IM^ COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX64135713 RC734 .L52 1884 A pharmacopoeia for RECAP ^^^ 5^^^- lio in tJje Citp of ^eto gorfe COLLEGE OF PHYSICIANS AND SURGEONS Reference Library Given by /i^> Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/pharmacopoeiafoOOIeff A PHARMACOPOEIA FOR THE TREATMENT OF DISEASES OF THE LARYNX, PHARYNX AND NASAL PASSAGES With Remarks on the Selection of Remedies and Choice of Instruments and on the Methods of Making Local Applications BY GEORGE MOREWOOD LEFFERTS, A.M., M.D. Clinical Professor of Laryngoscopy and Diseases of the Throat, CoUes^e of Physicians and Surgeon's, Medical Department of Columbia College New York SECOND EDITION, REVISED AND ENLARGED NEW YORK & LONDON G. P. PUTNAM'S SONS Vi^z ^nitkcibotkr ^rcss 1884 COPYRIGHT BY GEORGE MOREWOOD LEFFERTS Press of P. Putnam's Sons New York PREFACE. The experience of a number of years in clinical teacli- ing has convinced me that the time which is ordinarily devoted, during a limited course of lectures on a special subject, in dictating to the student in the first instance, and repeating in detail from time to time during the course, the necessarily large number and variety of formulae that are requisite for intelligent treatment, can be more profitably employed, and the subject itself bet- ter and more clearly understood without laborious and too often imperfect note-taking, by collecting the commoner and more reliable ones in a systematic but simple form, which will always be accessible and ready for reference. In pursuance of this conviction I have prepared this little volume for the use of my Students, and in connection with my lectures, and I offer this explanation to those members of the profession who may have occasion to consult my work, in view of the necessarily somewhat brief, even dogmatic, manner in which certain personal views are presented and certain courses of treatment advised. The following pages will be found to contain the for- mulae alone of such local applications as are adapted to the treatment of the various affections of the larynx, phar- ynx, and nasal passages, and which have been carefully tested in the light of personal clinical experience and found to possess a practical worth. IV PREFACE. Constitutional remedies are not included in the list, being foreign to the purpose of the work, but they are none the less regarded as of the highest importance in the treatment of many of the affections with which it deals. The formulae have been collected from various works and authorities ; many of them are original. I have availed myself of the labors of my predecessors and con- temporaries whenever it has been possible, and here ren- der them my general acknowledgment, specific credit in all instances to the sources of information being imprac- ticable in a work of this character and size. Many drugs and combinations that have been recom- mended from time to time in the rapid development of the speciality have been rejected as having no real value, but none that are'to-day regarded as essential have, it is believed, been omitted. I have thought it desirable, in the present new edition, to add certain suggestions which will serve as a guide to the student in his choice of remedies, and remarks on the proper method of making applications to the various parts, together with illustrations of the requisite apparatus, all with the view of rendering the entire matter of local treatment clear and readily understood. All matters relating to practical Pharmacy have been kindly revised for me by George D. Hays, M.D., Ph.G. If the little volume now presented to the medical class will aid in systematizing and simplifying the labors of its students in this department of therapeutics, its mission will have been fulfilled. G. M. L. October, 1884. CONTENTS. I. Pigmenta ........ A. — For External Use B. — For Internal Use (Nasal Passages.) II. Collunaria — Cleansing and Disinfecting Solutions III. Aquae Medicatse — Medicated Sprays . IV. Collyria — Medicinal Solutions for Local Application V. Pulveres — Powders for Insufflation VI. Buginaria — Nasal Bougies ..... VII. Gossypia — Medicated Cotton-Wools . VIII. Inhalationes — Inhalations ..... A. — ^Vapores Calidi — Steam Inhalations. B. — Nebulae — Atomized Fluid Inhalations. C. — Fumi — Fumincr Inhalations. 3 12 25 29 36 39 40 IX. Gargarismas — Gargles . . 56 X. Trochisci — Lozenges— Pastils 61 XI. Caustica — Caustics .... 68 XII. Varise — Miscellaneous 79 Appendix ...... 82 Classified Index. .... . . 91 PIGMENTA. A. For External Use. Employed in some forms of Laryngitis, as counter-irritants. Ap- plied externally over the larynx. Ceratum Cantharidis. Charta Cantharidis. Linimentum Cantharidis. Tinctura lodi. Tinctura lodinii Composita (U.S. P., 1870). Linimentum lodi (B.P.). Used as anesthetics, in the forms of Hyperaesthesia of the Larynx. Applied externally over the organ. Ungaentum Aconitiae (B.P.). Linimentum Aconiti (U.S. P., 1870). Linimentum Belladonnae. Linimentum Chloroformi. Pulveris Camphorse. Chloralis . . . . aa f ss Rub together in a warm mortar until liquefied, then filter. Signa — Camphorated chloral. PHA RMA COP CEIA , B. For Internal Use. Used as applications to the nasal passages, by means of a camel's- hair pencil or brush. Fig. I. — Brushes for applications to the nasal passages. Petrolati (Vaseline) Petrolati Hydragyri Chloridi Mitis M. Ft. unguentum. ^ Unguenti Belladonnae . q. s. 3 ss 3 ss q. s. ^ Acidi Carbolici . . . gr. ii lodi gr. ii Atropinse . . . . gr. ss Petrolati . . .ad 3 i M. Ft. unguentum. Signa — In Chronic Rhinitis, 11. COLLUNARIA— CLEANSING AND DISIN- FECTING SOLUTIONS. Solutions for general cleansing purposes, used in coarse spray in the larynx and nasal passages, or by means of the anterior and pos- terior nasal syringe, to the latter region, at a temperature of about 90°-ioo° F. LarynXo Careful cleansing of the mucous surfaces of the larynx is not infrequently a necessary procedure, prior to the application of the medicated spray or powder. Notably is this the case in Laryngeal Phthisis, where the secre- tions are thick, abundant, and tenacious, and thus mask the diseased parts — specially the ulcerations, which lie beneath them. The cleansing process is best performed by means of the laryngeal spray, used with compressed air (see page 13), and one or two applications are to be made, either with or without the aid of the laryngoscopic mirror, at each sitting, before use of the medicament. The following solution may be used * 3 4 F HARM A COP (EI A . Sodii Bicarbonatis. Sodii Boratis . . . aa 3 ss Listenne ... 31 Aquae . . . .ad | iv Nasal Passages. A very essential principle in the local treatment of catarrhal affections of the nasal passages is thorough cleanliness ; it underlies all others. There certainly can be little remedial value in the application of a medicated spray or powder that only reaches parts covered and pro- tected by a layer of thick, tenacious mucus, or, still less, those encased in an armor of hard, inspissated crusts. On the other hand, I am convinced that this matter of cleanliness, if the latter be understood to mean frequent, daily, even several times a day, syringing of the nose, is overdone, and that it does much harm. The comfort, fancied or real, that the patient experiences after the use of his ''nasal douche," even though this relief be only temporary, as it always is, leads him to repeat the process with constantly increasing frequency. Instances are not unknown where patients will use a quart of strong saline solution, under higli pressure, through the nose several times daily. Physicians are not entirely guiltless in the matter, for it is not infrequently that the patient is mis- led by their belief that the cure of a nasal catarrh lies in the use of a " douche." Such practices, I repeat, are productive of no good, but much harm. Even apparent * See page 23. COLLUNAKIA. 5 temporary good effects ultimately fail. The use of strong saline solutions in large quantity, passed through the nares under high pressure, is not infrequently an efficient factor in the propagation, if not in the causation, as I be- lieve that I have many times seen it, of a chronic inflam- mation of the delicate nasal mucous membrane, with its usual result of permanent infiltration of the mucous and submucous structures. All this rather than a means for its relief. While, then, cleanliness is essential, mechanical means for attaining it are to be used with great discretion. There is nothing curative in their employment. They are by no means as generally necessary as was formerly supposed. I believe that in my practice I have discon- tinued their use in more than fifty per cent, of cases, and the latter not only do just as well, but better, being relieved of an element of irritation. All instruments, then, for cleansing purposes, and I include here the "nasal douche " with its many modifications, anterior and pos- terior nasal syringes, and the like — I even add cleansing sprays — are only necessary and are only to be used in exceptional cases of aggravated catarrhal inflammation, with accumulation of pent-up or hardened secretions, and in cases attended by the formation and firm impac- tion in the passages of hard, dense crusts, as in atrophic or fetid catarrh and in ozaena. In simple chronic rhini- tis, and in some — perhaps one half — of the cases of hypertrophic rhinitis their use is not required as a rule. The patient can readily remove the soft, semi-fluid secre- tions by simply blowing the nose ; if he cannot, or if the secretions collect at the vault of the pharynx, one jet of PHARMA COP mi A . spray containing some alkali or some '' Listerine," thrown behind the velum or into the anterior nares, just prior to the use of the medicated spray or powder will be amply sufficient to loosen and remove them. Let us suppose, however, that we are called upon to treat a case such as I have described, where the use of some instrument is a necessity in order that the pent-up or hardened secretions may be removed before you make your application of the remedial agent. What form of instrument shall we use ? Which method prefer ? Never use a " nasal douche," it is an inefficient instrument for the purpose for which it was designed, insomuch as it does not thoroughly wash or cleanse the nasal cavities, even when carefully used. I prefer, and I strongly advise the employment of the instrument that I show Fig. 2. — Nasal spray apparatus. here, and which I devised some years ago. It is simply an apparatus arranged to throw a very coarse spray in the right direction into the anterior nares. The conical tip closes one nostril completely; the fluid then enters one COLLUNARIA. y nasal passage and passes out by the other. Power is obtained by means of a double hand-ball tube. We call it the "nasal spray apparatus." With it the nasal passa- ges and upper pharynx may, except in rare instances, be thoroughly cleansed of secretions and crusts by the use of less than one ounce of the medicated fluid contained in its bottle or reservoir. Here, at once, is an immense advantage gained over the quart or even pint of fluid used commonly in the " douche." Being a coarse spray it washes up, loosens, and dislodges the secretions (unless they are firmly impacted in extreme cases) by the con- stant commotion of the fluid in the nasal passages, and this very readily and quickly. Explicit directions are to be given in every case to the patient for its use. They are as follows : 1. Warm the medicated fluid in the bottle before using, by holding the filled bottle for a few moments in hot water. 2. Hold the body erect and incline the head very slightly forward over the toilet basin. 3. Introduce the conical nozzle of the apparatus into the nostril (first on the side most occluded) far enough to close it perfectly, holding at the same time the horizontal' tube of the apparatus directly outwards from the face ; do not turn it from side to side or downward, and make a trial of the spray by compressing the hand ball once, to prove that the opening in the nozzle is not occluded in the nostril ; then — 4. Open the mouth widely and breathe gently but quickly through it in a snoring manner ; avoid carefully all attempts at speaking, swallowing, or coughing (at the 8 PHARMACOPCEIA. moment that the fluid passes into the upper part of the throat from the nostril being operated upon, a desire to swallow will be experienced; resist it, and the next second the fluid passes forward through the opposite nostril). 5. Hold the end ball of the apparatus firmly in the right hand (the left holds the bottle) and operate it briskly^ until the spray of medicated fluid, which should be felt at once to enter the nasal passage, has passed around it and appears at the opposite nostril; at this moment, stop. 6. Remove the nozzle from the nostril; allow the sur- plus fluid to run out of the latter ; then blow the nose gently — 7iever vigorously. 7. Repeat the operation upon the opposite nostril. In the severer forms of nasal disease — those attended by the formation and impaction of hard, dense crusts and masses in the nasal passages and upper pharynx — the use of this " nasal spray apparatus " will not be sufficient to dislodge them in the first instance, and a more powerful means (short of direct instrumental removal) must be employed. This result is obtained by the ''posterior nasal syringe," of hard rubber or metal, with a long, curved nozzle, which is used to cleanse the parts posteriorly (by way of the upper pharynx and posterior nares). Fig. 3. — Posterior nasal syringe. COLLUNARIA. 9 Or still better, by means of the apparatus figured below. Fig 4. — Post-nasal tube with metal syringe. This procedure is always disagreeable, sometimes pain- ful, to the patient, and care must always be taken not to bruise the parts during the introduction of the nozzle of the syringe or tube. Toleration will be established after a time. For cleansing purposes through the anterior nares an easier matter — the large, hard-rubber syringe of the aurist answers the purpose well. Fig. 5. — Anterior nasal syringe. Cleansing and Disinfecting Solutions. ]^ Sodii Bicarbonatis. Sodii Boratis . . aa 3 ss "Listerine" . . . . §i Aquae . . .ad ^ iv M. Signa — Used with the nasal spray apparatus. lO PHARMACOPCEIA, Acidi Carbolici . . gr. v-x Sodii Boratis. Sodii Bicarbonatis . . aa 3 ss Glycerini. Aquae Rosae . . . aa 3 ii Aquae ... ad 3 iv M. Signa — Used with the nasal spray apparatus. " Listerine " . 3 ss, 3 i, 3 ii, % iv Aquae ..... f iv M. Signa — Used with the nasal spray apparatus. Where a much larger quantity of a cleansing solution is necessarily used, as with the anterior or posterior nasal syringe, simple warm water, with the addition of borax — ten grains to each ounce — or " Listerine " in the propor- tion of one part to from two to ten of warm water, will answer the purpose. I sometimes — when the disagree- able odor is strong — use, after a thorough syringing with an alkaline solution, 2, spray of equal parts of " Listerine " and water ; it destroys fetor very quickly, and substitutes for it the pleasant odor of the thyme. Other cleansing solutions for use in large quantity, with the syringe, are as follows. They should all be used at or near the temperature of 100° F. Glyceriti Acidi Carbolici (U.S. P. 1870) 3 jss Sodii Boratis . . . . . 3 i Aqus ad Oi M. COLLUNARIA. \i Liquoris Potassii Permanganatis (U.S. P. 1870) 3 iss Sodii Boratis . . . . . . . 3 i Aquse . ad O i M. ^ Acidi Salicylici . gr. X Sodii Bicarbonatis . 3i Aquae .... Oi M. 5 Sodii Bicarbonatis. Sodii Boratis. Sodii Chloridi . . aa gr. vii Sacchari . . . . gr. xv M. Signa — The powder should be dissolved in about half a tumblerful of tepid water. Sodii Boratis 3i Glyceriti Acidi Carbolici (U.S.P. 1870) . 3 ii Sodii Bicarbonatis . . . . . 3 i Aquae .... . . O ss M. Signa— " Dobell's Solution." The water should be warm. Chlorate of potash or " Condy's fluid " solution of permanganate of potassium may be used in place of the Borax in this formula. in. AQIJJE MEDICATiE — MEDICATED SPRAYS. Solutions for local applications, by means of glass, hard-nibber, or metal spray tubes and the compressed air-apparatus, or by any of the many forms of hand-ball atomizer, adapted for the purpose, to the larynx, pharynx, anterior and posterior nares. My own experience prejudices me strongly in favor of the medicated spray, as a means of making a thorough and efficient application to a diseased laryngeal mucous membrane. In regard to its superiority over other methods in applications to the upper pharyngeal space and posterior nares, as well as anteriorly, through the nasal passages, there is, I think, no question. I believe, that with a proper spray tube and a pressure of com- pressed air of about forty pounds to the square inch, no more perfect application can be made to the parts. I prefer this high pressure of compressed air to the lower power so often recommended. I have never done harm to the mucous membrane with it, and the increased power of propulsion in the cloud of spray, renders it possible to reach instantly — before any spasmodic contraction of the larynx takes place — its entire mucous surface. In the 12 AQUM MEDIC A Tj^. T^ nasal passages the same pressure causes the spray to en- ter and thoroughly bathe all of the many irregularities and recesses that here abound- Larynx. A spray application to the larynx should always be made, as is that with the laryngeal brush (see remarks : Collyria), under the guidance afforded by the laryngo- scopic mirror — the concave forehead mirror and artificial illumination being used, the patient holding his own tongue and phonating the vowel sound " e," in order to elevate the epiglottis and bring the vocal cords to- gether at the instant before the volume of spray is dis- charged into the larynx ; the operator holds the spray tube in his right hand, and the laryngoscopic mirror in his left. Pharynx. A spray application to the middle pharynx is made at the moment that the operator, with his left hand holding the spatula, depresses the patient's tongue well down into the floor of the mouth, and while the latter is breath- ing quietly, in order that the parts — viz., the faucial pillars, soft palate, and constrictor muscles of the pharynx — may be relaxed, not contracted. A much larger space is thus uncovered to the spray, and a corresponding degree of effectiveness gained. Nasal Passages. A spray to the nasal passages should always be applied, if possible, through the upper pharynx and 14 P HARM A COPCEIA. posterior nares, as follows : The patient depressing his tongue by means of a spatula, the velum palati must be drawn forward — that is, away from the posterior pharyn- geal wall — by means of a suitable strong wire, bent at its end into a small, rounded hook and covered by bougie material — a procedure that can readily be accomplished in all cases after a little practice, and one that I regard as absolutely essential to the thorough success of the appli- FlG. 6. — Compressed-air spray apparatus.* cation, as it is the only way in which a practicable degree of space can be gained through w'hich to throw a spray up- ward and forward through the nasal passages. To at- tempt an application w^ith the velum drawn upward and backward — closely approximated to the pharyngeal wall, is nonsense ; in this position it will be found, the moment * The complete compressed-air spray apparatus is manufactured by J. Reynders & Co., of New York. AQUM MEDICATE. 15 that you introduce your spray tube into the patient's mouth, in nine cases out of ten. The ''palate hook " is held in the operator's left hand, his right holds and controls the spray tube and the spray (the tube, being passed back of the velum,) is thus thrown upwards into the vault of the pharynx and forwards Fig. 7. — Compressed-air spray apparatus. through both nasal passages, so that it appears, at both nostrils, in a fine cloud. Such applications as are here described are thorough and complete, not painful nor even very disagreeable to the patient, and that the results, obtained by a series of such, far exceed those obtained by any other method of local applications, ample experience has shown me. l6 PH ARM A COP (EI A. The spray tubes shown in fig. 8 are made of vulcanized rubber ; the best and cheapest tubes, however, are those made of glass, but they are, of course, more fragile than the above, or than the others made of metal and nickel- plated, which can only be used with certain non-corrosive solutions. A spray tube has been designed by Wile, that is modelled after the pattern of Sass, but, instead of being made of two tubes cemented together, as in the case of glass, or riveted, as in the ordinary hard-rubber tubes, both of which are liable to break or spring apart, the tubes in question are made of one solid piece of hard rubber ; and the tips, instead of being permanently at- tached to the body of the tubes, are screwed in and are made interchangeable. By means of a small wrench, they are readily unscrewed and taken out for purposes of cleansing. The " automatic cut-off," for attachment to the end of the spray tube for the purpose of controlling the- air current (fig. 9), is preferred by some operators. A cheaper and, I think, a better method, is to attach the spray tube to the connecting rubber tube (covered with silk or mohair) — (see fig. 6 and fig. 7) from the air receiver, by means of a metal, air-tight bayonet joint, and then control the air current through the rubber tube, by pressure of this with the thumb of the hand that holds the spray tube against the end of the latter (see fig. 6) ; or, if necessary — but it is less convenient — the connect- ing rubber tube from the air receiver may be simply slipped over the end of the spray tube at the time the application is made to the throat with the latter, and the air-current controlled by the thumb, as above described. AQU^E MEDICATE. 17 Three spray tubes constitute a set. One is so arranged as to throw the jet of spray upwards (naso-pharynx) ; the second, downwards, (larynx) ; and the third, directly out- wards (pharynx and anterior nasal passages). Fig. 8. — Hard-rubber spray tubes. Fig. 9, — Automatic cut-off, for spray tube. If the general practitioner has not, or cannot obtain, the above instruments — viz., the compressed-air ap- paratus with air-pump and spray tubes — he is necessarily obliged to depend upon some form of hand atomizer, constructed upon either the principle of Richardson or Bergson, and in which the propelling power is developed by the use of hand-ball bulbs and tubes. Of these atomizers there is a great variety ; they are sold every- where, and at a moderate cost. A very good one is manu- factured by the Davidson Rubber Co., and called Hard- rubber Atomizer, Continuous Spray, No. 61, Others are shown in the following figures. Codman & Shurtleff, of Boston, manufacture likewise a large variety of very useful and efficient forms of hand-ball atomizer. 1 8 PHARMACOPCEIA. There is, then, no difficulty in securing a proper ap- paratus, and, by means of such, an application can be made with care, with good effect, rarely, how- ever, with the efficiency that attends the use of the compressed-air apparatus. In any of these forms of atomizer, the hand-balls should be double, in order that a continuous spray may be produced, and each instrument must be provided with three separate tips (occasionally only two are furnished, one of which is reversible), which screw or fasten on the horizontal Fig. 10. — Hard-iTibber atomizer, Fig. ii. — Hard-rubber atomizer, continuous spray (with two continuous spray (with three tips). tips). hard-rubber bar of the spray tube (one throws the spray downward to the larynx, one upward into thenaso-pharynx, and the third directly backward into the pharynx). The disadvantages of this form of spray apparatus, which make it inferior to the use of compressed air, are the length of time that it takes to develop the propelling power by means of hand-ball pressure, and the fact that both of the operator's hands are required to work the in- strument. Both of these points are of importance when A Q UM ME Die A TAL. 1 9 the latter is in position in an irritable throat, where time is all requisite, and a speedy application a necessity. Larynx. To make an application to the larynx with this instru- ment, the patient must stand or sit, facing a window, so that a good light is thrown into the widely-opened mouth ; or, still better, the operator should use the concave fore- head reflector, with artificial light. The patient draws his tongue well out of the mouth, and holds it between two fingers of the right hand, the tongue having first been covered by a small, clean napkin. The operator now carefully passes the horizontal bar of the instrument, on which is placed the tip which throws the spray down- ward, well back into the pharynx, without, however touching the posterior pharyngeal wall, and holds it steadily with his left hand, in a position which his ana- tomical knowledge tells him is such that the point of the instrument is directly above the mouth of the larynx (the laryngoscope cannot, of course, be used during this pro- cedure, as both of the operator's hands are occupied). The patient now takes a deep, full, and quick inspiration, at the same moment that the operator begins to compress the air-bulbs of the apparatus vigorously. A short, sharp laryngeal cough will be the evidence that the spray has entered the larynx. Pharynx. The application to the posterior pharyngeal wall is an easier matter, for the parts are directly before the operator. 20 PH ARM A COP (EI A. and under his vision. The patient depresses his tongue by means of a spatula, and breathes quietly. The proper tip is of course to be placed on the spray tube. Nasal Passages. A proper application with the " hand-ball spray " to the posterior nasal passages and upper pharynx is the most difficult. A patient is rarely found with a throat tolerant enough to allow of the spray being thrown with this in- strument up behind the velum, into the vault of the pharynx and posterior nares. Both of the operator's hands being again occupied with the atomizer, he cannot use the "palate-hook " to draw the velum forward, and, as a rule, therefore, he had better confine himself to ap- plications made through the anterior nares, and forced well and quickly back through them into the pharynx, if he employs this form of instrument. For simple applications to the pharynx, one of the fol- lowing forms in default of other apparatus may be advan- tageously employed. Their use is far superior in effective medication to that gained by the prescription of a gargle. They may also be used by the patient, his right hand holding the instrument, his left holding the spatula, by means of which he depresses his tongue. AQUM MEDICATE. 21 Fig. 12. — Atomizer (with re- movable tip) throwing a coarse spray. Fig. 13. — Atomizer throwing a coarse spray, ^ Larynx and Pharynx. Astringent Solutions.* Ferri et Ammonii Sulphatis Zinci lodidi . Zinci Chloridi Zinci Sulphocarbolatis Ferri Chloridi Ferri Sulphatis Zinci Sulphatis Cupri Sulphatis Aluminis Acidi Tannici Potassii Chloratis Liquoris Plumbi Subacetatis Diluti .... 3 ss- 3 i .ad gr. X— XX gr. x-xxx gr. x-xx 3 ss- 3 i 3 ss- 3 i 3 ss gr. v-xv. gr, x-xv gr. v-xx 3i TUXX-XXX aquae ^ Stimulant. Argenti Nitratis . . gr x, xx, xxx- 3 i ad aquae 3 i * These are given in order of preference as to use. — (Lefiferts.) 3ss, 3i ad aquaS' gr. ii-x «C (( gr. ii-x a a 2 2 P^-A RMA COP (EI A . -P, Antiseptic. Acidi Carbolici . . gr. lu-v ad aquae % i Potassii Permanganatis . gr. v-x Sodii Benzoatis . . gr. xx-xxx " " Acidi Sulphurosi . . q. s. not more than 3 i at each application. -r> Sedative. ^ .. . . Potassii Bromidi Ammonii Bromidi . Extracti Opii Extracti Belladonnse Liquoris Morphinae Sulphatis (Magendie), ttl xii " lodoformi . . . . . . 3 1 ^Etheris Fortioris . . . . ' . 1 i M. Signa — Spray in Syphilitic and Phthisical Laryngitis. Zinci Chloridi gr. xv Liquoris Morphinae Sulphatis (Magendie), 3 i Glycerini 3 ss Aquae ad § i M. Signa — Spray in Laryngeal Phthisis. ^ Anti-Diphtheritic. Acidi Lactici . . TU xxx ad aquae % i Sodii Salicylatis . . 3 i ad aquae |i Liquoris Calcis (U. S. P.) . q. s. Nasal Passages and Vault of the Pharynx. Applications to these parts should always be employed of a strength that will cause no irritation of the mucous membrane, — one much more susceptible than either that of the pharynx or larynx. A preliminary trial of the strength of the solution should always be made. AQUJS MEDIC ATM. 23 The following are the ones ordinarily used by me, given in order of preference : 1^ Zinci lodidi gr. V ad aquae | i Zinci Sulphocarbolatis gr. V " Zinci Sulphatis gr. V '' Ferri et Aramonii Sulphatis gr. V " Ferri Chloridi gr. V '1 Acidi Tannici . gr. v-xx Potassii Chloratis 3i " The above are suited for cases of Simple Chronic Rhin- itis and Hypertrophic Rhinitis in its earlier stages ; still later in the latter disease the following may be used : (See also rules for cleansing, page 4.) lodi ... Potassii lodidi . Zinci lodidi Zinci Sulphocarbolatis " Listerine " * . Aqu?e . . . . . .ad M. "Spray." gr. IV gr. X 3i 3i f i \ iv * The *' Listerine " in this formula is a preparation recently intro- duced to the Profession by Lambert & Co., of St. Louis, containing the essential antiseptic constituent of thyme, eucalyptus, baptisia, gaultheria, and mentha arvensis in combination. Each fluid-drachm also contains two grains of refined and purified benzo-boracic acid. Thus, it may be used in this formula and in the majority of the solu- tions of astringents etc., that have been mentioned, as a men- struum, in the proportion of one part " Listerine " to two of water. It will be found to serve a useful and pleasant purpose where the addi- tion of an antiseptic is desirable. The thyme and eucalyptus, besides being disinfectants, act also as stimulants to the mucous membrane, the benzo-boracic acid as an emollient. ^4 PHARMACOPCEIA. In Atrophic or Fetid Rhinitis, the indications for treat- ment are twofold : first, to cleanse and disinfect, and then to keep clean and disinfected, the nasal passages of all decomposing crusts and secretions ; and, second, to stimulate the atrophied mucous membrane, with a view to the regeneration of function and character of secretion in the muciparous follicles and serous glands, if this latter can be accomplished, a matter which my experience has led me strongly to doubt. The first indication is met by the daily use of the anterior or post-nasal syringe, occa- sionally by the necessary direct removal of hard crusts by means of forceps, and thorough washing of the pas- sages \vith an antiseptic and alkaline solution until all offending secretions are removed. Formulae for this pur- pose have been given (see page lo). The second indication requires the use of such drugs as sanguinaria, galanga, carbolic acid, creosote, salicylic acid, iodine, bromide of potassium, etc., which are recom- mended as efficient in the early stages of the disease. They are mentioned in the order of preference. They probably act by giving rise to a local irritation of the mu- cous membrane, which in turn leads to a stimulation of the glandular structures, and an increased discharge of serum and mucus. IV. COLLYRIA— MEDICINAL SOLUTIONS FOR LOCAL APPLICATION. Used with the laryngeal brush, to the larynx, or by means of a large camel's-hair pencil, to the pharynx. Fig. 14. — Brushes for the larynx. Fig, 15. — Brush for the pharynx. The use of some one of the following solutions is indi- cated in ail chronic, and in many sub-acute, inflammatory 25 26 PHARMACOPCEIA. affections of the larynx and middle pharynx. In acute inflammations of these parts, their employment is, as a rule, contra-indicated. Applications, to be of service, must be thoroughly, skilfully, and regularly made, to the affected mucous membrane. In chronic affections, daily applications for the first week, on alternate days during the second and third weeks, twice in the fourth week and thenceforth at gradually increasing intervals, according to the indications presented in the given case, will be a safe general rule. Alternation of the remedies is sometimes of service in old and inveterate cases. The same rules will apply to the use of the medicated sprays (see page 13). The laryngoscopic mirror should always be used as a guide to the introduction of the brush into the interior of the laryngeal cavity. Astringent. ^ . .. . Ferri et Ammonii Sulphatis , , . 3 i Glycerini. Aquae . . ... . • aa | ss M. Zinci lodidi 3 ss Glycerini. Aquae aa 1 ss M. ^ . . Zinci Sulphocarbolatis ■, • . 3 ss Glycerini. Aquae aa ^ ss M. COLLYRIA. Zinci Chloridi .... Glycerini. Aquae . M .... Tincturse Ferri Chloridi Glycerini. Aquae . M " • . . . Ferri Sulphatis .... Glycerini. Aquae . M • . . . Zinci Sulphatis . . Glycerini. Aquae . M Aluminis ..... Glycerini. Aqu^ . M .... Stimulant. Argenti Nitratis . . gr. x, xx, xxx, 3 i Aquas . 2 ,• M. ^ Cupri Sulphatis . . . . gr, xv Glycerini. ^/qu^ • . . . , aa 3 ss M. 27 gr. XV aa ! ss 3 i-3 ii aa 3 ss . 3 ii aa f ss . 3 ss aa 3 ss 3 i aa X ss 28 P HARM A COP (EI A , Antiseptic. Acidi Carbolici Puri . . . . lU xv Glycerini. Aquae . . , . . . aa | ss M. Stimulant, Alterative, and Resorptive. Tincturse lodi . • • • . TU iv, xii Potassii lodidi . • • • . gr. v-x Glycerini. Aquae . aa § ss M. ]^ lodi . o • • gr. ii Potassii lodidi . . * • gr. iv Zinci lodidi. Zinci Sulphocarb olatis aa gr. x Glycerini. Aquae . • • aa 1 ss M. - Glycerita. The following glycerites of the U. S. P. 1870 may also be used as local applications to the larynx . Glyceritum Acidi Carbolici, Glyceritum Acidi Gallici. Glyceritum Acidi Tannici. Glyceritum Amyli (U. S. P. 1880). Glyceritum Sodii Boratis. V. PULVERES.— POWDERS. For insufflation into the larynx or nasal passages by means of an appropriate form of powder-blower. Larynx. Opinions will be found to vary as to the efficacy of medicated powders in the treatment of laryngeal disease. The German and English method still retains them. In America they are not commonly used. In Acute and Sub-acute Laryngitis, as well as in some grades of, specially Phthisical and in Syphilitic Laryngitis, they are occasion- ally indicated. On the other hand, in advanced Chronic Laryngitis they are of little or no service. For use in Tracheal affections they have been strongly recommended. Should their use be determined upon in a given case, the powder selected may be applied to the larynx by means of one of the following forms of apparatus, ; the same rules being observed as in the case of the use of the laryngeal spray (seepage 13). The laryngoscopic mirror should always be employed to ensure accurate application of the powder. 29 30 PHARMA COP (EI A . Fig. i6. — Powder insufflators for the larynx. Astringent.* 1^ Acidi Tannici. Pulveris Amyli M. aa 3 ii Aluminis. Pulveris Amyli M. aa 3 ii Sedative. Morphinse Acetatis Pulveris Amyli . ... M. gr. ii, v, viii, x 1 ss * See also nasal powders. FUL VERES. 31 This powder should be well prepared in a mortar, so that the Mor- phine is thoroughly incorporated. The strength of the special powder selected will depend upon the degree of sedative action required. Only a small portion of powder is placed in the insufflator at each ap- plication. Morphinae Acetatis . . gr. lodoformi ii, V, ■ ad viii, X 1 ss M. — (See rule for Dreparation and use given above.) lodoformi. Bismuthi Subnitratis * M. aa 3ii lodoformi q. s. Bismuthi Subnitratis Pulveris Amyli .... M. ad 3 iii I ss Sodii Boratis .... Pulveris Amyli .... M. 'ad 3 iii I ss * 1l\iq Bismzithi Oxychloridum, (BiClg, Bi203)2 HgO, is preferred by Mackenzie as being more impalpable and less irritating than either the carbonate, subnitrate, or oxide of bismuth. It is also less soluble, which renders it better adapted to produce the me- chanical effect of forming a coating over inflamed or raw mucous surfaces. It may be prepared by slowly pouring a solution of bis- muth in nitric acid into a solution of sodium chloride. 3 2 FHA RMA COF (EI A . Nasal Passages. In cases where medicated spray applications are not well borne by the nasal mucous membrane, causing pain and irritation, or perhaps, in any case, in accordance with the special views of the physician, a medicated pow- der may be substituted. Powders are particularly adapted to the treatment of Simple Chronic Rhinitis, where the secretions are readily removable, the parts soft and absorptive. In Hypertrophic Rhinitis they are, I believe, of little use, and in Atrophic or Fetid Rhinitis contra- indicated. The forms of powder insufflator adapted for the treat- ment of diseases of the nasal passages are shown in the following wood-cuts. One is arranged to deliver, by means of the air-pressure developed by the hand-ball, a charge of the finely pulverized powder with which the bottle is charged, into the anterior nares. The other, with a longer curved tube, — which shoul-d be introduced with care behind the velum of the patient, — performs the same operation in the posterior nares and vault of the pharynx. Fig. t 7. — Powder insufflator for the anterior nares. PULVERES. 33 Fig.. i8. — Powder insufflator for the posterior nares. ^ Pulveris Folise Belladonnse Pulveris Morphinse Sulphatis Pulveris Acacise ad M. Signa. — For Acute Coryza. Morphinse Sulphatis .... Bismuthi Subnitratis .... Pulveris Acacise .... M. Signa. — " Ferrier's Snuff," for Acute Coryza. Pulveris Camphorse .... Acidi Tannici ..... Pulveris Sacchari Lactis . . ad M. Signa. — For Acute Coryza in infants. gr. XX gr. ii X ss gr. 1 3iii 3i 3ii 3 ss 5 ss The following powders may be used for the forms of Simple Chronic Rhinitis : 34 PHA KM A COP CEIA . n Pulveris lodoformi Pulveris Camphorse . Pulveris Acidi Tannic! Pulveris Acaciae ad M. T} Pulveris Morphinse Sulphatis Pulveris Foliae Belladonnse Hydrargyri Chloridi Mitis Sodii Bicarbonatis Pulveris Acacise ad M. ^ n 3i gr. V ? ss gr. 1 gr. X gr. XX gr. XV |ss ^ Pulveris Camphorse. Pulveris lodoformi Pulveris Acidi Tannici . Pulveris Morphinse Sulphatis Pulveris Foli^ Belladonnfe. . Pulveris Acacias . aa 31 . gr. iii • • gr. ss ad gr v ss M. 1^ Morphinae Acetatis Pulveris lodoformi. Bismuthi Subcarbonatis Pulveris Acaciae . gr. IV aa 3 i ad 5 ss M. Pulveris Cubebae . Acidi Salicylici , Sodii Bicarbonatis. Pulveris Acacise . M. 3ii gr. X aa 3 i PULVERES. 35 B Zinci Chloridi Pulveris Foliae Belladonnae Pulveris Acacias . M. 5 Pulveris Argenti Nitratis Pulveris Acacise . gr. V gr. X ad X ss gr. 11, IV, VI, X ^ ss 5 Pulveris Acidi Tannici * 3 ss ad Pulveris Acacise f ss Aluminis . • gr. x Acidi Salicylici . 3i Ferri et Ammonii Sulphatis . gr. x Ferri Sulphatis . gr. x lodi . . , gr. i, ii Potassii Bromidi 3 i PotassiiChloratis gr. xv Sodii Salicylatis 3 ss Zinci Sulphatis 3 i Zinci Chloridi gr. v Belladonnas Foliae 3 ss Catechu . . 3 ss Galangae . . i ss Sanguinariae . 3 ii * Many of the following powders are equally well adapted for insufflations into the larynx. (See page 29.) VI. BUGINARIA— NASAL BOUGIES. Medicated Bougies for tlie treatment of the various chronic affections of the nasal passages have been advised by Catti of Vienna (Zur Therapie der Nasenkrankheiten, Wie7ier medizinische Zeitung, 1876). They are made of medicated gelatin, and are a little over three inches in length, slightly conical, about one quarter of an inch in diameter at the thick end, and taper almost to a point. Their introduction into the nasal passage is attended with no difficulty, if a rotary as well as an onward motion is given to them during their passage. The elastic body of the bougie adapts itself to every irregu- larity in the nasal cavity, passes very easily through the narrower parts of the meatus, and dilates the parts by gentle pressure. After their introduction in the manner described, the nostril is plugged loosely with cotton, in order to prevent the liquefied gelatin from escaping by any other orifice than that of the posterior nares. The bougie will melt in from twenty minutes to an hour, depending upon the amount of secretion present, in the given case. It is evident that, by their use, a medica- ment is gradually and persistently brought in contact 36 BUGINARIA. 37 with the affected mucous membrane, and that gentle dila- tation of the passage is effected. The following formulae are procurable * — each bougie contains : I Acidi Carbolici gr. 4- . 2 Acidi Salicylici . gr. i 3 Acidi Tannici gr. i 4 Belladonnse Ext. Ale. gr. i 5 Ergotse Ext. gr. V 6 Hydrastis Ext. Fid. . TTL V 7 lodoformi gr. ii 8 lodoformi gr. V j lodoformi gr. ii 9 ( Belladonnae Ext. gr. i lo Kramerise Ext. . gr. iii II Liquoris lodi Comp. . m V 12 Liquoris lodi Comp. . m X j Liquoris lodi Comp. m V ^^ ( Acidi Carbolici mi 14 Morphinae Sulphatis . gr. i 15 Opii Extracti gr. 1 16 Sanguinariae Ext. Fid. m ii 17 Zinci Salicylatis gr. i 18 Zinci Sulphatis gr. i j Zinci Sulphatis ^ I Acidi Carbolici gr. 1 gr. i { Zinci Sulphatis gr. i 20 \ Acidi Carbolici gr. i ( Hydrastis Ext. Fid. m V j Zinci Sulphatis. « ^^ \ Opii Ext. aa gr. i j Zinci Sulphatis 1 Belladonnas Ext. Ale. gr. 1 . gr.i j Zinci Sulphatis gr. 1 ^^ I Morphinae Sulphatis gr. \ 24 Zinci Chloridi . gr.i * Manufactured by Mitchell, Phila.. Pa. 38 PHA RMA COP (EI A . The following suggestions as to their use are offered : Simple Chronic Nasal Catarrh, with free secretion, numbers i8, 24, 6, 19, 20, 21, 22, 23, 3, 10. Hypertrophic Nasal Catarrh, numbers 7, 8, 9, and the above. Atrophic Nasal Catarrh, numbers 6, 4, 16, i, 2, 11, 12, 13- Fetid Nasal Catarrh, Syphilitic and Strumous Ozaena, numbers 7, 8, i, 2, 17, 9. VII. GOSSYPIA— MEDICATED COTTON- WOOLS. Cotton tampons, medicated by the addition of various drugs, are recommended and used in the treatment of some of the affections of the nasal passages and naso- pharyngeal region, by certain authorities. Such desira- ble results as they may effect are based upon the same principle as that of the use of the medicated nasal bou- gies, to which, however, they are far inferior (see page 36.), viz. : that the medicament is persistently brought and maintained in contact with the diseased mucous mem- brane. They are of value m.ainly, I believe, for their anti- septic and haemostatic effects.* The indications for their employment will be apparent from their constitution. Borated Cotton (15 fo Boracic Acid in solution). Borated Cotton (45 ^ Boracic Acid in solution). Carbolated Cotton. Haemostatic Cotton (Subsulphate of Iron 45 "^ "^ "^ --^ > > > > tJ3bJ3b/3EotJ3fcflb/)tjOt/3 & ti) tiJ t/J Eo cr 5o »- cr tx) Pi; < to t^Q- ------- '3 ■C/3 I < 'a o ^ c C/5 ..^ t/2 '5 c c ^ _a-;^ jir^ !£- '£ u £^ -2 x^ i4 t- s c N N :a2 - -2 cJ O N c t-iH '-' :S w w s o o O INHALATIONES. 55 C, Fumi — Fuming Inhalations. Fuming inhalations are specially indicated in cases of spasmodic affections of the larynx, trachea, and bronchial tubes. They can best be carried out by steeping unsized paper in a solution of nitrate of potash of definite strength, cutting the paper into strips of three inches long by half an inch broad, lighting the paper at one end, and dropping it into a cylindrical vessel, four inches high by two in diameter, from which the smoke can be inhaled by repeated deep inhalations. It will be found convenient to have three solutions. No. i. — Potassii Ni- tratis, gr. xxx., ad Aquae, | i. No. 2. — Potassii Nitratis, gr xlv., ad Aquae, 3 i, and No. 3. — Potassii Nitratis, 3 i, ad Aquae, | i. A particular character may be given to these papers by the addition of various volatile principles, thus Spirit of Camphor and Oil of Cassia increase their powers, while Compound Tincture of Benzoin, Oil of Sandal, and Tinc- ture of Sumbul reduce their action and make them less irritating. The medium-strength nitrated paper (No. 2) is gener- ally employed in the above case, and the best method of preparing it is to moisten the paper in a tincture, or, in the case of essential oils, in a solution of the oil (one drachm dissolved in nine drachms of rectified spirit), and then expose it for a few moments in order to allow the spirit to pass off. These papers should be kept in tinfoil, or prepared iui small quantities as required. From one to six papers, according to the indications in the particular case, should be used, one after the other, at each inhalation. — (London. Throat Hospital, Pharmacopoeia.) IX. GARGARISM^— GARGLES. A gargle — so-called — is seldom of any value, if it be intended by its use to medicate parts located posteriorly to the anterior pillars of the fauces. A careful trial in individual cases will demonstrate that, as a rule, the act of gargling is incompletely, — the poster- ior pharyngeal wall not being reached by the fluid, — and therefore uselessly, performed. Gargles are, moreover, contra-indicated in all cases where the necessary movements of the parts in the act are painful and cause irritation, as will be found to be the case in most acute diseases of the fauces and tonsils. For these reasons their employment is a restricted one. and is superseded in efficiency by the direct application of a medicated solution in the form of spray. Rules for Use. Should they be prescribed — and being a time-honored institution, they probably will continue to be — the patient should be instructed to use them as a lotion or wash for the inflamed surfaces, as far as they can be reached, and not as a gargle, — that is to say, he should bring the medi- 56 GARGARISM^E. 57 cated fluid into contact with the parts, by allowing it to flow upon them by gravity, as the head is held far back- wards, or still better, as he is lying upon his back, with the mouth widely opened, and the head turned slowly from side to side, so as to thoroughly bathe the mucous membrane. At least half a fluid-ounce of the lotion should be taken into the mouth on each occasion, allowed to flow into the back of the throat and retained there as long as possible ; this act to be repeated, and its repetition ordered from four to six, or even more times, daily, according to the indications. Used in this manner, a lotion possesses a certain degree of value in affections of the mouth, soft palate, and anterior fauces; to a lesser degree, in those of the tonsils. If a lotion is prescribed that contains a mineral acid, the patient must be cautioned to rinse the mouth with water after its use, in order to prevent injury to the teeth. Astringent. Ferri et Ammonii Sulphatis . . 3 iss Glycerini ...... | i Aquae ad f viii M. Aluminis ...... 3 iss Glycerini ...... § i Aquai . p . . „ ad ^ viii 58 PHA RMA COP (EI A , 5 M. Aluminis. Acidi Tannic! Glycerin! Aquae Zinci Chloridi Glycerini Aquae M. Zinci Sulphocarbolatis Glycerini .... Aquae .... M. Pulveris Krameriae Aquae at ioo° C. Signa. — Infuse for one hour and strain. Sodii Boratis Tincture Myrrhae Glycerini . „ . . Aquae . . . . M. ^ Acidi Tannic! Acidi Gallici M. aa ad ad ad ad 3 iss § i 3 ^'iii 3 ss ; viii 3i| 1 i viii 3 IV viii 3iv 3SS 1 i ! viii gr. 360 sr. 120 This powder should be thoroughly mixed and then kept in a glass-stoppered bottle ready for use. It is GARGARISM.'E. 59 gr- XX 1 i ^ viii 3ii f i Z viii useful for arresting the hemorr/iage after ainpuiatio7i of the tonsils. A small quantity may be prepared at the time of the operation by mixing with a little water so as to form a paste. This is applied to the cut surfaces by means of a brush. It acts quickly and effectually. Antiseptic and Stimulant. Acidi Carbolici ..... Glycerini ...... Aquae ad M. Acidi Acetici ..... Glycerini ...... Aquae ad M. 6^j'^.-^Useful in the sub-acute inflammatory affections occurring during the course of the exanthemata. Potassii Chloratis . . . . 3 ii Glycerini ...... ^ ss Aquae ad | viii M. Liquoris Potassii Permanganatis (U. S. P. 1870.) 3 i Aquae ...... M. Sodii Sulphocarbolatis Sodii Boratis .... Glycerini ..... Aquae #,..,, M. ad ! viii ad 3 ss 3ii 1 i 3 viii 6o PHA RMA COP (EI A , Sedative. Potassii Bromidi . . . . . 3 iss Glycerini ...... ^ i Aquae ad ? viii M. The following Glycerites of the U. S. P. 1870 not in- frequently serve a ready and efficient purpose as gargles. They should be diluted with water or with " Listerine " and water to the proper strength according to the indi- cations : Glyceritum Acidi Carbolici. Glyceritum Acidi Tannici vel Gallici. Glyceritum Sodii Boratis. " Listerine," * diluted with from two to sixteen parts of water, makes a very agreeable and useful gargle. It may be substituted in many of the above formulae in the place of the Glycerine. * See page 23. X. TROCHISCI— LOZENGES, PASTILS. Medicated lozenges or pastes, when used with a view to an immediate local effect, not infrequently play a conven- ient and useful role in the treatment of faucial and pharyngeal affections, as an adjuvant to the direct local treatment elsewhere described. In laryngeal diseases their efficacy is more doubtful, but certain forms, notably those containing Benzoic Acid or Cubebs, have a certain reputation as " voice " stimulants, and act probably through their stimulant qualities, exciting, by the medium of the pharyngeal mucous membrane, a reflex influence upon the larynx, by the path of the pharyngeal plexus of nerves, — this aside from their mere local action in stimu- lating the secretions of the parts. Rules for Use. One lozenge may be taken by the patient into his mouth at the back of the tongue and allowed to dissolve slowly ; four or five times daily, the saliva, impregnated with the drug, being swallowed. In acute affections, their more frequent use is indicated. No fluids should be drunk for a short time after their use. 6i 62 PHARMA COP (EI A . D \r. 1 ^O S c iii s-^ < ■^^ jj ; k" ^ : 'C o '^ 'Ti fe p > o t/2 S ^ '^ F^ "^ ci "^ -^S X d 6 "o /—• 'C .ti -*-' > 1^^ o -^^ .2 .S o 10 "^r-i .2 O! c 2^ w . < u D y " •r c; ' S. u u X 5 o -J O X !=l O , o . c^ p:! > IT. r^ Q . -^3 r; . ^ O C3 " ^ ^ I < S b/) f=^'~' < '7. •-! 13 _. o ^ — ii C O •— C X 5 ^ J o •- t3 h::; <; H p:^ O M ^" V t/3 ^ ^ •"^ < u ci U 10 CJ ^rt o t—^ ^ C qH rt ^-i ■iJ u o CS y ^ u O O fcyj cS 1) w - ,- ^ "" •^ j_^ fcJO _j, EV . "^ p: r^ 1 tjD M (M M n a o.ii 5 <-> B S g -j^ d s CS ^ K 12 rs ^ o 'o "o 'o o ,_( < << < < Ej: tfi _o c^ N ^ B • • u ^ H _r^ U -i3 CJ rt cj - a u • d .;^ oj <" C/j ^ <-! u . o" X -M s. E s. in . Ex N o ■« !-i W tJO fcJO u V-*-,'^*^ N N M d 'd o X o d o B o S TROCHISCI. 63 ^3 U (0 • »-l o o u h N c a; o Oh 1) O C rt bX) 'c%%-^^ -^ <^^-<^>^^ r^ bX) bjo^ ^ f^ •« ^ " C3 ra J3 ai rH ^ -imulant opical Si opical Si very Va very Us ild Dete Sedative fill Co ••-« -*-» •r-t Q4 c/3 H H -i --H O O >, X o PL, PL< PL, H c/2 ft >. * in c\1 s ctf ^ w a; a 3 U ^ y "5 o 'x9 ■ ci ^ aoou a " ~ B ^." ci a 64 PHARMA COPCEIA . 0) h D 1-1 Q < rC u ^ ^ — >, » ^ rt d) > .s •^ o t/5 Ifl bjO K •— * O o K > ;-! .rH !« •T-l ^-l •1— « &< ■ , W3 •r-l .1-1 •1-1 l-t •!-! ip ig3 %^ ,* c ^ So 1?^ t/3 tJJ Ul b/3 b/3 t/3 a r2 t/5 rt Xfl •■^ 'il3 t s ^3 3u ^ 'Id 73 Co <; o J-l U tin . ^^ ^H .— 2 ^ •^ pa ■55 -p pp ITi • — s :;: a i! ^ '-C3 ^-1 C 00005 << '^ a TROCHISCL 65 Whistler— Pastilli. Pastils, the basis of which is Glyco-gelatine, that renders them softer and more mucilaginous in nature, as well as more palatable both in appearance and taste, than the ordinary lozenge or troch made with fruit paste or gum, were introduced originally by Dr. Whistler, as a special means of applying Iodoform to the throat, (see Medical Times and Gazette^ Nov. 1878). Their consistence when freshly made is that of firm jelly, in order that they may dissolve readily in the secretions of the mouth. Tannin, Kino, Rhatany, and all substances given above that are chemically incompatible with Gelatine, cannot be used with the basis, Glyco-gelatine. The formula of this latter is : Gelatinae Purificatse . . . . J i Glycerini (ab pondere) . . . | iiss Liquoris Carminse Ammoniatse* . , q. s. Aquae Aurantii Florum . . . o J iiss The process to be followed in combining these ingre- dients will be found in detail in the Pharmocopoeia of the Hospital for Diseases of the Throat, London, 1881, Four of the most useful formulae of Dr. Whistler are here given. The directions are for making one pastil ; one ounce of the mass will make twenty-four. * Pure carmine should be completely soluble in ammonia. 66 PHA RMA COP (EI A . Pastillus lodoformi. Pulveris lodoformi (a larger or smaller quantity according to the indica- tions) . . . . . . gr. i Glycerini ...... fTii Rub together and add to the Glyco-gelatin (melted in a water bath), gr. xviii. M. Set aside to cool. Make one pastil. Signa. — In Syphilitic eruptions and ulcerations of the Tongue, Mouth, and Throat, and in Chronic Pharyngitis. Pastillus Bismuthi et Potassii Chloratis. Bismuthi Subcarbonatis . . . gr. iii Potassii Chloratis . . . . gr. ii Glycerini ...... lUiii Rub together and add to the Glyco-gelatin (melted in a water bath), gr. xviii. M. Set aside to cool. Make one pastil. Signa. — In acute and sub-acute catarrhal affections of the Pharynx and Larynx, and in Tonsilitis, Simple and Follicular, Pastillus Bismuthi et Morphinae. Bismuthi Subcarbonatis . . • gr. iii Morphinse Acetatis . . . • gr. -^-q Glycerini ...... TTj^iii Rub together and add to the Glyco-gelatin (melted in a water bath), gr. xviii. M. Set aside to cool. Make one pastil. Signa. — In acute and sub-acute catarrh of the Pharynx and Larynx, in Tonsillitis, and especially as a sedative in Laryngeal Phthisis. TROCHisci. by Pastillus Acidi Boraci. Pulveris Acidi Boraci . . . . gr. ii Glycerini ...... fTlii Rub together and add to the Glyco-gelatin (melted in a water bath), gr. xviii. M. Set aside to cool. Make one pastil. Signa. — In aphthous affections of the Mouth and Throat. Further formulae, viz. : Pastillus Acidi Carbolici, Pastillus Ammonii Chloridi, Pastillus Bismuthi will be found in the Pharmacopoeia alluded to above. XL CAUSTICA— CAUSTICS. Argenti Nitras Fusus, U. S. Acidum Chromicum. Acidum Nitricum. Acidum Aceticum Glaciale. Caustica Zinci lodali. Potassii lodidi ....... gr. 240 lodi ........ gr. 480 Aquoe Destillatae . . . . . . 3 iii Dissolve by trituration in a glass mortar. Add the above drop by drop to the following solution : Zinci Sulphatis ...... gr. 200 Aquse Destillatse ...... TI|,i40 Dissolve. Allow to stand for six hours, then decant liquid from sediment. Keep in a well-stoppered bottle. Caustica Zinci Chloridi. Zinci Chloridi, Farinas Tritici — of each equal parts. Reduce the Chloride of Zinc to a fine powder ; add the flour and rub together until they form a mass ; dry until the mass becomes of proper consistence ; then cut iuto strips ; roll into cylinders of the required size, and keep at a moderate temperature until dry, re-rolling them from time to time if necessary. The little cylinders must be kept in a horizontal position in a well-closed bottle until used. Pasta Londinensis. 68 CAUSTIC A. 69 Socte (U. S. P.), Calcis (U. S. P.) — of each equal parts. Reduce to a fine powder in a warm mortar and mix intimately. Keep in well-closed bottles, and when required for use take as much as sufficient and make into a paste with water. Actual Cautery. Galvano-Cautery. Caustics are of importance in the treatment of many diseases of the throat, and specially of those of the nasal passages. The most reliable of the destructive agents, and therefore those commonly employed, will be found in the above list. Upon both the nature of the case and the locality of the parts to be destroyed will depend the choice of the particular form of caustic, the latter varies also, accord- ing to the views of the particular operator who uses it. Larynx. In the Larynx, caustic applications, for the purpose of destroying neoplasms of various nature, are by no means as frequently employed as formerly ; the laryngeal for- ceps in some one of its varieties, or some other mechan- ical device for their removal, having justly superseded them. Some operators still advise the use of the Gal- va?io-catitery, beyond question the best method, should the caustic treatment be adopted, and one very properly employed in some cases for the purpose of destroying the base and site of a laryngeal growth to prevent its repro- duction, the greater part or all of which has been previously removed by means of the forceps or hraseur. Fig. 22. — Galvano-cautery instruments for use in the larynx. 70 CAUSTICA. 71 The destruction of the base of a laryngeal growth, after its removal by forceps or otherwise, may be likewise ac- complished by tlie use of Argenti Nitras or the Aciduni Chromicum^ either salt being carried into the larynx and to the desired point by means of a delicate probe, under the guidance afforded by the laryngoscopic mirror. Pharynx. Chronic Follicular Pharyngitis is most satisfactorily treated by the destruction of the individual follicles and their nutrient vessels. Here again the fine Galvano- cautery point, carried deeply into each hypertrophied follicle until its base is reached, forms the most efficient means. The Actual cautery is recommended by some, and still another method lies in an incision into each hypertrophied fol- licle (a i^"^ only being treated at each sitting) by means of a small tenotomy knife, and the immediate subsequent application to each, of the Caustica Zinci lodati, Zinci Chlo7'idi, or of Acidimi Chromicum, to ensure their de- struction. Secondary Syphilitic Lesions of the Mouth, Tonsils, and Pharynx (mucous patches and superficial ulcerations) may be lightly touched from time to time with Argenti Nitras until they disappear. Tertiary Syphilitic Ulcerations of the throat require the same treatment until each individual ulcer has assumed a healthy aspect and presents a clean granulating base. From this stage onward they are best treated by the application of iodoform in fine powder. It may not be inappropriate at this point to call atten- ^2 PHARMA COP (EI A . tion to the danger, realized in more than one instance upon record, of the ordinary crayon of nitrate of silver breaking and falling into the air-passages, when used in the throat in an ordinary quill or common caustic holder. The porte caustique shown in the cut will reduce this danger to a minimum, but it may readily be rendered impossible, Fig. 23. — Porte caustique. by fusing a small rounded button of the silver salt upon the end of an aluminium or silver probe, a few crystals having been melted in a small porcelain crucible over a gas flame, and the end of the probe having been dipped once or twice into the melted mass and then cooled. Fig. 24. — Silver-tipped probe, for caustic. Fig. 25. — Porcelain crucible for smelting nitrate of silver. After the use of nitrate of silver in the throat, the pa- tient should at once gargle with a weak solution of chloride of sodium in water ; all further corrosive action of the CAUsricA. 73 drug is thus prevented, an inert chloride of silver being formed with the excess of the silver salt. In using this caustic, as well as all of the other forms, the more powerful ones specially, a dextrous and steady hand is required, in order that the application may be made thoroughly yet carefully, accurately and neatly, to the affected point alone. Tonsils. The destruction of Hypertrophied Tonsillar Tissue demands the employment of the more active caustics. Aside from the Galvano- cautery, the Caustica Zinci lodati and the Pasta Londmensis are used, being applied in small quantities by means of a glass rod, at suitable inter- vals. Any such method of treatment, however, is neces- sarily prolonged and unnecessarily cruel to the patient, as well as in its ultimate results, far inferior to those gained by the excision of the hypertrophied gland by means of the tonsillitome. Fig. 26 — Tonsillitome. 74 PHA RMA COP (EI A . Nasal Passages. The Rhino-surgery of the day relies largely upon the use of caustics, as a means of destroying the redundant tissue, in cases of Hypertrophic Nasal Catarrh, and in hypertrophy of the adenoid tissue at the vault of the pharynx, — '' Adenoid Vegetations." Fig. 27. — Galvano-cautery instruments for use in the nasal passages. The Galvatio-cautery, if used for the above purpose, is unquestionably a radical and efficient agent, and has its warm advocates ; but instances where its use is a neces- sity are not very many, and I believe that we may often accomplish the same results as it attains with less heroic means. I allude here to its employment in the morbid CAUSTICA. 75 conditions of both nasal passages and vault of the phar- ynx. In the former locality the agents employed are, in my experience, as to order of merit, Acidum Nitricum^ Acidiiin Aceticu7ji Glaciale^ Acidum C/iromicum, and Argen- ti Nitras. The operation is as follows : In Hypertrophic Rhinitis, where the hypertrophied mucous membrane is found to be located mainly over the inferior turbinated bone, in one or both nasal passages, and where there is partial, intermittent, or permanent occlusion occasioned by its presence, take a small probe, its end wrapped in absorbent cotton, and saturate Fig. 28. — Hard-rubber probes. this with nitric acid, press out the excess of acid, pass it then through a suitable nasal speculum into the naris to be operated upon under the guidance of a good reflected light from the forehead mirror, and with a steady hand, draw it along, or press it firmly upon, the turbinated bone at its point of greatest convexity, contact being kept up for a few seconds. The pain quickly passes away, and on withdrawing the probe the parts are seen to have become well whitened or blanched ; moderate inflamma- tory reaction with a slough of varying depth follows, while the consolidation of the sub-mucous tissues by the hyperplastic results of the inflammatory process, and the Qontraction of the cicatricial tissue occupying the site of 76 PHARMACOPCEIA. the destroyed parts, serve to reduce the hypertrophy and its resultant nasal obstruction in a most satisfactory manner. Frequently, one application answers all purpo- ses in freeing the nasal passage to the extent of allowing of uninterrupted respiration. The process, however, may require repetition. The operation with glacial acetic acid is performed in the same manner ; it is less painful, causes little secondary inflammation, and destroys less tissue. This agent, then, may be selected for the more moderate and more recent cases of hypertrophy. Chromic acid is less painful in its use than nitric ; its fumes, though, are distressing to the patient. It pos- sesses no advantage over the other two. Nitrate of silver, as a destructive agent, I mention but to condemn. It causes but a superficial slough, and the application is of necessity frequently repeated in treating hypertrophied tissue of any extent ; moreover, owing to its powerfully stimulating qualities, it excites cell prolif- eration, and causes structural changes that are not desirable. After the use of any form of caustic in the nasal passa- ges, immediately upon the withdrawal of the probe, the parts should be flooded with an alkaline solution. The subsequent treatment of the case, at least until the slough has separated and the resultant ulcer healed, is based upon ordinary principles of cleanliness. In cases where the hypertrophy of the tissues is ex- treme, and is mainly limited to the posterior extremities of the inferior turbinated bones, a locality inaccessible to the use of caustics, the procedure devised by Jarvis, CAUSTIC A. yy for its removal with the wire ecraseur, must be under- taken. In cases also in which the hypertrophied tissue is located, in marked degree, over the anterior extremi- ties of the inferior turbinated bones, the operation of Jarvis is preferable to the use of caustic. (See Lefferts " Chronic Nasal Catarrh," Philadelphia Medical JVews, April 26, May 3, 1884). Vault of the Pharynx. In the treatment of hypertrophy of the Adenoid Tissue at the Vault of the Pharynx, mineral caustics, viz., Acidum Chromicum and Argeiiti JVitras Fusus have justly been superseded in, I believe, the majority of hands, by the use of instruments. A pair of long forceps, suitably curved, to be passed behind the velum, and furnished with cutting blades at their extremity (Woakes' forceps, modified by Semon), will be found to be the best means. Fig. 29. — Post-nasal forceps. Except when the hypertrophy of the tissues extends broadly, in the shape of small, slightly elevated, nodular masses, over the entire pharyngeal vault, when a sharp curette such as is used in uterine operations, but suitably 7 8 PHA RMA COP (EI A . curved to pass behind the velum into the upper pharynx- will answer a better purpose in scraping away the vegeta- tions than the forceps, which would here be difficult of exact application. Fig. 30. — Post-nasal curette. XII. VARIiE-MISCELLANEOUS. " Anti-Catarrhal Smelling Salts." 5 No. I Acidi Carbolici ..... 3 i Carbonis Ligni ..... | ss lodi . . . . . . . 3i Mix the carbolic acid with one half of the charcoal, mix the iodine with the other, then mix together thor- oughly. ^ No. 2 Ammonii Carbonatis . . . . § i Carbonis Ligni ..... | ss Camphorae ...... | i M. Add No. I and No. 2 together lightly, then add Olei Lavandulae, gtt. xx., and sufficient quantity of Tinc- turae Benzoini Compositse to make a thick paste ; keep in a wide-mouthed, glass-stoppered bottle, from which inhalations through the nose are made from time to time. Use. — Recommended for acute coryza. 79 8o PHARMA COPCEIA. Fig. 31. — Pocket inhaler. Hager-Brand's Remedy for Acute Coryza. Acidi Carbolic! Alcoholis Aquse Ammonise Fortioris Aquae Destillatae . 31 3 iii 3i 3ii M. A few drops of this solution are to be sprinkled on the handkerchief, or, more conveniently, some of the solution is placed on the sponge of the pocket inhaler, and inhaled through the nose as long as its strength lasts ; this is to be repeated every two or three hours. Snuff for Chronic Coryza. 5 Hydrastis Canadensis . gr. V Indigo .... gr. ss Pulveris Camphorse gr. ii Acidi Carbolici . gr. ii Sodii Chloridi 3i M. Oleatum Hydrargyri. ^ Hydrargyri Oxidi Flavi Acidi Oleici 3i 3 ix M. Use. — For promoting absorption in cases of Fibrous Goitre, and specially of Indurated Cervical Glands. VARIM. 8 1 Oleatum Hydrargyri cum Morphina. Morphinae (pure alkaloid) . . . gr. x Acidi Oleici 3 v Dissolve and add Oleati Hydrargyri (lo ^) . . . 3v M. Use. — Same as above ; in cases where the simple oleate causes much pain. Unguentum lodinii Compositum, U. S. P., 1870. Use. — Same as above. APPENDIX. Air-Compressing Apparatus.* A number of different forms of hand-pump apparatus are procurable for the purpose of obtaining a given de- gree of air-pressure in the cylinder or reservoir, which is connected with them by means of " hydraulic " rubber tubing, and in turn with the glass, rubber, or metal spray- tubes by rubber tubing of small calibre, which should be overspun with silk or mohair, in order that it may possess strength combined with flexibility (see fig. 6), and is firmly secured to the connecting fittings by plated metal collars. The cylinder, or condensed air-receiver, should be wrought of copper — riveted sheet-brass receivers sel- dom remaining air-tight for any length of time — is bur- nished to a high degree of finish, and usually nickel-plated. Its stop-cocks — of which there should be but two, one of entrance and one of exit for the compressed air — must be well and carefully ground, in order to be perfectly air- tight. A gauge for registering the amount of air-pressure is a very useful adjunct to any form of air-receiver. * The necessity for such information as is furnished in the Appen- dix has been suggested to me by repeated inquiries concerning the practical points therein alluded to, on the part of my students. 82 APPENDIX. 83 Fig. 32. — Condensed-air receiver. A more modern device has substituted for the two stop-cocks shown above ; one^ which consists of a rod, conic at one extremity, supplied with a screw, thread, and a wheel for readily propelling it outward or for gently screwing the conic end of the rod perfectly air-tight into a compartment containing soft metal, thus (when the ap- paratus is not in use) relieving of pressure the stop-cocks of entrance and exit of the compressed air, and thus pre- venting the escape of air through them, when worn by active use (see fig. 6). This receiver is made of the following dimensions : io-|- inches by 7 J inches, and its advantage over the older forms lies in the reduction in size and in the arrangement of the stop-cocks, which reduces the escape of the com- pressed air from the cylinder, either when in or out of use, to a minimum. The forms of hand air-compressors that are known to me are as follows : 84 PHARMA COFCEIA . I. The Burgess Double-Acting Air-Compressor, in which the construction is simple and manner of working easy and effectual, as a pressure of fifty pounds to the square inch can be obtained with but little effort. The person working the pump stands in an upright posi- tion, and can throw his weight against the lever without bending the body or using violent exertion (as with the lift or crank motion). The pump being double-acting, forcing air at each stroke, no power is lost in its manipu- lation. The pump is made of iron, having two cylinders cast in one piece, each three inches in diameter. The piston heads are connected together and operated by a lever^ which can be removed from the socket, allowing the pump to occupy but little space, /. ^., 12 inches in length, 9 inches high, 7 inches wide — weight 25 pounds. The valves are carefully adjusted, and seat themselves readily. The packing rings are of leather, and can be lubricated by removing the two screws on top of the cylinder. II. The Burgess Air-Compressor. In this apparatus the pump cylinder is made of iron, and mounted on an arched stand, and contains a piston having a valve opening upward. The piston is connected by a forked connecting-rod, and is moved by a slight and easy motion of the foot. The upper end of the pump cylinder is closed, with the exception of a valve aperture opening into a small or sub air-chamber, which is secure- ly attached to a large air-reservoir, made of heavy char- coal tin, measuring 9 inches in diameter, and 14 inches APPENDIX. 85 high. Connection is made between the sub air-cham- ber and the reservoir by a small brass tube, the air being admitted or confined by a stop-cock. Near the top of the reservoir there is a second stop-cock, to which is attached a flexible rubber tube leading to the spray-tube. In the upper end, near the edge of the reservoir, is secured a small pressure gauge, indicating the pressure to the square inch of the air contained in the apparatus — from one to twenty pounds, III. Wile's Spray Apparatus. The pump of this apparatus is attached to a bracket with an oscillating piston and lever, and can be pumped to a hundred pounds pressure to the square inch. When the gauge indicates one pound pressure, every full stroke of the piston increases the pressure one pound. IV. The Novelty Air-Pump (Besseler) is capable of compressing one hundred pounds to the square inch ; in two minutes will give fifty pounds pres- sure in an ordinary receiver. V. The small hand-pump which is usually furnished by the instrument maker, in connection with the complete " Compressed-air apparatus " (fig. 6), I cannot recom- mend. (It is made of brass and has valves which prevent the return of the air from the receiver, and through the pump, whilst working the latter.) Its disadvantage lies in the fact that it must be held upon the floor by the feet of 86 PHARMA COPCEIA . the operator, or even if secured by screws to the former, the position of the operator who is using it is both incon- venient and laborious. Moreover, a low degree of air- pressure only can be obtained by its means. VI. Weindel's Double-Acting Air-Compressors. The forms of air-compressors that I have used con- stantly and satisfactorily for a number of years are shown in the following wood-cuts, and I regard them as superior in their working qualities to any other form of hand-apparatus, for the purpose of compressing air, with which I am acquainted. They are manufactured by Weindel, of Philadelphia. 8; Fig. 33. — " Acme " double-acting air-compressor. Base-Board, 13 x 9 in. Height, 24 in. Fly-Wheels, 12 in. Cylin- der, 2 X 4 in. stroke. Weight, 34 pounds. A pressure of 30 lbs. and higher, can be reached in a large receiver in little more than a minute, as the regular speed is about 160 revolutions per minute. 88 Fig. 34.—" Reliance " double-acting air-compressor. Wheels, iS in. Cylinders, 2f^ and i{\ ^ Sh i^. stroke. AVeight 126 lbs. APPENDIX. 89 This pump is designed for 120 lbs. pressure — gives therefore 50 to 60 lbs. with the greatest ease in the ordinary-sized receiver (a receiver of the size shown in the wood-cut is never necessary for the purpose of the physician). INDEX. Acetic acid in hypertrophic rhinitis 76 Actual cautery .... 69 Adenoid vegetations 74 Air-compressing apparatus 82 "Acme" 87 "Reliance" 88 Weindel's 86 Air-compressor, Burgess 84 Air passages, Benzoic acid in affections ( 3f 44 Air pump, Besseler's " Novelty " . 85 Air-receiver . . . . . 83 Ammonia in inhalations 46 Amyl nitrite, vapor of . 50 Anaesthetics .... " Camphorated Chloral . " Linimentum Aconiti . " Linimentum Belladonnse " Linimentum Chloroformi " Unguentum Aconitiae Anterior nasal syringe . 9. 24 Anti-catarrhal smelling salts 79 Anti-diphtheritic spray . 22 Antiseptic spray 22 Antiseptic troches 63, 64 Aphonia, Ammonia in 46 Aphthous affections 67 Aquae Medicatae 12 " Anti-diphtheritic 22 " Antiseptic . 22 91 92 PHA RMA COP (EI A . Aquas Astringent . " Sedative " Stimulant Directions for use Asthma, nitrite of amyl Astringent spray . Astringent troches . Atomized fluid inhalations Atomizer (hand), Bergson's Codman and Shurtleff " " Davidson's . " " Richardson's " " Directions for use Automatic cut-off . Bismuthi Oxychloridum Bronchial tubes, Spasm of Buginaria .... " Directions for use , Camphorated Chloral Carcinomatous ulceration of throat Catarrh, Atrophic ... Fetid " Hypertrophic . " Nasal, chronic Caustica .... " Argenti Nitras Fusus " Acidum Chromicum " Acidum Nitricum " Acidum Aceticum Glaciale " Caustica Ziuci lodati ' ' Caustica Zinci Chloridi " Actual Cautery " Galvano-cautery " Pasta Londinensis " Directions for use 21 22 21 12, 14, 22 50 21 62, 63 51, 54 17 17 17, 18 17 19, 20 16 31 55 36, 37 36, 38 I 51 23, 32, 38 23, 32, 38 23, 32, 38 23, 32. 38 68 68, 71, 75, 77 68, 71 75,77 68,75 68,75 • 68 71, 73 68, 71 69, 71 69, 71 73, 74 68, 73 69, 78 INDEX. 93 Caustics ..... " Directions for use . Ceratum Cantharidis Charta Cantharidis Chromic acid in hypertrophic rhinitis Chromic acid in hypertrophic pharyngitis Collunaria .... " Directions for use . " Alkaline " Carbolic acid and borax " Chloride of sodium " Listerine " Permanganate of potassium " Salicylate of sodium Collyria " Alterative . " Antiseptic . " Astringent " Stimulant . " Directions for use Compressed-air spray apparatus Condensed-air receiver . Condy's fluid Coryza, Acute " Hager-Brand's remedy for Cotton-wools, Medicated Borated " Carbolated " Haemostatic " Iodized " Iodoform . " Salicylated " Styptic " Tannated . Counter-irritants . ' ' Ceratum Cantharidis " Charta Cantharidis 68 69, 78 I I 76 77 3 5, 4, 10 9 10 II 10 II II 25 28 28 26 27 26 14, 15 83 II 33. 79 80 39 39 39 39 39 39 39 39 39 I I I 94 PHARMA COP (EI A. Counter-irritants Linimentum Cantharidis '* " lodi " Tinctura lodi *• " lodini Composita Croup-kettle . Crucible for nitrate of silver Diphtheria Dobell's solution . Expectorant troches Fauces, Acute diseases of " Affections of anterior Ferrier's snufF Fibrous goitre, Absorption of Fumi .... Fuming inhalations " " directions for use Galvano-cautery instruments Gargarismse . Gargles .... " Antiseptic . ' ' Astringent ' ' Rules for the use of " Sedative Glands, indurated cervical Glottis, spasm of . Glycerita Glyceritum Acidi Carbolici " Acidi Gallic! *' Acidi Tannici ' ' Amyli Sodii Boratis Goitre, Fibrous Gossypia I I I I 42 72 22, 53 II 63 56 57 33 80 55 55 55 70, 74 56 56 59 57 56 60 80 50 28 28, 60 28, 60 28, 60 28 28, 60 80 39 INDEX. 95 Haemoptysis Hemorrhage from amputated tonsils Inhalation es . . . • Inhalations .... ' ' Atomized fluid " Fuming " Steam . ** Directions for use Inhalers, Eclectic . " Hospital •' Pocket . " Mackenzie's . " Maw's . Portable . Insufflations into larynx " " nasal passages Insufflator for larynx •• " anterior nares . •' " posterior nares Insufflations — directions for use Jarvis' operation . Kaolin, Prepared, in inhalations Laryngeal spray . Laryngorrhcea, Vapor cubebae in Laryngoscopic mirror Larynx, Applications to, Anti-diphtherit " •' " Antiseptic ♦• •' " Astringent «« '• " Brush for •' " " Caustic . «' " " Local «« " " Sedative . " " " Spray •* " " Stimulant 42. 53 59 40 40 54 55 40 52, 55 41 41 80 41 42 41 29 29 30 32 33 29, 32 77 44 13 45 16, 26 22 21, 28 26, 30 25 69 28 22, 30 13, 19 21, 27, 28 13 96 PHA RMA COP (EI A . Larynx, Cleansing of " Congestion of . * ' Hemorrhage from '* Hypersesthesia of " Inflammation of , Acute " " " Chronic " Glandular " Subacute " Irritation of " Insufflations into " Phthisis of " Spasmodic affections of " " contraction of " Syphilis of Linimentum Aconiti * ' Belladonnse " Cantharidis " Chloroformi lodi . Listerine .... Lozenges .... Medicated waters . Medicated cotton-wools *' sprays . Nasal bougies Rules for use catarrh . . . douche passages . Chronic inflammation of Cleansing of . Medicated powders for Spray applications to Caustic Ointments for 5. 29 25 3, 29 49 6, 10 13 3 47 53 I 29, 40 40, 48 47 29, 40 59 29, 35 49, 66 50,55 12 29 23, 60 61 12 39 12 36 36 38, 74 4, 5 4 5 4 32, 35 20, 22 74 2 INDEX. 97 Nasal spray apparatus ........ 6 " " " Directions for using , 7,8 " syringe, Anterior .... 9. 24 •' " Posterior 8,24 " tube, Posterior, with syringe 9 Nebulas ....... 51 " Rules for use ..... 52 Neoplasms, Removal of ... 69 Oil of lemon in inhalations . 46 " pine leaves in inhalations 48 Oleatum Hydrargyri .... 80 " " cum Morphina 81 Ozsena, Strumous ..... 38 Syphilitic .... 38 Pasta Londinensis .... 68 Pastils - . 61 " Whistler's . . . . 65 Pastillus Acidi Boraci .... 67 " Acidi Carbolici .... 67 *' Ammonii Chloridi 67 Bismuthi .... 67 " Bismuthi et Morphinse 66 " Bismuthi et Potassii Chloratis . 66 ** lodoformi .... 66 Petrolati 2 Pharynx, applications to. Anti-diphtheritic 22 " " " Antiseptic . 21, 28 *' " " Astringent 21, 26 " Brush for 25 *' " Caustic . 71, 77 " " Sedative 22 " Spray . I 3, 19, 22, 23 " Stimulant 21, 27, 28 " Hypertrophy of vault of . 77 *' inflammation of. Acute . 40 48, 62 98 PHA RMA COP (EI A . Pharynx, inflammation of, Chronic " Follicular " Subacute Pigmenta, External " Internal Pocket inhaler Porte caustique Powder insufflators Powders ' ' Directions for using ' ' Astringent ' ' for nasal passages " for larynx *' Sedative . Posterior nasal syringe . Post-nasal curette . " forceps . tube Probe for caustic . " Hard-rubber Pulveres " Directions for using Rhinitis, Atrophic Fetid " Hypertrophic . " Simple chronic Sedative troches Sialogogue troches Silver nitrate, Danger in use of " " in tonsillar hypertrophy Smelling salts Snuff, Ferrier's " for acute coryza . Solutions, Cleansing and disinfecting Spasm of the glottis 26 71 26, 40 I 2 80 72 30, 32, 33 29 29, 32 30 33, 34, 35 30, 31, 35 30 8 . . 78 77 9 72 75 29 29, 32 23, 32, 38 23, 32, 38 5, 23, 32, 75, 38 2, 5, 23, 32, 38 . . 62 62 72, 76 77 79 33 80 9, 10, II 50 INDEX. 99 Spirits of camphor in inhalations Spray apparatus, Wile's " applications, Method of employing " tubes .... Sprays, Medicated " Anti-diphtheritic " Antiseptic " Astringent " Sedative . " Stimulant . Steam-atomizing apparatus '* " Rules for the use Steam inhalations . " " Rules for the use of Syphilis, Tertiary . Syphilitic lesions of mouth " " tonsils . " ulceration of throat Syringe, Anterior nasal " Posterior nasal Terebene . . . - . Thymol in inhalations . Tinctura lodi Tinctura lodinii Composita (U. S. P. 1870) Tonsillitis, Follicular " Simple Tonsillitome Tonsils, Caustic application to " Hemorrhage from amputation o " Hypertrophied " inflammation of, Acute " Subacute Trachea, Affections of " Chronic congestion of, vapors in " Spasmodic affections of Troches .... of 40, 47 85 3, 13 16 10, 12 22 21 10, 22 22 21 51 52 40 42 51 66,71 66,71 66,71 9 8 49 48 r I 66 48, 66 73 73 59 73 47, 62 40 29 47 55 6i I OO PHA 3MA COP (EI A . Trochisci 6i " Browne's ........ 63 " Cooper's ........ 63 " MacKenzie's . 62, 63 •• Wyeths 64 " Rules for use of ....... 61 Unguentum Acidi Carbolic! ....... 2 " " " cum lodo et Atropina ... . 2 " Aconitiae ........ 2 " Belladonnse ....... 2 " Hydrargyri Chloridi Mitis ..... 2 " lodinii Compositum . . . . . .81 Valsalvan Inhalations, vapor for ...... 49 Vapor Acidi Benzoici ........ 44 " Acidi Carbolici ........ 51 " Acidi Hydrocyanici ....... 49 '• yEtheris .50 " Ammoniae 46 " Ammonii Benzoatis . . . - . . . . 45 " Amyl Nitritis 50 " Benzoini . . . . . . ... 44 ' ' Calami Aromatici ....... 47 " Camphorae ......... 47 " Chloroformi 50 " Creasoti 47 •' Cubeb^ . . . . ■ 45 " Cubebse cum Limone ....... 46 " lodi Benzoinati . . . . . . . . 45 ' ' lodi Camphorati ........ 49 " Juniperi Anglici 46 " Myrti 48 " Pini Sylvestris ........ 48 " Terebenis . . . . . . . . .49 " Thymolis ......... 48 Vapores Calidi ......... 40 INDEX. ioi Vapores, Calidi, Rules for Using Vapors, Stimulating " Sedative . 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