, 735. Conium, 786. Eucalyptus, 781. Glycerine, 820. Hamamelis, 873. Heat, 185. Iodine, 471. Iodoform, 681. Lead Dressings, 596. Wounds. Nitrate of Silver, 575. Nitric Acid, 480. Opium, 722. Petroleum, 647. Permanganate of Potassa, 515 Potassic Chloride, 513. Poultices, 402. Salicylic Acid, 693. Sodium Chloride, 524 Sugar, 906. Sulphurous Acid, 477. Tannin, 875. Turkish Baths, 404. Turpentine, 882. Zinc Sulphate and Chloride, 570. Yellow Fever. Aconite, 701. Arsenic, 608. Belladonna, 836. Byronia, 785. Calomel, 588. Camphor, 862. Cantharides, 926. Capsicum, 835. Charcoal, 459, 460. Chlorate of Potash, 513. Chlorodyne. Cimicifuga, 703. Gelsemium, 827. Iodide of Potassium, 518. Ipecacuanha, 804. Lead Acetate, 597. Liquor Calcis, 550. Mercury, 584. Nitrate of Silver, 575. Nux Vomica, 821. Quinine, 801. Salicylic Acid, 693. SodaBenzoate, 531. Stimulants, 656. Sulphur Baths. Tannic Acid, 875. Tartar Emetic, 617. Turpentine, S82. Vegetable Charcoal, 460. Veratrum Viride, 893. £ per cent, solution. BIBLIOGRAPHICAL INDEX. Acids. Bertram, Z. f. Biol., xiv., p. 55S. Bobrik, Konigsberger Diss., 1863. Brunton and Cash, Phil. Trans., Pt. i., 18S4, p. 231. Buchheini, Arch. f. pbysiol. Heilk., 1857, p. 122; Pfl tiger's Arch., Bd. xii., 1876. Cvon, Arch. f. Anat. u. Physiol., 1866, p. 416. E'delfsen, Centralbl. f. d. med. Wiss., 1S78, p. 513 (Phosphoric acid). Elsiisser, Die Magenerweickung d. Sauglinge, 1S46. Feitelberg, Dorpat. Diss., 1883. Gahtgens, Centralbl. f. d. med. Wiss., 1872, vol. x., p. 833. Gamgee, Centralbl. f. d. med. Wiss., 1879, p. 253 (different kinds of Phosphoric acid). Gaskell, Journ. of Physiol., vol. iv., p. 48. Goltz, Virch. Arch,, Bel. xxvi., p. 1. Heiss, Zeitschr. f. Biologie, 1876, Bd. xii., p. 151. Hermann, Toxicolog., 1874, p. 160. Hertwig, Thierheilkunde. Hofbauer, Bossback's Pharmacol. Unters., Bd. iii. Hofmann, Zeitschr. f. Biologie, 1871, Bd. vii., p. 338. Hoppener, Dorpat. Diss., 1863. Kobert, Schmidt's Jahrb., Bd. elxxix., p. 225. Koch, Zeitschr. f. rat. Medicin, 3B.Bd.xxiv., p. 264. Kiihne, Unters. lib. d. Protoplasma, Leipzig, 1864. Kurtz, Joh., Alkalientzieh. a. d. Thierk. Dorpat. Diss., 1S74; u. Centralb. f. d. medi- cin. Wiss., 1S74, vol. xii., p. 569. Lassar, O., Pfliiger's .Arch., 1874, vol. ix.,p.44. Levden u. Muhk, Virch. Arch., Bd. xxii., p. 237. Malv, Liebig's Annal., Bd. clxxiii., p. 227, 1874. Meissener, G., Zeitschr. f. rat. Med., 3 B. Bd. xxiv., p. 97. Miquel, Arch. f. physiol. Heilk., 1851, p. 479. Orisum, Arch. f. path. Anat,, Bd. xxviii. Piotrowski, Dorpat. Diss., 1856. Quincke, Corr. Blatt f. Schweizer Herzte, iv., No. 1, 1874. Salkowski, Yirch. Arch., Bd. lviii., p. 460. Sieber, N. Journ. f. pract. Chemie, N. F., Bd. xix., 1879, p. 433 (Antiseptic action). Strassburg, Pfliiger's Arch., Bd. iv., p. 454. Striibing, A., f. exp. Path. u. Pharm., Bd. vi., 266 (Phosphoric acid). Szabo, Z., f. physiol. Chern., i., p. 140 (com- plete literature of the acids in gastric . juice). Trachtenberg, Dorp. Diss., 1861. Walter, Arch. f. exp. Path. u. Pharm., 1877, p. 148. Ziilzer, Yirch. Arch., Bd. lxvi., pp. 223 and 282 (Phosphoric acid). ACONITINE. Achscharumoff, Keichert u. Du Bois's Archiv., 1866, p. 255 ; Schmidt's Jahrb., cxxxvi., p. 157, 1S67. ACOXITIXE. Berthemot, Pharmaz. Centralbl., 1837, p. 733. Bohm u. Ewers, Arch. f. exp. Path. u. Pharm., Bd. iii., p. 385. Bohm und Wartmann, Yerh. d. physik med. Ges. in Wiirtzburg, N. F., Bd. iii. Brodie, Phil. Trans., 1811, p. 178. Coulson, Schmidt's Jahrb., xix., 285. Cramoisy, E. P., Paris, J. B. Bailliere et fils, p. 30, 1S65. Debout & Gubler, Schmidt's Jahrb., cxxv., p. 19, 1864. Dyce Duckworth, Brit. Med. Journ., vol. i., p. 224, 1861 ; Schmidt's Jahrb., cxi., p. 23, 1861. Ferrand de l'Aconit. Lyon, Chauvine, 1861. Fleming, An Inquiry into the Phys. and Medicinal Properties of the Aconitum napellus. Edinb., 1S45. Fothersdll, Digitalis, London, 1871, p. 6. FristedTt., Norcl. Med. Ark. iii., 3, No. 18, p. 38, 1871. Geiger, Hesse, Brandes Pharmaz. Centralbl., 1835, p. 85. Grehant & Duquesnel, Bull. gen. de Therap., Aug., 1871, p. 492. Gubler, Bull. gen. de Therap., lxvi.. p. 3S5, May, 1S64. Hahn, Essai sur l'Aconit, Strasbourg, 1863. Harley, St. Thomas' Hosp. Beports, v., p. 149. Hottot et Debout, Bull. Ther., lxvi., p. 360, Ap., 1864. Janus, Corn, de Man. Spec. Medic, inaug. de Aconito Lugd. Batav., 1841, Svo., p. 68. Lewin, Prager Yierteljahrs, Bd. cxxxL.p. 20. Liegeois & Hottot, Journ. de Phvsiol., iv., p. 520, Oct., 1861 : Schmidt's Jahrb., cxiv., p. 291,1862; Bull.de Therap., Paris, lxv., p. 20S, 1863. Mackenzie & A. Guillaud, Arch. d. Phvsiol., 1875, p. 766. Mackenzie, G. H, London Practitioner, xx., p. 100. Maninii, Dell' Aconito Napello, Keggio, 1S66, p. 30. Nunneley, F. B., Proceed, of the Eoyal So- ciety, vol. xviii., p. 46, 1870. Orfila'on Poisons (translated by Waller), 7th ed., vol.ii., p. 46. Pereira, Elements of Mat, Med., 4th ed., ii., pt. ii., p. 684. Praag, L. von, Yirchow's Archiv., Bd. vii., 43S-47S, 1854. Einger, S. & W., Murrell, Joarn. of Phvs., i., p. 232, Nos. 4, 5. Schroff, von, sen., Prager Yierteljahrs, xlii., p. 129, 1854 ; Oest Med. Jahrb., xvii., p. 57, 1861 ; Schm. Jahrb., cxii., 15, 1861. Schulz, Marburger Diss., 1846. Simon u. Sobernheim, Handb. d. Tox., p. 60. Skey, Froriep's Not., ii., 80, 1S37 ; Schmidt's Jahrb., xvii., p. 306. Soubeiran, Schmidt's Jahrb., xix., p. 285. Turnbull, on the Preparations and Medical Properties of the Natural Order Banuncu- lacea?, London, 1S35 ; Froriep's Not., L, 302, ii., 252, 1837 ; Schmidt's Jahrb., xix., 285. Weyland, Eckhard's Beitr., v. 1, p. 29. Wibrner, Wirkungen, i., p. 33. (1015; 1016 BIBLIOGRAPHICAL IKDEX. Alcohol. Anstie, Stimulants and Narcotics, London, 1864; Lond. Practitioner, viii., p. 148, Mar., 1S72. July, 1S74; Lond. Med. Review, 1S62; reprint, Lancet, ii., Sep. 11, 1865; p. 343. Baudot, E.,L'Union Medicale, 1863. Becharop, London Lancet, 1S73, vol. i., p. S46. Bernard, CI., Lecons sur les Effets des Sub- stances toxiques, Paris, p. 397 ; Gaz. Med. de Paris, 1S56, p. 295. Binz, Virchow's Archiv, 1871, iv., p. 529, Bd. liii., Berl. Klin. Woch., xi., 11, p. 129, 1874- 1876, p. 54; Archiv fiir exp. P. u. Ph., vi., 287. Blair, Glasgow, Med. Journ.,Feb., 1870, p. 204. Boeck, v., Unters. iib. d. Zersetz. d. Eiweiss., Mimchen, 1871. Boeck, v., u. Bauer, Zeitschrift f. Biol., Bd. x., p. 361. Boeker, Beitr. z. Heilkde., i.. p. 247, 1849. Bonwetsch, Dorpat. Diss., 1S69, p. 39. Bouvier, Cuny, Pfliiger's Arch., Bd.ii.,p. 370; Wirk. der Alcohol auf d. Korpertempera- tur, Bonn, 1869 : Centralb. f. d. med. W., vol. ix., p. 807, 1871. Brodie, Phil. Trans., Lond., 1811, p. 17S. Brunton, Lauder, Book of Health, Cassell & Co., p. 183. Practitioner, xvi., p. 56; Con- temporary Beview, xxxiii., p. 691. Carpenter, Alcohol in Health and Disease, Lond., 1851, 2d ed. Clemens, Theodor, of Frankfort, Deutsche Klinik, 1874, 1875. Daub, P., Centralb. f. d. med. Wiss., 1873, p. 466. Davies, N. S., Trans, of the American Med. Assoc, 1S55; Diction. Ency eloped. , ii. Al- cohol, p. 582. Dogiel, J., Pfliiger's Arch., 1874, Bd. viii. Dupre.The Doctor, Feb. 1, 1873; Lond. Prac- titioner, vol. viii., 148, ix., 1872, p. 28, vol. xiii., p. 15. Edes, B. D., Bost. Med. & Surg. Journ., 1872, vol. lxxxvi. Flourens, Svsteme Nerveux. Paris, 1842, p. 400. Fokker. Xederlandsch. Tijdschrift vor Ge- neeskunde, 1871. Fontana, Berlin, 1787, p. 439. Ford, N. Y. Med. Journ., Jan., 1872. Giacomini, Traite Philos. de Mat. Med. et Therap. Paris, 1842. Hammond, Phys. Memoirs, Philadelphia, 1863; Amer. Journ. Med. Sci., Oct., 1856, p. 305. Horwatb, Gaz. des Hopitaux, Sept., 1878. Huss, Magnus, Chron. Alkoholkrankh., Stockholm, 1852. Leuret & Lassaigne, Paris, 1825, p. 200. Leudet, Arch. Gcn.de Med., Jan., 1867, vol. ix.. pp. 5-39. Lichtenfels u. Frohlicb, Denkschr. d. k. k. Acad. d. W. in Wien, 1852; Math. Nat. CI., Bd. iii., 113. Lieben, .\., Ann. d. Chemie u. Pbarm., 1870, ii.: Buppl. Bd., p. 236. Ludger, Lallemand, Perrin, Duroy, Paris, I860, p. 42 1, Chameret edit. Magendie, Precis l Lem. de Phys., Paris, 1825. Ma-nan, de I'Alcoolisme, Paris, 1874: Gaz. Mfed. de Paris, x,,. xl., p. 444, 1871. Man asseiD, Centralb. f. a. Med. Wiss.. ix., p. 689, 1871. Marvaud, Paris, Bailliere et fils, Ire ed., 1871, I». B9, 169. Meihulzen, Arch. d. Ges. Phys.. vii., 4 u. 5, 1). 201, l-::;. Obernier, Pflttger'e Arch., Pd. ii., p. 494. Orfila, Tox. Gen., 1818. Parkea u. Wollowicz, I 'ion (.'(lings of the Royal Society, i s 7. 673. Liebig, V. Ann. d. ("hem. u. Pharm., lx.wii., p. 25. L&fller, (Saltpeter), Schmidt's Jahrb., IMS Bd. Ix. p. 18. Loniikowsky, Berl. klin. Woch., 1ST.;, p. 175. Magendie, I oion M6d., 1852, p. 198. Marchand, Virchow's Arch., lid. lxxvii., 1879. Mauricet, Schmidt's Jahrb., cxviii., 18, i Merandon, Act. Phys. des Sels de Potasse, These de Paris. 1868. BIBLIOGRAPHICAL INDEX. 1017 Alkalies. Mialhe, Cliimie Applique, Paris, 1S56, p. 5S ; Bull. Therap., lxxxiv., p. 154, 2S Feb., 1873. Nasse, H. "Wagner's Handworterbuch der Phys., i., p. 167 (Blut.) Podoeopaw, A T irch. Arch., xxxiii., 505. Eanke, F., Eeichert's u. Du Bois-Beyrnond's Arch., 1864, p. 320. Eabuteau, Gaz. Hebdom., 1871, 43, 46, 48. Billiet, Arch. Geo. de Med., iv., 35, 1S48. Bohrig, Arch. f. wissensch. Heilk., vi., 3, 4, p. 396, 1863. Salkowski, Arch. f. Path. Anat., Bd. liii. ; Centralol. Med. Wiss., xi., 1873, p. 774. Schmidt, Al. u. Aronstein, Pfliiger's Archiv., Bd. viii., p. 75. Setschenow, Centralbl. f. d. med. W., 1873, p. 355. Sertiirner, Ann. f. d. Universal System d. Elements, Jahrg., 1826. Tilt, Lancet, i., 1861, p. 556, June. Traube, Berl. Klin. Wochenschrift, 1864, p. 18. Trousseau, Clin. Med. de l'Hotel Dieu., Paris, 1861. Trousseau and Pidoux, Traite de Therap., Paris, Asselin, 1868, Se ed., p. 420. Voit, Unters. lib. d. Einflus. d. Kochs. auf die Stoffweehsel, Miinchen, 1S60; unci Ber. d. Miinchen, Acad., 1S69. Voit, Z. f. Biol., Bd. i., p. 195 (Glaubersalz, StofiVechsel). Yoit und Bauer, Zeitschrift f. Biol., 1869, Bd. v., p. 536. Zuntz, Pfltig. Arch., i., p. 361. Alkaline Earths. Bence-Jones, Chem. Soc. Quart. Journ., xv. Beneke, Pathologie des Stoffwechsels, 1876. Boussingault, Ann. d. Chem. u. Pharm. lix., (Phosphors, alk. Erden). Chossat, Gaz. Med. de Paris, 1842 (Phos- phates). Diakonow, Centralbl. f. d. med. W., 1S67, vol. v., p. 673. Dussart, Beneke, & Feissier, Arch. Gen., 6e ser. tome xiv., p. 670, xv., pp. 66 and 198. Neubauer u. Vogel, on Urine, etc., 1863. Piorrv, Journal de Chem. Med., tome ix., 1863". Eoloff, Virchow's Arch., Bd. xlvi., p. 305. W f eiske, Zeitschrift, f. Biol., Bd. vii., p. 333. Zalesky in Hoppe-Seyler's Med. Chem. Unters. Alkaloids. Heger, Journ. d. med. Chir. et. Pharm. de Bruxelles, 1879 (Sur 1'Absorption des Alca- loides dans la Foie, les Poumons et les Muscles). Eossbach, Verh. d. Wiirzb. phvsiol. med. Ges. N.F., Bd. v., l, vi., 162. u. 190, vii., 20; Pflii- ger's Arch., x., 438. xxi. 1 (Antagonism) ; A'erhandlung d. Wiirzb. phvsiol. med. Ges. N. F., Bd. iii., 346, 1872, Bd. Vi., p. 162, 1874 ; Pfliiger's Arch., xxi., 213, 1880. Aloes, vide Purgatives. Buchheim, Die scharfen Stoffe, p. 27. Barker, Fordyce, American Practitioner, 1872. Gerhard, North American Med. and Surg. Journ. Groves, Pharm. Journ., xvi. Husemann, Pflanzenstoffe, p. 1047. Lienau, Oldenb. Corresp. Blatt, 9, 10, 1861. Smith, T. and H., Chem. Gaz. 1851, 107. Stille, Therapeutics, vol. ii., p. 444. Trousseau and Pidoux. Alum. Barthez, Frank's Magazin, iii. Blanc. l'Union, 117, 120, 1873. Gamgee, Schmidt's Jahrb.,cli., p. 23, 1871. Alum. Homolle, Paris, Malteste, 1861, p. 125 ; l'Union, 15, 17, 1861. Mitscherlich, Lehrb. d. Arzneimittellehre, 1847. Paulier, Gaz. Hebd. (2), x., p. 717, 1873. Eosenstirn in Eossbach's Pharmakolog. Unters, 1874, Bd. ii., p. 78. Schreber, Jahrb. f. Kinderheilk., iii., 2, p. 138, 1860. Smith, Curtis, Phila. Med. and Surg. Eeport., xxiv., p. 409. Ammoniacal Salts. Barclay, Med. Times & Gaz., ^ov., 1853, p. 553. Bellini, Lo Sperimentale, 1S72, Giugno, 561. Bence-Jones, Philos. Trans., London, 1851, p. 399. Bichlmayr, Z. fur Biol., 1867, 381. Billroth, Arch. f. Klin. Chirurg., Bd. vi., p. 421. Blake, St. George's Hosp. Eep., v., p. 73, 1S70. Bohm u. Lange., A. f. exp. P. u. Pharm., ii., s. 364 ; und Dorpater Diss., 1874. Cazenave, Bull. Gen. de Therap., xxxi., 70. Cholmelev, St. Andrew's Med. Grad. Assoc'n. Trans., iii., 102, 1870. Fayrer, Indian Annals of Med. -Science, 1872. Delioux, Bull, de l'Acad., xxxv., No. 23, 15 Dec. 1870, p. 883. Feder, Z. f. Biol., xiii., p. 256. Feltz, V., and E. Bitter, Journ. d'Anatomie et de la Physiol., 1874, p. 326. Funke u. Deahna., Pfliiger's Arch., 1874, ix., p. 416. Gmelin, Apparatus Medicamin., ii., 1, 48. Halford, G. B., Melbourne Argus, 1872. Hallervorden, A. f. Exp. P. u. Pharm., x.,p. 125. Huxham, On Fevers, p. 299. Knieriem, von, Zeitschr. f. Biol., 1874, Bd. x., p. 263. Knoll, Wein. Acad. Sitzber., 1874, Bd. lxviii. Kiihne u. Strauch, Centralbl. Med. Wiss., 1864, No. 36, pp. 561, 577. Lange, F., Arch. f. Exp. Path. u. Pharm., Bd. ii., p. 368. Maurecet, Schmidt's Jahrb., clxviii., p. 18, 1863. Mitscherlich, Zeits. des Preuss. Vereins f. Heilk., Nos. 43, 44, 45, 46, 1841 ; Lehrb. der Arznei., ii. 228. Munk, Zeitschr. f. phvsiol. Chem., ii., p. 29. Priestlv, On Air, ii., p. 369, 1790. Salkovrski, Zeitsch. f. phys. Chem., Bd. i., pp. iv., 1, 374. Eabuteau, Gaz. Hebd .,43, 46, 48, 1871; Comptes Bend., lxx., 25, p. 1356, 1870. Schiffer, Berl. Klin. Wochenschr., 1872. Schmiedeberg, A. f. Exp. P. u. Pharm., viii., p. 1. Stevenson, Guy's Hosp. Eep., 3d ser., xvii., 225, 1872. Thirv, Henle u. Pfeufer's Zeits. (3), xvii., p. 166, 1864. Trousseau & Pidoux, Traite, 9th ed. 1, p. 453. Walter, A. f. Exp. P. u. Pharm., vii., p. 148, u. W T ibmer, Wirk. d. Arzneim. u. Gifie, Mu- nich, 1831, pp. 123, 127, 139, 144. Aniline. Bergmann. Prager Yierteljahrsschr., Bd. lxxxviii., p. 109, 1S65. Feltz, u. Bitter, Compt. Eend.,lxxxii.,p.l512, 1S76. Schuchhardt, Virch. Arch., Bd. xx., p. 446. Antimony. Ackermann, Virch. Arch., Bd. xxv., 1862, p. 531; Eostock, 1S56 (Ader) iv.,p. 44; Henle u. Pfeufer's Zeits. f. ration. Med., 3, E. ii., Heft. 3, 1S58. 1018 BIBLIOGRAPHICAL IKDEX. Antimony. Balfour, Tartar Emetic in Fever, Inflara., Asthma, etc., Lond., 1818. Buchheim u. Eisenmenger,Eckhardt's Beitr., Bd. v. Brinton, Todd's Cyclop, of Anat. and Physiol. Suppl., p. 319. Bocker, Beitr. z. Heilk., ii., p. 234, 1849. Corput.van den, Journ. med.de Brux,xxxv, p. 491, Nov., 1863. Denny, Brit. Med. Journ., Jan. 28, 89, 1871. Daffin, Edin. Med. & Surg. Journ., xix., 3, p. 354, 1823. Eisenmenger, U. d. Einfl. Gifte a. d. Zuck- ungscurved. Frosches Muskeln, iv., Giessen, 1869, p. 7. Forget, Bull. gen. de Therap, lviii., June, 1860, p. 481. Fonssagrives, Bull. gen. de Therap., lvii., Aug., 1859, p. 145. Gianuzzi, Centralbl. med. Wiss., 1865, p. 129. Grimm, Pfliig. Arch., iv., p. 205. Jankowich, Oesterr. Jahrb. N. F.,xxxviii., p. 53, 1842. Jones, Handfield, Med. Times & Gaz., Dec, 1852, p. 362. Koschlakoff u. Bogomoloff, Centralbl. med. Wiss., 1868, p. 628 ; Pfliiger's Arch., v., p. 2S0, 1872. Kleiman u. Simonowitsch, Arch. f. d. ges. Phvsiol., Bd. v., p. 280. Lange, D., Klinik, 28, 30, 31, 1863; Schmidt's Jahrb., cxxiii., 283, 1864. Lepelletier, Paris, 1835, p. 171. Long, Bull. gen. de Therap., lix., Oct., 1860, p. 317. Magendie, Paris, 1813. Mayerhofer, Heller's Arch., iii., 3-5, p. 356, 1846. Mosso, Schmidt's Jahrb., Bd. clxix., p. 236. Nobiling, Zeits. f. Biol., Bd. iv., p. 40, 1868; Schmidt's Jahrb., cxl., 24. Orfila, Memoires de 1' Acad. roy. de Med. viii., 1840, p. 509. Papillaud, Schmidt's Jahrb., clvi., p. 267, 1872. Pecholier, Comptes Bend., lvi., 1863, p. 718; Gaz. Hebd., 17 Ap., 1863, p. 275. Basori, Milano, 1830; Arch. gen. de Med., 1824, iv., pp. 300, 415. Bayer & Bonnet, Diet, de Med. et de Chir., iii., 69, Paris, 1829. Badziejewski, Arch. f. Anat. u. Physiol., 1871, p. 472. Bichardson, Med. Times and Gaz., May, 1856, ]). 473. Saikowski,Yirch. Arch., xxxiv., p. 73. Solon, Martin, Memoires de 1'Acad. roy. de .Med., viii., 1S40, p. 518. Stedmann, Med. Times & Gaz., Dec, 1852,641. Tavlor, Ouy's Hosp. Bep, 1860, p. 397. Traube, Centralbl. med. Wiss., 1864, p. 490. Trousseau &. Pidoux, Traite de Therap., et de Mat. Med., 9e ed., 1870, ii., p. 954. Vibore and Hertwig quoted by Wibmer, Wirk. d. Arzneim. u. Gifte, v., 187, 194. Witt, .1. II. I), de, Groningae apud Wilkens, 8, 1847, p. 32. Wood, Phila, Med. Times, vol. iii. Apiol. ( rallico ii. Poggeschi, Bull. gen. Therap., 1861, ii., ]). 279. .lor.i, Bull. Therap.. Feb., 1860, lix., p. 97. Jorel a Homolle, Jours, de Pharm. et de Chim. 8e Ber., i w iii., 212. Marotti, Hull. Therap., lxv., pp. 295 and 341, 1868, Gaz. Eebd. 45. Apomorphia. Bourgeois. These de Paris, 1874, No. 19, Bull. -ii de Th6rap., lxxxvi., p. 286, 1874. Chouppe, Boc. . 165. Apomorphia. Dujardin-Beaumetz, Bull. gen. de Therap., lxxxvii., Oct. 8, 1874, p. 345. Eichberg, Wurtemberg, Corr. Bl. S9, p. 1819- 1873. Fronmiiller, Memorabil., xviii., 9, 1S73. jGanghofner, Bohn. Corrs. Blat., i., 3. p. 65, 1873. Gee, St. Barth. Hosp. Reports, vol. v., p. 215, Trans. Clin. Soc, ii., p. 166, 1870. Gellhorn, Allgem. Ztschr. f. Psych, xxx., 46, 1873. Greve, Berl. Klin. Wochens., xi., 28, 29, 1874. Harnack, Arch. f. exp. Path. u. Pharm., Bd. ii., p. 291, 1874. Huchard, H., Union med., Oct. 1874, p. 493. Juratsz's, Centralbl. f. d. med. Wiss., p. 499, 1874. Lob, Berlin, Klin. Wochens, 1872. p. 400. Mattheissen, B. & C. B. A. Wright, Proceed- ings Boy. Soc, xvii., 455. Mayer, E. L., Berichte Deutsch. Chem. Ges., Berlin, 1871, iv., 121. Meyer, De, Bull, de la Soc. roy. de Pharm. de Bruxelles, 1872. Moller, Bull, de l'Acad. de Med. de Belgique, viii., 3, 1873, p. 749. Moerz, A. Prager Vierteljahr, 1872, Bd. cxv., p. 82. Oberlin, Bevue. Med. de l'Est, Aug., 1874, ii., p. 98. Onsum, Norsk. Mag., 3 B. iii., 155, 1S72. Quehl, Hallenser Diss., 1872. Pierce, British Medical Journ., 1870, vol i., p. 204. Biegel u. Boehm, Deutsch. Arch. f. Klin. Medicin, Bd. ix.,211, 239, 1871. Bouty, These de Paris, 1874, No. 437. Siebert u. Boehm, Arch. d. Heilk., Bd. xii., 6. Heft, 1871, p. 522. Wertner, M., Wien. Med. Presse, 1876, 269. Ziolkowski, Apomorphin. Inaug. Diss. Greifs- wald, 1872. Araroba or Chrysaroba. Fayrer, Med. Times, ii., 1874, pp. 470, 547, 1876 ; ii. p. 711. Thompson, I. Ashburton, British Med. Jour., May, p. 607, 1877. Arnica. p. SS5, Dec Balding, C. C, Lancet, vol. 1870. Fayrer, Practitioner, xvi., p. 52. White, Boston Med. and Surg. Journ., Jan., 1875, p. 61. Aromatic Compounds. Baumann u. Herter, Z. f. physiol. Chem., i., 244, ii., 335. Brieger, A. f. Anat. u. Phys., 1S79, Physiol. Abth. Suppl. Bd. s.61 (Pyrocatechin,Hydro- chinon, Besorcin). Arsenic. Bin/, u. Sehulz, Arch. f.Exp. Path. u. Pharm., Bd. xi., p. 200. Bergeron and Lemaitro, Brit. & For. Med. Chir. Beview, vol. xlviii., j). 226, 1871. Blake, Edin. Med. and Surg. Jour., 1889. Boeck, Von, Zeitschr. f. Biol., Bd. vii.. p. us, u. xii., p. 512; u. Centralbl. d. Med. Wiss, 1876, Ub. d. Zersetzung des Kiweisses, Miin- chen, ' ■. Bimmer, 1871, p. 11. Bohin u. Sch&fer, lib. den Einfluasdes Arson auf. Ungeform. Fermente,Wurtzbnrg Ver- nandlgen. N. F, Hd. iii., 1872. I'.rodie, Phil. Trans, 1811, 1812. [Jnterberger, Arch. f. exp. P. u. Pharm, Bd. xi, j). 89. BIBLIOGRAPHICAL INDEX. 1019 Arsenic. Cunze, Henle u. Pfeufer's Ztschr. f. rat. Med., 3,xxviii., p. 33, 1866, Schmidt's Jahrb., cxxxi., 19. Downie, K. M., Indian Medical Journ, 1872. D'Etiolles, Leroy, Gaz. Hebd., 1857, vol. iv. Fleck, Arch. f. Biologie, Bd. viii., p. 444. Flandin aDd Danger, Hausemann, Toxicolo- gic, p. 823. okl Fokker, Schmidt's Jahrb., clviii., 15. Fowler, Med. Rep. on Arsenic in Ague, etc., Lond. 1786. Gaethgens, Arch. f. exp. P. u. Pharm., Bd. v., p. 128 u. Centralbl. f. med. W., 1876. Gies, Arch. f. exp. Path. u. Pharm., Bd. viii., p. 175. Grohe, Fr. and Fr. Mosler, Virch. Arch., Bd. xxxiv., p. 213. Herapath, Philosophical Mag., 1851, p. 345. Heisch, Chas., Pharmaceutical Journ. and Trans., vol. i., 2d series, 1859, 1860, p. 556. Hoffman, Virch. Arch., Bd. 1. (50), p. 456. Imbert-Gourbeyre, Histoire des Eruptions arsenicales, Monit. des Hopit, 1857. Jager, Wirk. d. Arseniks auf Pflanzen, Stutt- gart, Schweizerbart, 1864, p. 113. Johanosohn, Arch. f. exp. P. u. Pharm., Bd. ii., p. 106. Jackson, .W. C, Amer. Journ. of the Med. Sciences, July, 1858, p. 57. Karajau, Tardieu, Sur l'empoisonnement, p. 335. Kendall and Edwards, London Pharmaceuti- cal Journal, ix., 1850. Kohler, H., of Halle, Brit, and Foreign Med. Chir. Rev., 1870, vol. xlv., p. 538. Kossell and Gaethgens, Arch. exp. Path, et Pharm. Bd. v., 133, and Centralbl. Med. Wiss., 1875, 530, 1876, 833. Lachese, Ann. d'Hyg. et de Med. legale, 1837, le serie, tome xvii., page 334. Lesser, A., Virch. Arch., Bd. lxxiii., p. 398, and lxxiv., p. 125, 1878. Leube, Deutsch. Arch. f. klin. Medicin, Bd. v., 372, 1869. Mass, Verhandl. d. Leipziger Naturforsch. Vers. 1872. Mackenzie, Ind. Med. Gazette, 1872. Maclagan, C, Edin. Med. Journal, vol. x., 1864, p. 203. Nunn, Emily A., Journ. of Physiology, i., 247. Pinkham, Boston Med. and Surg. Journ., 1878, vol. xcix., 358. Renner, Wiirtzburger Diss., 1876. Ringer and Murrell, Journal of Physiol., i., p. 213. Saikovski, Virch. Arch., Bd. xxxiv., p. 77. Saikowsky, Mosler u. Grohe, Virch. Arch. 1865, Sept. u. Oct., p. 208. Salomon, Alex., Wirk. kleiner Dosen Arsenik, Diss. Berl., 1873, p. 35. Sawitsch, Dorpater Dissert., 1854. Schmidt and Stiirzwage, Moleschott's Unters., vi. 3, 283, 1859. Schroff (senior), v. Zeitschr. d. Wiener Aerzte, N. F. ii., 44, Schmidt's Jahrb., 1860, cv., 176, 1860. Schulz, Arch. f. exp. P. u. Pharm., Bd. xi., p. 131. Sklarek, W., of Berlin, Reichert's Arch., 1866, p. 481, Schmidt's Jahrb., cxxxii., 290. Sturtzwage, Dorpater Dissert., 1859. Taylor, Guy's Hosp. Reports, vol. x., 3d series, 1864, p. 227. Unterberger, S., u. Bohm. Arch. f. exp. Path. u. Pharm., Bd. ii., p. 89, 99, 1874. Virchow, Virchow's Arch., Bd. xlvii., p. 524. Vogt, Lehrbuch d. Pharmacodynamik, 3te Aufl., Bd. i. Weir-Mitchell, New York Med. Journ., vol.i. Wyss, Arch. d. Heilkde., 1870, p. 15. Aspidospermin, vide Quebracho. Atropia. Anrep, Pfliiger's Arch., Bd.xxi., 1880 (chron. Atropinvergiftung.) Arlt, Arch. f. Ophthalmologic, 1869, p. 294. Bennett, Hughes, Brit. Med. Journ., 1874, vol. ii., 547, London Med. Record, 1877, p. 341. Bernard, CI., Physiol, u. Path, du Systeme Nerveux, Parts, vol. ii., p. 212. Bezold, V., u. Blobaum, Unters, a. d. physiol. Labor, in Wiirtzburg, Bd. i., 1867. Boehm, Stodien iiber Herzgifte, Wiirtzburg, 1871. Borelli, Ed. Med. Journ., Nov. 1871, vol. xvi., p. 480. Braun, Arch. f. Ophthalmologic, Band, v., Abth. ii., p. 112. Botkin, Virchow's Arch., Bd. xxiv., p. 83. Budge, Ueb. d. Bewegung der Iris, 1855. Chambers, Lancet, 1864, vol. i., p. 8. Da Costa, Amer. Journ. Med. Sciences, July, 1865, p. 71; Pennsylvania Hosp. Rep., 1858; Philad. Med. Times, Feb. 15, 1871. Dogiel, J. Max Schultze's Arch. f. microscop. Anat., Bd. vi., Heft, i., 1870, p. 85. Donders, The Accommodation and Refrac- tion of the Eye, Syd. Soc. ed., p. 584, 588. Fraser, Transaction of the Royal Society of Edinburgh, May, 1869, vol. xxv., 450, Bd. xxvi., 1872, with complete resume of older literature. Fraser, T. R., Bartholow, Oglesby, Nunnely, The Practitioner, iv., 65, 27, and 217. Graefe, Von, Deutsches Klinik, 1851. Harley, The Old Veg. Neurotics, London, 1869, p. 220. Hayden, Dublin Quarterly, Aug. 1863, p. 51. Heidenhain, Pfliig. Arch., Bd. v., p. 309. Hirschmann, L. Zur. Lehre v. d. durch Arz- neiin, etc., Reichert's Arch., 1863, p. 309. Iwanoff, Alex, and Alex. Rollett, Arch. f. Ophtham., vol. xv., p. 17. Jones, Wharton, Med. Times and Gazette, p. 28, vol i., 1857. Ladenberg, Ber. d. deutsch. chem. Ges. Jg., xii., 1879, p. 941. Lemattre, Arch. Generates, Aug., 1865, p. 173. Lichteniels u. Frohlich, Denkschr. d. Wien. Acad. Math. Naturw CI., 1852, p. 113. Meuriot, De la Methode physiol. en Thera- peutique et de ses Applications a" l'Etude de la Belladonne, Paris, 1868, p. 73. Norris, Wm. F., Amer. Journ. of Med. Sci., Oct., 1862, p. 395. Putnam, Miss Mary, New York Med. Record, 1873. Rossbach, Pharmakol, Unters, Bd. i., ii., iii., Wiirtzburg, 1873 (vide also Alkaloids). Rossbach, u. Frolich, Pharm. Unters. Wiirtz- burg, i., p. 6, N. F., v. 1874. Schroff, Zeitschr. d. Wien. Aerzte, 1852. Schmiedeberg, Arb. des Phys. Instit. z. Leip- zig, v., p. 41, 1870. Stellwag v. Carion, Der intraoculare Druck u. d. Innervations-Verhaltn. der Iris, Wien, 1868. Valentin, Y. Versuch einer physiol. Path- ologie der Nerven, Leipzig, 1864, 2e Abth., p. 368. Weir-Mitchell, Injuries of Nerves, Philadel- phia, 1872, p. 258. Wood, Amer. Journ. Med. Sci., Ap., 1873, p. 332 ; N. S., p. 128, Jan., 1871 ; Philadelphia Med. Times, vol. i., p. 290. Zeller, Virch's Arch., lxvi., p. 384. Barium. Bohm u. Mickwitz, Arch. f. exp. Path. u. Pharm., 1875, Bd. iii., p. 216. Brunton and Cash, Roy. Soc. Proa, No. 226, 1883; Phil. Trans., 1884; Cent. d. Med. Wiss., 1884, p. 545. Hermann, Toxicologic, 1191. Onsum, Arch. F. path. Anat., Bd. xxviii., p. 233. 1020 BIBLIOGRAPHICAL IXDEX. Bebeeru Bark. Albers, Yirch. Arch., Bd. xxiv., p. 304. Binz, Yirchow's Arch., Bd. xlvi., p. 130. Fliickiger, X. Jahrb. Pharm., 1S69. Gaingee and Maclagan, Edin. Rov. Soc. Trans., 1S69, p. 567. Walz, N. Jahrb. Pharm., xii., 1861, p. 302. Benzoic Acid. Bird, Golding, Urinarv Deposits, Philad., 1859, p. 160. Bucholtz, Arch. exp. Path. u. Pharm., Bd. iv., p. l. Brown, Zur Therapie der Diphtheritis, Arch. f. exp. Path. u. Pharm., Bd. viii., p. 140. Bryant, Lancet, ii., 1876, 747. Dougall, Med. Times and Gazette, i., p. 495, 1S72. Delcours, Gaz. des Hop., Dec, 1844. Fleck, Benzoesaure, Carbolsaure, Zimmt- saure, Mitnehen, 8vo., Oldenburg, 1875. Garrod, Memoirs of the Chem. Soc, i., 1842; London Lancet, ii., p. 239, 1844. Griibe, W., Centralbl. f. Chim., 1876, pp. 777, 778. Hallwachs u. Kiihne, Gotting, Nachr., 8, 1857. Saarsveld, A. f. exp. P. u. Pharm., x., 268. Jaffe, Ber. d. deutsch. chem. Ges., 1877, p. 1925. Keller, Ann. der Chem. und Pharm. xliii., 108 : Lancet, ii., Nov., 1844, p. 239. Lamaire, Phil. Med. Times, iv., 638. Meissener, u. Sbepard, Unters. lib. d. Enste- hen des Hippurs. im thier. Organismus, Hannover, S66. Morri, Trans. Phil. Coll. of Med., March, 7, 1855. Rhode, Berl. klin. AVoch., 1871, 10. Salkowski, E.> Berl. klin. "Wochens., 1875, 297. Seligshon, Chem. Centralbl., 1861. Shepard, U. C, Der Hippursaure im thier. Organismus, Hannover, 1866. Ure, Medico. Chir. Trans., xxiv., p. 30, 1841. Ure & Wood, Phil. Trans., March 7, 1856. Bexzol. Hoffmann, F. A., quoted by Bohm, Ziemssen's Cyclopaedia., vol. xvii., p. 513. Perrin, l'Union Med., 1861, No. 6, p. 92. Bichloride of Methylene. Richardson, B. W., Med. Times & Gaz., 1867, p. 470; Medical Times and Gazette, 1869, ii., 524; Brit. Med. Journ., vol. i., p. 332, 1871; vol. ii., p. 249, 1872; London Lancet, 1877, ii., 26. Bismuth. Beckf-r A: Jansen, Arch, der Pharm., Iv., 31. lxviii., 129, lxxvii., 231, lxxviii., 18. Bergeret & Mayenc, Journ. de l'Anatomie, 1873, p. 2 12. Feder-Meyer, Wiirtzburg Diss., 1879. anowitsch-Lebedeff, Virch.'s u. Hirsch's Jahresb., 1869, p. 325. Wiggers, Canstatt'a Jahresb. Pharm., 1848, p. 104, 1851, p. 105, 1-54, 109. Bitters. Buchheim u. Engel, in Buchheim's Beitr. z. Arzneimittellenre, Leipzig, 1849. Koehler, H., Tageblatt, d. 46 Naturforacher Versamml. zu Wiesbaden, 1873,8.70. liL.MTA Orientalis. I i nolotr, Lond. Record, 1877, p. 502. erger, Petersburg Med. Wochcnsch, 1876. Blood Boot. Smith, R. M., Amer. Journ. Med. Sci., Oct., 1876, p. 346. Borax. Binsvranger, Pharm. TVurdigung der Bor- saure des Borax, etc., 1846. Buchholz, Arch. exp. Path. u. Pharm., Bd. iv., p. 1. Copland, Diet, of Pr. Med. (Art., Abortion.) Dumas & Schnatzles, Pharmac Journ., Ap. 1S74. Gmelin, App. Medicaminum, i., p. 104. Guibourt, Histoires des Drogues simples, i., p. 191. Homberg, Mem. de l'Acad. des Sci. de Paris, 1702, 33. Richter, Ausfiihrl. Arzneiml., ill., p. 558. Yogt, Pharmakol., ii., 587. Wibmer, Wirk. d. Arzneim u. Gifte, v., 51. Brayera. Bedall, Sydenh. Year-Book, 1S68, p. 476; l'Union, 116, p. 596, 1S63. Leidesdorf, Wien. Med. ^Voch., xii., 26, 1871. Yiale, Journ. de. Chimie med., 5, ii., p. 207, Bromixe axd Bromide of Po- tassium. Anstie, Practitioner, xii., p. 19, 1874. Bartholow, The Bromides, 1871. Binz, Practitioner, xii., p. 6, Jan., 1874. Blake, Journ. of Ant., iv., 1, 1870. Clouston, Journ. Mental Sci., Oct., 1868, vol. xiv., p. 305. Clarke & Amory, Bromide of Potass., Boston, 1872. Eulenburg u. Giittmann, Schmidt's Jahrb., exxxvii., p. 158, 1868. Hammond, Quart. Journ. of Psycholog.Med., vol. iii., p. 46, 1S69. Laborde, Paris, A. Delahaye, p. 30, 1870. Marchand, R., These de Paris, 1S68, p. 32. Xamias, Compt. Rendus, lxx.. 16, p. 882, 1S70. Ozanam, Gaz. des Hop., No. 66, 1856. Podcopaw, Virch. Arch., xxxiii., p. 505, 1S65. Paul, C, Gaz. des Hop., 91, 1866. Purser, J. M. Dub. Quart. Journ., xlii., 94, May, 1869. Ringer, Sidney Lancet, i., p. 392, 1869. Teissier, Gaz. med. de Lyon., p. 501, Nov. 15, 1868. Williams, Obstet. Trans., xii., 249, 1871. Complete Literature, see Krosz, Arch. f. exp. P. u. Phaim., 1S76, Bd. vi., p. 46. Bromal Hydrate. McKendrick, J. G.., Ed. Med. Journ., July, 1874, p. 1. Rabuteau, Gaz., Hebdoni., xliii., p. 6S1. Steinauer, E., Virch. Arch., 1870, Bd. 1. p. 235, lix., p. 65. Brominated Camphor. Besnier, < . 119; Comptee Hend., A.ug., 1875. Cricbton-Brown, Eki, Pfliiger's Arch., Bd. v., p. 210, 335, 1872, Centralbl. med. Wiss. 1876, p. 818. Schafter, Journ. f. pract. Chimie, N. F. xviii., p. 282. Senator, Berl. kin. Wbchenschr., 1876, p. 69. Sonnenburg, Dent. Zeits. f. Chir., Bd. ix., p. BtSdeler, Ann. d. Chem. u. 1'harm., Bd. l.w.w ii.. p. 17. Stevenson, Brit. Med. Journ., vol. i., p. 142, 1870: and Guy's Eosp. Rep., 1868, p. 407. Bchmidt, T., Centralbl. f. Chir., 1876, 552. Tauber, Z. r phys. Chem. ii. : 866. i rmmetnun, < idttingen I>i>s., 1873. Volkmann, Yolkmann's Samml. Klin. Vorr., 1875, >'(>. xcvi., in Beit. /. Chir., p. 12. Waldenstrom, Zeitsclir. d. allgemeinen Apo- thek. Vereins, Jan. 10, 1872. Wilson, Erasmus, Journ. Cutaneous Med., June, 1870. Carbon. Liebermann, Sitzber. d. k. k. Acad. d. Wiss.. Wien, 1S77, p. 321. Stenhouse, Economical Applications of Char- coal, 3d ed., Lond., 1855. Carbonic Acid. Basch, von, u.'Dietl, Wien, m. Jahrb., 1870» xxvi., 3. Beddoes, on the Med. Effects of Factitious Airs, p. iv., p. 42. Bernard, CI., Subst. toxiques, etc, p. 135. Bert, Comptes Bend. T., Ixxxvii., p. 628. Buchheim, A. f. Exp. P. u. Ph., Bd. iv., p. 137. Christison on Poisons, 3d ed., p. 745. Donder's, Pfliiger's Arch., Bd. v., p. 20. Friedlander u. Herter, Z. f. phvsiol. Chem., 1S78, ii., y9, and 1879, iii., 19. Heidenhain u. L. Meyer, Stud. d. physiolog. Instit. zu Breslau, Bd. ii. Hickman, Seance de l'Acad. Boy., Sep. 24, 1828. Humboldt, von, U. ub. d. gereizte Xerven u. Muskelfaser, ii., p. 321. Hermann, L. Exper. Toxicologic, 1S74, p. 118. Liebig, G., Arch. f. Anat. u. Physiol., 1850, p. 401. Pfluger, Pfliiger's Arch., Bd. i. Priestley, on Airs, vol. i., p. 302. Preyer, Wiener Acad. Sitzber. Math.-nat, CI. Bd. xlix. ; Pfliiger's Arch., Bd. i., p. 395. Quincke, A. f. exp. P. u. Ph., vii., p. 101, 1877. Setschenow, Wiener Acad. Sitzungber, Math.- nat, CI., Bd. xxxvi. ; Z. f. rat. Med., Bd. x., p. 101 ; Centralbl. t. d. med. Wiss., 1873, p. 355, 1877, 625, u. 1879, p. 369. Zuntz, Centralbl. f. d. med. Wiss. Bonner Diss., I860, Berl. klin. AVcchenschr. 1S5, 1870. Carbonic Oxide. Friedberg, Die Vergift. durch Kohlendunst> Berlin, 1866. Hoppe-Sevler, Virch. Arch., 1857, Bd. xii. Ktihne, Centralbl. f. d. med. Wiss., 1864, p. 134. Lothar Meyer, Breslauer Diss., 1858. Poiikrowskv, Arch. f. Anat. u. Phvs., 1866 r p. 59. Senff, Dorpater Diss, 1862. Traube, Gesamnielte Beitriige, Berlin, 1878, iii. Chloral Hydrate. Adams, Lancet, i., pp. 212 and 567, 1870. Adrian, N. Y. Med. Journ., 1S70. Andrews & Da Costa, Amer. Journ. Med. Sci. > April, 1870, p. 359. Anstie & Andrews, Amer. Journ. of Insan.> July, 1871. Beck, Jos. B., St. Louis Med. and Surg. Journ., June, 1872. Bouchut, N. Y. Med. Gaz., Dec, 1870. Bradburv, J. B., Brit. Med. Journ., vol. 1, p. 363, 1871. Brunton, Lauder, Journ. Anat., viii., p. 332, 1874. Clarke, Lancet, May 2, 1874, p. 643. Clemens, Schmidt's Jahrb., Bd. cli., p. 105. Demarquay, Bull. Therap., t, lxxvii., p. 307. Dieulafoy & Krishaber, Amer. Journ. Med. Sci., Jan., 1870, p. 284. Djurberg, Schmidt's Jahrb., Bd. cli., p. 84. Dujardin-Beaumetz & Hirne, Bull. Therap., lxxxvi., p. 224, 1872. Elliott, G R, Lancet, 1873, i., 754. Fuller, H.W., Lancet, March, 403, 1871. ( rascoyen, Brit. .Med. Journ., vol. i., p. 91, 1872. Giovanni & Bauzoli, Schmidt's Jahrb., lid. cli., p. 91. Hannnarsten, Deutsche Klinik, 1 Schmidt's Jahrb., Bd. cli., p. 90. BIBLIOGKAPHICAL INDEX. 1023 Chloral Hydrate. Keen & Personne, Phila. Med. Times, vol.iv. p. 385. Keen, Schmidt's Jahrbiicher, clxxvii., p. 139; Ainer. Journ. Med. Sci., July, 1875, pp. 76 and 150. Kirn, Ludwig, Allgem. Zeits. f. Pschychiatrie, xxix., 1872; Practitioner, vol. x., p. 361. Leavitt, Amer. Journ. Med. Sci., Ap., 1871, p. 363. Levinstein, Lancet, i., p. 279, 1874. Lewisson, Reichert's Arb. f. Anat. u. Phys., . 1870, p. 348. Liebreicb, Chloralhydrat, ein neues Hypno- ticum, Berlin, 1869 ; Wiener Med. Wochens., Aug., 1869, p. 1087. Macnaniara, Pract., vol. ix., 257. Morgenstern, Wien. Med. Presse, Nov., 1871, p. 1212. Mosso, Schmidt's Jahrb., clxxvii., p. 138. Murchison, Lancet, ii., p. 596, 1870. Owsjannikow, Leipz. Acad. d. W., 1871. Pellogio, Schmidt's Jahrb., Bd. cli., p. 89. Personne, Journ. de Pharm. et de Chimie, 1870, p. 1. Playfair, Lyon, Lancet, 1874, vol. i., p. 263. Rajewski, Centralb., f. d. med. Wiss., 1870, p. 211; Schmidt's Jahrb., Bd. cli., p. 90. Rehn, Jahrb. f. Kinderkrankh., 1871, p. 430. Reynolds, Practitioner, 1870, iv., p. 188. Richardson, Med. Times and Gaz., vol. ii., p. 374, 1870. Rigden, Practitioner, vol. v., p. 151, 1870. Russell, Glasgow Med. Journ., Feb., 1870, p. 209. Schmidt's Jahrb., Bd. cli.; Kohler's Abstracts of papers. Schule, Allgem. Zeitschr. f. Psych., xxviii., p.l. Smith, N. R.,Bost. Med. and Surg. Journ., vol. viii., p. 33, 1871. Tomasczewitz, Pfl tiger's Arch., Bd. ix., p. 35. Watson, Med. and Surg. Reporter, Jan. 27, 1871. Waterhouse, Practitioner, Dec, 1870, vol. v., p. 344. Widenhofer, Bost. Med. and Surg. Journ., 1874. Chloride of Sodium. Becquerel & Rodier, Gaz. de Paris, xlviii., 1844. Bert, P., Comp. Rend., lxxiii., p. 382. Berzelius, Lehrbuch, ix., p. 98. Guttmann, Klin. Woch., 1865, xxxiv.-xxxvi. Hoppe, Deutsche Klinik, xxxii., 1863. Klein u. Verson, Centralb. f. med. Wiss., 1867, p. 788. Lehmann, Physiol. Chem., i., p. 440, ii., 171, 241, iii., 141, 255. Chlorate of Sodium. Nasse, H., R. Wagner's Handworterbuch, i., (Art, Blut.), p. 167. Panum, Virch. Arch., iv., 1852. Poggiale & Plouviez, Comp. Rend., xxv., p. 110. Rabuteau, Bull, de Therap., lxxxi., 1871, p. 562. Voit, Unters. iib. d. Einfluss d. Kochsalzes, &c, Miinchen, 1860. Wiscknewsky, Canstatt's Chimie, p. 116,1867. Chloroform. Anstie, Stimulants and Narcotics, p. 321. Baudin, Le Progres Med., Sep., 1874. Bernard, CI., Lecons sur les Anesthesiques, Paris, 1875. Bernstein, Centralb. f. d. med. W., 1867, Bd. v., p. 38; Schmidt's Jahrb., Bd. clxii., p. 218. Bert, Comp. Rend., t. lxiv., 1867; Journ. of Anat. & Phys., May, 1870, p. 312. Bonwetsch, Dorpater Dissert., 1869. Chloroform. Bottcher, Virch. Arch., Bd. xxxii., p. 126. Bowditch, H. P., & C. S. Minot, Boston. Med. & Surg. Journ., May, 1874. Carter, Brit. Med. Journ., vol. i., p. 208, 1867. Chloroform Committee, Med. Chir. Trans., vol. xlvii., p. 326. Dogiel, Arch. f. Anat. u. Phys., 1866. English Chloroform Committee, Medico-Chir. Trans., 1864, vol. xlvii. Glover, Ed. Med. Journ., 1842, pp. 709 and 1009. Gosselin, Arch. Gen., 1848, vol. xviii., p. 385. Harley, Phil. Trans., London, 1865. Hartmann, Giessener Dissert,, 1855. Hermann, Arch. f. Anat, u. Phys., 1866, p. 27. Holmes, E. L., Chicago Med. Examiner, Sep., 1868. Husemann's Abstracts in Virchow-Hirsch's Jahresber; Schmidt's Jahrb., Bd. cli., p. 80. Knoll, Wien. Acad. Sitzber., 1874, 1876 u. 1877. Lallemand, Perrin, Duroy, du Role de 1' Al- cohol et des Anesthesiques, Paris, 1860. Leute, T. D., Psychol. & Med. Legal Journ., Feb., 1875. Noel, Lond. Med. Record, 1877, p. 457. Nothnagel, Berl., klin. Wochenschr., 1866, Bd. iii. Ranke, H, Centralb. f. med. W., 1867, p. 209 u. 1877, No. 34, p. 608. Richardson, Med. Times & Gazette, 1866-1870. Sabarth, Das Chloroform, Wurzburg, 1866. Sansom, Chloroform, p. 55, Philadelphia, 1866. Scheinesson, Dorpater Diss., 1868, u. Arch. d. Heilk.,Bd. x., p. 36. Schenk, Sitzbericht d. Wien. Acad. M. N. CI., 1868, Bd. lxviii. Schmidt's Jahrb., Bd. cxlii., cxlv., cli., H. Kohler's Abstracts. Schmidt, A., u. F. Schweiger-Seidel, Ber. d. Konig, Sachs. Gesell. d. Wiss. Math. Phys. Klin., 1867, p. 190. Schmiedeberg, Dorpater Diss., 1867. Simpson, Edin. Month. Journ. of Med. Sci., 1847, p. 33, and 1848, p. 315. Simonin, Centralb. Chir., 1876, p. 234. Snow, On Chloroform and. other Anaesthetics, London, 1858. Westphal, Virch. Arch., Bd. xxvii., p. 409. Winslow, W. H., Phil. Med. Times, vi., p. 275. Chrysophanic Acid. Gehe's Handelsberichte, 1878 u.1879. Squire, Centralbl. f. d. med. Wiss., 1877, p. 384, u. 1878, s. 699. ClMICIFUGA. Chapman, N., Elements of Therap., 6th ed., vol. i. Davies, N. S., Trans. Amer. Med. Assoc, 1848, vol. i., p. 351. Young, Amer. Journ. Med. Sci., vol. ix., 1831, p. 310. Cocaln. Anrep, Pfliiger's Arch., Bd. xxi., 3, 38 (with complete list of literature). Bennett, A. Hughes, Edin. Med. Journ., Oct., 1873. Koller, vide Cent. f. d. med. Wiss., 1884, p. 870; Jessop, Practitioner, xxxiv., p. l. Codeia, vide Opium Alkaloids. Barbier, Gaz. Med. ii., p. 147, 1834. Barnay, De la Codeine, Paris, 1877. Baxt, W., Reichert's Arch., 1869, p. 125. Berthe, Compt, Rend., lix., p. 914, 1865. Cruni Brown and Fraser, Proceed. Roy Soc of Edin., xxv., Jan. 6, 1868. Des Brulais, Mon. des Hop., xcvi.,p. 767, 1856. Dumont, Mon. des Hop., xxviii., p. 221, 1858. 1024 BIBLIOGRAPHICAL INDEX. Codeia, vide Opium Alkaloids. Falck, Deutsches Klin., 1870. Guibert, Nouveaux Med., 397. Husemann. Pflanzenstoffe, p. 155. Harley, Old Veg. Neurotics, p. 179. Krebel, Med. Ztg. Russlands, 1856, p. 59. Kunkel, Journ. de Chimie Med.,xi., 223, 1S33. Mitcbell, "Weir, Ainer. Journ. Med. Sci., Jan., 1S70, p. 26. Myrtle, Brit. Med. Journ., 1874, i., 478. Ott, Opium Alkaloids. Scbrotf, Yon, Pharmakologie, 3 Aufl., p. 483. Wacbs, L., Das Codein, Diss. Marburg, 1858. COLCHICUM. Albers, Deutscbe Klinik, 1856. Bacmeister, Arcb. d. Pbarmacie, 1857. Bird, Urinary Deposits, Pbila., 1859, p. 354. Garrod, A. B., Med. Cbir. Trans., 1858, xii., 348. Geiger, Annal. Cbem. Pharm., vii, 274. Hammond, Proc. Pbila. Acad. Nat. Sci., Dec, 1858. Hoppe u. Ascboff, Vierteljahrs. f. Prakt. Pbarm., vi. Krabmer, Journ. f. Pbarmacodynamik, ii., 561. Lewins, P., Ed. Med. and Surg. Journ., 1841, vol. lvi., p. 200. Ludwig and Pfeiffer, Arcb.der Pbarm., cxi., 3. Maclagan, Ed. Monthly Journ. of Med. Sci., 3d series, vol. xiv., p. 24. Major, G. W., Canada Med. Surg. Journ., Dec, 1873. Percy, S. B., Amer. Med. Times, Ap., 1862, p. 173. Rossbacb, Pbarm. Unters., Bd. ii., 1876, s. 1-58. Schroff, V., Zeitscbr. d. Ges. d. Aerzte, 1851, u. osster. Zeitscbr. f. prakt. Heilk., 1856. Scudamore, On Gout, London, 1835. Taylor, Med. Juris., 2d ed., vol. i. Wood, Geo. B., U. S. Dispensatory, 13tb ed., p. 1504. Colocynth, vide Purgatives. Bucbheim, Die scbarfen Stoffe, &c. Husemann, Handbucb d. Toxicol., p. 525. Marine, W., Zeits. f. rat. Mediz., xxvi., 61. Scbrott', Von, Pbarmacologie, 4 Aufl., p. 368, 1873. CONDURANGO. Brunton, Lauder, Journ. of Phys., v., 17. Ernst, Yjhrschr. f. ger. Med., xvi., 2, p. 321, u.Scbmidt's Jahrb., clvii., p. 121. Friedreich, Berliner Klin. Wocbenschrift, 1874, No. 1. Gianuzzi, Cent. f. d. med. Wiss., 1873, p. 824. Hulke, Centralb. f. d. Med. Wiss., 1872,p. 111. Obalinski, Centralbl. f. Cbir, 1874, No. 12, p. 177. Riegel, Berl. klin. Wochenschr., 1S74, No. 35, u. 36. Sanctis, De, Schmidt's Jahrb., clvii., p. 121. Sandahl, Hygiea, 1872, p. 14, and Schmidt's Jahrb., clviii., p. 121. BchrofF, un., Schmidt's Jahrb., clviii., p. 211. Copaiba. Bernatzik, Pr&ger. Vierteljahrs., lid. c, 1868, p. 289. Blanchard, Gaz. des Hop., xl.,i*52. Gubler, Comment. Therap. du Code, p. 88, Bull, de la Boo. dc Thfirapeut., l, series \ \ i. Mitseherlik, PreUss. Vereinsz., xix., 22, 1848. Bees, i ruy'a Hosp. Rep., vol. xvii. Schweizer, Poggeild. Ann., Bd. xvii., pp. 487 and 1095. Valentine, Grundrias der Phya. Weikart ll , Arcb.d. Heilk., 1860,p. 170. \\iik-. Lancet, i., 12, Mar., j.. 410, 1878. Copper. Bailly, l'Union, 6, 1874; Schmidt's Jahrb., clxiii., 1874, iii., Bd., p. 61. Bergeret u. Mayengon, Journ. de l'Anat. et Phys., 1873. Blake, Frank's Magaz., ii , 405, Blasius, Zeitschr. f. rat. Med., 3 Beihe, Bd. xxvi., p. 240. Buchner, Toxikol., 2 Aufl., p. 525. Burq, Ducom, Schmidt's Jahrb., 1878, Bd. clxxviii., 14; Archde Phvs. Norm, et Path., 1877, t. iv., 183. Clapton, Med. Times and Gaz., vol. i., p. 658, June, 1868. Clemens, Schmidt's Jahrb., exxxi., p. 82, 1866. Falck, Deutsches Klinik, xi., 1859. Faulk, Deutsch. Klin., x., 439. Galippe, Etude toxicol. sur la Cuivre, Paris, 1875; Comptes Bendus, t. lxxxiv., pp.404 and 718. Harnack, Arch. f. exp. P. u. Pbarm., Bd. iii., p. 46, u. Bd. ix., p. 162, 1874. HonerkopfF, Ueb. d. Anwend. d. schwefel- sauren Kupferoxydes gegen Croup. Leip- zig, 1852, p. 60. Lieberkiihn, PoggendorfT's An., 1852, Bd. lxxxvi. London Clinical Soc. Transactions, 1870, p. 13. Merat et de Lens, Diet. univ. de Mat. Med., ii., p. 67, Mitscherlich, Midler's Arch., 1837, p. 91. Neebe, Marburger Diss., 1857. Pierre, St. and Pecholier, Med. Centralbl., 1854, p. 270. Wibmer, Wirk.der Arzneim. u. Gifte, ii.,260. 1838. COTO. Albertoni. Arcb. f. Path. u. Pharm. xviii., 291. Burkhart.Berl. klin. Wocb., 1877, p. 276. Jobst, Ber. d. deutsch. chem. Ges., 1876, No. 17. Croton Oil, vide Purgatiyes. Adams, Husemann, Toxicol., Bd. ii., p. 443. Brunton, Lauder, Practitioner, xii., 346. Bucbheim, Virchow's Arch., xii., 1. Giacomini, Stille, Therapeutics, vol. ii., p. 451. Hertwig, Stille, Therapeutic-, 2d ed., vol. ii., p. 449. Joret, Bull, de Therap , lxi., p. 385, 1861. Badziejewsky, Casuistik der Vergiit. bei Huse- mann. Handbucb, p. 442, u. Pflauzen- storte, p. 111: 1 .. Wibmer, Wirkungen, cv.e., ii., 222. CUBEBAS. Adams, Edinb. Med. Surg. Journ., xv., 61. Bernatzik, Prag., Vierteljahrs., 1864, B.lxxxi., p. 9. Clarus, Arzneiml., p. 728. Crawford, Edin. JVIed. Surg. Journ., xiv., 32. Crane, Edin. Med. Surg. Journ., xxi., 802, Godecke, Preuss. Yereinsz., 34, 35, 1850. Curare. Bucbheim u. Loos, Ueber d. pharmakolog. Gruppe des Curarins, Giessener Dissert., 1S70. Bernard, CI., Leeons sur les Substances i<>.\- ifjucs, Paris, 1857, ]>. 888. Bezold, Reichert's u. Bois Arch., 1859. Colasanii, PflUger's Arch., Bd. xvi., p. i"i7. ' EJckhardt, Beitr. z. An. u. Physiol., Bd. vi., p. 19, GleS8en, 1871 (Historical). Funke, Ber.d. k. sflchs. Acad., 1869. Hermann, Pfliiger's Arch., Ba. xviii., p. 458, 1S78. Ktflliker, Vlrch. Arch., Bd. x„ p. l. BIBLIOGRAPHICAL INDEX. 1025 Curare. Kiihne, Reichert's u. Du Bois' Arch,, 1860, p. 477. Rohrig u. Zuntz, Pfliiger's Arch., Bd. iv., p. 57, 1871. Steiner, J., Reichert's u. Du Bois' Arch., 1875, u. eigene Schrift. Leipzig, 1877. Zuntz, Pfliiger's Arch., Bd.xii., p. 522, 1876. Cyanogen, vide Prussic Acid. Daturia. Laurent, Ch., These, Paris, 1870, p. 22. Digitalis. Ackermann, Deutsch. Arch. f. Klin. Med., Bd. xi., 9, p. 135; Volkmann's samnil. Klin. Vortrage, No. 48, Leipzig, 1872. Bert, P., Gaz. Med. de Paris, xi., 1873. Boldt, Inaug. Diss., Schmidt's Jahrb., March, 1872. Bohm, Pfliiger's Arch., Bd. v., 4 u. 5, p. 153, 1872. Bordier, Bull. Therap., 1868, vol. lxxiv., p. 110. Brunton, Lauder, on Digitalis, London, 1868. Brunton & Meyer, Journ. of Anat. and Phys., vii., 1872, p. 134. Coblentz, Z. E., Strasburg Thesis, 1862. Costa, Da, Amer. Journ. Med. Sci,, Jan., 1871, p.l. Dybkowsky, W., and E. Pelikan, Zeitschr. f. Wiss.Zool., Bd. xi., 1852. Dickinson, Med. Chir. Trans., vol. xxxix., p.l. Eulenberg u. Ehrenkaus, Med. central Z., xxviii., 777, 1859. Fagge and StevensoD, Proceed, of the Royal Soc. London, vol. xiv., p. 270. Fothergill, Digitalis, Lon., 1871 ; Brit. Med. Journ., pp. 5, 27, 57, 90, 115 and 146, 1871. Gortz, Schmidt's Jahrb., Bd. clviii., Unters. iib. Digitalis Praparationen,Dorpat, 1873. Gourvat,Gaz. Med. de Paris, 1871. Gaunot, Phila. Med. Times, iv., 30. Hammond, Proc. Biol. Dep. Acad. Nat. Sci., Phila., Dec, 1858 ; Am. Med. Journ., Jan., 1859, p. 275. Homolle, Arch., Gener. de Med., July, 1861, p. 5 ; Journ. de Pharm. et de Chimie (3), vii., p. 57. Kohler, H., Arch., Exp. Path.u. Pharm., i., 2, p. 138, 1873. Kohnhorn, Lancet, 1876, i., p. 582. Koppe, Arch. f. Exp. Path. u. Pharm., Bd. iii., p. 274. Kosmann, Bull, de Therap., lix., July, p. 60, 1860. Lorain, Paul, Journ. de l'Anat. et Phys., 1870, p. 128. Meihuizen, Arch. f. Phys., vii., p. 201, 1873. Meusnier, Aug., De PAction de la Digitale sur la Fonction glycogenique, Paris, Thesis, 1868. Meyer, A. B., Arb. u. d. Phys. Inst, zu Zurich, Centralbl. f. med. Wiss., xvii.,p. 270, 1869. Onimus, Journ. de l'Anat. et Phys., ii., 337, July, 1865. Paul, C, Bull. Therap., 1868, lxxiv., p. 193. Perrier, Arch. f. Exp. Path. u. Pharm., Bd. iv., p. 191. Quevenne, Homolle et, Arch, de Phys. de Therap., etc., par Bouchard at, i., 1854. Ranvier, Comptes Rendus, 1869, vol. lxix., p. 1327. Roucher, Practit.,ix., p. 304, 1872. Sanders, Edin. Med. Journ., iv., 369. Schmiedeberg, Arch. f. Exp. Path. u. Pharm., Bd. iii., p. 16. Schroff, v., Wien. W. S., xxiv., Wochenblatt d. k. k. G. der Aerzte z. Wien., xx., xxii., 65 Digitalis. Skoda, Wien. m. Presse, xiii., Jahrb., 142, p, 21, 1864. Stadion, Prager Viertehahrs. f. d. prak. Heilk., 1862, Bd. lxxiv., p. 97", 1872; Sydenham Soc. Year-Book, 1862, p. 451. Stannius, Arch. f. phys. Heilk., Bd. x., 1851, p. 177. Tardiau, Clinique, p. 685, Obs. viii., Paris, 1867. Traube, Annalen. d. Charitekrankenh. in Berlin, 1851, Bd. ii., p. 1; Gesammelte Bei- trage. z. Path. u. Physiol., Bd. i., Berlin, 1871; Med. Central. Z. xxx., 94, 1863; Berl. Klin. Woch., vii., 201, 213, 1870, xxxi., xxxiii., 1871. Vulpian, Comptes Rendus de la Soc. de Biol,, 1855, p. 70. Weil, A., Reich. Arch. f. Anat., 1871, p. 252. Winkel, Phila. Med. Times, 1874, iv., p. 6, p. 554, 1861. Winogradoff, Virch. Arch. f. Anat.,Bd. xxii., p. 457. Wood, Amer. Journ. Med? Sci., July, 1871. W underlich, Manual Med . Therm ., Sydenham Soc. Transl., p. 325. DUBOISIN. Mamie, Nachr. v. d. k. Ges. d. Wiss. u. d. G. A. Universit. zu Gottingen, 1878, No. xii., p. 413. Elaterium. Gibson, Brit, Med, Journ., Nov., 1861. Kohler, Virch. Arch.,Bd. xlix., p. 408, L. 2, p. 273, 3, 375, 1870. Morries, Repertor. f. Pharm., xxxix,, p. 134. Schroff, Von, Pharmakologie, 4te Aufl., 371, 1873. Stille, Therap., vol. ii., p. 459. Emetine. Ackermann, Rostocker Diss., 1856. Carriger, J. H., New York Med. Journ., 491, 1878. Chouppe, Le Progres Med., 1874, p. 425; Bull, de Therap., June, 1874, 86, p. 481. D'Ornellas, Gaz. Med., 1873, p. 537. Duckworth, Dyce, Bartholomew Hosp. Rep., vol. v., p. 218, 1869, vol. vii., p. 91, 1871. Foulkrod, Phila. Med. Times, viii., p. 554. Harnack, E., Arch. f. Exp. Path. u. Pharm., Bd. ii., p. 299, iii., 44. Magendie u. Pelletier, Journ. d. Pharmacie, lix., p. 223, 1817. Orfila, Toxicol., i., 551. Pecholier, Comptes Rendus, Bd. Iv., 1862 ; p. 771, Gaz. Med., 1862. Podwyssotski, A. f. Exp. Path. u. Pharm., Bd. xi., p. 231, 1879. Pollichronie, L'Ipecacuanha, Paris, 1874. Weylandt, Eckhardt's Beitrage z. Anat, u. Physiol., Giessen, 1869, v. i., u. Inaug. Dissert. Woodhull, A. A., Atlanta Med. and Surgical Journ., 1875. Ergot, vide Secale Cornutum. Bailly and See, Bull. Therap., t. lxxviii., p. 435. Barlau-Fontayral, Journ. des Sci. med. pra- tiques de Montpellier, tomes vi., vii, Boldt, Schmidt's Jahrb., March, 1872. Bonjean, Traite de l'Ergot de Siegle, Paris, 1845. Boreischa, Arbeit. Pharm. Lab. Moskaw, i., 55. Bodin, Journ. des Connaissances Med., 1842. Brown-Sequard, Arch, de Phys., 1870, t. iii., p. 434. Buchheim, Berl. Klin. Wochenschr., 1876, p. 309, No. xxii. ; Arch. Exp, Path, u, Pharm., Bd. iii., p. 1. 1026 BIBLIOGKAPHICAL INDEX. Ergot, vide Secale Corntjtum. Clemens, Deutsches Klinik., 1865, 267. Christmann, Centralbl. f. d. rued. "Wiss., p. S00, Nov., 1869. Costa, Da,Amer. Med. Journ. Sci., Jan., p. 117, 1S75. Diez, Stille, Therap., 2 ed., vol. ii., p. 585. Dragendorff u. Podwissotzkv, Arch. f. exp. Path. u. Pharmak., Bd. vi., p. 153, 192. Duboue, Becherches sur les Proprietes therap. du Seigle ergote, Paris, 1873. Eberty, Hallenser Diss., 1873; Schmidt's Jahrb., Bd. clvhi., p. 127. Goodall, Proceed. Med. Soc. Pennsylvania, 1873. Hampel, Practitioner, vol. i., p. 263. Haudelin,Dorp. Diss., 1871; Schmidt's Jahrb., Bd. civ., p. 1-43. Hensinger, Journ. f. Pharmacodyn, Bd. i., p. 405. Hermann, Biichner's Bepertor. f. Pharm., 1871. Hildebrandt, Berl. Klin. Woch., p. 297, 1872. Holmes, Ch. L., Arch, de Physiol., t. iii., p. 38-4, 1S70. Kersch, Betz's Memorabilien , vol. xviii. Kitchen, Amer. Journ. Insan., July, 1873. Kobert, Practitioner, xxxiii., 409. Kohler, H., Virch. Arch., Bd. lx., p. 384. Langenbeck, Berl. Klin. Woch., p. 117, 1869. Le Gendre, Bull. Therap., t. lxxvii., p. 282. Levi, Lo Sperimentale, Aug.. 1875. Luton, A., Gaz. Hebdom., Oct., 1871, p. 610. Meadows, Practitioner, vol. i., 166. Nicitin, Kossbach's Pharm. Unters., Bd. iii., 1878. . Nicoll, P., and Mossop, Brit, and For. Med. Chir. Rev., vol. 1., 1872, p. 252. Oldwright, Canada Med. Journ., 1870,320, 321, 404. Ostere, Stille, Therap., 2 ed., vol. ii. Povet & Commarmond, Annal. de la Soc. de Med. de St. Etienne et de la Loire, 1863. Bamsbotharn, Principles and Practice of Ob- stetric Med. and Surg., Phila., 1860, p. 31S. Rossbacb, Pbarm. Unters., Bd. i. Salkowski, Berl. Klin. Wochenschr., 1876, p. 228. Schiiller, Berl. Klin. "Wochenschr., 1874, p. 305. Tanret, Bull. Therap., xciii., p. 231. Tulasne, Ann. Sien. Natur. Botan., 3e serie, t. xx., 1853. Vogt, P., Berl. Klin. Wochenschr., 1869, No. xii., p. 117, March, 1872, p. 115. Wernieh, Yircb. Arch., Bd., hi., p. 505, 1872; u. Beitr. z. Geburtsh., Bd. iii., Berlin, 1874. Winckler, Amer. Journ. Pharm., May, 1864. Woakes, Practitioner, vol. i., p. 257. Wood, Phila. Med. Times, vol. iv. Wright, S. A.. Ed. Med. and Surg. Journ., Oct., 1839, vol. Iii., p. 293. Zweifel, Arch. f. exp. Path. u. Pharm., Bd. iv., p. 387. Erigeron. Starke, Lond. Med. Bee, 1876, p. 267. Etjier Oil. Binz, Arch. f. exp. Path. u. Pharm., Bd. v., p. 109, Bd. nil, p. .",0. Bohm u. Kobert, ('., f. d. mod. Wiss., 1S79, p. 689. Grisar, Bonner Dissertation, 1873. Hogyes, Centralblatt f. d. med. Wissen., 1879, p. 32. Kohler and liis pupils, Schmidt's Jahrb., Bd. clxxiv., p. 19, 80, 121. Eucalyptus Oil. Arou, Schmidt's Jahrb., Bd. clvii., p. 239. Binz, Brit. Med. Journ., i.. L874, p. 15. Bolin, Berl. Klin. Wocheus., p. 110, 1872. Eucalyptus Oil. Brudell, Bull. Therap., May, 1875, p. 108, vol. lxxxix. Cortau, Montpellier Med., Mav, 1872. Gimbert, Arch. Gen., 1873, xxi., p. 141. Haller, Wien. med. Wochens., xxvi. Keller, Wien. med. Wochens., xxii., p. 227, 1872. Kohler, H., Arch. d. Pharm., 3 Eeihe, Bd. iii., Heft, 2. Lorrinser, Wien. med. Wochens., xix., xx. Martin, S., Bull. Therap., lxxxiii., p. 453. Mosler, Deutsch. Arch. Klin. Med., 1872, x., 160. Pappillon, Gaz., Hebdom., 1872, p. 501. Babuteau, Bull. Therap , lxxxiii., 549. Schlager, Inaug. Diss. Gottingen, 1874. Seitz, Bayer. Arztl. Intell. Blatt, 1870, p. 310. Siegen, Bonner Diss., 1873. Tristany, Buchner's Bepertor., xix., 1870. Fat. Lassar, Berl. Klin. Wochenschr., 1879, No. xviii., p. 261. Munk, J., Verb. d. physiol. Ges. in Berlin, Jahrg., 1877-79, No. 13. Gelsemtum. Bartholow, Lond. Practitioner, v., p. 203. Centralbl. f. d. med. Wiss., 1S76, p. 128, 320, 384, 608, 927; 1877, p. 783; lS78,p.652; 1880, s. 74. Court wright, Cincinnati Lancet and Obs., 1876, p. 963. Ott, Phila. Med. Times, v., p. 691, vii., p. 289. Binger and Murrell, Lancet, ii., 1875, p. 908, 1876, i., p. 83, 1876, vol. ii.. p. 78 and 569. Tweedy, J., Lond. Lancet, 1877, i., p. 833. Wormley, Amer. Journ. Pharm., 1870. Glycerine. Dujardin-Beaumetz and Audige, Bull.Thera., xci., p. 62. Eckhard, Centralbl. med. Wiss., 1876, p. 273. Luchsinger, Pfliig. Arch.,Bd. xi.,p. 502; Cen- tralbl. med. Wiss., 1877. Lewin, L., Z. f. Biologie., 1879, Bd. xv., p. 243. Munk, J., Verh. d. physiol. Ges. zu Berlin, 13, Dec, 1878, u. Virch. Arch., Bd. lxxvi., Heft 1, p. 119. Schultzen, Berliner klin. Wochenschr., 1872, No. xxxv., p. 417. Schwann, Lekhart's Beitrage z. Anat. u. Physiol, viii., p. 159. Ziemssen'sEncyclop., vol. xvi., for Literature. GUAIAC. Bell, Lond. Med. Gaz., Oct., 1840, p. 202. Bryden, Brit. Med. Journ., No. 47, 1857, p. 967, No. 97, p. 927, 1858. Husemann, Die Ptianzenstoffe, p. 1106. Sandras, Bull, de Ther., v., 371. Walker, Brit. Med. Journ., vol. i., p. 528 and 660, 1864. Wood, U. S. Dispensatory, p. 1233. Hellebore. Helm, Wiirzburger m. Z. S., ii. 5, 6, p. 448, 1861. Marine, Z. f. rat. Med., 3 Reihe., Bd. xxvi., p. 1098. Scattergood, EL, Journ. de Bruxelles, xxxix., p. 550, In) I. Sch rod", Von, Pra'ger. Vierteljahrss., lxii., 1859, p. 19, 95, 106, lxiii., p. 95. Hyoscya.mia. Earley, old Veg. Neurotics. Eellmann. Beitr. d. phys. W'irk.des Ilyoscya- inins, DiBS. Jena, 1873. BIBLIOGRAPHICAL INDEX. 1027 Hyoscyamia. Heikuann, Beitr. z. Kenntniss d, phys. Wirk. des Hyoscyaniins, Jen., 1873. Hohn, Arch. d. Pharm., 1868, p. 215. Laurent, De l'Hyoscyauiine et de la Daturine, p. 15, Paris, 1870. Lernattre, Arch. Gen., 1S65, vol. vi. Oulinont, Bull. Gen. de Therap., lxxxiii., p. 481, 1872; Practitioner, vol. x., p. 1, 1S73. Schroff, V., Woch. d. Zeits. d. Gesellsch. d. Aerzte z. Wien, 1865. Iodine and Iodide of Potas- sium. Annuschat, A. f. exp. P. u. Pharm., x., 261 (Action in Lead Poisoning). Bachrach, Berl. Diss., 1878. Balfour, Ed. Med. Journ., xiii., p. 775, xiv., p. 33, xv., p. 47, xvi., p. 704; Brit. Med. Journ., 1874, i., 112. Behier, Nerven Centralorg., Schmidt's Jahrh., cxxvi., 162, 1865. Bernard, CI., Arch. Gener., 1S53, Bd. i., p. 5. Benedikt, M., Wien. Jahrb., xviii., ii., 94, 1862. Binz, Virch. Arch., Bd. lxii., p. 124, u. Arch. f. exp. P. u. Ph., Bd. viii., s. 309. Bock, V., Z. f. Biol., 1869; Bd. iii., 126; Bd. v., 393; Schmidt's Jahrb., Bd. cxlv., p. 142. Bbhm, u. Berg, A. f. exp. P. u. Ph., v., 337, 1876. Branne, Diss. Leipzig, 1856. Buchheim, Arch. f. exp. Path. u. Pharm., Bd. iii., 104. Chuckerbutty, Brit. Med. Journ., vol. ii., pp. 61 aud 85, 1862 (in Aneurysm). Cogswell, Edinburgh, 1837. Comdet, Froriep's Notizen, i., 55, 89, 1S22. Devergie Arch, gen. de Med., x., 2, p. 255, 1826; Frank's Mag., iii., i., p. 201. Dorpater Diss. v. Arroneet, 1S52; Strauch, 1852; Heubel, 1865; Sartisson, 1S66. Euleuburg, Berlin, Klin. W. S., xvi., 1870. Fournier, Centralb. f. d. med. W., 187S, p. 55. Issersohn, Berl. l^iss., 1877. Greeuhalgh, Brit. Med. Journ., vol. i., p. 52, 1868. Handheld, Jones, Beale's Arch., i. Heubel, E., Dorpat. Diss., 1865, p. 70. Kammerer, Yirch. Arch., Bd. fix., p. 459; Bd. lx., p. 527. Keith, Edin. Med. Journ., xviii., p. 1077, 1873. Kochler, Deutsche Zeitschr. f. pract. Med., 1877, No. xl. Melseus, Schmidt's Jahrb., Bd. cxxxiv., 19, 1867 ; Memoire sur l'Emploi de l'foduie de Potassium pour combattre les Affections Saturnines mercurielles et les allid. con- secut. de la Syphilis, Bruxelles, 1868. Pellikan, V., Beitrage zur Pharm. u. Tox. Wiirzb., 1858, p. 118. Kabuteau, Gaz. Med. de Paris, xix., p. 190, xxii., p. 302, xxiii., p. 313, 1869. Rilliet, Bull, de l'Acad. Roy., xxv. Ringer, Practit., March, 1872, vol. viii., p. 129. Rose, Arch. f. path. Anat., 1866; Bd. xxxv. Rosier, Frank's Mag., ii., p. 120, 136. See, Lond. Med. Rec, i., p. 757, 777. Sharpe, T. S., Amer. Journ. Med. Sci., Jan., 1876, p. 124. Taylor, R. W., Amer. Journ. Syphil. and Derma., April, 1873. Wallace, L, Liverpool Med. and Surg. Rep., 1871. IODOFORM. Binz, Arch. f. exp. P. u. Ph., viii., 309. Elsberg, Phila. Med. Times, Oct. 4, 1873, vol. iv., p. 4. Fereol, Bull. Therap., t. Ixxiv., p. 400, Mav, 1868. Hogyes, Arch. f. exp. P. u. Ph., x., 228. Izard, A. A., ISTew Treat, of Vener. Diseases, Boston, 1872. Iodoform. Kennedy, S., Med. and Surg. Rep., Jan., 1870, p. 50. Lazansky, Centralbl. Chir., 1876, 219. Moleschott, Wien, med. Wochenschr., 1S78 ; Lond. Med. Rec, Nov., 1878, pp. 350 and 464. Oberlander, Centralbl. f. d. Med. W., 1879, s. 336. Pelletan, Phila. Med. Times, iv., 695. Volker, G., Bull. Therap., t. lxxiii., p. 493, * Dec, 1S67. Ipecacuanha, vide Emetia. Ackermann, Beobachtungen iib. physiol. Wirk. d. Emetica, Rostock, 1856, 4 Diss. Cunningham, Edin. Med. J., vii., p. 25, July, 1871. Duekworth, Dyce, St. Barth. Hosp. Rep., v., p. 230, 1869, vii., p. 98, 1871. Higginbottom, Brit. Med. Journ., vol. i., p. 143, 1869. Pecholier, Comp. Rend., vol. lvi., p. 718, 1863. Schuchard, Arzneim., p. 586. Wibmer, Wirk. d. Arzneim. u. Gifte, ii., 77. Irritants, vide Oil of Mustard. Iron. Bernard, CI., L'Union Med., 1854. Becquerel, Simon's Chemistry, vol, ii., p. 254. Blake, Journ. of Anat. and Phys., p. 280, Nov., 1868. Cutler & Bradford, Amer. Journ. Med. S., f. 1S7S, p. 78. Complete list of Literature (228 Nos.) by Scherpf, in Rossbach's pharmakolog. Un- ters., 1877, Bd. ii. ; later works, Hamburger Z. f. phys. Chein., v. 1; Hoppe-Seyler, ii., p. 191. Mialhe, Chim. Appliquee, Paris, 1856. Mitscherlich, C. g. Preuss. Vereins. Z., 1846, xxi. Nasse, Lond. Med. Rec, 1877, p, 498 ; Wag- ner's Handworterb., Bd. i. (Art. Blut.) Podrowskv, W., Yirch. Arch., Bd. xxii., 5 and 6, p. 476, 1861. Quincke, Ueb. Siderosis, Festschr. z. Haller's Jubelf. Bern. Reichert u. Du Bois' Arch., vi., p. 757, 1868. Quevenne, Memoire sur l'Action phys. et therap. des Ferrugineux, Arch, de Phys., de Therap. et d'Hvgiene, Oct., 1854, p. 93. Sasse, A., Yierteljahrs. f. Prakt. Heilk., 1866, 2Bd. Scherpf, Resorpt. u. Assim. d. Eisens, Wiirzb., 1878. Simon, Animal Chem., Lond., 1845, Syd. Soc ed. Tiedemann u. Gmelin, Heidelberg, 1820. Jaborandi, vide Pilocarpin. Carville, Journ. de Therap., 1875, p. SI. Fereol, Journ. de Therap., Jan., 1875, p. 45. Galezowski, Med. Times and Gaz., 1877, ii., 558. Greene, Phila. Med. Times, vi., p. 56. Hardy, Journ. d. Therap., 88, p. 469, 1875. Langlev, J. > ., Brit. Med. Journ., 1875, vol. i., p. 241 ; Journ. d. Phys., 1878, p. 339 ; Journ. Anat., x., 188, 194. Luchsinger, PfKiger's Arch., xv., 482. Pillicier, Med. Centralbl., 1876, p. 430. Purjesz. Deutsch. Arch. klin. Med., xvii.. p. 533. Ringer, Lancet, i., 1875, p. 159; Lond. Pract., xvii., p. 401. Schwann, Med. Centralbl., 1874, p. 440. Scotti, Berl. klin. Wochens., 1877, p. 141. Stumpf, Deutsch. Arch. f. klin. Med., xvi., p, 255. Tweedy, Lancet, i., 1875, p. 159. Weber, Med. Centralbl, 1874, p. 770. 1028 BIBLIOGRAPHICAL INDEX. Jalap, vide Purgatives. Lactic Acid. Auerbach, A., Deutsch. Zeitschr. f. pract. Medicin, 1877, No. xlvii. Erler. Centralbl. med. Wiss., 1876, p. 658. Fischer, Lond. Med. Eec, 1877, p. 193. Lothar, Meyer, Virch. Arch., Bd. lxvi., p. 120. Mendel, Deutsch. rued. Wochens., 1S76, No. 17. Preyer, Centralbl. med. Wiss., 1875, p. 577. Botticher, Berl-. klin. Wochens., 1877, p. 537. Lead. Annuschat, A. f. exp. Path u, Pharm., Bd. Tii., p. 45, und Bd. x., p. 261. Bardenhewer, E., Berl. klin. Wochens., 1877, 126. Blake, Edin. Med. and Surg. Journ., lvi., 1, p. 116, 1841. Chatin, Comptes Eendus Soc. Biolog., t. iy., 1S62, p. 84. Cours, De, A., De l'Hemianaesthesia saturnine, Paris, 1S75. Debove et Renaut, Le Progres Med., 1876, 151. Eulenburg, A., Deutsch. Arch, fur klin. Med., Bd. iii., p. 506. Falck, Virch. Handbuch d. spec. Path, und Ther., ii., 1, 1855. Frank, A., Deutsch. Arch. klin. Med., xvi., 423. Friedlander, Virch. Arch., Bd. lxxv., p. 24, 1879. Gusserow, Arch. f. path. An., Bd. xxi. Harnack, A. f. exp. P. u. Pharm., Bd. iii., 54, 1874, Bd. ix„ 152. Henle, Zeitschrift f. rat. Med., 3 E., Bd. iv., u. Handb. d, rat. Path., 1847, Bd. ii., 179. Hermann, Arch. f. Anat. u. Phys., 1867, 64. Heubel, Pathogen, u. Sympt. d. chron. Blei- Tergift,1871; Virch. u. Hirsch's Jahrbiicher, 1871, vol. i., p. 316. Hitzig, Studien ii. Bleivergiftg., 1868. Kussmaul u. Merer, Arch. f. klin. Med., Bd. ix.,283. Lancereaux, E., Comptes Eendus de la Soc. Biol., liv., 3d ser., 1862, p. 84. Lewy, E„ Schmidfs Jahrb., Bd. clii., p. 250. Lewald, Enters, iib. d. Ausscheid. von Arz- neim., aus dem Organismus, Breslau, 1861. Malassez, Arch, de Phys., 1874, p. 50. Manouvriez, Arch. d. Phys. Normal et Pathol., 1870, 411, 1876, 762; Recherches cliniques sur l'lntox. Saturnine locale et directe, Paris, 1874. Paul, C, Arch. Gen., 5th series, vol. xv., 1860, p. 513. Eemak, Arch. f. Psvchiatr. u. Nervenkr., Bd. ix., Heft 3, p. 510." Renaut, Gazette med., 1878, No. 32, u. Centralb., f. d. med. W., 1S79, p. 159. Rosenstein, Arch. f. path. Anat., Bd. xxxiv., 1867, p. 4. Rosenstirn, Rossbach's pharmak. Enters. Wiirtzburg, 1874. Tanquerel des Planches, Die gesammten Blei- krankh., fibers v. Frankeuberg, 1842. Trousseau, Froriep's Notiz., xviii., No. 13, p. 207, 1827. Wood, Geo. B., Therapeutics, vol. i., p. 158. Lithium, vide Alkalies. Gibb, Eeport of Brit. Assoc for Advancement of Science, 1864 Mitchell, Weir, Anier. Journ. Medical Sci- ences, Oct., 1870, p. h:;. Lobelia. Ott, 1., Boet. Med. and Surg. Journ., 1875, vol. xcii., p. 121; Phila. Med. Times, vi., p. 121. Magnesium, vide Alkaline Earths. Manganese. Charvet, Bull. deTherap., lxxviii., p. 80, 1870, Lungengangran. Garrod, Med. Times and Gaz. Gmelin, U. S. Dispensatory. Laschkewitz, Journ. de B'ruxelles, Bd. xliv., p. 534, June, 1867. Leared, Glasgow Med. Journ., Jan., 1865, p. 488. Petrequin, Nouvelles Recherches du Manga- nese, 2 ed., Paris, 1852; Bull. Therap., Mar., 1852, p. 193. Williams, American Journ., N. S., cxvii., p. 74, Jan., 1870. Mercury. Baerensprung, Ann. d. Charite, 1856, Bd. vii., p. 2. Bamberger, Wien, med. Wochenschr., 1876, Nos. xi. u. xir. Boeck, V., Z. f. Biologie, v. 3, 1869; Schmidt's Jahrb., Bd. cxlv., p. 142. Foot, A. W., Dub. Journ. Med. Sci., 1873. Furbringer, Berl. klin. Wochenschr., 1878, No. xxiii., p. 332. Hassenstein, Konigsberger Diss., 1879. Heilborn, Arch. f. exp. Path. u. Pharm., Bd. viii., s. 361. Keves, E. L., Amer. Journal Med. Sci., Jan., 1876, p. 17. Kolliker, Th., Verh. d. Wiirtzburger phys. med. Ges., N. F., Bd. x., 1877. ■ Eussmaul, Inters, iib. d. constit. Mercurial, 1861, p. 17. Eewin, Charite-Ann., Bd. xiv. Mussy, N. G. de, Gaz. des Hopitaux, 1868. Oetlingen, V., Dorp. Diss., 1848. Overbeck, Mercur. u. Syphil., Berlin, 1861. Rmdfleisch, Arch. f. Dermatol., 1870. Saikowski, Virch. Arch., Bd. xxxvii., p. 346. Sigmond, Mercury, Blue Pill, and Calomel, Lond., 1840. Sigmund, Wien, med. Wochenschr., 1859. Stern, Berl. klin. Wochenschr., 1878, p. 59. Voit, Ueb. d. Aufnahme des. Q. u. seinerVerb., and Korper in his Phys. chem. Unters., 1857. Wilbouchewitcz, Arch, de Physiol., Sep., 1874, p. 509. Morphia, vide Opium Alka- loids. Muscarin. Bauerlein, Zur Accommodat. des menschl. Auges Wiirtzburg, 1876. Bogolowski, Centralbl. f. d. med. Wiss., 1870, p. 97. Harnack, Arch. f. exp. Path. u. Pharm., Bd. iv., p. 168, 1875. Krenchel, Arch. f. Ophthalni., xx., ii., p. 134. Schmiedeberg u. Koppe, Das Muscarin, Leip- zig, 1869. Schmiedeberg u. Harnack, Arch. f. exp. Path, u. Pharm., Bd. vi., s. 101, 1876. Musk. Barbier, Mat. Med., ii., p. 217. Eilchne, Sitzungsber. der Erlanger phys. med. lies., 1876: a. Centralbl. f. d. med. Wiss., 1876. p. 880. JSrg. Materalien ■/.. e. ■/.. Arzneimittellehre, p. 285, Leipzig, 1825. Tralles, Com.de rebus in Sc. Natur ct Med. golis, xxvi., p. 484. an & PidoUX, Traitr, etc., 8, ed. ii., p. 187. BIBLIOGRAPHICAL INDEX. 1029 Narcia, vide Opium Compounds. Albers, Vireli. Arch., vol. xxvi., p. 225. Baxt, Eeichert's Arch., 1869, p. 112. Belner&Debout, Bull.Therap., t. lxvii., p. 145. Bernard CI., Arch., Generates, 1864, 6e ser., t. iv., p. 459. Eulenberg, Schmidt's Jahrb., Aug. and Oct., 1866, cxxxi., p. 22. Fronmiiller, Schmidt's Jahrb., Bd. cxli., p. 15. Harley.The Old Veg. Narcotics, p. 143; Penn- syl. Hosp. Reports, 1868. Husemann, Pfanzenstoffe, p. 184. Kerseh, S., Schmidt's Jahrb., Bd. cxli., p. 15. Line, Journ. de Pharm., et de Chemie, 4e ser., t. iii., p. 386. Mitchell, Weir, Amer. Journ. Med. Sci., Jan., 1870, p. 17. Oetlinger, Inaug. Diss., Tubingen, 1866. Narcotics, vide Opium Alka- loids. Rumpf, Centralb. med. Wiss., 18S4, p. 366. NlCOTIN. Albers, Deutsche Klinik, 1851, ISTo. 32. Anrep, V., Du Bois-Reym, A. f. An. u. Phys. ; Phys. Abth., Jg., 1S79 ; Suppl. Bd., p. 167 ; u. Jg., 1SS0, p. 209. Basch, V., u. Oser.,Wien. Med. Jahrb., 1872, p. 367. Bernstein u. Dogiel, Yerhandl. des nat, Med. Vereins. zu Heidelberg, iv., 28. Benham, W.T., West Riding Lunatic Asylum Reports, vol. iv., p. 307, 1874. Bernard, CI., Substances Tox., p. 399, 410. Bibra, V., Die Narkot Genussmittel, 1855, p. 297. Blatin, Recherches, phys. and clin. sur la Nicotine et le Tabac, Paris, 1870. Bohm, Herzgifte, Wurzburg, 1S71, p. 12. Bon, Le, Med.Centralzeit xli., 1, June, 1872. Bottger, Buchner's Neue Repert. der Pharm., xvi., 579. Brodie, Phil. Trans., 1811, p. 17S. Buchheim u. Loos, iib d. Griippe d. Curarius, Diss. Giessen, p. 48. Eulenberg u. Vohl, Vierteljahrsschr. f. Ge- richtl. Medicin, Bd. No. 6, p. 249, xiv. Griinhagen, Centralb. fiir med. Wiss., 1S63, p. 577. Hammond, Amer. Jour. Med. Sci., p. 282, 1S57. Haushton, p. 55. Hirschmann, L. Reich. Arch., 1863, p. 309. Husemann, Handb. d. Toxicol., vol. ii., 483. Kolliker, Virch. Arch., x., p. 253, 1856. Krocker, Berl. Diss., 1855. Nasse, V., Beitr. z. Darrubewegung, Leipzig, 1S66. Namias, Comp. Rend., lix., p. 90, 1864. Orfila, Memoire sur la Nicotine et sur la Coni- cine, Bruxelles, Youker, freres, 1851. Praag, L. v., Virch. Arch., Bd. viii., p. 56. Rogow, Zeitschr. f. rat. Med., xxix., p. 1. Reil, Journ. f. Pharmacodvn,Bd. ii., p. 203. Rosenthal, Centralb. f. d.med. Wiss., 1863, p. 737. Schmiedeberg, Sitzber. d. E. Sachs. Acad., 1870. See, Nouveau Diet. d. Med. V. art, Asthma, p. 715, 1865; Journ. of Anat,, May, 1870, p. 315. Savory, The Lancet, 1863, vol. i., p. 549. Surminskv, Ztschr. f. rat. Med. (3), xxxvi., p. 205. Tscheschichin, Reich, u. Dubois' Arch., 1866, p. 151. Traube, Allgemeine Med. Central. Zeit., 1862. Truhart, Dorpater Diss.. 1869. Uspensky, Reich, u. Dubois' Arch., 1S68, p. 522. Yulpian, Comptes Rend, de la Soc. de Biol., 1851, p. 151. Wertheim, Zeitschr. d. k. k. Gesellsch. d. Aerzte z. Wien. 1851, 8. Nitrite of Amyl. Aldridge, Ch., West Riding Lunatic Reports, vol. L, p. 71. Amez-Droz, Arch, de Phys. Norm. et. Path., Sept., 1S73, p. 467. Arb, a. d.physiol. Inst. z. Leipzig, 1869 ; Journ. of Anat. and Phys., vol. v., p. 93 ; Loud. Clin. Soc. Reports, vol. iii. Balard, Ann. de Chimie et de Phys., xii., 1844, p. 294. Berger, O., Allgem. Med. Central Zeit,, May, 1871. Brunton, Lauder, Lancet, vol. ii., p. 97, 1867. Filehne, Pfl tiger's Arch., Bd. ix., p. 411 ; and Arch. f. Anat. u. Phvsiol., 1879, p. 385. Fothergill, Brit. Med. journ., 1874, i., p. 77. Gamgee, A., Philos. Trans., 1868, p. 589. Giacosa, Z. f. Physiol. Chimie, iii., p. 54. Grav, St. Clair, Glasg. Med. Journ., 1S71, p. 188. Guthrie, Ann. d. Cheni. u. Pharm., Bd. iii. Hoffmann, F. A., Reichert's Arch., 1872, 747. Jacobi, Mary Putnam, New York Med. Rec, Jan., 1875, p. 11. Jolvet u. Regnard, Centralbl. f. d. med. Wis;., 1876, p. 860; Gaz. Med. de Paris, 1876, No. 29. Ladendorf,Berl.klin.Wochens.,No. 43, 1S74, 537. Mayer, S., A. f. exp. P. u. Pharm., v., 55, 63. Mitchell, -Weir, Phila. Med. Times, 1872, vol. v., p. 353. Pick, fiber d. Amylnitrit, 2 Aufl., bei Hirsch- wald, Berlin, 1877; mit ausfiihrlicher alterer Literaturangabe, Centralbl. Med. Wiss., No. 55, p. 865, 1S73; Deutsch. Arch. Elin. med, xvii., 143. Richardson, B. W., Trans. Brit. Med. Assn. for Advance of Science, 1864-1872. Schuller, Berl. klin. Wochens., No. 25, 1874, 294. Urbantschitsch, Wien. Med. Presse, 1877. Wood, Amer. Journ. Med. Sci., July, 1871, p. 39. NlTROBEXZOLE. Bahrdt, Arch. f. physiol. Heilk., 1871, p. 320. Filehne, A., f. exp., P. u. Ph., ix., p. 339. Guttmann. Arch. f. Anat. u. Phys., 1866. Helbis;, Deutsche mil.-arztl. Zeitschr., Bd.ii., 1873. Letheby, Med. Chirurg. Review. Lewin, Virchow's Arch., lxxviii., p. 193, 1879. Poincare, Centralbl. f. d. med. Wiss., 1S79, p. 937. Nitrogen. Chevreul, Nouv. bullet, d. 1. soc. philomet,, 1816. Meyer, L. Zeitschr. f. r. Med. N. F., Bd. viii., p. 256. Regnault u. Reiset, Compt. Rend., Bd. xxvi. Nitroglycerin. Brunton, Lauder, andTait, St. Bartholomew's Hosp. Rep., 1S76, p. 140. Green, Practitioner, xxviil, 102. Murrell, Lancet, 1879, pp. 80, 113, 225. Pellikan, Beitriige. Nitric Oxide. Podolinsky, Arch. f. ges. Physiol., 1S72, Bd. vi., p. 553. Nitrous Oxide. Amory, N. Y. Med. Journ., Aug., 1870, p. 1. Bert, Gaz. d. Hop., 1S79, No. xxxvii. u. xli. Cotton, Phys. Action of Nitrous Oxide Gas, Pbila., 1871. Goltstein, Pfliiger's Arch., 1S78, Bd.xvii., 331. Hermann, L. Arch. f. Anat, u. Physiol., 1864, p. 521. 1030 BIBLIOGRAPHICAL INDEX. Nitrous Oxide. Jolvet and Blanche, Arch. d. Phys., July, 1873, p. 364. Thomson, E., Phil. Med. Times, Nov. 15, 1873, p. 97, vol. iv. White, T.W., Dental Mat. Med., Phila., 1868. Zuntz, Pfluger's Arch., xvii., 135. Oil of Mustard. Heidenhain, Pfluger's Arch., Bd. iii., p. 504; Bd. v., p. 309; Bd. vi., s. 20. Kohler, Centralbl. f. d. med. W., 1878, p. 433 u. 450. Naumanu,Prag.Vierteljahrsschr.,Bd.lxxvii., p. 1. Paalzow, Pfluger's Arch., 1871, vol. iv., p. 492. Opium Alkaloids. Albers, Arch. f. path. Anat., Bd. xxvi., p. 229. Baxt (Thebaia), Wien.Acad. Sitzber.,2 Abth., Bd. lvi., p. 189; u. Arch. f. Anat. u. Phys., 1869, p. 128; Ludwig's Arbeiten. Bernard, CI. Lecons sur l'Anesth. et s. l'As- phyxie, Paris, 1875; Arch. Gen., p. 455, vol. iv., 6th ser., 1864. Bouchardat, Schmidt's Jahrb., Bd. cxx., p. 280. Boeck, V., Unters. iib. p. Zersetz d. Eiweiss. Miinchen, 1871. Buskirk, Washington Post, Jan. 23, 1878. Chalkius, Quart. Journ. Psychol. Med., 1868, vol. ii., 739. Charvet, Pereira's Mat. Med., vol. ii., p. 1035, Phila., 1854. Dain, Amer. Med. Journ., July, 1874. Dietl and Vintschgau, Pfliig. Arch., Bd. xvi., p. 316. Dragendorff, Pharm. Zeitschr. f. Russland, 1866. Eckard, C. u. F. Eckard's Beitriige z. An. u. Phys., Bd.viii., s. 79, 138, 1878. Eulenberg (Narceinj, Deutsch. Arch. f. klin. Med., Bd. i., p. 55. Fiset, Morrison, N. Y. Med. Rec, July, 1874, p. 342. (rscheidlen (Morphin), Unters. a. d. physiol. Lab. in Wurtzburg, Bd. ii., 1869. Harley, Old. Veg. Neurotics, 107, London, 1869. Kauzmann, Dorpater Diss., 1868. Kolliker, Arch. f. path. Anat., Bd. x.; Virch. Arch., Bd. x., p., 248. Literature, complete, Arch. f. Path. u. Pharm., vii., 24. Loomis, A., New York Med. Rec, 1873. Meihuizen, Pfliiger's Arch., Bd. vii., 1873, p. 201. Mitchell, Weir, Amer. Journ. Med. Sci., Jan., 1869, p. 37, Jan., 1870, p. 17. Miiller (Thebaia), Marburger Dissert., 1868. Nasse, Beitr. z. Physiol, d. Darmbeu, Leip- zig 1866. Nothnagel, Handb. d. Arzneim., Berlin, 1870, p. 8. Oetinger (Narcein), Tubinger Diss., 1866. Paby, Med. Times & Gaz., June, 1869, p. 641, Reese, Amer. Journ. Med. Sci., Jan., 1871, pp. 133 and 373. Balvioli, Ludwig's Arbeiten. Smith, EL Lancet, vol. i., p. 419, 1854. Wachs, iib. (Codeia), Marburger. Diss., 1868. Witkowski (Morphia), Arch, f.exp. Pathol, u. Pharm., Bd. vii., p. 247, Complete Literature. Wood, Boat. Med. Surg. Journ., vol. 1 i x . , p. 268, 1868. Organic Acids, vide Acid.-. Oil of Turpentim:. Cruclfl, I/on, Dc la Trn'binthinc, Paris, The- L874. Fleischmann In Bossbach'B pharm. Unten., Bd. ii., Vgl, Sthezische Ocle. Oil of Turpentine. Hoppe, Journ. f. Pharmacodyn., Bd. i., p. 105. Robert, R, Centralbl. f. med. Wiss., 1877, p. 129. Oxygen. Afanassiev, Ber. d. k. saohs Ges. d. Wiss., 1873. Assmuth, Dorp. Diss., 1864. Bert, Lecons sur la Respiration. Buchheim, Arch, f.exp. P . u. Ph., Bd. iv., p. 137. Donders, Pfluger's Arch., Bd. v., p. 20. Dybkowski in Hoppe-Seyler's Med. Chem. Unters., Bd. i. Estor u. St. Pierre, Journ. de l'Anatomie et de la Phys., Bd. ii., 106. Fernet, Ann. d. Sciences nat, vi,, Bd. viii. Friedlimder u. Herter, Z. f. physiol. Chem., iii., 19. Gorup-Besanez, Annal. d. Chem. u. Pharm,, Bd. ex., u. exxv. Hacker, Dissert. Dorpat. Riga., 1863. Herter, Ueber d. Spannung desO. inarteriel- len Blut. Z. f. Physiol. Chem., iii., 98, 1879. Hoppe-Sevler, Med. Chem. Unters. Bd. i., in Arch. f. Physiol., Bd. vii., 9; Physiol. Chimie, i'., s. 7, u. 39. Hiifner, Zeits. f. phys. Chimie, i., p. 317, u. 386, u. Centralbl., 1878, p. 710. Liebig, G., Aerzl. Intelligenzbl., 1879,No.xix. Magnus, Poggendorfs Ann., Bd. xl., p. 583, u. lxvi., p. 177. Manassein, Centralbl. f. m. Wiss., 1871, xliv., p. 688. Meyer, Lothar, Zeitsch. f. rat. Med., No. i., Bd. viii., p. 256. Muller, W., Wien. Acad. Sitzber., Bd. xxxiii., 99. Pfliiger in Seinem Arch., Bd. 1., p. 274. Regnault u. Reiset, Compt. Rend., Bd. xxvi., pp. 3, 4, 17. Schmidt, Al., Ozom. im Blut. Dorpat. 1872 ; Hamatol. Studien Dorpat, 1865; Centralbl. f. d. Med. Wiss., 1867 ; Ber. d. k. sachs Ges. d. Wiss. M. phys. CI., Bd. xix.; Arch. f. path. Anat. u. Phvs., Bd. xlii. Schonbein, Roy. Soc. Proc, 1840. Pellitory. Browne, London Practitioner, xvii., p. 86. Peppermint. Marcusson, Hallenser Diss., 1877. Pepsin. Albertoni, Centralb. f. d. med. Wissen., 1878, p. 641. Beale, Arch. f. 1850, i., iv. Davidson, Practit,, March, 1872, vol. viii., p. 131. Dowdeswcll, Pract., Papain, vol. xxx., p. 485. Ewald, Frerichs u. Leyden'sZ. f. klin. Med., i., 231. Gray, Jas., Edin. Med. Journ., Jan., 1853, p. 31. Jovnes, L. S., Richm. and Louisville Med. journ., 1869. Leube, W. ()., Deutschcs Arch. f. klin. Med., ix., 532, x., 1,1872. .Manassein, Yinh. Arch., 1872, vol. Iv., p. 413. Roberts, W. Tuson, Med. Times and Gaz., vol. ii., 1882. Wayne, Amer. Journ. Pharm., 1868, Pepton. Penzoldt, Deut. med. Wochenschr., Bd. !▼., b. 418, 426. Schmidt-Muhlheim, Ludwig's Arh. Seegcn, Pfluger's Arch., vol. xxv., p. 165. BIBLIOGRAPHICAL INDEX. 1031 Peroxide of Hydrogen. Assmuth, Dorp. Diss., 1864. Guttraann, Virch., Arch., Bd. lxxiii., p. 23, u. lxxv., p. 255. Richardson, Lancet, vol. i., p. 383, 1862. Stohr, Arch. f. klin. Med., 1867, Bd. iii., p. 421. Petroleum. Lassar, Berl. klin. Wochenschr., 1879, No. xviii., s. 261. Phosphorus. Abstract of the Literature up to 1867, in Schmidt's Jahrb., Bd. cxxxvi., p. 209. . Andant, Journ. de Med. de Bruxelles, 1868-79. Anstie, Pract., 1873, vol. xi., 103. Aufrecht, Deut. Arch. f. klin. Med., xxiii., 331. Bauer, Zeitschr. f. Biologie, Bd. vii. to xiv. Bollinger, Deutsch. Arch. klin. Med., Bd. v., p, 149, 1869 ; Bd. vi., p. 94, 1870. Demarbaix and Wilmart, Presse Med. beige, xxi., p. 197, xxv., 1869 ; Schmidt's Jahrb., b. cxliv., v., p. 152. Dybkowsky, Hoppe-Seyler's Med. Chem. Unters., Heft- i., p. 54. Eames, H., Dab. Journ., Med. Sci., Jan., 1872, p.l. Eulenberg and Guttman, Aertz Literatur- blatt, 1868, No. 12; Syd. Year-Book, 1868, p. 450. Falk, jun., Arch. f. exp. Path. u. Pharm., Bd. vii., 1877. Freise, Berl. klin. Wochens., 1877, p. 437. Hartmann, Dorp. Diss., 1866. Hermann u. Brunner, Pfliiger's Arch., Bd. iii., p. 1 ; Deut, Arch. klin. Med., p. 198. Kohts, O. Pfl tig. Arch., vol. xiii., p. 84, Deutsch. Arch., f. klin. med., Bd. v., p. 168. Kohler, Berl. klin. Wochens., 1870. Lebert and Wyss, Arch. Gen., 1868. Mayer, Canstatt's Jahresb., Bd. v., 1862, p. 123. Munk and Leyden, Die Acute Phosphorverg. Berl., 1865. Ossikowsky, Wein. Med. Presse, 1872. Percy, S. R., Prize Essay, Trans. Amer. Med. Assoc, 1872, p. 659. Poulet, Gaz. Med. de Paris, Aug., 1872. Schiff, Arch. Exp. Path. u. Pharm., Bd. ii., p. 347. Schulzen u. Reiss, Ann. de Charite, Bd. xv. Schuchardt, Henle and Pfeufer's Arch , N. F., Bd. viii., p. 235. Sotnitschewsky, Z. f. physiol. Chimie, iii., p. 391, 1879. Thompson, J. A., Lond. Pract., vol. xi., pp. 13 and 27, July, 1873. Vetter, Virch. Arch., Bd. liii., p. 186, p. 21. Yigier, Bull. Therap., xc, Jan. 1876. Virchow, Sein. Arch., Bd. xxxi., p. 399, 1864. Wegner, Virch. Arch., Bd. lv., p. 11, June 22, 1872; Wien. Med. Presse, Jan., 1872. Weyl, Arch. d. Heilk., 1878, p. 163. Physostigma. Amagat, Journ. de Therap., 1876. Arnstein, C, and Sustschinsky, Unters. Phys. Lab. Wiirzburg, 2 Th. p. 86. Edwards, J. B., Med. Times and Gaz., vol. ii., p. 212, 1864. Englehardt, Unters. a. d. Phys. Lab. Wurz- burg, 2 Th., 526. Fraser, Trans. Royal Society of Edin., vol. xxiv. Frolich, Pharm. Unters., i., 56. Grunhagen, Virch. Arch., Bd. xxv., p. 521. Harnack u. Witkowski, Arch. f. Exp. Path. u. Pharm., v., 142. Jones, W., Pract,, 1869, vol. iii., p. 163. Keyworth, Glasg. Med. Journ., N. S., 1869, i., p. 54. Physostigma. Kleinwachter. Revue Photogra. des Hopitaux, 1870. Kohler, Arch. Exp. Path. u. Pharm., Bd. i., 280. Laschkewitch, Virch. Arch., 1866, Bd. xxxv.. 294. Leven and Laborde, Schmidt's Jahrb., Bd. cxlvi., p. 136. Lewisson, Reich. Arch., 1870, p. 346. Merson, Journ. of Mental Sci., Jan., 1875, vol. xx., p. 602. Papi, C, Schmidt's Jahrb., cxlii., 287 ; Gaz. Lomb., 1858. Robertson, Argyll, Edinb. Med. Journ., 1863. Roemer, St. Louis Med. and Surg. Journ., 1873, 367. Rosenthal, Reich. Arch. Stubbotin, Arch. f. klin. Med., Bd. vi., 285, 1869. Tachau, Arch. d. Heilk., 1865, p. 70. Vee and Leven, Comptes Rend, de la Soc. de Biol., 1865, p. 161. Westermann, Schmidt's Jahrb., Bd. cxxxviii., p. 290. PlLOCARPIN. Complete List of Literature (117 Authors), bei Lewin, Berl. Cnarite Annal., v. Jahrg., 1878, p. 559. Prussic Acid. Bernard, CI., Lecons sur les Subst, toxiques, p. 193, Paris, 1857. Bischoff, Ueb. Vergift. Wein, 1844. Bohni, Arch. f. exp. P. u. Pharm., Bd. ii. Bohm u. Knie, Arch. f. exp. Path. u. Therap., Bd. ii., p. 135, 137. Bunge, A. f. exp. P. u. Pharm., xii., 1 (Gan- gas). Coze, Gaz. Med. de Paris, 1849; Comptes Rend., t. xxviii., 1849, p. 780. Fagge, Hilton, Guy's Hosp. Rep., 1868, p. 259. Funke, Ber. d. K. sachs Gesell. d. Wiss. z. Leipzig, Bd. xl , 1859, p. 28. Gahtgens in Hoppe-Sevler's Med. Chem. Unters. Berl., 1866, 324,"s. 346. Geinitz, E. Pfliiger's Arch., Bd. iii., 1870, p. 46. Harley, Lond. Phil. Trans., 1865, p. 706. Hiller, Centralbl. f. d. med. W., 1877, 577- Hiller and Wagner, Lancet, 1877, ii., 933. Hoppe-Seyler, Med. Chem. Unters. Berl., 1867, 140; Virch. Arch., Bd. xxxviii., p. 475. Hiinefeld, Der Chemismus in d. thierischen. Organisation, Leipsic, 1840. Jones, J., N. Y. Med. Rec, vol. ii., p. 459. Keen, Proc , Phil. Acad. Nat. Sci., 1869. Kiedrowski, Virch. Jahresb., 1858, vol. i., p 48. Kolliker, Virch. Arch., Bd. x., p. 272. Lankester, Ray, Pfliiger's Arch., vol. ii., 1869, p. 492. Laschkewitch, Reich. Arch., f. Anat., 1868, p. 653. Lecorche and Meuriot, Arch. Gen., t. xi., 6e serie, pp. 539, 543. Lewisson, Reich. Arch., 1870, p. 352. Preyer, Die Blausaure physiol. Unters., 2 Thle. Bown, 1868 u. 1870, contains a full resume of literature on the subject up to 1870. Preyer, Arch. f. exp. Path. u. Ph., Bd. iii., p. 381. Rossbach u. Papilsky in Rossbach's pharm. Unters., Bd. iii., 1877. Schonbein, Schmidt's Jahrb., Bd. ex]., 1868, p. 161. Schubarth, Horn's Arch. f. med. Erf., Berl., 1824. Sobernheim, J. F., Handb. d. Prakt. Toxicol., Berlin, 1838. Stannius, Arch. f. Anat,, 1858, p. 95. Vietz, F. B., Med. Jahrb. d. k. k. oesterreich. Staates, Bd. ii., 1814. 1032 BIBLIOGRAPHICAL INDEX. Prussic Acid. Wahl, De Vi et Effectu Acido Hydrocyanato, Bonn, 1865. Wallach, Ber. d. deutscli. chem. Gen., x., 2120. Purgatives. Asp, Ludwig's Arbeiten, 1868. Brieger, Arch. f. exp. Path., Bd. viii., p. 355. Brunton, Lauder, Med. Press and Circular, Dec. 31, 1S73, p. 590; Pract., vol. xii., pp. 342 and 403. Buchheim, Arch. f. physiol. Heilk., Bd. xiii. u. xiv.; Virchow's Arch., Bd. xii., p. 1, Falck, Virchow's Arch., Bd. liv., p 173. Headland, Action of Medicines, London, 1867, p. 443. Hay, Matthew, Journ. of Anat. and Physiol., vol. xvi. Kohler, H., Virchow's Arch., Bd. xlix., p. 408. Moreau, F. A., Memoires de Physiologie, Paris, 1877; Comp. Ptend., t. lxvi., 1868; Arch Generates, 6e ser., t. xvi., p. 234. Hosier, Berl. klin. Wochens., No. xlv., 1873, p. 533. Nasse, N., Beitr. z. physiol. der Darmbewe- gung, Leipzig, 1866. Radziejewski, Eeichert's und Du Bois-Rey- mond, Arch., 1870, p. 37. Rohrig, A., Strieker's Med. Jahrb., 1873, p. 240 ; Exp. Unters. ii. d. Phys. d. Gallenabsonder- ung, Wien, 1873. Rutherford, British Med. Journ., vol. i., p. 362, 1877; Schmidt's Jahib., 1878, Bd. clxxvii., p. 11, u. folgende. Schiff, II Morgagni, 1867. Simon, Gus., Arch. d. klin. Chir., xv., p. 99. Thiry, Sitzungsber. d. Wiener Acad. Math. Naturw. CI., 1864, Bd. i., p. 95; Gaz. Med., 1871. Vulpian, Gaz. Med., 1873, p. 309. Wood, Amer. Journ. Med. Sci., vol. lix., p. 395, 1870. QUININE. Albertoni & Giotto, Bull. Therap., xc, p. 403. Appert, Virch. Arch., Bd. lxxi., p. 364. Baldwin, W. O., Amer. Journ. Med. Sci., Ap., 1847, p. 292. Bauer u. Kiinstle, Deutsch. Arch. f. klin. Med., Bd. xxiv., s. 53. Binz, Zur Salicylsaure u. Chininwirkung. Arch. f. exp. Path. u. Pharm., Bd. i., p. 18, 1873, Bd. v., p. 39, Bd. vii., p. 275; Lond. Pract., p. 4, vol. v., 1870; Virch. Arch., Bd. xlvi., 1864, p. 138. Bochefontaine, Recherches exp. a laContrac- tilitg de la Kate, Paris, 1873; Arch, de Physiol, July, 1873. Boeck, Von, Unters. u. d. Zersetzung des Eiwcises im Thirkorper, Munich, 1871. Briquet, TraitC Therap. de Quinquina, Paris, 1855. Brunton, Lauder, and Pardington, St. Barth- olomew's Hosp. Rep., 1876, p. 150. Hurt, Med. and Surg. Reporter, 1870. Chalvet, Schmidt's Jahrb., Bd. cxli., p. 152; ( .az. Hehdom., 2d ser., t. v., 1868. Chaperon, Piliig. Arch. f. Phys., 1869, vol. ii., p. 295. Chiara, 1'Un. Med., Nor. 20, 1873, p. 795. Clapton, Med. Times and (iaz., vol. J., p. 462, 1864. Complete Collection Of Literature up to 1875 ; (82 Nob.) In Binz., Das Chinin Berlin bei Hirsctrwald, 1875. Cutler, J. B.,Psyoh. and Med. Legal Journ., Dietl, Wien. Med. Wochens., 1852. Dupuis, [/Action I Mi vs. do Quinine, Paris, 1877. En le n i H in', L, Reich. Arch. f. Anal. 1865, p. 128. Qeltowsky, I. ond. Pract., vol. viii., p. 321. Quinine. Hallier, das Cholera-Contagium, Leipsic, 1867. Hamilton, J. B., Tnd. Med. Gaz., 1873. Henbach, Arch. f. exp. Path. u. Pharm., Bd. v., p. 233; Centralbl. med. Wiss., 1874, p. 673. Henke, Deutsch. Arch. f. klin. Med., Bd. xii., p. 630. Hesse, Ber. d. deutsch. Chem. Ges., x., 2152. Jacobowitch, Magnan, Revue des Sci. Med., 1873. Jerusalimsky, ueb. d. phys. Wirk. d. Chinin. Berl. bei Hirschwald, 1875 ; Centralbl. med. Wiss., 1876, p. 476. Jones, Bence, Lectures on Path, and Therap., London, 1867. Kerner, Lond. Pract., vol. x., 169; Pfliig. Arch. f. Phys., 1870, p. 93. Kohler, Zeitschrift f. d. ges. Naturwiss, f. Sachsen,inThiiringen, Bd. xlix.,u. Sitzber. der Naturforscher Gesellsch. zu Halle, 1876. Lauderer, Repertorium f. Pharm., Bd. xxv., 1836, 1839, 1842. Liebermeister, Deutsch. Arch. f. klin. Med., Bd. iii., 1867. Magendie, Gaz. Med., 1847. Martin, A., Inaug. Dies. Giessen., 1868. Melier, Memoires de l'Acad., t. xii., p. 722, 1843. Mosler, Path. d. Leukaemie,Berl., 1872 ? p. 451. Monteverdi, Ann. et Bull, de la Societe de Med. de Gand, May, 1871. Naunyn & Quincke, Reich. Arch. f. Anat., 1869. Pages, Gaz. Med., 1846. Personne, Centralbl. f. d. med. Wiss., 1879, s. 110. Piorry, Arch. Gen. de Med., 1847. Pringle, Abs. on Diseases of the Army, Lond., 1765. Rabuteau, Bull. Therap., t. lxxv., p. 475. Raucillia, l'Union Med., 1873. Rapmund, Deutsch. klin., 1874. p. 51. Rausone, Inaug. Diss. Bonn., 1871. Renzi. D., Bull. Therap., xci., p. 45. Rhoads, E., & W. Pepper, jun., Pennsyl. Hos. Rep., vol. i., 1868. Rich, Charleston Med. Journ. and Review. Rossbach, Pharm. Unters , Bd. i., Heft iii. Sayre, Amer. Pract., 1871, p. 260. Seharrenbroich, Inaug. Diss. Bonn., 1867. Schloekow, De Child sulfurici Vi physi- nonnulla Exp. Vratisl., 1860. Schrofi; Strieker's Med. Jahrb., 1875, p. 175. Schulte, A., Centralbl. f. d. med. Wiss., p. 727, Nov. 1871. Walranen, Boston Med. and Surg. Journ., 1873. West, Jos. J., Savannah Journ. Med., vol. i., p. 19, 1858. Wilson, J. S., South. Med. and Surg. Journ., p. 341, 1855, Sept., 1860. Zunst., Beit. z. Phys. des Blutes, Inaug. Diss. Bonn., 1868; Arch. f. Exp. Path., Bd. ii., p. 343. Rhubarb, vide Purgatives. Ricin, vide Purgatives. Rui:. Cahours et Gerhard, Annales de Chini. et de Physique, \\i\., p. 227, ser. iii.; Pharmaz. Jahreso. v. Wiggers, \ iii., 50. Cooper, <;. T., Med. Exam., N. S., Lx., 720. Gorup-Besanez, Neues Report, fiir Pharmaz., xix., 885. Helie, Bull de Therap., xv., 75; Schmidfa Jahrb., xxi., p. 275. BIBLIOGKAPHICAL INDEX. 1033 Salicylate and Salicylic Acid. Balz, Arch. d. Heilk., xviii., p. 60. Bochefontaine & Chabret. Bochefontaine, Le Progres Med., 1877, p. 630. Buchholtz, Arch. exp. Path. u. Pharm., Bd. iv.; Dorpat. Diss., 1(^66. Byasson, Centralbl. f. Chir., 1877, p. 809. Callender, Trans. Lond. Clin. Soc, ix., p. 9. Danewsky, Arbeit, in Pharm. Lab. Moskaw, i., p. 190. Drasche, Centralbl. f. Chir., 1876, p. 777. Farsky, Sitzber. d. k. Akad. d. Wiss., Bd. ii., lxxiv., p. 49. Jacoud, Le Progres Med., 1877, pp. 528, 745. Laborde, Bull, de Therap., xciii., p. 276. Marine, Gottinger Nachricht, 1878, No. vii., p. 229. Martenson, Petersb. Med. Zeits., 1875, p. 343. Meyer & Kolbe, Journ. f. prakt. Chem., Bd. xii., p. 9. Musey, Bull. Therap., xiii., p. 318. Riess, Berl. klin. Wochens., xii., 1875, pp. 674, 675. Robin, Lond. Med. Rec., 1877, p. 151. Scheffer, Marburger Diss., 1860. Schroeder, Deutsch. Arch. f. klin. Med., xviii., 516. See, Bull, de l'Acad. Med., 1877, p. 697. Senator, Berl. klin. Wochens., 1875, p. 461. Strieker, A. E., Berl. klin. Wochens., xiii., p. 1, 1876. Weber, Bull, de Therap., xciii., p. 328. Wolffberg, Deutsch. Arch. klin. Med., xv., p. 403. Wolfsohn, Konigsberg Diss., 1876 ; Centralb. f. med. Wiss., 1877, p. 30. Salicylic Acid. Bertagnini, Annal. d. Chemie u. Pharm., Heft xcvii., s. 248, 1856. Binz, Niederrh. Ges. f. Nat. u. Heilk. Sitz, v. 6, Dec, 1875, u. 20 Marz., 1876; u. Berl. klin. Wochenschr., 1876, No. xxvii. Butt, Centralbl. i. d. med. Wiss., 1875, No. xviii., p 276; u. zur antipyret. Bedeutung d. Salicylsaure ii. d. salicyls. Natrons, Stuttgart, 1876. Ebstein, Berl. klin. Wochenschr., 1873, 1875, 1876. Feser u. Friedberger, Arch. f. wiss. u. prac. Thierheilk., 1875, Heft ii., iii. u. vi., 1876, Heft ii. u. iii. Fleischer, Centralbl. f. d. med. Wiss., p. 628, 1876, No. xxxvi.; u. Arch. f. klin. Med., 1877, Bd. xix. Fleck, Benzoe'saure, Carbolsiiure, Salicylsaure, Zimmetsaure, Vergl. Versuche., Munchen, 1875. Furbringer, Centralb. f. d. med. Wiss., p. 273 1875, No. xviii. . Goltdammer, Berl. klin. Wochenschr., 1876, No. iv. Kohler, H., Centralb. f. d. med. Wiss., 1876, 161, 195; Deutsch. Zeitschr. f. pract. Med. v. Kunze, 1877. Kolbe, Journ. f. pract. Chem., N. F., Bd. xii., 1875, B. xi., p. 9. Moli, Berl. klin. Wochenschr., 1875, No. xxviii. Salkowski, Berl. klin. Wochenschr., 1875, No. xxii. Thiersch. Klin. Ergebnisse der Lister'schen Wundbehandl. in Volkmann'sSamml. klin. Vortrage, Nos. Ixxxiv. and lxxxv. Wolfsohn, Dissert. Konigsberg, 1876. Sanguinaria. Smith, R. M., Amer. Journ. Med. Sci., Oct., 1876, p. 346. Santonin. Andaul, Brit. Med. Journ., vol. i., p. 186, 1872. Berg, Wurttemberg Medic. Correspond., 1862. Santonin. Binz, Arch. f. exp. P. u. Ph., Bd. vi., p. 300. Brown, Dyce, Brit, and For. Med. Chir. Rev. April, 1871, p. 472. Falck, Deutsche Klinik, 1860. Guepin & Martin, Ann. de Therap., 1862. Krauss, Inaug. Diss. Tubingen, 1869. Manns, Marburger Diss., 1858. Rose, Virch. Arch., Bd. xvi.,p. 233, Bd. xviii., p. 15, Bd. xix., p. 522, Bd. xx., p. 245, Bd. xxviii., p. 30, Bd. xxx., p. 442. Walz, Jahresber. f. Pract. Phaim., Bd. xv. Saponin. Buchheim u. Eisenmenger, Eckhardt's Bei- tra'ge, v. 3, Giessen, 1869. Harnack, Arch. f. exp. Pharm., ii., 1874. Keppler, Berl. klin. Wochenschr., 1878, p. 475. Kohler, H., Die totale Anasth. durch Saponin, Halle, 1873. Lautenbacb, Phila. Med. Times. Pellikan, Berl. klin. Wochenschr., xxxvi., 1867, p. 375; u. Bulletin d. k. Acad, zu S. Petersburg, xii., 1867, p. 253. Savin. Letheby, Loudon Lancet, vol. i., p. 677,1845. Silver Nitrate, etc. Bogolowski, Arch. f. path. Anat., Bd. xlvi., p. 413. Charcot and Ball, Gaz. Med., 1864. Curci, Lond. Med. Rec, 1877, p. 72. Eichmann, Husemann Toxicologie, 871. Fragstein, Berl. klin. Wochens., 1877, 294. Frommann, A r irch. Arch., Bd. xvii., p. 135. Jacobi u. Gissmann, A. f. exp. P. u. Pharm., Bd. viii., p. 217, 1878. Higgiubottom, Lond. Pract., vol. ii., p. 34, 1869. Kramer, Das Silber als Arzneim, Halle, 1845. Neumann, Med. Jahrb., 1877, p. 369. Pepper, Trans. Phila. Coll. Phys., 1877. Riemer, Aich. f. Heilk., Bd. xvi., p. 296. Rosenstirn in Rossbach's pharmak. Unters. Bd. i. Rouget, Arch, de PAnatom. et de Physiol., Julv, 1873. p. 356, u. Jahresber. d. ges. Med., 1870; Bd. i., p. 363. Roszahegzi, A. f. exp. P. u. Pharm. Bd. ix., p. 289, 1878. Weichselbaum, Centralb. f. d. med. Wiss., 1878, p. 954. Yandell, Amer. Pract., June, 1872. Soda, vide Alkalies. Barnard, Phys. Exp., t, ii., p. 393, Phila. Med. Times, vol. v. Bidder and Schmidt, Canstatt's Jahresb., 1852. Grandeau, Robin's Journ. de l'Anat., 1864, p. 378. Guttmann, Virch. Arch., Bd. xxxv., p. 450. Longet, Physiologie, Paris, 1861, t. i., p. 196. Munich, Arch. Ver^ins Gemeinsch. Aid.; Bd vi., p. 369, 1863. : Nothnagel, Virchow's Archiv. Plouviez, Com. Rend., t. xxv., 1847, p. 113. Podkaepow, Virch. Arch., Bd. xxxiii., p. 507. Rabuteau,L'Union Med., t. xii., p. 186, 1871. Roberts, Urinary and Renal Diseases, Am Ed., 1866, p. 240. Spigelia. Eberle, Materia Med. and Therap., vol. i. Spalsbury, Bost. Med. and Surg. Journ., vol iii., p. 72, 1855. 1034 BIBLIOGRAPHICAL INDEX. Squill. Dassen, Groninger Diss., 188J. Husemann, Arch. d. Pharmacie., Bd. vi., Heft iv., 1876 : Deutsch. Med. Wocherjs., xiii., p. 149, 1875; Lond. Med. Eec, 1876, p. 120, Toxicologic, Bd. i., 413. Jarmersted, A. f. exp. P. u. Pharin., 1S79, Bd. ii., p. 22. Scliroff, Wien. Wochenschr., 1864, 43, p. 673. Wolfring, Bayer, arztl. Intelligenzbl., 1842. Strychnine. Ainagat, Journ. d. Therap., 1S75, p. 467. Ambrosoli, Gaz. Med., 1357, p. 525. Bennett, Brit. Med. Journ., vol. ii., p. 436, 1874. Bernard, CI , Leeons sur les Substances Tox- iques, Paris. Bochefoutaine, Arch, de Phvs. norrn.etpath., 1873, p. 664. Brown-iequard, Comptes Eendus, 1S49, 29, p. 672. Buchheini u. Engel, Beitr. z. Arzneiml., Leipzig, 1849, i., p. 92. Cohn, Wien. Med. Wochens., Nos. xlii., xlvii., 1873, Deen, Van, Phys. de la Moelle epiniere. Falck.F. A., jun., Yierteljahrsschr. f.gerichtl. Med., N. F.,Bd. xx., 2,193, xxi., 12, u. xxiii., 1874. Falck, Senior, Virch, Arch., xlix.,1870,p. 458. Freusberg, Arch. f. exp. Path. u. Pharm., Bd. iii., p. 2u4, and 348, 1875. Harley, Lancet, July, 1856, p. 40. Heinernann, C., Virch. Arch., Bd. xxxiii., p. 394. Hippel, V., Wirk. des Strvch. auf. Augen., Berlin, 1873, p. 77. Husemann, Arch. d. Pharrn., Bd. viii., Heft 3, 1877. Jacond, Pathol. Interne., i., 441. Jochelsobn, Eossbach's pharm. Unters., Bd. i. Klapp, Journ. Mental Diseases, Oct., 1878. Kolliker, Virch. Arch., Bd. x., p. 239, 1856. Lange, F., Konigsberger Diss., 1S74. Leube, Arch. f. Anat. u. Phys., 1867, p. 629. Magendie, Paris Soc. Philom., N. Bull., i., 368, 1808. Mager, S. Wiener, acad. Sitzungsber. Math. Nat. Wiss. CI. 3 Abth., 1871. Martin-MagronandBuisson,Brown-Sequard's Journ. de la Phys., 1860, t. iii., pp. 130, 342. Matteucci, Traite des Phenom. electro-phy- siol., Paris, 1884. Meschede, Berl. klin. W., 1878, No. xxiv. Moreau, Comptes. Bend. Soc. de Biol., 1855, p. 173. Nagel, Die Behandl. d. Amaurosen u. Ambly- opeen in. Strvch. Tubingen, 1871. Nasse, O., Ceutralbl. f. med. Wiss., 1S65, p. 787. O'Farrell, L., Phila. Med. Times, vol. iii., p. 311 Orr, Gaz. Med., July 6, 1872. Pellikan, E., Beitr. z. ger. Med., p. 92, 1858. Eatike, Virch. Arch., lxxv , p. 1, 1878. Richter, Zeitschr. f. rat, Med., iii., Bd. xviii., ]). 7t;. Rosenthal a. Leube, Arch.fiir. Anat. u.Phys., 1867, p. 629. Rosenthal, Compt. Rend., lxiv., p. 1142. ich, Centralbl. f. med. Wi-s, p. 369, 1873, xxiv. Rossbach u. Jochelsten, Wlirtzburg. Abhandl., 1878, p. 92. . Lancet, May, 1863, Schmidt's Jahrb., cxix..p. 286, 1863. Bchiff, Schmidt's Jahrb., Bd. exit, p. 25. Schlesiuger, Wien. Med, Jahrb., 1874. Bchroff, v., juii., Wien. Med. Jahrb., L872, p. 420. Schultzeu, Anli. f. Anai. u. I'll vs. (Dubois), p. 491, 1864 Bpence, A.T., Edln. Med. Journ., July, 1866. .xii., i., p. 41. Strychnine. Tschepke, Deut. Klinik., xiii., 1861. Uspensky, Arch. f. Anat. u. Phys., 1868, iv., p. 522. Valentin, Path. der. Nerven, p. 327, pt, ii., Leipzig, 1864; Arch, de Physiol., Nov., 1870, p. 125, d. t, iii., p. 120. Wittich, Bericht Fortschritte Anat., 1857, p. 434. Wundt, Unt. d. med. d. Nerven, Stuttgart, 1871. Sugar. Mering u. Musculus, Hoppe-Seyler's Z. f. phys., Ch. i., p. 395, and ii., 177. Sulphide of Calcium. Einger, Sidney, Lancet, Feb., 1874, vol. i., p. 264. Sulphur and Sulphuretted Hydrogen. Dorpater Diss. Krause, 1853, Trachtenberg, 1861, Hoppener, 1863. Hermann, Toxicologic Hoppe-Seyler, Centralbl. f. d. med. Wiss., 1863, p. 433; Med. chem. Unters., 1867, Bd. ii. Ivunkel, Pfliiger's Arch., Bd. xiv., p. 344. Poleck, Die chem. Natur der Minengase, etc. Berl., 1867. Eegensburger, Centralbl. med. Wiss., 1877, p. 328. Eosenthal u. Kaufmann, Eeichert's Arch., 1866, p. 647. Schmiedeberg, Arch. d. Heilk., 1867, Bd. viii., p. 422. Sertoli, Instituto fisiol. di. Pavia, 1869. Tannic Acid. Hennig, Arch. d. Pharm., Bd. exxxiii. Eoseustirn, Eossbach's pharmak. Unters., Bd. i. Sehroff, Die Pfianzenstoffe, Lehrb. d. Pharm., lte Aufiage. Tannin, vide Tannic Acid. Thuja. liohne, Gottingen Diss., 1883. Thymol. Husemann, Arch. f. exp. Path. u. Pharm., Bd. iv., 1875, p. 288. Lewin, Centralbl. f. d. med. Wiss., 1875, p. 324. Tobacco, vide Nicotine. Benham, W. T., West Eiding Luii. Eeports, vol. iv.,]>. 306, 1874. Bernard, (1., Substances Toxiques, p. 410. Copeland, Diet, of Pract. Med. art. Colic. Ilii-Mlniianii, Keich. Arch , 1868, |). 309. Huseinaiin, Ilaudb. d. Toxicol., vol. ii.,p.483. Nasse, Beitrfige /. Phvs. der Darmbcweguiig, Leipzig, 1866. Bell, Journ. f. Pharmacodyn, Bd.ii., p. 203. Rosenthal, Centralbl. f. med. Wiss., 1863, p. 738. Traube. Allgem. Med. Central. Zelt., 1862. Uspensky. Reich. Arch., 1868, p. 525. Vuipian, I lomptes Eendus. de la Soc. de Biol., 1859, )). 151. BIBLIOGKAPHICAL INDEX. 1035 Trimethylamine, or Propyla- mine Huseraann, Selige, Arch. f. exp. Path. u. Pharm., Bd. vi., p. 55. VALERIANATE OF AMYL. Wade, W. F., Brit. Med. Journ., i., 1874, p. 741. Veratrine. Bezold, V., u. Hirst, Unters. a. d. Wiirtzburger- physiol. Laborator., Bd. i., 1869. (Contains the entire older Literature.) Brunton and Cash, Cent. f. d. med. Wiss., 1883, p. 81; Journ. of Physiol., iv., 1. Claus., Journ. of Anat., viii., p. 228. Eisenmenger, Ueber d. Einnuss d. Gifte u. d. Zuckungscurve des Froschmuskels. Diss. Giessen., 1862, p. 40. Fick u. Bohm, Verhandl. d. phys. med. Ges. in Wiirtzburg, N. F. Bd. ill., p. 198, 229. Guttmann, Eeich. Arch. f. Anat., 1866, p. 498. Jones, Phila. Med. and Surg. Beporter, xvii., p. 361, 1872. Kolliker, Virch. Arch., Bd. x., p. 257, exp. ix. Ott, Toxicol. Studies, Phila., 1874. Pellikan, V., u. Kolliker, Wiirtzburg. Verb., ix., p. 106. Praag, L. von, Virch. Arch., vii., p. 252, 1854. Veratrine. Ringer, Arch, of Med., vii., Feb., 1882. Robin's Journ. de l'Anat., 1868; t. v., p. 206, Gaz. Med. de Paris, No. 5, p. 69, 8, p. 120, 10, p. 148, 11, p. 167, 1857. Rossbach, Clostermeyer u. Harteneck, in Bossbach's pharm. Unters. Bd. iii., and Pfliiger's Arch., Bd. xiii. u. xv. Bossbach u. Anrep, Pfliiger's Arch., Bd. xxi., 240, 1880. Taylor, Med. Jurisp. 2d ed., London, 1873. Turnbull, Investigation of Extern. Applic. of Veratria, London, 1829 ; Schmidt's Jahrb., ii., 379. Weyland, vergleich. Unters. iib. Veratrin Sabadillin. Delphinin., &c, Giessen, 1869. Wood, H., Amer. Journ. Sci., Jan., 1870, p. 36. Whey. Mav, Bair. Arztl. Intelligenzbl., 1879, No. xii., s. 123. Zinc. Harnack, Arch. f. exp. Path. u. Pharm., Bd. iii., p. 44. Meihuizen, Arch. f. ges. Physiol., Bd. vii., p. 212. 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A., Librarian of the National Medical Library, Washington, thus graphically outlines the character and services of The American Journal — "The ninety-seven volumes of this Journal need no eulogy. They contain many original papers of the highest value ; nearly all the real criticisms and reviews which we possess ; and such carefully prepared summaries of the progress of medical science, and abstracts and notices of foreign works, that from this file alone, were all other productions of the press for the last fifty years destroyed, it would be possible to reproduce the great majority of the real contributions of the world to medical science during that period." This opinion of a man pre-eminently qualified to judge is corroborated by the great circle of readers of the Journal, which includes the thinkers of the profession in all parts of the world. During the coming year the features of the Journal which have given unalloyed satisfaction to two generations of medical men, will be maintained in their vigorous maturity. The Original Department will consist of elaborate and richly illustrated articles from the pens of the most eminent members of the profession in all parts of the country and England. The Review Department will maintain its well-earned reputation for discernment and impartiality, and will contain elaborate reviews of new works and topics of the day, and numerous analytical and bibliographical notices by competent writers. Following these comes the Quarterly Summary of Improvements and Dis- coveries in the Medical Sciences, which, being a classified and arranged condensation of important articles appearing in the chief medical journals of the world, furnishes a compact digest of medical progress abroad and at home. The subscription price of The American Journal op the Medical Sciences has never been raised during its long career. It is still sent free of postage for Five Dollars per annum in advance. Taken together, the Journal and News combine the advantages of the elaborate prep- aration that can be devoted to a quarterly with the prompt conveyance of intelligence by the weekly ; while, by special management, duplication of matter is rendered im- possible. It will thus be seen that for the very moderate sum of NINE DOLLARS in advance the subscriber will receive free of postage a weekly and a quarterly journal, both reflecting the latent advances of the medical sciences, and containing an equivalent of more than 4000 octavo pages, stored with the choicest material, original and selected, that can be furnished by the best medical minds of both hemispheres. It would be impossible to find elsewhere ho large an amount of matter of the same value offered at so low a price. Lea Brothers & Co.'s Publications — Period., Compends, Manuals. 3 The safest mode of remittance is by bank check or postal money order, drawn to the order of the undersigned ; where these are not accessible, remittances for subscrip- tions may be made at the risk of the publishers by forwarding in registered letters. Address, Lea Brothers & Co., Nos. 706 and 708 Sansom St., Philadelphia. *** Communications to both these periodicals are invited from gentlemen in all parts of the country. Original articles contributed exclusively to either periodical are liberally paid for upon publication. When necessary to elucidate the text, illustrations will be fur- nished without cost to the author. All letters pertaining to the Editorial Department of The Medical News and The American Journal of the Medical Sciences should be addressed to the Editorial Offices, 1004 Walnut Street, Philadelphia. All letters pertaining to the Business Department of these journals should be addressed exclusively to Lea Brothers & Co., 706 and 708 Sansom Street, Philadelphia. HAHTSHOKNE, HENKY, A. M., M. D., Lately Professor of Hygiene in the University of Pennsylvania. A Conspectus of the Medical Sciences ; Containing Handbooks on Anatomy, Physiology, Chemistry, Materia Medica, Practice of Medicine, Surgery and Obstetrics. Second edition, thoroughly revised and greatly improved. In one large royal 12mo. volume of 1028 pages, with 477 illustrations. Cloth, $4.25 ; leather $5.00. industry and energy of its able editor. — Boston Medical and Surgical Journal, Sept. 3, 1874. The object of this manual is to afford a conven- ient work of reference to students during the brief moments at their command while in attendance upon medical lectures. It is a favorable sign that it has been found necessary, in a short space of time, to issue a new and carefully revised edition. The illustrations are very numerous and unusu- ally clear, and each part seems to have received its due share of attention. We can conceive such a work to be useful, not only to students, but to practitioners as well. It reflects credit upon the "We can say, with the strictest truth, that it is the best work of the kind with which we are acquaint- ed. It embodies in a condensed form all recent contributions to practical medicine, and is there- fore useful to every busy practitioner throughout our country, besides being admirably adapted to the use of students of medicine. The book is faithfully and ably executed.— Charles ton Medical Journal. April, 1875. STV .DENTS' SERIES OF MANUALS. A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine and Surgery, written by eminent Teachers or Examiners, and issued in pocket-size X2mo. volumes of 300-540 pages, richly illustrated and at a low price. The following vol- umes are now ready: Gould's Surgical Diagnosis, Bobertson's Physiological Physics, Bruce's Materia Medica omd Therapeutics, Power's Human Physiology, Clarke and Lockwood's Dissectors' Manual, Balfe's Clinical Chemistry, Treves' Surgical Applied Anatomy, Pepper's Surgical Pathology, and Klein's Elements of Histology. The following are in press : Bellamy's Operative Surgery, Bell's Comparative Physiology and Anatomy, (shortly), Pepper's Forensic Medicine, and Curnow's Medical Applied Anatomy. For separate notices see index on last page. SERIES OF CLINICAL MANUALS. In arranging for this Series it has been the design of the publishers to provide the profession with a collection of authoritative monographs on important clinical subjects in a cheap and portable form. The volumes will contain about 550 pages and will be freely illustrated by chromo-lithographs and woodcuts. The following volumes are just ready: Treves on Intestinal Obstruction; and Savage on Insanity and Allied Neu- roses; The following are in active preparation: Hutchinson on Syphilis; Bryant on the Breast; Morris on Surgical Diseases of the Kidney; Broadbent on the Pulse; Butlin on the Tongue (shortly); Owen on Surgical Diseases of Children; Lucas on Diseases of the Urethra; Marsh on Diseases of the Joints, Pick on Fractures and Disloca- tions, and Ball on the Pedum and Anus. For separate notices see index on last page. NEILL, JOHN, M. D., and SMITH, F. G., M. JD., Late Surgeon to the Penna. Hospital. Prof, of the Institutes of Med. in the Univ. of Penna. An Analytical Compendium of the Various Branches of Medical Science, for the use and examination of Students. A new edition, revised and improved. In one large royal 12mo. volume of 974 pages, with 374 woodcuts. Cloth, $4; leather, $4.75. LUDLOW, J.L,,M.JD., Consulting Physician to the Philadelphia Hospital, etc. A Manual of Examinations upon Anatomy, Physiology, Surgery, Practice of Medicine, Obstetrics, Materia Medica, Chemistry, Pharmacy and Therapeutics. To which is added a Medical Formulary. Third edition, thoroughly revised, and greatly extended and enlarged. In one handsome royal 12mo. volume of 816 large pages, with 370 illus- trations. Cloth, $3.25 ; leather, $3.75. The arrangement of this volume in the form of question and answer renders it espe- cially suitable for the office examination of students, and for those preparing for graduation. Lea Brothers & Co.'s Publications — Dictionaries. nxmGLISON, BOBLEY, M.Z>., Late Professor of Institutes of Medicine in the Jefferson Medical College of Philadelphia. MEDICAL LEXICON; A Dictionary of Medical Science: Containing a concise Explanation of the various Subjects and Terms of Anatomy, Physiology, Pathol- ogy, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Juris- prudence and Dentistry, Notices of Climate and of Mineral Waters, Formulae for Officinal, Empirical and Dietetic Preparations, with the Accentuation and Etymology of the Terms, and the French and other Synonymes, so as to constitute a French as well as an English Medical Lexicon. Edited by Richard J. Dunglison, M. D. In one very large and handsome royal octavo volume of 1139 pages. Cloth, $6.50 ; leather, raised bands, $7.50 ; very handsome half Russia, raised bands, $8. The object of the author, from the outset, has not been to make the work a mere lexi- con or dictionary of terms, but to afford under each word a condensed view of its various medical relations, and thus to render the work an epitome of the existing condition of medical science. Starting with this view, the immense demand which has existed for the work has enabled him, in repeated revisions, to augment its completeness and usefulness, until at length it has attained the position of a recognized and standard authority wherever the language is spoken. Special pains have been taken in the preparation of the present edition to maintain this enviable reputation. The additions to the vocabulary are more numerous than in any previous revision, and particular attention has been bestowed on the accentuation, which will be found marked on every word. The typographical arrangement has been greatly improved, rendering reference much more easy, and every care has been taken with the mechanical execution. The volume now contains the matter of at least four ordinary octavos. A book of which every American ought to be proud. When the learned author of the work passed away, probably all of us feared lest the book should not maintain its place in the advancing science whose terms it defines. Fortunately, Dr. Richard J. Dunglison, having assisted his father in the revision of several editions of the work, and having been, therefore, trained in the methods and imbued with the spirit of the book, has been able to edit it as a work of the kind should be edited — to carry it on steadily, without jar or inter- ruption, along the grooves of thought it has trav- elled during its lifetime. To show the magnitude of the task which Dr. Dunglison has assumed and carried through, it is only necessary to state that more than six thousand new subjects have been added in the present edition. — Philadelphia Medical Times, Jan. 3, 1874. About the first book purchased by the medical student is the Medical Dictionary. The lexicon explanatory of technical terms is simply a sine qua non. In a science so extensive and with such col- laterals as medicine, it is as much a necessity also to the practising physician. To meet the wants of students and most physicians the dictionary must be condensed while comprehensive, and practical while perspicacious. It was because Dunglison's met these indications that it became at once the dictionary of general use wherever medicine was studied in the English language. In no former revision have the alterations and additions been so great. The chief terms have been set in black letter, while the derivatives follow in small caps; an arrangement which greatly facilitates reference. — Cincinnati Lancet and Clinic, Jan. 10, 1874. As a standard work of reference Dunglison's work has been well known for about forty years, and needs no words of praise on our part to recom- mend it to the members of the medical, and like- wise of the pharmaceutical, profession. The latter especially are in need of a work which gives ready and reliable information on thousands of subjects and terms which they are liable to encounter in pursuing their daily vocations, but with which they cannot be expected to be familiar. The work before us fully supplies this want. — American Jour- nal of Pharmacy, Feb. 1874. Particular care has been devoted to derivation and accentuation of terms. With regard to the latter, indeed, the present edition may be consid- ered a complete "Pronouncing Dictionary of Medical Science." It is perhaps the most reliable work published for the busy practitioner, as it con- tains information upon every medical subject, in a form for ready access, and with a brevity as ad- mirable as it is practical. — Southern Medical Record, Feb. 1874. A valuable dictionary of the terms employed in medicine and the allied sciences, and or the rela- tions of the subjects treated under each head. It well deserves the authority and popularity it has obtained.— British Med. Jour., Oct. 31, 1874. Few works of this class exhibit a grander monu- ment of patient research and of scientific lore. — London Lancet, May 13, 1875. Dunglison's Dictionary is incalculably valuable, and indispensable to every practitioner of medi- cine, pharmacist and dentist. — Western Lancet, March, 1874. It has the rare merit that it certainly has no rival in the English language for accuracy and extent of references. — London Medical Gazette. HOBLYN, BICHABD !>., M. 2>. A Dictionary of the Terms Used in Medicine and the Collateral Sciences. Revised, with numerous additions, by Isaac Hays, M. D., late editor of The American Journal of the Medical Sciences. In one large royal 12mo. volume of 520 double-columned pages. Cloth, $1.50 ; leather, $2.00. It is the best book of definitions we have, and ought always to be upon the student's table. — Southern Medical and Surgical Journal. BOI>WELL, G. F., F. B. A. S., F. C. S., Lecturer on Natural Science at Clifton College, England. A Dictionary of Science : Comprising Astronomy, Chemistry, Dynamics, Elec- tricity, Heat, I Iydrodynamies, J Iydrostatirs, Light, Magnetism, Mechanics, Meteorology, Pneumatics, Sound and Statics. Contributed by J. T. Bottomley, M. A., F.C.S., William Crookes, F.K.S., F.C.S., Frederick Guthrie, B.A., Ph.D., R. A. Proctor, B.A., F.R.A.S., G. P. Rod well, Editor, Charles Tondinson, F.R.S., F.C.S., and Richard Wornell, M. A., B.Sc. Preceded by an Essay on the History of the Physical Sciences. In one handsome octavo volume of 702 pages, with 143 illustrations. Cloth, $5.00. Lea Brothers & Co.'s Publications — Anatomy. 5 GMAT, HFJSTMY, F. M. S., Lecturer on Anatomy at St. George's Hospital, London. Anatomy, Descriptive and Surgical. The Drawings by H. V. Carter, M. D., and Dr. Westmacott. The dissections jointly by the Author and Dr. Carter. "With an Introduction on General Anatomy and Development by T. Holmes, M. A., Surgeon to St. George's Hospital. Edited by T. Pickering Pick, F. R. C. S., Surgeon to and Lecturer on Anatomy at St. George's Hospital, London, Examiner in Anatomy, Royal College of Surgeons of England. A new American from the tenth enlarged and improved London edition. To which is added the second American from the latest English edition of Landmarks, Medical and Surgical, by Luther Holden, F.R. C. S., author of " Human Osteology," " A Manual of Dissections," etc. In one imperial octavo volume of 1023 pages, with 564 large and elaborate engravings on wood. Cloth, $6.00 ; leather, $7.00 ; very handsome half Russia, raised bands, $7.50. This work covers a more extended range of subjects than is customary in the ordinary text-books, giving not only the details necessary for the student, but also the application to those details to the practice of medicine and surgery. It thus forms both a guide for the learner and an admirable work of reference for the active practitioner. The engravings form a special feature in the work, many of them being the size of nature, nearly all original, and having the names of the various parts printed on the body of the cut, in place of figures of reference with descriptions at the foot. They thus form a complete and splendid series, which will greatly assist the student in forming a clear idea of Anatomy, and will also serve to refresh the memory of those who may find in the exigencies of practice the necessity of recalling the details of the dissecting-room. Combining, as it does, a complete Atlas of Anatomy with a thorough treatise on systematic, descriptive and applied Anatomy, the work will be found of great service to all physicians who receive students in their offices, relieving both preceptor and pupil of much labor in laying the groundwork of a thorough medical education. Landmarks, Medical and Surgical, by the distinguished Anatomist, Mr. Luther Holden, has been appended to the present edition as it was to the previous one. This work gives in a clear, condensed and systematic way all the information by which the practitioner can determine from the external surface of the body the position of internal parts. Thus complete, the work, it is believed, will furnish all the assistance that can be rendered by type and illustration in anatomical study. This well-known work comes to us as the latest American from the tenth English edition. As its title indicates, it has passed through many hands and has received many additions and revisions. The work is not susceptible of more improvement. Taking it all in all, its size, manner of make-up, its character and illustrations, its general accur- acy of description, its practical aim, and its per- spicuity of style, it is the Anatomy best adapted to the wants of the student and practitioner. — Medical Record, Sept. 15, 1883. There is probably no work used so universally by physicians and medical students as this one. It is deserving of the confidence that they repose in it. If the present edition is compared with that issued two years ago, one will readily see how much it has been improved in that time. Many pages have been added to the text, especially in those parts that treat of histology, and many new cuts have been introduced and old ones modified. — Journal of the American Medical Association, Sept. 1, 1883. Also for sale separate — HOLDER, IUTHFM, F. M. C. S., Surgeon to St. Bartholomew' 1 s and the Foundling Hospitals, London. Landmarks, Medical and Surgical. Second American from the latest revised English edition, with additions by W. W. Keen, M. D., Professor of Artistic Anatomy in the Pennsylvania Academy of the Fine Arts, formerly Lecturer on Anatomy in the Phila- delphia School of Anatomy. In one handsome 12mo. volume of 148 pages. Cloth, $1.00. This little book is all that can be desired within its scope, and its contents will be found simply in- valuable to the young surgeon or physician, since they bring before him such data as he requires at every examination of a patient. It is written in language so clear and concise that one ought almost to learn it by heart. It teaches diagnoais by external examination, ocular and palpable, of the body, with such anatomical and physiological facts as directly bear on the subject. It is eminently the student's and young practitioner's book. — Phy- sician and Surgeon, Nov. 1881. WILSON, FHASMUS, F. M. 8. A System of Human Anatomy, General and Special. Edited by W. H. Gobrecht, M. D., Professor of General and Surgical Anatomy in the Medical College of Ohio. In one large and handsome octavo volume of 616 pages, with 397 illustrations. €loth, $4.00; leather, $5.00. SMITH, H. H, M. D., and HOMNFM, WM. M, M.D., Emeritus Prof, of Surgery in the Univ. of Penna., etc. Late Prof, of Anat. in the Univ. of Penna. An Anatomical Atlas, Illustrative of the Structure of the Human Body. In one large imperial octavo volume of 200 pages, with 634 beautiful figures. Cloth, $4.50. CLFLAND, JOHN, M. !>., F. M. $., Professor 6f Anatomy and Physiology in Queen's College, Oalway. A Directory for the Dissection of the Human Body. In one 12mo. volume of 178 pages. Cloth, $1.25. 6 Lea Brothers & Co.'s Publications — Anatomy. ALLEN, HARRISON, M. D., Professor of Physiology in the University of Pennsylvania. A System of Human Anatomy, Including Its Medical and Surgical Relations. For the use of Practitioners and Students of Medicine. With an Intro- ductory Section on Histology. By E. O. Shakespeare, M. D., Ophthalmologist to the Philadelphia Hospital. Comprising 813 double-columned quarto pages, with 380 illustrations on 109 full page lithographic plates, many of which are in colors, and 241 engravings in the text. In six Sections, each in a portfolio. Section I. Histology. Section II. Bones and Joints. Section HI. Muscees and Fasciae. Section IY. Arteries, Veins and Lymphatics. Section V. Nervous System. Section VI. Organs op Sense, of Digestion and Genito-Urinary Organs, Embryology, Development, Teratology, Superficial Anatomy, Post-Mortem Examinations, and General and Clinical Indexes. Just ready. Price per Section, each in a handsome portfolio, $3.50; also bound in one volume, cloth $23.00; very handsome half Russia, raised bands and open back, $25.00. For sale by subscription only. Apply to the Publishers. Extract from Introduction. It is the design of this book to present the facts of human anatomy in the manner best suited to the requirements of the student and the practitioner of medicine. The author believes that such a book is needed, inasmuch as no treatise, as far as he knows, contains, in addition to the text descriptive of the subject, a systematic presentation of such anatomical facts as can be applied to practice. A. book which will be at once accurate in statement and concise in terms ; which will be an acceptable expression of the present state of the science of anatomy ; which will exclude nothing that can be made applicable to the medical art, and which will thus embrace all of surgical importance, while omitting nothing of value to clinical medicine, — would appear to have an excuse for existence in a country where most surgeons are general practitioners, and where there are few general practitioners who have no interest in surgery. It is to be considered a study of applied anatomy in its widest sense — a systematic presentation of such anatomical facts as can be applied to the practice of medicine as well as of surgery. Our author is concise, accurate and practical" in his statements, and succeeds admirably in infusing an interest into the study of what is generally con- sidered a dry subject. The department of Histol- ogy is treated in a masterly manner, and the ground is travelled over by one thoroughly famil- iar with it. The illustrations are made witn great care, and are simply superb. There is as much of practical application of anatomical points to the every-day wants of the medical clinician as to those of the operating surgeon. In fact, few general practitioners will read the work without a feeling of surprised gratification that so many points, concerning which they may never have thought before are so well presented for their con- sideration. It is a work which is destined to be the best of its kind in any language. — Medical Record, Nov. 25, 1882. CLARKE, W. B., F.R. C.S. & LOCKWOOD, C. B., F.R. C.S. Demonstrators of Anatomy at St. Bartholomew's Hospital Medical School. London. The Dissector's Manual. In one pocket-size 12mo. volume of 396 pages, with 49 illustrations. Limp cloth, red edges, $1.50. Just ready. See Students' Series of Manuals, page 3. This is a very excellent manual for the use of the student who desires to learn anatomy. The meth- ods of demonstration seem to us very satisfactory. There are many woodcuts which, for the most part, are good and instructive. The book is neat* and convenient. We are glad to recommend it.— Boston Medical and Surgical Journal, Jan. 17, 1884. TREVES, FREDERICK, F. R. C. S>, Senior Demonstrator of Anatomy and Assistaiit Surgeon at the London Hospital. Surgical Applied Anatomy. In one pocket-size 12mo. volume of 540 pages, with 61 illustrations. Limp cloth, red edges, $2.00. Just ready. See Students' Series of Manuals, page 3. He has produced a work which will command a larger circle of readers than the class for which it was written. This union of a thorough, practical acquaintance with these fundamental branches, quickened by daily use as a teacher and practi- tioner, has enabled our author to prepare a work which it would be a most difficult task to excel.— The American Practitioner Feb. 1884. CTJRJSOW, JOHN, M. D., F. R. C F., Professor of Anatomy at King's College, Physician at King's College Hospital. Medical Applied Anatomy. In one pocket-size 12mo. volume. Preparing. See Students' Series of Manuals, page 3. BELLAMY, EDWARD, F. R. C. S.,- Senior Assistant-.- • : Charing- C¥o68 JIosj>ital, London. The Student's Guide to Surgical Anatomy : Being a Description of the most Important Surgical Regions of the Human Body, and intended as an Introduction to operative Surgery, in one 12mo. volume of 300 pages, with 50 illustrations. Cloth, $2.25. HARTSHORNE'S HANDBOOK OF ANATOMY HORNER'S SPECIAL ANATOMY AND HISTOL- AND PHYSIOLOGY. Second edition, revised. I OGY. Eighth edition, extensively revised and in one royal 12mo. volume of 310 pages, with 2'10 modified, in two octavo volumes of 1007 pages, woodcuts. Cloth, 81.75. witli 820 woodcuts. Cloth, $0.00. Lea Brothers & Co.'s Publications — Ana t., Physics, Physiol. I) ALTON, JOHN C, M. D-, Professor Emeritus of Physiology in the College of Physicians and Surgeons, New York. The Topographical Anatomy of the Brain. In three very handsome quarto volumes comprising 178 pages of descriptive text. Illustrated with 48 full page photo- graphic plates of Brain Sections, with a like number of explanatory plates, as well as many woodcuts through the text. Price for the complete work, $36. Just ready. For sale by subscription. As but few of the copies reserved for this country now remain unsold, gentlemen desiring the work will do well to apply to the publishers at an early date. precise and accurate, and the methods by which the sections were made and the specimens re- produced are given very plainly in an introductory chapter, which cannot fail to' be of the greatest This is one of the most magnificent works on anatomy that has appeared during the present generation, and will not only supersede all its Sredecessors on the topographical anatomy of the rain, but make any further work on the same lines unnecessary. It contains forty-eight ex- quisite illustrations of the brain en masse and in sections. Not only has perfect accuracy been secured, but one of the finest and most artistic works of recent times has been presented to the medical public. Its value as a work of reference is considerably increased by the very careful out- line sketches which accompany the plates and which enable them to be easily followed and understood. These sketches are very complete and accurate, and have been reproduced from tracings. The descriptions by the author are clear, value to any one desirous of making similar prep- arations. Criticism on such a work is super- fluous. We can only congratulate Dr. Dalton, his assistants, and the publishers on the energy they have shown in undertaking such a work, and the success with which they have overcome a task presenting so many mechanical difficulties. We envy our American confreres the authorship and execution of so beautiful and useful an addition to medical literature. Much light is thrown on some obscure relations of parts of the brain which have never before been seen in correct juxtaposition. — London Lancet, April 18, 1885. BY THE SAME AUTHOR. Doctrines of the Circulation of the Blood. A History of Physiological Opinion and Discovery in regard to the Circulation of the Blood. In one handsome 12mo. volume of 293 pages. Cloth, $2. Just ready. In the progress of physiological study no fact was of greater moment, none more completely revolutionized the theories of teachers, than the discovery of the circulation of the blood. This explains the extraordinary interest it has to all medical historians. The volume before us is one of three or four which have been written within a few years by American physicians. It is in several respects the most complete. The volume, though small in size, is one of the most creditable con- tributions from an American pen to medical history that has appeared.— Med. & Surg. Rep., Dec. 6, 1884. ELLIS, GEOBGE VINEB, Emeritus Professor of Anatomy in University College, London. Demonstrations of Anatomy. Being a Guide to the Knowledge of the Human Body by Dissection. From the eighth and revised London edition. In one very handsome octavo volume of 716 pages, with 249 illustrations. Cloth, $4.25 • leather, $5.25. BOBEBTS, JOHN B., A. M., W. &., Prof, of Applied Anat. and Oper. Surg, in Phila. Polyclinic and Coll. for Graduates in Medicine. The Compend of Anatomy. For use in the dissecting-room and in preparing for examinations. In one 16mo. volume of 196 pages. Limp cloth, 75 cents. DBAFEB, JOHN C, M. D., LL. JD., Professor of Chemistry in the University of the City of New York. Medical Physics. A Text-book for Students and Practitioners of Medicine. In one octavo volume of 725 pages, with 376 woodcuts, mostly original. Cloth, $4. In a few days; From the Preface. The fact that a knowledge of Physics is indispensable to a thorough understanding of Medicine has not been as fully realized in this country as in Europe, where the admirable works of Desplats and Gariel, of Eobertson and of numerous German writers constitute a branch of educational literature to which we can show no parallel. A full appreciation of this the author trusts will be sufficient justification for placing in book form the sub- stance of his lectures on this department of science, delivered during many years at the University of the City of New York. Broadly speaking, this work aims to impart a knowledge of the relations existing between Physics and Medicine in their latest state of development, and to embody in the pursuit of this object whatever experience the author has gained during a long period of teaching this special branch of applied science. BOBEBTSON, J. McGBEGOB, M. A., M. B., Muirhead Demonstrator of Physiology, University of Glasgow. Physiological Physics. In one 12mo. volume of 537 pages, with 219 illustra- tions. Limp cloth, $2.00. Just ready. See Students' Series of Manuals, page 3. The title of this work sufficiently explains the nature of its contents. It is designed as a man- ual for the student of medicine, an auxiliary to his text-book in physiology, and it woul d be particu larly useful as a guide to his laboratory experi- ments. It will be found of great value to the practitioner. It is a carefully prepared book of reference, concise and accurate, and as such we heartily recommend it.— Journal of the American Medical Association, Dec. 6, 1884. BELL, F. JEFFBEY, 31. A., Professor of Comparative Anatomy at King's College, London. Comparative Physiology and Anatomy. Shortly. See Students' Series of Manuals, page 3. ^^HHHH 8 Lea Brothers & Co.'s Publications — Physiology, Chemistry, B ALTON, JOBHV C, M. JD., Professor of Physiology in the College of Physicians and Surgeons, New York, etc. A Treatise on Human Physiology. Designed for the use of Students and Practitioners of Medicine. Seventh edition, thoroughly revised and rewritten. In one very handsome octavo volume of 722 pages, with 252 beautiful engravings on wood. Cloth, $5.00 ; leather, $6.00 ; very handsome half Eussia, raised bands, $6.50. The merits of Professor Dalton's text-book, his smooth and pleasing style, the remarkable clear- ness of his descriptions, which leave not a chapter obscure, his cautious judgment and the general correctness of his facts, are perfectly known. They have made his text-book the one most familiar to American students.— Med. Record, March 4, 1882. Certainly no physiological work has ever issued from the press that presented its subject-matter in a clearer and more attractive light. Almost every page bears evidence of the exhaustive revision that has taken place. The material is placed in a more compact form, yet its delightful charm is re- tained, and no subject is thrown into obscurity. Altogether this edition is far in advance of any previous one, and will tend to keep the profession posted as to the most recent additions to our physiological knowledge. — Michigan Medical News, April, 1882. One can scarcely open a college catalogue that does not have mention of Dalton's Physiology as- the recommended text or consultation-book. ' For American students we would unreservedly recom- mend Dr. Dalton's work.- Va, Med. Monthly, July,'82. FOSTER, MICHAEL, M. JD., F. R. $., Professor of Physiology in Cambridge University, England. Text-Book of Physiology. Third American from the fourth English edition,. *ith notes and additions by E. T. Beichert, M. T>. In one handsome royal 12mo. volume *f over 1000 pages, with about 300 illustrations. Cloth, $3.25 ; leather, $3.75. In a few days. A notice of the previous edition is appended. A more compact and scientific work on physiol- ogy has never oeen published, and we believe our- selves not to be mistaken in asserting that it has now been introduced into every medical college in which the English language is spoken. This work conforms to the latest researches into zoology and comparative anatomy, and takes into consid- eration the late discoveries in physiological chem- istry and the experiments in localization of Ferrier and others. The arrangement followed is such as- to render the whole subject lucid and well con- nected in its various parts.— Chicago Medical Jour- nal and Examiner, August, 1882. POWER, HENRY, M. B., F. R. C. $., Examiner in Physiology, Royal College of Surgeons of England. Human Physiology. In one handsome pocket-size 12mo. volume of 396 pages, with 47 illustrations. Cloth, $1.50. See Students 7 Series of Manuals, page 3. The prominent character of this work is that of judicious condensation, in which an able and suc- cessful effort appears to have been made by its accomplished author to teach the greatest number of facts in the fewest possible words. The result is a specimen of concentrated intellectual pabu to every one of our readers. — The American Jour- nal of the Medical Sciences, October, 1884. This little work is deserving of the nighest praise, and we can hardly conceive how the main facts of this science could have been more clearly or concisely stated. The price of the work is such lum seldom surpassed, which ought to be care- | as to place it within the reach of all, while the ex- fully ingested and digested by every practitioner | cellence of its text will certainly secure for it most who desires to keep himself well informed upon | favorable commendation — Cincinnati Lancet and this most progressive of the medical sciences. Clinic, Feb. 16, 1884. The volume is one which we cordially recommend | CARPENTER, WM. B., 31. JD., F. R. S., F. G. 8., F. L. 8., Registrar to the University of London, etc. Principles of Human Physiology. Edited by Henry Power, M. B., Lond., F. K. C. S., Examiner in Natural Sciences, University of Oxford. A new American from the eighth revised and enlarged edition, with notes and additions by Francis G. Smith, M. D., late Professor of the Institutes of Medicine in the University of Pennsylvania. In one very large and handsome octavo volume of 1083 pages, with two plates and 373 illus- trations. Cloth, $5.50 ; leather, $6.50 ; half Eussia, $7. FOWNE8, GEORGE, Ph. JD. A Manual of Elementary Chemistry; Theoretical and Practical. Ke- vised by Henry Watts, B. A., F. R. S. New American edition. In one large royal 12mo. volume of over 1 000 pages, with 200 illustrations on wood and a colored plate. Cloth, $2.7-"); leather, $3.25. In press. A notice of the previous edition is appended. The book opens with a treatise on Chemical Physics, Including Heat, Light, Magnetism and Electricity. These subjects are treated clearly and briefly, but enough is given to enable the stu- dent to comprehend the facta ana laws of Chemis- try proper. It is the fashion of late years to omit these topics from works on chemistry, but their omission is not to becommended. As was required by the great advance in the science of Chemistry of late years, the chapter on the General Principles of Chemical Philosophy has been entirely rewrit- ten. The latest views on Equivalents, Quantiva- lence, etc., are clearly and fully set forth. This last edition is a great improvement upon its prede- cessors, which is saying not a little of a book that has reached its twelfth edition.— Ohio Medical Re- corder, Oct., 1878. Wohler's Outlines of Organic Chemistry. Edited by Fittig. Translated by Ira Rk.msent, M. I)., Ph. D. In one 12mo. volume of 550 pages. Cloth, $3. GALLOWAY'S QUALITATIVE ANALYSIS. New edition. LNN'S MANUAL OF CHEMICAL PHYS- IOLOGY, in one octavo volume <>f 827 pages, with 41 illustrations. Cloth, $2.26. CARPENTER'S PRIZE ESSAY ON THE USE AND >r AXOOHOLIC Liquors in Health and Dis- BASE. With explanations of scientific words. Small lL'mo. 178 pages. Cloth, GO cents. Lea Brothers & Co.'s Publications — Chemistry. 9 FBANKLAND, E., D. C.L., F. M.S., &JAFF, Ph. !>., F. I. C, Professor of Chemistry in the Normal School of Science, London. Assist. Prof, of Chemistry in the Normal School of Science, London. Inorganic Chemistry. In one handsome octavo volume of 600 pages, with 51 woodcuts and 2 lithographic plates. Cloth, $3.75 ; leather, $4.75. In press. This work on elementary chemistry is based upon principles of classification, nomen- clature and notation which have been proved by nearly twenty years experience in teaching to impart most readily a sound and accurate knowledge of the science. ATTFIFLiy, JOHN, Fh. F., Professor of Practical Chemistry to the Pharmaceutical Society of Great Britain, etc. Chemistry, General, Medical and Pharmaceutical; Including the Chem- istry of the U. S. Pharmacopoeia. A Manual of the General Principles of the Science, and their Application to Medicine and Pharmacy. A new American, from the tenth English edition, specially revised by the Author. In one handsome royal 12mo. volume of 728 pages, with 87 illustrations. Cloth, $2.50 ; leather, $3.00. to put himself in the student's place and to appre- ciate his state of mind. — American Chemical Jour- nal, April, 1884. A text-book which passes through ten editions in sixteen years must have good qualities. This remark is certainly applicable to Attfield's Chem- istry, a book which is so well known that it is hardly necessary to do more than note the appear- ance of this new and improved edition. It seems, however, desirable to point out that feature of the book which, in all probability, has made it so popular. There can be little doubt that it is its thoroughly practical character, the expression being used in its best sense. The author under- stands what the student ought to learn, and is able It is a book on which too much praise cannot be bestowed. As a text-book for medical schools it is unsurpassable in the present state of chemical science, and having been prepared with a special view towards medicine and pharmacy, it is alike indispensable to all persons engaged in those de- partments of science. It includes the whole chemistry of the last Pharmacopoeia. — Pacific Medi- cal and Sugrical Journal, Jan, 1884. BLOXAM, CHARLES L., Professor of Chemistry in King's College, London. Chemistry, Inorganic and Organic. New American from the fifth Lon- don edition, thoroughly revised and much improved. In one very handsome octavo volume of 727 pages, with 292 illustrations. Cloth, $3.75 ; leather, $4.75. Comment from us on this standard work is al- most superfluous. It differs widely in scope and aim from that of Attfield, and in its way is equally beyond criticism. It adopts the most direct meth- ods in stating the principles, hypotheses and facts of the science. Its language is so terse and lucid, and its arrangement of matter so logical in se- quence that the student never has occasion to complain that chemistry is a hard study. Much attention is paid to experimental illustrations of chemical principles and phenomena, and the mode of conducting these experiments. The book maintains the position it has always held as one of the best manuals of general chemistry tn the Eng- lish language. — Detroit Lancet, Feb. 1884. The general plan of this work remains the same as in previous editions, the evident object being to give clear and concise descriptions of all known elements and of their most important compounds, with explanations of the chemical laws and principles involved. We gladly repeat now the opinion we expressed about a former edition, that we regard Bloxam's Chemistry as one ot the best treatises on general and applied chemistry. — American Jour, of Pharmacy, Dec. 1883. SIMON, W., Fh. &., M. &., Professor of Chemistry and Toxicology in the College of Physicians and Surgeons, Baltimore, and Professor of Chemistry in the Maryland College of Pharmacy. Manual of Chemistry. A Guide to Lectures and Laboratory work for Beginners in Chemistry. A Text-book, specially adapted for Students of Pharmacy and Medicine. In one 8vo. vol. of 410 pp., with 16 woodcuts and 7 plates, mostly of actual deposits, with colors illustrating 56 of the most important chemical reactions. Cloth, $3.00 ; also without plates, cloth, $2.50. Just ready. This book supplies a want long felt by students of medicine and pharmacy, and is a concise but thorough treatise on the subject. The long expe- rience of the author as a teacher in schools of medicine and pharmacy is conspicuous in the perfect adaptation of the work to the special needs of the student of these branches. The colored plates, beautifully executed, illustrating precipi- tates of various reactions, form a novel and valu- able feature of the book, and cannot fail to be ap- preciated by both student and teacher as a help over the hard places of the science.— Maryland Medical Journal, Nov. 22, 1884. MEMSEN, IMA, M. &., Fh. D. 9 Professor of Chemistry in the Johns Hopkins University, Baltimore. Principles of Theoretical Chemistry, with special reference to the Constitu- tion of Chemical Compounds. Second and revised edition. In one handsome royal 12mo. volume of 240 pages. Cloth, $1.75. Just ready. of chemistry. The high reputation of the author assures its accuracy in all matters of fact, and its judicious conservatism in matters of theory, com- bined with the fulness with which, in a small compass, the present attitude of chemical science towards the constitution of compounds is con- sidered, gives it a value much beyond that accorded to the average text-books of the day,— American Journal of Science, March, 1884. The book is a valuable contribution to the chemi- cal literature of instruction. That in so few years a second edition has been called for indicates that many chemical teachers have been found ready to endorse its plan and to adopt its methods. In this edition a considerable proportion of the book has been rewritten, much new matter has been added and the whole has been brought up to date. We earnestly commend this book to every student 10 Lea Brothers & Co.'s Publications — Chemistry, CMARLE8, T. CRAN8TOVN, M. D., F. C. 8., 31. 8., Formerly Asst. Prof, and Demonst. of Chemistry and Chemical Physics, Queen's College, Belfast. The Elements of Physiological and Pathological Chemistry. A Handbook for Medical Students and Practitioners. Containing a general account of Nutrition, Foods and Digestion, and the Chemistry of the Tissues, Organs, Secretions and Excretions of the Body in Health and in Disease. Together with the methods for pre- paring or separating their chief constituents, as also for their examination in detail, and an outline syllabus of a practical course of instruction for students. In one handsome octavo volume of 463 pages, with 38 woodcuts and 1 colored plate. Cloth, $3.50. Dr. Charles' manual admirably fulfils its inten- The work is thoroughly trustworthy, and in- formed throughout by a genuine scientific spirit. The author deals with the chemistry of the diges- tive secretions in a systematic manner, which leaves nothing to be desired, and in reality sup- plies a want in English literature. The book ap- pears to us to be at once full and systematic, and to show a just appreciation of the relative import- ance of the various subjects dealt with. — British Medical Journal, November 29, 1884. tion of giving his readers on the one hand a sum- mary, comprehensive but remarkably compact, of the mass of facts in the sciences which have be- come indispensable to the physician ; and, on the other hand, of a system of practical directions so minute that analyses often considered formidable may be pursued by any intelligent person. — Archives of Medicine, Dec. 1884. HOFFMAJYJST, F, A.M.,Fh.L>., & FOWER F.B., Fh.D., Public Analyst to the State of Nexo York. Prof, of Anal. Chem. in the Phil. Coll. of Pharmacy. A Manual of Chemical Analysis, as applied to the Examination of Medicinal Chemicals and their Preparations. Being a Guide for the Determination of their Identity and Quality, and for the Detection of Impurities and Adulterations. For the use of Pharmacists, Physicians, Druggists and Manufacturing Chemists, and Pharmaceutical and Medical Students. Third edition, entirely rewritten and much enlarged. In one very handsome octavo volume of 621 pages, with 179 illustrations. Cloth, $4.25. "We congratulate the author on the appearance of the third edition of this work, published for the first ^me in this country also. It is admirable and the information it undertakes to supply is both extensive and trustworthy. The selection of pro- cesses for determining the purity of the substan- ces of which it treats is excellent and the descrip- tion of them singularly explicit. Moreover, it is exceptionally free from typographical(errors. "We have no hesitation in recommending it to those who are engaged either in the manufacture or the testing of medicinal chemicals. — London Pharma- ceutical Journal and Transactions, 1883. CLOWE8, FRAJSE1, Z>. 8c, London, Senior Science- Master at the High School, Newcastle-under-Lyme, etc. An Elementary Treatise on Practical Chemistry and Qualitative Inorganic Analysis. Specially adapted for use in the Laboratories of Schools and Colleges and by Beginners. Third American from the fourth and revised English edition. In one very handsome royal 12mo. volume of about 400 pages, with about 50 illustrations. Cloth, $2.50. In a few days. The d emand for four editions of this work proves the success of Professor Clowes' effort to provide a simple, concise and trustworthy guide to qualitative analysis. The use and preparation of apparatus, and the directions for working have been so fully and clearly detailed that the book is admirably adapted not only to relieve the teacher of unnecessary labor, but also to answer all the requirements of self-instruction. RALFE, CHARLES JET., M. D., F. R. C. F., Assistant Physician at the London Hospital. Clinical Chemistry. In one pocket-size J12mo. volume of 314 pages, with 16 illustrations. Limp cloth, red edges, $1.50. This is one of the most instructive little works that we have met with in a long time. The author is a physician and physiologist, as well as a chem- ist, consequently the book is unqualifiedly prac- tical, telling the physician just what he ougnt to know, of the applications of chemistry in medi- See Students 1 Series of Manuals, page 3. cine. Dr. Ralfe is thoroughly acquainted with the latest contributions to his science, and it is quite refreshing to find the subject dealt with so clearly and simply, yet in such evident harmony with the modern scientific methods and spirit.— Medical Record, February 2, 1884. CLA88EJST, ALEXANDER, Professor in the Royal Polytechnic School, Aix-la-Chapelle. Elementary Quantitative Analysis. Translated, with notes and additions, by Edgar F. Smith. Ph. D., Assistant Professor of Chemistry in the Towne Scientific School, University of Penna. In one 12mo. volume of 324 pages, with 3G illust. Cloth, $2.00. It is probably the best manual of an elementary nature extant insomuch as its methods are the best. It teaches by examples, commencing with single determinations, followed by separations, and then advancing to the analysis of minerals and such products as are met with in applied chemis- try. It is an indispensable book for students in chemistry.— Boston Journal of Chemistry, Oct. 1878. GREENE, WILLIAM H., M. D., Demonstrator of Chemistry in the Medical Department of the University of Pennsylvania. A Manual of Medical Chemistry. For the use of Students. Based upon Bow- man's Medical Chemistry. In one 12mo. volume of 310 pages, with 74 illus. Cloth, $1.75. It is a concise, manual of three hundred pages, the recognition of compounds due to pathological giving mi excellent BUtnmary of fche besl methods conditions. The detection of poisons is treated of analyzing the liquids and solids of the body, both with sufficient fulness for the purpose of thestu- forthe estimation of their normal constituents and dent or practitioner. — Boston Jl. of Chem., June, '80. Lea Brothers & Co.'s Publications — Pliarm., Mat. Med., Therap. 11 PARRISH, En WARD, Late Professor of the Theory and Practice of Pharmacy in the Philadelphia College of Pharmacy. A Treatise on Pharmacy : designed as a Text-book for the Student, and as a Guide for the Physician and Pharmaceutist. With many Formulae and Prescriptions. Fifth edition, thoroughly revised, by Thomas S. Wiegajstd, Ph. G. In one handsome octavo volume of 1093 pages, with 256 illustrations. Cloth, $5 ; leather, $6. No thoroughgoing pharmacist will fail to possess himself of so useful a guide to practice, and no physician who properly estimates the value of an accurate knowledge of the remedial agents em- ployed by him in daily practice, so far as their miscibility, compatibility and most effective meth- ods of combination are concerned, can afford to leave this work out of the list of their works of reference. The country practitioner, who must always be in a measure his own pharmacist, will find it indispensable. — Louisville Medical News, March 29, 1884. This well-known work presents itself now based upon the recently revised new Pharmacopoeia. Each page bears evidence of the care bestowed upon it, and conveys valuable information from the rich store of the editor's experience. In fact, all that relates to practical pharmacy — apparatus, processes and dispensing— has been arranged and described with clearness in its various aspects, so as to afford aid and advice alike to the student and to the practical pharmacist. The work is judi- ciously illustrated with good woodcuts — American Journal of Pharmacy, January, 1884. There is nothing to equal Parrish's Pharmacy in this or any other language.— London Pharma- ceutical Journal. BRTJNTOW, T. LAUDER, M. I)., Lecturer on Materia Medica and Therapeutics at St. Bartholomew's Hospital, London, etc. A Text-book of Pharmacology, Materia Medica and Therapeutics. In one handsome octavo volume of about 1000 pages, with over 200 illustrations. Cloth, $5.50 ; leather, $6.50. In press. It is with peculiar pleasure that the early appearance of this long expected work is announced by the publishers. Written by the foremost authority on its subject in Eng- land, it forms a compendious treatise on materia medica, pharmacology, pharmacy, and the practical use of medicines in the treatment of disease. Space has been devoted to the fundamental sciences of chemistry, physiology and pathology, wherever it seemed necessary to elucidate the proper subject-matter of the book. A general index, an index of diseases and remedies, and an index of bibliography close a volume which will undoubtedly be of the highest value to the student, practitioner and pharmacist. • HERMAJSJST, Dr. L~, Professor of Physiology in the University of Zurich. Experimental Pharmacology. A Handbook of Methods for Determining the Physiological Actions of Drugs. Translated, with the Author's permission, and with extensive additions, by Robert Meade Smith, M. D., Demonstrator of Physiology in the University of Pennsylvania. In one handsome 12mo. volume of 199 pages, with 32 illustrations. Cloth, $1.50. Prof. Hermann's handbook, which Dr. Smith has translated and enriched with many valuable addi- tions, will be gladly welcomed by those engaged in this department of physiology. It is an excellent little book, full of concise information, and it should find a place in every laboratory. It ex- plains the various methods and instruments used, and points out what lines of investigation are to be pursued for studying different phenomena, and also how and what particularly to observe.— American Journal of the Medical Sciences, Jan. 1884, MAIS CS, JOHJSTM., Fhar. D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. A Manual of Organic Materia Medica; Being a Guide to Materia Medica of the Vegetable and Animal Kingdoms. For the use of Students, Druggists, Pharmacists and Physicians. New (second) edition. In one handsome royal 12mo. volume of 550 pages, with 242 illustrations. Cloth, $3.00. Just ready. This work contains the substance, — the practical excellent, being very true to nature, and are alone "kernel of the nut" picked out, so that the stu- worth the price of the book to the student. To the dent has no superfluous labor. He can confidently practical physician and pharmacist it is a valuable accept what this work places before him, without any fear that the gist of the matter is not in it. Another merit is that the drugs are placed before him in such a manner as to simplify very much the study of them, enabling the mind to grasp them more readily. The illustrations are most work for handy reference and for keeping fresh in the memory the knowledge of materia medica and botany already acquired. We can and do heartily recommend it.— Medical and Surgical Re- porter, Feb. 14, 1885. BRUCE, J. MITCHELL, M. I)., F. It. C. P., Physician and Lecturer on Materia Medica and Therapeutics at Charing Cross Hospital, London. Materia Medica and Therapeutics. An Introduction to Eational Treat- ment. In one pocket-size 12mo. volume of 555 pages. Limp cloth, $1.50. Just ready. See Students' Series of Manuals, page 3. One of the very latest works upon Materia Medica and Therapeutics, replete with informa- tion abreast of the times, we unhesitatingly recommend it as one of the very best for either medical student or practitioner of medicine. — Cincinnati Medical News, August, 1884. GRIFFITH, ROBERT EGLESFIELD, M. D. A Universal Formulary, containing the Methods of Preparing and Adminis- tering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceut- ists. Third edition, thoroughly revised, with numerous additions, by John M. Maisch, Phar. D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. In one octavo volume of 775 pages, with 38 illustrations. Cloth, $4.50 ; leather $5.50. 12 Lea Brothers & Co.'s Publications — Mat. Med., Therap. STILLE, A., M.n.,LL.I>., & MAISCH, J. M.,I>har.n., Professor Emeritus of the Theory and Prac- Prof, of Mat. Med. and Botany in Phila. tice of Medicine and of Clinical Medicine College of Pharmacy, Sec 'y to the Ameri- in the University of Pennsylvania. can Pharmaceutical Association. The National Dispensatory : Containing the Natural History, Chemistry, Phar- macy, Actions and Uses of Medicines, including those recognized in the Pharmacopoeias of the United States, Great Britain and Germany, with numerous references to the French Codex. Third edition, thoroughly revised and greatly enlarged. In one magnificent imperial octavo volume of 1767 pages, with 311 fine engravings. Cloth, $7.25; leather, $8.00; half Russia, open back, $9.00. With Denison's "Beady Reference Index" $1.00 in addition to price in any of above styles of binding. Just ready. In the present revision the authors have labored incessantly with the view of making the third edition of The National Dispensatory an even more complete represen- tative of the pharmaceutical and therapeutic science of 1884 than its first edition was of that of 1879. For this, ample material has been afforded not only by the new United States Pharmacopoeia, but by those of Germany and France, which have recently appeared and have been incorporated in the Dispensatory, together with a large number of new non- officinal remedies. It is thus rendered the representative of the most advanced state of American, English, French and German pharmacology and therapeutics. The vast amount of new and important material thus introduced may be gathered from the fact that the additions to this edition amount in themselves to the matter of an ordinary full-sized octavo volume, rendering the work larger by twenty-five per cent, than the last edition. The Therapeutic Index (a feature peculiar to this work), so suggestive and convenient to the practitioner, contains 1600 more references than the last edition — the General Index 3700 more, making the total number of references 22,390, while the list of illustrations has been increased by 80. Every effort has been made to prevent undue enlargement of the volume by having in it nothing that could be regarded as superfluous, yet care has been taken that nothing should be omitted which a pharmacist or physician could expect to find* in it. The appearance of the work has been delayed by nearly a year in consequence of the determination of the authors that it should attain as near an approach to absolute ac- curacy as is humanly possible. With this view an elaborate and laborious series of examinations and tests have been made to verify or correct the statements of the Pharma- copoeia, and very numerous corrections have been found necessary. It has thus been ren- dered indispensable to all who consult the Pharmacopoeia. The work is therefore presented in the full expectation that it will maintain the position universally accorded to it as the standard authority in all matters pertaining to its subject, as registering the furthest advance of the science of the day, and as embody- ing in a shape for convenient reference the recorded results of human experience in the laboratory, in the dispensing room, and at the bed-side. Comprehensive in scope, vast in design and splendid in execu-tion, The National Dispensatory may be justly regarded as the most important work of its kind extant. — Louisville Medical News, Dec. 6, 1884. We have much pleasure in recording the appear- ance of a third edition of this excellent work of reference. It is an admirable abstract of all that relates to chemistry, pharmacy, materia medica, pharmacology and therapeutics. It may be re- garded as embodying the Pharmacopoeias of the civilized nations of the world, all being brought up to date. The work has been very well done, a large number of extra-pharmacopceial remedies having been added to those mentioned in previous editions. — London Lancet, Nov. 22, 1884. Its completeness as to subjects, the comprehen- siveness of its descriptive language, the thorough- ness of the treatment of the topics, its brevity not sacrificing the desirable features of information for which such a work is needed, make this vol- ume a marvel of excellence. — Pharmaceutical Re- cord, Aug. 15, 1884. FARQUHARSOJT, ROBERT, M. D., Lecturer on Materia Medica at St. Mary's Hospital Medical School. A Guide to Therapeutics and Materia Medica. Third American edition, specially revised by the Author. Enlarged and adapted to the U. S. Pharmacopoeia by Frank Woodbury, M. D. In one handsome 12mo. volume of 524 pages. Cloth, f 2.25. Dr. Farquharson's Therapeutics is constructed upon a plan which brings before the reader all the essential points with reference to the properties of drugs. It impresses these upon him in such away .able him to take a clear view of the actions of medicines and the disordered conditions in Which they must prove useful. The double-col- umned pages — one side containing the recognized physiological action of the medicine, and the other the disease in which observers (who are nearly al- ways mentioned) have obtained from it good re- sults — make a very good arrangement. The early chapter containing rules for prescribing is excel- lent. — Canada Med. and Surg. Journal, Dec. 1882. STILLE, ALFRED, M. L>., LL. D., Professor of Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna. Therapeutics and Materia Medica. A Systematic Treatise on the Action and Uses of MedidnaJ Agents, including their Description and History. Fourth edition, revised and enlarged. In two large and handsome octavo volumes, containing 1936 pages. Cloth, $10.00; leather, $12.00; very handsome half Russia, raised bands, $13.00. We can hardly admit that it has a rival in the in pharmacodynamics, but as by far the most com- multitnde of its citations and the fulness of its plete treatise upon the clinical and practical side research into clinical histories, and we must assign of the question. — Boston Medical andSurgical Jour- it a place in the physician's library; not, indeed, nal, Nov. 5, 1874. as fully representin g the present state of knowledge Lea Brothers & Co.'s Publications — Pathol., Histol. 13 COATS, JOSEPH, M. D., F. F. JP. S., Pathologist to the Glasgow Western Infirmary. A Treatise on Pathology. In one very handsome octavo volume of 829 pages, with 339 beautiful illustrations. Cloth, $5.50 • leather, $6.50. condition effected in structures by disease, and points out the characteristics of various morbid agencies, so that they can be easily recognized. But, not limited to morbid anatomy.it explains fully how The work before us treats the subject of Path- ology more extensively than it is usually treated in similar works. Medical students as well as physicians, who desire a work for study or refer- ence, that treats the subjects in the various de- partments in a very thorough manner, but without prolixity, will certainly give this one the prefer- ence to any with which we are acquainted. It sets forth the most recent discoveries, exhibits, in an interesting manner, the changes from a normal the functions of organs are disturbed by abnormal conditions. There is nothing belonging to its de- partment of medicine that is not as fully elucidated as our present knowledge will admit.— 'Cincinnati Medical News, Oct. 1883. GBFFW, T. MBJSTBY, M. D., Lecturer on Pathology and Morbid Anatomy at Charing-Cross Hospital Medical School, London. Pathology and Morbid Anatomy. Fifth American from the sixth revised and enlarged English edition. In one very handsome octavo volume of 482 pages, with 150 tine engravings. Cloth, $2.50. Just ready. The fact that this well-known treatise has so rapidly reached its sixth edition is a strong evi- dence of its popularity. The author is to be con- fratulated upon the thoroughness with which he as prepared this work. It is thoroughly abreast with all the most recent advances in pathology. No work in the English language is so admirably adapted to the wants of the student and practi- tioner as this, and we would recommend it most earnestly to every one. — Nashville Journal of Medi- cine and Surgery, Nov. 1884. WOODMFAI), G. SIMS, M. D., F. B. €. JP. F., Demonstrator of Pathology in the University of Edinburgh. Practical Pathology. A Manual for Students and Practitioners. In one beau- tiful octavo volume of 497 pages, with 136 exquisitely colored illustrations. Cloth, $6.00. The author merits all praise for having produced a valuable work. — Medical Record, May 31, 1884. It is manifestly the product of one who has him- self travelled over the whole field and who is skilled not merely in the art of histology, but in the obser- vation and interpretation of morbid changes. The work is sure to command a wide circulation. It It forms a real guide for the student and practi- tioner who is thoroughly in earnest in his en- deavor to see for himself and do for himself. To the laboratory student it will be a helpful com- panion, and all those who may wish to familiarize themselves with modern methods of examining morbid tissues are strongly urged to provide themselves with this manual. The numerous drawings are not fancied pictures, or merely schematic diagrams, but they represent faithfully the actual images seen under the microscope. should do much to encourage the pursuit of path- ology, since such advantages in histological study have never before been offered.— The Lancet, Jan. 5, 1884. SCMAFBB, FDWABJO A., F. M. S., Assistant Professor of Physiology in University College, London. The Essentials of Histology. In one octavo volume of about 300 pages, with about 325 illustrations. In press. COBWIL, V., and BAJSTIFB, L., Prof, in the Faculty of Med. of Paris. Prof, in the College of France. A Manual of Pathological Histology. Translated, with notes and additions, by E. O. Shakespeare, M. D., Pathologist and Ophthalmic Surgeon to Philadelphia Hospital, and by J. Henry C. Simes, M. D., Demonstrator of Pathological Histology in the University of Pennsylvania. In one very handsome octavo volume of 800 pages, with 360 illustrations. Cloth, $5.50 ; leather, $6.50 ; half Kussia, raised bands, $7. KLEIN, F., M. J)., F. B. S., Joint Lecturer on General Anat. and Phys. in the Med. School of St. Bartholomew's Hosp. t London. Elements of Histology. In one pocket-size 12mo. volume of 360 pages, with 181 illus. Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 3. Although an elementary work, it is by no means The illustrations are numerous and excellent. We superficial or incomplete, for the author presents commend Dr. Klein's Elements most heartily to in concise language nearly all the fundamental facts the student.— Medical Record, Dec. 1, 1883. regarding the microscopic structure of tissues. BEPBEB, A. J., M.B., M. S., F. B. C. S., Surgeon and Lecturer at St. Mary's Hospital, London. Surgical Pathology. In one pocket-size 12mo. volume of 511 pages, with 81 illustrations. Limp cloth, red edges, $2.00. See Students' Series of Manuals, page 3. It is not pretentious, but it will serve exceed ingly well as a book of reference. It embodies a treat deal of matter, extending over the whole eld of surgical pathology. Its form is practical, its language is clear, and the information set forth is well-arranged, well-indexed and well- illustrated. The student will find in it nothing that is unnecessary. The list of subjects covers the whole range of surgery. The book supplies a very manifest want and should meet with suc- cess. — New York Medical Journal, May 31, 1884. SCHAFER'S PRACTICAL HISTOLOGY. In one handsome royal 12mo. volume of 308 pages, with 40 illustrations. ©LUGE'S ATLAS OF PATHOLOGICAL HISTOL- OGY.- Translated by Joseph Leidt, M. D. In one volume, very large imperial quarto, with 320 copper-plate figures, plain and colored and des- criptive letter-press. Cloth, $4.00„ 14 LeA Brothers & Co.'s Publications — Practice of Med. FLINT, AUSTIN, 31. D., Prof, of the Principles and Practice of Med. and of Clin. Med. in Bellevue Hospital Medical College, N. T. A Treatise on the Principles and Practice of Medicine. Designed for the use of Students and Practitioners of Medicine. With an Appendix on the Researches of Koch, and their bearing on the Etiology, Pathology, Diagnosis and Treatment of Phthisis. Fifth edition, revised and largely rewritten In one large and closely-printed octavo volume of 1160 pages. Cloth, $5.50 ; leather, §6.50 ; half Russia, $7. Koch's discovery of the bacillus of tubercle gives promise of being the greatest boon ever conferred by science on humanity, surpassing even vaccination in its benefits to mankind. In the appendix to his work, Professor Flint deals with the subject from a practical standpoint, discussing its bearings on the etiology, pathology, diagnosis, prog- nosis and treatment of pulmonary phthisis. Thus enlarged and completed, this standard work will be more than ever a necessity to the physician who duly appreciates the re- sponsibility of his calling. A well-known writer and lecturer on medicine recently expressed an opinion, in the highest de- gree complimentary of the admirable treatise of Dr. Flint, and in eulogizing it, he described it ac- curately as " readable and reliable." No text-book is more calculated to enchain the interest of the student, and none better classifies the multitudi- nous subjects included in it. It has already so far won its way in England, that no inconsiderable number of men use it alone in the study of pure medicine; and we can say of it that it is in every way adapted to serve, not only as a complete guide, but also as an ample instructor in the science and practice of medicine. The style of Dr. Flint is always polished and engaging. The work abounds in perspicuous explanation, and is a most valuable text-book of medicine. — London Medical News. This work is so widely known and accepted as the best American text-book of the practice of medicine that it would seem hardly worth while to give this, the fifth edition, anything more than a passing notice. But even the most cursory exami- nation shows that it is, practically, much more than a revised edition ; it is, in fact, rather a new work throughout. This treatise will undoubtedly continue to hold the first place in the estimation of American physicians and students. No cna of our medical writers approaches Professor Flint in clearness of diction, breadth of view, and, what we regard of transcendent importance, rational esti- mate of the value of remedial agents. It is thor- oughly practical, therefore pre-eminently the book for American readers.— S£. Louis Clin. Bee, Mar. '81. HAKTSHORNE, HENMY, M. JD., II. D., Lately Professor of Hygiene in the University of Pennsylvania. Essentials of the Principles and Practice of Medicine. A Handbook for Students and Practitioners. Fifth edition, thoroughly revised and rewritten. In one royal 12mo. volume of 669 pages, with 144 illustrations. Cloth, $2.75 ; half bound, $3.00. "Within the compass of 600 pages it treats of the history of medicine, general pathology, general symptomatology, and physical diagnosis (including laryngoscope, ophthalmoscope, etc.), general ther- apeutics, nosology, and special pathology and prac- tice. There is a wonderful amount of information contained in this work, and it is one of the best of its kind that we have seen. — Glasgow Medical Journal, Nov. 1882. An indispensable book. No work ever exhibited a better average of actual practical treatment than this one ; and probably not one writer in our day had a better opportunity than Dr. Hartshorne for condensing all the views of eminent practitioners into a 12mo. The numerous illustrations will be very useful to students especially. These essen- tials, as the name suggests, are not intended to supersede the text-books of Flint and Bartholow, but they are the most valuable in affording the means to see at a glance the whole literature of any disease, and the most valuable treatment.— -Chicago Medical Journal and Examiner, April, 1882. BBISTOWE, JOHN STEM, M. !>., F. B. C. P., Physician and Joint Lecturer on Medicine at St. Thomas' 1 Hospital. A Treatise on the Practice of Medicine. Second American edition, revised by the Author. Edited, with additions, by James H. Hutchinson, M.D., physician to the Pennsylvania Hospital. In one handsome octavo volume of 1085 pages, with illustrations. Cloth, $5.00 ; leather, $6.00 ; very handsome half Russia, raised bands, $6.50. The reader will find every conceivable subject connected with the practice of medicine ably pre- sented, in a style at once clear, interesting and concise. The additions made by Dr. Hutchinson are appropriate and practical, and greatly add to its usefulness to American readers. — Buffalo Med- ical and Surgical Journal, March, 1880. WATSON, SIR THOMAS, M. !>., Late Physician in Ordinary to the Queen. Lectures on the Principles and Practice of Physic. A new American from the fifth English edition. Edited, with additions, and 190 illustrations, by Henry Hartshorne, A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. In two large octavo volumes of 1840 pages. Cloth, $9.00 ; leather, $11.00. LECTURES ON THE STUDY OF FEVER. By A. Hudson, M. D., M. R. I. A. In one octavo volume of 308 pages. Cloth, 82.50. 3TOKES' LECTURES ON FEVER. Edited by John William Moore, M. D., F. K. Q. C. P. In one octavo volume of 280 pages. Cloth, $2.( .nil. A TREATISE ON FEVER. By Robert D. Lyons, K. C. C. In one 8vo. vol. of 354 pp. Cloth, 82.26. LA ROCHE ON YELLOW FEVER, considered in its Historical, Pathological, Etiological and Therapeutical Relations. In two large and hand- some octavo volumes of 1468 pp. Cloth, 87.00. A CENTURY OF AMERICAN MEDICINE, 1776—1876. By Drs. E. H. Clarke, H. J. Biorxow, S. D. Gross, T. Gk Thomar. and .1. 8. Hu-linos. In one 12mo. volume of 370 pages. Cloth, 82.25. Lea Brothers & Co.'s Publications — Systems of Med. 15 For Sale by Subscription Only, A System of Practicai Medicine. B Y AMERICAN A TJTHORS. Edited by WILLIAM PEPPER, M. D., LL. D., PROVOST AND PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE AND OF CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA, Assisted by Louis Starr, M. D., Clinical Professor of the Diseases of Children in the Hospital of the University of Pennsylvania. In five imperial octavo volumes, containing about 1100 -pages each, with illustrations. Price per volume, cloth, $5 ; leather, $6 ; half Russia, raised bands and open bach, $7. Volume I. (General Pathology, Sanitary Science and General Diseases) contains 1094 pages, with 24 illustrations and is just ready. Volume II. (General Diseases [con- tinued] and Diseases of the Digestive System) will be ready June 1st, and the subsequent volumes at intervals of four months thereafter. The publishers feel pardonable pride in announcing^ this magnificent work. For three years it has been in active preparation, and it is now in a sufficient state of forward- ness to justify them in calling the attention of the profession to it as the work in which for the first time American medicine is thoroughly represented by its worthiest teachers, and presented in the full development of the practical utility which is its preeminent characteristic. The most able men — from the East and the West, from the North and the South, from all the prominent centres of education, and from all the hospitals which afford special opportunities of study and practice — have united in generous rivalry to bring together this vast aggregate of specialized experience. The distinguished editor has so apportioned the work that each author has had assigned to him the subject which he is peculiarly fitted to discuss, and in which his views will be accepted as the latest expression of scientific and practical knowledge. The practitioner will therefore find these volumes a complete, authoritative and unfailing work of reference, to which he may at all times turn with full certainty of finding what he needs in its most recent aspect, whether he seeks information on the general principles of medi- cine, or minute guidance in the treatment of special disease. So wide is the scope of the work that, with the exception of midwifery and matters strictly surgical, it embraces the whole domain of medicine, including the departments for which the physician is accustomed to rely on special treatises, such as diseases of women and children, of the genito-urinary organs, of the skin, of the nerves, hygiene and sanitary science, and medical ophthalmology and otology. Moreover, authors have inserted the formulas which they have found most efficient in the treatment of the various affections. It may thus be truly regarded as a Complete Library of Practical Medicine, and the general practitioner possessing it may feel secure that he will require little else in the daily round of professional duties. In spite of every effort to condense the vast amount of practical information fur- nished, it has been impossible to present it in less than 5 large octavo volumes, containing about 5500 beautifully printed pages, and embodying the matter of about 15 ordinary octavos. Illustrations are introduced wherever they serve to elucidate the text. As material for the work is substantially complete in the hands of 'the editor, the pro- fession may confidently await the appearance of the remaining volumes upon the dates above specified. A detailed prospectus of the work will be sent to any address on appli- cation to the publishers. It is a large undertaking, but quite justifiable in the case of a progressive nation like the United States. At any rate, if we may judge of future volumes from the first, it will be justified by the result. We have nothing but praise to bestow upon the work. The articles are the work of writers, many of whom are already recognized in this country as authorities on the particular topics on which they deal, whilst the others show by the way they have handled their subjects that they are fully equal to the task they had undertaken. * * * A work which we cannot doubt will make a lasting reputation for itself. — London Medical Times and Gazette, May 9, 1885. MEYJVOLDS, J. MVSSBLL, M. JD., Professor of the Principles and Practice of Medicine in University College, London. A System of Medicine. With notes and additions by Henry Hartshorne, A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. In three large and handsome octavo volumes, containing 3056 double-columned pages, with 317 illustra- tions. Price per volume, cloth, $5.00 ; sheep, $6.00 ; very handsome half Kussia, raised bands, $6.50. Per set, cloth, $15 ; leather, $18 ; half Russia, $19.50. Sold only by subscription. There is no medical work which we have in times past more frequently and fully consulted when perplexed by doubts' as to treatment, or by having unusual or apparently inexplicable symp- toms presented to us, than "Reynolds' System of Medicine." It contains just that kind of informa- tion which the busy practitioner frequently finds himself in need of. In order that any deficiencies may be supplied, the publishers nave committed the preparation of the book for the press to Dr. Henry Hartshorne, whose judicious notes distrib- uted throughout the volume afford abundant evi- dence of the thoroughness of the revision.— A-m er- ica n Journal of the Medical Sciences, Jan. 1&80. 16 Lea Brothers & Co.'s Publications — Clinical Med., etc, STILLE, ALFRED, M. L>., LL. JD., Professor Emeritus of the Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna. Cholera: Its Origin, History, Causation, Symptoms, Prevention and Treatment. In one handsome 12mo. volume of about 175 pages, with a chart. Cloth, $1.25. Shortly. The threatened importation of cholera into the country renders peculiarly timely this work of an authority so eminent as Professor Stille. The history of previous epi- demics, their modes of propagation, the vast recent additions to our knowledge of the causation, prevention and treatment of the disease, all have been handled so skilfully as to present with brevity the information which every practitioner should possess in ad- vance of a visitation. FLINT, AUSTLW, 31. JD. Clinical Medicine. A Systematic Treatise on the Diagnosis and Treatment of Diseases. Designed for Students and Practitioners of Medicine. In one large and hand- some octavo volume of 799 pages. Cloth, $4.50 ; leather, $5.50 ; half Eussia, $6.00. sistently with brevity and clearness, the different subjects and their several parts receiving the attention which, relatively to their importance, medical opinion claims for them, is still more diffi- cult. This task, we feel bound to say, has been executed with more than partial success by Dr. Flint, whose name is already familiar to students of advanced medicine in this country as that of the author of two works of great merit on special subjects, and of numerous papers exhibiting much originality and extensive research.— The Dublin Journal. Dec. 1879. It is here that the skill and learning of the great clinician are displayed. He has given us a store- house of medical knowledge, excellent for the stu- dent, convenient for the practitioner, the result of a long life of the most faithful clinical work, col- lected by an energy as vigilant and systematic as untiring, and weighed by a judgment no less clear than his observation is close. — Archives of Medicine, Dec. 1879. To give an adequate and useful conspectus of the extensive field of modern clinical medicine is a task of no ordinary difficulty; but to accomplish this con- By the Same Author. Essays on Conservative Medicine and Kindred Topics. In one very hand- some royal 12mo. volume of 210 pages. Cloth, $1.38. BBOAEBENT, W. EC., M. JD., F. B. C. B., Physician to and Lecturer on Medicine at St. Mary's Hospital. The Pulse. In one 12mo. volume. See Series of Clinical Manuals, page 3. SCEEBEJTBEB, JDB. JOSEBJBE. A Manual of Treatment by Massage and Methodical Muscle Ex- ercise. Translated by Walter Mendelson, M. D., of Few York. In one handsome octavo volume of about 300 pages, with about 125 fine engravings. Preparing. FIJSLAYSOir, JAMES, M. J)., Editor, Physician and Lecturer on Clinical Medicine in the Glasgow Western Infirmary, etc. Clinical Diagnosis. A Handbook for Students and Practitioners of Medicine. With Chapters by Prof. Gairdner on the Physiognomy of Disease ; Prof. Stephens on Diseases of the Female Organs; Dr. Eobertson on Insanity; Dr. Gem m ell on Physical Diagnosis ; Dr. Coats on Laryngoscopy and Post-Mortem Examinations, and by the Editor on Case-taking, Family History and Symptoms of Disorder in the Various Systems. In one handsome 12mo. volume of 546 pages, with 85 illustrations. Cloth, $2.63. This is one of the really useful books. It is at- tractive from preface to the final page, and ought to be given a place on every office table, because it contains in a condensed form all that is valuable in semeiology and diagnostics to be found in bulkier volumes; and because of its arrangement and complete index it is unusually convenient for quick reference in any emergency that may come upon the busy practitioner.— N. C. Med. Journ. t Jan. 1879. FENWICK, SAMUEL, M. JD., Assistant Physician to the London Hospital. The Student's Guide to Medical Diagnosis. From the third revised and enlarged English edition. In one very handsome royal 12mo. volume of 328 pages, with 87 illustrations on wood. Cloth, $2.25. TAJSTNEB, THOMAS SAWKES, M. JD. A Manual of Clinical Medicine and Physical Diagnosis. Third American from the second London edition. Revised and enlarged by Tilbury Fox, M. D., Phy- sician to the Skin Department in University College Hospital, London, etc. In one small 12mo. volume of 362 pages, with illustrations. Cloth, $1.50. FOTHEBGILL, J. M., M. JD., Edin., M. B. C. B., Lond., Physician to the City of London Hospital for Diseases of the Chest. The Practitioner's Handbook of Treatment ; Or, The Principles of Thera- peutics. New edition. In one octavo volume. Preparing. STURGES' INTRODUCTION TO THE STUDY OF CLINICAL MEDICINE. BeingaGuide to the investigation of Disease. In one handsome 12mo. volume of 127 pages. Cloth, 81.25. DAVIS' CLINICAL LECTURES ON VARIOUS IMPORTANT DISEASES. By N. S. Davis, M. D. Edited by Frank H. Davis, M. D. Second edition. 12mo. 287 pages. Cloth, 81.75. Lea Brothers & Co.'s Publications — Hygiene, Electr., Pract. 17 MICHAHDSON, B. W., M.A., M.I)., LL. D., F.B.S., F.S.A. Fellow of the Royal College of Physicians, London. Preventive Medicine. In one octavo volume of 729 pages. Cloth, $4; leather, $5 ; very handsome half Russia, raised bands, $5.50. Dr. Richardson has succeeded in producing a work which is elevated in conception, comprehen- sive in scope, scientific in character, systematic in arrangement, and which is written in a clear, con- cise and pleasant manner. He evinces the happy faculty of extracting the pith of what is known on the subject, and of presenting it in a most simple, intelligent and practical form. There is perhaps no similar work written for the general public thatcontains such a complete, reliable and instruc- tive collection of data upon the diseases common to the race, their origins, causes, and the measures for their prevention. The descriptions of diseases are clear, chaste and scholarly; the discussion of the question of disease is comprehensive, masterly and fully abreast with the latest and best knowl- edge on the subject, and the preventive measures advised are accurate, explicit and reliable. — The American Journal of the Medical Sciences, April, 1884. This is a book that will surely find a place on the table of every progressive physician. To the medical profession, whose duty is quite as much to prevent as to cure disease, the book will be a boon. — Boston Medical and Surgical Journal, Mar. 6, 1884. The treatise contains a vast amount of solid, valu- able hygienic information. — Medical and Surgical Reporter, Feb. 23, 1884. BABTHOLOW, MOBEKTS, A. M., M. !>., LL. L>., Prof, of Materia Medica and General Therapeutics in the Jefferson Med. Coll. of Phila., etc. Medical Electricity. A Practical Treatise on the Applications of Electricity to Medicine- and Surgery. Second edition, pages, with 109 illustrations. Cloth, $2.50. The second edition of this work following so soon upon the first would in itself appear to be a sufficient announcement; nevertheless, the text has been so considerably revised and condensed, and so much enlarged by the addition of new mat- ter, that we cannot fail to recognize a vast improve- ment upon the former work. The author has pre- pared his work for students and practitioners — for those who have never acquainted themselves with the subject, or, having done so, find that after a time their knowledge needs refreshing. We think he has accomplished this object. The book is not too voluminous, but is thoroughly practical, sim- ple, complete and comprehensible. It is, more- over, replete with numerous illustrations of instru- ments, appliances, etc. — Medical Record, November 15, 1882. In one very handsome octavo volume of 292 A most excellent work, addressed by a practi- tioner to his fellow-practitioners, and therefore thoroughly practical. The work now before us has the exceptional merit of clearly pointing out where the benefits to be derived from electricity must come. It contains all and everything that the practitioner needs in order to understand in- telligently the nature and laws of the agent he is making use of, and for its proper application in practice. In a condensed, practical form, it pre- sents to the physician all that he would wish to remember after perusing a whole library on medical electricity, including the results of the latest in- vestigations. It is the book for the practitioner, and the necessity for a second edition proves that it has been appreciated by the profession. — Physi- cian and Surgeon, Dec. 1882. TELE YEAB-BOOK OF TREATMENT. A Comprehensive and Critical Review for Practitioners of Medi- cine. In one 12mo. volume of 320 pages, bound in limp cloth, with red edges, $1.25. This work presents to the practitioner not only a complete classified account of all the more important advances made in the treatment of Disease during the year ending Sept. 30, 1884, but also a critical estimate of the same by a competent authority. Each department of practice has been fully and concisely treated, and into the consideration of each subject enter such allusions to recent pathological and clinical work as bear directly upon treatment. As the medical literature of all countries has been placed under contri- bution, the references given throughout the work, together with the separate indexes of subjects and authors, will serve as a guide for those who desire to investigate any thera- peutical topic at greater length. The contributions are from the pens of the following well-known gentlemen: — J. Mitchell Bruce, M.D. ; T. Lauder Brunton, M.D., F.B.S. ; Thomas Bryant, F.E. C.S. ; F. H. Champneys, M.B. ; Alfred Cooper, F.E.C.S. ; Sidney Coupland, M.D. ; Dyce Duckworth, M.D. ; George P. Field, M.B.C.S. ; Beginald Harrison, F.B. C.S. ; J. Warrington Haward, F.E.C.S. ; F. A. Mahomed, M.B. ; Malcolm Morris, F.E.C.S., Ed. ; Edmund Owen, F.E.C.S. ; E. Douglas Powell, M.D. ; Henry Power, M.B., F.E.C.S.; C. H. Ealfe, M.D. ; A. E. Sansom, M.D.; Felix Semon, M.D.; Walter G. Smith, M.D. ; J. Knowsley Thornton, M.B. ; Frederick Treves, F.E.C.S. ; A. de Watteville, M.D. ; John Williams, M.D. BEABEBSBLOlSr, S. O., M. !>., Senior Physician to and late Lect. on Principles and Practice of Med. at Guy's Hospital, London. On the Diseases of the Abdomen ; Comprising those of the Stomach, and other parts of the Alimentary Canal, (Esophagus, Caecum, Intestines and Peritoneum. Second American from third enlarged and revised English edition. In one handsome octavo volume of 554 pages, with illustrations. Cloth, $3.50. PAVY'S TREATISE ON THE FUNCTION OF DI- GESTION; its Disorders and their Treatment. From the second London edition. In one octavo volume of 238 pages. Cloth, $2.00. CHAMBERS' MANUAL OF DIET AND REGIMEN IN HEALTH AND SICKNESS. In one hand- . some octavo volume of 302 pp. Cloth, $2.75. BARLOW'S MANUAL OF THE PRACTICE OF MEDICINE. With additions by D. F. Condie, M. D. 1 vol. 8vo., pp. 603. Cloth, $2.50. TODD'S CLINICAL LECTURES ON CERTAIN ACUTE DISEASES. In one octavo volume of 320 pages. Cloth, $2.50. HOLLAND'S MEDICAL NOTES AND REFLEC- TIONS. 1 vol. Svo., pp. 493. Cloth, $3.50. ■■■■ 18 Lea Brothers & Co.'s Publications — Throat, Lungs, Heart. COHEN, J. SOLIS, M. D., Lecturer on Laryngoscopy and Diseases of the Throat and Chest in the Jefferson Medical College. Diseases of the Throat and Nasal Passages. A Guide to the Diagnosis and Treatment of Affections of the Pharynx, (Esophagus, Trachea, Larynx and Nares. Third edition, thoroughly revised and rewritten, with a large number of new illustrations. In one very handsome octavo volume. Preparing. SEILEM, CAML, M. D., Lecturer on Laryngoscopy in the University of Pennsylvania. A Handbook of Diagnosis and Treatment of Diseases of the Throat, Nose and Naso-Pharynx. Second edition. In one handsome royal 12mo. volume of 294 pages, with 77 illustrations. Cloth, $1.75. It is one of the best of the practical text-books on this subject with which we are acquainted. The present edition has been increased in size, but its eminently practical character has been main- tained. Many new illustrations have also been introduced, a case-record sheet has been added, and there are a valuable bibliography and a good index of the whole. For any one who wishes to make himself familiar with the practical manage- ment of cases of throat and nose disease, the book will be found of great value. — New York Medical Journal, June 9, 1883. The work before as is a concise handbook upon the essentials of diagnosis and treatment in dis- eases of the throat and nose. The art of laryngos- copy, the anatomy of the throat and nose and the pathology of the mucous membrane are discussed with conciseness and ability. The work is pro- fusely illustrated, excels in many essential feat- ures, and deserves a place in the office of the practitioner who would inform himself as to the nature, diagnosis and treatment of a class of dis- eases almost inseparable from general medical practice. With advanced students the book must be very popular on account of its condensed style. — Louisville Medical News, June 26, 1883. BKOWNE, LENNOX, F. M. C. S., Edin., Senior Surgeon to the Central London Throat and Ear Hospital, etc. The Throat and its Diseases. Second American from the second English edi- tion, thoroughly revised. With 100 typical illustrations in colors and 50 wood engravings, designed and executed by the Author. In one very handsome imperial octavo volume of about 350 pages. Preparing. FLINT, AUSTIN, M. D., Professor of the Principles and Practice of Medicine in Bellevue Hospital Medical College, N. T. A Manual of Auscultation and Percussion ; Of the Physical Diagnosis of Diseases of the Lungs and Heart, and of Thoracic Aneurism. Third edition. In one hand- some royal 12mo. volume of 240 pages. Cloth, $1.63. It is safe to say that there is 'not in the English language, or any other, the equal amount of clear, exact and comprehensible information touching the physical exploration of the chest, in an equal number of words. Professor Flint's language is precise and simple, conveying without dubiety the results of his careful study and ample ex- perience in such wise that the young will find it the best source of instruction, and the old the most pleasant means of reviving and complementing their knowledge. — American Practitioner, June, 1883. BY THE SAME AUTHOR. Physical Exploration of the Lungs by Means of Auscultation and Percussion. Three lectures delivered before the Philadelphia County Medical Society, 1882-83. In one handsome small 12mo. volume of 83 pages. Cloth, $1.00. A Practical Treatise on the Physical Exploration of the Chest and the Diagnosis of Diseases Affecting the Respiratory Organs. Second and revised edition. In one handsome octavo volume of 591 pages. Cloth, $4.50. Phthisis: Its Morbid Anatomy, Etiology, Symptomatic Events and Complications, Fatality and Prognosis, Treatment and Physical Diag- nosis ; In a series of Clinical Studies. In one handsome octavo volume of 442 pages. Cloth, $3.50. A Practical Treatise on the Diagnosis, Pathology and Treatment of Diseases of the Heart. Second revised and enlarged edition. In one octavo volume of 550 pages, with a plate. Cloth, $4. GKOSS, S. !>., M.I)., LL.D., D.C.L. Oxon., LL.JD. Cantab. A Practical Treatise on Foreign Bodies in the Air-passages. In one octavo volume of 452 pages, with 59 illustrations. Cloth, $2.75. FULLER ON DISEASES OF THE LUNGS AND AIBrPASSAGES. Their Pathology, Physical Di- agnosis, Symptoms and Treatment. Prom the second and revised English edition. In one octavo volume of 475 pages. Cloth, $3.r>(). 8LADE ON DIPHTHERIA; its Nature and Treat- ment, with an account of the History of its Pre- valence in various Countries. Second and revised edition. In one 12mo. vol., pp. 158. Cloth, $1.25. WALSHE ON THE DISEASES OP THE HEART AND GREAT VESSELS. Third American edi- tion. In 1 vol. 8vo., 410 pp. Cloth, $3.00. SMITH ON CONSUMPTION; its Early and Reme- diable Stages. 1 vol. 8vo., pp. 253. Cloth, $2.25. LA ROCHE ON PNEUMONIA. 1 vol. 8vo. of 490 pages. Cloth, $3.00. WILLIAMS ON PULMONARY CONSUMPTION; its Nature, Varieties and Treatment. With an analysis of one thousand cases to exemplify its duration. In one 8vo. vol. of 303 pp. Cloth, $2.50. JONES' CLINICAL OBSERVATIONS ON FUNC- TIONAL NERVOUS DISORDERS. Second Am- erican edition. In one handsome octavo volume of 340 pages. Cloth, $3.25. Lea Brothers & Co.'s Publications — Nerv.andMent. Dis.,°etc. 19 MITCHELL, 8. WEIM, M. D., Physician to Orthopcedic Hospital and the Infirmary for Diseases of the Nervous System, Phila., etc. Lectures on Diseases of the Nervous System; Especially in Women. Second edition. In one 12mo. volume of 288 pages. Cloth, $1.75. Just ready. So great have been the achievements of the system perfected by the author for the treat- ment of hysterical and nervous diseases that the profession will welcome the second and enlarged edition of a work which gives in detail the methods of enforced rest, massage and systematic feeding on which this mode of treatment is based. Many of these lectures are original studies of well-known diseases, and others deal with subjects which have been hitherto slighted in medical literature or which are almost unknown to it. The interest lies in the keen insight into the nature of the subject and in the suggestions which the author manages to throw into his accounts. The lectures must command the thoughtful attention and careful study of all who desire to read what is best in medical science. — The London Lancet, May 16, 1885. HAMILTON, ALLAN McLANE, Mo JD., Attending Physician at the Hospital for Epileptics and Paralytics, BlackwelVs Island, N. T. ^ Nervous Diseases ; Their Description and Treatment. Second edition, thoroughly revised and rewritten. In one octavo volume of 598 pages, with 72 illustrations. Cloth, $4. When the first edition of this good book appeared we gave it our emphatic endorsement, and the E resent edition enhances our appreciation of the ook and its author as a safe guide to students of clinical neurology. One of the best and most critical of English neurological ournals, Brain, has characterized this book as the best of its kind in any language, which is a handsome endorsement from an exalted source. The improvements in the new edition, and the additions to it, will justify its purchase even by those who possess the old. — Alienist and Neurologist, April, 1882. TUHE, DANIEL HACK, M. D., Joint Author of The Manual of Psychological Medicine, etc. Illustrations of the Influence of the Mind upon the Body in Health and Disease. Designed to elucidate the Action of the Imagination. New edition. Thoroughly revised and rewritten. In one handsome octavo volume of 467 pages, with two colored plates. Cloth, $3.00. It is impossible to peruse these interesting chap- ters without being convinced of the author's per- fect sincerity, impartiality, and thorough mental grasp. Dr. Tuke has exhibited the requisite amount of scientific address on all occasions, and the more intricate the phenomena the more firmly has he adhered to a physiological and rational method of interpretation. Guided by an enlight- ened deduction, the author has reclaimed for science a most interesting domain in psychology, previously abandoned to charlatans and empirics. This book, well conceived and well written, must commend itself to every thoughtful understand- ing. — New York Medical Journal, September 6, 1884. CLOUSTOJST, THOMAS 8., M. H, F. H. C. F., L. H. C. 8., Lecturer on Mental Diseases in the University of Edinburgh. Clinical Lectures on Mental Diseases. With an Appendix, containing an Abstract of the Statutes of the United States and of the Several States and Territories re- lating to the Custody of the Insane. By Charles F. Foxsom, M. D., Assistant Professor of Mental Diseases, Medical Department of Harvard University. In one handsome octavo volume of 541 pages, illustrated with eight lithographic plates, four of which- are beautifully colored. Cloth, $4. The practitioner as well as the student will ac- cept the plain, practical teaching of the author as a forward step in the literature of insanity. It is refreshing to find a physician of Dr. Clouston's experience and high reputation giving the bed- side notes upon which his experience has been founded and his mature judgment established. Such clinical observations cannot but be useful to the general practitioner in guiding him to a diag- nosis and indicating the treatment, especially in many obscure and doubtful cases of mental dis- ease. To the American reader Dr. Folsom's Ap- pendix adds greatly to the value of the work, and will make it a desirable addition to every library. — American Psychological Journal, July, 1884. 'Dr. Folsom's Abstract may also be obtained separately in one octavo volume of 108 pages. Cloth, $1.50. SAVAGE, GEOMGE H., M. D., Lecturer on Mental Diseases at Guy's Hospital, London. Insanity and Allied Neuroses, Practical and Clinical. In one 12mo. vol- ume of 551 pages, with 18 typical illustrations. Cloth, $2.00. Just ready. See Series oj Clinical Manuals, page 3. As a handbook, a guide to practitioners and stu- dents, the book fulfils an admirable purpose. The many forms of insanity are described with char- acteristic clearness, the illustrative cases are care- fully selected, and as regards treatment, sound common sense is everywhere apparent. We re- peat that Dr. Savage has written an excellent manual for the practitioner and student. — Am- erican Journal of Insanity, April, 1885. FLATFAIM, W. S., M. D., F. M. C. P., The Systematic Treatment of Nerve Prostration and Hysteria. one handsome small 12mo. volume of 97 pages. Cloth, $1.00. In Blandford on Insanity and its Treatment : Lectures on the Treatment, Medical and Legal, of Insane Patients. In one very handsome octavo volume. 20 Lea Brothers & Co.'s Publications — Surgery. GBOSS, S. D., M. D., LL. JO., L>. C. L. Oxon., LL. D. Cantab, , Emeritus Professor of Surgery in the Jefferson Medical College of Philadelphia. A System of Surgery : Pathological, Diagnostic, Therapeutic .and Operative. Sixth edition, thoroughly revised and greatly improved. In two large and beautifully- printed imperial octavo volumes containing 2382 pages, illustrated by 1623 engravings. Strongly bound in leather, raised bands, $15; half Eussia, raised bands, $16. Dr. Gross' System of Suraery has long been the standard work on that subject for students and practitioners.— London Lancet, May 10, 1884, The work as a whole needs no commendation. Many years ago it earned for itself the enviable rep- utation of the leading American work on surgery, and it is still capable of maintaining that standard. The reason for this need only be mentioned to be appreciated. The author has always been calm and judicious in his statements, has based his con- clusions on much study and personal experience, has been able to grasp his subject in its entirety, and, above all, has conscientiously adhered to truth and fact, weighing the evidence, pro and con, accordingly. A considerable amount of new material has been introduced, and altogether the distinguished author has reason to be satisfied that he has placed the work fully abreast of the state of our knowledge.— Med. Record, Nov. 18, 1882. His System of Surgery, which, since its first edi- tion in 1859, has been a standard work in this country as well as in America, in "the whole domain of surgery," tells how earnest and labori- ous and wise a surgeon he was, how thoroughly he appreciated the work done by men in other countries, and how much he contributed to pro- mote the science and practice of surgery in his own. There has been no man to whom America is so much indebted in this respect as the Nestor of surgery.— British Medical Journal, May 10, 1884. ASMHJJBST, JOHN, Jr., M. L>., Professor of Clinical Surgery, Univ. of Penna., Surgeon to the Episcopal Hospital, Philadelphia. The Principles and Practice of Surgery. Fourth edition, enlarged and revised. In one large and handsome octavo volume of about 1100 pages, with about 575 illustrations. In press. GOULD, A. JPEABCE, M. S., M. B., F. B. C. S„ Assistant Surgeon to Middlesex Hospital. Elements of Surgical Diagnosis. In one pocket-size 12mo. volume of 589* pages. Cloth, $2.00. Just ready. See Students' Series of Manuals, page 3. The student and practitioner will find the principles of surgical diagnosis very satisfactorily set forth with all unnecessary verbiage elimi- nated. Every medical student attending lectures should have a copy to study during the intervals, and if practitioners would devote a portion of their leisure to the study of it, they would receive immense benefit in the way of refreshing their knowledge and bringing it up to the present state of progress. — Cincinnati Medical News, Jan., 1885. GIBJVEY, V. P., M. J>., Surgeon to the Orthopaedic Hospital, New York, etc. Orthopaedic Surgery. For the use of Practitioners and Students, some octavo volume, profusely illustrated. Preparing. In one hand- BOBEBTS, JOHN B., A. M., M. &., Lecturer on Anatomy and on Operative Surgery at the Philadelphia School of Anatomy. The Principles and Practice of Surgery. For the use of Students and Practitioners of Medicine and Surgery. In one very handsome octavo volume of about 500 pages, with many illustrations. Preparing. BELLAMY, EJDWABJD, F. B. Surgeon and Lecturer on Surgery at Charing College of Surgeons, London. a s., Cross Hospital, Examiner in Anatomy Royal Operative Surgery. Shortly. See Students' Series of Manuals, page 3. STIMSOJST, LEWIS A., B. A., M. JD., Prof, of Pathol. Anat. at the Univ. of the City of New York, Surgeon and Curator to Bellevue Ho&p* A Manual of Operative Surgery. In one very handsome royal 12mo. volume of 477 pages, with 332 illustrations. Cloth, $2.50. every student should possess one. This work This volume is devoted entirely to operative sur- gery, and is intended to familiarize the student with the details of operations and the different modes of performing them. The work is hand- somely Illustrated, and the descriptions are clear and well-drawn. It is a clever and useful volume ; does away with the necessity of pondering over larger works on surgery for descriptions of opera- tions, as it presents in a nutshell what is wanted by the surgeon without an elaborate search to find it.— Maryland Medical Journal, August, 1878. SARGENT ON HAN PAGING and OTHER OPERA- TIONS OF MINOR SURGERY. New edition, with a Chapter on military surgery. Onel2mo. volume of 888 pages, with 187 cuts. Cloth, $1.75. MILLER'S PRINCIPLES OP SURGERY. Fourth American from the third Edinburgh edition. In one 8vo. vol. of 688 pages, with :M0 illustrations. Cloth, 83.75. MILLER'S PRACTICE OP SURGERY. Fourth and revised American from the last Edinburgh edition. In one large 8vo. vol. of 082 pages, with 3C4 illustrations. Cloth, 83.75. PIRRIE'S PRINCIPLES AND PRACTICE OF SURGERY. Edited by John Neill, M. D. In one 8vo. vol. of 784 pp. with 316 illus. Cloth, $3.75. COOPER'S LECTURES ON THE PRINCIPLES AND PRACTICE OF SURGERY. In one 8vo.vol. of 707 pages. Cloth, 82.00. SKEY'S OPERATIVE SURGERY. In one vol. 8vo- of 661 pages, with 81 woodcuts. Cloth, 83.25. GIBSON'S INSTITUTES AND PRACTICE OF SURGERY. Eighth edition. In two octavo vols- of 965 pages, with 34 plates. Leather 86.50. Lea Brothers & Co.'s Publications — Surgery. 21 FBLCJK8FJST, JOHJT JE., F. B. 8., F. B. C. 8., Professor of Surgery in University College, London, etc. The Science and Art of Surgery ; Being a Treatise on Surgical Injuries, Dis- eases and Operations. From the eighth and enlarged English edition. In two large and beautiful octavo volumes of 2316 pages, illustrated with 984 engravings on wood. Cloth, $9; leather, raised bands, $11 ; half Eussia, raised bands, $12. Just ready. After the profession has placed its approval upon a work to the extent of purchasing seven editions, it does not need to be introduced. Simultaneous with the appearance of this edition a translation is being made into Italian and Spanish. Thus this favorite text-book on surgery holds its own in spite of numerous rivals at the end of thirty years. It is a grand book, worthy of the art in the interest of which it is written. — Detroit Lancet, Jan. 10, 1885. After being before the profession for thirty years and maintaining during that period a re- putation as a leading work on surgery, there is not much to be said in the way of comment or criti- cism. That it still holds its own goes without say- ing. The author infuses into it his large experi- ence and ripe judgment. Wedded to no school, committed to no theory, biassed by no hobby, he imparts an honest personality in his observations, and his teachings are the rulings of an impartial judge. Such men are always safe guides, and their works stand the tests of time and experience. Such an author is Erichsen, and such a work is his Surgery.— Medical Record, Feb. 21, 1885. BBYANT, THOMA8, F. B. C. 8., Surgeon and Lecturer on Surgery at Guy's Hospital, London. The Practice Of Surgery. Fourth American from the fourth and revised Eng- lish edition. In one large and very handsome imperial octavo volume of 1040 pages, with 727 illustrations. Cloth, $6.50; leather, $7.50; half Eussia, $8.00. Just ready. This most magnificent work upon surgery has The treatise takes in the whole field of surgery, that of the eye, the ear, the female organs, ortho- paedics, venereal diseases, and military surgery, as well as more common and general topics. All of these are treated with clearness and with sufficient fulness to suit all practical purposes. The illustrations are numerous and well printed. We do not doubt that this new edition will con- tinue to maintain the popularity of this standard work. — Medical and Surgical Reporter, Feb. 14, '85. reached a fourth edition in this country, showing the high appreciation in which it is held by the American profession. It comes fresh from the pen of the author. That it is the very best work on surgery for medical students we think there can be no doubt. The author seems to have understood just what a student needs, and has prepared the work accordingly. — Cincinnati Medical News, January, 1885. By the same Author. Diseases of the Breast. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 3. F8MABCH, Dr. FBIFDBICH, Professor of Surgery at the University of Kiel, etc. Early Aid in Injuries and Accidents. Five Ambulance Lectures. Trans- lated by H. E. H. Princess Christian. In one handsome small 12mo. volume of 109 pages, with 24 illustrations. Cloth, 75 cents. The course of instruction is divided into five sections or lectures. The first, or introductory lecture, gives a brief account of the structure and organization of the human body, illustrated by clear, suitable diagrams. The second teaches how to give judicious help in ordinary injuries — contu- sions, wounds, haemorrhage and poisoned wounds. The third treats of first aid in cases of fracture and of dislocations, in sprains and in burns. Next, the methods of affording first treatment in cases of frost-bite, of drowning, of suffocation, of loss of consciousness and of poisoning are described ; and the fifth lecture teaches how injured persons may be most safely and easily transported to their homes, to a medical man, or to a hospital. The illustrations in the book are clear and good. — Medi- cal Times and Gazette, Nov. 4, 1882. TBFVE8, FBEDFBICK, F. B. C. 8., Assistant Surgeon to and Lecturer on Surgery at the London Hospital. Intestinal Obstruction. In one pocket-size 12mo. volume of 522 pages, with 60 illustrations. Limp cloth, blue edges, $2.00 page 3. A standard work on a subject that has not been so comprehensively treated by any contemporary English writer. Its completeness renders a full review difficult, since every chapter deserves mi- nute attention, and it is impossible to do thorough Just ready. See Series of Clinical Manuals, justice to the author in a few paragraphs. InteS' tinal Obstruction is a work that will prove of equal value to the practitioner, the student, the pathologist, the physician and the operating sur- geon. — British Medical Journal, Jan. 31, 1885. BALL, CMABLF8 B., M. Ch., Dub., F. B. C. 8. M. 9 Surgeon and Teacher at Sir P. Dun's Hospital, Dublin. Diseases of the Rectum and Anus. In one 12mo. volume of 550 pages. Preparing. See Series of Clinical Manuals, page 3. See Series of Clinical BTJTLIN, JELFWBT T., F. B. C. 8., Assistant Surgeon to St. Bartholomew's Hospital, London. Diseases of the Tongue. In one 12mo. volume. Manuals, page 3. Shortly. DBTJITT, BOBFBT, M. B. C. 8., etc. The Principles and Practice of Modern Surgery. From the eighth London edition. In one 8vo. volume of 687 pages, with 432 illus. Cloth, $4 ; leather, $5. 22 Lea Brothers & Co.'s Publications — Surgery. HOL3IES, TI3IOTHY, 31. A., Surgeon and Lecturer on Surgery at St. George's Hospital, London. A System of Surgery ; Theoretical and Practical. IN TREATISES BY VARIOUS AUTHORS. American edition, thoroughly revised and re-edited by John H. Packard, M. D., Surgeon to the Episcopal and St. Joseph's Hospitals, Philadelphia, assisted by a corps of thirty-three of the most eminent American surgeons. In three large and very handsome imperial octavo volumes containing 3137 double- columned pages, -with 979 illustrations on wood and 13 lithographic plates, beautifully colored. Price per volume, cloth, $6.00 ; leather, $7.00 ; half Russia, $7.50. Per set, cloth, $18.00 ; leather, $21.00 ; half Russia, $22.50. Sold only by subscription. Volume I. contains General Pathology, Morbid Processes, Injuries in Gen- eral, Complications of Injuries and Injuries op Regions. Volume II. contains Diseases of Organs of Special Sense, Circulatory Sys- tem, Digestive Tract and Genito-Urinary Organs. Volume HI. contains Diseases of the Respiratory Organs, Bones, Joints and Muscles, Dlseases of the Nervous System, Gunshot Wounds, Operative and Mlnor Surgery, and Miscellaneous Subjects (including an essay on Hospitals). This great work, issued some years since in England, has won such universal confi- dence wherever the language is spoken that its republication here, in a form more thoroughly adapted to the wants of the American practitioner, has seemed to be a duty owing to the profession. To accomplish this, each article has been placed in the hands of a gentleman specially competent to treat its subject, and no labor has been spared to bring each one up to the foremost level of the times, and to adapt it thoroughly to the practice of the country. In certain cases this has rendered necessary the substitution of an entirely new essay for the original, as in the case of the articles on Skin Diseases, on Diseases of the Absorbent System, and on Anaesthetics, in the use of which American practice differs from that of England. The same careful and conscientious revision has been pursued throughout, leading to an increase of nearly one-fourth in matter, while the series of illustrations has been nearly trebled, and the whole is presented as a complete exponent of British and American Surgery, adapted to the daily needs of the working practitioner. In order to bring it within the reach of every member of the profession, the five vol- umes of the original have been compressed into three by employing a double-columned royal octavo page, and in this improved form it is offered at less than one-half the price of the original. It is printed and bound to match in every detail with Reynolds' System of Medi- cine. The work will be sold by subscription only, and in due time every member of the profession will be called upon and offered an opportunity to subscribe. The authors of the original English edition are men of the front rank in England, and Dr. Packard has been fortunate in securing as his American coadjutors such men as Bartholow, Hyde, Hunt, Conner, Stimson, Morton, Hodgen, Jewell and their colleagues. As a whole, the work will be solid and substantial, and a valuable addition to the library of any medical man. It is more wieldly and more useful than the English edition, and with its companion work — " Reynolds' System of Medi- cine " — will well represent the present state of our science. One who is familiar with those two works will be fairly well furnished head-wise and hand- •iy Mi wise.— The Medical News, Jan. 7, 1882. STIMSOW, LEWIS A., B. A., M. D., Professor of Pathological Anatomy at the University of the City of New York, Surgeon and Curator to Bellevue Hospital, Surgeon to the Presbyterian Hospital, New York, etc. A Practical Treatise on Fractures. In one very handsome octavo volume of 598 pages, with 360 beautiful illustrations. Cloth, $4.75 ; leather, $5.75. The author has given to the medical profession in this treatise on fractures what is likely to be- come a standard work on the subject. It is certainly not surpassed by any work written in the English, or, for that matter, any other language. The au- thor tells us in a short, concise and comprehensive manner, all that is known about his subject. There is nothing scanty or superficial about it, as in most other treatises ; on the contrary, everything is thor- ough. The chapters on repair of fractures and their treatment show him not only to be a profound stu- dent, but likewise a practical surgeon and patholo- gist. His mode of treatment of the different fract- ures is eminently sound and practical. We consider this work- one of the best on fractures; and it will be welcomed not only as a text-book, but also by the surgeon in full practice. — N. O. Medical and Surgical Journal, March, 1883. The author gives in clear language all that the practical surgeon need know of the science of fractures, their etiology, symptoms, processes of union, and treatment, according to the latest de- velopments. On the basis of mechanical analysis the author accurately and clearly explains the clinical features of fractures, and by the same method arrives at the proper diagnosis snd rational treatment. A thorough explanation of the patho- logical anatomy and a careful description of the various methods of procedure make the book full of value for every practitioner. — Centralblatt fur Chirurgie, May 19, 1883. 3IAJIS1I, HOWARD, F. B. C. S., Senior Assistant Surgeon to and Lecturer on Anatomy at St. Bartholomew's Hospital, London. Diseases of the Joints. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 3. PICK, I. PICKERING, F. It. C. S., Surgeon to and Lecturer on Surgery at St. George's Hospital, London. Fractures and Dislocations. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 3. Lea Brothers & Co.'s Publications — Frac, Disloc, Ophtkal. 23 HAMILTON, FMANKJBC., M. D., LL. D., Surgeon to Bellevue Hospital, New York. A Practical Treatise on Fractures and Dislocations. Seventh edition, thoroughly revised and much improved. In one very handsome octavo volume of 998 pages, with 379 illustrations. Cloth, $5.50 open back, $7.00. Just ready. Hamilton's great experience and wide acquaint- ance with the literature of the subject have enabled him to complete the labors of Malgaigne and to place the reader in possession of the advances made during thirty years. The editions have fol- lowed each other rapidly, and they introduce us to the methods of practice, often so wise, of his American colleagues. More practical than Mal- gaigne's work, it will serve as a valuable guide to the practitioner in the numerous and embarrass- ing cases which come under his observation. — Archives Generates de Medecine, Paris, Nov. 1884. This work, which, since its first appearance twenty-five years ago, has gone through many editions, and been much enlarged, may now be fairly regarded as the authoritative book of refer- ence on the subjects of fractures and dislocations. Each successive edition has been rendered of greater value through the addition of more re- leather, $6.50 ; very handsome half Eussia, cent work, and especially of the recorded re- searches and improvements made by the author himself and his countrymen. — British Medical Journal, May 9, 1885. With its first appearance in 1859, this work took rank among the classics in medical literature, and has ever since been quoted by surgeons the world over as an authority upon the topics of which it treats. The surgeon, if one can be found who does not already know the work, will find it scientific, forcible and scholarly in text, exhaustive in detail, and ever marked by a spirit of wise con- servatism. — Louisville Medical News, Jan. 10, 1885. For a quarter of a century the author has been elaborating and perfecting his work, so that it now stands as the best of its kind in any lan- guage. As a text-hook and as a book of reference and guidance for practitioners it i3 simply invalu- able. — New Orleans Med, and Surg, Journal, Nov. 1884. JTTLEM, HEJVHY E., F. M. C. S., Senior Ass't Surgeon, Royal Westminster Ophthabnic Hosp. ; late Clinical Ass't, Moorfields, London. A Handbook of Ophthalmic Science and Practice. In one handsome octavo volume of 460 pages, with 125 woodcuts, 27 colored plates, and selections from the Test-types of Jaeger and Snellen. Cloth, $4.50 ; leather, $5.50. Just ready. and typical illustrations of all important eye affections, placed in juxtaposition, so as to be f rasped at a glance. Beyond a doubt it is the est illustrated handbook of ophthalmic science which ha&- ever appeared. Then, what is still better, these illustrations are nearly all original. We have examined this entire work with great care, and it represents the commonly accepted views of advanced ophthalmologists. We can most heartily commend this book to all medical stu- dents, practitioners and specialists. — Detroit Lancet, Jan. 1885. This work is distinguished by the great num- ber of colored plates which appear in it for illus- trating various pathological conditions. They are very beautiful in appearance, and have been executed with great care as to accuracy. An ex- amination of the work shows it to be one of high standing, one that will be regarded as an authority among ophthalmologists. The treatment recom- mended is such as the author has learned from actual experience to be the best. — Cincinnati Medi- cal News, Dec. 1884. It presents to the student concise descriptions WELLS, J. SOELBEMG, E. It. C. S., Professor of Ophthalmology in King's College Hospital, London, etc. A Treatise on Diseases of the Eye. Fourth American from the third London edition. Thoroughly revised, with copious additions, by Charles S. Bull, M. D., Surgeon and Pathologist to the New York Eye and Ear Infirmary. In one large octavo volume of 822 pages, with 257 illustrations on wood, six colored plates, and selections from the Test- types of Jaeger and Snellen. Cloth, $5.00 ; leather, $6.00 ; half Eussia, $6.50 The present edition appears in less than three years since the publication of the last American edition, and yet, from the numerous recent inves- tigations that have been made in this branch of medicine, many changes and additions have been required to meet the present scope of knowledge upon this subject. A critical examination at once shows the fidelity and thoroughness with which the editor has accomplished his part of the work. The illustrations throughout are good. This edi- tion can be recommended to all as a complete treatise on diseases of the eye, than which proba- bly none better exists.— Medical Record, Aug. 18, '83. NETTLESHIP, EDWARD, F. M. C. $., Ophthalmic Surg, and Led. on Ophth. Surg, at St. Thomas' Hospital, London. The Student's Guide to Diseases of the Eye. Second edition. With a chap- ter on the Detection of Color-Blindness, by William Thomson, M. D., Ophthalmologist to the Jefferson Medical College. In one royal 12mo. volume of 416 pages, with 138 illustrations. Cloth, $2.00. This admirable guide bids fair to become the favorite text-book on ophthalmic surgery with stu- dents and general practitioners. It bears through- out the imprint of sound judgment combined with vast experience. The illustrations are numerous and well chosen. This book, within the short com- pass of about 400 pages, contains a lucid exposition of the modern aspect of ophthalmic science.— Medical Record, June 23, 1883. BMOWNE, EDGAM A., Surgeon to the Liverpool Eye and Ear Jnfirmary and to the Dispensary for Skin Diseases. How to Use the Ophthalmoscope. Being Elementary Instructions in Oph- thalmoscopy, arranged for the use of Students. In one small royal 12mo. volume of 116 pages, with 35 illustrations. Cloth, $1.00. LAWSON ON INJURIES TO THE EYE, ORBIT AND EYELIDS : Their Immediate and Remote Effects. 8 vo., 404 pp., 92 illus. Cloth, $3.50. LAURENCE AND MOON'S HANDY BOOK OF OPHTHALMIC SURGERY, for the use of Prac- titioners. Second edition. In one octavo vol- ume of 227 pages, with 65 illust. Cloth, $2.75. CARTER'S PRACTICAL TREATISE ON DISEAS- ES OF THE EYE. Edited by John Gbeen, M. D. In one handsome octavo volume. i^^^HBH 24 Lea Brothers & Co.'s Publications — OtoL, Urin. Dis.,Dent. BURNETT, CHARLES H., A. M., M. D., Professor of Otology in the Philadelphia Polyclinic ; President of the American Otological Society. The Ear, Its Anatomy, Physiology and Diseases. A Practical Treatise for the use of Medical Students and Practitioners. New (second) edition. In one handsome octavo volume of 580 pages, with 107 illustrations. Cloth, $4.00 ; leather, $5.00. Just ready. We note with pleasure the appearance of a second edition of this valuable work. When it first came out it was accepted by the profession as one of the standard works on modern aural surgery in the English language; and in his second edition Dr. Burnett has fully maintained his reputation, for the book is replete with valuable information and suggestions. The revision has been carefully carried out, and much new matter added. Dr. Burnett's work must be regarded as a very valua- ble contribution to aural surgery, not only on account of its comprehensiveness, but because it contains the results of the careful personal observa- tion and experience of this eminent aural surgeon. —London Lancet, Feb. 21, 1885. BOLITZER, ADAM, Imperial-Royal Prof, of Aural Therap. in the Univ. of Vienna. A Text-Book of the Ear and its Diseases. Translated, at the Author's re- quest, by James Patterson Cassells, M. D., M. E. C. S. In one handsome octavo vol- ume of 800 pages, with 257 original illustrations. Cloth, $5.50. The work itself we do not hesitate to pronounce the best upon the subject of aural diseases which has ever appeared, systematic without being too diffuse on obsolete gubjects, and eminently prac- tical in every sense. The anatomical descriptions of each separate division of the ear are admirable, and profusely illustrated by woodcuts. They are followed immediately by the physiology of the section, and this again by the pathological physi- ology, an arrangement which serves to keep up the interest of the student by showing the direct ap- plication of what has preceded to the study of dis- ease. The whole work can be recommended as a reliable guide to the student, and an efficient aid to the practitioner in his treatment. — Boston Med- ical and Surgical Journal, June 7, 1883. ROBERTS, WILLIAM, M. D., Lecturer on Medicine in the Manchester School of Medicine, etc. A Practical Treatise on Urinary and Renal Diseases, including Uri- nary Deposits. Fourth American from the fourth London edition. In one hand- some octavo volume of about 650 pages, with 81 illustrations. Cloth, $3.50. Just ready. cerely to be congratulated that he has been able amidst his many public and private duties to pre- sent a new edition of this standard work, thoroughly brought up to the present date. — Lon- don Medical Record, May 15, 1885. This excellent book has now reached its fourth edition, and not too soon, for the third has been exhausted for some years, and it is one of those works which no good physician's or surgeon's library should be without. The profession is sin- GROSS, S. &., M. JD., LL. JD., JD. C. L., etc. A Practical Treatise on the Diseases, Injuries and Malformations of the Urinary Bladder, the Prostate Gland and the Urethra. Third edition, thoroughly revised by Samuel W. Gross, M. D., Professor of the Principles of Surgery and of Clinical Surgery in the Jefferson Medical College, Philadelphia. In one octavo volume of 574 pages, with 170 illustrations. Cloth, $4.50. MORRIS, HENRY, M. B., F. R. C. S., Surgeon to and Lecturer on Surgery at Middlesex Hospital, London. Surgical Diseases of the Kidney. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 3. LUCAS, CLEMENT, M. B., B. S., F. R. C. S., Senior Assistant Surgeon to Guy's Hospital, London. Diseases of the Urethra. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 3. THOMPSON, SIR HENRY, Surgeon and Professor of Clinical Surgery to University College Hospital, London. Lectures on Diseases of the Urinary Organs. Second American from the third English edition. In one 8vo. volume of 203 pp., with 25 illustrations. Cloth, $2.25. By the Same Author. On the Pathology and Treatment of Stricture of the Urethra and Urinary Fistulse. From the third English edition. In one octavo volume of 359 pages, with 47 cuts and 3 plates. Cloth, $3.50. COLEMAN, A., L.R. C. P., F. R. C. S., Exam. L. D. S., Senior Dent. Surg, and Lect. on Dent. Surg, at St. Bartholomew's Hosp. and the Dent. Hosp., London. A Manual of Dental Surgery and Pathology. Thoroughly revised and adapted to the use of American Students, by Thomas C. Stellwagen, M. A., M. D., D. D. S., Prof, of Physiology at the Philadelphia Dental College. In one handsome octavo volume of 412 pages, with 331 illustrations. Cloth, $3.25. BASHAM ON RENAL DISEASES: A Clinical I ome 12mo. vol. of 304 pages, with 21 illustrations. Guide to their Diagnosis and Treatment. In | Cloth, $2.00. Lea Brothers & Co.'s Publications — Venereal, Impotence. 25 BUMSTFAD, F. J., M. JD., XX. D., Late Professor of Venereal Diseases at the College of Physicians and Surgeons, New York, etc. and TAYLOR, R. W., A. M., M. D. 9 Surgeon to Charity Hospital, New York, Prof, of Venereal and Skin Diseases in the University of Vermont, Pres. of the Avi. Dermatological Ass'n. The Pathology and Treatment of Venereal Diseases. Including the results of recent investigations upon the subject. Fifth edition, revised and largely re- written, by Dr. Taylor. In one large and handsome octavo volume of 898 pages with 139 illustrations, and thirteen chromo-lithographic figures. Cloth, $4.75; leather, $5.75; very handsome half Russia, $6.25. It is a splendid record of honest labor, wide research, just comparison, careful scrutiny and original experience, which will always be held as a high credit to American medical literature. This is not only the best work in the English language upon the subjects of which it treats, but also one which has no equal in other tongues for its clear, comprehensive and practical handling of its themes. — American Journal of the Medical Sciences, Jan, 1884. It is certainly the best single treatise on vene- real in our own, and probably the best in any lan- guage. — Boston Medical and Surgical Journal, April 3, 1884. The character of this standard work is so well known that it would be superfluous here to pass in review its general or special points of excellence. The verdict of the profession has been passed; it has been accepted as the most thorough and com- plete exposition of the pathology and treatment of venereal diseases in the language. Admirable as a model of clear description, an exponent of sound pathological doctrine, and a guide for rational and successful treatment, it is an ornament to the medi- cal literature of this country. The additions made to the present edition are eminently judicious, from the standpoint of practical utility. — Journal oj Cutaneous and Venereal Diseases, Jan. 1884. mutcmlnsojst, Jonathan, f. r. $., f. r. c. s., Consulting Surgeon to the London Hospital. Syphilis. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 3. CORJSTIL, v., Professor to the Faculty of Medicine of Paris, and Physician to the Lour cine Hospital. Syphilis, its Morbid Anatomy, Diagnosis and Treatment. Specially revised by the Author, and translated with notes and additions by J. Henry C. Simes, M. D., Demonstrator of Pathological Histology in the University of Pennsylvania, and J. William White, M. D., Lecturer on Venereal Diseases and Demonstrator of Surgery in the University o f Pennsylvania. In one handsome octavo volume of 461 pages, with 84 very beautiful illustrations. Cloth, $3.75. The anatomical and histological characters of the hard and soft sore are admirably described. The multiform cutaneous manifestations of the disease are dealt with histologically in a masterly way, as we should indeed expect them to be, and the accompanying illustrations are executed carefully and well. The various nervous lesions which are the recognized outcome of the syphilitic dyscrasia are treated with care and consideration. Syphilitic epilepsy, paralysis, cerebral syphilis and locomotor ataxia are subjects full of interest; and nowhere in the whole volume is the clinical experience of the author or the wide acquaintance of the translators with medical literature more evident. The anat- omy, the histology, the pathology and the clinical features of syphilis are represented in this work in their best, most practical and most instructive form, and no one will rise from its perusal without the feeling that his grasp of the wide and impor- tant subject on which it treats is a stronger and surer one. — The London Practitioner, Jan. 1882. GROSS, SAMUEL W., A. M., M. D., Professor of the Principles of Surgery and of Clinical Surgery in the Jefferson Medical College. A Practical Treatise on Impotence, Sterility, and Allied Disorders of the Male Sexual Organs. Second edition, thoroughly revised. In one very hand- some octavo volume of 168 pages, with 16 illustrations. Cloth, $1.50. The author of this monograph is a man of posi- tive convictions and vigorous style. This is justi- fied by his experience and by his study, which has gone hand in hand with his experience. In regard to the various organic and functional disorders of the male generative apparatus, he has had ex- ceptional opportunities for observation, and his book shows that he has not neglected to compare his own views with those of other authors. The result is a work which can be safely recommended to both physicians and surgeons as a guide in the treatment of the disturbances it refers to. It is the best treatise on the subject with which we are acquainted. — The Medical News, Sept. 1, 1883. This work will derive value from the high stand- ing of its author, aside from the fact of its passing so rapidly into its second edition. This is, indeed, a book that every physician will be glad to place in his library, to be read with profit to himself, and with incalculable benefit to his patient. Be- sides the subjects embraced in the title, which are treated of in their various forms and degrees, spermatorrhoea and prostatorrhcea are also fully considered. The work is thoroughly practical in character, and will be especially useful to the general practitioner. — Medical Record, Aug. 18, 1883. CULLFRIFR, A., & BUMSTFAD, F. J., M.L>., LL.D., Surgeon to the Hdpital du Midi. Late Professor of Venereal Diseases in the College of Physicians and Surgeons, New York. An Atlas of Venereal Diseases. Translated and edited by Freeman J. Bum- stead, M. D. In one imperial 4to. volume of 328 pages, double-columns, with 26 plates, containing about 150 figures, beautifully colored, many of them the size of life. Strongly bound in cloth, $17.00. A specimen of the plates and text sent by mail, on receipt of 25 cts. HILL ON SYPHILIS AND LOCAL CONTAGIOUS j FORMS OF LOCAL DISEASE AFFECTING DISORDERS. In one 8vo vol. of 479 p. Cloth, $3.25. PRINCIPALLY THE ORGANS OF GENERA- LEE'S LECTURES ON SYPHILIS AND SOME | TION. In one 8vo. vol. of 246 pages. Cloth, $2.25. 26 Lea Brothers & Co.'s Publications — Diseases of Skin. SYJDE, J. JSFVINS, A. M-, M. JD., Professor of Dermatology and Venereal Diseases in Rush Medical College, Chicago. A Practical Treatise on Diseases of the Skin. For the use of Students and Practitioners. In one handsome octavo volume of 570 pages, with 66 beautiful and elab- orate illustrations. Cloth, §4.25 ; leather, §5.25. The author has given the student and practi- tioner a work admirably adapted to the wants of each. We can heartily commend the book as a valuable addition to our literature and a reliable guide to students and practitioners in their studies and practice. — Am. Journ. of Med. Sci., July, 1883. Especially to be praised are the practical sug- gestions as to what may be called the common- sense treatment of eczema. It is quite impossible to exaggerate the judiciousness with which the formulas for the external treatment of eczema are selected, and what is of equal importance, the full and clear instructions for their use. — London Medi- cal Times and Gazette, July 28, 1883. The work of Dr. Hyde will be awarded a high position. The student of medicine will find it peculiarly adapted to his wants. Notwithstanding the extent of the subject to which it is devoted, yet it is limited to a single and not very large vol- ume, without omitting a proper discussion of the topics. The conciseness of the volume, and the setting forth of only what can be held as facts will also make it acceptable to general practitioners. — Cincinnati Medical News, Feb. 1883. The aim of the author has been to present to his readers a work not only expounding the most modem conceptions of his subject, but presenting what is of standard value. He has more especially devoted its pages to the treatment of disease, and by his detailed descriptions of therapeutic meas- ures has adapted them to the needs of the physi- cian in active practice. In dealing with these questions the author leaves nothing to the pre- sumed knowledge of the reader, but enters thor- oughly into the most minute description, so that one is not only told what should be done under given conditions but how to do it as well. It is therefore in the best sense " a practical treatise." That it is comprehensive, a glance at the index will show. — Maryland Medical Journal, July 7, 1883, Professor Hyde has long been known as one of the most intelligent and enthusiastic representa- tives of dermatology in the west. His numerous contributions to the literature of this specialty have gained for him a favorable recognition as a careful, conscientious and original observer. The remarkable advances made in our knowledge of diseases of the skin, especially from the stand- point of pathological histology and improved methods of treatment, necessitate a revision of the older text-books at short intervals in order to bring them up to the standard demanded by the march of science. This last contribution of Dr. Hyde is an effort in this direction. He has at- tempted, as he informs us, the task of presenting in a condensed form the results of the latest ob- servation and experience. A careful examination of the work convinces us that he has accomplished his task with painstaking fidelity and with a cred- itable result. — Journal of Cutaneous and Venereal Diseases, June, 1883. FOX, T., M.D., F.JEt. C. P., and FOX, T. €., B.A., M.B. C.S., Physician to the Department for Skin Diseases, llec Physician for Diseases of the Skin to the Westminster Hospital, London. University College Hospital, London. An Epitome of Skin Diseases. With Formulae. For Students and Prac- titioners. Third edition, revised and enlarged. In one very handsome 12mo. volume of 238 pages. Cloth, $1.25. The third edition of this convenient handbook calls for notice owing to the revision anl expansion which it has undergone. The arrangement of skin diseases in alphabetical order, which is the method of classification adopted in this work, becomes a positive advantage to the student. The book is one which we can strongly recommend, not only to students but also to practitioners who require a compendious summary of the present state of dermatology. — British Medical Journal, July 2, 1883. We cordially recommend Fox's Epitome to those whose time is limited and who wish a handy manual to lie upon the table for instant reference. Its alphabetical arrangement is suited to this use, for all one has to know is the name of the disease, and here are its description and the appropriate treatment at hand and ready for instant applica- tion. The present edition has been very carefully revised and a number of new diseases are de- scribed, while most of the recent additions to dermal therapeutics find mention, and the formu- lary at the end of the book has been considerably augmented.— The Medical News, December, 1883. MOBBIS, MALCOLM, M. D., Joint Lecturer on Dermatology at St. Mary's Hospital Medical School, London. Skin Diseases ; Including their Definitions, Symptoms, Diagnosis, Prognosis, Mor- bid Anatomy and Treatment. A Manual for Students and Practitioners. In one 12mo. volume of 316 pages, with illustrations. Cloth, $1.75. To physicians who would like to know something about skin ^.diseases, so that when a patient pre- sents himself for relief they can make a correct diagnosis and prescribe a rational treatment, we unhesitatingly recommend this little book of Dr. Morris. The affections of the skin are described in a terse, lucid manner, and their several charac- teristics so plainly set forth that diagnosis will be easy. The treatment in each case is such as the experience of the rnosteminent dermatologists ad- vises. — Cincinnati Medical News, April, 1880. This is emphatically a learner's book; for we can safely say, that in the whole range of medical literature there is no book of alike scope which for clearness of expression and methodical ar- rangement is better adapted to promote a rational conception of dermatology — a branch confessedly difficult and perplexing to the beginner.— ££. Louis Courier of Medicine, April, 1880. The writer has certainly given in a small compass a large amount of well-compiled information, and his little book compares favorably with any other which has emanated from England, while in many points he has emancipated himself from the stub- bornly adhered to errors of others of his country- men. There is certainly excellent material in the book which will well repay perusal. — Boston Med. and Surg. Journ., March, 1880. WILSON, FBASMUS, F. B. S. The Student's Book of Cutaneous Medicine and Diseases of the Skin. In one handsome small octavo volume of 535 pages. Cloth, $3.50. HILLIFB, THOMASTM-Io^r Physician to the Skin Department of University College, London. Handbook of Skin Diseases; for Students and Practitioners, Second Ameri- can edition. In one 12mo. volume of 853 pag< s, with plates. Cloth, $2.25. Lea Brothers & Co.'s Publications — Dis. of Women. 27 AN AMERICAN SYSTEM OF GYNECOLOGY, A System of Gynaecology, in Treatises by Various Authors. Edited by Matthew D. Masn, M. D., Professor of Obstetrics and Gynaecology in the Uni- versity of Buffalo, N. Y. In two handsome octavo volumes, richly illustrated. In active preparation. LIST OF CONTRIBUTORS. FORDYCE BARKER, M. D., ROBERT BATTEY, M. D., SAMUEL C. BUSEY, M. D., HENRY F. CAMPBELL, M. D., BENJAMIN F. DAWSON, M. D., WILLIAM G00DELL, M. D., HENRY F. GARRIGUES, M. D., SAMUEL W. GROSS, M. D., JAMES B. HUNTER, M. D., WILLIAM T. HOWARD, M. D., A. REEVES JACKSON, M. D., EDWARD W. JENKS, M. D., WILLIAM H. CHARLES CARROLL LEE, M. D., WILLIAM T. LUSK, M. D., MATTHEW D. MANN, M. D., ROBERT B. MAURY, M. D., C. D. PALMER, M. D., WILLIAM M. POLK, M. D., THADDEUS A. REAMY, M. D., A. D. ROCKWELL, M. D., ALBERT H. SMITH, M. D., R. STANSBURY SUTTON, A. M., M. D. T. GAILLARD THOMAS, M. D., CHARLES S. WARD, M. D., WELCH, M. D. TMOMAS, T. GAILLARD, M. D., Professor of Diseases of Women in the College of Physicians and Surgeons, N. Y. j A Practical Treatise on the Diseases of Women. Fifth edition, thoroughly revised and rewritten. In one large and handsome octavo volume of 810 pages, with 266 illustrations. Cloth, $5.00 ; leather, $6.00 ; very handsome half Eussia, raised bands, $6.50. The words which follow "fifth edition" are in this case no mere formal announcement. The alterations and additions which have been made are both numerous and important. The attraction and the permanent character of this book lie in the clearness and truth of the clinical descriptions of diseases; the fertility of the author in thera- peutic resources and the fulness with which the details of treatment are described; the definite character of the teaching; and last, but not least, the evident candor which pervades it. We would also particularize the fulness with which the his- tory of the subject is gone into, which makes the book additionally interesting and gives it value as a work of reference. — London Medical Times and Gazette, July 30, 1881. The determination of the author to keep his book foremost in the rank of works on gynaecology is most gratifying. Recognizing the fact that this can only be accomplished by frequent and thor- ough revision, he has spared no pains to make the present edition more desirable even than the pre- vious one. As a book of reference for the busy practitioner it is unequalled. — Boston Medical any Surgical Journal, April 7, 1880. It has been enlarged and carefully revised. It is a condensed encyclopaedia of gynaecological medi- cine. The style of- arrangement, the masterly manner in which each subject is treated, and the honest convictions derived from probably the largest clinical experience in that specialty of any in this country, all serve to commend it in the highest terms to the practitioner. — Nashville Jour, of Med. and Surg., Jan. 1881. That the previous editions of the treatise of Dr. Thomas were thought worthy of translation into German, French, Italian and Spanish, is enough to give it the stamp of genuine merit. At home it has made its way into the library of every obstet- rician and gynaecologist as a safe guide to practice. No small number of additions have been made to the present edition to make it correspond to re- cent improvements in treatment. — Pacific Medical and Surgical Journal, Jan. 1881. MJDIS, AMTHUtt W., M, D., Lond., F.M. O..P., M.M. C. S., Assist. Obstetric Physician to Middlesex Hospital, late Physician to British Lying-in Hospital. The Diseases of Women. Including their Pathology, Causation, Symptoms, Diagnosis and Treatment. A Manual for Students and Practitioners. In one handsome octavo volume of 576 pages, with 148 illustrations. Cloth, $3.00 ; leather, $4.00. It is a pleasure to read a book so thoroughly good as this one. The special qualities which are conspicuous are thoroughness in covering the whole ground, clearness of description and con- ciseness of statement. Another marked feature of the book is the attention paid to the details of many minor surgical operations and procedures, as, for instance, the use of tents, application of leeches, and use of hot water injections. These are among the more common methods of treat- ment, and yet very little is said about them in many of the textbooks. The book is one to be warmly recommended especially to students and general practitioners, who need a concise but com- plete resume of the whole subject. Specialists, too, will find many useful hints in its pages. — Boston Med. and Surg. Journ., March 2, 1882. The greatest pains have been taken with the sections relating to treatment. A liberal selection of remedies is given for each morbid condition, the strength, mode of application and other details being fully explained. The descriptions of gynae- cological manipulations and operations are full, clear and practical. Much care has also been be- stowed on the parts of the book which deal with diagnosis — we note especially the pages dealing with the differentiation, one from another, of the different kinds of abdominal tumors. The prac- titioner will therefore find in this book the kind of knowledge he most needs in his daily work, and he will be pleased with the clearness and fulness of the information there given. — The Practitioner, Feb. 1882. P., BARNES, ROBERT, M. D., F. R. C. Obstetric Physician to St. Thomas' Hospital, London, etc. A Clinical Exposition of the Medical and Surgical Diseases of Women. In one handsome octavo volume, with numerous illustrations. New edition. Preparing. WEST, CMAMLES, M. J>. Lectures on the Diseases of Women. Third American from the third Lon- don edition. In one octavo volume of 543 pages. Cloth, $3.75 ; leather, $4.75. CHURCHILL ON THE PUERPERAL FEVER I MEIGS ON THE NATURE, SIGNS AND TREAT- AND OTHER DISEASES PECULIAR TO WO- MENT OF CHILDBED FEVER. In one 8vo. MEN. In one 8vo. vol. of 464 pages. Cloth, $2.50. | volume of 346 pages. Cloth, $2.00. M 28 Lea Brothers & Co.'s Publications — Dis. of Women, Midwfy. EMMET, THOMAS AL>JDIS, M. D., LL. !>., Surgeon to the Woman's Hospital, New York, etc. The Principles and Practice of Gynecology ; For the use of Students and Practitioners of Medicine. New (third) edition, thoroughly revised. In one large and very handsome octavo volume of 880 pages, with 150 illustrations. Cloth, $5 ; leather, $6. (Just ready.) Excerpt from the Author's Preface to the Second Edition. So great have been the advance and change of views during the past four years in Gynaecology, that the preparation of this edition has necessitated almost as much labor as to have rewritten the volume. Every portion has been thoroughly revised, a great deal ha9 been left out, and much new matter added. The chapters on the relation of education and social condition to development, those on pelvic cellulitis, the diseases of the ovary and on ovariotomy, together with that on stone in the bladder, have been nearly rewritten. The chapters on prolapse of the vaginal walls and lacerations of the vaginal outlet, the methods of partial and complete removal of the uterus for malignant disease, the surgical treatment of fibrous tumors, diseases of the Fallopian tubes, and the diseases of the urethra, are essentially new, with the views and experience of the author in a form which has not been presented to the profession before. To these chapters not less than one hundred and seventy-five pages of new material have been added. We are in doubt whether to congratulate the author more than the profession upon the appear- ance of the third edition of this well-known work. Embodying, as it does, the life-long experience of one who has conspicuously distinguished himself as a bold and successful operator, and who has devoted so much attention to the specialty, we feel sure the profession will not fail to appreciate the privilege thus offered them of perusing the views and practice of the author. His earnestness of purpose and conscientiousness are manifest. H9 gives not only his individual experience but endeavors to represent the actual state of gynae- cological science and art. — British Medical Jour- nal, May 16, 1885. Any work on gynaecology by Emmet must always have especial interest and value. He has for many years been an exceedingly busy prac- titioner in this department. Few men have had his experience and opportunities. As a guide either for the general practitioner or specialist, it is second to none other. No one can read Emmet without pleasure, instruction and profit. — Cincinnati Lancet and Clinic, Jan 31, 1885. JDVNCAN, J. MATTHEWS, M.D., LL. D., F. It. S. E., etc. Clinical Lectures on the Diseases of Women ; Delivered in Saint Bar- tholomew's Hospital. In one handsome octavo volume of 175 pages. Cloth, $1.50. stamp of individuality that, if widely read, as they They are in every way worthy of their author ; indeed, we look upon them as among the most valuable of his contributions. They are all upon matters of great interest to the general practitioner. Some of them deal with subjects that are not, as a rule, adequately handled in the text-books; others of them, while bearing upon topics that are usually treated of at length in such works, yet bear such a certainly deserve to be, they cannot fail to exert a wholesome restraint upon the undue eagerness with which many young physicians seem bent upon following the wild teachings which so infest the gynaecology of the present day.— IV. Y. Medical Journal, March, 1880. HOJDGE, HVGHL., M. L>., Emeritus Professor of Obstetrics, etc., in the University of Pennsylvania. On Diseases Peculiar to Women; Including Displacements of the Uterus. Second edition, revised and enlarged. In one beautifully printed octavo volume of 519 pages, with original illustrations. Cloth, $4.50. By the Same Author. The Principles and Practice of Obstetrics. Illustrated with large litho- graphic plates containing 159 figures from original photographs, and with numerous wood- cuts. In one large quarto volume of 542 double-columned pages. Strongly bound in cloth, $14.00. * * * Specimens of the plates and letter-press will be forwarded to any address, free by mail, on receipt of six cents in postage stamps. TAIiNIEB, S., and CHAJSTTBEUIL, G. A Treatise on the Art of Obstetrics. Translated from the French. In two large octavo volumes, richly illustrated. BAMSBOTHAM, FRANCIS H., M. D. The Principles and Practice of Obstetric Medicine and Surgery: In reference to the Process of Parturition. A new and enlarged edition, thoroughly revised by the Author. With additions by W. V. Keating, M. D., Professor of Obstetrics, etc., in the Jefferson Medical College of Philadelphia. In one large and handsome imperial octavo volume of 040 pages, with 04 full-page plates and 43 woodcuts in the^ text, contain- ing in all nearly 200 beautiful figures. Strongly bound in leather, with raised bands, $7. ASHWELL'S PRACTICAL TREATISE ON THE l American from the third and revised London DISEASES PECULIAR TO WOMEN. Third I edition. In one 8vo. vol., pp. 520. Cloth, 83.50. Lea Brothers & Co.'s Publications — Midwifery. 29 PLAYFAIH, W. S., M. B. 9 F. B. C. B., Professor of Obstetric Medicine in King's College, London, etc. A Treatise on the Science and Practice of Midwifery. New (fourth) American edition, revised by the Author. Edited, with additions, by Eobebt P. Har- ris, M. D. In one handsome octavo volume of about 700 pages, with 183 illustrations and 3 plates. Cloth, $4 ; leather, $5 ; half Kussia, $5.50". Just ready. A few notices of the previous edition are appended: of the subject are omitted.— Cincinnati Medical if inquired of by a medical student what work on obstetrics we should recommend for him, par excellence, we would undoubtedly advise him to choose Playfair's. It is of convenient size, but what is of chief importance, its treatment of the various subjects is concise and plain. While the discussions and descriptions are sufficiently elabo- rate to render a very intelligible idea of them, yet all details not nece'ssary for a full understanding News, Jan., 1880. It certainly is an admirable exposition of the science and practice of midwifery. Of course the additions made by the American editor, Dr. R. P. Harris, who never utters an idle word, and whose studious researches in some special departments of obstetrics are so well known to the profession, are of great value.— The Amer. Practitioner, April, 1880. BABKFB, FOBBYCE, A. M., M. D., XX. B. Bdin., Clinical Professor of Midwifery and the Diseases of Women in the Bellevue Hospital Medical College, New York, Honorary Fellow of the Obstetrical Societies of London and Edinburgh, etc., etc. Obstetrical and Clinical Essays. In one handsome 12mo. volume of about 300 pages. Preparing. KING, A. F. A., M B., Professor of Obstetrics and Diseases of Women in the Medical Department of the Columbian Univer- sity, Washington, D. C., and in the University of Vermont, etc. A Manual of Obstetrics. New edition. In one very handsome 12mo. volume of 331 pages, with 59 illustrations. Cloth, $2.00. In a series of short paragraphs and by a con- densed style of composition, the writer has pre- sented a great deal of what it is well that every obstetrician should know and be ready to practice or prescribe. The fact that the demand for the volume has been such as to exhaust the first edition in a little over a year and a half speaks well for its popularity. — American Journal of the Medical Sciences, April, 1884. This little work upon obstetrics will be highly valued by medical students. We feel quite sure that it will be in great demand by them, so suited is it to their wants. Of a size that it can be easily carried, yet it contains all of the main points in obstetrics sufficiently elaborated to give a full and correct idea of them. The general practitioner will also find it very useful for reference, for the purpose of refreshing the mind. We can confi- dently assert that it will be found to be the best class text-book upon obstetrics that has been issued from the press. — Cincinnati Medical News, March, 1884. It must be acknowledged that this is just what it pretends to be — a sound guide, a portable epit- ome, a work in which only indispensable matter has been presented, leaving out all padding and chaff, and one in which the student will find pure wheat or condensed nutriment. — New Orleans Med- ical and Surgical Journal, May, 1884. BABWES, BOBEBT, 31. B., and FAJSTCOUBT, M.J}., Phys. to the General Lying-in Hosp., Lond. Obstetric Phys. to St. Thomas' Hosp., Lond. A System of Obstetric Medicine and Surgery, Theoretical and Clin- ical. For the Student and the Practitioner. The Section on Embryology contributed by Prof. Milnes Marshall. In one handsome octavo volume of about 1000 pages, profusely illustrated. Cloth, $5 ; leather, $6. In press. BABJSTES, FAJSTCOUBT, 31. B., Obstetric Physician to St. Thomas' Hospital, London. A Manual of Midwifery for Midwives and Medical Students. In one royal 12mo. volume of 197 pages, with 50 illustrations. Cloth, $1.25. BABVHST, THEOBHILTJS, 31. B., LL. B., Professor of Obstetrics and the Diseases of Women and Children in the Jefferson Medical College. A Treatise on Midwifery. In one very handsome octavo volume of about 550 pages, with numerous illustrations. In BABBY, JOHN S., M. D., Obstetrician to the Philadelphia Hospital, Vice-President oj the Obstet. Society of Philadelphia. Extra - Uterine Pregnancy : Its Clinical History, Diagnosis, Prognosis and Treatment. In one handsome octavo volume of 272 pages. Cloth, $2.50. TAJSWEB, THOMAS BCAWKES, M. B. On the Signs and Diseases of Pregnancy. First American from the second English edition. In one handsome octavo volume of 490 pages, with 4 colored plates and 16 woodcuts. Cloth, $4.25. WINCKEL, F. A Complete Treatise on the Pathology and Treatment of Childbed, For Students and Practitioners. Translated, with the consent of the Author, from the second German edition, by James Read Chad wick, M. D. In one octavo volume of 484 pages. Cloth, $4.00. 30 Lea Brothers & Co.'s Publications — Miclwfy., Dis. Childn. LEISHMAJT, WILLIAM, M. L>., Regius Professor of Midwifery in the University of Glasgow, etc. A System of Midwifery, Including the Diseases of Pregnancy and the Puerperal State. Third American edition, revised by the Author, with additions by John 8. Parry, M. D., Obstetrician to the Philadelphia Hospital, etc. In one large and very handsome octavo volume of 740 pages, with 205 illustrations. Cloth, $4.50 ; leather, $5.50; very handsome half Russia, raised bands, §6.00. The author is broad in his teachings, and dis- preparation of the present edition the author has cusses briefly the comparative anatomy of the pel- vis and the mobility of the pelvic articulations. The second chapter is devoted especially to the Svudy of the pelvis, while in the third the female organs of generation are introduced. The structure and development of the ovum are admirably described. Then follow chapters upon the various subjects embraced in the study of mid- wifery. The descriptions throughout the work are plain and pleasing. It is sufficient to state that in this, the last edition of this well-known work, every recent advancement in this field has been brought forward. — Physician and Surgeon, Jan. 1S80. We gladly welcome the new edition of this ex- cellent text-book of midwifery. The former edi- tions have been most favorably received by the profession on both sides of the Atlantic. In the made such alterations as the progress of obstetri- cal science seems to require, and we cannot but admire the ability with which the task has been performed. We consider it an admirable text- book for students during their attendance upon lectures, and have great pleasure in recommend- ing it. As an exponent of the midwifery of the present day it has no superior in the English lan- guage. — Canada Lancet, Jan. 1880. To the American student the work before us must prove admirably adapted. Complete in all its parts, essentially modern in its teachings, and with demonstrations noted for clearness ana precision, it will gain in favor and be recognized as a work of standard merit. The work cannot fail to be popular and is cordially recommended. — N. O. Med. and Surg. Journ., March, 1880. SMITH, J. LEWIS, 31. JD., Clinical Professor of Diseases of Children in the Bellevue Hospital Medical College, N. Y. A Complete Practical Treatise on the Diseases of Children. Fifth edition, thoroughly revised and rewritten. In one handsome octavo volume of 83G pages,- with illustrations. Cloth, $4.50 ; leather, $5.50 ; very handsome half Kussia, raised bands, f This is one of the best books on the subject with which we have met and one that has given us satisfaction on every occasion on which we have consulted it, either as to diagnosis or treatment. It is now in its fifth edition and in its present, form which we venture to say will be a favorable one. — Dublin Journal of Medical Science, March, 1883. There is no book published on the subjects of which this one treats that is its equal in value to the physician. While he has said just enough to is a very adequate representation of the subject it J impart the information desired by general practi- treatsof as at present understood. The important j tioners on such questions as etiology, pathology, subject of infant hygiene is fully dealt with in the ! prognosis, etc., he has devoted more attention to early portion of the book. The great bulk of the the diagnosis and treatment of the ailments which work is appropriately devoted to the diseases of he so accurately describes ; and such information infancy and childhood. We would recommend ! is exactly what is wanted by the vast majority of any one in need of information on the subject to "family physicians." — Va. Med. Monthly, Feb. 1882. procure the work and form his own opinion on it, | in KEATING, JOHNM., M. !>., Lecturer on the Diseases tf CJiildren at the University of Pennsylvania, etc. The Mother's Guide in the Management and Feeding of Infants one handsome 12mo. volume of 118 pages. Cloth, $1.00. Works like this one will aid the physician im- ! the employment of a wet-nurse, about the proper mensely, f«»r it saves the time he is constantly giv- * Ing his patients in instructing them on the sub- jects here dwelt upon so thoroughly and prac tically. Dr. Keating has written a practical book has carefully avoided unnecessary "repetition, and fully instructed the mother in .such details . her child as devolve upon her. B . '.1,-iy omitted giving prescriptions, the mother when to call upon the totally distinct from hers. -1, October, 1881. Dr. K lear of the common fault food for a nursing mother, about the tonic effects of a bath, about the perambulator versus the nurses, " arms, and on many other subjects concerning which the critic might say, "surely this is obvi- ous," but which experience teaches us are exactly the things needed to be insisted upon, with the rich as well as the poor. — London Lancet, January, 28 1882 A book small in size, written in pleasant style, in language which can be readily understood by any mot her, and eminently practical and safe; in fact a book for which we have been waiting a long time, and which we can most heartily recommend : .is sort, viz., mixing the duties of to mothers as the book on this subject. — New York or with those proper to the doctor. There I MedicalJournal and Obstetrical Review, Feb. 1882. . the remarks about I .>b OWEN, EDMUND, 31. B., F. B. C. S., v.s Hospital, (in at. Ormond St., London. Surgical Diseases of Children. In one 12mo. volume. Preparing. See Serie* Of t ,d WEST, CHARLES, 31. I)., Hoepital for Sick ( "Ion, etc. Lectures on the Diseases of Infancy and Childhood. Fifth Amei -i. » from 6tl | [ n one octavo volume of 68 6 pagea. Cloth, $4.50 ; leather, $5.51© — — By the Same Author. On Some Disorders of tho Nervous System in Childhood. In one small ( 'loth, $1.00. ISE ON 'I : ! nted. In one octavo volume of \ Lea Brothers & Co.'s Publications — Med. Juris., Miscel. 31 TIDY, CHAMLE8 MEYMOTT, M. B., E. & 8., Professor of Chemistry and of Forensic Medicine and Public Health at the London Hospital, etc. Legal Medicine. Volume II. Legitimacy and Paternity, Pregnancy, Abor- tion, Rape, Indecent Exposure, Sodomy, Bestiality, Live Birth., Infanticide, Asphyxia, Drowning, Hanging, Strangulation, Suffocation. Making a very handsome imperial oc- tavo volume of 529 page*. Cloth, $6.00; leather, $7.00. Volume I. Containing 864 imperial plates. Cloth, $6.00 ; leather, $7.00. The satisfaction expressed with the first portion of this work is in no wise lessened by a perusal of the second volume. We find it characterized by the same fulness of detail and clearness of ex- pression which we had occasion so highly to com- mend in our former notice, and which render it so valuable to the medical jurist. The copious octavo pages, with, two beautiful colored tables of cases appended to each division of the subject, must have cost the author a prodigious amount of labor and research, but they constitute one of the most valuable features of the book, especially for reference in medico-legal trials. — American Journal of the Medical Sciences, April, 1884. TAYZOM, ALFMBJy 8., M. &., Lecturer on Medical Jurisprudence and Chemistry in Gutfs Hospital, London. A Manual of Medical Jurisprudence. Eighth American from the tenth Lon- don edition, thoroughly revised and rewritten. Edited by John J. Eeese, M. D., Professor of Medical Jurisprudence and Toxicology in the University of Pennsylvania. In one large octavo volume of 937 pages, with 70 illustrations. Cloth, $5.00 ; leather, $6.00 ; half Russia, raised bands, $6.50. The American editions of this standard manual j only have to seek for laudatory terms.— American have for a long time laid claim to the attention of j Journal of the Medical Sciences, Jan. 1881. the profession in this country; and the eighth | This celebrated work has been the standard au- comes before us as embodying the latest thoughts j thority in its department for thirty-seven years, and emendations of Dr. Taylor upon the subject both in England and America, in both the profes- r-o which he devoted his life with an assiduity and s ions which it concerns, and it is improbable that success which made him facile princeps among jt will be superseded in many years. The work is English writers on medical jurisprudence. Both | simply indispensable to every physician, and nearly the author and the book have made a mark too j so to every liberally-educated lawyer, and we deep to be affected by criticism, whether it be | heartily commend the present edition to both pro- - ~ -Albany Law Journal, March 26, 1881. censure or praise, whether it be In this case, however, we should fessions. By the Same Author. The Principles and Practice of Medical Jurisprudence. Third edition. In two handsome octavo volumes, containing 1416 pages, with 188 illustrations. Cloth, $10 ; leather, $12. Just ready. For years Dr. Taylor was the highest authority in England upon the subject to which he gave especial attention. His experience was vast, his judgment excellent, and his skill beyond cavil. It is therefore well that the work of one who, as Dr. Stevenson says, had an "enormous grasp of all matters connected with the subject," should be brought up to the present day and continued in its authoritative position. To accomplish this re- sult Dr. Stevenson has subjected it to most careful editing, bringing it well up to the times.— Ameri- can Journal of the Medical Sciences, Jan. 1884. By the Same Author. Poisons in Relation to Medical Jurisprudence and Medicine. Third American, from the third and revised English edition. In one large octavo volume of 788 pages. Cloth, $5.50 ; leather, $6.50. PEPPEM, AUGUSTUS J., M. 8., M. B., F. M. C. 8., Examiner in Forensic Medicine at the University of London. Forensic Medicine. In one pocket-size 12mo. volume. Preparing. See Students' Series of Manuals, page 3. IEA, SENMY C. . Superstition and Force : Essays on The Wager of Law, The Wager of Battle, The Ordeal and Torture. Third revised and enlarged edition. In one handsome royal 12mo. volume of 552 pages. This valuable work is in reality a history of civ- ilization as interpreted by the progress of jurispru- [ mce. . . In " Superstition and Force " we have a { hilosophic survey of the long period intervening 1 primitive barbarity and civilized enlight- . There is not a chapter in the work that uween snment Cloth, $2.50. should not be most carefully studied ; and however well versed the reader may be in the science of jurisprudence, he will find much in Mr. Lea's vol- ume of which he was previously ignorant. The book is a valuable addition to the literature of so- cial science. — Westminster Review, Jan. 1880. By the Same Author. Studies in Church History. The Kise of the Temporal Power -Ben- it of Clergy — Excommunication. tavo volume of 605 pages. Cloth, $2.50. The author is pre-eminently a scholar. He takes up every topic allied with the leading theme, and traces it out to the minutest detail with a wealth of knowledge and impartiality of treatment that compel admiration. The amount of information compressed into the book is extraordinary. In no .. ther single volume is the development of the New edition. In one very handsome royal Just ready. primitive church traced with so much clearness, and with so definite a perception of complex or conflicting sources. The fifty pages on the growth of the papacy, for instance, are admirable for con- ciseness and freedom from prejudice. — Boston Traveller, May 3, 1883. Allen's Anatomy .... American Journal of the Medical Sciences American System of Gynaecology . American System of Practical Medicine *Ashliurst's Surgery .... Ash well on Diseases of Women AttSeid's Chemistry .... Ball nn the Rectum and Anus Barker's Obstetrical and Clinical Fssays. Barlow's Practice of Medicine Barnes' Midwifery *Barnes on Diseases of Women Barnes' System of Obstetric Medicine Bartholow on Electricity Basham on Penal Diseases . Bell's Comparative Physiology and Anatomy Bellamy's Operative Surgery Bellamy's Surgical Anatomy Blandford on Insanity Bloxanrs Chemistry . ... Bowman's Practical Chemistry . . *Bristowe's Practice of Medicine . Broadbent on the Pulse Browne on the Ophthalmoscope . . Browne on the Throat Brace's Materia Medica and Therapeutics Brunton's Materia Medica and Therapeutics Bryant on the Breast .... *Bryant's Practice of Surgery *Burastead on Venereal Diseases , , *Burnett on the Ear .... Butlin on the Tongue .... Carpenter on the Use and Abuse of Alcohol *Carpenter's Human Physiology . , Carter on the Eye , Century of American Medicine Chambers on Diet and Regimen Charles' Physiological and Pathological Chem Churchill on Puerperal Fever Clarke and Lockwood's Dissectors' Manual Classen's Quantitative Analysis Cleland's Dissector . Clouston on Insanity . . , Clowes' Practical Chemistry Coats' Pathology .... Cohen on the Throat .... Coleman's Dental Surgery . Condie on Diseases of Children Cooper's Lectures on Surgery Cornil on Syphilis .... *Cornil and Ranvier's Pathological Histology Cullerier's Atlas of Venereal Diseases Curnow's Medical Anatomy Dalton on the Circulation 'Dalton's HumanPhysiology Dalton's Topographical Anatomy of the Brain Davis' Clinical Lectures Draper's Medical Physics Druitt's Modern Surgery Duncan on Diseases of "Women *Dunglison's Medical Dictionary . Edison Diseases of Women . Ellis' Demonstrations of Anatomy Emmet's Gynaecology *Erichsen's System of Surgery Esmarchs Early Aid in Injuries and Accid'ts Farquharson's Therapeutics and Mat. Med. Fenwick's Medical Diagnosis Finlayson's Clinical Diagnosis . . Flint on Auscultation and Percussion Flint on Phthisis .... Elint on Physical Exploration of the Lungs Flint on Respiratory Organs Flint on the Heart *Flint's Clinical Medicine Flint's Essays . . . *Flint's Practice of Medicine Folsom's Laws of U. S. on Custody of Insane Foster's Physiology .... ♦Fothergill's Handbook of Treatment . Fownes' Elementary Chemistry Fox on Diseases of the Skin . Frankland and Japp's Inorganic Chemistry Fuller on the Lungs and Air Passages . Galloway's Analysis .... Gibney's Orthopeedic Surgery q's surgery .... Gluge'a Pathological Histology, by Leidy Surgical Diagnosis ... *Gray's Anatomy ... ' rreene a Medical Chemistry . Green's Pathology and Morbid Anatomy Griffith's Universal Formulary .i) Foreign Uodi^s in Air- Passages on Impotence and Sterility . • .'i Orfnary < >; gang ol ry Habershonon the Abdomen •Hamilton on Fractun :W>iKW jiMiwjiwiiii^^MwiniiwwWWitWiii iBHw m Both* Hwr WliHf Mfflflffl EHHH m Us 1 QBMQKk ■yfah fifflfli flg maWB BbHESv k$ aaacr.