hinders 'Question Comnauk ■Essentials of MATERIAMEI)I€A Ml) Till Hf.XKY M« '{ SEP 8 1898 ESSENTIALS OF Materia Medica, Therapeutics, and Prescription-Writing. Since the issue of the first volume of the Saunders Question=Compends, OVER 160,000 COPIES of these unrivalled publications have been sold. This enormous sale is indisputable evidence of the value of these self-helps to students and physicians. SAUNDERS' QUESTION-COMPENDS, No. 7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS., AND PRESCRIPTION WRITING ARRANGED IN THE FORM OF QUESTIONS AND ANSWERS PREPARED ESPECIALLY FOR STUDENTS OF MEDICINE. BY HENRY MORRIS, M.D., Fellow of the College of Physicians of Philadelphia; Honorary Member of the Altoona Academy of Medicine: Associate Member of the Association of Military Surgeons of the United States; Member of the American Medical Association, of the Pennsylvania State Medical Society, of the Philadel- phia County Medical Society, of the Pathological Society of Philadelphia; Physician to St. Joseph's Hospital. FIFTH EDITION, REVISED AXD ENLARGED. PHILADELPHIA : W. B. SAUNDERS, I £25 Walnut Sttoeet. i 1898. r ^K v > ancreatin), a mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog [sus scrofa). 4. Papain, a ferment obtained from the fruit of Carica papaya [Nat. Orel Papayaceae), a tree of South America. What are the physiological actions of these substances ? 1. Pepsin (when combined with an acid) digests albumen, which it converts into albuminose. 2. Ingluvin also aids the digestion of albumen, this action being probably due to a bitter principle which it contains and which stimu- lates the gastric glands. 3. Pancreatin (in neutral or alkaline solutions) converts albumen into albuminose and starches into glucose and aids in emulsifying fats. 4. Papain digests albumen and dissolves false membranes, asca- rides and taenia. What are the therapeutic uses of the digestants ? 1. Pepsin is useful when the secretion of the peptic glands is not sufficient for the purposes of digestion, as in atonic dyspepsia, a/pep- 36 ESSENTIALS OE MATERIA MEDICA AND THERAPEUTICS. sia of infants, anaemia, chlorosis, gastric ulcer and cancel' and infantile diarrhoea. It has been used for the relief of reflex vomit- ing, as that of pregnancy. It is an invaluable addition to nutritive enemata, and has been injected into tumors to arrest their growth and aid in their absorption. 2. Ingluvin is used chiefly for the relief of vomiting of pregnancy, also in indigestion accompanied with flatulen-nj , and in acute dys- pepsia. 3. Pancreatin is used in intestinal indigestion, and to aid in emul- sifying fats. It is also added to nutritive enemata. 4. Papain is sometimes used in dyspepsia, to aid the digestion of albuminous foods, but more frequently for its solvent action on false membranes and taenia. Pepsin, pancreatin (under the name of trypsin) and papain have been successfully used to dissolve the membranes of croup and diph- theria. They are used in solution, either in the form of spray or applied by a brash to the part. What are the preparations and doses of the digestants ? Pepsinum saccharatum (saccharated pepsbi) should digest 300 times its own weight of freshly coagulated and disintegrated egg- albumen, dose gr. v-xxx (0.3-2.0). Ingluvin (not official) may be given in doses of gr. v-xv (0.3-1.0). Pancreatinum {pancreatin) in doses of gr. v-xv (0.3-1.0). Papain (not official) in doses of gr. j-v (0.065-0.49). Name some of the substances which are incompatible with the digestants. Alcohol and many of the mineral salts destroy their properties. Alkalies (when sufficiently powerful) interfere with the action of pepsin and ingluvin, while materially aiding that of pancreatin. Acids retard and finally destroy the action of pancreatin while aid- ing those of pepsin and ingluvin. How and at what time should the digestants be given ? Pepsin and ingluvin should be given with meals, either in solution with an acid or in capsules, powder or compressed pill. Often they are combined with sodium bicarbonate, to which bis- muth is sometimes added, and administered before eating. TONICS— SIMPLE BITTERS. 37 Panereatin is usually given from 2 to 4 hours after meals, com- bined with an alkali. Papain is taken after meals, in powder, capsule or compressed pill. ORDER II.— Tonics. What are tonics ? Tonics are remedies which, in conditions of debility, impart a gradual and permanent increase of vigor to the body or its various parts, restoring the energy and strength which were wanting. How may tonics be divided 1 They may be divided into vegt igetable and mineral tomes. Vegetable Tonics. What subdivisions of vegetable tonics are made ? Vegetable Tonics are divisible into simple or pure bitters, aromatic bitters and peculiar bitters. Simple Bitters. Mention the simple bitters. 1. Quassia, the wood of Picraena excelsa (Nat. Orel. Simaru- bege, a lofty tree of the West Indies. 2. Gentiana {gentian), the root of the Gentiana lutea [Wat. Ord. Gentianeaa), a plant of the mountainous portions of Central and Southern Europe. 3. Calumba, the root of Jateorrhiza palmata {Nat. Ord. Meni- spermacese), a plant of the southeastern coast of Africa. 4. Chirata, Swertia chirata {Nat. Ord. Gentianeae), a plant of India. What are their chief chemical constituents 1 1. Quassia-wood contains quassin, a neutral bitter principle ; 2. Gentian, an acid, gentisic acid (gentisin) ; a fixed oil, and a bitter principle, gentianm or gentiopicrin ; 3. Calumba, an alkaloid, berberine (which is found in many other plants, and has been used as a tonic and febrifuge) ; a bitter princi- ple, columbin, and an acid, columbic acid; and 38 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 4. Chirata, a neutral bitter principle, cliiratin; and an amor- phous acid, ophelic. What are the physiological actions of the simple bitters ? The simple bitters increase the secretions, and impart tone to the mucous membranes ; increase the appetite and digestion, and thus promote nutrition and improve the condition of the blood, but when taken continuously for too long a time they disorder digestion and cause gastric catarrh. Gentian, in full doses, by increasing the intestinal secretion, acts as a mild laxative. Calumba is least likely to disorder the stomach. What are the therapeutic uses of the simple bitters ? They are given (1) to increase secretion and promote appetite in atonic dyspepsia, in chronic gastric catarrh and during convalescence from acute diseases. Calumba is the mildest, and, being best adapted to weak stomachs, may be used in vomiting of pregnancy and in sea- sickness ; quassia, gentian and chirata are well adapted to cases of dyspepsia with relaxation or torpor of the mucous membrane and resulting constipation. (2) To give tone to the mucous membranes, in diarrhoea and in accumulations of flatus in the bowel from a relaxed condition, calumba may be used. (3) As vehicles for the administration of other medicines, as acids or alkalies. (4) To destroy ascarides, an infusion of quassia may be used as an enema. What are the preparations and doses of these substances ? 1. Extractum QuASSliE (extract of quassia), dose gr. j-v (0.065- 0.5), principally used as an excipient. Extractum Quassi^e Fluidum {fluid extract of quassia), dose TTtv-xxx (0.308-1.848). Tinctura Quassle {tincture of quassia), f 3j-ij (4.0-8.0). Quassin (not official), dose gr. }~h (0.016-0.032). 2. Extractum Gentians (extract of gentian), dose gr. j-xxx (0.065-2.0). Extractum Gentians Fluidum (fluid, extract of gentian), dose f 3ss-j (2.0-4.0). Tinctura Gentians Composita (compound tincture of gentian), dose f 3ss-ij (2.0-8.0). 3. Extractum Calumba Fluidum (fluid extract of calumba), dose f 3ss-j (2.0-4.0). TONICS— AROMATIC BITTERS. 39 Tinctura CALUMBiE (tincture ofcaJumba), close f3ss-ij (2.0-8.0). Berber ine (not official), dose gr. j-x (0.065-0.648) as a sulphate or hydrochlorate. 4. Extractum Chirat^ Fluidum (fluid extract of chirata), doseffU-xx (0.616-1.3). Tinctura Ciiirat^e (tinctura of chirata), dose fflv-f3j (0.308- 4.0). What medicines should not be prescribed with gentian? Iron sulphate and the salts of silver and of lead are incompatible with gentian. How and at what time should the simple bitters be given ? The simple bitters are given before eating, either alone or com- bined with other medicines in pills or in mixtures or solutions. Aromatic Bitters. How do the aromatic differ from the simple bitters ? The aromatic hitters are more stimulating to the mucous tract than the simple bitters, because of the aromatic volatile oils which they contain ; they also contain tannic or gallic acid, which renders them more or less astringent. Mention the aromatic bitters. 1. Serpentaria (Virginia snakeroot), the rhizome and rootlets of Aristolochia serpentaria (Nat. Ord. Aristolochiacese) and other varieties of Aristolochia, indigenous plants ; 2. Eucalyptus, the leaves of E. globulus or blue gum-tree (Nat. Ord, Myrtaceae), a tree of Australia ; 3. Prunus Virginiana, the bark of P. serotina or wild cherry (Nat. Ord, Rosaceae), an indigenous tree ; 4. Anthemis, the flower-heads of A. nobilis or chamomile (Nat. Ord. Compositae), a native of Europe ; 5. Matricaria, the flower-heads of M. Chamomilla or German chamomile {Nat Ord. Compositae) ; 6. Eupatorium, the leaves and flowering tops of E. perfoliatum, boneset or thoroughwort(A r «i. Ord. Compositae), a common indigen- ous plant ; 7. Cascarilla, the bark of Croton Eluteria (Nat. Ord. Euphor- biaceae), a small tree of the West India Islands ; and 40 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 8. Absinthium, the leaves and tops of Artemisia Absinthium or wormwood (Nat. Ord. Composite), a European plant. What are the chief chemical constituents of the aromatic bitters ? They all contain a volatile oil, a bitter principle, resin and tannic acid. The volatile oil of eucalyptus is composed of two terpenes, cymol and eucalyptol ; that of Primus Virginiana contains hydrocyanic acid, which is formed by the reaction in water of a peculiar ferment (not emulsin) existing in the bark, with the bitter principle; that of absinthium contains absinthol. The bitter principle of serpentaria is called aristolochin ; that of anthemis, anthemic acid; that of eupatorium, eupaturin; that of cascarilla, cascarillin ; and that of absinthium, absinthin. What are the physiological actions of the aromatic bitters ? Owing to the bitter principles which they contain, their action on digestion, nutrition and secretion is similar to that produced by the simple bitters. They have, in addition, a stimulating influence on the mucous membranes, due to the volatile oils (which are eliminated by the bronchial mucous membrane, skin and kidneys, and increas- ing their secretions are, somewhat, expectorants, diaphoretics and diuretics), and an astringent effect, owing to their tannic acid. In large doses they are emetic and laxative. The oil of eucalyptus destroys germs, and is an irritant when applied locally. It quickens the pulse and respiration and lowers the blood pressure. In large doses it causes diarrhoea, Prunus Virginiana has a sedative influ- ence over the pneumogastric nerve, from the hydrocyanic acid which is developed in it, and thus quiets cough. Absinthium in large doses, or when habitually used in the form of the liqueur (absinthe), produces epileptiform convulsions. What are the therapeutic uses of the aromatic bitters ? They are used for the same purposes as the simple bitters. Serpentaria is used as a cardiac stimulant and tonic in low fevers, and occasionally as a stimulating expectorant in capillary bronchitis and low pneumonias. Eucalyptus is used in chronic catarrhal con- ditions of 'the gastric, broncho-pulmonary, and genito-urinary, mucous TONICS — AROMATIC BITTERS. 4l membranes, and from its destructive influence on germs it is of bene- fit in vomiting due to sarcina ventriculi. As an antimalarial agent it is far inferior to cinchona, but sometimes proves useful where the latter has failed. As a local application, it is employed in stomatitis. Prunus Virginiana is also used as a stomachic tonic, but is especially employed as a cough-relieving agent in bronchial catarrh and in phthisis. What are the preparations and doses of these substances? 1. Extractum Serpentaris Fluidum (fluid extract of serpen- taria), dose f&ss-j (2.0-4.0). Tinctura Serpentaris (tincture of serpentaria), dose f3j-ij (3.0-7.0). 2. Extractum Eucalypti Fluidum {fluid extract of eucalyptus), dose f3ss-j (2.0-4.0). Oleum Eucalypti (oil of eucalyptus), dose ^Iv-xv (0.3-1.0) (in capsules or in emulsion). Eucalyptol, a neutral body obtained from the volatile oil of Eucalyptus globulus and of some other species of Eucalyptus, dose TTtv-xv (0.3-1.0). 3. Extractum Pruni Virginians Fluidum [fluid extract of prunus virginiana), dose f3j-ij (3.0-7.0). Infusum Pruni Virginians (infusion of prunus virginiana), dose f^ss-ij (15.0-60.0). Syrupus Pruni Virginians (syrup of prunus Virginia) to), dose f3j-f|ss (3.5-15.0). 4 and 5. There are no official preparations of anthemis and matri- caria, the latter of which is not much used in this country. They are usually given in infusion (chamomile tea) in doses of f^ij (60.0) t. i. d., as a stomachic tonic. 6. Extractum Eupatorii Fluidum (fluid extract of eupato- rium), dose f3ss-j (2.0-4.0). 7 and 8. Cascarilla and absinthium may be given in infusion. There are no official preparations. At what time should the aromatic bitters be administered ? They should be given shortly before meals when intended to pro- mote appetite and digestion, but when given for their effects on the bronchial or vesical mucous membranes, or for their action on the heart, they should be given between meals. 42 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Peculiar Bitters. What are the peculiar bitters ? They are such bitters as, owing to peculiarity of action, cannot be classed with either of the preceding groups. jName the peculiar bitters. Cinchona and hydrastis. CINCHONA. What is cinchona ? Cinchona is the barks of all species of Cinchona {Nat. Ord. Kubi- acese) which contain not less than 5 per cent, of total alkaloids, and at least 2. 5 per cent, of quinine. What is the habitat and what are the principal varieties of cinchona ? The cinchona trees are natives of the mountainous regions of the western parts of S. America, from 22° south latitude to 10° north latitude, but have been successfully cultivated in India, Ceylon, Java, the West Indies and other parts of the world. The two principal varieties are cinchona calisaya from which is derived the cinchona jiava (yellow or calisaya bark) and the cinchona succi- rubra, whence comes the cinchona rubra (red bark). Other vari- eties are C. rnicrayiilia and G- condaminea, from which is obtained cinchona pallida or pale bark, no longer official. How is the bark obtained ? The bark was formerly obtained by stripping the trees, but as this killed them and threatened to extinguish the genus, the present method has been adopted. One-fifth the circumference of the tree is denuded of bark in longitudinal strips each year, in the dry season, for five years, at the enl of which time the bark has again grown ever the portion first denuded. The process is then repeated. What are the chemical constituents of cinchona ? The most important constituents are the alkaloids quinine and cinchonine, of which the former is found to preponderate in the yellow bark, the latter in pale barks, and both exist in about equal propor tions in red bark. Other important alkaloids are quinidine .and cm- chonidme. Combined with these alkaloids are Jrinic, Mnovic, cincho- tannic and hinovo-tannic acids. Other less important alkaloids are TONICS— CINCHONA. 43 also found, as aricine, paricine, quinamine and paytine. Quinieine and cinchonicine are amorphous modifications of quinine and cin- chonine. Describe a chemical test for the cinchona alkaloids. If quinine and quinidine, or their salts, are treated with fresh chlorine-water, an emerald-green precipitate will form when ammo- nia-water is added. When the same test is applied to cinchonine, cinchonidine, or their salts, a white precipitate results. What are the physiological effects of cinchona and its alka- loids? Locally cinchona and its alkaloids are irritant and antiseptic, de- stroying minute organisms or inhibiting their movements. Internally it acts on the alimentary canal as a simple bitter, in small doses increasing the appetite and digestion ; if long continued, producing indigestion and gastric catarrh. In ordinary doses cin- chona constipates. In large doses cinchona or its alkaloids irritate the mucous membrane and cause vomiting and diarrhoea. Nutrition is stimulated and the excretion of waste products in- creased by small doses ; large doses, however, diminish the amount of urea and uric and phosphoric acids in the urine. In malarial fever the products of waste tissue are much increased. In the blood it interferes with the oxygen-carrying function of the red corpuscles, and diminishes the number, inhibits the movements, and prevents the migration of the white corpuscles, both in health and disease. Circulation : in small doses the cardiac action is increased ; large doses, by acting on the cardiac motor ganglia, depress the heart, sometimes causing it to intermit, and finally arrest it in diastole ; the blood pressure is lowered. The temperature in health is very slightly, if at all, influenced ; in fevers a rapid decline takes place, due to the action on the blood and circulation. Nervous system ; small doses stimulate the cerebral functions ; large doses cause cinchonism (i. e. , a constricted feeling in the forehead ; giddiness and tinnitus aurium, with impairment of hearing and some- times of vision) ; after toxic doses these symptoms are aggravated and delirium, weak pulse, coma (sometimes convulsions), and in rare 44 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. cases death, supervene. It probably reduces the reflex excitability of the spinal cord, and although it never causes, may energize uter- ine contractions when present. Elimination takes place chiefly by the urine, the greater portion escaping from the system within eight hours. Cutaneous eruptions, as erythema, urticaria or herpes are pro- duced in some subjects by even small doses of cinchona or its alka- loids. What are the therapeutic uses of cinchona and its alkaloids ? 1. As a tonic. The cinchona preparations, as well as the salts of its alkaloids, are largely used to improve the appetite and digestion in debility, the latter stages of inflammations and in convalescence from acute diseases generally, also in atonic dyspepsia (combined with a mineral acid), in relaxed conditions of the alimentary mucous membrane and in summer complaint of children. The alkaloids are also used as tonics to sustain the vital forces in diphtheria, erysipelas, pyaemia, septicaemia in all typhoid conditions, in the eruptive fevers, and in surgical shock. In the various neuralgias combined with other remedies (as morphine or belladonna, iron or arsenic), it is % valuable agent. From its influence on the migration of leuco- cytes and on cell proliferation it is used (in larger doses) in the early stages of inflammation. 2. As an antipyretic in all conditions of hyperpyrexia quinine may )e used in large doses, repeated in about six or eight hours to main- tain its effects, but the newer and more powerful antipyretics have argely superseded this practice. 3. As an antiperiodic, cinchona has no rival in the materia medica. The salts of the alkaloids are preferred for this purpose. Quinine may be used as a prophylactic against malaria in small doses, given early in the morning (gr. iij-x, 0.2-0.65). In the treatment of intermittent (gr. x (0.65) during the sweating stage, repeated five hours before the next paroxysm is expected), remittent (gr. xxx (2.0) per day in two doses, given at any time), hemorrhagic and pernicious malarial fevers (gr. xx-3j (1.3-4.0) administered promptly by the mouth or rectum or even subcutaneously), it acts as a specific. It is useful also in malarial cachexia, but must often be combined or alternated with arsenic and other treatment. TONICS — CINCHONA. 45 4. Locally, quinine may be applied in solution as an astringent and antiseptic to the nares in summer catarrh, etc. , or to the mouth in muguet. What are the preparations and doses of cinchona and its alkaloids ? Extractum ClNCHONiE (extract of (yellow bark of) cinchona), dose as a tonic gr. x-xxx (0.65-2.0). Extractum Cinchona Fluidtjm {fluid extract of (yellow bark of) cinchona), dose as a tonic f3j (4-0). Tinctura CiNCHONiE (tincture of (yellow bark of) cinchona), dose f3j-iv (4.0-15.0). Tinctura Cinchona Composita (compound tincture (Huxh&m's) of cinchona), containing red bark, serpentaria, bitter orange peel, glycerin, alcohol, and water, dose f3j-iv (4.0-15.0). Infusum Cinchona (infusion of cinchona), containing aromatic sulphuric acid, dose fjjss-ij (15.0-60.0). Quinin^e Sulphas (quinine sulphate), the basic sulphate, not very soluble in water, but rendered more soluble by the addition of diluted sulphuric acid, dose as a tonic, gr. j-vj (0.065-0.4) ; as an antipyretic, gr. x-xx (0.65-1.3), repeated as indicated; as an anti- periodic, gr. xvj-xx (1.0-1.3) or more. Quinine Bisulphas (quinine bisulphate), the normal sulphate, more soluble, but containing less quinine than the basic sulphate, and given in slightly larger doses. Quinine Hydrobromas (quinine hydrobr ornate), better adapted for hypodermic injection than the sulphates ; dose, by the mouth, the same as of quinine sulphate, a little less when used hypo- dermically. Quinine Hydrochloras (quinine hydrochlorate), also adapted for subcutaneous use ; dose, as of the preceding preparations. Quinine Valerianas {quinine valerianate), dose gr.j-vj (0.065- 0.389). QuiNiDiNiE Sulphas (quinidine sulphate), dose slightly larger than those of quinine. Cinchonin^ Sulphas (cinchonine sulphate), dose £ larger than those of quinine. Cinchonidin^e Sulphas (cinclwnidine sulphate), dose gr. j-xv (0.065-1.0) according to the effects desired. 46 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What medicines are incompatible with cinchona ? The alkalies and alkaline earths precipitate the alkaloids of cin- chona ; tannic, gallic and tartaric acid, the tincture and the com- pound solution of iodine form insoluble compounds with them ; and the ferric salts precipitate cincho-tannic acid from the preparations of cinchona. How are cinchona and its alkaloids administered ? The preparations of cinchona are frequently combined with the mineral acids or administered alone as tonics ; the alkaloids are given in solution, freshly made pills or capsules, or may be made into suppositories, or used subcutaneously. They are often com- bined with iron, arsenic and other medicines. Saccharin is said to disguise their unpleasant taste. HYDRASTIS. What is hydrastis? Hydrastis is the rhizome and roots of H. canadensis, yellow root or golden seal (Nat. Ord. Ranunculacese), an indigenous plant. What alkaloids does it contain ? It contains hydrastine (not hydrastin, which is an eclectic prepara- tion) and berberiue. What are its physiological actions ? It acts on the appetite, digestion, nutrition and secretions like the simple bitters ; it increases the secretions, especially of the glandu- lar appendages of the intestine and probably that of the liver ; when given to animals in sufficient doses, it is said to act on the ner- vous system like stiychnine, but less powerfully, stimulating the reflex centres of the spinal cord, heightening the irritability of the motor nerves and causing incoordination, tremor, convulsions, and, finally, death from tetanic spasm of the respiratory muscles. It is also claimed that it always provokes uterine contractions. What are the therapeutical applications of hydrastis ? It is used as a tonic, to promote appetite, digestion, and nutrition in atonic dyspepsia and chronic gastric catarrh. From its effects on secretions, it is ueed in catarrhal jaundice, and in constipation from deficient secretion, and as a diuretic and blennorrhetic in chronic interstitial nephritis and chronic cystitis. It has also been recom- MINERAL TONICS. 47 mended internally to check uterine hemorrhage. As an anti- periodic in intermittent fever and chronic malaria it is inferior to quinine. Locally, it has been used as an application to sore mouth, fissured nipples, sores and ulcers generally, and as an injection in gleet and vaginal leucorrhoea. What are the preparations and doses of hydrastis ? Extractum Hydrastis Fluidum {fluid extract of hydrastis), dose ir\,v-f3j (0.3-4.0) ; as a stomachic tonic, n\,v-xv (0.3-1.0) before meals. Tinctura Hydrastis (tincture of hydrastis), dose Nlx-fSj (0.6-4.0). Glyceritum Hydrastis {glycerite of hydrastis) is chiefly used as a local application. HYDRASTININ^E HYDROCHLORAS (hydrastinine hydrochlorate) has been used to check uterine hemorrhage, and also as a heart tonic (vid. oxytocics); dose gr. £-1 (0.016-0.06). Mineral Tonics. Name the mineral tonics. The Mineral Tonics are the preparations of iron and of man- ganese (which are sometimes classed separately as hcematinics or blood medicines), phosphorus, zinc phosphide, the mineral acids, and lactic acid, although of animal origin, is usually considered in connection with the latter. FERRUM — IRON. What is the source of iron ? Iron is the most common of all the metals, and is found widely distributed both in the metallic state and as oxide, sulphide, carbon- ate, phosphate, etc. What are the physiological effects of iron ? Metallic iron is inert, but when swallowed it is dissolved by the acid of the stomach, and forms salts. It probably enters the blood as an albuminate. Any iron which is not absorbed passing into the intestines, is converted into a sulphide, and colors the stools black. Iron exists normally in the red corpuscles of the blood in the pro- 48 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. portion of 1 part of iron to 230 parts of corpuscles. When deficient in the blood, under a coarse of iron the number of corpuscles in- crease, the blood is improved in quality, and consequently the tissues are better nourished and all the functions of the body are better performed. In appropriate cases it promotes the appetite and digestion by stimulating the gastric glands, but if given for too long a time it disorders digestion. The more soluble preparations of iron, if given in large doses, cause nausea and vomiting ; its salts, with the mineral acids and with iodine, possess more or less toxic properties. The sulphates, nitrates and chlorides of iron are astringent, dimin- ishing the secretions of the mucous membranes, thus causing con- stipation, and coagulating albumen, thus proving haemostatic. Iron is eliminated by the faeces, bile and urine. What are the therapeutic uses of iron ? 1. As a general tonic to improve the appetite and digestion, when it should be combined with a purgative, as aloes. 2. To improve the condition of the blood and aid nutrition, in anosmia and chlorosis ; in malarial anosmia (with quinine) ; in various cachexias, as the scrofulous, strumous or syphilitic (iodides); in amenorrhoza, dysmenorrhoea or menorrhagia associated with anaemia; in fatty degeneration and in dilatation of the heart; in many forms of neuralgia, and in many nervous affections associated with anaemia, as epilepsy or chorea; in convalescence from acute diseases, and after exhausting hemorrhages. In erysipelas iron is almost a specific (tincture of the chloride rr^xx-xxx (1.2-2.0) every 2 or 3 hours), and in diphtheria it is also useful. 3. As an astringent it is sometimes used internally in chronic diarrhoea and in dysentery. In chronic albuminuria it is useful both as a tonic and astringent. 4. As a hemostatic, in all passive hemorrhages in the anaemic (tincture of the chloride), and in hemorrhages from the lungs, stomach, bowels or kidneys (subsulphate, tersulphate or nitrate in drop doses largely diluted and frequently repeated). 5. Locally it is employed as a styptic (subsulphate), to check the bleeding from hemorrhoids and leech bites, or to arrest capillary oozing from a large surface ; in the form of spray in epistaxis, and TONICS— IRON. 49 hcemoptysis, and it is sometimes injected into the cavity of the uterus (more or less dangerous) to check bleeding from that organ. As an astringent, it is applied to syphilitic vegetations (Monsel's solution) and as an injection (largely diluted) in gonorrhoea and leucorrhoea. What are the preparations of iron and their doses ? Ferrum Reductum {reduced iron — Quevennes iron), an impal- pable powder of metallic iron, well borne by the stomach, and not astringent; dose gr. j-v (0.065-0.324). Ferri Oxidum Hydratum (hyd rated ferric oxide) and Ferri Oxidum Hydratum cum Magnesia {hydrated ferric oxide with magnesia), used almost exclusively as antidotes in arsenical poison- ing; dose f^ss (16.0), every 5 or 10 minutes. Trochisci Ferri (troches of iron), each lozenge contains of ferric hydrate nearly gr. v (0.30). Emplastrum Ferri (plaster of iron) contains ferric hj^drate, lead plaster, Burgundy pitch, and olive oil. FERRI CARBONAS SACCHARATUS {saccharatnl ferrous carbonate), dose gr. ij-x (0.130-0.650). Massa Ferri Carbonatis (mass of ferrous carbonate— Vallet's mass), dose gr. iij-v (0.20-0.30). Pilules Ferri Carbonatis (pills of iron carbonate— Elaud 's pills). Each pill is intended to contain about gr. j (0.0648) of ferrous carbonate, an excellent preparation in anaemia and chlorosis ; dose 2-5 pills. Mistura Ferri Composite [confound iron mixture— Griffith' s anti-hectic mixture), dose, in anaemia or chlorosis, fgss-ij (15.0-60.0). Ferri Sulphas (ferrous sulphate — green vitriol or copperas). One of the most active and astringent preparations of iron. It is irritant to the stomach, and in overdoses a poison. It is used locally as a styptic and astringent, and in solution to disinfect privies and drains; dose (in pill) gr. ss-ij (0.03-0.13). Ferri Sulphas Exsiccatus [dried ferrous sulphate), ferrous sulphate deprived of its water of crystallization ; dose gr. \-2 (0.016-0.13). Ferri Sulphas Granulatus (granulated ferrous sulphate), dose gr. j-v (0.065-0.30). 4 50 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Liquor Ferri Tersulphatis {solution of ferric sulphate), a solution of normal ferric sulphate ; rarely used except in making hydrated ferric oxide. Liquor Ferri Subsulphatis {solution of ferric subsulphate — MonseVs solution), a solution of basic ferric sulphate. It maybe given internally, largely diluted, as a hasmostatic ; dose n\j-x (0.06- 0.6). It is chiefly used locally as a styptic. Ferri Chloridum (ferric chloride), rarely used internally ; dose gr.j-ij (0.065-0.13). Liquor Ferri Chloridi {solution of ferric chloride), dose Tr^ij-v (0.123-0.30), largely diluted ; externally it is used as a styptic. TiNCTURA Ferri Chloridi {tincture of ferric chloride), one of the best preparations of iron for internal use. It possesses diuretic properties; dose fflv-xxx (0.30-1.85). Liquor Ferri et Ammonii Acetatis {solution of iron and ammonium acetate — Bashams mixture), an excellent preparation, combining tonic and diuretic properties, very valuable in chronic desquamative nephritis and chronic dropsies generally ; dose f^ss-j (15.0-30.0). Ferri Iodidum Saccharatum [saccharated ferrous iodide), dose gr. iij-x (0.20-0.65). Syrupus Ferri Iodidi (syrup of ferrous iodide), dose ttlv-xxx (0.30-1.85). Pilul^e Ferri Iodidi (pills of ferrous iodide), dose 1 to 3 pills. Ferri Phosphas Solubilis {soluble ferric phosphate), dose gr. ij-v (0.13-0.32). Ferri Pyrophosphas Solubilis (soluble ferric pyrophosphate), dosegr. ij-v (0.13-0.32). Ferri Hypophosphis (ferric hypophosjmite), dose gr. v-x (0.32-0.65). Liquor Ferri Nitratis {solution of ferric nitrate), used inter- nally as an astringent and haemostatic; dose Tr\jj-v (0.123-0.30), freely diluted. Ferri Citras {ferric citrate), dose gr. ij-x (0.13-0.65). Liquor Ferri Citratis {solution of ferric citrate), dose ^lij-x (0.183-0.61). Liquor Ferri Acetatis {solution of ferric acetate), rarely used internally; dose tt^x-xxx (0.61-1.85). TONICS— IRON. 51 Ferri Lactas {ferrous lactate), a mild chalybeate, agreeing well with the stomach, and useful in anaemia and chlorosis, with weak digestion; dose gr. ij-x (0.13-0.65). Ferri Valerianas {ferric valerianate), dose gr. j-iij (0.065- 0.20). Ferri et Potassii Tartras {iron and potassium tartrate— -potas- sio-tartrate of iron) may be prescribed with alkalies ; dose gr. ij-x (0.13-0.65). Ferri et Ammonii Tartras (iron and ammonium tartrate), a mild preparation; dose gr. ij-x (0.13-0.65). Ferri et Ammonii Sulphas {ferric ammonium sulphate- am mouio-ferric alum) is given internally as an astringent in chronic diarrhoea and dysentery ; dose gr. j-v (0. 065-0. 32). Ferri et Ammonii Citras {iron and ammonium citrate), dose gr. ij-v (0.13-0.32). Vinum Ferri Citratis {wine of iron citrate), dose f3j (4.0). Ferri et Quinine Citras (iron and quinine citrate), Ferri et Quinine Citras Solubilis {soluble iron and quinine citrate), each contains 85 per cent, of feme citrate, and 12 per cent, of the alkaloid, and may be given in doses of gr. j-v or x (0.065- 0.32 or 0.65). Yinum Ferri Amarum (bitter wine of iron), dose f3j-ij (4.0-8.0). Ferri et Strychnine Citras {iron and strychnine citrate) con- tains 98 per cent, of iron and ammonium citrate and 1 per cent, of the alkaloid; dose gr. ij-v (0.13-0.32). Syrupus Ferri Quinine et Strychnine Phosphatum (syrup of iron, quinine, and strychnine phosphates), dose f3j (4.0). What medicines are incompatible with the iron prepara- tions ? I. Tlie alkaline preparations of iron are incompatible with the acids and acidulous salts. II. The salts formed by mineral acids with iron, with the alkalies and alkaline earths and their carbonates. III. The iodides, bromides and salts containing vegetable acids, with the alkalies and alkaline earths and their carbonates, and with acids and (other) acidulous salts. IV. ATI theiron preparations, with substances containing tannic or 52 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. gallic acids, hence they cannot be prescribed with any of the vege- table tonics except the simple bitters. When and how should iron be administered? The fluid preparations should all be given freely diluted. The solid preparations may be given combined with other remedies in pilular form or in solution. Iron causes less gastric irritation and enters the blood more readily if given with or immediately after meals. If gastric irritability is present in anaemia, a course of bit- ters with the acids had better precede the administration of iron, which, as these symptoms subside, may be given in the form of the lactate, followed by the bitter wine, and finally by the dried sul- phate with arsenic in pill, or by the tincture of the chloride. In anaemia iron should be given in rapidly increasing doses until head- ache, flushing of the face, and some nausea supervene, when the dose should be diminished or the medicine withheld for a few days. It is important to overcome the resulting constipation by occasional laxatives. MANGANUM — MANGANESE. What are the sources of manganese ? Manganese is obtained from the native (impure) dioxide, and also from the carbonate. What are its physiological actions ? Manganese exists normally in the blood, hair, bile, etc. , associated with iron; the proportion to iron in the red corpuscles being as 1 to 20. Given internally in small doses, it improves the appetite, digestion and nutrition ; in larger doses, it depresses the heart's action and lowers the blood pressure; if large doses are given for some time, the effects resemble those of zinc (wasting and feeble- ness, staggering gait, and finally paraplegia). In toxic doses it is a gastro-intestinal irritant. The sulphate is an emeto-cathartic and cholagogue. Potassium permanganate is a powerful oxidizing agent, and hence an antiseptic. It increases the menstrual flow. For what medicinal purposes is manganese used ? It has been used (1) to improve the condition of the blood in anos- mia and chlorosis and in various cachexia, either combined with iron TONICS — PHOSPHORUS. 53 or as a substitute for it ; (2) to improve the appetite and digestion in gastrodynia and pyrosis; (3) as a cholagogue in jaundice when of malarial origin (sulphate) ; (4) as an antidote to snake bites and other animal poisons, and in poisoning by morphine (potassium perman- ganate internally and locally) ; (5) in amenorrhea (potassium per- manganate) ; and (6) locally as a disinfectant and to correct fetor in scarlatina and diphtheria (permanganate as a gargle), or applied to cancerous or other ulcers, abscesses, otorrhcea, etc. What are the preparations and doses of manganese ? Mangani Dioxidum (manganese dioxide), dose gr. j-x (0.065- 0.65), in pill, powder, or capsule. Mangani Sulphas {manganese sulphate), dose gr. j-v (0.065- 0.32). Potassii Permanganas (potassium permanganate), dose gr. ss-ij (0.032-0.13) in distilled water, in capsule, or made into pill with kaolin. What medicines are incompatible with manganese ? The salts of lead, silver, and mercury, and the caustic alkalies are chemically incompatible with the manganese preparations. phosphorus. What is the source from which phosphorus is obtained ? Phosphorus is obtained from the calcium phosphate of bones. What are the physiological effects of phosphorus ? Phosphorus exists normally in nervous tissue and in the bones. Locally applied, phosphorus causes inflammation, ulceration, and even gangrene of the skin. The vapor, when inhaled, irritates the mucous membrane, and if caries of the teeth exist, may cause caries or necrosis of the maxillae. In medicinal doses, phosphorus increases the appetite and diges- tion (if too long continued, it disorders digestion), and causes eructations of hydrogen phosphide ; increases nutrition, the cardiac action and cutaneous circulation, mental activity, sexual activity, the formation of the compact tissue of bone, and the excretion of phos- phates by the urine. It is eliminated by the liver, kidneys, mucous membrane and skin. 54 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What are the toxic effects of phosphorus ? From 1 to 3 hours after a poisonous dose has been swallowed, violent epigastric pains occur, followed by nausea and vomiting (the vomited matter smeUing of phosphorus and being luminous in the dark) ; vomiting of blood occurs at a later period ; violent purging takes place if the phosphorus passes into the bowel. Jaundice may supervene after several days if the patient lives. The pulse is at first strong, soon becoming feeble and rapid. There is great thirst, restlessness, anxiety, noisy delirium or coma and death, preceded by convulsions. The urine is diminished, contains albumen, blood, and (after jaundice occurs), biliary pigment. After death, acute fatty degeneration of various viscera, as the liver, kidneys, heart and the walls of the arterioles and capillaries is found : the red corpuscles are altered in form and the blood contains much fat. What is the treatment of acute poisoning by phosphorus ? 1. Give cupric sulphate gr. v (0.32) at once as an emetic and as an antidote (forming a less soluble phosphide). 2. Give hydrated magnesia as a purgative. 3. Continue the use of cupric sulphate in small doses (gr. T ^ (0.005) every fifteen or twenty minutes) as an antidote or emetic, or, better, giv r e turpentine (French acid turpentine or old common, crude turpentine, which forms with phosphorus an almost insoluble spermaceti-like mass) as soon as possible, to neutralize the poison. 4. Give opium to counteract the general depression. 5. If the blood is much damaged, transfusion should be resorted to. 6. Never, under any circumstances, give any oils (except turpen- tine) or fats, as they increase the solubility of phosphorus. What are the medicinal uses of phosphorus ? Phosphorus is used as a tonic to promote nutrition : (1) In various nervous affections associated with anaemia, as, cerebral exhaustion, locomotor ataxia, paralysis agitans, and the various neuralgice; (2) in general diseases, as, osteomalacia, rickets and pernicious anaemia ; (3) in functional impotence, and (4) as a substitute for arsenic in certain skin diseases, as lupus and psoriasis. MINERAL ACIDS. 55 What are the preparations of phosphorus and their doses ? Pilule Phosphori [pills of phosphorus) ; each pill contains gr. y^o (0.006) of phosphorus; dose j-v pills, t. i. d. Spiritus Phosphori [spirit of phosphorus — tincture of phos- phorus) contains 1.2 gm. of phosphorus to 1000 c.c. of the prep- aration, and is used in making Elixir Phosphori [elixir of phosphorus)] each c.c. contains 0.00025 gm. of phosphorus; dose nu-f3j (0.61-4.0). Oleum Phosphoratum [phosphorated oil) contains phosphorus (1 percent.) dissolved in ether and almond oil ; dose wlj-v (0.06-0.31). Zinci Phosphidum [zinc phosphide) is identical in its actions and uses with phosphorus, but not so active ; dose gr. ^-tj, or even \ (0.003-0.03) given in pill or granule. What medicines are incompatible with phosphorus ? Hydratecl magnesia, lime-water, cupric sulphate, powdered char- coal and oil of turpentine are chemically incompatible with it. What substances aid its absorption? The oils and fats. What caution should be observed in prescribing it? Great care should be taken, especially when large closes are pre- scribed, that the remedy be not administered for a long period con- tinuously, for fear of causing fatty degenerations of the viscerse. Mineral Acids. What are the general effects of the acids and alkalies upon secretions ? Law I. Acids increase alkaline secretions. Law II. Acich decrease acid secretions. Law III. Alkalies increase acid secretions. Law IV. Alkalies decrease alkaline secretions. How may these laws be applied to the treatment of digestive disturbances ? 1. To decrease excessive acidity of the gastric juice — [a) Give an acid before meals to diminish its secretion, or (/>) An alkali after meals to neutralize the acid present. 2. To increase the acidity of the gastric juice when it is deficient in that quality — 56 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. (a) Give an alkali before meals to increase the secretion of acid, or (b) An' acid after meals to supply the deficiency. Name the mineral acids. The mineral acids are sulphuric, nitric, hydrochloric, nitro-hydro- chloric and phosphoric. What are their physiological effects ? Locally the strong acids are escharotics, abstracting water from the tissues and combining with the bases. Sulphuric and phosphoric acids penetrate the tissues more deeply than the others. Sulphuric produces a black, while nitric acid causes a yellow eschar. Internally, in a diluted state and in medicinal doses, they increase the appetite, digestion and nutrition (hydrochloric and phosphoric being more pronounced in their effects). If taken for some time continuously, they diminish the acid of the gastric juice and disorder digestion (sulphuric acid more quickly than the others). Sulphuric acid possesses an astringent influence over the secretions of the skin and bowels; nitric acid, on the contrary, appears to increase the alimentary secretions and that of the liver. They are eliminated by the secretions of the kidneys, bowels and skin. In large doses they act as irritant corrosive poisons. How should poisoning by the mineral acids be treated ? 1. Give alkalies or alkaliiie earths (tooth powder or soap may be used) to neutralize the acid. 2. Give eggs, milk, or other demulcents to protect the surface. 3. Give opium and nutritive and stimulating enemata, or intra- venous injection of ammonia, to counteract the resulting depression. 4. As stricture of the oesophagus often follows in these cases if they survive, the passage of an oesophageal bougie should be practiced within 3 or 4 months after the poisoning. What are the therapeutic uses of the mineral acids ? 1. For their effects on digestion and nutrition. To prevent excessive formation of acid (both where too much is secreted and where it is formed by fermentation of the food), diluted hydrochloric or phos- phoric acid is given before meals ; or in atonic dyspepsia and indi- gestion due to deficient acid, they may be taken after meals (often TONICS— SULPHURIC ACID. 57 combined with pepsin). In fevers, they are used to aid digestion and secretions generally and allay thirst (by stimulating the secre- tions of the mouth and fauces, thus keeping these parts moist). 2. For their effects on secretion. Diluted nitric or nitro-hydro chloric acid is used internally to increase the secretions, and as a bath (f^iij to water Cj), in chronic hepatic congestions and inflam- mations, in malarial and catarrhal jaundice and in duodenal catarrh. As an astringent in diarrhoeas, dysentery and cholera diluted sul- phuric acid is given combined with opium ; and to arrest profuse sweat- ing diluted or aromatic sulphuric acid may be temporarily employed. 3. As a hemostatic the same agent is often used in uterine or in- testinal hemorrhage and occasionally in purpura. 4. In the treatment of, or as a preventive to, lead poisoning diluted sulphuric acid is administered (forming an insoluble lead sulphate). 5. Locally, as an escharotic, fuming nitric acid may be applied to chancroids, phagedenic ulcers, hospital gangrene or gangrene in wounds. It is also used to remove warts, and as an intra-uterine application in various forms of endometritis. As a stimulating lotion to unhealthy granulations, and to check bleeding from hemor- rhoids, weak solutions of nitric acid are used. What are the preparations of the mineral acids, and what are their doses ? 1. AciDUM Sulphuricum {sulphuric acid — oil of vitriol) contains not less than 92.5 per cent, of absolute sulphuric acid, and is too strong for internal use. Acidum Sulphuricum Dilutum {diluted sulphuric acid) contains 10 per cent., by weight, of the official sulphuric acid, and is used internally as a tonic, refrigerant., astringent, and haemostatic; dose TTiij-xx (0.123-1.23) freely diluted. Acidum Sulphuricum Aromaticum {aromatic sulphuric acid — elixir of vitriol) contains 10 per cent, of the official acid, with alcohol, tincture of ginger, and oil of cinnamon. It is used as a pleasant substitute for the preceding preparation and is given in the same doses. 2. Acidum Nitricum {nitric acid) contains 68 per cent, of the absolute acid, and is not employed internally. Acidum Nitricum Dilutum {diluted nitric acid) contains 10 per cent., by weight, of absolute nitric acid; dose flUj-xx (0.123-1.23) freely diluted. 58 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. 3. AciDUM Hydrochloricum [hydrochloric acid—muriatic acid) contains nearly 32 per cent. , by weight, of absolute acid, and is not used internally. Acidum Hydrochloricum Dilutum [diluted hydrochloric add — diluted muriatic acid) contains 10 per cent, of the absolute acid. It is (probably) a normal constituent of the gastric juice, and is used as an aid to digestion ; dose n^v-xx (0.31-1.23) freely diluted. 4. Acidum Nitrohydrochloricum [nitrohydrochloric acid— nitromuriatic acid — aqua regia) is used as a stomachic tonic and to increase the secretions of the liver and intestines; dose Nlij-x (0.123-1.23) freely diluted. Acidum Nitrohydrochloricum Dilutum [diluted nitrohydro- chloric acid — diluted nitromuriatic acid) ; dose wiij-xx (0.123-1.23) freely diluted. 5. Acidum Phosphoricum [phosphoric acid) contains 85 per cent., by weight, of absolute ortho-phosphoric acid, and is not used internally. Acidum Phosphoricum Dilutum [diluted phosphoric acid) con- tains 10 per cent., by weight, of absolute ortho-phosphoric acid, and is chiefly used as an aid to digestion; dose wiv-xxx (0.31-1.85) freely diluted. What medicines are incompatible with the mineral acids ? 1. Alkalies and their carbonates and the salts of lime and lead are incompatible with the mineral acids, which also decompose salts of the vegetable acids, uniting with their bases. 2. The mercurial salts should not be given during the administra- tion of hydrochloric or nitro-hydrochloric acids or their prepara- tions, as they may react with the mercury and form corrosive subli- mate. How and when are these acids administered ? They are administered before or after meals, according to the in- dications present, and may be given freely diluted with water either alone or with glycerin and syrup, or with some of the bitters. They should be taken through a glass tube to prevent injury to the teeth, or the mouth may be washed out immediately after their use with some weak alkaline solution. ALTERATIVES. 59 ACIDTJM LACTICUM — LACTIC ACID. What is lactic acid ? Lactic acid is a syrupy liquid, formed by the souring of milk. What are its effects and uses ? It is a normal ingredient of the gastric juice. In medicinal doses it increases the appetite, aids digestion and stimulates nutrition. In large doses (f3j) or long continued it disorders digestion, causing flatulency and epigastric pain. Injected into the peritoneal cavity (dog's) it produces endocarditis, and when given for a very long- time (in diabetes) it has caused acute rheumatism. Lactic acid is used to diminish the acidity of the gastric juice, or to replace the deficiency of the acid; to aid digestion and nutrition in oxalic, phos- phatic or uric acid diathesis; in diabetes, and locally as a solvent for the false membranes of croup and diphtheria. It has been claimed that it is a hypnotic in insomnia due to nervous excitement, but this is still sub judice. What are its preparations and doses ? Acidum Lacticum (lactic acid) contains 75 per cent, of absolute lactic acid. Dose tt\,v-xxx (0.30-1.85) freely diluted and often pre- scribed in a mixture with pepsin. ORDER III.— Alteratives. What are alteratives ? Alteratives are medicines which, without exerting any very perceptible action on any particular organ, so modify the nutritive processes as to enable nature to restore healthy action in many diseased conditions. Mention the principal alteratives. The preparations of mercury and of gold ; iodine and the iodides .• the arsenical preparations ; cod-liver oil ; the phosphates and hypo- phosphites ; the chlorides of ammonium and calcium ; colchicum ; sarsaparilla ; guaiac ; and perhaps mezereon ; menispermum ; calen- dula ; sassafras, stillingia, dulcamara, and lappa. 60 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. HYDRARGYRUM — MERCURY. What is mercury? Mercury is a liquid metal principally obtained from the native sulphide or cinnabar. What are the physiological effects of mercury? Metallic mercury (quicksilver) is inert either when swallowed or applied to the skin, but if retained in the alimentary canal or after prolonged contact with the skin, it often becomes converted into an oxide and produces constitutional effects. When inhaled in a state of vapor it frequently causes salivation, ulceration of the mouth, necrosis and wasting ; or in other cases loss of memory, vertigo, shaking palsy and other nervous symptoms. Minute doses of mercurials, not too frequently repeated, increase the number of red corpuscles in the blood and improve nutrition. In small and repeated doses they stimulate the secretions of the skin and mucous membranes, the liver and kidneys and the salivary glands and pancreas, and promote absorption. Corrosive sublimate is an hepatic stimulant of considerable power, but the other prepa- rations probably increase the flow of bile by irritating the duodenal mucous membrane, thus causing reflex contractions of the gall bladder. By stimulating the liver, corrosive sublimate increases the formation of urea, and thus proves diuretic. It also feebly stimu- lates the intestinal glands. In moderate doses the mercurials are cathartic (especially calomel and blue mass). In large doses, or con- tinued for some time, the secretions are much increased and become pathological ; the gums are swollen and tender, the mouth sore, the teeth feel elongated, salivation occurs, which becomes profuse if the medicine is continued ; the breath is offensive, a metallic taste is experienced ; the proportion of albumen, fibrin and red corpuscles to the fluid of the blood is diminished ; the body wastes, and, if the abuse of mercury be continued, mercurial fever, diarrhoea, ulceration and sloughing of the gums, loosening of the teeth and sometimes necrosis of the alveolar processes, albuminuria, marasmus and grave nervous symptoms occur. Salivation (ptyalism) is more easily caused by blue mass and calomel, less so by corrosive sublimate and mercury with chalk. Corrosive sublimate, beside its cbolagogue and diuretic properties, ALTERATIVES— MERCURY. 61 retards hyperplasia of connective tissue, is a powerful gastrointes- tinal irritant, and locally the best antiseptic, proving rapidly destruc- tive to germs. What are the symptoms and treatment of poisoning by cor- rosive sublimate ? The symptoms are violent gastro-enteritis with vomiting and purging, bloody stools, abdominal pain and tenderness, albuminous urine and death from collapse. The treatment consists in (1 )giving an antidote, albumen is the best {white of eggs, milk or wheat flour) ; (2) giving an emetic; and (3) the free use of opiates and demulcents. What are the therapeutic uses of mercury ? Mercury is used (1) as an antisyphilitic, either by the mouth (yellow iodide, calomel, blue mass, corrosive sublimate), fumigation (calomel), inunction (mercurial ointment or oleate), or hypodermic injection (albuminate, peptonate, or even calomel or corrosive subli- mate). It is of most use in secondary syphilis, the iodides (alone or combined with the red iodide or corrosive chloride) giving better results in tertiary syphilis. (2) As an antiplastic and sorbefacient in acute glandular affections, iritis and the latter stages of inflammations after plastic effusion has occurred. In diphtheria and membranous croup calomel is advan- tageously given in repeated doses guarded by minute doses of opium. In the latter disease the subsulphate is often used as an emetic. Mercurials are useful in ileo-colitis of infants (gray powder) and in acute dysentery (corrosive sublimate). (3) As an indirect tonic and to stimulate secretions, calomel, gray powder or blue mass are used in dyspepsia attended with constipation and torpid liver, and in the early stages of acute diseases. (4) As a purgative calomel and blue mass are often used, frequently followed by some saline. (5) Locally as antiseptics mercuric chloride or iodide are almost indispensable in surgical practice. Various preparations are used locally in various skin diseases, especially of parasitic origin, to promote absorption in goitre, enlarged spleen, chronic epididymitis and orchitis and other glandular swellings. The ointments are also used in conjunctivitis. What are the preparations of mercury and their doses ? Mass A Hydrargyri (mass of mercury — blue mass), dose as a 62 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. laxative, gr. v-xv (0.33-1.0) ; as an alterative, antw/philitic, or sorbe- facient, gr. ss-iij (0.03-0.2), t. i. d., guarded by opium, and often com- bined in the treatment of syphilis with iron or quinine. Unguentum Hydrargyri {mercurial ointment — blue ointment). Not used internally. Used externally for inunction in syphilis ; as a sorbefacient, to destroy pedicidi ; and as a dressing to syphilitic ulcers. Emplastrum Hydrargyri [mercurial plaster), used locally as a sorbefacient. Emplastrum Ammoniaci cum Hydrargyro {plaster of ammo- niac with mercury), is more stimulating than the former. Hydrargyrum cum Creta [mercury vmh chalk — g ray powder), contains mercury, 38 parts, with prepared chalk and sugar of milk, and is used as an alterative and antisyplulitic ; dose for an adult gr. j-v (0.06-0.32), for a child gr. \ (0.02) t. i. d. ; as a mild laxative gr. v-xv (0.33-1.0) (for a child gr. iij-v (0.2-0.33)). It should not be prescribed in pill form. Hydrargyri Oxidum Bubrum [red mercuric oxide) and Hydrargyri Oxidum Flavum [yellow mercuric oxide) are rarely used except in the form of Unguentum Hydrargyri Oxidi Rubri [ointment of red mer- curic oxide — red precipitate ointment) and Unguentum Hydrargyri Oxidi Flavi [ointment of yellow mer- curic oxide), each containing 10 per cent, of mercuric oxide, and which are applied in granular and other forms of conjunctivitis and in corneal ulcers. Oleatum Hydrargyri [mercurial oleate), contains 10 per cent, of the yellow oxide dissolved in oleic acid. Used chiefly for inunction in syphilis. Hydrargyri Chloridum Mite (mercurous chloride — calomel), dose, as a purgative or anthelmintic, gr. ss-j-x (0.03-0.06-0.6) at bedtime ; as an ant /'syphilitic gr. ^-j (0.006-0.06), t, i. d. , with opium ; as an alterative and absorbent gr. ss-j (0.03-0.06) every 2 or 3 hours; for its effect on secretions gr. ss-j (0.03-0.06) t. i. d. ; to arrest vomiting gr. tH (0.006-0.06) combined with sodium bicarbonate and fre- quently repeated. It is used externally as a dusting powder to the conjunctiva, and as an ointment in various skin affections. It is also used by fumigation in syphilis. Hydrargyri Chloridum Corrosivum [mercuric chloride — cor- ALTERATIVES— MERCURY. 63 rosive sublimate), used as an alterative and aittisyphilitic; dose gr. ^~ £ (0.004-0.008) by the mouth, gr. ¥ VtV (0.001-0.004) by hypoder- mic injection. Locally, in weak solutions as an injection in gonorrhoea after the more acute stage has passed (gr. T V~i— f^viij (0.005-0.008- 236.5)) or as a tosniacide in ringworm, etc., or for the destruction of pediculi. As an antiseptic gr. vijss to hot water Oij = 1 part to 2000. Hydrargyri Iodidum Flavum [mercurous iodide), dose as an antisyphilitic gr. f-j (0.008-0.065) combined with opium in pill. Used also locally, in the form of ointment, to syphilitic ulcers. Hydrargyri Iodidum Rubrum [mercuric iodide), dose as an alterative ox antisyphilitic gr. ^q-\ (0.004-0.016). It is often com- bined with potassium iodide in the treatment of tertiary syphilis, and is used locally in the form of ointment to promote the absorp- tion of glandular swellings, goitre, enlarged spleen, etc. As an antiseptic it is used in solution of gr. iv-vijss (0.259-0.454) to hot water Oij (950.3). Potassium iodide increases its solubility. Hydrargyri Cyanidum [mercuric cyanide) is used in syphilis as a substitute for corrosive sublimate, dose gr. te-ts (0.004-0.005). Hydrargyrum Ammoniatum [ammoniated mercury — white pre- cipitate) is only used externally as Unguentum Hydrargyri Ammoniati [ointment of ammoniated mercury), which contains 10 per cent, of ammoniated mercury, and is used especially in parasitic skin diseases and to destroy pediculi. Hydrargyri Subsulphas Flavus {yellow mercurial sulmlphate — turpeth mineral), dose as an alterative gr. ?-ss (0.016-0.032); as an emetic in croup, gr. j-v (0.065-0.324), in syrup, repeated every 10 or 15 minutes until free vomiting occurs. Unguentum Hydrargyri Nitratis {ointment of mercurial nitrate — citrine ointment), used externally (usually diluted with other ointment) in various skin affections, especially those of parasitic origin, to destroy pediculi and as a dressing for venereal ulcers. Liquor Hydrargyri Nitratis {solution of mercuric nitrate — arid nitrate of mercury), used as an escharotic. Diluted with water, it forms a useful stimulating application to indolent ulcers. What substances are incompatible with the mercurial prepa- rations ? The metallic preparations and calomel are incompatible with the 64 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. chlorides, hydrochloric and nitro-hydrochloric acids, which are apt to form with them corrosive sublimate. Calomel is also incompatible with the alkalies, their carbonates, alkaline earths, soap and the hydrosulphates. Corrosive sublimate is decomposed by nearly every- thing, and green mercurous iodide is converted into the more active red mercuric iodide by combination with iodine and other iodides. AURUM — GOLD. What are the physiological effects of the salts of gold? Locally they are caustic. Internally in small doses they increase the appetite, digestion, glandular secretions, and excretions of urine and perspiration ; they stimulate the nervous system, and particu- larly the spinal cord ; they stimulate the sexual organs, and in women (probably) increase the menstrual flow. In larger doses, or after prolonged use, they disorder digestion, cause salivation without ulceration of the gums, diminish the oxygen-carrying function of the red globules, and stimulate the lymphatic system, thus causing rapid wasting. In overdoses they are gastro-intestinal irritants, the symptoms and antidote being the same as those of poisoning by cor- rosive sublimate. What are the medicinal uses of the gold salts ? They are used as substitutes for corrosive sublimate in the treat- ment of tertiary syphilis; as alteratives in scrofula, chronic Bright' s disease, myelitis, chronic ovarian inflammations and neuralgia ; and as aphrodisiacs in functional impotence. The so-called " bichloride of gold" or " Keely cure" does not consist in the administration of gold bichloride, as no such salt is known. The cures are probably largely effected by suggestion. It frequently fails to effect a cure, and many relapses occur. What are the preparations and doses of the gold salts ? Auri ET Sodh Chloridtjm {gold and sodium chloride) is the only official preparation ; dose gr. ^j-fV (0.002-0.006), in pill or capsule. ALTERATIVES— IODINE. 65 IODUM — IODINE. What is iodine ? Iodine is a non-metallic element, obtained from the ashes of seaweed. What are the physiological effects of iodine and the iodides? Iodine is a disinfectant and antiseptic. Locally applied, it is au irritant caustic to the skin and mucous membranes, staining the former yellow and causing superficial inflammation and desquama- tion, and sometimes even vesication. The vapor, when inhaled, is irritant to the air passages. In sufficient amounts it is a gastro- intestinal irritant. It enters the blood readily, and, combining with sodium or potassium, corresponds, in its constitutional effects, to the iodides. They stimulate the lymphatic system and cause the absorp- tion especially of newly-formed tissues and diseased cells, thus re- moving indolent swellings, inflammatory and syphilitic deposits and various metallic poisons, as lead, mercury, etc., which may have been deposited in the tissues. When too long administered, they cause great emaciation and depression of the vital powers. They are rapidly eliminated%y the mucous membranes (irritating them in their passage), salivary glands and kidneys. Given in large quantities, they cause iodism, i. e. , malaise, some fever, frontal headache, coryza, lachrymation, sore throat, difficult swallowing, various eruptions on " the face and shoulders and ant- aphrodisiac effects, sometimes permanent. The susceptibility varies greatly in different persons, but these symptoms may in great measure be prevented by copious draughts of water frequently taken during the course of treatment. What is the treatment of acute poisoning by free iodine ? A decoction of starch is the antidote, followed by emetics, and opium and demulcents. What are the therapeutic uses of iodine and the iodides ? They are employed as alteratives and absorbents in the active manifestations of tertiary syphilis (iodides chiefly), in the treatment of scrofulous and glandular enlargements, in the early stages of 5 66 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. cirrhosis of the liver or kidneys, in the various forms of sclerosis of the nervous centres, and in chronic poisoning by mercury, lead and other metals ; to aid the absorption of lingering pneumonic consoli- dation (ammonium iodide) and of plastic and serous inflammatory exudations (potassium iodide), in aneurisms (large doses of potassium iodide), in chronic rheumatism aud in malaria (iodine preparations). For their effects on the mucous secretions the iodides are given in chronic bronchitis, spasmodic asthma, catarrhal pneumonia, acute catarrh, hay fever and duodenal catarrh. It is highly recommended internally in the treatment of typhoid fever, and has been used to check the vomiting of pregnancy. Locally, iodine is used by inhala- tion in catarrh, coryza and hay fever, and is applied to aid absorp- tion and as a counter -iriitant to chronic inflammations and chronic glandular and other swellings. The tincture is injected undiluted into the serous cavity after the removal of the fluid in empyema, hydrocele, etc, , and is applied to the uterine cavity in various forms of endometritis. What are the preparations and doses of iodine and the iodides ? Liquor Iodi Compositus {compound solution of iodine — LugoVs solution), containing iodine (5 parts), potassium iodide (10 parts), and water (85 parts) ; dose tt^v-xv (0.308-0.924) t, i. d. TlNCTURA Iodi {tincture of iodine), containing 8 per cent, of iodine ; dose ^lij-xv (0. 123-0.924) t. i. d. It is chiefly used externally. Unguentum Iodi {iodine ointment) contains iodine (4 parts), potassium iodide (I part), water (2 parts), and benzoinated lard (93 parts). Potassii Iodidum (potassium iodide), dose gr. ij-xv-3j (0.130- 0.972-3.888) t. i. d. Unguentum Potassii Iodidi (ointment of potassium iodide) is much less powerful than iodine ointment. Ammonii Iodidum (ammonium iodide), dose gr. ij-xv (0.132- 0.972). Sodii Iodidum (sodium iodide), dose gr. v-xxx (0.324-1.944). Sulphuris Iodidum (sulphur iodide) is but little used ; dose gr. H (0.032-0.065). ALTERATIVES— ARSENIC. 67 Strontii Iodidum {strontium iodide) is supposed to be as effica- cious as the other iodides and to be less likely to cause iodism; dose gr. v-x (0.324-0.648). The mercurial iodides and iron iodide have already been men- tioned. Arsenic, zinc and lead iodides will be described in their appropriate places. What are the incompatibilities of these preparations ? The iodides are incompatible with the acids and acidulous salts, with the soluble metallic salts generally ; with most of the alkaloids and with sweet spirits of nitre. Iodine is precipitated from the tincture on the addition of water. How are iodine and the iodides administered? Lugol's solution may be given in syrup and water. The iodides may be administered in compressed pill or capsule, or they may be given dissolved in water flavored with orange syrup, or in one of the bitter tinctures, or in compound syrup of sarsaparilla. Nothing effectually disguises their unpleasant taste. ARSENUM— ARSENIC. What is arsenic ? Arsenic is a metallic element, found in various ores combined witt other metals as an arsenide. Mention some of the tests for arsenic. When in powder, if heated with charcoal in a small test tube, it sublimes and condenses in the form of a brilliant steel gray ring of minute octahedral crystals, soluble in sodium or calcium hypochlo- rite. When in solution, the addition of sulphuretted hydrogen 01 ammonium sulphide produces a lemon-yellow arsenic trisulphide, insoluble in diluted hydrochloric acid, but soluble in a solution of ammonium carbonate : also the addition of ammonia water followed by a solution of silver nitrate, gives a canary -yellow silver arsenite. Marsh's and Reinsch's tests should also be used. 68 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What are the physiological effects of arsenical prepara- tions ? Metallic arsenic is inert, but when swallowed may be converted into arsenous acid and cause poisoning. No matter how adminis- tered, it has a selective action on the gastro-intestinal and broncho- pulmonary mucous membranes. Locally, arsenous acid is a painful caustic, and when in sufficient amount produces so much inflamma- tion that absorption cannot take place. The inhalation of arsenical fumes (as from wall papers) have caused poisoning. Given inter- nally in small doses it improves the appetite, digestion, nutrition and condition of the blood ; stimulates the secretions of the alimen- tary canal and increases peristalsis ; slightly stimulates the respira- tory and circulatory centres and the cerebral functions ; and lessens the excretion of carbonic acid and urea. In larger doses (not toxic), or when taken for some time continuously, it irritates the mucous membranes, disorders digestion, gives rise to epigastric pain, nausea and vomiting, diarrhoea, tenesmus and sometimes dysentery, palpi- tation, oppressed breathing, oedema of the eyelids, albuminuria, cutaneous eruptions, tremor and disordered sensation. It is elimi- nated by the mucous membrane, liver, kidneys and skin. Tolerance is sometimes established, and veiy large doses may be taken without poisonous effect. What are the symptoms, pathological anatomy and treat- ment of acute arsenical poisoning? The symptoms of the gastro-intestinal variety of poisoning are intense burning pain in the epigastrium, radiating over the abdomen, violent vomiting, great thirst, bloody and offensive stools, strangury and bloody urine, rapid feeble heart, oppressed breathing and col- lapse, sometimes simulating cholera. Those of the cerebral variety are sudden, profound insensibility and coma with collapse. Pathological Anatomy. — Alimentary mucous membrane congested, eroded, softened and ecchymotic ; broncho-pulmonary mucous mem- brane and lungs congested ; fatty degeneration of the liver, kidneys and other organs. Treatment, (1) give a prompt emetic or use the stomach pump; (2) give as antidotes hydrated ferric oxide or the hydrated ferric oxide with magnesia, and continue the emetics; (3) mucilaginous ALTERATIVES— ARSENIC. 69 drinks to protect the surfaces; (4) large amounts of diluents to favor elimination. Prognosis. — Death often results long afterward, from the patho- logical conditions produced by the poison. What are the medicinal uses of the arsenical preparations ? Arsenic is used as a tonic and alterative in anaemia and chlorosis, persistent malaria, rheumatoid arthritis and chronic rheumatism, and to delay the formation of connective tissue in the various scleroses and the growth of carcinomata. In minute doses it is used as a gastric tonic in irritative dyspepsia, gastric nicer and cancer, and in gastralgia and enteral gia. (Fowler's Solution.) In emphysema, chronic bronchitis and phthisis it is of value. For its nervous action it is used in chorea, neuralgias, paralysis agitans and melancholia. In chronic slan diseases, as psoriasis, eczema and acne, it is of the greatest service, and in diabetes and sexual debility it is highly recommended. Locally, arsenous acid has been used as a caustic in lupus, onychia maligna, cancer, and to destroy the nerves of carious teeth. Cigarettes made of bibulous paper saturated with a solution of sodium arsenate are smoked for the relief of asthma. What are the preparations and doses of arsenic ? Acldum Arsenosum (arsenous acid— white arsenic), dose gr. T V~ ^ (0.004-0.005) in pills t. i. d. Liquor Potassii Arsenitis (solution of jiotassium arsenite— Foicler s Solution) contains arsenous acid gr. ^ in eacli f'3j of solu- tion ; dose ny-x (0.061-0.C16) freely diluted. Liquor Acidi Arsenosi (solution of arsenous acid), dose n\j- x (0.061-0.616) freely diluted. Sodii Arsenas {sodium arsenate) is milder in its action than the foregoing preparations; dose gr. T V"? (0.005-0.016). Liquor Sodii Arsenatis (solution of sodium arsenate), dose ttVij-x (0.123-0.616) freely diluted. Arseni Iodidum (arsenic iodide), dose gr. I (0.008) t. i. d. Liquor Arseni et Hydrargyri Iodidi (solution of arsenic and mercuric iodide — Donovans Solution) contains 1 per cent, of arsenic iodide and of mercuric iodide each, and is used in obstinate syphilis and in papular and squamous skin diseases; dose truj-x (0.123- 0.616) freely diluted. 70 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. What medicinal substances are incompatible with these pre- parations ? The salts of iron, magnesium and calcium and the astringents are chemically incompatible with the preparations of arsenic. Fowler's Solution should not be prescribed with infusions or decoctions of cinchona nor Donovan's Solution with the alkalies, or the salts of the alkaloids. How and when is arsenic administered ? As individual susceptibility to arsenic varies greatly,* it is better to give a small dose at first. When it is determined that the patient can take arsenic, large doses should be given until some constitu- tional symptoms occur, when the medicine is discontinued for a few days. Or full doses of the liquid preparations gradually decreased to the minimum and as gradually increased may be given when it is desirable to continue the medicine for some time. Arsenic is less apt to disorder the stomach when freely diluted and taken after eating. OLEUM MORRHU^H — COD-LIVER OIL. What is cod-liver oil ? Cod-liver oil is a fixed oil obtained from the fresh livers of Gadus morrhuae, or codfish ( Class Pisces ; Ord. Teleostia; Fam. Gadida). What are its principal chemical constituents ? It contains various fatty acids, several biliary principles, gaduin, iodine, chlorine and traces of bromine. What are its physiological effects ? Cod-liver oil is more of a food than a medicine. It is readily ab- sorbed, whether rubbed into the skin or taken internally. Oil is digested in the intestines (not in the stomach), and is readily assimi- lated, increasing the deposit of fat in the tissues and the number of corpuscles in the blood. In suitable doses it improves the appetite and digestion and increases nutrition. In large doses, or in very hot weather, it causes nausea and diarrhoea. * The author has seen gastro-enterie symptoms follow the administration of one dose of Fowler's Solution Taj. ALTERATIVES— THE PHOSPHATES AND HYPOPHOSPHITES. 71 What are its therapeutic applications ? Cod-liver oil is used as a nutrient in chronic wasting diseases, par- ticularly in phthisis (the earlier it is given, the more pronounced are its effects), also in rickets, scrofula, chlorosis, rheumatoid arthritis, chronic rheumatism, chronic bronchitis, emphysema and chronic intes tinal diseases leading to mal-nutrition. It is applied locally for its constitutional effects when it cannot be taken internally, and also in squamous skin affections. What is the dose of cod-liver oil, and how should it be ad- ministered ? Oleum Morrhu^ {cod-liver oil) is given in doses of f3j-f:|ss (3.696-15.0) t, i. d., and preferably \ to 2 hours after meals. The pure oil is the best form for administration. If it nauseates, it may be given in emulsion with the hypophosphites, or with mucilage of acaciae and oil of lemon. The addition of a few drops of ether renders it more easy of digestion. THE PHOSPHATES AND HYPOPHOSPHITES. What is the chemical difference between a phosphide, a phos- phate and a phosphite ? A phosphide is formed by the direct union of phosphorus ; a phos- phate by the union of phosphoric acid, and & phosphite by the union of phosphorous acid with a base. * What are the physiological actions of the phosphates and hypophosphites ? They increase the nutrition of the body. Calcium phosphate exists normally in all the tissues of the body, and hence is an important nutrient. It is to this salt that bone owes its hardness. * In other words, whenever a salt ends in ide it is formed hy the union of an element with a base (thus, iron ossicle, iron and oxygen ; iron phosphiV/e, iron and phosphorus ; iron iodide, iron and iodine ; iron sulph?'c?e, iron and sulphur) ; when a salt ends in ate, it shows the union of an acid ending in ic with a base (thus, iron phosphate, iron and phosphoric acid ; iron sulphate, iron and sul- phuric acid; iron nitrate, iron and nitric acid) ; when a salt ends in ite, it is composed of an acid ending in ous and a base (thus, sodium sulph/te, sodium and sulphurous acid ; amyl nitn'te, amyl and nitrous acid, etc.). 72 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What are the medicinal uses of these substances ? They are used as alteratives and nutrients in diseases of mal-nutri- tion, especially when these . salts are wanting in the system, as in rickets, mottities ossium, caries and necrosis, delayed union of frac- tures, superlactation, prolonged suppuration, anosmia, chronic diarrhoea and chronic phthisis. The hypophosphites have been lauded in the treatment of phthisis, but probably act only as nu- trients. What are the preparations of these salts and their doses ? Calcii Phosphas Pr^ecipitatus {precipitated calcium phos- phate), a very insoluble preparation, and apt to form intestinal con- cretions ; dose gr. v-x (0. 324-0. 648). It may be given in milk. Syrupus Calcii Lactophosphatis (syrup of calcium lactophos- phate) ; the addition of lactic acid renders the calcium phosphate much more soluble; dose f3j-iv (4.0-15.0) t. i. d. Calcii Hypophosphis (calcium hypophosphite) ; Potassii Hypophosphis (potassium hypophosphite) ; Sodii Hypophosphis (sodium hypophosphite). may each be given in doses of gr. x-xxx (0.048-1.944) t. i. d. Usually administered as Syrupus Hypophosphitum (syrup of hypophosphites), dose f3j- ij (4.0-8.0) t. i. d. Syrupus Hypophosphitum cum Ferro [syrup of hypophos- phites with iron) contains 1 per cent, of ferrous lactate ; dose f3j-ij (4.0-8.0) t. i. d. The ferric phosphates and hypophosphite have been considered under iron ; sodium phosphate will be mentioned with the cathartics. CALCII CHLORIDUM — CALCIUM CHLORIDE. What are the effects, uses, and doses of this salt ? Calcium chloride is a gastro-intestinal irritant, and is supposed to possess alterative powers in strumous affections, glandular enlarge- ments, uterine fibroid and ovarian tumors. Dose gr. x-xx (0.648- 1.296) in milk or water. AMMONII CHLORIDUM — AMMONIUM CHLORIDE. What are the effects, uses and doses of ammonium chloride ? In addition to the general effects of the ammonium salts (q. v. ) it ALTERATIVES— COLCHICUM. 73 is an alterative and expectorant. Locally it is an irritant. Inter- nally, in small doses, it stimulates the mucous membranes, increas- ing their secretions and epithelial exfoliation. It stimulates the intestinal glands and, perhaps, the liver. It aids the excretion of waste products and increases all the solids in the urine except uric acid. It is said to increase the menstrual flow in women. In large doses it irritates the stomach and intestines and proves purgative. It is used as an expectorant (q. v.) and as an alterative in enlarged glands, plastic exudations (given internally and used locally), in uterine fibroids, functional amenorrhea, in muscular and chronic rheumatism and myalgia, and in the early stages of cirrhosis of the liver. In albuminoid or waxy infiltration of the liver, kidneys and spleen it is a very valuable agent. It is also used in neuralgia and neuralgic headache. Externally it is applied as a refrigerant (3j (31.10) to water Oss (120.0)) in the early stages of inflammation and in the later stages as a sorbefacient. Dose gr. v-xxx (0. 324- 1.944) every three or four hours, in compressed pills, capsules, or in solution with fluid extract of liquorice, which somewhat disguises its unpleasant taste. COLCHICUM. What is colchicum? Colchicum is the corm and seed of C. autumnale or meadow saf- fron {Nat. Ord. Liliaceae), a native of Europe. What alkaloid does it contain ? It contains colchicine, which is converted by mineral acids into colchicein. What are its physiological effects ? Locally applied it is irritant. Internally, colchicum, or its alkaloid in small doses, increase the secretions generally, particularly the urine, increasing greatly the amount of urea and uric acid elimi- nated ; in larger doses it causes nausea and vomiting, frequent purging, and depresses the heart's action ; in excessive doses it acts as an irritant poison, producing violent vomiting and purging, great depression, collapse and death by failure of respiration. How should poisoning by colchicum be treated ? (1) Give emetics and cathartics ; (2) tannic acid, as a partial anti 74 ESSENTIALS OE MATERIA MEDICA AND THERAPEUTICS. dote ; (3) demulcents, to protect the surfaces, and (4) opium and stimulants, to counteract the resulting depression. What are the therapeutical uses of colchicum? Colchicum is used as an alterative and diuretic in acute gout (often combined with magnesia and magnesium sulphate (Scudamore's draught) or with potassium iodide or other alkali) and in rheuma- tism. As a diuretic it is employed in ascites and other varieties of dropsy. As a cholagogue it is given in congestions of the portal circulation. What are the preparations and doses of colchicum ? Extractum Colchici Radicis {extract of colchicum root), dose gr. j-ij (0.065-0.130) in pill. Extractum Colchici Radicis Fluidum {fluid extract of col- chicum root), dose niij-iv (0.123-0.246). Extractum Colchici Seminis Fluidum {fluid extract of colchi- cum seed), dose rruj-vj (0.123-0.40). Tinctura Colchici {tincture of colchicum) , made from the seed; dose f3ss-j (2.0-4.0). Vinum Colchici Radicis {icine of colchicum root), dose nrv-xx (0.308-1.232) ; as a purgative f3ss (2.0). Vinum Colchici Seminis {wine of colchicum seed), dose ttvv-xxx (0.308-2.0)— the best preparation. Colchicine (not official), dose for hypodermic use gr. jfe (O.001). SARSAPARILLA. What is sarsaparilla ? SarsapariTla is the root of smilax officinalis and other species of smilax {Nat. Ord. Sniilacese), prickly shrubs of Mexico, Central and South America. What special chemical principle does it contain ? A glucoside, called smilacin or panllin, which resembles saponin. What are its effects and uses ? It has a very slight diaphoretic action, and in large doses is emetic and purgative. It is popularly supposed to depurate the blood. It has been used as an alterative in tertiary syphilis and in chronic rheumatism and various cachectic conditions. ALTERATIVES — MEZEREON. 75 What are its preparations and doses ? Extractum Sarsaparill^e Fluidum {fluid extract of sarsa- parilla), dose f^ss (2.0) t. i. d. Extractum Sarsaparill^e Fluidum Compositum {compound fluid extract of sarsaparilla) , containing also sassafras, mezereon, and glycyrrhiza ; dose f3j (4.0). Decoctum Sarsaparilla Compositum {compound decoction of sarsaparilla), containing the above ingredients and guaiac wood; dose fgiij-vj (80.0-200.0) t. i. d. Syrupus Sarsaparilla Compositus {compound syrup of sar- saparilla), containing guaiac wood, pale rose, senna, glycyrrhiza, sassafras, anise, and gaultheria. It decomposes corrosive sublimate, converting it into calomel. Dose f^ss-j (15.0-30.0) t. i. d. GUAIACI LIGNUM — GUAIAC WOOD. GUAIACI RESINA— GUAIAC. What are these substances ? Guaiacum wood, or lignum vitse, is the heart wood of Gr. officinale and Gr. sanctum (.Nat Ord. Zygophyllaceae), evergreen trees of S. America- Guaiac is the resin of the wood of Gr. officinale, and is composed of guaiaconic, guaiac and guaiacresinic acids, guaiac beta-resin, guaiac yellow and guaiacin. What are the effects, uses, preparations and doses of these substances ? Guaiac ivood and resin slightly increase the secretions of the skin and mucous membranes, and in large doses prove emetic and cathar- tic. They have been used as alteratives in syphilis and chronic rheu- matism, and also as emmenagogues in amenorrhea and congestive dysmenorrhea. In tonsillitis the tincture (f^ss (2.0) every 3 or 4 hours) is of value. The preparations are Tinctura Guaiaci (tincture of guaiac) and Tinctura Guaiaci Ammoniata {ammoniated tincture of guaiac) ; dose of either, f'3ss-ij (2.0-8.0), 3 or 4 times daily, in milk. MEZEREUM — MEZEREON. What is mezereon ? It is the bark of daphne mezereum and other species of daphne 76 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. (Nat. Ord. Thymelacese), and contains daphnin (a bitter glucoside) and an acid resin. Locally it is irritant ; internally in medicinal doses it increases the secretions, especially of the salivary glands, skin and kidneys ; in overdoses it is an irritant poison and may cause death. It is used (generally with sarsaparilla) as an alterative in chronic rheumatism, tertiary syphilis and strumous affections, and as a masticatory, it has been chewed in paralysis of the muscles of the tongue and deglutition. Extractum Mezerei Fluidum (fluid extract of mczereon), dose nix (0.616). What is memispermum ? It is the rhizome and roots of M. canadense, yellow parilla or Canada moonseed [Nat. Ord, Menispermaceae), and contains berbe- rine. It is supposed to be tonic, diuretic, diaphoretic, and alterative, and is used as a substitute for sarsaparilla. The only preparation is the fluid extract [extractum menispermi fluidum), dose flLv-xxx (0.308-2.0). What is calendula ? Calendula is the fresh floweiing herb of C. officinalis or marigold (Nat. Ord, Composite). It contains calendulin, and is supposed to be diuretic, diaphoretic and alterative. It is not much used. Ttnctttra Calendula {tincture of calendula) ; dose f3ss-j (2.0- 4.0). It may be used externally (diluted) as an application to wounds and contusions. What is sassafras ? Sassafras is the bark of the root of S. variifolium (Nat. Ord. Lau- r'nere), and contains a volatile oil. It is supposed to be a mild alter- ative and diaphoretic, and is used in combination with sarsaparilla. The oil is used as a flavoring ingredient and as a perfume. Oleum Sassafras (oil of sassafras), dose gtt. ij-x (0.06-0.308). Whatisstillingia? It is the root of S. sylvatica or Queen's Delight {Nat. Ord. Eu- phorbiacese) and contains a volatile oil and a resin. It increases all the secretions and excretions, slightly stimulates the cardiac action and is believed to be alterative. It has been used in secondary and in tertiary syphilis, scrofula and chronic rheumatism. ANTIPYRETICS. 77 ExTRACTUM STILLINGI^E FLUIDUM {fluid extract of stillingia), dose f3ss (2.0). What is dulcamara? It is the young branches of solanum dulcamara, woody nightshade or bittersweet {Nat. Orel. Solanacese), and contains solamine and dulcamarine. It is feebly narcotic, diaphoretic and diuretic. In large doses it is a cardiac depressant. It sometimes causes nausea and vomiting. It is neither hypnotic nor anodyne. It is chiefly used as an alterative in chronic eczema, psoriasis, etc. , and has been recommended in whooping-cough, bronchitis and asthma. Extractum Dulcamara Fluidum (fluid extract of dulcamara), dose f&ss-j (2.0-4.0). What is lappa? Lappa or Burdoch is the root of Arctium Lappa and other species of Arctium (Nat. Ord. Composite). It contains a bitter extractive, perhaps a glucoside. tannin, resin, etc., and possesses tonic, laxative, and slight diuretic, diaphoretic, and alterant properties. It is used in chronic rheumatism, syphilis, and "scrofulous affections" and occasionally in chronic cutaneous diseases, as psoriasis and prurigo. Locally, it is used as an application to contusions. Extractum Lapp^e Fluidum [fluid extract of lapjia), dose "ixv-fSj (0.924-4.0). ORDER IV.— Antipyretics. What are antipyretics, and how do they act ? Antipyretic^ are remedies which reduce temperature in fever, but in medicinal doses have little or no effect upon it in the normal con- dition. The temperature maybe lowered (1) by lessening the pro- duction of heat, or (2) by increasing the loss of heat. Heat pro- duction maybe diminished either (1) by depressing nutrition (i. e., by retarding oxidation and cell-proliferation), or (2) by depressing the circidation of the part (as by local abstraction of blood, etc.), or of the system (cardiac sedatives) ; while the loss of heat may be increased (1) by increased evaporation from the surface (diaphor- etics), (2) by increasing heat radiation, through dilatation of the cutaneous vessels (amyl nitrite, alcohol, etc.), or (3) by direct with- draival of heat from the surface (cold applications, etc. ). The anti- pyretic group of medicines act chiefly by their effects on nutrition. 78 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Mention the principal antipyretics. Antipyrine; acetanilid (antifebrin) ; phenacetin; phenacoll; quin- ine ; salicin ; salicylic acid and the salicylates ; salol ; salophen ; guaiacol ; resorcin ; hydroquinone ; pyrocatechin ; chinoline ; thai- line and kairine. ANTIPYRINE. What is antipyrine ? Antipyrine (not official) is an alkaloidal substance usually synthet- ically prepared, but also obtained from the destructive distillation of coal tar, and belonging chemically to the phenyl group of carbon compounds. According to the latest investigations, antipyrine is a derivative of pyozol, which is derived from pyrrol. What are the physiological effects of antipyrine ? Locally applied it is antiseptic, antifermentatwe, and anaesthetic. Internally it exerts its influence principally on febrile temperature and the nervous system, as an antipyretic and analgesic. In fevers, when an antipyretic dose (gr. xx-xxx (1.0-2.0)) is taken, the temper- ature rapidly falls several degrees (due principally to its direct action upon the heat-regulating apparatus of the nervous system, also partly to interference with the oxygen-carrying function of the blood, thus diminishing heat-production, and partly to dilatation of the cutaneous vessels, thus regulating heat-distribution and increasing heat-radiation), and more or less profuse sweating occurs. After an interval of from 4 to 12 hours the fever returns, sometimes pre- ceded by a chill (which is not as severe as that caused by many of the other antipyretics, as kairine) and sometimes (very rarely) by depression almost amounting to collapse. Given in the same doses to a healthy man it only causes tinnitus aurium, nausea, and a slight fall of temperature (about ^°) ; large doses (3j (4.0)) cause vomiting and giddiness. Antipyrine is quickly absorbed, and probably interferes with nutri- tion by combining with the haemoglobin of the red corpuscles, form- ing methsemoglobin (the face becomes livid and the lips bluish when large doses are taken). It does not permanently impair their func- tion nor alter their form. Medium doses stimulate the heart and raise the arterial pressure (partly from spasm of the internal vessels) ; very large doses (in animals) directly paralyze the heart and lower ANTIPYRETICS— ANT1PYRINE. 79 the blood-pressure. Small doses have little or no effect upon the respiration. Given in large doses it increases the rapidity of the respiration and in poisonous doses it causes death apparently by respiratory paralysis. This action appears to be centric. It is a cerebral sedative and analgesic, acting especially on the sensory nerves, and dilates the pupils. It is eliminated by the kidne3's, and when the perspiration is slight increases the urine. It sometimes produces a cutaneous rash and (very rarely in therapeutic doses) induces vomiting. It is said to be haemostatic. What are the symptoms of poisoning by this drug ? When an overdose is taken there are often nausea and vomiting, a sense of fulness in the head, tinnitus aurium, relaxation of the muscular system and muscular weakness, cyanosis, cutaneous erup- tionSj sweating, rapid breathing, and feeble pulse. Occasionally the reflexes are absent. Consciousness is retained. How should these symptoms be treated ? The treatment consists in keeping the patient in a recumbent posi- tion ; maintaining the body-heat ; administering alcoholic and diffu- sible stimulants ; giving atropine hypodermically and, if the cyanosis is marked, inhalations of alcohol. The profuse sweating which is sometimes seen is best combated by giving atropine or agaricine. The cutaneous eruptions rapidly disappear when the drug is discontinued. What are its therapeutic uses ? It is used as an antipyretic in all cases ot hyperpyrexia, as in typhoid fever, in sunstroke with high temperature, in the exanthe- mata, surgical fever, pneumonia, erysipelas, and influenza. In acute rheumatism it not only lowers temperature but relieves the pain. It is not an antiperiodic, but may be used to reduce the temperature in malarial fevers. As an analgesic it is much employed in neuralgia', the "lightning- pains ' ' of locomotor ataxia, muscular rheumatism, myalgia, dys- menorrhoea, to allay the pains of the first stage of labor, and in influenza. In acute coi'yza it is useful as a spray to the nasal mucous membrane (4 per cent, solution), preceded by the local appli- cation of cocaine. 80 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What is the dose of antipyrine, and how may it be admin- istered ? The dose as an antipyretic is gr. xv-xxx (1.0-2.0), repeated as circumstances require ; as an analgesic, gr. x-xv (0.648-1.0), repeated in from 1 to 4 hours, if necessary. It is given in capsules or in solution. As it is non-irritating, it may be used hypodermically. It is incompatible with calomel and with sweet spirits of nitre, tannates, and solutions of chloral, mercury, arsenic, and carbolic acid. ACETANILIDUM— ACETANILID. What is acetanilid ? Acetanilid or antifebrin is a neutral chemical product, obtained by the action of glacial acetic acid and heat on aniline. It is an acetyl derivative of aniline and is known chemically as phenylaceta- mide (C 6 H 5 NH,C 2 H 3 0). What are its physiological actions ? Like antipyrine, acetanilid is markedly antipyretic and analgesic. 78 As an antipjTetic in fevers it acts more slowly than antipyrine, influ- encing the temperature in the same manner and being attended with the same symptoms and with more marked cyanosis. As the temperature declines the pulse becomes slower and stronger and the arterial tension is elevated. Gastric and intestinal disturbance and other unpleasant concomitants rarely result. Given to healthy men in ordinary doses it produces no apparent effect. In decided doses acetanilid lessens the conductivity of nerves, depresses the reflex centres, and acts as a hypnotic. In poisonous amounts it causes motor and sensory paralysis. Its effects are chiefly expended upon the sensory cord and nerves. Given to animals in toxic doses, beside cyanosis it causes general prostration, stupor, rapidly lowered temperature, with primary stimulation and afterward depression of the heart and respiration, coma, convulsions, and death. It is elimi- nated by the kidneys as para-amido-phenol sulphate. What are its uses ? It is used as an antipyretic in all cases of high temperature, as typhoid fever, acute rheumatism, scarlatina, phthisis, influenza, ANTIPYRETICS— PHENOCOLL. 81 pneumonia, and acute sepsis. As an anodyne it is employed, also, in the same diseases in which antipyrine is indicated, and has been found useful in epilepsy, particularly in the lesser attacks {petit mat). It is also used locally as an antiseptic. How may it be administered, and in what doses ? The dose of acetanilid is from gr. iv-x (0.25-0.64). It is quite insoluble in water, and is better given in capsules or in powder. PHENACETIN. What is phenacetin ? Phenacetin or acetphenetidin (not official) is an acetyl derivative of amido-phenol. What are its physiological effects ? It is a nervous sedative, acting principally upon the sensory por- tions of the spinal cord. In small doses it has no effect upon the circulatory system. Large doses produce a general cyanosis due to the formation in the blood of niethsemoglobin. It slightly depresses normal temperature, and reduces markedly that of fever, usually causing but slight diaphoresis. When admin- istered in the evening its effects upon febrile temperature appear to be more marked than when given in the morning. After large doses, in addition to cyanosis, vomiting, incoordination, hurried breathing, and somnolence may occur. What are its therapeutic uses and doses ? As an antipyretic in febrile conditions generally, as in typhoid fever, pneumonia, pleurisy, tuberculosis, influenza, acute rheumatism, etc. As an analgesic in migraine, headache from any cause, myalgia, etc. It is better to administer this, as well as the other coal-tar products, cautiously in all cases of weak heart. Dose gr. iij-xx (0.2-1.29). PHENOCOLL. What is phenocoll ? Phenocoll (not official) or amidophenacetin is a coal-tnr product prepared "by the action of glycocoll, which is amido-acetic acid, upon phenacetin. ' ' 6 82 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. It is a white crystalline powder and is soluble in 16 parts of water. It is incompatible with the alkalies. It is said to reduce febrile temperature very rapidly by diminish- ing the heat-production without affecting the heat-radiation, and to have no unpleasant sequelae, except occasionally profuse perspiration. It should be used with care, however, in all cases of prostration, as it may then produce cyanosis and cardiac depression. It has been used as a hydrochloride for its antipyretic effect in various febrile conditions; as an analgesic in acute rheumatism and in neuralgia, and as & sedative in whooping-cough. Dose of the hydro- chloride gr. v-xv (0.32-1.0). QUININE. Is quinine used as an antipyretic ? Quinine {via 1 , p. 00) was formerly much used for this purpose, but at the present time it has been largely superseded by other agents. As an antipyretic it is given in doses of gr. x-xx (0.64-1.30) repeated as required. SALICIN, SALICYLIC ACID, AND THE SALICYLATES. What are these substances, and whence are they obtained ? Salicin is a neutral principle found in several species of salix. Salicylic acid is a derivative of salicin, is found also as a salt (of methyl) in oil of gaultheria, and lias been prepared synthetically by combining pure carbolic acid with dry carbon dioxide by means of heat, The salicylates are the salts formed by the union of this acid with bases. What are the physiological effects of these substances ? The effects of salicin resemble those of salicylic acid, but its action is slower and less powerful. It is antipyretic, tonic, antifer- mentative, antiseptic, and to a slight extent antiperiodic. It does not depress the heart to the same extent as does salicylic acid, and is much less toxic. It is eliminated by the urine (chiefly as salicylic and salicyluric acids) and by the perspiration, rendering both of these excretions alkaline. Salicylic acid, when locally applied, is antiseptic and antifermeuta- tive. Administered internally in full doses it lowers the temperature ANTIPYRETICS— SALICIN, SALICYLIC ACID AND SALICYLATES. 83 in fevers, causes profuse, sometimes exhausting sweats, and produces symptoms similar to those of cinehonism, such as tinnitus aurium, partial deafness, headache, etc. After very large doses these symp- toms are all increased, and dyspnoea, with depression of the heart and nervous system and dilated pupils, is observed. If a toxic dose be given, delirium, irregular respiration, involuntary evacuations, stupor, and death from respiratory failure occur. In healthy subjects salicylic acid in full doses often causes nausea and vomiting, is a cardiac depressant, inhibits the movements of the leucocytes, quickens and deepens the respiratory movements (producing dyspnoea), is a dia- phoretic, does not affect the normal temperature, and is eliminated chiefly by the urine, which, if large amounts have been taken, will be of a green color (due to an increase of indican). The urine fre- quently contains albumin. The salicylates administered internally are less irritant to the stomach than is salicylic acid; in other respects their effects are identical. What are the medicinal uses of these substances ? Salicin is not much employed. It has been used as an antipyretic, especially in rheumatism, for which purpose gr. iij-xv (0.2-1.0) may be given every few hours. Salicylic acid has been given as an antipyretic in various fevers, but is now little used for this purpose except in acute rheumatism in robust subjects, where it not only lowers the temperature and moder- ates the pain, but materially aids in the elimination of uric acid, yet probably does not decrease the frequency of cardiac complications. It is also used successfully in ])leurisy with effusion. It has also been used with success as an anthelmintic. Externcdly it is applied for the removal of corns and warts ; to check sweating of the feet ; in eczema ; and as an antiseptic to wounds and ulcers. The salicylates are used internally as antipyretics in acute rheuma- tism and as autizymotics to prevent fermentation of food in the stomach. What are the preparations and doses of these remedies ? Salicinum {salicin), dose gr. x-3j (0.648-4.0). In acute rheu- matism, gr. iij-xv (0.2-1.0) may be given every few hours. AciDUM Salicylicum {salicylic acid), dose gr. x-5j (0.648-4.0). 84 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. In acute rheumatism, gr. x (0.648) may be administered every hour until six doses are taken. If more is necessary, decrease the fre- quency of the dose. Sodii Salicylas (sodium salicylate) (3j (0.648) contains of sali- cylic acid gr. 48 (3.12) ; dose gr. v-3j (0.324-4.0). It is more solu- ble and less apt to cause vomiting than the acid, and hence is pre- ferred for internal use. Lithii Salicylas (lithium salicylate) is used for the same pur- poses and in the same doses. Methyl Salicylas (methyl salicylate — artificial (or synthetic) oil of icintergreeii) is a product obtained by the distillation of salicylic acid, or its salts, and methyl alcohol in the presence of sulphuric acid. It is identical with volatile oil of betula and differs in no re- spect from the other salicylates either in physiological action or in therapeutic use. It is less irritating to the stomach than the oil of gaultheria. Dose nrj- v (0.06-0.31). Phenyl salicylate will be described under the head of " saloV Physostigmine salicylate will be spoken of in connection with physostigma. What other official preparations are used for the salicylate which they contain ? Oleum Gaultheria (oil of gaultheria), a volatile oil distilled from Graultheria procumbens or wintergreen. It contains methyl salicylate, and acts similarly to salicylic acid upon the system. In large doses it is toxic. It is administered for the same purposes as are the salicylates in doses of tt\,x-xv (0.61-0.92) in capsules, repeated as required. Oleum Betula Volatile (volatile oil of betula — oil of sweet birch), a volatile oil obtained by distillation from the bark of Betula lenta (Nat. Orel. Betulacese). It is identical with methyl salicylate and nearly identical with oil of gaultheria. Dose n\j-v (0.06-0.31). What should be done if, during the use of these medicines, tinnitus aurium or other symptoms of intoxication should occur? The dose should immediately be decreased or the medicine dis- continued. ANTIPYRETICS — SALOPHEN. 85 SALOL. What is salol ? Salol {phenyl salicylate) is the salicylic ether of phenol and occurs as a white crystalline, slightly aromatic, and nearly tasteless powder, insoluble in water, but soluble in alcohol. What are its physiological effects ? Locally it is antiseptic. Internally it lowers febrile temperature and produces sweating. The circulation is practically uninfluenced ; the respirations increase in frequency and become shallow, tinnitus aurium and other salicylic acid symptoms sometimes occur. It is somewhat analgesic. In the intestine the pancreatic juice converts it into salicylic and carbolic acids, which render antiseptic the re- mainder of the alimentary canal. It seems to make the bile more watery. It is eliminated chiefly in the urine, which after its use re- sists decomposition and becomes darker in color. What are its uses and doses ? As an antipyretic it is used in acute rheumatism, in typhoid and other fevers ; in phthisis and in pneumonia; as an intestinal anti- septic in duodenal catarrh, catarrhal jaundice, typhoid fever, and cholera ; to prevent decomposition of urine in cystitis and pyelitis, and as an analgesic in neuritis, neuralgia, nervous headache, etc. It is also employed in pharyngitis and in chronic sore throat depend- ing upon the uric acid diathesis. It may be given in any stage of gonorrhoea for its influence on the urine. It is also said to be use- ful in diabetes. Locally it is used as an antiseptic in surgical dressings. Dose gr. v-3j (0.324-4.0) in pills, capsules, or in solution in alcohol or oil. It should be administered cautiously in disease of the kidneys, be- cause of the carbolic acid which it contains. SALOPHEN. What is salophen ? Salophen (not official) is acetylpara-amidophenol salicj'late. Like salol it is decomposed in the intestine by the pancreatic juice, being split into salicylic acid and actylpara-amidophenol, which is harmless, thus possessing an advantage in point of safety over salol. It is 86 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. chiefly eliminated under these forms in the urine, a small quantity- passing unchanged in the stools. It is an antipyretic, intestinal antiseptic, and analgesic. Its most marked antipyretic effect is seen in acute rheumatism. It has also been used as an intestinal anti- septic in typhoid fever, cholera, and dysentery, and as an analgesic in sciatica, migraine, and neuralgia. It appears to be non-toxic. Dose gr. x-xv (0.64-1.0) in compressed pill or capsule every 2 hours until gr. xc (6.0) are taken in 24 hours. GUAIACOL — GUAIACOL CARBONATE. What are guaiacol and guaiacol carbonate ? Guaiacol (not official) or methylpyrocatechin is a colorless volatile liquid, with a strong aromatic odor, prepared by the fractional dis- tillation of beechwood creasote, of which it forms 60 to 90 per cent. It is also prepared by the dry distillation of guaiae resin, and, synthetically by the action of methyl-sulphuric acid upon pyro- catechin. The latter product is the purest form of guaiacol. It is slightly soluble in water (1 part in 85, Helbing), but more so in ether and alcohol. Guaiacol carbonate (not official) is made "by decomposing guaia- col in a solution of soda Avith carbonyl chloride. It is a neutral, white, crystalline powder, containing 91 per cent, of chemically pure guaiacol in combination with 9 per cent, of carbonic acid. ' ' Insoluble in water and in cold alcohol, it dissolves readily in ether, in chloro- form, and in boiling alcohol, sparingly in the fixed oils and in glycerin. What are their effects ? When guaiacol is given internally or administered hypodermically to healthy persons it produces no effects beyond slight depression and slight diaphoresis. When given in suitable doses to febrile patients a gradual reduction of the febrile temperature takes place, the fever declining for from 2 to 4 hours. When the lowest point has been reached the temperature rises rather rapidly to its former height, half the time being occupied in the ascent which was re- quired for the decline of the temperature. As the temperature falls the patient often complains of much depression, but in ordinary doses the effects upon the respiration and pulse are evanescent. It is eliminated by the lungs and kidneys as guaiaco-sulphuric ANTIPYRETICS — GUAIACOL CARBONATE. 87 ether, giving a dark color to the urine when a large dose has been taken. There is but one case of poisoning on record. When applied locally it is antipyretic and analgesic. It rapidly lowers febrile tem- perature, the subsequent rise being, as when it is administered internally, much more rapid than the fall. There are also profuse sweating and feeble cardiac action approaching syncope. The action is most pronounced when applied to the abdomen, not so marked when rubbed on the chest, and least marked when applied to the thigh (Da Costa), probably because of the relative absorptive powers of different parts of the body. It appears to lower the temperature by direct action on the therm ogenetic centres. Guaiacol is also an antiseptic. The carbonate when given internally is antipyretic, and, being decomposed in the small intestine into pure guaiacol and carbonic acid, acts as a local antiseptic upon the alimentary canal. For what purposes are they employed ? They are much used as substitutes for creasote in the treatment of pulmonary tuberculosis, acute or chronic, especially in the first and second stages of the disease. In suitable cases it lessens the fever, improves the appetite and digestion, and moderates the cough. By some "it is believed that it forms compounds in the blood with the toxins produced by the presence of the bacillus tuberculosis in the organism, and that it aids in eliminating them from the system. ' ' It may be used internally, either by inhalation or by hypo- dermic injection, or it may be applied locally. The internal use of the carbonate is probably to be preferred in these cases. In typhoid fever as an antipyretic when the cold bath cannot be employed or is contraindicated, and as an intestinal antiseptic, guaiacol is very useful, employed locally and given internally in the form of the carbonate. It has also been used as an antipyretic in other acute infectious diseases accompanied with high temperature, as in pneumonia, in- fluenza, erysipelas, etc., and has been used for its diaphoretic action in pleurisy with effusion, as a means of promoting absorption. As an analgesic it has been successfully used in sciatica and in various neuralgice painted over the painful areas, and has also been 88 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. used locally in arthritis deformans as a pain-relieving agent. In the latter affection the author has not seen the beneficial effects which have been produced by this agent in the hands of other physicians. In acute rheumatism with high fever its local application in selected cases is of value. It has also been used locally in follicular tonsillitis, and while not curative, will relieve the pain and enable the patient to swallow more easily. In gonorrhoeal epididymitis painted over the scrotum it is said to relieve the pain quickly. It has also been recommended as a local anaesthetic in dental and minor surgical procedures. It is used as an inhalation in fetid bronchorrhoea and in gangrene of the lung. Dose of guaiacol Hliij-v (0.18-0.3) four times a day in capsule, pill, or in solution in oil or alcohol. Hypodermically gr. j-iv (0. 06-0. 2) in sterilized oil maybe used. The smaller dose should always be administered at first and gradually increased. Locally ttlv-xI (0.3-2.0) may be employed. When used in this manner the skin should be thoroughly cleansed and the guaiacol applied with a camel's hair pencil and rubbed in until absorbed. The surface should then be covered with oiled silk or paraffin paper to prevent evaporation. As an inhalation ntv-x (0.3-0.6) in a pint of hot water may be used, or an oxygen inhaler may be employed. Guaiacol carbonate is preferable for internal administration, as it is free from the odor and taste of guaiacol, which are objectionable to many persons, and does not irritate the alimentary canal. It is used in tuberculosis and typhoid fever. Dose gr. v (0.3) t. i. d. in cap- sules increased gradually until gr. xlv (3.0) are taken in divided doses in 24 hours. What other antipyretics are occasionally used ? Resorcin ; hydroquinone ; pyrocatechin ; chinoline ; thalline, and kairine, of which only the first is official. Describe their effects and uses. Resorcin (resorcinum), hydroquinone, and 'pyrocatechin are isomers, being respectivery meta-, para-, and ortho-oxyphenol. Locally they are antiseptic and antifermentative. Internally they reduce febrile temperature and cause profuse diaphoresis, followed ANTIPYRETICS— CHINOLINE, KATRINE, THALLINE. 89 by a more or less well-marked chill and gradual return of the fever. Fulness of the head or headache, flushed face, and tinnitus auriuni accompany these eifects ; the pulse and respiration are at first accel- erated but soon depressed. Large doses given to animals cause tremor, epileptiform convulsions, weak and rapid pulse, and finally failure of respiration. They are eliminated by the urine. Chinoline is antiseptic and antipyretic, acting very similarly to resorcin. It depresses the heart and respiration, and paralyzes the reflex centres. Katrine is also antipyretic, often causing much depression and acting dangerously on the blood. ThalUne is a synthetically prepared alkaloid used in the form of sulphate or tartrate. It is antipyretic, but causes profuse diaphoresis with, sometimes, dangerous depression almost amounting to collapse. These substances have been used in all cases of high temperature as antipyretics, but have been superseded by newer and less danger- ous drugs. Resorcin is used locally as an antiseptic, analgesic, and caustic. In purulent and offensive discharges from the nose, ears, or vagina an injection of the strength of gr. x-xx (0.64-1.29) to f£j (30.0) of water may be used. In chronic otitis media, it may be applied diluted with 7 parts of boric acid. It has also been used locally to the larynx in pertussis, in chronic aphonia, and to stimulate chronic ulcers of the larynx. In the form of ointments varying in strength from 1-50 per cent, it has been used in chronic cutaneous diseases, especially those of bacterial origin. Of resorcin the dose is gr. v-xxx (0.32-2.0) in solution ; of hydro- quinone and pyrocatechin gr. ij-x (0.13-0.64); of chinoline gr. vii-xv (0.32-1.0) in solution in oil; ofkairine gr. vij-xx (0.32-1.3) ; and of thalline gr. ij-xv (0.13-1.0) in pills or capsules. 90 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Class II. — Medicines acting on the body by their effects on the various organs. (A) ON THE NERVOUS SYSTEM. ORDER I.— Hypnotics. What are hypnotics ? Hypnotics are remedies which are administered to induce sleep. Most of them are narcotics, or remedies which by a stupefying effect on the nerve centres, diminish our relationship with external nature ; and many of them are also anodynes, or remedies which by lessen- ing the excitability of the nerves and nerve centres, tend to relieve pain. How do hypnotics act ? As during sleep the functional activity of the hrain is depressed, while the nutritive function is active, and as it is necessary for the nutrition of an organ that the hlood should pass through the capilla- ries in a slow, steady and continuous stream, removing the waste pro- ducts and giving up substances capable of replacing the tissue de- stroyed, while (hiring functional activity the blood is in larger amount, hurried through the vessels (which are dilated) in a tumul- tuous manner, and does not remove the waste as fast as it accumulates in the tissues, therefore a medicine to cause sleep must depress the cere- bral functions or regulate the blood supply to the brain by either contract- ing its vessels or by determining more blood to other portions of the body. Name the principal hypnotics. Opium and its alkaloids ; chloral ; chloralamide ; chloralose ; the bromides; hyoscine ; sulphonal; trional; tetranal ; paraldehyd; urethan ; cannabis Indica ; humulus, and lactuearium. OPIUM. What is opium ? Opium is the concrete milky exudation of the unripe capsules of Papaver somniferam (Nat Ord. Papaveracese), a native of Persia, but cultivated throughout the civilized world. HYPNOTICS — OPIUM. 91 WTiat are its principal chemical ingredients ? It contains the following alkaloids : Morphine, narcotine, codeine, narceine, paramorphine (thebaine), papaverine, pseudomorphine, landaniine, hydrocotarnine, cryptopine, porphyroxine, meconine and others. These are in combination with meconic and thebolactic acids. What are the chemical tests for the presence of opium ? With even very diluted solutions of opium, ferric chloride or sul- phate produces a blood-red ferric meconate. With morphine and its salts, ferric chloride or sulphate gives rise to a deep blue color, while concentrated nitric acid strikes with them a rich orange-red, slowly fading to yellow. What are the physiological actions of opium ? Opium is hypnotic, anodyne, antispasmodic and diaphoretic. It also depresses the circulation and respiration. A moderate dose at first slightly stimulates, then calms, and finally depresses the cere- bral functions, consciousness finally being lost in sleep, which is often disturbed by dreams ; the reflex centres are depressed, and if the dose be toxic, finally paralyzed, death occurring from paralysis of the respiratory centre. The pupil is contracted from stimulation of the 3d pair of nerves. It depresses the cardiac motor ganglia, the pulse becoming slower and fuller and the arterial tension ele- vated. Respiration is slowed. The secretions are all diminished, except that of the skin, which is increased. Peristalsis is retarded. Elimination takes place chiefly through the kidneys. Occasionally, intense itching of the skin, and sometimes cutaneous rashes occur. Headache, nausea and constipation commonly follow a medium dose of opium. What are the symptoms and treatment of opium poisoning ? The symptoms of opium-poisoning may be divided into tbree stages : The first stage — not always present, and when present usually of short duration — in which there is mental exhilaration or excitement, with some confusion of ideas ; a sensation of heat and often itching of the nose and face ; a dry skin ; and sometimes nausea and vom- iting. This quickly passes into T/ir second stage, in which there is overpowering drowsiness, pass- 92 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. ing into stupor ; contraction of the pupils ; dryness of the mouth and throat ; sweating ; full, regular respirations, diminishing in fre- quency as the poisoning proceeds ; and congested face. This stage gradually passes into The third stage, with deepening coma ; minutely contracted pupils (pin-point pupils); very slow, stertorous breathing ; abolition of reflexes ; pale, cyanosed face ; rapid, feeble circulation, and death from respiratory failure. Before death occurs the pupils often become widely dilated. Death has resulted, in an adult, from morphine gr. |-, hypodermic- ally (rare), and from opium gr. ivss (rare). Children are very sus- ceptible to its action. Treatment. — (1) Remove any poison present in the stomach by the stomach pump or emetics (zinc sulphate gr. xx-xxx, or cupric sulphate gr. v-x in a glass of tepid water, or apomorphine gr. T V, hypodermically) ; (2) Catheterize the patient to prevent resorption of the opium from the urine ; (3) Maintain respiration and circula- tion by hypodermics of atropine sulphate gr. ■£-$, repeated in half the amount at the end of 15 to 30 minutes if necessary, the guide to its administration being the respiration. Strychnine, caffeine or cocaine are also recommended. Faradization, cold effusions and arti- ficial respiration are useful. Potassium permanganate has been, of recent years, strongly recommended as an antidote to opium-poison- ing. While it is not probable that it can act on the opium after the latter has been absorbed, yet it is well to employ a solution of the permanganate in washing out the stomach. Post-mortem examination shows no characteristic changes in the organs. How does the action of its alkaloids differ from that of opium ? The action of morphine differs from opium in that the former is less constipating, less of a diaphoretic, and about four times more powerful in other respects. Codeine is uncertain as an anodyne and hypnotic, but appears to possess a sedative effect on the vagus, thus quieting cough and bronchial irritation. The results of experiments with the other alkaloids are so conflicting that no reliance can be placed in them. HYPNOTICS — OPIUM. ( J3 In what diseases is opium used medicinally ? As an anodyne opium or morphine is used in almost all diseases of which pain is a prominent and persistent symptom, and is only contraindicated when acute inflammation of the brain is present. As a hypnotic in delirium tremens (often combined with the bromides or chloral) and in sleeplessness of fevers and other acute diseases ; to allay irritation, especially when accompanied with painful spasm, as in the various forms of colic or in asthma (mor- phine hypodermically) ; in severe acute vomiting (by suppositories) ; to check morbid discharges or restrain peristalsis, as in cholera, diar- rhoea, dysentery, and enteritis. In peritonitis for the latter effect and as an anodyne, large doses are required, a tolerance to opium being established. In puerperal septiccemia, to support the system and as an anodyne it is of great value. As a motor depressant in cerebrospinal fever very large doses are tolerated ; also in urccmic convulsions (dangerous if the renal structure is much diseased), puerperal eclampsia, tetanus, hydrophobia and other affections with increased excitability of the reflex centres. In the early stages of various inflammations, for its influence on the circulation and tendency to retard effusion and re- lieve pain, and as a diaphoretic (Dover's powder) in muscular rheu- matism, the early stages of acute catarrhs, etc. , it is much employed. In diabetes opium and codeine are most reliable drugs to decrease the amount of sugar in the urine. Great caution should be exer- cised in prescribing opium in chronic diseases, as the opium-habit is almost certain to result. Locally opium is applied in solution as anodyne and sedative. What are the preparations and doses of opium and its alka- loids? Opii Pulvis [powdered opium) contains not less than 13 nor more than 15 per cent, of morphine. It is used in making the other preparations. Opium Deodoratum {deodorized opium) contains 14 per cent, of morphine; dose gr. ss-ij (0.032-0.130). Pilule Opii {opium pills), each pill contains of powdered opium gr. j (0.065). Extractum Opii [extract of opium), dose gr. ss (0.032). 94 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Emplastrum Opii (opium plaster) contains the extract with Bur- gundy pitch and lead plaster. Trochisci Glycyrrhiza et Opii {troches of glycyrvhiza and opium — Wistar 's cough lozenges)', each lozenge contains of extract of opium gr. 2V (0.003). Very useful in laryngeal and pharyngeal coughs. Pulvis Ipecacuanha et Opii (powder of ipecac and opium- Dover s powder) is a diaphoretic and anodyne; dose gr. x (0.648), containing of opium and ipecac each gr. j (0.06) with sugar of milk. Tinctura Opii [tincture of opium — laudanum), dose ttlxij or 25 drops (0.74). Tinctura Opii Deodorati (tincture of deodorized opium), dose "Uij (0.74). Tinctura Opii Camphorata (camphorated tincture of opium — paregoric) contains opium, diluted alcohol, oil of anise, benzoic acid, glycerin, and camphor; dose f3j-iv (3.696-14.786). To a young child gtt. iij-xx (0.185-1.232), according to age. Tinctura Ipecacuanha et Opii (tincture of ipecac and opium). This is Dover's powder in a fluid form. Dose nvxij-xx (0.74-1.232). Acetum Opii (vinegar of opium — black drop), dose ttlxij (0.74). VlNUM Opii (wine of opium — Sydenham' s laudanum), dose ntxij (0.74). Morphina Sulphas (morphine sulphate) ; Morphina IIydro- CHLORAS (morphine hydrocMorate) ; MORPHINA Acetas (morphine acetate). The salts are preferred to the pure alkaloid because they are more soluble. Dose of either gr. ?;-] (0.010-0.016) is equal to opium gr. j (0.065). They are well adapted to hypodermic use. Pulvis Morphina Compositus (compound powder of morphine — Tullys powder) contains of morphine sulphate 1 part, with 20 parts each of camphor, liquorice, and calcium carbonate ; dose gr. v-xv (0.324-0.972). Trochisci Morphina et Ipecacuanha (troches of morphine and. ipecac). Each lozenge contains of morphine sulphate gr. - 4 J o, (0.0016) and of ipecac gr. ^ (0.005). Magendieh solution (not official) contains of morphine gr. xvj to the ounce. It is sometimes used hypodermically, but it is better to make a fresh solution of morphine for each injection, as bacteria HYPNOTICS— OPIUM. 95 frequently develop in solutions of the alkaloids when kept for some time, and also because otherwise there is some risk of confusion, as the French Magendie's solution contains about gr. xijss to the ounce. Also the solutions of morphine official in the British Pharmacopoeia do not correspond in strength to either of the above solutions. Codeina (codeine), dose gr. i-ij or even gr. v (0.016-0.130-0.32). What medicines are incompatible with opium ? The alkalies precipitate morphine from solutions of opium and vegetable infusions containing tannic acid form a less soluble t annate of morphine ; many mineral salts are also decomposed by solutions of opium. How is opium administered ? Opium is often administered in the form of the officinal prepara- tions, either alone or combined with other substances. The bro- mides, chloral or other hypnotics are often added to increase its soporific influence ; belladonna, etc. , to enhance its anodyne effects ; lead or other astringent to act more powerfully in intestinal dis- orders ; potassium nitrate, or minute doses of antimony, to increase, while atropine is often combined with morphine to diminish, its action as a diaphoretic. It may be administered by the mouth or rectum (suppositories or laudanum enemata), and its alkaloids may also be given hypodermically. CHLORAL. What is chloral ? Anhydrous chloral is an oily liquid made by saturating absolute alcohol with dry chlorine gas, and is tridWora/fdehyd. By uniting with water, a hydrate, the official chloral, is formed, which occurs as a crystalline solid. What are its physiological effects? Locally applied, chloral is antiseptic and irritant. Given inter- nally, it is a hypnotic, motor depressant and cardiac sedative. In medicinal doses, it causes quiet, natural sleep, contraction of the pupil and deep, regular breathing. After large doses, the sleep is deeper and may even pass into coma, respiration is slowed, the car- diac action is weakened and diminished, the temperature falls, and sensibility and reflex action are depressed. It is not an anodyne. 96 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Nausea and vomiting sometimes occur from its irritant action on the mucous membrane, and in some persons excitement and even delirium may take the place, of the sleep which it usually produces. The continued use of chloral causes chloralism or the chloral habit, and produces an anaemic condition, with weak, irregular heart, irritable temper and loss of self control : a state similar to delirium tremens has been observed. What are the symptoms and treatment of chloral poisoning ? After toxic doses, profound narcosis, great muscular relaxation, slow and very weak pulse, diminished frequency of breathing, marked contraction of the pupil and lividity of surface, with great reduction of body heat, occur. Death is due to paralysis of respiration or to sudden failure of the heart from paralysis of its motor ganglia. The smallest recorded fatal dose is gr. xxx (2.0). The treatment for chloral poisoning consists in (1) maintaining the temperature by artificial heat ; (2) maintaining the cardiac action by atropine in small doses, repeated as required, and (3) maintaining the respiration (partly by the atropine or by morphine, and partly by artificial manipulations). While chloral is the best antidote for strychnine poisoning, the converse does not hold good. What are its therapeutical uses? As a hypnotic, chloral is employed in insomnia, hysterical or maniacal excitement, and in delirium tremens and mania-a-potu, but is contraindicated in any condition where the heart is weak or has undergone fatty degeneration. As a motor depressant in urcemic, infantile or puerperal convulsions, in tetanus, and in poisoning by strychnine, it is of great service, and has been used in whooping- cough and chorea. It is also recommended in sea-sickness (gr. v t. d. ) and to relax a rigid cervix during the first stage of labor. Locally, in diluted solution, it has been used as an anodyne and antiseptic dressing, and, triturated with equal parts of camphor, it forms a valuable liniment in neuralgic and muscular pains. How is chloral administered? The dose of chloral is gr. ij-xx (0.130-1.296), which may be repeated in an hour or two if sleep is not produced. It is better given in syrup. It should not be given with alkalies, which decom- pose it, chloroform and formic acid being formed. HYPNOTICS— THE BROMIDES. 97 What is croton-chloral hydrate? Croton-chhral hydrate (not official), or butyl-chloral hydrate, is made by the action of chlorine gas on ethylic aldehyd, and occurs in small, glittering crystals. Its effects and uses are similar to those of chloral, and as it possesses a very decided anaesthetic influence over the filaments of the trigeminii, it is much used in the neuralgiae affecting the branches of these nerves. Dose gr. v-xx (0. 324-1.296), in glycerin or syrup. CHLORALAMIDE. What is chloralamide? Chloralamide (not official) is a compound prepared by the action of formamide upon chloral. It is soluble in water, but more so in alcohol. Its action is similar to that of chloral, but it is not so certain a hypnotic, and neither depresses the heart nor irritates the stomach and kidneys to the same extent as does the latter drug. It is excreted as urochloralic acid. Occasionally, after the exhibition of large doses, it causes slight poisoning, the symptoms being chilliness followed by a sensation of heat, sweating, arrhythmia, nausea, and sometimes vomiting, with respiratory depression. These symptoms are rarely severe and usually pass off rapidly. It is used as a hypnotic and nervous sedative in the same condi- tions for which chloral is prescribed, and is especially useful in insomnia due to nervous causes, but fails usually when insomnia is due to pain. It is also recommended in sea-sickness. Dose gr. x-xxx (0.65-2.0) given in capsule or solution one hour before its effects are desired. It may be administered by the rectum. CHLORALOSE. What is chloralose ? Chloralose (not official) is formed by heating a mixture of anhy- drous chloral and glucose. It occurs as fine white crystals having an unpleasant, rather sharp taste, and being readily soluble in hot water and alcohol, but only slightly soluble in cold water. While it appears to be a reliable hypnotic, it induces toxic symp- toms readily, apparently by increasing the reflex excitability of the 7 98 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. medulla oblongata, and would at present seem rather difficult to handle, as the toxic dose varies with different individuals, and is smaller in nervous and hysterical patients and in alcoholic subjects. In sufficient doses general convulsions are produced, frequently accompanied by involuntary urination. The toxic symptoms rapidly disappear on discontinuing the drug and appear to leave no serious consequences behind them. It has been used as a hypnotic and analgesic. Dose gr. ij-iij or iv (0. 13-0. 2-0. 25), always beginning with the smaller dose. THE BROMIDES. What are the physiological effects of the bromides ? The bromides are hypnotic and depressors of the reflex spinal centres. Applied locally to the pharynx, they diminish its reflex irritability. Given internally they cause drowsiness and often sleep by inducing a condition of cerebral anaemia, depress the reflex spinal centres and the functions of the end-organs of peripheral nerves, thus lessening nervous irritability, reflex activity and cutaneous sensibility. They also depress the functions of the sympathetic nervous system . In very large doses potassium bromide lessens the cardiac frequency and force, lowers the arterial tension (while contracting the blood vessels), and finally in animals paralyzes the heart in diastole. This seems to be due to the potassium only (which is a cardiac and nerve poison), for the other bromides do not arrest the cardiac action. They slow the respiration and lower the temperature of the body. They are eliminated by the kidneys, skin and mucous membrane. What is bromism ? When taken for a long time they induce a condition known as bromism, the symptoms of which are acne, anaemia, drowsiness, defective memory, malaise, impaired reflexes, malnutrition, loss of sexual power and desire, and often a tendency to melancholia. These symptoms pass away when the drug is discontinued. No case of acute poisoning is on record. What are the medicinal uses of the bromides ? They are used as hypnotics in all forms of insomnia due to cerebral hyperemia, but are contraindicated when anaemia is present. In HYPNOTICS — THE BROMIDES. 99 the early stages of delirium tremens they are of great service. They are also given as depressor motors in local or general convulsions as chorea, urcemic, puerperal, hysterical or infantile convulsions, tetanus, and as an antidote to strychnine poisoning (inferior to chloral). In the treatment of epilepsy they rank among the best remedies. In reflex vomiting, as of sea-sickness or pregnancy, they are of use. In whooping cough ammonium bromide is often efficacious. In mi- graine they are sometimes beneficial. For their influence over the sexual functions they are used to control nymphomania, priapism, and masturbation. Conjoined with ergot they are used to decrease the uterine blood supply in menorrhagia, and are of utility in sub- involution of the uterus. Strontium bromide is said markedly to diminish the amount of sugar in the urine in glycosuria. What are the official bromides ? Potassii Bromidum {potassium bromide), dose gr. v-3j (0.32- 4.0). Ammonii Bromidum {ammonium bromide) has less influence on the circulation, respiration, and temperature than the potassium salt ; dose gr. v-xxx (0.32-2.0). Sodii Bromidum {sodium bromide), dose gr. v-3j (0.32-4.0). Calcii Bromidum {calcium bromide), dose gr. v-3j (0.32-4.0). Zinci Bromidum {zinc bromide), dose gr. j-x (0.065-0.648) (not much used). Strontii Bromidum {strontium bromide), dose gr. iij-x (0.2-0.6). Acidum Hydrobromicum Dilutum [diluted hydrobromic acid), containing 10 per cent, of the absolute acid, is said to possess similar effects to the bromides. It is chiefly used as a hypnotic, and added to quinine mixtures to prevent cinchonism. Dose f3ss-j (2.0-4.0). What medicines are incompatible with the bromides ? Acids and the acidulous and metallic salts are chemically incom- patible with the bromides. They are antagonized by cardiac and vaso-motor stimulants. How may they be administered ? They may be given in powder or in solution in syrup. Zinc bro- mide may be used in pilular form. They are often given together in small doses, and to enhance their hypnotic effect may be com- bined with opium or its alkaloids, chloral or cannabis indica. 100 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. HYOSCINE HYDROBROMAS. What is hyoscine hydrobromate ? Hyoscine is one of the alkaloids found in Hyoscyamus niger, or henbane (q. v. ). It is an efficient hypnotic when used hypoderm- ically, and is employed in the form of hydrobromate in acute mania, alcoholic delirium, and hysteria. Dose gr. gV (0.0008) by the mouth, or hypodermically gr. -^ (0.0005). PARALDEHYDUM. What is paraldehyd ? Paraldeliyd is a colorless liquid with a disagreeable odor and taste, prepared by heating ethyl aldehyd with a mineral acid or with zinc chloride. What are its physiological actions ? In medicinal doses paraldehyd produces sleep closely simulating natural sleep, without affecting the cardiac action. It depresses the reflex centres, especially those of the upper part of the cord, and in toxic amounts depresses and finally paralyzes the respiratory centre, diminishing the amount of carbonic acid exhaled, and lowering the body temperature. It has no anodyne virtues. It often irritates the mucous membranes, and cutaneous eruptions sometimes follow its use. What are its medicinal uses and dose ? It may be given as a hypnotic, where sleeplessness is not induced by pain, as in delirium tremens, hysteria, etc. As a reflex depressor it has been employed in epilepsy, and in animals poisoned by strych- nine has proved antidotal. It is given in doses of f3j (4.0), and should be freely diluted. SULPHONAL. What is sulphonal ? Sulphonal or dional (not official) is a substance prepared synthet- ically and described chemically as diethylsulphon-dimethylmethane. It occurs as heavy, prismatic crystals, colorless, odorless, and nearly tasteless, and is soluble in 100 parts of cold water, but freely soluble in hot water and also in ether and alcohol. What are its physiological and its toxic effects ? The physiological action of sulphonal is not thoroughly under- stood. It acts chiefly on the cerebral centres, depressing them and HYPNOTICS — SULPHONAL. 101 causing sleep. Sometimes, especially after large doses have been taken, it depresses the reflexes, disorders digestion, and causes cutaneous eruptions. In large doses it depresses respiration, render- ing it slow, weak, and, when excessive doses have been taken, ster- torous, and finally producing death by cessation of the respiratory act. It has but little effect on the circulation, and experimenters differ as to its effect upon the blood, the majority believing that it causes no change in that fluid which can be detected by chemical or spectro- scopic analysis. It is probably eliminated in great part by the urine, and frequently changes the color of that excretion to a reddish-brown — a change supposed to be due to the presence of haematoporphyrin, although the coloring-matter differs from the latter on spectroscopic analysis. Disagreeable after-effects sometimes follow the use of sulphonal, as drowsiness, giddiness, headache, and occasionally incoordination of gait, sometimes cutaneous eruptions or disordered digestion, per- haps nausea and vomiting, occur. Sulphonal is by no means an absolutely innocuous drug, and death has resulted from large doses in many recorded cases, from respira- tory failure. The symptoms of poisoning are various, the most common being drowsiness, stupor, muscular incoordination, mental and physical hebetude, depression of reflexes, nausea and vomiting, and usually constipation. Sometimes ataxic nervous symptoms, "diplopia, muscular tremor or paresis, ptosis, oedema of the eyelids, slow and weak (possibly stertorous) respiration, slow pulse, elevation of tem- perature, general anaesthesia, urine changed in color to reddish- brown, diminished in quantity or suppressed, aphasia, and cyanosis" (M. L. Foster). In several cases with recovery which the author has seen the symptoms were drowsiness almost amounting to stupor; mental hebetude ; slow speech ; slight hallucinations ; slow, shallow respi- ration ; slow, weak pulse, and staggering gait with slight cyanosis. In non-fatal cases recovery is usually rapid. Sulphonal is cumula- tive in its action. During its administration it is of the utmost importance that the bowels should be made to act daily (Schulz) and that the urinary secretion should be abundant. 102 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. If symptoms of poisoning appear, the drug should at once be discontinued ; the bowels should be freely opened, saline diuretics administered, and the patient kept in the recumbent position. If there is much depression of the circulation or respiration, stimulants may be administered. What are its therapeutic uses ? Sulphonal is much used as a hypnotic and cerebral sedative in nervous insomnia, and even in melancholia, delirium tremens, and acute mania. In the insomnia of low fevers, as that of typhoid fever, it sometimes gives good results. It has been recommended as a sedative reflex depressant in asthma, hiccough, trismus neonatorum, and in convulsions due to dentition, and has even been used in epilepsy and chorea. It is said that in small doses (gr. viij (0.5)) it is effective in arresting the night-sweats of phthisis, and that in diabetes it will temporarily diminish the amount of sugar excreted in the urine. It is said to be contraindicated in angina pectoris. Dose gr. v-xxx (0.3-2.0), which may be given in capsules, but is better administered dissolved in hot water or milk, two hours at least before the time when its effects are desired. As it is cumulative in its action, it is better not to give more than gr. xxx (2.0) in 24 hours. TRIONAL. What is trional ? Trional (not official) is a sulphone differing from sulphonal in that it contains one atom more of carbon and one less of hydrogen than the latter. Its chemical name is diethylsulphon-methylethylmethane. It occurs as white, odorless, almost tasteless crystals, not very soluble in cold, but readily soluble in boiling water, and also in alcohol and milk. What are its effects and uses ? Trional is a hypnotic, acting more quickly than sulphonal, being easily decomposed in the body, sometimes slightly lowering the pulse and blood-pressure, and rarely leaving any disagreeable after- effects. It is not cumulative. Occasionally after its long-continued use the urine is colored reddish-brown from the presence of haemato- porphyrin. HYPNOTICS — TETRONAL. 103 Toxic doses given to animals cause death from respiratory paralysis. Occasional after-effects are loss of appetite, epigastric pain, nausea and vomiting, vertigo, and unsteadiness of gait. These symptoms usually soon disappear. It is supposed to act directly on the cerebral cortex. Several cases of acute poisoning by trional have been reported ; the symptoms being drowsiness, staggering gait, vertigo, vomiting, diar- rhoea, loss of muscular power, and lowered temperature, sometimes attended with rapid pulse and respiration, excitement, and collapse. Trional is used as a hypnotic in insomnia due to organic cerebral affections, neurasthenia, or other functional psychosis, worry or mental over-work. As a sedative in cerebral excitement it is decidedly inferior to tetronal, and in sleeplessness due to pain it usually fails entirely. It is a " safe and efficient hypnotic for children " when pain is not present (Claus). It has also been recommended in epilepsy, either alone or com- bined with the bromides. Dose xv-xxx (1.0-2.0) about half an hour before its effect is desired. If it is administered for any length of time, it is better to intermit the dose occasionally, in order to guard against any possible cumula- tive effect, and it is important also to insure a daily evacuation of the bowels. TETRONAL. What is tetronal? Tetronal (not official) belongs chemically to the disulphone group, to which also sulphonal and trional belong. It is diethylsulphon- diethylmethane. These three products differ from each other chem- ically only in the number of molecules of ethyl and methyl which they contain. Thus sulphonal contains two molecules each of ethyl and of methyl, and is sometimes spoken of as dional ; trional con- tains three molecules of ethyl and one of methyl, and tetronal con- tains four molecules of ethyl and none of methyl. Tetronal is formed synthetically, and occurs in colorless, shining plates, without odor or taste, soluble in about 500 parts of cold, more soluble in hot water ; soluble also in alcohol and in ether. i04 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What are its effects and uses ? Its effects and uses are similar to those of trional, but it has a more decided sedative effect. Occasionally its administration is followed by disagreeable after-effects, as headache, anorexia, nausea, vomit- ing, vertigo, and even incoordination. It is not decomposed in the system, and is excreted under its own form in the urine. Dose gr. v-xv (0.3-1.0), repeated in an hour if necessary. The best vehicle for its administration is hot milk. When given for a length of time it is better to intermit its use every 3d or 4th night. URETHAN. What are the effects and uses of urethan ? Urethan (not official) or ethyl carbamate is a synthetical product formed by the interaction of ethyl carbonate and ammonia, or by that of urea nitrate and ethyl alcohol, and occurs in crystalline masses readily soluble in water and alcohol. In medicinal doses it causes tranquil sleep, preceded by a short period of excitement. It depresses the reflex centres, at first quickens but soon slows the respiration, and somewhat reduces the temperature, and in over- doses causes, in animals, death from respiratory paralysis. The effect upon the heart is disputed. It is not analgesic. It has been used as a hypnotic in simple insomnia with varied success, and appears to be more applicable to cases where the action of chloral on the heart contraindicates the use of that agent. As a motor dqvessant it has been employed in tetanus, infantile convuhio?is, and puerperal eclampsia. Dose gr. ij-xxx (0.130-2.0). It has been used locally as an antiseptic dressing for wounds. CANNABIS INDICA— INDIAN CANNABIS. What is this drug ? Cannabis Indica is the flowering tops of the female plant of C. sativa or hemp {Nat. Ord, Urticaceae), grown in the East Indies. What are the active chemical constituents of hemp ? The alcoholic extract contains a resin (cannabin) and a volatile oil. It is claimed that several alkaloids have been discovered, but their existence is, as yet, doubtful. HYPNOTICS — CANNABIS INDICA. 105 What are the physiological actions of cannabis ? In full 'medicinal doses it at first stimulates and then depresses the cerebro-spinal functions without affecting respiration or circulation to any marked extent. The mental exhilaration is usually of a pleasurable kind, the pupils are dilated, ideas flow rapidly and con- ception of time and space are so altered that seconds seem hours and objects a few feet off seem miles away ; an active, busy delirium usually occurs and sometimes increase of the sexual appetite ; this is followed by a sense of weight in the extremities, depression of the reflexes, some loss of muscular power and cutaneous anaesthesia, succeeded by sleep. It increases but does not originate uterine con- tractions. No fatal case from its use is recorded. What are its therapeutic uses ? It is used as a hypnotic in mania and in mania-a-potu ; as an anodyne in neuralgia, migraine, dysmenorrhcea, rheumatism, and gout, and to relieve pain in acute and chronic Bright 's disease; as an antispasmodic in tetanus, chorea, hysteria, and spasm of the neck of the bladder ; as an addition to cough medicines to allay irritation of the throat, and to promote a condition of euthanasia in the later stages of phthisis. It is highly recommended in dysentery, and is of undoubted service in checking uterine hemorrhages not due to abortion or following labor. In sexual impotence, when functional, it is sometimes of use. In gonorrhoea it is said to lessen the dis- charge and prevent chordee. As a local application it enters into the composition of many corn-cures. What are its preparations and doses ? Extractum Cannabis Indkle {extract of cannabis Indica), dose gr. f-j (0.016-0.065). Extractum Cannabis Indict Fluidum (fluid extract of can- nabis Ind'tca). dose n\j-x (0.06-0.6). Tinctura Cannabis Indict [tincture of cannabis Indica), dose nixxx (2.0). In using a new sample of cannabis Indica always begin with the minimum dose, as different samples vary much in strength. 106 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. HUMULUS. What are the effects, uses, preparations, and doses of humu- lus? Humulus is the strobiles of H. lupulus or hop vine {Nat. Ord. Urticaceae). Lupulin is a yellow powder found near the base of the strobiles. It contains a volatile oil, choline (formerly called lupuline, a strongly alkaline liquid), lupamaric acid (a bitter princi- ple), resin, etc. Hops are tonic, very feebly narcotic, anaphrodisiac, and diuretic. They are used as a hypnotic in mild forms of delirium tremens, and in restlessness and sleeplessness from overwork ; as an anaphrodisiac in priapism, chordee, nymphomania, and satyriasis; as an anti- spasmodic and sedative in hysteria and neurasthenia; as a diuretic and anodyne in irritation of the bladder, and locally as an anodyne poultice, and as a sedative injection in acute vaginitis. Hop pillows are a popular remedy for sleeplessness due to nerv- ousness. Tinctura Humuli (tincture of humulus), dose f3j-iv (4.0-15.0) or more. Lupulinum [lupulin), dose gr. v-x (0.324-0.648), but not much used in this form. Extractum Lupulini Fluidum [fluid extract of lupulin), dose f'3ss-ij (2.0-8.0). Oleoresina Lupulini (oleoresin of lupulin), dose ^Ix-xxx (0.61-2.0). LACTUCARIUM. What are the effects, uses, and preparations of lactucarium ? Lactucarium is the concrete milk-juice of Lactuca verosa, the garden lettuce (Nat. Ord. Composite), and contains lactucin, which is said to be even more feebly hypnotic than the crude drug. Lac- tucarium is supposed to possess anodyne and hypnotic powers, and has been used as a substitute for opium when the latter is indicated, but cannot, for any reason, be given. Its action, if any, is very mild. Tinctura Lactucarii (tincture of lactucarium), dose ttlx-f3j (0.6-3.6). Syrupus Lactucarii {syrup of lactucarium), dose f3ij-iv (8.0- 15.0). MYDRIATIC ANODYNES— BELLADONNA. 107 ORDER II. — Mydriatic Anodynes. What are the mydriatic anodynes ? The mydriatic anodynes are remedies employed as analgesics and antispasmodics, which possess no hypnotic effect, but cause dilatation of the pupil and, in large doses, a restless delirium. What medicines are included under this head ? Belladonna, stramonium, hyoscyamus, duboisa, coca, and their alkaloids, and antipyrine. BELLADONNA. What is belladonna ? Belladonna is the leaves and root of Atropa Belladonna or deadly nightshade {Nat. Ord, Solanaceae), a European plant, cultivated in this country. What are the chemical constituents of belladonna ? Its properties depend upon an alkaloid called atropine, which exists in the plant as a malate. Both the leaves and the root also contain belladonine (probably oxyatropine), hyoscyamine (sometimes the predominating alkaloid in the leaves and often the only alkaloid in young roots), and atropamine. What are the tests for atropine 1 ? A delicate test is the addition of hydrobromic acid, which pro- duces a yellow, amorphous precipitate, soon becoming crystalline. The physiological test (viz. , the dilatation of the pupil in the lower animals after the local application of the suspected solution) should always be resorted to. What are the physiological effects of belladonna and its alkaloid ? Applied locally to the skin, it is absorbed, lessens the sensibility of the sensory nerves, and produces constitutional effects. Small doses, administered internally, cause diyness of the mouth and throat, with some headache ; after larger amounts, there is difficulty in swallowing, from arrest of the mucous and salivary secretions, the pupils dilate widely, the skin becomes dry and a scarlatinoid rash appears, the cardiac action is accelerated, and an active delirium occurs. In moderate doses, they act as cerebral excitants ; larger 108 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. doses produce hallucinations and impair the excitability of the motor and sensory nerves, thus producing a peculiar delirium in which there is a great desire for constant motion associated with lassitude. The spinal reflex centres are first stimulated, afterward paralyzed, if the amount taken be sufficiently large. It paralyzes the 3d nerves and stimulates the end organs of the syni pathetic, thus dilating the pupil whether used locally or internally ; the power of accommoda- tion is also paralyzed, and after large doses the intraocular tension is lessened. The cardiac action is at first slowed, if the dose be small (from stimulation of the inhibitory centre), but is soon much quickened (from progressive paralysis of the peripheral filaments of the vagus and stimulation of the cardio-accelerator centres or nerves). Large doses paralyze the cardiac muscle. Atropine stimulates the vaso- motor centres and raises the arterial pressure, but after toxic doses the arterioles dilate, from paralysis of their muscular walls, and the blood pressure falls. It first stimulates and then paralyzes the respiratory centre. The temjicrature rises after moderate doses, probably from stimulation of the thermo-genetic spinal centres ; but after toxic amounts have been taken a decided fall of temperature occurs, probably from vaso-motor paralysis. Small doses probably increase intestinal peristalsis, by depressing the inhibitory fibres of the splanchnics, while large doses paralyze the non-striated muscular fibres of the intestines and bladder. It arrests the secretions of the skin, mammary, salivary and muciparous glands, and probably of the liver and pancreas, by paralyzing the terminal filaments of the secre- tory nerves. The intestinal secretions are probably increased, as is that of the kidneys (usually). After large doses, the urine may be entirely suppressed. Atropine is eliminated principally by the kidneys. What are the symptoms and treatment of atropine poisoning ? The pupils dilate so widely that the iris can scarcely be seen ; swallowing is impossible, from dryness of the throat and mouth ; the muscular system is relaxed ; maniacal delirium occurs, with impaired sensation, failing pulse, quickened followed by failing respi- ration, stupor, coma, sometimes convulsions, diminished body heat, and death usually from asphyxia. The treatment consists of: (1) MYDRIATIC ANODYNES— BELLADONNA. 109 evacuation of the contents of the stomach (by emetics or stomach pump), bowels (by cathartics) and bladder (by the catheter), to pre- vent further absorption of the poison; (2) giving tannic acid freely as a chemical antidote ; (3) giving pilocarpine, physostigmine or morphine hypodermically, as partial physiological antagonists, and (4) maintaining the circulation and respiration by electricity and artificial respiration. What are the medicinal uses of belladonna and atropine ? As an anodyne in the various neuralgice, either locally or given by the mouth, rectum or subcutaneously, it is of value, and is often combined with morphine. In muscular rheumatism and in myalgia it is also of service. In conjunctivitis and in iritis it is used locally, not only to dilate the pupil but to lessen pain. As an antispasmodic it is used to relax spasm and allay pain in lead colic, spasmodic dysmenorrhoza, and cramps of the bowel, bladder and urethra ; also to relax the rigid cervix uteri in labor. In asthma, in laryngysmus stridulus and whooping cough it often proves of use. In habitual constipation, a small amount combined with purgatives increases their action by relaxing spasm of the intes- tinal muscular layer and stimulating peristalsis. It is a valuable remedy in the treatment of incontinence of urine in children when given in doses sufficient to produce some constitutional effect. As a cardiac and vaso-motor stimulant in all cases of threatened collapse from heart failure it is advantageously employed, and has been highly recommended to contract the blood-vessels in acute in- flammatory affections generally. To check excessive secretion, as in salivation, excessive sweating, especially the night-sweats of phthisis, and in colliquative diarrhoea, it is of great value, and is a well-known galactafuge, being used internally and applied locally for this pur- pose. As a respiratory stimulant in opium poisoning atropine is of great service, and may be used in cases of poisoning by other sub- stances attended with failure of respiration. Locally, belladonna is used as an ointment, liniment or plaster for the relief of pain in neuralgia, myalgia and muscular rheumatism ; to allay cardiac palpitation; to relax spasmodic stricture of the urethra (applied on a bougie or given by suppository), and as a galactafuge. In ophthalmic practice a solution of atropine (gr. ^-iv 110 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. (0.003-0.25) to water f3j (4.0)) maybe dropped into the conjunc- tival sac to dilate the pupil and to paralyze accommodation, so that an examination can be readily performed or the refraction of the eye determined. In various inflammations of the ocular apparatus, as conjunctivitis, keratitis, iritis, etc., it is used to lessen pain and diminish the blood-supply to the inflamed parts. What are the preparations and doses of belladonna ? Extractum Belladonna Foliorum Alcoholicum (alcoholic extract of belladonna leaves), dose gr. $-ss (0-008-0.032) in pill or suppository. Extractum Belladonna Radicis Fluidum (fluid extract of belladonna root), dose rr\J— ij (0.061-0.12). Tinctura Belladonna [tincture of belladonna), dose tt[v-xxx (0.3-2.0). Linimentum Belladonna [liniment of belladonna) contains 95 per cent, of the fluid extract and 5 per cent, of camphor. Unguentum Belladonna [ointment of belladonna) contains 10 per cent, of fluid extract. Emplastrum Belladonna [plaster of belladonna). Atropina [atropine), usually employed in the more soluble form of Atropina Sulphas [atropine sidphate), dose gr. Tho~wo (0.0005-0.001). What substances are incompatible with belladonna ? Alkalies precipitate atropine from solutions of belladonna, and tannic acid forms with it atropine tannate, a less soluble salt. What is homatropine hydrobromate ? It is a non-official salt of an alkaloid derived artificially from atro- pine. It differs from atropine in dilating the pupil more rapidly and much more transiently, in not causing much constitutional dis- turbance when used locally for this purpose, and in slowing, not accelerating, the heart's action. It is used as a substitute for atropine in ocular therapeutics. MYDRIATIC ANODYNES — HYOSCYAMTJS. Ill STRAMONIUM. What are the source, composition, action and uses of stra- monium ? Stramonium is the leaves and seeds of Datura Stramonium, thorn- apple, Jamestown weed or gypsum {Nat. Ord. Solanacese), a com- mon indigenous plant. It contains an alkaloid called daturine, iso- meric with atropine and having the same action. As this is the active principle of stramonium, the effects of the latter are identical with those of belladonna, and it may be used for the same purposes. The leaves have been made into cigarettes and smoked to avert a threatened paroxysm of asthma, and it has been used externally as a poultice or as ointment to painful ivounds, external inflamma- tions, hemorrhoids and fissure of the anus. The officinal prepara- tions (all made from the seed) are : — Extractum Stramonii Seminis {extract of stramonium seed ), dose gr. ss (0.03). Extractum Stramonii Seminis Fluidum {fluid extract of stramonium seed), dose tt\j-v (0.06-0.3). Tinctura Stramonii Seminis {tincture of stramonium seed), dose TiLv-xv (0.3-1.0). Unguentum Stramonii {ointment of stramonium) contains 10 per cent, of the extract. HYOSCYAMUS. What is hyoscyamus ? Hyoscyamus is the leaves and flowering tops of H. niger, or hen- bane (Nat. Ord. Solanaceae), a native of Europe. What does it contain ? It contains two alkaloids, hyoscyamine and hyoscine (identical with scopolamine) both of which are isomers of atropine and daturine. What are the physiological effects of hyoscyamus and its alkaloids ? Hyoscyamine appears to be identical in action to its isomer atro- pine, but feebler and less irritant. It does not dilate the pupil as rapidly; sometimes retards, sometimes quickens the heart's action; and at first quickens, then slows the respiration. Hyoscine causes dryness of the mouth and throat, flushing of the 112 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. face, sleep, slow respiration, and in large doses slow, full pulse, muscular weakness, incoordination, diaphoresis, and, it is said, a rise in temperature. The treatment of poisoning by hyoscine con- sists in the administration of alcoholic stimulants and coffee or caffeine ; in artificial respiration ; in the use of faradism, and per- haps the cautious use of physostigmine. Hyoscyamus combines the action of its alkaloids, differing from that of belladonna in proving hypnotic. What are the uses of hyoscyamus and its alkaloids ? Hyoscyamus has been used as a substitute for belladonna in the diseases in which the latter is employed. It has also been used as a hypnotic in various forms of insanity, in delirium tremens, and in hysteria. Added to purgatives it enhances their efficacy and pre- vents griping. Hyoscyamine has been found useful as a sedative to the nervous system in insanity ; to lessen spasm and allay pain in vesical tenes- mus ^ and in irritable bladder ; and, to prevent griping, as an addi- tion to purgatives. It has sometimes proved useful in chorea. Hyoscine is used as a cerebral sedative and hypnotic in maniacal excitement, but should only be employed temporarily, and then only in cases where excitement is a prominent symptom. In melancholia it has proved useless or injurious. Cases do not do well under its continued use. It may be employed to produce sleep when mor- phine or chloral is contraindicated in advanced renal disease and in cases of weak heart. To produce hypnotic effects it should be administered hypodermically. It has been found efficacious in paralysis agitans and in various forms of tremor. Disagreeable after-effects are rare. What are the preparations and doses of these substances ? Extractum Hyoscyami (extract of hyoscyamus), a preparation of uncertain strength; dose gr. j-ij (0.065-0.13). Extractum Hyoscyami Fluidum^mmZ extract of hyoscyamus), doset^v-x (0.3-0.6). Tinctura Hyoscyami [tincture of hyoscyamus), dosef3ss-j (2.0- 4.0). HYOSCYAMlNiE Sulphas [hyoscyamine sulphate), dose gr. ^l^- MYDRIATIC ANODYNES-COCA. 113 t*b (0.0006-0.0013) to begin with ; much larger doses may be given with impunity. Hyoscyaminje Hydrobromas [hyoscy amine hydrobromate), dose gr. y^Wo (0.0006-0.0013). Hyoscin^e Hydrobromas [hyoscine hydrobromate), dose gr. t%tj-£u (0.0006-0.0008) ; if given hypodermically, dose gr. T io _ T&u (0.0001-0.00064) to begin with, but much larger doses may be used. DUBOISIA. What is duboisia ? Duboisia (not official) is the leaves of D. myoporoides (Nat. Ord. Solanacese), a shrub of Australia. It contains an alkaloid, called duboisine, which is isomeric with atropine. Locally applied to the conjunctival sac it paralyzes accommodation and dilates the pupil more rapidly but for a shorter time than does atropine, and is less irritating. Given internally it dilates the pupil, stimulates the respiratory centre, and depresses the inhibitory cardiac ganglia, thus causing increase in frequency both of the respiration and cardiac action. It is used as a substitute for atropine in ophthalmic practice. COCA. What is coca ? Coca is the leaves of Erythroxylon Coca {Nat. Ord. Lineae), a shrub of Peru. - What does it contain ? It contains an alkaloid called cocaine combined with cocatannic acid. What are the physiological effects of erythroxylon ? Coca is a cerebral stimulant, producing a sense of calm and well- being, followed, if the dose is large, by a pleasant delirium. It lessens the sense of fatigue and of hunger, but does not take the place of food. Small doses appear to slow, while large quicken the pulse and cause an elevation of temperature. It diminishes the amount of urea excreted. Large doses cause, also, muscular weak- ness, drowsiness, and finally deep sleep. When taken in large doses habitually it causes disordered digestion, enfeeblement of the in- tellectual powers, emaciation, ascites, and death from marasmus. 8 314 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Cocaine produces similar effects. It is a cerebral stimulant, caus- ing delirium in large doses followed by epileptiform convulsions and coma if the dose has been excessive. It first stimulates, then de- presses the reflex spinal centres. Toxic doses depress and finally paralyze the nerves, these effects being more marked on the nerves of sensation. The effect on the circulation is disputed, but in small doses it increases the strength and frequency of the cardiac contrac- tions. It acts as a powerful stimulant upon the respiratory centre, but in large doses paralyzes it, the heart continuing to beat after the breathing has stopped. Injected hypodermically into the superficial tissues it causes local anaesthesia ; if a deep injection is given a slight general lessening of sensibility, dilated pupils, a slight rise in tem- perature with strong cardiac contractions result. Locally applied it causes marked anaesthesia of the surface with which it comes in contact, with some diminution of sensibility of the deeper structures. There is at first local pallor from contraction of vessels, followed by redness. Applied to the conjunctiva it dilates the pupil (which may, however, be contracted by eserine) transiently, lessens without entirely suspending the power of accom- modation, and lowers ocular tension. In toxic doses cocaine causes symptoms varying much in different persons. The most common symptoms are stimulation of the mental faculties ; loquacity ; incoherence ; depression of temperature accom- panied by profuse sweating; shallow, irregular respiration; feeble pulse; dilated pupils and disturbed vision; nausea and collapse. Sometimes there is intellectual torpor with tonic or clonic convul- sions. Sometimes the mental excitement is almost maniacal. Respiratory disturbances are always marked, in severe cases being of the Cheyne-Stokes type, and the sufferer may die from respira- tory paralysis. Individual susceptibility to the drug varies greatly, and even persons who have used it before without inconvenience may experi- ence a toxic effect from a dose of the same size as that which they had before taken. Even weak solutions applied to a mucous membrane occasionally produce alarming symptoms. The treatment of poisoning by cocaine consists in inhalations of amyl nitrite and chloroform ; ammonia should be given internally, and artificial respiration resorted to and continued for a long time. MYDRIATIC ANODYNES— COCA. 115 Opium, or morphine, and chloral may be used if convulsions occur. What are the medicinal uses of coca and its alkaloid? Coca is not much employed in medicine. It may be given as a stomachic tonic in wasting diseases, as in phthisis. Cocaine is principally used as a local anaesthetic (2 to 10 per cent, solution), in operations on the various mucous membranes, particu- larly those of the eye, nose, mouth, pharynx and larynx, but also to those of the vagina, rectum and urethra. Injected into the super- ficial tissues it diminishes sensation sufficiently to allow of the per- formance of many operations in minor surgery, particularly if its diffusion is prevented by compressing the circulation of the part. In ophthalmology it is useful both for this purpose and from its rapid and transient mydriatic effect. To relieve pain and contract the blood vessels in the early stages of acute catarrhal inflammations, as coryza, hay fever, laryngitis and bronchitis ; to deaden sensation and thus lessen reflex cough in per- tussis, influenza, advanced phthisis and chronic laryngitis, it may be used in spray, or directly applied to the part by a brush. It has also been used as a hemostatic, applied to the mucous membranes, sspecially to the nasal mucous membrane, previous to an operation. It is highly recommended to allay the burning and itching of rhus poisoning. Internally it has been employed in gastrodynia, ner- vous dyspepsia, and to check reflex vomiting, as that of pregnancy or of sea-sickness (by the mouth or injected into the epigastric region), as a cardiac tonic in low fevers, and as a substitute for mor- phine in persons accustomed to the habitual use of the latter alka- loid. When used for this purpose the cocaine habit is apt to be formed, but can apparently be broken off suddenly without danger to the patient. What are the preparations and doses of coca ? Extractum Coo® Fluidum {fluid extract oferythroxylon), dose f3ss-ij (2.0-8.0). Cocaine Hydrochloras (cocaine hydrochlorate), dose gr. £-J (0.016-0.06). 116 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. ANTIPYRINE. Is antipyrine a mydriatic anodyne ? Antipyrine and other members of the antipyretic group are anodynes of considerable power, as has already been stated, and in large doses dilate the pupil, but are not used as mydriatics. ORDER III. — Anaesthetics. What are anaesthetics ? This name is applied to a group of medicines, the vapor of which when inhaled causes a temporary loss of sensibility to painful im- pressions {analgesia), with diminution and finally abolition of general sensation and reflex action, and lastly, complete loss of conscious- Name the agents of this group. Ether, chloroform, nitrous oxide, methylene bichloride, ethyl bromide and bromoform. AETHER— ETHER. What is ether? Ether is ethyl oxide, obtained by the distillation of alcohol with sulphuric acid. It is a colorless liquid, with a strong, disagreeable odor, and a hot, burning taste, and evaporates rapidly at ordinary temperatures. Its vapor is heavy — more than two and a half times as heavy as the atmosphere — and is very inflammable. What are its physiological effects ? When applied locally ether produces a feeling of coldness by its rapid evaporation, thus obtunding the sensibility of the part, and if the application be continued the part may be entirely frozen. When the vapor of ether is inhaled a sense of burning is experi- enced in the throat, followed by a feeling of suffocation and an irri- tative cough ; then comes a stage of stimulation, during which the action of the higher nerve centres is more or less interfered with, there is a feeling of lightness in the head and buzzing in the ears, and the circulation is quickened ; this passes into the narcotic stage, the patient becoming delirious and laughing, weeping, moaning, talking, singing or fighting. The face is suffused, the eyeballs in- jected and often protruding, the veins turgid, sensibility is dimin- ANESTHETICS— ETHER. 117 ished, and tonic contractions of the muscles are often present. If the inhalation is continued the stage of anaesthesia soon supervenes, in which the functions of the spinal cord are influenced ; thus, there is not only complete insensibility, but also entire abolition of the reflexes. This stage may be continued indefinitely by care Pally regulating the inhalation. If, however, too much be given, the stage of paralysis ensues, in which the reflex centres of the medulla oblongata are paralyzed and the respiration and circulation cease. Stertorous respiration, from paralysis of the muscles of the palate, is the first indication of the approach of this stage. During the inhalation of ether the pupils at first contract slightly, afterward slightly dilate, but always respond to light. Sudden, wide dilatation is a sign of danger. The pulse is increased in frequency during the early stages of ether inhalation, afterward returning gradually to about the normal. The arterial pressure is increased, due principally to contraction of the peripheral capillary vessels and to the increased power of the cardiac beat. During the stage of paralysis the pressure falls when respiratory failure begins. In the first stage the respiration is increased both in frequency and depth, becoming much more shallow in the second stage, but again becoming deep and even stertorous in the third stage, and finally ceasing if the etherization be continued into the fourth stage from paralysis of the respiratory centre, the heart continuing to pulsate after the arrest of the respiratory movement. The after-effects are headache, vomiting, and a taste of ether in the mouth. Some hours elapse after profound anaesthesia before the patient fully regains the use of his mental faculties. Taken internally ether increases the secretions and is a cerebral and cardiac stimulant, being similar in its action to alcohol. It is rapidly eliminated by the lungs. What are the therapeutical uses of ether ? 1. As an anaesthetic, ether is employed by inhalation for the pre- vention of pain during surgical operations and examinations, and during the passage of renal or biliary calculi. For these purposes the inhalation should be carried to the third stage — that of complete anaesthesia. To alleviate suffering during labor ether is often ad- 118 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. ministered, but here it should only be inhaled during the pains, and the stage of complete anaesthesia is rarely required, unless some obstetric manipulations, as version, the application of the forceps, or craniotomy is necessary, or when it is desirable to prevent the patient from "bearing down," either from fear of laceration of the soft parts, or of the strain on the circulation in cardiac disease, or where thorough relaxation of a rigid cervix uteri is desired. 2. As a reflex depressant it is inhaled in various forms of convulsions during the paroxysms, and to promote the reduction of a hernia, or aid in diagnostic manipulations by relaxing tensely contracted muscles. In persistent hiccough it is sometimes successful when given internally, or may be used by inhalation to check the paroxysm. 3. As a car- diac stimulant it may be given hypodermically or by the mouth in cases of syncope or threatened cardiac failure. 4. It is sometimes used as a tceniackle ; and, 5. it has sometimes proved useful as an anodyne in neuralgia (injected in the vicinity of the nerve), and in nervous headache (given internally). 6. Locally it is employed to relieve pain in neuralgia, myalgia, muscular rheumatism and before the performance of minor surgical operations. What cautions should be observed in administering ether ? As ether is highly inflammable, it should not be administered by inhalation at night near a candle or gas light, nor near an open fire or very hot stove. If a light is in the room it should be placed as high as possible above the patient, as the vapor of ether sinks toward the floor. Ether is contraindicated in advanced pulmonary disease, and should be cautiously administered, if at all, in cases of cerebral tumors, grave renal disease and excessive exhaustion of the nerve centres. In cardiac diseases it is the safest anaesthetic and may be cau- tiously employed. How should alarming symptoms be treated ? (1) Stop the inhalation and lower the head ; (2) dash cold water on the face and chest and allow the patient plenty of fresh air; (3) use artificial respiration, make rhythmic tractions of the tongue at the rate of about 20 per minute, give atropine, strychnine, or nitro- glycerin hypodermically ; and (4) apply the faradaic current to the thoracic muscles. ANESTHETICS— CHLOROFORM. 119 What are the official preparations of ether and how are they administered ? iETHER [ether— aether fort io r, U. S. P. 1880) contains about 96 per cent, by weight of absolute ether or ethyl oxide in alcohol and water ; dose n\, v -f3j (0.31-3.70). Spiritus iETHERis [spirit of ether-) contains 32.5 per cent, of ether in alcohol; dose irUv-f'Sj (0.92-3.70). When ether is administered by inhalation the patient should be, if possible, in the recumbent position, and, the nose and throat having been sprayed with a 10 per cent, solution of cocaine (Rosen- berg of Berlin), f^ss (15.0) may be poured on a napkin or sponge placed in a cone of stiff paper, which is then applied to the patient's mouth and nose, and kept there continuously, only removing it momentarily from time in time to add more ether, until the desired effect is produced. The anaesthetizer should pay the strictest attention to the condi- tion of his patient, watching closely the effect on the respiration and on the circulation as shown by the pulse and by the color of the skin or conjunctival mucous membrane. Ether inhalations are better administered on an empty stomach, as the after-effects, especially the tendency to vomiting, are thus lessened. Spraying the nose and throat with cocaine, as mentioned above, is said to increase the safety of the patient during the anaesthesia, and certainly prevents the coughing, gagging, and vomiting which otherwise usually accompany the action of the anaesthetic, and lessens the vomiting, headache, and persistent taste of ether which so often follow its use. CHLOROFORMTTM — CHLOROFORM. What is chloroform ? Chloroform is methenyl chloride or formyl terchloride, and is ob- tained by distilling alcohol with chlorinated lime and slaked lime. It is a limpid, colorless liquid, having a pleasant ethereal odor and an acrid, sweetish taste. It is soluble in alcohol and the oils, but is not very soluble in water. 120 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What are its physiological effects ? Applied locally it is to some extent anaesthetic ; if evaporation be prevented it is an irritant and even a painful vesicant. It assists the absorption of organic alkaloids by the skin, which otherwise wonld not penetrate the epidermis. When the vapor of chloroform is inhaled anaesthesia and unconsciousness rapidly result. The stage of stimulation is not as well marked as in the case of ether inhalation ; the narcotic stage is usually short in duration and the struggles of the patient are, as a rule, not violent. The pulse is quickened and apparently strengthened until the stage of anaesthesia, when with the abolition of consciousness and sensation and muscular relaxation it diminishes slightly in frequency and is more or less weak. The stage of paralysis is one of imminent danger. In addi- tion to the symptoms of the anaesthetic stage, there is stertorous breathing, entire abolition of the reflexes, with a weak and rapid pulse, and finally death, usually from cardiac paralysis* When swalr lowed in small doses it stimulates the secretions and increases peri- stalsis. In large amounts it is an irritant, causing gastro-enteritis, and after its absorption producing anaesthesia and coma. It is elimi- nated by the lungs and kidneys. How do the physiological actions of ether and chloroform compare ? Ether is the safer anaesthetic ; chloroform the more rapid, more transient in its effects, which are produced by smaller amounts, pleasanter, less irritating, and with less disagreeable after-effects. It does not cause so much vomiting, and its vapor is not inflammable. Death from ether (rare) is usually the result of respiratory paralysis and is gradual, while death from chloroform (much more frequent) is usually sudden, and is due to cardiac failure. What are the therapeutical uses of chloroform ? It has been used as an anaesthetic by inhalation in the same range of cases in which ether is given, but its employment for this pur- * The Hyderabad commission concluded, from their very elaborate experi- ments upon dogs, that death always occurs from respiratory paralysis, a con- clusion which at present is not in accord with clinical observation. The author has therefore adhered to the older view as to the mode of death under chloroform. ANESTHETICS— CHLOROFORM. 1 2 1 pose is now very generally limited to diseases like puerperal eclamp- sia, in which it is necessary rapidly to produce anaesthesia and de- press reflex action. In obstetric practice it is largely used, but even here ether is safer. Administered internally it has proved service- able in cholera, protracted diarrhoea, and various forms of colic. It has also been used as a tceniacide. Given before the expected chill of malarial fevers it frequently aborts the paroxysm. Deep injec- tions in the vicinity of the affected nerve sometimes afford relief in obstinate neuralgia. Locally as an anodyne it is employed in the form of liniment in muscular pains and in neuralgic affections. Its contraindications as an anaesthetic are identical with those of ether, and in addition it should never be administered when any disease of the circulatory system exists or if the heart is feeble from any cause whatsoever. How should the occurrence of dangerous symptoms be met ? Stop the inhalations ; invert the patient ; artificial respiration ; fara- dization ; and atropine, strychnine, or nitroglycerin hypodermically. If it has been administered internally, treat the case as one of irritant or narcotic poisoning. What are the official preparations, and how may they be administered ? Chloroformum {chloroform), dose WLxv-fSj (1.0-4.0) in emulsion. As an inhalation, 20 drops of chloroform may be poured on a folded napkin and placed cautiously over the nose and mouth in such a manner that the vapor is freely diluted with atmospheric air Not more than 3? per cent, of chloroform should be contained in the air inspired. Aqua Chloroformi (chloroform ivater), dose f3j-jv (4.0- 15.0). Spiritus Chloroformi [spirit of chloroform), dose f3ss-ij (2.0-8.0). Emulsum Chloroformi (emulsion of chloroform), dose f^j-ij (4.0-8.0). Linimentum Chloroformi [liniment of chloroform) contains chloroform 30 per cent, in soap liniment. 122 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. NITROUS OXIDE. What is nitrous oxide ? Nitrous oxide (not official) or nitrogen monoxide is a colorless, almost odorless gas, made by the action of heat on ammonium nitrate. What are its physiological actions ? When nitrous oxide is inhaled in from one to three minutes com- plete anaesthesia occurs with loss of consciousness, often preceded by a stage of excitement ; the face is livid and the patient presents the appearance of asphyxia. The anaesthesia is probably due to diminu- tion in the relative amount of oxygen in the blood. When the inhalation is discontinued, consciousness and sensation speedily return, and as a rule no after-effects are manifested. When death results it is generally due to asphyxia. What are the therapeutics and the mode of administration of nitrous oxide ? As an anaesthetic in minor surgical operations of short dura- tion, as the extraction of teeth or the opening of abscesses, it is advantageously employed, but when the operation necessitates the maintenance of anaesthesia for some time, ether is a safer agent. It is best administered from an india-rubber bag, connected with an iron reservoir, containing at least eight gallons, furnished with a mouth-piece having two valves, so that the expired air may not pass back into the bag. METHYLENE BICHLORIDE: ETHYL BROMIDE: BROMOFORM. What are these substances ? Methylene bichloride (not official) is a neutral, colorless liquid, resembling chloroform in odor. Its vapor is inflammable. When inhaled it rapidly produces anaesthesia and unconsciousness, and these effects as rapidly disappear when the inhalation is discon- tinued. Death is due to cardiac paralysis. It is not much employed in this country. Ethyl bromide (not official) is a colorless, neutral liquid, having an ethereal odor and a disagreeable, sweetish taste. When inhaled LOCAL ANAESTHETICS. 123 it is anaesthetic, acting on the heart like chloroform, and seems to be fully as dangerous. Bromoform (not official) is a heavy liquid with an agreeable taste and smell. Its effects resemble chloroform, but are slower. It is not much used as an anaesthetic. As an antispasmodic it has been used in pertussis in doses of gtt. ij-v (0.12-0.3) t. i. d. LOCAL ANESTHETICS. What are local anaesthetics ? They are remedies which produce an anaesthetic effect limited to the particular part to which they are applied. What are the indications for their employment, and what are the objections to their use? They are employed whenever it is necessary to obtund the pain in a part, either caused by disease or induced by a surgical operation, and when it is not necessary for any reason that the patient should lose consciousness. They are generally made use of prior to minor surgical operations for the avoidance of pain, although they have also been employed for the same purpose before major operations, as amputations. In such cases, however, it is often advantageous to have the patient unconscious, as the knowledge of what is being done, even in the absence of pain, may prove injurious by causing nervous per- turbation or by allowing the patient to interfere with the operator. They are objectionable in some cases on account of the anaemia which they produce, as during the reaction the resulting hyperaemia may be sufficiently intense to cause hemorrhage, or occasionally inter- fere with the healing process. How is local anaesthesia produced ? Either by freezing the part which it is desired to anaesthetize, or by the application to, or injection into it of an anaesthetic drug. How may a part be frozen for such a purpose, and what are the agents employed ? The part may be frozen by the direct application for a few minutes of a freezing mixture such as powdered ice and salt, or by spraying it with a very volatile liquid, such as rhigolene, ether, or ethyl chloride. 124 ESSENTIALS OP MATERIA MEDIC A AND THERAPEUTICS. What are these substances, and how are they used ? Rhigolene (not official) is a very volatile and inflammable liquid obtained in the distillation of petroleum, and is used in the ordinary hand-atomizer. Ether has already been spoken of as a local anaesthetic. Ethyl Chloride (not official), or hydrochloric ether, is a very volatile liquid, which is sold in glass bottles having a minute orifice against which a tightly fitting stopper, moved by a small lever, is kept constantly pressed by means of elastic bands. When it is desired to use it the lever is pressed down, the orifice of the bottle passed rapidly over the part to be anaesthetized at a short distance from it, and the heat of the hand volatilizing the liquid in the bottle, the part is soon frozen by the spray. These agents are used as local anaesthetics in all minor surgical operations, such as opening abscesses or felons, the extraction of ingrowing toenails, paracentesis thoracis or abdominis, and are sometimes used to numb the.pazM.of headache and neuralgia. What drugs are employed topically or by hypodermic injec- tion for this purpose ? Cocaine (vid. Mydriatic Anodynes) is used locally as has already been mentioned, applied to the conjunctival, to the nasal, and to other mucous membranes as a local anaesthetic. It is also used by injection into the skin for the same purpose. When this is desired the part is first sprayed with ethyl chloride, and as soon as sensibility is obtunded the needle of the hypodermic syringe is inserted and a few drops of the cocaine solution instilled just beneath the integument. By injecting the solution in front of the point of the needle, which is then pushed further into the anaesthet- ized area, and a few more drops inserted, it is possible gradually to anaesthetize quite a large surface. By casting a ligature around the part and thus preventing the cocaine from passing out by the blood current, this anaesthetic action may be prolonged. By this or similar means local anaesthesia has been maintained for periods considerably over an hour, during which operative procedures of some magnitude have been performed. It is probably better, however, to employ general anaesthesia for major surgery unless LOCAL ANAESTHETICS. 125 there is some contraindication to its employment, and to restrict the anaesthetic use of cocaine to minor surgery. Eucaine (not official) has been highly recommended as a local anaesthetic. The hydrochloride is used, and occurs as brilliant color- less crystals, readily soluble in water (which is not the case with eucaine itself). It is much more stable than cocaine, uot even decomposing when kept in solution. Locally applied to mucous membranes in 2 to 5 per cent, solutions it causes anaesthesia, but it neither dilates the pupil nor causes ischaemia, as does cocaine, when applied to the conjunctiva. In fact, it appears to favor hyperaemia and does not interfere with the pupil reflex. It is said to produce a primary reduction in the cardiac frequency when given internally. In animals after large doses there is general nervous excitement fol- lowed by paralysis, sometimes preceded by tonic and clonic convul- sions. The blood-pressure falls and finally death occurs from respira- tory failure. No toxic symptoms have been reported as occurring in the human subject. It has been used as a substitute for cocaine to produce local anaesthesia, and may be employed in solutions of the strength of 2 to 5 per cent. It has also been injected subcutaneously in the same manner as cocaine prior to the opening of abscesses or the removal of small tumors. It is said that as much as gr. xxx (1.9) has been used subcutaneously for this purpose without ill effect. Menthol (official) is a " stearopten (having the character of a secondary alcohol), obtained from the official oil of peppermint (from Mentha piperita), or from Japanese or Chinese oil of peppermint (from Mentha arvensis" u and Mentha canadensis," Nat. Orel. Labiatae). It occurs in the form of colorless, acicular or prismatic crystals, having a strong and pure odor of peppermint, and a warm, aromatic taste, followed by a sensation of cold when air is drawn into the mouth, and being only slightly soluble in water, but freely so in alcohol, ether, and chloroform. Menthol is a superficial, local anaesthetic. Given internally to animals in sufficient doses it depresses both the sensory and motor nerves, lowers the temper- ature, and depresses the respiration, which becomes slow and shallow. 126 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. It is chiefly used as a local anaesthetic painted or sprayed on the part in ethereal or alcoholic solutions varying in strength from 10 to 50 per cent. , in cases of neuralgia, toothache, and other superficial pains. The author has seen the burning pains which often follow herpes zoster quickly relieved and often permanently cured by a few applications of a 50 per cent, alcoholic solution. Urticaria and senile pruritus may be temporarily relieved by the application of a 10 per cent, solution in albolene. It is also used with lanolin as an ointment, and has been used as an antiphlogistic remedy in super- ficial inflammations of the skin and mucous membranes. Guaiacol (not official), which has been considered among the antipyretics (q. v.), is also used as a local anaesthetic in neuralgice, especially in sciatica, and in rheumatic pains. Various other remedies, among which may be mentioned Tincture of Aconite {via 1 . Cardiac Sedatives), have been used locally in neuralgia for their local anaesthetic effect. ORDER IV. — Antispasmodics. What are antispasmodics ? Antisjxismodics are remedies which prevent or allay spasmodic action of voluntary or involuntary muscles by increasing the inhibit- ing power of the higher over the lower nerve centres. Name the antispasmodics. Musk, valerian, the valerianates, asafcetida, camphor, ethereal oil, and Hoffman's anodyne, cypripedium, and Scutellaria. MOSCHUS— MUSK. What is musk? Musk is the dried secretion from the preputial follicles of Moschus moschiferus, or musk deer. What are its effects and uses ? Musk is a mild cerebral stimulant and antispasmodic, slightly increasing the cardiac frequency. In cases of nervous exhaustion, however, it acts more powerfully, and when a pure article can be obtained no better nervous stimulant can be employed in the later stages of typhoid fever with great depression of vital forces, and in typhoid pneumonia. It is also of use in hysteria, hiccough, and chorea. ANTISPASMODICS— AS AFETIDA. 127 What are the preparations of musk ? Moschus (musk) is very expensive and is often adulterated, and imitations are not infrequently substituted for the genuine article ; dose gr. x-xv (0.65-1.0) in capsule or emulsion. It is often given per rectum. Tinctura Moschi [tincture of mush), dose £3j-ij (4.0-8.0). VALERIANA — VALERIAN. What is valerian, and what does it contain ? Valerian is the rhizome and roots of V. officinalis or wild valerian (Nat. Orel. Valerianeae). It contains a volatile oil and a colorless volatile acid (valerianic). What are the effects and uses of valerian ? Large doses of valerian may cause nausea, vomiting, and some- times colicky pains. It slightly stimulates the brain and circulation, and increases the secretions of the skin and kidneys. Its effects are more decided in nervous excitement due to depression of the cerebral functions, as in hysteria or " nervousness," and in hypochondriasis. It has also been used as a cerebral stimulant in the delirium of low fevers and in delirium tremens. What are the preparations and doses of valerian? Extractum Valerianae Fluidum (fluid extract of valerian), dose f3j (4.0). Tinctura Valerianae (tincture of vederian), dose f3.j (4.0). Tinctura Valerianae Ammoniata (ammoniated tincture of valerian), dose f3j-ij (4.0-8.0). Ammonii Valerianas (ammonium valerianate) is much used in hysteria, neuralgia, and nervous headache ; dose gr. ij-x (0.13-0.65) in capsules or elixir. Iron valerianate and quinine valerianate have already been con- sidered ; zinc valerianate will be noticed under the zinc preparations. ASAFCETIDA — ASAFETIDA. What is asafetida, and of what is it composed ? Asafetida is a gunk-resin obtained from the root of Ferula foetida ( Nat. Ord. Umbelliferae), a native of Afghanistan. It is composed of a gum-resin united to a volatile oil. 128 ESSENTIALS OF MATEIUA MEDIC A AND THERAPEUTICS. What are its effects and uses? It is a gastric stimulant and carminative, and produces a sense of exhilaration. It increases the mucous secretions and peristalsis, and in large doses quickens the pulse and respiration. Very large doses may cause nausea and vomiting. It is used as an antispasmodic in hysteria and nervous exhaustion ; as a carminative in tympanites (by the rectum); as a stomachic tonic in dyspepsia with flatulent colic, and as an expectorant in chronic bronchitis and in whooping-cough, where it also acts as an antispasmodic. What are its preparations and doses ? Emulsum Asafcetid^e (emulsion of asafetida — lac asfoetidce), dose fgss-j (15.0-31.0), or as an enema f^ij-iv (62.0-124.0). Piluue Asafcetid^e (pills of asafetida), each pill containing gr. iij (0.2) of asafetida; dose No. ij-iv. Tinctura Asafcetid^e (tincture of asafetida) contains 20 per cent, of asafetida; dose f3ss-j (2.0-4.0). Pilule Aloes et Asaf(Etid^e (pills of aloes and asafetida), each pill contains of aloes, asafetida and soap gr. j£ (0.09) each. CAMPHORA— CAMPHOR. What is camphor? Camphor is a stearopten, derived from Cinnamomum Camphora, or camphor laurel {Nat. Ord. Laurineae), an evergreen tree of China and Japan. It is obtained by boiling chips of the tree in water and skimming off the camphor as it rises to the surface. This crude camphor is afterward refined by sublimation with quicklime. What are the physiological effects of camphor ? Locally camphor is an irritant. Internally in moderate doses it is to some extent an anodyne and a cerebral exhilarant, sometimes quickening the pulse and raising arterial tension, and occasionally proving aphrodisiac. In large doses (gr. xx (0.13)) it depresses the circulation, and produces lassitude and diaphoresis. It is also anaphrodisiac. In toxic doses (3ss-j (2.0-4.0)) it causes faintness, vertigo, headache, delirium, violent epigastric pain, unconsciousness, and sometimes convulsions. No case is recorded to have proved fatal in an adult. ANTISPASMODICS — CAMPHOR. 1 29 What are the medicinal uses of camphor ? It is employed as an antispasmodic in " nervousness, " nervous headaches, hysterical complaints, dysmenorrhoea, u after-pains," simple diarrhoea, and combined with other remedies in cholera. It is also used in low forms of fever, to quiet delirium and sustain the system. As an anaphrodisiac to quiet abnormal sexual excitement in chordee, nymphomania, and priapism. Externally it is employed as a liniment in myalgia, muscular rheumatism, and sprains. Dis- solved in oil of turpentine it forms an efficient liniment in mild bronchial affections. What are its preparations and their uses ? Camphora {camphor) : dose gr. j-x (0.06-0.65), or even gr. xx (1.3) given in emulsion, or in pill or capsule. Not much used in this form. Aqua Camphors {camphor-water) contains 1 part of camphor in 125 parts of the preparation ; dose f3ss-ij (15.0-60.0). It is used chiefly as a vehicle or where a mild antispasmodic is needed. Spiritus Camphors {spirit of camphor) contains 10 per cent, of camphor. It is used as an embrocation, and is also given internally where a stronger preparation than the water is desired ; dose ^Iv-foj (0.3-4.0). Linimentum Camphors (camphor-liniment) contains 20 per cent, of camphor in cottonseed oil. Ceratum Camphors (camphor-cerate) contains 1 per cent, of camphor-liniment, Linimentum Saponis (soap-liniment) is much used externally, either alone or combined with stronger liniments. Camphora Monobromata (monobromated camphor) ; dose gr. v-x (0.32-0.65) in gelatin-coated pill or capsule. It is useful as an antispasmodic in hysteria, and as an anaphrodisiac in chordee and priapism. Hopes Camphor Mixture (not official) consists of nitrous acid f3j (4.0); laudanum ffixij (0.74); camphor-water fsviij (240.0). Dose, f^ss (15.0) repeated as required. Much used in diarrhoea and dysentery. 9 130 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. OLEUM ^ETHEREUM— ETHEREAL OIL. What is ethereal oil ? Ethereal oil, or oil of wine, is made by distilling alcohol with an excess of sulphuric acid and diluting with an equal volume of ether, and is a nearly colorless volatile liquid. It is antispasmodic, and in small doses a cardiac and vaso-motor stimulant, while in large doses it paralyzes the cardiac muscle and the vaso-motor nerves. It is only used medicinally as SPIRITUS ^ETHERIS COMPOSITUS — COMPOUND SPIRIT OF ETHER. What is this substance ? Compound spirit of ether, or Hoffman s anodyne, is a solution of ethereal oil (2.5) in ether (32.5) and alcohol (65.0), and is a good antispasmodic, circulatory stimulant and carminative, and is useful in the class of diseases to which antispasmodics are applicable, espe- cially when a cardiac stimulant is required; dose f3j-ij (4.0-8.0) repeated, and best administered in iced water. CYPRIPEDIUM : SCUTELLARIA. What are these remedies ? Cypripedium is the rhizome and roots of C. pubescens and of C. parviflorum (Nat. Ord. Orchideae), indigenous plants, commonly called ladies' slipper and moccasin plant. Scutellaria is the herb S. laterifolia or skullcap (Nat. Ord. Labiatse), an indigenous herb. They possess mild antispasmodic properties, and have been used as substitutes for valerian. Extractum Cypripedii Fluidum (fluid extract of cypripedium), dose tt\,x-xx (0.6-1.2). Extractum Scutellariae Fluidum ( fluid extract of Scutellaria), dose f3j (4.0). ORDER V.— Excito-Motors. What are excito-motors ? Excito-motors are medicines which by stimulating the reflex centres of the spinal cord excite muscular action. Name the excito-motors. Nux vomica and its alkaloids ; rhus toxicodendron and picrotoxin. EXCITO-MOTORS — NUX VOMICA. 131 NUX VOMICA. What is nux vomica ? Nux vomica is the seed of the Strychnos Nux-vomica or poison nut {Nat. Ord. Loganiaceae), a tree of India. What active principles does it contain ? It contains two alkaloids, strychnine and brucine, combined with igasuric acid, and according to some investigators, a third alkaloid, igasurine, has been discovered. How may the presence of these alkaloids be detected ? Strychnine may be detected by the addition of a crystal of po. tassium bichromate to a solution of the alkaloid in concentrated sul- phuric acid on a porcelain plate, when a deep, rich blue color passing through purple into red rapidly makes its appearance. The 'physiological test is the production of tetanic spasms in a small animal (preferably a frog) to whom a minute amount of the suspected substance has been administered. Brucine with concentrated nitric acid strikes a blood-red color, fading into yellow. What are the physiological effects of nux vomica? The effects of nux vomica are identical with those of its alkaloids. The action of brucine is similar to, but much weaker than, that of strychnine. In small closes it increases the appetite and digestion and the peri- staltic movements of the intestines. When continued for some time in small doses it is a cardiac and vaso-motor stimulant, and increases the sensibility of the sensory nerves and nerves of special sense, so that sight, hearing and touch are more acute, and also stimulates the respiratory centre. In large doses it causes malaise, restlessness, anxiety, muscular twitchings, and finally clonic convulsions. Strych- nine acts principally on the spinal cord, stimulating especially its reflex, but also its motor, vaso-motor and sensory functions. After large doses, the reflex functions are so exalted that the slightest im- pression conveyed by a sensory nerve produces general convulsions. It is eliminated unchanged in the urine. What are the symptoms and treatment of strychnine poi- soning ? Sudden shuddering, quickly followed by tetanic convulsions of all 132 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. the voluntary muscles, accompanied with muscular pains, opisthoto- nos, the risus sardonicus (a ghastly grin), a pale face, becoming livid from embarrassed respiration. After a time the muscles relax and an interval of quiet occurs, to be succeeded again and again by con- vulsions, if a liberal dose has been taken and is not antagonized by antidotes, until the sufferer dies of asphyxia from fixation of the respiratory muscles during a paroxysm ; or the patient may die of paralysis and collapse during one of the intervals. The mind is clear to the end. It differs from tetanus in history, in clonic (not tonic) spasms, in the muscles of the jaw not being affected before other voluntary muscles. The treatment consists in (1) evacuating the contents of the stomach by emetics or the stomach-pump before the convulsive stage, or washing out the stomach under ether or chloroform if not seen until the convulsions have commenced ; (2) giving tannic acid as a chemical antidote and chloral (hypodermically) as an antagonist ; and (3) the frequent use of the catheter to prevent resorption of the poison from the bladder. What are the therapeutical uses of nux vomica and strych- nine? It is employed (1) as an excito-motor in all cases of paralysis due to depression of the spinal or other motor centres, as in diphtheritic, alcoholic, or lead paralyses, paraplegia,, infantile paralysis and hemiplegia after the subsidence of irritation. As it stimulates the nerve centres, it is contraindicated whenever inflammation or ex- citation of these centres is present ; hence, in paralyses due to the presence of blood-clots it may do great injury if too early exhibited. In constipation due to atony and relaxation of muscular fibres, or in diarrhoea, dysentery, impotence, or incontinence of urine from the same cause, it is very useful. (2) In amaurosis, especially when due to the abuse of tobacco or of alcohol, and in amblyopia from disease, strychnine pushed to the verge of tolerance is very efficacious. It is more useful before atrophy of the optic nerve fibres has occurred. (3) As a cardiac and respiratory stimulant in dyspnoea depending on chronic bronchitis, emphysema, phthisis, or due to cardiac disease, as fatty or dilated heart, it is of value, and is often combined or alternated with digitalis in the latter affection. (4) As a general EXCITO-MOTORS— RHUS TOXICODENDRON. 133 tmic it is advantageously given in atonic dyspepsia, gastric catarrh, ancemia and chlorosis (combined with iron), as an adjunct to quinine in obstinate malarial fevers, in various neuralgice occurring in debil- itated subjects, and in convalescence from acute diseases (combined with iron and other tonics). Minute doses of nux vomica (tincture) will often arrest the vomiting of pregnancy. What are the official preparations and their doses ? Extractum Nucis Vomica {extract of mix vomica), dose gr. 1-j (0.016-0.065) given in pill. It is frequently combined with purgatives to enhance their effect. Extractum Nucis Vomica Fluidum (fluid extract of nux vomica), dose ^Uj-x (0.12-0.61). Tinctura Nucis Vomicae {tincture of nux vomica), dose ^VJ-xx (0.06-1.2). Chiefly used as a bitter tonic. Strychnina {sti-ychnine), preferably given as — Strychnine Sulphas {strychnine sulphate), dose gr. ^-^o (0.002-0.003) internally, or gr. ^ (0. 001) , cautiously increased, if used hypodermically. As a cardiac tonic strychnine is often given in large doses, frequently repeated. It is not safe, however, to begin with a larger dose than gr. ^-~2^ (0.002-0.003). As a tonic, minute doses may be given in pill, alone or combined with other medicines. In nervous affections it should be given in solution, the dose being gradually increased until slight muscular twitchings are produced. Iron and strychnine citrate and syrup of iron, quinine and strych- nine phosphates have been noticed with the iron preparations. RHUS TOXICODENDRON. What is this substance ? It is the fresh leaves of the Rhus radicans, poison-oak or poison- ivy {Nat. Ord. Anacardieoe), which contains toxicodendric acid. Locally applied it produces in many persons a very distressing eczematous eruption attended with much inflammation and swell- ing of the skin. Some persons are so susceptible that these symp- toms occur if they are in the vicinity of the growing plant, even without coming in contact with it. The treatment consists in alkaline washes, lotions of lead or corro- 134 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. sive sublimate (1 to 8000 or even weaker) or the application of car- bolic acid in glycerin. Internally it is a gastro-intestinal irritant, causing also drowsiness, stupor, delirium and convulsions. Its pre- cise use is not clear, but it has been given as a substitute for nux vomica in paralysis and in incontinence of urine. Dose gr. j-iij (0.06-0.19), perhaps, if given at all; best administered in the form of a tincture. PICROTOXINUM — PICROTOXIN. What is picrotoxin? Picrotoxin is a neutral principle prepared from the seeds of Ana- mirta paniculata {Nat Ord. Menispermaceae), a climbing shrub of India. Its action on the brain resembles that of belladonna, while it affects the spinal centres somewhat like nux vomica : thus, it causes nausea, vertigo, delirium, incoordination, muscular twitching, followed by epileptiform convulsions, alternating tonic and clonic spasms, coma and cardiac paralysis. It stimulates all the motor and inhibitory centres of the medulla, particularly the respiratory and vagus centres, and excites the motor and reflex spinal centres. It is at present chiefly used to check the night-sweats of phthisis, but has also been recommended as an excito-motor in functional paralysis and in paralysis or relaxation of the sphincters. It is said to be of ser- vice in chorea when given in full doses. Locally it is used as an ointment (gr. v-x to ^j (0.3-0.6 to 31.0)) in parasitic skin diseases and to destroy pediculi, but care should be used in applying it, as constitutional effects and even death have followed its employment externally. Dose gr. 2 tioned. It acts rapidly, but transiently, and may be used internally, or better still, hypodermically in cases of sudden cardiac failure. AMMONIUM. What are the sources of ammonium? Ammonium is abundantly present in nature as the result of ani- mal and vegetable decay, but is chiefly obtained for commercial pur- poses from the ammoniacal liquor of gas works. What are the general physiological actions of ammonium preparations ? Ammonia Gas in solution is an irritant. Kept in contact with the skin it reddens and finally vesicates. When the gas is inhaled it irritates, producing a sense of suffocation, spasm, and, if contin- ued, inflammation of the air passages. When injected into the veins of animals in sufficient quantities, it damages the blood and causes convulsions, rapid respiration and death. Ammonia temporarily stimulates the accelerator nerves of the heart, thus increasing the rapidity of its action. After intravenous injection, the blood pressure at first falls, but rapidly rises as the pulse becomes quicker. It aids in maintaining the fluidity of the blood by retaining the fibrogenous materials in solution. In toxic amounts, the oxygen-carrying function of the red corpuscles is inter- fered with. Intra-venous injections of ammonia quicken respiration 150 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. by powerfully stimulating the respiratory centres. The convulsions are due to stimulation of the motor and reflex spinal centres. It is eliminated chiefly by the urine as uric acid and, perhaps, as urea. Its salts are also eliminated by the broncho-pulmonary mucous mem- brane. When taken internally in medicinal doses it is antacid and carminative, but if continued for too long a period, it disorders di- gestion and causes emaciation. What are the symptoms and treatment of poisoning by am- monia ? When a strong solution is swallowed it causes inflammation of the lips, mouth, fauces, pharynx, oesophagus and stomach. GEcleina of the glottis may occur, and secondary strictures of the oesophagus or even of the pylorus may result. Death may be due to asphyxia or tc collapse preceded by symptoms of corrosive poisoning. The treatment consists in neutralizing the alkali by vegetable acids (vine= gar) ; protecting the injured surfaces by oils and demulcents and the occasional passage of an oesophageal bougie, for at least a year, to prevent secondary stricture. The occurrence of oedema of the glot- tis demands immediate tracheotomy. What are the therapeutical uses of the ammonium prepara- tions ? Ammonia is a rapid and powerful cardiac stimulant, but its effects are of brief duration. It is used for this purpose both internally and by inhalation in all cases of acute cardiac failure, and may be used to antagonize the action of snake poison andprussic acid on the heart, but should here be employed as an adjuvant to alcohol. For sudden cardiac failure during anaesthesia or from surgical shock it may be given hypodermically. It has been used by intra-venous injection to maintain the fluidity of the blood in cases of threatened cardiac thrombosis; and as a stimu- lating expectorant in pneumonia, especially when typhoid symptoms are present. It is given as an alkali in acidity, flatulence and in nervous headache. Ecternally it is an ingredient of stimulating and irritating lini- ments and may be used as a vesicant. CARDIAC STIMULANTS— NITROGLYCERIN. 151 What preparations of ammonium are used as cardiac stim- ulants ? Aqua Ammonite Fortior [stronger ammonia water) contains 28 per cent, by weight of gaseous ammonia. It is a powerful corrosive poison. It is best adapted for hypodermic use in doses of TiLx-xxv (0.6-1.5), diluted with four times its volume of water, and repeated in 1 5 minutes if necessary, and may be used externally as a rapid (but painful) vesicant by inverting a watch crystal full of it on the skin. Aqua Ammonia [ammonia water) contains 10 per cent, by weight of ammonia-gas; dose for internal use, gtt. x-xxx (0.6-2.0) freely diluted. Spiritus Ammonias (spirit of ammonia) contains 10 per cent, by weight of the gas in solution in alcohol ; dose ntx-xxx (q. 5-2. 0) freely diluted. Spiritus Ammonia Aromaticus {aromatic spirit of ammonia) contains also ammonium carbonate and aromatics; dose f£ss-j (2.0- 4.0), freely diluted. Ammonii Carbonas (ammonium carbonate) is used as a cardiac stimulant, and also in threatened thrombosis. It is very valuable as a stimulating expectorant in capillary bronchitis, typhoid pneumonia, and other low forms of chronic pulmonary disease where an expec- torant is required. Dose gr. v-x (0.3-0.6). The iodide, bromide and the acetate, tartrate, and citrate of iron and ammonium, and valerianate of ammonium have already been noticed ; the acetate, benzoate and chloride will be discussed here- after. The nitrate of ammonium is only used in making other official preparations. AMY! NITRIS — AMYL NITRITE— NITROGLYCERIN. Are these substances used as cardiac stimulants ? Inhalations of amyl nitrite have been employed in cases of sudden heart-failure, as in fatty heart, or during anaesthesia. Nitroglycerin has been used also as a cardiac stimulant, especially in cases associ- ated with high arterial tension. These remedies have been discussed under the head of Depresso-Motors. 152 ESSENTIALS OP MATERIA MEDIC A AND THERAPEUTICS. ATRO PINJE — ATROPINE. Is atropine used as a cardiac stimulant ? Atropine [vid. belladonna^. 107) is used as a cardiac stimulant in cases of sudden or threatened heart-failure. Dose gr. rzo~Fij (0- 0005- 0.001), given hypoder in ically. DIGITALIS. What is digitalis ? Digitalis is the leaves of D. purpurea, or purple foxglove (Nat. Ord. Scrophularineae), obtained from plants of the second years growth. It is a European plant, cultivated in this country. What are its chemical constituents ? The constituents of digitalis* are, digitalin, digitalosmin (stear- opten), digitaleic acid, resin, mucilage, etc. " Commercial digitalin is a mixture of several compounds of which the following have been investigated to some extent:'' Digitoxin ; Digitonin, a crystallizable glucoside, is decomposed by warm hydrochloric acid into dextrose, galactose and digitogenin ; Digitalein ; Digitalin, and Digitin. All these principles except the last are cardiac poisons. What are the physiological effects of digitalis? Its effects are much more slowly produced, but are much more lasting than those of the medicines previously considered, and it is therefore more of a tonic than a stimulant to the heart. In moderate doses it slows and strengthens the cardiac beat, elevates the blood pressure and causes diuresis. It sometimes interferes with the appetite and digestion. After very large doses, or when too long continued, nausea and vomiting may occur ; the pulse becomes dicrotic, weak, and sometimes rapid, and diaphoresis more or less profuse takes place. Toxic doses cause the same symptoms, and in addition vertigo, disordered vision, lowered reflexes, muscular tremors, lassitude, reduced temperature, delirium, stupor, usually convulsions, and death from cardiac paralysis. In moderate doses it stimulates the peripheral cardio-inhibitory fibres of the vagi (thus slowing the heart by increasing the length of * A Manual of Organic Materia Mediea, by John M. Maisch, Ph. M., Pharm. D., 6th ed., 1895, pp. 228, 229. CARDIAC STIMULANTS— DIGITALIS. 153 the diastole), the cardiac muscle and its contained motor ganglia (thus increasing the strength and force of the systole), and the vaso- motor centres (thus raising the arterial tension). It also acts directly on the muscular walls of the vessels, and thus lessens their calibre. When full medicinal doses are taken, or when the pulse has been greatly slowed by it, a sudden change from the recumbent to the erect posture may give rise to a small, weak, rapid pulse, with low- ered arterial tension. When fatal doses are taken the heart is arrested in systole. In poisonous doses it lowers reflex action by stimulating Setsche- now's inhibitory reflex centres and, later, by paralyzing directly the spinal cord. It also lowers the contractility of muscles. It usually proves diuretic, probably from elevating the arterial tension. It is eliminated chiefly by the urine. How should poisoning" by digitalis be treated ? (1) Give emetics and cathartics to remove the poison from the alimentary canal ; (2) tannic acid as a chemical antidote ; alcohol, ammonium carbonate and opium, or saponin, as physiological antago-' nists. What are the medicinal uses of digitalis ? As a cardiac tonic digitalis is used in all cases of loss of cardiac power, as in dilatation or in weakness of the cardiac muscle. It should never be prescribed in simple hypertrophy, nor when hyper- trophy is sufficient to compensate for valvular lesion. In advanced cases of fatty heart, it should be used very cautiously, if at all, as the increased systolic power which it induces may lead to rupture ol the friable cardiac walls. In valvular diseases, when the hyper- trophy is not compensatory, or when dilatation is taking place, it is invaluable. In "irritable heart ," functional palpitation and venous engorgements (by lengthening the diastole it allows the veins more time to empty their contents into the auricles), it is much used. The tincture (HLx-xx (0.6-1.2)) may be employed hypodermically in cases of sudden cardiac failure. To sustain the action of a depressed heart in various acute diseases, particularly in pneumonia, it is often administered. 154 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. In delirium tremens, where the pulse is soft and compressible, digitalis is often given in large doses with benefit. It is also used as a physiological antidote to poisoning by aconite, delphinine and muscarine, all of which arrest the heart in diastole. To contract the blood vessels it has been used in acute inflamma- tions and in hemorrhages, and as it is supposed to stimulate involun- tary muscle-fibres generally, it is given in menorrhagia and in sper- matorrhoea. As a cardiac tonic and diuretic it is used in all forms of cardiac and of renal dropsy, in acute suppression of urine and in acute des- quamative nephritis. What are the preparations of digitalis, and how are they administered? Digitalis leaves are sometimes given in powder or pill, dose gr. j (0.06) t. i. d., gradually increased. The official prepara- tions are — Extractum Digitalis {extract of digitalis), dose gr. \ (0.016), gradually increased. Extractum Digitalis Fluidum [fluid extract of digitalis), dose «\j (0.06). Tinctura Digitalis {tincture of digitalis), dose ^Iv-x (0.3-0.6), gradually increased. Infusum Digitalis {infusion of digitalis), one of the best prep- arations; dose f^ss-jv (2.0-15.0). Occasionally after digitalis has been taken for some time continu- ously, especially when free diuresis has not taken place, its action becomes suddenly manifested by the pulse rapidly falling and the supervention of other effects characteristic of the drug. This is probably due to some delay in the absorption or elimination of the medicine, and when it occurs the remedy should be promptly dis- continued. So-called commercial digitalin should never be pre- scribed because of its variable composition. Mercies German digi- talin is a stable and valuable remedy, representing the full value of digitalis, without its irritating effects upon the digestive tract. Dose gr. £rl (0.006-0.03). CARDIAC STIMULANTS— CAFFEINE. 155 CAFFEINA — CAFFEINE. What is caffeine ? Caffeine [theine) is a feebly basic, proximateprinciple, obtained from the dried leaves of Thea sinensis or tea plant {Nat. Orel. Ternstrse- niiaceae), from the dried seeds of Coifea arabiea or coffee plant ( Nat. Ord. Rubiaceae), or from guaraua (a paste prepared from the crushed or ground seeds of Paullinia cupana (Nat. Ord. Sapindaceae). Guarana is official.) What are its physiological actions ? In medicinal doses, caffeine is a cerebral stimulant, causing ner- vous restlessness, increased mental activity and wakefulness; it also increases the cardiac force, raises the arterial pressure, and acts as a decided diuretic. After poisonous amounts, there is also confusion of thought, with delirium, muscular tremblings, cardiac oppression, quickened respiration, cold extremities, symptoms of collapse, rise of temperature, and (in animals) tonic and clonic convulsions, mus- cular weakness, general paresis, and death from paralysis of respiration. It increases the power of the heart and raises arterial tension, probably by a direct stimulant effect upon the heart muscle. It is diuretic, not only indirectly by increasing the blood pressure, but also by some direct action on the secreting cells of the kidney itself. The convulsions are probable due to spinal stimulation. In moderate doses, caffeine is said to be entirely destroyed in the system ; in toxic doses, it is partly destroyed and partly eliminated by the kidneys. Its effect on the elimination of waste products is at present uncertain. What are its medicinal uses ? As a cardiac tonic (more rapid in action, but not so enduring as digitalis), it is used to meet the same indications which call for the use of digitalis. In cases of sudden heart failure, it may be used hypodermically combined with equal parts of sodium salicylate, which renders it more soluble in water. As a combined cardiac stimulant and diuretic it is very useful in the latter stages of chronic B right's disease with weak heart. As a diuretic in all renal and cardiac dropsies it is very service- able. It is also employed as a cerebral stimulant in nervous and neuralgic headaches, and combined with other antagonists in opium poisoning. 156 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. How is caffeine administered ? Caffeina ( Caffeine) may be given in pill, capsule or solution', dose gr. j-v (0.06-0.3) or more. For administration in fluid form caffeine citrate (so-called) is preferred as more soluble. When given as a cerebral stimulant, one dose of gr. ij-v (0.13-0.3) is usually sufficient, but as a cardiac tonic and diuretic this dose should be repeated twice daily, and gradually increased if necessary up to gr. x-xij (0.6-0.8). Caffeina Citrata {titrated caffeine), dose gr. ij-v (0.13-0.3). Caffeina Citrata Effervescens (effervescent titrated caffeine), dose 3j-iij (4.0-12.0). Guarana {Guarana) contains tannic add, as well as caffeine in considerable quantities, and is principally used in neuralgic and in sick-headache. In Brazil, whence it comes, it is also used as an astringent in diarrhoeal affections, dose 3.) (4.0). Extractum Guarana Fluidum (fluid extract of guarana), dose ffU-xx (0.6-1.2). ADONIDIN. What is adonidin? Adonidin (not official) is a glucoside, obtained from the root of Adonis vernalis (Nat. Orel. Ranunculaceae), a plant of northern and central Europe. What are its effects, uses and modes of administration? The effects of adonidin are almost identical with those of digitalis (but are much more quickly produced), as it stimulates the cardiac muscle and contained motor ganglia, thus increasing the force of the cardiac contractions at the same time that, by stimulating the inhibitory fibres of the vagi, it increases the length of the diastole and thus slows the heart. The arterial tension is also elevated, prob- ably by stimulation of the vaso-motor centres. In large doses it paralyzes both the heart and vessels, the arterial tension falls and the heart is finally arrested in diastole. It sometimes (not as fre- quently as does digitalis) causes nausea, vomiting and diarrhoea. It sometimes proves diuretic. It is used as a cardiac tonic in the same class of diseases in which digitalis is employed, and may be substi- tuted for it where the latter disagrees or is too slow in its action. CARDIAC STIMULANTS— SPARTEINE SULPHATE. 157 It may be alternated with digitalis for a few weeks during a course of the latter. Dose gr. %-% (0.008-0.03) every 3 or 4 hours, in pill or capsule. STROPHANTHUS. What is strophanthus ? Strophanthus is the seed of S. hispidus {Nat. Ord. Apocynacese), an African plant which has been used by the natives as an arrow- poison, and called by them Kombe or Inee. It contains a crystal- line glucoside, called strophanthin. What are its effects, uses and modes of administration ? The effects of strophanthus are more rapid in action, but much more evanescent, than those of digitalis. It appears to act upon the muscles directly, and to have little or no effect upon the nervous system. In moderate doses it greatly increases the strength of the cardiac systole, prolongs the diastole and increases the arterial tension proba- bly by acting on the muscular walls of the vessels. In large doses it increases the contractibility of all the striated muscles and finally arrests the heart in systole. It proves diuretic by increasing the arterial tension, and has no cumulative effects. It is used as a substitute for digitalis in cardiac diseases when a temporary effect or a temporary change of medi- cines is desirable. From its diuretic action it has been successfully employed in various forms of oedema depending on a weak circula- tion and general cardiac and renal dropsies. The tincture of stro- phanthus (tiuctura stroplianthi — 5 per cent, by weight) is used; dose nij-x (0.06-0.6) t, i. d. ; or strophanthin may be cautiously administered hypodermically ; dose gr. t^o~wu (0.0006-0.001). SPARTEINE SULPHAS — SPARTEINE SULPHATE. What is sparteine ? Sparteine is a liquid alkaloid obtained from Cytisus Scoparius, or broom (Nat. Ord, Leguminosse). What are its effects and uses, and how is it administered ? Sparteine is a cardiac tonic, in moderate doses increasing the force and persistence of the cardiac contractions by direct action upon the 158 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. heart or its contained motor ganglia, and at first increasing its fre- quency by paralyzing the vagi, afterward decreasing the pulse-rate by its direct action on the heart, When the cardiac rhythm is dis- turbed it renders its contractions regular. In large doses it depresses the heart and causes death from paralysis of the respiratory centre. It depresses the cerebral and spinal centres. It has no diuretic properties. It has been used as a substitute for digitalis in cardiac diseases, and in cases of feebleness and irregularity of cardiac action- It is inferior to digitalis as a cardiac tonic, but may be used as a suc- cedaneum to it. It is administered in the form of sulphate (official), of which the dose is gr. 2V"? (0.003-0.01), hypodermic-ally ; or if given internally, gr. J-j or ij (0.01-0.06-0.13) in capsule or pill. STRYCHNINA — STRYCHNINE. Is strychnine prescribed for its cardiac effects ? The use of strychnine as a cardiac tonic has been noticed under the head of nux vomica {q. v.) ; dose gr. ^Wo (0.002-0.003) inter- nally, or gr. sir (0.001) if used hypodermically. CIMICIFUGA. What is cimicifuga ? Gimicifuga is the rhizome and roots of C. racemosa, black snake- root or cohosh [Nat. Ord. Ranunculaceae), a common indigenous plant, It contains a volatile oil, to which its virtues are probably due. A crystalline principle has also recently been obtained from it. Its effects on the circulation are supposed to resemble those of digitalis, while it acts on involuntary muscular fibres similarly to ergot. Recently it has been said, however, that it is a direct depressant to the cardiac muscle or its ganglia. It depresses the reflexes and occasionally causes nausea and vomiting. Its action is mild and not well understood. It is also diuretic and expectorant. It has been used as a cardiac tonic in fatty heart, as a diaphoretic in rheumatism, as a diuretic in dropsies, as an expectorant in chronic bronchitis, and as an antispasmodic in chorea, in which disease it is sometimes of value, combined with tonics and laxatives. It is not often prescribed. Extractum Cimicifuga Fluidum {fluid extract of cimicifuga), dose fcss-j (2.0-4.0). CARDIAC SEDATIVES — ANTIMONY. 159 TlNCTURA Cimicifuga {tincture of cimicifuga), dose f3ss-ij (2.0- 8.0). Extractum Cimicifuga {extract of cimicifuga), dose gr. iij-v (0.2-0.3). CONVALLARIA. What is convallaria ? Convallaria is the rhizome and roots of C. majalis, or lily of the valley {Nat. Ord. Liliacese), a European plant naturalized in this country. It contains two glucosides, convallamarin and convallarin, to the former of which it probably owes its action on the heart, while the latter appears to cause nausea, diarrhoea and gastric pain. The results of the investigations regarding the physiological action of this plant are very contradictory, but it seems to slow the heart and increases the blood- pressure in small doses. In toxic doses the cardiac action becomes rapid, the arterial pressure gradually falls, and death occurs from heart-failure. It is used in all cases of cardiac weakness whether accompanied by valvular lesion or not, as in dilatation or fatty heart. It is also used in palpitation. Extractum Convallaria Fluldum {fluid extract of conval- laria), dose tt\,v-xv (0.3-0.9). ORDER II.— Cardiac Sedatives. What are cardiac sedatives ? Cardiac sedatives are medicines which are used to diminish the force and frequency of the cardiac contractions when they are mor- bidly increased, and thus to depress the circulation. Name the principal cardiac sedatives. Antimonials, aconite and its alkaloid, veratrum viride and its alkaloids, veratrine, gelsemium, Pulsatilla, arnica, the vegetable acids. ANTIMONIUM — ANTIMONY . What are the sources of antimony ? Antimony is a metallic element found native in the form of black antimonious sulphide. 160 ESSENTIALS OP MATERIA MEDIC A AND THERAPEUTICS. Mention some of the tests for antimony. Sulphuretted hydrogen iu solution forms with solutions of anti inonial salts an orange-colored precipitate. The metal should also be reduced by Marsh's test, and chemically and microscopically dis- tinguished from arsenic. What are the general physiological effects of antimonials ? When applied locally to the skin, the salts of antimony produce an eruption of papules, which become pustules, somewhat resembling the eruption of smallpox. After prolonged use, the fauces some- times present a similar eruption. Internally, in small doses, they are diaphoretic. In somewhat larger doses, they cause nausea, depressed circulation, weakness, and increase of the mucous and cutaneous secretions. In large doses, they prove emetic, with very weak pulse, great general depression and relaxation of the muscular system. In poisonous doses, they are gastro-intestinal irritants, causing emesis, catharsis with cramps in the extremities, and col- lapse, often resembling Asiatic cholera, and death from asthenia, sometimes preceded by tonic and clonic spasms. Antimonials slow the heart, increase the duration of its diastole and diminish the force of its systole by direct depression of the cardiac functions ; they lower the blood pressure partly by cardiac depression and partly by paralyzing the peripheral vaso-motor sys- tem. The pulse finally becomes rapid and very feeble, the pressure sinks almost to nil and the heart is arrested in diastole. They depress and paralyze the reflex, sensory, and, to a less extent, the motor functions of the spinal cord. The temperature is reduced by poisonous doses. The emesis is probably partly from local and partly from centric irritation. When given for a length of time, they cause fatty degeneration of various viscera. Antimony is eliminated by the mucous membranes, especially of the stomach, by the liver, kidneys and skin. What is the treatment of poisoning by antimony? Wash out the stomach to remove any poison present ; give tannic acid as a chemical antidote, and opium and stimulants to overcome the resulting depression. CARDIAC SEDATIVES— ANTIMONY. 161 What are the medicinal uses of antimonials ? They are used as cardiac sedatives in the early stages of acute sthenic inflammations, but are probably inferior to aconite or vera- trum viride for this purpose. They are very useful in the early stages of acute bronchitis and in acute laryngitis from their com- bined sedative, diaphoretic and expectorant qualities. As dia- phoretics they are used in minute doses, frequently repeated, in fever mixtures, or combined with minute amounts of morphine, which increases their action. The depression which they produce should always be remembered. As nauseants and emetics they are rarely resorted to, because of the great depression which they produce. Sulphurated antimony, or the old Kermes mineral, is sometimes used as a nauseant in membranous croup. Locally, as a counter-irritant it is rarely employed. What are the antimonial preparations? Antimonii et Potassii Tartras (antimonium and potassium tartrate — tartar emetic — tartarated antimony) ; dose, as a sedative, gr. k~k (0.01-0.03), increased to gr. j-ij (0.06-0.12), as tolerance to its action is established ; as a diaphoretic and expectorant, gr. j^-J (0.004-0.016), in solution, repeated every 2 or 3 hours until the desired results are produced ; as an emetic, gr. j-ij (0.06-0.13). VlNUM Antimonii {wine of antimony) contains 4 parts of tartar emetic in 1000 of the preparation (about gr. ij-f3j). Dose as a diaphoretic and expectorant n^x-xxx (0.6-2.0); as an emetic f3j-iv (4.0-15.0). SYRUPUS SciLLiE COMPOSITUS {compound syrup of sqnrfl— Coxes hive syrup) contains tartar emetic, 2 parts in 1000 of the preparation (about gr. j to the f^j). It is used in croup as an emetic and also as an expectorant ; dose ttlv-f3j (0.3-4.0). The following preparations are somewhat uncertain, and are rarely employed : — Antimonii Oxidum {antimonious oxide), dose gr. j-ij (0.06-0.13). PULVIS Antimonialis {antimo)tial j)oirder — James powder) con- tains antimonious oxide 33 per cent, with precipitated calcium phos- phate; dose gr. iij-x (0.2-0.6). 11 162 ESSENTIALS OF MATERIA MEMCA AND THERAPEUTICS. Antimonh Sulphidum (antimonious sulphide) and Antimonh Sulphidum Purificatum ( purified antimonious sidphide) are used in making the other preparations. Antimonh Sulphuratum {sulphurated antimony — Kermes min- eral), dose gr. j-iij (0.06-0.2) ; as an emetic gr. v-x (0.3-0.6). Pilule Antimonh Composite {compound pills of antimony— Hummer's pill). Used as an alterative. Each pill contains of calomel and sulphurated antimony each gr. ^ (0.04). ACONITTJM — ACONITE. What is aconite, and what is its chemical composition ? Aconite is the tuber of Aconitum Napellus, aconite, monkshood or wolfsbane (Nat. Ord. Ranunculaceae), a native of the mountains of Europe and Asia. The active principle is an alkaloid called aconitine. Other alkaloids have been discovered in it, viz. : aconine, isaconitine, and picraconatine. What are its physiological effects ? Locally applied, aconite or aconitine benumbs the sensory nerves and causes a sensation of tingling. Internally in small doses it les- sens the force and frequency of the cardiac contractions, diminishes the blood pressure, causes tingling in the lips, tongue and extremi- ties and produces a feeling of weakness. When large doses are taken, these symptoms are more marked, the pulse becomes very weak and slow, a tendency to fainting is manifested on assuming the erect posture or on any exertion, and the respirations are reduced in number. After poisonous doses these symptoms are much intensi- fied ; the countenance is anxious, a cold sweat covers the body, the pulse and respiration are very slow, weak and irregular, general anaesthesia is present, and collapse and death from syncope, some- times preceded by convulsions, occur. Aconite affects the heart by directly depressing the cardiac muscle, and its contained motor ganglia. It probably also stimulates the cardio-inhibitory apparatus, but does not affect the vaso-motor nerves or centres. It paralyzes the peripheral end organs of both motor and sensory nerves, the latter being first affected by it, and the nerve trunks and centres being only involved as the poisoning deepens. The loss of reflex function is probably due to interference CARDIAC SEDATIVES— ACONITE. 163 with conduction. It depresses and finally paralyzes the respiratory centre. What is the treatment of poisoning- by aconite ? Evacuate the contents of the stomach and wash it out by means of the stomach pump ; keep the sufferer perfectly quiet, with his head low ; give cardiac stimulants, as alcohol, ether or ammonia, and administer digitalis hypodermically. What are the medicinal uses of aconite ? As a cardiac sedative aconite is of great value in the early stages of all acute inflammations and all fevers, in which the patient is vigorous and young and the pulse tense, full, bounding and strong, and is only contraindicated when the heart is weak, when there is gastro-enteric inflammation, or where a typhoid condition is present. Thus it is used to diminish the circulation, arterial tension and tem- perature, and to promote diaphoresis and diuresis in the sthenic forms of surgical fever, in acute coiijza, acute broncho-pulmonary catarrhs, acute pleuritis and acute peritonitis, in acute meningitis either cerebral or spinal, and in the essential fevers, when not of the asthenic type. In scarlet fever and in measles (when the tempera- ture is high), it is of great value, and is often used during the exa- cerbations of remittent malarial fevers. In lobar pneumonia vera- trum viride is a safer remedy, but aconite will prove very serviceable if employed with great caution before consolidation has taken place. In cardiac hypertrophy uncomplicated by valvular lesion, or even if the latter is present, provided the hypertrophy be in excess of the requirements of the system, it is an invaluable medicine. As a local anaesthetic it has been advantageously given internally and applied externally in neuralgia, particularly of the face and head, and has been used locally in chronic muscular rheumatism and in rheumatic neuralgia?. What are the preparations of aconite and their doses ? Extractum Aconiti {extract of aconite), dose gr. J-ss (0.008- 0.03). Extractum Aconiti Fluidoi (fluid extract of aconite), dose TTlss-ij (0.03-0.123). Tinctura Aconiti (tincture of aconite), dose ny-v (0.06-0.3), frequently combined with other medicines in fever mixtures. 164 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. In fevers and inflammations aconite is preferably given in small doses, repeated every few hours, and carefully watched, until its effects on the pulse are obtained. Aconitine is not official and should not be used internally, as even in the minutest doses it is a powerful poison. Duquesnel's aconitine has, however, been administered with great care in tic douloureux with success. Dose gr. zho-^ho (0. 0002-0. 0003). Morson's aconite is probably even more powerful. Aconitine is used locally as an anodyne in neuralgia, in the form of liniment (gr. ij (0.13)-f3j (4.0)) or as an addendum to ointments. VERATRUM VIRIDE. What is veratrum viride, and what does it contain ? It is the rhizome and roots of Veratrum viride, American or swamp hellebore or Indian poke (Nat. Ord. Liliaceas), a plant indigenous to swampy places in the eastern part of the United States. It contains two alkaloids, veratroidine and jercine, to which its effects are due ; also rubijervine, pseudojervine, resin, etc. What are their physiological effects ? Jervine taken internally causes great weakness, depresses the spinal cord and lowers reflex action, lessens the force and frequency of the heart by direct action on the cardiac muscle or its contained motor ganglia, greatly reduces the blood pressure, both by its action on the heart and by depressing and finally paralyzing the vaso-motor centres, causes profuse salivation, and death from asphyxia, preceded by convulsions of cerebral origin. Veratroidine gives rise to the same general effects, but in addition always produces vomiting and often purging. When directly applied to the heart muscle, it paralyzes it. Given internally, it first slows the heart and lowers the blood pressure by stimulating the vagus, then, the pulse remaining slow, the heart-beats increase in force and the blood pressure rises to normal, but suddenly, from peripheral paralysis of the vagi, the cardiac action becomes very rapid and diminishes in force, and, as asphyxia increases, the arterial tension is much elevated. Death is due to paralysis of the respiratory muscles. Veratrum viride combines the effects of its alkaloids, and is a powerful arterial and spinal depressant, diminishing the frequency CRADIAC SEDATIVES —VERATRINE. 165 and force of the cardiac contractions, by depressing the heart muscle and stimulating inhibition, and lowering the blood pressure by para- lyzing the vaso-motor system. It often causes vomiting. It is a diaphoretic, reduces the temperature, and sometimes proves diuretic. Poisoning rarely occurs, as an overdose causes emesis. Should dan- gerous symptoms arise, they should be treated with alcoholic and other cardiac stimulants. What are the medicinal uses of veratrum viride ? It is given as a cardiac sedative in the same inflammatory and cardiac affections in which aconite is administered, and its contra- indications are identical with those of the latter drag, with the addi- tion that in peritonitis it is not a safe remedy, because of its liability to cause vomiting. In acute lobar pneumonia it is considered much safer than aconite. In acute mania and in mania -a-potu (when the patient is strong and the pulse full and bounding), it is a valuable medicine, but should never be given in delirium tremens. It has been highly recommended in puerperal eclampsia, in doses of "H^x- xx (0.6-1.2) of the tincture, given hypodermic-ally, partly as an arterial sedative and partly as a reflex depressant. What are its preparations and their doses ? Extractum Veratri Viridis Fluidum {fluid extract of vera- trum viride), dose n\j-iv (0.06-0.24). Tinctura Veratri Viridis {tincture of veratrum viride), NUj-x (0.123-0.6). Its effects are better obtained by giving small and increasing doses at intervals of an hour, being careful not to cause vomiting, and closely watching the pulse. VERATRINA— VERATRINE. What is veratrine ? Veratrine is a mixture of alkaloids obtained from the seed of Asagraea officinalis (Nat. Ord. Liliaceae), a Mexican plant. How may its presence be detected ? When warmed in concentrated hydrochloric acid a persistent dark-red color is produced, resembling a strong solution of potassium permanganate. This is Trapps test for veratrine. 166 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What are its physiological actions ? Locally veratrine is irritant, causing heat and pain, followed by numbness, and if long applied, redness of the surface. After small doses the pulse is weakened and reduced in frequency. Large doses are followed by vomiting and purging and muscular weakness ; with cold, clammy skin ; weak, rapid, irregular pulse and muscular tremors. Veratrine appears to stimulate the excito-motor cardiac ganglia and muscle (temporarily increasing the pulse), but soon depresses, and finally paralyzes them. It excites and then destroys the function of the vagi (thus lessening the pulse-rate, which, how- ever, in poisoning, become rapid again as the vagi are paralyzed). The vaso-motor centres are first stimulated, then depressed. It first stimulates and then depresses the nerve trunks (or their peripheral end-organs) and the muscles, without apparently affecting the cere- brum or spinal cord. It depresses and finally paralyzes the respira- tory centre, death occurring from this cause. The temperature is also lowered. It is eliminated chiefly by the skin and kidneys, in- creasing their secretion. No fatal case of poisoning is recorded ; the treatment is the same as that employed in poisoning by veratmrn viride. What are its therapeutic uses and preparations ? Although it has been used as a cardiac depressant, yet as it is in- ferior in this respect to the remedies already considered, it is now but little given internally. It is chiefly used as an external applica- tion in rheumatic pains and in neuralgia. Unguentttm Veratrine {ointment of veratrine) contains 4 per cent, of veratrine. Oleatum Veratrine (oleate of veratrine) contains 2 per cent, of veratrine. GELSEMIUM. Is gelsemium used as a cardiac sedative ? It has been employed for this purpose in sthenic inflammation and fevers. Its medicinal uses have been described among the depresso-motors. CARDIAC SEDATIVES— ARNICA. 167 PULSATILLA. What is Pulsatilla ? It is the herb of Anemone Pulsatilla and A. pratensis (Nat. Orel. Ranunculaceae), and contains a volatile oily substance which when kept decomposes, forming auemonin and anemonic acid. What are its effects and uses ? Locally Pulsatilla is irritant ; internally it depresses the circulation and lowers the blood-pressure, and in poisonous doses causes vomit- ing and purging, dilated pupils, convulsions, paralysis, diminished sensation, coma and death. It is eliminated by the kidneys. Pul- satilla is not much used, as it is decidedly inferior to other cardiac sedatives. It may be given in doses of gr. j-v (0.065-0.324) in powder, pill, capsule or infusion, or a tincture or fluid extract may be prepared. ARNICA What is arnica ? It is the flower-heads and the rhizome and roots of Arnica mon- tana, leopard's bane (Nat. Ord. Compositae). It contains arnic*«, a volatile oil, resins, etc. What are its effects and uses ? Locally applied arnica is a stimulant and often a decided irritant. Internally it slows the heart, but seems to raise the arterial pressure slightly. In large doses it is emetic and cathartic, causes great muscular weakness, a rapid pulse, and if the dose be excessive, col- lapse. It seems to be eliminated by the skin and kidneys. Arnica is not much used in this country except as an external application to sprains and contusions. When thus employed its irritant qualities should be borne in mind. The preparations are : — Extractum Arnic;e Kadicis [extract of arnica root), dose gr. v-x (0.324-0.648). Extractum Arnic^e Badicis Fluidum {fluid extract of arnica root), dose tt\,x-xx (0.6-1.2). Tinctura Arnic^e Eadicis {tincture of arnica root) and Tinc- tura Arnic^e Floroi (tincture of arnica floicers), dose ttlx-xxx (0.6-2.0). Emplastrum Arnica {plaster of arnica). 168 essentials of materia medlca and therapeutics. The Vegetable Acids. Name the vegetable acids. The officinal vegetable acids are : acetic, citric and tartaric acids. What are their general effects and uses ? When applied to an abraded surface they are irritant (tartaric acid being most, and citric the least, powerful). Given internally they increase the saliva and thus diminish thirst in fever. In large doses they are gastro-intestinal irritants and cardiac sedatives. They are probably oxidized in the blood and converted into carbonic acid, which by abstracting part of the base of the alkaline phosphates, converts them into acid phosphates, thus increasing the acidity of the urine. When taken in large quantities they cause flatulence, tormina and diarrhoea. Their long-continued use disorders the digestion, and causes emaciation and an anaemic condition. They are eliminated, chiefly as carbonates, by the intestines and kidneys. The vegetable acids are used as refrigerants and perhaps cardiac sedatives in fevers (citric acid), as antiscorbutic agents (citric or acetic acid), in acute rheumatism (lemon juice is, however, inferior to the alkaline treatment), in indigestion depending on superacidity of gastric juice (lemon juice before meals), and as diuretic to in- crease the amount of urine, and render it acid in reaction (tartaric or citric acid). They are also used as chemical antidotes to poisoning by the alkalies. Locally acetic acid is used as a caustic to remove corns and warts, as a stimulating liniment in sprains, as an injection in vaginal leu- corrhcea, and diluted with water it is given per rectum to destroy ascarides, and as a cooling lotion in fevers. The preparations are — Acidum Acettcum GrLAClALE {glacial acetic acid) (nearly or quite absolute acetic acid) and Acidum Aceticum {acetic acid) (containing 36 per cent, by weight of absolute acetic acid) are used externally as caustics. Acidum Aceticum Dilutum {diluted acetic acid) may be used internally; dose f3j-ij (4.0-8.0) diluted. It is a pure form of vinegar. Acidum Citricum {citric acid), 5j (31.0) to water Oj (480.0), may be used as a substitute for lemonade. APHRODISIACS. 169 Syrupus Acidi Citrici {syrup of citric acid) contains 10 parts of the acid in the 1000 of the preparation. Limonis Succus {lemon-juice), Oleum Limonis [oil of lemons), and Spiritus Limonis {spirit of lemon— essence of lemon) are also official. Acidum Tartaricum {tartaric acid) is rarely used in medicine, except as an ingredient of Seidlitz powders. (C) ON THE SEXUAL ORGANS. ORDER I.— Aphrodisiacs. What are aphrodisiacs? Aphrodisiacs are medicines used to excite the functions of the genital organs when they are morbidly depressed. What medicines are used for this purpose ? When the nutritive functions are not properly performed, the tonics or alteratives, especially phosphorus, zinc phosphide, the phos- phates and hypophosphites, the salts of iron, gold or arsenic, and cod-liver oil are used. When there is an absence of sexual desire, small doses of opium, very minute amounts of alcohol, cannabis In- dica, musk, or small doses of camphor may be useful by stimulating the cerebral centres. If impotence be due to want of erectile power, the tonics and alteratives are of use, as are also agents acting on the genital centre in the lumbar portion of the spinal cord and agents which either determine a flow of blood to the part by increasing the general or local circulation or which, by contracting the veins, aid in producing and maintaining erection. Thus, nux vomica or its alka- loid, the cardiac stimulants, hamamelis, ergot, cantharides and myrrh are useful in this condition. Good hygiene, cold baths, proper food and sea air and bathing, electricity, and moral means are important. The above medicines have either been considered already or will be found in their appropriate places. 170 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. ORDER II. — Anaphrodisiacs. What are anaphrodisiacs ? Anaphrodisiacs are medicines which are used to depress the sexual functions when they are morbidly excited. What medicines are employed for this purpose ? Morbid excitation of the sexual organs is treated by medicines which depress the functions of the body generally, as nauseants and purgatives, or those which, by depressing the brain or spinal cord, will prove sedative to centres governing these organs : thus full doses of opium or of camphor will depress the cerebral centre, while potas- sium or ammonium bromide (very useful), monobromated camphor, iodine and the iodides, potassium nitrate, ammonium chloride, bel- ladonna, tobacco, and conium act more especially on the spinal cen- tre and nerves. Medicines diminishing the circulation of the parts will also prove advantageous, as the cardiac sedatives or full doses of digitalis and the bromides. Cocaine locally applied acts by contract- ing the vessels and diminishing the secretions of the sensory nerves. Other agents used for this purpose are the local use of cold, gen- eral blood-letting, a low diet, avoidance of stimulation, and the with- drawal of blood to other parts of the body, as by hard mental work or exercise with the upper extremities. ORDER III.— Oxytocics. What are oxytocics ? Oxytocics are medicines which are employed to increase the power of a contracting uterus, thus aiding in the expulsion of its contents. Name the medicines belonging to this order. Ergot ; hydrastis ; hydrastinine hydrochlorate ; gossypii radicis cortex, and quinine. ERGOTA— ERGOT. What is ergot ? Ergot is the schrotium of Claviceps purpurea [Nat. Ord. Fungi), replacing the grain of Secale cereale [Nat. Ord. Graminaceae), or, in other words, it is a fungus growing from the diseased ovary of rye. ' ' When more than a year old it is unfit for use. ' ' OXYTOCICS — ERGOT. 171 What does it contain ? The exact chemical composition of ergot is still a matter of doubt, but the latest researches seem to show that it contains a resinoid sub- stance, sphacelinic acid, and a neutral principle, cornutin, which together represent the value of the drag. What are its physiological effects ? The effects of ergot are chiefly manifested on the uterus of the pregnant female and on the circulation. In the non-pregnant, small doses produce no perceptible effect ; moderate doses slow the heart, probably by stimulating the peripheral fibres of the vagi, and enor- mously increase the blood pressure by stimulating the vaso-motor centres. Large doses cause nausea and vomiting, increased peri- stalsis and purging. Toxic doses depress the heart by acting directly on its muscle or contained ganglia, and lower the blood-pressure, partly by its action on the heart and partly from depression of the vaso-motor centres. When poisonous doses are given to animals, there is salivation, vomiting and sometimes diarrhoea, rapid pulse and respiration, dilated pupil, trembling, great thirst, prostration, paraplegia, convulsions and death. The nervous symptoms appear to be due to action on the nerve centres. Ergot possesses the property of causing contraction of all non- striated muscular fibres: thus it contracts the arterioles, increases intestinal peristalsis, and increases the power as well as the duration of the uterine contractions during labor, but does not always origi- nate them during pregnancy or at other times, except immediately prior to and after parturition. What is ergotism ? When ergot is used continuously in large amounts as an article of diet, it produces a condition of chronic poisoning, which manifests itself either by gangrene (usually dry, but occasionally moist and attended with septicaemia) or by tetanic spasms. What are the medicinal uses of ergot ? Ergot is used as an oxytocic in small doses in uterine inertia during the second stage of labor, when there is no resistance either on the part of the bony canal or the soft parts of the mother. When thus administered, it energizes the uterine contractions, but if given in 172 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. large doses it renders them tetanic and continuous, thus greatly increasing the danger both to the mother and child. To prevent post-partum hemorrhage by contracting the uterus, and thus compressing the uterine sinuses, it is invaluable, but had better be withheld until the placenta has left the uterine cavity, as prior to this it will tend to imprison the placenta by contracting the cervix. After the uterus is empty, it may be given in full doses, either by the mouth or hypodermically. It has been used to induce premature labor, but is at best an uncertain remedy for this purpose. To arrest hemorrhage in cases of tlweatened abortion, ergot is worse than useless, unless the uterus is emptied. In these cases, by contracting the cervix, it imprisons the ovum, and thus, by preventing its escape, keeps the uterus dis- tended. If given at all in these cases, its administration should be conjoined with the application of vaginal tampons. It is also given to aid the expulsion of uterine polypi. As a haemostatic, it is used in all hemorrhages where surgical means of arrest cannot be employed, and is often given as an adju- vant to their local treatment. In menorrhagia, epistaxis, hemorrhage from the gums, and in broncho-pulmonary, intestinal or renal hem- orrhage it is very efficient. In hcematemesis, it is not so serviceable. In purpura, it acts beneficially. From its influence in contracting blood vessels, it has been used in the early stages of pneumonia and other inflammatory affections, in spinal congestions, in cerebrospinal meningitis, and for the cure of internal aneurisms. It has been injected hypodermically near the seat of disease for the cure of varices, hemorrhoids, and impotence due to dilatation of the dorsal vein of the penis. It may be employed with great advantage, either internally or hypodermically, to reduce the size of an enlarged spleen. In glycosuria and in polyuria it does good, and, from its influence on unstriped muscular fibres generally, it is useful in relaxation of the sphincters, diarrhoea, dysentery, spermatorrhoea, uterine subinvolu- tion, and to diminish the size of subperitoneal uterine fibroids. What are the preparations of ergot and their doses ? Extractum Ergots {extract of ergot) is five times as strong as the fluid extract ; dose gr. v-xv (0.3-1.0). It may be used hypoder- mically, dissolved in water and filtered. OXYTOCICS— BARK OF COTTON ROOT. 173 Extractum Ergots Fluidum {fluid extract of ergot), dose n[v-f3iv (0.3-15.0). Vinum Ergot^e {wine of ergot) contains 15 per cent, of powdered ergot; dose f3j-iv (4.0-15.0). HYDRASTIS. What is hydrastis ? Hydrastis is the rhizome and roots of H. canadensis, yellow root or golden seal {Nat Ord. Ranunculaceas). It has been already considered under the Bitter Tonics {q. v.). HYDRASTIN^ HYDROCHLORAS — HYDRASTINE HYDROCHLORATE. What is this substance ? It is the hydrochlorate of an artificial alkaloid produced by the oxidation of hydrastine, and has been found to produce powerful uterine contractions, stimulating also the muscular fibres of the heart, arterioles, and intestines. It probably stimulates the volun- tary muscles, but in a lesser degree. In fatal doses it depresses powerfully the entire motor nervous tract and causes death by respiratory failure. It has been used with success in menorrhagia and metrorrhagia and other uterine hemorrhages. It is also recommended as a heart tonic. Dose gr. £-j (0.016- 0.065). GOSSYPII RADICIS CORTEX — BARK OF COTTON ROOT. What is gossypii radicis cortex ? It is the bark of the root of Gossypiurn herbaceum and other spe- cies of Gossypium {Nat. Ord. Malvaceae). Given to animals, it first slows and then quickens the cardiac action, which is always enfeebled by first stimulating and then paralyzing the cardio-inhibitory apparatus and depressing the cardio-motor gan- glia. It stimulates and then depresses the vaso-motor centres, causing a rise, but subsequently a fall, in the blood pressure. It stimulates non-striated muscular fibres, and appears to excite rhythmical con- tractions of the gravid uterus and to increase their power when present. It depresses the reflex centres of the cord, and causes 174 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. death by respiratory paralysis, generally preceded by convulsions, which are not of cerebral origin. It has been recommended as a substitute for ergot in uterine inertia, postpartum hemorrhage, and to aid the expulsion of uterine myo- mata. It has been used in chonic metritis, and although not as efficient as ergot, is useful in menorrhagia. Extractum GossYPii Radicis Fluidum {fluid extract of cotton root), dosef3ss-j (2.0-4.0). QUININA — QUININE. Is quinine oxytocic ? Although quinine is used for this purpose, it probably posseses no action on the uterus per se, but as an antiperiodic or as a tonic, is capable of overcoming the morbid conditions (as malaria) which, by depressing the system at large, may prevent normal, healthy uterine contractions. ORDER IV. — Uterine Sedatives. What are uterine sedatives ? They are medicines which are employed to depress the uterine mus- cular or nervous apparatus and restrain violent, irregular or untimely uterine contractions. What medicines are used for this purpose, and when are they employed ? They are principally useful during pregnancy, to prevent abortion which is threatening, but not inevitable. They are also of service in arresting the irregular uterine contractions which sometimes occur prior to labor, and are called "false labor pains." For the former purpose opium, cannabis indica and the motor depressants — as chloral, the bromides, tartar emetic and viburnum prunifolium, especially the first- and last-named remedies — are used, while for the latter opium and chloral are employed. To moderate too violent contractions during labor, ether is the best remedy. Of these medicines all have been described except UTERINE SEDATIVES— VIBURNUM PRUNIFOLIUM. 175 VIBURNUM PRUNIFOLIUM. What is viburnum prunifolium ? It is the baric of V. prunifolium, sloe or black haw (Nat. Ord. Caprifoliaceae), a small indigenous tree. It contains valerianic acid, a bitter principle [viburnin), resin, tannin, etc. Its physiological effects are not understood. It appears to diminish reflex irritability and to have a sedative effect on involuntary muscular fibre and pos- sibly lowers blood-pressure. Toxic effects are only seen after enormous doses have been administered, and consist of headache, dryness of the mouth and throat, and disordered vision. It has been employed as a uterine sedative in habitual and in threatened abortion, in congestive and neuralgic dysmenorrhoea, in menorrhagias and in nervous disturbances occurring at the climacteric period, in post-partum dolores when no clots or fragments of the placenta remain in the uterus, and in false labor-pains. It has also been used in colicky diarrhoea and dysentery, and is even recom- mended for cramps occurring in the voluntary muscles. Extractum Viburni Fluidum [fluid extract of viburnum) , dose f3ss-ij (2.0-8.0) in elixir of orange. ORDER Y.— Emmenagogues. What are emmenagogues ? Emmenagogues are medicines employed to increase or reestablish the menstrual flow when it is scanty or suppressed from other causes than pregnancy or the climacteric period. When the catamenia are arrested from pregnancy, medicines used to bring them on cannot but be injurious to the woman, as the doses necessaiy are sufficient to cause poisoning, one of the symptoms of which may (or may not) be uterine hemorrhage. This is especially true of cantharides and of the volatile oils. What medicines are used as emmenagogues ? When amenorrhoea depends upon anaemia or chlorosis the best emmenagogues are iron (combined with aloes or myrrh), arsenic or manganese. When local anaemia or an atonic condition of the uterus is present, aloes [q. v.) is very useful. If, on the other hand, pelvic plethora exists with constipation and a scanty flow often of a 176 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. thick black discharge accompanied with pelvic pain and fullness, the saline cathartics are employed. In suppression of the menses from cold, aloes and potassium permanganate are usually more successful. In amenorrhoea due to an atonic condition of the uterus, the more stimulating emmena- gogues are given, generally with aloetic purgatives. STIMULATING EMMENAGOGUES. Name the stimulating emmenagogues. Savine, tansy, apiol, cantharides and guaiac. SABINA — SAVINE. What is savine ? Savine is the tops of Juniperus Sabina (Nat. Ord. Coniferse), a small evergreen shrub of Southern Europe. It contains a volatile oil. When applied locally savine is irritant. In medicinal doses it increases the circulation, is a gastric, uterine and renal irritant, and proves diuretic. In overdoses it is a gastro-intestinal irritant with great depression, unconsciousness, convulsions, hemorrhages from the uterus and kidneys, suppression of urine and, in pregnant females, abortion. Death occurs from collapse. Savine is used in relaxed states of the uterus and uterine vessels, and has proved successful in the treatment both of amenorrhoea and menorrhagia when due to atonic condition of this organ. Extractum Sabine Fluidum (fluid extract of savine), dose nuv-x (0.3-0.6). Oleum Sabin^e (oil of savine), the best preparation for internal use; dose gtt. v-x (0.3-0.6), in capsules or emulsion, every 3 or 4 hours. TANACETUM — TANSY. What is tansy ? Tansy is the leaves and tops of Tanacetum vulgare {Nat. Ord- Compositse). It contains a volatile oil and a bitter principle (tan- acetin). It is a gastro-intestinal irritant and diuretic, and in large doses causes death from respiratory paralysis, preceded by epilepti- form convulsions of cerebral origin, and unconsciousness. It is used as a stimulating emmenagogue, but is a very dangerous remedy. The minimum fatal quantity is unknown. Dose gr. x-xxv (0.6-1.5), in infusion ; of the oil, n\J (0.06) may be given. EMETICS. 177 APIOL. What is apiol ? Aptol (not official), or parsley-camphor, is obtained from the vol- atile oil of the root of Petroselinum sativum (Nat. Orel. Umbelli- ferae). It is very efficacious as a stimulating emmenagogue m func- tional and anaemic amenorrhoea and in neuralgic dysmenorrhea, but is contraindicated in any condition of plethora. Dose gtt. iij-x (0.18-0.6) in gelatin capsules given morning and evening for 4 or 5 days before the expected menstrual period. The French capsules or pearls usually contain gr. iij^j (0.25) of apiol. CANTHARIDES — GUAIAC. What are these substances ? Canikarides will be considered under "Irritants." The tincture is used as a stimulating emmenagogue, dose nUij-v (0.18-0.3), t. i. d., great care being taken to avoid strangury. Guaiac has been considered with the " Alteratives." (D) ON THE ALIMENTARY CANAL. ORDER I.— Emetics. What are emetics, and how do they act? Emetics are medicines which are given to induce vomiting. They may act either by directly irritating the stomach, thus causing expulsion of its contents in a reflex manner, when they are called local emetics, or by acting, after absorption, on the reflex centre of the medulla which governs emesis, when they are called systemic emetics. It does not always follow that a remedy is a systemic emetic because it causes vomiting when given hypodermically or per rectum, for it may be eliminated by, and produce irritation of, the gastric mucous membrane, thus exciting reflex vomiting. For what purposes are emetics used? Emetics are used (1 ) to unload the stomach ; (2) to depress the circulatory system by inducing nausea (as in the early stages of bronchitis or of tonsillitis, in which emetics, frequently repeated in 12 178 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. small doses, will sometimes arrest trie inflammation) ; (3) to relax the muscular system and relieve spasm (as in spasmodic croup) ; (4) to promote secretion and excretion ; (5) to expel foreign bodies or secretions from the air passages, and (6) as revulsives. What are the contraindications to their employment ? They should never be employed in cases of cerebral or gastric in- flammation, and should be used cautiously, if at all, in the latter stages of pregnancy, in hernia, or where great depression exists, as in the latter stages of capillary bronchitis or of croup. Name the medicines employed as emetics. The vegetable emetics are ipecac, apomorphine and mustard. The mineral emetics are zinc sulphate, copper sulphate, alum, turpeth mineral and tartar emetic. IPECACUANHA — IPECAC. What is ipecac, and what chemical principles does it contain? Ipecac is the root of Cephaelis Ipecacuanha (Nat. Ord, Rubiaceae), a plant of Brazil. Its effects depend upon an alkaloid, emetine, which is combined with ipecacuanhic acid. What are its physiological actions ? Locally applied, ipecac is an irritant, either to the skin or mucous membranes. Given internally in small doses, repeated, it increases the perspiration, saliva, bile, the secretions from the broncho-pulmonary and gastro -intestinal mucous membranes, and causes nausea. In sufficient amounts it greatly augments the secre- tions and induces vomiting, without much nausea or depression, no matter how exhibited, emesis being more rapid when it is taken by the mouth. Toxic doses in animals depress the respiration and paralyze the heart directly. Post-mortem examination shows the mucous mem- branes of the stomach, intestines and lungs to be intensely con- gested. Sometimes, however, the lungs are almost exsanguine. What are the medicinal uses of ipecac ? Ipecac is employed as an emetic, and is the safest remedy which can be given for this purpose, especially to children. It is particu- EMETICS— IPECAC. 179 larly of service when it is desired to evacuate the contents of an overloaded stomach without producing much depression, as an adjunct to other remedies in croup and in the earlier stages of capillary bronchitis. In narcotic poisoning it is not as efficient as the mineral emetics. As an expectorant it is added to cough medicines in the dry stage of bronchitis. As a cholagogue it is a valuable addition to purga- tive pills. As a haemostatic it is highly recommended in haemoptysis and post-partum hemorrhage. In the treatment of dysentery, especially when epidemic, it is of great service, given in large dose (gr. xx-£ij (1.28-8.0), every few hours). When thus administered a tolerance is soon established, and no nausea or vomiting is produced. It is also useful in various kinds of diarrhoea, especially of choleriform and tuberculous diar- rhoea. Reflex vomiting, as the vomiting of pregnancy, has some- times been arrested by minute doses of the wine of ipecac. What are the preparations of ipecac and their doses ? Ipecac may be given in powder, dose as an emetic gr. x-xx (0.64- 1.28); as a nauseant, gr. ss-ij (0.03-0.13); as an expectorant and diaphoretic, gr. \-% (0.016-0.032) ; as a stomachic tonic and hepatic stimulant, gr. ^-J- (0.005-0.008). Extractum Ipecacuanha Fluidum {fluid extract of ipecac), dose as an emetic Ttlxx-xxx (1.23-1.8), repeated until vomiting occurs. Vinum Ipecacuanha {wine of ipecac) contains 10 per cent, of the fluid extract; dose as emetic f3j-iv (4.0-16.0). Syrupus Ipecacuanha {syrup of ipecac) contains 7 per cent. of the fluid extract; as an emetic f3j-ij (4.0-8.0) may be given to a child, or n\,v-x (0.3-0.6) as an expectorant. Trochisci Ipecacuanha {troches of ipecac), each contains about gr. £ (0.02) of ipecac. Powder of ipecac and opium (Dover's powder), tincture of ipecac and opium, and troches of ipecac and morphine have been consid- ered under "Opium." APOMORPHINA HYDROCHLORAS — APOMORPHINE HYDROCHLORATE. What is apomorphine hydrochlorate ? It is the hydrochlorate of an artificial alkaloid obtained from morphine or codeine. 180 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. What are its physiological actions ? Griven to warm-blooded animals in small doses it causes vomiting ; after large doses there is salivation, violent vomiting and muscular tremors ; toxic doses induce great restlessness, paresis, convulsions, hurried respiration and death from asphyxia, without the occurrence of emesis. It is a systemic emetic, probably in medicinal doses stimulating the reflex centre for vomiting, but in large doses depressing and paralyzing it. No matter how administered, emesis takes place promptly, with but little nausea and rarely accompanied by much de- pression. Large doses appear to stimulate and finally paralyze the respiratory centre. It increases the pulse-rate by stimulating the accelerator fibres (?), and in large doses by stimulating the vaso- motor centres, it raises the arterial pressure. In toxic doses it de- presses the cardiac muscle and thus reduces the blood pressure. In large doses it is at first a cerebral stimulant, but later depresses and paralyzes the brain. The cause of the convulsion is not understood. It is a muscle poison. What are the uses and doses of apomorphine hydrochlorate ? It may be employed as an emetic whenever prompt evacuation of the stomach is required, and may be administered either hypodermi- cally or by the mouth. In narcotic poisoning it is highly recom- mended. As an expectorant in the early stages of acute bronchitis or in chronic bronchitis without much expectoration, it is very serviceable, and can be advantageously used in capillaiy bronchitis of children both as an expectorant and emetic. The adult dose as an emetic is gr. tV (0.004) hypodermically, or gr. ^-i (0.005-0.008) by the mouth. As as expectorant smaller doses are required. SINAPIS — MUSTARD. What is mustard, and how is it used as an emetic ? Mustard is the seed of Brassica nigra and B. alba (Nat- Ord. Cruciferse). Mustard flour is irritant to the mucous membranes as well as to the skin, and is a prompt and efficient local emetic, espe- cially useful when torpor of the stomach is present. It will be more fully considered hereafter. Dose as an emetic from a teaspoonful to GASTRIC SEDATIVES. 181 a tablespoonful (4.0-16.0) of the flour, in a glass of tepid water, repeated, if necessary, in 1 5 or 20 minutes. What mineral emetics are employed ? Zinci Sulphas [zinc sulphate) is a prompt and efficient local emetic. Dose gr. x-xx (0.6-1.2), or even gr. xxx (1.9) in narcotic poisoning. Cupri Sulphas {copper sulphate) is a prompt local emetic, but more irritating than the zinc salt. Dose gr. iij-v (0.10-0.3) or even gr. x (0.6) in narcotic poisoning. It is the best emetic in poisoning by phosphorus (q. v.). Alumen (alum) is also a local emetic of value, especially useful in membranous croup, and useful also in capillary bronchitis ; dose a teaspoonful (4.0) of the powdered drug in molasses, or, better, in syrup of ipecac. Hydrargyri Subsulphas Flavus (yellow mercurial subsul- phate — Turpeth mineral), used as an emetic in croup ; dose gr. j-v (0.06-0.3) repeated every 10 or 15 minutes until free vomiting occurs. Antimonii et Potassh Tartras (antimonium and potassium tartrate — tartar emetic) is rarely used as an emetic because of the great depression which it induces; dose gr. j-ij (0.06-0.13). Of these substances the three first will be found under the head of astringents, while the two last have already been considered. ORDER II.— Gastric Sedatives. What are gastric sedatives ? They are medicines employed to diminish gastric irritability, and thus allay nausea and vomiting. What medicines are nsed for this purpose ? When vomiting is due to acute irritation, as from an overloaded stomach, the ingestion of acrid substances, or cholera morbus, it is best treated, after the contents have been evacuated, by minute doses of calomel (gr. T *o (0.005)) with sodium bicarbonate (gr. j (0.06)); pellets of ice dissolved in the mouth ; lime-water and rest. A small dose of brandy will sometimes kt settle the stomach." If irritability persists, small doses of morphine, or of diluted hydrocyanic acid or 182 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. creasote, or bismuth and sodium bicarbonate answer better. When due to the formation of gases from fermentation, creasote, carbolic acid, thymol, sulphurous acid, the sulphites or charcoal are given. When vomiting occurs on taking food after long abstinence, and perhaps preceding irritation, calomel and sodium bicarbonate in minute amounts, followed by small doses of brandy, and milk and lime-water by the teaspoonful (4.0) at intervals, should be employed. Ether-vomiting is best met with teaspoonful (4.0) doses of very hot water given every 10 or 15 minutes. Reflex vomiting, as of sea- sickness or of pregnancy, usually requires a medicine which will depress the centre in the medulla presiding over the act, as opium, the bromides, or diluted hydrocyanic acid. Among other remedies used for the latter variety of vomiting may be mentioned, tincture of nux vomica (gtt. J-j (0.015-0.06), cerium oxalate (gr. J-v (0.016- 0.3)), wine of ipecac (gtt. \-\] (0.015-0.12)), and Fowler's solution (fflr-j (0.015-0.06)). Counter-irritation over the epigastrium often aids the action of gastric sedatives. The above remedies have already been noticed or will be discussed in their appropriate places. ORDER III.— Carminatives. What are carminatives ? Carminatives are medicines employed to aid the expulsion of gases from the stomach and intestines. What medicines are used as carminatives ? The aromatics, which owe their virtues principally to the volatile oil which they contain, are especially used for this purpose. Other drugs containing volatile oils, as asafetida, eucalyptus, etc. , are also carminative ; and ether is sometimes employed for the same object. What are the general effects of the aromatics ? Locally they are irritant and rubefacient. The oils are also local anaesthetics. Internally in medicinal doses they are gastric and intestinal stimulants, increasing peristalsis and temporarily increasing to a slight extent the force and frequency of the pulse. In larger doses they stimulate the brain and cause a species of intoxication. In very large doses they are irritant and narcotic poisons. CARMINATIVES. 183 What are their medicinal uses ? The aroniatics are used internally as carminatives ; to prevent the griping of purgatives ; to correct the unpleasant taste or smell of other medicines, and as gastric stimulants. Locally they are employed as rubefacients, antiseptics and ano- dynes. They should never be used when inflammation of the stomach or bowels is present, but in diarrhoea due to relaxation they are often of service. Name the aromatics, their chemical constituents, prepara- tions and doses. Capsicum, or red pepper, is the fruit of C. fastigiatum (Nat. Ord. Solanaceae). It contains a resin, a. fixed and a volatile oil. It is used as a condiment, as a gastric stimulant, particularly in the case of drunkards, as an addendum to tonic pills, as a carminative in cases of feeble digestion, as a gargle in tonsillitis, and externally as a rubefacient. Extractum Capsici Fluidum [fluid extract of capsicum), dose ttvv-x (0.3-0.6). Tinctura Capsici (tincture of capsicum), dose Tr\,v-f3j (0.3-4.0). Oleoresina Capsici (oleoresin of capsicum), dose gr. ss-j (0.03- 0.06). Emplastrum Capsici {plaster of capsicum), for external use. Piper (pepper) is the unripe fruit of Piper nigrum (Nat Ord. Piperacefe). It contains a volatile oil, an acrid resin and a neutral principle, piperin, which increases the respiration and circulation, dilates the pupil, and finally paralyzes the heart in systole. It has been used as an antiperiodic. Pepper is used as a condiment and sometimes as a stomachic stimulant, combined with other medicines, in atonic dyspepsia, and as a carminative. Oleoresina Piperis (oleoresin of pepper), dose gr. ss-ij (0.03- 0.13). Piperinum (piperin), dose gr. j-v (0.06-0.3). ClNNAMOMDM Cassia (cassia cinnamon), the bark of the shoots of one or more undetermined species of cinnamomum. grown in China (Nat. Ord. Laurineae) ; Cinnamomum Saigonicum (Saigon cinnamon), the bark of an undetermined species of cinnamomum 184 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. (Nat. Ord. Laurineae) (which comes from Cochin-China) ; and Cin- NAMOMUM Zeylanicum (Ceylon cinnamon), the inner bark of the shoots of cinnamomnm Zeylanicum {Nat. Ord. Laurineae), are all recognized by the Pharmacopoeia. Of these varieties the latter is considered the finest and the former the poorest in quality. They contain volatile oil, tannic acid, etc. , are slightly astringent, and are used as carminatives, flavonng ingredients, and vehicles. TlNCTURA Cinnamomi {tincture of cinnamon) contains 10 per cent, of powdered Ceylon cinnamon; dose f3j-ij (4.0-8.0). Aqua Cinnamomi {cinnamon water) contains 0.2 per cent, of the oil of cinnamon, and is used as a vehicle. Oleum Cinnamomi (oil of cinnamon) is a volatile oil distilled from cassia cinnamon ; dose gtt. j-iij (0.06-0.18). Spiritus Cinnamomi (spirit of cinnamon) contains 10 per cent, of the oil; dose l^x-xxx (0.6-2.0). Myristica (nutmeg); Macis (mace). These are parts of the fruit of Myristica fragrans (Nat. Ord. Myristicaceae), the arillode of the seed being mace, and the seed nutmegs. Both contain vola- tile oils. They are aromatic stimulants, carminatives, and in large doses narcotics. Oleum Myristica (oil of nvtmeg), dose gtt. j-v (0.06-0.3). Spiritus Myristic^e (spirit of nutmeg) contains 5 per cent, of the oil; dose f3ss-ij (1.8-7.3). Caryophyllus (cloves) is the vn expanded flowers of Eugenia aromatica {Nat. Ord. Myrtaceae). They contain volatile oil, tannic acid, caryopliyllin and en gen in. They are gastric stimulants and carminatives, but are principally employed as a condiment. The oil is used as a local anodyne to carious teeth. Oleum Caryophylli (oil of cloves), dose gtt. iij-v (0.18-0.3). Pimenta, or allspice, is the nearly ripe fruit of Pimenta officinalis {Nat. Ord. Myrtaceae). It contains a volatile oil, and is carminative. Oleum Pimento (oil of pimenta), dose gtt. iij-v (0.18-0.3). Zingiber (giuger) is the rhizome of Z. officinale (Nat. Ord. Scitamineae). It contains a volatile oil and an acrid resin. It is a CARMINATIVES. 185 gastric stimulant and carminative, much employed in flatulency and colic and as an addition to other stomachics. Extractum ZlNGlBERlS Fluidum {fluid extract of ginger), dose ttu-xxx (0.6-2.0). Tinctura Zingiberis {tincture of ginger), dose f3ss-j (2.0-4.0). Syrupus Zingiberis [syrup of ginger), used as a vehicle for other medicines. Oleoresina Zingiberis {oleoresin of ginger), used as a correc- tive to purgative pills to prevent griping; dose i^lss-ij (0.03-0.12). Trochisci Zingiberis {troches of ginger), dose 2 or 3 lozenges. Cardamomum {cardamom) is the fruit of Elettaria repens [Nat. Ord. Scitamineae), and contains a volatile oil. It is used as a gastric stimulant and carminative, and as an adjuvant and corrective of other medicines. Tinctura Cardamomi {tincture of cardamom), dose f£>j-ij (4.0-8.0). Tinctura Cardamomi Composita {compound tincture of carda- mom) contains also caraway, cassia, cinnamon, and cochineal ; dose fSJ-ij (4.0-8.0). Pulyis Aromaticus {aromatic poioder) consists of ceylon cinna- mon and ginger (35 per cent, each), with cardamom and nutmeg (15 per cent, each). An excellent carminative preparation. Dose gr. x-xxx f 0.6-2.0). Extractum Aromaticum Fluidum {aromatic fluid extract) is a fluid extract of aromatic powder. Dose tt\,xv-xxx (1.0-2.0). Oleum Cajuputi {oil of cajuput) is the volatile oil distilled from the leaves of Melaleuca Leucadendron {Nat. Ord. Myrtacese), and is very destructive to low organisms. It has been employed as a remedy against ascarides and, locally, in parasitic skin diseases, but is chiefly used as a gastric stimulant and carminative in flatulent colic and to prevent the griping of cathartics. Dose mj-v (0.06- 0.3). Calamus is the rhizome of Acorus Calamus {Nat. Ord. Aroideae). It contains a volatile oil and a glucoside, acorin. It is an aromatic stimulant and is somewhat tonic. Extractum Calami Fluidum {fluid extract of calamus), dose KU-xxx (0.6-2.0). 186 ESSENTIALS OF MATERIA MEDlCA AND THERAPEUTICS. Oleum Gaultheria (oil of gaultheria) is a volatile oil distilled from the leaves of G. procumbens or wintergreen [Nat Ord. Erica- ceae), and has been considered under the head of " Salicylic Acid ". It consists almost entirely of methyl salicylate and is nearly identical with volatile oil of Betula (vid. Salicylates) ; dose in rheumatism ttLv-xv (0.31-0.93 c. c). Spiritus Gaultheria [spirit of gaultheria) contains 5 per cent, of the oil; dose HLx-xxx (0.62-1.85 c. c). The following herbs, belonging to the Nat Ord. Labiatse, con- tain volatile oils, and are used as carminatives, gastric stimulants and flavoring ingredients: — Oleum Lavendula Florum (oil of lavender flowers) is a volatile oil distilled from the flowers of L. vera. Dose gtt. j-v (0.06-0.3). Spiritus Lavendulce [spirit of lavender) and Twctura Lavendulce Composita (compound tincture of lavender) are also official; dose of either f3ss-j (2.0-4.0). Mentha Piperita [peppermint) and Mentha Viridis [spear- mint). The leaves and tops are official. The oils [oleum menthce piperita? and oleum menthce viridis, dose gtt. j-v (0.06-0.3)) are usually given in the form of spirit (spiritus menthce piperitce and spiritus menthce viridis), dose ttLv-xxx (0.3-2.0). The waters [aqua menthce piperitce and aqua menthce viridis) are used as vehicles. Troches of peppermint [trochisci menthce piperita?) are sometimes used in flatulent colic. Oleum Rosmarini [oil of rosemary) is a volatile oil distilled from the leaves of Rosmarinus officinalis. It is carminative, but is chiefly used as an ingredient of rubefacient liniments. Hedeoma (pennyroyal). The leaves and tops of H. pulegioides are official. The volatile oil (oleum hedeomce) may be given in doses of mj-v (0.06-0.3). Marrubium (horehound). The leaves and tops of M. vulgare are used as a gastric stimulant and expectorant. Salvia (sage). The leaves of S. officinalis are slightly astringent as well as aromatic. An infusion is sometimes used as a gargle in sore throat. Oleum Thymi (oil of thyme), a volatile oil distilled from the leaves and flowering tops of Thymus vulgaris, contains much thymol CARMINATIVES. 187 [q. v.), and is therefore not only aromatic and carminative, but anti- septic and antifermentative. The following seed are derived from plants belonging to the Nat. Ord. Uinbelliferge : — F(ENICULUM {fennel), from F. capillaceum. Of the oil {oleum fceniculi), the dose is gtt. v-x (0.3-0.6). A water {aqua fceniculi) is also official. Carum {caraway), from C. Carvi. Dose of the oil {oleum can) gtt. j-x (0.06-0.6). Anisum {anise), from Pimpinella anisum. Dose of the oil {oleum anisi) gtt. v-xv (0.3-0.9). A spirit {spiritus anisi) and a water {aqua anisi) are also official. Coriandrum {coriander), from C. sativum. The oil {oleum coriandri) is official. Illicium {star-anise) is the fruit of I. verum [Nat. Ord. Mag- noliacese). It contains a volatile oil, and is used as a substitute for anise. The following preparations are only used as flavors and vehicles : — Aurantii Amari Cortex {bitter orange peel) ; Aurantii Dul- cis Cortex {sweet orange peel). These are respectively the rind of the fruits of Citrus vulgaris (bitter orange) and of C. Aurantium (sweet orange) {Nat. Ord. Rutacese). The following preparations are official : — Oil of orange flowers, or oil of neroli [oleum aurantii florum), a volatile oil distilled from the fresh flowers of the bitter orange; stronger orange flower water {aqua aurantii florum fortior — aqua aurantii florfim, Pharm. 1880 — triple orange floive?' ivater), water saturated with the volatile oil of fresh orange flowers, obtained as a by-product in the distillation of the oil of orange flowers ; orange flower water {aqua aurantii florUm), equal volumes of stronger orange flower water and distilled water freshly mixed ; syrup of orange flowers {syrupus aurantii florum); syrup of orange peel {syrupus aurantii); oil of orange peel {oleum aurantii corticis) ; spirit of orange [spiritus aurantii); compound spirit of orange {spiritus aurantii compositus) contains oil of orange peel (200), oil 188 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. of lemon (50), oil of coriander (20), and oil of anise (5) in 1000 parts of the preparation. It is used in making elixir aromaticum (aro- matic elixir), which contains 12 parts of the compound spirit in 1000 parts of the preparation ; fluid extract of bitter orange peel [extraction aurantii amari flnidum) ; tinctures of bitter and of sweet orange peel (tinctura aurantii amari, tinctura aurantii dulcis) — dose of either tincture, f3j-ij (4.0-8.0). Vanilla, the fruit of V. planifolia {Nat. Ord, Orchidacese), con- tains vanillin. The tincture (tinctura vanilla?) is official. The oil of turpentine is an excellent carminative and will be con- sidered hereafter. ORDER IV.— Cathartics. What are cathartics? Cathartics are medicines employed to produce an evacuation from the bowels either by increasing intestinal peristalsis, or by increasing the secretions of the canal and its appendages. For what purposes are they used ? They are used (1) to unload the bowels ; (2) to deplete the blood vessels by abstracting water from the blood ; (3) to promote absorp- tion ; (4) to stimulate secretion ; (5) to eliminate noxious material from the blood (as the poison of uraemia) ; (6) to act as revulsives, and (7) to influence the pelvic circulation. How may cathartics be classified ? Cathartics are divided into laxatives, simple purgatives, salines and drastics. Laxatives. What are laxatives ? Laxatives are such substances as unload the bowels, acting with- out irritation and not causing purgation. Name the laxatives. Tamarind, manna, cassia fistula, frangula, cascara sagrada, castor oil, sulphur and sulphurated potassa. CATHARTICS— CASTOR OIL. 189 TAMARINDUS — TAMARIND. MANNA. VIOLA TRICOLOR. What are these substances ? Tamarindus {tamarind) is the preserved pulp of the fruit of T. indica {Nat. Ord. Leguminosse), a tree of India. Eaten as a pre- serve (^ss-j (15.0-31.0)) it is laxative. An infusion makes a pleasant refrigerant drink. It enters into confection of senna. Manna is the concrete saccharine exudation of Fraxinus Ornus (Nat. Ord. Oleacese). It contains mannit, fraxiii, and resin which is probably the laxative principle. Manna is usually com- bined with other cathartics. Dose for an adult ^j-ij (31.0-62.0) ; for children, 3j-iv (4.0-15.0). CASSIA FISTULA. FRANGULA. RHAMNUS PURSHIANA. What are these substances ? Cassia Fistula is the fruit of C. Fistula or purging cassia (Nat. Ord, Leguminosae). It is an ingredient of the confection of senna. Dose 3J-3J (4.0-31.0). Frangula is the bark of Rhamnus Frangula or alder buckthorn (Nat. Ord. Rhamneae). It contains frangulin and emodiu, and as it is an active emetic and hydragogue when fresh, it should be kept a year at least before being used ; dose of the fluid extract (extractum frangula^ fluidum) f^ss-j (2.0-4.0). Rhamnus Purshiana (cascara sagrada or chittem bark) is the bark of R. Purshiana (A T at. Ord, Rhainnaceae), a tree of California. It contains several resins and is an efficient laxative, very useful in habitual constipation ; dose of the fluid extract (extractum rhamni purshiana fluidum) tt\,x-f3j (0.6-4.0). OLEUM RICINI — CASTOR OIL. What is castor oil? It is a fixed oil expressed from the seed of Ricinus communis, or Palmi Christi (Nat. Ord, Euphorbiaceae). What are its effects and uses ? In small doses it is a mild laxative, in larger amounts a simple 190 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. purgative. Applied with friction to the abdomen of children it frequently purges. It is very useful whenever it is desired to evacuate the bowels and remove any irritant materials, as undigested food. For this purpose it is often used in acute dysenteries and diarrhoeas, especially of children ; dose f3.j-iv (4.0-16.0), best given in whiskey and water, in such a manner that the entire inside of the glass will be wetted to its margins with the vehicle and the oil form a globule surrounded by the fluid ; or it may be given beaten up with double the quantity of sherry ; or mixed with equal parts of glycerin and flavored with some aromatic oil. SULPHUR. What is sulphur ? Sulphur is a chemical element obtained by purifying native sul- phur or by decomposing native sulphides. What are its effects, uses and preparations ? It acts as a mild laxative and is eliminated in all the excretions. Its continued use causes flatulence from the formation of sulphu- retted hydrogen. It is used as a laxative, especially in cases of hemorrhoids, and as an alterative both internally and externally in chronic rheumatism, muscular rheumatism, sciatica, and in various forms of skin disease, especially those of parasitic origin. As sulphur is excreted largely by the hair, it has been used locally and internally in the treatment of alopecia. It is also used as an expectorant. It is official as Sulphur Sublimatum {sublimed sulphur, sometimes called " flowers of sulphur"), Sulphur Lotum {washed sulphur), and Sulphur Pr^ecipitatum (precipitated sid- phur) ; dose of either preparation, 3j-iv (4.0-16.0) in syrup. Un- GUENTUM Sulphuris [sulphur ointment, containing 30 per cent, of washed sulphur) is used externally. POTASSA SULPHURATA— SULPHURATED POTASSA. What is sulphurated potassa ? Sulphurated potassa, or liver of sulphur, is an uncertain com- pound containing about 50 per cent, of potassium sulphide. In small doses it is decomposed in the stomach and acts like sulphur. In large doses it is a gastro-intestinal irritant and has CATHARTICS — RHUBARB. 191 produced death. It may be used to fulfil the indications of sulphur, but is chiefly employed as an alterative where a tendency to the formation of abscesses exists, in chronic rheumatism and in scaly skin affections. It is used externally in the form of bath or oint- ment ; dose gr. ij-x (0.1-0.6). SIMPLE PURGATIVES. What are the simple purgatives ? They are medicines employed to produce active purgation, but which do not produce sufficient irritation to cause inflammation or depression, even when large doses are given. Name the agents of this group. Castor oil, rhubarb, juglans, aloes, senna, leptandra, euonymus, and mercurials. Castor oil has been described with the laxatives. RHEUM — RHUBARB. JUGLANS. What are these medicines ? Rhubarb is the root of Rheum officinale [Nat. Ord. Polygon- aceae). It contains chrysophan, chrysophanic acid, 4 resins (eryth- roretin, emodin, phcerotin and aporetin), rheotannic and rheumic acids. It is a tonic, mild purgative, and an astringent owing to the rheotannic acid, and hence after purging it has a tendency to cause constipation. It tinges the milk and urine yellow, and stim- ulates the flow of bile. It is much used in diarrhoea from relaxation, in the early stages of summer complaint of children and in dyspepsia with constipation. The official preparations and their doses are : the extract {extractum rhei), gr. v-xx (0.3-1.3); pills (pih dm rhei) each contain gr. iij (0.2) of rhubarb ; compound pills [pilulce rhei composite^) each contain gr. ij (0.13) of rhubarb, gr. jss (0.1) of aloes, with myrrh and oil of peppermint ; dose No. j-iv ; compound powder [pulvis rhei compositus) contains rhubarb and magnesia, dose 3ss-j (2.0-4.0); fluid extract (extractum rhei flu id urn), ntxx- xxx (1.2-2.0) ; mixture of rhubarb and soda (mistura rhei et sod,m), for a child f3ss-j (2.0-4.0), for an adult f3j-iv (4.0-16.0); syrup (syrupus rhei), tt^x-xx (0.6-1.2) for an infant; aromatic or spiced syrup (syrupus rhei aromaticus), for an infant f^ss-j (2.0-4.0); tincture [tinctura rhei), f3j-ij (4.0-8.0); aromatic tincture {tinctura 192 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. rhei aromaticus), f3ss-j (2.0-4.0) ; sweet tincture (tinctura rhei dulcis), f3j-ij (4.0-8.0). Juglans is the baric of the root of Juglans cinerea, butternut or white walnut (Nat. Orel. Juglandacese), collected in autumn. It is used as a substitute for rhubarb, which it resembles in action. The extract (extractum juglandis) may be given in doses of gr. x-xxx (0.6-2.0). ALOE— ALOES. What is aloes ? Aloes is the inspissated juice of the leaves of Aloe Perryi, socotrine aloes (aloe socotrina) and of Aloe vera, Barbadoes aloes (aloe Bar- badensis) (Nat. Ord. Liliacese). Each variety contains a neutral crystalline principle, aloin. It is a tonic to the mucous membrane and a purgative, being slow in its action and affecting principally the large intestine, and apparently causing a determination of blood to the pelvic viscera. It is also a hepatic stimulant. It is used in habitual constipation, especially when torpor of the large bowel exists ; in hemorrhoids from relaxation of the veins and congestion of the portal circle ; in amenorrhoea and in menorrkagia due to want of tone of the uterine vessels. The official preparations are made of purified (socotrine) aloes (aloe pimficata), and are, pills (pihdee aloes), each containing gr. ij (0.13) of aloes; pills of aloes and mastich (pilulce aloes et mastiches), called also Lady Webster s dinner-pill, each containing gr. ij (0.13) of aloes; pills of aloes and myrrh (pihdee aloes et myrrhce) or Rufus' pill, each containing gr. ij (0.13) of aloes ; pill of aloes and iron (pihdee aloes etferri) each containing gr. j (0.07) of aloes, of dried ferrous sulphate and of aromatic powder (the two last named pills are useful in amenorrhoea) ; pills of aloes and asafetida (pilulce aloes et asafcett'da;), each con- taining gr. ji (0.09) of aloes, asafetida and soap (useful in flatulent dyspepsia with constipation) ; extract (extractum aloes), dose gr. j-v (0.06-0.3); tincture (tinctura aloes), dose f.5j-iv (4.0-16.0); tincture of aloes and myrrh (tinctura aloes et myrrhce), dose f3j-ij (4.0-8.0). Aloinum (aloin) is official, dose gr. T VJ (0.006-0.06). MERCURIAL CATHARTICS. 193 SENNA. LEPTANDRA. EUONYMUS. What are these medicines ? Senna is the leaflets of Cassia acutifolia (Alexandria Senna) and of C. angustifolia (Indian Senna) {Nat Ord. Leguminosae). It contains cathartic acid, chrysophauic acid, sennit and sennacrol. It is a prompt and efficient purgative, and probably acts on the entire length of the intestine, causing some griping. It is a mild hepatic stimulant. It is used where a prompt and decided cathartic effect is desired, usually in combination to prevent griping. Its prepara- tions are, the fluid extract (extraction sennce fluidum) dose f3j-iv (4.0-16.0); confection (confectio sennce), an^excellent purgative during pregnancy, 3j-ij (4.0-8.0); compound infusion (infusum sennce compositum), also called black draught, f^ss-iv (15.0-120.0) ; syrup (syrupus senna) f3j-ij (4.0-8.0) ; compound powder of glycyrrhiza (or of liquorice) (pulvis glycyrrhizce compositus), an excellent purga- tive, dose a teaspoonful (4.0) at bedtime. Leptandra is the rhizome and roots of Veronica virginica, Culver's root or physic (Nat. Ord. Scrophularineae). It contains leptandrin, and is a feeble stimulant to the liver and intestinal glands. Dose of the extract (extraction leptandra?) gr. j-iv (0.06-0.25) ; of the fluid extract (extraction leptandrce fluidum) f^ss-j (2.0-4.0). Euonymus, or wahoo, the hark of the root of ID. atropurpureus (Nat. Ord. Celastrinege), contains a bitter principle, euonymin, resins, euonic acid, etc. ; is a powerful hepatic stimulant, and increases the intestinal secretion. It is used as a purgative in tor- pidity of the liver and intestines. Dose of the extract (extraction euonymi) gr. ij-iv (0.13-0.26) in pill. Mercurial Cathartics. What mercurials are used as simple purgatives ? HYDRARGYRI CHLORIDUM MlTE (merenrons chloride or calomel), dose gr. ss-j to'x (0.03-0.6), at bedtime ; and Massa Hydrargyri (mercurial or blue mass), dose gr. v-xv (0.3-1.0). The} 7 will be found under the head of " Alteratives." 13 194 essentials of materia medic a and therapeutics. Saline Cathartics. What are saline cathartics ? The saline cathartics are certain salts which produce an evacuation of the bowel not only by increasing peristalsis from their irritant effect, but also by promoting outward osmosis from the blood, thus rendering the stool liquid, depleting the bloodvessels, and con- sequently favoring absorption of effused fluids. Name the medicines of this group. The magnesium salts, some of the sodium and some of the potas- sium salts, and manganese sulphate. Describe the effects, uses, preparations, and doses of the mag- nesium salts. Magnesia {calcined magnesia) and Magnesia Ponderosa {heavy magnesia — is similar to Henry's, Husband's, and Ellis' mag- nesias) are antacid and cathartic, are mild in their action and are excellent preparations for children ; dose as an antacid gr. xx (1.2), as a cathartic 3j (4.0) or more. Magnesh Carbonas {magnesium carbonate — magnesia alba), not much used ; dose as an antacid gr. x-xx (0.6-1.2), as a cathartic 3j-ij (4.0-8.0). Magnesh Sulphas {magnesium sulphate — Epsom salt) is much more powerful than the preceding preparations, and produces free, watery purgation with very little irritation. It is used as a purga- tive to remove fecal accumulations ; as a depletant in entero-colitis and acute dysentery (with opium) ; to aid absorption (given in very concentrated solutions) in dropsical effusions, especially hydrothorax ; and for the relief of colica pictonum and other forms of lead-poison- ing; dose 3ss-j (15.0-31.0). Magnesh Citras Effervescens {effervescent magnesium citrate), dose 3j-iv (4.0-16.0) taken in water while effervescing. Liquor Magnesh Citratis {solution of magnesium citrate). The citrates are similar in effect to the sulphate, but are more apt to irritate ; dose half to a whole bottle full (180.0-360.0 c.c). What salts of sodium are used as cathartics ? Sodii Sulphas {sodium sulphate— Glauber s salt) is similar in its DRASTIC CATHARTICS. 195 effects to Epsom salt, but more irritant and disagreeable. It is a mild hepatic stimulant, It is not much used ; dose 3j-iv (4.0-16.0). Sodii Phosphas (sodium phosphate) is a mild cathartic and hepatic stimulant. It is an excellent purgative in catarrhal condi- tions of the bowel, in catarrhal jaundice, and in chronic infantile diarrhoea with pasty stools; dose 3j-^j (4.0-31.0). Sodii Pyrophosphas [sodium pyrophosphate) resembles the preceding salt in action and uses; dose 5ss-iv (2.0-16.0). What potassium salts are used as cathartics ? Potassii Sulphas [potassium sulphate) was formerly, but is not at present, much used ; dose gr. xv-3j (1.0-4.0). Potassii Bitartras (potassium bitartrate — cream of tartar — cremor tartar) is a diuretic, refrigerant and cathartic. In overdoses it causes gastro-enteritis. Dose as diuretic gr. x-3j (0.6-4.0), as a mild laxative 3ss-j (2.0-4.0), as a saline cathartic 3ss (16.0). Potassii et Sodii Tartras (potassium and sodium tartrate — Rochelle salt) resembles Epsom salt, but is not so powerful ; dose gss-j (16.0-31.0). Pulyis Effervescens Compositus (compound effervescing pow- der — seidlitz powder) consists of Rochelle salt 3ij (7.75) with sodium bicarbonate gr. xl (2.59) in a blue, and tartaric acid gr. xxxv (2.25) in a white paper, their contents to be dissolved separately, the solutions mixed and taken while effervescing, on an empty stomach. What is manganese sulphate ? Mangani Sulphas (manganese sulphate) has been discussed with the tonics. It is a hepatic stimulant and cathartic also, resem- bling Epsom salt, but is a dangerous remedy, and is not much em- ployed ; dose gr. j-v (0.06-0.3). Drastic Cathartics. What are drastic cathartics ? Cathartics which cause much irritation and act very powerfully are so called. Most of them in overdoses cause irritant poisoning. When they produce very free, watery evacuations they are some- times spoken of as " hydragogues. ' ' The more powerful drastics are used as revulsives in cerebral affections. 196 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Describe the medicines employed as drastics. Jalapa (jalap), the tuberous root of Ipomoea Jalapa (Nat. Ord. Convolvulaceae), a Mexican plant, contains a resin, to which its pur- gative properties are due. It is a prompt and powerful hydragogue and cholagogue in over- doses, causing gastro-intestinal irritation and even death. It is used as a hydragogue in dropsies of cardiac or renal origin, as in ascites or anasarca, and sometimes as a cerebral revulsant. Its preparations are extract [extractum jalapce), dose gr. j-x (0.06-0.6); compound powder ( pulvis jalapce compositus), containing 35 percent, of jalap with cream of tartar, dose gr. x-3j (0.6-4.0) ; and the resin (resina jalapa), dose gr. j-v (0.06-0.3). Bryonia (bryony), the root of B. alba and B. dioica (Nat. Ord. Cucurbitaceae), European climbing vines, contains a glucoside, bry- onin, probably the active principle. It is a violent hydragogue cathartic resembling jalap in its effects, and also proving diuretic. It is used as a hydragogue in dropsies, especially in hydrothorax and hydropericardium. The tincture (tinctura bryonice) may be used in doses of f3ss-j (2.0-4.0). Podophyllum, the rhizome and roots of P. peltatum, May-apple or mandrake [Nat. Ord. Berberidese), a common indigenous plant, containing a resinous substance podophyllotoxin, consisting of picro- podophyllin, the purgative principle, and podophyllinic acid, which is inert. It is an active hydragogue and cholagogue, acting slowly and especially on the upper part of the small intestine and causing much irritation. In overdoses it is a gastro-intestinal irritant capable of causing death. It is used as a purgative and cholagogue in acute and chronic con- stipation, bilious attacks and in torpor of the liver. The dose of the extract (extractum podophylli) is gr. v-xv (0.3-1.0) ; of the fluid extract (extractum podophylli fluidum) tt\,x-xx (0.6-1.2); of the resin gr. 7^- \ (0.006-0.03) ; the latter preparation is the only one in common use. Podophyllotoxin (not official) may be used in the form of a 1 per cent, alcoholic solution, the dose of which is gtt. x-xxx (1.0-3.0). It is used hypodermically, dose gr. I (0.016). DRASTIC CATHARTICS. 197 Iris, the rhizome and roots of I. versicolor, or blue-flag [Nat. Ord. Irideae) ; contains a purgative resin. It is a powerful stimu- lant to the liver and intestinal glands, acting like podophyllum, but with less irritation. It is diuretic, and in overdoses irritant and depressant, It is used in dropsies, jaundice of malarial origin, and torpor of the liver. Dose of the extract (extractum iridis) gr. ij-iv (0.1-0.25); of the fluid extract (extractum iridis fluidum) fllx~3j (0.6-4.0). Chelidonium, celandine or tetterwort, is the herb C. majus {Nat. Ord. Papaveraceae) ; contains chderytJirine and chelidonine combined with chelidoniuic acid. It is used as a hydragogue cathartic, and is supposed to possess cholagogue effects and some narcotic properties. It may be given in doses of gr. x-3j (0.6-4.0), in a fluid extract or infusion. Scammonium (scammony) is a resinous exudation from the living root of Convolvulus Scammonia (Nat. Ord. Convolvulaceae), a Syrian plant. The resin scammonin is the active portion. It is a violent hydragogue, resembling jalap in its action, but much more irritating. It is never given except in combination with other cathartics. The dose of the resin (resina scammonii) is gr. ij-viij (0.13-0.5). It is one of the ingredients of compound extract of colocynth. Colocynthis (colocynth), the fruit, deprived of the rind, of Citrullus colocynthis, or bitter cucumber {Nat. Ord. Cucurbitaceae), contains a glucoside (the purgative principle) called colocynthiu, also a resin, colocynthitin, etc. It is an hepatic stimulant and violent hydragogue, and in over- doses causes death from gastro-enteritis. It is never given alone, but is used in small doses to increase the effects of milder cathartics. The extract (extractum colocynthidis) is used in combination with other purgatives, dose gr. ij-v (0.13-0.3); compound extract [ex- tractum colocynthidis compositum) containing also aloes, resin of scammony, cardamom and soap, dose gr. iij-x (0.2-0.64). Cambogia (gamboge) is a gum-resin obtained from Grarcinia 198 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. Hanburii {Nat. Ord. Guttiferae), a tree of Siam. The resin is the purgative principle and is called cambogic acid. It is a very power- ful hydragogue cathartic, and in overdoses has caused death. It is rarely used alone. Dose gr. ij-v (0.13-0.3). Piluls Cathartics Composite {compound cathartic pills). Each pill contains of compound extract of colocynth gr. j£ (0.08), of calomel and of extract of jalap each gr. j (0.06) and of gamboge gr. \ (0.015). Piluls Cathartics Vegitabiles [vegetable cathartic pills). Each pill contains of compound extract of colocynth gr. j (0.06), of extract of hyoscyanius and of jalap each gr. ss (0.03), of extract of leptandrin and of resin of podophyllum each gr. \ (0.015) with oil of peppermint, Elaterinum (elaterin) is a neutral principle extracted from Ela- terium, a substance deposited by the juice of the fruit of Ecballium Elaterium, or squirting cucumber (Nat. Ord. Cucurbitaceae). It is one of the most powerful of the hydragogues, also proving diuretic, and in excessive doses often causing death. It is much used in dropsies, in urcemia and as a cerebral revulsive. The dose is gr. ^ (0.003); of the trituration (trituratio elaterini) gr. ]-ss (0.016-0.03). Oleum Tiglii {croton oil) is a fixed oil expressed from the seeds of Croton Tiglium {Nat. Ord. Euphorbiaceae), a tree of India. The active principle has not been isolated. When applied to the skin croton oil is an intense irritant, causing a papular eruption which soon becomes pustular. Given internally it is a powerful and rapid hydragogue cathartic, causing severe griping pains and to some extent depressing the circulation. In overdoses it produces great depression and often proves fatal. In obstinate constipation it is very serviceable, and as a revulsive in cerebral affections, as apoplexy, it is the best hydragogue. It has been used externally as a counter-irritant (q. v. ). Dose gtt. j (0.016- 0.12), which may be given in pill or emulsion, or mixed with a few drops of glycerin or olive oil and placed on the patient's tongue when he cannot or will not swallow. ANTHELMINTICS. 199 Enemata. What are enemata ? Enemata are liquids injected into the rectum. They may be nutritive, cathartic, or forced enemata. Nutritive enemata are used to nourish the patient when the stomach cannot retain or digest food. They should be small in amount, not exceeding f.^iij-iv (90.0-120.0) at a time, nor should they be too frequently repeated, else they will cause irritability of the rectum. They should be combined with some digestant, as pepsin or pancreatin. Cathartic enemata are used to unload the bowels when irritation or inflammation of the stomach is present ; to aid the action of cathartics taken by the mouth ; to remove faecal accumulations or retained and irritating secretions from the large intestine ; to relieve tympanites ; to remove ascarides ; or to act as revulsives. The fluid used may be cold or warm water, either simple or medicated, and the quantity will depend on the case. The injection should be made slowly and carefully, and the introduction of air is to be avoided. Forced enemata are made slowly and gradually, the fluid, either warm water or warmed oil, being poured into a large funnel or rub- ber bag (fountain syringe) to which a long rubber tube is attached, armed with an injection pipe. By elevating the funnel or bag the fluid flows in a steady stream, the force being regulated by the height at which the bag is held. Forced enemata are employed principally to reduce intussusception of the bowels. ORDER V. — Anthelmintics. What are anthelmintics? Anthelmintics are medicines used to kill {vermicides) or cause the expulsion of {vermifuges) intestinal worms. How are they administered'? They should be given fasting, and should be followed in 4 to 6 hours by a purgative, as calomel or castor oil. Describe the medicines nsed as anthelmintics. SpiCxELIA, or pinkroot, the rhizome and roots of S. marilandica or Carolina pink {Nat Ord. Loganiacese), contains a bitter principle, 200 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. volatile oil, resin, tannic acid, etc. It slows the heart by stimulating the inhibiting centres, reduces arterial pressure by depressing the heart, and in overdoses quickens the pulse, increases the blood- pressure, dilates the pupil, causes delirium, and, in fatal cases, death from respiratory paralysis. It is very efficient in causing the expul- sion of lumbrici, but should be followed by a purge. Dose of the fluid extract (extraction spigelian fluidum) f3j-ij (4.0-8.0), or to a child gtt. x (0.5) on sugar. Chenopoditjm or American wormseed, the fruit of C. ambrosi- oides or Jerusalem oak (Nat. Ord. Chenopodiaceae), contains a volatile oil, to which its effects are due. It is a very efficient remedy for the expulsion of lumbrici, and should be followed by a brisk cathartic. The oil (oleum chenopodii) is given in doses of gtt. v-x (0.25-0.5) on sugar, to a child 3 years old, before meals. Santonica or Levant wormseed is the unexpanded flower-heads of Artemisia pauciflora (Nat. Ord, Composite). The active prin- ciple is santonin. Large doses cause salivation, rapid breathing, slow, labored pulse, trembling, yellow vision and yellow urine, unconscious- ness, convulsions, dilated pupils and death. It is used almost exclu- sively as a remedy for lumbrici. Dose of santonin (santoninum) for an adult gr. ss-v (0.03-0.3); for a child 2 years old gr. I (0.016). Troches of santonin (trochisci santonini) each contain gr. ss (0.03) of santonin, dose 1 to 6 troches. Aspidium, the rhizome of Dryopteris filix-mas, or male fern, and D. marginale (Nat. Ord, Filices), contains filicic acid, volatile and fixed oils, resin, etc., and is used as a tceniacide. Like all reme- dies employed for this purpose, its administration should be preceded by a fast of 24 hours and followed by a brisk cathartic. In over- doses it has caused death from enteritis. Dose of the oleoresin (oleoresina aspidii) f^ss-j (2.0-4.0). GrRANATUM (pomegranate), the bark of the stem and root of Punica Granatum (Nat. Ord. Lythrariese), contains four alkaloids, pellet -ferine : and three allied alkaloids, which are powerful tamiacides, as is also granatum itself. In overdoses they are said to act on the muscles like woorara. Dose of pomegranate in decoction (^ij (59.147) to water Oij (946.358) boiled to Oj (473.179)) fgij (59.147) repeated 3 times at an hour's interval, before breakfast; of pelle- tierine tannate gr. v-x (0.3-0.6). ANTHELMINTICS. 201 Cusso (Kousso; Brayera, Pharm. 1880), the female inflorescence of Hagenia abyssinica (Nat. Ord. Rosacea*), contains protokosin (a crystalline, inactive resin) and kosotoxin (an amorphous, highly active resin), and is used as a tceniacide; dose of the fluid extract {extractum cusso fluidum) , f3ij-iv (8.0-15.0). Kamala, the glands and hairs from the capsules of Mallotus philippinensis (Nat Ord. Euphorbiaceae), contains rottlerin and isorottlerin, resinoid substances, and is used as a tceniacide; dose 5j-ij (4.0-8.0) of the powder in syrup, or given in the form of tincture. Pepo (pumpkin-seed), the seed of the Cucurbita pepo or pumpkin (Nat. Ord. Cucurbitaceae), contains a resin, and is one of the most powerful twniacides in the materia medica and perfectly harmless ; dose of the fresh seed (powdered with sugar) ^j-ij (30.0-65.0). Oleum Terebinthin^e (oil of turpentine) is an efficient but not a harmless remedy for tasnia and lumbrici. It will be found under the head of "Diuretics." Dose f^ss-j (15.0-30.0) combined with castor oil. Hydrargyri Chloridum Mite (mercurom chloride or calomel) is used alone or combined with other anthelmintics for the expulsion of lumbrici and (rarely) to?,nia. It should be given in full purgative doses (v. Alteratives). What remedies are used for the destruction of ascarides ? Mild purgatives, as calomel or sulphur, may be used to dislodge them from the small intestines, but injections of quassia-infusion, common salt, naphtol, tannin, alum or lime ivater must be employed to get rid of those in the colon. Injections of sweet oil at bedtime are useful to kill any which may be in the rectum, and prevent the excessive itching which they cause. The child should be prevented from scratching the anus, as the ova are very tenacious, and adhering to the finger nails may be conveyed to the mouth and reproduce the trouble. What are useful adjuncts to the anthelmintics? Iron and the bitter tonics, by restoring tone to the mucous mem- branes, prevent the excessive secretion of mucus which forms a suit- able nidus for the development of parasites. 202 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Class III.— Medicines acting on the body by their effect on the various secretions and excretions. ORDER I.— Diuretics. What are diuretics? Diuretics are medicines used to increase the excretion of urine, acting either directly on the secreting cells of the kidney, or indit rectly by their influence on the blood-pressure in the glomeruli. For what purposes are they used? They are used (1) to maintain the function of the kidneys in sup- pression of urine independent of the cause ; (2) to promote the excretion of urinary solids (injurious waste products) or of poisons from the blood, as in uraemia, gout, rheumatism, fevers, and in cases of various metallic and vegetable poisons ; (3) to promote the excretion of water, thus tending to dilute highly concentrated urine or to aid in the removal of effused (dropsical) fluids ; and (4) to alter the chemical reaction of the urine and render that fluid more bland, thus lessening vesical and urethral irritation and any tendency which may exist to the formation of calculi. A certain relation exists between the functions of the skin, kid- neys and bowels, so that free catharsis or free diaphoresis will dimin- ish the urinary secretion and vice versd. How may diuretics be classified? They may be divided into alkaline, hydragogue and alterative diuretics. ALKALINE DIURETICS. What are the alkaline diuretics ? They are those salts which, without materially increasing the amount of water, usually increase the elimination of its solid ingre- dients and modify or alter its chemical reaction. Name the alkaline diuretics. The potassium and lithium salts, and strontium lactate. DIURETICS— POTASSIUM. 203 POTASSIUM. What is the source of potassium? Potassium is obtained from the ashes of plants, from native nitre, and from tartar or argol, deposited from wine during fermentation. What are the general physiological actions of its salts ? Locally applied caustic potash destroys tissues by abstracting water, dissolving albumin and saponifying fats. Internally in small doses before meals, they increase the acidity of the gastric juice ; in large doses, or after meals, they neutralize the acid present in the stomach. The bicarbonates, when taken on an empty stomach, enter the blood readily, and abstracting the base from basic and neutral potassium phos- phate convert it into the acid phosphate, thus increasing the acidity of the mine ; but if taken after or during meals, they are decomposed in the stomach, and entering the blood as a carbonate, diminish the acidity of the urine. The salts formed with the vegetable acids are converted into carbonates in the system and render the urine less acid. Potassium and its salts promote oxidation (and hence cause emaciation when used continuously), decreasing the amount of uric acid and increasing the urea excreted by the urine. The nitrate and chlorate are not decomposed in the system, and having effects peculiar to themselves, will be separately considered. All the po- tassium salts are protoplasmic poisons, in very large doses paralyzing the heart in diastole by direct action on its muscle and contained ganglia. They also depress and paralyze the functions of the brain and spinal cord. They all prove diuretic, increasing the amount of water passed and, by promoting oxidation, the elimina- tion of urea. Poisoning by caustic potash is due to its corrosive properties, and if recovery takes place from the acute effects, various stenoses are apt to follow. The carbonate in overdoses causes vio- lent gastro-enteritis with great cardiac depression and sometimes par- alysis. The treatment of potassium poisoning consists in neutralizing the alkali by a vegetable acid, giving demulcents and fixed oils as protectives, and stimulating if requisite. What are the therapeutical uses of the potassium salts ? The potassium salts are used as diuretics (increasing as they do both the water and salts of the urine, and converting uric acid into 204 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. the more soluble urea as well as rendering the urine alkaline) in acute rheumatism, uric acid diathesis, in desquamative nephritis, and to alkalinize the urine in cystic and urethral irritation. What are the potassium preparations, their uses and doses ? Liquor Potass^e {solution of potassa) contains 5 per cent, of potassium hydrate, and is antacid and diuretic. It is used to render the urine alkaline in cystic irritability and in gonorrhoea ; dose m,x- xx (0.6-1.2) freely diluted. Potassii Carbonas (potassium carbonate) is antacid and diu- retic, but is more irritating to the stomach than the bicarbonate ; dose gr. x-xx (0.6-1.2). Potassii Bicarbonas (potassium bicarbonate) is antacid and diuretic; dose gr. xx-3j (1.2-4.0). It is much used in the treat- ment of acute rheumatism, especially in plethoric persons (3jss (45.0) are given in the first twenty-four hours, half as much during the second day, and afterward enough to keep the urine alkaline). Potassii Citras (potassium citrate) is used as a diuretic in acute rheumatism and as a refrigerant diaphoretic in fevers and acute in- flammations ; dose gr. xx (1.2) in solution every hour or two. Liquor Potassii Citratis (solution of potassium citrate) con- tains 8 per cent, of the bicarbonate and 6 per cent, of citric acid. It is often prescribed with sweet spirits of nitre, in fever mixtures ; dose f^ss (15.0). Potassii Citras Effervescens [effervescent potassium citrate) is made by mixing thoroughly, drying and powdering citric acid (63.0), potassium bicarbonate (90.0), and sugar (47.0). Dose 3ss-j (2.0-4.0). Neutral mixture (not official) is made by neutralizing fresh lemon- juice, with the bicarbonate. The official solution of potassium citrate has superseded it, as being the more exact and more elegant method of prescribing the same medicine; dose fjss-j (15.0-30.0). Effervescing draught (not official) is made by adding f^j (29.57) of a solution of the bicarbonate (3j (3.88)-f^iij (88.7)) to f£j (29.57) of lemon-juice and water (equal parts). It is particularly acceptable to febrile patients with irritable stomachs. Potassii Acetas (potassium acetate) is antacid, diuretic, and in large doses a mild cathartic. It is chiefly used as a diuretic in acute rheumatism and to some extent in dropsies, and in uric acid diathesis ; dose gr. xx-3j (1.2-4.0). DIURETICS— POTASSIUM. 205 Potassii BlTARTRAS {potassium bitartrate — cream of tartar) is a diuretic and saline cathartic (q. v.) much employed in dropsies. Potassii Nitras {potassium nitrate — saltpetre — nitre) locally applied is a powerful irritant to the mucous membranes and to raw surfaces. It passes through the system unchanged, and is elimi- nated chiefly by the urine, increasing the amount passed but not affecting its reaction to the same extent as the other salts. Poison- ing occurs more frequently from the nitrate than from any other potassium salt, the symptoms being burning pain in the throat and epigastrium, hsemateniesis and bloody stools, muscular weakness, syncope, collapse sometimes preceded by convulsions or paralysis, suppression of urine and death. The treatment consists in evacu- ating the contents of the stomach and administering opiates, de- mulcents and stimulants. It is used in acute rheumatism as a diuretic, but is probably inferior to the salts formed with the vegetable acids. It is used in fevers for the same purpose and has been given in small doses combined with Dover's powder as a diaphoretic in acute muscular rheumatism. Dose of potassium nitrate gr. x-xxx (0. 6-1 .9). Papers of potassium, nitrate (charta potassii nifratis), consisting of strips of unsized paper immersed in a 20 per cent, solution of the salt, are burned and the fumes inhaled with success in spasmodic asthma. It is probable that the nitrite is formed by the combustion and is the active agent in these cases. Potassii Chloras {potassium chlorate) is a local irritant. Inter- nally in large doses it causes gastro-enteritis, affects the circulation as do the other potassium salts, damages the blood corpuscles and interferes with oxygenation by the formation of niethsemoglobin, and produces a condition of acute tubal nephritis. Cases of poisoning are not infrequent, and death is usually preceded by profuse saliva- tion, great dyspnoea, cyanosis, delirium, coma, tonic and clonic spasms, and sometimes ecchymoses and jaundice. It increases the excretion of urine, but does not affect its chemical reaction. It has been used as a diuretic in dropsies, but is dangerous and inferior to other preparations. As an alterative in the exanthemata it is now little employed. In mercurial, follicular or aphthous stomatitis it is of unquestionable value, given internally with sugar or used as a gargle. In ordinary sore throat and in tonsillitis it is 206 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. useful as a local application ; dose gr. v-xxx (0.3-2.0). It must be given freely diluted. It should not be prescribed in powder with readily oxidizable or combustible substances, as when triturated with them it forms explosive compounds. As a gargle 3ss-iv (2.0-15.0) in water Oj (473.1) may be used. The troches {trochisci potass ii chloratis) each contain gr. v (0.3) of the salt. The other potassium preparations have been or will be considered in their appropriate place. LITHIUM. What are the sources of lithium ? Lithium is a chemical element, found native in the form of sili- cates, phosphates, etc. What are the physiological effects aud uses of the lithium salts? The lithium salts appear to resemble those of potassium. They are eliminated by the urine as urates, increasing the urine and ren- dering it much more strongly alkaline than a corresponding amount of a potassium salt. As the urate of lithium is much more soluble than either the urate of sodium or of potassium, the lithium prepa- rations are advantageously used in the treatment of chronic gout and lithcemia, and as a local application to gouty deposits either before or after the skin has broken. It has also been employed internally in glycosuria. What are the preparations of lithium and their doses ? Lithii Carbonas (lithium carbonate), dose gr. v-x (0.3-0.6) freely diluted. As a local sorbefacient for gouty deposits a solution (gr. v (0.3)-f^j (30.0)) should be kept constantly applied. Lithii Citras {lithium citrate), dose gr. v-xx (0.3-1.2). Lithii Citras Effervescens {effervescent lithium citrate) is made by triturating and thoroughly drying citric acid (370.0) with sugar (about 200.0) ; then triturating the mixture with lithium carbonate (70.0), sodium bicarbonate (280.0) and sugar (enough to make the product weigh 1000.0). Dose 3j-ij (4.0-8.0). Lithii Benzoas {lithium benzoate), dose gr. v-xx (0.3-1.2). Lithium bromide and L. salicylate have been previously men- tioned. DIURETICS — LITHIUM. 207 What sodium salt has been used as a diuretic ? Sodii Acetas {sodium acetate) is supposed to possess properties similar to those of potassium acetate, and has been used for the same purposes and in the same doses. What preparation of strontium is used as a diuretic ? Strontii Lactas {strontium lactate) has been used as a diuretic, especially in acute desquamative nephritis, with scanty urine, where it has been found to increase the amount of urine and diminish the albumin present in that excretion. It has also been used in other forms of kidney disease, but is much less efficient in chronic than in acute cases. It has been used as an intestinal antiseptic, but is of little value for this purpose. Dose gr. v-xv (0.3-1.0) in solution. Hydragogue Diuretics. What are hydragogue diuretics ? The medicines of this group greatly increase the flow of the watery element of the urine, and are hence used in the treatment of dropsies. Name the hydragogue diuretics ? Squill, digitalis, caffeine, sodio-theobromine salicylate, apocynum, broom, dandelion, sweet spirit of nitre, and mercurials. SCILLA— SQUILL. What is squill? Squill is the bulb of Urginea maritima {Nat. Ord. Liliaceae) deprived of its dry, membranous outer scales, and cut into thin slices, the central portions being rejected. It contains scillipicrin, scillitoxin, and scillin. In small doses squill increases the mucous secretions and is a stimulating expectorant, while it markedly increases the urinary secretion. In large doses it causes nausea, vomiting, and sometimes purging, and in excessive doses produces in addition great abdominal pain, with scanty, bloody, or even sup- pressed urine, great depression, collapse, convulsions and death. Scillipiciin appears to be the diuretic principle. Scillitoxin slows the pulse, and in overdoses causes diastolic cardiac arrest by stimu- lating the peripheral vagi ; after large doses the vagi are finally paralyzed and the pulse becomes rapid. Scillin is devoid of diuretic effects, but appears to be the emetic principle. 208 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. The treatment of poisoning consists of evacuating the contents of the stomach and the use of opiates and demulcents. If collapse occurs alcohol must be employed. Squill is used as a diuretic in dropsy, but should not be employed if kidney disease or cystitis is present. It is frequently combined with digitalis in cardiac dropsies, and in chronic pleurisy or peri- carditis is often given with calomel. As an expectorant it is much used in bronchial affections. As an emetic it is too dangerous a remedy to employ. As a diuretic or expectorant squill may be given in doses of gr. j-ij (0.06-0.13) repeated every 2 hours and gradually increased until nausea occurs. Doses of gr. vj-xij (0.389-0.778) generally prove emetic. The dose of the fluid extract {extractum scillw fluidum) is n\j-ij (0.06-0. 12) ; of the tincture (tinctura scillce) nu-xxx (0.6-1.8) ; of the vinegar {acetum scillce) ntx-xxx (0.6-1.8); of the syrup [syrupus scillce) f3ss-j (2.0-4.0); of the compound syrup {syrupus scillce compos itus — Coxes hive syrup), containing squill and senega and gr. j (0.059) of tartar emetic in each ounce (29.5), TT\,v-f3j (0.3-4.0). DIGITALIS — CAFFEINE. Are these drugs used as diuretics ? The uses of these remedies as diuretics have already been discussed under the head of ' ' Cardiac Stimulants. ' ' For this purpose the best preparations of digitalis are the infusion, the powdered leaves or the tincture. SODIO-THEOBROMINE SALICYLATE. What is sodio-theobromine salicylate ? Sodio-theobromine salicylate, or diuretin {the proprietary name), is a non-official preparation "obtained by mixing aqueous solutions of equal molecules of sodium theobromine and salicylic acid, and evaporating to dryness ; a definite compound appears to be formed containing theoretically 49.7 per cent, of theobromine and 38.1 per cent, of salicylic acid. It occurs as a white powder, odorless, of a saline, alkaline taste, and soluble in one-half its weight of warm water, the solution remaining perfect on cooling."* * National Dispensatory. DIURETICS— SODIO-THEOBROMINE SALICYLATE. 209 Its physiological action is not fully understood. It is a powerful diuretic in certain diseased conditions, as when anasarca is present, due to disease of the heart or kidneys, but appears to have no diuretic effect when given to healthy persons. It has little if any effect upon the circulation except in the dis- eased conditions above mentioned, when it appears to increase the force and render more regular the beat of the heart, probably by increasing diuresis and removing the fluid which has been acting as a mechanical obstruction to the circulation. The action on the kidneys is not understood, but is non -irritating in character. Under its use the amount of solid as well as the fluid of the urine is much increased, the latter sometimes enormously, as much as three gallons of urine having been reported as passed in 24 hours while using the drug. As the dropsical accumulation diminishes, the amount of urine lessens. Sometimes sodio-theobromine salicylate causes "nervousness," headache or vertigo, tinnitus aurium, and palpitation. Occasionally a rise in temperature is seen after its use. In rare cases a cutaneous eruption attended with more or less intense itching appears. More frequently, however, it acts as a gastro-intestinal irritant, causing loss of appetite, nausea, and sometimes severe vomiting and purging. The therapeutical uses of this drug are indicated by what has been already said. It is of great value in all dropsical effusions depend- ing on disease of the kidney or heart, and should always be tried in these conditions when remedies like digitalis, strophanthus, etc., have not succeeded in reducing the dropsy. In pleuritic effusions it is not so certain in its action. In ascites due to portal obstruction it usually appears to produce no effect. In dropsies dependent on tubercular inflammation it is absolutely valueless. Dose gr. xv (1.0) repeated every 2 or 3 hours until some effect is produced. The author has never found it necessary to give more than 3jss (6.0) in 24 hours, although some observers have prescribed double that quantity in the same period of time without ill effect. It is admin- istered in solution in plain water flavored with peppermint or other aromatic. It may be given in capsules. 14 210 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. APOCYNUM. What is apocynum ? Apocynum, Canadian hemp, or milk-weed, is the root of A. cannabinum {Nat. Ord. Apocynacese) and contains apocynin and apocyne'in, a glucoside. These substances are supposed to be cardiac tonics, acting on the heart similarly to digitalis. They are also diuretic. Apocynum is laxative in small, but emetic and cathartic in large doses. It is chiefly used as a diuretic in dropsies, and should not be given in quantities sufficient to purge when the former effect is desired; extractum apocyni fluidum {fluid extract of apocynum), doseTTW-xxx (0.3-2.0). SCOPARIUS. What is scoparius ? Scoparius is the tops of Cytisus Scoparius or broom (Nat. Ord. Leguminosse), and contains a volatile liquid alkaloid, sparteine (v. " Cardiac Stimulants"), and a neutral principle, scoparin, in which the diuretic properties are supposed to reside. Broom is an efficient hydragogue diuretic, and in large doses produces free purging and sometimes vomiting. It is much used in the treatment of dropsies and is best given in decoction (^ss (14.7) to water Oj (473.1) boiled down to Oss (236.5), dose foj (30.0) every 2 or 3 hours until an effect is produced) or the fluid extract (extractum scoparii fluidum) may be given in doses of f3ss-j (2.0-4.0). TARAXACUM. What is taraxacum ? It is the root of Taraxacum officinale or dandelion ((Nat Ord. Composite) gathered in the autumn, and contains a bitter principle, taraxacin ; also taraxacerin, imdin, resin, etc. It is diuretic, laxacive, and slightly cholagogue, and is used in dropsies of hepatic origin and dyspepsia with torpor of the liver. Dose of the extract (extractum taraxaci) gr. xx-5j (1.28-4.0), of the fluid extract {extractum taraxaci fluidum) f3j-ij (4.0-8.0). SPIRITUS ^THERIS NITROSI — SPIRIT OF NITROUS ETHER. Is this medicine a diuretic ? Sioeet spirit of nitre is diuretic in large doses if the surface of the body is kept cool. It is usually combined with other diuretics, but DIURETICS — PAREIRA. 211 may be given alone where the urinary secretion is scanty from simple congestion or from purely functional causes. It will be considered more fully under "Diaphoretics." Dose f3j-iv (4.0-15.0) freely diluted. MERCURIALS. Axe the mercurial preparations ever used as diuretics ? Calomel (q. v.) has been employed as a diuretic in cardiac dropsy, dose gr. iss 4 or 5 times a day. It is a useful adjunct to squill in hydrothorax and hydropericardium. Corrosive sublimate will probably prove to be a more powerful diuretic, as by its action on the liver it increases the formation of urea, which of itself always increases the excretion of water by the urine. Alterative Diuretics. What are alterative diuretics ? They are medicines which are employed not only as diuretics but also for their effect on the mucous membrane of the urinary tract, by which they are possibly to some extent excreted, or on which they exercise an alterant and sedative effect during their passage in the urine. Name the medicines belonging to this group. Buchu, pareira, uva ursi, chimaphila, triticum, juniper, oil of erigeron, oil of santal, stigmata maydis, turpentine, copaiba, cubeb, matico, cantharides. BUCBU. PAREIRA. What are these medicines ? Buchu, the leaves of Barosma betulina and other species (Nat Ord. Rutaceae), natives of S. Africa, contains a volatile oil and a bitter principle. It is a mild tonic and diuretic, and slightly stimu- lates the genito-urinary mucous membranes, having also an altera- tive effect upon them. It is used in chronic catarrhal conditions of the genito-urinary mucous tract, as chronic pyelitis, chronic cystitis and especially in irritation of the neck of the bladder ; dose of the fluid extract (extractum buchu fluidum) f^ss-j (2.0-4.0). 212 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Pareira, the root of Chondodendron tormentosum {Nat. Ord. Menispermaceae), a Brazilian plant, contains a bitter alkaloid, cissam- peline, and has been nsed with success in the treatment of chronic cystitis, gleet and ' ' irritable bladder. " It is said to be also tonic and laxative. Dose of the fluid extract {extractum pareiroe, fluidum) f5sB-j (2.0-4.0). UVA URSI. CHIMAPHILA. What are these medicines ? Uva Ursi is the leaves of Arctostaphylos Uva ursi or bearberry {Nat. Ord. Ericaceae), and contains tannic and gallic acid, a gluco- side called arbutin, ericolin (a bitter substance), etc. It is used as a mild astringent tonic, and diuretic in chronic pyelitis and cystitis, and has also been employed in chronic bronchitis. Arbutin is the diuretic principle, and as it is, partially at least, eliminated as hydroquinone {vid. "Antipyretics"), it is supposed to act as an antiseptic to the urogenital tract. It has been employed in the above diseases and internally in gonorrhoea. Dose of the fluid extract {extractum uvce ursi fluidum) f3ss-ij (2.0-8.0), t. i. d. ; of the extract {extractum uvce ursi) gr. v-x (0.3-0.9). Chimaphila, the leaves of C. umbellata, pipsissewa, wintergreen, or ground holly {Nat. Ord. Ericaceae), contains arbutin, tannic acid, chimaphilin, etc. It is tonic, astringent, and diuretic, resembling buchu and uva-ursi in its effects and uses. Special alterative qualities have been claimed for it in scrofulous affections. Dose of the fluid extract {extractum chimaphiloz fluidum) f3ss-j (2.0-4.0), t. i. d. TRITICUM. What is triticum ? Triticum, the rhizome of Agropyrum repens or couch grass {Nat. Ord. Gramineae), contains triticin and several sugars, and is feebly diuretic. It is useful in cystitis and in irritation of the neck of the bladder. Dose of the fluid extract {extractum tritici fluidum) f3ss-ij (2.0- 8.0). DIURETICS— OIL OF SANTAL. 213 JUNIPERUS— JUNIPER. What is juniper? Juniperus [juniper) (not official) is the fruit (or berries) of J. communis (Nat. Ord. Coniferae), and contains a volatile oil (oleum juniperi, dose gtt. v-xv (0. 3-0.9)), on which its diuretic effects depend. It is a stimulant to the kidneys, capable in overdoses of causing strangury and bloody urine, and is sometimes used as an emmen- agogue. It is chiefly employed as an adjuvant to other diuretics, particularly the alkaline group. As an alterative diuretic it is used in chronic pyelitis and chronic cystitis. It is sometimes given in subacute renal congestion, but is contraindicated where active inflammation is present. It is occasionally used as a carminative and stomachic. The preparations (official) are the spirit (spiritus juniperi), containing 5 per cent, of the oil, dose 3j-ij (4.0-8.0); the compound spirit (spiritus juniperi compositus) contains also the oils of caraway and fennel in alcohol and water, and is about the same strength as gin, which is often used as a substitute for it, dose f3j-jv (4.0-15.0). OLEUM ERIGERONTIS— OIL OF ERIGERON. What is the oil of erigeron ? It is the oil distilled from the fresh flowering herb of Erigeron canadense, or Canada fleabane (Nat. Ord. Composite), and yields on distillation a resin and a terpene. It is diuretic and hemostatic, and is useful in hemorrhages due to relaxation of the genito-urinary mucous membrane. It has been used with success in gonorrhoea. Dose ff\.v-xxx (0.3-2.0) on sugar or in capsule, every two or three hours. OLEUM SANTALI — OIL OF SANTAL. What is the oil of santal? It is a volatile oil distilled from the wood of Santalum album (Nat. Ord. Santalaceae). It is an alterative, diuretic, and blennor- rhetic, sometimes causing vertigo, when its use should be discon- tinued or the dose decreased. Occasionally it produces gastro- intestinal irritation. It is used in the second stage of gonorrhoea, and in chronic bronchitis it is often beneficial ; dose ^Lv-xx (0.3-1.2) in emulsion or capsule, t. i. d. 214 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. ZEA. What is this substance ? Zea, or corn silk, the styles and stigmas of Zea Mays or Indian corn (Nat. Ord. Graniinese), is a mild, stimulating diuretic, and is strongly recommended in cystitis, both acute and chronic, in gonor- rhoea, in irritability of the bladder depending upon a highly concen- trated urine, in nocturnal incontinence in children, and even in cardiac dropsy. It is given in infusion ad libitum, or in the form of fluid extract (extractum zecefluidum), of which the dose is f3j-ij (4.0-8.0) every hour or two. TEREBINTHINA — TURPENTINE. What are the officinal varieties of turpentine ? 1. Terebinthina (turpentine or white turpentine) is a concrete oleoresin obtained from Pinus palustris, yellow or pitch pine, and other varieties of Pinus (Nat Ord. Coniferse) trees indigenous to the Southern States. 2. Terebinthina Canadensis (Canada turpentine, Canada balsam or balsam of fir) is a liquid oleoresin obtained from Abies balsamea, the American silver fir, or balm of gilead tree {Nat Ord. Coniferae), found in the northern portions of N. America. 3. Unofiicinal varieties known to commerce are Chian turpentine derived from Pistacea Terebinthinus (Nat Ord. Anacardaceae), formerly used as a specific for internal (especially uterine) cancer, but possessing no curative power ; Bordeaux turpentine, Venice tur- pentine, etc. What do the turpentines contain ? They contain a resin, or rosin (resina) united to a volatile oil (oleum terebinthina^). What are the effects and uses of turpentine ? The effects of turpentine are those of the oil which it contains. They are rarely used internally, but have been given as an alterative to the broncho-pulmonary and genito-urinary mucous membranes in chronic catarrhal conditions, and have been used as an anthel- mintic, but for all these purposes the oil is preferred. Dose as a diuretic and blennorrhetic gr. xx~3j (1.3-4.0), in pill or emulsion; as an anthelmintic Sss-j (15.5-31.0). DIURETICS — OIL OF TURPENTINE. 215 Resina (resin) is only used externally as a basis for plasters and ointments. Its preparations are a cerate (ceratum resince), sometimes called basilicon ointment, and a, plaster [emplastrum resince), adhesive or sticking plaster. OLEUM terebinthin^:— oil of turpentine. What is the oil of turpentine ? Oil of turpentine or spirit of turpentine is a volatile oil distilled from turpentine. What are its effects and uses ? Locally it is rubefacient. Internally it is carminative, in large doses causing mental exhilaration and increasing the force and frequency of the pulse and proving cathartic. It is eliminated by the lungs and kidneys, imparting a violet-like odor to the urine. In excessive doses it is capable of causing death (rare). The symp- toms of poisoning are unconsciousness, bloody, often suppressed urine, and rapid, feeble pulse. Vomiting and strangury or purging sometimes occur and occasionally the pupils are dilated. Small doses seem to increase the pulse rate by direct action on the heart, while large doses stimulate the vagi and slow the heart. Moderate doses are diuretic, but when large amounts are given renal irritation results. It is used as an alterative diuretic in chronic cystitis, gleet and chronic pyelitis. In impotence and spermatorrhoea depending on relaxation it is sometimes employed. In typhoid pneumonia and bronchitis, and in hypostatic pulmonary congestion, as in typhoid fever, it is often used externally and internally with the happiest effect. It is very useful in idceration of the stomach or intestines, and in typhoid fever when the tongue becomes brown and dry or cracked, red and glazed, or when the ulcers are very slow to heal ; it acts not only locally but also as a cardiac stimulant. In hemon-hages from the lungs, stomach or bowels, in post-partum hemorrhages and in purpura hemorrhagica it is sometimes useful. As an addition to stimulating enemata to cause the expulsion of flatus or to rouse the system to shock it is much resorted to. It is also used as an anthel- mintic. Locally as a counterirritant, either as a liniment or fomentation, it is much used in bronchitis and in muscular rheumatism, and in the 216 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. latter manner in peritonitis, hysterical abdominal pains and in flatulency. Dose ^Uv-xv (0.3-0.9) 4 or 5 times daily in emulsion or capsule; as a cathartic enema or anthelmintic f^ss-j (15.0-30.0) may be given. Externally a liniment (linimentum terebinthino?) is employed, or the oil may be used either full strength or diluted with sweet oil. A saturated solution of camphor in oil of turpentine is a good rubefacient liniment. Oleum Terebinthin^e Kectificatum (rectified oil of turpentine), dose TT\,v-xxx (0.3-1.8). COPAIBA. What is copaiba ? Copaiba is the oleoresin of Copaiba Langsdorffii and other species {Nat. Ord. Leguininosse), trees of S. America. It is cathartic, and sometimes emetic, in large doses, slightly stimulates the circu- lation and acts as an alterative blennorrhetic on the mucous mem- branes by which it is excreted. After large doses a resinous pre- cipitate will occur if nitric acid be added to the urine, which, how- ever, is soluble in alcohol. When the resin is taken in considerable quantities the urine responds to the copper tests for sugar. Copaiba is chiefly eliminated by the genito-urinary mucous membranes and to a slight extent by the lungs. Its use is sometimes followed by urticaria. It is used in chronic genito-urinary inflammations, espe- cially in gonorrhoea after the subsidence of the acute stage. In bronchorrhcea it is sometimes employed. The oil has been lauded as a hydragogue diuretic in dropsies when not of renal origin. The dose of copaiba is Nlx-3j (0.6-3.6) or more in emulsion, pill, or capsule. The mass (massa copaiba? — solidified copaiba) contains 94 per cent, with magnesia, dose gr. v-xxx (0.3-2.0) ; of the oil (oleum copaibce) the dose is ffiv-xv (0.3-0.9) in emulsion or capsule. CUBEBA— CUBEB. What is cubeb? Cubeb is the unripe fruit of Piper Cubeba (Nat. Ord. Piperacese), an East Indian plant. It contains a volatile oil, a neutral principle (cubebin) and cubebic acid. Cubeb is diuretic and carminative, slightly accelerating the pulse. In large doses it often causes vomit- ing and purging. It is eliminated by the mucous membranes and DIAPHORETICS. 217 urine, increasing the excretion of uric acid. Its use is sometimes followed by urticaria. The addition of nitric acid to the urine after the use of cubeb produces a resinous precipitate. It is used in gonorrhoea and is less apt than copaiba to disorder the digestion. It is also used in bronchitis, and has been smoked in cigarettes to relieve sore throat and hoarseness. The powder, used as a snuff, is employed in coryza. The dose of powdered cubeb is 5ss-iij (2.0-11.6); of the oil [oleum cubebcv) n\,x-xv (0.6-0.9) gradu- ally increased. It is not as efficacious as the oleoresin (oleoresina cubebo?), dose tt\,v-xxx (0.3-2.0) given in emulsion. Of the tincture (tinctura cubebce) the dose is f3j-ij (4.0-8.0); of the fluid 'extract (extraction cubeboe fluidum) f3ss-j (2.0-4.0). The troches (trochisci cubeba?) each contain gr. ss (0.04) of the oleoresin. MATICO. What is matico ? Matico is the leaves of Piper angustifolium {Nat. Ord. Piper- acese), a shrub of Peru. It contains a volatile oil. resin, artanthic and tann ic acids, etc. It is used as an alterative blennorrhetic in gonor- rhoea, as a hemostatic in internal hemorrhages, and locally as a styptic. Dose of the fluid extract (extractum matico) f3ss-j (2.0- 4.0); of the tincture [tinctura matico) f3j-ij (4.0-8.0). CANTHARIS — C ANTHARIDES . Is cantharides used as an alterative diuretic ? Cantharides is an intense stimulant and irritant to the kidneys, being diuretic in small doses, and frequently causing strangury, pri- apism and bloody urine. It is sometimes used in gleet, and in sper- matorrhoea and impotence from weakness. It will be noticed at length under " Epispastics." Dose of the tincture {tinctura can- tharidis) gtt. v-x (0.3-0.6) t. i. d. ORDER II.— Diaphoretics. What are diaphoretics ? Diaphoretics are medicines which increase the secretion of sweat, either by (1), stimulating the secretory nerve fibres in the glands; (2) stimulating the nerve centre governing the secretion of sweat ; 218 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. or (3) relaxing the skin, dilating the blood vessels and regulating the force of the circulation. For what purposes are they used and how are they classi- fied? They are used (1) to abort an oncoming disease (as a catarrh or inflammation of mucous or serous membranes after exposure to cold) or aid in its subsidence (as in the paroxysm of a malarial fever) ; (2) to aid absorption, as in dropsies, and (3) to eliminate poisons from the blood. They are divided into Nauseating, Sedative, Saline and Special Diaphoretics. Nauseating Diaphoretics. What are the nauseating diaphoretics ? The act of emesis is accompanied by general relaxation and dia- phoresis, and even in nausea a more or less pronounced perspiration occurs. Any of the emetics in doses just sufficient to nauseate will produce this effect, but the only one which is in general use for this purpose is Ipecac (v. " Emetics"), which is used either alone (in doses of gr. ss-j every two hours) or combined with opium in the form of Dover's Powder (v. " Opium") in the early stages of inflammations, in "cold" in muscular rheumatism and in acute suppression of the menses to break up the train of morbid symp- toms. Sedative Diaphoretics. What are sedative diaphoretics ? When the circulation is much excited, as in fevers and inflamma- tions generally, medicines which tend to reduce the force and rapid- ity of the circulation and to lower the temperature, act as diapho- retics. Many of these agents (particularly antimonials, aconite and veratrum viride) tend to nauseate or even to cause vomiting when given in full doses. In sthenic inflammations the ANTIMONIAL PRE- PARATIONS (q. v. ) especially if combined with minute doses of mor- phine are often very efficacious, and may be used in the early stages of laryngitis and bronchitis and in combination with other remedies in fever. Aconite and Veratrum Viride are also sometimes resorted to in the early stages of sthenic inflammations for their com- DIAPHORETICS — SriRIT OF NITROUS ETHER. 219 bined sedative and sudorific effect. In this group also should be placed salicylic acid and other antipyretics {q. v.) which pro- duce more or less profuse perspiration. Saline Diaphoretics. What are the saline diaphoretics ? While some of the saline diaphoretics have a sedative effect upon the circulation, which is not, however, as marked as the remedies of the preceding group, they have no tendency to nauseate even when given in large doses, on the contrary, they are acceptable to the stomach, and form the basis of most fever mixtures. Potassium Citrate and its preparations have been noticed among the ' l Diuretics. ' ' LIQUOR AMMONII ACETATIS— SOLUTION OF AMMONIUM ACETATE. What is the solution of ammonium acetate ? The solution of ammonium, acetate or spirit of mindererus is a mild stimulant, diaphoretic and diuretic, often employed in febrile and inflammatory affections combined with other remedies. Dose fgss-j (15.0-30.0) SPIRITUS ^THERIS NITROSI— SPIRIT OF NITROUS ETHER. What is this substance ? Spirit of nitrous ether, or sweet spirit of nitre, is a solution of about 4 per cent, of nitrous ether (ethyl nitrite) in alcohol. In small doses it is a diaphoretic and stimulant, in larger doses an anti- spasmodic, and (if the skin be kept cool) diuretic ; in excessive doses, either internally or when inhaled, it is a depresso-motor, acting sim- ilarly to the other nitrites (q. v. ) and capable of causing death. It is much used as a diaphoretic in fevers, and occasionally as a diuretic (q. v.) and antispasmodic in nervous children. Dose for an adult f3j-iv (4.0-15.0). It is given as a diaphoretic in minute doses, frequently repeated and largely diluted, the body being kept warm. 220 essentials oe materia medica and therapeutics. Special Diaphoretics. pilocarpus. What is pilocarpus ? Pilocarpus or Jaborandi is the leaflets of P. Selloanus (Rio de Janeiro Jaborandi) and of P. Jaborandi (Pernambuco Jaborandi) (Nat. Ord. Rutacese), a Brazilian shrub. What are its chief chemical constituents ? It contains an alkaloid, pilocarpine, and a volatile oil ; a second alkaloid, jaborine, probably a derivative of pilocarpine, has been isolated, and lately two other derivative alkaloids pilocarpidine and jaborandine have been described. What are the physiological effects of these substances ? In medicinal doses pilocarpus or pilocarpine produces profuse diaphoresis and salivation, sometimes copious, with flushed face and quickened circulation and respiration. Sometimes the mucous secretions are increased also, and nausea, even vomiting, may occur. It increases both the watery portion and the solids (especially urea) of the perspiration by a direct influence on the nerve endings gov- erning its secretion, and probably increases the secretion of the gastric juices and bronchial mucus in the same manner. It appears to act directly as a stimulant upon the cells of the salivary glands. There seems to be some relation between its influence over the secretions of perspiration and saliva, the one being more profuse when the other is scanty, and vice versa. In small doses frequently repeated it proves diuretic. It seems to stimulate the nutrition of the hair. The car- diac action is at first quickened, but soon slowed, and the arterial tension is elevated. Applied to the eye it contracts the pupil (by peripheral action) and increases the tension of accommodation. Pi- locarpine and atropine are antagonists as regards their action on the heart, intestines and pupil, and on the secretions of perspiration and saliva. Jaborine acts upon the heart, pupil, intestines and salivary glands like atropine. Pilocarpidine causes profuse diaphoresis, sali- vation, vomiting and purging; while jaborandine resembles atropine in its cardiac effects. What are the medicinal uses of pilocarpus and its alkaloid ? Pilocarpus or pilocarpine is used as a diaphoretic to abort disease SEDATIVE EXPECTORANTS. 221 in incipient catarrh and at the onset of a paroxysm of malarial fever ; in various forms of dropsy, to aid in removal of the fluid, especially hydrothorax, and in pulmonary oedema; in uraemia, to eliminate the poison from the blood, it is of great value, and similarly in acute or chronic Bright 's disease, to relieve the kidneys of some of their work, it is very useful. It is also employed in subacute and muscular rheumatism. As a diuretic, minute doses (pilocarpine gr. ^ (0.005), are given in acute suppression of urine, but when thus used in the early stages of acute desquamative nephritis it must be employed with great caution. As an expectorant it has been given in bronchitis and asthma and, with varying success, in croup and diphtheria. To stimulate the growth of hair in alopecia, pilocarpine may be administered inter- nally or hypodermically, and applied locally as well, and it has been employed hypodermically with success to arrest severe and prolonged hiccough. It should not be given in diseases of the gastro-intestinal mucous membrane, nor in weak heart due to cardiac disease. What are the officinal preparations of pilocarpus and their doses? Extractum Pilocarpi Fluldum (fluid extract of pilocaipus), dose f&s-j (2.0-4.0). Pilocarpine Hydrochloras (pilocarpine hydrochl orate), dose gr. i-ss (0.008-0.032). It is well adapted to hypodermic use. ORDER III.— Expectorants. What are expectorants ? Expectorants are remedies which are given to modify the secre- tions of, and promote their expulsion from, the air passages. How may they be classified ? They are divided into sedative and stimulating expectorants ? Sedative Expectorants. What are sedative expectorants ? They are remedies which increase the secretion and at the same 222 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. time tend to lower the blood pressure, cause nausea and, if fre- quently repeated, vomiting. Name the sedative expectorants. Ipecac, apomorphine, tartar emetic, pilocarpine, lobelia and grindelia. Of these ipecac and apomorphine have been discussed with the "emetics," tartar emetic with the "sedatives," pilocarpine with the "diaphoretics," and lobelia with the " depresso-motors." GRINDELIA. What is grindelia? Grindelia is the leaves and flowering tops of Gr. robusta and G. squarrosa {Nat. Ord. Composite ). It appears to depress the motor nerves and muscles, and in large doses to slow the heart and reduce the blood-pressure. Toxic doses produce narcosis with dilated pupils. It is eliminated by the kidnej^s, increasing the flow of urine, and to some extent by the broncho-pulmonary mucous mem- brane. It has been highly recommended in spasmodic and car- diac asthma, in hay asthma and hay fever, in whooping-cough and in acute and chronic bronchitis. In chronic cystitis it has been advantageously employed, and as a local application in vaginitis and in poisoning by rhus toxicodendron has met with some success. Dose of the fluid extract {extractum grindelice fluidum) TT\,x-f3j (0.6-4.0). Stimulating Expectorants. What are stimulating' expectorants ? They are remedies which probably modify the secretion by toning up the broncho-pulmonary mucous membrane through which they are eliminated. Most of them seem to exert an alterative effect in passing through the membrane, and many of them elevate the arterial tension. Name the stimulating expectorants. Ammonium chloride, senega, quillaja, quebracho, asclepias, erio- dictyon, garlic, sanguinaria, ammoniac, benzoin, Peruvian balsam, balsam of Tolu, squill, eucalyptus, serpentaria, turpentine, tar, terpin hydrate, and terebene. EXPECTORAN'IS— SENEGA. 223 AMMONII CHLORIDUM — AMMONIUM CHLORIDE. What is ammonium chloride ? Ammonium chloride, called also ammonium muriate or sal am- moniac, is a crystalline salt obtained from gas liquor. What are its effects and uses ? Locally it is irritant. In medicinal doses it is believed to influence especially the mucous membranes, promoting very decidedly nutritive changes and hastening epithelial exfoliation. When given con- tinuously for a length of time it diminishes the solids of the blood and stimulates the secretions. It is supposed to stimulate the he- patic functions, for the amount of urea excreted is greatly increased, as are all the other solids of the urine except uric acid. Large doses are purgative. It is used as a stimulating and alterative expectorant in the moist stage of acute and in chronic bronchitis, in pneumonia and the various catarrhs of children. Abroad it is employed also in gastric and intestinal catarrJis, in chronic hepatitis and in the early stages of hepatic cirrhosis. In cases of albuminoid liver, spleen or kidneys it is very useful. In subacute muscular rheumatism and in neuralgia, especially ovarian, it is advantageous, and it has been used internally as an alterative and employed locally as a sorbefacient in scrofulous adenitis of the cervical glands, and uterine fibroid tumors. Dose gr. x-xxx (0.6-2.0). The unpleasant taste may be partially disguised by liquorice. The troches (trochisci ammonii chloridi) each contain about gr. ij (0.1) of the salt. SENEGA. What is senega? Senega is the root of Polygala Senega or senega snake-root {Nat. Ord. Polygaleae) and contains polygalic acid or senegin, a glucoside identical with saponin. What are its effects and uses ? Locally, it is an irritant. Internally, it stimulates the mucous membranes, and in large doses is emetic and cathartic. It is given as a stimulating expectorant in the latter stages of acute and in sub- acute and chronic bronchitis, especially when the mucous membranes are wanting in tone. It has also been used as an emnienagogue in 224 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. amenorrhea and as a diuretic in dropsies. Dose of the fluid extract {extractum senegee fluidum) Tn,x-xx (0.6-1.2) ; of the syrup {syrupus senega?) f3j-y (4.0-8.0). It is an ingredient of the compound syrup of squill. QUILLAJA. What is quillaja? Quillaja, or soap-bark, is the inner bark of Q. Saponaria {Nat. Ord, Rosaceae), a S. American tree, containing saponin, which foams like soap when in infusion. Locally, saponin is an irritaut and protoplasmic poison. Given internally in sufficient doses it is a nerve and muscle poison, and completely antagonizes the effects of digitalis on the heart, which it paralyzes in diastole. It increases the secretion of bronchial mucus. Quillaja has been used as an expectorant in chronic bronchitis, emphysema, and dilated bronchi. It is also used to aid in emulsifying oils. Dose of the tincture (tinc- tura quillaje) n\,xv-xxx (0.9-2.0). ASPIDOSPERMA. What is aspidosperma ? Aspidosperma, or Quebracho, is the bark of A. Quebracho-blancho {Nat. Ord. Apocynaceae). It contains 5 alkaloids, aspidospermatine (which is believed to represent the entire virtues of the bark), and aspidospermine, quebrachine, hypoquebrachine, and quebrachamine. It has been used in dyspnea independent of cause, but as it appears to have no action on the heart or kidney it probably is of service only in bronchial asthma and emphysema. It has also been used as a bitter tonic. Dose of the fluid extract {extractum aspidosper- matisfluidum) TT\,xv-f£>j (1.0-4.0). ASCLEPIAS. What is asclepias ? Asclepias, or pleurisy root, is the root of A. tuberosa {Nat. Ord. Asclepiadeae). It is an expectorant, diaphoretic, and diuretic, and causes considerable cardiac depression. In large doses it is a gastro- intestinal irritant. It is but little used. Dose of the fluid extract {extractum asclepiadis fluidum) tt\,xv-xxx (1.0-2.0). EXPECTORANTS — SANGUINARIA. 225 ERIODICTYON. What is eriodictyon ? It is the leaves of E. glutinosum, or California tar-bush [Nat. Orel. Hydroph3 r llaceae). and is known also as yerba, santa. It is used as an expectorant in chronic pulmonary disorders, and as a vehicle (in the form of elixir) to disguise the taste of quinine and other bitter drugs. Dose of the fluid extract (extr actum eriodictyi fluidum) nixx-f3j (1.2-4.0). ALLIUM — GARLIC. What is garlic ? Garlic is the bulb of Allium sativum (Nat. Ord. Liliaceae) and contains a very volatile oil. Locally applied it is a rubefacient. Taken internally it is a condiment, stimulating digestion, increasing the secretions generally, especially the broncho-pulmonary, and quickening the circulation. It is used as a stimulating expectorant in subacute and chronic bronchitis and in acute bronchitis of infants, especially when the disease begins to assume the capillary form. Externally it is used as a counter-irritant in the above diseases, and in infantile convulsions, applied to the spine, legs and feet in the form of a poultice. Dose of the syrup [syrupus allii) f3j (4.0) for a child. SANGUINARIA. What is sanguinaria ? Sanguinaria or blood-root, the rhizome of S. canadensis (Nat. Ord. Papaveracese), contains an alkaloid, sanguinarine. It is a local irritant. Large doses cause vomiting with great depression, a slow, irregular pulse (from direct action on the heart) and lowered blood-pressure, dilated pupil, collapse and death from paralysis of the respiratory centre, sometimes preceded by convulsions of spinal origin and lowered reflex activity. Moderate doses increase the arterial pressure from stimulation of the vaso-motor centres, which are paralyzed by larger doses. It stimulates the liver, the mucous membranes and the salivary and intestinal glands. It is used chiefly as a stimulating expectorant in lingering cases of bronchitis. Dose of the tincture (tinctura sanguinaria?) tt^v-xxx (0.3-2.0); of the fluid extract (extractum sanguinarice fluidum) TTlij-v (0.12-0.3). Sanguinarine (not official) has also been used as an expectorant in the dose of gr. ^i (0.005-0.008). 15 226 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. AMMONIACUM— AMMONIAC. What is ammoniac ? Ammoniac is a gum-resin obtained from Dorema Ammoniacum (Nat Ord. Unibelliferge). It is used internally as a stimulating expectorant in chronic bronchitis and in bronchorrhoea, and locally as a counter irritant. Dose gr. x-xxx (0.6-2.0) ; of the emulsion (emulsum ammoniaei— formerly called the mixture, Pharm. 1880) f£ss (15.0). A plaster is official (emplastrum ammoniaei cum hydrargyro — plaster of ammoniac with mercury). BENZOINUM — BENZOIN. What is benzoin? Benzoin, a balsamic resin obtained from Styrax Benzoin, or Ben- jamin tree (Nat, Ord. Styraceae) contains benzoic acid, resin, volatile oil, and often cinnamic acid. The effects of benzoin are due to benzoic acid (v. "Antiseptics"). Locally it is an irritant. Internally it stimulates the broncho-pul- monary and genito-urinary mucous membrane. It is eliminated chiefly by the urine as hippuric acid, increasing the acidity of that excretion. It is chiefly used by inhalation (compound tincture 5j(4.0), in a cupful (120.0) of boiling water,) in laryngitis, or to quiet spasmodic laryngeal cough, as in influenza. It has also been employed inter- nally in chronic bronchitis and in chronic cystitis with alkaline urine and phosphatic dep>osits, but for the latter purpose benzoic acid or its salts are preferred. It is added to ointments to prevent rancid- ity, and is much employed in the form of fumigating pastilles. It is also used locally as an antiseptic and protective {compound tincture) in fissured nipple, chapped, hands, and fissure of the anus, and has even been employed as a substitute for carbolic and salicylic acids, for its antiseptic effects, in the treatment of wounds. Dose of the tincture (tinctura benzoini) f^ss-j (2.0-4.0) ; of the compound tinc- ture (tinctura benzoini composite:) f^ss-ij (2.0-8.0). Benzoinated lard (adeps benzoinatus) contains 2 per cent, of benzoin. EXPECTORANTS — TAR. 227 BALSAMUM PERUVIAN UM— BALSAM OF PERU. BALSAMUM TOLU- TANUM — BALSAM OF TOLU. What are these substances ? Balsam of Peru is a balsam obtained from Toluifera Pereirge {Nat. Orel. Leguminosse), and contains cinnamein, resin, benzalco- hol, benzylic benzoate. stilbene, and cinnamic and benzoic acids. It is a stimulant and tonic to the mucous membranes, and has been used in various catarrhs. Dose f£ss (2.0) in emulsion. Balsam of Tolu is a balsam obtained from Toluifera Balsamum (Nat. Ord. Leguminosse) and contains resins, benzylic benzoate and cinnamate, tolene, and cinnamic and benzoic acids. Its effects and uses are similar to those of balsam of Peru, to which it is preferred because of its more pleasant taste. Dose gr. x-xxx (0.6-2.0) in emulsion, every few hours. It is, however, principally used as a vehicle. Dose of the tincture (tiuctura tolutani) is f3j-ij (4.0-8.0) ; of the syrup {syrupus tohitanus) f3j-iv (40-15.0). It is also an ingredient of the compound tincture of benzoin. PIX LIQUIDA— TAR. What is tar ? Tar is an empyreumatic oleoresin obtained by destructive distilla- tion of the wood of Pinus palustris and other species of P. {Nat. Ord. Coniferae). When distilled it yields pyroligneous acid, oil of tar, and a black residuum known as pitch. The oil of tar contains creasote. Tar resembles turpentine in its effects on the mucous membranes, but is more antiseptic. Externally it is an irritant. It is used as a stimulating expectorant in the later stages of acute, bronchitis, particularly where the disease does not yield readily to other treatment, and in chronic bronchitis. Externally it is employed in chronic skin diseases, especially in squamous affec- tions. Tar-water (not official) may be given in doses of f^ss-j (15.0-30.0) or the syrup {syrupus picis liquidce), which is better, in doses of f^ss (15.0). Locally, the oilipleum picis liquidce) is used as a sub- stitute for "oil of cade " {oleum cadinum), which is also official, or the ointment (unguentum picis liquidce) may be applied. 228 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. TERPINI HYDRAS — TERPIN HYDRATE. What is terpin hydrate ? It is the hydrate of the diatomic alcohol terpin. It occurs in colorless, rhombic, lustrous prisms; is odorless, but has a slightly aromatic, rather bitter taste. It acts on the nervous system and on mucous membranes in a man- ner similar to turpentine. It is eliminated by the urine, to which it imparts a turpentine odor. When given in large doses or for a long time, it may cause strangury, albuminuria, or even hsematuria. From its stimulating influence on mucous membranes it has been much used as an expectorant in bronchitis, either acute or chronic, especially when the secretion is very free. It has also been used in cystitis, in gonorrhoea, and in chronic kidney disease. Dose gr. j-iij (0.06-0.2) every 4 hours, in pill or capsule. TEREBENUM— TEREBENE. What is terebene ? Terebene is a liquid consisting chiefly of pinene, and containing not more than very small proportions of terpinene and dipentene, and is prepared by gradually adding sulphuric acid to the oil of tur- pentine. In its general effects it resembles turpentine. It is a good stimulating expectorant, very useful in the declining stages of acute and chronic bronchitis. It is also useful in emphysema, phthisis, and pleurisy. In fetid bronchitis and bronchiectasis it is very efficacious. It has also been employed in flatulent dyspepsia and genito-urinary. inflammations. Dose ntv-xx (0.3-1.2) in capsule or emulsion t. i. d. , or its vapor may be inhaled diluted with steam. What substances are often used as expectorants which have been previously considered in other medicinal groups ? Squill and turpentine [v. u Diuretics"), eucalyptus, serpentaria. and Prunus Virginiana (v. " Aromatic Bitters"). ORDER IV.— Astringents. What are astringents ? Astringents are remedies employed to cause contraction of the tissues with which they come in contact and thus lessen secretion. ASTRINGENTS— TANNIC ACID. 229 For what purposes are they used ? They are used to check profuse secretion (e. g., ptyalism, etc.) or morbid discharges (e. #., diarrhoea), to overcome relaxation of the tissues, and as haemostatics and styptics. How may the astringents be classified ? They are divided into vegetable and mineral astringents. Vegetable ' Astringents. What are the vegetable astringents ? They are tannic and gallic acids, and the various plants which are used as astringents on account of containing these principles. Name the vegetable astringents. Tannic acid, gallic acid, nutgalls, catechu, kino, krameria, haerna- toxylon, white-oak, geranium, witch-hazel, red and white rose, sumach, chestnut leaves. ACIDUM TANNICUM — TANNIC ACID. What is tannic acid? Tannic acid (gallo-tannic acid — digallic acid) is an organic acid obtained from nutgall. It is widely distributed throughout the vegetable kingdom and exists under two forms, gallo-tannic acid (which is the official variety and strikes a blue-black color with the ferric salts) and kino-tannic acid (which produces a greenish-black color with the same salts). Gallo-tannic acid is a light yellowish, amorphous powder, usually cohering in the form of glistening scales or spongy masses, without smell, but having a strongly astringent taste. It is freely soluble in water and in alcohol, and may readily be dissolved in glycerin by the aid of moderate heat. What are its physiological effects ? Tannic acid is a powerful astringent, coagulating albumins, con- tracting blood-vessels and con stringing tissues with which it comes in contact. It checks the secretions of the alimentary canal when taken internally, and restrains peristalsis, thus tending to constipate. It is converted into an alkaline tannate and into gallic acid in the prima via and slowly absorbed. It is eliminated by the faeces and urine under its own form and as gallic and pyrogallic acids. 230 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. For what purposes is it used in medicine ? When remote astringent effects are desired gallic acid is preferable, but tannic acid is employed whenever the part to be acted on is so situated that the drug can come in direct contact with it. Thus, it is given to arrest morbid discharges from the bowels in diarrhoea and dysentery \ both internally and by enema, and is used externally for the same purpose in leucorrhoea, gleet, colliquative sweating, and as an application to chronic ulcers. To counteract relaxation of tissues it is employed in the treatment of spongy gums, chronic pha- ryngitis and laryngitis, mercurial stomatitis and hemorrhoids. It is used also to arrest hemorrhages from the nose, gums, pharynx, stomach and bowels, and locally as a styptic ; to harden tissues sub- jected to pressure, as in threatened bed-sores and tender feet, and as an antidote to antimony and other metallic poisons. Dose, in diarrhoea, gr. j-xv (0.06-1.0) in pill ; in hemorrhage, gr. v-xx (0.3-1.3) in powder. The troches (trochisci acidi tannici) each contain gr. j (0.06), and may be used in relaxed palate or sore throat. The ointment (unguentum acidi tannici) or the glycerite (glyceritum acidi tannici), a solution in glycerin, may be used locally. ACIDUM GALLICUM— GALLIC ACID. What is gallic acid ? Gallic acid is an organic acid, usually prepared from tannic acid, and is tannic acid -f- a molecule of water ; thus, HC u H 9 9 (tannic acid) +3H 2 = 2(HC 7 H 5 5 +H 2 0) (gallic acid). It occurs as white or pale fawn-colored, silky, interlaced needles or triclinic prisms ; odorless, having an astringent or slightly acidulous taste. It is very soluble in boiling alcohol and boiling water, less so in cold alcohol, glycerin, ether, or cold water. It does not coagulate albumin, and hence is not as efficacious as a local astringent, but is preferred to tannic acid when it is desirable that the astringent should be absorbed and act through the blood on some remote part. It is used as a hemostatic in hemoptysis, hematuria, and uterine hemor- rhage. It is also employed to lessen secretion, as in colliquative sweats and bronchorrhoea , and to check morbid discharges, as in chronic albu- minuria. Dose gr. v-xxx (0.3-2.0), in powder, pill, or solution. ASTRINGENTS — KRAMERIA. 231 Describe the preparations, doses, and uses of the vegetable astringents which owe their virtues to tannic and gallic acids. Galla {nut gall) is an excrescence found on Quercus lusitanica, the gall oak {Nat. Orel Cupuliferas) caused by the punctures and deposited ova of a fly (Cynips Quercus folii or Diplolepis Gallae tinc- toriae). Before the maturity of the larvae and their escape from the gall, they contain tannic acid (50-60 per cent.) and gallic acid (3 per cent.); afterward they are much inferior and contain compar- atively little of these substances. They are but little used except as the source of tannic and gallic acids. The tincture {tinctura gallee) is chiefly used as a chemical test. The ointment {unguentum gallee) combined with powdered opium is sometimes applied to hemorrhoids. Catechu, an extract prepared from the ivood of Acacia Catechu {Nat. Orel. Legnminosae), contains kino-fannic and catechuic acids [catechin). It is a powerful astringent, much used in diarrhoeas and to some extent in hemorrhages, and locally as an astringent in sore throat, as an injection in gonorrhoea, and leucorrhcea, and as a styptic. Dose gr. x-xxx (0.6-2.0) in emulsion or capsules. Of the compound tincture {tinctura catechu composita) f3j-iij (4.0-12.0) may be given. The troches {trochisci catechu) each contain gr. j (0.06). Kino, the inspissated juice of Pterocarpus Marsupium{i\W. Ord. Legnminosae) and other trees; contains Mno-tannic acid, hino'in, pyrocatechin, etc., and has similar properties and uses to catechu. Dose of the powder gr. x-xxx (0.6-2.0); of the tincture [tinctura kino) f3j-ij (4.0-8.0). Krameria, the root of K. triandra and of K. Ixina [Nat Ord, Polygaleae), S.American shrubs; contains hramero-tannic add, and is a powerful astringent, similar to kino and catechu. Dose of the extract [extractum kramen'ce) gr. v-xv (0.3-1.0) ; of the fluid extract [extractum hramerias, flw'dum) f,3ss-j (2.0-4.0) ; of the tincture [tinctura krameria) foss-ij (2.0-8.0); of the syrup (syrupus hramerue) f3j-jv (4.0-15.0). The troches {trochisci kramerice) each contain gr. j (0.06). 232 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. H^ematoxylon, logwood or Cam peachy wood, is the heart wood of H. campeachianum {Nat. Ord. Leguminosae), containing tannic acid, hamiatoxylin, etc. It is a good astringent in diarrhoeas due to relaxation, especially in children, but the discharges will stain the linen blood-red. Of the extract (extraction hwmatoxyli) the dose is gr. x-xxx (0.6-2.0). Quercus Alba, or white oak (Nat Ord. Cupuliferae). The bark is official, and contains querci-tannic acid. It is occa- sionally used in diarrhoeas, but more often as an enema in hemor- rhoids and prolapsus ami, or as a vaginal wash in leucorrhcea or relaxed conditions with tendency to cystocele or rectocele. It makes an indelible stain on linen. Geranium, the rhizome of G. maculatum, crow's foot or crane's bill (Nat Ord. Geraniaceae) ; contains tannic and gallic acids, and is an efficient indigenous astringent. Dose of the fluid extract (extractum geranii fluidum) f 3ss-j (2.0-4.0). Hamamelis, the leaves of H. virginica or witch hazel {Nat. Qrd. Hamamelaceae) ;, contains tannic acid and a bitter 'principle. It is an astringent and seems to contract the veins of the skin and mucous membranes. It has been used in passive hemorrhages as a hemostatic, as an astringent enema in hemorrhoids, and locally in congestions and inflammations. Dose of the fluid extract (extractum hamamelidis fluidum) f 3ss-j (2.0-4.0). Rosa Gallic a (red rose) ; Rosa Centifolia (pale rose), (Nat. Ord. Rosaceae). Their petals are official. The former is a very mild astringent, but they are principally used as flavoring ingredients and vehicles. The preparations of red rose are a fluid extract (ex- tractum roso? fluidum), a honey (mel roso?), & syrup (syrupus rosa?) and a confection (confectio roso?) ; those of pale rose are a triple or stronger rose water (aqute rosai fortior), and another milder water (aquae, rosce) from which is made an ointment (unguentum aquos rosm — cold cream). Rhus Glabra (sumach) (Nat. Ord. Anacardieae). The fruit ASTRINGENTS— LEAD. 233 is official. It is a good astringent in sore mouth and pharyngitis. The Jiu id extract [extractum rho'is glabrae fluidum) may be diluted with two or more parts of water and used as a gargle. Castanea, the leaves of C. dentata or chestnut [Nat. Ord. Cupuli- ferae), is astringent and supposed to possess antispasmodic prop- erties. It is chiefly used in whooping-cough. Dose of the fluid extract {extractum castanece fluidum) f3ss-ij (2.0-8.0). Mineral Astringents. Name the mineral astringents. Most of the metallic salts possess astringent properties, but those especially used for this purpose are the lead salts ; alum ; aluminium sulphate ; the salts of copper, of zinc, of silver, and of bismuth ; and cerium oxalate. PLUMBUM — LEAD. What is the source of lead ? Lead is obtained by roasting galena, the native sulphide. What are its physiological actions ? Metallic lead is inert, as are probably also the sulphide and sul- phate. All other salts of lead, when applied locally in solution, are astringent, or if the solution be strong, irritant. In medicinal doses they are astringent to the alimentary canal, decreasing its secretions and also the secretion of bile. They are but slowly absorbed. When taken for some time they reduce the volume and frequency of the pulse by stimulation of the cardio-inhibitory centre and the periph- eral filaments of the vagi. They are eliminated by the liver and kidneys. What are its toxicological actions ? In large doses several of the lead salts are capable of causing acute poisoning, the symptoms being intense gastro-intestinal irritation, vomiting, coma, paralysis and collapse. Chronic poisoning is caused by saturation of the system with lead, either by drinking pure water conveyed in lead pipes (the contained air forming a soluble oxide), constantly eating substances adulterated with lead salts, exposure in lead factories, etc. Lead colic (or 234 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. painters' colic), the most common form, consists of sharp pains about the umbilicus, obstinate constipation, hard, contracted abdomen, and often nausea and vomiting. This is probably due to intense stimulation of the intestinal ganglia by the lead, causing arrest of peristalsis and spasm of the muscular coat of the bowel. It is quickly relieved by belladonna, atropine or pilocarpine. Sometimes the poisoning takes the form of lead-arthralgia, manifesting itself by severe pain in the joints and limbs, and cramps. Lead paralysis is loss of voluntary motion in groups of muscles, particularly the flexors of the upper extremity, causing vrrist-drop. Electro-muscular contractility is affected, the muscles waste, and often anaesthesia of the affected or opposite side is present. The poison may also affect the brain, kidney, or other organs. An im- portant symptom of lead poisoning is a blue line upon the gums where they join the teeth, and in case of doubt lead may be detected in the urine by the chemical tests. What are the tests for lead, and how should saturnine poi- soning be treated? Sulphuretted hydrogen gives a black, and a solution of potassium iodide a yellow precipitate with soluble lead salts. The treatment of acute poisoning consists in evacuating the contents of the stomach, and administering diluted sulphuric acid, or sodium or magnesium sulphate as a chemical antidote. In chronic poisoning, discover its source and remove it (in the case of painters, insist on scrupulous cleanliness of the hands and nails, and the use of very diluted sul- phuric acid as a drink) ; give purgatives to overcome the resulting constipation ; give diluted sulphuric acid or the soluble sulphates, with baths of potassium sulphide as antidotes, and aid elimination by large quantities of diluents and potassium iodide. In lead colic atropine is of service, and in lead palsies electricity (the faradaic current when the muscles respond) and strychnine are advantageously employed. For what medicinal purposes are the lead salts used? They are used internally as astringents in diarrhoeas and dysen- teries, as hemostatics, and in the treatment of internal aneurism. Locally, as astringent injections in leucorrhcea and gonorrhoea, and ASTRINGENTS — LEAD. 235 us sedative and astringent lotions in inflammations. The acetate is the only lead salt which is administered internally. What are the preparations of lead and their nses ? Plumbi Oxidum (lead oxide), or litharge, is occasionally used as a dusting powder for ulcers, but is chiefly employed to make a plaster (emplastrum plumbi), which is the basis for most officinal plasters ; diachylon ointment (unguentum diachylon), useful in skin diseases, and soap-plaster (emplastrum saponis). Plumbi Acetas (lead acetate), or sugar of lead, is used internally as an astringent in diarrhoea, often combined with opium, and is also useful in dysentery. To lessen the expectoration in chronic bronchitis and to check the night sweats of phthisis it is sometimes given. As a hemostatic in yellow fever it does some good, and perhaps also in hemoptysis. It has been employed as a sedative in the treatment of internal aneurism. Locally as a sedative and astnngent lotion it is much used in inflammations (not applicable to ocular therapeutics, as it may cause corneal opacity), and to check morbid discharges. Dose gr. j-viij (0.06-0.5) two or three times a day. As an injection in gonorrhoea gr. ss-ij (0.03-0. 1 2)— f 3 j (30.0) ; as a lotion in inflammation gr. v-x (0.3-0.6)-t3J (30.0). Liquor Plumbi Subacetatis (solution of lead subacetate — 1 Goulard's extract) contains about 25 per cent, of lead subacetate in solution, and is used externally and in the preparation of lead water (liquor plumbi subacetatis dilutus — diluted solution of lead subacetate), which contains 3 per cent, of the stronger solution ; and of Goulard' ' s cerate (ceratum plumbi subacetatis — cerate of lead subacetate). Plumbi Iodidum (lead iodide). It may be used internally, dose gr. ij-iij (0.13-0.19), but is chiefly employed externally in the form of ointment (unguentum plumbi iodidi), which contains 10 per cent, of the salt. Plumbi Nitras (lead nitrate) is used as a disinfectant (Ledoycu's disinfecting fluid contains 3j to the f.fj — about 4.0 to 30.0), astrin- gent and sedative, in wounds, ulcers, cracked nipples, on}T-hia maligna, etc. Plumbi Oarboxas (lead carbonate — white lead) is used chiefly as an application to fresh burns. If applied to a large surface, care 236 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. should be taken to guard against poisoning. An ointment [unguen- tum plumbi carbonatis) is official, and contains 10 per cent, of the carbonate. ALUMEN— ALUM. What is alum ? Official alum is a double sulphate of aluminum and potassium. There are other varieties in which potassium is replaced by some other base, as ammonium or sodium. What are its effects and uses ? Alum is a powerful astringent, and in large quantity an irritant, whether used locally or internally. In large doses it is emetic, and in excessive doses has caused death from gastro-intestinal irritation. It is used in solution as an astringent, by atomization in bronchorrhasa, by injection in leucorrhoza, gonorrhoea and gleet, as a gargle in sore- throat, relaxed palate and uvula, as a lotion in conjunctivitis and on cotton as a tampon in cystocele, rectocele and uterine prolapse. As a hemostatic in hemoptysis, a saturated solution may be used by atomization ; and as a styptic [aqua pagliari consists of alum, com- pound tincture of benzoin and water boiled together) it is employed locally to arrest hemorrhage. As an emetic it is used in croup in capillary bronchitis and as an adjuvant to other emetics. It is also efficient in the treatment of lead colic. Dose as an astringent gr. x-xxx (0.6-2.0) ; as an emetic 3j-iv (4.0-16.0). In lead-poisoning a teaspoonful (4.0) may be given every 3 or 4 hours. Dried alum (alumen exsiccation) is alum deprived of its water of crystallization by heat. In excessive doses it has proved fatal. Dose gr. v-x (0.3-0.6). Externally it is applied as a mild escharotic to fungous granulations. ALUMINI SULPHAS— ALUMINUM SULPHATE. What is aluminum sulphate ? It is a powerful astringent and antiseptic, and is employed for these purposes externally and as an injection in gonorrhoea. Its solution has been used to preserve cadavers for dissection. ASTRINGENTS— COPPER. 237 CUPRUM— COPPER. What are the sources and the effects of copper ? Copper is obtained from copper pyrites, a double sulphide of iron and copper. The metal itself is inert. The salts are mild astrin- gents and stimulants when in weak solution, and when strong, act as irritants; in powder they are mild caustics. Taken internally in small doses they are astringent, and are supposed to act as tonics to the nervous system. In larger doses they are local emetics. In excessive amounts they act as irritant poisons, causing gastrointesti- nal inflammation, hematuria, sometimes jaundice, convulsions, paralysis, delirium, coma and death. The post-mortem reveals fatty degeneration of the liver and decomposition of the blood corpuscles. When taken continuously for a very long time a condition of chronic poisoning results, with giddiness, occasional diarrhoea, cramps, wast- ing, and sometimes progressive palsies, respiratory failure and death. A. green line is sometimes observed on the gums. The tests for the soluble copper salts are potassium ferrocyanide, which gives a mahogany-colored precipitate ; ammonia, which gives a beautiful blue color, and metallic iron on which metallic copper will be deposited from a solution. The treatment of acute poisoning is albumen (milk or eggs) ; opium, demulcents and treating symp- toms as they arise. In chronic poisoning, endeavor to eliminate it as if the poison were lead. For what purposes is copper used in medicine ? It is used internally as an astringent in chronic diarrhoea, espe- cially when ulceration exists, as an emetic (the sulphate), especially in narcotic poisoning, and occasionally as a tonic in nervous debility and functional nervous diseases. Locally it is efficacious as a stimu- lant to ulcers, as an escharotic in granular conjunctivitis and flabby granulations, and as an astringent injection in gonorrhoea. What are the preparations of copper and their doses ? Ccpri Sulphas (copper sulphate) called also blue vitriol, or blue stone. Dose as an astringent gr. \-'} (0.01-0.00). in pill ; as an emetic gr. iij-v (0.2-0.3) ; as an injection in gonorrhoea gr. j-j (0.01-0.06) to fgj (30.0). 238 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. ZINCUM— ZINC. What are the sources, action, uses and preparations of zinc? Zinc is obtained principally from the native carbonate and sulph- ide. The effects of the zinc salts are similar to those of copper, but are less powerful. In excessive doses they cause an acute poisoning very similar to that produced by copper, the antidotes being milk and eggs, alkalies and their carbonates. Chronic poisoning is so rare as to be disputed. The test for zinc in solution is the addition of ammonium sulphide, which precipitates white zinc sulphide, the only white sulphide met with. They are used as astringents in diarrhoeas ; as emetics ; as nerve tonics in epilepsy and chorea, and locally as astringents in conjunc- tivitis, gonorrhoea, etc. ; as sedatives and astringents in eczema and erysipelas; as dusting powders, and as mild stimulants to ulcers. Zinci Sulphas {zinc sulphate — white vitriol), dose as a tonic or astringent gr. ij-v (0.13-0.3); as an emetic (safer than copper sul- phate) gr. x-xx (0.6-1.3). Locally, as a collyrium or as an injec- tion in gonorrhoea, gr. j-ij (0.06-0.13) to fgj (30.0). Zinci Oxidum {zinc oxide) used internally in catarrhal diarrhoea, . membranous enteritis, epilepsy, chorea, and occasionally to check colliquative sweats. Dose gr. j-v (0.06-0.3) in pill. It is used also as a dusting powder. Oleeitum zinci {oleate of zinc) contains 5 per cent, of zinc oxide, and is used externally. The ointment {unguentum zinci oxidi) contains 20 per cent, of the salt and is much employed. Impure or commercial zinc oxide, sometimes called " tutty," is used in pharmacy. Zinci Acetas {zinc acetate) is used as a collyrium (gr. ij (0.13) to f^j (30.0)) as an injection in the third stage of gonorrhoea (gr. j-xx (0.06-1.3) to i%\ (30.0)) and in leucorrhoea (3j to Oj— about 4.0 to 473.0). Zinci Carbonas Pr^ecipitatus {precipitated zinc carbonate) is used as a dusting powder and a mild astringent ointment (3j~^j —about 4.0 to 30.0). Zinci Chloridum {zinc chloride) is a powerful caustic and anti- septic, employed to destroy lupus and indolent granulations. It is used also to preserve cadavers for dissection. Burnett's disinfecting fluid contains gr. 200 to f&j (about 13.0 to 30.0). ASTRINGENTS — SILVER. 239 Liquor zinci chloridi {solution of zinc chloride) may be used to disinfect water-closets and sinks. ZlNCl Iodidum (zinc iodide) is a local stimulant and caustic. Zinci Valerianas [zinc valerianate) is employed as a nerve tonic in epilepsy and chorea ; dose gr. j-ij (0.06-0.13) t. i. d. Zinci Bromidum (zinc bromide) is also official. Zinci Phosphidum (zinc phosphide) has been mentioned under phosphorus [vid. Mineral Tonics). ARGENTUM— SILVER. What are the physiological effects of silver? Metallic silver is inert. Of its soluble salts, the oxide and nitrate are chiefly employed. Locally applied the nitrate coagulates albumen, is an astringent and superficial caustic, contracting the cutaneous vessels and producing a white stain on the skin which becomes black on exposure to light. Taken internally they are astringent, and after absorption exert a tonic influence upon the nervous system. In targe doses they are gastro-intestinal irritants, often producing also violent convulsions, disturbed respiration, coma, dilated pupils, paralysis and death from respiratory failure. If too long continued, even in minute doses, chronic argyria results, consisting in emacia- tion, impaired memory and a peculiar indelible blue discoloration, first manifesting itself on the mucous membranes, and extending to the skin and internal organs. What are the tests for silver, and how should argyria be treated ? The addition of hydrochloric acid or sodium chloride to a solu- tion of silver produces a white precipitate of silver chloride, soluble in ammonia. Acute argyria is treated by giving immediately, as an antidote, a large amount of common salt, and treating symptoms p. r. n. In chronic argyria nothing does much good as a rule ; potas- sium iodide may be tried as an ehminative agent. What are the medicinal uses of the silver salts ? They are used as astringents in chronic diarrhoeas and in dysen- teries (internally or by enema) especially when ulceration is present, and are very useful in organic dyspepsias especially in gastric idccr and in chronic gastritis. As a nerve tonic they are employed in 240 ESSENTIALS OF MATERIA MEDIC A AND THERAPEUTICS. locomotor ataxia and other spinal scleroses. Externally as a stimu- lant and mild caustic the nitrate is applied to slowly granulating surfaces or to unhealthy ulcers. As an antiphlogistic and astringent it is used in solution in various inflammations of the mucous mem- branes, as conjunctivitis, pharyngitis, laryngitis, etc., and may be used as an injection in the later stages of gonorrhoea (gr. j-ij (0.06- 0.13) to f^j (30.0)) in the male, or in acute vaginitis (painting the inflamed vagina with strong solutions). It is employed also in super- ficial inflammations of the skin, in erysipelas, and to prevent pitting in smallpox. What are the official silver salts and their doses ? Argenti Nitras {silver nitrate), dose gr. %-\ (0.008-0.016) gradually increased to gr. ss-j (0.032-0.06). Great care should be taken to prevent staining the skin. For external use solutions are employed varying in strength from gr. j-3ij (0.06-8.0) to fjj (30.0) of distilled water. Moulded silver nitrate or lunar caustic {argenti nitras fusus) is silver nitrate melted and poured into small moulds, for external use. Diluted silver nitrate {argenti nitras dilutus) is 30 parts of silver nitrate and potassium nitrate 60 parts, moulded as above. Argenti Oxidum (silver oxide), dose gr. ss-j (0.03-0.06) in pill. Argenti Iodidum (stiver iodide), dose as an alterative gr. j (0.06). Argenti Cyanidum (silver cyanide), used for preparing diluted hydrocyanic acid. BISMUTHUM — BISMUTH. What are the actions, uses and preparations of bismuth ? Metallic bismuth is inert. The less soluble salts are not actively toxic when pure, as they are absorbed with difficulty. Bismuth and ammonium citrate is much more irritant, and may in large doses cause gastro-enteritis. In medicinal doses, they are astringent and sedative to the mucous membranes. A portion is absorbed and is eliminated by the kidneys chiefly, while that which is not absorbed is converted into a sulphide and colors the stools black. Locally applied they are antiseptic and sedative. They are used internally as sedatives and astringents to check ANTACIDS. 241 nausea and vomiting in gastric irritation, and to relieve pain in gastralgia, gastric ulcer and cancer. In acute diarrhoeas from irritation and in chronic diarrhoeas, especially those occurring in children during the summer months, they are very valuable. Ex- ternally as mild astringents and antiseptics they are useful in the treatment of ulcers, and as an injection (suspended in mucilage) in acute gonorrhoea and in vaginitis. They are also used as dusting powders in intertrigo and as snuff in acute coryza. Bismuth Subnitras {bismuth subnitrate) called also pearl white or magistery of bismuth, dose gr. v-3j (0.3-4.0). Bismuthi Subcarbonas {bismuth subcarboiiate) , dose gr. v-xxx (0.3-2.0). Bismuthi et Ammonii Citras {bismuth and ammonium citrate), dosegr. j-v (0.06-0.3). CERII OXALAS — CERIUM OXALATE. What is cerium oxalate ? It is supposed to resemble the salts of bismuth in its effects, but has not been investigated. It is used with success in reflex vomiting, particularly the vomiting of pregnancy. Dose gr. j-iij (0.06-0.19), t. i. d. in pill or capsule. ORDER V.— Antacids. What are antacids ? Antacids are remedies capable of neutralizing acids. The term, however, is here used in a more limited sense, and embraces only those medicines which are used in medicine to correct excessive acidity in the alimentary canal, as manifested by heartburn, acid eructations, gastric uneasiness, and diarrhoea of infants with 1 ' chopped spinach stools. ' ' Excessive acidity may be due to an ex- cessive secretion of acid by the stomach, and here the antacids may be given after meals to neutralize the acid present, or the same effect may be produced by administering an acid before meals, which will decrease the acid secretion. On the other hand, it may be due to a deficient secretion of acid and consequent imperfect digestion and fermentation of the food. In these cases an antacid given before meals is useful by increasing the outward osmosis of acid, or a mix- ture of pepsin and acid after meals may supply the place of the deficient secretion. In acidity due to the development of the sarcina 16 242 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. ventriculi, sulphurous acid, the sulphites, carbolic acid or other antizymotics give the best results. Name the antacids employed for the above purposes. While all of the alkalies, alkaline earths and their carbonates are really antacids, yet in medical practice the sodium and calcium salts are chiefly used. Solution of potassa (q. v.) is sometimes, but not often, employed. The spirit and aromatic spirit of ammonia (q. v. ) are frequently used, especially in sick headache or where a stimu- lating antacid is required. SODIUM. What are the effects and uses of the sodium salts ? Caustic soda and its solution are escharotics. The sodium salts taken on an empty stomach increase the secretion of acid gastric juice, but if given after a meal in sufficient quantity they neutralize the acid present. They diffuse readily into the blood and act some- what as do the potassium salts, being, however, less irritant, more feebly diuretic, and possessing little if any poisonous influence ovei the (mammalian) heart, nerves or muscles. The medicinal uses of the sodium preparations have been con- sidered in discussing the general uses of the antacids. What are the preparations of sodium ? Liquor Sod^e (solution of soda), dose ttlij-x (0.12-0.3) freely diluted. Sodii Carbonas {sodium carbonate) is much used as an antacid in dyspepsia. In overdoses it is a corrosive poison. The antidotes are the vegetable acids. Dose gr. x-xxx (0.6-2.0). It is some- times deprived of its water of crystallization and prescribed in pill form as the dried carbonate (sodii carbonas eocsiccatus), in doses of gr. v-xv (0.3-1.0). Sodii Bicarbonas (sodium bicarbonate), is preferred to the carbonate because it is a more permanent salt and is less irritating to the stomach. Dose gr. x-xxx (0.6-2.0). It is an ingredient of seidlitz powders {q. v.) and other preparations. The troches (trochisci sodii bicarbonatis) each contain gr. iij (0.2) of the bicar- bonate. The other sodium salts are rarely used as antacids, and most of them have been sufficiently described previously. ANTACIDS — CALCIUM. 243 CALCIUM. What are the effects, uses and preparations of calcium? Unslaked lime is a caustic. The calcium salts are antacid, slightly astringent and sedative to the mucous membranes, and are consequently much used in vomiting and in diarrhoea. The vapor arising from slaking lime is inhaled with advantage in membranous croup and in diphtheria. The preparations are Liquor Calcis (lime-solution — lime-water), used as an antacid and gastric sedative in nausea and vomiting from irritability of the stomach, and often added to milk to increase its digestibility and render it more readily tolerated by the stomach. As an antacid and astringent it is useful in diarrhoea, especially in teething children. Locally it is used as an alkaline wash in various skin affections and as a dressing to burns, scalds, ulcers, etc., in the form of the Liniment {linimentum calcis) often called carron oil (equal parts of lime-water and linseed oil). Syrupus Calcis [syrup of lime), a saturated, aqueous solution of calcium hydrate, the percentage of which varies with the temper- ature, but is about 0.17 at 59° F., is used as an astringent in diar- rhoeas and as an antidote to poisoning by carbolic acid. Dose f^ss- ij (2.0-8.0), freely diluted. Calcii Carbonas Pr^cipitatus {precipitated calcium carbon- ate) (dose gr. xx-.^j (1.3-4.0)) possesses no especial advantage over prepared chalk [cretce prceparata), which is used in diarrhoeas. Dose gr. x-xxx (0.6-2.0). They are used externally as dusting- powders in intertrigo. Compound chalk powder [pulvis cretce com- positus) contains 30 per cent, of prepared chalk. Chalk mixture {mistura cretce) contains 20 per cent, of the compound powder in water and cinnamon water, and is much used, combined with astringents and opium, in diarrhoeas, especially those of teething children. Dose f^ss-j (15.0-30.0). Troches of chalk (trochisci cretce) ; each contains gr. jv (0.25) of prepared chalk. Other preparations of calcium have been previously considered. 244 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. GROUP II.— TOPICAL MEDICINES. Class I. — Antiseptics. What are antiseptics? Antiseptics are medicines which prevent fermentation and decom- position by destroying, or preventing the development of, the germs on which these processes depend. They are not always germicides (remedies which kill the germs of disease), for some of them hinder the growth and prevent the development of fresh germs, without destroying those already present ; nor are they always deodorants (remedies which destroy disagreeable odors), for the microbes of disease may be destroyed, and foul chemical emanations continue, or the latter may exist without the presence of the former. Name the chief antiseptics. Antiseptics may be divided, according to their chemical composi- tion, into the inorganic or elementary, and the organic antiseptics (or those belonging to the group of carbon compounds, including anti- septic oils and their camphors). To the first group belong hydro- gen dioxide, potassium permanganate, chlorine water, chlorinated lime, Labarraque's solution, mercuric chloride, bromine, iodine, mercuric iodide, iodoform, iodol, sulphurous acid, sulphites, sul- phides, boric acid, borates, and many of the mineral salts previously mentioned, as iron sulphate, lead nitrate, etc. In the second division are included carbolic acid and the carbonates, creosote, benzoic acid and the benzoates, naphthalin, naphtol, formaldehyd, the antipyretics {q. v.), the antiseptic oils [v. " Carminatives"), and thymol. AQUA HYDROGENII DIOXIDI— SOLUTION OF HYDROGEN DIOXIDE. What is solution of hydrogen dioxide ? It is a slightly acid, aqueous solution of hydrogen dioxide (also known as hydrogen peroxide), containing, when freshly prepared, about 3 per cent., by weight, of the pure dioxide, corresponding ANTISEPTICS— CHLORINE WATER. - 245 to about 10 volumes of available oxygen. It occurs as a colorless liquid, without odor, but having a slightly acidulous taste. It parts readily with its oxygen, and thus acts as an oxidizing disinfectant. It is of course greatly inferior to mercuric chloride as a disinfect- ant, antiseptic, and germicide, but has the advantage of being non- poisonous. When brought in contact with pus, as on a suppurating surface, gas is evolved more or less abundantly, depending on the amount of pus present ; a slight, superficial coagulation forms on the surface and the pus corpuscles are disintegrated. It has been used as an antiseptic injection into abscess cavities after the evacuation of their contents, and into sinuses; and also as a local application to superficial wounds and idcers, whether of common or specific origin. It is also used as an injection in gonorrhoea. In scarlatinal or diphtheritic sore throat, and in tonsillitis, it is often used as a gargle or spray. It is a good buccal disinfectant and may advantageously be used for this purpose in typhoid and otJier low fevers, or in any case where the secretions tend to collect in the mouth and become offensive. On account of the oxygen evolved it is an active bleaching agent, and is used in solutions of 10 to 15 per cent, strength to bleach black hair. POTASSII PERMANGANAS — POTASSIUM PERMANGANATE. What is potassium permanganate? Potassium permanganate has been considered with the prepara- tions of manganese (v. " Mineral Tonics"). Its disinfectant powers are great, but it is decomposed immediately on contact with organic matter, and hence is chiefly used in solution as a gargle in scarlatina and diphtheria, as a lotion to cancerous and other ulcers, to correct foetor in otorrhoea, etc., and as an injection in leucorrhoea and in gonorrhoea. It is given internally as an emmenagogue (q. v. ). AQUA CHLORI — CHLORINE WATER. What is chlorine-water? It is an aqueous solution, containing at least 0.4 per cent, of chlorine. It is a powerful irritant and antiseptic. Albumin is the best antidote. 246 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. It is chiefly used, diluted, as a gargle in diphtheria, and as a wash for foul ulcers and wounds. CALX CHLORATA — CHLORINATED LIME. What is chlorinated lime ? It is composed of calcium hypochlorite and chloride, and when exposed to the air is decomposed, yielding about 35 per cent, of chlorine. It is an antiseptic, and is used to disinfect the air of sick rooms, urine, sputum and fecal discharges and privies. LIQUOR SOD.E CHLORATE — SOLUTION OF CHLORINATED SODA. What is this substance ? Solution of chlorinated soda, or Labarraquds solution, contains at least 2.6 per cent., by weight, of available chlorine, and may be used for the same purposes as the foregoing preparations. HYDRARGYRI CHLORIDUM CORROSIVUM — MERCURIC CHLORIDE. What is mercuric chloride? This preparation has been considered with the mercurial salts (v. "Alteratives"). It is a valuable germicide, and is used in aqueous solutions of various strengths (1-2000 to 1-16,000) in all manner of surgical operations and affections where an antiseptic is required and can be employed. As several cases of poisoning have been reported, especially from its use in gynaecological and obstetrical practice, it should be employed with some caution. BROMUM — BROMINE. IODUM — IODINE. Are these substances antiseptic? Bromine (v. " Eschar otics") and iodine are powerful antiseptics, but are rarely used for this purpose, as their management requires great care and experience. HYDRARGYRI IODIDUM RUBRUM— MERCURIC IODIDE. Is mercuric iodide antiseptic? Mercuric iodide is a powerful germicide, and has been employed as a substitute for corrosive sublimate, but, so far, has not super- seded the latter. ANTISEPTICS— IODOFORM. 247 IODOFORMUM — IODOFORM. What is iodoform? Iodoform is formyl teriodide, and occurs in minute yellowish crys- tals, with a disagreeable odor. It is insoluble in water, but freely soluble in ether and alcohol. What are its effects and uses? Locally, it is an antiseptic and local anaesthetic. It prevents the multiplication of germs, but will not destroy them if present before its use. It seems to be more readily absorbed by abraded than by mucous surfaces. Internally, it is tonic and alterative. Moderate doses stimulate the cardio-inhibitory centre, slowing and strengthen- ing the cardiac beat and elevating the blood pressure, while large doses depress this centre, and finally paralyze the cardiac muscle. The temperature is generally reduced. It increases the salivary, biliary and intestinal secretions, and is eliminated chiefly by the kidneys (as sodium iodate), but to a slight extent by the lungs also. When excessive amounts are absorbed, either from internal or external sources, glomerulo-nephritis and fatty degenerations of various organs occur. Cases of poisoning may be divided into six classes, the danger increasing progressively from the first to the last : 1. High fever ; 2. Fever, gastro-entero irritation, rapid pulse ; 3. Very rapid, compressible pulse, no fever ; 4. Very rapid pulse and high fever ; 5. Great depression and collapse, rapidly fatal ; 6. Symptoms like meningitis. Should poisoning occur, remove every particle of the dressing if it has been used locally, give opium and stimulants and treat symptoms. Iodoform has been used internally as a cardiac tonic in valvular disease with insufficient hypertrophy, and as an alterative in syphilitic rheumatism, neuralgiae and the early stages of phthisis. In diabetes mellitus it has been advantageously given. Externally, it is employed as an anaesthetic and antiseptic drying to irritable ulcers of all kinds, burns and wounds. In ethereal solution it has been injected into the cavities of strumous abscesses, after the evacuation of their contents, to destroy the giant cells of tubercle and promote healthy granulation. In sup- positories it is u*ed in inflammation and ulceration of the vagina, uterus and rectum. Bougies containing iodoform are sometimes used in septic affections of the uterus and in gonorrhoea. Dose gr. \-y (0.01-0.3), in pill or capsule. 248 ESSENTIALS uP MATERIA MEDICA AND THERAPEUTICS. The ointment (unguentum iodoformi) contains 10 per cent, of iodoform. IODOL. What is iodol? Iodol (not (official) is made by the action of iodine on pyrol, and contains 88. 9 per cent, of the former. It is recommended as a sub- stitute for iodoform, being tasteless, odorless, and, as it is more slowly absorbed, less likely to produce dangerous effects. It is espe- cially recommended in nasal, pharyngeal and laryngeal cases, par- ticularly in tubercular laryngitis, and may be used either in powder (by insufflation) or in solution with alcohol and glycerin. It has also been used internally in those cases to which iodoform is appli- cable. Dose gr. ss-iij (0.03-0.19), in pill or capsule. ACIDUM SULPHUROSUM — SULPHUROUS ACID. What is sulphurous acid ? Sulphurous acid is an aqueous solution of about 6.4 per cent., by weight, of sulphurous acid gas. What are its effects and uses ? It is a powerful deoxydizing agent, and deodorant. When suffi- ciently concentrated the gas is probably a germicide. When inhaled it is irritant, and, if in sufficient amount, causes inflammation and even acts as a caustic from the formation of sulphuric acid. It is eliminated by the urine and feces as sulphates. It is used internally (diluted) in yeast-vomiting to prevent the formation of sarcina ven- triculi in flatulency depending on fermentation of the food, and locally as a wash in various parasitic skin diseases. In the form of burning sulphur it is employed to disinfect rooms. Dose Triv-f3j (0.3-4.0), freely diluted. THE SULPHITES AND SULPHIDES.* What are the effects and uses of these salts ? The effects of the sulphites depend upon the sulphurous acid which they contain, and which is readily evolved on the addition of almost *See footnote, p. 71. ANTISEPTICS— BORIC ACID. 249 any acid. On exposure to the air they are converted into sulphates. Taken internally they are decomposed by the acid of the gastric juice, evolve sulphurous acid, are finally converted into sulphates, and thus absorbed and eliminated. They are used to fulfill the indi- cations for sulphurous acid. The dose of sodium sulphite {sodii sulphis) is gr. v-xxx (0.3-2.0) t. i. d. ; sodium bisulphite (sodii bisul- phis) gr. v-xx (0.3-1.3); sodium hyposulphite [sodii hyposulphis) gr. v-xx (0.3-1.3). The sidphides are said to possess the power of arresting the forma- tion of pus in threatened boils and abscesses, and are used internally for this purpose. Calx sulphurata [sulphurated lime) consists of a mixture contain- ing at least 60 per cent, of calcium monosulphide together with unchanged calcium sulphate and carbon, in varying proportions, and is given in doses of T V~i (0.006-0.03), repeated every h-l hour. Sulphurated potassa will be found among the sulphur preparations [v. " Cathartics"). ACIDUM BORICUM — BORIC ACID. SODII BORAS — BORAX. What are the effects and uses of boric acid and its salts ? Locally boric acid is antiseptic and deodorant. Internally they are somewhat diuretic, and retard the decomposition of the urine. Two fatal cases from the injection of large quantities into the pleural sac, and the cavity of a large lumbar abscess, have been reported, death being due to collapse and cardiac failure. Boric acid is used as an antiseptic in powder or solution in many external inflammations and wounds, and in inflammations and aph- thous or diphtheritic ulcerations of the mouth and fauces, the acid or its salts are of undoubted value. In solution it has also been used to wash out abscess cavities and as an injection in gonorrhoea. As a disinfectant and deodorant in ophthalmic and aural practice it is very useful. Boric acid is recom- mended internally in cystitis depending on ammoniacal decomposition of the urine, and as an injection into the bladder in the cystitis of spinal diseases. Dose of the acid gr. v-x (0.3-0.6), t, i. d. ; of the saltgr. xx-3j (1.2-4.0). 250 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Glyceritum boroglycerini {glycerite of boroglycerin — glycerite of glyceryl borate — solution of boroglycerite) is made by dissolving 31 per cent, of boric acid in glycerin by means of heat, and is used as an external application for the disinfection of unhealthy ulcers or suppurating surfaces generally. It is a useful application to burns, and has been applied with advantage to inflamed mucous membranes, as the pharynx, nasal passages, or conjunctiva. ACIDUM CARBOLICUM— CARBOLIC ACID. What is carbolic acid ? Carbolic acid, phenol or pJienic acid is an oily liquid, or crystalline solid, which readily deliquesces, and is derived from coal-tar by fractional distillation. What are the tests for carbolic acid? The addition of ferric sulphate produces a lilac color ; bromine- water causes a yellowish precipitate ; it coagulates albumen, and precipitates nitro-cellulose from collodion. What are its physiological actions? Carbolic acid is a local anaesthetic and caustic (producing a white eschar) when used in concentrated solutions ; it is antiseptic and germicide. Internally, it is a powerful gastro-intestinal irritant when taken undiluted. In diluted solutions it is an astringent. It first stimulates and then exhausts the vagi (causing slowing, followed by acceleration of the heart's action, which is finally para- lyzed), reduces the arterial pressure by paralyzing the vasomotor centres of the cord, increases and then depresses the respiratory movements, from its influence on the vagi and respiratory centre, and in large doses lowers the temperature slightly. In poisonous doses it causes vertigo, tremors, contracted pupils, stupor, coma, impaired motion, sensation and reflex action, and in the lower ani- mals convulsions of spinal origin. It is eliminated chiefly by the kidneys and lungs, imparting a smoky color to the urine when the dose is excessive. This is a sign of impending danger. If poisoning occur from external applications, remove the dress- ings immediately ; if the acid has been swallowed, give a saturated ANTISEPTICS — THE SULPHOCARBOLATES. 251 solution of calcium carbonate. In either case administer atropine hypodermically, to counteract its respiratory and cardiac effects, and diluents freely, to aid its elimination. What are its medicinal uses ? Carbolic acid was used externally as an antiseptic dressing and lotion in the various surgical affections and operations to which the mercuric chloride is applicable. It has also been used as a local anaesthetic previous to minor surgical operations, as the opening of small abscesses and felons, and in dilute solution to allay pruritus. It has been injected into the cavities of chronic abscesses and of the tunica vaginalis, to cause obliteration of their sacs after the with- drawal of the contained fluid. Internally carbolic acid has been much used as a gastric sedative to check vomiting ; as an astringent in diarrhoea ; as an antifermen- tative; as a germicide in sarcina ventriculi ; and as an antizymotic in typhoid fever, smallpox, scarlatina, and diphtheria. It is also used by inhalation in nasal catarrh, hay fever, bronchorrhoea, per- tussis, and pulmonary gangrene. What are its preparations and doses ? Acidum Carbolicum {carbolic acid), dose gr. j-ij (0.06-0.13). Glyceritum Acidi Carbolici (glycerite of carbolic acid) contains 20 per cent, of the acid dissolved in glycerin. Dose tt\, ij-v (0.12- 0.3). Acidum Carbolicum Crudum (crude carbolic acid) may be used externally as a disinfectant. The ointment {unguentum acidi car- bolici) contains 5 per cent, of the acid. THE SULPHOCARBOLATES. What are the sulphocarbolates ? Sodii sulphocarbolas {sodium sulphocarbolate or sodium para- phenol sulphonate) — the only one which is official - is used inter- nally to fulfill the indications of carbolic acid, and as an antifermen- tative in flatulency from fermentation of the food. It is also used locally as a sedative application to inflamed mucous membranes. Dose gr. x-xv (0.6-1.0) t. i. d. 252 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. CREOSOTUM— CREOSOTE. What is creosote? Creosote is a substance closely resembling carbolic acid, derived from wood-tar by dry distillation. It may be distinguished from carbolic acid by not coagulating collodion. It resembles carbolic acid in its effects and uses, and a solution of the latter is generally sold for it in the shops. The dose of pure creosote is ^lj-iij (0.06- 0.18). Aqua creosoti {creosote water) is a 1 per cent, solution of creosote. ACIDUM BENZOICUM — BENZOIC ACID. What is benzoic acid ? Benzoic acid is obtained from benzoin by sublimation, and is an ingredient of many of the substances (the balsams) previously con- sidered. Locally it is an irritant, antiseptic aud germicide. Inter- nally it increases the secretions generally, and is eliminated chiefly by the urine increasing the acidity of that fluid, hence its value in the phosphatic diathesis. It has been used locally as an antiseptic in the treatment of wounds and ulcers, but is not much employed for these purposes at present. It is also used as a stimulant and anti- septic application in the treatment of chapped hands, fissured nip- ples, etc., but for this purpose the preparations of benzoin are preferred. Benzoic acid or its salts are of great value in the treat- ment of cystitis from alkaline urine, phosphatic deposits in the urine, etc. , for by acidulating the urine it renders the phosphates more soluble. They are also used internally as antiseptics in diphtheria, erysipelas, etc. Benzoic acid is added to unguents, to prevent ran- cidity. The dose is gr. v-xx (0.3-1.2) ; but for internal administra- tion the salts are generally preferred. Sodii benzoas [sodium benzoate) has been used as an antipyretic in rheumatism, and as an antiseptic in pertussis, diphtheria, and the exanthemata. Dose 3j-ij (4.0-8.0). Ammonii benzoas {ammonium benzoate) is the best remedy for incontinence due to vesical irritation from alkaline decomposition of the urine. Dose gr. v-xx (0.3-1.2). ANTISEPTICS— NAPHTOL. 253 NAPHTALINUM— NAPHTALIN. What is naphtalin ? Naphtalin, also called naphthalene ox naphthalin, is a hydrocarbon obtained from coal-tar, occurring in colorless, transparent plates, and having a strong, peculiar odor, and a burning, somewhat aromatic taste. It is soluble in alcohol, but insoluble in water. Naphtalin is antiseptic and antiparasitic. Locally it is mildly stimulant. When given internally in large doses or for a length of time it causes gastric irritation. Very little is absorbed when taken internally, the greater part being eliminated by the faeces and act- ing as an intestinal antiseptic. Some little, however, passes into the system and is eliminated by the kidneys and by the lungs. It is said that its continued administration to animals has resulted in cataract. It is chiefly used as an intestinal antiseptic in typhoid fever, diar- rhoeas, and dysentery. It is also used as an anthelmintic, given inter- nally for the removal of lumbrici, or used as an injection (gr. x-xx (0.6-4.2)) in sweet oil (f$iij (90.0)) to destroy the oxyuris. It has also been given in pyelitis, cystitis, etc. , for its antiseptic effect on the urine, and has been employed in the treatment of bronchorrhoea and fcetid bronchitis. As a local antiseptic it is not much used. It has been used as a dressing for wounds, ulcers, and chronic abscesses. Dose gr. ij-x (0.12-0.64), administered in capsules. NAPHTOL. What is naphtol ? Kaphtol, also called isonaphthol or bctanaphthol, is a hydrocarbon prepared from naphthalene. It occurs as a white or yellowish-white powder, or in crystalline plates, with a faint phenol-like odor and a pun- gent taste. It is freely soluble in alcohol, but only slightly so in water. In its action it resembles closely naphthalene. In animals large doses cause death by respiratory paralysis. No toxic symptoms have been reported in the human subject from its use. Its uses are similar to those of naphtalin. It is a good intestinal antiseptic, preventing fermentation and consequent flatulence, and is used in gastric or intestinal fermentation, in dilated stomach, and in diarrhoeas and dysentery. Dose gr. ij-v (0. 12-0.32) although much larger doses have been given without deleterious effect. It is usually administered in capsules, which may be keratin-coated when 254 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. used as an intestinal antiseptic. It is often advantageously com- bined with bismuth subnitrate and sodium bicarbonate. FORMALDEHYD. What is this substance? Formaldehyde or formic aldehyd (not official), is an aqueous solu- tion containing 40 per cent, of formalin or formal, obtained by oxidation of methyl alcohol. It forms a colorless solution having a pungent odor and taste. It has been much used as a deodorant and disinfectant and is said to be poisonous in a very moderate degree. Concentrated solutions applied to the skin arc said (R. H. Cun- ningham) to cause a peculiar necrosis, unaccompanied by signs of inflammation. The gas is liberated by heating the solution, and it is said that an atmosphere containing 2.5 per cent, of the gas is speedily fatal to all micro-organisms. It has been used to disinfect the surgeon's hands and instruments, in the preparation of aseptic catgut ligatures, and in dilute solu- tions (1 : 2000) in the treatment of gonorrhoea!, affections of the female. In the male it has sometimes effected a cure in acute gonorrhoea, more frequently when the disease was situated in the deeper parts of the urethra, Occasionally the irritation caused by its use was so great that the irrigation had to be discontinued. It has also been used in solutions of the same strength in acute con- junctivitis. Recently it has been recommended as a spray (1 per cent, solution, in the treatment of pertussis, and, used in the same manner, is strongly recommended in the treatment of hay asthma. The Antipyretics and Antiseptic Oils. Are these substances used as antiseptics ? The antipyretics {q. v.) have been sufficiently considered. The antiseptic properties of the volatile oils classed with the ''Carminatives" (q. v.) have been alluded to under that head. Those of importance not hitherto mentioned are : THYMOL. What is thymol? Thymol {cymylic phenol) is a crystalline substance found in the oil of thyme (oleum thymi) (q. v. ) . Locally it is a powerful antiseptic and ANTISEPTICS— THYMOL. 255 local anaesthetic. Given internally it lowers febrile temperature to some extent, and causes diaphoresis. In excessive amount it causes tinnitus aurium, deafness, diarrhoea, and sometimes delirium and col- lapse. It is used as an antiseptic gargle and mouth-wash in aph- thous and diphtheritic ulcers of the mouth and fauces, and internally as a gastric sedative to allay vomiting. As an anti-fermentative, in flatulency from fermentation of the food and in intestinal indigestion, \i is very useful. Dose gr. ss-ij (0.03-0.13). As much as gr. xx- xxx (1.2-2.0) have been given in 24 hours. It is administered in solution in glycerin, alcohol, and water. 256 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Class II. — Irritants. What are irritants ? Irritants are medicines which are used locally to produce counter- irritation or inflammation of the parts to which they are applied. They are divided, according to the violence of their action, into Rube- facients, Vesicants, Suppurants, and Escharotics or Caustics. ORDER I.— Rubefacients. What are rubefacients ? Rubefacients are medicines which are employed to produce a pow- erful but temporary irritation and congestion of the surface. They are useful in arousing the system in shock ; in stimulating the circu- lation of a part in case of frost-bite, or to aid in bringing on reaction in the cold stage of a congestive chill ; in all cases of congestion and in the formative stages of inflammations. The application of rube- facients for the relief of neuralgic and muscular pains is often fol- lowed by improvement which may even be permanent. Mention the principal rubefacients. Mustard ; capsicum ; oil of turpentine ; ammonia ; Burgundy pitch, and Canada pitch. SINAPIS ALBA — WHITE MUSTARD. SIN APIS NIGRA — BLACK MUSTARD. What is mustard ? Mustard is the seed of Brassica alba, or white mustard, and B. nigra, or black mustard {Nat. Orel. Cruciferas). What chemical principles do they contain? Mustard seed contains a fixed oil. Black mustard seed yield on distillation a volatile oil (allyl sulphocyanide) which does not preexist in the seed, but is formed by the action of water on sinigrin or potas- sium myronate. The white seed yield an acrid fixed principle which is formed by the action of water on sinalbin. These changes are probably due to the presence of myrosin, an albuminous ferment. IRRITANTS — BURGUNDY PITCH. 257 What are the effects and uses of mustard ? Locally, it is an irritant rapidly causing redness and a sensation of heat ; if the application is long continued, inflammation and even gan- grene may result. Internally it is a stomachic in small doses, an emetic in larger amounts, and a severe gastro-intestmal irritant if an excessive quantity be taken. Mustard is used as a rubefacient in the form of a mustard plaster (made of the powdered seed known as mustard flour), whenever a mild counter-irritant effect is desired. The mustard should not be allowed to come in contact with the skin, but should be separated from it by a piece of gauze or a fold of muslin or newspaper. When a prolonged but gentle effect is desirable, the mustard may be added to a flaxseed poultice or diluted with flour. Internally, mustard- flour is used as an emetic, and is especially valuable when torpor of the stomach is present. What are the preparations of mustard, and their doses ? The dose of powdered mustard as an emetic is 3j-iv (4.0-16.0). The official preparations are mustard-papers (charta sinapns), a convenient form for external use. Each square inch of paper con- tains about gr. vj of black mustard deprived of its oil. They should be dipped in warm water before applying. The volatile oil (oleum sinapis volatile) is very irritant, and is used in preparing the cam- pound liniment (linimentum sinapis composition). CAPSICUM. OIL OF TURPENTINE. AMMONIA. Are these substances used as rubefacients ? The uses of these substances as rubefacients will be found in detail under the respective drugs. Linimentum ammonia' {liniment of ammonia) contains 3.5 per cent, of ammonia water in cotton-seed oil and alcohol. PIX BURGUNDICA— BURGUNDY PITCH. What is Burgundy pitch? Burgundy pitch is the prepared resinous exudation from Abies excelsa, or Norway spruce [Nat. Ord. Conifers). It contains a resin and a volatile oil, and is a mild rubefacient, used in the form of plaster in subacute and chronic bronchitis, to the back in lumbago, and to the joints in chronic rheumatism, 17 258 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Pitch plaster with cantharides [emplastrum picis cum cantharide) is more stimulating than the plaster {emplastrum picis Burgundicce). Iron and opium plasters contain Burgundy pitch. ORDER II.— Vesicants. What are vesicants? Vesicants are remedies which, when applied to the skin, cause sufficient inflammation to produce an effusion of serum under the cuticle, or, in other words, to raise a blister. They are also called epispastics, or blisters. They are used in inflammations of the serous membranes, especially when accompanied by an outpouring of serum ; to deplete the vessels in inflammations of the brain and its mem- branes ; in chronic joint affections ; in neuritis, and for the relief of various neuralgic pains, and are sometimes used in inflammations of the parenchymatous viscera. They are contraindicated in the very young or very old, where there is great depression of the vital powers, or where there is very high arterial tension. Name the principal vesicants. Spanish fly, potato fly, and stronger water of ammonia. cantharis — cantharides. What is cantharides ? Cantharis vesicatoria or Spanish fly ( Class, Insecta; Order, Coleop- tera) is an insect found in the temperate parts of Europe, but especi- ally in Spain and Italy. When dried they contain a volatile oil and a neutral crystalline principle, cantharidin, the vesicating principle. What are its effects and uses ? Locally, cantharides is an intense irritant to any surface with which it comes in contact ; thus, applied to the skin it causes inflammation of sufficient intensity to result in a serous effusion under the cuticle, and if the application be too long continued, gangrene may result. Constitutional effect may be caused from the local application of cantharides. Internally, in small doses, it is diuretic ; in larger amounts it is an irritant, causing pain on urination, priapism, strangury, and even bloody urine. Sexual desire does not usually occur. In excessive doses it is a gastro -enteric irritant, -causing SUPPURANTS. 259 vomiting and purging, and even death, often preceded by dilated pupils, delirium, convulsions, and collapse. On post-mortem ex- amination severe inflammation of the alimentary canal, kidneys, and bladder is found. The treatment consists in removing the applica- tion, or evacuating the contents of the stomach ; the free use of diluents ; opium (especially by the rectum) ; and avoiding all oily substances, as these aid the absorption of the poison. What are its medicinal uses ? The internal uses of cantharides have previously been noticed {v. " Emmenagogues" and "Diuretics"). Externally it is used as a blistering agent, almost to the exclusion of other remedies. It must be remembered that poisoning may result from its local appli- cation. What are its preparations and their doses ? The cerate, (ceratum cantharidis) is used locally as a blistering agent, and is often known as blistering cerate. Cantharidal collo- dion (collodium cant ha ri datum) is applied with a brush, and is a convenient way of applying a blister to an irregular surface. The tincture (tinctura cantharidis) is used internally; dose gtt. v-x (0.3-0.6). CANTHARIS VITTATA— POTATO FLY. What is this substance ? The potato fly (not official) is an indigenous insect which contains cantharidin, and may be used as a substitute for the Spanish fly. AQUA AMMONUE FORTIOR — STRONGER WATER OF A3IMONIA. Is this ever used as a blistering agent? Stronger ammonia-water is a rapid but painful vesicant. It forms the basis of Granville 's vesicating lotion and of Gondret \s vesicating ointment, It is but little used for this purpose. ORDER III.— SUPPURANTS. What are suppnrants? Suppurants are remedies which cause such powerful irritation of the surface to which they are applied as to produce a crop of pus- 260 ESSENTIALS OP MATERIA MEDICA AND THERAPEUTICS. tules. They are seldom employed at present except as an appli- cation to the throat and chest in chronic laryngeal or bronchial affections, or to the surface of a joint when chronic inflammation is present. The only medicines belonging to this order are Croton oil and antimonial ointment. These remedies have been previously described. Antimonial ointment is the more painful and its effects are more lasting. It is no longer official. ORDER IV.— Escharotics. What are escharotics? Escharotics are medicines which are applied locally to destroy the structure and vitality of the tissues. The dead tissue excites inflam- mation, and is thrown off by ulcerative action. It is called the slough, or eschar. Escharotics are used to destroy morbid growths, as lupus, epithelium, condylomata, warts, fungous granulations, etc. ; to destroy the virus of malignant pustule, hospital gangrene, the bites of rabid animals or poisonous reptiles, the virus of chancre, etc. ; to substitute a healthy for diseased action, and to stimulate indolent ulcers, sinuses, etc. Mention the principal medicines used for these purposes ? Caustic potash ; caustic soda ; arsenious acid ; bromine ; zinc chloride ; acid nitrate of mercury ; corrosive sublimate ; potassium bichromate ; the mineral acids ; silver nitrate ; copper sulphate ; and burnt alum. POTASSA. What is potassa ? Potassa is formed by the rapid evaporation of the solution of po- tassa, and is moulded into thin cylindrical sticks. What are its effects and uses ? It is an exceedingly powerful caustic, destroying the surrounding tissues and penetrating to some depth below the surface. When it is used, it is well to protect the surrounding tissues from its action by adhesive plaster with a hole cut in its centre, through which the caustic is applied. It is used when a powerful effect is desired. Potassa cum Calce {potassa with lime) consists of equal parts of potassa and quicklime, and is a powerful caustic. It is sometimes called Vienna paste. ESCHAROTICS— ZINC CHLORIDE. 261 SODA. What is soda ? Caustic soda is made by the rapid evaporation of the solution of soda, and is a very powerful caustic, resembling potassa in its effects and uses. London paste is made by rubbing up equal parts of soda and lime. ACIDUM ARSENOSUM — ARSENOUS ACID. Is arsenous acid used as a caustic ? The uses of this substance as a caustic will be found under the arti- cle "Arsenic" (v. "Alteratives"). BROMUM — BROMINE. What is bromine ? Bromine is a halogen element, and is a very powerful caustic. It is a volatile liquid, and has very great affinity for hydrogen. Locally it is a powerful deodorant and disinfectant, and a severe and deeply penetrating caustic. When inhaled, it is an intense irritant, pro- ducing laryngitis, bronchitis and even pneumonia. Internally, if not sufficiently diluted, it is a corrosive poison. It is used as a caustic in hospital gangrene after the removal of the slough. As it is heavier than water it may be poured into a wide-mouthed bottle half filled with water, which will prevent it from giving off irritating fumes. From this it may be sucked up with a syringe and injected into the wound which it is desired to cauterize. The fumes are sometimes cautiously inhaled for the cure of acute coryza, chronic nasal catarrh, ozcena. hay asthma, etc. For purposes of inhalation a solution of 3ss (2.0) in jfjv (120.0) of alcohol may be used. ZINCI CHLORIDUM — ZINC CHLORIDE. LIQUOR HYDRARGYRI NITRATIS— SOLUTION OF MERCURIC NITRATE. HYDRARGYRI CHLORIDUM CORROSIVUM — MERCURIC CHLORIDE. Are these medicines escharotics ? The uses of these substances as caustics will be found under Zinc {v. ""Astringents ") and Mercury (v. "Alteratives"). 262 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. POTASSII BICHROMAS — POTASSIUM BICHROMATE. What is potassium bichromate ? It is an irritant internally, and in overdoses a corrosive poison. Externally it is a caustic, used to destroy syphilitic condylomata, warts, etc. Internally it is used as an alterative in doses of gr. \ (0.013) t. i. d. The Mineral Acids. Are the mineral acids used as caustics ? The mineral acids are powerful caustics, and are often employed to remove warts, or other excrescences, to cauterize chancres, indo- lent sinuses and ulcers. Nitric acid is preferred as an escharotic. Silver Nitrate, Copper Sulphate, and Alum have all been previously spoken of as caustics under their appropriate heads. DEMULCENTS. 263 Class III. — Demulcents. What are demulcents ? Demulcents are bland remedies which, when applied to inflamed or irritated surfaces, exert a soothing influence upon them and are employed internally for this purpose. They are used in acute inflam- mations of the alimentary canal ; in pharyngeal, laryngeal and bronchial irritation ; in renal, cystic, and urinary affections gener- ally ; and to suspend medicinal substances which are insoluble in water. They are also used as light articles of diet. Describe the demulcents. Aqua [icater) is used in medicine in its purest attainable state, i. e. , rain or melted snow. For pharmaceutical purposes it should only be used in the form of distilled water {aqua destiUata), A certain amount of water is necessary for the proper performance of the functions of the body. It is an active diuretic, increasing not only the watery, but also the solid ingredients of the urine. It is eliminated by the kidneys, skin, lungs and bowels. It is used as a diuretic in acute renal diseases, and is also often serviceable in chronic Bright' s disease. To dilute a highly concentrated urine in ardor urince, especially when there is a tendency to the formation of gravel or calculi, it is invaluable. It is useful in fevers, as it aids the elimination of the waste pro- ducts. ExternaEy, it is used in the form of baths, either hot v?r cold, not only for purposes of cleanliness, but also as a therapeutic agent. Impregnated with carbonic acid gas under pressure, it makes an agreeable drink known as soda-water, which is often useful in allaying nausea and vomiting. Acacia, or gum arabic, is a gummy exudation from Acacia Sen- egal (Nat. Ord. Leguminosre), a tree of Africa. It contains arable acid, and is much used in solution as a demulcent in various forms of sore throat. It is also used in making emulsions and pills. Its preparations are: a, mucilage {mucdago acacice) and & syrup (syrupus acacice). Emulsion of almonds (emulsum amygdala-) is an agreeable form for administration. 264 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Tragacantha (tragacanth) is a gwrnmy exudation from Astra- galus gummifer and other species of Astragalus {Nat. Ord. Legu- minosse}j and contains arabin and tragacanthin. It is only used internally as an agent to suspend heavy powders or to give consist- ence to lozenges. A mucilage (mucilago tragacanthce) is official. Ulmus (elm) is the inner bark of the Ulmus fulva, or slippery elm (Nat. Ord, Urticaceae), and contains a large amount of muci- laginous matter, and though more often used externally as an emol- lient poultice, is sometimes employed as a demulcent in inflamma- tions of the bowels, and in laryngitis. A mucilage (mucilago ulmi) is official. Althaea, the root of A. officinalis, or marsh- mallow (Nat. Ord. Malvaceae), is a pleasant demulcent. A syrup (syrupus althaxe) is official. Linum (flaxseed) is the seed of Linum usitatissimum, or flax ( Nat. Ord. Lineae), and contains flxcd oil, mucilaginous matters, vegetable albumen, etc. The oil (oleum lini) is a laxative, but is chiefly used externally in emollient liniments. The seed may be used internally as an infusion, flavored with lemon and sugar (flaxseed tea), in bronchial catarrhs, enteric inflammations, dysentery, and renal, ves- ical, or urethral irritations. The ground seed are much used to make emollient poultices. Sassafras Medulla {sassafras pith) is the pith of the stems of S. variifolium {Nat. Ord, Laurineas). The mucilage (mucilago sas- safras medulla) may be used internally as a demulcent, but is chiefly employed locally in inflammations of the eye. Glycyrrhiza, commonly called liquorice-root, is the root of Gr. glabra (Nat. Ord. Leguminosae). It contains a glucoside (glyeyrrhi- zin), asparagin, resin, etc. It is chiefly used as a demulcent in catarrhal affections of the respiratory organs and to disguise the taste of quinine, of the ammonium salts, and of other disagreeable medicines ; occasionally, also, in kidney and bowel complaints. The preparations are an extract (extractum glycyrrliizai), often called liquorice ; refined extract (extractum glycyrrliizce purum) ; fluid ex- tract (extractum glycyrrliizaz fluidum), used as an addendum to DEMULCENTS. 265 cough medicines ; ammonia ted glycyrrhizin (glycyrrhizinum ammo- niatum) dose gr. v-x (0.3-0.6); compound glycyrrhiza mixture, brown mixture {mistura glycyrrhizoi composita) contains the refined extract, mucilage of acacia, syrup, paregoric (12 per cent.), anti- monial wine (6 per cent, ), sweet spirits of nitre and water ; dose f^ss (15.0). Compound liquorice powders (containing sulphur and senna, — used as a laxative), have been previously mentioned. Cetraria. — Cetraria islandica, or Iceland moss {Nat. Ord. Lichenes), is a lichen growing in the northern portions of both continents. It contains lichenin and a bitter principle, cetrarin, and is used as a demulcent. A decoction (decoctrum cetrarice) is official. Chondrus. — Chondrus crispus, Irish Moss, or Carrageen {Nat. Ord. Algae), is a marine plant found on the coast of Ireland and New England. It contains carragecnin, etc., and is used as a nutri- tive (in the form of a blance-mange), as a demulcent, and locally as an emollient poultice. Amylum (starch). — This is the fecula of the seed of Zea mays [Nat. Ord. Grarninaceae). With iodine its solution forms a rich blue iodide. It is converted into glucose in the alimentary canal, and thus absorbed. It is used as an article of diet and locally as a dusting powder. Its solution is employed as a vehicle for laudanum enemata. Glyceritum amyli {glycerite of starch or plasmine) is used as a vehicle for astringent applications to the eye, and as an unguent in scarlatina aud smallpox. Lycopodium, the sporules of L. clavatum, or club-moss and other species of lycopodium {Nat. Ord. Lyeopodiaceae), is used as a dusting powder for intertrigo, and is very useful in children with excoriated nates. Ichthyocolla (isinglass) is prepared from the swimming bladder of Acipenser Huso (the sturgeon) and other species. ( Class, Pisces ; Ord. Sturiones). It is the purest form of gelatine, and is chiefly used locally as a plaster {emplastrwm ichthyocolla — court-plaster). Gelatine is also used as an article of diet, and in the form of capsules for administering other medicines. ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Class IV.— Emollients. What are emollients ? Emollients are bland, fatty substances used externally to soften the skin and render it more pliable or to serve as a vehicle for other medicaments. Describe the emollients. Adeps (lard), the prepared internal fat of the abdomen of Sus Scrofa (the hog), consists of olein and stearine, and is used in the preparation of unguents. Ointment (unguentum) consists of lard (80 per cent. ) melted with yellow wax. Cerate (ceratum) contains 70 per cent, of lard and 30 per cent, of white wax. Adeps (benzoin- ated lard) contains 2 per cent, of benzoin to prevent rancidity. Adeps Lan^ Hydrosus (hydrous wool-fat — lanolin) is the puri- fied fat of the wool of sheep (Ovis Aries) mixed with not more than 30 per cent, of water. Sevum (suet), the internal fat of the abdomen of Ovis Aries (the sheep), consists, when purified, almost entirely of stearine. Cetaceum (spermaceti), a peculiar, concrete, fatty substance obtained from Physeter macrocephalus or sperm-whale. A cerate (ceratum cetacei) is official, and it also enters into the preparation of cold cream. Cera Flava (yellow) and Cera Alba (ivhite wax). The former is a peculiar, concrete substance, prepared by Apis mellifica, or honey bee. The latter is the former which has been bleached. They are used in making cerates, plasters, and ointments. Acidum Oleicum (oleic acid), used chiefly in preparing the ole- ates of mercury and veratrine. Glycerinum (glycerin) is the hydrate of glyoeril and exists in animal oils combined with fatty acids. Internally it is nutrient, demulcent, and, in large doses, laxative. Administered by the EMOLLIENTS. 267 bowel it is laxative even in small amounts, for which purpose the suppositories (suppositoria glycerini) are much used. Locally, it is much used as an emollient. Glyceritum Vitelli (glycerite of yolk of egg) is used in making emulsions. Glycerite of starch (v. ' ' Amylum ") is used externally. The gJycerites of carbolic acid, of tannic acid, of boroglycerin, and of Hydrastis are also official. Oleum Theobromatis (oil of theobroma) or cacao-butter, is the fixed oil expressed from the seed of Theobroma Cacao (Nat, Ord. Sterculiacese), and is used as an unguent and to give form and con- sistence to suppositories. Oleum GrOSSYPii Seminis (cottonseed oil), a fixed oil expressed from the seed of Gossypium herbaceum (q. v.), is used as a substi- tute for almond or olive oil, and enters into the composition of numerous liniments. Oleum Sesami (oil of sesamum — oil of benne) is & fixed oil ex- pressed from the seed of Sesamum indicum (Nat. Ord. Pedaliacese). It is used for the same purposes as cottonseed oil. Petrolatum Molle (soft petrolatum) is a mixture of hydrocar- bons, chiefly of the marsh-gas series, obtained by distilling off the lighter and more volatile portions from petroleum and purifying the residue. It differs from Petrolatum Liquidum (liquid petrolatum) and from Petrolatum Spissum (hard petrolatum) chiefly in its consist- ence, in its melting-point, and in its specific gravity. The latter is of the consistence of cerate, and the former that of an oil, while soft petrolatum more nearly approaches that of an ointment. Under the names of vaseline and cosmoline, the heavier petroleum oils are much used externally as emollients and as a basis for oint- ments, and internally to allay irritation of the mucous membranes. Many of the "Demulcents'" also are employed in the form of poultices as emollients. 268 ESSENTIALS OF MATERIA MEDICA AND THERAPEUTICS. Class V.— Protectives. What are protectives? Protectives are substances used to exclude light or air from the surface to which they are applied, or otherwise to protect it from injurious influences. Many surgical appliances are thus "protect- ives, ' ' but do not belong to the domain of ' ' Materia Medica. ' ' The plasters and unguents, when simply used to protect the surface, come under this class. The following agents have not been pre- viously considered : Collodion, solution of gutta-percha and solution of sodium silicate. What are these substances ? Calcii Sulphas Exsiccatus (dried gypsum, dried calcium sul- phate or plaster of Paris) is a powder containing about 95 per cent., by weight, of calcium sulphate. It is used as a permanent dressing in the treatment of fractures, caries of the vertebrae, etc., where it is necessary to give continual support to the parts for some time. For this purpose it is moistened and thoroughly rubbed into successive layers of previously moist- ened roller bandage. It sets very rapidly, forming with the band- age a stiff, board-like support. Collodium {collodion) is a solution of pyroxylin or soluble gun- cotton (pyroxylinum) (4 per cent ), in stronger ether and alcohol. When applied to the skin, the solvents rapidly evaporate, leaving a colorless, transparent, flexible and strongly contractile film, closely adherent, difficult to detach, and impervious alike to air and water. It has been used in surgery as an antiphlogistic in inflammation, on account of its contractile power, and also applied on gauze, as a sub- stitute for adhesive plaster in the treatment of wounds. Its con- tractile power is an objection to its use as a simple protective, for which purpose it is better to employ flexible collodion (collodium flexile), which contains Canada turpentine (5 per cent.) and castor oil (3 per cent.), and is more pliable and elastic. Styptic collodion (collodium stypticum) contains, in addition to collodion, tannic acid (20 per cent.), ether (25 per cent.), and alcohol (5 per cent.). COLORING AGENTS. 269 Elastica {India rubber or caoutchouc) is the prepared milk-juice of various species of Hevea {Nat. Ord. Euphorbiaceae), known in commerce as Para Rubber. It is used in making plasters, bougies, etc., and has been used dissolved in commercial chloroform as a protective to small abrasions, chaps, threatened bedsores, etc. Liquor Sodii Silicatis {solution of sodium silicate), commonly called solution of soluble glass, is principally used in the treatment of fractures, applied on successive layers of roller bandage as a permanent dressing. Class VI.— Coloring Agents. What are coloring agents ? They are employed almost exclusively to give their particular coloi to tinctures, spirits and ointments, and are — Coccus {cochineal), the female dried insect. Coccus cacti, a native of Mexico and Central America, containing carminic acid, to which it owes its peculiar red color. It has been used also as an antispas- modic; dose gr. i (0.02), t. i. d. Crocus {saffron), the stigmas of Crocus sativus {Nat Ord. Irideae), contains safraniu. A tincture {tinctura croci) is official. Santalum Rubrum {red saunders), the ivood of Pterocarpus santalinus {Nat. Ord. Leguminosse), contains sandal, santalic acid, and pterocarpin , and is used to give a red color to pharmaceutical preparations. INDEX. Absinthium, 40 Acacia, 263 mucilage of, 263 syrup of, 263 Aceta, 22 Acetauilid, 80, 81 Acetanilidum, 80, 81 Acetic acid, 168 diluted, 168 glacial, 168 Acetpheuetidin, 81 Acetum opii, 91 scillae, 208 Acid nitrate of mercury, 63 Acids, 168, 169 Acidum aceticum, 168 dilutum, 168 glaciale, 168 arsenosum, 69, 261 benzoicum, 252 boricum, 219,250 carbolicum, 250, 251 citricum, 168, 169 gallicum, 230 hydrobromicum dilutum, 99 hydroehlorieum, 58 hydrocyanicum dilutum, 139, 111 lii'cticum, 59 nitricum, 57 nitrohvdrochloricum, 58 oleicum, 266 phosphoricum, 58 sulphuricum, 57 sulphiirosum, 248 tannicum, 229 tartaricum, 169 Aconine. 162 Aconite, 162-161, 218 preparations and doses of, 163, 164 Aconitine, 162-164 Aconitum, 162, 164 Adeps, 265 benzoinatus, 226 lanee hydrosus, 266 Administration of medicines, 32 Adonidin, 156, 157 iEther, 116-119, 149 fortior, U.S. P. 1880, 119 preparations of, li'j Alcohol, 116-149 absolutum, 148 official preparations, 148, 149 Alcoholic extract of belladonna leaves, 110 Alkaloids, cinchona, 42, 46 Allium, 225 Allspice, 184 Allyl, sulphocyanide, 256 Almonds, preparations of, 142 Aloe purificata, 192 Aloes, 192 pills of asafcetida and, 128 Aloin, 192 Aloinum, 192 Alteratives, 59-77 Althea, 264 Alum, 181, 236, 262 A lumen, 181,236 Alumina sulphas, 236 Aluminum sulphate, 236 Amidophenacetin, 81, 82 Ammonia, 151, 242, 257 gas, 149 liniment, 257 stronger water of, 259 Ammoniac, 222, 226 Ammoniacum, 226 Ammoniated glycyrrhizin, 265 mercury, 63 tincture of guaiac, 75 Ammonii benzoas, 252 bromidum, 99 carbonas, 151 chloridum, 72, 73, 223 iodidum, 66 valerianas, 127 Ammonium, 149, 151 acetate, solution of, 219 benzoate, 252 carbonate, 151 chloride, 72, 73, 222, 223 iodide, 66 muriate, 223 valerianate, 127 Amulsum amygdalae, 142 Amvl nitris, 138, 151 nitrite, 138, 151 Amylum, 265, 267 Anaesthetics. 116, 123 Anemonic acid, 167 Anemonii, 167 Anise, 187 Anisum, 187 Anthemis, 39. 41 271 272 INDEX. Antifebrin, 80, 81 Antimonial ointment, 269 powder, 161 Antimonii et potassii tartras, 161, 181 oxidnm, 161 sulphidum, 162 sulphidum purificatum, 162 sulphuratum, 162 Antimonium, 159, 162 and potassium tartrate, 161, 181 Antimonious oxide, 161 sulphide, 162 Antimony, 159, 162 Antipyretics, 77, 89 Antipyrine, 78, 80, 116 Antispasmodics, 126, 130 Apiol, 177 Apocynnm, 210 Apomorphine, 222 hydrochlorate, 179, 180 Apothecaries' measure, 24 relation of, to metrical system, 25 weight, 23 relation of, to metrical system, 25 Approximate measurements, 26 Aqua, 262 ammonite, 151 fortior, 151, 259 amygdalse, 144 anisi, 187 aurantii florum fortior, 187 camphi/tte, 129 chloroformi, 121 cinnamomi, 184 creosoti, 252 destillata, 263 fceniculi, 187 hydrogenii dioxidi, 244, 245 menthse piperita?, 186 viridis, 186 pagliarii, 236 rosse, 232 Aquse, 21 Arbutin, 212 Argenti cyanidum, 141, 240 iodidum, 240 nitras, 240 dilutus, 240 fusus, 240 oxidum, 240 Argentum, 239, 240 Arnica, effects and uses of, 167 flowers, tincture of, 167 fluid extract of, 167 plaster of, 167 root, extract of, 167 tincture of, 167 Arnicin, 167 Aromatic bitters, 39-41 preparations and doses of, 41 elixir, 188 powder, 185 spirit of ammonia, 151 sulphuric acid, 57 Arsenic, 67-70 Arsenic iodide, 69 preparations and doses of, 69 symptoms and treatment of poison- ing by, 68, 69 Arseni iodidum, 69 Arsenous acid, 69, 261 Arsenum, 69-70 Asafoetida, 127, 128 emulsion of, 128 pills of, 128 pills of aloes, etc., 128 preparations and doses of, 128 tincture of, 128 Asclepias, 222, 224 fluid extract of, 224 Aspidium, 200 Aspidosperma, 224 fluid extract of, 224 Atropinse, 152 Atropine, 107-110, 152, 220 sulphas, 110 treatment of poisoning by, 108, 109 Aurantii amari cortex, 187 dulcis cortex, 187 Auri et sodii chloridum, 64 Aurum, 64 Balsam of fir, 214 Peru, 227 tolu, 222, 227 Balsamum peruvianum, 227 tolutanum, 222, 227 Bark of cotton root, 173, 174 Basham's mixture, 50 Belladonna, 107, 110 liniment of, 110 ointment of, 110 plaster of, 110 root, fluid extract of, 110 tincture of, 110 treatment of poisoning by, 108, 109 Benne, oil of, 267 Benzoic acid, 226, 252 Benzoin, 222, 226 compound tincture of, 226 tincture of, 226 Benzoinated lard, 226, 266 Benzoinum, 226 Berberine, 37, 39, 46 Beta-naphtol, 243 Bismuth, 240, 244 and ammonium citrate, 241 subcarbonate, 241 subnitrate, 241 Bismuthi et ammonii citras, 241 subcarbonas, 241 sub nitras, 241 Bismuthum, 240, 241 Bitter almond, water of, 141 essence of, 142 spirits of, 141, 142 tonics, 37 wine of iron, 51 Bitters, 37-39 aromatic, 39-41 INDEX. 273 Bitters, peculiar, 42-47 simple, 37-39 Black draft, 193 drop, 94 Blaud's pills, 49 Blue gum tree, 39 mass, 61, 62, 193 ointment, 62 stone, 237 vitriol, 237 Borax, 249, 250 Boric acid, 249, 250 Brandy, 148 Brayera, 201 Bromide of ammonium, 99 calcium, 99 potassium, 99 sodium, 99 strontium, 99 zinc, 99 Bromides, 98, 99, 136 Bromine, 246 Bromoform, 123 Bromum, 246 Brown mixture, 265 Brucine, 131 Bryonia, 196 Brvony, 196 Buchu, 211 fluid extract of, 211 Burdock, 77 Burgundy, 257 nn Burnett's disinfecting fluid, 238 Butyl chloral hydrate, 97 Caffeina, 155, 156 citrata, 156 effervescens, 156 Caffeine, 155, 156, 208 administration of, 156 citrated, 156 effervescent, 156 Cajuput, oil of, 185 Calamus, 185 fluid extract of, 185 Calcii hromidum, 99 carbonas praecipitatus, 243 chloridum, 72 hypophosphis, 72 phosphas pnecipitatus, 72 sulphas exsicoatus, 268 Calcined magnesia, 194 Calcium. 243 chloride, 72 hypophosphite, 72 phosphate, 71, 72 sulphate, dried,. 268 Calendula, 76 tincture of, 76 Calomel, 62, 139, 211 Calumba, 37, 38, 39 Calumbo, 38, §9 Calx chlorata, 246 sulphurata, 249 Camhogia, 197 18 Campeachy wood, 232 Camphor, 128, 129 cerate, 129 liniment, 129 monobromated, 129 preparations and uses of, 129 spirit of, 129 Avater of, 129 Camphora, 128, 129 monobromata, 129 Camphorated tincture of opium, 94 Canada balsam, 214 Canadensis, 46 Cannabis Indica, 104, 105 extract of, 105 fluid extract of, 105 tincture of, 105 Cantharidal collodion, 259 Cantharides, 177, 217, 258, 259 tincture of, 217, 259 Cantharis, 217, 258, 259 vesicatoria, 258 vittata, 259 Caoutchouc 269 Capsicum, 183, 257 fluid extract of, 183 oleoresin of, 183 plaster of, 183 tincture of, 183 Capsules, 23 Caraway, 187 Carbolic acid, 250, 251 crude, 251 glycerite of, 251 ointment of, 251 Cardamom, 185 compound tincture of, 185 tincture of, 185 Cardamomum, 185 Carica papaya, 35 Carrageen, 265 Carron oil, 243 Carum, 187 Caryophyllus, 184 Cascara saerrada, 189 Cascarilla, 39 Cassia cinnamon, 183, 184 fistula, 189 Castanse, 233 fluid extract of, 233 Castor oil, 189, 190, 191 Catechu, 231 compound tincture of, 231 troches of, 231 Caustic soda, 242, 261 Celandine, 197 Centimeter, 24 Cera alba, 266 Cera flava, 266 Cerata, 21 Cerates, 20, 21 Ceratum camphorse, 129 cantharidis, 259 cetacei, 266 plumbi subacetatis, 235 274 INDEX. <1 Cerii oxalas, 241 Cerium oxalate, 241 Cetaceum, 266 Cetraria, 26-3 islandica, 265 Chalk, 243 compound powder, 243 mixture, 213 prepared, 243 troches of, 243 Chamomile, 39 German, 3D Charta potassii nitratis, 205 Charta sinapis, 257 Chartae, 20 Chelidonium, 197 Chenopodium. 200 oil of, 200 Chian turpentine, 214 Chimaphila, 212 fluid extract of, 212 Chinoline, 89 Chirata, 37, 39 Chiratee, 39 Chittem bark, 189 Chloral, 95-97, 136 treatment of poisoning by, 96 Chloralamide, 97 Chloralose, 97, 98 Chlorinated lime, 246 soda, solution of, 247 Chlorine-water, 245, 246 Chloroform, 119-121 emulsion of, 121 liniment of, 121 preparations of, 121 spirit of, 121 water, 121 Chloroformum, 119-121. Choline, 106 Chondrus, 265 Cimicifuga, 158, 159 extract of, 159 fluid extract of, 158 tincture of, 159 Cinchona, 42-46 administration of, 46 alkaloids, 42-46 calisaya, 42 chemical constituents of, 427 condaminea, 42 infusion of, 45 micrantha, 42 pallida, 42 succirubra, 42 Cinchonicine, 43 Cinchonidinse sulphas, 45 Cinchonidine, 42 sulphate, 45 Cinchonse sulphas, 45 Cinchonine, 42 sulphate, 45 Cinnamomum cassia, 183, 184 saigonicum, 183 zeylanicum, 184 Cinnamon, 183, 184 oil of, 184 spirit of, 184 tincture of, 184 water of, 181 Citric acid, 168, 169 syrup of, 169 Citrine ointment, 63 Classification of medicines, 33 Cloves, 184 oil of, 184 Coca, 113-115 preparations and doses of, 115 Cocaine hydrochloras, 115 Cocaine, 114, 124, 125 hydrochlorate, 115 treatment of poisoning by, 114, 115 Coccus, 269 Cochineal, 269 Codeine, 95 Cod-liver oil, 70, 71 dose and administration, 71 Colchicia, 73 Colchicine, 73, 74 Colchicum, 74 fluid extract of; 74 preparations and doses of, 74 root, extract of, 74 fluid extract of, 71 Cold cream, 232 Collodion, flexible, 268 styptic, 268 Collodium cantharidatum, 259 flexile, 268 stvpticum, 268 Colocynth, 197 Colocynthis, 197 Compound cathartic pills, 198 decoction of sarsaparilla, 75 effervescing powder, 195 fluid extract of sarsaparilla, 75 glycyrrhiza mixture, 265 liquorice powders, 265 pills of antimony, 162 powder of morphine, 94 solution of iodine, 66 syrup of sarsaparilla, 75 squill, 161 Confectio rosse, 232 sennpe, 193 Confectiones, 20 Confections. 20 Conium, 143-144 extract of, 143 fluid extract of, 144 preparations and doses of, 143, 144 Conserves, 20 Convallamarin, 159 Convallaria, 159 fluid extract of, 159 Convallarin, 159 Conydrine, 143 Copaiba, 216 massa, 216 oil of, 216 INDEX. 275 >er, 237 sulphas, 181 sulphate, 237, 262 Copperas, 49 Coriander, 187 Coriandrum, 187 Cornutin, 171 Corrosive sublimate, 60, 61, 211 treatment of poisoning by, 61 Cotton bark, 174 fluid extract of, 174 root, 173, 174 Cottonseed oil, 267 Court-plaster 265 Cowling's rule for dose in children, 31 Coxe's hive-syrup, 161, 208 Cream of tartar, 195, 205 Cremor tartari, 195 Creosote, 252 water, 252 Creosotum, 252 Cretan pra?parata, 243 Crocus, 269 tincture of, 269 Croton chloral hydrate, 97 eluteria, 39 oil, 198, 260 Cubeb, 216 Cubeba, 216 fluid extract of, 217 oil of, 217 oleoresin of, 217 tincture of, 217 troches of, 217 Cubebin, 216 acid, 216 Cupri sulphas, 181, 237 Cuprum, 237 Curare, 144 Curarine, 144 Cusso, 201 Cyan ids, 141 Cvpripedium, 130 "fluid extract, 130 Daturine, 111 Decimal system, 24, 25 relation to apothecaries' weight and . measure, 25, 26 weights and measures, 24,25 Decoeta, 22 Decoctions, 20, 22 Decoctum cetraria?, 265 sarsaparilla? compositum, 75 Definitions, 18-23 Depresso-motors, 134, 145 Diachvlon ointment, 235 Digallic acid, 229 Digestants, 35, 37 Digitalein, 152 Digitalin, 152 Digitalis, 152-154, 208 extract of, 154 fluid extract of, 154 infusion of, 154 Digitalis, preparations of, 154 tincture of, 154 Digitalosmin, 152 Digitin, 152 Digitonin, 152 Digitoxin, 152 Diluted hydrobromic acid, 99 hvdrocvanic acid, 139-141 Diohal, 100 Dispensatory, 19 Donovan's solution, 69 Dosage, 29-32 Dover's powder, 94, 218 Dried gypsum, 268 Duboisia, 113 Duboisine, 113 Dulcamara, 77 fluid extract of, 77 Effervescent magnesium citrate, 194 Effervescing draught, 204 Elastica, 269 Elaterin, 198 Elaterinum, 198 Elixir aromaticum, 188 phosphorii, 55 phosphorus, 55 vitriol, 57 Ellis' magnesia, 194 Elm, 264 Emetine, 178 Emplastra, 21 Emplastrum, ammoniaci cum hydrar- gyri, 62, 226 arnica?, 167 belladonna?, 110 capsici, 183 ferri, 49 hydrargvri, 62 ichthyocollse, 265 opii, 94 picis cum cantharide, 258 burgundicse, 258 plumbi, 235 saponis, 235 Emulsa, 23 Emulsion of almonds, 263 Emulsions, 23 Emulsum, ammoniaci, 226 amygdalae, 263 asa'feetida, 128 chloroformi, 121 Enemata, 23, 199 Epsom salt, 194 Ergot, 170, 173 extract of, 172 fluid extract of, 173 preparations and doses of, 172, 173 wine of, 173 Ergota, 170, 173 Eriodictvon. 222, 22.") fluid extract of, 225 Erythema. 44 Erythroxylon, 113 fluid extract of, 115 276 INDEX. Ether, 116-119, 130 compound spirit of, 130 preparations of, 119 spirit of, 119 Ethereal oil, 130 Ethyl bromide, 122, 123 chloride, 124 hydrate, 146 nitrite, 219 oxide, 116-119 Eucaine, 125 Eucalyptol, 41 Eucalyptus, 39, 41, 222, 228 fluid extract of, 41 Euonymus, 193 Eupatorium, 39 fluid extract of, 41 Excito-motors, 130-134 Extracta, 20 fluida, 22 Extracts, 20 fluid, 20-22 Extractum aconiti, 163 fluidum, 163 aloes, 192 apocyni fluidum, 210 arnicae radicis, 167 fluidum, 167 aromaticum fluidum, 185 asclepiadis fluidum, 224 aspidospermatis fluidum, 224 aurantii amari fluidum, 188 dulcis fluidum, 188 belladonna; foliorum alcoholicum, 110 radicis fluidum, 110 buchu fluidum, 211 calami fluidum, 185 cannabis indicae, 105 fluidum, 105 capsici fluidum, 183 castame fluidum, 233 chimaphihe fluidum, 212 cimicifugae, 159 fluidum, 158 cinchonas, 45 fluidum, 45 coca? fluidum, 115 colchici radicis, 74 fluidum, 74 seminis fluidum, 74 colocynthidis, 197 compositum, 197 conii, 143 fluidum, 144 convallarise fluidum, 159 cubebae fluidum, 217 cusso fluidum, 201 cypripedii fluidum, 130 digitalis, 154 fluidum, 154 dulcamara; fluidum, 77 crgotae, 173 fluidum, 174 eriodicyti fluidum, 225 Extractum eucalypti fluidum, 41 euonymi, 193 eupatorii fluidum, 41 frangulse fluidum, 189 gelsemii fluidum, 139 geranii fluidum, 232 glycyrrhizse, 264 fluidum, 264 purum, 264 gossypii radicis fluidum, 174 grindeliae fluidum, 222 guaranae fluidum, 156 haematoxyli, 232 hamemelidis fluidum, 232 hydrastis fluidum, 47 hyoscyami, 112 fluidum, 112 ipecacuanhas fluidum, 179 iridis, 197 fluidum, 197 jalapae, 196 juglandis, 192 krameriae, 231 fluidum, 231 lappae fluidum, 77 leptandrae, 193 fluidum, 193 lobelia; fluidum, 142 lupulini fluidum, 106 matico, 217 menispermi fluidum, 76 mezerei fluidum, 76 nucis vomicae, 133 fluidum, 133 opii, 93 pareirse fluidum, 212 physostigmatis, 136 pilocarpi fluidum, 221 podophylli, 196 fluidum, 196 pruni virginianae fluidum, 41 rhamni purshiana fluidum, 189 rhei, 191 fluidum, 191 rhois glabrae fluidum, 233 rosae fluidum, 232 sabinae fluidum, 176 sanguinariae fluidum, 225 sarsaparillae fluidum, 75 compositum, 75 scillae fluidum, 208 scoparii fluidum, 210 Scutellariae fluidum, 130 senegas fluidum, 224 sennae fluidum, 193 serpentarise fluidum, 41 spigelian fluidum, 200 stillingiae fluidum, 77 stramonii seminis, 111 fluidum, 111 taraxaci, 210 fluidum, 210 tritici fluidum, 212 uvae ursi, 212 fluidum, 212 INDEX. 277 Extractum Valerianae fluidum, 127 veratri viridis fluidum, 165 viburnum fluidum, 175 zere fluidum. 214 zingiberis fluidum, 185 Fennel, 186 Ferri carbonas saccharatus, 49 chlorklum, 50 citras, 50 et ammonii citras 51 sulphas, 51 tartras, 51 potassii tartras, 51 quininae citras, 51 solubilis, 51 strychnine citras, 51 hypophosphis, 50 iodidum saccharatum, 50 lactas, 51 oxidum hydratum, 49 cum magnesia, 49 phosphas solubilis, 50 pyrophosphas, 50 sulphas, 49 exsiccatus, 49 granulatus, 49 valerianas, 51 Ferric ammonium sulphate, 51 chloride, 50 citrate, 50 hypophosphite, 50 valerianate, 51 Ferrous carbonate, mass of, 49 iodide, pills of, 50 lactate, 51 sulphate, 49 dried, 49 granulated, 49 Ferrum, 47-52 reductum, 49 Flaxseed, 264 tea, 264 Flower of sulphur, 190 Fluid extracts, 20, 22 Foeniculum, 187 Fomentations, 23 Formaldehyd, 254 Formalin, 2")} Formic aldehyd, 254 Formyl terchloride, 119 Fowler's solution, 69 Frangula, 189 Galla, 231 ointment of, 231 tincture of, 231 . Gallic acid, 230 Gallo-tannic acid, 229 Gamboge, 197 Gargles, 23 Garlic, 222, 225 Gaultheria, 186 oil of, 186 spirit of, 186 Gelatine, 265 Gelsemine, 138 Gelseminic acid, 138 Gelseminine, 138 Gelsemium, 138, 139, 166 fluid extract of, 139 preparations and doses of, 139 tincture of, 139 Gentian, 37, 38, 39 Gentiana, 37 Gentianse, 38 Gentisic acid, 37 Gentisin, 37 Geranium, 232 fluid extract of, 232 Ginger, 184, 185 fluid extract of, 185 oleoresin of, 185 syrup of, 185 tincture of, 185 troches of, 185 Glauber's salt, 194, 195 Glycerin, 266, 267 Glycerinum, 266, 267 Glycerita, 22 Glycerite of boroglycerin, 250, 267 of carbolic acid, 267 glyceryl borate, 250 hydrastis, 267 starch, 267 or plasm ine, 265 tannic acid, 267 yolk of egg, 267 Glyce rites, 20, 22 Glyceritum acidi carbolici, 251 tannici, 230 amyli, 265 boroglycerini, 250 hydrastis, 47 vitelli, 267 Glycyrrhiza, 264 extract of, 264 fluid extract of, 264, 265 refined extract of, 264 troches of opium and, 94 Glycvrrhizinum ammoniatum, 265 Gold, 64 and sodium chloride, 64 preparations and doses of, 64 salts, 64 Golden seal, 46 Gossypii radicis cortex, 173, 174 Goulard's extract, 235 cerate, 235 Gramme, 24 Granatum, 200 Granules, 23 (rranville's vesicating lotion, 259 Gray powder, 62 Green vitriol, 49 Griffith's anti-hectic mixture, 49 Grindelia,2 22 fluid extract of, 222 Grondret's vesicating ointment, 259 Guaiac, 75, 177 278 INDEX. Guaiac acid, 75 beta-resin, 75 preparations and doses of, 75 resina, 75 wood, 75 yellow, 75 Guaiaci lignum, 75 Guaiacin, 75 Guaiacol, 86, 88, 126 carbonate, 86-88 Guaiaconic acid, 75 Guarana, 156 fluid extract of, 156 Gum arabic, 263 Gypsum, dried, 268 HiEMATOXYLON, 232 extract of, 232 Hamamelis, 232 fluid extract of, 232 Hedeoma, 186 Henry's magnesia, 194 Hoffmann's anodyne, 130 Homatropine hvdrobromate, 110 Honey, 20, 22 Hope's campbor mixture, 129 Horebound, 186 Humulus, 106 tincture of, 106 Husband's magnesia, 194 Hydrargyri chloridum corrosivum, 62, 63, 246, 261 mite, 62, 193, 201 cyanidum, 63 iodidum flavum, 63 rubrum, 63, 246 oxidum flavum, 62 rubrum, 62 subsulphas flavus, 63, 181 Hydrargyrum, 60-64 ammoniatum, 63 cum cretpe, 62 preparations and doses of, 61-63 Hydrastine, 46 Hydrastinime bydrocbloras, 47, 173 Hydrastinine bvdrochlorate, 47, 173 Hydrastis, 42, 46, 45, 173 fluid extract of, 47 glycerite of, 47 preparations and doses of, 47 tincture of, 47 Hydrate, 222 Hydrated ferric oxide, 49 witb magnesia, 49 Hydrochloric acid, 56, 58 diluted, 58 ether, 124 Hydrocyanic acid, 139, 141 Hydrogen dioxide, solution of, 244, 245 peroxide, 244, 245 Hydroquinone, 88, 89 Hydrous wool-fat, 266 Hyoscinee hydrobromas, 100 Hyoscine hydrobromate, 100 Hyoscyaminse hydrobromas, 113 Hyoscyaminfe sulphas, 112, 113 Hyoscyamine hydrobromate, 113 sulphate, 112, 113 Hyoscyam.ua, 111, 113 extract of, 112 fluid extract of, 112 preparations and doses of, 112, 113 tincture of, 112 Hypnotics, 90-106 Hypophosphites, 71, 72 preparations and doses of, 72 Iceland moss, 265 Ichtbyocolla, 265 Igasuric acid, 131 Igasurine, 131 Illicum, 187 India rubber, 269 Indian cannabis, 104, 105 preparations and doses, 105 Infusa, 22 Infusions, 20, 22 Infusum cinchonoe, 45 digitalis, 154 pruni virginianse, 41 sennse composituni, 193 Ingluvin, 35, 36 Inhalations, 23 Injections, 23 Iodides, 65-67 preparations and doses of, 66, 67 Iodine, 65-67, 246 ointment, 66 preparations and doses of, 66, 67 treatment of poisoning by, 65 Iodoform, 247. 248 ointment, 247 Iodoformum, 247, 248 Iodol, 248 Iodum, 65-67, 246 Ipecac, 178,218,222 fluid extract of, 179 powder of opium and, 90, 179 preparations and doses of, 179 syrup of, 179 tincture of opium and, 90, 179 troches of, 179 Ipecacuanha, 178, 179 preparations and doses of, 179 Ipecacuanhic acid, 179 Iris, 197 extract of, 197 fluid extract of, 197 Irish moss, 265 Iron, 47-52 and ammonium tartrate, 51 citrate, 51 potassium tartrate, 51 quinine citrate, 51 strychnine citrate, 51 carbonate, pills of, 49 compound mixture of, 49 plaster of, 49 preparations and doses of, 49-51 reduced, 49 INDEX. 279 Iron sulphate, 39 therapeutic uses of, 48, 49 troches of, 40 Esaconitine, 162 Isinglass, 265 Isonaphthol, 253 Jabokandine, 220 Jalap, 196 compound powder of, 196 extract of, 1% resin of, 196 Jala pa, 196 James' powder, 161 Jervine, 164 Juglans, 191 Juniper, 213 compound spirit of, 213 spirit of, 213 Juniperus, 213 Kaibine, so Kamala, 201 Kermes mineral, 162 Kim., 231 powder, 231 tincture of, 231 tannic acid, 229 Kousso, 201 Krameria. 231 extract of, 231 fluid extract of, 231 syrup of, 231 tincture of, 231 troches of, 231 Labarraque's solution, 246 Lac asafoeticl.se, 12^ Lactic acid.-") 1 .) preparations and doses of, 59 Lactucarium,106 syrup of, 106 tincture of, 106 Lady Webster's dinner pills, 192 Lanolin. 266 Lappa, 77 fluid extract of, 77 Lard. 266 Laudanum, 94 Lauder P>runton's rule for dose in chil- dren, 31 Lavender, compound tincture of, 186 flowers, oil of, 1st', spirit of, 186 Lead. 233, 236 carbonate, 235, 236 iodide, 235 nitrate. 235 ointment. 235 oxide. 235 preparations of. 235 subacetate, cerate of, 235 solution of. 235 diluted, 235 sugar of, 235 Ledoyen's disinfecting fluid, 235 Lemon, essence of, 169 juice of, 169 oil of, 169 spirit of, 169 Leptandra, 193 Lime liniment, 243 solution, 243 syrup of, 243 water, 243 Limonis succus, 169 Linimenta, 21 Liniments, 20, 21 Linimentum ammonias, 257 belladonnas, 110 calcis, 243 eamphorre. 129 chloroformi, 121 saponis, 129 sinapis compositum, 257 terebinthina;, 216 Linum, 264 Liquids, 19, 20 Liquor acidi arsenosi, 69 ammonii acetatis, 219 arseni et hydrargyri iodidi, 69 ferri acetatis, 50 chloridum, 50 citratis, 50 et ammonii acetatis, 50 nitratis, 50 subsulphatis, 50 tersulphatis, 50 hydrargyri nitratis, 63, 261 iodi compositus. 66 magnesii citratis, 194 plumbi subacetatis, 235 dilutus, 235 potassa?, 204 potassii arsenitis, 69 citratis, 204 soda?, 242 chloratae, 246 sodii arsenatis, 69 silicatis. 269 zinci chloridi, 239 Liquorice. 193, 264 compound powder of, 193 root, 264 Liquores, 21 Litharge, 235 Lithii benzoas, 206 carbonas, 206 citras, 206 effervescens, 206 Lithium. 206 benzoate, 206 bromide. 206 carbonate, 206 citrate, effervescent, 206 salicylate, 206 Lobelia. 112. 222 fluid extract of. 142 preparations and doses of, 142 tincture of, 142 280 INDEX. Lobelic acid, 142 Lobeline, 142 Local anaesthetics, 123-126 Logwood, 232 London paste, 2G1 Lotions, 23 Lozenges, 19, 20 Lugol's solution, GG, 67 Lupulin, 106 fluid extract of, 106 oleoresin of, 106 Lupulinum, 106 Lycopodium, 165 Mace, 184 Macis, 184 Magendie's solution, 94 Magnesia, 194 alba, 194 ponderosa, 194 Magnesii carbonas, 194 citras effervescens, 194 sulphas, 194 Magnesium carbonate, 194 citrate, effervescent, 194 solution of, 194 sulphate, 194 Manganese, 52, 53 dioxide, 53 preparations and doses of, 53 sulphate, 53, 195 Mangani dioxidum, 53 sulphas, 53, 195 Manganum, preparations and doses of, 52, 53 Manna, 189 Marrubium, 186 Massa eopaibae, 216 hydrargyri, 61, 62, 193 Materia raedica, 17 proper, 17 Matico, 217 fluid extract of, 217 tincture of, 217 Matricaria, 39, 41 Measure, wine, 24 Measurements, approximate, 26 Measures, 23, 26 Mellita, 22 Mel rosae, 232 Menispermum, 76 fluid extract of, 76 Mentha piperita, 186 viridis, 186 Menthol, 125, 126 Mercurial cathartics, 193 ointment, 62 oleate, 62 plaster, 62 Mercuric chloride, 62, 63, 246, 261 cyanide, 63 iodide, 63, 246 Mercurous chloride, 62, 193 iodide, 63 Mercury, 60-64 Mercury, mass of, 61, 62 metallic, 60 preparations and doses of, 61-63 with chalk, 62 Methenyl chloride, 119 Methvl-conine, 143 Methylene bichloride, 122, 123 Methylpyrocatechin, 86, 88 Metrical weights, 24, 25 Mezereon, 75, 76 fluid extract of, 76 Mezereum, 75, 76 Mineral acids, 55, 59 names of, 56 therapeutic uses of, 56 treatment of poisoning by, 56 tonics, 47, 59 Mistura cretse, 243 ferri composite, 49 glycyrrhizte compositse, 265 rhei et soda\ 191 Misturae, 21 Mixtures, 20, 21 Morphinn? acetas, 94 hydrochloras, 94 sulphas, 94 Morphine acetate, 94 hydrochlorate, 94 sulphate, 94 troches of ipecac and, 94 Moschus, 126, 127 Mucilago acacia?, 263 sassafras medullar, 264 tragacanthse, 264 ulmi, 264 Muriatic acid, 58 diluted, 58 Musk, 126, 127 preparations of, 127 tincture of, 127 Mustard, 180, 181 black, 256, 257 liniment, 257 papers, 257 volatile oil of, 257 white, 256, 257 Mydriatic anodynes, 107, 116 Myristica, 184 Naphtalin, 253 Naphtalinum, 253 Naphthalin, 253 Naphtol, 253 Neutral mixture, 204 Nicotianin, 144 Nicotine, 144 Nitre, 205 Nitric acid, 56, 57 diluted, 57 Nitrites, 136-138 preparations and doses of, 138 Nitrogen monoxide, 122 Nitroglycerin, 151 triturates of, 138 Nitrohydrochloric acid, 56-58 INDEX. 281 Nitrohydrochloric acid, aqua regia, diluted, 58 Nitromuriatic acid, aqua regia, 58 diluted, 58 Nitrous oxide, 122 Nutmeg, 184 oil of, 184 spirit of, 184 Nux vomica, 131-133 extract of, 133 fluid extract of, 133 preparations and doses of, 133 tincture of, 133 Official preparations, 19 Oil of bitter almond, 141 cade, 227 erigeron, 213 gaultheria, 84 neroli, 187 orange flowers, 187 santal, 213 sweet birch, 84 thyme, 186 turpentine, 188, 201, 215, 257 rectified, 210 vitriol, 57 wintergreen, 84 Ointment, 266 of ammoniated mercury, 63 of mercurial nitrate, 63 of potassium iodide, 66 of red mercuric oxide, 62 of vellow mercuric oxide, 62 Ointments, 20, 21 Oleata, 21 Oleate of zinc, 238 Oleates. 20, 21 Oleatum hydrargyri, 62 veratrinae, 166 zinci, 238 Oleic acid, 266 Oleoresina, aspidii, 200 cubebae, 217 lupulini, 106 piperis, 183 zingiberis, 185 Oleoresina?., 23 Oleoresins, 20, 23 Oleum athereum, 130 amygdalae amarae, 141 ani'si, 187 aurantii corticis, 187 riorum, 187 betula volatile, 84 cadinum, 227 cajuputi, 185 cari, 187 earyophylli, 184 chenopodii, 200 cinnamomi, 184 copaibae, 216 coriandri, 187 erigerontis, 213 fceniculi, 187 Oleum gaultheriae, 84, 186 gossypii seminis, 267 hedeoma, 186 juniperi, 213 lavendulae riorum, 186 limonis, 169 lini, 264 menthae piperita, 186 viridis, 186 morrhuae, 70, 71 myristicae, 184 phosphoratum, 55 picis liquidae, 227 ricini, 189 rosmarini, 186 sabinse, 176 santali, 213 sassafras, 76 sesami, 267 sinapis volatile, 257 terebinthinae, 201, 214, 215 rectificatum, 216 thvmi, 186, 254, 255 tiglii, 198 Opii emplastrum, 94 extractum, 93 pulvis, 93 Opium, 90, 95, 179 chemical ingredients, 91 deodoratum, 93 deodorized, 93 extract of, 93 pills, 93 plaster, 94 powdered, 93 powder of ipecac and, 90, 179 preparations and doses of, 93, 94 tincture of ipecac and, 90, 179 treatment of poisoning by, 92 Orange, bitter, 187 compound spirit of, 187 fluid extract of bitter, 187 oil of, 187 spirit of, 187 syrup of, 187 Orange flower, stronger water of, 187 syrup of, 187 triple water of, 187 Orange peel, sweet, 187 tincture of bitter and sweet, 188 Ovis aries, 266 Tale rose, 232 ointment of, 232 stronger water of, 232 Pancreatin, 35, 36, 37 Pancreatinum, 35, 36 Papain, 35, 36, 37 Papers, 19, 20 Paraldehydum, 100 Pareira, 211 fluid extract of, 212 Parillin, 74 Parvules, 23 Peculiar bitters, 42-47 282 INDEX. Pelletierine tannate, 200 Pennyroyal, 186 Pepo, 20 Pepper, 183 oleoresin of, 183 Peppermint, 186 troches of, 186 Pepsin, 35, 36 Pepsinum, 35, 36 saccharatum, 36 Peruvian balsam, 222 Petrolatum, liquid, 267 Petrolatum liquidum, 267 molle, 267 spissum, 267 Pharmocology, 17 Pharmacopoeia, 19 Pharmacy, 17 Phenacetin, 81 doses of, 81 Phenic acid, 250 Phenocoll, 81, 82 Phenol, 250 cymylic, 254, 255 Phosphates, 71, 72 preparations and doses of, 72 Phosphide, 72 Phosphite, 71 Phosphorated oil, 55 Phosphoric acid, 56, 58 diluted, 58 Phosphorus, - r >3, 55 - pills of, 55 preparations and doses of, 55 tincture of, 55 toxic effects of, 54 treatment of poisoning by, 54 uses of, 54 Physostigma, 135, 136 extract of, 136 preparations and doses of, 136 tincture of, 136 Physostigminse salicylas, 136 sulphas, 136 Physostigmine salicylate, 136 sulphate, 136 Picroconitine, 162 Picrotoxin, 134 Picrotoxinum, 134 Pills, 19, 20 Pilocarpidine, 220 Pilocarpine hydrochloras, 221 Pilocarpine, 222 hydrochlorate, 221 Pilocarpos, 220,221 fluid extract of, 221 preparations and doses of, 221 Pilule, 20 aloes, 192 et asafcetide, 128, 192 ferri, 192 mistaches, 192 myrrhe, 192 antimonii compositse, 162 asafcetide, 128 Pilule cathartice compositse, 198 vegitables, 198 ferri carbonatis, 49 iodidi, 50 opii, 93 phosphori, 55 rhei, 191 composite, 197 Pimenta, 184 oil of, 184 Piped n, 183 Piperinum, 183 Pitch plaster with cantharides, 258 Pix burgundica, 257 liquida, 227 Plaster of ammoniac with mercury, 6: of Paris, 268 Plasters, 20, 21 Pleurisy, 224 Plumbi acetas, 235 carbonas, 235, 236 iodidum, 235 nitras, 235 oxidum. 2! 5 Plumbum, 233, 236 Plummer's pills, 162 Podophyllotoxin, 196 Podophyllum, 196 Pomegranate, 200 Potassa, 'Jin, 260 cum calce, 260 solution of, 204, 242 sulphurata, 190, 191 with lime, 260 Potassii acetas, 204 bicarbonas, 204 bicbromas, 262 bitartras, 195, 205 bromidum, 99 chloras, 205 citras. 204 effervescens, 204 cyanidum, 141 et sodii tartras, 195 hypophosphis, 72 iodidum, 66 nitras, 205 pernianganas, 53, 245 sulphas, 195 Potassio-tartrate of iron, 51 Potassium acetate, 204 and sodium tartrate, 195 bicarbonate, 204 bichromate, 262 bitartrate, 195, 205 bromide, 99 carbonate, 204 chlorate, 205 citrate, 204, 219 effervescent, 204 solution of, 204 cyanide, 141 hypophosphite, 72 iodide, 66 myronate, 256 INDEX. 283 Potassium nitrate, 205 nitrite, 138 permanganate, 52, 53, 245 sulphate, 194 Potato fly, 259 Poultices, 23 Powder of ipecac and opium, 94 Powders, 19, 20 Precipitated calcium carbonate, 243 phosphate, 72 sulphur, 190 Preparations, official, 19 Prepared chalk, 243 Prescription-writing, 26, 29 Prunus virginiana, 39, 41, 228 fluid extract of, 41 infusion of, 41 syrup of, 41 Prussic acid, 139, 141 treatment of poisoning by, 140 Pseudoconhvdrine, 143 Pulsatilla, 167 Pulveris, 20 Pulvis antimonialis, 161 aromaticus, 185 cretse compositus, 243 effervescens compositus, 195 glycyrrhiza? compositus, 193 ipecacuanha? et opii, 94 jalapa? compositus. 196 morphinse compositus, 94 rhei compositus, 191 Pumpkin seed, 201 Pure bitters, 37 Purified antimonious sulphide, 161 Pyrocatechin, 88, 89 Quassia, 37,39 Quassia?, 38 Quebracho, 222 Quercus alba, 232 Quevenne's iron, 49 Quicksilver, 60 Quillaja, 222, 224 tincture of, 224 Quinieine, 43 Quinidinse sulphas, 45 Quinidine, 42_ sulphate, 45 Quinina?, 174 bisulphas, 45 hydrobromas, 45 hydrochloras, 45 sulphas, 45 valerianas, 45 Quinine, 42, 45, 82, 174 bisulphate, 45 hydrobromate, 45 hydrochlorate 45 sulphate, 45 valerianate, 45 Red r.vrk, 42 mercuric oxide, 62 pepper, 183 I Red precipitate ointment, 62 rose, 232 confection, 232 fluid extract of, 232 honey, 232 syrup, 232 saunders, 269 wine, 148, 149 Remedies, 18, 19 dietetic, 18 hygienic, 18, 19 mechanical, 18 pharmaceutical, 18, 19 physical, 18 Resin, 214, 215 Resina, 214, 215 ja lapse, 196 scammonii, 197 Resorcin, 88, 89 Resorcinum, 88, 89 Rhamnus purshiana, 180 Rheum, 191 Rhigolene, 124 Rhubarb, 191 aromatic tincture of, 191 syrup of, 191 compound pills of, 191 extract of, 191 fluid extract of, 191 mixture of soda and, 191 pills, 191 sweet, tincture of, 191 syrup of, 191 tincture of, 191 Rhus glabra, 232, 233 toxicodendron, 133 Rochelle salt, 195 Rosa centifolia, 232 gallica, 232 Rosemary, oil of, 186 Rose water, 232 Rufus pill, 192 SABINA, 176 Saccharated ferrous iodide, 50 pepsin. 36 Saffron, 269 Sage, 39 Saigon cinnamon, 183 Sal ammoniac, 223 Salicin, 82-86 preparations and doses of, 83, 84 Salic vlas. 84 lithii, 84 methyl, 84 sodii, 84 Salicylate, 84 lithium, 84 methyl, 84 phenyl, 84 physostigmine, 84 sodium, 84 Salicylates, 82-86 preparations and doses of, 83, 84 I Salicylic acid, 82, 84, 219 284 INDEX. Salicylic acid, preparations and doses of, 83, 84 Salicylicum, 83 acidum, 83, 84 Salol, 85 doses of, 85 Salophen, 85, 86 Saltpetre, 205 Salts of gold, 64 lead, 39 silver, 39 Salvia, 186 Sanguinaria, 222, 225 fluid extract of, 225 tincture of, 225 Sanguinarine, 225 Santalum rubrum, 269 Santonica, 200 Santonin, 200 troches of, 200 Santoninum, 200 Saponin, 224 Sarsaparilla, 74, 75 compound fluid extract of, 75 fluid extract of, 75 preparations and doses of, 75 Sassafras, 76 medulla, 264 oil of, 76 pith, 264 Savine, 176 fluid extract of, 176 oil of, 176 Scammonium, 197 Scammony, 197 Scilla, 207, 208 Scoparius, 210 Scutellaria, 130 fluid extract of, 130 Seidlitz powder, 195 Semi-solids, 19, 20 Senega, 222, 223 fluid extract of, 224 syrup of, 224 Senna, 193 compound infusion of, 193 powder of glycyrrhiza and, 193 confection of, 193 fluid extract of, 193 syrup of, 193 Serpentaria, 39, 41, 222, 228 fluid extract of, 41 tincture of, 41 Sesamum, oil of, 267 Sevum, 266 Silver, 239, 240 cyanide, 141, 240 iodide, 240 nitrate, 240, 262 diluted, 240 moulded, 240 oxide, 240 Simple bitters, 37-39 preparations and doses of, 38, 39 syrup, 22 Sinalbin, 256 Sinapis, 180, 181 alba, 256, 257 nigra, 256, 257 Sinigrin, 256 Sinilacin, 74 Soap liniment, 129 plaster, 235 Socotrine aloes, 192 Soda, 261 caustic, 242, 261 solution of, 242 Sodii acctas, 207, 208 arsenas, 69 bicarbonas, 242 benzoas, 252 bisulphis, 249 boras, 249, 250 bromidum, 99 carbonas, 242 exsiccatus, 242 hypophosphis, 72 hyposulphis, 249 iodidum, 66 nitris, 138 phosphas, 195 pyropbosphas, 195 sulphas, 194, 195 sulphis, 249 sulphocarbolas, 251 Sodio-theobromine salicylate, 208, 209 Sodium acetate, 207 arsenate, 69 benzoate, 252 bicarbonate, 242 troches of, 242 bisulphate, 249 carbonate, 242 hypophosphite, 72, 249 nitrite, 138 paraphenol sulphonate, 251 phosphate, 196 preparations of, 242 pyrophospbas, 195 silicate, solution of, 269 sulphate, 194, 195 sulphocarbolate, 251 Soft petrolatum, 267 Solidified copabia, 216 Solids, 19 Soluble ferric phosphate, 50 iron and quinine citrate, 51 pyrophosphate, 50 Solution of ammonium acetate. 219 of arsenic and mercuric iodide, 69 of arsenous acid, 69 of boroglycerite, 250 of ferric acetate, 50 chloride, 50 citrate, 50 nitrate, 50 subsulphate, 50 sulphate, 50 of iron and ammonium acetate, 50 of mercuric nitrate, 63, 261 INDEX. 285 Solution of potassium arsenite, of sodium arsenate, 69 silicate, 269 of zinc chloride, 239 Solutions, 20, 21 Spanish fly, 258 Sparteine sulphas, 157, 210 Sparteine sulphate, 157 Spearmint, 186 Spermaceti, 266 Sphacelinic acid, 171 Spigelia, 199 fluid extract of, 200 Spirit of glonoin, 138 of mindererus, 219 of nitroglycerin, 138 of nitrous ether, 210, 211, 219 of phosphorus, 55 Spirits, 20, 22 Spiritus, 22 etheris, 119, 130 compositus, 130 nitrosi, 210, 211, 219 ammoniee, 151 aromaticus, 151 amygdalae amarse, 141, 142 anisi, 187 aurantii, 187 compositus, 187 camphorse, 129 chloroformi, 121 cinnamomi, 184 frumenti, 148 gaultberiae, 186 glonoini, 138 juniperi, 213 compositus, 213 lavendulse, 186 limonis, 169 myristicse, 184 ptiosphori, 55 vini gallici, 148 Squill, 207, 222, 228 compound syrup of, 208 fluid extract of, 208 syrup of, 208 tincture of, 208 Star anise, 187 Starch, 265 Stillingia, 76, 77 fluid extract of, 77 Stramonium, 111 fluid extract of, 111 ointment of, 111 preparations of, 111 seed, extract of, 111 tincture of, 111 Strontii bromidum, 99 iodidum, 67 lactas, 207 Strontium iodide, 67 lactate, 207 Strophanthin, 157 Strophanthus, 157 tincture of, 157 Strychnine, 133 sulphas, 133 Strychnine, 131-133, 166 preparations and doses of, 133 sulphate, 133 treatment of poisoning by, 132 Sublimated sulphur, 190 Suet, 266 Sugar of lead, 235 Sulphides, 248,249 Sulphites, 248, 249 Sulphonal, 100, 102 Sulphur, flowers of, 190 iodide, 166 lotum, 190 ointment, 190 sublimatum, 190 washed, 190 Sulphurated antimony, 162 lime, 249 potassa, 190, 191, 249 Sulphuric acid, 56, 57 diluted, 58 Sulphuris iodidum, 66 Sulphurous acid, 248 Sumach, 232, 233 fluid extract, 233 Suppositoria, 21 glycerini, 267 Suppositories, 20, 21 Sweet spirit of nitre, 219 Swertia chirata, 37 Sydenham/s laudanum, 94 Syrupi, 22 Syrup of calcium lactophosphate, 72 of ferrous iodide, 50 of hypophosphites, 72 with iron, 72 of iron, quinine, and strychnine phosphate, 51 simple, 22 Syrups, 20, 22 Syrupus acacia?, 263 acidi citrici, 169 alii, 225 althaea?, 264 amygdala?, 142 aurantii, 187 florurn, 187 calcii lactophosphatis, 72 calcis, 243 ferri iodidi, 50 quinine, et strychninee phos- phatum, 50 hypophosphitum, 72 cum ferro, 72 ipecacuanha^, 179 krameriae, 231 lactucarii, 106 picis liquids, 227 primus virginianae, 41 rhei, 191 aromaticus, 191 rosae, 232 sarsaparillae compositus, 161, 208 28(5 INDEX. Syrupus senegas, 224 sennas, 198 tolutanus, 227 zingiberis, 18") Systemic medicines, 35, 244 Taba-cum, 144, 145 Tamarind, 189 Tamarindns, 189 Tanacetin, 176 Tanacetnm, 176 Tannic acid, 229 glyeerite of, 230 ointment of, 230 troches of, 230 Tansy, 176 Tar, 222, 227 oil of, 227 ointment of, 227 water, 227 Taraxacum, 210 extract of, 210 fluid extract of, 210 Tartarated antimony, 161 Tartar emetic, 161, 181,222 Tartaric acid, 169 Terebene, 222, 228 Terebenum, 228 Terebinthina, 214, 216 Canadensis, 214 Terpin, 222 hydrate, 228 Terpini hydras, 227 Test for cinchona alkaloids, 43 Tetronal, 103, 104 Tetterwort, 197 Thalline, 87 Theine, 155 Therapeutics, 17, 18 empirical, 18 rational, 18 Thorough wort, 39 Thymol, 186, 254, 255 Tirictura aconiti, 163 aloes, 192 et myrrhas, 192 arnicas radicis, 167 asafcetida, 128 belladonnas, 110 benzoini, 226 composita, 226 byronise, 196 calendulas, 76 cannabis indicas, 105 cantharidis, 217, 259 cardamomi, 185 composita, 185 catechu composita, 231 cimieifugas, 159 cinchonas, 45 composita, 45 cinnamomi, 184 colchici, 74 croci, 269 cubebas, 217 Tinctura capsici, 183 digitalis, 154 ferri chloridi, 50 gallas, 231 gelsemii, 139 guaiaci, 75 humuli, 106 hyoscyami, 112 iodi, 66 ipecacuanhas, 94 kino, 231 kramerias, 231 lactucarii, 106 lavendulas composita, 186 lobelias, 142 matico, 217 moschi, 127 nucis vomicas, 133 opii, 94 camphorata, 94 deodorata, 94 physostigmatis, 136 quillajas, 224 rhei, 191 aromaticus, 192 dulcis, 192 sanguinarias, 225 scillas, 208 serpentarias, 41 stramonii seminis, 111 strophanthi, 157 tolutani, 226 valerinas, 127 ammoniata, 127 vanillas, 188 veratri viridis, 165 zingiberis, 185 Tincturas, 22 Tincture of aconite, 126 of camphorated opium, 94 of colchicum,74 of deodorized opium, 94 of elaterine, 198 of ferric chloride, 50 of guaiac, 75 of iodine, 66 of ipecac and opium, 94 of opium, 94 Tinctures, 20, 22 Tobacco, 144, 145 camphor, 144 Tolu, balsam of, 227 syrup of, 227 tincture of, 227 Tonics, mineral, 47, 59 vegetable, 37-47 subdivision of, 37 Toxicology, 17 Tragacanth, 264 Tragacantha, 264 Trional, 102 Triticum, 212 fluid extract of, 212 Trituratio elaterine, 198 Triturationes, 20 INDEX. 28 1 Triturations, 19, 20 Troches, 20 Trochisci, 20 acidi tannici, 230 amnionii chloridi, 233 catechu, 231 cretae, 243 cubebse, 217 ferri, 49 glycyrrhizse et opii, 94 ipecacuanha?, 179 krameria?, 231 mentha? piperita?, 186 morphina? et ipecacuanha?, 94 potassii chloratis, 20G santonini, 200 sodii bicarbonatis, 242 zingiberis, 185 Tully's powder, 94 Turpentine, 214, 216, 222, 228 Bordeaux, 214 Canada, 214 Chian, 214 Venice, 214 Turpeth mineral, 63, 181 Tutty, 238 Ulmus, 264 Unguenta, 21 Unguents, 21 Unguentum, 266 acidi carbolici, 251 tannici, 230 aqua? rosa?, 232 belladonna?, 110 diachylon, 235 gallaV231 hydrargyri, 62 ammoniati, 63 nitratis, 63 oxidi flavi, 62 rubri, 62 iodi, 66 iodoformi, 248 picis liquida?, 227 plumbi carbonatis, 236 iodidi, 235 potassii iodidi, 66 straraonii, 111 sulphurus, 190 veratrina?, 166 zinci oxidi, 238 Unslaked lime, 243 Urethan, 104 Uva ursi, 212 Valerian, 127 ammoniated tincture of, 127 fluid extract of, 127 preparations and doses of, 127 tincture of, 127 Valeriana, 127 Vanilla, 188 Vanillin, 188 Vegetable cathartic pills, 198 Vegetable tonics, 37-47 Veratrine, 165, 166 ointment of, 166 oleate of, 166 uses and preparations of, 166 Veratroidine, 164 Veratrum viride, 164, 165, 218 fluid extract of, 165 preparations and doses of, 165 tincture of, 165 Viburnum, fluid extract of, 175 pruni folium, 175 Vienna paste, 260 Vina, 22 Vinegar of opium, 94 Vinegars, 20, 22 Vinum album, 148 antimonii, 161 colchici radicis, 74 ergota?, 173 ferri amarum, 51 citratis, 51 ipecacuanha?, 179 opii, 94 rubrum, 148, 149 seminis, 74 Viola tricolor, 189 Virginia snakeroot, 39 Veratrina, 165, 166 uses and preparations of, 166 Volatile oil of betula, 84 Wahoo, 193 Washed sulphur, 190 Washes, 23 Waters, 20, 21 Wax, white, 266 yellow, 266 Weight, apothecaries', 23 relation of, to metrical system, 25 Weights and measures, 23-26. decimal, 24 metrical, 24 Whiskey, 148 White arsenic, 69 lead, 232 oak, 232 precipitate 63 vitriol, 238 wine, 148 Wild cherry, 39 Wine measure, 24 relation of, to metrical system, 28 of antimony, 161 of colchicum root, 74 seed, 74 of iron citrate, 51 of opium, 94 Wines, 20, 22 Wintergreen, 186 Wisters' cough drops, 94 Witch hazel, 232 Woorali, 144 Woorara, 144 Wormwood, 40 288 INDEX. Yellow bark, 42 mercurial subsulphate, 61, 181 mercuric oxide, 62 root, 46 Young's rule for dose in children, 31 Zea, 214 fluid extract of, 214 Zinc acetate, 238 bromide, 99, 239 carbonate, precipitated, 238 chloride, 238, 261 iodide, 239 ointment, 238 Zinc oxide, 238 phosphide, 55, 239 sulphate, 181, 238 valerianate, 239 Zinci acetas, 238 bromidum, 99, 239 carbonas prsecipitatus, chloridum, 238, 2C1 iodidum, 239 phosphidum, 55, 239 sulphas, 181, 238 valerianas, 239 Zincum, 238, 239 Zingiber, 184, 185 STANDARD Medical and Surgical Works PUBLISHED BY W. B. SAUNDERS, 925 Walnut Street, Philadelphia, Pa. PAGE *American Text-Book of Applied Thera- peutics 4 *American Text-Book of Dis. of Children . 9 *An American Text-Book of Diseases of the Eye, Ear, Nose, and Throat 31 *An American Text-Book of Genito-Uri- nary and Skin Diseases 31 *American Text-Book of Gynecology ... 8 *American Text-Book of Obstetrics ... 5 *American Text-Book of Physiology ... 3 *American Text-Book of Practice .... 6 *American Text-Book of Surgery . . . 7 Anders' Theory and Practice of Medicine . 31 Ashton's Obstetrics 28 Atlas of Skin Diseases 12 Ball's Bacteriology 28 Bastin's Laboratory Exercises in Botany . 22 Beck's Surgical Asepsis 26 Boisliniere's Obstetric Accidents 23 Brockway's Physics 28 Burr's Nervous Diseases 26 Butler's Materia Medica and Therapeutics 29 Cerna's Notes on the Newer Remedies . . 18 Chapin's Compendium of Insanity . . . .31 Chapman's Medical Jurisprudence .... 26 Church and Peterson's Nervous and Men- tal Diseases 31 Clarkson's Histology 14 Cohen and Eshner's Diagnosis 28 Corwin's Diagnosis of the Thorax .... 29 Cragin's Gynaecology 28 Crookshank's Text-Book of Bacteriology . 13 DaCosta's Manual of Surgery 26 De Schweinitz's Diseases of the Eye ... 15 Dorland's Obstetrics 26 Frothingham's Bacteriological Guide ... 16 Garrigues' Diseases of Women 20 Gleason's Diseases of the Ear 28 *Gould and Pyle's Anomalies and Curi- osities of Medicine 30 Griffin's Materia Medica and Therapeutics 26 Griffith's Care of the Baby 24 Gross's Autobiography 10 Hampton's Nursing 23 Hare's Physiology 28 Hart's Diet in Sickness and in Health . . 22 Haynes' Manual of Anatomy 26 Heisler's Embryology 31 Hirst's Obstetrics 31 Hyde's Syphilis and Venereal Diseases . . 26 Jackson and Gleason's Diseases of the Eye, Nose, and Throat 28 Keating's Pronouncing Dictionary .... 10 Keating's Life Insurance 23 Keen's Operation Blanks 22 Keen's Surgery of Typhoid Fever . . . .31 Kyle's Diseases of Nose and Throat ... 26 Lame's Temperature Charts 18 PAGE .26 Lockwood's Practice of Medicine . Long's Syllabus of Gynecology 20 Macdonald's Surgical Diagnosis and Treat- ment 31 McFarland's Pathogenic Bacteria .... 16 Mallory and Wright's Pathological Tech- nique 31 Martin's Surgery 28 Martin's Minor Surgery, Bandaging, and Venereal Diseases 28 Meigs' Feeding in Early Infancy 16 Moore's Orthopedic Surgery 31 Morris' Materia Medica and Therapeutics 28 Morris' Practice of Medicine 28 Morten's Nurses' Dictionary 24 Nancrede's Anatomy and Dissection ... 17 Nancrede's Anatomy 28 Norris' Syllabus of Obstetrical Lectures . 21 Penrose's Gynecology 31 Powell's Diseases of Children 28 Pye's Bandaging and Surgical Dressing . 29 Raymond's Physiology 26 Rowland's Clinical Skiagraphy 14 Saundby's Renal and Urinary Diseases . . 29 *Saunders' American Year-Book of Medi- cine and Surgery 32 Saunders' Medical Hand-Atlases . . .33, 34 Saunders' Pocket Medical Formulary . . 19 Saunders' Pocket Medical Lexicon .... 32 Saunders' New Series of Manuals . . . 25, 26 Saunders' Series of Question Compends 27, 28 Sayre's Practice of Pharmacy 28 Semple's Pathology and Morbid Anatomy 28 Semple's Legal Medicine, Toxicology, and Hygiene 28 Senn's Genito-Urinary Tuberculosis . . .31 Senn's Tumors 11 Senn's Syllabus of Lectures on Surgery . . 21 Shaw's Nervous Diseases and Insanity . . 28 Starr's Diet-Lists for Children 24 Stelwagon's Diseases of the Skin 28 Stengel's Manual of Pathology 26 Stevens' Materia Medica and Therapeutics 18 Stevens' Practice of Medicine 17 Stewart's Manual of Physiology 21 Stewart and Lawrance's Medical Elec- tricity 28 Stoney's Practical Points in Nursing ... 13 Sutton and Giles' Diseases of Women . . 26 Thomas's Diet-List and Sick-Koom Dietary24 Thornton's Dose-Book and Manual of Pre- scription-Writing 26 Van Valzah and Nisbet's Diseases of the Stomach 31 Vierordt and Stuart's Medical Diagnosis . 12 Warren's Surgical Pathology 11 Wolff's Chemistry 28 Wolff's Examination of Urine 28 The works indicated thus (*) are sold by subscription {not l>y booksellers), usually through travelling solicitors, but they can be obtained direct from the office of publication (charges of shipment prepaid) by remitting the quoted prices. Full descriptive circulars of such works will be sent to any address upon application. All the other books advertised in this catalogue are commonly for sale by booksellers in all parts of the United States; but any book will be sent by the publisher to any address (post-paid) on receipt of the price herein given. * GENERAL INFORMATION. One Price. One price absolutely without deviation. No discounts allowed, regardless of the number of books purchased at one time. Prices on all works have been fixed extremely low, with the view to selling them strictly net and for cash. Orders. An order accompanied by remittance will receive prompt attention, books being sent to any address in the United States, by mail or express, all charges prepaid. We prefer to send books by express when possible, and if sent C. O. D. we pay all charges for returning the money. Small orders of three dollars or less must invariably be accompanied by remit- tance. How to Send There are four ways by which money can be sent at our Money by risk, namely: a post-office money order, an express money Mail. order, a bank-check (draft), and in a registered letter. Money sent in any other way is at the sender's risk. Silver should not be sent through the mail. Shipments. Subscription Books. Latest Editions. Bindings. Descriptive Circulars. All books, being packed in patent metal-edged boxes, neces- sarily reach our patrons by mail or express in excellent condi- tion. Books in our catalogue marked " For sale by subscription only" may be secured by ordering them through any of our authorized travelling salesmen, or direct from the Philadelphia office ; they are not for sale by booksellers. All other books in our catalogue can be procured of any bookseller at the advertised prices, or directly from us. We handle only our own publications, and cannot supply second-hand books nor the publications of other houses. In every instance the latest revised edition is sent. In ordering, be careful to state the style of binding desired — Cloth, Sheep, or Half-Morocco. A complete descriptive circular, giving table of contents, etc. of any book sold by subscription only, will be sent free on application. CATALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by William H. Howell, Ph. D., M. D., Professor of Physiology in the Johns Hopkins University, Baltimore, Md. One handsome octavo volume of 1052 pages, fully illustrated. Prices : Cloth, $6.00 net; Sheep or Half- Morocco, $7.00 net. This work is the most notable attempt yet made in America to combine in one volume the entire subject of Human Physiology by well-known teachers who have given especial study to that part of the subject upon which they write. The completed work represents the present status of the science of Physiology, particularly from the standpoint of the student of medicine and of the medical practitioner. The collaboration of several teachers in the preparation of an elementary text- book of physiology is unusual, the almost invariable rule heretofore having been for a single author to write the entire book. One of the advantages to be derived from this collaboration method is that the more limited literature necessary for consultation by each author has enabled him to base his elementary account upon a comprehensive knowledge of the subject assigned to him; another, and perhaps the most important, advantage is that the student gains the point of view of a number of teachers. In a measure he reaps the same benefit as would be obtained by following courses of instruction under different teachers. The different standpoints assumed, and the differences in emphasis laid upon the various lines of procedure, chemical, physical, and anatomical, should give the student a better insight into the methods of the science as it exists to-day. The work will also be found useful to many medical practitioners who may wish to keep in touch with the development of modern physiology. The main divisions of the subject-matter are as follows : General Physiology of Muscle and Nerve — Secretion — Chemistry of Digestion and Nutrition — Movements of the Alimentary Canal, Bladder, and Ureter — Blood and Lymph — Circulation — Respiration — Animal Heat — Central Nervous System — Special Senses — Special Muscular Mechanisms — Reproduction — Chemistry of the Animal Body. CONTRIBUTORS : HENRY P. BOWDITCH, M. D., Professor of Physiology, Harvard Medi- cal School. JOHN G. CURTIS, M. D., Professor of Physiology, Columbia Uni- versity, N. Y. (College of Physicians and Surgeons). HENRY H. DONALDSON, Ph.D., Head-Professor of Neurology, Univer- sity of Chicago. W. H. HOWELL, Ph. D., M. D., Professor of Physiology, Johns Hopkins University. FREDERIC S. LEE, Ph. D., Adjunct Professor of Physiology, Colum- bia University, N. Y. (College of Physicians and Surgeons). WARREN P. LOMBARD, M. p., Professor of Physiology, University of Michigan. GRAHAM LUSK, Ph.D., Professor of Physiology, Yale MedicaJ School. W. T. PORTER, M.D., Assistant Professor of Physiology, Har- vard Medical School. EDWARD T. REICHERT, M.D., Professor of Physiology, University of Pennsylvania. HENRY SEW ALL, Ph.D., M. D., Professorof Physiology, Medical Deparfr ment, University of Denver. W. B. SAUNDERS' For Sale by Subscription. AN AMERICAN TEXT-BOOK OF APPLIED THERAPEU- TICS. For the Use of Practitioners and Students. Edited by James C. Wilson, M. D., Professor of the Practice of Medicine and of Clinical Medicine in the Jefferson Medical College. One handsome octavo volume of 1326 pages. Illustrated. Prices: Cloth, $7.00 net; Sheep or Half-Morocco, $8.00 net. The arrangement of this volume has been based, so far as possible, upon modern pathologic doctrines, beginning with the intoxications, and following with infections, diseases due to internal parasites, diseases of undetermined origin, and finally the disorders of the several bodily systems— digestive, re- spiratory, circulatory, renal, nervous, and cutaneous. It was thought proper to include also a consideration of the disorders of pregnancy. The list of contributors comprises the names of" many who have acquired dis- tinction as practitioners and teachers of practice, of clinical medicine, and of the specialties. CONTRIBUTORS : Dr. I. E. Atkinson, Baltimore, Md. Sanger Brown, Chicago, 111. John B. Chapin, Philadelphia, Pa. William C. Dabney, Charlottesville, Va. John Chalmers DaCosta, Philada., Pa. I. N. Danforth, Chicago, 111. John L. Dawson, Jr., Charleston, S. C. F. X. Dercum, Philadelphia, Pa. George Dock, Ann Arbor, Mich. Robert T. Edes, Jamaica Plain, Mass. Augustus A. Eshner, Philadelphia, Pa. J. T. Eskridge, Denver, Col. F. Forchheimer, Cincinnati, O. Carl Frese, Philadelphia, Pa. Edwin E. Graham, Philadelphia, Pa. John Guiteras, Philadelphia, Pa. Frederick P. Henry, Philadelphia, Pa. Guy Hinsdale, Philadelphia, Pa. Orville Horwitz, Philadelphia, Pa. W. W. Johnston, Washington, D. C. Ernest Laplace, Philadelphia, Pa. A. Laveran, Paris, France. Dr. James Hendrie Lloyd, Philadelphia, Pa. John Noland Mackenzie, Baltimore, Md. J. W. McLaughlin, Austin, Texas. A. Lawrence Mason, Boston, Mass. Charles K. Mills, Philadelphia, Pa. John K. Mitchell, Philadelphia, Pa. W. P. Northrup, New York City. William Osier, Baltimore, Md. Frederick A. Packard, Philadelphia, Pa. Theophilus Parvin, Philadelphia, Pa. Beaven Rake, London, England. E. O. Shakespeare, Philadelphia, Pa. Wharton Sinkler, Philadelphia, Pa. Louis Starr, Philadelphia, Pa. Henry W. Stelwagon, Philadelphia, Pa. James Stewart, Montreal, Canada. Charles G. Stockton, Buffalo, N. Y. James Tyson, Philadelphia, Pa. Victor C. Vaughan, Ann Arbor, Mich. James T. Whittaker, Cincinnati, O. J. C. Wilson, Philadelphia, Pa. The ai-ticles, with two exceptions, are the contributions of American writers. Written from the standpoint of the practitioner, the aim of the work is to facili- tate the application of knowledge to the prevention, the cure, and the allevia- tion of disease. The endeavor throughout has been to conform to the title of the book — Applied Therapeutics — to indicate the course of treatment to be pursued at the bedside, rather than to name a list of drugs that have been used at one time or another. While the scientific superiority and the practical desirability of the metric system of weights and measures is admitted, it has not been deemed best to discard entirely the older system of figures, so that both sets have been given where occasion demanded. CATALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK OF OBSTETRICS. Edited by Richard C. Norris, M. D. ; Art Editor, Robert L. Dickinson, M. D. One handsome octavo volume of over iooo pages, with nearly 900 colored and half-tone illustrations. Prices : Cloth, $7.00 ; Sheep or Half-Morocco, $8.00. The advent of each successive volume of the series of the American Text- Books has been signalized by the most flattering comment from both the Press and the Profession. The high consideration received by these text-books, and their attainment to an authoritative position in current medical literature, have been matters of deep international interest, which finds its fullest expression in the demand for these publications from all parts of the civilized world. In the preparation of the "American Text-Book of Obstetrics" the editor has called to his aid proficient collaborators whose professional prominence entitles them to recognition, and whose disquisitions exemplify Practical Obstetrics. While these writers were each assigned special themes for dis- cussion, the correlation of the subject-matter is, nevertheless, such as ensures logical connection in treatment, the deductions of which thoroughly represent the latest advances in the science, and which elucidate the best modern methods of procedure. The more conspicuous feature of the treatise is its wealth of illustrative matter. The production of the illustrations had been in progress for several years, under the personal supervision of Robert L. Dickinson, M. D., to whose artistic judgment and professional experience is due the most sumptuously illustrated work of the period. By means of the photographic art, combined with the skill of the artist and draughtsman, conventional illustration is super- seded by rational methods of delineation. Furthermore, the volume is a revelation as to the possibilities that may be reached in mechanical execution, through the unsparing hand of its publisher. CONTRIBUTORS Dr. James C. Cameron. Edward P. Davis. Robert L. Dickinson. Charles Warrington Earle. James H. Etheridge. Henry J. Garrigues. Barton Cooke Hirst. Charles Jewett. Howard A. Kelly. Richard C. Norris. Chauncey D. Palmer. Theophilus Parvin. George A. Piersol. Edward Reynolds. Henry Schwarz. "At first glance we are overwhelmed by the magnitude of this work in several respects, viz. : First, by the size of the volume, then by the array of eminent teachers in this depart- ment who have taken part in its production, then by the profuseness and character of the illustrations, and last, but not least, the conciseness and clearness with which the text is ren- dered. This is an entirely new composition, embodying the highest knowledge of the art as it stands to-day by authors who occupy the front rank in their specialty, and there are many of them. We cannot turn over these pages without being struck by the superb illustrations which adorn so many of them. We are confident that this most practical work will find instant appreciation by practitioners as well as students." — New York Medical Times. Permit me to say that your American Text-Book of Obstetrics is the most magnificent medical work that 1 have ever seen. I congratulate you and thank you for this superb work, which alone is sufficient to place you first in the ranks of medical publishers. With profound respect I am sincerely yours, Alex. J. C. Skene. W. B. SAUNDEKS* For Sale by Subscription. AN AMERICAN TEXT-BOOK ON THE THEORY AND PRACTICE OF MEDICINE. By American Teachers. Edited by William Pepper, M. D., LL.D., Provost and Professor of the Theory and Practice of Medicine and of Clinical Medicine in the University of Pennsylvania. Complete in two handsome royal-octavo volumes of about iooo pages each, with illustrations to elucidate the text wherever necessary. Price per Volume : Cloth, #5.00 net; Sheep or Half-Morocco, $6.00 net. VOLUME I. CONTAINS: Hygiene. — Fevers (Ephemeral, Simple Con- tinued, Typhus, Typhoid, Epidemic Cerebro- spinal Meningitis, and Relapsing). — Scarla- tina, Measles, Rotheln, Variola, Varioloid, Vjccinia, Varicella, Mumps, Whooping-cough, Anthrax, Hydrophobia, Trichinosis, Actino- mycosis, Glanders, and Tetanus.— Tubercu- losis, Scrofula, Syphilis, Diphtheria, Erysipe- las, Malaria, Cholera, and Yellow Fever. — Nervous, Muscular, and Mental Diseases etc. Urine (Chemistry and Microscopy). — Kid- ney and Lungs. — Air-passages (Larynx and Bronchi) and Pleura. — Pharynx, Oesophagus, Stomach and Intestines (including Intestinal Parasites), Heart, Aorta, Arteries and Veins. VOLUME II. CONTAINS: Peritoneum, Liver, and Pancreas. — Diathet- ic Diseases (Rheumatism, Rheumatoid Ar- thritis, Gout, Lithaemia, and Diabetes.) — Blood and Spleen. — Inflammation, Embolism, Thrombosis, FeVer, and Bacteriology. The articles are not written as though addressed to students in lectures, but are exhaustive descriptions of diseases, with the newest facts as regards Causa- tion, Symptomatology, Diagnosis, Prognosis, and Treatment, including a large number of approved formulae. The recent advances made in the study of the bacterial origin of various diseases are fully described, as well as the bearing of the knowledge so gained upon prevention and cure. The subjects of Bacteriology as a whole and of Immunity are fully considered in a separate section. Methods of diagnosis are given the most minute and careful attention, thus enabling the reader to learn the very latest methods of investigation without consulting works specially devoted to the subject. CONTRIBUTORS : Dr. J. S. Billings, Philadelphia. Francis Delafield, New York. Reginald H. Fitz, Boston. James W. Holland, Philadelphia. Henry M. Lyman, Chicago. William Osier, Baltimore. Dr. William Pepper, Philadelphia. W. Gilman Thompson, New York. W. H. Welch, Baltimore. James T. Whittaker, Cincinnati. James C. Wilson, Philadelphia. Horatio C. Wood, Philadelphia. " We reviewed the first volume of this work, and said : ' It is undoubtedly one of the best text-books on the practice of medicine which we possess.' A consideration of the second and last volume leads us to modify that verdict and to say that the completed work is, in our opinion, the best of its kind it has ever been our fortune to see. It is complete, thorough, accurate, and clear. It is well written, well arranged, well printed, well illustrated, and well bound. It is a model of what the modern text-book should be." — New York Medical Journal. "A library upon modern medical art. The work must promote the wider diffusion of sound knowledge." — American Lancet. " A trusty counsellor for the practitioner or senior student, on which he may implicitly rely." — Edinburgh Medical Journal. CATALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK OF SURGERY. Edited by Wil- liam W. Keen, M.D., LL.D., and J. William White, M. D., Ph. D. Forming one handsome royal-octavo volume of 1250 pages (10x7 inches), with 500 wood-cuts in text, and 37 colored and half-tone plates, many of them engraved from original photographs and drawings furnished by the authors. Prices : Cloth, $7.00 net; Sheep or Half-Morocco, $8.00 net. SECOND EDITION, REVISED AND ENLARGED, With a Section devoted to " The Use of the Rbntgen Rays in Surgery." The want of a text-book which could be used by the practitioner and at the same time be recommended to the medical student has been deeply felt, espe- cially by teachers of surgery; hence, when it was suggested to a num6er of these that it would be well to unite in preparing a text-book of this description, great unanimity of opinion was found to exist, and the gentlemen below named gladly consented to join in its production. While there is no distinctive Amer- ican Surgery, yet America has contributed very largely to the progress of modern surgery, and among the foremost of those who have aided in developing this art and science will be found the authors of the present volume. All of them are teachers of surgery in leading medical schools and hospitals in the United States and Canada. Especial prominence has been given to Surgical Bacteriology, a feature which is believed to be unique in a surgical text-book in the English language. Asep- sis and Antisepsis have received particular attention. The text is brought well up to date in such important branches as cerebral, spinal, intestinal, and pelvic surgery, the most important and newest operations in these departments being described and illustrated. The text of the entire book has been submitted to all the authors for their mutual criticism and revision — an idea in book-making that is entirely new and original. The book as a whole, therefore, expresses on all the important sur- gical topics of the day the consensus of opinion of the eminent surgeons who have joined in its preparation. One of the most attractive features of the book is its illustrations. Very many of them are original and faithful reproductions of photographs taken directly from patients or from specimens. CONTRIBUTORS: Dr. Charles H. Burnett, Philadelphia. Phineas S. Conner, Cincinnati. Frederic S. Dennis, New York. William W. Keen, Philadelphia. Charles B. Nancrede, Ann Arbor, Mich. Roswell Park, Buffalo, N. Y. Lewis S. Pilcher, New York. Dr. Nicholas Senn, Chicago. Francis J. Shepherd, Montreal, Canada. Lewis A. Stimson, New York. William Thomson, Philadelphia. J. Collins Warren, Boston. J. William White, Philadelphia. , . . t ^ ,s text -book is a fair reflex of the present position of American surgery, we must admit it is of a very high order of merit, and that English surgeons will have to look very carefully to their laurels if they are to preserve a position in the van of surgical practice."— London Lancet. It', fi. $AUNDEk$ s For Sale by Subscription, AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL AND SURGICAL, for the use of Students and Practitioners. Edited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume, with 341 illustrations in text and 38 colored and half-tone plates. Prices : Cloth, $6.00 net; Sheep or Half-Morocco, $7.00 net. SECOND EDITION, THOROUGHLY REVISED. In this volume all anatomical descriptions, excepting those essential to a cleat understanding of the text, have been omitted, the illustrations being largely de- pended upon to elucidate the anatomy of the parts. This work, which is thoroughly practical in its teachings, is intended, as its title implies, to be a working text-book for physicians and students. A clear line of treatment has been laid down in every case, and although no attempt has been made to dis- cuss mooted points, still the most important of these have been noted and ex- plained. The operations recommended are fully illustrated, so that the reader, having a picture of the procedure described in the text under his eye, cannot fail to grasp the idea. All extraneous matter and discussions have been carefully excluded, the attempt being made to allow no unnecessary details to cumber the text. The subject-matter is brought up to date at every point, and the work is as nearly as possible the combined opinions of the ten specialists who figure as the authors. CONTRIBUTORS : Dr. Henry T. Byford. John M. Baldy. Edwin Cragin. »'. H. Etheridge. William Goodell. Dr. Howard A. Kelly. Florian Krug. E. E. Montgomery. William R. Pryor. George M. Tuttle. "The most notable contribution to gynecological literature since 1887, .... and the most complete exponent of gynecology which we have. No subject seems to have been neglected, .... and the gynecologist and surgeon, and the general practitioner who has any desire to practise diseases of women, will find it of practical value. In the matter of illustrations and plates the book surpasses anything we have seen." — Boston Medical and Surgical Journal. "A valuable addition to the literature of Gynecology. The writers are progressive, aggressive, and earnest in their convictions." — Medical News, Philadelphia. " A thoroughly modern text-book, and gives reliable and well-tempered advice and in- struction." — Edinburgh Medical Journal. " The harmony of its conclusions and the homogeneity of its style give it an individuality which suggests a single rather than a multiple authorship." — Annals of Surgery. " It must command attention and respect as a worthy representation of our advanced clinical teaching." — American Journal of Medical Sciences. CATALOGUE OF MEDICAL WORKS. For Sale by Subscription. AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL- DREN. By American Teachers. Edited by Louis Starr, M. D., assisted by Thompson S. Westcott, M. D. In one handsome royal-8vo volume of 1250 pages, profusely illustrated with wood-cuts, half-tone and colored plates. Net Prices : Cloth, $7.00; Sheep or Half-Morocco, $8.00. SECOND EDITION, REVISED AND ENLARGED. The plan of this work embraces a series of original articles written by some sixty well-known podiatrists, representing collectively the teachings of the most prominent medical schools and colleges of America. The work is intended to be a PRACTICAL book, suitable for constant and handy reference by the practi- tioner and the advanced student. Especial attention has been given to the latest accepted teachings upon the etiology, symptoms, pathology, diagnosis, and treatment of the disorders of chil- dren, with the introduction of many special formulae and therapeutic procedures. Special chapters embrace at unusual length the Diseases of the Eye, Ear, Nose and Throat, and the Skin ; while the introductory chapters cover fully the important subjects of Diet, Hygiene, Exercise, Bathing, and the Chemistry of Food. Tracheotomy, Intubation, Circumcision, and such minor surgical pro- cedures coming within the province of the medical practitioner are carefully considered. CONTRIBUTORS : Dr. S. S. Adams, Washington. John Ashhurst, Jr., Philadelphia. A. D. Blackader, Montreal, Canada. David Bovaird, New York. Dillon Brown, New York. Edward M. Buckingham, Boston. Charles W. Burr, Philadelphia. W. E. Casselberry, Chicago. Henry Dwight Chapin, New York. W. S. Christopher, Chicago. Archibald Church, Chicago. Floyd M. Crandall, New York. Andrew F. Currier, New York. Roland G. Curtin, Philadelphia J. M. DaCosra, Philadelphia. I. N. Danforth, Chicago. Edward P. Davis, Philadelphia. John B. Deaver, Philadelphia. G. E. de Schwcinitz, Philadelphia. John Doming, New York. Charles Warrington Earle, Chicago. Wm. A. Edwards, San Diego, Cal. F. Forchheimer, Cincinnati. J. Henry Fruitnight, New York. J. P. Crozer Griffith, Philadelphia. W. A. Hardaway. St. Louis. M. P Hatfield, Chicago. Barton Cooke Hirst, Philadelphia. H. Illovvay, Cincinnati. Henry Jackson, Boston. Charles G. Jennings, Detroit, Henry Koplik, New York. Dr. Thomas S. Latimer, Baltimore. Albert R. Leeds, Hoboken, N. J. J. Hendrie Lloyd, Philadelphia. George Roe Lockwood, New York. Henry M. Lyman, Chicago. Francis T. Miles, Baltimore. Charles K Mills, Philadelphia. James E Moore, Minneapolis. F. Gordon Morrill, Boston. John H. Musser, Philadelphia. Thomas R. Neilson, Philadelphia. W. P. Northrup, New York. William Osier, Baltimore. Frederick A. Packard, Philadelphia. William Pepper, Philadelphia. Frederick Peterson, New York. W. T. Plant, Syracuse, New York. William M. Powell, Atlantic City. B. Alexander Randall, Philadelphia. Edward O. Shakespeare, Philadelphia F. C. Shattuck, Boston. J. Lewis Smith, New York. Louis Starr, Philadelphia. M. Allen Starr, New York. Charles W. Townsend, Boston. James Tyson, Philadelphia. W. S. Thayer, Baltimore. Victor C. Vaughan, Ann Arbor, Mich Thompson S. Westcott, Philadelphia. Henry R. Wharton, Philadelphia. J. William White, Philadelphia. J. C. Wilson, Philadelphia. IO IV. B. SAUNDERS A NEW PRONOUNCING DICTIONARY OF MEDICINE, with Phonetic Pronunciation, Accentuation, Etymology, etc. By John M. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila- delphia; Vice-President of the American Paediatric Society; Ex-President of the Association of Life Insurance Medical Directors ; Editor " Cyclo- paedia of the Diseases of Children," etc. ; and Henry Hamilton, author of " A New Translation of Virgil's ^Eneid into English Rhyme ;" co- author of "Saunders' Medical Lexicon," etc.; with the Collaboration of J. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D. With an Appendix containing important Tables of Bacilli, Micrococci, Leucomaines, Ptomaines, Drugs and Materials used in Antiseptic Sur- gery, Poisons and their Antidotes, Weights and Measures, Thermometric Scales, New Official and Unofficial Drugs, etc. One very attractive volume of over 800 pages. Second Revised Edition. Prices: Cloth, $5.00 net ; Sheep or Half- Morocco, #6.00 net; with Denison's Patent Ready- Refer- ence Index; without patent index, Cloth, $4.00 net; Sheep or Half- Morocco, $5.00 net. PROFESSIONAL OPINIONS. " I am much pleased with Keating's Dictionary, and shall take pleasure in recommending it to my classes." Henry M. Lyman, M. D., Professor of Principles and Practice of Medicine, Rush Medical College, Chicago, III. " I am convinced that it will be a very valuable adjunct to my study-table, convenient in size and sufficiently full for ordinary use." C. A. LlNDSLEY, M. D., Professor of Theory and Practice of Medicine, Medical Dept. Yale University ; Secretary Connecticut State Board of Health, New Haven, Conn, AUTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Pro- fessor of Surgery in the Jefferson Medical College of Philadelphia, with Reminiscences of His Times and Contemporaries. Edited by his sons, Samuel W. Gross, M. D., LL.D., late Professor of Principles of Surgery and of Clinical Surgery in the Jefferson Medical College, and A. Haller Gross, A. M., of the Philadelphia Bar. Preceded by a Memoir of Dr. Gross, by the late Austin Flint, M. D., LL.D. In two handsome volumes, each containing over 400 pages, demy 8vo, extra cloth, gilt tops, with fine Frontispiece engraved on steel. Price per Volume, $2.50 net. This autobiography, which was continued by the late eminent surgeon until within three months of his death, contains a full and accurate history of his early struggles, trials, and subsequent successes, told in a singularly interesting and charming manner, and embraces short and graphic pen-portraits of many of the most distinguished men — surgeons, physicians, divines, lawyers, states- men, scientists, etc. — with whom he was brought in contact in America and in Europe ; the whole forming a retrospect of more than three-quarters of a century. CATALOGUE OF MEDICAL WORKS. II SURGICAL PATHOLOGY AND THERAPEUTICS. By John Collins Warren, M. D., LL.D., Professor of Surgery, Medical Depart- ment Harvard University; Surgeon to the Massachusetts General Hospital, etc. A handsome octavo volume of 832 pages, with 136 relief and litho- graphic illustrations, 33 of which are printed in colors, and all of which were drawn by William J. Kaula from original specimens. Prices : Cloth, $6.00 net; Half-Morocco, $7.00 net. " The volume is for the bedside, the amphitheatre, and the ward. It deals with things not as we see them through the microscope alone, but as the prac- titioner sees their effect in his patients ; not only as they appear in and affect culture-media, but also as they influence the human body ; and, following up the demonstrations of the nature of diseases, the author points out their logical treatment." {New Yo?'k Medical Journal). " It is the handsomest specimen of book-making * * * that has ever been issued from the American medical press" (American Journal of the Medical Sciences, Philadelphia). "Without Exception, the Illustrations are the Best ever Seen in a Work of this Kind. "A most striking and very excellent feature of this book is its illustrations. Without ex- ception, from the point of accuracy and artistic merit, they are the best ever seen in a work of this kind. * * * Many of those representing microscopic pictures are so perfect in their coloring and detail as almost to give the beholder the impression that he is looking down the barrel of a microscope at a well-mounted section." — Annals of Surgery , Philadelphia. PATHOLOGY AND SURGICAL TREATMENT OF TUMORS. By N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and of Clinical Surgery, Rush Medical College ; Professor of Surgery, Chicago Polyclinic ; Attending Surgeon to Presbyterian Hospital ; Surgeon-in-Chief, St. Joseph's Hospital, Chicago. One volume of 710 pages, with 515 engravings, including full-page colored plates. Prices: Cloth, $6.00 net; Half-Morocco, $7.00 net. Books specially devoted to this subject are few, and in our text-books and systems of surgery this part of surgical pathology is usually condensed to a de- gree incompatible with its scientific and clinical importance. The author spent many years in collecting the material for this work, and has taken great pains to present it in a manner that should prove useful as a text-book for the student, a work of reference for the busy practitioner, and a reliable, safe guide for the surgeon. The more difficult operations are fully described and illustrated. More than one hundred of the illustrations are original, while the remainder were selected from books and medical journals not readily accessible. " The most exhaustive of any recent book in English on this subject. It is well illus- trated, and will doubtless remain as the principal monograph on the subject in our language for some years. The book is handsomely illustrated and printed, .... and the author has given a notable and lasting contribution to surgery." — Journal of American Medical Asso- ciation, Chicago. 12 tV. B. SAUNDERS MEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of Medicine at the University of Heidelberg. Translated, with additions, from the Fifth Enlarged German Edition, with the author's permission, by Francis H. Stuart, A. M., M. D. In one handsome royal-octavo volume of 600 pages. 194 fine wood-cuts in the text, many of them in colors. Prices: Cloth, $4.00 net; Sheep or Half-Morocco, $5.00 net. FOURTH AMERICAN EDITION, FROM THE FIFTH REVISED AND ENLARGED GERMAN EDITION. In this work, as in no other hitherto published, are given full and accurate explanations of the phenomena observed at the bedside. It is distinctly a clin- ical work by a master teacher, characterized by thoroughness, fulness, and accu- racy. It is a mine of information upon the points that are so often passed over without explanation. Especial attention has been given to the germ-theory as a factor in the origin of disease. This valuable work is now published in German, English, Russian, and Italian. The issue of a third American edition within two years indicates the favor with which it has been received by the profession. THE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI- LITIC AFFECTIONS. (American Edition.) Translation from the French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy- sician to, and Physician to the department for Diseases of the Skin at, the Middlesex Hospital, London. Photo-lithochromes from the famous models of dermatological and syphilitic cases in the Museum of the Saint-Louis Hospital, Paris, with explanatory wood-cuts and letter-press. In 12 Parts, at $3.00 per Part. Parts I to 8 now ready. " The plates are beautifully executed." — Jonathan Hutchinson, M. D. (London Hospital). " The plates in this Atlas are remarkably accurate and artistic reproductions of typical examples of skin disease. The work will be of great value to the practitioner and student." — William Anderson, M. D. (St. Thomas Hospital). " If the succeeding parts of this Atlas are to be similar to Part 1, now before us, we have no hesitation in cordially recommending it to the favorable notice of our readers as one of the finest dermatological aliases with which we are acquainted." — Glasgow Medical Journal, Aug., 1895. " Of all the atlases of skin diseases which have been published in recent years, the present one promises to be of greatest interest and value, especially from the standpoint of the general practitioner." — American Medico-Surgical Bulletin, Feb. 22, 1896. " The introduction of explanatory wood-cuts in the text is a novel and most important feature which greatly furthers the easier understanding of the excellent plates, than which nothing, we venture to say, has been seen better in point of correctness, beauty, and general merit." — New York Medical Journal, Feb. 15, 1896. " An interesting feature of the Atlas is the descriptive text, which is written for each picture by the physician who treated the case or at whose instigation the models have been made. We predict for this truly beautiful work a large circulation in all parts of the medical world where the names St. Louis and Baretta have preceded it." — Medical Record, N. Y., Feb. 1, 1896. CATALOGUE OF MEDICAL WORKS. PRACTICAL POINTS IN NURSING. For Nurses in Private Practice. By Emily A. M. Stoney, Graduate of the Training-School for Nurses, Lawrence, Mass. ; Superintendent of the Training-School for Nurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely illustrated with 73 engravings in the text, and 9 colored and half-tone plates. Cloth. Price, #1.75 net. SECOND EDITION, THOROUGHLY REVISED. In this volume the author explains, in popular language and in the shortest possible form, the entire range of private nursing as distinguished from hospital nursing, and the nurse is instructed how best to meet the various emergencies of medical and surgical cases when distant from medical or surgical aid or when thrown on her own resources. An especially valuable feature of the work will be found in the directions to the nurse how to improvise everything ordinarily needed in the sick-room, where the embarrassment of the nurse, owing to the want of proper appliances, is fre- quently extreme. The work has been logically divided into the following sections : I. The Nurse : her responsibilities, qualifications, equipment, etc. II. The Sick-Room : its selection, preparation, and management. III. The Patient : duties of the nurse in medical, surgical, obstetric, and gyne- cologic cases. IV. Nursing in Accidents and Emergencies. V. Nursing in Special Medical Cases. VI. Nursing of the New-born and Sick Children. VII. Physiology and Descriptive Anatomy. The Appendix contains much information in compact form that will be found of great value to the nurse, including Rules for Feeding the Sick; Recipes for Invalid Foods and Beverages; Tables of Weights and Measures; Table for Computing the Date of Labor; List of Abbreviations ; Dose-List; and a full and complete Glossary of Medical Terms and Nursing Treatment. " This is a well-written, eminently practical volume, which covers the entire range of private nursing as distinguished from hospital nursing, and instructs the nurse how best to meet the various emergencies which may arise and how to prepare everything ordinarily needed in the illness of her patient." — American Journal of Obstetrics and Diseases of Women and Children, Aug., 1896. A TEXT-BOOK OF BACTERIOLOGY, including the Etiology and Prevention of Infective Diseases and an account of Yeasts and Moulds, Hsematozoa, and Psorosperms. By Edgar M. Crookshank, M. B., Pro- fessor of Comparative Pathology and Bacteriology, King's College, London. A handsome octavo volume of 700 pages, with 273 engravings in the text, and 22 original and colored plates. Price, $6.50 net. This book, though nominally a Fourth Edition of Professor Crookshank's " Manual of Bacteriology," is practically a new work, the old one having been reconstructed, greatly enlarged, revised throughout, and largely rewritten, forming a text-book for the Bacteriological Laboratory, for Medical Ofhcers of Health, and for Veterinary Inspectors. 14 W. B. SAUNDERS 1 A TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC- TICAL. For the Use of Students. By Arthur Clarkson, M. B., CM., Edin., formerly Demonstrator of Physiology in the Owen's College, Manchester; late Demonstrator of Physiology in the Yorkshire College, Leeds. Large 8vo, 554 pages, with 22 engravings in the text, and 174 beautifully colored original illustrations. Price, strongly bound in Cloth, $6.00 net. The purpose of the writer in this work has been to furnish the student of His- tology, in one volume, with both the descriptive and the practical part of the science. The first two chapters are devoted to the consideration of the general methods of Histology ; subsequently, in each chapter, the structure of the tissue or organ is first systematically described, the student is then taken tutorially over the specimens illustrating it, and, finally, an appendix affords a short note of the methods of preparation. "We would most cordially recommend it to all students of histology." — Dublin Medical Journal. " It is pleasant to give unqualified praise to the colored illustrations ; . . . the standard is high, and many of them are not only extremely beautiful, but very clear and demonstra- tive. . . . The plan of the book is excellent." — Liverpool Medical Journal. ARCHIVES OF CLINICAL SKIAGRAPHY. By Sydney Rowland, B. A., Camb. A series of collotype illustrations, with descriptive text, illustrating the applications of the New Photography to Medicine and Sur- gery. Price, per Part, $1.00. Parts I. to V. now ready. The object of this publication is to put on record in permanent form some of the most striking applications of the new photography to the needs of Medicine and Surgery. The progress of this new art has been so rapid that, although Prof. Rontgen's discovery is only a thing of yesterday, it has already taken its place among the approved and accepted aids to diagnosis. WATER AND WATER SUPPLIES. By John C. Thresh, D. Sc, M. B., D. P. H, Lecturer on Public Health, King's College, London ; Editor of the "Journal of State Medicine," etc. i2mo, 438 pages, illus- trated. Handsomely bound in Cloth, with gold side and back stamps. Price, $2.25 net. This work will furnish any one interested in public health the information requisite for forming an opinion as to whether any supply or proposed supply is sufficiently wholesome and abundant, and whether the cost can be considered reasonable. The work does not pretend to be a treatise on Engineering, yet it contains sufficient detail to enable any one who has studied it to consider intelligently any scheme which may be submitted for supplying a community with water. CATALOGUE OF MEDICAL WORKS. 15 DISEASES OF THE EYE. A Hand-Book of Ophthalmic Prac- tice. By G. E. de Schweinitz, M. D., Professor of Ophthalmology in the Jefferson Medical College, Philadelphia, etc. A handsome royal- octavo volume of 679 pages, with 256 fine illustrations, many of which are original, and 2 chromo-lithographic plates. Prices: Cloth, $4.00 net; Sheep or Half-Morocco, $5.00 net. The object of this work is to present to the student, and to the practitioner who is beginning work in the fields of ophthalmology, a plain description of the optical defects and diseases of the eye. To this end special attention has been paid to the clinical side of the question; and the method of examination, the symptomatology leading to a diagnosis, and the treatment of the various ocular defects have been brought into prominence. THIRD EDITION, THOROUGHLY REVISED. The entire book has been thoroughly revised. In addition to this general revision, special paragraphs on the following new matter have been introduced : Filamentous Keratitis, Blood-staining of the Cornea, Essential Phthisis Bulbi, Foreign Bodies in the Lens, Circinate Retinitis, Symmetrical Changes at the Macula Lutea in Infancy, Hyaline Bodies in the Papilla, Monocular Diplopia, Subconjunctival Injections of Germicides, Infiltration-Anaesthesia, and Steriliza- tion of Collyria. Brief mention of Ophthalmia Nodosa, Electric Ophthalmia, and Angioid Streaks in the Retina also finds place. An Appendix has been added, containing a full description of the method of determining the corneal astigmatism with the ophthalmometer of Javal and Schiotz, and the rotations of the eyes with the tropometer of Stevens. The chapter on Operations has been enlarged and rewritten. "A clearly written, comprehensive manual. . . . One which we can commend to students as a reliable text-book, written with an evident knowledge of the wants of those entering upon the study of this special branch of medical science."— British Medical Journal. " The work is characterized by a lucidity of expression which leaves the reader in no doubt as to the meaning of the language employed. . . . We know of no work in which these diseases are dealt with more satisfactorily, and indications for treatment more clearly given, and in harmony with the practice of the most advanced ophthalmologists." — Mari- time Medical News. " It is hardly too much to say that for the student and practitioner beginning the study of Ophthalmology, it is the best single volume at present published."— Medical News. " The latest and one of the best books on Ophthalmology. The book is thoroughly up to date, and is certainly a work which not only commends itself to the student, but is a ready reference for the busy practitioner." — International Medical Review. PROFESSIONAL. OPINIONS. "A work that will meet the requirements not only of the specialist, but of the general practitioner in a rare degree. I am satisfied that unusual success awaits it." William Pepper, M. D. Provost and Professor of Theory and Practice of Medicine and Clinical Medicine in the University of Pennsylvania. " Contains in concise and reliable form the accepted views of Ophthalmic Science." William Thomson, M. D., Professor of Ophthalmology, Jefferson Medical College, Philadelphia, Pa. 6 W. B. SAUNDERS' TEXT-BOOK UPON THE PATHOGENIC BACTERIA. Spe- cially written for Students of Medicine. By Joseph McFarland, M. D., Professor of Pathology and Bacteriology in the Medico-Chirurgical College of Philadelphia, etc. 497 pages, finely illustrated. Price, Cloth, $2.50 net. SECOND EDITION, REVISED AND GREATLY ENLARGED. The work is intended to be a text-book for the medical student and for the practitioner who has had no recent laboratory training in this department of medi- cal science. The instructions given as to needed apparatus, cultures, stairiings, microscopic examinations, etc. are ample for the student's needs, and will afford to the physician much information that will interest and profit him relative to a subject which modern science shows to go far in explaining the etiology of many diseased conditions. In this second edition the work has been brought up to date in all depart- ments of the subject, and numerous additions have been made to the technique in the endeavor to make the book fulfil the double purpose of a systematic worf upon bacteria and a laboratory guide. " It is excellently adapted for the medical students and practitioners for whom it is avowedly written. . . . The descriptions given are accurate and readable, and the book should prove useful to those for whom it is written. — London Lancet, Aug. 29, 1896. " The author has succeded admirably in presenting the essential details of bacteriological technics, together with a judiciously chosen summary of our present knowledge of pathogenic bacteria. . . . The work, we think, should have a wide circulation among English-speaking students of medicine." — N. Y. Medical Journal, April 4, 1896. " The book will be found of considerable use by medical men who have not had a special bacteriological training, and who desire to understand this important branch of medical science." — Edinburgh Medical Journal, July, 1896. LABORATORY GUIDE FOR THE BACTERIOLOGIST. By Langdon Frothingham, M. D. V., Assistant in Bacteriology and Veteri- nary Science, Sheffield Scientific School, Yale University. Illustrated. Price, Cloth, 75 cents. The technical methods involved in bacteria-culture, methods of staining, and microscopical study are fully described and arranged as simply and concisely as possible. The book is especially intended for use in laboratory work " It is a convenient and useful little work, and will more than repay the outlay necessary for its purchase in the saving of time which would otherwise be consumed in looking up the various points of technique so clearly and concisely laid down in its pages." — American Med.- Surg. Bulletin. FEEDING IN EARLY INFANCY. By Arthur V. Meigs, M. D. Bound in limp cloth, flush edges. Price, 25 cents net. Synopsis : Analyses of Milk — Importance of the Subject of Feeding in Early Infancy — Proportion of Casein and Sugar in Human Milk — Time to Begin Arti- ficial Feeding of Infants — Amount of Food to be Administered at Each Feed- ing — Intervals between Feedings — Increase in Amount of Food at Different Periods of Infant Development — Unsuitableness of Condensed Milk as a Sub- stitute for Mother's Milk — Objections to Sterilization or " Pasteurization " of Milk— Advances made in the Method of Artificial Feeding of Infants. CATALOGUE OF MEDICAL WORKS. 17 ESSENTIALS OF ANATOMY AND MANUAL OF PRACTI- CAL DISSECTION, containing " Hints on Dissection." By Charles B. Nancrede, M. D., Professor of Surgery and Clinical Surgery in the University of Michigan, Ann Arbor; Corresponding Member of the Royal Academy of Medicine, Rome, Italy ; late Surgeon Jefferson Medical Col- lege, etc. Fourth and revised edition. Post 8vo, over 500 pages, with handsome full-page lithographic plates in colors, and over 200 illustrations. Price : Extra Cloth or Oilcloth for the dissection-room, #2.00 net. Neither pains nor expense has been spared to make this work the most ex- haustive yet concise Student's Manual of Anatomy and Dissection ever pub- ,cl> ed, either in America or in Europe. The colored plates are designed to aid the student in dissecting the muscles, .rteries, veins, and nerves. The wood-cuts have all been specially drawn and engraved, and an Appendix added containing 60 illustrations representing the ructure of the entire human skeleton, the whole being based on the eleventh edition of Gray's Anatomy, " The plates are of more than ordinary excellence, and are of especial value to students in their work in the dissecting-room."— Journal of American Medical Association. " Should be in the hands of every medical student."— Cleveland Medical Gazette. " A concise and judicious work."— Buffalo Medical and Surgical Journal. A MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the University of Penn- sylvania, and Demonstrator of Pathology in the Woman's Medical College of Philadelphia. Specially intended for students preparing for graduation and hospital examinations, and includes the following sections : General Diseases, Diseases of the Digestive Organs, Diseases of the Respiratory System, Diseases of the Circulatory System, Diseases of the Nervous Sys- tem, Diseases of the Blood, Diseases of the Kidneys, and Diseases of the Skin. Each section is prefaced by a chapter on General Symptomatology. Post Svo, 520 pages. Numerous illustrations and selected formulae. Price, $2.50, bound in flexible leather. FIFTH EDITION, REVISED AND ENLARGED. Contributions to the science of medicine have poured in so rapidly during the last quarter of a century that it is well-nigh impossible for the student, with the limited time at his disposal, to master elaborate treatises or to cull from them that knowledge which is absolutely essential. From an extended experience in teaching, the author has been enabled, by classification, to group allied symp- toms, and by the judicious elimination of theories and redundant explanations to bring within a comparatively small compass a complete outline of the prac- tice of medicine. 1 8 W. B. SAUNDERS MANUAL OF MATERIA MEDICA AND THERAPEUTICS. By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the University of Pennsylvania, and Demonstrator of Pathology in the Woman's Medical College of Philadelphia. 445 pages. Price, Cloth, #2.25. a SECOND EDITION, REVISED. This wholly new volume, which is based on the last edition of the Pharma- copoeia, comprehends the following sections: Physiological Action of Drugs; Drugs ; Remedial Measures other than Drugs ; Applied Therapeutics ; Incom- patibility in Prescriptions ; Table of Doses ; Index of Drugs ; and Index of Diseases ; the treatment being elucidated by more than two hundred formulae. "The author is to be congratulated upon having presented the medical student with as accurate a manual of therapeutics as it is possible to prepare."— Therapeutic Gazette. " Far superior to most of its class ; in fact, it is very good. Moreover, the book is reliable and accurate." — New York Medical Journal. " The author has faithfully presented modern therapeutics in a comprehensive work, . . . and it will be found a reliable guide."— University Medical Magazine. NOTES ON THE NEWER REMEDIES: their Therapeutic Ap- plications and Modes of Administration. By David Cerna, M. D., Ph. D., Demonstrator of and Lecturer on Experimental Therapeutics in the University of Pennsylvania. Post-octavo, 253 pages. Price, #1.25. SECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED. The work takes up in alphabetical order all the newer remedies, giving their physical properties, solubility, therapeutic applications, administration, and chemical formula. It thus forms a very valuable addition to the various works on therapeutics now in existence. Chemists are so multiplying compounds, that,, if each compound is to be thor- oughly studied, investigations must be carried far enough to determine the prac- tical importance of the new agents. " Especially valuable because of its completeness, its accuracy, its systematic consider- ation of the properties and therapy of many remedies of which doctors generally know but little, expressed in a brief yet terse manner." — Chicago Clinical Review. TEMPERATURE CHART. Prepared by D. T. Laine, M. D. Size 8x 13^ inches. Price, per pad of 25 charts, 50 cents. A conveniently arranged chart for recording Temperature, with columns for daily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On the back of each chart is given in full the method of Brand in the treatment of Typhoid Fever. CATALOGUE OF MEDICAL WORKS. 1 9 SAUNDERS' POCKET MEDICAL LEXICON; or, Dictionary of Terms and Words used in Medicine and Surgery. By John M. Keating, M. D., editor of " Cyclopaedia of Diseases of Children," etc. ; author of the " New Pronouncing Dictionary of Medicine;" and Henrv Hamilton, author of " A New Translation of Virgil's yEneid into Eng- lish Verse;" co-author of a " New Pronouncing Dictionary of Medicine." A new and revised edition. 32mo, 282 pages. Prices: Cloth, 75 cents s * Leather Tucks, $1.00. This new and comprehensive work of reference is the outcome of a demand for a more modern handbook of its class than those at present on the market, which, dating as they do from 1855 to 1884, are of but trifling use to the student by their not containing the hundreds of new words now used in current litera- ture, especially those relating to Electricity and Bacteriology. " Remarkably accurate in terminology, accentuation, and definition." — Journal of Amer~ ican Medical Association. " Brief, yet complete .... it contains the very latest nomenclature in even the newest departments of medicine." — New York Medical Record. SAUNDERS' POCKET MEDICAL FORMULARY. By William M. Powell, M. D., Attending Physician to the Mercer House for Invalid Women at Atlantic City. Containing 1800 Formulae, selected from several hundred of the best-known authorities. Forming a handsome and con- venient pocket companion of nearly 300 printed pages, with blank leaves for Additions; with an Appendix containing Posological Table, Formulae and Doses for Hypodermatic Medication, Poisons and their Antidotes, Diameters of the Pemale Pelvis and Foetal Head, Obstetrical Table, Diet List for Various Diseases, Materials and Drugs used in Antiseptic Surgery, Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Fourth edition, revised and greatly enlarged. Handsomely bound in morocco, with side index, wallet, and flap. Price, $1.75 net. A concise, clear, and correct record of the many hundreds of famous formulae which are found scattered through the works of the most eminent physicians and surgeons of the world. The work is helpful to the student and practitioner alike, as through it they become acquainted with numerous formulae which are not found in text-books, but have been collected from among the rising genera- tion of the profession, college professors, and hospital physicians and surgeons. "This little book, that can be conveniently carried in the pocket, contains an immense amount of material. It is very useful, and as the name of the author of each prescription is given is unusually reliable." — New York Medical Record. " Designed to be of immense help to the general practitioner in the exercise of his daily calling." — Boston Medical and Surgical Journal. 20 W. B. SAUNDERS' DISEASES OF WOMEN. By Henry J. Garrigues, A.M., M. D., Professor of Gynecology and Obstetrics in the New York School of Clinical Medicine ; Gynecologist to St. Mark's Hospital and to the German Dis- pensary, New York City. In one handsome octavo volume of 728 pages, illustrated by 335 engravings and colored plates. Prices : Cloth, $4.00 net ; Sheep or Half Morocco, $5.00 net. A PRACTICAL work on gynecology for the use of students and practitioners, written in a terse and concise manner. The importance of a thorough know- ledge of the anatomy of the female pelvic organs has been fully recognized by the author, and considerable space has been devoted to the subject. The chap- ters on Operations and on Treatment are thoroughly modern, and are based upon the large hospital and private practice of the author. The text is eluci- dated by a large number of illustrations and colored plates, many of them being original, and forming a complete atlas for studying embryology and the anatomy of the female genitalia, besides exemplifying, whenever needed, morbid condi- tions, instruments, apparatus, and operations. Second Edition, Thoroughly Revised. The first edition of this work met with a most appreciative reception by the medical press and profession both in this country and abroad, and was adopted as a text-book or recommended as a book of reference by nearly one hundred colleges in the United States and Canada. The author has availed himself of the opportunity afforded by this revision to embody the latest approved advances in the treatment employed in this important branch of Medicine. He has also more extensively expressed his own opinion on the comparative value of the different methods of treatment employed. "One of the best text-books for students and practitioners which has been published in the English language ; it is condensed, clear, and comprehensive. The profound learning and great clinical experience of the distinguished author find expression in this book in a most attractive and instructive form. Young practitioners, to whom experienced consultants may not be available, will find in this book invaluable counsel and help." Thad. A. Reamy, M. D., LL.D., Professor of Clinical Gynecology, Medical College of Ohio ; Gynecologist to the Good Samaritan and Cincinnati Hospitals. A SYLLABUS OF GYNECOLOGY, arranged in conformity witn "An American Text-Book of Gynecology." By J. W. Long, M. D., Professor of Diseases of Women and Children, Medical College of Vir- ginia, etc. Price, Cloth (interleaved), $1.00 net. Based upon the teaching and methods laid down in the larger work, this will not only be useful as a supplementary volume, but to those who do not already possess the text-book it will also have an independent value as an aid to the practitioner in gynecological work, and to the student as a guide in the lecture- room, as the subject is presented in a manner at once systematic, clear, succinct, paid practical. CATALOGUE OF MEDICAL WORKS. A MANUAL OF PHYSIOLOGY, with Practical Exercises. For Students and Practitioners. By G. N. Stewart, M. A., M. D., D. Sc, lately Examiner in Physiology, University of Aberdeen, and of the New Museums, Cambridge University ; Professor of Physiology in the Western Reserve University, Cleveland, Ohio. Handsome octavo volume of 800 pages, with 278 illustrations in the text, and 5 colored plates. Price, Cloth, $3.50 net. " It will make its way by sheer force of merit, and amply deserves to do so. It is one oj the very best English text-books on the subject." — London Lancet. " Of the many text-books of physiology published, we do not know of one that so nearly comes up to the ideal as does Professor Stewart's volume." — British Medical Journal. ESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX. By Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diagno- sis in the Rush Medical College, Chicago ; Attending Physician to the Central Free Dispensary, Department of Rhinology, Laryngology, and Diseases of the Chest. 200 pages. Illustrated. Cloth, flexible covers. Price, #1.25 net. SYLLABUS OF OBSTETRICAL LECTURES in the Medical Department, University of Pennsylvania. By Richard C. Norris, A. M., M. D., Lecturer on Clinical and Operative Obstetrics, University of Pennsylvania. Third edition, thoroughly revised and enlarged. Crown 8vo. Price, Cloth, interleaved for notes, $2.00 net. " This work is so far superior to others on the same subject that we take pleasure in call- ing attention briefly to its excellent features. It covers the subject thoroughly, and will prove invaluable both to the student and the practitioner. The author has introduced a number of valuable hints which would only occur to one who was himself an experienced teacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially pleased with the portion devoted to the practical duties of the accoucheur, care of the child, etc. The paragraphs on antiseptics are admirable; there is no doubtful tone in the direc- tions given. No details are regarded as unimportant ; no minor matters omitted. We ven- ture to say that even the old practitioner will find useful hints in this direction which he can- not afford to despise." — New York Medical Record. A SYLLABUS OF LECTURES ON THE PRACTICE OF SUR- GERY, arranged in conformity with " An American Text-Book of Surgery." By N. Senn, M. D., Ph. D., Professor of Surgery in Rush Medical College, Chicago, and in the Chicago Polyclinic. Price, $2.00. This, the latest work of its eminent author, himself one of the contributors to " An American Text-Book of Surgery," will prove of exceptional value to the advanced student who has adopted that work as his text-book. It is not only the syllabus of an unrivalled course of surgical practice, but it is also an epitome of or supplement to the larger work. " The author has evidently spared no pains in making his Syllabus thoroughly comprehen- sive, and has added new matter and alluded to the most recent authors and operations. Full references are also given to all requisite details of surgical anatomy and pathology."— British Medical Journal, London. 22 W, B< SAUNDERS' AN OPERATION BLANK, with Lists of Instruments, etc. re- quired in Various Operations. Prepared by W. W. Keen, M. D., LL.D., Professor of Principles of Surgery in the Jefferson Medical Col- lege, Philadelphia. Price per Pad, containing Blanks for fifty operations, 50 cents net. SECOND EDITION, REVISED FORM. A convenient blank, suitable for all operations, giving complete instructions regarding necessary preparation of patient, etc., with a full list of dressings and medicines to be employed. On the back of each blank is a list of instruments used — viz. general instru- ments, etc., required for all operations ; and special instruments for surgery of the brain and spine, mouth and throat, abdomen, rectum, male and female genito-urinary organs, the bones, etc. The whole forming a neat pad, arranged for hanging on the wall of a sur- geon's office or in the hospital operating-room. " Will serve a useful purpose for the surgeon in reminding him of the details of prepa- ration for the patient and the room as well as for the instruments, dressings, and antiseptics needed " — New York Medical Record " Covers about all that can be needed in any operation." — American Lancet. " The plan is a capital one."— Boston Medical and Surgical Journal. LABORATORY EXERCISES IN BOTANY. By Edson S. Bastin, M. A., Professor of Materia Medica and Botany in the Philadelphia Col- lege of Pharmacy. Octavo volume of 536 pages, 87 full-page plates. Price, Cloth, $2.50. This work is intended for the beginner and the advanced student, and it fully covers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers, bulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross and microscopical structure of plants, and to those used in medicine. Illustra- tions have freely been used to elucidate the text, and a complete index to facil- itate reference has been added. " There is no work like it in the pharmaceutical or botanical literature of this country, and we predict for it a wide circulation." — American Journal of Pharmacy. DIET IN SICKNESS AND IN HEALTH. By Mrs. Ernest Hart, formerly Student of the Faculty of Medicine of Paris and of the London School of Medicine for Women ; with an Introduction by Sir Henry Thompson, F. R. C. S., M. D., London. 220 pages; illustrated. Price, Cloth, $1.50. Useful to those who have to nurse, feed, and prescribe for the sick. In each case the accepted causation of the disease and the reasons for the special diet prescribed are briefly described. Medical men will find the dietaries and recipes practically useful, and likely to save them trouble in directing the dietetic treatment of patients. CATALOGUE OF MEDICAL WORKS. 23 HOW TO EXAMINE FOR LIFE INSURANCE. By John M. Keating, M. D., Fellow of the College of Physicians and Surgeons of Philadelphia; Vice-President of the American Pediatric Society; Ex- President of the Association of Life Insurance Medical Directors. Royal 8vo, 211 pages, with two large half-tone illustrations, and a plate prepared by Dr. McClellan from special dissections ; also, numerous cuts to elucidate the text. Second edition. Price, Cloth, $2.00 net. " This is by far the most useful book which has yet appeared on insurance examination, a subject of growing interest and importance. Not the least valuable portion of the volume is Part II., which consists of instructions issued to their examining physioians by twenty-four representative companies of this country. As the proofs of these instructions were corrected by the directors of the companies, they form the latest instructions obtainable. If for these alone, the book should be at the right hand of every physician interested in this special branch of medical science." — The Medical News, Philadelphia. NURSING: ITS PRINCIPLES AND PRACTICE. By Isabel Adams Hampton, Graduate of the New York Training School for Nurses attached to Bellevue Hospital; Superintendent of Nurses and Principal of the Training School for Nurses, Johns Hopkins Hospital, Baltimore, Md. ; late Superintendent of Nurses, Illinois Training School for Nurses, Chicago, 111. In one very handsome i2mo volume of 484 pages, profusely illustrated. Price, Cloth, $2.00 net. This original work on the important subject of nursing is at once comprehensive and systematic. It is written in a clear, accurate, and readable style, suitable alike to the student and the lay reader. Such a work has long been a desidera- tum with those entrusted with the management of hospitals and the instruction of nurses in training-schools. It is also of especial value to the graduated nurse who desires to acquire a practical working knowledge of the care of the sick and the hygiene of the sick-room. OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA- TIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of Obstetrics in the St. Louis Medical College. 381 pages, handsomely illus- trated. Price, $2.00 net. " For the use of the practitioner who, when away from home, has not the opportunity of consulting a library or of calling a friend in consultation. He then, being thrown upon his own resources, will find this book of benefit in guiding and assisting him in emergencies." INFANT'S WEIGHT CHART. Designed by J. P. Crozer Griffith, M. D., Clinical Professor of Diseases of Children in the University of Penn- sylvania. 25 charts in each pad. Price per pad, 50 cents net. A convenient blank for keeping a record of the child's weight during the first two years of life. Printed on each chart is a curve representing the average weight of a healthy infant, so that any deviation from the normal can readily be detected. 24 W. B. SAUNDERS' THE CARE OF THE BABY. By J. P. Crozer Griffith, M. D, Clinical Professor of Diseases of Children, University of Pennsylvania; Physician to the Children's Hospital, Philadelphia, etc. 404 pages, with 67 illustrations in the text, and 5 plates. 121110. Price, #1.50. SECOND EDITION, REVISED. A reliable guide not only for mothers, but also for medical students and practitioners whose opportunities for observing children have been limited. " The whole book is characterized by rare good sense, and is evidently written by a mas- ter hand. It can be read with benefit not only by mothers, but by medical students and by any practitioners who have not had large opportunities for observing children."— American Jjurnal of Obstetrics. THE NURSE'S DICTIONARY of Medical Terms and Nursing Treatment, containing Definitions of the Principal Medical and Nursing Terms, Abbreviations, and Physiological Names, and Descriptions of the Instruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods, Appliances, etc. encountered in the ward or the sick-room. By Honnor Morten, author of " How to Become a Nurse," " Sketches of Hospital Life," etc. i6mo, 140 pages. Price, Cloth, $1.00. This little volume is intended for use merely as a small reference-book which can be consulted at the bedside or in the ward. It gives sufficient explanation to the nurse to enable her to comprehend a case until she has leisure to look up larger and fuller works on the subject. DIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas, M. D., Visiting Physicia-n to the Home for Friendless Women and Children and to the Newsboys' Home ; Assistant Visiting Physician to the Kings County Hospital; Assistant Bacteriologist, Brooklyn Health Department. Price, Cloth, $1.50 (Send for specimen List.) One hundred and sixty detachable (perforated) diet lists for Albuminuria, Anaemia and Debility, Constipation, Diabetes, Diarrhoea, Dyspepsia, Fevers, Gout or Uric-Acid Diathesis, Obesity, and Tuberculosis. Also forty detachable sheets of Sick-Room Dietary, containing full instructions for preparation of easily-digested foods necessary for invalids. Each list is numbered only, the disease for which it is to be used in no case being mentioned, an index key being reserved for the physician's private use. DIETS FOR INFANTS AND CHILDREN IN HEALTH AND IN DISEASE. By Louis Starr, M. D., Editor of " An American Text-Book of the Diseases of Children." 230 blanks (pocket-book size), perforated and neatly bound in flexible morocco. Price, #1.25 net. The first series of blanks are prepared for the first seven months of infant life ; each blank indicates the ingredients, but not the quantities, of the food, the latter directions being left for the physician. After the seventh month, modifications being less necessary, the diet lists are printed in full. Formula ioi trie preparation of diluents and foods are appended. saunders' New Series of Manuals for Students and Practitioners* THAT there exists a need for thoroughly reliable hand-books on the leading branches of Medicine and Surgery is a fact amply demonstrated by the favor with which the SAUNDERS NEW SERIES OF MANUALS have been received by medical students and practitioners and by the Medical Press. These manuals are not merely condensations from present literature, but are ably written by well-known authors and practitioners, most of them being teachers in representative American colleges. Each volume is concisely and authoritatively written and exhaustive in detail, without being encumbered with the introduction of "cases," which so largely expand the ordinary text- book. These manuals will therefore form an admirable collection of advanced lectures, useful alike to the medical student and the practitioner : to the latter, too busy to search through page after page of elaborate treatises for what he wants to know, they will prove of inestimable value ; to the former they will afford safe guides to the essential points of study. The SAUNDERS NEW SERIES OF MANUALS are conceded to be superior to any similar books now on the market. No other manuals afford so much information in such a concise and available form. A liberal expenditure has enabled the publisher to render the mechanical portion of the work worthy of the high literary standard attained by these books. Any of these Manuals will be mailed on receipt of price (see next page for List). W, B. SAUNDERS, Publisher, 925 Walnut Street, Philadelphia, SAUNDERS' NEW SERIES OF MANUALS. VOLUMES PUBLISHED. PHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor of Physiology and Hygiene and Lecturer on Gynecology in the Long Island College Hospital, etc. Price, #1.25 net. SURGERY, General and Operative. By John Chalmers DaCosta, M. D„ Demonstrator of Surgery, Jefferson Medical College, Philadelphia, etc. Octavo, 911 pages, 386 illustrations. Cloth, $4.00 net; Half- Morocco, $5.00 net. DOSE-BOOK AND MANUAL OF PRESCRIPTION- WRITING. By E. Q. Thornton, M. D., Demonstrator of Therapeutics, Jefferson Medical College, Philadelphia. Price, #1.25 net. MEDICAL JURISPRUDENCE. By Henry C. Chapman, M. D., Pro- fessor of Institutes of Medicine and Medical Jurisprudence in the Jeffer- son Medical College of Philadelphia, etc Price, $1.50 net. SURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark's Hospital and to the German Poliklinik ; Instructor in Surgery, New York Post-Graduate Medical School, etc. Price, $1.25 net. MANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct Professor of Anatomy and Demonstrator of Anatomy, Medical Department of the New York University, etc. (Double number.) Price, $2.50 net. SYPHILIS AND THE VENEREAL DISEASES. By James Nevins Hyde, M. D., Professor of Skin and Venereal Diseases, and Frank H. Montgomery, M. D., Lecturer on Dermatology and Genito- urinary Diseases, in Rush Medical College, Chicago. (Double number.) Price, #2.50 net. PRACTICE OF MEDICINE. By George Roe Lockwood, M. D., Professor of Practice in the Woman's Medical College of the New York Infirmary, etc. (Double number.) Price, $2.50 net. OBSTETRICS. By W. A. Newman Dorland, M. D., Asst. Demonstrator of Obstetrics, University of Pennsylvania ; Chief of Gynecological Dispen- sary, Pennsylvania Hospital. (Double number.) Price, $2.50 net. DISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant Surgeon to the Middlesex Hospital, and Surgeon to the Chelsea Hospital for Women, London; and Arthur E. Giles, M. D., B. Sc. Lond., F. R. C. S. Edin., Assistant Surgeon to the Chelsea Hospital for Women, London. 436 pages, handsomely illustrated. (Double number.) Price, $2.50 net. VOLUMES IN PREPARATION. NERVOUS DISEASES. By Charles W. Burr, M. D., Clinical Pro- fessor of Nervous Diseases, Medico-Chirurgical College, Philadelphia, etc. NOSE AND THROAT. By D. Braden Kyle, M. D., Clinical Professor of Laryngology and Rhinology, Jefferson Medical College, Philadelphia. *#* There will be published in the same series, at short intervals, carefully prepared works on various subjects, by prominent specialists. SAUNDERS' QUESTION COMPENDS. Arranged in Question and Answer Form, THE LATEST, MOST COMPLETE, and BEST ILLUSTRATED SEEIES OF COMPENDS EVEE ISSUED. Now the Standard Authorities in Medical Literature Students and Practitioners in every City of the United States and Canada. THE REASON WHY. They are the advance guard of " Student's Helps " — that DO help; they are the leaders in their special line, well and authoritatively written by able men, who, as teachers in the large colleges, know exactly what is wanted by a student preparing for his examinations. The judgment exercised in the selection of authors is fully demonstrated by their professional elevation. Chosen from the ranks of Demonstrators, Quiz-masters, and Assistants, most of them have be- come Professors and Lecturers in their respective colleges. Each book is of convenient size (5x7 inches), containing on an average 250 pages, profusely illustrated, and elegantly printed in clear, readable type, on fine paper. The entire series, numbering twenty- four subjects, has been kept thoroughly revised and enlarged when necessaiy, many of them being in their fourth and fifth editions. TO SUM UP. Although there are numerous other Quizzes, Manuals, Aids, etc. in the mar- ket, none of them approach the " Blue Series of Question Compends;" and the claim is made for the following points of excellence : 1. Professional distinction and reputation of authors. 2. Conciseness, clearness, and soundness of treatment. 3. Size of type and quality of paper and binding. *** Any of these Compends will be mailed on receipt of price (see over for List), SAUNDERS' QUESTION-COMPEND SERIES. Price, Cloth, $1.00 per copy, except when otherwise noted. 1. ESSENTIALS OF PHYSIOLOGY. 3d edition. Illustrated. Re- vised and enlarged by H. A. Hare, M. D (Price, #1.00 net.) 2. ESSENTIALS OF SURGERY. 6th edition, with an Appendix on Antiseptic Surgery. 90 illustrations. By Edward Martin, M. D. 3. ESSENTIALS OF ANATOMY. 5th edition, with an Appendix. 180 illustrations. By Charles B. Nancrede, M. D. 4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND INORGANIC. 4th edition, revised, with an Appendix. By Law- rence Wolff, M. D. 5. ESSENTIALS OF OBSTETRICS. 4th edition, revised and en- larged. 75 illustrations. By W. Easterly Ashton, M. D. 6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. 7th thousand. 46 illustrations. By C. E. Armand Semple, M. D. 7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, AND PRESCRIPTION- WRITING. 4th edition. By Henry Morris, M. D. 8. 9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry Morris, M. D. An Appendix on Urine Examination. Illustrated. By Lawrence Wolff, M. D. 3d edition, enlarged by some 300 Es- sential Formulae, selected from eminent authorities, by Wm. M. Powell, M. D. (Double number, price $2.00.) 10. ESSENTIALS OF GYNECOLOGY. 4th edition, revised. With 62 illustrations. By Edwin B. Cragin, M. D. 11. ESSENTIALS OF DISEASES OF THE SKIN. 3d edition, re- vised and enlarged. 71 letter-press cuts and 15 half-tone illustrations. By Henry W. Stelwagon, M. D. (Price, $1.00 net.) 12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND VENEREAL DISEASES. 2d edition, revised and enlarged. 78 illustrations. By Edward Martin, M. D. 13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE. 130 illustrations. By C. E. Armand Semple, M. D. 14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND THROAT. 124 illustrations. 2d edition, revised. By Edward Jackson, M. D., and E. Baldwin Gleason, M. D. 15. ESSENTIALS OF DISEASES OF CHILDREN. Second edi tion. By William H. Powell, M. D. 3. ESSENTIALS OF EXAMINATION OF URINE. Colored " Vogel Scale," and numerous illustrations. By Lawrence Wolff, M. D. (Price, 75 cents.) 17. ESSENTIALS OF DIAGNOSIS. By S. Solis-Cohen, M. D., and A. A. Eshner, M. D. 55 illustrations, some in colors. (Price, $1.50 net.) 18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E. Sayre. 2d edition, revised. 20. ESSENTIALS OF BACTERIOLOGY. 3d edition. 82 illustra- tions. By M. V. Ball, M. D. 21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. 48 illustrations. 3d edition, revised. By John C. Shaw, M. D. 22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d edition, revised. By Fred J. Brockway, M. D. (Price, $1.00 net.) 23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations. By David D. Stewart, M. D., and Edward S. Lawrance, M. D. 24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Gle\- RECENT PUBLICATIONS PENROSE'S DISEASES OF WOMEN A Text=Book of Diseases of Women. By Charles B. Penrose, M.D., Ph.D., Professor of Gynecology in the University of Pennsylvania; Surgeon to the Gynecean Hospital, Philadelphia. Octavo volume of 529 pages, handsomely illustrated. Cloth, $3.50 net. "I shall value very highly the copy of Penrose's "Diseases of Women " received. I have already recommended it to my class as the best book."— Howard A. Kelly, Professor of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Md. SENN'S GENITOURINARY TUBERCULOSIS Tuberculosis of the Genito=Urinary Organs, Male and Female. By Nicholas Senn, M.D., Ph.D., LL.D., Professor of the Practice of Surgery and of Clinical Surgery, Rush Medical College, Chicago. Handsome octavo volume of 320 pages, illustrated. Cloth, $3.00 net. SUTTON AND GILES' DISEASES OF WOMEN Diseases of Women. By J. Bland Sutton, F.R.C.S., Assistant Surgeon to Middle- sex Hospital, and Surgeon to Chelsea Hospital, London; and Arthur E. Giles, M.D., B.Sc. Lond., F R.C.S. Edin., Assistant Surgeon to Chelsea Hospital, London. 436 pages, handsomely illustrated. Cloth, $2.50 ne t. BUTLER'S MATERIA MEDICA, THERAPEUTICS, AND PHAR= MACOLOGY. Second Edition, Revised A Text=Book of Materia Medica, Therapeutics, and Pharmacology. By George F. Butler, Ph.G., M.D., Professor of Materia Medica and of Clinical Medicine in the College of Physicians and Surgeons, Chicago ; Professor of Materia Medica and Therapeutics, Northwestern University, Woman's Medical School, etc. Octavo, 858 pages, illustrated. Cloth, $4.00 net ; Sheep, $5.00 net. SAUNDBY'S RENAL AND URINARY DISEASES Lectures on Renal and Urinary Diseases. By Robert Saundby, M.D. Edin., Fellow of the Royal College of Physicians, London, and of the Royal Medico-Chirur- gical Society ; Physician to the General Hospital; Consulting Physician to the Eye Hospital and to the Hospital for Diseases of Women ; Professor of Medicine in Mason College, Birmingham, etc. Octavo volume of 434 pages, with numerous illustrations and 4 colored plates. Cloth, $2.50 net. PYE'S BANDAGING Elementary Bandaging and Surgical Dressing, with Directions Concerning the Immediate Treatment of Cases of Emergency. For the Use of Dressers and Nurses. By Walter Pye, F.R.C.S., Late Surgeon to St. Mary's Hospital, London. Small i2mo, with over 80 illustrations. Cloth, flexible covers. Price, 75 cents net. MALLORY AND WRIGHT'S PATHOLOGICAL TECHNIQUE Pathological Technique. By Frank B. Mallory, A.M., M.D., Assistant Professor of Pathology, Harvard University Medical School ; and James H. Wright, A.M., M.D., Instructor in Pathology, Harvard University Medical School. Octavo volume of 396 pages, handsomely illustrated. Cloth, $2.50 net. " I have been looking forward to the publication of this book, and I am glad to say that I find it to be a most useful laboratory and post-mortem guide, full of practical infor- mation, and well up to date."— William H. Welch, Professor of Pathology, Johns Hopkins University, Baltimore, Md. ANDERS* PRACTICE OF MEDICINE. Second Edition A Text=Book of the Practice of Medicine. By James M. Anders, M.D., Ph.D., LL.D., Professor of the Practice of Medicine and of Clinical Medicine, Medico- Chirurgical College, Philadelphia. In one handsome octavo volume of 1287 pages, fully illustrated. Cloth, #5.50 net ; Sheep or Half Morocco, $6.50 net. ANOMALIES AND CURIOSITIES OF MEDICINE. BY GEORGE M. GOULD, M. D., and WALTER L. PYLE, M. D. Several years of exhaustive research have been spent by the authors in the great medical libraries of the United States and Europe in collecting the material for this work, fledical literature of all ages and all languages has been carefully searched, as a glance at the Bibliographic Index will show. Tha facts, which will be of extreme value to the author and lecturer, have been arranged and annotated, and full reference footnotes given, indicating whence they have been obtained. In view of the persistent and dominant interest in the anomalous and curious, a thorough and systematic collection of this kind (the first of which the authors have knowledge) must have its own peculiar sphere of usefulness. As a complete and authoritative Book of Reference it will be of value not only to members of the medical profession, but to all persons interested in general scientific, sociologic, and medico-legal topics ; in fact, the general inter- est of the subject and the dearth of any complete work upon it make this volume one of the most important literary innovations of the day. An especially valuable feature of the book consists of the Indexing. Besides a complete and comprehensive General Index, containing numerous cross-references to the subjects discussed, and the names of the authors of the more important reports, there is a convenient Bibliographic Index and a Table of Contents. The plan has been adopted of printing the topical headings in bold = face type, the reader being thereby enabled to tell at a glance the subject- matter of any particular paragraph or page. Illustrations have been freely employed throughout the work, there being 165 relief cuts and 130 half-tones in the text, and 12 colored and half-tone full- page plates — a total of over 320 separate figures. The careful rendering of the text and references, the wealth of illustrations, the mechanical skill represented in the typography, the printing, and the bind- ing, combine to make this book one of the most attractive medical publications ever issued. Handsome Imperial Octavo Volume of 968 Pages. PRICES: Cloth, $6.00 net; Half Morocco, $7.00 net. 3° JUST ISSUED AN AMERICAN TEXT=BOOK OF GENITOURINARY AND SKIN DISEASES Edited by L. Bolton Bangs, M.D., Late Professor of Genito-Urinary and Venereal Diseases, New York Post-Graduate Medical School and Hospital ; and William A. Hardaway, M.D., Professor of Diseases of the Skin, Missouri Medical College. Octavo volume of over 1200 pages, with 300 illustrations in the text, and 20 full-page colored plates. Prices: Cloth, $7.00 net ; Sheep or Half Morocco, $8.00 net. MOORE'S ORTHOPEDIC SURGERY A Manual of Orthopedic Surgery. By James E. Moore, M.D., Professor of Ortho- pedics and Adjunct Professor of Clinical Surgery, University of Minnesota, College of Medicine and Surgery. 8vo, 356 pages, handsomely illustrated. Cloth, $2.50 net. MACDONALD'S SURGICAL DIAGNOSIS AND TREATMENT Surgical Diagnosis and Treatment. By J. W. Macdonald, M.D. Edin., L.R.C.S. Edin., Professor of the Practice of Surgery and of Clinical Surgery in Hamline Uni- versity ; Visiting Surgeon to St. Barnabas' Hospital, Minneapolis, etc. Octavo volume of 800 pages, handsomely illustrated. Cloth, 55.00 net; Half Morocco, $6.00 net. CHAPIN ON INSANITY A Compendium of Insanity. By John B. Chapin, M.D., LL.D., Physician-in-Chief, Pennsylvania Hospital for the Insane; late Physician-Superintendent of the Willard State Hospital, New York, etc. i2mo., 234 pages, illustrated. Cloth, $1.25 net. KEEN ON THE SURGERY OF TYPHOID FEVER The Surgical Complications and Sequels of Typhoid Fever. By Wm. W. Keen, M.D., LL.D., Professor of the Principles of Surgery and of Clinical Surgery, Jeffer- son Medical College, Philada. Octavo volume of 400 pages. Cloth, $3.00 net. VAN VALZAH AND NISBET'S DISEASES OF THE STOMACH Diseases of the Stomach. By William W. van Valzah, M.D., Professor of General Medicine and Diseases of the Digestive System and the Blood, New York Polyclinic ; and J. Douglas Nisbet, M.D., Adjunct Professor of General Medicine and Diseases of the Digestive System and the Blood, New York Polyclinic. Octavo volume of 674 pages, illustrated. Cloth, $3.50 net. IN PREPARATION AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, EAR, NOSE, AND THROAT Edited by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jefferson Medical College; and B. Alexander Randall, M.D., Professor of Diseases of the Ear in the University of Pennsylvania and in the Philadelphia Polyclinic. CHURCH AND PETERSON'S NERVOUS AND MENTAL DISEASES Nervous and Mental Diseases. By Archibald Church, M.D., Professor of Mental Diseases and Medical Jurisprudence, Northwestern University Medical School, Chicago; and Frederick Peterson, M.D. , Clinical Professor of Mental Diseases, Woman's Medical College, New York, etc. KYLE ON THE NOSE AND THROAT Diseases of the Nose and Throat. By D. Braden Kvle, M.D., Clinical Professor of Laryngology and Rhinology, Jefferson Medical College, Philadelphia ; Consulting Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital, etc. STENGEL'S PATHOLOGY A Manual of Pathology. By Alfred Stengel, MDi, Physician to the Philadel- phia Hospital; Professor of Clinical Medicine in the Woman's Medical College; Physician to the Children's Hospital, etc. HIRST'S OBSTETRICS A Text=Book of Obstetrics. By Barton Cooke Hirst, M.D., Professor of Ob stetrics, University of Pennsylvania. HEISLER'S EMBRYOLOGY A Text=Book of Embryology. By John C. Heisler, M.D., Professor of Anatomy, Medico-Chirurgical College, Philadelphia. s NOW KEADY, VOLUMES FOR 1896,1897,1898. s^tt:£t:d:e:r,s 7 AMERICAN YEAR-BOOK OF MEDICINE and SURGERY, Edited by GEORGE M. GOULD, A. NL, M. D. Assisted by Eminent American Specialists and Teachers. n. s> • ^ Notwithstanding the rapid multiplication of medical and surgical works, © still these publications fail to meet fully the requirements of the general physician^ ^ inasmuch as he feels the need of something more than mere text-books of well- ;* known principles of medical science. Mr. Saunders has long been impressed ^ ,5 with this fact, which is confirmed by the unanimity of expression from the pro- *" 8 fession at large, as indicated by advices from his large corps of canvassers. fcj This deficiency would best be met by current journalistic literature, but most >£ % practitioners have scant access to this almost unlimited source of information, <* » and the busy practiser has but little time to search out in periodicals the many <* g interesting cases whose study would doubtless be of inestimable value in his 5 O practice. Therefore, a work which places before the physician in convenient k ^ form an epitomization of this literature by persons competent to pronounce upon % § . The Value of a Discovery or of a Method of Treatment ^. «> cannot but command his highest appreciation. It is this critical and judicial § .% function that will be assumed by the Editorial staff of the " American Year- ^ Book of Medicine and Surgery." £? g It is the special purpose of the Editor, whose experience peculiarly qualifies «. 8 him for the preparation of this work, not only to review the contributions to fcg Oi 50 American journals, but also the methods and discoveries reported in the leading § fe medical journals of Europe, thus enlarging the survey and making the work ^ » characteristically international. These reviews will not simply be a series of * § undigested abstracts indiscriminately run together, nor will they be retrospective « £ of " news " one or two years old, but the treatment presented will be synthetic §?• ^ and dogmatic, and will include only what is new. Moreover, through expert $ £ condensation by experienced writers these discussions will be Comprised in a Single Volume of about 1200 Pages. The work will be replete with original and selected illustrations skilfully reproduced, for the most part in Mr. Saunders' own studios established for the purpose, thus ensuring accuracy in delineation, affording efficient aids to a right comprehension of the text, and adding to the attractiveness of the volume. Prices : Cloth, $6.50 net; Half Morocco, $7.50 net. W. B. SAUNDERS, Publisher, 925 Walnut Street, Philadelphia.